To report two cases of psychiatric symptoms associated with zonisamide, an antiepileptic drug, and raise clinical awareness of this potential adverse effect. Two male patients with epilepsy treated with zonisamide were retrospectively analyzed. Case 1 (25 years old) developed acute emotional and behavioral abnormalities (e.g., insomnia, aggression, incoherent speech) after switching from sodium valproate to zonisamide (200 mg/day). Case 2 (48 years old) had long-term zonisamide use (≥5 years) with persistent treatment-resistant psychotic symptoms (e.g., delusions, command hallucinations). Clinical courses, medication adjustments, and symptom responses were documented. In Case 1, psychiatric symptoms resolved after discontinuing zonisamide and switching to sodium valproate, with improved mood stability and reduced impulsivity. In Case 2, despite escalating antipsychotic medications (risperidone, clozapine), psychotic symptoms persisted, likely due to ongoing zonisamide use. Both cases highlighted zonisamide’s potential to exacerbate or induce psychiatric manifestations, possibly via mechanisms involving sodium/calcium channel inhibition and neurotransmitter dysregulation (e.g., dopamine, serotonin). Zonisamide can cause or worsen psychiatric symptoms, particularly in vulnerable individuals. Clinicians should monitor for mental health changes during zonisamide treatment and consider drug discontinuation or substitution with alternative antiepileptics (e.g., sodium valproate) if psychiatric adverse effects emerge. Awareness of this association is crucial to avoid misdiagnosis and optimize epilepsy management.

Background Benzothiazoles and benzotriazoles are ubiquitously detected in drinking water, posing potential health risks. Developing a reliable and sensitive analytical method is critical for assessing their exposure levels and associated risks. Objective To establish an automated solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry method for the simultaneous determination of benzothiazole, 2-aminobenzothiazole, benzotriazole, and 5-chlorobenzotriazole in drinking water. Methods Key parameters were systematically optimized. Three mobile phase systems were compared to evaluate their effects on chromatographic peak shape and separation; three SPE cartridges were tested for extraction efficiency; the influences of water pH on extraction recoveries and matrix effects were investigated; the contributions of pretreatment steps to benzothiazole blank were analyzed, and control measures were established; nitrogen evaporation temperatures were tested to ensure analyte stability. The optimized parameters were used to develop the method, validate its performance, and analyze drinking water samples. Results Drinking water samples were first adjusted to pH 6.0 with formic acid, and then extracted using HLB cartridges. After elution with 6 mL methanol, the eluate was concentrated under nitrogen evaporation at 45 °C, followed by separation on a C18 column using a gradient elution of acetonitrile-0.1% formic acid solution, and tandem mass spectrometry detection. Avoiding nitrogen blow-drying during SPE and eliminating the use of polypropylene materials during nitrogen evaporation can effectively minimize benzothiazole contamination. Good calibration linearity was obtained for the target analytes in the concentration range of 5.0-250 μg·L⁻¹, with a correlation coefficient of r > 0.995. The method detection limits were in the range of 1.0-5.0 ng·L⁻¹. The recoveries of the target analytes in pure water and tap water were 80.2%-119.5% and 72.2%-115.6%, respectively, with relative standard deviations of were 3.2%-12.8% and 2.3%-11.6%, respectively. When applying this method to actual water samples, benzotriazole was detected in 100% of treated and tap water samples, with median concentrations of 79.4 ng·L⁻¹ and 114 ng·L⁻¹, respectively. Benzothiazole was detected in 83.3% of treated water samples and 100% of tap water samples, with median concentrations of 48.3 ng·L⁻¹ and 65.4 ng·L⁻¹, respectively. In addition, 5-chloro-benzotriazole exhibited low detection rates and concentrations, while 2-amino-benzothiazole was undetected. Conclusion The developed method demonstrates high accuracy, reliability, and sensitivity, making it suitable for the analysis of trace levels of benzothiazoles and benzotriazoles in drinking water.

ObjectiveTo investigate the clinical characteristics， diagnostic challenges， and treatment strategies in pediatric patients with ureteropelvic junction obstruction （UPJO） complicated with ipsilateral ureterovesical junction obstruction （UVJO）. MethodsA retrospective analysis was conducted on clinical data of pediatric patients admitted to our hospital between January 2014 and December 2024 with a confirmed diagnosis of UPJO complicated with UVJO. The collected clinical parameters included gender， age at presentation， initial diagnosis， lesion laterality， imaging findings， surgical procedures， and follow-up outcomes. ResultsThe study cohort comprised 14 pediatric patients （male=10 and female=4） with a median age of 3.1 months at presentation. The initial diagnoses were UPJO in 9 cases and UVJO in 5 cases. Preoperatively， only 6 cased showed ureteral dilation on MRU. The definitive diagnosis was confirmed by intraoperative retrograde pyelography in 5 cases， postoperative antegrade pyelography via a nephrostomy tube in 7 patients， and combined application of the two modalities in 2 patients. For primary surgical intervention， 9 patients underwent pyelo-plasty， 2 underwent ureteral reimplantation， 2 received percutaneous nephrostomy， and 1 underwent ureteral orifice dilation. Intraoperative nephrostomy tube placement was performed in 10 patients. With a median follow-up duration of 5.5 years， 4 patients required revision surgery. Of these， only 1 patient ， who had an initial diagnosis of UPJO， required staged management for persistent obstruction， whereas UPJ obstruction resolved after ureteroneocystostomy in the remaining 3 patients with an initial diagnosis of UVJO. Among the 10 patients who did not undergo revision surgery， 8 showed delayed distal urinary drainage on APG， yet remained asymptomatic with continuous improvement of hydronephrosis after nephrostomy tube clamping. ConclusionsPreoperative diagnosis of concurrent UPJO and ipsilateral UVJO in pediatric patients is clinically challenging. Further intraoperative evaluation is mandatory when antegrade or retrograde ureteral stent placement fails during surgery. For patients with an initial diagnosis of UPJO， pyeloplasty is the first-line treatment. Routine retrograde pyelography is not recommended， whereas nephrostomy tube with subsequent postoperative APG evaluation can prevent unnecessary ureteroneocystostomy. For patients with an initial diagnosis of UVJO accompanied by severe ureteral dilation， primary ureteroneocystostomy is feasible initial management strategy.

Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Objective To explore the influencing factors of acute kidney injury in severe burn patients,and to construct a visual risk nomogram model.Methods A total of 390 patients with severe burn admitted to the Institute of Burn Frostbite and Tissue Function Reconstruction of Chinese People's Armed Police Force Specialty Medical Center from January 2018 to January 2022 were collected as an internal training data set,and 50 patients with severe burn admitted from February to December 2022 were collected as an external validation data set.The 390 patients of the internal training data set were divided into the acute kidney injury group and the non-acute kidney injury group according to the occurrence of acute kidney injury,and the baseline data of patients in the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the risk factors of acute kidney injury in severe burn patients of the internal training data set,and a nomogram model was drawn.Subsequently,the model was verified both internally and externally.Kaplan-Meier analysis and Log-rank test were used to compare the 90-day survival rate of patients between the acute kidney injury group and the non-acute kidney injury group.Results The burn area(OR=1.18,95%CI:1.06 to 2.36,P=0.004),sequential organ failure assessment(SOFA)score(OR=1.81,95%CI:1.21 to 5.92,P<0.001),inhalation injury(OR=3.21,95%CI:1.23 to 6.35,P<0.001),neutrophil to lymphocyte ratio(NLR)(OR=1.22,95%CI:1.05 to 3.65,P<0.001)and albumin(ALB)(OR=0.78,95%CI:0.57 to 0.92,P=0.011)were the independent risk factors for the development of acute kidney injury in severe burn patients.The nomogram model was established by the above factors.The area under the receiver operating characteristic curve(AUC)of the internal training data set was 0.833(95%CI:0.752 to 0.935),the sensitivity was 81.2%,and the specificity was 83.2%.The AUC of the external validation data set was 0.842(95%CI:0.762 to 0.912),the sensitivity 87.2%,and the specificity was 78.7%.The 90-day survival rate of patients in the acute kidney injury group after burns was significantly lower than that in the non-acute kidney injury group(P<0.001).Conclusion Larger burn area,higher SOFA score,combined inhalation injury,increased NLR,and decreased ALB level are the risk factors for the occurrence of acute kidney injury in severe burn patients,which are related to the 90-day survival rate of patients after burns.The nomogram model based on the risk factors can provide certain reference for clinical individualized prevention and treatment of acute kidney injury in severe burn patients.

Objective:To investigate the expression levels and clinical significance of miR-627 and miR-448 in colorectal cancer tissues.Methods:Ninety-eight patients with colorectal cancer admitted to Xi’an Jiaotong University Affiliated Red Cross Hospital from Apr. 2019 to Apr. 2021 were gathered. Colorectal cancer tissue and adjacent tissues were collected during surgery, and the expression levels of miR-627 and miR-448 were detected by qRT-PCR. According to postoperative follow-up, patients were separated into a good prognosis group and a poor prognosis group. Kaplan-Meier survival curve was applied to analyze the relationship between miR-627, miR-448 and the prognosis of colorectal cancer patients. ROC curve was plotted to analyze the predictive value of miR-627 and miR-448 for poor prognosis in colorectal cancer. The prognostic factors of colorectal cancer patients were analyzed using COX regression.Results:There was a difference in the expression levels of miR-627 and miR-448 between colorectal cancer tissue and adjacent tissues ( P<0.05). The expression of miR-627 and miR-448 in colorectal cancer tissue was related to clinical features (TNM stage, differentiation degree, lymph node metastasis, and depth of infiltration) ( P<0.05). The survival rate of patients with high expression of miR-627 was higher than that of patients with low expression ( χ2=10.050, P<0.05); the survival rate of patients with high expression of miR-448 was higher than that of patients with low expression ( χ2=9.033, P<0.05). The expression levels of miR-627 and miR-448 in the poor prognosis group were greatly lower than those in the good prognosis group ( P<0.05). According to the ROC curve, the AUC of miR-627 in predicting poor prognosis of colorectal cancer was 0.811, the AUC of miR-448 in predicting poor prognosis of colorectal cancer was 0.772, and the AUC of combination of the two in predicting poor prognosis of colorectal cancer was 0.859. The combination of the two was better than their individual predictions (Z combination vs. miR-627=2.538, Z combination vs. miR-448=2.572, P<0.05). Multivariate COX regression found that miR-627, miR-448, and clinical features (TNM stage, degree of differentiation, lymph node metastasis, and depth of infiltration) were risk factors affecting the prognosis of colorectal cancer patients ( P<0.05) . Conclusion:The expression levels of miR-627 and miR-448 in colorectal cancer tissues were greatly reduced. The combination of the two is related to the clinical characteristics and prognosis of patients, and can greatly improve the predictive value for prognosis of colorectal cancer patients.

Objective:To investigate the influence and mechanism of bone marrow mesenchymal stem cells (BMSCs) overexpressing growth arrest specific 6, i.e. GAS6/BMSCs on full-thickness skin defect wounds in diabetic mice.Methods:This study was an experimental study. Twelve 8-week-old male C57BL/6J mice were divided into a control wound group with only full-thickness skin defects and a diabetic wound group with diabetic full-thickness skin defects according to the random number table method, with 6 mice in each group. The wound healing rates were calculated at 3, 7, 14, and 21 days after injury. At 21 days after injury, wound tissue specimens were collected for hematoxylin-eosin staining to observe the histopathological conditions; Masson staining was performed to detect collagen deposition; immunohistochemical staining was performed to detect the number of proliferating cell nuclear antigen (PCNA)-positive cells and CD31-positive cells, representing cell proliferation and capillary density, respectively; immunofluorescence staining was performed to detect the number of F4/80 and myeloperoxidase (MPO) double-positive cells, indicating efferocytosis. Two 4-week-old male C57BL/6J mice were used to extract BMSCs, and GAS6/BMSCs were constructed through adenovirus transfection and successfully identified. Eighteen 8-week-old male C57BL/6J mice were used to create diabetic full-thickness skin defect wound models and divided into phosphate buffered solution (PBS) group, BMSC group, and GAS6/BMSC group (with 6 mice in each group) according to the random number table method. Immediately after injury, PBS, BMSC single-cell suspension, and GAS6/BMSC single-cell suspension were injected locally into the wounds of the three groups of mice, respectively. The wound healing rates were calculated, and the cell proliferation, capillary density, and efferocytosis were detected at the same time points as the previous experiments.Results:At 3, 7, 14, and 21 days after injury, the wound healing rates of mice in diabetic wound group were significantly lower than those in control wound group (with t values of 7.99, 8.62, 9.80, and 5.85, respectively, P<0.05). Compared with those in control wound group, the wound tissue of mice in diabetic wound group showed the infiltration of a large number of inflammatory cells and reduced collagen deposition at 21 days after injury. At 21 days after injury, the number of PCNA-positive cells and CD31-positive cells in the wound tissue of mice in diabetic wound group were significantly less than that in control wound group (with t values of 6.61 and 5.38, respectively, P<0.05). At 21 days after injury, the number of F4/80 and MPO double-positive cells in the wound tissue of mice in diabetic wound group was 3.3±0.8, which was significantly less than 12.7±1.8 in control wound group ( t=11.00, P<0.05). At 14 and 21 days after injury, the wound healing rates of mice in BMSC group were significantly higher than those in PBS group ( P<0.05); at 3, 7, 14, and 21 days after injury, the wound healing rates of mice in GAS6/BMSC group were significantly higher than those in BMSC group ( P<0.05). At 21 days after injury, the number of PCNA-positive cells in the wound tissue of mice in BMSC group was significantly higher than that in PBS group ( P<0.05), and the number of PCNA-positive cells and CD31-positive cells in the wound tissue of mice in GAS6/BMSC group were significantly higher than that in BMSC group ( P<0.05). At 21 days after injury, the number of F4/80 and MPO double-positive cells in the wound tissue of mice in BMSC group was 4.2±1.2, which was similar to 3.5±1.1 in PBS group ( P>0.05); the number of F4/80 and MPO double-positive cells in the wound tissue of mice in GAS6/BMSC group was 8.2±1.2, which was significantly more than that in BMSC group ( P<0.05). Conclusions:Dysfunctional efferocytosis of macrophage exists in the full-thickness skin defect wounds of diabetic mice, while GAS6/BMSC can promote wound healing by restoring the efferocytosis of macrophages.

Objective:To investigate the expression levels and clinical significance of miR-627 and miR-448 in colorectal cancer tissues.Methods:Ninety-eight patients with colorectal cancer admitted to Xi’an Jiaotong University Affiliated Red Cross Hospital from Apr. 2019 to Apr. 2021 were gathered. Colorectal cancer tissue and adjacent tissues were collected during surgery, and the expression levels of miR-627 and miR-448 were detected by qRT-PCR. According to postoperative follow-up, patients were separated into a good prognosis group and a poor prognosis group. Kaplan-Meier survival curve was applied to analyze the relationship between miR-627, miR-448 and the prognosis of colorectal cancer patients. ROC curve was plotted to analyze the predictive value of miR-627 and miR-448 for poor prognosis in colorectal cancer. The prognostic factors of colorectal cancer patients were analyzed using COX regression.Results:There was a difference in the expression levels of miR-627 and miR-448 between colorectal cancer tissue and adjacent tissues ( P<0.05). The expression of miR-627 and miR-448 in colorectal cancer tissue was related to clinical features (TNM stage, differentiation degree, lymph node metastasis, and depth of infiltration) ( P<0.05). The survival rate of patients with high expression of miR-627 was higher than that of patients with low expression ( χ2=10.050, P<0.05); the survival rate of patients with high expression of miR-448 was higher than that of patients with low expression ( χ2=9.033, P<0.05). The expression levels of miR-627 and miR-448 in the poor prognosis group were greatly lower than those in the good prognosis group ( P<0.05). According to the ROC curve, the AUC of miR-627 in predicting poor prognosis of colorectal cancer was 0.811, the AUC of miR-448 in predicting poor prognosis of colorectal cancer was 0.772, and the AUC of combination of the two in predicting poor prognosis of colorectal cancer was 0.859. The combination of the two was better than their individual predictions (Z combination vs. miR-627=2.538, Z combination vs. miR-448=2.572, P<0.05). Multivariate COX regression found that miR-627, miR-448, and clinical features (TNM stage, degree of differentiation, lymph node metastasis, and depth of infiltration) were risk factors affecting the prognosis of colorectal cancer patients ( P<0.05) . Conclusion:The expression levels of miR-627 and miR-448 in colorectal cancer tissues were greatly reduced. The combination of the two is related to the clinical characteristics and prognosis of patients, and can greatly improve the predictive value for prognosis of colorectal cancer patients.

Objective:To analyze the expression of serum lysyl oxidase like protein 4(LOXL4)and protein tyrosine phosphatase non receptor type 3(PTPN3)in patients with colorectal cancer and their relationship with postoperative liver metastasis.Methods:Totally 137 patients with colorectal cancer who visited Qingdao Central Hospital,University of Health and Rehabilitation Science from April 2017 to December 2019 were recruited as the cancer group.Complying with whether liver metastasis occurred during the follow-up period of 5 years,the patients were classified into the liver metastasis group(27 cases)and the non liver metastasis group(110 cases).Another 137 healthy individuals who underwent physical check ups were recruited as the control group.The qRT-PCR method was used to detect the ex-pression levels of serum LOXL4 and PTPN3 mRNAs.The serum LOXL4 and PTPN3 mRNAs were compared under dif-ferent clinical pathological data,and the pathological data of liver metastasis group and non liver metastasis group were compared.Cox regression analysis was used to explore the influencing factors of postoperative liver metastasis in pa-tients with colorectal cancer.ROC curve was used to explore the predictive value of serum LOXL4 and PTPN3 for postoperative liver metastasis in patients with colorectal cancer.Results:Compared with the control group,the can-cer group had higher levels of serum LOXL4 and PTPN3 mRNAs expression(P<0.05).Compared with patients with medium to high differentiation,infiltration depth≤1/2 muscle layer,and TNM stage I-II,patients with low differentia-tion,infiltration depth>1/2 muscle layer,and TNM stage III had higher levels of serum LOXL4 and PTPN3 mRNAs ex-pression(P<0.05).Compared with the non liver metastasis group,the liver metastasis group had higher levels of se-rum LOXL4 and PTPN3 mRNAs expression(P<0.05).High expression of serum LOXL4 and PTPN3 mRNAs were risk factors for liver metastasis after colorectal cancer surgery(P<0.05).Compared with the single prediction of serum LOXL4 and PTPN3 mRNAs,the AUC of serum LOXL4 combined with PTPN3 in predicting postoperative liver metasta-sis in colorectal cancer patients was higher(P<0.05).Conclusion:Serum LOXL4 and PTPN3 mRNAs expression lev-els are abnormally elevated in patients with colorectal cancer,which is related to the deterioration of pathological data such as differentiation degree,infiltration depth,and TNM staging.Elevated serum LOXL4 and PTPN3 mRNAs expres-sion levels may increase the risk of postoperative liver metastasis in patients,and the combination has higher predic-tive value for postoperative liver metastasis.