Objective:To explore the value and related mechanism of preoperative serum sialic acid (SA) on evaluating microvascular invasion (MVI) in patients with intrahepatic cholangiocarcinoma (ICC).Methods:A total of 91 patients who underwent surgical resection and were pathologically diagnosed with ICC from December 2020 to September 2024 at the Oriental Hepatobiliary Surgery Hospital affiliated to the Naval Medical University were included in this retrospective analysis. The patients were divided into non-MVI (41 cases) and MVI groups (50 cases). The general data and laboratory examination indexes were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for predicting MVI. The predictive value of serum indicators for MVI was evaluated by receiver operating characteristic curves. The correlation between MVI and SA was analyzed by point-biserial correlation. ICC cells stably overexpressing β-galactoside α2, 6-sialyltransferase 1 (ST6GAL1) were generated through lentiviral transfection. ST6GAL1 protein expression and mRNA expression were detected by Western blot and quantitative real-time polymerase chain reaction, respectively. Sambucus nigra (SNA) lectin fluorescence staining was used to detect α2, 6-sialylation levels on cells. Cell migration ability was assessed by wound healing and Transwell assays, and cell proliferation was evaluated by colony formation assays.Results:Compared with the non-MVI group, patients in the MVI group exhibited significantly higher levels of fibrinogen, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, SA and 5′-nucleotidase (5′-NT) (all P<0.05). Multivariate logistic regression analysis revealed that SA ( OR=1.01,95% CI 1.01-1.02, P=0.023) was the only independent predictor for MVI. The area under curve of SA in predicting MVI was 0.757 (95% CI 0.640-0.870), sensitivity 67.65%, specificity 77.78%. SA was positively correlated with MVI ( r=0.443, P<0.001). ICC cells overexpressing ST6GAL1 were featured with increased mean fluorescence intensity of SNA lectin, and increased level of α2, 6-sialylation on the cell surface (both P<0.05). The number of colonies formed by hypersialylated ICC cells was also increased ( P<0.05), and both the migration rate and the number of migrating cells were significantly higher ( P<0.05). Conclusions:Serum SA is an independent predictor for MVI in ICC patients. Hypersialylation in ICC cells is associated with higher malignancy.

Objective:To explore the value and related mechanism of preoperative serum sialic acid (SA) on evaluating microvascular invasion (MVI) in patients with intrahepatic cholangiocarcinoma (ICC).Methods:A total of 91 patients who underwent surgical resection and were pathologically diagnosed with ICC from December 2020 to September 2024 at the Oriental Hepatobiliary Surgery Hospital affiliated to the Naval Medical University were included in this retrospective analysis. The patients were divided into non-MVI (41 cases) and MVI groups (50 cases). The general data and laboratory examination indexes were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for predicting MVI. The predictive value of serum indicators for MVI was evaluated by receiver operating characteristic curves. The correlation between MVI and SA was analyzed by point-biserial correlation. ICC cells stably overexpressing β-galactoside α2, 6-sialyltransferase 1 (ST6GAL1) were generated through lentiviral transfection. ST6GAL1 protein expression and mRNA expression were detected by Western blot and quantitative real-time polymerase chain reaction, respectively. Sambucus nigra (SNA) lectin fluorescence staining was used to detect α2, 6-sialylation levels on cells. Cell migration ability was assessed by wound healing and Transwell assays, and cell proliferation was evaluated by colony formation assays.Results:Compared with the non-MVI group, patients in the MVI group exhibited significantly higher levels of fibrinogen, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, SA and 5′-nucleotidase (5′-NT) (all P<0.05). Multivariate logistic regression analysis revealed that SA ( OR=1.01,95% CI 1.01-1.02, P=0.023) was the only independent predictor for MVI. The area under curve of SA in predicting MVI was 0.757 (95% CI 0.640-0.870), sensitivity 67.65%, specificity 77.78%. SA was positively correlated with MVI ( r=0.443, P<0.001). ICC cells overexpressing ST6GAL1 were featured with increased mean fluorescence intensity of SNA lectin, and increased level of α2, 6-sialylation on the cell surface (both P<0.05). The number of colonies formed by hypersialylated ICC cells was also increased ( P<0.05), and both the migration rate and the number of migrating cells were significantly higher ( P<0.05). Conclusions:Serum SA is an independent predictor for MVI in ICC patients. Hypersialylation in ICC cells is associated with higher malignancy.

Objective To investigate the protective effect and mechanism of CDK4/6 inhibitor palbociclib against radiation-induced injury in rats'small intestinal crypt epithelial cell line(IEC-6).Methods(1)Using CCK-8 colorimetric assay,colony formation assay,the PI staining method,Annexin V-FITC/PI dual staining and Western blot,the impact of palbociclib on proliferation,cell cycle dynamics,apoptosis,DNA damage,as well as phosphorylation events at Rb-780 and 795 sites in irradiated IEC-6 cells was investigated.(2)An IEC-6 cell line overexpressing Rb was established,and the effects of Rb overexpression on proliferation,cell cycle,and apoptosis in the IEC-6 cell line were assessed using the CCK-8 colorimetric assay,PI staining method,Annexin V-PE/7-AAD dual staining and Western blot.Additionally,the impact of Rb overexpression on the protective effect of palbociclib against radiation damage was verified in the Rb-overexpressing IEC-6 cell line.Results(1)Administration of palbociclib was demonstrated to enhance the proliferative capacity of IEC-6 cells following exposure to 10 Gy X-ray irradiation,increase colony formation ability post 4-8 Gy X-ray exposure while concomitantly reducing the proportion of cells in the G2/M phase after 10 Gy irradiation and diminishing apoptosis in irradiated IEC-6 cells.Protein expression analysis revealed that palbociclib inhibited phosphorylation at Rb-780 and 795 sites and attenuated the production of γ-H2AX in IEC-6 cells following irradiation.(2)After transfection of IEC-6 cells with Rb overexpression lentivirus,there was a significant increase in the total protein expression of Rb.The phosphorylation levels at Rb-780 and 795 sites were markedly elevated.Consequently,cell proliferation was accelerated,the proportion of cells in the S phase of the cell cycle increased,and the apoptotic rate significantly rose after exposure to 10 Gy X-ray irradiation.(3)Treatment with a lower dose of palbociclib(0.05 μmol/L)was found to suppress the phosphorylation of Rb at 780 and 795 sites in IEC-6 cells overexpressing Rb.Additionally,it reduced apoptosis in IEC-6 cells overexpressing Rb following exposure to 10 Gy X-ray irradiation.However,this treatment did not inhibit the phosphorylation of Rb at 780 and 795 sites in IEC-6 cells transfected with the empty vector,nor did it exert a protective effect against radiation-induced damage in these cells.Conclusion The CDK4/6 inhibitor palbociclib demonstrates significant protective effects against radiation-induced damage in rats'intestinal crypt epithelial cell line(IEC-6),with the Rb protein potentially playing a crucial role in mediating this radioprotective response.

Objective:To establish a lectin enzyme-linked immunosorbent assay (lectin-ELISA) for the dection of sialylated fetuin-A and to explore the clinical diagnostic value of sialylated fetuin-A in hepatocellular carcinoma (HCC).Methods:From January 2017 to December 2020, 300 HCC patients and 160 disease controls, including 36 liver cirrhosis subgroups and 124 chronic hepatitis B subgroups, were collected from Shanghai Eastern Hepatobiliary Surgery Hospital. At the same time, 100 healthy subjects were collected as healthy controls. Lectin-ELISA method for detecting sialylated fetuin A was established based on the principle that Sambucus nigra lectin (SNA) can recognize the structure of α-2, 6-linked sialic acid residues. Differences between groups were compared using t-test or analysis of variance. Logistic regression method was used to establish the multi-index joint detection model, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of single index and joint detection model in the diagnosis of HCC.Results:A lectin-ELISA method for the detection of serum Sia-fetuin A was established. The linear regression coefficient of the system was 0.978 5, and the precision evaluation and interference experiments were in line with the clinical detection requirements. Using this method to detect serum Sia-fetuin A levels in each group, the levels of HCC group, disease control group and healthy control group were 1.362±0.310, 1.199±0.370, 1.086±0.420, respectively, and the three groups decreased in turn. The areas under the curve of Sia-fetuin A, α-fetoprotein, and their combined detection models for differential diagnosis of HCC were 0.790, 0.809, and 0.860, respectively. The diagnostic model had a sensitivity of 79.3% (238/300) and a specificity of 95.0% (247/260). Among the 300 patients in the HCC group, 138 (46%) patients were negative for serum AFP (<20 μg/L), and their serum Sia-fetuin A level was 1.364±0.305. Combining the disease control group and the healthy control group into the non-Cancer group, the serum Sia-fetuin A level was 1.146±0.381. The serum level of Sia-fetuin A in AFP-negative HCC patients was higher than that in non-HCC group ( t=6.134, P<0.001). The areas under the curve of Sia-fetuin A and the combined diagnostic model for the diagnosis of AFP-negative HCC were 0.776 and 0.919, respectively. The combined diagnostic model had a sensitivity of 93.4% (129/138) and a specificity of 77.3% (201/260). Conclusion:Serum Sia-fetuin A and combined determination model can provide a new auxiliary diagnostic index for AFP-negative HCC.

Objective:To explore diagnostic value of tumor necrosis factor-α (TNF-α) in patients with pulmonary infection after liver transplantation.Methods:The clinical data of 80 patients with pulmonary infection after liver transplantation in the the First Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2019 were retrospectively analyzed. According to different pathogens, they were divided into bacteria infection group ( n=35) and non-bacteria infection group ( n=45). The general data, levels of serum TNF-α, C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. Logistic regression was performed to explore risk factors for pulmonary infection after liver transplantation. Receiver operating characteristic (ROC) curves were performed to analyze diagnostic value of TNF-α, CRP and PCT. Results:The levels of serum TNF-α, CRP and PCT in bacteria infection group were significantly higher than those in non-bacteria infection group ( P<0.05). Multivariate analysis showed that high TNF-α, CRP, and PCT levels were independent risk factors for bacterial pneumonia after liver transplantation. ROC analysis showed that sensitivity, specificity and areas under ROC curves (AUC) of TNF-α, CRP and PCT for diagnosis of bacterial pulmonary infection after liver transplantation were (80.12%, 72.12%, 80.18%), (83.45%, 73.46%, 83.38%) and (0.802, 0.751, 0.803), respectively. The AUC, sensitivity, and specificity between TNF-α and PCT for diagnosis of bacterial pulmonary infection after liver transplantation were similar ( P>0.05). The AUC, sensitivity and specificity of TNF-α for diagnosis of bacterial pulmonary infection after liver transplantation were better than those of CRP ( P<0.05). Conclusions:The diagnostic value of TNF-α for pulmonary infection after liver transplantation is similar to that of PCT, and is superior to CRP. It can be applied as a reliable index for identifying bacterial pneumonia and non-bacterial pneumonia.

Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.

Objective To evaluate the feasibility of dual-source low-dose computed tomography (CT) of the paranasal sinus in children, with acquisition at an ultra-low tube voltage (70 kVp) combined with the Flash scan. Methods CT scans of the paranasal sinus were performed on 80 pediatric patients who were divided into two groups according to different protocols (70 kVp protocol with Flash scan mode and the iterative reconstruction, pitch 3, the experimental group (group A), n = 40; 80 kVp protocol with conventional spiral mode, pitch 1.5, control group (group B), n = 40). For each examination, the CT dose index (CTDIvol), dose-length product (DLP) and effective dose (ED) were estimated. The image noise, signal-to-noise ratio (SNR) and overall subjective diagnostic image quality were also evaluated. Results The images of these two groups were all satisfied for the clinical diagnosis. For radiation dose, the CTDIvol (mGy), DLP (mGycm) and ED (mSv) values of the 70 kVp protocol were significantly lower than those of the 80 kVp protocol [CTDIvol: 0.39 ± 0.004 vs1.57 ± 0.009 mGy, P < 0.001; DLP: 6.31 ± 0.52 vs 19.88 ± 2.01 mGycm, P < 0.001; ED: 0.024 ± 0.005 vs 0.079 ± 0.016 mSv, P < 0.001. Compared with those of the 80-kVp protocol, the image noise and the SNR_bone increased, the SNR_soft-tissue decreased. There was no statistical difference in the subjective scores of the two groups of image quality by the two physicians (P > 0.05). Conclusion When diagnosing the paranasal sinus in children, an ultralow tube voltage (70 kVp) combined with the Flash scan technique can reduce the radiation dose significantly while maintaining diagnostic image quality with clinically acceptable image noise.

Objective:To explore the clinical effects of uncut Roux-en-Y anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 194 patients who underwent laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Military Medical University from January 2017 to May 2019 were collected. There were 130 males and 64 females, aged (57±10)years, with a range from 27 to 78 years. Of 194 patients, 62 undergoing uncut Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy and 132 undergoing Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy were allocated into uncut group and traditional group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted at the postoperative 3 months and 6 months to detect Roux stasis syndrome (RSS), tumor recurrence, readmission, and survival of patients. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test Fisher exact probability. Comparison of ordinal data between groups was analyzed using the nonparametric rank sum test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 104 of 194 patients had successful matching, including 52 in the uncut group and 52 in the traditional group respectively. Before propensity score matching, cases with age ≤60 years or >60 years, cases in stage Ⅰ, Ⅱ, Ⅲ of American Society of Anesthesiologists were 43, 19, 27, 28, 7 for the uncut group, respectively, versus 63, 69, 24, 92, 16 for the traditional group, showing significant differences between the two groups ( χ2=1.279, Z=2.818, P<0.05). After propensity score matching, the above indicators were 33, 19, 20, 25, 7 for the uncut group, versus 34, 18, 15, 33, 4 for the traditional group, showing no significant difference between the two groups ( χ2=0.000, Z=0.500, P>0.05). (2) Intraoperative and postoperative situations: 104 patients underwent laparoscopic distal gastrectomy successfully and received R 0 resection, without intraoperative complications or conversion to open surgery. After propensity score matching, the time of digestive tract reconstruction was (41±10)minutes for the uncut group, versus (52±15)minutes for the traditional group, showing a significant difference between the two groups ( t=4.511, P<0.05). (3) Follow-up: 104 patients were followed up at the postoperative 3 months and 6 months. The incidence of RSS at the postoperative 3 months was 0 for the uncut group, versus 30.8%(16/52) for the traditional group, showing a significant difference between the two groups ( P<0.05). The incidence of RSS at the postoperative 6 months was 0 for the uncut group, versus 9.6%(5/52) for the traditional group, showing no significant difference between the two groups ( P>0.05). There was no tumor recurrence, readmission, death within postoperative 30 days, or cancer-related death in the 104 patients. Conclusion:Uncut Roux-en-Y anastomosis is safe and feasible in the laparoscopic distal gastrectomy, which can effectively shorten the time of digestive tract reconstruction and reduce the occurrence of RSS after 3 months surgery.

Objective: To understand the incidence of school violence and its related factors among senior students in rural primary schools in Guizhou and Anhui provinces in 2016. Methods: From September to November 2016, one county was randomly selected from 47 impoverished counties of Guizhou and one county was randomly selected from 18 impoverished counties of Anhui Province by using multi-stage cluster sampling method. A total of 4 schools were randomly selected from primary schools which had more than 70% students with rural resident registration in each selected county, and 3 classes were randomly selected from fifth and sixth grades of each selected school. All students in each selected class were included in this study. A total of 2 521 students were included, and 2 506 valid questionnaires were collected with an effective response rate about 99.4%. Self-designed questionnaires were used to collect data on individual information, family information, and the incidence of school violence with related factors. Multivariable logistic regression was conducted to analyze related factors of school violence. Results: The incidence of violence in rural primary schools was 50.4% (1 264/2 506) in 2016. The number of students who had physical assault, fought or been bullied was 682 (27.2%), 689 (27.5%) and 764 (30.5%), respectively. The results of multivariable logistic regression showed that the OR (95%CI) values of incidence of school violence for male students was 2.13(1.78-2.54) compared with female students; and the OR(95%CI) values of incidence of school violence for students with high peer acceptance, high family intimacy, more physical activity and mother who had education background of junior high school, senior high school, technical secondary school and junior college, bachelor′s degree or above were 0.39 (0.26-0.57), 0.47 (0.40-0.57), 0.64 (0.52-0.78), 0.79 (0.66-0.96), and 0.65 (0.46-0.92) compared with those with low peer acceptance, low family intimacy, less physical activity and mother who had primary education and below. Conclusion The incidence of violence in rural primary schools is not optimistic. Gender, peer acceptance, family intimacy, physical activity and mother education are related to school violence.

To understand the incidence of school violence and its related factors among senior students in rural primary schools in Guizhou and Anhui provinces in 2016. Methods From September to November 2016, one county was randomly selected from 47 impoverished counties of Guizhou and one county was randomly selected from 18 impoverished counties of Anhui Province by using multi?stage cluster sampling method. A total of 4 schools were randomly selected from primary schools which had more than 70% students with rural resident registration in each selected county, and 3 classes were randomly selected from fifth and sixth grades of each selected school. All students in each selected class were included in this study. A total of 2 521 students were included, and 2 506 valid questionnaires were collected with an effective response rate about 99.4%. Self?designed questionnaires were used to collect data on individual information, family information, and the incidence of school violence with related factors. Multivariable logistic regression was conducted to analyze related factors of school violence. Results The incidence of violence in rural primary schools was 50.4% (1 264/2 506) in 2016. The number of students who had physical assault, fought or been bullied was 682 (27.2%), 689 (27.5%) and 764 (30.5%), respectively. The results of multivariable logistic regression showed that the OR (95%CI) values of incidence of school violence for male students was 2.13(1.78-2.54) compared with female students; and the OR (95%CI) values of incidence of school violence for students with high peer acceptance, high family intimacy, more physical activity and mother who had education background of junior high school, senior high school, technical secondary school and junior college, bachelor′s degree or above were 0.39 (0.26-0.57), 0.47 (0.40-0.57), 0.64 (0.52-0.78), 0.79 (0.66-0.96), and 0.65 (0.46-0.92) compared with those with low peer acceptance, low family intimacy, less physical activity and mother who had primary education and below. Conclusion The incidence of violence in rural primary schools is not optimistic. Gender, peer acceptance, family intimacy, physical activity and mother education are related to school violence.