BACKGROUND:Exercise is an effective method for preventing and treating osteoporosis,but it is unclear whether its effect on postmenopausal osteoporosis is related to changes in bone autophagy levels. OBJECTIVE:To observe the effects of exercise via cellular autophagy on the morphology and mechanical properties of bone tissue in ovariectomized rats,and to explore the mechanism of exercise on bone mass in ovariectomized rats from the perspective of autophagy. METHODS:A rat model of postmenopausal osteoporosis was established,and a 24-week moderate-intensity exercise was used for intervention.After the experiment,serum estradiol levels were measured by ELISA,and bone mineral density and bone microstructure of the cortical and trabecular bone were detected by micro-CT.The biomechanical indicators of the tibia were tested by a three-point bending test.Autophagosomes were observed by transmission electron microscopy.The expression of LC3 and ATG7 proteins was analyzed by western blot. RESULTS AND CONCLUSION:The serum estradiol level in the ovariectomized group was significantly lower than that of the sham-operation group and ovariectomized+exercise group(P＜0.01).The body mass of rats in each group increased,and the order was the ovariectomized group＞the ovariectomized+exercise group＞the sham-operation group＞the sham-operation+exercise group.The bone mineral density and bone mass of rats in all groups significantly increased(P＜0.01),but the increase in the ovariectomized group was significantly lower than that of the other groups,and the increase in the ovariectomized+exercise group was significantly higher than that of the ovariectomized group.Compared with the sham-operation group,the bone mineral density of the tibial cancellous bone in the sham-operation+exercise group was significantly increased(P＜0.01),while the bone mineral density in the ovariectomized and ovariectomized+exercise groups was significantly decreased(P＜0.01).Compared with the ovariectomized+exercise group,the ovariectomized group showed significantly lower bone volume fraction,number of trabeculae,and bone mineral density of cancellous bone(P＜0.05),extremely significantly lower trabecular thickness(P＜0.01),and significantly higher mean trabecular pattern factor,trabecular separation,and structural model index(P＜0.01).Compared with the ovariectomized group,the LC3-Ⅱ/LC3-I ratio and the relative expression of ATG7 protein significantly increased in the ovariectomized+exercise group(P＜0.05).Compared with the sham-operation and ovariectomized groups,the number of autophagosomes increased in the sham-operation+exercise and ovariectomized+exercise groups,respectively.To conclude,moderate-intensity treadmill exercise can improve the bone microstructure and biomechanical properties of the tibial cancellous bone and increase bone mass in ovariectomized rats by increasing serum estradiol levels and bone autophagy levels.

Objective To observe the effects of different frequencies of electroacupuncture on the degree of atrophy of quadriceps femoris in rabbits with anterior cruciate ligament(ACL)injury model;To explore the possible mechanisms of electroacupuncture in treating ACL injury.Methods Totally 24 New Zealand rabbits were randomly divided into blank group,model group,low-frequency electroacupuncture group and high-frequency electroacupuncture group,with 6 rabbits in each group.Except for the blank group,ACL injury models were established in the other groups.On the 7th day after modeling,the low-frequency electroacupuncture group and the high-frequency electroacupuncture group performed electroacupuncture treatment(continuous wave,frequency of 2 Hz and 100 Hz respectively,and left the needle in place for 20 min)at"Xuehai"and"Liangqiu"of the operation side,and the remaining groups were only grasped and immobilized,for 21 days.The mass ratio of the quadriceps femoris was calculated,the histopathological morphology of the quadriceps femoris tissue of the rabbits in each group was observed by HE staining,the expressions of NO,iNOS in quadriceps femoris tissue were detected by ELISA,the content of ROS in quadriceps femoris tissue was detected by fluorescent probe,the protein expressions of PERK,ATF6,IRE1,MuRF1,MAFbx in quadriceps femoris tissue were detected by Western blot.Results Compared with the blank group,the quadriceps femoris muscle mass ratio of the model group rabbits was significantly reduced(P<0.01),with irregular arrangement of muscle cells,accompanied by swelling and atrophy,significant interstitial edema,and extensive inflammatory infiltration,the contents of NO,iNOS and ROS in quadriceps femoris tissue significantly increased(P<0.01),while the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly increased(P<0.01).Compared with the model group,the quadriceps femoris muscle mass ratio in the low-frequency and high-frequency electroacupuncture groups significantly increased(P<0.01),with regular arrangement of muscle cells,improved swelling and atrophy of cells,and reduced interstitial edema and inflammation,the contents of NO,iNOS and ROS in quadriceps femoris tissue were significantly reduced(P<0.01),and the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly decreased(P<0.01).Moreover,the low-frequency electroacupuncture group had better effects than the high-frequency electroacupuncture group(P<0.05).Conclusion Different frequencies of electroacupuncture intervention in ACL injury rabbits can better delay the degree of quadriceps femoris atrophy,and its mechanism may be related to reducing the expressions of oxidative metabolites NO,iNOS,ROS,and reducing the expressions of endoplasmic reticulum stress-related proteins PERK,ATF6,IRE1 in quadriceps fermoris,which in turn inhibit the expressions of quadriceps atrophy factors MuRF1,MAFbx,and delaying the degradation of quadriceps muscle proteins.The effect of low-frequency electroacupuncture is superior to the high-frequency electroacupuncture.

Objective To analyze and summarize the acupoint selection law of acupuncture and moxibustion for the treatment of temporomandibular joint dysfunction syndrome(TMD)using data mining technology.Methods Clinical literature about acupuncture and moxibustion for the treatment of TMD was retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Embase and Cochrane Library from the establishment of the databases to March 1,2024.Excel 2021 was used to establish a prescription database of acupoints.SPSS Modeler 18.0 and SPSS Statistics 27.0 were used to analyze the frequency of use of acupoints,meridians,locations,specific acupoints,and the analysis of association rules,factor analysis,and clustering analysis.Results A total of 480 articles and 480 prescriptions were included in the study,containing 90 acupoints,with a total frequency of 2 290 times.The high-frequency acupoints were Xiaguan,Hegu,Jiache,Tinggong and Ashi point;the commonly used meridians were the stomach meridian,large intestine meridian,small intestine meridian,bile meridian,and triple-energizer meridian;the most frequently chosen acupoints were the Jiaohui acupoints,Yuan acupoints and Wushu acupoints;and mostly involved acupoints were located at the head and neck area,the upper limb area and the lower limb area.The association analysis showed that the top five combinations were"Xiaguan-Hegu","Xiaguan-Jiache","Xiaguan-Hegu-Jiache","Xiaguan-Tinggong","Xiaguan-Tinggong-Jiache";clustering analysis showed that five valid clusters were extracted;factor analysis extracted seven valid common factors.Conclusion The core acupoints of acupuncture and moxibustion for the treatment of TMD is Xiaguan-Hegu-Jiache-Tinggong,and mainly follows the principle of combining proximal and distal acupoints.

Objective To investigate the effects of aerosolized inhalation of different doses of pros-taglandin E1(PGE1)on pulmonary shunt and oxygenation during one-lung ventilation(OLV)when the fraction of inspiration O2 was 40％.Methods A total of 156 patients undergoing radical operation of esophageal cancer,121 males and 35 females,aged 18-64 years and BMI 18-30 kg/m2,ASA physical status Ⅱ or Ⅲ were included in the study.The patients were randomly assigned into 4 groups using a random number table:PGE1 0.1 μg/kg group(group L,n=39),PGE1 0.2 μg/kg group(group M,n=38),PGE 0.3 μg/kg group(group H,n=39),and a saline control group(group C,n=40).Patients re-ceived different therapy before OLV,namely inhaling either PGE1 0.1,0.2,0.3 μg/kg,and saline into right lung for a duration of 10 minutes.Venous blood and arterial blood were drawn from right internal jugu-lar vein catheter and radial artery catheter for blood gas analysis at pre-anesthesia(T0),pre-nebulization(T1),OLV 10 minutes(T2),OLV 15 minutes(T3),OLV 30 minutes(T4),OLV 60 minutes(T5),and OLV 120 minutes(T6).HR,MAP,PaO2,oxygenation index(OI),pulmonary shunt fraction(Qs/Qt),PaCO2,and peak airway pressure(Ppeak)were also recorded at above time points.Intraoperative hypox-emia,intraoperative hypotension,clinical pulmonary infection score(CPIS)on the second postoperative day and postoperative pulmonary complications(PPCs)within 7 days were recorded.Results Compared with group C,groups L,M,and H showed a lower incidence of hypoxemia(P＜0.05),group H demon-strated lower MAP at T2 and T3(P＜0.05),groups L,M,and H displayed lower Qs/Qt and higher PaO2 and OI at T2-T4(P＜0.05),group H had a lower CPIS on the second postoperative day(P＜0.05).Compared with group L,group H exhibited lower Qs/Qt at T2-T4,and higher PaO2 and OI at T3 and T4.There were no significant differences in the incidence of hypotension,HR,PaCO2,Ppeak,and the occur-rence of PPCs within 7 days among the four groups.Conclusion Nebulized inhalation of PGE,0.1,0.2 and 0.3 μg/kg under FiO2 40％before OLV can effectively reduce Qs/Qt,improve oxygenation and de-crease the incidence of hypoxemia.However,it has no significant impact on PPCs.PGE,0.3 μg/kg exhibits the best improvement in oxygenation and can also reduce CPIS on the second postoperative day,close monitoring of circulatory fluctuations is still required.

【Objective】 To compare the efficacy and safety of blue laser en bloc enucleation and traditional plasmakinetic electrocautery in the treatment of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A total of 50 NMIBC patients treated in our hospital during Oct.2018 and Dec.2019 were enrolled. A randomized, incomplete blinding, parallel control design and non-inferior test method was adopted. The control group (electrocautery group) used plasmakinetic electrocautery for transurethral resection, and the experimental group (blue laser group) used semiconductor blue laser for transurethral en bloc enucleation. The effective resection rate, operation time, postoperative catheter indwelling time, length of hospital stay, perioperative hemoglobin changes and obturator nerve reflex were compared. 【Results】 There were 24 patients in the blue laser group and 26 in the electrocautery group. The effective dissection rate and hemostasis rate in both groups reached 100%. The blue laser group had slightly longer operation time than the electrocautery group (55 min vs.42 min, P=0.009), but lesser hemoglobin decrease (5.7 g/L vs. 10.4 g/L, P=0.007). There were no significant differences in urinary catheter indwelling time, length of hospital stay and reoperation rate between the two groups. The electrocautery group had 3 cases of obturator nerve reflex, while the blue laser group had none. 【Conclusion】 Compared with the traditional electrocautery, blue laser has good vaporization cutting and coagulation hemostatic effects on bladder tumor tissue, and can completely enucleate tumors in a front-firing model with less bleeding and no obturator nerve reflex, which can be used as a new, efficient, safe and easy-to-learn method for NMIBC surgery. However, its effects on postoperative recurrence rate and progression rate still need further studies.

【Objective】 To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer (NMIBC) in the day surgery model. 【Methods】 The clinical data of 22 NMIBC patients (average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed. On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation. On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged. The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded. 【Results】 The pre-hospital waiting time was 2 to 7 days, average (4.1±1.3)days. The operation time was 29 to 50 minutes, average (40.8±5.5)minutes. The length of hospital stay was 0.6 to 1.2 days, average (0.9±0.2)days. Hemoglobin decrease was 1 g/L to 8 g/L, average (3.8±1.8)g/L. The catheter was indwelt for 0.5 to 1 day, average (0.7±0.1)day. The medical costs were 13 790 to 16 811 Yuan, average (14 941.5±690.2) Yuan. Patients’ satisfaction rate was 100.0%. Mild intraoperative and postoperative complications occurred in 2 cases. One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets. No adverse events such as obturator nerve reflex or bladder perforation occurred. After removal of the catheter, no urinary retention was observed. 【Conclusion】 This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.

Objective:To establish and validate a radiomics nomogram based on MR for predicting cervical lymph node metastasis in laryngeal cancer.Methods:One hundred and seventeen patients with laryngeal cancer who underwent MR examinations and received open surgery and neck dissection between January 2016 and December 2019 were included in this study. All patients were randomly divided into a training cohort ( n=89) and test cohort ( n=28) using computer-generated random numbers. Clinical characteristics and MR were collected. Radiological features were extracted from the MR images. Enhanced T1 and T2WI were selected for radiomics analysis, and the volume of interest was manually segmented from the Huiyihuiying radiomics cloud platform. The variance analysis (ANOVA) and the least absolute shrinkage and selection operator (LASSO) algorithm were used to reduce the dimensionality of the radiomics features in the training cohort. Then, a radiomic signature was established. The clinical risk factors were screened by using ANOVA and multivariate logistic regression. A nomogram was generated using clinical risk factors and the radiomic signature. The calibration curve and receiver operator characteristic (ROC) curve were used to confirm the nomogram′s performance in the training and test sets. The clinical usefulness of the nomogram was evaluated by decision curve analysis (DCA). Furthermore, a testing cohort was used to validate the model. Results:The radiomics signature consisted of 21 features, and the nomogram model included the radiomics signature and the MR-reported lymph node status. The model showed good calibration and discrimination. The model yielded areas under the ROC curve (AUC) in the training cohort, specificity, and sensitivity of 0.930, 0.930 and 0.875. In the test cohort, the model yielded AUC, specificity and sensitivity of 0.883, 0.889 and 0.800. DCA indicated that the nomogram model was clinically useful.Conclusion:The MR-based radiomics nomogram model may be used to predict cervical lymph node metastasis of laryngeal cancer preoperatively. MR-based radiomics could serve as a potential tool to help clinicians make an optimal clinical decision.

Objective To investigate the effect of Zhutan Tongluo Tang on the articular cartilage degeneration in a rat osteoar-thritis model ,and explore the potential mechanism .Methods Thirty-healthy SD rats were equally divided into the normal control group ,the model control group and Zhutan Tongluo Tang group .Rats were induced osteoarthritis models with 4% mass fraction of papain .After replication of osteoarthritis models ,Zhutan Tongluo Tang group were given Zhutan Tongluo Tang with 2 mL/(kg · d) ,the model control group were given lavage with normal saline ,the normal control group with rovtine feeding .After treat-ments for 3 months ,the cartilage morphology were observed using HE stains ,and the expression of IL-1β,TNF-α and MMP-3 in synovial fluid were measured by ELISA .Results The degeneration of cartilage in Zhutan Tongluo Tang group was better than the model control group .Compared with the model control group ,the expression levels of IL-1β (12 .13 pg/mL vs .16 .62 pg/mL ) , TNF-α (13 .76 pg/mL vs .18 .26 pg/mL) and MMP-3 (14 .21 ng/mL vs .21 .57 ng/mL) in synovial fluid were significantly de-creased in Zhutan Tongluo Tang group(P<0 .05) .Conclusion Zhutan Tongluo Tang has the function of treating delaying osteoar-thritis cartilage degeneration and decreasing inflammation ,whose mechanism is related to inhibiting the expression of inflammatory cytokines .

Objective To observe the effects of aerosolized prostaglandin E1 (PGE1 )via right lung before one-lung ventilation (OLV ) on shunt rate (Qs/Qt ) and oxygenation in patients undergoing surgery for oesophageal cancer.Methods Sixty patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly located into two groups.Patients in each group received different therapy before OLV,namely inhaling PGE1 0.2μg/kg via right lung in group P and inhaling normal saline in group C.The PaO 2 and hemodynamic indicators of two groups were recorded at these points:before OLV(T1 ),OLV 10 min (T2 ),OLV 1 5 min (T3 ),OLV 30 min (T4 ),OLV 60 min (T5 ),OLV 120 min (T6 ),.Results PaO 2 in both groups were declined straightly since OLV and fell to the lowest point at T4 in group C.PaO 2 in group P at T2-T4 were significantly higher than that in group C (P <0.05),and the lowest point of which was recorded at T5 .Qs/Qt in group P was significantly lower than that in group C at T2-T4 (P <0.05).There were no significant differences in hemodynamics indicators between the two groups. Conclusion Inhalation of 0.2 μg/kg PGE1 before OLV via one lung can reduce pulmonary shunt and improve PaO 2 in thoracic surgery patients.

Objective To compare the cellular immune function during postoperative analgesia with dezocine and fentanyl in the patients with gynecologic malignant tumors.Methods Fifty patients scheduled for elective surgery for gynecologic malignant tumors, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , were equally and randomly divided into either dezocine group (group D) or fentanyl group (group F) using a random number table.Total intravenous anesthesia was used for all the patients, and the intraoperatively administered anesthetics was the same.The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained dezocine 0.8 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group D.PCIA solution contained fentanyl 0.01 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group F.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h after a loading dose of 2 ml in the two groups.Tramadol 100 mg was given intravenously as rescue analgesic to maintain visual analogue scale score ≤ 4.Before surgery (T0), at the end of surgery, and at 24 and 48 h after surgery (T2,3) , venous blood samples were collected for detection of T lymphocyte subsets CD3+, CD4+ , CD8+ and natural killer (NK) cell levels (by flow cytometry).CD4+/CD8+ ratio was calculated.The requirement for rescue analgesics and occurrence of adverse reactions such as nausea, vomiting, hypotension and respiratory expression were recorded after surgery.Results No patients required tramadol as rescue analgesic in either group.Compared with the value at T0, the levels of CD3+ , CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T1,2, and the CD8+level was increased at T1 in group D, and the levels of CD3+ cells at T1,2, CD4+ cells at T1 and NK cells at T1-3 were decreased (P＜0.05) , and no significant change was found in CD8+ cell level and CD4+/CD8+ ratio in group F (P＞0.05).Compared with group F, the levels of CD3+ and NK cell were significantly increased at T3 (P＜0.05) , and no significant change was found in the incidence of adverse reactions after surgery in group D (P＞0.05).Conclusion The inhibitory degree of the cellular immune function is reduced when postoperative analgesia is performed with dezocine as compared with that when fentanyl is used in the patients with gynecologic malignant tumors.