ObjectiveTo investigate the potential mechanisms of Zhimu （Anemarrhena asphodeloides）-Huangbai （Phellodendron amurense） medicinal pair in alleviating postmenopausal osteoporosis （PMOP）. MethodsSixty unpregnant female SD rats were randomly divided into five groups， blank group， model group， low-dose Zhimu-Huangbai group， high-dose Zhimu-Huangbai group， and estradiol group， with 12 rats in each group. Except for the blank group， all other groups had their ovaries removed to create PMOP rat models， while the blank group only had the fat tissue around the ovaries removed. One week after the ovarian removal， the low-dose and high-dose Zhimu-Huangbai groups received concentrated solution of Zhimu and Huangbai with 1.8， 7.2 g/（kg·d） via gavage， the estradiol group received estradiol solution 0.09 mg/（kg·d） via gavage， and the blank group and the model group received 10 ml/（kg·d） of normal saline via gavage， once daily for 12 weeks. Before sampling， the body mass of the rats was recorded， and uterine tissue was taken to calculate the uterine index. The levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） in serum were detected by ELISA； micro CT was used to examine the parameters of femoral microstructure， including bone volume/tissue volume （BV/TV）， trabecular number （Tb.N）， trabecular thickness （Tb.Th）， bone mineral density （BMD）， trabecular separation （Tb.Sp）， and cortical bone area （Ct.Ar）. HE staining was used to observe pathological changes in the femur； RT-qPCR was used to detect the mRNA expression of osteogenic-adipogenic differentiation-related factors in femoral tissue， including Runt-related transcription factor 2 （Runx2）， bone morphogenetic protein 2 （BMP-2）， peroxisome proliferator-activated receptor γ （PPARγ）， chemerin and chemokine-like receptor 1 （CMKLR1）. ResultsCompared with the blank group， the model group showed a significant increase in body mass， a significant decrease in the uterine index， BV/TV， Tb.N， Tb.Th and BMD， a significant increase in Tb.Sp， and serum IL-1β， IL-6， and TNF-α levels， a significant reduction of mRNA expression of Runx2 and BMP-2 in bone tissue， and a significant increased mRNA expression of PPARγ， chemerin， and CMKLR1 （P＜0.01）. HE staining revealed that the femoral tissue showed a reduction and sparsity of trabeculae， a significant enlargement of the medullary cavity， and a large number of fat cells. Compared to the model group， the low-dose， high-dose Zhimu-Huangbai groups， and estradiol group showed significant improvements in all the above-mentioned indicators （P＜0.05 or P＜0.01）. HE staining revealed a significant increase in trabeculae， more organized arrangement， and a marked reduction in fat cells. Compared to low-dose Zhimu-Huangbai group， the high-dose Zhimu-Huangbai group exhibited a significant increase in the uterine index and BMD， and a significant reduction in body mass and PPARγ and Chemerin mRNA expression （P＜0.05 or P＜0.01）. Compared to high-dose Zhimu-Huangbai group， the estradiol group showed a decrease in uterine index， BV/TV， Tb.N， Tb.Th， BMD， and BMP-2 mRNA expression， while the levels of IL-1β， TNF-α， and IL-6， as well as Tb.Sp and the mRNA expressions of PPARγ， chemerin， and CMKLR1 increased （P＜0.05 or P＜0.01）. ConclusionThe Zhimu-Huangbai medicinal pair can alleviate PMOP bone loss， and its mechanism of action is related to reducing the levels of inflammatory factors， correcting the disorder of osteogenic-adipogenic differentiation of bone marrow mesenchymal stem cells （BMSCs）， and promoting the differentiation of BMSCs into osteoblasts.

BACKGROUND:The development of tissues and organs in the body is a precise and autonomously regulated process,and the function of biomechanical factors at this macroscale is a basic scientific question worth exploring. OBJECTIVE:To investigate the roles of cell mechanics in morphogenesis of the lobular organoid of 3D Madin-Darby canine kidney(MDCK). METHODS:The formation of MDCK lobular organoid was visualized by fluorescence resonance energy transfer technology,and the influence of different cellular mechanical signals and extracellular matrix environment on lobular organoid formation and corresponding changes in extracellular regulated protein kinases(ERK)activity were examined. RESULTS AND CONCLUSION:(1)Inhibition of ERK signaling pathway can inhibit the growth of MDCK lobular organoid.(2)Inhibition of cell contractile force signals such as ROCK pathway and Myosin Ⅱ activity,reduced ERK activity and lobular organoid size.(3)Selective inhibition of calcium channels in plasma membrane and endoplasmic reticulum led to reduced ERK activity and lobular organoid growth.(4)By inhibiting the mechanically-sensitive receptor Piezo ion channel or integrin signal on the cell membrane,the lobular organoid became smaller or MDCK cells could not generate tissue morphology.(5)Extracellular matrix compositions affected the morphogenesis of lobular organoid.The addition of type I collagen in Matrigel changed the lobular organoid to elongated shape.(6)The results of this study preliminarily show that mechanical signals in the cells and extracellular matrix environment play an important role in culturing MDCK lobular organoid,and provides certain molecular mechanisms.

During the complete denture restoration process, accurate impression making is a crucial step for achieving good denture retention. With the increasing popularity of intraoral scanning technology in fixed restoration, the use of intraoral scanning technology in complete denture restoration for edentulous jaw has also been developed. This article systematically reviews the research progress and application of intraoral scanning of edentulous soft tissue, focusing on difficulties in intraoral scanning of edentulous jaws, scanning accuracy, clinical application effects, as well as precautions involved. The aim is to provide references for clinical application.

Objective To investigate the association between recurrent low back pain(RLBP)and postoperative weight gain(PWG)after recurrent low back pain(TLIF)at three-month follow-up.Methods We analyzed 254 patients at three-month after TLIF from September 2020 to September 2022.Data such as age,gender,height and weight before surgery,smoking status,Pfirrmann grade of preoperative intervertebral disc degeneration,visual analogue scale(VAS)before surgery and 7 days,1 month and 2 months after surgery were collected.RLBP was defined for patients with low back pain with VAS score ≤3 on the 7th,1st and 2nd month after surgery,but ≥4 on the 3rd month after surgery.Three months after surgery,PWG was divided into 4 groups:＜0 kg group,0～＜5 kg group,5～＜10 kg group,and ≥10 kg group.Multivariate Logistic regression analysis of odds ratio(ORs).Results The prevalence of persistent RLBP was 18.5％(n=47).Compared to patients with a PWG of＜0 kg,patients with a PWG of 5 kg to＜10 kg and ≥ 10 kg had a higher prevalence of RLBP(OR=2.48 and 4.19,respectively);the difference was statistically significant(P＜0.05).However,no significant difference was found for patients with a PWG of 0 kg to＜5 kg.In addition,Logistic regression analysis also showed female,higher preoperative body mass index(BMI)and higher preoperative Pfirrmann grade were other three independent risk factors of RLBP.Conclusion PWG in TLIF patients is one of the independent risk factors for RLBP.Postoperative weight intervention for patients can reduce the incidence of RLBP and improve patient satisfaction with the surgery.

Objective:To evaluate the value of ultrasonography in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC) in infants.Methods:CBA or CC children <3 months of age diagnosed by surgery in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2015 to 2023 were collected, and the differences in general conditions and ultrasound manifestations between CBA group and CC group were retrospectively analyzed.Results:Among the 55 children, 30 were in CBA group and 25 were in CC group. The mean length diameter and width diameter of cysts in the CBA group were about (1.45±1.05)cm and (1.04±0.73)cm, respectively, which were significantly smaller than those in the CC group (5.41±2.98)cm and (3.21±2.90)cm ( P<0.001). The incidence of fibrous plaque (50.0%, 15/30) and abnormal gallbladder morphology (73.3%, 22/30) in the CBA group was significantly higher than that in the CC group [4.0%(1/25) and 16.0%(4/25), respectively]. The incidence of intrahepatic biliary mud deposition (52.0%, 13/25) and intrahepatic biliary duct dilation (64.0%, 16/25) in the CC group was significantly higher than that in the CBA group [0, 3.3%(1/30), respectively]. Conclusions:There are some differences in ultrasonography between CBA and CC children. The length and width of cysts in children with CC are significantly larger than those in children with CBA, and biliary mud deposits or intrahepatic bile duct dilatation are seen in the cysts. The incidence of fibrous plaque and abnormal gallbladder morphology in CBA children is significantly higher than that in CC children.

As a ligand-dependent transcription factor,retinoid-associated orphan receptor γt(RORyt)that controls T helper(Th)17 cell differentiation and interleukin(IL)-17 expression plays a critical role in the pro-gression of several inflammatory and autoimmune conditions.An emerging novel approach to the therapy of these diseases thus involves controlling the transcriptional capacity of RORyt to decrease Th17 cell development and IL-17 production.Several RORyt inhibitors including both antagonists and inverse agonists have been discovered to regulate the transcriptional activity of RORyt by binding to orthosteric-or allosteric-binding sites in the ligand-binding domain.Some of small-molecule inhibitors have entered clinical evaluations.Therefore,in current review,the role of RORyt in Th17 regulation and Th17-related inflammatory and autoimmune diseases was highlighted.Notably,the recently developed RORyt inhibitors were summarized,with an emphasis on their optimization from lead compounds,ef-ficacy,toxicity,mechanisms of action,and clinical trials.The limitations of current development in this area were also discussed to facilitate future research.

Objective:To evaluate the feasibility and clinical efficacy of deformed complex vertebral osteotomy (DCVO) technique on the treatment of angular kyphosis of cured spinal tuberculosis.Methods:A retrospective study was performed on patients with angular kyphosis of cured spinal tuberculosis who underwent the DCVO technique or posterior vertebral column resection (PVCR) technique from Jan, 2007 to Jan, 2019. 33 patients were included, 18 males and 15 females, the average age was 39.5±15.0 years old (ranged 9-78 years old). The vertebral deformity in thoracic vertebrae 14 cases, thoracolumbar vertebrae 16 cases, and lumbar vertebrae 3 cases. 20 cases underwent the DCVO technique, while 13 cases underwent PVCR technique. For DCVO group, the multiple malformed vertebrae were considered a malformed complex, and a larger range and angle wedge osteotomy was performed within the complex using the DCVO technique. PVCR technique would resect the whole deformed vertebrae, and subsequently brought the two separated spinal columns together with instruments and titanium mesh. The intro-operative blood loss, operating time and complications were recorded. The radiological measurements included preoperative and postoperative spinopelvic parameters, which including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and segmental kyphosis. The recovery of neurological function was evaluated by Frankle classification.Results:All patients were followed up for 7-72 months. Comparing with the cases underwent PVCR technique, the DCVO group has a significantly lower blood loss (1315.00±462.57 ml), operating time (293.00±83.86 min) and complications rate (1.5%). At the time of preoperation, postoperation and last follow-up, the deformity angle of DCVO group was 96.80°±6.32°, 29.10°±6.96°and 29.05°±6.49°, which gained an average 69.9% correction rate. The statistical analysis suggested that deformity angle was enormously corrected. And there was an insignificant difference between DCVO group and PVCR group. Meanwhile, the preoperative, postoperative and follow-up TK of DCVO group was 96.96°±29.13°, 37.15°±4.88° and 37.00°±3.89°respectively, whosecorrection rate was 67.1%; LL was 66.70°±21.21°, 42.25°±5.53° and 41.90°±4.98°, which have a significant difference between pre-operation and post-operation/follow-up ( F=23.997, P<0.001) ; SVA was 75.95±18.63 mm, 16.30±6.88 mm and 16.55±7.30 mm. PI was 47.50°±6.12°, 47.35°±5.54°and 47.90°±5.93°, PT was 37.25°±9.63°, 18.50°±1.99° and 19.00°±1.65°; SS was 10.25°±8.27°, 29.15°±5.91° and 28.85°±5.77°. The sagittal and spinopelvic parameters of two groups improved significantly at postoperation and follow-up. No obviously difference of spinal parameters was found between two groups at preoperation and postoperation. Both groups have cases with dysneuria. And all of these cases achieved different degrees of recovery at follow-up. Conclusion:The use of DCVO technique for the treatment of post-tubercular angular kyphosis is safe and efficiency. DCVO leads a better clinical outcomes and lower complication rate than VCR technique.

Objective:To investigate the ultrasonographic features of internal jugular venous vein pseudo-aneurysm.Methods:The ultrasonographic and clinical features of a patient with internal jugular venous vein pseudo-aneurysm in Union Hospital Affiliated to Huazhong University of Science and Technology were retrospectively analyzed. These characteristics of this patient combined with cases from literatures were summarized.Results:Ultrasound showed that the 38.6 mm×14.0 mm×29.9 mm anechoic area in the soft tissue layer of the left neck communicated with the left internal jugular vein through the 3.8 mm wide breach, and a 12.9 mm×6.6 mm slightly hyperechoic mass was found in the anechoic area. Color Doppler flow imaging showed that the internal jugular vein communicated with the anechoic area through the crevasse. There was no obvious blood flow signal in slightly hyperechoic mass. The bidirectional burr-like blood flow signal could be detected by pulse-wave Doppler. Contrast enhanced ultrasound showed that the contrast agent flowed into the mass from the internal jugular vein through the breach, and the slightly hyperechoic mass appeared the contrast filling defect, and contrast agent was well filled in the rest of the anechoic area. Ultrasound diagnosis: left internal jugular vein pseudoaneurysm with thrombosis. 35 cases of cervical vein pseudo-aneurysm patients were finally included in 23 documents, including 12 males, 23 females, 15 cases on the left side, 20 cases on the right side, 6 cases of the internal jugular vein, 27 cases of the external jugular vein; one case only describes the neck veins and supraclavicular vein in another one case. Among them, 34 cases showed subcutaneous anechoic masses on ultrasound, 1 case showed slightly hyperechoic masses, and 35 cases showed venous wall breaches.Conclusions:Ultrasound examination has high diagnostic value for vein pseudo-aneurysm owing to its convenience, fast and serial observation. Therefore, it is the preferred method and can be widely used in clinical practice. Contrast-enhanced ultrasound can clearly show the blood perfusion, and help to improve the diagnostic confidence of the operator.

Objective:The purpose of our study was to assess the clinical value of ultrasound in the diagnosis of retroaortic left renal vein (RLRV) behind abdominal aorta.Methods:The ultrasound images of patients with RLRV diagnosed by ultrasound in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2013 to 2018 were retrospectively analyzed. The general information, clinical symptoms, ultrasound images and other clinical data of the patients were collected and analyzed.Results:RLRV was detected in 16(0.46%) cases of the 3 519 patients from 2013 to 2018 using ultrasonography, and the male to female ratio was 11 to 5. All patients presented with hematuria, including 7 patients with other symptoms, such as left flank pain. Ultrasound were firstly performed in all patients. Of the 16 patients, 15(93.75%) cases were of complete retroaortic type Ⅰ, including 13(81.25%) cases with left renal vein compression and 2(12.5%) cases with complete retroaortic type without left renal vein compression. In 16 cases, 1 case (6.25%) was type Ⅲ, with compression of both branches.Conclusions:Ultrasound may be the preferred method for the left renal vein examination when a clinical suspicion of Nutcracker syndrome is required. Ultrasound can clearly show the left renal vein in most patients, to determine whether the left renal vein is mutated or compressed. Ultrasound has the highest sensitivity for detecting the type Ⅰ, which is not easy to misdiagnose. However, type Ⅲ is easy to misdiagnosis. Whereas the type Ⅱ and type Ⅳ is difficult to detect using ultrasound, which may be related to the limitations of ultrasound imaging.

Objective:To explore the clinical application value of vector flow mapping (VFM) in assessment of early cardiac dysfunction in aortic stenosis (AS) patients with normal left ventricular ejection fraction (LVEF).Methods:The clinical study consisted of 37 patients with various degrees of AS (LVEF>50%) from October 2015 to February 2017 in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, including 16 mild to moderate ones (AS1 group ) and 21 severe ones ( AS2 group ). A group of 35 age- and gender-matched healthy volunteers were selected as control group. Using Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic system, general two-dimensional parameters of left ventricular structure and function were measured. Furthermore, standard dynamic apical long axis view color Doppler flow images during 3 completed cardiac cycles were acquired for DAS-RS1 off-line workstation.Based on time-flow curve(T-F curve) of left ventricle, ECG, and the open-close of valves, the diastole period of left ventricle was divided into the isovolumic relaxation phase(P1), rapid filling phase(P2), slow filling phase(P3), atria contract phase (P4), and total diastolic phase(P0); the systole period was divided into isovolumetric contraction phase (P5), rapid ejecting phase(P6), slow ejecting phase(P7), and total systolic phase(P8). The left ventricular energy loss (EL) of three groups were acquired in all phases.Results:Left ventricular EL: ①Three peaks of EL appeared in P2, P4 and P6 respectively and total diastolic EL was almost equal to systolic. ②Compared with control group, the EL values of AS1 group increased in all phases, but only in P4, P7 and P0 with significant differences ( P<0.05). ③Compared with the other two groups, the EL values in AS2 group increased significantly in all phases of AS2 group ( P<0.01). Correlation analysis: ①For control group and AS group, there were both significant positive correlations between P0-EL, P8-EL and LVMI ( r=0.561, 0.585; 0.635, 0.652 respectively; P<0.01). ②There were both significant positive correlations between P2-EL and E, e′( r=0.623, 0.537; 0.576, 0.502 respectively; P<0.01), while P4-EL and A( r=0.482, 0.555, P<0.01). ③There were both significant positive correlations between P0-EL, P8-EL and E/e′( r=0.480, 0.459; 0.673, 0.590 respectively; P<0.01) and negative correlations between P0-EL, P8-EL and LVEF ( r=-0.537, -0.596; -0.569, -0.625 respectively; P<0.01). Conclusions:Quantitative evaluation of left ventricular EL by VFM technique is expected to provide a sensitive indicator for evaluating the cardiac structure and functional status in AS patients with normal LVEF.