To investigate the effects ofS-Adenosylmethionine(SAM)on liver injury induced by carbon tetrachloride(CCl4)in mice,In this study,60 C57BL/6 mice were randomly divided into CON group,CCl4 group,low dose group(CCl4+SAM-L,50 mg/kg SAM),medium dose group(CCl4+SAM-M,100 mg/kg)and high dose group(CCl4+SAM-M,200 mg/kg).Except CON group,mice in other groups were intraperitoneally injected with CCl4(10 mL/kg,0.2％),and mice in CON group were injected with equal volume olive oil,3 times a week for 4 weeks,to establish mouse liver injury model.At the same time,mice in low,medium and high dose groups were given 100 μL SAM,CON group and CCl4 group were given equal volume PBS for 4 weeks.The results showed that CCl4 promoted liver fibrosis and increased serum ALT,AST and TBIL levels(P＜0.05).Different doses of SAM significantly alleviated liver fibrosis injury and decreased serum ALT,AST and TBIL levels(P＜0.05).Compared with CON group,CCl4 significantly decreased the liver T-AOC,SOD,CAT and GSH-Px levels(P＜0.05),and increased the liver MDA level(P＜0.05).Compared with CCl4 group,the levels of T-AOC,SOD,CAT and GSH-PX in liver of mice in CCl4+SAM group were significantly increased(P＜0.05),while the level of MDA was significantly decreased(P＜0.05).Compared with CON group,liver levels of IL-6,IL-1β and TNF-α in CCl4 group were significantly increased(P＜0.05).Compared with CCl4 group,different doses of SAM could significantly reduce the levels of IL-6,IL-1β and TNF-α in liver of mice(P＜0.05).Compared with CON group,the expressions of Nrf2,NQO-1 and HO-1 genes in liver of CCl4 group were decreased(P＞0.05),while the expression of Keap1 gene was significantly increased(P＞0.05).Compared with CCl4 group,medium and high doses of SAM significantly increased the expressions of Nrf2,NQO-1 and HO-1 genes in liver of mice(P＜0.05),and decreased the expres-sion of Keap1 gene(P＞0.05).Compared with CON group,the contents of acetic acid,propionic acid and butyric acid in cecum of CCl4 group were significantly decreased(P＜0.05).Compared with CCl4 group,the contents of propionic acid and butyric acid in high-dose SAM group were sig-nificantly increased(P＜0.05).Microbial analysis showed that CCl4 significantly decreased the rel-ative abundance of Akkermansia and Prevotellaceae_NK3B31_group(P＜0.05),and changed the composition of intestinal microorganisms.These results indicate that SAM regulates the gene ex-pression of Nrf2 antioxidant signaling pathway to a certain extent,increases intestinal SCFAs con-tent,regulates intestinal microbial structure,and thus alleviates liver injury,oxidative stress and inflammation caused by CCl4.This study provides reference and theoretical basis for SAM in the treatment and remission of drug-induced liver injury.

OBJECTIVE:To assess the efficacy and safety of transcranial magnetic stimulation in the treatment of refractory depression and to compare the differences in efficacy between various transcranial magnetic stimulation treatment protocols in refractory depression,thereby providing a theoretical basis for the clinical selection of transcranial magnetic stimulation treatment protocols.METHODS:A comprehensive search was conducted across multiple databases,including PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,CBM and VIP.The search terms were"transcranial magnetic stimulation,treatment-resistant depression,randomized controlled trial"in Chinese,and"depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial"in English.The objective was to identify randomized controlled trials on the treatment of patients with refractory depression published from the establishment of the databases to September 2024.The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool,version 5.1.0,and the Physiotherapy Evidence Database scale.Meta-analysis of the outcome indicators was conducted using the Review Manager 5.4 and Stata 18.0 software.RESULTS:(1)Following a comprehensive review,20 randomized controlled trials were included in the analysis.All of the trials were assessed to be of high or very high quality according to the Physiotherapy Evidence Database scale.(2)Meta-analysis results showed that,compared with the sham stimulation group,high-frequency repetitive transcranial magnetic stimulation could significantly reduce the scores of Hamilton Depression Rating Scale[mean difference(MD)=-3.89,95％confidence interval(CI):-6.14 to-1.65,P＜0.05)or the Montgomery Depression Rating Scale(MD=-3.97,95％CI:-6.57 to-1.36,P＜0.05).(3)The probability ranking results of the network Meta-analysis showed that,in terms of the Hamilton Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(69.9％)＞intermittent theta burst stimulation(62.8％)＞bilateral theta pulse stimulation(57.5％)＞low-frequency repetitive transcranial magnetic stimulation(54.9％)＞bilateral sequential transcranial magnetic stimulation(49.0％)＞transcranial pulsed electromagnetic field(37.0％)＞sham stimulation(18.9％).And in terms of the Montgomery Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(93.3％)＞bilateral theta pulse stimulation(50.3％)＞sham stimulation(45.9％)＞low-frequency repetitive transcranial magnetic stimulation(32.1％)＞bilateral sequential transcranial magnetic stimulation(28.4％).CONCLUSION:Transcranial magnetic stimulations can improve the depressive symptoms of patients with treatment-resistant depression.Among them,the high-frequency repetitive transcranial magnetic stimulation mode has the best effect on improving the depressive symptoms of patients with treatment-resistant depression,followed by the intermittent θ burst stimulation mode.

Objective A scoping review of studies related to the burden on family carers of haemodialysis patients was conducted with the aim of comprehensively dissecting the current state of research in this area and informing subsequent studies.Methods A scope review reporting framework was used to search the CNKI,China Biomedical Literature Database,Vip Database,Wanfang Database,Chinese Medical Journal Full Text Database,PubMed,CINAHL,Web of Science,Cochrane Library,Scopus,and Embase,with a timeframe for searching the database from its construction to 29 March 2025.The included literature was summarised and analysed.Results A total of 25 papers were included,of which 21 reported scores/incidence of family carer burden,with overall results dominated by mild to moderate burden,involving 5 tools for assessing family carer burden,influencing factors(including demographic,disease-related,psychosocial,economic social,caregiving factors)and 6 other aspects.Intervention covers peer support groups,the 5-A model of self-management,health behaviours teaching,problem-focused strategies,etc.Conclusion The burden of family caregivers of haemodialysis patients at home and abroad is a common problem,which is affected by many factors,and it is urgent to carry out multi-centre,large-sample longitudinal studies and family-centred intervention studies in the future,so as to reduce the adverse effects of the burden of family caregivers,and to improve the patients' adherence to the treatment as well as the physical and mental health of the family caregivers.

Objective:To construct a machine learning classification prediction model using planning-omics (planomics) features to predict the γ pass rate of intensity-modulated radiotherapy (IMRT) plan dose verification in fixed-field thoracic tumors, and evaluate the application of planomics in radiotherapy quality assurance.Methods:The fixed-field IMRT plans of 240 patients with chest tumors admitted to Department of Radiotherapy, Henan Cancer Hospital from August 2022 to March 2023 were retrospectively analyzed. All plans underwent dose verification using the electronic portal imaging system detector on the Varian accelerator to collect field dose data. The dose verification results were analyzed through Portal Dosimetry in the treatment planning system of Eclipse. The γ pass rate standard was set at 2%/2 mm with a 10% dose threshold. From the planning documents, 48 conventional planning features, 2476 planomics features, and the combination of the previous two feature sets were extracted. Subsequently, an auto-encoder classification model was constructed. To evaluate the classification efficacy of various feature sets, 20 random train-test divisions were conducted by calculating the area under the receiver operating characteristic curve (AUC) values along with the accuracy rates.Results:After the feature selection, 2 conventional features and 16 planomics features were finally selected. In the testing set, the AUC values for the model using combined features, planomics features, and conventional planned features were 0.802±0.030, 0.740±0.069, and 0.673±0.083, respectively. In contrast, in the training set, these AUC values were 0.844±0.074, 0.816±0.047, and 0.687±0.036, respectively. The accuracy rates were 0.752±0.083, 0.703±0.110, and 0.648±0.081 in the testing set, and 0.753±0.098, 0.751±0.075, and 0.624±0.054 in the training set for the combined, planomics, and conventional planning feature sets, respectively.Conclusions:For thoracic fixed-field adjusted radiotherapy planning, the machine learning method based on planomics features can be utilized to build a classification model for predicting the γ pass rate. Combining planomics features with conventional planned features can enhance the predictive performance of the classification models.

Objective:To evaluate the detection capability of the contrast-enhanced three-dimensional turbo spin-echo (CE-SPACE) sequence for brain metastases (BM), aiming to provide evidence for precise target delineation in stereotactic radiotherapy (SRT).Methods:A total of 123 BM patients who received radiotherapy at the Affiliated Cancer Hospital of Zhengzhou University from May to November 2024 were enrolled. All patients underwent contrast-enhanced (CE) MRI and CT scans in the same treatment position, with images rigidly registered in the Eclipse planning system. Two experienced radiation oncologists independently delineated BM lesions on CE-MPRAGE and CE-SPACE sequences in a blinded manner. Patients were divided into the delayed group (10 min, n=61) and a priority group (5 min, n=62) based on the time interval between gadolinium injection and CE-SPACE acquisition. The non-parametric Wilcoxon rank-sum test was used to compare the lesion counts and volume differences between the two imaging sequences. Point-biserial correlation analysis was performed to assess the correlation between the additional lesions identified by CE-SPACE and lesion volume. Results:The overall analysis demonstrated that CE-SPACE detected 421 BM lesions, achieving an 8.2% higher detection rate than CE-MPRAGE ( Z=3.78, P<0.001). In terms of lesion volume, the median BM lesions volume identified by CE-SPACE [0.30(0.07,1.53)cm 3] was 8.7% larger than that by CE-MPRAGE [0.23 (0.04, 1.34) cm 3] ( Z=12.88, P<0.001). CE-SPACE demonstrated superior sensitivity for lesions ≤ 0.06 cm3, with negative correlation between the number of additional lesions detected and lesion volume ( r=-0.104, P=0.034). Subgroup analysis revealed that in the delayed group, CE-SPACE detected significantly more lesions [median 2 (1, 3.5) vs. 2 (1, 3), P=0.002] and larger volumes [0.39 (0.08, 2.24) cm3 vs. 0.29 (0.05, 1.99) cm3, P<0.001] than CE-MPRAGE. In the priority group, CE-SPACE detected significantly larger lesion volumes [0.55 (0.09, 2.06) cm3 vs. 0.45 (0.08, 1.88) cm3, P<0.001], but no significant difference was observed in lesion counts between two sequences ( P=0.059). Conclusions:Three-dimensional CE-SPACE sequence offers superior detection sensitivity for small BM (≤ 0.06 cm3), providing crucial guidance for accurate target delineation in SRT.

OBJECTIVE: To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). METHODS: The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. RESULTS: The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). CONCLUSION The application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Humans ; Spinal Fusion/instrumentation* ; Titanium ; Cervical Vertebrae/surgery* ; Diskectomy/instrumentation* ; Bone Plates ; Male ; Printing, Three-Dimensional ; Female ; Retrospective Studies ; Middle Aged ; Treatment Outcome ; Benzophenones ; Adult ; Spondylosis/surgery* ; Aged ; Polymers ; Ketones ; Polyethylene Glycols

Objective A scoping review of studies related to the burden on family carers of haemodialysis patients was conducted with the aim of comprehensively dissecting the current state of research in this area and informing subsequent studies.Methods A scope review reporting framework was used to search the CNKI,China Biomedical Literature Database,Vip Database,Wanfang Database,Chinese Medical Journal Full Text Database,PubMed,CINAHL,Web of Science,Cochrane Library,Scopus,and Embase,with a timeframe for searching the database from its construction to 29 March 2025.The included literature was summarised and analysed.Results A total of 25 papers were included,of which 21 reported scores/incidence of family carer burden,with overall results dominated by mild to moderate burden,involving 5 tools for assessing family carer burden,influencing factors(including demographic,disease-related,psychosocial,economic social,caregiving factors)and 6 other aspects.Intervention covers peer support groups,the 5-A model of self-management,health behaviours teaching,problem-focused strategies,etc.Conclusion The burden of family caregivers of haemodialysis patients at home and abroad is a common problem,which is affected by many factors,and it is urgent to carry out multi-centre,large-sample longitudinal studies and family-centred intervention studies in the future,so as to reduce the adverse effects of the burden of family caregivers,and to improve the patients' adherence to the treatment as well as the physical and mental health of the family caregivers.

OBJECTIVE:To assess the efficacy and safety of transcranial magnetic stimulation in the treatment of refractory depression and to compare the differences in efficacy between various transcranial magnetic stimulation treatment protocols in refractory depression,thereby providing a theoretical basis for the clinical selection of transcranial magnetic stimulation treatment protocols.METHODS:A comprehensive search was conducted across multiple databases,including PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,CBM and VIP.The search terms were"transcranial magnetic stimulation,treatment-resistant depression,randomized controlled trial"in Chinese,and"depressive disorder,treatment-resistant,transcranial magnetic stimulation,randomized controlled trial"in English.The objective was to identify randomized controlled trials on the treatment of patients with refractory depression published from the establishment of the databases to September 2024.The quality of the included studies was evaluated using the Cochrane risk of bias assessment tool,version 5.1.0,and the Physiotherapy Evidence Database scale.Meta-analysis of the outcome indicators was conducted using the Review Manager 5.4 and Stata 18.0 software.RESULTS:(1)Following a comprehensive review,20 randomized controlled trials were included in the analysis.All of the trials were assessed to be of high or very high quality according to the Physiotherapy Evidence Database scale.(2)Meta-analysis results showed that,compared with the sham stimulation group,high-frequency repetitive transcranial magnetic stimulation could significantly reduce the scores of Hamilton Depression Rating Scale[mean difference(MD)=-3.89,95％confidence interval(CI):-6.14 to-1.65,P＜0.05)or the Montgomery Depression Rating Scale(MD=-3.97,95％CI:-6.57 to-1.36,P＜0.05).(3)The probability ranking results of the network Meta-analysis showed that,in terms of the Hamilton Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(69.9％)＞intermittent theta burst stimulation(62.8％)＞bilateral theta pulse stimulation(57.5％)＞low-frequency repetitive transcranial magnetic stimulation(54.9％)＞bilateral sequential transcranial magnetic stimulation(49.0％)＞transcranial pulsed electromagnetic field(37.0％)＞sham stimulation(18.9％).And in terms of the Montgomery Depression Rating Scale score,the probability ranking results were as follows:high-frequency repetitive transcranial magnetic stimulation(93.3％)＞bilateral theta pulse stimulation(50.3％)＞sham stimulation(45.9％)＞low-frequency repetitive transcranial magnetic stimulation(32.1％)＞bilateral sequential transcranial magnetic stimulation(28.4％).CONCLUSION:Transcranial magnetic stimulations can improve the depressive symptoms of patients with treatment-resistant depression.Among them,the high-frequency repetitive transcranial magnetic stimulation mode has the best effect on improving the depressive symptoms of patients with treatment-resistant depression,followed by the intermittent θ burst stimulation mode.

To investigate the effects ofS-Adenosylmethionine(SAM)on liver injury induced by carbon tetrachloride(CCl4)in mice,In this study,60 C57BL/6 mice were randomly divided into CON group,CCl4 group,low dose group(CCl4+SAM-L,50 mg/kg SAM),medium dose group(CCl4+SAM-M,100 mg/kg)and high dose group(CCl4+SAM-M,200 mg/kg).Except CON group,mice in other groups were intraperitoneally injected with CCl4(10 mL/kg,0.2％),and mice in CON group were injected with equal volume olive oil,3 times a week for 4 weeks,to establish mouse liver injury model.At the same time,mice in low,medium and high dose groups were given 100 μL SAM,CON group and CCl4 group were given equal volume PBS for 4 weeks.The results showed that CCl4 promoted liver fibrosis and increased serum ALT,AST and TBIL levels(P＜0.05).Different doses of SAM significantly alleviated liver fibrosis injury and decreased serum ALT,AST and TBIL levels(P＜0.05).Compared with CON group,CCl4 significantly decreased the liver T-AOC,SOD,CAT and GSH-Px levels(P＜0.05),and increased the liver MDA level(P＜0.05).Compared with CCl4 group,the levels of T-AOC,SOD,CAT and GSH-PX in liver of mice in CCl4+SAM group were significantly increased(P＜0.05),while the level of MDA was significantly decreased(P＜0.05).Compared with CON group,liver levels of IL-6,IL-1β and TNF-α in CCl4 group were significantly increased(P＜0.05).Compared with CCl4 group,different doses of SAM could significantly reduce the levels of IL-6,IL-1β and TNF-α in liver of mice(P＜0.05).Compared with CON group,the expressions of Nrf2,NQO-1 and HO-1 genes in liver of CCl4 group were decreased(P＞0.05),while the expression of Keap1 gene was significantly increased(P＞0.05).Compared with CCl4 group,medium and high doses of SAM significantly increased the expressions of Nrf2,NQO-1 and HO-1 genes in liver of mice(P＜0.05),and decreased the expres-sion of Keap1 gene(P＞0.05).Compared with CON group,the contents of acetic acid,propionic acid and butyric acid in cecum of CCl4 group were significantly decreased(P＜0.05).Compared with CCl4 group,the contents of propionic acid and butyric acid in high-dose SAM group were sig-nificantly increased(P＜0.05).Microbial analysis showed that CCl4 significantly decreased the rel-ative abundance of Akkermansia and Prevotellaceae_NK3B31_group(P＜0.05),and changed the composition of intestinal microorganisms.These results indicate that SAM regulates the gene ex-pression of Nrf2 antioxidant signaling pathway to a certain extent,increases intestinal SCFAs con-tent,regulates intestinal microbial structure,and thus alleviates liver injury,oxidative stress and inflammation caused by CCl4.This study provides reference and theoretical basis for SAM in the treatment and remission of drug-induced liver injury.

Objective:To construct a machine learning classification prediction model using planning-omics (planomics) features to predict the γ pass rate of intensity-modulated radiotherapy (IMRT) plan dose verification in fixed-field thoracic tumors, and evaluate the application of planomics in radiotherapy quality assurance.Methods:The fixed-field IMRT plans of 240 patients with chest tumors admitted to Department of Radiotherapy, Henan Cancer Hospital from August 2022 to March 2023 were retrospectively analyzed. All plans underwent dose verification using the electronic portal imaging system detector on the Varian accelerator to collect field dose data. The dose verification results were analyzed through Portal Dosimetry in the treatment planning system of Eclipse. The γ pass rate standard was set at 2%/2 mm with a 10% dose threshold. From the planning documents, 48 conventional planning features, 2476 planomics features, and the combination of the previous two feature sets were extracted. Subsequently, an auto-encoder classification model was constructed. To evaluate the classification efficacy of various feature sets, 20 random train-test divisions were conducted by calculating the area under the receiver operating characteristic curve (AUC) values along with the accuracy rates.Results:After the feature selection, 2 conventional features and 16 planomics features were finally selected. In the testing set, the AUC values for the model using combined features, planomics features, and conventional planned features were 0.802±0.030, 0.740±0.069, and 0.673±0.083, respectively. In contrast, in the training set, these AUC values were 0.844±0.074, 0.816±0.047, and 0.687±0.036, respectively. The accuracy rates were 0.752±0.083, 0.703±0.110, and 0.648±0.081 in the testing set, and 0.753±0.098, 0.751±0.075, and 0.624±0.054 in the training set for the combined, planomics, and conventional planning feature sets, respectively.Conclusions:For thoracic fixed-field adjusted radiotherapy planning, the machine learning method based on planomics features can be utilized to build a classification model for predicting the γ pass rate. Combining planomics features with conventional planned features can enhance the predictive performance of the classification models.