Objective To evaluate the efficacy and safety of intraoperative pleural irrigation with Nocardia rubra cell-wall skeleton (N-CWS) for reducing pleural effusion drainage after radical surgery for lung cancer. Methods A retrospective analysis was conducted on the clinical data of lung cancer patients who underwent lobectomy and mediastinal lymph node dissection at the First Affiliated Hospital of Xiamen University between December 2024 and May 2025. Patients were divided into a control group and an irrigation group based on the intraoperative use of N-CWS. Patients in the irrigation group received pleural irrigation with 800 μg of N-CWS diluted in 10 mL of normal saline. The following outcomes were compared between the two groups: pleural effusion drainage volume at 0-24 h, 24-48 h, and 48-72 h postoperatively, degree of air leak, chest tube duration, postoperative length of stay, and the incidence of adverse events (fever, chest pain, and nausea and vomiting). Results A total of 245 patients were included (97 males, 148 females) with a mean age of (61.28±6.26) years, with 205 in the control group and 40 in the irrigation group. Compared to the control group, the irrigation group showed significantly lower pleural effusion drainage volumes at 0-24 h, 24-48 h, and 48-72 h, as well as shorter chest tube duration and postoperative length of stay (all P<0.05). There was no statistical difference in the degree of postoperative air leak (P=0.661). No significant differences were observed between the two groups regarding the highest body temperature within 72 h post-surgery (P=0.130), fever grade (P=0.196), severity of chest pain (P=0.105), or the incidence of nausea and vomiting (P=0.376). Conclusion Intraoperative pleural irrigation with N-CWS in patients undergoing lobectomy and mediastinal lymph node dissection for lung cancer can significantly reduce postoperative pleural effusion drainage volume, shorten chest tube duration and length of hospital stay. The procedure is safe and feasible.

Objective To understand the current status of blood pressure variability and dyslipidemia in young and middle-aged patients with ischemic stroke, and to explore their relationship with prognosis. Methods A total of 312 young and middle-aged patients with ischemic stroke who met the inclusion criteria in Beijing Pinggu District Hospital from January 2022 to January 2025 were selected. The prognosis status [modified Rankin scale (mRS)], blood pressure variability, and blood lipids [total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] were analyzed. The correlation of blood pressure variability and blood lipids levels with prognosis was explored by logistic regression analysis. Results There were 206 patients with good prognosis and 106 patients with poor prognosis. The number of patients who received diversified health education in the good prognosis group was more than that in the poor prognosis group (P<0.05). The systolic blood pressure successive variation (SV) and average real variability (ARV), and diastolic blood pressure SV and ARV were lower in the good prognosis group than those in the poor prognosis group (P<0.05). Furthermore, compared with the poor prognosis group, the good prognosis group had lower levels of TC, TG and LDL-C, while the number of patients receiving diversified health education and the level of HDL-C were higher (P<0.05). After logistic regression analysis, it was found that the levels of TC, TG, LDL-C, systolic blood pressure SV and ARV, and diastolic blood pressure SV and ARV were risk factors for poor prognosis. Conversely, receiving diversified health education and HDL-C level were protective factors for poor prognosis (P<0.05). Conclusion High blood pressure fluctuation, dyslipidemia, and lack of health education will increase the risk of poor prognosis in young and middle-aged stroke patients.

OBJECTIVE To investigate the effects and mechanisms of oliceridine fumarate （TRV130） in improving postoperative cognitive dysfunction （POCD） in elderly rats based on the Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB） pathway. METHODS Rats were randomly divided into the control group （normal saline）， the model group （normal saline）， the TRV130 group （2.8 mg/kg）， the TLR4/NF-κB pathway inhibitor （TAK-242） group （3 mg/kg）， the β -arrestin inhibitor （Barbadin） group （3 mg/kg）， and the traditional opioid drug （morphine） group （2.8 mg/kg）， with 15 rats in each group. Except for the control group， POCD models were established in all other groups. From the first day after surgery， drugs/normal saline were administered via caudal vein injection once daily for 3 consecutive days. After the last administration， the pathological damage of hippocampal tissue was observed； the cognitive function， serum inflammatory factor levels， hippocampal neurons apoptosis rate， and the expression of ionized calcium-binding adapter molecule 1 （Iba-1）， glial fibrillary acidic protein （GFAP）， and TLR4/NF-κB pathway-related mRNA and protein in hippocampal tissue were detected. RESULTS In the model group， the neurons in the CA1 region of the hippocampus were disordered and sparse， with decreased number， pyknotic and fragmented nuclei accompanied by inflammatory cell infiltration. Compared with the control group， the escape latency， serum levels of tumor necrosis factor α （TNF-α）， interleukin-6 （IL-6）， and IL-1β， hippocampal neurons apoptosis rate， average fluorescence intensities of Iba-1 and GFAP， mRNA expression levels of TLR4 and NF-κB p65， and their protein expression/phosphorylation levels in hippocampal tissue were significantly increased/elevated in the model group （ P ＜0.05）； the time spent in the target quadrant and the number of platform crossings were significantly shortened/decreased （ P ＜0.05）. Compared with the model group， the cognitive function， pathological， inflammatory， and apoptosis-related indicators were significantly improved in the TRV130 group， TAK-242 group， and Barbadin group （ P ＜0.05）； the mRNA expression levels of TLR4 and NF-κB p65 and their protein expression/phosphorylation levels were significantly decreased in the TRV130 group and TAK-242 group （ P ＜0.05）. CONCLUSIONS TRV130 may improve POCD in elderly rats by inhibiting the TLR4/NF-κB pathway and alleviating postoperative central nervous system inflammatory responses.

Objective: To explore the core features of trait aggression in children and adolescents, so as to provide a theoretical basis for behavioral interventions targeting the central psychological characteristics of aggression in children and adolescents. Methods: From March to May 2020, a simple random convenience sampling method was employed to recruit 39 165 students from grades 4 to 12 in Sichuan, Chongqing, Guizhou, and Shandong. Data were collected via online questionnaires, with all participants completing the Chinese Version of the Aggression Questionnaire. Psychometric network analysis was utilized for data processing. Results: Trait aggression among Chinese children and adolescents was at a moderately low level. The core nodes of the network structure included physical aggression [if someone intentionally causes trouble for me, I will hit them severely (AGG6); if someone hits me, I will retaliate (AGG11)] and self aggression [When I am very irritable, I think of hurting myself (AGG5); when I am in a bad mood, I engage in behaviors that harm my health, such as overeating (AGG25)]. Across grade levels, core nodes primarily originated from the anger dimension [When I m angry, I feel like a powder magazine that could explode at any moment (AGG13); I can t control my temper (AGG18); I am prone to getting angry when I see things that are not pleasing to the eye (AGG23); I will get angry for no reason (AGG27)]. Except for grades 7 and 9, core nodes in other grades included the verbal aggression dimension [I am prone to arguments with people (AGG22)]. Before grade 8, core nodes incorporated the self aggression dimension (AGG 5, AGG 25); after grade 8, core nodes included the physical aggression dimension [AGG 6, AGG 11, I fight slightly more than others (AGG16), and if people around me make things difficult for me to a certain extent, I will fight with them (AGG26)]. No statistically significant differences were found in the trait aggression network structures across grades, genders, or within gender comparisons of different grades. Conclusion These findings broaden our understanding of aggression in children and adolescents, suggesting that behavioral interventions can effectively reduce aggressive behaviors in this population.

ObjectiveTo investigate the possible mechanism of Shufeng Jiedu capsules （SFJD） in alleviating influenza A （H1N1） virus pneumonia and focus on its effect on Toll-like receptor （TLR） signaling pathway in respiratory epithelial cells. MethodsA mouse model of viral pneumonia was established via the A/PR/8/34 （PR8） strain of influenza A virus. Mice were randomly divided into a normal group， a PR8 infection （PR8） group， and an SFJD group （8.4 g·kg^-1）， with 10 mice in each group. The day of infection was designated as day 1. The SFJD group was administered intragastrically at a volume of 20 mL·kg^-1 daily， while the normal and PR8 groups were given an equal volume of deionized water. Micro-computed tomography （Micro-CT） was performed on day 5， and the mice were dissected to collect their lungs， after which the lung index was calculated to verify the therapeutic effect of SFJD. Single-cell sequencing was used to analyze the differentially expressed genes in respiratory epithelial cells. Multiplex fluorescence immunohistochemistry was employed to detect the expression of TLR， tumor necrosis factor receptor-associated factor 6 （TRAF6）， and myeloid differentiation factor 88 （MyD88） proteins in epithelial cell adhesion molecule （EpCAM）-positive cells， and the proportion of respiratory epithelial cells expressing TLR pathway proteins was calculated. Respiratory epithelial cells were then sorted by flow cytometry， and Western blot was used to detect the expression of TLR， MyD88， TRAF6， Toll-interleukin receptor domain-containing adaptor inducing interferon-β （TRIF）， inhibitor of κB kinase α （IKKα）， and nuclear factor-κB （NF-κB） in the sorted epithelial cells. Enzyme-linked immunosorbent assay （ELISA） was used to measure the levels of interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α） in lung tissue. ResultsAt the transcriptional level， SFJD reversed the expression of TLR signaling pathway genes in respiratory epithelial cells， downregulating multiple TLR signaling pathway-related genes （P<0.01）. At the protein level， SFJD significantly reduced the proportion of respiratory epithelial cells expressing TLR3 （P<0.05）， the expression levels of TLR2， TLR3， TLR4， TRIF， TRAF6， IKKα， and NF-κB in epithelial cells（P<0.05， P<0.01）， as well as the levels of pro-inflammatory cytokines IL-1β and TNF-α in lung tissue （P<0.01）. ConclusionSFJD may alleviate viral pneumonia by suppressing the expression of TLR in respiratory epithelial cells and their subsequent signaling cascades.

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

Objective:To investigate the therapeutic effect of combined extracranial-intracranial revascularization on elderly patients with symptomatic chronic internal carotid artery occlusion, and to evaluate its safety and efficacy in the elderly population.Methods:A retrospective analysis was conducted on 35 elderly patients(aged ≥60 years)who underwent combined extracranial-intracranial revascularization for symptomatic chronic internal carotid artery occlusion in the Department of Neurosurgery, Renmin Hospital of Wuhan University from January 2017 to June 2022.The clinical data during hospitalization, as well as the follow-up data within 2 years after operation, were collected and analyzed.Results:A total of 35 cases of combined extracranial-intracranial revascularization were performed on 35 patients.The age at surgery ranged from 60 to 74 years(mean age 65.5 ± 4.2 years). The incidence of reversible neurological deficits within 2 weeks postoperation was 34.3%, and the incidence of focal cerebral infarction within 30 days postoperation was 5.7%.The patency rate of the bridging vessel was 97.1% at 3 months postoperation., and the incidence of focal cerebral infarction during the follow-up period of 30 days to 2 years postoperation was 2.9%.At 3 months after surgery, computed tomography perfusion imaging showed that regional cerebral blood flow(rCBF), regional cerebral blood volume(rCBV), regional mean transit time(rMTT), and regional time to peak(rTTP)were improved compared with those before surgery.The modified Rankin scale score decreased compared to preoperative values, while the Montreal Cognitive Assessment showed improvement in cognitive function compared to preoperative levels(all P<0.05). From 6 months to 1-year postoperation, cerebral angiography showed that 38.7% of the patients had neovascularization of Matsushima grade A or grade B. No cases of cerebral hemorrhage or death was observed during the treatment and follow-up. Conclusions:Combined extracranial-intracranial revascularization is safe and effective for elderly patients with symptomatic chronic internal carotid artery occlusion, which can improve the patient′s hemodynamic disorders, prevent infarction events, and improve the patients′ neurological function and cognitive ability.

Objective To determine the related substances in ornidazole active pharmaceutical ingredient(API)and injections using high performance liquid chromatography(HPLC)and to study the impurity profile of ornidazole using liquid chromatography-tandem mass spectrometry(LC-MS/MS)combined with forced degradation tests,aiming to clarify the sources of impurities and their correlation with the prescription and production process and providing technical support for the unified evaluation and quality control of this product.Methods A Phenomenex Luna C18column(4.6 mm×250 mm,5 μm)was used for the separation of ornidazole and its impurities,with 0.000 5%formic acid as mobile phase A and methanol as mobile phase B under gradient elution.The impurity content of 4 batches of APIs,3 batches of reference preparations,and 11 batches of domestic generic preparations were determined.The structure of unknown impurities was predicted using Jet Stream Ion Focusing Electrospray Ionization-Time of Flight Mass Spectrometry(AJS-TOF-MS/MS),and the sources of impurities were identified combined with forced degradation experiments,the prescription and the production process of various manufacturers.Results Ornidazole and its known impurities were well separated under the chromatographic conditions.The structures of five unknown impurities were inferred,and the sources of the impurities were identified.Conclusion This study provides a reference for impurity analysis,quality control,and overall evaluation of ornidazole API and injection.

Anorectal malignant melanoma is a rare and highly aggressive malignant tumor,often misdiagnosed as benign conditions such as rectal polyps or thrombosed hemorrhoids.In this case,the patient underwent 3D laparoscopic abdominoperineal resection for rectal cancer at our hospital on April 16,2024,with pathological examination confirming malignant melanoma.As of August 9,2024,contrast-enhanced computed tomography of the chest and abdomen and magnetic resonance imaging of the whole abdomen suggested multiple systemic metastases.This underscores that patients with malignant melanoma are often at an advanced stage at the time of clinical presentation.Current treatment primarily involves surgery combined with various adjuvant therapies;however,the prognosis remains poor.The cornerstone of management lies in early recognition and timely intervention.

Objective To investigate the effect of continuous theta burst stimulation-intermittent theta burst stimulation(cTBS-iT-BS)priming protocols with different time intervals on the plasticity of primary motor cortex(M1).Methods A total of 39 healthy young adults were recruited from Changzhou De'an Hospital from March to August,2024.Participants received cTBS-iTBS priming protocols with intervals of 5 minutes,10 minutes and 15 minutes using a randomized crossover design.Motor-evoked potential(MEP)amplitudes in M1 were recorded at baseline(before intervention)and 0 minute,10 minutes,20 minutes and 30 minutes after intervention.Results The main effects of stimulation protocol(F=19.761,P<0.001)and measurement time(F=10.224,P<0.001)were significant.At each time point after intervention,the MEP amplitude was significantly higher under the 10-minute interval than under the 5-minute and 15-minute intervals(t>3.010,P<0.05).Conclusion The 10-minute interval of cTBS-iTBS is more effective on M1 plasticity.