BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and familie...BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.展开更多
Objective:To explore the rehabilitation effect of pulmonary rehabilitation training in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:Elderly COPD patients hospitalized from June 2024 to Dec...Objective:To explore the rehabilitation effect of pulmonary rehabilitation training in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:Elderly COPD patients hospitalized from June 2024 to December 2024 were selected as subjects for a quasi-experimental study.The study randomly assigned patients into two equal groups of 50 each.One group served as the control and received standard treatment and nursing care,while the other group,the intervention group,was given additional pulmonary rehabilitation exercises alongside the conventional care.The lung function indexes[forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC],6-minute walk distance(6MWD),Borg’s Category Scale for perceived exertion(BCSS),COPD Assessment Test(CAT),Barthel Index for activities of daily living,blood oxygen saturation,and Modified Medical Research Council(MMRC)dyspnea scale were compared between the two groups before and after intervention.Results:Following the intervention,the intervention group demonstrated improved lung function compared to the control group(P<0.05).However,no significant difference was observed in the 6-minute walk distance(6MWD)(P>0.05).The intervention group had lower Bronchitis Severity Scale(BCSS)scores(P<0.05)and better quality of life scores(P<0.05)than the control group.No notable differences were found in activities of daily living scores or blood oxygen saturation(P>0.05).Additionally,the intervention group exhibited a lower proportion of residual severe dyspnea(P<0.05).Conclusion:Pulmonary rehabilitation can enhance respiratory function in individuals with COPD,leading to beneficial therapeutic outcomes and ultimately improving their overall quality of life.展开更多
BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data...BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.However,whether these research findings can be“replicated”in clinical practice still requires further validation through real-world studies.This study aims to evaluate the effectiveness and safety of chemo-therapy combined with bevacizumab with or without anti-programmed death 1(PD-1)immunotherapy as the first-line regimen for MSS mCRC in the real world.AIM To evaluate the effectiveness and safety of chemotherapy combined with beva-cizumab with or without anti-PD-1 immunotherapy as the first-line regimen for MSS mCRC in the real world.METHODS We conducted a retrospective analysis of patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital between January 2020 and December 2024.Patients were stratified into two treatment groups:(1)An experimental group receiving first-line chemotherapy combined with bevaci-zumab and anti-PD-1 immunotherapy;and(2)A control group receiving chemo-therapy plus bevacizumab alone.Propensity score matching was employed to balance baseline characteristics,including age,gender,Eastern Cooperative Onco-logy Group performance status,number of metastatic sites,and primary tumor location.The primary endpoints were progression-free survival and overall survival,while secondary endpoints included disease control rate,objective response rate,and treatment-related adverse events.Survival outcomes were assessed using Kaplan-Meier analysis with log-rank testing.Additionally,inverse probability of treatment weighting was applied for sensitivity analysis to validate the robustness of our findings.RESULTS The propensity score matching analysis identified 103 well-balanced patient pairs with a median follow-up of 25.5 months.The experimental group demonstrated numerically higher objective response(36.00%vs 23.08%,P=0.309)and disease control rates(96.00%vs 91.03%,P=0.6759)compared to the control group,though these differences were not statistically significant.Similarly,no significant survival benefit was observed for either progression-free survival[hazard ratio(HR)=0.7076,95%confidence interval(CI):0.4069-1.23,P=0.22]or overall survival(HR=1.154,95%CI:0.4712-2.827,P=0.75).Multivariate analysis identified liver metastases as an independent poor prognostic factor(HR=3.36,95%CI:1.71-6.60,P<0.001),while subgroup analyses revealed potential benefits of the experimental regimen in male patients(HR=0.33,95%CI:0.14-0.81,P=0.025)and those with right-sided primary tumors(HR=0.40,95%CI:0.17-0.95,P=0.022).Safety profiles were comparable between groups,though elevated lactate dehydrogenase emerged as an independent risk factor for poorer outcomes in the experimental group(HR=4.11,95%CI:1.02-16.55,P=0.046).CONCLUSION Chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy could not demonstrate promising efficacy in treating MSS mCRC compared to the standard first-line chemotherapy regimen with bevacizumab.Male patients or those with right-sided mCRC may derive benefits from immune-based combination therapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from combined immunotherapy approaches.展开更多
Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter rel...Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter release,and signal transmission,and dysregulation of lipid metabolism is closely associated with various neurodegenerative diseases.The complex roles of lipids in synaptic function and neurological diseases have recently garnered increasing attention,but their specific mechanisms remain to be fully understood.This review aims to explore how lipids regulate synaptic activity in the central nervous system,focusing on their roles in synapse formation,neurotransmitter release,and signal transmission.Additionally,it discusses the mechanisms by which glial cells modulate synaptic function through lipid regulation.This review shows that within the central nervous system,lipids are essential components of the cell membrane bilayer,playing critical roles in synaptic structure and function.They regulate presynaptic vesicular trafficking,postsynaptic signaling pathways,and glial-neuronal interactions.Cholesterol maintains membrane fluidity and promotes the formation of lipid rafts.Glycerophospholipids contribute to the structural integrity of synaptic membranes and are involved in the release of synaptic vesicles.Sphingolipids interact with synaptic receptors through various mechanisms to regulate their activity and are also involved in cellular processes such as inflammation and apoptosis.Fatty acids are vital for energy metabolism and the synthesis of signaling molecules.Abnormalities in lipid metabolism may lead to impairments in synaptic function,affecting information transmission between neurons and the overall health of the nervous system.Therapeutic strategies targeting lipid metabolism,particularly through cholesterol modulation,show promise for treating these conditions.In neurodegenerative diseases such as Alzheimer’s disease,Parkinson disease,and amyotrophic lateral sclerosis,dysregulation of lipid metabolism is closely linked to synaptic dysfunction.Therefore,lipids are not only key molecules in neural regeneration and synaptic repair but may also contribute to neurodegenerative pathology when metabolic dysregulation occurs.Further research is needed to elucidate the specific mechanisms linking lipid metabolism to synaptic dysfunction and to develop targeted lipid therapies for neurological diseases.展开更多
Effective treatment methods for stroke,a common cerebrovascular disease with a high mortality rate,are still being sought.Exosome therapy,a form of acellular therapy,has demonstrated promising efficacy in various dise...Effective treatment methods for stroke,a common cerebrovascular disease with a high mortality rate,are still being sought.Exosome therapy,a form of acellular therapy,has demonstrated promising efficacy in various diseases in animal models;however,there is currently insufficient evidence to guide the clinical application of exosome in patients with stroke.This article reviews the progress of exosome applications in stroke treatment.It aims to elucidate the significant potential value of exosomes in stroke therapy and provide a reference for their clinical translation.At present,many studies on exosome-based therapies for stroke are actively underway.Regarding preclinical research,exosomes,as bioactive substances with diverse sources,currently favor stem cells as their origin.Due to their high plasticity,exosomes can be effectively modified through various physical,chemical,and genetic engineering methods to enhance their efficacy.In animal models of stroke,exosome therapy can reduce neuroinflammatory responses,alleviate oxidative stress damage,and inhibit programmed cell death.Additionally,exosomes can promote angiogenesis,repair and regenerate damaged white matter fiber bundles,and facilitate the migration and differentiation of neural stem cells,aiding the repair process.We also summarize new directions for the application of exosomes,specifically the exosome intervention through the ventricular-meningeal lymphatic system.The review findings suggest that the treatment paradigm for stroke is poised for transformation.展开更多
The voltage-gated sodium channel Nav1.6,encoded by the sodium voltage-gated channel alpha subunit 8 gene,is a crucial regulator of neuronal excitability,with widespread expression throughout the central and peripheral...The voltage-gated sodium channel Nav1.6,encoded by the sodium voltage-gated channel alpha subunit 8 gene,is a crucial regulator of neuronal excitability,with widespread expression throughout the central and peripheral nervous systems.Recent breakthroughs in structural biology,particularly the elucidation of the cryo-EM architecture of Nav1.6 at a resolution of 0.31 nm,have provided unprecedented insights into its molecular organization and functional modulation.As a key mediator of action potential initiation and propagation,Nav1.6 possesses unique biophysical properties,including persistent and resurgent sodium currents that critically influence neuronal firing patterns.This comprehensive review synthesizes current knowledge on the physiological functions and pathological roles of Nav1.6 in multiple neurological conditions.Key findings include the following:(1)Epilepsy studies reveal more than 250 sodium voltage-gated channel alpha subunit 8 mutations with distinct genotype-phenotype correlations,where gain-of-function variants lead to severe epileptic encephalopathies,while loss-of-function variants are associated with generalized epilepsy,highlighting the potential of Nav1.6-selective blockers such as XEN901 and GS967.(2)In Alzheimer’s disease,Nav1.6 mediates amyloid-βoligomer-induced neuronal hyperexcitability through amyloid precursor protein-dependent membrane trafficking and regulates beta-secretase 1 expression via nuclear factor of activated T cells 1 signaling,suggesting novel disease-modifying strategies.(3)Parkinson’s disease research has demonstrated that Nav1.6 upregulation in reactive astrocytes in the globus pallidus contributes to motor deficits through calcium-mediated abnormalities in neuronal synchronization.(4)Amyotrophic lateral sclerosis involves Nav1.6-dependent cortical hyperexcitability preceding motor neuron degeneration,with riluzole showing partial efficacy through sodium current modulation.(5)Multiple sclerosis pathophysiology features Nav1.6 redistribution in demyelinated axons,which drives calcium-dependent axonal injury via reverse Na+/Ca2+exchange.(6)Chronic pain mechanisms involve Nav1.6 overexpression in dorsal root ganglia neurons,regulated by the p38 mitogen-activated protein kinase and tumor necrosis factor-αsignaling pathways.(7)Traumatic brain injury models show that exercise-induced cognitive improvement is correlated with the normalization of Nav1.6-mediated excitability.Therapeutic development has progressed from nonselective sodium channel blockers to precision approaches,including state-dependent pore blockers designed using structural insights;allosteric modulators targeting specific conformations;gene therapy strategies using clustered regularly interspaced short palindromic repeats and antisense oligonucleotides;and miRNA-based regulation of channel expression.Current challenges include achieving sufficient subtype selectivity,optimizing blood-brain barrier penetration,and developing clinically relevant biomarkers for patient stratification.Future directions emphasize the integration of advanced technologies-such as single-cell multiomics to map neuronal subtype-specific expression patterns,patient-derived organoids for personalized drug testing,and machine learning-assisted drug design-to accelerate translation.Large-scale collaborative efforts will be essential to validate therapeutic candidates and establish genotype-guided treatment protocols for Nav1.6-related disorders.展开更多
Dear Editor,Linear and whorled nevoid hypermelanosis(LWNH)is a rare,sporadic pigmentary disorder characterized by hyperpigmented macules arranged in linear streaks and whorls along Blaschko's lines,typically appea...Dear Editor,Linear and whorled nevoid hypermelanosis(LWNH)is a rare,sporadic pigmentary disorder characterized by hyperpigmented macules arranged in linear streaks and whorls along Blaschko's lines,typically appearing within the first few weeks of life[1],and remains a challenge to treat.Here,we report a case of LWNH and review the relevant literature to help clinicians better understand this disease.展开更多
Some patients with systemic lupus erythematosus experience neuropsychiatric symptoms.Although magnetic resonance imaging can detect abnormal signals in the white matter of the brain,conventional methods often struggle...Some patients with systemic lupus erythematosus experience neuropsychiatric symptoms.Although magnetic resonance imaging can detect abnormal signals in the white matter of the brain,conventional methods often struggle to accurately capture microstructural changes.Various diffusion models have been used to study white matter in systemic lupus erythematosus;however,comparative analyses of their sensitivity and specificity for detecting microstructural changes remain insufficient.To address this,our team designed a diagnostic trial that used multimodal diffusion imaging techniques to observe white matter microstructural changes in patients with systemic lupus erythematosus who had neuropsychiatric symptoms,with an aim to identify key diagnostic biomarkers for these patients.Patients with active lupus who received treatment at the Department of Rheumatology and Immunology,The First Affiliated Hospital of China Medical University,from September 2023 to March 2024 were recruited.According to the standards of the American College of Rheumatology,patients with systemic lupus erythematosus who had neuropsychiatric symptoms were assigned to the systemic lupus erythematosus group,whereas those without neuropsychiatric symptoms were assigned to the non-systemic lupus erythematosus group.Additionally,healthy volunteers matched by region,sex,and age were recruited as controls.All three groups underwent the same diffusion magnetic resonance imaging examination protocol to compare differences in diffusion parameters.Advanced diffusion imaging models were able to sensitively detect microstructural changes in the white matter fibers of patients with systemic lupus erythematosus who had neuropsychiatric symptoms,with specific diffusion parameters showing significant abnormalities in key brain regions.In the left superior longitudinal fasciculus subregion and the right thalamic radiations of patients with systemic lupus erythematosus who had neuropsychiatric symptoms,we also identified abnormal diffusion characteristics that were clearly correlated with disease activity,suggesting that microstructural changes in these areas may reflect the dynamic process of neuroinflammatory damage.The present study addresses critical challenges in the diagnosis of systemic lupus erythematosus by identifying specific white matter imaging biomarkers and elucidating the association between microstructural damage and clinical manifestations.The main contributions of our study include:1)establishing axial regression probability parameters from mean apparent propagator magnetic resonance imaging as sensitive biomarkers for systemic lupus erythematosus,particularly in the third subregion of the left superior longitudinal fasciculus;2)demonstrating that multimodal diffusion imaging may be superior to conventional diffusion tensor imaging for detecting white matter microstructural abnormalities in patients with systemic lupus erythematosus;and 3)integrating tract-based spatial statistics with clinically relevant analyses to link imaging findings to pathological mechanisms.展开更多
Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
AIM:To evaluate the visual function and optical quality in adults aged 80y and older following the bilateral implantation of zonal refractive multifocal intraocular lens(IOL,LS-313 MF30).METHODS:A single-center,non-ra...AIM:To evaluate the visual function and optical quality in adults aged 80y and older following the bilateral implantation of zonal refractive multifocal intraocular lens(IOL,LS-313 MF30).METHODS:A single-center,non-randomized,prospective clinical trial was conducted,involving cataract patients aged 80 y and older.Patients received bilateral implantation of the LS-313 MF30 or CT Asphina 409MP,based on personal preference.Postoperative assessments included uncorrected and corrected visual acuity at distance,intermediate,and near ranges,as well as defocus curve.Subjective evaluations were performed using the visual function(VF-14)questionnaire,spectacle independence rates,and patient satisfaction surveys.Photic phenomena such as glare,halos,and starbursts were also analyzed.RESULTS:The MF30 group(16 eyes from 8 participants,85.38±2.56 y)exhibited superior uncorrected and corrected intermediate and near visual acuity compared to the 409MP group(26 eyes from 13 participants,85.77±2.20 y),while distance visual acuity was comparable between groups.The defocus curve of the MF30 group revealed two peaks at 0.00 D and-3.00 D,indicating a broader depth of focus.Patients in the MF30 group reported higher rates of spectacle independence and greater satisfaction.While photic phenomena such as glare(28.6%vs 18.5%,P=0.584),starburst(9.5%vs 3.7%,P=0.567)and halos(23.8%vs 11.11%,P=0.438)were more prevalent in the MF30 group,they were generally mild and did not significantly impact daily activities.CONCLUSION:Zonal refractive multifocal IOLs provide elderly patients with improved distance and near vision,greater spectacle independence,and greater satisfaction.Although photic phenomena were slightly more frequent with MF30,they are generally reported as non-disruptive and do not affect their daily life compared to monofocal IOLs.展开更多
Acute carbon monoxide(CO) poisoning constitutes a lethal hazard globally,causing substantial mortality and morbidity worldwide.^([1-2]) Studies have shown that multiple mechanisms contribute to acute CO poisoning,incl...Acute carbon monoxide(CO) poisoning constitutes a lethal hazard globally,causing substantial mortality and morbidity worldwide.^([1-2]) Studies have shown that multiple mechanisms contribute to acute CO poisoning,including ischemic-hypoxic injury,reactive oxygen species(ROS) generation and inflammatory responses.^([2-5]) Furthermore,excessive inflammatory responses can induce adverse metabolic changes.^([6-7]) Considering these evidence,an interaction may exist between acute CO poisoning and both inflammatory factors and metabolites.However,the mechanisms through which inflammatory factors mediate CO toxicity via metabolic pathways remain largely unexplored.展开更多
Objectives:Gastric cancer(GC)is among the most prevalent malignancies worldwide,ranking as the fifth most common cancer and the fifth leading cause of cancer-related mortality.This study intends to investigate how Inh...Objectives:Gastric cancer(GC)is among the most prevalent malignancies worldwide,ranking as the fifth most common cancer and the fifth leading cause of cancer-related mortality.This study intends to investigate how Inhibin subunit beta A(INHBA)promotes the progression of GC by activating the mitogen-activated protein kinase(MAPK)signaling pathway via targeting Integrin alpha-6(ITGA6).Methods:Quantitative reverse transcription-Polymerase Chain Reaction(qRT-PCR)and Immunohistochemistry(IHC)were utilised to validate the expression levels of INHBA in GC,which were subsequently correlated with the clinicopathological factors and outcomes.Cellular and animal studies were conducted to ascertain the role of INHBA in GC.RNA-sequencing(RNA-seq)and bioinformatics analysis were used to screen for the downstream target and pathway of INHBA,with Co-immunoprecipitation(Co-IP),Co-Immunofluorescent(Co-IF),Western blot(WB)and Rescue experiments validating their mechanisms of action in GC.Results:IHC and qRT-PCR analysis confirmed that GC tissues exhibited higher INHBA expression than adjacent noncancerous tissues.This elevated INHBA expression was found to be significantly associated with the incidence of tumor lesions,lymph node metastasis,and progression to higher TNM stages.Functional experiments showed that INHBA promoted GC cell proliferation and enhanced their migration and invasion in vitro while inhibiting apoptosis.Animal studies results indicated that INHBA overexpression promoted tumor growth and increased tumor weight and volume.Through a series of experiments,including RNA-seq,Co-IP,Co-IF,WB,and rescue assays,this study demonstrated that INHBA promotes GC progression by targeting ITGA6 to regulate the MAPK signaling pathway.Conclusions:INHBA/ITGA6/MAPK axis can provide new insights into GC therapy.Targeted INHBA inhibition holds promise as a therapeutic approach for GC treatment.展开更多
This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection b...This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection began to appear on day 16 of admission,and both sputum and catheter tip cultures revealed R.mannitolilytica.The infection control department of the hospital later sampled and identified R.mannitolilytica in the ventilator tube that was used by the patient with the exact gene sequence as the infecting strain.These findings indicate that ventilator tubing is a significant contamination source of this pathogen,and hospitals need to enhance their disinfection methods of ventilator-related devices.展开更多
Background:Calcium and vitamin D play crucial roles in muscle health and fat distribution.Both dietary intake and serum levels of calcium and vitamin D are commonly examined in relation to overall body health.Methods:...Background:Calcium and vitamin D play crucial roles in muscle health and fat distribution.Both dietary intake and serum levels of calcium and vitamin D are commonly examined in relation to overall body health.Methods:The United Kingdom Biobank(UKB)database was searched and analyzed.Dietary and serum calcium and vitamin D levels were extracted from the data to evaluate potential associations with body composition.Linear regression analysis,ordinal regression analysis,and interaction analysis were used to examine the associations between variables.Results:In the survey of over 50,000 individuals in the UKB,the frequency of low handgrip strength was higher among those with low dietary calcium intake at baseline.Furthermore,individuals with low serum vitamin D levels exhibited a higher prevalence of high body fat percentage(BFP)events.Notably,these influences were observed to persist for nearly 10 years.Moreover,the data suggested that serum vitamin D levels should exceed 50 nmol/L and the daily dietary calcium intake should be at least 1,000 mg to maintain the strength and keep a lower BFP(OR:0.68,95%CI:0.52-0.90,P=0.0057).Conclusions:These findings underscore the importance of increasing calcium and vitamin D intake and monitoring serum vitamin D levels for effective public health strategies.展开更多
Gel-based flexible wearable sensors have attracted considerable interest in aquatic environments.However,the development of underwater conductive gel sensors with outstanding anti-swelling,mechanical,and sensing capab...Gel-based flexible wearable sensors have attracted considerable interest in aquatic environments.However,the development of underwater conductive gel sensors with outstanding anti-swelling,mechanical,and sensing capabilities faces significant challenges.The aim of this study is to develop anti-swelling and conductive zwitterionic gels and investigate their applications in wireless underwater strain sensing.Multi-functional zwitterionic gels were fabricated by copolymerizing[2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide(SBMA)and acrylic acid(AA)in a mixed solution of aluminum chloride(AlCl3)and poly(vinyl alcohol)(PVA)under ultraviolet light(360 nm).PSBMA was switched from a neutral polymer to a positively charged polymer because of the combination of Al^(3+)with the negative groups SO_(3)^(−).The water molecules were eliminated because of electrostatic repulsion.The gels exhibited anti-swelling properties(swelling ratio<11%),high stretchability(600%strain),and toughness(2451 kJ/m^(3)).The PPAS-Al^(3+)gel was integrated with a wireless Bluetooth system to construct underwater wearable strain sensors that could accurately capture the signals caused by human joint movements and speech recognition even in water.Antibacterial activity(>98.9%inhibition)and stable wireless sensing have potential applications in the fields of wearable sensors,underwater communication,and intelligent healthcare.展开更多
Objective To develop a dual-branch deep learning framework for accurate multi-label classification of fundus diseases,addressing the key limitations of insufficient complementary feature extraction and inadequate cros...Objective To develop a dual-branch deep learning framework for accurate multi-label classification of fundus diseases,addressing the key limitations of insufficient complementary feature extraction and inadequate cross-modal feature fusion in existing automated diagnostic methods.Methods The fundus multi-label classification dataset with 12 disease categories(FMLC-12)dataset was constructed by integrating complementary samples from Ocular Disease Intelligent Recognition(ODIR)and Retinal Fundus Multi-Disease Image Dataset(RFMiD),yielding 6936 fundus images across 12 retinal pathology categories,and the framework was validated on both FMLC-12 and ODIR.Inspired by the holistic multi-regional assessment principle of the Five Wheels theory in traditional Chinese medicine(TCM)ophthalmology,the dualbranch multi-label network(DBMNet)was developed as a novel framework integrating complementary visual feature extraction with pathological correlation modeling.The architecture employed a TransNeXt backbone within a dual-branch design:one branch processed redgreen-blue(RGB)images to capture color-dependent features,such as vascular patterns and lesion morphology,while the other processed grayscale-converted images to enhance subtle textural details and contrast variations.A feature interaction module(FIM)effectively integrated the multi-scale features from both branches.Comprehensive ablation studies were conducted to evaluate the contributions of the dual-branch architecture and the FIM.The performance of DBMNet was compared against four state-of-the-art methods,including EfficientNet Ensemble,transfer learning-based convolutional neural network(CNN),BFENet,and EyeDeep-Net,using mean average precision(mAP),F1-score,and Cohen's kappa coefficient.Results The dual-branch architecture improved mAP by 15.44 percentage points over the single-branch TransNeXt baseline,increasing from 34.41%to 44.24%,and the addition of FIM further boosted mAP to 49.85%.On FMLC-12,DBMNet achieved an mAP of 49.85%,a Cohen’s kappa coefficient of 62.14%,and an F1-score of 70.21%.Compared with BFENet(mAP:45.42%,kappa:46.64%,F1-score:71.34%),DBMNet outperformed it by 4.43 percentage points in mAP and 15.50 percentage points in kappa,while BFENet achieved a marginally higher F1-score.On ODIR,DBMNet achieved an F1-score of 85.50%,comparable to state-of-the-art methods.Conclusion DBMNet effectively integrates RGB and grayscale visual modalities through a dual-branch architecture,significantly improving multi-label fundus disease classification.The framework not only addresses the issue of insufficient feature fusion in existing methods but also demonstrates outstanding performance in balancing detection across both common and rare diseases,providing a promising and clinically applicable pathway for standardized,intelligent fundus disease classification.展开更多
Background:This study aimed to comprehensively elucidate the hepatotoxic effects of Dioscorea bulbifera L.(DBL)in mice and to explore the underlying molecular mechanisms.Methods:Mice were administered different doses ...Background:This study aimed to comprehensively elucidate the hepatotoxic effects of Dioscorea bulbifera L.(DBL)in mice and to explore the underlying molecular mechanisms.Methods:Mice were administered different doses of DBL via intragastric gavage for 21 days.Organ indices of multiple organs were then measured,and histopathological changes were systematically evaluated.Particular attention was paid to biochemical markers and hepatic histopathological alterations associated with liver injury.Subsequently,the composition of the gut microbiota in colonic contents was analyzed using 16S rDNA sequencing,and the levels of short-chain fatty acids(SCFAs)were determined by gas chromatography(GC).Furthermore,protein expression levels of YinYang 1(YY1),Farnesoid X Receptor(FXR),Nuclear factor erythroid 2-related factor 2(Nrf2),and bile acids(BAs)-related proteins in the liver were assessed by Western blot analysis.Results:Our findings revealed that DBL induced varying degrees of multi-organ toxicity in mice,with the most pronounced hepatotoxicity observed.Liver injury was induced in a dose-dependent manner,accompanied by increased hepatic inflammation and oxidative stress,as well as enhanced hepatocyte apoptosis.Furthermore,DBL may modulate the YY1-FXR/Nrf2 signaling pathway,leading to upregulation of BAs-related proteins such as cholesterol 7α-hydroxylase(CYP7A1),while downregulating other BAs-related proteins,including sodium taurocholate cotransporting polypeptide(NTCP),bile salt export pump(BSEP),multidrug resistance protein 2(MRP2),and P-glycoprotein(P-gp).These changes promoted excessive BAs synthesis and impaired the excretion and reabsorption of BAs,ultimately disturbing BAs homeostasis.Additionally,DBL induces gut microbiota dysbiosis and reduces SCFAs production,leading to intestinal damage and disruption of intestinal barrier integrity.Conclusion:DBL-induced hepatotoxicity may be associated with altered expression of the YY1-FXR/Nrf2 signaling pathway and BAs–related proteins,accompanied by increased hepatic BAs accumulation and gut microbiota dysbiosis.展开更多
Addiction,a complex and chronic neurobiological disorder,is characterized by compulsive substance use despite harmful consequences,leading to persistent alterations in brain function,particularly within the reward,mot...Addiction,a complex and chronic neurobiological disorder,is characterized by compulsive substance use despite harmful consequences,leading to persistent alterations in brain function,particularly within the reward,motivation,and decision-making systems.Despite the availability of a range of treatment options,including pharmacotherapy and behavioral therapies,relapse remains a major challenge,with many individuals struggling to maintain long-term recovery.Current treatments often show limited efficacy,underscoring the need for novel therapeutic strategies that can address the underlying neurobiological disruptions in addiction.展开更多
Objectives:Although standardized residency trainees are at high risk for depression,anxiety,and suicidal ideation,the psychological pathways connecting depression and anxiety to suicidal ideation,especially the modera...Objectives:Although standardized residency trainees are at high risk for depression,anxiety,and suicidal ideation,the psychological pathways connecting depression and anxiety to suicidal ideation,especially the moderating role of resilience,remain elusive.This study aimed to examine the associations between depression,anxiety,and suicidal ideation among physicians undergoing standardized residency training,and to investigate the moderating roles of different dimensions of individual resilience,namely tenacity,strength,and optimism.Methods:A convenience sampling method was adopted to recruit 133 resident physicians.Validated instruments assessing individual resilience,depressive symptoms,anxiety levels,and suicidal ideation were administered.Spearman correlation analysis was used to evaluate the relationships among the variables.Hierarchical regression analysis was conducted to assess the moderating roles of tenacity,strength,and optimism in the associations between depression,anxiety,and suicidal ideation.Results:Depressive symptoms and anxiety levels were both positively associated with suicidal ideation(p<0.001).All three resilience dimensions were negatively correlated with suicidal ideation(tenacity:r=−0.504,strength:r=−0.477,optimism:r=−0.440,all p<0.001).Tenacity,strength,and optimism significantly moderated the associations between depression and suicidal ideation(all p<0.05).When resilience levels in these dimensions were high,the associations between depression and suicidal ideation were weaker.Strength and optimism also moderated the associations between anxiety and suicidal ideation(strength:p=0.028,optimism:p=0.028).When the resiliences(strength and optimism)were high,the associations between anxiety and suicidal ideation were weaker.Conclusion:Individual resilience,particularly in the dimensions of tenacity,strength,and optimism,may serve as protective correlates for physicians in training,being associated with weaker relationships between depression,anxiety,and suicidal ideation.These findings highlight the potential value of resilience-enhancing strategies in clinical training settings,although causal inferences cannot be drawn due to the cross-sectional design.展开更多
Objectives This study aimed to compare the effectiveness of the semi-virtual simulation and traditional simulation teaching models based on the Standards of Best Practice(SOBP)according to the International Nursing As...Objectives This study aimed to compare the effectiveness of the semi-virtual simulation and traditional simulation teaching models based on the Standards of Best Practice(SOBP)according to the International Nursing Association for Clinical Simulation and Learning(INACSL)in the Adult Nursing course.Methods This study used a quasi-experimental design.A total of 94 third-year nursing students from a university in Beijing between November and December 2022 were recruited as participants.An innovative semi-virtual simulation teaching model was designed based on the SOBP established by the INACSL.In the Adult Nursing course,both the semi-virtual and traditional simulation teaching models were implemented.At the end of the simulation sessions,participants completed the Chinese version of the Simulation Effectiveness Tool-Modified(SET-M)to assess the effectiveness of the two teaching models.Results All nursing students completed the simulation sessions.There was no difference(t=−0.93,P=0.353)in the total scores between the semi-virtual simulation teaching model(50.87±5.30)and the traditional simulation teaching model(50.37±5.16).However,there was a statistically significant difference(t=−2.65,P=0.010)in the prebriefing section(semi-virtual simulation:5.60±0.71;traditional simulation:5.33±0.78).In contrast,no statistically significant differences were found for the scenario and debriefing sections(P>0.05).At the individual item level,statistical differences(P<0.05)between the two models were identified for items 1 and 9,but not for the remaining items(P>0.05).By analyzing the open-ended question,it was found that both simulation models were effective,and students’comments were similar.Conclusions The study demonstrated equivalent effectiveness between the semi-virtual and traditional simulation teaching models.Semi-virtual simulation teaching model could offer a more flexible and feasible approach to simulation teaching.展开更多
基金Supported by Guiding Project of Hebei Provincial Health Commission,No.20201190 and 20180220.
文摘BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.
基金Hohhot Health Science and Technology Program Project(Project No.:2024-HHWK-041)。
文摘Objective:To explore the rehabilitation effect of pulmonary rehabilitation training in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:Elderly COPD patients hospitalized from June 2024 to December 2024 were selected as subjects for a quasi-experimental study.The study randomly assigned patients into two equal groups of 50 each.One group served as the control and received standard treatment and nursing care,while the other group,the intervention group,was given additional pulmonary rehabilitation exercises alongside the conventional care.The lung function indexes[forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),FEV1/FVC],6-minute walk distance(6MWD),Borg’s Category Scale for perceived exertion(BCSS),COPD Assessment Test(CAT),Barthel Index for activities of daily living,blood oxygen saturation,and Modified Medical Research Council(MMRC)dyspnea scale were compared between the two groups before and after intervention.Results:Following the intervention,the intervention group demonstrated improved lung function compared to the control group(P<0.05).However,no significant difference was observed in the 6-minute walk distance(6MWD)(P>0.05).The intervention group had lower Bronchitis Severity Scale(BCSS)scores(P<0.05)and better quality of life scores(P<0.05)than the control group.No notable differences were found in activities of daily living scores or blood oxygen saturation(P>0.05).Additionally,the intervention group exhibited a lower proportion of residual severe dyspnea(P<0.05).Conclusion:Pulmonary rehabilitation can enhance respiratory function in individuals with COPD,leading to beneficial therapeutic outcomes and ultimately improving their overall quality of life.
基金Supported by the National High Level Hospital Clinical Research Funding(Multi-Center Clinical Research Project of Peking University First Hospital),No.2022CR65.
文摘BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.However,whether these research findings can be“replicated”in clinical practice still requires further validation through real-world studies.This study aims to evaluate the effectiveness and safety of chemo-therapy combined with bevacizumab with or without anti-programmed death 1(PD-1)immunotherapy as the first-line regimen for MSS mCRC in the real world.AIM To evaluate the effectiveness and safety of chemotherapy combined with beva-cizumab with or without anti-PD-1 immunotherapy as the first-line regimen for MSS mCRC in the real world.METHODS We conducted a retrospective analysis of patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital between January 2020 and December 2024.Patients were stratified into two treatment groups:(1)An experimental group receiving first-line chemotherapy combined with bevaci-zumab and anti-PD-1 immunotherapy;and(2)A control group receiving chemo-therapy plus bevacizumab alone.Propensity score matching was employed to balance baseline characteristics,including age,gender,Eastern Cooperative Onco-logy Group performance status,number of metastatic sites,and primary tumor location.The primary endpoints were progression-free survival and overall survival,while secondary endpoints included disease control rate,objective response rate,and treatment-related adverse events.Survival outcomes were assessed using Kaplan-Meier analysis with log-rank testing.Additionally,inverse probability of treatment weighting was applied for sensitivity analysis to validate the robustness of our findings.RESULTS The propensity score matching analysis identified 103 well-balanced patient pairs with a median follow-up of 25.5 months.The experimental group demonstrated numerically higher objective response(36.00%vs 23.08%,P=0.309)and disease control rates(96.00%vs 91.03%,P=0.6759)compared to the control group,though these differences were not statistically significant.Similarly,no significant survival benefit was observed for either progression-free survival[hazard ratio(HR)=0.7076,95%confidence interval(CI):0.4069-1.23,P=0.22]or overall survival(HR=1.154,95%CI:0.4712-2.827,P=0.75).Multivariate analysis identified liver metastases as an independent poor prognostic factor(HR=3.36,95%CI:1.71-6.60,P<0.001),while subgroup analyses revealed potential benefits of the experimental regimen in male patients(HR=0.33,95%CI:0.14-0.81,P=0.025)and those with right-sided primary tumors(HR=0.40,95%CI:0.17-0.95,P=0.022).Safety profiles were comparable between groups,though elevated lactate dehydrogenase emerged as an independent risk factor for poorer outcomes in the experimental group(HR=4.11,95%CI:1.02-16.55,P=0.046).CONCLUSION Chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy could not demonstrate promising efficacy in treating MSS mCRC compared to the standard first-line chemotherapy regimen with bevacizumab.Male patients or those with right-sided mCRC may derive benefits from immune-based combination therapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from combined immunotherapy approaches.
基金supported by the National Natural Science Foundation of China,No.82201568(to QQ)Capital’s Funds for Health Improvement and Research,No.2024-2-1031(to QQ)Beijing Nova Program,No.20240484566(to QQ).
文摘Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter release,and signal transmission,and dysregulation of lipid metabolism is closely associated with various neurodegenerative diseases.The complex roles of lipids in synaptic function and neurological diseases have recently garnered increasing attention,but their specific mechanisms remain to be fully understood.This review aims to explore how lipids regulate synaptic activity in the central nervous system,focusing on their roles in synapse formation,neurotransmitter release,and signal transmission.Additionally,it discusses the mechanisms by which glial cells modulate synaptic function through lipid regulation.This review shows that within the central nervous system,lipids are essential components of the cell membrane bilayer,playing critical roles in synaptic structure and function.They regulate presynaptic vesicular trafficking,postsynaptic signaling pathways,and glial-neuronal interactions.Cholesterol maintains membrane fluidity and promotes the formation of lipid rafts.Glycerophospholipids contribute to the structural integrity of synaptic membranes and are involved in the release of synaptic vesicles.Sphingolipids interact with synaptic receptors through various mechanisms to regulate their activity and are also involved in cellular processes such as inflammation and apoptosis.Fatty acids are vital for energy metabolism and the synthesis of signaling molecules.Abnormalities in lipid metabolism may lead to impairments in synaptic function,affecting information transmission between neurons and the overall health of the nervous system.Therapeutic strategies targeting lipid metabolism,particularly through cholesterol modulation,show promise for treating these conditions.In neurodegenerative diseases such as Alzheimer’s disease,Parkinson disease,and amyotrophic lateral sclerosis,dysregulation of lipid metabolism is closely linked to synaptic dysfunction.Therefore,lipids are not only key molecules in neural regeneration and synaptic repair but may also contribute to neurodegenerative pathology when metabolic dysregulation occurs.Further research is needed to elucidate the specific mechanisms linking lipid metabolism to synaptic dysfunction and to develop targeted lipid therapies for neurological diseases.
基金supported by the Natural Science Foundation of Chongqing,No.CSTB2023NSCQ-mSX0561(to WL).
文摘Effective treatment methods for stroke,a common cerebrovascular disease with a high mortality rate,are still being sought.Exosome therapy,a form of acellular therapy,has demonstrated promising efficacy in various diseases in animal models;however,there is currently insufficient evidence to guide the clinical application of exosome in patients with stroke.This article reviews the progress of exosome applications in stroke treatment.It aims to elucidate the significant potential value of exosomes in stroke therapy and provide a reference for their clinical translation.At present,many studies on exosome-based therapies for stroke are actively underway.Regarding preclinical research,exosomes,as bioactive substances with diverse sources,currently favor stem cells as their origin.Due to their high plasticity,exosomes can be effectively modified through various physical,chemical,and genetic engineering methods to enhance their efficacy.In animal models of stroke,exosome therapy can reduce neuroinflammatory responses,alleviate oxidative stress damage,and inhibit programmed cell death.Additionally,exosomes can promote angiogenesis,repair and regenerate damaged white matter fiber bundles,and facilitate the migration and differentiation of neural stem cells,aiding the repair process.We also summarize new directions for the application of exosomes,specifically the exosome intervention through the ventricular-meningeal lymphatic system.The review findings suggest that the treatment paradigm for stroke is poised for transformation.
基金supported by the Science and Technology Program Joint Program(Applied Basic Research Project)of Liaoning Province,China,No.2023JH2/101700079(to JunW).
文摘The voltage-gated sodium channel Nav1.6,encoded by the sodium voltage-gated channel alpha subunit 8 gene,is a crucial regulator of neuronal excitability,with widespread expression throughout the central and peripheral nervous systems.Recent breakthroughs in structural biology,particularly the elucidation of the cryo-EM architecture of Nav1.6 at a resolution of 0.31 nm,have provided unprecedented insights into its molecular organization and functional modulation.As a key mediator of action potential initiation and propagation,Nav1.6 possesses unique biophysical properties,including persistent and resurgent sodium currents that critically influence neuronal firing patterns.This comprehensive review synthesizes current knowledge on the physiological functions and pathological roles of Nav1.6 in multiple neurological conditions.Key findings include the following:(1)Epilepsy studies reveal more than 250 sodium voltage-gated channel alpha subunit 8 mutations with distinct genotype-phenotype correlations,where gain-of-function variants lead to severe epileptic encephalopathies,while loss-of-function variants are associated with generalized epilepsy,highlighting the potential of Nav1.6-selective blockers such as XEN901 and GS967.(2)In Alzheimer’s disease,Nav1.6 mediates amyloid-βoligomer-induced neuronal hyperexcitability through amyloid precursor protein-dependent membrane trafficking and regulates beta-secretase 1 expression via nuclear factor of activated T cells 1 signaling,suggesting novel disease-modifying strategies.(3)Parkinson’s disease research has demonstrated that Nav1.6 upregulation in reactive astrocytes in the globus pallidus contributes to motor deficits through calcium-mediated abnormalities in neuronal synchronization.(4)Amyotrophic lateral sclerosis involves Nav1.6-dependent cortical hyperexcitability preceding motor neuron degeneration,with riluzole showing partial efficacy through sodium current modulation.(5)Multiple sclerosis pathophysiology features Nav1.6 redistribution in demyelinated axons,which drives calcium-dependent axonal injury via reverse Na+/Ca2+exchange.(6)Chronic pain mechanisms involve Nav1.6 overexpression in dorsal root ganglia neurons,regulated by the p38 mitogen-activated protein kinase and tumor necrosis factor-αsignaling pathways.(7)Traumatic brain injury models show that exercise-induced cognitive improvement is correlated with the normalization of Nav1.6-mediated excitability.Therapeutic development has progressed from nonselective sodium channel blockers to precision approaches,including state-dependent pore blockers designed using structural insights;allosteric modulators targeting specific conformations;gene therapy strategies using clustered regularly interspaced short palindromic repeats and antisense oligonucleotides;and miRNA-based regulation of channel expression.Current challenges include achieving sufficient subtype selectivity,optimizing blood-brain barrier penetration,and developing clinically relevant biomarkers for patient stratification.Future directions emphasize the integration of advanced technologies-such as single-cell multiomics to map neuronal subtype-specific expression patterns,patient-derived organoids for personalized drug testing,and machine learning-assisted drug design-to accelerate translation.Large-scale collaborative efforts will be essential to validate therapeutic candidates and establish genotype-guided treatment protocols for Nav1.6-related disorders.
文摘Dear Editor,Linear and whorled nevoid hypermelanosis(LWNH)is a rare,sporadic pigmentary disorder characterized by hyperpigmented macules arranged in linear streaks and whorls along Blaschko's lines,typically appearing within the first few weeks of life[1],and remains a challenge to treat.Here,we report a case of LWNH and review the relevant literature to help clinicians better understand this disease.
基金supported by the National Natural Science Foundation Joint Fund,No.U22A20309(to PY)the Natural Science Foundation of LiaoningProvince,No.2023-MS-07(to HuL)the Unveiling Key Scientific and Technological Projects of Liaoning Province,No.2021JH1/10400051(to HuL).
文摘Some patients with systemic lupus erythematosus experience neuropsychiatric symptoms.Although magnetic resonance imaging can detect abnormal signals in the white matter of the brain,conventional methods often struggle to accurately capture microstructural changes.Various diffusion models have been used to study white matter in systemic lupus erythematosus;however,comparative analyses of their sensitivity and specificity for detecting microstructural changes remain insufficient.To address this,our team designed a diagnostic trial that used multimodal diffusion imaging techniques to observe white matter microstructural changes in patients with systemic lupus erythematosus who had neuropsychiatric symptoms,with an aim to identify key diagnostic biomarkers for these patients.Patients with active lupus who received treatment at the Department of Rheumatology and Immunology,The First Affiliated Hospital of China Medical University,from September 2023 to March 2024 were recruited.According to the standards of the American College of Rheumatology,patients with systemic lupus erythematosus who had neuropsychiatric symptoms were assigned to the systemic lupus erythematosus group,whereas those without neuropsychiatric symptoms were assigned to the non-systemic lupus erythematosus group.Additionally,healthy volunteers matched by region,sex,and age were recruited as controls.All three groups underwent the same diffusion magnetic resonance imaging examination protocol to compare differences in diffusion parameters.Advanced diffusion imaging models were able to sensitively detect microstructural changes in the white matter fibers of patients with systemic lupus erythematosus who had neuropsychiatric symptoms,with specific diffusion parameters showing significant abnormalities in key brain regions.In the left superior longitudinal fasciculus subregion and the right thalamic radiations of patients with systemic lupus erythematosus who had neuropsychiatric symptoms,we also identified abnormal diffusion characteristics that were clearly correlated with disease activity,suggesting that microstructural changes in these areas may reflect the dynamic process of neuroinflammatory damage.The present study addresses critical challenges in the diagnosis of systemic lupus erythematosus by identifying specific white matter imaging biomarkers and elucidating the association between microstructural damage and clinical manifestations.The main contributions of our study include:1)establishing axial regression probability parameters from mean apparent propagator magnetic resonance imaging as sensitive biomarkers for systemic lupus erythematosus,particularly in the third subregion of the left superior longitudinal fasciculus;2)demonstrating that multimodal diffusion imaging may be superior to conventional diffusion tensor imaging for detecting white matter microstructural abnormalities in patients with systemic lupus erythematosus;and 3)integrating tract-based spatial statistics with clinically relevant analyses to link imaging findings to pathological mechanisms.
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
基金Natural Science Foundation of Fujian Province(No.2024J011611)Natural Science Foundation of Nanping City(No.N2021J020)。
文摘AIM:To evaluate the visual function and optical quality in adults aged 80y and older following the bilateral implantation of zonal refractive multifocal intraocular lens(IOL,LS-313 MF30).METHODS:A single-center,non-randomized,prospective clinical trial was conducted,involving cataract patients aged 80 y and older.Patients received bilateral implantation of the LS-313 MF30 or CT Asphina 409MP,based on personal preference.Postoperative assessments included uncorrected and corrected visual acuity at distance,intermediate,and near ranges,as well as defocus curve.Subjective evaluations were performed using the visual function(VF-14)questionnaire,spectacle independence rates,and patient satisfaction surveys.Photic phenomena such as glare,halos,and starbursts were also analyzed.RESULTS:The MF30 group(16 eyes from 8 participants,85.38±2.56 y)exhibited superior uncorrected and corrected intermediate and near visual acuity compared to the 409MP group(26 eyes from 13 participants,85.77±2.20 y),while distance visual acuity was comparable between groups.The defocus curve of the MF30 group revealed two peaks at 0.00 D and-3.00 D,indicating a broader depth of focus.Patients in the MF30 group reported higher rates of spectacle independence and greater satisfaction.While photic phenomena such as glare(28.6%vs 18.5%,P=0.584),starburst(9.5%vs 3.7%,P=0.567)and halos(23.8%vs 11.11%,P=0.438)were more prevalent in the MF30 group,they were generally mild and did not significantly impact daily activities.CONCLUSION:Zonal refractive multifocal IOLs provide elderly patients with improved distance and near vision,greater spectacle independence,and greater satisfaction.Although photic phenomena were slightly more frequent with MF30,they are generally reported as non-disruptive and do not affect their daily life compared to monofocal IOLs.
基金supported by the National Natural Science Foundation of China (82372211)。
文摘Acute carbon monoxide(CO) poisoning constitutes a lethal hazard globally,causing substantial mortality and morbidity worldwide.^([1-2]) Studies have shown that multiple mechanisms contribute to acute CO poisoning,including ischemic-hypoxic injury,reactive oxygen species(ROS) generation and inflammatory responses.^([2-5]) Furthermore,excessive inflammatory responses can induce adverse metabolic changes.^([6-7]) Considering these evidence,an interaction may exist between acute CO poisoning and both inflammatory factors and metabolites.However,the mechanisms through which inflammatory factors mediate CO toxicity via metabolic pathways remain largely unexplored.
基金funded by Medical Science Foundation of Hebei University 2024B03Hebei Provincial Government-funded Provincial Medical Excellent Talent Project ZF2023025,ZF2024134,ZF2025045,ZF2025048,and ZF2025051+3 种基金Hebei Natural Science Foundation H2022206292,H2024206140Key R&D Program of Hebei Province 223777103D and 223777113DHebei Province County General Hospital Appropriate Health Technology Promotion Project 20220018other projects of Hebei Province SGH201501.
文摘Objectives:Gastric cancer(GC)is among the most prevalent malignancies worldwide,ranking as the fifth most common cancer and the fifth leading cause of cancer-related mortality.This study intends to investigate how Inhibin subunit beta A(INHBA)promotes the progression of GC by activating the mitogen-activated protein kinase(MAPK)signaling pathway via targeting Integrin alpha-6(ITGA6).Methods:Quantitative reverse transcription-Polymerase Chain Reaction(qRT-PCR)and Immunohistochemistry(IHC)were utilised to validate the expression levels of INHBA in GC,which were subsequently correlated with the clinicopathological factors and outcomes.Cellular and animal studies were conducted to ascertain the role of INHBA in GC.RNA-sequencing(RNA-seq)and bioinformatics analysis were used to screen for the downstream target and pathway of INHBA,with Co-immunoprecipitation(Co-IP),Co-Immunofluorescent(Co-IF),Western blot(WB)and Rescue experiments validating their mechanisms of action in GC.Results:IHC and qRT-PCR analysis confirmed that GC tissues exhibited higher INHBA expression than adjacent noncancerous tissues.This elevated INHBA expression was found to be significantly associated with the incidence of tumor lesions,lymph node metastasis,and progression to higher TNM stages.Functional experiments showed that INHBA promoted GC cell proliferation and enhanced their migration and invasion in vitro while inhibiting apoptosis.Animal studies results indicated that INHBA overexpression promoted tumor growth and increased tumor weight and volume.Through a series of experiments,including RNA-seq,Co-IP,Co-IF,WB,and rescue assays,this study demonstrated that INHBA promotes GC progression by targeting ITGA6 to regulate the MAPK signaling pathway.Conclusions:INHBA/ITGA6/MAPK axis can provide new insights into GC therapy.Targeted INHBA inhibition holds promise as a therapeutic approach for GC treatment.
文摘This study examined a case of ventilator-associated pneumonia caused by Ralstonia mannitolilytica in a neonatal department in order to determine the source of infection and mode of transmission.Symptoms of infection began to appear on day 16 of admission,and both sputum and catheter tip cultures revealed R.mannitolilytica.The infection control department of the hospital later sampled and identified R.mannitolilytica in the ventilator tube that was used by the patient with the exact gene sequence as the infecting strain.These findings indicate that ventilator tubing is a significant contamination source of this pathogen,and hospitals need to enhance their disinfection methods of ventilator-related devices.
基金supported by the Doctor of Excellence Program,The First Hospital of Jilin University(No.JDYY-DEP-2022024).
文摘Background:Calcium and vitamin D play crucial roles in muscle health and fat distribution.Both dietary intake and serum levels of calcium and vitamin D are commonly examined in relation to overall body health.Methods:The United Kingdom Biobank(UKB)database was searched and analyzed.Dietary and serum calcium and vitamin D levels were extracted from the data to evaluate potential associations with body composition.Linear regression analysis,ordinal regression analysis,and interaction analysis were used to examine the associations between variables.Results:In the survey of over 50,000 individuals in the UKB,the frequency of low handgrip strength was higher among those with low dietary calcium intake at baseline.Furthermore,individuals with low serum vitamin D levels exhibited a higher prevalence of high body fat percentage(BFP)events.Notably,these influences were observed to persist for nearly 10 years.Moreover,the data suggested that serum vitamin D levels should exceed 50 nmol/L and the daily dietary calcium intake should be at least 1,000 mg to maintain the strength and keep a lower BFP(OR:0.68,95%CI:0.52-0.90,P=0.0057).Conclusions:These findings underscore the importance of increasing calcium and vitamin D intake and monitoring serum vitamin D levels for effective public health strategies.
基金financially supported by the Fundamental Research Program of the Shanxi Province(No.202203021211023).
文摘Gel-based flexible wearable sensors have attracted considerable interest in aquatic environments.However,the development of underwater conductive gel sensors with outstanding anti-swelling,mechanical,and sensing capabilities faces significant challenges.The aim of this study is to develop anti-swelling and conductive zwitterionic gels and investigate their applications in wireless underwater strain sensing.Multi-functional zwitterionic gels were fabricated by copolymerizing[2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide(SBMA)and acrylic acid(AA)in a mixed solution of aluminum chloride(AlCl3)and poly(vinyl alcohol)(PVA)under ultraviolet light(360 nm).PSBMA was switched from a neutral polymer to a positively charged polymer because of the combination of Al^(3+)with the negative groups SO_(3)^(−).The water molecules were eliminated because of electrostatic repulsion.The gels exhibited anti-swelling properties(swelling ratio<11%),high stretchability(600%strain),and toughness(2451 kJ/m^(3)).The PPAS-Al^(3+)gel was integrated with a wireless Bluetooth system to construct underwater wearable strain sensors that could accurately capture the signals caused by human joint movements and speech recognition even in water.Antibacterial activity(>98.9%inhibition)and stable wireless sensing have potential applications in the fields of wearable sensors,underwater communication,and intelligent healthcare.
基金Natural Science Foundation of Hunan Province(2025JJ90031)Key Research and Development Program of Hunan Province of China(23A0273)Hunan Provincial Administration of Traditional Chinese Medicine(A2023048).
文摘Objective To develop a dual-branch deep learning framework for accurate multi-label classification of fundus diseases,addressing the key limitations of insufficient complementary feature extraction and inadequate cross-modal feature fusion in existing automated diagnostic methods.Methods The fundus multi-label classification dataset with 12 disease categories(FMLC-12)dataset was constructed by integrating complementary samples from Ocular Disease Intelligent Recognition(ODIR)and Retinal Fundus Multi-Disease Image Dataset(RFMiD),yielding 6936 fundus images across 12 retinal pathology categories,and the framework was validated on both FMLC-12 and ODIR.Inspired by the holistic multi-regional assessment principle of the Five Wheels theory in traditional Chinese medicine(TCM)ophthalmology,the dualbranch multi-label network(DBMNet)was developed as a novel framework integrating complementary visual feature extraction with pathological correlation modeling.The architecture employed a TransNeXt backbone within a dual-branch design:one branch processed redgreen-blue(RGB)images to capture color-dependent features,such as vascular patterns and lesion morphology,while the other processed grayscale-converted images to enhance subtle textural details and contrast variations.A feature interaction module(FIM)effectively integrated the multi-scale features from both branches.Comprehensive ablation studies were conducted to evaluate the contributions of the dual-branch architecture and the FIM.The performance of DBMNet was compared against four state-of-the-art methods,including EfficientNet Ensemble,transfer learning-based convolutional neural network(CNN),BFENet,and EyeDeep-Net,using mean average precision(mAP),F1-score,and Cohen's kappa coefficient.Results The dual-branch architecture improved mAP by 15.44 percentage points over the single-branch TransNeXt baseline,increasing from 34.41%to 44.24%,and the addition of FIM further boosted mAP to 49.85%.On FMLC-12,DBMNet achieved an mAP of 49.85%,a Cohen’s kappa coefficient of 62.14%,and an F1-score of 70.21%.Compared with BFENet(mAP:45.42%,kappa:46.64%,F1-score:71.34%),DBMNet outperformed it by 4.43 percentage points in mAP and 15.50 percentage points in kappa,while BFENet achieved a marginally higher F1-score.On ODIR,DBMNet achieved an F1-score of 85.50%,comparable to state-of-the-art methods.Conclusion DBMNet effectively integrates RGB and grayscale visual modalities through a dual-branch architecture,significantly improving multi-label fundus disease classification.The framework not only addresses the issue of insufficient feature fusion in existing methods but also demonstrates outstanding performance in balancing detection across both common and rare diseases,providing a promising and clinically applicable pathway for standardized,intelligent fundus disease classification.
基金supported by the National Natural Science Foundation of China(82204790)Shaanxi University of Chinese Medicine Science and Technology Program(2024-LJRC-04)+1 种基金Shaanxi Province Natural Science Foundation(2024JC-YBMS-759)Qinchuangyuan TCM Industry Innovation Project(L2024-QCY-ZYYJJQ-X29).
文摘Background:This study aimed to comprehensively elucidate the hepatotoxic effects of Dioscorea bulbifera L.(DBL)in mice and to explore the underlying molecular mechanisms.Methods:Mice were administered different doses of DBL via intragastric gavage for 21 days.Organ indices of multiple organs were then measured,and histopathological changes were systematically evaluated.Particular attention was paid to biochemical markers and hepatic histopathological alterations associated with liver injury.Subsequently,the composition of the gut microbiota in colonic contents was analyzed using 16S rDNA sequencing,and the levels of short-chain fatty acids(SCFAs)were determined by gas chromatography(GC).Furthermore,protein expression levels of YinYang 1(YY1),Farnesoid X Receptor(FXR),Nuclear factor erythroid 2-related factor 2(Nrf2),and bile acids(BAs)-related proteins in the liver were assessed by Western blot analysis.Results:Our findings revealed that DBL induced varying degrees of multi-organ toxicity in mice,with the most pronounced hepatotoxicity observed.Liver injury was induced in a dose-dependent manner,accompanied by increased hepatic inflammation and oxidative stress,as well as enhanced hepatocyte apoptosis.Furthermore,DBL may modulate the YY1-FXR/Nrf2 signaling pathway,leading to upregulation of BAs-related proteins such as cholesterol 7α-hydroxylase(CYP7A1),while downregulating other BAs-related proteins,including sodium taurocholate cotransporting polypeptide(NTCP),bile salt export pump(BSEP),multidrug resistance protein 2(MRP2),and P-glycoprotein(P-gp).These changes promoted excessive BAs synthesis and impaired the excretion and reabsorption of BAs,ultimately disturbing BAs homeostasis.Additionally,DBL induces gut microbiota dysbiosis and reduces SCFAs production,leading to intestinal damage and disruption of intestinal barrier integrity.Conclusion:DBL-induced hepatotoxicity may be associated with altered expression of the YY1-FXR/Nrf2 signaling pathway and BAs–related proteins,accompanied by increased hepatic BAs accumulation and gut microbiota dysbiosis.
基金supported by the National Natural Science Foundation of China(T2350008)the STI2030-Major Projects[2021ZD0203000(2021ZD0203003)]the Open Research Fund of the State Key Laboratory of Brain-Machine Intelligence,Zhejiang University(BMI2400014).
文摘Addiction,a complex and chronic neurobiological disorder,is characterized by compulsive substance use despite harmful consequences,leading to persistent alterations in brain function,particularly within the reward,motivation,and decision-making systems.Despite the availability of a range of treatment options,including pharmacotherapy and behavioral therapies,relapse remains a major challenge,with many individuals struggling to maintain long-term recovery.Current treatments often show limited efficacy,underscoring the need for novel therapeutic strategies that can address the underlying neurobiological disruptions in addiction.
基金supported by Jiangsu Cancer Hospital Science and Technology Development Fund Project(NO.XHMS202404)Nanjing Medical Science and Technology Development Fund Project(GBX22289).
文摘Objectives:Although standardized residency trainees are at high risk for depression,anxiety,and suicidal ideation,the psychological pathways connecting depression and anxiety to suicidal ideation,especially the moderating role of resilience,remain elusive.This study aimed to examine the associations between depression,anxiety,and suicidal ideation among physicians undergoing standardized residency training,and to investigate the moderating roles of different dimensions of individual resilience,namely tenacity,strength,and optimism.Methods:A convenience sampling method was adopted to recruit 133 resident physicians.Validated instruments assessing individual resilience,depressive symptoms,anxiety levels,and suicidal ideation were administered.Spearman correlation analysis was used to evaluate the relationships among the variables.Hierarchical regression analysis was conducted to assess the moderating roles of tenacity,strength,and optimism in the associations between depression,anxiety,and suicidal ideation.Results:Depressive symptoms and anxiety levels were both positively associated with suicidal ideation(p<0.001).All three resilience dimensions were negatively correlated with suicidal ideation(tenacity:r=−0.504,strength:r=−0.477,optimism:r=−0.440,all p<0.001).Tenacity,strength,and optimism significantly moderated the associations between depression and suicidal ideation(all p<0.05).When resilience levels in these dimensions were high,the associations between depression and suicidal ideation were weaker.Strength and optimism also moderated the associations between anxiety and suicidal ideation(strength:p=0.028,optimism:p=0.028).When the resiliences(strength and optimism)were high,the associations between anxiety and suicidal ideation were weaker.Conclusion:Individual resilience,particularly in the dimensions of tenacity,strength,and optimism,may serve as protective correlates for physicians in training,being associated with weaker relationships between depression,anxiety,and suicidal ideation.These findings highlight the potential value of resilience-enhancing strategies in clinical training settings,although causal inferences cannot be drawn due to the cross-sectional design.
文摘Objectives This study aimed to compare the effectiveness of the semi-virtual simulation and traditional simulation teaching models based on the Standards of Best Practice(SOBP)according to the International Nursing Association for Clinical Simulation and Learning(INACSL)in the Adult Nursing course.Methods This study used a quasi-experimental design.A total of 94 third-year nursing students from a university in Beijing between November and December 2022 were recruited as participants.An innovative semi-virtual simulation teaching model was designed based on the SOBP established by the INACSL.In the Adult Nursing course,both the semi-virtual and traditional simulation teaching models were implemented.At the end of the simulation sessions,participants completed the Chinese version of the Simulation Effectiveness Tool-Modified(SET-M)to assess the effectiveness of the two teaching models.Results All nursing students completed the simulation sessions.There was no difference(t=−0.93,P=0.353)in the total scores between the semi-virtual simulation teaching model(50.87±5.30)and the traditional simulation teaching model(50.37±5.16).However,there was a statistically significant difference(t=−2.65,P=0.010)in the prebriefing section(semi-virtual simulation:5.60±0.71;traditional simulation:5.33±0.78).In contrast,no statistically significant differences were found for the scenario and debriefing sections(P>0.05).At the individual item level,statistical differences(P<0.05)between the two models were identified for items 1 and 9,but not for the remaining items(P>0.05).By analyzing the open-ended question,it was found that both simulation models were effective,and students’comments were similar.Conclusions The study demonstrated equivalent effectiveness between the semi-virtual and traditional simulation teaching models.Semi-virtual simulation teaching model could offer a more flexible and feasible approach to simulation teaching.
