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Danxu Ma,1 Huili Li,1 Rong Shi,1 Yinan Yang,1 Haoda Liu,2 Xiaodong Ge1 1Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Anesthesiology, Beijing Huairou Maternal and Child Health Care Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xiaodong GeDepartment of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongtinan Road, Chaoyang District, Beijing 100020, People’s Republic of ChinaEmail xiaodongge2005@163.comBackground: Persistent or recurring radicular pain after lumbar surgery is a clinical condition of failed back surgery syndrome (FBSS) that seriously affects the life quality of patients. Conventional medication and physiotherapy do not fully relieve this pain. A simpler, safer, and less invasive option is lumbar selective nerve root block or paravertebral block. Here, we share our experience regarding lumbar paravertebral block for a patient with FBSS, which successfully alleviated radicular pain after lumbar surgery.Case Presentation: An 80-year-old man with left lower limb radicular pain diagnosed as L4-5, L5-S1 intervertebral disc protrusion, spinal canal stenosis, and degenerative scoliosis underwent lumbar surgery. Four months after surgery, he experienced left lower limb radicular pain. After designing the puncture route based on X-ray film, we performed a combined ultrasound-guided L4 and L5 paravertebral block. With his improved pain control, his functional status and ability to perform daily activities also markedly improved.Conclusion: Real-time ultrasound-guided lumbar paravertebral block performed with a pre-designed route on X-ray film can provide a simple and safe way to relieve radicular pain in FBSS.Keywords: lumbar paravertebral block, failed back surgery syndrome, ultrasound-guided, pre-designed route

Hong-Peng Chen,1,2,* Xiao-Yan Wang,1,* Xiao-Yan Pan,1 Wang-Wang Hu,1 Shu-Ting Cai,1 Kiran Joshi,3 Lie-Hua Deng,1,2 Daqing Ma3 1Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 2Zhanjiang Key Laboratory of Organ Injury and Protection and Translational Medicine, Zhanjiang, Guangdong, People’s Republic of China; 3Division of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK*These authors contributed equally to this workCorrespondence: Lie-Hua Deng; Daqing MaDepartment of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, ChinaEmail glinson@126.com; d.ma@imperial.ac.ukIntroduction: Because of its high morbidity and mortality, sepsis remains the leading cause of death in the ICU. Microparticles (MP) have been largely studied as potential diagnostic or prognostic markers in various diseases including sepsis.Objective: The biological and clinical relevance of neutrophil-derived microparticles (NDMPs) within the MP population remains unclear. The objective of this study was to elucidate the relationship between plasma NDMPs and the prognosis of patients with sepsis and/or septic shock.Methods: The study was designed as an observational, noninterventional clinical study. The cohort for this study included 40 sepsis and 40 septic shock patients together with 10 healthy controls admitted to the Intensive Care Unit (ICU) and the Health Surveillance Center in the Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China, from January to November 2018, respectively. The degree of critical disease for sepsis and septic shock was evaluated, with data analyses conducted from 2018 to 2019.Results: On days 1, 3 and 5 post-admission a series of data including plasma NDMP levels, patient demographics, TNF-α levels, IL-6 levels, sTREM-1 levels, and the sepsis severity score measurements were collected. A survival curve was plotted against levels of plasma NDMPs. Levels of NDMPs were observed to be higher in the septic shock patients than in the sepsis patients on days 1, 3, and 5 post-ICU admission (p < 0.05). NDMP levels were significantly increased in sepsis and septic shock patients with a parallel increase in pro-inflammatory mediators and sepsis severity score (p < 0.05) as well as mortality.Conclusion: Our data suggest that NDMPs may be a biomarker of sepsis severity and mortality although its implications on sepsis prognosis warrant further study.Keywords: sepsis, septic shock, cell-derived microparticles, biomarker, prognosis

Rong Shi, Danxu Ma, Yinan Yang, Yun Wang Department of Anesthesia and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People’s Republic of ChinaCorrespondence: Yun WangDepartment of Anesthesia and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongtinan Road, Chaoyang District, Beijing 100020, People’s Republic of ChinaEmail wangyun129@ccmu.edu.cnBackground: Imaging-guided celiac plexus neurolysis using ultrasound (US) guidance via a transabdominal approach and endoscopic-ultrasound (EUS) has been increasingly applied for the treatment of pancreatic cancer-associated abdominal pain.Objective: To investigate the application of ultrasound-guided and fluoroscopy-assisted celiac plexus neurolysis in a patient with advanced pancreatic cancer suffering from refractory abdominal pain for which oral opioid treatment was ineffective.Case Report: We report a case of ultrasound-guided and fluoroscopy-assisted celiac plexus neurolysis in a patient with advanced pancreatic cancer with refractory abdominal pain. With the patient in the prone position, celiac plexus neurolysis was performed under real-time US guidance. The transducer was placed below the costal margin and a puncture needle with an ultrasound enhancement tip was inserted in-plane aiming for the lateral anterior end of the vertebral body. The correct needle tip position was confirmed by the C-arm with contrast material located anterior to the vertebral body and posterior to the diaphragm.Conclusion: We highlight the use of an US-guided and fluoroscopy-assisted posterior approach for use in celiac plexus neurolysis procedures, particularly in patients suffering from contraindications from the US or EUS-guided anterior approaches.Keywords: ultrasound, image-guidance, posterior approach, celiac plexus neurolysis, pancreatic cancer, abdominal pain

Yongheng Ye1 ,* Lingli Zhang2 ,* Yuhu Dai,1 Zhi Wang,3 Cuie Li,3 Yue Peng,4 Dong Ma,2 Peiheng He1 1Department of Orthopedic Surgery, Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangzhou, Guangdong Province 510080, People’s Republic of China; 2Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou 510632, People’s Republic of China; 3Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, Guangdong Province 510530, People’s Republic of China; 4Department of Otorhinolaryngology Head and Neck Surgery, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province 519000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Peiheng HeDepartment of Orthopedic Surgery, Guangdong Prov Key Laboratory Orthopaed & Traumatol, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province 510080, People’s Republic of ChinaEmail hepeiheng@mail.sysu.edu.cnDong MaKey Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou 510632, People’s Republic of ChinaEmail tmadong@jnu.edu.cnObjective: This study aimed to develop aptamer-anchored hyperbranched poly(amido amine) (HPAA) for the systemic delivery of miRNA-133a-3p and to evaluate its therapeutic potential against bone metastasis of prostate cancer in vivo and in vitro.Methods: A glutathione (GSH)-responsive cationic HPAA was prepared by the Michael addition reaction. Furthermore, HPAA-PEG was produced by PEGylation, and then the aptamer targeted to prostate-specific membrane antigen (PSMA) was conjugated to the HPAA-PEG. The obtained HPAA-PEG-APT could form nanocomplexes with miRNA-133a-3p through electrostatic adsorption.Results: The results of immunocytochemistry indicated that the complexes could target PSMA-expressing LNCaP cells. The ability of HPAA-PEG-APT to facilitate the delivery of miRNA-133a-3p into LNCaP cells was proven, and HPAA-PEG-APT/miRNA-133a-3p demonstrated enhanced antitumor activity, lower cytotoxicity and better biocompatibility in vitro. Moreover, in a mouse tibial injection tumor model, the intravenous injection of the HPAA-PEG-APT/miRNA-133a-3p complex significantly inhibited cancer growth and extended the survival time.Conclusion: This study provided an aptamer-anchored HPAA-loaded gene system to deliver miRNA-133a-3p for better therapeutic efficacy of bone metastasis of prostate cancer.Keywords: miRNA, aptamer, hyperbranched polyamide amine, bone metastasis, prostate cancer

Donghe Ma,1 Yan Zhang,2 Guanghua Chen,3 Jia Yan1 1Digestive Department, University-Town Hospital of Chongqing Medical University, Chongqing 401331, People’s Republic of China; 2Neurology Department, People’s Hospital of Hechuan Chongqing, Chongqing 401520, People’s Republic of China; 3Dermatology Department, Children’s Hospital of Chongqing Medical University, Chongqing 400014, People’s Republic of ChinaCorrespondence: Jia Yan Tel +86-17782351875Fax +86-23-65715900Email yanjia19850730@163.comPurpose: The objective of this study was to investigate the effect of miR-148a on the polarization and recruitment of tumor-associated macrophages (TAMs).Methods: In human monocyte THP-1 cells, M1 or M2 differentiation was induced by phorbol 12-myristate 13-acetate (PMA) with specific induction supplements and identified using flow cytometry and ELISA. To alter cellular miR-148a expression level, THP-1 cells were transfected with miR-148a mimics or inhibitors. A dual-luciferase assay was used to determine whether miR-148a could directly regulate the expression of signal regulatory protein α (SIRPα). Expression of miR-148a and SIRPα was detected with RT-PCR or Western blot. A co-culture system of THP-1 cells and colorectal cancer SW480 cells was used for TAM induction. The recruitment of macrophage to SW480 cells was measured using chemotaxis assay. In SW480 cells, apoptosis induced by macrophages was detected using flow cytometry and a xenograft assay. Macrophage infiltration was detected by immunofluorescence assay in tumor tissues.Results: miR-148a over-expression increased M1-related CD86 expression in THP-1 cells and promoted differentiation to M1-like macrophages. Inhibition of miR-148a increased M2-related CD206 expression and promoted differentiation to M2-like macrophages. In the co-culture system, THP-1 cells were induced to the M2-like state by SW480 cells. The level of miR-148a negatively correlated with the levels of M2-related cytokines. Additionally, miR-148a expression level was negatively associated with macrophage recruitment by colorectal cancer cells. Furthermore, in miR-148a over-expression, the number of macrophages recruited by SW480 cells was reduced. Meanwhile, cancer cell apoptosis induced by macrophages was enhanced. Thus, miR-148a expression was beneficial for the transformation of macrophages, from an immune-suppressive status to an immune-promoting status. These anti-cancer effects of miR-148a were related to the down-regulation of SIRPα in macrophages, directly targeted by miR-148a. A xenograft assay showed that the co-inoculation of macrophages over-expressing miR-148a reduced subcutaneous tumorigenesis and M2 macrophage infiltration.Conclusion: miR-148a promoted the differentiation of M0 macrophages into anti-tumor classical activation type M1, and reduced TAM recruitment by targeting SIRPα to inhibit colorectal cancer cell viability.Keywords: colorectal cancer, tumor-associated macrophage, microRNA-148a, polarization, signal regulatory protein alpha

Qi Jia,1 Fan Jiang,2 Daliang Ma,1 Jun Li,1 Fan Wang,1 Zhiqiang Wang1 1Encephalopathy Center, The Third People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People’s Republic of China; 2Neonatal Intensive Care Unit, The First People’s Hospital of Urumqi, Urumqi 830000, People’s Republic of ChinaCorrespondence: Zhiqiang WangEncephalopathy Center, The Third People’s Hospital of Xinjiang Uygur Autonomous Region, No. 168, Nanchang Road, Urumqi 830000, People’s Republic of ChinaTel/ Fax +86-9917530284Email xjwjwzq@163.comPurpose: To study the association between IL-6 level and seizure recurrence in patients with the first post-ischemic stroke seizure and assess its predictive value for seizure recurrence.Patients and Methods: A total of 2976 consecutive ischemic stroke patients were retrospectively enrolled. Among them, 209 (7.02%) patients with the first post-ischemic stroke seizure were included in this analysis. The IL-6 mRNA expression level was evaluated through quantitative real-time PCR (qRT-PCR) and the 2−ΔΔCt method. Demographic data and clinical characteristics were collected. Univariate analysis was performed with independent-samples t-test, Mann–Whitney U-test, or chi-square test. Multivariate analysis was conducted using a backward stepwise logistic regression model for variables with P< 0.10 in univariate analysis. The predictive value was assessed using a receiver operating characteristic (ROC) curve.Results: Among the patients included, 105 (50.24%) had recurrence of seizures, and 104 (49.76%) had no recurrence. Multivariate analysis demonstrated that the IL-6 mRNA expression level was independently correlated with seizure recurrence in patients with the first post-ischemic stroke seizure after adjusting for age, NIHSS scores, time of seizure, seizure type, lesion size, location of the offending lesion to different hemispheric lobes, cortical involvement, gender, electroencephalography (EEG) findings, and hemorrhagic transformation. When the IL-6 mRNA expression level was used to predict seizure recurrence, the area under the ROC curve (AUC) was 0.763 (SE=0.033, 95% CI=0.698– 0.829). The diagnostic power was moderate.Conclusion: IL-6 was independently correlated with seizure recurrence in patients with the first post-ischemic stroke seizure and might be a potential biomarker for prediction of seizure recurrence.Keywords: post-ischemic stroke seizure, seizure recurrence, IL-6, predictive value

Soyeon Bang,1 Junhong Li,2 Meiqin Zhang,3 Renjie Cui,3 Xingwen Wu,4 Zhaochen Xin,1 Duan Ma,3,5 Jin Zhang,3 Hongwei Zhang1 1Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Urology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China; 3Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 4Department of Dentistry, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 5Children’s Hospital, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Hongwei ZhangDepartment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, People’s Republic of ChinaTel +86-13681973106Fax +86 21-64038472Email zhang.hongwei@zs-hospital.sh.cnDuan MaKey Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, 130 Dong an Road, Xuhui District, Shanghai 200032, People’s Republic of ChinaTel +86-13916126452Fax +86 21-54237441Email duanma@shmu.edu.cnBackground: Krüppel-like factor 16 (KLF16), a member of the KLF family, is involved in metabolism and regulation of the endocrine system and has emerging roles in tumor progression. However, the expression of KLF16 and its role in breast cancer are elusive.Methods: We investigated the expression and prognostic value of KLFs in breast cancer using data acquired from the TCGA BRCA dataset and the Kaplan–Meier plotter dataset. The protein levels of KLF16 in breast specimens were detected by immunohistochemistry (IHC). KLF16 silencing using shRNAs was performed to explore the effects of KLF16 on breast cancer cell growth, migration, and invasion. The expression of EMT markers in cells manipulated for KLF16 expression was assessed by Western blotting.Results: Using publicly available dataset and specimens from breast cancer patients, we found that the expression levels of KLF16 were significantly higher in tumor tissues and that high levels of KLF16 were associated with poor prognosis in breast cancer patients. Moreover, KLF16 expression levels had relation to several clinicopathological parameters of breast cancer, including the molecular subtype and histological grade. Importantly, knockdown of KLF16 dramatically suppressed cell proliferation both in vitro and in vivo. Also, KLF16 deletion impaired migration, and invasion in breast cancer cells, and suppressed epithelial–mesenchymal transition (EMT).Conclusion: Our results suggest that KLF16 has important oncogenic functions in breast cancer and that the expression levels of KLF16 are associated with prognosis in breast cancer patients. Our findings also suggest that KLF16 is involved in proliferation, migration, and invasion in breast cancer cells. Thus, KLF16 might be a promising prognostic marker and a therapeutic target for breast cancer.Keywords: breast cancer, EMT, Krüppel-like factor 16, metastasis, proliferation

Lin Zhu,1 Bo Yang,2 Dongxia Ma,3 Lan Wang,4 Wu Duan5 1Department of Pediatrics, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China; 2Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China; 3Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China; 5Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan 250012, People’s Republic of ChinaCorrespondence: Wu DuanDivision of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan 250012, People’s Republic of ChinaTel/ Fax +86-531-8692-7544Email duan5wu@qq.comAbstract: Hydrogen sulfide (H2S) is now increasingly considered to be the third gasotransmitter alongside other gaseous signaling molecules, nitric oxide (NO) and carbon monoxide (CO). H2S is produced by a variety of endogenous enzymatic and non-enzymatic pathways and acts as a modulator of the physiological and pathological events of the body. Adipocytes express the cystathionine γ lyase (CSE)/H2S system, which modulates a variety of biological activities in adipose tissue (AT), including inflammation, apoptosis, insulin resistance, adipokine secretion and adipocyte differentiation. Abnormalities in the physiological functions of AT play an important role in the process of diabetes mellitus. Therefore, this review provides an overview of the general aspects of H2S biochemistry, the effect of H2S on AT function and diabetes mellitus and its molecular signalling mechanisms as well as the potential application of H2S in pharmacotherapy.Keywords: hydrogen sulfide, adipose tissue, diabetes mellitus, drug therapy

Jun Jiao,1 Xinlin Jiao,1 Qingqing Liu,1 Wenjie Qu,1 Daoxin Ma,2 Youzhong Zhang,1 Baoxia Cui1 1Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, People’s Republic of China; 2Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan 250012, People’s Republic of ChinaCorrespondence: Baoxia Cui Tel +8618560081862Email cuibaoxia@sdu.edu.cnPurpose: Accumulating evidence indicates that circular RNAs (circRNAs) are closely involved in canceration and cancer progression. However, the role of circRNAs in cervical cancer (CC) is largely unknown. Here, we characterized the role of circRNA_101308 in CC.Materials and Methods: The expression of circRNA_101308 in CC tissues was measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Then, circRNA_101308 was overexpressed in CC cells to detect its function by proliferation and apoptosis assays, Transwell assays and animal experiments. The potential mechanism of circRNA_101308 in CC was explored by RNA pull-down, Gene Ontology (GO) and pathway analyses.Results: CircRNA_101308 was significantly downregulated in CC tissues. The level of circRNA_101308 was much lower in CC patients with lymph node metastasis or deep myometrial invasion compared to those patients without lymph node metastasis and superficial myometrial invasion. CircRNA_101308 overexpression inhibited CC cell proliferation, invasion and migration. MiR-26a-5p, miR-196a-5p, miR-196b-5p, miR-335-3p, and miR-1307-3p were found to be sponged by circRNA_101308 in CC cells. Further, GO and pathway analyses predicted the potential functional processes and pathways of circRNA_101308 in CC.Conclusion: CircRNA_101308 is downregulated and acts as a tumor suppressor in CC. CircRNA_101308 can participate in many different processes by sponging different miRNAs in CC cells. This exploration of circRNA_101308 provides new directions for research on cancer development and the clinical treatment of CC.Keywords: circular RNA, cervical cancer, circRNA_101308, microRNA

Yanshuang Liu,1,2,* Yingran Liang,3,* Bin Zheng,3 Li Chu,3 Donglai Ma,3 Hongfang Wang,3 Xi Chu,4 Jianping Zhang2,5 1Department of Diagnostics, School of Integrated Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China; 2Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Shijiazhuang 050200, Hebei, People’s Republic of China; 3Department of Pharmaceutics, School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China; 4Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, People’s Republic of China; 5Department of Pharmacology, School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xi ChuThe Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei, People’s Republic of ChinaTel/Fax +86 311 86095324Email chux2014@126.comJianping ZhangSchool of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, People’s Republic of ChinaTel/Fax +86 311 89926719Email zhangjianping14@126.comPurpose: Arsenic trioxide (ATO) has been shown to induce hepatic injury. Crocetin is a primary constituent of saffron, which has been verified to have antioxidant and anti-inflammatory effects. In the current experiment, we evaluated the efficacy of crocetin against ATO-induced hepatic injury and explored the potential molecular mechanisms in rats.Methods: Rats were pretreated with 25 or 50 mg/kg crocetin 6 h prior to treating with 5 mg/kg ATO to induce hepatic injury daily for 7 days.Results: Treatment with crocetin attenuated ATO-induced body weight loss, decreases in food and water consumption, and improved ATO-induced hepatic pathological damage. Crocetin significantly inhibited ATO-induced alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) increases. Crocetin prevented ATO-induced liver malondialdehyde (MDA) and reactive oxygen species (ROS) levels. Crocetin abrogated the ATO-induced decrease of catalase (CAT) and superoxide dismutase (SOD) activity. Crocetin was found to significantly restore the protein levels of interleukin 6 (IL-6), interleukin 1β (IL-1β), and tumor necrosis factor-alpha (TNF-α). Furthermore, crocetin promoted the expression of nuclear factor erythroid 2 related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and NADP(H): quinone oxidoreductase 1 (NQO1).Conclusion: These findings suggest that crocetin ameliorates ATO-induced hepatic injury in rats. In addition, the effect of crocetin might be related to its role in antioxidant stress, as an anti-inflammatory agent, and in regulating the Nrf2 signaling pathway.Keywords: crocetin, arsenic trioxide, hepatotoxicity, oxidative stress, inflammation, Nrf2 signaling pathway

Luo Zhao, Yingzhi Qin, Dongjie Ma, Li Li, Zhijun Han, Shanqing Li, Hongsheng Liu Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, People’s Republic of ChinaCorrespondence: Hongsheng LiuDepartment of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, People’s Republic of ChinaTel +86 18519667758Fax +86 10 69152630Email pumchlhsnj@163.comPurpose: To assess the use of video-assisted thoracoscopic surgery to treat lung metastases from refractory choriocarcinoma.Patients and Methods: We reviewed patients diagnosed with refractory choriocarcinoma who underwent lung resection by video-assisted thoracoscopic surgery combined with chemotherapy between October 2013 and August 2019 at the Peking Union Medical College Hospital. The surgical records, pathologic findings and survival rates were analyzed.Results: The study included 73 patients who underwent 78 thoracoscopic surgeries. Most patients underwent lobectomy (48.7%), and 17 patients (21.8%) underwent resection of more than one lobe. The median operation time and bleeding volume were 95 minutes and 50 mL, respectively. The median duration of chest tube use and hospital stay were 3 days and 4 days, respectively. Postoperative complications were documented in 6 patients (7.7%). The thoracic lymph nodes were harvested in 51 patients (65.4%), but none of these patients had positive nodes. A total of 69.2% of the patients had positive pathologic findings. The mean follow-up time was 30 months. During follow-up, 11 patients experienced disease relapse, and 2 of them died because of brain metastasis. The overall disease-free rate was 83.6%, and the survival rate was 97.0% after excluding those lost to follow-up. Patients with decreased postoperative β-hCG showed a higher disease-free rate during follow up (P< 0.05).Conclusion: The minimally invasive video-assisted thoracoscopic approach is a valuable and safe treatment for refractory choriocarcinoma patients with lung metastases. Lymphadenectomy is not suggested for these patients. Patients with decreased postoperative β-hCG levels may achieve a much better prognostic result.Keywords: video-assisted thoracoscopic surgery, lung metastases, choriocarcinoma

Danyan Ma,1,* Xuanlin Zheng,2,* Lianqin Dong,3 Caiyu Zheng,4 Yun Chen,3 Zheng Chen,2 MingZhu Lin,2 Xuejun Li,5 Zhibin Li,6 Changqin Liu3,7 1School of Medicine, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China; 2Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China; 3The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China; 4Fujian Medical University Xiamen Humanity Hospital, Xiamen City, Fujian Province, People’s Republic of China; 5Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen Diabetes Institute, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China; 6Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China; 7Department of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Changqin LiuDepartment of Endocrinology and Diabetes, Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of ChinaTel +86-592-2137610Fax +86-592-2137557Email liuchangqin@xmu.edu.cnZhibin LiEpidemiology Research Unit, The First Affiliated Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of ChinaTel +86-592-2137364Fax +86-592-2137557Email zhibinli33@hotmail.comObjective: To explore the association of serum vitamin-D levels with the severity of obstructive sleep apnea (OSA) in patients with type 2 diabetes mellitus (T2DM).Methods: A cross-sectional study of 136 patients with T2DM who underwent overnight polysomnography (PSG) tests and serum 25‐hydroxyvitamin‐D3 (25(OH)D3) level detections was conducted. Multivariable linear regression and logistic regression analyses were performed to determine the associations of serum 25(OH)D3 levels with apnea–hypopnea index (AHI) and obstructive sleep apnea (OSA).Results: The prevalence rates of OSA were 84.4% for male and 65.2% for female patients, respectively (p = 0.011). With increasing severities of OSA categories (none, mild, moderate and severe), patients were more likely to be male and obese, but there was no significant difference in serum 25(OH)D3 level ((mean ± standard deviation) 21.8 ± 8.8, 27.7 ± 14.6, 24.2 ± 9.8 and 26.8 ± 6.2 ng/mL, respectively, p=0.086). Serum 25(OH)D3 level was not significantly correlated with AHI (log-transformed), with the correlation coefficient of 0.133 (p=0.124). With adjustment for potential confounding factors, multivariable linear regression and logistic regression analyses showed that serum 25(OH)D3 level was not significantly associated with either AHI (log-transformed) or the risk of OSA, with the standardized regression coefficient (95% confidence interval (CI)) of 0.098 (− 0.004– 0.014, p=0.252) and the adjusted odds ratio (95% CI) of 1.055 (0.991– 1.124, p=0.095), respectively.Conclusion: Serum 25(OH)D3 level was not significantly associated with either AHI or the risk of OSA in patients with T2DM.Keywords: obstructive sleep apnea, polysomnography, 25-hydroxyvitamin-D3, apnea–hypopnea index, type 2 diabetes mellitus

Song Yao,1,* Junwei Yan,2,* Ling Li,1 Dongchun Ma,1 Jie Liu,1 Qing Wang,1 Aimin Wang,1 Fangjin Bao,1 Zekun Zhang,1 Xundi Bao1 1Tuberculosis Prevention and Treatment Institute of Anhui Province (Anhui Chest Hospital), Hefei 230022, Anhui, People’s Republic of China; 2Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People’s Hospital, Anhui Metal Health Center, Hefei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Junwei Yan No. 316, Huangshan Road, Hefei 230022, Anhui, People’s Republic of ChinaTel/Fax +86-551-63658250Email 594347807@qq.comBackground: Multidrug-resistant tuberculosis (MDR-TB) is currently a major problem in China. The prevention and treatment work for MDR-TB patients started late in Anhui province. To determine the prevalence of MDR-TB in sputum smear-positive TB patients (SSPTBPs) and analyze the risk factors for MDR-TB in Anhui province, we conducted an investigation of drug resistance among SSPTB outpatients from September 2015 to August 2016.Methods: A stratified cluster-randomized sampling method was used to obtain a representative sample. It was estimated that 2290 new cases and 440 previously treated cases of SSPTBPs needed to be recruited from 40 survey sites. Isolates were tested for resistance to six first-line and second-line anti-TB drugs. Information from patient questionnaire survey was used to identify factors linked to MDR-TB.Results: Finally, a total of 3047 SSPTBPs were recruited from 40 survey sites; of these, 2530 specimens were successfully cultured and had drug susceptibility testing done. The proportions of rifampin resistant (RR)-TB were 11.42% (289/2530, 95% CI: 10.18– 12.66%), 7.64% (163/2133, 95% CI: 6.38– 8.62%) and 31.74% (126/397, 95% CI: 27.38– 36.60%) in all cases, new cases and previously treated cases, respectively, and the proportions of confirmed MDR-TB were 7.63% (193/2530, 95% CI: 6.59– 8.66%), 4.97% (106/2133, 95% CI: 4.05– 5.89%) and 21.91% (87/397, 95% CI: 17.83– 26.00%), respectively. The ofloxacin resistance rate in previously treated SSPTBPs reached 21.66% (95% CI: 17.33– 26.75%). Patients who had received two or more anti-TB treatment courses were significantly associated with MDR-TB compared to patients who have received one anti-TB course.Conclusion: MDR-TB prevalence was high among SSPTBPs in Anhui province, and past anti-TB treatment course was associated with MDR-TB.Keywords: drug resistance, multidrug-resistant, Mycobacterium tuberculosis, tuberculosis

Jian Cao,1,2,* Zhixu Liu,1,* Dongyang Ma,2 Shunyao Shen,1 Xudong Wang1 1Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery, The 940th Hospital of People’s Liberation Army, Lanzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xudong WangDepartment of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai 200011, People’s Republic of ChinaTel +86 21 53315159Email xudongwang70@hotmail.comPurpose: Although negative pressure wound therapy (NPWT) has been widely used in complicated wound care, there are still some obstacles regarding its use in the treatment of severe deep fascial space infections in the head and neck. The purpose of this study is to describe a new modified usage of NPWT and investigate the clinical efficacy of this system in a consecutive case series of severe deep fascial space infections.Methods: The investigators implemented a new modification of NPWT for the management of severe deep fascial space infections. In this new system, the half-plugged bar-shaped foam material was arranged along with the through-and-through side-holed latex drainage tube, which could maintain negative pressure in the distal part of the spaces, and the tube was easy to remove 5– 7 days after surgery. Twelve patients had severe deep fascial space infections in the head and neck with a direct threat to the airway. The median time of removal of the NPWT device, the median amount of drainage fluid and the median healing time were investigated.Results: A total of 7 male and 5 female patients with an average age of 63.2 years old were included in this study. The median time of removal of the NPWT device was 6 days (ranging from 4 to 7 days). The median amount of drainage fluid within 3 days after surgery was 420 mL (ranging from 280– 760 mL), and the median time for complete wound healing was 12 days (ranging from 10 to 21 days).Conclusion: The results of this study suggest that the modification of NPWT provides various advantages and leads to excellent clinical outcomes in the treatment of severe deep fascial space infections. Future studies will focus on the safety verification of portable usage and the cost effectiveness analysis of NPWT.Keywords: negative pressure wound therapy, severe deep fascial space infections, modified usage, head and neck

Zhifeng Zhao, 1,* Miaomiao Liu, 1,* Yuanyuan Zhang, 1 Yingran Liang, 1 Donglai Ma, 1 Hongfang Wang, 1 Zhihong Ma, 2 Shengjiang Guan, 2 Zhonglin Wu, 3 Xi Chu, 3 Yue Lin, 2 Li Chu 1, 4 1School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, People’s Republic of China; 2School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, People’s Republic of China; 3The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei, People’s Republic of China; 4Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Shijiazhuang 050200, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Li ChuSchool of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, People’s Republic of ChinaEmail chuli0614@126.comYue LinSchool of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, People’s Republic of ChinaTel/Fax +86 311 89926718Email yuelin8992@126.comPurpose: Monoammonium glycyrrhizinate (MAG) is an aglycone of glycyrrhizin that is found in licorice and is often used clinically as an injection to treat liver diseases. However, the effect of MAG injection on cardiac function and its possible cellular mechanisms remain unclear. We explored the protective effects of MAG against myocardial ischemic injury (MII) induced by isoproterenol (ISO), as well as the cellular mechanisms via molecular biology techniques and patch-clamp recording.Methods: A rat model of myocardial ischemia injury was induced by administering ISO (85 mg/kg) subcutaneously for 2 consecutive days. ECG, cardiac functional parameters, CK and LDH levels, SOD and GSH activities, MDA concentration, histological myocardium inspection, mitochondria ultrastructure changes, intracellular calcium concentrations were observed. Influences of MAG on ICa-L and contraction in isolated rat myocytes were observed by the patch-clamp technique.Results: MAG reduced damage, improved cardiac morphology, inhibited oxidative stress, decreased the generation of reactive oxygen species, and decreased intracellular Ca 2+ concentration. Exposure of the rats’ ventricular myocytes to MAG resulted in a concentration-dependent reduction in L-type calcium currents (ICa-L). MAG reduced ICa-L in a consistent and time-dependent fashion with a semi-maximal prohibitive concentration of MAG of 14 μM. MAG also shifted the I-V curve of ICa-L upwards and moved the activation and inactivation curves of ICa-L to the left.Conclusion: The findings indicate that MAG injection exerts a protective influence on ISO-induced MII by inhibiting oxidative stress and regulating Ca 2+ homeostasis by ICa-L.Keywords: cardiopretection, reactive oxygen species, calcium influx, isoproterenol, calcium concentration

A high-resolution (40km horizontal) global model is used to examine controls on the South Asian summer monsoon by orography and surface heat fluxes. In a series of integrations with altered topography and reduced surface heat fluxes, monsoon strength, as indicated by a vertical wind shear index, is highly correlated with the amplitude of the maximum boundary layer equivalent potential temperature (θeb) over South Asia. Removal of the Tibetan Plateau while preserving the Himalayas and adjacent mountain ranges has little effect on monsoon strength, and monsoon strength decreases approximately linearly as the height of the Himalayas is reduced. In terms of surface heat flux changes, monsoon strength is most sensitive to those in the location of the θeb maximum just south of the Himalayas. These results are consistent with the recent idea that topography creates a strong monsoon by insulating the thermal maximum from dry extratropical air. However, monsoon strength is found to be more sensitive to variations in the θeb maximum when topography is altered than when surface heat fluxes are reduced, and it is suggested that free-tropospheric humidity changes lead to deviations from strict convective quasi equilibrium and cause this difference. When topography is reduced, dry extratropical air intrudes into the troposphere over the θeb maximum and is entrained by local deep convection, requiring a higher θeb to achieve convective equilibrium with a given upper-tropospheric temperature and associated balanced monsoon flow. These results illustrate potential complexities that need to be included in simple theories for monsoon strength built on strict convective quasi equilibrium. © 2014 American Meteorological Society.

Fan Yang,1,2 Xu Xia Wang,1,3 Dan Ma,1,2 Qun Cui,1,2 De Hua Zheng,1,2 Xiao Can Liu,1,2 Jun Zhang1,2 1Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong Province, People’s Republic of China; 2Department of Orthodontics, School of Stomatology, Shandong University, Jinan, Shandong Province, People’s Republic of China; 3Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, Shandong Province, People’s Republic of ChinaCorrespondence: Jun ZhangDepartment of Orthodontics, School of Stomatology, Shandong University, 44 Wenhua West Road, Jinan 250012, People’s Republic of ChinaTel +86 139 5310 9816Fax +86-531-88565657Email zhangj@sdu.edu.cnPurpose: The aim of this study was to investigate the effects of triptolide on the tooth movement and root resorption in rats during orthodontic treatment.Material and methods: A total of 48 male Wistar rats were divided into three groups of 16 each. The right maxillary first molars of rats were drawn mesially by closed coil nickel–titanium spring with a force of 50 g. The two experimental groups received intraperitoneal injections of triptolide for 14 days at a dose of 15 μg/kg/day and 30 μg/kg/day, respectively. The control group received vehicle injections. After 14 days, the rats were humanely killed. The amount of tooth movement was measured. Eight rats from each group were randomly chosen for analysis of the percentage of root resorption area by scanning electron microscopy. For the remaining eight rats in each group, the H&E staining, tartrate-resistant acid phosphatase (TRAP) staining and immunohistochemistry analysis were performed.Results: The amount of tooth movement and the ratio of root resorption area were significantly decreased in the triptolide-treated rats. The number of TRAP-positive cells was significantly lower in triptolide-treated groups. Moreover, the expression of nuclear factor kappa B ligand (RANKL) was reduced. In contrast, the expression of osteoprotegerin was significantly up-regulated. In the tension side, the expressions of runt-related transcription factor 2 and osteocalcin were significantly enhanced by triptolide injection.Conclusion: Triptolide injection could arrest orthodontic tooth movement and reduce root resorption in rats via inhibition of osteoclastogenesis. In addition, triptolide may exert a positive effect on osteoblastogenesis.Keywords: triptolide, osteoclast, scanning electron microscope, tooth movement, bone formation

Wen-Xiu Yuan,1 Xu-Xia Wang,2 De-Hua Zheng,1 Dan Ma,1 Qun Cui,1 Fan Yang,1 Jun Zhang1 1Department of Orthodontics, School and Hospital of Stomatology, Shandong University and Shandong Provincial Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong Province, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Shandong University and Shandong Provincial Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong Province, People’s Republic of ChinaCorrespondence: Jun ZhangDepartment of Orthodontics, School and Hospital of Stomatology, Shandong University and Shandong Provincial Key Laboratory of Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, Shandong Province, People’s Republic of ChinaTel +86 139 5310 9816Email zhangj@sdu.edu.cnObjectives: This study was performed to evaluate the effects of muscone on the proliferation, migration and differentiation of human gingival mesenchymal stem cells (GMSCs) and to explore the relevant mechanisms.Materials and methods: We performed studies to determine the effects and mechanisms of muscone on GMSC proliferation, migration and differentiation. We conducted CCK-8, colony formation, transwell chamber, scratch wound, alkaline phosphatase (ALP) staining and activity, and alizarin red and oil red O staining assays, as well as real-time quantitative polymerase chain reaction (qRT-PCR), to ascertain the effects of muscone on GMSC proliferation, migration and differentiation in vitro. The mechanism by which muscone influences the osteogenic and adipogenic differentiation of GMSCs was elucidated by qRT-PCR and Western blotting.Results: We found that muscone significantly promoted GMSC proliferation, chemotaxis, wound healing and fat droplet formation and inhibited ALP activity and mineral deposition. Notably, we observed that the Wnt/β-catenin pathway was closely related to the ability of muscone to inhibit the osteogenic differentiation and promote the adipogenic differentiation of GMSCs. The effect of muscone on the multidirectional differentiation capacity of GMSCs was significantly reversed by the agonist lithium chloride through the Wnt/β-catenin signaling pathway.Conclusion: Muscone effectively increased the proliferation and migration, promoted the adipogenic differentiation and inhibited the osteogenic differentiation of GMSCs by inhibiting the Wnt/β-catenin signaling pathway. These results may provide a theoretical basis for the application of GMSCs and muscone in tissue engineering and regenerative medicine.Keywords: muscone, gingival mesenchymal stem cells, GMSCs, differentiation, Wnt/β-catenin signaling pathway, proliferation, chemotaxis

Hongge Liang1, Di Ma2, Yan Xu1, Jing Zhao1, Minjiang Chen1, Xiaoyan Liu1, Wei Zhong1, Junling Li2, Mengzhao Wang1 1Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Oncology, Chinese Academy of Medical Sciences Cancer Institute and Hospital, Beijing, People’s Republic of ChinaCorrespondence: Wei ZhongDepartment of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, No. 1 Shuanfuyuan Wangfujing Dongcheng District, Beijing 100730, People’s Republic of ChinaTel +86 0 106 915 5039Email zw_pumch@126.comMengzhao WangDepartment of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, No. 1 Shuanfuyuan Wangfujing Dongcheng District, Beijing 100730, People’s Republic of ChinaTel +86 0 106 915 5154Email mengzhaowang@sina.comBackground: Targeted therapy is an important treatment for advanced non-small cell lung cancer (NSCLC) patients with specific genetic mutations, crizotinib can prolong survival in advanced NSCLC patients with echinoderm microtubule-associated protein-like 4–anaplastic lymphoma kinase (EML4-ALK) rearrangement. We performed a retrospective analysis to investigate the association between the lactate dehydrogenase (LDH) levels and progression-free survival (PFS) in patients with EML4-ALK rearrangement NSCLC receiving treatment with crizotinib.Methods: Advanced (stage IIIb–IV) NSCLC patients with EML4-ALK rearrangement receiving treatment with crizotinib were enrolled between January 2007 and January 2016 at Peking Union Medical College and Cancer Hospital Chinese Academy of Medical Sciences.Results: Overall, 212 patients were enrolled. Kaplan–Meier univariate analysis showed that elevated pre-treatment LDH level (7.9 vs 14.1 months, HR =1.251, CI: 1.008–1.553, P=0.004) was significantly associated with shorter PFS, while the post-treatment mean-LDH level (13.3 vs 14.3 months, HR=1.439, 95% CI: 0.994–2.082, P=0.970) was not significantly associated with PFS. Cox proportional hazards model also identified that pre-treatment LDH level (HR=2.085, 95% CI: 1.150–3.781, P=0.016) was associated with the PFS. Logistic regression analysis showed that post-treatment LDH level was associated with creatine kinase (OR=6.712, 95% CI 3.395–13.273, P250 U/L) was significantly associated with shorter PFS in patients with EML4-ALK rearrangement NSCLC. Post-treatment elevated serum LDH level was not significantly associated with PFS, which related to adverse events including muscle damage and anemia.Keywords: non-small cell lung cancer, lactate dehydrogenase, crizotinib, echinoderm microtubule-associated protein-like 4–anaplastic lymphoma kinase, progression-free survival

De-Hua Zheng,1 Xu-Xia Wang,2 Dan Ma,1 Li-Na Zhang,3 Qing-Fang Qiao,1 Jun Zhang41Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong Province, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery, School of Dentistry, Shandong University, Jinan, Shandong Province, People’s Republic of China; 3Department of Orthodontics, Liaocheng People’s Hospital, Liaocheng, Shandong Province, People’s Republic of China; 4Department of Orthodontics, School of Stomatology, Shandong University, Jinan, Shandong Province, People’s Republic of ChinaObjectives: The aim of this study is to examine the roles of erythropoietin (EPO) in regulating proliferation and osteogenic differentiation of periodontal ligament stem cells (PDLSCs) and analyze the underlying signaling of these processes.Materials and methods: PDLSCs were isolated and characterized. The PDLSCs were transfected with β-catenin shRNA. qRT-PCR and Western blot analysis were used to examine the osteogenic effects of EPO on the expression of osteogenic-related genes and protein (Runx2, OCN and Osterix) in PDLSCs. Alizarin Red-S staining was used to detect mineralized nodule formation. In addition, the relationship between the Wnt/β-catenin pathway and the effect of EPO on the osteogenesis of PDLSCs was investigated.Results: The results suggested that EPO exerts positive osteogenic effects on PDLSCs. The results showed that EPO decreased the growth of PDLSCs slightly and increased alkaline phosphatase activity and calcium deposition in a dose-dependent manner. The expression of Runx2, Osterix and OCN was increased after EPO administration. EPO increases β-catenin and Cyclin D1 in PDLSCs. After transfected with β-catenin shRNA, the osteogenic effect of EPO on PDLSCs was attenuated.Conclusion: EPO promotes osteogenic differentiation of PDLSCs. The underlying mechanism may be activating Wnt/β-catenin signaling pathway.Keywords: erythropoietin, periodontal ligament stem cell, osteogenesis, Wnt/β-catenin