Objective To investigate the effect and mechanism of dabrafenib （DAB） combined with tremelimumab （TREM） on melanoma. Methods The effects of DAB combined with TREM on cell viability, cytotoxicity and cell migration of A375 cells were evaluated by Cell Counting Kit-8 （CCK-8） method, lactate dehydrogenase （LDH） method and scratch assay. The levels of reactive oxygen species （ROS）, adenosine triphosphate （ATP）, malondialdehyde （MDA）, and superoxide dismutase （SOD） were detected to evaluate the effects of combined drugs on oxidative stress and energy metabolism. In addition, A375 tumor-bearing nude mice model was used to evaluate the inhibitory effect of the combined treatment on tumor growth in vivo, and the degree of cell apoptosis and cell proliferation in tumor tissues were analyzed by terminal deoxynucleotidyl transferase-mediated dutP Nick end labeling （TUNEL） and proliferating cell nuclear antigen （PCNA） immunohistochemical staining. Results The combined treatment significantly inhibited the survival rate and migration ability of A375 cells and enhanced the cytotoxicity. The combined intervention also significantly increased ROS level, decreased ATP, SOD and MDA levels. It effectively inhibited tumor growth in tumor-bearing nude mice, increased the apoptosis rate of tumor cells and inhibited cell proliferation. Conclusion DAB combined with TREM may improve the therapeutic effect of melanoma by enhancing oxidative stress, inhibiting energy metabolism, and promoting cell apoptosis. This combination therapy may provide a new therapeutic strategy to overcome the limitations of singledrug therapy.

Objective: To explore the network structure characteristics and core items of rural middle school students suffering from campus bullying and anxiety symptoms, so as to provide a reference basis for the precise prevention and intervention of the comorbidity of campus bullying and anxiety symptoms. Methods: From September 2021 to March 2022, a multi stage random cluster sampling method was used to select 1 920 rural middle school students from Xuzhou. The Chinese version of the Olweus Bully/Victim Questionnaire was used to investigate the situation of campus bullying, and the Chinese version of the Generalized Anxiety Disorder (GAD-7) was used to assess anxiety symptoms. The network analysis method was used to construct the network between suffering from campus bullying and anxiety symptoms of rural middle school students to evaluate the centrality, bridge strength, stability and accuracy of each item. Results: The total score of suffering from campus bullying symptoms of rural middle school students was (10.42±3.26) points, and the total score of anxiety symptoms was (11.47±4.93) points. The symptom with the highest strength and expected influence was "unable to stop or control one s worry emotions", and the node strength and expected influence value was 1.041 7. The nodes "feel nervous, anxious or irritable" and "unable to stop or control one s worry emotions" were most closely related. The symptoms with the highest bridge strength were "others give me ugly nicknames to scold me or make fun of and satirize me" and "unable to stop or control one s worry emotions". Conclusions Rural middle school students suffering from campus bullying is related to anxiety symptoms. Accurate intervention according to the intervention targets may minimize the negative impact of suffering from campus bullying and anxiety symptoms on rural middle school students.

Objective To investigate the predictive value of C-reactive protein/albumin(CRP/Alb)ratio on early small or medi-um-sized coronary artery aneurysm(CAA)of children with Kawasaki disease(KD).Methods The clinical data of 116 children with KD admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2018 to December 2021 were retrospectively analyzed,and they were divided into CAA group(n=34)and non-CAA group(n=82).The general conditions,clinical characteris-tics and laboratory indicators were compared between the two groups.Univariate analysis was used to screen the related factors of early small or medium-sized CAA of children with KD,and multivariate Logistic regression analysis was used to estimate the independent risk factors of early small or medium-sized CAA of children with KD.Then the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of CRP/Alb ratio on early small or medium-sized CAA of children with KD.Results Univariate analysis showed that compared with the non-CAA group,the proportion of males in CAA group was higher,the incidence of pleomorphic rash was higher,CRP,fibrinogen and CRP/Alb ratio were significantly increased,and the differences were statistically significant(P＜0.05).The multivariate logistic regression analysis showed that male,fibrinogen and CRP/Alb ratio were the independent risk factors for early small or medium-sized CAA of children with KD.The ROC curve analysis showed that CRP/Alb ratio had a good predictive value for early small or medium-sized CAA of children with KD,with the best cut-off value of 1.4,with sensitivity of 82％,specificity of 66％,and the area under the ROC curve of 0.811.Conclusion CRP/Alb ratio can be used as a marker of predict the early small or medium-sized CAA of children with KD.

Objective:To compare the clinical efficacy of ultrasound-guided spinal nerve block (SNB) and paraverteral nerve block (PVB) in treating postherpetic neuralgia.Methods:A total of 52 patients with postherpetic neuralgia who visited the Pain Clinic of the Xiangya Hospital, Central South University from February 2020 to December 2022 were selected and randomly divided into an ultrasound-guided SNB group and a PVB group using a random number table method, with 26 patients in each group. Patients in the SNB group received ultrasound-guided spinal nerve block therapy; The PVB group received ultrasound-guided paraverteral nerve block treatment. Visual Analog Scale (VAS) scores, 36-Item Short Form Survey (SF-36) scores, and total effective rate were observed in two groups of patients before treatment, 2 weeks after treatment, 1 month after treatment, 3 months after treatment, and 6 months after treatment. Complications during treatment were also observed.Results:The total effective rates of SNB group patients at 1, 3, and 6 months after treatment were significantly higher than those of PVB group (all P<0.05). After treatment, the VAS scores of both groups of patients at each time point were significantly reduced compared to before treatment (all P<0.05); The VAS scores of patients in the SNB group were lower than those in the PVB group at 1, 3, and 6 months after treatment, but the difference was not statistically significant (all P>0.05). There was no statistically significant difference in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores between SNB and PVB groups before nerve block treatment (all P>0.05). The MCS and PCS scores of the two groups of patients were significantly higher than before treatment at 2 weeks, 1 month, 3 months, and 6 months after treatment (all P<0.05). The MCS scores of the SNB group were significantly higher than those of the PVB group at 2 weeks, 1 month, 3 months, and 6 months after treatment (all P<0.05), but there was no statistically significant difference in PCS scores between the two groups (all P>0.05). Both groups of patients did not experience any serious complications related to the treatment in this study during the follow-up period. Conclusions:Both ultrasound-guided spinal nerve block and paraverteral nerve block can safely and effectively treat postherpetic neuralgia. The clinical effect of ultrasound-guided spinal nerve block in treating postherpetic neuralgia is better than that of paraverteral nerve block.

Restoration of teeth after removal of previous restorations is a common problem in the dental clinic. The situation of teeth after removal of previous restoration is complex and often requires multidisciplinary cooperation. However, there is a lack of systematic and concise guidelines for determining the treatment plan for those teeth. Through a combination of restorative clinical experience and the opinions of endodontic specialists, the author systematically described the problems that may exist after the removal of previous restorations in the teeth that have not undergone or have undergone root canal treatment (RCT) and those with post and core restorations. And summarized the corresponding treatment recommendations according to their pulpal and periapical status, the quality of RCT and the presence or absence of post and core restorations. ①For teeth without RCT, the vitality of the pulp, the occurrence of pulpal/periapical disease and the amount of re-preparation need to be assessed to determine whether RCT is necessary. ②For teeth with RCT, if the quality of RCT is good and no periradicular lesion exists, direct restorative treatment can be considered. If the quality of the RCT is unsatisfactory but no periradicular lesion exists, root canal retreatent (re-RCT), follow up or direct restorative treatment should be performed as appropriate and treatment plan can be developed in conjunction with the endodontist if necessary. If the quality of the RCT is unsatisfactory and periradicular lesion exists, re-RCT is necessary before restorative treatment.③For teeth with post and core restorations, if the quality of RCT is good and no periradicular lesion exists, direct restorative treatment can be considered. If the quality of the RCT is unsatisfactory but no periradicular lesion exists, follow up or direct restorative treatment should be performed as appropriate and treatment plan can be developed in conjunction with the endodontist if necessary. If the quality of RCT is unsatisfactory and periradicular lesion exists, for teeth with thin post and thick root canal walls, re-RCT after removal of the post can be attempted. For teeth with thick post and thin root canal walls, preservation of the post and apical surgery can be considered. For the teeth with excessively large defects or extremely poor periodontal conditions, extraction is recommended. The author refined the above recommendations into a set of treatment procedures, aiming to provide a reference for the selection of treatment options for teeth after removal of previous restorations.

Lateral Ligament, Ankle/injuries* ; Ankle Joint

Bacillus cereus belongs to Gram-positive bacteria, which is widely distributed in nature and shows certain pathogenicity. Different B. cereus strains carry different subsets of virulence factors, which directly determine the difference in their pathogenicity. It is therefore important to study the distribution of virulence factors and the biological activity of specific toxins for precise prevention and control of B. cereus infection. In this study, the hemolysin BL triayl was expressed, purified, and characterized. The results showed that the bovine pathogenic B. cereus hemolysin BL could be expressed and purified in the prokaryotic expression system, and the bovine pathogenic B. cereus hemolysin BL showed hemolysis, cytotoxicity, good immunogenicity and certain immune protection in mice. In this study, the recombinant expression of hemolysin BL triayl was achieved, and the biological activity of hemolysin BL of bovine pathogenic ceroid spore was investigated. This study may facilitate further investigating the pathogenic mechanism of B. cereus hemolysin BL and developing a detection method for bovine pathogenic B. cereus disease.
Cattle ; Animals ; Mice ; Bacterial Proteins/metabolism* ; Bacillus cereus/metabolism* ; Hemolysin Proteins/metabolism* ; Virulence Factors/metabolism* ; Enterotoxins/metabolism*

Traditional Chinese medicine injections for the prevention and treatment of cardiotoxicity of antineoplastic drugs was summarized, including Shengmai injection, Shenmai injection, Shenfu injection, Shenqi Fuzheng injection, Kangai injection, Huangqi injection, Xinmailong injection, Danhong injection, Danshen injection, Honghua injection, Kushen injection, Cinobufacin injection and Yinxingdamo injection. The mechanism of effect mainly includes inhibition of lipid peroxidation, reduction of calcium overload and anti-cardiomyocyte apoptosis, which provides the basis for the prevention and treatment of cardiotoxicity of antitumor drugs by traditional Chinese medicine.

Pain caused by surgery is an important clinical issue that seriously affects postoperative rehabilitation and health-related quality of life. Failure to effectively manage postoperative pain not only leads to a decrease in patient quality of life, increases medical expenses, but also has a negative impact on patient recovery. Therefore, it is of great clinical significance to address the challenges of acute postoperative pain management, find effective management strategies, and improve the quality of pain management. This article summarizes the current status of acute postoperative pain management in recent years, including the mechanism of pain occurrence, pain assessment methods, drug and non drug management strategies, and predictive factors for chronic postoperative pain. It also looks forward to future research directions and application prospects.

Objective:To analyze the clinical characteristics of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods:A retrospective study was conducted on AAV patients with long-term follow-up in the rheumatology outpatient clinic of Peking Union Medical College Hospital between February 2015 and February 2022. The demographic characteristics, clinical manifestations, concurrent events, treatment, and prognosis of the three clinical subtypes of AAV were collected and analyzed.Results:There were 71, 45, and 31 cases of granulomatous polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatous polyangiitis (EGPA), respectively, among 147 patients. The ANCA positivity rates in the three groups were 91.5%, 95.6%, and 19.4% ( χ2=76.68, P<0.01), respectively. The upper respiratory tract and lungs were the most frequently affected organs in GPA and EGPA, and the kidneys and lower respiratory tract were the main organs involved in MPA. In addition, cardiac and neurological involvement and thrombosis rates were significantly higher in EGPA patients than in GPA and MPA (12.9%, 9.7%, 41.9% and 19.4%, respectively; χ2=8.51、7.13、7.54、0.02, P<0.05) .The median follow-up time for the three groups of patients was 43, 28, and 46 months respectively.Relapse was more common in patients with GPA and EGPA (up to 59.2% and 64.5%; χ2=11.26, P=0.004), with the lungs and ENT being the most common relapse organs (GPA of 61.9% and 40.5%, EGPA of 55.0% and 50.0%), the lungs and kidneys were the most common manifestations in MPA relapse (64.3% and 60.0%, respectively). The main therapeutic agents were glucocortoid (95.9%), cyclophosphamide (71.4%), methotrexate (54.4%), tripterygium wilfordiz (34.0%),mycophenolate mofetil (31.3%), azathioprine (29.3%), leflunomide (19.0%), rituximab (19.0%), and tacrolimus/cyclosporine (8.8%). There were 6 deaths (4.1%) occurred during the follow-up period of this study. Conclusion:The clinical features of AAV are similar to those reported in the literature and relapses are common>he vast majority of patients need to be treated with glucocorticoid combined with immunosuppressive agents.