Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Objective:To investigate the effects of melatonin(Mel)on inflammatory damage in the retina of rats with oxygen-induced retinopathy(OIR)and the molecular mechanisms.Methods:Healthy neonatal SD rats were di-vided into the sham group(Sham),the model group(OIR),and the melatonin treatment group(OIR+Mel).The OIR model was induced by alternating 50%/10%oxygen concentration exposure for 14 d.The OIR+Mel group was in-jected intraperitoneally with 10 mg-kg-1 melatonin.Hematoxylin-eosin(HE)staining was used to observe the morpho-logical changes in the retinal tissue;immunohistochemical staining was used to detect the expression of retinal cleaved-caspase-1 and IL-1β proteins;and immunofluorescence staining was used to detect the expression of cGAS-STING-NL-RP3 signaling molecules and gasdermin(GSDMD)in the microglia of the retina.Results:HE staining results showed that compared with the Sham group,the retinal cells in the OIR group were disorganized and the thickness of the inner retina was significantly thinner,and the retinal cells in the OIR+Mel group were more neatly arranged compared with those in the OIR group(P<0.05).Immunohistochemical staining results showed that the number of cleaved-caspase-1+and IL-1β+cells in the retina of rats in the OIR group increased significantly compared with that in the Sham group,and the number of cleaved-caspase-1+and IL-1β+cells in the retina of rats in the OIR+Mel group decreased signifi-cantly compared with that of the OIR group(P<0.05).Immunofluorescence staining results showed that the number of cGAS+,STING+and NLRP3+cells in the retina of rats in the OIR group increased significantly compared with that in the Sham group,and the number of cGAS+,STING+and NLRP3+cells in the retina of rats in the OIR+Mel group de-creased significantly compared with that in the OIR group(P<0.05);The number of Iba-1+/N-GSDMD+cells in-creased significantly in the OIR group compared with the Sham group,whereas the number of Iba-1+/N-GSDMD+cells in the OIR+Mel group was significantly less than that in the OIR group,but still more than that in the Sham group(P<0.05).Conclusion:Mel inhibits the pyroptosis of retinal microglia,thus attenuates retinal inflammatory injury in OIR rats,and its mechanism may be related to the cGAS-STING-NLRP3 signaling pathway.

Background and purpose:As one of the first-line treatment methods for differentiated thyroid cancer(DTC),131I treatment is an important therapeutic approach for most patients with medium-high recurrence risk DTC after total or near-total thyroidectomy.Risk stratification and real-time dynamic assessment before 131I treatment after surgery are important steps in deciding on 131I treatment,enabling individualized treatment.This retrospective study aimed to explore the role of diagnostic whole body scan(DxWBS)in the decision-making of treatment for DTC after surgery and before 131I therapy.Methods:DTC patients who underwent pre-ablation evaluation were included.Patients were divided into low,medium and high sTg groups based on their pre-131I treatment stimulated thyroglobulin(sTg)levels(＜1 ng/mL,1 ng/mL≤sTg＜10 ng/mL,sTg≥10 ng/mL).The concordance rates of DxWBS and post treatment whole body scan(RxWBS)in each patient of the whole cohort were compared.The lesion detection rate between DxWBS and RxWBS in different sTg level groups was also explored.The"thyroid stunning effect"by DxWBS was evaluated by RxWBS.Through these analyses,the role of DxWBS in 131I treatment decision-making and its predicting treatment objectives were assessed.This study was approved by the Ethics Committee of Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences(ethics number:JS-2151).Results:A total of 91 patients were included.The low,medium and high sTg groups accounted for 15.4%(14/91),34.1%(31/91)and 50.5%(46/91)of the patients,respectively.Comparison of DxWBS and RxWBS results in the same patients in each sTg group showed no evidence of a stunning effect on 131I treatment.The overall concordance rate between DxWBS and RxWBS was 89.0%(81/91);In different sTg level groups was 100.0%(14/14),90.3%(28/31),84.8%(39/46)respectively.Taking sTg levels into consideration,DxWBS accurately predicted the need for total thyroidectomy,with a 100%(20/20)agreement with RxWBS.Among the 71 patients who received adjuvant therapy and/or remnant ablation due to suspected elevated Tg or high recurrence risk stratification or the iodine-avid metastatic lesions identified by DxWBS,87.5%(63/71)showed only residual thyroid tissue by DxWBS;Through the purpose verification by RxWBS and single photon emission computed tomography(SPECT)/CT,only 12.7%(9/71)of cases were verified as adjuvant or tumoricidal treatment due to iodine-avid cervical lymph node and/or lung metastasis identified by RxWBS,87.3%(62/71)were residual thyroid ablation.In the medium and high sTg group,the overall detection rate of functional cervical lymph node metastasis by DxWBS and RxWBS was 5.5%(5/91).For the detection of functional lung metastases,the overall detection rate of DxWBS was slightly lower than that of RxWBS(3.3%vs 5.5%).This indicates that DxWBS can be used to accurately pre-judge the purposes of 131I treatment,particularly for thyroid ablation and adjuvant therapy.Conclusion:DxWBS did not induce"thyroid stunning"effect.Integrating DxWBS as a theranostic tool into the real-time decision-making and evaluation system of 131I treatment,as well as with sTg and other biochemical indicators,may help to bridge the limitations of static evaluations based on pathology and clinical data,and provides a clear understanding and more precise objectives of 131I treatment.

OBJECTIVE To study the therapeutic effect of Hongqi Shenmai Drink on heart failure(HF)after acute myocardial in-farction(AMI)with qi-yin deficiency and blood stasis,and its regulatory effect on serum secretory phosphoprotein 1(SPP1)in AMI-HF patients.METHODS Seventy-six patients with AMI-HF of qi-yin deficiency and blood stasis type were enrolled in this study from three centers:Affiliated Hospital of Integrated Traditional and Western Medicine,Nanjing University of Chinese Medicine;Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine;and Changzhou Hospital of Traditional Chinese Medicine.They were randomly di-vided into a traditional Chinese medicine(TCM)group and a control group,with 38 patients in each group.During the treatment period,4 patients in the TCM group and 3 patients in the control group dropped out.The control group received conventional Guideline-directed medical therapy(GDMT),while the TCM group received GDMT plus Hongqi Shenmai Drink.The treatment course for both groups was 12 weeks.The TCM syndrome scores of the two groups of patients were compared before and after treatment,and the clini-cal efficacy and readmission rate were assessed.Echocardiography was used to assess cardiac structure and function.ELISA was used to detect changes in serum SPP1,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-1β(IL-1β),type Ⅰ collagen α1(COL1α1),and matrix metalloproteinase 9(MMP9)levels.The 6-minute walk test(6MWT)was used to assess exercise tolerance,and the Minnesota living with heart failure questionnaire(MLHFQ)was used to assess patients'quality of life.Adverse reactions were monitored in both groups during treatment.RESULTS After treatment,the TCM syndrome scores of both groups decreased signifi-cantly(P<0.01),with the TCM group showing a significantly lower score than the control group(P<0.01).The total effective rate of TCM clinical efficacy in the TCM group was superior to that in the control group(P<0.05),and the readmission rate in the TCM group was significantly lower than that in the control group(P<0.01).Left ventricular end diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),6MWT,and MLHFQ scores improved in both groups(P<0.01),with the TCM group showing superior improvement compared to the control group(P<0.05,P<0.01).Serum levels of NT-proBNP,IL-1β,COL1α1,and MMP9 decreased in both groups(P<0.05,P<0.01).Serum SPP1 levels were significantly decreased in the TCM group(P<0.01),and serum levels of NT-proBNP,IL-1β,COL1α1,and MMP9 in the TCM group were significantly lower than those in the con-trol group(P<0.01).The change in SPP1(ΔSPP1)showed a negative correlation with the change in the cardiac function ΔLVEF(r=-0.42,P<0.01),and a positive correlation with the myocardial fibrosis marker ΔCOL1α1(r=0.58,P<0.01)and the matrix degradation marker ΔMMP9(r=0.51,P<0.01).There was no significant difference in adverse reaction rates between the two groups during treat-ment(P>0.05).CONCLUSION Hongqi Shenmai Drink combined with GDMT can effectively improve clinical symptoms and cardiac function in patients with AMI-HF of qi-yin deficiency and blood stasis type,with good safety.Its mechanism may be related to the in-hibition of SPP1-mediated inflammation-fibrosis pathway and the downregulation of IL-1β,COL1α1,and MMP9 expression.

Objective To explore the role of icariin on diabetic osteoporosis(DOP)in rats by regulating estrogen reoeptor 1(ER1).Methods Fifty SD rats were randomly divided into five groups:control,diabetes(STZ),low-dose icariin[four weeks after successful establishment of diabetic model rats,50 mg/(kg·d)icariin was administered by gavage for eight weeks],high-dose icariin[100 mg/(kg·d)icariin administered by gavage for eight weeks],and high-dose icariin+ER1-siRNA group[icariin 100 mg/(kg·d)administered by gavage for eight weeks.A total of 10 μL ER1-siRNA was injected via the tail vein once every four weeks,two times in total],with 10 rats in each group.HE staining was used to detect the pathological morphology of the femoral tissue.Enzyme-linked immunosorbent assay(ELISA)was used to measure serum ALP,TRAP,and blood calcium concentrations.Protein-protein interaction(PPI)network analysis predicted icariin core targets and validated molecular docking.ER1,PDE5A,Wnt,and β-cantenin expression levels in rat femoral tissue were detected using Western blotting.Results In the STZ group,the number of empty lacunae in the subchondral region increased,ALP expression and blood calcium concentration decreased(P＜0.01),and TRAP expression increased(P＜0.01),compared with the control group.In the low-and high-dose icariin groups,blood glucose levels decreased(P＜0.01),the number of empty bone lacunae in the subchondral region decreased,ALP expression and blood calcium concentration increased(P＜0.01),and TRAP expression decreased(P＜0.01),compared with the STZ group.PPI network analysis and molecular docking showed that icariin stably bound to the ER1 protein structure.Com-pared with the control group,expression of ER1,Wnt,and β-cantenin decreased in STZ group(P＜0.01).The expression of ER1,Wnt,and β-cantenin in the high-dose icariin group increased compared with the STZ group(P＜0.01).Moreover,expression of ER 1,Wnt,andβ-cantenin decreased in the high-dose icariin+ER1-siRNA group,compared with the high-dose icariin group(P＜0.01).The protective effects of icariin were reversed by ER1-siRNA administration.Conclusion Icariin could significantly improve osteoporosis in diabetes rats,which may be relevant to the activation of the ER 1-mediated Wnt/β-cantenin pathway.

Objective To explore the regulatory effect of moderate intensity aerobic exercise on glu-cose and lipid metabolism disordersafter immune stimulation in high-fat diet induced insulin resistance(IR)mice by inducing tolerance of trained immunity.Methods Eighteen of 70 male C57BL/6 male mice were randomly selected as the control group(CON group),while the remaining mice were subjected to high-fat diet intervention(HFD group)for 8 weeks.After modeling,six of the CON group and HFD group were measured their glucose and lipid metabolism and inflammation levels.The remaining mice in the HFD group were randomly divided into HFD sedentary group(HS group)and HFD exer-cise group(HE group),each of 16.The HE groups underwent a daily 60-minute running on a hori-zontal treadmill at 12 m/min,5 days a week for 8 weeks.After that,the CON,HS and HE groups were randomly divided into an immune stimulation group(lipopolysaccharides,LPS group)and a con-trol group(phosphate buffered saline,PBS group),with 6 in CON-PBS and CON-LPS groups,and 8 in HS-PBS,HS-LPS,HE-PBS and HE-LPS groups.The LPS group received intraperitoneal injec-tion of LPS as an immune stimulus,and were taken samples 24 hours after intervention.During the intervention period,the body weight,food intake,fasting blood glucose(FBG),glucose tolerance,and insulin tolerance were tested for all groups.Then,the serum blood lipid level was tested.More-over,the levels of tumor necrosis factor-α(TNF-α),interleukin-1 β(IL-1β)and interleukin-10(IL-10)in serum were detected by using the enzyme-linked immunosorbent assay,while the protein expression of IL-1β,IL-10,induciblenitricoxidesynthase(iNOS)andarginase-1(Arg-1)were measured by using Western Blot.Results(1)After 8 weeks of high-fat diet intervention,compared with the CON group,there was a significant increase in the body weight,food intake,and FBG,the level of TNF-α and IL-1β in serum and expressions of IL-1β and iNOS in liver,skeletal muscle and adipose tissue,but a significant decrease in glucose and insulin tolerance,the level of anti-in-flammatory factor IL-10,as well as IL-10 and Arg-1 in liver and Arg-1 in adipose tissues in group HFD(P<0.01,P<0.05).(2)After 8 weeks of diet intervention,the body weight of group HS-PBS was still significantly higher than group CON-PBS(P<0.01).However,no significant differences were found between group CON-PBS and HS-PBS in other indicators(P>0.05).After LPS intervention,the food intake of both CON-LPS and HS-LPS groups was significantly lower than the corresponding PBS group(P<0.05).However,the levels of FBG,TG,TC,LDL-C,TNF-α and IL-1β in serum,IL-1β and iNOS in liver and adipose tissues,and iNOS in skeletal muscles of group HS-LPS were signif-icantly higher compared with group HS-PBS and CON-LPS(P<0.05).Meanwhile,the levels of IL-10 in serum,skeletal muscles and adipose tissues,and Arg-1 in skeletal muscles and adipose tissues of group HS-LPS decreased significantly compared with group HS-PBS and CON-LPS(P<0.05).(3)Af-ter simultaneous aerobic exercise intervention,there were no significant differences between group HE-LPS and HE-PBS in FBG,TC,LDL-C,TNF-α,IL-1β and IL-10 in serum,as well as IL-1β,iN-OS and IL-10 in the liver,skeletal muscles and adipose tissues(P>0.05).Moreover,thelevels of FBG,TG,TC,TNF-α,IL-1β in serum,and IL-1β and iNOS in the liver,skeletal muscle and adi-pose tissue decreased significantly in group HE-LPS compared with group HS-LPS(P<0.05).Howev-er,the levels of IL-10 in the serum and liver,and IL-10 and Arg-1 in skeletal muscles and adi-pose tissues increased significantly in group HE-LPS compared with group HS-LPS(P<0.05).Conclu-sion Eight-week aerobic exercise can effectively relieve the glucose and lipid metabolism disorder after immune stimulation in IR mice,which may be related to the stimulation of immunologic tolerance in innate immune cells,thereby reducing the excessive inflammatory response caused by secondary im-mune stimulation.

BACKGROUND:The lower-limb muscle strength shows a significant physiological decline with aging.There may be a certain correlation between sedentary behavior,fear of falling,age and lower-limb muscle strength,but the influence path and effect relationship among them are not yet clear.OBJECTIVE:To examine the relationship between sedentary behavior and lower-limb muscle strength,and to explore the influences of fear of falling and age in such an association among community-dwelling older adults.METHODS:This cross-sectional study recruited 331 community-dwelling older adults(aged≥60 years)in Shanghai.A questionnaire survey was conducted to collect basic information,demographic data,etc.The Short Form of the International Physical Activity Questionnaire was applied to measure sedentary time.Lower-limb muscle strength was assessed by the 30-second chair-stand test.Fear of falling was measured by the Chinese version of Fall Efficacy Scale-International.Descriptive statistics analysis,correlation analysis,regression-based path analysis and mediation analyses were performed on the data.RESULTS AND CONCLUSION:Valid data from 318 community-dwelling older adults[78.9%females,mean age(67.8±5.5)years old]were finally included in the analysis.There were 185 with sedentary time≥3 hours and 133 with sedentary time<3 hours.(1)There was a positive correlation between sedentary behavior and fear of falling(P<0.01),and there were negative correlations between lower-limb muscle strength and sedentary behavior(P<0.01)and between lower-limb muscle strength and fear of falling(P<0.001).(2)Sedentary behavior negatively predicted lower-limb muscle strength(β=-0.125,P<0.05),and positively predicted fear of falling(β=0.182,P<0.01).Fear of falling negatively predicted lower-limb muscle strength(β=-0.293,P<0.001).(3)Fear of falling mediated the relationship between sedentary behavior and lower-limb muscle strength(β=-0.053,95%confidence interval:-0.100 to-0.018).(4)Sedentary behavior had a statistically significant predictive effect on fear of falling(β=0.164,P<0.01),indicating that age moderates the effect of sedentary behavior on fear of falling.

Objective:To identify circulating proteins associated with cardiovascular, renal, and cardiorenal comorbidity events in individuals with metabolic syndrome, to construct a predictive model incorporating these proteins to improve prediction accuracy and to investigate their mediating effects on the interplay between cardiovascular and renal diseases.Methods:Data from the UK Biobank cohort were utilized. Cox proportional hazards models were applied to identify circulating proteins associated with various outcomes, followed by time-truncated sensitivity analyses. A predictive model incorporating protein scores was then developed using the LightGBM algorithm and compared with other models. Gene Ontology(GO) functional enrichment analysis was performed to explore the biological pathways of the identified proteins. Finally, mediation effect analysis was conducted to assess the role of circulating proteins in cardiorenal interactions. Results:The Cox analysis identified 180, 275, and 322 circulating proteins associated with cardiovascular events, renal events, and cardiorenal comorbidity events, respectively. Incorporating protein scores significantly improved model performance; the areas under the curve(AUC) for cardiovascular, renal, and cardiorenal events were 0.833, 0.907, and 0.890, respectively. GO functional enrichment analysis demonstrated significant enrichment in pathways such as cytokine activity(GO: 0005125), glycosaminoglycan binding(GO: 0005539), and humoral immune response(GO: 0006959) among all outcome-related proteins. Notably, EDA2R, GDF15, and WFDC2 exhibited significant mediating effects, each with mediation proportions exceeding 10%. Conclusions:A predictive model incorporating circulating protein scores can substantially improve prediction accuracy for cardiovascular and renal outcomes in individuls with metabolic syndrome.

OBJECTIVES: To investigate the effect of high glucose on macrophage polarization and the role of immune-responsive gene 1 (IRG1) in mediating its effect. METHODS: RAW264.7 cells were transfected with IRG1-overexpressing plasmid or IRG1 siRNA via electroporation and cultured in either normal or high glucose for 72 h to observe the changes in cell viability and morphology using CCK-8 assay and phase contrast microscopy. The protein levels of IRG1, iNOS, Arg-1, IL-1β and IL-10 in the treated cells were detected with Western blotting, and the fluorescence intensities of iNOS and Arg-1 were detected using immunofluorescence assay. The protein levels of IL-1β and IL-10 in the culture medium were determined with ELISA. RESULTS: High glucose exposure significantly reduced IRG1 and Arg-1 expressions, increased iNOS and IL-1β expressions and IL-1β secretion, and decreased IL-10 level in RAW264.7 cells. Transfection with the IRG1-overexpressing plasmid provided the cells with obvious resistance to high glucose-induced changes in iNOS, Arg-1, IL-1β and IL-10, whereas IRG1 knockdown further enhanced the effects of high glucose exposure on Arg-1 expression and the expression and secretion of IL-10. CONCLUSIONS High glucose promotes M1 polarization of the macrophages possibly through a mechanism to inhibit the expression of IRG1 protein, thus leading to chronic inflammatory response.
Animals ; Mice ; Macrophages/drug effects* ; Glucose/pharmacology* ; Interleukin-10/metabolism* ; Nitric Oxide Synthase Type II/metabolism* ; RAW 264.7 Cells ; Interleukin-1beta/metabolism* ; Arginase/metabolism* ; RNA, Small Interfering/genetics* ; Transfection ; Inflammation