Pruritus is one of the serious side effects in patients receiving opioid analgesia in clinic.A lot of studies have eluci-dated the analgesic mechanisms of opioids,but the mechanism of opioid-induced pruritus is still unclear,and the relationship between pruritus and analgesia is ambiguous.In the recent stud-ies,after activation of μ,κ and δ opioid receptors,opioids transmit itch information by interacting with the gastrin-releasing peptide receptor(GRPR)directly or indirectly.Neuropeptides such as neuromedin B(NMB),neuropeptide Y(NPY),B-type natriuretic peptide(BNP)and other receptors transient receptor potential vanilloids 1 receptor(TRPV1R),N-methyl-D-aspar-tate receptor(NMDAR)and 5-hydroxytryptamine(5-HT)re-ceptor also play important roles in morphine-induced itching.In addition,the prevention and treatment of opioid-induced pruritus are still one of the difficulties and hot spots of perioperative mor-phine analgesia.Therefore,it is important to clarify the specific occurrence mechanism of pruritus to find new research ideas for the prevention and treatment of opioid-induced pruritus.

Objective:To explore the early- to mid-term therapeutic efficacy of using porous-coated metaphyseal sleeves to reconstruct severe bone defects in revision total knee arthroplasty (rTKA).Methods:A retrospective analysis was conducted of the clinical data of the 39 patients (40 knees) who had undergone rTKA by porous-coated metaphyseal sleeve reconstruction at Department of Orthopaedics, West China Hospital, Sichuan University between May 2017 and September 2023. The cohort included 6 males (6 knees) and 33 females (34 knees), with an age of (67.0±9.7) years. The revision was to cure periprosthetic infection after TKA in 12 knees, to correct prosthesis loosening in 19 knees, to treat periprosthetic fracture in 4 knees, to stabilize postoperative joint instability in 4 knees, and to manage postoperative joint stiffness in 1 knee. All patients underwent standard revision procedures, including removal of the original prosthesis, management of bone defects, implantation of revision prosthesis, and adjustment of ligamentous balance and fixation. The patients' surgical time, intraoperative blood loss, incidence of complications, as well as visual analogue scale (VAS), knee range of motion, and Hospital for Special Surgery (HSS) knee joint scores at the last follow-up were recorded.Results:The surgical time was (2.7±0.8) hours, and intraoperative blood loss (337.5±165.4) mL for this cohort. All the 39 patients were followed up for (4.8±2.1) years after surgery. At the last follow-up, their VAS pain score was 2.0 (1.0, 2.0) points, their knee range of motion reached 116.3°±12.2°, and their total score, pain score, and function score of the HSS system were respectively 87.0 (82.8, 89.3) points, 25.0 (22.8, 29.0) points, and 61.0 (60.0, 62.0) points, all showing statistically significant improvements compared with their preoperative values [(6.8±1.7) points, 70.4°±15.2°, (43.1±9.6) points, (9.3±3.1) points, and (33.8±10.1) points] ( P<0.05). In all patients, incisions healed at one stage after surgery, and no complications such as deep vein thrombosis or neurovascular injury occurred. Complications included popliteal artery thrombosis in 1 patient (1 knee) immediately after surgery, acute infection in 1 patient (1 knee) at 3 years after surgery, and periprosthetic fracture due to a traffic accident in 1 patient (1 knee) at 4 years after surgery, and distal prosthesis-related pain in 3 patients (3 knees). Conclusion:Use of porous-coated metaphyseal sleeves in rTKA to reconstruct severe bone defects exhibits favorable early- to mid-term therapeutic outcomes.

Pruritus is one of the serious side effects in patients receiving opioid analgesia in clinic.A lot of studies have eluci-dated the analgesic mechanisms of opioids,but the mechanism of opioid-induced pruritus is still unclear,and the relationship between pruritus and analgesia is ambiguous.In the recent stud-ies,after activation of μ,κ and δ opioid receptors,opioids transmit itch information by interacting with the gastrin-releasing peptide receptor(GRPR)directly or indirectly.Neuropeptides such as neuromedin B(NMB),neuropeptide Y(NPY),B-type natriuretic peptide(BNP)and other receptors transient receptor potential vanilloids 1 receptor(TRPV1R),N-methyl-D-aspar-tate receptor(NMDAR)and 5-hydroxytryptamine(5-HT)re-ceptor also play important roles in morphine-induced itching.In addition,the prevention and treatment of opioid-induced pruritus are still one of the difficulties and hot spots of perioperative mor-phine analgesia.Therefore,it is important to clarify the specific occurrence mechanism of pruritus to find new research ideas for the prevention and treatment of opioid-induced pruritus.

Objective:To explore the early- to mid-term therapeutic efficacy of using porous-coated metaphyseal sleeves to reconstruct severe bone defects in revision total knee arthroplasty (rTKA).Methods:A retrospective analysis was conducted of the clinical data of the 39 patients (40 knees) who had undergone rTKA by porous-coated metaphyseal sleeve reconstruction at Department of Orthopaedics, West China Hospital, Sichuan University between May 2017 and September 2023. The cohort included 6 males (6 knees) and 33 females (34 knees), with an age of (67.0±9.7) years. The revision was to cure periprosthetic infection after TKA in 12 knees, to correct prosthesis loosening in 19 knees, to treat periprosthetic fracture in 4 knees, to stabilize postoperative joint instability in 4 knees, and to manage postoperative joint stiffness in 1 knee. All patients underwent standard revision procedures, including removal of the original prosthesis, management of bone defects, implantation of revision prosthesis, and adjustment of ligamentous balance and fixation. The patients' surgical time, intraoperative blood loss, incidence of complications, as well as visual analogue scale (VAS), knee range of motion, and Hospital for Special Surgery (HSS) knee joint scores at the last follow-up were recorded.Results:The surgical time was (2.7±0.8) hours, and intraoperative blood loss (337.5±165.4) mL for this cohort. All the 39 patients were followed up for (4.8±2.1) years after surgery. At the last follow-up, their VAS pain score was 2.0 (1.0, 2.0) points, their knee range of motion reached 116.3°±12.2°, and their total score, pain score, and function score of the HSS system were respectively 87.0 (82.8, 89.3) points, 25.0 (22.8, 29.0) points, and 61.0 (60.0, 62.0) points, all showing statistically significant improvements compared with their preoperative values [(6.8±1.7) points, 70.4°±15.2°, (43.1±9.6) points, (9.3±3.1) points, and (33.8±10.1) points] ( P<0.05). In all patients, incisions healed at one stage after surgery, and no complications such as deep vein thrombosis or neurovascular injury occurred. Complications included popliteal artery thrombosis in 1 patient (1 knee) immediately after surgery, acute infection in 1 patient (1 knee) at 3 years after surgery, and periprosthetic fracture due to a traffic accident in 1 patient (1 knee) at 4 years after surgery, and distal prosthesis-related pain in 3 patients (3 knees). Conclusion:Use of porous-coated metaphyseal sleeves in rTKA to reconstruct severe bone defects exhibits favorable early- to mid-term therapeutic outcomes.

Mitral annular calcification(MAC)is an age-related,chronic,degenerative change in localized fibrous support structures,and current research suggests that it is a process similar to the active onset of atherosclerosis and aortic valve calcification,both of which are accompanied by the deposition of lipoprotein(α)[Lp(α)]and the formation of chronic inflammatory foci.Among them,Lp(α)is the hot spot of research.In recent years,the relationship between Lp(α)and aortic valve calcification has received extensive attention.A large number of studies have demonstrated that elevated Lp(α)and its associated oxidized phospholipids(OxPL)can promote aortic valve calcification and stenosis through multiple calcium-regulated pathways,but the pathophysiological process of MAC is much more complex and unclear,and there has been a preliminary exploration of the relationship between Lp(α)and MAC.To make the current relationship between the two clearer,and thus provide new possibilities for preventing or delaying MAC,the paper will review the three aspects of MAC,Lp(α),and the research progress between the two.

The study established a mouse itch model induced by acute opioid and non-opioid pruritogens. The effects and mechanism of partial opioid agonist thienorphine on acute scratching behavior caused by opioid and non-opioid pruritogens was demonstrated. The noninvasive scratching behavior analysis system was established to test scratching behavior induced by morphine, bombesin, 5-hydroxytryptamine (5-HT) or chloroquine in C57 BL/6J mice. The effect of thienorphine (0.75, 1.5, 3 mg·kg^-1) on acute itch caused by above pruritogens were studied. The expression of protein kinase C δ (PKC δ) in mouse spinal cord was detected by Western blot after pruritogens addition with or without thienorphine pretreatment. All operations in the experiment were approved by the Institutional Animal Care and Use Committee of the Academy of Military Medical Sciences (IACUC-2021-017W). The scratching behavior increased significantly under morphine (1 nmol, i.t), bombesin (0.3 nmol, i.t), 5-HT (5 nmol, i.d) or chloroquine (20 nmol, i.d) treatment, respectively. Thienorphine (1.5 mg·kg^-1) significantly inhibited the scratching behavior induced by the morphine, bombesin, 5-HT and chloroquine. Thienorphine significantly reversed the changes in PKC δ protein expression induced by morphine or 5-HT. In conclusion, the partial opioid agonist thienorphine could inhibit scratching behavior induced by opioid and non-opioid pruritogens. It might reverse PKC δ through different pathways to inhibit opioids and non-opioids induced scratching behavior, which provided a new idea for exploring and treating itch.

Objective:To investigate the effect of exosomes loaded with Lycium barbarum miRNA(Lb-miR2911)on spermato-genic function recovery in non-obstructive azoospermia(NOA)rats through cross-regulation of the Wnt/β-catenin signaling pathways.Methods:We established an NOA model in 30 four-week-old male SD rats by intraperitoneal injection of busulfan.At 5 weeks after modeling,we equally randomized the rats into a model control group(MC,untreated),an Lb-miR2911EXO group(Lb-miR2911EXO,treated by intratesticular injection of Lb-miR2911-loaded exosomes),and a sham group(Shame,treated by intratesticular injection of exosomes-empty drug),with another 10 male SD rats taken as normal controls(NC).We observed the uptake and metabolic changes of Lb-miR2911 in the testis tissue of the rats by RNA FISH at 2 and 6 weeks after treatment,detected cell proliferation,spermatogenesis and gene expressions of the Wnt/β-catenin signaling pathways in the testis tissue by Transcriptome sequencing analysis combined with Western blot and RT-PCR at 12 weeks,evaluated the recovery of the spermatogenic function based on the testis tissue morphology and sperm quality,and assessed the organ toxicity of Lb-miR2911 in the tissue and organs of the rats based on histomorphological analysis and the levels of serum TNF-α,IL-1β,Aspartate aminotransferase(AST),Alanine aminotransferase(ALT)and other relevant indi-cators.Results:After 12 weeks of treatment,histomorphological analysis showed regular arrangement of spermatogenic cells at all levels in the testis tissue,with a large number of mature sperm in the tubular lumen,and with significantly higher Johnsen scores,tes-tis weight,testicular index,sperm concentration and sperm motility in the Lb-miR2911EXO than in the sham group(all P<0.05).Compared with the model controls,the Lb-miR2911EXO group exhibited remarkably down-regulated gene expression of DACT3(P<0.05),up-regulated expressions of DVL2 and β-catenin(P<0.05),elevated levels of p-DVL2 and β-catenin(nucleus)proteins(P<0.05),increased expressions of cell proliferation-related genes CCND1,CCNE1 and CCNE2(P<0.05)and spermatogenesis-related genes DMC1,CCR6,JAM2 and KLC3(P<0.05).No pathological changes were observed in the lung,liver and kidney tis-sues of the rats,or in the levels of serum TNF-α,IL-1β,AST,ALT,creatinine and urea nitrogen in the rats treated with Lb-miR2911EXO compared with the normal controls(P>0.05).Conclusion:Lb-miR2911-loaded exosomes promote spermatogenic function recovery in NOA rats through cross-regulation of the DACT3,Wnt and β-catenin signaling pathways.

Objective: To analyze the trends of the age of menarche among Chinese Han girls aged 9 to 18 years from 2010 to 2019. Methods: Data were extracted from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019. A total of 253 037 Han girls aged 9 to 18 years with complete data on menarche were selected in this study. They were asked one-on-one about their menstrual status, age and residence information. The median age of menarche was estimated by probability regression. U tests were used to compare the difference in median age at menarche in different years. Results: The median age at menarche (95%CI) among Chinese Han girls was 12.47 (12.09-12.83) years in 2010, 12.17 (11.95-12.38) years in 2014 and 12.05 (10.82-13.08) years in 2019, respectively. Compared with that in 2010, the median age at menarche in 2019 decreased by 0.42 years (U=-77.27, P<0.001). The annual average changes were-0.076 years from 2010 to 2014 (U=-57.19, P<0.001) and-0.023 years from 2014 to 2019 (U=-21.41, P<0.001), respectively. The average annual changes in urban areas in the periods of 2010 to 2014 and 2014 to 2019 were-0.071 years and 0.006 years, respectively, while those in rural areas were-0.082 years and-0.053 years, respectively. The average annual changes in the regions of north, northeast, east, south central, southwest and northwest were-0.064, -0.099, -0.091, -0.080, -0.096 and-0.041 years in the period of 2010 to 2014 and 0.001, -0.040, -0.002, -0.005, -0.043 and-0.081 years in the period of 2014 to 2019. Conclusion: The age of menarche among Chinese Han girls aged 9 to 18 years shows an advanced trend from 2010 to 2019, and the trends in urban and rural areas and different regions have different characteristics.

Objective: To analyze and predict the epidemic trend of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019. Methods: Data were collected from the Chinese National Survey on Students Constitution and Health in 1985, 1995, 2000, 2005, 2010, 2014, and 2019 with the sample size of 409 945, 204 931, 209 209, 234 420, 215 317, 214 353, and 212 711, respectively. Overweight and obesity were evaluated according to the "classification standard of the weight index value of overweight and obesity screening for Chinese school-age children and adolescents" of the Working Group on Obesity in China (WGOC). The detection rate and average annual growth rate of overweight and obesity, and single obesity among children and adolescents aged 7-18 years were calculated, and ArcGis10.6 software was used to analyze the difference in the prevalence of overweight and obesity among children and adolescents in different regions in 2019. Polynomial regression function was used to fit the prevalence and average annual growth rate of overweight and obesity, and single obesity among children and adolescents from 1985 to 2019, and to predict the prevalence of overweight and obesity and single obesity among children and adolescents in China. Results: In 2019, the total prevalence of overweight and obesity among children and adolescents aged 7-18 years in China was 23.4%, and the prevalence of single obesity was 9.6%. The prevalence of overweight and obesity among urban children and adolescents was higher than that in rural areas (25.4% vs. 21.5%), and the prevalence in boys was higher than that in girls (28.4% vs. 18.4%) (both P values<0.001). In 2019, there was a large regional disparity in the prevalence of overweight and obesity in different provinces, with the lowest in Guangdong (12.2%) and the highest in Shandong (38.9%), and the high epidemic areas were mainly concentrated in North China and Northeast China. From 1985 to 2019, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China increased from 1.2% to 23.4%, with an increase of 18.1 times, while the prevalence of obesity alone increased from 0.1% to 9.6%, with an increase of 75.6 times. The prevalence of overweight and obesity in urban boys, urban girls, rural boys and rural girls increased from 1.3%, 1.5%, 0.5%, and 1.6% in 1985 to 31.2%, 19.4%, 25.6%, and 17.4% in 2019, with an increase of 22.3, 11.7, 54.2, and 10.1 times, respectively. According to the prediction model, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China will increase from 23.4% in 2019 to 32.7% in 2030, and the prevalence of obesity alone will increase from 9.6% in 2019 to 15.1% in 2030. The growth of rural children and adolescents is obvious. By 2025, the prevalence of overweight and obesity among rural children and adolescents in China will comprehensively exceed that of urban, and there will be an "urban-rural reversal" phenomenon. At the same time, the prevalence of children's obesity in China's low, medium and high epidemic areas will also continue to increase. By 2035, the prevalence of overweight and obesity among children and adolescents in medium epidemic areas will exceed that in high epidemic areas, and there will be a "provincial reversal" phenomenon. Conclusion: From 1985 to 2019, the overweight and obesity of children and adolescents in China will continue to grow rapidly with large regional differences.

Objective: To analyze the prevalence trend of malnutrition among Chinese Han children and adolescents aged 7-18 years from 2010 to 2019. Methods: Based on the data from the Chinese National Surveys on Students' Constitution and Health in 2010, 2014 and 2019, about 215 102, 214 268 and 212 713 Han students aged 7-18 years were included in this study. According to the National Screening Standard for Malnutrition of School-age Children and Adolescents, the detection rate of malnutrition among Chinese Han children and adolescents aged 7-18 was calculated, and the prevalence trend of malnutrition from 2010 to 2019 was analyzed. Results: In 2019, the detection rate of malnutrition among Chinese Han students aged 7-18 years was 8.64% (18 381/212 713), of which the rate of growth retardation, moderate-to-severe wasting and mild wasting was 0.50% (1 062/212 713), 3.25% (6 914/212 713) and 4.89% (10 405/212 713), respectively. In 2019, the detection rate of malnutrition in these boys was higher than that of girls (9.97% vs. 7.31%), and the detection rate in rural areas was higher than that in cities (9.30% vs. 7.98%). The detection rates were 9.74% (5 252/53 916), 8.17% (4 408/53 937), 7.29% (3 885/53 310), and 9.38% (4 836/51 550) in 7-9, 10-12, 13-15, and 16-18 years groups, and 8.14% (6 563/80 618), 7.61% (4 237/55 694) and 9.92% (7 581/76 401) in the eastern, central, and western regions. Malnutrition among students in China was mainly caused by mild wasting, and the detection rate of growth retardation accounted for only 5.78% (1 062/18 381). Malnutrition was mostly concentrated in the southwest region, and the rate was relatively low in eastern provinces. In three surveys from 2010 to 2019, the detection rate of malnutrition among Han students aged 7-18 in China decreased gradually, and the differences were statistically significant (P<0.05). Among them, the detection rates in western rural areas decreased significantly, as well as the gap between urban and rural areas. Compared with that in 2014, the detection rate of malnutrition in Shandong, Hunan, Qinghai and Hainan provinces in 2019 decreased significantly (P<0.05). Conclusion: In 2019, the malnutrition of Chinese children and adolescents aged 7-18 years is dominated by wasting malnutrition. The detection rate shows a downward trend from 2010 to 2019, with regional differences.