Objective To systematically evaluate the therapeutic effects of different surgical procedures for ischemic mitral regurgitation (IMR). Methods Computer searches were conducted in CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science, with the search time limit from the inception of the databases to February 2024. Two researchers independently screened the literature, extracted data, used the Cochrane bias risk assessment tool to evaluate the quality of the included studies, and used Stata 17.0 software to analyze the data. Results A total of 19 randomized controlled trials involving 6139 patients were finally included, involving six surgical procedures, and the overall quality of the included studies was relatively high. The results of the network meta-analysis showed that the 30-day all-cause mortality rate of mitral valve repair (MVr) was significantly lower than that of coronary artery bypass grafting (CABG) [OR=0.24, 95%CI (0.07, 0.87), P<0.01], mitral valve replacement (MVR) [OR=0.43, 95%CI (0.23, 0.79), P=0.02], CABG+MVR [OR=0.21, 95%CI (0.04, 0.95), P=0.03] and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip [OR=0.13, 95%CI (0.02, 0.87), P<0.01]. The 30-day all-cause mortality rate of CABG+MVr was significantly lower than that of CABG [OR=0.56, 95%CI (0.33, 0.93), P=0.02] and CABG+MVR [OR=0.48, 95%CI (0.24, 0.94), P=0.04], and the best probability ranking results showed that MVR might be the most effective in reducing the 30-day all-cause mortality rate. The incidence of renal complications in CABG+MVr was significantly lower than that in CABG+MVR [OR=0.42, 95%CI (0.21, 0.83), P=0.01]; the best probability ranking results showed that CABG+MVr might be the most effective in reducing renal complications. Conclusion The current limited evidence suggests that CABG+MVr and MVr may be the best surgical intervention methods for IMR patients at present. Due to the limitations of the number and quality of included studies, the above conclusions still need to be verified by more high-quality studies.

Atherosclerosis （AS） is a vascular disease primarily affecting large and medium-sized arteries. It serves as the pathological basis for many cardiovascular and cerebrovascular diseases and is associated with a relatively high incidence of complications and mortality worldwide. Traditional Chinese medicine （TCM） plays an important role in the prevention and treatment of AS， demonstrating unique therapeutic advantages through multiple targets and pathways. Ligusticum chuanxiong， a commonly used Chinese medicine in clinical practice， contains key active components against AS， including ligustrazine， senkyunolide， ligustilide， quercetin， ferulic acid， vanillic acid， chlorogenic acid， gallic acid， protocatechuic acid， caffeic acid， chrysophanol， and β-sitosterol. Recent literature indicates that these active components can regulate AS through multiple mechanisms， including improving endothelial cell dysfunction， alleviating lipid metabolism disorders， inhibiting macrophage foam cell formation， suppressing the invasion， proliferation， and migration of smooth muscle cells， inhibiting apoptosis， exerting anticoagulant effects and inhibiting platelet activation， protecting mitochondrial function， and modulating intestinal flora and its metabolites， demonstrating significant pharmacological activity and clinical potential. Clinically， L. chuanxiong is often combined with Salvia miltiorrhiza， Paeonia lactiflora， Angelica sinensis， and borneol to form compound formulations， enhancing therapeutic effects and achieving synergistic anti-AS activity. Compound treatment with L. chuanxiong primarily focuses on promoting blood circulation and shows significant efficacy for different AS syndrome types. This article provides an in-depth review of the active components， drug pairs， and compound preparations of L. chuanxiong in the prevention and treatment of AS， aiming to lay a foundation for subsequent theoretical research and clinical applications in managing AS and its related complications.

Incretin-based drugs have demonstrated significant clinical value in weight management and the treatment of metabolic diseases by mimicking or enhancing endogenous incretin signaling. These agents primarily target multiple receptors including glucagon-like peptide-1， glucose-dependent insulinotropic polypeptide， and glucagon， exerting weight-reducing effects through multiple mechanisms such as central appetite regulation， gastrointestinal function modulation， and peripheral metabolic improvement， while further ameliorating blood glucose， blood lipids， fatty liver， and cardiorenal metabolic risks. This review focuses on incretin-based drugs， systematically summarizing the key clinical application points and relevant research progress of domestically marketed and investigational candidate drugs in the field of weight reduction. Available evidence indicates that semaglutide and tirzepatide demonstrate substantial weight reduction with multiple metabolic benefits； domestic innovative drugs represented by mazdutide and ecnoglutide also exhibit favorable weight-reducing effects and safety profiles. Regarding safety， these agents are generally well-tolerated， with the most common adverse reactions being mild-to-moderate gastrointestinal events， while potential risks including gallbladder events， pancreatitis， and mood changes require attention. In special populations， individualized assessment is warranted for use in children， elderly people， and pregnant women. Future research should focus on the screening of predictive biomarkers for efficacy， the development of long-acting oral formulations， and the accumulation of long-term safety follow-up data.

This paper summarizes the clinical experience in treating children adenoid hypertrophy using the "opening the orifices and regulating qi method". It is considered that the pathogenesis of adenoid hypertrophy in children is rooted in dysfunction of zangfu （脏腑） organs， with binding of phlegm and stasis as the branch. Obstruction of the cervical passes and rebellious， chaotic qi flow run through the entire course of the disease. The "opening the orifices and regulating qi method" is proposed， which emphasizes the regulation of the lung， spleen， liver， and stomach. By opening the cervical passes， regulating zangfu organs， and eliminating phlegm and stasis to harmonize the ascent and descent of qi， a comprehensive application of external traditional Chinese medicine （TCM） therapies， such as acupuncture， umbilical moxibustion with medicinals， collateral bloodletting， and sole therapy， is utilized. Addressing both root and branch causes， this approach provides new perspectives for treating children adenoid hypertrophy using external TCM therapies.

Objective To investigate the effect of acupuncture at key muscle movement points combined with exercise training on neurophysiological indicators,muscle tone and quality of life in patients with spinal cord injury(SCI).Methods Eighty SCI patients admitted to the Rehabilitation Diagnosis and Treatment Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from September 2022 to June 2024 were selected.Patients were divided into the control group(receiving routine acupuncture combined with exercise training,40 cases)and the observation group(receiving acupuncture combined with exercise training at key muscle movement points,40 cases)according to the random number table method.The neurophysiological indicators[motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)],limb function[Fugl-Meyer Assessment(FMA),Modified Ashworth Scale(MAS)]and quality of life[Barthel index,functional independence measure(FIM)]were compared between the two groups.Results After intervention,the MNCV and SNCV of median nerve,ulnar nerve,tibial nerve and common peroneal nerve were increased in the observation group than those in the control group(P＜0.05).After intervention,there were higher FMA scores,Barthel index and FIM scores in the observation group than those of the control group,while the MAS score was lower than that of the control group(P＜0.05).Conclusion Acupuncture at key muscle movement points combined with exercise training can effectively improve the neuroelectrophysiological indicators,limb functions and quality of life of SCI patients,which is feasible rehabilitation intervention program.

Objective To explore the gender differences in the relationship between depressive symptoms and cognitive functions in patients with depression.Methods From January 2021 to June 2024,375 patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)criteria for depression were selected by convenience sampling from the Affiliated Psychological Hospital of Anhui Medical University.Depressive symptom severity was assessed using the 24-item Hamilton depression scale(HAMD-24),while cognitive function was evaluated using a series of neuropsychological assessment tools,including the trail making test,logical memory,figure memory,digit symbol substitution test,digit span backward,and Wisconsin card sorting test.Network analysis was performed using R software to examine the relationships between symptoms and cognitive function.Results The core symptom factors and core cognitive domains for male depressive patients are sleep disturbances(strength=1.253)and information processing speed(strength=1.605),respectively;In contrast,female patients exhiboted emotional stagnation(strength=1.322)and working memory(strength=1.289).Sleep disturbances and emotional stagnation were the bridging nodes(bridge strength=1.253 and 1.322)for male and female patients,respectively.The correlation stability(CS)coefficients for the node strength centrality in male and female patient groups were 0.514 and 0.515,respectively,both exceeding threshold of 0.25,indicating good network stability.There were no significant differences between genders in terms of global network strength(male vs.female:2.22 vs.4.87;P=0.356)and edge weight distribution(P=0.293).Conclusion The network relationships between depressive symptoms and cognitive function in depression patients show significant gender differences.Sleep disturbance and information processing speed play central roles in males,whereas emotional retardation and working memory impairment are core features in females.These findings provide a theoretical basis for developing gender-specific intervention strategies.

Objective:To develop and validate clinical predictive models for identifying poor short-term response to recombinant human growth hormone(rhGH) treatment in children with short stature.Methods:A retrospective analysis was conducted on 118 children diagnosed with growth hormone deficiency or idiopathic short stature who were treated at the First Affiliated Hospital of Zhengzhou University and two other hospitals between January 1, 2020, and January 1, 2024. A poor response to rhGH was defined as a height increase of less than 0.2 standard deviation score(SDS) after 6 months of rhGH treatment. LASSO regression was used to identify predictive variables from baseline and follow-up data. Two logistic regression models were conducted: Model A(incorporating baseline variables only) and model B(incorporating both baseline and follow-up variables), and nomograms were created for visualization. External data and internal resampling were used for dual validation of the models, and their performance was compared.Results:A total of 118 children with short stature were included. Six baseline predictive variables(diagnosis, initial height SDS, bone age, bone age-chronological age difference, rhGH dose, and gender) and one follow-up variable(height SDS after 3 months of rhGH treatment) were identified. Area under the curve values for Model A and Model B were 0.753(95% CI 0.696-0.811) and 0.930(95% CI 0.891-0.975), respectively. Calibration curves, decision curve analysis, and other evaluation metrics demonstrated good discrimination and clinical utility for both models. Model B, incorporating the 3-month follow-up variable, showed superior predictive performance compared to Model A. Conclusions:The clinical prediction models developed in this study(Model A and Model B) are practical and reliable tools for quantitatively, conveniently, and intuitively identifying children with short stature at risk of poor response to rhGH treatment.

Objective:To evaluate the effect of disulfiram on sepsis-associated encephalopathy (SAE) and the relationship with NOD-like receptor family pyrin domain-containing 3 (NLRP3)/caspase-1 signaling pathway in rats.Methods:Forty-five SPF healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-220 g, were divided into 3 groups ( n=15 each) using a random number table method: sham operation group, SAE group, and SAE+ disulfiram group (SAE+ DSF group). The SAE model was established by by using cecal ligation and puncture in anesthetized rats. SAE+ DSF group received an intraperitoneal injection of 50 mg/kg disulfiram 4 h before the cecal ligation and puncture. The survival status of rats was recorded within 72 h after surgery. Their neurobehavioral scores were assessed and recorded on days 1-3 after surgery. On the 3rd day after surgery, novel object recognition test (cognitive index) and open field test (activity distance and time in the central area) were conducted sequentially. Following the behavioral testing, the rats were anesthetized, and their hippocampi were dissected and isolated to observe the pathological changes in the hippocampal region (using HE staining) and to determine the expression of NLRP3 and caspase-1 (by Western blot) and the expression of interleukin-1beta (IL-1β), IL-18 and tumor necrosis factor-alpha (TNF-α) mRNA (by fluorescent quantitative polymerase chain reaction). Results:Compared with Sham group, the 72-h survival rate and postoperative neurobehavioral scores were significantly decreased, the activity distance and time in the central area of the open field were shortened, and the cognitive index was decreased, the expression of NLRP3, caspase-1 and IL-1β, IL-18 and TNF-α mRNA was up-regulated ( P<0.05), and the pathological damage was marked in the hippocampus in SAE group ( P<0.05). Compared with SAE group, postoperative neurobehavioral scores were significantly increased, the activity distance and time in the central area of the open field were prolonged, the cognitive index was increased, and the expression of NLRP3 and caspase-1 and IL-1β, IL-18 and TNF-α mRNA was down-regulated ( P<0.05), no significant change was found in the 72-h survival rate ( P>0.05), and the pathological damage to the hippocampus was significantly alleviated in SAE+ DSF group. Conclusions:Disulfiram can alleviate SAE in rats, and the mechanism may be related to the inhibition of the NLRP3/caspase-1 signaling pathway.

Objective:To conduct a comparative analysis of the oxygen depletion and oxygen effect of FLASH irradiation and conventional irradiation by direct measurement of oxygen content.Methods:The oxygen content in different tissues and organs of mice was measured using a phosphorescent probe. A subcutaneous xenograft tumor model in mice was established, to receive electron-beam irradiation at different doses and dose rates. The oxygen depletion of tumor and normal tissue was analyzed, and tumor control was evaluated. The oxygen depletion of conventional irradiation and FLASH irradiation was further analyzed using an in vitro model. The survival fraction (SF) of normal cells after conventional irradiation and FLASH irradiation was calculated using colony formation assay under different partial pressures of oxygen, and the data were fitted to the oxygen enhancement ratio (OER) curve. Results:The mean oxygen content of subcutaneous xenograft tumor in mice was 1.28%, suggesting hypoxia. The mean oxygen content of normal tissue ranged from 3.51% to 6.53%, suggesting physioxia. In animal experiments, oxygen depletion was not observed during conventional irradiation. High-dose-rate (20 Gy/s) and ultra-high-dose-rate (FLASH, 40 Gy/s) irradiation produced oxygen depletion. During FLASH irradiation, with the increase of oxygen content, the oxygen depletion was 0.1-0.2 mm Hg/Gy for tumor tissue and 0.19-0.21 mm Hg/Gy for skin tissue, which tended to stabilize. FLASH irradiation maintained equivalent tumor control compared to conventional irradiation. The tumoricidal effect was significantly enhanced with the increase of oxygen content in the tissue ( t=3.46, P<0.01). In in vitro experiments, the mean oxygen depletion rate was about 0.16 mm Hg/Gy for conventional irradiation and 0.16-0.18 mm Hg/Gy for FLASH irradiation, which did not change significantly with the increase of oxygen content. FLASH irradiation was associated with an oxygen effect. When the partial pressure of oxygen decreased from physioxia to hypoxia, the OER value significantly reduced. Conclusions:Normal tissues and organs are in physioxia, which exhibits a lower oxygen content than that in the air. FLASH irradiation can consume a proportion of oxygen, producing an oxygen effect. When oxygen content decreases, the oxygen depletion rate slows down after FLASH irradiation.

Objective:To evaluate the prevalence, potential risk factors, and correlation between coronary and peripheral microvascular dysfunction in heart failure with non-reduced ejection fraction (nHFrEF) patients.Methods:This was a prospective registry study. nHFrEF patients admitted to Zhongshan Hospital affiliated with Fudan University from December 2021 to December 2023 were enrolled. According to coronary flow reserve (CFR) or reactive congestion index (RHI), enrolled patients were divided into coronary microvascular endothelial dysfunction (CMD) group (CFR<2.5) and no CMD group (CFR≥2.5) or peripheral microvascular endothelial dysfunction (MED) group (RHI<1.67) and no MED group (RHI≥1.67). Patients′ general information, laboratory and auxiliary examination data were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of CMD and MED in nHFrEF patients, and Spearman correlation analysis was used to evaluate the correlation between MED and CMD.Results:A total of 142 nHFrEF patients were enrolled, aged 69.0 (59.0, 74.0) years, with a male proportion of 66.9% (95/142). The grouping results were as follows: (1) According to CFR, there were 73 cases in the CMD group and 69 cases in the no CMD group; (2) According to RHI, there were 57 cases in the MED group and 85 cases in the no MED group. The prevalence of CMD and MED in this study was 51.4% (73/142) and 40.1% (57/142), respectively. Univariate logistic regression analysis showed that increased heart rate, chronic kidney disease, atrial fibrillation, elevated N-terminal pro-B type natriuretic peptide levels, and increased urinary albumin/creatinine ratio were risk factors for CMD, while increased RHI was a protective factor for CMD; Atrial fibrillation is a risk factor for MED, while increased CFR is a protective factor for MED. Incorporating clinically significant variables from univariate analysis into multivariate analysis, the results showed that increased heart rate and elevated RHI remained risk and protective factors for CMD, respectively; increased CFR remains a protective factor for MED. Spearman correlation analysis showed that CFR was negatively correlated with lg urinary albumin/creatinine ratio, lg cardiac troponin T, lg N-terminal pro-B type natriuretic peptide, and heart rate; RHI is positively correlated with CFR.Conclusions:The prevalence of CMD and MED in nHFrEF patients is high, and the two have a certain positive correlation. Increased heart rate and RHI are risk and protective factors for CMD, respectively, while increased CFR is a protective factor for MED. MED may be a potential therapeutic target for nHFrEF patients.