BACKGROUND:In China,the patient population with osteonecrosis is large,and there is an urgent need to find new preventive targets to develop more effective treatment strategies.Metabolomics studies have shown that there is an association between human metabolites and osteonecrosis,but the causal relationship between blood metabolites and osteonecrosis has not yet been clarified.OBJECTIVE:To investigate the causal relationship between blood metabolites and osteonecrosis through two-sample Mendelian randomization analysis.METHODS:The public data of 486 blood metabolites(exposure factors)and osteonecrosis(outcome factors)were collected.Data of 486 blood metabolites were derived from a genome-wide association estimate for blood metabolites published in Nature Genetics in 2014,which covered 7 824 European adults.The single nucleotide polymorphism data for osteonecrosis were obtained from the FinnGen public database R11 dataset,containing information on a total of 431 614 samples and 21 306 430 single nucleotide polymorphism loci,with 1 788 cases of osteonecrosis and 429 826 controls,with all participants being of European descent.Mendelian randomization analysis(inverse variance weighting method,MR-Egger method,and weighted median method)was performed by Rstudio software,and then the heterogeneity test,horizontal pleiotropy test and Steiger directionality test were performed to ensure the robustness and reliability of the results.RESULTS AND CONCLUSION:(1)Sixteen blood metabolites were identified as having a significant causal relationship with osteonecrosis(Pinverse variance weighting＜Pfalse discovery rate＜0.05).(2)Eight blood metabolites increased the risk of osteonecrosis(including four known metabolites and four unknown metabolites),specifically pantothenate,beta-hydroxyisovalerate,hippurate,salicyluric glucuronide,X-08766,X-11452,X-12776 and X-14662.(3)Eight blood metabolites could reduce the risk of osteonecrosis(six known metabolites and two unknown metabolites),including cortisol,1-palmitoylglycerol(1-monopalmitin),pyroglutamyl glycine,2-stearoylglycerophosphocholine,p-cresol sulfate,ergothioneine,X-06307,X-12092.(4)The above results suggest that there is a causal relationship between 16 blood metabolites and osteonecrosis,which is expected to be a potential target for intervention in the occurrence and treatment of osteonecrosis in the future.(5)Despite the lack of relevant data from large-scale Asian populations at present,this study provides important reference value for the field of osteonecrosis in China based on European population data.In the future,domestic medical workers may be able to achieve precise intervention for osteonecrosis by regulating metabolite levels.In addition,based on the results of this study,relevant researchers can further explore the mechanism of action of metabolites in the treatment of osteonecrosis with traditional Chinese medicine,which not only helps to deepen the understanding of traditional Chinese medical therapies but also promotes the progress of integrated traditional Chinese and Western medicine research,driving the development of personalized treatment plans that are more suitable for the characteristics of the Chinese population.

BACKGROUND:In China,the patient population with osteonecrosis is large,and there is an urgent need to find new preventive targets to develop more effective treatment strategies.Metabolomics studies have shown that there is an association between human metabolites and osteonecrosis,but the causal relationship between blood metabolites and osteonecrosis has not yet been clarified.OBJECTIVE:To investigate the causal relationship between blood metabolites and osteonecrosis through two-sample Mendelian randomization analysis.METHODS:The public data of 486 blood metabolites(exposure factors)and osteonecrosis(outcome factors)were collected.Data of 486 blood metabolites were derived from a genome-wide association estimate for blood metabolites published in Nature Genetics in 2014,which covered 7 824 European adults.The single nucleotide polymorphism data for osteonecrosis were obtained from the FinnGen public database R11 dataset,containing information on a total of 431 614 samples and 21 306 430 single nucleotide polymorphism loci,with 1 788 cases of osteonecrosis and 429 826 controls,with all participants being of European descent.Mendelian randomization analysis(inverse variance weighting method,MR-Egger method,and weighted median method)was performed by Rstudio software,and then the heterogeneity test,horizontal pleiotropy test and Steiger directionality test were performed to ensure the robustness and reliability of the results.RESULTS AND CONCLUSION:(1)Sixteen blood metabolites were identified as having a significant causal relationship with osteonecrosis(Pinverse variance weighting＜Pfalse discovery rate＜0.05).(2)Eight blood metabolites increased the risk of osteonecrosis(including four known metabolites and four unknown metabolites),specifically pantothenate,beta-hydroxyisovalerate,hippurate,salicyluric glucuronide,X-08766,X-11452,X-12776 and X-14662.(3)Eight blood metabolites could reduce the risk of osteonecrosis(six known metabolites and two unknown metabolites),including cortisol,1-palmitoylglycerol(1-monopalmitin),pyroglutamyl glycine,2-stearoylglycerophosphocholine,p-cresol sulfate,ergothioneine,X-06307,X-12092.(4)The above results suggest that there is a causal relationship between 16 blood metabolites and osteonecrosis,which is expected to be a potential target for intervention in the occurrence and treatment of osteonecrosis in the future.(5)Despite the lack of relevant data from large-scale Asian populations at present,this study provides important reference value for the field of osteonecrosis in China based on European population data.In the future,domestic medical workers may be able to achieve precise intervention for osteonecrosis by regulating metabolite levels.In addition,based on the results of this study,relevant researchers can further explore the mechanism of action of metabolites in the treatment of osteonecrosis with traditional Chinese medicine,which not only helps to deepen the understanding of traditional Chinese medical therapies but also promotes the progress of integrated traditional Chinese and Western medicine research,driving the development of personalized treatment plans that are more suitable for the characteristics of the Chinese population.

BACKGROUND:Hormonal osteonecrosis of the femoral head is strongly associated with aging,but the regulatory targets and mechanisms are still unclear.Through bioinformatics combined with machine learning analysis and experimental verification,the key genes of hormonal osteonecrosis of the femoral head mediated by cell senescence will be identified,which will provide new ideas for the prevention and treatment of hormonal osteonecrosis of the femoral head.OBJECTIVE:To screen and validate the senescence core genes of hormonal osteonecrosis of the femoral head using bioinformatics analysis to explore its mechanism of action.METHODS:The GSE123568 dataset was obtained from the GPL15207 platform of the GEO database,which contained the gene expression profiles of peripheral serum samples of 30 hormonal osteonecrosis of the femoral head patients and 10 healthy controls.Data on 279 cellular senescence-related genes were obtained from the CellAge database.Differential analysis and weighted correlation network analysis(WGCNA)were performed on hormonal osteonecrosis of the femoral head gene profiles,and both were intersected with senescence-related genes and then concatenated to obtain hormonal osteonecrosis of the femoral head senescence potential genes,and GO and KEGG analyses were performed.The machine learning method screened out the pivotal genes,constructed nomogram model,and performed consensus clustering and immune infiltration analysis.Finally,clinical femoral samples were collected for validation by qPCR and western blot assay.RESULTS AND CONCLUSION:(1)41 potential genes were obtained,which were mainly enriched in biological processes such as aging and oxidative stress response,as well as FoxO and tumor necrosis factor signaling pathways.(2)The pivotal genes catalase,connective tissue growth factor,forkhead box protein O3,insulin receptor substrate 2,and mitogen-activated protein kinase kinase 11 were obtained after machine learning identification,and the predictive ability of nomogram model was good.(3)The patients were classified into three groups,namely a,b and c,by the consensus clustering analysis.Catalase,forkhead box protein O3,insulin receptor substrate 2,and mitogen-activated protein kinase kinase 11 were differentially expressed among the three molecular subtypes(P＜0.05).Results of immune infiltration showed that the abundance of immune cells,such as activated CD4+T cells,activated CD8+T cells,and eosinophils,differed among the three molecular subclasses(P＜0.05).(4)The results of qPCR and western blot assay showed that the expression of catalase,connective tissue growth factor,forkhead box protein O3,and mitogen-activated protein kinase kinase 11 was lower in hormonal osteonecrosis of the femoral head group compared to the control group(P＜0.05),and the expression of insulin receptor substrate 2 was elevated(P＜0.05).(5)It is concluded that through in-depth analysis combined with bioinformatics and machine learning,and further experimental verification,five hormonal osteonecrosis of the femoral head age-related hub genes were finally identified.These genes are catalase,connective tissue growth factor,forkhead box o3,insulin receptor substrate 2,and serine/threonine kinase 11.These genes may provide potential molecular targets for the prevention and treatment of hormonal osteonecrosis of the femoral head in the future by regulating the cellular aging process.

BACKGROUND:Hormonal osteonecrosis of the femoral head is strongly associated with aging,but the regulatory targets and mechanisms are still unclear.Through bioinformatics combined with machine learning analysis and experimental verification,the key genes of hormonal osteonecrosis of the femoral head mediated by cell senescence will be identified,which will provide new ideas for the prevention and treatment of hormonal osteonecrosis of the femoral head.OBJECTIVE:To screen and validate the senescence core genes of hormonal osteonecrosis of the femoral head using bioinformatics analysis to explore its mechanism of action.METHODS:The GSE123568 dataset was obtained from the GPL15207 platform of the GEO database,which contained the gene expression profiles of peripheral serum samples of 30 hormonal osteonecrosis of the femoral head patients and 10 healthy controls.Data on 279 cellular senescence-related genes were obtained from the CellAge database.Differential analysis and weighted correlation network analysis(WGCNA)were performed on hormonal osteonecrosis of the femoral head gene profiles,and both were intersected with senescence-related genes and then concatenated to obtain hormonal osteonecrosis of the femoral head senescence potential genes,and GO and KEGG analyses were performed.The machine learning method screened out the pivotal genes,constructed nomogram model,and performed consensus clustering and immune infiltration analysis.Finally,clinical femoral samples were collected for validation by qPCR and western blot assay.RESULTS AND CONCLUSION:(1)41 potential genes were obtained,which were mainly enriched in biological processes such as aging and oxidative stress response,as well as FoxO and tumor necrosis factor signaling pathways.(2)The pivotal genes catalase,connective tissue growth factor,forkhead box protein O3,insulin receptor substrate 2,and mitogen-activated protein kinase kinase 11 were obtained after machine learning identification,and the predictive ability of nomogram model was good.(3)The patients were classified into three groups,namely a,b and c,by the consensus clustering analysis.Catalase,forkhead box protein O3,insulin receptor substrate 2,and mitogen-activated protein kinase kinase 11 were differentially expressed among the three molecular subtypes(P＜0.05).Results of immune infiltration showed that the abundance of immune cells,such as activated CD4+T cells,activated CD8+T cells,and eosinophils,differed among the three molecular subclasses(P＜0.05).(4)The results of qPCR and western blot assay showed that the expression of catalase,connective tissue growth factor,forkhead box protein O3,and mitogen-activated protein kinase kinase 11 was lower in hormonal osteonecrosis of the femoral head group compared to the control group(P＜0.05),and the expression of insulin receptor substrate 2 was elevated(P＜0.05).(5)It is concluded that through in-depth analysis combined with bioinformatics and machine learning,and further experimental verification,five hormonal osteonecrosis of the femoral head age-related hub genes were finally identified.These genes are catalase,connective tissue growth factor,forkhead box o3,insulin receptor substrate 2,and serine/threonine kinase 11.These genes may provide potential molecular targets for the prevention and treatment of hormonal osteonecrosis of the femoral head in the future by regulating the cellular aging process.

Objective:To investigate the effects of tuina, treadmill running or both on the expression of factors related to gastrocnemius muscle proteins after acute muscle injury and to explore the mechanisms involved.Methods:Thirty adult male Sprague-Dawley rats were randomly divided into a control group, a natural recovery group, a tuina group, a treadmill running group and a combined treatment group, each of 6. An impactor was used to induce an acute skeletal muscle injury in the right hind legs of all of the rats except those of the control group. One day after the successful modelling, the tuina, treadmill running and combined groups were given interventions as their name implied, 5 times a week for 3 weeks. The gait of rats in each group was analyzed and the number of times the rats fell into and striken by the electrical grid was counted. The injured muscles′ cross-sectional areas (CSAs) and the diameters of muscle fibers were observed using hematoxylin and eosin staining. The expression of mTOR, p-mTOR, p70S6K, p-p70S6K and smad2/3 protein were tested using western blotting. The relative expression of myostatin (MSTN) mRNA was measured using real-time quantitative polymerase chain reactions.Results:Compared with the natural recovery group, all the other groups fell into the electrical grid significantly less often. The average CSA and wet weight of the affected gastrocnemius had increased significantly in the tuina, treadmill running and combined treatment groups, with the average CSA increases in the treadmill running and combined treatment groups significantly greater compared with the tuina group. The average relative expression of mTOR, p-mTOR, p70S6K, and p-p70S6K in the other four groups increased significantly compared with the control group, while that of Smad2/3 and MSTN decreased significantly. Compared with the natural recovery group, the average increases in the other groups were significantly greater. Compared with the tuina group, the treadmill running and combined treatment groups showed significantly better improvements, on average.Conclusions:Tuina, treadmill running and their combination all can improve recovery from skeletal muscle trauma, at least in rats. However, treadmill running and combined treatment are more effect than tuina alone.

Objective To explore the effects and mechanism of electroacupuncture (EA) on denervation-induced atrophy in rats. Methods A total of 18 male Sprague-Dawley rats were divided into sham group (n=6), model group (n=6) and EA group (n=6). The latter two groups were clamped right sciatic nerve to establish atrophy model of skeletal muscle. On the second day after modeling, EA group accepted electroacupuncture on right Zusanli (ST36) and Huantiao (GB30) for two weeks. Their gastrocnemius muscles were obtained after intervention, and the wet weight ratio of the gastrocnemius muscles was calculated. The cross-sectional area (CSA) and diameter of muscle fibers were measured after HE staining. The protein expression of mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), 70-KD ribosomal protein S6 kinase (p70S6K) and phosphorylated p70S6k (p-p70S6k) was tested with Western blotting. The gene expression of mTOR and p70S6K was detected with real-time quantitative polymerase chain reaction. Results Compared with the sham group, the wet weight ratio of the gastrocnemius muscle, CSA and diameter of the muscle fibers decreased in the model group and EA group (P<0.001), which were more in EA group than in the model group (P<0.01); the protein expression of mTOR, p-mTOR, p70S6K and p-p70S6K increased in the model group (P<0.01), and increased more in EA group (P<0.05); the gene expression of mTOR and p70S6K increased in the model group (P<0.05) , and increased more in EA group (P<0.05).Conclusion Electroacupuncture delays the atrophy of denervated skeletal muscles, which may relate to activation of mTOR/p70S6K signal pathway to impact synthesis of skeletal muscle proteins.

Medical activities consist of a series of operational procedures,involving the manipulation of pa-tient's body and the use of information materials,which exists the risk of privacy exposure.Based on expounding the working process of interventional operating room,this paper analyzed the potential risks and factors of privacy exposure of interventional patients existing in the process of each interventional surgery procedure: before the inter-ventional surgery,during the interventional surgery,after the completion of the interventional surgery,and put for-ward protective measures to avoid exposure of patient privacy,thus to avoid patient's privacy exposure,respect pa-tients,respect patients' personality and reflect the concept of humanistic literacy service.

Objective To compare the infusion outcome of the posterior interbody autogenous micromor-selized bone graft and structure bone graft ,which were used to cure single-segment spinal tuberculosis. Methods The posterior focus debridement and bone graft fusion were conducted on 35 single-segment spinal tuberculosis patients who were cured by micromorselized bone graft and structure bone graft in the hospital from January 2010 to June 2015. Sixteen patients received micromorselized bone graft cases and 19 patients received structure bone graft. According to JOA and VAS,the fusion effects were compared and analyzed in the following aspects,such as opera-tion time,blood loss volume during the operation,kyphosis distorted Cobb angles before and after the operation and fusion time. Results Follow-up visits were paid to all 35 patients and lasted for 12 to 24 months with an aver-age visit time of 18.5 months. Spinal grafted bones showed desirable fusion without invalid screws and grated bones in the spinal canal.(1)No statistical differences were observed between two groups in terms of post-operation JOA and VAS scores.(2)The operation time and blood loss amount during the operation were smaller in the micromor-selized bone graft than those in the structure bone graft ,with significant differences between 2 groups.(3)No sig-nificant differences were observed between the two groups in terms of kyphosis distortion angle ,but regarding to loss of Cobb angles in different intervals after the operation ,it′s greater in the former group than that in the latter one. (4)No significant differences between the two groups in terms of fusion time were observed. Conclusions The two fusion approaches demonstrated no prominent difference in alleviation of the clinical symptoms and the fu-sion time. The micromorselized bone grafting was superior to the structure bone graft in aspects such as operation time and blood loss amount. However ,it′s more likely for the former to lose Cobb angles in the follow-up visits. Both of the two grafting methods were effective in the single-segment spinal tuberculosis operation. All patients ex-cept those with severely unstable spines and osteoporosis and those were too old can adopt the micromorselized bone grafting approach.

According to the principles of constructing evaluation index system in designed experiments,we formulated the content,designed the weights and established the evaluation index system in designed experiments based on analytical hierarchy process and Delphi.This system can assess students' cognition and attitudes,abilities of innovation,practice,teamwork and cooperation as well as scientific writing skills by providing objective and comprehensive evaluation criteria.