Objective To investigate the regulatory mechanism of transforming growth factor-β1 (TGF-β1) in different types of mitral valvular disease (MVD) with atrial fibrillation (AF). Methods From August 2011 to August 2012, patients with moderate to severe MVD accompanied by AF who required mitral valve replacement at the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, were included. Based on echocardiographic results, patients were divided into two groups: a mitral regurgitation (MR) with AF (MR-AF) group and a mitral stenosis (MS) with AF (MS-AF) group. Left atrial tissue samples were collected during surgery. Techniques such as enzyme-linked immunosorbent assay, real-time fluorescence quantitative polymerase chain reaction, immunohistochemistry, and Western blotting were used to detect key molecules in the TGF-β1/JNK pathway. Results Sixteen patients were enrolled. There were 8 patients in the MR-AF group, including 5 males and 3 females, with an average age of (41.38±11.19) years; and 8 patients in the MS-AF group, including 6 males and 2 females, with an average age of (43.12±5.30) years. The left atrial volume load was higher in MR-AF patients, while the left atrial pressure load was higher in MS-AF patients. In MS-AF patients, the relative expression levels of MAPK9, JUN, CASP3, BAX, and BCL2 mRNA in left atrial tissues were significantly upregulated. The serum TGF-β1 protein level and the relative expression levels of p-JNK, p-c-Jun, and Caspase-3 proteins in the left atrial tissues of the MR-AF group were higher. Myocardial cell damage was more severe in the MS-AF group, and the protein expression level of Bcl-2 was higher. Conclusion Different MVD have distinct hemodynamic characteristics. The myocardium of the left atrium in MR-AF patients is more prone to apoptosis, possibly through the activation of the TGF-β1/JNK signaling pathway.

Ductular reaction （DR） refers to the adaptive pathological changes that occur after hepatobiliary injury， and it is essentially a repair response involving the proliferation， fibrosis， and inflammation of biliary epithelial cell （BEC）. With the understanding of the biological function of BEC， the potential value of DR in disease prognosis and treatment has gradually become a research hotspot. This article systematically reviews the molecular mechanism of DR， its potential as a therapeutic target， and future development directions， as well as novel therapies suggested by targeting these molecular mechanisms， in order to provide a new direction for overcoming current bottlenecks in the treatment of bile duct diseases.

Methods: Six finite element models of T12 burst fractures were developed to simulate short-segment stabilization under normal or osteoporotic bone conditions, with/without augmentation screws at the fractured vertebra. Spinal stiffness, implant stresses, and axial displacement/micromotion of the bony defect were measured and compared under mechanical loading. Results: Osteoporotic models exhibited a greater range of motion (ROM) than normal bone. All six-screw constructs reduced ROM across all motions compared with traditional four-screw models. Osteoporotic fracture models gained greater benefit from intermediate screw augmentation at the fracture vertebra, which also lowered axial displacement/micromotion. In six-screw models, rod stress increased while pedicle screw stress decreased. Intermediate screws at fractured vertebrae produced similar changes in stress distribution across all fixation models, regardless of bone quality. Conclusions Our findings may facilitate implant selection for osteoporotic burst fractures, supporting the use of more rigid fixation sixscrew constructs to reduce the risk of mechanical failure and postoperative re-collapse.

[Objective] To evaluate the efficacy and practicality of autologous platelet-rich plasma (aPRP) in patients undergoing total aortic arch replacement for aortic dissection. [Methods] A retrospective analysis was performed on 483 patients diagnosed with type A aortic dissection who underwent total aortic arch replacement between January 2016 and November 2023. Patients were categorized into two groups based on whether they received aPRP. Baseline characteristics, intraoperative blood product usage and postoperative outcomes were compared between the two groups. [Results] The aPRP group exhibited reduced usage of allogeneic platelets (1.55±1.04 vs 1.60±1.27)U, allogeneic plasma (480.89±432.49 vs 746.50±508.81)mL, allogeneic RBC (red blood cell)(5.95±1.91 vs 6.17±3.52)U, bivalirudin (2.66±1.51 vs 3.31±1.59)U and coagulation factor Ⅶ (0.67±1.03 vs 1.22±1.43)mg compared to the non-aPRP group (P<0.05). The incidence of postoperative hypoxemia was lower in the aPRP group (43.98% vs 48.41%), and the duration of mechanical ventilation was significantly shorter[median 50.91 (interquartile range 18.71, 113.71) vs 83.40 (37.73, 151.98) hours]. There were no significant differences between the two groups in terms of postoperative mortality, continuous bedside hemofiltration, cerebral infarction, cerebral hemorrhage, paraplegia or re-exploration for hemostasis(P>0.05). [Conclusion] The application of aPRP in total aortic arch replacement effectively diminishes intraoperative blood product usage and the incidence of lung injury-related complications. However, it does not demonstrate significant benefits in terms of mortality, cerebral infarction and other complications.

Objective To explore the effect of endoscopic ultrasonography(EUS)with different probes on the measurement of gastrointestinal submucosal tumor(SMT)diameter.Methods The clinical data of 356 patients(with a total of 372 lesions)initially diagnosed as SMT by EUS at the Second Affiliated Hospital of Army Medical University from January 2023 to June 2024 were analyzed retrospectively.The basic characteristics of the origin layers and pathological distribution of SMT were analyzed.The differences between the EUS-measured diameters and the actual diameters of SMT at different diameter ranges of lesions were compared.Taking the postoperative pathological diagnosis results as the gold standard,the effects of different clinicopathological features and probe types on the relative error in EUS-measured diameters of SMT were analyzed.Results Among the 372 gastrointestinal SMT lesions,lesions were more frequent in female patients,gastric lesions was the most common,and leiomyoma was the predominant pathological type.The accuracy of EUS in diagnosing SMT was 94.4%.A statistically significant difference was observed between the EUS-measured diameters and the actual diameters of SMT(P<0.05).There were significantly differences in various ranges of lesions between the EUS-measured diameters and the actual diameters(P<0.05).The gender,age,lesion location,and pathological type had no significant effect on the relative error of EUS-measured diameters(P>0.05);while probe types had a significant effect on the relative error of EUS-measured diameters(P<0.05).For lesions with an actual diameter of 2.0 to 3.9 cm,the relative error of SMT diameters measured by small-probe EUS was significantly greater than that by large-probe EUS(P<0.05).Conclusion Large-probe EUS exhibits a smaller relative error in measuring the diameter of SMT with a diameter of≥2.0 cm.Therefore,large-probe EUS is recommended for the examination of SMT with an estimated diameter exceeding 2.0 cm.

Objective:The Social Isolation Scale for people with type 2 diabetes mellitus (T2DM) was developed and tested for reliability and validity, which provided an effective tool for measuring the social isolation level of patients with T2DM.Methods:The initial scale was developed through literature review, qualitative interviews, and expert consultation. Convenience sampling method was used to select T2DM patients who met the inclusion and exclusion criteria for questionnaire survey. The item analysis method was used to select the items of the scale. Exploratory and confirmatory factor analyses were used to evaluate construct validity. The content validity of the scale was evaluated by the scale-level content validity index and the item-level content validity index. The criterion validity was verified by using the Lubben Social Network Scale-6 and the De Jong Gierveld Loneliness Scale. Reliability was tested through internal consistency and test-retest reliability.Results:Through literature review and qualitative interviews, 30 items of the scale were selected to form the first version scale. After two rounds of inquiries from 16 experts (expert authority coefficient = 0.897), the second version of the scale was formed. A total of 407 questionnaires were distributed in two stages using the second version scale. Among the 407 patients, there were 214 males and 193 females. Exploratory factor analysis extracted 4 common factors, with a cumulative variance contribution rate of 61.338%. The final scale was determined to include 4 dimensions and 16 items, with the dimensions being "social support network", "frequency of social participation", "satisfaction with interpersonal relationships", and "diabetes-related sense of isolation".The average content validity index at the scale level was 0.929, the content validity index at the item level was 0.830 - 1.000, and the criterion validity was - 0.647 and 0.681. The Cronbach′s α coefficient of the total scale was 0.822, and the test-retest reliability was 0.858.Conclusions:The Social Isolation Scale for people with T2DM has good reliability and validity. It is a reliable and valid tool for assessing social isolation in T2DM patients.

Objective:To evaluate the role of cannabinoid receptor 1 (CB1) in the spinal membrane in electroacupuncture (EA)-induced alleviation of morphine-triggered opioid-induced hyperalgesia (OIH) and the relationship with phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, in which intrathecal catheters were successfully implanted, were divided into 4 groups ( n=12 each) using a random number table method: normal saline group (NS group), morphine group (M group), morphine+ EA group (ME group), and morphine+ EA+ CB1 antagonist group (MEA group). The OIH model was established by intrathecal injection of morphine 15 μg (10 μl) twice a day for 7 consecutive days. The equal volume of normal saline 10 μl was given instead in NS group. EA of the " Yanglingquan" (GB34) and " Zusanli" (ST36) acupoints lasting 30 min was performed after the first administration of medication each day, with a current intensity of 2 mA and frequency of 2 Hz in ME group. In MEA group, morphine (15 μg) and CB1 antagonist AM251 30 μg (10 μl) were intrathecally injected twice a day for 7 consecutive days, with other treatments similar to those previously described in ME group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before administration (T 0) and on days 1, 3, 5 and 7 after administration (T 1-4). Rats were deeply anesthetized and sacrificed at T 3, 4 after administration, and the L 4-6 spinal cord tissues were collected for determination of the expression of membrane CB1, ERK1/2 and p-ERK1/2 by Western blot. Results:Compared with NS group, the MWT was significantly decreased and the TWL was shortened at T 3, 4 in M, ME and MEA groups, the expression of spinal membrane CB1 and p-ERK1/2 was significantly up-regulated at T 4 after administration in M group, and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with M group, the MWT was significantly increased and the TWL was prolonged at T 3, 4, and the expression of p-ERK1/2 was down-regulated at T 4 after administration in ME group ( P<0.05), no significant change was found in MWT or TWL at T 3, 4 in MEA group ( P>0.05), and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with ME group, the MWT was significantly decreased and the TWL was shortened at T 3, 4, and the expression of spinal membrane CB1 and p-ERK1/2 was up-regulated at T 4 after administration in MEA group ( P<0.05). Conclusions:Up-regulation of spinal membrane CB1 expression is involved in EA-mediated alleviation of morphine-induced OIH, which is associated with the inhibition of ERK1/2 phosphorylation in rats.

Objective:To carry out a systematic review of the development, introduction or validation of drug literacy assessment tools for adults at home and abroad, and to summarize and analyze the characteristics of the assessment tools.Methods:The research framework of the scoping review was used to systematically search 8 Chinese and English databases, such as China National Knowledge Infrastructure, China Biology Medicine disc, PubMed, Web of Science, and Embase. The search period was from database establishment to October 31, 2023. Studies on adult drug literacy assessment tools were screened and included, tool characteristics were extracted and analyzed, and ultimately the extracts were standardized for reporting.Results:A total of 31 articles that met the criteria were included, of which 26 were on the development and validation of assessment tools, three were on the localization and application of assessment tools, and two were on the revision of assessment tools, covering 33 assessment tools.Conclusions:It is needed to recognize the importance of drug literacy assessment, actively explore the diversity of drug literacy assessment tools, clarify the limitations of existing drug literacy assessment tools, further improve the reliability and validity of existing tools, continue to develop and introduce assessment tools suitable for China's national conditions, so as to increase the accuracy of drug literacy assessment.

Objective To explore the effect of endoscopic ultrasonography(EUS)with different probes on the measurement of gastrointestinal submucosal tumor(SMT)diameter.Methods The clinical data of 356 patients(with a total of 372 lesions)initially diagnosed as SMT by EUS at the Second Affiliated Hospital of Army Medical University from January 2023 to June 2024 were analyzed retrospectively.The basic characteristics of the origin layers and pathological distribution of SMT were analyzed.The differences between the EUS-measured diameters and the actual diameters of SMT at different diameter ranges of lesions were compared.Taking the postoperative pathological diagnosis results as the gold standard,the effects of different clinicopathological features and probe types on the relative error in EUS-measured diameters of SMT were analyzed.Results Among the 372 gastrointestinal SMT lesions,lesions were more frequent in female patients,gastric lesions was the most common,and leiomyoma was the predominant pathological type.The accuracy of EUS in diagnosing SMT was 94.4%.A statistically significant difference was observed between the EUS-measured diameters and the actual diameters of SMT(P<0.05).There were significantly differences in various ranges of lesions between the EUS-measured diameters and the actual diameters(P<0.05).The gender,age,lesion location,and pathological type had no significant effect on the relative error of EUS-measured diameters(P>0.05);while probe types had a significant effect on the relative error of EUS-measured diameters(P<0.05).For lesions with an actual diameter of 2.0 to 3.9 cm,the relative error of SMT diameters measured by small-probe EUS was significantly greater than that by large-probe EUS(P<0.05).Conclusion Large-probe EUS exhibits a smaller relative error in measuring the diameter of SMT with a diameter of≥2.0 cm.Therefore,large-probe EUS is recommended for the examination of SMT with an estimated diameter exceeding 2.0 cm.

Objective:To evaluate the role of cannabinoid receptor 1 (CB1) in the spinal membrane in electroacupuncture (EA)-induced alleviation of morphine-triggered opioid-induced hyperalgesia (OIH) and the relationship with phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, in which intrathecal catheters were successfully implanted, were divided into 4 groups ( n=12 each) using a random number table method: normal saline group (NS group), morphine group (M group), morphine+ EA group (ME group), and morphine+ EA+ CB1 antagonist group (MEA group). The OIH model was established by intrathecal injection of morphine 15 μg (10 μl) twice a day for 7 consecutive days. The equal volume of normal saline 10 μl was given instead in NS group. EA of the " Yanglingquan" (GB34) and " Zusanli" (ST36) acupoints lasting 30 min was performed after the first administration of medication each day, with a current intensity of 2 mA and frequency of 2 Hz in ME group. In MEA group, morphine (15 μg) and CB1 antagonist AM251 30 μg (10 μl) were intrathecally injected twice a day for 7 consecutive days, with other treatments similar to those previously described in ME group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before administration (T 0) and on days 1, 3, 5 and 7 after administration (T 1-4). Rats were deeply anesthetized and sacrificed at T 3, 4 after administration, and the L 4-6 spinal cord tissues were collected for determination of the expression of membrane CB1, ERK1/2 and p-ERK1/2 by Western blot. Results:Compared with NS group, the MWT was significantly decreased and the TWL was shortened at T 3, 4 in M, ME and MEA groups, the expression of spinal membrane CB1 and p-ERK1/2 was significantly up-regulated at T 4 after administration in M group, and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with M group, the MWT was significantly increased and the TWL was prolonged at T 3, 4, and the expression of p-ERK1/2 was down-regulated at T 4 after administration in ME group ( P<0.05), no significant change was found in MWT or TWL at T 3, 4 in MEA group ( P>0.05), and the expression of spinal membrane CB1 was significantly up-regulated at T 3, 4 after administration in ME and MEA groups ( P<0.05). Compared with ME group, the MWT was significantly decreased and the TWL was shortened at T 3, 4, and the expression of spinal membrane CB1 and p-ERK1/2 was up-regulated at T 4 after administration in MEA group ( P<0.05). Conclusions:Up-regulation of spinal membrane CB1 expression is involved in EA-mediated alleviation of morphine-induced OIH, which is associated with the inhibition of ERK1/2 phosphorylation in rats.