ObjectiveTo evaluate the effect of sex on phenotypic stability in mouse models of chemotherapy-induced alopecia (CIA) induced by cyclophosphamide (CYP) or paclitaxel (PTX), and to explore potential mechanisms underlying phenotypic heterogeneity in female mice. MethodsTwenty-eight wild-type specific pathogen-free (SPF) C57BL/6J mice (half male and half female) aged 6-8 weeks were selected for synchronous back hair removal. On the 9th day after hair removal (T0), the mice were randomly divided into a wild-type female CYP group, a wild-type male CYP group, a female negative control group and a male negative control group. Mice in the CYP groups were intraperitoneally injected with a single dose of 120 mg/kg CYP, and mice in the negative control groups were intraperitoneally injected with the same volume of normal saline. Subsequently, the phenotypic changes of the CIA model induced by CYP were continuously observed and photographed. Eleven 6-week-old SPF female C57BL/6J mice underwent bilateral ovariectomy (OVX group). Following successful surgery, these mice and five XY (Sry⁻) mice bred from Four Core Genotypes breeding stock were used to establish the chemotherapy-induced alopecia (CIA) model using the same protocol. Serum was collected from mice in the OVX group, wild-type female CYP group, and wild-type male CYP group on T7 after CYP administration for steroid hormone analysis by mass spectrometry to evaluate the effects of gonadal estrogen and sex chromosome background changes on the stability of the CYP-induced female alopecic phenotype. Finally, twenty SPF C57BL/6J mice aged 6-8 weeks (half male and half female) were randomly divided into a PTX low-dose group and a PTX high-dose group. On the 9th day after simultaneous hair removal, PTX was injected intraperitoneally at a single dose of 80 mg/kg or 120 mg/kg, respectively. Mice from the PTX low-dose group and the PTX high-dose group were continuously observed and photographed to compare the intra-group consistency of the phenotypes of female and male mice. Six SPF C57BL/6J mice (half male and half female) aged 6-8 weeks were used to repeat the construction method of the PTX low-dose group, and the hair follicle histological examination was performed at T0, T4, T7, T14 and T21, respectively, to observe the damage caused by PTX to hair follicle regeneration. ResultsThe phenotypes of CYP-induced male CIA mice are stable and reproducible. There are obvious individual differences in the alopecia phenotype in the CYP-induced female CIA model mice, which may be mainly caused by the differences in the relevant estrogens in the estrous cycle. The difference between OVX+CYP group and XY (Sry⁻) +CYP group disappeared, suggesting that ovarian-derived hormones and XY (Sry⁻) sex chromosome background may be involved in the formation of phenotypic heterogeneity of CYP-induced alopecia in female mice. The mice in the high-dose PTX group and the low-dose PTX group showed a relatively consistent alopecia and regrowth process, and there was no significant sex difference. ConclusionCYP-induced CIA is strongly influenced by sex, and ovariectomy or alteration of the sex chromosome background can improve the consistency of CYP-induced alopecic phenotypes in female mice. PTX-induced CIA shows good phenotypic consistency in both female and male mice, indicating broad applicability across sexes. Taken together, the choice of animal sex in CIA model construction, mechanistic studies, and evaluation of anti-alopecia interventions should take into account the type of chemotherapeutic agent, the study objective, and the required degree of phenotypic stability. Sex should therefore be considered an important variable in model standardization and interpretation of experimental findings.

Objective Patients with lung cancer often experience interrelated symptoms such as fatigue, pain, and sleep disturbances during chemotherapy, forming a core symptom cluster that significantly impacts daily functioning, treatment experience, and quality of life. Currently, evidence on non-pharmacological management of this core symptom cluster is scattered, and there is a lack of standardized, patient- and caregiver-friendly guidance tools that are easy to understand and implement. This patient guideline aims to provide decision support for self-management of the core symptom cluster in patients undergoing chemotherapy for lung cancer. Methods Guided by evidence-based methodology, qualitative interviews and on-site questionnaire surveys were conducted to identify the health-related needs of stakeholders. Domestic and international guideline websites, relevant professional association websites, and comprehensive databases were systematically searched according to the inclusion and exclusion criteria. The included literature was evaluated for quality, and recommendations were extracted, integrated, and graded to form a summary of the best evidence. Based on the identified health issues and evidence summary, preliminary recommendations for the patient guideline were developed. The recommendations were then revised through two rounds of Delphi expert consultation, and consensus was reached on the strength of recommendations, forming the final version of the patient guideline. Results The patient guideline covered four major sections: screening and assessment of core symptom clusters, daily management, intervention measures, and timing of referral. The core content included nine aspects: screening of core symptom clusters, assessment, lifestyle habits, dietary interventions, sleep environment, exercise interventions, psychological interventions, Traditional Chinese Medicine interventions, and referral indications. In total, the guidelines addressed 16 health issues and provided 25 recommendations. Conclusion The development process of this patient guideline is rigorous and fully considered the needs of patients. Expert review concludes that the recommendations are highly feasible and appropriate.

Objective To explore the predictive value of combined detection of serum CXC chemokine lig-and 12(CXCL12),caspase-cleaved cytokeratin 18(CCCK-18)and matrix metalloproteinase-9(MMP-9)for short-term poor prognosis in patients with acute hemorrhagic stroke.Methods A total of 138 patients with a-cute hemorrhagic stroke admitted to a hospital from October 2021 to March 2023 were selected as the study objects.Serum CXCL12,CCCK-18 and MMP-9 levels were detected after admission and before treatment.Pa-tients were followed up for 6 months after treatment and were divided into good prognosis group and poor prognosis group according to the modified Rankin scale score.Clinical data and serum CXCL12,CCCK-18 and MMP-9 levels of the two groups were compared to analyze the factors affecting the short-term poor prognosis of patients with acute hemorrhagic stroke.Receiver operating characteristic(ROC)curve was drawn to evalu-ate the predictive value of single and combined detection of serum CXCL12,CCCK-18 and MMP-9 in patients with acute hemorrhagic stroke.Results Among 138 patients,there were 52 cases in the poor prognosis group and 86 cases in the good prognosis group,and the poor prognosis rate was 37.68%.Serum CXCL12,CCCK-18 and MMP-9 levels,age,blood loss at admission,National Institutes of Health Stroke Scale(NIHSS)score at admission,systolic blood pressure and diastolic blood pressure at admission in the poor prognosis group were higher than those in the good prognosis group.The score of Glasgow Coma Scale(GCS)at admission was lower than that of good prognosis group,and the difference was statistically significant(P<0.05).Multivari-ate Logistic regression analysis showed that high level of serum CXCL12,high level of CCCK-18,high level of MMP-9,older age,large amount of blood loss upon admission,high NIHSS score and high systolic blood pres-sure were all risk factors for short-term poor prognosis of acute hemorrhagic stroke(P<0.05).High GCS score on admission was a protective factor(P<0.05).ROC curve analysis showed that the area under the combined prediction curve of serum CXCL12,CCCK-18 and MMP-9 was higher than that of the single and pairwise combined prediction of each index(P<0.05).Conclusion The combined detection of serum CX-CL12,CCCK-18 and MMP-9 has a good value in predicting the short-term poor prognosis of patients with a-cute hemorrhagic stroke.

Postoperative pulmonary complications(PPCs)represent a frequent and severe challenge following surgery,particularly in patients undergoing thoracic or abdominal procedures that necessitate tracheal intubation and mechanical ventilation.PPCs typically manifest within 7 days post-surgery.Effective perioperative management,encompassing optimization of lung-protective ventilation strategies,real-time monitoring of pulmonary ventilation status,and timely interventions,can substantially decrease the incidence of PPCs.As an emerging non-invasive imaging modality,electrical impedance tomography(EIT)has garnered significant attention in recent years for its clinical applications,especially in perioperative lung-protective ventilation.EIT enables real-time and dynamic visualization of lung ventilation distribution,providing a critical foundation for developing personalized ventilation strategies.This significantly enhances the safety and efficacy of mechanical ventilation while improving patient outcomes.The aim of this article is to elucidate the fundamental principles and advantages of EIT,explore its role in perioperative lung protection,and examine its future development prospects,thereby offering additional reference and guidance for clinical practice.

[Objective]To explore the etiology,pathogenesis,syndrome and treatment of coronary heart disease with depression based on the theory of"the pathways of spirit".[Methods]Starting from the theory of"the pathways of spirit",the relationships among insufficient control of spirit,obstructed the pathways of spirit and impaired heart-spirit functioning in coronary heart disease with depression were analyzed,and the treatment principles at different stages were summarized.[Results]The evolution of coronary heart disease with depression is based on the deficiency of Qi and blood and the insufficient control of spirit.At this stage,Guipi Decoction,Guizhi Longgu Muli Decoction and Jiji Decoction should be used to supplement Qi and blood.The root cause of coronary heart disease with depression is the combination of blood stasis and toxin,which leads to the obstruction of the pathways of spirit.At this stage,Xuefu Zhuyu Decoction or Simiao Yong'an Decoction should be used to dissipate blood stasis and detoxing,combined with large dosage of Astragalus membranaceus to strengthen the healthy Qi without retaining pathogens.The important reason for the deterioration of coronary heart disease with depression is stagnation of Qi which causes impaired heart-spirit functioning.At the obvious stage of Qi stagnation,modified prescriptions such as Bupleurum based formulas and Yueju Pill should be flexibly applied to promote Qi circulation and relieve depression,combined with acupuncture in order to prevent the deterioration of the disease.[Conclusion]"The pathways of spirit"is the way of heart spirit interaction,and communication and coordination between the heart and other organs.Insufficient control of spirit,obstructed pathways of spirit,and impaired heart-spirit functioning are important pathogenesis for the occurrence and development of coronary heart disease with depression.Based on the theory of"the pathways of spirit",it helps to understand the disease evolution process of coronary heart disease with depression,improve the staged diagnosis and treatment rules and specific prescriptions for coronary heart disease with depression.

Objective To investigate the effects of obesity-related indexes on cardiovascular autonomic nervous function in type 2 diabetes mellitus(T2DM)patients.Methods A total of 421 T2DM patients treated in the Department of Endocrinology of Gansu Provincial People's Hospital were enrolled in this study from October 2020 to October 2023.All the patients were divided into simple T2DM group with VFA<100 cm2(n=193)and obese group with VFA≥100 cm2(OB,n=228)according to visceral fat area(VFA).BMI,waist-to-height ratio(WHtR),waist-to-hip ratio(WHR),lipid accumulation index(LAP),visceral fat index(VAI),Chinese visceral fat index(CVAI),tapeness index(CI),body shape index(ABSI),and body roundness index(BRI)were calculated.Time domain parameters of heart rate variability(HRV)in 24 h holter electrocardiogram were recorded,including the global standard deviation(SDNN)of normal sinus RR interval,standard deviation of mean value of sinus RR interval(SDANN),root mean square difference(RMSSD)of normal continuous sinus RR interval.The percentage of adjacent RR interval difference>50 ms in total interval(PNN50),the HRV triangle index,the standard deviation of the difference of the entire adjacent NN interval length(SDSD).Results Compared with T2DM group,the OB group showed an increase in age,weight,BMI,WC,hip circumference(HC),neck circumference(NC),SBP,HbA1c,TG,SUA,CI,WHtR,WHR,VFA,SFA,VAI,LAP,CVAI,and BRI(P<0.05 or P<0.01),while a decrease in HDL-C(P<0.05).The SDNN,SDANN,SDSD,RMSSD,HRV trigonometric index,and PNN50 were lower in OB group than in T2DM group(P<0.05 or P<0.01).Spearman correlation analysis showed that SDNN and HRV trigonometric index was negatively correlated with age,DM duration,HR,SBP,PWV,WHtR,TG,SUA,VAI,LAP,BRI,VFA,LAP,and CVAI(P<0.05 or P<0.01).Logistic regression analysis shows that age,VFA,and LAP are influencing factors for cardiac autonomic dysfunction.The analysis of the working characteristic curve of the subjects showed that the area under the curve of VFA,age,and LAP in predicting cardiovascular autonomic dysfunction was 0.680,0.614,and 0.577,with sensitivity of 87.5%,41.7%,and 61.8%,and specificity of 47.3%,73.6%,and 55.6%respectively.Conclusions BMI,HC,NC,WC,TG,SFA,CI,WHtR,WHR,LAP,BRI,VAI,CVAI and VFA are closely related to cardiovascular autonomic nervous function in T2DM patients.As VFA,Ageand LAP increase,the risk of cardiovascular autonomic dysfunction increases.

Objective:To investigate the characteristics of cell subsets in rheumatoid arthritis patients complicated with interstitial lung disease (RA-ILD).Methods:The clinical data of 344 patients with RA admitted to the Affiliated Hospital of Nantong University from June 2022 to November 2023 were analyzed. The patients were categorized into two groups based on the diagnostic criteria of ILD: 120 cases in the RA associated with ILD group (RA-ILD group) were included and 224 cases in the RA without ILD group (RA group), the clinical characteristics were compared between the RA-ILD group and the RA group. The influence factors of RA-ILD were analyzed by univariate and multivariate logistic regression.Results:Compared with RA patients, RA-ILD patients were more common in males, with older age, longer course of disease, and higher smoking rate ( P<0.05). The high titer anti-cyclic citrullinated peptide (CCP) antibody, white blood cells, neutrophil, neutrophil to lymphocyte count ratio, aspartate aminotr-ansferase(AST), creatinine (Cr) and lactate dehydrogenase (LDH) levels in RA-ILD patients were higher than those in RA patients. The triglyceride level was lower than that of RA patients ( P<0.05). The percentage of total T cells in peripheral blood lymphocyte subsets in RA-ILD patients [68.65%(62.22%, 76.78%)] was lower than that in RA patients [71.88%(65.83%, 78.39%)] ( Z=-2.26, P=0.024). The percentage of CD4 +T cells [40.2% (32.10%, 45.23%)] was lower than that of RA patients [46.5% (39.74%, 53.19%)] ( Z=-6.29, P<0.001). CD4 +T cell count [486.50 (324.25, 636.75)cells/μl] was lower than that of RA patients [564.50 (438.25, 752.00)cells/μl] ( Z=-4.50, P<0.001). CD4 +/CD8 + levels [1.86 (1.26, 2.18)] were lower than those of RA patients [2.03 (1.40, 2.94)] ( Z=-2.79, P=0.005). B cell count [127.00 (78.00, 207.25)cells/μl] was lower than that of RA patients [163.50 (91.25, 231.50)cells/μl] ( Z=-2.11, P=0.035), The percentage of NK cells in peripheral blood lymphocyte subsets in RA-ILD patients [19.72%(13.14%, 25.83%)] was higher than that in RA patients [12.55% (8.23%, 17.80%)] ( Z=6.13, P<0.001). NK cell count [182.50 (109.00, 293.75)cells/μl] was higher than that of RA patients [156.00 (89.00, 194.75)cells/μl] ( Z=3.17, P=0.002). The percentage of CD8 +T cells [25.10 %(18.74%, 29.86%)] was higher than that of RA patients [22.27% (17.32%, 29.21%)] ( Z=2.00, P=0.046). Imaging types of RA-ILD patients showed that usual interstitial pneumonia (UIP) was more common, followed by non-specific interstitial pneumonia (NSIP). CD8 + T cell count and percentage expression level in UIP were higher than NSIP, and CD4 +/CD8 + expression level was lower than NSIP ( P<0.05). Multivariate logistic regression analysis of indicators with statistical differences were male gender [ OR(95% CI)=2.888 (1.556, 5.360), P=0.001], age [ OR(95% CI)=1.065 (1.033, 1.098), P<0.001], disease duration [ OR(95% CI)=1.004 (1.001, 1.007), P=0.013], high titer anti-CCP antibody [ OR(95% CI)=2.764 (1.214, 6.292), P=0.015], LDH [ OR(95% CI)=1.006 (1.002, 1.009), P=0.001], CD4 +T cell percentage [ OR(95% CI)=0.964 (0.929, 1.000), P=0.049], CD4 +T cell count [ OR(95% CI)=0.998 (0.996, 1.000), P=0.011] and NK cell count [ OR(95% CI)=1.004 (1.001, 1.007), P=0.003]. These indicators were correlated factors for RA-ILD. Conclusion:Male patients with older age, history of smoking and a long disease course are more likely to develop ILD. Male gender with older, long disease course, high titer anti-CCP antibody, increased LDH and NK cell count, CD4 +T cell percentage and decreased CD4 +T cell count are correlation factors for RA-ILD, which may help RA patients to recognize ILD early.

Objective:To investigate the correlation between uterine volume and intrauterine adhesion (IUA).Methods:From June 2018 to November 2019, totally 7 007 patients who underwent hysteroscopy in outpatient operating rooms of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed . Patients of reproductive age with IUA without uterine fibroids and adenomyosis were selected as IUA group, and patients of reproductive age without uterine fibroids and adenomyosis without IUA during the same period were selected as the control group. The propensity score matching (PSM) method was used to perform 1∶1 matching for the two groups of patients, matching variables included age, height, weight, body mass index (BMI), gravidity, parity, and number of abortion curettage. Whether there was any difference in uterine volume between the two groups of patients was compared, and whether uterine volume was an influencing factor of IUA was explored. The patients in IUA group were also categorized into mild, moderate and severe to explore whether uterine volume influenced the severity of IUA. Results:(1) After inclusion and exclusion criteria, 351 patients were included in IUA group and 2 986 patients in the control group. With PSM, 327 patients in IUA group and 327 patients in the control group were finally enrolled in this study. There were no statistically significant differences in age, height, weight, BMI, gravidity, parity, and number of abortion curettage between the two groups of patients after matching (all P>0.05). (2) After PSM, there was a significant difference between the uterine volume of IUA group (median: 44.23 cm 3) and the uterine volume of the control group (median: 57.20 cm 3; P<0.001). (3) Reduced uterine volume ( OR=0.961, 95% CI: 0.952-0.970) was an independent risk factor for IUA ( P<0.001). (4) Uterine volume had a significant effect on the severity of IUA ( P<0.001), the larger the uterine volume ( B=-0.030, 95% CI: -0.044 to -0.017), the less severe the IUA. Conclusions:Reduced uterine volume is an independent risk factor for IUA, and uterine volume has a significant effect on the severity of IUA. In patients with small uterine volume size, primary and secondary prevention of IUA should be emphasized.

Objective:To investigate the predictive value of uterine volume for intrauterine adhesion (IUA) caused by endometrial injury, and to provide a new perspective for the primary prevention of IUA.Methods:The clinical data of 7 007 patients of reproductive age who underwent outpatient hysteroscopy in the Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital from June 2018 to November 2019 were retrospectively analyzed. Patients of reproductive age with IUA without uterine fibroids and adenomyosis were selected as the IUA group (351 cases), and patients of reproductive age without uterine fibroids and adenomyosis and without IUA during the same period were selected as the control group (2 986 cases). The uterine volume was compared between the two groups. Multivariate binary logistic regression analysis was used to determine whether uterine volume was an independent factor for the occurrence of IUA. Ordinal multinomial logistic regression was used to analyze the correlation between uterine volume and menstrual volume in IUA patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of uterine volume for IUA caused by endometrial injury.Results:(1) The uterine volume of the IUA group was significantly smaller than that of the control group (median: 44.15 vs 62.59 cm 3; Z=-15.742, P<0.001). (2) Multivariate binary logistic regression analysis showed that decreased uterine volume was an independent risk factor for IUA ( OR=0.184, 95% CI: 0.139-0.245; P<0.001). (3) The area under the ROC curve of uterine volume to predict IUA was 0.756, and the optimal cut-off value of uterine volume to predict IUA was 51.49 cm 3. (4) The risk of IUA caused by endometrial injury in patients with uterine volume≤51.49 cm 3 was 4.658 times higher than that in patients with uterine volume>51.49 cm 3 (95% CI: 3.681-5.893; P<0.001). (5) The smaller the uterine volume ( β=-0.032, 95% CI:-0.046 to -0.018; P<0.001), the more likely the IUA patients were to have menorrhagia and amenorrhea. Conclusions:Uterine volume has a certain predictive value for the occurrence of IUA caused by endometrial injury. For patients with small uterine volume, it is necessary to be alert to the occurrence of IUA caused by endometrial injury and improve the awareness of primary prevention.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.