AIM: To investigate the diagnostic and prognostic value of differential expression of Cyclin D1 and p53 in eyelid tumors.METHODS: This retrospective study enrolled patients who underwent surgical resection for eyelid tumors at our hospital between March 2018 and March 2023. Participants were categorized into benign and malignant groups based on tumor characteristics. Clinical data were collected. Genetic data for eyelid tumors were obtained from the GEO database, and differential gene analysis, including volcano plot visualization and KEGG pathway enrichment analysis, was performed using the Sangerbox 3.0 platform. Immunohistochemistry was used to detect the expression levels of Cyclin D1, p53, and BAX in tissue samples. Correlations with clinical features were analyzed using Spearman analysis, and prognostic factors were identified via Logistic regression analysis.RESULTS: This study included 69 patients with eyelid tumors(78 eyes), categorized into a benign group(37 patients, 41 eyes)and a malignant group(32 patients, 37 eyes)based on tumor characteristics. There were significant differences between the two groups in histological subtype, TNM staging, vascular invasion, differentiation status, and local infiltration(all P<0.05). Among benign tumors: pigmented nevi in 11 eyes(27%), hemangiomas in 9 eyes(22%), squamous cell papillomas in 5 eyes(12%), epidermoid cysts in 5 eyes(12%), seborrheic keratoses in 4 eyes(10%), neurofibromas in 3 eyes(7%), and both calcifying epithelioma and xanthelasma in 2 eyes each(5%); among malignant tumors: basal cell carcinoma in 18 eyes(49%), meibomian gland carcinoma in 8 eyes(22%), squamous cell carcinoma in 5 eyes(14%), sebaceous gland carcinoma in 4 eyes(11%), lymphoma and malignant melanoma each in 1 eye(3%). At the follow-up cutoff date of March 2025, the 2-year survival rate in the benign group(95%)was significantly higher than that in the malignant group(78%; P<0.05). Bioinformatics analysis identified 4 103 differentially expressed genes, including Cyclin D1, p53, and BAX, which were predominantly involved in pathways such as the p53 signaling pathway and calcium-related signaling. Spearman analysis revealed that local invasion(rs=0.71, P<0.05)and TNM stage(rs=0.73, P<0.05)correlated with Cyclin D1 expression; local invasion(rs=0.76, P<0.05)and histological subtype(rs=0.65, P<0.05)correlated with p53 expression. Logistic regression results indicated that Cyclin D1, p53, TNM staging, and local invasion were prognostic risk factors. ROC curve analysis demonstrated that the combined detection of these four indicators had the highest predictive value for prognosis(AUC=0.83).CONCLUSION: High expression of cyclin D1 and p53 serves as molecular markers for distinguishing benign from malignant eyelid tumors and assessing prognosis. Combined detection of these markers with TNM staging and local invasion demonstrates high predictive value for prognosis.

Objective: To explore the correlation between blind box consumption and non-suicidal self-injury(NSSI) among middle school students, so as to provide new theoretical insights for the prevention of NSSI. Methods: Using stratified random cluster sampling method, 2 807 middle school students aged 11-19 years old were selected from Hunan and Gansu provinces from November 2024 to March 2025. The blind box consumption questionnaire and Functional Assessment of Self mutilation Scale were administered to collect data on students blind box consumption frequency, as well as NSSI behavior. The χ 2 test was used to compare differences in the distribution of NSSI across different groups. Multivariate Logistic regression analysis was performed to infer the correlation and gender differences. Results: A total of 15.3% of middle school students reported having at least one NSSI incident in the past year, among which the reported rates of occasional NSSI (1-4 times) and repeated NSSI (≥5 times) were 5.5% and 9.8% respectively. The results of univariate analysis showed that there was statistically significant different in NSSI distribution among groups with different blind box consumption frequencies ( χ 2=55.72, P <0.05). After adjusting for confounding factors such as age, gender, school stage, family type, discipline style, pocket money, impulsiveness and emotion management, the results of multiple Logistic regression models showed that compared with the group without blind box consumption, the risks of "occasional NSSI" and "repeated NSSI" were higher in the group with blind box consumption ( OR =1.54, 1.66), and the frequency of blind box consumption(continous variable) was positively correlated with the risks of "occasional NSSI" and "repeated NSSI" among middle school students ( OR =1.26, 1.34)(all P <0.05).After gender stratification, the consumption behavior of blind boxes and the frequency of blind box consumption (continuous variable) of boys and girls were associated with "repeated NSSI"(boys: OR =1.61, 1.32, girls: OR =1.65, 1.35), and only in the male group was a correlation between blind box consumption and "occasional NSSI" observed ( OR =2.27) (all P <0.05). Conclusion Blind box consumption may be related to NSSI among middle school students, and there are gender differences in its correlation with NSSI among middle school students.

Objective To analyze the diagnostic value of serum biomarkers in patients with pulmonary tuberculosis complicated by invasive pulmonary aspergillosis.Methods A retrospective collection of laboratory test results,including blood analysis,liver function,lymphocyte counts,and cytokine levels,from 54 patients diagnosed with pulmonary tuberculosis and invasive pulmonary aspergillosis admitted to the Third People's Hospital of Kunming between January 2021 and May 2024.Additionally,70 patients with simple pulmonary tuberculosis and 50 healthy individuals were collected as control groups to compare serum biomarker levels across the three groups and analyze relevant factors and diagnostic value for pulmonary tuberculosis patients with invasive pulmonary aspergillosis.Results Among different age groups,the incidence of pulmonary tuberculosis with invasive pulmonary aspergillosis was 29 cases(53.7％)in youth,15 cases(27.8％)in middle age,and 10 cases(18.5％)in the elderly.In terms of gender distribution,there were 41 males(75.9％)and 13 females(24.1％).The serum levels of CRP(6.85[2.10,27.0])ng/L,PCT(0.05[0.05,0.15])ng/mL,RBC(4.55±0.65)× 1012/L,Hb(129.13±19.10)g/L,TP(66.23±6.82)g/L,ALB(37.03±4.77)g/L,and CHOL(4.30[3.71,4.91])mmol/L in the invasive pulmonary aspergillosis group showed no significant difference compared to the simple tuberculosis group and healthy control group(P＞0.05).The levels of CD3+T,CD4+T,and CD8+T in the invasive pulmonary aspergillosis group were significantly lower than those in the simple tuberculosis group and healthy control group(P＜0.05).The levels of IL-2,IL-4,IL-5,IL-8,IL-10,IL-12p70,IFN-α,and TNF-α in the invasive pulmonary aspergillosis group were significantly higher than those in the healthy control group(P＜0.05);IL-8,IL-12p70,and IFN-α were also higher compared to the simple tuberculosis group,with statistical significance(P＜0.05).Conclusion The population with pulmonary tuberculosis complicated by invasive pulmonary aspergillosis is predominantly male and younger.The serum indicators of infection severity and nutritional status in these patients are similar to those with simple tuberculosis and lack specificity;however,their immune function is significantly lower than that of simple tuberculosis patients.Multiple cytokines are elevated,particularly IL-8,IL-12p70,and IFN-α,which can aid in the differential diagnosis of pulmonary tuberculosis infection.

BACKGROUND:Post and core restoration is a common choice for tooth defects,but the repair effects of various post and core materials are different. OBJECTIVE:To evaluate the stress distribution at the post and core,tooth root,and bonding agent site of post and core models made of different elastic modulus post and core materials using finite element method. METHODS:A three-dimensional root canal treated maxillary central incisor model was built using three-dimensional modeling software,which was restored with a full ceramic crown.The post and core materials in the restoration used nanoceramic resin(elastic modulus=12.8 GPa),composite resin(elastic modulus=16 GPa),hybrid ceramic(elastic modulus=34.7 GPa),glass ceramic(elastic modulus=95 GPa),titanium alloy(elastic modulus=112 GPa),and zirconia(elastic modulus=209.3 GPa).The model was fixed in cortical bone.A 100 N concentrated force of 45° from the long axis of the tooth was applied to 1/3 of the crown and tongue side of the central incisor.The stress distribution of the post and core,dentin,and tooth-root bonding agent in the model was repaired by the maximum principal stress criterion. RESULTS AND CONCLUSION:(1)When the post and core materials with higher elastic modulus was used,the post-core stress in the repair model was more concentrated.When the elastic modulus of the post and core materials(nanoceramic resin and composite resin)was close to dentin,the stress distribution of the post and core was more uniform.The stress distribution of dentin in all restoration models was similar regardless of post and core materials.When the post and core with higher elastic modulus was used,more stress concentration was shown at the post and root bonding agent in the repair model.(2)The maximum stress values at the post and core,tooth root,and the bonding agent site of post and tooth root in the nanoceramic resin model were 31.00,33.21,and 0.51 MPa,respectively.The maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root in the composite resin model were 36.84,33.14,and 0.59 MPa,respectively.In the mixed ceramic model,the maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root were 64.05,32.83,and 1.00 MPa,respectively.In the glass ceramic model,the maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root were 112.30,32.69,and 1.73 MPa,respectively.In the titanium alloy model,the maximum stress values of the post and core,tooth root,and the bonding agent between the post and tooth root were 120.00,32.17,and 1.86 MPa,respectively.In the zirconia model,the maximum stress values of the post and core,tooth root,and the bonding agent between the post and tooth root were 148.80,31.85,and 2.28 MPa,respectively.(3)The higher the elastic modulus of the post and core material,the higher the maximum stress at the post and core during restoration.The elastic modulus of the post and core material had no significant effect on the maximum stress of the dental bonding agent and dentin.

Objective Utilizing patient journey mapping to decipher disease management behaviors,barriers,and needs in young and middle-aged liver transplant recipients,providing implications for self-management optimization and quality of life improvement.Methods Using purposive sampling,12 young and middle-aged liver transplant patients who attended outpatient clinics or were hospitalized in liver transplant center of a tertiary hospital in Qingdao were selected for semi-structured interviews from September to November 2024.Thematic extraction and analysis were performed using Colaizzi's 7-step analysis,ultimately resulting in the development of a patient journey map.Results The journey stages were divided into transplantation decision-making period,transplantation waiting period,perioperative period,and post-discharge management period,and the journey key elements were designed as behaviors,barriers,and needs.A total of 25 themes were extracted,including behaviors(such as referrals to higher-level hospitals,verification of treatment options),barriers(such as lack of decision-making autonomy,health information-seeking barriers),and needs(such as shared decision-making,financial assistance).Ultimately,resulting in a map of the disease management journey for young and middle-aged liver transplant recipients.Conclusion The behaviors,barriers,and needs in disease management among young and middle-aged liver transplant recipients demonstrate distinct phase-specific patterns.Healthcare providers should deliver precise and dynamic interventions tailored to each clinical phase,aiming to foster optimal self-management behaviors,address phase-specific banriers,and meet evolving patient needs throughout the transplant continuum.

Objective:To assess the effect of transversus abdominis plane block (TAPB) with liposomal bupivacaine and general anesthesia on postoperative delirium (POD) in elderly patients with prior novel coronavirus pneumonia (COVID-19).Methods:In this randomized double-blind controlled study, 416 patients of either sex, aged 65-90 yr, weighing 50-90 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, diagnosed as having COVID-19 within 6 months prior to surgery, who underwent laparoscopic colorectal cancer surgery under combination of elective TAPB and combined intravenous-inhalational general anaesthesia at Qingdao Municipal Hospital from June 2023 to December 2024, were selected. The patients were divided into liposomal bupivacaine group ( n=208) and bupivacaine hydrochloride group ( n=208) using the random number table method. After induction of anaesthesia, bilateral TAPB was performed with liposomal bupivacaine injectio 266 mg (40 ml) in liposomal bupivacaine group and with 0.5% bupivacaine hydrochloride 40 ml in bupivacaine hydrochloride group. The primary outcome measure was the occurrence of POD within 7 days after surgery. Secondary outcome measures included severity of POD, pain scores at 24, 48 and 72 h after operation, the rate of postoperative rescue analgesia and consumption of morphine, duration of post-anesthesia care unit stay, and length of hospital stay. The occurrence of complications such as death, reoperation, atelectasis and pneumonia was recorded at 30 days after surgery. Results:Compared with bupivacaine hydrochloride group, the incidence of POD was significantly decreased (21.5% [43/200]versus 12.0% [24/200]), pain scores at 24, 48 and 72 h after operation were decreased, the rate of postoperative rescue analgesia and consumption of morphine were decreased, and the duration of post-anesthesia care unit stay and length of hospital stay were shortened in liposomal bupivacaine group ( P<0.05). There was no significant difference in the severity of POD and the case fatality rate and related complications within 30 days after surgery between the two groups ( P>0.05). Conclusions:Liposomal bupivacaine TAPB combined with general anesthesia can reduce the development of POD in elderly patients with prior COVID-19.

Objective:To evaluate the relationship between preoperative concentrations of soluble triggering receptor expressed on myeloid cells 2 (sTREM2) in cerebrospinal fluid (CSF) and postoperative delirium (POD) in patients undergoing total knee/hip arthroplasty.Methods:Six hundred and twenty-five patients of either sex, aged 50-90 yr, weighing 50-80 kg, with American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ, with the preoperative Mini-Mental State Examination score > 23, who underwent elective knee/hip arthroplasty under combined spinal-epidural anesthesia at Qingdao Municipal Hospital from January 2022 to December 2023, were selected. The CSF specimens 2 ml were withdrawn from the subarachnoid space after successful subarachnoid puncture for determination of the concentrations of sTREM2, Amyloid beta protein (Aβ 42), total tau protein (T-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay. POD was assessed using the Confusion Assessment Method. Patients were divided into POD group and non-POD group based on whether POD occurred. Logistic regression was used to identify the risk and protective factors for POD. The performance of CSF sTREM2 concentration combined with CSF biomarker levels in predicting POD was evaluated using the receiver operating characteristic (ROC) curve and clinical decision curve. The mediating effect of CSF biomarker concentrations in the relationship between CSF sTREM2 concentration and POD was analyzed. Results:Five hundred and nineteen patients were finally included, with 112 patients in POD group and 407 patients in non-POD group. The results of logistic regression analysis showed that the elevated preoperative sTREM2 concentration in CSF was the risk factor for POD after adjusting for multiple confounding factors such as age, sex, body mass index, years of education, Mini-Mental State Examination score, history of smoking, history of drinking, hypertension, diabetes mellitus and coronary heart disease. The area under the ROC curve of the preoperative sTREM2 concentration in CSF in predicting POD was 0.716, and the area under the ROC curve of the preoperative sTREM2 concentration in CSF combined with CSF biomarkers in predicting POD was 0.796. This model had high clinical application value and predictive efficacy. The relationship between the preoperative sTREM2 concentration in CSF and POD was partially mediated by the CSF p-tau concentration (proportion of mediated effect 24.67%) and t-tau protein concentration (proportion of mediated effect 17.33%).Conclusions:The elevated preoperative concentration of sTREM2 in CSF is a risk factor for POD in patients undergoing total knee/hip arthroplasty, and concentrations of t-tau and p-tau in CSF play a mediating role in the relationship between the preoperative CSF sTREM2 concentration and POD.

Objective:To evaluate the association between postoperative delirium (POD) and preoperative frailty in elderly patients undergoing knee or hip arthroplasty.Methods:This nested case-control study utilized medical records from elderly patients who underwent knee or hip arthroplasty under combined spinal-epidural anesthesia at Qingdao Municipal Hospital between September 2021 and May 2023. Participants were divided into 2 groups based on clinically diagnosed POD: POD group ( n=53) and non-POD group ( n=256). Univariate analysis was conducted on suspected influencing factors, and logistic regression analysis was utilized to identify the risk factors for POD. Receiver operating characteristic and clinical decision curves were plotted to evaluate the predictive performance of these risk factors for POD. Mediation analysis was performed, and a clinically applicable nomogram was constructed to achieve visual prediction of outcomes. Results:There were statistically significant differences in age, preoperative frailty, body mass index, American Society of Anesthesiologists Physical Status classification, Memorial Delirium Assessment Scale scores, and concentrations of Aβ 42, Aβ 40, phosphorylated tau protein (p-tau protein) and tau protein, Aβ 42/tau ratio and Aβ 42/p-tau ratio in cerebrospinal fluid (CSF) between non-POD group and POD group ( P<0.05). Preoperative frailty was a risk factor for POD ( P<0.05). Mediation analysis revealed that the association between preoperative frailty and POD was mediated by CSF tau protein concentrations. The area under the receiver operating characteristic curve of preoperative frailty and CSF biomarker concentrations in predicting POD was 0.974 ( P<0.05). The clinical decision curve demonstrated that the model combining the preoperative frailty and CSF biomarker concentrations predicted a higher net benefit ( P<0.05). The clinical decision curve showed that the model combining preoperative frailty and CSF biomarker concentrations predicted a higher net benefit. Conclusions:Preoperative frailty is a risk factor for POD in elderly patients undergoing knee or hip arthroplasty, and its combination with CSF biomarker concentrations can effectively predict the occurrence of POD. CSF tau concentration mediates the association between preoperative frailty and development of POD.

Objective:To evaluate the association between the preoperative aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and postoperative delirium (POD) in patients undergoing total knee/hip arthroplasty.Methods:In this nested case-control study, medical records from patients, aged ≥55 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with Mini-Mental State Examination (MMSE) scale score >24 on preoperative day 1, scheduled for elective total knee/hip arthroplasty under combined spinal-epidural anesthesia at Qingdao Municipal Hospital between November 2021 and December 2023, were collected. POD was assessed using the Confusion Assessment Method. Patients were categorized into POD and non-POD groups based on the occurrence of POD. Logistic regression was employed to identify protective and risk factors for POD. The predictive performance of preoperative AST/ALT ratio alone and its combination with cerebrospinal fluid (CSF) biomarker concentrations for POD was evaluated using receiver operating characteristic curves, and the clinical utility of the prediction models was assessed using decision curve analysis. Mediation analysis was conducted to examine the mediation role of CSF biomarkers in the relationship between the preoperative AST/ALT ratio and POD. Restricted cubic splines were used to assess the nonlinear relationship between the preoperative AST/ALT ratio and POD.Results:A total of 460 patients were finally included, with 49 in POD group and 411 in non-POD group. After adjustment for multiple confounding factors including age, sex, educational level, MMSE score, history of hypertension, history of diabetes, history of smoking and history of alcohol use, multivariable logistic regression identified that the higher preoperative AST/ALT ratio, CSF total tau protein (t-tau) and phosphorylated tau protein (p-tau) concentrations were independent risk factors for POD, whereas lower CSF β-amyloid 42 (Aβ 42) concentration, Aβ 42/t-tau ratio and Aβ 42/p-tau ratio served as protective factors ( P<0.05). The area under the receiver operating characteristic curve of the preoperative AST/ALT ratio combined with CSF biomarkers in predicting POD was 0.939 ( P<0.001), demonstrating high clinical efficacy. After adjusting for age, educational level, sex, MMSE score, history of hypertension, history of diabetes, history of smoking, history of alcohol use and body mass index, restricted cubic splines revealed a nonlinear relationship between preoperative AST/ALT levels and the probability of POD, and the probability of POD increased with rising ratios when the preoperative AST/ALT ratio ranged from 1.09 to 1.40 ( Poverall < 0.05, Pnonlinear <0.05). After stratification by sex, the preoperative AST/ALT ratio demonstrated a linear relationship with the probability of POD ( Poverall <0.05, Pnonlinear>0.05). Mediation analysis indicated that the relationship between the preoperative AST/ALT ratio and POD was partially mediated by CSF p-tau concentration (proportion mediated 18.1%), CSF t-tau concentration (proportion mediated 12.0%), and the Aβ 42/t-tau ratio (proportion mediated 15.4%). Conclusions:A higher preoperative AST/ALT ratio is an independent risk factor for POD in total knee/hip arthroplasty patients. The concentrations of CSF t-tau and p-tau and Aβ 42/t-tau ratio have a mediating role in the relationship between the preoperative AST/ALT ratio and POD.

Objective:To evaluate the association between preoperative cardiometabolic multimorbidity (CMM) and postoperative delirium (POD) in elderly patients undergoing knee or hip replacement.Methods:Based on a perioperative neurocognitive dysfunction and biomarker lifestyle cohort, a nested case-control study was conducted using medical records of patients scheduled for elective knee or hip joint replacement at Qingdao Municipal Hospital from January 2022 to November 2023. Patients were divided into POD group ( n=124) and non-POD group ( n=414) based on whether POD occurred. The influencing factors were collected, and intergroup differences were analyzed. Logistic regression was used to identify the risk factors for POD, and sensitivity analysis was conducted to assess the stability of the regression model. A mediation model was employed to examine whether cerebrospinal fluid (CSF) biomarkers mediated the association between CMM and POD. Results:There were statistically significant differences in the rate of CMM, age, years of education, rate of hypertension, rate of diabetes mellitus, rate of coronary heart diseases, rate of stroke, Aβ 42 concentration, t-tau concentration, p-tau concentration, Aβ 42/t-tau ratio, and Aβ 42/p-tau ratio in CSF between POD group and non-POD group ( P<0.05). The results of logistic regression analysis showed that preoperative CMM was a risk factor for POD ( P<0.05). Mediation analysis revealed that the relationship between CMM and POD was partly mediated by Aβ 42 concentrations in CSF. Conclusions:Preoperative CMM is a risk factor for POD in elderly patients undergoing knee or hip replacement, and the CSF Aβ 42 concentration may play a partly mediating role in the association between preoperative CMM and POD.