Objective To investigate the differences in personality traits between the patients with anx-ious depression(AND)and non-anxious depression(NAD)in order to provide the possible basis for early find of the patients with AND.Methods A total of 572 adult patients with depression visiting in the psychiatric outpatient department of the First Affiliated Hospital of Chongqing Medical University from January 2022 to December 2022 were selected to conduct the questionnaire survey.General demographic questionnaire,Self-rating Depression Scale(SDS),Generalized Anxiety Disorder Scale(GAD-7)and Minnesota Multiphasic Per-sonality Inventory(MMPI)were collected and analyzed.The patients with GAD-7 total score ≥5 points served as the AND group(n=499)and those with GAD total score＜5 points served as the NAD group(n=73).The correlation between the general demographic questionnaire,SDS and GAD-7 with MMPI was ana-lyzed.Results There were statistically significant differences in the place of residence,number of children in a family,education years,MMPI total score and high score proportions of psychopathy,athopia,hysteria,depres-sion,hypochondriasis,paranoea,schizophrenia,social introversion and hypomania dimensions between the two groups(P＜0.05).The SDS and GAD-7 scores in the AND group were higher than those in the NAD group(P＜0.05).The MMPI total score,athopia,hysteria,depression,hypochondriasis,paranoea,schizophrenia,so-cial introversion and hypomania were positively correlated with SDS and GAD-7(P＜0.05).Conclusion The patients with depression accompanied by anxiety symptom could be early identified by the MMPI testing results.

Objective:To assess the long-term outcome of sequential radical surgery after immune combined with targeted therapy for patients with initially unresectable hepatocellular carcinoma (HCC).Methods:Clinical data of 100 patients with initially unresectable HCC undergoing sequential radical surgery after immune combined with targeted therapy at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital from December 2018 to August 2023 were prospectively collected, including 87 males and 13 females, with a median age of 55 (24-73) years. The pre-treatment tumor staging was determined using the China liver cancer staging (CNLC). The efficacy of immune combined with targeted therapy was accessed using the modified response evaluation criteria in solid tumor (mRECIST). The cycles of immune combined with targeted therapy were analyzed. The tumor residual of resected tissue was analyzed through a standard pathological protocol. The prognosis was analyzed using the Kaplan-Meier method.Results:Upon initial diagnosis, there were 46 cases (46.0%) staged CNLC-Ⅲa and 40 (40.0%) staged CNLC-Ⅲb. There were also 14 cases (14.0%) staged CNLC-Ⅰb, Ⅱa, and Ⅱb who underwent immune combined with targeted therapy due to rupture of tumor or insufficient liver remnant. All patients received a median of 5 (3-28) cycles of immune combined with targeted therapy and underwent radical surgery after successful conversion. According to mRECIST, 14 (14.0%) were determined as complete remission, 63 (63.0%) as partial remission, 18 (18.0%) as stable disease, and 5 (5.0%) as disease progression. Of 24 (24.0%) were defined as pathologically complete remission by postoperative pathology. Furthermore, pathological tumor residue was less than 10% in 61 (61.0%) cases and less than 50% in 82 (82.0%) cases. The 1, 3, and 5 year-overall survival rates of patients were 98.0%, 83.1%, and 74.5%, respectively. The 1, 2 and 3 year-recurrence-free survival rates were 67.5%, 54.8%, and 49.6%, respectively.Conclusion:Sequential radical surgery after immune combined with targeted therapy benefits the long-term survival of patients with initially unresectable HCC.

Objective To explore the action of Bufei Jianpi formula(BJF)on mitochondrial damage to skeletal muscle in chronic obstructive pulmonary disease(COPD)rats via its regulation of the IRS-1/PI3K signaling axis.Methods 60 SPF SD rats were randomly divided into Control group,Model group(COPD stable stage group),aminophylline(Am)group,BJF group,pioglitazone(PIO)group and BJF+PIO group,with 10 rats per group.A stable COPD rat model was established via forced smoking and Klebsiella pneumoniae nasal drip method.Samples were taken from the 9th week to the end of the 20th week,and the weight of the rats was measured every week.Routine sectioning and HE staining were performed on lung and skeletal muscle tissue,and corresponding pathological changes were observed under a light microscope.The lung function of the rats was observed by whole-body plethysmography in weeks 0,8,and 20,including tidal VT,PEF,and EF50.The mRNA expression of IRS-1,leptin,PGC1-α,and PI3K in rat skeletal muscle was detected by qPCR.The expression of PGC-1α,TFAM,IRS-1,PI3K,AKT,p-AKT,and leptin in rat skeletal muscle tissue was detected by Western blot.Results The Model group,but not the Control group,showed a large number of inflammatory cells infiltrating the alveolar interstitium and bronchus,indicative of lung disease;some alveolar walls had broken and fused to form air cavities,and fiber networks were destroyed.After drug treatment,the rats showed improved alveolar wall and fiber network integrity and reduced inflammatory cell infiltration in the bronchus,especially those in the BJF and Am groups.In the drug treatment groups,the skeletal muscle pathology of each group showed improved spatial arrangement,the atrophy and fracturing of muscle fibers were ameliorated to different degrees,and cytoplasmic staining of muscle cells was uneven,and the BJF group showed the most significant effects.Compared with the Control group,the Model group's PEF,VT,and EF50 significantly decreased from week 8(P＜0.01),while the BJF,BJF+PIO and Am groups had significantly increased PEF and EF50(P＜0.01).Compared with Control group,the Model group's mRNA and protein expression levels of IRS-1,PGC-1α,and PI3K were significantly decreased(P＜0.05,P＜0.01),the level of leptin was significantly increased(P＜0.01).Compared with the Model group,the mRNA and protein expressions of IRS-1,PGC-1α and PI3K in the BJF group were significantly increased(P＜0.05,P＜0.01),and the mRNA expression of IRS-1 in the PIO group was significantly increased(P＜0.01).The BJF+PIO group's mRNA levels of PGC-1α(P＜0.01)and mRNA and protein levels of IRS-1 and PI3K were significantly increased(P＜0.05,P＜0.01).The mRNA and protein expression levels of PI3K in the Am group were significantly increased(P＜0.01).The expression levels of leptin mRNA were significantly decreased in the four treatment groups(P＜0.01),and the expression of leptin protein was significantly decreased in all treatment groups except the Am group(P＜0.01).Compared with the Control group,the Model group's quadriceps femoris tissue showed a significant decrease in TFAM and p-AKT expression.TFAM and p-AKT expression in all the treatment groups showed an increasing trend,but the difference was not statistically significant(P＞0.05).Conclusions By regulating the IRS-1/PI3K signaling axis,Bufei Jiempi reduces mitochondrial damage to skeletal muscle,increases the expression of PGC-1α and mitochondrial transcription factor TFAM,enhances mitochondrial biosynthesis,and reduces pathological damage to lung and skeletal muscle tissue.

AIM:To investigate the effects of the three Tiao-Bu Fei-Shen therapies on renal injury in rats with chronic obstructive pulmonary disease(COPD),and to explore the mechanisms.METHODS:SPF-grade SD rats were randomly divided into control,COPD,pyrrolidinedithiocarbamate ammonium(PDTC),Bufei-Jianpi formula(BJF),Bu-fei-Yishen formula(BYF),Yiqi-Zishen formula(YZF),BJF combined with PDTC(BJF+PDTC),BYF combined PDTC(BYF+PDTC),and YZF combined PDTC(YZF+PDTC)groups.Cigarette smoke exposure combined with bacterial infec-tion were used to develop a stable-phase rat model of COPD,and kidney-injured rats were screened for subsequent treat-ment.Pulmonary and renal functions,pathological changes in lung and kidney tissues,24 h urine volume,urine biochem-ical indexes,aquaporin(AQP)levels,ratio of inflammatory cells in the bronchoalveolar lavage fluid(BALF),serum in-flammatory factor levels,and mRNA and protein expressions of IκB kinase(IKK)and nuclear factor-κB(NF-κB)were observed at the end of the 16th week.RESULTS:Compared with control group,the rats in COPD group showed reduced lung function indexes of forced expiratory vital capacity(FVC),forced expiratory volume in 0.1 second(FEV0.1)and FEV0.1/FVC(P<0.05).The lung histopathology exhibited alveolar wall fracture and fusion and airway inflammatory cell infiltration.The renal function indexes serum creatinine,blood urea nitrogen and serum cystatin C(Cys-C)were signifi-cantly increased(P<0.01).The renal histopathology showed swollen and disorderly arranged tubular epithelial cells.The 24 h urine volume decreased(P<0.01).The urinary biochemical indexes 24 h urinary total protein,urinary kidney injury molecule-1(KIM-1),urinary Cys-C,and urinary N-acetyl-β-D-glucosaminidase significantly increased(P<0.01).The protein levels of AQP1～4 were significantly increased(P<0.01).The ratio of neutrophils and lymphocytes in the BALF were increased(P<0.01).The ratio of monocytes was decreased(P<0.01).The serum levels of tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-13,IL-1β,and transforming growth factor-β1(TGF-β1)were significantly increased(P<0.01).And the mRNA and protein expression levels of IKK,NF-κB were significantly elevated in the renal tissue(P<0.05).Compared with COPD group,the above symptoms and indexes of the rats were improved to different degrees after the intervention in treatment groups,among which BJF,BYF and YZF demonstrated similar effects to PDTC,and BJF+PDTC,BYF+PDTC and YZF+PDTC exhibited better improvements than the corresponding monotherapy.CONCLU-SION:The three Tiao-Bu Fei-Shen therapies can reduce the airway and systemic inflammatory response,improve renal function and attenuate renal injury in COPD rats.The mechanism may be related to the inhibition of NF-κB signaling path-way.

Objective To investigate the mechanism by which Xuanfei Jiedu Formula(XFJDF)ameliorates pulmonary damage in rats with multidrug-resistant Pseudomonas aeruginosa(MDR-PA)pneumonia,by modulating the activity of the inhibitor of nuclear factor(NF)-κB kinase(IKK)IKK/NF-κB signal transduction cascade.Methods Eighty-four rats were divided randomly into seven groups:control,model,XFJDF-low dose,XFJDF-medium dose,XFJDF-high dose,imipenem(IPM),and pyrrolidinedithiocarbamate ammonium(PDTC)groups(n=12 rats per group).A MDR-PA pneumonia rat model was established by oral tracheal intubation.After successful model construction,rats in the low-,medium-,and high-dose XFJDF groups were given the corresponding dose of drugs by gavage,rats in the IPM group were given an intraperitoneal injection of IPM,and rats in the control and model groups were given the same volume of normal saline by gavage,twice a day for 7 days.PDTC was injected intraperitoneally 1 h before model establishment,12 h and 24 h after model establishment in the NF-κB inhibitor group.The behavior status,body weight changes,spleen and thymus indexes,and lung wet weight/dry weight ratio were observed in the different groups.Histological changes in the lung tissue were assessed by hematoxylin and eosin staining.Terminal deoxynucleotidyl transferase dUTP nick end labeling was used to detect apoptosis of lung tissue cells,and serum levels of interleukin(IL)-1 β,tumor necrosis factor(TNF)-α,transforming growth factor(TGF)-β,and IL-10 were detected by enzyme-linked immunosorbent assay,and glutathione(GSH)and malondialdehyde(MDA)levels,myeloperoxidase(MPO)activity and total antioxidant capacity(T-AOC)were determined by colorimetry and thiobarbituric acid assay.NF-κBp65 in lung tissue was identified by immunohistochemical analysis,IKKβ and NF-κBp65 mRNA were analyzed by reverse transcription quantitative polymerase chain reaction,and expression levels of IKKβ,phosphorylated(p)-IKKβ,NF-κBp65,and p-NF-κBp65 were measured by Western blot.Results Compared with the control group,rats in the model group exhibited decreased appetite,dull fur,sluggish responsiveness,decreased mobility,increased respiratory rate,audible murmurs,and notable weight loss(P＜0.01).The spleen and thymus indices were significantly enhanced(P＜0.01)and the lung wet/dry weight ratio was significantly increased(P＜0.01),concurrent with increased alveolar secretions in lung tissue.Infiltration of abundant inflammatory cells and increased apoptosis in lung tissue were also noted.Serum concentrations of IL-1β,TNF-α,TGF-β,and IL-10 were increased(P＜0.01)and the MDA content and MPO activity were also increased(P＜0.01).Conversely,GSH levels and T-AOC were significantly decreased(P＜0.01).Lung levels of IKKβ and NF-κBp65 mRNA were significantly increased(P＜0.01)and the ratios of p-IKKβ/IKKβ and p-NF-κBp65/NF-κBp65 were also significantly increased(P＜0.01)compared with the control group.XFJDF,IPM and PDTC improved these parameters to varying degrees,compared with the model group(P＜0.05,P＜0.01),with particularly significant effects in the high-dose XFJDF and IPM groups.Conclusions XFJDF may improve lung injury in rats with MDR-PA pneumonia by inhibiting the IKK/NF-κB signaling pathway.

Objective To investigate the mechanism by which Xuanfei Jiedu Formula(XFJDF)ameliorates pulmonary damage in rats with multidrug-resistant Pseudomonas aeruginosa(MDR-PA)pneumonia,by modulating the activity of the inhibitor of nuclear factor(NF)-κB kinase(IKK)IKK/NF-κB signal transduction cascade.Methods Eighty-four rats were divided randomly into seven groups:control,model,XFJDF-low dose,XFJDF-medium dose,XFJDF-high dose,imipenem(IPM),and pyrrolidinedithiocarbamate ammonium(PDTC)groups(n=12 rats per group).A MDR-PA pneumonia rat model was established by oral tracheal intubation.After successful model construction,rats in the low-,medium-,and high-dose XFJDF groups were given the corresponding dose of drugs by gavage,rats in the IPM group were given an intraperitoneal injection of IPM,and rats in the control and model groups were given the same volume of normal saline by gavage,twice a day for 7 days.PDTC was injected intraperitoneally 1 h before model establishment,12 h and 24 h after model establishment in the NF-κB inhibitor group.The behavior status,body weight changes,spleen and thymus indexes,and lung wet weight/dry weight ratio were observed in the different groups.Histological changes in the lung tissue were assessed by hematoxylin and eosin staining.Terminal deoxynucleotidyl transferase dUTP nick end labeling was used to detect apoptosis of lung tissue cells,and serum levels of interleukin(IL)-1 β,tumor necrosis factor(TNF)-α,transforming growth factor(TGF)-β,and IL-10 were detected by enzyme-linked immunosorbent assay,and glutathione(GSH)and malondialdehyde(MDA)levels,myeloperoxidase(MPO)activity and total antioxidant capacity(T-AOC)were determined by colorimetry and thiobarbituric acid assay.NF-κBp65 in lung tissue was identified by immunohistochemical analysis,IKKβ and NF-κBp65 mRNA were analyzed by reverse transcription quantitative polymerase chain reaction,and expression levels of IKKβ,phosphorylated(p)-IKKβ,NF-κBp65,and p-NF-κBp65 were measured by Western blot.Results Compared with the control group,rats in the model group exhibited decreased appetite,dull fur,sluggish responsiveness,decreased mobility,increased respiratory rate,audible murmurs,and notable weight loss(P＜0.01).The spleen and thymus indices were significantly enhanced(P＜0.01)and the lung wet/dry weight ratio was significantly increased(P＜0.01),concurrent with increased alveolar secretions in lung tissue.Infiltration of abundant inflammatory cells and increased apoptosis in lung tissue were also noted.Serum concentrations of IL-1β,TNF-α,TGF-β,and IL-10 were increased(P＜0.01)and the MDA content and MPO activity were also increased(P＜0.01).Conversely,GSH levels and T-AOC were significantly decreased(P＜0.01).Lung levels of IKKβ and NF-κBp65 mRNA were significantly increased(P＜0.01)and the ratios of p-IKKβ/IKKβ and p-NF-κBp65/NF-κBp65 were also significantly increased(P＜0.01)compared with the control group.XFJDF,IPM and PDTC improved these parameters to varying degrees,compared with the model group(P＜0.05,P＜0.01),with particularly significant effects in the high-dose XFJDF and IPM groups.Conclusions XFJDF may improve lung injury in rats with MDR-PA pneumonia by inhibiting the IKK/NF-κB signaling pathway.

Objective:To assess the clinical efficacy of sequential radical surgery after immune and targeted therapy in downstaging patients with initially unresectable hepatocellular carcinoma.Methods:Data were prospectively collected from December 2018 to July 2022 on patients with initially unresectable hepatocellular carcinoma which were downstaged to undergo sequential surgery after treatment with immune and targeted therapy at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital. There were 79 patients, with 69 men and 10 women, aged (53.0±10.9) years, being enrolled into this study. The Kaplan-Meier method was used to calculate the survival rate, and the log-rank test was used for survival rate comparison. Univariate and multivariate Cox regression were used to analyze factors influencing patient prognosis.Results:There were 7 patients (8.9%) with China Liver Cancer Staging (CNLC) Ⅰb, Ⅱa, Ⅱb who had insufficient residual liver volume or tumor rupture before the downstaging therapy, and 38 patients (48.1%) with CNLC Ⅲa and 34 patients (43.0%) with CNLC Ⅲb. These 79 patients underwent R 0 resection after 3-20 cycles (median 5 cycles) of immune and targeted therapy. Based on the modified response evaluation criteria in solid tumor, the results of preoperative imaging assessment were: complete remission in 12 patients (15.2%), partial remission in 50 patients (63.3%), stable disease in 15 patients (19.0%), and disease progression in 2 patients (2.5%). The overall survival rates of patients at 1, 2, and 3 years after diagnosis were 96.1%, 83.5%, and 76.6%; and the recurrence-free survival rates at 1, 2, and 3 years after surgery were 62.1%, 52.9%, and 34.7%, respectively. On multivariate Cox regression analysis, patients with a preoperative alpha-fetoprotein >20 μg/L ( HR=2.816, 95% CI: 1.232-6.432, P=0.014) and a high proportion of pathological residual tumors ( HR=1.015, 95% CI: 1.004-1.026, P=0.006) had a higher risk of postoperative recurrence; and patients with a high proportion of pathological residual tumors ( HR=1.028, 95% CI: 1.007-1.049, P=0.007) and preoperative alpha-fetoprotein >400 μg/L ( HR=4.099, 95% CI: 1.193-14.076, P=0.025) had a higher risk of death. Conclusion:Immunotherapy combined with targeted therapy and sequential surgery for patients with initially unresectable hepatocellular carcinoma provided long-term survival benefits. Elevated preoperative alpha-fetoprotein and a high proportion of pathological residual tumor were independent risk factors for recurrence-free survival and overall survival in this group of patients.

Objective:To analyze the value of alpha-fetoprotein(AFP) in predicting survival of patients who underwent salvage surgery after tumor downstaging therapy in patients with advanced hepatocellular carcinoma.Methods:The data of 50 patients with Barcelona Clinic Liver Cancer Staging (BCLC) C hepatocellular carcinoma treated at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from December 2018 to December 2021 were collected. There were 45 males and 5 females, with the age of (53.0±10.5) years. The patients were divided into two groups based on the serum AFP level after tumor downstaging therapy, AFP normal group ( n=27, AFP≤20 μg/L) and the control group ( n=23, AFP>20 μg/L). Patient survival and tumor recurrence were followed up by outpatient review or telephone follow-up. The survival rate was calculated by the Kaplan-Meier method and compared by the log-rank test. The efficacy of combined immunotargeted therapy were compared between the two groups. Univariate and multivariate Cox regression analysis were carried to analyse the factors influcing prognosis. Results:The median survival time was not reached in both groups. The 1-year and 2-year cumulative survival rates were 95.0% and 88.2% in the normal group and 73.4% and 54.1% in the control group, respectively. The median relapse-free survival time of the normal group was not reached, and the median relapse-free survival time of the control group was 11 months. The 1-year recurrence-free survival rate was 78.1% in the normal group and 39.5% in the control group. The cumulative survival rate and relapse-free survival rate in the normal group were significantly higher than those in the control group (χ 2=7.60, 8.83, P=0.006, 0.003). The complete response, partial response and pathological complete response of tumors in the normal group were significant better than those in the control group. Multivariate Cox regression analysis showed that patients with serum AFP >20 μg/L ( HR=2.952, 95% CI: 1.023-8.517, P=0.045) after immunotherapy combined with targeted therapy had an increased risk of postoperative recurrence. Conclusion:The reduction of serum AFP to normal after downstaging therapy could be used as a prognostic indicator of salvage surgical in patients with BCLC C hepatocellular carcinoma, and AFP was related to the efficacy of downstaging therapy in patients.

Humans ; Adult ; Serum Albumin, Human ; Consensus ; Cardiac Surgical Procedures ; Thoracic Surgery

Objective:To investigate the effect of exclusive enteral nutrition (EEN) on plasma amino acid levels in patients with Crohn′s disease (CD) .Methods:Adult patients with moderate to severe active CD in the Sixth Affiliated Hospital of Sun Yat-sen University from December 1, 2020 to December 31, 2021 were prospectively recruited. All the participants received nasogastric EEN monotherapy for 8 weeks. Patients were divided into clinical response group and non-response group according to CD activity index (CDAI). Clinical data were collected from all the participants before and after EEN. Targeted metabolomics was used to detect and analyze the changes of 25 amino acids levels in plasma in CD patients before and after EEN, as well as the differences between response group and non-response group.Results:Thirteen patients were included in the study. The clinical remission rate reached 69.2% (9/13) after 8 weeks of EEN treatment. Compared with pre-treatment, the plasma levels of tryptophan, threonine, alanine, proline and cysteine in CD patients were significantly higher after EEN treatment. At week 8 after EEN, tryptophan metabolites including indole acetic acid and indole acetamide were significantly lower in patients with clinical remission compared to patients without remission. Correlation analysis showed the plasma levels of tryptophan was negatively correlated with CDAI and erythrocyte sedimentation rate (ESR), and the level of kynurenine was negatively correlated with ESR.Conclusion:EEN therapy is an effective way to induce clinical remission in active CD patients. After EEN, plasma levels of tryptophan, threonine, alanine, proline and cysteine are significantly increased. Tryptophan and cysteine metabolisms may be the key pathways leading to the efficacy of EEN treatment.