BACKGROUND:Primary osteoporosis has a high incidence,but the pathogenesis is not fully understood.Currently,there is a lack of effective early screening indicators and treatment programs. OBJECTIVE:To further explore the mechanism of primary osteoporosis through comprehensive bioinformatics analysis. METHODS:The primary osteoporosis data were obtained from the gene expression omnibus(GEO)database,and the differentially expressed genes were screened for Gene Ontology(GO)function and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.In addition,the differentially expressed genes were subjected to protein-protein interaction network to determine the core genes related to primary osteoporosis,and the least absolute shrinkage and selection operator algorithm was used to identify and verify the primary osteoporosis-related biomarkers.Immune cell correlation analysis,gene enrichment analysis and drug target network analysis were performed.Finally,the biomarkers were validated using qPCR assay. RESULTS AND CONCLUSION:A total of 126 differentially expressed genes and 5 biomarkers including prostaglandins,epidermal growth factor receptor,mitogen-activated protein kinase 3,transforming growth factor B1,and retinoblastoma gene 1 were obtained in this study.GO analysis showed that differentially expressed genes were mainly concentrated in the cellular response to oxidative stress and the regulation of autophagy.KEGG analysis showed that autophagy and senescence pathways were mainly involved.Immunoassay of biomarkers showed that prostaglandins,retinoblastoma gene 1,and mitogen-activated protein kinase 3 were closely related to immune cells.Gene enrichment analysis showed that biomarkers were associated with immune-related pathways.Drug target network analysis showed that the five biomarkers were associated with primary osteoporosis drugs.The results of qPCR showed that the expression of prostaglandins,epidermal growth factor receptor,mitogen-activated protein kinase 3,and transforming growth factor B1 in the primary osteoporosis sample was significantly increased compared with the control sample(P<0.001),while the expression of retinoblastoma gene 1 in the primary osteoporosis sample was significantly decreased compared with the control sample(P<0.001).Overall,the study screened and validated five potential biomarkers of primary osteoporosis,providing a reference basis for further in-depth investigation of the pathogenesis,early screening and diagnosis,and targeted treatment of primary osteoporosis.

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic acute kidney injury (SAKI) is one of the most common complications of sepsis, and the occurrence of acute kidney injury (AKI) indicates that the patient's condition is critical with a poor prognosis. The traditional view holds that the main mechanism of SAKI is the reduction of renal blood flow, inadequate renal perfusion, inflammatory response, and microcirculatory dysfunction caused by sepsis, which subsequently leads to ischemia and necrosis of renal tubular cells. Recent research findings indicate that processes such as autophagy and other forms of programmed cell death play an increasingly important role. Autophagy is a programmed intracellular degradation process and is a form of programmed cell death. Cells degrade their cytoplasmic components via lysosomes, breaking down and recycling intracellular constituents to meet their metabolic needs, maintain intracellular homeostasis, and renew organelles. During SAKI, autophagy plays a crucial protective role through various mechanisms, including regulating inflammation and immune responses, clearing damaged organelles, and maintaining stability in the intracellular environment. In recent years, the role of autophagy in the pathogenesis and treatment of SAKI has received widespread attention. Research has confirmed that various intracellular signaling pathways and signaling molecules targeting autophagy [such as mammalian target of rapamycin (mTOR) signaling pathway, AMP-activated protein kinase (AMPK) signaling pathway, nuclear factor-κB (NF-κB) signaling pathway, and Sirtuins (SIRT), autophagy associated factor Beclin-1, and Toll-like receptor (TLR)] are involved in the development of SAKI. Due to the complex pathogenesis of SAKI, current treatment strategies include fluid management, infection control, maintenance of internal environment balance, and renal replacement therapy; however, the mortality remains high. In recent years, it has been found that autophagy plays a critical protective role in sepsis-mediated AKI. As a result, an increasing number of drugs are being developed to alleviate SAKI by regulating autophagy. This article reviews the latest advances in the role of autophagy in the pathogenesis and treatment of SAKI, with the aim of providing insights for the development of new drugs for SAKI patients.
Humans ; Acute Kidney Injury/etiology* ; Autophagy ; Sepsis/complications* ; Signal Transduction

Most patients with hepatocellular carcinoma(HCC)are diagnosed at an intermediate or advanced stage,losing the opportunity for surgical resection.Conversion therapy,which uses non-surgical approaches to render initially unresectable tumors resectable,has gradually become part of routine clinical practice and a research focus.However,multiple challenges remain,including the lack of clear criteria for identifying"potentially resectable"cases,difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy,controversy over the necessity of surgery in patients achieving radiological complete response,the need for optimization of perioperative assessment and management,uncertainty in determining the optimal timing of surgery,and the absence of consensus on postoperative sequential systemic therapy regimens and duration.Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials.With the accumulation of clinical experience,growing evidence,and advances in treatment,more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Objective:To explore the medication adherence of elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City and analyze its influencing factors.Methods:From April to July 2023, convenience sampling was used to select rural 240 elderly patients with chronic diseases and polypharmacy in five administrative districts (counties) of Hangzhou as participants. The survey was conducted using the General Information Questionnaire, Social Support Rating Scale, Medication Knowledge and Beliefs Questionnaire, and the Chinese version of the 8-item Morisky Medication Adherence Scale. Multiple linear regression was used to analyze the factors influencing medication adherence in elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City.Results:A total of 240 questionnaires were distributed and 220 valid questionnaires were collected, with an effective response rate of 91.67%. Among 220 elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City, 135 had poor medication adherence. Multiple linear regression analysis showed that age, educational level, family doctor contract, medication knowledge, and beliefs were the influencing factors of medication adherence in elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City ( P<0.05) . Conclusions:The medication adherence of elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou urgently needs to be improved. Medical and nursing staff should pay special attention to patients who are old, have a low level of education, have not signed a family doctor, and have poor knowledge and beliefs about medication. It is suggested that the contract system for family doctors be further promoted, focusing on health education on medication knowledge and beliefs, to improve medication adherence among elderly chronic disease patients in rural areas.

Objective:To explore the medication adherence of elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City and analyze its influencing factors.Methods:From April to July 2023, convenience sampling was used to select rural 240 elderly patients with chronic diseases and polypharmacy in five administrative districts (counties) of Hangzhou as participants. The survey was conducted using the General Information Questionnaire, Social Support Rating Scale, Medication Knowledge and Beliefs Questionnaire, and the Chinese version of the 8-item Morisky Medication Adherence Scale. Multiple linear regression was used to analyze the factors influencing medication adherence in elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City.Results:A total of 240 questionnaires were distributed and 220 valid questionnaires were collected, with an effective response rate of 91.67%. Among 220 elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City, 135 had poor medication adherence. Multiple linear regression analysis showed that age, educational level, family doctor contract, medication knowledge, and beliefs were the influencing factors of medication adherence in elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou City ( P<0.05) . Conclusions:The medication adherence of elderly patients with chronic diseases and polypharmacy in rural areas of Hangzhou urgently needs to be improved. Medical and nursing staff should pay special attention to patients who are old, have a low level of education, have not signed a family doctor, and have poor knowledge and beliefs about medication. It is suggested that the contract system for family doctors be further promoted, focusing on health education on medication knowledge and beliefs, to improve medication adherence among elderly chronic disease patients in rural areas.

Most patients with hepatocellular carcinoma(HCC)are diagnosed at an intermediate or advanced stage,losing the opportunity for surgical resection.Conversion therapy,which uses non-surgical approaches to render initially unresectable tumors resectable,has gradually become part of routine clinical practice and a research focus.However,multiple challenges remain,including the lack of clear criteria for identifying"potentially resectable"cases,difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy,controversy over the necessity of surgery in patients achieving radiological complete response,the need for optimization of perioperative assessment and management,uncertainty in determining the optimal timing of surgery,and the absence of consensus on postoperative sequential systemic therapy regimens and duration.Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials.With the accumulation of clinical experience,growing evidence,and advances in treatment,more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Objective To establish a personalized Stanford type B aortic dissection numerical simulation model, and using computational fluid dynamics (CFD) numerical simulation to obtain the hemodynamic behavior and law of the type B aortic dissection at different stages of development. Methods Based on the theory of three-dimensional model reconstruction, we used CT images of a patient with type B aortic dissection in the Xiamen Cardiovascular Hospital of Xiamen University, relevant medical image processing software to reconstruct a personalized aortic three-dimensional model, and CFD to reconstruct the model which was simulated in fluid mechanics. Results The three-dimensional reconstruction model could intuitively observe the changing trend of the false cavity at different stages of the dissection development. Through fluid mechanics simulation, the blood flow rate, pressure, wall shear stress, vascular wall Von Mises stress and other parameters at different stages of the dissection development were obtained. Conclusion The hemodynamic behavior and law of relevant parameters in the development stage of aortic dissection are analyzed. The combination of the values of relevant parameters and clinical medical detection and diagnosis can well predict the development of the disease, and finally provide more theories and methods for the scientific diagnosis of aortic dissection.

Objective The existing evidence of exercise rehabilitation in patients undergoing surgery for valvular heart disease was analyzed,described and evaluated by using evidence mapping methods.Methods Systematic reviews and randomized controlled trials on exercise rehabilitation of patients undergoing valvular heart disease surgery were searched from CNKI,Wanfang Data,VIP,CBM,Embase,PubMed,Cochrane Library,Web of Science,Ovid,CINAHL and other databases,and the search period was established until April 23,2024.The quality of the included literature was evaluated,and the feature information of the included literature was visualized in the form of bubble map and table.Results Fifty-one literatures(including 44 randomized controlled trials and 7 systematic evaluations)were finally included.Among the 44 randomized controlled trials,the types of exercise were mainly related to anaerobic exercise(3 literatures),aerobic exercise(11 literatures),flexibility training(8 literatures),and multisport exercise(22 literatures);postoperative inpatient rehabilitation accounted for a relatively high proportion(16 literatures),followed by overall postoperative rehabilitation(13 literatures)and pre-operative prehabilitation(7 literatures).Twenty-seven conclusions were categorized as"beneficial",15 as"possibly beneficial,"and one ach as"unclear"and"no effect".Seven systematic evaluations were subjected to Meta-analysis,and in terms of the design of the included studies,there were only 3 systematic reviews that included randomized controlled trials.Of the study conclusions,three were"beneficial",three were"possibly beneficial"and one was"unclear".Conclusion The evidence mapping shows that exercise rehabilitation is generally beneficial or potentially beneficial in the rehabilitation of valvular heart disease surgery,mainly in the postoperative inpatient rehabilitation phase.High-quality studies are needed to further investigate the effectiveness of exercise programs with different intensities,frequencies,and durations,as well as different valve types,adverse effects of exercise,and other outcome indicators.

Objective To systematically review the efficacy of enhanced recovery after surgery(ERAS)nursing on patients with dissection of aorta.Methods Nine databases,including PubMed,CNKI,etc were searched to identify randomized controlled trials involving dissection of aorta patients undergoing ERAS nursing.The retrieval time was from setting up of the databases until March 2024.Literature quality assessment followed by"Cochrane handbook for systematic reviews of interventions.Version 5.1.0",and Meta-analysis was conducted utilizing software of RevMan 5.4.Results Nine literatures with a total of 723 patients were included.The results of Meta-analysis showed that compared with the conventional nursing model,the application of ERAS nursing model could effectively promote the process of patients'postoperative recovery,and there were significant differences in indicators such as the time of postoperative mechanical ventilation,the time of the first postoperative out-of-bed activity,the time of tubing removal,the incidence of complications,the length of hospital stay,and the degree of perceived pain(P＜0.05).Conclusion Implementing nursing model based on ERAS on dissection of aorta patients can effectively enhance patients'postoperative recovery outcomes,thus worth clinical promotion and application.

Objective To evaluate the effect of mindfulness-based intervention in patients after percutaneous coronary intervention(PCI)through Meta-analysis.Methods Nine databases,including CNKI and PubMed,were searched for randomized controlled trials on the effect of mindfulness intervention in patients after PCI,and the search period was from the establishment of the database to May 31,2024.Two researchers independently screened the literature,extracted data and evaluated the quality,and used Revman 5.4 software for Meta-analysis.Results A total of 11 randomized controlled trials involving 998 patients were included.The results of Meta-analysis showed that compared with conventional care,the use of mindfulness-based intervention therapy could positively improve patients'postoperative anxiety,perceived stress level,mindfulness awareness and other indicators.In terms of safety measures,the incidence of cardiac adverse events was not statistically significant compared with usual care(P＞0.05).Conclusion Mindfulness intervention has a significant effect in patients after PCI.