Objective To exploring the correlation between serum periostin,uric acid/albumen ratio(UAR) levels and recurrence after radiofrequency ablation (RFCA) in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods The 108 elderly NAVF patients who received RFCA treatment at the Cardiovascular Center of Peking Tongren Hospital Affiliated to Capital Medical University from January 2019 to October 2022 were selected as the observation group,selected 108 healthy individuals who had medical checkups at Beijing Tongren Hospital Affiliated to Capital Medical University during the same period as the control group,and the patients were followed up for a period of 1 year. And according to the follow-up,they were divided into the recurrence group (n=42) and the non-recurrence group (n=66). Sex,age,body mass index (BMI),history of hypertension,diabetes mellitus,hyperlipidemia,smoking,alcohol consumption,left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD),white blood cell counts were collected. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum Periostin level. Fully automated biochemical analyzer was applied to measure the levels of serum albumin (ALB) and uric acid (UA),whose ratio was the level of UAR. Logistic regression was applied to analyze the influencing factors of recurrence in NVAF patients after RFCA. Receiver Operating Characteristic (ROC) curve was applied to analyze the predictive value of serum Periostin and UAR levels for recurrence after RFCA in elderly NAVF patients. Results Preoperative Periostin,UAR levels in the observation group were significantly higher than serum Periostin (53.53±6.27ng/L),UAR (4.09±0.78) in the postoperative(50.53±7.23 ng/L,3.41±0.91)and control groups(31.29±4.21 ng/L,1.24±0.27),and the differences were statistically significant (t=3.258,30.603;5.896,35.883,all P<0.05). The LVEF was lower in the recurrent group (51.16％±6.49％) than in the non-recurrent group (55.39％±6.71％),the levels of UAR (4.01±0.92),Periostin (55.77±6.56 ng/L) and percentage of history of hyperlipidemia (66.67％) were higher in the relapse group than those in the non-relapse group (3.02±0.63,47.19±5.44 ng/L,34.85％),and the differences were statistically significant (x2/t=3.234,6.458,7.180,10.426,all P<0.05). Serum Periostin[OR(95％ CI):1.856(1.148～3.000)]and UAR[OR(95％ CI):2.127(1.145～3.951)]were independent risk factors for recurrence after RFCA in patients (P<0.05). The area under the curve (95％ confidence interval)[AUC(95％CI)]of serum Periostin and UAR levels to predict relapse after RFCA in elderly NAVF patients were 0.856(0.776～0.916),0.817(0.731～0.884),respectively,the cutoff values were 53.00 ng/L,3.99,the Youden index was 0.569,0.509,the sensitivity was 88.10％,85.71％ and the specificity was 71.21％,65.15％,respectively. The combined predicted of the AUC(95％CI),Youdon index,sensitivity and specificity by the two method were as flows 0.924 (0.857～0.966),0.736,85.71％ and 87.88％,respectively. The combined prediction was significantly higher than that of each index alone (Z=2.296,2.880,P=0.022,0.004). Conclusion Serum Periostin and UAR levels are upregulated in elderly patients with NAVF,there is a certain correlation with recurrence after RFCA,the combination of the two has a high efficacy in predicting recurrence in elderly NAVF patients after RFCA.

Atrial fibrillation is the most common type of chronic cardiac arrhythmia. Catheter ablation and left atrial appendage occlusion are effective treatment methods for atrial fibrillation， but these procedures require anesthesia support. However， anesthetic drugs often cause side effects such as nausea， vomiting， involuntary movements， and respiratory depression. This paper presents a case of a successful one-stop procedure for cryoballoon ablation and left atrial appendage occlusion of atrial fibrillation performed entirely under acupuncture anesthesia. Thirty minutes before the procedure， acupuncture needles were inserted perpendicularly at bilateral Neiguan （PC 6）， Lieque （LU 7）， Ximen （PC 4） and （LU 6）. After obtaining the deqi （得气） sensation， an electroacupuncture device was connected， and electroacupuncture anesthesia was used for pain control throughout the procedure. The patient exhibited good tolerance and cooperation， with electroacupuncture anesthesia completely replacing intravenous anesthetics， ensuring the smooth completion of the surgery. Postoperative follow-up showed favorable outcomes.

Objective To exploring the correlation between serum periostin,uric acid/albumen ratio(UAR) levels and recurrence after radiofrequency ablation (RFCA) in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods The 108 elderly NAVF patients who received RFCA treatment at the Cardiovascular Center of Peking Tongren Hospital Affiliated to Capital Medical University from January 2019 to October 2022 were selected as the observation group,selected 108 healthy individuals who had medical checkups at Beijing Tongren Hospital Affiliated to Capital Medical University during the same period as the control group,and the patients were followed up for a period of 1 year. And according to the follow-up,they were divided into the recurrence group (n=42) and the non-recurrence group (n=66). Sex,age,body mass index (BMI),history of hypertension,diabetes mellitus,hyperlipidemia,smoking,alcohol consumption,left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD),white blood cell counts were collected. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum Periostin level. Fully automated biochemical analyzer was applied to measure the levels of serum albumin (ALB) and uric acid (UA),whose ratio was the level of UAR. Logistic regression was applied to analyze the influencing factors of recurrence in NVAF patients after RFCA. Receiver Operating Characteristic (ROC) curve was applied to analyze the predictive value of serum Periostin and UAR levels for recurrence after RFCA in elderly NAVF patients. Results Preoperative Periostin,UAR levels in the observation group were significantly higher than serum Periostin (53.53±6.27ng/L),UAR (4.09±0.78) in the postoperative(50.53±7.23 ng/L,3.41±0.91)and control groups(31.29±4.21 ng/L,1.24±0.27),and the differences were statistically significant (t=3.258,30.603;5.896,35.883,all P<0.05). The LVEF was lower in the recurrent group (51.16％±6.49％) than in the non-recurrent group (55.39％±6.71％),the levels of UAR (4.01±0.92),Periostin (55.77±6.56 ng/L) and percentage of history of hyperlipidemia (66.67％) were higher in the relapse group than those in the non-relapse group (3.02±0.63,47.19±5.44 ng/L,34.85％),and the differences were statistically significant (x2/t=3.234,6.458,7.180,10.426,all P<0.05). Serum Periostin[OR(95％ CI):1.856(1.148～3.000)]and UAR[OR(95％ CI):2.127(1.145～3.951)]were independent risk factors for recurrence after RFCA in patients (P<0.05). The area under the curve (95％ confidence interval)[AUC(95％CI)]of serum Periostin and UAR levels to predict relapse after RFCA in elderly NAVF patients were 0.856(0.776～0.916),0.817(0.731～0.884),respectively,the cutoff values were 53.00 ng/L,3.99,the Youden index was 0.569,0.509,the sensitivity was 88.10％,85.71％ and the specificity was 71.21％,65.15％,respectively. The combined predicted of the AUC(95％CI),Youdon index,sensitivity and specificity by the two method were as flows 0.924 (0.857～0.966),0.736,85.71％ and 87.88％,respectively. The combined prediction was significantly higher than that of each index alone (Z=2.296,2.880,P=0.022,0.004). Conclusion Serum Periostin and UAR levels are upregulated in elderly patients with NAVF,there is a certain correlation with recurrence after RFCA,the combination of the two has a high efficacy in predicting recurrence in elderly NAVF patients after RFCA.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.

Objective: To explore the relationship of sleep quality and emotional regulation difficulties in middle school students, and to analyze its mediating role of daytime dysfunction, social rejection and selfcontrol ability, so as to provide a scientific reference for improving middle school students mental health. Methods: From October to November, 2023, the Pittsburgh Sleep Quality Index, Adolescent Social Rejection Questionnaire, Brief Selfcontrol Scale and Difficulties in Emotion Regulation Scaleshort Form (DERS-16) were used to assess 806 students recruited from four middle schools in Bengbu City by a convenient cluster random sampling method. And model-6 of PROCESS and 5 000 Bootstraps were used to make a chainmediating model analysis. Results: Daytime dysfunction was positively correlated with sleep quality(r=0.57), social rejection(r=0.19), selfcontrol(r=0.29, P＜0.01). Selfcontrol was positively correlated with emotional regulation difficulties(r=0.54, P<0.01).Poor sleep quality showed a significant positive association with on daytime dysfunction, and daytime dysfunction further affected social rejection, selfcontrol ability and emotional regulation difficulties (β=0.86, 0.60, 1.27, 1.56, P<0.05). Meanwhile, daytime dysfunction, social rejection and selfcontrol played a serial mediating role in the relationship between sleep quality and emotional regulation difficulties (Estimate=0.11,95%CI=0.04-0.20,P<0.05). Conclusion The study reveals the complex relationship between sleep quality and emotional regulation difficulties in middle school students and provides a new theoretical basis for adolescent sleep improvement and mental health interventions.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

Hepatosteatosis is characterized by abnormal accumulation of triglycerides(TG),leading to prolonged and chronic inflammatory infiltration.To date,there is still a lack of effective and economical therapies for hepatosteatosis.Oridonin(ORI)is a major bioactive component extracted from the traditional Chinese medicinal herb Rabdosia rubescens.In this paper,we showed that ORI exerted significant protective ef-fects against hepatic steatosis,inflammation and fibrosis,which was dependent on LXRα signaling.It is reported that LXRα regulated lipid homeostasis between triglyceride(TG)and phosphatidylethanol-amine(PE)by promoting ATCL and EPT1 expression.Therefore,we implemented the lipidomic strategy and luciferase reporter assay to verify that ORI contributed to the homeostasis of lipids via the regulation of the ATGL gene associated with TG hydrolysis and the EPT1 gene related to PE synthesis in a LXRα-dependent manner,and the results showed the TG reduction and PE elevation.In detail,hepatic TG overload and lipotoxicity were reversed after ORI treatment by modulating the ATCL and EPT1 genes,respectively.Taken together,the data provide mechanistic insights to explain the bioactivity of ORI in attenuating TG accumulation and cytotoxicity and introduce exciting opportunities for developing novel natural activators of the LXRα-ATGL/EPT1 axis for pharmacologically treating hepatosteatosis and metabolic disorders.