OBJECTIVE:Elevated blood pressure increases the risk of cardiovascular diseases.Isometric exercise training has been shown to significantly reduce resting blood pressure,but the factors influencing its effectiveness remain unclear,and specific application guidelines are yet to be established.This study aims to evaluate the impact of isometric exercise training on resting blood pressure through meta-analysis,explore its moderating factors,and provide evidence-based recommendations based on its dose-response relationship.METHODS:Following the PRISMA guidelines,a systematic search was conducted in PubMed,Embase,Cochrane Library,Scopus,and Web of Science databases using keywords"Isometric exercise training,""Systolic blood pressure,"and"Diastolic blood pressure,"covering literature up to September 2024.Randomized controlled trials involving isometric exercise training and resting blood pressure were included.Three independent researchers performed literature screening and data extraction,assessing bias risk and quality grades using the Risk of Bias 2.0 tool and GRADE framework.Main effect pooling,publication bias assessment,subgroup,and regression analysis were conducted using R software(version 4.3.4).RESULTS:A total of 28 articles(comprising 32 randomized controlled trials)involving 977 participants were included.(1)Meta-analysis results indicated that isometric exercise training significantly reduced resting systolic blood pressure(MD=-8.01,95％CI=-9.22 to-6.80,P＜0.01,I2=18.20％,low evidence grade)and diastolic blood pressure(MD=-3.46,95％CI=-4.64 to-2.28,P＜0.01,I2=0％,moderate evidence grade)compared to no exercise.(2)Subgroup analysis results revealed significant influences of gender,health status,exercise modality,frequency,intensity,duration,sets per session,rest duration,and baseline blood pressure on the main effects for both systolic(P＜0.01)and diastolic blood pressure(P＜0.05).(3)Regression analysis results did not show any significant influencing factors,but body mass index(β=-4.11,P=0.091)showed a significant negative trend on the main effect for systolic blood pressure.(4)No significant publication bias was observed in the meta-analysis results(P＞0.05).CONCLUSION:(1)Isometric exercise training significantly lowers systolic(low evidence grade)and diastolic(moderate evidence grade)blood pressure with clinically meaningful thresholds.(2)Participant characteristics(gender,health status,baseline blood pressure,and body mass index)and isometric exercise training protocols(modality,frequency,intensity,duration,cycle,sets per session,and rest duration)influence its antihypertensive effects.(3)The article recommends the optimal blood pressure management prescription:three sessions per week,with four sets per session,each set lasting 2 minutes with a 2-minute rest,at an intensity of 95％HRpeak using isometric wall squat exercises;the intervention period can be adjusted around a 6-week node.Future high-quality research is urgently needed to further validate and support these conclusions.

OBJECTIVE:Elevated blood pressure increases the risk of cardiovascular diseases.Isometric exercise training has been shown to significantly reduce resting blood pressure,but the factors influencing its effectiveness remain unclear,and specific application guidelines are yet to be established.This study aims to evaluate the impact of isometric exercise training on resting blood pressure through meta-analysis,explore its moderating factors,and provide evidence-based recommendations based on its dose-response relationship.METHODS:Following the PRISMA guidelines,a systematic search was conducted in PubMed,Embase,Cochrane Library,Scopus,and Web of Science databases using keywords"Isometric exercise training,""Systolic blood pressure,"and"Diastolic blood pressure,"covering literature up to September 2024.Randomized controlled trials involving isometric exercise training and resting blood pressure were included.Three independent researchers performed literature screening and data extraction,assessing bias risk and quality grades using the Risk of Bias 2.0 tool and GRADE framework.Main effect pooling,publication bias assessment,subgroup,and regression analysis were conducted using R software(version 4.3.4).RESULTS:A total of 28 articles(comprising 32 randomized controlled trials)involving 977 participants were included.(1)Meta-analysis results indicated that isometric exercise training significantly reduced resting systolic blood pressure(MD=-8.01,95％CI=-9.22 to-6.80,P＜0.01,I2=18.20％,low evidence grade)and diastolic blood pressure(MD=-3.46,95％CI=-4.64 to-2.28,P＜0.01,I2=0％,moderate evidence grade)compared to no exercise.(2)Subgroup analysis results revealed significant influences of gender,health status,exercise modality,frequency,intensity,duration,sets per session,rest duration,and baseline blood pressure on the main effects for both systolic(P＜0.01)and diastolic blood pressure(P＜0.05).(3)Regression analysis results did not show any significant influencing factors,but body mass index(β=-4.11,P=0.091)showed a significant negative trend on the main effect for systolic blood pressure.(4)No significant publication bias was observed in the meta-analysis results(P＞0.05).CONCLUSION:(1)Isometric exercise training significantly lowers systolic(low evidence grade)and diastolic(moderate evidence grade)blood pressure with clinically meaningful thresholds.(2)Participant characteristics(gender,health status,baseline blood pressure,and body mass index)and isometric exercise training protocols(modality,frequency,intensity,duration,cycle,sets per session,and rest duration)influence its antihypertensive effects.(3)The article recommends the optimal blood pressure management prescription:three sessions per week,with four sets per session,each set lasting 2 minutes with a 2-minute rest,at an intensity of 95％HRpeak using isometric wall squat exercises;the intervention period can be adjusted around a 6-week node.Future high-quality research is urgently needed to further validate and support these conclusions.

Objectives: . This study aimed to explore the role of the Pcdh15 gene in hearing maintenance and to examine the effects of its deficiency on cochlear structure, cochlear function, and hearing loss in mice. Methods: . CRISPR/Cas9 technology was used to generate Pcdh15 knockout (KO) mice. Auditory function was evaluated using hearing tests, while histological approaches were employed to assess morphological changes in cochlear hair cells and spiral ganglion neurons (SGNs). RNA sequencing (RNA-seq) was performed on cochlear tissue from postnatal day 18 (P18) wild-type (WT) and Pcdh15 KO mice to identify differentially expressed genes (DEGs). These DEGs were subjected to functional annotation and pathway analysis, with particular emphasis on oxidative phosphorylation (OXPHOS). Reactive oxygen species (ROS) levels were quantified using flow cytometry and DCFH-DA assays. Results: . Pcdh15 KO mice exhibited progressive sensorineural hearing loss, which worsened to profound deafness by P18. Notably, cochlear hair cells and SGNs showed substantial loss and pronounced morphological abnormalities, particularly within the basal high-frequency region. RNA-seq analysis identified 1,359 DEGs, including 1,024 downregulated and 335 upregulated genes. Pathway analysis indicated that Pcdh15 deficiency was associated with inhibition of the OXPHOS pathway, potentially disrupting mitochondrial respiratory chain complexes I, III, IV, and V and thereby impairing energy production and ATP metabolism. In addition, early-stage cochleae from KO mice demonstrated elevated ROS levels and increased oxidative stress, suggesting that redox imbalance may contribute to hearing damage. Conclusion . Pcdh15 plays a critical role in hearing maintenance. Its deficiency is associated with severe hearing loss and marked cochlear abnormalities, which are linked to inhibition of OXPHOS, disruption of energy metabolism, and exacerbation of oxidative stress. Together, these findings provide new insights into the mechanisms underlying hearing loss and suggest potential targets for therapeutic intervention.

Objectives:To investigate the clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression(ULBD)in the treatment of lumbar spinal stenosis under local anesthe-sia,and to compare the anesthetic effects of single-stage and two-stage local anesthesia.Methods:A retro-spective analysis was conducted on the data of 106 patients with lumbar spinal stenosis who underwent uni-lateral biportal endoscopy assisted ULBD treatment under local anesthesia in our hospital from January 2022 to June 2023.There were 51 males and 55 females,aged 55-83(66.7±14.5)years old,with the following le-sion segments:17 cases at L3-4,36 cases at L4-5,and 53 cases at L5-S1.Schizas classification:25 cases of grade B,36 cases of grade C,and 45 cases of grade D.Among them,52 patients underwent single-stage local anesthesia and were included in the single anesthesia group(Group A),while 54 patients received two-stage local anesthesia and were included in the two-stage local anesthesia group(Group B).There were no statistically significant differences in age,gender ratio,body mass index(BMI),surgical segments,Schizas classification and American Society of Anesthesiologists(ASA)classification between the two groups of patients.The perioperative complications,operative time,as well as the visual analogue scale(VAS)score,oxygen saturation,mean arterial pressure,heart rate in both groups before surgery(T1),during exposure(T2),during traction of the nerve root(T3),and immediately after surgery(T4)were recorded;The VAS scores for low back pain and leg pain,as well as the Oswestry disability index(ODI),were compared between the two groups before and after surgery.The MacNab assessment criteria were used to evaluate the overall postoperative efficacy of the patients at the final follow-up.Results:All patients successfully completed the operation.Two cases had dural tear,but no dural repair was performed;Five cases had mild headache,which disappeared after symptomatic treatment;Four cases had increased lower limb pain and numbness compared to pre-operative conditions,which were treated with symptomatic treatment for swelling reduction,and the symptoms alleviated or disappeared 3-5d after surgery;All incisions healed in stage Ⅰ.During the operation,the vital signs remained stable throughout and no unexpected incidents occurred.There was no statistical difference between group A and group B in operative time(101.9±17.3min vs.103.6±15.9min,P＞0.05).No statistically significant difference was observed in VAS scores,mean arterial pressure and heart rate between the two groups at T1 and T2(P＞0.05).At T3 and T4,the VAS scores,mean arterial pressure and heart rate of group A were significantly higher than those of group B(P＜0.05).At each time point after surgery,the VAS scores and ODI of the two groups improved significantly compared with those before surgery(P＜0.05),but there was no statistically significant difference between the two groups at the same time point(P＞0.05).At the final follow-up,31 cases in group A were excellent,14 cases were good,and 7 cases were fair,with an excellent and good rate of 86.5％;36 cases in group B were excellent,13 cases were good,and 5 cases were fair,with an excellent and good rate of 90.7％.There was no statistically significant difference in the excellent and good rate between the two groups(P＞0.05).Conclusions:The unilateral biportal endoscopy technique under local anesthesia for ULBD in the treatment of lumbar spinal canal stenosis can achieve good clinical efficacy,and two-stage local anesthesia provides a superior analgesic effect compared to single-stage local anesthesia.This method holds significant clinical application value,particularly for patients with lumbar spinal canal stenosis accompanied by complex comorbidities and at high risk for general anesthesia.

Objective:To explore the relationship between serum osteopontin (OPN), annexin A2 (ANXA2) and recurrence after partial laryngectomy in patients with early-stage glottic laryngeal cancer (EGC).Methods:A retrospective study was conducted by collecting clinical data from EGC patients who underwent partial laryngectomy at Beijing Shijitan Hospital from June 2020 to May 2022. Serum levels of OPN and ANXA2 were measured at the time of admission. Clinical data during the perioperative period were also collected. The recurrence within 2 years after surgery was used as the endpoint event. Patients were divided into a recurrence group and a non-recurrence group based on the occurrence of recurrence. The data were compared between the groups, and Cox regression was used to analyze the correlation between recurrence after partial laryngectomy and key factors. Receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive value of serum OPN and ANXA2 for recurrence within 2 years after surgery.Results:Among 167 EGC patients, 42 patients experienced recurrence within 2 years after surgery (recurrence group), with a median recurrence time of 16.00 (13.75, 19.25) months, and a recurrence rate of 25.15%; 125 patients did experience recurrence within 2 years after surgery (non-recurrence group). Compared to the non-recurrence group, the proportions of poorly differentiated tumors and anterior commissure invasion in the recurrence group were higher, the serum levels of OPN, ANXA2 and testosterone were higher: 52.38% (22/42) vs. 20.80% (26/125), 52.38% (22/42) vs. 20.00% (25/125), (24.26 ± 4.64) μg/L vs. (18.83 ± 4.17) μg/L, (37.62 ± 6.15) μg/L vs. (31.24 ± 5.56) μg/L, (27.26 ± 5.31) nmol/L vs. (22.85 ± 4.62) nmol/L, with significant differences ( P<0.05). Cox regression analysis result showed that recurrence after partial laryngectomy in EGC patients was potentially related to tumor differentiation, anterior commissure invasion, and abnormal serum expression of OPN, ANXA2 and testosterone ( P<0.05). ROC curve analysis revealed that serum OPN and ANXA2 had an area under the curve of 0.80 and 0.79, respectively, showing predictive value, with optimal cutoff values of 21.40 and 34.72 μg/L. Decision curve analysis indicated that serum OPN and ANXA2 had predictive significance for recurrence after partial laryngectomy in EGC patients, and the combined use of pathological grade, anterior commissure invasion, and testosterone improved the net benefit. Conclusions:Recurrence after partial laryngectomy in EGC patients may be associated with elevated serum OPN and ANXA2 levels, which could increase the risk of postoperative recurrence. Early detection of serum OPN and ANXA2 could be valuable for predicting recurrence after surgery in EGC patients.

Objectives:To investigate the predictive value of Murray's law-based quantitative flow ratio(μQFR)in side branches for long-term clinical prognosis in patients with non-left main bifurcation lesions who underwent simple main branch stenting,and to provide a potential functional assessment standard for intervention decision-making on coronary bifurcation lesions.Methods:A retrospective analysis was conducted in 408 patients with non-left main bifurcation lesions who underwent simple main branch stenting at Lianyungang First People's Hospital and Nanjing First Hospital between July 2018 and January 2021.The study utilized third-generation QFR software to analyze pre-and post-procedure anatomical and functional parameters of the target lesion's main branch and key branches.The primary endpoint was target vessel failure(TVF)events during the 3-year follow-up.Patients were stratified into TVF and non-TVF groups.Baseline characteristics,procedural data,and pre-/post-procedural parameters of target vessels were compared between groups.Multivariable Cox regression was performed to identify predictors of TVF.Diagnostic efficacy of predictors was evaluated using area under the receiver operating characteristic(ROC)curve(AUC)with DeLong's method for comparison.Patients were dichotomized based on the optimal cutoffof post-procedural side branch μQFR,with TVF incidence rates compared via Cox regression and Kaplan-Meier analysis.Results:During 3-year follow-up,54 patients(13.2%)experienced TVF(TVF group),data were compared with 354 patients(86.76%)without TVF(non-TVF group).The TVF group showed higher post-procedural side branch diameter stenosis([32.93±17.80]%vs.[22.62±11.96]%,P<0.001)and lower μQFR(0.80±0.10 vs.0.89±0.07,P<0.001).Multivariate Cox regression identified higher post-procedural side branch μQFR as an independent protective factor against 3-year TVF(per 0.01 increase:HR=0.903,95%CI:0.850-0.959,P<0.001).ROC curves indicated that post-procedural side branch μQFR had moderate diagnostic efficacy for predicting 3-year TVF(AUC=0.769,95%CI:0.678-0.861,P<0.001),with a significantly higher AUC value than post-operative side branch area stenosis and minimal lumen diameter(both P<0.001),the optimal cutoffvalue was 0.84.Multivariate Cox regression and Kaplan-Meier survival analysis revealed markedly higher 3-year TVF rates in patients with μQFR≤0.84 compared to patients with μQFR>0.84(HR=4.007,95%CI:2.342-6.855,P<0.001;28.3%vs.7.9%,log-rank P<0.001).Conclusions:For patients with bifurcation lesions not involving the left main,the immediate post-procedural side branch μQFR could better predict 3-year TVF than anatomical indices.Maintaining post-stenting side branch μQFR>0.84 may optimize clinical outcomes when using a single-stent strategy.

Objective To observe the effects of Bushen Huoxue Prescription on the pathway related to necroptosis of nucleus pulposus cells in a model rabbit of intervertebral disc degeneration;To explore its mechanisms in delaying intervertebral disc degeneration.Methods A intervertebral disc degeneration rabbit model was established using the spinal instability method.Totally 40 model rabbits were randomly divided into model group,ibuprofen group and Bushen Huoxue Prescription low-,medium-and high-dosage groups.Additionally,a normal control group and a sham-operation group were set up,with 8 rabbits in each group.Each treatment groups received the corresponding drugs via gavage for two consecutive weeks.HE staining was used to observe morphology of nucleus pulposus tissue,transmission electron microscopy was used to observe ultrastructure in nucleus pulposus cells,immunohistochemical staining was used to assess the expressions of Aggrecan and Collagen Ⅱ in nucleus pulposus tissue,Western blot was used to detect the expressions of p-RIPK1,p-RIPK3 and p-MLKL protein in nucleus pulposus tissue.Results Compared with the sham-operation group,the model group showed a significant decrease in nucleus pulposus cells,disordered cell arrangement,reduced extracellular matrix,interrupted cell membrane continuity under transmission electron microscopy,organelle swelling,nuclear membrane disruption,partial chromatin loss,and positive expression of Aggrecan and Collagen Ⅱ in nucleus pulposus tissue decreased(P<0.01),while the expressions of p-RIPK1,p-RIPK3 and p-MLKL protein significantly increased(P<0.01).Compared with the model group,the treatment groups showed an increased number of nucleus pulposus cells with orderly arrangement and more extracellular matrix,the ultrastructural damage of the cell membrane,organelle and nucleus in nucleus pulposus cells was partially restored under transmission electron microscopy,the positive expressions of Aggrecan and Collagen Ⅱ significantly increased in Bushen Huoxue Prescription medium-and high-dosage groups and the ibuprofen group(P<0.05,P<0.01),while the expressions of p-RIPK1,p-RIPK3 and p-MLKL protein significantly decreased(P<0.05,P<0.01).Conclusion Bushen Huoxue Prescription may delay intervertebral disc degeneration of the model rabbit by inhibiting the expressions of p-RIPK1,p-RIPK3 and p-MLKL protein in nucleus pulposus cells,and promoting the generation of extracellular matrix components Aggrecan and Collagen Ⅱ.

[Purpose]To analyze the trend of prostate cancer mortality in China from 2011 to 2020,and to predict the prostate cancer mortality trend from 2021 to 2030.[Methods]The data were collected from the National Mortality Surveillance System(NMSS)from 2011 to 2020,the burden of prostate cancer in China from 2011 to 2020 were analyzed by the number of deaths,age-standardized mortality rate(ASMR),years of life lost(YLL)and age-standardized YLL rate.Joinpoint regression model was used to calculate the average annual percentage change(AAPC)to describe the trend of change.The Bayesian age-period-cohort model was used to predict the mor-tality rate of prostate cancer from 2021 to 2030 and estimate the number of deaths of prostate can-cer in the future.Decomposition analysis was carried out to explore the potential drivers of changes of mortality.[Results]The number of prostate cancer deaths in China in 2020 was 30 805 with an ASMR of 5.56/105.The ASMR for prostate cancer in urban and rural areas was 6.56/105 and 4.84/105,respectively.From 2011 to 2020,the number of prostate cancer deaths,ASMR and age-standardized YLL rate of prostate cancer in China showed an upward trend,AAPC was 5.4％(95％CI:4.7％～6.1％),1.5％(95％CI:1.4％～1.6％)and 1.1％(95％CI:1.1％～1.2％),respective-ly.The ASMR of prostate cancer was higher in the eastern region than those in the central and western regions.Prostate cancer deaths increased in both urban and rural areas among people aged 60 years old and above.In 2030,it is predicted the ASMR of prostate cancer would increase to 5.74/105.Population aging,changes in age-specific mortality rates,and natural population growth accounted for 24.75％,2.77％,and 7.45％of the changes in total deaths of prostate can-cer,respectively.[Conclusion]The burden of prostate cancer is increasing in China.Targeted measures should be implemented in high-risk areas and high-risk groups to effectively reduce the disease burden caused by prostate cancer.

Objectives:To investigate the clinical outcomes of unilateral biportal endoscopy assisted unilateral laminotomy for bilateral decompression(ULBD)in the treatment of lumbar spinal stenosis under local anesthe-sia,and to compare the anesthetic effects of single-stage and two-stage local anesthesia.Methods:A retro-spective analysis was conducted on the data of 106 patients with lumbar spinal stenosis who underwent uni-lateral biportal endoscopy assisted ULBD treatment under local anesthesia in our hospital from January 2022 to June 2023.There were 51 males and 55 females,aged 55-83(66.7±14.5)years old,with the following le-sion segments:17 cases at L3-4,36 cases at L4-5,and 53 cases at L5-S1.Schizas classification:25 cases of grade B,36 cases of grade C,and 45 cases of grade D.Among them,52 patients underwent single-stage local anesthesia and were included in the single anesthesia group(Group A),while 54 patients received two-stage local anesthesia and were included in the two-stage local anesthesia group(Group B).There were no statistically significant differences in age,gender ratio,body mass index(BMI),surgical segments,Schizas classification and American Society of Anesthesiologists(ASA)classification between the two groups of patients.The perioperative complications,operative time,as well as the visual analogue scale(VAS)score,oxygen saturation,mean arterial pressure,heart rate in both groups before surgery(T1),during exposure(T2),during traction of the nerve root(T3),and immediately after surgery(T4)were recorded;The VAS scores for low back pain and leg pain,as well as the Oswestry disability index(ODI),were compared between the two groups before and after surgery.The MacNab assessment criteria were used to evaluate the overall postoperative efficacy of the patients at the final follow-up.Results:All patients successfully completed the operation.Two cases had dural tear,but no dural repair was performed;Five cases had mild headache,which disappeared after symptomatic treatment;Four cases had increased lower limb pain and numbness compared to pre-operative conditions,which were treated with symptomatic treatment for swelling reduction,and the symptoms alleviated or disappeared 3-5d after surgery;All incisions healed in stage Ⅰ.During the operation,the vital signs remained stable throughout and no unexpected incidents occurred.There was no statistical difference between group A and group B in operative time(101.9±17.3min vs.103.6±15.9min,P＞0.05).No statistically significant difference was observed in VAS scores,mean arterial pressure and heart rate between the two groups at T1 and T2(P＞0.05).At T3 and T4,the VAS scores,mean arterial pressure and heart rate of group A were significantly higher than those of group B(P＜0.05).At each time point after surgery,the VAS scores and ODI of the two groups improved significantly compared with those before surgery(P＜0.05),but there was no statistically significant difference between the two groups at the same time point(P＞0.05).At the final follow-up,31 cases in group A were excellent,14 cases were good,and 7 cases were fair,with an excellent and good rate of 86.5％;36 cases in group B were excellent,13 cases were good,and 5 cases were fair,with an excellent and good rate of 90.7％.There was no statistically significant difference in the excellent and good rate between the two groups(P＞0.05).Conclusions:The unilateral biportal endoscopy technique under local anesthesia for ULBD in the treatment of lumbar spinal canal stenosis can achieve good clinical efficacy,and two-stage local anesthesia provides a superior analgesic effect compared to single-stage local anesthesia.This method holds significant clinical application value,particularly for patients with lumbar spinal canal stenosis accompanied by complex comorbidities and at high risk for general anesthesia.

Phototherapy plays a significant role in vitiligo treatment.Narrow-band ultraviolet B(NB-UVB)remains the first-line phototherapy for non-segmental vitiligo in clinical practice.In recent years,visible light has emerged as a novel therapeutic approach for vitiligo.Studies indicate that helium-neon laser demonstrates superior efficacy in segmental vitiligo,blue light is more effective for localized vitiligo,and NB-UVB is better suited for generalized or extensive vitiligo.Different phototherapy modalities exhibit distinct mechanisms of action,involving multiple biological proteins and signaling pathways in melanocyte activation and repigmentation.This review sum-marizes recent advances in phototherapy for vitiligo treatment.