Objective To explore the challenges in sedentary behavior modification among patients with lower extremity arteriosclerosis obliterans(ASO),with the goal of informing the development of personalized physical acti-vity interventions to address sedentary behavior patterns.Methods A purposive sample of 16 patients diagnosed with lower extremity ASO was recruited as participants from the department of vascular surgery at a tertiary hospital in Sichuan province between August and November 2024.Semi-structured interviews were conducted to collect data and the Colaizzi 7 steps was used to analyze the data based on Capacity-Opportunity-Motivation-Behavior model.Results 3 themes and 12 sub-themes were identified,namely capacity(lower extremity and somatic dysfunction,psychological perception constraints,disease literacy deficits),motivation(inadequate perceived value of physical activity,diminished self-efficacy,kinesiophobia,negative cognitive framing),opportunity(generalization of guidance on disease knowledge,constrained healthcare resources,the normalization of sedentary entertainment practices,financial burden constraints,inadequate family support).Conclusion The factors influencing sedentary behavior in ASO patients are complex and diverse.Healthcare professionals need to comprehensively assess the multifaceted factors contributing to patients' difficulties in changing sedentary behavior,and develop targeted strategies accordingly to promote improvements in their sedentary habits.

AIM:This study aims to investigate the effects of Feixin decoction(FXD)on pyroptosis of pulmo-nary artery smooth muscle cells(PASMCs)by modulating nuclear factor κB(NF-κB)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)pathway,and to explore how FXD attenuates hypoxic pulmonary hypertension(HPH)in mice.METHODS:A mouse model of HPH was established using the Sugen 5416 combined hypoxia(SuHx)method.Sixty C57BL/6 mice were randomly divided into 6 groups:control group,SuHx group,sildenafil group,and low-,medium-and high-dose FXD groups,with 10 mice in each group.Five weeks after treatment,echocardiographic pa-rameters,including pulmonary artery acceleration time(PAT),pulmonary artery ejection time(PET),right ventricular anterior wall thickness at diastole(RVAWd)and tricuspid annular plane systolic excursion(TAPSE),were measured.Right ventricular systolic pressure(RVSP)was assessed via right heart catheterization.Right ventricular hypertrophy in-dex(RVHI)was determined by weighing the hearts.Histological examination using HE staining was conducted to observe pathological changes in small pulmonary arteries and the right ventricle,while Masson staining was used to assess fibrosis in the right ventricular wall.Immunofluorescence staining was used to detect co-localized expression of α-smooth muscle actin(α-SMA)with NLRP3,N-terminal fragment of gasdermin D(N-GSDMD)and caspase-1 in the pulmonary arteries.Western blot analysis was conducted to measure the protein levels of NF-κB,p-NF-κB,NLRP3,apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),N-GSDMD,interleukin(IL)-1β,IL-18 and cleaved caspase-1 in lung tissues.Transmission electron microscopy was employed to observe the ultrastructure of PASMCs.RE-SULTS:Compared with control group,the mice in SuHx group exhibited elevated RVSP and RVHI(P＜0.01),de-creased right heart function(P＜0.01),increased right ventricular wall fibrosis,and pulmonary vascular remodeling(P＜0.01).There was also increased co-localized expression of α-SMA with NLRP3,N-GSDMD and caspase-1 in small pul-monary arteries(P＜0.01),as well as elevated levels of p-NF-κB,NLRP3,ASC,N-GSDMD,IL-1β,IL-18 and cleaved caspase-1 in lung tissues(P＜0.01),indicating induced pyroptosis of PASMCs.Compared with SuHx group,FXD treat-ment significantly reduced RVSP and RVHI,improved right ventricular function,and attenuated right ventricular wall fi-brosis and pulmonary vascular remodeling(P＜0.05 or P＜0.01).Treatment with FXD also decreased the co-localized ex-pression of α-SMA with NLRP3,N-GSDMD and caspase-1 in small pulmonary arteries(P＜0.05 or P＜0.01),and down-regulated the protein expression of p-NF-κB,NLRP3,ASC,N-GSDMD,IL-1β,IL-18 and cleaved caspase-1 in lung tis-sues(P＜0.05 or P＜0.01),thereby attenuating the pyroptosis of PASMCs.CONCLUSION:FXD attenuates pulmonary vascular remodeling and right ventricular dysfunction in a mouse model of HPH.This effect may be attributed to its inhibi-tion of NF-κB/NLRP3 pathway,which subsequently reduces the pyroptosis of PASMCs.

Objective To explore the challenges in sedentary behavior modification among patients with lower extremity arteriosclerosis obliterans(ASO),with the goal of informing the development of personalized physical acti-vity interventions to address sedentary behavior patterns.Methods A purposive sample of 16 patients diagnosed with lower extremity ASO was recruited as participants from the department of vascular surgery at a tertiary hospital in Sichuan province between August and November 2024.Semi-structured interviews were conducted to collect data and the Colaizzi 7 steps was used to analyze the data based on Capacity-Opportunity-Motivation-Behavior model.Results 3 themes and 12 sub-themes were identified,namely capacity(lower extremity and somatic dysfunction,psychological perception constraints,disease literacy deficits),motivation(inadequate perceived value of physical activity,diminished self-efficacy,kinesiophobia,negative cognitive framing),opportunity(generalization of guidance on disease knowledge,constrained healthcare resources,the normalization of sedentary entertainment practices,financial burden constraints,inadequate family support).Conclusion The factors influencing sedentary behavior in ASO patients are complex and diverse.Healthcare professionals need to comprehensively assess the multifaceted factors contributing to patients' difficulties in changing sedentary behavior,and develop targeted strategies accordingly to promote improvements in their sedentary habits.

AIM:This study aims to investigate the effects of Feixin decoction(FXD)on pyroptosis of pulmo-nary artery smooth muscle cells(PASMCs)by modulating nuclear factor κB(NF-κB)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)pathway,and to explore how FXD attenuates hypoxic pulmonary hypertension(HPH)in mice.METHODS:A mouse model of HPH was established using the Sugen 5416 combined hypoxia(SuHx)method.Sixty C57BL/6 mice were randomly divided into 6 groups:control group,SuHx group,sildenafil group,and low-,medium-and high-dose FXD groups,with 10 mice in each group.Five weeks after treatment,echocardiographic pa-rameters,including pulmonary artery acceleration time(PAT),pulmonary artery ejection time(PET),right ventricular anterior wall thickness at diastole(RVAWd)and tricuspid annular plane systolic excursion(TAPSE),were measured.Right ventricular systolic pressure(RVSP)was assessed via right heart catheterization.Right ventricular hypertrophy in-dex(RVHI)was determined by weighing the hearts.Histological examination using HE staining was conducted to observe pathological changes in small pulmonary arteries and the right ventricle,while Masson staining was used to assess fibrosis in the right ventricular wall.Immunofluorescence staining was used to detect co-localized expression of α-smooth muscle actin(α-SMA)with NLRP3,N-terminal fragment of gasdermin D(N-GSDMD)and caspase-1 in the pulmonary arteries.Western blot analysis was conducted to measure the protein levels of NF-κB,p-NF-κB,NLRP3,apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),N-GSDMD,interleukin(IL)-1β,IL-18 and cleaved caspase-1 in lung tissues.Transmission electron microscopy was employed to observe the ultrastructure of PASMCs.RE-SULTS:Compared with control group,the mice in SuHx group exhibited elevated RVSP and RVHI(P＜0.01),de-creased right heart function(P＜0.01),increased right ventricular wall fibrosis,and pulmonary vascular remodeling(P＜0.01).There was also increased co-localized expression of α-SMA with NLRP3,N-GSDMD and caspase-1 in small pul-monary arteries(P＜0.01),as well as elevated levels of p-NF-κB,NLRP3,ASC,N-GSDMD,IL-1β,IL-18 and cleaved caspase-1 in lung tissues(P＜0.01),indicating induced pyroptosis of PASMCs.Compared with SuHx group,FXD treat-ment significantly reduced RVSP and RVHI,improved right ventricular function,and attenuated right ventricular wall fi-brosis and pulmonary vascular remodeling(P＜0.05 or P＜0.01).Treatment with FXD also decreased the co-localized ex-pression of α-SMA with NLRP3,N-GSDMD and caspase-1 in small pulmonary arteries(P＜0.05 or P＜0.01),and down-regulated the protein expression of p-NF-κB,NLRP3,ASC,N-GSDMD,IL-1β,IL-18 and cleaved caspase-1 in lung tis-sues(P＜0.05 or P＜0.01),thereby attenuating the pyroptosis of PASMCs.CONCLUSION:FXD attenuates pulmonary vascular remodeling and right ventricular dysfunction in a mouse model of HPH.This effect may be attributed to its inhibi-tion of NF-κB/NLRP3 pathway,which subsequently reduces the pyroptosis of PASMCs.

Objective To analyze the causal relationship between gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD) based on the bidirectional two-sample Mendelian randomization (MR). Methods Genetic variation information of GERD and COPD was obtained from Genome-Wide Association Studies (GWAS) and used as instrumental variables. Inverse variance-weighted (IVW), weighted median and MR-Egger methods were used for MR analysis, and sensitivity analysis was performed to validate the robustness of the results. Results A significant positive correlation was observed between genetically predicted GERD and the incidence risk of COPD, but there was no statistical association between COPD and the incidence risk of GERD. Positive IVW result showed that the odds ratio (OR) was 1.305 7, the 95% confidence interval (95%CI) was 1.114 4 to 1.529 8, and the P value was 0.000 9; the reverse IVW result showed that the OR was 0.982 3, the 95%CI was 0.917 4 to 1.051 9, and the P value was 0.610 4. Sensitivity analysis did not find any potential bias. Conclusion MR analysis shows that GERD is a risk factor for COPD, and treating GERD may help prevent or delay the progression of COPD.

Objective:To evaluate the regeneration and biomechanical property recovery of semitendinosus tendon(ST)/gracilis tendon(GT) after anterior cruciate ligament(ACL) reconstruction using shear wave elastorgraphy (SWE) combined with high-frequency ultrasound(HFUS).Methods:Twenty-five patients who underwent ST/GT autograft reconstruction after ACL rupture at the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to June 2022 were prospectively enrolled. All patients underwent HFUS, SWE and flexion strength assessment at pre-operation and 1, 3, 6, 12, 24 months postoperatively. The morphology, length, cross-sectional area and SWE of ST/GT and flexion strength of knee were recorded at each time point. Repeated measures analysis of variance was employed to compare the cross-sectional area and elasticity value of regenerated ST/GT at different time points. Spearman correlation analysis was used to investigate the relationship between the elasticity value of regenerated ST/GT and flexion strength.Results:The regeneration rates of ST/GT after being harvested for ACL reconstruction were 88% and 92%. The length of the regenerated ST/GT were shorter than before operation(both P<0.05). Repeated measures analysis of variance revealed significant differences in the cross-sectional area of regenerated ST/GT, both in terms of time effect and inter-group effect ( F=27.264, 28.980; both P<0.001), but no significant difference was observed in the interaction effect ( F=0.670, P=0.652). The cross-sectional area of regenerated ST/GT was the largest at 3 months postoperatively ( P<0.05), and restored to the preoperative level at 12 and 24 months postoperatively (both P>0.05). Repeated measures analysis of variance showed that the elasticity values of the regenerated ST/GT were significantly different in terms of time effect, group effect, and interaction effect ( F=265.402, 33.015, 11.475; all P<0.001). The elasticity of regenerated ST/GT post-operation gradually increased over time. The flexion strength level of knee gradually improved post-operation(χ 2=34.83, P<0.001). The elasticity values of the regenerated ST and GT showed significant positive correlations with the flexion strength ( rs=0.755, 0.761; both P<0.001). Conclusions:HFUS discovers that most of ST/GT can be regenerated after being harvested for ACL reconstruction. The flexion strength and elasticity value of regenerated tendon recover gradually with time. It is suggested that the SWE can predict the recovery of biomechanical property of regenerated ST/GT.

Objective To summarize the best evidence of nutrition management in patients with severe pneumonia,aiming to offer evidence-based guidance for clinical healthcare professionals.Methods All evidence on nutrition management in patients with severe pneumonia was retrieved from various databases and websites including BMJ Best Practice,UpToDate,National Guideline Clearinghous(NGC),Guidelines International Network(GIN),Registered Nurses'Association of Ontario(RNAO),National Institute for Health and Care Excellence(NICE),Cochrane Library,OVID,PubMed,Embase,Web of Science,CINAHL,Chinese Medical Journal Full-text Database,CNKI,VIP,Wanfang,CBM,American Society for Parenteral and Enteral Nutrition(ASPEN),European Society for Clinical Nutrition and Metabolism(ESPEN),Society of Critical Care Medicine(SCCM)and European Society of Intensive Care Medicine(ESICM).The retrieved evidence included clinical decisions,guidelines,systematic reviews,expert consensuses and evidence summaries.The search period ranged from January 1st,2012 to December 31st,2022.There were 2 researchers who independently assessed the quality of the included studies and then extracted and summarized the evidence by topic.Results A total of 13 articles were involved,including 3 clinical decisions,4 guidelines,1 systematic review,and 5 expert consensuses.A total of 24 pieces of evidence were summarized across 6 aspects which encompassed team building,nutrition screening and assessment,nutritional requirements,nutrition intervention,nutrition monitoring,and health education.Conclusion The production process of this evidence summary followed standardized procedures,ensuring comprehensive content.Medical professionals should integrate clinical conditions,patient factors,and family preferences to select the most optimal evidence in order to enhance patient prognosis and improve medical quality.

Objective To analyze the influencing factors of postoperative subsyndromal delirium in elderly patients undergoing abdominal surgery,and to develop a nomogram risk prediction model.Methods A convenience sampling method was used to select 497 elderly patients who underwent abdominal surgery in a tertiary hospital in Sichuan Province from February to October 2022.The risk prediction model and nomograms model were constructed using Logistic regression analysis and R software.The area under the subject's working characteristic curve(AUC)and Hosmer-Lemshow test were used to evaluate the discrimination and calibration of the model.Results The results of Logistic regression showed that age(OR=1.066),functional activities(OR=1.143),patient controlled intravenous analgesia(OR=5.811),transanal drainage tube(OR=2.276)and postoperative blood transfusion(OR=4.322)were independent influences on the occurrence of postoperative subsyndromal delirium.The p-values of the prediction model in both the training and validation sets were greater than 0.05;the area under the ROC curves were 0.734 and 0.691;the model was presented in the form of nomogram.Conclusion The prediction model developed in this study has good discrimination and accuracy.It can be used to assist clinical staff in identifying patients at high risk of developing postoperative subsyndromal delirium and provide the reference for developing preventive and intervention measures.

Objective:To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma (ENKTCL) based on PET-CT staging.Methods:Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed. All patients were divided into bone marrow biopsy + bone marrow aspiration group ( n=186) and PET-CT + bone marrow biopsy group ( n=139). The sensitivity, specificity, positive and negative predictive values were compared between two groups. The data were analyzed and plotted. Survival analysis was performed using Kaplan-Meier method and log-rank test. Results:In the whole cohort, 45 patients were positive for bone marrow biopsy, and 30 of them were positive for bone marrow aspiration. A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration. A total of 139 patients completed PET-CT staging and bone marrow biopsy. And 30 patients were diagnosed with positive bone marrow by PET-CT, in which 22 of them were confirmed positive by bone marrow biopsy. Among 109 patients diagnosed with negative bone marrow by PET-CT, 5 of them were confirmed positive by bone marrow biopsy. All these cases were classified as stage Ⅳ due to distant metastases. PET-CT had a diagnostic sensitivity of 81.5%, a specificity of 92.9%, a positive predictive value of 73.3%, and a negative predictive value of 95.4%. Among early stage (Ⅰ-Ⅱ stage) patients diagnosed with PET-CT, all of them were negative for bone marrow biopsy (the negative predictive value was 100%). In stage Ⅳ patients ( n=55), the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT ( n=35) compared with their counterparts with the involvement of other organs ( n=20) was 28.7% vs.42.0% ( P=0.13), and 1-year progression free survival rates was 23.2% vs. 23.3% in ( P=0.94). Conclusions:Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging. Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis, indicating that bone marrow biopsy still has certain value.

Objective:To systematically evaluate the application effect of somatosensory interactive games in patients with chronic obstructive pulmonary disease (COPD) in order to provide a basis for clinical application.Methods:Randomized controlled trials and quasi-experimental studies on the application of somatosensory interactive games in patients with COPD were retrieved from PubMed, Embase, Cochrane Library, CINAHL, Chinese Biomedical Literature Database, Wanfang, China Knowledge Network and VIP. The retrieval time limit is from the establishment of the database to October 2022. RevMan5.2 software was used for Meta analysis.Results:Ten articles involving 611 patients were included. The results of Meta-analysis showed that the somatosensory interactive game group was superior to the conventional training group in improving FEV 1/FVC% ( WMD=6.83, 95% CI 3.71-9.95, Z=4.29, P<0.01), 6-minute walking distance (6MWD) ( WMD=13.36, 95% CI 0.50-26.23, Z=2.04, P<0.05), Hospital Anxiety and Depression Scale ( WMD=-1.64, 95% CI -2.31--0.97, Z=4.78, P<0.01), COPD Assessment Test score ( WMD=-2.95, 95%CI -4.08--1.82, Z=5.13, P<0.01) in COPD patients. However, there was no significant difference in FEV1 % ( WMD=2.91, 95% CI -1.61-7.43, P=0.210) and dyspnea ( SMD=0.63,95% CI -0.24-1.49, P=0.150) between the two groups. Conclusions:Compared with conventional training, somatosensory interactive game training can effectively improve lung function and quality of life in patients with COPD, relieve anxiety and depression. Due to the limited quantity and quality of the included literature, the reliability of the conclusions still needs to be verified by more high-quality studies.