Postoperative cognitive dysfunction (POCD) is a clinically significant complication in elderly patients, largely driven by surgery-induced neuroinflammation. The cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) pathway, a crucial regulator of innate immunity, has been implicated in neuroinflammatory activation. This study investigated whether electroacupuncture (EA) improves POCD by modulating this pathway in aged rats. Aged male Sprague-Dawley rats were subjected to sevoflurane anesthesia and splenectomy to establish a POCD model. Animals were divided into sham, POCD, POCD+EA, and POCD+EA+cGAS inhibitor groups. The EA groups received stimulation at Baihui (Governor Vessel 20 (GV20)), Neiguan (Pericardium 6 (PC6)), and Zusanli (Stomach 36 (ST36)) acupoints. Cognitive function was evaluated using the Morris water maze, while hippocampal expression of cGAS-STING pathway components and downstream effectors—interferon regulatory factor 3 (IRF3), nuclear factor kappa B (NF-κB), and interleukin-1 beta (IL-1β)—was assessed by Western blot. Cellular localization was determined by immunofluorescence staining. Compared with the Sham group, rats in the POCD group showed significant impairments in spatial memory, accompanied by upregulated protein expression of cGAS, STING, NF-κB, IRF3, and IL-1β in the hippocampus. Upon pathway activation, cGAS and STING proteins were predominantly co-localized with neurons, and their fluorescence intensity in the hippocampus was markedly increased. These behavioral deficits and molecular alterations were partially reversed in both the POCD+EA and POCD+EA+inhibitor groups. Electroacupuncture alleviates POCD in aged rats by inhibiting hippocampal cGAS-STING pathway activation and reducing neuroinflammation, suggesting a promising non-pharmacological strategy for POCD management.

Objective:Cognitive interviews were used to explore the target population's understanding and cognition of the Questionnaire about Gynaecological and Pelvic Pain Symptoms (ENDOPAIN-4D) in the Chinese context. The consistency of language expression and concept between the Chinese version ENDOPAIN-4D and the original scale was verified.Methods:Qualitative research methods were employed. Objective sampling method was used to select the patients with endometriosis/adenomyosis in the gynecological ward of Chinese Academy of Medical Sciences & Peking Union Medical College Hospital from October to December 2023 as the interview subjects. Two rounds of cognitive interviews were conducted, and the interview data were coded and analyzed using the Question Appraisal System. Based on the interview results and the recommendations of the expert group, the scale items were revised to form the Chinese version of ENDOPAIN-4D, and reliability and validity tests were conducted.Results:This study ultimately included 24 patients with endometriosis/adenomyosis, aged 24-47 years. The results of the first round of interviews showed that some interviewees had ambiguous understandings of the 16 items in the questionnaire, most of the item questions were concentrated in the category of "3 clarity, 4 hypotheses", and a small number of questions appeared in the category of "2 guidance, 5 knowledge/memory, 7 options", and were revised. The results of the second round of interviews showed that respondents could correctly understand the scale items. The Cronbach α coefficient of the total scale was 0.874, and the retest reliability was 0.952. The correlation coefficient of the Chinese version of the Global Pain Scale as the reference index of compatibility validity was 0.764 ( P<0.01), and the exploratory factor analysis extracted a total of 4 dimensions, with a cumulative variance contribution rate of 61.169%. The final formal questionnaire included 21 items in 4 dimensions including spontaneous pelvic pain, pain during sexual intercourse, intestinal pain and/or symptoms, and other symptoms. Conclusions:Cognitive interviews were used to identify cognitive biases in the target population during the completion of the scale and to address them appropriately, reducing the differences in the target population's understanding of the ENDOPAIN-4D scale and improving its scientific validity and reliability.

Objective To analyze the association between eye-related behaviors and myopia among preschool chil-dren in Ningxia Hui Autonomous Region,and to develop a predictive nomogram model.Methods Using stratified cluster random sampling,36 062 preschool children from 400 randomly selected kindergartens in Ningxia Hui Autonomous Region were enrolled between October and December 2023.Primary caregivers of participants completed structured question-naires.Data were randomly split into a training set(n=25 243,70％)and a validation set(n=10 819,30％)in a ratio of 7∶3.The training set was used for model construction,and the validation set for external validation.Calibration plots and the Hosmer-Lemeshow(H-L)goodness-of-fit test assessed agreement between predicted and observed risks.Decision curve analysis(DCA)and clinical impact curve analysis(CICA)evaluated clinical utility.Results The myopia preva-lence among preschool children in Ningxia Hui Autonomous Region was 3.8％.A nomogram model based on binary Logistic regression showed area under the curve(AUC)values of 0.88(95％CI:0.87-0.89)for the training set and 0.89(95％CI:0.87-0.90)for the validation set,indicating strong discriminative ability.Calibration curves and H-L tests revealed good model fit(training set:x2=4.92,P=0.766;validation set:x2=5.52,P=0.961),with all P＞0.05.DCA and CICA confirmed clinical utility.The nomogram identified parental myopia,academic pressure,frequency of eye fatigue,daily screen time,and regular vision checks as the top five predictors of myopia.Conclusion The nomogram demonstrates promising potential for predicting myopia risk in preschool children in Ningxia Hui Autonomous Region,serving as a robust tool for clinical and educational myopia risk assessment.

OBJECTIVE To observe the effect of Shixiang plaster on promoting the wound healing of diabetic foot ulcer.METHODS Totally 50 male SPF grade SD rats were prepared to establish the diabetic models by feeding with high glucose and high fat forage and intraperitoneal injection of streptozotocin,the rats models that were es-tablished successfully were randomly divided into the model group,the Shixiang plaster group and the Kangfuxin solution group.The models of diabetic ulcers were established.The Shixiang plaster group was treated with exter-nal Shixiang plaster,the Kangfuxin solution group was given external Kangfuxin solution,and the model group was treated with coverage with sterile gauze.The wound healing status of the rats was observed,the wound tis-sues were collected for bacterial culture and hematoxylin-eosin(HE)staining after drug administration for 14 and 28 days,respectively.The expression levels of nuclear factor-red cell-2-related factor 2(Nrf-2),heme oxygenase-1(HO-1),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and vascular endothelial growth factor(VEGF)were detected by immunohistochemistry(IHC),the expression levels of Nrf-2 and HO-1 were detected with the use of Western Blot,and the levels of serum malondialdehyde(MDA),superoxide dismutase(SOD)and reactive oxygen species(ROS)were detected by enzyme-linked immunosorbent assay(ELISA).RESULTS After the drug administration for 14 and 28 days,the wound healing rates of the Shixiang plaster group were(62.15±3.82)％and(81.68±3.83)％,respectively,higher than(47.14±2.80)％and(69.96±6.49)％of the Kangfuxin solu-tion group and(29.14±9.52)％and(57.91±6.63)％of the model group,and there were significant differences(F=21.716,12.626,P=0.002,0.007).The bacterial colony counts of the Shixiang plaster group were less than those of the Kangfuxin solution group and the model group after the drug administration for 14 and 28 days(P＜0.05).The result of HE staining showed that the Shixiang plaster group had a better wound healing.The result of IHC indicated that the expression levels of Nrf-2,HO-1 and VEGF of the Kangfuxin solution group and the Shix-iang plaster group were up-regulated after the drug administration for 28 days,while the expression levels of TNF-α and IL-6 were down-regulated.The expression levels of Nrf-2 and HO-1 proteins of the Shixiang plaster group were higher than those of the Kangfuxin solution group and the model group after the drug administration for 14 and 28 days,the levels of serum MDA and ROS of the Shixiang plaster group were lower than those of the Kangfuxin solution group and the model group,and the serum SOD level of the Shixiang plaster group was higher than that of the model group(P＜0.05).CONCLUSIONS Shixiang plaster can effectively promote the wound heal-ing of the rats with diabetic foot ulcers and reduce the bacterial colony counts of wound surfaces.The mechanism may be associated with the alleviation of oxidative stress injury by mediating the Nrf-2/HO-1 signaling pathways,promotion of angiogenesis and inhibition of excessive inflammatory reactions.

Objective:To identify tumor-infiltrating immune cells that affect the prognosis of endometrial cancer(EC)with no specific molecular profile(NSMP)subtypeand to establish an integrated prognostic model based on immune cells.Methods:Gene expression data,whole exome sequencing data,and corresponding clinical infor-mation for EC patients were obtained from the The Cancer Genome Atlas(TCGA)database.The CIBERSORTx algorithm was used to evaluate the infiltration levels of 22 types of immune cells in the tumor microenvironment.Kaplan-Meier survival analysis,along with univariate and multivariate Cox regression analyses were used to identi-fy immune cells with prognostic values.A prognostic nomogram was subsequently developed based on significant immune cells and clinicopathological parameters.Results:A total of 169 EC patients classified as NSMP subtype-swere included in this study.Among them 123 patients(72.8％)were aged＜70 years,and 152 patients(89.9％)had type Ⅰ tumors.Kaplan-Meier curves showed that the proportion of plasma cells(P＜0.001),M1 macrophages(P=0.038)and activated NK cells(P=0.01)were significantly associated with overall survival.Multivariate Cox regression analysis revealed that the proportion of activated NK cells(proportion ≥0.027:HR 0.23,95％CI 0.08-0.66,P=0.006),age(≥70 years:HR4.59,95％CI 1.80-11.70,P=0.001)and tumor stage(stage Ⅱ:HR3.87,95％CI 1.18-12.70,P=0.026;stage Ⅲ:HR 6.08,95％CI 1.69-21.87,P=0.006;Ⅳ stage:HR 10.81,95％CI 3.07-38.08,P＜0.001)are independent prognostic indicators for NSMP tumors.A nomogram model was estab-lished by combining activation of NK cells,tumor stage and patient age.Internal cross-validation showed that the integrated prognostic model exhibited good predictive ability for the overall survival rates of patients(P＜0.001).Conclusions:Elevated tumor-infiltrating activated NK cells serve as an independent prognostic indicator for NSMP-subtype EC patients.When integrated with tumor stage and age,they form a robust multivariable prognos-tic model with superior predictive power.

Dental implantology has developed rapidly for over half a century,since pure titanium(99.7％)dental cylindrical threaded implants were exploited and osseointegration was introduced in 1960s by Prof.Br?nemark.The long term retention rates of 10 years or more are over 95％.However,the biological complications jeopardize the long term effects of dental implant treatment seriously.The prevalence of dental implant biological complications varies greatly among different reports resulting from the disparities on the defini-tions of dental implant biological complications.After analyzing and summarizing the major opinions proposed internationally in recent years,the consensus for the definition of dental implant biological complications has been reached.Generally the dental implant biologi-cal implications can be classified into early stage(before restoration)biological complications and late stage(after restoration)biological complications.The early stage biological complications include acute and chronic infections,pain,soft tissue deficiency,and osseointegration failure,etc.The late stage complications include peri-implant diseases(peri-implant mucositis and peri-implantitis),soft tissue deficiency around implant,implant loosening and dropping off,etc.The various risk factors related to different dental implant biological complications,the strategies of the prevention and treatment for the dental implant biological complications have been discussed comprehensively,and the consensus has been reached.It is aimed to advocate the dentist to pay more attention to the early prevention of the biological implant complications,to promote more researches on the implant biological complications,and to help elevate the level of dental implantology in our country.

Rheumatoid arthritis(RA)is a systemic inflammatory disease characterized by erosive arthritis that can eventually lead to joint deformity and loss of function,which is unknown.Autophagy is a self-degradation process in which cells reuse internal proteins and organelles allowing organisms to withstand adverse situations such as starvation and infection,and eventually allowing cells to survive.In recent years,many studies have discovered that autophagy plays a role in the pathogenesis of RA,including the production of pannus,synovitis,bone degradation,and other critical pathological connections that influence RA progression and prog-nosis.This article examines the function of autophagy in the pathogenesis of RA,with the goal of generating new ideas for future RA treatment and drug development.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective To develop and evaluate a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Methods With the systems management theory,a nursing protocol was developed for multidisciplinary team surgery assisted by a da Vinci surgical system.Convenience sampling was employed to select 100 patients who received surgery assisted by a da Vinci surgical system between October 2022 and September 2023 at a Tire-ⅢA hospital in Longyan.The patients received the surgery between October 2022 and April 2023(n=50)were assigned to the control group,and those between May 2023 and September 2023(n=50)were assigned to the trial group.The patients in the control group received routine nursing care,while those in the trial group received a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Preoperative preparation time,setup time for surgery,surgical time,time of hospital stay,ICU admission rate,rate of surgical complication,and scores of satisfaction from medical staff and patients were compared between the two groups.Results Patients in trial group had a shorter time in preoperative preparation and setup than those in the control group(both P<0.001),However,there was no significant difference in surgical time(P>0.05).Patients in the trial group had shorter time of hospital stay,fewer ICU admission and a lower surgical complication rate(all P<0.05),and with higher satisfaction scores from patients,nurses and surgeons(all P<0.001).Conclusion The developed nursing protocol for the multidisciplinary team surgery assisted by a da Vinci surgical system is scientific.It improves surgical efficiency,patient safety and satisfaction among patients,surgeons and nurses.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.