Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

ObjectiveTo investigate the effects of artemisinin （ART） on histopathological damage and salivary secretion in the submandibular gland （SMG） of mice with Sjögren's syndrome （SS） model，and on the expression of aquaporin 5 （AQP5） in SMG cells. MethodsThe NOD/Ltj mice were used as a model of SS and randomly divided into the SS model group，the ART group，and the hydroxychloroquine sulfate （HCQ） group，with six mice per group. Another 6 female BALB/c mice at the same week were selected as the control group. Mice in the ART group was fed with the ART solution daily in the dosage of 50 mg·kg^-1，and mice in the HCQ group was given with the HCQ solution （1 300 mg·kg^-1）. Mice in the SS model and control groups were given saline daily. The treatment lasted for 8 weeks. The 24-hour average water intake，salivary flow rate，SMG pathology scores of mice in each group were measured，as well as the expression levels of AQP5 protein and gene in the SMG tissues. ResultsCompared with the control group，the 24-hour average water intake of mice in the model group was significantly increased （P<0.01），and the saliva flow rate was significantly decreased （P<0.01）. Compared to the SS model group，the 24-hour average water intake of mice in the ART and HCQ groups was significantly reduced （P<0.01），and the salivary flow rate was significantly increased in the ART group（P<0.01），comparisons between groups showed that the ART was superior to the HCQ in reducing water intake and improving saliva flow rate in SS model mice （P<0.05）. The HE staining results showed that，compared with the normal group，the number of lymphocyte infiltration foci in SMG tissue in the model group increased，and the pathological score increased （P<0.01）. Compared to the SS model group，after the intervention of the ART and HCQ，the number of lymphocytic infiltration foci in the SMG tissue decreased，the area of the lymphocytic infiltration foci was reduced，and the pathology score of the SMG tissues was lowered in the ART group（P<0.01）. However，there was no difference in pathological scores between the ART and HCQ groups . The results of IHC，Western blot，and Real-time PCR showed that，compared with the normal group，the expression levels of AQP5 protein and gene in SMG tissue in the model group significantly decreased （P<0.05）. Comparing with the SS model group，the ART and HCQ groups could significantly up-regulated the expression levels of AQP5 protein and mRNA in the SMG tissue，and the treatment effect was better than that of HCQ. ConclusionART was able to ameliorate SMG structural damage and salivary secretion function in SS model mice，and its mechanism of action may be related to the up-regulation of AQP5 protein and gene expression levels in SMG cells.

Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa,in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis(Phase Ⅰ)to gastric precancerous lesions(Phase Ⅱ)and finally to GC(Phase Ⅲ).Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa.Intervening in early gastric mucosal lesions,i.e.,Phases Ⅰ and Ⅱ,will be the key strategy to prevent and treat GC.Natural products(NPs)have been an important source for drug development due to abundant sources,tremendous safety,and multiple pharmacodynamic mechanisms.This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis.In Phase Ⅰ,NPs modulate Helicobacter pylori urease activity,motility,adhesion,virulence factors,and drug resis-tance,thereby inhibiting H.pylori-induced gastric mucosal inflammation and oxidative stress,and facilitating ulcer healing.In Phase Ⅱ,NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle,apoptosis,autophagy,and angiogenesis to reverse gastric precancerous lesions.In Phase Ⅲ,NPs suppress cell proliferation,migration,invasion,angiogenesis,and cancer stem cells,induce apoptosis and autophagy,and enhance chemotherapeutic drug sensitivity for the treatment of GC.In contrast to existing work,we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development,providing new ideas for gastric cancer prevention,treatment,and drug development.

To verify a new diagnostic method in traditional Chinese medicine (TCM), we evaluated the function of meridians using thermal sensitivity measurement (TSM), and conducted a comparative study between nephropathy patients and healthy individuals. We also evaluated whether TSM is useful for diagnosing nephropathy. The subjects included nephropathy patients (n = 203) and healthy individuals (n = 826). Heat detection times were measured at the well points on both the left and right sides of the twelve meridians. Multivariate analysis was conducted, with the presence or absence of nephropathy as the objective variable and the heat detection times of each meridian as the explanatory variable. The meridians identified as important for diagnosing nephropathy included the pericardium meridian, the triple energizer (sanjiao) meridian, small intestine meridian, liver meridian, bladder meridian, and kidney meridian. A diagnostic method combining age and the heat detection times of these meridians achieved sensitivity and specificity of over 80%. This method intuitively and quantitatively reflects the sub-heat and sub-cold states of each meridian, and is expected to enrich the diagnostic methods in traditional Chinese and Oriental medicine.

Objective To evaluate the clinical utility of the f-wave to QRS complex amplitude ratio(f/R ratio)in intracardiac electrogram(IC-ECG)-guided positioning of peripherally inserted central catheter(PICC)tips in patients with atrial fibrillation(AF),providing evidence to enhance clinical practice.Methods This study employed a conve-nience sampling method to enroll eligible AF patients admitted to a tertiary hospital in Suzhou from July 2023 to July 2024.During PICC placement,IC-ECG was utilized to monitor f-wave and QRS complex amplitude variations.Following successful catheterization,the f/R ratio was measured,and chest X-ray was performed to confirm the catheter tip position.The accuracy of PICC tip positioning across different f/R ratio ranges was analyzed,and the incidence of arrhythmias was recorded.A receiver operating characteristic curve was constructed to assess the diag-nostic performance of the f/R ratio in PICC tip localization.Results A total of 68 AF patients were included,with f/R ratios ranging from 20.63％to 91.24％.PICC tip positioning accuracy varied significantly across different f/R ratio ranges(P=0.006).The area under the ROC curve(AUC)for f/R ratio in PICC tip positioning was 0.784(P=0.009),with a maximum Youden index of 0.567,an optimal diagnostic threshold of 40.00％,a sensitivity of 81.7％,a speci-ficity of 75.0％,a positive predictive value of 96.1％,and a negative predictive value of 35.3％.No arrhythmias other than AF occurred during the procedure.Conclusion The f/R ratio provides reliable and safe guidance for PICC tip positioning in AF patients.An f/R ratio ≥40％is associated with higher accuracy in identifying the optimal catheter tip position.

Objective To investigate the current status of hypertension in the old adults living in urban city and rural areas in Qinghai Plateau and analyze the related influencing factors in order to provide data and evidence for targeted formulation of preventive and control measures for the pop-ulation.Methods Cluster-random sampling was used to subject 1372 elderly people(aged ≥60 years)from 8 urban areas and 25 natural villages in Xining City,Qinghai Province.Questionnaires were used to collect their demographic data,body mass index(BMI),history of chronic diseases,and lipid-related indicators.According to complicated with hypertension or not,they were divided into a hypertension group(615 cases)and a non-hypertension group(757 cases).SPSS 26.0 soft-ware was employed to perform statistical analyses with descriptive analysis and multivarlate un-conditional logistic regression analysis.Results Among the 1372 elderly persons,615 participants had hypertension,and the overall prevalence was 44.8％,and that in urban area and rural area was 50.1％and 38.5％,respectively,with significant difference(P＜0.01).Statistical differences were observed between those with and without hypertension in terms of age,BMI,and proportions of coronary heart disease(CHD),diabetes and stroke(P＜0.05,P＜0.01).In the urban populations,there were obvious differences in marital status,BMI,and proportions of CHD and diabetes be-tween those with and without hypertension(P＜0.01).For the rural populations,notable differ-ences were observed in age and proportions of CHD and diabetes between those with and without hypertension(P＜0.05,P＜0.01).Multivariate unconditional logistic regression analysis revealed that urban areas,obesity,CHD and diabetes were risk factors for hypertension in the elderly living in the urban and rural areas(OR=1.622,95％CI:1.299-2.026,P=0.000;OR=0.564,95％CI:0.315-1.006,P=0.042;OR=0.604,95％CI:0.417-0.874,P=0.008;OR=0.472,95％CI:0.328-0.678,P=0.000;OR=0.474,95％CI:0.334-0.673,P=0.000).Obesity,CHD and diabetes were risk factors for hypertension in those in the urban areas(OR=0.553,95％CI:0.317-0.963,P=0.036;OR=0.506,95％CI:0.320-0.800,P=0.004;OR=0.458,95％CI:0.303-0.692,P=0.000),and CHD and diabetes were risk factors in those in the rural areas(OR=0.382,95％CI:0.219-0.666,P=0.001;OR=0.452,95％CI:0.253-0.807,P=0.007).Conclusion There is sig-nificant difference in the prevalence of hypertension between the elderly living in the urban city and rural areas in Qinghai Plateau.The old adults with overweight,obesity,and complication of CHD and diabetes are prone to developing hypertension.

Atherosclerosis is an arterial lesion involving abnor-mal lipid metabolism and an inflammatory response,and is the initiating factor of many cardiovascular and cerebrovascular dis-eases.Glycosylated ceramides are derivatives of ceramide mole-cules with a glycosylated group attached,which not only affect the structural integrity of cell membranes,but also regulate apop-tosis,inflammation and lipid metabolism,and disorders of glyco-sylated ceramide metabolism are closely related to the occurrence and progression of atherosclerosis.This review focuses on the specific functions of the glycosylated ceramide-related metabolic enzymes glucose ceramide synthetase,glucosylceramide syn-thetase,lactose ceramide synthetase,and galactosidase in athero-sclerosis,as well as their important effects on the development of atherosclerosis.Targeted therapeutic strategies for these meta-bolic enzymes,related drug development and significant potential in atherosclerosis prevention and treatment are also reviewed.

Background and Aims:Minimally invasive surgery,represented by laparoscopic techniques,plays a vital role in the treatment of gastric cancer.However,postoperative infectious complications remain a key factor affecting patient recovery and prognosis.This study was performed to identify the risk factors associated with early(≤1 month)infectious complications after laparoscopic surgery for gastric cancer,providing a reference for clinical prevention strategies.Methods:A retrospective analysis was conducted on 1 572 patients who underwent laparoscopic surgery for gastric cancer at the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to February 2024.Patients were divided into infection and non-infection groups based on the occurrence of postoperative infectious complications.Univariate and multivariate Logistic regression analyses were performed to identify related risk factors.Results:Among the 1 572 patients,194 cases(12.3％)developed early postoperative infectious complications,including intra-abdominal infections(4.1％),surgical site infections(3.7％),and pulmonary infections(5.6％).Univariate analysis revealed that a history of diabetes,pulmonary disease,smoking,and preoperative anemia and hypoalbuminemia were significantly associated with postoperative infections(all P＜0.05).Multivariate analysis indicated that a history of diabetes(OR=6.927,95％CI=4.194-12.935),smoking(OR=3.079,95％CI=2.261-4.913),and preoperative albumin＜35 g/L(OR=0.572,95％CI=0.302-1.578)were independent risk factors for early postoperative infectious complications.Conclusion:A history of diabetes,smoking,and preoperative hypoalbuminemia are closely associated with the occurrence of early postoperative infectious complications after laparoscopic gastric cancer surgery.Clinical attention should be paid to perioperative metabolic,nutritional,and lifestyle management,and early intervention for high-risk patients may help reduce the incidence of complications,improve recovery,and enhance treatment outcomes.

Objective To analyze ethnic differences in mutations of the PIK3CA and TP53 genes among breast cancer patients from the Han, Tibetan, and Hui ethnic groups in Qinghai, China, and their associations with clinicopathological characteristics. Methods A total of 382 breast cancer tissue samples were retrospectively collected from surgical patients (Jan 2020−Dec 2022), comprising 200 Han, 93 Tibetan, and 89 Hui ethnicity. Mutations in PIK3CA (E542K, H1047R, and E545K) and TP53 (R273H and R175H) were detected by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Correlations between mutations and clinicopathological parameters were analyzed. Results Significant differences were observed in pTNM stage, lymph node metastasis, molecular subtypes, and PR status among the three ethnic groups. The overall mutation rate of PIK3CA and TP53 was 48.95%. The PIK3CA-p.E542K mutation rate in Tibetan cohort was significantly higher than those in Han and Hui cohort, whereas the detection rate of the PIK3CA-p.E545K mutation was lower in Tibetan cohort than that in Han cohort. The PIK3CA-p.E542K mutation was associated with an increased risk of lymph node metastasis. The TP53-p.R175H mutation was significantly correlated with advanced pTNM stage, vascular invasion, and triple-negative breast cancer. The PIK3CA-H1047R and E545K mutations were enriched in the luminal A subtype of breast cancer. Conclusion Considerable ethnic disparities exist in breast cancer mutation profiles in Qinghai, with the high-frequency PIK3CA-p.E542K mutation in Tibetan population potentially serving as a region-specific therapeutic target. Mutations are closely linked to tumor aggressiveness and molecular subtypes, highlighting the value of PIK3CA/TP53 mutation detection for early risk stratification and personalized treatment of breast cancer in high-altitude populations.

Background The power industry is characterized by typical shift work systems, with 24-hour uninterrupted work demands, high intensity and high standard job characteristics, as well as emergent task pressure, which exposes employees to the long-term dual pressure of shift work and occupational stress and may lead to occupational burnout. It not only endangers the physical and mental health of employees, but also threaten the safe and stable operation of the power system. Objective To explore the impact of shift work and occupational stress, as well as their potential interaction, on occupational burnout among employees in power enterprises. Methods From November 2024 to April 2025, cluster sampling was used to select 1378 workers from two power companies in Fuzhou. A self-designed questionnaire, the Effort-Reward Imbalance model, and the Maslach Burnout Inventory were used to investigate the participants’ general information，shift work patterns, occupational stress, and occupational burnout. Statistical analysis was conducted using SPSS 19.0 software. Chi-square test was employed for intergroup comparison. Logistic regression was used to examine the associations between shift work, occupational stress, and job burnout. The multiplicative interaction and additive interaction between shift work and occupational stress on occupational burnout were evaluated. Results A total of 1378 questionnaires were distributed, and 1113 were valid questionnaires, with an effective rate of 80.77%. Among the participants, 37.92% were engaged in shift work, the positive rate of occupational stress was 29.83%, and the positive rate of occupational burnout was 55.80%. The logistic regression analysis showed that after adjusting for confounding factors, the risks of occupational burnout in the non-shift x occupational stress group and the shift x occupational stress group were 1.59 times (95%CI: 1.12, 2.27; P=0.01) and 4.07 times (95%CI: 2.56, 6.45; P<0.01) higher than that in the non-shift x non-occupational stress group. A multiplicative interaction (shift work and occupational stress b=0.75, P=0.01, OR=2.12, 95%CI: 1.18, 3.80) and an additive interaction (relative excess risk ratio=2.24, 95%CI: 0.54, 3.94; attributable fraction=0.55, 95%CI: 0.32, 0.78; interaction index=3.71, 95%CI: 1.47, 9.40) between shift work and occupational stress on job burnout were identified. Conclusion Shift work and occupational stress are risk factors for occupational burnout among employees in power enterprises, and there is a synergistic interaction between these two factors in terms of their impact on occupational burnout.