ObjectiveTo investigate the feasibility and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with oral cholangiopancreatography in the treatment of major duodenal papilla gallbladder polyps. MethodsA retrospective analysis was performed for the clinical data of eight patients with choledocholithiasis and gallbladder polyps who underwent ERCP and combined with oral cholangiopancreatography for major duodenal papilla cholecystectomy in Center of Digestive Endoscopy， Jilin People’s Hospital， from May 2022 to June 2024， and related data were collected， including the success rate of surgery， the technical success rate of gallbladder polyp removal， the superselective method of cystic duct， the time of operation， the time of gallbladder polyp removal， and surgical complications. ResultsBoth the success rate of surgery and the technical success rate of gallbladder polyp removal reached 100%， and of all eight patients， three patients used guide wire to enter the gallbladder under direct view， while five patients received oral cholangiopancreatography to directly enter the gallbladder. The time of operation was 51.88±12.34 minutes， and the time of gallbladder polyp removal was 23.13±10.94 minutes. The diameter of gallbladder polyp was 2‍ ‍—‍ ‍8 mm， and pathological examination showed inflammatory polyps in three patients， adenomatous polyps in one patient， and cholesterol polyps in four patients. There were no complications during or after surgery. The patients were followed up for 2‍ ‍—‍ ‍27 months after surgery， and no recurrence of gallbladder polyp was observed. ConclusionOral cholangiopancreatography is technically safe and feasible in endoscopic major duodenal papilla cholecystectomy.

Objective To compare the efficacy of artificial intelligence(AI)diagnostic group and artificial reading group in the diagnosis for osteoporotic vertebral compression fractures.Methods From January 2023 to December 2023,80 patients with osteoporotic vertebral compression fractures and 20 patients without fractures but with nonspecific low back pain were included in the study.According to the patient's computed tomography(CT)image,the AI software diagnosis and physicians of different seniority(one senior physician,one intermediate physician and one junior physician)diagnosis were performed.The diagnostic efficacy of different detection methods was compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and area under the receiver operating characteristic(ROC)curve(AUC)and Kappa value of each group were as follows:AI image interpretation:0.975,0.900,0.975,0.900,0.938,0.875;senior physician:0.950,0.900,0.974,0.818,0.925,0.819;intermediate physician:0.825,0.850,0.957,0.548,0.837,0.560;and junior physician:0.750,0.750,0.923,0.429,0.751,0.390.Conclusion The diagnostic performance of AI was comparable to that of senior physician,and significantly higher than that of intermediate and primary physicians.

Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux-en-Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS-J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B-TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti-reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS-J emphasizes nutritional safety, whereas B-TB incorporates a Braun anastomosis to enhance anti-reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

Objective To investigate the molecular mechanism by which super enhancers(SEs)regulate the expression of the genetic suppressor element 1(GSE1)and influence the proliferation of breast cancer cell line MCF-7.Methods The oncogene GSE1,driven by SEs,was identified through analysis of the ChIP-seq dataset of MCF-7 cells obtained from the GEO database.The protein expression level of GSE1 was assessed via Western blot following treatment with the bromodomain-containing protein 4(BRD4)inhibitor JQ1.The expression of GSE1 across various cancers and different breast cancer subtypes was analyzed using the Human Protein Atlas(HPA)and The Cancer Genome Atlas(TCGA)databases,respectively.Overall survival(OS)of breast cancer patients was compared between the GSE1 high-expression and low-expression groups using the GEPIA database.Immunohis-tochemistry(IHC)was performed to evaluate GSE1 expression in breast cancer tissue samples.The mRNA expres-sion levels of GSE1 in different breast cancer cell lines were validated by RT-qPCR.A GSE1 interference vector was constructed and transfected into MCF-7 cells,and the knockdown efficiency was assessed using Western blot.Cell proliferation and migration were evaluated using CCK-8 assay,colony formation assay,wound healing assay,and Transwell migration assay.Potential GSE1-interacting proteins were predicted using the STRING database.Finally,Western blot analysis was conducted to assess changes in epithelial-mesenchymal transition(EMT)-related proteins and key components of the Wnt/β-catenin signaling pathway.Results The integrative genomics viewer(IGV)was used to visualize ChIP-seq data from MCF-7 cells,and the rank ordering of super enhancers(ROSE)algorithm was applied to predict the SE region of GSE1 in the MCF-7 genome.GSE1 and BRD4 expression levels were significantly reduced following JQ1 treatment(P<0.05).High expression levels of GSE1 in breast cancer were confirmed through analyses using the HPA,TCGA,and GEPIA databases,as well as IHC,and these find-ings were associated with poor prognostic outcomes in breast cancer patients(P<0.05).RT-qPCR results further demonstrated that GSE1 is significantly upregulated in breast cancer cells(P<0.05).Analysis of the STRING database revealed a strong correlation between GSE1 and Snail(Snai1).Transfection of a GSE1-specific interference vector significantly inhibited the proliferation and migration of MCF-7 cells compared to the control group,upregu-lated E-cadherin and Occludin expression,and downregulated N-cadherin and Snail expression(P<0.05).Addi-tionally,knockdown of GSE1 resulted in decreased expression of Wnt/β-catenin signaling pathway-related proteins,including β-catenin,Wnt-5a,and Cyclin-D1,along with increased Axin1 expression(P<0.05).Conclusion SE driven GSE1 promotes the proliferation,migration and EMT of MCF-7 cells via the Wnt/β-catenin signaling pathway.

Objective To establish an online gel permeation chromatography-gas chromatography/mass spectrometry(GPC-GCMS)method for the determination of etomidate in blood.Methods Blood samples were extracted with acetonitrile,dehydrated with anhydrous sodium sulfate,purified with an online GPC system,and then analyzed by GCMS using large volume injection.The external standard curve method was used for quantification.Results The detection limit of etomidate was 0.002 μg/mL,with good linearity in the concentration range of 0.01～5 μg/mL and a correlation coefficient of 0.9992.The extraction recovery rates ranged between 90%and 120%.In an actual case,the content of etomidate detected in the blood sample was 0.024 μg/mL.Conclusion This method is fast,simple,accurate,and stable,providing a reliable basis for the determination of etomidate content in blood.

Objective:To establish and validate a lipid parameter-based prognostic model for predicting recurrence free survival (RFS) in pancreatic cancer patients receiving postoperative adjuvant chemotherapy.Methods:A retrospective analysis was conducted on the clinical and pathological data of 155 patients who underwent pancreatic cancer resection followed by adjuvant chemotherapy at Affiliated Hospital of Qingdao University between January 2019 and December 2022. The patients were randomly divided into a training set ( n=108) and a validation set ( n=47) in a 7∶3 ratio. X-tile software was used to determine cutoff values for lipid parameters. Univariate and multivariate Cox regression analyses were performed to construct a model predicting RFS, which was then visualized using a nomogram. The model's predictive performance, accuracy and stability, and clinical application value were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA), respectively. Individual risk scores for recurrence were calculated based on the nomogram model, and X-tile software was employed to identify optimal cutoff values for risk stratification, which was used to divide patients into low-risk and high-risk groups. Survival differences between two groups were analyzed using survival curves. Results:Among lipid parameters, patients with higher apolipoprotein A1 level had obviously longer RFS than those with low apolipoprotein A1 level (10.17 months vs 8.92 months, HR=0.397, 95% CI 0.237~0.664); patients with high total cholesterol level had obviously shorter RFS than those with low total cholesterol level (8.33 months vs 16.27months, HR=3.382, 95% CI 1.901~5.824) ; patients with high low-density lipoprotein level had obviously shorter RFS than those with low low-density lipoprotein level (8.53 months vs 11.43 months, HR=1.617, 95% CI 1.013~2.582) ; patients with high lipoprotein(a) had shorter RFS than those with low lipoprotein(a) (8.53 months vs 14.43 months, HR=2.640, 95% CI 1.514-4.604) ; and all the differences were statistical significant (all P value <0.05). Univariate Cox regression analysis identified advanced T stage, advanced N stage, high total cholesterol level, high low-density lipoprotein level, low apolipoprotein A1 level, high apolipoprotein B level, and high lipoprotein(a) level as risk factors for RFS. Multivariate Cox regression analysis revealed that tumors located in the pancreatic body or tail ( HR=0.63, 95% CI 0.36-0.86, P=0.042), advanced T stage ( HR=4.85, 95% CI 1.47-16.04, P=0.010), advanced N stage ( HR=0.48, 95% CI 0.26-0.87, P=0.015), elevated total cholesterol levels ( HR=3.61, 95% CI 1.46-8.91, P=0.005), high density lipoprotein levels ( HR=0.48, 95% CI 0.26-0.87, P=0.015), and elevated lipoprotein(a) levels ( HR=3.17, 95% CI 1.61-6.24, P<0.001) were independent risk factors for RFS. The nomogram model incorporating these six factors above demonstrated an AUC of 0.78 (95% CI 0.70-0.87) in the training set and 0.75 (95% CI 0.59-0.91) in the validation set. Calibration curves indicated a high degree of agreement between predicted and observed outcomes. DCA suggested that the model provides substantial clinical benefit. Kaplan-Meier survival curve analysis showed that patients in the high-recurrence risk group from training set and validation set both had significantly shorter RFS compared to those in the low-recurrence risk group (6.93 months vs 12.13 months, HR=4.024, 95% CI 2.594-6.243; 6.85 months vs 11.93 months, HR=2.314, 95% CI 1.227-4.362); and all the differences were statistical significant (all P value <0.05). Conclusions:The nomogram model based on lipid parameters can effectively predict recurrence free survival in patients undergoing adjuvant chemotherapy after pancreatic cancer surgery.

Diabetic retinopathy(DR)is a kind of microvascular disease caused by the long-term influence of diabetes mellitus(DM),and it is one of the main cause of global visual impairment and blindness.Its typical characteristics include microaneurysms,hard exudates,macular edema(DME)and neovascularization.Its pathogenesis is diverse,and the root cause is oxidative stress and advanced glycosylation end products.The nuclear red blood cell related factor 2(Nrf2)signa-ling pathway plays an important role in preventing various diseases.As one of the characteristics of DM,hyperglycemia will activate the generation of reactive oxygen species(ROS)in mitochondria.These oxidative stress factors activate the nucle-ar transcription factor κB pathway,becoming the main inducement of various complications of DM.This pathway will in-duce increased transcription of proinflammatory cytokines,including tumor necrosis factor-alpha,transforming growth fac-tor-beta and interleukin-1.The active ingredients of traditional Chinese medicine have significant antioxidant,anti-inflam-matory,anti-apoptotic and angiogenesis-promoting effects,and can block the progression of DR through various mecha-nisms.In this article,the research status of traditional Chinese medicine targeting the Nrf2 signaling pathway in the preven-tion and treatment of DR is reviewed to guide clinical and scientific research.

Objective:To investigate the clinical characteristics and survival outcomes of patients with nasopharyngeal carcinoma (NPC) complicated by multiple primary malignancies (MPCs) in a real-world setting.Methods:A retrospective study was performed on 238 NPC patients with MPCs who received radical radiotherapy at Fujian Cancer Hospital between January 1st, 2004 and December 31st, 2023. The primary endpoints were overall survival (OS) and cumulative survival rate. Survival analysis was conducted using the Kaplan-Meier method with log-rank / Breslow tests, and univariate analysis of prognostic factors was performed using the Cox proportional hazards model.Results:A total of 246 primary malignant tumors were identified in 238 patients, involving 12 organ systems and 39 tumor types. The most common coexisting malignancies occurred in the respiratory and intrathoracic organs [25.2% (62/246)], followed by digestive organ malignancies [22.8% (56/246)], malignancies of the lip, oral cavity, and pharynx [22.8% (56/246)], and thyroid and other endocrine gland malignancies [15.4% (38/246)]. The median OS was 186 months, and the 3-, 5-, and 10-year cumulative survival rates were 90.84%, 85.25%, and 69.45%, respectively. Poorer survival was associated with male sex, age>48 years at onset, locally advanced disease (stage IVA), synchronous MPCs and/or digestive system malignancies, fewer total cycles of chemotherapy, and lack of concurrent or adjuvant chemotherapy.Conclusions:In patients with NPC, MPCs most frequently involve the respiratory system, digestive system, and head and neck organs (including the thyroid). Male sex, older age, locally advanced primary NPC, synchronous and/or digestive system MPCs, fewer chemotherapy cycles, and lach of concurrent or adjuvant chemotherapy were significantly associated with poorer prognosis.

Objective The purpose of this study is to observe the dynamic changes of host intestinal microflora during the evolution and development of the pathogenesis of"spleen qi deficiency syndrome-spleen yin deficiency syndrome",so as to explore its possible mechanism.Methods The rat model of spleen Qi deficiency syndrome was established by exhaustive swimming and improper diet rhythm.On this basis,the rat model of spleen-yin deficiency syndrome was established by combining the method of consuming yin fluid.Immune-associated cytokines were assessed using ELISA assay and altered composition and diversity in gut microbiota were observed via 16S rRNA sequencing analysis.Results Compared with the control group,sIgA,IL-4,IL-10 and TGF-β in the small intestine of the model group decreased,while IFN-γ and IL-17 levels increased(P<0.05,P<0.01).The changes of immune-related cytokines proved that the immune function of spleen deficiency rats was low.In addition,the intestinal flora structure of rats with spleen deficiency has also changed significantly.The proportion of Firmicutes and Bacteroides changed and the abundance of Proteobacteria increased.The abundance of some probiotics like Lactobacillus and Oscillospira decreased(P<0.01,P<0.05)while some pathogens like Clostridium,SMB53,Campylobacterales,Desulfovibrionales and Enterobacteriales increased(P<0.05).The characteristic changes of intestinal flora in spleen Qi deficiency stage were the abnormal increase of Allobaculum,Bifidobacterium,Prevotella and Adlercreutzia(P<0.01),while in spleen Yin deficiency stage was characterized by a significant increase in the abundance of Ruminococcus(P<0.05).Conclusion Spleen deficiency syndrome is closely related to the changes of intestinal microflora.The abundance of probiotics in the gut microbiota of rats with spleen deficiency syndrome decreased and the abundance of pathogenic bacteria increased.The gut microbiota changes dynamically in the development of spleen deficiency syndrome,which have their own characteristics in the spleen Qi deficiency and spleen Yin deficiency stage respectively.

Objective:To observe the clinical characteristics of elderly patients with demyelinating optic neuritis (DON), and preliminarily analyze the related factors affecting their visual prognosis.Methods:A observational clinical case-control study. A total of 107 patients with DON who were diagnosed and hospitalized in Beijing Tongren Hospital and its medical alliance Department of Ophthalmology, Beijing Puren Hospital from March 2019 to October 2023 were included in this study. Detailed medical histories were recorded, including time of onset, presence of ocular pain, treatment modalities, and follow-up status. All affected eyes underwent best-corrected visual acuity (BCVA) testing, orbital magnetic resonance imaging (MRI), and laboratory tests, including erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), aquaporin-4 (AQP4) antibodies, and myelin oligodendrocyte glycoprotein (MOG) antibodies in peripheral blood. Based on age, patients were categorized into the elderly DON group (≥50 years) and the young and middle-aged DON group (<50 years), comprising 50 and 57 cases, respectively. Furthermore, the elderly DON group was subdivided by serum-specific antibody status into the AQP4 antibody-positive ON group (AQP4-ON group), the MOG antibody-positive ON group (MOG-ON group), and the double-negative ON group (DN-ON group), with 18, 10, and 22 cases respectively. The median follow-up duration was 36 months. Follow-up assessments were conducted using the same equipment, methods, and relevant examinations as those applied at baseline. Binary logistic regression analysis was performed to identify factors associated with visual prognosis in elderly DON patients.Results:Compared with the DON group of young and middle-aged people, the incidence of binocular disease, accelerated ESR, MRI imaging score, the incidence of combined cardiovascular and cerebrovascular diseases, diabetes, tumors, and the proportion of adverse reactions of glucocorticoids in the elderly group were higher, and the proportion of ocular pain was lower. The differences were statistically significant ( P<0.05). Six months after the treatment, the number of cases with BCVA> 0.3 in the affected eyes in the elderly DON group and the young and middle-aged DON group was 28 (56.0%, 28/50) and 42 (73.7%, 42/57), respectively. The number of patients with BCVA> 0.3 in the elderly DON group was significantly lower than that in the young and middle-aged DON group, and the difference was statistically significant ( P=0.034). Moreover, with the increase of age, the degree of improvement in visual acuity showed a decreasing trend. The proportion of females in the AQP4-ON group, the proportion of optic chiasm and posterior optic pathway involvement in acute MRI, and the positive rate of ANA/ENA were significantly higher than those in the MOG-ON group and the DN-ON group, and the differences were statistically significant ( P<0.05). The rate of optic disc edema in the MOG-ON group was significantly higher than that in the AQP4-ON group, and the difference was statistically significant ( P=0.031). One and six months after treatment, the BCVA in the MOG-ON group was significantly better than that in the AQP4-ON group and the DN-ON group, and the difference was statistically significant ( P<0.05). The results of binary logistic regression analysis showed that at the onset of the disease, BCVA <0.01 [odds ratio ( OR) =2.60, 95% confidence interval ( CI) 1.23-5.52, P=0.013] and accelerated ESR ( OR=4.68, 95% CI 1.08-20.18, P=0.039) was an independent risk factor affecting the prognosis of BCVA in elderly patients with DON. Conclusions:There are different clinical characteristics between elderly DON patients and young and middle-aged patients. The risk of combined systemic diseases and side effects of glucocorticoids is higher, and the visual prognosis is worse. There are also differences in clinical characteristics and visual prognosis among subgroups of different serological antibodies in elderly DON. Advanced age, the lowest visual acuity at onset and immune inflammatory indicators are all factors affecting the visual prognosis of DON.