ObjectiveTo conduct a theoretical study on the medical-rehabilitation integration. MethodsStarting from the background, objectives and content of the medical-rehabilitation integration, this study analyzed its innovative points from the dimensions of conceptual innovation, organizational innovation, model innovation and technological innovation. Results and ConclusionThe medical-rehabilitation integration is an innovation in medical services that takes conceptual innovation as the forerunner, organizational innovation as the foundation, model innovation as the carrier and technological innovation as the core.

[摘 要] 目的：探讨lncRNA核内富集丰富转录本1（NEAT1）调控miR-1287-5p/DNA损伤诱导转录本4（DDIT4）轴对卵巢癌SKOV3细胞增殖、凋亡和侵袭的影响及其机制。方法：收集2023年6月至2024年6月期间湖北医药学院附属随州医院手术切除的27例卵巢癌患者的癌及癌旁组织标本，以及正常人卵巢上皮细胞IOSE80和卵巢癌细胞系SKOV3、CAOV3和A2780，RT-qPCR检测卵巢癌组织与细胞中lncRNA NEAT1、miR-1287-5p及DDIT4 mRNA表达。将SKOV3细胞分为Ctrl组、si-NC组、si-NEAT1组、si-NEAT1 + anti-miR-NC组、si-NEAT1 + anti-miR-1287-5p组、si-NEAT1 + vector组、si-NEAT1 + OE-DDIT4组。CCK-8法、克隆形成实验、流式细胞术、Transwell实验分别检测各组细胞增殖、凋亡及侵袭能力，WB法检测细胞中DDIT4、细胞周期蛋白D1（cyclin D1）、p53、迁移侵袭增强子1（MIEN1）蛋白水平。双萤光素酶报告基因验证lncRNA NEAT1与miR-1287-5p/DDIT4靶向结合关系，RNA pull-down实验、RNA免疫沉淀实验分别验证lncRNA NEAT1与miR-1287-5p、miR-1287-5p与DDIT4的靶向结合关系。另设pcDNA组（转染空载体pcDNA3.1）和pc-NEAT1 组（转染pcDNA-NEAT1）以验证NEAT1过表达效应。结果：卵巢癌组织中lncRNA NEAT1、DDIT4 mRNA表达水平显著高于癌旁组织（P < 0.05），而miR-1287-5p表达显著低于癌旁组织（P < 0.05）。敲低lncRNA NEAT1后，与Ctrl组和si-NC组相比，si-NEAT1组lncRNA NEAT1表达、DDIT4 mRNA表达均显著降低（均P < 0.05），miR-1287-5p 表达显著升高（P < 0.05）；而过表达lncRNA NEAT1则下调miR-1287-5p表达并上调DDIT4表达，呈现与敲低实验相反的调控效应；敲低lncRNA NEAT1后，克隆形成数、细胞增殖活性、细胞侵袭数均显著降低（均P < 0.05），细胞凋亡率显著升高（P < 0.05）；DDIT4、cyclin D1、MIEN1蛋白表达均显著降低（均P < 0.05），p53蛋白表达显著升高（P < 0.05）。进一步实验证实，anti-miR-1287-5p或OE-DDIT4均可减弱si-NEAT1对SKOV3细胞增殖和侵袭的抑制作用，同时减弱其对细胞凋亡的促进作用。lncRNA NEAT1靶向调控miR-1287-5p/DDIT4。结论：lncRNA NEAT1通过靶向调控miR-1287-5p/DDIT4轴促进SKOV3细胞增殖和侵袭，抑制细胞凋亡。

Objective·To investigate the predictive value of the geriatric nutritional risk index(GNRI)for the occurrence of lung infection in hospitalized elderly patients with type 2 diabetes mellitus(T2DM).Methods·Elderly T2DM patients who were admitted to the Geriatric Department of Shanghai Tongren Hospital between June 2022 and June 2024 were retrospectively and consecutively enrolled.They were divided into infected and non-infected groups according to whether lung infection occurred during hospitalization.Baseline data(gender,age,height,weight,duration of diabetes,comorbidities,etc.)were collected and GNRI was calculated.A multivariate Logistic regression model was used to screen the independent risk factors for pulmonary infections,and the predictive value of GNRI for pulmonary infections in T2DM patients was analysed using receiver operating characteristic(ROC)curves.Results·A total of 264 elderly T2DM patients were enrolled,among whom 154 developed pulmonary infections.Significant differences were observed between the infected and non-infected groups in GNRI,albumin,leukocyte count,neutrophil ratio,lymphocyte ratio,glycated hemoglobin,fasting glucose,interleukin-6,C-reactive protein,and procalcitonin levels(P<0.05).Multivariate Logistic regression analysis showed that a lower GNRI was an independent risk factor for lung infection(OR=0.798,95%CI 0.712?0.894;P<0.001).Correlation analysis showed that GNRI was negatively correlated with C-reactive protein and calcitoninogen.ROC curve analysis showed that GNRI predicted pulmonary infection with an area under the curve of 0.828,a sensitivity of 77.9%,and a specificity of 76.6%.Conclusion·A lower GNRI is an independent risk factor for pulmonary infections in elderly T2DM patients,and also has a good predictive value for the occurrence of pulmonary infections.

The immune microenvironment plays a pivotal role in maintaining ovarian homeostasis. Polycystic ovary syndrome (PCOS), a common endocrine and metabolic disorder, is closely associated with immune microenvironment imbalance. This review systematically describes the dysregulation of innate immune cells (e.g., macrophages, natural killer cells and dendritic cells) and adaptive immune cells (e.g., Th1, Th2, Treg and Th17) in PCOS, highlighting their impacts on ovarian function, insulin resistance, and hyperandrogenemia. These findings underscore the central role of immune microenvironment disturbances in PCOS pathogenesis. Additionally, the association between gut microbiota dysbiosis and PCOS is explored, emphasizing how gut microbiota influences metabolic byproducts and hormonal levels to contribute to PCOS development. Furthermore, therapeutic strategies targeting immune microenvironment imbalance such as modulating macrophage polarization, restoring Th1/Th2 and Th17/Treg balance, and ameliorating gut microbiota dysbiosis are discussed, offering novel insights for PCOS immunotherapy. In conclusion, this review comprehensively analyzes the pathogenesis of PCOS from the perspective of the immune microenvironment, aiming to provide a theoretical foundation and reference for future research and clinical practice.

Objective:This study aimed to investigate the effects of glucagon-like peptide-1 receptor agonists(GLP-1RAs) on the emotional behaviors in wild-type mice and explore the underlying mechanisms.Methods:The study consisted of two parts.(1) Drug effect evaluation: C57BL/6 mice were randomly assigned to saline, semaglutide, or liraglutide groups. After 4 weeks of continuous subcutaneous administration, anxiety-like behaviors were evaluated by the open field tests and elevated plus maze, and depression-like behaviors were assessed by the forced swimming test and tail suspension test. Neurotransmitter levels, including NE, DA, 5-HT, GABA, and glutamate, were measured in target brain regions using LC-MS/MS. Hypothalamic activation subregions were identified by c-fos immunohistochemistry.(2) Time-course analysis: Mice received short-term administration(2 weeks), long-term administration(4 weeks), or drug withdrawal(assessed 4 weeks post-withdrawal). Behavioral performance, hypothalamic neurotransmitter levels, and plasma adrenocorticotropic hormone and corticosterone were measured.Results:Compared with the saline group, both GLP-1RAs significantly prolonged immobility time in the forced swimming and tail suspension tests. Multiple brain regions exhibited neurotransmitter abnormalities, including marked reductions in hypothalamic norepinephrine, dopamine, and γ-aminobutyric acid levels. Both GLP-1RAs significantly increased c-fos positive cell counts in the suprachiasmatic nucleus and arcuate nucleus of the hypothalamus. Time-course analysis revealed that short-term administration did not induce depressive phenotypes, whereas long-term administration led to depression-like behaviors, which recovered after drug withdrawal. Plasma adrenocorticotropic hormone and corticosterone levels were elevated even after short-term treatment and remained high after drug withdrawal, while hypothalamic neurotransmitter abnormalities normalized upon withdrawal.Conclusion:GLP-1RAs induce depression-like behaviors in a time-dependent manner, with neurotransmitter imbalance and persistent hyperactivation of the HPA axis likely contributing to the pathophysiological mechanism.

Objective:To investigate the predictive value of color Doppler ultrasound combined with electrocardio-gram for right heart dys function in patients with pulmonary heart disease(PHD).Methods:A total of 100 PHD patients admitted in Dongcheng Branch of First Affiliated Hospital of Anhui Medical University between January 2020 and December 2023 were retrospectively analyzed.According to results of 6min walking test(6MWT),pa-tients were divided into good right heart function group(n=64,≥350m)and right heart dysfunction group(n=36,＜350m).The indexes of cardiac color ultrasound[isovolumic relaxation time(IVRT),isovolumetric contraction time(IVCT)and right ventricular Tei index],ECG[24h mean R-R interval standard deviation(SDNN),normal R-R interval standard deviation per 5min(SDANN)and the ratio of low frequency components to high frequency components(LF/HF)]were compared between two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of color Doppler ultrasound,ECG and their combination for right heart dys-function in PHD patients.Spearman correlation coefficient was used to analyze the association of color Doppler ul-trasound,ECG and their combination with right heart dysfunction in PHD patients.Results:Compared with those in good right heart function group,patients in right heart dysfunction group had significant higher IVRT[(120.64±14.08)ms vs.(97.87±10.93)ms],IVCT[(84.28±12.33)ms vs.(71.92±10.61)ms]and Tei index[(0.85±0.11)vs.(0.63±0.07)](P＜0.001 all),and significant lower SDNN[(75.52±12.58)ms vs.(85.58±11.75)ms],SDANN[(63.86±10.92)ms vs.(76.75±11.71)ms]and LF/HF[(1.33±0.19)vs.(1.84±0.27)](P＜0.001 all).ROC curve indicated that the AUC of color Doppler ultrasound combined ECG in diagnosing right heart dysfunction in PHD patients was 0.911(95％CI 0.838～0.959),which was significantly higher than those of color Doppler ultrasound[0.775(95％CI 0.681～0.853),Z=2.404,P=0.016]and ECG[0.688(95％CI 0.588～0.777),Z=3.968,P=0.001]alone.Spearman correlation analysis indicated that there was a significant positive correlation of color Doppler ultrasound(r=0.547),ECG(r=0.375)and their combination(r=0.810)with right heart dysfunction in PHD patients(P＜0.001 all),and the correlation between combined detection and right heart dysfunction in PHD patients was significantly higher.Conclusion:Color Doppler ultrasound combined with ECG possesses high diagnostic performance for right heart dysfunction in PHD patients.

Objective:This study aimed to investigate the effects of glucagon-like peptide-1 receptor agonists(GLP-1RAs) on the emotional behaviors in wild-type mice and explore the underlying mechanisms.Methods:The study consisted of two parts.(1) Drug effect evaluation: C57BL/6 mice were randomly assigned to saline, semaglutide, or liraglutide groups. After 4 weeks of continuous subcutaneous administration, anxiety-like behaviors were evaluated by the open field tests and elevated plus maze, and depression-like behaviors were assessed by the forced swimming test and tail suspension test. Neurotransmitter levels, including NE, DA, 5-HT, GABA, and glutamate, were measured in target brain regions using LC-MS/MS. Hypothalamic activation subregions were identified by c-fos immunohistochemistry.(2) Time-course analysis: Mice received short-term administration(2 weeks), long-term administration(4 weeks), or drug withdrawal(assessed 4 weeks post-withdrawal). Behavioral performance, hypothalamic neurotransmitter levels, and plasma adrenocorticotropic hormone and corticosterone were measured.Results:Compared with the saline group, both GLP-1RAs significantly prolonged immobility time in the forced swimming and tail suspension tests. Multiple brain regions exhibited neurotransmitter abnormalities, including marked reductions in hypothalamic norepinephrine, dopamine, and γ-aminobutyric acid levels. Both GLP-1RAs significantly increased c-fos positive cell counts in the suprachiasmatic nucleus and arcuate nucleus of the hypothalamus. Time-course analysis revealed that short-term administration did not induce depressive phenotypes, whereas long-term administration led to depression-like behaviors, which recovered after drug withdrawal. Plasma adrenocorticotropic hormone and corticosterone levels were elevated even after short-term treatment and remained high after drug withdrawal, while hypothalamic neurotransmitter abnormalities normalized upon withdrawal.Conclusion:GLP-1RAs induce depression-like behaviors in a time-dependent manner, with neurotransmitter imbalance and persistent hyperactivation of the HPA axis likely contributing to the pathophysiological mechanism.

Objective·To investigate the predictive value of the geriatric nutritional risk index(GNRI)for the occurrence of lung infection in hospitalized elderly patients with type 2 diabetes mellitus(T2DM).Methods·Elderly T2DM patients who were admitted to the Geriatric Department of Shanghai Tongren Hospital between June 2022 and June 2024 were retrospectively and consecutively enrolled.They were divided into infected and non-infected groups according to whether lung infection occurred during hospitalization.Baseline data(gender,age,height,weight,duration of diabetes,comorbidities,etc.)were collected and GNRI was calculated.A multivariate Logistic regression model was used to screen the independent risk factors for pulmonary infections,and the predictive value of GNRI for pulmonary infections in T2DM patients was analysed using receiver operating characteristic(ROC)curves.Results·A total of 264 elderly T2DM patients were enrolled,among whom 154 developed pulmonary infections.Significant differences were observed between the infected and non-infected groups in GNRI,albumin,leukocyte count,neutrophil ratio,lymphocyte ratio,glycated hemoglobin,fasting glucose,interleukin-6,C-reactive protein,and procalcitonin levels(P<0.05).Multivariate Logistic regression analysis showed that a lower GNRI was an independent risk factor for lung infection(OR=0.798,95%CI 0.712?0.894;P<0.001).Correlation analysis showed that GNRI was negatively correlated with C-reactive protein and calcitoninogen.ROC curve analysis showed that GNRI predicted pulmonary infection with an area under the curve of 0.828,a sensitivity of 77.9%,and a specificity of 76.6%.Conclusion·A lower GNRI is an independent risk factor for pulmonary infections in elderly T2DM patients,and also has a good predictive value for the occurrence of pulmonary infections.

The immune microenvironment plays a pivotal role in maintaining ovarian homeostasis. Polycystic ovary syndrome (PCOS), a common endocrine and metabolic disorder, is closely associated with immune microenvironment imbalance. This review systematically describes the dysregulation of innate immune cells (e.g., macrophages, natural killer cells and dendritic cells) and adaptive immune cells (e.g., Th1, Th2, Treg and Th17) in PCOS, highlighting their impacts on ovarian function, insulin resistance, and hyperandrogenemia. These findings underscore the central role of immune microenvironment disturbances in PCOS pathogenesis. Additionally, the association between gut microbiota dysbiosis and PCOS is explored, emphasizing how gut microbiota influences metabolic byproducts and hormonal levels to contribute to PCOS development. Furthermore, therapeutic strategies targeting immune microenvironment imbalance such as modulating macrophage polarization, restoring Th1/Th2 and Th17/Treg balance, and ameliorating gut microbiota dysbiosis are discussed, offering novel insights for PCOS immunotherapy. In conclusion, this review comprehensively analyzes the pathogenesis of PCOS from the perspective of the immune microenvironment, aiming to provide a theoretical foundation and reference for future research and clinical practice.

Objective To observe the clinical efficacy and safety of vericiguat tablets combined with sacubitril valsartan sodium(Sac/Val)tablets in the treatment of patients with heart failure with reduced ejection fraction(HFrEF).Methods The HFrEF patients were divided into control group and treatment group according to the cohort method.The control group was treated with Sac/Val tablets 200 mg per time,bid,orally.On the basis of control group,the treatment group was treated with vericiguat tablets 2.5 mg per time,qd,taken with meal.Two groups were treated for 3 months.The clinical efficacy,left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD)and end-systolic diameter(LVESD),levels of high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),nitric oxide(NO),N-terminal pro-brain natriuretic peptide(NT-proBNP),blood urea nitrogen(BUN)and serum creatinine(SCr),and safety were compared between the two groups.During follow-up,the heart failure rehospitalization rates and major adverse cardiovascular events were compared between the two groups.Results Treatment group was enrolled 53 patients,control group was enrolled 53 patients.After treatment,the total effective rates of treatment and control groups were 94.34％(50 cases/53 cases)and 81.13％(43 cases/53 cases)with statistical significant difference(P＜0.05).After treatment,the LVEF of treatment and control groups were(48.02±5.20)％and(43.02±4.33)％,the LVEDDs were(52.85±6.30)and(55.63±6.88)mm,the LVESDs were(41.64±6.40)and(44.22±5.85)mm,the levels of hs-CRP were(10.22±2.63)and(14.60±2.98)mg L-1,the levels of IL-6 were(14.48±2.40)and(17.36±2.52)pg·mL-1,the levels of NO were(102.60±20.16)and(92.16±16.33)μmol·L-1,the levels of NT-proBNP were(898.74±102.20)and(1315.60±182.64)ng·L-1,the levels of BUN were(12.02±2.28)and(13.45±2.33)mmol·L-1,the levels of SCr were(82.22±5.89)and(85.64±6.03)μmol·L-1,the heart failure rehospitalization rates were 5.66％and 13.21％,respectively;the differences were statistical significant between two groups(all P＜0.05).The adverse drug reactions of treatment group were hyperkalemia,hypotension,renal dysfunction,dizziness and headache,while those in control group were renal dysfunction,hyperkalemia,and hypotension.The major adverse cardiovascular events of treatment group were angina pectoris and acute myocardial infarction,while those in control group were angina pectoris,acute myocardial infarction and atrial fibrillation.The incidences of total adverse drug reactions in treatment and control groups were 13.21％and 7.55％,the incidences of major adverse cardiovascular events were 5.66％and 13.21％,respectively,without statistically significant differences(all P＞0.05).Conclusion Vericiguat tablets combined with Sac/Val tablets have a definitive clinical efficacy in the treatment of HFrEF patients,which can improve cardiac and endothelial function,reduce inflammatory response and readmission times,without increasing the incidences of adverse drug reactions.