OBJECTIVE To investigate the effects and mechanisms of oliceridine fumarate （TRV130） in improving postoperative cognitive dysfunction （POCD） in elderly rats based on the Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB） pathway. METHODS Rats were randomly divided into the control group （normal saline）， the model group （normal saline）， the TRV130 group （2.8 mg/kg）， the TLR4/NF-κB pathway inhibitor （TAK-242） group （3 mg/kg）， the β -arrestin inhibitor （Barbadin） group （3 mg/kg）， and the traditional opioid drug （morphine） group （2.8 mg/kg）， with 15 rats in each group. Except for the control group， POCD models were established in all other groups. From the first day after surgery， drugs/normal saline were administered via caudal vein injection once daily for 3 consecutive days. After the last administration， the pathological damage of hippocampal tissue was observed； the cognitive function， serum inflammatory factor levels， hippocampal neurons apoptosis rate， and the expression of ionized calcium-binding adapter molecule 1 （Iba-1）， glial fibrillary acidic protein （GFAP）， and TLR4/NF-κB pathway-related mRNA and protein in hippocampal tissue were detected. RESULTS In the model group， the neurons in the CA1 region of the hippocampus were disordered and sparse， with decreased number， pyknotic and fragmented nuclei accompanied by inflammatory cell infiltration. Compared with the control group， the escape latency， serum levels of tumor necrosis factor α （TNF-α）， interleukin-6 （IL-6）， and IL-1β， hippocampal neurons apoptosis rate， average fluorescence intensities of Iba-1 and GFAP， mRNA expression levels of TLR4 and NF-κB p65， and their protein expression/phosphorylation levels in hippocampal tissue were significantly increased/elevated in the model group （ P ＜0.05）； the time spent in the target quadrant and the number of platform crossings were significantly shortened/decreased （ P ＜0.05）. Compared with the model group， the cognitive function， pathological， inflammatory， and apoptosis-related indicators were significantly improved in the TRV130 group， TAK-242 group， and Barbadin group （ P ＜0.05）； the mRNA expression levels of TLR4 and NF-κB p65 and their protein expression/phosphorylation levels were significantly decreased in the TRV130 group and TAK-242 group （ P ＜0.05）. CONCLUSIONS TRV130 may improve POCD in elderly rats by inhibiting the TLR4/NF-κB pathway and alleviating postoperative central nervous system inflammatory responses.

Objective: To investigate the status and influencing factors of influenza vaccination among the elderly, so as to provide insights into improving the strategies for influenza vaccination among the elderly. Methods: Elderly people aged 60 years and above were recruited from one community each in five sub-districts of Shihezi City, Xinjiang Uygur Autonomous Region using a random sampling method. Demographic information, knowledge about influenza and influenza vaccines, vaccine literacy and influenza vaccination status in the past year were collected through questionnaire surveys. Factors affecting influenza vaccination among the elderly were analyzed using a multivariable logistic regression model. Results: Totally 1 121 valid questionnaires were recovered, with an effective recovery rate of 95.08%. There were 417 males (37.20%) and 704 females (62.80%). The majority were aged 60-<81 years, accounting for 80.37% (901 individuals). The awareness of knowledge about influenza and influenza vaccines was 78.86%. Low vaccine literacy was observed in 786 individuals, representing 70.12%. The influenza vaccination rate was 20.96%. Multivariable logistic regression analysis showed that age (71-<81 years, OR=1.607, 95%CI: 1.041-2.479; ≥81 years, OR=1.719, 95%CI: 1.040-2.842), educational level (middle school/technical secondary school, OR=0.616, 95%CI: 0.416-0.911), medical expense payment (employee medical insurance, OR=6.531, 95%CI: 2.030-21.010; resident medical insurance, OR=3.385, 95%CI: 1.095-10.466; public expense, OR=4.828, 95%CI: 1.700-13.712), vaccination willingness (yes, OR=6.237, 95%CI: 3.277-11.871), influenza vaccination history (yes, OR=14.600, 95%CI: 8.733-24.408) and vaccine literacy (medium and above, OR=2.412, 95%CI: 1.636-3.555) were associated with influenza vaccination among the elderly. Conclusion The influenza vaccination rate among the elderly was relatively low, and was mainly affected by age, educational level, medical expense payment, vaccination willingness, influenza vaccination history and vaccine literacy.

Psoriasis is a common chronic inflammatory systemic disease in dermatology. Its high prevalence， recurrence rate， and numerous comorbidities impose a significant physical and mental burden on patients. With the continuous advancement of modern medicine， the emergence of biological agents has improved clinical efficacy， making it possible to overcome psoriasis， in addition to classical treatments. However， in clinical practice， adverse reactions， drug resistance， recurrence rates， and immune drift cannot be ignored. Traditional Chinese medicine （TCM） has a history of thousands of years in treating psoriasis， demonstrating good efficacy， high safety， and a low recurrence rate， but a standardized management system is lacking. Therefore， the 25^th Clinical Diseases Responding Specially to TCM Treatment Series （Psoriasis） Youth Salon， hosted by the Chinese Association of Chinese Medicine and organized by the Youth Committee of the Chinese Association of Chinese Medicine， invited 29 experts and scholars from TCM， Western medicine， and interdisciplinary fields to actively discuss the "Advantages， Challenges， and Clinical Transformation of TCM and Western Medicine in the Diagnosis and Treatment of Psoriasis". The experts at the meeting concluded that the advantages of TCM in the treatment of psoriasis are as follows. Firstly， in the TCM-led treatment plan， TCM's understanding of psoriasis follows the principle of combining the differentiation of disease and syndrome. This approach distinguishes the basic contradiction from the current main contradiction and enables a clear grasp of the dynamic process of psoriasis development. Based on the system of syndrome differentiation and treatment， TCM intervention is applied to address the current main contradiction， and the optimal TCM treatment plan is formulated by combining internal and external treatments. Adhering to the principle of "what is visible outside must be addressed inside"， TCM can prevent and treat psoriasis comorbidities early by differentiating syndrome types. Secondly， in the integrated TCM and Western medicine treatment plan， the combination of both methods not only enhances efficacy but also reduces the adverse reactions of immunosuppressants and biological agents， lowering the recurrence rate. This conference provides a reference for the diagnosis and treatment of psoriasis using TCM and integrated TCM and Western medicine， opening up new ideas for clinical and basic research and guiding future research directions.

Objective To investigate the role of additional platelet protein kinase C epsilon(PKCε)assay in risk stratification and additional diagnostic testing in elderly patients with acute chest pain and normal hypersensitive cardiac troponin I(hs-cTnI)level.Methods A prospective trial was conducted on 220 consecutive elderly patients with angina-like acute chest pain and normal hs-cTnI level in our hospital from April 2022 to April 2023.According to whether major adverse cardiovascular events(MACE)occurred during the 1-year follow-up period,they were assigned in-to MACE group(24 cases)and non-MACE group(196 cases).Their general clinical data and platelet PKCε expression were compared between the two groups.Kaplan-Meier survival curve was plotted to analyzed the event-free time between the platelet PKCε expression＜2.05％group and the≥2.05％group.Multivariate Cox regression analysis was used to investigate the impact of baseline data on the occurrence of MACE during the 1-year follow-up period.Decision tree model was employed to analyze the influencing factors for MACE.Results During 1-year follow-up,24 patients(10.91％)developed MACE.The platelet PKCε expression was significantly higher in the MACE group than the non-MACE group[9.25％(6.60％,15.25％)vs 1.70％(0.80％,3.25％),Z=-7.596,P＜0.01].Kaplan-Meier survival curve analysis showed that the patients in the PKCε＜2.05％group had no events within 360 d,while those in the ≥2.05％group had an average event-free time of 297.13±12.77 d,with a statistical difference(log rank Chi-square=27.051,P=0.000).Multivariate Cox regression analysis showed that highly suspicious angina,hs-cTnI and platelet PKCε were independent risk factors for MACE within 1 year of follow-up(HR=3.011,95％CI:1.049-8.641,P=0.040;HR=1.216,95％CI:1.044-1.418,P=0.012;HR=1.160,95％CI:1.104-1.218,P=0.000).In the decision tree model,the 1-year incidence of MACE was notably higher in the platelet PKCε≥2.05％group than the＜2.05％group(P=0.011).The probability of severe coronary artery stenosis or myocardial ischemia in the platelet PKCε≥2.05％group was remarkably higher than the＜2.05％group(P=0.006).Conclusion In elderly patients suffering from acute chest pain with normal hs-cTnI level,additional platelet PKCε detection appears to have a good prognostic gain.

Guidelines for Digital Ancient Books of TCM Indexing(T/CIATCM 119-2024)is based on the theoretical knowledge,disciplinary methods,and practical applications of TCM classical cataloging.Taking digital ancient books of TCM as the object,it systematically reveals the content of TCM knowledge,which is an essential indexing processing standard for building an intelligent retrieval system for TCM ancient books,and can provide support for the deep development and innovative utilization of TCM knowledge.It can not only promote the co-construction and sharing of ancient book resources in the TCM industry,but also promote the standardization construction and application of TCM information.This standard specifies the principles,methods,and examples of free indexing of digital ancient books of TCM based on their original content.It is applicable to the indexing and processing of digital ancient books of TCM for TCM professional libraries and related institutions,and to the data processing and construction of various types of TCM ancient book databases.

Objective:To investigate the level of urinary serine protease(Corin) in early diabetic kidney disease(DKD) and its correlation with clinical stage.Methods:One hundred and seventy-three patients with type 2 diabetes mellitus(DM) from two tertiary A hospitals in Henan, diagnosed between April 2023 and December 2023 were selected as the research group, and 120 healthy subjects were selected as the control group. Basic clinical information and laboratory data were collected, and urinary Corin level was detected. DM patients were classified into G1-G5 stages based on estimated glomerular filtration rate(eGFR), and those in the early DKD stages(G1-G3) were further divided into A1-A3 subgroups based on urinary albumin/creatinine ratio(ACR). Spearman correlation analysis was performed to assess relationships between urinary Corin and other indicators, linear regression analysis identified factors influencing urinary Corin in early DKD patients, logistic regression analysis evaluated the risk factors for early DKD, and receiver operating characteristic(ROC) curve analysis determined the diagnostic value of urinary Corin in early DKD. Results:Urinary Corin levels were significantly higher in early DKD patients compared to healthy controls, with levels increasing as ACR rose( P<0.05). Urinary Corin was positively associated with serum creatinine( r=0.570), urea( r=0.458), cystatin C( r=0.693), ACR( r=0.616), urinary transferrin( r=0.448), urinary α1 microglobulin( r=0.507), urinary n-acetyl-β-D-glucosaminase( r=0.388) and A subgroup( r=0.692) while was negatively correlated with eGFR( r=-0.647), albumin( r=-0.312)(all P<0.05). eGFR was the only independent factor affecting urinary Corin. After adjusting for confounding factors in logistic regression analysis, urinary Corin was still an independent influencing factor for early DKD. ROC curve analysis indicated that urinary Corin had a diagnostic AUC of 0.842(95% CI 0.791-0.892, P<0.001), with a cut-off value of 2 226.04 pg/mL, sensitivity of 0.712, and specificity of 0.858 for early DKD diagnosis. Conclusions:Urinary Corin was elevated in early DKD patients and correlated with clinical stage. Urinary Corin is an independent factor of early DKD, and a reliable predictor of early DKD diagnosis.

Objective:To investigate whether intermittent fasting alleviates insulin resistance in a polycystic ovary syndrome(PCOS) mouse model through the regulation of autophagy.Methods:Fifty 3-week-old female C57BL/6J mice were randomly assigned into the following groups using a random number table: normal control(NC) group( n=10), maintained on a standard chow diet; high-fat diet(HFD) group( n=10) fed a diet with 60% of calories derived from fat; and PCOS model group( n=30), established by combining a HFD with dehydroepiandrosterone(DHEA) administration. Successful modeling was confirmed by disrupted estrous cycles, hyperandrogenism, and polycystic ovarian morphology. The PCOS model mice were further divided into three groups: PCOS group( n=9), PCOS with intermittent fasting group(PCOS+ IF, n=9), and PCOS with intermittent fasting plus the autophagy inhibitor 3-methyladenine(3-MA) group(PCOS+ IF+ 3-MA, n=9). Autophagy levels were assessed by detecting markers LC3 and p62 and observing autophagosomes via transmission electron microscopy. Glucose tolerance test(GTT) and insulin tolerance test(ITT) were performed, and the area under the curve(AUC) was calculated to evaluate insulin resistance. Western blotting was used to detect phosphorylation levels of phosphatidylinositol 3-kinase(PI3K), protein kinase B(Akt), mammalian target of rapamycin(mTOR), and p70S6 kiase(p70S6K). Results:Compared with the NC group, the PCOS model group showed absent estrous cycles, significantly elevated serum testosterone, sex hormone binding globulin, and luteinizing hormone(LH) levels( P<0.001), and polycystic ovarian changes on hematoxylin-eosin staining, confirming successful model establishment. Immunohistochemistry, transmission electron microscopy, and Western blotting demonstrated that autophagy levels were increased in the PCOS+ IF group compared with the PCOS group, while 3-MA administration reduced the intermittent fasting - induced autophagy. The AUC values for both GTT and ITT were significantly lower in the PCOS+ IF group than those in the PCOS group( P<0.001, P=0.003), but increased in the PCOS+ IF+ 3-MA group compared to the PCOS+ IF group( P<0.001, P=0.020). Western blotting analysis showed that phosphorylation levels of PI3K, Akt, mTOR, and p70S6K were significantly decreased in the PCOS+ IF group compared with the PCOS group( P=0.002, P=0.001, P=0.001, and P<0.001, respectively), and increased in the PCOS+ IF+ 3-MA group compared with the PCOS+ IF group( P=0.021, P=0.041, P=0.047, and P=0.024, respectively). Conclusions:Intermittent fasting alleviates insulin resistance in a PCOS mouse model through inhibitiing PI3K/Akt/mTOR signaling pathway and promoting autophagy.

IgA nephropathy (IgAN) is a glomerulonephritis characterized by diffuse deposition of immune complexes mainly composed of IgA in the mesangial area of the glomerulus. However, some patients show monotypic IgA deposits in the immunofluorescence examination, and its clinicopathological significance is not yet clear. The renal pathological changes of IgAN with monotypic IgA deposition are similar to those of proliferative glomerulonephritis with monoclonal IgA deposit (IgA-PGNMID), which has a risk of progressing to hematological malignancies and a worse clinical prognosis. It is necessary to differentiate them based on clinical pathological manifestations and hematological examinations. Based on previous literature reports and the research results of our research group, this review summarizes and analyzes the mechanism, clinical and pathological characteristics, and prognosis of IgAN with monotypic IgA deposition, and the relationship between IgAN with monotypic IgA deposition and IgA-PGNMID, to improve clinical doctors' understanding of IgAN with monotypic IgA deposition, reduce missed diagnosis and misdiagnosis, and improve patients' prognosis.

Objective To investigate the effect of obstructive sleep apnea syndrome(OSAS)on nocturnal ambulatory blood pressure monitoring results in older adults without cardiovascular or cerebrovascular diseases,and to identify factors causing fluctuations in nocturnal blood pressure in older adults with OSAS.Methods A total of 169 older adult OSAS patients with no history of cardiovascular or cerebrovascular diseases were enrolled.According to their severity of OSAS,the participants were divided into 4 groups,including a normal OSAS group,a mild OSAS group,a moderate OSAS group,and a severe OSAS group.The baseline characteristics of the 4 groups were compared to identify differences.The relationship between polysomnography parameters and nocturnal ambulatory blood pressure monitoring results and the factors causing nocturnal blood pressure fluctuations in older adults with OSAS were further analyzed.Results The nocturnal blood pressure fluctuation(NBPF)index of the normal OSAS group,the mild OSAS group,the moderate OSAS group,and the severe OSAS group were 1.89±1.58,3.35±5.40,3.90±6.40,and 16.60±27.70,respectively,indicating that the NBPF index gradually increased with the increasing severity of OSAS(P＜0.05).According to findings from the partial correlation analysis,the NBPF index was positively correlated with apnea-hypopnea index(AHI),micro-awakening index(MAI),percentage of cumulative time with oxygen saturation under 90％in the total sleep time(TS90％),oxygen desaturation index(ODI),and the longest apnea time(LAT)(P＜0.05),and negatively correlated with the lowest oxygen saturation(LSpO2)and sleep quality index(SQI)(P＜0.05).The mean nocturnal systolic and diastolic blood pressures were positively correlated with AHI,ODI,and TS90％(P＜0.05).A multi-factor regression analysis showed that every time ODI increased by 1 unit,the NBPF index increased by 0.26 units(β=0.26;95％CI,0.03-0.50;P=0.030),and every time TS90％increased by 1 unit,the NBPF index increased by 26.78 units(β=26.78;95％CI,2.47-51.08;P=0.031).Conclusion In older adult OSAS patients without cardiovascular or cerebrovascular disease,fluctuations in blood pressure at night become more pronounced with increasing disease severity.ODI and TS90％are important factors that affect nocturnal blood pressure fluctuations.

Objective To evaluate the long-term effects of orthokeratology(ortho-k)lenses with different back optical zone diameters(BOZD)on the quality of vision in myopic children.Methods We conducted an exploratory analysis based on a prospective,randomized,double-blind clinical trial,focusing on the parameters related to visual quality.A total of 66 myopic children aged 8 to 12 years were enrolled and randomly assigned to either a 6-mm BOZD ortho-k lens group(the 6 mm group)or a 5-mm BOZD ortho-k lens group(the 5 mm group).The participants were followed up at baseline,and at 1 day,1 week,and 1,3,6,9,and 12 months after lens wearing.Visual quality measurements included uncorrected visual acuity(VA),best corrected VA,contrast sensitivity(CS),high-order aberrations(HOA),modulation transfer function(MTF),Strayer ratio(SR),and visual quality questionnaire.Results A total of 63 children(33 children in the 6 mm group and 30 children in the 5 mm group)completed the study.There were no significant differences in baseline data between the two groups(P>0.05).There were no significant differences in subjective uncorrected VA or best corrected VA between the two groups at any follow-up visit(P>0.05).After wearing the lenses for 3 months,the CS at high spatial frequency(18 cpd)in the 5 mm group was lower than that in the 6 mm group(P=0.015).However,at 12 months,no significant differences in the CS were found between the two groups(P>0.05).The ocular and corneal total HOA,spherical aberration,and coma aberration in both groups increased after wearing the lenses,and the HOA in the 5 mm group was higher than that in the 6 mm group(all P<0.05).After wearing the lenses for 3 months,the MTF and SR values in the 5 mm group were lower than those in the 6 mm group(P<0.05).At 12 months,there was no significant difference between the two groups(P>0.05).The vision-quality-related questionnaire scores showed no significant differences between the two groups(P>0.05).Conclusion In myopic children,wearing ortho-k lenses with different BOZD results in improved subjective satisfaction,with no difference in subjective visual quality.However,objective visual quality declined in both groups,with a greater impact observed in the 5 mm group.