ObjectiveTo investigate the mechanism by which Wumeiwan suppresses the development and progression of colorectal cancer（CRC） through the regulation of fatty acid metabolic reprogramming， thereby providing new experimental evidence for the prevention and treatment of CRC. MethodsA total of 120 C57BL/6 mice were randomly divided into the blank group， model group， Wumeiwan high-， medium-， and low-dose groups（54， 27， 13.5 g·kg^-1）， and the mesalazine group（0.01 g·kg^-1）， with 20 mice in each group. Except for the blank group， all mice were subjected to azoxymethane（AOM）/dextran sulfate sodium（DSS） treatment to establish an inflammation-associated CRC model. One week after AOM injection， mice in the treatment groups received intragastric administration of the designated drugs， while the blank and model groups received an equal volume of purified water， continuing until 20 d after the intervention endpoint. Hematoxylin-eosin（HE） staining was used to observe colonic histopathological alterations， and immunohistochemistry for vascular endothelial growth factor（VEGF） was performed to evaluate neovascularization and tumor invasion. Metabolomics combined with Kyoto Encyclopedia of Genes and Genomes（KEGG） and metabolite set enrichment analysis（MSEA） was applied to identify key CRC-related metabolic pathways， which were further validated by transcriptomic Gene Ontology（GO） enrichment and gene heatmap analysis. Subsequently， Western blot was performed to determine the expression levels of core proteins in these pathways， and immunofluorescence was used to analyze their localization and co-expression patterns in tissues， thereby elucidating the mechanism of Wumeiwan from multiple biological dimensions. ResultsCompared with the blank group， mice in the model group exhibited a significant decrease in body weight and a significant increase in the disease activity index（DAI） score（P<0.05）， with pronounced colonic mucosal damage accompanied by aggravated tumor invasion. Compared with the model group， Wumeiwan intervention markedly improved body weight loss and reduced DAI score， attenuated mucosal injury， and significantly decreased VEGF expression level（P<0.05）. Multi-omics analysis revealed that differential metabolites and genes across groups were commonly enriched in fatty acid metabolism， fatty acid biosynthesis， and other lipid-related pathways. Relative to the blank group， the model group showed significant upregulation levels of fatty acid synthesis-related genes， including sterol regulatory element-binding protein 1（SREBP1）， fatty acid synthase（FASN）， stearoyl-CoA desaturase 1（SCD1）， as well as saturated fatty acids（P<0.05）. Compared with the model group， treatment with Wumeiwan significantly reduced the expression of key genes involved in fatty acid metabolic pathways， including SREBP1， FASN， and SCD1（P<0.05）. Western blot results further confirmed that proteins in this pathway were significantly elevated in the model group， whereas they were markedly downregulated following Wumeiwan treatment（P<0.05）. Immunofluorescence analysis demonstrated enhanced co-localization of SREBP1 with the cancer-associated fibroblast（CAF） marker α-smooth muscle actin（SMA） in the model group， whereas this co-localization signal was attenuated after Wumeiwan intervention（P<0.05）. ConclusionWumeiwan can improve survival outcomes and alleviate colonic pathological damage in CRC mice， its therapeutic mechanism may be closely associated with the regulation of fatty acid metabolic reprogramming mediated by the SREBP1/FASN/SCD1 signaling pathway.

Objective:To learn about the current situation of organizational management and inter-departmental coordination and provide a basis for optimization the national joint prevention and control strategy of endemic fluorosis and arsenicosis.Methods:The staff engaged in prevention and control of endemic fluorosis and arsenicosis at the provincial, municipal, county, township, and village levels were selected as the investigation subjects. An online questionnaire survey was conducted to collect relevant information on organizational management and departmental coordination. SAS 9.4 software was used for data statistical analysis.Results:A total of 3 107 valid questionnaires were collected, covering 25 provinces, distributed in 6 regions including Northeast China, North China, East China, Central China, Northwest China, and Southwest China. Totally 92.52% (1 088/1 176) of the respondents believed that a leading group for prevention and control of endemic diseases had been established in their localities, there were statistically significant differences among different regions (χ 2 = 17.18, P = 0.004). However, the highest proportion of those who believed that no leading group had been established was in the Southwest China (14.09%, 21/149). Totally 83.97% (906/1 079) of the respondents believed that the coordination role of the leading group for endemic disease prevention and control was very good or relatively good. The proportion of survey respondents who believed that the local water resources department had a good/relatively good main responsibility in implementation of water improvement measures in drinking-water-borne fluorosis and arsenic poisoning areas, as well as in management of fluoride and arsenic reduction water improvement projects, were 90.51% (2 203/2 434) and 89.37% (2 143/2 398), respectively. The differences between different regions were statistically significant (χ 2 = 70.90, 57.40, P < 0.001). The highest proportion of general/poor cases was believed to be in the southwest region [25.14% (46/183), 24.58% (44/179)]. Totally 71.37% (187/262) of the respondents believed that the supply and distribution of low-fluorine brick tea in tea-drinking-borne endemic fluorosis areas were very good or good. Totally 90.55% (1 447/1 598) of the respondents believed that local medical insurance departments had included skeletal fluorosis patients who were covered by medical insurance. Totally 90.71% (1 474/1 625) of the respondents believed that social assistance departments had included eligible patients with skeletal fluorosis in the scope of social assistance. There were significant differences in the inclusion rate among different regions (χ 2 = 50.45, 46.22, P < 0.001). North China [18.99% (30/158), 21.43% (33/154)] and Southwest China [18.64% (33/177), 15.22% (28/184)] were the two regions with the highest percentage of respondents who believed that the above two were not included. Totally 83.19% (1 425/1 713) of the respondents believed that the local designated hospital for treatment of skeletal fluorosis had been established, there were statistically significant differences among different regions (χ 2 = 31.54, P < 0.001). North China (26.40%, 47/178) and Northwest China (24.56%, 42/171) had the highest proportion of those who believed that there were no designated treatment hospitals for skeletal fluorosis. Totally 83.58% (1 502/1 797) of the respondents believed that the utilization of medical insurance and other policy assistance was very good or good by skeletal fluorosis patients. In Northeast China (30.34%, 27/89), North China (28.41%, 50/176), Southwest China (24.00%, 48/200), and Northwest China (21.43%, 39/182), the proportion of those who believed that the utilization was average and poor were significantly lower than those in East China (11.57%, 96/180) and Central China (10.94%, 35/320, Pcorrect < 0.05). Totally 92.96% (2 747/2 955) of the respondents believed that the cooperation degree of education departments in school monitoring and health education was very good or good, and there were significant differences between different regions (χ 2 = 26.11, P < 0.001), and the highest proportion of respondents who believed that the degree of cooperation was average and poor was in Southwest China (12.63%, 37/293). Conclusions:Except for the East China and Central China, there are different degrees of problems in the organization management and/or departmental coordination and cooperation between departments of endemic fluorosis and arsenicosis prevention and control, especially in the Southwest region. All regions should raise awareness of risk prevention and control, strengthen joint prevention and control, and integrate medical and prevention mechanisms, and consolidate and improve the achievements of endemic fluorosis and arsenicosis prevention and control.

Objective:To investigate the water improvement status and current disease situation in drinking water-borne endemic fluorosis areas of Taiyuan City, evaluate the effect of prevention and control measures, and provide a basis for optimizing control measures.Methods:Monitoring data from 2019 to 2024 for drinking water-borne endemic fluorosis in the diseased areas in Taiyuan City were collected from the Taiyuan Center for Disease Control and Prevention. A retrospective analysis was conducted on water improvement status, water fluoride content, dental fluorosis in children aged 8 - 12, skeletal fluorosis, and urinary fluoride monitoring results in all endemic villages.Results:From 2019 to 2024, all endemic villages in the six endemic counties (districts) of Taiyuan City completed water improvement. The number of water improvement projects each year was 75, 75, 72, 68, 64, and 57, respectively, with all projects operating normally. The qualified rates of water fluoride content each year were 81.33% (61/75), 100% (75/75), 98.61% (71/72), 75.00% (51/68), 87.50% (56/64), and 75.44% (43/57), respectively, with statistical significant differences ( χ2 = 36.99, P < 0.001). The detection rates of dental fluorosis each year were 18.19% (600/3 298), 14.42% (530/3 676), 11.14% (435/3 904), 11.13% (421/3 781), 11.59% (435/3 754), and 5.37% (299/5 567), respectively, with statistical significant differences ( χ2 = 386.42, P < 0.001). In 2024, 824 people were screened for skeletal fluorosis, with 250 cases showing positive symptoms and signs. Among the 250 positive cases, 210 underwent X-ray examination, detecting 170 skeletal fluorosis patients, with an X-ray positive rate of 80.95% (170/210) and a skeletal fluorosis detection rate of 20.63% (170/824). Urinary fluoride monitoring results showed that the geometric mean of urinary fluoride in villages with excessive water fluoride content was 2.95 mg/L, which was higher than the normal upper limit (1.60 mg/L). However, there was no statistically significant difference in urinary fluoride levels between skeletal fluorosis patients and non-skeletal fluorosis individuals ( Z = 0.78, P = 0.434). Conclusions:From 2019 to 2024, the drinking water-borne endemic fluorosis areas in Taiyuan City have undergone comprehensive water improvement and the water improvement projects are operating well. The qualified rate of water fluoride content has fluctuated, while the detection rate of dental fluorosis has decreased. Continuous monitoring is needed in the future to implement long-term water improvement measures and strengthen screening and treatment efforts for patients with fluorosis.

Objective:To evaluate the efficacy of combined cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) in the management of dysphagia secondary to glossopharyngeal and vagal nerve injury.Methods:This retrospective cohort study collected the clinical data of 18 patients with persistent dysphagia due to glossopharyngeal and vagus nerve injuries, who underwent concurrent cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) at the Department of Otolaryngology, Peking Union Medical College Hospital, from January 2017 to December 2024. Pre-and postoperative assessments included electronic flexible laryngoscope, the Chinese version of Swallow Quality-of-Life Questionnaire (CSWAL-QOL), videofluoroscopic swallowing study (VFSS), body weight changes, and nasogastric tube (NGT) removal status with routine follow-up. The comparison of swallowing function before and after surgery was conducted using paired samples t-test and χ2 test. Results:The study cohort comprised 10 male and 8 female patients, with ages ranging from 33 to 70 years (mean±SD: 53.8±10.5). All surgical procedures were completed successfully without complications. During the 6-to 24-month follow-up period, 10 of the 13 patients who were initially nasogastric tube-dependent achieved successful decannulation. Compared with preoperative values, postoperative measurements demonstrated statistically significant improvements across all parameters: mean body weight increased from (56.95±9.14) kg to (59.22±8.72) kg ( t=3.689 , P<0.01), CSWAL-QOL scores improved from 91.89±17.81 to 130.83±25.42 ( t=6.921 , P<0.01), while, both VFSS scales showed marked reductions (VFSS-SWAL: 6.78±1.40 to 3.39±1.61, t=-8.001, P<0.01; PAS: 6.56±1.15 to 2.94±1.26, t=-10.114, P<0.01). Conclusions:Combined CPM and AFIL represents an effective surgical approach for dysphagia following glossopharyngeal and vagal nerve injury, thereby demonstrating significant improvements in both swallowing function and quality of life.

Objective:To investigate the current status of treatment delay and analyze its influencing factors in patients with breast cancer-related lymphedema.Methods:Using convenience sampling, 218 patients with breast cancer-related lymphedema from The First Affiliated Hospital of Zhengzhou University between April 2024 and January 2025 were enrolled. The General Information Questionnaire, Lymphedema Self-Management Support Scale for Breast Cancer Survivors (LSMS-BCs), Brief Illness Perception Questionnaire for Breast Cancer-related Lymphedema (BIPQ-BCRL), Perceived Barriers to Health Care-Seeking Decision-Chinese (PBHSD-C), and Health Literacy Scale for Chronic Patients (HLSCP) were used to conduct a cross-sectional survey. Logistic regression identified predictors of treatment delay, with model fit assessed by the Hosmer-Lemeshow test. Discriminative ability was evaluated using receiver operating characteristic (ROC) curve analysis.Results:The study included 218 female BCRL patients, aged (58.31 ± 10.54) years. Among 218 patients, 76 experienced treatment delay, the incidence of treatment delay was 34.8% (76/218). Independent risk factors included junior high school education or below, no regular arm circumference measurement, low self-management support scores, low illness perception scores, high perceived barriers to healthcare-seeking scores, and low health literacy scores (Wald χ2 values were 7.75-15.15, all P<0.05). The Hosmer-Lemeshow test indicated good model fit ( χ2=6.21, P>0.05). The combined predictive model demonstrated significantly better discrimination than individual factors, the area under the curve of ROC was 0.846 ( P<0.01). Conclusions:The incidence of treatment delay is relatively high among breast cancer-related lymphedema patients. Nursing staff should pay special attention to patients with a junior high school education or below, no regular arm circumference measurement, low LSMS-BCs scores, low BIPQ-BCRL scores, high PBHSD-C scores and low HLSCP scores, implement timely interventions to reduce treatment delay in lymphedema patients.

Objective:To evaluate the efficacy of combined cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) in the management of dysphagia secondary to glossopharyngeal and vagal nerve injury.Methods:This retrospective cohort study collected the clinical data of 18 patients with persistent dysphagia due to glossopharyngeal and vagus nerve injuries, who underwent concurrent cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) at the Department of Otolaryngology, Peking Union Medical College Hospital, from January 2017 to December 2024. Pre-and postoperative assessments included electronic flexible laryngoscope, the Chinese version of Swallow Quality-of-Life Questionnaire (CSWAL-QOL), videofluoroscopic swallowing study (VFSS), body weight changes, and nasogastric tube (NGT) removal status with routine follow-up. The comparison of swallowing function before and after surgery was conducted using paired samples t-test and χ2 test. Results:The study cohort comprised 10 male and 8 female patients, with ages ranging from 33 to 70 years (mean±SD: 53.8±10.5). All surgical procedures were completed successfully without complications. During the 6-to 24-month follow-up period, 10 of the 13 patients who were initially nasogastric tube-dependent achieved successful decannulation. Compared with preoperative values, postoperative measurements demonstrated statistically significant improvements across all parameters: mean body weight increased from (56.95±9.14) kg to (59.22±8.72) kg ( t=3.689 , P<0.01), CSWAL-QOL scores improved from 91.89±17.81 to 130.83±25.42 ( t=6.921 , P<0.01), while, both VFSS scales showed marked reductions (VFSS-SWAL: 6.78±1.40 to 3.39±1.61, t=-8.001, P<0.01; PAS: 6.56±1.15 to 2.94±1.26, t=-10.114, P<0.01). Conclusions:Combined CPM and AFIL represents an effective surgical approach for dysphagia following glossopharyngeal and vagal nerve injury, thereby demonstrating significant improvements in both swallowing function and quality of life.

Objective:To screen for microRNAs(miRNAs)highly expressed in the serum exosomes(Exo)of esophageal squamous cell carcinoma(ESCC)patients and analyze their relationship with the clinicopathological characteristics of the patients,and to explore the potential of Exo-derived miRNAs as clinical auxiliary diagnostic markers for ESCC.Methods:Serum and relevant clinical data of 50 healthy subjects and 45 newly diagnosed ESCC patients admitted to the Fourth Hospital of Hebei Medical University between December 2021 and June 2023 were collected,serving as the control group and the ESCC group respectively.The Gene Expression Omnibus(GEO)database and qPCR were used to screen and identify the candidate miRNA for increased expression in the serum of ESCC patients-miR-1246.The diagnostic efficacy of serum miR-1246 for ESCC was analyzed by the receiver operating characteristic curve.The relationship between miR-1246 and the clinical feature progression of ESCC patients was analyzed by Logistic regression,and the relationship between miR-1246 and the clinicopathological characteristics of ESCC patients was analyzed by the χ2 test.Exosomes in the serum of the subjects were isolated,purified and characterized for verification.The expression of miR-1246 in Exo was detected by qPCR.ESCC KYSE150 and KYSE30 cells were routinely cultured.mimics-NC and miR-1246 mimics were transfected respectively into KYSE150 cells using Lipofectamine 2000.Inhibitor-NC and miR-1246 inhibitor were transfected into KYSE30 cells,which were respectively denoted as the minics-NC,miR-1246 mimics,inhibitor-NC and miR-1246-inhibitor groups.KYSE150 and KYSE30 cells were treated with Exo derived from KYSE150 cells in the mimics-NC and miR-1246 mimics groups.The proliferation,migration and invasion abilities of cells in each group were detected by the CCK-8 assay,scratch wound healing assay and Transwell chamber assay respectively.The expressions of Exo markers,epithelial-mesenchymal transition-related proteins,TET family methylcytosine dioxygenase 2(TET2)and cell adhesion molecule 1(CADM1)proteins in each group of cells were detected by WB assay.The targeting binding relationship between miR-1246 and TET2 and CADM1 was verified by the dual-luciferase reporter gene assay.Results:Bioinformatics screening showed that the miRNA with the most significant differential expression in the serum of ESCC patients was miR-1246.The serum Exo extracted from the patients conformed to the typical Exo characteristics.The expression level of serum Exo-miR-1246 in ESCC patients at stages Ⅰ-Ⅱ was significantly higher than that in healthy subjects(P<0.01);the level of serum Exo-miR-1246 in ESCC patients at stages Ⅲ-Ⅳ was significantly higher than that in patients at stages Ⅰ-Ⅱ(P<0.01).ROC curve analysis showed that Exo-miR-1246 in serum had a high value for auxiliary differential diagnosis of ESCC(P<0.05),and the auxiliary diagnostic efficacy of Exo-miR-1246 for the clinical progression of ESCC patients was higher than that of CEA and SCC-Ag(P<0.05).The combined detection of the three could further improve the efficacy of auxiliary diagnosis of patient staging(P<0.01).Exo-miR-1246 might be an independent risk factor for the clinical progression of ESCC patients(P<0.05).The expression level of serum Exo-miR-1246 was associated with the T-stage,N-stage and clinical stage of ESCC(P<0.01).Overexpression of miR-1246 could promote the proliferation,migration,invasion,epithelial-mesenchymal transition and inhibit apoptosis of ESCC cells,while inhibition of miR-1246 had the opposite effect.Database data analysis found that TET2 and CADM1 were the target genes of miR-1246.The dual-luciferase reporter gene assay confirmed that miR-1246 could directly bind to TET2 and CADM1 mRNA and inhibit their expressions(P<0.01).Treatment of KYSE150 and KYSE30 cells with Exo derived from cells overexpressing miR-1246 had the same effect as overexpressing miR-1246 in these cells.Conclusion:Exo-derived miR-1246 has the potential to be a clinical auxiliary diagnostic marker for ESCC.It may affect the occurrence and development of ESCC by regulating the expression levels of TET2 and CADM1.

Objective To explore the application effect of immersive virtual reality(IVR)technology and different viewing content in pediatric patients with general anesthesia during elective surgery,and to provide references for clinical implementation.Methods A total of 180 pediatric patients who underwent elective surgery under general anesthesia in a tertiary hospital in Qingdao from February to October 2023 were selected as study population using convenient sampling method.According to the operation time,60 pediatric patients who underwent surgery from May to July 2023 were included in the immersive panoramic surgical education group,and they could watch the panoramic surgical education video immersively on the basis of routine care.A total of 60 pediatric patients who underwent surgery from August to October 2023 were included in the immersive animation group to watch cartoons immersively on the basis of routine care.A total of 60 pediatric patients who underwent surgery from February to April 2023 were included in the control group and routine preoperative care was implemented.The preoperative anxiety levels,anesthesia induction compliance,and incidence of emergence agitation were compared in the 3 groups by the modified Yale Preoperative Anxiety Scale-Short Form(mYPAS-SF),anesthesia induction cooperation grade,and the Pediatric Anesthesia Emergence Delirium scale(PAED).Results There were statistically significant differences in preoperative anxiety level,anesthesia induced compliance and incidence of emergence agitation during awakening between the 3 groups(P＜0.001).Among them,the preoperative anxiety level of the immersive panoramic surgical education group and the immersive animation group was lower than that of the control group,and the difference was statistically significant(P＜0.001).The anesthesia induced compliance degree of the immersive panoramic surgical education group and the immersive animation group was better than that of the control group,and the difference was statistically significant(P＜0.017),and the incidence of emergence agitation in the immersive panoramic surgical education group was lower than that of the control group,and the difference was statistically significant(P=0.004).Conclusion The use of IVR technology to watch panoramic surgical education videos and cartoons can help reduce the preoperative anxiety level and improve anesthesia induction cooperation degree of pediatric patients with general anesthesia during elective surgery,but the intervention effect of panoramic surgical education videos is better in improving the emergence agitation.

Objective:To investigate the mediating effect of rehabilitation exercise self-efficacy in the relationship between psychological pain and quality of life among postoperative patients with osteoporotic fractures.Methods:A total of 203 patients with osteoporotic fractures who underwent surgical treatment in the Department of Orthopedics of the Affiliated Hospital of Jining Medical University from June 2023 to June 2024 were recruited using convenience sampling. Postoperatively, patients were assessed with the General Information Questionnaire, the Self-Efficacy Rehabilitation Outcome Scale (SER), the Psychological Pain Scale, and the World Health Organization on Quality of Life Brief Scale (WHOQOL-BREF). The mediating role of rehabilitation exercise self-efficacy was tested using the bootstrap method.Results:A total of 210 questionnaires were distributed, with 203 valid responses collected, yielding an effective response rate of 96.67%. The mean scores of rehabilitation exercise self-efficacy, psychological pain, and quality of life were (65.56±8.89), (26.68±5.57), and (85.90±5.59), respectively. Correlation analysis showed that rehabilitation exercise self-efficacy was negatively correlated with psychological pain ( r=-0.562, P<0.01), psychological pain was negatively correlated with quality of life ( r=-0.801, P<0.01), and rehabilitation exercise self-efficacy was positively correlated with quality of life ( r=0.741, P<0.01). Mediation analysis revealed that rehabilitation exercise self-efficacy partially mediated the relationship between psychological pain and quality of life, with an effect size of -0.231 ( P<0.01), accounting for 38.95% of the total effect. Conclusions:Psychological pain not only directly affects the quality of life in postoperative patients with osteoporotic fractures but also indirectly affects it through rehabilitation exercise self-efficacy. Clinical medical staff should adopt targeted interventions to alleviate psychological pain and enhance rehabilitation exercise self-efficacy, thereby improving patients' quality of life.

Objective:To explore the predictive value of systemic immune inflammation index combined with stress response index for postoperative urinary tract infection in patients with complicated kidney stones.Methods:From June 2021 to June 2023,97 patients who underwent treatment for urinary tract infection after complex kidney stone operation in Cangzhou Hospital of Integrated Traditional and Western Medicine were selected as infected group,and 87 patients who did not develop urinary tract infection after complex kidney stone operation were selected as uninfected group.Systemic immunoinflammatory index(SII),neutrophils,lympho-cyte,platelet,malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT)levels were detected.Multivariate Logistic regression analysis was performed to analyze risk factors of postoperative urinary tract infection,and ROC curve was drawn to analyze the predictive value of SII,MDA,SOD and CAT alone and combined detection for postoperative urinary tract infection in patients with complex kidney stones.Results:Compared with uninfected group,levels of SII,neutrophils and MDA were increased in infected group,while levels of SOD and CAT were decreased(P<0.05).Levels of lymphocytes and platelets were decreased,the difference was not statistically significant(P>0.05).Multivariate Logistic regression analysis showed that presence of urinary tract history,opera-tion time≥100 min,urinary catheter retention time≥7 d,presence of preoperative urinary tract infection,stone load≥1 000 mm2,combined renal dysfunction,and preoperative blood glucose≥6.15 mmol/L were main risk factors for postoperative urinary tract infection in patients with complex kidney stones.ROC curve showed that combined detection was significantly more effective than single detec-tion of SII,MDA,SOD and CAT in the diagnosis of postoperative urinary tract infection in patients with precomplex kidney stones.Conclusion:Patients with urinary tract infection after complicated kidney stones have increased SII and MDA,decreased SOD and CAT levels,and the abnormal increased or decreased expression level are the predictors of risk of urinary tract infection after compli-cated kidney stones,which may be related with the diagnosis,development and prognosis of the disease.