ObjectiveTo investigate the effect and mechanism of modified Sini San in ameliorating intestinal mucosal barrier by observing its effects on short chain fatty acids （SCFAs） and high mobility group protein B1 （HMGB1）/receptor of advanced glycation end products （RAGE） signaling pathways in chronic stress rats. MethodsThe 50 male SD rats were randomly divided into control group，model group，low-dose modified Sini San group （7.34 g·kg^-1·d^-1），high-dose modified Sini San group （14.68 g·kg^-1·d^-1），and Fructo-oligosaccharides group （3.15 g·kg^-1·d^-1），with 10 rats in each group. Except for the control group，all other groups were subjected to chronic unpredictable stress/social isolation to create a chronic stress model for 6 weeks. After 4 weeks of modeling，each treatment group was given corresponding drugs by gavage for 2 weeks while modeling. The control group and model group were given the same volume of physiological saline. The effects of Modified Sini San on behaviors，body weight，Bristol score in feces and fecal moisture content in chronic stress rats were observed. Hematoxylin and eosin （HE） staining was used to observe the pathological changes in the cecum. The content of SCFAs in the cecal contents of rats were detected by Gas chromatography-mass spectrometry （GC-MS）. Immunohistochemistry and Western blot were used to detect the expression of HMGB1/RAGE pathway related proteins in cecal tissue. The levels of ZO-1，Occludin，and Claudin-1 in the cecal tissue were detected by enzyme linked immunosorbent assay （ELISA）. ResultsCompared with the model group，the sucrose preference rate，total distance traveled and the number of grid crossings in the open field test of rats in the low-dose modified Sini San group were obviously increased （P<0.05， P<0.01），and the immobility time in the open field test and the immobility time in the forced swimming test of rats in the low-dose and high-dose modified Sini San groups were obviously reduced （P<0.05， P<0.01）. Meanwhile，the Bristol score and fecal moisture content of rats in the low and high dose groups of modified Sini San were obviously increased （P<0.05）. The low-dose group of modified Sini San had intact mucosal layer structure in the cecal tissue and reduced infiltration of inflammatory cells. The content of SCFAs in the cecal contents increased，with a obviously increase in the content of acetic acid，propionic acid，butyric acid，and isovaleric acid （P<0.05， P<0.01） and the expression levels of HMGB1，RAGE，Toll-like receptor 2（TLR2），Toll-like receptor 4（TLR4），tumor necrosis factor-α（TNF-α），and nuclear factor kappa-B p65（NF-κB p65） proteins in cecal tissue were significantly decreased （P<0.05， P<0.01） in low-dose group of modified Sini San. Meanwhile，the contents of ZO-1，Occludin，and Claudin-1 in the cecal tissue were obviously increased （P<0.01） in low-dose group of modified Sini San. ConclusionModified Sini San can improve the function of intestinal mucosal barrier in chronic stress rats by increasing the content of SCFAs in the intestine and inhibiting the HMGB1/RAGE pathway.

Objective To explore the effect of exercise-induced fatigue on intra-and interhemispher-ic functional connectivity of the primary motor cortex during unilateral ankle plantar-dorsiflexion.Meth-ods Twenty-four healthy adult males(age:21.6±2.2 years;all right-side dominant)were selected as participants for the study.They ran on a treadmill at an individualized constant speed until fatigue.Fatigue was determined when all the following criteria were met:(1)participants failing to maintain the individualized constant speed despite the strong verbal encouragement from the experimenters;(2)reaching a rating of perceived exertion(RPE)score of at least 19;and(3)their heart rate reaching 90%of their age-predicted maximal heart rate(220-age).Moreover,EEG signals from four channels(C1,C2,C3,and C4)of the primary motor cortex were collected during unilateral ankle dorsi-plan-tarflexion movements before and after fatigue,followed by EEG coherence analyses on the collected da-ta.Results Compared to the pre-fatigue state,the coherence values of the intra-hemispheric primary motor cortex electrode pairs C1-C3 and C2-C4 during unilateral ankle plantar-dorsiflexion decreased significantly in the alpha and gamma bands after fatigue(both P<0.05).Conversely,the value of the interhemispheric primary motor cortex electrode pair C1-C2 increased significantly in the beta band(P<0.05).Conclusion Exercise-induced fatigue significantly weakens the intra-hemispheric functional con-nectivity of the primary motor cortex during unilateral ankle plantar-dorsiflexion.However,it may en-hance the interhemispheric functional connectivity and potentially collaborate to strengthen the regula-tion of fatigued muscles.

Objective To explore the effect of exercise-induced fatigue on intra-and interhemispher-ic functional connectivity of the primary motor cortex during unilateral ankle plantar-dorsiflexion.Meth-ods Twenty-four healthy adult males(age:21.6±2.2 years;all right-side dominant)were selected as participants for the study.They ran on a treadmill at an individualized constant speed until fatigue.Fatigue was determined when all the following criteria were met:(1)participants failing to maintain the individualized constant speed despite the strong verbal encouragement from the experimenters;(2)reaching a rating of perceived exertion(RPE)score of at least 19;and(3)their heart rate reaching 90%of their age-predicted maximal heart rate(220-age).Moreover,EEG signals from four channels(C1,C2,C3,and C4)of the primary motor cortex were collected during unilateral ankle dorsi-plan-tarflexion movements before and after fatigue,followed by EEG coherence analyses on the collected da-ta.Results Compared to the pre-fatigue state,the coherence values of the intra-hemispheric primary motor cortex electrode pairs C1-C3 and C2-C4 during unilateral ankle plantar-dorsiflexion decreased significantly in the alpha and gamma bands after fatigue(both P<0.05).Conversely,the value of the interhemispheric primary motor cortex electrode pair C1-C2 increased significantly in the beta band(P<0.05).Conclusion Exercise-induced fatigue significantly weakens the intra-hemispheric functional con-nectivity of the primary motor cortex during unilateral ankle plantar-dorsiflexion.However,it may en-hance the interhemispheric functional connectivity and potentially collaborate to strengthen the regula-tion of fatigued muscles.

Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective To evaluate the safety and efficacy of 450 nm blue laser vaporization prostatectomy in the treatment of benign prostatic hyperplasia(BPH).Methods A retrospective analysis was conducted on 40 BPH patients treated with 450 nm blue laser vaporization prostatectomy at our hospital during Mar.and Nov.2023.The preoperative and postoperative maximum urinary flow rate(Qmax),post-void residual volume(PVR),international prostate symptom score(IPSS),and quality of life(QoL)score were compared.The operation time,postoperative bladder irrigation time,and postoperative hemoglobin decrease were recorded.Results All operations were successful.One month after surgery,the Qmax[(7.9±2.1)mL/s vs.(16.8±2.5)mL/s]was significantly higher,while PVR[(110.0±42.1)mL vs.(14.6±11.4)mL],IPSS[(25.0±3.1)vs.(11.8±4.0)],and QoL[(5.1±0.9)vs.(2.5±0.6)]were significantly lower,with statistical significance(P＜0.05).The operation time was(52.5±15.5)min,the bladder irrigation time was(22.3±4.9)h,the postoperative hemoglobin drop was(6.5±3.8)g/L.Urinary retention occurred in 2 patients after removal of the catheter.Gross hematuria occurred in 1 patient after discharge.Conclusion Vaporization prostatectomy with 450 nm blue laser can significantly improve clinical symptoms and perioperative safety,with high vaporization efficiency and good hemostatic effects.It is worthy of clinical promotion and application.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology has the characteristics of high specificity and high throughput, making it rapidly applied and developed in the field of clinical testing. Its application in the monitoring of therapeutic drugs can effectively improve the quantitative accuracy and sensitivity, and formulate a personalized and optimal dosing plan for patients. However, this technology still faces some challenges, and automation, quality control, and quantitative traceability will be the future development direction.

Objective:To study the clinically curative effect of ureteroscopic holmium laser lithotripsy combined with intercepted basket of capture and extraction device for stone(N-trap)in treating middle and upper ureteral stones.Methods:A total of 112 patients with middle and upper ureteral stone who were diagnosed and treated in the Department of Urology of the Second Affiliated Hospital of Wannan Medical College from September 2020 to September 2022 were prospectively selected as the study subjects,and they were divided into two groups according to the random number table method,with 56 cases in each group.The control group was treated with ureteroscopic holmium laser lithotripsy alone,and the observation group was treated with ureteroscopic holmium laser lithotripsy combined with N-trap intercepted basket for treatment.The related indicators of surgery,the stone removal effect,renal function indicators,postoperative renal mass,postoperative recurrence and postoperative complications between two groups were compared.The scores of the Wisconsin Stone Quality of Life(WISQOL)questionnaire were used to compare and evaluate the postoperative quality of life between the two groups.Results:There were no significant differences in intraoperative operation time and intraoperative blood loss between the two groups(P>0.05),and the postoperative hospitalization time in the observation group was significantly shorter than that in the control group(t=3.464,P<0.05).The success rate of one-time lithotripsy and the clearance rate of stone within 30 d in the observation group were significantly higher than those in the control group,and the upward movement rate of stones of the observation group was significantly lower than that in the control group,and the difference was statistically significant(x2=6.698,7.240,5.489,P<0.05),respectively.The postoperative serum creatinine(Scr),blood urea nitrogen(BUN)and urine microalbumin(UMA)in the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=6.320,8.115,9.231,P<0.05),respectively.The degree of hydronephrosis at 3,6 and 12 months after surgery in the observation group were significantly lower than those in the control group,and the differences were statistically significant(t=3.218,3.345,2.985,P<0.05),respectively.The recurrence rates at 6 and 12 months after surgery in the inspection group were significantly lower than those in the control group,and the differences were statistically significant(x2=5.114,5.783,P<0.05),respectively.The incidence of postoperative complication in the observation group was significantly lower than that in the control group(x2=4.865,P<0.05).The total score of the each dimension of WISQOL scale,and the total score of energy,sleep status,physical symptoms and overall emotion in the observation group were significantly higher than those in the control group,and the differences were statistically significant(t=3.734,3.889,3.903,4.340,4.650,P<0.05),respectively.Conclusion:The curative effect of ureteroscopic holmium laser lithotripsy combined with N-trap intercepted basket is certain,which can effectively improve the clearance rate of stone,and shorten the postoperative hospitalization time,and reduce the incidence of postoperative complications and recurrence rate,and promote the recovery of renal function,and improve the quality of life of patients after surgery.

Objective The results of ASTRUM-007 reveal the clinical benefits of PD-L1-positive esophageal squamous cell carcinoma(ESCC)patients.This study aims to analyze the economics of first-line treatment of PD-L1-positive ESCC with brucella combined with chemotherapy from the perspective of China's health system.Methods A three-state partitioned survival model(PSM)including progression-free survival(PFS),disease progression(PD),and death(D)was established to evaluate the economy of serplulimab combined with chemotherapy,the first-line treatment for PD-L1 positive advanced ESCC,compared with the placebo combination chemotherapy.The cycle period was two weeks,the horizon of the simulation was a lifetime,and the annual discount rate was set to 5%.The main outcome parameters are total cost,quality-adjusted life year(QALY),and incremental cost-effectiveness ratio(ICER).One-way sensitivity analysis(OWSA),probability sensitivity analysis(PSA),and scenario analysis were used to evaluate the impact of the change of important parameters in the model on ICER.Results The basic results showed that the incremental effect and incremental cost of the serplulimab combined with chemotherapy compared with the placebo combination chemotherapy were 1.281 QALYs and 266 573.26 yuan,respectively,and the ICER was 208 166.24 yuan/QALY.OWSA showed that the price of serplulimab was the most sensitive parameter to ICER;PSA showed that when the WTP threshold was three times China's per capita GDP in 2022,Serplulimab combined with chemotherapy was significantly more economical than the placebo combination chemotherapy;scenario analysis revealed that according to the ASTRUM-007 study in the Central Asian group and the charitable drug donation program of serplulimab:in patients with PD-L1 1≤CPS<10,ICER was 205 056.83 yuan/QALY;with 218 022.59/QALY in patients with PD-L1 CPS≥10,and the mean value of ICER was lower than three times of China's per capita GDP.The ICER of all patients was 59 046.65 yuan/QALY,with 68 294.42 yuan/QALY of patients with PD-L1 1≤CPS<10,44 744.02 yuan/QALY of patients with PD-L1 CPS≥10.The ICER value was lower than China's per capita GDP.Conclusion Serplulimab combined with chemotherapy is more economical than placebo combined with chemotherapy in the treatment of PD-L1-positive ESCC patients.

A young female patient with acne and elevated testosterone level underwent plasma steroid hormones testing and found a significant increase in aldosterone. We excluded testing interference and verified the absence of hypertension, hypokalemia, and adrenal occupancy, as well as primary and secondary hyperaldosteronism. During follow-up, a temporal correlation was found between aldosterone levels and the use of drospirenone and ethinylestradiol tablets. It was observed that the combination of drospirenone and ethinylestradiol could lead to the increase of aldosterone level and the concentration ratio of aldosterone to direct renin through different mechanisms. Drospirenone exerts an antagonistic effect on mineralocorticoid receptor to prevent the development of hypertension or hypokalemia. In clinical practice, it is necessary to pay attention to the effect of this drug on screening markers for primary aldosteronism. In the laboratory examination, when female patients with no symptoms of hypertension and hypokalemia but with elevated aldosterone levels are encountered, it can be verified whether they have a history of use of compound estrogen-progestin such as drospirenone and ethinylestradiol tablets, and appropriate tips are provided in the report.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.