Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Objective:To explore the developmental trajectories of care dependency in patients after percutaneous coronary intervention (PCI) and to identify its influencing factors.Methods:A convenience sampling method was used to recruit patients who underwent PCI at China-Japan Friendship Hospital of Jilin University from August 2023 to July 2024. The Chinese version of the Care Dependency Scale was administered at 1 week, 1 month, 3 months, and 6 months postoperatively. A latent growth mixture model was employed to identify trajectories of care dependency. Logistic regression analysis was used to examine the influencing factors.Results:A total of 397 questionnaires were distributed, and 389 valid questionnaires were returned, with a response rate of 97.98% (389/397). Three distinct trajectories of care dependency were identified among the 389 patients: stable low dependency, recovering high dependency, and persistent high dependency. Age, cardiac function classification, number of comorbidities, frailty, self-efficacy, and utilization of chronic disease resources were significantly associated with different trajectory classes ( P<0.05) . Conclusions:Care dependency after PCI exhibits heterogeneity in its developmental trajectories. Patients in the persistent high-dependency group represent a high-risk subgroup requiring special attention. Nursing staff should enhance their ability to recognize trajectory patterns and implement precise interventions based on trajectory type and influencing factors.

Objective To investigate the impacts of knocking-down Keratin 17(KRT17)on proliferation,apoptosis and epithelial mesenchymal transition(EMT)of bladder cancer cells by regulating Wnt/β-catenin signaling pathway.Methods The expression of KRT17 mRNA and protein in bladder cancer tissue,adjacent tissue,bladder cancer cell lines(5637,T24 and UM-UC-3)and human immortalized urothelial cell line SV-HUC-1 were detected by qRT-PCR and Western blot assay.Immunohistochemical staining was used to detect the expression of KRT17 in the tissues.Cells transfected with NC siRNA and KRT17 siRNA were labeled as the NC siRNA group and the KRT17 siRNA group,respectively.T24 cells treated with 20 mmol/L LiCl were labeled as the LiCl group.T24 cells transfected with KRT17 siRNA and treated with 20 mmol/L LiCl were labeled as the KRT17 siRNA+LiCl group.The non transfected cells were used as the blank group.CCK-8,cloning formation experiment and flow cytometry were applied to detect cell proliferation and apoptosis.QRT-PCR was applied to detect KRT17 mRNA expression.Western blot assay was applied to detect the expression levels of KRT17,β-catenin,Cyclin D1,EMT related proteins Vimentin,E-cadherin and Snail1 proteins.Results The expression of KRT17 mRNA and protein was greatly increased in bladder cancer tissue and cells(P＜0.05).The cell proliferation,colony count,KRT17 mRNA and protein expression,β-catenin,Cyclin D1,Vimentin,and Snail expression were lower in the KRT17 siRNA group than those in the NC siRNA group and the blank group,while apoptosis and E-cadherin expression were higher(P＜0.05).LiCl reversed the inhibition of KRT17 knockdown on the malignant behavior of bladder cancer.Conclusion Knocking-down KRT17 inhibits the proliferation and EMT of bladder cancer cells and promotes their apoptosis by inhibiting Wnt/β-catenin signaling pathway.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Anxiety is a major emotional disorder manifested in the individual's expectation of future threats.The incidence rate of anxiety is about 7.3％,with the highest lifetime prevalence rate among mental health conditions.The mechanism of anxiety overlaps with depression,and anxiety is a typical symptom of various mental diseases or emotional disorders in traditional Chinese medicine.The high rates of comorbidity and disability pose serious threats to people's health.Animal models are important tools for studying anxiety and are of great use for deciphering the pathogenesis of anxiety and for developing drugs.The traditional paradigm of stress-induced anxiety,however,is relatively limited.Based on traditional theory combined with clinical and animal experimental data,we propose a new hypothesis of"insufficiency of ZhiYi'causing anxiety,defined as"an anxiety state induced by the inability of an individual to meet their own needs,limited or lacking after multiple attempts,rendered hindered and powerless by an inability to meet their desires".This hypothesis is more in line with the typical manifestations of despair,lack of pleasure,and social withdrawal in clinical patients,and is supported by traditional theory and experimental data showing"hunger but unable to eat,food but unable to obtain,and gain but not full".Based on this,the established modeling paradigm is easy to apply,with good repeatability and low cost,and can be used to establish anxiety models in rats and mice,to provide a theoretical and model basis for the development and pharmacological evaluation of anti-anxiety drugs.

Objective To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of axillary lymph node metastasis(ALNM)in breast cancer patients with low HER-2 expression.Methods A total of 297 breast cancer patients with low HER-2 expression treated at the Affiliated Hospital of Xuzhou Medical University were enrolled and divided into ALNM group(n=71)and non-ALNM group(n=226)according to whether there was ALNM.All patients underwent DCE-MRI,and DCE-MRI derived parameters were collected and analyzed.Logistic regression analysis was used to identify the risk factors for ALNM,and the efficacy of DCE-MRI in diagnosing ALNM was assessed using receiver operating characteristic curve.Results Significant differences were observed between two groups in lesion distribution,TNM staging,vascular invasion,and most DCE-MRI derived parameters including short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER(all P<0.05).Multivariate regression analysis revealed that the short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER were significant risk factors for ALNM in breast cancer patients.Comparative analysis demonstrated that the combination of DCE-MRI derived parameters yielded a maximum area under the curve of 0.976,with a sensitivity of 91.5%and a specificity of 92.9%.Conclusion DCE-MRI is an effective tool for determining the presence of ALNM in breast cancer patients with low HER-2 expression,providing significant diagnostic evidence for clinical practice.

Objective To investigate the impacts of knocking-down Keratin 17(KRT17)on proliferation,apoptosis and epithelial mesenchymal transition(EMT)of bladder cancer cells by regulating Wnt/β-catenin signaling pathway.Methods The expression of KRT17 mRNA and protein in bladder cancer tissue,adjacent tissue,bladder cancer cell lines(5637,T24 and UM-UC-3)and human immortalized urothelial cell line SV-HUC-1 were detected by qRT-PCR and Western blot assay.Immunohistochemical staining was used to detect the expression of KRT17 in the tissues.Cells transfected with NC siRNA and KRT17 siRNA were labeled as the NC siRNA group and the KRT17 siRNA group,respectively.T24 cells treated with 20 mmol/L LiCl were labeled as the LiCl group.T24 cells transfected with KRT17 siRNA and treated with 20 mmol/L LiCl were labeled as the KRT17 siRNA+LiCl group.The non transfected cells were used as the blank group.CCK-8,cloning formation experiment and flow cytometry were applied to detect cell proliferation and apoptosis.QRT-PCR was applied to detect KRT17 mRNA expression.Western blot assay was applied to detect the expression levels of KRT17,β-catenin,Cyclin D1,EMT related proteins Vimentin,E-cadherin and Snail1 proteins.Results The expression of KRT17 mRNA and protein was greatly increased in bladder cancer tissue and cells(P＜0.05).The cell proliferation,colony count,KRT17 mRNA and protein expression,β-catenin,Cyclin D1,Vimentin,and Snail expression were lower in the KRT17 siRNA group than those in the NC siRNA group and the blank group,while apoptosis and E-cadherin expression were higher(P＜0.05).LiCl reversed the inhibition of KRT17 knockdown on the malignant behavior of bladder cancer.Conclusion Knocking-down KRT17 inhibits the proliferation and EMT of bladder cancer cells and promotes their apoptosis by inhibiting Wnt/β-catenin signaling pathway.

Anxiety is a major emotional disorder manifested in the individual's expectation of future threats.The incidence rate of anxiety is about 7.3％,with the highest lifetime prevalence rate among mental health conditions.The mechanism of anxiety overlaps with depression,and anxiety is a typical symptom of various mental diseases or emotional disorders in traditional Chinese medicine.The high rates of comorbidity and disability pose serious threats to people's health.Animal models are important tools for studying anxiety and are of great use for deciphering the pathogenesis of anxiety and for developing drugs.The traditional paradigm of stress-induced anxiety,however,is relatively limited.Based on traditional theory combined with clinical and animal experimental data,we propose a new hypothesis of"insufficiency of ZhiYi'causing anxiety,defined as"an anxiety state induced by the inability of an individual to meet their own needs,limited or lacking after multiple attempts,rendered hindered and powerless by an inability to meet their desires".This hypothesis is more in line with the typical manifestations of despair,lack of pleasure,and social withdrawal in clinical patients,and is supported by traditional theory and experimental data showing"hunger but unable to eat,food but unable to obtain,and gain but not full".Based on this,the established modeling paradigm is easy to apply,with good repeatability and low cost,and can be used to establish anxiety models in rats and mice,to provide a theoretical and model basis for the development and pharmacological evaluation of anti-anxiety drugs.

Objective:To investigate the clinical efficacy of minimally invasive double anchoring combined with percutaneous kyphoplasty (PKP) for Kümmell disease.Methods:The clinical data of 24 patients with Kümmell disease who were treated with minimally invasive double anchoring combined with PKP in Cangzhou People's Hospital from October 2022 to March 2024 were retrospectively analyzed. Among them, there were 2 T 10 vertebrae, 5 T 11 vertebrae, 7 T 12 vertebrae, 6 L 1 vertebrae, and 4 L 2 vertebrae. There were 6 males and 18 females. The average age was 72.05±4.52 years (range, 66-80 years). The bone mineral density T value was -3.41±0.77 (range, -2.5-4.5). The stages of Li's Kümmell disease included 13 cases of stage II and 11 cases of stage III. The operation time, intraoperative blood loss, and volume of bone cement injected were recorded. The vertebral index, vertebral angle and Cobb angle of diseased segment were measured before and after operation. The visual analogue scale (VAS) was used to assess the degree of pain, the Oswestry disability index (ODI) and the Japanese Orthopaedic Association (JOA) low back pain scale were used to assess spinal function. The Medical Outcome Study short form 36 item health survey (SF-36) was used to assess the general health status of the patients. The postoperative symptom recovery was evaluated by Odom criteria. Results:The mean operative time of the 24 patients was 35.32±6.86 min, the injected volume of bone cement was 4.39±1.72 ml, and the intraoperative blood loss was 16.56±5.21 ml. All patients were followed up for 10 to 14 months, with an average of 11.7 months. Postoperative CT examination showed that the screw positions were satisfactory, and no loosening or displacement of bone cement mass occurred. On the first day after surgery, the vertebral body index, vertebral body angle and Cobb angle of diseased segment were 77.71%±2.75%, 12.40°±1.53° and 25.77°±4.49°, respectively, which represented significant improvements from the preoperative values of 43.09%±5.66%, 22.12°±2.92° and 46.98°±5.68° before surgery ( P<0.05). At the last follow-up, the values were 76.18%±2.32%, 12.41°±2.53°, 26.14°±4.87°, respectively, which were significantly improved compared with those before surgery ( P<0.05), but there was no statistical significance compared with the first day after surgery ( P>0.05). The VAS, ODI and JOA scores on the first day after surgery were 2.11±0.87 points, 22.46±5.49 points and 27.68±2.45 points, respectively, which were significantly improved compared with those before surgery 7.50±0.98 points, 76.25±8.56 points and 14.96±4.91 points ( P<0.05). At the last follow-up, the values were 2.26±0.88, 23.87±3.25 and 26.58±2.77, respectively, which were significantly improved compared with those before surgery ( P<0.05), and there was no statistical significance compared with the first day after surgery ( P>0.05). All 24 patients completed SF-36 scale assessment, and the results showed that there were statistically significant differences in physiological function, physiological role, physical pain, general health status, social function scores and mental health between the patients before surgery and the last follow-up ( P<0.05), while there were no statistically significant differences in vitality and emotional function ( P>0.05). At the last follow-up, the Odom criteria showed excellent results in 18 cases, good in 4 cases, and fair in 2 cases. Conclusions:The application of minimally invasive double anchoring (single nail fixation) combined with PKP in the treatment of Kümmell disease can effectively prevent the loosening and displacement of bone cement masses, and the fixation effect is satisfactory, which can restore the height of the injured vertebrum, reduce kyphosis and improve spinal function. The clinical symptoms of the patients were significantly improved, and the quality of life was enhanced.

Objective:To explore latent categories and influencing factors of disease uncertainty in atrial fibrillation patients undergoing radiofrequency ablation (RFA) .Methods:Convenience sampling was used to select 346 atrial fibrillation patients who underwent RFA from February 2022 to July 2024 at China-Japan Union Hospital of Jilin University. Patients were surveyed using the General Information Questionnaire, Mishel Uncertainty in Illness Scale-Adult Form (MUIS-A), Brief Illness Perception Questionnaire, Chinese version of the Sense of Coherence-13, and Family APGAR Index. Latent categories and influencing factors of disease uncertainty in atrial fibrillation patients with RFA were explored using latent profile analysis and Logistic regression analysis.Results:A total of 346 questionnaires were distributed and 328 valid questionnaires were recovered, with a valid recovery rate of 94.80% (328/346). The total MUIS-A score for 328 patients with atrial fibrillation was (97.06±9.41). Three latent categories of disease uncertainty existed in 328 atrial fibrillation patients with RFA, namely high-level disease uncertainty group ( n=138), intermediate-level disease uncertainty group ( n=120), and low-level disease uncertainty group ( n=70). Age, education level, number of RFA, type of atrial fibrillation, perception of disease, sense of coherence, and family care were the factors influencing the disease uncertainty in patients with atrial fibrillation ( P<0.05) . Conclusions:Disease uncertainty after RFA in patients with atrial fibrillation is above the intermediate level. Nursing staff should provide precise interventions for patients with different latent categories of disease uncertainty in conjunction with its influencing factors.