ObjectiveTo explore the effect of transcutaneous electrical acupoint stimulation （TEAS） on stress response in patients undergoing unilateral biportal endoscopy （UBE） and to identify optimal TEAS parameters. MethodsA total of 96 patients undergoing UBE were randomly grouped into total intravenous anesthesia （TIVA） group， acupuncture-assisted anesthesia with continuous waves （AACW） group， and acupuncture-assisted anesthesia with sparse-dense waves （AASDW） group， with 32 patients per group. All groups were given a standardized TIVA protocol. In the AACW group （100 Hz continuous wave stimulation） and the AASDW group （2/100 Hz sparse-dense wave stimulation）， TEAS intervention was applied to both bilateral Zusanli （ST36） and Sanyinjiao （SP6） 30 minutes before TIVA induction and continued until the end of the surgery. In the TIVA group， electrodes were only connected without electrical stimulation. The stress response indicators including cortisol （Cor） and adrenocorticotropic hormone （ACTH）， heart rate （HR）， mean arterial pressure （MAP）， and bispectral index （BIS） at before anesthesia induction （T0）， after tracheal intubation （T1）， during laminectomy （T2）， and 1 hour after surgery （T3） were compared across groups. The operation duration， anesthesia duration， extubation and recovery duration were recorded， as well as pain intensity including visual analogue scale （VAS）， and sedation level （by Ramsay sedation score） at 2， 6， 12 hours after surgery， and postoperative complications. ResultsThe AACW group and AASDW group had lower ACTH and COR levels at T1， T2 and T3， as well as lower HR and MAP levels at T1 and T2 than TIVA group， with AASDW group being lower than AACW group （P＜0.05）. At T3， the AASDW group had higher BIS than TIVA group and AACW group （P＜0.05）. No significant difference in operation duration was observed （P＞0.05）. The AACW group and AASDW group had shorter anesthesia， extubation and recovery duration than TIVA group， with AASDW group being the shortest （P＜0.05）. The VAS scores at 2 h， 6 h， and 12 h after surgery in the AACW and AASDW groups were lower than those in the TIVA group， with the AASDW group showing significantly lower scores than the AACW group （P＜0.05）. The Ramsay sedation scores in the AASDW group were lower than those in the AACW group at 2 h and 6 h after surgery （P＜0.05）. The total incidence of complications in the AASDW group was 6.25% （2/32）， significantly lower than 28.13% （9/32） in the TIVA group （P＜0.05）. ConclusionTEAS can effectively suppresses stress response in patients undergoing UBE， with the 2/100 Hz sparse-dense wave parameter being most effective， which can stabilize hemodynamics， accelerate recovery， improve postoperative sedation and analgesia quality， and reduces complications.

This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

BACKGROUND:Chronic rotator cuff injury is often companied by tendon degeneration and impaired function of tendon-derived stem cells.As am important cytokine,platelet-derived growth factor-DD has a regulatory effect on the proliferation and differentiation of tendon-derived stem cells.OBJECTIVE:To investigate the effect of platelet-derived growth factor-DD on the proliferation and multilineage differentiation of tendon-derived stem cells in human chronic rotator cuff injury.METHODS:Tendon-derived stem cells were isolated from human chronic rotator cuff injury tissue and cultured in vitro.Immunofluorescence staining was used to observe the cytoskeletal morphology of tendon-derived stem cells.Flow cytometry was used to identify the phenotype of tendon-derived stem cells.Tendon-derived stem cells were divided into two groups.The control group did not receive any intervention.The platelet-derived growth factor-DD group was treated with 5 μg/mL platelet-derived growth factor-DD.The effect of platelet-derived growth factor-DD on the proliferation and multilineage differentiation of tendon-derived stem cells was evaluated by cell proliferation assay and three-lineage differentiation assay.RESULTS AND CONCLUSION:(1)The number of EdU-positive cells in the platelet-derived growth factor-DD group was significantly increased compared with the control group(P＜0.05).Tendon-derived stem cells entered the rapid proliferation phase earlier,and the cell growth was logarithmic.(2)The positive areas of Oil Red O staining,Alcian Blue staining,and Alizarin Red staining in the platelet-derived growth factor-DD group were significantly larger than those in the control group(P＜0.05).(3)The above results show that platelet-derived growth factor-DD significantly promotes the proliferation and adipogenic,osteogenic,and chondrogenic differentiation of tendon-derived stem cells.

OBJECTIVE To establish a risk prediction model for antibiotic-associated diarrhea(AAD)in intensive care unit(ICU)patients receiving mechanical ventilation so as to provide bases for early identification of high-risk population and formulation of corresponding individualized prevention strategies.METHODS A total of 1016 pa-tients who received mechanical ventilation and were treated with antibiotics in the ICU of The First Medical Center of Chinese PLA General Hospital from Jan.1,2020 to Jun.30,2022 were retrospectively enrolled in the study and were divided into the AAD group with 200 cases and the non-AA group according to the diagnostic criteria for AAD.Multivariate logistic regression analysis was performed for risk factors for AAD in the ICU patients receiv-ing mechanical ventilation,and the nomogram prediction model was established with R software.The performance of the model was evaluated by means of receiver operating characteristic(ROC)curves and calibration curves.RESULTS Among the 1016 patients who underwent mechanical ventilation,200 had AAD,and the incidence rate of AAD was 19.69％.Multivariate logistic regression analysis showed that hemoglobulin[OR=0.990,95％CI(0.983 to 0.997)],C-reactive protein[OR=1.046,95％CI(1.009 to 1.085)],serum phosphorus[OR=0.498,95％CI(0.328 to 0.755)],serum lipase[OR=1.001,95％CI(1.000 to 1.002)],ceftriaxo ne sodium[OR=2.331,95％CI(1.253 to 4.334)],linezolid[OR=2.387,95％CI(1.329 to 4.289)],fluconazole[OR=2.083,95％CI(1.238 to 3.505)]and sedatives[OR=0.307,95％CI(0.160 to 0.590)]were the risk factors for the AAD in the ICU patients receiving mechanical ventilation.The area under ROC curve(AUC)of the predic-tion model established based on the risk factors was 0.705 for the training set,0.751 for the validation set.Hos-mer-Lemeshow test indicated that the predicated probability of the model was consistent with the actual risk for the occurrence(x2=6.057,5.304,P=0.641,0.725).CONCLUSION The nomogram model that is established based on the above influencing factors can quantitatively predict the risk for AAD in the ICU patients undergo-ing mechanical ventilation,and it has certain clinical predictive efficiency.

Objective:To study the characteristics of oral microbiota in patients with periodontitis and its effects on Toll-like recep-tors(TLRs)signaling pathway and levels of inflammatory factors.Methods:Fifty patients with periodontal disease who received treatment in our hospital from January 2021 to September 2023 were selected as the trial group,and 50 healthy physical examination people during the same period were selected as the control group.Subgingival microbiota was cultured and gingival crevicular fluid samples were collected.Subgingival bacterial diversity was detected by 16S rRNA,interleukin-6(IL-6),IL-1β and tumor necrosis factor-α(TNF-α)levels in gingival crevicular fluid were detected by enzyme-linked immunosorbent assay,and TLRs signaling path-way was detected by real-time quantitative polymerase chain reaction.Results:The subgingival Simpson index in the trial group was higher than that in the control group.Subgingival microbiota was significantly separated between the two groups,and the relative abundance of Prevotella,Hemophilus and Veillonella were significantly different(P＜0.05).The number of microbiota in the trial group was higher than that in the control group(P＜0.05).The levels of IL-6,IL-1β,TNF-α and mRNA relative expression of TLRs signaling pathway in gingival crevicular fluid in trial group were higher than those in control group(P＜0.05).The levels of IL-6,IL-1β and TNF-α in gingival crevicular fluid of patients with periodontal disease were positively correlated with the number of microbiota of Parvobacteria,Tenella forsythiae,Prevotella intermedia and Porphyromonas gingivalis.Logistic regression analysis showed that the number of microbiota of Parvobacteria,Tenneella forsythiae,Prevotella intermedia and Porphyromonas gingivalis were independent factors influencing the high expression of IL-6,IL-1β and TNF-α.Conclusion:In periodontitis patients,the subgingi-val microbiota was changed,the mRNA expression of TLRs signaling pathway and the expression of inflammatory factors were in-creased,and the number of subgingival microbiota was significantly correlated with the expression of inflammatory factors.

Objective:To investigate the effects of combined stent and catheter thrombectomy technique on severe cerebral venous sinus thrombosis.Methods:A single-center, prospective, randomized controlled study was conducted involving 78 patients with severe cerebral venous sinus thrombosis who were treated at Lishui People's Hospital from January 2019 to December 2023. Using the random number table method, these patients were divided into two groups: an experimental group ( n = 39) and a control group ( n = 39). The control group received heparin anticoagulation treatment, while the experimental group underwent stent placement combined with catheter thrombectomy. The patency rate of occluded venous sinuses, Glasgow Coma Scale scores, Glasgow Outcome Scale scores, overall prognosis, and the incidence of adverse events were compared between the two groups. Results:After treatment and at 90 days post-treatment, the patency rate of occluded venous sinuses in the experimental group was 89.7% (35/39) and 79.5% (31/39), respectively. These were significantly higher than those in the control group [71.8% (28/39), 56.4% (22/39), χ2 = 4.04, 4.77, both P < 0.05]. Both the Glasgow Coma Scale scores and Glasgow Outcome Scale scores significantly increased in both groups after treatment, with the experimental group showing higher scores than the control group (all P < 0.05). At 30 and 90 days after treatment, the proportion of patients with a modified Rankin Scale score of ≤ 2 in the experimental group was 87.2% (34/39) and 79.5% (31/39), respectively. These were significantly higher than those in the control group [66.7% (26/39), 53.8% (21/39), χ2 = 4.62, 5.77, both P < 0.05]. There was no significant difference in the total incidence of adverse events between the two groups ( P > 0.05). Conclusions:The stent combined with catheter thrombectomy technique exhibits a considerable application value for patients with severe cerebral venous sinus thrombosis. This approach can enhance the vascular recanalization rate, promote disease recovery, improve patient prognosis, and is considered safe.

Objective The Hybrid Education Competence Instrument(HybridEduCom)was sinicized,and its reliability and validity were tested.Methods The translation,cultural adjustment and pre-investigation of HybridEduCom were followed by the Brislin translation model.The reliability and validity of the HybridEduCom was tested by surveying 553 educators in medical and nursing related fields by convenience sampling from March to April 2024.Results The Chinese version of HybridEduCom consisted of 46 items in 5 dimensions:planning and resourcing competence,technology competence,interaction competence,digital pedagogy competence,and ethical competence in the hybrid education.The confirmatory factor analysis resulted in the second-order five-factor model,with the chi-square and degree of freedom ratio being 1.274,approximate root mean square error being 0.022,goodness of fit index being 0.913,and standard fit index(NFI)being 0.934,and Tucker-Lewis and comparative fit index being 0.985.All main evaluation indexes were within the acceptable range of the judgment criteria.The item-content validity index was 0.833-1.000,and the scale-content validity index was 0.968.The Cronbach's α for the whole scale was 0.982,while varied from 0.892 to 0.936 for each dimension.The test-retest reliability of the scale was 0.978.Conclusion The reliability and validity of the Chinese version of HybridEduCom were satisfactory,and it can serve as a valid assessment instrument for the implementation of hybrid education competence of Chinese higher medical and nursing educators.

Objective:To analyze the association between remnant cholesterol (RC) and the risk of atherosclerotic cardiovascular disease (ASCVD) in community population in Shanghai.Methods:Using baseline and follow-up data from the Shanghai Suburban Adult Cohort and Biobank, individuals with ASCVD (including coronary heart disease, stroke, myocardial infarction, and peripheral artery disease) at baseline were excluded. A Cox proportional hazards regression model was employed to analyze the relationship between RC and ASCVD risk and the association under different LDL-C levels.Results:A total of 57 281 participants were included, with a median follow-up of 5.61 person-years. During the follow-up, 1 436 ASCVD events (2.51%) were recorded. After adjusting for potential confounders, individuals with moderate ( HR=1.18, 95% CI: 1.03-1.36) or high RC levels ( HR=1.32, 95% CI: 1.15-1.51) had an increased risk of ASCVD. The association was stronger in participants younger than 60 years-old (interaction P=0.048). Participants with RC ≥0.97 mmol/L and LDL-C <3.40 mmol/L demonstrated a 19% ( HR=1.19, 95% CI: 1.06-1.35) increased risk of ASCVD. When RC ≥0.97 mmol/L and LDL-C ≥3.40 mmol/L, ASCVD risk increased by 42% ( HR=1.42, 95% CI: 1.21-1.67). Conclusions:Elevated RC increases ASCVD risk, regardless of LDL-C levels. RC can serve as a valuable predictor and intervention target for ASCVD.

Objective:To analyze the mediating effect of cardiovascular health status (CVH) on the association between educational level and cardiovascular disease (CVD).Methods:The participants were from Shanghai Suburban Adult Cohort and Biobank, and questionnaire survey, physical examination, blood biochemistry were conducted from 2016 to 2020 for baseline information collection, and follow up was conducted until March 31, 2024 based on the medical data, CVD incidence data and death surveillance data at different levels. The associations of educational level, CVH and time to CVD onset of the study population were analyzed using the accelerated failure time model to analyze the mediating effects of CVH, health behaviors, and health factors in the association of educational level and time to CVD onset. The mediating effects of educational level, gender, and age moderated associations were also analyzed.Results:A total of 57 312 participants were included, with 2 780 new cases of CVD during a median follow-up of 6.71 (6.71-6.72) years, and a mean incidence density of 7.77/1 000 person-years (95% CI: 7.48/1 000 person-years -8.06/1 000 person-years). In total, the less educational level and the lower CVH, the higher CVD incidence density ( P<0.05). The results of accelerated failure time models showed that the time ratio for CVD-free survival was 1.15 (95% CI: 1.06-1.24) and 1.33 (95% CI: 1.10-1.60) for moderate and high educational level, respectively. The results of the mediation effect analysis showed that the association between moderate and high educational level and time to CVD onset was 29.60% (20.50%-50.00%) and 36.10% (23.80%-59.00%), 9.97% (5.07%-20.00%) and 13.84% (6.84%-29.00%), 15.24% (9.64%-27.00%) and 17.55% (11.58%-33.00%) of mediators mediated by CVH, health behaviors, health factors, respectively. Among them, there was an exposure-mediated interaction of educational level and a positive moderating effect of age. Conclusion:CVH, health behaviors and health factors had a proportionate mediating effect in the association between educational level and risk of CVD development.

Akkermansia muciniphila, a probiotic is discovered years earlier, colonizes the human intestinal mucosa. In recent years, researchers have found the correlation between Akkermansia muciniphila and progression of kidney diseases based on the theory of the gut-kidney axis. The abundance of Akkermansia muciniphila in the gut changes during the onset, regression and treatment of renal diseases such as congenital nephrology, chronic kidney disease, complications after renal transplantation. The research on the correlation between Akkermansia muciniphila and renal diseases is still in the initial stage. The review introduces the research progress on the role of Akkermansia muciniphila in renal diseases from three aspects: the biological characteristics of Akkermansia muciniphila, the abundance change in the progression of renal diseases, and their biological effects to provide references for the following research on the mechanisms of Akkermansia muciniphila in renal diseases and the application of clinical renal disease treatment.