Objective:To evaluate the clinical value of cognitive and motor function in predicting conversion to neurodegenerative disorders in patients with isolated rapid eye movement sleep behavior disorder (iRBD).Methods:Forty-seven patients with iRBD were collected from the Department of Neurology of Tianjin Medical University General Hospital and Tianjin Medical University General Hospital Airport Site during October 2018 and June 2022. All participants received comprehensive evaluations of cognitive and motor function at baseline. The visuospatial function was evaluated by Rey-Osterrieth Complex Figure Test (ROCF)-copy, the memory function was evaluated by Auditory Verbal Learning Test and ROCF-recall, the attention-executive function was evaluated by Trail Making Test (TMT) and Stroop Color-Word Test, and the language function was evaluated by Boston Naming Test. The motor function was evaluated by Unified Parkinson′s Disease Rating Scale-Ⅲ, Alternate-tap Test (ATT), and 3-meter Timed Up and Go Test. The iRBD patients with phenoconversion were identified during follow-up. Receiver operating characteristic curve and generalized linear model Logistic regression were applied to identify the optimal combination of cognitive and motor tests in distinguishing the converters from non-converters in patients with iRBD. Multivariate Cox regression analyses were applied to evaluate the independent risk factors in predicting conversion to neurodegenerative diseases in patients with iRBD.Results:The median follow-up duration was 3 years. Forty-five iRBD patients were included in the analysis eventually, as 2 dropped out at follow-up. Twenty-one iRBD patients developed neurodegenerative disorders, with 14 presenting motor phenotype and 7 cognitive phenotype. Baseline ROCF-copy, TMT-A and ATT were best combination in identifying iRBD patients with phenoconversion [sensitivity: 90.0%, specificity: 87.5%, area under curve (AUC): 0.931, P<0.001]. Baseline TMT-A and ATT were best combination in identifying iRBD patients with motor phenotype conversion (sensitivity: 100.0%, specificity: 66.7%, AUC: 0.872, P<0.001); Baseline TMT-A performed best in identifying iRBD patients with cognitive phenotype conversion (sensitivity: 83.3%, specificity: 91.7%, AUC: 0.917, P<0.001). Multivariate Cox regression analysis showed that individuals with poorer performance of TMT-A (cut-off value: 63.0 s) and ATT (cut-off value: 205.5 taps/min) than the cut-off values at baseline had higher risks for developing to neurodegenerative disorders, with HR values of 5.455 (95% CI 1.243-23.941, P=0.025) and 11.279 (95% CI 1.485-85.646, P=0.019), respectively. Conclusions:In iRBD, ROCF-copy, TMT-A and ATT served as optimum combination in predicting phenoconversion, whereas TMT-A and ATT served as optimum combination in predicting motor phenotype, and TMT-A performed best in predicting cognitive phenotype. The performance in TMT-A and ATT in iRBD could predict the risk of developing to neurodegenerative disorders independently.

Objective To simulate the microflow field environment between the anastomotic nail surface and intestinal wall tissue after implantation and to study the effect of hydrophobic surfaces on the flow rate of extracellular fluid and the fluid shear force on the wall to regulate bacterial adhesion through changes in the flow field.Methods The microstructure of shark skin was observed,and a simplified two-dimensional(2D)movement model of bacteria in a microflow field was established.Using computational fluid dynamics(CFD)numerical simulation,the movement of bacteria on a smooth surface and micro-textured surface in a static and dynamic flow field were simulated.The flow field characteristics around bacteria and the magnitude of fluid shear force under the two surface environments were compared,and the internal mechanism of the fluid shear force affecting bacterial adhesion was analyzed.Results The addition of the biomimetic microtexture enhanced the flow rate of the extracellular fluid in the microflow field,and the fluid had little viscous effect on the bacteria in the static flow field.The fluid in the dynamic flow field had a stronger pushing effect on the bacteria.The fluid shear force on the microtextured wall increased when the pit width was within a specific range.Conclusions The bionic micro-textured surface of the anastomotic nail can accelerate the flow rate of extracellular fluid,increase the fluid shear force of micro-textured walls and bacteria,and influence bacterial adhesion.These result provide a theoretical basis for studying bacteriostatic surfaces of anastomotic nails.

Ischemic stroke （IS） is a serious cerebrovascular disease common in clinical practice. Targeting the pathogenesis of IS， intravenous thrombolysis for restoring blood flow is still the most effective therapy. However， intravenous thrombolysis has shortcomings such as increased bleeding risk， narrow therapeutic window， and contraindications， which limited its clinical application. Protection of the ischemic brain tissue before full recovery of blood flow is associated with the prognosis of IS. Studies have identified multiple pathways in the alleviation of the brain injury caused by IS， such as the mammalian target of rapamycin （mTOR） signaling pathway. Traditional Chinese medicine （TCM） has abundant therapies and unique advantages in the treatment of IS， especially in alleviating symptoms and improving the quality of life of patients. After the onset of IS， TCM can be integrated with Western medicine to play a role in the whole process of treatment， rehabilitation， and recurrence prevention as soon as possible， thus maximizing patient benefits. TCM has clinical significance for the recovery of neurological and motor functions after IS. Studies have shown that TCM can reduce the cerebral injury caused by IS by regulating and activating the mTOR signaling pathway， thereby regulating autophagy， inhibiting apoptosis of nerve cells， and reducing oxidative stress and inflammation. TCM exerts a positive effect for achieving cerebral protection and improving the prognosis of IS and provides new ideas for the prevention and treatment of IS. This article introduces the role of the mTOR signaling pathway in the pathogenesis of IS and reviews the research progress in the TCM regulation of this pathway in the treatment of IS， aiming to provide new therapeutic ideas and systematic scientific reference for the treatment of IS with TCM.

In order to understand the current status of the knowledge, attitude and practice (KAP) about prevention and control of COVID -19 in college students, and to provide theoretical basis for prevention and control work in college campus. This study investigated the KAP of COVID -19 of 1 847 college students in Shaanxi province by questionnaire using the convenience sampling method. Chisquare test and multivariate logistic regression analysis were used to analyze the influencing factors for the KAP of COVID -19. The results demonstrated that 48.3% of the students had a higher knowledge level of COVID -19, 11.7% had a fear attitude and 39.6% had good protective practices. Logistic regression results showed that female and urban household college students had higher cognitive level of COVID -19. The college students with anxiety state were more likely to have fear attitude. Students of female, urban household, anxiety, higher cognition and fear attitude showed better protective practices. The above results indicated that the knowledge level of COVID -19 in college students are not enough, and the attitude and protective practices need to be further improved. Therefore, relevant departments should follow the rules of KAP, carry out targeted propaganda and education on COVID -19 for college students, to improve their ability to cope with public health emergencies.

Pancreatic cancer is a common malignant tumor of the digestive system,with a low early diagnosis rate,a high surgical mortality rate,a low cure rate,and a poor overall prognosis.In recent years,with the continuous development of artificial intelligence in the medical field,artificial intelligence techniques,such as machine learning and deep learning,have been widely used in medical research.This article reviews the application of artificial intelligence techniques in the screening,diagnosis,treatment,complications,and prognosis prediction of pancreatic cancer,so as to provide a basis and new ideas for the application of artificial intelligence in the diagnosis and treatment of pancreatic cancer.

ObjectiveTo study the effect of Bazi Bushen capsules on delaying the aging process of naturally aging mice and its mechanism. MethodThe mice were randomly divided into four groups according to their body weight， namely， aging group， low-dose Bazi Bushen capsules group （1 g·kg^-1）， high-dose Bazi Bushen capsules group （2 g·kg^-1）， and rapamycin group （0.002 g·kg^-1）. The debilitating signs were detected by behavioral tests and the weakness index was measured. The percentages of spleen T and B lymphocytes， effector T cells （TE）， memory T cells （TM）， naive T cells （TN）， helper T cells （Th）， cytotoxic T cells （Tc） ，Th1 cells， Th2 cells， and regulatory T cells （Treg） were determined by flow cytometry. Cell proliferation and the cell counting kit-8 （CCK-8） assay was used to detect the proliferation of lymphocytes in mice. The hematoxylin-eosin （HE） staining was used to observe the histopathological changes in the mouse spleen. The expression of cyclin-dependent kinase inhibitor 2A （p16） and cyclin-dependent kinase inhibitor 1A （p21） was detected by immunohistochemistry （IHC）. The mRNA expression of senescence-related proteins p16 and p21 was determined by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）， and the inflammatory cytokines， including tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin （IL）-1β， IL-2， IL-4， IL-10， and IL-12 p70， in peripheral blood of mice were detected by Luminex. ResultAs compared with the aging group， mice in the Bazi Bushen capsules and rapamycin groups showed significantly improved debilitating signs and reduced weakness index scores （P<0.05， P<0.01）， increased proportions of T cells， TN cells， Tc cells， Th2 cells， and Treg cells in the spleen， decreased proportions of TE cells， TM cells， Th cells， Th1 cells （P<0.05， P<0.01）， and increased proliferation of splenic lymphocytes （P<0.05， P<0.01）. In the Bazi Bushen capsules and rapamycin groups， clear structure of the red and white marrow marginal zone was observed in the spleen of mice， the area of the white marrow was increased， and the area of the red marrow was correspondingly decreased. The protein and mRNA expression of aging-related proteins p16 and p21 in the spleen was decreased （P<0.01）， the levels of serum pro-inflammatory cytokines IL-1β， IL-2， IL-12 p70， IFN-γ， and TNF-α levels were decreased， and the levels of IL-4 and IL-10 were increased （P<0.05， P<0.01） in the Bazi Bushen capsules and rapamycin groups as compared with the aging group. ConclusionBazi Bushen capsules have the effect of regulating the debilitating signs of natural aging mice， regulating the immune homeostasis and inflammation level of the body， and reducing cell aging.

Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d⁻¹ increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹ were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week⁻¹ group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week⁻¹ group compared to the <1 serving·week⁻¹ SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (P_interaction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L⁻¹ and 0.18 mmol·L⁻¹, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.

Objective:To investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) level, ovarian response to gonadotropin stimulation and pregnancy rate for in vitro fertilization (IVF) patients with benign ovarian cysts.Methods:Patients with benign ovarian cysts who were admitted for cystectomy and had undergone IVF treatment were enrolled in the study. There were 373 participants with ovarian cysts underwent laparoscopic ovarian cystectomy in the experimental group. According to duration of post-surgery, there were four sub-groups: 1 year post-surgery (1Y POST), 2 years post-surgery (2Y POST), 4 years post-surgery (4Y POST) and ≥5 years post-surgery (≥5Y POST) in the experimental group. According to histopathologic types of ovarian cysts, there were two sub-groups: ovarian endometriotic cysts and ovarian non-endometriotic cysts. Two hundreds and three patients with no history of ovarian cysts and ovarian surgery were in the control group. The level of AMH and basic concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), estradiol (E 2) were measured. Antral follicle counts (AFC) were calculated. There were other study variables: total dose of gonadotropins, duration of ovarian stimulation, the number of oocyte retrieved, the number of embryo obtained, blastocyst transfer rate and pregnancy rate. Results:The control group was matched as closely as possible to the experimental group, including age, body mass index and menstrual cycle (all P>0.05). Compared to the women in control group, the women in ovarian endometriotic cystectomy sub-group had significantly higher levels of basal FSH and basal P, lower level of AMH (all P<0.05); the women in ovarian endometriotic cysts sub-group had significantly higher dose of gonadotropins (all P<0.05); the women in ovarian endometriotic cysts ≥5Y POST sub-group had significantly lower number of oocyte retrieved, lower number of embryo obtained, lower blastocyst transfer rate, and lower pregnancy rate (all P<0.05). Compared to the women in control group, the women in ovarian non-endometriotic cysts sub-group had a significantly higher level of basal FSH and basal P (all P<0.05). The women in ovarian non-endometriotic cysts sub-group had lower level of AMH, higher dose of gonadotropins, lower number of oocyte retrieved, lower number of embryo obtained, lower rate of blastocyst transfer and lower rate of pregnancy than the control group but there were no statistically significant differences among them (all P>0.05). The women with unilateral ovarian endometriotic cysts had significantly lower number of oocyte retrieved on the side of surgery than another side ( P<0.05). Conclusions:In short term laparoscopic ovarian cystectomy has no significant effect on ovarian reserve. But with long-term follow-up ovarian reserve, ovarian response to gonadotropin stimulation and pregnancy rate are decreased. The effect of laparoscopic ovarian cystectomy in benign cysts on ovarian is associated with whether or not it is the surgical side.

Objective:To explore the values of albumin-bilirubin (ALBI) score, carcinoembryonic antigen (CEA) and combination of the two in the prognostic assessment of colorectal cancer patients with postoperative liver metastasis.Methods:The clinicopathological data of 98 colorectal cancer patients with postoperative liver metastasis who were admitted to Lianyungang Oriental Hospital and receiving adjuvant chemotherapy from January 2016 to March 2020 were retrospective analyzed. The data of serum protein, bilirubin, and CEA before chemotherapy were obtained, the relationship between serum protein and bilirubin was analyzed, and the ALBI score was calculated. The ALBI-CEA score was judged according to the ALBI score and the CEA level. ALBI score > -2.60 points was categorized as high ALBI group, and ALBI score ≤ -2.60 points was categorized as low ALBI group; CEA >5 ng/ml was categorized as high CEA group, and CEA ≤5 ng/ml was categorized as low CEA group; patients were categorized into 0, 1, and 2 points groups based on ALBI-CEA score. Overall survival (OS) and progression-free survival (PFS) of ALBI score, CEA and ALBI-CEA score subgroups were analyzed by Kaplan-Meier method; with the actual survival and progress status of the patients as the gold standard, receiver operating characteristic (ROC) curve was used to analyze the effect of 3 indicators to assess patients' OS and PFS, and area under the curve (AUC) was compared; Cox proportional hazards model was used to analyze the influencing factors of OS and PFS.Results:The median albumin and bilirubin levels of the 98 patients were 34.4 g/L (26.8-42.8 g/L) and 16.6 μmol/L (7.6-44.6 μmol/L), and the result of Pearson correlation analysis showed a negative correlation between the levels of albumin and bilirubin ( r = -0.282, P < 0.001). The 3-year OS and PFS rates in the high ALBI group were lower than those in the low ALBI group (OS rate: 9.2% vs. 33.3%, PFS rate: 7.7% vs. 18.2%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 27.64, 23.30, both P < 0.001). The 3-year OS and PFS rates in the high CEA group were lower than those in the low CEA group (OS rate: 7.1% vs. 42.9%, PFS rate: 7.1% vs. 21.4%), and the differences in OS and PFS between the two groups were statistically significant ( χ2 values were 23.71, 17.14, both P < 0.001). The 3-year OS rates in the ALBI-CEA score 0, 1 and 2 points groups were 77.8%, 20.9% and 2.2%, and the 3-year PFS rates were 44.4%, 9.3% and 6.5%, and there were statistical differences in OS and PFS among the three groups ( χ2 values were 102.36, 76.55, both P < 0.001). The ROC curve analysis showed that the AUC of ALBI score, CEA and ALBI-CEA score for assessing OS were 0.688 (95% CI 0.544-0.832), 0.754 (95% CI 0.618-0.890) and 0.828 (95% CI 0.723-0.933) (all P < 0.05), and the AUC for assessing PFS were 0.618 (95% CI 0.436-0.799), 0.646 (95% CI 0.464-0.829) and 0.682 (95% CI 0.494-0.870) (all P > 0.05). Multivariate Cox regression analysis showed that ALBI-CEA score was an independent influencing factor for OS (2 points vs. 0 point: HR = 17.254, 95% CI 8.385-35.504, P < 0.001) and PFS (2 points vs. 0 point: HR = 6.144, 95% CI 3.725-10.134, P < 0.001) of patients. Conclusions:The colorectal cancer patients with liver metastasis and high ALBI-CEA score are at high risk of death and disease progression and have a poor prognosis, and they are recommended to receive intensive treatment.

Objective: To examine the effects of obesity and central obesity on hypertension, so as to provide insights into the prevention and control measures of hypertension. Methods: From September to December 2018, residents at ages of 35 to 75 years were sampled using the multi-stage random sampling method in Baiyin District, Baiyin City, Gansu Province, and subjected to questionnaire surveys and physical examinations. The interaction between obesity/central obesity and hypertension was evaluated using logistic regression analysis. The synergy index ( SI ), relative excess risk due to interaction ( RERI ) and attributable proportion due to interaction ( AP ) were calculated using Excel compiled by Andersson et al. Results: A total of 6 246 questionnaires were allocated and 6 169 valid questionnaires were recovered, with an effective recovery rate of 98.77%. The respondents included 3 038 men ( 49.25% ) and 3 131 women (50.75%), with a mean age of ( 52.05±8.78 ) years. There were 832 respondents with obesity ( 13.49% ) and 2 278 with central obesity ( 36.93% ). The crude and standardized prevalence rates of hypertension were 35.89% and 33.05%, respectively. Multivariable logistic regression analysis showed that obesity ( OR=2.020, 95%CI: 1.705-2.393 ) and central obesity ( OR=1.622, 95%CI: 1.433-1.836 ) were statistically associated with hypertension. There was no multiplicative interaction between obesity or central obesity and hypertension ( OR=1.011, 95%CI: 0.655-1.560 ), and no additive interaction was detected between obesity or central obesityand hypertension ( SI=1.405, 95%CI: 0.815-2.424; RERI=0.658, 95%CI: -0.298 to 1.614; AP=0.201, 95%CI: -0.075 to 0.476 ). Conclusions Obesity and central obesity increase the risk of hypertension; however, no interaction is detected between obesity or central obesity and hypertension.