Objective To explore the role and mechanism of warm malate ringer's solution(MR)in resuscitation of the lethal triad caused by severe trauma.Methods A rat model of severe trauma was established in SPF-grade SD rats(half male and half female,weighing 200～220 g)using combined multiple injuries and hemorrhagic shock,and the rats were randomly divided into 8 groups(n=8):Sham group,only arterial and venous catheterization;Trauma(Tra)groups with different time points(10,30,60,90,120,180 min)and a Trauma group that were observed without any treatment for 180 min after model establishment.The changes of activated clotting time(ACT),reaction time(R),maximum amplitude(MA),and rate of blood clot formation(Angle)at different time points were detected by using thromboelastography,and tail bleeding,core body temperature and arterial blood gas parameters,were also observed and detected.The plasma von Willebrand Factor(vWF)level,mitochondrial respiratory control ratio in pulmonary venous endothelium,and expression levels of vascular endothelial cadherin(VE-Cadherin),peroxisome proliferator activating receptor gamma coactivator 1α(PGC1α),dynamin-related protein 1(Drp1),p-Drp1,and mitofusin 2(Mfn2)were detected to evaluate the vascular endothelial injury and mitochondrial dysfunction.Another group of SD rats were randomly divided into severe trauma group(no treatment for 180 min after injury),and MR solution at room temperature and at 37 ℃ groups.MR solution at room temperature or at 37 ℃ was given to the rats using a medical blood transfusion apparatus at 60 min post-trauma.Above indicators were observed and detected to investigate the resuscitation effect of the MR solution.Results Compared with the Sham group,the severely traumatic rats at 180 min after injury had significantly prolonged ACT and R values(P＜0.05),shortened MA and decreased Angle values(P＜0.05),extended tail bleeding time(P＜0.05),lower partial pressure of carbon dioxide(PCO2)and HCO3-and base excess(BE)levels(P＜0.05),and continuously increasing K+(P＜0.05)and decreasing Na+(P＜0.05)and Ca2+levels(P＜0.05).Additionally,plasma vWF level(P＜0.05)and protein levels of VE-cadherin,PGC1α and Mfn2 in pulmonary vein endothelium were significantly reduced(P＜0.05),the expression of p-Drp1 was enhanced and the mitochondrial respiration control rate was declined in the rats at 180 min after injury(P＜0.05).MR solution resuscitation shortened tail bleeding time(P＜0.05),increased core body temperature(P＜0.05),elevated plasma vWF level(P＜0.05),increased protein levels of VE-cadherin,PGC1α and Mfn2(P＜0.05),and decreased that of p-Drp1 protein expression(P＜0.05)when compared with the rats at 180 min after severe traumatic injury.The above effects were more significant in the rats infused with the solution at 37 ℃ than those at room temperature.Conclusion Warm MR solution significantly improves the lethal triad in rats after severe trauma,which may be associated with its improving mitochondrial function and attenuating vascular endothelial damage.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

Objective To detect the expression of translationally-controlled tumor protein 1(TPT1)in renal cell carcinoma(RCC)and to explore its role in RCC.Methods Microarray dataset GSE15641(including 23 normal kidney tissue samples and 32 RCC tissue samples)was downloaded from the Gene Expression Omnibus,and differentially expressed genes between RCC tissue and normal kidney tissue were screened using R 4.3.0 software.The TPT1 expression in RCC tissue and adjacent non-tumor tissue of 90 patients diagnosed and treated at Affiliated Hospital of Nantong University,as well as in human RCC cells(769-P,786-O,ACHN,and Caki-1)and human embryonic kidney 293 cell(HEK293)was detected by quantitative polymerase chain reaction(qPCR)and Western blotting.The relationship between TPT1 expression and clinical pathological characteristics of RCC patients was analyzed by χ2 test.The clinical data of 522 RCC patients were derived from The Cancer Genome Atlas,and the correlation between TPT1 expression and prognosis of RCC patients was analyzed by receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve.After in vitro transfection of TPT1 small interfering RNA(siRNA)and its negative control(NC)into 786-O and Caki-1 cells,the TPT1 expression was detected by qPCR and Western blotting;the proliferation,migration,and invasion were detected by cell counting kit 8 assay,scratch assay,and Transwell assay,respectively;and the expression of apoptosis-related proteins was detected by Western blotting.Results TPT1 expression was significantly upregulated in the RCC tissue and cells compared with the normal kidney tissue and HEK293 cells(all P＜0.05).The RCC patients with low TPT1 expression levels had significantly smaller tumor size and lower metastasis rate than those with high TPT1 expression levels(both P＜0.05).The ROC curve analysis results indicated that TPT1 had high diagnostic value for RCC(area under curve was 0.856 9,95%confidence interval was 0.804 5-0.909 3,P＜0.001).The Kaplan-Meier survival analysis results showed that the overall survival of RCC patients in the low TPT1 expression group was significantly longer than that in the high TPT1 expression group(P=0.018 4).In the cell experiment,compared with the siRNA NC group,the proliferation activity,scratch healing rate,and invading transmembrane cell number of 786-O and Caki-1 cells were significantly decreased after transfection with TPT1 siRNA(all P＜0.01);the expression levels of B-lymphoma gene 2(Bcl-2)and matrix metalloproteinase-9 were significantly decreased,while the expression of Bcl-2 associated X protein was significantly increased(all P＜0.05).Conclusion TPT1 is involved in the progression of RCC and may be a potential therapeutic target for RCC.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making. Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up. Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively). Conclusion Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

Objective To investigate the relationships of serum angiopoietin-like protein 4 (ANGPTL4) and fibroblast growth factor-23 (FGF-23) levels with the severity and prognosis of patients with diabetic nephropathy. Methods A total of 120 patients (diabetic nephropathy group) with diabetic nephropathy were selected from July 2018 to July 2020 and divided into mild group (n=62) and severe group (n=58) according to the staging criteria of diabetic nephropathy; based on the prognosis within 3 years, they were also divided into good prognosis group (n=94) and poor prognosis group (n=26). Additionally, 102 diabetic patients were enrolled as diabetic group, and 81 healthy volunteers were selected as control group. The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to analyze the influencing factors of prognosis, and receiver operating characteristic (ROC) curves were drawn to analyze the values of ANGPTL4, FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy. Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group (P < 0.05); compared with the simple diabetic group, the levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group were significantly increased (P < 0.05); the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group (P < 0.05); the ROC curve analysis revealed that the areas under the curve (AUCs) for assessing disease severity of ANGPTL4, FGF-23 and their combination were 0.748, 0.781 and 0.858 respectively, and the combined diagnosis was significantly better than FGF-23 (Z=2.149, P=0.032) and ANGPTL4 (Z=2.886, P=0.004) alone; the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group (P < 0.05); significant differences were observed in diabetes duration, blood urea nitrogen (BUN), serum creatinine (Scr), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), hypertension, ANGPTL4 and FGF-23 levels between diabetic nephropathy patients with different prognoses (P < 0.05); the Scr, ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy (P < 0.05); the ROC curve analysis for prognosis assessment showed that the AUCs of ANGPTL4, FGF-23 and their combination were 0.774, 0.795 and 0.874 respectively; the combined diagnosis was significantly better than FGF-23 (Z=2.385, P=0.171) and ANGPTL4 (Z=2.317, P=0.021) alone. Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients, and they have certain reference value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective To observe the ameliorative effect of inhibiting acetyl-CoA carboxylase 2(ACC2)on cardiac dysfunction in septic mice and investigate its underlying mechanism.Methods Mouse model of sepsis was established by cecal ligation and perforation.A total of 24 male C57BL/6 mice(aged 8 weeks,weighing 20～25 g)were divided into sham operation group,sepsis group and ND-630+sepsis group.The cardiac specific ACC2 knockout(ACC2△CM)mice were constructed by Cre-LoxP recombinase system,and ACC2flox/flox Myh6-Cre-(ACC2fl/fl)mice were used as control.Several genetically engineered mice(8 weeks old,20～25 g,male)were divided into ACC2fl/fl+sham operation group,ACC2fl/fl+sepsis group,ACC2△CM+sepsis group,ACC2△CM+Mal-CoA+sepsis group,and ACC2△CM+sham operation group according to the random number table method.The contractile function and myofilament calcium sensitivity of cardiomyocytes were measured by a cell microtensiometer.Western blotting was used to detect the expression level of ACC2,and ELISA was employed to measure the level of malonyl-CoA(Mal-CoA)in myocardial tissue.The survival of the mice in 36 h after sepsis was observed.Results Compared with the sham operation group,the contraction amplitude of cardiomyocytes in sepsis group was decreased markedly,and the calcium sensitivity decreased significantly as well(P＜0.05).Based on the ACC2fl/fl+sham operation group,the ACC2△CM+sepsis group showed significant improvement in myocardial contraction compared with the ACC2fl/fl+sepsis group,with the contraction amplitude of cardiomyocytes recovered by 48.1％,and significantly restored calcium sensitivity(P＜0.05).ACC2△CM+Mal-CoA+sepsis group showed a notable decrease in myocardial cell contraction amplitude and a significant decrease in calcium sensitivity when compared to the ACC2△CM+sepsis group(P＜0.05).Compared with the sepsis group,the contraction amplitude of cardiomyocytes in the ND-630+sepsis group increased significantly,and the calcium sensitivity of myofilament also increased(P＜0.05).The expression level of ACC2 protein in the myocardial tissue of mice in the sepsis group increased compared to the sham operation group(P＜0.05).The level of myocardial Mal-CoA in the sepsis group was higher than that in the sham operation group(P＜0.05);Mal-CoA level in the myocardium of ACC2△CM+sepsis group mice was lower than that of sepsis group(P＜0.05).The 36-hour survival rate of the ACC2△CM+sepsis group.mice was 37.5％higher than that of the ACC2fl/fl+sepsis group mice.(P＜0.05).Conclusion Inhibition of ACC2 exerts a protective effect on myocardial contractility and calcium sensitivity in septic mice by reducing Mal-CoA.