Objective To evaluate the effectiveness of virtual reality technology in breast cancer chemotherapy patients.Methods Databases were searched for randomized controlled trials literature on the effects of virtual reality technology on interventions for breast cancer chemotherapy patients.The time frame of the search was from construction of the database to February 2024.After screening the relevant literature by two researchers based on predetermined inclusion and exclusion criteria,information and methodological quality assessment were extracted.Eight literature articles were included in this study.Data analysis was performed using Revman 5.4 software,and data that could not be merged were analyzed descriptively.Results Meta-analysis showed that virtual reality technology significantly improved anxiety,depression,cancer-caused fatigue,cognitive function and quality of life of breast cancer chemotherapy patients.Conclusion Virtual reality technology as a non-pharmacological intervention can effectively improve anxiety,depression,cancer-caused fatigue,cognitive function,and quality of life of breast cancer chemotherapy patients.

Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Objective:To characterize fine motor function in middle-aged and elderly individuals utilizing a novel wearable inertial motion capture device.Additionally, it seeks to investigate the relationship between fine motor deficits and overall cognitive function, as well as various cognitive dimensions.Methods:Participants aged 50 years and older were recruited between November 2022 and April 2023.The Montreal Cognitive Assessment Scale(MoCA)was employed to evaluate the cognitive function of the subjects, and a radar chart was utilized to illustrate the extent of impairment across different cognitive dimensions.An independent computerized fine motor evaluation system was developed using the motion capture technology of a novel wearable microelectromechanical system(MEMS)inertial sensor, enabling a quantitative assessment of fine motor skills.The differences in fine motor function characteristics between the two groups were compared.Spearman's correlation analysis and multivariate logistic regression were conducted to examine the relationship between fine motor deficits and cognitive dysfunction.Results:A total of 289 participants were recruited, among whom 140(48.4%)were classified into the cognitive impairment group.The mean MoCA scores for the cognitive impairment group and the non-cognitive impairment group were 22.2 ± 2.79 and 27.7 ± 1.19, respectively( P<0.001).The electronic assessment of fine motor function revealed that the motion parameters of hand function in the cognitive impairment group were significantly poorer across all three numerical evaluation tasks.Spearman's correlation analysis demonstrated a robust correlation between deficits in fine motor function and cognitive dysfunction.Furthermore, in the multiple logistic regression model, after adjusting for potential confounding factors including age, gender, and education level, a significant association between cognitive dysfunction and fine motor dysfunction persisted. Conclusions:A novel wearable motion capture technology was employed to facilitate the digital assessment of fine motor function.The findings revealed a significant correlation between deficits in fine motor function and cognitive dysfunction among middle-aged and elderly populations.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To investigate the effect and mechanism of remimazolam on circulatory function in septic shock rats.Methods Seventy-two SPF grade rats were randomly divided into the control group,the model group,the dexamethasone group,the low and high dose remimazolam groups and the high-dose remimazolam+Nrf2 inhibitor(ML385)group,with 12 rats in each group.The septic shock rat model was established by intravenous infusion of 10 mg/kg lipopolysaccharide(LPS).After 6 hours of modeling,the mean arterial pressure(MAP)and heart rate(HR)of rats were measured.Enzyme linked immunosorbent assay(ELISA)method was applied to measure serum levels of lactic acid(Lac),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,nitric oxide(NO),and endothelin-1(ET-1).Hematoxylin-eosin(HE)staining was applied to observe morphological changes in vascular tissue.TUNEL staining was applied to observe the apoptosis of vascular endothelial cells.DHE fluorescent probe was used to detect the level of ROS in vascular tissue.The colorimetric method was applied to detect the contents of MDA and the activity of SOD in vascular tissue.Western blot assay was applied to detect the protein expression of nuclear factor E2-related factor 2(Nrf2)and glutathione peroxidase 4(GPX4)in vascular tissue.Results Compared with the control group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were lower in the model group,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were higher(P＜0.05).Compared with the model group,MAP,SOD activity in vascular tissue,Nrf2 and GPX4 protein levels were higher in the dexamethasone group and in the low and high dose remimazolam groups,while HR,serum Lac,NO,ET-1,TNF-α,IL-1β,IL-6 levels,endothelial cell apoptosis rate,ROS level in vascular tissue and MDA content were lower(P＜0.05).Nrf2 inhibitor ML385 greatly reduced the protective effect of remimazolam on septic shock rats(P＜0.05).Conclusion Remimazolam may improve circulatory function in septic shock rats by activating the Nrf2/GPX4 pathway,inhibiting inflammatory response and oxidative stress,reducing endothelial cell damage.

Objective To explore the effect of maternal exercise on blood pressure,cardiac pheno-type and susceptibility to myocardial is chemia/reperfusion(MI/R)injury in adult male offsprings of mice.Methods Pregnant mice were randomly divided into a sedentary group(p-Ctr)and an exercise group(p-EX),each of 12.The exercise group underwent daily 60-minutenon-weight bearing swim-ming from gestational day(GD)1 to 18,6 days a week.Then,their male offsprings at 3 months of age(3M)were selected as the research subjects,namely the Ctr-3M group and the EX-3M group,with 12 mice in each group.The MI/R model was established by ligation of the anterior descending branch of the left coronary artery(LAD)surgery(30 min of ischemia,24 h of reperfusion).Then,the systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)were monitored non-invasively via tail artery blood pressure measurement,while the cardiac function was detected by using the small animal ultrasound.Moreover,the cardiac morphology and col-lagen volume fraction(CVF)of myocardium was observed by HE staining and Masson staining,respec-tively.Meanwhile,the cross-sectional area(CSA)of myocardial cells and myocardial infarction area(INF/AAR)was measured using WGA staining and Evans Blue-TTC double staining,accordingly.What's more,the apoptosis index(AI)of myocardial cells and serum cardiac troponin I(cTnI)were de-tected by using TUNEL staining and ELISA,respectively,while the expression levels of Bax and Bcl-2 proteins were determined by using Western blotting.Results 1)From GD11 to GD19,the body weight of females in the p-EX group was always significantly lower than that in the p-Ctr group(GD11,GD13;P<0.05;GD12,GD14～GD19;P<0.01),but there was no significant difference in the litter size and abortion rate(P>0.05).2)There were no significant differences between the EX-3M and Ctr-3M groups in the heart weight(HW),body weight(BW)and heart weight to body weight ratio(HW/BW),SBP,DBP,MAP,myocardial CVF,and CSA of male offsprings(P>0.05).After MI/R surgery,in both p-Ctr and p-EX groups,myocardial transverse striations disappeared and cardiomyocytes were disarranged with degeneration and necrosis.Moreover,CVF of the EX-3M group was significantly lower than the Ctr-3M group after MI/R surgery(P<0.05).3)No significant differenc-es were found between the Ctr-3M and EX-3M groups in the average cardiac ejection fraction(EF),fractional shortening(FS),left ventricle internal diameter in diastole(LVIDd),and left ventricle inter-nal diameter in systole(LVIDs)(P>0.05).However,after the MI/R surgery,the postoperative EF and FS(P<0.01),and LVIDs(P<0.05)in the EX-3M group were significantly higher than the Ctr-3M group,without significant difference in LVIDd(P>0.05).4)After MI/R surgery,the average AI,INF/AAR and serum cTnI level of the EX-3M group were significantly lower than the Ctr-3M group(P<0.01 for all).5)The relative expression level of myocardial Bcl-2 protein after MI/R surgery in the EX-3M group was significantly higher than the Ctr-3M group(P<0.05),while that of myocardial Bax protein(P<0.05)and the Bax/Bcl-2 ratio(P<0.01)were significantly lower than the latter.Conclu-sions Prenatal exercise significantly reduces the susceptibility to myocardial ischemia injury in 3-month-old male mice offspring,improves the contractile function of their heart,and attenuates the degree of cardiomyocyte apoptosis and necrosis,exerting a cardioprotective effect in MI/R injury.

Objective:To analyze hemodynamic characteristics during the initial phase of the head-up tilt test (HUTT) in children with postural orthostatic tachycardia syndrome (POTS) and the value for predicting vasovagal syncope(VVS).Methods:This was a case-control study involving 123 POTS patients who underwent HUTT in the Pediatric Cardiovascular Department at the Children's Hospital,Capital Institute of Pediatrics,from January 2021 to August 2023.According to HUTT results,participants were divided into POTS combined with VVS group( n=82) and POTS group( n=41).The general conditions,clinical symptoms,24-hour urine sodium levels,and hemodynamics changes during the initial phase of HUTT between the two groups were compared. Results:The prevalence of POTS combined with VVS was 66.13% (82/123).There were no significant differences in age,sex,body mass index,24-hour urinary sodium,heart rate,heart rate variability,and maximum heart rate variability during the initial phase of HUTT between the two groups( P>0.05).Compared to the POTS group,the 10-minute systolic blood pressure(SBP10),10-minute diastolic blood pressure (DBP10),and 10-minute mean blood pressure(MBP10) in the POTS combined with VVS group were significantly lower [SBP10: 104(98.8,114.3) vs. 111(105,121.5)mmHg, Z=-3.071, P<0.05; DBP10: 63.44±8.36 vs. 68.29±6.43 mmHg, t=-3.265, P <0.05; MBP10: 78.31±9.74 vs. 83.28±7.30 mmHg, t =-2.879, P<0.05].Receiver operating characteristic curve analysis showed that DBP10,the difference between baseline DBP and DBP at 10-minute (△DBP10),and the in creasing rate of DBP10(△DBPR10) were predictive factors for POTS combined with VVS,with cut-off values of 67.5 mmHg (AUC=0.687,sensitivity 67.5%,specificity 72.0%),7.5 mmHg (AUC=0.633,sensitivity 43.9%,specificity 79.3%),and -2.84% (AUC=0.631,sensitivity 92.7%,specificity 31.7%),respectively.The combined predictive value was more significant (AUC=0.709, P<0.05),with sensitivity and specificity of 70.7% and 67.1%,respectively.In terms of age,DBP10 exhibited a higher predictive value in patients aged 13-18 years,with a DBP10 cut-off of 64.5 mmHg,AUC of 0.762,sensitivity of 92.7%,and specificity of 31.7%. Conclusion:The rate of HUTT-proven VVS in POTS was 66.13%.△DBP10,DBP10 and △DBPR10 have predictive value for POTS combined with VVS.Additionally,DBP10 shows a higher predictive value in patients aged 13-18 years.

Maternal obesity has been shown to exert adverse transgenerational effects on offspring ovarian function,characterized by reduced ovarian follicle reserve,impaired granulosa cell function,and disrupted reproductive cycles.The underlying mechanisms involve cellular stress-induced damage characterized by mitochondrial dysfunction,oxidative stress,and apoptosis,as well as dysregulation in key regulatory pathways such as ovarian hormone secretion,gene expression,and epigenetic modifications.This review synthesizes existing evidence on how maternal obesity-induced acute stress and chronic genetic/epigenetic alterations jointly contribute to offspring ovarian impairment.The findings elu-cidate the complex relationship between maternal metabolic status and offspring reproductive health,providing a robust theoretical foundation for refining prenatal management and developing targeted intervention strategies.

Aim To explore the effects of exercise during pregnancy on renal structure,function and angiotensin Ⅱ(Ang Ⅱ)/transforming growth factor-β1(TGF-β1)/connective tissue growth factor(CTGF)signaling pathway in 3-month-old offspring of spontaneously hypertensive rats(SHR),the aim of this study was to provide experimental basis for early intervention of hypertension and protection of key target organs.Methods After mating SHR and WKY rats,pregnant rats were randomly divided into sedentary group(p-WKY-SED,p-SHR-SED)and exercise group(p-WKY-EX,p-SHR-EX).Blood pressure,serum urea nitrogen and creatinine were measured by caudal artery non-invasive blood pressure system and colorimetry in 3-month-old offspring rats.HE staining,Masson staining,ELISA and Western blot were used to detect the renal structure,collagen volume fraction,Ang Ⅱ concentration,renin-angiotension-aldosterone sys-tem(RAAS)and protein expression related to fibrogenic signal pathway in 3-month-old rats.Results(1)The sys-tolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)of offspring rats in p-SHR-SED group were significantly higher than those in p-WKY-SED group.The SBP,DBP and MAP of SHR male off-spring rats were significantly decreased by exercise during pregnancy(P＜0.05),but had no effect on the female offspring rats(P＞0.05).(2)There was no significant difference in serum urea nitrogen and creatinine among the groups(P＞0.05).(3)The glomerular volume and the collagen volume fraction in p-SHR-SED group were significantly higher than those in p-WKY-SED group(P＜0.05),and the glomerular volume and the collagen volume fraction in p-SHR-EX group were significantly lower than those in p-SHR-SED group(P＜0.05).(4)Renal Ang Ⅱ level of offspring rats in p-SHR-SED group was significantly higher than that in p-WKY-SED group,and renal Ang Ⅱ level of offspring rats in p-SHR-EX group was significantly lower than that in p-SHR-SED group(P＜0.05).(5)The expression levels of angiotensin Ⅱ type 1 receptor(AT1R),TGF-β1 and CTGF protein in p-SHR-SED group were significantly higher than those in p-WKY-SED group(P＜0.05),while the expression levels of angiotensin converting enzyme 2(ACE2),angiotensin Ⅱ type 2 receptor(AT2R)and MasR protein in p-SHR-SED group were significantly lower than those in p-WKY-SED group(P＜0.05).Conclusion(1)Exercise during pregnancy can significantly decrease the blood pressure of 3-month-old male offspring rats of hypertensive rats,but has no significant effect on that of 3-month-old female offspring.(2)Exercise during preg-nancy may reduce renal fibrosis in 3-month-old female/male offspring of hypertensive rats by regulating RAAS balance and inhibiting Ang Ⅱ/TGF-β1/CTGF signaling pathway.