ObjectiveTo establish a new noninvasive， simple， and convenient clinical predictive model by identifying independent predictive factors for rebleeding after endoscopic therapy in cirrhotic patients with esophagogastric variceal bleeding （EGVB）， and to provide a basis for individualized risk assessment and development of clinical intervention strategies. MethodsCirrhotic patients with EGVB who were diagnosed and treated in The First Affiliated Hospital of Xi’an Medical University from September 2018 to October 2023 were enrolled as subjects， and according to whether the patient experienced rebleeding within 1 year after endoscopic therapy， they were divided into rebleeding group with 93 patients and non-rebleeding group with 84 patients. Clinical data were collected and analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. A Logistic model was established based on the results of the univariate and multivariate analyses， and the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the accuracy of the model. R software was used to visualize the model by plotting a nomogram， and the Bootstrap method was used for internal validation of the model. ResultsThe multivariate analysis showed that red blood cell count （RBC）， cholinesterase （ChE）， alkaline phosphatase （ALP）， albumin （Alb）， thrombin time （TT）， portal vein trunk diameter， sequential therapy， and primary prevention were independent predictive factors for rebleeding. Based on the results of the multivariate analysis， a logistic model was established as logit（P）=-0.805-1.978×（RBC）+0.001×（ChE）-0.020×（ALP）-0.314×（Alb）+0.567×（TT）+0.428×（portal vein trunk diameter）-2.303×［sequential therapy （yes=1， no=0）］-2.368×［primary prevention （yes=1， no=0）］. The logistic model （AUC=0.928， 95% confidence interval ［CI］： 0.893—0.964， P<0.001） had a better performance in predicting rebleeding than MELD score （AUC=0.603， 95%CI： 0.520—0.687， P=0.003）， Child-Pugh class （AUC=0.650， 95%CI： 0.578—0.722， P=0.001）， and FIB-4 index （AUC=0.587， 95%CI： 0.503—0.671， P=0.045）. The model had an optimal cut-off value of 0.607， a sensitivity of 0.817， and a specificity of 0.817. Internal validation confirmed that the model had good predictive performance and accuracy. ConclusionSequential therapy， implementation of primary prevention， an increase in RBC， and an increase in Alb are protective factors against rebleeding， while prolonged TT and widened main portal vein diameter are risk factors. The logistic model based on these independent predictive factors can predict rebleeding and thus holds promise for clinical application.

Liver cirrhosis is the terminal stage of various chronic liver diseases， with the main clinical manifestation of portal hypertension， which can lead to spontaneous portosystemic shunt （SPSS）. SPSS is very common in clinical practice and is closely associated with the prognosis of patients. This article summarizes the recent studies in the clinical significance of cirrhotic portal hypertension with SPSS， the controversies in studies， and the current status and future prospects and challenges of treatment， in order to provide a reference for the standardized diagnosis and treatment of portal hypertension.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.

Nanozymes are a distinct category of nanomaterials that exhibit catalytic properties resembling those of enzymes such as peroxidase (POD), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Nanozymes derived from Chinese herbal medicines exhibit the catalytic functions of their enzyme mimics, while retaining the specific medicinal properties of the herb (termed "herbzymes"). These nanozymes can be categorized into three main groups based on their method of synthesis: herb carbon dot nanozymes, polyphenol-metal nanozymes, and herb extract nanozymes. The reported catalytic activities of herbzymes include POD, SOD, CAT, and GPx. This review presents an overview of the catalytic activities and potential applications of nanozymes, introduces the novel concept of herbzymes, provides a comprehensive review of their classification and synthesis, and discusses recent advances in their biomedical applications. Furthermore, we also discuss the significance of research into herbzymes, including the primary challenges faced and future development directions.
Nanostructures/chemistry* ; Humans ; Herbal Medicine/methods* ; Superoxide Dismutase/chemistry* ; Catalase/chemistry* ; Drugs, Chinese Herbal/chemistry* ; Catalysis ; Glutathione Peroxidase/chemistry*

Objective:To explore relevant factors to accurately diagnose BPPV in vertigo children. Methods:A retrospective study was conducted on the proportion of BPPV in children（<18 years） with vertigo who visited the Hearing and Vertigo Diagnosis and Treatment Center of Tianjin Medical University General Hospital from September 2017 to August 2023. The clinical characteristics of BPPV children, including general demographics, medical history, first visit department, comorbidities, canal involvement, response to treatment, and incidence of recurrence, were analyzed. Data analysis was conducted using SPSS 25.0 software. Results:BPPV was diagnosed in 22.8% of patients seen for vertigo during the study period. There are differences in the proportion of BPPV diagnosis among children with dizziness in different age groups（P<0.05）, and the diagnosis of BPPV in the 7-12-year-old group has a longer disease course than in the 13-17-year-old group（P<0.05）. 72.3%（47/65） of patients or their families were able to provide a typical history of positional vertigo. 49.2%（32/65） of BPPV patients had comorbidities, and there were differences in the proportion of comorbidities among different age groups of BPPV patients（P<0.05）. With the progress of study, the proportion of BPPV in children with vertigo has shown an upward trend, and the proportion of children with otolaryngology as the first diagnosis department has also increased（P<0.05）. The proportion of horizontal semicircular canals in children with BPPV has increased. All BPPV patients underwent canalith repositioning maneuvers, with good treatment outcomes and a recurrence rate of 12.3%（8/65）. The recurrence rate in the group of BPPV patients with comorbidities was 21.9%, which was higher than that in the group without comorbidities（P<0.05）. Conclusion:Childhood BPPV has clinical characteristics such as unclear medical history, high proportion of comorbidities, easy recurrence in BPPV children with comorbidities and high proportion of horizontal semicircular canal involvement. For children diagnosed with other vertigo diseases, do not ignore the BPPV diagnostic test. It is recommended to perform routine position tests on children with vertigo if conditions permit to reduce missed diagnosis of BPPV in children.
Humans ; Benign Paroxysmal Positional Vertigo/diagnosis* ; Child ; Retrospective Studies ; Adolescent ; Female ; Male ; Recurrence ; Vertigo/diagnosis* ; Comorbidity ; Child, Preschool

Sonodynamic therapy (SDT) can potentially induce immunogenic cell death in tumor cells, leading to the release of ATP, and facilitating the initiation of an immune response. Nevertheless, the enzymes CD39 and CD73 can swiftly convert ATP into immunosuppressive adenosine (ADO), resulting in an immunosuppressive tumor microenvironment (TME). This study introduced a nanomedicine (QD/POM1@NP@M) engineered to reprogram TME by modulating the CD39/CD73/ADO pathway. The nanomedicine encapsulated sonosensitizers silver sulfide quantum dots, and the CD39 inhibitor POM1, while also incorporating homologous tumor cell membranes to enhance targeting capabilities. This integrated approach, on the one hand, stimulates the release of ATP via SDT, thereby initiating the immune response. In addition, it reduced the accumulation of ADO by inhibiting CD39 activity, which ameliorated the immunosuppressive TME. Upon administration, the nanomedicine demonstrated substantial anti-tumor efficacy by facilitating the infiltration of anti-tumor immune cells, while reducing the immunosuppressive cells. This modulation effectively transformed the TME from an immunologically "cold" state to a "hot" state. Furthermore, combined with the checkpoint inhibitor α-PDL1, the nanomedicine augmented systemic anti-tumor immunity and promoted the establishment of long-term immune memory. This study provides an innovative strategy for combining non-invasive SDT and ATP-driven immunotherapy, offering new ideas for future cancer treatment.

Objective:To analyze the relationship between inflammatory burden index (IBI) and the diagnosis and prognosis of gastric cancer.Methods:A total of 180 patients with gastric cancer admitted to the First Affiliated Hospital of Xi'an Medical University from January 1, 2017 to December 31, 2021 were selected as the gastric cancer group, 180 cases of gastric precancerous diseases treated in this hospital during the same period were selected as the precancerous disease group, 180 healthy individuals who underwent physical examinations in this hospital during the same period were selected as the control group. The value of IBI in the diagnosis of gastric cancer was analyzed. The IBI values of the three groups were compared by one-way analysis of variance, and the optimal cut-off values of different indicators were determined by receiver operator characteristic (ROC) curve to further evaluate the diagnostic value of IBI for gastric cancer. LASSO regression analysis was performed using the R software package glmnet to screen variables. Univariate and multivariate Cox regression analysis were performed on the screened variables to further determine the independent risk factors affecting the prognosis of patients with gastric cancer.Results:The levels of IBI in gastric cancer, precancerous disease, and control group were 46.69±8.38, 35.53±6.11, and 21.47±4.36, respectively, with a statistically significant difference ( F=681.45, P<0.001). Further pairwise comparisons showed that the gastric cancer group was higher than the precancerous disease group and the control group, and the precancerous disease group was higher than the control group, with statistically significant differences ( t=14.43, P<0.001; t=34.15, P<0.001; t=25.13, P<0.001). ROC curve analysis showed that the optimal cut-off value for the neutrophil to lymphocyte ratio (NLR) was 3.15 (AUC=0.65, 95% CI: 0.54-0.73), with a specificity of 92.31% and a sensitivity of 43.97%. The optimal cut-off value for the platelet to lymphocyte ratio (PLR) was 137.36 (AUC=0.59, 95% CI: 0.51-0.68), with a specificity of 93.66% and a sensitivity of 34.98%. The optimal cut-off value for lymphocyte to monocyte ratio (LMR) was 5.18 (AUC=0.69, 95% CI: 0.58-0.76), with a specificity of 61.29% and a sensitivity of 73.33%. The optimal cut-off value for panimmune inflammation value (PIV) was 276.57 (AUC=0.73, 95% CI: 0.65-0.78), with a specificity of 78.41% and a sensitivity of 59.77%. The optimal cut-off value for the systemic immune inflammatory index (SII) was 654.37 (AUC=0.73, 95% CI: 0.66-0.78), with a specificity of 86.32% and a sensitivity of 62.11%. The optimal cut-off value for the IBI was 49.12 (AUC=0.82, 95% CI: 0.79-0.92), with a specificity of 85.36% and a sensitivity of 65.82%. LASSO regression analysis showed that there were 8 prognostic variables related to survival, including IBI, T stage, N stage, age, carcinoembryonic antigen (CEA), SII, PIV, and tumor grade. The results of univariate analysis showed that IBI ( HR=4.57, 95% CI: 3.82-5.32, P<0.001), T stage ( HR=2.54, 95% CI: 1.75-3.31, P<0.001), N stage ( HR=1.69, 95% CI: 1.15-2.21, P=0.032), CEA ( HR=1.38, 95% CI: 1.06-1.75, P=0.032), and tumor grade ( HR=1.87, 95% CI: 1.34-2.59, P=0.026) were prognostic factors for gastric cancer patients. The results of multivariate analysis showed that IBI ( HR=3.96, 95% CI: 3.51-4.48, P<0.001), T stage ( HR=2.31, 95% CI: 1.63-3.02, P=0.023), tumor grade ( HR=1.49, 95% CI: 1.12-1.83, P=0.042) were independent risk factors affecting the prognosis of gastric cancer patients. Compared with low-level IBI gastric cancer patients, the risk of death in high-level IBI patients was up to 3.96 times. Conclusion:IBI may be an important marker for diagnosis and prognosis prediction of gastric cancer, which has certain scientific and clinical value in the diagnosis and treatment of gastric cancer.

Objective:To analyze the factors related to the occurrence of electrocoagulation syndrome after esophageal tumor endoscopic submucosal dissection (ESD), thus to construct and validate a nomogram prediction model.Methods:A total of 240 patients who underwent esophageal tumor ESD in the First Affiliated Hospital of Xi'an Medical University, Huazhou District of Weinan City People's Hospital of Shaanxi Province, and Chenggu County Hospital of Shaanxi Province from October 2018 to May 2024 were selected as the study objects. The patients were divided into a modeling group and a validation group using the "createDataPartition" of caret package in R software at a ratio of 7∶3. Univariate and multivariate logistic regression were used to analyze the factors related to the occurrence of esophageal tumor post-endoscopic submusocal dissection electrocoagulation syndrome (PEECS) in the modeling group, and the nomogram prediction model was constructed. C-index and calibration curve were used to verify the prediction model.Results:All data in the modeling group ( n=168) and the validation group ( n=72) were comparable. Univariate analysis showed that gender ( OR=2.15, 95% CI: 1.38-3.76, P=0.004), age ( OR=2.53, 95% CI: 1.39-4.61, P=0.001), surgical time ( OR=5.88, 95% CI: 2.15-8.41, P<0.001) and lesion length ( OR=5.16, 95% CI: 1.85-7.33, P<0.001) were related factors influencing the occurrence of esophageal tumor PEECS. Multivariate analysis showed that gender ( OR=2.94, 95% CI: 1.46-5.33, P=0.011), age ( OR=2.12, 95% CI: 1.20-3.88, P=0.042), surgical time ( OR=4.62, 95% CI: 2.11-7.26, P<0.001) and lesion length ( OR=3.93, 95% CI: 1.78-5.94, P=0.003) were independent factors for the occurrence of esophageal tumor PEECS. Based on the above indexes, a nomogram prediction model for the occurrence of esophageal tumor PEECS was constructed, and its C-index value was 0.787 (95% CI: 0.692-0.863). The calibration curve showed that with the modeling group as the internal verification and the validation group as the external verification, the predicted probability was in good agreement with the actual probability. Conclusion:Gender, age, surgical time and lesion length are independent factors influencing the occurrence of esophageal tumor PEECS. The nomogram prediction model based on the above indexes has high predictive efficacy.

A novel amide alkaloid,bursatamide A(1),featuring an unprecedented propyl-hexahydronaphthalene carbon frame-work,was isolated from the infrequently studied sea hare Bursatella leachi,alongside a new 3-phenoxypropanenitrile alkaloid,bursatellin B(2),and twelve known compounds.The structures of 1 and 2 were elucidated through comprehensive spectroscopic data analyses,while their relative and absolute configurations(ACs)were established through total synthesis and a series of quantum chem-ical calculations,including calculated electronic circular dichroism(ECD)spectra,optical rotatory dispersion(ORD)methods,and DP4+probability analyses.Bursatamide A(1)demonstrated inhibitory effects against the human pathogenic bacteria Listeria monocyt-ogenes and Vibrio cholerae.Erythro-bursatellin B(21),a diastereoisomer of 2,exhibited notable antibacterial activity against the fish pathogenic bacterium Streptococcus parauberis FP KSP28,with an MIC90 value of 0.0472 μg·mL-1.