The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

OBJECTIVE: To explore the molecular mechanism of curcumin in inhibiting the nucleotide-binding oligomerization domain like receptor family pyrin domain-containing(NLRP3) inflammatory bodies induced by silica(SiO_2) in mouse alveolar macrophages(AM). METHODS: AMs were isolated from the bronchoalveolar lavage fluid of specific pathogen free C57 BL/6 mice and divided into 6 groups. Among them, the AM of the control group received no stimulation; the AM in the SiO_2 stimulation group was stimulated with SiO_2 suspension at the final mass concentration of 50 mg/L; the AM in nuclear factor(NF-κB)inhibition group was pretreated with 5-(4-fluorophenyl)-2-urea-thiophene-3-formamide with a final concentration of 200 nmoL/L for 1 hour, the AM in the low-, medium-and high-dose curcumin groups were pretreated with curcumin with the final concentrations of 20, 40 and 50 μmol/L for 1 hour, respectively, and then stimulated with SiO_(2 )suspension with a final concentration of 50 mg/L. Samples were collected after 6 hours of incubation. The mRNA expression of NLRP3 inflammasome related genes such as NLRP3, Caspase-1 and interleukin(IL)-1β was detected by real-time fluorescence quantitative polymerase chain reaction. The secretion level of maturation IL-1β(mIL-1β) and IL-18 in AM was detected by enzyme-linked immunosorbent assay. The protein expression and secretion level of cleaved Caspase-1, precursor-IL-1β(pro-IL-1β) and mIL-1β were analyzed by Western blotting. RESULTS: The mRNA relative expression of NLRP3, Caspase-1 and IL-1β, and the secretion levels of mIL-1β and IL-18, and the protein relative expression of Caspase-1, pro-IL-1β and mIL-1β, as well as the secretion levels of cleaved Caspase-1 and mIL-1β increased in the SiO_2 stimulated group compared with the control group(P<0.05). Except for the relative expression and the secretion level of cleaved Caspase-1, the other 8 indexes in the NF-κB inhibition group were lower than that in the SiO_2 stimulation group(P<0.05). Except for the relative expression of cleaved Caspase-1 and mIL-1β proteins in the low-dose curcumin group, the relative expression of all the above 10 indexes was lower in the three curcumin treated groups than that in the SiO_2 stimulation group(P<0.05). In addition, all the above indexes decreased with the increase of curcumin intervention dose(P<0.05). The mRNA relative expression of NLRP3 and IL-1β, and the protein relative expression of pro-IL-1β increased in the medium-dose curcumin group(P<0.05), the secretion levels of mIL-1β and IL-18, as well as the protein relative expression and secretion levels of cleaved Caspase-1 and mIL-1β decreased(P<0.05), compared with the NF-κB inhibition group. CONCLUSION: Curcumin can inhibit SiO_2-induced AM NLRP3 inflammasome activation in a dose-response relationship. This process may be related to the inhibition of NF-κB signaling pathway by curcumin and the down-regulating NLRP3 inflammasome-related genes at the transcriptional level. The important mechanism may be that curcumin directly blocks the activation, assembly, and downstream shearing of NLRP3 in inflammasomes.

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease of natural infectious focus caused by Hantavirus (HV) with clinical characteristics as fever, hemorrhage, hyperemia, hypotensive shock and renal damage. Through contacting the excreta or secretion of infected rats, human may get infected. The epidemiological characteristics of HFRS are significantly different in terms of population differences, geographical heterogeneity and seasonal variation, which are all closely related to the habitat of host animals and human productive activities. The reported number of HFRS is about 150 000 to 200 000 each year worldwide, and China accounted for 70 %-90 % of the total reported cases standing the most seriously infected country. In this study, we reviewed the epidemiological characteristics and the influencing factors of HFRS as well as the models and methods used in relevant ecological studies, in order to understand the distribution of time, regional and population and potential influencing factors on the transmission of HFRS better, so as to improve the strategies on investigation, monitoring, prevention and control of the diseases.

Ferroptosis is a new programmed cell death characterized by iron dependent and intracellular oxidative accumulation. Current studies have confirmed that ferroptosis is involved in the occurrence and development of neurotoxicity injury, tumors, cardiovascular diseases and other diseases. This paper reviews the mechanisms of ferroptosis and its role in related diseases based on recent studies.

Ferroptosis is a new programmed cell death characterized by iron dependent and intracellular oxidative accumulation. Current studies have confirmed that ferroptosis is involved in the occurrence and development of neurotoxicity injury, tumors, cardiovascular diseases and other diseases. This paper reviews the mechanisms of ferroptosis and its role in related diseases based on recent studies.

The new research of intrauterine transmission of HBV includes intrauterine dominant infection and occult infection. Intrauterine dominant infection of HBV is the traditional intrauterine infection. Although intrauterine infection of HBV has been studied for decades, the intervention effects on HBV infection are very limited. As a result, mother to child transmission has become the main route of the transmission of HBV. With the development of science and technology, people’s understand of intrauterine occult infection of HBV has been deepened, and the definition of intrauterine transmission of HBV has been further completed and expanded. The study of intrauterine occult infection of HBV will play an important role in prevention and control of hepatitis B in China through filling in a gap in the field of prevention and control of vertical transmission of HBV, exploring new research perspective and providing guideline for related decision-making.

Objective: To observe the repairing effect of adipose mesenchymal stem cells (ADSCs) on lung injury induced by silica in rats. Methods: Primary ADSCs-GFP was obtained from rats. ADSCs-GFP was injected into tail vein of silicosis model rats. The expression of green fluorescence in lungs was observed regularly to determine the homing ability of ADSCs. Primary ADSCs of rats were obtained and randomly divided into control group, exposure group, vehicle group and ADSCs group. Silicosis rat model was established by non-exposed tracheal drip method. 24 hours after silica exposure, rats in ADSCs group were injected with ADSCs of 1×10⁶/kg body weight through tail vein, and the pathological changes of lung tissue were observed and evaluated 28 days after intervention. To explore the early intervention mechanism of ADSCs on pulmonary fibrosis in silicosis model rats, apoptosis-related proteins were detected by immunohistochemistry. Results: 28 days after exposure to silica, rats in the exposure group showed obvious pulmonary fibrosis. Compared with exposure group and vehicle group, ADSCs group showed less pulmonary inflammation, less silica nodules and less collagen deposition area. Immunohistochemical results showed that the expression of Caspase-3 and cytochrome C protein decreased and Bcl-2 protein increased after ADSCs transplantation. Conclusion ADSCs infusion has an obvious intervention effect on postponing early silicosis fibrosis in rats exposed to silica, and its mechanism is related to the regulation of apoptotic process.

OBJECTIVE: To analyze the difference in gene expression profiles and screen silicosis development related differentially expressed genes(DEGs) and signaling pathways in peripheral blood specimens of rats exposed to silica dust using bioinformatics and gene chip. METHODS: GSE27023 gene expression profiles of peripheral blood samples of rats exposed to silica dust were downloaded from Gene Expression Omnibus database. After screening of the DEGs through paired-sample t-test and fold change method,DEGs related to rats exposed to silica dust was performed by Gene Ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis. The protein-protein interaction(PPI) network was constructed with the Search Tool for the Retrieval of Interacting Genes database and visualized using the software Cytoscape. RESULTS: Of the 2 767 DEGs screened,1 363 were up-regulated and1 404 were down-regulated. KEGG pathway enrichment analysis showed that 39 signaling pathways,such as the calcium signaling pathway,neuroactive ligand-receptor interaction,Ras-related protein 1 signaling pathway,were significantly enriched. DEGs enrichment and significance reached the highest level in the calcium signaling pathway. PPI network and module analysis suggested that mitogen-activated protein kinase 14(Mapk14),DNA-directed RNA PolymeraseⅡ,V-erb-a erythroblastic leukemia viral oncogene homolog 4,B-cell lymphoma-2(Bcl-2),receptor interacting serine/threonine kinase 4,PH domain leucine-rich repeat protein phosphatase 2,DNA-directed RNA polymerase Ⅲ,neurogenic locus notch homolog protein 1,histone deacetylase 1,yeast switch in mating type/Sucrose non fermentation related,matrix associated,actin dependent regulator of chromatin,subfamily a,member 4 were top 10 hub-proteins. Mapk14 had the highest node degree in up-regulated DEGs,and Bcl-2 had the highest node degree in down-regulated DEGs. CONCLUSION: We found 39 signaling pathways and 10 DEGs that are related to toxicity caused by exposure to silica dust in rats by analysis of peripheral blood gene chip data. Among them,calcium signaling pathway,Mapk14 and Bcl-2 may play important roles in the development and progress of silicosis in rats.

Objective To grope for an ideal immune strategy in grown-ups via comparison of immunological effects under 4 different vaccination schemes.Methods Study population was selected by stratified random cluster sampling.A total of 4 different vaccination proposals,including Strategy A (3 doses,10 μg,administrated repeatedly into the unilateral deltoid muscle at 0-1-6 months),Strategy B (2 doses,20 μg,administrated into the bilateral deltoid muscles simultaneously),Strategy C (3 doses,10 μ g,administrated repeatedly into the unilateral deltoid muscle at 0-1-2 months) and Strategy D (2 doses,10 μg,administrated to the bilateral deltoid muscles at the same time),were conducted in Liangzhou,Minqin Gulang,and the Tianzhu Tibetan Autonomic county respectively,in Wuwei city,Gansu province.Under 4 different strategies,post-vaccination immunological effectiveness was evaluated when blood samples of participants collected in the eighth months,post-first injection and in the third year,and tested by enzyme-linked immunoassays and electro-chemiluminescence immunoassay.Chi-squared test and Fisher exact test were used to evaluate the immumological differences between the 4 strategies.Wilcoxon's signed rank test and Kruskal-Waillis H test were conducted to compare the differences of the geometric mean titers (GMTs) of antibody against HBV surface antigen (anti-HBs) titers.Results A total of 1 621 eligible participants aged 16 to 60 years old,were recruited for the study.Numbers of administration and gender were testified as the presuming factors for influencing immune effectiveness.The vaccination completion rates were 53.97％ and 79.82％ in Strategy A and C,respectively,and the difference statistically significant (P＜0.05).In the first year,the protective antibody sero-conversion rates (standardization rate) were 89.21％,54.88％,92.11％,and 41.63％,in Strategy A,B,C and D,respectively,and the significant statistically differences emerged (P＜0.05) if Strategy B,C and D were compared with Strategy A (as the gold standard).Over a 3-year follow-up period,the levels of GMTs on protective antibody declined from 179.2 IU/L,51.6 IU/L,277.1 IU/L and 10.1 IU/L to 61.3 IU/L,21.2 IU/L,31.8 IU/L and 6.0 IU/L in Strategy A,B,C and D,respectively,and the differences of declination on GMTs showed statistically significant differences (P＜0.05) when compared within or between the 4 strategies.Conclusion The 0-1-2 months' prophylactic schedules (Strategy C) seemed superior to the others,in terms of effectively inducing the protective antibody,with shorter duration of vaccination,persisting longer immunity and having higher rate of completive vaccination,so is worth to be recommended as a feasible immune programme for adults,especially for migrants from the rural regions.

Objective To understand the nucleotide and amino acid differences of glycoprotein gene (G gene) between isolated rabies viruses in Henan Province and rabies vaccine strains used for human and animals. Methods G gene sequences of nine rabies viruses isolated from dogs in Xinyang city of Henan Province in December 2006 were amplified by reverse transcriptase (RT)-heminestedpolymerase chain reaction (PCR), and then were cloned and sequenced. The phylogenetic trees were constructed for analyzing the genetic characteristics of these rabies viruses. Results The homology of G gene among the nine isolates from Henan Province was 97.6% - 98.9% at nucleotide level and 99.2%-99.8% at amino acid level. The similarities between these isolates and CTN vaccine strain were 85.6%-93.0% and 91.9%-92.9% at nucleotide and amino acid level, respectively, which were higher than those between these isolates and other vaccine strains (80.4% - 83.3% and 87.7% - 92.5% at nucleotide and amino acid level, respectively). The nine isolates had several amino acid substitutions when compared to other genotype 1 rabies virus strains. Conclusions The nine rabies viruses strains isolated from Henan Province all belong to genotype 1. CTN may be an effective vaccine for preventing rabies in Henan Province.