ObjectiveTo investigate the potential mechanism of heat-sensitive moxibustion on chronic atrophic gastritis （CAG） through the phosphoinositide 3-kinase/protein kinase B （PI3K/Akt） signaling pathway. MethodsFifty-eight SD rats were randomly divided into blank group （n=14） and modeling group （n=44）. Rats in the blank group were fed routinely， while the rats in the modeling group received drinking water containing 1-methyl-3-nitro-1-nitrosoguanidine （MNNG） at a concentration of 140 μg/ml， combined with irregular fasting and feeding for 12 weeks to establish CAG model. After successful modeling， the rats were randomly divided into model group （n=10）， inhibitor group （n=10） and moxibustion group （n=20）. After 40 minutes of suspended moxibustion at "Zhongwan" （CV 12） daily， the rats in the moxibustion group were divided into heat-sensitive moxibustion group （n=10） and non-heat-sensitive moxibustion group （n=9） according to the change of tail temperature during moxibustion. The inhibitor group was bound for 40 minutes daily， and then administered with PI3K/Akt signaling pathway inhibitor， rapamycin solution， by gavage at a dose of 1 mg/kg. The model group received intragastric administration of 1 ml/kg normal saline after 40 minutes of restraint stress each day. All interventions were administered once daily for 28 consecutive days， while the blank group received no intervention. After the intervention finished， the body weight of rats in each group was compared. HE staining was used to observe the histopathological changes of gastric mucosa. The apoptosis-positive rate of gastric mucosal cells was detected by TUNEL assay. Immunohistochemistry was performed to determine the protein levels of matric metalloproteinase-7 （MMP7）， vascular endothelial growth factor A （VEGFA） and epidermal growth factor receptor （EGFR） in gastric mucosa. The mRNA expression levels of PI3K， Akt and mammalian target of rapamycin （mTOR） in gastric mucosal tissues were detected by qPCR. The protein levels of phosphorylated Akt （p-Akt） and phosphorylated mTOR （p-mTOR） in rat gastric mucosal tissues were measured by Western Blotting. ResultsCompared to the blank group， rats in all other groups exhibited decreased body weight， significantly increased gastric mucosal cell apoptosis-positive rates， elevated protein levels of MMP7， VEGFA and EGFR in gastric mucosa， increased mRNA expression levels of PI3K， Akt and mTOR， and enhanced protein expression levels of p-Akt and p-mTOR （P＜0.05 or P＜0.01）. Histopathological examination revealed thinning of the gastric mucosa， glandular disorganization and atrophy， accompanied by intestinal metaplasia.Compared to the model group， the heat-sensitive moxibustion group， the non-heat-sensitive moxibustion group and the inhibitor group all showed significant improvements in the above-mentioned indicators （P＜0.05 or P＜0.01）. Compared to the heat-sensitive moxibustion group， the non-heat-sensitive moxibustion group and the inhibitor group exhibited increased positive rates of gastric mucosal cell apoptosis； the non-heat-sensitive moxibustion group showed increased protein levels of MMP7， VEGFA and EGFR， as well as mRNA expression levels of PI3K， Akt and mTOR， and protein expressions of p-Akt and p-mTOR； the inhibitor group exhibited elevated protein expression level of EGFR （P＜0.05 or P＜0.01）. Histopathological examination showed that the gastric mucosal glands in the heat-sensitive moxibustion group were arranged more regularly， with an approximately normal structural appearance. ConclusionHeat-sensitive moxibustion can improve the body weight of CAG rats and repair gastric mucosal injury. Its therapeutic effects may be mediated by inhibiting excessive activation of gastric mucosal PI3K/Akt signaling pathway， thereby reducing gastric mucosal cell apoptosis.

ObjectiveTo investigate the potential mechanism of heat-sensitive moxibustion on chronic atrophic gastritis （CAG） through the phosphoinositide 3-kinase/protein kinase B （PI3K/Akt） signaling pathway. MethodsFifty-eight SD rats were randomly divided into blank group （n=14） and modeling group （n=44）. Rats in the blank group were fed routinely， while the rats in the modeling group received drinking water containing 1-methyl-3-nitro-1-nitrosoguanidine （MNNG） at a concentration of 140 μg/ml， combined with irregular fasting and feeding for 12 weeks to establish CAG model. After successful modeling， the rats were randomly divided into model group （n=10）， inhibitor group （n=10） and moxibustion group （n=20）. After 40 minutes of suspended moxibustion at "Zhongwan" （CV 12） daily， the rats in the moxibustion group were divided into heat-sensitive moxibustion group （n=10） and non-heat-sensitive moxibustion group （n=9） according to the change of tail temperature during moxibustion. The inhibitor group was bound for 40 minutes daily， and then administered with PI3K/Akt signaling pathway inhibitor， rapamycin solution， by gavage at a dose of 1 mg/kg. The model group received intragastric administration of 1 ml/kg normal saline after 40 minutes of restraint stress each day. All interventions were administered once daily for 28 consecutive days， while the blank group received no intervention. After the intervention finished， the body weight of rats in each group was compared. HE staining was used to observe the histopathological changes of gastric mucosa. The apoptosis-positive rate of gastric mucosal cells was detected by TUNEL assay. Immunohistochemistry was performed to determine the protein levels of matric metalloproteinase-7 （MMP7）， vascular endothelial growth factor A （VEGFA） and epidermal growth factor receptor （EGFR） in gastric mucosa. The mRNA expression levels of PI3K， Akt and mammalian target of rapamycin （mTOR） in gastric mucosal tissues were detected by qPCR. The protein levels of phosphorylated Akt （p-Akt） and phosphorylated mTOR （p-mTOR） in rat gastric mucosal tissues were measured by Western Blotting. ResultsCompared to the blank group， rats in all other groups exhibited decreased body weight， significantly increased gastric mucosal cell apoptosis-positive rates， elevated protein levels of MMP7， VEGFA and EGFR in gastric mucosa， increased mRNA expression levels of PI3K， Akt and mTOR， and enhanced protein expression levels of p-Akt and p-mTOR （P＜0.05 or P＜0.01）. Histopathological examination revealed thinning of the gastric mucosa， glandular disorganization and atrophy， accompanied by intestinal metaplasia.Compared to the model group， the heat-sensitive moxibustion group， the non-heat-sensitive moxibustion group and the inhibitor group all showed significant improvements in the above-mentioned indicators （P＜0.05 or P＜0.01）. Compared to the heat-sensitive moxibustion group， the non-heat-sensitive moxibustion group and the inhibitor group exhibited increased positive rates of gastric mucosal cell apoptosis； the non-heat-sensitive moxibustion group showed increased protein levels of MMP7， VEGFA and EGFR， as well as mRNA expression levels of PI3K， Akt and mTOR， and protein expressions of p-Akt and p-mTOR； the inhibitor group exhibited elevated protein expression level of EGFR （P＜0.05 or P＜0.01）. Histopathological examination showed that the gastric mucosal glands in the heat-sensitive moxibustion group were arranged more regularly， with an approximately normal structural appearance. ConclusionHeat-sensitive moxibustion can improve the body weight of CAG rats and repair gastric mucosal injury. Its therapeutic effects may be mediated by inhibiting excessive activation of gastric mucosal PI3K/Akt signaling pathway， thereby reducing gastric mucosal cell apoptosis.

Transcatheter aortic valve replacement (TAVR) has emerged as the first-line treatment for aortic valve stenosis. Coronary obstruction is a severe complication of TAVR, with mortality rates exceeding 30%. Coronary obstruction can be classified as acute or delayed based on the timing of the onset, and as direct or indirect obstruction according to the underlying mechanism. Risk factors for predicting coronary obstruction include a small sinus of Valsalva diameter, excessively long native leaflets, low coronary height, and small sinotubular junction height and diameter. Accurate preoperative assessment of these anatomical parameters using CT is crucial for selecting the appropriate valve type, size, and implantation depth. Preventive technical strategies for coronary obstruction include intraoperative interventional treatments (such as the "Chimney" stenting technique), leaflet modification (such as the BASILICA technique), and alignment of the annulus and coronaries. These techniques have demonstrated significant efficacy in reducing the incidence of coronary obstruction and associated mortality. This paper reviews the epidemiology, classification, and mechanisms of coronary obstruction, with a particular focus on the identification, prevention, and treatment of high-risk patients. The aim is to highlight the importance of recognizing and managing coronary risks during TAVR and to provide actionable recommendations for the prevention and treatment of coronary obstruction in clinical practice.
Humans ; Transcatheter Aortic Valve Replacement/methods* ; Risk Factors ; Aortic Valve Stenosis/surgery* ; Postoperative Complications/prevention & control* ; Coronary Occlusion/etiology*

[Objective]To propose syndrome differentiation and treatment approach of acupuncture for migraine based on the relationship between"spleen and stomach disorders"and the etiology and pathogenesis of migraine,providing theoretical and practical references for the clinical management.[Methods]The connotation of"spleen and stomach disorders"and its association with migraine were systematically reviewed.Based on this perspective,treatment strategies and acupuncture prescriptions for migraine were formulated,and supported by a representative clinical case study.[Results]"Spleen and stomach disorders"serves as a critical pathological foundation for migraine.Its pathogenesis can be summarized into four patterns"impaired spleen transport leading to malnourishment of the brain""phlegm-dampness obstructing the orifices and impairing mental clarity""spleen-stomach disharmony causing Qi stagnation"and"spleen deficiency with blood stasis resulting in orifice obstruction".Acupuncture treatment should prioritize regulating spleen-stomach function,supplemented by dredging local meridians and harmonizing Qi and blood.Key acupoints include Zhongwan(CV12),Xiawan(CV10),Qihai(CV6),and Guanyuan(CV4)for reinforcing primordial Qi,consolidating the foundation,and harmonizing Qi and blood;Zusanli(ST36),Shangjuxu(ST37)and Xiajuxu(ST39)for regulating Qi movement and balancing Yin and Yang;Sizhukong(TE23)and Fengchi(GB20)for clearing the head,improving vision,and relieving pain.In the presented case,the patient was diagnosed as dual deficiency of Qi and blood,acupuncture therapy focusing on replenishing Qi,nourishing blood and unblocking collaterals achieved significant clinical efficacy.[Conclusion]"Spleen and stomach disorders"is a pivotal mechanism underlying recurrent migraine.Acupuncture treatment for migraine should emphasize restoring spleen-stomach function,prioritizing the reinforcement of primordial Qi and harmonization of Qi and blood,thereby addressing the root cause to reduce migraine recurrence.

Objective To address the personalized differences in motion gait between stroke patients and healthy older adults,as well as the issue of abnormal gait recognition,a deep learning fusion-based approach is proposed to effectively improve the accuracy of abnormal gait recognition.Methods A model fusing convolutional neural networks(CNN)and bidirectional long short-term memory networks(BiLSTM)was adopted,with the introduction of a residual network(ResNet).Unilateral ankle joint movement data at different walking speeds within a comfortable range were collected from healthy older adults and stroke patients.Signals from inertial sensors and electromyography sensors were used as inputs,while gait features were analyzed and gait differences between the two groups were compared.The effectiveness of the model was validated by comparing the classification performance of traditional deep learning models and CNN-ResNet-BiLSTM models with different layer combinations in terms of abnormal gait recognition accuracy.Results The CNN-ResNet-BiLSTM model,which introduced residual connectivity,performed excellently in abnormal gait recognition.Compared with traditional deep learning models such as the gated recurrent unit(GRU)and long short-term memory network(LSTM),its prediction accuracy was improved by 13.6％and 8.36％,respectively.Additionally,compared with other model combinations,this model achieved an overall accuracy of 97.78％.Conclusions The algorithm proposed in this study can be applied to stroke-related abnormal gait detection,providing technique support for the early diagnosis and precise monitoring of such diseases.

Objective:To investigate the effects of KH-type splicing regulatory protein(KHSRP)targeting and regulating JAK1/STAT3 signaling axis on the proliferation,migration and invasion of the adenocarcinoma of esophagogastric junction(AEG)cells,as well as the growth of transplanted tumors and lung metastasis.Methods:A total of 64 pairs of AEG tissue and adjacent normal tissue samples,along with clinical data from patients diagnosed at Huaihe Hospital from January 2017 to December 2018 were collected.The expression level of KHSRP in AEG tissues and adjacent normal tissues was observed using immunohistochemical staining.The differential expression of KHSRP in AEG cells(OE-19,TE-7,BIC-1,FLO-1,SK-GT-4,BE-3)and normal esophageal epithelial cells(Het-1A)was detected by qPCR.Lentiviral vectors were used to knockdown and overexpress KHSRP in OE-19,TE-7,FLO-1,and SK-GT-4 cells.The experiment was divided into the following groups:sh-NC group,sh-KHSRP group,Vector group,and KHSRP overexpression group(KHSRP group).The knockdown or overexpression efficiency was detected by qPCR,and the effects of KHSRP knockdown or overexpression on AEG cell proliferation,migration and invasion were evaluated using CCK-8 and Transwell assays,respectively.A mouse xenograft and lung metastasis model was established to observe the effects of KHSRP on tumor growth and metastasis in vivo.The targeted regulation of JAK/STAT signaling pathway by KHSRP was verified by Western blotting.A rescue experiment was conducted to verify whether KHSRP promoted malignant progression of AEG cells through the JAK1/STAT3 signaling pathway.Results:Compared with adjacent normal tissues,the expression level of KHSRP in AEG tissues was significantly increased(P<0.05 or P<0.01).Cell function experiments showed that KHSRP overexpression significantly promoted AEG cell proliferation,migration,and invasion in vitro(P<0.05 or P<0.01).In vivo animal experiments showed that KHSRP promoted AEG cell xenograft tumor growth and lung metastasis in nude mice(P<0.05 or P<0.01).After KHSRP knockdown,the phosphorylation levels of JAK1 and STAT3 in the JAK/STAT signaling pathway were significantly reduced,while overexpression of KHSRP led to the opposite results(P<0.05 or P<0.01).Rescue experiment showed that KHSRP could reverse the inhibition of cell proliferation,migration,and invasion caused by JAK1/STAT3 knockdown(P<0.05 or P<0.01).Conclusion:KHSRP regulates the malignant progression of AEG cells by activating JAK1/STAT3 signaling axis.KHSRP may become a potential target for the clinical treatment of AEG.

Objective To investigate the effectiveness of continuous improvement projects based on FOCUS-PDCA on the pathogen sample submission rate before antimicrobial therapy for inpatients.Methods FOCUS-PDCA was used to improve the pathogen sample submission rate in Affiliated Hospital of Nantong University from Jun.to Jul.2023.The inpatients from Jan.to May 2023(before improvement)were enrolled as control group,and the inpatients from Aug.to Dec.2023(after improvement)were enrolled as improvement group.The utilization rate of antibiotics,the submission rate of pathogen samples,the submission rate of clinical microbial samples and the detection rate of multidrug-resistant organisms were compared between the 2 groups.Results The utilization rate of therapeutic antimicrobial agents(32.18％vs 32.93％,P=0.003)and antimicrobial consumption intensity(39.99 defined daily dose[DDD]/100 patient-days vs 44.19 DDD/100 patient-days)in the improvement group were significantly lower than those in the control group.The pathogen sample submission rates before antimicrobial therapy and key antimicrobial combination therapy in the improvement group were significantly higher than those in the control group(52.01％vs 23.64％,87.74％vs 77.71％;both P＜0.001).The qualified rate of microbial specimens in the improvement group was significantly higher than that in the control group(88.77％vs 80.11％,P＜0.001).The detection rates of multidrug-resistant organisms and carbapenem-resistant Klebella pneumoniae in the improvement group were significantly lower than those in the control group(40.45％vs 48.42％,29.65％vs 43.17％;both P＜0.001).Conclusion The continuous improvement projects based on FOCUS-PDCA can improve the pathogen sample submission rate,reduce the detection rate of multidrug-resistant organisms,and promote standardized hospital infection quality management.

Objective: To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies. Methods: In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR. Results: Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9% , and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60± 1.01 ) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR =1.38, 1.82, 1.55; AL/CR: β =0.01, 0.03, 0.03; all P <0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia ( OR =1.26, 1.49, both P <0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL ( β=0.14, P < 0.05). Conclusions Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

AIM:This study aims to investigate the mechanism by which Qingfei-Jiedu-Huatan Formula(QJHF)regulates autophagy in alveolar macrophages through mTOR in the treatment of severe pneumonia(SP)in rats.METHODS:Sixty SPF-grade male rats were randomly assigned to six groups:control,model,QJHF,moxifloxacin(MOX),rapamycin(RAPA),and QJHF+RAPA,with ten rats in each group.An SP rat model was established using Klebsiella pneumoniae.After seven days of treatment,changes in IL-33 and IFN-γ levels in bronchoalveolar lavage fluid(BALF)were measured using ELISA.Histopathological alterations in lung tissue were assessed via HE staining,and the autophagy of alveolar macrophages was detected using immunofluorescence co-localization methods.The expression levels of mTOR,beclin-1,and LC3 mRNA in lung tissue were analyzed using qPCR,while Western blot was employed to assess the protein levels of p-mTOR/mTOR,beclin-1,and LC3-II/LC3-I.RESULTS:Compared to the control group,the model group exhibited a deteriorated condition,characterized by alveolar wall rupture and thickening,significant inflammatory cell infiltration in the alveolar cavity,and extensive lung tissue damage(P<0.01).Elevated levels of IL-33 and IFN-γ in BALF were also observed(P<0.01),along with increased colocalization of CD68 and LC3 in immunofluorescence analy-sis.The mTOR mRNA expression in lung tissue decreased(P<0.01),while LC3 and beclin-1 mRNA expressions in-creased(P<0.01).Additionally,the protein expression ratio of p-mTOR/mTOR decreased(P<0.01),whereas LC3-II/LC3-I and beclin-1 protein levels increased(P<0.01).In comparison to the model group,significant improvements were noted after treatment with QJHF and MOX(P<0.01),while RAPA treatment led to a worsening of these indicators(P<0.05).A slight improvement was observed with the QJHF combined with RAPA intervention,though this was not statisti-cally significant.No significant differences were found between the MOX and QJHF groups.However,the QJHF+RAPA group displayed notable improvements in various indicators compared to the RAPA group(P<0.05).CONCLUSION:The QJHF can mitigate the inflammatory response associated with severe pneumonia,potentially by activating mTOR phos-phorylation activity,which in turn inhibits excessive autophagy in alveolar macrophages.

Objective:This study aims to explore the optimization needs of the cognitive training tool "Fun Brain" from a professional perspective, providing insights for its enhancement and application.Methods:In April 2024, a qualitative research approach was employed, involving group interviews with 61 elderly health professionals organized into 9 groups. The interviews primarily focused on the user experience and optimization suggestions related to the "Fun Brain" app. Thematic analysis was conducted, with NVivo 14 software utilized for data management and processing. Data analysis followed Braun and Clarke′s six-phase procedure to ensure the scientific and systematic extraction of themes. Furthermore, high-frequency word analysis was performed, offering crucial clues for subsequent thematic analysis.Results:The study identified 12 initial themes and 6 optimization themes, with a primary focus on age-appropriate interfaces, personalized modules, and feedback mechanisms. These themes were refined into three core themes, including adaptation of training content, optimization of interaction design, and enhancement of participant motivation.Conclusion:Optimizing cognitive training tools for elderly users requires careful consideration of their specific needs, particularly regarding functional adaptation, interface design, and interactive experience. Implementing these optimizations can improve user engagement and training effectiveness, offering both scientific and practical guidance for the design and promotion of cognitive training tools.