Objective: To investigate the aberrant alterations of microRNAs ( miRNAs) in exosomes derived from bone marrow stromal cells ( BMSCs) in the bone marrow supernatants of patients with acute myeloid leukemia (AML) and their impact on the prognosis of AML patients . Methods: Bone marrow supernatant samples were col- lected from three AML patients and three healthy donors . Exosomes were isolated using a commercial kit , identif- ying the morphology and marker expression , and subjected to miRNA sequencing to determine differentially ex- pressed miRNAs (DE-miRNAs) . The DE-miRNAs were then intersected with the exosomal miRNA expression pro- files of primary AML cells (GSE64029) to exclude AML cell - derived signals and to identify BMSC-derived DE - miRNAs . Subsequently , candidate miRNAs were identified through Cox regression and Lasso regression analyses based on data from The Cancer Genome Atlas (TCGA) . A prognostic risk model for AML was constructed , and pa- tients were stratified into high-risk and low-risk groups according to the median risk score . The prognostic value and clinical relevance of the model were further validated . Finally , the target genes of the candidate miRNAs were pre- dicted , followed by pathway enrichment analysis , construction of key regulatory networks , and correlation analysis between the expression levels of key miRNAs and their corresponding target genes . Results: Isolated exosomes ex- hibited a typical cup-shaped morphology with intact structures with particle size of 30 - 150 nm , and expressed exo- somal markers CD63 , ALIX , and TSG101 . miRNA sequencing identified 103 DE-miRNAs in AML patients com- pared with healthy donors; after intersection with the GSE64029 dataset , 83 BMSC-derived DE-miRNAs were re- tained . Among these , five candidate miRNAs ( miR-25-3p , miR-532-5p , miR-194-5p , miR-10a-5p , and miR- 20a-5p) were used to construct the prognostic model . Kaplan-Meier survival analysis demonstrated significantly lon- ger overall survival in the low-risk group compared with the high-risk group (P < 0. 05) . The areas under the ROC curve for the training/validation cohorts were 0. 80/0. 74 , 0. 80/0. 78 , and 0. 79/0. 64 at 1 , 2 , and 3 years , re- spectively . The prognostic model was significantly associated with risk stratification , patient age , and FAB classifi- cation (P < 0. 05) . KEGG pathway enrichment revealed that target genes of the candidate miRNAs were closely linked to cancer-related signaling pathways , including hepatocellular carcinoma , breast cancer , and non-small cell lung cancer. Correlation analysis indicated that the candidate miRNAs were significantly associated with key genes such as HIF1A , CREB1 , PIK3CA , IGF1R , PIK3R1 , TIAM1 , CRK , and PTEN (P < 0. 05) . Conclusion AML patients exhibit distinct miRNA expression profiles in BMSC-derived exosomes . A five-miRNA signature ( miR-25 - 3p , miR-532-5p , miR-194-5p , miR-10a-5p , and miR-20a-5p) demonstrates robust prognostic performance , sup- porting its potential clinical utility in risk stratification and outcome prediction for AML.

Objective:To investigate the association between different sleep patterns and anxiety and depression in hemodialysis patients, thereby providing a reference for improving their psychological and sleep conditions.Methods:This study was a cross-sectional survey.A convenience sampling method was used to select patients undergoing regular dialysis at a hemodialysis centre in the Sixth People's Hospital of Huizhou from May 2023 to May 2024. Sleep quality, anxiety and depression symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale for (SAS) and Self-rating Depression Scale (SDS). Potential profiles were analyzed using Mplus 8.3 and mixed-effects Logistic regression was used to explore the association between sleep pattern category and anxiety-depression.Results:A total of 264 valid questionnaires were returned, of which 142 were males and 122 were females, aged (56.61 ± 12.69) years old. The sleep patterns of hemodialysis patients were divided into three potential categories:patients with overall better sleep quality31.4%(83/264), patients with poor sleep using hypnotic medication12.9%(34/264), and patients with poor sleep without hypnotic medication 55.7%(147/264). Significant differences were found in age, education, anxiety and depression across different sleep categories ( χ2 values were 9.75-25.72, all P<0.05). Compared with the group with overall better sleep quality, the risk of anxiety was higher in the group with sleep difficulties without hypnotic medication ( OR=5.409, P<0.05), and the risk of anxiety and depression ( OR=5.010, 6.488, both P<0.05) was higher in the group with sleep disorders using hypnotic medication. Compared with patients with poor sleep without hypnotic medication, patients with poor sleep using hypnotic medication had a higher risk of depression ( OR=6.501, P<0.05). Conclusions:There are three potential categories of sleep patterns in hemodialysis patients and significant correlations between them and anxiety and depression, and precise screening and individualized interventions need to be implemented in the clinic to improve patients' quality of life.

Objective:To investigate the association between different sleep patterns and anxiety and depression in hemodialysis patients, thereby providing a reference for improving their psychological and sleep conditions.Methods:This study was a cross-sectional survey.A convenience sampling method was used to select patients undergoing regular dialysis at a hemodialysis centre in the Sixth People's Hospital of Huizhou from May 2023 to May 2024. Sleep quality, anxiety and depression symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale for (SAS) and Self-rating Depression Scale (SDS). Potential profiles were analyzed using Mplus 8.3 and mixed-effects Logistic regression was used to explore the association between sleep pattern category and anxiety-depression.Results:A total of 264 valid questionnaires were returned, of which 142 were males and 122 were females, aged (56.61 ± 12.69) years old. The sleep patterns of hemodialysis patients were divided into three potential categories:patients with overall better sleep quality31.4%(83/264), patients with poor sleep using hypnotic medication12.9%(34/264), and patients with poor sleep without hypnotic medication 55.7%(147/264). Significant differences were found in age, education, anxiety and depression across different sleep categories ( χ2 values were 9.75-25.72, all P<0.05). Compared with the group with overall better sleep quality, the risk of anxiety was higher in the group with sleep difficulties without hypnotic medication ( OR=5.409, P<0.05), and the risk of anxiety and depression ( OR=5.010, 6.488, both P<0.05) was higher in the group with sleep disorders using hypnotic medication. Compared with patients with poor sleep without hypnotic medication, patients with poor sleep using hypnotic medication had a higher risk of depression ( OR=6.501, P<0.05). Conclusions:There are three potential categories of sleep patterns in hemodialysis patients and significant correlations between them and anxiety and depression, and precise screening and individualized interventions need to be implemented in the clinic to improve patients' quality of life.

Objective To explore the comparative study of constructing prediction models for muscle invasive of bladder cancer based on different machine learning algorithms combined with MRI radiomic.Methods A total of 187 bladder cancer patients who underwent MRI examination and were confirmed by pathology were retrospectively selected.Patients were randomly divided into a training set and a test set in a 7∶3 ratio.The patients were divided into muscle invasive bladder cancer(MIBC)group and non-muscle invasive bladder cancer(NMIBC)group according to the surgical pathology results.Tumor volume of interest(VOI)was outlined on the images of T2 WI,diffusion weighted imaging(DWI),and apparent diffusion coefficient(ADC),and the radiomic features were extracted by A.K software,and dimensionality reduction was performed using the maximum relevance minimum redundancy(mRMR)algorithm combined with least absolute shrinkage and selection operator(LASSO).Six machine learning algorithms,including K-nearest neighbor(KNN),decision tree(DT),support vector machine(SVM),logistic regression(LR),random forest(RF),and explainable boosting machine(EBM)were used to construct the radiomic model and calculate the corresponding area under the curve(AUC),accuracy,sensitivity,and specificity,respectively.Results Six machine learning algorithms,including KNN,DT,SVM,LR,RF,and EBM were used to construct the radiomic model,and the AUC values for predicting MIBC in the training set were 0.863,0.838,0.853,0.866,0.977,0.997,and in the test set were 0.748,0.833,0.860,0.868,0.870,0.900.Among them,the MRI radiomic model constructed based on EBM had the highest predictive efficacy for MIBC,with AUC values,accuracy,sensitivity and specificity of 0.997,0.977,0.957 and 0.981 in the training set,and 0.900,0.877,0.800,and 0.894 in the test set,respectively.Conclusion Multiple machine learning algorithms combined with MRI radiomic to construct models have good predictive efficacy for MIBC,and the model constructed based on EBM shows the highest predictive value.

The Choledochal cyst is an extremely rare congenital anomaly of the bile duct. Early cyst resection and Roux-en-Y hepatojejunostomy are the primary surgical methods for treating choledochal cyst. With the emergence of enhanced recovery after surgery, laparoscopic surgery has effectively reduced the incidence of biliary complications and wound infections, but it still does not meet people's requirements for minimally invasive surgery. Robotic surgery system has the potential to enhance surgical precision and the maneuverability of surgeons due to clear surgical visualization and flexible mechanical arms. The authors review the relevant literatures and conduct a Meta-analysis to evaluate the efficacy of robot-assisted surgery and laparoscopic surgery for choledochal cyst.

Humans ; East Asian People ; Psoriasis/drug therapy* ; Antibodies, Monoclonal, Humanized/therapeutic use* ; Treatment Outcome ; Severity of Illness Index

【Objective】 To estimate the prevalence, associated factors and patterns of multimorbidity of non-communicable diseases among adults in Shaanxi Province so as to provide evidence for the prevention and control of non-communicable diseases. 【Methods】 We used the data of adults aged 18 years and older collected in the baseline survey of Shaanxi Project in the Regional Ethnic Cohort Study in Northwest China. Multinomial logistic regression was used to explore the associated factors for multimorbidity. Exploratory factor analysis was used to extract patterns of multimorbidity. 【Results】 The prevalence of multimorbidity was 10.7% among the 44 442 participants. Age increase, being males, urban residence, and being overweight or obesity were positively associated with multimorbidity. Compared with women, men had a higher risk of multimorbidity. The OR and 95% CI was 1.25 (1.12-1.39). The risk of multimorbidity increased with age among adults. Compared with participants aged 18.0-34.9 years, the ORs and 95% CIs of those aged 35.0-44.9, 45.0-54.9, 55.0-64.9, and ≥65.0 years were 4.73 (3.47-6.46), 15.61 (11.60-21.00), 41.39 (30.76-55.70) and 90.04 (66.58-121.77), respectively. The primary multimorbidity patterns among adults in Shaanxi were cardiovascular-metabolic multimorbidity (5.4%), viscero-articular multimorbidity (1.0%), and respiratory multimorbidity (0.3%). 【Conclusion】 More than one in ten adults in Shaanxi Province had multimorbidity, and the predominant pattern of multimorbidity was cardiovascular-metabolic multimorbidity. The prevention and control of non-communicable diseases should be reinforced in middle-aged and older people, males, people living in the urban, and overweight or obese people. More attention should be paid to the prevention and control of cardiovascular-metabolic diseases.

【Objective】 To evaluate the dietary quality with the dietary balance index (DBI_16) and the association between dietary quality and bone mass among middle-aged and elderly people in Gansu Province so as to provide evidence for improving dietary quality and bone health status of Gansu population. 【Methods】 Based on the information of the type and quantity of food intake and the bone mass of middle-aged and elderly people aged 35 years and above collected by the Gansu Project in the Regional Ethnic Cohort Study in Northwest China, DBI_16 was used to evaluate the intake level of cereals, vegetables, fruits, milk, beans, fish and shrimp, eggs and other foods, and the degree of inadequate, excessive and unbalanced dietary intake of the participants. Multiple linear regression was used to evaluate the associations of three component indexes of DBI_16, high bound score (DBI_HBS), low bound score (DBI_LBS), diet quality distance (DBI_DQD), and seven single indexes of DBI_16 with bone mass. 【Results】 Analyses of the dietary and bone mass data of 11,840 participants showed that 44.8% of participants consumed excessive amounts of cereals compared to the dietary recommendation. 96.3%, 90.6%, 90.1%, 71.9%, 95.1% and 60.3% of participants’ intake of vegetables, fruits, milk, soybeans, fish and shrimp, and eggs, respectively, were inadequate. 47.7% participants consumed less than 10 types of food. 2.3% participants’ DBI_LBS levels were appropriate. 54.7% participants’ DBI_HBS levels were appropriate. Only 1.2% participants’ DBI_DQD reached a balanced level. The bone mass level in the study population was (2.5±0.6) kg [(2.8±0.5) kg for men and (2.3±0.5) kg for women]. After adjusting for sociodemographic characteristics, lifestyle, total dietary energy intake and body mass index, DBI_LBS and DBI_DQD were negatively associated with bone mass [β and 95% CI was -0.002 01 (-0.003 62--0.000 40) and -0.001 76 (-0.003 09--0.000 43), respectively]. 【Conclusion】 Dietary intake imbalance is common among middle-aged and elderly people in Gansu Province, and the more severe the dietary intake imbalance, the lower the bone mass level.

Objective To study the relationship among the sense of organizational fairness, innovative self-efficacy (ISE) and innovative behavior in nurses. Methods A total of 392 nurses from a grade A tertiary hospital were selected as the research subjects using convenience sampling method. The Organizational Fairness Scale, Innovation Self-efficacy Scale, and Innovation Behavior Scale were used to evaluate the sense of organizational fairness, ISE, and innovation behavior, respectively. The mediate equation model was constructed, and Bootstrap analysis was applied for validation. Results The scores for organizational fairness, ISE, and innovative behavior among the nurses were (67.8±15.2), (23.9±3.5), and (30.5±6.7) points, respectively. Organizational fairness score was positively correlated with both innovative behavior and ISE scores ［correlation coefficients (r) were 0.38 and 0.36, respectively, both P<0.01］. ISE score was positively correlated with innovative behavior total score (r=0.51, P<0.01). The results of the mediation analysis indicated that the total effect of organizational fairness on innovation behavior was 0.34 (P<0.01),with a direct effect of 0.17 (P<0.01). ISE plays a mediating role between organizational fairness and innovation behavior among nurses(P<0.01) with standardized mediation effect of 0.17, accounting for 50.0% of the total effect. Conclusion Organizational fairness can influence the ability of innovative behavior directly or through the mediating role of ISE.

Objective    To systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting (CABG). Methods    Eight electronic databases including PubMed, EMbase, CENTRAL, Web of Science, CNKI, CBM, VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020. Two authors independently assessed the quality using the Newcastle-Ottawa Scale (NOS), and a meta-analysis was performed by RevMan 5.3 software. Results    A total of 15 studies involving 4 277 patients were included in this study and among them 1 273 patients suffered hypoxemia. Meta-analysis showed that age (OR=1.55, 95%CI 1.22 to 1.96, P=0.000 3), smoking (OR=3.22, 95%CI 2.48 to 4.17, P<0.000 01), preoperative chronic pulmonary diseases (OR=4.75, 95%CI 3.28 to 6.86, P<0.000 01), diabetes (OR=2.49, 95%CI 1.86 to 3.33, P<0.000 01), left ventricular ejection fraction (OR=3.15, 95%CI 2.19 to 4.52, P<0.000 01), number of coronary artery lesions (OR=2.20, 95%CI 1.63 to 2.97, P<0.000 1) were independent risk factors for hypoxemia after CABG; body mass index (OR=1.31, 95%CI 0.97 to 1.77, P=0.08) and cardiopulmonary bypass time (OR=3.40, 95%CI 0.72 to 15.94, P=0.12) were not associated with hypoxemia. Conclusion    Current evidence shows that age, preoperative chronic pulmonary diseases, smoking, diabetes, left ventricular ejection fraction, number of coronary artery are risk factors for hypoxemia after CABG, which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia. The results should be validated by large-scale standard studies in the future.