OBJECTIVE To investigate the influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines in elderly patients with ischemic stroke， and to analyze potential factors associated with poor prognosis. METHODS A retrospective study was conducted on elderly patients with ischemic stroke admitted to our hospital from June 2024 to June 2025， wh o underwent CYP2C19 genotype testing and received antiplatelet therapy with clopidogrel. The levels of platelet function indicators and inflammatory cytokines before and after treatment were compared among patients with different metabolic phenotypes. Based on the prognosis at 6 months post-treatment， patients were divided into poor prognosis group and good prognosis group. Univariate analysis was performed on general data， metabolic phenotype， the levels of platelet function indicators and inflammatory cytokines. Variables with P ＜0.05 and the levels of inflammatory cytokines before treatment were included in a multivariate Logistic regression analysis to identify independent risk factors for poor prognosis. Multiple linear regression was used to further analyze the relationship between metabolic phenotypes and inflammatory cytokines. RESULTS A total of 448 elderly patients with ischemic stroke were included； among them， 162 cases were normal metabolic phenotype， 218 were intermediate metabolic phenotype， and 68 were poor metabolic phenotype. No rapid or ultrarapid metabolic phenotypes were observed. After treatment， platelet aggregation rate， the levels of P-selectin and platelet activated complex-1 （PAC-1）， high-sensitivity C-reactive Protein （hs-CRP）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in the normal metabolic phenotype group， intermediate metabolic phenotype group， and poor metabolic phenotype group （except for platelet aggregation rate， and the levels of P-selectin and PAC-1 in the poor metabolic phenotype group） were significantly lower than those before treatment in the same group. Moreover， the above indicators in the normal metabolic phenotype group were significantly lower than those in the intermediate and poor metabolic phenotype groups at the corresponding time， and the levels of platelet function indicators in the intermediate metabolic phenotype group were significantly lower than those in the poor metabol ic phenotype group at the corresponding time （ P ＜0.05）. Univariate and multivariate Logistic regression analyses showed that combined with hypertension， combined with diabetes mellitus， and intermediate or poor metabolic genotypes were independent risk factors for poor prognosis in elderly patients with ischemic stroke （ P ＜0.05）. Multiple linear regression analysis showed that serum levels of hs-CRP， IL-1β， IL-6 and TNF-α before treatment were significantly higher in patients with intermediate and poor metabolic genotypes compared to those with normal metabolic genotype （ P ＜0.05）， with a greater magnitude of increase in inflammatory cytokines observed in the patients with poor metabolic genotype. CONCLUSIONS The elderly ischemic stroke patients with CYP2C19 intermediate and poor metabolic genotypes have poor inhibition effect on platelet and higher levels of inflammatory cytokines than normal metabolic genotype； CYP2C19 gene polymorphism， and in combination with hypertension and diabetes， can be used as independent predictors of poor prognosis.

Background/Aims: Belching can occur either independently or concurrently with reflux symptoms. This study aims to explore the relationship between belching and reflux and explore the underlying mechanisms involved. Methods: Firstly, patients with isolated belching symptoms or concurrent belching and reflux symptoms were retrospectively enrolled. High-resolution esophageal impedance manometry (HRIM) and 24-hour pH impedance monitoring were used to assess belching types and temporal relationship between belching and reflux. Secondly, subjects with belching disorder were prospectively recruited. Postprandial HRIM monitoring was used to clarify the relationship and underlying mechanisms between belching and reflux. Results: In the initial phase, 139 subjects were enrolled. Regardless of patients' symptom spectrum (with or without gastroesophageal reflux symptoms), the proportion of preceding-reflux belching was significantly higher in those with objective evidence of gastroesophageal reflux disease, compared to those without (both P < 0.05), which indicated that belching could trigger reflux events and led to more severe reflux burden. To clarify the potential mechanisms involved, 44 belching subjects were prospectively enrolled in the second phase of this study. HRIM analysis demonstrated that maximum intragastric pressure, gastric–lower esophageal sphincter pressure gradient and gastric–esophageal pressure gradient were significantly higher in preceding-reflux belching than those in independent belching. Conclusions This study demonstrated that belching might trigger reflux by increasing intragastric pressure, elevating the gastric-sphincter pressure gradient, which enables gastric contents to pass through the esophagogastric junction.These findings have crucial clinical significance, suggesting that reducing the occurrence of belching might be a potential treatment for refractory reflux.

OBJECTIVE To establish standards for the rational use of Compound amino acid injection （14AA-SF） （hereinafter referred to as “14AA-SF”）， and evaluate its rationality and cost-effectiveness.METHODS The standards for the rational use of 14AA-SF were established based on the Delphi method. Archived medical records of patients who used 14AA-SF in the Dept. of Neurosurgery of People’s Hospital of Bozhou from January 2024 to December 2025 were randomly selected. On the basis of the established standards for the rational use， the attribute hierarchical model was applied to evaluate the use rationality of 14AA-SF in the included medical records. The decision tree model was applied to calculate the incremental cost-effectiveness ratio （ICER）， so as to evaluate the cost-effectiveness of 14AA-SF administered via single-bottle infusion versus “all-in-one” infusion， and the robustness of the cost-effectiveness evaluation results was verified through sensitivity analysis.RESULTS A total of 205 medical records were collected， among which 163 records （79.51%） were qualified with medical record score （MRS） ≥90， and 42 records （20.49%） were unqualified with MRS ＜90. The main irrational types of 14AA-SF use included unreasonable infusion method （67 case-times， accounting for 32.68%）， unreasonable amino acid dosage （62 case-times， accounting for 30.24%） and unreasonable non-protein calorie-nitrogen ratio （55 case-times， accounting for 26.83%）. Compared wtih single-bottle infusion， the incremental cost of “all-in-one” infusion for each 1% increase in effective rate was 165.40 yuan. The one-way sensitivity analysis showed that the effective rate of single-bottle infusion had the greatest impact on ICER. The probabilistic sensitivity analysis showed that under the willingness-to-pay （WTP） threshold （89 358 yuan） set in this study， the cost-effectiveness probability of “all-in-one” infusion relative to single-bottle infusion was 89.9%. When the WTP threshold exceeds 17 871.60 yuan， the “all-in-one” infusion is more cost-effective than the single-bottle infusion.CONCLUSIONS The established standards for the rational use of 14AA-SF are practical and feasible. There are phenomena of irrational use of 14AA-SF in Dept. of Neurosurgery of the hospital in terms of indications， nutritional risk screening， infusion methods and other aspects， which need to be further standardized. The “all-in-one” infusion is more cost-effective than the single-bottle infusion.

Lipid rafts are microdomains in the cell membrane that are involved in cell signal transduction,metabolism,and intercellu-lar interactions.In recent years,studies have shown that lipid rafts play an important role in the pathogenesis of diabetes.Cholesterol and sphingolipids are the main lipid components in lipid rafts,and the protein components in lipid rafts include caveolin,flotillin,pal-mitoylated proteins,and glycosylphosphatidylinositol-anchored proteins.Changes in these components affect the structure and function of lipid rafts,which in turn may affect insulin signal transduction,leading to the occurrence of diabetes-related diseases.Lipid rafts are closely related to the occurrence and development of diabetes in different tissues.Pancreatic lipid rafts are closely related to insulin se-cretion,and their structural changes affect insulin synthesis and release.Changes in lipid rafts in adipose tissue are related to insulin resistance and disorders of glycolipid metabolism.Changes in lipid rafts in the liver can affect gluconeogenesis and glycogen synthesis.Lipid rafts in the kidney play a regulatory role in the progression of diabetic nephropathy.This article aims to provide a comprehensive overview of the role of lipid rafts in the pathogenesis of diabetes,offering insights into the identification of new targets for the prevention and treatment of diabetes in the future,as well as presenting a new perspective for the development of therapeutic agents for diabetes.

Objective To investigate the correlation between total oxidation state(TOS),superoxide dis-mutase(SOD),glutathione reductase(GR)and androgen receptor(AR)expression,as well as their predictive value for castration-resistant prostate cancer(CRPC).Methods A retrospective analysis was conducted on the clinical data of 382 patients with prostate cancer who received endocrine therapy in our hospital from Janu-ary 2021 to March 2023.These patients were divided into a CRPC group(91 cases)and a non-CRPC group(291 cases)based on whether they progressed to CRPC within one year.The clinical data of the two groups were compared,and the levels of TOS,SOD,GR,and AR expression before and after treatment were com-pared between the two groups.The correlation between TOS,SOD,GR,and AR expression was analyzed using the Spearman method.The relationship between TOS,SOD,GR,and AR expression in the CRPC group was analyzed using partial correlation analysis.Logistic regression analysis was used to investigate the impact of TOS,SOD,and GR on the occurrence of CRPC after 1 month of treatment,and receiver operating charac-teristic(ROC)curve analysis was used to evaluate the predictive efficacy of TOS,SOD,and GR on CRPC af-ter 1 month of treatment.Results Gleason score ≥8 and T4 in clinical stage in CRPC group were higher than those in non-CRPC group,and the difference was statistically significant(P＜0.05).After 1 month and 1 year of treatment,the positive expression rates of TOS and AR in both groups were higher than before treatment,while the levels of SOD and GR were lower than before treatment,with a statistically significant difference(P＜0.05).After 1 month and 1 year of treatment,the TOS level and AR positive expression rate in the CRPC group were higher than those in the non-CRPC group,while the SOD and GR levels were lower than those in the non-CRPC group,with statistical significance(P＜0.05).Spearman correlation analysis showed that TOS was positively correlated with AR expression in the CRPC group after 1 month and 1 year of treat-ment(P＜0.05),while SOD and GR were negatively correlated with AR expression(P＜0.05).Logistic re-gression analysis showed that,Gleason score ≥8,T4 in clinical stage,and TOS,SOD,and GR after 1 month of treatment were all associated with the occurrence of CRPC(P＜0.05).It was found that after adjusting for Gleason score and clinical stage,TOS,SOD,and GR were still independent factors for CRPC after 1 month of treatment(P＜0.05).The ROC curve analysis results showed that the area under the curve of TOS,SOD,and GR combined to predict CRPC after 1 month of treatment was 0.938(95％CI:0.908-0.960),which was higher than that of each indicator alone.Conclusion The expression of TOS,SOD,GR,and AR is correlated to some extent,and combined detection has certain predictive value for CRPC.It can be used as an auxiliary indicator for clinical prediction of CRPC and has certain guiding value for subsequent clinical decisions for patients.

Objective:To investigate the prospective association between lifestyle and the risk for all-cause mortality in middle-aged and elderly residents in China.Methods:The data from China Health and Retirement Longitudinal Study were used. Baseline information about the lifestyle were collected through questionnaire survey and physical measurements, and the mortality data were obtained through surveys conducted at 2-3 year intervals. A total of 5 436 study participants were included. A comprehensive lifestyle including smoking, alcohol consumption, sleep, BMI and physical activity was constructed, and a multivariate-adjusted Cox proportional hazards regression model was used to estimate the association between lifestyle and the risk for all-cause mortality.Results:During the follow-up of average 8.2 years, 695 deaths were recorded. The comprehensive lifestyle score was linearly associated with the risk for all-cause mortality. Compared with the study participants with comprehensive lifestyle score of 0-1, those with score of 2-5 all had lower risk for all-cause mortality, with HRs of 0.78 (95% CI: 0.62-0.98), 0.56 (95% CI: 0.44-0.72), 0.36 (95% CI:0.27-0.48), and 0.33 (95% CI: 0.21-0.52), respectively. The results of Cox proportional hazards regression model analysis of single lifestyle showed that compared with those with unhealthy lifestyles, the HRs of all-cause mortality for study participants who never smoked, had moderate alcohol consumption, had appropriate night sleep, maintained healthy body weight and kept active physical activity were 0.70 (95% CI: 0.57-0.84), 0.76 (95% CI: 0.64-0.90), 0.79 (95% CI: 0.67-0.94), 0.73 (95% CI: 0.62-0.87), and 0.68 (95% CI: 0.58-0.80), respectively. Conclusions:Keeping healthy lifestyles can significantly reduce the risk for all-cause mortality in middle-aged and elderly residents China. The higher the healthy lifestyle level, the lower the risk for all-cause mortality.

Objective:To investigate the diversity, temporal dynamics and influencing factors of serotypes of Salmonella among asymptomatic workers in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and provide reference for controlling the hidden transmission of Salmonella and for disease prevention among healthy populations. Methods:Anal rectal swabs were collected from asymptomatic workers in Yulin from 2013 to 2023 for the isolation and identification of Salmonella. The diversity of serotypes of Salmonella was evaluated by using Shannon index, while the isolation rates and composition ratio of different serotypes were compared with χ2 test. Spearman correlation analysis was used to evaluate the correlation of natural and social factors with serotype isolation rates for more than eight years, and stepwise multiple linear regression analysis were used to evaluate the impact of social factors on the serotype isolation rates for more than 8 years. Results:A total of 8 073 strains of Salmonella were isolated from 2013 to 2023, with an overall isolation rate of 18.88‰ During the 11-year period, 135 serotypes of Salmonella were identified, and the serotype diversity increased first and then decreased. The serotype with the highest isolation rate was Salmonella Typhimurium (3.04‰), followed by Salmonella Rissen (1.70‰), Salmonella Corvallis (1.41‰), Salmonella Agona (1.36‰), Salmonella Derby (1.22‰), and Salmonella London (1.02‰), accounting for 51.67% of the total Salmonella serotypes isolated. There was no significant trend in isolation rate of Salmonella over the years ( χ2=0.67, P=0.415); however, season significantly influenced the isolation rate, with lower rate being observed in winter and higher rate in summer ( χ2=615.91, P<0.001). The isolation rate of different serotypes of Salmonella was influenced by social and natural factors, showing a positive correlation with temperature, precipitation, and poultry consumption and production levels. Conclusions:The serotypes of Salmonella carried by asymptomatic workers were complex and diverse in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and the isolation rates of multi-serotypes increased from 2013 to 2023. Higher isolation rate was observed in summer and the isolation rate was widely influenced by natural factors such as temperature and precipitation, as well as social factors such as economic conditions. It is necessary to pay attention to the Salmonella serotype carriage in healthy population, and strengthen monitoring of both healthy individuals and pathogenic bacteria.

Objective To observe the efficacy,safety,and compliance of lamotrigine combined with magnesium valproate in treating children with depressive episodes of bipolar disorder,and to explore the effects on thyroid hormone levels,brain-derived neurotrophic factor(BDNF),C-reactive protein(CRP),interleukin-1(IL-1),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and plasma concentration of valproate.Methods The children with bipolar disorder diagnosed from January 2023 to February 2025 were selected,and divided into the observation group and control group.The control group was treated with magnesium valproate tablets,and the observation group was added lamotrigine in addition to the treatment given to the control group.Both groups were treated continuously for 8 weeks.The clinical efficacy,the Hamilton Depression Scale-24(HAMD-24)score,Clinical Global Impression(CGI)assessment,thyroid hormone levels,BDNF,CRP,IL-1,IL-10 and TNF-α,daily average dose of magnesium valproate(D),blood concentration of valproate(C),C/D ratio,mean dosing interval(h),incidence of adverse reactions,and medication adherence and satisfaction scores in both groups was observed.Results A total of 100 children were included,50 in each group.After treatment,the total effective rate of the observation group was 98.00％which was significantly higher than that of the control group(84.00％)(P＜0.05).The serum free triiodothyronine(FT3),free thyroxine(FT4),BDNF and IL-10 in both groups increased compared to the previous(P＜0.05),while HAMD-24 score,CGI score,thyroid-stimulating hormone(TSH),CRP,IL-1 and TNF-α decreased(P＜0.05),and all indicators in the observation group were better than those in the control group(P＜0.05).Both groups had no serious or new adverse drug reactions,and the incidence of total adverse reactions,the difference in the incidence of total adverse reactions was not statistically significant(P＞0.05).There was no statistically significant difference in valproic acid blood concentrations between the two groups of children(P＞0.05).The medication compliance score and satisfaction score of the observation group were significantly higher than those of the control group(P＜0.05).Conclusion Combination of lamotrigine with magnesium valproate in children with depressive episodes of bipolar disorder improves treatment effective and clinical symptoms,promotes a rise in thyroid hormone and BDNF as well as improves inflammatory factors and increases medication adherence and satisfaction in children with a better safety profile.

Objective:To investigate the prospective association between lifestyle and the risk for all-cause mortality in middle-aged and elderly residents in China.Methods:The data from China Health and Retirement Longitudinal Study were used. Baseline information about the lifestyle were collected through questionnaire survey and physical measurements, and the mortality data were obtained through surveys conducted at 2-3 year intervals. A total of 5 436 study participants were included. A comprehensive lifestyle including smoking, alcohol consumption, sleep, BMI and physical activity was constructed, and a multivariate-adjusted Cox proportional hazards regression model was used to estimate the association between lifestyle and the risk for all-cause mortality.Results:During the follow-up of average 8.2 years, 695 deaths were recorded. The comprehensive lifestyle score was linearly associated with the risk for all-cause mortality. Compared with the study participants with comprehensive lifestyle score of 0-1, those with score of 2-5 all had lower risk for all-cause mortality, with HRs of 0.78 (95% CI: 0.62-0.98), 0.56 (95% CI: 0.44-0.72), 0.36 (95% CI:0.27-0.48), and 0.33 (95% CI: 0.21-0.52), respectively. The results of Cox proportional hazards regression model analysis of single lifestyle showed that compared with those with unhealthy lifestyles, the HRs of all-cause mortality for study participants who never smoked, had moderate alcohol consumption, had appropriate night sleep, maintained healthy body weight and kept active physical activity were 0.70 (95% CI: 0.57-0.84), 0.76 (95% CI: 0.64-0.90), 0.79 (95% CI: 0.67-0.94), 0.73 (95% CI: 0.62-0.87), and 0.68 (95% CI: 0.58-0.80), respectively. Conclusions:Keeping healthy lifestyles can significantly reduce the risk for all-cause mortality in middle-aged and elderly residents China. The higher the healthy lifestyle level, the lower the risk for all-cause mortality.

Objective:To investigate the diversity, temporal dynamics and influencing factors of serotypes of Salmonella among asymptomatic workers in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and provide reference for controlling the hidden transmission of Salmonella and for disease prevention among healthy populations. Methods:Anal rectal swabs were collected from asymptomatic workers in Yulin from 2013 to 2023 for the isolation and identification of Salmonella. The diversity of serotypes of Salmonella was evaluated by using Shannon index, while the isolation rates and composition ratio of different serotypes were compared with χ2 test. Spearman correlation analysis was used to evaluate the correlation of natural and social factors with serotype isolation rates for more than eight years, and stepwise multiple linear regression analysis were used to evaluate the impact of social factors on the serotype isolation rates for more than 8 years. Results:A total of 8 073 strains of Salmonella were isolated from 2013 to 2023, with an overall isolation rate of 18.88‰ During the 11-year period, 135 serotypes of Salmonella were identified, and the serotype diversity increased first and then decreased. The serotype with the highest isolation rate was Salmonella Typhimurium (3.04‰), followed by Salmonella Rissen (1.70‰), Salmonella Corvallis (1.41‰), Salmonella Agona (1.36‰), Salmonella Derby (1.22‰), and Salmonella London (1.02‰), accounting for 51.67% of the total Salmonella serotypes isolated. There was no significant trend in isolation rate of Salmonella over the years ( χ2=0.67, P=0.415); however, season significantly influenced the isolation rate, with lower rate being observed in winter and higher rate in summer ( χ2=615.91, P<0.001). The isolation rate of different serotypes of Salmonella was influenced by social and natural factors, showing a positive correlation with temperature, precipitation, and poultry consumption and production levels. Conclusions:The serotypes of Salmonella carried by asymptomatic workers were complex and diverse in Yulin, Guangxi Zhuang Autonomous Region, from 2013 to 2023, and the isolation rates of multi-serotypes increased from 2013 to 2023. Higher isolation rate was observed in summer and the isolation rate was widely influenced by natural factors such as temperature and precipitation, as well as social factors such as economic conditions. It is necessary to pay attention to the Salmonella serotype carriage in healthy population, and strengthen monitoring of both healthy individuals and pathogenic bacteria.