OBJECTIVE To investigate the effect and potential mechanism of astilbin （AST） on renal injury in chronic renal failure （CRF） rats based on the Jagged-1/Notch-1 signaling pathway. METHODS CRF model was constructed by 5/6 nephrotomy. The successfully modeled rats were randomly separated into Model group， AST low-dose group （AST-L group）， AST high-dose group （AST-H group）， high-dose of AST+Notch pathway activator （Jagged-1/FC chimerin， referred to as “JFC”） group （AST-H+ JFC group）， and control group （CK group） for open surgery without resection was set up， with 10 rats in each group. The rats in the AST-L group and AST-H group were given 40 and 80 mg/kg AST， respectively； the rats in the AST-H+JFC group were simultaneously given 80 mg/kg AST and 0.5 mg/kg JFC， and the rats in the CK group and Model group were given an equal volume of normal saline， once a day， for 4 weeks. After the last administration， the serum levels of blood urea nitrogen （BUN）， serum creatinine （SCr）， and the level of 24 h urinary protein （UP） in urine， as well as the serum levels of lactate dehydrogenase （LDH）， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-10 in each group were detected. The morphology and fibrosis of renal tissue were observed. The content of adenosine triphosphate （ATP） and the activities of sodium-potassium ATPase and calcium-magnesium ATPase in mitochondria of renal tissue were detected. The protein expressions of transforming growth factor- β （TGF- β）， hypoxia-inducible factor-1α （HIF-1α）， α-smooth muscle actin （α-SMA）， cleaved-caspase-3， Jagged-1 and Notch-1 in renal tissue were also observed. RESULTS Compared with CK group， the renal tissue of rats in the Model group was obviously damaged， renal tissue fibrosis was severe； the serum BUN and SCr levels， urine UP level， serum 4 LDH， TNF-α and IL-6 levels， as well as the protein expressions of TGF-β， HIF-1α， α-SMA， cleaved-caspase-3， Jagged-1 and Notch-1 in renal tissue were significantly increased， while the serum IL-10 level， ATP content and activities of sodium-potassium ATPase and calcium-magnesium ATPase in mitochondria of renal tissue were significantly decreased （P＜0.05）. Compared with Model group， the renal tissue damage and fibrosis in the AST groups were reduced， the serum BUN and SCr levels， urine UP level， serum LDH， TNF-α and IL-6 levels， and the protein expressions of TGF-β， HIF-1α， α-SMA， cleaved-caspase-3， Jagged-1 and Notch-1 were significantly decreased， while the serum IL-10 level， ATP content and the activities of sodium-potassium ATPase and calcium-magnesium ATPase in mitochondria were significantly increased； the changes in the aforementioned indicators in AST- H group were more significant than those in the AST-L group（P＜0.05）. JFC could significantly reverse the improvement effect of high dose of AST on renal injury in CRF rats （P＜0.05）. CONCLUSIONS AST can reduce inflammation in CRF rats， alleviate renal tissue damage and fibrosis， and improve renal mitochondrial capacity metabolism， possibly by inhibiting the Jagged-1/Notch-1 signaling pathway.

Neurofibromatosis type 1 (NF1) presents with a diverse range of symptoms that can affect the skin, bones, eyes, central nervous system, and other organs. This article reports the diagnosis and treatment process of a patient with NF1 complicated by bilateral severe-to-profound sensorineural hearing loss. Genetic testing revealed a heterozygous variant of NF1 NM_ 000267.3: c.4054_ 4058del(p.Ser1352LeufsTer20, supporting the diagnosis of NF1. After thorough evaluation, a right cochlear implantation was performed, yielding satisfactory postoperative results. This case suggests that NF1 patients may exhibit phenotypic heterogeneity and atypicality, providing a reference for clinicians in the diagnosis and treatment of such patients.

This study identified six novel azaphilones, isochromophilones G-L (1-6), and three novel biosynthetically related congeners (7-9) from Diaporthe sp. SCSIO 41011. The structures and absolute configurations were elucidated through comprehensive spectroscopic analyses combined with experimental and calculated electronic circular dichroism (ECD) spectra. Significantly, three highly oxygenated azaphilones contain an acetyl group at the terminal chain (4) or linear conjugated polyenoid moieties (5 and 6), which occur infrequently in the azaphilone family. Additionally, several compounds demonstrated inhibition of lipopolysaccharide (LPS)-induced nuclear factor kappa-B (NF-κB) activation in RAW 264.7 macrophages at 20 μmol·L^-1. The novel compound (1) effectively inhibited receptor activator of NF-κB ligand (RANKL)-induced osteoclast differentiation without exhibiting cytotoxicity in bone marrow and RAW 264.7 macrophages, indicating its potential as a promising lead compound for osteolytic disease treatment. This research presents the first documented evidence of azaphilone derivatives as inhibitors of RANKL-induced osteoclastogenesis.
Animals ; Mice ; RANK Ligand/genetics* ; RAW 264.7 Cells ; Osteoclasts/metabolism* ; Benzopyrans/isolation & purification* ; Osteogenesis/drug effects* ; Macrophages/metabolism* ; Molecular Structure ; Pigments, Biological/isolation & purification* ; Ascomycota/chemistry* ; NF-kappa B/genetics* ; Cell Differentiation/drug effects*

Objective To systematic analyze the risk factors for new-onset urethral stricture after transurethral holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH).Methods A case-control study was conducted on 746 BPH patients undergoing HoLEP treatment in Department of Urology of the Third Medical Center of Chinese PLA General Hospital from November 2021 to August 2024.After 23 cases were excluded because of complication of prostate cancer,finally 723 patients were included.General clinical data such as age,height,weight,history of smoking and drinking,perioperative parameters,and follow-up data at 1,3 and 6 months after operation were collected.Univariate and multivariate logistic regression analyses were used to identify the clinical risk factors for new-onset urethral stricture after HoLEP.Results The subjected patients had a median age of 66.5(64.0,75.0)years,and a preoperative median prostate volume of 66(45,92)mL,and a median indwelling catheter time of 4(4,5)d.The incidence of new urethral stricture after operation was 5.8%(42/723),with membranous part of the urethra(61.9%)the most common site,followed by the external urethral orifice(21.4%)and the bladder neck(7.1%).Risk factor analysis indicated that low BMI(<18.5 kg/m2)(OR=4.682,P=0.037),young age(OR=0.946,P=0.005),and postoperative urinary tract infection(OR=4.513,P=0.001)were independent risk factors for new-onset urethral stricture after surgery.Prostate volume and indwelling time of urinary catheter had no significant association with the occurrence of new urethral stricture after surgery.Conclusion The occurrence of new-onset urethral stricture after HoLEP is significantly correlated with BMI,age and urinary tract infection.The above 3 factors can be used as better predictors of new-onset urethral stricture after HoLEP.

Objective:To analyze the influence of midwifeled accompanyon the psychological status and delivery outcomes of gestational diabetes patients, and to provide reference for the implementation of clinical intervention programs for gestational diabetes patients.Methods:A semi-randomized controlled trial was adopted.Convenience sampling method was used to select 120 gestational diabetes patients admitted to Langfang People′s Hospital from March 2021 to September 2023, and they were divided into control group and experimental group according to the admission order. Both groups were given intraspinal delivery analgesia, while the control group was combined with routine midwifery management, and the experimental group was combined with a midwife led accompany. Intervention lasted until 2 h postpartum in both groups, and follow-up for 1 month. The delivery indicators, psychological status, delivery outcome and satisfaction of the two groups were compared.Results:Finally, 120 gestational diabetes patients were included, 60 patients in the control group, aged (28.73 ± 2.79) years, and 60 patients in the experimental group, aged (27.98 ± 1.09) years. The first and second stages of labor in the experimental group were (416.35 ± 29.87) and (60.95 ± 7.44) min, respectively, which were shorter than (501.33 ± 37.59) and (80.28 ± 8.95) min in the control group, and the differences were statistically significant ( t = 13.71, 12.87, both P<0.05). The blood glucose during delivery and 2 h postpartum hemorrhage was (6.81 ± 0.10) mmol/L and (236.18 ± 37.58) ml, respectively, lower than (7.48 ± 0.45) mmol/L and (325.70 ± 59.88) ml in the control group, the differences were statistically significant ( t = 11.26, 9.81, both P<0.05). After 1 month of follow-up, the scores of Self-rating Anxiety Scale and Self-rating Depression Scale of the experimental group were (30.86 ± 2.55) and (21.45 ± 2.67) points, which were lower than (42.19 ± 3.86) and (42.97 ± 3.15) points in the control group, and the scores of Psychological Resilience Scale were (71.22 ± 6.54) points, which was higher than that of the control group (55.38 ± 6.06) points, the differences were statistically significant ( t = 18.97, 40.37, 13.76, all P<0.05). After intervention, the incidence rates of lateral resection and postpartum hemorrhage in the experimental group were 28.3%(17/60) and 5.0%(3/60), respectively, lower than 48.3%(29/60) and 18.3%(11/60) in the control group, and the total satisfaction rate of the experimental group was 93.3%(56/60), higher than 80.0% (48/60) of the control group. The differences were statistically significant ( χ2 = 5.08, 5.18, 4.62, all P<0.05). Conclusions:The midwife led accompany could shorten the labor process of gestational diabetes patients, reduce their blood glucose during delivery and the amount of blood 2 h postpartum, and improve their psychological status and delivery outcomes, which was conducive to improving patient satisfaction.

Objective:To explore the risk factors for complications related to internal fixation after Inter-Tan intramedullary nail fixation in the treatment of intertrochanteric fractures in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 314 elderly patients with intertrochanteric fractures admitted to the Seventh Medical Center of the Chinese PLA General Hospital from January 2016 to December 2020, including 100 males and 214 females, aged 60-98 years [(80.2±8.2)years]. All the patients underwent Inter-Tan intramedullary nail fixation. According to the 2018 AO/OTA classification, 103 patients were with stable fractures and 211 with unstable fractures. The patients were further divided into complication groups and non-complication groups according to the presence of the complications during the follow-up. Six patients (5.8%) with stable fractures had the complications including nonunion in 4 and cut-out in 2. Twenty-eight patients (13.3%) with unstable fractures developed the complications, including nonunion in 5, cut-out in 20, cut-through in 1, and broken nails in 2. With the internal fixation-related complications after surgery as dependent variables, and gender, age, complications [hypertension, coronary heart disease, arrhythmia, pulmonary infection, chronic obstructive pulmonary disease (COPD), renal insufficiency, diabetes], bone density, waiting time for surgery, anesthesia method, reduction method, reduction quality, tip-apex distance, head screw displacement and other influencing factors as independent variables, univariate and multivariate Logistic regression analyses were conducted on the patients with stable fractures and unstable fractures separately to screen the independent risk factors of internal fixation-related complications.Results:For the patients with stable fractures, the univariate analysis indicated significant differences in bone density and reduction quality between the complication group and non-complication group ( P<0.05 or 0.01); the multivariate Logistic regression analysis showed that bone density T value ≤-3.0 SD ( OR=33.17, 95% CI 2.40, 457.82, P<0.01) and poor reduction quality ( OR=71.38, 95% CI 3.58, 1 422.02, P<0.01) were significantly correlated with the incidence of the postoperative complications. For the patients with unstable fractures, the univariate analysis indicated significant differences in age, reduction quality, bone density, tip-apex distance, and screw displacement between the complication group and non-complication group ( P<0.05 or 0.01); the multivariate Logistic regression analysis showed that age >80 years ( OR=2.82, 95% CI 1.01, 7.93, P<0.05), bone density T value ≤-3.0 SD ( OR=6.10, 95% CI 2.06, 17.51, P<0.01), poor reduction quality ( OR=12.25, 95% CI 2.90, 51.79, P<0.01), tip-apex distance ≥25 mm ( OR=3.65, 95% CI 1.20, 11.08, P<0.05), and head screw displacement <4 mm ( OR=7.26, 95% CI 2.54, 20.81, P<0.01) were significantly correlated with the postoperative complications. Conclusion:For Inter-Tan intramedullary nail fixation of intertrochanteric fractures in elderly patients, low bone density and poor reduction quality are independent risk factors for the postoperative complications in patients with stable intertrochanteric fractures; old age, low bone density, poor reduction quality, tip-apex distance, and head screw displacement are independent risk factors for the postoperative complications in patients with unstable fractures.

Objective:To explore the risk factors for heart failure after hip fracture surgery in the elderly patients and the impact of heart failure on their prognosis.Methods:A retrospective study was conducted to analyze the data of 1,478 elderly patients with hip fracture who had been admitted to The 7th Medical Center, General Hospital of the Chinese People's Liberation Army from January 2012 to December 2019. There were 482 males and 996 females with an age of 81 (75, 90) years. The patients were divided into a failure group and a failure-free group based on whether they had experienced any heart failure during postoperative hospitalization. After the clinical data were compared between the 2 groups, the variables with P<0.05 were included in the following multivariate logistic regression analysis to determine the risk factors for postoperative heart failure in the elderly patients with hip fracture. The mortality rates at 30 days and 1 year after operation, hospital stay, and incidence of postoperative complications were compared between the 2 groups. Results:Postoperative heart failure occurred in 7.0% (104/1,478) of the patients. The multivariate logistic regression analysis showed that advanced age ( OR=1.035, 95% CI: 1.006 to 1.065, P=0.018), male ( OR=1.727, 95% CI: 1.125 to 2.651, P=0.012), arrhythmia ( OR=1.830, 95% CI: 1.104 to 3.031, P=0.019), a high volume of blood transfusion ( OR=1.100, 95% CI: 1.001 to 1.209, P=0.048), and preoperative use of anticoagulant or antiplatelet drugs ( OR=1.921, 95% CI: 1.053 to 3.505, P=0.033) were risk factors for postoperative heart failure in the elderly patients with hip fracture. In the failure group, the mortality rates at 30 days and 1 year after operation were 9.6% (10/104) and 22.1% (23/104), and the incidence of postoperative complications was 32.7% (34/104), all significantly higher than those in the failure-free group [3.6% (49/1,374), 13.8% (190/1,374), and 17.5% (241/1,374)] ( P<0.05). The hospitalization time for the failure group was 14 (11, 19) days, significantly longer than that for the failure-free group [11 (9, 15) days] ( P<0.05). Conclusions:Advanced age, male, arrhythmia, a high volume of blood transfusion, and preoperative use of anticoagulant or antiplatelet drugs are risk factors for heart failure in the elderly patients after hip fracture surgery. Patients with heart failure may face poor prognosis, a high mortality rate, multiple complications, and long hospital stay.

Objective:To compare the failure risks between restricted and unrestricted cephalomedullary nail sliding during InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients.Methods:A retrospective study was conducted to analyze the data of 192 elderly patients with intertrochanteric fracture who had been admitted to Department of Orthopaedics, The Seventh Medical Center, General Hospital of the People's Liberation Army from January 2021 to December 2022. The patients were divided into 2 groups based on whether the set screws were tightened or not during surgery. In the observation group of 78 cases, there were 31 males and 47 females with an age of (80.2±7.7) years, and 23 cases of type 31-A1 and 55 cases of type 31-A2 by the AO classification. Their set screws were not tightened during surgery to allow the cephalomedullary nail sliding. In the control group of 114 cases, there were 40 males and 74 females with an age of (81.6±7.8) years, and 42 cases of type 31-A1 and 72 cases of type 31-A2. Their set screws were tightened during surgery to restrict the cephalomedullary nail sliding. The incidence of postoperative fixation complications and sliding distances of the cephalomedullary nail within 1 year after surgery were compared between the 2 groups in the total fractures and in the stable and unstable fractures as well.Results:There was no statistically significant difference in the preoperative general data between the 2 groups of patients, indicating comparability ( P>0.05). The incidence of fixation complications within 1 year after surgery was 5.1% (4/78) for the observation group and 12.3% (14/114) for the control group, showing no statistically significant difference between the 2 groups ( P>0.05). The sliding distance of the cephalomedullary nail in the observation group [7.05 (6.00, 8.25) mm] was significantly larger than that in the control group [5.65 (3.55, 7.00) mm] ( P<0.05). For stable fractures, the incidence of fixation complications within 1 year after surgery was 7.1% (2/28) for the observation group and 7.0% (3/43) for the control group, showing no statistically significant difference ( P>0.05), and the sliding distance of the cephalomedullary nail in the observation group [6.00 (5.25, 7.00) mm] was significantly greater than that in the control group [3.05 (2.00, 5.00) mm] ( P<0.05). For unstable fractures, the incidence of fixation complications within 1 year after surgery for the observation group patients [4.0% (2/50)] was significantly lower than that for the control group patients [15.5% (11/71)], and the sliding distance of the cephalomedullary nail in the observation group [8.00 (6.70, 10.00) mm] was significantly greater than that in the control group [6.00 (4.87, 7.57) mm] ( P<0.05). Conclusions:In the InterTAN intramedullary nail fixation for intertrochanteric fractures in the elderly patients, tightening of set screws is crucial because it not only increases the stability but also limits compression at the fracture site. It is recommended not to tighten the set screws for unstable fractures, but further observation is needed before it can be determined whether the set screws should be tightened or not for stable fractures.

Objective To investigate the expression of long non-coding RNA(lncRNA)small nucleolar RNA host gene(SNHG)25 and microRNA(miR)-497-5p in glioma tissues and their relationship with clinical features and prognosis.Methods A total of 157 glioma patients admitted to the hospital from January 2019 to January 2020 were selected as the glioma group,and 100 patients who underwent surgical treatment due to craniocerebral injury in the same hospital during the same period were selected as the control group.The ex-pression levels of lncRNA SNHG25 and miR-497-5p were detected in glioma tissues and normal brain tissues resected during operation.The patients were followed up for 3 years.The correlation between the expression levels of lncRNA SNHG25 and miR-497-5p was analyzed,and the relationship between the expression level of lncRNA SNHG25 and miR-497-5p and the clinical characteristics and prognosis of patients were analyzed.Re-sults Compared with the control group,the expression level of lncRNA SNHG25 in the glioma group was in-creased(P＜0.05),and the expression level of miR-497-5p was decreased(P＜0.05).Compared with the maximum diameter of tumors＜4 cm,World Health Organization(WHO)central nervous system tumor grade Ⅰ-Ⅱ,the expression level of lncRNA SNHG25 was increased and the expression level of miR-497-5p was decreased in glioma tissues with the maximum diameter of tumors ≥4 cm and WHO central nervous sys-tem tumor grade Ⅲ-Ⅳ(P＜0.05).The expression level of lncRNA SNHG25 in glioma patients was nega-tively correlated with miR-497-5p(r=-0.370,P＜0.05).The cumulative survival rate of lncRNA SNHG25 high expression group was lower than that of lncRNA SNHG25 low expression group(P＜0.05),and the cu-mulative survival rate of miR-497-5p low expression group was lower than that of miR-497-5p high expression group(P＜0.05).Grade Ⅲ-Ⅳ of WHO central nervous system tumor grade and high expression of lncRNA SNHG25 were risk factors for poor prognosis of glioma patients(P＜0.05),while high expression of miR-497-5p was a protective factor(P＜0.05).Conclusion The expression of lncRNA SNHG25 is increased and the expression of miR-497-5p is decreased in glioma tissues,which is related to the maximum diameter of tumor and high WHO central nervous system tumor grade,and can lead to poor prognosis of glioma patients.

Objective To observe and compare in-hospital and 1-year survival and prognosis of patients with 4b acute myocardial infarction(AMI)caused by early and late stent thrombosis(ST).Methods A total of 302 patients with 4b acute myocardial infarction caused by ST were enrolled in this study from January 2015 to February 2018.ST patients were confirmed by coronary angiography.These patients were divided into two groups:the early ST group(n=26)and the late ST group(n=276)according to the time of ST occurrence.Endpoint events during hospitalization and one year of follow up were compared between the two groups of patients.The primary endpoint events included cardiac death and recurrent AMI.The secondary endpoint events included target lesion revascularization(TLR),re-stent thrombosis,heart failure and stroke.The incidence of no endpoint events was compared between two groups of patients by Kaplan and Meier survival analysis.Cox regression analysis was used to analyze risk factors for endpoint events in patients with type 4b AMI.Results There was no significant difference in the incidence of the primary endpoint events during hospitalization between the two groups(7.7%vs.3.3%,P=0.243).The incidence of heart failure was higher in the early ST group than that of the late ST group(11.5%vs.1.4%,P=0.016).There was no significant difference in the incidence rates of other secondary endpoint events between the two groups(P＞0.05).After a mean follow-up of 1 year,the incidence rates of primary endpoint events and the secondary eendpoint events were higher in the early ST group(20.0%vs.5.9%,P＜0.05 and 36.0%vs.11.5%,P＜0.01)than that of the late ST group.Kaplan and Meier survival analysis showed that the 1-year cumulative incidences of non-primary(P= 0.022)and non-secondary events(P＜0.001)were lower in the early ST group than those of the late ST group.Cox regression analysis showed that hypertension and history of coronary artery bypass grafting were independent risk factors for primary endpoint events in patients with 4b AMI,and intraoperative implantation of intraaortic balloon pump(IABP)and shortening the time from stent thrombosis to balloon dilation(ST to B)were independent protective factor.Conclusion Early ST patients have similar in-hospital outcomes and poor long-term prognosis compared with late ST induced 4b type AMI patients.Intraoperative implantation of IABP and shortening of ST to B time may improve the prognosis of 4b type AMI patients.