ObjectiveTo investigate the effect of Niuhuang Qingxinwan （NHQXW） in improving intracerebral hemorrhage （ICH） with Tanre Fushi （phlegm-heat and fu-organ excess） syndrome by maintaining blood-brain barrier （BBB） integrity， and to explore its potential mechanism. MethodsMale mice were administered with 15% autologous feces for 3 consecutive days to simulate spontaneous Tanre Fushi syndrome， followed by surgical induction of collagenase-induced ICH on the fourth day. Mice were randomly assigned to seven groups： Sham， Sham+NHQXW-H， collagenase， collagenase+feces， and NHQXW intervention groups at low （NHQXW-L， 0.225 g·kg^-1）， medium （NHQXW-M， 0.45 g·kg^-1）， and high （NHQXW-H， 0.9 g·kg^-1） doses. Treatments were administered for 3 days after surgery. NHQXW effects on Tanre Fushi syndrome were assessed via fecal water content and small intestinal carbon propulsion rate. Protective effects of NHQXW against ICH with Tanre Fushi syndrome were evaluated by measuring hematoma volume， neurological deficits， and brain water content. BBB integrity was further assessed using Evans blue staining， hematoxylin-eosin （HE） staining， immunofluorescence， and Western blot for Claudin-5， plasmalemma vesicle-associated protein （PLVAP）， matrix metalloproteinase （MMP）-2， and MMP-9. The potential mechanism of NHQXW was investigated by detecting protein expression of protein kinase B （Akt）， extracellular signal-regulated kinase 1/2 （ERK1/2）， signal transducer and activator of transcription 3 （STAT3）， Yes-associated protein （YAP）， and their phosphorylated forms. ResultsCompared with the collagenase+feces group， NHQXW-M and NHQXW-H significantly reduced fecal water content （P<0.05， P<0.01） and intestinal propulsion rate （P<0.01）， alleviated neurological deficits （P<0.01）， decreased hematoma volume （P<0.01） and Evans blue extravasation （P<0.01）， increased Claudin-5 protein expression （P<0.05， P<0.01） and fluorescence intensity （P<0.01）， and decreased PLVAP protein expression （P<0.01） and fluorescence intensity （P<0.05， P<0.01）， as well as MMP-2 （P<0.05， P<0.01） and MMP-9 （P<0.01） expression. NHQXW-H downregulated p-Akt （P<0.05）， p-ERK1/2 （P<0.05）， p-STAT3 （P<0.01）， and p-YAP （P<0.05）， with the most significant effect observed on STAT3 phosphorylation. ConclusionNHQXW effectively alleviates neurological deficits and BBB injury in ICH mice with Tanre Fushi syndrome， primarily by inhibiting STAT3 activation.

Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) are linked to numerous chronic conditions, including cardiovascular disease, atherosclerosis, chronic kidney disease, and type II diabetes. Previous research identified the natural flavonoid diosmin, derived from Chrysanthemum morifolium, as a regulator of glucose metabolism. However, its effects on lipid metabolism and underlying mechanisms remained unexplored. The AMP-activated protein kinase (AMPK) pathway serves a critical function in glucose and lipid metabolism. The relationship between diosmin and the AMPK pathway has not been previously documented. This investigation examined diosmin's capacity to reduce lipid content through AMPK pathway activation in hepatoblastoma cell line G2 (HepG2) and 3T3-L1 cells. The study revealed that diosmin inhibits lipogenesis, indicating its potential as an anti-obesity agent in obese mice. Moreover, diosmin demonstrated effective MASLD alleviation in vivo. These findings suggest that diosmin may represent a promising therapeutic candidate for treating obesity and MASLD.
Diosmin/administration & dosage* ; Animals ; AMP-Activated Protein Kinases/genetics* ; Humans ; Non-alcoholic Fatty Liver Disease/enzymology* ; Mice ; Obesity/enzymology* ; Hep G2 Cells ; Male ; 3T3-L1 Cells ; Mice, Inbred C57BL ; Signal Transduction/drug effects* ; Lipid Metabolism/drug effects* ; Chrysanthemum/chemistry* ; Lipogenesis/drug effects*

Objective:To construct a risk prediction model for radiation dermatitis in the perineum of cervical cancer patients undergoing radiotherapy, and verify the predictive effect of the model, so as to provide theoretical basis for reducing the risk of perineal radiation dermatitis in clinical practice.Methods:A prospective study design was used to conveniently select 247 cervical cancer patients who received radiotherapy at Tianjin Medical University Cancer Institute & Hospital from January 2022 to March 2023 as the modeling group. They were divided into a group with perineal radiodermatitis ( n = 130) and a group without perineal radiodermatitis ( n = 117). The data of the two groups were compared, and a risk prediction model was constructed based on the results of logistic regression analysis. Used the area under the receiver operating characteristic (ROC) curve to test the predictive performance of the model. From May to November 2023, 109 patients were selected as the validation group to conduct external validation of the model. Results:Among the 247 patients in the modeling group, the age of the group with perineal radiodermatitis was (45.31 ± 7.25) years old, and the age of the group without perineal radiodermatitis was (46.70 ± 6.43) years old. The incidence of perineal radiation dermatitis during radiotherapy in the modeling group was 52.6% (130/247), while in the validation group it was 44.0% (48/109). The final predictive variables included in the model were high blood sugar or not ( OR = 0.304, 95% CI 0.174-0.530), vaginal bleeding/discharge or not ( OR = 4.338, 95% CI 2.397-7.854), involvement of 1/3 of the vagina or not ( OR = 0.497, 95% CI 0.281-0.879), whether topical skin protectants could be used( OR = 3.479, 95% CI 1.596-7.583), whether skin protectants could be used in a standardized manner ( OR = 2.399, 95% CI 1.201-4.789), whether the skin could be cleaned with the correct cleaning agent ( OR = 3.155, 95% CI 1.603-6.209), and whether the skin could be wiped with the correct method ( OR = 3.325, 95% CI 1.806-6.121), totaling 7 predictive factors (all P<0.05). The area under the ROC curve of the prediction model was 0.866, the sensitivity was 0.735, and the specificity was 0.852, the Youden index was 0.587. Model validation results showed the area under the ROC curve was 0.762, the sensitivity was 0.815, the specificity was 0.717, and the accuracy was 80.73%, indicating good predictive performance. Conclusions:The predictive model constructed in this study had good predictive performance and could provide reference for clinical nursing staff to screen high-risk patients with perineal radiation dermatitis.

Objective:To construct a risk prediction model for radiation dermatitis in the perineum of cervical cancer patients undergoing radiotherapy, and verify the predictive effect of the model, so as to provide theoretical basis for reducing the risk of perineal radiation dermatitis in clinical practice.Methods:A prospective study design was used to conveniently select 247 cervical cancer patients who received radiotherapy at Tianjin Medical University Cancer Institute & Hospital from January 2022 to March 2023 as the modeling group. They were divided into a group with perineal radiodermatitis ( n = 130) and a group without perineal radiodermatitis ( n = 117). The data of the two groups were compared, and a risk prediction model was constructed based on the results of logistic regression analysis. Used the area under the receiver operating characteristic (ROC) curve to test the predictive performance of the model. From May to November 2023, 109 patients were selected as the validation group to conduct external validation of the model. Results:Among the 247 patients in the modeling group, the age of the group with perineal radiodermatitis was (45.31 ± 7.25) years old, and the age of the group without perineal radiodermatitis was (46.70 ± 6.43) years old. The incidence of perineal radiation dermatitis during radiotherapy in the modeling group was 52.6% (130/247), while in the validation group it was 44.0% (48/109). The final predictive variables included in the model were high blood sugar or not ( OR = 0.304, 95% CI 0.174-0.530), vaginal bleeding/discharge or not ( OR = 4.338, 95% CI 2.397-7.854), involvement of 1/3 of the vagina or not ( OR = 0.497, 95% CI 0.281-0.879), whether topical skin protectants could be used( OR = 3.479, 95% CI 1.596-7.583), whether skin protectants could be used in a standardized manner ( OR = 2.399, 95% CI 1.201-4.789), whether the skin could be cleaned with the correct cleaning agent ( OR = 3.155, 95% CI 1.603-6.209), and whether the skin could be wiped with the correct method ( OR = 3.325, 95% CI 1.806-6.121), totaling 7 predictive factors (all P<0.05). The area under the ROC curve of the prediction model was 0.866, the sensitivity was 0.735, and the specificity was 0.852, the Youden index was 0.587. Model validation results showed the area under the ROC curve was 0.762, the sensitivity was 0.815, the specificity was 0.717, and the accuracy was 80.73%, indicating good predictive performance. Conclusions:The predictive model constructed in this study had good predictive performance and could provide reference for clinical nursing staff to screen high-risk patients with perineal radiation dermatitis.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.

Implantable collamer lenses (ICL) implantation provides a new method for the treatment of children with high myopia, anisometropia and amblyopia, who may be spectacle aversive and unsuited to contact lens wear and corneal refractive surgery.Surgery can improve children's uncorrected visual acuity, increase contrast sensitivity, promote mental health and improve quality of life.This treatment has a significant effect on amblyopia.After ICL implantation, the refractive state is highly stable, and the stability is better than small incision lenticule extraction and laser subepithelial keratomileusis.The selection of ICL size and power is critical to the success of surgery, and preoperative prediction of vault should be made in consideration of children's eye development.Perioperative anesthesia, incision method as well as type, amount and duration of postoperative medication are different from those of adults.Furthermore, common postoperative complications in children include pupillary block glaucoma, elevation of intraocular pressure, loss of corneal endothelial cells, wound leak, and traumatic dislocation of the ICL.Implantation of ICL in children is a staged treatment during the sensitive period of refractive development.After the refractive development of both eyes is stabilized, refractive errors can be corrected by other methods.This article reviews the advantages of ICL implantation in the treatment of children with high myopia and amblyopia, and focuses on ICL selection, postoperative complications and remaining problems, to provide a reference for clinical application.

Objective To explore root cause of poor prognosis after successful endovascular treatment(EVT)in patients with acute ischemic stroke with large vascular occlusion(AIS-LVO)of anterior circulation.Methods Patients with AIS-LOV of anterior circulation who received successful EVT(postoperative modified thrombolysis incerebral infarction[mTICI]grade≥2b)were retrospectively and continuously collected in the Department of Neurology of Bozhou People's Hospital from January 2022 to March 2024.The baseline and clinical data of the patients were collected,including gender,age,vascular risk factors(hypertension,diabetes,coronary heart disease,hyperlipidemia,valvular heart disease,atrial fibrillation,smoking,and alcohol consumption),prior stroke or transient ischemic attack,baseline blood pressure,baseline National Institutes of Health Stroke scale(NIHSS)score,laboratory test indicators(pre-operative C-reactive protein and D-dimer,post-operative fasting blood glucose,lipid levels,homocysteine,etc).Meanwhile,the data of perioperative indicators was collected,including the time from onset to admission,the time from admission to puncture,the time from puncture to revascularization,the time from onset to puncture,the time from onset to revascularization,remedial measures(balloon dilation,stent placement,arterial thrombolysis)during the surgery or not,using tirofiban or not,postoperative complications(stroke-related pneumonia,stress ulcers,deep vein thrombosis,acute heart failure or renal failure,etc)or not.The patient's medical history and imaging data were collected,and these indicators were defined and collected,including Alberta stroke program early CT score(ASPECTS),location of occlusion(C1 segment of the internal carotid artery,C2 segment to C7 segment of the internal carotid artery,M1 segment of the middle cerebral artery),and the trial of org 10172 in acute stroke treatment(TOAST)classification and a postoperative transformation of cerebral infarction after ischemic stroke and symptomatic intracranial hemorrhage or not.According to the modified Rankin scale(mRS)score at 90 d after surgery,all patients were divided into poor prognosis group(mRS score≥ 3)and good prognosis group(mRS score≤2).The baseline and clinical data of two groups were compared using univariate analysis.Variables with P＜0.1 in the univariate analysis were selected as independent variables,and the poor prognosis was used as the dependent variable.Further,multivariate Logistic regression analysis was performed to identify the influencing factors of poor prognosis after EVT.Results Finally,a total of 192 patients with AIS-LVO of anterior circulation who received successful revascularization were included in this study.There were 101 male patients and 91 female patients.The poor prognosis group had 102 cases and the good prognosis group had 90 cases.Univariate analysis showed that the poor prognosis group had statistically significant differences with the good prognosis group in terms of age(Z=-3.088,P=0.002)and age distribution(x2=13.457,P=0.001),fasting blood glucose(Z=-3.347,P=0.001),baseline NIHSS score(Z=-4.469,P＜0.01),location of occlusion(x2=10.488,P=0.005),transformation of hemorrhage after ischemic stroke(x2=16.943,P＜0.01),and symptomatic intracranial hemorrhage(X2=25.449,P＜0.01),and the baseline ASPECTS of the poor prognosis group was significantly lower than that of the good prognosis group(Z=-4.547,P＜0.01).There were no significant differences in other baseline and clinical data(all P＞0.05).Further multivariate Logistic regression analysis showed that age＞80 years(OR,3.224,95％CI 1.033-10.058,P=0.044),baseline NIHSS score(OR,1.102,95％CI 1.013-1.199,P=0.023),baseline ASPECTS(OR,0.375,95％CI 0.212-0.665,P=0.001),and symptomatic intracranial hemorrhage(OR,7.127,95％CI 1.296-39.203,P=0.024)were independent influencing factors of poor prognosis.Conclusion The independent factors of 90 d poor prognosis after successful EVT in patients with AIS-LVO of anterior circulation are age＞80 years,baseline NIHSS score,baseline ASPECTS,and symptomatic intracranial hemorrhage.

BACKGROUND:Metal ions play an important role in the human body.With the progress of material synthesis and processing technology,a variety of metal ions that can be used in bone tissue engineering have been developed,such as magnesium(Mg2+),zinc(Zn2+),manganese(Mn2+),strontium(Sr2+),and copper(Cu2+). OBJECTIVE:To summarize the research progress and development direction of metal ions in bone tissue engineering. METHODS:The literature collected by CNKI,PubMed and WanFang databases from 2014 to 2022 was retrieved.The Chinese and English key words were"metal ions,bone tissue engineering,osteogenic activity,magnesium ions,zinc ions,manganese ions,strontium ions,copper ions,calcium ions,lithium ions,cobalt ions". RESULTS AND CONCLUSION:Different metal ions will be released to varying degrees after the materials are implanted into the body,which can change the tissue microenvironment,thus improving the ability of materials to form blood vessels and bones.Compared with growth factors,metal ions are easier to control the release rate,have lower cost,and can also improve the mechanical properties of implant materials.The application of metal ions in bone tissue engineering is full of prospects.Although some metal ions can already be used to treat bone defects,the mechanism of action of many metal ions in the human body is not completely clear,and the application effect is a lack of clinical experiment verification.Further exploration is needed before clinical application.

In recent years， the potential anti-tumor effects of metformin have attracted widespread attention in the field of cancer treatment. This article summarizes the research progress of metformin in the treatment of malignant tumors，finding its potential application in the treatment of malignant tumors in the digestive system （biliary tract cancer，gastric cancer，esophagus cancer，colorectal cancer，pancreatic cancer，liver cancer） and reproductive system （prostate cancer，ovarian cancer，breast cancer， cervical cancer），non-small cell lung cancer，renal cell carcinoma，and melanoma. Metformin can inhibit the proliferation of tumor cells and extend the overall survival of patients. Its mechanisms of action include，but are not limited to，inhibiting the activity of mitochondrial complex Ⅰ，activating adenosine monophosphate-activated protein kinase/p53 signaling pathway，and blocking the cell cycle. Additionally，the combined use of metformin with chemotherapy drugs has shown potential for reducing toxicity and enhancing efficacy. It can enhance the sensitivity of biliary tract cancer，ovarian cancer，and melanoma cells to chemotherapy drugs， improve the drug resistance of gastric and colorectal cancer cells to chemotherapy，and reduce the toxic reactions of breast cancer patients during chemotherapy. Metformin is also used as an immunomodulator，applied in the immunotherapy of patients with esophagus cancer，colorectal cancer，cervical cancer，non-small cell lung cancer，and melanoma.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.