Objective:To explore the clinical characteristics and identification of the independent risk factors for disease progression in patients with anti-gp210 antibody-positive primary biliary cholangitis (PBC).Methods:A retrospective cohort study was performed. A total of 323 cases with PBC diagnosed in Tianjin Medical University General Hospital from January 2013 to June 2023 (125 patients with anti-gp210 antibody-positive and 198 patients with anti-gp210 antibody-negative) were included. Baseline and follow-up data were collected. The independent sample t-test and Mann-Whitney U rank sum test were used for comparison between groups of continuous data. The χ2 test was used to compare the data between groups for the count data. The Pearson test was used for correlation analysis between continuous variables. The Kaplan-Meier method was used to analyze the disease progression-free survival rate. The Cox regression model was used to analyze the risk factors for disease progression. Results:The male proportion (11.2% vs. 5.1%, P=0.040) and IgM level [3.29(1.88, 4.80) g/L vs. 2.56(1.44, 3.87) g/L, P=0.019] were significantly higher in patients with PBC with positive anti-gp210 antibodies than those of the negative group. Histopathological analysis showed that the Scheuer score [1(0,3) vs. 0(0,2)], bile duct inflammation [(2(1,3) vs. 1(1,2)] and bile duct reaction score [(2(1,3) vs. 1(1,2)] were higher in the positive group than those of the negative group ( P<0.05), and the maturity of the tertiary lymphoid structure was higher ( P=0.011). Kaplan-Meier analysis showed that the 5-year disease-free survival rate was significantly lower in patients with positive anti-gp210 antibodies than that of the negative group (55.8% vs. 79.7%, P=0.006) at a median follow-up of 3(2,6) years. Multivariate Cox regression analysis showed that γ-glutamyl transferase [ HR=1.002 (95% CI: 1.000～1.003)] and platelet count [ HR=0.993 (95% CI: 0.988～0.999)] were the independent influencing factors for disease progression in patients with anti-gp210 antibody-positive PBC ( P=0.002, 0.017). Conclusion:Patients with anti-gp210 antibody-positive PBC have more severe clinical pathological manifestations and a higher risk of disease progression. Higher levels of γ-glutamyl transferase and lower platelet counts during the first visit are independent risk factors for disease progression in patients with anti-gp210 antibody-positive PBC, which can be used as dynamic monitoring indicators for this population, suggesting the need for early intensive intervention.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To investigate whether a distant-image screen display has an inhibitory effect on children's nearwork-induced transient myopia (NITM).Methods:A prospective self-controlled study was conducted.From March 2022 to March 2023, 120 pediatric volunteers, aged 4 to 12 years, with a mean age of (5.0±2.2) years, were recruited at Tianjin Eye Hospital.Subjects with refractive errors underwent tests wearing corrective lenses.Subjects were categorized based on accommodative response into three groups: accommodative lead (16 subjects, 32 eyes), accommodative equivalent (48 subjects, 96 eyes), and accommodative lag (56 subjects, 112 eyes). Subjects were also divided by myopia status into myopic (20 subjects, 40 eyes) and non-myopic (100 subjects, 200 eyes) groups.Using a random number table, the subjects were assigned to first view video images for 30 minutes on either an iPad or a distant light screen display.After a two-hour rest between the two sessions, the viewing modality was switched.Visual acuity, refractive power, lens thickness, NITM degree, and NITM recovery time were recorded before and after viewing videos via both modalities.Visual acuity, lens thickness, NITM degree, and recovery time following video viewing via the two modalities across different accommodation types and refractive types were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.2022099), and all guardians of the subjects provided informed consent for this study.Results:The NITM degree and recovery time after watching videos on a distant-image screen display were (0.00±0.36)D and (25.33±15.48) seconds, respectively.The NITM degree and recovery time after watching videos on an iPad were (-0.20±0.40)D and (33.33±17.68) seconds, respectively.Compared with watching videos on an iPad, watching videos on a distant-image screen display resulted in better immediate distance vision, lower myopic refractive power, thinner lens thickness, lower NITM degree, and shorter recovery time, with statistically significant differences ( t=-7.688, 7.842, -4.210, 2.331, -2.887; all P<0.05). After viewing the distant-image screen display and iPad, there was no significant difference in the overall comparison of visual acuity change, lens thickness change, NITM degree and NITM recovery time among the accommodative lead, accommodative equivalent and accommodative lag groups ( H=0.584, 4.923, 1.514, 2.634; all P>0.05. H=3.265, 1.884, 1.606, 1.922; all P>0.05), and there was also no significant difference between the myopic and non-myopic groups ( Z=-1.555, -1.700, -0.254, -2.336; all P>0.05. Z=-1.125, -0.446, -1.033, -0.759; all P>0.05). Conclusions:The use of a distant-image screen display can reduce the NITM caused by near viewing and shorten the NITM recovery time, which is effective for children with different refractive states and accommodative types.

Objective To explore the differences between various monitoring methods of anesthetic depth during total knee arthroplasty under general anesthesia combined with ultrasound-guided femoral nerve block.Methods From January 2021 to March 2021,60 patients undergoing total knee arthroplasty under ultrasound-guided femoral nerve block combined with general anesthesia were randomly divided into IoC group and BIS group,30 cases in each group.IoC group awareness index(Index of Consciousness,IoC)monitoring;bIS group was monitored by bispectral index(BIS)to guide the use of sedative and analgesic drugs during operation.The primary outcome measure was the time of first eye opening,and the secondary outcome measures included the average target concentration of sedative and analgesic drugs during operation,the number of perioperative adverse events and the quality of recovery.Results The average difference in the first eye opening time between the two groups was 1.57 min(95％confidence interval:-0.61～2.63).The upper limit of the 95％confidence interval was 2.63 min,which was less than the non-inferiority boundary value(δ=2.8 min),suggesting that the non-inferiority hypothesis of the main efficacy indicators was established.There was no significant difference in the dosage of propofol and sufentanil and the quality of recovery between the two groups(P＞0.05).The target-controlled concentration of remifentanil in IoC group(8.55±1.45)ng/ml was significantly higher than that in BIS group(4.62±0.96)ng/ml,and the difference was statistically significant(P＜0.05).At the same time,compared with BIS group,the number of stress hypertension(10 vs 32)in IoC group was significantly reduced and the number of bradycardia(17 vs 6)was significantly increased,the difference was statistically significant(P＜0.05).At the same time,no intraoperative awareness and body movement were found in both groups.Conclusion During total knee arthroplasty surgery under general anesthesia combined with ultrasound-guided femoral nerve block:1.IoC monitoring is not inferior to BIS monitoring in terms of awakening speed and quality.2.The increased use of remifentanil in the IoC group and the reduced incidence of hypertension may indicate that IoC monitoring is more sensitive to intraoperative nociceptive stimuli.

Aging is comprehensively influenced by multiple fac-tors such as internal genes,cellular metabolism,external envi-ronment,and lifestyle habits.Among them,epigenetic regula-tion plays a core role.Epigenetic modifications,including DNA methylation,histone modification,heterochromatin remodeling,and non-coding RNA regulation,act in concert with the three-di-mensional genome architecture to precisely regulate gene expres-sion.This review elaborates on the factors influencing epigenetic regulation,as well as the mechanisms of how epigenetics affects the occurrence of organismal aging and the corresponding inter-vention strategies,providing relevant insights for uncovering the mechanisms of aging and preventing/treating aging-related disea-ses.

Objective:To analyze the molecular characteristics of the virus in a local outbreak of dengue fever in Jiangsu province in 2023, and to provide a basis for the prevention and control of the outbreak.Methods:Serum samples were collected from suspected dengue patients in the acute phase of the outbreak for virus detection and serotyping by real-time fluorescence quantitative RT-PCR (RT-qPCR). Positive specimens were amplified with full-length genomic fragments and subjected to second-generation sequencing and related evolutionary analyses.Results:Four confirmed cases of dengue were found in Changzhou city, Jiangsu province, from October 18 to 21, 2023, with epidemiological association between the cases, which was recognized as a dengue outbreak. The serum RT-qPCR result of the four cases were all dengue type 1, and the whole genome sequences of three of the cases were obtained. The evolutionary tree of the E gene and the whole genome showed that the three sequences were located in the 3rd branch of the 1-I genotype, which is similar to the genotype 1-I. The genome-wide sequences of the E gene and the genome-wide evolution tree showed that the three sequences were located in the 3rd branch of the 1-I genotype, which is similar to the genome-wide genotype 1-Ⅰ. The E gene and the genome-wide evolutionary tree showed that all three sequences were located on branch 3 of genotype 1-Ⅰ, with high sequence similarity to the dengue virus epidemic strains in Guangdong and Yunnan provinces in 2023. Amino acid variant site analysis showed that there were 16 branch-specific amino acid site changes in the sequences of the three cases, among which the structural proteins, C protein and prM protein, had one variant site each, E protein had two, and the non-structural proteins had the largest number of NS5 variant sites (9).Conclusions:The local outbreak in Jiangsu was caused by dengue fever type 1 virus, with high nucleotide sequence similarity to strains from other regions of China, and amino acid site alterations.

Objective:To investigate whether a distant-image screen display has an inhibitory effect on children's nearwork-induced transient myopia (NITM).Methods:A prospective self-controlled study was conducted.From March 2022 to March 2023, 120 pediatric volunteers, aged 4 to 12 years, with a mean age of (5.0±2.2) years, were recruited at Tianjin Eye Hospital.Subjects with refractive errors underwent tests wearing corrective lenses.Subjects were categorized based on accommodative response into three groups: accommodative lead (16 subjects, 32 eyes), accommodative equivalent (48 subjects, 96 eyes), and accommodative lag (56 subjects, 112 eyes). Subjects were also divided by myopia status into myopic (20 subjects, 40 eyes) and non-myopic (100 subjects, 200 eyes) groups.Using a random number table, the subjects were assigned to first view video images for 30 minutes on either an iPad or a distant light screen display.After a two-hour rest between the two sessions, the viewing modality was switched.Visual acuity, refractive power, lens thickness, NITM degree, and NITM recovery time were recorded before and after viewing videos via both modalities.Visual acuity, lens thickness, NITM degree, and recovery time following video viewing via the two modalities across different accommodation types and refractive types were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.2022099), and all guardians of the subjects provided informed consent for this study.Results:The NITM degree and recovery time after watching videos on a distant-image screen display were (0.00±0.36)D and (25.33±15.48) seconds, respectively.The NITM degree and recovery time after watching videos on an iPad were (-0.20±0.40)D and (33.33±17.68) seconds, respectively.Compared with watching videos on an iPad, watching videos on a distant-image screen display resulted in better immediate distance vision, lower myopic refractive power, thinner lens thickness, lower NITM degree, and shorter recovery time, with statistically significant differences ( t=-7.688, 7.842, -4.210, 2.331, -2.887; all P<0.05). After viewing the distant-image screen display and iPad, there was no significant difference in the overall comparison of visual acuity change, lens thickness change, NITM degree and NITM recovery time among the accommodative lead, accommodative equivalent and accommodative lag groups ( H=0.584, 4.923, 1.514, 2.634; all P>0.05. H=3.265, 1.884, 1.606, 1.922; all P>0.05), and there was also no significant difference between the myopic and non-myopic groups ( Z=-1.555, -1.700, -0.254, -2.336; all P>0.05. Z=-1.125, -0.446, -1.033, -0.759; all P>0.05). Conclusions:The use of a distant-image screen display can reduce the NITM caused by near viewing and shorten the NITM recovery time, which is effective for children with different refractive states and accommodative types.

Aim To explore the key components and mechanisms of Lizhong decoction in treating rats with cold-damp diarrhea based on network pharmacology,molecular docking technology and animal experiments.Methods By literature review and database collec-tion,the components of Lizhong decoction,therapeutic targets,and the mapping with diarrhea disease targets were conducted to construct an intersection target pro-tein-protein interaction network for screening core tar-gets,and GO and KEGG pathway enrichment analysis was performed to build an"active component-target-pathway"network,followed by molecular docking vali-dation.Forty-eight rats were randomly divided into the normal control group(K),model group(DG),Lizhong decoction group(LZDG),and Pulsatilla decoction group(BTDG).Subsequently,a rat cold-damp diar-rhea model was established using Senna combined with low-temperature high-humidity environment,and the rats were intervened with Lizhong decoction and Pul-satilla decoction.HE staining was used to detect path-ological changes in intestinal tissue,ELISA was em-ployed to measure the levels of peripheral blood IL-6,IL-10,IL-1 β,and TNF-α,and western blot was used to determine the expression of colon tight junction pro-teins.Results Network pharmacology initially identi-fied 125 compounds in Lizhong decoction,5 186 drug target components,438 disease targets,and 60"drug-disease"shared targets.GO and KEGG enrichment a-nalysis showed that signaling pathways such as IL-17 and TNF were highly enriched.Molecular docking in-dicated that the core components of the drug had good binding activity with corresponding key targets.Liz-hong decoction could effectively improve the clinical symptoms of rats with cold-damp diarrhea,and com-pared with the DG group,the diarrhea rate,diarrhea in-dex,and other related indicators also gradually de-creased to normal levels.Compared with the DG group,the LZDG group showed reduced inflammation levels and a recovery in energy metabolism levels.Conclusion It can regulate targets such as MMP9 and IL-17 signaling pathways through multi-components like Calycosin and formononetin to exert its therapeutic effect on cold-damp diarrhea.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma.Methods:A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared.Results:A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups ( P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant ( χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm2/min VS cecum group 0.24 cm2/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion:Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.