BackgroundBipolar disorder is a severe mental disorder characterized by alternating episodes of mania and depression. It has a high recurrence rate and a high rate of disability. Elderly patients often suffer from more severe cognitive impairment due to neurodegenerative changes. The clinical intervention for bipolar disorder mainly relies on drug treatment， but drugs have limited effects on improving cognitive function， and some drugs may even aggravate cognitive impairment. Aerobic exercise， as a non-drug intervention method， has shown positive effects in improving cognitive function in patients with mental disorders. However， there are still insufficient studies on elderly patients with bipolar disorder. ObjectiveTo explore the impact of aerobic exercise on the cognitive function of elderly patients with bipolar disorder， so as to provide references for the formulation of strategies to improve the cognitive function of this population. MethodsA randomized controlled trial was conducted. A total of 60 elderly patients who were hospitalized at the Third People's Hospital of Lanzhou from January 2024 to March 2025 and met the diagnostic criteria for bipolar disorder as defined in the International Classification of Diseases，tenth edition （ICD-10） were selected. They were divided into the study group and the control group， with 30 cases in each group， based on the random number table method. Both groups were given quetiapine fumarate tablets and magnesium valproate sustained-release tablets. The study group additionally received aerobic exercise （including slow walking， doing exercises， and running）， three times a week， for 30 minutes each time. At the baseline and at the end of the 3^rd， 6^th， 9^th， and 12^th week of the intervention， the Hamilton Depression Scale -24 item （HAMD-24）， the Young Manic Rating Scale （YMRS）， the Montreal Cognitive Assessment （MoCA）， and Wechsler Adult Intelligence Scale Revised in China （WMS-RC） were used for assessment. ResultsThe time effect of the HAMD-24 score was statistically significant （Wald χ²=124.564， P<0.01）. The time effect of the YMRS score was also statistically significant （Wald χ²=145.608， P<0.01）， and the interaction effect between time and group was statistically significant （Wald χ²=14.968， P<0.05）. At the 3^rd， 9^th， and 12^th week of the intervention， the YMRS score of the study group was lower than that of the control group in the same period， and the differences were statistically significant （P<0.05）. The time effect and group effect of the MoCA score were both statistically significant （F=99.347， 16.623， P<0.01）. The time effect， group effect， and interaction effect between time and group of the WMS-RC memory quotient were all statistically significant （F=64.678， 10.197， 12.472， P<0.01）. At the 6^th， 9^th， and 12^th weeks of the intervention， the MoCA score and WMS-RC memory quotient of the study group were higher than those of the control group， and the differences were statistically significant （P<0.05）. ConclusionAerobic exercise may help improve the manic symptoms and cognitive functions （especially memory ability） of elderly patients with bipolar disorder. ［Funded by Science and Technology Project of Gansu Province （number， 24JRRA775）； Science and Technology Project of Lanzhou City（number， 2022-5-155）］

Objective To evaluate the clinical effectiveness of single-incision intervertebral foraminotomy in treating double-segment lumbar spinal stenosis accompanied by lumbar disc herniation.Methods A retrospective analysis was conducted on 40 cases of double-segment lumbar spinal stenosis and lumbar disc herniation treated in our orthopedic(spinal surgery)department from March 2016 to May 2018.Among these cases,11 patients(Group A)were treated with percutaneous discectomy,13 patients(Group B)underwent percutaneous endoscopic discec-tomy,and 16 patients(Group C)received double-incision percutaneous surgery.General clinical data for all patients were recorded.Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and clinical outcomes were assessed at five different time points:preoperatively,immediately postoperatively,one week postoperatively,one month postoperatively,and at the final follow-up.Statistical analysis was performed on the collected data.Results The operation time,the number of fluoroscopies performed on the hands,the length of the skin incision,and patient satisfaction were all statistically significant(P<0.05).An interaction effect was observed between the operation time and the surgical procedure on both the VAS and JOA scores.Both the operation time and the surgical method had significant main effects on the VAS and JOA scores(P<0.05).Significant differences in VAS and JOA scores were found among the three groups immediately post-surgery,one week post-surgery,one month post-operation,and at the end of the study(P<0.05).Immediately after surgery,there were statistically significant differences in VAS and JOA scores among the three groups(P<0.05).One week post-surgery,there were also statistically significant differences in VAS scores among the three groups(P<0.05).Conclusions The single-incision intervertebral foramen technique is an effective approach for simultaneously addressing double-seg-ment lumbar spinal stenosis and lumbar disc herniation through decompression.This method boasts a shorter opera-tive duration,reduced intraoperative radiation exposure,and minimal tissue damage.Patient satisfaction is high,making it a valuable addition to clinical practice.

Objective To evaluate the clinical effectiveness of single-incision intervertebral foraminotomy in treating double-segment lumbar spinal stenosis accompanied by lumbar disc herniation.Methods A retrospective analysis was conducted on 40 cases of double-segment lumbar spinal stenosis and lumbar disc herniation treated in our orthopedic(spinal surgery)department from March 2016 to May 2018.Among these cases,11 patients(Group A)were treated with percutaneous discectomy,13 patients(Group B)underwent percutaneous endoscopic discec-tomy,and 16 patients(Group C)received double-incision percutaneous surgery.General clinical data for all patients were recorded.Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and clinical outcomes were assessed at five different time points:preoperatively,immediately postoperatively,one week postoperatively,one month postoperatively,and at the final follow-up.Statistical analysis was performed on the collected data.Results The operation time,the number of fluoroscopies performed on the hands,the length of the skin incision,and patient satisfaction were all statistically significant(P<0.05).An interaction effect was observed between the operation time and the surgical procedure on both the VAS and JOA scores.Both the operation time and the surgical method had significant main effects on the VAS and JOA scores(P<0.05).Significant differences in VAS and JOA scores were found among the three groups immediately post-surgery,one week post-surgery,one month post-operation,and at the end of the study(P<0.05).Immediately after surgery,there were statistically significant differences in VAS and JOA scores among the three groups(P<0.05).One week post-surgery,there were also statistically significant differences in VAS scores among the three groups(P<0.05).Conclusions The single-incision intervertebral foramen technique is an effective approach for simultaneously addressing double-seg-ment lumbar spinal stenosis and lumbar disc herniation through decompression.This method boasts a shorter opera-tive duration,reduced intraoperative radiation exposure,and minimal tissue damage.Patient satisfaction is high,making it a valuable addition to clinical practice.

Objective To evaluate the diagnostic value of positive serum specific antibodies to Mycoplasma pneumoniae(MP)in children with Mycoplasma pneumoniae pneumonia(MPP).Methods PubMed,Cochrane Library,Embase,Sinomed,CNKI,Wanfang and VIP databases were searched for studies on the detection of MPP based on antibodies from the establishment of the database to March 31,2023.After literature screening and data extraction,STATA 16.0 software was used for Meta-analysis.Results A total of 9 literatures and 2 148 clinical samples were included.The combined sensitivities[M(95%CI)]of particle agglutination assay(PA)and enzyme-linked immunosorbent assay(ELISA)were 50%(31～69)and 88%(85～90),and the combined specificities[M(95%CI)]were 88%(76～95)and 88%(62～97).The combined diagnostic odds ratio(DOR)[M(95%CI)]were 5.61(3.30～9.53)and 43.82(12.78～150.19),and the summary receiver operating characteristic curve(SROC)area under the curve(AUC)were 0.80 and 0.88,respectively.Conclusion Serum MP specific antibody detection can be used for diagnosis and screening of children MPP,but needs to be combined with clinical symptoms improve the accuracy of the diagnosis.

Objective: To explore the protective effect and mechanism of Rhodiola rosea(Rho) bionic nanomedicine in rats with acute pancreatitis. Methods: Erythrocyte membrane vesicles(EMV) were used as biomimetic nanomedicine coating materials to construct Rho biomimetic nanomedicine. Meanwhile, rat models of acute pancreatitis were constructed and divided into acute pancreatitis model(AP) group, Rho group, EMV group and Rhodiola rosea erythrocyte membrane vesicles(R-EMV) group. R-EMV group rats were further treated with NLRP3 activator BMS-986299(R-EMV+BMS-986299 group) and inhibitor MCC950(R-EMV+MCC950 group). The changes of abdominal water volume were observed, and serum levels of interleukin(IL-6), IL-1β, endothelin(ET), diamine oxidase(DAO), malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) were detected by enzyme-linked immunosorbent assay(ELISA). Hematoxylin-eosin(HE) staining was used to observe the pathological changes of pancreatic tissue. Immunohistochemistry, reverse transcription-polymerase chain reaction(RT-PCR) and Western blot were used to analyze the expression of NOD-like receptor protein 3(NLRP3) and nuclear transcription factor-Kappa B(NF-κB) in pancreatic tissue. Results: The prepared R-EMVs were nearly circular, the average particle size was(244.61±1.08) nm, and the Zeta potential was-(11.13±1.25) mV. At the same time, the EMV could load(58.67±0.79) μg of Rho. Compared with Sham group, the abdominal water volume of rats in AP group was significantly higher(t=33.79,P<0.01), and the levels of peripheral blood immune indexes IL-1β, IL-6, ET and DAO increased(t=38.25, 42.54, 29.20, 34.92, allP<0.01). In AP group, there were obvious tissue hyperemia and edema, widening of lobular space, infiltration of a large number of inflammatory cells, and increased pancreatic pathological score(t=30.06,P<0.01). Compared with AP group, abdominal water volume, dry-wet weight ratio of pancreas, pathological score, amylase and lipase levels in Rho group decreased(F=1 523.7, 543.3, 839.9, 446.1, 172.2,P<0.05). Compared with other groups, the levels of serum IL-1β, IL-6, ET and DAO in AP group decreased to some extent. Compared with AP group, NF-κB p65 and NLRP3 protein levels and NF-κB and NLRP3 immunohistochemical staining scores decreased in R-EMV group(t=24.54 and 26.91, bothP<0.001). At the same time, the levels of serum IL-1β, IL-6, ET, DAO, MDA, SOD and GSH in R-EMV+MCC950 group were significantly lower than those in AP group, R-EMV group and R-EMV+BMS-986299 group. Conclusion R-EMV has a good pancreatic protection effect in acute pancreatitis, which is related to reducing the activity of NF-κB/NLRP3 pathway and down-regulating the expression of inflammatory factors such as IL-6 and oxidative stress indicators such as MDA.

Objective To evaluate the diagnostic value of positive serum specific antibodies to Mycoplasma pneumoniae(MP)in children with Mycoplasma pneumoniae pneumonia(MPP).Methods PubMed,Cochrane Library,Embase,Sinomed,CNKI,Wanfang and VIP databases were searched for studies on the detection of MPP based on antibodies from the establishment of the database to March 31,2023.After literature screening and data extraction,STATA 16.0 software was used for Meta-analysis.Results A total of 9 literatures and 2 148 clinical samples were included.The combined sensitivities[M(95%CI)]of particle agglutination assay(PA)and enzyme-linked immunosorbent assay(ELISA)were 50%(31～69)and 88%(85～90),and the combined specificities[M(95%CI)]were 88%(76～95)and 88%(62～97).The combined diagnostic odds ratio(DOR)[M(95%CI)]were 5.61(3.30～9.53)and 43.82(12.78～150.19),and the summary receiver operating characteristic curve(SROC)area under the curve(AUC)were 0.80 and 0.88,respectively.Conclusion Serum MP specific antibody detection can be used for diagnosis and screening of children MPP,but needs to be combined with clinical symptoms improve the accuracy of the diagnosis.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective To investigate the performance of a nomogram model established based on clinical indices and magnetic resonance imaging(MRI)signs in determining the traditional Chinese medicine(TCM)syndrome types of primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 138 patients with primary liver cancer who were hospitalized in The Affiliated Hospital of Shaanxi University of Chinese Medicine from September 2018 to July 2023,and the patients were divided into excess syndrome group with 84 patients and deficiency syndrome group with 54 patients.All patients underwent Gd-EOB-DTPA contrast-enhanced MRI scan before treatment.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square or the Fisher's exact test was used for comparison of categorical data between groups.A Logistic regression analysis was used to investigate the independent predictive factors for the TCM syndrome type of primary liver cancer,and a nomogram model was established.The patients were randomly divided into training group with 110 patients and validation group with 28 patients at a ratio of 8∶2,and the calibration curve,the receiver operating characteristic(ROC)curve,and the decision curve were used to evaluate the clinical performance of this model.Results There were significant differences between the excess syndrome group and the deficiency syndrome group in neutrophils,lymphocyte count(LYM),platelet count,albumin(Alb),neutrophil-lymphocyte ratio(NLR),prothrombin time(PT),alpha-fetoprotein(AFP),direct bilirubin(DBil),indirect bilirubin,total bilirubin,presence or absence of portal vein invasion,number of tumors,hepatobiliary tumor signal,and apparent diffusion coefficient(ADC)(all P<0.05).The Logistic regression analysis showed that AFP(odds ratio[OR]=0.003,95%confidence interval[CI]:0.000—0.052,P<0.001),PT(OR=0.032,95%CI:0.004—0.286,P=0.002),LYM(OR=0.032,95%CI:0.004—0.286,P=0.002),Alb(OR=0.009,95%CI:0.001—0.163,P=0.001),NLR(OR=0.040,95%CI:0.003—0.457,P=0.010),DBil(OR=0.014,95%CI:0.001—0.198,P=0.002),portal vein cancer thrombus(OR=0.005,95%CI:0.000—0.115,P=0.001),number of tumors(OR=12.740,95%CI:1.212—133.937,P=0.034),and ADC(OR=19.269,95%CI:3.163—117.387,P=0.001)were independent predictive factors for TCM syndrome types of primary liver cancer.In the training group,the model had an area under the ROC curve(AUC)of 0.962,a sensitivity of 84.1%,a specificity of 92.4%,and an accuracy of 89.1%,and in the validation group,the model had an AUC of 0.848,a sensitivity of 63.6%,a specificity of 100.0%,and an accuracy of 85.7%.The calibration curve showed that the nomogram model had good consistency between predicted syndrome types and actual syndrome types in the training group and the validation group,and the decision curve showed that the nomogram model had good net benefits within a relatively wide range of threshold probability.Conclusion The nomogram model based on clinical indices and MRI signs has good clinical efficacy and value in judging the TCM syndrome type of primary liver cancer.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective:To study the clinical features and treatment strategy of neonatal ureaplasma meningitis.Methods:During 2021, the clinical data of 2 neonates with ureaplasma meningitis treated in Children's Hospital of Hunan Province were retrospectively analyzed. Literature on this subject were searched in the following databases: CNKI, Wanfang Database, Chinese Medical Journal Full-Text Database, CQVIP database, SinoMed, PubMed, Embase and Web of Science (up to March 2022). The key words included “infant”, “neonate”, “newborn”, “ureaplasma”, “mycoplasma urealytium”, “meningitis”, “central nervous system infection”, “brain”. The clinical data, treatment and prognosis of patients from the literature were summarized.Results:Case 1, female, gestational age(GA) 33 +3 weeks, intracranial hemorrhage (ICH) and ventricular dilatation were found on 2 d after birth. The cerebrospinal fluid (CSF) routine and biochemistry tests indicated meningitis, but the CSF culture was negative. No improvement after antibiotic treatment. CSF metagenomic next-generation sequencing (mNGS) and 23S rRNA showed Ureaplasma urealyticum on 30 d after birth. The patient was treated with doxycycline (DOX) for 21 d until mNGS turned negative and DOX was discontinued. However, the disease recurred 23 d later and erythromycin was added with DOX as combined therapy. The patient was followed up until 6 months without neurodevelopmental disabilities. Case 2, male, GA 26 weeks, ICH and ventricular dilatation were found on 10 d after birth. The CSF routine and biochemistry tests indicated meningitis, but the CSF culture was negative. No improvement after antibiotic treatment. CSF mNGS and 23S rRNA showed Ureaplasma parvum. The patient received erythromycin therapy for 32 d and had normal neurodevelopment at 5 months. According to the literature, 43 cases were reported including the 2 cases descirbed above, 17 cases were full-term infants and 26 cases were preterm infants. The median CSF leukocytes, glucose and proteins were 566 cells/mm 3, 0.2 mmol/L and 2.2 g/L. 27 cases were diagnosed based on CSF culture, 6 cases using mNGS, 4 cases with both CSF culture and PCR method and 6 cases with other methods. Macrolides alone were used in 14 cases, macrolides combined with another antibiotic were used in 8 cases, non-macrolide antibiotics were used in 9 cases and 12 cases didn't receive any anti-ureaplasma therapy. All 17 term infants survived, however, 8 cases with hydrocephalus. Among the 26 preterm infants, 8 patients died, 18 patients had periventricular-intraventricular hemorrhage and 15 patients had hydrocephalus. Conclusions:Neonatal ureaplasma meningitis has significantly lower CSF glucose level with hydrocephalus as the common complication. For intracranial infections of unknown etiology and no response to treatment, mNGS is helpful in determining the pathogen.Neonatal ureaplasma meningitis should be treated with macrolides alone or as add-on therapy.