Systemic inflammation of cachexia is an important cause of high mortality of degenerative diseases such as ad-vanced cancer,and also the most important factor to aggravate the cachexia process.Systemic inflammation of cachexia has a profound impact on the proliferation and invasion of tumors and the catabolism of muscle and adipose tissue in patients with cachexia.In recent years,studies have shown that the dysfunction of gut microbiota during cachexia is an important cause of cachexia systemic inflamma-tion and a key therapeutic target.The dysfunctions of intestinal barrier mediated by gut microbiota and the translocation of bacterial tox-ins during the cachexia period are important causes of cachexia systemic inflammation.This article mainly summarized the relationship between gut microbiota and cachexia systemic inflammation,and summarized the mechanism of intestinal flora inducing cachexia sys-temic inflammation by regulating short chain fatty acids,lipopolysaccharide,flagellin,peptidoglycan and other substances,with a view to providing new ideas for the prevention and treatment of cachexia systemic inflammation from the perspective of intestinal flora.

Objective To compare the clinical outcomes of patients with coronary in-stent restenosis(ISR)who underwent drug-coated balloon(DCB)treatment,based on different clinical presentations.Methods This prospective study included 508 patients diagnosed with coronary ISR at Anzhen Hospital,Capital Medical University,between May 2020 and May 2022.All patients received DCB treatment.According to clinical presentation,the patients were divided into an acute coronary syndrome(ACS)group(185 patients)and a non-acute coronary syndrome(non-ACS)group(323 patients).All patients were followed for two years,primarily comparing the incidence of myocardial infarction(MI),target lesion revascularization(TLR),death,and major adverse cardiovascular events(MACE)between the two groups.Results Baseline data showed that the ACS group had a significantly higher proportion of hypertension,diabetes,and smoking compared to the non-ACS group(all P＜0.05).Additionally,the ACS group had a higher proportion of B2/C-type lesions,long lesions,and moderate to severe calcified lesions(all P＜0.05).The number,length,and diameter of stents implanted were also significantly larger in the ACS group(all P＞0.05).At the 1-year follow-up,the ACS group had a significantly higher incidence of TLR(8.1％vs.2.5％,P=0.007)and MACE(10.3％vs.5.3％,P=0.047)than the non-ACS group.By the end of the 2-year follow-up,the ACS group still had higher rates of TLR(18.9％vs.10.2％,P=0.007)and MACE(22.7％vs.14.9％,P=0.030).Conclusions ISR patients with ACS have higher cardiovascular risk and more complex lesions.They also experience a higher incidence of adverse events after DCB treatment.

Objective:To compare the safety and accuracy between robotic-assisted screw placement and free-hand screw placement in adolescent idiopathic scoliosis (AIS) surgery.Methods:The clinical data of 69 AIS patients underwent posterior spinal scoliosis orthomorphia from December 2021 to October 2023 in Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. Among them, 37 patients underwent robot-assisted screw placement (robot group), and 32 patients underwent fluoroscopy-assisted free-hand screw placement (free-hand group). The basic information of surgery (operation time, intraoperative blood loss, intraoperative radiation exposure time, postoperative hospital stay and postoperative complications), screw placement indexes (single screw placement time and accuracy of screw placement) and imaging indexes (main curve correction rate, kyphotic change and lumbar lordosis change) were compared between two groups. The ln curve regression analysis method was used to evaluate the learning curve of robot-assisted screw placement therapy for AIS.Results:A total of 716 screws were placed in 32 patients of free-hand group, and 766 screws in 37 patients of robot group. The operation time, intraoperative radiation exposure time, single screw placement time and accuracy of screw placement in robot group were significantly higher than those in free-hand group: (272.30 ± 67.98) min vs. (221.66 ± 67.32) min, (149.81 ± 57.21) s vs. (116.03 ± 63.10) s, (497.97 ± 51.74) s vs. (381.47 ± 46.58) s and 97.91% (750/766) vs. 91.48% (655/716), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in intraoperative blood loss, postoperative hospital stay, incidence of neurological complications, incidence of incision infection and number of screw between two groups ( P>0.05). There were no statistical differences in the main curve correction rate, kyphotic change and lumbar lordosis change between two groups ( P>0.05). When the fitting degree was the highest ( R2 = 0.729, P<0.01), the fitting equation was y = - 50.93ln x + 634.7 ( x was the number of operation, and y was the single screw placement time), and the number of vertices was 12 cases. The robot group was divided into three subgroups according to the order of surgery, subgroup A consisted of 12 patients who underwent the surgery from first to twelfth, subgroup B consisted of 12 patients who underwent the surgery from thirteenth to twenty-fourth, and subgroup C consisted of 13 patients who underwent the surgery from twenty-fifth to thirty-seventh. Among them, the single screw placement time in subgroup A was significantly longer than that in subgroup B and subgroup C: (560.92 ± 35.03) s vs. (465.75 ± 21.20) and (469.62 ± 24.94) s, and there was statistical difference ( P<0.05); there was no statistical difference between subgroup B and subgroup C ( P>0.05). Conclusions:Robot-assisted screw placement for AIS can effectively improve the accuracy of screw placement without affecting deformity correction, but it can increase screw placement time, operation time and radiation exposure time. A smooth learning curve is obtained after performing 12 procedures.

Aim To explore the possible regulatory effect of leptin on acyl-CoA synthetase long chain fami-ly member ACSL5 and their effect on migration and in-vasion of breast cancer cell,and to explore the underly-ing mechanism.Methods The expression of leptin receptor was detected by immunofluorescence assay.The migration and invasion ability of MCF-7 cells were detected by wound healing assay and Transwell assay respectively.The downstream target gene of leptin was analyzed by PCR microarray data.The expression of ACSL5 in breast cancer and its correlation with the staging and prognosis of breast cancer patients were as-sessed uing bioinformatics methods.The expression of ACSL5 in MCF-7 cells treated with different concentra-tions of leptin was detected using real time fluorescence quantitative polymerase chain reaction(RT-qPCR).Overexpressing ACSL5 was constructed by lentiviral transfection;the expressions of EMT related proteins,AMPK-α and p-AMPK-α were detected by Western blot.Results Leptin promoted breast cancer cell mi-gration and invasion and EMT.ACSL5 was significant-ly low expressed in breast cancer and related to progno-sis.Leptin downregulated the expression of ACSL5 through OBR.Leptin activated AMPK pathway to downregulate ACSL5 and promote migration,invasion and EMT of breast cancer cells.Conclusions Leptin may promote the migration,invasion and EMT of breast cancer by downregulating ACSL5 through activating AMPK pathway.

AIM To investigate the mechanism of Shaoyao Gancao Decoction in preventing meglumine diatrizoate-induced post-ERCP pancreatitis in rats through autophagy regulation.METHODS The rats were randomized into the normal group,the model group,the low-dose and high-dose Shaoyao Gancao Decoction(1.5,3.0 g/kg),and the indomethacin suppository group.A rat model of post-ERCP pancreatitis was induced by meglumine diatrizoate injection into the pancreatic duct under continuous pressure.The rats had their pancreatic tissues stained with HE to observe the pathological alterations,inflammatory cell infiltration,hemorrhage and necrosis;their serum levels of IL-1β,IL-6,IL-8,TNF-α,AMS,and IL-10 identified by ELISA;their autophagic vacuoles in pancreatic acinar cells observed by transmission electron microscopy;their pancreatic protein expressions of Beclin1,LC3B,p62,TRAF2 and p-JNK detected by IHC and Western blot;and their pancreatic mRNA expressions of Beclin1 and TRAF2 detected by RT-qPCR.RESULTS Compared with the model group,the high-dose Shaoyao Gancao Decoction group displayed no obvious hemorrhage;improvement in edema of acinar and interstitial cells;obviously less cellular inflammatory infiltration;substantially decreased serum levels of IL-1β,IL-6,TNF-α and AMS(P＜0.05,P＜0.01);drastically reduced amount of autophagosomes in acinar cells;and down-regulated expressions of autophagy-related proteins Beclin1,LC3,p62,TRAF2 and p-JNK(P＜0.05,P＜0.01).CONCLUSION Shaoyao Gancao Decoction can prevent post-ERCP pancreatitis by ameliorating pancreatic tissue injury,decreasing serum inflammatory response level,and interfering with abnormal autophagy of pancreatic acinar cells.Its molecular mechanism may involve inhibition of TRAF2 protein expression and modulation of p-JNK activation.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

Objective:To compare the safety and accuracy between robotic-assisted screw placement and free-hand screw placement in adolescent idiopathic scoliosis (AIS) surgery.Methods:The clinical data of 69 AIS patients underwent posterior spinal scoliosis orthomorphia from December 2021 to October 2023 in Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. Among them, 37 patients underwent robot-assisted screw placement (robot group), and 32 patients underwent fluoroscopy-assisted free-hand screw placement (free-hand group). The basic information of surgery (operation time, intraoperative blood loss, intraoperative radiation exposure time, postoperative hospital stay and postoperative complications), screw placement indexes (single screw placement time and accuracy of screw placement) and imaging indexes (main curve correction rate, kyphotic change and lumbar lordosis change) were compared between two groups. The ln curve regression analysis method was used to evaluate the learning curve of robot-assisted screw placement therapy for AIS.Results:A total of 716 screws were placed in 32 patients of free-hand group, and 766 screws in 37 patients of robot group. The operation time, intraoperative radiation exposure time, single screw placement time and accuracy of screw placement in robot group were significantly higher than those in free-hand group: (272.30 ± 67.98) min vs. (221.66 ± 67.32) min, (149.81 ± 57.21) s vs. (116.03 ± 63.10) s, (497.97 ± 51.74) s vs. (381.47 ± 46.58) s and 97.91% (750/766) vs. 91.48% (655/716), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in intraoperative blood loss, postoperative hospital stay, incidence of neurological complications, incidence of incision infection and number of screw between two groups ( P>0.05). There were no statistical differences in the main curve correction rate, kyphotic change and lumbar lordosis change between two groups ( P>0.05). When the fitting degree was the highest ( R2 = 0.729, P<0.01), the fitting equation was y = - 50.93ln x + 634.7 ( x was the number of operation, and y was the single screw placement time), and the number of vertices was 12 cases. The robot group was divided into three subgroups according to the order of surgery, subgroup A consisted of 12 patients who underwent the surgery from first to twelfth, subgroup B consisted of 12 patients who underwent the surgery from thirteenth to twenty-fourth, and subgroup C consisted of 13 patients who underwent the surgery from twenty-fifth to thirty-seventh. Among them, the single screw placement time in subgroup A was significantly longer than that in subgroup B and subgroup C: (560.92 ± 35.03) s vs. (465.75 ± 21.20) and (469.62 ± 24.94) s, and there was statistical difference ( P<0.05); there was no statistical difference between subgroup B and subgroup C ( P>0.05). Conclusions:Robot-assisted screw placement for AIS can effectively improve the accuracy of screw placement without affecting deformity correction, but it can increase screw placement time, operation time and radiation exposure time. A smooth learning curve is obtained after performing 12 procedures.

Objective:To explore the diagnostic value of total bilirubin to albumin ratio(B/A ratio)combined with alpha-fetoprotein(AFP)and abnormal prothrombin induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ)for hepatocellular carcinoma(HCC).Methods:35 HCC patients(HCC group),35 cirrhosis patients(cirrhosis group),35 HCC patients post-transcatheter arterial chemoembolization(TACE)(TACE postoperative group),and 35 healthy volunteers(healthy control group)were selected in our hospital from October 2023 to October 2024.The serum B/A ratio,AFP,and PIVKA-Ⅱ levles were measured and compared across the groups.The correlations between serum B/A ratio,AFP,and PIVKA-Ⅱ in the HCC group were analyzed.The B/A ratio,AFP,PIVKA-Ⅱ were compared across different clinical and pathological features in HCC patients.The serum B/A ratio,AFP,and PIVKA-Ⅱ levels were compared pre and post operation in the HCC group.The diagnostic value of B/A ratio,AFP,PIVKA-Ⅱ alone and in combination for HCC were analyzed by receiver operating characteristic(ROC)curves.Results:The serum B/A ratio,AFP,and PIVKA-Ⅱ levels in HCC group and TACE postoperative group were significantly higher than those in the cirrhosis group and healthy control group,and the HCC group was higher than that in the TACE postoperative group(P＜0.05).Pearson correlation analysis results showed that,B/A ratio in the HCC group was positively correlated with AFP(r=0.352,P=0.001),B/A ratio was positively correlated with PIVKA-Ⅱ(r=0.327,P=0.003),and AFP was positively correlated with PIVKA-Ⅱ(r=0.285,P=0.008).Higher TNM stage,larger tumor diameter,presence of vascular invasion,and lower differentiation degree of HCC patients,who had higher B/A ratio,AFP,and PIVKA-Ⅱ levels(P＜0.05).Serum B/A ratio,AFP,and PIVKA-Ⅱ levels in the HCC group post operation were significantly lower than those in pre operation(P＜0.05).ROC curve analysis results showed that,when B/A ratio,AFP,and PIVKA-Ⅱ were detected separately,the area under the curve(AUC)was 0.785,0.756,and 0.802,respectively.The AUC for joint detection was 0.925.The AUC in combination was greater than that of individual detection of each indicator.Conclusion:The combination of B/A ratio,AFP,and PIVKA-Ⅱ testing significantly improves the diagnostic efficiency for HCC,which is worthy of clinical application.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.