Objective: This prospective study evaluated the feasibility of chemical exchange saturation transfer (CEST) MRI for assessing disease activity in thyroid-associated ophthalmopathy (TAO). Materials and Methods: A total of 88 patients with active TAO, 76 with inactive TAO, and 30 healthy controls were enrolled. CEST MRI-derived magnetization transfer ratio (MTR) and MTR asymmetry (MTRasym) at 1 ppm, 2 ppm, and 3.5 ppm were calculated. Clinical data, MTR, and MTRasym values for the extraocular muscles (one representative muscle per eye, yielding two measurements per participant) were compared among the groups. Spearman’s correlation was used to examine associations between imaging parameters and the clinical activity score (CAS) in patients with TAO. Logistic regression analysis was used to identify independent associations between imaging parameters and disease activity in patients with TAO (active vs. inactive). Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic performance for discriminating active from inactive TAO. Results: Patients with active TAO showed lower MTR values (P < 0.001) and higher MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) (all P < 0.001) compared with those with inactive TAO. MTR was negatively correlated with CAS (r = -0.402; P < 0.001), while MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) were positively correlated with CAS (r = 0.369, 0.350, and 0.349, respectively;all P < 0.001). MTR and MTRasym (1 ppm) were independently associated with TAO activity. The areas under the ROC curve (AUCs) for MTR and MTRasym (1 ppm) in discriminating active from inactive TAO were 0.772 and 0.730, respectively. Combining MTR with MTRasym (1 ppm) significantly improved diagnostic performance compared with either parameter alone, achieving an AUC of 0.805 (P = 0.029 and 0.001). Conclusion MTR and MTRasym (1 ppm) were independently associated with TAO activity. Their combination further enhanced diagnostic performance in distinguishing active from inactive TAO, suggesting their potential as quantitative imaging biomarkers to guide treatment in patients with TAO.

Objective To investigate the dynamic functional connectivity differences between insomnia patients and healthy controls in triple brain networks[the significant network(SN),the default mode network(DMN),and the executive control network(ECN)]using functional magnetic resonance imaging,and uncover their associations with cognitive ability.Methods Dynamic functional connectivity analysis was performed on functional magnetic resonance imaging data from 40 insomnia patients and 40 healthy controls.The changes in dynamic functional connectivity values were studied for SN,DMN,ECN[including the left executive control network(LECN)and the right executive control network(RECN)];the similarities and differences in time characteristic indicators such as time score,average dwell time,and conversion rate were explored;and their associations with clinical information were analyzed.Results The SN-LECN and DMN-RECN dynamic functional connectivity was significantly higher in insomnia patients than in healthy controls(P=0.013,0.047),while the RECN-LECN and RECN internal functional connectivity strength was lower in insomnia patients than in healthy controls(P<0.001).Additionally,the fractional time in state 2 in insomnia group was significantly higher than that in healthy controls(P<0.001),and it was positively correlated with the Pittsburgh sleep quality index(r=0.524,P=0.001).Conclusion Insomnia patients exhibit significant abnormalities in triple brain network dynamic functional connectivity,which may be related to abnormalities in cognitive control and sensory processing in insomnia patients.These findings provide a new perspective for further research on the neural mechanisms and potential intervention strategies for insomnia.

Objective:To analyze the epidemiological characteristics and influencing factors of single-cigarette use and dual cigarette-cigar use in China.Methods:This study was a cross-sectional study that selected 85 638 urban and rural residents who met the inclusion criteria from the 2018 China Health Literacy Survey as research subjects. An analysis was conducted on 21 849 users of cigarettes and cigars among them. Due to the small number of individuals who exclusively used cigars (247 cases), the research subjects were divided into two categories: exclusive cigarette users and dual users of cigarettes and cigars. The groups were categorized by age (18-34 years, 35-54 years, ≥55 years), gender (male, female), education level (primary school and below, junior high school and high school, university and above) and annual household income (<20 000 yuan, 20 000-<80 000 yuan, ≥80 000 yuan) to compare the tobacco usage rate and conduct subgroup analyses for each subgroup. Multivariate logistic regression analysis was employed, incorporating general demographic characteristic information to explore the influencing factors of exclusive cigarette use and dual use of cigarettes and cigars, respectively.Results:The rate of exclusive cigarette use in our country was 24.3%, while the dual use rate of cigarettes and cigars was 0.9%. The exclusive cigarette use rate and the dual use rate of cigarettes and cigars among males were significantly higher than those among females (48.25% vs 2.48%, and 1.84% vs 0.06%) (both P<0.001). For males, the high-risk factors for exclusive cigarette use included living in urban areas ( OR: 1.37, 95% CI: 1.23-1.54), being Han ethnicity ( OR: 1.73, 95% CI: 1.51-1.98), and having an annual household income ≥20 000 yuan ( OR: 1.54, 95% CI: 1.38-1.82) while having a junior high school education or higher was a protective factor ( OR: 0.68, 95% CI: 0.52-0.90). Age≥35 years ( OR: 3.36, 95% CI: 2.62-4.32) and having a junior high school education or higher ( OR: 1.30, 95% CI: 1.02-1.67) were risk factors for dual use of cigarettes and cigars in males. Among females, living in urban areas ( OR: 1.53, 95% CI: 1.19-1.97) and being Han ethnicity ( OR: 5.96, 95% CI: 4.47-7.96) were risk factors for exclusive cigarette use, while having a university education or higher was a protective factor ( OR: 0.28, 95% CI: 0.18-0.42). However, for female dual use of cigarettes and cigars, no significant effects were observed for any demographic characteristics. Conclusions:The use rate of cigarettes alone in China is significantly higher than that of cigarette-cigar dual use, and the rates of cigarette use alone and cigarette-cigar dual use in men are significantly higher than those in women. Tobacco use is being affected by sociodemographic factors, among which place of residence, ethnicity and education level are the main influencing factors of cigarette use alone, and gender, age and education level are the main influencing factors of cigarette-cigar dual use.

Objective To explore the characteristics of traditional Chinese medicine(TCM)syndrome elements in patients with chronic heart failure(CHF)and their correlation with long-term prognosis,thus to provide an objective basis for clinical treatment of CHF.Methods From January 2006 to July 2014,a retrospective analysis was carried out in 546 patients diagnosed as CHF in the Cardiology Department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences.TCM syndrome elements of the patents were determined based on the data collected by four diagnostic methods.Patients were followed up for a maximum of 1 330 days,and long-term prognosis was recorded.With the patient's death as the endpoint event,and the patients were divided into a survival group(291 cases)and a death group(255 cases)according to the endpoint event.The distribution of TCM syndrome elements in the two groups was observed,and differences in the combination patterns of TCM syndrome elements were compared.After that,the correlation between long-term prognosis and TCM syndrome elements in CHF patients was analyzed.Results(1)The age of patients in the death group was greater and serum N-terminal pro-brain natriuretic peptide(NT-proBNP)level was higher than that in the survival group,the differences being statistically significant(P＜0.01).In terms of New York Heart Association(NYHA)functional classification,the patients of death group had low proportion of heart function level Ⅲ while high proportion of heart function level Ⅳ in comparison with the patients of survival group,the differences being statistically significant(P＜0.05 or P＜0.01).Statistically significant differences were presented in the cardiac ultrasound indicators of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and right ventricular end-diastolic diameter(RVEDD)between the two groups(P＜0.05 or P＜0.01),while left atrial diameter(LA)showed no significant difference between the two groups(P＞0.05).In terms of underlying diseases,the proportion of coronary heart disease in the death group(87.45%)was higher than that in the survival group(80.76%),with a statistically significant difference(P＜0.05).No significant differences were presented in other underlying diseases(P＞0.05).(2)The death group had more cases of qi deficiency and yin deficiency syndrome elements while less cases of qi stagnation syndrome element than the survival group,and the differences were statistically significant(P＜0.05 or P＜0.01).The death group had higher proportions of syndrome element combinations such as qi deficiency and yin deficiency with blood stasis,yang deficiency and blood stasis with phlegm-heat,qi deficiency and yin deficiency with phlegm-heat,and yang deficiency and blood stasis with phlegm turbidity than the survival group,and the differences were statistically significant(P＜0.05 or P＜0.01).Conclusion CHF has the prognosis of developing into yin deficiency or yang deficiency.The death group has higher proportions of qi deficiency and yin deficiency with blood stasis syndrome,and yang deficiency and blood stasis with phlegm turbidity syndrome than the survival group,indicating that there is a poor prognosis,and more attention and early intervention should be done to avoid adverse events.

Objective To investigate the distribution patterns of traditional Chinese medicine(TCM)syndrome types in patients with chronic heart failure(CHF)complicated with chronic kidney disease(CKD),and to explore the correlation between TCM syndrome types and physicochemical indicators as well as the prognosis.Methods A total of 217 patients with CHF and CKD hospitalized in the Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences between January 2006 and March 2014 were included.Data from the four-examination methods of TCM were collected to determine TCM syndrome types.General information and physicochemical indicators of the patients were also recorded.SPSS 26.0 statistical software was used to analyze the distribution characteristics of TCM syndrome types and their relationships with general information,physicochemical indicators,and the prognosis.Results(1)Among the 217 patients,114 were male and 103 were female,with a male-to-female ratio of 1.11∶1,indicating similar incidence between genders.(2)The distribution of TCM syndrome types in descending order was as follows:yang deficiency with phlegm-stasis syndrome(23.04％),yin deficiency with phlegm-stasis syndrome(22.12％),blood stasis and phlegm turbidity syndrome(21.20％),qi and yin deficiency syndrome(17.51％),and qi deficiency with blood stasis syndrome(16.13％).(3)Regarding age,the blood stasis and phlegm turbidity syndrome group was the youngest,while the qi and yin deficiency syndrome group and the yin deficiency with phlegm-stasis syndrome group were relatively old.The differences between the blood stasis and phlegm turbidity syndrome group and the other two groups were statistically significant(P＜0.05).In terms of disease duration,the blood stasis and phlegm turbidity syndrome group had a shorter course than the yang deficiency with phlegm-stasis syndrome group,with a statistically significant difference(P＜0.01).Regarding mortality,the blood stasis and phlegm turbidity syndrome group had a lower mortality rate compared to the qi and yin deficiency syndrome,yin deficiency with phlegm-stasis syndrome,and yang deficiency with phlegm-stasis syndrome groups,with statistically significant differences(P＜0.01).(4)The N-terminal pro-brain natriuretic peptide(NT-proBNP)level in the qi and yin deficiency syndrome group was higher than that in the blood stasis and phlegm turbidity syndrome group.The estimated glomerular filtration rate(eGFR-EPI)level in the yin deficiency with phlegm-stasis syndrome,yang deficiency with phlegm-stasis syndrome,and qi and yin deficiency syndrome groups was higher than that in the blood stasis and phlegm turbidity syndrome group.The very low-density lipoprotein(VLDL)level in the yin deficiency with phlegm-stasis syndrome and yang deficiency with phlegm-stasis syndrome groups was higher than that in the qi and yin deficiency syndrome group.The blood chloride(Cl-)level in the qi and yin deficiency syndrome group was lower than that in the yin deficiency with phlegm-stasis syndrome group.All these differences were statistically significant(P＜0.05 or P＜0.01).Additionally,no statistically significant differences were observed among different syndrome types in terms of gender,time of death,platelet count(PLT),white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),C-reactive protein(CRP),uric acid(UA),blood potassium(K+),blood sodium(Na+),triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),ejection fraction(EF),fractional shortening(FS),serum creatinine(Scr),blood urea nitrogen(BUN),and New York Heart Association(NYHA)functional classification(P＞0.05).Conclusion In clinical assessment of patients with CHF and CKD,it is essential to focus on the transition between deficiency and excess syndromes and to emphasize the intervention for the underlying deficiency.Efforts should be made to delay disease progression,prolong the timeline of transformation from excess to deficiency,and extend survival.Furthermore,the phlegm-stasis concretion is the core pathogenesis in these patients.Based on the TCM theory of the spleen being the source of phlegm production,interventions for mixed deficiency-excess syndromes should not only eliminate pathogenic factors but also reinforce spleen qi.Concurrently,attention should be paid to accompanying symptoms such as blood stasis and qi deficiency.By addressing the root cause and cutting off the source of internal phlegm formation while ensuring pathways for its elimination,targeted treatment can be achieved through clarifying the etiology and pathogenesis.

Objective:To evaluate the effectiveness of empiric eradication therapy recommendations and medication principles for refractory infections based on the 2022 Helicobacter pylori ( H. pylori) infection treatment guidelines in China in clinical practice. Methods:A retrospective analysis was conducted to evaluate the eradication efficacy of H. pylori and the safety and treatment compliance among of 637 patients with refractory H. pylori infection in our center over the past 10 years. Risk factors affecting efficacy of H. pylori eradication were evaluated. Results:The overall eradication rate, incidence of adverse reactions and medication percentage of 14-day bismuth quadruple therapy were 92.3%, 40.3% and 92.2%, respectively. The eradication rate, incidence of adverse reactions, and proportion of administered treatments were as follows: 87.3%, 36.4% and 92.7% for amoxicillin+metronidazole; 91.1%, 39.2% and 93.7% for amoxicillin+tetracycline; 92.9%, 23.8% and 94.0% for amoxicillin+furazolidone; 92.1%, 47.1% and 90.0% for tetracycline+metronidazole; 94.5%, 41.7% and 92.0% for tetracycline+furazolidone, and 91.3%, 46.3% and 92.5% for furazolidone+metronidazole. Poor compliance was a risk factor for the failure of eradication therapy (94.7% vs. 64.0%, P<0.05). There was no statistically significant difference ( P>0.05) in the eradication rate among patients in terms of sex, age, body mass index, smoking status, alcohol consumption, previous eradication frequency, eradication interval, or eradication regimens. Conclusion:The empirical treatment regimens and medication principles recommended in the 2022 H. pylori infection treatment guidelines in China achieve good eradication efficacy, safety, and compliance.

Objective:To explore the relationship between intestinal bacterial overgrowth (SIBO) and ulcerative colitis (UC).Methods:From December 2023 to June 2024, 85 patients with UC from the Gastroenterology Department of the Luquan branch of the Second Hospital of Hebei Medical University were enrolled. The lactulose hydrogen-methane breath test was performed to assess the prevalence of SIBO. Clinical data, including basic information, clinical manifestations, endoscopic manifestations, inflammatory indicators, current medication regimen, and past medical history, were collected. Furthermore, the body mass index (BMI), modified Mayo score, and patient-reported outcome (PRO2) score were calculated to evaluate disease activity in each patient. The Student′s t-test, Chi-square test, non-parametric test, and multiple logistic regression were used to analyze the data and explore the relationship between SIBO and UC. Results:The incidence of abdominal pain and bloating in patients who were SIBO positive with UC was higher than in those who were SIBO negative [abdominal pain: 50.0%(10/20) vs. 23.1%(15/65), χ2=5.34, P=0.021; abdominal distension: 40.0% (8/20) vs. 13.8% (9/65), χ2=5.01, P=0.025]; the difference was statistically significant ( P<0.05). Patients who were SIBO positive with UC were more likely to develop hypoproteinemia and anemia than those who were SIBO negative [hypoproteinemia: 50.0% (10/20) vs. 15.4% (10/65), χ2=8.35, P=0.004; anemia: 35.0% (7/20) vs. 9.2% (6/65), χ2=5.98, P=0.014]; the difference was statistically significant ( P<0.05). In the intestinal methanogen overgrowth (IMO) positive group, the number of patients with UC with 1-2 stool times/day was higher, and the distribution of stool times between the IMO positive and IMO negative groups was significantly different ( χ2=6.45, P=0.040). Furthermore, combined hypoproteinemia and anemia were risk factors for SIBO in patients with UC (hypoproteinemia OR=4.331, 95% CI 1.117-16.799, P=0.034; anemia OR=5.515, 95% CI 1.231-24.700, P=0.026). Conclusions:We observed a clinical overlap between SIBO and UC. SIBO could be targeted to optimize the treatment of patients with UC in the future.

Objective:Utilizing the principles of mechanical vibrations dissections and low-temperature coagulation of harmonic scalpel, and combining the magnifying effect of 3D thoracoscopy and the advantage of low trauma, we used harmonic scalpel to harvest the left internal mammary artery (LIMA) under thoracoscopy, and explored the feasibility and early effect of harmonic scalpel in minimally invasive coronary artery bypass grafting (MICABG).Methods:A total of 488 patients who underwent MICABG from July 2021 to December 2023 in Dong E Hospital were collected. Among them, 347 patients was harvested using harmonic scalpel under thoracoscopy. Following anastomosis, the blood flow and pulsatility index (PI) from the graft to the target vessel were determined using a transit time flow meter (MiraQ, Medistim, Norway), and patency was checked. Data from 347 patients were analyzed.Results:All 347 patients were performed under non-extracorporeal circulation and successful graft patency was achieved in all patients. Analysis of 79 patients revealed a median time to LIMA acquisition of 32 min and a median length of acquisition of 15 cm. No graft-related events or complications occurred in any of the patients, and 2 patients died postoperatively. During a median follow-up of 12.1 months, only one patient experienced graft occlusion necessitating intervention.Conclusion:The utilization of harmonic scalpel for LIMA harvesting in MICABG is feasible and yields stable early results.

Objective To explore the real experiences of nutrition impact symptoms in esophageal cancer patients during diagnosis and treatment,and to provide references for developing nutritional management strategies.Methods Using purposive sampling,15 esophageal cancer patients admitted to the thoracic surgery department of a tertiary grade A hospital in Guangzhou from October to December 2024 were selected for semi-structured interviews.Thematic analysis was used for data analysis.Results 4 themes and 12 sub-themes were identified:①Multiple symptom perceptions:esophageal obstruction-dysphagia,appetite-affecting symptoms,multiple symptom over-lap,and individual differences in symptom perception.② Insufficient symptom cognition:overestimation of symptom controllability and biased symptom attribution.③ Negative emotional reactions:anxiety and fear about eating,frustration with declining eating function,and helplessness and guilt about losing control over eating.④ Di-verse symptom coping strategies:avoidance coping,adaptive coping,and active nutritional management.Conclusion The nutrition impact symptom experiences of esophageal cancer patients are complex and diverse.Healthcare professionals should promptly identify and assess nutrition impact symptoms,provide nutrition health education,strengthen psychological guidance,and develop culturally distinctive individualized nutritional management strategies.

One of the technical bottlenecks limiting the high yield of 1,4-butanediamine is the insufficient tolerance of strains to 1,4-butanediamine. Enhancing the tolerance of strains to 1,4-butanediamine is therefore a primary challenge that needs to be addressed for the construction of strains with high yields of 1,4-butanediamine. Staphylococcus pasteuri 326180 exhibits exceptional tolerance to high-concentration 1,4-butanediamine, serving as both an ideal model for studying the mechanism underlying the 1,4-butanediamine tolerance and a novel host for constructing strains capable of efficiently producing 1,4-butanediamine. However, for both the research on the tolerance mechanism and the modification of chassis strains, gene editing of S. pasteuri needs to be carried out at the molecular level. The research objective of this paper is to establish a genetic manipulation system for S. pasteuri, laying foundation for subsequent studies on tolerance mechanism and the modification of chassis strains. This study systematically optimized the electroporation conditions, including key parameters such as the growth phase of cells, electric field strength, electroporation buffer, and recovery medium, successfully establishing an electroporation method for S. pasteuri. Additionally, we constructed the gene editing plasmid pCpfOA by replacing the resistance expression cassette, optimized the selection markers for gene editing, and finally established a CRISPR/Cpf1-based gene editing technology for S. pasteuri, achieving an editing efficiency of 90%. The genetic manipulation system of S. pasteuri established in this study provides technical support for research into the tolerance mechanism of this bacterium and the genetic modification of chassis strains.
Staphylococcus/drug effects* ; Gene Editing/methods* ; Electroporation/methods* ; Plasmids/genetics* ; CRISPR-Cas Systems ; Genetic Engineering/methods*