Within the prefrontal-cingulate cortex, abnormalities in coupling between neuronal networks can disturb the emotion-cognition interactions, contributing to the development of mental disorders such as depression. Despite this understanding, the neural circuit mechanisms underlying this phenomenon remain elusive. In this study, we present a biophysical computational model encompassing three crucial regions, including the dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, and ventromedial prefrontal cortex. The objective is to investigate the role of coupling relationships within the prefrontal-cingulate cortex networks in balancing emotions and cognitive processes. The numerical results confirm that coupled weights play a crucial role in the balance of emotional cognitive networks. Furthermore, our model predicts the pathogenic mechanism of depression resulting from abnormalities in the subgenual cortex, and network functionality was restored through intervention in the dorsolateral prefrontal cortex. This study utilizes computational modeling techniques to provide an insight explanation for the diagnosis and treatment of depression.
Prefrontal Cortex/physiology* ; Humans ; Emotions/physiology* ; Cognition/physiology* ; Gyrus Cinguli/physiology* ; Computer Simulation ; Models, Neurological ; Neural Pathways/physiology* ; Nerve Net/physiology*

Objective:To investigate the therapeutic efficacy of autologous hematopoietic stem cell transplantation (auto-HSCT) for treatment of diffuse large B-cell lymphoma (DLBCL) and the factors affecting the prognosis.Methods:A retrospective case series study was conducted. The clinical data of 51 patients with DLBCL who underwent auto-HSCT in the First Affiliated Hospital of Xinjiang Medical University from March 2019 to January 2024 were retrospectively analyzed. Patients were divided into high-risk group (19 cases) and non-high-risk group (low-risk, low-moderate-risk and moderate-high-risk groups, 32 cases) based on different risk stratifications; patients were divided into the germinal center B-cell (GCB) group (29 cases) and non-GCB group (22 cases) based on different cellular origins; patients were divided into BEAM group (39 cases) and BeEAM group (12 cases) based on different conditioning regimens before auto-HSCT; patients were divided into auto-HSCT consolidation therapy group (41 cases) and auto-HSCT after relapsed/refractory group (10 cases) based on different transplantation timings. The Kaplan-Meier method was used for survival analysis and log-rank was used for subgroup comparison.Results:All 51 patients achieved the hematopoietic reconstitution with no transplantation-related death within 100 d. Before auto-HSCT, 39 cases achieved complete remission and 12 cases (23.5%) achieved partial remission. After auto-HSCT, all cases achieved complete remission. Follow-up was until May 31, 2024, and the median follow-up time [ M ( Q1, Q3)] of 51 DLBCL patients was 33 (8, 43) months. After 51 DLBCL patients receiving auto-HSCT, 7 patients relapsed and 6 cases died including 3 cases with relapse-related death and 3 cases with non relapse-related death. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 78.5% (95% CI: 64.4%-92.6%) and 85.5% (95% CI: 73.2%-97.8%), respectively. The 3-year PFS rate was 94.7% (95% CI: 84.7%-104.7%) in the high-risk group, 82.2% (95% CI: 67.9%-96.5%) in the non-high-risk group, and the difference in the PFS was not statistically significant between the high-risk group and the non-high-risk group ( P = 0.158). The 3-year PFS rate was 80.1% (95% CI: 64.4%-95.8%) in the GCB group, 88.1% (95% CI: 72.3%-104.2%) in the non-GCB group, and the difference in PFS was not statistically significant between the 2 groups ( P = 0.803). The 3-year PFS rate was 84.9% (95% CI: 72.6%-97.2%) in BEAM group, 61.1% (95% CI: 25.0%-97.2%) in the BeEAM group, and the difference in PFS was not statistically significant between the 2 groups ( P = 0.106). The 3-year PFS rate was 85.4% (95% CI: 73.4%-97.4%) in the auto-HSCT consolidation therapy group, 64.3% (95% CI: 31.4%-96.4%) in the auto-HSCT after relapsed/refractory group, and the difference in PFS was not statistically significant between the 2 groups ( P = 0.171). Conclusions:auto-HSCT is an effective therapy method for DLBCL.

Objective:To investigate the efficacy and safety of venetoclax and azacitidine combined with GHA (human granulocyte colony stimulating factor, homoharringtonine and low-dose cytarabine) priming regimen in treatment of patients with relapsed/refractory acute myeloid leukemia.Methods:A retrospective case series study was conducted. Twenty-three patients with relapsed/refractory acute myeloid leukemia (non-acute promyelocytic leukemia) who received treatment with the combination of venetoclax and azacitidine with GHA priming regimen at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2020 to July 2024 were selected, and the treatment efficacy, minimal residual disease (MRD)-negative rate in patients with comprehensive complete remission (cCR) (including complete remission, complete remission with partial hematologic recovery and complete remission with incomplete hematologic recovery) and the adverse reactions were analyzed; patients were followed-up, and their overall survival (OS) was analyzed by using Kaplan-Meier method.Results:The median age of the 23 patients was 60 years (range: 21-79 years), including 10 males and 13 females. The cCR rate for 1 course of treatment was 52.2% (12/23), with 4 cases of MRD negative among cCR patients; 5 cases received 2 courses of treatment, with 3 cases achieving cCR, of which 2 cases were MRD negative; 2 cases received 3 courses of treatment, with 1 case achieving complete remission with incomplete hematologic recovery. Six patients underwent allogeneic hematopoietic stem cell transplantation. The patients were followed up until July 31, 2024, and the median follow-up period was 5.3 months (range: 1.1-41.7 months). Ten cases survived, 12 cases died, 1 case was lost to follow-up, and the median OS time of 23 patients was 7.9 months. The 6-month OS rate was 60.2% (95% CI: 42.7%-84.8%), and the 12-month OS rate was 44.6% (95% CI: 26.8%-74.3%). Common adverse reactions during treatment included infection [69.6% (16/23)], nausea [56.5% (13/23)], febrile neutropenia [52.2% (12/23)], bleeding [52.2% (12/23)], vomiting [34.8% (8/23)], and pneumonia [34.8% (8/23)]. Conclusions:The combination of vinaclotide and azacitidine with GHA priming regimen has certain efficacy and good safety in the treatment of relapsed/refractory acute myeloid leukemia.

Multimorbidity management for the elderly is a big challenge for China′s healthcare system and the people centered integrated care (PCIC) is a new concept in health care reform, and the application of the PCIC in multimorbidity management can better improve the health servece for elderly patients. This article applies SWOT analysis to assess the internal strengths and weaknesses as well as external opportunities and threats of applying the PCIC to the geriatric management of multimorbidity; also proposes strategies of geriatric management for elderly patients with Chinese characteristics based on concept of PCIC. The proposed stretegies optimize the personalized assessment with the digital technology, promotes the management with close-knit healthcare system, and strengthen the role of primary medical institutions to improve the long-term management mechanism of multimorbidity.

Objective:To systematically retrieve, analyze and evaluate risk prediction models of postoperative urinary retention, so as to provide a basis for the application and optimization of the model.Methods:The research on the risk prediction model of postoperative urinary retention was electronically retrieved in PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc and other databases. The language of the literature was Chinese or English. The search period was from database establishment to February 20, 2023. Two researchers independently conducted literature screening and data extraction, and independently evaluated the bias risk and applicability of the included literature using the Prediction Model Risk of Bias Assessment Tool.Results:A total of 10 articles were included, including 17 risk prediction models for postoperative urinary retention. The areas under the receiver operating characteristic curve of 17 models were 0.700 to 0.920. The five most common predictors included in the model were age, gender, postoperative analgesia, diabetes, and operation time. The applicability of the model was good among the 10 studies, but there was some bias, mainly due to insufficient sample size, neglect of missing data and processing methods, overfitting issues, conversion of continuous variables into binary variables, and use of single factor screening for predictive factors.Conclusions:The risk prediction model of postoperative urinary retention has good prediction performance, but there is a certain risk of bias. The clinical value of the model needs further verification. External validation and continuous optimization are required for existing prediction models. Prospective research should also be carried out to develop a universal prediction model with good prediction performance, so as to provide an accurate and practical tool for clinical evaluation of postoperative urinary retention.

Obesity is a very common public health problem.It is a chronic metabolic disease of multi-factorial origin with limited treatment options.Weight loss surgery is considered to be the most effective treatment option for obesity,which can reduce the body weight and improve metabolism.About 60％of obese patients have abnormal changes in blood lipid levels,and dyslipidemia is considered to be an independent risk factor for the development of atherosclerosis-related diseases.Weight loss surgery can significantly improve the serum lipid profile of obese patients and reduce the risk of cardiovascular disease,but its specific mecha-nism is still inconclusive.This paper introduces the possible mechanism of lipid metabolism changes from the aspects of the mass change of visceral tissues,adipokine changes,insulin sensitivity improvement,gastrointes-tinal hormones and intestinal flora,bile acid metabolism pathway,vitamins and trace elements.It is expected to further clarify the lipid-lowering mechanism of weight loss surgery in the future and provide a new way for the treatment of dyslipidemia.

Objective To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis(HT)combined with papillary thyroid carcinoma(PTC)using machine learning(ML)models,and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis(LNM).Methods A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM.The groups were subsequently designated the With LNM Group and the Without LNM Group.Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features.Two modes,radiomic features and radiomics-clinical features,were used to construct random forest(RF),support vector machine(SVM),LightGBM,K-nearest neighbor(KNN),and XGBoost models.The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic(ROC)curves on the test dataset,and SHapley Additive exPlanations(SHAP)was used for model visualization.Results All five ML models showed good performance,with area under the ROC curve(AUC)ranging from 0.798 to 0.921.LightGBM and XGBoost demonstrated the best performance,outperforming the other models(P＜0.05).The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features(P＜0.05).The SHAP visualization of the best-performing models indicated that the anteroposterior diameter,superoinferior diameter,original_shape_VoxelVolume,age,wavelet-LHL_firstorder_10Percentile,and left-to-right diameter had the most significant effect on the LightGBM model.On the other hand,the superoinferior diameter,anteroposterior diameter,left-to-right diameter,original_shape_VoxelVolume,original_firstorder_InterquartileRange,and age had the most significant effect on the XGBoost model.Conclusion ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC.Among the 5 ML models,LightGBM and XGBoost demonstrate the best evaluation performance.

Objective To investigate the awareness, implementation, and application of the Radiation Shielding Specification for Radiotherapy Room, Part 3: Radiotherapy Room of γ-Ray Sources (GBZ/T201.3—2014) by medical institution personnel, to collect problems and recommendations, and to provide a scientific basis for further amendments and implementation of the standard. Methods A questionnaire survey about the awareness, training and application situation and the modification advices of the standard was conducted among practitioners engaged in the production, use, and machine room design related to γ-ray source radiotherapy equipment (collectively referred to as medical institution personnel) in 12 provinces and direct-administered municipalities in China. The questionnaires were collected and a special Excel database was set up for statistical analysis using SPSS 22.0. Results A total of 126 practitioners responded and completed the questionnaire. Approximately 75.4% of respondents indicated that they either “understood” or “understood well” the standard; 42.86% received relevant training; 45.24% and 54.76% indicated that the standard “met” or “basically met” the requirements of detection of γ-ray radiotherapy equipment shielding or design of shielding room. The standard was highly evaluated for suitability. However, the awareness of the standard was inadequate, the rate of training participation was low, and its practical application was limited. Conclusion The standard generally aligns with the requirements for shielding room design in γ-ray radiotherapy. Some revisions should be done according to the current situation of γ-ray radiotherapy.

Objective:To evaluate the role of Toll-like receptor 4 (TLR4)/nuclear transcription factor κB (NF-κB) signaling pathway in long-term cognitive impairment induced by multiple exposures to sevoflurane anesthesia in neonatal rats.Methods:Seventy-five SPF healthy newborn Sprague-Dawley rats of either sex, aged 6 days, weighing 12-20 g, were divided into 3 groups ( n=25 each) using a random number table method: control group (group C), multiple exposures to sevoflurane anesthesia group (group S) and TLR4 inhibitor plus multiple exposures to sevoflurane anesthesia group (group I+ S). The rats in group S and group I inhaled 3% sevoflurane for 2 h at 6, 7 and 8 days after birth. TLR4 inhibitor TAK-242 10 mg/kg was intraperitoneally injected before each exposure to sevoflurane in group I, and the equal volume of normal saline was given instead in the other two groups. The spontaneous activity was evaluated by open field test on day 29 after birth, and the cognitive function was assessed by Morris water maze test on days 30-34 after birth. After the behavioral test, the blood samples from the abdominal aorta were collected, and then the rats were sacrificed under deep anesthesia to isolate the hippocampal tissues for measurement of the levels of S100β and neuron-specific enolase (NSE) in serum and hippocampal interleukin-1β (IL-1β), IL-6 and tumor necrosis factor α (TNF-α) (by enzyme-linked immunosorbent assay), expression of TLR4, NF-κB p65 and phosphorylated NF-κB p65 (p-NF-κB p65) (by Western blot) and for microscopic examination of the pathological changes of hippocampal CA1 region after HE staining. Results:Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the TLR4 expression was up-regulated, the ratio of p-NF-κB p65/NF-κB p65 was increased, the levels of serum S100β protein and NSE and hippocampal IL-1β, IL-6 and TNF-α were increased ( P<0.05), and the pathological changes in the hippocampal CA1 region were aggravated in group S. Compared with group S, the escape latency was significantly shortened, the number of crossing the original platform was increased, TLR4 expression was down-regulated, the ratio of p-NF-κB p65/NF-κB p65 was decreased, the levels of S100β and NSE in serum and hippocampal IL-1β, IL-6 and TNF-α were decreased ( P<0.05), and the pathological changes in hippocampal CA1 area were significantly attenuated in group P. Conclusions:The mechanism by which multiple exposures to sevoflurane anesthesia induces long-term cognitive impairment is related to activation of TLR4/NF-κB signaling pathway and increase in hippocampal inflammatory responses in neonatal rats.

Objective:To evaluate the role of nuclear factor E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway in edaravone-induced attenuation of long-term cognitive impairment caused by long-time sedation with propofol in the neonatal rats.Methods:Eighty SPF healthy newborn Sprague-Dawley rats of both sexes, aged 7 days, weighing 15-20 g, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), propofol group (group P), edaravone+ propofol group (group EP) and Nrf2 inhibitor ML385+ edaravone+ propofol group (group MEP). Propofol 75 mg/kg was intraperitoneally injected once a day for 7 consecutive days in P group, EP group and MEP group, respectively, while the equal volume of medium/long chain fat emulsion injection was intraperitoneally injected in C group. Edaravone 3 mg/kg was intraperitoneally injected at 30 min before each propofol injection in EP and MEP groups, and ML385 15 mg/kg was intraperitoneally injected simultaneously in group MEP. The spontaneous activity was evaluated by the open field test on day 29 after birth, and the cognitive function was assessed by Morris water maze test on days 30-34 after birth. The rats were sacrificed after the end of water maze test, and brains were removed and hippocampal tissues were obtained for determination of reactive oxygen species (ROS) levels (by flow cytometry), superoxide dismutase (SOD) and malondialdehyde (MDA) levels (by enzyme-linked immunosorbent assay) and expression of Nrf2 and HO-1 (by Western blot) and for microscopic examination of the pathological changes in the hippocampal CA1 area (using HE staining). Results:There was no significant difference in the speed, distance and time of stay at the center of the open field among the four groups ( P>0.05). Compared with C group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, the levels of MDA and ROS were increased, the activity of SOD was decreased, the expression of Nrf2 and HO-1 was down-regulated ( P<0.05), and the pathological injury was observed in the hippocampal CA1 region in group P. Compared with P group, the escape latency was significantly shortened, the number of crossing the original platform quadrant was increased, the levels of MDA and ROS in the hippocampus were decreased, the activity of SOD was increased, the expression of Nrf2 and HO-1 was up-regulated ( P<0.05), and the pathological injury in the hippocampal CA1 region was significantly alleviated in EP group. Compared with EP group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, the levels of MDA and ROS were increased, the activity of SOD was decreased, the expression of Nrf2 and HO-1 was down-regulated ( P<0.05), and the pathological injury was aggravated in the hippocampal CA1 region in MEP group. Conclusions:The mechanism by which edaravone attenuates long-term cognitive impairment caused by long-time sedation with propofol is related to activation of Nrf2/HO-1 signaling pathway and inhibition of oxidative stress in the neonatal rats.