AIM:To investigate the effect of fibroblast growth factor 21(FGF21)on high glucose-induced oxidative stress in retinal pigment epithelial(RPE)cells and to clarify the underlying molecular mechanisms.METHODS:Single-cell sequencing data from the GEO database were analyzed to determine the expression profile of the FGF21 receptor FGFR1 in RPE cells. Human ARPE-19 cells were cultured and randomly assigned to control, high glucose(30 mmol/L), and high glucose+FGF21 analog treatment groups, with additional siFGFR1 and PI3K inhibitor groups. Cell viability in different treatment groups was assessed using CCK-8 assay, intracellular reactive oxygen species(ROS)levels were quantified using DCFH-DA fluorescent probing combined with immunofluorescence staining and flow cytometry. Transcriptome sequencing was performed on cells from the high glucose group and high glucose+FGF21 group to analyze the enrichment level of the PI3K/Akt signaling pathway. Western blotting was performed to detect phosphorylation levels of PI3K/Akt pathway components.RESULTS:Single-cell sequencing revealed specific expression of FGFR1 in RPE cells of retinal tissues from diabetic model mice. Under In vitro experiments, high glucose(30 mmol/L)exposure reduced ARPE-19 cell viability by 49.7% and increased ROS levels by approximately 2-fold. Whereas treatment with the FGF21 analog(60 ng/mL)restored cell viability and attenuated high glucose-induced ROS accumulation. Mechanistic studies demonstrated that FGFR1 knockdown inhibited the antioxidative stress of FGF21. Further validation of the molecular mechanism revealed that high glucose significantly suppressed the PI3K/Akt pathway activation(the levels of p-Akt and p-PI3K were decreased by 33.9% and 36.6%, respectively), while FGF21 effectively reversed this inhibitory effect and restored the expression of p-Akt and p-PI3K. Treatment with the PI3K inhibitor LY294002 inhibited the cytoprotective effect of FGF21 and significantly increased the ROS-positive cells, these findings confirm that PI3K/Akt signaling is indispensable downstream mechanism for FGF21 to exert its effects.CONCLUSION:FGF21 alleviates high glucose-induced oxidative stress and cellular injury in RPE cells by activating the PI3K/Akt signaling pathway through its receptor FGFR1.

BACKGROUND: The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined. METHODS: All CTO vessels treated with successful anatomical PCI in patients from PANDA III trial were retrospectively measured for post-PCI QFR. The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs, composite of target vessel-related cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization). Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs, and all vessels were stratified by this optimal cutoff value. Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI. RESULTS: Among 428 CTO vessels treated with PCI, 353 vessels (82.5%) were analyzable for post-PCI QFR. 31 VOCEs (8.7%) occurred at 2 years. Mean value of post-PCI QFR was 0.92 ± 0.13. Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91. The incidence of 2-year VOCEs in the vessel with post-PCI QFR < 0.91 (n = 91) was significantly higher compared with the vessels with post-PCI QFR ≥ 0.91 (n = 262) (22.0% vs. 4.2%, HR = 4.98, 95% CI: 2.32-10.70). CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO. Achieving functionally optimal PCI results (post-PCI QFR value ≥ 0.91) tends to get better prognosis for patients with CTO lesions.

Objective:To investigate the prevalence of dysphagia in community-dwelling elderly patients with chronic dis-eases and to analyze the correlation between the categories of chronic diseases and the prevalence of dysphagia.Method:Elderly people(aged ≥60 years)with one of five common chronic diseases(hypertension,diabetes,coronary heart disease,respiratory diseases,and hepatobiliary diseases)were recruited from Shipai Community health service center of Tianhe District.Eating assessment tool-10 and Water Swallow Test were used to evalu-ate swallowing function.Age-adjusted Charlson comorbidity index(ACCI)classification,grip strength test and 4-meter walking test were used to evaluate physical endurance of patients.The prevalence of dysphagia was de-termined among individuals with these chronic diseases and varying degrees of multimorbidity.The correlation between dysphagia and gender,age,chronic diseases,grip strength and walking endurance was analyzed.Result:The total number of respondents was 2352,of which 2121 were effectively surveyed.Among them,252 cases were positive for dysphagia,and the prevalence of dysphagia was 11.88％.The prevalence of dys-phagia was 63.89％for hypertension,28.57％for diabetes,39.68％for coronary heart disease,8.73％for respi-ratory diseases,and 2.78％for hepatobiliary diseases.There was no statistically significant difference in the cor-relation between gender,age and grip strength and dysphagia.Univariate regression analysis showed that respi-ratory diseases(t=3.987,P＜0.001),hepatobiliary diseases(t=2.158,P＜0.05),ACCI(t=2.745,P＜0.05),4-meter walk test(t=7.082,P＜0.001),the results were statistically significant(P＜0.05).Conclusion:Dysphagia is highly prevalent among elderly individuals with chronic diseases in the community.Respiratory diseases,hepatobiliary diseases,ACCI score,and 4m walk test are positively correlated with the prevalence of dysphagia.

Choroidal neovascularization (CNV) is a common fundus neovascularization disease, which often leads to irreversible vision loss.The pathological mechanisms are extremely complex, involving the participation of a variety of cells and cellular contacts.Currently, there are still many deficiencies in the treatment of CNV.We are concerned that blood vessels are not only a " conduits" for transporting nutrients and metabolic waste, but also providing angiocrine factors for organ growth and development.A variety of tissue-specific vascular endothelial cells have been proved to be able to deliver a variety of cytokines under certain conditions, which act on surrounding cells and participate in the control of angiogenesis and homeostasis.Therefore, this review focuses on the research progress on the involvement of angiocrine in pericytes, retinal pigment epithelial cells, mononuclear macrophages, neutrophils and endothelial precursor cells in CNV through various forms such as extracellular vesicles, in order to provide new ideas for the treatment of CNV.

Choroidal neovascularization (CNV) is a common fundus neovascularization disease, which often leads to irreversible vision loss.The pathological mechanisms are extremely complex, involving the participation of a variety of cells and cellular contacts.Currently, there are still many deficiencies in the treatment of CNV.We are concerned that blood vessels are not only a " conduits" for transporting nutrients and metabolic waste, but also providing angiocrine factors for organ growth and development.A variety of tissue-specific vascular endothelial cells have been proved to be able to deliver a variety of cytokines under certain conditions, which act on surrounding cells and participate in the control of angiogenesis and homeostasis.Therefore, this review focuses on the research progress on the involvement of angiocrine in pericytes, retinal pigment epithelial cells, mononuclear macrophages, neutrophils and endothelial precursor cells in CNV through various forms such as extracellular vesicles, in order to provide new ideas for the treatment of CNV.

Objective:To investigate the prevalence of dysphagia in community-dwelling elderly patients with chronic dis-eases and to analyze the correlation between the categories of chronic diseases and the prevalence of dysphagia.Method:Elderly people(aged ≥60 years)with one of five common chronic diseases(hypertension,diabetes,coronary heart disease,respiratory diseases,and hepatobiliary diseases)were recruited from Shipai Community health service center of Tianhe District.Eating assessment tool-10 and Water Swallow Test were used to evalu-ate swallowing function.Age-adjusted Charlson comorbidity index(ACCI)classification,grip strength test and 4-meter walking test were used to evaluate physical endurance of patients.The prevalence of dysphagia was de-termined among individuals with these chronic diseases and varying degrees of multimorbidity.The correlation between dysphagia and gender,age,chronic diseases,grip strength and walking endurance was analyzed.Result:The total number of respondents was 2352,of which 2121 were effectively surveyed.Among them,252 cases were positive for dysphagia,and the prevalence of dysphagia was 11.88％.The prevalence of dys-phagia was 63.89％for hypertension,28.57％for diabetes,39.68％for coronary heart disease,8.73％for respi-ratory diseases,and 2.78％for hepatobiliary diseases.There was no statistically significant difference in the cor-relation between gender,age and grip strength and dysphagia.Univariate regression analysis showed that respi-ratory diseases(t=3.987,P＜0.001),hepatobiliary diseases(t=2.158,P＜0.05),ACCI(t=2.745,P＜0.05),4-meter walk test(t=7.082,P＜0.001),the results were statistically significant(P＜0.05).Conclusion:Dysphagia is highly prevalent among elderly individuals with chronic diseases in the community.Respiratory diseases,hepatobiliary diseases,ACCI score,and 4m walk test are positively correlated with the prevalence of dysphagia.

Objective:To observe the effects of SARS-CoV-2 infection on the morphology, proliferation, apoptosis, cell cycle, and immune response function of mouse retinal photoreceptor cells (661w cells).Methods:A cell experiment. Logarithmic growth phase 661w cells were cultured in vitro and transfected with angiotensin-converting enzyme 2 (ACE2) overexpressing lentivirus to construct ACE2 overexpressing 661w cells that could be infected with SARS-CoV-2 pseudovirus (hereafter referred to as 'pseudovirus’). The 661w cells were divided into three groups: the normal group (untreated), the siACE2 group (overexpressing ACE2 and not infected with the pseudovirus) and the infected group (overexpressing ACE2 and infected with the pseudovirus), in which the infected group was 5 TU/ml pseudovirus group, 15 TU/ml pseudovirus group, 30 TU/ml pseudovirus group and 50 TU/ml pseudovirus group, and the cells were infected with the pseudovirus for 12, 24, 48 and 72 h, respectively. The infected group was infected with 5 TU/ml pseudovirus group, 15 TU/ml pseudovirus group, 30 TU/ml pseudovirus group and 50 TU/ml pseudovirus group, respectively, for 12, 24, 48 and 72 h. Fluorescence microscopy was used to observe the transfection efficiency of ACE2; protein immunoblotting (Western blot) was used to detect the relative expression level of ACE2 in the cells; light microscope was used to observe the morphology of the cells in the normal and the infected groups; cell proliferation was detected by Cell Counting Kit-8 (CCK8) assay; flow cytometry was used to detect the cell cycle; Western blot and real-time quantitative polymerase chain reaction (qPCR) were used to detect the relative expression of interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), B lymphocytoma-2 (Bcl-2), Bcl-2-associated X-protein (Bax) proteins and mRNA in the cells of siACE2 group, infected group (30 TU/ml pseudovirus group); qPCR was used to detect the relative expression of nuclear factor ( NF)- κB1 and NF-κB2, as well as NF- kB enhancer ( P65) and precursor protein ( P100) in cells of the siACE2 group and the infected group (30 TU/ml pseudovirus group). One-way ANOVA was used for comparison between multiple groups; t-test was used for comparison between two groups. Results:Compared with the siACE2 group, the cells in the infected group showed different degrees of crumpling, and with the increase of the concentration and time of pseudovirus induction, the crumpling of the cells worsened, and the number of cells decreased. Compared with the normal group, the cells in the infected group showed a gradual decrease in cell viability with the prolongation of pseudovirus induction time, and the difference was no statistically significant ( F=0.840, 0.412, 1.498, 1.138; P>0.05), and the apoptotic index of the cells induced in the 30 and 50 TU/ml pseudovirus group was significantly elevated, and the difference was statistically significant ( F=2.523, 6.716, 3.477, 3.421; P<0.05). At 72 h of pseudovirus induction, compared with the siACE2 group, the G1 phase cells in the 30 TU/ml pseudovirus group were significantly increased, and the difference was statistically significant ( t=3.812, P<0.05); the relative expression of IL-6, TNF-α, Bax protein and mRNA in the cells was up-regulated ( t=7.601, 6.039, 3.088, 5.193, 6.427, 7.667; P<0.05), the relative expression of Bcl-2 protein and mRNA was down-regulated ( t=3.614, 6.777; P<0.05), and the relative expression of NF-κB1, NF-κB2, P65, and P100 mRNA was significantly up-regulated with statistically significant differences ( t=3.550, 3.074, 3.307, 4.218; P<0.05). Conclusion:SARS-CoV-2 infection may inhibit photoreceptor cell proliferation, promote apoptosis and cycle blockade by activating the NF-κB signalling pathway.

Objective·To explore the influencing factors of oral nutritional supplement compliance in postoperative patients with digestive tract cancer based on COM-B model,and to analyze the mediating role of medication belief and self-efficacy in oral nutritional supplement.Methods·A total of 300 postoperative gastrointestinal cancer patients were selected by convenience sampling method.The General Information Questionnaire,Morisky Medication Adherence Scale,Digestive Cancer Patients Nutrition Knowledge,Attitude and Practice Questionnaire,Multidimensional Scale of Perceived Social Support,Beliefs about Medicines Questionnaire and General Self-Efficacy Scale were used.A mediating effect model was used to analyze the influencing factors of compliance with oral nutritional supplements.Results·The score of Morisky Medication Adherence scale was 1.61±1.38,which was at a low level.Oral nutritional supplement compliance was significantly positively correlated with nutrition knowledge,social support,medication belief and self-efficacy(r=0.391,0.401,0.438,0.410,all P＜0.01).Medication belief had a partial mediating effect between nutrition knowledge and adherence to oral nutritional supplements(effect size=0.097,accounting for 18.00%of the total effect).Self-efficacy had a partial mediating effect between nutrition knowledge and oral nutritional supplement compliance(effect size=0.044,accounting for 8.16%of the total effect).Self-efficacy had a partial mediating effect between social support and oral nutritional supplement compliance(effect size=0.044,accounting for 16.67%of the total effect).Conclusion·The compliance of oral nutritional supplements in postoperative patients with gastrointestinal cancer is at a low level.The individualized nursing intervention can increase the nutritional knowledge of patients,improve the social support,reduce the concerns of patients about oral nutrition,and improve the self-efficacy of patients,so as to promote the compliance of patients with oral nutritional supplements.

Objective:To construct a prediction model for ventilator-associated pneumonia (VAP) in mechanically ventilated preterm infants in the neonatal intensive care unit (NICU) and to test its clinical effect.Methods:This was a cross-sectional study. A total of 740 preterm infants admitted to the NICU for mechanical ventilation from July 2018 to June 2023 were retrospectively selected as the study subjects, and were divided into the modeling set (518 cases) and the validation set (222 cases) according to the ratio of 7∶3 using the computer-generated random number method. The modeling set was divided into the VAP group (181 cases) and the non-VAP group (337 cases) according to whether VAP occured, and 21 clinical characteristics were analyzed, using single factor difference analysis to screen predictive factors, the independent risk factors of VAP in mechanically ventilated preterm infants were determined by multivariate Logistic regression analysis, and the nomogram model was made by R software. Then, the nomogram model was tested by validating the data of the validation set. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test, calibration curve and clinical decision curve were used to evaluate the efficacy and practical value of the model.Results:There were 88 males and 93 females in the VAP group, with 156 cases of gestational age<34 weeks and 25 cases of gestational age≥34 weeks. There were 155 males and 182 females in the non-VAP group, with 196 cases of gestational age<34 weeks and 141 cases of gestational age≥34 weeks. Birth weight ( OR=0.114, 95% CI 0.044-0.268, P<0.05) and oral care of breast milk ( OR=0.124, 95% CI 0.0.057-0.249, P<0.05) were protective factors for VAP in mechanically ventilated preterm infants, and Apgar score at 5 min after birth ( OR=2.895, 95% CI 1.318-6.419, P<0.05), serum prealbumin at 72 h of mechanical ventilation ( OR=4.837, 95% CI 2.643-9.063, P<0.05), gastric contents reflux ( OR=6.754, 95% CI 3.156-15.240, P<0.05), and time of mechanical ventilation ( OR=7.784, 95% CI 3.491-18.160, P<0.05) were independent risk factors for VAP in mechanically ventilated preterm infants. The area under the curve (AUC) of the ROC curve of the modeling set was 0.929 (95% CI 0.907-0.950, P<0.01), and the validation set (AUC) was 0.917 (95% CI 0.882-0.952, P<0.01), the model has good discrimination. The C indices of the modeling set and the validation set were 0.93 and 0.92 respectively by sampling 500 times by the Bootstrap method, indicating that the model had good consistency, and the decision curve suggested that the prediction model was far from the extreme curve and the net return value was high, indicating that the nomogram prediction model constructed this time had high prediction value. Conclusions:Birth weight, Apgar score at 5 min after birth, time of mechanical ventilation, oral care of breast milk, serum prealbumin at 72 h of mechanical ventilation, and gastric contents reflux are independent influencing factors for VAP in mechanically ventilated preterm infants. The nomogram prediction model constructed can provide a visual and simple evaluation tool for early identification of high-risk children and reducing the occurrence of VAP.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.