Objective:To investigate the relationship between serum insulin-like growth factor-1 (IGF-1) levels and intracranial or extracranial atherosclerosis in patients with cerebral small vessel disease (CSVD).Methods:A total of 407 patients with CSVD admitted to Xiangya Hospital of Central South University between July 2021 and September 2023 were enrolled in the study. Carotid duplex ultrasound was used to measure the internal diameter, intima-media thickness (IMT), vascular wall thickness, plaque property score, stenosis index, and stenosis ratio of the bilateral common carotid arteries, internal carotid arteries, external carotid arteries, and vertebral arteries. Magnetic resonance angiography was used to assess the degree of stenosis in intracranial arteries. Patients were divided into 4 groups based on the serum IGF-1 levels (low level group:≤5.21 ng/ml, medium level group:>5.21 ng/ml and ≤10.73 ng/ml, high level group:>10.73 ng/ml and ≤24.26 ng/ml, extremely high level group:>24.26 ng/ml). The IMT of the common carotid artery, carotid plaques, diameters of various cervical vascular lumens, carotid artery diameter stenosis, and intracranial artery stenosis in 4 groups of the patients were compared. The relationship between IGF-1 and intracranial and extracranial atherosclerosis was analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis.Results:There were inter group differences among the 4 groups in internal carotid artery diameter [low level group 5.45 (0.50) mm vs medium level group 5.32 (0.55) mm vs high level group 5.30 (0.55) mm vs extremely high level group 5.30 (0.50) mm; H=8.210, P=0.042]. The carotid IMT [low level group 0.80 (0.05) mm vs medium level group 0.80 (0.05) mm vs high level group 0.83 (0.03) mm vs extremely high level group 0.83 (0.09) mm; H=8.107, P=0.044], the proportion of carotid artery vascular wall thickening [low level group 52.9%(54/102) vs medium level group 48.0%(49/102) vs high level group 68.3%(69/101) vs extremely high level group 60.8%(62/102); χ2=9.889, P=0.020], the carotid artery plaque property score [low level group 1 (2) vs medium level group 2 (2) vs high level group 2 (2) vs extremely high level group 2 (2); H=8.913, P=0.030] and the proportion of anterior cerebral artery stenosis [low level group 2.9%(3/102) vs medium level group 2.0%(2/102) vs high level group 4.0%(4/101) vs extremely high level group 10.8%(11/102); χ2=10.473, P=0.014] had inter group differences among the 4 groups, and the differences were statistically significant. Univariate Logistic regression analysis indicated that carotid artery vascular wall thickening ( OR=1.197, 95% CI 1.003-1.429, P=0.046), anterior cerebral artery stenosis ( OR=1.814, 95% CI 1.148-2.867, P=0.011), and basilar artery stenosis ( OR=1.530, 95% CI 1.084-2.159, P=0.015) were correlated with IGF-1 levels. Multivariate Logistic regression analysis revealed that after adjusting for age, gender, low-density lipoprotein cholesterol (LDL-C), and C-reactive protein, IGF-1 was positively correlated with the carotid artery vascular wall thickening ( OR=1.311, 95% CI 1.014-1.696, P=0.039); after adjusting for age, IGF-1 was positively correlated with the anterior cerebral artery stenosis ( OR=2.130, 95% CI 1.201-3.776, P=0.010); after adjusting for gender, low-density lipoprotein cholesterol, and cholesterol levels, IGF-1 was positively correlated with basilar artery stenosis ( OR=1.688, 95% CI 1.063-2.681, P=0.027). Conclusions:There is an association between IGF-1 levels and intracranial and extracranial atherosclerosis in patients with CSVD. IGF-1 may play a role in the development and progression of atherosclerosis in CSVD.

Objective:To investigate the relationship between serum insulin-like growth factor-1 (IGF-1) levels and intracranial or extracranial atherosclerosis in patients with cerebral small vessel disease (CSVD).Methods:A total of 407 patients with CSVD admitted to Xiangya Hospital of Central South University between July 2021 and September 2023 were enrolled in the study. Carotid duplex ultrasound was used to measure the internal diameter, intima-media thickness (IMT), vascular wall thickness, plaque property score, stenosis index, and stenosis ratio of the bilateral common carotid arteries, internal carotid arteries, external carotid arteries, and vertebral arteries. Magnetic resonance angiography was used to assess the degree of stenosis in intracranial arteries. Patients were divided into 4 groups based on the serum IGF-1 levels (low level group:≤5.21 ng/ml, medium level group:>5.21 ng/ml and ≤10.73 ng/ml, high level group:>10.73 ng/ml and ≤24.26 ng/ml, extremely high level group:>24.26 ng/ml). The IMT of the common carotid artery, carotid plaques, diameters of various cervical vascular lumens, carotid artery diameter stenosis, and intracranial artery stenosis in 4 groups of the patients were compared. The relationship between IGF-1 and intracranial and extracranial atherosclerosis was analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis.Results:There were inter group differences among the 4 groups in internal carotid artery diameter [low level group 5.45 (0.50) mm vs medium level group 5.32 (0.55) mm vs high level group 5.30 (0.55) mm vs extremely high level group 5.30 (0.50) mm; H=8.210, P=0.042]. The carotid IMT [low level group 0.80 (0.05) mm vs medium level group 0.80 (0.05) mm vs high level group 0.83 (0.03) mm vs extremely high level group 0.83 (0.09) mm; H=8.107, P=0.044], the proportion of carotid artery vascular wall thickening [low level group 52.9%(54/102) vs medium level group 48.0%(49/102) vs high level group 68.3%(69/101) vs extremely high level group 60.8%(62/102); χ2=9.889, P=0.020], the carotid artery plaque property score [low level group 1 (2) vs medium level group 2 (2) vs high level group 2 (2) vs extremely high level group 2 (2); H=8.913, P=0.030] and the proportion of anterior cerebral artery stenosis [low level group 2.9%(3/102) vs medium level group 2.0%(2/102) vs high level group 4.0%(4/101) vs extremely high level group 10.8%(11/102); χ2=10.473, P=0.014] had inter group differences among the 4 groups, and the differences were statistically significant. Univariate Logistic regression analysis indicated that carotid artery vascular wall thickening ( OR=1.197, 95% CI 1.003-1.429, P=0.046), anterior cerebral artery stenosis ( OR=1.814, 95% CI 1.148-2.867, P=0.011), and basilar artery stenosis ( OR=1.530, 95% CI 1.084-2.159, P=0.015) were correlated with IGF-1 levels. Multivariate Logistic regression analysis revealed that after adjusting for age, gender, low-density lipoprotein cholesterol (LDL-C), and C-reactive protein, IGF-1 was positively correlated with the carotid artery vascular wall thickening ( OR=1.311, 95% CI 1.014-1.696, P=0.039); after adjusting for age, IGF-1 was positively correlated with the anterior cerebral artery stenosis ( OR=2.130, 95% CI 1.201-3.776, P=0.010); after adjusting for gender, low-density lipoprotein cholesterol, and cholesterol levels, IGF-1 was positively correlated with basilar artery stenosis ( OR=1.688, 95% CI 1.063-2.681, P=0.027). Conclusions:There is an association between IGF-1 levels and intracranial and extracranial atherosclerosis in patients with CSVD. IGF-1 may play a role in the development and progression of atherosclerosis in CSVD.

Cancer toxin is a specific pathogenesis leading to the heterogeneity of breast cancer.The nature and virulence of the cancer toxin determine the differences in the heterogeneity of breast cancer,which can dynamically evolve over time and space,resulting in varying invasion abilities and characteristics of the tumor.Cancer cells in the primary lesion possess"toxicity"that targets specific organs for metastasis,and cancer toxins can influence the metastatic propensity of different types of breast cancer.Therefore,breast cancer treatment strategies based on the theory of cancer toxins emphasize the continuous eradication of the cancer toxin,focusing on differentiating its strength and nature,protecting unaffected areas first,identifying the state based on symptoms,and targeting accordingly to combat resistance arising from tumor heterogeneity.This article aims to provide a new theoretical basis for the treatment strategies of different types of breast cancer.

Objective To retrieve,evaluate and summarize the best evidence summary for prevention and nursing care of pregnancy-induced diastasis recti abdominis and to provide references for clinical practice.Methods We systematically searched computer decision support systems,guideline websites,association official websites and databases for evidence on prevention and nursing care of pregnancy-induced diastasis recti abdominis,including guidelines,expert consensuses,clinical decision-making,systematic reviews and randomized controlled trials.The retrieval period was from the inception of databases to January 2024.There were 4 researchers who evaluated the quality of the included literature independently,extracted and summarized the evidence according to the subject.Results A total of 18 articles were included,including 2 clinical decisions,4 guidelines,5 expert consensuses,3 systematic reviews,and 4 randomized controlled trials.24 pieces of best evidence were summarized from 5 aspects,including the antenatal prevention,team building,nursing assessment,intervention strategies,and effecti-veness evaluation.Conclusion This study summarizes the best evidence summary for prevention and nursing care of pregnancy-induced diastasis recti abdominis,which can provide a reference basis for nurses to manage diastasis recti abdominis and improve the life quality of maternal woman.

Objective:To analyze the disease burden of Parkinson's disease (PD) in China from 1990 to 2021 and predict the disease burden of PD from 2022 to 2030.Methods:Based on the data of PD incidence in China from the Global Burden of Disease Study 2021 (GBD 2021), changes in PD disease burden from 1990 to 2021 were analyzed. Age-period-cohort model was used to analyze the independent influences of age, period and cohort in PD incidence (according to age group of 5 years, patients were divided into 15 groups: group of 20-24 years, group of 25-29 years..., and group of 90-94 years; according to a 5-year period, patients were divided into 6 groups: group of 1992-1996, group of 1997-2001..., and group of 2017-2021; because of birth cohort=period-age, patients were divided into 20 birth cohorts: birth cohort of 1897-1906, birth cohort of 1902-1911..., and birth cohort of 1992-2001). Nordpred model was used to predict the disease burden of PD from 2022 to 2030.Results:(1) From 1990 to 2021, number of PD patients, and PD incidence and standardized incidence in China showed upward trends. The standardized incidence increased by 89.68% for the total population, 89.71% for males, and 77.64% for females. (2) PD incidence was low in young subjects and increased obviously in subjects aged 60 years. PD incidence in subjects aged 20-24 years or 90-94 years was 0.07/100 000 and 643.31/100 000, respectively. Compared with female subjects, male subjects aged 60-94 years had higher PD incidence. (3) The onset relative risk increased from 0.71 (95% CI: 0.69-0.73) in group of 1992-1996 to 1.17 (95% CI: 1.16-1.19) in group of 2017-2021 in the total population, increased from 0.68 (95% CI: 0.66-0.70) to 1.18 (95% CI: 1.16-1.21) in males, and increased from 0.75 (95% CI: 0.73-0.77) to 1.14 (95% CI: 1.12-1.16) in females. (4) Onset relative risk was 0.40 (95% CI: 0.33-0.48) in the earliest birth cohort (1897-1906), which increased to 1.81 (95% CI: 0.95-3.43) in the latest birth cohort (1992-2001). (5) Number of PD patients in males, females and total population in China would increase to 455 010, 301 173 and 756 183, respectively, and the standardized incidence would increase to 56.45/100 000, 32.28/100 000 and 43.40/100 000, respectively, till 2030. Conclusion:PD disease burden in China from 1990 to 2021 is severe, particularly among males and the elderly; the disease burden is projected to continue rising up till 2030.

Based on the theory of "sanjiao membrane and interstice"， it is believed that ovarian cancer originates from sanjiao membrane and interstice， and can be transferred to other places from sanjiao membrane and interstice， and the disease is located in the lower jiao， with key pathogenesis as the malfunction of sanjiao membrane and interstice caused by original yang deficiency and disturbance of qi movement in sanjiao membrane and interstice. The treatment advocates combining disease and syndrome， treating the root and branch simultaneously， focusing on regulating the function of sanjiao membrane and interstice， making sanjiao membrane and interstice smooth by warming yang and benefiting qi， moving qi and activating blood circulation， eliminating blood stasis and removing phlegm， detoxifying and dissipating masses， and so on， with Yiqi Huoxue Jiedu Formula （益气活血解毒方） as a basic formula for treating ovarian cancer. Meanwhile， focusing on the staging of treatment， western medicine treatment can be assisted in the acute stage to reduce the toxicity， increase the effect， and reduce the adverse reaction； in the remission or stabilisation stage， as well as in the advanced stage with palliative treatment， individualised addition and subtraction of medications can be given according to the patient's physical condition and the characteristics of traditional Chinese medicine syndrome， so as to improve the microenvironment of the tumour.

Objective:To analyze the disease burden of Parkinson's disease (PD) in China from 1990 to 2021 and predict the disease burden of PD from 2022 to 2030.Methods:Based on the data of PD incidence in China from the Global Burden of Disease Study 2021 (GBD 2021), changes in PD disease burden from 1990 to 2021 were analyzed. Age-period-cohort model was used to analyze the independent influences of age, period and cohort in PD incidence (according to age group of 5 years, patients were divided into 15 groups: group of 20-24 years, group of 25-29 years..., and group of 90-94 years; according to a 5-year period, patients were divided into 6 groups: group of 1992-1996, group of 1997-2001..., and group of 2017-2021; because of birth cohort=period-age, patients were divided into 20 birth cohorts: birth cohort of 1897-1906, birth cohort of 1902-1911..., and birth cohort of 1992-2001). Nordpred model was used to predict the disease burden of PD from 2022 to 2030.Results:(1) From 1990 to 2021, number of PD patients, and PD incidence and standardized incidence in China showed upward trends. The standardized incidence increased by 89.68% for the total population, 89.71% for males, and 77.64% for females. (2) PD incidence was low in young subjects and increased obviously in subjects aged 60 years. PD incidence in subjects aged 20-24 years or 90-94 years was 0.07/100 000 and 643.31/100 000, respectively. Compared with female subjects, male subjects aged 60-94 years had higher PD incidence. (3) The onset relative risk increased from 0.71 (95% CI: 0.69-0.73) in group of 1992-1996 to 1.17 (95% CI: 1.16-1.19) in group of 2017-2021 in the total population, increased from 0.68 (95% CI: 0.66-0.70) to 1.18 (95% CI: 1.16-1.21) in males, and increased from 0.75 (95% CI: 0.73-0.77) to 1.14 (95% CI: 1.12-1.16) in females. (4) Onset relative risk was 0.40 (95% CI: 0.33-0.48) in the earliest birth cohort (1897-1906), which increased to 1.81 (95% CI: 0.95-3.43) in the latest birth cohort (1992-2001). (5) Number of PD patients in males, females and total population in China would increase to 455 010, 301 173 and 756 183, respectively, and the standardized incidence would increase to 56.45/100 000, 32.28/100 000 and 43.40/100 000, respectively, till 2030. Conclusion:PD disease burden in China from 1990 to 2021 is severe, particularly among males and the elderly; the disease burden is projected to continue rising up till 2030.

Objective:To investigate the current status of hospitalized neonatal death of different gestational ages in Shaanxi Province.Methods:All neonatal deaths in six hospitals in Shaanxi Province from 2016 to 2020 were retrospectively analyzed, and the differences in perinatal complications, the causes of death, and the age at death were compared using Chi-square (or Fisher's exact ) test. Results:(1) Totally, 220 488 neonates were delivered in the obstetric department of the six hospitals during the study period; 71 782 out of them were admitted to the neonatal department. While 424 neonatal death was reported, giving the total hospitalized neonates mortality rate of 5.5‰ (394/71 782), which included 152 deaths of transferred patients ( n=9 103, 16.7‰), 226 premature (53.3%), 196 term (46.2%), and two post-term infants (0.5%). (2) Among mothers of dead neonates, 73.6% were found to have at least one perinatal complication. The most common one was fetal distress (146 cases, 34.4%), followed by gestational diabetes mellitus (113 cases, 26.7%), amniotic fluid abnormalities ( n=73, 17.2%), maternal infectious diseases ( n=71, 16.8%), and hypertensive disorders in pregnancy (HDP) ( n=52, 12.3%). The lower the gestational age, the higher the proportion of multiple pregnancies and assisted reproduction technology applied (Fisher exact test, P<0.05). On the contrary, the higher the gestational age, the higher the cesarean section rate ( χ 2=26.69, P<0.001). HDP was more likely to occur in the gestational age of 28-31 +6 and 32-34 +6 weeks ( χ 2=37.16, P<0.001), and amniotic fluid abnormalities were more likely to occur in those over 37 weeks ( χ 2=27.47, P<0.001). (3) The five leading causes of neonatal death were neonatal respiratory distress syndrome (NRDS, n=100, 23.6%), neonatal asphyxia ( n=88, 20.8%), maternal infectious diseases ( n=80, 18.9%), and birth defects ( n=54, 12.7%), and pulmonary hemorrhage ( n=22, 5.2%). The first three causes of death in term and post-term infants were neonatal asphyxia ( n=65, 32.8%), birth defects ( n=42, 21.2%), and infectious diseases ( n=26, 13.1%). NRDS ( n=83, 36.7%), infectious diseases ( n=54, 23.9%), and neonatal asphyxia ( n=23, 10.2%) were the three leading causes of death of premature babies. (4) Out of the 326 (76.9%) neonatal deaths within seven days after birth, 162 (38.2%) died within 24 h after birth and 164 cases (38.7%) between one to seven days after birth. Conclusions:Most neonatal deaths occurred among preterm ones and within seven days after birth, whose mothers suffered perinatal complications. The causes of neonatal death vary among different gestational age groups.

Objective: To investigate the status of insomnia, Internet addiction, and depressive symptoms among medical students and to analyze the effect of Internet addiction on insomnia and the mediating role of depressive symptoms, in order to provide a basis for the development of targeted interventions and measurements for medical students. Methods: A stratified whole group sampling method was used to select full-time college students from three medical universities in Anhui Province. The Chinese version of Insomnia Severity Index (ISI), Internet Addiction Test (IAT) scale and 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate the symptoms of insomnia, Internet addiction and depressive in students. A multivariate Logistic regression analysis was used to explore the factors influencing insomnia among medical students and to analyze the relationship between insomnia with Internet addiction and depressive symptoms, respectively. Results: The overall rate of Internet addiction was 49.5%, depressive symptoms was 39.5%, insomnia was 18.6%. High academic stress, and the presence of surrounding people diagnosed with COVID-19 were associated with a higher risk of insomnia ( P <0.05). The higher the level of Internet addiction (mild, OR =2.60; moderate/severe, OR =4.21) and depression. (mild, OR =6.35; moderate/severe, OR =19.32), the higher the risk of insomnia. Mediated effect analysis showed that Internet addiction had a direct predictive effect ( β =0.02, P <0.05) on insomnia and also indirectly affected insomnia through depression (indirect effect=0.07，95% CI =0.06-0.08). Conclusion The detected rates of insomnia, Internet addiction and depressive symptoms are high among medical students in Anhui Province, and Internet addiction and depressive symptoms are risk factors for insomnia, which should be given more attention and appropriate interventions when necessary to improve their physical and mental health.

Objective:To explore the protective role and possible mechanism of neural stem cells combined with edaravone in cortical neurons after oxygen-glucose deprivation/reperfusion (OGD-R).Methods:(1) Neural stem cells from brain tissues of SD fetal rats aged 14-16 d were cultured in vitro, and identified with Nestin, glial fibrillary acidic protein (GFAP), and microtubule-associated protein 2 (MAP2) immunofluorescent staining. Expressions of neuron-specific nuclear protein (NeuN) and β-Tubulin were detected by immunofluorescent staining in primary cortical neurons from SD rats born within 24 h. (2) Primary cortical neurons were divided into normal group (normal culture), OGD-R model group (re-oxygenated culture for 24 h after hypoxia for 1.5 h), OGD-R+neural stem cells group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h), OGD-R+edaravone group (re-oxygenated culture for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia), OGD-R+neural stem cells+edaravone group (re-oxygenated co-culture with cortical neurons and neural stem cells for 24 h after hypoxia for 1.5 h; 100 μmol/L edaravone before hypoxia); 24 h after each treatment, neuron proliferation in each group was detected by cell counting Kit 8 (CCK8), apoptosis rate was detected by flow cytometry, contents of interleukin-1β (IL-1β), and tumor necrosis factor α (TNF-α) in neuronal supernatant were detected by enzyme-linked immunosorbent assay (ELISA), and real-time quantitative fluorescent polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the mRNA and protein expressions of Notch1, Hes1 and Hes5, respectively. Results:(1) Immunofluorescent staining results showed that neural stem cells were positive for Nestin, GFAP and MAP2, and cortical neurons were positive for NeuN and β-Tubulin; all of them were successfully identified. (2) Compared with normal group, OGD-R model group, OGD-R+neural stem cell group and OGD-R+edaravone group had decreased neuron viability, increased apoptosis, increased supernatant IL-1β and TNF-α contents, and increased Notch1 mRNA and protein expressions, with significant differences ( P<0.05). Compared with OGD-R model group, OGD-R+neural stem cells+edaravone group had increased neuron viability, decreased apoptosis, decreased supernatant IL-1β and TNF-α contents, and decreased mRNA and protein expressions of Hes1 and Hes5, with significant differences ( P<0.05). Compared with the OGD-R model group, OGD-R+edaravone group and OGD-R+neural stem cell+edaravone group had significantly decreased Notch1 mRNA and protein expressions ( P<0.05). Conclusion:Combination of edaravone and neural stem cell therapy can reverse the neuronal damage caused by OGD-R, whose mechanism may be by inhibiting the expressions of inflammatory factors and key signaling molecules in Notch signaling pathway, such as Notch1, Hes1, and Hes5.