Objective:To investigate the effect of puerarin on myocardial inflammation in rats with heart failure from the Toll-like receptor 4(TLR4)/nuclear transcription factor-κB(NF-κB)inflammatory pathway.Methods:The rat model of heart failure was established by subcutaneous injection of isoproterenol(5 mg/kg for 7 days),and was divided into model group,puerarin group,TLR4 activator group(RS09,25 μg/kg),TLR4 inhibitor group(TAK-242,0.5 mg/kg),puerarin+TLR4 activator group,with 20 rats in each group.Another 20 rats were selected as normal control group.Echocardiography was used to detect heart function;HE staining was used to observe pathological damage of myocardial tissue;TUNEL method was used to detect apoptosis of myocardial tissue cells;ELISA method was used to detect the levels of inflammatory factors IL-6,IL-1β and tumor necrosis factor-α(TNF-α)in myocardial tissue;immunohistochemical method was used to detect the expression of TLR4 and macrophage activation marker-F4/80;Western blot was used to detect the protein expressions of TLR4/NF-κB pathway,MyD88,IL-1 receptor-associated kinase(IRAK)and Galec-tin-3.Results:Compared with the normal control group,the necrosis,inflammatory infiltration and apoptosis of rat myocardial cells were severe in the model group,the heart function was decreased,the inflammatory factor release,macrophage activation,and TLR4/NF-κB pathway protein expression were increased(P<0.05).Puerarin and TLR4 inhibitors could improve the pathological damage of heart failure rats such as myocardial cell necrosis,inflammatory infiltration and apoptosis to the same extent,improve heart function,reduce inflammatory response,inhibit macrophage activation and reduce TLR4/NF-κB pathway activation(P<0.05).TLR4 activator could promote the activation of TLR4/NF-κB pathway,aggravate myocardial cell damage,apoptosis and cardiac function damage in rats with heart failure,and weaken the above-mentioned effects of puerarin(P<0.05).Conclusion:Puerarin may inhibit the activation of TLR4/NF-κB pathway,reduce myocardial inflammation,and play an anti-heart failure effect.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

OBJECTIVE: To explore the genetic basis for 4 patients with globozoospermia. METHODS: Semen and blood samples were collected from the patients for the determination of sperm concentration, viability, survival rate, morphology and acrosome antigen CD46. Meanwhile, DNA was extracted for whole exome sequencing (WES), and candidate variants were validated by Sanger sequencing. RESULTS: All of the four patients were found to harbor variants of the DPY19L2 gene. Patients 1 ~ 3 had homozygous deletions of the DPY19L2 gene. Sanger sequencing confirmed that the DPY19L2 gene in patient 3 was disrupted at a recombination breakpoint area BP2, resulting in nonallelic homologous recombination and complete deletion of the DPY19L2 gene. Patients 2 and 3 respectively harbored novel homozygous deletions of exons 2 ~ 22 and exons 14 ~ 15. Patient 4 harbored heterozygous deletion of the DPY19L2 gene, in addition with a rare homozygous deletion of the 3' UTR region. CONCLUSION DPY19L2 gene variants probably underlay the globozoospermia in the four patients, which has fit an autosomal recessive pattern of inheritance and the characteristics of genomic diseases.
Male ; Humans ; Teratozoospermia/genetics* ; Homozygote ; Semen ; Sequence Deletion ; 3' Untranslated Regions ; Membrane Proteins

Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Objective To investigate the application value of pre-implantation genetic testing(PGT)in patients with Turner syndrome.Methods The clinical data,embryonic development,PGT results and pregnancy outcome of 18 patients with Turner syndrome who underwent PGT in the reproductive center of 900th Hospital from January 2016 to June 2023 were retrospectively analyzed.Results All 18 patients had spontaneous puberty development,of which 4 patients had primary ovarian insufficiency(POI).A total of 24 oocyte retrieval cycles were performed in 18 patients,of which 6 patients had no biopsied embryos for 10 cycles.Sixty-one embryos were biopsied and 60 embryos were clearly diagnosed,including 25 with chromosomal abnormalities.Seven patients with mosaic Turner syndrome obtained clinical pregnancies after transplantation,including 4 healthy boys had already been delivered and 3 are in pregnancy.Conclusion There are numerous types of karyotype in Turner syndrome.The clinical phenotypes vary greatly in individuals with Turner syndrome,and prognosis of PGT is significant different.Patients with Turner syndrome who had biopsied embryos can obtain available embryo using PGT,and achieve ideal clinical outcomes.

Objective:To compare the characteristics of MSM with different types of primary sexual partners and to analyze the factors associated with MSM not being tested for HIV in the last six months.Methods:MSM were recruited in nine cities of Shandong Province from April to July 2021, and face-to-face questionnaires were conducted to collect information on sociodemographic characteristics, high-risk behaviors, and HIV testing of MSM. Blood samples were taken for serological tests of HIV and syphilis antibodies.Results:A total of 3 008 men who had anal sex with men in the last six months were divided into three groups according to the type of primary sexual partner in the last six months: the fixed sexual partner group (36.83%, 1 108/3 008), the commercial sexual partner group (3.06%, 92/3 008), and casual sexual partner group (60.11%, 1 808/3 008). There were statistically significant differences in the distribution of age, local residence time, education level, the primary place to find male sexual partners, use of new-type drugs in the last six months, consistent condom use every time during same-sex anal sex in the last six months, group sex in the last six months, no HIV testing in the last six months, having had a sexually transmitted disease in the last year, receiving peer education in the last year, and frequency of syphilis testing in the last year among different groups ( P<0.05). Multivariable logistic regression analysis showed that related factors of not being tested for HIV in the last six months in MSM were those aged less than 30 years old (a OR=1.39, 95% CI: 1.06-1.83), married/cohabiting (a OR=1.74, 95% CI: 1.39-2.16), high school education or less (a OR=1.39, 95% CI: 1.15-1.67), had not used new-type drugs in the last six months (a OR=2.27, 95% CI: 1.89-2.71), had not received peer education in the last year (a OR=1.59, 95% CI: 1.28-1.98), had never been tested for syphilis (a OR=11.30, 95% CI: 8.15-15.66), had not been tested in the last year but had been previously tested for syphilis (a OR=5.65, 95% CI: 4.19-7.62), the type of primary sexual partner in the last six months being a commercial sexual partner (a OR=1.80, 95% CI: 1.01-3.20), and the type of primary sexual partner in the last six months being a casual sexual partner (a OR=1.50, 95% CI: 1.26-1.80). Conclusions:The characteristics of MSM with different types of primary sexual partners are different, and the proportion of HIV testing still needs to be improved. In the future, we should make full use of the Internet and peer education to expand the coverage of HIV testing for MSM, targeting the characteristics of MSM with different types of primary sexual partners.

Objective:To explore the influencing factors of AIDS-related deaths among HIV-infected patients in Shandong Province, to help reduce the risk of death and prolong survival time.Methods:The study population was HIV-infected patients in Shandong Province from 2017-2021, and Cox proportional hazards regression model was used to analyze the influencing factors of AIDS-related deaths and deaths within one year of confirmation.Results:Among 14 700 HIV- infected patients reported in Shandong Province in 2017-2021, 351 AIDS-related deaths occurred, accounting for 2.4% (351/14 700). The results of multifactorial Cox proportional hazards regression model analysis showed that the risk factors for AIDS-related deaths among HIV-infected patients included education level of junior high school, high school, and secondary school (a HR=1.37, 95% CI:1.01-1.84), sample source from healthcare institutions (a HR=1.61, 95% CI:1.22-2.12), duration of disease in AIDS stage (a HR=9.86,95% CI:6.86-14.19), baseline CD4 +T lymphocytes (CD4) undetected (a HR=3.93, 95% CI:2.69-5.75), duration of antiviral treatment (ART) <6 months (a HR=3.46, 95% CI:2.42-4.93) and no ART (a HR=1.45, 95% CI:1.02-2.07), final CD4 <200 cells/μl (a HR=3.51, 95% CI:2.18-5.65) and final CD4 undetected (a HR=10.58, 95% CI:6.15-18.19), and final viral load (VL) values of 50-999 copies/ml,≥1 000 copies/ml and undetected (a HR=2.59, 95% CI:1.07-6.26; a HR=9.50, 95% CI:5.60-16.12; a HR=15.33, 95% CI:8.91-26.36). Factors with higher risk of AIDS-related deaths within one year of confirmation of HIV-infected patients included samples originating from healthcare facilities (a HR=1.68, 95% CI: 1.19-2.36), AIDS stage of disease (a HR=10.60, 95% CI:7.13-15.75), baseline CD4 undetected (a HR=3.71, 95% CI:2.34-5.90), duration of ART <6 months (a HR=4.30, 95% CI:2.85-6.49) and no ART (a HR=2.05, 95% CI:1.35-3.13), final CD4 <200 cells/μl (a HR=5.45,95% CI:2.04-14.60) and final CD4 undetected (a HR=20.95, 95% CI: 7.69- 57.04), and final VL values of 50-999 copies/ml, ≥1 000 copies/ml and undetected (a HR=15.21, 95% CI: 2.54-91.21; a HR=42.93, 95% CI:9.64-191.20; a HR=61.35, 95% CI:13.85-271.77). Conclusions:Expanding the coverage of testing, promoting early detection and treatment, strengthening regular follow-up and the test of HIV-infected patients, grasping the progress of the disease to provide accurate management and treatment are important for reducing the disease mortality rate and prolonging the survival time of HIV-infected patients.

Objective:To analyze the awareness status and influencing factors of hepatitis C among patients presented to hospitals in Shandong province, to provide reference for the prevention and control of viral hepatitis C.Methods:A total of 22, 139 questionnaires were collected from local residents aged 15-65 who visited general hospitals in 16 cities in Shandong province from May to December 2021. The survey was conducted in the form of face-to-face questionnaires, including general demographic information and questions and answers on hepatitis C prevention, treatment. and related behavioral characteristics. There are a total of 8 questions on the prevention and treatment of hepatitis C, and if 6 questions are correct, it is judged as knowing.Results:The overall awareness rate of hepatitis C-related knowledge among those who visited hospitals in Shandong province was 57.75%. The awareness rate of hepatitis C knowledge among respondents aged less than or equal to 20, 21-40, and 41-59 was higher than that of the age group over 60 years old. The OR values were 1.49, 2.30 and 1.88, respectively; the awareness rate of respondents with education level of high school or junior college and above was higher than that of people with education level of junior high school and below, the OR values were 1.14 and 1.21, respectively; The awareness rate of physical examination population and invasive diagnosis and treatment population was higher than that of family planning clinic visits, with OR values of 1.20 and 1.28, respectively. The awareness rate of respondents with a history of visiting a doctor in an informal medical service was lower than that of the population without such behavior. Conclusions:The awareness rate of hepatitis C knowledge among hospital patients in Shandong province needs to be further improved. Carrying out different forms of publicity and education for different groups of people is an effective means and method to reduce the hepatitis C infection rate.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.