Objective:To investigate the changes in the expression of miR-146a-5p and steroidogenic acute regulatory protein (StAR) in the blood vessels of rats with hypertension complicated with sepsis, and to preliminarily evaluate the underlying mechanisms of vascular lesions in hypertension complicated with sepsis.Methods:Twenty-four clean-grade healthy male Wistar rats, aged 12 weeks, weighing 250-270 g, were divided into 4 groups ( n=6 each) using the random number table method: sham operation group, sepsis group, hypertension group, and hypertension complicated with sepsis group. In sham operation group, laparotomy was performed, and sterile normal saline was subcutaneously infused using a micro-osmotic pump for 4 weeks. The sepsis model was established by cecal ligation and perforation after anesthesia in sepsis group. The hypertension model was established by subcutaneously infusing angiotensin Ⅱ at a rate of 500 ng·kg -1·min -1 for 4 weeks using a micro-osmotic pump in hypertension group. In hypertension complicated with sepsis group, angiotensin Ⅱ was subcutaneously infused, and 4 weeks later the sepsis model was established by cecal ligation and perforation. Blood pressure was measured at the end of establishing the model in each group, and blood samples of the abdominal aorta and specimens of aorta were obtained under deep anesthesia, and the serum tumor necrosis factor-alpha (TNF-α) concentration was determined by enzyme-linked immunosorbent assay. The systolic and diastolic functions of the aorta were detected using the aortic vascular ring assay. The collagen volume fraction (CVF) was calculated after Masson staining. The expression of α-smooth muscle actin (α-SMA) and StAR was detected using the immunohistochemical staining assay, and the thickness of the aortic wall was measured. The expression of StAR mRNA and miR-146a-5p was detected using quantitative real-time polymerase chain reaction. Results:Compared with sham operation group, the aortic contraction rate was significantly decreased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in the other three groups, and the systolic blood pressure and CVF were significantly increased, the thickness of the aortic wall was increased, the expression of α-SMA was up-regulated, and the thickness of the aortic wall was increased in hypertension and hypertension complicated with sepsis groups ( P<0.05). Compared with sepsis group, the systolic pressure was significantly increased, the aortic contraction rate was decreased, CVF was increased, the expression of α-SMA was up-regulated, the thickness of the aortic wall was increased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in hypertension complicated with sepsis group ( P<0.05). Compared with hypertension group, the aortic contraction rate was significantly decreased, the diastolic rate was increased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in hypertension complicated with sepsis group ( P<0.05). Conclusions:Down-regulation of miR-146a-5p and up-regulation of StAR in the blood vessels of rats with hypertension complicated with sepsis may be associated with the vascular lesions caused by hypertension complicated with sepsis.

BACKGROUND:Paraspinal muscle degeneration is one of the main causative factors of low back pain,and the changes in the paraspinal muscles are closely related to its occurrence and development.At present,clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases,but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles.OBJECTIVE:To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs,and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles,in order to provide a reference for clinical prevention and treatment.METHODS:Chinese keywords"lumbar intervertebral disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,magnetic resonance imaging"were used to search the relevant literature in Chinese databases such as CNKI,VIP,and WanFang.English keywords"lumbar disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,MRI"were used to search the relevant literature in databases such as Medline,PubMed,and Web of Science.After preliminary screening of titles and abstracts,68 articles were finally selected for result analysis according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration,and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system.It is found that clinical diagnosis and treatment should pay attention to gender differences,and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles,in order to develop more individualized treatment plans.(2)There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration,but the research results are controversial.Most studies have found that fat infiltration of the paraspinal muscles(especially the multifidus muscle)is positively correlated with the degree of lumbar intervertebral disc degeneration.(3)It is currently believed that the three mechanisms of disuse atrophy,denervation,and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles,which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain.(4)Clinically,attention should be paid to the changes of the muscles at the level below the affected nerve root segment,which is helpful for the diagnosis and localization of lumbar radiculopathy.At the same time,inhibition of inflammatory factors may become a potential target for treatment.(5)Clinically,the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain,and then carry out targeted muscle rehabilitation training.If necessary,consider using new treatment methods such as interferential current electrical stimulation to improve the patient's symptoms and prognosis.

Spinal cord injury is a central nervous system disorder caused by direct or indirect trauma to the spinal cord, with an increasing incidence year by year. Neuroinflammation, oxidative stress, and local edema following spinal cord injury can lead to motor, sensory and cognitive impairment in patients, resulting in an extremely high disability rate. Conventional treatments primarily involve surgery combined with pharmacotherapy, yet clinical outcomes remain unsatisfactory. Hesperidin, a citrus-derived flavonoid and its derivatives (neohesperidin, hesperetin, etc.) exhibit anti-inflammatory, antioxidant, anti-apoptotic, and pyroptosis-inhibitory properties. When used in the management of spinal cord injury, they can effectively improve post-injury motor dysfunction. However, hesperidin and its derivatives still face problems such as poor blood-brain-spinal cord barrier penetration and incomplete understanding of their key mechanisms, limiting the efficacy of monotherapy with hesperidin and its derivatives in the management of spinal cord injurg. To this end, the authors reviewed the research progress on mechanism of action of hesperidin and its derivatives in the management of spinal cord injury, aiming to provide a reference for its future research and clinical application.

Pyroptosis is a kind of programmed cell death,which is not only related to colorectal cancer,bladder cancer,gastric cancer,breast cancer and other tumors,but also related to cervical cancer,ovarian cancer and endometrial cancer.In recent years,the diagnosis and treatment of gynecological tumors have been improved,but their incidence and mortality are still high,which seriously threaten women's health.The current difficulty in treating gynecological tumors is reflected in the chemotherapy resistance of cervical cancer,the difficulty in early detection of ovarian cancer,the rapid progression and easy recurrence of late stage ovarian cancer,and the poor prognosis of late stage endometrial cancer.Therefore,this article reviews the roles of pyroptosis in the occurrence and development of gynecologic tumors,in order to provide clues for early diagnosis and treatment of gynecological tumors.

Pyroptosis is a kind of programmed cell death,which is not only related to colorectal cancer,bladder cancer,gastric cancer,breast cancer and other tumors,but also related to cervical cancer,ovarian cancer and endometrial cancer.In recent years,the diagnosis and treatment of gynecological tumors have been improved,but their incidence and mortality are still high,which seriously threaten women's health.The current difficulty in treating gynecological tumors is reflected in the chemotherapy resistance of cervical cancer,the difficulty in early detection of ovarian cancer,the rapid progression and easy recurrence of late stage ovarian cancer,and the poor prognosis of late stage endometrial cancer.Therefore,this article reviews the roles of pyroptosis in the occurrence and development of gynecologic tumors,in order to provide clues for early diagnosis and treatment of gynecological tumors.

Objective:To investigate the changes in the expression of miR-146a-5p and steroidogenic acute regulatory protein (StAR) in the blood vessels of rats with hypertension complicated with sepsis, and to preliminarily evaluate the underlying mechanisms of vascular lesions in hypertension complicated with sepsis.Methods:Twenty-four clean-grade healthy male Wistar rats, aged 12 weeks, weighing 250-270 g, were divided into 4 groups ( n=6 each) using the random number table method: sham operation group, sepsis group, hypertension group, and hypertension complicated with sepsis group. In sham operation group, laparotomy was performed, and sterile normal saline was subcutaneously infused using a micro-osmotic pump for 4 weeks. The sepsis model was established by cecal ligation and perforation after anesthesia in sepsis group. The hypertension model was established by subcutaneously infusing angiotensin Ⅱ at a rate of 500 ng·kg -1·min -1 for 4 weeks using a micro-osmotic pump in hypertension group. In hypertension complicated with sepsis group, angiotensin Ⅱ was subcutaneously infused, and 4 weeks later the sepsis model was established by cecal ligation and perforation. Blood pressure was measured at the end of establishing the model in each group, and blood samples of the abdominal aorta and specimens of aorta were obtained under deep anesthesia, and the serum tumor necrosis factor-alpha (TNF-α) concentration was determined by enzyme-linked immunosorbent assay. The systolic and diastolic functions of the aorta were detected using the aortic vascular ring assay. The collagen volume fraction (CVF) was calculated after Masson staining. The expression of α-smooth muscle actin (α-SMA) and StAR was detected using the immunohistochemical staining assay, and the thickness of the aortic wall was measured. The expression of StAR mRNA and miR-146a-5p was detected using quantitative real-time polymerase chain reaction. Results:Compared with sham operation group, the aortic contraction rate was significantly decreased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in the other three groups, and the systolic blood pressure and CVF were significantly increased, the thickness of the aortic wall was increased, the expression of α-SMA was up-regulated, and the thickness of the aortic wall was increased in hypertension and hypertension complicated with sepsis groups ( P<0.05). Compared with sepsis group, the systolic pressure was significantly increased, the aortic contraction rate was decreased, CVF was increased, the expression of α-SMA was up-regulated, the thickness of the aortic wall was increased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in hypertension complicated with sepsis group ( P<0.05). Compared with hypertension group, the aortic contraction rate was significantly decreased, the diastolic rate was increased, the expression of StAR protein and mRNA was up-regulated, the expression of miR-146a-5p was down-regulated, and the serum TNF-α concentration was increased in hypertension complicated with sepsis group ( P<0.05). Conclusions:Down-regulation of miR-146a-5p and up-regulation of StAR in the blood vessels of rats with hypertension complicated with sepsis may be associated with the vascular lesions caused by hypertension complicated with sepsis.

BACKGROUND:Paraspinal muscle degeneration is one of the main causative factors of low back pain,and the changes in the paraspinal muscles are closely related to its occurrence and development.At present,clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases,but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles.OBJECTIVE:To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs,and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles,in order to provide a reference for clinical prevention and treatment.METHODS:Chinese keywords"lumbar intervertebral disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,magnetic resonance imaging"were used to search the relevant literature in Chinese databases such as CNKI,VIP,and WanFang.English keywords"lumbar disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,MRI"were used to search the relevant literature in databases such as Medline,PubMed,and Web of Science.After preliminary screening of titles and abstracts,68 articles were finally selected for result analysis according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration,and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system.It is found that clinical diagnosis and treatment should pay attention to gender differences,and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles,in order to develop more individualized treatment plans.(2)There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration,but the research results are controversial.Most studies have found that fat infiltration of the paraspinal muscles(especially the multifidus muscle)is positively correlated with the degree of lumbar intervertebral disc degeneration.(3)It is currently believed that the three mechanisms of disuse atrophy,denervation,and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles,which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain.(4)Clinically,attention should be paid to the changes of the muscles at the level below the affected nerve root segment,which is helpful for the diagnosis and localization of lumbar radiculopathy.At the same time,inhibition of inflammatory factors may become a potential target for treatment.(5)Clinically,the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain,and then carry out targeted muscle rehabilitation training.If necessary,consider using new treatment methods such as interferential current electrical stimulation to improve the patient's symptoms and prognosis.

Spinal cord injury is a central nervous system disorder caused by direct or indirect trauma to the spinal cord, with an increasing incidence year by year. Neuroinflammation, oxidative stress, and local edema following spinal cord injury can lead to motor, sensory and cognitive impairment in patients, resulting in an extremely high disability rate. Conventional treatments primarily involve surgery combined with pharmacotherapy, yet clinical outcomes remain unsatisfactory. Hesperidin, a citrus-derived flavonoid and its derivatives (neohesperidin, hesperetin, etc.) exhibit anti-inflammatory, antioxidant, anti-apoptotic, and pyroptosis-inhibitory properties. When used in the management of spinal cord injury, they can effectively improve post-injury motor dysfunction. However, hesperidin and its derivatives still face problems such as poor blood-brain-spinal cord barrier penetration and incomplete understanding of their key mechanisms, limiting the efficacy of monotherapy with hesperidin and its derivatives in the management of spinal cord injurg. To this end, the authors reviewed the research progress on mechanism of action of hesperidin and its derivatives in the management of spinal cord injury, aiming to provide a reference for its future research and clinical application.

Objective:To evaluate the effect of goal-directed fluid therapy (GDFT) on postoperative acute kidney injury (AKI) in elderly patients undergoing long-time abdominal surgery.Methods:The medical records from elderly patients of both sexes, aged ≥ 65 yr, with a duration of operation ≥ 8 h and American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective first abdominal surgery for gastrointestinal tumors at the Shanxi Provincial People′s Hospital from October 1, 2016 to June 30, 2022, were collected from the electronic medical record database. Patients were divided into conventional fluid therapy group (group C) and GDFT group (group G) according to whether GDFT was employed during operation. In group C, blood pressure was maintained ≥90/60 mmHg or mean arterial pressure≥65 mmHg, and urine output more than 30 ml/h. In group G, the stroke volume variation was maintained ≤13%, and cardiac index ≥2.5 L·min -1·m -2. The patient general characteristics, requirement for fluid, urine output, blood loss, requirement for vasoactive agents and abdominal hyperthermic perfusion, and operation time were recorded during operation. The development of AKI within 72 h after operation and development of other complications (pneumonia, anastomotic leakage, surgical site infection, septic shock, arrhythmia) after operation were recorded. The length of hospital stay and 30-day mortality after operation were recorded. Results:A total of 125 patients were included in this study, with 41 patients in group C and 84 patients in group G. Postoperative AKI occurred in 19 patients, with an incidence of 15.2%. Compared with group C, the requirement for colloid, total volume of fluid infused and urine volume were significantly decreased during operation, the requirement for vasoactive agents was increased during operation ( P<0.05), the risk of postoperative AKI was reduced ( OR=0.23, P<0.05), and no significant change was found in the incidence of other postoperative complications, 30-day mortality, and length of hospital stay in group G ( P>0.05). Conclusions:GDFT can reduce the risk of AKI in the elderly patients undergoing long-time abdominal surgery.

Objective:To systematically integrate the disease experience of patients with systemic lupus erythematosus, and to provide evidence-based evidence for the formulation of health management programs based on the psychological experience of patients with systemic lupus erythematosus.Methods:Qualitative studies on psychological experience of patients with systemic lupus erythematosus were searched by computer in PubMed, Cochrane Library, CINAHL, Embase, Web of Science, ProQuest, CNKI, Wanfang Database, VIP and China Biology Medicine disc. The search period was from the establishment of the databases to July 2023. The quality of literature was evaluated using the Quality Evaluation Criteria (2020) of Evidence-Based Health Care Center of Joanna Briggs Institute, Australia, and the results of literature studies were integrated by Meta integration method.Results:A total of 13 articles were included, 48 research results were extracted and eight categories were summarized, ultimately forming three integrated results including "negative psychological experience", "increased disease demand" and "active regulation strategies".Conclusions:Medical staff should pay attention to the physical and mental feelings of patients with systemic lupus erythematosus during the disease process and provide targeted and effective intervention strategies in clinical practice to alleviate their negative emotions and improve their quality of life.