Doxorubicin (Dox) is an anthracycline drug widely applied in various malignancies. However, the fatal cardiotoxicity induced by Dox limits its clinical application. Post-transcriptional protein modification via ubiquitination/deubiquitination in cardiomyocytes mediates the pathophysiological process in Dox-induced cardiotoxicity (DIC). In this study, we aimed to clarify the regulatory role and mechanism of a deubiquitinating enzyme, ubiquitin-specific peptidase 13 (USP13), in DIC. RNA-seq analysis and experimental examinations identified that cardiomyocyte-derived USP13 positively correlated with DIC. Mice with cardiac-specific deletion of USP13 were subjected to Dox modeling. Adeno-associated virus serotype 9 (AAV9) carrying cTNT promoter was constructed to overexpress USP13 in mouse heart tissues. Cardiomyocyte-specific knockout of USP13 exacerbated DIC, while its overexpression mitigated DIC in mice. Mechanistically, USP13 deubiquitinates the stimulator of interferon genes (STING) and promotes the autolysosome-related degradation of STING, subsequently alleviating cardiomyocyte inflammation and death. Our study suggests that USP13 serves a cardioprotective role in DIC and indicates USP13 as a potential therapeutic target for DIC treatment.

Objective : To investigate the prevalence of negative emotions in hospitalized youth patients with type 2 diabetes(T2DM) and its correlation with coping strategies and psychological resilience. Methods : 141 youth T2DM patients who met the research standards were selected. Blood glucose related indicators, blood pressure, body mass index(BMI), diabetes chronic complications screening results and other data were collected. The basic information and disease related information questionnaire, self-rating depression scale(SDS), self-rating anxiety scale(SAS), diabetes distress scale(DDS), medical coping modes questionnaire(MCMQ) and Connor-Davidson resilience scale(CD-RISC) were completed. Results: Among 141 hospitalized youth T2DM patients, 37.6% were combined with depression, 32.6% were combined with anxiety, and 35.5% were combined with diabetic distress(DD). Univariate analysis showed that systolic blood pressure(P<0.01), educational level, and the form of hospitalization expenses(P<0.05) were significantly correlated with depression. Marital status(P<0.01), family residence, blood glucose monitoring methods, and the last fasting blood glucose(P<0.05) were significantly correlated with anxiety. BMI, whether it was first diagnosed or treated(P<0.01), gender, occupation, disease course, weekly blood glucose monitoring frequency, and the presence of chronic complications(P<0.05) were significantly correlated with DD. In multivariate analysis, systolic blood pressure(P<0.01), educational level, and the form of hospitalization expenses were significantly correlated with depression, marital status(P<0.05) was significantly correlated with anxiety; BMI and weekly blood glucose monitoring frequency(P<0.01) were significantly correlated with DD. SDS, SAS, total scores and dimensions of DDS were negatively correlated with the total score and dimensions of CD-RISC(rs=-0.182--0.467, P<0.05 or 0.01), and positively correlated with the yielding coping strategies(rs=0.177-0.271,P<0.05 or 0.01). SAS,total scores and dimensions of DDS were positively correlated with avoiding coping strategies(rs=0.237-0.419,P<0.05 or 0.01). The total and dimensions of CD-RISC were positively correlated with facing coping strategies(rs=0.215-0.349,P<0.05 or 0.01),and negatively correlated with yielding coping strategies(rs=-0.234--0.325,P<0.01). Conclusion More than 30% of hospitalized youth T2DM may experience negative emotions such as depression,anxiety,and DD. The occurrence of negative emotions in such patients may be related to disease management or socio-economic issues such as systolic blood pressure,educational level,hospitalization expenses,marital status,BMI,and frequency of blood glucose monitoring,as well as decreased psychological resilience and negative coping strategies.

Objective:To explore the anatomical parameters of the ideal trajectory for pedicle screw fixation through the lamina in the treatment of L 5 spondylolysis. Methods:CT data from 40 male patients with bilateral L 5 spondylolysis (age, 24.95±4.01 years; range, 20-36 years), treated at the 940th Hospital of PLA Joint Logistics Support Force between January 2021 and June 2024, were analyzed. Three-dimensional vertebral models were reconstructed using this data. Measurements included the lumbosacral angle, the thickness at the midpoint of the superior and inferior lamina edges, mid-lamina thickness, the distance from the lateral edge of the lamina to the spinous process midline, the thickness at the defect of the pars interarticularis, and the vertical diameter of the defect. The screws were inserted from the inferior edge of the lamina, passing through the pars interarticularis defect, and exiting at the superior edge of the pedicle. In the vertical direction of the lamina, the inferior and superior edges of the lamina were divided into three zones, named A, B, C (for the inferior lamina edge) and 1, 2, 3 (for the superior pedicle edge). Seven trajectories (A2, A3, B1, B2, B3, C2, and C3) were designed by combining these zones. Screws with diameters of 5.0, 4.5, 4.0, and 3.5 mm were sequentially inserted along each trajectory. Screw trajectories with an insertion success rate ≥95% were selected and evaluated for feasibility. Parameters such as screw length, medial inclination angle, caudal inclination angle, and entry point position were measured. The ideal trajectory and screw dimensions were determined by considering anatomical features, screw characteristics, and insertion safety. Results:The measurement results from the 3D model showed that the lumbosacral angle was 36.22°±5.23°, and the midpoint thickness of the superior lamina edge was 4.14±0.66 mm (left) and 4.18±0.65 mm (right), the mid-lamina thickness was 6.73±0.72 mm (left) and 6.72±0.70 mm (right), the midpoint thickness of the inferior lamina edge was 6.50±0.56 mm (left) and 6.50±0.66 mm (right), the distance from the lateral edge of the lamina to the spinous process midline was 25.95±2.86 mm (left) and 26.39±3.10 mm (right), the thickness at the pars defect was 9.67±0.57 mm (left) and 9.67±0.51 mm (right), and the vertical diameter of the pars defect was 18.76±2.16 mm (left) and 19.26±2.03 mm (right). No statistically significant differences were found between the left and right sides for these parameters ( P>0.05). The trajectories considered feasible and with an insertion success rate ≥95% were B2, B3, C2, and C3. Safe screw diameters were B2 (4.5 mm), B3 (4.0 mm), C2 (4.0 mm), and C3 (3.5 mm). Corresponding screw lengths were B2 (38.28±2.34 mm), B3 (37.03±2.99 mm), C2 (38.37±2.42 mm), and C3 (36.88±2.87 mm). The caudal inclination angles were B2 (52.73°±5.29°), B3 (55.06°± 4.46°), C2 (49.09°±3.92°), and C3 (50.18°±4.36°). The medial inclination angles were B2 (21.21°±3.01°), B3 (5.11°±1.58°), C2 (22.55°±2.46°), and C3 (12.59°±1.80°). The distances from the entry point to the spinous process midline were B2 (13.23±1.68 mm), B3 (13.15±1.46 mm), C2 (11.12±0.64 mm), and C3 (11.09±0.65 mm). The distances from the entry point to the root of the spinous process were B2 (8.23±1.46 mm), B3 (8.21±1.31 mm), C2 (6.65 ±0.76 mm), and C3 (6.67±0.72 mm). Differences in screw length, caudal inclination angle, medial inclination angle, and entry point position across trajectories were statistically significant ( P<0.05). Conclusion:The ideal screw trajectory for L 5 spondylolysis involves insertion through the midpoint of the entry zone, passing through the pars defect, and exiting at the midpoint of the superior edge of the pedicle. The optimal entry point is located on the inferior edge of the lamina, 8.23±1.46 mm from the root of the spinous process and 13.23±1.68 mm from the spinous process midline. The screw should be placed at a caudal inclination angle of 52.73°±5.29° and a medial inclination angle of 21.21°±3.01°. The recommended screw length is 38.28±2.34 mm, with a diameter of 4.5 mm (range, 4.5-5.0 mm).

Objective To investigate effect of preimplantation genetic testing for aneuploidies(PGT-A)on the reproductive outcomes of women of advanced maternal age(AMA)(≥ 38 years),and to analyze factors influencing the live birth rate in AMA women who have received PGT-A.Methods A retrospective cohort study was conducted.AMA women undergoing PGT-A were enrolled in the PGT-A group.All of them underwent their first oocyte retrieval cycle between January 2019 and June 2023.AMA women undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and their first oocyte retrieval cycle over the same period of time were enrolled in the control group(the non-PGT-A group)via propensity score matching.The PGT-A group and the non-PGT-A group each included 193 cycles,which were followed up until January 2024.Follow-up concerning live births was completed for all oocyte retrieval cycles conducted between January 2019 and October 2022.The reproductive outcomes were compared between the two groups.The primary outcome indicator was cumulative live birth rate(CLBR)per oocyte retrieval,while the secondary outcome indicators were cumulative clinical pregnancy rate(CCPR)per oocyte retrieval and spontaneous abortion rate.For the 145 cycles in the PGT-A group with completed live birth follow-up,binary logistic regression analysis and receiver operator characteristic(ROC)curves were used to analyze the influencing factors of live birth rates.Results A total of 145 cycles in the PGT-A group and 161 cycles in the non-PGT-A group completed follow-up for live births.The CLBR per oocyte retrieval of the PGT-A group was 25.52％(37/145),while that of the non-PGT-A group was 28.50％(46/161),with no significant difference being observed between the two groups(P＜0.05).Of the 193 oocyte retrieval cycles in each group,53 cycles in the PGT-A group and 72 cycles in the non-PGT-A group resulted in clinical pregnancies,with the difference in the CCPR per oocyte retrieval being statistically significant(27.46％vs.37.31％,P＜0.05).Concerning clinical pregnancies,the spontaneous abortion rate of the PGT-A group was lower than that of the non-PGT-A group,with the difference being statistically significant(7.55％vs.25.00％,P＜0.05).In AMA women who had undergone PGT-A for reproductive assistance,maternal age(odds ratio[OR]=0.786,95％confidence interval[CI]:0.635-0.973)and the antral follicle count(AFC)(OR=1.110,95％CI:1.013-1.216)were correlated with the outcome of live births outcome.The probability of live births decreased with increasing maternal age and decreasing AFC.When the female age was ≥ 42 years or when AFC ≤ 8,the expected live birth outcome of PGT-A assisted pregnancy was poor.Conclusion PGT-A does not affect the CLBR per oocyte retrieval in AMA women,but it can effectively reduce the risks of implantation failure and spontaneous abortion due to fetal aneuploidies.For PGT-A-assisted pregnancy in AMA women,maternal age and AFC are important factors affecting the live birth outcomes.

Objective To evaluate the effect of different operation methods on the early swallowing function in the patients with laryngocarcinoma.Methods A total of 138 patients with the first time of open laryngectomy in this hospital from January 2021 to December 2022 were selected as the research subjects by convenience sampling method.The patients were divided into the vertical laryngeal resection group(vertical group,n=34),horizontal laryngeal partial resection(horizontal group,26 cases),suprachloroid laryngeal par-tial resection annular hyoid epiglottis fixation group(SCPL-CHEP group,n=26)and total laryngeal resection group(total laryngeal group,n=52)according to the operation methods.The Anderson Dysphagia Scale,Syd-ney Dysphagia Scale and modified swale drinking water test were used to evaluate the swallowing function on the first day of postoperative oral feeding in the patients.Results The total scores and scores of various di-mensions of the Chinese version of Anderson Dysphagia Scale,total scores and scores of various dimensions of Sydney Swallowing Scale and the results of the modified swale drinking water test had statistical differences a-mong the various groups(P＜0.01);the above indexes had statistical difference between the total laryngeal group and the other groups(P＜0.01),but the above indexes had no statistical difference between the two groups in the horizontal group,vertical group and SCPL-CHEP group(P＞0.05).Conclusion In the patients with laryngeal cancer undergoing open laryngectomy,the dysphagia is less severe during early eating after to-tal laryngectomy,which has little impact on life.

Objective To investigate the value of multimodal MRI radiomics in predicting muscle-invasive bladder cancer.Methods A total of 178 patients with pathology diagnosis of bladder cancer were retrospectively collected,including 31 cases of muscle invasive bladder cancer(MIBC)and 147 cases of non-muscle invasive bladder cancer(NMIBC).Patients were randomly divided into training group and testing group at a ratio of 7︰3.The range of bladder tumors in T2WI,diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)images were segmented as volume of interest(VOI)by using ITK-SNAP software.Radiomics features were extracted through A.K software.The optimal radiomics features were obtained through radiomics algorithm and least absolute shrinkage and selection operator(LASSO)method.Finally,the logistic regression analysis method and random forest model method were used to construct prediction models.The performance of prediction models was evaluated by the receiver operating characteristic(ROC)curve.Results This study constructed four groups of models containing T2WI prediction model,DWI prediction model,ADC prediction model,and T2WI+DWI+ADC prediction model.The area under the curve(AUC)of T2WI,DWI,and ADC prediction models for identifying MIBC and NMIBC were separately 0.920,0.914,and 0.954 in the training group while those were respectively 0.881,0.773,and 0.871 in the testing group.There was no statistical significance between T2WI,DWI,and ADC prediction models.In training and testing groups,the AUC of T2WI+DWI+ADC prediction model were respectively 0.959 and 0.909,which were higher than the single sequence prediction model.The sensitivity and specificity of the training group were 0.905 and 0.853 and the sensitivity and specificity of the testing group were 0.778 and 0.795.Conclusion MRI radiomics prediction model can effectively differentiate MIBC and NMIBC.The T2WI+DWI+ADC prediction model shows better prediction efficiency.

Preeclampsia (PE), a multisystem disorder in pregnancy, is one of the leading causes of perinatal morbidity and mortality that poses financial and physical burdens worldwide. Preterm PE with delivery at <37 weeks of gestation is associated with a higher risk of adverse maternal and perinatal outcomes than term PE with delivery at ≥37 weeks of gestation. A myriad of first trimester screening models have been developed to identifying women at risk of preterm PE. In fact, the Fetal Medicine Foundation (FMF) first trimester prediction model has undergone successful internal and external validation. The FMF triple test enables the estimation of patient-specific risks, using Bayes theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. Establishing a quality control process for regular monitoring and to ensure data standardization, reliability, and accuracy is key to maintaining optimal screening performance. The rate of preterm PE can be reduced by 62% by using the FMF prediction model, followed by the administration of low-dose aspirin. Recent evidence has also demonstrated that metformin has the potential for preventing PE in patients at high-risk of the disorder. In this article, we will summarize the existing literature on the different screening methods, different components of risk assessment, therapeutic interventions, and clinical implementation of the first trimester screening and prevention program for PE with specific considerations for Chinese mainland.

Preeclampsia (PE), a multisystem disorder in pregnancy, is one of the leading causes of perinatal morbidity and mortality that poses financial and physical burdens worldwide. Preterm PE with delivery at <37 weeks of gestation is associated with a higher risk of adverse maternal and perinatal outcomes than term PE with delivery at ≥37 weeks of gestation. A myriad of first trimester screening models have been developed to identifying women at risk of preterm PE. In fact, the Fetal Medicine Foundation (FMF) first trimester prediction model has undergone successful internal and external validation. The FMF triple test enables the estimation of patient-specific risks, using Bayes theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. Establishing a quality control process for regular monitoring and to ensure data standardization, reliability, and accuracy is key to maintaining optimal screening performance. The rate of preterm PE can be reduced by 62% by using the FMF prediction model, followed by the administration of low-dose aspirin. Recent evidence has also demonstrated that metformin has the potential for preventing PE in patients at high-risk of the disorder. In this article, we will summarize the existing literature on the different screening methods, different components of risk assessment, therapeutic interventions, and clinical implementation of the first trimester screening and prevention program for PE with specific considerations for Chinese mainland.

Objective:To explore the anatomical parameters of the ideal trajectory for pedicle screw fixation through the lamina in the treatment of L 5 spondylolysis. Methods:CT data from 40 male patients with bilateral L 5 spondylolysis (age, 24.95±4.01 years; range, 20-36 years), treated at the 940th Hospital of PLA Joint Logistics Support Force between January 2021 and June 2024, were analyzed. Three-dimensional vertebral models were reconstructed using this data. Measurements included the lumbosacral angle, the thickness at the midpoint of the superior and inferior lamina edges, mid-lamina thickness, the distance from the lateral edge of the lamina to the spinous process midline, the thickness at the defect of the pars interarticularis, and the vertical diameter of the defect. The screws were inserted from the inferior edge of the lamina, passing through the pars interarticularis defect, and exiting at the superior edge of the pedicle. In the vertical direction of the lamina, the inferior and superior edges of the lamina were divided into three zones, named A, B, C (for the inferior lamina edge) and 1, 2, 3 (for the superior pedicle edge). Seven trajectories (A2, A3, B1, B2, B3, C2, and C3) were designed by combining these zones. Screws with diameters of 5.0, 4.5, 4.0, and 3.5 mm were sequentially inserted along each trajectory. Screw trajectories with an insertion success rate ≥95% were selected and evaluated for feasibility. Parameters such as screw length, medial inclination angle, caudal inclination angle, and entry point position were measured. The ideal trajectory and screw dimensions were determined by considering anatomical features, screw characteristics, and insertion safety. Results:The measurement results from the 3D model showed that the lumbosacral angle was 36.22°±5.23°, and the midpoint thickness of the superior lamina edge was 4.14±0.66 mm (left) and 4.18±0.65 mm (right), the mid-lamina thickness was 6.73±0.72 mm (left) and 6.72±0.70 mm (right), the midpoint thickness of the inferior lamina edge was 6.50±0.56 mm (left) and 6.50±0.66 mm (right), the distance from the lateral edge of the lamina to the spinous process midline was 25.95±2.86 mm (left) and 26.39±3.10 mm (right), the thickness at the pars defect was 9.67±0.57 mm (left) and 9.67±0.51 mm (right), and the vertical diameter of the pars defect was 18.76±2.16 mm (left) and 19.26±2.03 mm (right). No statistically significant differences were found between the left and right sides for these parameters ( P>0.05). The trajectories considered feasible and with an insertion success rate ≥95% were B2, B3, C2, and C3. Safe screw diameters were B2 (4.5 mm), B3 (4.0 mm), C2 (4.0 mm), and C3 (3.5 mm). Corresponding screw lengths were B2 (38.28±2.34 mm), B3 (37.03±2.99 mm), C2 (38.37±2.42 mm), and C3 (36.88±2.87 mm). The caudal inclination angles were B2 (52.73°±5.29°), B3 (55.06°± 4.46°), C2 (49.09°±3.92°), and C3 (50.18°±4.36°). The medial inclination angles were B2 (21.21°±3.01°), B3 (5.11°±1.58°), C2 (22.55°±2.46°), and C3 (12.59°±1.80°). The distances from the entry point to the spinous process midline were B2 (13.23±1.68 mm), B3 (13.15±1.46 mm), C2 (11.12±0.64 mm), and C3 (11.09±0.65 mm). The distances from the entry point to the root of the spinous process were B2 (8.23±1.46 mm), B3 (8.21±1.31 mm), C2 (6.65 ±0.76 mm), and C3 (6.67±0.72 mm). Differences in screw length, caudal inclination angle, medial inclination angle, and entry point position across trajectories were statistically significant ( P<0.05). Conclusion:The ideal screw trajectory for L 5 spondylolysis involves insertion through the midpoint of the entry zone, passing through the pars defect, and exiting at the midpoint of the superior edge of the pedicle. The optimal entry point is located on the inferior edge of the lamina, 8.23±1.46 mm from the root of the spinous process and 13.23±1.68 mm from the spinous process midline. The screw should be placed at a caudal inclination angle of 52.73°±5.29° and a medial inclination angle of 21.21°±3.01°. The recommended screw length is 38.28±2.34 mm, with a diameter of 4.5 mm (range, 4.5-5.0 mm).

Objective:To explore the effect of gradual dural decompression(GDD)in preventing intraoperative encephalocele in severe traumatic brain injury (TBI).Methods:A retrospective case-control study was conducted to analyze the clinical data of 78 patients with severe TBI admitted to Affiliated Hospital of North Sichuan Medical College from January 2015 to October 2018, including 55 males and 23 females, aged 15-68 years with an average age of 38.2 years. Thirty-eight patients were treated by GDD (GDD group). During the operation, the hematoma was cleared by opening a window in the area with more hematoma, then gradually cleared in the area without opening a window. Finally, the dural "junction" was cut and the skull was closed quickly after covering the dural patch. The other 40 patients were operated by fast open dural (FOD) operation (FOD group). The incidence of intraoperative encephalocele, intracranial pressure data at the time, 24 hours, 72 hours and 7 days after operation, incidence of delayed intracranial hematoma and glasgow outcome score (GOS) at 3 months after operation were compared between the two groups.Results:All patients (except for 26 deaths) were followed up for 3-14 months, with an average of 8 months. None had intraoperative encephalocele in GDD group, compared to 8 patients in FOD group ( P<0.05). Intracranial pressure in GDD group was respective (18.4±3.6)mmHg, (20.4±4.0)mmHg, (27.7±4.6)mmHg and (28.3±4.5)mmHg at the time, 24 hours, 72 hours and 7 days after operation, showing no significant differences compared to FOD group [(19.1±3.4)mmHg, (20.9±3.9)mmHg, (27.0±3.5)mmHg, (27.6±3.4)mmHg, respectively] ( P>0.05). There was no significant difference in the incidence of delayed intracranial hematoma between the two groups [16% (6/38) in GDD group and 16% (5/32) in FOD group (except 8 cases of intraoperative encephalocele)] ( P>0.05). Three months after operation, the good rate of GOS score of GDD group was 61% (23/28) higher than that of FOD group [28% (11/40)], and the mortality rate of GDD group was 21% (8/38) lower than that of FOD group [45% (18/40)] ( P<0.05). There was no significant difference between the two groups in medium severe disability and plant survival rate ( P>0.05). Conclusions:For patients with severe TBI, compared with FOD, GDD is more effective in reducing the incidence of intraoperative encephalocele, improving the prognosis and decreasing mortality.