OBJECTIVE To investigate the effects of subanesthetic dose of esketamine on postoperative anxiety and recovery in patients undergoing laparoscopic cholecystectomy. METHODS A total of 200 patients scheduled for laparoscopic cholecystectomy at Suzhou Ninth Hospital Affiliated to Soochow University from January 2023 to December 2024 were randomly assigned to control group （n＝100） and observation group （n＝100）. One minute before the initiation of anesthesia， patients in the control group received intravenous injections of Propofol emulsion injection， Sufentanil citrate injection， and Succinylcholine chloride injection. On this basis， patients in the observation group received an intravenous injection of Esketamine hydrochloride injection. The anxiety status of patients in both groups was compared， along with their general intraoperative conditions （including sufentanil dosage， duration of pneumoperitoneum， operative time， anesthesia time， and extubation time）， postoperative recovery， incidence of adverse reactions， and the need for dezocine rescue analgesia. Heart rate and mean arterial pressure， entropy index （state entropy and response entropy）， inflammatory marker levels [interleukin-6 （IL-6） and C-reactive protein （CRP）]， numerical rating scale （NRS） for pain intensity were compared between the two groups at different time points. RESULTS No significant differences were found between the two groups in pneumoperitoneum duration， operative time， anesthesia time，extubation time， incidence of postoperative dry mouth， entropy index or length of stay in the post-anesthesia care unit （P＞0.05）. Compared with the control group， the observation group showed significantly lower postoperative STAI-S scores， reduced intraoperative sufentanil consumption， decreased incidence of postoperative nausea， vomiting， and shivering， the need for dezocine rescue analgesia， as well as lower plasma IL-6 and CRP levels at 24 h after surgery， and NRS （P＜0.05）. The heart rate and mean arterial pressure of patients in the observation group at the start of surgery， end of surgery， and during extubation were all significantly higher than those in the control group （P＜0.05）. CONCLUSIONS Subanesthetic dose of esketamine can effectively alleviate postoperative anxiety， reduce intraoperative opioid consumption， suppress postoperative inflammatory response， relieve postoperative pain， and promote recovery in patients undergoing laparoscopic cholecystectomy.

ObjectiveTo establish a mouse model of rheumatoid arthritis with interstitial lung disease （RA-ILD） in DBA/1 mice using Porphyromonas gingivalis （Pg） infection combined with collagen-induced arthritis （CIA）， and to comprehensively evaluate pathological characteristics in joints， lungs， and serum. MethodsForty DBA/1 mice were randomly divided into four groups， i.e.， Control， Pg infection （Pg）， CIA， and Pg infection combined with CIA （Pg+CIA）， with 10 mice in each group. Arthritis clinical symptoms were evaluated by recording arthritis incidence and clinical scores. Micro-CT scanning was used to assess knee joint pathology. Histopathological changes and collagen deposition in knee joints and lung tissues were analyzed using hematoxylin-eosin （HE） and Masson staining. Immunohistochemistry was performed to detect protein expression of α-smooth muscle actin （α-SMA）， typeⅠ collagen （ColⅠ）， and fibronectin （FN） in lung tissues. Real-time quantitative polymerase chain reaction（Real-time PCR）was used to measure mRNA expression levels of α-SMA， ColⅠ， FN， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and IL-1β in lung tissues. Enzyme-linked immunosorbent assay （ELISA） was used to detect serum levels of Pg， cyclic citrullinated peptide （CCP）， and immunoglobulin G （IgG）. ResultsJoint lesions： The CIA and Pg+CIA groups showed 100% arthritis incidence， with evident joint redness， swelling， and deformity. The number of affected limbs was 27 and 28， and clinical scores were 68 and 70， respectively. No obvious clinical symptoms were observed in the Pg group. Histopathological and imaging analyses showed severe joint lesions in the CIA and Pg+CIA groups， with significantly increased histopathological scores， bone mineral density， bone volume fraction， trabecular thickness， and trabecular number compared to the Control group （P<0.01）. No obvious joint pathology was observed in the Pg group. Lung lesions： The Pg+CIA group exhibited marked alveolar inflammation， interstitial inflammatory cell infiltration， and alveolar wall thickening， with pronounced blue staining of collagen fibers. Histopathological scores and collagen area ratios were significantly higher than those of the Control， Pg， and CIA groups （P<0.05）. Lung protein and mRNA expression levels of α-SMA， ColⅠ， and FN were markedly increased， and mRNA levels of IL-6， TNF-α， and IL-1β were significantly elevated compared to the Control group （P<0.05）. Serology： The Pg+CIA group showed significantly higher levels of CCP， Pg， and IgG compared with the Control， Pg， and CIA groups （P<0.05）. ConclusionDBA/1 mice subjected to Pg infection combined with CIA exhibited pronounced symptoms and pathological features of RA-ILD， along with elevated serum anti-CCP antibody levels. This model represents a novel RA-ILD mouse model， providing a valuable experimental tool for investigating RA-ILD pathogenesis and developing new therapeutics， and serves as a basis for establishing anti-cyclic citrullinated peptide antibody （ACPA）-positive RA-ILD animal models.

ObjectiveTo investigate the status of overlapping hepatitis B virus （HBV） infection in patients with chronic hepatitis C virus （HCV） infection and the serological characteristics of such patients. MethodsA total of 8 637 patients with HCV infection who were hospitalized from January 1， 2010 to December 31， 2020 and had complete data of HBV serological markers were enrolled， and the composition ratio of patients with overlapping HBV serological markers was analyzed among the patients with HCV infection. The patients were divided into groups based on age and year of birth， and serological characteristics were analyzed， and the distribution of HBV-related serological characteristics were analyzed across different HCV genotypes. ResultsThe patients with HCV/HBV overlapping infection accounted for 5.85%， and the patients with previous HBV infection accounted for 48.10%； the patients with protective immunity against HBV accounted for 14.67%， while the patients with a lack of protective immunity against HBV accounted for 31.39%. The patients were divided into groups based on age： in the 0 — 17 years group， the patients with protective immunity against HBV accounted for 61.41% （304 patients）； the 18 — 44 years group was mainly composed of patients with previous HBV infection （698 patients， 37.31%）， the 45 — 59 years group was predominantly composed of patients with previous HBV infection （1 945 patients， 50.38%）， and the ≥60 years group was also predominantly composed of patients with previous HBV infection （1 486 patients， 61.66%）. The patients were divided into groups based on the year of birth： in the pre-1992 group， the patients with previous HBV infection accounted for 51.63% （4 112 patients）； in the 1992 — 2005 group， the patients with protective immunity against HBV accounted for 54.72% （168 patients）； in the post-2005 group， the patients with protective immunity against HBV accounted for 64.38% （235 patients）. In this study， 6 301 patients underwent HCV genotype testing： the patients with genotype 1b accounted for the highest proportion of 51.71% （3 258 patients）， followed by those with genotype 2a （1 769 patients， 28.07%）， genotype 3b （63 patients， 1.00%）， genotype 3a （10 patients， 0.16%）， genotype 4 （21 patients， 0.33%）， and genotype 6a （5 patients， 0.08%）. ConclusionWith the implementation of hepatitis B planned vaccination program in China， there has been a significant reduction in the proportion of patients with previous HBV infection among the patients with HCV/HBV overlapping infection， but there is still a relatively high proportion of patients with a lack of protective immunity against HBV.

Neurocritical care involves complex pathophysiological mechanisms, and its incidence is higher, injuries are more severe, and treatment is more challenging in high-altitude environments. This consensus, based on the latest domestic and international evidence-based medical data, establishes a standardized, goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide. The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation, resulting in 32 recommendation statements covering three parts: management systems, monitoring and assessment, and core strategies. Key updates include: advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treatment based on the "Five Differences in Critical Care" concept; constructing a "trinity" multimodal brain monitoring system centered on cerebral blood flow, cerebral oxygenation, and brain function, emphasizing routine bedside transcranial Doppler ultrasound, cerebral oximetry, and continuous electroencephalography monitoring; shifting management strategies from mild hypothermia therapy to targeted temperature management, and defining the "446" target management pathway for the supercritical stage; emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management; elevating cerebrospinal fluid management goals to the level of "glymphatic system" function maintenance; implementing a multidisciplinary collaborative, whole-process management model focusing on patients' long-term neurological functional outcomes; de-escalation criteria include multidimensional indicators such as recovery of brain structure, restoration of cerebrovascular autoregulation, improvement in cerebrospinal fluid dynamics, and reduction in biomarker levels; and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation planning. This consensus systematically integrates the entire process of neurocritical care management, reflecting the modern connotation of goal-oriented, dynamic, and multimodal integration in neurocritical care medicine. It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms, the integration of medicine and engineering, and the empowerment of artificial intelligence, thereby further advancing the discipline of critical care medicine.

Objective:To investigate the correlation between serum soluble intercellular adhesion molecule-1 (sICAM-1) and the severity of white matter hyperintensities (WMHs).Methods:Medical examinees in the Department of Neurology, Suzhou Hospital Affiliated to Anhui Medical University from February 2021 to October 2022 were selected as the research subjects. Head MRI was performed and the severity of WMHs was assessed by Fazekas scale. The enzyme-linked immunosorbent assay was used to detect serum sICAM-1 expression level. Multivariate logistic regression analysis was used to determine the independent influencing factors of the severity of WMHs. Results:A total of 171 subjects were enrolled, including 112 males (65.5%), aged 65.50±9.07 years. There were 92 patients (53.8%) with no WMH or mild WMHs and 79 patients (46.2%) with moderate to severe WMHs. The serum sICAM-1 levels in the moderate to severe WMH group were significantly higher than those in the no or milds WMH group ( t=5.679, P<0.001). Ordinal multivariate logistic regression analysis showed that after adjusting for confounding factors, higher sICAM-1 level was independently correlated with the severity of WMHs (compared to the 1 st quartile group, the 3 rd quartile group: odds ratio 3.149, 95% confidence interval 1.147-8.645, P=0.026; the 4 th quartile group: odds ratio 6.087, 95% confidence interval 2.051-18.061; P=0.001). Conclusion:Elevated serum sICAM-1 level is an independent influencing factor of WMHs.

Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke. Stenting is a treatment option for symptomatic ICAS, but it also has problems such as procedure-related complications and in-stent restenosis. This article reviews the application of stenting, particularly different stent systems, in patients with symptomatic ICAS.

Secondary white matter injury after ischemic stroke refers to the secondary changes in the white matter structure outside the infarct site that are not directly damaged after stroke, often involving key connecting areas such as the corpus callosum and contralateral internal capsule. This injury is closely associated with post-stroke cognitive impairment, motor dysfunction, and language disorders, which affects the long-term outcome. Its pathophysiological mechanisms mainly include immune and inflammatory imbalance, excitotoxicity and mitochondrial dysfunction, blood-brain barrier damage, axonal injury, and remyelination disorder. Exploring these mechanisms in depth can help promote early diagnosis and intervention of secondary white matter damage after ischemic stroke, provide theoretical basis for the development of targeted treatment strategies, and promote functional recovery in patients with stroke.

Objective:To construct a predictive model for the efficacy of immunotherapy in non-small cell lung cancer (NSCLC) based on CT image-weighted radiomics score.Methods:A total of 185 patients with NSCLC who received immunotherapy in Affiliated Shuyang Hospital of Xuzhou Medical University from January 2021 to December 2023 were selected as the study objects. All patients underwent 3 consecutive cycles of nivolumab (240 mg) treatment, and therapeutic efficacy was evaluated using the Response Evaluation Criteria in Solid Tumors version 1.1. The patients were divided into treatment-effective group and treatment-ineffective group based on therapeutic outcomes. Based on pre-treatment arterial phase CT images, all volume regions of interest were resampled using PyRadiomics tool, and image preprocessing was performed (including methods such as Wavelet transform and Laplacian filtering) . The multi-focal imaging radiomics features of the two groups of patients were extracted, and standardized processing of the extracted features was carried out on the Dr. Wise research platform. At the same time, a CT image-weighted radiomics score model was constructed using an attention-based multi-instance learning (a-MIL) algorithm, the least absolute shrinkage and selection operator (LASSO) regression, and logistic regression, and the CT image-weighted radiomics score of each patient was calculated. The nomogram was plotted using R software (version R4.3.3) and the rms package. The concordance index (C-index) was used to evaluate the concordance of the model. Receiver operator characteristic (ROC) curve was used to evaluate the performance of the nomogram model in predicting immunotherapy efficacy in NSCLC. The calibration curve was used to evaluate the consistency of the predicted probabilities with the actual outcomes, while the decision curve was used to evaluate net benefit of the model across different thresholds.Results:There were statistically significant differences in sex ( χ2=3.86, P=0.049) , pathological type ( χ2=8.41, P=0.015) , smoking history ( χ2=5.70, P=0.017) , and pre-treatment pulmonary metastasis ( χ2=5.88, P=0.015) between the treatment-effective group ( n=66) and treatment-ineffective group ( n=119) . The original multi-focal radiomics features were weighted and summated by a-MIL algorithm at case level, and a total of 342 imaging radiomics features were extracted, 162 features among which had good consistency (intra-class correlation coefficient >0.80) . After variance analysis, 134 features were eliminated, 28 features remained. After dimensionality reduction by LASSO regression, 7 imaging radiomics features were obtained. They were GLCMEnergy_angle45_offset, ShortRunEmphasis_angle90_offset1, maximum gray value, Spiculation, GLCMEnergy_angle45_offset7, Sphericity, and Vessel. Based on the above imaging radiomics features, the weighted radiomics score model was constructed as follows: Radscore=0.624+0.022×GLCMEnergy_angle45_offset-0.227×ShortRunEmphasis_angle90_offset1+0.395×maximum gray value-8.687×Spiculation+0.384×GLCMEnergy_angle45_offset7-0.012×Sphericity-0.284×Vessel. The CT image-weighted radiomics score in the treatment-effective group (0.75±0.10) was significantly higher than that in the treatment-ineffective group (0.43±0.14) , with a statistically significant difference ( t=18.00, P<0.001) . ROC curve analysis showed that the area under the curve (AUC) of CT image-weighted radiomics score for predicting immunotherapy efficacy of NSCLC was 0.96 (95% CI: 0.92-0.98) , and the optimal cutoff value was 0.62. Multivariate analysis showed CT image-weighted radiomics score ≥0.62 ( OR=14.77, 95% CI: 3.25-22.35, P<0.001) , pathological type (squamous cell carcinoma) ( OR=1.74, 95% CI: 1.35-3.52, P=0.035) , smoking history ( OR=4.01, 95% CI: 1.05-15.30, P=0.042) , and pre-treatment pulmonary metastasis ( OR=1.20, 95% CI: 1.01-1.38, P=0.010) were all independent predictors of immunotherapy effectiveness in NSCLC. Based on the above 4 variables, a nomogram model was constructed to predict the immunotherapy efficacy of NSCLC, and the model validation results showed that the C-index was 0.96 (95% CI: 0.93-0.99) . Calibration curve analysis showed good consistency of the predicted probabilities with the actual probabilities, closely aligning with the ideal curve. ROC curve analysis showed that AUC was 0.97 (95% CI: 0.94-0.99) . Decision curve analysis showed that the model had a net benefit within the prediction range of 2% to 100%. Conclusion:The nomogram model based on CT image-weighted radiomics score is effective in predicting immunotherapy efficacy of NSCLC patients.

SHCBP1 is a type of Src homologous collagen that can specifically bind to the SH2 structural domain. It can act as a key regulatory protein, and exhibits abnormally high expression in a variety of malignant tumors. Through affecting the processes such as cell cycle, proliferation, and invasion, it participates in tumor genesis and development. In addition, high expression of SHCBP1 is closely related to chemotherapy resistance and poor prognosis of many malignant tumors, and its targeted inhibition can enhance the sensitivity of chemotherapy and provide new therapeutic strategies for a variety of solid tumors, making it an important biomarker for prognostic assessment and a potential therapeutic target.

Objective:To evaluate the clinical efficacy and impact on quality of life of the biofeedback (BF) therapy combined with the Wenyang Yiqi Prescription and self-efficacy interventions in patients with functional defecation disorders (FDD).Methods:A prospective, randomized controlled trial design was employed. A total of 128 FDD patients were selected from the Pelvic Floor Center of the Department of Proctology, Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, between January 2021 and April 2023. These patients were randomly divided into two groups, with 64 cases in each group. Additionally, 41 historical control patients, who had received conventional BF training between June 2015 and January 2018 at the same center, were included for comparison. The historical control group received conventional BF therapy, the intervention group 1 combined BF therapy with self-efficacy interventions, and the intervention group 2 added the Wenyang Yiqi Prescription based on intervention group 1's treatment. All three groups underwent two treatment courses. Constipation symptom scores before and after treatment were performed; self-efficacy was assessed via the Self-Rated Abilities for Health Practices scale (SRAHP); health behaviors were evaluated using the Health-Promoting Lifestyle Profile (HPLP); anxiety and depression were evaluated through Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS); quality of life was measured through SF-36. Clinical efficacy was evaluated based on constipation symptom scores.Results:During the treatment period, seven patients dropped out due to personal reasons, leaving 61 patients in intervention group 1 and 60 patients in intervention group 2 for efficacy analysis.　The total effective rates were 80.32% (49/61) in intervention group 1, 83.33% (50/60) in intervention group 2, and 56.10% (23/41) in the historical control group. The total effective rates of both intervention groups were significantly higher than those in the historical control group ( χ2=7.06, 9.15; P=0.029, 0.010, respectively). After treatment, intervention group 2 showed significantly lower constipation-related straining scores [1 (1, 2) vs. 2 (1, 2), Z=-4.51] compared to intervention group 1 ( P<0.05). Additionally, intervention group 2 had lower scores for straining [1 (1, 2) vs. 2 (1, 2), Z=-3.15] and defecation time [1 (0, 1) vs. 1 (1, 2), Z=-3.13] compared to the historical control group ( P<0.05). Psychological comfort efficacy (19.13 ± 2.51 vs. 16.98 ± 1.86, t=5.36), health responsibility efficacy (23.63 ± 4.69 vs. 22.59 ± 3.05, t=2.06), and overall SRAHP scores (75.98 ± 4.44 vs. 72.33 ± 5.16, t=4.17) were higher in intervention group 2 compared to intervention group 1 ( P<0.05). The HPLP scores (79.33 ± 11.13 vs. 72.80 ± 9.20, t=3.10) of intervention group 2 were higher than those of the historical control group ( P<0.05). Emotional functioning scores (75.98 ± 18.45 vs. 68.92 ± 20.58 and 68.55 ± 18.21, F=20.91) in intervention group 2 were higher than in both intervention group 1 and the historical control group ( P<0.05). Conclusion:The combination of the Wenyang Yiqi Prescription with BF therapy and self-efficacy interventions effectively improves the clinical symptoms and quality of life in FDD patients.