Tinnitus refers to the perception of one or more sounds in the ear or skull without an external sound source,and subjective tinnitus is only perceived by the patient.The central mechanism of subjective tinnitus is related to both the auditory and non-auditory central nervous system.The main factors of tinnitus production in the central auditory conduction pathway are central gain,increased spontaneous firing rate of neurons,and increased synchronization between neurons.In addition,the somatosensory pathway and the limbic system in the non-auditory central nervous system also have a huge impact on tinnitus.The study of the pathogenesis of subjective tinnitus can provide further research ideas for its diagnosis and treatment.

Objective To share our experience of laparoscopic papillary ureterovesical replantation,so as to provide reference for the treatment of patients with lower ureteral lesions.Methods A retrospective analysis was conducted on 22 patients treated in our hospital during 2019 and 2024,including 12 cases of lower ureteral stenosis,3 cases of congenital macroureter,2 cases of terminal ureteral tumor,3 cases of bladder diverticulum,and 2 cases of ureterovaginal fistula.The operation time,intraoperative blood loss,drainage tube removal time,urinary catheter removal time,postoperative hospital stay,DJ tube removal time and occurrence of postoperative complications were statistically analyzed.Results All operations were successfully completed.The operation time(156.73±36.73)minutes,the intraoperative blood loss(35.64±11.47)mL,the drainage tube removal time(7.14±1.77)days,the catheter removal time(10.05±2.73)days,the postoperative hospital stay(13.04±3.79)days,and the DJ tube removal time(69.91±9.35)days.During the follow-up of 3 to 24 months,re-examinations such as B ultrasound and urography indicated no obvious ureterovesical anastomotic stenosis;cystography showed one patient had ureteral reflux.After long-term follow-up,no renal function impairment or ureteral reflux was observed.Conclusion The papillary ureterovesical replantation is safe,effective,simple and easy to operate in the treatment of lower ureteral lesions.It also has characteristics of short operation time and good anti-reflux effect,which is worthy of clinical recommendation.

Objective:To establish a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography (MDCTA) and to explore its clinical application effects.Methods:This study was a retrospective observational study. From January 2021 to October 2023, 7 patients and 6 patients with post-traumatic skin and soft tissue defects in extremity and conformed to the inclusion criteria were admitted to the Affiliated Hospital of Jiangsu University and Wuxi No. 9 People's Hospital, respectively. There were 8 males and 5 females, aged 21 to 68 years. Nine patients had wounds on the hand and 4 patients had wounds on the foot. The wound area after debridement ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. Through the three-dimensional navigation process based on MDCTA, 14 perforator flaps were designed and resected, including 11 free anterolateral thigh perforator flaps and 3 pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain, with flap size ranging from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Six wounds in the flap donor sites were directly sutured, and eight wounds in the flap donor sites were transplanted with skin grafts. The consistency of the location, type, and source of the perforators was compared between the preoperative navigation display and actual intraoperative detection. Immediately after surgery, the coverage of wound by the flap was evaluated according to the self-made criteria. The postoperative flap survival was observed. The occurrence of complications was observed during follow-up. At the last follow-up, the appearance of the flaps was observed, the blood supply of the flaps and the hand function of the 9 patients with hand trauma were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the foot function of the 4 patients with foot trauma was assessed using the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scoring System.Results:The location, type, and source of the perforators displayed in preoperative navigation were consistent with the actual intraoperative detection. Immediately after surgery, the coverage of the wounds by 11 flaps was rated as excellent, and that of 3 flaps was rated as moderate. Postoperatively, 13 flaps survived completely, and 1 flap had partial necrosis, which healed after a full-thickness skin grafting from the thigh. Patients were followed up for 4 to 24 months postoperatively, one patient developed a hematoma under the flap, and one patient had local infection. At the last follow-up, the flaps of all patients were good in color and texture, and 5 patients with bloated flaps post operation had good appearance after thinning surgery; the blood supply was excellent in 12 flaps and was good in 2 flaps; among patients with hand trauma, the hand function was rated as excellent in 2 cases, good in 4 cases, and poor in 3 cases; among patients with foot trauma, the foot function was rated as excellent in 3 cases and good in 1 case.Conclusions:The three-dimensional navigation process for design and resection of perforator flaps based on MDCTA realizes precise evaluation of perforator vessels in flap donor sites and skin and soft tissue defects in the recipient sites. Guided by the three-dimensional navigation process, the application of free anterolateral thigh perforator flaps and pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain in repairing skin and soft tissue defects in extremity realizes precise surgery, reducing flap donor site injury and achieving excellent clinical outcomes.

Objective:To investigate the association between exposed cardia glands and gastroesophageal reflux disease (GERD) and identify risk factors for exposed cardia glands.Methods:Patients who underwent gastroscopy at Chengde Central Hospital from December 2023 to March 2024 were prospectively enrolled. Patients with exposed cardia glands meeting inclusion criteria comprised the observation group, while controls had no exposed cardia glands but met identical criteria. Demographic, lifestyle, and endoscopic characteristics were compared between the two groups.Results:A total of 204 patients were included in the observation group, while 310 in the control group. Univariate analysis demonstrated statistically significant differences between the observation group and the control group in the following factors: body mass index, waist circumference, smoking, alcohol consumption, tea/coffee intake, spicy food preference, sleeping posture, use of calcium channel blockers, Helicobacter pylori infection, peptic ulcer disease, and GERD ( P<0.05). Binary logistic regression analysis identified the following independent risk factors for exposed cardia glands: waist circumference ( P=0.012, OR=1.070, 95% CI: 1.015-1.129), alcohol consumption ( P=0.003, OR=2.166, 95% CI: 1.293-3.631), spicy food preference ( P=0.048, OR=1.611, 95% CI: 1.004-2.582), right-side sleeping posture ( P<0.001, OR=3.219, 95% CI: 1.696-6.108), use of calcium channel blockers ( P<0.001, OR=3.871, 95% CI: 2.263-6.621), Helicobacter pylori infection ( P<0.001, OR=3.512, 95% CI: 1.953-6.317), and GERD ( P<0.001, OR=2.905, 95% CI: 1.829-4.613) .Conclusion:Exposed cardia glands demonstrates significant association with GERD. Key independent risk factors include waist circumference, alcohol consumption, spicy diet, right-side sleeping position, calcium channel blockers use, and Helicobacter pylori infection.

Super-enhancers are highly transcriptionally active epigenetic regulatory regions enriched with multiple enhancers, playing a crucial role in regulating gene activity and cell specialization. These regions are closely associated with tissue characteristics and disease development. While current research on super enhancers predominantly focuses on cancer and development, studies related to immune diseases are still in their infancy. This paper systematically reviews the potential applications of super enhancers in immune diseases, the related research techniques and methods, and the progress in understanding their roles in disease development. The aim is to provide a reference for developing super enhancer-based therapeutic strategies and to offer more effective treatment options for immune diseases.

This study aimed to elucidate the mechanism of action of metformin (MET) in inhibiting the malignant progression of hepatocellular carcinoma (HCC) by regulating the degradation of aldo-keto reductase family 1 member C3 (AKR1C3). The correlation between the sensitivity of different hepatocellular carcinoma cell lines to MET and their basal expression levels of AKR1C3 was firstly evaluated. MET was found to significantly reduce the level and accelerate the degradation rate of AKR1C3 protein by Western blot. The interaction between MET and AKR1C3 protein was confirmed by cellular thermal shift assay (CETSA). Proteasome inhibitor MG132 and the lysosomal inhibitor chloroquine (CQ) were used to screen the degradation pathway, and confirm, in combination with the HBSS starvation-induced autophagy model, that MET mediated the degradation of AKR1C3 through the autophagy lysosome pathway. Ubiquitylation assay showed that MET specifically enhanced the K63-linked polyubiquitylation modification of AKR1C3. Sequestosome 1 (SQSTM1/p62) knockdown, immunoprecipitation, and immunofluorescence co-localization analyses confirmed that the autophagy receptor p62 plays a key role in mediating MET-induced degradation of AKR1C3. The adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) inhibitor compound C was used to demonstrate that the regulatory effect of MET on AKR1C3 is independent of the classical AMPK signaling pathway. The experimental results showed that metformin promoted the ubiquitination modification of AKR1C3 by targeting AKR1C3, enhanced the binding of AKR1C3 to autophagy receptor p62, then degraded the AKR1C3 protein through selective autophagy-like pathway, and ultimately inhibited the malignant phenotypes of hepatocellular carcinoma cells, which is a regulatory mechanism free of the classical AMPK activation pathway of metformin.

Objective To share our experience of laparoscopic papillary ureterovesical replantation,so as to provide reference for the treatment of patients with lower ureteral lesions.Methods A retrospective analysis was conducted on 22 patients treated in our hospital during 2019 and 2024,including 12 cases of lower ureteral stenosis,3 cases of congenital macroureter,2 cases of terminal ureteral tumor,3 cases of bladder diverticulum,and 2 cases of ureterovaginal fistula.The operation time,intraoperative blood loss,drainage tube removal time,urinary catheter removal time,postoperative hospital stay,DJ tube removal time and occurrence of postoperative complications were statistically analyzed.Results All operations were successfully completed.The operation time(156.73±36.73)minutes,the intraoperative blood loss(35.64±11.47)mL,the drainage tube removal time(7.14±1.77)days,the catheter removal time(10.05±2.73)days,the postoperative hospital stay(13.04±3.79)days,and the DJ tube removal time(69.91±9.35)days.During the follow-up of 3 to 24 months,re-examinations such as B ultrasound and urography indicated no obvious ureterovesical anastomotic stenosis;cystography showed one patient had ureteral reflux.After long-term follow-up,no renal function impairment or ureteral reflux was observed.Conclusion The papillary ureterovesical replantation is safe,effective,simple and easy to operate in the treatment of lower ureteral lesions.It also has characteristics of short operation time and good anti-reflux effect,which is worthy of clinical recommendation.

Tinnitus refers to the perception of one or more sounds in the ear or skull without an external sound source,and subjective tinnitus is only perceived by the patient.The central mechanism of subjective tinnitus is related to both the auditory and non-auditory central nervous system.The main factors of tinnitus production in the central auditory conduction pathway are central gain,increased spontaneous firing rate of neurons,and increased synchronization between neurons.In addition,the somatosensory pathway and the limbic system in the non-auditory central nervous system also have a huge impact on tinnitus.The study of the pathogenesis of subjective tinnitus can provide further research ideas for its diagnosis and treatment.

Super-enhancers are highly transcriptionally active epigenetic regulatory regions enriched with multiple enhancers, playing a crucial role in regulating gene activity and cell specialization. These regions are closely associated with tissue characteristics and disease development. While current research on super enhancers predominantly focuses on cancer and development, studies related to immune diseases are still in their infancy. This paper systematically reviews the potential applications of super enhancers in immune diseases, the related research techniques and methods, and the progress in understanding their roles in disease development. The aim is to provide a reference for developing super enhancer-based therapeutic strategies and to offer more effective treatment options for immune diseases.

Objective:To establish a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography (MDCTA) and to explore its clinical application effects.Methods:This study was a retrospective observational study. From January 2021 to October 2023, 7 patients and 6 patients with post-traumatic skin and soft tissue defects in extremity and conformed to the inclusion criteria were admitted to the Affiliated Hospital of Jiangsu University and Wuxi No. 9 People's Hospital, respectively. There were 8 males and 5 females, aged 21 to 68 years. Nine patients had wounds on the hand and 4 patients had wounds on the foot. The wound area after debridement ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. Through the three-dimensional navigation process based on MDCTA, 14 perforator flaps were designed and resected, including 11 free anterolateral thigh perforator flaps and 3 pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain, with flap size ranging from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Six wounds in the flap donor sites were directly sutured, and eight wounds in the flap donor sites were transplanted with skin grafts. The consistency of the location, type, and source of the perforators was compared between the preoperative navigation display and actual intraoperative detection. Immediately after surgery, the coverage of wound by the flap was evaluated according to the self-made criteria. The postoperative flap survival was observed. The occurrence of complications was observed during follow-up. At the last follow-up, the appearance of the flaps was observed, the blood supply of the flaps and the hand function of the 9 patients with hand trauma were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the foot function of the 4 patients with foot trauma was assessed using the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scoring System.Results:The location, type, and source of the perforators displayed in preoperative navigation were consistent with the actual intraoperative detection. Immediately after surgery, the coverage of the wounds by 11 flaps was rated as excellent, and that of 3 flaps was rated as moderate. Postoperatively, 13 flaps survived completely, and 1 flap had partial necrosis, which healed after a full-thickness skin grafting from the thigh. Patients were followed up for 4 to 24 months postoperatively, one patient developed a hematoma under the flap, and one patient had local infection. At the last follow-up, the flaps of all patients were good in color and texture, and 5 patients with bloated flaps post operation had good appearance after thinning surgery; the blood supply was excellent in 12 flaps and was good in 2 flaps; among patients with hand trauma, the hand function was rated as excellent in 2 cases, good in 4 cases, and poor in 3 cases; among patients with foot trauma, the foot function was rated as excellent in 3 cases and good in 1 case.Conclusions:The three-dimensional navigation process for design and resection of perforator flaps based on MDCTA realizes precise evaluation of perforator vessels in flap donor sites and skin and soft tissue defects in the recipient sites. Guided by the three-dimensional navigation process, the application of free anterolateral thigh perforator flaps and pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain in repairing skin and soft tissue defects in extremity realizes precise surgery, reducing flap donor site injury and achieving excellent clinical outcomes.