Constipation,a common functional gastrointestinal disorder,not only severely impairs patients'quality of life but is also highly comorbid with psychiatric conditions such as anxiety and depression.Emerging evidence indicates that gut microbiota dysbiosis is a critical link connecting these two disease states.On one hand,dysbiosis exacerbates constipation by affecting host metabolism and intestinal function;on the other,it plays a central role in the pathophysiology of mood disorders.This complex interaction is primarily mediated through the"microbiota-gut-brain axis."Therefore,elucidating the intrinsic relationship among anxiety,depression,gut microbiota,and constipation has become a frontier of interdisciplinary research.

Adipocytic tumors are the most common type of soft tissue tumors,which can be divided into lipomas and liposarcomas.Studies have found that benign lipomas resected from the same site can transform into liposarcomas,especially atypical lipomatous tumors(ALT),suggesting an underlying biological association.In this case,the patient underwent resection of a right neck mass in our hospital in 2017,and the pathology showed fibrolipoma.One year later,the mass recurred at the original site but was not treated.By 2023,the mass had significantly enlarged and extended deeply.MRI showed that the lesion had an unclear boundary with the surrounding fat,suggesting liposarcoma.Puncture and molecular pathology showed MDM2 gene amplification,and the diagnosis of ALT was made,which was confirmed by pathology after complete surgical resection.It can be seen that adipocytic tumors have great differences in biological behavior,and benign lipomas can transform into liposarcomas(especially ALT).Clinically,it is necessary to combine imaging,pathology and molecular detection(such as MDM2/CDK4)for differentiation to formulate treatment plans.

Objective:To analyze the evolution and diffusion characteristics of policies related to life expectancy(LE)and healthy life expectancy(HLE)in China from 1982 to 2024 using a biometric approach to policy analysis,revealing the patterns of policy diffusion.Methods:By retrieving databases such as PKULAW.com,We comprehensively collected 701 policy documents closely related to LE and HLE during the period(including 62 central policies and 639 local policies),the policy diffusion process was quantified in four dimensions:diffusion intensity,diffusion breadth,diffusion speed and diffusion direction by using the policy—reference network analysis method.Results:Related policy has gone through the germination period(1982-2001),the development period(2002-2010),the rapid rise period(2011-2015)and the four stages of innovation and pioneering period(2016—present).Policy diffusion is influenced by the hierarchical level of the issuing institution,policy type,and regional economic development level.Policies promulgated by central institutions exhibit stronger and broader diffusion,with guideline—type policies diffusing most widely.The diffusion rate follows a trend of"initial growth,followed by deceleration,and then a slight increase."The primary diffusion directions are vertical diffusion from central to local levels and horizontal diffusion among peers.Conclusion:The diffusion of policies related to LE and HLE is characterized by significant stages,regions and levels.

Objective To investigate the efficacy of treating adhesive small intestinal obstruction using blind insertion of a nasal ileus catheter in combination with continuous enteral nutrition.Methods The data of patients with adhesive small intestinal obstruction admitted to our department from January 2022 to December 2023 were retrospectively collected.Group A was treated with blind insertion of a nasal jejunal decompression catheter,whereas Group B was managed with a nasogastric tube.Continuous enteral nutrition was initiated after the resolu-tion of intestinal obstruction in both groups.The nutritional indices,abdominal improvement,inflammatory markers,and complication rates were compared between the two groups before and after treatment.Results In terms of nutritional indices,the scores for Alb,Pa,and NRS2002 in Group A were significantly higher than those in Group B on the 7th day(P<0.05).Regarding abdominal improvement indices,Group A demonstrated significantly better outcomes than Group B in daily average decompression drainage volume,daily average reduction in abdominal circumference,relief time for abdominal distension and pain,recovery time for exhaust,defecation,time to resump-tion of enteral nutrition,and total hospitalization duration(P<0.05).Concerning inflammatory indices,CRP,IL-6,and WBC levels in Group A were significantly lower than those in Group B on both the 4th and 7th days post-treatment(P<0.05).With regard to complications,Group A exhibited fewer cases of EN intolerance,reflux,and conversion due to conservative treatment ineffectiveness compared to Group B(P<0.05).Conversely,Group B had fewer instances of water and electrolyte imbalance compared to Group A(P<0.05).Conclusion Adhesive small intestinal obstruction treated with blind insertion of a nasal ileus catheter combined with continuous enteral nutrition is a safe and effective approach,making it worthy of promotion in clinical practice.

Objective To investigate the efficacy of treating adhesive small intestinal obstruction using blind insertion of a nasal ileus catheter in combination with continuous enteral nutrition.Methods The data of patients with adhesive small intestinal obstruction admitted to our department from January 2022 to December 2023 were retrospectively collected.Group A was treated with blind insertion of a nasal jejunal decompression catheter,whereas Group B was managed with a nasogastric tube.Continuous enteral nutrition was initiated after the resolu-tion of intestinal obstruction in both groups.The nutritional indices,abdominal improvement,inflammatory markers,and complication rates were compared between the two groups before and after treatment.Results In terms of nutritional indices,the scores for Alb,Pa,and NRS2002 in Group A were significantly higher than those in Group B on the 7th day(P<0.05).Regarding abdominal improvement indices,Group A demonstrated significantly better outcomes than Group B in daily average decompression drainage volume,daily average reduction in abdominal circumference,relief time for abdominal distension and pain,recovery time for exhaust,defecation,time to resump-tion of enteral nutrition,and total hospitalization duration(P<0.05).Concerning inflammatory indices,CRP,IL-6,and WBC levels in Group A were significantly lower than those in Group B on both the 4th and 7th days post-treatment(P<0.05).With regard to complications,Group A exhibited fewer cases of EN intolerance,reflux,and conversion due to conservative treatment ineffectiveness compared to Group B(P<0.05).Conversely,Group B had fewer instances of water and electrolyte imbalance compared to Group A(P<0.05).Conclusion Adhesive small intestinal obstruction treated with blind insertion of a nasal ileus catheter combined with continuous enteral nutrition is a safe and effective approach,making it worthy of promotion in clinical practice.

AIM To observe the effects of Hugan Tablets on high-fat diet induced non-alcoholic fatty liver disease(NAFLD)in a mouse model,and the autophagy,pyroptosis and the PI3K/Akt/mTOR signaling pathway as well.METHODS The C57BL/6 mice were randomly divided into the normal group,the model group,the Hugan Tablets group(0.7 g/kg)and the Yishanfu group(0.23 g/kg),with 10 mice in each group.The NAFLD mouse model was established by 16 weeks feeding of high-fat diet.From the 13th week,the mice started their corresponding dosing of the drug by gavage followed by killing of the mice at the end of 16th week and collection of their serum and liver tissue samples.The mice had their serum ALT,AST,TG,TC,LDL levels,liver TG,TC,NEFA,MDA levels and activities of SOD and GSH-Px detected;their serum levels of IL-1β,IL-6 and TNF-αdetected by ELISA;their hepatic pathological changes observed using HE staining and oil red O staining;and their hepatic protein expressions of ACC,CPT1A,FAS,p-PI3K,p-Akt,p-mTOR,P62,LC3,NLRP3,GSDMD and Caspase1 detected by Western blot.RESULTS Compared with the model group,the Hugan Tablets group displayed decreased body weight and hepatosmatic index level(P＜0.01);decreased levels of serum ALT,AST,TG,TC,LDL,IL-6,IL-1β and TNF-α(P＜0.05,P＜0.01);increased hepatic levels of TG,TC,NEFA and MDA(P＜0.05);decreased activities of SOD and GSH-Px(P＜0.05);improved pathological changes of hepatic lipid deposition and hepatocytic ballooning and decreased NAS score and oil red O staining area(P＜0.01);decreased hepatic protein expressions of ACC1,FAS,NLRP3,Caspase1,GSDMD,P62,p-PI3K,p-Akt and p-mTOR(P＜0.05,P＜0.01);and increased protein expressions of CPT1A and LC3(P＜0.01).CONCLUSION Hugan Tablets can effectively prevent and control the development of high-fat diet induced NAFLD in mice,and the mechanism may be associated with the promotion of autophagy in hepatocytes and the inhibition of pyroptosis via the inhibition of PI3K/Akt/mTOR signaling pathway.

Objective To investigate the effect of Eriodictyol(ERI)on the development of metabolic dysfunction-associated steatotic liver disease by regulating the expression of ubiquitin A 52(UBA52)at both in vivo and in vitro levels.Methods A mouse metabolic dysfunction-associated steatotic liver disease model was established using a high-fat diet induction.The mice were randomly separated into the normal control group(normal group),the model group,the low-dose ERI group(ERI-L group,50 mg/kg ERI)and the high-dose ERI group(ERI-H group,100 mg/kg ERI),with 12 mice in each group.Oil red O staining was applied to observe lipid deposition in mouse liver tissue.HE staining was applied to observe pathological changes in mouse liver tissue.ELISA method was applied to detect serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)and triglycerides(TG)in mice.The expression of UBA52 protein in liver was detected by Western blot assay.HepG2 cells were treated with 0.5 mmol/L oleic acid to induce an in vitro metabolic dysfunction-associated steatotic liver disease model.HepG2 cells were randomly divide into the control group,the oleic acid induced group,the low concentration ERI group(ERI low group,50 μmol/L ERI),the high concentration ERI group(ERI high group,100 μmol/L ERI),the high concentration ERI+si-NC group(ERI high+si-NC group,100 μmol/L ERI+transfected with si-NC)and the high concentration ERI+si-UBA52 group(ERI high+si-UBA52 group,100 μmol/L ERI+transfected with si-UBA52).Oil red O staining was applied to detect lipid deposition in HepG2 cells of each group.ELISA method was applied to detect the levels of TG,TC,SOD and MDA in HepG2 cells in each group.Immunoblotting was used to detect the expression levels of UBA52,p62 and autophagy related proteins in HepG2 cells.Results Compared with the normal group,serum levels of ALT,AST,LDL-C,TC,TG and the expression of UBA52 protein in liver tissue were increased in the model group(P＜0.05),and the lipid deposition in liver increased,pathological damage was severe,and the proportion of lipid deposition area and non-alcoholic fatty liver disease(NAFLD)activity score were also increased(P＜0.05).Changes in the corresponding indicators in the ERI-L group and the ERI-H group were opposite to those of the model group(P＜0.05),and the ERI-H group was even lower(P＜0.05).The lipid deposition in liver decreased and the pathological damage was alleviated.Compared with the control group,the levels of TG,TC,MDA,the proportion of lipid droplet area and the expression of UBA52 protein were increased in HepG2 cells of the oleic acid-induced group,while the levels of SOD,p62 and LC3Ⅱ/LC3Ⅰ decreased(P＜0.05).Changes in the corresponding indicators of the low-concentration ERI group and the high-concentration ERI group were opposite to those of the oleic acid-induced group(P＜0.05),and the therapeutic effect of ERI on metabolic dysfuntion-associated steatotic liver disease was enhanced after knocking down the expression of UBA52.Conclusion ERI may slow down the progression of metabolic dysfuntion-associated steatotic liver disease by down-regulating the expression of UBA52 at both in vivo and in vitro levels.

Objective To explore the feasibility and corresponding implementation methods of constructing a sample resource bank based on individual-level data of completed clinical trials and using it to construct external controls for drug/device clinical trials.Methods Taking the pre-marketing clinical trial of transcatheter active valve replacement(TAVR)for the treatment of aortic valve stenosis as an example,the individual-level databases of multiple trials were standardized to form a sample bank.The original data of any trial in the sample bank were selected as the experimental group,and the remaining samples were selected as the control group.The potential confounding was handled by using the propensity score matching and stratification methods to clarify the process of constructing external controls based on the sample bank of individual-level data of clinical trials.Results This study included individual-level data of single-group trials of 4 TAVR devices,with a total of 569 subjects(59.2%male).The number of subjects in Trials 1 to 4 was 120,120,163,and 166,respectively.Propensity score matching enabled the matching of 113,117,125,and 147 subjects with comparable or similar characteristics from individual-level data from other trials,respectively,demonstrating a high matching success rate.The PS score distribution plot after stratification showed that the proportions of subjects in the experimental and control groups in strata 1 to 5 in scheme 1 were 4/103,11/103,22/92,32/87,and 51/64,respectively.For all constructed external controlled trials,a certain number of control samples with similar baseline characteristics to the experimental groups were distributed within each propensity score stratum.The results of the simulation test also reflected the potential differences between different devices in the 12-month all-cause mortality rate.Conclusions The sample bank constructed with individual-level data from clinical trials,as a high-quality data source,can serve as a source of external control for single-arm trials in the same field,and as a useful supplement to the external control scenario of real-world evidence to support drug and device development.At the same time,targeted research on research methods and bias control measures in related fields is also needed.

Objective To investigate the effects of long non coding RNA(lncRNA)metastasis associated lung adenocarcinoma transcript 1(MALAT1)on the proliferation and osteogenic differentiation of human periodontal ligament stem cells(PDLSCs)by regulating the miR-150-5p/X-box binding protein 1(XBP1)axis.Methods Quantitative real-time PCR(qRT-PCR)was used to detect the expression of lncRNA MALAT1,miR-150-5p and XBP1 mRNA in undifferentiated and differentiated PDLSCs.The third generation PDLSCs were divided into control group,pcDNA group,pcDNA-lncRNA MALAT1 group,anti-miR-NC group,anti-miR-150-5p group,pcDNA-lncRNA MALAT1+mimic NC group and pcDNA-lncRNA MALAT1+miR-150-5p mimic group.The expression of lncRNA MALAT1,miR-150-5p and XBP1 mRNA of PDLSCs were detected by qRT-PCR.CCK-8 and the clone formation assay were used to detect the proliferation of PDLSCs.P-nitrophenolphosphate substrate method was used to detect alkaline phosphatase(ALP)activity.Alizarin red staining was applied to detect the formation rate of mineralized nodules.Western blot was used to detect XBP1,Cyclin D1,osteocalcin(OCN),Runt related transcription factor 2(RUNX2)and osteopontin(OPN)proteins.Dual luciferase assay was used to verify the targeting relationship between lncRNA MALAT1 and miR-150-5p,and between miR-150-5p and XBP1 was validated.Results Compared with the undifferentiated group,the expression of lncRNA MALAT1(1.95±0.14 vs 1.00±0.00)and XBP1 mRNA expression(1.63±0.12 vs 1.00±0.00)increased in the differentiated PDLSCs,the expression of miR-150-5p decreased(0.26±0.01 vs 1.00±0.00)in differentiated group,with the differences were statistical significance(t=16.622,12.860,181.262,all P<0.001).Overexpression of lncRNA MALAT1 or down-regulation of miR-150-5p could promote the proliferation and osteogenic differentiation of human PDLSCs(t=13.693～45.518),miR-150-5p mimic reversed the effects of overexpression of lncRNA MALAT1 on proliferation and osteogenic differentiation of PDLSCs(t=9.229～27.854),and the differences were statistically significant(all P<0.05),respectively.Dual luciferase assay confirmed that overexpression of miR-150-5P reduced the luciferase activity in transfected lncRNA MALAT1-WT and XBP1-WT cells(t=56.546,89.826,all P<0.001).Conclusion Overexpression of lncRNA MALAT1 may promote XBP1 expression by downregulating miR-150-5p,thereby promoting proliferation and osteogenic differentiation of human PDLSCs.

Objective:To investigate the value of pelvic floor reconstruction with gluteus maximus myocutaneous flap in second-stage surgery for patients with failed perineal wound healing after pelvic exenteration (PE).Methods:This was a descriptive case series study. The clinical data of 24 patients with locally advanced (LARC) or recurrent (LRRC) rectal cancer who underwent PE and had long-term nonunion of postoperative perineal wounds were collected from the department of colorectal surgery of the Second Affiliated Hospital of Navy Medical University (Shanghai Changzheng Hospital) from January 2022 to January 2023. The specific operation methods of pelvic reconstruction by gluteus maximus myocutaneous flap are as follows: the necrotic tissue of the perineal wound was debrided and rinsed repeatedly, the gluteus maximus muscle was cut and separated from the gluteus superior and inferior arteries, the middle muscle pedicle was retained, part of the skin and muscle were separated from the medial margin, part of the epidermis was removed, the muscle and subcutaneous tissue at the medial margin of the flap were fixed to the medial edge of the wound, negative pressure suction tubes were placed above and below the wound cavity and in the muscle space on the right side, and the subcutaneous muscle and fat layer were sutured. The skin was sutured intersegmentally, and a negative pressure suction device was placed on the wound surface. After surgery, the patient should remain prone, and the drainage tube should be placed for at least 7 days. The drainage tube can be removed after 24-hour drainage is less than 30 ml. Perineal wound healing and complications related to gluteal major myocutaneous flap were observed.Result:The median reconstruction time of 24 patients was 180 (150 ~ 230) minutes, and the median intraoperative blood loss was 100 (30 ~ 200) ml. 91.7% (22/24) patients had successful healing of perineal wound within 30 d after operation. After a follow-up of 6 months, no complete or partial flap necrosis occurred. The incidence of complications related to gluteus maximus myocutaneous flap was 8.3% (2/24). One patient had flap infection and sinus tract, and one patient had flap sinus tract. All patients healed after debridement under local anesthesia.Conclusion:For LARC/LRRC patients with poor perineal wound healing after PE, pelvic floor reconstruction with gluteus maximus myocutaneous flap in second-stage operation is safe and feasible, and could successfully close the perineal wound, and has a low incidence of postoperative flap-related complications.