Background::Psychological stress has been reported to be a potential risk factor for hypertension among females, but it remains unclear whether spousal chronic stress levels alter the risk of hypertension among women. We examined the associations between stress within the family and hypertension among married women.Methods::Reproductive-aged women who were planning for pregnancy and their husbands were recruited from the National Free Pre-pregnancy Checkup Projects (NFPCP) across 31 provinces in China in 2016 and 2017. Perceived stress of wives or husbands was measured with a 5-point Likert-type scale, and assessed from three domains: work/life-related stress, economic stress, and overall stress. Multivariable-adjusted logistic regression models were used to assess the associations between stress status and the prevalence of hypertension.Results::Of 10,027,644 couples, 261,098 (2.60%) women had hypertension. The results showed that higher stress levels among themselves or their husbands were associated with a higher prevalence of hypertension in women ( Pfor trend <0.001). Compared with non-stressed participants, female participants with the highest stress themselves were at a greater risk of hypertension, with adjusted odds ratio (OR) of 1.31 (95% confidence interval [CI]: 1.25-1.37); and compared with participants whose husbands had no stress, those whose husbands had the highest stress level were at a higher risk of hypertension with adjusted OR of 1.24 (95% CI: 1.20-1.29). Moreover, compared with non-stressed status for both couples, only-wife-stressed, only-husband-stressed, and both-stressed couples were found to be significantly associated with increased risks of wives’ hypertension, with adjusted ORs of 1.28 (95% CI: 1.25-1.31), 1.19 (95% CI: 1.17-1.21), and 1.28 (95% CI: 1.26-1.31), respectively. Conclusion::Moderate to severe stress in both spouses might be associated with female hypertension prevalence, which highlights the importance of paying attention to the psychological stresses of couples within the family.

Objective:To explore the composition and trajectory of symptom clusters during perioperative period in middle-aged and elderly patients with gynecological malignant tumors, so as to provide reference for formulating symptom management programs.Methods:From December 2022 to September 2023, convenience sampling was used to select 145 middle-aged and elderly patients with gynecological malignant tumors who underwent surgical treatment at the Affiliated Cancer Hospital of Xinjiang Medical University as the study subject. A longitudinal survey was conducted on patients at four time points [1 day before surgery (T1), 1 day after surgery (T2), 3 days after surgery (T3), and 7 days after surgery (T4, before discharge) ] using the General Information Questionnaire and the Chinese version of the Anderson Symptom Inventory-Perioperative Module in Patients with Gynecological Cancer.Results:A total of 145 questionnaires were distributed, and 130 valid questionnaires were collected, with an effective response rate of 89.66% (130/145). Exploratory factor analysis extracted six symptom clusters, namely perimenopausal symptom cluster, psychological symptom cluster, fatigue-pain symptom cluster, gastrointestinal symptom cluster, energy deficiency symptom cluster, and surgery related symptom cluster. Perimenopausal symptom group was a specific symptom cluster of gynecological malignant tumor patients, existing at T1. Psychological symptom cluster persisted during the patient's perioperative period. Fatigue-pain symptom cluster and surgery related symptom cluster existed at T2 to T4. Gastrointestinal symptom cluster and energy deficiency symptom cluster existed at T2 and T3.Conclusions:Middle aged and elderly patients with gynecological malignant tumors have various symptoms during the perioperative period, and the symptoms can cluster at different time points. The number of symptom clusters increases with the progress of surgical treatment, while the core symptoms within the cluster remain relatively stable over time. Clinical nursing staff should pay attention to the dynamic changes in the patient's perioperative symptom cluster, adopt efficient and targeted management measures based on the trajectory of symptom clusters, and reduce the burden of perioperative symptoms on patients.

This study was aimed at analyzing the molecular epidemiological characteristics of all 14 cases of human infection with avian influenza A(H7N9)virus in Xinjiang from 2014 to 2018,to provide a scientific basis for prevention,control,and treatment.The genomic sequence was obtained through high-throughput gene sequencing after nucleic acid extraction.Homolo-gy analysis,evolution analysis,mutation locus analysis,and homology modeling were performed in bioinformatics analysis software.The nucleotide homology and amino acid homology of the HA gene in 14 human infected H7N9 viruses were(97.39％-100％)and(98.38％-100％),respectively.The nucleotide homology of the NA gene and the amino acid homology ranged from 97.73％to 100％.All viruses were low pathogenic avian influenza viruses belonging to the Yangtze River Delta lin-eage and were divided into two subclades,which were most similar to the A/Hunan/02650/2016 vaccine strain.All HA pro-teins G186V and T160A were mutated;13 strains of Q226L were mutated;and none of the four key neuraminidase inhibitor resistance sites of NA protein were mutated.All sites of M2 protein S31N and V27A were mutated,all sites of PB1 protein T368V were mutated,and all sites of PA protein K356R were mutated.Xinjiang H7N9 virus exhibited double receptor bind-ing,and was resistant to amantadine drugs and sensitive to neuraminidase inhibitors,which may be used in early disease sta-ges.Strengthened monitoring and timely detection of avian in-fluenza virus genome changes will be critical for prevention and control,and formulation of countermeasures.

Objective:To investigate the clinical efficacy and safety of ixazomib-containing regimens in the treatment of patients with multiple myeloma(MM).Methods:A retrospective analysis was performed on the clinical efficacy and adverse reactions of 32 MM patients treated with a combined regimen containing ixazomib in the Hematology Department of the First People's Hospital of Lianyungang from January 2020 to February 2022.Among the 32 patients,15 patients were relapsed and refractory multiple myeloma(R/RMM)(R/RMM group),17 patients who responded to bortezomib induction therapy but converted to ixazomib-containing regimen due to adverse events(AE)or other reasons(conversion treatment group).The treatment included IPD regimen(ixazomib+pomalidomide+dexamethasone),IRD regimen(ixazomib+lenalidomide+dexamethasone),ICD regimen(ixazomib+cyclophosphamide+dexamethasone),ID regimen(ixazomib+dexamethasone).Results:Of 15 R/RMM patients,overall response rate(ORR)was 53.3％(8/15),among them,1 achieved complete response(CR),2 achieved very good partial response(VGPR)and 5 achieved partial response(PR).The ORR of the IPD,IRD,ICD and ID regimen group were 100％(3/3),42.9％(3/7),33.3％(1/3),50％(1/2),respectively,there was no statistically significant difference in ORR between four groups(x2=3.375,P=0.452).The ORR of patients was 50％after first-line therapy,42.9％after second line therapy,60％after third line therapy or more,with no statistically significant difference among them(x2=2.164,P=0.730).In conversion treatment group,ORR was 88.2％(15/17),among them,6 patients achieved CR,5 patients achieved VGPR and 4 patients achieved PR.There was no statistically significant difference in ORR between the IPD(100％,3/3),IRD(100％,6/6),ICD(100％,3/3)and ID(60％,3/5)regimen groups(x2=3.737,P=0.184).The median progression-free survival(PFS)time of R/RMM patients was 9 months(95％CI:6.6-11.4 months),the median overall survival(OS)time was 18 months(95％CI:11.8-24.4 months).The median PFS time of conversion treatment group was 15 months(95％CI:7.3-22.7 months),the median OS time not reached.A total of 10 patients suffered grade 3-4 adverse event(AE).The common hematological toxicities were leukocytopenia,anemia,thrombocytopenia.The common non-hematological toxicities were gastrointestinal symptoms(diarrhea,nausea and vomit),peripheral neuropathy,fatigue and infections.Grade 1-2 peripheral neurotoxicity occurred in 7 patients.Conclusion:The ixazomib-based chemotherapy regimens are safe and effective in R/RMM therapy,particularly for conversion patients who are effective for bortezomib therapy.The AE was manageable and safe.

AIM To establish an HPLC method for the simultaneous content determination of gallic acid,catechin,epicatechin,rhein 8-O-β-D-glucoside,chlorogenic acid,chrysophanol 8-O-β-D-glucoside,emodin-8-O-β-D-glucoside,emodin-3-methyl ether-8-O-β-D-glucoside,aloe emodin,rhein,cyperotundone,luteolin,α-cyperone,emodin,chrysophanol and emodin-3-methyl ether in Binglang Sixiao Pills.METHODS The analysis was performed on a 30℃thermostatic Kromasil C18 column(250 mm×4.6 mm,5 μm),with the mobile phase comprising of methanol-0.1%formic acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 260 nm.Subsequently,cluster analysis and principal component analysis were made.RESULTS Fifteen constituents showed good linear relationships within their own ranges(r＞0.999 0),whose average recoveries were 96.00%-101.00%%with the RSDs of 0.50%-1.50%.Various batches of samples were clustered into two categories,and four principal components demonstrated the accumulative variance contribution rate of 90.004%.CONCLUSION This simple,accurate and reproducible method can be used for the quality control of Binglang Sixiao Pills.

AIM To observe the effects of Danggui Buxue Decoction on myocardial ferroptosis in a rat model of heart failure with preserved ejection fraction(HFpEF).METHODS The rats were randomly divided into the control group,the model group and the Danggui Buxue Decoction group.After 8 weeks feeding of 8%high-salt diet in the model and trial groups to induce the rats into HFpEFd models,rats of the Danggui Buxue Decoction group were given 4 g/kg Danggui Buxue Decoction once daily for 4 weeks,in contrast to those of the control group given 12 weeks feeding of 0.3%low-salt diet.The rats had their left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS),left ventricular end-diastolic diameter(LVIDD),and end-diastolic left ventricular posterior wall thickness(LVPWd)detected by echocardiography;their pathological changes of myocardial tissue by HE and Masson staining;their myocardial mitochondrial morphology observed by transmission electron microscopy;their serum BNP,NT-proBNP levels,myocardial tissue Fe3+levels,and their levels of ROS,MDA,LPO and GSH,and SOD activity in serum and myocardium detected by ELISA method;and their myocardial expressions of ferroptosis marker proteins GPX4,FTH1 and xCT detected by immunofluorescence staining and Western blot method.RESULTS Compared with the model group,the Danggui Buxuetang group displayed increased LVEF,LVFS(P＜0.01);decreased LVIDD,LVPWd(P＜0.05,P＜0.01);decreased serum BNP,NT-proBNP levels(P＜0.01);decreased myocardial Fe3+level(P＜0.01);decreased MDA,ROS and LPO levels in serum and myocardium(P＜0.01);increased GSH level and SOD activity(P＜0.01);and increased expressions of myocardial ferroptosis related protein GPX4,FTH1 and xCT(P＜0.05,P＜0.01).CONCLUSION Danggui Buxue Decoction protects the cardiac function of the rat model of HFpEF through inhibiting the occurrence of myocardial ferroptosis and reducing the myocardial oxidative stress level as well.

Biliary fibrosis (BF) is the result of pathological repair of bile tract injury, characterized by thickening and sclerosis of the bile duct wall and progressive stricture of the lumen, which may ultimately lead to serious adverse outcomes such as biliary obstruction, biliary cirrhosis, liver failure, and hepatobiliary malignancies. Current research describes BF as a pathological feature of certain bile tract diseases, lacking a systematic summary of its etiology, pathophysiology, molecular mechanisms, and treatment. BF is a common but easily neglected disease state in biliary system, which may promote the development and progression of hepatobiliary diseases through abnormal repair mechanism after pathological biliary tract injury. Based on the latest research progress from both domestic and international perspectives, the authors review the concept, clinical manifestation, etiology, pathogenesis, and therapeutic strategies of BF to provide a reference for clinical physicians.

Objective:To explore the clinical efficacy and cardiovascular protective effect of sodium-glucose co-transporter 2 inhibitor(SGLT-2i)on patients with type 2 diabetic nephropathy(T2DN).Methods:A total of 376 T2DN patients admitted in our Department of Endocrinology and Department of Cardiology from January 2018 to December 2021 were selected.According to therapeutic program,they were divided into control group(n=177,re-ceived routine treatment program)and SGLT-2i group(n=199,received SGLT-2i based on routine treatment program),both groups were continuously treated for 1 year.Blood glucose,blood pressure,blood lipids,uric acid,body mass index,renal function-related indexes and the occurrence of major adverse cardiovascular events were compared between the two groups after 12 months,as well as the adverse drug reactions.Results:After 12-month treatment,compared with control group,there were significant reductions in levels of blood pressure,fasting blood glucose(FBG),glycosylated hemoglobin A1e(HbA1c),urinary albumin/creatinine ratio(UACR),creatinine(Cr),blood urea nitrogen(BUN),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and uric acid(UA),and significant rise in estimated glomerular filtration rate(eGFR),levels of high density lipoprotein cholesterol(HDL-C),albumin(Alb)and alanine aminotransferase(ALT)in SGLT-2i group(P＜0.05 or＜0.01).Incidence rates of acute myocardial infarction(1.51％vs.6.21％)and heart failure caused-readmission(2.51％vs.6.78％)in SGLT-2i group were significantly lower than those of control group,and inci-dence rate of urinary system infection(8.54％vs.1.69％)was significantly higher than that of control group(P＜0.05 all).Conclusion:SGLT-2i can not only effectively control blood glucose,but also reduce body weight and blood pressure,improve blood lipids,reduce uric acid,improve renal hyperfiltration,reduce urinary protein and possess unique cardiovascular benefits,but risk of urinary system infection calls for attention.

Activation of nuclear factor erythroid 2-related factor 2(Nrf2)by Kelch-like ECH-associated protein 1(Keap1)alkylation plays a central role in anti-inflammatory therapy.However,activators of Nrf2 through alkylation of Keap1-Kelch domain have not been identified.Deoxynyboquinone(DNQ)is a natural small molecule discovered from marine actinomycetes.The current study was designed to investigate the anti-inflammatory effects and molecular mechanisms of DNQ via alkylation of Keap1.DNQ exhibited signif-icant anti-inflammatory properties both in vitro and in vivo.The pharmacophore responsible for the anti-inflammatory properties of DNQ was determined to be the α,β-unsaturated amides moieties by a chemical reaction between DNQ and N-acetylcysteine.DNQ exerted anti-inflammatory effects through activation of Nrf2/ARE pathway.Keap1 was demonstrated to be the direct target of DNQ and bound with DNQ through conjugate addition reaction involving alkylation.The specific alkylation site of DNQ on Keap1 for Nrf2 activation was elucidated with a synthesized probe in conjunction with liquid chromatography-tandem mass spectrometry.DNQ triggered the ubiquitination and subsequent degra-dation of Keap1 by alkylation of the cysteine residue 489(Cys489)on Keap1-Kelch domain,ultimately enabling the activation of Nrf2.Our findings revealed that DNQ exhibited potent anti-inflammatory capacity through α,β-unsaturated amides moieties active group which specifically activated Nrf2 signal pathway via alkylation/ubiquitination of Keap1-Kelch domain,suggesting the potential values of targeting Cys489 on Keap1-Kelch domain by DNQ-like small molecules in inflammatory therapies.

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression(PSD).Methods The clinical data of 179 patients with ischemic stroke were included,and the demographic information,medical history,stroke severity and laboratory indicators at admission were collected.After 6 months of follow-up,all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale(HAMD-17).Patients were divided into the PSD group(48 cases)and the non-PSD group(131 cases).Differences in clinical characteristics were compared between the PSD group and the non-PSD group.CALLY index was calculated from C-reactive protein(CRP),albumin(ALB)and lymphocyte counts.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CALLY index to PSD.Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients.K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD.Results The CALLY index of 179 patients ranged from 0.54 to 1.79,with a median of 1.08.ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09,and the area under ROC curve was 0.757(95%CI:0.687-0.818).Compared with the non-PSD group,the proportion of females was higher in the PSD group,and the proportion of patients with hyperlipidemia was increased with shorter years of education.The serum C-reactive protein(CRP)was higher,and albumin(ALB)and CALLY index were lower(P＜0.05).The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group(CALLY≤1.08)than that in the higher CALLY index group(CALLY＞1.08,33.0%vs.20.5%,Log rank χ2=8.553,P=0.004).Cox regression analysis showed that after adjusting for other covariates,the decreased CALLY index was an independent risk factor for PSD(HR=2.651,95%CI:1.269-5.540,P＜0.05).Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients,which is helpful for early identification and timely intervention to improve the prognosis of patients.