Ferroptosis is a novel form of programmed cell death that plays a critical role in the body's disease resistance processes. Research has shown that ferroptosis plays a significant role in the pathogenesis of depression. Traditional Chinese medicine （TCM） has unique advantages in the prevention and treatment of depression， and the effective application of ferroptosis theory to guide TCM in the prevention and treatment of depression has become a current research hotspot. This article provides a summary and review of the regulatory mechanisms of ferroptosis， its relationship with depression， and the current research status of TCM in the prevention and treatment of depression based on ferroptosis. It has been found that the occurrence of ferroptosis is related to processes such as iron metabolism disorders， uncontrolled lipid peroxidation， and abnormal amino acid metabolism. Ferroptosis plays an important regulatory role in the onset， progression， and treatment of depression， offering new ideas for therapeutic approaches to the condition. Additionally， research on TCM interventions that regulate ferroptosis to exert antidepressant effects has identified several effective components， such as saikosaponin B₂， luteolin， quercetin， gallic acid， catalpol， turmerone， oxypaeoniflorin， and traditional compound formulas such as Dihuang Yinzi and Xiaoyaosan， as well as acupuncture and moxibustion. These interventions have been shown to exert antidepressant effects by regulating ferroptosis， providing scientific evidence and references for further research into ferroptosis theory and its application in guiding the prevention and treatment of depression through TCM.

Objective To investigate the diagnostic value of neutrophils CD64(nCD64)index,C reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)in viral and bacterial upper respiratory tract infections.Methods Patients with upper respiratory tract infection treated in Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from January 2023 to January 2024 were selected as study objects.According to the results of etiological examination,they were divided into bacterial infection group(46 cases)and viral infection group(58 cases).The levels of nCD64 index,CRP,IL-6 and PCT before medication were compared between two groups.Receiver operating characteristic(ROC)curve was used to evaluate the value of infection markers in the differential diagnosis of bacterial and viral upper respiratory tract infections.Results The levels of CRP,nCD64 index,IL-6 and PCT in bacterial infection group were significantly higher than those in viral infection group(P＜0.01).ROC curve results showed that the area under the curve(AUC)of nCD64 index,CRP,PCT and IL-6 to distinguish the two types of infection were 0.818,0.776,0.692 and 0.654,respectively,and the combined AUC of four indexes was 0.870.Conclusion nCD64 index,CRP,IL-6 and PCT are closely related to the pathogen types of patients with upper respiratory tract infection,and the combined detection of all indicators can improve the diagnostic efficiency of upper respiratory tract infection types.

Objective:To investigate the antidepressant mechanism of Ziziphi Spinosae Semen and Albiziae Flos through network pharmacology,molecular docking,and cellular experiments.Methods:Active compounds and targets were identified using TCMSP,BATMAN-TCM,GeneCards,and OMIM databases,followed by standardization via the Uniprot database.A Venn diagram was created using venn2.1.0,and a protein-protein interaction(PPI)network was constructed with Cytoscape 3.8.2 and STRING to identify core targets.GO functional and KEGG pathway enrichment analyses were performed using R language.Molecular docking was validated using AutoDock Vina,and the key path-ways and targets were verified by constructing an in vitro model.Results:Twelve active components of Ziziphi Spinosae Semen and Albiziae Flos act on 109 potential depression targets.GO and KEGG analyses identified 2,439 and 163 en-tries,respectively.Based on degree value and enrichment level,core targets such as transcription factor JUN,AKT1,IL-6,and pathways including AGE-RAGE and PI3K/AKT were identified.Molecular docking demonstrated a favorable binding affinity between the active components and core targets.Cellular experiments revealed that serum containing Ziziphi Spinosae Semen and Albiziae Flos at low,medium,and high doses alleviated CORT-induced PC12 cell damage,increased Cell viability,and reduced apoptosis rates.It also upregulated PI3K/AKT pathway protein expression and downregulated endoplasmic reticulum stress related apoptotic protein expression,with more pronounced improvements observed in the medium and high-dose groups(all P＜0.01).Conclusion:The antidepressant effects of Ziziphi Spi-nosae Semen and Albiziae Flos are largely achieved by activating the PI3K/AKT signaling pathway and inhibiting exces-sive ERS,which in turn reduces neuronal apoptosis.

Objective:To investigate the antidepressant mechanism of Ziziphi Spinosae Semen and Albiziae Flos through network pharmacology,molecular docking,and cellular experiments.Methods:Active compounds and targets were identified using TCMSP,BATMAN-TCM,GeneCards,and OMIM databases,followed by standardization via the Uniprot database.A Venn diagram was created using venn2.1.0,and a protein-protein interaction(PPI)network was constructed with Cytoscape 3.8.2 and STRING to identify core targets.GO functional and KEGG pathway enrichment analyses were performed using R language.Molecular docking was validated using AutoDock Vina,and the key path-ways and targets were verified by constructing an in vitro model.Results:Twelve active components of Ziziphi Spinosae Semen and Albiziae Flos act on 109 potential depression targets.GO and KEGG analyses identified 2,439 and 163 en-tries,respectively.Based on degree value and enrichment level,core targets such as transcription factor JUN,AKT1,IL-6,and pathways including AGE-RAGE and PI3K/AKT were identified.Molecular docking demonstrated a favorable binding affinity between the active components and core targets.Cellular experiments revealed that serum containing Ziziphi Spinosae Semen and Albiziae Flos at low,medium,and high doses alleviated CORT-induced PC12 cell damage,increased Cell viability,and reduced apoptosis rates.It also upregulated PI3K/AKT pathway protein expression and downregulated endoplasmic reticulum stress related apoptotic protein expression,with more pronounced improvements observed in the medium and high-dose groups(all P＜0.01).Conclusion:The antidepressant effects of Ziziphi Spi-nosae Semen and Albiziae Flos are largely achieved by activating the PI3K/AKT signaling pathway and inhibiting exces-sive ERS,which in turn reduces neuronal apoptosis.

Objective To investigate the diagnostic value of neutrophils CD64(nCD64)index,C reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)in viral and bacterial upper respiratory tract infections.Methods Patients with upper respiratory tract infection treated in Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from January 2023 to January 2024 were selected as study objects.According to the results of etiological examination,they were divided into bacterial infection group(46 cases)and viral infection group(58 cases).The levels of nCD64 index,CRP,IL-6 and PCT before medication were compared between two groups.Receiver operating characteristic(ROC)curve was used to evaluate the value of infection markers in the differential diagnosis of bacterial and viral upper respiratory tract infections.Results The levels of CRP,nCD64 index,IL-6 and PCT in bacterial infection group were significantly higher than those in viral infection group(P＜0.01).ROC curve results showed that the area under the curve(AUC)of nCD64 index,CRP,PCT and IL-6 to distinguish the two types of infection were 0.818,0.776,0.692 and 0.654,respectively,and the combined AUC of four indexes was 0.870.Conclusion nCD64 index,CRP,IL-6 and PCT are closely related to the pathogen types of patients with upper respiratory tract infection,and the combined detection of all indicators can improve the diagnostic efficiency of upper respiratory tract infection types.

Objective:To investigate the application value of Overlap guiding tube (OGT) in Overlap esophagojejunostomy of laparoscopic total gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with gastric cancer who were admitted to Nanfang Hospital of Southern Medical University from June to July in 2021 were collected. There were 3 males and 2 females, aged from 48 to 61 years, with a median age of 54 years. Patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative anastomotic stenosis and esophageal reflux up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 5 patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy and D 2 lymph node dissection success-fully, achieving R 0 resection. There was no combined organ resection, intraoperative conversion to laparotomy or combined thoracotomy. There was no intraoperative conversion to other esophagoje-junostomy method either. The tumor diameter, length of surgical incision, the number of lymph nodes dissected, time of esophagojejunal anastomosis, time of digestive reconstruction, operation time, volume of intraoperative blood loss of 5 patients were 3.0(2.8)cm, 5.0(2.0)cm, 47.0(21.0), 21.0(5.0)minutes, 62.0(23.0)minutes, 295.0(75.0)minutes, and 50.0(60.0)mL, respectively. The anvil fork of linear stapler was successfully inserted into esophageal lumen by once operation in 4 cases of 5 patients and by twice operation in 1 case to complete the esophagojejunostomy. (2) Post-operative situations: the time to first out-of-bed activities, time to postoperative first anal flatus, time to postoperative initial liquid diet intake, time to postoperative initial semi-liquid diet intake, time to abdominal drainage tube removal, duration of postoperative hospital stay of 5 patients were 2.0(1.0)days, 3.0(2.0)days, 4.0(3.0)days, 6.0(3.0)days, 7.0(4.0)days, and 9.0(6.0)days, respectively. Results of postoperative pathological examination of 5 patients showed gastric adenocar-cinoma in all the 5 patients, with the TNM staging as stage pT2-4aN0M0. The esophageal surgical margin was negative in all cases, and the length of proximal margin from esophagus was 5.0(4.0)cm. None of the 5 patients developed anastomotic leakage, anastomotic bleeding or anastomotic stenosis. Two cases with mild pneumonia (Clavien-Dindo grade Ⅱ) were cured by conservative treatment such as anti-infection and expectoration promotion. There was no unplanned secondary surgery or perioperative death occurred to the 5 patients. (3) Follow-up: 5 patients were followed up for 3 months. None of the 5 patients developed anastomotic stenosis or esophageal reflux during the follow-up. Conclusion:OGT-assisted Overlap esophagojejunostomy of laparoscopic total gas-trectomy is safe and feasible, with good short-term effects.

Objective:To analyze the dosimetric differences of volumetric modulated arc therapy (VMAT) plans for lung cancer caused by different dose calculation algorithms and radiation field settings and thus to provide a reference for designing clinical VMAT plans for lung cancer.Methods:This study randomly selected 20 patients with lung cancer and divided them into four groups of VMAT plans, namely, a group adopting two fields and two arcs based on the AAA algorithm (2F2A_AAA), a group employing two fields and two arcs based on the AXB algorithm (2F2A_AXB), a group using two fields and two arcs based on the MC algorithm (2F2A_MC), and a group adopting one field and two arcs based on the MC algorithm (1F2A_MC). Then, this study evaluated the target coverage, high-dose control, dose homogeneity index (HI), conformity index (CI), and organs at risk (OARs) of the plans using different algorithms and radiation field settings.Results:The planning target volume (PTV) results of two fields combined with two arcs (2F2A) of three groups using different algorithms are as follows. 2F2A_MC achieved better results in both D1% and V 95% (the relative volume of the target volume surrounded by 95% of the prescribed dose) of planning gross target volume (PGTV) than 2F2A_AAA (D1%: t=-2.44, P=0.03; V95%:z=-2.04, P=0.04) and 2F2A_AXB (D1%: t=2.34, P=0.03; z=-3.21, P < 0.01). 2F2A_AXB outperformed 2F2A_AAA ( z=-3.66, P < 0.01) and was comparable to 2F2A_MC in terms of the CI of PGTV. Regarding OARs, 2F2A_AXB and 2F2A_MC decreased the V5 Gy of the whole lung by 0.68% ( z=-2.69, P=0.01) and 3.05% ( z=-3.52, P < 0.01), respectively compared to 2F2A_AAA. 2F2A_AXB achieved a whole-lung Dmean of 1776.44 cGy, which was superior to that of 2F2A_MC ( t=2.67, P=0.02) and 2F2A_AAA ( t=8.62, P < 0.01). Compared to 2F2A_AAA and 2F2A_MC, 2F2A_AXB decreased the V20 Gy of Body_5 mm by 1.45% ( z=-3.88, P < 0.01) and 2.01% ( z=-3.66, P < 0.01), respectively. The results of the two groups with different field settings showed that 1F2A_MC was superior to 2F2A_MC in both the CI of PTV1 and the HI of PTV2 (CI: t=2.61, P=0.02; HI: z=-2.20, P=0.03). Moreover, 1F2A_MC increased the Dmean of the whole lung by 26.29 cGy compared to 2F2A_MC ( t=2.28, P=0.04). Conclusions:Regarding the design of VMAT plans for lung cancer, the MC algorithm is suitable for the target priority and the AXB algorithm is suitable for the OAR priority. When only the MC algorithm is available, it is recommended to choose 1F2A in the case of target priority and select 2F2A in the case of OAR priority.

Objective:To explore the serum tenascin-C levels in patients with acute ST-segment elevation myocardial infarction (STEMI) and its impact on the long-term prognosis.Methods:One hundred and thirteen STEMI patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Dalian Medical University and successfully underwent emergency PCI from June 2015 to June 2016 were included in this prospective study. The serum tenascin-C levels were measured during hospitalization, and the patients were divided into tenascin-C ≥ 120 μg/L group and tenascin-C<120 μg/L group according to the serum tenascin-C level. Major adverse cardiovascular events (MACE) were observed during the 5 years follow up in all patients. According to the incidence of MACE, the patients were divided into MACE group and non-MACE group, and the predictive factors of MACE were analyzed. Continuous variables were presented as the mean±standard deviation and compared with the Student′s t-test. Categorical variables were presented as percentages and compared with the Chi-square test or Fisher′s exact test. Receiver operating characteristic (ROC) curve was used to analyze the value of serum tenascin-C level in predicting MACE in STEMI patients. Kaplan Meier survival analysis was used to compare the incidence of MACE between two groups. Cox proportional hazards regression model was used to analyze the risk factors of MACE during the 5 years follow up.Results:The serum tenascin-C levels in the STEMI patients increased on the first day after the onset of disease (46.5±24.8 μg/L), peaked on the third day (97.5±41.2 μg/L), and then gradually decreased. All patients were followed up for 5 years. There were 37 cases of MACE, including 4 cases of cardiac death (3.5%), 14 cases of heart failure (12.4%), 14 cases of recurrent myocardial infarction or revascularization (12.4%), and 5 cases of stroke (4.4%). For prediction of MACE, the area under the curve of the serum TN-C level was 0.953 (95% CI 0.918-0.988, P<0.05), which was thus a valuable biomarker in predicting MACE for STEMI patients. The incidence of MACE in the group of tenascin-C≥120 μg/L group was higher than that in the group of tenascin-C<120 μg/L group (86.4% [19/22] vs 19.8% [18/91]), and Kaplan-Meier survival analysis showed that the difference was statistically significant ( P<0.05). Cox proportional hazards model analysis showed that serum tenascin-C level was an independent predictor of MACE for STEMI patients during the 5 years follow-up ( HR=1.007, 95% CI 1.001-1.012, P<0.05). In addition, other variables including high sensitivity C-reactive protein ( HR=1.028, 95% CI 1.007-1.049, P<0.05), and cardiac troponin Ⅰ ( HR=1.004, 95% CI 1.000-1.008, P<0.05) were also found to be the independent predictors of MACE. Conclusions:The serum tenascin-C levels in STEMI patients increased significantly during the acute disease phase. Detecting the serum tenascin-C levels is valuable for predicting MACE in STEMI patients, and serum tenascin-C is an independent predictor of MACE in STEMI patients during the long-term follow-up period after acute myocardial infarction.

Objective:To explore the influencing factors of lower extremity ischemic injury in patients with extracorporeal membrane oxygenation (ECMO) .Methods:From July 2016 to December 2020, convenience sampling was used to select 123 ECMO patients admitted to the Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine as the research object. Based on the occurrence of lower extremity ischemia, the patients with lower extremity ischemia were included in the ischemic injury group ( n=21) , and the patients without lower extremity ischemia were included in the non-ischemic injury group ( n=102) . The clinical data of the two groups of patients were collected, and the influencing factors of lower extremity ischemia in ECMO patients were analyzed by multivariate Logistic regression. Results:Multivariate Logistic regression analysis showed that diabetes, cardiac arrest, left ventricular ejection fraction, and ECMO adjuvant time were all influencing factors for lower extremity ischemia in ECMO patients, and the differences were statistically significant ( P<0.05) . Conclusions:The occurrence of lower extremity ischemia in ECMO patients is related to factors such as diabetes mellitus and left ventricular ejection fraction, which needs medical and nursing staff to attach great importance to it and take measures to actively prevent it.

Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.