Objective:To explore the clinical efficacy of targeted epidural space block combined with acupotomy in the treatment for lumbar disc herniation(LDH)under the monitor of X-ray image,and to analyze the safety of its operation.Methods:A total of 60 LDH patients who admitted to Department of Pain,Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine from January 2022 to September 2023 were selected,and they were randomly divided into observation group and control group as random number table,with 30 cases in each group.The observation group adopted targeted epidural space block combined with acupotomy under monitor with X-ray for anterior epidural space,while the control group adopted conventionally epidural block,all of which were treated only once.The Visual Analogue Scale(VAS)scores and Oswestry Disability Index(ODI)scores of two groups before treatment and at the 3rd day,7th day and 30th day after treatment were compared.At the 30th day after treatment,the curative effects of two groups were evaluated according to ODI scores,at the same time,the safe distance between puncture and acupotomy in patients of observation group was analyzed.Results:The effective rates of the treatment of observation group and control group were respectively 96.67%and 70%,and the difference of that between the two groups was statistically significant(x2=7.680,P<0.05).The VAS scores of the two groups at the 3rd day,7th day and 30th day after treatment were lower than those before treatment,and the observation group(2.30±0.87),(1.53±0.86)and(1.47±0.81)were lower than the control group(4.43±0.89),(2.23±0.89)and(4.27±0.82),the difference was statistically significant(t=9.374,3.098,13.306,P<0.05).The ODI scores of the two groups were at the 3rd day,7th day and 30th day after treatment were lower than those before treatment,and the differences of them between two groups were statistically significant(t=7.112,10.690,10.151,P<0.05).In 30 patients of observation group,the gap between the dural sac and the inner edge of facet joint on the affected side was larger than 4.0mm in 25 cases,and all of them can safely conduct puncture with targeting.Conclusion:The targeted epidural space block combined with acupotomy by adopting monitor with X-ray image can effectively improve the symptom of pain,and activities of daily life of LDH patients,which treatment is safe and effective.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

Pleckstrin homology-like domain family A member 1(PHLDA1)is a pro-apoptotic factor as well as a key regulator of metabolic diseases.In obesity-related diseases,PHLDA1 can reduce liver triglyceride production through inhibition of the expression of sterol regulatory?element binding proteins?1(SREBP?1),and reduce fat syn?thesis through inhibition of peroxisome proliferator?activated receptor γ(PPARγ).However,in cardiovascular dis?eases,PHLDA1 increases vascular calcification,dysfunction,thereby aggravates ischemia?reperfusion injury in the heart and brain.The dual role of PHLDA1 has also been confirmed in tumors.In summary,PHLDA1,as a multi?functional factor,plays different functional roles through various mechanisms.

Objective To investigate the infection status and clinical parameters of human metapneumovirus(HMPV)in children with acute respiratory tract infections in Jianyang area.Methods A total of 2 669 hospitalized children with acute respiratory tract infec-tions at Jianyang People's Hospital from March 2023 to February 2024 were enrolled.Thirteen kinds of respiratory pathogens were de-tected using multiplex PCR and capillary electrophoresis.The clinical data of HMPV-infected children were collected and analyzed.Re-sults Out of 2 669 children with acute respiratory tract infections,209 were detected with HMPV,with a positive rate of 7.83%.HMPV-positive children were mainly concentrated in under 5 years old(73.21%),with cough,fever,wheezing,and shortness of breath as main clinical manifestations.The rate of single HMPV infection was 58.85%,and those of mixed bacterial infection and mixed viral infection were 26.69% and 13.88%,respectively.The levels of white blood cells(WBC),lymphocytes(LYM),platelets(PLT),C-reactive protein(CRP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),troponin I(cTn I),and procalcitonin(PCT)in the mixed infection group were significantly higher than those in the single HMPV infection group(P＜0.05),while the levels of hemoglobin(Hb),total protein(TP),and creatinine(Cr)were significantly lower than those in the single HMPV infection group(P＜0.05).Compared with the non-severe pneumonia group,the levels of WBC,Hb,PLT,and CRP in the severe pneumonia group were significantly increased(P＜0.05).Multivariate Logistic regression analysis showed that age＜3 years,co-infection,and CRP≥20 mg/L were risk factors for severe HMPV pneumonia(P＜0.05).Conclusion HMPV is one of the important pathogens causing acute respiratory tract infections in children in Jianyang area.The elevated levels of some laboratory indicators are associated with the severity of infection.Early and comprehensive bacteriological testing and detection of inflammatory markers are beneficial for guiding clinical treatment.

Objective To explore the effect of hypoxia-inducible factor-1α(HIF-1α)inhibitor LW6 on ferroptosis in septic cardiomyopathy rats.Methods Rat septic cardiomyopathy model was prepared using cecal ligation and puncture(CLP)method.Thirty-six specific pathogen-free(SPF)6-8 weeks male SD rats were randomly divided into the sham-operated group,CLP group,CLP+solvent group,LW6 group,ferrostatin-1(Fer-1)group,and LW6+Fer-1 group.The degree of myocardial damage in each group was evaluated through hematoxylin-eosin stai-ning and detection of lactate dehydrogenase and creatine kinase content in cardiac tissue.Myocardial mitochondrial damage was observed by transmission electron microscopy.Ferroptosis level was determined by detecting iron ion concentration,reduced glutathione,malondialdehyde,and reactive oxygen species.Protein expression levels of HIF-1α,solute carrier family 7 member 11(SLC7A11),and glutathione peroxidase 4(GPX4)in cardiac tissue were detected by Western blotting.Results Compared with the CLP group and the CLP+solvent group,the LW6 group could ameliorate myocardial damage,alleviate mitochondrial damage,inhibit ferroptosis-related indicators(all P＜0.05),reduce HIF-1α protein expression levels(P＜0.05),and enhance SLC7A11 and GPX4 protein expression levels(both P＜0.05).Conclusion LW6 decreases HIF-1α expression and ferroptosis levels through the SLC7A11/GPX4 pathway,and ameliorates sepsis-induced cardiomyopathy.

Objective:To analyze changes of donor corneal endothelial cell density (ECD) and morphology from eye bank before and after keratolasty and the influencing factors.Methods:An observational case series study was performed.A total of 118 donor corneas, retrieved by the Shandong Province Eye Bank between July 2020 and June 2021 for penetrating keratoplasty (PKP) and endothelial keratoplasty (EK) were included.Among them, 99 corneas (83.90%) were used for PKP, and 19(16.10%) for EK.The basic information of donors and the results of corneal quality tests were analyzed and compared with ECD measured by endothelial microscopy one month after keratolasty.Morphological changes in endothelial cells before and after surgery were observed, and factors influencing corneal ECD and morphology were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shandong Eye Hospital (No.SDSYKYY20170319).Written informed consent was obtained from each subject.Results:Among the 99 donor corneas for PKP, there were statistically significant differences in preoperative donor corneal ECD and 1-month postoperative ECD of implant among different age groups ( F=18.136, 5.936; both P<0.01), which were lower in the 31-60-year-old group and the >60-year-old group than in the 0-30-year-old group and higher in the 31-60-year-old group than in the >60-year-old group, with statistically significant differences (all P<0.01).There were statistically significant differences in the preoperative donor corneal ECD among different donor cause of death groups ( F=4.524, P<0.01), which was higher in the traumatic accident group compared to the cardiovascular and cerebrovascular disease group, chronic organ failure group and malignant tumor group (all P<0.01).The preoperative donor ECD in the death-tissue retrieval time ≤6 hours group was (2 577.66±284.63)cells/mm 2, which was higher than (2 372.46±399.75)cells/mm 2 in the death-tissue retrieval time >6 hours group, with a statistically significant difference ( t=2.289, P<0.05).There were statistically significant differences in 1-month postoperative ECD among the preservation-surgery time ≤3 days, 3-6 days, and >6 days groups ( F=6.201, P<0.01), with higher ECD in preservation-surgery time ≤3 days groups than in 3-6 days and >6 days groups (both P<0.01).The preoperative donor corneal ECD applied to EK was significantly higher than that applied to PKP ( t=-2.660, P<0.01).ECD at 1 month after surgery applied to PKP was significantly higher than that applied to EK ( t=4.286, P<0.01).The ECD reduction rate was 7.14% (0.01%, 17.69%) and 31.07% (22.11%, 45.86%) in PKP group and EK group, respectively, with a statistically significant difference ( Z=4.969, P<0.01).The ECD was lower in the group with dark area than in the non-dark area group before PKP, with a statistically significant difference ( t=6.789, P=0.011).There was no significant difference in ECD at 1 month after keratoplasty between the two groups ( t=0.005, P=0.945).Multivariate logistic regression model results showed that preservation-surgery time >6 days and the cause of donor death being malignant tumor were risk factors for the appearance of dark areas in donor corneal endothelium ( OR=9.038, P=0.030; OR=6.577, P=0.018). Conclusions:The older the donor, the lower the ECD.Prolonged preservation-surgery time (>6 days) is the main factor contributing to the decline in ECD after keratolasty.Compared to PKP, there is a higher endothelial cell loss after EK.The tissue preservation-surgery time >6 days and the cause of donor death being malignant tumor are the main risk factors affecting the appearance of dark areas in the donor corneal endothelium.But the presence of physiological dark areas does not significantly influence the ECD after surgery.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective To study the effects of ethanol extract of the root of anacyclus pyrethrum(EEAP)on blood glucose and gut microbiota in mice induced by high-fat diet.Methods Forty-eight male C57BL/6N mice were randomly allocated into groups using a random number table:control group,model group,low-,medium-,and high-dose EEAP groups,as well as a metformin group,with each group consisting of 8mice.Mice in the low,medium,and high dose EEAP groups were administered EEAP at 100,200 and 400mg/kg,respectively.The metformin group was given metformin at 280mg/kg.Both the control and model groups were given an equivalent a-mount of distilled water.Gavage was performed once daily for 12 consecutive weeks.Except the control group mice were fed normal diet,the other groups were fed high-fat diet.Fasting and random blood glucose were detected by blood glucose test strips.The levels of in-flammatory factors in mice were detected by enzyme-linked immunosorbent assay kit.Gut microbiota was detected by 16S rDNA real-time quantitative polymerase chain reaction.Results At 12th weeks,compared with the model group,the body mass of mice in low-dose,medium-dose and high-dose EEAP groups and metformin group were decreased significantly.Compared with the model group,the fasting blood glucose and random blood glucose in high-dose EEAP group and metformin group were significantly decreased.Com-pared with the model group,the abundations of Akkermansia muciniphila and Faecalibacterium prausnitzii in the intestinal tracts of mice in medium-dose and high-dose EEAP groups and metformin group were significantly increased,while the abundations of desulfovibrio were significantly decreased.Conclusion EEAP can improve dysglycemia induced by high-fat diet in mice,and its mechanism may be related to regulating gut microbiota and inhibiting inflammatory reaction.

Objective To investigate the relationship between the mean platelet volume(MPV)to platelet count(PLT)ratio(MPV/PLT),blood urea nitrogen(BUN)to lipoprotein a[Lp(a)]ratio[BUN/Lp(a)]and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods A total of 106 patients with acute exacerbation of COPD admitted to the hospital from January 2021 to January 2024 were selected as the research objects.According to the prognosis,they were divided into sur-vival group(72 cases)and death group(34 cases).The results of routine laboratory tests,blood lipid and lipo-protein levels were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of death in patients with acute exacerbation of COPD.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of MPV/PLT and BUN/Lp(a)for the prognosis of pa-tients with acute exacerbation of COPD.Results Compared with the survival group,the invasive ventilation rate,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,C reactive protein(CRP),white blood cell count(WBC),MPV,BUN,MPV/PLT and BUN/Lp(a)were significantly increased in the death group(P＜0.05).The non-invasive ventilation rate,lymphocyte count,PLT and Lp(a)levels were signifi-cantly decreased(P＜0.05).Multivariate Logistic regression analysis showed that APACHE Ⅱ score,CRP,WBC,lymphocyte count,MPV,PLT,MPV/PLT,BUN,Lp(a)and BUN/Lp(a)were the influencing factors of death in patients with acute exacerbation of COPD(P＜0.05).ROC curve results showed that the sensitivity and specificity of MPV/PLT combined with BUN/Lp(a)for predicting the prognosis of patients with acute exacerbation of COPD were 88.2％and 84.7％,respectively,and the area under curve was 0.887.Conclusion MPV/PLT and BUN/Lp(a)are closely related to the prognosis of patients with acute exacerbation of COPD.The combination of MPV/PLT and BUN/Lp(a)has a high predictive value for the prognosis of patients.