ObjectiveThis paper aims to investigate the protective effects of the Tanyu Tongzhi Youhua prescription（TYTZP） against myocardial ischemia/reperfusion injury in rats via regulation of the cyclic GMP-AMP synthase （cGAS）/stimulator of interferon genes （STING） signaling pathway. MethodsFifty-six 8-week-old male Sprague-Dawley （SD） rats were randomly divided into sham group， model group， ticagrelor group （32.4 mg·kg^-1）， RU320521 （RU.521cGAS inhibitors） group （5 mL·kg^-1）， groups of TYTZP with low dose （3.6 g·kg^-1）， medium dose （7.2 g·kg^-1）， and high dose （14.4 g·kg^-1）， with eight rats per group. The ticagrelor group and groups of TYTZP with different doses received pre-treatment for seven days according to their respective protocols. The RU.521 group received an intraperitoneal injection one hour before modeling. A rat model of the no-reflow phenomenon in myocardial ischemia/reperfusion injury was established by ligating the left anterior descending coronary artery in situ. Myocardial no-reflow area was determined by thioflavin staining. Histopathological morphology of myocardial tissue was observed via hematoxylin and eosin （HE） staining. Cardiac function was detected by echocardiography. Myocardial microcirculation function change was observed by using real-time myocardial contrast echocardiography. The myocardial enzyme levels in the serum were measured by serum biochemical analysis. The double-stranded DNA （dsDNA） levels were detected by using PicoGreen. The protein expression of cGAS， STING， and nuclear factor-κB （NF-κB） p65 in myocardial tissue was detected by Western blot. The levels of cardiac troponin Ⅰ （cTNⅠ）， cardiac troponin T （cTNT）， interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α） in the peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA）. ResultsCompared with the sham group， the model group showed a significantly increased myocardial no-reflow area （P<0.01）. Myocardial fiber rupture and disarray and inflammatory cell infiltration were observed by HE staining. The ultrasound results indicated that left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） （P<0.01） were significantly decreased. Real-time myocardial contrast echocardiography showed that the peak time of myocardial blood perfusion was significantly prolonged （P<0.01）， and the levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， cTNⅠ， cTNT， and dsDNA were significantly elevated （P<0.01）. Western blot results showed that the myocardial protein expressions of cGAS， STING， and NF-κB p65 were upregulated （P<0.01）. ELISA results showed that the inflammatory factors in the serum such as IL-6， IL-1β， and TNF-α were increased （P<0.01）. Compared with the model group， the group of the TYTZP significantly reduced the levels of myocardial enzyme， troponins， and dsDNA （P<0.01， P<0.05）， improved cardiac function and myocardial microcirculation， alleviated histopathological morphology and inflammatory infiltration， inhibited activation of the cGAS/STING pathway， reduced the expression of NF-κB p65 （P<0.01， P<0.05）， and inhibited inflammatory response. ConclusionThe TYTZP mitigates the no-reflow phenomenon in myocardial ischemia/reperfusion injury， and its mechanism is associated with inhibiting the activation of the cGAS/STING pathway and attenuating inflammatory responses.

ObjectiveThis paper aims to investigate the protective effects of the Tanyu Tongzhi Youhua prescription（TYTZP） against myocardial ischemia/reperfusion injury in rats via regulation of the cyclic GMP-AMP synthase （cGAS）/stimulator of interferon genes （STING） signaling pathway. MethodsFifty-six 8-week-old male Sprague-Dawley （SD） rats were randomly divided into sham group， model group， ticagrelor group （32.4 mg·kg^-1）， RU320521 （RU.521cGAS inhibitors） group （5 mL·kg^-1）， groups of TYTZP with low dose （3.6 g·kg^-1）， medium dose （7.2 g·kg^-1）， and high dose （14.4 g·kg^-1）， with eight rats per group. The ticagrelor group and groups of TYTZP with different doses received pre-treatment for seven days according to their respective protocols. The RU.521 group received an intraperitoneal injection one hour before modeling. A rat model of the no-reflow phenomenon in myocardial ischemia/reperfusion injury was established by ligating the left anterior descending coronary artery in situ. Myocardial no-reflow area was determined by thioflavin staining. Histopathological morphology of myocardial tissue was observed via hematoxylin and eosin （HE） staining. Cardiac function was detected by echocardiography. Myocardial microcirculation function change was observed by using real-time myocardial contrast echocardiography. The myocardial enzyme levels in the serum were measured by serum biochemical analysis. The double-stranded DNA （dsDNA） levels were detected by using PicoGreen. The protein expression of cGAS， STING， and nuclear factor-κB （NF-κB） p65 in myocardial tissue was detected by Western blot. The levels of cardiac troponin Ⅰ （cTNⅠ）， cardiac troponin T （cTNT）， interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α） in the peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA）. ResultsCompared with the sham group， the model group showed a significantly increased myocardial no-reflow area （P<0.01）. Myocardial fiber rupture and disarray and inflammatory cell infiltration were observed by HE staining. The ultrasound results indicated that left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） （P<0.01） were significantly decreased. Real-time myocardial contrast echocardiography showed that the peak time of myocardial blood perfusion was significantly prolonged （P<0.01）， and the levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， cTNⅠ， cTNT， and dsDNA were significantly elevated （P<0.01）. Western blot results showed that the myocardial protein expressions of cGAS， STING， and NF-κB p65 were upregulated （P<0.01）. ELISA results showed that the inflammatory factors in the serum such as IL-6， IL-1β， and TNF-α were increased （P<0.01）. Compared with the model group， the group of the TYTZP significantly reduced the levels of myocardial enzyme， troponins， and dsDNA （P<0.01， P<0.05）， improved cardiac function and myocardial microcirculation， alleviated histopathological morphology and inflammatory infiltration， inhibited activation of the cGAS/STING pathway， reduced the expression of NF-κB p65 （P<0.01， P<0.05）， and inhibited inflammatory response. ConclusionThe TYTZP mitigates the no-reflow phenomenon in myocardial ischemia/reperfusion injury， and its mechanism is associated with inhibiting the activation of the cGAS/STING pathway and attenuating inflammatory responses.

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 explore an evaluation method for the operational status of tertiary public hospitals, identify strengths and weaknesses in hospital operations, and provide decision-making support for hospital managers.Methods:In 2023, an evaluation index system for the operation of tertiary public hospitals was constructed based on literature analysis and the Delphi method. The combined weights of the evaluation indexes were determined using the cooperative game theory method. An evaluation model for hospital operational status based on the extensible cloud model was established, with the determination of evaluation index thresholds and standards based on the operational data of a tertiary public hospital in Liaoning Province from 2020 to 2022. The operational status of the hospital was then comprehensively evaluated using the evaluation model based on the hospital′s operational data from 2023.Results:The constructed evaluation index system for the operation of tertiary public hospitals included five dimensions and 14 indicators: financial health, service efficiency, medical quality, satisfaction, and sustainable development. The indicators with higher weight values were net cash flow (0.135), average appointment rate for outpatient patients (0.088), and budget savings from government procurement (0.087). The overall operational status evaluation score of the sample hospital was 4.48, with an evaluation grade of level V. The scores for the dimensions of financial health, medical quality, and sustainable development were 4.99, 4.74, and 5.00, respectively, all reaching level V. The scores for service efficiency and satisfaction were 4.00 and 3.70, respectively, both at level Ⅳ.Conclusions:The evaluation index system and the determined weights constructed in this study were reasonable to a certain extent. The hospital operational status evaluation model based on the extensible cloud model can objectively reflect the operational status of the hospital, and the evaluation results can provide decision-making support for managers.

Objective:To investigate the epidemic characteristics of human brucellosis and the awareness of brucellosis prevention and control knowledge among occupational populations in Xuzhou City, Jiangsu Province.Methods:The data of brucellosis cases reported from January to December 2023 in the China Disease Prevention and Control Information System's Infectious Disease Surveillance System where the current residence was Xuzhou City, were collected. The epidemiological distribution characteristics across the three dimensions (time, region, and population) were analyzed, and the etiological characteristics of Brucella strains collected from sentinel hospitals in Xuzhou City during the same period were analyzed. Meanwhile, in September 2023, a survey was conducted on the awareness of brucellosis prevention and control knowledge among occupational populations in 7 counties (cities, districts) with a high incidence of brucellosis in Xuzhou City. Binary logistic regression was used to analyze the influencing factors. Results:In 2023, a total of 124 human brucellosis cases were reported in Xuzhou City, with an annual incidence rate of 1.37/100 000. Brucellosis occurred in all months of the year, with a peak incidence from May to August, accounting for 46.77% (58/124). The incidence rate of brucellosis in Feng County, Pei County, Suining County, Xinyi City and Pizhou City (1.86/100 000) was higher than that in Gulou District, Yunlong District, Quanshan District, Jiawang District and Tongshan District (0.71/100 000), with a statistically significant difference (χ 2 = 19.15, P < 0.001). Among 124 cases of brucellosis, 81 cases (65.32%) were males and 43 cases (34.68%) were females. The incidence rate of brucellosis in males (1.78/100 000) was higher than that in females (0.96/100 000), with a statistically significant difference (χ 2 = 11.08, P < 0.001). The 55 - 64 age group reported a relatively higher number of cases (45 cases, 36.29%), with an incidence rate of 3.97/100 000. The main occupation was farmers (85 cases, 68.55%). In 2023, a total of 9 strains of Brucella were collected from the sentinel hospitals in Xuzhou City, all of which were Brucella melitensis, mainly classified as biotype 3 (7/9). In 2023, a total of 984 occupational population with brucellosis were surveyed in Xuzhou City, and the overall awareness rate of brucellosis prevention and control knowledge was 3.25% (32/984). By binary logistic regression analysis, the awareness rates of brucellosis prevention and control knowledge among veterinarians and those with high school or vocational school education, college education or above were relatively high [ OR (95% CI): 21.24 (1.52 - 297.74), 13.32 (3.48 - 50.96), 18.90 (3.68 - 97.13), P < 0.05]. Conclusions:In 2023, the incidence rate of human brucellosis in Xuzhou City is at a relatively high level, with men, middle-aged and elderly people, and farmers as the main population. The awareness rate of brucellosis prevention and control knowledge among occupational population is relatively low, and it is necessary to strengthen publicity, education, and behavioral intervention.

Objective To observe conventional ultrasound and contrast-enhanced ultrasound(CEUS)manifestations of Ewing sarcoma(ES)in children.Methods Fifteen children with pathologically confirmed ES were retrospectively collected.Conventional ultrasound and CEUS characteristics of lesions were analyzed.Results Among 15 cases,ES of bone(ESB)was found in 7 cases,while extraskeletal ES(EES)was observed in the other 8 cases.Solitary tumor was noticed in 14 cases,with a median maximum diameter of 7.50 cm,while multiple abdominal masses were found in 1 case.The tumors had irregular shapes and poorly defined boundaries,with medium echogenicity in 7 cases,low echogenicity in 6 cases,while in other 2 cases present as cystic-solid lesions.CDFI showed sparse blood flow in 11 cases,abundant or slightly abundant blood flow in 2 and 1 case,respectively,while no obvious blood flow was observed in 1 case.Rapid high enhancement and rapid washout were found in all 7 cases underwent CEUS,while patchy no-enhancement areas were detected in 4 cases.Conclusion Conventional ultrasonic manifestations of ES had certain specificities,which demonstrated a rapid enhancement and rapid washout pattern during CEUS and may be accompanied by necrosis.

Objective:To explore an evaluation method for the operational status of tertiary public hospitals, identify strengths and weaknesses in hospital operations, and provide decision-making support for hospital managers.Methods:In 2023, an evaluation index system for the operation of tertiary public hospitals was constructed based on literature analysis and the Delphi method. The combined weights of the evaluation indexes were determined using the cooperative game theory method. An evaluation model for hospital operational status based on the extensible cloud model was established, with the determination of evaluation index thresholds and standards based on the operational data of a tertiary public hospital in Liaoning Province from 2020 to 2022. The operational status of the hospital was then comprehensively evaluated using the evaluation model based on the hospital′s operational data from 2023.Results:The constructed evaluation index system for the operation of tertiary public hospitals included five dimensions and 14 indicators: financial health, service efficiency, medical quality, satisfaction, and sustainable development. The indicators with higher weight values were net cash flow (0.135), average appointment rate for outpatient patients (0.088), and budget savings from government procurement (0.087). The overall operational status evaluation score of the sample hospital was 4.48, with an evaluation grade of level V. The scores for the dimensions of financial health, medical quality, and sustainable development were 4.99, 4.74, and 5.00, respectively, all reaching level V. The scores for service efficiency and satisfaction were 4.00 and 3.70, respectively, both at level Ⅳ.Conclusions:The evaluation index system and the determined weights constructed in this study were reasonable to a certain extent. The hospital operational status evaluation model based on the extensible cloud model can objectively reflect the operational status of the hospital, and the evaluation results can provide decision-making support for managers.

Objective:To identify and synthesize the best available evidence for the prevention and management of enteral nutrition intolerance in postoperative patients with gastric cancer.Methods:Following the hierarchical structure of the "6S Evidence Resource Pyramid" model, evidence was systematically retrieved from evidence-based databases, clinical guidelines and professional societies' websites, and comprehensive literature databases. Studies related to the prevention and management of enteral nutrition intolerance in postoperative gastric cancer patients were screened. Two researchers, both trained in evidence-based nursing, independently conducted quality appraisal, evidence extraction, and integration. The search covered literature published from database inception to February 25, 2025.Results:A total of 23 studies were included, comprising 2 clinical guidelines, 1 evidence summary, 2 systematic reviews, 4 expert consensuses, 9 randomized controlled trials, 1 quasi-experimental study, 1 cohort study, 2 analytical cross-sectional studies, and 1 case-control study. Based on 6 key aspects (including preparation by Medical staff before surgery, postoperative patient assessment, formulation of feeding, rehabilitation exercises, traditional Chinese medicine interventions, and management of enteral nutrition intolerance), a total of 26 best evidence recommendations were summarized.Conclusions:The evidence summarized in this study provides an evidence-based foundation for clinical medical staff, contributing to the reduction of enteral nutrition intolerance in postoperative patients with gastric cancer.