Objective To explore the clinical efficacy of robot-assisted coronary artery bypass grafting through a small incision in the left intercostal space in the treatment of multivessel coronary disease. Methods A retrospective analysis was conducted on the clinical data of patients who underwent coronary artery bypass grafting through a small incision in the left intercostal space at Central China Fuwai Hospital of Zhengzhou University from January 1, 2023 to October 15, 2024. Patients were divided into a robotic group and a minimally invasive group based on whether the surgery was assisted by the Da Vinci robot. Results A total of 81 patients were included, with 57 in the minimally invasive group, including 41 males and 16 females, with a median age of 65.0 (57.5, 69.5) years; and 24 in the robotic group, including 17 males and 7 females, with a median age of 61.0 (56.0, 69.0) years. There was no statistically significant difference in baseline data between the two groups (P>0.05). The robotic group had less intraoperative bleeding [300 (200, 438) mL vs. 500 (375, 600) mL, P=0.006], shorter postoperative mechanical ventilation time [15.0 (13.3, 23.5) h vs. 22.0 (15.5, 39.5) h, P=0.037], and lower incidence of postoperative pain [8 (33.3%) vs. 33 (57.9%), P=0.043]. The hospitalization cost in the robotic group was higher than that in the minimally invasive group [130491 (123298, 135691) yuan vs. 123892 (115543, 133449) yuan, P=0.023]. There was no statistical difference in postoperative laboratory indicators between the two groups (P>0.05). There was also no statistical difference in the duration of surgery, postoperative 24 h drainage volume, ICU stay time, postoperative hospital stay or incidences of perioperative compications including pleural effusion, transfusion, new-onset atrial fibrillation, acute kidney injury, non-union of incision, major cardiovascular and cerebrovascular adverse events, and reoperation between the two groups (P>0.05). Conclusion Compared with the minimally invasive group, the robotic group shows satisfactory efficacy and can effectively reduce postoperative pain and intraoperative bleeding, and shorten postoperative mechanical ventilation time.

Objective To investigate the impact of graft type on perioperative outcomes and long-term prognosis in patients undergoing surgical repair of post-myocardial infarction ventricular septal rupture (VSR) with concurrent coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on clinical data from patients who underwent VSR repair and concurrent CABG at Fuwai Hospital between 2005 and 2022. Patients were divided into an arterial graft group and a saphenous vein graft (SVG)-only group based on the type of bypass grafts used. Clinical outcomes were compared between the two groups. Results A total of 92 patients were included, comprising 56 males and 36 females, with a mean age of (62.4±7.9) years. The arterial graft group consisted of 60 patients, and the SVG-only group consisted of 32 patients. There were no statistical differences between the two groups in age, gender, body mass index, past medical history, time interval from myocardial infarction to surgery, or culprit vessel distribution (P>0.05). A higher proportion of patients in the SVG-only group received preoperative intra-aortic balloon pump (IABP) support (56.3% vs. 35.0%, P=0.049). However, cardiopulmonary bypass time, aortic cross-clamp time, and early mortality rates were similar between the two groups (P>0.05). Follow-up data revealed no statistically significant differences in cumulative 10-year survival (82.8% vs. 80.0%, P=0.940) or freedom from major adverse cardiovascular and cerebrovascular events (49.6% vs. 58.6%, P=0.491) between the SVG-only and arterial graft groups. Furthermore, graft type did not significantly affect long-term mortality in patients with a culprit vessel in the left anterior descending artery or those with multivessel disease. Conclusion In patients undergoing delayed repair of VSR with concomitant CABG, the use of arterial or saphenous vein grafts does not significantly impact perioperative outcomes or long-term prognosis. Future research should further explore the benefits of different revascularization strategies to optimize treatment for this population.

Xuanfuhua Decoction （旋覆花汤） is considered as the theoretical prototype of the method of unbloc-king collaterals with acrid and moistened medicinals. Guided by the theories of "chronic disease entering the collaterals" and "collaterals performing their functions when there is free flow"， YE Gui further developed this approach into a systematic method. The core of this approach lies in dispersing and opening constraint with acrid medicinals， nourishing and harmonizing collaterals with moistened medicinals， eliminating pathogens and unblocking collaterals with insect medicinals. The disease course of idiopathic pulmonary fibrosis （IPF） is prolonged， with a complex of deficiency and excess， and chronic disease entering the collaterals. The core pathogenesis involves lung collaterals obstruction， fluid depletion with blood stasis， and chronic disease entering the collaterals. Treatment can be guided by the method of unblocking collaterals with acrid and moistened medicinals based on Xuanfuhua Decoction， following a strategy of "dispersing and unblocking， moistening and nourishing， penetrating and venting". Specifically， for lung collaterals obstruction， acrid medicinals can be used to disperse lung qi and open bi （痹）. In case of fluid depletion and blood stasis， moistened medicinals for nourishing lung collaterals are suggested to restore vitality. For chronic disease ente-ring collaterals， it is advised to search and eliminate collateral pathogens in order to dissipate masses.

Objective To establish an in vitro enzymatic activity evaluation system for OTULIN （OTU domain DUB with linear linkage specificity）and provide an experimental basis for OTULIN inhibitor screening. Methods The linear ubiquitin substrate protein His-Ub-Ub-Flag was designed, expressed, and purified. Using OTULIN^80-352 as the target enzyme and PR619 as a positive control, the enzyme-to-substrate ratio and reaction time were optimized to establish an in vitro OTULIN activity evaluation system. Results The linear ubiquitin substrate protein His-Ub-Ub-Flag was successfully obtained. OTULIN activity was significantly inhibited by PR619, which confirmed the feasibility of the assay. The optimal enzyme-to-substrate ratio of OTULIN^80-352 to His-Ub-Ub-Flag was 1∶16, and the optimal reaction condition was incubation at 37℃ for 20 min. Conclusion An in vitro enzymatic activity evaluation system for OTULIN was successfully established, which could be used to evaluate the inhibitory effects of candidate compounds on OTULIN activity and provide technical support for subsequent screening of OTULIN small-molecule inhibitors.

ObjectiveTo investigate the role and mechanism of ribosomal DNA （rDNA） transcription and ribosome biogenesis in muscle atrophy induced by acute kidney injury （AKI）. MethodsEight male C57BL/6 mice were randomly divided into a control group （Ctrl） and a model group （AKI）. An AKI model was established via intraperitoneal injection of cisplatin. Muscle atrophy was phenotypically assessed by measuring muscle mass， myofiber cross-sectional area （HE staining）， and mRNA expression levels of atrophy-related genes （Murf-1， Atrogin-1， Igf-1） using qRT-PCR. In vivo protein synthesis rates were determined via the SUnSET assay （puromycin incorporation）. Ribosome biogenesis was evaluated by assessing rRNA content and 47S pre-rRNA expression levels. Myotubes differentiated from mouse skeletal muscle cell lines （C2C12 myotubes） were treated with serum from AKI mice， and the effects on rDNA transcription， ribosome biogenesis， and protein metabolism were analyzed using chromatin immunoprecipitation followed by quantitative polymerase chain reaction （ChIP-qPCR） and Western blot. ResultsAKI successfully induced muscle atrophy， as evidenced by a significant reduction in skeletal muscle mass. The most pronounced decrease occurred in the extensor digitorum longus muscle （21.0%， P 0.01）， along with a trend toward reduced myofiber cross-sectional area. At the molecular level， AKI inhibited muscle protein synthesis （83.14% reduction in puromycin incorporation， P 0.000 1） and impaired ribosome biogenesis， manifested by suppressed rDNA transcription elongation （52.62% decrease in 47S pre-rRNA ITS-1 levels， P 0.01） and reduced total rRNA content （65.29%， P 0.000 1）. In contrast， serum from AKI mice promoted rDNA transcription initiation and protein synthesis in C2C12 myotubes in vitro. ConclusionAKI induces muscle atrophy by suppressing rDNA transcription and ribosome biogenesis in skeletal muscle， leading to impaired protein synthesis. Dysregulated ribosome biogenesis may play a critical role in AKI-induced muscle atrophy.

ObjectiveTo investigate the metabolic alterations of serum short chain fatty acids （SCFAs） in pediatric patients with atopic dermatitis （AD） and their correlation with different clinical phenotypes using targeted metabolomics. MethodsThis study enrolled 87 AD patients and 67 healthy controls （HC）. Serum levels of eight SCFAs were quantified by ultra-high-performance liquid chromatography-mass spectrometry. The associations between SCFAs and AD were assessed using various statistical methods. ResultsCompared with the HC group， levels of acetic acid （AA）， propionic acid （PA）， and caproic acid （CA） （P=0.002，P=0.002，P=0.043） decreased in the AD group. Logistic regression analysis identified AA （OR=0.449， 95% CI： 0.289–0.698） and PA （OR = 0.487， 95% CI： 0.324–0.732） as protective factors against AD. The combination of AA and PA yielded an area under the curve （AUC） greater than 0.7， indicating good diagnostic efficacy. Age-stratified analysis revealed that AA reduction was predominant in childhood， whereas PA reduction was predominant in adolescence. Pathway enrichment analysis showed significant enrichment of fatty acid biosynthesis （FDR=0.341， P=0.003） and vitamin K metabolism （FDR=1， P=0.039） pathways. Furthermore， subgroup analyses based on disease severity， personal/family history of atopy， and sex revealed no significant differences in SCFAs levels among the groups. ConclusionDifferential serum SCFAs and their enriched metabolic pathways may be implicated in the pathogenesis of AD.

ObjectiveTo examine the prevalence of hypertension and abnormal electrocardiogram (ECG) among the noise-exposed population in Songjiang District, Shanghai, and to analyze the influencing factors for hypertension and abnormal ECG. MethodsOccupational health examination data, encompassing basic demographic information, physical examinations, audiometric testing, blood pressure measurements, and ECG assessments, were collected from 20 165 noise-exposed workers across all manufacturing enterprise in Songjiang District in 2024. Hypertension and abnormal ECG findings were identified as indicators of health impairment. Categorical data were presented as frequencies and percentages (%). Univariate chi-square tests and multivariate logistic regression analyses were employed to identify factors associated with hypertension and abnormal ECG outcomes. ResultsThe detection rates of hypertension and abnormal ECG among noise-exposed workers in the manufacturing industry in Songjiang District were 22.78% and 13.06%, respectively. Across different enterprise scales, industry categories and economic types, micro-sized enterprises (26.90%, 25.29%), furniture manufacturing enterprises (31.01%, 31.28%) and domestic-funded enterprises (23.43%, 15.57%) had the highest detection rates of hypertension and abnormal ECG. The detection rates of hypertension and abnormal ECG were relatively high among male workers, those aged ≥60 years old and those with a Body Mass Index(BMI) ≥24.0 kg·m^-2. The detection rates of hypertension and abnormal ECG in workers exposed to noise combined with other hazards such as heat stress (27.47%, 16.87%) and benzene (22.22%, 23.46%) were higher than those exposed to noise alone (21.40%, 11.60%) (P<0.01). Compared to workers in the general equipment manufacturing industry, those in the automotive manufacturing industry had a higher risk of hypertension (OR=1.284, 95%CI: 1.098‒1.501), and those in the furniture manufacturing industry had a higher risk of abnormal ECG (OR=2.615, 95%CI: 2.014‒3.385). Micro and small enterprises, BMI ≥24.0 kg·m^-2 and advanced age had potential associations with hypertension and abnormal ECG. In addition, compared to the group exposed to noise alone, the group with noise and other physical hazards had a higher risk of hypertension (OR=1.146, 95%CI: 1.071‒1.288) and abnormal ECG (OR=1.179, 95%CI: 1.072‒1.297). Compared to the normal group, the risks of hypertension and abnormal ECG in workers with abnormal high-frequency hearing threshold for both ears increased by 21.5% (OR=1.215, 95%CI: 1.082‒1.364) and 21.0% (OR=1.210, 95%CI: 1.006‒1.410), respectively. ConclusionDifferent types of employers (economic type, industry category, enterprise size) and individual characteristics of workers (gender, age, length of service, BMI, exposure to other physical hazards, and abnormal high-frequency hearing threshold in both ears) impacted the association between noise exposure and hypertension/ECG abnormalities. Employers should enhance the management of occupational noise. In addition to hearing impairment, attention should be paid to abnormal changes in blood pressure and ECG of workers, and corresponding intervention measures should be implemented to reduce the occurrence and development of cardiovascular diseases among workers exposed to noise.

Diarrhea-predominant irritable bowel syndrome （IBS-D） exhibits typical characteristics of psychosomatic comorbidity. Its core pathogenesis is considered to involve simultaneous disorders of both the body and the spirit， for which the former is attributed to liver constraint and spleen deficiency， and dysfunction of large intestine conduction， whereas the latter is induced by spirit restlessness of zang （脏） organs， and gate insecurity of the corporeal soul. Based on this understanding， the therapeutic principle of "simultaneous regulation of body and spirit" is established. For regulating the body， the methods include soothing the liver， fortifying the spleen， consolidating the intestines， and stopping diarrhea， with emphasis on the front-mu （募） points of the related zang-fu （脏腑） organs and acupoints of the foot yangming （阳明） stomach channel and foot taiyin （太阴） spleen channel. For regulating the spirit， the methods include calming the brain spirit， tranquilizing the zang organs spirit， and securing the corporeal soul gate， mainly selecting acupoints of Governer Vessel （督脉） and the back-shu （背俞） points of the corresponding zang-fu organs. Needle manipulation techniques for supplementation and drainage are flexibly applied according to the deficiency or excess nature of the syndrome. In addition， comprehensive application of moxibustion， electroacupuncture， and auricular therapy is emphasized， with the aim of providing clinical insights for diagnosis and treatment.

Accommodative dysfunction, particularly accommodative lag, acts as a core hub connecting near work activity to myopic axial elongation. This review thoroughly explores the multidimensional biological mechanisms by which accommodative function drives axial growth. In addition to the classic pathway where hyperopic defocus signals induce retinal-choroidal-scleral biochemical remodeling, two other mechanisms are highlighted: a biomechanical pathway involving direct mechanical traction on the equatorial sclera caused by sustained ciliary muscle contraction, and a neural pathway where abnormal accommodative micro fluctuations degrade retinal image quality, thereby triggering abnormal ocular growth. Based on these comprehensive mechanisms, this paper systematically analyzes the principles of pharmacological(atropine), optical(orthokeratology, defocus lenses), and vision therapy interventions. Myopia progression results from the integrated regulation of optical defocus, mechanical stress, and neural dynamics. Future myopia control should advance toward precise, personalized combination strategies tailored to individual accommodative and genetic profiles.