AIM: To investigate the effects of insulin-like growth factor 1(IGF-1)on the secretion of transforming growth factor β2(TGF-β2), matrix metalloproteinase 2(MMP-2)and hypoxia-inducible factor 1α(HIF-1α)in human scleral fibroblasts(HSF)and their mechanism.METHODS: The cells were cultured with IGF-1 and PI3K/AKT pathway inhibitor LY294002, respectively. CCK-8 method was used to detect cell viability and determine the optimal concentration and time of drug action. Cell migration activity was observed by cell scratch method. To determine the effects of IGF-1 on HSF cells and the regulatory role of PI3K/AKT pathway, HSF cells were divided into control group(without drugs), IGF-1(80 μg/L)group, IGF-1+LY294002(80 μg/L+5 mmol/L)group, and LY294002(5 mmol/L)group, and were cultured for 24 h; the protein expression levels of TGF-β2, MMP-2, HIF-1α, PI3K and AKT were detected by Western blot; the fluorescence expression of TGF-β2, MMP-2 and HIF-1α was detected by cellular immunofluorescence.RESULTS: The results of CCK-8 showed that the cell viability of the 80 μg/L IGF-1 group cultured with different concentrations of IGF-1 was the highest(all P<0.05), and the cell viability of the 80 μg/L IGF-1 group at 24 h was the highest under different culture times. Therefore, the concentration of IGF-1 was selected as 80 μg/L for 24 h. The viability of cells cultured with different concentrations of LY294002 gradually decreased from 6 h(all P<0.05). According to the IC50 value, therefore, the concentration of LY294002 was selected as 5 mmol/L for 24 h. The cell scratch results showed that compared with the control group, the cell mobility of 40 μg/L and 80 μg/L IGF-1 groups was increased(all P<0.05). Compared with the control group, cell mobility in the 2.5 and 5 mmol/L LY294002 groups was decreased(all P<0.05). Western blot results showed that compared with the control group, the protein expressions of TGF-β2, MMP-2, HIF-1α, PI3K and AKT in the IGF-1 group were increased, while those in the LY294002 group were decreased(all P<0.05). Compared with the IGF-1 group, the expression levels of TGF-β2, MMP-2, HIF-1α, PI3K and AKT in the IGF-1+LY294002 group were decreased(all P<0.05). The results of cell immunofluorescence showed that compared with the control group, the fluorescence expressions of TGF-β2, MMP-2 and HIF-1α in the IGF-1 group were increased, while those in the LY294002 group were decreased(all P<0.05). Compared with the IGF-1 group, the fluorescence expressions of TGF-β2, MMP-2 and HIF-1α in the IGF-1+LY294002 group were significantly decreased(all P<0.05).CONCLUSION: IGF-1 promoted the proliferation and migration of human HSF. IGF-1 may up-regulate the expression of TGF-β2, MMP-2 and HIF-1α in HSF through the PI3K/AKT signaling pathway, and participate in the occurrence and development of myopia.

Objective To evaluate the clinical utility of the f-wave to QRS complex amplitude ratio(f/R ratio)in intracardiac electrogram(IC-ECG)-guided positioning of peripherally inserted central catheter(PICC)tips in patients with atrial fibrillation(AF),providing evidence to enhance clinical practice.Methods This study employed a conve-nience sampling method to enroll eligible AF patients admitted to a tertiary hospital in Suzhou from July 2023 to July 2024.During PICC placement,IC-ECG was utilized to monitor f-wave and QRS complex amplitude variations.Following successful catheterization,the f/R ratio was measured,and chest X-ray was performed to confirm the catheter tip position.The accuracy of PICC tip positioning across different f/R ratio ranges was analyzed,and the incidence of arrhythmias was recorded.A receiver operating characteristic curve was constructed to assess the diag-nostic performance of the f/R ratio in PICC tip localization.Results A total of 68 AF patients were included,with f/R ratios ranging from 20.63％to 91.24％.PICC tip positioning accuracy varied significantly across different f/R ratio ranges(P=0.006).The area under the ROC curve(AUC)for f/R ratio in PICC tip positioning was 0.784(P=0.009),with a maximum Youden index of 0.567,an optimal diagnostic threshold of 40.00％,a sensitivity of 81.7％,a speci-ficity of 75.0％,a positive predictive value of 96.1％,and a negative predictive value of 35.3％.No arrhythmias other than AF occurred during the procedure.Conclusion The f/R ratio provides reliable and safe guidance for PICC tip positioning in AF patients.An f/R ratio ≥40％is associated with higher accuracy in identifying the optimal catheter tip position.

Objective:To construct a risk assessment model based on probabilistic hesitant fuzzy set(PHFS)for pressure-related injuries in medical equipment,and analyze its application value in control and management for risk of pressure-related injuries in medical equipment in the department of emergency.Methods:The frequency of events caused by pressure-related injuries of equipment was counted as statistical method.Combined with the risk assessment factors of pressure-related injuries,the technique for order preference by similarity to ideal solution(TOPSIS)based on PHFS was used to evaluate the risk level of pressure-related injuries of equipment,and formulate corresponding measures for risk management of pressure-related injuries.A total of 120 used medical equipment at the Department of Emergency of the First Affiliated Hospital of Xi'an Jiaotong University from January 2024 to December 2024 were selected.Using the random number table method,60 equipment were managed with the conventional risk management mode for pressure-related injuries(conventional management mode),and the other 60 equipment were managed with risk assessment model based on PHFS(model management mode)for pressure-related injuries in medical equipment.The incidence of pressure-related injuries of equipment,scores of operational quality of equipment,incidence of pressure-related injuries at different staging were compared between two kinds of management modes.A self-made questionnaire was used to investigate the satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment,who used and managed equipment.Results:The scores of operational standardization,pressure controllability,and diagnostic comfort in the model management mode were respectively(93.36±4.56),(90.54±3.69)and(93.65±4.69)points,which were significantly higher than those in the conventional management mode,while the score of material sensitivity was(30.23±3.26)points,which was significantly lower than that in the conventional management mode(t=15.941,11.896,11.511,17.200,P<0.05).The incidences of occurring pressure-related injuries in the referred logs of diagnosis and treatment of respiratory equipment,monitoring equipment,infusion equipment,and oxygen supply equipment in the model management mode were significantly lower than those in the conventional management mode(x2=9.924,9.493,9.796,8.075,P<0.05).The incidences of stage 1,2,3,and 4 of pressure-related injuries of equipment in the model management mode were significantly lower than those in the conventional management mode(x2=7.209,6.985,8.048,7.473,P<0.05).The satisfactions of emergency doctors,nurses,patients,and medical engineers in the department of equipment for the clinical use of equipment in the model management mode were significantly higher than those in the conventional management mode(t=12.499,13.200,14.410,9.226,P<0.05).Conclusion:The risk assessment model based on PHFS for pressure-related injury of medical equipment can reduce the incidences of pressure-related injuries of medical equipment in the department of emergency,and improve the safety of using medical equipment,and enhance the service quality of clinical equipment,and increase the satisfaction for equipment in clinical applications.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

The catalytic activity of 3-mercaptopyruvate (3MP) sulfurtransferase (MPST) converts 3MP to hydrogen sulfide (H₂S). However, the regulatory mechanisms governing MPST and its impact on the brain remain largely unexplored. Our study reveals the neuroprotective role of endothelial MPST-generated H₂S, regulated by protein phosphatase 2A (PP2A). Bioinformatics analysis and RNA sequencing demonstrated that endothelial PP2A is associated with neurodegenerative disease pathways. Cerebral ischemic mice exhibited significant inactivation of endothelial PP2A, evidenced by the reduction of PP2Acα in the brain endothelium. Mice with endothelium-specific null PP2A (PP2A^EC-cKO) exhibited neuronal loss, cognitive dysfunction, and long-term potentiation deficits. Postnatal inactivation of endothelial PP2A also contributes to cognitive dysfunction and neuronal loss. However, regaining endothelial PP2A activity by overexpressing Ppp2ca rescued neuronal dysfunction. Mechanistically, PP2A deficiency is intricately linked to the MPST-H₂S signaling pathway. A robust reduction in endothelial MPST-dependent H₂S production followed PP2A deficiency. Exogenous H₂S treatment and AAV-mediated overexpression of MPST in brain endothelial cells significantly mitigated neuronal dysfunction in PP2A^EC-cKO mice. Furthermore, PP2A deficiency promotes an increase in calcium influx and calpain2 phosphorylation, subsequently leading to MPST degradation. The PP2A activator (FTY720) and MPST activator (3MP sodium) both remarkably restored endothelial MPST-dependent H₂S production, subsequently rescuing ischemia-induced neurological deficits. In conclusion, our study demonstrates that endothelial PP2A deficiency leads to MPST degradation by activating calpain2, thus damaging neuronal function.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective: To explore the association between physical activity, anxiety symptoms and academic performance among junior high school students, so as to provide data support for optimizing school physical education and health work and formulating physical activity guidelines. Methods: From September to December 2022, a convenience cluster sampling method was used to survey 2 800 junior high school students in a middle school from Anqing City, Anhui Province. Data were collected on the students anxiety symptoms, academic performance, 24 hour physical activity [moderate to vigorous intensity physical activity(MVPA), light intensity physical activity(LPA), sedentary behavior(SB), and sleep(SLP) duration] as well as demographic characteristics. Compositional data analysis was used to explore the associations between 24 hour physical activity, anxiety symptoms and academic performance among junior high school students, and to predict the optimal time use combination pattern. Results: Among the junior high school students, 16.0% (447 students) reported anxiety symptoms, and 42.0% (1 175 students) achieved excellent or good academic performance. Compositional data analysis showed that increased SLP duration was associated with both reduced anxiety symptoms ( β =-0.18) and decreased academic performance ( β =-0.03) among junior high school students; increased MVPA duration was correlated with fewer anxiety symptoms ( β =-0.02) and lower academic performance ( β =-0.13); in contrast, increased SB duration was linked to more anxiety symptoms ( β =0.09) and higher academic performance ( β =0.09) (all P <0.01). LPA duration exhibited a non linear relationship with anxiety symptoms and academic performance in junior high school students (all P >0.05). The time use combination pattern corresponding to the lowest anxiety symptoms and highest academic performance (top 5%) in adolescents was 611 (520-640) minutes of SLP, 258 (230-320) minutes of SB, 454 (280-610) minutes of LPA, and 117 (20-200) minutes of MVPA per day. Conclusions The 24 hour physical activity of junior high school students is associated with anxiety symptoms and academic performance. Therefore, it is recommended to increase the time spent on SB, MVPA, and LPA for junior high school students, while reducing SB.

Objective To compare the positioning errors,required planning target volume(PTV)outer expansion boundary and three-dimensional displacement of two different positioning fixation devices CIVCO Uni-frame carbon fiber adjustable angle head frame and domestic integrated board in radiotherapy for the pa-tients with head tumor,and to investigate the application value of CIVCO headrest in the positioning of head tumor radiotherpay.Methods The clinical data of 82 patients with head tumors who underwent radiotherapy in this hospital from January to December 2023 were analyzed retrospectively.The patients were divided into the adjustable angle head frame group and integrated plate group,41 cases in each group.Both groups were fixed with U-shaped thermoplastic head film.Radiotherapy was performed by using ELEKTA infinity linear accelerator.The cone beam computed tomography(CBCT)image guidance was used,combined with bone reg-istration and manual calibration to obtain the patient positioning errors in three directions:X axis,Y axis and Z axis.The positioning error data of each CBCT was recorded;based on the PTV outward expansion boundary formula(2.5∑+0.7σ),the PTV outward expansion boundaries required by the two fixation devices in all di-rections for the treatment of head tumors were calculated;the 3-dimensional spatial displacement was calculat-ed based on the patient's single radiotherapy positioning error.Results The absolute positioning errors in the X,Y,and Z directions of the adjustable angle head frame group were 0.13(0.07,0.22),0.16(0.16,0.27),0.10(0.05,0.18)cm respectively,which in the integrated board group were 0.14(0.07,0.24),0.18(0.08,0.32),0.09(0.04,0.10)cm respectively.The absolute error of the Y direction in the adjustable angle head frame group was smaller than that of the integrated board group(P=0.006),and the difference in the relative error between the two groups was not statistically significant(P＞0.05).According to the PTV expansion formula,the calculated expansion boundaries of the X,Y,and Z directions in the adjustable head frame group were 0.24,0.30,0.22 cm,which in the integrated plate group were 0.21,0.36,0.21 cm,respectively.The three-dimensional space comprehensive positioning error value could be calculated by the formula calculation using the positioning error values in three directions.The mean values of the three-dimensional space positio-ning errors of the adjustable angle headstock group and domestic integrated plate group were 0.320 cm and 0.340 cm respectively,there was no statistically significant difference between the two groups.Conclusion The absolute error in Y direction and the median value of three-dimensional displacement of the CIVCO adjustable angle head rest are smaller than those of the domestic integrated plate,which is worthy of clinical promoted applica-tion if conditions permit.

Objective:To explore the predictive value of T cell subtype characteristics and peripheral blood inflammatory indicators in patients with liver cancer for myelosuppression after hepatic artery infusion chemotherapy.Methods:A total of 115 patients with primary hepatocellular carcinoma who received transcatheter arterial chemoembolization (TACE) treatment in the Department of Oncology of Taizhou Jiangyan Traditional Chinese Medicine Hospital from May 2022 to May 2024 were enrolled as the research subjects. According to whether myelosuppression occurred after TACE treatment, the patients were divided into a non-myelosuppression group ( n=93) and a myelosuppression group ( n=22). The clinical data, the proportions of T cell subsets before TACE treatment, and the differences in the levels of peripheral blood inflammatory indexes were compared between the two groups. Spearman correlation analysis and multivariate logistic regression analysis were used to screen out the influencing factors of myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. The receiver operator characteristic (ROC) curve was used to analyze the efficacy of each influencing factor in predicting the myelosuppression of patients. Results:There were no statistically significant differences in age, sex, history of hypertension, body mass index, type of hepatitis virus infection, status of hypersplenism, Barcelona staging, Child-Pugh classification of liver function, number of TACE treatments, and the proportion of CD8 + T cells between the patients in the myelosuppression group and non-myelosuppression group (all P>0.05). However, there were statistically significant differences in diabetes ( χ2=3.94, P=0.047), history of alcohol consumption ( χ2=5.47, P=0.019), the longest diameter of the tumor ( Z=2.31, P=0.021), the presence of ascites ( χ2=4.10, P=0.043), the proportion of CD4 + T cells ( t=4.66, P<0.001), the ratio of CD4 +/CD8 + ( t=4.98, P<0.001), the neutrophil/lymphocyte ratio (NLR) ( t=4.98, P<0.001), the monocyte/lymphocyte ratio (MLR) ( t=2.31, P=0.023), and the systemic immune inflammation index (SII) ( t=5.31, P<0.001). Spearman correlation analysis showed that diabetes ( r=0.19, P=0.048), history of alcohol consumption ( r=0.22, P=0.019), the presence of ascites ( r=0.19, P=0.043), the longest diameter of the tumor ( r=0.22, P=0.020), NLR ( r=0.39, P<0.001), MLR ( r=0.30, P=0.001), and SII ( r=0.36, P<0.001) were all positively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma, while the proportion of CD4 + T cells ( r=-0.37, P<0.001) and the ratio of CD4 +/CD8 + ( r=-0.40, P<0.001) were negatively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. Multivariate logistic regression analysis showed that the ratio of CD4 +/CD8 + ( OR=0.01, 95% CI: 0.01-0.11, P=0.002) was an independent protective factor for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma, and NLR ( OR=1.82, 95% CI: 1.31-5.60, P=0.013) and SII ( OR=1.03, 95% CI: 1.01-1.05, P=0.002) were both independent risk factors for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. ROC curve analysis showed that the areas under the curve (AUCs) of the ratio of CD4 +/CD8 +, NLR, and SII for predicting myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma alone were 0.79 (95% CI: 0.70-0.89), 0.78 (95% CI: 0.65-0.92), and 0.76 (95% CI: 0.65-0.87), respectively. The AUC of the combined prediction of the three was 0.91 (95% CI: 0.83-0.99), which was higher than that of the ratio of CD4 +/CD8 + ( Z=4.21, P<0.001), NLR ( Z=4.36, P<0.001), and SII ( Z=4.48, P<0.001) for prediction alone. Conclusions:The ratio of CD4 +/CD8 +, as well as NLR and SII levels before TACE treatment are independent factors influencing the occurrence of myelosuppression after treatment in patients with primary hepatocellular carcinoma, and are expected to be important indicators for predicting myelosuppression after hepatic artery infusion chemotherapy in patients with primary hepatocellular carcinoma.

Objective To evaluate the clinical utility of the f-wave to QRS complex amplitude ratio(f/R ratio)in intracardiac electrogram(IC-ECG)-guided positioning of peripherally inserted central catheter(PICC)tips in patients with atrial fibrillation(AF),providing evidence to enhance clinical practice.Methods This study employed a conve-nience sampling method to enroll eligible AF patients admitted to a tertiary hospital in Suzhou from July 2023 to July 2024.During PICC placement,IC-ECG was utilized to monitor f-wave and QRS complex amplitude variations.Following successful catheterization,the f/R ratio was measured,and chest X-ray was performed to confirm the catheter tip position.The accuracy of PICC tip positioning across different f/R ratio ranges was analyzed,and the incidence of arrhythmias was recorded.A receiver operating characteristic curve was constructed to assess the diag-nostic performance of the f/R ratio in PICC tip localization.Results A total of 68 AF patients were included,with f/R ratios ranging from 20.63％to 91.24％.PICC tip positioning accuracy varied significantly across different f/R ratio ranges(P=0.006).The area under the ROC curve(AUC)for f/R ratio in PICC tip positioning was 0.784(P=0.009),with a maximum Youden index of 0.567,an optimal diagnostic threshold of 40.00％,a sensitivity of 81.7％,a speci-ficity of 75.0％,a positive predictive value of 96.1％,and a negative predictive value of 35.3％.No arrhythmias other than AF occurred during the procedure.Conclusion The f/R ratio provides reliable and safe guidance for PICC tip positioning in AF patients.An f/R ratio ≥40％is associated with higher accuracy in identifying the optimal catheter tip position.