Morroniside exerts a proosteogenic effect, which can prevent bone loss. However, the detailed mechanism underlying Morroniside-regulated bone formation is unclear. Morroniside can maintain cell homeostasis by promoting PI3K/Akt/mTOR signaling. The purpose of this study is to explore the significance of PI3K/Akt/mTOR signaling in Morroniside-regulated osteogenesis. The results showed that Morroniside promoted the activities of PI3K, Akt, and mTOR in osteoblast precursor MC3T3-E1. The differentiation of MC3T3-E1 to mature osteoblasts promoted by Morroniside can be reversed by the pharmacological inhibition of PI3K or mTOR. Importantly, in the presence of Morroniside, the osteoblast differentiation suppressed by PI3K inhibitor was reversed by mTOR overexpression. In vivo assays showed that in bone tissue of ovariectomized mice, Morroniside-enhanced osteoblast formation was reversed by the pharmacological inhibition of PI3K or mTOR. In conclusion, Morroniside can promote the osteogenesis through PI3K/Akt/mTOR signaling, which provides a novel clue for the strategy of Morroniside in treating osteoporosis.

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Background: This study prospectively explored the clinical effect of a reversed digital artery island flap (RDAIF) in repairing fingertip defects and the impact of the anastomosis of superficial veins in the recipient area on the incidence of venous crisis. Methods: A total of 92 patients with fingertip defects who underwent RDAIF from February 2016 to February 2018 were enrolled in this prospective, randomized, controlled trial. Of these, 44 patients underwent superficial vein anastomosis. The perioperative data, clinical efficacy and complications of the two groups were compared by the chi-squared test and binary logistic regression analysis. Results: The average follow-up time was 7.0 ± 2.9 months. The incidence of venous congestion was significantly correlated with flap size, surgical time and anastomosis of superficial veins (Wald = 6.512, 9.353 and 11.662; P = 0.011, 0.002 and 0.001, respectively). The fingertips of the two groups of patients were well repaired, wear resistant and stable in holding, and the two-point discrimination was 5-8 mm. Conclusion: RDAIF is a safe and effective method for the treatment of fingertip defects, especially in patients who require maintenance of function or contour of the fingertip. Anastomosis of the superficial veins and reduction of the flap area and surgical time can significantly reduce the incidence of venous congestion.