1.Spatiotemporal distribution of Aedes albopictus and its influencing factors in China from 2000 to 2019
Zerui JIAO ; Lei QU ; Duoquan WANG ; Yi ZHANG ; Shan LÜ
Chinese Journal of Schistosomiasis Control 2025;37(3):268-275
Objective To investigate the spatial distribution of Aedes albopictus in China at different time periods from 2000 to 2019, so as to provide insights into precise management of Ae. albopictus in China. Methods Data pertaining to the distribution of Ae. albopictus in China from 2000 to 2019 were collected through literature retrieval with terms of “Aedes albopictus”, “monitoring”, “survey”, “density”, “distribution”, and “outbreak” in national and international databases. The title and time of the publication, sampling sites, sampling time, mosquito capture methods, and mosquito species and density were extracted, and the longitude and latitude of sampling sites were obtained through Baidu Map. Meteorological element data at meteorological observation stations within China were obtained from the National Climatic Data Center of the United States, and the annual maximum temperature, annual minimum temperature, average temperature in January, average temperature in July, annual temperature range, daily temperature range and relative humidity were calculated and subjected to Kriging interpolation. Monthly cumulative precipitation grid data and monthly average temperature grid data with a resolution of 1 km for China from 2000 to 2019 were obtained from the National Tibetan Plateau Scientific Data Center, and the annual precipitation and annual average temperature were calculated cumulatively. Population density data in China from 2000 to 2019 were obtained from the WorldPop Hub, and the gross domestic product (GDP) in China was obtained from the Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences. The above data were divided into 5-year intervals to calculate data during the periods from 2000 to 2004, from 2005 to 2009, from 2010 to 2014, and from 2015 to 2019. Ae. albopictus distribution data were modeled in China from 2000 to 2019 and during each period with the classification random forest (RF) model, to predict the distribution of Ae. albopictus across the country and analyze the distribution of Ae. albopictus based on the seven major climate zones in China. The performance of RF models was evaluated by accuracy, precision, recall, and area under the receiver operating characteristic curve (AUC), and the importance of each feature in the RF model was evaluated with mean decrease accuracy (MDA). Results A total of 1 191 Chinese publictions and 391 English publications were retrieved, among which 580 articles provided detailed data on the sampling sites of Ae. albopictus and specific sampling years, meeting the inclusion criteria. A total of 2 234 Ae. albopictus sampling sites were included in China from 2000 to 2019, and RF modeling results showed that the overall Ae. Albopictus distribution area was mainly found in southeastern and southwestern provinces of China from 2000 to 2019, with scattered distribution in coastal areas of northeastern provinces, such as Liaoning Province. The accuracy, precision, recall and AUC of the RF model were 0.915 to 0.947, 0.933 to 0.975, 0.898 to 0.978, and 0.902 to 0.932 for the distribution of Ae. albopictus at different time periods from 2000 to 2019. Among all features in the RF models, population density was the most contributing factor to the distribution of Ae. albopictus in China, followed by GDP, and all meteorological variables contributed relatively less to the predictive power of the RF model. In China’s seven major climate zones, Ae. albopictus was almost entirely distributed in the marginal tropical humid region, the north subtropical humid region, and the warm temperate semi-humid region. The combined distribution area of these three zones accounted for 100.0% of the national distribution area from 2000 to 2004, from 2005 to 2009, and from 2010 to 2014, and 99.9% from 2015 to 2019, and the proportion of Ae. albopictus distribution area in the warm temperate semihumid region increased gradually from 20.2% to 30.2%. Conclusions Ae. albopictus is mainly distributed in the southeastern and southwestern provinces of China and is greatly influenced by population and economic factors. The warm temperate semi-humid region in China is gradually becoming a hot spot for the distribution of Ae. albopictus.
2.Brain injury biomarkers and applications in neurological diseases.
Han ZHANG ; Jing WANG ; Yang QU ; Yi YANG ; Zhen-Ni GUO
Chinese Medical Journal 2025;138(1):5-14
Neurological diseases are a major health concern, and brain injury is a typical pathological process in various neurological disorders. Different biomarkers in the blood or the cerebrospinal fluid are associated with specific physiological and pathological processes. They are vital in identifying, diagnosing, and treating brain injuries. In this review, we described biomarkers for neuronal cell body injury (neuron-specific enolase, ubiquitin C-terminal hydrolase-L1, αII-spectrin), axonal injury (neurofilament proteins, tau), astrocyte injury (S100β, glial fibrillary acidic protein), demyelination (myelin basic protein), autoantibodies, and other emerging biomarkers (extracellular vesicles, microRNAs). We aimed to summarize the applications of these biomarkers and their related interests and limits in the diagnosis and prognosis for neurological diseases, including traumatic brain injury, status epilepticus, stroke, Alzheimer's disease, and infection. In addition, a reasonable outlook for brain injury biomarkers as ideal detection tools for neurological diseases is presented.
Humans
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Biomarkers/cerebrospinal fluid*
;
Nervous System Diseases/diagnosis*
;
Brain Injuries/metabolism*
;
Phosphopyruvate Hydratase/cerebrospinal fluid*
;
Glial Fibrillary Acidic Protein/blood*
;
S100 Calcium Binding Protein beta Subunit/blood*
;
tau Proteins/cerebrospinal fluid*
;
Ubiquitin Thiolesterase/blood*
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Myelin Basic Protein/cerebrospinal fluid*
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Neurofilament Proteins/blood*
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MicroRNAs/blood*
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Brain Injuries, Traumatic/metabolism*
3.Effect and mechanism of Buyang Huanwu Decoction in improving neurological function in ischemic stroke rats based on IRE1α/ASK1/JNK pathway.
Xin-Rong ZHANG ; Tian-Lang WANG ; Jia-Hao ZHANG ; Lu JIN ; Jian-Bo WANG ; Ya-Nan XUE ; Yi QU
China Journal of Chinese Materia Medica 2025;50(14):3857-3867
This study aimed to investigate the effect and mechanism of Buyang Huanwu Decoction in regulating endoplasmic reticulum stress via the inositol-requiring enzyme 1α(IRE1α)/apoptosis signal-regulating kinase 1(ASK1)/c-Jun N-terminal kinase(JNK) pathway to improve neurological function in rats with cerebral ischemia/reperfusion injury(CIRI). SPF-grade male sprague-dawley(SD) rats were randomly divided into Sham group, model group, Buyang Huanwu Decoction group, and edaravone group. Except for the Sham group, the other groups were subjected to the modified suture method to establish a middle cerebral artery occlusion/reperfusion(MCAO/R) model. After treatment, neurological function was assessed using the Zea Longa scoring system. Gait analysis was used to detect the motor function. Detection of relative infarct area in brain tissue using 2,3,5-triphenyltetrazolium chloride(TTC) staining. Nissl staining was used to observe the structure of neuronal cells. Western blot and real-time fluorescence quantitative PCR(RT-qPCR) were used to detect IRE1α, ASK1, JNK, B cell lymphoma-2(Bcl-2), Bcl-2 related X protein(Bax), and Caspase-3 in the brain tissue. Immunohistochemistry was used to detect the positive expression of IRE1α, ASK1, and JNK. Immunofluorescence was used to detect the fluorescence expression levels of Bax, Bcl-2, and Caspase-3. The results showed that compared with the Sham group, the model group exhibited increased neurological scores(P<0.01), increased ratio of ground contact area and strength in both forelimbs(P<0.01), enlarged relative infarct area of brain tissue(P<0.05), and a reduced number of Nissl staining-positive cells(P<0.01). The protein and mRNA expression levels of IRE1α, ASK1, JNK, Bax, and Caspase-3 in brain tissue were significantly elevated, while those of Bcl-2 were decreased(P<0.05). Compared with the model group, both the Buyang Huanwu Decoction group and edaravone group showed reduced neurological scores(P<0.05), decreased ratio of ground contact area and strength in both forelimbs(P<0.05), smaller relative infarct area(P<0.05), alleviated neuronal damage, and increased number of Nissl staining-positive cells(P<0.05). The expression levels of IRE1α, ASK1, JNK, Bax, and Caspase-3 protein and mRNA in brain tissue were significantly reduced, while those of Bcl-2 were significantly increased(P<0.05). The results indicated that Buyang Huanwu Decoction can effectively improve brain injury in CIRI rats, and its mechanism of action may be related to regulating the endoplasmic reticulum stress IRE1α/ASK1/JNK signaling pathway.
Animals
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Male
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Rats, Sprague-Dawley
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Protein Serine-Threonine Kinases/genetics*
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Drugs, Chinese Herbal/administration & dosage*
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Rats
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MAP Kinase Kinase Kinase 5/genetics*
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Ischemic Stroke/physiopathology*
;
Humans
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MAP Kinase Signaling System/drug effects*
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Apoptosis/drug effects*
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Endoribonucleases/genetics*
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JNK Mitogen-Activated Protein Kinases/genetics*
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Endoplasmic Reticulum Stress/drug effects*
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Multienzyme Complexes
4.Sub-committee of Anesthesiology of Guangzhou Integrated Traditional Chinese and Western Medicine Society.
Yi LU ; Cunzhi LIU ; Wujun GENG ; Xiaozhen ZHENG ; Jingdun XIE ; Guangfang ZHANG ; Chao LIU ; Yun LI ; Yan QU ; Lei CHEN ; Xizhao HUANG ; Hang TIAN ; Yuhui LI ; Hongxin LI ; Heying ZHONG ; Ronggui TAO ; Jie ZHONG ; Yue ZHUANG ; Junyang MA ; Yan HU ; Jian FANG ; Gaofeng ZHAO ; Jianbin XIAO ; Weifeng TU ; Jiaze SUN ; Yuting DUAN ; Bao WANG
Journal of Southern Medical University 2025;45(8):1800-1808
OBJECTIVES:
To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and.
RESULTS:
Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.
CONCLUSIONS
The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans
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Medicine, Chinese Traditional
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Cancer Pain/therapy*
;
Drugs, Chinese Herbal/therapeutic use*
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Drug Delivery Systems
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Pain Management/methods*
;
China
5.Long-term outcome of patients with rectal cancer who achieve complete or near complete clinical responses after neoadjuvant therapy: a multicenter registry study of data from the Chinese Watch and Wait Database
Yiming ZHAO ; Weihu WANG ; Wei ZHANG ; Lin WANG ; Shuai LI ; Jingwen WANG ; Leen LIAO ; Guanyu YU ; Zhen SUN ; Yanli QU ; Yang GONG ; Yun LU ; Tao WU ; Yunfeng LI ; Quan WANG ; Guohua ZHAO ; Yi XIAO ; Peirong DING ; Zhen ZHANG ; Aiwen WU
Chinese Journal of Gastrointestinal Surgery 2024;27(4):372-382
Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.
6.Development and Application of Catheter Electrodes for Rat Airway High-Voltage Pulsed Electric Field Ablation
Nana ZHANG ; Yirong AN ; Jiawei TIAN ; Xuan HAN ; Shen'ao QU ; Haoze LENG ; Shiran TAO ; Fenggang REN ; Yi LYU ; Haoyang ZHU
Chinese Journal of Medical Instrumentation 2024;48(5):568-572
High-voltage pulsed electric field(HV-PEF)ablation technology has demonstrated promising applications in the clinical treatment of chronic obstructive pulmonary disease(COPD).However,its use has been limited to exploratory applications in a small number of cases,and the underlying mechanisms remain largely undefined.To facilitate broader clinical implementation,comprehensive molecular mechanism studies via extensive animal experimentation are essential.Rats,due to their ease of modeling COPD and the availability of comprehensive molecular reagents,serve as an optimal model for such studies.Consequently,the development of electrodes specifically designed for HV-PEF respiratory ablation in SD rats is of significant importance.In this study,we meticulously examined the anatomical structure of rat airways and investigated various equipment parameters,including material composition,rigidity,diameter,electrode ring dimensions,spacing between positive and negative poles,insulation coating for the catheters,welding techniques between the guidewire and electrode ring,and the design of vent holes in the catheter.Based on these considerations,we fabricated PVC ablation electrode catheters with integrated ventilation functionality.Subsequently,we employed finite element simulation to estimate the field strengths that could be applied by these electrodes.The simulation results were then validated in normal rats to assess the electrical safety and efficacy of the electrodes.These findings laid the groundwork for further investigation into the mechanisms of HV-PEF treatment for COPD.
7.N-acetylcysteine regulates NF-κB signaling pathway alleviates the pulmonary toxicity induced by indium-tin oxide nanoparticles in rats
Weikang LI ; Yi ZHANG ; Xiaoyu QU ; Yinqiao LIN ; Yanzi ZHAO ; Nan LIU
Chinese Journal of Industrial Hygiene and Occupational Diseases 2024;42(10):721-729
Objective:The current study aimed to evaluate the possible protective effects of N-acetylcysteine (NAC) against Indum-tin oxide (ITO) nanoparticle (Nano-ITO) -induced pulmonary alveolar proteinosis (PAP) in rats, especially via modulation of nuclear factor kappa B (NF-κB) signaling.Methods:In October 2019, 50 adult male Sprague-Dawley rats were randomly allocated into five groups (10 rats each) as follows: blank control group, saline control group, NAC control group (200 mg/kg), Nano-ITO group (receiving a repeated intratracheal dose of 6 mg/kg Nano-ITO) and NAC intervention group (pre-treated intraperitoneally with 200 mg/kg NAC 1.5 h before the administration of an intratracheal dose of 6 mg/kg Nano-ITO). The rats were exposed twice a week for 12 weeks. Rats were then euthanized under anesthesia, and their lungs were removed for histopathological and immunohistochemical analysis. The comparison of indicators reflecting oxidative stress and pulmonary inflammation among groups was conducted using one-way analysis of variance (ANOVA) and Bonferroni's test. The effect of NAC on Nano-ITO induced NF-κB signaling pathway in rats was analyzed.Results:Histopathological examination of Nano-ITO exposed rats revealed diffuse alveolar damage, including PAP, cholesterol crystals, alveolar fibrosis, pulmonary fibrosis, and alveolar emphysema. Immunohistochemical results of Nano-ITO exposed rats showed strong positive for nuclear factor κB p65 (NF-κB p65) and nuclear factor Kappa B inhibitory factor kinase (IKK-β) and weak positive for nuclear factor κB inhibitory protein α (IκB-α) in the nuclei of bronchiolar and alveolar epithelial cells. Compared with blank control group, saline control group and NAC control group, the level of total protein (TP) in bronchoalveolar lavage fluid of rats in Nano-ITO group was significantly increased ( P<0.05), and the activities of lactate dehydrogenase (LDH), superoxide dismutase (SOD), malondialdehyde (MDA) content and total antioxidant capacity (T-AOC) were significantly increased ( P<0.05), the levels of proinflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were significantly increased ( P<0.05), and the levels of NF-κB p65, IKK-β, inducible nitric oxide synthase (iNOS) and reactive oxygen species (ROS) in lung tissue were significantly increased ( P<0.05). Compared with Nano-ITO group, the levels of TP, T-AOC, MDA and TNF-α in bronchoalveolar lavage fluid of rats in NAC intervention group were significantly decreased ( P<0.05), and the levels of NF-κB p65 and ROS in lung tissue were significantly decreased (P<0.05). Western blot results showed that compared with the control groups, the protein expressions of NF-κB p65 and IKK-β in the lung tissue of Nano-ITO group were increased, while the protein expression of IκB-α was decreased ( P<0.05). Compared with Nano-ITO group, the protein expressions of NF-κB p65 and IKK-β in lung tissue of rats in NAC intervention group were decreased, while the protein expression of IκB-α was increased ( P<0.05) . Conclusion:The study demonstrated that Nano-ITO might induce pulmonary toxicity through the activation of NF-κB signaling pathway, and NAC could antagonize the pulmonary toxicity of Nano-ITO by inhibiting the NF-κB signaling pathway.
8.Evaluation of disinfection effect of high-energy pulse ultraviolet disinfection equipment in medical institution settings
Zhengchun SUN ; Jincai ZHU ; Tingting ZHU ; Xiaorong QU ; Nan LI ; Yuxin ZHAO ; Shuang WANG ; Xiaodong YUAN ; Guoliang LI ; Nengwei ZHANG ; Yi XING ; Qi YAO
Chinese Journal of Preventive Medicine 2024;58(6):857-861
Objective:To evaluate the disinfection effect of high-energy pulse ultraviolet disinfection equipment in medical institution settings.Methods:The disinfection effect was evaluated through field tests and laboratory tests. Among them, 135 high-frequency contact points were selected from nine departments in the field test. Samples were collected before and after disinfection, and the disinfection effects of 75% alcohol wipes wiping disinfection, high-energy pulse ultraviolet disinfection robot disinfection and high-energy pulse ultraviolet handheld disinfection instrument were compared. In the laboratory test, 30 infected areas of the simulated test table were exposed to vertical ultraviolet irradiation and the bacterial-killing rate before and after disinfection was calculated.Results:In the field test, the bacteria-killing rates of 75% alcohol wipes, high-energy pulse ultraviolet disinfection robot and high-energy pulse ultraviolet handheld disinfection instrument were 94.99%, 91.53% and 95.94%, respectively, and the difference was statistically significant. The disinfection effect of the high-energy pulse ultraviolet handheld disinfection instrument was better than that of the high-energy pulse ultraviolet disinfection robot ( P values <0.05). In the laboratory test, the killing log value of Staphylococcus aureus and Escherichia coli on the carrier were both greater than 3.00. In the simulated field test, the killing log value of Staphylococcus aureus on the surface samples were 4.99. Conclusion:Both the high-energy pulse ultraviolet handheld disinfection instrument and the high-energy pulse ultraviolet disinfection robot have good disinfection effects, which are similar to the disinfection effects of conventional 75% alcohol wipes.
9.Improvement and exploration of potassium-competitive acid blockers dual therapy for the eradication of Helicobacter pylori
Weiwei CHEN ; Ruolin PENG ; Yi QU ; Zhenyu ZHANG
The Journal of Practical Medicine 2024;40(19):2806-2812
Helicobacter pylori infection is an important causative factor in a variety of gastrointestinal diseases,such as atrophic gastritis,peptic ulcer disease,and gastric cancer.Timely eradication treatment is con-ducive to maintaining the health of patients.With the increase of drug resistance in Helicobacter pylori,dual therapy with proton pump inhibitors combined with high-dose amoxicillin has gradually gained attention.Potassium-competitive acid blockers are new types of antacids that have a faster onset of action and a longer lasting acid sup-pression effect than traditional proton pump inhibitors,making it more suitable for dual therapy.In recent years,scholars have carried out a lot of exploration,improvement and verification of potassium-competitive acid blockers dual therapy,and this article reviews its research progress.
10.A study on the dynamic and static functional connectivity changes of amygdala subregions in patients with bilateral idiopathic tinnitus and hearing loss based on fMRI
Yue SHI ; Lanyue CHEN ; Yi ZHANG ; Xiaobo MA ; Wei LI ; Xiaoxia QU ; Qian WANG ; Yantao NIU ; Zhaohui LIU
Chinese Archives of Otolaryngology-Head and Neck Surgery 2024;31(9):574-579
OBJECTIVE To observe the changes of static functional connectivity(sFC) and dynamic functional connectivity(dFC) of amygdala subregions in patients with bilateral idiopathic tinnitus and hearing loss(TINHL). METHODS The resting-state functional magnetic resonance imaging(fMRI) data of 30 patients with bilateral tinnitus and hearing loss and 37 normal controls(NCs) were collected to analyze the intensity changes of sFC and dFC in 8 subregions of amygdala and the whole brain in TINHL patients. RESULTS There were no significant differences in age,sex and education between the two groups. Compared with the NCs group,the sFC intensity of the right basolateral subregion and right cerebellar peduncle 1 region,the left basolateral subregion and left orbital medial frontal gyrus and left angular gyrus in TINHL group was significantly decreased. The dFC intensity of left amygdalostriatal subregion and left precuneus in TINHL group was increased,but the dFC intensity was reduced in the left basolateral subregion and right angular gyrus as well as between the right superficial subregion and right medial orbital of superior frontal gyrus. CONCLUSION Among the 8 subregions of amygdala,the bilateral basolateral subregions,the left amygdalostriatal subregion and the right superficial region shown abnormal functional connectivity with other regions of the brain,which are the important parts of emotional abnormalities in TINHL.

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