Aim To investigate the shared transcriptional characteristics of non-alcoholic fatty liver disease(NAFLD)and atherosclerosis(As)using bioinformatics techniques.The goal is to identify potential mechanisms and key targets of As that are linked to NAFLD through gene crosstalk analysis of both diseases.Additionally,the study will validate the expression levels of these key targets in animal tissues and human serum samples.Methods The gene ex-pression profiles of NAFLD(dataset GSE89632)and As(dataset GSE43292)were obtained from GEO database.Differ-ential gene analysis and weighted gene co-expression network analysis were conducted to identify common genes between the two diseases.These shared genes were further analyzed using the String database for protein interaction analysis and R software.Core genes were identified through calculations in Cytoscape software,validation with external datasets(GSE100927),and machine learning techniques(LASSO regression).Finally,key core genes were determined by crea-ting nonalcoholic fatty liver and As mouse models on a high-fat diet and collecting peripheral serum samples from patients with NAFLD and coronary heart disease(CHD).Results Seventy-five shared genes were identified between the two diseases,with major enrichment pathways including cytokine-cytokine receptor interaction,IL-17 signaling pathway,lipid and atherosclerosis,and NF-κB signaling pathway.Through integration of multiple bioinformatics methods,two core genes(MMP-9 and CCL3)were identified.Subsequent animal experiments demonstrated a significant increase in MMP-9 and CCL3 levels in the liver and aortic sinus of mice fed with high-fat diet,MMP-9 and CCL3 levels in the liver tissue of high-fat diet-fed mice were 2.43 times(P＜0.001)and 1.35 times(P＜0.01)higher than the control group,in the aortic sinus tissue,MMP-9 and CCL3 levels were 2.10 times(P＜0.001)and 1.58 times(P＜0.01)higher.Human serum sample verification further supported these findings,showing MMP-9 and CCL3 levels in patients with both NAFLD and CHD to be 1.21 times(P＜0.01)and 1.29 times(P＜0.01)higher than in patients with CHD alone.Conclusion This study identified MMP-9 and CCL3 may play key roles in NAFLD-related As,providing potential targets for the study of NAFLD-related As.

Objective:To investigate the characteristics of brain functional networks alterations in patients with inflammatory bowel disease (IBD) and explore their correlations with clinical indicators and psycho-psychological scores.Methods:A cross-sectional survey study was conducted. A total of 48 IBD patients diagnosed at the Changzhou Second People′s Hospital from June 2021 to June 2023 were collected, and 32 healthy individuals matched for age, gender, and education level were selected as the healthy control group. Resting-state functional magnetic resonance imaging data were enrolled, and the topological properties of brain networks between the two groups of subjects were compared by using graph theory analysis. Pearson correlation and Spearman′s partial correlation analyses were used to explore the correlations between changes in IBD patients′ brain networks topological properties and clinical indicators and psycho-psychological scores.Results:In the IBD group, 29 patients were males (60.4%) and 19 were females (39.6%) ; the total disease course was 1.0 (0.3, 5.0) years; 34 patients were Crohn′s disease and 14 ulcerative colitis; they were mainly in the active phase (58.84%, 28/48) . The scores of the hospital anxiety and depression scale (HADS-A and HADS-D) in IBD patients were higher than those in the healthy control group (both P<0.01) . In terms of global properties, both the IBD group and the healthy control group had "small-world" properties (both σ>1.1) . Compared with the healthy control group, the IBD group had lower clustering coefficients, global efficiency, and local efficiency, and longer characteristic path lengths, with all differences being statistically significant (all P<0.05) . In terms of local properties, compared with the healthy control group, the IBD group had higher degree centrality and nodal efficiency in the left middle frontal gyrus, higher betweenness centrality in the left thalamus, lower betweenness centrality and degree centrality in the right parahippocampal gyrus, lower nodal clustering coefficients in the bilateral middle temporal gyrus, right anterior cingulate gyrus and paracingulate gyrus, and lower nodal local efficiency in the bilateral caudate nuclei and left middle temporal gyrus, with all differences being statistically significant (all P<0.05) . The degree centrality of the right parahippocampal gyrus in the IBD group was negatively correlated with the HADS-A score ( r = -0.401, P = 0.005) , and the betweenness centrality was also negatively correlated with the HADS-A score ( r = -0.343, P = 0.017) . The nodal clustering coefficient of the right middle temporal gyrus in the IBD group was positively correlated with the total disease course ( rs = 0.589, P<0.001) . Conclusion:IBD patients have decreased overall information transmission capacity in brain networks, reduced limbic system function, and abnormal functions in brain areas related to pain perception, which are correlated to some extent with the disease course and psycho-psychological state.

Objective:To investigate the characteristics of brain functional networks alterations in patients with inflammatory bowel disease (IBD) and explore their correlations with clinical indicators and psycho-psychological scores.Methods:A cross-sectional survey study was conducted. A total of 48 IBD patients diagnosed at the Changzhou Second People′s Hospital from June 2021 to June 2023 were collected, and 32 healthy individuals matched for age, gender, and education level were selected as the healthy control group. Resting-state functional magnetic resonance imaging data were enrolled, and the topological properties of brain networks between the two groups of subjects were compared by using graph theory analysis. Pearson correlation and Spearman′s partial correlation analyses were used to explore the correlations between changes in IBD patients′ brain networks topological properties and clinical indicators and psycho-psychological scores.Results:In the IBD group, 29 patients were males (60.4%) and 19 were females (39.6%) ; the total disease course was 1.0 (0.3, 5.0) years; 34 patients were Crohn′s disease and 14 ulcerative colitis; they were mainly in the active phase (58.84%, 28/48) . The scores of the hospital anxiety and depression scale (HADS-A and HADS-D) in IBD patients were higher than those in the healthy control group (both P<0.01) . In terms of global properties, both the IBD group and the healthy control group had "small-world" properties (both σ>1.1) . Compared with the healthy control group, the IBD group had lower clustering coefficients, global efficiency, and local efficiency, and longer characteristic path lengths, with all differences being statistically significant (all P<0.05) . In terms of local properties, compared with the healthy control group, the IBD group had higher degree centrality and nodal efficiency in the left middle frontal gyrus, higher betweenness centrality in the left thalamus, lower betweenness centrality and degree centrality in the right parahippocampal gyrus, lower nodal clustering coefficients in the bilateral middle temporal gyrus, right anterior cingulate gyrus and paracingulate gyrus, and lower nodal local efficiency in the bilateral caudate nuclei and left middle temporal gyrus, with all differences being statistically significant (all P<0.05) . The degree centrality of the right parahippocampal gyrus in the IBD group was negatively correlated with the HADS-A score ( r = -0.401, P = 0.005) , and the betweenness centrality was also negatively correlated with the HADS-A score ( r = -0.343, P = 0.017) . The nodal clustering coefficient of the right middle temporal gyrus in the IBD group was positively correlated with the total disease course ( rs = 0.589, P<0.001) . Conclusion:IBD patients have decreased overall information transmission capacity in brain networks, reduced limbic system function, and abnormal functions in brain areas related to pain perception, which are correlated to some extent with the disease course and psycho-psychological state.

Objective:To investigate preliminary results of chest wall reconstruction with local kiss flap following mastectomy for locally advanced breast cancer (LABC).Methods:Clinical data of the LABC patients receiving treatment at the Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University between June 2020 and July 2021 was retrospectively analyzed. All patients underwent modified radical mastectomy after neoadjuvant chemotherapy. And the local kiss flap was used for reconstruction of the secondary chest wall soft tissue defects. Two small local flaps were designed intraoperatively and harvested from inferior (flap A) and lateral (flap B) to the defect, respectively, resurfacing a large chest wall soft tissue defect side by side with primary closure of both two donor sites. The flap perfusion was routinely monitored postoperatively. Adjuvant systemic therapies were implemented based on both pre- and post-operative pathological results. And the adjuvant radiotherapy was started immediately after wound healed completely. All cases were followed up regularly.Results:A total of five female patients were included, with an average age of 53.4 (ranging from 41 to 71). Stage Ⅲ (T 3-4N 2-3M 0) breast cancer was diagnosed in all cases. After mastectomy, chest wall soft tissue defect was presented in all cases, ranging from 12.0 cm × 12.0 cm to 22.0 cm × 20.0 cm. The flap A measured from 7.0 cm × 7.0 cm to 14.0 cm × 13.0 cm and the flap B from 5.0 cm × 4.0 cm to 11.0 cm × 7.0 cm. Only 1 flap A suffered tip necrosis and the remnant flaps survived totally. All donor sites recovered uneventfully and no donor-site morbidity was noted. The mean post-operative follow-up period was 15.8 months (ranging from 13 to 20 months). No tumor recurrence or metastasis was noted in all patients, except one patient, who did not receive radiotherapy, suffered local recurrence 4 months after surgery. Conclusion:Given its simplicity and satisfying results, the local kiss flap is a feasible and reliable reconstructive option for chest wall soft tissue defect reconstruction after mastectomy in selected LABC patients.

Objective:To investigate the characteristics of primary catheter malposition (PCM) following totally implantable venous access port (TIVAP) implantation via the internal jugular vein (IJV) and management strategies.Methods:Clinical data of 587 consecutive breast cancer patients undergoing TIVAP implantation via the IJV performed by single team at the Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University from Aug 2017 to Aug 2022 was retrospectively analyzed.Results:A total of 593 TIVAP were implanted and PCM was found in 18 cases (3.0%). Four hundred and twenty five TIVAP were implanted via the right IJV with one PCM case (0.2%). One hundred and sixty eight TIVAP implantations were performed via the left IJV and PCM occurred in 17 cases (10.1%). The interventional management with a pigtail catheter was performed as a first-line strategy in 11 of the 18 PCM cases, with a success in 10 cases and failure in one. Three cases were successfully managed with the digital subtraction angiography (DSA)-guided open approach. Four cases underwent blind open procedure firstly and 2 suffered a failure.Conclusions:A higher incidence of PCM is found in TIVAP implantations via the left IJV than the right one. The interventional management with a pigtail catheter or the DSA-guided open procedure proves to be feasible for the correction of PCM.

Objective:To investigate preliminary results of chest wall reconstruction with local kiss flap following mastectomy for locally advanced breast cancer (LABC).Methods:Clinical data of the LABC patients receiving treatment at the Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University between June 2020 and July 2021 was retrospectively analyzed. All patients underwent modified radical mastectomy after neoadjuvant chemotherapy. And the local kiss flap was used for reconstruction of the secondary chest wall soft tissue defects. Two small local flaps were designed intraoperatively and harvested from inferior (flap A) and lateral (flap B) to the defect, respectively, resurfacing a large chest wall soft tissue defect side by side with primary closure of both two donor sites. The flap perfusion was routinely monitored postoperatively. Adjuvant systemic therapies were implemented based on both pre- and post-operative pathological results. And the adjuvant radiotherapy was started immediately after wound healed completely. All cases were followed up regularly.Results:A total of five female patients were included, with an average age of 53.4 (ranging from 41 to 71). Stage Ⅲ (T 3-4N 2-3M 0) breast cancer was diagnosed in all cases. After mastectomy, chest wall soft tissue defect was presented in all cases, ranging from 12.0 cm × 12.0 cm to 22.0 cm × 20.0 cm. The flap A measured from 7.0 cm × 7.0 cm to 14.0 cm × 13.0 cm and the flap B from 5.0 cm × 4.0 cm to 11.0 cm × 7.0 cm. Only 1 flap A suffered tip necrosis and the remnant flaps survived totally. All donor sites recovered uneventfully and no donor-site morbidity was noted. The mean post-operative follow-up period was 15.8 months (ranging from 13 to 20 months). No tumor recurrence or metastasis was noted in all patients, except one patient, who did not receive radiotherapy, suffered local recurrence 4 months after surgery. Conclusion:Given its simplicity and satisfying results, the local kiss flap is a feasible and reliable reconstructive option for chest wall soft tissue defect reconstruction after mastectomy in selected LABC patients.

This article reports a case of small cell lung cancer with chronic intestinal pseudo-obstruction as the initial manifestation in the Changzhou No.2 People′s Hospital, and reviews relevant literature reports in order to improve clinicians′ understanding of paraneoplastic syndrome associated with small bowel obstruction and reduce missed diagnosis and misdiagnosis.

This article reports a case of small cell lung cancer with chronic intestinal pseudo-obstruction as the initial manifestation in the Changzhou No.2 People′s Hospital, and reviews relevant literature reports in order to improve clinicians′ understanding of paraneoplastic syndrome associated with small bowel obstruction and reduce missed diagnosis and misdiagnosis.

Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)-P300-bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid-liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.

Objective:To explore the application effect of the teaching ward-round workshop on the teaching ability training for clinical teachers.Methods:From July to October 2019, 83 clinical teachers from The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University included in the study were divided into 8 groups for the training of teaching ward-round workshop. After the training, the evaluation results of clinical teaching ward-round, the satisfaction of clinical teaching ward-round, and the satisfaction of the workshop teaching model were compared. Chi-square test and t test were performed by SPSS 22.0. Results:The trainees were highly satisfied with the training mode of the teaching ward-round workshop. After the training, the clinical teaching ward-round assessment scores [(96.83±1.77) points] were higher than the average scores of the same period from April to June in 2019 [(91.25±2.86) points], with statistical significance ( P<0.05). In terms of satisfaction with clinical teaching ward rounds, the scores of 7 dimensions including preparation before ward rounds, highlighting the key and difficulties, and standard physical examination after the training were all higher than those before the training, with significant differences ( P<0.05). Conclusion:The training model of the teaching ward-round workshop helps to enhance the training effect, promote the teaching ability of clinical teachers, and improve the clinical teaching ward-round assessment results and satisfaction, which provides new ideas and references for the training of clinical medical professionals.