Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

AIM:To investigate the antitumor activity and targets of baicalein(Bai)in pancreatic cancer using network pharmacology combined with in vitro and in vivo experiments.METHODS:The targets of Bai and pancreatic can-cer were analyzed via multi-data screening.A protein-protein interaction network was constructed using STRING,and core targets were identified via Cytoscape.Functional enrichment was analyzed by Gene Ontology(GO)and Kyoto Ency-clopedia of Genes and Genomes(KEGG).Antitumor effects of Bai were assessed in pancreatic cancer cells Aspc-1 and Bxpc-3 using MTT and colony formation assays for proliferation,flow cytometry for apoptosis and cell cycle analysis,and Transwell assays for migration and invasion.A xenograft tumor model was established to evaluate tumor proliferation,im-munohistochemistry was performed to detect the protein expression of AKT in tumor tissues,and Western blot was used to analyze the expression levels of AKT,β-catenin,N-cadherin and Slug.RESULTS:A total of 108 overlapping targets were identified between Bai and pancreatic cancer.Among these,7 core targets were recognized,including proto-onco-gene tyrosine-protein kinase Src,heat shock protein 90 alpha family class A member 1(HSP90AA1),estrogen receptor 1(ESR1),tumor protein p53(TP53),epidermal growth factor receptor(EGFR),AKT1,and mitogen-activated protein ki-nase 3(MAPK3).The GO analysis revealed significant enrichment in oxidative stress response,protein phosphorylation,and serine/threonine kinase activity.The KEGG analysis primarily enriched the PI3K/AKT,MAPK and Ras signaling pathways.The MTT and colony formation assays showed that Bai inhibited the viability of Aspc-1 and Bxpc-3 cells in a dose-dependent manner(72 h IC50 values were 73.6 μmol/L and 83.4 μmol/L,respectively)and reduced cell colony for-mation(P<0.05 or P<0.01).Flow cytometry confirmed that Bai induced apoptosis of Aspc-1 and Bxpc-3 cells(P<0.01)and blocked the cell cycle at the G0/G1 phase(P<0.05 or P<0.01).Transwell experiments indicated that Bai inhibited the migration and invasion of Aspc-1 and Bxpc-3 cells(P<0.05 or P<0.01).In vivo,Bai significantly inhibited the growth of Aspc-1 cell xenograft tumors(P<0.01).Immunohistochemistry revealed a significant reduction in AKT expression in tu-mor tissues(P<0.01),and Western blot showed decreased expression of AKT,β-catenin,N-cadherin and Slug in both Aspc-1 and Bxpc-3 cells(P<0.01).CONCLUSION:Baicalein inhibits pancreatic cancer cell proliferation,migration,and invasion,potentially through down-regulation of AKT,β-catenin,N-cadherin,and Slug expression.

Objective:To explore the relationship between post-traumatic growth and stress perception as well as the chain-mediated roles of psychological resilience and navigating social support in patients with primary liver cancer(PLC), in order to provide theoretical ideas for the nursing and intervention of PLC patients.Methods:Convenience sampling was used to select PLC patients admitted to the First Affiliated Hospital, Third Affiliated Hospital, and Fourth Affiliated Hospital of Xinjiang Medical University from October 2023 to May 2024 as the research subjects. A cross-sectional survey was conducted using Posttraumatic Growth Inventory, the Chinese Perceived Stress Scale, Perceived Social Support Scale, and the Connor-Davidson Resilience Scale.Results:A total of 236 PLC patients were ultimately included, including 189 males and 47 females. Age distribution was as follows: 18-40 years years (7 cases), 41-60 years (128 cases), and ≥61 years (101 cases). Posttraumatic growth showed a significant negative correlation with perceived stress ( r=-0.512, P<0.01), while demonstrating positive correlations with psychological resilience and perceived social support ( r=0.605, 0.515, both P<0.01). Psychological resilience and perceived social support had mediating and chain mediating effects between perceived stress and posttraumatic growth, with mediating effects of -0.176 and -0.069, accounting for 29.24% and 11.46% of the total effect, respectively. The chain mediating effect value was 0.073, accounting for 12.13% of the total effect. Conclusions:The pathway of stress perception on post-traumatic growth in patients with PLC is indirect, and stress perception can contribute to the growth of post-traumatic growth in patients through psychological resilience, and navigating social support.

Objective:To anatomically and phenotypically characterize the insular cortex(IC)-nucleus tractus soli-tarii(NTS)neural pathway.Methods:Adult male Sprague-Dawley rats were divided into three experimental cohorts for neural circuit tracing.Anterograde labeling was achieved by injecting anterograde self-complementary adeno-associated viruses(scAAVs)into the IC.Retrograde tracing involved NTS injections of either retrograde scAAVs or FluoroGold(FG),combined with immunofluorescence histochemical staining to identify IC-originating projection neurons.For postsynaptic neurochemical phenotype characterization,IC was injected with AAV2/1-CaMKII-Cre,while a mixture of AAV2/9-Syn-DIO-mCherry and AAV2/9-VGAT1-EGFP was injected into the NTS.The rats were allowed to survive for one week following scAAVs or FG injection or four weeks after recombinase-dependent systems injection.Then the rats were sacrificed,and serial brain sections were prepared for immunofluorescence histochemical staining(brain section containing FG)and subsequent fluorescence/confocal microscopic analysis.Results:(1)Anterograde viral tracing re-vealed dense axonal terminals from the IC projecting to the medial subnucleus of the NTS,while retrograde tracing re-vealed that IC neurons projecting to the NTS were predominantly localized within the dysgranular layer;(2)IC-NTS projection neurons were exclusive glutamatergic(100%,n=3);(3)NTS neurons receiving IC inputs were mainly lo-calized in the medial subnucleus,and were predominantly GABAergic(79.8±3.2%,n=3).Conclusion:The pres-ent results indicate that a descending pathway from excitatory neurons of the IC terminates onto inhibitory neurons of the NTS,which might represent a potential neuromodulatory target for visceral pain disorders.

Objective:To investigate the effects of annulus fibrosus(AF)suture or not on the lumbar biome-chanics following microendoscopic discectomy(MED)through establishing finite element models(FEMs)of unsu-tured AF incision and sutured AF incision.Methods:A 27-year-old healthy young adult male volunteer was recruited and underwent lumbar CT to exclude spinal deformities,tumors,and other osseous pathologies.CT images of the L4/L5 segment were imported into the software Mimics for three-dimensional reconstruction and contour extraction.The resulting model was further processed using Geomagic,SolidWorks,and Workbench for solid modeling.An intact L4/5 segment model,an L4/5 model with an unsutured AF incision following MED(unsutured AF model),and an L4/5 model with a sutured AF incision following MED(sutured AF model)were established.Intervertebral range of motion(ROM),Von-Mises stress on the facet joints,and Von-Mises stress on the AF of the models were measured,and model validity was verified by comparison with previously pub-lished studies.After validation,the inferior end of the L5 vertebral body in all the three models was fixed.An axial load of 500N was applied to the superior end of the L4 vertebral body,and a bending moment of 7.5N·m was separately applied under six physiological loading conditions(flexion,extension,left/right lateral bending,and left/right axial rotation).The biomechanical properties of the three models at the L4/5 level,in-cluding intervertebral ROM and Von-Mises stress in facet joints,and Von-Mises stress on the AF were com-pared under different loading conditions.Results:No significant discrepancies were noted when data obtained under these six motion conditions were compared with the findings from prior literature,thus validating the models.Stress nephogram results revealed that under each motion condition,high-stress areas were located at the unsutured defect of the intervertebral disc AF and the surrounding facet joint processes.Compared with the intact model,the intervertebral ROM of the sutured AF model was 8.6802°,8.596°,4.8514°,5.0249°,2.2474°,and 1.9092°,respectively,under the six motions,while that of the unsutured AF model was 8.7475°,8.9453°,5.6441°,5.2546°,2.5886°,and 1.9487°,respectively.The ROM of the sutured AF model was 9％,19％,44％,38％,50％,and 40％higher than that of the intact model;Compared with the unsutured AF mod-el,it was reduced by 1％,4％,14％,4％,13％,and 2％respectively.For Von Mises stress on the AF under the six motion conditions,the stress of the sutured AF model was 2％,65％,21％,32％,51％,and 38％higher than that of the intact model,but 8％,48％,52％,10％,37％,and 48％lower than that of the unsu-tured AF model respectively.For Von-Mises stress in facet joints,the stress values of the sutured AF model were 12.109MPa,8.3601MPa,13.998MPa,12.969MPa,10.219MPa,and 10.074MPa respectively,while those of the unsutured AF model were 13.399MPa,9.6094MPa,18.175MPa,17.967MPa,12.409MPa,and 11.6384MPa respectively.The stress values of Von-Mises stress in facet joints of the sutured AF model was 5％,10％,32％,17％,31％,and 34％higher than that of the intact model;Compared with the unsutured AF model,it was decreased by 9％,13％,22％,27％,17％,and 13％respectively.Conclusions:Among the three con-structed L4/5 FEMs,the sutured AF model exhibits more favorable intervertebral ROM,and Von-Mises stress of facet joints and AF compared with the unsutured AF model.This indicates that AF suture contributes to enhancing intervertebral stability.

Objective To establish normal reference values of video head impulse test(vHIT)for civil avia-tion student pilots to provide a reference basis for the accurate assessment of the vestibular function of civil aviation student pilots.Methods Forty civil aviation student pilots in the theoretical training phase were randomly selected for vHIT.The average gain of the vestibulo-ocular reflex(VOR)and the asymmetry ratios of the semicircular ca-nals were compared.Results The VOR values for the right horizontal,anterior,and posterior semicircular canals were 1.05±0.07,0.92±0.13,0.81±0.09,respectively.For the left horizontal,anterior,and posterior semicir-cular canals,the values were 1.00±0.06,0.85±0.10,0.86±0.10,respectively.There was no compensatory sac-cade in any of the subjects.The asymmetry ratios of bilateral horizontal,left anterior-right posterior,and right an-terior-left posterior semicircular canals were 5.56％±3.64％,9.65％±4.74％,8.68％±7.07％,respectively.Conclusion This study establishes vHIT normal reference values for civil aviation student pilots,providing an ob-jective basis for their selection and vestibular function evaluation.

Objective To explore the quantitative electroencephalography(qEEG)characteristics of the prefrontal cortex in patients with mild cognitive impairment(MCI)during digital screening tasks for MCI screening.Methods A total of 592 MCI patients(MCI group)and 317 normal cognitively elderly individuals(control group)were recruited from 40 communities in Nanjing,Jiangsu Province,from July to August,2024.All participants were as-sessed using Montreal Cognitive Assessment-Beijing Version(MoCA-BJ).Prefrontal EEG data were collected using a portable EEG device,and power spectral analysis was performed via Fast Fourier Transform.An XG-Boost algorithm was employed to construct an MCI identification model based on qEEG power features,and the model's performance was evaluated using receiver operating characteristic(ROC)curve.Results Compared with the control group,prefrontal δ,α,and β band power increased during screening tasks in MCI group(P<0.05);δ power was negatively correlated with MoCA-BJ total scores,and visuospatial/executive func-tion,attention and delayed recall scores(r=-0.269,-0.169,-0.133,-0.171,P<0.001);α power was negative-ly correlated with MoCA-BJ total scores,attention and delayed recall scores(r=-0.113,-0.075,-0.091,P<0.05).The XGBoost model based on δ and α power was excellent in MCI identification,with an area under the curve of 0.91,accuracy of 0.81,precision of 0.89,F1 score of 0.84,recall of 0.80,and specificity of 0.81.Conclusion MCI patients exhibit increased power in the prefrontal δ and α frequency bands during digital screening tasks,which is associated with cognitive decline.An XGBoost model based on qEEG power features can enable early prediction of MCI.

Objective:To explore the relationship between serum osteopontin (OPN), annexin A2 (ANXA2) and recurrence after partial laryngectomy in patients with early-stage glottic laryngeal cancer (EGC).Methods:A retrospective study was conducted by collecting clinical data from EGC patients who underwent partial laryngectomy at Beijing Shijitan Hospital from June 2020 to May 2022. Serum levels of OPN and ANXA2 were measured at the time of admission. Clinical data during the perioperative period were also collected. The recurrence within 2 years after surgery was used as the endpoint event. Patients were divided into a recurrence group and a non-recurrence group based on the occurrence of recurrence. The data were compared between the groups, and Cox regression was used to analyze the correlation between recurrence after partial laryngectomy and key factors. Receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive value of serum OPN and ANXA2 for recurrence within 2 years after surgery.Results:Among 167 EGC patients, 42 patients experienced recurrence within 2 years after surgery (recurrence group), with a median recurrence time of 16.00 (13.75, 19.25) months, and a recurrence rate of 25.15%; 125 patients did experience recurrence within 2 years after surgery (non-recurrence group). Compared to the non-recurrence group, the proportions of poorly differentiated tumors and anterior commissure invasion in the recurrence group were higher, the serum levels of OPN, ANXA2 and testosterone were higher: 52.38% (22/42) vs. 20.80% (26/125), 52.38% (22/42) vs. 20.00% (25/125), (24.26 ± 4.64) μg/L vs. (18.83 ± 4.17) μg/L, (37.62 ± 6.15) μg/L vs. (31.24 ± 5.56) μg/L, (27.26 ± 5.31) nmol/L vs. (22.85 ± 4.62) nmol/L, with significant differences ( P<0.05). Cox regression analysis result showed that recurrence after partial laryngectomy in EGC patients was potentially related to tumor differentiation, anterior commissure invasion, and abnormal serum expression of OPN, ANXA2 and testosterone ( P<0.05). ROC curve analysis revealed that serum OPN and ANXA2 had an area under the curve of 0.80 and 0.79, respectively, showing predictive value, with optimal cutoff values of 21.40 and 34.72 μg/L. Decision curve analysis indicated that serum OPN and ANXA2 had predictive significance for recurrence after partial laryngectomy in EGC patients, and the combined use of pathological grade, anterior commissure invasion, and testosterone improved the net benefit. Conclusions:Recurrence after partial laryngectomy in EGC patients may be associated with elevated serum OPN and ANXA2 levels, which could increase the risk of postoperative recurrence. Early detection of serum OPN and ANXA2 could be valuable for predicting recurrence after surgery in EGC patients.

Objective:To investigate the effects of baicalin on ferroptosis of mouse fibroblasts (Fbs) under high glucose treatment and its mechanism, and to provide a basis for the treatment of diabetic wounds.Methods:The study was an experimental study. Mouse Fbs were collected and divided into control group with conventional culture, high glucose group treated with glucose at final molarity of 30.0 mmol/L, and low baicalin group and high baicalin group pretreated with baicalin at final molarties of 5 and 10 μmol/L respectively and then treated as that in high glucose group. After 48 h of culture, the cell survival rate was detected by the cell counting kit-8, the reactive oxygen species level in cells was detected by the fluorescent probe method, the levels of malondialdehyde, glutathione, and ferrous ion in cells were detected by colorimetry, and the protein expression levels of solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) in cells and nuclear factor-erythroid 2-related factor 2 (Nrf2) in cytoplasm and nucleus were detected by Western blotting. Another batch of mouse Fbs were collected and divided into control group, high glucose group, high baicalin group, and high baicalin+ML385 group. The cells in the first three groups were treated as before, the cells in the last group were pretreated with baicalin and ML385 of Nrf2 inhibitor at final molarties of 10 μmol/L and then treated as that in high glucose group. After 48 h of culture, the protein expression levels of SLC7A11 and GPX4 in cells and the protein expression level of Nrf2 in cytoplasm and nucleus were detected as before. Except that the sample number in detecting SLC7A11 and GPX4 was 4, the sample number in detecting other indexes was 3.Results:After 48 h of culture, the cell survival rates in control group, high glucose group, low baicalin group, and high baicalin group were (100.0±10.7)%, (70.0±5.0)%, (80.9±3.2)%, and (91.4±1.9)%, respectively. Compared with those in control group, the cell survival rate, the glutathione level, and SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level were significantly decreased in high glucose group ( P<0.05), and the levels of reactive oxygen species, malondialdehyde, and ferrous ion in cells, and cytoplasmic Nrf2 protein expression level were significantly increased in high glucose group ( P<0.05). Compared with those in high glucose group, the cell survival rate, glutathione level, SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level in low baicalin group and high baicalin group were significantly increased ( P<0.05), the reactive oxygen species and ferrous ion levels in cells, and cytoplasmic Nrf2 protein expression level in low baicalin group and high baicalin group were significantly decreased ( P<0.05), and the malondialdehyde level in cells in high baicalin group was significantly decreased ( P<0.05). Compared with those in low baicalin group, the cell survival rate, glutathione level, SLC7A11 and GPX4 protein expression levels in cells, and nuclear Nrf2 protein expression level in high baicalin group were significantly increased ( P<0.05), and the reactive oxygen species, malondialdehyde, and ferrous ion levels in cells, and cytoplasmic Nrf2 protein expression level in high baicalin group were significantly decreased ( P<0.05). After 48 h of culture, compared with those in control group, the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly decreased ( P<0.05), and the cytoplasmic Nrf2 protein expression level was significantly increased in high glucose group ( P<0.05); compared with those in high glucose group, the cytoplasmic Nrf2 protein expression level was significantly decreased ( P<0.05), and the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly increased in high baicalin group ( P<0.05); compared with those in high baicalin group, the cytoplasmic Nrf2 protein expression level was significantly increased ( P<0.05), and the nuclear Nrf2 protein expression level and SLC7A11 and GPX4 protein expression levels in cells were significantly decreased in high baicalin+ML385 group ( P<0.05). Conclusions:Baicalin can inhibit the occurrence of ferroptosis in cells by activating the Nrf2 signaling pathway and up-regulating the expressions of proteins related to SLC7A11/GPX4 axis in Fbs in high glucose treatment, thus increasing the cell survival rate.