Objective To explore the preferences and influencing factors of terminal malignant tumor patients,and to provide a basis for optimizing hospice care.Methods A convenience sampling method was employed to select 485 patients with terminal malignant tumors from the oncology departments of two tertiary,class-A hospitals in Sichuan Province between September 2023 and November 2024.Data on demographic characteristics,decision-making-related information,preferences regarding resuscitation,and cultural belief levels were collected using a structured questionnaire.Results In critical situations,39.4%of patients opted for active rescue,33.6%chose to forgo treatment,and 27.0%preferred to maintain current treatment.Acceptance rates for nine specific interventions ranged from 28.9%to 61.2%.Multivariate logistic regression analysis revealed that stronger cultural beliefs,younger age,having a spouse,being the primary caregiver,employee medical insurance coverage,and use of invasive tubes were significantly associated with a tendency toward active or continued treatment(P<0.05).Prioritizing quality of life or concerns about economic burden were significantly associated with the decision to forgo life-sustaining interventions(P<0.05).Conclusions Patients with terminal malignant tumors exhibit diverse preferences regarding end-of-life resuscitation,significantly shaped by cultural beliefs,demographic factors,and family support.Clinicians should integrate patients'values,cultural backgrounds,and individual needs to provide tiered decision-making support,thereby facilitating medically appropriate and value-concordant care choices.

Objective:To investigate the effects of circular RNA circ_0086376 on the expression of acne-related inflammatory factors by targeting microRNA (miR) -5195-3p.Methods:Circ_0086376-overexpressing or -interferred stable HaCaT cell lines were constructed and co-cultured with Propionibacterium acnes ( P.acne). Quantitative real-time PCR was used to detect the effect of co-culture on circ_0086376 expression, while enzyme-linked immunosorbent assay (ELISA) was performed to measure the expression of inflammatory factors in the cell culture supernatant. The overexpression or interference of circ_0086376 plasmid and lentivirus mimicking or inhibiting miR-5195-3p fragment were transfected into HaCaT cells, and ELISA was used to detect the expression of inflammatory factors in the culture supernatant of HaCaT cells after overexpression or interference of circ_0086376 cultured alone or with P.acne. The luciferase reporter assay was conducted to verify the targeting relationship between circ_0086376 and miR-5195-3p. Additionally, ELISA was used to detect the effects of overexpression/interference of circ_0086376 and mimic/inhibition of miR-5195-3p on the expression of inflammatory factors in the culture supernatant of HaCaT cells co-cultured with P.acne. Results:After co-culture with P.acne, the levels of inflammatory factors in the culture supernatant were significantly higher than those in the HaCaT cells cultured alone, including Interleukins (IL) -1β ([355.80 ± 23.20] vs. [260.50 ± 16.58] pg/ml, t = 5.79, P < 0.01), IL-6 ([38.04 ± 2.69] vs. [14.33 ± 0.75] pg/ml, t = 14.65, P < 0.01), IL-12 ([10.87 ± 0.78] vs. [6.52 ± 0.77] pg/ml, t = 6.89, P < 0.01), IL-18 ([222.60 ± 21.07] vs. [146.10 ± 9.14] pg/ml, t = 5.77, P < 0.01), and Tumor necrosis factor (TNF) -α ([50.39 ± 1.29] vs. [20.46 ± 0.83] pg/ml, t = 33.83, P < 0.01). The expression levels of IL-1β, IL-6, IL-12, IL-18 and TNF-α in the culture supernatant of HaCaT cells in the circ-empty vector + P.acne group were higher than those in the circ-empty vector overexpression group. The levels of inflammatory factors mentioned above in circ-overexpression + P.acne group were lower than those in circ-overexpression empty vector + P.acne group ( P < 0.01). The expression levels of inflammatory factors mentioned above in the culture supernatant of HaCaT cells in the interference circ-empty vector + P.acne group were higher than those in the interference circ-empty vector group. Compared with the interference circ-empty vector + P.acne group, the expression of circ in the interference circ + P.acne group was higher ( P < 0.01). Luciferase reporter assay confirmed that circ_0086376 could bind to miR-5195-3p. The expression levels of IL-1β, IL-6, IL-12, IL-18 and TNF-α in the circ-overexpression group were lower than those in the empty vector group ( P < 0.05), and the levels of these inflammatory factors in the circ-overexpression + miR mimic group were higher than those in the circ overexpression group ( P < 0.05). The expression levels of inflammatory factors in the interference circ group were higher than those in the empty vector group, levels of inflammatory factors in the circ + miR-inhibiting group were lower than those in the circ interference group ( P < 0.05) . Conclusion:Circ_0086376 can inhibit the expression of acne-related inflammatory factors by targeting and downregulating miR-5195-3p.

Objective:To compare the clinical efficacy and safety of nanomicroneedle- versus ultrasound-mediated delivery of tranexamic acid for the treatment of melasma.Methods:A prospective, randomized, controlled study was conducted. Patients with melasma were collected from the Department of Dermatology, Guangzhou Dermatology Hospital from March 2023 to May 2024, and divided into a nanomicroneedle group (receiving nanomicroneedle-mediated delivery of tranexamic acid) and an ultrasound group (receiving ultrasound-mediated delivery of tranexamic acid) using the random number table method. Both groups underwent the treatment once a week for a total of 8 sessions. At week 12, outcomes including melasma area and severity index (MASI) scores, treatment response rates, VISIA brown spot scores, pain scores, and adverse reactions were evaluated and compared between the two groups. Statistical analyses were carried out using two-independent-sample t test, Mann-Whitney U test, and chi-square test. Results:A total of 80 patients with melasma were included, with 40 in each group. In the nanomicroneedle group, the patients were aged 40.35 ± 7.39 years (range: 25 - 55 years), with the disease duration being 8.45 ± 4.77 months (range: 1 - 16 months) ; in the ultrasound group, the patients were aged 40.25 ± 7.76 years (range: 25 - 55 years), and their disease duration was 10.45 ± 5.07 months (range: 2 - 17 months) ; there were no significant differences in ages or disease duration between the two groups (both P > 0.05). At week 12, both groups demonstrated reduced MASI scores compared to baseline scores, and the MASI scores were significantly lower in the nanomicroneedle group ( M[ Q1, Q3]: 5.80[4.20, 9.35]) than in the ultrasound group (8.65[5.70, 10.80], Z = 2.50, P = 0.012). The overall response rate was significantly higher in the nanomicroneedle group (97.5%, 39/40) than in the ultrasound group (55.0%, 22/40; χ2 = 19.95, P < 0.001). The lateral facial VISIA brown spot scores were also significantly lower in the nanomicroneedle group (left side: 126.18 ± 36.54 points; right side: 138.50 ± 40.76 points) than in the ultrasound group (left side: 142.37 ± 32.40 points; right side: 157.13 ± 39.59 points; t = -2.10, -2.07, P = 0.039, 0.041, respectively). In the nanomicroneedle group, the pain scores were 4.12 ± 1.47 points, and varying severity of adverse reactions such as erythema, edema and dryness occurred after operation, all of which resolved spontaneously within 48 hours. No marked adverse reactions were observed in the ultrasound group. Conclusion:Nanomicroneedle-mediated delivery of tranexamic acid demonstrated superior clinical efficacy and favorable safety profiles compared to the ultrasound-mediated delivery, providing more options for the treatment of melasma.

Objective:To investigate the effects of circular RNA circ_0086376 on the expression of acne-related inflammatory factors by targeting microRNA (miR) -5195-3p.Methods:Circ_0086376-overexpressing or -interferred stable HaCaT cell lines were constructed and co-cultured with Propionibacterium acnes ( P.acne). Quantitative real-time PCR was used to detect the effect of co-culture on circ_0086376 expression, while enzyme-linked immunosorbent assay (ELISA) was performed to measure the expression of inflammatory factors in the cell culture supernatant. The overexpression or interference of circ_0086376 plasmid and lentivirus mimicking or inhibiting miR-5195-3p fragment were transfected into HaCaT cells, and ELISA was used to detect the expression of inflammatory factors in the culture supernatant of HaCaT cells after overexpression or interference of circ_0086376 cultured alone or with P.acne. The luciferase reporter assay was conducted to verify the targeting relationship between circ_0086376 and miR-5195-3p. Additionally, ELISA was used to detect the effects of overexpression/interference of circ_0086376 and mimic/inhibition of miR-5195-3p on the expression of inflammatory factors in the culture supernatant of HaCaT cells co-cultured with P.acne. Results:After co-culture with P.acne, the levels of inflammatory factors in the culture supernatant were significantly higher than those in the HaCaT cells cultured alone, including Interleukins (IL) -1β ([355.80 ± 23.20] vs. [260.50 ± 16.58] pg/ml, t = 5.79, P < 0.01), IL-6 ([38.04 ± 2.69] vs. [14.33 ± 0.75] pg/ml, t = 14.65, P < 0.01), IL-12 ([10.87 ± 0.78] vs. [6.52 ± 0.77] pg/ml, t = 6.89, P < 0.01), IL-18 ([222.60 ± 21.07] vs. [146.10 ± 9.14] pg/ml, t = 5.77, P < 0.01), and Tumor necrosis factor (TNF) -α ([50.39 ± 1.29] vs. [20.46 ± 0.83] pg/ml, t = 33.83, P < 0.01). The expression levels of IL-1β, IL-6, IL-12, IL-18 and TNF-α in the culture supernatant of HaCaT cells in the circ-empty vector + P.acne group were higher than those in the circ-empty vector overexpression group. The levels of inflammatory factors mentioned above in circ-overexpression + P.acne group were lower than those in circ-overexpression empty vector + P.acne group ( P < 0.01). The expression levels of inflammatory factors mentioned above in the culture supernatant of HaCaT cells in the interference circ-empty vector + P.acne group were higher than those in the interference circ-empty vector group. Compared with the interference circ-empty vector + P.acne group, the expression of circ in the interference circ + P.acne group was higher ( P < 0.01). Luciferase reporter assay confirmed that circ_0086376 could bind to miR-5195-3p. The expression levels of IL-1β, IL-6, IL-12, IL-18 and TNF-α in the circ-overexpression group were lower than those in the empty vector group ( P < 0.05), and the levels of these inflammatory factors in the circ-overexpression + miR mimic group were higher than those in the circ overexpression group ( P < 0.05). The expression levels of inflammatory factors in the interference circ group were higher than those in the empty vector group, levels of inflammatory factors in the circ + miR-inhibiting group were lower than those in the circ interference group ( P < 0.05) . Conclusion:Circ_0086376 can inhibit the expression of acne-related inflammatory factors by targeting and downregulating miR-5195-3p.

Objective:To compare the clinical efficacy and safety of nanomicroneedle- versus ultrasound-mediated delivery of tranexamic acid for the treatment of melasma.Methods:A prospective, randomized, controlled study was conducted. Patients with melasma were collected from the Department of Dermatology, Guangzhou Dermatology Hospital from March 2023 to May 2024, and divided into a nanomicroneedle group (receiving nanomicroneedle-mediated delivery of tranexamic acid) and an ultrasound group (receiving ultrasound-mediated delivery of tranexamic acid) using the random number table method. Both groups underwent the treatment once a week for a total of 8 sessions. At week 12, outcomes including melasma area and severity index (MASI) scores, treatment response rates, VISIA brown spot scores, pain scores, and adverse reactions were evaluated and compared between the two groups. Statistical analyses were carried out using two-independent-sample t test, Mann-Whitney U test, and chi-square test. Results:A total of 80 patients with melasma were included, with 40 in each group. In the nanomicroneedle group, the patients were aged 40.35 ± 7.39 years (range: 25 - 55 years), with the disease duration being 8.45 ± 4.77 months (range: 1 - 16 months) ; in the ultrasound group, the patients were aged 40.25 ± 7.76 years (range: 25 - 55 years), and their disease duration was 10.45 ± 5.07 months (range: 2 - 17 months) ; there were no significant differences in ages or disease duration between the two groups (both P > 0.05). At week 12, both groups demonstrated reduced MASI scores compared to baseline scores, and the MASI scores were significantly lower in the nanomicroneedle group ( M[ Q1, Q3]: 5.80[4.20, 9.35]) than in the ultrasound group (8.65[5.70, 10.80], Z = 2.50, P = 0.012). The overall response rate was significantly higher in the nanomicroneedle group (97.5%, 39/40) than in the ultrasound group (55.0%, 22/40; χ2 = 19.95, P < 0.001). The lateral facial VISIA brown spot scores were also significantly lower in the nanomicroneedle group (left side: 126.18 ± 36.54 points; right side: 138.50 ± 40.76 points) than in the ultrasound group (left side: 142.37 ± 32.40 points; right side: 157.13 ± 39.59 points; t = -2.10, -2.07, P = 0.039, 0.041, respectively). In the nanomicroneedle group, the pain scores were 4.12 ± 1.47 points, and varying severity of adverse reactions such as erythema, edema and dryness occurred after operation, all of which resolved spontaneously within 48 hours. No marked adverse reactions were observed in the ultrasound group. Conclusion:Nanomicroneedle-mediated delivery of tranexamic acid demonstrated superior clinical efficacy and favorable safety profiles compared to the ultrasound-mediated delivery, providing more options for the treatment of melasma.

Objective To screen the independent influencing factors for gastrointestinal bleeding(GIB)in hospitalized patients with coronary heart disease(CHD)and to construct and validate a no-mogram prediction model.Methods A total of 440 CHD patients who developed GIB during hospi-talization were selected as GIB group,and another 320 CHD patients hospitalized in the department of cardiovascular medicine were randomly selected as non-GIB group.The clinical data of the two groups were analyzed and compared.Multivariate logistic regression analysis was used to screen the indepen-dentinfluencing factors for GIB.Based on these factors,a nomogram prediction model for the risk of GIB in hospitalized CHD patients was constructed.The entire dataset was randomly divided into train-ing set(n=532)and validation set(n=228)in a 7∶3 ratio.The performance of the nomogram model was evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Multivariate logistic regression analysis showed that body mass index(BMI),history of digestive system diseases,CHD classification,albumin,white blood cell count,monocyte-to-lymphocyte ratio(MLR),and low-density lipoprotein were all independent influencing factors for GIB in CHD patients(P＜0.05).ROC curve analysis indicated that the nomo-gram model(excluding low-density lipoprotein)constructed based on independent influencing factors exhibited good discrimination in both the training set(area under the curve:0.839,95％CI,0.805 to 0.873)and the validation set(area under the curve:0.810,95％CI,0.751 to 0.868).Calibration curve analysis demonstrated good consistency between the predicted probabilities and the observed incidence of GIB in hospitalized CHD patients in both the training and validation sets.DCA results revealed that the nomogram model had a good clinical net benefit.Conclusion The nomogram model constructed based on independent influencing factors has good predictive performance for the risk of GIB in hospitalized CHD patients and can provide a basis for clinicians to promptly identify GIB and adjust medication regimens.

Epidural spinal cord stimulation (eSCS) represents an emerging neuromodulation technology that ameliorates motor dysfunction in patients with spinal cord injury, Parkinson's disease, and stroke by activating sensory afferent fibers, enhancing spinal cord neural network integration, optimizing brain-spinal cord information transmission, and inducing neural plasticity. This article reviews the mechanism, electrode implantation, and stimulation parameter of eSCS, and application of eSCS in spinal cord injury, Parkinson's disease, and stroke, aiming to provide valuable insight for its clinical implementation.

Objective To evaluate the clinical efficacy of Shexiang Tongxin dropping pills combined with"Quadruple therapy"in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 193 elderly HFpEF patients admitted to Affiliated Hospital of Yangzhou University from January to June 2022 were selected as study objects,and were divided into observation group(97 cases)and control group(96 cases)according to random number table method.The control group was treated with sacubitril valsartan sodium tablets+dapagliflozin tablets+metoprolol tartrate tablets+spironolactone tablets,and the observation group was treated with Shexiang Tongxin dropping pills on the basis of control group treatment,and both groups were treated for 6 months.The changes of cardiac function indexes,serum myocardial injury markers,endothelial function and inflammation indexes before and after treatment were compared between two groups.The average length of hospitalization,readmission rate within 30 days and the effective rate of treatment were analyzed.After 6 months of follow-up,the 6-minute walk test,6-month readmission rate and the incidence of major adverse cardiovascular event(MACE)were compared between two groups.Results After 30 days of treatment,the total effective rate of observation group was significantly higher than that of control group(93.8％vs.90.6％,x2=3.982,P=0.031).After 30 days of treatment,left ventricular end diastolic diameter,left ventricular end systolic diameter,N-terminal pro-brain natriuretic peptide,cardiac troponin I,nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 in observation group were significantly lower than those in control group,left ventricular ejection fraction,early peak mitral valve diastolic blood flow velocity(E)/advanced peak mitral valve diastolic blood flow velocity(A)and nitric oxide were significantly higher than those in control group,and 6 min walking distance was significantly longer than that in control group(P＜0.05).After 6 months of follow-up,the average length of hospital stay in observation group was significantly lower than that in control group,and the readmission rate within 30 days was significantly lower than that in control group(P＜0.05).There was no significant difference in the 6-month readmission rate and the incidence of MACE between two groups(P＞0.05).Conclusion Shexiang Tongxin dropping pills can inhibit cardiac inflammation.Combined with the"Quadruple therapy",the clinical effect of HFpEF in elderly patients is better than that of western medicine alone,and it is worthy of clinical promotion and application.

Objective To explore the preferences and influencing factors of terminal malignant tumor patients,and to provide a basis for optimizing hospice care.Methods A convenience sampling method was employed to select 485 patients with terminal malignant tumors from the oncology departments of two tertiary,class-A hospitals in Sichuan Province between September 2023 and November 2024.Data on demographic characteristics,decision-making-related information,preferences regarding resuscitation,and cultural belief levels were collected using a structured questionnaire.Results In critical situations,39.4%of patients opted for active rescue,33.6%chose to forgo treatment,and 27.0%preferred to maintain current treatment.Acceptance rates for nine specific interventions ranged from 28.9%to 61.2%.Multivariate logistic regression analysis revealed that stronger cultural beliefs,younger age,having a spouse,being the primary caregiver,employee medical insurance coverage,and use of invasive tubes were significantly associated with a tendency toward active or continued treatment(P<0.05).Prioritizing quality of life or concerns about economic burden were significantly associated with the decision to forgo life-sustaining interventions(P<0.05).Conclusions Patients with terminal malignant tumors exhibit diverse preferences regarding end-of-life resuscitation,significantly shaped by cultural beliefs,demographic factors,and family support.Clinicians should integrate patients'values,cultural backgrounds,and individual needs to provide tiered decision-making support,thereby facilitating medically appropriate and value-concordant care choices.

Objective To evaluate the clinical efficacy of Shexiang Tongxin dropping pills combined with"Quadruple therapy"in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 193 elderly HFpEF patients admitted to Affiliated Hospital of Yangzhou University from January to June 2022 were selected as study objects,and were divided into observation group(97 cases)and control group(96 cases)according to random number table method.The control group was treated with sacubitril valsartan sodium tablets+dapagliflozin tablets+metoprolol tartrate tablets+spironolactone tablets,and the observation group was treated with Shexiang Tongxin dropping pills on the basis of control group treatment,and both groups were treated for 6 months.The changes of cardiac function indexes,serum myocardial injury markers,endothelial function and inflammation indexes before and after treatment were compared between two groups.The average length of hospitalization,readmission rate within 30 days and the effective rate of treatment were analyzed.After 6 months of follow-up,the 6-minute walk test,6-month readmission rate and the incidence of major adverse cardiovascular event(MACE)were compared between two groups.Results After 30 days of treatment,the total effective rate of observation group was significantly higher than that of control group(93.8％vs.90.6％,x2=3.982,P=0.031).After 30 days of treatment,left ventricular end diastolic diameter,left ventricular end systolic diameter,N-terminal pro-brain natriuretic peptide,cardiac troponin I,nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 in observation group were significantly lower than those in control group,left ventricular ejection fraction,early peak mitral valve diastolic blood flow velocity(E)/advanced peak mitral valve diastolic blood flow velocity(A)and nitric oxide were significantly higher than those in control group,and 6 min walking distance was significantly longer than that in control group(P＜0.05).After 6 months of follow-up,the average length of hospital stay in observation group was significantly lower than that in control group,and the readmission rate within 30 days was significantly lower than that in control group(P＜0.05).There was no significant difference in the 6-month readmission rate and the incidence of MACE between two groups(P＞0.05).Conclusion Shexiang Tongxin dropping pills can inhibit cardiac inflammation.Combined with the"Quadruple therapy",the clinical effect of HFpEF in elderly patients is better than that of western medicine alone,and it is worthy of clinical promotion and application.