Objective: To investigate the influencing factors for vaccination willingness of herpes zoster vaccine (HZV) among the elderly, so as to provide the basis for improving the HZV vaccination strategy for the elderly. Methods: From July 2023 to June 2024, permanent residents aged ≥60 years in Yangzhou City, Jiangsu Province were selected using the multistage random sampling method and probability proportionate to size sampling method. Basic information, disease history, awareness of herpes zoster (HZ) and HZV, vaccination history, and vaccination willingness of HZV were collected through questionnaire surveys. Multivariable logistic regression model was used to analyze the influencing factors for vaccination willingness of HZV among the elderly. Results: Totally 1 209 valid questionnaires were recovered, with an effective recovery rate of 95.95%. The respondents included 657 males (54.34%) and 552 females (45.66%). Among them, 626 (51.78%) individuals were aged 60 -<70 years. There were 113 individuals had vaccination willingness of HZV, with a vaccination willingness rate of 9.35%. The multivariable logistic regression analysis showed that female (OR=2.872, 95%CI: 1.624-5.080), urban (OR=4.909, 95%CI: 2.732-8.818), individual monthly income of 1 000-<2 000 yuan (OR=3.085, 95%CI: 1.602-5.940), accessibility of vaccination clinics (OR=5.717, 95%CI: 1.109-29.462), presence of chronic diseases (OR=2.423, 95%CI: 1.325-4.431), history of varicella infection (OR=2.114, 95%CI: 1.213-3.684), awareness of HZ (OR=2.194, 95%CI: 1.096-4.394), awareness of HZV (OR=3.562, 95%CI: 2.005-6.330), history of influenza vaccine vaccination (OR=7.833, 95%CI: 4.189-14.645), and history of 23-valent pneumococcal vaccine vaccination (OR=2.955, 95%CI: 1.603-5.449) were promoting factors for vaccination willingness of HZV. Conclusion The vaccination willingness rate of HZV among the elderly is relatively low, which is mainly affected by factors such as gender, residence, individual monthly income, accessibility of vaccination clinics, presence of chronic diseases, history of varicella infection, awareness of HZ and HZV, and history of influenza vaccine and 23-valent pneumococcal vaccine vaccination.

Objective:To compare the clinical efficacy of radiofrequency ablation and liver resection in the treatment of gastrointestinal stromal tumor liver metastasis.Methods:A retrospective cohort study was conducted, collecting medical records of 46 patients with gastrointestinal stromal tumor liver metastasis treated at the First Medical Center of the Chinese People′s Liberation Army General Hospital from January 2018 to December 2022. Patients were divided into radiofrequency ablation group ( n=20) and liver resection group ( n=26) based on the treatment method. Short-term efficacy and long-term prognosis between the two groups were compared. Short-term efficacy was evaluated based on intraoperative bleeding volume, operative time, hospital stay, hospitalization costs, while long-term efficacy was assessed by progression-free survival and overall survival. Normally distributed measurement data were expressed as mean±standard deviation ( ± s) and compared using the t-test. Non-normally distributed measurement data were expressed as M( Q1, Q3) and compared using the Wilcoxon rank-sum test. Count data were expressed as frequency (%) and compared using the chi-square test. The long-term prognosis of patients in both groups was compared using the Kaplan-Meier curve. Results:The intraoperative blood loss, operative time, postoperative hospital stay, and hospitalization costs for the radiofrequency ablation group were 5 (3, 5) mL, 60 (55, 60) min, 4.0 (3.0, 4.0) d, and 4.6 (3.8, 5.3) ten thousand yuan, respectively; for the liver resection group, these were 100 (50, 275) mL, 180 (155, 215) min, 7.0 (4.5, 9.5) d, and 8.6 (6.1, 10.8) ten thousand yuan, respectively, with statistically significant differences between the two groups( P<0.05). The median progression-free survival for the liver resection group was 37 months, with 1 and 3-year progression-free survival rates of 96% and 50%, respectively. For the radiofrequency ablation group, the median progression-free survival was 20.5 months, with 1 and 3-year progression-free survival rates of 65% and 20%, respectively, showing statistically significant differences between the two groups ( P<0.05). The 1, 3, and 5-year overall survival rates for the liver resection group were 100%, 100%, and 78.3%, respectively, while for the radiofrequency ablation group, they were 100%, 100%, and 82.2%, respectively, with no statistically significant difference ( P>0.05). Conclusions:Both liver resection and radiofrequency ablation can be considered as treatment options for gastrointestinal stromal tumor liver metastasis, with comparable long-term efficacy. Liver resection has a clear advantage in terms of local tumor control compared to radiofrequency ablation, which has the advantages of fewer complications, faster recovery, and shorter hospital stay.

Objective:To investigate the impact of proximal versus total gastrectomy on survival outcomes in patients with advanced upper gastric cancer following neoadjuvant therapy, aiming to provide evidence-based guidance for optimal surgical approach selection.Methods:A retrospective cohort study was conducted to collect clinical data from 114 patients with upper gastric cancer who underwent surgical treatment after neoadjuvant therapy in the PLA General Hospital between November 2014 and November 2023, consisting of 96 males and 18 females, with an age range of 41 to 78 years and a median age of 64 years. According to the extent of surgical resection, 44 patients underwent proximal gastrectomy (PG), and 70 patients underwent total gastrectomy (TG). Propensity score matching was used to match patients with advanced upper gastric cancer who received proximal gastrectomy or total gastrectomy after neoadjuvant therapy based on factors such as gender, age, surgical approach, BMI, ypT stage, ypN stage, tumor size, R0 resection status, neoadjuvant therapy cycles, and neoadjuvant therapy regimen, with a 1∶1 matching ratio. In the end, 44 patients in the PG group and 44 patients in the TG group were successfully matched and analyzed. The primary outcomes were overall survival (OS) and disease-free survival (DFS), while secondary outcomes included operative duration, R0 resection rate, complication rate, total number of lymph nodes dissected, number of lymph nodes dissected in each group, and lymph node metastasis rate. Data analysis was performed using SPSS 25.0, and survival curves were generated using the Kaplan-Meier (K-M) method.Results:After propensity score matching, the operative time in the TG group was significantly longer than that in the PG group [(222.0±42.5) min vs (257.0±62.0) min, χ2=3.07, P=0.003], while the differences in other baseline characteristics between the two groups were not statistically significant ( P>0.05). In terms of postoperative complications, the incidence of Clavien-Dindo grade II or higher complications was 29.5% in the PG group and 34.1% in the TG group ( P=0.819), indicating no significant difference. The 5-year overall survival (OS) rates were 55.8% for the PG group and 49.5% for the TG group ( P=0.592), showing no statistically significant difference. Lymph node metastasis rates in the TG group were 5.71% (4/70) in group 4d, 4.29% (3/70) in group 5, 2.86% (2/70) in group 6, and 2.86% (2/70) in group 12a. Conclusions:For patients with advanced upper gastric cancer who undergo proximal gastrectomy or total gastrectomy following neoadjuvant therapy, there is no significant difference in perioperative complications and long-term survival rates. Therefore, proximal gastrectomy is a safe and reliable option for these patients, allowing partial preservation of gastric function and potentially improving quality of life.

Sepsis-associated encephalopathy (SAE) is the most common neurological complication of sepsis, with an incidence of up to 70% in sepsis, and contributes to the increased mortality and disability in sepsis. To date, the exact pathogenesis of SAE is not clear. Most of current researches indicated that blood-brain barrier (BBB) dysfunction, active neuroinflammation, glial cell over activation as well as cerebral microcirculation dysfunction contributed to the pathophysiology of SAE. BBB, as a complex cellular structure between the central nervous system and the peripheral system, strictly controls the entrance and discharge of substances and plays an important role in maintaining the balance between biochemical system and immune system of central system. During the progress of sepsis, inflammatory cytokines and reactive oxygen species resulting from peripheral system directly or indirectly resulted in the damage to the integrity and structure of BBB, which helped above species easily enter into the central system. Above these damages caused glial cell activation (microglia and astrocyte), the imbalance of neurotransmitters, mitochondrial dysfunction and neural apoptosis, which also reversely contributed to the damage to the integrity and permeability of BBB via decreasing the expression of tight junctional protein between cells. Therefore, this review focuses on the structural and functional changes of BBB in SAE, and how these changes lead to the development of SAE, in order to seek a BBB-targeted therapy for SAE.

Objective:To investigate the role of GABAergic neurons in the bed nucleus of the stria terminalis (BNST) in isoflurane-induced general anesthesia-emergence in mice.Methods:Twenty-three healthy male Vgat-Cre transgenic mice, aged 8-10 weeks, weighing 22 g, were used in the study. In the immunofluorescence staining experiment, 8 mice were selected and divided into 2 groups ( n=4 each) using a random number table method: oxygen group and isoflurane group. Oxygen group inhaled oxygen at a rate of 1.0 L/min for 2 h, while isoflurane group inhaled 1.4% isoflurane + 1.0 L/min oxygen for 2 h. The animals were then sacrificed, and brain tissues were removed and subjected to immunofluorescence staining for determination of the expression of c-Fos and the rate of co-labeling with GABA neurons. For the optogenetic experiment, 15 mice were divided into 3 groups ( n=5 each) using a random number table method: control group (CON group), optogenetic excitation group (CHR2 group) and optogenetic inhibition group (eNpHR group). The rAAV-Ef1a-DIO-mCherry, rAAV-Ef1a-DIO-CHR2-mCherry, and rAAV-Ef1a-DIO-eNpHR3.0-mCherry viruses were injected to the BNST brain region. After 3 weeks of virus expression, the mice were exposed to 1.0% isoflurane + 1.0 L/min oxygen, and their cortical EEG was simultaneously monitored. When the mice reached a stable anesthetic state, optogenetic methods were utilized to modulate the viability of GABAergic neurons in the BNST brain region, and the burst suppression ratio (BSR) of the cortical EEG was recorded at 2 min before light stimulation and 2 min of light stimulation. Results:Compared with oxygen group, the rate of c-Fos co-labeling with GABA neurons in the BNST brain region was significantly reduced ( P<0.05), and the c-Fos-positive neurons were reduced in isoflurane group. Compared with CON group or with the prestimulation level, BSR was significantly decreased in CHR2 group ( P<0.001), and no significant change was found in BSR during light stimulation in eNpHR group ( P>0.05). Conclusions:Decreased viability of GABAergic neurons in the BNST brain region may be involved in the process of loss of consciousness in isoflurane-anesthetized mice, while increased viability of GABAergic neurons in the BNST brain region promotes the transition from anesthesia to emergence.

Objective To explore the injury types and characteristics of children hospitalization with accidental injuries in a tertiary general hospital in Guangdong Province,and to provide important data evidences for reducing accidental injuries in children.Methods Children hospitalization of accidence in 2019-2021 from a tertiary general hospital were analyzed.The X2 test analysis was used for comparing different years,sources of patients and age difference between accident types.Results 1 561 children were hospitalized due to accidental injuries.The top three reasons were falling,traffic accidents and external inju-ries.There are significant differences among age groups and types of accident harm(x2=186.606,P＜0.001),and significant differences among different damage rate of surgery(x2=45.017,P＜0.001).The children who underwent surgery after injury were most likely to fall(72.3％).The accidental injuries occurred at home accounted for 88.8％,and therein the upper limb injuries were the main injuries(67.8％).Conclusion Accidental injuries in children's hospitalization are mainly caused by falls,traffic accidents,and external injuries.Targeted prevention should be carried out according to the types of injuries in differ-ent age groups,especially falls,which are the most harmful types of injuries in terms of incidence rate and surgical rate.There-fore,prevention and control should be emphasized.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Bladder cancer （BCa） is the most common malignant tumor of the urinary system， and its incidence is increasing year by year. At present， for all patients with resectable non-metastatic muscle-invasive BCa， radical cystectomy + bilateral pelvic lymph node dissection is strongly recommended， but they still face the risk of recurrence， metastasis and death. In recent years， the proportion of patients with advanced and metastatic BCa is increasing among patients with newly diagnosed BCa. Although current treatment models are diverse， they often struggle to achieve significant efficacy due to their low effectiveness and adverse effects， resulting in low survival rates for patients with advanced and metastatic BCa. Therefore， the treatment of BCa still faces great challenges， and there is an urgent need to discover an effective new antitumor drug. With the improvement of medical standards， traditional Chinese medicine has shown great advantages in the treatment of BCa. Traditional Chinese medicine is mild and easy to accept， and can inhibit tumor progression through a multi-pathway， multi-way and multi-target manner， so as to exert its anticancer effect. Taraxaci Herba is a medicinal and food homologous plant， which has many biological activities， such as antibacterial， anti-inflammatory， anti-oxidation， anti-tumor， protecting liver and gallbladder， reducing blood sugar and enhancing immunity， and it has shown a clear anticancer effect in breast cancer， liver cancer， gastric cancer， tongue cancer and lung cancer. By reviewing previous studies worldwide， this article summarizes the mechanism of Taraxaci Herba extract in inducing autophagy and apoptosis， inhibiting cell migration and invasion， regulating cell cycle and proliferation， regulating cell metabolism， inhibiting tumor angiogenesis， combining the effects of chemotherapeutic drugs， and regulating the transduction of related signal pathways. On this basis， this study systematically elaborates on the potential mechanism of Taraxaci Herba against BCa， in order to provide a theoretical basis for the research and treatment of BCa.

BACKGROUND:Growth differentiation factor 5 is a member of the transforming growth factor superfamily and one of the earliest markers of joint development.Growth differentiation factor 5 has an important role in cartilage repair. OBJECTIVE:To explore the action mechanism of growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells. METHODS:Rabbit bone marrow mesenchymal stem cells were isolated and cultured.CCK-8 assay was used to detect the effect of different mass concentrations of growth differentiation factor 5 on the proliferation activity of bone marrow mesenchymal stem cells.RT-PCR was utilized to detect the expression of genes related to chondrogenic differentiation of bone marrow mesenchymal stem cells induced by different mass concentrations of growth differentiation factor 5.To further investigate the action mechanism of growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells,we added inhibitor XAV-939 and activator Laduviglusib of Wnt/β-catenin signaling pathways to induce cell culture for 14 days.RT-PCR and western blot assay were performed to detect the expression of cartilage-related genes and Wnt/β-catenin signaling pathway proteins. RESULTS AND CONCLUSION:(1)CCK-8 results showed no significant effect of growth differentiation factor 5 on the proliferation of bone marrow mesenchymal stem cells.(2)Growth differentiation factor 5 promoted the expression of cartilage-related genes type Ⅱ collagen,aggrecan and Sox9,among which growth differentiation factor 5 induced a significant upregulation of cartilage-related genes in the 50 ng/mL group.(3)Addition of Laduviglusib,an activator of Wnt/β-catenin signaling pathway,upregulated Sox9,β-catenin and type Ⅱ collagen expression(P<0.05).Addition of XAV939,an inhibitor of Wnt/β-catenin signaling pathway,down-regulated Sox9,β-catenin and type Ⅱ collagen expression(P<0.05).(4)Taken together,growth differentiation factor 5-induced chondrogenic differentiation of bone marrow mesenchymal stem cells may be associated with the activation of the Wnt/β-catenin signaling pathway.

BACKGROUND:Superior lower limb mobility is regarded as one of the prerequisites for winning competitions.Wearable resistance training can effectively overcome the deficiency in the transfer efficiency of traditional strength training in enhancing lower limb mobility.Considering that the impact of wearable resistance training based on different body parts on lower limb mobility may have significant differentiated characteristics,it is particularly important to review and summarize the specific application strategies and acute and chronic intervention effects. OBJECTIVE:To comb and analyze acute and chronic intervention effects of wearable resistance training based on different body parts on lower limb mobility,in order to provide insightful and methodological references for optimizing application strategies for lower limb movement ability. METHODS:A literature search was conducted in CNKI,Wanfang,VIP,Web of Science,Medline,SPORTDiscus,and PubMed databases for publications up to October 2023.Chinese and English search terms were"arm,forearm,limb,leg,lower extremity,vest,trunk,resist,weight,load,sprint,agility,change of direction".A total of 60 articles were ultimately included for review after screening the retrieval results. RESULTS AND CONCLUSION:(1)Trunk loading of 6-20%of body mass is suitable for optimizing acceleration in sprinting,while trunk loading of≤6%body mass is suitable for optimizing high-speed running.A trunk load of 5%body mass is applicable for optimizing change-of-direction movement;forearm,calf,or thigh loading often uses 1%or 2%body mass.(2)Trunk loading optimizes the functional performance of the lower limb stretch-shortening cycle by increasing vertical load.This enhances the efficiency of ground reaction force utilization and strengthens the coordinated stability control of the whole body musculature.Forearm loading effectively enhances the driving force of the upper limb swing,improves the propulsive force of the lower limb sprint,and optimizes the efficiency of inter-limb coordination.Calf loading can impose restrictions on the function of the hip joint,thereby leading to localized load stimulation and compensatory functional enhancement in the knee or ankle joint.Thigh loading partially restricts the peak extension angle and speed of the knee joint,creates specific load stimulation at the hip joint,and significantly improves its rotational kinetic energy output.(3)During larger-angle change-of-direction movements,the impact of calf loading is more significant than thigh loading.Thigh loading stimulation helps to enhance power output,while calf loading stimulation aids in improving stability control and directional change.(4)Currently,wearable resistance training has been proven to be an effective way to improve sprint and change-of-direction performance.The methodological strategies to improve sprint performance are relatively mature,but the optimal application scheme to improve change-of-direction performance needs to be further refined and optimized.Further research is recommended to supplement this area.