Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

Aim To construct and analyze the genotype of G protein-coupled receptor kinase 2(GRK2)conditional knockout mice in synoviocytes,and to provide an animal model for stud-ying the function of GRK2 in synoviocytes.Methods Grk2flox/+mice were bred to generate Grk2flox/flox mice,Grk2flox/flox mice were bred to Col1a1-iCre+mice,Grk2flox/+Col1a1-iCre+mice were bred to Grk2flox/flox mice.Grk2flox/flox Col1a1-iCre+mice were ob-tained as target mice.DNA was extracted and amplified by PCR to identify the genotype.Western blot was used to verify the effect of Grk2 knockout in synovium,liver and kidney tissues.HE staining was used to detect the effects of Grk2 conditional knockout in synovial cells on ankle synovium,liver and kidney tissues.Multiple immunofluorescence was used to detect GRK2 expression in synovial cells.Results The results of gene iden-tification showed that Grk2flox/flox Col1a1-iCre+mice had both Flox and Col1a1-iCre genotypes.Western blot results showed that GRK2 expression decreased in synovial tissues of Grk2flox/flox Col1a1-iCre+mice,but there was no significant change in the expression of GRK2 in liver and kidney tissues.HE staining showed that Grk2flox/flox Col1a1-iCre+mice had no significant pathological changes in the ankle synovium,liver and kidney.The results of multiple immunofluorescence showed that GRK2 expression in synovial cells of Grk2flox/flox Col1a1-iCre+mice de-creased.Conclusion Grk2 conditional knockout mice in syno-viocytes are successfully constructed and identified,which pro-vides an animal model for further study of the role of GRK2 in synovial-related diseases.

Aim To construct and analyze the genotype of G protein-coupled receptor kinase 2(GRK2)conditional knockout mice in synoviocytes,and to provide an animal model for stud-ying the function of GRK2 in synoviocytes.Methods Grk2flox/+mice were bred to generate Grk2flox/flox mice,Grk2flox/flox mice were bred to Col1a1-iCre+mice,Grk2flox/+Col1a1-iCre+mice were bred to Grk2flox/flox mice.Grk2flox/flox Col1a1-iCre+mice were ob-tained as target mice.DNA was extracted and amplified by PCR to identify the genotype.Western blot was used to verify the effect of Grk2 knockout in synovium,liver and kidney tissues.HE staining was used to detect the effects of Grk2 conditional knockout in synovial cells on ankle synovium,liver and kidney tissues.Multiple immunofluorescence was used to detect GRK2 expression in synovial cells.Results The results of gene iden-tification showed that Grk2flox/flox Col1a1-iCre+mice had both Flox and Col1a1-iCre genotypes.Western blot results showed that GRK2 expression decreased in synovial tissues of Grk2flox/flox Col1a1-iCre+mice,but there was no significant change in the expression of GRK2 in liver and kidney tissues.HE staining showed that Grk2flox/flox Col1a1-iCre+mice had no significant pathological changes in the ankle synovium,liver and kidney.The results of multiple immunofluorescence showed that GRK2 expression in synovial cells of Grk2flox/flox Col1a1-iCre+mice de-creased.Conclusion Grk2 conditional knockout mice in syno-viocytes are successfully constructed and identified,which pro-vides an animal model for further study of the role of GRK2 in synovial-related diseases.

Objective:To investigate the application effect of strengths,weaknesses,opportunities and threats(SWOT)analysis-guided risk control management in patients with atherosclerotic obliterans(ASO).Methods:This randomized controlled study enrolled 105 ASO patients admitted in Chinese People's Liberation Army Rocket Force Characteristic Medical Center between November 2017 and November 2022.They were divided into control group(n=52,routine nursing)and intervention group(n=53,SWOT analysis-guided risk control management).Renal function,postoperative recovery,psychological status,sleep quality,pain,incidence of adverse reactions and nursing satisfaction were compared between two groups.Results:3 d after surgery,compared with patients in con-trol group,those in intervention group had significant lower cystatin C(CysC)[(1.04±0.11)mg/L vs.(1.40±0.12)mg/L],serum creatinine(Scr)[(70.70±6.48)μmol/L vs.(82.93±9.32)μmol/L]and urinary protein[(2.38±0.13)g/L vs.(3.56±0.17)g/L](P＜0.001 all);7d after surgery,compared with patients in control group,those in intervention group had significant lower incidence of adverse reactions(7.55％vs.23.08％),scores of self-rating anxiety scale(SAS)[(34.09±3.40)points vs.(39.50±3.12)points],self-rating depression scale(SDS)[(24.42±3.34)points vs.(32.04±2.77)points],Pittsburgh sleep quality index(PSQI)[(7.09±1.48)points vs.(10.19±1.65)points]and visual analogue scale(VAS)[(3.09±0.84)points vs.(4.33±1.15)points],and significant higher limp distance[(2407.89±130.09)m vs.(1521.26±102.26)m]and ankle-brachi-al index[(0.87±0.03)vs.(0.62±0.04)](P＜0.05 or＜0.01).After discharge,nursing satisfaction in inter-vention group was significantly higher than that of control group(92.45％vs.73.08％,P=0.008).Conclusion:SWOT analysis-guided risk control management could effectively reduce the damage of renal function caused by in-terventional surgery,reduce pain,improve negative emotion and sleep quality,and reduce incidence of adverse e-vents after surgery in patients with arteriosclerosis obliterans.

Objective To compare the efficacy,economic burden,psychological impact,and quality of life between surgical and medical castration following radical prostatectomy(RP)in patients with very high-risk prostate cancer(VHR PCa).Methods Clinical data of 167 patients with VHR PCa who underwent RP in the Department of Urology,the First Affiliated Hospital of Anhui Medical University during Jul.2019 and Mar.2024 were retrospectively collected.Patients were divided into two groups:the surgical castration group(n=44)and medical castration group(n=123).The effects of different castration methods on the biochemical recurrence(BCR)were analyzed with Cox proportional hazards models.The survival curves of BCR-free and progress to castration-resistant prostate cancer(CRPC)were plotted with the Kaplan-Meier method.The differences in functional assessment of cancer therapy-prostate(FACT-P)and hospital anxiety and depression scale(HADS)between the two groups were evaluated with linear regression model.Results The total costs were significantly lower in the surgical castration group than in the medical castration group[(47 422.0±3 998.3)yuan vs.(59 017.2±8 014.1)yuan,P＜0.001].One month postoperatively,the surgical castration group had significantly lower prostate-specific antigen(PSA)level[0.028(0.010,0.159)ng/mL vs.0.100(0.029,0.895)ng/mL,P=0.002].However,no significant differences were observed in the PSA level between the two groups at 3,6,and 12 months postoperatively,or in PSA nadir and time to nadir(P＞0.05).Cox regression analysis suggested a potentially higher risk of BCR in the medical castration group(HR=2.23),but the difference was not statistically significant(P=0.112).The 1-and 3-year BCR-free survival rates were higher in the surgical castration group(90.9％vs.85.4％;86.4％vs.70.7％,respectively),whereas 1-and 3-year progression-free survival rates were comparable between the two groups(97.7％vs.97.6％;95.5％vs.91.9％),with no significant differences(P＞0.05).No significant differences were found in FACT-P[(57.3±10.2)vs.(57.3±7.6)]or HADS[(12.6±5.1)vs.(11.3±4.8)]scores between the two groups(P＞0.05).Conclusion In VHR PCa patients,surgical castration performed following RP is not inferior to drug castration in terms of PSA control,and potential delay of BCR.It had a lower cost and does not significantly increase the psychological burden.As an underutilized strategy,surgical castration can become an optional option for individualized treatment.

Background and Aims:Laparoscopic pancreaticoduodenectomy(LPD)has become a preferred approach for periampullary tumors,yet delayed gastric emptying(DGE)remains a frequent complication that hampers postoperative recovery.The nasojejunal feeding tube(NJT)is commonly used for early enteral nutrition,but its impact on DGE is controversial.This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods:A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed.Patients were divided into two groups based on intraoperative NJT placement(NJT group,n=200;non-NJT group,n=119).The incidence of DGE and postoperative outcomes were compared.Multivariate logistic regression and propensity score matching(PSM)were performed to identify independent risk factors for DGE.Results:The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group(36.5%vs.21.8%,P=0.006).NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs(both P<0.05).Multivariate analysis revealed intraoperative NJT placement(OR=1.960,95%CI=1.142-3.363,P=0.015)and intraoperative blood loss>400 mL(OR=1.921,95%CI=1.155-3.194,P=0.012)as independent risk factors for DGE.These findings were consistent after PSM.Conclusions:Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE,prolonged hospitalization,and increased medical costs.Routine NJT placement should therefore be avoided,and individualized strategies should be adopted to minimize postoperative complications and enhance recovery.

Objective To carry out emergency medical system modification design for EC135 P3H helicopter without compromising the original airframe structure so as to enhance aeromedical rescue capabilities.Methods Firstly,the original cabin seats were removed and medical floor was installed in the cabin;secondly,the medical chair,medical stretcher trolley and its fixing components,storage boxes and oxygen cylinders were mounted onto the floor;finally,a medical equipment fixing frame was formed based on the original helicopter sill structure so as to accommodate medical devices such as defibrillators,ventilators and injection pumps.The modification design scheme had its effectiveness verified with overall aircraft load balance analysis,mechanical analysis,dynamic impact tests of seats and actual modification and flight tests.Results EC135 P3H helicopter proved to meet all the airworthiness certification requirements after emergency medical system modification.Conclusion The proposed modification scheme enables EC135 P3H helicopter to rapidly transition between standard and medical configurations,enhancing its emergency medical rescue capabilities and providing references for medical modifications of helicopters with similar configurations.

Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years. However, substantial gaps remain between guideline recommendations and clinical practice, which justify the urgent need to improve the quality of care for patients with these conditions. The Chinese Society of Cardiology and the Chinese Society of Diabetes, in collaboration with the American Heart Association and the American Diabetes Association, designed the China Diabetes Cardiovascular project. The China Diabetes Cardiovascular project is a nationwide registry study aimed at improving the quality of care for patients with acute coronary syndrome and diabetes in China. Launched in 2021, this project has enrolled 36 hospitals across mainland China. Patients with a primary discharge diagnosis of comorbid acute coronary syndrome and diabetes will be eligible to participate. Pre-defined performance measures will be adopted to evaluate the quality of care for these patients. Multiple quality improvement strategies will be adopted, including providing monthly quality reports based on these measures, conducting a series of training courses, and distributing educational materials. A comprehensive dataset, encompassing patients' characteristics, medical history, treatment before and during the current hospitalization, and discharge medications for secondary prevention, will be collected through a web-based data collection platform. This project has the potential to improve the quality of care and reduce the care disparities in the management of patients with these diseases. Moreover, with its comprehensive data collection, this project will provide a strong foundation for exploring key clinical questions.

Objective:To evaluate the role of leucine-rich repeat kinase 2 (LRRK2) in the spinal dorsal horn in diabetic neuropathic pain (DNP) and to determine whether the mechanism involved nuclear factor kappa B (NF-κB) signaling pathway in rats.Methods:SPF healthy male Sprague-Dawley rats, aged 8 weeks, weighing 205-238 g, were fed a high-sugar and high-fat diet and received intraperitoneal injection of streptozotocin to induce a type 2 diabetes mellitus model. Successful DNP model was defined as the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) being below 85% of the baseline in type 2 diabetes mellitus rats. Thirty-six rats with DNP were allocated into 3 groups ( n=12 each) using a random number table method: DNP group, MLi-2 (LRRK2 inhibitor) group, and MLi-2+ phorbol 12-myristate 13-acetate (PMA) (NF-κB activator) group. MLi-2 1 mg/kg was intrathecally injected at L 5-6 in MLi-2 group. In MLi-2+ PMA group, MLi-2 1 mg/kg was intrathecally injected, and 1 h later PMA 20 μg/10 μl was intrathecally injected. In group DNP, the equal volume of 5% dimethyl sulfoxide was intrathecally injected. Twelve healthy rats were randomly selected and served as control group (C group). The animals were fed a standard diet, normal saline 2 ml was intraperitoneally injected, and the equal volume of 5% dimethyl sulfoxide was intrathecally injected in group C. Intrathecal injection was performed once a day for 7 consecutive days. The MWT and TWL were measured at 1, 3, 5 and 7 days after intrathecal injection, and the motor nerve conduction velocity (MNCV) was measured using neuroelectrophysiological techniques. The L 4-6 segments of the spinal cord were collected, and histopathological changes were observed through HE staining. The co-localization of leucine-rich repeat kinase 2 (LRRK2) in the spinal dorsal horn with the microglial activation marker ionized calcium-binding adaptor molecule-1 (Iba-1) was observed by immunofluorescence staining. The L 4-6 segments of the spinal dorsal horn were harvested for determination of the level of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6 (using enzyme-linked immunosorbent assay) and expression of LRRK2, Iba-1, nuclear factor kappa B (NF-κB) p65 and phosphorylated NF-κB p65 (p-NF-κB p65) (by Western blot). Results:Compared to C group, the TWL was significantly shortened, the MNCV was decreased, the percentage of cells co-expressing LRRK2 and Iba-1 in the spinal dorsal horn was increased, the contents of TNF-α, IL-1β and IL-6 were increased, the expression of LRRK2 and Iba-1 was up-regulated, the ratio of p-NF-κB p65/NF-κB p65 was increased ( P<0.05), and histological examination revealed nuclear shrinkage and inflammatory cell infiltration in the spinal dorsal horn tissue in DNP group. Compared with DNP group, the MWT was significantly increased, the TWL was prolonged, the MNCV was elevated, the percentage of cells co-expressing LRRK2 and Iba-1 was decreased, the contents of TNF-α, IL-1β and IL-6 were decreased, the expression of LRRK2 and Iba-1 was down-regulated, the ratio of p-NF-κB p65/NF-κB p65 was decreased ( P<0.05), and pathological changes of the spinal dorsal horn tissue were significantly attenuated in MLi-2 group. Compared to MLi-2 group, the MWT was significantly decreased, the TWL was shortened, the MNCV was decreased, the percentage of cells co-expressing LRRK2 and Iba-1 was increased, the contents of TNF-α, IL-1β and IL-6 were increased, the expression of Iba-1 was up-regulated, and the ratio of p-NF-κB p65/NF-κB p65 was increased in MLi-2+ PMA group ( P<0.05). Conclusions:LRRK2 in spinal dorsal horn may be involved in the maintenance of DNP by promoting the inflammatory response mediated by microglial activation, and the mechanism may be related to the activation of NF-κB signaling pathway in rats.

Background and Aims:Laparoscopic pancreaticoduodenectomy(LPD)has become a preferred approach for periampullary tumors,yet delayed gastric emptying(DGE)remains a frequent complication that hampers postoperative recovery.The nasojejunal feeding tube(NJT)is commonly used for early enteral nutrition,but its impact on DGE is controversial.This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods:A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed.Patients were divided into two groups based on intraoperative NJT placement(NJT group,n=200;non-NJT group,n=119).The incidence of DGE and postoperative outcomes were compared.Multivariate logistic regression and propensity score matching(PSM)were performed to identify independent risk factors for DGE.Results:The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group(36.5%vs.21.8%,P=0.006).NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs(both P<0.05).Multivariate analysis revealed intraoperative NJT placement(OR=1.960,95%CI=1.142-3.363,P=0.015)and intraoperative blood loss>400 mL(OR=1.921,95%CI=1.155-3.194,P=0.012)as independent risk factors for DGE.These findings were consistent after PSM.Conclusions:Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE,prolonged hospitalization,and increased medical costs.Routine NJT placement should therefore be avoided,and individualized strategies should be adopted to minimize postoperative complications and enhance recovery.