Background and Amis:Gallbladder cancer(GBC)is the most common malignant tumor of the biliary tract,accounting for approximately 80%-95%of biliary tract cancers.This type of tumor has a poor prognosis,and currently,there are no effective tools for evaluating the prognosis of GBC.Therefore,this study was performed to investigate the factors influencing the prognosis of GBC patients to provide a reference for clinical practice.Methods:The clinical data and follow-up information from 160 GBC patients treated in the Hunan Provincial People's Hospital from January 2018 to January 2024 was retrospectively conducted.The clinicopathologic characteristics of GBC patients were analyzed.Kaplan-Meier and Log-rank tests were used to calculate and compare the differences in overall survival(OS)among GBC patients with different clinicopathologic characteristics and treatment methods.Multivariate analysis using Cox regression was performed to identify independent prognostic factors for GBC.Results:Among the 160 patients,113 were females and 47 were males.The median age of the patients was 62 years,with the main clinical manifestations being abdominal pain/distention(55.63%),jaundice(40.63%),appetite loss(30.62%),and weight loss(19.38%).Serum tumor markers,including CA19-9,CA125,CEA,and CA724,were elevated in 58.75%,30.63%,30.00%,and 20.63%of GBC patients,respectively.Clinical stage classification revealed that 139 patients(86.87%)had stage Ⅲ/Ⅳ disease,132 patients(82.5%)had T3/T4 stage,91 patients(56.87%)had N1/N2 stage,and 54 patients(33.75%)had M1 stage.The pathological type of GBC was predominantly adenocarcinoma(92.50%),with the majority classified as moderately differentiated(19.38%),moderately to poorly differentiated(34.37%),and poorly differentiated(24.37%).Neural or vascular invasion was present in 29.37%and 21.25%of patients,respectively.Univariate analysis showed that diabetes,jaundice,liver function(Child-Pugh classification),tumor marker levels(CA19-9,CA125,CEA,CA724,CYFRA 21-1),clinical TNM stage,degree of differentiation,vascular or neural invasion,surgical treatment,and other treatments(chemotherapy,immunotherapy,targeted therapy,traditional Chinese medicine,etc.)were significantly associated with the prognosis of GBC patients(all P<0.05).Multivariate Cox regression analysis revealed that diabetes,elevated CA125,and TNM stage were independent risk factors for poor prognosis in GBC,while chemotherapy-based drug treatment was an independent protective factor(all P<0.05).Conclusion:Diabetes,elevated CA125,TNM staging,and treatment methods are closely related to the prognosis of GBC patients.Targeted treatment strategies should be developed for patients with risk factors,and surgery or chemotherapy-based drug therapy should be prioritized to improve patient prognosis.

Background and Amis:Gallbladder cancer(GBC)is the most common malignant tumor of the biliary tract,accounting for approximately 80%-95%of biliary tract cancers.This type of tumor has a poor prognosis,and currently,there are no effective tools for evaluating the prognosis of GBC.Therefore,this study was performed to investigate the factors influencing the prognosis of GBC patients to provide a reference for clinical practice.Methods:The clinical data and follow-up information from 160 GBC patients treated in the Hunan Provincial People's Hospital from January 2018 to January 2024 was retrospectively conducted.The clinicopathologic characteristics of GBC patients were analyzed.Kaplan-Meier and Log-rank tests were used to calculate and compare the differences in overall survival(OS)among GBC patients with different clinicopathologic characteristics and treatment methods.Multivariate analysis using Cox regression was performed to identify independent prognostic factors for GBC.Results:Among the 160 patients,113 were females and 47 were males.The median age of the patients was 62 years,with the main clinical manifestations being abdominal pain/distention(55.63%),jaundice(40.63%),appetite loss(30.62%),and weight loss(19.38%).Serum tumor markers,including CA19-9,CA125,CEA,and CA724,were elevated in 58.75%,30.63%,30.00%,and 20.63%of GBC patients,respectively.Clinical stage classification revealed that 139 patients(86.87%)had stage Ⅲ/Ⅳ disease,132 patients(82.5%)had T3/T4 stage,91 patients(56.87%)had N1/N2 stage,and 54 patients(33.75%)had M1 stage.The pathological type of GBC was predominantly adenocarcinoma(92.50%),with the majority classified as moderately differentiated(19.38%),moderately to poorly differentiated(34.37%),and poorly differentiated(24.37%).Neural or vascular invasion was present in 29.37%and 21.25%of patients,respectively.Univariate analysis showed that diabetes,jaundice,liver function(Child-Pugh classification),tumor marker levels(CA19-9,CA125,CEA,CA724,CYFRA 21-1),clinical TNM stage,degree of differentiation,vascular or neural invasion,surgical treatment,and other treatments(chemotherapy,immunotherapy,targeted therapy,traditional Chinese medicine,etc.)were significantly associated with the prognosis of GBC patients(all P<0.05).Multivariate Cox regression analysis revealed that diabetes,elevated CA125,and TNM stage were independent risk factors for poor prognosis in GBC,while chemotherapy-based drug treatment was an independent protective factor(all P<0.05).Conclusion:Diabetes,elevated CA125,TNM staging,and treatment methods are closely related to the prognosis of GBC patients.Targeted treatment strategies should be developed for patients with risk factors,and surgery or chemotherapy-based drug therapy should be prioritized to improve patient prognosis.

Objective:To investigate the people's cardiopulmonary resuscitation (CPR) ability in Hunan Province and whether there are differences in the skill level of CPR among respondents of different ages and education levels.Methods:A self-made questionnaire was conducted to survey people in Hunan Province by means of WeChat from May 2018 to April 2019. The questionnaire referred to 2016 National consensus on cardiopulmonary resuscitation in China issued by Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association and 2017 version of American Heart Association (AHA) CPR operational guide, and combined with the CPR assessment scale of Hunan Provincial People's Hospital. The contents of the survey included the basic information of the subjects, the common knowledge and skills of first aid, the willingness to learn CPR skills and implement CPR, and the operational requirements of high quality CPR, etc. Results:A total of 6 563 people received the on-site first aid knowledge questionnaire, and 4 355 people completed and submitted the questionnaire. The recovery rate was 66.36%, of which 3 602 valid questionnaires were from IP in Hunan Province, and the qualified rate was 82.71%. Among the subjects, 1 532 were men (42.53%) and 2 070 were women (57.47%). The majority aged group from 19 to 30 (59.41%) and from 31 to 50 (36.70%). 307 were rural (8.52%) and 3 295 were urban (91.48%); and the majority levels of education were senior or technical secondary school (38.26%) and undergraduate or junior college (44.50%). Of the 3 602 respondents, 39.09% indicated that they had been exposed to CPR knowledge and only 0.36% indicated that they did not wish to participate in CPR training. 69.93% of the respondents said they would actively to help if they wet cardic arrest, and 97.92% of those were willing to do so if the patients were relatives or friends. The survey results showed that only 8.91% of respondents chose relatively high-quality CPR options (chest compressions were performed first, the pressing point was located in the sternum of the midpoint of bilateral nipple line, the pressing frequency was 100-120 times/min, pressing depth was 5-6 cm, the ratio of chest compression to artificial ventilation was 30∶2). Among these people, the correct rate was higher in the ages of 31-50 years old and ≤ 18, 19-30 than those ≥51 years old (12.71% vs. 0%, 6.87%, 8.70%, χ2 = 41.420, P < 0.01). The correct rate of education at graduate level and above was higher than those in junior middle school and below, high school or technical secondary school, undergraduate or junior college (19.57% vs. 2.07%, 3.41%, 13.72%, χ2 = 152.262, P < 0.01). Conclusions:The public in Hunan Province have a strong sense of first aid, and some of the theoretical knowledge of CPR. People between 31 years old and 50 years old of age and with graduate education and above know more about CPR, but the overall mastery of CPR skills is poor. It is necessary to further improve the ability of the public as the first witness by teaching various skills of CPR in various forms.

Acute myocardial infarction with cardiogenic shock (AMI-CS) refers to the rapid decrease in cardiac output in a short period of time, and it leads to severe insufficient perfusion of various organs and causes systemic microcirculatory dysfunction, which is the most common cause of the death of patients with acute myocardial infarction (AMI). At present, the main strategy for clinical treatment of AMI-CS is revascularization, which reduces the mortality of AMI-CS. However, myocardial ischemia and reperfusion can cause ischemia/reperfusion (I/R) injury, induce myocardial mitochondrial dysfunction, and a large amount of reactive oxygen species (ROS) accumulation. Mitochondrial-mediated apoptosis of cardiomyocytes is the main reason of cardiomyocyte death during reperfusion injury. This article summarizes the role of mitochondrial in AMI-CS, which focus on three aspects of mitochondrial permeability transition pore (mPTP) opening, mitochondrial autophagy and mitochondrial fusion/division. It is expected to provide new ideas for clinical AMI-CS and identify potential complications targets.

[摘 要] 目的：用组织代谢组学方法，探讨甲状腺乳头状癌（papillary thyroid carcinoma, PTC）组织及癌旁组织的代谢差异，寻找PTC的潜在生物标志物，探索PTC的发病机制与治疗策略。方法：收集2018年10月至2020年2月期间湖南省人民医院乳甲外科手术切除的40例PTC患者的癌组织及癌旁组织标本。利用HPLC-MS技术平台对PTC组织及癌旁组织样本的差异性代谢物进行多维统计分析，寻找与PTC相关的异常代谢通路。结果：经PCA、PLS-DA、OPLS-DA分析得知癌组织和癌旁组织的代谢轮廓具有显著性差异。经OPLS-Loading plot分析，结合VIP>1、FC>2，且P<0.05，筛选出76个潜在差异性代谢物。其中亮氨酸、2-褪黑素、香草酸等33种代谢物在PTC组织中表达上调；3-葡萄糖苷、甘油磷脂、磷脂酰胆碱、乳糖等43代谢物在PTC癌组织中表达下调。寻找到与差异性代谢物相关的13条异常代谢通路，如半胱氨酸与蛋氨酸代谢、与甘油磷脂代谢、嘧啶代谢、半乳糖代谢以及丙氨酸、天冬氨酸和谷氨酸代谢、柠檬酸循环等，这些代谢通路可能参与PTC代谢的病理生理过程。ROC曲线下面积大于0.9的差异性代谢物有5种，分别是庚二酸、糖醇、辛二酸、乳糖和L-丝氨酸。结论：PTC组织中半乳糖代谢和氨基酸代谢发生改变，PTC组织细胞中存在沃伯格效应(Warburg effect)。庚二酸、糖醇、辛二酸、乳糖、L-丝氨酸五种差异性代谢物可以用来区分PTC患者与正常人。

Objective:To ananlyze the toxic effects and mechanisms of Cr (Ⅵ) subchronic exposure based on metabonomics techniques.Methods:Twenty-nine female Sprague-Dawley rats were randomly divided into control group, low dose group and high dose group, 10, 9, 10, respectively. The control group, low dose group and high dose group were treated with 0, 10, 50 mg/L Cr (Ⅵ) for 90 days respec tively. The serum samples of rats with different dose of Cr (Ⅵ) treatment were detected Using UPLC-Q-TOF-MS/MS technique and data was analyzed by PCA, PLS-DA and OPLS-DA to compare with metabolic profile in different Cr (Ⅵ) dose treatments. Pathway analysis was performed using MetaboAnalyst 4.0 software.Results:UPLC-Q- TOF-MS/MS has stable detection performance and reliable experimental data. The control group, low Cr (Ⅵ) and high Cr (Ⅵ ) metabolic profiles of rats serum differences was obviously, and there is significant difference of serum metabolic profile among rats treated with different dose of Cr (Ⅵ) . 18 differential metabolites were screened between Cr (Ⅵ) low dose group and control group, 23 differential metabolites between Cr (Ⅵ) high dose group and control group. Compared to control group, there were 13 differential metabolites in both Cr (Ⅵ) high dose group and Cr (Ⅵ ) low dose group, such as 3-Hydroxy-11Z-octadecenoylcarnitine, Anserine, Farnesyl pyrophosphate, Linoleoyl ethanolamid e, Linoleyl carnitine, Lithocholate 3-O-glucuronide, LysoPC [20∶2(11Z, 14Z) ], LysoPC[20∶3 (5Z, 8Z, 11Z) ], LysoPC[22∶2(13Z, 16Z) ], PG[16∶0/22∶5(7Z, 10Z, 13Z, 16Z, 19Z) ], PI[18∶1 (11Z) /20∶4(5Z, 8Z, 11Z, 14Z) ], PI[20∶3(5Z, 8Z, 11Z) /18∶0], Serotonin. These differential metabolites were related to Glycerophospholipid metabolism, Tryptophan metabolism, Pentose and glucuronate interconversions, Terpenoid backbone biosynthesis.Conclusion:Cr (Ⅵ) subchronic exposure could induce the significant difference of serum metabolic profile. The differential metabolites induced by Cr (Ⅵ) subchronic ex- posure were mainly related to amino acid and lipid metabolism.

Objective:To ananlyze the toxic effects and mechanisms of Cr (Ⅵ) subchronic exposure based on metabonomics techniques.Methods:Twenty-nine female Sprague-Dawley rats were randomly divided into control group, low dose group and high dose group, 10, 9, 10, respectively. The control group, low dose group and high dose group were treated with 0, 10, 50 mg/L Cr (Ⅵ) for 90 days respec tively. The serum samples of rats with different dose of Cr (Ⅵ) treatment were detected Using UPLC-Q-TOF-MS/MS technique and data was analyzed by PCA, PLS-DA and OPLS-DA to compare with metabolic profile in different Cr (Ⅵ) dose treatments. Pathway analysis was performed using MetaboAnalyst 4.0 software.Results:UPLC-Q- TOF-MS/MS has stable detection performance and reliable experimental data. The control group, low Cr (Ⅵ) and high Cr (Ⅵ ) metabolic profiles of rats serum differences was obviously, and there is significant difference of serum metabolic profile among rats treated with different dose of Cr (Ⅵ) . 18 differential metabolites were screened between Cr (Ⅵ) low dose group and control group, 23 differential metabolites between Cr (Ⅵ) high dose group and control group. Compared to control group, there were 13 differential metabolites in both Cr (Ⅵ) high dose group and Cr (Ⅵ ) low dose group, such as 3-Hydroxy-11Z-octadecenoylcarnitine, Anserine, Farnesyl pyrophosphate, Linoleoyl ethanolamid e, Linoleyl carnitine, Lithocholate 3-O-glucuronide, LysoPC [20∶2(11Z, 14Z) ], LysoPC[20∶3 (5Z, 8Z, 11Z) ], LysoPC[22∶2(13Z, 16Z) ], PG[16∶0/22∶5(7Z, 10Z, 13Z, 16Z, 19Z) ], PI[18∶1 (11Z) /20∶4(5Z, 8Z, 11Z, 14Z) ], PI[20∶3(5Z, 8Z, 11Z) /18∶0], Serotonin. These differential metabolites were related to Glycerophospholipid metabolism, Tryptophan metabolism, Pentose and glucuronate interconversions, Terpenoid backbone biosynthesis.Conclusion:Cr (Ⅵ) subchronic exposure could induce the significant difference of serum metabolic profile. The differential metabolites induced by Cr (Ⅵ) subchronic ex- posure were mainly related to amino acid and lipid metabolism.

Objective: To investigate the changes of brain gray matter volume in patients with occupational noise-induced hearing loss by voxel based morphometry (VBM) . Methods: 16 age-and education-matched healthy controls and 42 patients with occupational noise induced hearing loss, including 27 in mild group and 15 in severe group, received MRI 3D-FSPGR sequence T1WI sagittal scan, and then underwent VBM of brain gray matter volume data analysis. Results: The brain gray matter volume of the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus and the near midline area of cerebellum differed between experimental group and control group (P<0.01) . Conclusion The volume of gray matter in specific brain areas of patients with occupational noise-induced hearing loss was changed, and the effect of noise on brain structure was revealed from the perspective of imaging.

Objective To reveal the pathophysiological changes of sepsis, the plasma metabonomics of septic rats was determined and differential metabolites were determined by gas chromatography-mass spectrometry (GC-MS). Methods Male Spraguee-Dawley (SD) rats about 8 weeks were randomly divided into sham group (n = 18) and sepsis group (n = 24). Cecal ligation and puncture (CLP) was used to build sepsis model, while cecum was kept intact only in the sham group. 6 hours after the operation, rats were anesthetized, and blood was harvested through heart thoracotomy. Then the plasma metabonomics was detected by GC-MS and metabolic profile analysis was performed to find the relative differential metabolites.Results Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) showed that the metabolic profiling of the sepsis group was significantly different from the sham group. 259 kinds of metabolites were got by GC-MS, and 69 kinds of differential metabolites were found between sham group and sepsis group, in which 23 differential metabolites were related to amino acid metabolism. Compared with sham group, the contents of putrescine, N-glutamic acid, hydroxynorvaline, 3-cyanuric acid, D-alanyl-D-alanine and urea in the plasma of septic rats increased significantly, which ratios of sepsis/sham group were 10.876, 6.394, 2.800, 2.226, 1.323, 1.203, respectively (allP < 0.05). On the other hand, the contents of oxygen generation of proline, citrulline, glutamine, su-beta-hydroxy aspartic acid, citric acid, N-methyl-DL-alanine, serine, lysine, threonine, N-formyl-L-methionine, methionine, alanine, nicotinuric acid, N-methyl-L-glutamic acid, trans-4-hydroxy-L-proline, proline, L-glutamic acid in the plasma of septic rats decreased significantly, which ratios of sepsis/sham group were 0.858, 0.853, 0.834, 0.816, 0.816, 0.814, 0.813, 0.801, 0.793, 0.792, 0.774, 0.766, 0.748, 0.727, 0.716, 0.674, 0.603, respectively (allP < 0.05).Conclusions Through the GC-MS analysis of plasma metabonomics of septic rats, we found abnormal energy metabolism changes. The content of amino acid in plasma might be a method to evaluate the energy metabolism status of sepsis.

Objective To investigate the psychology , personality and behavior characteristics of the patients with acute angle -closure glaucoma , so as to explore the clinical significance of psychological factor in the prevention and treatment of the disease . Methods Measurement and analysis were made in 116 patients with acute angle-closure glaucoma , 56 patients with chronic angle-clo-sure glaucoma, 120 patients with cataract and 50 normal subjects, with questionnaire survey by using SCL-90, A style behavior and Ey-senck Personality Questionnaire (EPQ).Results In SCL-90, the scores of depression and anxiety in the patients with acute angle-clo-sure glaucoma were higher than those of the other 3 groups, with statistical significance(P<0.05).There was no statistical significance in the scores of 7 symptoms (somatization, obsessive-compulsive, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, psychoticism), when compared with those of the patients with chronic angle-closure glaucoma.However, statistical significance could be noted, when compared with those of the cataract and normal subjects (P<0.05).In the evaluation of questionnaire survey of A-style behavior , the scores of TH in the patients with acute angle-closure glaucoma were significantly higher than those of the other 3 groups (P<0.05).However, there was no statistical significance in the scores of CH , as compared with those of the other 3 groups. The scores of TH+CH were closely identical to those of the patients with chronic angle -closure glaucoma , without statistical signifi-cance, but they were significantly higher than those of the cataract and normal subjects (P<0.05).In EPQ questionnaire survey, no statistical significance could be seen in the scores of nervousness , introversion and extraversion , nervous emotion and masking , when comparisons were made between the patients with acute angle-closure glaucoma and chronic angle-closure glaucoma .However , there were significance differences in the scores of introversion and extraversion as well as nervousness in the patients with acute angle -closure glaucoma, as compared with those of the cataract patients and normal subjects , with statistical significance (P<0.05).Conclusion Psychological factor seems to be obviously associated with the onset of acute angle -closure glaucoma .The patients with acute angle-clo-sure glaucoma mainly display A-style personality and neurotic tendency .