Changes of serum SOST and SFRP5 levels in patients with traumatic osteoarthritis and their prognostic value / 国际检验医学杂志

Objective To investigate the changes of serum sclerostin(SOST)and secreted frizzled related protein 5(SFRP5)levels and their prognostic value in patients with post-traumatic osteoarthritis(PTOA).Methods 84 patients with PTOA admitted to the hospital from January 2020 to January 2022 were selected as the disease group,and 84 healthy patients who underwent physical examination in the hospital during the same period were selected as the health group.Serum SOST and SFRP5 levels were detected in the diseased and healthy groups by enzyme-linked immunosorbent assay.The patients in the disease group were followed up for 1 year and the prognosis of PTOA patients was evaluated by Lysholm knee function score.Spearman correla-tion analysis was used to analyze the correlation between serum SOST,SFRP5 and Lysholm knee function score in PTOA patients.Multivariate Logistic regression was used to analyze the prognostic factors of PTOA patients.The predictive value of serum SOST and SFRP5 levels in poor prognosis of PTOA patients was ana-lyzed by receiver operating characteristic(ROC)curve.Results Compared with the healthy group,the serum SOST and SFRP5 levels in the disease group were significantly decreased,and the difference was statistically significant(P＜0.05).Spearman correlation analysis showed that serum SOST and SFRP5 levels were posi-tively correlated with Lysholm knee function score.Multivariate Logistic regression analysis showed that body mass index＞25 kg/m2,Kelgran-Lawrence grade Ⅲ/Ⅳ at admission and cartilage Outerbridge grade Ⅲ/Ⅳ at admission were independent risk factors for poor prognosis in PTOA patients(P＜0.05).Long-term exercise,SOST and SFRP5 levels were protective factors(P＜0.05).ROC curve analysis showed that the area under ROC curve(AUC)of serum SOST and SFRP5 combined in predicting poor prognosis of PTOA patients was higher than that of SOST and SFRP5 alone in predicting poor prognosis of PTOA patients(Z=2.316,P=0.021;Z=2.356,P=0.019).Conclusion Serum SOST and SFRP5 levels are reduced in PTOA patients compared to healthy individuals,both of which are associated with poor prognosis in PTOA patients and have some predictive efficacy for patient prognosis.

Bioinformatics identification of CA9 as a signature gene for cartilage-associated ferroptosis in steroid-induced osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND:Disturbances in bone metabolism have a significant association with ferroptosis in steroid-induced osteonecrosis of the femoral head(SONFH).Furthermore,the pathologic process of SONFH is characterized by the presence of cartilage damage and degeneration.However,the specific regulatory targets and the relationship between ferroptosis and cartilage concerning SONFH remain unclear. OBJECTIVE:To employ bioinformatics and machine learning techniques to identify specific genes associated with ferroptosis that target cartilage and to investigate the correlation between ferroptosis and cartilage,thereby providing novel ideas and methodologies for the study and treatment of SONFH. METHODS:Disease datasets pertinent to the study and ferroptosis-related genes were retrieved from the GEO and FerrDb databases.Subsequently,the disease datasets were normalized and differential analysis using the R language to identify ferroptosis-related differential genes(Fe-DEGs).We conducted Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis of Fe-DEGs.Furthermore,ferroptosis-related signature genes were filtered based on the protein-protein interaction network of Fe-DEGs and machine learning methods.Finally,the rabbits were divided into normal and model groups.The normal group was given the same dose of saline to simulate the modeling drug,and the animal model of SONFH in rabbits was constructed by injection of modified horse serum combined with methylprednisolone.After successful modeling,the expression of signature gene was verified between different groups,and the phenotype of ferroptosis in cartilage was analyzed. RESULTS AND CONCLUSION:Through the normalization and differential analysis of the dataset,a total of 1 315 differentially expressed genes were identified.Additionally,379 ferroptosis-related genes were obtained from the FerrDb database.After intersecting both gene sets,19 Fe-DEGs were obtained.The GO analysis revealed that Fe-DEGs were mainly involved in biological processes such as cell migration and cellular response to oxidative stress,cellular components such as kinase complexes,amino acid complexes,and cytoplasmic membranes,as well as molecular functions such as kinase activity,receptor activity,and protein binding.The KEGG analysis revealed that Fe-DEGs were mainly enriched in the FoxO signaling pathway,vascular endothelial growth factor signaling pathway,and FcγR-mediated phagocytosis.Constructing a protein-protein interaction network and using machine learning,we identified the ferroptosis-related signature gene,CA9.The gene set enrichment analysis of the signature gene CA9 revealed an upregulated expression in biological processes such as fatty acid metabolism and O-GlcNAc glycosylation modification,while being inhibited in terms of neural activity and ligand-receptor interactions.RT-PCR and western blot results showed that compared with the normal group,the expressions of ACSL4 and CA9 at mRNA and protein levels were significantly higher in the model group(P<0.05),while the expressions of SLC7A11 and GPX4 at mRNA and protein levels were significantly lower in the model group(P<0.05),coinciding with the expression levels of the signature genes in the dataset.These findings indicate that the cartilage of SONFH is closely related to ferroptosis,and targeting the signature gene may provide certain ideas and directions for the study and treatment of SONFH.

Factors influencing abnormal posterior corneal surface elevation with normal corneal biomechanical parameters / 眼科新进展

Objective To investigate the influence factors of abnormal posterior corneal surface elevation of myopia patients under normal corneal biomechanical state.Methods A retrospective case-control study was conducted.A total of 99 myopia patients(99 right eyes)who were going to undergo refractive surgery in Nanjing Aier Eye Hospital from April 2022 to December 2022 were included.All patients received routine preoperative examinations,and the corneal morphologi-cal and biomechanical examinations were performed by Pentacam combined with Corvis ST.For patients with normal Cor-vis biomechanical index(CBI,corneal biomechanical indexes measured by Corvis ST),corneal back difference(BD,difference between the enhanced posterior surface elevation and the normal posterior surface elevation)obtained by BADⅢ-Belin/Ambrósio Enhanced Ectasia Display(BAD)of the Pentacam 3D anterior segment analysis system was used to di-vide the posterior corneal surface elevation into group A(BD＜12 μm,33 patients,33 eyes,control group),group B(12μm≤BD≤16 μm,32 patients,32 eyes,suspicious corneal abnormality group),and group C(BD＞16 μm,34 patients,34 eyes,corneal abnormality group).Basic information about the patients,such as gender and age,was collected;ocular pa-rameters,such as intraocular pressure,spherical equivalent(SE),thinnest pachymetry(THP)and anterior chamber depth(ACD),were included;corneal morphological parameters obtained by Pentacam,such as corneal horizontal diameter(HWTW),BD,anterior Sim Ks(ASK),posterior Sim Ks(PSK),BAD system-related indicators[including deviation of normality of the front elevation(Df),deviation of normality of pachymetric progression(Dp),deviation of normality of corneal thinnest point(Dt),and overall deviation of normality(Do)]and pachymetric progression index(PPI),were en-rolled;corneal biomechanical integration parameters obtained by Corvis ST,such as stiffness parameters,integrated radius(IR,area under the inverse concave radius curve),Ambrósio relational thickness to the horizontal profile(ARTh,THP/thickness change rate)and deformation amplitude ratio,were included.The comparison between groups was conducted with one-way ANOVA test and H test,Spearman Correlation was used to analyze the correlation between the BD and ocular parameters in each group,and a multivariate logistic regression model was used to explore the main factors affecting the classification of BD values under normal corneal biomechanical state.The probability distribution of abnormal posterior corneal surface elevation under normal corneal biomechanical state was plotted according to the logistic regression equa-tion,and then the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficiency of the logistic regression equation.Results There were statistically significant differences in THP,HWTW,PSK,Df,Dp,Dt,Do,PPImin,PPIavg,ACD,Db and ARTh among the three groups(all P＜0.05);in pairwise comparisons,only PSK(F=11.385),Db(H=87.107),Do(F=50.051)and PPImin(F=16.556)showed statistically significant differences(allP＜0.01),and the other parameters only showed statistically significant differences between Group A and Group B,Group A and Group C(all P＜0.05).The BD of the three groups were highly positively correlated with Db(r=0.957,0.914 and 0.952,all P＜0.05).In addition,the BD in Group A was slightly negatively correlated with PSK(r=-0.437,P＜0.05)and slightly positively correlated with Do(r=0.432,P＜0.05);the BD in Group C showed a low degree of negative corre-lation with SE(r=-0.399,P＜0.05)and a moderate negative correlation with HWTW(r=-0.482,P＜0.05).Using BD as the dependent variable and other parameters as covariates for multivariate logistic regression,the results showed that the influencing factors of BD in Group B were THP,HWTW and ARTh,the influencing factors of BD in Group C were THP,HWTW,ARTh and IR,and the overall percentage of model classification was 72.7％.According to ROC curve analysis,the new parameter Logistic(C)in multivariate logistic regression could improve the diagnostic efficiency of normal corneal bio-mechanical parameters with abnormal corneal posterior surface elevation,and its area under the curve(sensitivity,speci-ficity)was 0.975(100.0％,90.9％).Conclusion THP,HWTW,ARTh and IR are the main influencing factors of ab-normal posterior corneal surface elevation in myopic patients under normal corneal biomechanical state;the influence of corneal morphological and biomechanical parameters should be considered when diagnosing the abnormal posterior corneal surface elevation.

Relationship between lens parameters and ocular anatomical characteristics in myopia patients / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the relationship among lens parameters and their correlation with ocular anatomic characteristics in myopia patients implanted with posterior-chamber phakic implantable collamer lens(Phakic-ICL).METHODS:Retrospective study. A total of 46 myopia patients(46 eyes)who underwent Phakic-ICL implantation were collected in the Wuxi Huaxia Eye Hospital from June 2022 to June 2023. Preoperative evaluation of ocular anatomical characteristics included corneal central thickness(CCT), anterior chamber depth(ACD), axial length(AL), white-to-white(WTW), horizontal sulcus to sulcus(STSH), horizontal angle to angle(ATAH), and vertical sulcus to sulcus(STSV), vertical angle to angle(ATAV). Furthermore, lens parameters included horizontal crystalline lens rise(CLRH), vertical CLR(CLRV)and vertical lens thickness(LTV). The difference, consistency and correlation of the above parameters were analyzed.RESULTS:Except for differences between WTW and STSV, STSH and ATAV, which were not statistically significant(all P&#x003E;0.05), the other horizontal and vertical ocular anatomical characteristics were statistically significant(P&#x003C;0.05). CLRH and CLRV had statistically significant difference(P&#x003C;0.01), while LTH and LTV were not statistically significant difference(P&#x003E;0.05). Bland-Altman results revealed that the anatomical characteristics in the horizontal or vertical diameters showed poor consistency. The consistency between CLRH and CLRV was poor. There was consistency between LTH and LTV, with the 95% limits of agreement(LoA)between the differences ranging from -0.21 to 0.28 mm, and the proportion of out-of-line points off the 95% LoA was 4.35%. Pearson correlation analysis revealed that there were correlations between the anatomical characteristics of the horizontal and vertical diameters(P&#x003C;0.01). Meanwhile, there was no correlation between the anteroposterior diameters(P&#x003E;0.05). There were correlations between the lens parameters(P&#x003C;0.05), excepted for the CLRH, LTH and LTV, which had no correlation. AL correlated with the anatomical characteristics of the horizontal and vertical diameters(P&#x003C;0.05), but it had no correlation with lens parameters(P&#x003E;0.05). Multiple linear regression analysis revealed that LT=0.419+0.017×age-0.548×ACD+0.371×ATAH+0.884×CLRV, CLRH=-0.443+0.809×CLRV, CLRV=-0.092-0.200×ATAH+0.560×CLRH(corrected R2=0.458, 0.482, 0.589, respectively).CONCLUSION:Horizontal and vertical diameters were not interchangeable. CLRH and CLRV were not interchangeable, while LTH and LTV were interchangeable. Partial lens parameters, WTW, STS, and ATA were correlated with ACD. Finally, age, ACD, ATAH, and CLRV influenced LT.

Progress in Biomechanics and Mechanobiology of Dendritic Cells / 医用生物力学

Dendritic cells (DCs) are now known as the most powerful antigen-presenting cells in vivo, with efficient antigen uptaking, and processing capabilities. They can present antigens to naïve T cells in secondary lymphoid tissues, thereby induce immune response or tolerance, and play a key role in initiating and amplifying innate and adaptive immunity. DCs experience complex chemical and mechanical microenvironment changes and show different mechanophenotypes and immunophenotypes in the process of exerting their physiological functions. Deeply understanding the chemical and mechanical factors that regulate the mechanophenotypes and immunophenotypes of DCs is a prerequisite for using DCs to treat immune related diseases. In this review, the progress in the biomechanics and mechanobiology research of DCs was mainly introduced, and their potential applications and future development directions in the treatment of immune related diseases were explored.

Correlation between ciliary sulcus diameter and corneal diameter of patients with low to moderate myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the correlation among horizontal ciliary sulcus(HCS)diameter, vertical ciliary sulcus(VCS)diameter and corneal diameter in different anterior chamber depth(ACD)levels from patients with low to moderate myopia.METHODS: Retrospective study. A total of 78 patients(129 eyes)with low to moderate myopia who had preoperative examination of implantable contact lens(ICL)implantation in Shanghai Bright Eye Hospital from April 2021 to April 2022 were included. HCS, VCS and white to white(WTW)were measured and compared. Patients were divided into shallow ACD group(2.8 mm ≤ ACD ≤3.2 mm), medium ACD group(3.2 mm < ACD ≤3.4 mm)and deep ACD group(ACD > 3.4 mm)based on the ACD obtained by Pentacam. The HCS, VCS and WTW within and among groups were compared, and the correlation of WTW, HCS and VCS among each group was analyzed by Pearson and linear regression equation.RESULTS: There was no statistical difference in WTW and HCS overall and in groups with different ACD(P>0.05), while there was difference between VCS and both HCS and WTW(P<0.01). The WTW had a correlation with both HCS and VCS in each group, while correlation between WTW and VCS was weak in the deep ACD group(r=0.470, R2=0.221, P<0.01). Furthermore, the WTW, HCS and VCS in the shallow ACD group were statistically different from those in the medium and deep ACD groups(P<0.01).CONCLUSION: The WTW was suggested predicting HCS rather than perfectly replacing HCS before patients had the ICL operation among patients with low to moderate myopia. The predictability of VCS would decline as the ACD depth increasing, predicting VCS by WTW was not recommended.

Efficacy of alcohol septal ablation in mildly symptomatic or severely symptomatic patients with hypertrophic obstructive cardiomyopathy / 中华心血管病杂志

Objective: To compare the prognosis of mildly or severely symptomatic patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent alcohol septal ablation (ASA). Methods: This retrospective study cohort consisted of patients with OHCM who received ASA treatment in Beijing Anzhen Hospital, Capital Medical University from March 2001 to August 2021. These patients were divided into mildly and severely symptomatic groups according to the severity of clinical symptoms. Long-term follow-up was conducted, and the following data were collected: duration of follow-up, postoperatire treatment, New York Heart Association (NYHA) classification, arrhythmia events and pacemaker implantation, echocardiographic parameters, and cause of death. Overall survival and survival free from OHCM-related death were observed, and the improvement of clinical symptoms and resting left ventricular outflow tract gradient (LVOTG) and the incidence of new-onset atrial fibrillation were evaluated. The Kaplan-Meier method and log-rank test were used to determine and compare the cumulative survival rates of the different groups. Cox regression analysis models were used to determine predictors of clinical events. Results: A total of 189 OHCM patients were included in this study, including 68 in the mildly symptomatic group and 121 in the severely symptomatic group. The median follow-up of the study was 6.0 (2.7, 10.6) years. There was no statistical difference in overall survival between the mildly symptomatic group (5-year and 10-year overall survival were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year overall survival were 94.2% and 83.9%, respectively, P=0.405); there was also no statistical difference in survival free from OHCM-related death between the mildly symptomatic group (5-year and 10-year survival free from HCM-related death were 97.0% and 94.4%, respectively) and the severely symptomatic group (5-year and 10-year survival free from HCM-related death were 95.2% and 92.6%, respectively, P=0.846). In the mildly symptomatic group, NYHA classification was improved after ASA (P<0.001), among which 37 patients (54.4%) were in NYHA class Ⅰ, and the resting left ventricular outflow tract gradient (LVOTG) decreased from 67.6 (42.7, 90.1) mmHg (1 mmHg=0.133 kPa) to 24.4 (11.7, 35.6) mmHg (P<0.001). In severely symptomatic group, NYHA classification was also improved post ASA (P<0.001), among which 96 patients (79.3%) improved by at least one NYHA classification, and the resting LVOTG decreased from 69.6 (38.4, 96.1) mmHg to 19.0 (10.6, 39.8) mmHg (P<0.001). The incidence of new-onset atrial fibrillation was similar between the mildly and severely symptomatic groups (10.2% vs. 13.3%, P=0.565). Cox multivariate regression analysis showed that age was an independent predictor of all-cause mortality in OHCM patients post ASA (HR=1.068, 95%CI 1.002-1.139, P=0.042). Conclusions: Among patients with OHCM treated with ASA, overall survival and survival free from HCM-related death were similar between mildly symptomatic group and severely symptomatic group. ASA therapy can effectively relieve resting LVOTG and improve clinical symptoms in mildly or severely symptomatic patients with OHCM. Age was an independent predictor of all-cause mortality in OHCM patients post ASA.

Effects and mechnism of abnormal stress promoting MIF,COX2 and PGE2 in the progression of temporomandibular joint osteoarthritis / 解放军医学杂志

Objective To investigate the effects and mechnism of abnormal stress promoting macrophage mobility inhibitory factor(MIF),cyclooxygenase 2(COX2)and prostaglandin E2(PGE2)in the progression of temporomandibular joint osteoarthritis(TMJOA).Methods From January 2020 to December 2021,TMJOA and temporomandibular joint internal derangement(TMJID)patients(30 cases in each group,we divided the TMJOA into group TMJ Ⅰ,Ⅱ,Ⅲ according to the stage)who were admitted to TMJOA special clinic of the First Affiliated Hospital of Xinjiang Medical University and accompanied by abnormal occlusion were collected.The pain score of the occlusal state of the patients was evaluated by visual analogue scale.The expression levels of MIF,COX2 and PGE2 in synovial fluid were detected by ELISA.We used the unilateral anterior crossbite for TMJOA(UAC)rats model(the grouped into:UAC-4 weeks,UAC-8 weeks and UAC-12 weeks group),and control group at the same time(grouped into:Ctrl-4 weeks,Ctrl-8 weeks and Ctrl-12 weeks group),each group had 6 rats.The expression levels of MIF,COX2 and PGE2 in serum and synovial fluid of rats were detected by ELISA.The expression levels of IL-1β,IL-18,MIF,COX2 and PTGER2 in temporomandibular joint of rats were detected by Western blotting.The fluid flow shear stress(FFSS)model of fibroblast-like synovial cells(FLSs)was established,and the mRNA and protein expression levels of above indexes were detected by RT-PCR and Western blotting.Results Visual analogue scale evaluation showed that the pain score of TMJOA Ⅰ and Ⅱ group was significantly higher than that of TMJID(P<0.001).ELISA results showed that the expression levels of MIF,COX2 and PGE2 in synovial fluid in TMJOA group were higher than those in TMJID group(P<0.05),and the expression levels were the highest in TMJOA Ⅱ group.Compared with control group,the expressions of MIF,COX2 and PGE2 in serum and synovial fluid at UAC-4 weeks,8 weeks and 12 weeks were slightly higher,and significantly higher at UAC-8 weeks in rat TMJOA model(P<0.05).In addition,the expression trend of protein levels in temporomandibular joint tissues was similar,which showed higher expression levels of IL-1β,IL-18,MIF,COX2 and PTGER2(P<0.05).In the cell model where FFSS interfered with FLSs,with the increase of FFSS,cell with deformation,incomplete cell membrane and reduced number.Compared with control group,the expression levels of IL-1β,IL-18,MIF,COX2 and PGE2(PTGER2)of FLSs were increased in 1,3,5 and 10 dyn/cm2 intervention groups(P<0.05).Conclusion MIF,COX2 and PGE2 were highly expressed in temporomandibular joint synovial fluid of TMJOA patients with malocclusion.And these three factors were also highly expressed in serum and synovial fluid of UAC rats.The abnormal fluid shear stress promotes the secretion of MIF,COX2 and PGE2 by FLSs to participate in joint microenvironment inflammation and accelerate disease progression.

To explore the value of TRAb in predicting permanent hypothyroidism after 131I treatment of Graves' disease / 中国综合临床

Objective:The effect of serum thyrotropin receptor antibody (TRAb) on permanent hypothyroidism (HT) after 131I treatment in Graves disease patients and its predictive value Methods:479 Graves' disease patients who underwent 131I treatment at the Nuclear Medicine Department of North China University of Technology Affiliated Hospital from October 2013 to October 2021 were selected. Among them, 350 cases (permanent HT group) had permanent HT during follow-up, while 129 cases (non permanent HT group) did not. Collect general clinical data such as gender, age, degree of thyroid enlargement, as well as indicators such as iodine intake rate, thyroid function, and treatment dose 24 hours before treatment, from two groups of patients. Compare the general clinical data and pre treatment levels of various detection indicators between two groups of patients, analyze the risk factors for permanent HT in Graves disease patients after 131I treatment, and evaluate the predictive value of pre treatment serum TRAb levels, and evaluate the consistency between the predicted results and clinical diagnosis. The econometric data with a normal distribution is represented by xˉ± s, and two independent sample t-tests are used for comparison between the two groups; The econometric data that do not conform to the normal distribution are represented by M（ Q1， Q3）, and the Wilcoxon rank sum test is used for comparison between the two groups; The counting data is represented as an example (%), and the comparison between the two groups is conducted using the four grid χ 2 test, while the comparison of grade data is conducted using the Willcoxon rank sum test; The logistic regression model was used for multivariate analysis. Draw a subject work characteristic curve to evaluate the predictive efficacy of TRAb, and screen the predictive threshold based on the Chayoden index; Calculate sensitivity and specificity, and evaluate the consistency between the predicted results and clinical diagnosis by calculating Kappa values. Results:There were no statistically significant differences in gender, age, degree of thyroid enlargement, 24-hour iodine uptake rate, serum thyroid stimulating hormone, free triiodothyronine, free thyroxine levels, and 131I treatment dose between the permanent HT group and the non permanent HT group (all P>0.05); The pre treatment TRAb levels in the permanent HT group were higher than those in the non permanent HT group [14.51(4.95,33.58) U/L vs 3.40(1.67,16.5) U/L], with a statistically significant difference ( Z=5.87, P<0.001). The results of multivariate logistic regression analysis showed that pre treatment TRAb levels were a risk factor for permanent HT in Graves' disease patients after 131I treatment (odds ratio=1.042,95% confidence interval: 1.025-1.059, P<0.001). The area under the working characteristic curve for predicting permanent HT in Graves' disease patients after 131I treatment with pre-treatment TRAb levels is 0.674 (95% confidence interval: 0.616~0.732), and the optimal critical value is 7.025 U/L. Using TRAb>7.025 U/L before treatment as the standard for predicting postoperative permanent HT in patients, the sensitivity and specificity were 73.7% and 75.2%, respectively. The predicted results showed moderate consistency with clinical diagnosis ( Kappa=0.426). Conclusions:The pre treatment TRAb level is a risk factor for permanent HT in Graves disease patients after 131I treatment ( P<0.001), and the diagnostic efficacy of permanent HT is best when TRAb>7.025 U/L.

Association between work stress and primary headache in nursing staff in Changchun / 中风与神经疾病杂志

@#Objective To investigate the association between stress and primary headache in nursing staff and the methods for managing such headache. Methods A semi-structured questionnaire was used to conduct a hospital-based cross-sectional study among 225 nursing staff members in a grade A tertiary teaching hospital in Changchun, Jilin, China. A total of 32 items were measured, including basic information, headache-and stress-related questions, job satisfaction, and coping strategies. According to the International Headache Society criteria, headache patients with migraine or episodic tension-type headache （with attacks for less than 15 days a month） were included for analysis. The Student's t-test, a one-way analysis of variance, and the chi-square test were used for statistical analysis. Results Among the 210 respondents, 103 （48.9%） reported the experience of primary headache in the previous year, and 98 （46.7%） experienced episodic headache （less than 15 days a month）. Detailed neurological interviews of the latter group showed that 56 respondents （26.5%） had migraine, 28 （13.3%） had tension-type headache, 11 （5.2%） had a combination of migraine and tension-type headache, and 4 （1.9%） had headache due to other causes. There were no significant differences in demographic data between headache patients and non-headache patients, although there was a significant difference in self-reported sources of stress between the two groups （individual P values ranging from 0.021 to <0.001）. The patients with headache experienced greater job-related stress than the individuals without headache （P<0.001）. The nursing staff members with a younger age, less experience, an unmarried status, and a lower educational level tended to report higher levels of stress. Treatment methods for headaches included sleep, medication, rest, medical consultation, and psychological help. Nurses often used nonsteroidal anti-inflammatory drugs for pain relief. Conclusion The results show that work stress is associated with primary headache among nursing staff, and nurses seldom seek help at the early stage of the disease. Therefore, education on how to alleviate stress and cope with headache for nursing staff may help them provide better care to patients.

NF-κB-induced activation of NLRP3 inflammasome by LCN2 after intracerebral hemorrhage in rats / 中风与神经疾病杂志

@#Objective To investigate the mechanism of the elevated expression of LCN2 during intracerebral hemorrhage(ICH) and its involvement in inflammatory response after hemorrhage. Methods Male Sprague-Dawley rats were given an injection of autologous arterial blood(100 μl) at the basal ganglia,and the rats in the control group were given an injection of an equal volume of normal saline using the same surgical procedure. Ventricular injection of the NF-κB-specific inhibitors parthenolide and BAY11-7082 was performed for pretreatment,and after transfection with scrambled LCN2RNA or LCN2 siRNA,the levels of NLRP3,ASC,and cleaved caspase-1 were measured as the indicators for the status of inflammasome activation. Western blot,RT-PCR,and immunohistochemistry were used to measure the protein and mRNA expression levels of LCN2.Results Western blotting showed that there was a significant increase in the protein expression level of LCN2 in the ipsilateral basal ganglia on days 1,3,and 7 after hemorrhage and a significant reduction in this level on day 14.On day 3 after intracerebral hemorrhage,the protein expression level of LCN2 in the ipsilateral side was 71 times higher than that in the contralateral side(2.70±0.46 vs 0.04±0.01,P<0.001) and was 84 times higher than that in the control group(0.92±0.14 vs 0.01±0.01,P<0.001). Pretreatment with the NF-κB-specific inhibitors parthenolide and BAY11-7082 could inhibit the expression of LCN2.There were significant increases in the protein expression levels of NLRP3,ASC,and cleaved caspase-1 after transfection with scrambled siRNA,and LCN2 siRNA significantly reduced the expression of these inflammasome-associated proteins. Conclusion This study suggests that iron release after ICH can induce the expression of LCN2,and LCN 2 may play an important role in the inflammatory process after hemorrhage.

GAO Wei-bin's clinical experience in treatment of neurogenic bladder with acupuncture / 中国针灸

The paper introduces GAO Wei-bin's clinical experience in acupuncture treatment for neurogenic bladder. In association with the etiology, the location and types of neurogenic bladder and in accordance with nerve anatomy and meridian differentiation, the acupoints are selected accurately in treatment. Four acupoint prescriptions are allocated. For frequent urination and urinary incontinence, the foot-motor-sensory area of scalp acupuncture, Shenshu (BL 23) and Huiyang (BL 35) are used. For all kinds of urine retention, especially the patients who are not suitable for acupuncture at the lumbar region, Zhongji (CV 3), Qugu (CV 2), Henggu (KI 11) and Dahe (KI 12) are selected. For all kinds of urine retention, Zhongliao (BL 33) and Ciliao (BL 32) are applicable. For the patients with both dysuria and urinary incontinence, Zhongliao (BL 33), Ciliao (BL 32) and Huiyang (BL 35) are chosen. In treatment of neurogenic bladder, both biao (root causes) and ben (primary symptoms) are considered, as well as the accompanying symptoms; and electroacupuncture is combined accordingly. During the delivery of acupuncture, the sites where the acupoints located are detected and palpated so as to rationally control the depth of needle insertion and the operation of reinforcing and reducing needling techniques.

SUN Shen-tian's clinical experience in treating Tourette's syndrome with acupuncture / 中国针灸

To introduce the clinical experience of professor SUN Shen-tian in treatment of Tourette's syndrome (TS) with acupuncture. TS is a psychosomatic disease and the core pathogenesis refers to blood deficiency producing internal wind. The disease is located in the heart and liver. Acupoints are selected according to the functional orientation of the cerebral cortex. The extrapyramidal system area is preferred for tic disorder, and the emotional area is for behavioral disorder. The treatment focuses on regulating the mind by multiple methods, including manual needling technique used the transcranial repeated acupuncture, and regulating the mind by taking multiple acupoints, Baihui (GV 20), Neiguan (PC 6), Shenmen (HT 7) and Dazhong (KI 4) are stimulated. For abdominal twitching and mental symptoms of TS children, the first and third abdominal areas are selected. The target symptoms (biao) are treated specially by local acupoints, the combination of the starting and ending acupoints of the affected meridian, or the acupoints of the meridians with same name. The modified chaihu longgu muli decoction and siwu decoction are prescribed to sooth liver, nourish blood and soothe wind. In association with the characteristics and target symptoms of TS, the sequential therapy is used with filiform needling, intradermal needling, Chinese herbal medication and psychotherapy.

Exploring the significance of chemotherapy in the perioperative application of biliary tract carcinomas / 中华外科杂志

Biliary tract cancer is extremely malignant with a poor prognosis. At the moment, the only curative method available is radical resection. Targeted and immunotherapy are currently advancing quickly, but chemotherapy still holds a key role in the perioperative management of biliary cancer. Perioperative chemotherapy aims to decrease tumor volume before surgery so that patients can have their tumors surgically removed or have a higher radical resection rate. It also aims to remove any tumor cells that remain after surgery and prevent the growth of new tumors. Chemotherapy-based combination treatment techniques have been increasingly investigated in recent years to improve perioperative care and patient survival. From the standpoint of chemotherapy regimens and clinical trial success in the perioperative phase of radical surgery, the value of chemotherapy in the perioperative period of biliary tract cancer were explored in this paper.

Survival analysis of patients with intrahepatic cholangiocarcinoma treated with adjuvant chemotherapy after radical resection based on CoxPH model and deep learning algorithm / 中华外科杂志

Objective: To establish a predictive model for survival benefit of patients with intrahepatic cholangiocarcinoma (ICC) who received adjuvant chemotherapy after radical resection. Methods: The clinical and pathological data of 249 patients with ICC who underwent radical resection and adjuvant chemotherapy at 8 hospitals in China from January 2010 to December 2018 were retrospectively collected. There were 121 males and 128 females,with 88 cases>60 years old and 161 cases≤60 years old. Feature selection was performed by univariate and multivariate Cox regression analysis. Overall survival time and survival status were used as outcome indicators,then target clinical features were selected. Patients were stratified into high-risk group and low-risk group,survival differences between the two groups were analyzed. Using the selected clinical features, the traditional CoxPH model and deep learning DeepSurv survival prediction model were constructed, and the performance of the models were evaluated according to concordance index(C-index). Results: Portal vein invasion, carcinoembryonic antigen>5 μg/L,abnormal lymphocyte count, low grade tumor pathological differentiation and positive lymph nodes>0 were independent adverse prognostic factors for overall survival in 249 patients with adjuvant chemotherapy after radical resection (all P<0.05). The survival benefit of adjuvant chemotherapy in the high-risk group was significantly lower than that in the low-risk group (P<0.05). Using the above five features, the traditional CoxPH model and the deep learning DeepSurv survival prediction model were constructed. The C-index values of the training set were 0.687 and 0.770, and the C-index values of the test set were 0.606 and 0.763,respectively. Conclusion: Compared with the traditional Cox model, the DeepSurv model can more accurately predict the survival probability of patients with ICC undergoing adjuvant chemotherapy at a certain time point, and more accurately judge the survival benefit of adjuvant chemotherapy.

A nomogram for preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma based on inflammation-related markers / 中华外科杂志

Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.

Content analysis and quality evaluation of main active components and mineral elements of Cynomorium songaricum in different habitats / 中国中药杂志

To clarify the content characteristics of the main active components and mineral elements of Cynomorium songaricum under different habitat conditions, and further explore the relationship between the quality of C. songaricum and habitats, this study took C. songaricum from 25 different habitats in China as the research object, and measured the contents of 8 main active components and 12 mineral elements separately. Diversity analysis, correlation analysis, principal component analysis and cluster analysis were carried out. The results showed that the genetic diversity of total flavonoids, ursolic acid, ether extract, potassium(K), phosphorus(P) and zinc(Zn) in C. songaricum was high. The coefficient of variation of crude polysaccharide, ether extract, gallic acid, protocatechuic aldehyde, catechin, epicatechin, calcium(Ca), sodium(Na), magnesium(Mg), sulfur(S), iron(Fe), manganese(Mn), selenium(Se) and nickel(Ni) were all over 36%, indicating that the quality of C. songaricum was significantly affected by habitats. There were strong synergistic and weak antagonistic effects among the contents of the 8 active components, and complex antagonistic and synergistic effects among the contents of the 12 mineral elements. Principal component analysis revealed that crude polysaccharide, ursolic acid, catechin, epicatechin and total flavonoids could be used as the characteristic components to evaluate the quality of C. songaricum, and Na, copper(Cu), Mn and Ni were the characteristic elements to evaluate the quality of C. songaricum. In cluster ana-lysis, the second group with the main active components as cluster center had better quality in terms of the content of active substances, and the second group with the mineral elements as cluster center had higher utilization potential in the exploitation of mineral elements. This study could provide a basis for resource evaluation and breeding of excellent varieties of C. songaricum in different habitats, and provide a reference for cultivation and identification of C. songaricum.

Morphological Characteristics and the Role of Mitochondria in Ferroptosis / 中国生物化学与分子生物学报

Ferroptosis is a unique mode of iron-dependent cell death driven by lipid peroxidation. It is characterized by morphological changes in mitochondria, including densification of mitochondrial membranes and associated reduction in the volume, rupture of outer membranes and reduction or disappearance of the mitochondrial crest, which is different from that of apoptosis, autophagy and pyroptosis. Mitochondria, as the core of cell metabolism, are important organelles for iron metabolism, lipid metabolism and energy metabolism. However, it remains controversial debates as how mitochondria participate in ferroptosis and the underlying mechanisms during its progression. This review summaries the current understanding of the occurrence and defense mechanisms of ferroptosis, and the role of mitochondria in promoting and inhibiting ferroptosis, which includes the tricarboxylic acid cycle and glycolysis, reactive oxygen species, and lipid metabolism in mitochondria and their roles in driving ferroptosis. Moreover, we also summarize the defense mechanisms against ferroptosis through detoxification of mitochondrial lipid peroxidation by mitochondrial dihydroorotate dehydrogenase, as well as mitochondrial ferritin. Other mitochondrial molecules and their regulation of ferroptosis is stated at the end. This paper reviews the latest research progress of mitochondria in the process of ferroptosis, which aims to further understand the function of mitochondria in ferroptosis and its mechanism in the occurrence and development of ferroptosis, and therefore provides a theoretical foundation for the basic research of cell biology and strategies for investigation of clinical diseases.

Cuproptosis-Related 4-Gene Risk Model for Predicting Immunotherapy Drug Response and Prognosis of Kidney Renal Clear Cell Carcinoma / 中国医学科学杂志(英文版)

Background Kidney renal clear cell carcinoma (KIRC) is one of the most common renal malignancies with a high mortality rate. Cuproptosis, a novel form of cell death, is strongly linked to mitochondrial metabolism and is mediated by protein lipoylation, leading to a proteotoxic stress response and cell death. To date, few studies have ellucidated the holistic role of cuproptosis-related genes (CRGs) in the pathogenesis of KIRC.Methods We comprehensively and completely analyzed the RNA sequencing data and corresponding clinical information from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. We screened for differentially expressed CRGs and constructed a prognostic risk model using univariate and multivariate Cox proportional regression analyses. Kaplan-Meier analysis was performed and receiver operating characteristic (ROC) curves were plotted to predict the prognosis of KIRC patients. Functional enrichment analysis was utilized to explore the internal mechanisms. Immune-related functions were analyzed using single-sample gene set enrichment analysis (ssGSEA), tumour immune dysfunction and exclusion (TIDE) scores, and drug sensitivity analysis.Results We established a concise prognostic risk model consisting of four CRGs (DBT, DLAT, LIAS and PDHB) to predict the overall survival (OS) in KIRC patients. The results of the survival analysis indicated a significantly lower OS in the high-risk group as compared to the patients in the low-risk group. The area under the time-dependent ROC curve (AUC) at 1, 3, and 5 year was 0.691, 0.618, and 0.614 in KIRC. Functional enrichment analysis demonstrated that CRGs were significantly enriched in tricarboxylic acid (TCA) cycle-related processes and metabolism-related pathways. Sorafenib, doxorubicin, embelin, and vinorelbine were more sensitive in the high-risk group.Conclusions We constructed a concise CRGs risk model to evaluate the prognosis of KIRC patients and this may be a new direction for the diagnosis and treatment of KIRC.

Application of information health education combined with teach-back method in patients with posterior fossa tumors during perioperative period / 中国实用护理杂志

Objective:To analyze the application effect of information health education combined with teach-back method in patients with posterior fossa tumor during perioperative period and provide experience and reference for clinical practice.Methods:From March 2022 to October 2022, a total of 80 patients diagnosed as posterior fossa tumors in the neurosurgery department were divided into a control group and an experimental group, with 40 patients in each group to conduct an experimental research, based on the length of hospitalization. The control group was given the conventional health education combined with the teach-back method, and the experimental group was given the information health education combined with the teach-back method. The scores of standard swallowing assessment, quality of life, awareness score of health education and incidence of respiratory aspiration were compared between the two groups.Results:On the 7th day after surgery and 1 day before discharge, the standard swallowing score of the experimental group were 25.29 ± 2.21 and 22.97 ± 3.36, which was significantly lower than that of the control group 26.45 ± 2.01 and 24.92 ± 3.56, ( t=2.44, 2.52, both P<0.05). The total score of quality of life on the day before discharge was 64.55 ± 4.27, significantly higher than 61.80 ± 4.82 in the control group, with a statistically significant difference ( t=-2.09, P<0.05). The patients in the experimental group were familiar with preoperative guidance, various dietary requirements, various drug effects and precautions, the prevention of various complications, various rehabilitation training methods, and the purpose and precautions of the head drainage tube, with the score of 4.70 ± 0.56, 4.52 ± 0.71, 4.65 ± 0.57, 4.67 ± 0.52, 4.72 ± 0.50, 4.77 ± 0.47, were higher than the control group 3.40 ± 1.05, 3.62 ± 0.97, 3.77 ± 0.94, 3.80 ± 0.88, 3.75 ± 0.89, 3.92 ± 0.88. The difference was statistically significant ( t values were -6.86 to -4.69, all P<0.05). The incidence of respiratory aspiration in experimental group was 0, significantly lower than that in control group 12.5%(5/40) ( χ2=5.33, P<0.05). Conclusions:The application of information health education combined with back teaching can improve the quality of life, health education awareness rate and reduce the incidence of aspiration in patients with posterior fossa tumor.