Objective To explore the effects of Jinghou Zengzhi Granules(JHZZG),on ovarian GDF9 secretion and granulosa cells(GCs)apoptosis in controlled ovarian hyperstimulation(COH)rats through p38MAPK/CK2/IκBα/NF-κB pathway.Methods A model of COH rats was prepared and 18 rats were randomly divided into 3 groups,including natural ovulation group(NO group),COH group,and COH+JHZZG group.The expression of p38MAPK,CK2,IκBα,NF-κB,GDF9 mRNA and protein were detected by qRT-PCR and Western blot,and the apoptosis rate of ovarian GCs by TUNEL.Results Compared with the NO group,the expression of p38MAPK and NF-κB in the ovarian tissue of rats in the COH group increased,while the expression of CK2,IκBα and GDF9 decreased,and the apoptosis rate of ovarian GCs increased(all P<0.01).Compared with the COH group,the expression of p38MAPK and NF-κB in the ovarian tissue of rats in the COH+JHZZG group decreased,while the expression of CK2,IκBα and GDF9 increased(all P<0.01),and the apoptosis rate of ovarian GCs decreased(P<0.05).Conclusion Jinghou Zengzhi Granules could promote the secretion of ovarian GDF9 and inhibit the apoptosis of ovarian GCs of COH rats through p38MAPK/CK2/IκBα/NF-κB signaling pathway,which thereby improve the quality of COH oocytes.

Objective To investigate the effect of acupuncture on the morphology of the dry eye rabbit's cornea and the nuclear factor κB(NF-κB)signaling pathway of the corneal tissue to analyze the mechanism of acupuncture on dry eyes.Methods Twenty-four healthy New Zealand rabbits,without restriction on sex,were randomly divided into four groups,including a blank group,a model group,an acupuncture group,and a sham acupuncture group,with 6 in each group.Rabbits in the blank group were not treated;rabbits in the other three groups were treated with scopolamine hydro-bromide 2.0 mg·kg-1 by subcutaneous injection at 8:00,11:00,14:00 and 18:00 each day for 35 consecutive days un-til the end of the experiment.Rabbits in the sham acupuncture group were treated with sham acupuncture on the 22nd day after successful modeling by quickly pricking acupoints(Jingming BL1,Cuanzhu BL2,Sizhukong SJ23,Taiyang EX-HN5 and Tongziliao GB1)with a blunt acupuncture needle,once a day,for a total of 14 days.Rabbits in the acupuncture group were treated with acupuncture at the same acupoints as the sham acupuncture group after successful modeling.The corneal fluorescence staining was conducted on Days 0,21,28 and 35 after modeling.On Day 35,corneal confocal microscope ex-aminations were conducted.Then,the rabbits were sacrificed,the corneal morphological changes were observed by light microscope and transmission electron microscope,and the expression of corneal NF-κB protein was detected by Western blot.Results Compared with the model group,the score of rabbit corneal fluorescein staining in the acupuncture group and blank group decreased on the 28th and 35th days after modeling,and the differences were statistically significant(all P＜0.05).The results of the confocal microscope examination on Day 35 after modeling showed that,compared with other groups,there were a large number of globular immune cells and activated stromal cells with unclear boundaries and irregu-lar sizes in the stromal layer and inflammation in the area with irregular intercellular space in the model group and the sham acupuncture group.In the acupuncture group,the morphology of stromal layer cells improved,the cells were slightly acti-vated,and there were no obvious abnormalities in the corneal nerve morphology.On the 35th day after modeling,the re-sults of the light microscope showed that,the surface of the corneal tissue in the model group and the sham acupuncture group showed hyperkeratinized flat epithelial cells,lymphocyte infiltration,increased number of focal epithelial cell layers,and epithelial cell detachment.In the acupuncture group,there were 4-6 layers of epithelial cells in the corneal epitheli-um,and epithelial shedding decreased.In addition,the lymphocyte infiltration decreased compared with the model group.On the 35th day after modeling,the results of the transmission electron microscope showed that abnormal microvilli oc-curred and epithelial cells were absent in the corneal epithelial cells of rabbits in the model group and the sham acupuncture group,the cell space was widened,the rough endoplasmic reticulum was severely expanded,and desmosomes were dis-banded with mitochondrial swelling.In the acupuncture group,the microvilli structure of epithelial cells was sparse and short,local deletion was still observed,the rough endoplasmic reticulum was slightly expanded,and no obvious swelling of mitochondria was observed.On the 35th day after modeling,the Western blot examination results showed that,compared with the blank group,the expression of p-NF-κB p65 was up-regulated in both the model group and sham acupuncture group(both P＜0.05);compared with the model group and sham acupuncture group,the expression of p-NF-κB p65 in the acupuncture group was down-regulated(both P＜0.05).Conclusion Acupuncture can inhibit the NF-κB signaling path-way to play an anti-inflammatory role and relieve corneal inflammation and injury of dry eye rabbit models.

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 explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.

【Objective】 To compare the efficacy, safety and survival of partial nephrectomy (PN) and radical nephrectomy (RN) in the treatment of clinical T1b and T2a renal cell carcinoma (RCC). 【Methods】 A total of 115 patients with stage T1b and T2a RCC treated during Apr.2014 and Jul.2017 were retrospectively analyzed. According to the different surgical methods, the patients were divided into PN group (n=55) and RN group (n=60). The clinical data and prognosis of the two groups were compared. 【Results】 There were no significant differences in the general clinical data and perioperative related factors between the two groups (P>0.05). The incidence of complications was significantly higher in PN group than in RN group (P=0.024), but there was no significant difference in serious complications (Clavien grade ≥3) (P>0.05). In terms of renal function recovery, there was no significant difference in serum creatinine between the two groups before operation (P>0.05), but the serum creatinine was significantly lower in PN group than in RN group on the 1st day, 3rd, 6th and 12th months after operation (P<0.05). After more than 5 years of follow-up, there was no significant difference in 5-year survival rate, overall survival rate, recurrence and metastasis rate, and cancer specific survival rate between the two groups (P>0.05). 【Conclusion】 Both PN and RN are safe and effective in the treatment of stage T1b and T2a RCC, and can achieve good oncological control effects. Compared with RN, PN can fully and effectively protect the postoperative renal function, but it causes more surgical complications. However, there is no significant difference in severe complications (Clavien grade ≥3).

Objective:To explore the application value of the new gastric cancer screening scoring system for risk populations in the island of Fujian province.Methods:From April to June 2019, gastric cancer screening was performed on the population of Nanri Island, Putian City, Fujian Province, and epidemiological data of all subjects were prospectively collected. Participants underwent gastroscopy based on gastric cancer risk stratification of the new scoring system. Suspected positive cases further received magnifying endoscopy and biopsy. Additional endoscopic procedures and other surgical treatments were conducted. The detection rates of gastric cancer and precancerous lesions in each group of gastric cancer risk stratification were compared, and the Chi-square test was used for statistical analysis.Results:A total of 1 423 subjects were included, and 19 cases (1.34%) of gastric cancer were detected. The detection rates of gastric cancer were 0.88% (9/1 025) in the low-risk group, 1.76% (6/341) in the medium-risk group, and 7.02% (4/57) in the high-risk group. Paired comparison between the low-risk group and the high-risk group showed significant difference ( χ2=12.364, P=0.003). There was no significant difference between the low-risk group and medium-risk group, or between the medium-risk group and high-risk group ( P>0.05). Among all participants, 87 (6.11%) cases of gastric precancerous lesions were identified. The detection rates of precancerous lesions in the low-risk, medium-risk, and high-risk groups were 6.24% (64/1 025), 5.87% (20/341), and 5.26% (3/57) respectively, with no significant difference among the three groups ( P>0.05) .Conclusion:During gastric cancer screening, the novel gastric cancer screening scoring system helps to stratify gastric cancer risk for population in the islands of Fujian province, serving as a foundation for subsequent detailed endoscopy.

OBJECTIVE: To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. METHODS: Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. RESULTS: All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. CONCLUSION The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
Male ; Female ; Humans ; Child ; Child, Preschool ; Calcium Sulfate ; Humerus ; Humeral Fractures/surgery* ; Plastic Surgery Procedures ; Fracture Fixation, Internal/methods* ; Bone Wires ; Fracture Healing ; Treatment Outcome ; Range of Motion, Articular

Objective: To investigate the expression pattern，underlying function and clinical significance of Guanylate-binding protein 1 ( GBP1) in pulmonary tuberculosis ( pTB) ． Methods: Immunohistochemical staining was applied to detect the expression of GBP1 in pTB specimensand control samples． Combined with Gene Expression Omnibus ( GEO) datasets ，including GSE83456 and GSE34608，receiver operating characteristic ( ROC) curve was depicted to assess the diagnostic value of GBP1 in pTB．Then，the correlation between GBP1 and related regulatory factors was analyzed by protein-protein interaction network ( PPI) ; Finally，the potential molecular mechanism of GBP1 in pTB was probed by Gene Set Enrichment Analysis( GSEA) . Results: Compared with the control group，GBP1 was significantly overexpressed in human pTB samples，including lung tissue and blood．The positive rate of GBP1 protein in pTB was 73. 9% . ROC curve analysis revealed that GBP1 might have important value in early diagnosis of pTB．GSEA analysis suggested that the hyper-expression of GBP1 was closely related to the host inflammatory response，IFN-γ/ α signaling pathway and TNF-α/ IL-6 signal transduction． Conclusion GBP1 is highly expressed in pTB tissues and is involved in the process of inflammatory response and host anti-tuberculosis infection ; GBP1 may be used as an early diagnostic marker or therapeutic target for pTB.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Endometrial cancer is one of the malignant tumors of female reproductive system. The prognosis of advanced endometrial cancer is poor. How to improve the overall survival rate and improve the prognosis of patients with advanced endometrial cancer is still one of the clinical problems. In recent years, the research on tumor gene changes is increasing gradually. Epigenetics is the study of genetic changes in gene expression without changing the nucleotide sequence of genes. Epigenetics includes many phenomena, such as DNA methylation, microRNA expression and gene silencing, chromatin remodeling. These changes may be important factors in the occurrence and development of tumors, and may become new therapeutic targets for tumors. With the study on epigenetics of endometrial cancer in the future, new therapeutic targets may be found. Meanwhile, those study may provide new ideas for targeted therapy of endometrial cancer.