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Ying Gu,&ast; Ning Chen,&ast; Min He, Duo Zheng, Juan Liu, Xia-Ling Fang Department of Pediatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xia-Ling Fang, Email farrough@21cn.comObjective: To analyze the preventive and therapeutic effects of comprehensive nursing interventions on chemotherapy-induced oral mucositis in pediatric patients with hematologic malignancies.Methods: A retrospective analysis was conducted, and 80 pediatric patients with hematologic malignancies who underwent chemotherapy in our hospital from January 2020 to December 2023 were selected as the research subjects. According to different nursing intervention methods, the patients were divided into an experimental group (45 cases) and a control group (35 cases). The experimental group received comprehensive nursing interventions, including oral care, dietary guidance, and psychological support; the control group received routine care. The observation indicators included the incidence of oral mucositis, Oral Mucositis Daily Questionnaire (OMDQ) scores, pain index (Visual Analog Scale), and levels of inflammatory markers (IL-6 and CRP) in saliva.Results: In the first, second, and fourth weeks of chemotherapy, the incidence of oral mucositis in the experimental group was significantly lower than in the control group (P < 0.05), with a total incidence of 51.11% compared to 77.14% (P = 0.017). Before chemotherapy, no significant difference was observed in OMDQ or VAS scores between the groups (p> 0.05). However, in the first, second, and fourth weeks, OMDQ and VAS scores in the experimental group were significantly lower than those in the control group (P < 0.001). Similarly, levels of IL-6 and CRP showed no baseline difference between groups but were significantly reduced in the experimental group during these weeks (P < 0.001).Conclusion: Comprehensive nursing interventions significantly reduce the incidence and severity of chemotherapy-induced oral mucositis in pediatric patients with hematologic malignancies, alleviate oral pain in pediatric patients, and effectively reduce the levels of inflammatory markers in saliva. The application of comprehensive nursing interventions in clinical nursing practice can improve the quality of care for pediatric patients with hematologic malignancies.Keywords: pediatric oncology, hematologic malignancies, chemotherapy-induced oral mucositis, comprehensive nursing interventions, oral mucositis prevention, nursing outcomes, mucositis management, oral care, supportive care in pediatrics

Hui Tian,&ast; Xiaorong Zhu,&ast; Hongwang Liu, Yangfang Liao, Kaiwang Cui, Jianping Liu, Xiangwen Gong Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, the Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangwen Gong; Jianping Liu, Department of Respiratory and Critical Care Medicine, The Fifth People’s Hospital of Ganzhou, Dongjiangyuan Road 666, Zhanggong District, Ganzhou, Jiangxi Province, 341000, People’s Republic of China, Email gzwyhys@126.com; gzwyhxk@126.comPurpose: Identifying factors that influence Chinese herbal medicine (CHM) use in chronic lung disease (CLD) patients can inform targeted strategies to boost CHM use. However, the prevalence and factors affecting CHM use for treating CLD in middle-aged and older Chinese patients remain understudied. This study aims to examine the prevalence and influencing factors of CHM use among middle-aged Chinese patients with CLD.Patients and Methods: The data analyzed in this study were extracted from the China Health and Retirement Longitudinal Study in 2018. A cross-sectional analysis of 2784 participants aged 45 years and older taking CHM for CLD was included, and influencing factors (demographic characteristics, health status, and healthcare service use) predicting the use of CHM for CLD were identified through multivariate logistic regression model.Results: The prevalence of using CHM to treat CLD was 22.4% (624/2784). Compared to participants with CLD who did not use CHM, those with CLD who used CHM were more likely to be female, and non-smoking, non-drinking, purchased insurance (OR=2.35; 95% CI=1.09, 5.04), went to a traditional Chinese medicine hospital (OR=3.5; 95% CI=1.96, 6.25) and self-treatment (OR=1.67; 95% CI=1.33, 2.10), the health status being poor (OR =1.74; 95% Cl=1.18, 2.56), asthma (OR=1.55; 95% Cl=1.16, 2.09) and depression (OR =1.42; 95% Cl=1.14, 1.75). In the additive interaction analysis, patients who tend to self-medicate and with depression were most likely to use CHM (OR=2.52; 95% Cl=1.85, 3.42).Conclusion: A considerable middle-aged and older Chinese patient with CLD uses CHM for treatment. Multiple factors can influence CHM use, particularly self-treatment and depression.Keywords: influencing factors, Chinese herbal medicine, chronic lung disease, Chinese, middle-aged and older adults, cross-sectional study

Li Wei,1,2,&ast; Xingying Zhao,1,2,&ast; Xiaomei Chen,1 Yuxuan He,1 Jia Liu,1 Jishu Xian,2 Yanni Yang1 1School of Nursing, Army Medical University (Third Military Medical University), Chongqing, 434008, People’s Republic of China; 2Neurosurgery Department, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, 434008, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanni Yang, School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 434008, People’s Republic of China, Email yangyanni@tmmu.edu.cnBackground: Providing informal care for patients with neurocritical diseases is a challenging job, and family caregivers usually experience psychological distress and high caregiver burden. Previous studies have focused on caregiver burden for patients in the home rehabilitation stage, while few studies investigate caregiver burden among informal caregivers of early postoperative inpatients.Objective: This study aimed to investigate caregiver burden for caregivers of patients with neurocritical diseases during hospitalization and to identify predictive factors related to caregiver burden.Methods: From November 2023 to April 2024, a cross-sectional study was conducted using a convenience sampling method to assess patients with neurocritical disease and their family caregivers. The fundamental data regarding patients and caregivers were examined. Family caregivers were requested to complete the Zarit Burden Interview (ZBI), the Coping Adaptation Processing Scale (CAPS-15), the Chinese Auditory Verbal Learning Test of Huashan Version (AVLT-H), the Multifactorial Memory Questionnaire (MMQ), and the Hospital Anxiety and Depression Scale (HADS-A). The variables associated with caregiver burden were identified through the use of multiple linear regression analyses.Results: 300 patients and their family caregivers participated in the study. Predominantly male family caregivers accounted for 55.7%, and the mean age was 46.7 ± 13.1 years. The patients’ average age was 52.8 ± 14.3 years, 151 (50.3%) were men, and 153 (50.3%) had brain tumors. The average caregiver burden was 33.94 ± 17.2. Family caregivers of inpatients with neurocritical diseases experienced a mild to moderate caregiver burden. Patients’ physical function, caregiver’s age, relationship with patients, comorbid chronic disease status, memory function, adaptation level, and anxiety independently predicted caregiver burden, accounting for 66.3% of the total variation.Conclusion: Family caregivers of inpatients with neurocritical diseases experience mild to moderate level of caregiver burden. Tailored early support plans should be developed based on caregivers’ characteristics, including anxiety strategies, memory support, communication optimization, and role adjustment, to reduce their burden.Keywords: caregiver burden, family caregivers, influencing factors, neurocritical disease, hospitalization

Yueyue Fu,1 Yuling Xing,2 Linlin Yang,3 Jing Liu,2 Huijuan Ma3 1Graduate School of North China University of Science and Technology, Tangshan, People’s Republic of China; 2Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China; 3Department of Endocrinology, the First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of ChinaCorrespondence: Jing Liu, Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China, Tel +86 13673186039, Email liujing981531@163.com Huijuan Ma, Department of Endocrinology, the First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China, Tel +86 18032838686, Email huijuanma76@163.comPurpose: To explore the correlation between fasting C-peptide to diabetes duration ratio (FCP/DD) and diabetic peripheral neuropathy (DPN).Methods: The study was conducted on 816 patients with type 2 diabetes (T2DM). Subjects were classified into a diabetic peripheral neuropathy group (DPN, n=408) and a non-diabetic peripheral neuropathy group (NDPN, n=408) depending on the presence of DPN. Collected patients’ baseline data, calculated the FCP/DD ratio, and analyzed the correlation between FCP/DD and DPN.Results: A comparative analysis of general characteristics revealed that the DPN group exhibited higher values for age, DD, proportion of hypertension, proportion of DN, and proportion of DR compared to the NDPN group, Conversely, the DPN group demonstrated lower proportions of eGFR, FCP/DD, FCP, and fatty liver relative to the NDPN group, with all differences achieving statistical significance (P < 0.05). Compared to the high FCP/DD group, the low FCP/DD group exhibited higher values in age, DD, the proportion of DPN, DN, DR, and hypertension, as well as elevated levels of HDL-C and NEUT (P< 0.05). Conversely, the low FCP/DD group demonstrated a lower proportion of patients who smoked and those with fatty liver, along with reduced BMI, ALB, FBG, UA, eGFR, TC, TG, and LDL-C levels (P < 0.05). In patients with T2DM, after adjusting for confounding factors, high levels of FCP/DD were found to be a protective factor for DPN (P < 0.05). The area under the curve of the FCP/DD Model predicting DPN (AUC=0.737) was higher than that of single FCP (AUC=0.587), DD (AUC=0.665).Conclusion: The high FCP/DD ratio was a protective factor for T2DM with DPN. Additionally, the FCP/DD ratio was found to be a better predictor for the occurrence of DPN in T2DM compared to FCP and DD alone.Keywords: Diabetic peripheral neuropathy, type 2 diabetes, FCP/DD

Jiali Liu,1 Yebao Huang,2 Xiaoshuo Fu,1 Jiali Wei,1 Ping Wei3 1Department of Anorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, People’s Republic of China; 2Department of Anorectal Surgery, Liuzhou People’s Hospital Affiliated of Guangxi Medicine University, Liuzhou, 545000, People’s Republic of China; 3Department of Anorectal Surgery, Lianyungang Hospital of Traditional Chinese Medicine/Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine, Lianyungang, 222000, People’s Republic of ChinaCorrespondence: Ping Wei, Department of Anorectal Surgery, Lianyungang Hospital of Traditional Chinese Medicine/Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine, No. 160 Chaoyang Middle Road, Xinpu Area, Lianyungang, Jiangsu, 222000, People’s Republic of China, Email 1996000029@jou.edu.cnObjective: Psychiatric disorders have been associated with Constipation in observational studies, although their causal relationships remain uncertain. We used Mendelian randomization analysis to infer causality between Schizophrenia and Major Depressive Disorder with Constipation.Methods: The exposure of interest was Psychiatric disorders, including Schizophrenia (SCZ) and Major Depressive Disorder (MDD). Summary statistics for psychiatric disorders were recruited from the PGC, SCZ (30,490 cases and 312,009 controls), MDD (170,756 cases and 329,443 controls), whereas Constipation summary genetic data were obtained from a FinnGen involving 17,246 cases and 201,546 controls. The inverse variance weighted (IVW) method was used as the primary analysis to assess the causal relationship between SCZ and MDD with Constipation.Results: LDSC indicated that Constipation was genetically correlated with Psychiatric disorders (rg range: |0.04– 0.05). The Mendelian randomization analysis indicated that there was significant evidence that genetically determined SCZ (OR = 1.05, 95% CI = 1.02– 1.07, P< 0.01) and MDD (OR = 1.21, 95% CI = 1.10– 1.33, P< 0.01) were statistically significantly causally associated with the risk of Constipation. SCZ effects remained within the range of practical equivalence (ROPE).Conclusion: The Mendelian randomization analysis suggested that SCZ and MDD increase the risk of Constipation. However, the association between SCZ and constipation, predominantly within the ROPE range, suggested only limited clinical implications.Keywords: Mendelian randomization, Schizophrenia, SCZ, major depressive disorder, MDD, constipation

YuanLi Huang,1 JinJie Liu,1,2 ChunLian Lin,1,2 Qing Zhu,1,3 LiGao Wu1,3 1Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, People’s Republic of China; 2Graduate School of Bengbu Medical University, Bengbu, Anhui, People’s Republic of China; 3Department of Pathology, School of Basic Medicine, Bengbu Medical University, Bengbu, Anhui, People’s Republic of ChinaCorrespondence: LiGao Wu, Email wlgahbb@126.comBackground: Globally, the disease that has the greatest impact on human health and is the most difficult to overcome is cancer (tumor or malignant tumor is another name for it). Cancers currently known to us can arise from almost any organ or tissue in the human body. Its uncontrolled growth pattern and metastasis characteristics are the fundamental reasons for the high mortality rate of cancer and its current incurability. An increasing number of studies have found that pyroptosis, a mode of programmed cell death, may inhibit tumor growth by changing the tumor immune microenvironment (TIME).Methods: Through a retrospective study, we selected 160 cases of different tumor tissues (including 40 cases each of esophageal cancer, gastric cancer, breast cancer, and cervical cancer), and identified the expression of caspase3/GasderminE in the tumor tissues through immunohistochemical staining and infiltration of tumor-related immune cells. And analyze its relationship with clinical parameters of tumor patients. In addition, we also marked caspase8 and caspase9 among the caspase family members to analyze the main factors upstream of caspase3.Results: The results showed that the expression level of caspase3/GSDME in different tumor tissues was positively correlated with the infiltration degree of tumor-related immune cells (natural killer cells, CD8+T cells, macrophages, etc). In addition, the expression level of caspase3 was positively correlated with caspase8, but not caspase9.Summary: The expression levels of caspase3 and GSDME exhibited significant impacts on the survival prognosis of patients with diverse tumors as well as alterations in the immune microenvironment of tumor tissues, demonstrating statistical significance. After Caspase3/GSDME triggers the pyroptosis pathway, it may change the components of the immune microenvironment of tumor tissue, thereby achieving the effect of inhibiting tumors.Keywords: pyroptosis, caspase3, GSDME, tumor immune microenvironment, cancer

Chang Su, Juan Tian, Xueqing He, Xiaona Chang, Guang Wang, Jia Liu Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of ChinaCorrespondence: Guang Wang; Jia Liu, Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, NO. 8, Gongti South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +8610-85231737 ; +8610-85231710, Email drwg6688@126.com; liujia0116@126.comBackground: Dyslipidemia has been implicated in the pathogenesis of several diseases, including thyroid dysfunction and immune disorders. However, whether circulating lipids and long-term use of lipid-lowering drugs influence the development of autoimmune thyroid disease (AITD) remains unclear. This study aims to evaluate the effects of lipid-lowering drugs on AITD and explore their potential mechanisms.Methods: Two-sample and two-step Mendelian randomization (MR) studies were performed to assess the causal relationships between circulating lipids (LDL-C, TC, TG, and ApoB) and seven lipid-lowering drug targets (ApoB, CETP, HMGCR, LDLR, NPC1L1, PCSK9, and PPARα) with AITD. Mediation analyses were conducted to explore potential mediating factors.Results: There was no clear causality between circulating lipids (ApoB, LDL-C, TC, and TG) and AITD (p > 0.05). ApoB inhibition is related to a reduced risk of autoimmune thyroiditis (AT) (OR = 0.462, p= 0.046), while PCSK9 inhibition is related to reduced Graves’ disease (GD) risk (OR = 0. 551, p = 0.033). Moreover, PCSK9 inhibition (OR = 0.735, p = 0.003), LDLR inhibition (OR = 0.779, p = 0.027), and NPC1L1 inhibition (OR = 0.599, p = 0.016) reduced the risk of autoimmune hypothyroidism (AIH). Mediation analysis showed that NPC1L1 inhibition and PCSK9 inhibition exerted effects on AIH through IL-4 and FGF-19 levels. And the effect of PCSK9 inhibition on GD through TNF-β levels.Conclusion: There was no clear causality between circulating lipids (ApoB, LDL-C, TC, and TG) and AITD. Lipid-lowering drug target gene inhibitors reduced the AITD risk by modulating inflammatory factors.Keywords: Mendelian randomization, drug targeting, thyroid autoimmune disease, lipid trait, inflammatory factors

Xi Wen,1 Peng Dong,1 Jia Liu,1 Shi-Jun Wang,1 Jian Li1,2 1Department of Gynecology and Obstetrics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China; 2Department of Family Planning, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100010, People’s Republic of ChinaCorrespondence: Jian Li, Department of Family Planning, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 17 Qihe Lou, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +86 13661343676, Email lijian1047@126.com Shi-Jun Wang, Department of Gynecology and Obstetrics, Xuanwu Hospital, Capital Medical University, Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86 13601222289, Email wsj9188@126.comObjective: This study aimed to investigate the role of immune inflammation in recurrent spontaneous abortions (RSA).Methods: In this study, decidua tissues from 12 patients were collected. These included six individuals with RSA in the RSA group and six in the control group. The differences in gene and metabolite expression in the decidua of the placenta between normal pregnancies and patients with RSA were compared using transcriptomic and metabolomic analyses. The differentially expressed genes and metabolites were further analyzed through functional enrichment analysis using high-throughput sequencing technology.Results: There was a significant upregulation of genes associated with immunity and inflammation in the RSA group compared to the control group. The TNF signaling pathway was upregulated in the RSA group. Inflammatory mediators were expressed at higher levels in the RSA group, and arachidonic acid metabolism was the most significant differential metabolite set. The regulation of inflammatory mediators of transient receptor potential (TRP) channels were enriched in RSA cases. The integrated analysis of the data further suggests that the immune-inflammatory response might be an important factor in RSA. The expression levels of genes related to inflammation and hypoxia in tissues from patients with RSA were verified using quantitative reverse transcription polymerase chain reaction (qRT-PCR), and this revealed that the expression of MARK10 and TNFAIP3 genes was significantly upregulated in samples from RSA patients compared to normal tissues.Conclusion: The findings suggest a strong association between immune-related inflammation and RSA. Addressing metabolic and inflammatory aspects in patients with RSA may potentially help enhance pregnancy outcomes.Keywords: decidua tissue, immune inflammation, metabolomics, recurrent spontaneous abortion, transcriptomics

Teng-Yue Zhao,1,2 Bing-Jie Wang,3 Jiang Liu,1 Chu Liu,1 Ji-Qiang Bu,1 Yu Liu,1 Fang Yan,1 Wen-Li Zhang,1 Zi-Ying Chen,1 Yu-Ming Wu2 1Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China; 2Department of Physiology, Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China; 3Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of ChinaCorrespondence: Zi-Ying Chen, Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, No. 215 of Heping West Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +86 15803210520, Email ziyingchenorg@126.com Yu-Ming Wu, Department of Physiology, Hebei Medical University, No. 361 of Zhong Shan East Road, Shijiazhuang, 050017, People’s Republic of China, Tel +8631186261288, Email wuym@hebmu.edu.cnObjective: The employment of the no-touch technique in harvesting the great saphenous vein (GSV) for coronary artery bypass grafting has been associated with a significant improvement in clinical patency rates. Despite these advantages, such grafts may predispose patients to complications in the lower limbs. This study endeavors to evaluate the incidence of complications in the lower extremities by deploying an enhanced protocol for the no-touch harvesting technique.Methods: The historical control group in this study included patients who underwent coronary artery bypass grafting (CABG) with the no-touch technique for GSV harvesting at our institution from August 2018 to April 2020, in compliance with ethical standards. The intervention group consisted of patients who received CABG and were subjected to an optimized no-touch technique for GSV harvesting from May 2020 to June 2022. Technical modifications were applied to reduce lower limb complications, including limited use of electrocautery, minimization of extravascular tissue preservation, relaxation of postoperative elastic compression bandages, and elevation of the lower extremities. These measures aimed to decrease the incidence of postoperative lower limb complications, such as pain, numbness, edema, exudation, and delayed healing. The occurrences of postoperative complications were meticulously documented, compared, and analyzed between the two groups.Results: The adoption of the optimized no-touch technique resulted in a significant decrease in the incidence of postoperative lower extremity incisional complications among patients subjected to off-pump CABG (p < 0.05).Conclusion: The results of this study substantiate that the application of an optimized no-touch technique to harvest the GSV significantly diminishes the incidence of postoperative lower limb complications in patients receiving CABG. These results highlight the importance of adopting and integrating this optimized technique into clinical protocols, emphasizing its critical role in advancing patient care outcomes.Keywords: historical controlled study, lower limb complications, no-touch great saphenous vein, off-pump coronary artery bypass grafting, propensity score matching

Fang Ye,1,&ast; Xiaonan Hou,1,&ast; Jie Chen,1 Hui Qin,1 Xiaojing Xu,1 Die Liu,1 Jing Liu,2 Qi Sun,1 Haiyan Liu,3 Fang Hu,4 Yuwan Zhou,5 Pengfei Xu,1,&ast; Qi Zhang1,&ast; 1Department of Pediatrics, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 2Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi an, People’s Republic of China; 4Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623, People’s Republic of China; 5Department of Prevention Care, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Pengfei Xu; Qi Zhang, Department of Pediatrics, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, People’s Republic of China, Email xpf@263.net; zhangqi0355@sina.comPurpose: The objective of this study was to investigate the behavioral changes in the core features and challenging behaviors of children with Autism Spectrum Disorder (ASD) during the COVID-19 Omicron wave (from December 2022 to January 2023) in China.Patients and Methods: A total of 515 caregivers of children with ASD completed an online survey. This survey was designed to assess the sociodemographic characteristics of the children and their caregivers, the clinical features of COVID-19, the manifestation of core ASD features and challenging behaviors, and the alterations in daily life following the COVID-19 Omicron variant wave.Results: The children with ASD had an average age of 5.4 years, with 79.6% being male. After the Omicron wave, the proportions of participants with worsening core ASD features and challenging behaviors were 22.9% and 37.1%, respectively. Sleep disorders (20.0%), eating problems (18.6%), and inattentive symptoms (17.5%) were the most frequently reported worsening behaviors. The factors associated with the worsening of core ASD features included infection with the Omicron variant of COVID-19, reduced outdoor activity, and a lower score of caregiver health-related quality of life (HRQoL). The worsening of challenging behaviors was associated with infection with the Omicron variant of COVID-19, a lower frequency of rehabilitation training, and a lower score of HRQoL.Conclusion: The outbreak of the COVID-19 Omicron variant had an impact on the behaviors of autistic children. The behavior changes in core ASD features and challenging behaviors differed and were associated with COVID-19 infection and other factors.Keywords: core feature, challenging behavior, behavior worsening, infection, autism spectrum disorder

Hua Wang,1 Jichong Ying,2 Jianlei Liu,2 Tianming Yu,2 Dichao Huang2 1Department of Medical Imaging, Ningbo No.6 hospital, Ningbo, People’s Republic of China; 2Department of Orthopedics, Ningbo No.6 hospital, Ningbo, People’s Republic of ChinaCorrespondence: Dichao Huang, Department of Orthopedics, Ningbo No.6 hospital, Ningbo, People’s Republic of China, Email hsdichaohuang@163.comBackground: Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses.Methods: In this study, we acquired 1453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved meticulous preprocessing of images, including normalization and resampling, followed by a systematic comparative evaluation of the models based on accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models’ predictive focus points.Results: The 3D-EfficientNetB7 model outperformed the other models, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. It demonstrated particularly effective in the accurate detection and localization of subtle and complex fractures. Grad-CAM visualizations confirmed the model’s focus on clinically relevant areas, aligning with expert assessments and enhancing trust in automated diagnostics. Spatial localization techniques were pivotal in improving interpretability, offering clear visual guidance for pinpointing fracture sites.Conclusion: Our findings highlight the effectiveness of the 3D-EfficientNetB7 model in diagnosing ankle fractures, supported by robust performance metrics and enhanced visualization tools.Keywords: 3d convolutional neural networks, ankle fractures, diagnostic accuracy, Grad-CAM, image processing, machine learning, medical imaging, orthopedic diagnostics

Cunjin Wang,1– 4,&ast; Xiaowei Song,1,2,&ast; Jing Liu,1,2 Yinghao Song,1,3,4 Ju Gao1– 4 1Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People’s Republic of China; 2Department of Anesthesiology, Northern Jiangsu People’s Hospital, Yangzhou, 225001, People’s Republic of China; 3Department of Pain Treatment, Northern Jiangsu People’s Hospital, Yangzhou, 225001, People’s Republic of China; 4The Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, 225001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Cunjin Wang, Department of Anesthesiology, Northern Jiangsu People’s Hospital, No. 98 Nan Tong Western Road, Yangzhou, Jiangsu, 225001, People’s Republic of China, Tel +86- 18051061453, Email cunjinwang@163.comPurpose: Postherpetic Neuralgia (PHN), recognized as the most common complication of Herpes Zoster, is experiencing an increasing trend in its occurrence. The goal of this study was to identify the independent risk factors for PHN and create a dynamic nomogram using routine clinical characteristics to predict PHN in patients with herpes zoster, for early identification and prevention of PHN.Patients and Methods: A total of 2420 patients were retrospectively reviewed and divided into training (n=1696) and validation (n=724) cohort using a 7:3 random allocation. Univariable, LASSO and multivariable logistic regression analysis was performed to identified independent risk factors for PHN. A dynamic nomogram was assessed through the area under the receiver operating characteristic curve (AUC), calibration curves and Hosmer-Lemeshow test. The decision curve analysis (DCA) was used to evaluate its clinical validity.Results: Multivariable logistic regression identified several independent risk factors for PHN, including age, female, diabetes mellitus, malignant tumors, and connective tissue diseases. The area under the curve was 0.698 (95% CI, 0.666– 0.730) for training cohort and 0.713 (95% CI, 0.663– 0.763) for the validation cohort. Calibration curve revealed a moderate consistency between actual observation and prediction. Decision curve analysis showed a risk threshold of 16% and demonstrated a clinically effective predictive model.Conclusion: We have developed a user-friendly dynamic nomogram to predict PHN in patients with herpes zoster, which can assist in early identification and prevention of PHN.Keywords: postherpetic neuralgia, herpes zoster, risk factors, dynamic nomogram

Juyi Li,1,2 Yang Ge,3 Yuwei Chai,1 Chunjia Kou,1 Tian Tian Sun,4 Jia Liu,3,5– 7 Haiqing Zhang1,3,5– 7 1Department of Endocrinology, Shandong Provincial Hospital, Shandong University; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Endocrinology, Geriatrics Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, People’s Republic of China; 3Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China; 4Department of Infectious Diseases, Jinan People’s Hospital, Jinan, Shandong, 271100, People’s Republic of China; 5Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, 250021, People’s Republic of China; 6Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, 250021, People’s Republic of China; 7Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, 250021, People’s Republic of ChinaCorrespondence: Jia Liu; Haiqing Zhang, Department of Endocrinology, Shandong Provincial Hospital, 324 Jingwu Road, Jinan, Shandong Province, 250021, People’s Republic of China, Tel +86 18653155865 ; Tel +86 15168888303, Email liujia_625@163.com; zhanghq@sdu.edu.cnPurpose: Thyroid-stimulating hormone (TSH) has been identified as an independent risk factor for non-alcoholic fatty liver disease (NAFLD), TSH binds to the TSH receptor (TSHR) to exert its function. However, the underlying mechanisms by which TSHR influences NAFLD development remain unclear. This study investigates the role of miR374b in NAFLD progression.Methods: Firstly, a rat model of non-alcoholic fatty liver was constructed and divided into a normal group and a model group. The liver tissue pathology and fat accumulation were detected by Oil Red O staining and hematoxylin-eosin staining. Western blot and Real time PCR were used to detect for the impact of TSHR/miR-374b/C/EBP β/ FoxO1 pathway in the NAFLD model, and the expression of relevant inflammatory factors in each group was detected by ELISA assay. A NAFLD cell model was constructed using HepG2 cells, TSHR overexpression and interference, combined with miR-374b inhibitor and mimics, were transfected simultaneously to demonstrate TSHR/miR-374b/C/EBP β/ The mechanism of FoxO1 adipogenesis in vitro.Results: TSHR stimulates miR374b secretion in human liver cancer cells (HepG2) and promotes lipid accumulation in the liver. Deficiency of miR374b in HepG2 cells attenuated NAFLD progression. Mechanistically, TSH increases miR374b expression, which then suppresses the transcription of its target genes, CCAAT/enhancer binding protein-b (C/EBP β) and Forkhead Box Protein O1 (FOXO1). This suppression influences the expression of downstream lipid metabolism proteins, including PPARγ, SREBP2, and SREBP1c. Additionally, miR374b directly targets the 3′UTR of C/EBP β and FOXO1, establishing a negative feedback loop in lipid metabolism.Conclusion: These findings suggest that TSHR-induced upregulation of miR374b accelerates NAFLD progression by modulating lipid metabolism pathways through C/EBP β and FOXO1. Keywords: NAFLD, miR374b, TSHR

Fengshan Ouyang,1,2 Sheng Chen,1 Shuhuan Li,3 Lanyuan Liu,4 Senhong Guan,1 Zhaohan Yan,1 Shumin Wu,5 Yunying Zeng,1 Jiemei Liu,2 Jiankai Zhong1 1Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 2Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 3Department of Pediatrics, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 4Department of Ultrasound Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China; 5Department of Clinical Pharmacy, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of ChinaCorrespondence: Jiankai Zhong, Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), No. 1 Jiazi Road, Lunjiao Street, Shunde District, Foshan City, Guangdong Province, 528308, People’s Republic of China, Tel +86 13824530303, Email doctor-zh@smu.edu.cn Jiemei Liu, Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China, Email liujiemei90@hotmail.comObjective: This study aimed to examine the correlation and prognostic value of serum irisin levels in acute ischaemic stroke (AIS) and the subsequent development of hemiplegia.Methods: This study recruited participants from the Department of Neurology and Rehabilitation Medicine at Shunde Hospital, Southern Medical University. The Fugl–Meyer Assessment was used to assess functional impairment. Serum irisin levels were measured using the enzyme-linked immunosorbent assay method. Multivariate logistic regression was employed to explore the factors related to serum irisin levels and AIS.Results: Serum irisin levels in the AIS group were significantly lower than those in the control group. However, no significant association was observed between serum irisin and stroke severity within the AIS cohort. Multivariate logistic regression analysis revealed an inverse correlation between serum irisin levels and AIS risk, indicating that it serves as a protective factor against AIS. The increase in serum irisin levels (adjusted odds ratio (OR) 0.938, 95% confidence interval [CI]: 0.899– 0.977 per 100 pg/mL increment) was associated with a decreased risk of AIS. Analysis of the receiver operating characteristic curve confirmed the diagnostic value of serum irisin for AIS, with the area under the curve being 0.591 (95% CI: 0.522– 0.659, p = 0.012).Conclusion: Serum irisin levels were significantly lower in AIS and were identified as a protective factor, suggesting that serum irisin may have diagnostic value for AIS.Keywords: irisin, acute ischaemic stroke, hemiplegia, risk factors, predictive value

Fanfan Wang,1,2 Jian Liu,1,2 Yanyan Fang,1,3 Yue Sun,2 Mingyu He1,2 1The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China; 2Department of Rheumatism Immunity, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China; 3Department of Clinical Data Center, The first Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of ChinaCorrespondence: Jian Liu, The first Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China, Email liujianahzy@126.comObjective: The present study aimed to investigate the potential association between the treatment with Xinfeng Capsule (XFC) and the risk of readmission among patients with rheumatoid arthritis (RA).Methods: Through a retrospective approach, data were collected from all hospitalized patients diagnosed with RA at the First Affiliated Hospital of Anhui University of Chinese Medicine between 2013 and 2021. To mitigate selection bias and confounding factors, patients were stratified into an XFC group and a Non-XFC (Non-XFC) group based on their treatment status using propensity score matching with a 1:2 ratio. Variables such as age, gender, and baseline medications were adjusted. Subsequently, the Cox proportional hazards model was employed to calculate the hazard ratio (HR) for readmission among RA patients, while Kaplan-Meier curves were utilized to depict the incidence of readmission.Results: A total of 9987 RA patients were included in this study. Following rigorous inclusion/exclusion criteria and propensity score matching, the XFC group comprised 2036 patients, while the Non-XFC group contained 4072 patients. The Cox proportional hazards model analysis revealed that XFC acted as a protective factor, significantly reducing the risk of readmission among RA patients. Further examination of Kaplan-Meier curves demonstrated that XFC use not only effectively lowered the frequency of readmissions but also exhibited a more pronounced effect in diminishing the risk of readmission with extended usage durations (beyond 12 months). Additionally, association rule analysis underscored the strong link between XFC and freedom from readmission, as well as the robust correlation between XFC usage and significant improvements in multiple laboratory indicators, including C3, C4, CRP, ESR, and others.Conclusion: This study underscores a robust and long-term association between XFC usage and lower readmission rates among RA patients. As a protective factor against readmission risk in these patients, the clinical value of XFC merits further promotion and investigation.Keywords: rheumatoid arthritis, readmission, cohort study, xinfeng capsule

Jie Liu, Yu Wei, Yanhui Zhu, Yu Li, Qiong Wang, Lei Yu, Langen Zhuang, Guoxi Jin, Xiaoyan Pei Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui Province, People’s Republic of ChinaCorrespondence: Guoxi Jin; Xiaoyan Pei, Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical University, No. 287 Changhuai Road, Bengbu, Anhui Province, 233000, People’s Republic of China, Email jyzjyz1999@163.com; 245899985@qq.comBackground: Thyroid hormone resistance syndrome (RTH) is a rare hereditary endocrine disease that can manifest as hyperthyroidism, hypothyroidism, or remain asymptomatic. It can easily be confused with other types of thyroid diseases. The diagnosis of the disease depends on genetic testing.Case Report: We report a 19-year-old male patient with elevation of thyroid hormones. Serological examination showed elevated thyroid hormone levels, and thyroid-stimulating hormone levels within the reference interval. The patient was finally diagnosed with RTH after genetic testing that identified a gene mutation inherited from his mother. Due to timely diagnosis, the patient’s condition has been well controlled, and his prognosis is good.Conclusion: The clinical manifestations of RTH lack specificity, and serological examination typically shows elevated thyroid hormone levels and unsuppressed thyrotropin levels. Differential diagnosis requires a combination of serological examination, imaging studies, and functional tests to distinguish RTH from other conditions. The purpose of this treatment is to improve symptoms and should not involve the blind administration of antithyroid drugs, thyroid surgery, or radiotherapy.Keywords: Inappropriate secretion of thyroid-stimulating hormone, resistance to thyroid hormone, thyroid hormone receptor β, THRB gene

Xianheng Zhang,1,2 Jian Liu1,3 1Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, 230031, People’s Republic of China; 2Anhui University of Chinese Medicine, Hefei, Anhui Province, 230012, People’s Republic of China; 3Institute of Rheumatology, Anhui Academy of Traditional Chinese Medicine, Hefei, Anhui Province, 230009, People’s Republic of ChinaCorrespondence: Jian Liu, Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, 230031, People’s Republic of China, Email liujianahzy@126.comAbstract: Gout is a metabolic disease characterized by inflammatory arthritis caused by abnormal uric acid metabolism. It is often complicated with cardio-renal damage and vascular lesions. In recent years, the relationship between lipid metabolism and gout has attracted increasing attention. Changes in blood lipids in gout patients are often clinically detectable and closely related to uric acid metabolism and inflammatory response in gout. With the development of lipidomics, the changes in small lipid molecules and their metabolic pathways have been gradually discovered, yielding a greater understanding of the lipid metabolism changes in gout patients and their potential role in gout development. Through searching the literature on lipid metabolism in gout since 2000 in PubMed and Web of Science, this article reviewed lipid metabolism changes in gout patients and their role in the risk of gout, uric acid metabolism, inflammatory response, and comorbidities. Additionally, the strategies to regulate the abnormal lipid metabolism in gout have also been summarized from the aspects of drugs, diet, and exercise. These will provide a new perspective for understanding gout pathogenesis and its treatment and management.Keywords: gout, lipid metabolism, treatment, management

Shupeng Chen,1 Jie Liu,1 Guilian He,1 Nana Tang,2 Yingjian Zeng2 1School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330004, People’s Republic of China; 2Hematology Department, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, 330006, People’s Republic of ChinaCorrespondence: Yingjian Zeng, Jiangxi University of Traditional Chinese Medicine Affiliated Hospital, Hematology Department, Nanchang, 330006, People’s Republic of China, Email tcmdrc2023@outlook.comBackground: Cancer poses a major global health challenge, and immunotherapy, known as the third revolution in cancer treatment, has brought new hope to patients. The emerging field of immunometabolism has further enhanced the safety and efficacy of immunotherapy. Over the past two decades, this field has rapidly evolved in oncology, leading to numerous significant findings. This review systematically examines the literature on immunometabolism in cancer, visualizing research trends and identifying future directions.Methods: A comprehensive literature search was conducted in the Web of Science, PubMed, and Scopus databases, covering publications from January 2000 to December 2023. We employed tools like Citespace, VOSviewer, and RStudio for visual analysis of publication trends, regional contributions, institutions, authors, journals, and keywords.Results: A total of 3320 articles were published by 8090 authors across 1738 institutions, involving 71 countries. Leading contributors were China (n=469), the United States (n=361), and Germany (n=82). Harvard University was the most influential institution, while Frontiers in Immunology had the highest number of publications. The top research areas included glucose, lipid, and amino acid metabolism, the tumor microenvironment, and immune cell regulation.Conclusion: International collaboration and interdisciplinary efforts are advancing the field of cancer immunometabolism. Future research will likely focus on the interplay between metabolism and immunity, metabolic markers, immune cell reprogramming, and tumor-immune metabolic competition.Keywords: immunity, metabolism, tumor, metabolic reprogramming, immune evasion, bibliometrics

Jiayun Liu, Rui Sun, Guomin Gao, Mogen Zhang, Huiping Fan, Xiaonan Ma, Yanhong Yu, Yanmei Yuan, Lulu Zhang, Changying Niu Department of Dermatology, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, People’s Republic of ChinaCorrespondence: Changying Niu, Department of Dermatology, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, People’s Republic of China, Tel +86-536-3081272, Email niucy0125@126.comObjective: The relationship between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and psoriasis remains unclear. This study aims to analyze the association between ACE gene I/D polymorphism and the risk of psoriasis vulgaris in the Chinese Han population and to examine the correlation between ACE gene I/D polymorphism and psoriasis with comorbid hypertension and diabetes.Methods: A total of 358 patients with psoriasis vulgaris and 347 age- and sex-matched healthy volunteers from the Chinese Han population were selected. Clinical data, including blood pressure and fasting blood glucose, were collected from the patients. The ACE gene I/D polymorphism was analyzed using polymerase chain reaction (PCR). The association between ACE gene I/D polymorphism and psoriasis vulgaris, as well as comorbid hypertension and diabetes, was analyzed using the Pearson χ²-test.Results: The frequency of the ACE II genotype (OR = 1.84, 95% CI = 1.30, 2.61; P < 0.01) and the I allele (OR = 1.51, 95% CI = 1.22, 1.86; P < 0.01) was significantly higher in psoriasis patients compared to the control group. Conversely, the frequency of the ACE DD genotype (OR = 0.62, 95% CI = 0.44, 0.87; P < 0.01) and the D allele (OR = 0.66, 95% CI = 0.54, 0.82; P < 0.01) was significantly lower in psoriasis patients compared to the control group. No statistically significant differences were observed when stratified by blood pressure and blood glucose abnormalities (P > 0.05).Conclusion: The ACE II genotype and I allele are risk factors for psoriasis vulgaris in the Northern Chinese Han population.Keywords: psoriasis vulgaris, angiotensin-converting enzyme, insertion/deletion mutation, gene polymorphism, Chinese Han ethnic group

Yuhao Zhao,&ast; Shun Zhao,&ast; Yuchen Shi, Qin Ma, Ze Zheng, Ping Wang, Jinghua Liu Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ping Wang; Jinghua Liu, Email wang_ping@vip.sina.com; liujinghua@vip.sina.comBackground: There is limited research on the long-term prognosis of percutaneous coronary intervention (PCI) in coronary chronic total occlusion (CTO) patients who have previously undergone coronary artery bypass grafting (CABG). Additionally, the prognostic value of a novel systemic immune inflammation index (SII) in this specific patient population remains unclear.Methods: To adjust for differences in baseline features and minimize bias, 335 pairs of patients with or without prior CABG undergone PCI were obtained after probability score matching (PSM) in a single-center cohort. The clinical characteristics were collected, and the primary outcomes were major cardiovascular events (MACE), which included all-cause death, nonfatal MI and unplanned revascularization, were recorded during the follow-up period after discharge. The group with prior CABG were divided according to the median level of SII: Lower SII group (SII ≤ 570.10, N = 167) and higher SII group (SII ≥ 570.10, N = 168).Results: The SII values were significantly higher in the prior CABG group than in the without prior CABG group [570.10 (444.60, 814.12) vs 519.65 (446.86, 565.84), P < 0.001, respectively]. The survival Kaplan–Meier analysis showed that patients with prior CABG was significantly associated with a higher risk of MACE than patients without prior CABG (P = 0.016) in the long-term follow-up. As SII levels increased, the cumulative risk of MACE became significantly higher in the patients with prior CABG (P = 0.023) stratified by the median value of SII. The Cox proportional hazards regression model analysis indicated that the level of SII (hazard ratio = 2.035, 95% CI, 1.103– 3.753, P = 0.023) emerged as independent predictors of MACE. The restricted cubic spline (RCS) analysis illustrated that the HR for MACE increased with increasing SII.Conclusion: SII is a reliable predictor of long-term cardiovascular events after PCI in CTO patients with prior CABG, suggesting that SII may be helpful in identifying high-risk patients who need more aggressive treatment and follow‐up strategies.Keywords: systemic immune inflammation index, coronary chronic total occlusion, coronary artery bypass grafting, percutaneous coronary intervention, major adverse cardiovascular events

Xiu Wang,1,2 Qianqian Yu,3 Jun Zhu,4 Junlan Liu,2 Xuyuan Gao,2 Xiudie Wang,2 Lanlan Wang,2 Xia Xu2 1Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai City, Shandong Province, 264199, People’s Republic of China; 2College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei City, Anhui Province, 230012, People’s Republic of China; 3Department of Critical Care Medicine, Qingdao University Affiliated Hospital, Qingdao City, Shandong Province, 266035, People’s Republic of China; 4Department of Traditional Chinese Medicine, Anhui College of Traditional Chinese Medicine, Wuhu, Anhui, 241005, People’s Republic of ChinaCorrespondence: Xia Xu, College of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, 1 Qianjiang Road, Yaohai District, Hefei City, Anhui Province, People’s Republic of China, Tel +86 15955170282, Email 907367552@qq.comObjective: This systematic review and meta-analysis aims to investigate the effectiveness and safety of acupuncture and moxibustion in managing perioperative anxiety during gynecological surgery.Methods: Relevant studies published from the establishment of the databases to March 20, 2023, were searched in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM. Literature screening and data extraction were independently conducted by two investigators. The Cochrane risk-of-bias tool 2.0 was utilized to assess the risk of bias in the included studies. Data analysis was carried out using Stata 15.1 software.Results: The analysis included a total of 3254 patients from twenty studies. It was found that acupuncture and moxibustion therapy resulted in a reduction of postoperative State-Trait Anxiety Inventory (STAI-S) scores (mean difference [MD] = − 3.50, 95% confidence interval [CI] [− 6.93 to − 0.07], P = 0.046), as well as both preoperative and postoperative Visual Analogue Scale-Anxiety (VAS-anxiety) and Self-Rating Anxiety Scale (SAS) scores (pre-operation: SMD = − 1.04, 95% CI [− 1.73 to − 0.35], P = 0.003; post-operation: SMD = − 0.78, 95% CI [− 1.21 to − 0.35], P < 0.001) in comparison to the control group. Nonetheless, no significant variances were noted between the two groups with regards to preoperative and intraoperative STAI-S scores (pre-operation: MD = − 3.38, 95% CI [− 9.58 to 2.82], P = 0.286; intraoperative: MD = − 1.09, 95% CI [− 7.32 to 5.13], P = 0.730), and intraoperative VAS-anxiety and SAS scores (SMD = − 0.44, 95% CI [− 1.51 to 0.64], P = 0.427).Conclusion: During the perioperative period of gynecological surgery, acupuncture and moxibustion therapy show potential in alleviating anxiety in patients. It is noteworthy that the current level of evidence is limited by the small sample size. Therefore, further validation of these findings is necessary.Keywords: perioperative anxiety, gynecological surgery, acupuncture, systematic review, meta-analysis

Huixin Cheng,1 Xuehan Wang,1 Juyi Yao,2 Chunbo Yang,3 Jian Liu1,4 1The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, People’s Republic of China; 2Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China; 3Department of Critical Medicine Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China; 4Department of Intensive Care Unit, Gansu Provincial Maternity and Child Health Hospital/Gansu Provincial General Hospital, Lan Zhou, Gansu Province, People’s Republic of ChinaCorrespondence: Jian Liu, The First Clinical Medical College of Lanzhou University, No. 222 Tianshui South Road, Lanzhou, Gansu Province, 730013, People’s Republic of China, Email medecinliujian@163.comAbstract: Sepsis is a common critical illness characterized by high mortality rates and a significant disease burden. In the context of sepsis-induced organ dysfunction, the lungs are among the initial organs affected, which may progress to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Recent studies have highlighted the crucial roles of mitophagy and ferroptosis in the development and progression of sepsis-induced ALI/ARDS. Identifying key convergence points in these processes may provide valuable insights for the treatment of this condition. In recent years, certain herbs and their bioactive compounds have demonstrated unique benefits in managing sepsis-induced ALI/ARDS by modulating mitophagy or ferroptosis. This review summary the mechanisms of mitophagy and ferroptosis, explores their interactions, and emphasizes their regulatory roles in the progression of sepsis-induced ALI/ARDS. Additionally, it offers a novel perspective on treatment strategies by summarizing various herbs and their bioactive compounds relevant to this condition.Keywords: sepsis, acute lung injury, acute respiratory distress syndrome, mitophagy, ferroptosis

Shengfeng Liu,1,2 Jian Liu,1,2 Xueni Cheng,1 Dahai Fang,1 Xiaolu Chen,1 Xiang Ding,1 Xianheng Zhang,1 Yiming Chen1 1Department of Rheumatology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of China; 2Anhui Key Laboratory of Application and Development of Internal Medicine of Modern Chinese Medicine, Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of ChinaCorrespondence: Jian Liu, Department of Rheumatology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of China, Tel +86 13955109537, Email liujianahzy@126.comAbstract: Rheumatoid arthritis (RA) is a chronically progressive autoimmune disease with increasing age-standardized prevalence and incidence of RA worldwide. Its pathological features are persistent synovitis of the joint, accompanied by the release of a large number of inflammatory cytokines and cartilage and bone destruction. RA can lead to progressive joint damage, stiffness and swelling, vascular and bone-related complications, and irreversible disability, which seriously affects patients’ life treatment. Early diagnosis and treatment can enhance the quality of life of RA patients. Platelet-to-lymphocyte ratio (PLR), as a common indicator in routine blood tests, has been proposed as an indicator of systemic inflammation in recent years. Its clinical detection is less invasive, economical, rapid and simple, and has been applied to the clinical evaluation of a variety of diseases. Of note, this indicator is important in assessing disease activity in RA, co-diagnosing RA, detecting subclinical complications, and monitoring responses to anti-inflammatory therapy. Therefore, this review summarizes the relationship between PLR and RA and the relevant mechanisms, further advancing the understanding of the clinical value of PLR.Keywords: platelet-to-lymphocyte ratio, rheumatoid arthritis, inflammatory, blood platelets, lymphocytes

Qian Cheng,1 Yishu Tang,2 Jing Liu,1 FeiYang Liu,1,&ast; Xin Li1,&ast; 1Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: FeiYang Liu; Xin Li, Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, People’s Republic of China, Tel +86-731-88618814 (88618214) ; Tel +86-731-88618814 (88618214), Email 546917399@qq.com; lixiner1975@163.comObjective: The role of chest computed tomography (CT) in distinguishing the causative pathogens of pulmonary infections in patients with hematological malignancies (HM) is unclear. The aim of our study was to compare and assess the clinical characteristics, radiologic features and potential differential diagnostic value of CT in HM patients and other different immune statuses patients with pulmonary infections.Methods: Patients were divided into immunocompetent (105 cases) and immunocompromised groups (99 cases) according to immune status. Immunocompromised patients included the HM group (63 cases) and the non-HM group (42 cases). The basic clinical data and CT findings were collected and statistically analyzed.Results: Regarding the pathogen distribution, viral, Pneumocystis jirovecii and mixed infections were more common in the immunocompromised group than the immunocompetent (p < 0.01), but viral infections were more common in the HM group than in the non-HM group (p=0.013). Immunocompromised patients had more diverse CT findings and more serious lesions (mostly graded 2– 4) than immunocompetent patients. The most common CT findings in HM patients were consolidation and ground-glass opacities (GGO), which were also found in the non-HM group. The overall diagnostic accuracy of CT was lower in immunocompromised patients than in immunocompetent patients (25.7% vs 50.5%, p< 0.01). CT had better diagnostic efficacy for fungi and Pneumocystis jirovecii in HM patients.Conclusion: CT diagnosis is less efficient in distinguishing the causative pathogens of HM patients. However, CT can help distinguish fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients.Clinical Relevance Statement: Our study might facilitate clinical decision-making in fungal pneumonia and Pneumocystis jirovecii pneumonia in HM patients.Keywords: pneumonia, hematological malignancies, computed tomography, diagnostic value

Xiao Shen,1 Jin-Xing Zhang,1 Jin Liu,2 Sheng Liu,1 Hai-Bin Shi,1 Yuan Cheng,3 Qing-Qiao Zhang,4 Guo-Wen Yin,5 Qing-Quan Zu1 1Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, People’s Republic of China; 2Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, People’s Republic of China; 3Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, People’s Republic of China; 4Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, People’s Republic of China; 5Department of Interventional Radiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, People’s Republic of ChinaCorrespondence: Qing-Quan Zu, Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86-13913807470, Fax +86-25-83724440, Email zuqingquan@njmu.edu.cnPurpose: Transarterial chemoembolization (TACE), when used in combination with immunotherapy and antiangiogenic therapy, has been shown to have synergistic anticancer effects. The aim of this study was to further assess the efficacy and safety of TACE combined with atezolizumab and bevacizumab in the treatment of unresectable hepatocellular carcinoma (HCC) in the real world.Methods: Between August 2021 and September 2023, clinical information was collected from consecutive HCC patients who received treatment via TACE-Atezo/Bev at four tertiary institutions. This study evaluated the objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) as outcomes. Predictors for OS and PFS were also analyzed. Treatment-related adverse events (TRAEs) were recorded and assessed.Results: Ninety-two patients were enrolled in this study, with a median follow-up duration of 14.1 months. The ORRs based on the modified Response Evaluation Criteria in Solid Tumors (RECIST) and RECIST 1.1 criteria were 54.3% and 41.3%, respectively. The median OS and PFS of the patients were 15.9 months [95% confidence interval (CI), 14.5– 17.2 months] and 9.1 months (95% CI, 7.4– 10.8 months), respectively. Multivariate analyses revealed that the Eastern Cooperative Oncology Group score and neutrophil‒lymphocyte ratio were independent risk factors for OS, whereas tumor size and extrahepatic metastasis were independent risk factors for PFS. Grade 3/4 TRAEs occurred in 16.3% (15/92) of the patients and were controlled conservatively.Conclusion: The combination of Atezo/Bev with TACE demonstrated acceptable synergistic therapeutic effects and manageable safety profiles in patients with unresectable HCC.Keywords: atezolizumab, bevacizumab, efficacy, hepatocellular carcinoma, transarterial chemoembolization

Maolin Hou,1,&ast; Jinghua Chen,2,&ast; Le Yang,3,&ast; Lei Qin,3 Jie Liu,4 Haibo Zhao,5 Yujin Guo,6 Qing-Qing Yu,6 Qiujie Zhang5 1Department of Internal Medicine, Siziwangqi People’s Hospital, Wulancabu, 011800, People’s Republic of China; 2Department of Oncology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, 250000, People’s Republic of China; 3Department of Gastrointestinal Surgery, Jining, 272000, People’s Republic of China; 4Department of Pediatric Intensive Care Unit, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, 250000, People’s Republic of China; 5Department of Oncology, Jining, 272000, People’s Republic of China; 6Department of Clinical Pharmacology, Jining, 272000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qiujie Zhang, Department of Oncology, Jining No. 1 People’s Hospital, Jining, 272000, People’s Republic of China, Email zhangqiujie86@163.com Qing-Qing Yu, Department of Clinical Pharmacology, Jining No. 1 People’s Hospital, Jining, 272000, People’s Republic of China, Email yuqingqing_lucky@163.comIntroduction: Gastric cancer, the fifth most common malignant tumor in the world, poses a serious threat to human health. However, the role of fatty acid metabolism (FAM) in gastric cancer remains incompletely understood. We aim to provide guidance for clinical decisions by utilizing public database of gastric adenocarcinoma to establish an FAM-related gene subtypes via machine learning algorithm.Methods: The intersection of FMGs from KEGG, Hallmark, and Reactome bioinformatics databases and the DEGs of the TCGA-STAD cohort was used to decompose the gene matrix related to establish FAM-related gene subtypes by NMF. Comparison of immune infiltrating differences between subtypes using ESTIMATE and Cibersort algorithms. The multifactor Cox regression to identify independent risk genes for patient prognosis based on the subtypes. A prognostic model including independent risk genes was built using random survival forest and Cox regression. IHC validation in gastric cancer and adjacent tissues confirmed the above gene expression level.Results: 71 DEGs related to FMGs of STAD were identified, which was used to established the FAM-related gene subtypes, C1 and C2. The immune infiltrating analysis showed that most immune features of C2 were significantly upregulated compared to C1. The independent risk genes were CGβ 8, UPK1B, and OR51G based on the subtypes. A gastric cancer prognostic model consisting of independent risk genes was constructed and patients were classified into high-risk and low-risk groups with survival differential analysis. Finally, IHC showed that CGβ 8 and UPK1B expression were upregulated in gastric cancer, while OR51G2 did not detect differences in expression.Conclusion: The study developed a machine learning-based gastric cancer prognosis risk model using FMGs. This model effectively stratifies patients according to their risk levels and provides valuable insights for clinical decision-making, enabling accurate evaluation of patient prognosis.Keywords: Gastric cancer, fatty acid metabolism-related genes, machine learning, genomics, signature

Dan Wu,1 Fang Li,2 Feifei Yang,3 Jun Liu4 1Department of Dermatology, Peking University First Hospital Ningxia Women and Children’s Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan City, Ningxia Hui Autonomous Region, 750011, People’s Republic of China; 2Department of Pathology, Peking University First Hospital Ningxia Women and Children’s Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan City, Ningxia Hui Autonomous Region, 750011, People’s Republic of China; 3Department of Dermatology, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing City, 101101, People’s Republic of China; 4Department of Critical Care Medicine, the First People’s Hospital of Yinchuan, Yinchuan City, Ningxia Hui Autonomous Region, 750001, People’s Republic of ChinaCorrespondence: Jun Liu, Department of Critical Care Medicine, the First People’s Hospital of Yinchuan, No. 2 Liqun West Street, Xingqing District, Yinchuan City, Ningxia Hui Autonomous Region, 750001, People’s Republic of China, Email JunLiunnu@outlook.comBackground: Numerous lines of evidence suggest that neuropeptide Y (NPY) is critically involved in the modulation of neuropathic pain. Postherpetic neuralgia (PHN) is characterized by prolonged duration, severe pain, and significant treatment resistance, substantially impairing patients’ quality of life. This study aims to evaluate the potential of plasma NPY levels in patients with PHN as a predictive biomarker for the development of this condition.Methods: Between February 2022 and December 2023, 182 patients with herpes zoster (HZ) were recruited. Thirty-eight volunteers with no history of HZ were also recruited as controls. Clinical factors, NPY, brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) were assessed within 3 days of healing. Logistic regression analysis was used to predict the development of PHN.Results: NPY levels were lower and BDNF and NGF were higher in HZ patients than those in controls. Only NPY levels were lower in patients with PHN (n = 59) compared with those without PHN (n = 123). Age, acute pain severity, and rash area were independent predictors of PHN, as were NPY levels. The area under the curve (AUC) to predict the development of PHN based on the combination of NPY levels and clinical factors was 0.873 (95% CI: 0.805 to 0.940), and the AUC was 0.804 based on only clinical factors (AUC: 0.804, 95% CI: 0.728 to 0.881).Conclusion: Low plasma NPY levels are a predictor of developing PHN in patients with HZ. Combining clinical predictors with NPY levels may improve predictive accuracy.Keywords: neuropeptide Y, herpes zoster, postherpetic neuralgia, sensory neurons

Junmei Fan,1,&ast; Jinghui Zhao,2,&ast; Junkun Zhang,3 Yanhua Chen,1 Xingyu Bi,1 Huiping Liu,1 Junfen Liu,1 Jinbao Wang,1 Xueqing Wu1 1Department of Reproductive Medicine Center, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, 030013, People’s Republic of China; 2Department of Pediatric and Adolescent Gynecology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, 518000, People’s Republic of China; 3Department of Intensive Care Unit, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xueqing Wu, Department of Reproductive Medicine Center, Children’s Hospital of Shanxi and Women Health Center of Shanxi, 13th Xinmin North Street, Xinghualing District, Taiyuan, Shanxi, 030013, People’s Republic of China, Tel +86 351 3360725, Email xueqingw_wu95@163.comBackground: This study aimed to explore the effect of vitamin D supplementation on lymphocyte subsets in infertile women.Methods: The study involved a total of 247 patients who suffered recurrent embryo implantation failure (RIF) or recurrent spontaneous abortion (RSA) between January and December 2019 in the Reproductive Medicine Center of Children’s Hospital of Shanxi and Women Health Center of Shanxi. The differences in the vitamin D and lymphocyte subsets of the two diseases, the correlation between the 25-hydroxy vitamin D and lymphocyte subsets, the changes in the lymphocyte subsets after vitamin D supplementation and the impact on pregnancy outcome were analysed.Results: The prevalence of vitamin D deficiency was 77.33% (191/247). After vitamin D supplementation, there were no significant differences in helper T cells (Th), cytotoxic T cells (Tc), Th/Tc and natural killer cells (NK) (p > 0.05), but there were significant differences in leukocyte differentiation antigens 3+ (CD3+), natural killer T cells (NKT), B lymphocytes and vitamin D (p < 0.05). Before vitamin D supplementation, the difference in the composition ratio of different vitamin D levels between the RIF and RSA groups was not statistically significant. At different vitamin D levels, there were no significant differences in CD3+, Th, Tc, Th/Tc, NK or B lymphocyte (p > 0.05), but there was a significant difference in NKT (p < 0.05).Conclusion: Vitamin D supplementation can reduce the level of NKT in infertile women, which may be of benefit to the pregnancy outcome of couples who experience RIF.Keywords: recurrent embryo implantation failure, infertility, lymphocyte subsets, recurrent spontaneous abortion, vitamin D

Ji Yang,1,&ast; Zhenyu Ding,2,&ast; Ying Yu,1 Junde Liu,1 Shuang Song,1 Zhendong Zheng,2 Huiying Yu1 1Basic Medicine Laboratory, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China; 2Department of Clinical Oncology, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huiying Yu, Basic Medicine Laboratory, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China, Email hyingy@sina.com Zhendong Zheng, Department of Clinical Oncology, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China, Email gcp_zzd@sian.comObjective: Colorectal carcinoma (CRC) is the third most common malignancy. In addition to comprehensive cancer treatments, such as surgery, chemotherapy, and radiotherapy, the adoptive immune cell therapy (ACT) has played an increasingly important role in recent years, and the adaptive transfusion of autologous NK cells and CIK cells is a brand-new approach to cellular therapy for solid tumors.Case Presentation: A 57-year-old man underwent a radical resection of microsatellite stable (MSS) rectal cancer with synchronous liver metastases. After surgery of the primary lesion surgery, he was treated with autologous CIK/NK cells combined with XELOX translational therapy. Each cycle can obtain over 10 × 109 CIK cells or over 6 × 109 NK cells combined chemotherapy of XELOX every 3 weeks. After 2 cycles of therapy, he achieved partial response (PR). He immediately underwent a hepatic metastasis resection. After surgery, the patient continued to receive autologous CIK/NK cells in combined with 4 cycles of XELOX. To date, he has achieved and maintained no evidence of disease (NED) for over 40 months.Conclusion: This is a case of successful treatment of rectal cancer with liver metastasis using ACT in conjunction with first-line chemotherapy. The advantage of this treatment plan is that it has few side effects and achieves long-term control of tumor recurrence by improving the patient’s immune function. However, its responsiveness and benefit rate still need further investigation.Keywords: autologous CIK cells, autologous NK cells, chemotherapy, advanced rectal cancer

Ziyan Zhong,1,&ast; Jian Liu,2,&ast; Yan Luo,1 Mei Wu,1 Feng Qiu,1 Hongqing Zhao,1 Yang Liu,1 Yajing Wang,3 Hongping Long,2 Lei Zhao,4 Yuhong Wang,1 Yuanshan Han,2 Pan Meng1 1Science & Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People’s Republic of China; 2The First Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China; 3Office of Science & Technology, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People’s Republic of China; 4School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanshan Han, The First Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China, Email 121983755@qq.com Pan Meng, Science & Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People’s Republic of China, Email 004181@hnucm.edu.cnBackground: Depression, a leading cause of disability worldwide, is characterized by dysfunction of immature neurons, resulting in dysregulated calcium homeostasis and impaired structural plasticity. Jujuboside A (JuA), a biologically active compound derived from Semen Ziziphi Spinosae, has demonstrated anti-anxiety and anti-insomnia properties. Recent studies suggest that JuA may be a promising antidepressant, but its underlying mechanisms remain unclear.Methods: Sprague-Dawley rats were subjected to chronic unpredictable mild stress (CUMS) to induce a depression model. JuA (12.5 mg/kg, 25 mg/kg, 50 mg/kg) was administered orally for 4 weeks. Emotional and cognitive function were assessed. Monoamine neurotransmitter levels were measured using enzyme-linked immunosorbent assay (ELISA). The number of immature neurons and calcium homeostasis were evaluated by immunofluorescence. Western blotting and immunofluorescence were employed to detect the expression of Sonic hedgehog (Shh) signaling proteins. Additionally, lentiviral vector expressing Shh shRNA (LV-Shh-RNAi) were infused intracerebrally to investigate the role of Shh in JuA’s antidepressant effects.Results: JuA significantly ameliorated depressive-like behavior and cognitive dysfunction in CUMS rats, increased monoamine neurotransmitter levels in serum and hippocampal tissue, reduced the number of BrdU/DCX (bromodeoxyuridine/doublecortin)-positive immature neurons, and attenuated calcium ion (Ca2+) concentration and Ca2+/calmodulin-dependent protein kinase II (CaMKII) levels in immature neurons. JuA also markedly elevated synaptic density and prominence complexity, upregulated Shh, Gli family zinc finger 1 and 2 (Gli1/2), synaptophysin (Syn) and postsynaptic density protein-95 (PSD-95) expression in the ventral dentate gyrus (vDG). However, knockdown of Shh in the vDG counteracted JuA’s therapeutic effects.Conclusion: These findings collectively suggest that JuA improves depressive-like behavior in CUMS rats by modulating calcium homeostasis and synaptic structural plasticity in immature neurons through the Shh signaling pathway.Keywords: Jujuboside A, Sonic hedgehog, Immature neuron, Calcium homeostasis, Depression

Yongkang Zhang,&ast; Jiarui Liu,&ast; Yuzhen Wang, Yuan Zong, Kangli Yin, Fang Cao, Xinyu Liang, Yemin Cao Diagnosis and Treatment Center of Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yemin Cao; Yongkang Zhang, Diagnosis and Treatment Center of Vascular Disease, Shanghai TCM-Integrated Hospital, No. 230 Baoding Road, Hongkou District, Shanghai, People’s Republic of China, Tel +8613361831119 ; +8613761921568, Email caoyemin@shutcm.edu.cn; zhangyongkang_tcm@163.comPurpose: Peripheral arterial disease (PAD) is a chronic ischemic disease caused by atherosclerosis of the lower extremities, with early clinical symptoms manifesting mainly as intermittent claudication. Current treatment of PAD is based on the control of cardiovascular risk factors. However, even vasoactive drugs are not ideal for improving ischemic symptoms in the lower limbs of PAD patients. Ruanjian Qingmai granules, derived from the classic formula of the late Professor Jiuyi Xi, a famous traditional Chinese medicine doctor in Shanghai, have good clinical efficacy in the treatment of the pattern of blood vessel stasis and obstruction of PAD and have been used by more than 600,000 PAD patients over the past three decades. This study aims to evaluate the efficacy and safety of Ruanjian Qingmai granules in patients with symptomatic PAD.Patients and methods: A prospective, center-randomized, double-blind, placebo-controlled clinical trial will be conducted at 9 grade A tertiary hospitals in Shanghai. It is anticipated that 250 patients with early symptomatic PAD will be recruited and randomized to the control and intervention groups (1:1 ratio of central randomization). Subjects will be treated with Ruanjian Qingmai granules or placebo at 6 g twice daily for 16 weeks. The primary efficacy indicators are the pain-free walking distance and maximum walking distance. The secondary efficacy indicators are the ankle-brachial index, walking impairment questionnaire, quality of life score, and Chinese medicine syndrome score.Conclusion: Positive results from this study will demonstrate the efficacy and safety of Ruanjian Qingmai granules in improving ischemic symptoms in patients with symptomatic PAD.Clinical Registration: This study has been registered with the Chinese Clinical Trials Registry (ChiCTR2200056109, Date: 02/01/2022, https://www.chictr.org.cn/showproj.html?proj=150982).Keywords: peripheral arterial disease, Ruanjian Qingmai granules, intermittent claudication, efficacy, randomized controlled trial, protocol

Xinyang Nie,1– 3,&ast; Jian Liu,1,2,&ast; Daohan Wang,1,2,&ast; Chuan Li,1,2 Yuxin Teng,1,2 Zhufeng Li,1,2 Yangpu Jia,1,2 Peiyao Wang,1,2 Jingyu Deng,2,3 Weidong Li,1,2 Li Lu1,2 1Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 2Tianjin Medical University, Tianjin, People’s Republic of China; 3Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Lu; Weidong Li, Department of General surgery, Tianjin Medical University General Hospital, 154, Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China, Email luli_1989@126.com; tjmughgs_lwd@163.comBackground: Cisplatin (DDP) resistance in gastric cancer (GC) is likely to come from gastric cancer stem cells (GCSC). It is a new idea to study the mechanism of the DDP-resistance in GCSC from miRNA.Materials and Methods: CD44+ GCSCs and CD44- control cells were constructed based on the HGC27 gastric cancer cell line. DDP sensitivities in CD44+ and CD44- cells were detected via CCK-8 assay. The differential expression of miR-21-5p in these cell lines was detected by RT‒qPCR. The expression levels of downstream TGF-β 2, SMAD2 and SMAD3 were determined through RT‒PCR and Western blotting. A luciferase assay was used to detect the relationship between miR-21-5p and TGFB2, and the TCGA database, clinical data from our centre, and vivo experiment were used for validation. Finally, we knocked down miR-21-5p to detect changes in cisplatin resistance in GCSCs and to verify changes in the levels of downstream pathways in GCSCs.Results: CD44+ GCSCs induced cisplatin resistance compared with CD44- cells. miR-21-5p was highly expressed in GCSCs, and the TGF-β 2/SMAD pathway was also highly expressed. TGFB2 was proven to be a downstream target gene of miR-21-5p and had a positive relationship with it in phenotype. After knockdown of miR-21-5p, the TGF-β 2/SMAD pathway was also inhibited, and the resistance of GCSCs to cisplatin was specifically decreased.Conclusion: MiR-21-5p promotes cisplatin resistance in gastric cancer stem cells by regulating the TGF-β 2/SMAD signalling pathway.Keywords: miR-21-5p, cisplatin resistance, GCSCs, TGF-β 2 pathway

Jing He,1,&ast; Nan Lin,2,&ast; Ting Jin,2 Ming Lin,1 Zuowei Huang,1 Shuxian Li,1 Jinling Liu,1 Lin Su,1 Xian Ye,2 Lei Wu,1 Zhenghong Song,2 Hongzhen Xu,2 Zhimin Chen1 1Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People’s Republic of China; 2Nursing Department, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhimin Chen, Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, People’s Republic of China, Email zmchen@zju.edu.cn Hongzhen Xu, Master of nursing, Nursing Department, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, People’s Republic of China, Email 6184020@zju.edu.cnBackground: Allergic conditions, identified as a significant global health challenge, are profoundly influenced by indoor allergens, especially house dust mites (HDM). Yet the relationship between mite sensitized components and respiratory allergies and asthma control remains poorly understood.Methods: A cohort of 96 children, either with allergic rhinitis (AR) or rhinitis with asthma syndrome (ARAS), was assessed. Protein microarray technology was deployed to quantify sIgE responses to the allergenic components of Der p and Der f.Results: The study cohort comprised 18 AR and 78 ARAS patients; with 43 mild and 53 moderate-to-severe AR; with 28 uncontrolled, 21 partially controlled, and 29 well-controlled asthma. Sensitization prevalence for HDM components was highest with Der p (97.9%), Der f 2 (97.9%), Der p 2 (94.8%), Der f 1(94.8%), Der p 1 (93.8%), Der p 23 (57.3%). Notably, sIgE concentrations for Der f and Der f 2 were significantly greater in the ARAS compared to AR (P < 0.05). While sIgE levels varied between mild and moderate-to-severe AR, the differences were not statistically significant (P > 0.05). However, Der p 23 sIgE levels demonstrated a significant fluctuation across the asthma control strata (P < 0.05), with the well-controlled group exhibiting the lowest readings.Conclusion: The sIgE levels to HDM allergens were higher in ARAS group compared to AR group, especially Der f and Der f 2, indicating an association between sIgE reactivity and the diagnosis of asthma. Reduced Der p 23 sIgE levels were indicative of enhanced asthma control.Keywords: house dust mite, allergic rhinitis, asthma, molecular sensitization, children

Yuhao Wei,1 Renwei Li,1 Yusha Wang,1,2 Jiali Fu,3 Jifeng Liu,4,5 Xuelei Ma1 1Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China; 2Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China; 4Department of Otolaryngology Head and Neck Surgery/Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 5State Key Laboratory of Intelligent Construction and Healthy Operation and Maintenance of Deep Underground Engineering, Sichuan University, Chengdu, People’s Republic of ChinaCorrespondence: Xuelei Ma; Jifeng Liu, Email drmaxuelei@gmail.com; liujifeng777@wchscu.cnAbstract: Immunotherapy is a promising cancer treatment because of its ability to sustainably enhance the natural immune response. However, the effects of multiple immunotherapies, including ICIs, are limited by resistance to these agents, immune-related adverse events, and a lack of reasonable therapeutic targets available at the right time and place. The tumor microenvironment (TME), which features tumor-associated macrophages (TAMs), plays a significant role in resistance owing to its hypoxic microenvironment and lack of blood vessels, resulting in cancer immune evasion. To enhance immunotherapy, photodynamic therapy (PDT) can increase innate and adaptive immune responses through immunogenic cell death (ICD) and improve the TME. Traditional photosensitizers (PSs) also include novel nanomedicines to precisely target tumor cells or TAMs. Here, we reviewed and summarized current strategies and possible influencing factors for nanomedicines for cancer photoimmunotherapy.Keywords: cancer, tumor-associated macrophages, photodynamic therapy, nanomedicines, immunotherapy

Shuping Song,1,&ast; Jieqiong Liu,2,3,&ast; Wei Su,1 Haitao Yu,4 Binbin Feng,1 Yinshan Wu,1 Feng Guo,1 Zhenwei Yu2 1Intensive Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 2Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 3Department of Pharmacy, The 903rd Hospital of PLA Joint Logistic Support Force, Hangzhou, People’s Republic of China; 4Department of Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Feng Guo; Zhenwei Yu, Email 3408003@zju.edu.cn; yzw_srrsh@zju.edu.cnBackground: Tigecycline is considered one of the last resorts for treating infections caused by multidrug-resistant bacteria. Continuous renal replacement therapy (CRRT) is widely used in critically ill patients, especially those with acute kidney injury or severe infections. However, pharmacokinetic data for tigecycline in patients receiving CRRT are limited.Methods: This was a single-center prospective clinical study with intensive sampling that included critically ill patients who received tigecycline and CRRT. A population pharmacokinetic (PPK) model was developed and evaluated by goodness-of-fit plots, bootstrap analysis, visual predictive checks, and numerical predictive checks. Pharmacokinetic/pharmacodynamic target attainment and cumulative fraction of response analyses were performed to explore the potential need for dose adjustments of tigecycline in CRRT.Results: In total, 21 patients with 167 concentrations were included. A two-compartment model adequately described the tigecycline concentration–time points, but no covariates were found to adequately explain the viability in the pharmacokinetic parameters of tigecycline. The typical values of CL, Q, V1 and V2 were 4.42 L/h, 34.8 L/h, 30.9 L and 98.7 L, respectively. For most infections, the standard regimen of 50 mg/12 h was deemed appropriate, expect for skin and soft skin tissue infections and community-acquired pneumonia caused by Acinetobacter baumannii and Klebsiella pneumoniae, which required a dosage regimen of 100 mg/12 h or higher.Conclusion: A tigecycline PPK model describing critically ill patients undergoing CRRT was successfully developed. The optimized dosage regimens for various infections are recommended.Keywords: tigecycline, population pharmacokinetics, critically ill, continuous renal replacement therapy

Xinchen Wang,1,&ast; Haiwei Bu,1,2,&ast; Chen Wei,1 Jingyi Liu,1– 3 Yuewen Qi,3,4 Weichao Shan,1– 3 Ying Zhang,1– 3 Lixian Sun1– 3 1Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde, People’s Republic of China; 2The Cardiovascular Research Institute of Chengde, Chengde, People’s Republic of China; 3Hebei Key Laboratory of Panvascular Diseases, Chengde, People’s Republic of China; 4Central Laboratory of The Affiliated Hospital of Chengde Medical University, Chengde, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lixian Sun, Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde, China, No. 36, Nanyingzi Street, Shuangqiao District, Chengde, Hebei Province, People’s Republic of China, Tel +86 0314 227 9016, Fax +86 0314 227 4895, Email lixiansun01@126.comPurpose: To elucidate the predictive values of adipocytokines in patients with acute coronary syndrome (ACS).Patients and Methods: Overall, 297 patients with ACS were consecutively enrolled in this prospective cohort study between June 2015 and July 2017 and completed follow-up with a median follow-up time of 6.5 years. For consistency, the last visit date was June 20, 2023. Serum levels of retinol-binding protein-4 (RBP4), interleukin-1β (IL-1β), monocyte chemoattractant protein 1(MCP-1), adrenomedullin (ADM), netrin 1 (NTN 1), and omentin were measured using enzyme-linked immunosorbent assay. Follow-up data were collected during clinical visits or through telephone interviews at 1, 3, 6, 12 months, and annually. The primary endpoint was defined as major adverse cardiovascular events (MACEs), including all-cause mortality, rehospitalization for percutaneous coronary intervention, and severe angina requiring rehospitalization.Results: All biomarkers displayed a good diagnostic ability of MACEs. The Kaplan–Meier curve showed that the cumulative survival rates of high level of RBP4, IL-1β, and MCP-1 and low level of the ADM, NTN1, and omentin had lower cumulative survival rates (Log rank tests: all p< 0.05). After adjustment in the Cox hazard proportional model, the results were RBP4 ≥ 6.87 ng/mL, hazard ratio (HR)=2.512, p=0.003; IL-1β≥ 58.95 pg/mL, HR=3.809, p< 0.001; MCP-1 ≥ 401.75 pg/mL, HR=4.047, p< 0.001; ADM≤ 120.01 ng/mL, HR=3.930, p=0.008; NTN1 ≤ 63.7 pg/mL, HR=3.345, p=0.007; omentin ≤ 4.54 ng/mL, HR=2.830, p=0.004. P-values for interaction were > 0.05 in the sex, age, and dyslipidemia subgroups.Conclusion: Pro-inflammation adipocytokines RBP4, IL-1β, and MCP-1 increased and anti-inflammation biomarkers ADM, NTN1, and omentin decreased were independently associated with a higher risk of MACEs in patients with ACS.Keywords: acute coronary syndrome, adipocytokines, prognosis

Wei Qiang,1,&ast; Mengyi Li,1,2,&ast; Sucai Song,1,3 Ruiqing Dong,1 Tongxin Zhang,1 Xuna Kou,1 Yuan Wu,1 Zhaoxu Wang,1,4 Jiayue Liu,1 Juan Liu,1 Yi Wang,1 Xiaoyan Wu,1 Bingyin Shi,1 Hui Guo1 1Department of Endocrinology and Metabolism, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Department of Endocrinology, Xi’an People’s Hospital, Xi’an, Shaanxi, 710100, People’s Republic of China; 3Department of Endocrinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 4Department of Endocrinology, Luohe Central Hospital, Luohe, Henan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Guo, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Street, Xi’an, People’s Republic of China, Tel +86-13709292996, Fax +86-029-85323974, Email 13709292996@139.comIntroduction: The long-acting insulin analogue insulin degludec (IDeg) is increasingly recommended for type two diabetes (T2DM), yet clinical experience in China remains limited. This retrospective study aimed to delineate the initiation strategy for IDeg in Chinese hospitalized patients with T2DM.Methods: We retrospectively analyzed 217 Chinese hospitalized patients with T2DM who initiated IDeg from December 2018 to June 2020, calculating the initial dose and examining correlations between clinical characteristics and glucose profiles.Results: The initial IDeg doses ranged from 0.15 to 0.18 IU/kg·d, showing no association with clinical characteristics. During titration, mean blood glucose levels (MEAN) correlated positively with diabetes duration, age, and Glycosylated Hemoglobin (HbA1c), and negatively with body mass index (BMI), triglycerides (TG), and low-density lipoprotein (LDL). The coefficient of variation (CV) in glucose levels correlated positively with HbA1c and negatively with BMI and TG. The mean amplitude of glycemic excursions (MAGE) mirrored these trends, with additional negative correlations to estimated glomerular filtration rate (eGFR) and serum albumin (ALB). Notably, glycemic variability parameters did not correlate with the presence of diabetic ketoacidosis (DKA) at admission. Hypoglycemia was observed in 21 patients, with differences in MEAN and CV during titration being the only significant findings.Conclusion: The initial IDeg dosing was inadequate and not tailored to clinical features, and there were weak correlations between diabetes duration, age, BMI, eGFR, LDL, and ALB levels and glucose profile post-initiation.Keywords: T2DM, insulin degludec, glucose variability, insulin initiation

Jingjing Liu, Gaosheng Zhou, Zewen Tong, Xiaoting Wang, Dawei Liu Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Dawei Liu, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1&num; Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, People’s Republic of China, Tel +86-10-69152305, Email daweiliu05@163.comBackground: Metabolic changing is the significant host stress response during sepsis, but there is increasing evidence that uncontrolled metabolic reprogramming is a contributing factor to sepsis. Nevertheless, its association with outcome in patients with sepsis has been poorly investigated. As the key enzyme of metabolic reprogramming, the clinical value of PDK1 and LDH in patients with sepsis will be investigated in this study.Methods: We collected serum from 167 ICU patients within 24 hours of admission for a single-center prospective observational study. The levels of PDK1 and LDH were detected by enzyme-linked adsorption method. Pearson or Spearman coefficient for correlation analysis between PDK1, LDH and clinical indicators. Areas under the ROC curves for evaluation of mortality prediction. Kaplan–Meier survival curve analysis was performed, and Cox proportional hazards model was performed to determine the risk factors for 28-day mortality.Results: The PDK1/LDH in the septic shock group was statistically different between both the sepsis group and ICU control group, and had good correlation with ScvO2 and lactate. In predicting 28-day mortality in patients with sepsis, the best AUC was observed for PDK1/LDH, and was higher than the AUC for PDK1, lactate, and SOFA. Additionally, patients with lower PDK1/LDH had markerablely higher 28-day mortality. The multivariate Cox proportional hazards model revealed that PDK1/LDH < 0.1808 were the independent risk factors for 28-day mortality in sepsis.Conclusion: The level of PDK1/LDH at admission was markedly decreased in patients with septic shock, which can serve as a novel independent prognostic biomarker for predicting mortality.Keywords: sepsis, septic shock, PDK1/LDH, metabolic reprogramming, mortality

Yang Xu,1,&ast; Yue Wu,1,&ast; Jianhong Liu,2 Lili Xiao,1 Ying Zhang1 1Department of Gastroenterology, Daqing Oilfield General Hospital, Daqing, Heilongjiang, 163000, People’s Republic of China; 2Department of Breast and Thyroid Surgery, Daqing Oilfield General Hospital, Daqing, Heilongjiang, 163000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Zhang, Email zhangying750114@163.comBackground: The study explored the prognostic value of caudal-type homeobox transcription factor 2 (CDX2) in stage II and III gastric cancer.Methods: This study evaluated the expression level of CDX2 in gastric cancer in a hospital cohort (n=197) using immunohistochemistry. According to a semiquantitative score used to determine CDX2 expression, the cases were divided into a low CDX2 group (116 cases) and a high CDX2 group (81 cases). The RNA-seq expression data from 291 patients with stage II and III gastric cancer from The Cancer Genome Atlas (TCGA) cohort were used to verify the immunohistochemistry results. Based on the median CDX2 expression value, the TCGA patients were divided into a low CDX2 group (145 cases) and a high CDX2 group (146 cases). The relationships among CDX2 expression and clinicopathological features were determined using the Chi-square test. Cox proportional hazards regression models were applied to estimate the independent prognostic factors. The probability of survival was determined using the Kaplan-Meier method and Log rank tests.Results: Based on the Cox multivariate analysis, CDX2 was the independent prognostic factor in the hospital and TCGA cohorts. In the hospital cohort, CDX2 expression was associated with an improved DFS (hazard ratio [HR] = 0.4076, 95% CI, 0.2675– 0.6210, P = 0.0001) and OS (HR = 0.4183, 95% CI, 0.2744– 0.6375, P = 0.0002). In the TCGA cohort, CDX2 expression also was associated with an improved DFS (HR = 0.5948, 95% CI, 0.4153– 0.8521, P = 0.0054) and OS (HR = 0.5976, 95% CI, 0.4172– 0.8561, P = 0.0058). Furthermore, the CDX2 expression level was correlated with an improved DFS (P = 0.0025) and OS (P = 0.0015) using the Kaplan-Meier Plotter database for gastric cancer.Conclusion: CDX2 is a potential prognostic biomarker for stage II and III gastric cancer. In addition, CDX2 positive cancer patients are more likely to have resectable tumors and exhibit better survival rates.Keywords: gastric cancer, CDX2, immunoreactivity, chemotherapy, prognostic marker

Panpan Fan,1,&ast; Pan Fu,2,3,&ast; Jing Liu,1,&ast; Chuanqing Wang,2,3 Xiaolei Zhang,1 Yixue Wang,1 Yingying Zhang,1 Ting Zhu,1 Caiyan Zhang,1 Guoping Lu,1 Gangfeng Yan,1 Members and affiliations of China Paediatric Intensive care Unit Pathogen Surveillance Network (CHIPS)Panpan Fan,1 Pan Fu,2 Jing Liu,1 Xiaolei Zhang,1 Yixue Wang,1 Yingying Zhang,1 Ting Zhu,1 Caiyan Zhang,1 Chuanqing Wang,2 Guoping Lu,1 Gangfeng Yan,1 Hong Ren,3 Juanzhen Li,3 Yucai Zhang,4 Yiping Zhou,4 Chengmei Zhang,5 Zhenjie Chen,5 Mingming Zhou,5 Zhengjiang Bai,6 Saihu Hang,6 Lili Hang,6 Hehe Chen,7 Yao Zheng,7 Qunying Chen,7 Pengwei Zhu,8 Yong Li,8 Yan Xu,8 BiZhen Zhu,9 Huixuan Shi,9 Shaoxian Hong,10 Yukun Huang,10 Meilian Huang,10 Danqun Jing,11 Wenjia Tong,11 ChengYu Zhang,11 Weiguo Yang,12 Weike Mang,12 Qing meng,12 Yibing Cheng,13 Qunqun Zhang,13 Kaijie Gao,13 Huiming Xu,14 Yuxia Li,14 Hanghai Ding,14 Xiulan Lu,15 Jiaotian Huang,15 Jianlong Liu,15 Yourong Zhu,16 Yuanyuan Chen,16 Shufang Xiao,17 Juan He,17 Li Jiang,17 Jianli Chen,18 Yi Lin,18 Jia Lei18 1Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 2Lab of Microbiology, Department of Clinical Laboratory, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 3Nosocomial Infection Control Department, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 1Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 2Clinical Microbiology Laboratory, Department of Nosocomial Infection Control, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 3Department of Pediatric Intensive Care Unit, Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Pediatric Intensive Care Unit, Shanghai Children’s Hospital affiliated to Shanghai Jiaotong University, Shanghai, People’s Republic of China; 5Department of Pediatric Intensive Care Unit, Children’s Hospital Affiliated to Zhejiang University Medical School, Hangzhou, People’s Republic of China; 6Department of Pediatric Intensive Care Unit, Children’s Hospital of Soochow University, Suzhou, People’s Republic of China; 7Department of Pediatric Intensive Care Unit, Ningbo Women and Children’s Hospital, Ningbo, People’s Republic of China; 8Department of Pediatric Intensive Care Unit, Wuxi Children’s Hospital, Wuxi, People’s Republic of China; 9Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China; 10Department of Pediatric Intensive Care Unit, Xiamen Children’s Hospital, Xiamen, People’s Republic of China; 11Department of Pediatric Intensive Care Unit, Anhui Children’s Hospital, Hefei, People’s Republic of China; 12Department of Pediatric Intensive Care Unit, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China; 13Department of Pediatric Intensive Care Unit, Henan Children’s Hospital, Zhengzhou, People’s Republic of China; 14Department of Pediatric Intensive Care Unit, Kaifeng Children’s Hospital, Kaifeng, People’s Republic of China; 15Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, People’s Republic of China; 16Department of Pediatric Intensive Care Unit, Jiangxi Provincial Children’s Hospital, Nanchang, Kunming, People’s Republic of China; 17Department of Pediatric Intensive Care Unit, Kunming Children’s Hospital, People’s Republic of China; 18Department of Pediatric Intensive Care Unit, Guiyang Children’s Hospital, Guiyang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guoping Lu; Gangfeng Yan, Email 13788904150@163.com; gangfeng_yan@fudan.edu.cnObjective: To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae (K. pneumoniae) infection in pediatric intensive care unit (PICU).Methods: K. pneumoniae strains from 17 domestic PICUs were analyzed for overall condition and drug resistance using WHO-NET software.Results: From 2016 to 2022, there was a linear increase in the detection rate of K. pneumoniae (P< 0.05), with a total of 2591 (9.7%) strains detected. The primary sites of K. pneumoniae detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). K. pneumoniae’s resistance to penicillin drugs exceeded 90%, and are over 50% to cephalosporins. Resistance to cefoperazone-sulbactam decreased from 51.7% to 25.7%, and ranged from 9.1% to 20.8% for ceftolozane-tazobactam. Carbapenem-resistant K. pneumoniae strains constituted 32.3%. Resistance to imipenem and meropenem have decreased to 33.8% and 40.2%, while increased to 35.2% for ertapenem. Levofloxacin and amikacin resistance rates have decreased to 25.7% and 9.1%, but remain high at 63.8% for moxifloxacin and 44.6% for ciprofloxacin. K. pneumoniae demonstrated the lowest resistance rates to polymyxin B (0.9%), tigecycline (2.2%), and polymyxin E (3.1%). No strain of K. pneumoniae was resistant to both polymyxin B and meropenem. However, some strains showed co-resistance to meropenem with other antibiotics, including tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%), and levofloxacin (41%).Conclusion: The rates of isolation and drug resistance of K. pneumoniae in PICU have significantly increased over 7 years. Careful antibiotic use, infection control strategies, and appropriate antibiotic combinations are crucial in addressing this problem.Keywords: pediatric intensive care unit, Klebsiella pneumoniae, bacterial drug resistance

Jiale Xu,&ast; Musen Xu,&ast; Xin Gao, Jiahang Liu, Jingchao Sun, Ruiqi Ling, Xuchen Zhao, Xifeng Fu, Shaojian Mo, Yanzhang Tian Department of Biliary and Pancreatic Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanzhang Tian, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, No. 99, Longcheng Street, Xiaodian District, Taiyuan, Shanxi Province, People’s Republic of China, Phone/Fax +86-13903512030, Email tyz2030@163.comObjective: To analyze the influence of diabetes mellitus on the clinical outcomes of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).Methods: This retrospective study included patients diagnosed with MSAP and SAP at Shanxi Bethune Hospital from January 1, 2017, to December 31, 2021. Clinical data were collected, including patient demographics, 24-hour laboratory indicators, and inflammation indices. Propensity score matching (PSM) was used to compare outcomes before and after matching. Patients were randomized into training and validation sets (7:3) to develop and validate a clinical prediction model for infected pancreatic necrosis (IPN).Results: Among 421 patients, 79 had diabetes at admission. Before PSM, diabetic patients had higher incidences of peripancreatic fluid (71% vs 47%, p< 0.001) and IPN (48% vs 10%, p< 0.001), higher surgical intervention rates (24% vs 12%, p=0.008), and significant differences in abdominocentesis (22% vs 11%, p=0.014). After PSM, 174 patients were matched, and the diabetes group still showed higher incidences of peripancreatic fluid (69% vs 47%, p=0.008), IPN (48% vs 11%, p< 0.001), and surgical intervention rates (27% vs 13%, p=0.037). Diabetes, modified CT severity index (MCTSI), serum calcium, and HDL-c were identified as independent risk factors for IPN. The prediction model demonstrated good predictive value.Conclusion: In MSAP and SAP patients, diabetes mellitus can exert an influence on their clinical outcome and is an independent risk factor for IPN. The alignment diagram and web calculator constructed on the basis of diabetes mellitus, modified CT severity index (MCTSI), serum calcium and high-density lipoprotein cholesterol (HDL-c) have good predictive value and clinical guidance for the occurrence of IPN in MSAP and SAP.Keywords: acute pancreatitis, diabetes, propensity score matching, predictive model

Mengyi Shen,1,&ast; Leyu Zhou,1,&ast; Xiaoli Fan,1 Ruiqi Wu,1 Shuyun Liu,2 Qiaoyu Deng,1 Yanyi Zheng,1 Jingping Liu,2 Li Yang1 1Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver Disease, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Yang; Jingping Liu, Email yangli_hx@scu.edu.cn; liujingping@scu.edu.cnBackground: Autoimmune hepatitis (AIH) is a serious liver disease characterized by immune disorders, particularly effector T-cell overactivation. This study aimed to explore the therapeutic effect and underlying mechanism of mesenchymal stem cell-derived extracellular vesicle (MSC-EV) treatment on CD4+ T-cell overactivation and liver injury in AIH.Methods: The metabolic changes of CD4+ T cells were assayed in human AIH and mouse hepatitis models. The liver protective effect of MSC-EVs was evaluated by transaminase levels, liver histopathology and inflammation. The effect of MSC-EVs on the metabolic state of CD4+ T cells was also explored.Results: Enhanced glycolysis (eg, ~1.5-fold increase in hexokinase 2 levels) was detected in the CD4+ T cells of AIH patient samples and mouse hepatitis models, whereas the inhibition of glycolysis decreased CD4+ T-cell activation (~1.8-fold decrease in CD69 levels) and AIH liver injury (~6-fold decrease in aminotransferase levels). MSC-EV treatment reduced CD4+ T-cell activation (~1.5-fold decrease in CD69 levels) and cytokine release (~5-fold decrease in IFN-γ levels) by reducing glycolysis (~3-fold decrease) while enhancing mitochondrial oxidative phosphorylation (~2-fold increase in maximal respiration) in such cells. The degree of liver damage in AIH mice was ameliorated after MSC-EV treatment (~5-fold decrease in aminotransferase levels). MSC-EVs carried abundant mitochondrial proteins and might transfer them to metabolically reprogram CD4+ T cells, whereas disrupting mitochondrial transfer impaired the therapeutic potency of MSC-EVs in activated CD4+ T cells.Conclusion: Disordered glucose metabolism promotes CD4+ T-cell activation and associated inflammatory liver injury in AIH models, which can be reversed by MSC-EV therapy, and this effect is at least partially dependent on EV-mediated mitochondrial protein transfer between cells. This study highlights that MSC-EV therapy may represent a new avenue for treating autoimmune diseases such as AIH.Keywords: autoimmune hepatitis, extracellular vesicles, metabolic reprogramming, mitochondria, inflammation

Yun Zhu,1,&ast; Lingyan Li,2,&ast; Wenxiao Wang,3,&ast; Xiaodan Liu,1 Meng Xue Zhang,1 Xiumin Chen,4 Xiaofeng Hou,5 Weimei Wang,6 Tuo Min,7 Jinmei Liu,8 Lecui Liu,9 Chengjun Liu,10 Zhong Jiang,11 Yanping Wang,12 Dayun Chang,13 Hua Pan1 1Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 2Department of Pediatrics, Zibo Maternal and Child Health Hospital, Zibo, Shandong, People’s Republic of China; 3Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China; 4Department of Pediatrics, Qingzhou People’s Hospital, Weifang, Shandong, People’s Republic of China; 5Department of Pediatrics, Laizhou City People’s Hospital, Laizhou, Shandong, People’s Republic of China; 6Department of Pediatrics, Haiyang People’s Hospital, Haiyang, Shandong, People’s Republic of China; 7Department of Pediatrics, Jining First People’s Hospital, Jining, Shandong, People’s Republic of China; 8Department of Pediatrics, West Coast New District Hospital of Chinese Medicine, Huangdao, Shandong, People’s Republic of China; 9Department of Neonatology, People’s Hospital of Wulian, Wulian, Shandong, People’s Republic of China; 10Department of Pediatrics, Linyi Central Hospital, Linyi, Shandong, People’s Republic of China; 11Department of Pediatrics, Rehabilitation University Qingdao Central Hospital, Qingdao, Shandong, People’s Republic of China; 12Department of Pediatrics, Qingdao Traditional Chinese Medicine Hospital, Qingdao, Shandong, People’s Republic of China; 13Department of Pediatrics, Weihai Municipal Hospital, Weihai, Shangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hua Pan, Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, 266003, People’s Republic of China, Tel +8618366205226, Email panhua1881@163.comIntroduction: The Omicron variant is the present predominant COVID-19 strain worldwide. Accurate mortality prediction can facilitate risk stratification and targeted therapies. The study aimed to evaluate the feasibility of the difference in hematocrit and albumin (HCT-ALB) levels, alone or combined with the pediatric Sequential Organ Failure Assessment (pSOFA) score and lactate level, to predict the in-hospital mortality of COVID-19 Omicron variant-infected pediatric patients.Methods: A multicenter retrospective cohort study was performed for children with COVID-19 Omicron variant infection between December 2021 and January 2022. The demographics, clinical characteristics, hospital admission laboratory test results, and treatments were recorded. The in-hospital mortality was documented. The associations between HCT-ALB levels and mortality, and between HCT-ALB+pSOFA+lactate and mortality were analyzed.Results: A total of 119 children were included. The median age was 1.6 (interquartile range: 0.5– 6.2) years old. There were 70 boys and 49 girls. The mortality rate was 14.3% (17/119). The univariate and multivariate Cox regression analysis revealed that HCT-ALB was associated to in-hospital mortality (hazard ratio: 1.500, 95% confidence interval: 1.235– 1.822, p< 0.001). The receiver operating characteristic curve analysis revealed that HCT-ALB can be used to accurately predict in-hospital mortality at a cut-off value of − 0.7 (area under the curve: 0.888, sensitivity: 0.882, specificity: 0.225, Youden index: 0.657, p< 0.001). These patients were assigned into three groups based on the HCT-ALB level, pSOFA score, and lactate level (low-, medium-, and high-risk groups). The Kaplan-Meier analysis revealed that the mortality increased in the high-risk group, when compared to the medium-risk group (p< 0.01). The latter group had a higher mortality, when compared to the low-risk group (p< 0.01).Conclusion: The HCT-ALB level can be applied to predict the in-hospital mortality of children infected with the COVID-19 Omicron variant. Its combination with other variables can improve prediction performance.Keywords: COVID-19, omicron variant, hematocrit, albumin, mortality

Wenlu Li,1,2,&ast; Yaolin Gong,1,2,&ast; Jing Zhang,1,2 Jiong Liu,1,2 Jiali Li,1,2 Shaozhi Fu,3 Wen Xiu Ren,1,2 Jian Shu1,2 1Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China; 2Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China; 3Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wen Xiu Ren; Jian Shu, Department of Radiology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, Sichuan, 646000, People’s Republic of China, Email xrenwenxiux@swmu.edu.cn; shujiannc@swmu.edu.cnIntroduction: Targeting, imaging, and treating tumors represent major clinical challenges. Developing effective theranostic agents to address these issues is an urgent need.Methods: We introduce an “all-in-one” tumor-targeted theranostic platform using CuFeSe2-based composite nanoparticles (CuFeSe2@PA) for magnetic resonance (MR) and computed tomography (CT) dual model imaging-guided hyperthermia tumor ablation. Plerixafor (AMD3100) is bonded to the surface of CuFeSe2 as a targeting unit. Due to the robust interaction between AMD3100 and the overexpressed Chemokine CXC type receptor 4 (CXCR4) on the membrane of 4T1 cancer cells, CuFeSe2@PA specifically recognizes 4T1 cancer cells, enriching the tumor region.Results: CuFeSe2@PA serves as a contrast agent for T2-weighted MR imaging (relaxivity value of 1.61 mM− 1 s− 1) and CT imaging. Moreover, it effectively suppresses tumor growth through photothermal therapy (PTT) owing to its high photothermal conversion capability and stability, with minimized side effects demonstrated both in vitro and in vivo.Discussion: CuFeSe2@PA nanoparticles show potential as dual-mode imaging contrast agents for MR and CT and provide an effective means of tumor treatment through photothermal therapy. The surface modification with Plerixafor enhances the targeting ability of the nanoparticles, performing more significant efficacy and biocompatibility in the 4T1 cancer cell model. The study demonstrates that CuFeSe2@PA is a promising multifunctional theranostic platform with clinical application potential. Keywords: tumor targeting, photothermal therapy, dual model imaging, theranostic platform, chemokine cxc type receptor 4

Chang-Sheng Ma,1,2,&ast; Ya-Ping Ma,1,3,&ast; Bo Han,1,2,&ast; Wan-Li Duan,1 Shu-Chen Meng,1 Min Bai,1 Hao Dong,1 Li-Ying Zhang,1 Meng-Yuan Duan,1,2 Jing Liu,1 Ai-Jun Deng,2 Mao-Tao He1,2 1Department of Basic Medical Sciences, Shandong Second Medical University, Weifang, Shandong, People’s Republic of China; 2Department of Ophthalmology, Affiliated Hospital of Shandong Second Medical University, Weifang, People’s Republic of China; 3Department of Pathology, The 942Hospital of the People’s Liberation Army Joint Logistic Support Force, Yinchuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mao-Tao He, Department of Basic Medical Sciences, Shandong Second Medical University, Weifang, Shandong, People’s Republic of China, Tel +86-18209617186, Fax +86-0536-3081201, Email hemaotao@sdsmu.edu.cn Ai-Jun Deng, Department of Ophthalmology, Affiliated Hospital of Shandong Second Medical University, Weifang, People’s Republic of China, Email dengaijun@hotmail.comPurpose: Ischemic stroke is a refractory disease wherein the reperfusion injury caused by sudden restoration of blood supply is the main cause of increased mortality and disability. However, current therapeutic strategies for the inflammatory response induced by cerebral ischemia-reperfusion (I/R) injury are unsatisfactory. This study aimed to develop a functional nanoparticle (MM/ANPs) comprising apelin-13 (APNs) encapsulated in macrophage membranes (MM) modified with distearoyl phosphatidylethanolamine-polyethylene glycol-RVG29 (DSPE-PEG-RVG29) to achieve targeted therapy against ischemic stroke.Methods: MM were extracted from RAW264.7. PLGA was dissolved in dichloromethane, while Apelin-13 was dissolved in water, and CY5.5 was dissolved in dichloromethane. The precipitate was washed twice with ultrapure water and then resuspended in 10 mL to obtain an aqueous solution of PLGA nanoparticles. Subsequently, the cell membrane was evenly dispersed homogeneously and mixed with PLGA-COOH at a mass ratio of 1:1 for the hybrid ultrasound. DSPE-PEG-RVG29 was added and incubated for 1 h to obtain MM/ANPs.Results: In this study, we developed a functional nanoparticle delivery system (MM/ANPs) that utilizes macrophage membranes coated with DSPE-PEG-RVG29 peptide to efficiently deliver Apelin-13 to inflammatory areas using ischemic stroke therapy. MM/ANPs effectively cross the blood-brain barrier and selectively accumulate in ischemic and inflamed areas. In a mouse I/R injury model, these nanoparticles significantly improved neurological scores and reduced infarct volume. Apelin-13 is gradually released from the MM/ANPs, inhibiting NLRP3 inflammasome assembly by enhancing sirtuin 3 (SIRT3) activity, which suppresses the inflammatory response and pyroptosis. The positive regulation of SIRT3 further inhibits the NLRP3-mediated inflammation, showing the clinical potential of these nanoparticles for ischemic stroke treatment. The biocompatibility and safety of MM/ANPs were confirmed through in vitro cytotoxicity tests, blood-brain barrier permeability tests, biosafety evaluations, and blood compatibility studies.Conclusion: MM/ANPs offer a highly promising approach to achieve ischemic stroke-targeted therapy inhibiting NLRP3 inflammasome-mediated pyroptosis. Keywords: apelin-13, cerebral ischemia-reperfusion injury, macrophage membrane, ischemic stroke therapy, pyroptosis

Lu Xu,1,&ast; Jing Liu,2,&ast; Suli Li,1 Xingchen Lu,1 Wenjie Gu,1 Shunhua Zhu,1 Meng Wang,1 Xiaojin Wu,3 Qingli Huang1 1Public Experimental Research Center of Xuzhou Medical University, Xuzhou, Jiangsu Province, 221004, People’s Republic of China; 2Department of Neurology, the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou No. 1 People’s Hospital, Xuzhou, Jiangsu Province, 221100, People’s Republic of China; 3Department of radiotherapy, the affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou No. 1 People’s Hospital, Xuzhou, Jiangsu Province, 221100, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaojin Wu; Qingli Huang, Email xiaojinwu@xzhmu.edu.cn; qlhuang@xzhmu.edu.cnPurpose: Developing novel multimodal nanomaterials-based anticancer agents to meet complex clinical demands is an urgent challenge. This study presents a novel uniform hollow S-doped NiCuFe Prussian blue analogue (NiCuFe-S) with satisfactory size and properties as anticancer agents for efficient cervical cancer therapy using a simple and environmentally friendly procedure.Methods: The formation mechanism and the reason for enhanced performance of NiCuFe-S were characterized and discussed by diverse spectroscopic and microscopic methods. Moreover, to demonstrate the anti-cancer ability of NiCuFe-S, in vitro and in vivo experiments were carried out.Results: Compared to the non-doped NiCuFe, the NiCuFe-S exhibited significantly enhanced photothermal and catalytic activity attributed to the electronic bandgap-narrowing effect and the increased electron circuit paths resulting from S doping. The hollow structure of NiCuFe-S facilitated the loading of small-molecule drugs, such as doxorubicin (DOX), transforming it into a multimodal nanoplatform for cervical cancer treatment. In vitro and in vivo experiments proved the potential of the NiCuFe-S nanotheranostic agent for chemodynamic therapy (CDT), photothermal therapy (PTT), and chemotherapy for cervical cancer.Conclusion: This research not only overcomes inherent limitations but also significantly broadens the applications of Prussian blue analogues in biomedicine.Keywords: nanomaterials, Prussian blue analogue, catalytic, photothermal therapy, anticancer

Siyuan Chen,1,2 Jia Liu,1,2 Zhili Feng,1,2 Liubo Zhou,1,2 Yuexiang Cai,1,2 Qiancheng Jing1,2 1Department of Otolaryngology Head and Neck Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China; 2Institute of Otolaryngology Head and Neck Surgery, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Qiancheng Jing, Department of Otolaryngology Head and Neck Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People’s Republic of China, Email 2022050001@usc.edu.cnBackground: Exosomes carry various types of transcripts and serve as promising biomarkers for inflammatory diseases. However, the role of serum exosomal microRNAs (miRNAs) in chronic rhinosinusitis with nasal polyps (CRSwNP) is poorly clarified.Methods: A prospective exploratory cohort of 10 CRSwNP patients was conducted, and the serum exosome samples were subjected to miRNA sequencing. Two independent prospective cohorts, consisting of 40 and 54 patients respectively, were recruited from different medical centers for validation. These cohorts were monitored for over two years, with postoperative recurrence serving as the primary outcome measure. The top 3 differentially exosomal miRNAs were validated in the serum samples, and their predictive values for recurrence were assessed.Results: Eight CRSwNP patients completed the follow-up, comprising 4 non-recurrent cases and 4 recurrent cases. Distinctive profiles of serum exosomal miRNAs were identified between the two groups. In the first validation cohort, reverse transcription-polymerase chain reaction results indicated elevated serum exosomal miR-3174 and miR-6750-5p expressions, along with reduced miR-192-3p levels in the recurrence group compared to the non-recurrence group. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival analysis demonstrated significant correlations between expressions of exosomal miR-3174 and miR-192-3p and the risk of postoperative recurrence. These findings were further validated in the second cohort, confirming the elevation of both miRNAs in the recurrence group and their associations with recurrence risk. Additionally, serum exosomal miR-3174 levels increased in recurrent cases compared to their baseline levels.Conclusion: Circulating exosomal microRNA signatures may influence the risk of postoperative recurrence in CRSwNP patients. Serum exosomal elevated exosomal miR-3174 and decreased miR-192-3p were correlated with CRSwNP recurrence risk.Keywords: exosome, chronic rhinosinusitis with nasal polyps, biomarker, recurrence

Jingfei Weng,1,2,&ast; Yuyao Xiao,1,&ast; Jing Liu,3,&ast; Xiaohua Liu,4 Yuqing He,2 Fei Wu,1 Xiaoyan Ni,1 Chun Yang1 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Radiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China; 3Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 4Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chun Yang; Xiaoyan Ni, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China, Tel +86 18702135336 ; +86 15201803582, Email dryangchun@hotmail.com; nixiaoyan1103@126.comPurpose: To study the MRI features (based on LI-RADS) and clinical characteristics of P53-mutated hepatocellular carcinoma (HCC) patients.Patients and Methods: This study enrolled 344 patients with histopathologically confirmed HCC (P53-mutated group [n = 196], non-P53-mutated group [n = 148]). We retrospectively evaluated the preoperative MRI features, clinical and pathologic features of the lesions and assigned each lesion according to the LI-RADS. MRI findings, clinical features, and pathologic findings were compared using the Student’s t test, χ 2 test, and multivariable regression analysis.Results: Most HCC patients were categorized as LR-5. On multivariate analysis, the Edmondson–Steiner grade (odds ratio, 2.280; 95% CI: 1.268, 4.101; p = 0.006) and rim enhancement (odds ratio, 2.517; 95% CI: 1.095, 5.784; p = 0.030) were found to be independent variables associated with P53-mutated HCC. In the group of HCC lesions with the largest tumor diameter (LTD) greater than or equal to 10mm and less than or equal to 20mm, enhancing capsule was an independent predictor of P53-mutated HCC (odds ratio, 6.200; 95% CI: 1.116, 34.449; p = 0.037). Among the HCC lesions (20 mm ˂ LTD ≤ 50 mm), corona enhancement (odds ratio, 2.102; 95% CI: 1.022, 4.322; p = 0.043) and nodule-in-nodule architecture (odds ratio, 2.157; 95% CI: 1.033, 4.504; p = 0.041) were found to be independent risk factors for P53 mutation. Among the HCC lesions (50 mm ˂ LTD ≤ 100 mm), diameter (odds ratio, 1.035; 95% CI: 1.001, 1.069; p = 0.044) and AFP ≥ 400 (ng/mL) (odds ratio, 3.336; 95% CI: 1.052, 10.577; p = 0.041) were found to be independent variables associated with P53-mutated HCC.Conclusion: Poor differentiation and rim enhancement are potential predictive biomarkers for P53-mutated HCC, while HCCs of different diameters have different risk factors for predicting P53 mutations.Keywords: liver neoplasms, magnetic resonance imaging, P53-mutated

Wenguang Lai,1,&ast; Xiaoli Zhao,2,&ast; Zhiyong Gao,1 Haozhang Huang,3,4 Donghui Huang,1 Yang Zhou,3,4 Guoxiao Liang,3,4 Shiqun Chen,3,4 Jin Liu,3 Yong Liu3 1Department of Pharmacy, Heyuan People’s Hospital; Guangdong Provincial People’s Hospital, Heyuan Hospital, Heyuan, 517001, People’s Republic of China; 2Department of Cardiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 3Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China; 4Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yong Liu; Jin Liu, Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China, Tel +86 02083827812-10528, Fax +86 02083851483, Email liuyong@gdph.org.cn; ljaw397017568@163.comPurpose: Heart failure with preserved ejection fraction (HFpEF) is inherently a complex inflammatory syndrome, and heightened inflammation is strongly associated with an increased risk of death. However, the association of systemic inflammation levels with total and cardiovascular death among patients with HFpEF remains unknown. We aimed to investigate the prognostic impact of systemic inflammation on all-cause and cardiovascular death among patients with HFpEF.Patients and Methods: Patients with HFpEF were included in this study. Systemic inflammation response index (SIRI) is defined as the multiplication of neutrophil and monocyte divided by lymphocyte count, and patients were divided into four groups based on SIRI quartiles. Cox regression models and competing risk models were used to examine the relationships between SIRI and total and cardiovascular‑specific mortality, respectively.Results: 9,986 patients with HFpEF were included in five tertiary hospitals. During a median follow-up period of 4.4 years, a total of 2004 patients died, of which 965 were cardiovascular deaths. After fully adjusting for confounders, elevated SIRI level was significantly related to the increased risk of all-cause death (Q2, Q3, Q4: adjusted hazard ratio (aHR) [95 confidence interval (CI)%] =1.17[1.01– 1.35], 1.31[1.13– 1.52], 1.51[1.30– 1.76], respectively; P for trend < 0.001). The elevated quartile of SIRI showed higher risks of cardiovascular death, but there was no statistically significant increased risk of cardiovascular death across the lower SIRI quartile (model 3: Q2, Q3, Q4: aHR [95CI%] =1.22[0.99– 1.51], 1.50[1.20– 1.86], 1.73[1.37– 2.18], respectively; P for trend < 0.001).Conclusion: Elevated systemic inflammation level on admission was correlated with an increased risk of all-cause and cardiovascular death among patients with HFpEF. The SIRI may serve as a promising marker of risk stratification for patients with HFpEF.Keywords: heart failure with preserved ejection fraction, systemic inflammatory response index, all-cause death, cardiovascular death

Jia Liu, Fan Zhang Department of Geriatrics, Peking University Third Hospital, Beijing, People’s Republic of ChinaCorrespondence: Fan Zhang, Department of Geriatrics, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, People’s Republic of China, Email zhangfan_puh3@yeah.netBackground: Emerging evidence suggests a link between muscle health and the autonomic nervous system, but research is scarce. This study examines the connection between long-term heart rate variability (HRV) measured autonomic function and sarcopenia in the elderly, focusing on muscle mass and strength.Patients and Methods: This retrospective cross-sectional study comprised 132 elderly hospitalized patients. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, involving reduced muscle mass and strength. HRV was assessed using standard deviation of NN intervals (SDNN), with values below 100 milliseconds indicating reduced HRV. Multivariate logistic regression and Pearson’s correlation analyses were conducted to explore the associations between sarcopenia, muscle metrics, and HRV parameters.Results: Among elderly hospitalized patients, 45.45% had reduced HRV, with sarcopenia patients showing a fivefold higher risk (OR: 5.042; p = 0.034). Grip strength and SARC-CalF scores were independent factors associated with reduced HRV. Moderate correlations were noted between grip strength and HRV indices, particularly with SDNN (r = 0.393, p = 0.001) and the triangular index (r = 0.385, p < 0.001), while a weaker correlation was found with very low frequency power (VLF) (r = 0.283, p = 0.006). No significant correlations were identified between HRV and muscle mass. Regression analyses revealed significant independent associations between HRV parameters and the decline in muscle strength and the onset of sarcopenia.Conclusion: Reduced HRV is closely linked to sarcopenia and diminished muscle strength in the elderly, with the triangular index and SDNN as key indicators, highlighting HRV’s potential in muscle health assessment.Keywords: muscle strength, SDNN, triangular index, muscle mass