Objective:To observe the projections from tyrosine hydroxylase(TH)positive neurons in locus coerule-us(LC)to tachykinin-1(TAC1)neurons in paraventricular nucleus of the thalamus(PVT),and morphologically determine whether they are involved in transmission and modulation of nociceptive information.Methods:TAC1-ires-Cre mice were hybridized with Rosa26:CAG-LSL-tdTomato(Ai9)mice.And spared nerve injury(SNI)induced neu-ropathic pain model was established with TAC1-ires-Cre::Ai9 mice to observe the colocalization of TAC1 and Fos and the close appositions between TAC1/FOS double-labeled neurons and TH positive axonal terminals.The distribution of the TH positive neurons and FG retrogradely labeled neurons were observed in the LC after Fluorogold(FG)was injec-ted into the PVT.Finally,the coexistences of TH positive neurons and RV labeled neurons in the LC were observed after injection of RV-mediated retrograde tracing system.Results:TAC1 positive neurons were shown with red fluores-cence in TAC1-ires-Cre::Ai9 mice.TAC1/FOS double-labeled neurons were found in the PVT of the SNI model.Some TAC1/FOS double labeled neurons made close appositions with TH positive axonal terminals.FG retrogradely labeled neurons were observed in the LC after FG injected into the PVT,and some of the FG labeled neurons coexisted with TH positive neurons.Using RV retrograde transsynaptic tracing virus,the results showed that presynaptic neurons of TAC1 positive neurons in the PVT were found in the LC,and most of the presynaptic neurons were TH positive neu-rons.Conclusion:TH positive neurons in the LC project to TAC1 positive neurons of the PVT,forming LCTH+-PVTTAC1+neural circuit,which were activated by nociceptive information.It demonstrates that this pathway plays a role in pain transmission or regulation.

Fracture is a disease caused by violence or bone disease in which the continuity of bone structure is completely or partially broken. The healing of fracture mainly includes three processes: hematoma mechanization stage, callus formation stage and callus remodeling stage. At different stages, various cells and molecules are important factors regulating fracture healing. There is growing evidence that miRNA plays an important role in various bone diseases, such as osteosarcoma, osteoarthritis, osteonecrosis, and fractures. Recent studies have shown that miRNA can regulate the process of fracture healing and may be potential biomarkers of fracture healing. This article reviews the expression, function and mechanism of miRNA in the process of fracture healing.

TCM treatment for slow transit constipation(STC)has the advantages of good efficacy,multiple levels,rich targets,multi-channel and two-way regulation.As relevant experimental research gradually deepens,it is known that SCF/C-kit and its cascading signaling pathways of PI3K/AKT,PLC-γ,MAPKs and other key pathways are involved.To further clarify the underlying mechanisms,this article reviewed current experimental research status of TCM intervention on SCF/C-kit and its cascading signaling pathways in STC rats and mice in recent years.It can be concluded that its mechanism may be to restore the normal structure and function of the colon mucosa,regulate the content and gene expression of signaling pathway related proteins,maintain the number and function of intestinal cells of Cajal,regulate the content of intestinal neurotransmitters and aquaporin,and reduce the release of inflammatory factors.It explored the specific targets and mechanisms of TCM intervention in SCF/C-kit and its cascading pathways in STC rats and mice,in order to provide reference for further in-depth research.

Objective:To compare the efficacy of internal fixation using cannulated screw combined with fibular allograft and internal fixation using cannulated screw alone in the treatment of femoral neck fracture in young and middle-aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 75 young and middle-aged patients with femoral neck fracture admitted to the Third Hospital of Hebei Medical University from January 2020 to December 2022, including 44 males and 31 females, aged 34-56 years [(46.1±12.7)years]. According to Garden classification, 26 patients were classified as type II, 35 type III and 14 type IV. According to the Pauwels classification, 9 patients were classified as type I, 31 type II and 35 type III. Forty-nine patients were treated with internal fixation using three cannulated screws alone (cannulated screw group) and 26 with internal fixation using three cannulated screws combined with double-barrel fibular allograft (cannulated screw combined with bone grafting group). The operation time, intraoperative blood loss, length of hospital stay, and quality of fracture reduction were compared between the two groups. At 4, 8 months after operation and at the last follow-up, grading of femoral neck shortening, number of patients walking with crutches, Barthel index, and Harris hip function score were evaluated. The incidence of complications was measured at the last follow-up.Results:All the patients were followed up for 16-37 months [(23.2±4.5)months]. The operation time of the cannulated screw combined with bone grafting group was (86.3±16.1)minutes, longer than (76.9±20.8)minutes of the cannulated screw group ( P<0.05). The intraoperative blood loss was 100.0(50.0, 200.0)ml in the cannulated screw combined with bone grafting group, more than 50.0(50.0, 100.0)ml in the cannulated screw group ( P<0.01). There were no significant differences in the length of hospital stay or the quality of fracture reduction between the two groups ( P>0.05). At 4 months after operation, grading of the femoral neck shortening in the cannulated screw combined with bone grafting group [24 patients (92.3%) with grade 1, 2(7.7%) with grade 2, and 0(0.0%) with grade 3] was better than that in the cannulated screw group [18 patients (36.7%) with grade 1, 28(57.1%) with grade 2, and 3(6.2%) with grade 3] ( P<0.01). At 8 months after operation, grading of femoral neck shortening in the cannulated screw combined with bone grafting group [22 patients (84.6%) with grade 1, 3(11.5%) with grade 2, and 1(3.8%) with grade 3] was better than that in the cannulated screw group [13 patients (26.5%) with grade 1, 27(55.1%) with grade 2, and 9(18.4%) with grade 3] ( P<0.01). At the last follow-up, grading of femoral neck shortening in the cannulated screw combined with bone grafting group [19 patients (73.0%) with grade 1, 5(19.2%) with grade 2, and 2(7.6%) with grade 3] was better than that in the cannulated screw group [8 patients (16.3%) with grade 1, 31(63.2%) with grade 2, and 10(20.4%) with grade 3] ( P<0.01). At 4, 8 months after operation and at the last follow-up, 12(46.2%), 8(30.8%) and 5(19.2%) patients in the cannulated screw combined with bone grafting group and 38(77.6%), 27(55.1%) and 20(40.8%) patients in the cannulated screw group had to walk with crutches, respectively, showing significant difference between the two groups at the other two time points ( P<0.05 or 0.01) except for at the last follow-up ( P>0.05). The Barthel index values were 85.3±3.2, 90.3±4.3, and 95.3±3.9 in the cannulated screw combined with bone grafting group at 4, 8 months after operation and at the last follow-up, significantly higher than 80.8±7.3, 85.4±7.4, and 90.9±7.8 in the cannulated screw group ( P<0.05 or 0.01). The Harris hip scores were (87.0±2.9)points, (92.0±2.9)points and (91.3±2.4)points in the cannulated screw combined with bone grafting group at 4, 8 months after operation and at the last follow-up, significantly higher than (81.0±6.1)points, (85.7±5.8)points, and (89.6±2.0)points in the cannulated screw group ( P<0.01). At the last follow-up, the complication rate was 3.8%(1/26) in the cannulated screw combined with bone grafting group, significantly lower than 22.4%(11/49) in the cannulated screw group ( P<0.05). Conclusion:For femoral neck fractures in young and middle-aged patients, compared with internal fixation using cannulated screw alone, internal fixation using cannulated screw combined with fibular allograft has more advantages in correcting femoral neck shortening, restoring independent living activities and hip joint function, and reducing the incidence of complications despite its longer operation time and more intraoperative blood loss.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the correlation between red blood cell distribution width(RDW),systemic immune-inflammation index(SII)and major depressive disorder(MDD).Methods The clinical data of 176 MDD patients hospitalized in the clinical psychology department of our hospital from 2020 to 2022 and 209 non-MDD comparators who were routinely examined in Hebei General Hospital were retrospectively analyzed.Blood analysis was conducted to obtain values of RDW,SII,and red blood cell distribution width/platelet ratio(RPR).The data was used to plot the receiver operator characteristic(ROC)curve to determine the optimal threshold and the area under the curve(AUC)for RDW to discriminate between patients and controls.Result Patients in the MDD group had significantly higher RDW[median and quartiles:13.20(12.70,13.98)vs.12.80(12.40,13.35)],and SII levels[median and quartiles 510.87(350.95,878.12)vs.405.33(313.74,539.92)]compared with those in non-MDD group(P<0.05).There was no significant difference in RPR between the two groups(P>0.05).Multifactorial logistic regression analysis showed that RDW was positively correlated with MDD after adjusting for confounders(OR=3.086,95% CI:1.926-4.944).ROC curve showed that the optimal threshold for RDW to differentiate the risk of developing MDD was 12.85,with an AUC of 0.647(95% CI:0.592-0.702;P<0.001).Conclusion Present study shows that high RDW is a risk factor for the occurrence of MDD and an important parameter for the risk of developing depression.

Objectives:To evaluate the cost-effectiveness of typical pharmaceutical smoking cessation intervention strategies in China in the context of primary cancer prevention.Methods:Markov cohort simulation models were established to simulate the burden of 12 smoking caused cancer, including lung cancer, oral cancer, nasopharyngeal cancer, laryngeal cancer, esophageal cancer, gastric cancer, pancreatic cancer, liver cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukemia. Taking incremental cost effectiveness ratio (ICER) as the main indicator, the model sets one year as the cycling period for 50 periods and simulates the cohort of 10 000 thirty-five-year-old current smokers with various smoking cessation strategies. To ensure the robustness of conclusion, univariate sensitivity analysis, probability sensitivity analysis, and age-group sensitivity analysis were conducted.Results:The results showed that varenicline intervention was the most cost-effective intervention. Compared to the next most effective option, incremental cost of each additional quality-adjusted life year is 11 140.28 yuan, which is below the threshold of willingness to pay (1 year GDP per capita). The value of ICER increased as the increasing age group of adopting intervention, but neither exceeded the threshold of willingness to pay. One-way sensitivity analysis showed that the value of discount rate, the hazard ratio and cost of intervention strategy had a greater impact on the result of ICER.Conclusion:In China, the use of varenicline to quit smoking is highly cost effective in the context of cancer primary prevention, especially for younger smokers.

Carotid artery stenosis is an important cause of ischemic stroke, and its mechanism is mainly associated with the formation of atherosclerotic plaques. Head and neck radiotherapy may accelerate plaque formation, leading to carotid artery stenosis. In addition, radiotherapy can also cause the damage to the intima and adventitia of blood vessels, exacerbating the degree of carotid artery stenosis. This carotid artery stenosis caused by radiotherapy is different from atherosclerotic carotid artery stenosis in etiology, pathogenesis, prevention and treatment. Therefore, a thorough understanding of the pathogenic mechanism is crucial for selecting appropriate prevention and treatment methods.

Endothelial progenitor cells (EPCs) are immature endothelial cells that can proliferate and differentiate into mature endothelial cells. After vascular injury, EPCs migrate from the bone marrow to the ischemic area, participating in damaged endothelial repair and neovascularization, providing a new potential therapeutic approach for vascular diseases including ischemic stroke. This article reviews the feasibility and limitations of EPCs as potential therapeutic targets for ischemic stroke.

Objective:To investigate the relationship between white blood cells, neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR) and monocyte-lymphocyte ratio(MLR) with patients suffering from first episode depression.Methods:This retrospective study was conducted among inpatients of Hebei General Hospital from January 2021 to December 2021.Ultimately, 193 patients with first-episode depression were enrolled.According to the score of Hamilton depression scale-24 (HAMD-24), the patients were divided into mild-moderate depression group(20≤HAMD-24<35 score, n=98) and severe depression group (HAMD-24 score ≥35, n=95). White blood cells and the counts of each cell subtype were detected and the NLR, MLR and PLR were calculated.SPSS 25.0 statistical software was used to analyze the data.Mann-Whitney U test was used to compare differences in the two groups and Binary Logistic regression analyses were performed to recognize the predictive factors of the severity of first episode depression. Results:(1) The white blood cells and NLR in the severe depression group were significantly higher than those in the mild-moderate depression group (white blood cells: 5.77(2.05)×10 9/L vs 5.11(1.31)×10 9/L; NLR: 1.86 (1.04) vs 1.57(0.55), P<0.05). There were no significant differences in PLR and MLR between the two groups ( P>0.05). (2)Multiple regression analysis of NLR, white blood cells and HAMD-24 score showed that there were significant differences in the effect of different white blood cells and NLR levels on HAMD-24 score( B=1.398, P=0.003; B=2.624, P=0.001). (3)Binary Logistic regression revealed that white blood cell count and NLR were risk factors for the severity of depression patients( OR were 1.612 and 2.336, respectively, P<0.05). Conclusion:The results suggest that white blood cells and NLR may be relate with the severity of first episode depression.