Cardiac fibrosis is characterized by an elevated amount of extracellular matrix (ECM) within the heart. However, the persistence of cardiac fibrosis ultimately diminishes contractility and precipitates cardiac dysfunction. Circular RNAs (circRNAs) are emerging as important regulators of cardiac fibrosis. Here, we elucidate the functional role of a specific circular RNA CELF1 in cardiac fibrosis and delineate a novel feedback loop mechanism. Functionally, circ-CELF1 was involved in enhancing fibrosis-related markers' expression and promoting the proliferation of cardiac fibroblasts (CFs), thereby exacerbating cardiac fibrosis. Mechanistically, circ-CELF1 reduced the ubiquitination-degradation rate of BRPF3, leading to an elevation of BRPF3 protein levels. Additionally, BRPF3 acted as a modular scaffold for the recruitment of histone acetyltransferase KAT7 to facilitate the induction of H3K14 acetylation within the promoters of the Celf1 gene. Thus, the transcription of Celf1 was dramatically activated, thereby inhibiting the subsequent response of their downstream target gene Smad7 expression to promote cardiac fibrosis. Moreover, Celf1 further promoted Celf1 pre-mRNA transcription and back-splicing, thereby establishing a feedback loop for circ-CELF1 production. Consequently, a novel feedback loop involving CELF1/circ-CELF1/BRPF3/KAT7 was established, suggesting that circ-CELF1 may serve as a potential novel therapeutic target for cardiac fibrosis.

Cancer toxin is a specific pathogenesis leading to the heterogeneity of breast cancer.The nature and virulence of the cancer toxin determine the differences in the heterogeneity of breast cancer,which can dynamically evolve over time and space,resulting in varying invasion abilities and characteristics of the tumor.Cancer cells in the primary lesion possess"toxicity"that targets specific organs for metastasis,and cancer toxins can influence the metastatic propensity of different types of breast cancer.Therefore,breast cancer treatment strategies based on the theory of cancer toxins emphasize the continuous eradication of the cancer toxin,focusing on differentiating its strength and nature,protecting unaffected areas first,identifying the state based on symptoms,and targeting accordingly to combat resistance arising from tumor heterogeneity.This article aims to provide a new theoretical basis for the treatment strategies of different types of breast cancer.

Objective:To explore the application effect of lower limb strength training based on "Internet +" in the home rehabilitation of knee osteoarthritis (KOA) patients.Methods:Using the convenient sampling method, a total of 80 KOA patients who visited Pain Outpatient Department of Beijing Friendship Hospital, Capital Medical University from May 2021 to December 2022 were selected. They were randomly divided into the observation group and the control group by the random number table method, with 40 cases in each group. The control group adopted routine home rehabilitation nursing, and the observation group implemented lower limb strength training based on "Internet +" on the basis of the control group. Both groups were intervened for 3 months, and the knee joint pain degree (VAS score), knee joint function (KOOS score) and exercise compliance of the two groups were compared.Results:After intervention, the VAS score of the observation group was lower than that of the control group and the KOOS score was higher than that of the control group, and the differences were statistically significant ( P<0.05). There were 26 cases of high compliance, 11 cases of partial compliance and 3 cases of low compliance in the observation group, and 19, 10 and 11 cases in the control group, respectively. The exercise compliance of the observation group was better than that of the control group, and the difference was statistically significant ( Z=1.997, P=0.046) . Conclusions:The implementation of lower limb strength training rehabilitation management based on "Internet +" can effectively alleviate knee pain in knee osteoarthritis patients, improve knee function, and improve their compliance with home exercise.

Objective:To explore the predictive value of leukocyte derived markers for postoperative delirium (POD) in patients undergoing cardiac valve surgery.Methods:A prospective cohort study was conducted. The patients who underwent cardiac valve surgery admitted to Beijing Anzhen Hospital of Capital Medical University from October 2021 to March 2023 were enrolled. The demographic, baseline and perioperative data were collected, and the neutrophil to lymphocyte ratio (NLR) and platelet to white blood cell ratio (PWR) were calculated before operation and within 24 hours after operation. Delirium assessment was conducted twice a day for patients within 1-5 days after surgery or discharged within 5 days. According to the evaluation results, the patients were divided into delirium group and non-delirium group. The clinical indexes between the two groups were compared. Multivariate Logistic regression analysis was used to screen the independent risk factors of POD, and the POD predictive model was constructed. The predictive value of POD predictive model was evaluated by receiver operator characteristic curve (ROC curve).Results:A total of 235 patients were enrolled in the analysis, of which 83 patients had POD (35.32%) and 152 patients did not have POD (64.68%). Compared with the non-delirious group, the patients in the delirious group had higher Charlson comorbidity index (CCI) score and lower mini-mental state examination (MMSE) score. In terms of perioperative data, compared with the non-delirium group, the patients in the delirium group had longer operative time, duration of cardiopulmonary bypass, length of intensive care unit (ICU) stay, duration of mechanical ventilation, and postoperative hospital stay, higher incidence of perioperative atrial fibrillation, and lower discharge life score. In terms of leukocyte derived markers, NLR within 24 hours after surgery in both groups were significantly higher than those before surgery, and PWR were significantly lower than those before surgery. The NLR within 24 hours after surgery, PWR difference and NLR difference in the delirium group were significantly higher than those in the non-delirium group. Multivariate Logistic regression analysis showed that CCI score [odds ratio ( OR) = 1.394, 95% confidence interval (95% CI) was 1.038-1.872, P = 0.027], perioperative atrial fibrillation ( OR = 3.697, 95% CI was 1.711-7.990, P < 0.001), duration of cardiopulmonary bypass ( OR = 1.008, 95% CI was 1.002-1.015, P = 0.016), length of ICU stay ( OR = 1.006, 95% CI was 1.002-1.010, P = 0.002), NLR difference ( OR = 1.029, 95% CI was 1.009-1.050, P = 0.005) and PWR difference ( OR = 1.044, 95% CI was 1.009-1.080, P = 0.013) were independently correlated with POD. POD predictive model was constructed by multivariate Logistic regression analysis result: POD predictive model index = -4.970+0.336×CCI score+1.317×perioperative atrial fibrillation+0.009×duration of cardiopulmonary bypass+0.006×length of ICU stay+0.030×NLR difference+0.044×PWR difference. ROC curve analysis showed that the area under the ROC curve (AUC) of NLR difference for predicting POD was 0.659 (95% CI was 0.583-0.735), the optimal critical value was 16.62, the sensitivity was 60.2%, and the specificity was 70.4% ( P < 0.05). The AUC of PWR difference for predicting POD was 0.608 (95% CI was 0.528-0.688), the optimal critical value was 25.68, the sensitivity was 51.8%, and the specificity was 75.7% ( P < 0.05). The AUC of POD predictive model for predicting POD was 0.805 (95% CI was 0.745-0.865), the optimal critical value was 0.39, the sensitivity was 74.7%, and the specificity was 79.6% ( P < 0.05). Conclusion:The differences of NLR and PWR are independently related to POD, which has potential value in predicting POD after cardiac valve surgery.

Objective To investigate the epidemiological characteristics and diagnosis of imported Plasmodium malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Guangxi Zhuang Autonomous Region and Henan Province from 2014 to 2021, so as to provide insights into malaria control in these five provinces. Methods All data pertaining to malaria cases reported in five provinces of China were captured from Chinese Disease Control and Prevention Information System from 2014 to 2021, and the epidemiological characteristics of imported P. malariae and P. ovale malaria cases were analysed using a descriptive epidemiological method. The duration from onset of malaria to initial diagnosis, duration from initial diagnosis to definitive diagnosis, institutions of initial and definitive diagnoses, and proportion of correct malaria diagnosis at initial diagnosis were statistically analyzed. Results A total of 1 223 imported P. malariae and P. ovale malaria cases were reported in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021, there were 158 P. malariae malaria cases (12.92%) and 1 065 P. ovale malaria cases (87.08%). Totally 98.53% (1 205/1 223) of the imported malaria cases were from Africa, with Angola (18.99%, 30/158), Nigeria (11.39%,18/158), Cameroon (10.76%, 17/158), Ghana (10.13%, 16/158) and the Democratic Republic of the Congo (10.13%,16/158) as predominant countries where P. malariae malaria cases were from, and Ghana (23.19%, 247/1 065), Cameroon (14.74%, 157/1 065), Nigeria (9.39%, 100/1 065) and Angola (6.95%, 74/1 065) as predominant countries where P. ovale malaria cases were from. There were significant differences in the duration from onset of malaria to initial diagnosis (χ² = 27.673, P = 0.000) and duration from initial diagnosis to definitive diagnosis of P. malariae and P. ovale malaria cases (χ² = 29.808, P = 0.000), and the proportions of correct initial diagnosis of P. malariae and P. ovale malaria cases were 38.61% (61/158) and 56.53% (602/1 065). There were 74.69% (118/158) of P. malariae malaria cases with definitive diagnosis in county-, city-, and province-level medical institutions, and 79.25% (844/1 065) of P. ovale malaria cases with definitive diagnosis in county- and city-level medical institutions and county-level centers for disease control and prevention. Conclusions The imported P. malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021 were mainly returned from Africa and the proportion of correct diagnosis of P. malariae and P. ovale malaria was low at initial diagnosis. Persistent improvements in the diagnostic capability of malaria are required in medical institutions.

Objective:To investigate the risk factors for intraoperative hemorrhage during endoscopic submucosal dissection (ESD) for colorectal lesions.Methods:Data of 386 patients with colorectal lesions, who underwent ESD at The Third People's Hospital of Datong and its cooperative hospital, Nanjing Drum Tower Hospital, from December 2019 to August 2021 were retrospectively analyzed. The patients were divided into the hemorrhage group ( n=85) and the non-hemorrhage group ( n=301) according to intraoperative hemorrhage. The correlationship of patients'basic information, lesion-related factors and hemorrhage during colorectal ESD was analyzed. Univariate and multivariate logistic regression were used to identify the risk factors for intraoperative hemorrhage during ESD. The risk predictive model of intraoperative hemorrhage during ESD was established according to the screened risk factors, and receiver operator characteristic (ROC) curve was used to evaluate the predictive model. Results:Univariate logistic regression showed that a history of diabetes ( OR=2.340, P<0.05), a history of coronary atherosclerotic heart diseases ( OR=3.100, P<0.05), the lesion located in the rectum ( OR=3.272, P<0.05), longer lesion ( OR=1.093, P<0.05), wider lesion ( OR=1.057, P<0.05), larger lesion ( OR=1.126, P<0.05), depressed lesion ( OR=6.128, P<0.05), the laterally spreading lesion ( OR=2.651, P<0.05), the lesion infiltrated into the SM-S layer ( OR=0.088, P<0.05), the lesion infiltrated into the SM-D layer ( OR=0.174, P<0.05), the diameter of hemorrhage vessels 0.5~<1.0 times of the diameter of incision knife ( OR=246.854, P<0.05), the postoperative pathology as early cancer ( OR=7.000, P<0.05) were risk factors for intraoperative hemorrhage during ESD. Considering the quantitative relationship between the length, the width and the area of lesions, multi-factor models were constructed using the length and area of lesions respectively. Forward stepwise regression was used to screen variables and determine the final model, and the results showed that a history of coronary atherosclerotic heart diseases, the depressed lesion, the longer lesion, the larger lesion, the diameter of hemorrhage vessels 0.5~<1.0 times of the diameter of the incision knife were independent risk factors for intraoperative hemorrhage during ESD. The two modeling results of the lesion length and the lesion area were very similar. Therefore, lesion length was recommended to describe lesions in clinical practice. Conclusion:A history of coronary atherosclerotic heart disease, the depressed lesion, the longer lesion, the larger lesion, the diameter of vessels 0.5~<1.0 times of that of the incision knife are independent risk factors for intraoperative hemorrhage during ESD.

Objective:To explore the effect of multidiscipline team for pain (PMDT) led by anesthesia nursing team in perioperative period of liver transplantation patients.Methods:From January 2018 to December 2020, 100 patients with liver transplantation who were admitted to Beijing Friendship Hospital affiliated to Capital Medical University were selected as the study subject by convenience sampling. According to the method of random number table, the patients were divided into the control group and the observation group, 50 cases in each. The patients in the control group received routine pain management during the perioperative period, and the patients in the observation group received PMDT led by the anesthesia nursing team on the basis of the patients in the control group. The anesthesia related indexes and the use of analgesia pump were compared between the two groups.Results:The operation anesthesia time, anesthesia resuscitation time, and the use time of the patient-controlled analgesia pump in the observation group were shorter than those in the control group, the dosage of sufentanil and dexmedetomidine in the patient-controlled analgesia pump was lower than that in the control group, the above differences were statistically significant ( P<0.05) . Conclusions:PMDT led by anesthesia nursing team can effectively shorten the anesthesia time of liver transplantation, reduce the dosage of postoperative analgesics, and improve the analgesic effect.

Objective:To analyze changes in nutritional status and immune function of elderly men receiving regular physical examinations, and to investigate the effects of aging on the nutritional status and immune function among elderly men.Methods:A total of 209 elderly men aged 60-101(72.9±11.5)years and receiving regular physical check-ups were enrolled.All research subjects were subjected to nutritional risk screening(NRS2002)and monitoring of nutrition and immune-related indicators, including routine blood work, blood biochemistry, immunoglobulin and T lymphocyte subsets.Results:Body weight, body mass index, hemoglobin, total protein, albumin and serum iron of elderly men decreased with age( F=21.754, 6.257, 47.528, 12.285, 18.397, 18.667, all P<0.001), with those aged 80 and above showing more significant decline and a greater proportion with malnutrition( χ2=77.134, P<0.001). The B lymphocyte counts of elderly men aged 80 and above were significantly lower( P<0.05)while serum IgA and IgG levels were significantly higher( F=3.110, 3.866, P=0.047, 0.022)than those of the 70-79 year old group.In addition, the B lymphocyte count and B lymphocyte ratio in malnourished elderly men were significantly lower( t=2.512, 2.874, P=0.013, 0.005), and IgA was significantly increased( t=2.513, P=0.017), compared with those with normal nutrition. Conclusions:The risk of malnutrition and reduced immune function among elderly men aged 80 years and above is significantly increased, and assessment and screening of the risk of malnutrition in the elderly should be stressed.

Objective: To analyze the trends of weight, blood pressure and serum uric acid levels in college graduates during 2016-2020, so as to provide the evidence for chronic diseases prevention and control in university students. Methods: A cross sectional study was conducted to collect the data of physical examination of new graduates of Peking University during 2016-2020. It analyzed the differences in the BMI, blood pressure, serum uric acid, prevalence of overweight/obesity, hypertension, and hyperuricemia. Results: For males, the prevalences of overweight/obesity, hypertension of 2016-2020 and hyperuricemia of 2018-2020 varied significantly ( χ 2=52.94, 37.63, 55.53, P <0.01), but not significant difference of overweight/obesity, hypertension among the four groups of 2016-2019 ( χ 2=6.45, 1.05, P >0.05). The highest prevalences of overweight (29.25%), obesity ( 11.37 %), hypertension (12.60%) and hyperuricemia (43.84%) were observed in the group of 2020. For females, the prevalence of hypertension of 2016-2020 and hyperuricemia of 2018-2020 were significantly different ( χ 2=14.14, 14.59, P <0.01)，but not significant difference of hypertension of 2016-2019( χ 2=0.34, P >0.05). The highest prevalences of hypertension (2.35%) and hyperuricemia (13.86%) were both found in the group of 2020. Conclusion High prevalence of hypertension and hyperuricemia in college graduates of 2020 suggest unhealthy lifestyle probably has adverse impact on health consequences in young adult students.

Objective To understand the number and prevalence of chronic filariasis patients in Hubei Province, and to provide a basis for effective care for patients. Methods The chronic filariasis patients registered in Hubei Province were interviewed to investigate the general condition of patients, the results of previous microfilaria examinations, and the current clinical symptoms, signs and onset of illness. Results A total of 487 chronic filariasis patients were investigated. The youngest was 32 years old, the oldest was 97 years old, and the average age was 76 years old. The 80-89 years old group had the largest number, accounting for 44.97%. The male accounted for 46.61%, and the female accounted for 54.39%. The occupation was dominated by farmers, accounting for 89.94%. Patients with lymphangitis accounted for 72.28%, with dermatitis accounted for 89.12%, with chyluria accounted for 11.29%, and with hydrocele accounted for 6.16%. Among the 352 patients with lymphangitis/lymphadenitis, the site of the attack was mainly at groin and lower limbs, accounting for 96.02%. Among the 433 patients with lymphedema/elephantiasis, the disease staging of the left and right legs was mainly concentrated in stage I-III, and there was no stage VII patient. Among the 55 patients with chyluria, the dysuria accounted for 30.91%. Of the 30 patients with hydrocele, 17 had tenderness, and 8 had positive light transmission tests. Conclusions Chronic filariasis patients in Hubei Province gradually decreased with the natural attrition. More care should be given by CDC at all levels and primary medical units to patients with chronic filariasis to alleviate their symptoms and improve their quality of life. Since the filariasis has not been eliminated globally, it is still necessary to strengthen the surveillance of migrant workers who go abroad to filariasis-endemic areas.