At present, the treatment of sepsis depends largely on non-specific methods, highlighting an urgent need for novel therapeutic strategies. Stem cells have garnered significant attention in the treatment of various diseases due to their unique biological properties. Stem cells enhance sepsis survival through mechanisms such as reducing bacterial burden, modulating inflammation, and ameliorating organ dysfunction. Recent studies have shown that stem cells can increase the survival rate of sepsis patients through multiple pathways such as reducing the bacterial load of the host, regulating inflammatory homeostasis, and improving multi-organ dysfunction. Their derivatives, exosomes, can also alleviate the imbalanced immune response in sepsis patients. Recent advances in stem cell-based therapies for sepsis were summarized in this paper.

The prototype willingness model (PWM), a dual process model consisting of a rational pathway and a social reactive pathway, offers a more comprehensive and appropriate theoretical framework for understanding adolescent risk behaviors. To elucidate the formation mechanisms of three key adolescent risk behaviors (alcohol drinking, smoking, and social media risk disclosure behaviors), the paper systematically reviews the application process of the PWM in these three major adolescent risk behaviors and compares the similarities and differences in its core variables and underlying mechanisms across different behavior types. The paper contributes to a deeper understanding of the causes of typical adolescent risk behaviors and offers theoretical and empirical support for the development of targeted intervention strategies.

OBJECTIVE To preliminarily investigate the antiasthmatic effect and mechanism of Ephedrae Herba-Armeniacae Semen Amarum herb pair on the respiratory center. METHODS Male SD rats were randomly divided into blank group， model group， dexamethasone group （positive control）， and Ephedrae Herba-Armeniacae Semen Amarum 2∶1， 1∶1 and 1∶2 groups. Rats in each group were administered different ratios of the herb pair decoction [all at 18 g （crude drug）/kg]， dexamethasone suspension （0.5 mg/kg）， or normal saline intragastrically twice daily for seven consecutive days. Forty minutes after the last administration， medicated cerebrospinal fluid was collected to determine the content of effective components entering the brain. One and a half hours after the last administration， the nucleus tractus solitarius （NTS） was located using a stereotaxic apparatus. Histamine phosphate （1 μL） was injected into the NTS region at a constant rate of 1 μL/min using a 10 μL microsyringe to induce excitation of the respiratory center in rats； the blank group was injected with normal saline. The contents of neurotransmitters [nerve growth factor （NGF）， substance P （SP）， norepinephrine （NA）， 5-hydroxytryptamine （5-HT） and acetylcholine （Ach）] in the medulla oblongata brain tissue were detected. The mRNA expressions of neurokinin-1 receptor （NK-1R）， p38 mitogen-activated protein kinase （MAPK）， and c-fos in the medulla oblongata， as well as the protein expressions of NK-1R， p38 MAPK， and c-fos in the NTS region， were determined. RESULTS The main active components of Ephedrae Herba-Armeniacae Semen Amarum herb pair entering the brain were ephedrine， pseudoephedrine， and methylephedrine. Compared with blank group， the contents of NGF， SP， NA， 5-HT and Ach， and the relative expression levels of NK-1R， p38 MAPK， and c-fos mRNA and protein were significantly increased in the model group （ P ＜0.01）. Compared with model group， Ephedrae Herba-Armeniacae Semen Amarum herb pair groups with different ratios significantly reduced the neurotransmitter contents and the relative expression levels of NK-1R， p38 MAPK， and c-fos mRNA and protein （ P ＜0.01）， with the 2∶1 Ephedrae Herba-Armeniacae Semen Amarum herb pair and 1∶1 mass ratios showing relatively better effects. CONCLUSIONS Ephedrae Herba alkaloids are the main active components in affecting the function of the respiratory center. The herb pair groups with a larger proportion of Ephedrae Herba exhibit stronger effects. Ephedrae Herba-Armeniacae Semen Amarum herb pair can reduce the excitability of the respiratory center by down-regulating the expression of the NK-1R/MAPK/c-fos pathway in the NTS and decreasing the abnormal release of neurotransmitters such as NGF and SP.

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

OBJECTIVE: To investigate the frequency and related factors of ineffective triggering (IT) and double triggering (DT) in patients with acute brain injury undergoing invasive mechanical ventilation. METHODS: A retrospective cohort study was conducted using data from a single-center observational trial. Patients with acute brain injury [traumatic brain injury, stroke, and post-craniotomy for brain tumors] undergoing mechanical ventilation in the intensive care unit (ICU) of Beijing Tiantan Hospital, Capital Medical University between June 2017 and July 2019 were retrospectively analyzed. Demographic and clinical data were collected. Respiratory parameters and waveforms during the first 3 days of mechanical ventilation were recorded, with 15-minute waveform segments collected 4 times daily. Airway occlusion pressure (P_0.1) was measured via end-expiratory hold at the end of each recording. IT and DT were identified based on airway pressure, flow, and esophageal pressure waveforms, and the ineffective triggering index (ITI) and DT incidence were calculated. Multivariate Logistic regression was used to identify factors associated with IT and DT. RESULTS: A total of 94 patients with acute brain injury were ultimately enrolled, including 19 cases of traumatic brain injury (20.2%), 39 cases of stroke (41.5%), and 36 cases of post-craniotomy for brain tumor (38.3%). Supratentorial injury was observed in 49 patients (52.1%), while infratentorial injury was identified in 45 patients (47.9%). A total of 94 patients with 1 018 datasets were analyzed; 684 (67.2%) datasets were on pressure support ventilation (PSV), and 334 (32.8%) were on mandatory ventilation. IT was detected in 810 (79.6%) datasets, with a median incidence of 2.1% (0.3%, 12.0%). Datasets demonstrating IT were characterized by lower P_0.1, higher tidal volume (VT), reduced respiratory rate (RR), and decreased minute ventilation (MV) compared to those without IT. The proportion of datasets exhibiting IT was higher during PSV than in mandatory ventilation [83.8% (573/684) vs. 71.0% (237/334), P < 0.05], while, the prevalence of ITI ≥ 10% was lower [23.8% (163/684) vs. 33.5% (112/334), P < 0.05]. DT was detected in 305 datasets (30%), with a median incidence of 0.6% (0.4%, 1.3%). Datasets exhibiting DT were characterized by higher VT, reduced RR, and lower pressure support levels. The incidence of DT was lower in PSV compared to mandatory ventilation modes [0% (0%, 0.3%) vs. 0% (0%, 0.5%), P < 0.05]. The post-craniotomy for brain tumors group exhibited higher ITI, lower RR, reduced MV, and a greater proportion of infratentorial lesions, compared to the TBI group. The infratentorial lesion group demonstrated higher ITI and incidence of DT compared to the supratentorial lesion group [ITI: 3.1% (0.7%, 17.8%) vs. 1.5% (0%, 8.3%), incidence of DT: 0% (0%, 0.5%) vs. 0% (0%, 0%), both P < 0.05]. After adjusting for confounding factors through multivariate logistic regression analysis, infratentorial lesion [odds ratio (OR) = 2.029, 95% confidence interval (95%CI) was 1.465-2.811, P < 0.001], lower P_0.1 (OR = 0.714, 95%CI was 0.616-0.827, P < 0.001), and mandatory ventilation (OR = 1.613, 95%CI was 1.164-2.236, P = 0.004) were independently associated with IT. Additionally, infratentorial lesion (OR = 1.618, 95%CI was 1.213-2.157, P = 0.001), large tidal volume (OR = 1.222, 95%CI was 1.137-1.314, P < 0.001), lower pressure support levels (OR = 0.876, 95%CI was 0.829-0.925, P < 0.001), and mandatory ventilation (OR = 2.750, 95%CI was 1.983-3.814, P < 0.001) were independently associated with DT. CONCLUSION IT and DT were common in patients with acute brain injury. Infratentorial lesions and mandatory ventilation were independently associated with both IT and DT.
Humans ; Respiration, Artificial/methods* ; Retrospective Studies ; Brain Injuries/therapy* ; Intensive Care Units ; Male ; Female ; Middle Aged ; Brain Injuries, Traumatic/therapy* ; Logistic Models ; Aged ; Adult

Stafne bone cavity, also known as static bone cavity, is a rare bony defect on the lingual side of the mandible. It rarely shows progressive changes, and requires only follow-up bservation. This article described a case of progressive enlargement of a Stafne bone cavity and analyzed the causes of its progress by reviewing relevant literature.
Humans ; Mandible

Objective To introduce the application scene,operating steps and preliminary clinical effect of tibial bone mass preservation technique in medial unicompartmental knee arthroplasty(MUKA).Methods A total of 15 patients with antero-medial knee osteoarthritis(AMOA)treated in this hospital from May 2022 to May 2023 were selected as the study subjects.The tibial bone mass preservation technique was a-dopted to complete MUKA(fixed platform prosthesis).The operating time,intraoperative bleeding volume,hospitalization duration and operation complications were recorded.The VAS score before operation and in last follow up,range of motion(ROM)of knee joint,Knee Society Score(KSS),hip and knee stomping angle(HKA)of lower extremity in the operation side and image results were recorded to evaluate the clinical effect.Results The operations in 15 cases were successfully completed.The average operation time was(82.73±9.97)min,mean intraoperative bleeding volume was(21.00±9.49)mL and average hospital stay was(4.9±1.4)d.There was no intraoperative nerve,vascular and medial collateral ligament injury,no iatro-genic fracture,and no postoperative surgical site infection.All patients were followed up for average(5.87±2.77)months.The VAS score of knee joint,ROM,KSS and HKA angle of lower limb in the operated side were significantly improved compared with before operation(P<0.05).There was no prosthesis loosening,displacement or fragmentation,and no obvious degeneration aggravation of the lateral compartment of the knee joint.Conclusion The tibial bone mass preservation technique is a simple,effective and reliable method to deal with the slightly tight flexion space after tibial osteotomy during MUKA,and the postoperative clinical efficacy and imaging results are excellent.

Objective:To investigate the alterations in the topological properties of gray matter and white matter dynamic and static functional brain networks in patients with major depressive disorder (MDD) and bipolar depression (BDD) using graph theory analysis, and to evaluate the potential of their combination as biomarkers for differential diagnosis between unipolar and bipolar depression.Methods:From March 2021 to April 2024, inpatients were recruited from the Department of Psychosomatic Medicine, Zhongda Hospital, Southeast University, including 132 patients with MDD, 84 patients with BDD, and 91 healthy controls (HCs). Resting-state structural and functional MRI data were collected, and dynamic and static functional brain networks of gray matter and white matter were constructed. Graph theory analysis was applied to calculate global and nodal network properties, differences in topological attributes among the three groups were compared by One-way analysis of covariance, and Turkey′s post hoc test was used for further pairwise comparison. The network topology attribute indicators with statistically significant inter-group differences were selected using the Least Absolute Shrinkage and Selection Operator regression (LASSO) for feature classification. The diagnostic performance of combined gray and white matter network features for distinguishing MDD from BDD was assessed using receiver operating characteristic (ROC) curves and a random forest model.Results:In the analysis of the static gray matter functional network, both MDD and BDD patients showed abnormal local topological properties. Compared with HCs, the MDD group exhibited abnormal betweenness centrality (BC) in the left inferior frontal gyrus, left precuneus, left ventromedial occipital cortex, right ventromedial occipital cortex, and right anterior thalamus ( t=-3.95-3.62, all P<0.05). The degree centrality (DC) of the left and right anterior thalamus was also abnormal in the MDD group ( t=3.78,4.14, both P<0.001), as was the nodal efficiency (Ne) of the left precuneus and bilateral anterior thalamus ( t=2.37, 3.61, 3.82, all P<0.05). Compared with HCs, the BDD group showed abnormalities in DC and Ne of the left precuneus ( t=-2.76, P=0.014; t=-3.01, P=0.007). In the analysis of the dynamic white matter functional network, both MDD and BDD patients demonstrated abnormal temporal variability of local topological properties. Compared with HCs, the MDD and BDD groups showed reduced BC temporal variability in the left superior corona radiata ( t=-2.39, P=0.047; t=-4.28, P<0.001), and there were significant differences in DC temporal variability in the right posterior limb of the internal capsule and lentiform nucleus ( t=2.65, P=0.021; t=3.49, P=0.001) in MDD group compared with HCs and BBD. The differential diagnosis model combining gray and white matter dynamic and static network topological features achieved an area under the ROC curve of 0.80. Conclusion:Both MDD and BDD exhibit altered topological properties in static gray matter functional networks and dynamic white matter functional networks. The combination of these features may aid in the differential diagnosis of MDD and BDD.

Objective:To investigate the potential utility of the lymphocyte to monocyte ratio (LMR) and its modified index, albumin-LMR product, as predictive biomarkers for disease activity and presence of lupus nephritis in systemic lupus erythematosus (SLE).Methods:A total of 264 patients with newly diagnosed SLE who were treated at Henan Provincial People′s Hospital between December 2016 and September 2022 were included in this study. Their clinical data were subsequently collected for analysis. Patients were classified into non-active disease group (SLEDAI<5, n=55) and active disease group(SLEDAI≥5, n=209) based on the SLE SLEDAI. The Mann-Whitney U test was employed to compare the differences in clinical parameter levels, LMR and albumin-LMR product between the two groups. Additionally, the active disease group was further stratified into mild(SLEDAI 5~9, n=86), moderate(SLEDAI 10~14, n=96) and severe (SLEDAI≥15, n=27) subgroups to assess differences in LMR and albumin-LMR product. Further more patients were stratified into two groups based on renal involvement: those without lupus nephritis(non-LN) and those with lupus nephritis (LN). For non-parametric comparisons, the Mann-Whitney U test was used for intergroup comparisons between two groups, while the Kruskal-Wallis H test was applied for comparisons among three groups. If the Kruskal-Wallis H test revealed statistically significant differences ( P<0.05), pairwise comparisons were performed using the Mann-Whitney U test, and the significance level was adjusted using the Bonferroni method to account for multiple testing.Correlations between LMR, albumin-LMR product, and disease activity indicators were analyzed using Spearman′s correlation. The diagnostic value of LMR and albumin-LMR product for SLE activity was evaluated using the receiver operating characteristic (ROC) curves. Results:Both LMR and albumin-LMR product were significantly lower in active disease group compared to the non-active group {LMR:3.56 (2.15, 5.00) vs. 5.68 (3.89, 7.00); albumin-LMR product [93.21 (59.50, 143.98)g/L] vs. [187.89 (137.67, 260.90)]g/L, Z=-5.68, -7.05, P<0.001 for all}. Further subgroup analysis revealed that LMR and albumin-LMR product levels in severe, moderate, and mild active disease were also significantly decreased compared to the non-active disease group {LMR:3.83(1.78, 5.09)、3.09(2.06, 4.90)、3.65(2.45, 5.03) vs. 5.68(3.89, 7.00); albumin-LMR product: [95.69(66.57, 121.61)]g/L、[79.82(49.02, 126.91)]g/L、[104.73(69.21, 169.01)]g/L vs. [187.89(137.67, 260.90)]g/L, H=34.27, 58.29, P<0.001 for all}. A significant disparity in the levels of LMR and albumin-LMR product was detected between the non-LN and LN, with statistical significance ( Z=-3.44, P=0.001 and Z=-7.06, P<0.001). Correlation analysis indicated that LMR negatively correlated with SLEDAI( r=-0.31), urea( r=-0.29), creatinine ( r=-0.28) and 24-hour urinary protein level ( r=-0.27), all P<0.001, with no significant correlation to complement C3 or C4. Albumin-LMR product showed stronger negative correlations with SLEDAI ( r=-0.44), urea ( r=-0.40), creatinine ( r=-0.37), and 24-hour urinary protein ( r=-0.55), all P<0.001, and a positive correlation with complement C3 ( r=0.18, P=0.004). The areas under the ROC curves for LMR and LMR combined with complement C3 were 0.749 and 0.795, respectively, while for albumin-LMR product and its combination with complement C3, they were 0.809 and 0.833, indicating superior diagnostic efficacy for the modified albumin-LMR product. Conclusion:LMR and albumin-LMR product levels are significantly associated with SLE disease activity and may serve as potential biomarkers for assessing SLE activity and the degree of lupus nephritis.

Objective:To evaluate the effect of the degree of neuromuscular blockade on the intraoperative surgical conditions and postoperative recovery quality in patients undergoing lumbar interbody fusion.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-79 yr, with a body mass index of 18.5-35.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification < Ⅳ, scheduled for elective lumbar interbody fusion at the Affiliated Hospital of Xuzhou Medical University from August to October 2024, were allocated into 2 groups ( n=50 each) using stratified randomization based on the number of lumbar segments: deep neuromuscular blockade group (group D) and moderate neuromuscular blockade group (group M). The intraoperative post-tetanic count was maintained at 1 or 2 in group D, and the intraoperative train-of-four was maintained at 1 or 2 in group M. The scores for surgical conditions, duration of operation, blood loss, length of incision, occurrence of severe hypoxemia after extubation, requirement for rescue analgesia in post-anesthesia care unit, 15-item Quality of Recovery scale score and length of stay were recorded. Results:Compared with group M, the scores for surgical conditions were significantly increased, the rate of rescue analgesia in post-anesthesia care unit was decreased, 15-item Quality of Recovery scale scores were increased at 3 days after surgery ( P<0.05), and no significant changes were found in the duration of operation, blood loss, length of incision, incidence of severe hypoxemia after extubation and length of hospital stay in group D ( P>0.05). Conclusions:Compared with moderate neuromuscular blockade, deep neuromuscular blockade can provide better surgical conditions and improve the quality of early postoperative recovery for patients undergoing lumbar interbody fusion.