Objective:To investigate the role and mechanisms of cellular FLICE-like inhibitory protein (cFLIP) in mediating oxidative stress induced by myocardial ischemia-reperfusion injury (MI/RI) in rats.Methods:Forty-eight male Sprague-Dawley rats with body weight of 180-200 g, were randomly divided into 4 groups ( n=12 per group) using a random number table: sham operation group (sham group), ischemia-reperfusion group (I/R group), virus control group (I/R+Ad-NC group), and cFLIPL-overexpressing group (I/R+Ad-cFLIPL group). A myocardial ischemia-reperfusion injury (MI/RI) model was established by ligating the left anterior descending coronary artery for 30 min followed by 3 h of reperfusion. The left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) in rats were evaluated via echocardiography, and a biochemical analyzer was used to measure the serum lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB) levels to evaluate the extent of myocardial injury. The 2,3,5- triphenyl tetrazolium chloride (TTC) staining method was used to detect the infarct area of the rat myocardium, and hematoxylin and eosin (HE) staining was performed to observe the morphology of the rat myocardial tissue. Commercial kits were used to measure the levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-px), and malondialdehyde (MDA). Dihydroethidium (DHE) staining was used to assess the number of reactive oxygen species (ROS)-positive cells in the myocardial tissue. Western blot analysis was performed to evaluate the protein expression of cFLIPL, Nrf2, and HO-1. Results:During MI/RI, compared with the sham group, the protein expression of cFLIPL was significantly decreased in the I/R group, and compared with the I/R+Ad-NC group, the protein expression of cFLIPL was significantly increased in the I/R+Ad-cFLIPL group (both P<0.05). Compared with sham group, the level of LDH, CK-MB, MDA, ROS-positive cell count, and myocardial infarct size were significantly increased, whereas the LVEF, LVFS, SOD, and GSH-px were significantly decreased in I/R group (all P<0.05). Compared to the I/R+Ad-NC group, the level of LDH, CK-MB, MDA, ROS-positive cell count, and myocardial infarct area were significantly decreased, whereas the LVEF, LVFS, SOD, and GSH-px were significantly increased in I/R+Ad-cFLIPL group (all P<0.05). Western blot revealed that compared with the sham group, the protein expression of Nrf2 and HO-1 in I/R group were significantly increased, and compared with the I/R+Ad-NC group, the protein expression of Nrf2 and HO-1 in the I/R + Ad-cFLIPL group were significantly increased (all P<0.05). Conclusion:Overexpression of cFLIPL can alleviate myocardial ischemia-reperfusion injury (MI/RI) in rats by activating the Nrf2/HO-1 signaling pathway to inhibit oxidative stress.

Objective:To develop the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy and evaluate its reliability and validity.Methods:Based on the theory of unpleasant symptoms, a preliminary version of the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy was developed through literature analysis, semi-structured interviews, and the Delphi method. After revising certain items in the pre-survey, convenience sampling was used to select patients who underwent bladder instillation chemotherapy in the Department of Urology Surgery of three ClassⅢ Grade A hospitals in Yunnan Province from January to July 2024 as research subjects to test the reliability and validity of the scale.Results:A total of 168 questionnaires were distributed, and 162 valid questionnaires were collected, with a valid response rate of 96.429% (162/168). The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy covered two areas of symptom severity and symptom distress, comprising five dimensions and 27 items. The Cronbach's α coefficient for the total scale was 0.953, and the split-half reliability coefficient was 0.806. Exploratory factor analysis revealed that the four common factors for symptom severity contributed to 73.196% of the cumulative variance, while the single common factor for symptom distress accounted for 68.285% of the cumulative variance. Confirmatory factor analysis revealed that all indicators met the fit criteria, indicating that the model possessed good goodness-of-fit. The content validity index at the scale level was 0.940, while the content validity index at the item level ranged from 0.833 to 1.000.Conclusions:The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy developed in this study demonstrates good reliability and validity, and is suitable for evaluating symptoms in patients undergoing bladder infusion chemotherapy.

Objective:To develop the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy and evaluate its reliability and validity.Methods:Based on the theory of unpleasant symptoms, a preliminary version of the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy was developed through literature analysis, semi-structured interviews, and the Delphi method. After revising certain items in the pre-survey, convenience sampling was used to select patients who underwent bladder instillation chemotherapy in the Department of Urology Surgery of three ClassⅢ Grade A hospitals in Yunnan Province from January to July 2024 as research subjects to test the reliability and validity of the scale.Results:A total of 168 questionnaires were distributed, and 162 valid questionnaires were collected, with a valid response rate of 96.429% (162/168). The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy covered two areas of symptom severity and symptom distress, comprising five dimensions and 27 items. The Cronbach's α coefficient for the total scale was 0.953, and the split-half reliability coefficient was 0.806. Exploratory factor analysis revealed that the four common factors for symptom severity contributed to 73.196% of the cumulative variance, while the single common factor for symptom distress accounted for 68.285% of the cumulative variance. Confirmatory factor analysis revealed that all indicators met the fit criteria, indicating that the model possessed good goodness-of-fit. The content validity index at the scale level was 0.940, while the content validity index at the item level ranged from 0.833 to 1.000.Conclusions:The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy developed in this study demonstrates good reliability and validity, and is suitable for evaluating symptoms in patients undergoing bladder infusion chemotherapy.

Background:Obesity has been confirmed as one of the risk factors for gastric cancer.Obesity can affect hormone levels,but studies on the impact of obesity-related hormones on gastric cancer are limited in China.Aims:To investigate the effects of obesity-related hormones on cardia gastric cancer(CGC)and non-cardia gastric cancer(NCGC).Methods:This case-control study included 316 patients diagnosed with gastric cancer at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2021 to June 2024,while 632 individuals who underwent physical examination during the same period were enrolled as the control group.According to the location of cancer,gastric cancer patients were divided into CGC and NCGC groups.General data and obesity-related hormone levels were compared among the three groups.Multivariate Logistic regression analysis was used to identify the risk factors for CGC and NCGC stratified by gender.Results:Compared with the control group,the levels of C-peptide and insulin-like growth factor-1(IGF-1)in both CGC and NCGC groups were significantly increased(all P<0.05),while the dehydroepiandrosterone(DHEA)level was significantly decreased(all P<0.05).The levels of leptin and sex hormone binding globulin(SHBG)in CGC group were significantly higher than those in the control group(all P<0.05).Compared with NCGC group,CGC group showed significantly higher levels of C-peptide,IGF-1,leptin and SHBG(all P<0.05),and significantly lower level of DHEA(P<0.05).Risk factors for male CGC included obesity,history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,consumption of hot food≥3 times/week,smoking,Helicobacter pylori(Hp)infection,IGF-1≥250 ng/mL,leptin≥7 μg/L,DHEA<15 nmol/L,and SHBG≥80 mmol/L(all P<0.05),while education duration≥9 years was a protective factor(P<0.05).For female CGC,risk factors were history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,smoking,Hp infection,C-peptide≥400 pmol/L,and IGF-1≥250 ng/mL(all P<0.05),while consumption of vegetables≥1 time/day and fruits≥3 times/week were protective factors(all P<0.05).For male NCGC,risk factors included history of mental illness,family history of gastric cancer,meat consumption≥3 times/week,smoking,alcohol drinking,Hp infection,and IGF-1≥250 ng/mL(all P<0.05),while education duration≥9 years and preference for light taste were protective factors(all P<0.05).For female NCGC,risk factors included family history of gastric cancer,irregular meals,consumption of fried food≥3 times/week,Hp infection,and C-peptide≥400 pmol/L(all P<0.05),while vegetables consumption≥1 time/day,fruits consumption≥3 times/week,and tea drinking were protective factors(all P<0.05).Conclusions:Some obesity-related hormones might have significant effects on the development of gastric cancer.

Background:Obesity has been confirmed as one of the risk factors for gastric cancer.Obesity can affect hormone levels,but studies on the impact of obesity-related hormones on gastric cancer are limited in China.Aims:To investigate the effects of obesity-related hormones on cardia gastric cancer(CGC)and non-cardia gastric cancer(NCGC).Methods:This case-control study included 316 patients diagnosed with gastric cancer at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2021 to June 2024,while 632 individuals who underwent physical examination during the same period were enrolled as the control group.According to the location of cancer,gastric cancer patients were divided into CGC and NCGC groups.General data and obesity-related hormone levels were compared among the three groups.Multivariate Logistic regression analysis was used to identify the risk factors for CGC and NCGC stratified by gender.Results:Compared with the control group,the levels of C-peptide and insulin-like growth factor-1(IGF-1)in both CGC and NCGC groups were significantly increased(all P<0.05),while the dehydroepiandrosterone(DHEA)level was significantly decreased(all P<0.05).The levels of leptin and sex hormone binding globulin(SHBG)in CGC group were significantly higher than those in the control group(all P<0.05).Compared with NCGC group,CGC group showed significantly higher levels of C-peptide,IGF-1,leptin and SHBG(all P<0.05),and significantly lower level of DHEA(P<0.05).Risk factors for male CGC included obesity,history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,consumption of hot food≥3 times/week,smoking,Helicobacter pylori(Hp)infection,IGF-1≥250 ng/mL,leptin≥7 μg/L,DHEA<15 nmol/L,and SHBG≥80 mmol/L(all P<0.05),while education duration≥9 years was a protective factor(P<0.05).For female CGC,risk factors were history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,smoking,Hp infection,C-peptide≥400 pmol/L,and IGF-1≥250 ng/mL(all P<0.05),while consumption of vegetables≥1 time/day and fruits≥3 times/week were protective factors(all P<0.05).For male NCGC,risk factors included history of mental illness,family history of gastric cancer,meat consumption≥3 times/week,smoking,alcohol drinking,Hp infection,and IGF-1≥250 ng/mL(all P<0.05),while education duration≥9 years and preference for light taste were protective factors(all P<0.05).For female NCGC,risk factors included family history of gastric cancer,irregular meals,consumption of fried food≥3 times/week,Hp infection,and C-peptide≥400 pmol/L(all P<0.05),while vegetables consumption≥1 time/day,fruits consumption≥3 times/week,and tea drinking were protective factors(all P<0.05).Conclusions:Some obesity-related hormones might have significant effects on the development of gastric cancer.

Objective:To explore the clinical effect of perforator pedicled propeller flap (PPPF) in reconstruction of soft tissue defect in ankle and foot, as well as the role of preoperative ultrasonography in assistance of the location of perforators in donor site.Methods:From January 2017 to June 2023, the Department of Microorthopedics of the Second Affiliated Hospital of Luohe Medical College of Higher Education applied PPPF to reconstruct small and medium-sized soft tissue defects in the ankle and foot for 26 patients. The patients were 17 males, 9 females, aged 18 to 68 years old with 46 years old in average. The defect sites were 3 in forefoot and 6 in midfoot and combined with different degrees of tendon and bone exposure, 17 in ankle and heel and combined with various degrees of bone exposure, 12 with ankle open injury and 5 with Achilles tendon exposure. The area of soft tissue defects ranged from 2.5 cm×1.5 cm to 16.0 cm × 6.5 cm. The width of injury was measured before surgery, and a HHD was used to detect the perforators proximal to the defect site, and then high-frequency CDU was used to locate and confirm the location of the perforator and its alignment, blood flow and diameter. The line drawn between the 2 perforators was set as the axis of flap. The donor site was assessed by a "pinching and lifting" method to determine a direct closure of donor site or to have it closed by a flap transfer. The sizes of flap were from 2.8 cm×1.5 cm to 24.0 cm×7.5 cm. Twenty-two donor sites were directly closed and 4 received flap transfers. Four flaps had sutures with the skin nerves in the recipient site. Masquelet technique was performed in 6 patients with bone defects in the surgery. Patients received outpatient reviews with 1-2 weeks of intervals in the first 2 months after surgery, and X-ray reviews per 1-2 months for those with bone implants until bone healing.Results:All flaps survived successfully without any special treatment after surgery, except 1 flap that had blood vessel congestion and showed swelling and poor blood supply to the distal flap at 24 hours after surgery. The blood vessel congestion was revised by removal of part of the suture at the tip of flap pedicle. One week later, the tip of the flap remained with a small area of necrosis, which was then healed after dressing changes. A total of 21 patients were included in postoperative follow-up with 4 months to 3 years. All of the flaps had satisfactory appearance, colour and texture, and without any ulceration. Three cases of nerve suture were also included in follow-up. According to the assessment criteria of British Medical Research Council (BMRC), the sensory recovery of the flaps was found of S 2 in 1 flap and S 3 in 2 flaps. According to the American Orthopaedic Foot and Ankle Society (AOFAS), the ankle-hindfoot function scores, there were excellent in 16 patient and good in 5 patients. Conclusion:With the assistance of ultrasound, the PPPF can be effectively used in reconstruction of soft tissue defects in ankle and foot.

Objective:To study the operational efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province in the new era of rural revitalization, so as to provide a reference for further promoting township health centers to make up for their shortcomings and improve their service capabilities.Methods:Data was sourced from databases such as the Health and Health Statistics Annual Report, Health Finance Annual Report of Hubei Province for the year 2022. The number of health technicians, business premises area, actual bed count, and the number of equipment worth more than 10 000 yuan in 1 010 township health centers from 36 poverty-lifted counties and 47 non-poverty counties in Hubei Province were taken as input variables. The number of discharged patients, total outpatient visits, the number of people aged 65 and above receiving health management, and the number of hypertensive and type 2 diabetes patients receiving standardized management were taken as output variables. The number of permanent population, per capita regional GDP, population density, urbanization rate, and local general public budget investment were taken as environmental variables. The three-stage data envelopment analysis(DEA) method was applied to measure the operational efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province.Results:Environmental variables had different impacts on the operational efficiency of township health centers in poverty-lifted and non-poverty counties ( P<0.01). After removing the impacts, the comprehensive technical efficiency, pure technical efficiency, and scale efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province were 0.894, 0.960, 0.931 and 0.840, 0.919, 0.911, respectively; there were 22 pure technical efficiency township health centers in poverty-lifted counties, accounting for 61.10%, with 13 having a scale efficiency of 1, accounting for 36.00%, and 19 with increasing returns to scale, accounting for 52.78%; there were 22 pure technical efficiency township health centers in non-poverty counties, accounting for 46.80%, with 13 having a scale efficiency of 1, accounting for 27.66%, and 22 with increasing returns to scale, accounting for 46.81%. Conclusions:The operational efficiency of poverty-lifted counties was better than that of non-poverty counties. The main reason for the poor operation efficiency of township health centers in poverty-lifted counties was the low scale efficiency, and the poor operation efficiency of township health centers in non-poverty counties was mainly due to insufficient investment in technology development and scale. It is suggested that township health centers in poverty-lifted counties should seize the strategic opportunity of rural revitalization and expand reasonably. Township health centers in non-poverty counties should innovate development methods while improving the capacity of basic medical services.

Objective:To study the operational efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province in the new era of rural revitalization, so as to provide a reference for further promoting township health centers to make up for their shortcomings and improve their service capabilities.Methods:Data was sourced from databases such as the Health and Health Statistics Annual Report, Health Finance Annual Report of Hubei Province for the year 2022. The number of health technicians, business premises area, actual bed count, and the number of equipment worth more than 10 000 yuan in 1 010 township health centers from 36 poverty-lifted counties and 47 non-poverty counties in Hubei Province were taken as input variables. The number of discharged patients, total outpatient visits, the number of people aged 65 and above receiving health management, and the number of hypertensive and type 2 diabetes patients receiving standardized management were taken as output variables. The number of permanent population, per capita regional GDP, population density, urbanization rate, and local general public budget investment were taken as environmental variables. The three-stage data envelopment analysis(DEA) method was applied to measure the operational efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province.Results:Environmental variables had different impacts on the operational efficiency of township health centers in poverty-lifted and non-poverty counties ( P<0.01). After removing the impacts, the comprehensive technical efficiency, pure technical efficiency, and scale efficiency of township health centers in poverty-lifted and non-poverty counties in Hubei Province were 0.894, 0.960, 0.931 and 0.840, 0.919, 0.911, respectively; there were 22 pure technical efficiency township health centers in poverty-lifted counties, accounting for 61.10%, with 13 having a scale efficiency of 1, accounting for 36.00%, and 19 with increasing returns to scale, accounting for 52.78%; there were 22 pure technical efficiency township health centers in non-poverty counties, accounting for 46.80%, with 13 having a scale efficiency of 1, accounting for 27.66%, and 22 with increasing returns to scale, accounting for 46.81%. Conclusions:The operational efficiency of poverty-lifted counties was better than that of non-poverty counties. The main reason for the poor operation efficiency of township health centers in poverty-lifted counties was the low scale efficiency, and the poor operation efficiency of township health centers in non-poverty counties was mainly due to insufficient investment in technology development and scale. It is suggested that township health centers in poverty-lifted counties should seize the strategic opportunity of rural revitalization and expand reasonably. Township health centers in non-poverty counties should innovate development methods while improving the capacity of basic medical services.

Objective To explore the relationship between non-high density lipoprotein cholesterol(non-HDL-C)level and leptomeningeal collateral circulation in patients with acute middle cerebral artery occlusion.Methods A total of 85 patients with first-onset acute cerebral infarction with middle cerebral artery M1 segment occlusion were enrolled.According to the results of DSA,LMC circulation was assessed by American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Circulation Assess-ment System.All patients were assigned to better LMC circulation group(score 2～4,n = 30)and worse LMC circulation group(score 0～1,n = 55),and the levels of non-HDL-C were compared between the two groups.Results The levels of LDL-C and non-HDL-C in worse LMC circulation group were significantly higher than those of the better LMC circulation group(P = 0.026,P = 0.010).non-HDL-C was an independent risk factor for the worse LMC circulation(OR = 3.019,95%CI:1.053～8.658,P = 0.04).LMC circulatory score of patients was negatively correlated with the levels of non-HDL-C level(r =-0.228,P = 0.036).The AUC of non-HDL-C predicted for the worse LMC circulation was 0.638(95%CI:0.521～0.755,P = 0.036).Conclusions non-HDL-C in patients with acute cerebral infarction was significantly related to worse LMC circulation,and was a risk factor for worse LMC circulation.It is suggested that the higher expression of non-HDL-C could be used to predict worse LMC circulation as a serological indicator.

A 51-year-old schizophrenic patient with long-term clozapine treatment developed intestinal obstruction combined with infection. Subsequently, the patient′s clozapine plasma concentration abnormally increased to 3 094.80 μg/L (reference range 350-600 μg/L), accompanied with pulmonary infection. Patient′s symptoms showed significant improvement after clozapine was discontinued, along with intravenous fluid reinfusion and antibiotic treatment. This current article also provided a literature review of 16 reported cases of infection with abnormally elevated clozapine plasma concentration. Clozapine plasma concentration and blood routine should be monitored in clozapine users, and adverse reactions should be treated in time. For clozapine users with infection but normal leukocyte count, multiple bacterial infection indicators such as the neutrophil proportion and C-reactive protein should begiven comprehensive consideration, and antibiotics should be used when appropriate. If clozapine plasma concentration is abnormally high, clozapine can be discontinued and intravenous fluid reinfusion can accelerate clozapine elimination. After the patient′s condition stabilizes, clozapine could be reused.