Objective To evaluate the effect of ultrasound-guided selective brachial plexus block on postoperative muscle strength in the block area of patients after wrist surgery.Methods Sixty patients who underwent wrist surgery,33 males and 27 females,aged 18-64 years,BMI 21-28 kg/m2,ASA physi-cal status Ⅰ or Ⅱ,were randomly divided into two groups by random number table method:ultrasound guided selective brachial plexus block in the middle of the forearm group(group A)and ultrasound guided axillary brachial plexus block group(group B),30 patients in each group.In group A,the ulnar nerve,and/or median nerve,and/or radial nerve were selectively blocked in the middle of the forearm according to the location of the surgical incision,and 0.4％ropivacaine was injected into each nerve with 5 ml.Patients in group B received conventional axillary brachial plexus block under ultrasound guidance and injected 30 ml of 0.4％ropivacaine.In the both two groups,dexmedetomidine 0.8 μg/kg was injected for 10 minutes be-fore nerve block,and was changed to 0.4 μg·kg-1·h-1 until the end of operation,and then patients were transferred to the recovery room for observation 30 minutes and then returned to the ward.Muscle strength 2,4,8,12,24,48 hours after operation and recovery time to grade 5 were recorded.VAS pain scores at rest and exercise 2,4,8,12,24,and 48 hours after surgery and tourniquet tolerance scores were recorded.Satisfaction score,nerve block operation time,anesthesia onset time,duration of analgesia,number of addi-tional postoperative analgesics,occurrence of postoperative remedial analgesia,and length of hospital stay were recorded.Complications such as hematoma,nerve injury and infection were recorded.Results Com-pared with group B,the muscle strength score of patients in group A 2,4,8 and 12 hours after surgery was significantly higher(P＜0.05),the time of muscle strength recovery to level 5 in group A was significantly shorter(P＜0.05).Compared with group B,the satisfaction score in group A was better(P＜0.05),the duration of nerve block operation and hospitalization in group A was shorter(P＜0.05),the intraoperative tourniquet tolerance score of in group A was worse(P＜0.05),and both groups were tolerated.There were no significant differences in VAS pain scores at rest and exercise,the onset time of anesthesia,duration of analgesia,number of postoperative analgesia remedies between the two groups.There were no complications such as hematoma,nerve injury and infection in the two groups.Conclusion Ultrasound-guided selective brachial plexus block has little effect on the motor function of upper arm and forearm,and muscle strength recovers quickly after operation,can be safely and effectively adopted in short wrist surgery.

Objective To systematically evaluate the efficacy and safety of mesenchymal stem cells(MSC)in the treatment of acute-on-chronic liver failure(ACLF).Methods This study was conducted according to PRISMA guidelines,with the PROSPERO registration number of CRD42024517851.PubMed,Embase,Wanfang Data,VIP,CNKI,CBM,and the Cochrane Library were searched for randomized controlled trials(RCT)and cohort studies on MSC in the treatment of ACLF published up to November 1,2023,and the articles were screened according to inclusion and exclusion criteria.After data extraction and quality assessment,RevMan 5.3 software was used to perform the Meta-analysis.Results A total of 11 articles involving 803 subjects were included in this meta-analysis.The results showed that for the patients with ACLF,MSC could improve 8-week survival rate(odds ratio[OR]=2.71,95%confidence interval[CI]:1.58-4.67,P=0.000 3),12-week survival rate(OR=2.24,95%CI:1.36-3.69,P=0.001),24-week survival rate(OR=2.09,95%CI:1.37-3.17,P=0.000 6),and 48-week survival rate(OR=2.09,95%CI:1.29-3.40,P=0.003)and reduce 12-week Model for End-Stage Liver Disease(MELD)score(mean difference[MD]=-3.27,95%CI:-6.07 to-0.48,P=0.02)and 24-week MELD score(MD=-2.24,95%CI:-3.16 to-1.33,P<0.000 01);it could also reduce the level of total bilirubin after 4 weeks of treatment(MD=-36.86,95%CI:-48.72 to-25.01,P<0.000 01)and increase 4-week albumin level(MD=2.11,95%CI:0.62-3.61,P=0.006)and 24-week albumin level(MD=3.54,95%CI:2.06-5.02,P<0.000 01).Adverse events were evaluated in 6 studies,with no serious adverse events.Conclusion MSC have a good safety in treatment and can improve the survival rate of patients and enhance liver function to some extent,and therefore,it holds promise for clinical application.

Objective:To investigate the influence of curative-intent resection with textbook outcomes of liver surgery (TOLS) on long-term prognosis of gallbladder carcinoma (GBC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, who were admitted to 15 medical centers from January 2014 to January 2021, were collected. There were 285 males and 539 females, aged (62±11)years. According to the evalua-tion criteria of TOLS, patients were divided into those who achieved TOLS and those who did not achieve TOLS. Measurement data with normal distribution were represented as Mean± SD, and com-parison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data were conduc-ted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-rank test was used for survival analysis. The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses. Results:(1) Achievement of TOLS. Of the 824 patients undergoing curative-intent resection for GBC, there were 510 cases achieving TOLS and 314 cases not achieving TOLS. (2) Follow-up. Of the 824 patients undergoing curative-intent resection for GBC, after excluding 112 deaths within 90 days after discharge, 712 cases were included for the survival analysis. The median follow-up time, median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months, 47.6(30.6,64.6)months and 47.5%. The median follow-up time, median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months, 24.3(20.0,28.6)months and 21.0%. There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS ( χ2=58.491, P<0.05). (3) Analysis of factors influencing prognosis of patients. Results of multivariate analysis showed that TOLS, carcinoembryonic antigen (CEA), CA19-9, poorly differentiation of tumor, T2 stage of eighth edition of American Joint Committee on Cancer (AJCC) staging, T3 and T4 stage of eighth edition of AJCC staging, N1 stage of the eighth edition of AJCC staging, N2 stage of the eighth edition of AJCC staging, adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC ( hazard ratio=0.452, 1.479, 1.373, 1.612, 1.455, 1.481, 1.835, 1.978, 0.538, 95% c onfidence interval as 0.352-0.581, 1.141-1.964, 1.052-1.791, 1.259-2.063, 1.102-1.920, 1.022-2.147, 1.380-2.441, 1.342-2.915, 0.382-0.758, P<0.05). Conclusion:Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.

Esketamine,which was recently intro-duced in China,is a type of intravenous general an-esthetic that is widely used in clinical practice for general anesthesia and anti-depression therapy.Studies have found that esketamine can be safely used to intrathecally produce analgesic,sedative,and anti-depressive effects at subanesthetic doses.This review summarizes the mechanism of action,safety,adverse reactions,and various clinical appli-cations of esketamine intrathecally,so as to pro-vide relevant references for further research.

Objective:To investigate the role of miRNA-4298/PADI4/p53 signal axis in mediating 4f-induced apoptosis of leukemia cells.Methods:The cell growth density was observed under inverted microscope and the proliferation of leukemia cells was detected by CCK-8 counting assay. The expression of PADI4 and P53 at mRNA level was detected by qRT-PCR. Cell cycle and apoptosis were measured with flow cytometry. The expression of PADI4, P53, Bcl-2, Bax, caspase-3 and caspase-9 at protein level was detected by Western blot. Differential miRNA and mRNA expression profiles was detected by next generation sequencing. Databases such as TargetScan were used to predict the potential upstream and downstream genes of PADI4. A luciferase reporter assay was used to detect the 3′UTR of PADI4 targeted by miRNA-4298. Cell transfection assay was used to detect the effect siRNA, PADI4 vector, miRNA mimics and miRNA inhibitor in interference and rescue.Results:Nuclear factor erythroid 2-related factor 2 (Nrf2) inhibitor 4f could inhibit the proliferation of THP-1, K562 and U937 cells, and induce the apoptosis of these leukemia cells. It downregulated the expression of PADI4 mainly through the binding activity of miRNA-4298 to miRNA sponges, which resulted in the proliferation inhibition and apoptosis of leukemia cells. The inhibited proliferation and apoptosis of leukemia cells by 4f were associated with the increase of P53 expression after the decrease of PADI4 expression. The PADI4-dependent upregulation of P53 led to the ratio inversion of downstream Bcl-2/Bax, which activated caspase-3 or caspase-9 to induce the apoptosis of leukemia cells.Conclusions:The apoptosis of leukemia cells induced by Nrf2 inhibitor 4f was mainly associated with the miRNA-4298/PADI4/p53 axis, suggesting that it might be a novel signaling pathway for targeted therapy.

Objective : To investigate the imunomodulatory effects of umbilical cord mesenchymal stem cells(UC⁃MSCs) modified by miR⁃125b⁃5p through JAK2/STAT3 pathway on systemic lupus erythematosus(SLE) . Methods: UC⁃MSCs were isolated and cultured under aseptic conditions ; Peripheral blood mononuclear cells ( PBMCs)were separated from SLE patients by density gradient centrifugation. The relative expressions of IL⁃17A , Foxp3 ,IFN⁃γ , IL⁃4 genes in PBMCs cultured with UC⁃MSCs for 48 h were detected by RT⁃qPCR; The relative expressions of JAK2 , p ⁃JAK2 , STAT3 , p ⁃STAT3 and IL⁃18 proteins in kidney tissues of MRL/lpr mice were detected by west⁃ern blot. Results : Compared with the PBMCs culture group , the expression of IFN⁃γ and IL⁃17A and the propor⁃tion of Th17/Treg cells were significantly down⁃regulated in UC⁃MSCs + miR⁃125b⁃5p group , UC⁃MSCs + miR⁃NC group and UC⁃MSCs group(P < 0. 01) , the expression of the proportion of Th1/Th2 cells (P < 0. 05) was down⁃regulated in UC⁃MSCs + miR⁃125b⁃5p group and UC⁃MSCs + miR⁃NC group ; Compared with the untreated group of MRL/lpr mice , the relative expressions of JAK2 , p ⁃JAK2 , STAT3 , p ⁃STAT3 and IL⁃18 proteins in kidney tissues of MRL/lpr mice were significantly down⁃regulated in UC⁃MSCs + miR⁃125b⁃5p group (P < 0. 01) , and the rela⁃tive expressions of IL⁃18 proteins was significantly down⁃regulated in UC⁃MSCs + miR⁃NC group and UC⁃MSCs group (P < 0. 01) . Conclusion miR⁃125b⁃5p plays a synergistic role in UC⁃MSCs ,which regulates the differenti⁃ation of Th2 cells in PBMCs of SLE patients and the relative expressions of p ⁃JAK2/JAK2 , p ⁃STAT3/STAT3 , and IL⁃18 proteins in kidney tissues of MRL/lpr mice. UC⁃MSCs modified by miR⁃125b⁃5p may play immunomodulato⁃ry effect on SLE by JAK2/STAT3 signaling pathway.

ObjectiveTo investigate the distribution of vascular cognitive impairment （VCI） with kidney Yang deficiency syndrome and explore the biological nature of VCI with kidney Yang deficiency syndrome from the perspective of DNA methylation under the combination of disease and syndrome， so as to provide an epigenetic target for traditional Chinese medicine （TCM） treatment of this disease with this syndrome in the future. MethodCommunity residents in Beijing were screened out for cognitive impairment from September 2020 to November 2022 through the scale， and VCI patients were analyzed for the syndrome. VCI patients with kidney Yang deficiency syndrome and healthy people were enrolled in this study. Peripheral venous blood was collected and subjected to genome-wide DNA methylation detection by Illumina Human Methylation 850K BeadChip. Then， differentially methylated genes （DMGs） were screened out for bioinformatics analysis. ResultA total of 1 902 people were investigated in this study， and 201 of them had VCI， accounting for 10.57%， including 72.14% with kidney Yang deficiency syndrome. The methylation results showed that compared with the normal group， the VCI group had 386 differential methylation sites， and 136 DMGs were annotated. The Kyoto Encyclopedia of Gene and Genomes（KEGG） signaling pathway enrichment analysis showed that the DMGs between the two groups were mainly involved in mammalian target of rapamycin（mTOR） signaling pathway， Estrogen signaling pathway， cyclic adenosine monophosphate（cAMP） signaling pathway， etc. Protein-protein interaction （PPI） analysis showed that DMGs， such as epidermal growth factor receptor（EGFR）， epidermal growth factor （EGF）， and signal transducer and activator of transcription 3（STAT3）， played important roles in the network. ConclusionKidney Yang deficiency is the main syndrome in VCI patients. DMGs including EGFR， EGF， and STAT3 and the related pathways such as mTOR signaling pathway， Estrogen signaling pathway， and cAMP signaling pathway may play a vital role in the occurrence and development of VCI with kidney Yang deficiency syndrome.

OBJECTIVE: To summarize the regulatory effect of non-coding RNA (ncRNA) on type H vessels angiogenesis of bone. METHODS: Recent domestic and foreign related literature about the regulation of ncRNA in type H vessels angiogenesis was widely reviewed and summarized. RESULTS: Type H vessels is a special subtype of bone vessels with the ability to couple bone formation. At present, the research on ncRNA regulating type H vessels angiogenesis in bone diseases mainly focuses on microRNA, long ncRNA, and small interfering RNA, which can affect the expressions of hypoxia inducible factor 1α, platelet derived growth factor BB, slit guidance ligand 3, and other factors through their own unique ways of action, thus regulating type H vessels angiogenesis and participating in the occurrence and development of bone diseases. CONCLUSION At present, the mechanism of ncRNA regulating bone type H vessels angiogenesis has been preliminarily explored. With the deepening of research, ncRNA is expected to be a new target for the diagnosis and treatment of vascular related bone diseases.
Humans ; RNA, Untranslated/genetics* ; RNA, Long Noncoding ; Bone Diseases/genetics* ; MicroRNAs/genetics* ; RNA, Small Interfering

Purpose: To evaluate the incidence and identify the risk factors for radiotherapy-induced oral mucositis among patients with nasopharyngeal carcinoma. Methods: A meta-analysis was conducted. Eight electronic databases (Medline, Embase, Cochrane Library, CINAHL Plus with Full Text, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journals Database) were systematically searched from inception to 4 March 2023 for relevant studies. Study selection and data extraction were conducted by two independent authors. The Newcastle‒Ottawa scale was used for quality assessment among the included studies. Data synthesis and analyses were performed in R software package version 4.1.3 and Review Manager Software 5.4. The pooled incidence was calculated using proportions with 95% confidence intervals (CIs), and the risk factors were evaluated using the odds ratio (OR) with 95% CIs. Sensitivity analysis and predesigned subgroup analyses were also conducted. Results: A total of 22 studies published from 2005 to 2023 were included. The results of the meta-analysis showed that the incidence of radiotherapy-induced oral mucositis was 99.0% among nasopharyngeal carcinoma patients, and the incidence of severe radiotherapy-induced oral mucositis was 52.0%. Poor oral hygiene, overweight before radiotherapy, oral pH < 7.0, the use of oral mucosal protective agents, smoking, drinking, combined chemotherapy, and the use of antibiotics at early treatment stage are risk factors for severe radiotherapy-induced oral mucositis. Sensitivity analysis and subgroup analyses also revealed that our results are stable and reliable. Conclusions Almost all patients with nasopharyngeal carcinoma have suffered from radiotherapy-induced oral mucositis, and more than half of patients have experienced severe oral mucositis. Facilitating oral health might be the key focus of reducing the incidence and severity of radiotherapy-induced oral mucositis among nasopharyngeal carcinoma patients.Registration numberCRD42022322035.

Objective:To systematically review the risk prediction models for hypoglycemia in diabetic patients.Methods:The literatures published up to March 25, 2022 was retrieved from PubMed, Embase, Web of Science, Cochrane Library, CINAHL, MEDLINE, China National Knowledge Infrastructure, Wanfang, VIP and SinoMed. Two researchers independently screened the literatures, extracted information, and applied the PROBAST tool to evaluate the quality of the included models.Results:A total of 11 literatures and 13 models were included. The area under the receiver operating characteristic curve or C statistic of all models was 0.666-0.890, with a high risk of bias and a low risk of applicability, and the most included predictors were chronic kidney disease and age. The main reason for the bias in the model were insufficient number of events in the dependent variable, improper handling of continuous variables, and screening of predictors by single factor analysis. Conclusions:The existing hypoglycemia risk prediction models for diabetic patients are still in the development stage, and medical and nursing staff can choose the existing hypoglycemia models according to the results of this systematic review and clinical practice. In the future, we should improve the existing models based on tools or carry out large-sample, multi-center, prospective cohort studies, and build a high-quality hypoglycemia risk prediction model for diabetic patients that is more suitable for China based on more comprehensive and accurate statistical methods and clinical data.