ObjectiveTo investigate the effects of modified Buyang Huanwu Tang on cerebral ischemia-reperfusion injury （CI/RI） in mice via the PTEN-induced putative kinase 1/E3 ubiquitin ligase （PINK1/Parkin） signaling pathway-mediated mitophagy， and to explore the underlying mechanism by which modified Buyang Huanwu Tang improves CI/RI. MethodsSeventy-two male C57BL/6J mice were randomly divided into six groups （n = 12 per group）： Sham-operated group， middle cerebral artery occlusion/reperfusion （MCAO/R） model group， low-， medium-， and high-dose modified Buyang Huanwu Tang groups （8.84， 17.68， 35.36 g·kg^-1·d^-1）， and an aspirin group （13.00 mg·kg^-1·d^-1）. Neurological deficit scores were assessed using the Zea-Longa method. Cerebral infarct volume ratio was measured by 2，3，5-triphenyltetrazolium chloride （TTC） staining. Histopathological changes and neuronal injury in brain tissues were observed using hematoxylin-eosin （HE） staining and Nissl staining. Apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL） assay. Mitochondrial ultrastructure in brain tissue was observed by transmission electron microscopy （TEM）. Serum levels of superoxide dismutase （SOD） and malondialdehyde （MDA） were determined by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expression levels of PINK1， Parkin， microtubule-associated protein 1 light chain 3B （LC3B， LC3Ⅱ/Ⅰ）， and p62 in brain tissues were detected by real-time quantitative reverse transcription PCR （Real-time PCR） and Western blot， respectively. ResultsCompared with the sham-operated group， the MCAO/R model group showed significantly increased neurological deficit scores and cerebral infarct volume ratios （P<0.01）. Severe cortical injury on the infarct side was observed， characterized by decreased neuronal density， cytoplasmic vacuolation， nuclear pyknosis， a marked reduction in Nissl bodies， dissolution of Nissl bodies in the cytoplasm of some pyramidal neurons， and blurred cellular boundaries. The number of TUNEL-positive cells increased significantly （P<0.01）. Mitochondria exhibited cristae membrane rupture and matrix vacuolation， with rupture of the outer mitochondrial membrane and formation of autophagosomes， the number of which increased significantly. Serum SOD activity decreased significantly （P<0.01）， while MDA content increased significantly （P<0.01）. In infarcted brain tissues of model mice， the relative mRNA expression and protein levels of PINK1， Parkin and LC3B were significantly increased （P<0.05， P<0.01）， whereas p62 mRNA and protein expression were significantly decreased （P<0.05， P<0.01）， showing statistical significance. Compared with the model group， all treatment groups showed significantly decreased neurological deficit scores and cerebral infarct volume ratios （P<0.01）. Neuronal density increased significantly， cytoplasmic vacuolation was alleviated， nuclear morphology tended to be more regular and clearer， Nissl body density increased significantly with reduced dissolution and improved contour clarity. The mitochondrial cristae structure was partially restored， with some mitochondria showing autophagosome encapsulation， and the degree of mitochondrial damage was alleviated. Serum SOD activity increased significantly （P<0.01）， while MDA content decreased significantly. The mRNA and protein expression levels of PINK1， Parkin， and LC3Ⅱ/Ⅰ were significantly increased （P<0.05， P<0.01）， while p62 mRNA and protein expression in the low- and medium-dose modified Buyang Huanwu Tang groups were significantly decreased （P<0.05， P<0.01）， showing statistical significance. ConclusionModified Buyang Huanwu Tang can upregulate the protein expression levels of PINK1， Parkin， and LC3Ⅱ/Ⅰ and downregulate p62 protein expression， suggesting that it may improve CI/RI by regulating the expression of proteins related to the PINK1/Parkin signaling pathway. Regulation of the mitophagy pathway may be one of the mechanisms by which modified Buyang Huanwu Tang alleviates CI/RI in mice.

OBJECTIVES: Rheumatoid arthritis (RA) imposes a heavy burden on individuals, families, and society. This study analyzed the incidence and mortality trends of RA in China from 1990 to 2023 to provide epidemiological evidence for precise prevention and control. METHODS: Data on RA incidence, age-standardized incidence rate (ASIR), deaths, and age-standardized mortality rate (ASMR) in China by sex and age group from 1900 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression was used to analyze trends in ASIR and ASMR. An age-period-cohort model was constructed using R4.3.1 to evaluate longitudinal age trends and estimate relative risk (RR) values for period and cohort effects. RESULTS: In 2021, the number of RA cases, ASIR, deaths, and ASMR in China were 247 300, 13.70 per 100 000, 10 300, and 0.54 per 100 000, respectively. From 1990 to 2021, the ASIR of RA increased annually among both females and males, with average annual percentage changes (AAPCs) of 0.44% and 0.72%, respectively. Over the same period, ASMR declined in the total population and among females, with AAPCs of -0.78% and -1.19%, while the change in males was not statistically significant. Age-period-cohort analysis showed that the peak incidence occurred in women aged 60-64 years and men aged 75-79 years, and mortality increased with age. The period effect for incidence rose in both sexes, reaching 1.10 [95% confidence interval (CI) 0.94 to 1.27] for females and 1.14 (95% CI 1.02 to 1.27) for males during 2017 to 2021, compared with 2002 to 2006. The mortality period effect RR exhibited a downward-upward-downward pattern, decreasing to 0.56 (95% CI 0.52 to 0.61) in females and 0.75 (95% CI 0.68 to 0.82) in males in 2017 to 2021. Cohort analysis indicated that the highest incidence risk occurred in individuals born during 2012 to 2016, while the cohort effect RR for female RA mortality showed a continuous decline beginning with the 1922 to 1926 birth cohort. CONCLUSIONS The incidence and mortality risks of RA in China have continued to decline. However, with the aging of the population, the incidence and mortality risks among the elderly have increased. Middle-aged women and elderly men should receive focused attention. Health authorities should strengthen education, prevention, and screening among middle-aged women and enhance disease monitoring in elderly populations to reduce the national burden of RA.
Humans ; China/epidemiology* ; Arthritis, Rheumatoid/epidemiology* ; Incidence ; Male ; Female ; Middle Aged ; Adult ; Aged ; Cohort Studies ; Mortality/trends* ; Age Distribution ; Age Factors ; Aged, 80 and over ; Adolescent

Objective: To explore the effects of group sports game intervention on social ability and quality of life of children with austism spectrum disorders (ASD),so as to provide reference for rehabilitation intervention of social and quality of life of children with ASD. Methods: From September 2021 to January 2022, 72 children with ASD aged 4-6 in the children s rehabilitation department of Xiangyang Central Hospital were selected to participate in the study, and were randomly divided into experimental group ( n =36) and control group ( n =36). The control group received routine rehabilitation training (including individual sports game training), and the experimental group replaced individual sports game training with group sports game training on the basis of routine rehabilitation.The course content mainly included three parts: warm up before class, group sports games and relaxation after class. The course combined social skills with sports games, and was carried out in a group form (divided into 12 groups with 3 people in each group), and was trained five times a week for 60 minutes, for a total of 12 weeks. The scores of Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC), Social Responsiveness Scale (SRS) and Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales (PedsQL 4.0) were observed before and after treatment. t-test and χ 2 test were used for statistical analysis. Results: There was no significant difference in SRS scores between the experimental group and the control group before intervention ( t =-0.63, P >0.05). After the intervention, the total response rate in the experimental group was 83.33 %, higher than 41.67% in the control group χ 2=13.33, P <0.05),and the SRS scores decreased in the experimental group and control group ( t =17.75,8.71, P <0.05). The SRS scale score of the experimental group Social perception (17.67±4.12) , social cognition (30.33±4.99) , social communication (50.33±9.39) , social motivation (24.25±6.78) scores and total scores ( 152.67± 25.82) were lower than those of the control group(22.17±5.34，36.00±4.13，62.58±11.07，34.42±7.13，186.33±29.03)( t = -4.88，-2.03，-2.13，-3.58，-3.01， P ＜0.05).After the intervention, the scores of social function (53.33±18.01) and total score (283.83±51.83) on PedsQL 4.0 scale in experimental group were higher than those in control group(23.33±15.13，218.00±39.01) ( t =4.42，3.52， P ＜0.05). After the intervention, Autism Treatment Evaluation Scale (ATEC) scores of experimental groups(44.33±14.72) was lower than that in control group ( 59.33±16.95)( t =-2.32, P ＜0.05). Conclusion The intervention of group sports game has a significant effect on improving social ability and life quality of children with ASD.

Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. Methods The Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.

ObjectiveTo explore the method of optimizing the performance of traditional Chinese medicine （TCM） syndrome diagnostic models using Stacking ensemble learning. MethodsTaking the construction of TCM syndrome diagnostic model for lung cancer as an example， 2598 cases of clinical symptoms and signs from lung cancer patients in 9 hospitals were used as independent variables （i.e.， feature variables）， TCM syndrome information as dependent variables， and the clinical data were divided into training set and testing set in 8：2 ratio according to random number table method using Python 3.7 software. The stable features of TCM syndrome of lung cancer were screened using chi-square test， Spearman's correlation test， and Least Absolute Shrinkage and Selection Operator （LASSO） logistic regression analysis； nine machine learning algorithms are trained， including support vector machines （SVMs）， k-nearest neighbors （KNN） algorithm， Random Forest （RF）， Extremely Randomized Trees， Extreme Gradient Boosting （XGBoost）， Lightweight Gradient Boosting （LightGBM）， Adaptive Boosting （AdaBoost）， Gradient Boosting （GB） and the multi-layer perceptron （MLP）， to obtain 9 basic models. Four models with better performance were screened out from the above basic models and fused to form a fusion model by using the Stacking ensemble learning， and the fusion model was trained twice by the above nine machine learning algorithms and evaluated by accuracy rate， micro-average ROC curves， area under the curve （AUC）， and confusion matrix metrics， to screen the optimal diagnostic model. ResultsAfter data processing， 79 stable features and 13 TCM syndromes were obtained. In the basic model training， the comprehensive performance of RF， ExtraTrees， MLP and SVM basic models were better， so the predicted distributions of the syndromes of these four models were used as the secondary training data， and nine fusion models were obtained based on the Stacking ensemble learning （SVM， KNN， RF， ExtraTree， XGBoost， LightGBM， GB， AdaBoost， MLP）. Among them， the XGBoost fusion model performed the best， with an accuracy of 0.850 and 0.838 in the training set and test set， respectively， an overfitting difference of 0.012， and an area under the micro-average ROC curve of 0.996. All fusion models showed an improvement in accuracy and area under the micro-average ROC curve compared with the base model in the test set. ConclusionTaking the TCM syndrome information of lung cancer as an example， the XGBoost fusion model has significant advantages in improving the diagnostic performance of TCM syndrome information of lung cancer through Stacking ensemble learning. It can be seen that the advantages of Stacking ensemble learning to integrate multiple models and effectively improve the diagnostic efficiency of TCM diagnostic models， which provided a methodological reference for similar studies.

ObjectiveTo conduct a bibliometric analysis on the research status of occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") severity assessment indicators. Methods The domestic and foreign articles on the research of pneumoconiosis severity assessment indicators were accessed from China National Knowledge Infrastructure, Wanfang Data, VIP Database, China Biomedical Literature Service System, PubMed, Cochrane Library, and Web of Science. The methodological quality evaluation and analysis of severity assessment indicators were performed with the relevant articles. Results A total of 88 relevant articles on pneumoconiosis severity assessment indicators were included. The overall evaluation of the literature with good-, moderate-, and poor-quality articles accounted for 18.18%, 69.32%, and 12.50%, respectively. The median sample size reported in each article was 86 cases. The articles reporting the stage of pneumoconiosis accounted for 81.82%, and 80.68% reported the types of pneumoconiosis which was mainly simple silicosis and coal worker's pneumoconiosis. Only 12 articles reported two or more types of pneumoconiosis. A total of 122 severity assessment indicators in four categories were reported in 88 articles, including 99 physiological and biochemical indicators, 10 imaging indicators, six symptoms and signs indicators, and seven other indicators. The articles used a single severity assessment indicator to assess the severity of pneumoconiosis accounted for 76.14%, while 23.86% of the articles used multiple severity assessment indicators, and only 5.68% of the articles selected specific severity assessment indicators for pneumoconiosis patients in different stages. Conclusion The quality of research on pneumoconiosis severity assessment is relatively low. The applicability of the combined use of severity assessment indicators is poor and confused.

Objective To observe whether the IL-23/Th17 inflammatory pathway is involved in the development of calcific aortic valve disease,and whether secukinumab can delay the progression of calcific aortic valve disease by inhibiting this pathway.Methods Forty-seven mice were divided into a blank control group,model group,and secukinumab group according to the random number table method.The blank control group was fed normal chow,while the model group and secukinumab group were fed pro-calcification chow for 16 weeks to establish a calcific aortic valve disease model.After intervention with secukinumab for 4 weeks,peak flow velocity changes in the aortic valves were detected under Doppler ultrasonography in all mice.Relevant indexes were determined by hematoxylin and eosin staining,Von Kossa staining,immunohistochemical staining,ELISA,and qPCR.Results Compared with the model group,the secukinumab group showed significantly reduced peak flow velocity(P＜0.05)and serum IL-6,IL-17,and IL-23 levels(P＜0.05)in the aortic valve.Compared with the secukinumab group,the model group's leaflet thickness was significantly increased,and there were more calcium deposits.Immunohistochemical result showed that macrophage infiltration(P＜0.05),IL-17A(P＜0.05)and IL-23(P＞0.05)levels in the valve leaflets were reduced in the secukinumab group compared with the model group.PCR result suggested that the expression of STAT3,BMP-2,and α-SMA mRNA was significantly lower in the secukinumab group than the model group(P＜0.05).Conclusions The IL-23/Th17 inflammatory pathway is involved in the pathogenesis of calcific aortic valve disease.The inflammation,fibrosis,osteogenic differentiation,and calcification of mouse valves were alleviated after intervention with secukinumab,which may delay disease progression by inhibiting the IL-23/Th17 inflammatory pathway.

Objective:To investigate the factors that influence the occurrence of complications following deep inferior epigastric perforator (DIEP) flap breast reconstruction, and to determine whether these complications have an impact on the patient's quality of life.Methods:The clinical and follow up data from patients who underwent DIEP flap breast reconstruction at the Department of Breast, Affiliated Cancer Hospital of Zhengzhou University from Dec 2019 to Mar 2023 were retrospectively analyzed.Results:A total of 85 patients underwent DIEP flap breast reconstruction, including 71 stage Ⅰ reconstructions and 14 stage Ⅱ reconstructions. Postoperative complications occurred in 22 cases 25.9%, including flap complications in 11 cases (12.9%) and abdominal donor site complications in 11 cases (12.9%). Univariate and multivariate analyses showed that the overall incidence of complications was associated with high BMI and early surgery ( P<0.05). Flap complications were associated with high BMI, surgery performed at initial phase, and the use of internal mammary vascular branches as recipient vessels ( P<0.05). Abdominal complications were associated with previous abdominal surgery scars ( P<0.05). BREAST-Q scores showed no significant differences between the surgical complication group and the no complication group in terms of breast satisfaction, mental health, physical health-chest, physical health-abdomen, satisfaction with abdomen, sexual health, etc. ( P>0.05). Conclusions:DIEP flap breast reconstruction has a significant learning curve. The patient's own clinical characteristics (such as BMI and abdominal incision scars) and intraoperative choices (such as the selection of recipient vessels) may influence the occurrence of postoperative complications. However, the presence of postoperative complications does not appear to have an impact on patient-reported outcomes.

Objective:To explore the value of contrast enhancement T1 fluid-attenuated inversion recovery sequence (CE-T1FLAIR) based on modulated flip angle technique in refocused imaging with extended echo train (MATRIX) in detecting metastases.Methods:One hundred and seventy-six patients with pathologically diagnosed malignant tumors and brain metastases accepted enhanced 3.0T MRI scan in Department of Medical Imaging, He'nan Provincial Cancer Hospital from October 2023 to February 2024 were enrolled. Lianying's intelligent brain metastasis AI-assisted detection system and sequences of MATRIX CE-T1FLAIR, 3D GRE_fsp CE-T1FLAIR and FSE CE-T1FLAIR were used to detect the brain metastasis lesions, respectively. Length of the lesions was measured according to Lianying's intelligent brain metastasis AI-assisted detection system, and all lesions were divided into 3 categories: <3 mm, 3-10 mm, and >10 mm. Differences in detection rate in brain metastases of different lengths and locations among the 3 sequences were compared.Results:Detection rates of MATRIX CE-T1FLAIR, 3D GRE_fsp CE-T1FLAIR, and FSE CE-T1FLAIR in brain metastases were 99.67%, 90.52%, and 71.02%, which were decreased successively, with significant differences ( P<0.05). Detection rates of MATRIX CE-T1FLAIR, 3D GRE_fsp CE-T1FLAIR and FSE CE-T1FLAIR in brain metastases with length<3 mm (99.24%, 79.95% and 46.45%) or length of 3-10 mm (100%, 98.19% and 87.53%) were decreased successively, with significant differences ( P<0.05). Detection rates of MATRIX CE-T1FLAIR (100%, 80.56% and 64.24%), 3D GRE_fsp CE-T1FLAIR (100%, 97.25% and 76.11%), and FSE CE-T1FLAIR (100%, 91.18% and 70.59%) in metastases at the superficial area of the brain convexity, gray-white matter junction area, and cerebellum were decreased successively, with significant differences ( P<0.05). Detection rates of FSE CE-T1FLAIR in brain metastases in the basal ganglia and brainstem (69.33% and 50%) were significantly lower than those of MATRIX CE-T1FLAIR and 3D GRE_fsp CE-T1FLAIR (97.33% and 92.86%; 88% and 78.57%, P<0.05). Conclusion:MATRIX CE-T1FLAIR sequence is better than 3D GRE_fsp CE-T1FLAIR and FSE CE-T1FLAIR sequences in detecting brain metastases, especially for metastases with length<10 mm and metastases located at the superficial area of the brain convexity, gray-white matter junction area and cerebellum.

Objective:To investigate the clinical application effect of internal mammary artery perforator (IMAP) as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap (DIEPF) immediately after breast cancer surgery.Methods:From May 2020 to May 2023, a total of 18 patients with DIEPF breast reconstruction using IMAP as recipient vessels were selected from the Department of Breast Disease of Henan Cancer Hospital. The patients were 31 to 50 years old, with an average of 41.5 years old. The stages of breast cancer were cT is/1-2N 0-2M 0, and all of the patients received immediate breast reconstruction after the breast cancer surgery. The size of flaps were from 9.0 cm × 26.0 cm to 15.0 cm × 38.0 cm. Preoperative chest and abdominal wall CTA were performed to identify the location of intercostal space and the calibre of IMAP. Intraoperatively, the number of IMAP, the diameters of corresponding arteries and accompanying veins in the recipient site were recorded. All patients were included in the scheduled postoperative follow-up through outpatient clinic or via WeChat. The quality of flap survival was evaluated, the condition of breast appearance and recovery of the abdominal donor site were evaluated according to the breast cancer patient reported outcome measures (BREAST-Q). Results:All the 18 patients had the IMAP visualised in surgery, with 13 had the IMAP located at the second intercostal space and 3 at the third intercostal space. The other 2 patients were found with the IMAP located in both the second and third intercostal spaces, in which 1 was found that both of IMAP were suitable for anastomosis. It was also found that there was 1 accompanying vein in 15 breasts and 2 accompanying veins in 2 breasts. One breast had found without an accompanying vein. The diameters of arteries were 1.1 mm±0.1 mm and that of the veins were 1.8 mm±0.3 mm. The average follow-up period was 28 months, ranged from 6 to 40 months. Of the 18 flaps, 17 were completely survived. Venous compromise occurred in 1 flap due to extensive venous thrombosis, and it was replaced with a breast implant. No patient experienced concave deformities in the reconstructed breasts. Seventeen patients with an average BREAST-Q score of 94.4. One patient with a BREAST-Q score of 79.0.Conclusion:IMAP can serve as a reliable recipient vessel for immediate breast reconstruction with DIEPF after breast cancer surgery. With strict selection criteria, this technique could be put on further trials with larger sample size and multi-centres.