Objective:To discuss the effect of asiatic acid(AA)on the inflammation and oxidative stress damage induced by lipopolysaccharide(LPS)in the primary cultured hippocampus neurons,and to clarify its mechanism.Methods:The primary cultured rat hippocampus neurons(cell purity identified by immunofluorescence staining)were divided into control group,LPS(10 mg·L-1)group,and LPS+AA group(10 mg·L-1 LPS+10,20,and 40 μmol·L-1 AA),AA group(20 μmol·L-1 AA),ML385 group[10 μmol·L-1 nuclear factor erythroid 2-related factor(Nrf2)inhibitor],and LPS+ML385+AA group(10mg·L-1 LPS+10 μmol·L-1 ML385+20 μmol·L-1 AA).After drug treatment,methylthiazolyldiphenyl-tetrazolium bromide(MTT)method was used to detect the survival rates of the hippocampus neurons in various groups;lactate dehydrogenase(LDH)kit was used to detect the LDH leakage rates of the hippocampus neurons in various groups;enzyme linked immunosorbent assay(ELISA)kit was used to detect the expression levels of inflammatory factors[interleukin(IL)-1β and tumor necrosis factor(TNF)-α]and the activities of superoxide dismutase(SOD)and malondialdehyde(MDA)levels in the hippocampus neurons in various groups;Griess method was used to detect the nitric oxide(NO)levels in supernatant of the hippocampus neurons in various groups;immunofluorescence staining was used to detect the expressions of Nrf2 and heme oxygenase-1(HO-1)proteins in the hippocampus neurons in various groups;Western blotting method was used to detect the expression levels of Nrf2,HO-1,nuclear factor-kappa B(NF-κB),and B-cell lymphoma 2(Bcl-2)proteins in the hippocampus neurons in various groups.Results:Compared with control group,the survival rate of the hippocampus neurons,SOD activity,and Bcl-2 expression level in the cells in LPS group were significantly decreased(P＜0.01),while the LDH leakage rate,expression levels of IL-1β and TNF-α,MDA level,and NO level,as well as the expression level of NF-κB protein,were significantly increased(P＜0.01);the fluorescence intensities and expression levels of Nrf2 and HO-1 proteins in hippocampus neurons were significantly decreased(P＜0.01).Compared with LPS group,the survival rates of hippocampus neurons,SOD activities,and expression levels of Bcl-2 in the cells in LPS+10 μmol·L-1 AA group and 20 μmol·L-1 AA group were significantly increased(P＜0.01),while the LDH leakage rates,expression levels of IL-1β and TNF-α,MDA levels,and NO levels,as well as expression levels of NF-κB protein,were significantly decreased(P＜0.05 or P＜0.01),and the fluorescence intensities and protein expression levels of Nrf2 and HO-1 in the cells were significantly increased(P＜0.01).Compared with LPS+20 μmol·L-1 AA group,the fluorescence intensities of Nrf2 and HO-1 in the cells in LPS+ML385+AA group were significantly decreased(P＜0.01),and the expression levels of Nrf2 protein in the nucleus and cytoplasm,the expression levels of HO-1 and Bcl-2 proteins in the cells were significantly decreased(P＜0.01),while the expression level of NF-κB protein was significantly increased(P＜0.01).Conclusion:AA can improve LPS-induced inflammation and oxidative stress damage in the primary cultured rat hippocampus neurons,and its mechanism may be related to the activation of the Nrf2/HO-1 signaling pathway.

Neuraxial labor analgesia effectively alleviates maternal pain and enhances pain control dur-ing delivery.However,breakthrough pain(BTP)following labor analgesia may occur in some parturients after neuraxial anesthesia,potentially prolonging labor progression,compromising maternal-fetal safety,and in-creasing the risk of cesarean delivery.Therefore,understanding and managing breakthrough pain are crucial in clinical practice.This review synthesizes current evidence on risk factors,neuraxial anesthesia modalities,ma-intenance techniques,and rational use of analgesic drugs to reduce BTP.

Objective To explore the application value of turbo spin echo-diffusion weighted imaging(TSE-DWI)sequences in 3.0 T rectal cancer MRI examination by comparing the image quality difference be-tween TSE-DWI and conventional echo planar imaging-diffusion weighted imaging(EPI-DWI)sequences.Methods The medical records of forty-two patients with newly diagnosed rectal cancer confirmed by colonos-copy were prospectively collected.All patients simultaneously underwent both TSE-DWI and EPI-DWI se-quence scans.The image quality of the two groups performed the subjective evaluation(lesion contrast,mag-netic susceptibility artifacts,geometric distortion)and objective evaluation[signal-to-noise ratio(SNR),con-trast-to-noise ratio(CNR),contrast,etc].Results In the subjective evaluation,compared with the conven-tional EPI-DWI sequences,the proportions of subjective score 3-5 points for the lesion contrast,magnetic susceptibility artifacts and geometric distortion in the TSE-DWI sequences lesions were over 95％,which all were higher the conventional EPI-DWI sequences;among them,the differences in the subjective scoring results of magnetic susceptibility artifacts and geometric deformation were statistically significant(x2=12.464,5.610,P＜0.05),while there was no statistical significance in lesion contrast(x2=2.363,P＞0.05).In the objective evaluation,SNR and CNR in the TSE-DWI sequences all were higher than those in the conventional EPI-DWI sequences,in which the difference in CNR was statistically significant(Z=—5.645,P＜0.05),while the difference in SNR was not statistically significant(Z=—1.057,P＞0.05).The contrast in the TSE-DWI sequences was lower than that in the conventional EPI-DWI sequences,and the difference was statistical-ly significant(t=3.012,P＜0.05).Conclusion The TSE-DWI sequence images have small geometric de-formation and few magnetic susceptibility artifacts,the image quality is superior to the EPI-DWI sequences.Especially in 3.0T rectal cancer MRI plain scan,the patients with gas accumulation in the intestinal lumen of rectal lesion could directly adopt the TSE-DWI sequences by replacing the conventional EPI-DWI sequences in order to increase the clinical application efficiency and image quality.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To investigate the expression changes of interferon gene stimulating factor(STING)and E-box zinc finger binding protein 1(ZEB1)in elderly cervical cancer(CCA)patients and their correlation with human papillomavirus(HPV)infection.Methods Sixty-two patients with CCA who underwent patho-logical examination in this hospital from January 2021 to September 2022 were selected as the CCA group,65 patients with cervical intraepithelial neoplasia(CIN)as the CIN group,and 63 patients with normal cervix as the control group.The positive expression rates of cervical STING and ZEB1 and high-risk HPV infection in each group were observed and recoraded.The correlation of STING and ZEB1 levels with clinicopathological features of CCA and high-risk HPV infection was analyzed.Results The positive expression rates of STING and ZEB1 in CCA group were higher than those in CIN group and control group,and the level of ZEB1 in CIN group was higher than that in control group,with statistical significance(P＜0.05).The detection rates of HPV16 and 18 in CCA group were higher than those in CIN group and control group,and the detection rates of HPV16 and 18 in CIN group were higher than those in control group,the differences were statistically sig-nificant(P＜0.05).The infiltration depth and FIGO stage of CCA patients were correlated with the positive expression rates of STING and ZEB1,the degree of tumor differentiation and lymph node metastasis were cor-related with the positive expression rates of STING(P＜0.05),and the positive expression rates of STING and ZEB1 in CCA patients were positively correlated with the infection rates of HPV16 and 18(P＜0.05).Conclusion The positive expression levels of STING and ZEB1 proteins in the CCA group are higher than those in the control group and CIN group,and their expression levels were related to FIGO staging and depth of cervical cancer infiltration.STING and ZEB1 proteins are positively correlated with HPV16 and 18 infec-tion,and STING and ZEB1 proteins may jointly act with HPV16 and 18 on the occurrence and development of CCA.

OBJECTIVE To observe the effect of Huangjing Jiangya Decoction on blood pressure and sleep in patients with hy-pertension of qi-deficiency type accompanied by insomnia.METHODS 73 patients with hypertension of qi-deficiency type accompa-nied by insomnia who met the inclusion criteria were selected and randomly divided into an observation group of 36 cases and a control group of 37 cases.The control group was treated with amlodipine besylate tablets,and the observation group was given Huangjing Jian-gya Decoction oral treatment on the basis of the control group.Both groups were treated continuously for 8 weeks.The changes in TCM syndrome scores,office blood pressure monitoring(OBPM),home blood pressure monitoring(HBPM),24-hour ambulatory blood pressure monitoring(ABPM),Pittsburgh Sleep Quality Index(PSQI)scores and clinical efficacy of the two groups of patients before and after treatment were observed.RESULTS After treatment,the TCM syndrome scores in the observation group were significantly decreased(P<0.05,P<0.01),which were better than the control group(P<0.01);OBPM and HBMP in both groups were signifi-cantly reduced(P<0.05,P<0.01),the observation group was better than the control group(P<0.05,P<0.01);the ABPM of the observation group was significantly reduced(P<0.01),which was better than the control group(P<0.05,P<0.01);the sleep quali-ty,sleep latency,sleep duration,daytime dysfunction score and PSQI total score of the observation group were significantly decreased(P<0.01),which were better than those in the control group(P<0.05,P<0.01);the clinical efficacy of hypertension and insomnia in the observation group was both better than the control group(P<0.01).CONCLUSION Huangjing Jiangya Decoction combined with amlodipine can improve the symptoms of patients with hypertension of qi-deficiency type accompanied by insomnia,lower blood pressure,improve sleep quality,shorten sleep latency,alleviate daytime dysfunction,and has good clinical efficacy.

Objective:This study aims to analyze the clinical characteristics of elderly patients with lung adenocarcinoma and to construct a predictive model for assessing their survival.Methods:We conducted a retrospective analysis of clinical data sourced from the SEER database for patients aged 60 years or older who were diagnosed with lung adenocarcinoma between 2013 and 2018.Cox regression analysis was employed to identify independent prognostic factors affecting the survival of elderly lung adenocarcinoma patients, leading to the development of a nomogram model.The discriminative ability and calibration of the nomogram were assessed using the C-index and calibration curve.Each patient's total risk score was calculated based on the predictive model, and patients were stratified according to the quartiles of their total risk scores.The Kaplan-Meier method and Log-rank test were utilized to evaluate survival differences among the identified risk groups.Results:Among 38, 852 lung adenocarcinoma patients, 17, 200 were males and 21, 652 were females.Significant differences in survival rates were observed among lung adenocarcinoma patients based on age, gender, marital status, histological grade, TNM stage, tumor size, and the presence of bone, brain, or liver metastases, as well as the type of treatment received, including surgical treatment, radiation therapy, and chemotherapy(all P<0.001).The C-index of the training model was 0.815(95% CI: 0.811-0.819), while the validation model yielded a C-index of 0.810(95% CI: 0.804-0.816).The prediction model demonstrated higher Area Under Curve(AUC)values of 0.746, 0.768, and 0.775 for 1-year, 3-year, and 5-year survival in the modeling dataset, respectively, and 0.747, 0.770, and 0.777 in the validation dataset.Furthermore, the risk stratification model effectively distinguished patients at varying levels of risk( P<0.001). Conclusions:Age, gender, marital status, histological grade, TNM stage, tumor size, and the presence of bone, brain, and liver metastases, along with treatment modalities such as surgery, radiotherapy, and chemotherapy, were identified as independent prognostic factors for elderly patients with lung adenocarcinoma.The risk prediction model developed in this study effectively differentiates between patients at varying levels of risk, which holds significant implications for predicting treatment responses in elderly lung adenocarcinoma patients and advancing the practice of precision medicine.

Objective:To explore the demand and actual supply of community-based care services for the elderly residents and the factors that affecting care mode for them in the context of rapid urbanization and population aging in China.Methods:Based on the cross-sectional data of the seventh China Longitudinal Survey on Health and Longevity(CLHLS)(2018), 15 854 elderly residents aged 60 and above were selected as the research population.Logistic regression method was used to analyze the patterns of community-based care services and their influencing factors.Results:Among 15 854 elderly residents, 6 912(43.60%)were male and 8 942(56.40%)were female.The results of activities of daily living(ADL)evaluation showed that 11 109 elderly residents could take care of themselves completely, and 3 889 elderly residents were disabled.The disability rate was 25.93%.The proportion of social services that elderly town dwellers expect the community to provide is higher than those living in cities and rural areas in terms of daily care, spiritual care, providing health care knowledge, and dealing with neighborhood disputes.From the perspective of social services actually provided by the community, in addition to providing home-based care, the proportion of community services available to the elderly living in towns and rural areas are similar, but significantly lower than the proportion of social services provided for elderly city dwellers.Age, marital status, residence, cultural differences, health status, source of life and living preference had significant impacts on the choice of care demand patterns.Those of older age( OR=2.29, 95% CI: 1.04-5.03 for 70-79 years old; OR=2.94, 95% CI: 1.38-6.25 for elderly 80 years old or above), having no spouse( OR=3.50, 95% CI: 2.49-4.92), and with higher levels of disability( OR=4.24, 95% CI: 3.12-5.77 for mild disability; OR=7.54, 95% CI: 5.19-10.95 for moderate disability; OR=10.50, 95% CI: 7.59-14.53 for severe disability)are more inclined to choose socialized care. Conclusions:In the process of rapid urbanization in China, the demands for care services of elderly living in towns has increased, but the actual care services provided for them by the communities are yet to be improved.Moreover, elderly town dwellers are still inclined to family care, the same as those of elderly rural dwellers.

{L-End}Objective To establish the construction of intelligent management system for equipment and supplies of medical rescue teams for provincial nuclear and radiation accidents, based on modern Internet+ Internet of Things. {L-End}Methods The current status and requirements of emergency equipment and supplies allocation and management of medical emergency teams for provincial nuclear and radiation accidents were analyzed. Utilizing technologies such as Internet of Things, low-power Bluetooth, and radio frequency identification, an intelligent management system for medical rescue teams, its equipment and supplies for provincial nuclear and radiation accidents was designed. {L-End}Results The intelligent management system for medical rescue teams, its equipment and supplies for nuclear and radiation accidents was able to perform the inventory warning, expiration date warning, maintenance alert, and warning for emergency personnel health status, based on dynamic management of rescue personnel, equipment and supplies. It provided an effective support for on-site commanders in making emergency decisions. {L-End}Conclusion The use of Internet+Internet of Things technology can achieve intelligent management for medical rescue teams and its equipment and supplies can effectively improve the level of personnel and equipment support for the rescue of nuclear and radiation accidents at the provincial level.

Objective:To analyze whether the sample of elderly subjects in clinical trials of prostate cancer drugs is representative.Methods:From the level of trial design, the age distribution of subjects in clinical trials of prostate cancer drugs for elderly patients from January 2019 to December 2021 was inquired on the platform of drug clinical trial registration and information disclosure.From the actual enrollment level, the prostate cancer drug clinical trials initiated and completed by a hospital from January 2010 to June 2022 were collected.The age information of subjects in all centers was collected for multicenter trials with a summary report, and the age data of subjects in the center was collected for trials without a summary report or single-center trials.The average age of prostate cancer onset and the incidence of prostate cancer in different age groups were compared with the Chinese Cancer Registry System, so as to compare whether the two were consistent.Results:Most of the trials(72.1%、44/61)did not set upper age limit at the protocol design level.Phase Ⅲ and phase Ⅳ trials did not set an upper age limit for enrolled subjects in the protocol.From the actual enrollment level, a total of 19 studies were included in this study, with 1 402 subjects, and the average age of subjects was 67.1±8.6 years old, which was significantly different from the average age of prostate cancer in China and Beijing(all P<0.001). The age group with the largest number of participants was 60-64 years old(34.2%、479/1 402). The population aged ≥75 years was the least(21.5%, 301/1 402), which was different from the high incidence age group of prostate cancer in China in 2017(421.77/100 000). Conclusions:Clinical trials of prostate cancer drugs are designed to cover all age groups of elderly patients, but the actual sample representation of the enrolled elderly subjects is insufficient.Under the premise of protecting the safety of subjects, the trial population who are matched for the average age of prostate cancer onset and the incidence of prostate cancer in age groups, should be gradually increased.