ObjectiveTo investigate the metabolic alterations of serum short chain fatty acids （SCFAs） in pediatric patients with atopic dermatitis （AD） and their correlation with different clinical phenotypes using targeted metabolomics. MethodsThis study enrolled 87 AD patients and 67 healthy controls （HC）. Serum levels of eight SCFAs were quantified by ultra-high-performance liquid chromatography-mass spectrometry. The associations between SCFAs and AD were assessed using various statistical methods. ResultsCompared with the HC group， levels of acetic acid （AA）， propionic acid （PA）， and caproic acid （CA） （P=0.002，P=0.002，P=0.043） decreased in the AD group. Logistic regression analysis identified AA （OR=0.449， 95% CI： 0.289–0.698） and PA （OR = 0.487， 95% CI： 0.324–0.732） as protective factors against AD. The combination of AA and PA yielded an area under the curve （AUC） greater than 0.7， indicating good diagnostic efficacy. Age-stratified analysis revealed that AA reduction was predominant in childhood， whereas PA reduction was predominant in adolescence. Pathway enrichment analysis showed significant enrichment of fatty acid biosynthesis （FDR=0.341， P=0.003） and vitamin K metabolism （FDR=1， P=0.039） pathways. Furthermore， subgroup analyses based on disease severity， personal/family history of atopy， and sex revealed no significant differences in SCFAs levels among the groups. ConclusionDifferential serum SCFAs and their enriched metabolic pathways may be implicated in the pathogenesis of AD.

Objective To develop a predictive model for postoperative mortality risk in patients with acute aortic dissection(AAD)using the Extreme Gradient Boosting(XGBoost)algorithm combined with Shapley Additive Explanation(SHAP),and to establish a prediction website to serve as a diagnostic and therapeutic support platform for clinicians and patients.Methods A retrospective cohort study design was adopted.Data from 782 AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2013 to December 2023 were collected,including basic information and initial serum biomarker test results.Patients were randomly divided into training and test sets at a 7:3 ratio.An external validation set consisting of 313 AAD patients admitted to the Second Hospital of Hebei Medical University from January 2020 to December 2023 was also established for further model validation.Variables were screened using LASSO regression,and an XGBoost machine learning model was constructed and interpreted using SHAP.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curve analysis.Using the Shiny package,the XGBoost model was deployed to shinyapps.io to create a prediction website for postoperative mortality risk in AAD patients.One patient was selected by simple random sampling from the test set and the external validation set respectively for the prediction example on the Shiny webpage.Results The XGBoost model demonstrated high predictive performance for postoperative mortality in AAD patients,with area under the ROC curve(AUC)values of 0.928(95%CI 0.901-0.956)in the training set,0.919(95%CI 0.891-0.949)in the test set,and 0.941(95%CI 0.915-0.967)in the external validation set.SHAP values indicated the following order of variable importance in the model(from highest to lowest):"lactate dehydrogenase""blood chlorine""multiple organ injury""carbon dioxide combining power""prothrombin time""α-hydroxybutyric acid""creatine kinase isoenzyme""Stanford classification""combined use of bedside blood purification""gender""acute kidney injury""gastrointestinal bleeding""brain injury"and"shock".A risk prediction website for adverse postoperative outcomes in AAD patients was developed using XGBoost-SHAP method(https://dun-dunxiaolu.shinyapps.io/document/)and validated with examples.One randomly selected patient from each of the test and external validation sets was applied:the predicted mortality risk value for patient 1(who died postoperatively)was 0.9539,and that for patient 2(who survived postoperatively)was 0.0206.Conclusions The XGBoost-SHAP model demonstrates high accuracy in predicting postoperative mortality risk for AAD patients.The online prediction tool established based on this model enhances the identification efficiency of high-risk postoperative mortality patients.

ObjectiveTo evaluate the efficacy of Sanhua essential oil inhalation as aromatherapy in patients with breast cancer-related depression.MethodsIn total, 144 patients with breast cancer-related depression who underwent postoperative chemotherapy were recruited. The participants in the control group (n = 52) were offered a placebo (sunflower oil) daily, whereas those in the essential oil group (n = 52) were administered Sanhua essential oil. This study evaluated depression improvement, Hamilton Depression Scale score, scores of symptoms in traditional Chinese medicine (TCM), Pittsburgh Sleepiness Quotient Index score, incidence of nausea and vomiting, and signal changes on functional magnetic resonance imaging.ResultsDepression improved by 48.1% and 21.2% in the essential oil and control groups, respectively (P = .010). The Hamilton Depression Scale score (P = .017), scores for symptoms in TCM (P = .002), and the incidence of nausea and vomiting in the acute and delayed phases were lower in the essential oil group than in the control group (nausea in the acute phase, P = .017; nausea in the delayed phase, P = .039; vomiting in the acute phase, P = .008; vomiting in the delayed phase, P = .081). The Pittsburgh Sleepiness Quotient Index score was lower in the essential oil group than in the control group (P = .005). Significant differences existed between the two groups in the left superior parietal gyrus, right precuneus, left dorsolateral superior frontal gyrus, and right precentral gyrus according to functional connectivity on functional magnetic resonance imaging.ConclusionInhalation of Sanhua essential oil alleviated depression in patients undergoing chemotherapy for breast cancer, improved sleep quality, relieved TCM symptoms, reduced nausea and vomiting, and regulated activities in the brain regions.

Objective To evaluate the clinical effectiveness and safety of different traditional Chinese medicine(TCM)prescriptions combined with conventional western drugs to improve idiopathic membranous nephropathy(IMN)based on the Chinese medicine evidence system.Methods A computerized search of databases was conducted to collect randomized controlled trials(RCTs)of TCM compound formulas combined with conventional western medicines for the treatment of IMN,with a search timeframe from the establishment of the database to October 2023.Thirty-five RCTs involving six interventions and containing 2518 IMN patients were finally included.The quality of the included literature was evaluated.Reticulated Meta-analysis was performed,and surface under the cumulative ranking(SUCRA)curve was used to rank the clinical efficacy and safety of the six interventions,aiming to provide an evidence-based basis for the rational clinical selection of prescriptions for treating patients with IMN.Results The formula of tonifying deficiency and eliminating stasis combined with conventional western medicine showed significant effects in lowering 24-hour urine protein quantification(SUCRA=95.3％)and total cholesterol level(SUCRA=98.2％).The formula of tonifying deficiency,eliminating stasis,purging heat,and dispelling dampness combined with conventional western medicine was effective in lowering blood creatinine(SUCRA=80.4％)and increasing serum albumin level(SUCRA=72.9％).The formula of tonifying deficiency and clearing heat and dampness combined with conventional western medicine was more effective in lowering M-type phospholipase A2 receptor antibody titer(SUCRA=86.0％).Conclusion In terms of safety,the adverse effects of the TCM compound formula combined with conventional western drugs were overall less than those of conventional western drugs alone.

Objective To observe the performance and safety of self-developed real-time three-dimensional intracardiac echocardiography(ICE)system(system).Methods The self-developed system was constructed using disposable sterile real-time three-dimensional ICE catheter(catheter)and multifunctional cart-mounted digital ultrasound imaging host(ultrasound host).The diameter of catheter was 10F,with effective length of 90 cm and two-dimensional array transducer array(840 elements)integrated at tip.The ultrasound host was connected to the catheter through matching connector.The performance of this system was evaluated with self-made experimental equipment and standard phantom,and live animal experiment was performed to observe its safety and imaging quality.Results The maximum imaging depth of this system was ≥60 mm.Its axial resolution was ≤1 mm and lateral resolution was ≤1 mm within the depth of 40 mm,the horizontal and vertical geometric position accuracy errors were ≤10％and ≤5％,respectively,while the image geometric distortion was ≤10％,and the measurement volume error was ≤30％.The catheter was successfully inserted into right atrium of pig through femoral vein under ultrasound guidance,smoothly passing through the vascular pathway without any bending or jamming with good controllability.The cardiac images of this system were clear,which completely displayed cardiac chamber structures,and the image resolution met diagnostic requirement.No injury related to interventional procedures was found in laboratory tests nor anatomical results.Conclusion The self-developed ICE system was stable and safe,and initial results showed it could meet clinical application expectations.

Rheumatoid arthritis(RA)is a chronic autoimmune disease of unknown etiology that can cause joint destruction and deformity.As a small molecule cytokine,the chemokine C-X-C motif chemokine ligand 12(CXCL12)regulates the pathogenesis of rheumatoid arthritis by binding to the specific receptor CXC chemokine receptor 4(CXCR4).Therefore,based on the bio-logical characteristics of CXCL12 and CXCR4,this paper intro-duces the pathogenesis of CXCL12/CXCR4 in RA and summari-zes the progress in RA-related research,with the aim of providing clinical value for understanding the pathogenesis of RA and de-veloping novel therapeutic targets.

Objective Compare the depression phenotypes of a breast cancer tumor-bearing mouse model constructed using two different method and a mouse model of breast cancer depression with clinical manifestations,as well as assess their suitability for basic research.Methods We constructed a tumor model with 4T1 breast cancer cells alone(4T1 group)and a tumor-depression composite model given chronic unpredictable mild(CUMS)(4T1+CUMS group).The experimental period was 42 d,and the body mass,tumor volume,and survival time of the mice were monitored throughout the whole process.Two depressive behavioral tests(of sucrose preference test,open field test,tail suspension test,and elevated plus maze)were performed on the 15th and 29th days,respectively.Hematoxylin-eosin(HE)staining was used to observe the pathological changes of hippocampal neurons in brain tissue sections.Results(1)Body mass:The body mass of the 4T1 group and 4T1+CUMS group began to decrease from 29 d,and the body mass of the 4T1+CUMS group was significantly lower than that of the 4T1 group and Control group at the end of the experiment(P<0.001).(2)Tumor volume:There was no significant difference in the growth rate of tumors between the two model groups throughout the experiment(P>0.05).(3)Survival time:The survival rates of the 4T1 group and 4T1+CUMS group were 100％and 60％,and the first death of mice in the 4T1+CUMS group was on the 36th day.(4)Behavior test of depression:There was no significant difference between the three groups in the first depressive behavior tests(P>0.05),and the two groups showed obvious depressive phenotypes in the second behavioral tests.The sucrose preference index and activity distance in the central area were significantly decreased in the two model groups(P<0.001),and the immobility time was significantly increased(P<0.001).(5)Pathological section of brain tissue:On pathological examination of brain tissue,we observed a reduced number of neuronal cells in the hippocampus of the 4T1 group and 4T1+CUMS group,their morphology was irregular,the arrangement between the cells was disordered and the gap was unclear,and some nucleoli were blurred.Conclusions Although the tumor-only method and the tumor with compound stress stimulation method can both be used to prepare breast cancer depression models,the tumor-only modeling method is simpler and the mortality rate after successful modeling is higher.The long window of time is convenient for subsequent drug administration and detection,and the causes of the depression phenotype are more in line with the clinical causes and manifestations.Therefore,the 4T1 model can provide a reference model for future animal experiments on breast cancer tumor-related depression.

OBJECTIVE: This study examines utilizes the advantages of machine learning algorithms to discern key determinants in prognosticate postoperative circulatory complications (PCCs) for older patients. METHODS: This secondary analysis of data from a randomized controlled trial involved 1,720 elderly participants in five tertiary hospitals in Beijing, China. Participants aged 60-90 years undergoing major non-cardiac surgery under general anesthesia. The primary outcome metric of the study was the occurrence of PCCs, according to the European Society of Cardiology and the European Society of Anaesthesiology diagnostic criteria. The analysis metrics contained 67 candidate variables, including baseline characteristics, laboratory tests, and scale assessments. RESULTS: Our feature selection process identified key variables that significantly impact patient outcomes, including the duration of ICU stay, surgery, and anesthesia; APACHE-II score; intraoperative average heart rate and blood loss; cumulative opioid use during surgery; patient age; VAS-Move-Median score on the 1st to 3rd day; Charlson comorbidity score; volumes of intraoperative plasma, crystalloid, and colloid fluids; cumulative red blood cell transfusion during surgery; and endotracheal intubation duration. Notably, our Random Forest model demonstrated exceptional performance with an accuracy of 0.9872. CONCLUSION We have developed and validated an algorithm for predicting PCCs in elderly patients by identifying key risk factors.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; Machine Learning ; Postoperative Complications/etiology* ; Risk Factors ; Randomized Controlled Trials as Topic ; Secondary Data Analysis

PURPOSE: To investigate the protective effect of sub-hypothermic mechanical perfusion combined with membrane lung oxygenation on ischemic hypoxic injury of yorkshire brain tissue caused by traumatic blood loss. METHODS: This article performed a random controlled trial. Brain tissue of 7 yorkshire was selected and divided into the sub-low temperature anterograde machine perfusion group (n = 4) and the blank control group (n = 3) using the random number table method. A yorkshire model of brain tissue injury induced by traumatic blood loss was established. Firstly, the perfusion temperature and blood oxygen saturation were monitored in real-time during the perfusion process. The number of red blood cells, hemoglobin content, NA⁺, K⁺, and Ca²⁺ ions concentrations and pH of the perfusate were detected. Following perfusion, we specifically examined the parietal lobe to assess its water content. The prefrontal cortex and hippocampus were then dissected for histological evaluation, allowing us to investigate potential regional differences in tissue injury. The blank control group was sampled directly before perfusion. All statistical analyses and graphs were performed using GraphPad Prism 8.0 Student t-test. All tests were two-sided, and p value of less than 0.05 was considered to indicate statistical significance. RESULTS: The contents of red blood cells and hemoglobin during perfusion were maintained at normal levels but more red blood cells were destroyed 3 h after the perfusion. The blood oxygen saturation of the perfusion group was maintained at 95% - 98%. NA⁺ and K⁺ concentrations were normal most of the time during perfusion but increased significantly at about 4 h. The Ca²⁺ concentration remained within the normal range at each period. Glucose levels were slightly higher than the baseline level. The pH of the perfusion solution was slightly lower at the beginning of perfusion, and then gradually increased to the normal level. The water content of brain tissue in the sub-low and docile perfusion group was 78.95% ± 0.39%, which was significantly higher than that in the control group (75.27% ± 0.55%, t = 10.49, p < 0.001), and the difference was statistically significant. Compared with the blank control group, the structure and morphology of pyramidal neurons in the prefrontal cortex and CA1 region of the hippocampal gyrus were similar, and their integrity was better. The structural integrity of granulosa neurons was destroyed and cell edema increased in the perfusion group compared with the blank control group. Immunofluorescence staining for glail fibrillary acidic protein and Iba1, markers of glial cells, revealed well-preserved cell structures in the perfusion group. While there were indications of abnormal cellular activity, the analysis showed no significant difference in axon thickness or integrity compared to the 1-h blank control group. CONCLUSIONS Mild hypothermic machine perfusion can improve ischemia and hypoxia injury of yorkshire brain tissue caused by traumatic blood loss and delay the necrosis and apoptosis of yorkshire brain tissue by continuous oxygen supply, maintaining ion homeostasis and reducing tissue metabolism level.
Animals ; Perfusion/methods* ; Disease Models, Animal ; Brain Injuries/etiology* ; Swine ; Male ; Hypothermia, Induced/methods*

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.