ObjectiveTo investigate the association between immunoglobulin G （IgG）/immunoglobulin M （IgM） ratio and prognosis in patients with initially unresectable hepatocellular carcinoma （iuHCC） receiving TTP triple therapy with transcatheter arterial chemoembolization （TACE）， tyrosine kinase inhibitor （TKI）， and programmed cell death protein-1 （PD-1） inhibitors. MethodsA retrospective analysis was performed for the clinical data of 151 iuHCC patients who received TTP triple therapy in Department of Hepatobiliary Surgery， Guangxi Medical University Cancer Hospital， from November 2019 to December 2022， and according to IgG/IgM ratio， they were divided into high IgG/IgM group （IgG/IgM ratio >13.23） and low IgG/IgM group （IgG/IgM ratio ≤13.23）. The t-test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method and the log-rank test were used for survival analysis， and the Cox proportional hazards model was used to investigate the potential influencing factors for overall survival （OS）. ResultsThe 151 patients had a median OS of 26.7 months （95% confidence interval ［CI］： 19.8-not reached） and a median progression-free survival of 12.5 months （95%CI： 10.4 — 15.8）. The objective response rate was 83.4% and the disease control rate was 94.0%. There were no significant differences in baseline data between the high IgG/IgM group and the low IgG/IgM group （all P>0.05）. There was a significant difference in median OS between the high IgG/IgM group and the low IgG/IgM group （20.6 months vs not reached， P=0.016）. In both the high IgG/IgM group and the low IgG/IgM group， salvage hepatectomy was significantly associated with the improvement in OS （χ²=8.297 and 10.307， both P<0.05）. The multivariate analysis showed that high IgG/IgM ratio （hazard ratio ［HR］=1.799， 95%CI： 1.077 — 3.006， P=0.025）， baseline alpha-fetoprotein >400 ng/mL （HR=1.762， 95%CI： 1.017 — 3.050， P=0.043）， and BCLC stage （HR=2.265， 95%CI： 1.212 — 4.232， P=0.010） were independent influencing factors for OS. ConclusionHigh IgG/IgM ratio is associated with a poorer prognosis in iuHCC patients receiving TTP triple therapy， and salvage hepatectomy has a potential value in improving the prognosis of patients with a high IgG/IGM ratio.

BACKGROUND:Lysosomal storage diseases,as a group of rare genetic metabolic disorders,exhibit complex pathogenesis often leading to dysfunction of cells,tissues,and organs.Current therapeutic approaches have certain limitations.Stem cell transplantation,as an emerging treatment method,offers new options for patients with lysosomal storage diseases.OBJECTIVE:To review the mechanisms of action of stem cells in regulating lysosomes for the treatment of lysosomal storage diseases and explore the feasibility of traditional Chinese medicine in treating such diseases,providing new insights for the treatment of lysosomal storage diseases with stem cells.METHODS:Relevant literature from 2010 to 2024 was searched in CNKI and PubMed databases using keywords"stem cells,lysosomal storage disease,lysosome"in English and Chinese.Ultimately,78 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)Stem cells treat lysosomal storage diseases by regulating lysosomes primarily through three aspects:regulating stem cell differentiation and replacement,improving intercellular communication and the microenvironment,and enhancing lysosomal enzyme expression through gene editing.(2)Stem cells have achieved significant effects in the treatment of some lysosomal storage diseases,such as Niemann-Pick disease,mucopolysaccharidoses,Gaucher disease,and metachromatic leukodystrophy.(3)The procedure for stem cell transplantation needs further optimization.Adverse reactions post-transplantation urgently need to be addressed,and the efficiency and safety of gene-modified stem cells also need to be further improved.In the future,more research on the treatment of lysosomal storage diseases with traditional Chinese medicine is required to reveal the relevant mechanisms for the treatment of lysosomal storage diseases with traditional Chinese medicine.

BACKGROUND:Lysosomal storage diseases,as a group of rare genetic metabolic disorders,exhibit complex pathogenesis often leading to dysfunction of cells,tissues,and organs.Current therapeutic approaches have certain limitations.Stem cell transplantation,as an emerging treatment method,offers new options for patients with lysosomal storage diseases.OBJECTIVE:To review the mechanisms of action of stem cells in regulating lysosomes for the treatment of lysosomal storage diseases and explore the feasibility of traditional Chinese medicine in treating such diseases,providing new insights for the treatment of lysosomal storage diseases with stem cells.METHODS:Relevant literature from 2010 to 2024 was searched in CNKI and PubMed databases using keywords"stem cells,lysosomal storage disease,lysosome"in English and Chinese.Ultimately,78 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)Stem cells treat lysosomal storage diseases by regulating lysosomes primarily through three aspects:regulating stem cell differentiation and replacement,improving intercellular communication and the microenvironment,and enhancing lysosomal enzyme expression through gene editing.(2)Stem cells have achieved significant effects in the treatment of some lysosomal storage diseases,such as Niemann-Pick disease,mucopolysaccharidoses,Gaucher disease,and metachromatic leukodystrophy.(3)The procedure for stem cell transplantation needs further optimization.Adverse reactions post-transplantation urgently need to be addressed,and the efficiency and safety of gene-modified stem cells also need to be further improved.In the future,more research on the treatment of lysosomal storage diseases with traditional Chinese medicine is required to reveal the relevant mechanisms for the treatment of lysosomal storage diseases with traditional Chinese medicine.

Objective:To explore the effect of preoperative intensive functional training on the balance and functional recovery of patients with knee osteoarthritis (KOA) receiving total knee arthroplasty (TKA).Methods:Sixty KOA patients were randomly divided into an outpatient group, a home-based group and a control group, each of 20. Before their TKAs, both the outpatient and home-based groups underwent intensive functional training for 4 weeks, while the control group did nothing special. After the TKA, all received 4 weeks of standardized postoperative rehabilitation training. Before any training, after the 4 weeks of preoperative training and 4 weeks after the TKAs, all of the subjects performed the timed up and go test (TUGT), and their joint range of motion (ROM) was recorded. They also completed the 30-second chair stand strength test (30sCST), and the 6-minute walk exercise endurance test (6MWT). KOA osteoarthritis indices (WOMACs) were also recorded.Results:After the 4 weeks of preoperative training, significant differences were observed in the trajectory length, elliptical area and TUGT times of both the outpatient and home-based groups. Four weeks after the TKAs, significant differences were observed in all of the measurements in all three groups, but the results of the outpatient and home-based groups were significantly better than those of the control group, on average. After the 4 weeks of postoperative training, there were significant differences between the outpatient and home-based groups in terms of the average knee flexion angle, knee extension angle, 30sCST and 6MWT results. There were significant differences among the 3 groups in all of the measurements 4 weeks after the TKAs, with those of the two training groups showing significantly better results than the control group. The pain scores, stiffness scores, function scores and total WOMAC scores had improved significantly compared with the control group, but the average function and total WOMAC scores of the outpatient group (24.25±2.38) and (35.41±3.02) were then significantly superior to the home-based group′s averages.Conclusions:Intensive preoperative functional training conducted in an outpatient clinic or at home can significantly improve the balance, lower limb strength, exercise endurance and symptoms of KOA patients after TKA.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective:To explore the effect of preoperative intensive functional training on the balance and functional recovery of patients with knee osteoarthritis (KOA) receiving total knee arthroplasty (TKA).Methods:Sixty KOA patients were randomly divided into an outpatient group, a home-based group and a control group, each of 20. Before their TKAs, both the outpatient and home-based groups underwent intensive functional training for 4 weeks, while the control group did nothing special. After the TKA, all received 4 weeks of standardized postoperative rehabilitation training. Before any training, after the 4 weeks of preoperative training and 4 weeks after the TKAs, all of the subjects performed the timed up and go test (TUGT), and their joint range of motion (ROM) was recorded. They also completed the 30-second chair stand strength test (30sCST), and the 6-minute walk exercise endurance test (6MWT). KOA osteoarthritis indices (WOMACs) were also recorded.Results:After the 4 weeks of preoperative training, significant differences were observed in the trajectory length, elliptical area and TUGT times of both the outpatient and home-based groups. Four weeks after the TKAs, significant differences were observed in all of the measurements in all three groups, but the results of the outpatient and home-based groups were significantly better than those of the control group, on average. After the 4 weeks of postoperative training, there were significant differences between the outpatient and home-based groups in terms of the average knee flexion angle, knee extension angle, 30sCST and 6MWT results. There were significant differences among the 3 groups in all of the measurements 4 weeks after the TKAs, with those of the two training groups showing significantly better results than the control group. The pain scores, stiffness scores, function scores and total WOMAC scores had improved significantly compared with the control group, but the average function and total WOMAC scores of the outpatient group (24.25±2.38) and (35.41±3.02) were then significantly superior to the home-based group′s averages.Conclusions:Intensive preoperative functional training conducted in an outpatient clinic or at home can significantly improve the balance, lower limb strength, exercise endurance and symptoms of KOA patients after TKA.

Objective:To evaluate the relationship between the mechanism of preoperative sleep deprivation aggravating postoperative cognitive dysfunction and theta oscillations in the hippocampal CA1 region in aged mice.Methods:Twenty-four SPF male C57BL/6J mice, aged 18 months, weighing 20-30 g, were divided into 3 groups ( n=8 each) by a random number table method: normal control group (group C), operation group (group S) and preoperative sleep deprivation + operation group (group SD+ S). The sleep deprivation model was established using the sleep deprivation rod method, and the sleep deprivation time was 24 h before operation. The sleep deprivation rod was set to rotate continuously at 6 rpm/min, and the direction was randomly reversed to force the mice to exercise to achieve the purpose of sleep deprivation. Group C received no treatment. Group S underwent exploratory laparotomy under isoflurane anesthesia. After sleep deprivation for 24 h, SD+ S group underwent exploratory laparotomy under isoflurane anesthesia. Y-maze and Morris water maze tests were used to evaluate postoperative cognitive function. The theta oscillations in the hippocampal CA1 region were observed and recorded by EEG electrodes in vivo. The animals were then sacrificed and brain tissues were obtained for determination of the density of dendritic spines in the hippocampal CA1 region. Results:Compared with group C, the number of crossing the original platform was significantly decreased, and the time of staying at the original platform quadrant and time of exploring the novel arm were shortened, and the number of entries into the novel arm was reduced, the density of dendritic spines in the hippocampal CA1 region was reduced, and the percentage of theta oscillation power was decreased during the Y maze test in group S ( P<0.05). Compared with S group, the number of crossing the original platform was significantly decreased, and the time of staying at the original platform quadrant and time of exploring the novel arm were shortened, and the number of entries into the novel arm was reduced, the density of dendritic spines in the hippocampal CA1 region was reduced, and the percentage of theta oscillation power was decreased during the Y maze test in SD+ S group ( P<0.01). Conclusions:The mechanisms by which preoperative sleep deprivation exacerbates postoperative cognitive dysfunction may be related to reduction in theta oscillations in the hippocampal CA1 region of aged mice.

Objective:To explore the value of Plan-Do-Check-Act (PDCA) management model in improving the quality of breast ultrasound diagnosis.Methods:From January 1 to December 31, 2021, patients undergoing breast nodule surgery in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected for breast ultrasound Breast Imaging Reporting and Data System (BI-RADS) classification diagnosis and follow-up. Using pathological results as the gold standard, the malignant rate of different BI-RADS grade and the coincidence rate of ultrasound diagnosis of breast cancer before the first treatment were analyzed. PDCA cycle management mode was introduced to analyze, learn and sort out the quality of breast ultrasound diagnosis. The same method was used to follow up the breast ultrasound diagnosis in the ultrasound department of our hospital from January 1 to December 31, 2022. The results of two follow-up visits were compared.Results:Compared with 2021, the malignancy rates of category 3 and 4a BI-RADS diagnosed by ultrasonic diagnosis of breast nodules in hospitals in 2022 were closer to the malignancy rates recommended by the classification guidelines of BI-RADS (all P<0.05). There was no significant difference in the malignant rate of BI RADS 4b, 4c and 5 types of nodules (all P>0.05). In 2022, compared with 2021, the ultrasound diagnosis coincidence rate before the first treatment of breast disease increased from 90.4%(1 592/1 761) to 95.9%(1 806/1 884). Conclusions:PDCA management mode is helpful to improve the classification and diagnosis quality of breast ultrasound BI-RADS, and better assist clinical diagnosis and treatment.

[Objective]To investigate the association between screen content and the frequency of screen exposure at the age of one and a half years and hyperactive behavior in preschool,and to explore how the association is affected by the interaction between outdoor activities and screen behaviors,which could provide theoretical basis and feasible solutions for the prevention and intervention of behavioral problems in childhoood.[Methods]The survey was conducted from June 2022 to June 2023 in Huicheng District,Huizhou (China) stratified by whole cluster sampling methods. Parents and teachers of 5648 children in 61 kindergartens were sampled for questionnaire surveys. The Conners Teacher Rating Scale (TRS) was used to investigate hyperactive behavior. A self-administered questionnaire was used to investigate basic demographic information of children,screen content,frequency of screen exposure and outdoor activities at the age of one and a half years. Multivariate logistic regression was used to explore the association between video screen behavior and hyperactive behavior and its interaction with outdoor activities by controlling for covariates such as children's age,gender,and parental education.[Results]Result showed the overall prevalence of 3.2％ for hyperactive behavior,2.1％ for conduct problems,2.1％ for hyperactivity problems,1.3％ for inattention-passivity problems,and 0.9％ for hyperactivity index. After adjusting for confounding factors,multiple logistic regression analysis showed that screen exposure of "two to four times a week" at one and a half years old was associated with an increased detection rate of hyperactive behaviors in preschool children,with an estimated ORs (95％ CI) of 1.682 (1.141,2.480). Daily screen exposure was associated with increased detection rates of hyperactive behavior,conduct problems,hyperactivity issues,inattention-passivity problems,and hyperactivity index in pre-school age. The estimated ORs (95％ CI) were 2.136 (1.218,3.746),2.321 (1.185,4.546),2.300 (1.208,4.380),2.776 (1.267,6.085) and 3.640 (1.525,8.687),respectively. But the above associations were not found in children who were engaged in daily outdoor activities at the age of one and a half years (P value for interaction<0.001). No association was found between screen content and hyperactive behavior (P>0.05).[Conclusions]Frequency of screen exposure in early childhood is significantly associated with hyperactive behavior problems in preschool,and outdoor activities could weaken the correlation between high-frequency screen exposure and hyperactive behavior,suggesting that parents and schools should prioritize scientifically guiding children's video viewing behavior and outdoor activities,ensuring a well-arranged daily life,to lay a good foundation for the healthy development of children's behavior.