BACKGROUND: Bile acids (BAs) facilitate the progression of gastric intestinal metaplasia (GIM). Long non-coding RNAs (lncRNAs) dysregulation was observed along with the initiation of gastric cancer. However, how lncRNAs function in GIM remains unclear. This study aimed to explore the role and mechanism of lncRNA PVT1 in GIM, and provide a potential therapeutic target for GIM treatment. METHODS: We employed RNA sequencing (RNA-seq) to screen dysregulated lncRNAs in gastric epithelial cells after BA treatment. Bioinformatics analysis was conducted to reveal the regulatory mechanism. PVT1 expression was detected in 21 paired biopsies obtained under endoscopy. Overexpressed and knockdown cell models were established to explore gene functions in GIM. Molecular interactions were validated by dual-luciferase reporter assay, RNA immunoprecipitation (RIP), and chromatin immunoprecipitation (Ch-IP). The levels of relative molecular expression were detected in GIM tissues. RESULTS: We confirmed that lncRNA PVT1 was upregulated in BA-induced GIM model. PVT1 promoted the expression of intestinal markers such as CDX2 , KLF4 , and HNF4α . Bioinformatics analysis revealed that miR-34b-5p was a putative target of PVT1 . miR-34b-5p mimics increased CDX2 , KLF4 , and HNF4α levels. Restoration of miR-34b-5p decreased the pro-metaplastic effect of PVT1 . The interactions between PVT1 , miR-34b-5p, and the downstream target HNF4α were validated. Moreover, HNF4α could transcriptionally activated PVT1 , sustaining the GIM phenotype. Finally, the activation of the PVT1 /miR-34b-5p/ HNF4α loop was detected in GIM tissues. CONCLUSIONS BAs facilitate GIM partially via a PVT1/miR-34b-5p/HNF4α positive feedback loop. PVT1 may become a novel target for blocking the continuous development of GIM and preventing the initiation of gastric cancer in patients with bile reflux.
Humans ; RNA, Long Noncoding/metabolism* ; MicroRNAs/metabolism* ; Hepatocyte Nuclear Factor 4/genetics* ; Bile Acids and Salts ; Kruppel-Like Factor 4 ; Metaplasia/metabolism*

Deep learning method can be used to automatically analyze electrocardiogram (ECG) data and rapidly implement arrhythmia classification, which provides significant clinical value for the early screening of arrhythmias. How to select arrhythmia features effectively under limited abnormal sample supervision is an urgent issue to address. This paper proposed an arrhythmia classification algorithm based on an adaptive multi-feature fusion network. The algorithm extracted RR interval features from ECG signals, employed one-dimensional convolutional neural network (1D-CNN) to extract time-domain deep features, employed Mel frequency cepstral coefficients (MFCC) and two-dimensional convolutional neural network (2D-CNN) to extract frequency-domain deep features. The features were fused using adaptive weighting strategy for arrhythmia classification. The paper used the arrhythmia database jointly developed by the Massachusetts Institute of Technology and Beth Israel Hospital (MIT-BIH) and evaluated the algorithm under the inter-patient paradigm. Experimental results demonstrated that the proposed algorithm achieved an average precision of 75.2%, an average recall of 70.1% and an average F ₁-score of 71.3%, demonstrating high classification accuracy and being able to provide algorithmic support for arrhythmia classification in wearable devices.
Humans ; Arrhythmias, Cardiac/diagnosis* ; Algorithms ; Electrocardiography/methods* ; Neural Networks, Computer ; Signal Processing, Computer-Assisted ; Deep Learning ; Classification Algorithms

To explore the effect of simulation technology in the training of flexible fiberoptic intubation for undergraduate students. The research subjects were 39 students majoring in dentistry at Air Force Medical University, including 22 males and 17 females with an average age of 20.62 years. The study subjects were randomly divided into two groups, with 19 in experimental group and 20 in control group. There were no significant differences in gender and age distribution. The experimental group used the flexible fiberoptic bronchoscopy to perform 5 times in endoscopic operation training module, while the control group was only familiar with flexible fiberoptic bronchoscopy without simulation training. The two groups were evaluated for their skills after training. The evaluation included the duration of placing the fiberoptic bronchoscope into the airway and the time to find the target pattern. The duration of placing and finding the target pattern were compared between two groups. The Global rating scale(GRS) was used to evaluate the proficiency of positioning, operation and direction. The students gave self-confidence feedback before and after the training, and the rating was based on the Liker five-level scale. The experimental group of students had a bronchoscopy insertion time of 18.0 (18.0, 20.0) s and a target pattern search time of 20.0 (17.0, 21.0) s, both of which were significantly faster than the control group′s times of 30 (36.0, 47.0) s and 39.0 (30.0, 41.0) s, respectively, P<0.001. The experimental and control groups′ GRS scores for task proficiency were 3.0 (3.0, 4.0) and 3.0 (3.0, 4.0), respectively, which were substantially higher than those in the control group (2.0, 1.0, 2.0) and 2.0 (1.0, 2.0) ( P<0.001). There was no statistically significant difference in confidence feedback between the two groups prior to training, according to the results of the trainees′ feedback on operational confidence. The control group had a confidence feedback score of 2.0 (1.0, 2.0) after training, while the experimental group earned a feedback score of 3.0 (2.0, 3.0), showing a substantial gain in student confidence ( P<0.001). Fiberoptic bronchoscopy intubation simulation training is excellent for novices to quickly understand this technology, increase their academic performance and confidence, and provide an effective reference for undergraduate teaching of this technology.

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.

Paraganglioma（PGL）is an extra-adrenal catecholamine-secreting endocrine tumor. We reported a young female patient who was admitted to the hospital with right flank pain and diagnosed with right retroperitoneal PGL with Mayo Ⅳ inferior vena cava tumor thrombus（double tumor thrombus）. After multidisciplinary consultation，right retroperitoneal PGL resection，right nephrectomy，inferior vena cava Mayo Ⅳ tumor thrombus resection and reconstruction were performed. Postoperative pathology showed that the primary tumor and inferior vena cava tumor thrombus was consistent with PGL. Genetic testing revealed a heterozygous germline nonsense mutation at c.69_70delinsTT（p.Q24*）locus of the SDHB gene in the patient. His mother was a carrier of the gene，but his father and sister did not carry the mutation. The patient recovered smoothly after surgery.

Objective To compare the effects of main artery clamping(MAC)and selective artery clamping(SAC)strategies on postoperative renal function in patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy.Methods A retrospective cohort study was conducted on 231 patients with preoperative chronic renal insufficiency[eGFR<90 mL/(min·1.73 m2)with renal injury markers or eGFR<60 mL/(min·1.73 m2)]who underwent robot-assisted partial nephrectomy in the Department of Urology of the First Affiliated Hospital of Army Medical University from February 2018 to February 2024.According to intraoperative renal artery clamping strategy,they were divided into a MAC group(n=129)and a SAC group(n=102).Preoperatively,individualized renal artery clamping strategies were developed using a machine learning-based multimodal holographic 3-D reconstruction technique.Serum creatinine(Scr)level was measured at 3 d and 3 months after surgery,and estimated glomerular filtration rate(eGFR)was calculated using the chronic kidney disease epidemiology collaboration equation(CKD-EPI)formula.Renal dynamic imaging with 99mTc-DTPA or 99mTc-MAG3 was used to assess the GFR of the affected kidney.Results At 3 d after surgery,the decrease in GFR of the affected kidney was significantly lower[(8.3±7.7)vs(16.0±10.2)mL/(min·1.73 m2),95%CI:-10.2～-5.2,P<0.001]in the SAC group than the MAC group.Scr increment analysis showed that the SAC group exhibited notably lower Scr increase[8.2(2.5,18.7)vs 15.5(5.8,28.3)μmol/L,95%CI:-12.3～-1.8,P=0.027],and milder eGFR decline[3.0(0.5,7.8)vs 7.5(2.0,14.3)mL/(min·1.73 m2),95%CI:-6.2～-0.8,P=0.015].And,in 3 months after surgery,the SAC group had lower Scr level[(89.2±23.1)vs(95.3±22.1)μmol/L,95%CI:-11.9～-0.3,P=0.042],and higher GFR of the affected kidney[(33.5±10.5)vs(26.1±10.9)mL/(min·1.73 m2),95%CI:4.6～10.2,P<0.001].Conclusion For patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy,SAC strategy is superior to MAC strategy in protecting postoperative renal function without increasing surgical risk.

Objective To investigate the expression levels of LINC02009 and LOC107984895 in peripheral lymphocytes of patients with atrial fibrillation and their clinical significance.Methods A total of 75 hospitalized patients with atrial fibrillation(50 with persistent atrial fibrillation and 25 with paroxysmal atrial fibrillation)from Kunming First People's Hospital between January 2023 and December 2023 were selected as study subjects,along with 50 normal control patients.Real-time quantitative PCR was used to detect the expression levels of LINC02009 and LOC107984895 in peripheral blood leukocytes of patients with atrial fibrillation.Logistic regression analysis was employed to assess the relationship between expression levels and risk factors for atrial fibrillation,and ROC curves were used to predict the diagnostic cut-off values for LINC02009 and LOC107984895 in diagnosing atrial fibrillation.Results There were statistically significant differences in baseline diseases such as hypertension and coronary heart disease,biochemical indicators such as Cr and BNP,and myocardial remodeling indicators such as LAd and LVEF between the AF(paroxysmal atrial fibrillation and persistent atrial fibrillation)group and the Normal group(P＜0.05).The expression levels of LINC02009 and LOC 107984895 in the plasma of the atrial fibrillation group were significantly higher than those in the control group(P＜0.05)and were negatively correlated with LVEF(P＜0.05).The areas under the curve(AUC)of LINC02009 and LOC 107984895 in predicting atrial fibrillation were 0.967(95％CI:0.938～0.995)and 0.900(95％CI:0.838～0.963),respectively.The optimal cut-off values were 1.985 and 0.915,with sensitivities of 88％and 76％,respectively,and specificities of 94％and 90％,respectively.Conclusion LINC02009 and LOC 107984895 are independent risk factors for atrial fibrillation and have certain predictive value for the occurrence of atrial fibrillation.

Objectives:To investigate the clinical efficacy and safety of posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior oblique lumbar interbody fusion(OLIF)+posterior O-arm navi-gated internal fixation in the treatment of patients with degenerative scoliosis.Methods:A retrospective anal-ysis was performed on the 55 patients with degenerative scoliosis who were treated in our hospital between May 2016 and June 2023.According to surgical method,the patients were divided into posterior O-arm navi-gated internal fixation+osteotomy orthopedic group(group A,20 cases)and anterior OLIF+posterior O-arm navi-gated internal fixation group(group B,25 cases).Group A consisted of 8 males and 12 females,aged 47-81(66.4±7.4)years old;Group B consisted of 8 males and 17 females,aged 52-81(67.4±8.2)years old.The pe-rioperative data of the patients were collected,and the visual analogue scale(VAS)score and Oswestry disabil-ity index(ODI)were recorded before operation,at postoperative 1 week and final follow-up to evaluate the clinical efficacy,and full-length spinal X-ray were taken in the standing position at the same time point to measure the coronal Cobb angle,sagittal vertical axis(SVA),lumbar lordosis(LL),intervertebral space height,vertebral fusion rate.The complications were recorded and compared between groups.Results:The patients were followed up for 18-38(26.5±5.3)months in group A and 20-36(24.3±4.2)months in group B,with no statistical difference(P＞0.05).Statistical differences(P＜0.05)were observed between group A and group B in operative time(219.0±25.7min vs 169.4±25.6min),intraoperative blood loss(1087.5±353.1mL vs 672.5±308.6mL),postoperative drainage volume(364.7±22.9mL vs 109.3±25.3mL),postoperative ambulation time(11.0±3.4d vs 6.3±1.8d),and number of blood transfusions(18 vs 8).The VAS scores were 6.2±0.9 points and 1.8±0.8 points in group A at postoperative 1 week and final follow-up respectively,which were 4.4±0.9 and 1.3±0.5 in group B,and group B was lower than group A at the same postoperative time point(P＜0.05).The ODI of group A and group B at postoperative 1 week were(22.8±4.8)％and(19.9±2.9)％,and group B was lower than group A(P＜0.05),while there was no significant difference between the two groups at final follow-up(P＞0.05).At postoperative 1 week and final follow-up,the sagittal SVA of group A was 47.0±1 1.5mm and 43.9±19.7mm,which was 35.2±19.9mm and 30.9±19.9mm in group B,and the sagittal correction in group A was better than that in group B(P＜0.05).There was no statistical difference between the two groups in coronal Cobb angle and LL at postoperative 1 week and final follow-up(P＞0.05).The intervertebral space height of group A was 48.1±8.2mm and 46.1±8.5mm at postoperative 1 week and final follow-up,which was 57.4±5.4mm and 56.3±5.6mm in group B,and group B was better than group A(P＜0.05).There were 2 cases of postoperative cerebrospinal fluid leakage,2 cases of delayed incision healing,1 case of nail and rod fracture,1 case of screw loosening in group A,and the complication rate was 30％(6/20);2 cases in group B had postoperative pain on the anteromedial side of the left thigh,and 2 cases had transient left hip flexion weak-ness,all of which recovered at follow-up,and the complication rate was 16％(4/25).The complication rate was higher in group A than group B(P＜0.05).Both groups had no incision infection or spinal cord injury complications.At final follow-up,the bone graft and fusion device were osseous fusion in both groups.Con-clusions:Both posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior OLIF+posterior O-arm navigated internal fixation can achieve satisfactory clinical efficacy in the treatment of degen-erative scoliosis,the former has better sagittal orthopedic effect,but has the problems of long operative time,large amount of bleeding,long postoperative bed rest,and many complications,while the latter has a similar scoliosis correction,as well as the advantages of minimally invasive,less traumatic,fast recovery and fewer complications,which can provide a new option for the minimally invasive treatment of degenerative scoliosis.

Objective:To investigate the incidence of shoulder work-related musculoskeletal disorders (WMSDs) among occupational population in China, and to explore their intrinsic association with personal and work-related factors.Methods:In April 2024, 73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China, and the general information, occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected. By using Chi-square test and confirmatory factor analysis, the relationship between shoulder fatigue and pain in key occupational groups and individual factors, work type, work posture and work organization was discussed, and the internal relationship was analyzed based on structural equation model.Results:Higher incidence of shoulder fatigue and pain were associated with female, lack of physical exercise, uncomfortable working posture and neck leaning forward ( P<0.05). Structural equation model analysis showed that work type, work posture and work organization were strongly correlated ( r=0.58, 0.55). Work organization and work type were strongly correlated with shoulder fatigue ( r=0.65) and moderately correlated with shoulder fatigue ( r=0.21). Shoulder fatigue was moderately associated with shoulder pain ( r=0.40). Individual factors, work type, work posture and shoulder fatigue could directly affect shoulder pain ( OR=0.07, -0.09, 0.17 and 0.40), and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue ( OR=0.08, 0.03). Work organization only indirectly affected shoulder pain through shoulder fatigue ( OR=0.26) . Conclusion:The main influencing factor of shoulder pain is shoulder fatigue, followed by work posture and individual factors. Structural equation model can better reflect the complex relationship between work type, work posture and work organization and shoulder WMSDs. Improving work posture and work organization may be an effective way to control the influence of shoulder fatigue on shoulder pain.

Objective:To explore the structural equation model to explore the levels of work-related musculoskeletal disorders (WMSDs) and various risk factors in the feet and ankle of China's occupational population, providing scientific basis for for preventing WMSDs in feet and ankles.Methods:Data of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders. The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors (including individual factors, work organization, work posture, work type, fatigue, etc.) in key occupational groups in China, and structural equation model hypothesis, fitting, verification, and path and intermediary effect analysis were carried out. The model fit evaluation indexes included Chi-square specific degrees of freedom ( χ2/ df), gauge fit index (NFI), Tucker Lewis index (TLI), goodness of Fit index (GFI), adjusted Goodness of Fit index (AGFI) and approximate root mean square error (RMSEA) . Results:A total of 73497 occupational workers were surveyed, with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17% and 12.06%, respectively. The fitting index of the adjusted structural equation model basically meets the standard (GFI=1, AGFI=1, RMESA=0.042, NFI=0.716, TLI=0.663). The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue, work type, and work organization, with standardized path coefficients of 0.221, 0.105, and 0.095, respectively. The top two factors affecting feet and ankle muscle fatigue are work organization and work type, with standardized path coefficients of 0.548 and 0.383, respectively. Feet and ankle muscle fatigue, work type, work organization, and work posture have a direct effect on feet and ankle WMSDs, with effect values of 0.221, 0.105, 0.095, and 0.077, respectively. The organization and type of work can also have indirect effects through feet and ankle muscle fatigue, with effect values of 0.121 and 0.084, respectively.Conclusion:Feet and ankle muscle fatigue has a direct impact on WMSDs, and plays a mediating role between ankle and ankle WMSDs caused by work organization and work type. Feet and ankle muscle fatigue is an important pathway leading to feet and ankle WMSDs. It is recommended that employers and managers detect job fatigue early and take corresponding prevention and intervention measures, which can play a key role in preventing feet and ankle WMSDs.