OBJECTIVE To investigate the effects of galangin （GLA） on autophagy and apoptosis of chondrocytes in knee osteoarthritis （KOA） rats by regulating the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR）/UNC-51-like kinase 1 （ULK1） signaling pathway. METHODS KOA rat model was constructed and separated into model group， L-GLA， M-GLA， H-GLA groups [subcutaneous injection of 100， 200， 400 μg/kg GLA]， GLA+Compound C group [subcutaneous injection of 400 μg/kg GLA+0.2 mg/kg AMPK inhibitor Compound C]， with 10 rats in each group. Additionally， 10 normally fed rats were selected as the sham operation group. After the last medication， the degree of knee joint swelling of rats in each group was detected； the pathology of knee joints in KOA rats was observed. The serum expressions of matrix metalloproteinase 13 （MMP-13） and interleukin-1β （IL-1β） in KOA rats were detected； the autophagy of chondrocytes in KOA rats was observed； the chondrocyte apoptosis in KOA rats was detected； the phosphorylation of AMPK/mTOR/ULK1 pathway-related proteins in cartilage tissue of knee joint were detected in rats. RESULTS Compared with the sham operation group， the arrangement of articular chondrocytes in the model group was disordered， with nuclear pyknosis and severe fibrosis of the articular cartilage layer， accompanied by a large amount of inflammatory cell infiltration； the degree of joint swelling， the number of autophagic vacuoles and apoptosis rate of chondrocytes， serum levels of MMP-13 and IL-1β， and the phosphorylation of mTOR protein in cartilage tissue of knee joint were all increased significantly （P＜0.05）， while the phosphorylation of AMPK and ULK1 protein were all decreased significantly in cartilage tissue of knee joint （P＜0.05）. Compared with the model group， L- GLA， M-GLA， H-GLA groups showed significant improvement in joint cartilage injury and reduced infiltration of inflammatory cells in rats. The above quantitative indicators were significantly reversed in a dose-dependent manner，except the number of autophagic vacuoles increased significantly （P＜0.05）. Compared with the H-GLA group， the GLA+ Compound C group showed aggravated cartilage tissue of joint cartilage injury and inflammatory cell infiltration in rats， and the above quantitative indicators were reversed significantly （P＜0.05）. CONCLUSIONS GLA can promote autophagy and inhibit apoptosis of chondrocytes in KOA rats， the mechanism of which may be associated with activating AMPK/mTOR/ULK1 signaling pathway.

OBJECTIVE: To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. METHODS: Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. RESULTS: All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. CONCLUSION The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.
Humans ; Male ; Adult ; Female ; Perforator Flap ; Upper Extremity ; Fingers/surgery* ; Ulnar Artery ; Skin Transplantation

This is a report of a complex defects in the right upper extremity treated in the Department of Hand and Microsurgery, 521 Hospital of Norinco Group, in October 2016. The patient received multi-transfers of flaps for one-stage reconstruction, including a double-paddled ALTPF and a compound flap of the great toe and the second toe. Vascular compromises occurred in flaps on the 2nd day after surgery. All the flaps were rescued and survived completely after surgical exploration. Followed-up at 3 year after surgery showed that the appearance and function of the affected limb recovered well. The flexion and extension of elbow and wrist were normal. The pinch function of the reconstructed thumb and index finger recovered well.

【Objective】 To systematically evaluate the correlation between pretransfusion prophylactic medication and the incidence of adverse reactions to blood transfusion(ARBT) by Meta analysis. 【Methods】 The relevant literature concerning the effect of pretransfusion prophylactic medication on the incidence of ARBT was searched via Pubmed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP databases, with the date duration from database creation to May 9, 2021. The literature was independently screened by two researchers according to the inclusion and exclusion criteria, relevant data information was extracted, quality evaluation was performed, and Meta analysis was performed using RevMan 5.3 software. 【Results】 A total of 36 publications were finally included, involving 137 996 transfusion recipients, of which 62 581 were administered medication before transfusion while 75 415 not. And1742 patients experienced ARBT. Meta analysis results showed that the incidence of ARBT in the pre-transfusion medication group was not statistically different from that in the non-medication group {[RR=0. 88, 95% CI(0.76, 1.01), P>0.05]}, the incidence of febrile reactions was lower in the pre-transfusion group than in the control {[RR=0. 72, 95% CI(0.61, 0.86), P<0.05]}, and the incidence of allergic reactions and hemolytic reactions were not statistically different between the two groups, i. e. [RR=0. 94, 95% CI(0.577, 1.16), P>0.05] vs [RR=0. 24, 95% CI(0.03, 2.13), P>0.05]. Pre-transfusion use of dexamethasone, isoproterenol, and niclosamide had no preventive effect on ARBT, i. e. [RR=0. 91, 95% CI(0.79, 1.04), P>0.05] vs [RR=0. 83, 95% CI(0.68, 1.01), P>0.05] vs [RR=1.21, 95% CI(0.69, 2.10), P>0.05]. 【Conclusion】 The incidence of ARBT in the pre-transfusion prophylaxis group was not significantly different from that in the control without considering the patient's history of transfusion, history of ARBT, and use of leukocyte-deleted blood products. The incidence of febrile reactions in the pre-transfusion medication group was lower than that in the control, and further studies in larger randomized controlled trials of higher quality still need to be established due to the suboptimal quality of the included literature and study size. Strictly grasping the indications for blood transfusion, strengthening the monitoring and awareness of ARBT, and using life-saving drugs rationally remain the key clinical concerns.

Objective:To compare the impact of remimazolam and propofol on the quality of postoperative recovery in aged patients with goal-directed hemodynamic management strategies.Methods:Ninety patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic gastrointestinal tumor surgery, were divided into 2 groups ( n=45 each) using a random number table method: remimazolam group (group R) and propofol group (group P). Anesthesia was induced as follows: remimazolam 6 mg·kg -1·h -1 was intravenously infused in group R, and propofol 2 mg/kg was intravenously injected in group P. Anesthesia was maintained as follows: remimazolam 0.5-1.0 mg·kg -1·h -1 was intravenously infused in group R, propofol 4-12 mg·kg -1·h -1 was intravenously infused in group P, and BIS values were maintained at 40-60 during operation.Both groups adopted a goal-directed hemodynamic management strategy during operation, and the volume infused and vasoactive drugs were adjusted according to stroke volume variation of 4%-12% and cardiac index of 2.5-4.0 L ·min -1·m -2.The 40-item Quality-of-Recovery scale (QoR-40) was used to assess the quality of postoperative recovery.QoR-40 score was performed 1 day before surgery, 3 days after surgery and 30 days after surgery.The intraoperative consumption of vasoactive drugs and occurrence of intraoperative hypotension and bradycardia were recorded, and the concentration of lactic acid was measured before operation, after operation and 24 h after operation in the two groups.The recovery time of consciousness, tracheal extubation time, duration of postanesthesia care unit stay and postoperative length of hospital stay were recorded.The occurrence of postoperative complications was also recorded. Results:Compared with P group, the incidence of intraoperative hypotension and bradycardia was significantly decreased, the consumption of dopamine and norepinephrine was reduced, the concentration of lactic acid was decreased, QoR-40 scores were increased at 3 and 30 days after operation, the postoperative length of hospital stay was shortened, and the incidence of postoperative complications was decreased in group R ( P<0.05). Conclusion:Remimazolam provides better efficacy than propofol in improving the quality of postoperative recovery in elderly patients with goal-directed hemodynamic management strategy.

Objective To investigate the effects of leptin on Treg cells and the possible mecha-nism. Methods Leptin-deficient ( ob/ob) mice and homologous wild-type mice were used in this study. The percentages of Treg cells in spleen tissues and peripheral blood samples were measured by flow cytometry ( FCM) . Differences in Treg cell functionality were compared between the two groups. Splenic CD4+T cells, separated from the ob/ob mice and the wild-type mice by magnetic beads, were respectively cultured with leptin and anti-leptin neutralization antibody to evaluate the effects of leptin on Treg cells. Quantitative real-time PCR was performed to analyze the expression of Treg cell-related cytokines at transcriptional level. The levels of IL-10 and TGF-β in the supernatants of CD4+T cell culture were measured with Luminex technolo-gy. Results Compared with the wild-type mice, the ob/ob mice showed higher percentages of Treg cells in both peripheral blood samples and spleen tissues [(11. 56 ± 0. 72)％ vs (5. 47 ± 0. 81)％, (10. 16 ± 0.93)％ vs (6.29±0. 69)％]. Treg cells isolated from the ob/ob mice had stronger immunosuppressive effects on the proliferation of effector T ( Teff) cells and the secretion of TNF-α and IFN-γ than those from the wild-type mice [TNF-α:(1. 6±0. 2)％ vs (2. 4±0. 5)％, IFN-γ:(4. 3±0. 3)％ vs (7. 2±1. 2)％]. The percentages of Treg cells were decreased from (12. 2±1. 8)％ to (7. 6±0. 9)％ upon the in vitro treat-ment of CD4+ T cells from the ob/ob mice with leptin and the immunosuppressive effects of Treg cells were also weakened. However, the percentages of Treg cells were increased from (7. 8±0. 85)％ to (13. 1± 1. 5)％ upon the in vitro treatment of CD4+T cells from the wild-type mice with anti-leptin antibody and the immunosuppressive effects of Treg cells were improved as well. Moreover, the expression of Foxp3, IL-10 and TGF-β at transcriptional level and the levels of IL-10 and TGF-β in the ob/ob group were higher than those in the wild-type group. Conclusions Leptin deficiency significantly promoted the generation of Treg cells in mice and resulted in an increased expression of Foxp3, IL-10 and TGF-βat mRNA level and elevat-ed levels of IL-10 and TGF-β. The treatment of CD4+T cells with leptin might inhibit the generation of Treg cells through down-regulating the transcription of Foxp3, IL-10 and TGF-β.

OBJECTIVETo analyze the core acupoints and compatibility of electroacupuncture (EA) for simple obesity based on complex network technique, and to explore the usage of EA waveform.

METHODSThe clinical research literature regarding EA for simple obesity published from January of 1980 to June of 2016 were searched in PubMed, CNKI, , VIP, CBM and TCM online database to establish a prescription database of EA for simple obesity. The Matlab2014a software was used to perform the center analysis and cluster analysis, and the analysis of core points and compatibility were conducted. Gephi 9.1 software was used to demonstrate the complex network diagram to further analyze the usage of EA waveform.

RESULTSTotally 238 prescriptions were obtained. The selection of acupoints at -meridians were equally important with acupoints at -meridians. The meridians with highest core degree were stomach meridian, conception vessel and spleen meridian. The acupoints with highest core degree were Sanyinjiao (SP 6), Tianshu (ST 25) and Zusanli (ST 36). The cluster analysis indicated three acupoint clusters, including the key-acupoint cluster, syndrome-acupoint cluster, and -point cluster; it was revealed Tianshu (ST 25) and Zhongwan (CV 12) had the highest intensity of compatibility. The sparse-dense wave was mostly used in EA for simple obesity, followed by continuous wave, indicating both sparse-dense wave and continuous wave had high clinical application value.

CONCLUSIONThe acupoints of EA for simple obesity are mainly in stomach meridian, conception vessel and spleen meridian; sparse-dense wave is mostly used, followed by continuous wave.

Objective To evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobecto-my by comparing with paravertebral nerve block. Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20- 27 kg∕m2 , of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups (n= 45 each) using a random number table: ultrasound-guided paravertebral nerve block ( group P) and ultra-sound-guided ESP block group (group E). Morphine 0. 1 mg∕kg and parecoxib sodium 40 mg were intrave-nously injected at 30 min before surgery. Ultrasound-guided ESP and paravertebral nerve blocks were per-formed with 0. 5％ ropivacaine 20 ml after anesthesia induction in E and P groups, respectively. Both groups received patient-controlled intravenous analgesia with 0. 1％ morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion. Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded. The operation time of nerve block and development of pleu-ral puncture and vascular injury during operation were also recorded. The cumulative consumption of mor-phine was recorded at 2, 4, 6, 24 and 48 h after surgery. The development of postoperative nausea and vomiting and respiratory depression was recorded. Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3. Results The operation time of nerve block was significantly shorter in group E than in group P (P<0. 05). There was no significant difference in the total consumption of intraoperative remifentanil, cumulative consumption of morphine, incidence of nausea and vomiting or requirement for rescue analgesia between two groups (P>0. 05). Pleural puncture, vascu-lar injury, pruritus or respiratory depression was not found in two groups. Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients un-dergoing video-assisted thoracoscopic pulmonary lobectomy.

Objective To evaluate the role of C-X-C chemokine receptor type 4 ( CXCR4) in the dorsal root ganglia ( DRG) in incisional pain in rats. Methods Thirty-two male Sprague-Dawley rats, aged 7-10 weeks, weighing 250-300 g, in which intrathecal catheters were successfully implanted, were divided into 4 groups (n＝8 each) using a random number table method: sham operation group (group S), CXCR4 antagonist AMD3100 plus sham operation group (group A+S), incisional pain group (group I) and CXCR4 antagonist AMD3100 plus incisional pain group (group A+I). Rats were anesthetized with sevoflu-rane. AMD3100 20 μg (in 10 μl of normal saline) was intrathecally injected, and no incision was made 30 min later in group A+S. A 1-cm longitudinal incision was made through skin, fascia and muscle of the plantar aspect of the left hindpaw in group I. AMD3100 20 μg (in 10 μl of normal saline) was intrathecally injected, and 30 min later the model of incisional pain was established in group A+I. The mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal latency ( TWL) were measured at 24 h before surgery and 2, 4, 8, 16 and 24 h after surgery. The rats were sacrificed after the last measurement of pain threshold and the DRGs of the lumbar segment (L4-6) were removed for detecting the expression of CXCR4, phosphorylated extracellular regulated protein kinase ( p-ERK) and total ERK ( t-ERK) by Western blot. Results Compared with group S, MWT was significantly decreased and TWL was shortened at T1-5in group I and group A+I, and the expression of CXCR4 and p-ERK in DRGs was significantly up-regulated (P＜0. 05), and no significant change was found in the expression of t-ERK in group I, no significant change was found in the expression of CXCR4, p-ERK and t-ERK in group A+I, and no significant change was found in the parameters mentioned above in group A+S (P＞0. 05). Compared with group I, MWT was significantly increased and TWL was prolonged at T1-5, the expression of CXCR4 and p-ERK in DRGs was down-regulated (P＜0. 05), and no significant change was found in the expression of t-ERK in group A+I (P＞0. 05). Conclusion CXCR4 in DRGs is involved in incisional pain, and the mechanism may be re-lated to activating ERK1∕2 signaling pathway in rats.

Objective To investigate the effect of downregulated activating transcription factor 3 ( ATF3) expression on proliferation of adrenocortical carcinoma cells and its mechanisms. Methods Immunohistochemistry and Western blotting were used to detect the expression of ATF3 in human adrenocortical tumor tissues and cells. Adrenocortical carcinoma cells, Sw-13, and NCI-H259R cells, were transfected with siATF3 using lipidosome 2000, and expression of ATF3 mRNA was determined using RT-PCR; expression of ATF3, cleaved caspase 3, caspase 3, cleaved PARP, and PARP proteins were detected using Western blotting; cell growth inhibition rate and apoptosis rate were monitored using MTT and AnnexinV-FITC/PI, respectively. Sw-13 and NCI-H259R cells were treated with NVP-BEZ235, Perifosine, BKM120, IWP-2, PP2, KN93, Everolimus respectively followed by detected expression of ATF3 mRNA by realtime PCR. The effect of ATF3 on cell proliferation after inhibition of related signaling pathways were detected by MTT. Results The ATF3 in human adrenocortical gland tumor tissues and cells showed high expression. The levels of ATF3 mRNA and protein in Sw-13 and NCI-F259R cells transfected with siATF3 were significantly reduced. Compared with the negative control group ( NC siRNA), siATF3 transfection significantly inhibited the proliferation of Sw-13 and NCI-F259R cells ( P＜0. 05 ), and increased the apoptosis rate ( P＜0.05). Western blotting shown that the levels of cleaved caspase 3 and cleaved PARP protein in siATF3 transfected cells increased significantly; and realtime PCR results indicated that the expression of ATF3 mRNA was dramatically inhibited by PP2, KN93, and IWP-2 in NCI-F259R cells compared with control group ( DMSO ); but ATF3 significantly promoted the proliferation activity of NCI-F259R cells which treated by PP2, KN93, and IWP-2 signaling inhibitors. Conclusion High expression of ATF3 is existed in adrenocortical carcinoma cells. Downregulated ATF3 expression may inhibit cell proliferation and activate apoptosis pathway, resulting in apoptosis in Sw-13 and NCI-F259R cells, this mechanism of action is related to activating Wnt/β-catenin, CaMKI, and SRC pathway.