Frailty is a complex aging syndrome characterized by diminished strength and physiological dysfunction.Early diagnosis of frailty is of great value in helping the elderly to improve the quality of life.However,specific bio-logical markers to diagnose frailty are still lacking.In recent years,moderate protein intake has been shown to be an effective intervention in the management of frailty in older adults,and the relationship between frailty and amino acid metabolism has received widespread attention.This review discusses recent advances in the study of the mecha-nisms by which amino acid metabolism affects frailty and provide new ideas for searching specific biomarkers of frailty.

Objective To explore the influence of intensified blood glucose control on the diaphragmatic function of patients with sepsis in the intensive care unit(ICU).Methods Sixty-six sepsis patients admitted to the ICU of Affiliated Lihuili Hospital of Ningbo University from January to December 2024 were selected and divided into experimental group and control group according to the random number table method,with 33 cases in each group.The experimental group received intensified blood glucose control,while control group received conventional blood glucose control.The diaphragm distance(DD)and diaphragm thickness fraction(DTF)of two groups of patients were continuously measured by bedside ultrasound,and the mechanical ventilation time,weaning outcome and hospital stay were recorded.Results With the prolongation of treatment time and mechanical ventilation time,the DD and DTF of both groups of patients showed an upward trend.There was no statistically significant difference in DD between two groups of patients at different times(P＞0.05).On the 4th and 6th days,the DTF of patients in experimental group was significantly greater than that in control group(P＜0.05).The weaning success rate of patients in experimental group was significantly higher than that in control group(P=0.026).There was no statistically significant difference in mechanical ventilation time,ICU stay time and total hospital stay time between two groups of patients(P＞0.05).There was no statistically significant difference in the incidence of hypoglycemia between two groups of patients(P＞0.05).Conclusion Intensified control of blood glucose can improve diaphragmatic function of patients with sepsis in the ICU,increase the success rate of weaning from the ventilator,and has high safety.

Objective To explore the influence of intensified blood glucose control on the diaphragmatic function of patients with sepsis in the intensive care unit(ICU).Methods Sixty-six sepsis patients admitted to the ICU of Affiliated Lihuili Hospital of Ningbo University from January to December 2024 were selected and divided into experimental group and control group according to the random number table method,with 33 cases in each group.The experimental group received intensified blood glucose control,while control group received conventional blood glucose control.The diaphragm distance(DD)and diaphragm thickness fraction(DTF)of two groups of patients were continuously measured by bedside ultrasound,and the mechanical ventilation time,weaning outcome and hospital stay were recorded.Results With the prolongation of treatment time and mechanical ventilation time,the DD and DTF of both groups of patients showed an upward trend.There was no statistically significant difference in DD between two groups of patients at different times(P＞0.05).On the 4th and 6th days,the DTF of patients in experimental group was significantly greater than that in control group(P＜0.05).The weaning success rate of patients in experimental group was significantly higher than that in control group(P=0.026).There was no statistically significant difference in mechanical ventilation time,ICU stay time and total hospital stay time between two groups of patients(P＞0.05).There was no statistically significant difference in the incidence of hypoglycemia between two groups of patients(P＞0.05).Conclusion Intensified control of blood glucose can improve diaphragmatic function of patients with sepsis in the ICU,increase the success rate of weaning from the ventilator,and has high safety.

Objective To establish a machine learning radiomics model that can accurately predict MRI enhancement patterns of glioma based on T2 fluid attenuated inversion recovery(T2-FLAIR)images for optimizing the workflow of magnetic resonance imaging(MRI)examinations of glioma patients.Methods We retrospectively collected preoperative MR T2-FLAIR images from 385 patients with pathologically confirmed glioma,who were divided into enhancing and non-enhancing groups according to the enhancement pattern.Predictive radiomics models were established using Gaussian Process,Linear Regression,Linear Regression-Least absolute shrinkage and selection operator,Support Vector Machine,Linear Discriminant Analysis or Naive Bayes as the classifiers in the training cohort(n=201)and tested both in the internal(n=85)and external validation cohorts(n=99).The receiver-operating characteristic curve was used to assess the predictive performance of the models.Results The predictive model constructed based on 15 radiomics features using Gaussian Process as the classifier had the best predictive performance in both the training cohort and the internal validation cohort,with areas under the curve(AUC)of 0.88(95%CI:0.81-0.94)and 0.80(95%CI:0.71-0.88),respectively.In the external validation cohort,the model showed an AUC of 0.81(95%CI:0.71-0.90)with sensitivity,specificity,positive predictive value and negative predictive value of 0.98,0.61,0.76 and 0.96,respectively.Conclusion The T2-FLAIR-based machine learning radiomics model can accurately predict the enhancement pattern of gliomas on MRI.

Objective:To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection.Methods:A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study.Results:The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months.Conclusions:MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

Objective To establish a machine learning radiomics model that can accurately predict MRI enhancement patterns of glioma based on T2 fluid attenuated inversion recovery(T2-FLAIR)images for optimizing the workflow of magnetic resonance imaging(MRI)examinations of glioma patients.Methods We retrospectively collected preoperative MR T2-FLAIR images from 385 patients with pathologically confirmed glioma,who were divided into enhancing and non-enhancing groups according to the enhancement pattern.Predictive radiomics models were established using Gaussian Process,Linear Regression,Linear Regression-Least absolute shrinkage and selection operator,Support Vector Machine,Linear Discriminant Analysis or Naive Bayes as the classifiers in the training cohort(n=201)and tested both in the internal(n=85)and external validation cohorts(n=99).The receiver-operating characteristic curve was used to assess the predictive performance of the models.Results The predictive model constructed based on 15 radiomics features using Gaussian Process as the classifier had the best predictive performance in both the training cohort and the internal validation cohort,with areas under the curve(AUC)of 0.88(95%CI:0.81-0.94)and 0.80(95%CI:0.71-0.88),respectively.In the external validation cohort,the model showed an AUC of 0.81(95%CI:0.71-0.90)with sensitivity,specificity,positive predictive value and negative predictive value of 0.98,0.61,0.76 and 0.96,respectively.Conclusion The T2-FLAIR-based machine learning radiomics model can accurately predict the enhancement pattern of gliomas on MRI.

Objetive： To investigate the mechanism of antidepressant effect of verbascoside based on high-throughput sequencing technology （RNA-Seq），and to explore the possible targets and signaling pathways. MethodsForty C57BL/6 mice were randomly divided into control group，model group，fluoxetine group and verbascoside group，10 mice in each group. Except for the control group，all the other three groups were constructed with chronic unpredictable mild stimulation （CUMS） combined with solitary feeding for four weeks. Control group，fluoxetine group and verbascoside group were administered by gavage once daily for three weeks during the second week of modeling. The mice were assessed by sugar-water preference test，forced swimming test，open field test，elevated cross maze test，and water maze test. Enzyme linked immunosorbent assay（ELISA） was performed to detect the levels of major neurotransmitters and inflammatory factors in mice serum，and mRNA high-throughput sequencing was performed in the nucleus accumben and colon to screen differentially expressed genes and perform pathway enrichment analysis. Real-time polymerase chain reaction（Real-time PCR） was used to detect the mRNA expression of Gad，Slc32a1（VGAT） and brain-derived neurotrophic factor (BDNF） in nucleus accumbens. ResultCompared with the control group，the anxiety and depression-like behaviors in the model group increased，while the learning and memory ability decreased significantly. The content of neurotransmitter in serum decreased significantly. The content of pro-inflammatory factors increased significantly. The mRNA expression of Gad and Slc32a1（VGAT） in nucleus accumbens decreased significantly，while that of BDNF increased significantly. Compared with the model group，the anxiety and depression-like behavior of mice in verbascoside group was significantly relieved. The neurotransmitter content increased significantly，and the pro-inflammatory factors decreased significantly. The mRNA expression of Gad and Slc32a1（VGAT） in nucleus accumbens increased significantly，while that of BDNF decreased significantly.A total of 48 differentially expressed genes in nucleus accumbens and 43 differentially expressed genes in colon were screened by high-throughput sequencing. Differential genes in nucleus accumbens mainly focus on neuroactive ligand-receptor interaction， γ-aminobutyric acid（GABA）ergic synapse，synaptic vesicle cycle and other pathways. Colonic differential genes are mainly concentrated in GABAergic synapses，synaptic vesicle circulation，cyclic adenosine monophosphate（cAMP） signal pathway and other signal pathways. Compared with the control group，the mRNA expression of Gad and Slc32a1（VGAT） in nucleus accumbens of model group decreased significantly，while the mRNA expression of BDNF increased significantly. ConclusionVerbascoside has significant antidepressant effects. Its antidepressant effect may be related to the increase of monoamine neurotransmitters，the decrease of pro-inflammatory factors and the restoration of neurotransmitter homeostasis by increasing GABA，and it mainly acts through the signaling pathways such as neuroactive ligand-receptor interaction，GABAergic synapses，synaptic vesicle cycle and cAMP signaling pathway.

OBJECTIVE: To investigate the expression profile of long non-coding RNAs (lncRNA) and identify potential lncRNA-related competing endogenous RNAs (ceRNA) in placenta accrete spectrum disorders (PAS). METHODS: Five tissue specimens of placental implantation and 5 adjacent normal placental tissues were collected from cesarean section deliveries complicated by PAS in our hospital between December, 2017 and June, 2018. Human microarrays were used to identify the lncRNAs that were differentially expressed in PAS, and 5 of the identified lncRNAs were further validated using qRT-PCR. GO and KEGG pathway analyses were performed to indentify the most significant enrichment functions. A ceRNA network was constructed based on ENST00000511361 (RP5-875H18.4), NR_027457 (LINC00221) and NR_126415 (FOXP4-AS1) to pinpoint the potential lncRNAs-related ceRNA. RESULTS: A total of 329 lncRNAs and 179 mRNAs were identified to have differential expression in PAS. The results of qRT-PCR were consistent with the human microarrays results. Transforming growth factor-β (TGF-β) signaling pathway was the most significantly enriched pathway. The constructed ceRNA network suggested that RP5-875H18.4--miRNA-218--SLIT2 had a potential ceRNA regulatory mechanism in PAS. CONCLUSIONS The differentially expressed lncRNAs are involved in the occurrence and progression of PAS possibly by regulating the TGF-β signaling pathway. The ceRNA network of RP5-875H18.4--miRNA-218--SLIT2 may play a role in the occurrence of PAS.

Objective To evaluate the surgical strategy for pulmonary valve preservation in repair of tetralogy of Fallot (TOF) and analyze the outcomes in young children patients.Methods A total of 211 TOF younger children less than threeyear-old between January 2009 and December 2015 had received pulmonary valve-sparing(PVS) surgical repair.At the end of the procedure,the peak RV/LV pressure ratio(PRV/PLV) and transannular pressure gradient were performed in all patients.114 patients had higher PRV/PLV rati ≥ 0.8.The former 54 patients,right ventricle infundubulum sparing (RVIS) stragery were made to relieve the RVOTO.However,only 8 patinets of the later 60 cases had received RVIS in TOF repair,whose systemic blood pressure was instable with the large dose of dopamine≥10 μg · kg-1 · min-1 and epinephrine≥0.05 μg · kg-1 · min-1 or the transannular pressure gradient≥30 mmHg (1 mmHg =0.133 kPa).114 patients were divided by two group(52 cases in PVS group and 62 cases in RVIS group) and compared by the early outcomes.Results The median cardiopulmonary bypass time of RVIS group was significantly more than that of PVS group[(110.3 ± 12.0)min vs(77.7 ± 10.0)min].The postoperative index of the patients in PVS group,including transannular pressure gradient [(21.0 ± 5.4) mmHg vs (16.0 ± 3.6) mmHg,P ＜ 0.05],PRV/PLV ratio(0.82 ± 0.03 vs.0.67 ± 0.12,P ＜ 0.01),median using time of dopamine and epinephrine[(6.03 ±9.60)days vs.(4.20 ±1.90)days,P＜0.01],median extubation time[(81.2 ±27.6)h vs.(38.5 ±33.0) h,P ＜ 0.01],ICU stay time [(6.3 ± 1.7) days vs.(4.3 ± 1.9) days,P ＜ 0.01],using of peritoneal dialysis (8/52 vs 4/62,P ＜ 0.01)were more than those in RVIS group.There was no difference of mortality between two groups.Fellow up 12-50 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of PVS group was significant less than those of RVIS group.Conclusion PVS and RVIS in TOF repair could decrease the severity of pulmonary regurgitation after operation.

Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG.Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011,57 patients(44.2％) underwent CABG combined with MVP,and 72 patients(55.8％) underwent CABG.Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients,with LVESD,LVEF,LVEDD to evaluate the reverse of left ventricular remodeling;The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded.Results There was no significant difference between two groups in the preoperative data(P ＞ 0.05).The mortality rate was 3.9％ (5 cases),2 cases (2.8 ％) died in CABG group,3 cases (5.3 ％) died in the combined surgery group.The average follow-up was 24 months,9 cases of late death (5 in CABG group,4 in CABG + MVP group),the cumulative survival rate(P =0.645) and the major cardiovascular events(P =0.761) of the two groups were not statistically different.The degree of mitral regurgitation(P ＜ 0.01) was significantly decreased in the combined surgery group.Compared with the preoperative state,the two groups of left ventricular remodeling indicators such as LVESD,LVEF,LVEDD were significantly improved(P ＜0.05),but the difference between two groups was not significant(P ＞0.05).NYHA heart function classification was significantly improved (P ＜ 0.001).Conclusion MVP can effectively improve the reverse flow of patients with moderate IMR,but CABG combined with MVP can not bring more benefits in the reversal of left ventricular remodeling,short-term survival and cardiac function.