Objective:To analyze the anatomical characteristics and surgical management measures of acute Stanford type A aortic dissection (AAD) involving coronary arteries, and to preliminarily explore the clinical efficacy of different coronary artery treatment techniques.Methods:A retrospective analysis was conducted on the clinical data of 42 patients who underwent surgery for AAD involving coronary arteries in Hunan Provincial People′s Hospital from January 2022 to May 2025. They were divided into the MI group (14 cases) and the nMI group (28 cases) according to whether they had acute myocardial infarction before surgery. The clinical data such as the actual surgical methods and mortality in the two groups were summarized.Results:Among 294 surgeries, 42 cases (14.3%) had definite coronary artery involvement, including 14 cases in the MI group and 28 cases in the nMI group; 1 case had bilateral coronary artery involvement and 41 cases had right coronary artery involvement. Regarding injury types: 16 cases were of the coronary trunk compression type, 12 cases were of the sinus intimal tear neal to ostium type, and 14 cases were of the coronary trunk intimal type. There was no statistically significant difference in the types of coronary artery involvement between the two groups ( P>0.05). There were 18 cases of Sun′s procedure with preserved aortic sinus and aortic valve, 7 cases of Bentall procedure without bypass, and 17 cases of Bentall procedure plus bypass. There was no statistically significant difference in the surgical plans between the two groups ( P>0.05). There were 4 deaths within 30 days (2 cases in each group). Conclusions:AAD involving coronary arteries is a critical condition, and accurate diagnosis is somewhat difficult. Myocardial ischemia is not significantly associated with the type of coronary artery involvement. The surgical plan depends on the type of coronary artery involvement. The classification method in this study is conducive to selecting appropriate surgical methods and improving surgical prognosis.

Objective To investigate the mediating effect of psychological flexibility on the relationship between pain self-efficacy and kinesiophobia in patients with lumbar disc herniation(LDH),so as to provide references for relief from kinesiophobia of the patients.Methods Convenience sampling was used to select 256 patients with LDH as the research subjects from the Outpatient Department of Spinal Orthopaedics of a Grade IIIA hospital in Guangdong Province between May and December 2023.The subjects were surveyed with a general information questionnaire,the kinesiophobia assessment scale,psychological flexibility inventory for pain patients,and chronic pain self-efficacy scale.The mediation effect of psychological flexibility on pain self-efficacy and kinesiophobia was analysed using SPSS 26.0 and the PROCESS 3.5 macro.Results The scores for kinesiophobia,psychological flexibility and pain self-efficacy among the LDH patients were 31.66±4.73,55.26±11.06 and 68.14±17.48,respectively.Kinesiophobia was positively correlated with the psychological flexibility(r=0.545,P<0.001)and negatively correlated with the pain self-efficacy(r=-0.599,P<0.001).The psychological flexibility was negatively correlated with the pain self-efficacy(r=-0.510,P<0.001).Psychological flexibility partially mediated the relationship between pain self-efficacy and kinesiophobia,with a mediating effect of-0.045,accounting for 27.78%of the total effect.Conclusion The patients who have LDH and under conservative treatment exhibit a high level of kinesiophobia and with a moderate levels of pain self-efficacy and psychological flexibility.The medical staff can improve the self-efficacy and psychological flexibility of patients,so as to reduce kinesiophobia level and its incidence.

Objective To investigate the mediating effect of psychological flexibility on the relationship between pain self-efficacy and kinesiophobia in patients with lumbar disc herniation(LDH),so as to provide references for relief from kinesiophobia of the patients.Methods Convenience sampling was used to select 256 patients with LDH as the research subjects from the Outpatient Department of Spinal Orthopaedics of a Grade IIIA hospital in Guangdong Province between May and December 2023.The subjects were surveyed with a general information questionnaire,the kinesiophobia assessment scale,psychological flexibility inventory for pain patients,and chronic pain self-efficacy scale.The mediation effect of psychological flexibility on pain self-efficacy and kinesiophobia was analysed using SPSS 26.0 and the PROCESS 3.5 macro.Results The scores for kinesiophobia,psychological flexibility and pain self-efficacy among the LDH patients were 31.66±4.73,55.26±11.06 and 68.14±17.48,respectively.Kinesiophobia was positively correlated with the psychological flexibility(r=0.545,P<0.001)and negatively correlated with the pain self-efficacy(r=-0.599,P<0.001).The psychological flexibility was negatively correlated with the pain self-efficacy(r=-0.510,P<0.001).Psychological flexibility partially mediated the relationship between pain self-efficacy and kinesiophobia,with a mediating effect of-0.045,accounting for 27.78%of the total effect.Conclusion The patients who have LDH and under conservative treatment exhibit a high level of kinesiophobia and with a moderate levels of pain self-efficacy and psychological flexibility.The medical staff can improve the self-efficacy and psychological flexibility of patients,so as to reduce kinesiophobia level and its incidence.

Objective:To analyze the anatomical characteristics and surgical management measures of acute Stanford type A aortic dissection (AAD) involving coronary arteries, and to preliminarily explore the clinical efficacy of different coronary artery treatment techniques.Methods:A retrospective analysis was conducted on the clinical data of 42 patients who underwent surgery for AAD involving coronary arteries in Hunan Provincial People′s Hospital from January 2022 to May 2025. They were divided into the MI group (14 cases) and the nMI group (28 cases) according to whether they had acute myocardial infarction before surgery. The clinical data such as the actual surgical methods and mortality in the two groups were summarized.Results:Among 294 surgeries, 42 cases (14.3%) had definite coronary artery involvement, including 14 cases in the MI group and 28 cases in the nMI group; 1 case had bilateral coronary artery involvement and 41 cases had right coronary artery involvement. Regarding injury types: 16 cases were of the coronary trunk compression type, 12 cases were of the sinus intimal tear neal to ostium type, and 14 cases were of the coronary trunk intimal type. There was no statistically significant difference in the types of coronary artery involvement between the two groups ( P>0.05). There were 18 cases of Sun′s procedure with preserved aortic sinus and aortic valve, 7 cases of Bentall procedure without bypass, and 17 cases of Bentall procedure plus bypass. There was no statistically significant difference in the surgical plans between the two groups ( P>0.05). There were 4 deaths within 30 days (2 cases in each group). Conclusions:AAD involving coronary arteries is a critical condition, and accurate diagnosis is somewhat difficult. Myocardial ischemia is not significantly associated with the type of coronary artery involvement. The surgical plan depends on the type of coronary artery involvement. The classification method in this study is conducive to selecting appropriate surgical methods and improving surgical prognosis.

Objective To investigate the effects of exosomes derived from hypoxia-treated mesenchymal stem cells on chondrocyte injury.Methods After mesenchymal stem cells were subjected to hypoxic treatment,the secreted exosomes were collected and co-cultured with IL-1β-stimulated chondrocytes.Cell viability was assessed using the CCK-8 assay,while apoptosis was evaluated by flow cytometry and the measurement of Caspase-3 and PARP activities.Intracellular levels of ROS,Fe2+,and MDA were quantified using commercial assay kits.The expression of GPX4,SLC7A11,and ACSL4 was analyzed at both mRNA and protein levels via qRT-PCR and Western blot,respectively.Additionally,the secretion of COL2A1,MMP13,ADAMTS5,TNF-α,IL-6,and PGE2 was determined by ELISA.Results Chondrocyte viability was significantly enhanced following the uptake of exosomes derived from hypoxia-treated mesenchymal stem cells(H-Exo)(P<0.05).IL-1β treatment reduced chondrocyte viability,increased Caspase-3 and PARP activities,and promoted apoptosis(P<0.05);however,H-Exo effectively reversed IL-1 β-induced apoptotic effects.Furthermore,IL-1 β markedly down-regulated the expression of GPX4 and SLC7A11,up-regulated ACSL4 expression,and elevated intracellular levels of ROS,Fe2+,and MDA(P<0.05),indicating the induction of ferroptosis.Both the ferroptosis inhibitor and H-Exo significantly attenuated IL-1β-triggered ferroptosis,and H-Exo counteracted the detrimental effects of IL-1β as well as those induced by a ferroptosis inducer.Additionally,IL-1β suppressed the expression of the chondrogenic marker COL2A1,up-regulated the catabolic enzymes MMP13 and ADAMTS5,and enhanced the secretion of pro-inflammatory cyto-kines TNF-α,IL-6,and PGE2(P<0.05).Notably,H-Exo alleviated IL-1β-mediated inflammation and restored the balance between chondrogenic anabolism and catabolism.Conclusions Exosomes secreted by mesenchymal stem cells under hypoxic conditions can effectively inhibit chondrocyte apoptosis and ferroptosis,thereby alleviating cellular injury.These findings suggest that such exosomes exert a protective effect on chondrocytes and hold prom-ise as a novel therapeutic strategy for cartilage repair.

Objective This study aims to use subjective and objective evaluation indicators to accurately calculate the relative weights of various factors that affect blood glucose control in gestational diabetes and provide scientific basis for the formu-lation of clinical nutrition intervention plans and support for the evaluation of blood sugar intervention effects in the late stage of pregnancy.Methods The fuzzy analytic hierarchy process(FAHP)was used to construct a hierarchical model of nutrition man-agement for patients with gestational diabetes,calculate the weights of each criterion layer in detail,and integrate them with the weight adjustment coefficients of scoring experts to form a mathematical model for nutrition management of gestational diabetes.Results Based on 14 valid expert feedback questionnaires,the relative weights of the first,second,and 29 end indicators were calculated.The weights of the first indicators were nutrition assessment indicators for gestational diabetes(0.34142105),formu-lation of nutrition management plans for gestational diabetes(0.331055183),and implementation of nutrition management plans(0.327923333).The largest weights in the second indicators were laboratory indicators(0.110385024)and meal plans(0.117342182).Conclusion The fuzzy analytic hierarchy process can accurately estimate the relative weights of factors affect-ing personalized nutrition management in gestational diabetes,providing a theoretical basis for blood sugar management during the entire pregnancy.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Interleukin-17 (IL-17) and its receptor family members are involved in a variety of pathophysiological processes.Studies have shown that the IL-17 family may be closely related to the occurrence and development of interstitial cystitis/ bladder pain syndrome (IC/BPS).This paper explores the relationship between the IL-17 family and IC/BPS, introduces the members and structures of the IL-17 family, their value in inflammatory diseases, and discusses in depth the IL-17 pathways in IC/BPS and the latest research progress.Research has found that the IL-17 family is upregulated in IC/BPS, related to the exacerbation of pathological inflammatory reactions, and responsible for maintaining the chronic inflammatory state of IC/BPS patients.In addition, IL-17 is also associated with neuroinflammation, pain, and other biological effects in IC/BPS.This review aims to deepen the understanding of the mechanisms underlying IC/BPS and to provide references for the development of new therapeutic strategies.

By consulting relevant literature of ancient herbal books and processing specifications， this paper made a systematic research and analysis of Ostreae Concha， including the name， producing area， harvesting， quality， historical evolution of processing， relevant processing specifications， modern processing technology， and changes in chemical composition and pharmacological effects before and after processing， in order to provide documentary evidence for the research on processing technology and the establishment of quality standards. According to the textual research， it is known that Ostreae Concha has a long history of being used in medicine， and there have been many aliases and local names in each historical period. Shennong's Classic of the Materia Medica（Shennong Bencaojing） began to use Muli as the correct name， which has continued to use to today， and there were also aliases such as Muge， Zuogu Muli and Haoke. Ostreae Concha has a wide range of localities and irregular harvesting periods. The ancients believed that its left shell was of superior quality， but this has not been seen in modern. And there were many kinds of processing methods of Ostreae Concha， such as grinding， roasting， calcining， frying， simmering， quenching and so on， and the calcining was still in use. The different editions of Chinese Pharmacopoeia from 1963 to 2020 contain only calcined Ostreae Concha， and the local processing specifications mainly include three kinds of processed products（calcined products， salt-soaked products and vinegar-soaked products）. Modern processing research mainly focuses on process optimization， changes in chemical composition and pharmacological effects， and the research methods are relatively single. Overall， there are currently issues such as inconsistent processing standards， unclear process parameters and imperfect quality standards， which are not conducive to the quality control and standardized clinical use of Ostreae Concha. Therefore， it is necessary to further investigate the pharmacological substance basis of Ostreae Concha and its processed products in order to elucidate the processing mechanism， standardize the processing technology and improve the quality standard.

ObjectiveTo analyze the differences in color， odor and volatile components of Citri Reticulatae Pericarpium（CRP） before and after being stir-fried with Halloysitum Rubrum， and to explore the material basis of enhancing the effect of strengthening spleen after processing and the scientific connotation of decoction pieces processed with Halloysitum Rubrum as the auxiliary material. MethodsThe volatile components of the samples before and after processing were identified and relatively quantified by headspace gas chromatography-mass spectrometry（HS-GC-MS）， and the volatile components were analyzed by principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）. According to the principle of variable importance in the projection（VIP） value>1.5， volatile differential components before and after processing were screened. And combined with intelligent sensory technologies such as colorimeter and electronic nose， the chroma and odor information of CRP before and after being stir-fried with Halloysitum Rubrum were identified. Pearson correlation analysis was used to explore the correlation between volatile differential components and chroma values. ResultsA total of 112 volatile components were identified from CRP and CRP stir-fried with Halloysitum Rubrum， of which 84 were from CRP and 97 were from CRP stir-fried with Halloysitum Rubrum. And 7 differential components were selected， including α-pinene， β-myrcene， linalool， sabinene， ocimene isomer mixture， A-ocimene， and δ-elemene. After being processed with Halloysitum Rubrum， the brightness value（L^*）， yellow-blue value（b^*） and total chromatic value（E^*_ab） of CRP were decreased（P<0.01）， and red-green value（a^*） was increased（P<0.01）， the response values of S4， S5， S10 and S13 sensors were significantly increased（P<0.05）， and the response values of S3 and S8 sensors were significantly decreased（P<0.05）. Correlation analysis showed that α-pinene and β-myrcene were negatively correlated with L^* and E^*_ab， but positively correlated with a^*. Sabinene was positively correlated with L^* and E^*_ab. Linalool was positively correlated with L^* and E^*_ab， and negatively correlated with a^*. The ocimene isomer mixture was positively correlated with the L^*. ConclusionAfter being processed with Halloysitum Rubrum， the appearance color， odor and volatile components of CRP change significantly， and α-pinene， β-myrcene， sabinene， linalool and A-ocimene are the characteristic volatile components before and after processing， which can provide references for the quality evaluation and clinical application of CRP and its processed products.