BACKGROUND:Acupotomy is an effective method for the treatment of cervical spondylosis with definite clinical efficacy,but its key molecular mechanism is still unclear.OBJECTIVE:To observe the effect of acupotomy intervention on the expression of fibroblast growth factor family and kinase insert domain protein receptor in the splenius capitis muscles of rats with cervical spondylosis,and to study the therapeutic mechanism of acupotomy in cervical spondylosis.METHODS:The Genomics Expression Omnibus Database was searched to obtain the microarray dataset GSE153761,which was compatible with the study,and a bioinformatics approach was used for the initial screening of targets,followed by animal experiments.Twenty-four 6-month-old SPF grade Sprague-Dawley rats were randomly divided into four groups.The model of cervical spondylosis was established by unbalanced dynamic and static forces in the model and acupotomy groups.The muscles and ligaments were not cut in the sham operation group.After successful modeling,acupotomy intervention was performed in the acupotomy group,once a week,3 times in total.Normal rats were selected as controls.The posteroanterior and lateral X-rays of the cervical spine were taken for modeling verification;the open-field tests were performed in all rats to observe behavioral changes;the pathological structure of the splenius capitis muscles was observed by hematoxylin-eosin staining;the mRNA and protein expression of fibroblast growth factor family and kinase insert domain protein receptor in the splenius capitis muscles was detected by fluorescent quantitative PCR and immunohistochemical method,respectively.RESULTS AND CONCLUSION:Bioinformatics results indicated that fibroblast growth factor family/kinase insert domain protein receptor is an important signal axis for activating the phosphatidylinositol 3-kinase/protein kinase B signaling pathway.After modeling,the intervertebral space of the rats was narrowed,and the anterior and posterior borders of the vertebral body and the articular process were hyperosteogenous.In the open-field tests,the total distance and average speed in the model group were decreased after modeling(P<0.05),while the total rest time in the model group was increased(P<0.05).After treatment,the total distance and average speed in the acupotomy group were greater than those in the model group(P<0.05),while the total rest time in the acupotomy group was shorter than that in the model group(P<0.05).The pathological changes of the splenius capitis muscles indicated damage to the cervical muscle,and acupotomy improved cervical muscle strain.Compared with the normal group,The mRNA and protein expressions of fibroblast growth factor 7,fibroblast growth factor 9,fibroblast growth factor 10,fibroblast growth factor 18,and kinase insert domain protein receptor in the splenius capitis muscles were increased in the model group compared with the normal group(P<0.05).In contrast,acupotomy treatment could downregulate the above indicators(P<0.05).Thus,acupotomy may repair cervical muscle strain by regulating the expression of fibroblast growth factor 7,fibroblast growth factor 9,fibroblast growth factor 10,fibroblast growth factor 18,and kinase insert domain protein receptor,thereby improving intervertebral disc degeneration,which may be the key target for acupotomy treatment of cervical spondylosis.

Objective:To examine the validity and reliability of the Chinese version of the Transgender Atti-tudes and Beliefs Scale(TABS)in the general adult population.Methods:A total of 1 656 residents aged≥18 years were recruited by convenient sampling method,and were equally divided into sample 1 and sample 2 accord-ing to age group.The total sample was used for item analysis and internal consistency reliability test.Sample 1 was used for exploratory factor analysis,Sample 2 was used for confirmatory factor analysis,and 60 residents were se-lected for retesting at a 2-week interval.Results:The TABS Chinese version included a total of 26 items,with the content validity index(I-CVI)of each item ranging from 0.83 to 1.00,and the content validity index(S-CVI)of the scale being 0.98.Exploratory factor analysis extracted 3 common factors,namely interpersonal comfort,gender beliefs,and human value,with a cumulative total variance of 57.13％.Confirmatory factor analysis showed that the scale fit was acceptable(x2/df=2.95,RMSEA=0.05,GFI=0.92,AGFI=0.90).The Cronbach α coefficients of the total score of the scale and the scores of the 3 factors were 0.95,0.95,0.88 and 0.86.The retest reliabilities were 0.88,0.78,0.65 and 0.91.Conclusion:The Chinese version of the Transgender Attitudes and Beliefs Scale(TABS)has good validity and reliability in assessing general adults'attitudes toward the transgender community.

BACKGROUND:Acupotomy is an effective method for the treatment of cervical spondylosis with definite clinical efficacy,but its key molecular mechanism is still unclear.OBJECTIVE:To observe the effect of acupotomy intervention on the expression of fibroblast growth factor family and kinase insert domain protein receptor in the splenius capitis muscles of rats with cervical spondylosis,and to study the therapeutic mechanism of acupotomy in cervical spondylosis.METHODS:The Genomics Expression Omnibus Database was searched to obtain the microarray dataset GSE153761,which was compatible with the study,and a bioinformatics approach was used for the initial screening of targets,followed by animal experiments.Twenty-four 6-month-old SPF grade Sprague-Dawley rats were randomly divided into four groups.The model of cervical spondylosis was established by unbalanced dynamic and static forces in the model and acupotomy groups.The muscles and ligaments were not cut in the sham operation group.After successful modeling,acupotomy intervention was performed in the acupotomy group,once a week,3 times in total.Normal rats were selected as controls.The posteroanterior and lateral X-rays of the cervical spine were taken for modeling verification;the open-field tests were performed in all rats to observe behavioral changes;the pathological structure of the splenius capitis muscles was observed by hematoxylin-eosin staining;the mRNA and protein expression of fibroblast growth factor family and kinase insert domain protein receptor in the splenius capitis muscles was detected by fluorescent quantitative PCR and immunohistochemical method,respectively.RESULTS AND CONCLUSION:Bioinformatics results indicated that fibroblast growth factor family/kinase insert domain protein receptor is an important signal axis for activating the phosphatidylinositol 3-kinase/protein kinase B signaling pathway.After modeling,the intervertebral space of the rats was narrowed,and the anterior and posterior borders of the vertebral body and the articular process were hyperosteogenous.In the open-field tests,the total distance and average speed in the model group were decreased after modeling(P<0.05),while the total rest time in the model group was increased(P<0.05).After treatment,the total distance and average speed in the acupotomy group were greater than those in the model group(P<0.05),while the total rest time in the acupotomy group was shorter than that in the model group(P<0.05).The pathological changes of the splenius capitis muscles indicated damage to the cervical muscle,and acupotomy improved cervical muscle strain.Compared with the normal group,The mRNA and protein expressions of fibroblast growth factor 7,fibroblast growth factor 9,fibroblast growth factor 10,fibroblast growth factor 18,and kinase insert domain protein receptor in the splenius capitis muscles were increased in the model group compared with the normal group(P<0.05).In contrast,acupotomy treatment could downregulate the above indicators(P<0.05).Thus,acupotomy may repair cervical muscle strain by regulating the expression of fibroblast growth factor 7,fibroblast growth factor 9,fibroblast growth factor 10,fibroblast growth factor 18,and kinase insert domain protein receptor,thereby improving intervertebral disc degeneration,which may be the key target for acupotomy treatment of cervical spondylosis.

Objective:This study aimed to explore the utility of transcutaneous electrical acupoint stimulation (TEAS) combined with skin sympathetic response (SSR) in assessing the effectiveness of perigastric autonomic nerve preservation during radical gastrectomy.Methods:A retrospective cohort analysis was conducted involving 221 patients who underwent laparoscopic radical gastrectomy at the Department of Gastric Surgery, Taizhou People's Hospital, affiliated with Nanjing Medical University, between June 2022 and September 2024. The cohort comprised 109 patients who underwent laparoscopic radical total gastrectomy without autonomic nerve preservation (total gastrectomy without nerve preservation group). Additionally, 112 patients underwent laparoscopic radical distal gastrectomy, including 34 patients who received autonomic nerve preservation (nerve preservation group) and 78 patients who did not (without nerve preservation group). TEAS was administered at the Zusanli and Tianshu acupoints one day before and one day after surgery, during which SSR latency and voltage amplitudes in the upper and lower extremities were recorded and compared across groups. Differences in SSR latency and voltage amplitude between the nerve preservation and non-nerve preservation groups of the distal gastrectomy cohort were also analyzed. Further, TEAS was applied at the same acupoints for 15 minutes on the 1st, 2nd, and 3rd postoperative days, and changes in intestinal sounds and intestinal functional recovery time were monitored. Surgical parameters, including operative duration, intraoperative blood loss, and harvested lymph node, were documented. Postoperative inflammatory indicators, including interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), and the incidence of anastomotic leakage, were evaluated. At three months postoperatively, gastroscopy was performed to assess residual gastric food and bile reflux. Additionally, the prognostic nutritional index (PNI) was evaluated across all patient groups.Results:Following total gastrectomy, TEAS of Zusanli combined with arms' SSR revealed a latency of (23 59.71±410.55) ms and a voltage amplitude of (0.43±1.67) mV; for the legs, latency was (2 596.88±369.01) ms and voltage amplitude was (0.25±0.08) mV. TEAS of Tianshu combined with arms' SSR demonstrated a latency of (2 746.47±224.37) ms and a voltage amplitude of (0.31±0.14) mV; for the legs, latency was (2 891.90±193.61) ms and voltage amplitude was (0.19±0.72) mV. Postoperative latency was significantly prolonged, and voltage amplitude was markedly reduced (all P < 0.01). In the distal gastrectomy with nerve preservation group, TEAS of Zusanli combined with arms' SSR showed a latency of (1 668.04±261.91) ms and a voltage amplitude of (0.78±0.26) mV; for the legs, latency was (1 568.86±220.09) ms and voltage amplitude was (0.61±0.24) mV. TEAS of Tianshu combined with arms' SSR demonstrated a latency of (1 519.36±206.99) ms and a voltage amplitude of (0.66±0.34) mV; for the legs, latency was (2 004.80±508.53) ms and voltage amplitude was (0.55±0.28) mV. In the distal gastrectomy without nerve preservation group, TEAS of Zusanli combined with arms' SSR revealed a latency of (2 385.95±710.27) ms and a voltage amplitude of (0.23±0.11) mV; for the legs, latency was (2 506.81±779.37) ms and voltage amplitude was (0.26±1.29) mV. TEAS of Tianshu combined with arms' SSR indicated a latency of (2 697.78±385.55) ms and a voltage amplitude of (0.21±0.14) mV; for the legs, latency was (2 949.14±506.61) ms and voltage amplitude was (0.17±0.11) mV. The group without nerve preservation exhibited significantly prolonged latencies and reduced voltage amplitudes (all P<0.01). No statistically significant differences were observed between the groups in operative time, intraoperative bleeding, the number of dissected lymph nodes, inflammatory indicators (IL-6, CRP, PCT) at 3 days postoperatively, or anastomotic leakage rates (all P>0.05). In the group without nerve preservation, bowel sounds on postoperative days 1, 2, and 3 were (0.36±0.58), (1.04±0.97), and (1.74±1.10) times/min, respectively, with bowel function recovery time of (62.24±9.91) hours. The PNI at 3 months postoperatively was (37.42±3.01). Incidences of food residue in the residual stomach and bile reflux were 21.79% (17/78) and 29.49% (23/78), respectively. In the group with nerve preservation, bowel sounds on postoperative days 1, 2, and 3 were (0.76±0.82), (2.03±1.34), and (3.71±1.27) times/min, respectively, with bowel function recovery time of (44.94±8.05) hours. The PNI at 3 months postoperatively was (41.34±3.40). Incidences of food residue and bile reflux were 5.88% (2/34) and 11.76% (4/34), respectively. Statistically significant differences were observed between the groups (all P < 0.05). Conclusion:TEAS of Zusanli and Tianshu combined with SSR provides an objective measure for assessing the preservation of perigastric autonomic nerves during radical gastrectomy.

Objective:To examine the validity and reliability of the Chinese version of the Transgender Atti-tudes and Beliefs Scale(TABS)in the general adult population.Methods:A total of 1 656 residents aged≥18 years were recruited by convenient sampling method,and were equally divided into sample 1 and sample 2 accord-ing to age group.The total sample was used for item analysis and internal consistency reliability test.Sample 1 was used for exploratory factor analysis,Sample 2 was used for confirmatory factor analysis,and 60 residents were se-lected for retesting at a 2-week interval.Results:The TABS Chinese version included a total of 26 items,with the content validity index(I-CVI)of each item ranging from 0.83 to 1.00,and the content validity index(S-CVI)of the scale being 0.98.Exploratory factor analysis extracted 3 common factors,namely interpersonal comfort,gender beliefs,and human value,with a cumulative total variance of 57.13％.Confirmatory factor analysis showed that the scale fit was acceptable(x2/df=2.95,RMSEA=0.05,GFI=0.92,AGFI=0.90).The Cronbach α coefficients of the total score of the scale and the scores of the 3 factors were 0.95,0.95,0.88 and 0.86.The retest reliabilities were 0.88,0.78,0.65 and 0.91.Conclusion:The Chinese version of the Transgender Attitudes and Beliefs Scale(TABS)has good validity and reliability in assessing general adults'attitudes toward the transgender community.

Objective:To analyze the changes in the incidence trend of liver cancer in Taizhou of Jiangsu Province, from 2012 to 2020 and provide reference for tumor prevention and control and management.Methods:Liver cancer incidence data from 2012 to 2020 were extracted from the Taizhou Center for Disease Control and Prevention's tumor registry system. Demographic data were used to calculate the crude incidence rate, age-standardized incidence rate (ASIR), Chinese age-standardized incidence rate (CASIR; based on China's 2010 standard population), and world age-standardized incidence rate (WASIR; based on Segi's world standard population). The Joinpoint regression model was applied to identify inflection points in liver cancer incidence trends during 2012-2020, and annual percentage change (APC) with average annual percentage change (AAPC) were calculated.Results:In 2020, the crude incidence ratio (CIR) of liver cancer in Taizhou was 34.6 per 100 000, with CASIR and WASIR at 19.6 per 100 000 and 14.9 per 100 000, respectively. From 2012 to 2020, the male-to-female ratio of new liver cancer cases was 2.94∶1 (10 455 males vs. 3 559 females), with male incidence consistently higher than female. Overall liver cancer incidence in Taizhou initially increased and then decreased after 2017 (2012-2017: APC=6.4%, P=0.014; 2017-2020: APC=-9.5%, P=0.035), peaking at a CASIR of 26.2 per 100 000 in 2017. The trend in male incidence mirrored the overall pattern, rising before 2017 and declining thereafter (2012-2017: APC=6.2%, P=0.005; 2017-2020: APC=-9.0%, P=0.016). Female incidence remained relatively stable (2012-2016: APC=11.0%, P=0.054; 2016-2020: APC=-6.5%, P=0.130). Conclusions:Liver cancer incidence in Taizhou increased before 2017 and declined thereafter, with 2017 as the turning point. Amid population aging, liver cancer remains a persistent public health challenge requiring sustained attention.

Objective:To explore the clinical efficacy of double tract reconstruction and single flap valvuloplasty technique in laparoscopic proximal gastrectomy.Methods:A retrospective cohort study was adopted to analyze the clinical data of 65 patients with gastric cancer who underwent radical proximal gastrectomy at Taizhou People's Hospital Affiliated to Nanjing Medical University from July 2019 to April 2024. According to the different reconstruction methods, the patients were divided into the double tract reconstruction group (double tract; n=43) and oblique anastomosis of esophageal-gastric mucosal window with single flap valvuloplasty technique group (single flap n=22). The baseline data, surgical and postoperative recovery indicators, postoperative pathological results, gastroesophageal reflux at postoperative 6 months, and nutritional status at postoperative 1 year were compared between the two groups. Results:Comparisons of operative time, gastrointestinal reconstruction time, number of lymph nodes dissected, postoperative intestinal function recovery time, total protein, plasma albumin, hemoglobin, and lymphocyte count at 1 week postoperatively, prognostic nutritional index (PNI), time to normalization of postoperative white blood cell count and C-reactive protein, length of hospital stay, hospital costs, and incidence of postoperative pulmonary infection or anastomotic leakage between the two groups showed no statistically significant differences (all P>0.05). However, compared with the double tract group, the single muscle flap group had significantly higher intraoperative blood loss ( P<0.001), higher maximum postoperative body temperature ( P=0.004), and a significantly higher proportion of patients with pleural effusion ≥2 cm ( P=0.029).No statistically significant differences were observed between the two groups in terms of tumor length, length of esophageal involvement, Siewert classification, tumor differentiation degree, neural invasion, lymphovascular invasion, number of metastatic lymph nodes, tumor T stage and N stage, or UICC TNM staging for gastric cancer (all P>0.05). Nevertheless, the minimum distance of the lower resection margin in the double tract group was significantly longer than that in the single muscle flap group, with a statistically significant difference between the groups ( P<0.001). At 6 months postoperatively, results from the Quality of Life Questionnaire-Core 30 (QLQ-C30), Quality of Life Questionnaire-Stomach 22 (QLQ-ST022), Reflux Symptom Index scores, Visick grading, and gastroscopy (Los Angeles classification) all indicated that the incidence of reflux esophagitis in the double tract group was significantly lower than that in the single muscle flap group (all P<0.001). Gastrointestinal contrast examination showed no anastomotic stenosis in either group; gastroesophageal reflux occurred in 5 cases (11.6%) in the double tract group and 4 cases (18.2%) in the single muscle flap group, with no statistically significant difference (χ2=0.524, P=0.469). Gastroscopy results revealed that the incidence of reflux esophagitis at 6 months postoperatively was 9.3% (4/43) in the double tract group and 59.1% (13/22) in the single muscle flap group, with a statistically significant difference between the two groups (χ2=18.680, P<0.001).At 1 year postoperatively, the dual-chamber group showed better performance in body mass index(BMI), proportion of a decrease in BMI, plasma albumin, and PNI compared with the single muscle flap group, with statistically significant differences (all P<0.05). There were no statistically significant differences in hemoglobin or lymphocyte count between the two groups (all P>0.05). During 1 year of follow-up, one case of anastomotic recurrence occurred in each group, with no statistically significant difference between the groups ( P=0.624). Conclusions:Both proximal gastrectomy with double-tract anastomosis and esophagogastric mucosal window oblique anastomosis combined with single muscular flap valvuloplasty for digestive tract reconstruction are safe and feasible. However, double-tract anastomosis can better prevent the occurrence of postoperative reflux esophagitis, improve the patient's postoperative nutritional status, and enhance the patient's quality of life.

Objective:To explore the safety and long-term efficacy of transvaginal reconstructive pelvic surgery (TVRPS) in ≥70-year-old women with severe pelvic organ prolapse (POP).Methods:A single-center, prospective cohort study was conducted on 343 elderly women patients with severe POP who received TVRPS at the Fourth Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA from March 2007 to September 2024. There were 297 cases (86.6%, 297/343) of Ⅲ degree and 46 cases (13.4%, 46/343) of Ⅳ degree prolapse respectively. Among them, anterior pelvic prolapse accounted for 80.8% (277/343), and those with prolapse in two or more sites accounted for 30.0% (103/343). The age was (74.2±3.4) years (range: 70 to 89 years old). There were 300 cases (87.5%, 300/343) with more than one internal medicine disease. Preoperative general conditions were assessed using American Society of Anesthesiologists physical status classification system (ASA) and American College of Surgeons National Surgical Quality Improvement Program-frailty index (ACS NSQIP-FI). TVRPS surgeries included transvaginal hysterectomy, salpingooophorectomy, high uterosacral ligament suspension, sacrospinous ligament fixation, native tissue and mesh repair of the anterior and posterior vaginal walls, mid-urethral sling for anti-urinary incontinence, and levator anal muscle folding suture and perineal repair. Perioperative complications were evaluated using Clavien-Dindo classification system. The objective effect of TVRPS was determined based on pelvic organ prolapse quantification system (POP-Q), and the subjective results were evaluated using pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire-short form 7 (PFIQ-7) and patient global impression of improvement (PGI-I).Results:All patients had a preoperative ASA grade of ≤gradeⅡ, and ACS NSQIP-FI score of ≤0.27. All patients safely and successfully underwent all TVRPS surgeries. The operation time was (154.2±43.2) minutes. The perioperative morbidity and mortality rate were 0.6% (2/343) and 0 (0/343) respectively. None of the patient needed blood transfusion. The follow-up time was (7.5±4.3) years, with the longest being 17 years. Thirty-four cases (9.9%, 34/343) were lost to follow-up, and 22 cases (6.4%, 22/343) died of internal diseases during the follow-up period. The point values of Aa, Ba, C, Ap and Bp in the POP-Q system were significantly decreased after the operation (all P<0.01), the genital hiatus was significantly shortened (all P<0.01), and the perineal body was significantly elongated (all P<0.01). The scores of PFDI-20 and PFIQ-7 were significantly lower than those before the operation (all P<0.01). There were 332 cases (96.8%, 332/343) with an overall symptom impression improvement score of PGI-I≤2. Conclusion:The results on 343 elderly women with severe POP aged an average of 74.2 years show that for elderly POP patients who still have the desire to preserve the vagina and do not meet the conditions for colpocleisis, as long as there is a comprehensive understanding and strict evaluation of the overall condition before the operation, TVRPS is a safe, feasible and long-lasting therapeutic procedure.

This study investigated the prevalence and potential mechanisms of gentamicin heterore-sistance in Streptococcus isolates from dairy cows.In this study,A total of 39 Streptococcus isola-ted from raw milk were collected,and the minimum inhibitory concentration(MIC)of gentamicin and other drugs on the isolates was determined by micro broth dilution method,and the K-B paper diffusion method,colony analysis profile(PAP),and resistance stability test were used to investigate the heteroresistance characteristics of Streptococcus,and the mechanism of heteroresis-tance was analyzed based on whole genome sequencing and resequencing.Seven suspected heterore-sistance strains were identified by K-B paper diffusion method,accounting for 17.95％(7/39)of the total number of suspected strains.PAP confirmed that the MIC to MNIC ratio of L147,L108 and L174 was greater than 8,and the frequency of resistant subgroups ranged from 1.38×10-5 to 8.18 × 10-5,which was greater than 1 × 10-7,confirming that they were heteroresistance strains.Resistance stability tests revealed that the resistant subpopulations of all three strains were not stably inherited.Whole-genome sequencing revealed mutations in the ribosomal target genes of aminoglycoside antibiotics,rsmA,rsmB and rsmE,compared with the reference genome,which may lead to heteroresistance to gentamicin in Streptococcus.The occurrence of heteroresistance of Streptococcus to gentamicin is high in dairy sources,so more attention should be paid to the occur-rence of heteroresistance when using gentamicin for clinical treatment.

Objective:To explore the latent trajectory class of perioperative pain catastrophizing in patients undergoing lumbar internal fixation surgery and analyze the influencing factors of these latent classes.Methods:A total of 180 patients who underwent lumbar internal fixation surgery at Xinxiang Central Hospital from January to December 2023 were selected using convenience sampling. The Pain Catastrophizing Scale (PCS) was used to assess pain catastrophizing at 1 day preoperatively and on postoperative days 3, 7, and 14. Latent Class Growth Modeling (LCGM) was employed to identify trajectory classes of pain catastrophizing, and Logistic regression analysis was used to examine their influencing factors.Results:A total of 177 patients completed the follow-up, with a follow-up rate of 98.33% (177/180) . The overall perioperative PCS score was (30.39±10.86) . PCS scores at 1 day preoperatively and on postoperative days 3, 7, and 14 were (37.63±6.23) , (33.27±6.00) , (28.55±9.02) , and (23.81±9.33) , respectively. The proportions of patients with PCS≥38 at the four times were 42.94% (76/177) , 23.16% (41/177) , 22.60% (40/177) , and 12.43% (22/177) , respectively. LCGM identified three latent trajectory classes of perioperative pain catastrophizing: "high-level declining group" (55.93%, 99/177) , "high-level fluctuating group" (28.81%, 51/177) , and "persistent high-level group" (15.25%, 27/177) . Logistic regression analysis showed that payment method, surgical duration, and preoperative PCS score were significant influencing factors of pain catastrophizing trajectory classes ( P<0.05) . Conclusions:Pain catastrophizing levels in patients undergoing lumbar internal fixation surgery peaked preoperatively. While most patients showed a declining trend postoperatively, a subset exhibited fluctuating or persistently high levels. Payment method, surgical duration, and preoperative pain catastrophizing levels significantly influenced the trajectory of pain catastrophizing, warranting attention from clinical nursing staff.