OBJECTIVE:A great deal of evidence indicates that regular exercise can improve the health status of elderly individuals,including reducing overall and abdominal fat levels,increasing muscle mass and bone mineral density of the limbs,thereby preventing or delaying the onset of sarcopenia and its comorbidities.This study aims to determine the most reliable type,duration,and intensity of exercise interventions through meta-analysis to prevent,delay,and alleviate sarcopenia and its comorbidities in elderly individuals.METHODS:Randomized controlled trials examining the effects of exercise interventions on elderly individuals with sarcopenia and its comorbidities were searched in the PubMed,Embase,Web of Science,Cochrane Library,CNKI,and WanFang databases.The Cochrane Risk of Bias Tool was used to assess the quality of the included studies,and RevMan 5.3 software was employed for meta-analysis.Subgroup analyses were conducted to explore the effects of different exercise intervention protocols on various outcome measures.In addition,Stata 16.0 software was used to perform sensitivity analysis to assess the stability of the results,and funnel plots and Egger's test were employed to evaluate publication bias,ensuring the comprehensiveness and reliability of the results.RESULTS:(1)Sixteen studies involving 861 patients with sarcopenia and its comorbidities were included.(2)The meta-analysis results indicated that,compared with the control group,exercise significantly improved grip strength,knee muscle strength,appendicular skeletal muscle mass,skeletal muscle index,Timed Up and Go test results,gait speed,and insulin-like growth factor 1 levels(P＜0.05).However,the effect of exercise intervention on the sit-to-stand test was not significantly improved(P＞0.05).(3)Based on the results of subgroup analysis,it is recommended that elderly patients with sarcopenia and its comorbidities engage in exercise at least three times per week,with each session lasting no more than 30 minutes or exceeding 45 minutes,for at least 12 weeks.The exercise protocol should be flexibly adjusted according to the patient's health status and individual needs.CONCLUSION:Exercise interventions significantly improve muscle mass,muscle strength,physical function,and insulin-like growth factor 1 levels in elderly individuals with sarcopenia and its comorbidities,thereby enhancing their quality of life.However,further research is needed to validate these findings and optimize specific intervention protocols.

OBJECTIVE:A great deal of evidence indicates that regular exercise can improve the health status of elderly individuals,including reducing overall and abdominal fat levels,increasing muscle mass and bone mineral density of the limbs,thereby preventing or delaying the onset of sarcopenia and its comorbidities.This study aims to determine the most reliable type,duration,and intensity of exercise interventions through meta-analysis to prevent,delay,and alleviate sarcopenia and its comorbidities in elderly individuals.METHODS:Randomized controlled trials examining the effects of exercise interventions on elderly individuals with sarcopenia and its comorbidities were searched in the PubMed,Embase,Web of Science,Cochrane Library,CNKI,and WanFang databases.The Cochrane Risk of Bias Tool was used to assess the quality of the included studies,and RevMan 5.3 software was employed for meta-analysis.Subgroup analyses were conducted to explore the effects of different exercise intervention protocols on various outcome measures.In addition,Stata 16.0 software was used to perform sensitivity analysis to assess the stability of the results,and funnel plots and Egger's test were employed to evaluate publication bias,ensuring the comprehensiveness and reliability of the results.RESULTS:(1)Sixteen studies involving 861 patients with sarcopenia and its comorbidities were included.(2)The meta-analysis results indicated that,compared with the control group,exercise significantly improved grip strength,knee muscle strength,appendicular skeletal muscle mass,skeletal muscle index,Timed Up and Go test results,gait speed,and insulin-like growth factor 1 levels(P＜0.05).However,the effect of exercise intervention on the sit-to-stand test was not significantly improved(P＞0.05).(3)Based on the results of subgroup analysis,it is recommended that elderly patients with sarcopenia and its comorbidities engage in exercise at least three times per week,with each session lasting no more than 30 minutes or exceeding 45 minutes,for at least 12 weeks.The exercise protocol should be flexibly adjusted according to the patient's health status and individual needs.CONCLUSION:Exercise interventions significantly improve muscle mass,muscle strength,physical function,and insulin-like growth factor 1 levels in elderly individuals with sarcopenia and its comorbidities,thereby enhancing their quality of life.However,further research is needed to validate these findings and optimize specific intervention protocols.

Systemic lupus erythematosus （SLE） may lead to secondary gynecological and obstetric disorders such as decreased ovarian reserve function， menstrual abnormalities， and adverse pregnancy outcomes. Based on "bi （痹） of both body and viscera" theory， this paper proposed that the core mechanism of SLE secondary gynecological and obstetric diseases lies in the mutual transformation between "body bi" and "viscera bi"， which together affect the uterus. Physiologically， uterus forms an internal-external network with the body and viscera through the meridians and blood vessels. Pathologically， when the healthy qi is deficient， nourishment of the body and viscera is impaired； when toxins and stasis accumulate， pathogenic factors disturb the uterus through the chong （冲） and ren （任） meri-dians. The resulting obstruction in the uterus can， in turn， manifest externally and aggravate damage to the body and viscera. Therefore， the pathogenesis of SLE secondary gynecological and obstetric diseases follows a dynamic trajectory of "body bi first， body bi affecting viscera， and then bi of both body and viscera". In treatment， the principle of harmonizing and balancing the healthy qi is emphasized. The main approach is to regulate the viscera， stabilize the body， and nourish the uterus， with the coordination of nourishing the viscera through the body， thereby achieving simultaneous treatment of both body and viscera. This highlights the guiding significance of the "bi of both body and viscera" theory in preventing and treating SLE secondary gynecological and obstetric diseases.

Objective:To investigate the preventive and therapeutic effects of iridoid glycosides from Boschniakia rossica(IGBR)on precancerous lesions of liver cancer in rats,and to clarify its possible mechanism.Methods:Thirty Wistar rats were selected and the precancerous liver lesion model was established using the modified Solt-Faber method.The rats were randomly divided into sham operation group,model group,and IGBR group,and there were 10 rats in each group.The morphology of liver tissue of the rats in various groups were observed;the liver weights,liver indexes and liver regeneration degrees of the rats in various groups were measured;HE staining was used to observe the pathomorphology of liver tissue of the rats in various groups;immunohistochemistry method was used to detect the expression of glutathione-S-transferase(GST)-Pi protein in liver tissue of the rats in various groups;colorimetric method was used to detect the activities of γ-glutamyl transpeptidase(γ-GT),catalase(CAT),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and glutathione S-transferase(GST),and the level of malondialdehyde(MDA)in liver tissue and mitochondria of the rats in various groups;Western blotting method was used to detect the expression levels of α-smooth muscle actin(α-SMA),collagen type Ⅰ alpha 1 chain(ColⅠα1),matrix metalloproteinase(MMP)13,MMP2,tissue inhibitor of metalloproteinase(TIMP)1,TIMP2,transforming growth factor β1(TGF-β1),TGF-β1 receptor(TβR),mothers against decapentaplegic homolog(Smad)2/3,Smad4,and Smad7 proteins in liver tissue of the rats in various groups.Results:Compared with sham operation group,the liver weight,liver index and degree of liver regeneration of the rats in model group were increased(P<0.05);compared with model group,the liver weight and liver index of the rats in IGBR group showed a decreasing trend,but the difference was not statistically significant(P>0.05).The HE staining results showed that the liver lobule structure in sham operation group was intact and clear,with large hepatocytes,abundant eosinophilic cytoplasm,and hepatocytes arranged in single cords radiating from the central vein;there were irregular hepatic sinusoids between plates,with only a small amount of collagen fibers and inflammatory cell infiltration in the portal area,and no degeneration or necrosis of hepatocytes.In model group,the normal arrangement of hepatocytes disappeared,the liver lobule structure was disrupted,small cell hyperplasia(mainly oval cells)was observed in the portal area,with massive collagen deposition and significant fibrous tissue hyperplasia in the fibrous septum;hepatocytes showed extensive degenerative edema,hydropic degeneration or even ballooning degeneration and focal necrosis;basophilic hepatocytes formed proliferative areas with clear cytoplasm,centrally located nuclei and 1-2 prominent nucleoli;glassy hepatocytes with enlarged nuclei and pale transparent cytoplasm were also observed.In IGBR group,the liver lobule structure was basically preserved,with reduced inflammatory lesions,mild edema,and scattered spotty or focal necrosis;nuclear atypia and pathological mitotic figures or binucleation were observed.The immunohistochemistry results showed GST-Pi protein positive foci with brown-yellow cytoplasmic staining in round or oval nodules.The GST-Pi protein positive foci were observed in liver tissue of the rats in model group,indicating successful establishment of precancerous liver lesion model.The scattered GST-Pi protein positive foci were observed in IGBR group,which were significantly reduced compared with model group.Compared with sham operation group,the activity of γ-GT in liver tissue of the rats in model group was increased(P<0.05);compared with model group,the activity of γ-GT in liver tissue of the rats in IGBR group was decreased(P<0.05).Compared with sham operation group,the GST activity and MDA level in liver tissue and liver mitochondria of the rats in model group were increased(P<0.05),while the activities of SOD,CAT,and GSH-Px were decreased(P<0.05);compared with model group,the GST activity and MDA level in liver tissue and liver mitochondria of the rats in IGBR group were decreased(P<0.05),while the activities of SOD,CAT,and GSH-PX were increased(P<0.05).The Western blotting results showed that compared with sham operation group,the expression levels of α-SMA,ColⅠα1,TIMP1,and TIMP2 proteins in liver tissue of the rats in model group were increased(P<0.05),while the expression levels of MMP13 and MMP2 proteins were decreased(P<0.05),and the ratios of TIMP1/MMP13 and TIMP2/MMP2 were increased(P<0.05);compared with model group,the expression levels of α-SMA,ColⅠα1,and TIMP2 proteins in liver tissue of the rats in IGBR group were decreased(P<0.05),while the expression levels of MMP13 and MMP2 proteins were increased(P<0.05),and the ratios of TIMP1/MMP13 and TIMP2/MMP2 were decreased(P<0.05).Compared with sham operation group,the expression levels of TGF-β1 and Smad2/3 proteins in liver tissue of the rats in model group were increased(P<0.05);compared with model group,the expression levels of TGF-β1,Smad2/3 and Smad 4 proteins in liver tissue of the rats in IGBR group were decreased(P<0.05).Conclusion:IGBR can inhibit precancerous liver lesions and liver fibrosis in rats,and its mechanism may be related to enhancing the antioxidant capacity of liver tissue,inhibiting TGF-β/Smad signaling pathway and regulating TIMP/MMP balance.

Objective:To investigate the pulmonary function in patients with Parkinson's disease(PD)and the association between pulmonary function and motor symptoms.Methods:A total of 104 PD patients were included in the study,and a portable spirometer was used to assess pulmonary function.According to the results of pulmonary function,the patients were divided into ventilation dys-function group with 37 patients and non-ventilation dysfunction with 67 patients,and clinical data were compared between the two groups.Univariate and multivariate logistic regression analyses were used to investigate the factors associated with abnormal pulmonary function,and a Spearman correlation analysis was used to investigate the correlation between pulmonary function parameters and motor symptoms.Results:There were significant differences in the scores of bradykinesia and postural gait between the two groups(P<0.05),and the logistic regression analysis showed a positive correlation between pulmonary ventilation dysfunction and postural gait score(regression coefficient β=0.171,95%CI=1.015-1.386,P=0.032).There were significant differences between the patients with different stages of PD in the pulmonary function parameters of the percentage of forced vital capacity in predicted value(t=2.143,P=0.034),the percentage of forced expiratory volume in 1 second(t=2.118,P=0.037),the percentage of predicted peak expiratory flow(t=2.002,P=0.048),maximum expiratory pressure as a percentage of predicted value(t=2.412,P=0.018),and maximum inspiratory pressure as a percentage of predicted value(t=2.119,P=0.036).Conclusion:The pulmonary function parameters of PD patients are lower than expected values,and the incidence rate of pulmonary ventilation dysfunction is 35.58%,with the main manifestation of restrictive ventilatory dysfunction.There is a correlation between pulmonary function and motor symptoms in PD patients.

Objective:To investigate the efficacy of lightroom therapy on depressive mood and sleep problems in patients with depression, and the potential effects on physiological indices related to circadian rhythms.Methods:From October 2021 to July 2023, 54 patients with acute-phase depression hospitalized in the Mental Health Center of the First Hospital of Hebei Medical University were recruited. The participants were randomly assigned to either medication combined with the bright light therapy group (bright light group, n=36) or medication combined with the dim light therapy group (dim light group, n=18). Both groups received light therapy for 2 weeks, at 10 000 lx in the bright light group and 300 lx in the dim light group. Both groups received 30 minutes of light therapy from 7:30-8:00 a.m daily over two weeks, followed up for 1 week post-treatment. The Hamilton Depression Rating Scale (HAMD 17) was used to assess patients′ depressive symptoms, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess patients′ sleep quality at baseline, at the end of every week. The 32-Item Hypomania Checklist (HCL-32) was used at the end of week 2 to assess the risk of manic switching after treatment. Daily measurements of body temperature, heart rate, and blood pressure were taken before and after light therapy, along with recording adverse events related to the therapy. Paired t- tests were used to compare changes in physiological indicators before and after treatment, and repeated measures ANOVA was applied to compare clinical symptom changes between the two groups. Results:Thirty-one and fifteen patients completed this study in the bright light and dim light groups, respectively, with no statistically significant difference in dropout rates( P>0.05). There were significant interaction effects between the time and group for HAMD 17 and PSQI score( F=5.51,4.11, both P<0.05). Both groups showed significant reductions in HAMD 17 and PSQI scores at baseline, week 1, week 2, and week 3 ( P<0.001). In the bright light group, body temperature increased significantly post-treatment on days 1-4, day 7, and day 12 (all P<0.05). Heart rate elevated on day 5 ( P<0.05).Systolic blood pressure decreased on days 4, 5, 11, and 12 compared to the pre-treatment baseline(all P<0.05). In the dim light group, systolic blood pressure increased on day 11 ( P<0.05). Diastolic blood pressure in the bright light group decreased on days 1, 5, and 6( P<0.05). No serious adverse events, vision loss, ocular structural changes occurred in either group. No hypomania or mania episodes were observed. The incidence of adverse events did not differ significantly ( P>0.05). Conclusion:Medication combined with indoor bright light is more effective than the combination of dim light for depressive symptoms and sleep problems in patients with depression. Patients receiving bright light also may exhibit a higher body temperature, accelerated heart rate, and reduced blood pressure.

OBJECTIVE:To explore the efficacy of different exercise regimens to reduce fall risks in older adults.METHODS:PubMed,Embase,Web of Science,The Cochrane Library,WanFang,and CNKI were searched for studies about exercise interventions on fall risk in healthy older adult individuals at the age of 60 years and above.The search timeframe should cover from the inception of each database to July 2023.Quality assessment and risk-of-bias were assessed using the Cochrane risk of bias tool.Meta-analysis,subgroup analysis,sensitivity analysis,and publication bias were conducted using Review Manager 5.3 and Stata 16.0.RESULTS:A total of 45 papers containing 54 studies with 3 074 participants were included in the analysis.Overall,exercise intervention can improve the interventional effects on balance(the unipedal stance test with eyes open,functional reach,Timed"Up & Go",and Berg balance scale),lower limb muscle strength(30-second chair-stand test,Five-Times Sit-To-Stand Test,and Short Physical Performance Battery),and fall-efficacy(Falls Efficacy Scale-International),leading to reduced fall risk(P＜0.05).The Meta-analysis results revealed a dosage effect of different exercise regimens to reduce fall risk in the elderly.Mind-body exercise could efficiently increase scores of the unipedal stance test[mean difference(MD)=6.81,95％confidence interval(CI)(2.17,11.44),P＜0.01];resistance exercise could efficiently increase the scores of the Timed"Up & Go"[MD=-3.12,95％CI(-5.72,-0.52),P＜0.05]and the 30-second chair-stand test[MD=1.22,95％CI(0.37,2.08),P＜0.01];and multicomponent physical activity could efficiently increase the scores of functional reach[MD=4.50,95％CI(2.58,6.42),P＜0.01],Berg Balance Scale[MD=1.05,95％CI(0.39,1.71),P＜0.01],Five-Times Sit-To-stand Test[MD=-3.15,95％CI(-4.80,-1.50),P＜0.01],Short Physical Performance Battery[MD=0.55,95％CI(0.37,0.74),P＜0.01],and Falls Efficacy Scale-International[MD=-0.41,95％CI(0.69,-0.13),P＜0.01].Conclusion:Exercise interventions can effectively improve balance,enhance limb strength and functional ability,and reduce fear of falling,and lower the risk of falls in older adults.The components of different intervention programs(such as type of exercise,duration,frequency,and session length)have varying dose-response relationships with the results of fall risk screening tests in older adults.

Objective:Persistent proatlantal intersegmental artery (PPIA) is a rare variant of persistent carotid-vertebrobasilar anastomoses and mostly discovered incidentally. To explore the clinical features of PPIA, and enhance the understanding of this rare cerebrovascular variation.Methods:A retrospective analysis was performed. The clinical data of 6 patients with PPIA admitted to Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from June 2018 to June 2024 were analyzed. The imaging features, associated cerebrovascular diseases, treatments and follow-up results were summarized.Results:Among the 6 PPIA patients, 4 were with type I and 2 were with type II; 5 were with left PPIA and 1 patient was with right PPIA; 5 patients had bilateral vertebral artery hypoplasia or absence, and 1 patient had absence of the ipsilateral vertebral artery and normal development of the contralateral vertebral artery. Four PPIA patients were combined with intracranial aneurysms: 2 patients received dual stent-assisted embolization and flow diverter device combined with covered stent implantation, respectively (after 6 months of follow-up, modified Rankin scale score of 0 indicating good prognosis and healed intracranial aneurysms), and the other 2 patients with micro-aneurysms were not treated. One patient was combined with internal carotid artery stenosis and accepted stent placement (good prognosis at 6 months after follow-up). One patient was combined with acute basilar artery tip occlusion and accepted aspiration thrombectomy (died of brain herniation 7 days after thrombectomy).Conclusions:PPIA is often accompanied by vertebral artery developmental abnormalities and prone to have concurrent intracranial aneurysms or ischemic stroke. When performing surgical treatment for cerebrovascular diseases associated with PPIA, PPIA protection to ensure blood supply of the posterior circulation is essential.

Objective:To explore the clinical application value of transoral robotic surgery (TORS) in the treatment of tonsil squamous cell carcinoma (TSCC).Methods:A retrospective analysis was conducted. The clinical data of 157 TSCC patients were collected who received TORS at five medical centers, namely, the Sun Yat-sen University Cancer Center, Sun Yat-sen Memorial Hospital, Eye Ear Nose and Throat Hospital of Fudan University, the First Affiliated Hospital of China Medical University, and Tongji Hospital of Tongji Medical College, from January 1 2017 to July 31 2022. There were 130 males and 27 females, aged 24-85 years. All patients were followed-up at least for 2 years (2-year group), among them, 99 patients had a follow-up of 3 years (3-year group). The overall survival (OS), progression-free survival (PFS), clinical stage, human papillomavirus (HPV) infection status were analyzed. SPSS 25.0 and SAS 9.4 were used for statistical analysis.Results:The OS and PFS of the 2-year group were 91.7% and 87.9%, respectively. The OS and PFS of the 3-year group were 85.9% and 82.8%, respectively. The prognosis of patients with locally early-stage was better than that of locally advanced patients, with the OS of 94.4% for T1-2 vs. 78.0% for T3 ( P=0.005) and the PFS of 91.2% for T1-2 vs. 75.0% for T3 ( P=0.011) in the 2-year group; the OS of 91.1% for T1-2 vs. 65.0% for T3 ( P=0.004) and the PFS of 88.6% for T1-2 vs. 60.0% for T3 ( P=0.002) in the 3-year group; and also, the OS of 90.0% for stage Ⅰ-Ⅱ vs. 79.5% for stage Ⅲ-Ⅳ ( P=0.204) and the PFS of 86.7% for stage Ⅰ-Ⅱ vs. 76.9% for stage Ⅲ-Ⅳ ( P=0.188) in the 3-year group. The prognosis of HPV-positive TSCC patients was better than that of HPV-negative patients in the 3-year group, with the OS of 90.9% for HPV-positive vs. 80.5% for HPV-negative ( P=0.045) and the PFS of 90.9% for HPV-positive vs. 75.6% for HPV-negative ( P=0.047). The average time of postoperative tracheal cannula indwelling was 25.1 days. The indwelling rate and average indwelling time of the postoperative nasogastric tube were 94.3% (148/157) and 8.5 days, respectively. Conclusion:TORS has outstanding survival benefits for TSCC patients. HPV-positive TSCC patients have a better prognosis than HPV-negative patients. TORS treatment of TSCC patients has advantages in postoperative recovery and quality of life.