ObjectiveTo investigate the inhibitory effect of Biejia Decoction Pill on the proliferation， migration， and aerobic glycolysis of hepatocellular carcinoma （HCC） using cell experiments， as well as related mechanisms. MethodsHuman liver cancer cell line Huh7 was selected， and Sprague-Dawley rats were randomly divided into blank serum group， inhibitor group， and high-， middle-， and low-dose Biejia Decoction Pill groups. Rat serum containing the drug was prepared for the incubation of Huh7 cells. CCK8 assay and scratch assay were used to explore the effect of Biejia Decoction Pill on the proliferation and migration of HCC cells； glycolytic rate-limiting enzymes and metabolites were measured to explore the effect of Biejia Decoction Pill on aerobic glycolysis of liver cancer cells； RT-qPCR and Western blot were used to explore the effect of Biejia Decoction Pill on the mRNA expression， related proteins， and phosphorylation of the protein kinase B （AKT）/mammalian target of rapamycin （mTOR） signaling pathway. A one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test or the Dunnett’s T3 test were used for further comparison between two groups. ResultsCompared with the blank serum group， the Biejia Decoction Pill groups had significant reductions in OD value， migration rate during different periods of time， glycolytic rate-limiting enzymes （hexokinase， phosphofructokinase， pyruvate kinase）， and glycolytic metabolites （pyruvate， lactic acid， ATP） （all P<0.05）. RT-qPCR results showed that compared with the blank serum group， the high-， middle-， and low-dose Biejia Decoction Pill groups had a significant reduction in the mRNA expression level of mTOR， and the high- and low-dose Biejia Decoction Pill groups had a significant reduction in the mRNA expression level of AKT （all P<0.05）. Western blot results showed that compared with the blank serum group， the high-， middle-， and low-dose Biejia Decoction Pill groups had significant reductions in the expression levels of mTOR-related proteins and phosphorylated proteins， and the high- and middle-dose Biejia Decoction Pill groups had significant reductions in the expression levels of AKT-related proteins and phosphorylated proteins （all P<0.05）. ConclusionThis study preliminarily verifies that the serum containing Bijia Decoction Pill can inhibit the aerobic glycolysis of human hepatoma Huh7 cells， thereby inhibiting their proliferation and migration， possibly by inhibiting the expression of the proteins related to the AKT/mTOR signaling pathway.

Objective To investigate the prevalence of metabolic associated fatty liver disease(MAFLD)and its correlation with metabolic components among personnel on tropical islands.Methods The data of personnel who received health examination on islands in 2024 were analyzed,and they were grouped with the age limit of 30 years old to compare the detection rates of MAFLD and metabolic components in different age groups.In people aged≥ 30 years old,the age,gender,body mass index(BMI),waist circumference(WC),fasting blood glucose,blood lipids,liver function,kidney function and other indexes were compared between MAFLD and non-MAFLD groups.Univariate and multivariate logistic regression models were conducted to analyze the factors affecting the occurrence of MAFLD.The effects of various metabolic components on the risk of MAFLD in different age groups were analyzed by subgroup analyses.Results Among 1213 personnel,175(14.4％)cases had MAFLD,of which 141(80.6％)cases were mild,32(18.3％)were moderate,and 2(1.1％)were severe.The detection rates of MAFLD(25.6％[74/289]vs 10.9％[101/924])and overweight/obesity(55.7％[161/289]vs 37.7％[348/924])in age ≥ 30 years old were significantly higher than those in age＜30 years old(both P＜0.001).In people aged≥ 30 years old,compared with the non-MAFLD group,the BMI,WC,systolic blood pressure,diastolic blood pressure,triglyceride(TG),low density lipoprotein-cholesterol,alanine transaminase,aspartate transaminase,gamma glutamyltransferase and uric acid(UA)in the MAFLD group were significantly higher(all P＜0.05),and the high density lipoprotein-cholesterol(HDL-C)was significantly lower(P＜0.05).There were no significant differences in age,gender,fast blood glucose,total cholesterol,alkaline phosphatase,total bilirubin,serum creatinine,or blood urea nitrogen(all P＞0.05).Logistic regression analysis showed that WC was an independent risk factor for MAFLD(odds ratio[OR]=1.101,95％confidence interval[95％CI]1.030-1.176,P=0.004);HDL-C was an independent protective factor for MAFLD(OR=0.071,95％CI0.016-0.323,P=0.001);and BMI ≥24.0 kg/m2 and WC≥90 cm were positively correlated with MAFLD(both P＜0.01).In people aged≥30 years old,the risk of MAFLD was increased in those with overweight/obesity,arterial blood pressure≥ 130/85 mmHg(1 mmHg=0.133 kPa),TG≥1.7 mmol/L,HDL-C≤1.0 mmol/L and UA＞420 μmol/L(all P＜0.05),and the risk of MAFLD was most significantly increased in overweight/obesity people(hazard ratio[HR]=5.088,95％CI 2.724-9.504,P＜0.001).Among people aged＜30 years old,the risk of MAFLD was increased in those with overweight/obesity and UA＞420 μmol/L(both P＜0.01),and the risk of MAFLD was most significantly increased in overweight/obesity individuals(HR=6.305,95％CI3.973-10.006,P＜0.001).Conclusion The detection rates of MAFLD and various metabolic components are higher in the personnel on tropical islands,and the risk of MAFLD is higher in those with overweight/obesity,TG≥1.7 mmol/L and hyperuricemia.

Objective To investigate the relationship between 9 immunoinflammatory indicators derived from complete blood count and the severity of Mycoplasma pneumoniae pneumonia(MPP)in children of different ages.Methods Totally 2 132 children with MPP who were hospitalized in the Department of Pediatrics of The First Affiliated Hospital of Naval Medical University from Jul.1,2023,to Dec.31,2024 were enrolled,and were assigned to severe MPP(SMPP)or non-severe MPP(NSMPP)groups.According to age and gender 1∶1 matching,the children were assigned to 2 subgroups according to age(1-6 years old and＞6-16 years old).The basic data,laboratory examination and immunoinflammatory indicators from complete blood count of each group were collected and compared.The influencing factors of SMPP were analyzed by univariate and multivariate Cox proportional hazards regression models.Receiver operating characteristic curves were used to analyze the predictive value of indicators that showed statistically significant differences for SMPP.Results There were 220 patients with SMPP,accounting for 10.3%of MPP.In children aged 1-6 years,compared with the NSMPP group,the SMPP group had a longer hospital stay,higher platelet(PLT)count,platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio,derived neutrophil-to-lymphocyte ratio and systemic immune-inflammation index(all P＜0.05).PLR was an independent risk factor for SMPP(odds ratio=1.010,95%confidence interval[CI]1.003-1.018,P=0.007).The area under curve predicted by PLR for SMPP was 0.635(95%CI 0.560-0.711,P＜0.001),the best cut-off value was 125.04,and the corresponding sensitivity and specificity were 57.7%and 70.2%,respectively.All the children were assigned to low PLR group or high PLR group using the best cut-offvalue as the boundary,and the severe disease rate in the high PLR group was significantly higher than that in the low PLR group(65.9%[60/91]vs 37.6%[44/117],P＜0.001).All the children were assigned to Q1-Q4 groups by quartile,and the severe disease rate of the Q4 group(71.2%,37/52)was significantly higher than that of the Q1-Q3 group(all P＜0.05).In children aged＞6-16 years,compared with the NSMPP group,the PLT and PLR in the SMPP group were higher(both P＜0.05),but neither was an independent risk factor.All the children were assigned to low PLR group or high PLR group using the best cut-offvalue(137.03)as the boundary,and the severe disease rate in the high PLR group was significantly higher than that in the low PLR group(57.0%[77/135]vs 40.2%[39/97],P=0.011).All the children were assigned to Q1-Q4 groups by quartile,and the severe disease rate of the Q4 group(65.5%,38/58)was significantly higher than that of the Q1-Q3 group(all P＜0.05).Conclusion The immunoinflammatory indicators derived from complete blood count,especially PLR,have certain application value in predicting the severity of MPP children in different ages.

BACKGROUND:Currently,numerous experiments delve into the intricate anatomy and biomechanical behavior of distinct segments of the supraspinatus muscle.However,the impact of shoulder joint stress resulting from damage to various regions of this muscle remains a scarcely explored domain.Understanding the repercussions of supraspinatus muscle injuries across different regions on the stress distribution and magnitude of articular cartilage and the glenoid is crucial for providing some theoretical support for clinical diagnosis and treatment. OBJECTIVE:To ascertain the maximum stress values by simulating different degrees of supraspinatus muscle rupture on the humeral cartilage surface,glenoid lip,and glenoid cartilage joint surface using three-dimensional finite element software. METHODS:Normal and healthy shoulder joint CT or MRI scans were processed through Mimics and Geomagic to extract molds.Subsequently,models were constructed via Solidworks.Varying degrees of supraspinatus muscle damage were simulated for each model to mimic fractures in different regions.Finally,Ansys,mechanical software,was employed for three-dimensional finite element biomechanical analysis,calculating stress values for the humeral cartilage surface,glenoid lip,and glenoid cartilage joint surface. RESULTS AND CONCLUSION:(1)With worsening degrees of supraspinatus muscle injury,the stress on the shoulder joint cartilage surface and glenoid lip escalated.(2)Among various regions,the anterior part of the supraspinatus muscle exhibited paramount significance.(3)While supraspinatus muscle fractures of differing degrees impacted the magnitude of cartilage stress on the glenoid labial surface,the stress distribution remained constant.(4)It is indicated that during the initial stages of horizontal abduction of the shoulder joint,the anterior region assumes a pivotal role,followed by the posterior deep region.Injury to the anterior part of the supraspinatus muscle leads to a significant surge in stress within the shoulder joint's soft tissue,potentially causing damage to the top of the glenoid lip and the anterior part of the glenoid cartilage.

BACKGROUND:The incidence of medial collateral ligament injuries in the knee joint is easy to lead to secondary meniscus and cartilage damage,and long-term chronic damage can lead to the occurrence of osteoarthritis.At present,there are few studies on the mechanics of meniscus and articular cartilage injury caused by medial collateral ligament rupture. OBJECTIVE:To investigate the effect of different degrees of medial collateral ligament injury on the biomechanics of meniscus and cartilage of knee joint. METHODS:The CT and MRI examinations of the knee joint of a healthy volunteer were performed to obtain the image data.The scanning data were imported into Mimics,Geomagic,and Solidworks software in turn.After registration and fusion,a 3D model of normal knee joint was established.On this basis,models of medial collateral ligament injury in different degrees of knee joint were simulated,which were divided into four groups,including:(1)medial collateral ligament was intact;(2)deep medial collateral ligament fracture;(3)superficial medial collateral ligament fracture;(4)complete rupture of medial collateral ligament.Finally,Ansys software was introduced to apply three modes of loads to the knee joint:(1)10 N·m valvaration torque was applied to the top of the femur.(2)A 4 N·m internal torque was applied to the top of the femur.(3)A 4 N·m external torque was applied to the top of the femur.The effects of four groups of models on knee biomechanics under different loads were analyzed. RESULTS AND CONCLUSION:(1)In the extension position of the knee joint,when a 10 N·m valgus torque was applied to the knee joint,the overall stress of the posterolateral meniscus increased with different degrees of medial collateral ligament injuries,while the stress of the articular cartilage did not change significantly.The peak stress of the posterolateral meniscus increased significantly with superficial medial collateral ligament rupture.(2)In the knee extension position,when a 4 N·m internal rotation torque was applied to the knee joint,the overall stress of the medial and lateral meniscus increased after different degrees of medial collateral ligament injury.When superficial medial collateral ligament rupture occurred,the peak stress of the meniscus shifted from the anterior horn of the medial meniscus to the anterior horn of the lateral meniscus.(3)In the knee extension position,applying a 4 N·m external rotation torque to the knee joint,the peak stress of the posterolateral meniscus increased more significantly than that of the medial meniscus,and the stress of the articular cartilage changed less.(4)These results show that the risk of meniscus injury secondary to superficial medial collateral ligament rupture is much higher than that of deep medial collateral ligament rupture when the knee is in extension,and the lateral meniscus is more vulnerable to injury than the medial meniscus.Both superficial medial collateral ligament and deep medial collateral ligament play an important role in the rotational stability of the knee joint.

Fibroblasts are stromal cells widely distributed in tissues and organs throughout the body.Fibroblasts are involved in the synthesis and remodelling of the extracellular matrix.Fibroblasts participate in physiopathological processes such as tissue damage repair,inflammatory responses and immune regulation.Large numbers of activated fibroblasts have been found in fibrosis,autoimmune diseases and tumor lesions.Activated fibroblasts participate in tissue fibrosis and influence the tumor microenvi-ronment mainly by secreting collagen and fibronectin.They also secrete a variety of inflammatory and growth factors that play an immunomodulatory role in autoimmunity and tumors.In recent years,it has been found that modulating fibroblast activation can effectively delay the development of these diseases,and that targeting fibroblast activation biomarkers can assess the development and treatment of these diseases.Therefore,the use of fibroblast-targeted drugs and therapeutic tools is expected to achieve new breakthroughs in the clinical management of fibrosis,autoimmune diseases and tumors.

Objective:To analyze the clinical characteristics and prognosis of patients with myelodysplastic syndrome (MDS) with a bone marrow nucleated erythroid cell proportion of greater than or equal to 50% (MDS-E) .Methods:The clinical characteristics and prognostic factors of patients with MDS-E were retrospectively analyzed by collecting the case data of 1 436 newly treated patients with MDS diagnosed in the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences from May 2014 to June 2023.Results:A total of 1 436 newly diagnosed patients with complete data were included in the study, of which 337 (23.5%) patients with MDS-E had a younger age of onset and lower neutrophil and platelet counts compared with those in patients with an erythroid cell proportion of less than 50% (MDS-NE) (all P<0.05). The proportion of MDS cases with ring sideroblasts (MDS-RS) was higher in the MDS-E group than in the MDS-NE group, and multi-hit TP53 mutations were more enriched in the MDS-E group than in the MDS-NE group (all P<0.05). Among patients with MDS-RS, the frequency of complex karyotypes and the TP53 mutation rate were significantly lower in the MDS-E group than in the MDS-NE group (0 vs 11.9%, P=0.048 and 2.4% vs 15.1%, P=0.053, respectively). Among patients with TP53 mutations, the frequencies of complex karyotypes and multi-hit TP53 mutations were significantly higher in the MDS-E group than in the MDS-NE group (87.5% vs 64.6%, P=0.003 and 84.0% vs 54.2%, P<0.001, respectively). Survival analysis of patients with MDS-RS found that the overall survival (OS) in the MDS-E group was better than that in the MDS-NE group [not reached vs 63 (95% CI 53.3-72.7) months, P=0.029]. Among patients with TP53 mutations and excess blasts, the OS in the MDS-E group was worse than that in the MDS-NE group [6 (95% CI 2.2-9.8) months vs 12 (95% CI 8.9-15.1) months, P=0.022]. Multivariate analysis showed that age of ≥65 years ( HR=2.47, 95% CI 1.43-4.26, P=0.001), mean corpuscular volume (MCV) of ≤100 fl ( HR=2.62, 95% CI 1.54-4.47, P<0.001), and TP53 mutation ( HR=2.31, 95% CI 1.29-4.12, P=0.005) were poor prognostic factors independent of the Revised International Prognostic Scoring System (IPSS-R) prognosis stratification in patients with MDS-E. Conclusion:Among patients with MDS-RS, MDS-E was strongly associated with a lower proportion of complex karyotypes and TP53 mutations, and the OS in the MDS-E group was longer than that in the MDS-NE group. Among patients with TP53 mutations, MDS-E was strongly associated with complex karyotypes and multi-hit TP53 mutations, and among TP53-mutated patients with excess blasts, the OS in the MDS-E group was shorter than that in the MDS-NE group. Age of ≥65 years, MCV of ≤100 fl, and TP53 mutation were independent adverse prognostic factors affecting OS in patients with MDS-E.

Objective The purpose of writing the"Expert consensus on the prevention and control of intracranial hypertension in adult critical illness"(here in after referred to as the"Consensus")aimed to standardize the nursing work related to the prevention and control of elevated intracranial pressure in adult critical illness,and prevent the occurrence of complications such as cerebral herniation.Methods Guided by evidence-based practice,domestic and foreign databases were searched for guidelines,expert consensuses,systematic evaluation,evidence summaries,and original research related to increased intracranial pressure.The search period is from database establishment to March 2024.The high-quality evidence and suggestions in the field was evaluated,extracted,and summarized to form a preliminary consensus.27 experts were invited to conduct 2 rounds of expert inquiry and 8 experts were invited to conduct 2 expert discussion meetings,to revise and improve the content of the initial draft,and to ultimately form a final consensus.Results The effective response rates for both rounds of inquiry questionnaires were 100％,with expert authority coefficients of 0.884,judgment coefficients of 0.964,and familiarity levels of 0.804.The Kendall harmony coefficients for 2 rounds of inquiry were 0.107 and 0.083(P＜0.01),respectively.The consensus includes 4 aspects,including identification,monitoring,prevention and control strategies,emergency treatment and care for increased intracranial pressure.Conclusion This"Consensus"has strong scientific validity and can provide reference basis for nurses to carry out prevention and control of intracranial pressure increase.

Objective:To examine the structural network changes in participants with amnestic mild cognitive impairment(aMCI)and investigate the correlation between these changes and the onset of Alzheimer's disease(AD).Methods:In this prospective study, a total of 100 individuals with amnestic mild cognitive impairment(aMCI)were enrolled as the research group.Additionally, 25 healthy individuals who were matched in terms of age and sex were enrolled as healthy controls.Upon enrollment, all participants underwent MRI scans, neuropsychological assessments, and clinical evaluations.The participants were then followed every 6 months for a period of 36 months or until they withdrew from the study.Based on the outcome of the follow-up(whether Alzheimer's disease occurred), the aMCI participants were divided into two groups: stable aMCI group and progressive aMCI group.The Chinese version of the Brief Mental State Examination(MMSE), the Montreal Cognitive Assessment(MoCA), the Clinical Dementia Rating Scale(CDR), and the Auditory Word Learning Test(AVLT)were utilized to evaluate the overall mental and cognitive status of the subjects.Pearson correlation analysis was employed to investigate the relationship between structural network changes and cognitive decline.Logistic regression was performed to analyze the predictive ability of structural network changes in determining the onset of AD.Results:Compared to the stable aMCI group, the progressive aMCI group exhibited lower levels of global efficiency( P=0.002), local efficiency( P=0.007), feeder connections( P=0.003), local connections( P=0.008), and right precuneus nodal efficiency( P=0.010).Correlation analysis revealed that global efficiency( r=0.604, P=0.002), feeder connections( r=0.513, P=0.012), and right precuneus nodal efficiency( r=0.504, P=0.014)were correlated with AVLT-delay scores(baseline)in the progressive aMCI group.A logistic regression model demonstrated that global efficiency, feeder connections, and right precuneus nodal efficiency could significantly predict the onset of AD(all P<0.05, AUCunited=0.797, 95% CI: 0.684-0.884, sensitivity=73.91, 95% CI: 51.6-89.8, specificity=76.60, 95% CI: 62.0-87.7). Conclusions:Among participants with aMCI, individuals who exhibit lower global efficiency, feeder connections, or right precuneus nodal efficiency are at a higher risk of developing AD.These indicators are anticipated to serve as new targets for clinical intervention.

Objective:To explore the association between changes in brain structural network during the early stage of stroke recovery and the onset of post-stroke depression (PSD).Methods:A total of 87 acute ischemic stroke patients scheduled for discharge, who were admitted to the Yixing Hospital Affiliated to Jiangsu University from March 2020 to May 2021, were prospectively collected. During the same period, 34 healthy control subjects matched with the stroke patients were also collected. All participants underwent systematic magnetic resonance imaging scans and scale assessments, and were followed up longitudinally for 2 years. Based on the occurrence of depression during follow-up, the stroke patients were divided into PSD group and post-stroke non-depression (PSND) group. Graph theoretical analysis was used to analyze the topological characteristics of brain structural network. Analysis of variance was used to explore the differences in brain structural network attributes among groups. Logistic regression model was used to analyze the predictive power of differential brain network attributes for PSD. Linear regression analysis was conducted to investigate the relationship between the synergism of non-rich-club regions and changes in rich-club connectivity.Results:The rich-club connectivity and synergism of the non-rich-club regions were significantly lower in the PSD group than in the PSND group (rich-club connectivity, P<0.01; synergism of feeder/local, P<0.001). The regression model demonstrated that the synergism of non-rich-club regions had a good predictive power for the occurrence of PSD ( OR=1.195, 95%CI 1.073-1.471, P<0.001). Furthermore, linear regression analysis revealed a significant correlation between the synergism of non-rich-club regions and Δrich-club connectivity ( r=-0.691, P<0.001). Conclusion:The good synergism of non-rich-club regions during the early stage of stroke recovery promotes the repair of rich-club connectivity and inhibits the onset of PSD.