Objective:To observe the clinical efficacy of acupuncture combined with cognitive training in treating mild-to-moderate poststroke cognitive impairment and the impact on cognitive function and cerebral blood flow.Methods:Eighty-eight participants with mild-to-moderate cognitive impairment after a stroke were allocated to an observation group and a control group using the random number table method,each consisting of 44 cases.The two groups received the same conventional symptomatic treatment.In addition,the control group was intervened by cognitive training,and the observation group by cognitive training and Tong Du Xing Shen(unblocking the Governor Vessel and awakening the mind)acupuncture.The intervention lasted 4 weeks in both groups.By the end of the intervention,the two groups were observed for clinical efficacy and the improvements in the symptom score of traditional Chinese medicine(TCM),cognitive function[mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)],cerebral blood flow velocities[cerebral vascular resistance index(RI),arterial blood flow mean velocity(Vm),and arterial systolic velocity(Vs)],and serum biomarkers of neurological deficit[neuron-specific enolase(NSE)and S100 β protein(S100β)].Results:During the observation,each group had 2 eliminated cases.After the intervention,the observation group achieved a total effective rate of 90.5%,higher than that in the control group,which was 73.8%(P<0.05);increases were found in the MMSE and MoCA scores in both groups(P<0.05),and the observation group was higher than the control group(P<0.05);in contrast,decreases were found in the levels of RI and serum NSE and S100β(P<0.05),and the observation group was lower than the control group(P<0.05);the Vs and Vm levels increased in both groups(P<0.05)and were higher in the observation group than in the control group(P<0.05).Conclusion:Tong Du Xing Shen acupuncture plus cognitive training is effective in treating mild-to-moderate poststroke cognitive impairment and can enhance the patient's cognitive function;improving cerebral blood circulation and reducing cerebral nerve damage may be involved in the mechanism.

Objective:To observe the clinical efficacy of acupuncture combined with cognitive training in treating mild-to-moderate poststroke cognitive impairment and the impact on cognitive function and cerebral blood flow.Methods:Eighty-eight participants with mild-to-moderate cognitive impairment after a stroke were allocated to an observation group and a control group using the random number table method,each consisting of 44 cases.The two groups received the same conventional symptomatic treatment.In addition,the control group was intervened by cognitive training,and the observation group by cognitive training and Tong Du Xing Shen(unblocking the Governor Vessel and awakening the mind)acupuncture.The intervention lasted 4 weeks in both groups.By the end of the intervention,the two groups were observed for clinical efficacy and the improvements in the symptom score of traditional Chinese medicine(TCM),cognitive function[mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)],cerebral blood flow velocities[cerebral vascular resistance index(RI),arterial blood flow mean velocity(Vm),and arterial systolic velocity(Vs)],and serum biomarkers of neurological deficit[neuron-specific enolase(NSE)and S100 β protein(S100β)].Results:During the observation,each group had 2 eliminated cases.After the intervention,the observation group achieved a total effective rate of 90.5%,higher than that in the control group,which was 73.8%(P<0.05);increases were found in the MMSE and MoCA scores in both groups(P<0.05),and the observation group was higher than the control group(P<0.05);in contrast,decreases were found in the levels of RI and serum NSE and S100β(P<0.05),and the observation group was lower than the control group(P<0.05);the Vs and Vm levels increased in both groups(P<0.05)and were higher in the observation group than in the control group(P<0.05).Conclusion:Tong Du Xing Shen acupuncture plus cognitive training is effective in treating mild-to-moderate poststroke cognitive impairment and can enhance the patient's cognitive function;improving cerebral blood circulation and reducing cerebral nerve damage may be involved in the mechanism.

Objective To analyze causal relationship between education level and the occurrence of depression by using two sample Mendelian randomization(MR)study method.Methods The data of education level and depression were extracted from the Genome-Wide Association Study database,and the two-sample MR analysis was conducted,and sensitivity analysis was performed using the leave-one-out method.Results Ultimately,58 single nucleotide polymorphisms were successfully included.The results of bidirectional MR analysis showed that increase in education level can reduce the risk of depression(OR=0.95,95％CI:0.92-0.98,P＜0.01).MR-Egger regression and sensitivity analysis results showed that there was no horizontal pleiotropy in included single nucleotide polymorphisms(P＞0.05).Conclusion The risk of developing depression decreases with increasing education level.

Objective To analyze causal relationship between education level and the occurrence of depression by using two sample Mendelian randomization(MR)study method.Methods The data of education level and depression were extracted from the Genome-Wide Association Study database,and the two-sample MR analysis was conducted,and sensitivity analysis was performed using the leave-one-out method.Results Ultimately,58 single nucleotide polymorphisms were successfully included.The results of bidirectional MR analysis showed that increase in education level can reduce the risk of depression(OR=0.95,95％CI:0.92-0.98,P＜0.01).MR-Egger regression and sensitivity analysis results showed that there was no horizontal pleiotropy in included single nucleotide polymorphisms(P＞0.05).Conclusion The risk of developing depression decreases with increasing education level.

Objective To establish a nomogram model for efficiently predicting overall survival(OS)and cancer-specific survival(CSS)in patients with CRCHBM.Method 2239 patients from 2010 to 2019 were retrospectively analyzed from the Surveillance,Epidemiology,and End Results Program(SEER)databases and Wuhan Union Hospital Cancer Center.SEER is randomly assigned to the training and internal validation cohorts,and the Wuhan database serves as the external validation.Cox regression analyses were used to determine the independent clinicopathological prognosis factors affecting OS and CSS,and a nomogram was constructed to predict OS and CSS.The clinical utility of columnar plots was assessed using calibration curves,area under the curve(AUC),and decision curve analysis(DCA).Result OS column line graphs were constructed based on nine independent predictors:age,tumor location,degree of differentiation,tumor size,TNM stage,chemotherapy,primary focus surgery,number of lymph nodes sampled,and serum carcinoembryonic antigen(CEA)level.The C-index of the nomogram to predict the 1-,3-,and 5-year OS were 0.764,0.790,and 0.805 in the training group,0.754,0.760,and 0.801 in the internal validation group,and 0.822,0.874,and 0.906 in the external validation group.CSS column line graphs were constructed based on 3 independent predictors of TNM staging,radiotherapy and chemotherapy.The 1-,3-,and 5-year CSS AUROC values of the training group were 0.791,0.757,and 0.782,respectively.0.682,0.709,0.625 in the internal validation group and 0.759,0.702,0.755 in the external validation group,respectively.The results of receiver operating characteristic curve(ROC),ROC and DCA showed that the use of our model was more effective in predicting OS and CSS than other single clinicopathological features.Conclusion In summary,the nomogram based on significant clinicopathological features can be conveniently used to predict OS and CSS individually in patients with CRCHBM.

Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.

Objective:To compare the clinical efficacy between radiofrequency ablation(RFA)and pulmonary metastasectomy in the colorectal cancer(CRC)patients with lung metastases after radical resection. Methods:The clinical data of 80 CRC patients with lung metastases after radical resection were analyzed retrospectively,and were divided into the surgery group(33 cases)and the RFA group(47 cases)according to the local treatment.The overall survival(OS)and progression-free survival(PFS)of the two groups were compared,as well as the prognostic factors of patients were analyzed. Results:The 3-year PFS and OS rates were 42.4％vs 31.9％and 75.8％vs 72.3％in the surgery group and the RFA group,respectively.There was no significant difference in PFS and OS between the two groups(P＞0.05).In multivariate analysis,maximum lung metastasis diameter,preoperative serum carcinoembryonic antigen(CEA)level and history of extrapulmonary metastasis were independent factors influencing OS in the CRC patients with lung metastases after radical resection(P＜0.05).In addition,preoperative serum carcinoembryonic antigen(CEA)level and history of extrapulmonary metastasis were also independent factors influencing PFS in the CRC patients with lung metastases after radical resection(P＜0.05). Conclusion:The short-term efficacy of RFA is comparable to that of pulmonary metastasectomy in the CRC patients with lung metastases after radical resection,and long-term follow-up studies are needed.

The iatrogenic splenic injuries occurred in 49 patients who underwent abdominal surgery from January 2005 to January 2020; including grade I injury in 40 cases and grade Ⅱ injury in 9 patients. The normal saline-soaked gauze was placed on the wound surface of the injured spleen, then the high-frequency electric coagulator was employed for hemostasis. The bleeding was successfully stopped and the spleens were preserved without postoperative complications in all cases. The results show that moist electrothermal coagulation can be effectively and safely applied in treatment of grade I and grade Ⅱ injury iatrogenic splenic injuries, and no special equipment required.

A total of 521 patients underwent laparoscopic radical gastrectomy from January 2013 to January 2020 in the First People′s Hospital of Wenling. In 242 cases the splenomental fold was severed before dissecting the left half of omentum or spleen (pretreatment group), and in 279 cases the splenomental fold was not severed priorly (routine group). For pretreatment group the introoperative splenic injury occurred in 4 cases (1.65%), including 3 cases (1.24%) with class Ⅰ injury and 1 case (0.41%) with class Ⅱ injury; while for routine group splenic injury occurred in 24 cases (8.60%), including 22 cases (7.89%) with class Ⅰ injury and 2 cases (0.72%) with class Ⅱ injury, and the rupture of splenic capsule caused by tracting splenomental fold occurred in 19 cases(6.81%). There were significant differences in total number of splenic injuries, splenic injuries with class Ⅰ and rupture of splenic capsule caused by tracting splenomental fold between two groups ( P<0.05). The operation time of 28 cases with splenic injuries was (185±89) min, which was longer than that in 493 cases without splenic injuries [(172±95) min, P<0.05]. The results show that rupture of splenic capsule by tracting splenomental fold is main cause of splenic injury in laparoscopic radical gastrectomy and most of them are class Ⅰ injuries. To sever the splenomental fold priorly can reduce the incidence of iatrogenic splenic injury.

Objective:To investigate the regulatory mechanism of long non-coding RNA (lncRNA) NEF on T cell immune function in postmenopausal osteoporosis (PMOP) mice.Methods:Female Balb/c mice were used to construct OVX model ( n=46) and sham control group ( n=16) . Bone marrow mesenchymal stem cells (BM-SCs) from these two groups of mice were cultured. NEF recombinant expression vector (pIRSE2-NEF) was constructed and transfected into BMSCs. RT-qPCR was used to detect NEF and miR-21 levels in BMSCs cells in sham group, OVX group, and pIRSE2-NEF group. Luciferase gene report experiment was used to verify the binding effect of NEF and miR-21. The remaining 40 OVX mice were divided into 4 groups, including OVX group ( n=10) , pIRSE2-NEF injection group (pIRSE2-NEF group, n=10) , pIRSE2-NEF combined with PD-1 inhibitor group (pIRSE2-NEF+ PD-L1-IN-1 group, n=10) , and pIRSE2-NEF combined with miR-21 mimic (mimic) group (pIRSE2-NEF+ mimic group, n=10) . The remaining 10 mice in sham group were used as the control group. ELI-SA was used to detect the levels of IFN-γ, IL-2, IL-4, IL-13 and PD-1/PD-1L in peripheral blood. Flow cytometry was used to detect the shift of serum Treg-Th17 cell subsets. Results:Compared with the Sham group (1.01±0.04, 1.00±0.03) , the expression of NEF in BMSCs of OVX group was down-regulated (0.23±0.01) , and miR-21 was up-regulated (2.96±0.05) ( P<0.05) . Compared with OVX group (1.23±0.15, 5.20±0.31) , NEF in BMSCs cells of Pirse2-nef group was significantly up-regulated (6.83±0.35) ( P<0.05) , while miR-21 was down-regulated (0.29±0.11) ( P<0.05) .NEF has a direct binding base site with miR-21.The levels of IFN-γ (3.25±0.21) , IL-2 (2.44±0.06) and Th17/Treg ratio (3.18±0.65) in peripheral blood of mice in OVX group were significantly higher than those in Sham group (1.03±0.02, 1.00±0.01, 0.86±0.09) (all P<0.05) . The levels of IL-4 (0.45±0.02) , IL-13 (0.43±0.07) , PD-1 (0.24±0.03) and PD-1L (0.51±0.06) were significantly lower than those of Sham group (1.00±0.04, 1.00±0.02, 1.00±0.03, 1.00±0.00) ( P<0.05) ; Compared with OVX, IFN-γ (2.02±0.06) , IL-2 (0.88±0.01) and Th17/Treg ratio (1.43±0.22) in Pirse2-nef group were decreased. The levels of IL-4 (0.87±0.03) , IL-13 (0.84±0.07) , PD-1 (0.79±0.06) and PD-1L (0.77±0.06) were increased (all P<0.05) ; Compared with Pirse2-nef group, IFN-γ (2.89±0.06) , IL-2 (2.07±0.07) and Th17/Treg ratio (2.39±0.38) were increased in Pirse2-nef+ PD-L1-in-1 group. The levels of IL-4 (0.68±0.03) , IL-13 (0.76±0.08) , PD-1 (0.52±0.02) and PD-1L (0.83±0.04) were decreased (all P<0.05) . Moreover, the pIRSE2-NEF+ mimic group had the same adjustment effect as the pIRSE2-NEF+ PD-L1-IN-1 group. Conclusion:lncRNA-NEF improves immune imbalance and PD-1/PD-1L-mediated Treg-Th17 cell balance in postmenopausal osteoporosis mice by sponging miR-21.