BACKGROUND:Neurodegenerative diseases are closely related to the imbalance of mitochondrial autophagy regulation.Previous studies by the research group have shown that lycium barbarum polysaccharide has neuroprotective effects,but whether it can improve the damage of SH-SY5Y cells induced byβ-amyloid protein 1-42 by regulating mitochondrial autophagy is still unclear.OBJECTIVE:To explore the protective effect and mechanism of Lycium barbarum polysaccharide on SH-SY5Y cells induced by β-amyloid protein 1-42.METHODS:An Alzheimer's disease cell model was established by inducing SH-SY5Y cells with β-amyloid protein 1-42,and then intervening with Lycium barbarum polysaccharide.SH-SY5Y cells were divided into three groups:control group,β-amyloid protein 1-42 group(20 μmol/L β-amyloid protein 1-42 for 24 hours),and Lycium barbarum polysaccharide group(1 g/L Lycium barbarum polysaccharide was added 1 hour in advance to form a protective effect,and then 20 μmol/L β-amyloid protein 1-42 was added to intervene with Lycium barbarum polysaccharide for 24 hours).CCK8 assay was used to detect cell viability.Mitochondrial membrane potential was detected by JC-1.TUNEL staining was used to detect cell apoptosis.Immunofluorescence and western blot assay were used to detect the expression of synaptic,apoptosis,and mitophagy-related indicators.RESULTS AND CONCLUSION:(1)Compared with the control group,the cell viability of the β-amyloid protein 1-42 group decreased(P＜0.05);cell apoptosis rate increased(P＜0.05);mitochondrial membrane potential decreased(P＜0.05);the expressions of pro-apoptotic proteins Bax and Caspase3 increased(P＜0.05);the expression of anti-apoptotic protein Bcl-2 decreased(P＜0.05);the expression levels of synaptic-related proteins Syn and PSD-95 decreased(P＜0.05);the expression levels of mitochondrial autophagy-related proteins Pink1,LC3A/B,Parkin,and Beclin-1 decreased(P＜0.05);and the expression of P62 increased(P＜0.05).(2)Compared with the β-amyloid protein 1-42 group,the cell viability in the Lycium barbarum polysaccharide group was increased(P＜0.05);the apoptosis rate was decreased(P＜0.05);the mitochondrial membrane potential was increased(P＜0.05);the expression levels of Bax and Caspase3 were decreased(P＜0.05);the expression of Bcl-2 was increased(P＜0.05);the expressions of Syn and PSD-95 were increased(P＜0.05);the expression levels of Pink1,LC3A/B,Parkin,and Beclin-1 were increased(P＜0.05),and the expression of P62 was decreased(P＜0.05).These findings indicate that Lycium barbarum polysaccharide may inhibit β-amyloid protein 1-42-induced damage to SH-SY5Y cells by regulating mitophagy,reduce cell apoptosis,and increase neuronal synaptic plasticity.

Objective:To explore the clinical efficacy of the splenic vessel-oriented anatomical plane priority strategy in Da Vinci robotic Kimura distal pancreatectomy.Methods:A retrospective analysis was conducted on 26 patients who underwent robotic-assisted distal pancreatectomy at Zhejiang Provincial People’s Hospital from January 2019 to September 2024. The cohort included 7 male and 19 female patients, aged (49.3±16.7) years. Surgical outcomes, including operative time, intraoperative blood loss, postoperative complications, and hospital stay, were analyzed, and surgical techniques were summarized.Results:All 26 patients successfully completed the surgery. Pathological diagnoses included 5 cases of intraductal papillary mucinous neoplasm, 5 serous cystadenomas, 1 pancreatic neuroendocrine tumor, 6 solid pseudopapillary neoplasms, 4 mucinous cystic neoplasms, and 5 neuroendocrine tumors. The maximum tumor diameter was (2.3±1.1) cm, and the operative time was (183.2±77.4) min. The spleen preservation rate was 100% (26/26). Intraoperative blood loss was 50.0 (17.5, 125) ml, and postoperative hospital stay was (10.1±3.7) d. No Clavien-Dindo grade III or higher complications occurred. The post-operative pancreatic fistula (POPF) rate was 53.8% (14/26), including 38.5% (10/26) biochemical leak and 15.3% (4/26) grade B POPF, with no grade C POPF.Conclusion:The splenic vessel-oriented anatomical plane priority strategy in robotic-assisted spleen-preserving distal pancreatectomy (Kimura technique) is safe and feasible, significantly improving the spleen preservation rate.

Objective:To explore the risk factors of acute Kemmochi type V anterior talofibular ligament (ATFL) injury in X-ray negative children and their predictive efficacy .Methods:A retrospective cohort study was conducted to analyze the clinical data of 92 children with X-ray negative ATFL injury, who were treated at the outpatient department of Jinan Children′s Hospital from June 2023 to March 2025, including 55 boys and 37 girls, aged 5-14 years [8.8(7.0, 11.0)years]. The cause of injury was low-energy ankle sprain and X-ray examination showed no fracture, ie, X-ray negative. According to the Kemmochi classification for ATFL injury, the injury was classified as type V (Kemmochi type V group) in 42 patients and type I-IV (non-Kemmochi type V group) in 50. Gender, age, side of injury, time from injury to first visit, physical examination at the first visit [positive result of ankle inversion test, weight-bearing ability assessment, visual analogue score (VAS)], X-ray examination at the first visit (presence of os subfibulare), and musculoskeletal ultrasound examination at the first visit (swelling degree of ATFL, ankle joint effusion, enhanced blood flow signal of ATFL) were recorded in both groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for X-ray negative Kemmochi type V ATFL injury in children. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive efficacy of each independent risk factor for Kemmochi type V ATFL injury. Results:Univariate analysis showed significant differences between the two groups in age, VAS, ATFL swelling degree, and ankle joint effusion ( P<0.05) but no significant differences in gender, side of injury, time from injury to the first visit, positive result of ankle inversion test, weight-bearing ability assessment, presence of os subfibulare or enhanced blood flow of ATFL ( P>0.05). Binary Logistic regression analysis indicated that age ( OR=0.79, 95% CI 0.65, 0.97, P<0.05) and ATFL swelling degree ( OR=6.97, 95% CI 1.38, 35.32, P<0.05) were significantly correlated with Kemmochi type V ATFL injury in X-ray negative children. ROC curve analysis showed that the AUC for age and ATFL swelling degree were 0.65(95% CI 0.54, 0.75) and 0.78(95% CI 0.68, 0.86) and the AUC for age combined with ATFL swelling degree was 0.83(95% CI 0.74, 0.90). The optimal threshold values of age and ATFL swelling degree were 9.3 years and 1.0 mm. Conclusions:Age and ATFL swelling degree are independent risk factors for Kemmochi type V ATFL injury in X-ray negative children. Both age and ATFL swelling degree have relatively high independent predictive efficacy, and the combined predictive efficacy of the two is even higher.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

The operation assistant work team of public hospitals is an important bridge and link to realize the integration of industry and finance,and an important practitioner to promote the realization of lean operation management.It examines the service model of the operation assistant team engaged in Similar Multi-disciplinary Treatment,focusing on organizational structure,job responsibilities,and service mechanisms.Build a four-tiered lean operational management system and set up an operation assistant work team that combines production,university and research.Based on specific management matters,establish an operation assistant service mechanism such as problem assessment and classification management mechanism,project standardization management mechanism,reward and punishment assessment mechanism,etc.,to promote the optimization and integration of hospital medical education,research,prevention and management and core elements such as human,talent,material and technology resources.Help public hospitals to continuously improve their lean operation management level.

Objective:To investigate the epidemiological characteristics of human brucellosis in Yantai City of Shandong Province, and provide a basis for scientifically formulating brucellosis prevention and control strategies.Methods:A retrospective study was conducted to collect data on the epidemic situation of brucellosis in Yantai City from 2020 to 2022 from the "Infectious Disease Reporting Information Management System of China Disease Prevention and Control Information System". Descriptive analysis was conducted on the epidemic situation of brucellosis, the distribution of cases (region, time, population distributions), clinical symptoms and signs.Results:A total of 493 cases of brucellosis were reported in Yantai City from 2020 to 2022, including 129 cases in 2020, 172 cases in 2021, and 192 cases in 2022. The incidence rate was 1.905 3/100 000, 2.506 3/100 000, and 2.901 9/100 000, respectively. There were statistically significant differences between different years (χ 2 = 13.87, P = 0.001). The main distribution of brucellosis cases was in Laizhou City, Laiyang City, Zhaoyuan City, and Longkou City, accounting for 69.37% (342/493) of the total cases. Among them, Laizhou City had the highest proportion, accounting for 31.24% (154/493). There were reports of brucellosis cases in every month of the year, with the onset mainly concentrated from March to August, the cumulative cases accounted for 63.69% (314/493) of the total cases. In the population distribution, male cases were the main ones, with a male to female ratio of 2.24 ∶ 1.00 (341 ∶ 152). The age was (54.97 ± 13.59) years old, mainly concentrated in the age group of 45 - 59 years old, accounting for 43.20% (213/493). Farmers were the main occupation, accounting for 81.95% (404/493). The clinical symptoms of 493 cases of brucellosis were mainly fever, muscle and joint pain, and fatigue, accounting for 62.27% (307/493), 61.87% (305/493), and 61.46% (303/493), respectively. A few cases were accompanied by splenomegaly and hepatomegaly, accounting for 3.45% (17/493) and 1.22% (6/493), respectively. Direct contact with animals was the main route of infection for brucellosis cases, accounting for 57.00% (281/493). Conclusions:From 2020 to 2022, there are reports of brucellosis cases in every month of the year in Yantai City, with a high incidence in spring and summer. The main affected population is middle-aged male farmers, and direct contact with animals is the main route of infection. It is necessary to strengthen disease monitoring and health education for key populations during high incidence seasons.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective:To investigate the effect and mechanism of lycium barbarum polysaccharide(LBP)on lipopolysaccharide(LPS)-induced inflammatory response of NLRP3 inflammasome in BV2 microglial cells.Methods:BV2 microglial cells were routinely cultured.CCK-8 assay was used to detect the effect of different concentrations(0.5,1,1.5,2 g/L)LBP on cell activity.Cells were di-vided into three groups:control group,LPS group and LBP+LPS group.Effect of LBP on LPS-induced cell activity was detected by CCK-8 method;RT-qPCR and immunofluorescence assay were used to detect NLRP3,ASC,Caspase-1,IL-18 and IL-1β expressions.Western blot was used to detect expressions of NLRP3,ASC,Caspase-1,TLR4,MyD88,NF-κB p65,IL-18,IL-1β and TNF-α pro-teins.Results:CCK-8 assay showed that 1 g/L LBP was the most applicable.Compared with control group,cell viability in LPS group was decreased;RT-qPCR,immunofluorescence and Western blot results showed that fluorescence intensity,mRNA and protein expres-sions of NLRP3,ASC,Caspase-1,IL-18 and IL-1β were increased in LPS group.Western blot results showed that TLR4,MyD88,NF-κB p65 and TNF-α protein expressions were increased in LPS group.After LBP treatment,cell viability was increased;expres-sions of NLRP3,ASC,Caspase-1,NF-κB p65,TLR4,MyD88,IL-18,IL-1β and TNF-α were decreased.Conclusion:LBP may in-hibit LPS-induced NLRP3 inflammatory vesicles in BV2 cells via TLR4/MyD88/NF-κB signaling pathway.