Objective To explore the trajectory and influencing factors of changes in physical ac-tivity(PA)in patients with non-small cell lung cancer(NSCLC)during chemotherapy.Methods A random sampling method was used to select NSCLC patients receiving chemotherapy in Suzhou Ninth People's Hospital as the research objects.Patients' materials were collected using a general informa-tion questionnaire,the M.D.Anderson Symptom Inventory(MDASI),the Family Adaptation,Part-nership,Growth,Affection,and Resolve index(APGAR),and the Self-Rated Approaches for Health Promotion Scale(SRAHP).The International Physical Activity Questionnaire-long-form(IPAQ-L)was used to assess patients' PA levels before the first chemotherapy course(T0),before the second course(T1),before the fourth course(T2),and before the sixth course(T3).The latent growth mixture model(LGMM)was used to identify the trajectory types of patients' physical activity metabolic equivalents(MET).Unordered multinomial Logistic regression analysis was used to explore the influencing factors of PA change trajectories in NSCLC patients during chemotherapy.Results A total of 213 NSCLC patients completed this study.The PA values of NSCLC patients at T0,T1,T2 and T3 were(1 091.29±285.76),(456.43±92.78),(467.61±94.72),and(934.35±199.18)MET-min/week,respectively,with significant between-group differences(F=645.601,P＜0.001).After fitting with the LGMM,three latent categories were selected:the low PA maintenance group(ac-counting for 28.64％),the medium PA decline followed by late-stage recovery group(accounting for 51.64％),and the medium PA decline followed by mid-stage recovery group(accounting for 19.72％).Analysis showed that age,tumor stage,health behavior capacity,symptom severity and symptom distress,and family care were influencing factors for the PA trajectorycategories of NSCLC patients during chemotherapy(all P＜0.05).Analysis of variable interaction effects found that health behavior capacity(OR=0.376,95％CI,0.192 to 0.853)had a strong protective effect on the medium PA decline followed by mid-stage recovery group(there was an interaction effect,P＜0.05).Conclusion There is population heterogeneity in PA among NSCLC patients during chemo-therapy.Medical staffs should develop targeted measures based on the population characteristics and influencing factors of patients' PA trajectories to improve their PA levels.

Objective To investigate the effects of light-at-night exposure on anxiety and depression behaviors in mice and to explore the underlying neural mechanisms.Methods Six-week-old male C57BL/6J mice were randomly assigned to a control(Ctrl)group and a light-at-night exposure(LAN)group.Mice in the LAN group were exposed to 460 nm blue light for 1 h daily during the zeitgeber time(ZT)13-14 while the Ctrl group mice were maintained under a 12-h light/12-h dark cycle.Behavioral tests were conducted at different time points following LAN exposure to evaluate anxiety and depression behaviors in the mice.Immunofluorescence staining was used to observe the effect of LAN on c-fos expressions in the medial prefrontal cortex(mPFC),basal ateral amygdala(BLA),paraventricular nucleus(PVN)and paraventricular thalamus(PVT).ELISA was performed to measure changes in serum corticosterone,adrenocorticotropic hormone(ACTH)and corticotropin-releasing hormone(CRH)levels.Golgi staining was applied to measurethe dendritic spine density and morphology from mPFC and CA1.Western blotting analysis was conducted to detect expression levels of brain-derived neurotrophic factors(BDNFs),phosphorylated tropomyosin receptor kinase B(p-TrkB)/TrkB,postsynaptic density protein 95(PSD95)and synaptophysin(SYP)in the mPFC.Results Mice exhibited anxiety-like behaviors after 14 days of LAN exposure,with depression-like behaviors emerging after 28 days.LAN exposure of 28 days led to a significant increase in the number of c-fos-positive neurons in the mPFC,BLA,PVN and PVT(P＜0.05),resulted in elevated serum corticosterone levels(P＜0.01)and reduced protein expression levels of BDNF and SYP(P＜0.05).Furthermore,there was a marked decrease in synapse numbers and synaptic density in the mPFC(P＜0.01).Conclusion Prolonged exposure to blue light at night enhances neuronal activity in the mPFC and BLA and suppresses the BDNF/TrkB signaling pathway by activating the hypothalamic-pituitary-adrenal axis(HPA),thus leading to synaptic structural and functional damage and inducing anxiety and depression behaviors in mice.

Objective:To investigate therapeutic effect and mechanism of sanguinarine on postherpetic neuralgia(PHN)rats by modulating C-X-C chemokine ligand 12(CXCL12)/C-X-C chemokine receptor 4(CXCR4)signaling pathway.Methods:SD rats were randomly grouped into control group,model group,low-dose(50 mg/kg)sanguinarine group,high-dose(100 mg/kg)sanguina-rine group,NUCC-390(CXCL12/CXCR4 signal activator,2.2 mg/kg)group,high-dose(100 mg/kg)sanguinarine+NUCC-390(2.2 mg/kg)group,with 10 rats in each group.Rats in model group and drug-treated groups were injected with resin toxin(RTX)by intraperitoneal injection to induce PHN model,rats in control group were intraperitoneally injected with an equal dose of normal saline containing 10%Tween 80 and 10%ethanol.After treatment of sanguinarine and NUCC-390,symptoms of long-term spontaneous pain,mechanical hyperalgesia and thermal hyperalgesia were detected,number of spontaneous paw withdrawal reflexes,paw with-drawal threshold to mechanical stimulation(PWMT),and response latency to thermal stimulation(PWTL)were compared;spinal cord nerve cell apoptosis was detected by TUNEL staining;ELISA was used to detect levels of inflammatory factors TNF-α,IL-1β,cyclooxygenase-2(COX-2)in rat spinal cord tissue and serum;Western blot was used to detect expressions of CXCL12/CXCR4 path-way-related proteins in spinal cord tissues of rats in each group.Results:Compared with control group,PWMT of model group was obviously decreased(P<0.05),number of spontaneous foot withdrawal reflexes,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were obviously increased(P<0.05).Compared with model group,PWMT of rats in low-dose sanguinarine group and high-dose sanguinarine group was increased(P<0.05),number of spontaneous foot withdrawal reflexes,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were all decreased(P<0.05);PWMT of rats in NUCC-390 group was decreased(P<0.05),number of spontaneous foot withdrawal reflex,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were increased(P<0.05).Compared with high-dose sanguinarine group,PWMT of rats in high-dose sanguinarine+NUCC-390 group was decreased(P<0.05),number of spontaneous foot withdrawal reflex,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were increased(P<0.05).Conclusion:Sanguinarine can reduce expression of inflammatory factors by down-regulating CXCL12/CXCR4 signaling pathway,thereby preventing occurrence of inflammatory response in PHN rats,inhibiting apoptosis of spinal nerve cells,and finally reducing long-term spontaneous pain,mechanical allodynia and thermal hypoalgesia in rats.

Objective:To investigate expression levels of various myeloid suppressor cells(MDSCs)in bone marrow of patients with chronic myeloid leukemia(CML),and the difference and correlation of expression levels of BCR-ABL fusion gene and WT1 in CML patients at different stages,and explore its clinical significance.To analyze and compare the distribution differences of various MDSCs in CML with different remission depths after treatment.Methods:Proportions of various MDSCs in 58 CML patients were de-tected by flow cytometry.Relative expressions of WT1 and BCR-ABL were detected by RQ-PCR.Iron deficiency anemia patients were served as control group,differences of the distribution of MDSCs in CML patients with different BCR-ABL expression,different WT1 expression,different CD34+cell numbers and different disease course,and expressions of various types of MDSC at 3,6,12 and 24 months after treatment in patients with chronic phase of CML were analyzed.At the same time,changes of cellular immune status in CML patients at different stages were detected,and correlations between the changes of lymphocyte subsets and MDSCs were compared.Results:Proportions of G-MDSC and e-MDSC in chronic phase of CML were significantly higher than that in normal control group(P<0.05).Proportions of G-MDSC and e-MDSC in CML patients in accelerated phase and blast crisis phase were significantly higher than that in CML patients in chronic phase(P<0.05).However,the difference in proportion of M-MDSC between accelerated phase of CML and chronic phase of CML had no statistical significance.Proportion of G-MDSC in CML patients was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.558 7,0.530 7,0.598 1),proportion of M-MDSC was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.132 1,0.144 6,0.157 8).Proportion of e-MDSC was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.604 3,0.620 7,0.625 9).G-MDSC was significantly lower in the best response group than that in warning/failure group at all stages of treatment.e-MDSC was differential in the best response and warning/failure groups at only 3 months of treatment.M-MDSC was not statistically significant in the best response and warning/failure groups at all stages of treatment.And only G-MDSC cell ratio was positively correlated with its BCR-ABL ratio(r=0.798 1).Per-centage of T lymphocyte in CML blast crisis phase was significantly lower than that in accelerated and chronic phases,while percentage of NK cells was higher.Only the proportion of G-MDSC was negatively correlated with the proportion of T lymphocyte(r=-0.815 2).Conclusion:Various MDSCs are positively correlated with BCR-ABL,WT1 gene and CD34+cells,and positively correlated with the tumor burden of CML patients,while the correlation of M-MDSC is weaker than that of G-MDSC and e-MDSC.With the remission of CML,G-MDSC decreases,while M-MDSC does not change.e-MDSC only shows differences in the early 3-month of treatment.Change of G-MDSC ratio may predict the effect of CML treatment.MDSCs can inhibit the proliferation of T lymphocyte,and inhibitory effect of G-MDSC is stronger than that of M-MDSC and e-MDSC.

Objective:To investigate therapeutic effect and mechanism of sanguinarine on postherpetic neuralgia(PHN)rats by modulating C-X-C chemokine ligand 12(CXCL12)/C-X-C chemokine receptor 4(CXCR4)signaling pathway.Methods:SD rats were randomly grouped into control group,model group,low-dose(50 mg/kg)sanguinarine group,high-dose(100 mg/kg)sanguina-rine group,NUCC-390(CXCL12/CXCR4 signal activator,2.2 mg/kg)group,high-dose(100 mg/kg)sanguinarine+NUCC-390(2.2 mg/kg)group,with 10 rats in each group.Rats in model group and drug-treated groups were injected with resin toxin(RTX)by intraperitoneal injection to induce PHN model,rats in control group were intraperitoneally injected with an equal dose of normal saline containing 10%Tween 80 and 10%ethanol.After treatment of sanguinarine and NUCC-390,symptoms of long-term spontaneous pain,mechanical hyperalgesia and thermal hyperalgesia were detected,number of spontaneous paw withdrawal reflexes,paw with-drawal threshold to mechanical stimulation(PWMT),and response latency to thermal stimulation(PWTL)were compared;spinal cord nerve cell apoptosis was detected by TUNEL staining;ELISA was used to detect levels of inflammatory factors TNF-α,IL-1β,cyclooxygenase-2(COX-2)in rat spinal cord tissue and serum;Western blot was used to detect expressions of CXCL12/CXCR4 path-way-related proteins in spinal cord tissues of rats in each group.Results:Compared with control group,PWMT of model group was obviously decreased(P<0.05),number of spontaneous foot withdrawal reflexes,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were obviously increased(P<0.05).Compared with model group,PWMT of rats in low-dose sanguinarine group and high-dose sanguinarine group was increased(P<0.05),number of spontaneous foot withdrawal reflexes,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were all decreased(P<0.05);PWMT of rats in NUCC-390 group was decreased(P<0.05),number of spontaneous foot withdrawal reflex,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were increased(P<0.05).Compared with high-dose sanguinarine group,PWMT of rats in high-dose sanguinarine+NUCC-390 group was decreased(P<0.05),number of spontaneous foot withdrawal reflex,PWTL,spinal nerve cell apoptosis index,levels of TNF-α,IL-1β,COX-2 in spinal cord tissue and serum,and protein expressions of CXCL12 and CXCR4 in spinal cord tissue were increased(P<0.05).Conclusion:Sanguinarine can reduce expression of inflammatory factors by down-regulating CXCL12/CXCR4 signaling pathway,thereby preventing occurrence of inflammatory response in PHN rats,inhibiting apoptosis of spinal nerve cells,and finally reducing long-term spontaneous pain,mechanical allodynia and thermal hypoalgesia in rats.

Objective:To investigate expression levels of various myeloid suppressor cells(MDSCs)in bone marrow of patients with chronic myeloid leukemia(CML),and the difference and correlation of expression levels of BCR-ABL fusion gene and WT1 in CML patients at different stages,and explore its clinical significance.To analyze and compare the distribution differences of various MDSCs in CML with different remission depths after treatment.Methods:Proportions of various MDSCs in 58 CML patients were de-tected by flow cytometry.Relative expressions of WT1 and BCR-ABL were detected by RQ-PCR.Iron deficiency anemia patients were served as control group,differences of the distribution of MDSCs in CML patients with different BCR-ABL expression,different WT1 expression,different CD34+cell numbers and different disease course,and expressions of various types of MDSC at 3,6,12 and 24 months after treatment in patients with chronic phase of CML were analyzed.At the same time,changes of cellular immune status in CML patients at different stages were detected,and correlations between the changes of lymphocyte subsets and MDSCs were compared.Results:Proportions of G-MDSC and e-MDSC in chronic phase of CML were significantly higher than that in normal control group(P<0.05).Proportions of G-MDSC and e-MDSC in CML patients in accelerated phase and blast crisis phase were significantly higher than that in CML patients in chronic phase(P<0.05).However,the difference in proportion of M-MDSC between accelerated phase of CML and chronic phase of CML had no statistical significance.Proportion of G-MDSC in CML patients was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.558 7,0.530 7,0.598 1),proportion of M-MDSC was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.132 1,0.144 6,0.157 8).Proportion of e-MDSC was positively correlated with values of BCR-ABL,WT1 genes and proportion of CD34+cells(r=0.604 3,0.620 7,0.625 9).G-MDSC was significantly lower in the best response group than that in warning/failure group at all stages of treatment.e-MDSC was differential in the best response and warning/failure groups at only 3 months of treatment.M-MDSC was not statistically significant in the best response and warning/failure groups at all stages of treatment.And only G-MDSC cell ratio was positively correlated with its BCR-ABL ratio(r=0.798 1).Per-centage of T lymphocyte in CML blast crisis phase was significantly lower than that in accelerated and chronic phases,while percentage of NK cells was higher.Only the proportion of G-MDSC was negatively correlated with the proportion of T lymphocyte(r=-0.815 2).Conclusion:Various MDSCs are positively correlated with BCR-ABL,WT1 gene and CD34+cells,and positively correlated with the tumor burden of CML patients,while the correlation of M-MDSC is weaker than that of G-MDSC and e-MDSC.With the remission of CML,G-MDSC decreases,while M-MDSC does not change.e-MDSC only shows differences in the early 3-month of treatment.Change of G-MDSC ratio may predict the effect of CML treatment.MDSCs can inhibit the proliferation of T lymphocyte,and inhibitory effect of G-MDSC is stronger than that of M-MDSC and e-MDSC.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the impact of quercetin(Que)on postherpetic neuralgia(PHN)and chemokine ligand 3(CCL3,namely MIP-1α)/C-C chemokine receptor 1(CCR1)/C-C chemokine receptor 5(CCR5)signaling pathway in rats.Methods Sixty rats were divided into the control group(Con),the PHN group(model group),the L-Que(30 mg/kg)group,the M-Que(60 mg/kg)group,the H-Que(120 mg/kg)group and the H-Que+pathway activator MIP-1α(120 mg/kg Que+0.4 mg/kg recombinant MIP-1α)group.The mechanical paw withdrawal threshold(PWT)and thermal pain threshold(TWL)of rats were detected in each group.The kit was used to detect adenosine,Adenine ribonucleotide(AMP),adenosine diphosphate(ADP)and tumor necrosis factor in spinal dorsal horn samples-α(TNF-α),and interleukin-1 β(IL-1 β)levels in spinal dorsal horn samples.HE staining was applied to observe the pathological sections of spinal dorsal horn.Immunofluorescence staining was used to detect the activation of microglia in spinal dorsal horn.Western blot assay was applied to detect MIP-1α/CCR1/CCR5 signaling pathway protein expression.Results In the PHN group,the dorsal horn of the spinal cord was ruptured,the arrangement of nerve bundles was disordered,and inflammatory cell infiltration,edema,and slight atrophy of neurons appeared.Compared with the Con group,the PWT value,adenosine,AMP and ADP levels were obviously decreased in the PHN group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1-positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).After treatment with Que,the disordered arrangement of nerve bundles was improved,the infiltration of inflammatory cells was reduced,and the phenomenon of neuronal atrophy disappeared.Compared with the PHN group,the PWT value,adenosine,AMP and ADP levels were obviously increased in the L-Que group,the M-Que group and the H-Que group(P＜0.05).TWL value,TNF-αand IL-1β levels,the number of Iba1-positive microglia,and MIP-1α,CCR1 and CCR5 protein levels were obviously decreased(P＜0.05).The effect of Que was dose dependent.Compared with the H-Que group,PWT value,adenosine,AMP and ADP levels were obviously decreased in the H-Que+MIP-1α group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1 positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).Conclusion Que may reduce the inflammatory response in rats by inhibiting the MIP-1α/CCR1/CCR5 signaling pathway,thereby reducing PHN.

Objective To investigate the feasibility and effect of simple support bracket combined with one stitch suture in terminal ileostomy of two stomas during anus-preserving radical resection in low rectal cancer patients. Methods Retrospectively analysis was performed for rectal cancer patients with high risk factors for postoperative anastomotic leakage, who admitted to the Department of General Surgery our hospital from December 2019 to May 2021. The patients underwent laparoscopic-assisted low rectal cancer radical resection and terminal ileostomy. There were two groups including 35 patients in the group of simple bracket combined with one stitch suture, and 35 patients in the group of conventional suture. Preoperative and postoperative clinical data were analyzed. Results General data of two groups were similar. No difference statistical significantly in the rate of postoperative stoma‐related complications between the two groups ((P>0.05). All patients were without any severe complications. All stomas were successfully closed. The time of first-stage ileostomy (13.77±2.02) min vs. (22.66±3.64) min (P<0.001), second-stage stoma closure time (88.14±28.03) min vs. (103.29±30.96) min (P=0.04), and postoperative total time in hospital (14.54±2.32) d vs. (17.34±4.57) d (P=0.002) were shorter in simple bracket combined with one stitch suture group; both total cost in the hospital of first-stage operation (42 057.98±4 938.69) yuan vs. (44 728.46±5 223.62) yuan (P=0.03), and second-stage stoma closure blood loss (17.94±9.83) mL vs. (25.86±8.24) mL (P=0.001) lower compared with that in conventional suture group. Conclusions Simple support bracket combined with one stitch suture ileostomy did not increase postoperative stoma-related complications compared with conventional suture. However, it decreased the time for both first-stage ileostomy and second-stage stoma closure, and total cost in hospital. Therefore, it could be used for prophylactic ileostomy in low rectal cancer.

Objective:To explore the effectiveness of deep learning image reconstruction (DLIR) algorithm compared to adaptive statistical iterative reconstruction (ASIR-V) algorithm in improving the quality of low-dose brain CT images.Methods:Retrospective inclusion of patients who underwent brain CT examination in the People's Liberation Army General Hospital from November 2021 to August 2022. Four different algorithms were used to reconstruct low-dose CT scans of all patients to obtain 30% intensity ASIR-V (ASIR-V-30%) images, low intensity DLIR (DLIR-L) images, medium intensity DLIR (DLIR-M) images, and high intensity DLIR (DLIR-H) images. The regions of interest were selected from four sets of images, including superficial white matter, superficial gray matter, deep white matter, and deep gray matter, and their CT values and standard deviations were measured for calculating signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).Subjective evaluation of image quality was conducted by three neuroimaging physicians based on the Likert 5-component scale. The objective and subjective scores of the 4 groups of images were analyzed using ANOVA or Kruskal Wallis. If there are overall differences, pairwise comparisons were conducted within the group.Results:A total of 109 patients were enrolled, including 104 males and 5 females, aged 65-110 years (89.16 ± 9.53) years. The radiation exposure of brain CT low-dose scanning was (0.93 ± 0.01)mSv, significantly lower than that of conventional scanning (2.92 ± 0.01) mSv ( t = 56.15, P < 0.05). The differences in objective image quality analysis of ASIR-V-30%, DLIR-L, DLIR-M, and DLIR-H images of low-dose CT in SNR deep gray matter, SNR deep white matter, SNR superficial gray matter, SNR superficial white matter, CNR deep gray white matter, and CNR superficial gray white matter were statistically significant( F =98.23, 72.95, 68.43, 58.24, 241.13, 289.91, P < 0.05). Among them, DLIR-H images had the lowest noise in deep gray matter, deep white matter, superficial gray matter, and superficial white matter, and had statistically significant differences compared to other image groups ( t = 167.43, 275.46, 182.32, 361.54, P < 0.05). The subjective score of DLIR-H image quality was superior to ASIR-V-30%, DLIR-L, and DLIR-M, with the statistically significant difference ( t = 7.25, 8.32, 9.63, P < 0.05). Conclusions:Compared with ASIR-V, DLIR algorithm can effectively reduce image noise and artifacts in low-dose brain CT, and improve SNR and CNR. The subjective and objective image quality evaluation of DLIR-H is the best.