Acute lymphoblastic leukemia（ALL）is the most common pediatric cancer and has good outcome.However，the prognosis of relapsed/refractory ALL in children is poor.Intensive reinduction chemotherapy and hematopoietic stem cell transplantation have become alternative treatments. Bortezomib，as the primary generation proteasome inhibitor，has been approved for the treatment of multiple myeloma and mantle cell lymphoma. In recent years，several clinical studies have confirmed promising responses and well tolerated of bortezomib combined with various chemotherapeutic drugs in treating children with relapsed/refractory ALL，to improve the complete remission rate and survival rate. This article reviews the mechanisms of bortezomib in ALL and the clinical study progress and safety of bortezomib combined with chemotherapy in children with relapsed/refractory ALL.

[Objective]To explore SUN Congtian,a bibliophile,library scientist and proofreader in the Qing Dynasty,his achievements in collecting and reviewing ancient books of Chinese medicine and his academic thoughts on medicine.[Methods]Using the method of literature research,it summarized the medical bibliographies in SUN Congtian's Shangshantang Bibliograph,and studied Huoren Jinglun,Shizhi Medical Talk.[Results]In terms of ancient medical books,SUN Congtian collected and reviewed many ancient medical books,and put forward the idea of purchasing and collecting ancient medical books and editions.In terms of medical theory,he enlightened the student YE Tianshi's"collateral disease"theory and SHEN Jin'ao's"depression disease"diagnosis and treatment thought,and put forward the medical theory of"spleen and stomach construction".[Conclusion]SUN Congtian's Shangshantang Bibliography records 28 ancient Chinese medicine books,including many rare and precious editions.Huoren Jinglun and Shizhi Medical Talk have innovated medical theory and promoted the development of medical academia.His medical academic thought needs to be further explored and sorted out.

Objective:To explore the evaluation and influence factors of computed tomography(CT)and magnetic resonance imaging(MRI)on thoracolumbar burst fracture combined with injury of posterior ligament complex(PLC).Methods:A total of 68 patients with thoracolumbar burst fractures who were diagnosed and treated in Handan First Hospital from January 2020 to June 2023 were selected as the research object,and the surgical result was used as gold standard.The 32 cases,who were diagnosed as thoracolumbar burst fractures combined with PLC injury according to the gold standard,were divided into PLC group.The 32 cases without PLC injury were divided into non-PLC group.Before operation,all patients underwent CT and MRI examinations,and the positively and negatively predictive values of CT and MRI in diagnosing thoracolumbar burst fracture combined with PLC injury were calculated by four-grid method.The area under curve(AUC)value,sensitivity and specificity of CT and MRI in diagnosing thoracolumbar burst fracture combined with PLC injury were analyzed by receiver operating characteristic(ROC)curve.Logistic regression model was used to analyze the risk factors of patients with thoracolumbar burst fracture who occurred PLC injury.The differences of the scores of ligamentous complex stability(LCS)score,intraspinal space occupancy rate and thoracolumbar injury classification and severity(TLICS)score,and the scoliosis angle(Cobb),superior iliac crest angle(SIEA),local kyphosis(LK)angle and intervertebral disc space depth(IISD)between two groups were compared.Results:For 68 with thoracolumbar burst fractures,the 34 cases were confirmed as PLC injury and 34 cases were confirmed as non-PLC injury by using CT examination.The positively and negatively predictive values of CT examination were respectively 70.59%(24/34)and 76.47%(26/34)for PLC injury,and the consistency between CT and gold standard was general(Kappa=0.471,P<0.001).The 33 cases were confirmed as PLC injury and 35 cases were confirmed as non-PLC injury by using MRI examination.The positively and negatively predictive values of MRI examination were respectively 90.91%(30/33)and 94.29%(33/35)for PLC injury,and the consistency between MRI examination and gold standard was general(Kappa=0.853,P<0.001).The diagnostic accuracy of MRI was 92.65%(63/68),which was significantly higher than that(73.53%,50/68)of CT(x2=8.843,P<0.05).ROC curve analysis showed that the AUC values of CT and MRI were respectively 0.730 and 0.919 in diagnosing thoracolumbar burst fracture combined with PLC injury.The sensitivities of them were respectively 70.60%and 75.40,and the specificities of them were respectively 88.20%and 95.70%.There were no significant differences between PLC group and non-PLC group in gender,age,body mass index(BMI),cause of injury,LCS score and intraspinal space occupancy rate(P>0.05).There were significant differences in TLICS score,Cobb angle,SIEA,LK and IISD between the two groups(x2=19.443,4.181,4.973,5.198,5.056,P<0.05),respectively.Logistic regression analysis showed that TLICS score>5 points,Cobb angle,SIEA,LK and IISD were risk factors that affected the occurrence of PLC injury in patients with thoracolumbar burst fracture(OR=13.973,1.155,1.365,1.385,5.262,P<0.001),respectively.Conclusion:The efficiency of MRI is higher than that of CT in diagnosing PLC injury in patients with thoracolumbar burst fracture,and TLICS score,Cobb angle,SIEA,LK and IISD have influences on the occurrence of PLC injury in patients with thoracolumbar burst fracture.

Objective To elucidate the mechanism of dl-3-N-butylphthalide (NBP) on renal ischemia-reperfusion injury (IRI) in rat models. Methods Forty SD rats were randomly divided into the sham operation group (Sham group), model group (IRI group), NF-κB inhibitor pyrrolidine dithiocarbamate group (PDTC group), low-dose NBP group (NBP-L group) and high-dose NBP group (NBP-H group), with 8 rats in each group. Serum creatinine (Scr), serum cystatin C(Cys-C), blood urea nitrogen (BUN) and serum interleukin (IL)-1β and IL-18 levels were detected in all groups. Pathological injury of renal tissues in each group was observed by Hematoxylin-eosin (HE) staining. The expression levels of inflammatory factors and nuclear factor (NF)-κB signaling pathway and cell pyroptosis-related proteins in renal tissues were measured by Western blot and immunohistochemical staining. Results Compared with the Sham group, renal tissue injury was more severe, and the levels of Scr, Cys-C, BUN and serum IL-1β and IL-18 were all up-regulated in the IRI group. Western blot showed that the relative expression levels of NOD-like receptor protein (NLRP3), Gasdermin D(GSDMD), cysteinyl aspartate specific proteinase (Caspase)-1, IL-18, IL-1β, NF-κB p65 and p-NF-κB p65 proteins were all up-regulated, and immunohistochemical staining revealed that the expression levels of NF-κB p65 and p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were all up-regulated in the IRI group. Compared with the IRI group, renal tissue injury was alleviated, and the levels of Scr, Cys-C, BUN and serum IL-18 and IL-1β were down-regulated in the PDTC, NBP-L and NBP-H groups. Western blot showed that the expression levels of NLRP3, GSDMD, Caspase-1, IL-1β, IL-18, NF-κB p65 and p-NF-κB p65 proteins were down-regulated, and immunohistochemical staining indicated that the expression levels of NF-κB p65, p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were down-regulated in the PDTC, NBP-L and NBP-H groups, respectively. Compared with the NBP-L group, renal tissue injury was mitigated, and the levels of Scr, Cys-C, BUN, serum IL-18 and IL-1β were all down-regulated in the NBP-H group. Western blot showed the expression levels of NLRP3, GSDMD, Caspase-1, IL-1β, IL-18, NF-κB p65 and p-NF-κB p65 proteins were down-regulated in the NBP-H group. Immunohistochemical staining indicated that the expression levels of NF-κB p65, p-NF-κB p65, IL-1β, IL-18 and NLRP3 proteins were down-regulated in the NBP-H group. Conclusions NBP may down-regulate the activity of NF-κB/NLRP3 signaling pathway and reduce the expression levels of cell pyroptosis-related proteins and inflammatory factors after renal IRI, thereby suppressing cell pyroptosis and alleviating renal IRI.

Kidney ischemia-reperfusion injury (IRI) is the major cause of poor prognosis after kidney transplantation and partial nephrectomy. Besides, it is also a critical pathophysiological process of acute kidney injury. Consequently, the prevention and treatment of kidney IRI are of significance to improve clinical prognosis of recipients undergoing kidney transplantation. However, the mechanism underlying IRI is complex, and the exact mechanism remains elusive. Inflammation, as one of the main pathogenesis of IRI, plays a significant role in IRI-induced kidney injury. Nuclear factor (NF)-κB, as a rapid response transcription factor, has been proven to be involved in the regulation of inflammation during kidney IRI. Therefore, in this article, the structure of NF-κB, the activation pattern of NF-κB signaling pathway, the regulatory mechanisms of NF-κB upstream and downstream signaling pathways in kidney IRI were reviewed, and the role of NF-κB signaling pathway in kidney IRI was investigated, aiming to provide novel clinical ideas for the prevention and treatment of kidney IRI.

Objective To investigate the effect and mechanism of artesunate on renal ischemia-reperfusion injury (IRI) in rat. Methods Twenty-five SD rats were randomly divided into the sham operation group (Sham group), model group (IRI group), low-dose artesunate group (ART-L group), high-dose artesunate group (ART-H group) and NLRP3 inflammasome inhibitor group (INF39 group), with 5 rats in each group. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and pathological damage of renal tissue were analyzed. The levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in serum were quantitatively measured. The expression level of IL-1β in renal tissues was determined by immunohistochemical staining. The expression levels of pyroptosis-related proteins were detected by fluorescent staining and Western blot. Results Compared with the Sham group, the levels of Scr and BUN were higher, the renal tissue injury was aggravated, the expression levels of TNF-α, IL-6 and IL-1βwere higher, and the expression levels of kidney injury molecule (KIM-1), pyroptosis-related protein NOD-like receptor protein 3 (NLRP3), cysteinyl aspartate specific proteinase (Caspase-1), Gasdermin D (GSDMD) and IL-1β proteins were higher in the IRI group. Compared with the IRI group, the levels of Scr and BUN were decreased, the renal tissue injury was mitigated, the expression levels of TNF-α, IL-6 and IL-1β were down-regulated, and the expression levels of KIM-1, NLRP3, Caspase-1, GSDMD and IL-1β proteins were down-regulated in the ART-L, ART-H and INF39 groups. Conclusions Artesunate may inhibit pyroptosis induced by NLRP3 inflammasome, down-regulate the expression levels of pyroptosis -related proteins, reduce the release of inflammatory factors after renal IRI and alleviate renal IRI.

OBJECTIVE: To establish a method for simultaneous detection of 2-methoxyethoxy ethanol( 2-MEE) and2-ethoxyethoxy ethanol( 2-ETE) in workplace air by solvent desorption-gas chromatography. METHODS: The 2-MEE and 2-ETE in workplace air were collected by activated carbon tubes and desorbed with methanol-methylene chloride( 5 ∶ 95,V/V),then separated on DB-FFAP capillary chromatographic column,and finally detected using flame ionization detector.RESULTS: The 2-MEE and 2-ETE showed a good linear range in 2. 12-8 464. 00 and 2. 11-8 428. 00 mg/L respectively and the correlation coefficients was 0. 999 8. The minimum quantification limits were 0. 16 and 0. 20 mg/m~3 respectively( 3 L air sample). The average desorption efficiencies were 99. 33%-103. 72% and 99. 61%-104. 07% respectively. The withinrun relative standard deviations( RSDs) were 3. 68%-4. 73% and 3. 47%-4. 39% respectively,and the between-run RSDs were 4. 72%-6. 99% and 4. 77%-6. 28% respectively. The samples could be stored at room temperature for at least14 days. CONCLUSION: This method is simple,sensitive,precise and suitable for simultaneous detection of 2-MEE and 2-ETE in workplace air.

This study analyzed the key links and main challenges in the implementation of hierarchical medical system within the county, namely such aspects as medical services, medical insurance, information and management. We took the continuity of medical care in countywide medical community as an entry point, in order to expound the concept and application of continuous service. This program covers continuous clinical pathway guiding and normalizing the inter-agency services between county and township level medical staff;the integrated payment strengthening the motivation of collaboration; the interconnected information promoting timeliness and effectiveness of technical and non-technical information transfer; and the three-dimensional and bi-directional management mode of the supporting and operating mechanisms. Local governments can propel the program gradually according to the actual situation, change the ideas and habits of each parties, and eventually achieve a long-term, and complex systematic hierarchical medical system.

Objective To identify the plasma miRNAs which are differentially expressed in the patients with traumatic avascular necrosis of the femoral head by means of high-throughput screening so as to provide data for further research into the pathogenesis of traumatic avascular necrosis of the femoral head.Methods We selected 10 patients with femoral neck fracture who had been treated from January to April 2015 for traumatic avascular necrosis of the femoral head following manual reduction and internal fixation with percutaneous hollow screws (necrosis group) and another contemporary age-matched 10 patients with femoral neck fracture who had been treated in the similar way but did not develop traumatic avascular necrosis of the femoral head for over 2 years (control group).After the peripheral blood was obtained from the 20 patients,Axon GenePix 4000B chip scanner was used for peripheral blood chip screening to identify the miRNAs which were differentially expressed.QPCR technique was used to verify the top 5 miRNAs which were significantly up-regulated and the top 5 miRNAs which were significantly down-regulated.Results The Harris score for the necrosis group was significantly lower than that for the control group while the Visual Analog Scale score for the former significantly higher than that for the latter (P ＜ 0.05).There were no significant differences between the 2 groups in general data (P ＞ 0.05).In comparison of the 2 groups,the chip screening identified 95 miRNAs which were significantly up-regulated and 413 miRNAs which were significantly down-regulated.The "volcano" analysis screened out 147 miRNAs differentially expressed of which 35 were up-regulated genes and 112 down-regulated genes.Of the 10 genes selected,8 were found in line with the results of microarray screening:hsa-miR-93-5p,hsa-let-7i-5p,hsa-miR-320a,hsa-miR-25-3p,hsa-miR-16-2-3p,hsa-miR-122-5p,hsa-miR-4711-3p and hsa-miR-3191-5p.Conclusion This study indentified 8 differentially expressed miRNAs associated with traumatic osteonecrosis of the femoral head,providing data for further study.

BACKGROUND: Hip arthroplasty and internal fixation with intramedullary cannulated screws are mainly used for senile femoral neck fractures. However, osteoporosis can usually lead to failure in internal fixation.OBJECTIVE: To analyze the joint function after fixed with intramedullary cannulated screws in elderly patients with femoral neck fractures, and to explore the factors related to functional recovery.METHODS: Clinical data of 89 patients with femoral neck fractures undergoing internal fixation with intramedullary cannulated screws after 2-year follow-up were analyzed retrospectively. The sex, age, Garden type, bone mineral density, body mass index, screw distribution, reduction index, operation time, bearing time and Harris hip scores were analyzed. Rank related analysis and accumulative Logistic regression analysis were performed on SPSS18.0 software. RESULTS AND CONCLUSION: (1) Normal Q-Q plot and normality test results indicated that the Horris scores in all patients after 2-year follow-up presented with skewed distribution (P=0.000). (2) Rank related analysis showed that age,Garden type, bone mineral density, and reduction index were related with Harris score (P < 0.05 or P < 0.01). (3) Accumulative Logistic regression analysis showed that the independent variables including age, Garden type, bone mineral density, and reduction index made significant effect on Harris hip scores. (4) To conclude, age, Garden type,bone mineral density, and reduction index are important factors for functional recovery of the hip after fixed with intramedullary cannulated screws.