Objective To explore the role of resilience and stress in childhood maltreatment and adolescent depression and anxiety symptoms, and to provide a basis for adolescent psychological intervention. Methods From September to October 2022, a total of 11 217 students from four middle schools in Changsha were selected by multistage stratified sampling, and the Childhood Trauma Questionnaire, Depression–Anxiety–Stress Scales and the Resilience Scale for Chinese Adolescents were used to carry out online questionnaire survey. Results The detection rate of depressive symptoms and anxiety symptoms in adolescent was 19.43% (2 179) and 28.7% (3 224). The direct effect of childhood maltreatment on depressive symptoms was significant (β =0.09), Childhood maltreatment is a negative prediction of resilience (β = -0.57) and a positive prediction of pressure (β =0.06); Resilience can negatively predict stress (β = -0.61) and depressive symptoms (β = -0.25) (all P values <0.001); The direct effect of childhood maltreatment on anxiety symptoms was significant (β =0.03), resilience negatively predicts anxiety symptoms (β = -0.08) (all P values <0.01). Resilience and stress have a partially mediating role between childhood maltreatment and depressive symptoms, the mediation effect value was 0.39, accounting for 81.25% of the total effect. The effect values of the three pathways accounted for 29.17%, 8.33% and 43.75% of the total effect, respectively. Resilience and stress have a partial mediating effect between childhood abuse and anxiety symptoms, and the mediating effect was 0.36, accounting for 92.31% of the total effect, and the effect values of the three pathways accounted for 12.82%, 10.26% and 69.23% of the total effect, respectively. Conclusion Childhood maltreatment could affect adolescents’ depression and anxiety through the chain mediating effect of resilience and stress.

Objective To explore the clinical efficacy and safety of endoscopic endonasal dorsum sellae and posterior clinoid process resection combined with pituitary hemi-transposition in the treatment of pan-sellar area lesions. Methods Clinical data from 57 patients with pan sellar diseases who underwent endoscopic transnasal resection of the posterior clinoid process combined with lateral pituitary displacement surgery in the neurosurgery department of Zhongshan Hospital, Fudan University from January 2019 to January 2025 were collected, and their clinical surgical characteristics and prognosis were analyed. Results A total of 57 patients with pan-sellar area lesions were included in this study, comprising 27 craniopharyngiomas, 7 giant suprasellar pituitary adenomas, 7 chordomas, 6 chondrosarcomas, 5 diaphragma sellae/dorsum sellae meningiomas, and 5 rare lesions. All procedures were completed successfully, and gross total or near-total resection was achieved in all patients. No new neurovascular complications occurred intraoperatively. The follow-up duration ranged from 3 to 24 months. New postoperative anterior pituitary insufficiency occurred in 3 patients (5.3%), and new posterior pituitary insufficiency requiring long-term hormone replacement therapy occurred in 4 patients (7.0%). No additional pituitary dysfunction was observed in the remaining patients. Cerebrospinal fluid rhinorrhea occurred in 1 patient (1.8%) and was successfully repaired. Intracranial infection occurred in 3 patients (5.3%) and resolved after medical treatment. Conclusion Endoscopic resection of the posterior clinoid process combined with lateral displacement of the pituitary gland can effectively expand the surgical space, while repositioning the pituitary gland can reduce the extent of skull base defects. In addition, the risk of pituitary dysfunction caused by lateral displacement of the pituitary gland is relatively low.

Hypertension is an important risk factor that causes cardiovascular diseases and premature death in China.The pathogenesis of hypertension is complex and affected by numerous factors.Gut microbiota are involved in regulating many physiological processes of human body,making it a key factor in human health.Many studies have shown that there are close relationships between gut microbiota dysbiosis and the onset and progression of hyper-tension.Restoring gut microbiota homeostasis can reduce blood pressure.Thus,gut microbiota has become a poten-tial therapeutic target for hypertension.Therefore,this article mainly reviews the connection between gut microbiota and hypertension,as well as the study progress of adjusting gut microbiota homeostasis for the prevention and treat-ment of hypertension.

Objective To explore the effects and mechanisms of Changpu Yujin Tang(CPYJT)on the NOD-like receptor thermal protein domain associated protein 3/cysteinyl aspartate specific proteinase-1/Gasdermin D(NLRP3/Caspase-1/GSDMD)signaling pathway-mediated neuroinflammation in rats with Tourette syndrome(TS).Methods SPF-grade male SD rats were randomly divided into the Control and TS groups.After successful modeling in the TS group,the rats were randomly divided into the Model,Tiapride,and CPYJT groups,and were treated with the corresponding drugs for 4 weeks.After the treatment,the rats' behavior was scored,H & E staining was used to observe pathological changes in the striatum,ELISA was used to measure the content of IL-1β and IL-18,RT-qPCR was used to detect the expression of NLRP3 and ASC mRNA,and Western blot was used to detect the expression of NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins.Results Compared with the Control group,the Model group showed increased scores of stereotyped and motor behaviors(P＜0.01),pathological changes in the striatal tissue,increased content of IL-1β and IL-18(P＜0.01),and upregulated expression of NLRP3,ASC mRNA,and NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins(P＜0.01).Compared with the Model group,the Tiapride group and the CPYJT group showed decreased scores of stereotyped and motor behaviors(P＜0.01),improved pathological damage in the striatal tissue,reduced content of IL-1β and IL-18(P＜0.01),and inhibited expression of NLRP3,ASC mRNA,and NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins(P＜0.01).Conclusion The therapeutic effect of CPYJT on TS is related to the inhibition of the neuroinflammatory response mediated by the NLRP3/Caspase-1/GSDMD signaling pathway.

AIM To investigate the effects of Changpu Yujin Decoction(CPYJD)on striatal mitophagy and PINK1/Parkin signaling pathway in a rat model of Tourette syndrome(TS).METHODS Thirty-six SPF male SD rats were randomly assigned to the control group(n=9)and the TS modeling group(n=27).Rats in the modeling group received daily intraperitoneal injections of 3,3'-iminodipropionitrile(IDPN)(300 mg/kg)for 7 consecutive days to establish the TS model.Post-modeling,successfully induced TS rats were re-randomized into model group(no treatment),tiapride group(47.91 mg/kg)and CPYJD group(77.28 g/kg).All groups received their respective interventions via intragastric administration daily for 28 days.Following drug administration,behavioral scores were assessed in each group.Pathological alterations in the striatum were examined using HE staining,while ultrastructural changes were evaluated by transmission electron microscopy(TEM).Neuronal apoptosis was quantified via TUNEL staining,and ROS levels in striatum were measured by ELISA.Co-localization of PINK1 and LC3B was assessed using immunofluorescence(IF).Finally,mRNA and protein expressions of PINK1,Parkin,Beclin-1,P62 and LC3B(LC3B-Ⅱ/Ⅰ ratio)were analyzed by RT-qPCR and Western blot.RESULTS Compared to the control group,the model group demonstrated significantly increased behavioral scores(P＜0.01),elevated neuronal apoptosis rate and higher ROS levels in the striatum(P＜0.01);severe neuronal and mitochondrial damage in the striatum;significantly reduced mRNA and protein expressions of PINK1,Parkin,Beclin-1 and LC3B(LC3B-Ⅱ/Ⅰ ratio)in the striatum(P＜0.01);markedly upregulated P62 mRNA and protein expressions(P＜0.01).Compared to the model group,both the tiapride and CPYJD intervention groups exhibited significantly reduced behavioral scores(P＜0.01);decreased neuronal apoptosis rate and lower ROS levels(P＜0.01);improved pathological alterations in the striatal neurons and mitochondria;increased mRNA and protein expressions of PINK1,Parkin and Beclin-1 in the striatum(P＜0.05,P＜0.01);and decreased P62 mRNA and protein expressions(P＜0.01).Furthermore,the rats in the CPYJD group specifically showed elevated LC3B mRNA level and LC3B-Ⅱ/Ⅰ protein ratio in striatum(P＜0.05,P＜0.01).CONCLUSION The effect of CPYJD intervention in TS rats may involve activation of mitophagy through regulation of the PINK1/Parkin signaling pathway,improving mitochondrial function,reducing ROS levels,and thereby protecting neurons.

Background and Aims:Laparoscopic hiatal hernia repair with mesh reinforcement combined with fundoplication has become the standard surgical approach for treating moderate to severe cases.However,intraoperative and postoperative complications remain a significant concern.This study was conducted to explore the causes of common complications and their prevention and management strategies through retrospectively analyzing clinical data from a single center to optimize perioperative care and improve surgical safety.Methods:The clinical data of 432 patients who underwent laparoscopic hiatal hernia repair with mesh and fundoplication at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed.All procedures were performed by the same surgical team using the standardized seven-step protocol for laparoscopic repair.Postoperative care followed the enhanced recovery after surgery pathway.The incidences of intraoperative and postoperative complications were recorded,and univariate analysis was used to identify risk factors for major postoperative complications.Results:The overall complication rate was 15.3％among 432 patients.The most common intraoperative complication was bleeding(6.9％),primarily from the inferior phrenic vessels(3.2％),short gastric vessels(1.6％),and parenchymal organ injuries(1.9％).The most frequent postoperative complication was dysphagia(12.0％),followed by pneumothorax(3.2％),hernia recurrence(1.9％),mesh infection or erosion(0.7％),gas-bloat syndrome(6.3％),and gastroparesis(0.9％).Most complications were relieved through conservative treatment,endoscopic dilation,or interventional procedures.Two patients with persistent dysphagia underwent reoperation to remove the fundoplication wrap.The median follow-up period was 34 months,with a 6.0％loss to follow-up rate and no perioperative mortality.Univariate analysis showed that patients aged ≥50 years and those who underwent Nissen fundoplication had significantly higher rates of postoperative dysphagia(both P＜0.05).Conclusion:Laparoscopic hiatal hernia repair with mesh and fundoplication is generally safe and effective.However,intraoperative vascular injuries and postoperative dysphagia require special attention.Accurate dissection and identification of anatomical layers are critical during surgery.Surgical strategy should be tailored based on patient age and esophageal motility,with partial fundoplication(Toupet or Dor)preferred when appropriate.Combined with enhanced postoperative recovery protocols,standardized mesh placement and fixation can reduce complication rates and improve long-term outcomes.

BACKGROUND:The blood-brain barrier is an important structure that protects the central nervous system,and the study of the effects of high glucose on the blood-brain barrier is important for the prevention of high glucose-induced damage to the central nervous system.OBJECTIVE:To investigate the potential effect of high glucose on the blood-brain barrier function of hCMEC/D3 human brain microvascular endothelial cells.METHODS:hCMEC/D3 cells were cultured in regular sugar medium(glucose concentration of 25 mmol/L)and high-sugar medium(glucose concentration of 55 mmol/L).The morphology of cells in each group was observed by light microscopy.CCK-8 assay was used to detect changes in cell viability.A monolayer blood-brain barrier model was established using hCMEC/D3 cell line with Transwell chamber device.Changes in cell transmembrane resistance were monitored daily.The permeability of cell monolayers was detected by phenol red permeability.Flow cytometry was used to detect the apoptosis rate of the cells.Western blot assay was used to detect the expression of Bcl-2,Bax,Caspase-3,ZO-1,Occludin,Claudin-1,and histone deacetylase 4.The levels of histone deacetylase in cell supernatant were detected by ELISA.The expression of histone deacetylase 4 in cells was detected by immunofluorescence.RESULTS AND CONCLUSION:(1)The cell viability of high sugar group was significantly lower than that of control group(P＜0.000 1).(2)The cells of the control group were in a good growth state,interwoven into a dense mesh,with interconnections between synapses.The cell growth of high glucose group was suppressed,and the connection of inter-cellular synapses was reduced.(3)Compared with the control group,the transmembrane resistance value of the high glucose group was reduced(P＜0.05);phenol-red permeability of the monolayer cell membrane was increased(P＜0.05);cell apoptosis rate was increased(P＜0.01);the expression of Bax protein was increased(P＜0.000 1);the expression of Caspase-3 protein had no significant change(P＞0.05);the expression of Bcl-2,ZO-1,Occludin,Claudin-1,and histone deacetylase 4 proteins was decreased(P＜0.01,P＜0.001,P＜0.01,P＜0.000 1,P＜0.01);the fluorescence expression of histone deacetylase 4 was decreased(P＜0.001)in the high glucose group.(4)The level of histone deacetylase 4 in the cell supernatant of the high glucose group was lower than that of the control group(P＜0.05).The results show that high glucose induces the increased apoptosis and enhances permeability of hCEMCE/D3 cells,and its mechanism may be related to the decreased expression level of histone deacetylase 4.

Objective To analyze the complex relationships between individual or combined exposures to six aldehydes and hyperuricemia(HUA)and serum uric acid(SUA)levels in adults by Bayesian kernel machine regression(BKMR),and to explore the factors associated with aldehyde exposure leading to HUA.Methods Participants aged 20 years and older with available aldehyde data were selected from the National Health and Nutrition Examination Survey(NHANES)2013-2014.The study employed BKMR to explore the complex associations between individual or combined exposure to multiple aldehydes and both HUA and SUA.Multivariable Logistic regression analysis was performed to evaluate the association between aldehydes and HUA,while multiple linear regression models were used to examine the linear relationship between aldehydes and SUA.Stratified analysis was conducted to explore the association between aldehydes and HUA across populations with different characteristics.Results A total of 1,952 participants were included in the analysis,of whom 346(17.73％)were diagnosed with HUA.Butyraldehyde[OR=1.59,95％CI(1.23,2.07)],heptaldehyde[OR=1.58,95％CI(1.18,2.13)],and hexaldehyde[OR=1.68,95％CI(1.15,2.45)]were significantly associated with HUA.For each one-unit increase in the concentration of butyraldehyde,heptaldehyde,or hexaldehyde,the risk of developing HUA increased by approximately 59％,58％,and 68％,respectively.The results from the BKMR model indicated that the combined effect of aldehyde exposure was positively associated with both HUA and SUA.Among the individual aldehydes,hexaldehyde showed the highest posterior inclusion probability(PIP=0.324),suggesting the greatest contribution to the observed association.Six aldehydes were also significantly positively correlated with reduced glomerular filtration rate(GFR)and elevated levels of triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C).Conclusion Individual or combined exposure to aldehydes was positively associated with HUA.This association may be attributed to factors such as reduced GFR,as well as elevated levels of TG and LDL-C.

Objective To improve the accuracy of intelligent detection and evaluation of traditional Chinese medicine(TCM)pieces and solve the problems of leakage,misdetection,inaccurate localization and low confidence in the study of TCM pieces identification,YOLOv3 algorithm which has good detection effect for high overlap and small targets was improved.Methods An RGB image database containing 148 commonly used TCM pieces was established.Based on the YOLOv3 algorithm model,the anchor box size was improved by K-means clustering algorithm.The CIoU loss function was introduced for bounding box regression to improve the localization accuracy and confidence of bounding boxes.The traditional non-maximum suppression was improved to DIoUNMS to reduce the problems of missed detection and false detection of dense targets with high overlap by YOLOv3 algorithm.Results 148 kinds of TCM pieces were tested with the improved algorithm,and the average detection accuracy of 98.47%was achieved,which is 1.83%better than the original YOLOv3 algorithm.It realizes better detection effect for TCM pieces in complex situations such as dense,high overlapping,etc.Problems such as leakage,misdetection,imprecise positioning and low confidence level have been alleviated to a certain extent.Conclusion The improved algorithm effectively improves the recognition accuracy and generalization ability of TCM pieces,providing a new reference for the realization of automated intelligent detection of TCM pieces.

BACKGROUND:Percutaneous kyphoplasty through a unilateral puncture approach is considered more effective than a bilateral puncture approach for the treatment of osteoporotic vertebral compression fractures.However,due to the unique anatomical shape and location of the L5 vertebral body,the traditional unilateral puncture approach has limited applicability in treating L5 osteoporotic vertebral compression fractures.To address this issue,we propose the use of the"O"point puncture approach.OBJECTIVE:To compare the effectiveness of percutaneous kyphoplasty via basal transversal process-posterior superior pedicle-lateral articular process intersection("O"point)with conventional approach percutaneous kyphoplasty in treating the L5 osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 54 patients with L5 osteoporotic vertebral compression fractures treated with traditional percutaneous kyphoplasty or percutaneous kyphoplasty via the"O"point approach between January 2020 and December 2022 at Affiliated Hospital of Southwest Medical University.According to the surgical method,the patients were divided into the"O"point approach group(group A,n=29)and the traditional approach group(group B,n=25).The position of the"O"point and iliac spine and puncture angle were measured by orthography before operation in group A.Cobb angle,anterior vertebral margin,middle height,and bone cement distribution were compared between the two groups prior to and 2 days after surgery,and during final follow-up.Pain relief and daily living ability were assessed using the visual analog scale and Oswestry disability index prior to and 2 days after surgery,and during final follow-up.Complications related to the surgery were recorded.RESULTS AND CONCLUSION:(1)Operative time and intraoperative fluoroscopy times were significantly shorter in group A than in group B(P＜0.05).However,no significant differences were observed in intraoperative blood loss or bone cement injection amounts between the two groups.(2)Both groups demonstrated significantly lower visual analog scale scores and Oswestry disability index on day 2 after surgery and at the last follow-up in comparison to before surgery.However,group A experienced a more noticeable decrease than group B(P＜0.05).(3)On both sides,the"O"point was located on average 1.23 cm below the highest point of the iliac spine line.The mean transverse distance between the"O"point and the iliac spine was 2.89 cm.(4)During the final follow-up,the Cobb angle of both groups exhibited significant improvements compared to their respective preoperative values(P＜0.05).However,there was no significant difference between the two groups(P＞0.05).(5)After operation,the distribution of bone cement was good in group A,accounting for 97％(28/29),and good in group B,accounting for 88％(22/25).Group A was significantly better than group B(P＜0.05).(6)The efficacy of percutaneous kyphoplasty utilizing the"O"point puncture technique on osteoporotic vertebral compression fractures of the L5 vertebra was superior to that of the traditional percutaneous kyphoplasty approach.However,the bone cement distribution achieved with percutaneous kyphoplasty via"O"point puncture was more satisfactory,and the puncture approach was able to circumvent the influence of a high iliac spine on the L5 vertebra.