Objective To explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

Objective To evaluate the value of postoperative radiotherapy (PORT) in patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy. Methods Patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy were chosen from the SEER Research Plus Database [17 Registries, November 2012 Submission (2000-2019)]. The patients were divided into a PORT group and a non-PORT group according to whether the PORT was used. To balance baseline characteristics between non-PORT and PORT groups, R software was used to conduct a propensity score matching (PSM) with a ratio of 1 : 1 and a matching tolerance of 0.01. Both the Cox regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the value of PORT in terms of overall survival (OS) and disease-specific survival (DSS). Results In total, 2468 patients with stage ⅢA-N2 non-small cell lung cancer were enrolled, including 1078 males and 1390 females with a median age of 65 (58-71) years. There were 1336 patients in the PORT group, and 1132 patients in the non-PORT group. Cox regression analysis showed that PORT was not significantly associated with OS (multivariate analysis: HR=1.051, 95%CI 0.949-1.164, P=0.338) and DSS (multivariate analysis: HR=1.094, 95%CI 0.976-1.225, P=0.123). No statistical difference was found in the OS or DSS between non-PORT group and PORT group after PSM analysis (P＞0.05). Conclusion PORT does not have a survival benefit for patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy.

Objective:To investigate the predictive value of serum homocysteine (Hcy), neutrophil to lymphocyte ratio (NLR) and total imaging load score on cognition disorders in patients with small cerebral vascular disease (CSVD).Methods:A total of 106 CSVD patients treated in Shanxi Hongdong County People's Hospital from June 2021 to June 2024 were retrospectively selected as the study objects. The Montreal Cognitive Assessment Scale (MoCA) was used to assess cognitive function. Among them, 43 patients with cognition disorders and 63 patients without cognition disorders were evaluated. Another 30 healthy subjects over 60 years old were selected as control group. General data and serum Hcy, NLR and other indicators of the three groups were compared, MRI examination was performed, and the total imaging load score was calculated. Logistic regression was used to analyze the risk factors of cognition disorders in CSVD patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of Hcy, NLR and radiographic total load score for cognition disorders in CSVD patients.Results:The levels of Hcy, NLR and total imaging load scores in the CSVD group were higher than those in the CSVD group and the control group : (20.32 ± 3.24) μmol/L vs. (17.75 ± 2.81), (14.96 ± 3.84) μmol/L; 2.77 ± 0.75 vs. 2.27 ± 0.68, 1.93 ± 0.47; (1.28 ± 0.73) scores vs. (0.92 ± 0.55), (0.36 ± 0.21) scores, there were statistical differences ( P<0.05). The results of Logistic regression showed that Hcy, NLR and total load score were risk factors for cognition disorders ( P<0.05). The results of ROC curve showed that the area under the curve (AUC) of Hcy, NLR, total imaging load score combined prediction of cognition disorders was 0.798. Conclusions:Hcy, NLR and total imaging load score are risk factors for cognition disorders in CSVD, and have certain predictive value for cognition disorders.

Objective To explore medical institution-led exercise training interventions,prelimina-ry preventive measures,and comprehensive health service strategies for elderly adults.Methods Sixty elderly adults from communities under the jurisdiction of primary hospitals who voluntarily participated in the training and met the inclusion criteria were divided into 75 to 79 years old group and 80 to 84 years old group.Elastic bands exercise were selected as the method for physical training for elderly community members.A total of three sets(9 items)of exercise,including upper and lower limb mus-cle strength exercises and balance as well as coordination training,were designed.The training period lasted for 12 weeks,with each session lasting 1 hour,three times a week.The medical team partici-pated in training supervision and follow-up evaluations throughout the process,dynamically adjusting the training intensity based on individual needs.Results Comprehensive safety and support meas-ures significantly improved training participation and completion rates.No sports injuries or adverse events occurred throughout the process,and all participants completed the training plan.After train-ing,statistically significant differences were observed in grip strength,five-times sit-to-stand test duration,Berg Balance Scale(BBS)scores,and Timed Up and Go(TUG)test results(P＜0.05),indicating effective physical fitness improvement.Conclusion Elastic band exercises are a suitable mode for physical improvement training among elderly adults,significantly enhancing muscle strength in the limbs and trunk and improving balance function.The positive communication and in-teraction in group activities significantly boost elderly adults'confidence in healthy living,leading to notable improvements in their mental state.

Objective To establish an individualized nomogram model and evaluate its efficacy to provide a possible evaluation basis for the prognosis of lower third and abdominal part of oesophageal adenocarcinoma (EAC). Methods Lower third and abdominal part of EAC patients from 2010 to 2015 were chosen from the SEER Research Plus Database (17 Regs, 2022nov sub). The patients were randomly allocated to the training cohort and the internal validation cohort with a ratio of 7∶3 using bootstrap resampling. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) in EAC patients, which would be elected to construct the nomogram prediction model. C-index, calibration curve and receiver operating characteristic (ROC) curve were performed to evaluate its efficacy. Finally, the efficacy to evaluate the OS of EAC patients was compared between the nomogram prediction model and TNM staging system. Results In total, 3945 patients with lower third and abdominal part of EAC were enrolled, including 3475 males and 470 females with a median age of 65 (57-72) years. The 2761 patients were allocated to the training cohort and the remaining 1184 patients to the internal validation cohort. In the training and the internal validation cohorts, the C-index of the nomogram model was 0.705 and 0.713, respectively. Meanwhile, the calibration curve also suggested that the nomogram model had a strong capability of predicting 1-, 3-, and 5-year OS rates of EAC patients. The nomogram also had a higher efficacy than the TNM staging system in predicting 1-, 3-, and 5-year OS rates of EAC patients. Conclusion This nomogram prediction model has a high efficiency for predicting OS in the patients with lower third and abdominal part of EAC, which is higher than that of the current TNM staging system.

Objective:To investigate the predictive value of serum homocysteine (Hcy), neutrophil to lymphocyte ratio (NLR) and total imaging load score on cognition disorders in patients with small cerebral vascular disease (CSVD).Methods:A total of 106 CSVD patients treated in Shanxi Hongdong County People's Hospital from June 2021 to June 2024 were retrospectively selected as the study objects. The Montreal Cognitive Assessment Scale (MoCA) was used to assess cognitive function. Among them, 43 patients with cognition disorders and 63 patients without cognition disorders were evaluated. Another 30 healthy subjects over 60 years old were selected as control group. General data and serum Hcy, NLR and other indicators of the three groups were compared, MRI examination was performed, and the total imaging load score was calculated. Logistic regression was used to analyze the risk factors of cognition disorders in CSVD patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of Hcy, NLR and radiographic total load score for cognition disorders in CSVD patients.Results:The levels of Hcy, NLR and total imaging load scores in the CSVD group were higher than those in the CSVD group and the control group : (20.32 ± 3.24) μmol/L vs. (17.75 ± 2.81), (14.96 ± 3.84) μmol/L; 2.77 ± 0.75 vs. 2.27 ± 0.68, 1.93 ± 0.47; (1.28 ± 0.73) scores vs. (0.92 ± 0.55), (0.36 ± 0.21) scores, there were statistical differences ( P<0.05). The results of Logistic regression showed that Hcy, NLR and total load score were risk factors for cognition disorders ( P<0.05). The results of ROC curve showed that the area under the curve (AUC) of Hcy, NLR, total imaging load score combined prediction of cognition disorders was 0.798. Conclusions:Hcy, NLR and total imaging load score are risk factors for cognition disorders in CSVD, and have certain predictive value for cognition disorders.

Depressive disorder is the main cause of suicide death. According to data released by the World Health Organization, approximately 5% of adults globally suffer from depression in 2023, making it the primary threat to mental health. A large number of studies have shown that neurotransmitter imbalance is a common pathogenesis of depressive disorder. As an important neuropeptide neurotransmitter, orexin not only participates in regulating sleep-wake cycles and feeding behaviors related to depressive disorders, but can also directly act on multiple brain regions to bidirectionally regulate depression. This article reviews the regulatory role of orexin in different brain regions on the pathogenesis of depressive disorders, and the changes in orexin secretion levels in acute/chronic stress-induced depressive disorders. This is intended to provide a reference for the basic research on the pathogenesis of depressive disorders and to explore new targets for the clinical diagnosis and treatment of depressive disorder.

Depressive disorder is the main cause of suicide death. According to data released by the World Health Organization, approximately 5% of adults globally suffer from depression in 2023, making it the primary threat to mental health. A large number of studies have shown that neurotransmitter imbalance is a common pathogenesis of depressive disorder. As an important neuropeptide neurotransmitter, orexin not only participates in regulating sleep-wake cycles and feeding behaviors related to depressive disorders, but can also directly act on multiple brain regions to bidirectionally regulate depression. This article reviews the regulatory role of orexin in different brain regions on the pathogenesis of depressive disorders, and the changes in orexin secretion levels in acute/chronic stress-induced depressive disorders. This is intended to provide a reference for the basic research on the pathogenesis of depressive disorders and to explore new targets for the clinical diagnosis and treatment of depressive disorder.

Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.

Depression is a mental disease that seriously threatens life and health, and its pathogenesis is complicated. Recent studies have found that altitude is one of the important factors leading to depression. As an important transcription factor under hypoxic condition, hypoxia-inducible factor-1 regulates acute hypoxia, and upregulates neurotrophic factor and 5-hydroxytryptamine, thus exerting antidepressant effect by promoting brain metabolism; hypoxia-inducible factor-2 regulates chronic hypoxia, promotes inflammation and aggravates depression. This article focuses on the related research on hypoxia-inducible factors and pathogenesis of high altitude depression, to further explore the pathogenesis and prevent high altitude depression.