ObjectiveTo investigate the application value of a predictive model constructed based on quantitative imaging parameters and serum tumor markers in predicting the postoperative prognosis of patients with pancreatic ductal adenocarcinoma （PDAC）. MethodsA retrospective study was conducted among 146 patients with PDAC who underwent radical resection in Hebei Medical University Fourth Hospital from April 2020 to March 2023， and the patients were divided into a training set with 102 patients and a validation set of 44 patients at a ratio of 7∶3 using the completely randomized method. All patients underwent enhanced computed tomography （CT） and multi-parametric magnetic resonance imaging scans， and CT values in the arterial phase， the venous phase， and the delayed phase were recorded， as well as apparent diffusion coefficient （ADC） at b = 800 s/mm² and signal intensity （SI） of T₂ weighted imaging. The serum levels of carbohydrate antigen 19-9 （CA19-9） and carcinoembryonic antigen （CEA） were also measured. The independent-samples t test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. Kaplan-Meier survival curves were plotted for survival analysis； the univariate and multivariate Logistic regression analysis was used to investigate the association of clinical and imaging indicators with prognosis； the least absolute shrinkage and selection operator （LASSO）-Cox regression model was used to identify the important influencing factors for prognosis， and a prognostic prediction model was constructed. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of the model in predicting prognosis in both the training set and the validation set. ResultsThe Kaplan-Meier survival curve analysis showed a median survival time of 33.00 months in the training set and 32.00 months in the validation set， with no significant difference between the training set and the validation set （P>0.05）. The univariate analysis showed that patient age， degree of tumor differentiation， lymph node metastasis， tumor stage， vascular invasion， CA19-9， CEA， ADC value， and SI value were significantly associated with the survival prognosis of patients （χ²=5.906， 13.116， 12.807， 17.277， 14.611， 7.275， 14.339， 9.506， and 13.137， all P<0.05）. The LASSO-Cox multivariate regression analysis showed that six factors were incorporated into the regression model， i.e.， tumor stage （HR=8.934， 95%CI： 3.215 — 21.562， P<0.001）， lymph node metastasis （HR=2.971， 95%CI： 1.298 — 5.647， P=0.002）， CA19-9 （HR=3.948， 95%CI： 1.758 — 8.994， P<0.001）， CEA （HR=1.965， 95%CI： 1.083 — 3.664， P=0.039）， ADC value （HR=2.873， 95%CI： 1.307 — 6.037， P=0.003）， and SI value （HR=3.107， 95%CI： 1.264 — 7.339， P=0.001）. The nomogram model constructed based on these factors had an area under the ROC curve of 0.845 （95%CI： 0.774 — 0.915） in the training set and 0.919 （95%CI： 0.870 — 0.967） in the validation set. ConclusionThe combined model of quantitative imaging parameters and serum tumor markers constructed based on LASSO-Cox regression can effectively predict the postoperative prognosis of PDAC patients， thereby helping to identify high-risk patients and guide decision-making for adjuvant therapy.

ObjectiveThis study aims to observe the effect of sinomenine （SIN） on fatty acid binding protein 4 （FABP4） in synovial tissue of rats with osteoarthritis （OA） and investigate the therapeutic mechanism of SIN on OA， further providing new ideas for the management of osteoarthritis by traditional Chinese medicine （TCM）. MethodsAn OA rat model was constructed and randomly divided into a control group， an OA group， an OA + SIN-L group （50 mg·kg^-1）， an OA + SIN-M （100 mg·kg^-1）， an OA + SIN-H （200 mg·kg^-1）， and an OA + prednisone （PDN） group （5 mg·kg^-1）. Following surgical modeling for three weeks， an appropriate medication was administered for four weeks. During modeling and administration， a hot plate test was performed to detect the pain and swelling of the knee joints of the rats. The periarticular tissue was collected for arthropathological observation at the end of drug administration. The expression of cleaved Caspase-3， B-cell lymphoma-2 （Bcl-2）， Bcl-2 associated X protein （Bax）， and FABP4 in the synovial tissue of rats was detected by Western blot and real-time quantitative polymerase chain reaction （Real-time PCR）， and the expression and distribution of FABP4 protein in the synovial membrane were detected by immunofluorescence. ResultsCompared with those in the control group， the levels of inflammatory factors and FABP4 in the serum of rats in the OA group were significantly increased （P<0.05， P<0.01）， and joint swelling was significantly elevated （P<0.01）. The thermal pain threshold was significantly reduced （P<0.01）， and the expression of FABP4 protein and the fluorescence intensity were significantly increased （P<0.01）. The synovial tissue exhibited significantly increased inflammatory infiltration， proliferated fibroblasts， and an elevated apoptotic index （P<0.05， P<0.01）. Compared with those in the OA group， the serum lipid metabolism indexes of rats in the SIN administration group gradually returned to normal （P<0.05， P<0.01）， while the levels of inflammatory factors and FABP4 in the serum of rats in the SIN-administered group were significantly reduced （P<0.05， P<0.01）， and joint swelling was significantly decreased （P<0.05， P<0.01）. The thermal pain threshold was significantly elevated （P<0.05， P<0.01）， and the expression of FABP4 protein and fluorescence intensity in the synovial tissue were significantly decreased （P<0.05， P<0.01）. The synovial tissue displayed significantly reduced inflammatory infiltration and a decreased apoptotic index （P<0.05， P<0.01）. ConclusionThe therapeutic effect of SIN on OA may be related to the down-regulation of FABP4 expression， reduction of apoptosis， and inhibition of inflammatory factor expression.

BackgroundNon-suicidal self-injury （NSSI） behaviors are prevalent among adolescents， significantly affecting their physical and mental well-being. Understanding the risk factors associated with adolescent NSSI is crucial for prevention. Previous studies have identified mobile phone dependence as a risk factor for NSSI in adolescents. However， as a key form of mobile phone dependence， the evidence regarding the impact of mobile phone social media dependence on adolescent NSSI behavior remains insufficient. ObjectiveTo explore the impact of mobile phone social media dependence and its associated factors on adolescent NSSI behavior， so as to provide references for intervention strategies targeting NSSI in adolescents. MethodsA total of 100 adolescents diagnosed with NSSI according to the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and receiving treatment at Tongde Hospital of Zhejiang Province from January 2022 to December 2023 were included in the study group. Concurrently， 100 age- and sex-matched students from Hangzhou were recruited as the control group. Assessments were conducted using Ottawa Self-injury Inventory（OSI） Function Subscale and Addiction Features Subscale， Adolescents Self-Harm Scale（ASHS）， and Mobile Phone Social Media Dependence Questionnaire. Multiple linear regression was used to analyze the factors influencing NSSI behaviors. ResultsThe research group had a total of 99 patients （99.00%） who completed the study， while the control group consisted of 97 （97.00%） adolescents who finished this research.The study group had statistically significantly higher total scores on the Mobile Phone Social Media Dependence Questionnaire， as well as higher scores on the conflict and withdrawal dimensions， compared with control group（t=-3.061， -2.874， -2.368， P<0.05 or 0.01）. The study group also scored significantly higher on the OSI Function Subscale for internal emotion regulation， social influence， external emotion regulation， and sensation-seeking factors， as well as on the OSI Addiction Features Subscale scores， compared to the control group（t=-22.249， -8.854， -17.968， -10.591， -20.157， P<0.01）. OSI Function Subscale scores were positively correlated with Mobile Phone Social Media Dependence Questionnaire scores （r=0.321， P<0.01）， and OSI Addiction Features Subscale scores were positively correlated with Mobile Phone Social Media Dependence Questionnaire scores （r=0.282， P<0.01）. ASHS scores were positively correlated with Mobile Phone Social Media Dependence Questionnaire scores （r=0.145， P<0.05）. Multiple linear regression analysis showed that compulsivity （β=0.416， P<0.01） and conflict （β=0.256， P<0.05） were significant predictors for adolescent NSSI behaviors. ConclusionAdolescent NSSI behaviors are associated with mobile phone social media dependence. The compulsivity and conflict dimension of mobile phone social media dependence are influencing factors for adolescent NSSI behaviors. The higher level of the compulsivity and conflict are associated with an increased risk of the NSSI behaviors in adolescents. ［Funde by Zhejiang Medical and Health Science and Technology Plan Project in 2022 （number， 2022KY704］

Polygonatum sibiricum， as a traditional Chinese medicine with both medicinal and edible properties， has attracted considerable attention due to its functions of nourishing Yin and moistening the lungs， tonifying the spleen and benefiting Qi， and nourishing the kidneys and filling essence. Recent studies have demonstrated that Polygonatum sibiricum plays a significant role in regulating the immune system， effectively enhancing and improving the morphology and function of immune organs， stimulating the proliferation and activation of immune cells， and regulating the secretion and release of immune factors， thereby enhancing the immune function of the body and improving various immune-related diseases. Although a large number of studies have explored the pharmacological effects and mechanisms of P. sibiricum， there has been no systematic review and summary of its immune regulatory activity and mechanisms. Therefore， this article comprehensively reviews the research achievements of P. sibiricum polysaccharides and saponins in the field of immune regulation in recent years， and further sorts out the immune regulatory mechanisms of P. sibiricum in multiple aspects： including increasing the organ index of the spleen and thymus， increasing the number and activity of tumor-suppressive bone marrow hematopoietic stem cells， improving intestinal flora imbalance， regulating the quantity and proportion of T lymphocyte subsets， increasing the level of immunoglobulin， promoting the proliferation of macrophages， enhancing the activity of natural killer cells， increasing the number of white blood cells， and promoting the maturation of dendritic cells， providing a solid theoretical basis and scientific evidence for the research and application of P. sibiricum， and promoting its development and application in traditional Chinese medicine immune enhancers and various functional products.

Objective To investigate the epidemiology of elderly respiratory tract infection (RTI) cases in a hospital in Xuzhou region from 2020 to 2022. Methods The cases of RTI patients in a hospital were screened from May 2020 to December 2022, and 548 cases that met the criteria were included in the study. Patient case data were analyzed for symptoms, pathogen distribution, and differences in patient distribution under different screening conditions (age, disease, and season). Results More than 90.00% of the included RTI patients presented with symptoms of cough, sputum, wet rales and pleural effusion was less common. The top three comorbidities were cardiovascular disease (153 patients, 27.92%), cerebrovascular disease (133 patients, 24.27%), and gastrointestinal disease (105 patients, 19.16%).All 548 elderly patients tested positive for respiratory pathogens (100.00%). There were 540 cases of single pathogen infection (98.54%) and 8 cases of mixed infection (1.46%). The top five single pathogen infections were Pseudomonas aeruginosa (92 cases, 16.76%), Escherichia coli (78 cases, 14.21%), drug-resistant Staphylococcus aureus (69 cases, 12.57%), Klebsiella pneumoniae (65 cases, 11.84%), and Mycoplasma pneumoniae (46 cases, 8.38%). The highest detection rate of respiratory pathogens was found in patients >90 years old, whose main pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae and drug-resistant Staphylococcus aureus. The next highest rates of pathogen detection were found in patients aged 86-91 and 81-85 years, unlike patients >90 years, who had a higher rate of Escherichia coli detection. Unlike other age groups, patients <75 years old had a higher percentage of influenza B virus detection. The highest incidence of pneumonia was found in 45.62% (250 cases). Escherichia coli had the highest detection rate in acute bronchitis/episodes and pneumonia, respiratory syncytial virus had the highest detection rate in wheezing bronchitis, Klebsiella pneumoniae had the highest detection rate in bronchopneumonia, and Pseudomonas aeruginosa had the highest detection rate in fever. The highest detection rate of pathogens was found in fall (36.50%), followed by spring (27.01%). The distribution of pathogen infections in all seasons was matched with the results of pathogenicity testing. Streptococcus oxysporus had the highest number of infections in the fall (χ²=20.33, P<0.001). Conclusion Elderly respiratory tract infections in this region are most common in patients over 90 years old, with the highest incidence of pneumonia and high incidence in fall, and the pathogens are mainly Pseudomonas aeruginosa, Escherichia coli and drug-resistant Staphylococcus aureus. Attention to distinguish the above characteristics can provide some support for early diagnosis and treatment of respiratory infections in the elderly in this region.

Objective:To investigate the relationship between thoracic aortic calcification (TAC) and autonomic nervous system (ANS) function in patients receiving continuous ambulatory peritoneal dialysis (CAPD).Methods:It was a cross-sectional study. The CAPD patients with dialysis duration >6 months between January and December 2022 were retrospectively enrolled. The baseline clinical data, heart rate variability (HRV) data such as standard deviation of all normal to normal intervals (SDNN), root mean square of successive differences between adjacent normal-to-normal intervals (RMSSD), high frequency (HF), very low frequency (VLF), low frequency (LF), LF/HF, acceleration capacity (AC) and deceleration capacity (DC), and skin sympathetic nerve activity (SKNA) were collected. TAC was defined as TAC score (TACS) >100 AU. The patients were divided into TACS >100 AU group and TACS≤100 AU group based on whether the thoracic aorta was calcified. The differences of those data between the two groups were compared. Logistic regression model was used to analyze the related factors of TAC. Spearman correlation analysis method was used to analyze the correlation between peripheral blood neuropeptide Y, ANS parameters, average amplitude SKNA (aSKNA) and TACS.　Cox regression model was used to analyze the risk factors of all-cause mortality in patients with CAPD.Results:The study included 106 CAPD patients with 50 males (47.2%), age of (46.04±11.10) years and dialysis duration of (41.55±30.52) months. TACS>100 AU group exhibited significantly lower heart rate ( t=2.015, P=0.046), DC ( t=2.131, P=0.035), LF/HF ( Z=3.332, P<0.001) and ln(LF/HF) ( t=3.326, P=0.001), and higher AC ( t=-2.392, P=0.019) than TACS≤100 AU group. Multivariate logistic regression analysis results showed that after adjusting for age and eosinophil count, lnVLF ( OR=0.66, 95% CI 0.45-0.98, P=0.038), lnLF ( OR=0.69, 95% CI 0.49-0.97, P=0.032), DC ( OR=0.79, 95% CI 0.64-0.99, P=0.039) and AC ( OR=1.32, 95% CI 1.04-1.68, P=0.021) were independently correlated with the risk of TAC. Spearman correlation analysis showed that neuropeptide Y level in peripheral blood was correlated with aSKNA ( r=0.23, P=0.017), lnSDNN ( r=-0.20, P=0.036) and TACS ( r=0.19, P=0.048). During the follow-up period of (25.8±4.2) months, 5 patients (4.72%) died, including 1 patient in the TACS≤100 AU group and 4 patients in the TACS>100 AU group. Compared with the survival group, the death group had higher TACS ( Z=-2.262, P=0.024) and lower LF/HF ( Z=-2.750, P=0.006). Cox regression analysis results showed that increased ln(LF/HF) was an independent influencing factor for all-cause mortality in CAPD patients ( HR=0.22, 95% CI 0.05-0.83, P=0.026). Conclusions:HRV parameters (lnVLF, lnLF, AC and DC) of CAPD patients are independently associated with TAC. The dysfunction of ANS in CAPD patients (especially the decreased vagus nerve activity) may promote TAC.

Objective:To explore the latent class characteristics of demoralization in severely disabled stroke patients, and analyze the differences and influencing factors of each class by latent class analysis.Methods:Convenience sampling was used to select 335 patients in the Neurointensive Care Unit of three Class Ⅲ Grade A hospitals in Anhui Province from October 2023 to March 2024, and were confirmed to be with post-stroke disability through follow-up as research subjects. General Information Questionnaire and Demoralization Scale-Ⅱ were used for a survey. Latent class analysis was used to identify latent classes of demoralization, and multiple logistic regression was used to analyze the influencing factors of different latent classes.Results:A total of 335 questionnaires were distributed, and 321 valid questionnaires were retrieved. The effective recovery rate of the questionnaires was 95.8%. Demoralization of severe stroke patients with disability was classified into four categories of low demoralization (40.2%, 129/321), moderate demoralization with coping loss (12.1%, 39/321), moderate demoralization with goal loss (21.2%, 68/321), and high disability (26.5%, 85/321). Multiple Logistic regression analysis showed that age, gender, per capita monthly income of the family, whether was the economic pillar of the family, long-term residence, and relationship with cohabitants were the influencing factors of demoralization in severe stroke patients with disability (all P<0.05) . Conclusions:There are four latent classes of demoralization in stroke patients with disability, and age, gender, per capita monthly income of the family, whether they are the economic pillar of the family, long-term residence, and relationship with cohabitants are the influencing factors of demoralization in severe stroke patients with disability.

BACKGROUND:The adjustment of force lines in open wedge high tibial osteotomy can affect the retroversion of the knee joint and the height of the patella.In addition,the adjustment of force lines in open wedge high tibial osteotomy is also different according to different varus deformity.At present,the difference of weight bearing line adjustment is still controversial for the correlation index of knee joint and the function of knee joint after surgery.OBJECTIVE:To investigate the effect of line adjustment area on postoperative knee function and joint kinematics during open wedge high tibial osteotomy.METHODS:Totally 76 patients with knee osteoarthritis who received open wedge high tibial osteotomy in Binzhou People's Hospital Affiliated to Shandong First Medical University from March 2022 to March 2023 were selected,including 33 males and 43 females,all on one knee.The lateral border of the tibial plateau was considered as 100％.The position of the central intercondylar ridge of the knee joint was 0％.The weight bearing line of the affected limb was divided into two groups according to the difference of the lateral plateau area of the affected limb:the area of the force line passing through the lateral plateau of the tibial plateau(0-29％)was classified as group A(n=39),and the area of the lateral plateau of the tibial plateau was classified as group B(n=37)by 30％to 40％.The changes of tibiofemoral angle,medial proximal tibial angle,posterior inclination of tibia,and patellar height before and after operation were analyzed.The symptoms and function of the knee were evaluated by the Numeric Rating Scale score and the Hospital for Special Surgery knee score.RESULTS AND CONCLUSION:(1)At 1 year after surgery,the posterior inclination of tibia and the medial angle of proximal tibia were increased in both groups(P＜0.05),and the tibiofemoral angle was reduced and patellar height was decreased in both groups(P＜0.05).The posterior inclination of tibia,medial proximal tibial angle,tibiofemoral angle,and patellar height were significantly different between the two groups at 1 year after surgery(P＜0.05).(2)The Hospital for Special Surgery knee scores of the two groups of patients at all times after surgery were better than those before surgery,and showed a gradually increasing trend(P＜0.05).There was no significant difference in the Hospital for Special Surgery knee scores 1 week and 3 months after surgery between the two groups(P＞0.05).Hospital for Special Surgery knee score of group B at 6 and 12 months after surgery was better than that of group A(P＜0.05).(3)The Numeric Rating Scale score after surgery showed a gradual downward trend(P＜0.05).No significant difference was detected between the two groups(P＞0.05).(4)The results show that the knee function and symptoms were significantly improved in the early and middle period after open wedge high tibial osteotomy,and the knee joint related parameters changed with the outward shift of weight bearing line.At 1-year follow-up,the functional recovery of knee joint in group B was better than that in group A.Long-term knee function and clinical differences after surgery need further follow-up study.

Papillary cystadenocarcinoma of the prostate is a clinically rare condition, and we admitted one case in September 2022. The patient was an 82-year-old male presenting with asymptomatic gross hematuria for one week. Cystoscopy revealed a papillary lesion located anterior to the verumontanum. During surgery, resection of the urethral lesion and prostate tissue showed that the tumor base originated from the cystically dilated prostate gland with multiple papillary lesions. Postoperative pathological diagnosis confirmed papillary cystadenocarcinoma of the prostate. The patient was followed up for 18 months without recurrence of hematuria or other symptoms. Papillary cystadenocarcinoma of the prostate exhibits distinct aggressive and recurrent characteristics. For patients with a pathologically confirmed diagnosis, given the current unclear effectiveness of radiotherapy and chemotherapy, it is advisable to prioritize radical surgical treatment and/or lymph node dissection in patients with good general condition to achieve a better prognosis.

A 70-year-old male patient was treated with venetoclax 100 mg orally once daily for acute myeloid leukemia. Before treatment, laboratory tests showed serum potassium 3.61 mmol/L, serum calcium 1.88 mmol/L, inorganic phosphate 1.33 mmol/L, serum uric acid 276.3 μmol/L, aspartate aminotransferase (AST) 23 U/L, gamma-glutamyl transferase (GGT) 179 U/L, and lactate dehydrogenase (LDH) 797 U/L. Six hours later of medication, the patient experienced chest tightness, wheezing, fever with chills, and the highest body temperature was 38.3 ℃. Laboratory tests showed serum potassium 5.54 mmol/L, serum calcium 1.76 mmol/L, inorganic phosphate 3.41 mmol/L, serum uric acid 827.2 μmol/L, AST 205 U/L, GGT 157 U/L, LDH 4 789 U/L, and D-dimer 51.19 mg/L, respectively. It was considered that there was a high possibility of tumor lysis induced by venetoclax, and the drug was immediately stopped. Symptomatic treatments were given, including oxygen inhalation, electrocardiogram monitoring, fluid infusion, alkalinization of urine, and uric acid reduction. The fever of the patient was alleviated on the day of drug withdrawal, the symptoms of chest distress and asthma were improved the next day, and 3 days later, laboratory tests showed serum potassium 4.24 mmol/L, serum calcium 2.02 mmol/L, inorganic phosphate 1.76 mmol/L, serum uric acid 275.0 μmol/L, AST 37 U/L, GGT 80U/L, LDH 1 146 U/L, and D-dimer 7.97 mg/L; venetoclax treatment was resumed and the tumor lysis syndrome-related symptoms did not recur.