Objective To explore the molecular mechanism of chronic osteomyelitis and to clarify the role of MAPK signal pathway in the pathogenesis of chronic osteomyelitis,by collecting and analyzing the transcriptional information of bone tissue in patients with chronic osteomyelitis.Methods Four cases of traumatic osteomyelitis in limbs from June 2019 to June 2020 were selected,and the samples of necrotic osteonecrosis from chronic osteomyelitis(necrotic group),and normal bone tissue(control group)were collected.Transcriptome information was collected by Illumina Hiseq Xten high throughput sequencing platform,and the gene expression in bone tissue was calculated by FPKM.The differentially expressed genes were screened by comparing the transcripts of the Necrotic group and control group.Genes were enriched by GO and KEGG.MAP3K7 and NFATC1 were selected as differential targets in the verification experiments,by using rat osteomyelitis animal model and im-munohistochemical analysis.Results A total of 5548 differentially expressed genes were obtained by high throughput sequenc-ing by comparing the necrotic group and control group,including 2701 up-regulated and 2847 down-regulated genes.The genes enriched in MAPK pathway and osteoclast differentiation pathway were screened,the common genes expressed in both MAPK and osteoclast differentiation pathway were(inhibitor of nuclear factor κ subunit Beta,IκBKβ),(mitogen-activated protein ki-nase 7,MAP3K7),(nuclear factor of activated t cells 1,NFATC1)and(nuclear factor Kappa B subunit 2,NFκB2).In rat os-teomyelitis model,MAP3K7 and NFATC1 were highly expressed in bone marrow and injured bone tissue.Conclusion Based on the transcriptome analysis,the MAPK signaling and osteoclast differentiation pathways were closely related to chronic os-teomyelitis,and the key genes IκBKβ,MAP3K7,NFATC1,NFκB2 might be new targets for clinical diagnosis and therapy of chronic osteomyelitis.

Objective To explore the predictive value of soluble fms-like tyrosine kinase-1(sFlt-1)and leukotriene B4(LTB4)in patients with intracranial aneurysms for cerebral vasospasm(CVS)after interventional embolization.Methods A total of 98 patients with intracranial aneurysms admitted to our hospital from January 2019 to September 2023 were regarded as the observation group,and were divided into the CVS group(32 cases)and the non CVS group(66 cases)according to whether CVS occurred or not within 3 to 5 days after surgery;102 healthy examinees in our hospital were selected as the control group.Enzyme-linked immunosorbent assay was used to detect serum levels of sFlt-1 and LTB4;the influencing factors for CVS after interventional embolization of intracranial aneurysms were analyzed by Logistic regression analysis;the predictive value of serum sFlt-1 and LTB4 levels for the occurrence of CVS after interventional embolization of intracranial aneurysms was analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of sFlt-1 and LTB4 of patients in the observation group were obviously higher than those in the control group,and the differences were statistically significant(P<0.05).The serum levels of sFlt-1 and LTB4,and the proportions of patients with postoperative blood pressure fluctuation range≥30 mmHg and Hunt-Hess grade Ⅲ in the CVS group were obviously higher than those in the non CVS group,and the differences were statistically significant(P<0.05).SFlt-1(OR:2.985;95%CI:1.684 to 5.291)and LTB4(OR:2.868;95%CI:1.581 to 5.204)were the independent risk factors for CVS after interventional embolization of intracranial aneurysms(P<0.05).The area under the curve(AUC)of sFlt-1 and LTB4 alone and in combination for predicting the occurrence of CVS after interventional embolization of intracranial aneurysms were 0.839,0.825,and 0.915,respectively,with sensitivity of 84.44%,87.59%,and 81.36%,and specificity of 74.26%,75.87%,and 90.98%,respectively.The AUC of the combination of the two was higher than those of sFlt-1 and LTB4 alone,and the differences were statistically significant(Z=2.150,2.546,P<0.05).Conclusion The serum levels of sFlt-1 and LTB4 in patients with CVS after interventional embolization of intracranial aneurysms are increased,and the combination of the two can serve as the important indicators for predicting CVS.

Background and Aims:The repair of giant incisional hernia is challenging,as closing the significant defect in the abdominal wall can lead to life-threatening complications like abdominal compartment syndrome(ACS).Botulinum toxin type A(BTA)can temporarily relax the abdominal wall muscles,facilitating defect repair,while preoperative progressive pneumoperitoneum(PPP)can increase intra-abdominal volume,reducing intra-abdominal pressure caused by hernia content reintegration.Combining BTA with PPP for the preoperative preparation of giant incisional hernia repair may have a complementary effect.This study was conducted to evaluate the clinical value of combining BTA and PPP in the repair of giant abdominal incisional hernia. Methods:The clinical data of 213 patients with giant abdominal incisional hernia treated at the Sixth Affiliated Hospital of Sun Yat-sen University from December 2015 to December 2019 were retrospectively analyzed.Two weeks after receiving combined BTA and PPP treatment,changes in bilateral abdominal wall muscle,intra-abdominal adhesions,abdominal circumference,abdominal cavity volume,and hernia sac volume ratio were assessed using CT.Intraoperative details,incidence of complications,and postoperative follow-up outcomes were recorded. Results:Following combined BTA and PPP treatment,CT scan showed a significant extension of bilateral lateral abdominal wall muscles towards the midline in all 213 patients,with an average increase of 2.45(1.53-3.29)cm on the left side and 2.54(1.68-3.40)cm on the right side;muscle thickness was reduced by an average of 0.84(0.64-1.00)cm on the left and 0.82(0.62-1.05)cm on the right,the average distance between viscera and the abdominal wall increased to(7.52±1.78)cm,with a mean increase of 6.1(4.2-6.9)cm;the mean increase in abdominal cavity volume was 1 802(1 494.98-2 316.26)mL,and the hernia sac volume ratio decreased by an average of 9％(6％-12％),all changes were statistically significant(P＜0.05).Post-PPP CT scan revealed no abdominal adhesions in 18 patients(8.45％),while 195 patients(91.55％)had varying degrees of adhesions,including 39 cases(18.31％)of sheet adhesions and 156 cases(73.24％)of mixed adhesions.Adhesions mainly consisted of omentum and intestinal tissues in 59.15％of cases.There were 43 cases(20.19％)of grade Ⅰ complications during the BTA-PPP process,including abdominal pain(28 cases),shoulder pain(9 cases),subcutaneous emphysema(6 cases),and dyspnea(3 cases).Dyspnea improved with oxygen therapy,while other complications required no special intervention.All 213 patients successfully underwent laparoscopic incisional hernia repair without conversion to open surgery or organ resection for volume reduction.Fascial closure was achieved in 209 cases(98.12％),with 4 cases(1.88％)having incomplete defect closure.The average time for adhesiolysis was 28(11.00-44.50)min,with a total operative time of 178.0(132.50-255.00)min and an average blood loss of 20(10-30)mL.The median intra-abdominal pressure(IAP)after operation was between 10 mmHg(9.00-12.00 mmHg),Among them,47 cases(22.07％)had IAP exceeding 12 mmHg,and after implementing proactive measures such as diuresis and diachoresis to reduce intra-abdominal contents,the IAP in these patients decreased to below 12 mmHg.No severe complications such as skin flap necrosis or ACS were observed.There were no deaths within postoperative 30 d,and during a follow-up period of 26(16.50-33.00)months,13 cases(6.10％)had surgical site events,including infections in 5 cases(2.35％),seromas in 7 cases(3.29％),and hematoma in 1 case(0.47％),with no hernia recurrence. Conclusion:The combination of BTA and PPP not only aids in identifying abdominal wall adhesion areas,improving preoperative surgical planning and enhancing surgical safety,but also significantly increases abdominal cavity volume and extends lateral abdominal wall muscles,facilitating the closure of giant incisional hernia defects and reducing the incidence of severe postoperative complications like ACS.This approach is worthy of clinical promotion.

All-trans retinoic acid(ATRA)is able to induce promyelocytic differentiation effectively.However,its role in the process of erythroid differentiation remains unclear.To investigate the role of AT-RA in the process of erythroid differentiation and its epigenetic regulatory mechanism,we established an induced leukemia cell K562 model in this study.Firstly,hemin was used to induce the differentiation of K562 cells into erythroid cells.The results of flow cytometry showed that ATRA affected the lineage changes of cells during erythroid differentiation and blocked the process of cell differentiation.After AT-RA treatment of differentiating cells,the expression level of erythroid differentiation-related genes de-creased.Through chromatin conformational capture(3C),formaldehyde-assisted separation of regulatory elements(FAIRE),chromatin immunoprecipitation(ChIP)techniques,the epigenetic mechanism was explored and it was found that after ATRA treatment of cells,the chromatin accessibility within the β-glo-bin family gene locus decreased,and the frequency of interaction between the locus control region(LCR)and its target gene promoter decreased.The decrease in the chromatin accessibility of the gene locus led to a decrease in the enrichment frequency of erythroid-related transcription factors GATA binding protein 1(GATA1),LIM domain binding 1(LDB1),LIM domain only 2(LMO2),and BHLH transcription factor 1(TAL1)at the promoter regions of the LCR and the gene locus of the globin family.The above results indicate that the ATRA treatment of differentiating cells leads to a decrease in the chromatin acces-sibility of erythroid differentiation-related genes,and a more closed chromatin structure hinders the bind-ing of LCR-recruiting transcription factors to the promoter regions of genes,thereby further repressing the expression of β-globin family genes.This dynamic process elucidates the epigenetic mechanism of ATRA in regulating erythroid differentiation.

AIM To study the chemical constituents form the leaves of Castanopsis orthacantha Fance and their α-glucosidase inhibitory activities.METHODS The methanol extract form the leaves of C.orthacanth was isolated and purified by various column chromatography methods,such as MCI gel CHP 20P,Sephadex LH-20,Diaion HP20SS,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The α-glucosidase inhibitory activities were determined by PNPG method.RESULTS Eighteen compounds were isolated and identified as protocatechuic acid(1),gallic acid(2),3-O-α-L-arabininopyranosyl-4-hydroxybenzoic acid(3),3-O-galloyl shikimic acid(4),methyl 4-epi-shikimate-3-O-gallate(5),5-O-galloyl shikimic acid(6),5-O-caffeoylshikimic acid(7),6-O-galloyl-glucoside(8),1,6-di-O-galloyl-β-D-pyranogluloside(9),1,3-di-O-galloyl-α-D-glucoside(10),2,3-di-O-galloyl-D-glucoside(11),β-O-methylgluco-2,3-digalloyl esters(12),(3R,1'S)-[1'-(6"-O-galloyl-β-D-gluco-pyranosyl)oxyethyl]-3-hydroxy-dihydrofuran-2(3H)-one(13),4-O-D-(6'-O-galloyl)glucopyranyl-(E)-p-coumaryl acid(14),chestanin(15),1-desgalloyl eugeniin(16),picrorhiza acid(17),11-methyl chebulate(18).The IC50 values of compounds 2 and 16 were(0.12±0.059),(0.00089±0.00025)mmol/L,respectively.CONCLUSION All compounds are isolated from the leaves of C.orthacantha for the first time.Compounds 2 and 16 have strong α-glucosidase inhibitory activities.

Ascites is the most common complication in patients with decompensated cirrhosis. This condition results in a severely impaired quality of life, excessive healthcare use, recurrent hospitalizations and significant morbidity and mortality. While loop diuretics and mineralocorticoid receptor antagonists are commonly employed for symptom relief, our understanding of their impact on survival remains limited. A comprehensive understanding of the underlying pathophysiological mechanism of ascites is crucial for its optimal management. The renin-angiotensin-aldosterone system (RAAS) is increasingly believed to play a pivotal role in the formation of cirrhotic ascites, as RAAS overactivation leads to a reduction in urine sodium excretion then a decrease in the ability of the kidneys to excrete water. In this review, the authors provide an overview of the pathogenesis of cirrhotic ascites, the challenges associated with current pharmacologic treatments, and the previous attempts to modulate the RAAS, followed by a description of some emerging targeted RAAS agents with the potential to be used to treat ascites.

Ascites is the most common complication in patients with decompensated cirrhosis. This condition results in a severely impaired quality of life, excessive healthcare use, recurrent hospitalizations and significant morbidity and mortality. While loop diuretics and mineralocorticoid receptor antagonists are commonly employed for symptom relief, our understanding of their impact on survival remains limited. A comprehensive understanding of the underlying pathophysiological mechanism of ascites is crucial for its optimal management. The renin-angiotensin-aldosterone system (RAAS) is increasingly believed to play a pivotal role in the formation of cirrhotic ascites, as RAAS overactivation leads to a reduction in urine sodium excretion then a decrease in the ability of the kidneys to excrete water. In this review, the authors provide an overview of the pathogenesis of cirrhotic ascites, the challenges associated with current pharmacologic treatments, and the previous attempts to modulate the RAAS, followed by a description of some emerging targeted RAAS agents with the potential to be used to treat ascites.

Ascites is the most common complication in patients with decompensated cirrhosis. This condition results in a severely impaired quality of life, excessive healthcare use, recurrent hospitalizations and significant morbidity and mortality. While loop diuretics and mineralocorticoid receptor antagonists are commonly employed for symptom relief, our understanding of their impact on survival remains limited. A comprehensive understanding of the underlying pathophysiological mechanism of ascites is crucial for its optimal management. The renin-angiotensin-aldosterone system (RAAS) is increasingly believed to play a pivotal role in the formation of cirrhotic ascites, as RAAS overactivation leads to a reduction in urine sodium excretion then a decrease in the ability of the kidneys to excrete water. In this review, the authors provide an overview of the pathogenesis of cirrhotic ascites, the challenges associated with current pharmacologic treatments, and the previous attempts to modulate the RAAS, followed by a description of some emerging targeted RAAS agents with the potential to be used to treat ascites.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective To investigate the risk factors for bronchopulmonary dysplasia (BPD) in preterm infants,and to establish a risk prediction model. Methods A total of 120 preterm infants who were admitted to the neonatal intensive care unit of Shanghai Children's Hospital from January to December 2022 were included. According to the diagnostic criteria for BPD released by the National Institute of Child Health and Human Development in 2018,they were divided into a non-BPD group (84 infants) and a BPD group (36 infants). The clinical data of the infants and their mothers were compared between the two groups. The univariate analysis and the stepwise multivariate regression analysis were used to identify the risk factors for BPD and establish a risk prediction model. Results The results showed that a gestational age of<28 weeks,duration of noninvasive respiratory support,comorbidity with infectious pneumonia,and chorioamnionitis in the mother were independent risk factors for BPD in preterm infants (P<0.05). A nomogram model for predicting the development of BPD was established based on the risk factors,with an area under the receiver operating characteristic curve of 0.93,and the calibration curve of this nomogram had a slope of about 1. The goodness-of-fit test indicated the model fitted well (x2=8.287,P=0.406). Conclusions A gestational age of<28 weeks,duration of noninvasive respiratory support,comorbidity with infectious pneumonia,and chorioamnionitis in the mother are independent risk factors for BPD in preterm infants.