ObjectiveTo investigate the clinical effects and safety of Shuhe Granules （舒和颗粒） in patients with rheumatoid arthritis （RA） comorbid with insomnia. MethodsA single-arm prospective exploratory design was adopted. Thirty RA patients comorbid with insomnia and diagnosed with the traditional Chinese medicine （TCM） syndrome of kidney-heart deficiency and qi-blood disharmony were enrolled. On the basis of maintaining their original RA treatment regimens， all patients received oral Shuhe Granules， one dose per day， for 12 consecutive weeks. The outcomes were assessed before treatment and at weeks 4， 8， and 12 after treatment. Sleep and related psychosomatic function were evaluated using the insomnia severity index （ISI）， Pittsburgh sleep quality index （PSQI）， fatigue severity scale （FSS）， patient health questionnaire-9 （PHQ-9）， generalized anxiety disorder-7 （GAD-7）， and Montreal cognitive assessment （MoCA） scores. RA-related assessments included the 28-joint disease activity score based on C-reactive protein （DAS28-CRP）， pain visual analog scale （VAS）， tender joint count （TJC28）， swollen joint count （SJC28）， morning stiffness duration， and health assessment questionnaire （HAQ） score. Laboratory parameters included erythrocyte sedimentation rate （ESR）， serum C-reactive protein （CRP）， anti-cyclic citrullinated peptide antibody （anti-CCP）， and rheumatoid factor （RF） levels. A literature-based historical control group was established through literature retrieval and meta-analysis. The ISI， PSQI， DAS28-CRP， and pain VAS scores were compared between the treatment group in the present study and the historical control group. Safety assessments were also performed. ResultsCompared with baseline before treatment， ISI and PSQI scores decreased at weeks 4， 8， and 12， while MoCA scores increased at weeks 4， 8， and 12. FSS scores decreased at weeks 4 and 12. At weeks 8 and 12， GAD-7 scores， DAS28-CRP scores， duration of morning stiffness， TJC28， and SJC28 were reduced. At week 12， PHQ-9， pain VAS， and HAQ scores significantly decreased （P＜0.05）. FSS and DAS28-CRP scores at week 12 were lower than those at week 4， and CRP levels at week 8 were lower than those at week 4 （P＜0.05）. Compared with the historical control group， the treatment group showed superior improvement in ISI and PSQI scores （P＜0.001）； however， no statistically significant differences were observed between the two groups in DAS28-CRP or pain VAS scores （P＞0.05）. No serious adverse events occurred during the study， and the 4 reported mild adverse events were all considered unrelated to the study medication. ConclusionShuhe Granules significantly improve sleep quality， fatigue， emotional status， cognitive function， RA-related symptoms， and joint function in patients with RA comorbid insomnia， with good safety and tolerability.

Objective To evaluate the clinical effectiveness of single-incision intervertebral foraminotomy in treating double-segment lumbar spinal stenosis accompanied by lumbar disc herniation.Methods A retrospective analysis was conducted on 40 cases of double-segment lumbar spinal stenosis and lumbar disc herniation treated in our orthopedic(spinal surgery)department from March 2016 to May 2018.Among these cases,11 patients(Group A)were treated with percutaneous discectomy,13 patients(Group B)underwent percutaneous endoscopic discec-tomy,and 16 patients(Group C)received double-incision percutaneous surgery.General clinical data for all patients were recorded.Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and clinical outcomes were assessed at five different time points:preoperatively,immediately postoperatively,one week postoperatively,one month postoperatively,and at the final follow-up.Statistical analysis was performed on the collected data.Results The operation time,the number of fluoroscopies performed on the hands,the length of the skin incision,and patient satisfaction were all statistically significant(P<0.05).An interaction effect was observed between the operation time and the surgical procedure on both the VAS and JOA scores.Both the operation time and the surgical method had significant main effects on the VAS and JOA scores(P<0.05).Significant differences in VAS and JOA scores were found among the three groups immediately post-surgery,one week post-surgery,one month post-operation,and at the end of the study(P<0.05).Immediately after surgery,there were statistically significant differences in VAS and JOA scores among the three groups(P<0.05).One week post-surgery,there were also statistically significant differences in VAS scores among the three groups(P<0.05).Conclusions The single-incision intervertebral foramen technique is an effective approach for simultaneously addressing double-seg-ment lumbar spinal stenosis and lumbar disc herniation through decompression.This method boasts a shorter opera-tive duration,reduced intraoperative radiation exposure,and minimal tissue damage.Patient satisfaction is high,making it a valuable addition to clinical practice.

Objective:To evaluate the changes in cortical electroencephalogram (EEG) burst suppression rate (BSR) during sevoflurane anesthesia in septic mice and the correlation with cerebral blood perfusion.Methods:Forty SPF male C57BL/6J mice, aged 8-10 weeks, weighing 22-25 g, were divided into 2 groups ( n=20 each) by the random number table method: sham operation group (Sham group) and cecal ligation perforation group (CLP group). The sepsis model was established by cecal ligation and puncture in anesthetized animals. Mice in both groups inhaled 2% sevoflurane for 2 h. During sevoflurane anesthesia, BSR (30 min as an epoch) on electroencephalogram was recorded, and the cortical cerebral blood perfusion was recorded using the laser speckle flow imaging at 30, 60, 90 and 120 min of anesthesia. Results:Compared with Sham group, the cortical EEG BSR was significantly increased, and the cortical cerebral blood perfusion was decreased during sevoflurane anesthesia in CLP group ( P<0.05). Cortical EEG BSR was negatively correlated with cortical cerebral blood perfusion ( P<0.05). Conclusions:Cortical EEG BSR increases during sevoflurane anesthesia in septic mice, which may be related to decreased cortical cerebral blood perfusion.

Objective:To evaluate the role of ZIP7 in sepsis-induced cardiomyopathy in mice.Methods:Ninety wild-type and 90 cardiomyocyte-specific knockout ZIP7 (ZIP7 cKO) male C57BL/6 mice, aged 6-8 weeks, weighing 20-25 g, were divided into 2 groups using a random number table method: wild-type sham operation group (Sham group) and wild-type sepsis group (Sep group), ZIP7 cKO sham operation group (cKO + Sham group) and ZIP7 cKO sepsis group (cKO + Sep group), with 45 mice in each group. The sepsis-induced cardiomyopathy model was developed using the cecal ligation and puncture in anesthetized mice. Twenty mice were randomly selected to record the survival for 10 days postoperatively. At 18 h after surgery, the left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) were measured by echocardiography, and serum concentrations of cardiac troponin T (cTnT), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay. The contents of hydroxyl radical (·OH) and peroxynitrite anion (ONOO -) were determined using a colorimetric assay, the morphology of myocardial mitochondria was observed with a transmission electron microscope, and the expression of dynamin-related protein 1 (Drp1), mitofusin-2 (Mfn2), and optic atrophy 1 (Opa1) in myocardial tissues was detected using Western blot. Results:Compared to Sham group, the survival rate, LVEF and LVFS were significantly decreased, serum concentrations of cTnT, TNF-α and IL-6 were increased, the contents of ·OH and ONOO - in myocardial tissues were increased, the expression of Drp1 was up-regulated, the expression of Mfn2 and Opa1 was down-regulated ( P<0.05), myocardial cells exhibited mitochondrial swelling, and marked destruction of mitochondrial cristae was observed in Sep group, and no significant differences were found in the aforementioned parameters in cKO+ Sham group ( P>0.05). Compared to Sep group, the survival rate, LVEF and LVFS were significantly increased, serum concentrations of cTnT, TNF-α and IL-6 were decreased, the contents of ·OH and ONOO - in myocardial tissues were decreased, the expression of Drp1 was down-regulated, the expression of Mfn2 and Opa1 was up-regulated ( P<0.05), and mitochondrial swelling in myocardial cells was mild, with less dissolution and destruction of mitochondrial cristae in cKO+ Sep group. Conclusions:Myocardial ZIP7 can promote mitochondrial fusion and inhibit mitochondrial fission, potentially contributing to the mechanism of sepsis-induced cardiomyopathy in mice.

Objective:To evaluate the role of cannabinoid receptor 1 (CB1) in the spinal membrane in electroacupuncture (EA)-induced alleviation of morphine-triggered opioid-induced hyperalgesia (OIH) and the relationship with phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, in which intrathecal catheters were successfully implanted, were divided into 4 groups ( n=12 each) using a random number table method: normal saline group (NS group), morphine group (M group), morphine+ EA group (ME group), and morphine+ EA+ CB1 antagonist group (MEA group). The OIH model was established by intrathecal injection of morphine 15 μg (10 μl) twice a day for 7 consecutive days. The equal volume of normal saline 10 μl was given instead in NS group. EA of the " Yanglingquan" (GB34) and " Zusanli" (ST36) acupoints lasting 30 min was performed after the first administration of medication each day, with a current intensity of 2 mA and frequency of 2 Hz in ME group. In MEA group, morphine (15 μg) and CB1 antagonist AM251 30 μg (10 μl) were intrathecally injected twice a day for 7 consecutive days, with other treatments similar to those previously described in ME group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before administration (T 0) and on days 1, 3, 5 and 7 after administration (T 1-4). Rats were deeply anesthetized and sacrificed at T 3, 4 after administration, and the L 4-6 spinal cord tissues were collected for determination of the expression of membrane CB1, ERK1/2 and p-ERK1/2 by Western blot. Results:Compared with NS group, the MWT was significantly decreased and the TWL was shortened at T 3, 4 in M, ME and MEA groups, the expression of spinal membrane CB1 and p-ERK1/2 was significantly up-regulated at T 4 after administration in M group, and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with M group, the MWT was significantly increased and the TWL was prolonged at T 3, 4, and the expression of p-ERK1/2 was down-regulated at T 4 after administration in ME group ( P<0.05), no significant change was found in MWT or TWL at T 3, 4 in MEA group ( P>0.05), and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with ME group, the MWT was significantly decreased and the TWL was shortened at T 3, 4, and the expression of spinal membrane CB1 and p-ERK1/2 was up-regulated at T 4 after administration in MEA group ( P<0.05). Conclusions:Up-regulation of spinal membrane CB1 expression is involved in EA-mediated alleviation of morphine-induced OIH, which is associated with the inhibition of ERK1/2 phosphorylation in rats.

Objective To investigate the effects of regenerating islet-derived protein 3β(Reg3β)on intestinal function and glycolysis in septic mice,as well as its role in promoting lactylation.Methods ① In vivo experiments:a total of 36 adult male C57BL/6 mice,including wild-type(WT)and Reg3β knockout(KO)mice,were randomly divided into six groups using a random number table:WT sham group,WT cecal ligation and puncture(CLP)-induced sepsis group(WT CLP group),WT sham+Reg3β intervention group(WT sham group),WT CLP+Reg3β intervention group(WT CLP+Reg3β group),KO sham group,and KO CLP group(n=6 per group).Blood glucose levels were measured at 24 hours and 48 hours after modeling;At 48 hours after modeling,ileum tissues were collected for hematoxylin-eosin(HE)staining to observe histopathological changes,immunofluorescence staining was performed to assess the positive expression levels of lactylated proteins,Western blotting was used to detect the expression levels of lactylated proteins in ileum tissues.② In vitro experiments:Cultured RAW264.7 cells were randomly divided into four groups using a random number table:blank control group,lipopolysaccharide(LPS)-induced sepsis model group(LPS group),Reg3β group,and LPS+Reg3β group.After 24 hours of drug induction,cells were collected,and Western blotting was performed to measure the levels of lactylated proteins,the culture medium was collected to determine lactylation levels.Results ① Histopathological observations showed that compared with the WT CLP group,the WT CLP+Reg3β group exhibited milder villus breakage and inflammatory cell infiltration.The KO CLP group showed more severe damage,with significantly shortened intestinal villi and separation of the epithelial layer from the lamina propria.Compared with the WT CLP group,blood glucose levels were significantly higher in the KO CLP group(mmol/L:6.83±1.15 vs.4.78±1.37,P<0.05).Both Western blotting and immunofluorescence staining results indicated that,compared with the WT CLP group,lactylation levels were significantly decreased in the KO CLP group[lactylated protein expression(lactylated protein/β-actin):0.48±0.20 vs.0.78±0.09;positive lactylated protein expression(mean fluorescence intensity):59.84±6.02 vs.100.00±5.26,both P<0.01].② Western blotting results of RAW264.7 cells cultured for 24 hours showed that compared with the LPS group,the LPS+Reg3β group exhibited significantly increased lactylated protein expression levels(lactylated protein expression/β-actin:3.67±0.48 vs.1.64±0.49,P<0.01).Compared with the blank control group,the lactate levels in the culture medium of the LPS group were significantly increased(mmol/L:4.95±0.20 vs.3.82±0.09,P<0.01).Compared with the LPS group,the lactate levels in the culture medium of the LPS+Reg3β group were also significantly increased(mmol/L:6.03±0.32 vs.4.95±0.20,P<0.01).Conclusion Reg3β promotes intestinal protein lactylation and exerts a protective effect on the intestine in sepsis,suggesting that Reg3β may serve as a novel therapeutic target for sepsis.

Objective:To evaluate the changes in cortical electroencephalogram (EEG) burst suppression rate (BSR) during sevoflurane anesthesia in septic mice and the correlation with cerebral blood perfusion.Methods:Forty SPF male C57BL/6J mice, aged 8-10 weeks, weighing 22-25 g, were divided into 2 groups ( n=20 each) by the random number table method: sham operation group (Sham group) and cecal ligation perforation group (CLP group). The sepsis model was established by cecal ligation and puncture in anesthetized animals. Mice in both groups inhaled 2% sevoflurane for 2 h. During sevoflurane anesthesia, BSR (30 min as an epoch) on electroencephalogram was recorded, and the cortical cerebral blood perfusion was recorded using the laser speckle flow imaging at 30, 60, 90 and 120 min of anesthesia. Results:Compared with Sham group, the cortical EEG BSR was significantly increased, and the cortical cerebral blood perfusion was decreased during sevoflurane anesthesia in CLP group ( P<0.05). Cortical EEG BSR was negatively correlated with cortical cerebral blood perfusion ( P<0.05). Conclusions:Cortical EEG BSR increases during sevoflurane anesthesia in septic mice, which may be related to decreased cortical cerebral blood perfusion.

Objective:To evaluate the role of ZIP7 in sepsis-induced cardiomyopathy in mice.Methods:Ninety wild-type and 90 cardiomyocyte-specific knockout ZIP7 (ZIP7 cKO) male C57BL/6 mice, aged 6-8 weeks, weighing 20-25 g, were divided into 2 groups using a random number table method: wild-type sham operation group (Sham group) and wild-type sepsis group (Sep group), ZIP7 cKO sham operation group (cKO + Sham group) and ZIP7 cKO sepsis group (cKO + Sep group), with 45 mice in each group. The sepsis-induced cardiomyopathy model was developed using the cecal ligation and puncture in anesthetized mice. Twenty mice were randomly selected to record the survival for 10 days postoperatively. At 18 h after surgery, the left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) were measured by echocardiography, and serum concentrations of cardiac troponin T (cTnT), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay. The contents of hydroxyl radical (·OH) and peroxynitrite anion (ONOO -) were determined using a colorimetric assay, the morphology of myocardial mitochondria was observed with a transmission electron microscope, and the expression of dynamin-related protein 1 (Drp1), mitofusin-2 (Mfn2), and optic atrophy 1 (Opa1) in myocardial tissues was detected using Western blot. Results:Compared to Sham group, the survival rate, LVEF and LVFS were significantly decreased, serum concentrations of cTnT, TNF-α and IL-6 were increased, the contents of ·OH and ONOO - in myocardial tissues were increased, the expression of Drp1 was up-regulated, the expression of Mfn2 and Opa1 was down-regulated ( P<0.05), myocardial cells exhibited mitochondrial swelling, and marked destruction of mitochondrial cristae was observed in Sep group, and no significant differences were found in the aforementioned parameters in cKO+ Sham group ( P>0.05). Compared to Sep group, the survival rate, LVEF and LVFS were significantly increased, serum concentrations of cTnT, TNF-α and IL-6 were decreased, the contents of ·OH and ONOO - in myocardial tissues were decreased, the expression of Drp1 was down-regulated, the expression of Mfn2 and Opa1 was up-regulated ( P<0.05), and mitochondrial swelling in myocardial cells was mild, with less dissolution and destruction of mitochondrial cristae in cKO+ Sep group. Conclusions:Myocardial ZIP7 can promote mitochondrial fusion and inhibit mitochondrial fission, potentially contributing to the mechanism of sepsis-induced cardiomyopathy in mice.

Objective:To evaluate the role of cannabinoid receptor 1 (CB1) in the spinal membrane in electroacupuncture (EA)-induced alleviation of morphine-triggered opioid-induced hyperalgesia (OIH) and the relationship with phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, in which intrathecal catheters were successfully implanted, were divided into 4 groups ( n=12 each) using a random number table method: normal saline group (NS group), morphine group (M group), morphine+ EA group (ME group), and morphine+ EA+ CB1 antagonist group (MEA group). The OIH model was established by intrathecal injection of morphine 15 μg (10 μl) twice a day for 7 consecutive days. The equal volume of normal saline 10 μl was given instead in NS group. EA of the " Yanglingquan" (GB34) and " Zusanli" (ST36) acupoints lasting 30 min was performed after the first administration of medication each day, with a current intensity of 2 mA and frequency of 2 Hz in ME group. In MEA group, morphine (15 μg) and CB1 antagonist AM251 30 μg (10 μl) were intrathecally injected twice a day for 7 consecutive days, with other treatments similar to those previously described in ME group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before administration (T 0) and on days 1, 3, 5 and 7 after administration (T 1-4). Rats were deeply anesthetized and sacrificed at T 3, 4 after administration, and the L 4-6 spinal cord tissues were collected for determination of the expression of membrane CB1, ERK1/2 and p-ERK1/2 by Western blot. Results:Compared with NS group, the MWT was significantly decreased and the TWL was shortened at T 3, 4 in M, ME and MEA groups, the expression of spinal membrane CB1 and p-ERK1/2 was significantly up-regulated at T 4 after administration in M group, and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with M group, the MWT was significantly increased and the TWL was prolonged at T 3, 4, and the expression of p-ERK1/2 was down-regulated at T 4 after administration in ME group ( P<0.05), no significant change was found in MWT or TWL at T 3, 4 in MEA group ( P>0.05), and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with ME group, the MWT was significantly decreased and the TWL was shortened at T 3, 4, and the expression of spinal membrane CB1 and p-ERK1/2 was up-regulated at T 4 after administration in MEA group ( P<0.05). Conclusions:Up-regulation of spinal membrane CB1 expression is involved in EA-mediated alleviation of morphine-induced OIH, which is associated with the inhibition of ERK1/2 phosphorylation in rats.

Objective:To evaluate the role of tubulin tyrosin ligase like-6 (TTLL6)-mediated microtubule polyglutamylation and Spastin(a microtubule cleaving protein)-induced excessive microtubule cleavage in the developmental impairment of dendritic spines in neonatal mice following repeated sevoflurane anesthesia, by utilizing TTLL6 conditional knockout mice.Methods:Fifty SPF female TTLL6 brain tissue-specific knockout (TTLL6 CKO: Camk2-Cre + ; TTLL6 f/f) and fifty control (TTLL6 CON: TTLL6 f/f) mice with C57BL/6J background, aged 6 days old were selected.TTLL6 CKO mice were divided into TTLL6 CON control group and TTLL6 CON sevoflurane group, and TTLL6 CKO mice were divided into TTLL6 CKO control group and TTLL6 CKO sevoflurane group, with 25 mice in each group by random block method.Mice in the sevoflurane groups were exposed to 3% sevoflurane with 60% O 2 for 2 hours daily on postnatal days 6, 8, and 10.The mice in control groups received only 60% O 2 under the same condition.The polyGlu-Tubulin and postsynaptic density 95(PSD95) protein expression were detected using Western blot. The expressions of TTLL6, Spastin, and α-Tubulin were assessed via immunofluorescence.Golgi staining and electron microscopy were employed to observe the density of hippocampal dendritic spines and synaptic conditions. The Morris water maze test was used to evaluate spatial memory capabilities. Statistical analysis was performed using GraphPad Prism 8.0 software. Results:(1) Behavioral results showed significant time and group interactions among the four groups in terms of latency to find the platform ( F=8.22, P<0.001).Mice in the TTLL6 CON sevoflurane group had a significantly longer escape latency on days 3-7 compared with the TTLL6 CON control group (all P<0.05), while there was no significant difference between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group (all P>0.05). The number of platform crossings differed significantly among the four groups ( H=11.95, P=0.007).The TTLL6 CON sevoflurane group had significantly fewer crossing times than the TTLL6 CON control group ( P<0.05), but no significant difference was observed between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group ( P>0.05). (2) Golgi staining and electron microscopy results revealed significant differences in dendritic spine density and synapse number among the four groups( F=29.00, 41.94, both P<0.001). The dendritic spine density ((5.83±0.40)/10 μm) and the number of synapses ((3.67±0.58)/10 μm) in the TTLL6 CON sevoflurane group were both significantly lower than those in the TTLL6 CON control group ((12.87±1.70)/10 μm, (9.33±0.57)/10 μm)(both P<0.05). In contrast, there was no statistically significant difference between the TTLL6 CKO sevoflurane group and TTLL6 CKO control group (both P>0.05). (3) Immunofluorescence results showed significant differences in the percentage of TTLL6 and Spastin and α-Tubulin co-expressed positive cells in the CA3 region of the hippocampus among the four groups of mice ( F=215.20, 26.08, both P<0.001). The percentage of TTLL6 and Spastin and α-Tubulin co-expressed positive cells in the TTLL6 CON sevoflurane group ((16.75±1.81) %, (47.98±8.42) %) were significantly higher than those in the TTLL6 CON control group ((2.44±0.58) %, (20.07±4.54) %)(both P<0.05), while there was no statistically significant difference between the TTLL6 CKO sevoflurane group and TTLL6 CKO control group ( P>0.05). (4) Western blot results indicated significant differences in the expression of polyGlu-Tubulin and PSD95 proteins in the hippocampal tissue among the four groups of mice ( F=19.66, 8.57, both P<0.001). The TTLL6 CON sevoflurane group had higher polyGlu-Tubulin expression (0.86±0.19) and lower PSD95 expression (0.61±0.13) compared to the TTLL6 CON control group (0.51±0.11, 1.01±0.07) (both P<0.05).However, there was no significant difference between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group ( P>0.05). Conclusion:The mechanism underlying long-term cognitive impairment in developing brain of neonatal mice caused by repeated sevoflurane anesthesia may relate to the upregulation of TTLL6-induced microtubule polyglutamylation and accelerated Spastin-mediated microtubule severing, which ultimately leads to abnormal dendritic spine development.