OBJECTIVE To compare the efficacy and safety of evolocumab and probucol in patients with ultra-high-risk atherosclerotic cardiovascular disease （ASCVD） following percutaneous coronary intervention （PCI）. METHODS A retrospective analysis was conducted on 156 ultra-high-risk ASCVD patients who underwent PCI in our institution between January 1， 2023 and December 31， 2024. According to the lipid-lowering regimen， the patients were categorized into evolocumab group （ n ＝86） and probucol group （ n ＝70）. Changes in lipid parameters [total cholesterol （TC）， low-density lipoprot ein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， triglycerides， lipoprotein （a）， and lipid goal achievement rate ] ， inflammatory markers [interleukin-6 （IL-6） and C-reactive protein （CRP） ] ， and cardiac function indices （left ventricular ejection fraction， left ventricular end-systolic diameter， left ventricular end-diastolic diameter， and N-terminal pro-B-type natriuretic peptide） were compared between two groups at baseline and after 6 months of treatment. The incidence of adverse clinical events during treatment， including acute myocardial infarction， in-stent restenosis， acute heart failure， cerebral hemorrhage， and stroke， was also evaluated. RESULTS No statistically significant differences were observed between the two groups at baseline （ P ＞0.05）. After 6 months of treatment， both groups demonstrated significant improvements in lipid profiles （except HDL-C） and inflammatory markers compared to those at baseline （ P ＜0.05）. The evolocumab group exhibited greater reductions in TC， LDL-C， IL-6， and CRP， along with a higher lipid target achievement rate， compared with the probucol group （ P ＜0.05）. There were no statistically significant differences in the cardiac function-related indicators before and after treatment between the two groups， nor in the incidence of adverse events during the treatment （ P ＞0.05）. CONCLUSIONS For ultra-high-risk ASCVD patients after PCI， both of the above treatment options are associated with improvements in blood lipid and inflammatory response， with good safety during short-term follow-up. Evolocumab shows superior efficacy in TC， LDL-C and inflammatory markers reduction and lipid target achievement， compared to probucol.

Objective: To explore the relationship between snack consumption and depressive symptoms in first year junior high school students with different left behind experiences in Yunnan Province, so as to provide a basis for improving depressive symptoms among first year junior high school students with different left behind experiences. Methods: From October to December 2022,a cluster random sampling method was used to select 8 500 first year junior high school students from 11 ethnic minority areas (Fugong County, Longling County, Longyang District, Luchun County, Mojiang County, Nanjian County, Qiaojia County, Shuangjiang County, Tengchong City, Yuanmou County, Zhenyuan County) in Yunnan Province for a questionnaire survey. The Chinese version of Depression Anxiety Stress Scale-21 was applied to assess depressive symptoms in first year junior high school students, and snack consumption was collected by employing food frequency questionnaire. The generalized linear model was used to analyze the association between first year junior high school students snack consumption and depressive symptoms, and the analysis was stratified according to left behind experience. Results: The detection rates of depressive symptoms among firstyear junior high school students with and without left behind experience were 36.25% and 26.91%, respectively. After controlling for confounding variables, the generalized linear model analysis showed that sweet snacks ( β=0.16, 95%CI =0.07-0.25), fast food ( β=0.14, 95%CI =0.04-0.23) and carbonated drinks ( β=0.09, 95%CI =0.01-0.17) of first year junior high school students with left behind experience (all P <0.05). Compared with those without such behavior, the risk of depressive symptoms was higher in consumption of fast food ( β=0.13, 95%CI =0.07-0.18) and carbonated drinks ( β=0.10, 95%CI =0.06-0.15)among first year junior high school students without left behind experience (both P <0.05). Conclusion Snack consumption among first year junior high school students in Yunnan may increase the risk of developing depressive symptoms, while first year junior high school students with left behind experience may have a greater risk of developing depressive symptoms.

Hepatic fibrosis is a complex dynamic process caused by multiple chronic pathogenic factors， characterized by excessive accumulation of liver extracellular matrix and abnormal liver structure and function. If anti-fibrotic treatment is not performed in time， it can progress to liver cirrhosis and even liver cancer. Hepatic fibrosis has a complex pathogenesis， and previous studies mainly focused on the activation of hepatic stellate cells. Recent studies have shown that myeloid cells have the potential of multi-directional differentiation and can also participate in the development and progression of hepatic fibrosis. This article systematically reviews the role and regulatory mechanism of myeloid cells in hepatic fibrosis， in order to provide a reference for clinical diagnosis and targeted therapy.

This article provides a systematic interpretation and review of the Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design. Developed based on the Grading of Recommendations Assessment, Development and Evaluation methodology, the guideline address five core themes: ICU layout, room design, infection control, infrastructure, and staff spaces, and put forward 17 evidence-based recommendations, including 5 good practice statements. This article briefly introduces the guideline development methods and evidence characteristics, and focuses on summarizing key recommendations, including high-visibility layouts, single-bed ward settings, natural lighting and noise reduction strategies, integrated infection prevention and control design, remote monitoring, and flexible capacity expansion capabilities. Furthermore, it delves into the applicability and localized implementation pathways within China's healthcare environment, analyzing limitations in terms of evidence quality, specialty applicability, and cost-effectiveness. Furthermore, by integrating the Chinese Guidelines for the Construction and Development of Critical Care Medicine (2025 Edition) and current domestic practices, the article proposes tiered and phased implementation recommendations. This article aims to provide domestic healthcare institutions with a scientific reference that balances international cutting-edge concepts with China's real-world conditions for the construction and renovation of ICUs, thereby promoting the development of intensive care environments centered on patient safety, healthcare worker well-being, and infection control.

Objective: To validate the performance of the Procleix UltrioPlex E assay (Grifols, Spain) on the Procleix Panther automated nucleic acid detection platform, which employs the TMA method to simultaneously detect HIV-1/HIV-2/HCV/HBV/HEV viruses, and to evaluate its value for screening transfusion-associated infectious diseases. Methods: In accordance with the requirements of ISO15189"Application of the Guidelines for the Accreditation of Quality and Capabilities of Medical Laboratories in the Field of Molecular Diagnostics (CNAS-CL02-A009: 2018)", "Guidelines for Performance Validation of Molecular Diagnostic Testing Procedures (CNAS-GL039: 2019)", and the "Technical Operating Procedures for Blood Banks (2019 Edition)", this study validated the reagent's performance in terms of analytical sensitivity validation, performance consistency validation, interference resistance, and cross-contamination resistance. Results: Probit analysis revealed that the 95% detection limits (95% confidence interval) for HBV, HCV, HIV, and HEV were 2.0 IU/mL, 1.5 IU/mL, 18.0 IU/mL and 3.7 IU/mL, respectively, which were consistent with the minimum detection limits stated in the kit's package insert and were comparable to the Procleix Ultrio Elite kit. Both kits were used to test the performance validation serum plate simultaneously, yielding results consistent with the serum plate (Kappa=1), indicating stable performance. Detection of medium-and low-concentration lipemia and weakly positive hemolysis samples demonstrated good interference resistance. Cross-contamination performance validation showed that the kit exhibited excellent cross-contamination resistance. Conclusion: The Procleix UltrioPlex E nucleic acid detection kit enables combined detection of HIV-1, HIV-2, HCV, HBV, and HEV, allowing single-test screening for multiple viruses in donor blood. The kit's analytical performance is stable and meets basic laboratory requirements, making it suitable for screening transfusion-associated infectious diseases in blood banks.

Objective:To investigate the differences in clinical characteristics and antibiotic resistance of neonatal sepsis（NS）caused by different Gram-staining pathogens.Methods:A retrospective study was conducted on confirmed NS cases admitted to the Neonatal Ward of the Pediatric Department at The First Affiliated Hospital of Dali University，from June 1，2014，to May 31，2024.Patients were divided into Gram-positive and Gram-negative groups based on blood or cerebrospinal fluid（CSF）culture results.Clinical characteristics，pathogen distribution，and antibiotic resistance were compared between the two groups.Results:A total of 98 cases were included，with 81 in the Gram-positive group and 17 in the Gram-negative group.Multivariate logistic regression analysis revealed that NS cases with a high neutrophil percentage（ OR=0.933，95% CI：0.899-0.969）or hemorrhagic symptoms/signs（ OR=0.059，95% CI：0.008-0.458）were less likely to have Gram-positive pathogens detected in blood or CSF cultures（ P<0.05）.Common Gram-positive pathogens included Staphylococcus epidermidis with 35 strains（33.65%）and Staphylococcus hominis with 22 strains（21.15%）.The predominant Gram-negative pathogen was Escherichia coli with 14 strains（13.46%）.Gram-positive pathogens exhibited high resistance to oxacillin（91.30%），erythromycin（90.91%），and penicillin G（90.00%），but low resistance to tigecycline（0），linezolid（0），and vancomycin（0）.Gram-negative pathogens showed high resistance to ampicillin（92.31%），cefazolin（90.00%），and ampicillin/sulbactam（75.00%），but low resistance to amikacin（6.25%），latamoxef（0），and ertapenem（0）.The incidence of concurrent purulent meningitis was lower in the Gram-positive group than in the Gram-negative group（9.88% vs.47.06%， χ2=11.628， P<0.05），and there was significant difference. Conclusion:NS cases with high neutrophil percentages or hemorrhagic symptoms/signs are less likely to be caused by Gram-positive pathogens.Staphylococcus epidermidis and Staphylococcus hominis are common Gram-positive pathogens，while Escherichia coli is the predominant Gram-negative pathogen in NS.Both Gram-positive and Gram-negative pathogens exhibit resistance to specific antibiotics.NS caused by Gram-positive pathogens is less likely to be complicated by purulent meningitis compared to those caused by Gram-negative pathogens.

Objective To investigate the predictive value of combined detection of serum myelin basic pro-tein(MBP),creatine kinase isoenzyme(CKBB)and 8-hydroxydeoxyguanosine(8-OHDG)in the prognosis of neonatal hypoxic-ischemic encephalopathy(HIE).Methods A total of 150 neonates with neonatal HIE in the hospital from January 2020 to December 2023 were selected as the observation group,and 60 healthy neonates were selected as the control group.The levels of serum MBP,CKBB,and 8-OHDG were compared between two groups,the correlation between serum MBP,CKBB,and 8-OHDG levels and the severity of the disease was analyzed,clinical data and serum MBP,CKBB,and 8-OHDG levels of neonates with different prognosis were compared,and the influencing factors of neonatal HIE prognosis and the predictive value of MBP,CKBB,and 8-OHDG in the prognosis of neonatal HIE were analyzed.Results The serum levels of MBP,CKBB and 8-OHDG in mild,moderate and severe neonates in observation group were higher than those in control group(P<0.05).Serum levels of MBP,CKBB and 8-OHDG in observation group were positively correlated with the severity of the disease(P<0.05).The Apgar score 1 min after birth in the neonates with poor prognosis was lower than that in the neonates with good prognosis(P<0.05),and the severity of the disease,serum MBP,CKBB and 8-OHDG levels were higher than those in the neonates with good prognosis(P<0.05).Mul-tivariate Logistic regression analysis showed that Apgar score 1 min after birth,serum MBP,CKBB and 8-OHDG were independent influencing factors for the prognosis of neonates with HIE(P<0.05).The area un-der the curve of combined detection of serum MBP,CKBB and 8-OHDG for predicting the prognosis of neo-nates with HIE was 0.941,which was significantly higher than those predicted by each index alone(P<0.05).Conclusion Serum MBP,CKBB and 8-OHDG levels are related to the prognosis of neonates with HIE and the severity of brain injury,and the combination of the three could provide reference for the prognosis e-valuation of neonates with HIE.

Objective:To investigate the expression of platelet activating factor acetylhydrolase 1b catalytic subunit 3 (PAFAH1B3) in bladder cancer cells, and to explore the effects of PAFAH1B3 on proliferation, migration, and aerobic glycolysis in bladder cancer T24 cells and its mechanism.Methods:The relative expression of PAFAH1B3 in bladder cancer RT4, 5637, T24, J82T24 cells and human normal bladder epithelial SV-HUC-1 cells were detected using Western blotting. After culture, T24 cells were divided into a control group and a knockdown group based on treatment conditions. T24 cells were transfected with 50 nmol/L of negative control small interfering RNA (siRNA) or PAFAH1B3 siRNA, respectively. T24 cells with PAFAH1B3 knockdown were subsequently infected with an adenovirus vector overexpressing αB-crystallin ( CRYAB) at a multiplicity of infection of 50, and were designated as the overexpression group. The relative expression of PAFAH1B3 in T24 cells was detected using Western blotting. The cell survival rate, the number of colonies per unit field of view and the scratch closure rate of T24 cells were assessed using cell counting kit-8, colony formation assay and scratch assay, respectively. Glucose uptake, lactate production and adenosine triphosphate (ATP) levels of T24 cells were measured with corresponding commercial kits. The relative expression levels of glucose transporter 1 (GLUT1), hexokinase 2 (HK2), lactate dehydrogenase A (LDHA), CRYAB, phosphorylated phosphoinositide 3-kinase (p-PI3K) to PI3K and phosphorylated protein kinase B (p-Akt) to Akt were detected using Western blotting. Data were analyzed by an independent sample t test or one-way analysis of variance. Results:The relative expression levels of PAFAH1B3 protein in RT4, 5637, T24 and J82 cells (1.13±0.15, 1.40±0.10, 1.50±0.10, 0.77±0.13) were significantly higher than that in SV-HUC-1 cells (0.42±0.08) (all P<0.01). The relative expression levels of PAFAH1B3 protein in the knockdown group (0.22±0.08) was significantly lower than that in the control group (1.08±0.03) ( P<0.01). The cell survival rate, the number of colonies per unit field of view and the scratch closure rate in the knockdown group [(54.00±6.00)%, (104.00±8.00) cells, (42.00±3.00)%] were all lower than those in the control group [(96.00±3.00)%, (170.00±6.00) cells, (72.00±4.00)%] (all P<0.01). Glucose uptake, lactate production and ATP level in the knockdown group [(0.46±0.09) mg/ml, (22.67±2.67, 7.50±0.15) μmol/L] were lower than those in the control group [(1.21±0.11) mg/ml, (41.67±2.33, 18.00±2.00) μmol/L] (all P<0.01). The relative expression levels of GLUT1, HK2 and LDHA proteins in the knockdown group (0.31±0.04, 0.18±0.03, 0.47±0.07) were all lower than those in the control group (0.89±0.09, 0.97±0.04, 0.95±0.03) (all P<0.01). The relative expression of CRYAB, p-PI3K/PI3K and p-Akt/Akt proteins in the knockdown group (0.26±0.04, 0.44±0.03, 0.31±0.04) were all lower than those in the control group (0.99±0.05, 0.94±0.05, 0.99±0.06) (all P<0.01). The relative expression of CRYAB in the overexpression group (4.30±0.40) was higher than that in the knockdown group (0.94±0.05) ( P<0.01). The cell survival rate and the number of colonies per unit field of view in the overexpression group [(92.00±3.00)%, (172.00±8.00) cells] were all higher than those in the knockdown group [(46.00±3.00)%, (103.00±7.00) cells] (both P<0.01). Glucose uptake, lactate production and ATP level in the overexpression group [(1.25±0.06) mg/ml, (43.00±4.00, 21.00±2.00) μmol/L] were all higher than those in the knockdown group [(0.49±0.06) mg/ml, (19.00±3.00, 7.00±1.00) μmol/L] (all P<0.01). The relative expression levels of GLUT1, HK2 and LDHA proteins in the overexpression group (0.71±0.04, 0.98±0.04, 0.99±0.04) were higher than those in the knockdown group (0.26±0.03, 0.52±0.03, 0.21±0.02) (all P<0.01). The relative expression levels of p-PI3K/PI3K and p-Akt/Akt proteins in the overexpression group (0.77±0.03, 0.96±0.04) were all higher than those in the knockdown group (0.24±0.05, 0.18±0.03) (both P<0.01). Conclusions:PAFAH1B3 may promote the proliferation, migration and aerobic glycolysis of bladder cancer cells via regulation of the CRYAB/PI3K/Akt signaling pathway.

Objective To investigate the impact of nutritional risk screening based on the enhanced recovery after surgery(ERAS)concept on postoperative functional recovery and nutritional status in gastric cancer patients.Methods A total of 98 gastric cancer patients who underwent surgery at The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University between March 2020 and March 2023 were selected as research objects.They were assigned to control group or observation group by a random number table,with 49 patients in each group.Conventional postoperative rehabilitation and nutritional support were given to both groups.The observation group additionally received preoperative nutritional risk screening and ERAS-based nursing.Postoperative recovery indicators(gastrointestinal peristalsis time,evacuation time,defecation time,and bowel sound recovery time),gastrointestinal hormones(serum motilin,gastrin,and somatostatin),and gut microbiota distribution(Bifidobacterium,Enterococcus,Lactobacillus,and Escherichia coli)were compared between the two groups.Nutritional indicators(albumin,hemoglobin,transferrin,and total protein)were also compared before intervention,4 and 8 weeks after intervention.The overall nutritional status was assessed by the Nutritional Risk Screening 2002(NRS 2002),Patient-Generated Subjective Global Assessment(PG-SGA),dietary symptom scale,and dietary compliance scale.The incidence of gastrointestinal complications was compared.Results One day before surger,there were no significant differences in nutritional indicators,gastrointestinal hormones,or microbiota distribution between the two groups(P>0.05).The gastrointestinal peristalsis time,evacuation time,defecation time,and bowel sound recovery time in the observation group were significantly shorter than those in the control group after intervention(P<0.05).Serum motilin,gastrin,and somatostatin levels on day 7 after surgery were lower than preoperative levels in both groups,but the levels of gastrointestinal hormones in the observation group were higher than those in the control group(P<0.05).The observation group had more Bifidobacterium and Lactobacillus and less Enterococcus and Escherichia coli than the control group at 7 days postoperatively(P<0.05).The albumin,hemoglobin,transferrin,and total protein levels in the observation group were significantly higher than those in the control group at 4 and 8 weeks postoperatively(P<0.05).The observation group scored lowly in the NRS 2002,PG-SGA,and dietary symptom scale,and scored highly in the dietary compliance scale as compared with control group(P<0.05).The incidence of complications in the observation group was 12.24%(6/49),which was significantly lower than that in the control group(30.61%[15/49],P<0.05).Conclusion Preoperative nutritional risk screening combined with ERAS concept can effectively enhance postoperative functional recovery,improve gastrointestinal hormone levels,adjust gut microbiota distribution,optimize nutritional status,and reduce the incidence of gastrointestinal complications in gastric cancer patients.It is worthy of promotion and application in clinical practice.

ObjectiveTo investigate the role of paraventricular nucleus (PVN) corticotropin releasing hormone (CRH) neurons in chronic restraint stress (CRS)-induced anxiety-like behavior. And whether exercise relieves chronic restraint stress-induced anxiety through PVN CRH neurons. MethodsTwenty 8-week-old male C57BL/6J mice were randomly divided into control (Ctrl) group and chronic restraint stress (CRS) group. The open field test (OFT) and elevated plus maze (EPM) were used to evaluate anxiety-like behavior of the mice. Food intake was recorded after CRS. Immunofluorescence staining was used to label the expression of c-Fos expression in PVN and calculate the co-expression of c-Fos and CRH neurons. We used chemogenetic activation of PVN CRH neurons to observed the anxiety-like behavior. 8-week treadmill training (10-16 m/min, 60 min/d, 6 d/week) were used to explore the role of exercise in ameliorating CRS-induced anxiety behavior and how PVN CRH neurons involved in it. ResultsCompared with Ctrl group, CRS group exhibited significant anxiety-like behavior. In OFT, the mice in CRS groups spent less time in center area (P<0.001). In EPM, the time in open arm in CRS group were significantly decreased (P<0.001). Besides, food intake was also suppressed in CRS group compared with Ctrl group (P<0.05). Compared with Ctrl group, CRS significantly increase c-Fos expression in PVN and most of CRH neurons co-express c-Fos (P<0.001). Chemogenetic activation of PVN CRH neurons induced anxiety-like behavior (P<0.05) and inhibited feeding behavior (P<0.01). Exercise relieves chronic restraint stress-induced anxiety (P<0.001) and relieved the anorexia caused by chronic restraint stress (P<0.05). Aerobic exercise inhibited the CRS labeled c-Fos in PVN CRH neurons (P<0.001). Furthermore, ablation of PVN CRH neurons attenuated CRS induced anxiety-like behavior. ConclusionCRS activated PVN CRH neurons, induced anxiety-like behavior and reduced food intake. 8-week exercise attenuated CRS-induced anxiety-like behavior through inhibiting PVN CRH neuron. Ablation of CRH PVN neurons ameliorated CRS-induced anxiety-like behavior. These finding reveals a potential neural mechanism of exercise-relieving CRS-induced anxiety-like behavior. This provides a new idea and theoretical basis for the treatment of anxiety and related mental disorders.