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Ding Yang,1 Rulan Bai,1 Chengzhong Li,2 Yan Sun,2 Hongyu Jing,1 Zixu Wang,1 Yaoxing Chen,1 Yulan Dong1 1College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China; 2Department of Horticulture and Landscape Architecture, Jiangsu Agri-Animal Husbandry Vocational College, Taizhou, People’s Republic of ChinaCorrespondence: Yulan Dong, Email ylbcdong@cau.edu.cnBackground: The early childhood period is a critical development stage, and experiencing stress during this time may increase the risk of gastrointestinal disorders, including irritable bowel syndrome (IBS). Neonatal maternal separation (NMS) in rodent models has been shown to cause bowel dysfunctions similar to IBS, and 5-HT is considered to be a key regulator regulating intestinal function, but the precise underlying mechanisms remain unclear.Results: We established a maternal separation stress mouse model to simulate early-life stress, exploring the expression patterns of 5-HT under chronic stress and its mechanisms affecting gut function. We observed a significant increase in 5-HT expression due to NMS, leading to disruptions in intestinal structure and function. However, inhibiting 5-HT reversed these effects, suggesting its potential as a therapeutic target. Furthermore, our research revealed that excess 5-HT in mice with early life stress increased intestinal neural network density and promoted excitatory motor neuron expression. Mechanistically, 5-HT activated the Wnt signaling pathway through the 5-HT4 receptor, promoting neurogenesis within the intestinal nervous system.Conclusion: These findings shed light on the intricate changes induced by early life stress in the intestines, confirming the regulatory role of 5-HT in the enteric nervous system and providing potential insights for the development of novel therapies for gastrointestinal disorders.Keywords: 5-HT, IBS, early-life stress, neurogenesis

Shiyong Xiao,1,* Yongqi Dong,2,* Yuan Xia,3 Hongyan Xu,4 Falin Weng,5 Guohong Liang,6 Qianzhang Yi,7 Chengming Ai8 1Department of Clinical Nutrition, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China; 2Department of Gastroenterology, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 3Department of General Practice, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4Department of Infectious Diseases, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 5Department of Geriatric Medicine, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 6Department of Oncology, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 7Department of Radiology, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 8Department of Physical Examination Center, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chengming Ai, Department of Physical Examination Center, Wushan County People’s Hospital of Chongqing, Wushan County, Chongqing, People’s Republic of China, Email 790298077@qq.comBackground: In recent years, there has been a growing focus on chronic non-communicable diseases (NCD) and their impact on personal and social health. Effective management of NCD is essential for their prevention and treatment. This study aims to utilize bibliometric methods to analyze and summarize the current development and emerging trends in NCD management.Methods: A literature search and screening were conducted on the Web of Science Core Collection database from January 1, 2004, to December 31, 2023. VOSviewer and Citespace software was performed to examine publication volume, authors, institutions, countries, journals, citation frequencies, keywords, clustering, and burst terms, and to create a visual map.Results: A total of 996 valid publications from 464 journals were included in the study. The number of publications exhibited a gradual growth trend over the years. The United States was the most productive and influential country, contributing the highest proportion of both publications and total citations. BMC Health Services Research, Toronto University, and Marshall, Bruce C. were identified as the most productive journal, institution, and author, respectively. Further analysis of keyword co-occurrence and burst detection revealed that the most prevalent keywords were “improving primary care” and “integrated care”.Conclusion: This bibliometric analysis provides a comprehensive overview of the current status and trends in NCD management over the past two decades, providing valuable insights for future research directions. It indicates a potential shift towards enhancing primary healthy care, integrated care, and digital health.Keywords: non-communicable diseases, bibliometric analysis, management, primary health care, integrated care, digital health

Purpose – This paper aims to argue that important elements in the capital budgeting process are either undervalued or not considered and are a significant reason for both low and slow growth in large firms. Adopting an entrepreneurial mindset in conjunction with a portfolio approach based on different types of innovation to allow for growth projects to enter the process and be evaluated for possible selection are outlined as an alternative to strengthen the capital budgeting process. Design/methodology/approach – Concepts and processes drawn from the finance, economics and entrepreneurship literature are used to form a proposed new approach to the capital budgeting process. Findings – Only a handful of large firms even achieve returns more than their cost of capital. This manuscript argues that the reason for the lack of growth is a function of a capital budgeting process that does not allow the full spectrum of risk projects because of behavioral factors. This manuscript further proposes a portfolio approach that would allow for all projects to be fairly considered and aligned with stakeholder interests. Originality/value – The current literature tends to focus on the financial evaluative aspect of the capital budgeting process. The void in the literature is with other aspects of the capital budgeting process both in terms of currency and in pursuing alternative explanations for the reasons the full risk spectrum of projects is not considered.

Tiansu Lv,1,2,* Jie Tian,1,3,* Yaohuan Sun,1,3 Yujuan Zhang,1,2 Fang Qi,1,2 Liulan Xiang,1,2 Yutian Cao,1,2 Wenhui Zhang,1,2 Jiaxuan Huai,1,2 Yinfeng Dong,4 Xiqiao Zhou1,2 1Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 2The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 3School of Nursing, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 4Department of Pathology and Pathophysiology, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiqiao Zhou; Yinfeng Dong, Email zhouxiqiao@njucm.edu.cn; dongyf@njucm.edu.cnBackground: Metabolic Associated Fatty Liver Disease (MAFLD) poses a significant threat to human health, as it can result in hepatic fibrosis and potentially progress to cirrhosis, in addition to causing a range of extrahepatic complications. The early detection of MAFLD is crucial, particularly during the initial stages when the condition may be amenable to reversal and the body composition could be vital importance.Methods: Data from participants at the Jiangsu Province Hospital of Traditional Chinese Medicine, covering the period from January 1 to December 31, 2022, were collected and subsequently randomized into training and validation cohorts. Independent risk factors for MAFLD were identified using statistical methodologies in conjunction with clinical relevance, and these factors were ultimately utilized to develop the nomogram.Results: In the training cohort, there were 356 cases of MAFLD out of a total of 513 patients, representing 71.2%, while in the validation cohort, 161 cases of MAFLD were identified out of 220 patients, accounting for 73.2%. In terms of statistical outcomes and clinical relevance, we identified a total of 12 closely related or significant variables. To enhance our understanding of the critical role of body composition parameters in predicting the incidence of MAFLD, we developed two distinct nomograms, one of which included body composition data. Notably, the nomogram that incorporated body composition demonstrated superior predictive performance, as evidenced by a well-fitted calibration curve and a C-index of 0.893 (with a range of 0.8625 to 0.9242). Furthermore, the decision curve analysis indicated that utilizing the nomogram that included body composition would yield greater benefits.Conclusion: The nomogram serves as an effective tool for predicting MAFLD. Its utility in early risk identification of MAFLD is of significant importance, as it facilitates timely intervention and treatment for patients affected by this condition.Keywords: Metabolic Associated Fatty Liver Disease, Body Composition, Nomogram

Xuan Li,1,2,* Qiong Xiang,1,2,* Haixin Cen,1,2 Zhaolin Zhai,1– 3 Tianhao Gao,1– 3 Chang Lu,1– 3 Yuke Dong,1– 3 Yujian Ye,1,2 Chenxi Zhang,4 Kaiming Zhuo,1,2 Yan Wang,5 Dengtang Liu1– 3,6,7,* 1Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Clinical Center for Psychotic Disorders, National Center for Mental Disorders, Shanghai, People’s Republic of China; 3Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Department of Psychiatry, Feng Xian Mental Health Center, Shanghai, People’s Republic of China; 5School of Psychology and Cognitive Science, East China Normal University, Shanghai, People’s Republic of China; 6Institute of Mental Health, Fudan University, Shanghai, People’s Republic of China; 7Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dengtang Liu, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China, Email liudengtang@smhc.org.cn Yan Wang, School of Psychology and Cognitive Science, East China Normal University, Shanghai, People’s Republic of China, Email wangyan@psy.ecnu.edu.cnObjective: The objective of our study was to evaluate whether intermittent theta burst stimulation(iTBS) applied to the regions with the strongest cortico-hippocampal connectivity within the lateral parietal cortical (LPC) or dorsolateral prefrontal cortical (DLPFC) areas in individuals with schizophrenia could enhance associative memory.Methods: We randomized 96 participants with schizophrenia to receive either active iTBS applied to the right DLPFC, left LPC or sham iTBS for 20 days. Clinical and cognitive assessments were performed at baseline and at the end of treatment. The primary outcome was change in associative memory. The secondary outcome was change in other cognitive functions and psychiatric symptoms.Results: In comparison to the sham group, iTBS targeting the right DLPFC or left LPC in schizophrenia did not yield significant improvements in auditory-auditory associative memory (F=1.27, p=0.294), auditory-visual associative memory (F=0.49, p=0.617), or visual-visual associative memory (F=1.094, p=0.347). Furthermore, after adjusting for variables such as education, disease duration, and negative symptoms, no significant changes were observed in any of these three memory domains.Conclusion: Although our study suggests that iTBS applied to the cortical-hippocampal did not lead to a significant change in associative memory. However, further investigation combining hippocampal-targeted iTBS with functional magnetic resonance imaging (fMRI) is warranted to elucidate the regulatory effects of iTBS on hippocampal function.Trial Registration: clinicaltrials.gov NCT03608462.Keywords: theta burst stimulation, associative memory, schizophrenia, cortical-hippocampal network

Chi Zhou,1,&ast; Xu Li,1,&ast; Wenli Shen,2 Qunfang Huang,1 Xiaoling Lin,1 Gaofeng Zhang,3 Yin Dong3,4 1Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Health Development, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3The People’s Hospital of Yuhuan, Taizhou, Zhejiang, People’s Republic of China; 4Vanke School of Public Health, Tsinghua University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yin Dong, The People’s Hospital of Yuhuan, No. 18 Changle Road, Yucheng Street, Yuhuan, Taizhou, 317600, People’s Republic of China, Tel +86-18957678008, Email 9597082@qq.comBackground: The responsiveness of community health centers can reflect the soft capacity of medical institutions and is related to the improvement of health outcome indicators. This study is aimed at assessing the level and distribution of community health centers’ responsiveness and its associated factors among outpatients under the health-oriented integrated healthcare system in China.Methods: A total of 634 outpatients were recruited from six community health centers in Zhejiang Province, China, in July 2022. SPSS software was used to conduct the analysis (version 23.0). Health system responsiveness was used as a measure of outpatient responsiveness to health care services through a self-administered questionnaire. Determinants of community health centers’ responsiveness were determined by using a multiple linear regression model at a p-value < 0.05.Results: The total score of community health centers responsiveness was 8.25± 1.01, and the Gini coefficient is 0.027. Within these domains, social support and dignity received the highest scores, while choice of providers and autonomy scored the lowest. Age group between 60– 74 years (β: 0.129; 95% CI: 0.042– 0.529), ≥ 75 years (β: 0.095; 95% CI: 0.006– 0.707), monthly income with 8000 RMB and above (β: 0.098; 95% CI: 0.035– 0.653), having a family doctor (β: 0.124; 95% CI: 0.096– 0.410), and satisficing with community health service (β: 0.298; 95% CI: 0.848– 1.428) were significant predictors of community health centers’ responsiveness.Conclusion: The Chinese community health centers show high responsiveness, indicating that the construction of a health-oriented integrated healthcare system has been effective. The family doctor contract service is important and should continually enhance both technical proficiency and health promotion capabilities. Encourage residents to actively participate in their treatment process is also essential.Keywords: responsiveness, community health center, outpatient

Qian Liu,1,&ast; Jun Zhang,2,&ast; Mingqin Wei,1 Xue Zhou,3 Hao Sun,4 Youhong Dong,1 Dongdong Zhang1 1Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China; 2Department of Neurology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China; 3Department of Pathology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, 441000, People’s Republic of China; 4Department of Oncology, Baokang County People’s Hospital, Xiangyang, 441000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Youhong Dong, Dongdong Zhang, Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Jiefang Road No. 15, Xiangyang, Hubei, 441000, People’s Republic of China, Tel +8615072278600, Email dongyouhong2005@163.com; zhangdongdong@whu.edu.cnBackground: Pulmonary spindle cell carcinoma (PSCC), a highly malignant tumor, often exhibits cell pleomorphism, a histopathological characteristic. Owing to its extremely low incidence, atypical imaging and clinical presentations, and insufficient awareness among clinicians, PSCC is often misdiagnosed, which results in delays in treatment. Herein, we reported a rare case of PSCC that was initially misdiagnosed as granulomatous inflammation.Case Presentation: A 66-year-old male visited a local hospital with symptoms such as cough and hemoptysis. A computed tomography (CT) scan of the chest revealed a mass in his right lung, and no mediastinal lymphadenopathy was observed. Bronchoscopy showed no major abnormalities, and the results of fine needle aspiration biopsy showed granulomatous inflammation. Even though the patient received anti-infection treatment, his symptoms did not improve markedly. After two months, a follow-up CT scan of the lung showed a noticeably enlarged mass accompanied by multiple instances of mediastinal lymphadenopathy in the upper lobe of the right lung. Consequently, he underwent a second CT-guided lung biopsy at our hospital. The pathology report indicated PSCC. Due to financial constraints, genetic testing was not performed. Given his poor overall physical condition, the patient was unable to undergo systemic chemotherapy and instead received palliative radiotherapy. The prescribed radiotherapy dose for the right upper lobe lung cancer and multiple metastatic lymph nodes was 60 Gy, administered in 30 fractions. Unfortunately, he failed to adhere to scheduled follow-ups and succumbed to the disease 6 months later, as confirmed during a telephone follow-up.Conclusion: PSCC is a rare but highly malignant lung cancer. Multiple pathological biopsies are necessary to accurately and promptly diagnose the disease, which is crucial for early treatment intervention as well as improving patient prognosis.Keywords: pulmonary spindle cell carcinoma, granulomatous inflammation, radiotherapy, multiple pathological biopsies

Lei Gao,1,2,&ast; Yidi Xu,1,2,&ast; Xixue Zhang,1,2 Zhaoshun Jiang,1,2 Jiajun Wu,1,2 Yanjun Dong,1,2 Ming Li,3 Liang Jin,3 Jianjian Qiu,4 Lijue You,5 Chunhui Qin,6 Weidong Gu1,2 1Department of Anaesthesiology, Huadong Hospital Affiliated to Fudan University, Shanghai, People’s Republic of China; 2Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, People’s Republic of China; 3Department of Radiology, Huadong Hospital affiliated to Fudan University, Shanghai, People’s Republic of China; 4Department of Radiation Oncology, Huadong Hospital affiliated to Fudan University, Shanghai, People’s Republic of China; 5Department of Computer Center, Huadong Hospital affiliated to Fudan University, Shanghai, People’s Republic of China; 6Department of Pain Management, Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weidong Gu, Email hdmz0800@163.comBackground: Performing spinal anaesthesia in elderly patients with ligament calcification or hyperostosis is challenging for novice practitioners. This pilot study aimed to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) by novice practitioners in elderly patients.Methods: In this pilot study, 36 patients (aged ≥ 65 years) scheduled for elective surgery under spinal anaesthesia by anaesthesiology residents were included. Patients were randomly assigned to the MRasp group (n = 18) or the LGsp group (n = 18). The outcomes included the number of needle insertion attempts, redirection attempts, passes, the rate of successful first-attempt needle insertion, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications.Results: The median number of needle insertion attempts was significantly fewer in the MRasp group than in the LGsp group (1.0 vs 2.0, P = 0.023). The proportion of patients with successful first-attempt needle insertion was 72.2% in the MRasp group and 44.4% in the LGsp group (P = 0.176). The incidence of perioperative complications did not significantly differ between the two groups.Conclusion: This pilot study found that novice practitioners made significantly fewer needle insertion attempts in the MRasp group compared to the LGsp group when performing spinal anaesthesia on elderly patients. A future randomized controlled trial (RCT) is warranted to validate its effectiveness.Trial Registration: This trial was registered at https://www.chictr.org.cn/showproj.html?proj=178960 (ChiCTR-IPR-2300068520). Public title: Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: a randomized controlled pilot study. Principal investigator: Lei Gao. The registration date was February 22, 2023. The date of the first participant enrolment was February 27, 2023.Plain Language Summary: We developed virtual spine-presenting technology and patented optimal trajectory design technology to assist in spinal puncture and reported that the median number of needle insertion attempts was significantly fewer in the mixed reality-assisted spinal puncture group than in the landmark-guided spinal puncture group.Keywords: augmented reality, computer simulation, mixed reality, spinal puncture

Fangfang Du,1,&ast; Yujing Dong,2,&ast; Tian Tian,1 Weili Li,1 Feifei Wan,1 Suling Shi3 1Department of Nursing, Henan Vocational College of Tuina, Luoyang City, Henan Province, People’s Republic of China; 2Shool of Nursing,Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People’s Republic of China; 3Department of Nursing, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang City, Henan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fangfang Du, Department of Nursing, Henan Vocational College of Tuina, No. 10 Xuefu Street, Luolong District, Luoyang City, Henan Province, 471023, People’s Republic of China, Email dufangfang8119@163.comBackground: Stress urinary incontinence (SUI) is effectively managed through pelvic floor muscle training (PFMT), yet poor adherence often undermines its efficacy. Given square dancing’s popularity among middle-aged women, its integration with PFMT could potentially increase patient compliance. This study aims to investigate the impact of a hybrid program combining square dance and PFMT on SUI symptoms, quality of life, and treatment adherence in this demographic.Methods: Seventy-seven female participants from Luoyang were randomly allocated to an intervention group undergoing a 12-week program combining square dancing with PFMT, and two control groups receiving standard health advice or square dancing alone. Outcomes were assessed using subjective urinary incontinence rating, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Urinary Incontinence Quality of Life Scale (I-QOL), and a PFMT diary for compliance. Satisfaction was scored on a 10-point scale.Results: Participants (mean age: 53.35± 5.11 years) did not differ significantly at baseline. Post-intervention, the intervention group showed significant improvements in SUI symptoms and quality of life compared to both control groups (P < 0.05), with higher compliance (96.54% vs 54.82% in control I) and satisfaction (8.86± 0.85).Conclusion: Combining PFMT with square dancing significantly improved SUI symptoms, quality of life, and adherence among middle-aged women. Notably, despite the COVID-19 pandemic and associated restrictions during the 12-week intervention period, the communal and enjoyable nature of square dancing likely contributed to enhanced motivation and satisfaction. Keywords: stress urinary incontinence, pelvic floor muscle training, compliance, square dance, women, quality of life

Kun Li,1 Ahmad Alhaskawi,2 Haiyin Zhou,2 Yanzhao Dong,2 QingFang Zhao,3 Chenxi Wang,4 Hui Lu2 1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 4Medical Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Kun Li, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Email Likicu@zju.edu.cn Hui Lu, Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang Province, People’s Republic of China, Email HuiLu@zju.edu.cnObjective: This retrospective study examines risk factors and electromyographic (EMG) characteristics associated with acquired weakness in critically ill patients and assesses their impact on patient prognosis.Methods: Ninety-seven critically ill patients, ventilated for over 48 hours, were included. Patient data, encompassing general condition, medical history, Medical Research Council (MRC) scores, serum markers (c-reactive protein, calcitonin gene, albumin, brain natriuretic peptide, urea nitrogen, creatinine), EMG characteristics, respiratory treatment modalities, and parameters, were recorded. Mechanical ventilation duration, ICU stay duration, hospitalization duration, and patient prognosis were documented. Based on MRC scores, patients were categorized into the ICU-acquired weakness (ICU-AW) group (MRC < 48 points) and the non-ICU-AW group (MRC ≥ 48 points).Results: The study comprised 47 ICU-AW and 50 non-ICU-AW patients. Significant differences (p < 0.05) were observed in age, MRC scores, albumin levels, c-reactive protein, calcitonin gene, brain natriuretic peptide, urea nitrogen, creatinine, mechanical ventilation duration, ICU stay duration, and hospitalization duration between groups. In the ICU-AW group, nerve conduction examinations revealed slow conduction velocity, reduced wave amplitude, and in severe cases, a complete loss of motor and sensory potentials. Multivariate logistic analysis identified low serum albumin levels and MRC scores as potential ICU-AW risk factors.Conclusion: This study suggests that low serum albumin levels and MRC scores may contribute to ICU-AW risk. The ICU-AW group exhibited varied peripheral nerve damage and slow conduction velocities on EMG. Additionally, severe systemic inflammatory responses, renal function, brain natriuretic peptide levels, prolonged mechanical ventilation, and peripheral nerve damage may be associated with ICU-AW. Follow-up studies are essential for further understanding these complex interactions.Keywords: ICU-acquired weakness, risk factor, critical care, therapy, respiratory failure, electromyography

Jingjing Wang,1 Yirui Dong,1 Xuewei Zheng,1 Haodi Ma,1 Mengjiao Huang,1 Dongliao Fu,1 Jiangbo Liu,2 Qinan Yin1,3 1School of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, People’s Republic of China; 2Department of General Surgery, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, People’s Republic of China; 3Henan Engineering Research Center of Digital Pathology and Artificial Intelligence Diagnosis, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People’s Republic of ChinaCorrespondence: Qinan Yin, School of Medical Technology and Engineering, Henan University of Science and Technology, No. 263 Kaiyuan Avenue, Luoyang, People’s Republic of China, 471003, Email qinanyin@haust.edu.cn Jiangbo Liu, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Guanlin Avenue, Luoyang, 471031, People’s Republic of China, Email jiangboliuxing@163.comAbstract: Innate immunity is the first line of defense in the human body, and it plays an important role in defending against viral infection. Viruses are identified by different pattern-recognition receptors (PRRs) that activate the mitochondrial antiviral signaling protein (MAVS) or transmembrane protein 173 (STING), which trigger multiple signaling cascades that cause nuclear factor-κB (NF-κB) and interferon regulatory factor 3 (IRF3) to produce inflammatory factors and interferons (IFNs). PRRs play a pivotal role as the first step in pathogen induction of interferon production. Interferon elicits antiviral activity by inducing the transcription of hundreds of IFN-stimulated genes (ISGs) via the janus kinase (JAK) – signal transducer and activator of transcription (STAT) pathway. An increasing number of studies have shown that environmental, pathogen and host factors regulate the IFN signaling pathway. Here, we summarize the mechanisms of host factor modulation in IFN production via pattern recognition receptors. These regulatory mechanisms maintain interferon levels in a normal state and clear viruses without inducing autoimmune disease.Keywords: pattern recognition receptors, interferon-signaling pathway, host factors

Yu Dong, Aiping Wang The First Hospital of China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: Aiping Wang, The First Hospital of China Medical University, No. 155, North Street, Heping District, Shenyang, Liaoning Province, People’s Republic of China, 110001, Email jianghaoran88@hotmail.comBackground: The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people.Methods: Based on the framework of the scoping review methodology of Arksey and O’Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature.Results: Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results.Conclusion: In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.Keywords: visual impairment, health management models, strategies, the elderly, scoping review

Yu Qi,1– 3,&ast; Meiyan Zhou,1– 3,&ast; Wenting Zheng,1,2,&ast; Yaqi Dong,1,2 Weihua Li,2,4 Long Wang,1,2 Haijun Xu,1,2 Miao Zhang,1,5 Dunpeng Yang,1,5 Liwei Wang,1– 3 Hai Zhou1– 3 1The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China; 3Jiangsu Province Key Laboratory of Anesthesiology Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 4College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 5Department of Cardiothoracic Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hai Zhou; Liwei Wang, The Xuzhou Clinical College of Xuzhou Medical University, Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China, Email zhouhai339339@163.com; doctorlww@sina.comPurpose: Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.Patients and Methods: This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events.Results: The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups.Conclusion: The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.Keywords: S-ketamine, postoperative nausea and vomiting, hemodynamics, non-opioid analgesic, postoperative pain, video-assisted thoracoscopic surgery lobectomy

Jue Li,1– 3,&ast; Yingxian Dong,1– 3,&ast; Jiawei Guo,4 Lei Wang,1 Jie Tian,1– 3 Li Wang,4 Guowei Che1– 3 1Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 3West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 4The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guowei Che, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China, Tel/Fax +86-28-86298113, Email cheguoweixw@126.comObjective: To evaluate whether using a cocktail of intercostal nerve blocks (TINB) during thoracoscopic surgery results in better clinical outcomes than patient-controlled analgesia (PCIA).Methods: Patients in two medical groups undergoing video-assisted thoracoscopic surgery (VATS) for pulmonary nodules in West China Hospital of Sichuan University were collected consecutively between March 2022 and December 2022. The groups were divided into two subgroups based on their analgesic program, which were TINB group and PCIA group. The primary outcome was the visual analogue scale (VAS) of the two groups at different stage after surgery and after discharge. Any analgesic related adverse events (ARAEs) were also recorded.Results: A total of 230 patients who underwent VATS were enrolled, in which 113 patients (49.1%) received a cocktail TINB after surgery, and 117 patients (50.9%) received a PCIA. After PSM, 62 patients in each group were selected. The difference of resting VAS (RVAS) and active VAS (AVAS) at different stage during hospitalization was only related to the change of period (p < 0.05, p < 0.05), and the two groups showed no significant differences in RVAS or AVAS during hospitalization (p = 0.271, p = 0.915). However, the rates of dizziness (4.84% vs 25.81%, p = 0.002), nausea and vomiting (0 vs 22.58%, p < 0.05), fatigue (14.52% vs 34.87%, p = 0.012), and insomnia (0 vs 58.06%, p < 0.05) in TINB group were lower than that in PCIA group. Besides, AVAS and RVAS at 7, 14, and 30 days after discharge in TINB group were both significantly lower than that in PCIA group (p < 0.05, p < 0.05).Conclusion: Cocktail TINB provided better analgesia after discharge and reduced the incidence of ARAEs in patients undergoing VATS. Keywords: analgesia, thoracoscopic intercostal nerve block, cocktail analgesia, video-assisted thoracoscopic surgery

Rui Jing,1 Hui Dong,1 Kun Huang,2 Zhong Liu,1 Ran Xue,1 Yiran Dong,1 Mei Jiao,3 Na Li,4 Yumei Guo,5 Yun Liu,6 Wenqian Zhang,1 Hongyun Sun1 1Institute for Tuberculosis Control, Jinan Center for Disease Control and Prevention, Jinan, People’s Republic of China; 2Tuberculosis Control Division, Licheng Center for Disease Control and Prevention, Jinan, People’s Republic of China; 3Department of Sexually Transmitted Diseases and AIDS Prevention and Control, Lixia Center for Disease Control and Prevention, Jinan, People’s Republic of China; 4Tuberculosis and Vector Control Division, Shizhong Center for Disease Control and Prevention, Jinan, People’s Republic of China; 5Department of Infectious Diseases and Endemic Disease Control, Huaiyin Center for Disease Control and Prevention, Jinan, People’s Republic of China; 6AIDS Prevention and Control Department, Tianqiao Center for Disease Control and Prevention, Jinan, People’s Republic of ChinaCorrespondence: Wenqian Zhang; Hongyun Sun, Institute for Tuberculosis Control, Jinan Center for Disease Control and Prevention, Jinan, People’s Republic of China, Tel +86 0531-81278897 ; +86 0531 81278873, Email wqzh618@gmail.com; jncdcxxtb@jn.shandong.cnPurpose: This study aimed to investigate awareness of tuberculosis control among post-treatment tuberculosis patients, in order to provide a basis for future preventive and control work in this population.Patients and Methods: A cross-sectional descriptive study was conducted on post-treatment patients with tuberculosis in seven districts of Jinan City between July 2021 and December 2022. A face-to-face or telephone interviews using structured questionnaires for the research subjects were conducted by data collectors. Analyses were carried out first for all subjects, and then separately for male and female subjects.Results: A total of 837 valid questionnaires were collected, of which 495 were males and 342 were females. The awareness rate of the core TB knowledge was 82.46%. The ≥ 65 year group in the total group (OR=0.43, 95% CI: (0.28, 0.68)), male (OR=0.47, 95% CI: (0.27, 0.83)) and female group (OR=0.40, 95% CI: (0.19, 0.86)) was lower than that of the control group. Educational level and monthly income are the main factors of TB cognition in total group. People with university or higher education (OR=2.05, 95% CI: (1.38, 3.05)) and with a monthly income of ≥ 6,000 (OR=1.89, 95% CI: (1.10, 3.25)) had a higher awareness rate. The group with current residence in the city was more aware than the reference group.Conclusion: In the future, the communication of the main transmission route, suspicious symptoms, and cure of TB needs to be strengthened for the post-treatment TB patients. The elderly, those with secondary school education or below, agricultural workers and low-income people are the groups with weak knowledge of TB, and they are also the groups that need to be focused on health education. The above information should be focused on the above groups of people in order to educate them in a way that is easily acceptable to them.Keywords: pulmonary tuberculosis, awareness rate, completed treatment patients, layered analysis

Qingyan Jiao,1,&ast; Yeqing Dong,2,&ast; Xiaojuan Ma,3 Shiyi Suzy Ji,4 Xinyu Liu,1 Jian Zhang,1 Xia Sun,1 Dazhi Li,1 Xingguang Luo,5 Yong Zhang1 1Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, 300222, People’s Republic of China; 2Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, People’s Republic of China; 3Tianjin Medical College, Tianjin, 300222, People’s Republic of China; 4Teachers College, Columbia University, New York, NY, USA; 5Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA&ast;These authors contributed equally to this workCorrespondence: Yong Zhang, Unit of Bipolar Disorder, Tianjin Anding Hospital, 13 Liulin Road, Hexi District, Tianjin, 300222, People’s Republic of China, Tel/Fax +86 22 8818 8258, Email zhangyong@tjmhc.comPurpose: Major depressive disorder (MDD) is associated with worse cognitive functioning. We aim to examine the association between baseline cognitive functioning and the reduction rate in HDRS-17 total scores and to highlight the predictors of the reduction rate in HDRS-17 total scores in MDD with first-episode, drug-naïve (FED) patients.Patients and Methods: Ninety FED patients were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating Scale (HDRS-17), the 14-item Hamilton Anxiety Scale (HAMA-14), the Functioning Assessment Short Test (FAST) and the MATRICS Consensus Cognitive Battery (MCCB) at baseline and again at week 8.Results: Eighty-four FED patients completed the study. Comparison showed that response group had significantly higher T scores in TMT-A, BACS-SC, WMS-III, BVMT-R, MSCEI and CPT-IP, but showed significantly lower scores in FAST total scores including autonomy, occupational functioning, cognitive functioning, interpersonal relationship than non- response group (all p’s< 0.05). Partial correlation analysis also found that the reduction rate in HDRS-17 total scores could be negatively associated with autonomy, cognitive functioning and interpersonal relationship domains as well as total FAST scores, also was further positively associated with T-scores of BACS-SC, CPT-IP and MSCEI in MCCB, even when accounting for potential confounders. Furthermore, the levels of cognitive function domain, autonomy domain in FAST, and BACS-SC, CPT-IP in MCCB may predict the reduction rate in HDRS-17 total scores in FED patients (all p’s< 0.05).Conclusion: Our findings underscore significant correlations between baseline functioning and the reduction rate in HDRS-17 total scores in FED patients. Moreover, better baseline cognitive function, autonomy, speed of processing and attention/vigilance are more likely to predict patients’ response to antidepressant treatment, indicating pre-treatment better cognitive functioning may be predictors to treatment response in FED.Keywords: FED, FAST, MCCB, treatment response, the reduction rate in HDRS-17 total scores

Yanbei Duo,1 Shuoning Song,1 Xiaolin Qiao,2 Yuemei Zhang,3 Jiyu Xu,4 Jing Zhang,5 Zhenyao Peng,6 Yan Chen,2 Xiaorui Nie,2 Qiujin Sun,7 Xianchun Yang,7 Ailing Wang,8 Wei Sun,4 Yong Fu,1 Yingyue Dong,1 Zechun Lu,8 Tao Yuan,1,&ast; Weigang Zhao1,&ast; 1Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China; 5Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 6Department of Dean’s Office, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 7Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 8National Center for Women and Children’s Health, China CDC, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tao Yuan; Weigang Zhao, Email t75y@sina.com; xiehezhaoweigang@163.comObjective: Gestational diabetes mellitus (GDM) is a condition of glucose intolerance, which may be accompanied with inflammation. The levels of hematological parameters during pregnancy can reflect inflammatory conditions in pregnant women. This study aims to describe the dynamic change of blood cell parameters from the first trimester (6– 12 weeks of gestation) to the second trimester (24– 28 weeks of gestation) and to investigate the associations of these biomarkers with the risk of GDM.Methods: This study was a prospective double-center study conducted in Beijing, China (clinical trial number: NCT03246295). Hematological parameters were tested four times during the follow-up. Logistic regression analysis and Receiver Operating Characteristic (ROC) curve analysis were used to explore the association and predictive ability of hematological parameters for GDM.Results: There were 258 of 1027 pregnant women in our study developed GDM. Among the 1027 pregnant women, white blood cells (WBC) gradually increased, and red blood cells (RBC), hemoglobin (HGB), and platelet (PLT) tended to decrease from the first trimester to second trimester. After adjusting for confounding factors, higher levels of RBC, HGB, and PLT in both early and middle pregnancy were positively associated with GDM risk, whereas the level of WBC was associated with GDM risk only in early pregnancy. WBC, RBC, HGB, and PLT in early and middle pregnancy were all correlated with fasting insulin (FINS) in early pregnancy.Conclusion: Higher levels of hematological parameters in early and middle pregnancy were associated with glucose metabolism in early pregnancy and the subsequent risk of GDM.Keywords: hematological parameters, gestational diabetes mellitus, inflammation, insulin resistance, prospective study

Jie Bai,1 Jinxia Zheng,1 Nafei Guo,2 Yueyan Dong,1 Ke Wang,1 Cheng Cheng,3 Hui Jiang,2 Lin Qian4 1Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3School of Nursing, Fudan University, Shanghai, People’s Republic of China; 4Nursing Department, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Hui Jiang, Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China, Tel/Fax +86 21-20261221, Email jianghuitest@163.com Lin Qian, Nursing Department, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China, Email lc699536@126.comPurpose: Receiving assisted reproductive technology is stressful due to its long-lasting process, which might pose negative impacts on clients’ psychological well-being and quality of life. This study was to investigate coping profiles among couples undergoing assisted reproductive technology and examine their associations with psychological distress and quality of life.Methods: This cross-sectional study was conducted at the IVF center of a specialized hospital in Shanghai, China. Of 502 eligible clients completed a structured, online survey of socio-demographic information, Dyadic Coping Inventory, Kessler Psychological Stress Scale, and Fertility quality of life. Coping profiles were identified using latent profile analysis and differences between identified profiles on psychological distress and quality of life were examined using analyses of covariance.Results: A three-profile solution was supported: low dyadic coping group (n = 168, 33.50%), moderate dyadic coping group (n = 241, 48.00%), and high dyadic coping group (n = 93, 18.50%). Significant differences between those groups were found in psychological distress and quality of life.Conclusion: The findings of this study have revealed dyadic coping profiles in clients undergoing assisted reproductive technology, which are differentially associated with psychological distress and quality of life.Keywords: assisted reproductive technology, coping, latent profile analysis, psychological distress, quality of life

Qiankun Luo,1,&ast; Yifei Dong,1,&ast; Pan Liu,1,&ast; Chao He,2 Lei Chen,1 Kailun Zhang,1 Changjie Pan,1 Yahui Gao,1 Tao Qin1 1Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China; 2Department of Hepatobiliary and Pancreatic Surgery, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Tao Qin, Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, Henan, 450003, People’s Republic of China, Tel +86 13949116088, Email qtgoodfreecn@zzu.edu.cnIntroduction: Chemotherapy combined with immune checkpoint inhibitors (ChIM) is used to treat advanced pancreatic ductal adenocarcinoma (PDAC). However, the efficacy of ChIM is similar to that of chemotherapy alone.Methods: To assess potential factors affecting the effectiveness of ChIM, we analyzed the clinical data of 359 patients with PDAC who visited the hospital during June 2017 to December 2022.Results: Surgical resection, diabetes, and ChIM were risk factors for pancreatic exocrine insufficiency (PEI). The adjusted odds ratio of ChIM was 2.63 (95% confidence interval (CI) 1.492– 4.626) (P = 0.001). The incidence of PEI in the ChIM group (76.9%) was significantly higher than that of the chemotherapy group (60.2%) (P = 0.004). Survival analysis showed that ChIM did not improve the survival rate of patients with PDAC (hazard ratio (HR) 0.92, 0.707– 1.197) (P = 0.534) in comparison with that of the chemotherapy group. However, in patients without PEI, those receiving ChIM showed a higher 1-year overall survival (OS) rate of 70.8% (two-sided, P = 0.045) and a median OS of 22.0 months (95% CI 11.5– 32.5). Moreover, pancreatic enzyme replacement therapy significantly improved the OS of patients with PDAC (HR = 0.73, 95% CI = 0.561– 0.956) (P = 0.022).Conclusion: Immune checkpoint inhibitors (ICIs) increased the incidence of PEI in patients with PDAC. The OS was not different between patients receiving chemotherapy and ChIM due to irregular PERT treatment. The finding show that pancreatic enzyme replacement therapy may improve the response rate of patients with PDAC to ICIs.Keywords: pancreatic cancer, pancreatic exocrine insufficiency, immune checkpoint inhibitors, pancreatic enzyme replacement therapy

Lijun Zuo,1,&ast; Yanhong Dong,2,&ast; Xiaoling Liao,1 Yang Hu,1 Yuesong Pan,3 Hongyi Yan,3 Xingao Wang,1 Xingquan Zhao,1 Yilong Wang,1 Raymond CS Seet,4,5 Yongjun Wang,1,3 Zixiao Li1,3,6– 8 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore; 3China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 5Division of Neurology, Department of Medicine, National University Hospital, Singapore; 6Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 7National Center for Healthcare Quality Management in Neurological Diseases, Beijing, People’s Republic of China; 8Chinese Institute for Brain Research, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zixiao Li, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Email lizixiao2008@hotmail.comObjective: The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA).Methods: Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤ 22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment.Results: The study population comprised 1022 patients (mean age 61.6± 11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤ 22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (< 36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07– 2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA.Conclusion: The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.Keywords: mild stroke, post stroke cognitive impairment, hemoglobin, albumin, lymphocyte, platelet

Wangmei Liu,&ast; Jing Guo,&ast; Qiaomin Jiang, Guangnao Zhou, Yanyu Dong, Biqing Xu, Zhongda Liu, Zunjing Zhang, Jianjun Liu Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianjun Liu; Zunjing Zhang, Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, No. 800 Zhongshan Street, Liandu District, Lishui, 323000, People’s Republic of China, Tel +86 13757835027 ; +86 13884387661, Email jianjunliu888@126.com; zunjingzhangzj@126.comObjective: The purpose of this study is to examine the effect of quality control circle (QCC) activities on increasing the mask-wearing compliance of hospitalized patients diagnosed with tuberculosis (TB) during external examinations.Methods: To assess the mask-wearing compliance of patients diagnosed with TB admitted to a ward in our hospital in 2019, who visited other departments, we conducted activities in accordance with the ten steps of the QCC. We outlined the causes of non-compliance and developed and implemented improvement plans. We compared the results obtained before and after the implementation of the QCC to assess the enhancement in patient compliance concerning wearing masks during external examinations, particularly among individuals diagnosed with pulmonary tuberculosis.Results: The compliance rate for mask-wearing during external examinations rose from an initial 32.61% (45/138) prior to the intervention to 83.71% (149/178) following the intervention. The difference between the two groups was statistically significant (χ2 = 85.635, P

Muhammad Younas,1 Yan Dong,1 Rashid Menhas,2 Xinyi Li,1 Yu Wang,1 Uzma Noor3 1School of Educational Technology, Faculty of Education, Beijing Normal University, Beijing, People’s Republic of China; 2Research Center of Sport and Social Sciences, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 3School of Education, Soochow University, Suzhou, Jiangsu Province, People’s Republic of ChinaCorrespondence: Yan Dong, School of Educational Technology, Faculty of Education, Beijing Normal University, Beijing, People’s Republic of China, Email yan.dong@bnu.edu.cnBackground: Public health procedures under the COVID-19 pandemic lockdown policy negatively affect people’s health. Students’ physical issues have been increased due to restrictions which further impact their psychological and overall well-being.Objective: The research looks at the influence of coping behavior in mitigating the impact of the COVID-19 epidemic on students’ physical/psychological health and general well-being.Methods: The study’s participants were chosen from a pool of 2200 people using convenience sampling. Using an anonymous online poll, the main data were gathered. The collected data were analyzed by using Smart-PLS.Results: From eight direct correlations, seven were found to be true, except the route pandemic -> overall wellbeing, which was not true. Furthermore, it was shown that the mediating effect of coping behavior was statistically significant in the routes of mediation.Conclusion: Coping strategies have a significant role in how a person responds to trying circumstances. Our study’s results suggest that coping strategies had a statistically significant mediation role in reducing the effects of the COVID-19 pandemic. It is concluded that appropriate coping strategies are an effective adaptation of a protective barrier against the damaging effects of COVID-19 on health.Keywords: coping behavior, pandemic, students, physical health, psychological health

Lin Xia,1,&ast; Yu Liu,1,&ast; Zhonglu Yang,1 Yuguang Ge,1 Lu Wang,1 Yejun Du,1 Yinan Dong,2 Hui Jiang1 1Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, 110016, People’s Republic of China; 2Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning Province, 110016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Jiang, Department of Cardiovascular Surgery, General Hospital of Northern Theater, Command, 83 Wenhua Road, Shenyang, Liaoning Province, 110016, People’s Republic of China, Tel +86-024-2889-7390, Fax +86-024-2889-7391, Email jianghsyzy@163.comPurpose: Upper hemisternotomy (UHS) has benefits over conventional full sternotomy because it ameliorates trauma during cardiac surgery. Owing to its challenging and technically demanding nature, this incision in acute type A aortic dissection (ATAAD) has rarely been reported. This study aimed to analyze the learning curve of total arch replacement (TAR) with moderate hypothermic circulatory arrest via a single UHS approach, which is necessary to guide the training of surgeons in adopting minimally invasive procedures.Patients and Methods: A total of 202 consecutive patients who were definitively diagnosed with ATAAD between July 2016 and June 2021 were enrolled in this retrospective analysis. Patients were divided into three groups based on cumulative sum plots for circulatory arrest time in chronological order. Perioperative characteristics were compared between the groups.Results: There was significant difference in the circulatory arrest time and cross-clamp time respectively among three groups (39.0 min vs 28.0 min vs 15.0 min, P < 0.001; 104.5 min vs 106.2 min vs 84.1 min, P < 0.001). The ventilation time and first 24-h chest tube drainage were statistically different among groups (35.5 h vs 24.0 h vs 19.0 h, P = 0.031; 220.0 mL vs 192.5 mL vs 125.5 mL, P = 0.043). No other clinical outcome was observed as significant difference.Conclusion: A cardiac surgeon can convert a conventional full sternotomy to a single UHS for TAR after experiencing a learning curve, to ensure patient safety. The mastery of this minimally invasive surgical technique may be beneficial for the prognosis of patients with ATAAD.Keywords: aneurysm, dissecting, cardiac surgical procedures, sternotomy, circulatory arrest, deep hypothermia induced, learning curve

Cheng Huang,1 Peiming Zhang,2 Yu Dong,1 Ruchun Chang,2 Jinxiong Lao,2,3 Ziyong Li,2,3 Danchun Lan2 1Acupuncture and Rehabilitation Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 2Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, People’s Republic of China; 3The Eighth Clinical School of Medicine, Guangzhou University of Chinese Medicine, Foshan, People’s Republic of ChinaCorrespondence: Danchun Lan, Email Danchun2013@aliyun.comObjective: To systematically evaluate the efficacy of acupuncture in the treatment of schizophrenia.Methods: We searched China National Knowledge Infrastructure (CNKI), Wanfang Database, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), China Biology Medicine Database (CBM), PubMed, Embase, Web of Science, Cochrane Library for relevant literature on the acupuncture treatment of schizophrenia published from database inception to May 17, 2023. The evaluation criteria included total effective rate, incidence of adverse reactions, TESS scale, PANSS scale, BPRS scale, SANA scale, SAPS scale. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The RevMan 5.4 software was used for meta-analysis, risk of bias (ROB) evaluation tool was used to evaluate the risk of bias of the studies, and the GRADE evaluation tool was used to evaluate the quality of evidence. The study was registered on PROSPERO, CRD42023416438.Results: A total of 38 RCTs involving 3143 patients were included in the meta-analysis. The results showed that acupuncture can improve the total effective rate [OR=3.43 (95% CI: 2.71, 4.35), moderate credibility], reduce the incidence of adverse reactions [OR=0.45 (95% CI: 0.32, 0.63), moderate credibility], reduce the TESS score (side effect scale) [MD=− 1.83 (95% CI: − 2.94, − 0.71), very low credibility]. Acupuncture also reduced the PANSS total score [MD=− 5.75 (95% CI: − 8.08, − 3.42), very low credibility], SANA score [MD=− 2.66 (95% CI: − 6.84, 1.51), very low credibility], SAPS score [MD=− 1.26 (95% CI: − 2.55, − 0.02), very low credibility], and BPRS score [MD=− 7.02 (95% CI: − 10.59, − 3.46), very low credibility].Conclusion: Existing evidence indicates that acupuncture as an adjunctive therapy can improve the total effective rate of SZ patients, reduce the incidence of adverse reactions, improve clinical symptoms, and alleviate depression and anxiety in SZ patients. However, more high-quality clinical research evidence is still needed to support these findings.Keywords: acupuncture, meta-analysis, schizophrenia

Danyang Wang,1,2 Jianfeng Xing,2 Ying Zhang,2 Ziyang Guo,2 Shujing Deng,2 Zelin Guan,2 Binyang He,2 Ruirui Ma,2 Xue Leng,2 Kai Dong,2 Yalin Dong1 1Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of ChinaCorrespondence: Kai Dong, School of Pharmacy, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an, Shaanxi, 710061, People’s Republic of China, Tel/Fax +86-29-82655139, Email dongkai120@xjtu.edu.cn Yalin Dong, Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China, Te1 +86-29-85323241, Fax +86-29-85323240, Email dongyalin@mail.xjtu.edu.cn; donglyalin@medmail.com.cnAbstract: Chronic wounds are recalcitrant complications of a variety of diseases, with pathologic features including bacterial infection, persistent inflammation, and proliferation of reactive oxygen species (ROS) levels in the wound microenvironment. Currently, the use of antimicrobial drugs, debridement, hyperbaric oxygen therapy, and other methods in clinical for chronic wound treatment is prone to problems such as bacterial resistance, wound expansion, and even exacerbation. In recent years, researchers have proposed many novel materials for the treatment of chronic wounds targeting the disease characteristics, among which metal–phenolic networks (MPNs) are supramolecular network structures that utilize multivalent metal ions and natural polyphenols complexed through ligand bonds. They have a flexible and versatile combination of structural forms and a variety of formations (nanoparticles, coatings, hydrogels, etc.) that can be constructed. Functionally, MPNs combine the chemocatalytic and bactericidal properties of metal ions as well as the anti-inflammatory and antioxidant properties of polyphenol compounds. Together with the excellent properties of rapid synthesis and negligible cytotoxicity, MPNs have attracted researchers’ great attention in biomedical fields such as anti-tumor, anti-bacterial, and anti-inflammatory. This paper will focus on the composition of MPNs, the mechanisms of MPNs for the treatment of chronic wounds, and the application of MPNs in novel chronic wound therapies.Keywords: metal–phenolic networks, chronic wounds, antimicrobial, antioxidant, reactive oxygen species scavenging, revascularization

Yanjun Gao,1,2 Yingge Li,1,2 Zheming Liu,1,2 Yi Dong,1,2 Siqi Yang,1,2 Bin Wu,1,3 Mengxia Xiao,1,4 Chen Chen,5 Yingmei Wen,1,2 Lei Chen,1 Haijuan Jiang,6 Yi Yao1,2 1Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China; 2Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, 430200, People’s Republic of China; 3Department of Oncology, Huang-Gang Central Hospital, Huanggang, 438000, People’s Republic of China; 4Department of Oncology, Yichun People’s Hospital, Yichun, 336000, People’s Republic of China; 5Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China; 6Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People’s Republic of ChinaCorrespondence: Yi Yao, Email yaoyi2018@whu.edu.cnBackground: Activator of heat shock protein 90 (HSP90) ATPase Activity 1 (AHSA1) regulates proliferation, apoptosis, migration, and invasion of osteosarcoma and hepatocellular carcinoma (HCC). However, the novel mechanism of AHSA1 in the tumor biology of hepatocellular carcinoma (HCC) remains unclear.Methods: We analyzed AHSA1 expression in 85 pairs of clinical samples of HCC and the Cancer Genome Atlas database. The role of AHSA1 in HCC was proved by cell proliferation, colony formation, migration, cell cycle analysis in vitro, xenograft models and tumor metastasis assay in vivo, and bioinformatics.Results: High AHSA1 expression was demonstrated in HCC and associated with invasive depth, clinical stage, and poor overall survival of patients. Univariate Cox analysis confirmed that AHSA1 was an independent prognostic factor for patients with HCC. Meanwhile, AHSA1 upregulation promoted cell proliferation, colony formation, and cell migration in vitro and tumor cell proliferation and metastasis of HCC cells in vivo. AHSA1 upregulation increased the cell cycle transition from G1 to S phase by increasing the expression of cyclinD1, cyclinD3, and cyclin-dependent kinase 6(CD). Transforming growth factor beta 1 (TGF-β 1)-induced protein kinase B (Akt) signaling regulated the expression of downstream targets, including cyclinD1. AHSA1 expression was closely correlated with the expression of TGF-β, Akt, cyclinD1, cyclinD3, and CDK6 using the Gene Expression Profiling Interactive Analysis database. AHSA1 upregulation participated in HCC progression by regulating TGF-β/Akt-cyclinD1/CDK6 signaling.Conclusion: AHSA1 might serve as a biomarker for predicting the clinical outcome of patients with HCC. It is vital in tumor metastasis and disease progression of HCC and may facilitate the development of clinical intervention strategies against HCC.Keywords: AHSA1, AKT/cyclinD1/CDK6 signaling, cell cycle, hepatocellular carcinoma, TGF-&#x03B2

Yin Dong,1,&ast; Ming-Jing Li,2,&ast; Yan-Zhu Hong,3 Wen-Jie Li4 1Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 4Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yan-Zhu Hong, Xiamen University, No. 422, Siming South Road, Siming District, Xiamen, Fujian, 361005, People’s Republic of China, Tel +86 13671617025, Email hongyanzhu2020@sina.com Wen-Jie Li, Shanghai University of Traditional Chinese Medicine, No. 1200 Cai-lun Road, Pudong District, Shanghai, 201203, People’s Republic of China, Tel +86 15397687742, Email liwenjie@shutcm.edu.cnAbstract: Dysmenorrhea, classified as primary dysmenorrhea and secondary dysmenorrhea, is a common gynecological symptom that seriously affects female daily life. At present, studies on dysmenorrhea are numerous and complex. To better reflect the trend and innovative progress of dysmenorrhea-related research, this study screened papers on the Web of Science from January 1, 1992, to December 31, 2022. A total of 1012 papers were selected and analyzed for their affiliated countries, institutions, authors, keywords, etc. China is the country with the most academic output, Beijing University of Traditional Chinese Medicine is the most influential institution, and Yang Jie, from Chengdu University of Traditional Chinese Medicine, China, is the scholar with the most papers. We consider that the current research focus is on pathogenesis, treatment, epidemiology, and self-management. With increasing research on functional connectivity between dysmenorrhea and various brain regions, functional connectivity has gradually become the forefront of research. We hope our study can promote the further study of dysmenorrhea.Keywords: pathogenesis, treatment, management, traditional Chinese medicine

Xingran Shao, Yaqi Dong, Han Liu, Jiao Wei, Xiao Xiong Department of Dermatology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of ChinaCorrespondence: Jiao Wei; Xiao Xiong, Department of Dermatology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei, 442008, People’s Republic of China, Tel +86 15872706796 ; +86 13636169342, Email Dr_weijiao2023@163.com; xiongx2016@163.comAbstract: Eccrine poroma (EP) is a benign skin appendicular tumor that differentiates into the terminal sweat duct and is often differentiated from basal cell carcinoma (BCC) and seborrheic keratosis. This report describes a 58-year-old woman who presented with left occipital plaque. Histopathological analysis showed that the tumor cells were located in the lower part of the epidermis. The tumor cells were cuboidal or circular basal-like cells of the same size. The surrounding cells were not arranged in a palisade shape. Scattered tumor clusters composed of basal-like cells were also seen in the dermis, staining basophilic, and the surrounding cells were arranged in a palisade pattern. Immunohistochemistry showed that BerEP4, epithelial membrane antigen EMA, carcinoembryonic antigen CEA, Bcl-2, CD10, CK7 were positive, AR, PAS were negative. According to the pathological examination and immunohistochemical results, a case of eccrine poroma with concurrent basal cell carcinoma was diagnosed.Keywords: eccrine poroma, basal cell carcinoma, immunohistochemistry, carcinoembryonic antigen, CEA, epithelial membrane antigens, EMA, BerEP4

Fangfang Liu, Yinghan Dong, Yuan Yuan, Yingjie Jiang School of Psychology, Northeast Normal University, Changchun, Jilin, People’s Republic of ChinaCorrespondence: Yingjie Jiang, School of Psychology, Northeast Normal University, No. 5268, Renmin Street, Changchun, Jilin Province, People’s Republic of China, Email jiangyj993@nenu.edu.cnIntroduction: Interpersonal relationship serve as crucial of social support and a sense of security for left-behind children, playing a compensatory role in mitigating the absence of familial affection. Interpersonal distress can significantly impact their mental well-being. Although previous research has established a connection between empathy and interpersonal distress, the mechanisms by which empathy triggers interpersonal distress, as well as potential gender-based variations in this relationship, remain elusive. To bridge this gap in knowledge, this study investigates the mediating influence of emotion regulation and the moderating impact of gender in the relationship between empathy and interpersonal distress.Methods: A total of 713 rural left-behind children completed the Interpersonal Reactivity Index scale, Emotion Regulation Competence Scale, and Interpersonal Relationship Assessment Scale.Results: Pearson correlation analyses suggested strong significant correlations among empathy, emotion regulation ability, and interpersonal distress. Path analyses indicated that emotion regulation ability mediated the relationship between empathy and interpersonal distress. Furthermore, hierarchical regression analyses suggest a moderating effect of gender in the relationship between empathy and emotion regulation ability.Discussion: The present study reveals the role of emotion regulation ability and gender in the relationship between empathy and interpersonal distress, which has important theoretical and practical implications for the prevention and intervention of interpersonal distress in left-behind children. Moreover, it may strengthen the relationship between peer and teacher at school, and improve the quality of parent-child communication at home.Keywords: empathy, interpersonal distress, emotion regulation ability, gender, left-behind children

Hao Qin,1,&ast; Yuxiang Wan,2,&ast; Yuchao Dong,1 Qinying Sun1 1Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China; 2Department of Laboratory Diagnosis, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuchao Dong; Qinying Sun, Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China, Email dongyc1020@126.com; sqy20031@163.comAbstract: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC), accounting for about 1% of cases. These tumors are characterized by their high malignancy and frequent resistance to chemotherapy, resulting in a worse prognosis compared to other NSCLC subtypes. Currently, there is no established therapeutic strategy for PSC. Recent advancements in targeted therapies have led to the development of ret proto-oncogene (RET) inhibitors, such as selpercatinib and pralsetinib, which have been approved for the treatment of RET fusion-positive NSCLC patients. Despite their effectiveness in RET fusion-positive NSCLC is observed, the efficacy of these inhibitors in PSC remains unclear. In this context, we present a case of metastatic PSC harboring de novo KIF5B-RET fusion. The patient responded to first-line trametinib treatment. These findings suggest that RET inhibitors could be a potential treatment option for metastatic PSC patients with RET fusion-positive tumors.Keywords: pulmonary sarcomatoid carcinoma, RET, pralsetinib, efficacy

Yanqing Xing,1 Liting Feng,1 Yangdou Dong,2 Yupeng Li,1 Lulu Zhang,1 Qiannan Wu,1 Rujie Huo,1 Yanting Dong,1 Xinrui Tian,1 Xinli Tian3 1Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2College of Basic Medicine, Shanxi Medical University, Taiyuan, People’s Republic of China; 3Department of Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xinrui Tian, Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Xinghualing District, Taiyuan, People’s Republic of China, Tel +8613834575570, Email tianxr@126.com Xinli Tian, Department of Cardiology, Chinese PLA General Hospital, No. 7 Medical Center No. 5 Nanmencang, Dongsijiao, Dongcheng District, Beijing, People’s Republic of China, Email 18600501329@126.comPurpose: Asthma is a chronic inflammatory airway disease involving multiple mechanisms, of which ferroptosis is a form of programmed cell death. Recent studies have shown that ferroptosis may play a crucial role in the pathogenesis of asthma, but no specific ferroptosis gene has been found in asthma, and the exact mechanism is still unclear. The present study aimed to screen ferroptosis genes associated with asthma and find therapeutic targets, in order to contribute a new clue for the diagnosis and therapy of asthma.Methods: Ferroptosis-related differentially expressed genes (FR-DEGs) in asthma were selected by the GSE41861, GSE43696 and ferroptosis datasets. Next, the FR-DEGs were subjected by GO and KEGG enrichment, and the mRNA-miRNA network was constructed. Then, GSEA and GSVA enrichment analysis and Immune infiltration analysis were performed, followed by targeted drug prediction. Finally, the expression of FR-DEGs was confirmed using GSE63142 dataset and RT-PCR assay.Results: We found 13 FR-DEGs by the GSE41861, GSE43696 and ferroptosis database. Functional enrichment analysis revealed that the 13 FR-DEGs were enriched in oxidative stress, immune response, ferroptosis, lysosome, necrosis, apoptosis etc. Moreover, our results revealed the mRNA-miRNA network of the FR-DEGs and identified candidate drugs. Also, immune infiltration revealed that ELAVL1, CREB5, CBR1 and NR1D2 are associated with the immune cells and may be potential targets in asthma. Finally, 10 FR-DEGs were validated by the GSE63142 database. It was verified that 7 FR-DEGs were differentially expressed by collecting asthma patients and healthy controls.Conclusion: This study ultimately identified 7 FR-DEGs for the diagnosis and therapy of asthma. These 7 FR-DEGs contribute to oxidative stress and immune responses. This study provides potential therapeutic targets and biomarkers for asthma patients, shedding further light on the pathogenesis of asthma as well as providing new insights into the treatment of asthma.Keywords: asthma, bioinformatics, ferroptosis, GSEA, GSVA, immune microenvironment

Yanqing Xing,1 Yupeng Li,1 Liting Feng,1 Rujie Huo,1 Xinkai Ma,1 Yanting Dong,1 Dai Liu,1 Yuheng Niu,2 Xinrui Tian,1,&ast; Erjing Chen1,&ast; 1The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinrui Tian; Erjing Chen, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Xinghualing District, Taiyuan, Shanxi, People’s Republic of China, Email tianxr@126.com; mayyoubehappy44@163.comPurpose: To analyze the clinical characteristics and prognosis of patients hospitalized with non-severe, severe pneumonia and death in Omicron COVID-19.Patients and Methods: We collected clinical data from 118 patients with COVID-19 in China from 18 December, 2022 and 5 February, 2023. According to the outcome, the patients were divided into non-severe group, severe group and death group. Subsequently, we statistically analyzed the general condition, clinical manifestations, laboratory parameters, NLR, MLR, PLR and HALP of these groups. We also retrospectively analyzed the possible factors affecting the prognostic regression of patients with COVID-19.Results: A total of 118 COVID-19 patients were enrolled in this study, including 64 non-severe patients, 38 severe patients and 16 death patients. Compared with the non-severe group, T lymphocytes, B lymphocytes, Th1, Th2, Th17, Treg cells, IgA, IgG, IgM in the severe and death groups decreased more significantly (P< 0.05). The levels of myocardial markers, ALT, AST, BUN, Cr, D-dimer, fibrinogen, NLR, MLR and PLR in the severe and death groups were significantly higher than those in the non-severe group (P< 0.05). The level of HALP was significantly lower than that of non-severe group (P< 0.05). MLR is not only an independent risk factor for the transition from non-severe to severe disease, but also an independent risk factor for predicting the possibility of death in COVID-19 patients.Conclusion: The analysis of COVID-19 patients in China showed that severe patients were older, more likely to have related complications, lower lymphocyte count, liver and kidney function disorder, glucose and lipid metabolism disorders, myocardial injury, and abnormal coagulation function, suggesting the need for early anticoagulant therapy. In addition, NLR, MLR, PLR and HALP can be used as biomarkers to evaluate the severity and prognosis of COVID-19 patients.Keywords: COVID-19, omicron, clinical characteristics, lymphocyte subpopulation, Shanxi

Lijun Zuo,1 Yanhong Dong,2 Yuesong Pan,3 Hongyi Yan,3 Xia Meng,3 Hao Li,3 Xingquan Zhao,1 Yilong Wang,1 Yongjun Wang,1 Xiaoling Liao1 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore, 117597, Singapore; 3National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Xiaoling Liao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-010-59978350, Fax +86-010-59973383, Email liao828@sina.comObjective: Cognitive impairment after stroke/transient ischemic attack (TIA) has a high prevalence. Cystatin C (CysC) has been found as a novel biomarker of neurodegenerative diseases, such as dementia and Alzheimer’s disease. We aimed to explore the possible correlations of serum CysC level with cognitive impairment in patients who had mild ischemic stroke and TIA after 1 year.Methods: We measured serum CysC level in 1025 participants with a minor ischemic stroke/TIA from enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were divided into four groups according to quartiles of baseline CysC levels. Patients’ cognitive functions were assessed by Montreal Cognitive Assessment (MoCA)-Beijing at day 14 and at 1 year. Multiple logistic regression models were performed to evaluate the relationship between CysC and post-stroke cognitive impairment (PSCI) at 1-year follow-up.Results: Cognitive impairment was defined as MoCA-Beijing ≤ 22. Most patients were in 60s (61.52± 10.97 years old) with a median (interquartile range) National Institute of Health Stroke Scale(NIHSS) score of 3.00 (4.00) and greater than primary school level of education, and 743 participants (72.49%) were male. Among the 1025 participants, 331 participants (32.29%) patients suffered PSCI at 1-year follow-up. A U-shaped association was observed between CysC and 1-year PSCI [quartile (Q)1 vs Q3: adjusted odds ratio (aOR) 2.69, 95% CI 1.67– 4.34, p < 0.0001; Q2 vs Q3: aOR 1.63, 95% CI 1.03– 2.57, p = 0.0354; Q4 vs Q3: aOR 1.83, 95% CI 1.16– 2.87, p = 0.009]. Moreover, the U-shaped trends were also found between CysC level and the subscores of attention, recall, abstraction and language in MoCA.Conclusion: CysC showed a U-shaped correlation with 1-year overall cognitive function. It is probable that measurement of the serum CysC level would aid in the early diagnosis of PSCI.Keywords: mild stroke, post stroke cognitive impairment, cystatin C

Yanfang Zhang,1,&ast; Jinyan Huang,2,&ast; Shahbaz Hussain,3,&ast; Yaxin Dong2 1Foreign Languages Department, Beijing Union University, Beijing, People’s Republic of China; 2School of Teacher Education, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China; 3School of Management, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinyan Huang, Email huangniagara@hotmail.comPurpose: This study investigated how teaching, social, and cognitive presence within the community of inquiry (CoI) framework impacts Chinese college students’ online learning satisfaction through self-regulated learning and emotional states.Methods: A total of 2608 Chinese college students from 112 universities completed a 38-item Likert scale survey measuring teaching, social and cognitive presence, self-regulated learning, emotional states, and online learning satisfaction after COVID-19 restrictions were lifted on December 7, 2022. The study examined the influence of teaching, social, and cognitive presence on online learning satisfaction, mediated by self-regulated learning and moderated by emotional states using SmartPLS. It also analyzed demographic differences using multi-group analysis in the model.Results: The results indicated a significant positive relationship between a) self-regulated learning and online learning satisfaction, b) teaching presence, cognitive presence, and self-regulated learning, but no relationship between social presence and self-regulated learning. Additionally, self-regulated learning partially mediated the relationship between teaching and cognitive presence and online learning satisfaction. In contrast, self-regulated learning did not mediate the association between social presence and online learning satisfaction. Positive emotional states moderated the relationship between self-regulated learning and online learning satisfaction.Implications: The study advances the knowledge of these factors influencing online learners’ satisfaction, which can help create efficient programs and regulations for students, teachers, and policymakers.Keywords: the CoI framework, self-regulated learning, emotional states, online learning satisfaction, structural equation modeling

Lijun Zuo,1 YanHong Dong,2 Yang Hu,1 Xianglong Xiang,3 Tao Liu,4 Jianxin Zhou,5 Jiong Shi,1 Yongjun Wang1 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 117597 Singapore; 3China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, People’s Republic of China; 5Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Yongjun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-010-59978350, Fax +86-010-59973383, Email yongjunwang@ncrcnd.org.cnIntroduction: Stroke has been considered to raise the risk of dementia in several studies, but the relationship between brain structural changes and poststroke cognitive impairment (PSCI) is unclear.Methods: In this study, 23 PSCI patients with basal ganglia infarcts after 2 weeks and 29 age-matched controls underwent magnetic resonance imaging measuring cortical thickness and volume changes, as well as neuropsychological tests. CI was derived from a performance score < 1.5 standard deviations for normally distributed scores. We compared Z scores in different cognitive domains and cortical thickness and volumes in two groups. Multiple linear regressions were used to investigate the relationship between cortical thickness and volumes and neuropsychological tests.Results: A majority of PSCI patients were in their 50s (55.19± 8.52 years). PSCI patients exhibited significantly decreased Z scores in multiple domains, such as memory, language, visuomotor speed, and attention/executive function. The volumes of the middle posterior corpus callosum, middle anterior corpus callosum, and hippocampus in PSCI patients were markedly lower than controls. The thickness of the right inferior temporal cortex and insula were significantly smaller than controls. It found that the reduced right hippocampus was related to executive dysfunction. Hippocampus dysfunction may be involved in language impairment (p< 0.05) in PSCI patients with basal ganglia infarcts.Conclusion: These findings demonstrated that brain structure changed after ischemic stroke, and different gray-matter structural changes could lead to specific cognitive decline in PSCI patients with basal ganglia infarcts. Atrophy of the right hippocampus potentially serves as an imaging marker of early executive function of PSCI.Keywords: hippocampus volume, poststroke cognitive impairment, structural changes

Zhen Yang,1 Longfeng Sun,2 Yuanhui Sun,1 Yu Dong,1 Aiping Wang1 1Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China; 2Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of ChinaCorrespondence: Aiping Wang, Department of Public Service, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People’s Republic of China, Tel +86 13998890800, Email jianghaoran88@hotmail.comPurpose: This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic.Patients and Methods: A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data.Results: A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior.Conclusion: The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.Keywords: cardiac rehabilitation, adherence, qualitative study, conceptual model, quality of life

Yaolin Wang,1– 3,&ast; Kai Zhao,4,5,&ast; Nanling Wu,1– 3 Tao Ji,1– 3 Gaowei Su,1– 3 Xiaojie Cui,1– 3 Yushan Dong,1– 3 Xiuxia Chen1– 3 1NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 4Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China; 5Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiuxia Chen, Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Tel +86 18052268332, Email cxxlxy@sina.comPurpose: This study was designed to investigate the effects of different doses of butorphanol on postoperative shivering and quality of recovery in elderly patients.Patients and Methods: A total of 147 elderly patients (aged 60 or older) scheduled for elective transurethral resection of the prostate were enrolled in the current study. Patients were randomly and evenly assigned into four groups: Group C (0.9% normal saline), Group B1 (butorphanol 0.01 mg/kg), Group B2 (butorphanol 0.02 mg/kg) and Group B3 (butorphanol 0.03 mg/kg). All drugs were diluted to 5mL and injected intravenously slowly 5 min before induction of anesthesia. The primary outcome measure was the incidence of postoperative shivering in the post-anesthesia care unit. Quality of Recovery-40 (QoR-40) scores were assessed on postoperative day (POD) 1, 2 and 3. Perioperative core and skin temperature, extubation time and adverse events were also recorded.Results: Patients among the four groups had comparable baseline characteristics. Compared with Group C, the incidence of shivering was significantly lower in Group B2 and B3 (P = 0.006 and P = 0.005, respectively). The QoR-40 scores on POD1 were significantly higher in all butorphanol groups than that in Group C (P < 0.0083). In Group B2 and B3, patients experienced lower pain intensity (P < 0.001). In addition, the incidence of catheter-related bladder discomfort (CRBD) was lower in all butorphanol groups than in Group C (P < 0.0083).Conclusion: Butorphanol 0.02 or 0.03 mg/kg could effectively prevent the occurrence of postoperative shivering in elderly patients scheduled for transurethral resection of the prostate, provided effective postoperative recovery and postoperative analgesia.Keywords: butorphanol, elderly patients, postoperative shivering, recovery quality, postoperative pain

Yining Xiao,1– 3 Zhenjie Teng,1– 3 Jing Xu,2,3 Qianqian Qi,2 Tianyuan Guan,1,2 Xin Jiang,2,3 Huifang Chen,2 Xiaohua Xie,2 Yanhong Dong,2,3 Peiyuan Lv1– 3 1Department of Neurology, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 2Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China; 3Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, People’s Republic of ChinaCorrespondence: Peiyuan Lv, Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, 050051, People’s Republic of China, Email peiyuanlu2@163.comObjective: This study sought to explore the associations of the systemic immune-inflammation index (SII) with total cerebral small vessel disease (CSVD) burden and cognitive impairment.Methods: We enrolled 201 patients in the retrospective study with complete clinical and laboratory data. The SII was calculated as platelet count × neutrophil count/lymphocyte count. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). Total CSVD burden was assessed based on magnetic resonance imaging. We performed logistic regression models, Spearman correlation, and mediation analysis to evaluate the associations of SII with CSVD burden and cognitive impairment.Results: After adjustment for confounding factors in the multivariate binary logistic regression model, elevated SII (odds ratio [OR], 3.263; 95% confidence interval [CI], 1.577– 6.752; P = 0.001) or severe CSVD burden (OR, 2.794; 95% CI, 1.342– 5.817; P = 0.006) was significantly associated with the risk of cognitive impairment. Correlation analyses revealed that SII levels were negatively associated with MMSE scores (rs = − 0.391, P < 0.001), and positively associated with the total CSVD burden score (rs = 0.361, P < 0.001). Moreover, SII was significantly related to the severity of the CSVD burden (OR, 2.674; 95% CI, 1.359– 5.263; P = 0.004). The multivariable-adjusted odds ratios (95% CI) in highest tertile versus lowest tertile of SII were 8.947 (3.315– 24.145) for cognitive impairment and 4.945 (2.063– 11.854) for severe CSVD burden, respectively. The effect of higher SII on cognitive impairment development was partly mediated by severe CSVD burden.Conclusion: Elevated SII is associated with severe CSVD burden and cognitive impairment. The mediating role of severe CSVD burden suggests that higher SII may contribute to cognitive impairment through aggravating CSVD burden.Keywords: systemic immune-inflammation index, inflammation, cognitive impairment, cerebral small vessel disease, total burden

Yulan Dong, Qianqian Chen, Bin Tian, Jing Li, Jin Li, Zhidong Hu Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, People’s Republic of ChinaCorrespondence: Zhidong Hu, Department of Clinical Laboratory, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, People’s Republic of China, Tel +86 022-60814202, Email huzhidong27@126.comBackground: Due to limitations of traditional microbiological methods and the presence of the oropharyngeal normal flora, there are still many pathogens that cause lower respiratory tract infections (LRTIs) cannot be detected. Metagenomic next-generation sequencing (mNGS) has the potential capacity to solve this problem.Methods: This retrospective study successively reviewed 77 patients with LRTI and 29 patients without LRTI admitted to Tianjin Medical University General Hospital, China from August 2020 to June 2021. Pathogens in bronchoalveolar lavage fluid (BALF) specimens were detected adopting mNGS and traditional microbiological assays. The diagnostic performance of pathogens was compared between mNGS and BALF culture. The value of mNGS for aetiological and clinical impact investigation in LRTI was also evaluated.Results: Among 77 patients with LRTI, 22.1%, 40.3%, and 65.0% of cases were detected as definite or probable pathogens by culture, all conventional microbiological tests, and mNGS, respectively. Using the final diagnosis as a gold standard, mNGS exhibited a sensitivity of 76.6% (95% confidence interval [CI], 65.6– 85.5%), which was considerably superior to that of BALF culture (76.6% vs 18.2%; P < 0.01); specificity of 79.3% (95% CI, 60.3– 92.0%), which was similar (79.3% vs 89.7%; P = 0.38); positive-predictive value of 90.8% (95% CI, 81.0– 96.5%), and negative-predictive value of 56.1% (95% CI, 39.7– 71.5%). According to our data, mNGS identified potential microorganisms in 66.7% (42/63) of culture-negative samples. Among 59 patients with pathogens identified by mNGS, conventional microbiological methods confirmed pathogenic infections in less than half (28/59) cases. Within the 77 patients, 34 (44.2%) patients received pathogen-directed therapy, 7 (9.1%) patients underwent antibiotic adjustment, and 3 (3.9%) patients stopped using antibiotics due to mNGS results.Conclusion: mNGS exhibits high accuracy in diagnosing LRTI, and combine with traditional microbiological tests, causative pathogens can be detected in approximately 70.0% of cases, thus yields a positive effect on antibiotic application.Keywords: LRTIs, mNGS, pathogens, culture, diagnosis, infection

Yiwen Dong,1– 3 Litao Yao,2– 4,&ast; Lei Cai,1 Mi Jin,1 Tymour Forouzanfar,2,3 Lianjun Wu,1 Jinsong Liu,1,&ast; Gang Wu2,3 1School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, Amsterdam, the Netherlands; 3Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands; 4Department of Dentistry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Litao Yao, Department of Dentistry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China, Zhejiang, Email yaolt@srrsh.com Jinsong Liu, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China, Email jinsong0719@wmu.edu.cnIntroduction: An antibacterial and pro-osteogenic coaxially electrospun nanofiber guided bone regeneration (GBR) membrane was fabricated to satisfy the complicated and phased requirements of GBR process.Methods: In this study, we synthesize dual-functional coaxially electrospun nanofiber GBR membranes by encapsulating parathyroid hormone (PTH) in the core layer and magnesium oxide nanoparticles (MgONPs) in the shell layer (MgONPs-PCL/PTH-PCL). Herein, the physicochemical characterization of MgONPs-PCL/PTH-PCL, the release rates of MgONPs and PTH, and antibacterial efficiency of the new membrane were evaluated. Furthermore, the pro-osteogenicity of the membranes was assessed both in-vitro and in-vivo.Results: We successfully fabricated a coaxially electrospun nanofiber MgONPs-PCL/PTH-PCL membrane with the majority of nanofibers (> 65%) ranged from 0.40~0.60μm in diameter. MgONPs-PCL/PTH-PCL showed outstanding antibacterial potential against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) through the release of MgONPs. We also discovered that the incorporation of MgONPs significantly prolonged the release of PTH. Furthermore, both the in-vivo and in-vitro studies demonstrated that high dosage of PTH promoted pro-osteogenicity of the membrane to improve bone regeneration efficacy with the presence of MgONPs.Conclusion: The new composite membrane is a promising approach to enhance bone regeneration in periodontitis or peri-implantitis patients with large-volume bone defects.Keywords: antibacterial property, pro-osteogenicity, coaxially electrospun, barrier membrane, guided bone regeneration

Jing Zhang,1 Haijing Song,2 Yanan Dong,1 Ganghui Li,3 Jun Li,1 Qizhe Cai,4 Shoujun Yuan,5 Yi Wang,1 Haifeng Song1 1State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, People’s Republic of China; 2Emergency Medicine, PLA Strategic Support Force Medical Center, Beijing, 100101, People’s Republic of China; 3China Pharmaceutical University, Nanjing, 211198, People’s Republic of China; 4Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 5Beijing Institute of Radiation Medicine, Beijing, 100850, People’s Republic of ChinaCorrespondence: Haifeng Song; Yi Wang, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, People’s Republic of China, Tel +86 10 81139169, Fax +86 10 81139169, Email songhf@vip.163.com; yves.wangy@vip.163.comBackground: Extracellular vesicles (EVs) are considered a promising drug delivery platform. Naïve EVs face numerous issues that limit their applications, such as fast clearance, hepatic accumulations, and a lack of target-specific tropism. We aimed to explore a series of surface engineering approaches to: 1) reduce the non-specific adhesion of EVs, and 2) improve their enrichment in the target tissue. As a proof-of-concept, we investigated the therapeutic potentials of a multi-modal EVs system carrying a tumor-specific nanobody and the immuno-stimulant interleukin-12 (IL12) using in vivo models of hepatocellular carcinoma.Methods: The major cell adhesion molecule on the HEK293-derived EVs, integrin β 1 (ITGB1), was knocked out (KO) by CRISPR/Cas9-mediated gene editing, followed by deglycosylation to generate ITGB1−Deg EVs for the subsequent pharmacokinetic and biodistribution analyses. ITGB1−Deg EVs were further loaded with glypican-3 (GPC3)-specific nanobody (HN3) and mouse single-chain IL12 (mscIL12) to generate ITGB1−mscIL12+HN3+Deg EVs, for evaluation of tumor tropism and therapeutic potential in a mice model of hepatocellular carcinoma.Results: Removal of ITGB1 led to the broad suppression of integrins on the EVs surface, resulting in a decrease in cellular uptake. Deglycosylation of ITGB1− EVs gave rise to inhibition of the EVs uptake by activated RAW264.7 cells. ITGB1 removal did not significantly alter the pharmacokinetic behaviors of HEK293-EVs, whereas the ITGB1−Deg EVs exhibited enhanced systemic exposure with reduced hepatic accumulation. Loading of HN3 conferred the ITGB1−Deg EVs with tumor-specific tropism for both subcutaneous and metastasized tumors in mice. The ITGB1−mscIL12+HN3+Deg EVs activated mouse splenocytes with high potency. Systemic administration of the EVs with the equivalent dose of 1.5μg/kg of exosomal IL12 achieved satisfactory tumor growth inhibition and good tolerability.Conclusion: The combinatorial approach of EVs surface engineering conferred HEK293-EVs with reduced non-specific clearance and enhanced tumor targeting efficacy, which constituted an efficient delivery platform for critical cancer therapeutics like IL12.Keywords: exosome, glycosylation, glycan, drug delivery

Qin Xu,1,2,&ast; Dan Li,1,2,&ast; Yongning Dong,2,&ast; Yi Wu,2 Hong Cao,1,2 Feng Zhang,1,2 Yanping Xia,1 Jing Chen,1,2 Xuesong Wang1,2 1Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 2Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jing Chen; Xuesong Wang, No. 1000 Hefeng Road, Binhu District, Wuxi, People’s Republic of China, Email cj02303@163.com; victorwxs@jiangnan.edu.cnPurpose: The aim of this study was to investigate whether the personality traits of intern nursing students could serve as valid predictors of their psychological status and clinical decision making. Additionally, we aimed to understand the psychological state of intern nursing students during the regular epidemic prevention and control stage of COVID-19.Participants and Methods: This study was designed as a cross-sectional survey. A total of 181 intern nursing students involved in clinical placements participated in this study. Participants provided relevant data by completing the Big Five Inventory-44, the Self-Rating Anxiety Scale, the Perceived Stress Scale 14, and the Clinical Decision-Making in Nursing Scale.Results: The results showed that neuroticism (β = -0.282, p

Luting Yang, Chuhui Wang, Yijing Zhang, Quanfang Wang, Yulan Qiu, Sihan Li, Bo Yang, Qian Du, Jiaojiao Chen, Mengmeng Teng, Taotao Wang, Yalin Dong Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of ChinaCorrespondence: Yalin Dong; Taotao Wang, Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China, Tel +86-29-85323241 ; Tel/Fax +86-29-85323243, Fax +86-29-85323240, Email dongyalin@mail.xjtu.edu.cn; wangtaotao1989@mail.xjtu.edu.cnPurpose: Voriconazole (VRC) is an antifungal agent which is used for treatment and prophylaxis of invasive fungal infections. The common clinical adverse reactions mainly include central nervous system (CNS) toxicity and abnormal liver function. These adverse reactions limit the clinical use of voriconazole to a certain extent. Therefore, the aim of this study was to analyze the risk factors of voriconazole neurotoxic side effects and to determine the plasma trough concentration (Cmin) threshold of voriconazole-induced CNS toxicity, so as to improve the safety of voriconazole treatment.Patients and Methods: This study retrospectively collected the clinical data of 165 patients who received voriconazole and underwent therapeutic drug monitoring (TDM). CNS toxicity was defined using the National Cancer Institute (NCI) criteria, logistic regression was used to analyze the risk factors of CNS toxicity, classification and Regression tree (CART) model was used to determine the Cmin threshold for CNS toxicity.Results: Voriconazole-related CNS toxicity occurred during treatment in 34 of 165 patients (20.6%) and the median time from administration to onset of CNS toxicity was 6 days (range, 2– 19 days). The overall incidence of CNS toxicity was 20.6% (34/165), including visual disturbances in 4.8% (8/165) and nervous system disorders in 15.8% (26/165). Cmin significantly affects the occurrence of CNS toxicity and the threshold of Cmin for voriconazole CNS toxicity was determined to be 4.85 mg/L, when Cmin > 4.85 mg/L and ≤ 4.85 mg/L, the incidence of CNS was 32.9% and 11.6%, respectively.Conclusion: Voriconazole trough concentration of Cmin is an independent risk factor for CNS toxicity, and the threshold of Cmin for CNS toxicity is 4.85mg/L. TDM should be routinely performed in patients with clinical use of voriconazole to reduce the occurrence of CNS toxicity of voriconazole.Keywords: voriconazole, TDM, Cmin, CNS toxicity, cohort study

Jie Bai,1 Jinxia Zheng,1 Yueyan Dong,1 Ke Wang,1 Cheng Cheng,2 Hui Jiang3 1Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 2School of Nursing, Fudan University, Shanghai, 200032, People’s Republic of China; 3Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of ChinaCorrespondence: Hui Jiang, Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China, Tel +86 021-20261221, Fax +86 021-20261221, Email jianghuitest@163.comPurpose: Infertile clients undergoing assisted reproductive technology (ART) are exposed to a stressful situation and evidence has highlighted the importance of dyadic coping in reducing stress, yet little is known about the associations between psychological distress, dyadic coping, and quality of life in this population.Patients and Methods: A cross-sectional study was conducted at a tertiary hospital in Shanghai, China. A structured questionnaire was administered online to assess psychological distress, dyadic coping, and fertility quality of life. Sociodemographic information was collected. Descriptive statistics, Pearson correlation, and stepwise regression models were used to analyze the data.Results: Of 715 infertile males and females who completed the survey. Results showed that there was a negative association between psychological distress and quality of life. The use of positive dyadic coping was associated with better quality of life, whereas negative dyadic coping might contribute to worse quality of life. Moreover, males reported having a better quality of life in contrast to females.Conclusion: The findings of this study highlighted the significant associations between particular dyadic coping and quality of life in clients undergoing ART. Healthcare professionals should recognize the significance of dyadic coping in the context of ART and consider improving clients’ quality of life through coping-oriented interventions.Keywords: adaptation, infertility, psychological distress, reproductive techniques

Zixing Bai1 &ast;, Xuhan Cao1 &ast;, Yanjun Yang,1 Xudong Sun,1 Yongli Dong,2 Jianmin Wen,1 Weidong Sun1 1Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 2Scientific Research Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weidong Sun, Wangjing Hospital of China Academy of Chinese Medical Sciences, No. 6 Central South Road, Wangjing, Chaoyang District, Beijing, 100102, People’s Republic of China, Tel +86-84739140, Email sunweidong8239@aliyun.comObjective: To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.Methods: A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.Results: Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1– 2 (IMA1– 2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer–Lemeshow test showed a good degree of calibration (χ2 = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737– 0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%– 70%.Conclusion: Second metatarsal length, second metatarsal peak pressure, HVA, IMA1– 2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.Level of Evidence: Level III, retrospective comparative study.Keywords: hallux valgus, metatarsalgia, nomogram, predictive model, risk factors

Yi Li, Hui Dong, Yudi Dong, Qiaoyuan Wu, Ni Jiang, Qing Luo, Fang Chen Department of Cancer Research Laboratory, Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People’s Republic of ChinaCorrespondence: Qing Luo; Fang Chen, Department of Cancer Research Laboratory, Department of Pathology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou, 563003, People’s Republic of China, Tel +85128608074, Email zlsysluoqing@163.com; 819448232@qq.comObjective: The purpose of this study was to explore the expression and distribution of tumor-infiltrating immune cells (TIICs) and their relationship with recurrence and metastasis of nasopharyngeal carcinoma (NPC).Methods: The gene expression profiles of NPC were downloaded from GEO database (GSE53819 and GSE64634). The abundance of TIICs in NPC samples was calculated by the CIBERSORT algorithm, and TIICs with higher expression were screened in NPC. Then, we performed immunohistochemistry experiments to evaluate the expression of selected TIICs in 94 NPC samples from the Affiliated Hospital of Zunyi Medical University. We further explored the relationship between TIICs and recurrence and metastasis of NPC.Results: The results based on the GEO database showed that the expression of CD8 T cells, NK cells, macrophages and plasma cells was higher than that in normal tissues. Immunohistochemistry results showed that CD8 T cells, NK cells, macrophages and plasma cells were mainly expressed in the stroma, and the expression of CD8 T cells and NK cells in the stroma of patients without recurrence or metastasis was significantly higher than that in patients with recurrence or metastasis of NPC. Kaplan–Meier analysis showed that patients with high CD8 T cells and high NK cells expression in the stroma had favorable recurrence or metastasis-free survival and overall survival (P< 0.05). Univariate and multivariate Cox analyses indicated that CD8 T cells and NK cells in the stroma were independent factors for the recurrence or metastasis of NPC.Conclusion: The expression of CD8 T cells, NK cells, macrophages and plasma cells is significantly higher than that in normal tissues. Among them, the expression of CD8 T cells and NK cells is closely related to the recurrence and metastasis of NPC. They are independent factors affecting the recurrence and metastasis of NPC.Keywords: TIICs, nasopharyngeal carcinoma, recurrence and metastasis, CD8 T cells, NK cells

Fang Liu,1,&ast; Yanan Xu,1,&ast; Tianshuai Yang,2,&ast; Zhihua Li,3 Yakun Dong,1 Liang Chen,4 Xiaohua Sun4 1Department and Institute of Psychology, Ningbo University, Ningbo, People’s Republic of China; 2School of Mechanical Engineering and Automation, University of Science and Technology Liaoning, Anshan, People’s Republic of China; 3Institute of Education, Hunan University of Science & Technology, Xiangtan, People’s Republic of China; 4School of Marxism, University of Science and Technology Liaoning, Anshan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liang Chen; Xiaohua Sun, Email chenlfly@126.com; sunxh@ustl.edu.cnPurpose: Smartphone is an indispensable everyday tool for college students, while excessive usage of smartphones may lead to negative outcomes, such as academic procrastination. Previous research has suggested that smartphone addiction is a predisposing factor for procrastination. To further understand the above relationship, structural equation model analysis was used to examine the mediating effects of time management and learning strategic approach in the association with smartphone addiction and academic procrastination.Materials and Methods: A cross-sectional study was conducted in September 2021. A total of 1129 college students aged 18 to 22 participated in the present study was adopted the cluster random sampling method and the following tools were used: the Mobile Phone Addiction Index Scale, Time Management Disposition Scale, Revised Approaches to Studying Inventory, and Aitken Procrastination Scale.Results: Results indicated that smartphone addiction is positively linked to academic procrastination, while negatively linked to time management and learning strategic approach. Both time management and learning strategic approach were negatively linked to academic procrastination. Additionally, the results showed that time management and learning strategic approach serve sequential mediating roles in the association with smartphone addiction and academic procrastination among Chinese college students after controlling for age and sex (RMSEA = 0.045, SRMR = 0.035, TLI = 0.993, CFI = 0.979).Conclusion: Time management and learning strategic approach serve sequential mediating roles in the association with smartphone addiction and academic procrastination among Chinese college students. Therefore, intervention management that focusing on improving time management as well as strengthening learning strategic approach may be useful for reducing academic procrastination among college students.Keywords: smartphone addiction, academic procrastination, time management, learning strategic approach

Liu X, Dong Y, Song D. Cancer Manag Res. 2020;12:10559-10572. We, the Editors and Publisher of Cancer Management and Research, have retracted the following article. Since publication, concerns have been raised about the integrity of the data in the article. When approached for an explanation, the authors did not respond to our queries, nor did they provide original data for their study. As verifying the validity of the published work is core to the integrity of the scholarly record, we are therefore retracting the article and the authors were notified of this. We have been informed in our decision-making by our editorial policies and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.