BACKGROUND:Currently,exercise therapy is an effective non-pharmacological treatment for low back pain,and exercise therapy can maintain lumbar spine stabilization through mechanical-chemical coupling between bones and muscles,but there is no clear description of the research progress and optimal treatment protocols for exercise therapy to relieve chronic non-specific lower back pain through mechanical-chemical coupling. OBJECTIVE:To review the research progress related to the influence of paravertebral muscles on lumbar spine stabilization during exercise therapy through mechanical-chemical coupling,which in turn relieves chronic non-specific lower back pain,as well as the current optimal treatment protocols of exercise therapy for chronic non-specific lower back pain. METHODS:Literature searches were performed in WanFang database,CNKI,VIP,Web of Science,and PubMed database,with search terms of"chronic non-specific low back pain,lumbar spine stabilization,paravertebral muscles,exercise therapy"in Chinese and English.Relevant literature published from database inception to January 2024 was searched and 93 articles were included for final summarization. RESULTS AND CONCLUSION:Exercise therapy can act on the paravertebral muscles and bones through appropriate mechanical stimulation and produce corresponding changes.Exercise therapy is an important intervention for chronic non-specific lower back pain as it improves the quality of the paravertebral muscles,primarily through mechanical-chemical coupling,and thus maintains lumbar spine stabilization for better relief of chronic non-specific lower back pain.However,there are no clear reports on the exact effective protocols for exercise therapy to treat chronic non-specific lower back pain through lumbar spine stabilization.The development of an individualized exercise program is particularly important for the treatment and prognosis of chronic non-specific low back pain.Muscle mass and bone mass of the same individual are closely related,and imaging assessment of paravertebral muscle mass and quantity is important for disease detection and intervention.

AIM:To explore the expression of RhoC in oral squamous cell carcinoma(OSCC)and its effects on the malignant biological behavior of OSCC cells.METHODS:The UALCAN and K-M plotter databases,alongside tis-sue sample analyses,facilitated understanding RhoC expression in cancer and its links to clinicopathological traits.Two small interfering RNAs(RhoC-siRNA)were constructed according to the RhoC gene sequence.The mRNA and protein ex-pression levels of RhoC in OSCC cells were determined.The protein levels of FAK,p-FAK,MAPK,p-MAPK,matrix me-talloproteinase-2(MMP-2)and MMP-9 were also examined by Western blot.Furthermore,the invasion and migration of OSCC cells were analyzed by Transwell assay and scratch test.Finally,the pulmonary metastasis model of nude mice was established.RESULTS:The results of the databases showed that RhoC was highly expressed in OSCC tissues,which was closely related to pathological stage,pathological grade and lymph node metastasis,but not significantly related to the sur-vival rate of patients.Furthermore,compared with paracancer tissues,the mRNA and protein expression levels of RhoC were increased in OSCC tissues(P<0.01).Silencing of RhoC prominently reduced the migration and invasion of OSCC cells as well as the protein levels of p-FAK,p-MAPK,MMP2 and MMP9(P<0.05).The protein levels of MAPK and FAK were unchanged(P>0.05).The fluorescence intensity of the experimental group was significantly lower than that of the control group,and the results of HE staining showed that the number of lung nodules in the experimental group was sig-nificantly reduced(P<0.05).CONCLUSION:RhoC can effectively influence the migration and invasion of OSCC cells,and its potential mechanism may be related to FAK/MAPK/MMPs signaling pathway.

Objective:To investigate the effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty (TKA).Methods:A total of 411 patients with end-stage knee osteoarthritis who underwent primary TKA in the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2023 were retrospectively analyzed. There were 89 males and 322 females, aged 68.05±5.91 years (range, 50-82 years). The body mass index was 26.8±3.7 kg/m 2 (range, 17.4-39.8 kg/m 2). The group was divided into a preoperative thrombosis group (47 cases) and a preoperative none-thrombosis group (364 cases) according to whether or not there was a combination of old muscular calf vein thrombosis before TKA. The clinical characteristics (location and size) and lower limb swelling were observed, and the American Knee Society (AKS) score, visual analogue scale (VAS) and Villalta score were recorded to compare the differences between the two groups. Results:All patients successfully completed the operation and were followed up for 7.4±1.1 months (range, 6-9 months). Postoperative deep venous thrombosis (DVT) occurred in 96% (45/47) of the patients in the preoperative thrombus group, which was greater than the 38.5% (140/364) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=55.184, P<0.001). 29% (13/45) of the patients who developed DVT postoperatively in the preoperative thrombus group had DVT located in the main vein, which was greater than the 9% (12/140) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=12.028, P<0.001). 51% (23/45) of patients with DVT after operation had thrombosis ≥6 mm, which was higher than 34% (47/140) of patients in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=4.454, P=0.035). The rate of thigh swelling on postoperative day 3 was 8.42%±3.50% in the group with preoperative thrombus and 7.80%±4.12% in the preoperative none-thrombus group, and the differences were not statistically significant ( t=-0.995, P=0.320). The rate of calf swelling on postoperative day 3 was 8.14%±3.40% in the preoperative thrombus group, which was greater than the 5.51%±3.45% in the preoperative none-thrombus group, and the difference was statistically significant ( t=-4.923, P<0.001). Postoperative AKS scores were elevated in both groups and were greater than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in AKS score between the two groups before operation ( P>0.05), and the AKS scores in the preoperative thrombus group were smaller than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). Postoperative VAS scores were reduced in both groups and were smaller than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in preoperative VAS scores between the two groups ( P<0.05), and the VAS scores in the preoperative thrombus group were greater than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). The Villalta score of patients with DVT after operation in the preoperative thrombus group was 4.47±2.47 at the last follow-up, which was greater than that of the preoperative none-thrombus group, which was 2.90±1.92, and the difference was statistically significant ( t=-4.395, P<0.001). Conclusion:Preoperative combined old muscular calf vein thrombosis increases the incidence of postoperative DVT and the dangerousness of DVT is higher.

Objective To investigate the regulatory role of miR-26b-3p in proliferation,migration and invasion of glioma.Methods The expressions of miR-26b-3p and cAMP-responsive element binding protein 1(CREB1)in gliomas of different pathological grades were detected with RT-qPCR and Western blotting.Bioinformatic methods were used to analyze the target sequence of miRNA-26b-3p binding to CREB1,and dual luciferase gene reporter experiment was performed to explore the mechanism for targeted regulation of CREB1 by miR-26b-3p.Glioma U251 cells were treated with miR-26b-3p mimic or inhibitor,and the changes in CREB1 expression and cell proliferation,migration,invasion and apoptosis were determined with Western blotting,CCK-8 assay,wound healing assay,Transwell assay,and flow cytometry.Results The expression of miR-26b-3p decreased while CREB1 expression increased significantly as the pathological grade of gliomas increased(P<0.05).Dual luciferase gene reporter experiment confirmed that CREB1 was a downstream target of miR-26b-3p.Inhibition of miR-26b-3p significantly upregulated the expression of CERB1,suppressed apoptosis and promoted proliferation and invasion of glioma cells,and overexpression of miR-26b-3p produced the opposite effects(P<0.05).Conclusion MiR-26b-3p regulates CREB1 expression to modulate apoptosis,proliferation,migration and invasion of glioma cells,thereby participating in tumorigenesis and progression of glioma.

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2019 Edition)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

Objective To investigate the regulatory role of miR-26b-3p in proliferation,migration and invasion of glioma.Methods The expressions of miR-26b-3p and cAMP-responsive element binding protein 1(CREB1)in gliomas of different pathological grades were detected with RT-qPCR and Western blotting.Bioinformatic methods were used to analyze the target sequence of miRNA-26b-3p binding to CREB1,and dual luciferase gene reporter experiment was performed to explore the mechanism for targeted regulation of CREB1 by miR-26b-3p.Glioma U251 cells were treated with miR-26b-3p mimic or inhibitor,and the changes in CREB1 expression and cell proliferation,migration,invasion and apoptosis were determined with Western blotting,CCK-8 assay,wound healing assay,Transwell assay,and flow cytometry.Results The expression of miR-26b-3p decreased while CREB1 expression increased significantly as the pathological grade of gliomas increased(P<0.05).Dual luciferase gene reporter experiment confirmed that CREB1 was a downstream target of miR-26b-3p.Inhibition of miR-26b-3p significantly upregulated the expression of CERB1,suppressed apoptosis and promoted proliferation and invasion of glioma cells,and overexpression of miR-26b-3p produced the opposite effects(P<0.05).Conclusion MiR-26b-3p regulates CREB1 expression to modulate apoptosis,proliferation,migration and invasion of glioma cells,thereby participating in tumorigenesis and progression of glioma.

This study aims to establish a multiplex TaqMan fluorescence quantitative PCR(qPCR)assay for Pasteurella multocida(P.multocida).Specific primers and fluorescent labeling probes were designed based on the sequences of five podoplanar genes of P.multocida hyaC-hyaD,bcbD,dcbF,ecbJ,and fcbD in the NCBI database.We adjusted the annealing temperature by gradient setting,optimized the primer and probe concentrations by matrix method,constructed standard curves,and performed specificity,sensitivity and reproducibility tests,and finally established mul-tiplexed TaqMan qPCR assays for these five genes.The results showed that the established assay had a good linear relationship between the amplification curves.The sensitivity of this method was high,10-100 times higher than that of ordinary PCR;the specificity was strong,and there was no amplification curve in the DNA detection of eight pathogenic bacteria such as Bacillus,Proteus mirabilis,Staphylococcus aureus,and Rhizoctonia rad iodurans.This assay had a good linear rela-tionship,and the coefficients of variation for Ct values of the inter-and intra-group reproducibility tests were all less than 3％,and the detection rate of this assay was 11.25％higher than the con-ventional PCR assay through the detection of 90 clinical samples.The method established in this study is able to detect P.multocida rapidly and sensitively,which is important for its rapid clinical and laboratory diagnosis.

Objective:To investigate the effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty (TKA).Methods:A total of 277 patients with knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to September 2022 were retrospectively analyzed. There were 72 males and 205 females, aged 69.16±6.77 years (range, 52-87 years), body mass index 27.01±3.81 kg/m 2 (range 18.14-39.01 kg/m 2). The patients were divided into three groups according to the preoperative tilt angle of the patella: tilt angle<5° for mild tilt group, 5°≤tilt angle<10° for moderate tilt group, and tilt angle≥10° for severe tilt group. There were 103 cases in the mild group, 137 cases in the moderate group, and 37 cases in the severe group. The preoperative and postoperative visual analogue scale (VAS), Hospital for Special Surgery (HSS) score and Feller's score of patella were compared. Results:All patients were followed up for 15.73±3.06 months (range, 12-22 months). The patellar tilt angle was 6.86°±3.55° preoperatively and 3.63°±2.61° postoperatively ( t=19.086, P<0.001). The patellar tilt angle of mild group, moderate group and severe group decreased after operation, and the difference was statistically significant compared with that before operation ( P<0.05). The anterior knee VAS of the three groups decreased after operation, and the differences were statistically significant compared with those before operation. The anterior knee VAS at 3, 6, and 12 months after operation were lower than those before operation. The differences between groups at 6 and 12 months postoperatively were statistically significant ( P<0.05), with anterior knee VAS scores of 2.59±0.55 and 2.03±0.55 in the severe group being greater than those of 2.15±0.38 and 1.57±0.50 in the mild group and 2.19±0.49 and 1.67± 0.61 in the moderate group. The HSS score of the three groups was increased after operation, and the difference was statistically significant compared with that before operation ( P<0.05), and the HSS scores at 3, 6 and 12 months after operation were higher than those before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the HSS scores of the severe group were 86.27±2.04 and 87.73±2.28, which were lower than those of the mild group 89.02±2.33 and 89.83±1.48, and the moderate group 88.77±2.83 and 89.52±1.95. Postoperative patellar Feller score increased in all three groups, and the difference was statistically significant compared with that before operation ( P<0.05), the patellar Feller score at 3, 6 and 12 months after operation was higher than that before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the patellar Feller scores in the severe group were 18.32±1.99 and 20.32±1.60, which were lower than those in the mild group 20.92±1.01 and 23.07±1.39 and the moderate group 20.91±1.95 and 22.69±1.59. Conclusion:In TKA patients without patella replacement, the increase of patellar tilt angle before operation can lead to anterior knee pain and reduced knee function.

The standardized treatment of malignant tumor has always been the direction of continuous improvement of major medical institutions.In recent years,the basic research,prevention,screening and diagnosis and treatment level of gastric,gastroesophageal junction and esophageal cancer have been greatly improved,resulting in a significant improvement in the 5 years'survival rate of patients,but there are still great differences in the diagnosis and treatment level among different regions.Chinese gastric cancer,gastroesophageal junction cancer and esophageal cancer differ greatly from European and American countries in etiology,pathological types,high incidence sites,etc.Therefore,the relevant guidelines of European and American countries cannot fully meet Chinese clinical practice.In 2021,Elsevier Publishing Group launched the Chinese edition of Elsevier clinical pathway for gastric,gastroesophageal junction and esophageal cancer,and the first update edition was made in 2022,which aims to promote the quality control of tumor diagnosis and treatment,standardize tumor diagnosis and treatment behaviors,promote the homogenization and standardization of tumor diagnosis and treatment,and ultimately improve the survival rate and quality of life of patients with malignant tumor.This pathway refers to the National Comprehensive Cancer Network clinical practice guidelines,the Chinese Society of Clinical Oncology guidelines,combines evidence-based medicine and clinical experience,and follows the scientific,universal,standardized and operable principles.It has been promoted and applied in clinical practice,and is constantly updated according to the latest research results.

Objective:To analyze the effect of patellar tilt angle on postoperative outcomes after total knee arthroplasty (TKA) without patella resurfacing.Methods:A total of 143 patients with end-stage knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to October 2021 were retrospectively analyzed. There were 32 males and 111 females, aged 68.44±6.79 years (range, 52-86 years). Patients were divided into three groups according to the postoperative patellar tilt angle: tilt angle<5° was the mild tilt group (97 cases), 5°≤tilt angle<10° was the moderate tilt group (31 cases), and tilt angle≥10° was the severe tilt group (15 cases). All patients were followed up in the outpatient clinic at 3, 6 and 12 months after surgery, and knee visual analogue score (VAS), Hospital for Special Surgery (HSS) score and patella Feller score were observed and recorded to compare the postoperative knee pain and function of patients in different patella tilt groups.Results:All patients were followed up for 1.16±0.23 years (range, 1.0-2.0 years). There was no significant difference in baseline data between the groups. There were significant differences in the intra-group comparison of the VAS score before and after surgery among the three groups ( F=51.12, P<0.001; F=36.90, P<0.001; F=15.76, P<0.001). The VAS scores at 3, 6 and 12 months after operation were significantly lower than those before operation ( P<0.05). The knee VAS of the severe group was higher than that of the mild and moderate groups at 3, 6 and 12 months after surgery, and the difference was statistically significant ( P<0.05). There were statistically significant differences in knee HSS scores before and after surgery among the three groups ( F=81.12, P<0.001; F=36.05, P<0.001; F=32.93, P<0.001). The knee HSS scores at 3, 6 and 12 months after surgery were higher than those before surgery, and the difference was statistically significant ( P<0.05). The knee HSS scores of the severe tilt group at 3, 6 and 12 months after surgery were lower than those of the mild and moderate groups, and the difference was statistically significant ( P<0.05). There were statistically significant differences in the intra-group comparison of the patella Feller score before and after surgery among the three groups ( F=88.81, P<0.001; F=49.59, P<0.001; F=37.40, P<0.001). The patellar Feller score at 3, 6 and 12 months after surgery was higher than that before surgery, and the difference was statistically significant ( P<0.05). The patellar Feller score of the severe group at 3, 6 and 12 months after surgery was lower than that of the mild and moderate groups, and the difference was statistically significant ( P<0.05). Conclusion:Patellar tilt angle after TKA without patellar resurfacing will increase knee pain and limit joint function.