Depression is a common psychiatric disorder characterized by persistent low mood or mental disorders. Current treatments primarily focus on regulating neurotransmitter levels， but their effectiveness is limited. The mechanisms underlying its onset are complex， and there is no unified consensus. Abnormal signaling pathway transmission plays a crucial role in the development of depression， involving multiple pathways， including Toll-like receptor 4/nucleotide-binding oligomerization domain-like receptor protein 3 （TLR4/NLRP3）， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， mitogen-activated protein kinase/extracellular signal-regulated kinase （MAPK/ERK）， brain-derived neurotrophic factor/tyrosine kinase receptor B （BDNF/TrkB）， cyclic AMP/protein kinase A/cAMP response element-binding protein （cAMP/PKA/CREB）， and others. Traditional Chinese medicine（TCM） is based on a holistic approach and the principle of treatment based on the differentiation of syndromes， regulating the balance of multiple systems and organ functions from a macroscopic perspective. This approach has shown unique advantages in the treatment of depression. TCM attributes the onset of depression to dysfunction of the organ systems， involving liver Qi stagnation， heart spirit deficiency， kidney essence depletion， and spleen dysfunction. TCM compound treatments focus on soothing the liver， strengthening the spleen， calming the heart， and replenishing essence， with formulas such as Xiaoyaosan， Zishui Qinggan Yin， and Chahu Jia Guizhi Longgu Muli Tang. The active components of Chinese herbs mainly aim to tonify and regulate Qi， such as salidroside， ginsenoside Rb₁， astragaloside， and muscone. External TCM treatments， primarily acupuncture， aim to open the orifices and invigorate the spirit. Acupoints such as Baihui， Shenting， and Yintang are commonly used. Additionally， massage and moxibustion therapy can intervene in depression by regulating signaling pathways. This article reviews the core role of signaling pathways in the development of depression and the mechanism of TCM regulation of signaling pathways to intervene in depression， aiming to discover new therapeutic approaches that can improve the symptoms of depressed patients.

BACKGROUND:One-hole split endoscope technique has been widely used in the treatment of lumbar degenerative diseases,but there is no relevant literature on the safety analysis of this technique in the treatment of upper lumbar disc herniation. OBJECTIVE:To observe the position relationship of nerve roots,intervertebral space and bone landmarks in the upper lumbar spine by three-dimensional lumbar CT reconstruction technology,and to provide a basis for the clinical operation of one-hole split endoscope surgery. METHODS:Twenty-six patients with upper lumbar disc herniation underwent a lumbar CT scan.Mimics 17.0 software was imported to measure the related imaging parameters of L1/2 to L3/4 segments:(1)Measurement of vertical distance:In coronal view,the distance(a)from the intersection point of the medial facet of the superior articular process and the superior endplate(N)to the apex of the articular process(S);in the coronal view,the distance(b)from the sagittal intersection(M)of N and the inferior endplate to the apex of the inferior articular process(X).(2)Measured horizontal distance:the distance(c)between the cross-section of N and the lower edge of the outlet nerve root(N2);distance(d)between the cross-section of N and the intersection point of neural tissue(N1);N1 to N2 distance(e);distance(f)between the cross-section of M and the lateral edge of the nerve tissue(M1);M to M cross-section and exit nerve root intersection(M2)distance(g);distance(h)from M1 to M2;distance(i)from M2 to N1;distance(j)from the posterior edge of the articular surface(R)to M2 in sagittal view of the superior articular process. RESULTS AND CONCLUSION:(1)With the decrease of the segment,the distances a and b gradually increased,and the distance j gradually decreased.There was no significant difference between L1/2 and L2/3 segments(P>0.05).(2)With the decrease of the segment,distance d first decreased and then increased;distance f gradually decreased;distances c,e,g,h and i gradually increased;and there was no significant difference between L2/3 and L3/4 segments(P>0.05).(3)Distance i was the shortest distance without pulling nerve roots in the natural state,and the area of the safety zone was between four points M1,M2,N1,and N2.The bone was removed to the upper and lower endplates by biting the bone downward and upward through S and X,respectively,to expose the intervertebral space,and the window of distance g to M2 could be opened outward to avoid injury of the outlet nerve roots.(4)In conclusion,the upper lumbar vertebrae have unique anatomical characteristics.Based on the relevant measurements of nerve roots,spinal dura and intervertebral space,the parameters of the one-hole split endoscope technique are more accurate and safe during operation.

As a common clinical disease, fracture is often accompanied by pain, swelling, bleeding as well as other symptoms and has a high disability rate, even threatening life, seriously endangering patients' physical and psychological health and quality of life. Medical practitioners take many strategies for the treatment of fracture healing, including Traditional Chinese Medicine (TCM). In the early stage of fracture healing, the local fracture is often in a state of hypoxia, accompanied by the expression of hypoxia inducible factor-1α (HIF-1α), which is beneficial to wound healing. Through literature mining, we thought that hypoxia, HIF-1α and downstream factors affected the mechanism of fracture healing, as well as dominated this process. Therefore, we reviewed the local characteristics and related signaling pathways involved in the fracture healing process and summarized the intervention of TCM on these mechanisms, in order to inspirit the new strategy for fracture healing, as well as elaborate on the possible principles of TCM in treating fractures based on the HIF molecular mechanism.

Objective To investigate the effects patterned structure located on the surface of mechanical valve leaflet exerted on the hydrodynamic properties of valve prostheses.Methods Bileaflet aortic mechanical valves of GKS 21A and 23 A were randomly selected as the control group,hydrodynamic performance of each valve were assessed,as per ISO5840 by calculating mean transvalvular pressure(MTP),regurgitation fraction(REG),effective orifice area(EOA)and effective orifice area(eLoss).Then,laser etching was applied to construct a parallel-groove array pattern on leaflet surface perpendicular to the direction of the blood flow.The valve was subjected a-gain to the same test,and the data obtained were recorded and analyzed.Results In the pulsating flow test,the MTP of the experimental group was smaller than that of the control group at the same flow rate and size.The RE in GKS 21A experimental group was smaller than that in control group,and the RE in GKS 23A experimental group was larger than that in control group.The EOA in the experimental group was larger than that in the control group at the same flow rate and size.The eLoss in the GKS 21A experimental group was smaller than that in the control group,and the eLoss in the GKS 23A experimental group was larger than that in the control group.Conclusion The parallel-groove array pattern on the surface of the leaflet affected the hemodynamic performance of the valve prostheses.

Background::Lymph node staging of prostate cancer (PCa) is important for planning and monitoring of treatment. 18F-prostate specific membrane antigen positron emission tomography/computerized tomography ( 18F-PSMA PET/CT) has several advantages over 68Ga-PSMA PET/CT, but its diagnostic value requires further investigation. This meta-analysis focused on establishing the diagnostic utility of 18F-PSMA PET/CT for lymph node staging in medium/high-risk PCa. Methods::We searched the EMBASE, PubMed, Cochrane library, and Web of Science databases from inception to October 1, 2022. Prostate cancer, 18F, lymph node, PSMA, and PET/CT were used as search terms and the language was limited to English. We additionally performed a manual search using the reference lists of key articles. Patients and study characteristics were extracted and the QUADAS-2 tool was employed to evaluate the quality of included studies. Sensitivity, specificity, the positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence interval (CI) were used to evaluate the diagnostic value of 18F-PSMA PET/CT. Stata 17 software was employed for calculation and statistical analyses. Results::A total of eight diagnostic tests including 734 individual samples and 6346 lymph nodes were included in this meta-analysis. At the patient level, the results of each consolidated summary were as follows: sensitivity of 0.57 (95% CI 0.39-0.73), specificity of 0.95 (95% CI 0.92-0.97), PLR of 11.2 (95% CI 6.6-19.0), NLR of 0.46 (95% CI 0.31-0.68), DOR of 25 (95% CI 11-54), and AUC of 0.94 (95% CI 0.92-0.96). At the lesion level, the results of each consolidated summary were as follows: sensitivity of 0.40 (95% CI 0.21-0.62), specificity of 0.99 (95% CI 0.95-1.00), PLR of 40.0 (95% CI 9.1-176.3), NLR of 0.61 (95% CI 0.42-0.87), DOR of 66 (95% CI 14-311), and AUC of 0.86 (95% CI 0.83-0.89).Conclusions::18F-PSMA PET/CT showed moderate sensitivity but high specificity in lymph node staging of medium/high-risk PCa. The diagnostic efficacy was almost equivalent to that reported for 68Ga-PSMA PET/CT. Registration::International Prospective Register of Systematic Reviews (PROSPERO), No. CRD42023391101.

Objective:To evaluate the effect of prior statins use on the in-hospital mortality of adult sepsis patients with type 2 diabetes (T2DM).Methods:A total of 3 545 sepsis patients with T2DM were retrospectively collected from the Critical Care Medical Information Market (MIMIC Ⅳ) database, with in-hospital mortality rate as the outcome variable. According to whether they have taken statins in the past, they were divided into two groups and propensity score matching was used. Multivariate Cox regression analysis was performed to calculate the adjusted hazard ratio ( HR) and 95% CI, and the relationship between past statins use and in-hospital mortality in sepsis patients with T2DM was analyzed. Results:A total of 3 545 sepsis patients with T2DM were included between 2008 and 2016. 1 556 patients used statins before admission, and 1 989 patients did not use statins. After propensity score matching, the number of patients who had previously used statins and those who had not used statins were 1 230 and 1 298, respectively. After adjusting for potential confounding factors, it was found that previous use of statins was associated with a reduced in-hospital mortality rate ( HR=0.82, 95% CI: 0.61-0.99, P=0.038). Kaplan Meier curves showed that sepsis patients with T2DM who used statins before admission had a lower in-hospital mortality rate (Log rank test: P<0.001). Conclusions:Pre admission use of statins may be associated with a reduced mortality rate in sepsis patients with concomitant T2DM.

Gliomas are the most common central nervous system tumours; they are highly aggressive and have a poor prognosis. RGS16 belongs to the regulator of G-protein signalling (RGS) protein family, which plays an important role in promoting various cancers, such as breast cancer, pancreatic cancer, and colorectal cancer. Moreover, previous studies confirmed that let-7c-5p, a well-known microRNA, can act as a tumour suppressor to regulate the progression of various tumours by inhibiting the expression of its target genes. However, whether RGS16 can promote the progression of glioma and whether it is regulated by miR let-7c-5p are still unknown. Here, we confirmed that RGS16 is upregulated in glioma tissues and that high expression of RGS16 is associated with poor survival. Ectopic deletion of RGS16 significantly suppressed glioma cell proliferation and migration both in vitro and in vivo. Moreover, RGS16 was validated as a direct target gene of miR let-7c-5p. The overexpression of miR let-7c-5p obviously downregulated the expression of RGS16, and knocking down miR let-7c-5p had the opposite effect. Thus, we suggest that the suppression of RGS16 by miR let-7c-5p can promote glioma progression and may serve as a potential prognostic biomarker and therapeutic target in glioma.
Humans ; Phosphatidylinositol 3-Kinases/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; MicroRNAs/metabolism* ; Glioma/genetics* ; Genes, Tumor Suppressor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Cell Line, Tumor

Objective:To investigate the practicality and safety of performing a radical prostatectomy(RP)shortly after the diagnosis of prostate cancer using a combination of prostate targeted biopsy and intraoperative frozen section.Methods:Prospective enrollment was conducted for patients suspected of having prostate cancer based on abnormal prostate specific antigen(PSA)levels.The inclusion criteria for the study were as follows: patients aged 80 years or younger with an ECOG score of 1 or lower.Prior to biopsy, patients underwent both prostate magnetic resonance imaging(MRI)and prostate specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)to determine the likelihood of prostate cancer with clinical stages within T 2-3aN 0M 0.In order to be included in the study, patients must agree to receive RP after their prostate cancer diagnosis has been confirmed by biopsy.All enrolled patients underwent a targeted prostate biopsy, consisting of 1-2 cores.These specimens were then examined through frozen section analysis.For patients diagnosed with prostate cancer through intraoperative frozen section pathology, RP was immediately performed.In this study, transperineal prostate targeted+ systematic biopsy was utilized for patients with undiagnosed prostate cancer.Additionally, routine pathological examination of specimens was conducted.The study analyzed the baseline data, surgical conditions, pathological results, and follow-up information of patients in a descriptive manner. Results:Seven patients, ranging in age from 54 to 77 years with a mean age of 66.7 years, were enrolled in the study.Their mean PSA level was 12.668 μg/L, ranging from 4.359 to 22.195 μg/L.Of these patients, 4 had a PI-RADS score of 4 and 3 had a score of 5.The maximum diameter of the index lesion was 1.3 cm, ranging from 0.5 to 2.2 cm.PSMA PET/CT scores were 4 in 1 case and 5 in 6 cases.The index lesions detected by PSMA PET/CT were consistent with those detected by MRI, and the maximum standardized uptake value(SUVmax)was 15.7, ranging from 5.3 to 39.4.Prostate cancer was diagnosed through targeted biopsy and intraoperative frozen section pathology.Four cases had a Gleason score of 3+ 3=6, while one case had a Gleason score of 3+ 4=7, another had a score of 4+ 3=7, and the last had a score of 4+ 4=8.All patients underwent RP treatment immediately after the prostate cancer diagnosis.Only one patient had slight adhesion at the apex of the prostate, while the other six patients were evaluated by surgeons as having no obvious adhesion at the apex.All surgeries were completed successfully, with a mean operation time of 149.7(ranging from 108 to 255)minutes.After RP, whole mount pathology results indicated that all cases were prostate adenocarcinoma, with a Gleason score of 3+ 4=7 in four cases and 4+ 3=7 in three cases.The pathological stages were pT2 in three cases and pT3a in four cases, with five cases having negative surgical margins and two cases with positive surgical margins.During the study, all patients were monitored for a period of 5.4 months(ranging from 3 to 7 months)and no complications of Clavien Dino≥Ⅰ were observed.PSA levels were measured at 6 weeks and 3 months after surgery, with readings of 0.020 μg/L(ranging from 0 to 0.079 μg/L)and 0.016 μg/L(ranging from 0 to 0.087 μg/L), respectively.No hormonal therapy or radiotherapy was administered during this time.Four patients were able to recover from urinary continence.Conclusions:Based on a combination of MRI and PSMA PET/CT, it is both safe and feasible to promptly perform RP following the diagnosis of prostate cancer through targeted biopsy for index lesions, along with intraoperative frozen section.

Objective:To analyze the risk factors and prognosis of endoleak after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.Methods:The clinical data of patients with infrarenal abdominal aortic aneurysms treated by endovascular repair at the Department of Vascular Surgery,the First Affiliated Hospital of Guangxi Medical University from Jun 2012 to Nov 2021 were retrospectively analyzed.Results:During the first follow-up CTA after surgery,136 out of 299 patients had endoleak.A total of 186 patients had at least one CTA reexamination after discharge. Statistical analysis showed that excessive neck angulation was an independent risk factor for type Ⅰa endoleak ( t=-6.108, P<0.001), wider common iliac artery diameter (left Z=-2.787, P=0.005, Right Z=-2.381, P=0.017) and iliac aneurysm ( χ2=6.398, P=0.011) were risk factors for type Ⅰb endoleak. The survival time of patients in endoleak group was similar to no endoleak group. Conclusions:Excessive neck angulation is an independent risk factor for type Ⅰa endoleak. Most leaks resolve spontaneously ,the prognosis is fair.

Objective:To investigate the safety and efficacy of MR-guided focused ultrasound surgery (MRgFUS) in treating localized prostate cancer.Methods:Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study. The patients were all over 18 years old, with an average age of (68±10) years, and had not received any prior treatment for prostate cancer. Pretreatment pelvic MR and CT scans were performed to determine the region of treatment (ROT). Different urinary catheterization measures were given based on the location of the lesion. Under general anesthesia, the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed. The patients were followed up at 1, 3, and 6 months after treatment and annually thereafter. During follow-up, prostate-specific antigen (PSA) levels, pelvic MR scans, International Prostate Symptom Score (IPSS), International Index of Erectile Function-15 (IIEF-15) scores, and adverse events were assessed.Results:(1) All six patients underwent MRgFUS treatment for six lesions, with an average duration of (126±56) minutes, an average number of (7.3±3.2) focal ultrasound pulses per lesion, and an average non-perfusion volume of (3.8±1.1) cm 3, which covered the entire treatment target area. No treatment-related adverse events were reported. (2) The PSA levels at baseline, 1, 3, 6, and 12 months after treatment were (6.6±0.8), (3.6±1.3), (3.4±3.0), (2.5±1.7), and (2.3±1.8) ng/ml, respectively. PSA levels increased in 2 out of 6 patients during follow-up, and pelvic MR scan revealed recurrent lesions, while PSA levels continued to decrease in the remaining 4 patients, and pelvic MR scan were normal. (3) The IPSS scores at baseline, 1, and 3 months after treatment were 13.0 (4.0, 16.0), 10.0 (4.0, 12.0), and 5.0 (3.0, 6.0) points, respectively. For the three sexually active patients, the IIEF-15 scores at baseline were 40, 51, and 14 points, respectively, and IIEF-15 at 1 month after treatment were 9, 8, and 14 points, respectively, and at 3 months after treatment were 9, 66 and 26 points, respectively. (4) One patient was diagnosed with recurrence 10 months after treatment, and another patient was found to have a new lesion 6 months after treatment. Conclusions:MRgFUS might be a safe, non-invasive, and effective treatment for localized prostate cancer, but regular follow-up is vital for detecting tumor recurrence.