BACKGROUND:The relationship between rheumatoid arthritis and coronary atherosclerosis has received extensive attention.Inflammation is related to rheumatoid arthritis and coronary atherosclerosis,indicating that there may be a common pathophysiological pathway between the two diseases.However,observational studies have not yet clarified the causal relationship.OBJECTIVE:To explore whether there is a causal relationship between rheumatoid arthritis and coronary atherosclerosis,as well as the potential causal relationship with 1 400 serum metabolites and 91 inflammatory factors through a Mendelian randomization analysis.METHODS:Coronary atherosclerosis data are from Finngen database,rheumatoid arthritis data are from IEU OpenGWAS database,serum metabolites data are from Canadian Longitudinal Study on Aging,Augsburg Cooperative Health Research and British Twin Project Research,and data of 91 inflammatory proteins are from research published in Nature Immunology in 2023.Mendelian randomization analysis was performed using data from genome-wide association studies,and causal effects were evaluated using inverse variance weighting,MR-Egger regression,weighted median,weighted model,and simple model methods,with inverse variance weighting being the primary analysis method.To enhance robustness,Cochran's Q-test MR-Egger intercept was used for sensitivity analysis.RESULTS AND CONCLUSION:(1)Inverse variance weighting results showed that rheumatoid arthritis was positively correlated with the increased relative risk of coronary atherosclerosis(odds ratio=1.002,95％confidence interval=1.001-1.003,P=0.003).There was no reverse causal relationship between coronary atherosclerosis and rheumatoid arthritis.In addition,96 serum metabolites and 9 inflammatory factors were found to have causal relationships with coronary atherosclerosis.There was a causal relationship between 51 serum metabolites and 7 inflammatory factors and rheumatoid arthritis.(2)This study provided epidemiological evidence between rheumatoid arthritis and coronary atherosclerosis,and emphasized the potential role of serum metabolites and inflammatory factors in the pathogenesis of these diseases.These findings may contribute to the development of new treatment strategies.Due to the limited inclusion of data from Asian populations,most contemporary studies used international databases and European population analyses.By collecting and analyzing the health data of European populations,it is conducive to a better understanding of the effects and potential role of Chinese medicine in Europe,and to further promote the practice of modern integration of Western and Chinese medicine.Meanwhile,through the comparative study with the European databases,it is possible to reveal the genetic differences and susceptibility to diseases among different populations,providing more dimensions and perspectives for global health research.

BACKGROUND:The relationship between rheumatoid arthritis and coronary atherosclerosis has received extensive attention.Inflammation is related to rheumatoid arthritis and coronary atherosclerosis,indicating that there may be a common pathophysiological pathway between the two diseases.However,observational studies have not yet clarified the causal relationship.OBJECTIVE:To explore whether there is a causal relationship between rheumatoid arthritis and coronary atherosclerosis,as well as the potential causal relationship with 1 400 serum metabolites and 91 inflammatory factors through a Mendelian randomization analysis.METHODS:Coronary atherosclerosis data are from Finngen database,rheumatoid arthritis data are from IEU OpenGWAS database,serum metabolites data are from Canadian Longitudinal Study on Aging,Augsburg Cooperative Health Research and British Twin Project Research,and data of 91 inflammatory proteins are from research published in Nature Immunology in 2023.Mendelian randomization analysis was performed using data from genome-wide association studies,and causal effects were evaluated using inverse variance weighting,MR-Egger regression,weighted median,weighted model,and simple model methods,with inverse variance weighting being the primary analysis method.To enhance robustness,Cochran's Q-test MR-Egger intercept was used for sensitivity analysis.RESULTS AND CONCLUSION:(1)Inverse variance weighting results showed that rheumatoid arthritis was positively correlated with the increased relative risk of coronary atherosclerosis(odds ratio=1.002,95％confidence interval=1.001-1.003,P=0.003).There was no reverse causal relationship between coronary atherosclerosis and rheumatoid arthritis.In addition,96 serum metabolites and 9 inflammatory factors were found to have causal relationships with coronary atherosclerosis.There was a causal relationship between 51 serum metabolites and 7 inflammatory factors and rheumatoid arthritis.(2)This study provided epidemiological evidence between rheumatoid arthritis and coronary atherosclerosis,and emphasized the potential role of serum metabolites and inflammatory factors in the pathogenesis of these diseases.These findings may contribute to the development of new treatment strategies.Due to the limited inclusion of data from Asian populations,most contemporary studies used international databases and European population analyses.By collecting and analyzing the health data of European populations,it is conducive to a better understanding of the effects and potential role of Chinese medicine in Europe,and to further promote the practice of modern integration of Western and Chinese medicine.Meanwhile,through the comparative study with the European databases,it is possible to reveal the genetic differences and susceptibility to diseases among different populations,providing more dimensions and perspectives for global health research.

Objective:To investigate the application value of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in evaluating early postoperative complications for radical gastric cancer surgery.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 484 patients who underwent radical gastric cancer surgery in Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2016 to December 2018 were collected. There were 1 086 males and 398 females, aged (60±17)years. The early complica-tions of patients were classified by the CDC and the CCI was calculated. Measurement data with normal distribution were represented as Mean± SD. Count data are expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was conducted using Logistic regression analysis. Correlation analysis between CDC, CCI and duration of postopera-tive hospital stay, total hospital expenses was performed using the Spearman rank correlation. Multiple linear regression analysis was conducted to compare the correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Results:(1) Distribution of early postoperative complications by CDC and CCI. Among the 1 484 patients, 432 patients developed early postoperative complications, of which 322 cases had a single complication, and 110 cases had multiple complications. Among the 432 patients with complications, the numbers of patients with grades Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ, and Ⅴ of CDC were 231, 137, 45, 13, 3, and 3 cases, respectively. The CCI in the 432 patients with complications was 17.2±11.7, with peak values of 8.7 and 20.9. (2) Analysis of factors influencing early postoperative complications in patients undergoing radical gastric cancer surgery. Results of multivariate analysis showed that female, age ≥70 years, and preoperative serum albumin <35 g/L were independent risk factors for early postoperative complications in patients undergoing radical gastric cancer surgery ( odds ratios=1.391, 1.535, 1.521, 95% confidence intervals as 1.083-1.786, 1.187-1.985, 1.055-2.192, P<0.05). (3) Correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Among the 432 patients with post-operative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.574, 0.576, P<0.05), and both were positively correlated with total hospital expenses ( r=0.413, 0.438, P<0.05). Among the 110 patients with multiple postoperative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.514, 0.537, P<0.05), and both were positively correlated with total hospital expenses ( r=0.427, 0.474, P<0.05). (4) Regression analysis between CDC, CCI, and duration of postoperative hospital stay, total hospital expenses. Multiple linear regression analysis of duration of postoperative hospital stay showed that CDC ≥grade 3, age ≥70 years, preoperative C-reactive protein ≥10 g/L, and American Society of Anesthesiology (ASA) classification ≥grade 3 were associated with prolonged duration of postopera-tive hospital stay. The higher CCI indicated longer duration of postoperative hospital stay. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.467 versus 0.212). The regression analysis of total hospital expenses showed that CDC ≥grade 3, age ≥70 years, preoperative serum albumin <35 g/L, ASA classification ≥grade 3, and pathological stage Ⅲ-Ⅳ increased total hospital expenses, while gender of female reduced the expenses. The higher CCI indicated higher hospital expenses. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.449 versus 0.061). Conclusions:Both the CDC and CCI can effectively reflect the severity of postoperative complica-tions following radical gastric cancer surgery. Compared to the CDC, the CCI can better predict post-operative hospital stay and total hospital expenses.

Objective:To analyze the mediating role of maladaptive cognition between family relationships and internet gaming disorder (IGD) in adolescents.Methods:From September 2021 to April 2023, a total of 52 adolescents with IGD (IGD group) from the First Affiliated Hospital of Zhengzhou University and 51 normal adolescents (HC group) from community were selected as study subjects.The severity of adolescent internet addiction was assessed using the Young internet addiction scale (YIAS).Family relationships and maladaptive cognition were evaluated by the Chinese version of family environment scale (FES-CV) and the Chinese adolescents’ maladaptive cognitions scale (CAMCS).SPSS 22.0 software was used for descriptive analysis, correlation analysis and mediation analysis.Two-sample t-tests were used for quantitative data comparison, and chi-square tests were used for qualitative data comparison. Pearson correlation analysis was conducted to analyze the relationship of variables, and the intermediate variable test was performed using Bootstrap method. Results:(1) Compared with HC group, the score of YIAS in IGD group was higher, and the difference was statistically significant((63.69±10.36), (28.96±5.20), t=21.571, P<0.05). Compared with the HC group, the conflict score of FES-CV in the IGD group was higher((4.79±2.02), (3.33±1.42), t=4.228, P<0.05), and the cohesion score of FES-CV was lower ((4.46±1.64), (5.57±1.33), t=-3.768, P<0.05).Compared with the HC group, the CAMCS score in IGD group was higher, and the difference was statistically significant((28.88±10.11), (22.98±9.11), t=3.116, P<0.05). (2) There was a positive correlation between conflict of family relationships and IGD ( r=0.504, P<0.01), and a negative correlation between cohesion of family relationships and IGD( r=-0.474, P<0.01) in IGD group. (3) Path analysis and mediation effect test showed that conflict in family relationships positively predicted IGD ( β=0.331, 95% CI=0.100-0.563) and maladaptive cognition ( β=0.372, 95% CI=0.108-0.636). Maladaptive cognitive positively predicted IGD ( β=0.464, 95% CI=0.232-0.696). Maladaptive cognition played a mediating role between conflict of family relationships and IGD, and the mediating effect value was 0.173 (95% CI=0.020-0.366), accounting for 34.33%(0.173/0.504) of the total effect. Conclusion:Family relationships are related to IGD in adolescents. Maladaptive cognition may play a mediating role between family relationships and IGD in adolescents.

Objective:To investigate the application value of Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) in evaluating early postoperative complications for radical gastric cancer surgery.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 484 patients who underwent radical gastric cancer surgery in Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2016 to December 2018 were collected. There were 1 086 males and 398 females, aged (60±17)years. The early complica-tions of patients were classified by the CDC and the CCI was calculated. Measurement data with normal distribution were represented as Mean± SD. Count data are expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was conducted using Logistic regression analysis. Correlation analysis between CDC, CCI and duration of postopera-tive hospital stay, total hospital expenses was performed using the Spearman rank correlation. Multiple linear regression analysis was conducted to compare the correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Results:(1) Distribution of early postoperative complications by CDC and CCI. Among the 1 484 patients, 432 patients developed early postoperative complications, of which 322 cases had a single complication, and 110 cases had multiple complications. Among the 432 patients with complications, the numbers of patients with grades Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ, and Ⅴ of CDC were 231, 137, 45, 13, 3, and 3 cases, respectively. The CCI in the 432 patients with complications was 17.2±11.7, with peak values of 8.7 and 20.9. (2) Analysis of factors influencing early postoperative complications in patients undergoing radical gastric cancer surgery. Results of multivariate analysis showed that female, age ≥70 years, and preoperative serum albumin <35 g/L were independent risk factors for early postoperative complications in patients undergoing radical gastric cancer surgery ( odds ratios=1.391, 1.535, 1.521, 95% confidence intervals as 1.083-1.786, 1.187-1.985, 1.055-2.192, P<0.05). (3) Correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Among the 432 patients with post-operative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.574, 0.576, P<0.05), and both were positively correlated with total hospital expenses ( r=0.413, 0.438, P<0.05). Among the 110 patients with multiple postoperative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay ( r=0.514, 0.537, P<0.05), and both were positively correlated with total hospital expenses ( r=0.427, 0.474, P<0.05). (4) Regression analysis between CDC, CCI, and duration of postoperative hospital stay, total hospital expenses. Multiple linear regression analysis of duration of postoperative hospital stay showed that CDC ≥grade 3, age ≥70 years, preoperative C-reactive protein ≥10 g/L, and American Society of Anesthesiology (ASA) classification ≥grade 3 were associated with prolonged duration of postopera-tive hospital stay. The higher CCI indicated longer duration of postoperative hospital stay. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.467 versus 0.212). The regression analysis of total hospital expenses showed that CDC ≥grade 3, age ≥70 years, preoperative serum albumin <35 g/L, ASA classification ≥grade 3, and pathological stage Ⅲ-Ⅳ increased total hospital expenses, while gender of female reduced the expenses. The higher CCI indicated higher hospital expenses. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.449 versus 0.061). Conclusions:Both the CDC and CCI can effectively reflect the severity of postoperative complica-tions following radical gastric cancer surgery. Compared to the CDC, the CCI can better predict post-operative hospital stay and total hospital expenses.

Objective:To analyze the mediating role of maladaptive cognition between family relationships and internet gaming disorder (IGD) in adolescents.Methods:From September 2021 to April 2023, a total of 52 adolescents with IGD (IGD group) from the First Affiliated Hospital of Zhengzhou University and 51 normal adolescents (HC group) from community were selected as study subjects.The severity of adolescent internet addiction was assessed using the Young internet addiction scale (YIAS).Family relationships and maladaptive cognition were evaluated by the Chinese version of family environment scale (FES-CV) and the Chinese adolescents’ maladaptive cognitions scale (CAMCS).SPSS 22.0 software was used for descriptive analysis, correlation analysis and mediation analysis.Two-sample t-tests were used for quantitative data comparison, and chi-square tests were used for qualitative data comparison. Pearson correlation analysis was conducted to analyze the relationship of variables, and the intermediate variable test was performed using Bootstrap method. Results:(1) Compared with HC group, the score of YIAS in IGD group was higher, and the difference was statistically significant((63.69±10.36), (28.96±5.20), t=21.571, P<0.05). Compared with the HC group, the conflict score of FES-CV in the IGD group was higher((4.79±2.02), (3.33±1.42), t=4.228, P<0.05), and the cohesion score of FES-CV was lower ((4.46±1.64), (5.57±1.33), t=-3.768, P<0.05).Compared with the HC group, the CAMCS score in IGD group was higher, and the difference was statistically significant((28.88±10.11), (22.98±9.11), t=3.116, P<0.05). (2) There was a positive correlation between conflict of family relationships and IGD ( r=0.504, P<0.01), and a negative correlation between cohesion of family relationships and IGD( r=-0.474, P<0.01) in IGD group. (3) Path analysis and mediation effect test showed that conflict in family relationships positively predicted IGD ( β=0.331, 95% CI=0.100-0.563) and maladaptive cognition ( β=0.372, 95% CI=0.108-0.636). Maladaptive cognitive positively predicted IGD ( β=0.464, 95% CI=0.232-0.696). Maladaptive cognition played a mediating role between conflict of family relationships and IGD, and the mediating effect value was 0.173 (95% CI=0.020-0.366), accounting for 34.33%(0.173/0.504) of the total effect. Conclusion:Family relationships are related to IGD in adolescents. Maladaptive cognition may play a mediating role between family relationships and IGD in adolescents.

Objective:To explore the characteristic of dynamic function network connectivity (dFNC) of resting brain networks in internet gaming disorder (IGD) adolescents.Methods:Forty-four adolescent IGD subjects (IGD group, male/female: 38/6) and fifty healthy controls (HC group, male/female: 40/10) were collected, and the subjects completed demographic questionnaires, Young internet addiction scale(YIAS), Chinese adolescents' maladaptive cognitions scale(CAMAS), and functional magnetic resonance imaging (fMRI) tests. The fMRI data were preprocessed on the Matlab platform, and the preprocessed data was divided into 64 components for group level independent component analysis.The dynamic functional connectivity of obtained 18 effective independent components was analyzed by sliding time window technique, and the difference of dynamic functional connectivity of brain triple network between the IGD group and HC group was compared using SPSS 22.0 software.Results:Four repeated dFNC states were identified through cluster analysis.Each state indicated that different functional networks had different connection strengths.State 3, the most frequent state, had been indicated that the whole brain network of the subject was in a state of weak functional connectivity.The second frequent state was state 1, which indicated enhanced functional connectivity within the subject's central executive network (CEN).State 2 had been indicated enhanced functional connectivity within the subject's salience network (SN).State 4 had been indicated generally enhanced functional connectivity in the subjects' brain networks, and this state was the least frequent.The results of non-parametric permutation test on the time attribute showed that compared with the HC group, the IGD group had a longer time score (IGD group: 0.24±0.19, HC group: 0.13±0.15, t=1.19, P<0.05, non-parametric substitution test) for state 1 with strong connectivity within the CEN, which was positively correlated with the YIAS score and game time ( r=0.418, P=0.003; r=0.515, P=0.004).Compared with HC group, the functional connectivity of ICD group between the internal insula of the SN and the dorsal anterior cingulate cortex was enhanced ( P<0.05, FDR corrected), while the average residence time in weakly connected state 3 was longer ( Z=2.09, P<0.05, nonparametric substitution test). Conclusions:The difference in dynamic functional connectivity of the triple network in the brain of IGD adolescents under resting state is mainly manifested by strong connections in CEN, functional connections between insula and dorsal anterior cingulate cortex in SN is enhanced, and weakening of overall functional connections, which may play an important role in the pathological mechanism of IGD.

Objective:To investigate the associated factors of depressive symptoms among patients with neo-plasms.Methods:Nationwide(excluding Hong Kong,Macao,and Taiwan),30 505 residents were selected by a combination of stratified sampling and quota sampling according to the proportion of the seventh national population census.Patient Health Questionnaire-9(PHQ-9),General Anxiety Disorder-7(GAD-7),self-made questionnaire,and simplified perceived social support scale used to evaluate depressive symptoms,anxiety symptoms,behaviors,and perceived social support among patients with neoplasms.Results:Totally 359(1.2％)patients with self-repor-ted clinically diagnosed neoplasms were included,of which 151(42.1％)patients with malignant neoplasms and 208(57.9％)patients with benign neoplasms.The detection rate of depressive symptoms in patients with neo-plasms was 76.6％.Less than three days of walking for more than 10 minutes per day in the past week(OR=6.63),4-6 days of walking for more than 10 minutes per day in the past week(OR=5.00),the low(OR=4.80)or medium(OR=3.06)overall sleep quality,the lower perceived friend support(OR=4.66),and anxiety symp-toms(OR=1.74)among patients with neoplasms were risk factors for depressive symptoms.Conclusion:Patients with neoplasms generally might be at a high risk of depressive symptoms,especially for those patients with less ex-ercise,poor sleep quality,and low perceived social support.

Objective To investigate the mechanism underlying the neuroprotective effect of linarin(LIN)against microglia activation-mediated inflammation and neuronal apoptosis following spinal cord injury(SCI).Methods Fifty C57BL/6J mice(8-10 weeks old)were randomized to receive sham operation,SCI and linarin treatment at 12.5,25,and 50 mg/kg following SCI(n=10).Locomotor function recovery of the SCI mice was assessed using the Basso Mouse Scale,inclined plane test,and footprint analysis,and spinal cord tissue damage and myelination were evaluated using HE and LFB staining.Nissl staining,immunofluorescence assay and Western blotting were used to observe surviving anterior horn motor neurons in injured spinal cord tissue.In cultured BV2 cells,the effects of linarin against lipopolysaccharide(LPS)-induced microglia activation,inflammatory factor release and signaling pathway changes were assessed with immunofluorescence staining,Western blotting,RT-qPCR,and ELISA.In a BV2 and HT22 cell co-culture system,Western blotting was performed to examine the effect of linarin against HT22 cell apoptosis mediated by LPS-induced microglia activation.Results Linarin treatment significantly improved locomotor function(P<0.05),reduced spinal cord damage area,increased spinal cord myelination,and increased the number of motor neurons in the anterior horn of the SCI mice(P<0.05).In both SCI mice and cultured BV2 cells,linarin effectively inhibited glial cell activation and suppressed the release of iNOS,COX-2,TNF-α,IL-6,and IL-1β,resulting also in reduced neuronal apoptosis in SCI mice(P<0.05).Western blotting suggested that linarin-induced microglial activation inhibition was mediated by inhibition of the TLR4/NF-κB signaling pathway.In the cell co-culture experiments,linarin treatment significantly decreased inflammation-mediated apoptosis of HT22 cells(P<0.05).Conclusion The neuroprotective effect of linarin is medicated by inhibition of microglia activation via suppressing the TLR4/NF-κB signaling pathway,which mitigates neural inflammation and reduce neuronal apoptosis to enhance motor function of the SCI mice.

Objective To better mobilize the work motivation of the majority of medical staff and to explore the optimization strategy of the remuneration distribution mechanism in public hospitals.Methods A semi-structured interview was conducted on employees of a large public hospital in Henan Province using purposive sampling method in March 2024.Sort out,code,and integrate interview data based on grounded theory.Results Based on 40 interview materials,44 initial concepts,14 basic categories,6 main categories,and 3 core categories were summarized.A model of pay distribution mechanism in public hospitals based on pay distribution principle,pay distribution structure and pay management system was constructed.Conclusion It is recommended that hospitals ensure the fairness and competitiveness of salary distribution,implement diversified salary policies,and continuously improve the salary distribution structure and supervision and management system.