Objective:To investigate the clinical characteristics, prognosis, and the impact of different secondary prevention strategies on stroke recurrence in patients with carotid web (CaW)-associated acute anterior circulation large vessel occlusion (LVO).Methods:A retrospective analysis was conducted on 401 patients with acute anterior circulation LVO who underwent mechanical thrombectomy at 2 advanced stroke centers, Xingtai Central Hospital and Xingtai People′s Hospital, from January 2018 to June 2024. CaW was identified using digital subtraction angiography (DSA) and other imaging modalities. Based on the presence of CaW, patients were divided into CaW group and non-CaW group. Differences between the 2 groups in baseline characteristics, clinical features, and clinical outcomes were compared, and long-term follow-up was conducted for the CaW group.Results:Among the 401 patients, the CaW group consisted of 16 patients (4.0%), while the non-CaW group included 385 patients (96.0%). Compared to the non-CaW group, patients in the CaW group were younger [53 (46, 58) years vs 65 (56, 76) years, Z=-3.811, P<0.001], had a higher proportion of M1 segment middle cerebral artery occlusion [13/16 vs 54.0% (208/385), χ2=4.602, P=0.032] and a lower proportion of internal carotid artery terminus occlusion [1/16 vs 40.0% (154/385), χ2=6.024, P=0.014]; the 90-day modified Rankin Scale (mRS) score was significantly lower in the CaW group [1.00 (0, 1.75) vs 3.00 (1.00, 4.00), Z=14.210, P<0.001], and the proportion of patients with favorable functional independence (mRS score 0-2) was significantly higher [15/16 vs 45.7% (176/385), χ2=12.350, P<0.001] in the CaW group; the incidence of pneumonia in the CaW group was significantly lower [2/16 vs 42.6% (164/385), χ2=4.562, P=0.033]. Among the 16 CaW patients, 10 received antiplatelet therapy, 4 underwent carotid artery stenting (CAS), and 2 underwent carotid endarterectomy (CEA). During a median follow-up of 29 months, patients who underwent CAS and CEA had no stroke recurrence, while 2 patients who received antiplatelet therapy had stroke recurrence and subsequently underwent CAS and CEA. Conclusions:The proportion of CaW among patients with acute anterior circulation LVO was 4.0%. The patients with CaW were younger and had a higher proportion of M1 segment middle cerebral artery occlusion. Following mechanical thrombectomy, patients in the CaW group had good functional outcomes. Simple drug therapy may be insufficient to prevent stroke recurrence in CaW patients, and CAS and CEA may be effective therapeutic options.

Objective:To construct a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery and to validate this model.Methods:A retrospective study was conducted on 700 patients who underwent ileostomy at The First Affiliated Hospital of Wenzhou Medical University. The patients were randomly divided into a modeling group ( n = 490) and a validation group ( n = 210) in a 7:3 ratio. The incidence of incision infection was recorded, and logistic multiple regression analysis was performed on various factors that may affect incision infection. A predictive model was constructed, and the application value of the predictive model was assessed. Results:Based on the occurrence of postoperative incision infection, patients in the modeling group who underwent ileostomy reversal surgery were divided into an infection group ( n = 61) and a non-infection group ( n = 429). There were no statistically significant differences between the two groups in terms of sex, age, body mass index, history of smoking, history of hypertension, history of immune system diseases, tumor, node, and metastasis staging, history of abdominal surgery, preoperative albumin levels, intraoperative hypothermia, and intraoperative blood loss (all P > 0.05). However, the proportion of patients with a history of diabetes was higher in the infection group [27.87% (17/61)] compared with the non-infection group [5.59% (24/429)]. The proportion of patients with a surgical duration > 90 minutes was also higher in the infection group [70.49% (43/61)] compared with the non-infection group [49.88% (214/429)]. Additionally, the proportion of patients with postoperative subcutaneous drainage was lower in the infection group [16.39% (10/61)] than in the non-infection group [40.56% (174/429)]. The proportion of patients with a history of radiotherapy and chemotherapy was higher in the infection group [75.41% (46/61)] compared with the non-infection group [53.15% (228/429)]. The proportion of patients with peristomal dermatitis was higher in the infection group [31.15% (19/61)] than in the non-infection group [4.20% (18/429)]. All these differences were statistically significant ( χ2 = 34.56, 9.09, 13.30, 10.74, 51.78, all P < 0.05). A history of diabetes, postoperative subcutaneous drainage, surgical duration, a history of radiotherapy and chemotherapy, and peristomal dermatitis were included in the regression model (all P < 0.05). Among these, a history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy were identified as independent risk factors, while postoperative subcutaneous drainage was identified as a protective factor. The risk prediction model was constructed as follows: P = -3.791 + 2.594 × a history of diabetes + 1.839 × surgical duration - 2.261 × postoperative subcutaneous drainage + 2.673 × a history of radiotherapy and chemotherapy + 2.765 × peristomal dermatitis. The prediction of the nomogram model for the risk of incision infection after ileostomy reversal surgery in the modeling group showed an area under the receiver operating characteristic curve of 0.931 ( P < 0.001, 95% CI: 0.847-0.983), with a sensitivity of 83.41% and a specificity of 79.91%. The receiver operating characteristic curve results for the validation group indicated an area under the curve of 0.891 ( P < 0.001, 95% CI: 0.821-0.967), with a sensitivity of 75.00% and a specificity of 94.90%. Conclusions:A history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy are independent risk factors for incision infection after ileostomy reversal surgery, while postoperative subcutaneous drainage is a protective factor. Constructing a predictive model based on these factors shows good predictive value for the occurrence of incision infection after ileostomy reversal surgery and needs further clinical investigation.

Objective:To construct a risk prediction model for postoperative incision infection in patients with rectal cancer undergoing ileostomy reversal surgery and to validate this model.Methods:A retrospective study was conducted on 700 patients who underwent ileostomy at The First Affiliated Hospital of Wenzhou Medical University. The patients were randomly divided into a modeling group ( n = 490) and a validation group ( n = 210) in a 7:3 ratio. The incidence of incision infection was recorded, and logistic multiple regression analysis was performed on various factors that may affect incision infection. A predictive model was constructed, and the application value of the predictive model was assessed. Results:Based on the occurrence of postoperative incision infection, patients in the modeling group who underwent ileostomy reversal surgery were divided into an infection group ( n = 61) and a non-infection group ( n = 429). There were no statistically significant differences between the two groups in terms of sex, age, body mass index, history of smoking, history of hypertension, history of immune system diseases, tumor, node, and metastasis staging, history of abdominal surgery, preoperative albumin levels, intraoperative hypothermia, and intraoperative blood loss (all P > 0.05). However, the proportion of patients with a history of diabetes was higher in the infection group [27.87% (17/61)] compared with the non-infection group [5.59% (24/429)]. The proportion of patients with a surgical duration > 90 minutes was also higher in the infection group [70.49% (43/61)] compared with the non-infection group [49.88% (214/429)]. Additionally, the proportion of patients with postoperative subcutaneous drainage was lower in the infection group [16.39% (10/61)] than in the non-infection group [40.56% (174/429)]. The proportion of patients with a history of radiotherapy and chemotherapy was higher in the infection group [75.41% (46/61)] compared with the non-infection group [53.15% (228/429)]. The proportion of patients with peristomal dermatitis was higher in the infection group [31.15% (19/61)] than in the non-infection group [4.20% (18/429)]. All these differences were statistically significant ( χ2 = 34.56, 9.09, 13.30, 10.74, 51.78, all P < 0.05). A history of diabetes, postoperative subcutaneous drainage, surgical duration, a history of radiotherapy and chemotherapy, and peristomal dermatitis were included in the regression model (all P < 0.05). Among these, a history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy were identified as independent risk factors, while postoperative subcutaneous drainage was identified as a protective factor. The risk prediction model was constructed as follows: P = -3.791 + 2.594 × a history of diabetes + 1.839 × surgical duration - 2.261 × postoperative subcutaneous drainage + 2.673 × a history of radiotherapy and chemotherapy + 2.765 × peristomal dermatitis. The prediction of the nomogram model for the risk of incision infection after ileostomy reversal surgery in the modeling group showed an area under the receiver operating characteristic curve of 0.931 ( P < 0.001, 95% CI: 0.847-0.983), with a sensitivity of 83.41% and a specificity of 79.91%. The receiver operating characteristic curve results for the validation group indicated an area under the curve of 0.891 ( P < 0.001, 95% CI: 0.821-0.967), with a sensitivity of 75.00% and a specificity of 94.90%. Conclusions:A history of diabetes, peristomal dermatitis, surgical duration ≥ 90 minutes, and a history of radiotherapy and chemotherapy are independent risk factors for incision infection after ileostomy reversal surgery, while postoperative subcutaneous drainage is a protective factor. Constructing a predictive model based on these factors shows good predictive value for the occurrence of incision infection after ileostomy reversal surgery and needs further clinical investigation.

Objective:To investigate the clinical characteristics, prognosis, and the impact of different secondary prevention strategies on stroke recurrence in patients with carotid web (CaW)-associated acute anterior circulation large vessel occlusion (LVO).Methods:A retrospective analysis was conducted on 401 patients with acute anterior circulation LVO who underwent mechanical thrombectomy at 2 advanced stroke centers, Xingtai Central Hospital and Xingtai People′s Hospital, from January 2018 to June 2024. CaW was identified using digital subtraction angiography (DSA) and other imaging modalities. Based on the presence of CaW, patients were divided into CaW group and non-CaW group. Differences between the 2 groups in baseline characteristics, clinical features, and clinical outcomes were compared, and long-term follow-up was conducted for the CaW group.Results:Among the 401 patients, the CaW group consisted of 16 patients (4.0%), while the non-CaW group included 385 patients (96.0%). Compared to the non-CaW group, patients in the CaW group were younger [53 (46, 58) years vs 65 (56, 76) years, Z=-3.811, P<0.001], had a higher proportion of M1 segment middle cerebral artery occlusion [13/16 vs 54.0% (208/385), χ2=4.602, P=0.032] and a lower proportion of internal carotid artery terminus occlusion [1/16 vs 40.0% (154/385), χ2=6.024, P=0.014]; the 90-day modified Rankin Scale (mRS) score was significantly lower in the CaW group [1.00 (0, 1.75) vs 3.00 (1.00, 4.00), Z=14.210, P<0.001], and the proportion of patients with favorable functional independence (mRS score 0-2) was significantly higher [15/16 vs 45.7% (176/385), χ2=12.350, P<0.001] in the CaW group; the incidence of pneumonia in the CaW group was significantly lower [2/16 vs 42.6% (164/385), χ2=4.562, P=0.033]. Among the 16 CaW patients, 10 received antiplatelet therapy, 4 underwent carotid artery stenting (CAS), and 2 underwent carotid endarterectomy (CEA). During a median follow-up of 29 months, patients who underwent CAS and CEA had no stroke recurrence, while 2 patients who received antiplatelet therapy had stroke recurrence and subsequently underwent CAS and CEA. Conclusions:The proportion of CaW among patients with acute anterior circulation LVO was 4.0%. The patients with CaW were younger and had a higher proportion of M1 segment middle cerebral artery occlusion. Following mechanical thrombectomy, patients in the CaW group had good functional outcomes. Simple drug therapy may be insufficient to prevent stroke recurrence in CaW patients, and CAS and CEA may be effective therapeutic options.

Objective To explore the possible mechanism of Bushen Qiangjin capsule on synovitis and fibrosis in knee osteoarthritis(KOA).Methods In the animal experiment,the animal model of KOA was established by anterior cruciate ligament transection(ACLT).The rats were randomly divided into blank group,model group,Bushen Qiangjin capsule group and celecoxib capsule group.The levels of interleukin-1β(IL-1β)and IL-18 in serum of rats in each group were detected by ELISA,and the histopathological changes of synovium of rats in each group were observed by HE and Sirius red staining.Immunohistochemical staining was used to observe the expression of NLRP3,Caspase-1,GSDMD,TGF-β and COL1A1 in synovium of rats in each group.In the cell experiment,Lipopolysaccharide(LPS)combined with Adenosine triphosphate(ATP)was used to stimulate rat-FLS to simulate OA inflammatory environment and induce pyroptosis model.The cells were treated with Bushen Qiangjin capsule or MCC950,and the levels of IL-1β and IL-18 in the cell culture supernatant of each group were detected by ELISA;the localization and expression of NLRP3,Caspase-1 and GSDMD were observed by immunofluorescence staining;and the mRNA and protein expression of NLRP3,Caspase-1,GSDMD,TGF-β,COL1A1,PLOD2 and TIMP1 were detected by RT-qPCR and Western Blot,respectively.Results The results of animal experiment showed that compared with the model group,Bushen Qiangjin capsule could significantly reduce the score of synovial histomorphology of KOA rats(P<0.01);significantly reduce the levels of IL-1β and IL-18 in serum of KOA rats(P<0.01);also reduce the expression of NLRP3,Caspase-1,GSDMD,TGF-β and COL1A1 protein in synovium of KOA rats(P<0.05,P<0.01).The results of cell experiment showed that compared with the model control group,Bushen Qiangjin capsule could significantly reduce the levels of IL-1β and IL-18 in the supernatant of cell culture(P<0.01);significantly reduce the relative fluorescence expression of NLRP3,Caspase-1 and GSDMD(P<0.01),and significantly reduce the expression of NLRP3,Caspase-1,GSDMD,TGF-β,COL1A1,PLOD2,TIMP1 mRNA and protein(P<0.01).Conclusion Bushen Qiangjin capsule could improve KOA synovitis and fibrosis by inhibiting the activation of NLRP3 inflammasome and regulating FLS pyroptosis.

Fibrosis, which is a manifestation of the physiological response to injury characterized by excessive accumulation of extracellular matrix components, is a ubiquitous outcome of the repair process. However, in cases of repetitive or severe injury, fibrosis may become dysregulated, leading to a pathological state and organ failure. In recent years, a novel form of regulated cell death, referred to as ferroptosis, has been identified as a possible contributor to fibrosis; it is characterized by iron-mediated lipid peroxidation. It has garnered attention due to the growing body of evidence linking ferroptosis and fibrogenesis, which is believed to be driven by underlying inflammation and immune responses. Despite the increasing interest in the relationship between ferroptosis and fibrosis, a comprehensive understanding of the precise role that ferroptosis plays in the formation of fibrotic tissue remains limited. This review seeks to synthesize previous research related to the topic. We categorized the different direct and indirect mechanisms by which ferroptosis may contribute to fibrosis into three categories: (1) iron overload toxicity; (2) ferroptosis-evoked necroinflammation, with a focus on ferroptosis and macrophage interplay; and (3) ferroptosis-associated pro-fibrotic factors and pathways. Furthermore, the review considers the potential implications of these findings and highlights the utilization of ferroptosis-targeted therapies as a promising strategy for mitigating the progression of fibrosis. In conclusion, novel anti-fibrotic treatments targeting ferroptosis could be an effective treatment for fibrosis.

Objective:To construct a diagnostic prediction nomogram for antibody-mediated rejection (AMR) after kidney transplantation (KT) based upon peripheral blood gene expression profiling and preliminarily screening potential drugs for AMR.Methods:Seven large kidney transplant cohort datasets related to AMR were retrieved from the database of GEO. Differential expression analysis was utilized for identifying differentially expressed genes between AMR and normal recipients. Multiple machine learning algorithms of random forest (RF), extreme gradient boosting (XGB), support vector machine (SVM) and generalized linear model (GLM) were employed for constructing diagnostic models for AMR after kidney transplantation. Receiver operating characteristic (ROC) curve was plotted for comparing the accuracy of each model. The key genes of optimal model were integrated for creating a diagnostic prediction nomogram for AMR. Calibration curve and decision curve analyses were employed for evaluating the accuracy of nomogram. The differentially expressed genes from biopsy tissues of AMR recipients were uploaded to the database of CMap for identifying potential therapeutic drugs through screening Top 5 compounds with opposite expression patterns to AMR.Results:Seven genes of CXCL10, FCGR1B, GBP5, CD69, LY96, BCL2A1 and EVI2A were over-expressed in both peripheral blood and biopsy tissues of AMR recipients. There were statistically significant differences with recipients without AMR (FDR<0.05). The AMR diagnostic model based upon RF algorithm demonstrated the highest AUC value (0.904) among various machine learning algorithms. Its AUC values were 0.876 and 0.824 in external datasets of GSE50084 and GSE175718. As for the diagnostic prediction nomogram constructed through integrating five key genes of BCL2A1, CXCL10, FCGR1BP, CD69 & EVI2A from RF model, calibration curve indicated that the predicted outcomes of nomogram approximated actual outcomes. Decision curve indicated that net benefit rate of nomogram was higher than that of extreme curves over a wide range of horizontal axis. The predicted results of CMap suggested that Top 5 compounds were raltegravir, rilmenidine, hydrastine, metyrapone and valproic acid.Conclusions:The nomogram constructed based upon peripheral blood gene expression profiling demonstrates high accuracy and generalizability in the diagnosis of AMR. As predicted by CMap, raltegravir, rilmenidine, hydrastine, metyrapone and valproic acid may be potential therapeutic drugs for AMR.

ObjectiveTo explore the imbalance of paravertebral muscle group for patients with unilateral lumbar disc herniation. MethodsFrom January, 2022 to January, 2023, 30 patients with unilateral lumbar disc herniation (observation group) and 30 healthy people matching in general data (control group) were measured the tension and stiffness of multifidus and erector spinae with MyotonPRO, while the observation group was assessed with Visual Analogue Scale (VAS) for pain and Japanese Orthopaedic Association (JOA) score, and the time of disease was also recorded. ResultsThe mean of bilateral tension and hardness of multifidus and erector spinae was more in the observation group than in the control group (|t| > 5.407, P < 0.001), and the tension and hardness of multifidus and erector spinae of the affected side were more than those of the unaffected side in the observation group (|t| > 11.219, P < 0.001). The tension and hardness of multifidus and erector spinae of the affected side were positively correlated with VAS score (r > 0.942, P < 0.001), and negatively correlated with JOA score (|r| > 0.886, P < 0.001). ConclusionThe tension and hardness of multifidus and erector spinae of the affected side increase after unilateral lumbar disc herniation, resulting in asymmetry.

ObjectiveTo evaluate the inter-rater and test-retest reliability of echo intensity of ultrasound image for quality of quadriceps femoris in patients with knee osteoarthritis (KOA). MethodsFrom March to December, 2021, 33 patients with unilateral KOA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine were included. Ultrasound was used to observe the cross sections of rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL), and the images were saved. Two independent raters analyzed the average gray value of the picture with the Image J. One of the raters repeated the measurement. The intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and coefficient of variation (CV) were calculated and the Bland-Altman charts were drawn. ResultsThe gray value was higher in the RF, VM and VL in the affected side than in the healthy side (t > 2.262, P < 0.05). The inter-rater reliability was excellent, with ICC 0.982 to 0.995, SEM 1.60 to 3.82, CV 1.49% to 5.90%, and MDC value 4.43 to 10.59. The test-retest reliability of the rater was excellent, with ICC 0.969 to 0.990, SEM 2.37 to 5.41, CV 2.22% to 4.84%, and MDC value 6.57 to 15.00. Bland-Altman charts analysis showed that the consistency was good. ConclusionThe quadriceps femoris muscle quality is different between the affected and the healthy sides in patients with unilateral KOA. It is reliable to evaluate muscle echo intensity by Image J.

Objective To explore the effect of head acupuncturing therapy combined with massaging key head acupoints on language and cognitive function in children with autism.Methods 60 children with autism who visited the Department of Pediatric Rehabilitation of our hospital from January 2021 to June 2022 were selected as subjects,who were then randomly divided into the conventional group treated with the conventional rehabilitation training and the combination group treated with head acupuncturing therapy combined with massaging the key acu-points,apart from conventional rehabilitation training 30 cases in each group.The cognitive function,developmental status,and parental quality of life before and after the treatment were compared between the two groups,and so were the language function and safety.Results There were no significant differences in the scores by Autism Behavior Checklist(ABC)and Childhood Autism Rating Scale(CARS),adaptability scores,language scores,and individual-social interaction scores between the conventional group and the combination group before the treatment(P>0.05).After the treatment,the scores by ABC and CARS were significantly decreased in both groups,and the scores of the combination group were significantly lower than those in the conventional group(P<0.05);The adaptability scores,language,individual-social interaction scores were significantly increased in both groups,and the scores of the combined group were significantly higher than those of the conventional group(P<0.05).The abnormal rates of symbolic expression,language comprehension,action-oriented subjects,and language development delay in the combined group were all significantly lower than those in the conventional group(P<0.05).There was no significant difference in the scores by the QL-Index between the conventional group and the combined group before the treatment(P>0.05),but after the treatment,the QL-Index scores of the conventional group and the combination group were increased,and the score of the combination group was significantly higher than that of the conventional group(P<0.05).The results of blood routine,urine routine,stool routine,liver function,and kidney function in both groups were not significantly abnormal.There was one case of mild swelling and pain at the acupunctured site in the combination group,which was improved without intervention.Conclusion Head acupuncturing therapy combined with massaging the key head acupoints can improve language function,cognitive function,and development of autis-tic children.In addition,it can enhance parental quality of life and have a high level of safety.