Abstract:Objective: To systematically explore the pharmacokinetic distribution characteristics of the natural coumarin compound Auraptene in mice, as well as its improving effects and molecular mechanism on depression-like behavior induced by chronic unpredictable mild stress (CUMS). Methods: Male C57BL/6N mice were intraperitoneally administered Auraptene (AUR). Plasma and brain samples were subsequently collected at predetermined time points. High-performance liquid chromatography (HPLC) was used to evaluate its blood-brain barrier (BBB) penetration. Mice were randomly divided into control (CON) group, model (CUMS) group, AUR (15 mg/kg) group, and fluoxetine (Flx, 20 mg/kg) group, with drug intervention administered simultaneously after 4 weeks of CUMS modeling. Depressive- and anxiety-like behaviors were assessed using the sucrose preference test, open field test, three-chamber social interaction test, and tail suspension test. The expression levels of brain-derived neurotrophic factor (BDNF) in hippocampal tissues were detected by immunofluorescence and Western blot, and the contents of pro-inflammatory factors (IFN-γ, TNF-α) in hippocampal tissues were also measured. Results: Pharmacokinetic analysis showed that AUR was rapidly absorbed following intraperitoneal (i.p.) administration. The peak concentrations (Cmax) in plasma and brain tissue were observed at 30 and 45 minutes post-administration, respectively (Cmax of 1,845±127 ng/mL and 520±97.8 ng/g, respectively). Its plasma elimination half-life (t1/2) was approximately 199 min. The plasma exposure (AUC 0-240 min) over the observation period was 309,720.0 ng·min·mL?1, and the brain-to-plasma partition coefficient (Kp) was about 9.7%, indicating that AUR effectively penetrates the BBB. Behavioral assessments demonstrated that AUR intervention improved sucrose preference (P<0.001), reduced immobility time in the tail suspension test (P<0.001), and alleviated anxiety-like behaviors and social dysfunction (P<0.001). Molecular and biochemical analyses revealed that AUR not only attenuated the CUMS-induced abnormal increase in hippocampal pro-inflammatory factors (e.g., IFN-γ) (P<0.01), but also effectively reversed the CUMS-mediated downregulation of BDNF protein expression, particularly in the DG region (P<0.01). The comprehensive regulatory effect of AUR was comparable to that of the positive control drug, fluoxetine. Conclusion: Auraptene exhibits favorable blood-brain barrier permeability and can effectively ameliorate CUMS-induced depression, anxiety, and social withdrawal. The antidepressant mechanism of AUR may be closely associated with its actions in inhibiting neuroinflammatory responses, maintaining the neurotrophic system, and upregulating BDNF expression in the hippocampus.

Abstract:Objective: To investigate the regulatory effect of butyrate on intestinal epithelial barrier function during enterovirus A71 (EV71) infection and to explore the underlying molecular mechanisms. Methods: An in vitro intestinal epithelial barrier model was established using a Caco-2/HT29-MTX co-culture in Transwell inserts, and an EV71 infection system was subsequently developed. The cells were divided into a control group, an EV71 group, an EV71 + butyrate group, an ANT (GPR41/43 antagonist) + EV71 group, and an ANT + EV71 + butyrate group. Western blot was used to detect the protein expression of GPR41, GPR43, and the tight junction proteins Occludin, Claudin-1, and ZO-1. The secretion level of mucin 2 (MUC2) was measured by ELISA. RT-qPCR was used to measure EV71 RNA levels in the lower chamber of the Transwell system. Results: Compared with the control group, the EV71 group showed decreased expression levels of GPR41, GPR43, and the tight junction proteins Occludin, Claudin-1, and ZO-1 (P<0.05), along with a marked reduction in MUC2 secretion (P<0.05). Compared with the EV71 group, the EV71 + butyrate group exhibited increased expression of the above proteins and elevated MUC2 secretion levels (P<0.05). Compared with the EV71 + butyrate group, the ANT + EV71 + butyrate group exhibited lower expression of GPR41, GPR43, Occludin, Claudin-1, and ZO-1, together with reduced MUC2 secretion (P<0.05). RT-qPCR results showed that EV71 RNA expression was lower in the EV71 + butyrate group than in the EV71 group (P<0.05), whereas it was higher in the ANT + EV71 + butyrate group than in the EV71 + butyrate group (P<0.05). Conclusion: Butyrate may enhance intestinal epithelial barrier function and reduce EV71 transepithelial passage through GPR41/43-related signaling, possibly by upregulating tight junction protein expression and promoting MUC2 secretion.

Abstract:Objective: To investigate the potential role of PANoptosis-related genes (PRGs) in the pathogenesis of SCI using bioinformatics approaches. Methods: The GSE151371 dataset from the Gene Expression Omnibus (GEO) database, comprising 38 SCI samples and 10 healthy control samples, was analyzed. Differential expression analysis, weighted gene co-expression network analysis (WGCNA), and machine learning algorithms were integratively applied to identify key genes associated with SCI. Results: A total of 1,138 differentially expressed genes (DEGs) were identified between SCI patients and healthy controls. Among them, 19 overlapping signature genes were obtained from the intersection of PRGs and WGCNA module genes. Functional enrichment analysis indicated that these genes were mainly involved in the regulation of immune and inflammatory responses, inflammatory cell adhesion and differentiation, and protease-related processes. Machine learning-based feature selection identified 8 hub genes, among which only NOL3 was consistently validated in the independent GSE45006 dataset. Immune infiltration analysis further demonstrated that NOL3 expression was positively correlated with neutrophil and macrophage infiltration, and negatively correlated with multiple T cell subsets, with the strongest negative correlation observed in activated CD8? T cells. Conclusion: NOL3 may play an important role in the pathophysiology of SCI and has potential value as a diagnostic biomarker and therapeutic target.

Abstract:Objective: To compare the efficacy, safety, and pharmacoeconomic profiles of thrombopoietin receptor agonists (TPO-RAs) versus recombinant human interleukin-11 (rhIL-11) in the treatment of chemotherapy-induced thrombocytopenia (CIT) in patients with hematologic malignancies. Methods: A total of 87 patients with CIT secondary to hematologic malignancies were retrospectively enrolled and divided into a TPO-RAs group (n=43) and an rhIL-11 group (n=44) according to treatment regimen. Platelet recovery time, response rate, adverse events, and treatment costs were compared between the two groups. Results: Platelet counts increased with treatment time in both groups, and there was no statistically significant difference in the trend of change between the groups (P>0.05). There was no statistically significant difference in platelet counts between the two groups at each time point after treatment (P>0.05). The attainment rates of platelet count recovery to >50×10?/L, >75×10?/L, and >100×10?/L in the TPO-RAs group were 83.7%, 76.7%, and 60.5%, respectively, while those in the rhIL-11 group were 75.0%, 65.9%, and 52.3%, respectively. There was no statistically significant difference in attainment rate and median recovery time between the two groups (P>0.05). Multivariate Cox regression showed that baseline platelet level was an independent influencing factor for platelet recovery (P<0.05), while treatment group did not show statistical significance with platelet recovery (P>0.05). The incidence of adverse events in the TPO-RAs group was lower than that in the rhIL-11 group (P<0.05). In the cost analysis, there was no statistically significant difference in total cost between the two groups (P>0.05), but the total cost of the eltrombopag subgroup was the lowest in value. Conclusion: TPO-RAs and rhIL-11 demonstrate comparable efficacy in treating CIT in hematologic malignancies, whereas TPO-RAs offer a superior safety profile. Eltrombopag shows a numerical advantage in treatment cost. Baseline platelet level may serve as a reference indicator for assessing recovery potential.

Abstract:Objective: To explore the impact of nociception level (NOL) index guidance on the occurrence of acute postoperative pain (APP) and gastrointestinal function recovery after laparoscopic appendectomy (LA) in patients with acute purulent appendicitis, to analyze the related factors of APP after LA in patients with acute purulent appendicitis. Methods: A total of 120 patients with acute purulent appendicitis who underwent LA were selected and divided into an observation group and a control group according to different anesthesia method using the random number method, 60 cases in each group. Both groups of patients were given combined intravenous-inhalation anesthesia and standard anesthesia care. The observation group used NOL to guide intraoperative analgesia, while the control group adjusted the concentration and dose of analgesic drugs according to changes in hemodynamic parameters during the operation. The stress response indicators Cor, E, NE, and inflammatory indicators TNF-α, IL-1β, IL-6 levels of the two groups of patients were detected 2 hours before surgery and 60 minutes after surgery. The occurrence of emergence agitation, APP, and intraoperative remifentanil dose of the two groups of patients were recorded. The gastrointestinal function recovery time of the two groups of patients was observed. All patients were divided into APP group and non-APP group according to whether APP occurred, and the clinical data of the two subgroups were compared, and Logistic regression analysis was used to analyze the independent related factors of APP after LA in patients with acute purulent appendicitis. Results: At 60 minutes post-operation, the observation group exhibited lower levels of Cor, E, and NE compared to the control group, along with reduced inflammatory markers TNF-α, IL-1β, and IL-6 (P<0.05). The time to first flatus, first defecation, and first oral intake were shorter in the observation group (P<0.05). The incidence of emergence agitation (EA) and APP was lower in the observation group, accompanied by a reduced remifentanil dose (P<0.05). No statistically significant difference in adverse reactions was observed between the two groups (P>0.05). Logistic regression analysis showed that age (OR = 0.908, 95% CI: 0.851–0.961, P = 0.003) and NOL guidance (OR = 0.281, 95% CI: 0.099–0.799, P = 0.017) were independently associated with the occurrence of APP. Conclusion: NOL index guidance significantly decreases the incidence of APP in patients undergoing laparoscopic appendectomy while concurrently reducing intraoperative remifentanil consumption.

Abstract:Objective: To explore the correlation of coronary artery disease with fibrinogen/albumin ratio (FAR), blood urea nitrogen/albumin ratio (BAR) and glycated hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Methods: This study conducted a retrospective analysis of clinical data from 180 patients with T2DM in the hospital between January 2022 and December 2024. Based on presence or absence of CHD, the above subjects were assigned into two groups, comprising 45 cases without CHD (control group) and 135 cases with CHD (experimental group). The levels of FAR, BAR and HbA1c were compared between both groups. Furthermore, patients in the experimental group were classified into low-risk group (n=43), moderate-risk group (n=45) and high-risk group (n=47) according to the degree of coronary artery disease. The FAR, BAR and HbA1c were compared among the three groups. The correlation between each indicator and severity of coronary artery disease was explored by Spearman correlation analysis. Multivariate Logistic regression analysis was utilized to analyze whether FAR, BAR and HbA1c levels were independent risk factors for high-risk coronary artery disease in T2DM patients with CHD, and a prediction model was constructed. The value of the model was evaluated by receiver operating characteristic (ROC) curve. Results: Patients in the experimental group exhibited higher levels of FAR, BAR and HbA1c compared to the control group (P<0.05). Within subgroups of the experimental group, FAR, BAR and HbA1c showed increasing trends with escalating severity of coronary artery disease (low-risk group

Abstract:Objective: To evaluate the efficacy and safety of doxycycline and azithromycin in the treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Methods: 100 pediatric patients with Mycoplasma pneumoniae pneumonia treated with azithromycin or doxycycline were selected as the study subjects. After propensity score matching, 34 patients received azithromycin and were assigned to the azithromycin group, while 34 patients received doxycycline and were assigned to the doxycycline group. Data on the children's general characteristics, time to fever resolution, time to cough resolution, duration of pulmonary findings, C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer levels, and adverse events observed during treatment were collected from electronic medical records. Results: In the doxycycline group, pulmonary findings, time to cough resolution, and time to fever resolution were all shorter than those in the azithromycin group, with statistically significant differences (P<0.05). After treatment, the levels of CRP, D-dimer, and LDH in children from both groups were lower than before treatment, and those in the doxycycline group were lower than those in the azithromycin group, with statistically significant differences (P<0.05). There was no statistically significant difference in the incidence of adverse events (rash and gastrointestinal symptoms) between the doxycycline and azithromycin groups after treatment (P>0.05). Conclusion: Doxycycline treatment for macrolide-resistant Mycoplasma pneumoniae pneumonia in children can accelerate the resolution of clinical symptoms and reduce LDH, CRP, and D-dimer levels, with superior efficacy compared to azithromycin.

Abstract:Objective: To identify the longitudinal development trajectory of depressive symptoms in adolescents and explore its multi-level influencing factors, providing a basis for precise intervention. Methods: A multistage stratified random sampling method was used to conduct 5 rounds of follow-up surveys (6 time points in total, including baseline) on 12,280 primary and secondary school students in multiple regions. Depressive symptoms were evaluated using the CES-D-20 scale. Data on negative life events, behavioral-psychological factors, and sociodemographic characteristics were collected. K-means clustering identified developmental trajectories of symptoms, while mediating effect analysis and structural equation modeling were combined to explore the mediating mechanisms. Results: 3 types of depressive symptom trajectories were identified: high-risk increasing type (16.7%), moderate-fluctuation type (46.7%), and low-risk slow-increasing type (36.5%). Family financial hardship, low family satisfaction, insufficient sleep, and high academic pressure were core risk factors for depressive symptoms in adolescents. Negative life events influenced depressive symptoms through the mediating effects of family satisfaction (with the largest indirect effect), exercise frequency, and sleep quality, and there were interaction effects of gender-age and economic difficulty-academic pressure. Conclusion: For high-risk adolescent groups (e.g., adolescent females and those from families with financial hardship), interventions should focus on strengthening family functioning, standardizing behaviors, and enhancing support during academic transition periods, suggesting stratified interventions to prevent and alleviate their depressive symptoms.

Abstract:Objective: To explore the changes of serum hyaluronic acid (HA), transforming growth factor-β1 (TGF-β1) and interferon-γ/interleukin-4 (IFN-γ/IL-4) in patients with cervical low-grade squamous intraepithelial lesion (LSIL) before and after 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and analyze their predictive value on recurrence. Methods: A total of 100 patients with cervical LSIL were included and treated with ALA-PDT. They were divided into an effective group (n=84) and an ineffective group (n=16) based on the HPV negative conversion after 6 months of treatment. The patients in the effective group were followed up for another 6 months and divided into a recurrence group (cytology≥ASC-US and HPV positive, n=15) and a non-recurrence group (HPV negative, n=69) based on the results at the end of follow-up. Serum levels of HA, TGF-β1, and IFN-γ/IL-4 ratio were compared between the two groups before and after treatment. Demographic data and cervical LSIL characteristics were collected. Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for recurrence, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of changes in serum markers before and after treatment for recurrence. Results: At the end of treatment, HA and TGF-β1 levels in effective group were lower than those in ineffective group (P<0.05) while IFN-γ/IL-4 level was higher (P<0.05). The levels of HA and TGF-β1 in the non-recurrent group were lower than those in the recurrent group (P<0.05), the ratio of IFN-γ/IL-4 was higher than that in the recurrence group (P<0.05). Univariate and multivariate Logistic regression analyses showed that the HA change value and TGF-β1 change value were independent risk factors for recurrence after ALA-PDT in patients with cervical LSIL, while IFN-γ/IL-4 change value was an independent protective factor (P<0.05). The AUCs of the aforementioned factors for predicting recurrence after ALA-PDT were 0.862, 0.843 and 0.754, and the sensitivities were 73.33%, 80.00% and 66.67%, respectively, and the specificities were 92.75%, 79.71% and 86.96%, respectively (P<0.05). Conclusion: ALA-PDT can achieve good efficacy in the treatment of cervical LSIL, reduce the levels of serum HA and TGF-β1, and increase the IFN-γ/IL-4 ratio. The changes of the above indexes before and after treatment are independently related to the risk of recurrence. Early detection of the above indexes can provide guidance for clinical diagnosis and treatment.

Abstract:Objective: To analyze application of expansive water separation technique in ultrasound-guided minimally invasive rotary resection of benign breast tumor and its influences on serum inflammatory factors. Methods: A total of 492 patients with benign breast tumors undergoing ultrasound-guided minimally invasive rotary resection were enrolled. According to different local anesthesia methods, they were divided into traditional infiltration anesthesia group (n=234, traditional local infiltration anesthesia) and expansive water separation group (n=258, expansive water separation technique). The perioperative indexes (operation time, intraoperative blood loss, anesthesia time, length of hospital stay), scores of visual analogue scale (VAS), levels of serum interleukin (IL)-6, IL-10, C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were compared between the two groups. The occurrence of complications and score of Vancouver scar scale (VSS) were recorded. Results: Compared with traditional infiltration anesthesia group, operation time was shorter (P<0.05), intraoperative VAS score was lower (P<0.05), and anesthesia time was longer in expansive water separation group (P<0.05). At 3 d after surgery, levels of serum IL-6, IL-10, CRP and TNF-α in expansive water separation group were lower than those in traditional infiltration anesthesia group (P<0.05). The incidence of complications in expansive water separation group was lower than that in traditional infiltration anesthesia group (P<0.05). At 6 months after surgery, VSS scores in expansive water separation group were lower than those in traditional infiltration anesthesia group (P<0.05). Conclusion: The application of expansive water separation technique in ultrasound-guided minimally invasive rotary resection of benign breast tumor can shorten operation time, relieve intraoperative pain, inhibit inflammatory response, improve breast aesthetics and reduce complications.

Abstract:Objective: To explore the application value of the "U8" end-to-side invagination pancreaticojejunostomy (PJ) in laparoscopic pancreaticoduodenectomy (LPD). Methods: 61 patients who underwent LPD were selected as the research subjects. They were divided into study group (n=24, "U8" PJ) and control group (n=37, modified Blumgart PJ) according to different pancreaticointestinal anastomosis methods. Perioperative parameters and postoperative complications were compared. Results: For patients with a pancreatic duct diameter<3 mm, the PJ time in the study group was shorter than that in the control group [(37.6±2.5) min vs. (42.8±6.3) min, P<0.05]. The overall incidence of postoperative pancreatic fistula in the study group was lower than that in the control group (20.8% vs. 45.9%, P<0.05). There was no statistically significant difference in the incidence of postoperative bleeding, abdominal infection, bile fistula, delayed gastric emptying, and length of hospital stay between the two groups (P>0.05). Conclusion: The "U8" PJ is a safe and simple technique in LPD, particularly advantageous for patients with a pancreatic duct diameter<3 mm. It effectively reduces the incidence of POPF and is worthy of clinical promotion.

Abstract:Objective: To study the correlation between serum microRNA (miR)-491-5p and gap junction alpha-1 (GJA1) levels and cognitive impairment in patients with acute cerebral infarction (ACI). Methods: 139 patients with ACI were collected as the research subjects, and they were separated into normal cognitive group (n=68) and cognitive impairment group (n=71). ELISA was applied to detect serum GJA1 level, RT-PCR was applied to detect miR-491-5p level, Logistic regression was applied to analyze the influencing factors of cognitive impairment in patients with ACI. ROC curve was applied to analyze the diagnostic value of serum miR-491-5p and GJA1 levels for cognitive impairment in patients with ACI. Results: Compared with the cerebral infarction cognitive normal group, the serum miR-491-5p and GJA1 levels in the cerebral infarction cognitive impairment group were reduced (P<0.05). Statistically significant differences between the cognitively impaired group and the cognitively normal group were found between age, area of cerebral infarction, NIHSS score, and history of hypertension (P<0.05). Age, area of cerebral infarction, NIHSS score, and history of hypertension were risk factors affecting patients with ACI combined with cognitive impairment (P<0.05), and elevated levels of miR-491-5p and GJA1 were protective factors (P<0.05). Drawing receiver operating characteristic, it was found that the AUC of serum miR-491-5p, GJA1 levels and their combination in diagnosis of cognitive dysfunction in patients with ACI was 0.842, 0.857 and 0.931, respectively, the combined diagnosis was obviously better than that of miR-491-5p and GJA1 separately. Conclusion: Reduced levels of miR-491-5p and GJA1 in patients with ACI cognitive impairment have a certain auxiliary diagnostic value for ACI-complicated cognitive dysfunction, and the combined auxiliary diagnostic value is higher.

Abstract:Objective: To investigate the synergistic effect of rifaximin combined with rabeprazole in treating functional dyspepsia (FD) and analyze its mechanism. Methods: A total of 126 FD patients were enrolled and divided into an observation group and a control group (63 per group) according to different treatment methods. Patients in the control group received oral rabeprazole sodium enteric-coated tablets, while those in the observation group received additional rifaximin tablets. After 4 weeks of treatment, the two groups were compared in terms of therapeutic efficacy, gastrointestinal hormones, inflammatory factors, gut microbiota counts, and intestinal mucosal barrier markers. Results: After 4 weeks of treatment, the total effective rate in the observation group was higher than that in the control group (P<0.05), motilin levels were increased in both groups (P<0.05), and the observation group was higher than the control group (P<0.05), gastrin and somatostatin levels were decreased in both groups (P<0.05), and were lower in the observation group (P<0.05), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) levels were decreased in both groups (P<0.05), and were lower in the observation group (P<0.05). The counts of Enterococcus and Enterobacter were decreased in both groups (P<0.05), and were lower in the observation group (P<0.05), while the counts of Lactobacillus and Bifidobacterium were increased in both groups (P<0.05), and were higher in the observation group (P<0.05). Diamine oxidase (DAO) and D-lactate levels were decreased in both groups (P<0.05), and were lower in the observation group (P<0.05). Conclusion: The combination of rifaximin and rabeprazole shows a synergistic effect in treating FD, which may be related to improving gastrointestinal hormone levels, reducing inflammation, modulating gut microbiota, and repairing the mucosal barrier.

Abstract:Objective: To investigate the expression level and clinical significance of ATP6V1A, a subunit of vacuolar-type proton pump (V-ATPase), in colonic mucosal tissues of patients with ulcerative colitis (UC). Methods: A total of 116 UC patients were enrolled. According to the modified Mayo score, they were divided into the remission group (n=35) and the active group (n=81). The patients in the active stage of UC were further stratified into the mild subgroup (n=31), moderate subgroup (n=27) and severe subgroup (n=23) based on the modified Truelove and Witts classification criteria. Meanwhile, 50 healthy subjects who underwent colonoscopy in our hospital during the same period were selected as the control group. For UC patients, colonic mucosal tissue samples were collected from the most prominent lesion area under colonoscopy, for the control group, samples were obtained from the colonic mucosa with normal endoscopic morphology at 20 cm from the anus. Immunohistochemistry was employed to detect the expression of ATP6V1A in colonic mucosal tissues. The correlation between ATP6V1A expression and modified Mayo score of UC patients was analyzed, and the value of ATP6V1A expression in evaluating the occurrence of severe condition in active UC patients was assessed. Results: Compared with the control group, the expression level of ATP6V1A in the remission group and active group decreased (P<0.05), and the expression in the active group was lower than that in the remission group (P<0.05). Among patients with active UC, the expression level of ATP6V1A declined gradually with the aggravation of disease severity (P<0.05). Moreover, ATP6V1A expression in colonic mucosal tissues of UC patients was negatively correlated with the modified Mayo score (P<0.05). Logistic regression analysis revealed that low ATP6V1A expression (OR=0.451) and high modified Mayo score (OR=2.787) were independent risk factors for severe condition in patients with active UC (P<0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) of ATP6V1A expression level for evaluating severe condition in active UC patients was 0.758. Conclusion: ATP6V1A is lowly expressed in the colonic mucosal tissues of UC patients, and its expression level is correlated with disease severity, which has important value in evaluating the occurrence of severe condition in patients with active UC.

Abstract:Objective: To investigate the relationship of microRNA499 (miR-499) gene polymorphism with genetic susceptibility of hepatocellular carcinoma (HCC) and its predictive value on prognosis. Methods: 80 patients with HCC were selected as experimental group, and 30 patients who were admitted to the hospital for physical examination during the same period were regarded as control group. Venous blood samples were collected to obtain the gene distribution status of miR-499 rs3746444 locus, and the relationship between different genotypes and HCC genetic susceptibility was analyzed. The clinical information and follow-up status of experimental group were combined to explore the influence of miR-499 gene polymorphism on the prognosis of patients with HCC. Results: Carrying miR-499 C/C genotype and allele C could increase the genetic susceptibility of HCC by 2.399 times and 2.282 times (P<0.05). The overall survival rate of patients with miR-499 C/C genotype was lower than that of patients with C/T and T/T genotypes (P<0.05). High alpha-fetoprotein, low degree of differentiation and miR-499 C/C genotype were all independent risk factors of poor prognosis in patients with HCC (P<0.05). Conclusion: The C/C genotype of miR-499 gene is a susceptible genotype of HCC and an independent risk factor of poor prognosis.

Abstract:Objective: To explore the clinical efficacy of internal heat acupuncture therapy combined with sling exercise training (SET) in the treatment of discogenic low back pain (DLBP). Methods: 107 DLBP patients were selected as the research subjects and divided into a control group (n=54) and a study group (n=53) according to different treatment plans. The control group patients received SET treatment, and the patients in the research group were treated with SET combined with internal heat needle therapy for a course of 4 weeks. Clinical efficacy was compared between the two groups. The following parameters were assessed before and after treatment: lumbar spine function, lumbar range of motion, pain intensity, quality of life, and serum levels of interleukin (IL)-1β, IL-6, substance P (SP), and β-endorphin (β-EP). Results: The total effective rate in the study group was higher than that in the control group, with a statistically significant difference (P<0.05). After treatment, the study group showed higher scores on the Japanese Orthopaedic Association (JOA) score, lumbar spine mobility, quality of life, and β-EP level compared to the control group (P<0.05), while lower levels of the Oswestry Disability Index, pain intensity, IL-1β, IL-6, and SP compared to the control group (P<0.05). Conclusion: Internal heat acupuncture therapy combined with sling exercise training for DLBP of the cold-dampness obstruction pattern can improve lumbar function and range of motion, effectively alleviate pain, and enhance quality of life.

Abstract:Objective: To evaluate the clinical effects of unilateral thyroidectomy with thyroid isthmectomy in the treatment of papillary thyroid carcinoma. Methods: 107 patients with papillary thyroid carcinoma with maximum diameter≤1 cm were classified into control group (n=37, total thyroidectomy) and study group (n=70, unilateral thyroidectomy plus isthmectomy) based on surgical methods. The safety indicators (surgery time, intraoperative blood loss, permanent recurrent laryngeal nerve injury rate, incidence of permanent hypoparathyroidism), serological indicators [thyroglobulin (Tg) antibody, serum thyroglobulin, serum calcium and parathyroid hormone (PTH) levels], postoperative complications and TSH suppression treatment compliance rate and average daily maintenance dose of levothyroxine at 6 months after surgery were compared between the two groups. Results: Compared with the control group, the study group had slightly longer surgical time and less intraoperative blood loss volume (P<0.05), and the permanent recurrent laryngeal nerve injury rate and incidence rate of permanent hypoparathyroidism were reduced (P<0.05). The overall incidence rate of postoperative complications in the study group was lower compared to the control group (P<0.05). The Tg antibody, thyroglobulin, serum calcium and PTH levels in the study group at 1 month after surgery were better than those in control group (P<0.05), and the TSH suppression treatment compliance rate at 6 months after surgery was higher, and the required average daily maintenance dose of levothyroxine was less (P<0.05). Conclusion: For papillary thyroid carcinoma with maximum diameter≤1 cm, unilateral thyroidectomy combined with isthmectomy can protect parathyroid function and recurrent laryngeal nerve function while ensuring the radical effect of tumor, and reduce complications, thus it is a better surgical choice.

Abstract:Objective: To investigate the effect of oral carbohydrate administration 2 hours before surgery on the incidence of postoperative delirium in elderly patients undergoing elective laparoscopic colorectal cancer resection. Methods: 60 elderly patients aged 60~79 years, ASA grade I~III, scheduled for elective laparoscopic radical colorectal cancer resection under general anesthesia were selected. They were divided into carbohydrate group (CHO group, n=31) and control group (C group, n=29) according to different anesthesia methods. The C group followed conventional preoperative fasting (8 hours for solids, 6 hours for clear fluids). The CHO group, in addition to conventional fasting, orally ingested 200 mL of a carbohydrate beverage 2 hours before surgery. General patient data were recorded and compared. The incidence of delirium within 5 days postoperatively was assessed twice daily using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM). Fasting blood glucose (FBG), serum interleukin-6 (IL-6), and C-reactive protein (CRP) levels were measured preoperatively and on postoperative days 1, 3, and 5. Perioperative incidences of thirst, hunger, nausea, and vomiting were also recorded. Results: The overall incidence of postoperative delirium in the CHO group was lower than that in the C group (P<0.05). The levels of FBG, IL-6, and CRP in both groups increased 1 day after surgery compared to preoperative (P<0.001). Compared to the C group, the CHO group had lower FBG, IL-6, and CRP levels on days 1 and 3 (P<0.05). The incidence of perioperative thirst was lower in the CHO group than in the C group (12.90% vs. 44.83%, P<0.05), while no significant differences were found in the incidence of nausea or vomiting between the two groups. Conclusion: For elderly patients undergoing elective laparoscopic colorectal cancer resection, preoperative oral carbohydrate intake 2 hours before surgery can effectively reduce the incidence of postoperative delirium. The underlying mechanism may be associated with attenuating the postoperative stress response, reducing inflammatory cytokine levels, and improving patient perioperative comfort.

Abstract:Objective: To explore the application value of combining triple rule-out enhanced CTA with serum cardiac function indicators on predicting major adverse cardiovascular events (MACE) in emergency patients with non-traumatic chest pain. Methods: The clinical data of 160 patients with non-traumatic chest pain were retrospectively analyzed. According to whether MACE occurred within 6 months of follow-up, the above patients were classified into observation group (MACE, n=43) and control group (no MACE, n=117). Serum cardiac function indicators [creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), brain natriuretic peptide (BNP), cardiac troponin I (cTnI)] and triple rule-out enhanced CTA examination results were compared between both groups. Multivariate Logistic regression analysis was performed to analyze the independent risk factors affecting MACE, and a prediction model was constructed. Results: The D-dimer level in the observation group was higher than that in the control group (P<0.05). The levels of serum CK-MB, LDH, BNP and cTnI in the observation group were higher compared to the control group (P<0.05). The overall positive rate of triple rule-out enhanced CTA and proportions of severe coronary stenosis, aortic dissection and Stanford type A dissection were higher in the observation group (P<0.05). Multivariate Logistic regression analysis suggested that BNP and CTA severe coronary stenosis were independent risk factors for MACE in emergency patients with non-traumatic chest pain (P<0.05). The risk prediction model was constructed based on the results of multivariate Logistic regression analysis, and it was found that the AUC, sensitivity and specificity of combined model were 0.856 (95%CI: 0.795~0.918), 86.03% and 77.72% respectively. Conclusion: CTA severe coronary stenosis combined with BNP can improve the accuracy of MACE risk stratification, and provide an important reference for early clinical initiation of individualized intervention and reduction of adverse events.

Abstract:Objective: To explore the predictive value of the subcutaneous fat index (SFI) of the cervical spine in predicting residual cervical axial pain after anterior cervical corpectomy and fusion (ACCF). Methods: 120 patients who underwent ACCF were selected as the research subjects. They were divided into an observation group (n=35) and a control group (n=85) based on the presence of residual neck axial pain. The general clinical data of the two groups were compared, including age, gender, body mass index (BMI), length of hospital stay, history of hypertension, diabetes mellitus, smoking history, duration of surgery, intraoperative bleeding, operated vertebral segments, dural injuries and preoperative and postoperative clinical efficacy scores, and the preoperative and postoperative clinical efficacy scores were measured by measuring the subcutaneous fat thickness of the cervical vertebral segments subcutaneous fat thickness (SFT) and muscle thickness of cervical spine segments were measured and SFI was calculated. Risk factors for postoperative residual cervical axial pain were analyzed by univariate and multivariate Logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of SFI for residual neck axial pain after ACCF surgery. Results: The hospitalization time and BMI were higher in the observation group than in the control group (P<0.05), and the SFT and SFI were increased (P<0.05). There was no significant difference in VAS and cervical spine dysfunction index (neck disability index, NDI) between the two groups preoperatively and at 2 months postoperatively (P>0.05), but at 3, 6, and 12 months postoperatively, VAS and NDI scores in the observation group were higher than those in the control group (P<0.05). Univariate analysis showed that BMI, dural injury and SFI were risk factors for residual neck axial pain after ACCF (P<0.05), but multivariate Logistic regression analysis showed that there was no significant correlation between BMI, dural injury and residual cervical axial pain after ACCF surgery (P>0.05). Univariate and multifactorial Logistic regression analyses showed that SFI was associated in the residual neck axial pain group (P<0.05), and was a risk factor for postoperative residual neck axial pain. The ROC curve showed an AUC of SFI of 0.907 (95%CI: 0.848~0.965), with an optimal cutoff value of 0.955 (sensitivity 85.7%, specificity 89.4%). Conclusion: A higher SFI is associated with residual cervical axial pain after ACCF surgery. It is recommended to evaluate SFI preoperatively as an effective indicator for predicting residual cervical axial pain after surgery.

Abstract:Objective: To explore the clinical efficacy of modified Dachaihu decoction with Sijin decoction combined with conventional conservative treatment for cholecystolithiasis with acute cholecystitis. Methods: 109 patients with cholecystolithiasis complicated with acute cholecystitis were classified into control group (n=54, conventional treatment) and combined group (n=55, conventional treatment plus modified Dachaihu decoction with Sijin decoction) based on treatment methods. The efficacy, TCM symptoms scores, pain degree [visual analog scale (VAS) score] and inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-8 (IL-8) levels] and incidence of adverse reactions were compared between the two group. Results: Compared with the control group, the clinical efficacy in the combined group was improved, and the TCM syndromes scores were decreased after treatment (P<0.05). The VAS scores in both groups after 3 and 7 days of treatment were reduced, and the VAS scores were lower in the combined group compared to the control group (P<0.05). After treatment, the levels of CRP, IL-6 and IL-8 were decreased in the two groups, and the combined group had lower CRP, IL-6 and IL-8 levels than the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Modified Dachaihu decoction with Sijin decoction combined with conventional conservative treatment has significant efficacy on cholecystolithiasis with acute cholecystitis, and it can effectively improve the clinical symptoms of patients, and relieve the pain and inflammatory response, with high safety.

Abstract:Objective: To summarize the clinical manifestations, serological findings and electromyographic features of anti-MAG antibody-associated peripheral neuropathy, as well as its diagnosis and treatment, so as to deepen the understanding of this disease and reduce missed diagnoses. Methods: The clinical data of 1 patient with anti-MAG antibody-associated peripheral neuropathy were retrospectively analyzed, and relevant literature was reviewed for discussion. Results: The patient presented with fatigue and numbness in both lower limbs for 1 month. After being initially diagnosed with cerebral infarction and diabetic peripheral neuropathy, further serological tests were performed, and the final diagnosis of anti-MAG antibody-associated peripheral neuropathy was confirmed. Conclusion: When symptoms cannot be explained by a single etiology or the treatment response is poor, clinicians should actively explore potential causes and consider multiple differential diagnoses. For patients with peripheral neuropathy mainly manifested as sensory and motor dysfunction of both lower limbs, this disease should be suspected. Timely detection of monoclonal IgM and anti-MAG antibodies is recommended to achieve early diagnosis and treatment.

Abstract:Objective: To explore the influence of nursing chronic disease rehabilitation management program construction based on the optimal management control effect of cardiac rehabilitation exercise on patients after percutaneous coronary intervention (PCI). Methods: A total of 86 patients who underwent PCI were divided into a control group and an experimental group according to the nursing methods they received, with 43 patients in each group. The control group received routine nursing care, while the experimental group received intensified management based on an individualized cardiac rehabilitation program. Cardiac function, health-related physical fitness, 6-minute walking distance, and quality of life were compared between the two groups at different time points, and rehabilitation satisfaction was also assessed. Results: Compared with those before the intervention, left ventricular ejection fraction (LVEF), VO2max, oxygen pulse, 6-minute walking distance, and SF-36 scores at discharge and 3 months after discharge increased in both groups (P<0.05), while left ventricular end-diastolic volume (LVEDV) and resting heart rate (RHR) decreased (P<0.05). The above indicators in the experimental group were superior to those in the control group at all corresponding time points (P<0.05). Patient satisfaction in the experimental group was also higher than that in the control group (P<0.05). Conclusion: The nursing chronic disease rehabilitation management program based on optimized management of cardiac rehabilitation exercise is more beneficial for improving postoperative cardiac function in PCI patients, and is more effective in enhancing exercise endurance and quality of life, making it more acceptable to patients.

Abstract:Daytime dysfunction is a core element in the diagnosis of insomnia. Excessive daytime sleepiness, fatigue, emotional disturbances and other manifestations are typical symptoms among individuals with insomnia, imposing substantial economic burdens and safety hazards on both patients and society. Thousands of years ago, Huangdi Neijing (The Yellow Emperor's Internal Classic) put forward the theory of "being Energetic in Daytime and Sleeping at Night" (zhou jing ye ming), aligning with modern medicine's recognition of circadian rhythm regulation centered on the sleep-wake cycle. With the rapid development of the economy and society, the prevalence of shift work and rotating work schedules has led to a growing population with circadian rhythm disorders. Modern medicine has consequently attached greater importance to insomnia-induced daytime dysfunction, emphasizing that the diagnosis and treatment of insomnia should focus on patients' daytime functioning and quality of life—a view that aligns well with the "vigorous during the day and tranquil at night" theory in Huangdi Neijing. Currently, a variety of assessment tools are available for the clinical evaluation of daytime dysfunction in insomnia, yet their application lacks systematic standardization. Based on subjective and objective quantitative models, this paper systematically reviews multidimensional assessment instruments for diurnal function in insomnia, and conducts an in-depth analysis and summary of evaluation methods applicable to different populations with insomnia. It aims to explore the target populations and application scenarios of different assessment criteria, which is of great significance for advancing research on daytime dysfunction in the clinical diagnosis and treatment of insomnia.