Objective To find out whether photobiomodulation(PBM)can mitigate cognitive dysfunction caused by chronic stress by affecting levels of adenosine triphosphate(ATP)and adenosine receptors.Methods Twenty-four C57BL/6J mice were randomly divided into a control group,a stress group,and a treatment group.Chronic unpredictable mild stress was used to establish a mouse model of stress.Six weeks into modeling,the treatment group was subjected to one week of PBM interventions.Behavioral tests were conducted to observe behavioral changes in the mice.Western blotting(WB)was used to detect the expressions of A1,A2B,and A3 adenosine receptors in the hippocampus and prefrontal cortex of mice in the three groups.Twelve C57BL/6J mice were randomly divided into a control group and an intervention group.The intervention group received a week of PBM interventions and underwent behavioral testing.WB was used to detect the expression changes of A1,A2B,and A3 adenosine receptors in the hippocampus and prefrontal cortex in both groups.Immunofluorescence assay was adopted to detect the expression of c-Fos in the hippocampus of mice in the two groups.The ATP assay kit made by Beyotime Biotechnology Co.,Ltd.was used to measure changes in ATP contents in the hippocampus and prefrontal cortex tissues of mice.Cell experiments were conducted to verify the effect of PBM on intracellular ATP contents.Results Mice in the stress group covered a similar distance to the control group,but finished far fewer platform crossings.There was no significant difference between the treatment group and the control group in the number of times of platform crossings,but compared favorably with the stress group where the levels of adenosine receptors in the hippocampus and prefrontal cortex were lower,but were increased by PBM.After PBM interventions in normal mice,platform crossings were increased significantly compared to the control group.PBM also raised adenosine receptor levels and ATP contents in the hippocampus and prefrontal cortex,and increased hippocampal c-Fos expressions.In vitro,PBM elevated intracellular ATP levels.Conclusion PBM may improve chronic stress-induced cognitive dysfunction by regulating ATP levels and adenosine receptor expressions,thereby modulating neuronal responsiveness in the hippocampus.

Objective　To investigate the role of granulocyte-macrophage colony-stimulating factor (GM-CSF) deficiency in the pathogenesis of Exophiala oligosperma (E. oligosperma) infection, a dematiaceous fungus, aiming to provide new insights and evidence for the treatment of dematiaceous fungal infections. Methods　C57BL/6 wild-type (WT) mice and Csf2 gene knockout (KO) mice (C57BL/6 background) were selected. Using E. oligosperma isolated from patients with caspase recruitment domain-containing protein 9 (CARD9) gene deficiency, a murine subcutaneous infection model was established to simulate the human infection route. The natural progression of infection in the mice was observed for six weeks, with skin lesion tissues collected at appropriate time points for pathological analysis and monitoring immune responses. Results　Both WT and Csf2 KO mice exhibited spontaneous pathogen clearance and gradual recovery of foot tissue appearance during the progression of infection, with a 100% survival rate at the end of observation. Compared to WT mice, Csf2 KO mice showed reduced footpad swelling at 1 and 2 weeks post-infection (t=4.674, t=5.961, P<0.01). Fungal clearance in Csf2 KO mice was delayed, with fungal colonies still detectable in lesion tissues at week 4, and Periodic Acid-Schiff (PAS)-positive fungal spores observed in histopathological sections. There was no significant difference found in macrophage infiltration between WT and Csf2 KO mice during the early stages of infection (1-2 weeks) (P>0.05), while neutrophil infiltration was significantly reduced in Csf2 KO mice at week 2 (t=3.287, P<0.01). In addition, Csf2 KO mice exhibited lower levels of IL-6 and IL-1β in foot lesion homogenates at week 1 (t=4.686, t=4.102, P<0.05). Conclusions　This study demonstrated that GM-CSF deficiency delays pathogenic fungi clearance, prolongs the disease course and affects early inflammatory cytokine production as well as neutrophil infiltration during the early stages of fungal infections.

Objective To retrospectively analyze the correlation between inflammatory markers in complete blood counts(CBC)and influenza A virus infection in patients visited the outpatient department of Nanjing First Hospital.Methods The suspected influenza A virus infection patients visited the outpatient department of Nanjing First Hospital from February to March 2023 were collected and di-vided into the positive and negative groups based on the detection results of influenza A virus antigen.The differences in inflammatory markers in CBC between the two groups were compared.The Logistic regression analysis was used to evaluate the correlation between inflammatory markers and influenza A virus infection.Meanwhile,the restricted cubic spline(RCS)and age subgroup(≤6 years,7-12 years,13-17 years,and ≥18 years)analysis were also performed.Results A total of 1 487 outpatients were included,of which 404(27.2％)were positive for influenza A virus antigen.The Logistic regression analysis showed that white blood cell count(WBC),lymphocyte percentage(LY％),and lymphocyte count(LYM)were significantly negatively correlated with influenza A virus infection(P＜0.01),while the neutrophil percentage(NE％),monocyte/lymphocyte ratio(MLR),and neutrophil/lymphocyte ratio(NLR)were significantly positively correlated with influenza A virus infection(P＜0.01).The RCS analysis exhibited the same trend.The age subgroup analysis showed that when the age was greater than 6 years,LYM was significantly negatively correlated with influenza A virus infection(P＜0.01).When the age was greater than 12 years,MLR was significantly positively correlated with influenza A virus infec-tion(P＜0.01).Conclusion The WBC,LY％,LYM,NE％,MLR,and NLR in CBC parameters are important indicators associated with the occurrence of Influenza A virus infection,especially LYM in patients aged over 6 years and MLR in patients aged over 12 years,which may serve as biomarkers for the diagnosis and differential diagnosis of influenza A virus infection.

Objective To provide relevant suggestions for ethical considerations in clinical research by searching literature related to ethics in clinical research using the visualization analysis software CiteSpace,and to analyze and compare the current research status of clinical research ethics at home and abroad.Methods The papers on the application of medical ethics in clinical trials from the core collection of CNKI and Web of Science databases were collected and the bibliometric software CiteSpace was used to draw a knowledge map of domestic and foreign literature.The research hotspots and development trends of medical ethics in clinical trials were analyzed.Results In terms of the process of informed consent,risk minimization,fair selection,and protection on the rights and interests of vulnerable groups,the focus of medical ethics research in China were basically consistent with foreign literature.The difference was that foreign research focused more on ethical education,the quality of life of research participants,and ethical counseling.Otherwise,domestic research focused more on the quality management of clinical trials and the specificity of traditional Chinese medicine research,with research on vulnerable groups mostly focused on children.Conclusion Chinese researchers should strengthen multi-dimensional research on medical ethics in China,and gradually expand their view from ethical review points and management research to applied research solved clinical problems and the specificity of research participants,and increasing the number and dimensions of research.

Objective The aim of this study was to analyze the incidence and mortality of esophageal cancer and its trend in Lianyungang city from 2008 to 2019.Methods The data of esophageal cancer in all cancer registry areas in Lianyungang city were col-lected and sorted out,and the quality control reached the standards.The incidence,mortality,age-standardized rate of Chinese population(ASRC),age-standardized rate of World population(ASRW),cumulative rate at 0-74 years old,truncation rate of 35-64 years old,and composition ranking were calculated.The Joinpoint4.7.0.0software was used to analyze the average annual percentage change(AAPC)of the age-standardized incidence and mortality of esophageal cancer by the standard population(ASIRC and ASMRC).Results From 2008 to 2019,the incidence of esophageal cancer in Lianyungang city was 25.90/100,000,ASIRC was 17.95/100,000,ASIRW was 17.91/100,000,ranking the third in the incidence spectrum of malignant tumors.The mortality was 20.55/100,000,ASMRC was 13.86/100,000,and ASMRW was 13.71/100,000,ranking the third in the malignant tumor mortality spectrum.The incidence,mortali-ty,ASIRC and ASMRC of esophageal cancer were higher in men than those in women,and higher in rural areas than those in urban are-as.From 2008 to 2019,the change trend of incidence and mortality of esophageal cancer in Lianyungang city was the same,showing a downward trend.The AAPC of the ASIRC was-6.19%(95%CI:-7.08%-5.30%,P<0.001),and the AAPC of the ASMRC was-4.03%(95%CI:-5.81%-2.22%,P<0.001).Among them,the ASIRC and ASMRC of esophageal cancer in urban and rural areas showed a downward trend(P<0.05).Among them,the ASIRC and ASMRC of esophageal cancer in urban women decreased the most,with an average annual decline of-7.99%(95%CI:-10.86%-5.03%,P<0.001)and-9.19%(95%CI:-12.35%-5.93%,P<0.001).Conclusion The incidence and mortality of esophageal cancer in Lianyungang city have shown a downward trend,a rural areas and male populations are the key prevention and control populations for esophageal cancer.

Objective:To investigate the imaging characteristics of small intestinal epithe-lioid angiosarcoma.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 male patients with small intestinal epithelioid angiosarcoma who were admitted to 3 medical centers, including Yantaishan Hospital of Yantai et al, from January 2013 to December 2023 were collected. The age of 5 patients was 54 (range, 36-73)years. All 5 patients underwent computer tomography (CT) plain scan and dynamic contrast-enhanced scan, with 1 patient also undergoing magnetic resonance imaging (MRI) plain scan. Observation indicators: (1) results of CT and MRI examination; (2) surgical conditions and postoperative pathological examination; (3) follow-up. Measurement data with skewed distribution were represented as M(range), and count data were described as absolute numbers. Results:(1) Results of CT and MRI examination. Of the 5 patients with small intestinal epithelioid angiosarcoma, two cases were primary small intestinal epithelioid angiosarcoma and the other three cases were metastatic small intestinal epithelioid angiosarcoma. None of the five patients exhibited metastasis to other solid organs, and no significant ascites or peritoneal metastases. ① In two cases of primary small intestinal epithelioid angiosarcoma, three tumors were identified, appearing as round soft tissue nodules on CT plain scan, primarily growing intraluminally. The CT value for tumors of those two cases on plain scan were 30, 35, 32 HU, respec-tively. During the arterial phase of enhanced CT scan, moderate enhancement was observed for tumors of those two cases, with CT value of 57, 72, 65 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those two cases, with CT value of 76, 86, 88 HU, respectively. During the delayed phase of enhanced CT scan, slightly decreased enhancement was observed for tumors of those two cases, with CT value of 74, 79, 72 HU, showing no significant necrosis or cystic changes within the tumors. ② In three cases of metastatic small intestinal epithelioid angiosarcoma, four tumors were identified with uneven thickening of the intestinal wall appeared on CT plain scan. The CT value for tumors of those three cases on plain scan were 39, 37, 38, 28 HU, respectively. During the arterial phase of enhanced CT scan, mild to moderate enhancement was observed for tumors of those three cases, with CT value of 57, 56, 52, 45 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those three cases, with CT value of 84, 88, 82, 77 HU, respectively. During the delayed phase of enhanced CT scan, further changes of increased or decreased enhancement was observed for tumors of those three cases, with CT value of 95, 78, 72, 70 HU. One case of those three patients had thickened intestinal wall with low signal on T1-weighted imaging, heterogeneous high signal on fat-suppressed T2-weighted imaging, significant high signal on diffusion-weighted imaging and low signal on apparent diffusion coefficient imaging on MRI scan. (2) Surgical conditions and post-operative pathological examination. All five cases underwent complete tumor resection. In two cases of primary epithelioid angiosarcoma with three small intestinal tumor foci, there were two tumors invading the serosa and one tumor invading the submucosa. All three metastatic epithelioid angio-sarcoma cases showed four tumors invasion through the serosa, with one case exhibiting mesenteric lymph node metastasis. Microscopic examination revealed hemorrhagic necrosis on the tumor mucosal surface, with tumor cells located in the submucosa or throughout the intestinal wall, displaying infiltrative growth patterns. The distribution was diffuse, with local networks forming irregularly sized vascular-like structures, containing red blood cells and forming blood sinuses and vascular networks. Tumor cells were arranged in solid sheets, strands, and nests, exhibiting spindle-shaped or epithelioid characteristics, with marked atypia, large nuclei, prominent nucleoli, and mitotic figures. Immunohistochemical analysis showed diffuse strong positivity for CD31, Fli-1, and Vim in all five patients. (3) Follow-up. All five patients were followed up postoperatively for 6(range, 3?48)months. During the follow-up period, four patients succumbed to widespread metastasis. One patient with metastatic small intestinal epithelioid angiosarcoma underwent six cycles of chemotherapy and remained in good condition four years post-surgery.Conclusion:The imaging characteristics of small intestinal epithelioid angiosarcoma include abnormal thickening or masses of the intestinal wall.

Objective To retrospectively analyze the correlation between inflammatory markers in complete blood counts(CBC)and influenza A virus infection in patients visited the outpatient department of Nanjing First Hospital.Methods The suspected influenza A virus infection patients visited the outpatient department of Nanjing First Hospital from February to March 2023 were collected and di-vided into the positive and negative groups based on the detection results of influenza A virus antigen.The differences in inflammatory markers in CBC between the two groups were compared.The Logistic regression analysis was used to evaluate the correlation between inflammatory markers and influenza A virus infection.Meanwhile,the restricted cubic spline(RCS)and age subgroup(≤6 years,7-12 years,13-17 years,and ≥18 years)analysis were also performed.Results A total of 1 487 outpatients were included,of which 404(27.2％)were positive for influenza A virus antigen.The Logistic regression analysis showed that white blood cell count(WBC),lymphocyte percentage(LY％),and lymphocyte count(LYM)were significantly negatively correlated with influenza A virus infection(P＜0.01),while the neutrophil percentage(NE％),monocyte/lymphocyte ratio(MLR),and neutrophil/lymphocyte ratio(NLR)were significantly positively correlated with influenza A virus infection(P＜0.01).The RCS analysis exhibited the same trend.The age subgroup analysis showed that when the age was greater than 6 years,LYM was significantly negatively correlated with influenza A virus infection(P＜0.01).When the age was greater than 12 years,MLR was significantly positively correlated with influenza A virus infec-tion(P＜0.01).Conclusion The WBC,LY％,LYM,NE％,MLR,and NLR in CBC parameters are important indicators associated with the occurrence of Influenza A virus infection,especially LYM in patients aged over 6 years and MLR in patients aged over 12 years,which may serve as biomarkers for the diagnosis and differential diagnosis of influenza A virus infection.

[Objective] To explore the influencing factors of quality monitoring index on the nucleic acid pooling detection mode and continuously improve the detection quality of nucleic acid laboratory. [Methods] The quality monitoring indicators (NAT reactive rate, NAT resolution reactive rate, NAT invalid batch rate, NAT invalid result rate, equipment failure rate) and causes of invalidity in our laboratory from January 1, 2020 to December 31, 2022 were retrospectively analyzed. The quality monitoring indicators of the laboratory during 2020 to 2022 were compared longitudinally. The quality monitoring indicators of the laboratory in 2022 were compared horizontally with the overall level in Shandong for the same period to find the differences. [Results] From 2020 to 2022, a total of 218 686 samples were detected, the NAT reactive rate was 0.15‰ (32 samples in total), the resolution reactive rate was 39.02%, the invalid batch rate was 1.06%, the invalid result rate was 1.18%, and the equipment failure rate was 3.58%. There were no differences in the NAT reactive rate, NAT resolution reactive rate and NAT invalid batch rate among different years (P>0.05), but there were differences in the invalid result rate (P<0.05). Equipment failure was the main cause of invalid results (56.53%). Compared with other laboratories in Shandong, there were differences in the NAT reactive rate and invalid result rate (P<0.05). There were differences in the reaction rate, resolution rate and invalid result rate among different reagents (P<0.05). Compared with other two laboratories using the same manufacturer's reagent, there were differences in the reactive rate and invalid result rate (P<0.05), but no difference in the resolution rate and invalid batch rate (P>0.05). [Conclusion] Establishing quality indexes for process control and regular analysis can timely detect potential risks in laboratory operation. The use of quality indicators to implement self-comparison and inter-laboratory comparison can help the laboratory systematically and scientifically evaluate its own operating status and formulate corresponding quality management strategies, thereby improving the laboratory's testing capacity and ensure the safety of blood use.

Objective:To investigate the effects of preoperative enteral nutrition on nutrition-related complications and gastrointestinal function in esophageal cancer patients by administering EN before surgery.Methods:A total of 215 patients who underwent thoracoscopic esophagectomy at Nanjing Hospital of Traditional Chinese Medicine between January 2018 and December 2020 were retrospectively analyzed in this study. Among them, 145 patients received enteral nutrition preconditioning, while 70 patients received traditional nutritional support. The nutritional risk was assessed according to the Nutritional Risk Screening 2002 (NRS2002), and the patients were categorized into non-nutritional risk group (NRS2002<3) and nutritional risk group (NRS2002≥3). Patients in the traditional nutritional support group with NRS2002<3 were provided with a regular diet three days prior to surgery, whereas those with NRS2002≥3 received intravenous fat emulsion amino acid glucose for nutritional support. In the enteral nutrition preconditioning group, patients with NRS2002<3 received 500 mL/d of enteral nutrition suspension orally in addition to their regular diet for 3 days preoperatively; those with NRS2002≥3 received received 1000 mL/d of enteral nutrition suspension orally or via gastric tube. Postoperative hospital stay, time to gas passage and defecation, hospital expenses, gastrointestinal dysfunction incidence including diarrhea, abdominal distension and constipation, postoperative routine blood indicators, anastomotic fistula occurrence as well as infectious complications such as pneumonia and wound infection were compared between groups. Measurement data with normal distribution was expressed as Mean±SD, independent sample t-test was used on comparison between groups. Counting data was expressed as case(%), χ2 test was used on comparison between groups, P<0.05 was considered as statistically significant. Results:The incidence of anastomotic leakage and infectious complications in the enteral nutrition pre-adaptation group was 4.83% (7/145) and 4.83% (7/145), respectively, showing no statistically significant differences compared to the traditional nutrition support group [2.86% (2/70) and 8.57% (6/70)] ( χ2=0.46 and 1.16, P=0.499 and 0.280, respectively). The incidences of gastrointestinal dysfunction and overall complications in the enteral nutrition pre-adaptation group were 5.52% (8/145) and 13.10% (19/145), respectively, which were significantly lower than those in the traditional nutrition support group [37.14% (26/70) and 45.71% (32/70)] ( χ2=35.47 and 27.75, both P<0.001). Postoperative outcomes in the enteral nutrition pre-adaptation group, including hospital stay (14.05±3.75 days), time to first flatus (25.75±5.03 hours), time to first defecation (49.25±5.98 hours), and hospitalization costs (85,200±13,500 CNY), were significantly better than those in the traditional nutrition support group [(16.46±4.79 days, 31.53±6.55 hours, 63.45±11.43 hours, and 93,500±20,100 CNY)] ( t=3.70, 6.52, 9.77, and 3.17, all P<0.001). No significant differences were observed in routine postoperative blood tests between the two groups (all P>0.05). Stratified analysis revealed that among patients with preoperative nutritional risk, the enteral nutrition pre-adaptation group demonstrated superior outcomes in hospitalization costs (82,300±11,000 CNY), time to first flatus (26.17±5.69 hours), time to first defecation (50.31±5.59 hours), overall complication rate (15.79%), and gastrointestinal dysfunction rate (7.89%) compared to the traditional nutrition support group [100,800±28,800 CNY, 31.42±6.29 hours, 60.80±9.89 hours, 54.55%, and 40.91%] ( t=2.89, P=0.008; t=3.32, P=0.002; t=4.57, P<0.001; χ2=9.97, P=0.002; χ2=9.49, P=0.002). Similarly, among patients without preoperative nutritional risk, the enteral nutrition pre-adaptation group showed better results in hospital stay (13.69±3.83 days), time to first flatus (25.60±4.80 hours), time to first defecation (48.87±6.10 hours), overall complication rate (12.15%), and gastrointestinal dysfunction rate (4.67%) compared to the traditional nutrition support group [16.60±4.36 days, 31.58±6.73 hours, 64.67±11.98 hours, 41.67%, and 35.42%] ( t=4.19, t=5.56, t=8.65, χ2=17.23, χ2=25.72, all P<0.001). Conclusion:Enteral nutrition pre-adaptation positively impacts post-esophagectomy nutrition-related complications and gastrointestinal dysfunction.nutrtional support before surgery can't be neglected.

Objective:To explore the diagnostic value of transcranial magnetic stimulation (TMS), transsacral magnetic root stimulation combined with sacral reflexes, external anal sphincter electromyography and pudendal nerve somatosensory evoked potentials in the assessment of neurogenic lower urinary tract dysfunction (NLUTD).Methods:Twenty-one NLUTD patients (1 with a supra-pontine lesion, 5 with a spinal cord injury, 5 with a cauda equina injury, and 10 with pelvic floor disorders) were enrolled. Needle electromyography (EMG) was used to record TMS-induced and transsacral magnetic stimulation-induced motor evoked potentials (tc-MEPs and ts-MEPs, respectively) related to the external anal sphincter (EAS). The dorsal nerve of the penis or clitoris was stimulated electrically to record the latency of the sacral reflex related to the EAS. Central motor conduction time (CMCT) and the tc/ts-MEP latency ratio were calculated to distinguish central from peripheral lesions.Results:In the one patient with a supra-pontine lesion, although the tc-MEP and ts-MEP latencies were within normal limits, the CMCT was prolonged (28.2ms) and the tc/ts-MEP ratio was large (7.4). Among the five patients with a spinal cord injury, one exhibited prolonged tc-MEP latency (50.6ms) and CMCT (47.8ms), along with a large tc/ts-MEP ratio (18.1). In the five patients with cauda equina injury and the ten with NLUTD secondary to pelvic floor disorders, CMCT was within the normal range [averaging (22.9±4.9ms) and (24.2±3.5ms), respectively], but the ts-MEP latency was prolonged [(7.1±2.1ms) and (8.6±3.7ms), respectively], and the tc/ts-MEP ratio was small [(4.4±0.9) and (4.3±1.5), respectively]. The tc/ts-MEP ratio demonstrated the best rate of abnormality detection (93.8%), with an area under the curve of 0.99, indicating good sensitivity.Conclusions:The tc/ts-MEP ratio can be useful for distinguishing central and peripheral lesions. A markedly increased tc/ts-MEP ratio may suggest central nervous system injury, whereas a decreased ratio may indicate peripheral nervous system injury.