Atherosclerosis （AS） is a chronic and inflammatory vascular disease. Macrophages are common immune cells and play an important role in the development of AS. In recent years， research has found that the formation of AS plaques is closely related to pathological and physiological processes such as macrophage polarization， energy metabolism， and lipid phagocytosis. This review aims to summarize the mechanism of macrophages in the development of AS， and to explore potential therapeutic methods for delaying AS by regulating macrophages， providing new ideas for the treatment and research of AS.

Background and Aims:Laparoscopic hiatal hernia repair with mesh reinforcement combined with fundoplication has become the standard surgical approach for treating moderate to severe cases.However,intraoperative and postoperative complications remain a significant concern.This study was conducted to explore the causes of common complications and their prevention and management strategies through retrospectively analyzing clinical data from a single center to optimize perioperative care and improve surgical safety.Methods:The clinical data of 432 patients who underwent laparoscopic hiatal hernia repair with mesh and fundoplication at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed.All procedures were performed by the same surgical team using the standardized seven-step protocol for laparoscopic repair.Postoperative care followed the enhanced recovery after surgery pathway.The incidences of intraoperative and postoperative complications were recorded,and univariate analysis was used to identify risk factors for major postoperative complications.Results:The overall complication rate was 15.3％among 432 patients.The most common intraoperative complication was bleeding(6.9％),primarily from the inferior phrenic vessels(3.2％),short gastric vessels(1.6％),and parenchymal organ injuries(1.9％).The most frequent postoperative complication was dysphagia(12.0％),followed by pneumothorax(3.2％),hernia recurrence(1.9％),mesh infection or erosion(0.7％),gas-bloat syndrome(6.3％),and gastroparesis(0.9％).Most complications were relieved through conservative treatment,endoscopic dilation,or interventional procedures.Two patients with persistent dysphagia underwent reoperation to remove the fundoplication wrap.The median follow-up period was 34 months,with a 6.0％loss to follow-up rate and no perioperative mortality.Univariate analysis showed that patients aged ≥50 years and those who underwent Nissen fundoplication had significantly higher rates of postoperative dysphagia(both P＜0.05).Conclusion:Laparoscopic hiatal hernia repair with mesh and fundoplication is generally safe and effective.However,intraoperative vascular injuries and postoperative dysphagia require special attention.Accurate dissection and identification of anatomical layers are critical during surgery.Surgical strategy should be tailored based on patient age and esophageal motility,with partial fundoplication(Toupet or Dor)preferred when appropriate.Combined with enhanced postoperative recovery protocols,standardized mesh placement and fixation can reduce complication rates and improve long-term outcomes.

OBJECTIVES: To explore the therapeutic mechanism of puerarin for alleviating synovitis in rats with collagen-induced arthritis (CIA). METHODS: In a SD rat model of CIA, we tested the effects of daily gavage of puerarin at low, moderate and high doses (10, 30, and 100 mg/kg, respectively) for 3 weeks, with tripterygium glycosides (GTW, 10 mg/kg) as the positive control, on swelling in the hind limb joints regions evaluated by arthritis index scoring. Mass fraction of the liver of the rats was calculated, and pathologies in joint synovial membrane were observed with HE staining. The expressions of transforming growth factor β‑activated kinase-1 (TAK1), Toll-like receptor 4 (TLR4), and nuclear factor kappa-Bp65 (NF‑κB p65) at the mRNA and protein levels in the synovial tissues were detected using Real-time PCR and Western blotting. RESULTS: Compared with those in the model group, the rats in GTW group and high-dose puerarin group showed significantly reduced mass fraction of the liver. Treatment with GTW and puerarin at the 3 doses all significantly alleviated plantar swelling, lowered arthritis index scores, and improved synovitis in CIA rats (P<0.05), and the effects of puerarin showed an obvious dose dependence. Both GTW and puerarin treatments significantly lowered TAK1, TLR4, and NF‑κB p65 mRNA and protein expressions in the synovium of CIA rats. CONCLUSIONS Puerarin alleviates synovium damages in CIA rats possibly by suppressing the TLR4/NF‑κB signaling pathway via downregulating TAK1 expression.
Animals ; Toll-Like Receptor 4/metabolism* ; Rats, Sprague-Dawley ; Rats ; MAP Kinase Kinase Kinases/metabolism* ; Signal Transduction/drug effects* ; Arthritis, Rheumatoid/drug therapy* ; NF-kappa B/metabolism* ; Isoflavones/therapeutic use* ; Male ; Arthritis, Experimental/drug therapy* ; Transcription Factor RelA/metabolism* ; Synovial Membrane/metabolism*

Objective To explore the interaction mechanisms among different dimensions of online learning competence in undergraduates,providing scientific evidence for optimizing software design and online education strategies.Methods A cross-sectional study was conducted with 347 undergraduates from Kunming Medical University via an online questionnaire in October 2024.Reliability testing and exploratory factor analysis were performed using SPSS 26.0,while structural equation modeling was constructed with Amos 24.0.Results Driving force directly and positively influenced regulatory force(β=0.778,P<0.001)and reciprocal force(β=0.302,P=0.003),but had no significant direct effect on adaptive force(β=0.131,P=0.182).Regulatory force and reciprocal force both exerted direct positive effects on adaptive force(β=0.262,P=0.022;β=0.410,P<0.001).The indirect effect of driving force on adaptive force accounted for 78.1%of the total effect(P=0.007),with regulatory force showing a significant mediating role(β=0.178,P=0.023),while reciprocal force alone did not(β=0.108,P=0.060).A chain mediating effect(driving force→regulatory force→reciprocal force→adaptive force)was confirmed(β=0.124,P=0.004).Conclusion Driving force serves as the core of online learning competence,and adaptive capacity is enhanced through regulatory and reciprocal forces.To promote knowledge internalization and adaptability,it is required to optimize feedback mechanisms and deepen interactive designs in online learning platforms.

Objective:To conduct a survey on the influence of personality trait on depres-sive symptom and obesity in patients before bariatric and metabolic surgery.Methods:The retros-pective cross-sectional investigation study was conducted. Patients who underwent bariatric and metabolic surgery in The Third Xiangya Hospital of Central South University and The First Affiliated Hospital of Ji′nan University from January 1 to June 1,2024 were recruited. The survey was conducted in electronic format using the general information survey questionnaire, the patient health question-naire-9 (PHQ-9), and the Chinese big five personality inventory brief version (CBF-PI-B). Observa-tion indicators: (1) results of the questionnaire; (2) general data of patient; (3) personality trait scores for patient with different subtypes of obesity; (4) depression symptom scores for patient with different subtypes of obesity; (5) correlation analysis for patient personality trait, depressive symptom and body mass index (BMI). Comparison of measurement data with normal distribution between groups was conducted using the independent t test, and one-way analysis of variance was used for comparison among multiple groups. LSD test was used for pairwise comparison. Comparison of measurement data with skewed distribution among multiple groups was conducted using the Kruskal-Wallis H test, and Dunn Bonferroni test was used for pairwise comparison. The Spearman correlation analysis and Pearson correlation analysis were used for correlation analysis, and the mediation effect analysis was conducted using the Process 4.0 model and the Bootstrap test. Results:(1)Results of the questionnaire. A total of 146 questionnaires were distributed and collected, including 83 questionnaires from The Third Xiangya Hospital of Central South University and 63 questionnaires from The First Affiliated Hospital of Ji′nan University. Of 146 questionnaires, 137 questionnaires were valid, yielding an effective response rate of 93.836%(137/146). (2)General data of patient. Of the 137 patients who completed valid questionnaires, 52 were male with BMI of (41±5)kg/m 2, 85 were female with BMI of (38±6)kg/m 2, showing a significant difference between them ( t=2.586, P<0.05). There were 40 patients aged ≤25 years, with BMI of (42±5)kg/m 2, 28 patients aged 26-30 years, with BMI of (39±5)kg/m 2, 49 patients aged 31-40 years, with BMI of (38±6)kg/m 2, 14 patients aged 41-50 years, with BMI of (38±7)kg/m 2, 6 patients aged >50 years, with BMI of (37±3)kg/m 2. There were significant differences in BMI of patients of different age groups ( F=2.697, P<0.05). (3)Persona-lity trait scores for patient with different subtypes of obesity. Of the 137 patients who completed valid questionnaires, there were 15 patients of mild obesity, with personality trait neuroticism score of 19.0(14.0,24.0), personality trait strictness score of 32.5±5.2, personality trait extroversion score of 30.0(24.0,40.0), 36 patients of moderate obesity, with personality trait neuro-ticism score of 26.5(22.3,28.8), personality trait strictness score of 32.6±5.9, personality trait extro-version score of 34.0(26.3,39.0), 81 patients of severe obesity, with personality trait neuroticism score of 35.0(29.5,41.0), personality trait strictness score of 26.8±7.4, personality trait extroversion score of 28.0(20.5,35.0), 5 patients of extreme obesity, with personality trait neuroticism score of 28.0(26.5,44.0), personality trait strictness score of 19.6±3.4, personality trait extroversion score of 22.0(18.5,25.0). There were significant differences in personality trait neuroticism, strictness and extroversion among patients of different subtypes of obesity ( H=50.316, F=10.774, H=14.446, P<0.05). (4)Depression symptom scores for patient with different subtypes of obesity. Of the 137 pati-ents who completed valid questionnaires, the depressive symptom score were 4.0(2.0,9.0) for 15 pati-ents of mild obesity, 5.0(3.0,7.0) for 36 patients of moderate obesity, 13.0(8.5,17.0) for 81 patients of severe obesity, and 18.0(9.5,22.0) for 5 patients of extreme obesity, respectively, showing a significant difference among them ( H=50.129, P<0.05). (5) Correlation analysis for patient personality trait, depressive symptom and BMI. Results of Spearman correlation analysis showed that personality trait neuroticism were positively correlated with depressive symptoms and BMI ( r=0.780, 0.557, P<0.05), personality trait strictness was negatively correlated with depressive symptoms ( r=-0.523, P<0.05), personality trait extroversion were negatively correlated with depressive symptoms and BMI ( r=-0.448, -0.323, P<0.05), and depressive symptoms was positively correlated with BMI ( r=0.568, P<0.05). Results of Pearson correlation analysis showed that personality trait strictness was negatively correlated with BMI ( r=-0.489, P<0.05). Conclusion:Preoperative personality trait of patients undergoing bariatric and metabolic surgery can influence their depressive symptom and BMI.

Background and aims:Obesity is a major global health challenge,and laparoscopic sleeve gastrectomy(LSG)is a widely used bariatric procedure.However,weight loss outcomes vary considerably among patients.Psychological factors and eating behaviors are increasingly recognized as important determinants of postoperative success,yet the underlying mechanisms remain unclear.This study aimed to examine the relationship between self-control and 12-month postoperative weight loss(%EWL)after LSG,and to test the independent and chain mediating roles of depression and emotional eating.Methods:In a cross-sectional study,202 LSG patients from the Third Xiangya Hospital of Central South University completed the Brief Self-Control Scale(BSCS),Patient Health Questionnaire-9(PHQ-9),and the emotional eating subscale of the Dutch Eating Behavior Questionnaire(DEBQ).%EWL within 12 months after surgery was calculated.Pearson correlations were conducted,and mediation was tested using Process v4.0(model 6)with 5 000 bootstrap samples while controlling for sex and postoperative time.Results:Overall,BSCS,PHQ-9,DEBQ-EE,and%EWL averaged 21.76±4.15,5.54±3.91,30.72±11.25,and(60.94±31.61)%,respectively.Self-control correlated negatively with depression(r=-0.697)and emotional eating(r=-0.441)and positively with%EWL(r=0.566;all P<0.01).%EWL correlated negatively with depression(r=-0.467)and emotional eating(r=-0.348,P<0.01).Adjusted regression showed positive prediction of%EWL by self-control(β=0.291 9,P<0.01)and negative prediction by depression(β=-0.155 6,P<0.05)and emotional eating(β=-0.115 8,P<0.05).Mediation analysis showed that the indirect effect through the path"self-control → depression →%EWL"was 0.848 8(95%CI=0.178 7-1.573 0).The indirect effect through the path"self-control → emotional eating →%EWL"was 0.259 8(95%CI=0.033 4-0.564 3).The chain indirect effect through the path"self-control →depression → emotional eating →%EWL"was 0.131 7(95%CI=0.005 9-0.322 8);the total indirect effect accounted for 35.83%of the total effect.Conclusion:Higher self-control after LSG enhances weight loss both directly and indirectly by alleviating depression and emotional eating.Routine psychological screening and eating-behavior interventions are warranted to consolidate long-term benefits.

Background and Aims:Laparoscopic hiatal hernia repair with mesh reinforcement combined with fundoplication has become the standard surgical approach for treating moderate to severe cases.However,intraoperative and postoperative complications remain a significant concern.This study was conducted to explore the causes of common complications and their prevention and management strategies through retrospectively analyzing clinical data from a single center to optimize perioperative care and improve surgical safety.Methods:The clinical data of 432 patients who underwent laparoscopic hiatal hernia repair with mesh and fundoplication at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed.All procedures were performed by the same surgical team using the standardized seven-step protocol for laparoscopic repair.Postoperative care followed the enhanced recovery after surgery pathway.The incidences of intraoperative and postoperative complications were recorded,and univariate analysis was used to identify risk factors for major postoperative complications.Results:The overall complication rate was 15.3％among 432 patients.The most common intraoperative complication was bleeding(6.9％),primarily from the inferior phrenic vessels(3.2％),short gastric vessels(1.6％),and parenchymal organ injuries(1.9％).The most frequent postoperative complication was dysphagia(12.0％),followed by pneumothorax(3.2％),hernia recurrence(1.9％),mesh infection or erosion(0.7％),gas-bloat syndrome(6.3％),and gastroparesis(0.9％).Most complications were relieved through conservative treatment,endoscopic dilation,or interventional procedures.Two patients with persistent dysphagia underwent reoperation to remove the fundoplication wrap.The median follow-up period was 34 months,with a 6.0％loss to follow-up rate and no perioperative mortality.Univariate analysis showed that patients aged ≥50 years and those who underwent Nissen fundoplication had significantly higher rates of postoperative dysphagia(both P＜0.05).Conclusion:Laparoscopic hiatal hernia repair with mesh and fundoplication is generally safe and effective.However,intraoperative vascular injuries and postoperative dysphagia require special attention.Accurate dissection and identification of anatomical layers are critical during surgery.Surgical strategy should be tailored based on patient age and esophageal motility,with partial fundoplication(Toupet or Dor)preferred when appropriate.Combined with enhanced postoperative recovery protocols,standardized mesh placement and fixation can reduce complication rates and improve long-term outcomes.

Objective:To conduct a survey on the influence of personality trait on depres-sive symptom and obesity in patients before bariatric and metabolic surgery.Methods:The retros-pective cross-sectional investigation study was conducted. Patients who underwent bariatric and metabolic surgery in The Third Xiangya Hospital of Central South University and The First Affiliated Hospital of Ji′nan University from January 1 to June 1,2024 were recruited. The survey was conducted in electronic format using the general information survey questionnaire, the patient health question-naire-9 (PHQ-9), and the Chinese big five personality inventory brief version (CBF-PI-B). Observa-tion indicators: (1) results of the questionnaire; (2) general data of patient; (3) personality trait scores for patient with different subtypes of obesity; (4) depression symptom scores for patient with different subtypes of obesity; (5) correlation analysis for patient personality trait, depressive symptom and body mass index (BMI). Comparison of measurement data with normal distribution between groups was conducted using the independent t test, and one-way analysis of variance was used for comparison among multiple groups. LSD test was used for pairwise comparison. Comparison of measurement data with skewed distribution among multiple groups was conducted using the Kruskal-Wallis H test, and Dunn Bonferroni test was used for pairwise comparison. The Spearman correlation analysis and Pearson correlation analysis were used for correlation analysis, and the mediation effect analysis was conducted using the Process 4.0 model and the Bootstrap test. Results:(1)Results of the questionnaire. A total of 146 questionnaires were distributed and collected, including 83 questionnaires from The Third Xiangya Hospital of Central South University and 63 questionnaires from The First Affiliated Hospital of Ji′nan University. Of 146 questionnaires, 137 questionnaires were valid, yielding an effective response rate of 93.836%(137/146). (2)General data of patient. Of the 137 patients who completed valid questionnaires, 52 were male with BMI of (41±5)kg/m 2, 85 were female with BMI of (38±6)kg/m 2, showing a significant difference between them ( t=2.586, P<0.05). There were 40 patients aged ≤25 years, with BMI of (42±5)kg/m 2, 28 patients aged 26-30 years, with BMI of (39±5)kg/m 2, 49 patients aged 31-40 years, with BMI of (38±6)kg/m 2, 14 patients aged 41-50 years, with BMI of (38±7)kg/m 2, 6 patients aged >50 years, with BMI of (37±3)kg/m 2. There were significant differences in BMI of patients of different age groups ( F=2.697, P<0.05). (3)Persona-lity trait scores for patient with different subtypes of obesity. Of the 137 patients who completed valid questionnaires, there were 15 patients of mild obesity, with personality trait neuroticism score of 19.0(14.0,24.0), personality trait strictness score of 32.5±5.2, personality trait extroversion score of 30.0(24.0,40.0), 36 patients of moderate obesity, with personality trait neuro-ticism score of 26.5(22.3,28.8), personality trait strictness score of 32.6±5.9, personality trait extro-version score of 34.0(26.3,39.0), 81 patients of severe obesity, with personality trait neuroticism score of 35.0(29.5,41.0), personality trait strictness score of 26.8±7.4, personality trait extroversion score of 28.0(20.5,35.0), 5 patients of extreme obesity, with personality trait neuroticism score of 28.0(26.5,44.0), personality trait strictness score of 19.6±3.4, personality trait extroversion score of 22.0(18.5,25.0). There were significant differences in personality trait neuroticism, strictness and extroversion among patients of different subtypes of obesity ( H=50.316, F=10.774, H=14.446, P<0.05). (4)Depression symptom scores for patient with different subtypes of obesity. Of the 137 pati-ents who completed valid questionnaires, the depressive symptom score were 4.0(2.0,9.0) for 15 pati-ents of mild obesity, 5.0(3.0,7.0) for 36 patients of moderate obesity, 13.0(8.5,17.0) for 81 patients of severe obesity, and 18.0(9.5,22.0) for 5 patients of extreme obesity, respectively, showing a significant difference among them ( H=50.129, P<0.05). (5) Correlation analysis for patient personality trait, depressive symptom and BMI. Results of Spearman correlation analysis showed that personality trait neuroticism were positively correlated with depressive symptoms and BMI ( r=0.780, 0.557, P<0.05), personality trait strictness was negatively correlated with depressive symptoms ( r=-0.523, P<0.05), personality trait extroversion were negatively correlated with depressive symptoms and BMI ( r=-0.448, -0.323, P<0.05), and depressive symptoms was positively correlated with BMI ( r=0.568, P<0.05). Results of Pearson correlation analysis showed that personality trait strictness was negatively correlated with BMI ( r=-0.489, P<0.05). Conclusion:Preoperative personality trait of patients undergoing bariatric and metabolic surgery can influence their depressive symptom and BMI.

Background and aims:Obesity is a major global health challenge,and laparoscopic sleeve gastrectomy(LSG)is a widely used bariatric procedure.However,weight loss outcomes vary considerably among patients.Psychological factors and eating behaviors are increasingly recognized as important determinants of postoperative success,yet the underlying mechanisms remain unclear.This study aimed to examine the relationship between self-control and 12-month postoperative weight loss(%EWL)after LSG,and to test the independent and chain mediating roles of depression and emotional eating.Methods:In a cross-sectional study,202 LSG patients from the Third Xiangya Hospital of Central South University completed the Brief Self-Control Scale(BSCS),Patient Health Questionnaire-9(PHQ-9),and the emotional eating subscale of the Dutch Eating Behavior Questionnaire(DEBQ).%EWL within 12 months after surgery was calculated.Pearson correlations were conducted,and mediation was tested using Process v4.0(model 6)with 5 000 bootstrap samples while controlling for sex and postoperative time.Results:Overall,BSCS,PHQ-9,DEBQ-EE,and%EWL averaged 21.76±4.15,5.54±3.91,30.72±11.25,and(60.94±31.61)%,respectively.Self-control correlated negatively with depression(r=-0.697)and emotional eating(r=-0.441)and positively with%EWL(r=0.566;all P<0.01).%EWL correlated negatively with depression(r=-0.467)and emotional eating(r=-0.348,P<0.01).Adjusted regression showed positive prediction of%EWL by self-control(β=0.291 9,P<0.01)and negative prediction by depression(β=-0.155 6,P<0.05)and emotional eating(β=-0.115 8,P<0.05).Mediation analysis showed that the indirect effect through the path"self-control → depression →%EWL"was 0.848 8(95%CI=0.178 7-1.573 0).The indirect effect through the path"self-control → emotional eating →%EWL"was 0.259 8(95%CI=0.033 4-0.564 3).The chain indirect effect through the path"self-control →depression → emotional eating →%EWL"was 0.131 7(95%CI=0.005 9-0.322 8);the total indirect effect accounted for 35.83%of the total effect.Conclusion:Higher self-control after LSG enhances weight loss both directly and indirectly by alleviating depression and emotional eating.Routine psychological screening and eating-behavior interventions are warranted to consolidate long-term benefits.

Objective To investigate the mechanism of circadian clock protein Bmal1(Bmal1)on renal injury with chronic periodontitis,we established an experimental rat periodontitis model.Methods Twelve male Wistar rats were randomly divided into control and periodontitis groups(n=6,each group).The first maxillary molars on both sides of the upper jaw of rats with periodontitis were ligated by using orthodontic ligature wires,whereas the control group re-ceived no intervention measures.After 8 weeks,clinical periodontal parameters,including probing depth,bleeding index,and tooth mobility,were evaluated in both groups.Micro-CT scanning and three-dimensional image recon-struction were performed on the maxillary bones of the rats for the assessment of alveolar bone resorption.Histopatholo-gical observations of periodontal and renal tissues were conducted using hematoxylin-eosin(HE)and periodic acid-Schiff(PAS)staining.Renal function indicators,such as creatinine,albumin,and blood urea nitrogen levels,and oxida-tive stress markers,including superoxide dismutase,glutathione,and malondialdehyde levels,were measured using bio-chemical assay kits.MitoSOX red staining was used to detect reactive oxygen species(ROS)content in the kidneys.The gene and protein expression levels of Bmal1,nuclear factor erythroid 2-related factor 2(Nrf2),and heme oxygenase-1(HO-1)in rat renal tissues were assessed using real-time quantitative polymerase chain reaction(RT-qPCR)and immuno-histochemical staining.Results Micro-CT and HE staining results showed significant bone resorption and attachment loss in the maxillary first molar region of the periodontitis group.Histological examination through HE and PAS staining revealed substantial histopathological damage to the renal tissues of the rats in the periodontitis group.The findings of the assessment of renal function and oxidative stress markers indicated that the periodontitis group exhibited abnormal levels of oxidative stress,whereas the renal function levels showed abnormalities without statistical significance.Mito-SOX Red staining results showed that the content of ROS in the renal tissue of the periodontitis group was significantly higher than that of the control group,and RT-qPCR and immunohistochemistry results showed that the expression levels of Bmal1,Nrf2,and HO-1 in the renal tissues of the rats in the periodontitis group showed a decreasing trend.Conclu-sion Circadian clock protein Bmal1 plays an important role in the oxidative damage process involved in the renal of rats with periodontitis.