Background The increasing demand for emergency services coupled with the special working environment has exacerbated occupational stress and work-related rumination among emergency medical dispatchers, which is noteworthy for its impact on dispatchers' sleep quality. Objective To explore the relationship among occupational stress, work-related rumination, and sleep quality of emergency medical dispatchers, so as to provide reference for improving sleep quality and maintaining physical and mental health of this occupational group. Methods A total of 386 emergency medical dispatchers from 16 provinces and municipalities including Beijing, Shanghai, Tianjin, Inner Mongolia, Zhejiang, Shanxi, Jiangxi, Anhui, Hubei, Hebei, Henan, Sichuan, Guizhou, Yunnan, Fujian, and Hainan of China were investigated with the Chinese version of Effort-Reward Imbalance Questionnaire, Work-Related Rumination Questionnaire, and Insomnia Severity Index. Spearman correlation was used to analyze the association among occupational stress, work-related rumination, and sleep quality. A structural equation model was constructed, with occupational stress as independent variable, the two dimensions of work-related rumination as mediating variables, and sleep quality as dependent variable, respectively. Bootstrap testing was then used to verify potential mediating effect of work-related rumination on the relationship between occupational stress and sleep quality among the emergency medical dispatchers. Results Among the enrolled emergency medical dispatchers, the effort-reward imbalance (ERI) index was 1.03, the score of affective rumination was 15.35±5.26, the score of problem-solving rumination was 17.64±4.63, and the total score of sleep quality was 21.10±6.53. Their ERI index was positively correlated with affective rumination scores (r=0.636, P<0.01), but not with problem-solving rumination scores (P>0.05). Their ERI index, affective rumination scores, and problem-solving rumination scores were positively correlated with sleep quality scores (P<0.05). The direct effect size of occupational stress on sleep quality was 0.627, the indirect effect size of affective rumination was 0.124, and the mediating effect of affective rumination accounted for 16.4% of the total effect (0.755), while the problem-solving rumination had no mediating effect on the relationship between occupational stress and sleep quality. Conclusion Occupational stress and affective rumination in emergency medical dispatchers can predict their sleep quality. Occupational stress can directly affect sleep quality, and indirectly affect it through affective rumination. Managers should pay attention to and evaluate the affective rumination level of emergency medical dispatchers, so as to take corresponding intervention measures to reduce their occupational stress and improve their sleep quality.

Allergic rhinitis （AR） is one of the most common chronic non-infectious inflammatory diseases in children. Traditional Chinese medicine （TCM） employs a comprehensive therapeutic system integrating treatment by stages and syndrome differentiation and treatment， demonstrating significant advantages in the management of pediatric AR. This article systematically reviews the clinical treatment methods and underlying mechanisms of TCM for pediatric AR in recent years. It is found that internal therapies （such as herbal formulas or Chinese patent medicines like Xiaoqinglong decoction， Yiqi tuomin decoction）， external therapies （including intradermal needles， acupoint application， tuina， and herbal nasal therapy）， as well as combined internal and external approaches （oral herbs combined with acupoint application）， have demonstrated significant effects in alleviating clinical symptoms， improving immune indicators， and reducing recurrence rates in children with AR. The underlying mechanisms are primarily associated with the regulation of signaling pathways such as Toll-like receptor/nuclear factor-kappa B and mitogen-activated protein kinase， thereby modulating immune balance， suppressing inflammatory responses， inhibiting pyroptosis， reducing mucus secretion， and promoting nasal mucosal repair.

Acute kidney injury (AKI) has high morbidity and mortality, but effective clinical drugs and management are lacking. Previous studies have suggested that macrophages play a crucial role in the inflammatory response to AKI and may serve as potential therapeutic targets. Emerging evidence has highlighted the importance of forkhead box protein O1 (FoxO1) in mediating macrophage activation and polarization in various diseases, but the specific mechanisms by which FoxO1 regulates macrophages during AKI remain unclear. The present study aimed to investigate the role of FoxO1 in macrophages in the pathogenesis of AKI. We observed a significant upregulation of FoxO1 in kidney macrophages following ischemia-reperfusion (I/R) injury. Additionally, our findings demonstrated that the administration of FoxO1 inhibitor AS1842856-encapsulated liposome (AS-Lipo), mainly acting on macrophages, effectively mitigated renal injury induced by I/R injury in mice. By generating myeloid-specific FoxO1-knockout mice, we further observed that the deficiency of FoxO1 in myeloid cells protected against I/R injury-induced AKI. Furthermore, our study provided evidence of FoxO1's pivotal role in macrophage chemotaxis, inflammation, and migration. Moreover, the impact of FoxO1 on the regulation of macrophage migration was mediated through RhoA guanine nucleotide exchange factor 1 (ARHGEF1), indicating that ARHGEF1 may serve as a potential intermediary between FoxO1 and the activity of the RhoA pathway. Consequently, our findings propose that FoxO1 plays a crucial role as a mediator and biomarker in the context of AKI. Targeting macrophage FoxO1 pharmacologically could potentially offer a promising therapeutic approach for AKI.

Objective:To construct a nomogram model for predicting the incidence of hepatocellular carcinoma based on serum abnormal prothrombin and alpha-fetoprotein and evaluate the predictive effect.Methods:Retrospective analysis of data from 351 patients with liver disease who received treatment at the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023, including 285 males and 66 females, aged (52.9±11.9) years. Among the 351 patients, there were 229 cases (65.2%) of hepatocellular carcinoma, 87 cases (24.8%) of liver cirrhosis, and 35 cases (10.0%) of chronic hepatitis B. All patients were randomly divided into a training set ( n=245) and a testing set ( n=106) in a 7∶3 ratio without replacement sampling. The training set was used to construct the model, and the testing set was used to evaluate the model. At the same time, gender, age, disease type, and other indicators were compared between the two sets. The risk factors of hepatocellular carcinoma were analyzed by univariate and multivariate logistic regression based on the training set, and a nomogram was constructed to predict the incidence of hepatocellular carcinoma based on the multivariate results. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive performance of nomogram, and decision curve analysis was used to evaluate the clinical applicability of the model. Results:There was no statistically significant difference in age, gender, disease type, etc. between the training and testing sets of patients (all P>0.05). Univariate logistic regression analysis showed that age, abnormal prothrombin logarithm (LnPIVKA-Ⅱ), alpha-fetoprotein logarithm (LnAFP), and diabetes were associated with hepatocellular carcinoma (all P<0.05). Multivariate logistic regression analysis showed that older age ( OR=1.07, 95% CI: 1.03-1.12), higher LnPIVKA-Ⅱ ( OR=2.97, 95% CI: 1.97-4.46), higher LnAFP ( OR=1.43, 95% CI: 1.11-1.84) and diabetes ( OR=5.17, 95% CI: 1.02-26.17) were risk factors for hepatocellular carcinoma (all P<0.05). Based on the above variables, a nomogram model for predicting the incidence of hepatocellular carcinoma was constructed. The area under the ROC curve analysis of the nomogram for predicting the incidence of hepatocellular carcinoma was 0.920 (95% CI: 0.886-0.953) in the training set and 0.934 (95% CI: 0.891-0.977) in the testing set. The calibration curve fit well with the standard curve, and the prediction was basically consistent with the actual situation. The decision curve analysis showed that the net benefit of the model was greater than 0 under most thresholds (0.1-1.0). Conclusion:The nomogram constructed based on age, LnPIVKA-Ⅱ, LnAFP and diabetes can effectively predict the incidence of hepatocellular carcinoma and has clinical applicability.

Objective:To explore the moderating and mediating roles of psychological resilience in the relationship between job satisfaction and depressive symptoms among petrochemical workers.Methods:In April 2022, a cluster sampling method was used to conduct a questionnaire survey among 1087 in-service employees of a petrochemical enterprise in Henan Province. A total of 861 questionnaires were recovered, including 857 valid ones, with an effective rate of 99.54%. Data on job satisfaction, psychological resilience, and depressive symptoms were collected using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Job Satisfaction Questionnaire, and Patient Health Questionnaire-9 (PHQ-9). Spearman rank correlation analysis was applied to analyze the relationships among the scores of job satisfaction, psychological resilience, and depressive symptoms. Hierarchical linear regression analysis was used to test the moderating effect of psychological resilience, and the Bootstrap method was employed to verify the mediating effect of psychological resilience.Results:The scores of job satisfaction, psychological resilience, and depressive symptoms among petrochemical workers were 36.00 (31.00, 36.00) points, 36.00 (30.00, 41.00) points, and 7.00 (3.00, 9.00) points. The detection rate of depressive symptoms was 65.7% (563/857). Results of Spearman rank correlation analysis showed that job satisfaction of petrochemical workers was positively correlated with psychological resilience ( rs=0.270, P<0.01) and negatively correlated with depressive symptoms ( rs=-0.386, P<0.01), psychological resilience was negatively correlated with depressive symptoms ( rs=-0.515, P<0.01). Results of hierarchical linear regression analysis indicated that psychological resilience had no moderating effect on the relationship between job satisfaction and depressive symptoms of petrochemical workers ( b=0.001, P>0.05). Results of the mediating effect test showed that psychological resilience played a partial mediating effect in the relationship between job satisfaction and depressive symptoms ( P<0.01), with a mediating effect value of -0.071 (95% CI: -0.125, -0.045), accounting for 20.16% of the total effect. Conclusion:Psychological resilience exerts a partial mediating effect rather than a moderating effect in the relationship between job satisfaction and depressive symptoms among petrochemical workers.

To examine the evolution of surgical techniques and trends in overall inpatient burden for pediatric adenoidectomy in Beijing tertiary hospitals from 2013 to 2022. A retrospective observational study was conducted using the regional health information platform of Beijing. Data from children aged ≤14 years who underwent adenoidectomy between 2013 and 2022 were extracted, including total hospitalization cost, length of stay(LOS), surgical material cost, surgical fee, operative technique, perioperative antimicrobial drugs cost, coagulation factor cost, and blood transfusion cost. The Mann-Kendall trend test was used to assess temporal changes in total hospitalization expenses and the structure of cost components. The results showed that over the 10-year period from 2013 to 2022, a total of 25 989 children underwent adenoidectomy in tertiary hospitals. The proportion of children aged ≤6 years increased from 59.83% to 76.11%, showing a significant upward trend ( Z=2.15, P=0.032). Only one case required surgical hemostasis due to postoperative bleeding. During the ten-year period, the median hospitalization cost for adenoidectomy in tertiary hospitals was ￥12 425.82 (￥11 307.43, ￥14 955.42).Overall hospitalization cost demonstrated a fluctuating downward pattern, decreasing from ￥15 229.73 in 2013 to ￥13 927.52 in 2022, this declining trend was not statistically significant( Z=-0.54, P=0.592). In contrast, the surgical costs showed an upward trend over the decade increasing from ￥1 856.22 in 2013 to ￥3 726.45 in 2022, which was statistically significant ( Z=3.22, P=0.001), while the cost of surgical materials showed no significant increase ( Z=1.79, P=0.074).Concurrently, the average LOS decreased remarkably from 10.56 days in 2013 to 3.26 days in 2022 ( Z=-3.94, P<0.001). The cost of perioperative antimicrobial drugs decreased ( Z=-3.94, P<0.001), while the cost of coagulation factors and blood transfusion remained unchanged ( Z=0.54, P=0.592; Z=0.56, P=0.578). Comparison between 2013-2017 and 2018-2022 showed a significant increase in the use of coblation from 28.9% to 42.5% ( χ2=638.7, P<0.001).Furthermore, in the coblation group, total hospitalization cost decreased by 27.73%, surgical cost increased by 94.98%, surgical material cost decreased by 10.33%, LOS shortened by 56.24%, and antimicrobial drug cost increased by 43.03%. In contrast, the non-coblation group showed a 23.94% increase in total hospitalization cost, a 57.08% increase in surgical procedure cost, a 33.88% increase in material cost, and a 30.14% reduction in LOS and a 26.0% decrease in antimicrobial drugs cost. In conclusion,from 2013 to 2022, total hospitalization cost for pediatric adenoidectomy in Beijing tertiary hospitals remained stable. Compared to non-coblation techniques, coblation was associated with a shorter LOS, lower total costs, a higher proportion of surgical fees, and a decreased proportion of material costs, without a significant increase in overall healthcare costs.

BACKGROUND:Differentially expressed RNA-binding proteins in the intervertebral disc plays a key role in intervertebral disc degeneration,and decreased levels of the RNA-binding protein KRT18 are associated with degenerative disc disease,but its specific role in the nucleus pulposus cells has not yet been fully determined. OBJECTIVE:To investigate the interaction of KRT18 with mRNA and long non-coding RNA on nucleus pulposus cells of the intervertebral disc and its mechanism. METHODS:Normal and degenerated nucleus pulposus cells were obtained from nucleus pulposus samples of patients undergoing interbody fusion for lumbar fracture or intervertebral disc degeneration.iRIP-seq,functional enrichment analysis,and DNA microarray analysis were performed to identify the mRNA and long non-coding RNA binding with KRT18.Subsequently,KRT18 was knocked down in nucleus pulposus cells based on the analysis results,and the expression levels of related genes were detected at the protein and RNA levels through protein immunoblotting and qRT-PCR,respectively. RESULTS AND CONCLUSION:Through iRIP-seq analysis,we identified abundant KRT18 binding sites within the GUAAUC and AGCCUC sequences,indicating that KRT18 may be involved in regulating RNA transcription,translation,stability or play a role in cell signaling pathways.It can stably bind to mature mRNA,among which highly expressed genes include CRLF1,IGFBP4,etc.At the same time,the peak genes of long non-coding RNA binding with it include SNHG25,SNHG12,NEAT1,USP32,EIF4A2 and CDH4.Most of these genes are involved in various biological processes such as apoptosis and inflammation,and can mediate related pathways of extracellular matrix metabolism.KRT18 can regulate their stability,transport,translation,splicing and other functions,thus affecting gene expression and cell function.We further verified through experiments the knockdown of KRT18 in nucleus pulposus cells,and found that the level of extracellular matrix metabolism was inhibited and unbalanced,resulting in intervertebral disc degeneration in vitro.This study investigated the regulatory mechanism of KRT18 from the perspective of its binding with mRNA and long non-coding RNA for the first time,and speculated the potential function of KRT18 in the pathogenesis of intervertebral disc degeneration,laying a foundation for future research on the key functions of KRT18.

Hepatocellular carcinoma （HCC） with biliary duct tumor thrombus （BDTT） is currently not common in clinical practice and is easily misdiagnosed， and previously， it was often considered an advanced stage of the disease with a poor prognosis， making its treatment challenging. However， in-depth studies in recent years have gradually deepened our understanding of this disease， leading to significant changes in diagnostic and treatment concepts. Currently， comprehensive treatment， mainly surgery， is used for treatment， but there is still controversy over the selection of clinical treatment strategies. This article provides a detailed discussion on surgical methods and prognosis， in order to provide a reference for clinical treatment options.

Objective:This study aims to analyze historical trends and predict future trends of disability-adjusted life years (DALYs) attributable to high BMI for osteoarthritis (OA) in China. OA is a common chronic degenerative joint disease, with high body mass index (BMI) being a significant risk factor. in China.Methods:Based on the Global Burden of Disease (GBD) 2021 database, we analyzed trends in high-BMI-attributable OA. The ASR of hogh-BMI-attributable OA DALYs increased from DALYs in China from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was used to predict trends from 2022 to 2046. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated to assess trend changes of trends. A Bayesian age-period-cohort (BAPC) model was used to predict trends from 2022 to 2046. Chi-square tests were used to compare differences in high BMI attribution proportions between regions and years.Results:From 1990 to 2021, China′s OA DALYs increased from 1.829 to 5.327 million, with the proportion attributable to high BMI rising from 13.47% to 21.86% ( χ2=60 527.25, P<0.001). The ASR of high-BMI-attributable to OA increased from 27.4 (-2.2, 81.5) per 100,000 to 53.0 (-4.7, 150.7) per 100 000, with an EAPC of 2.48% [95% (uncertainty interval, UI): 2.35, 2.62]. In 2021, females showed significantly higher ASR (69.2 per 100 000) than males (36.1 per 100 000). Knee OA (ASR: 50.5/100 000) demonstrated substantially higher burden than hip OA (ASR: 2.5/100 000). Age effect analysis showed DALYs peaked at ages 80~90; period effect indicated accelerated growth after 2005; cohort effect showed a U-shaped trend with the 1990 birth cohort having the highest relative risk (approximately 3.0). Projections indicated that up to 2046, total OA DALYs will reach approximately 2.39 million with an ASR of about 71, showing more significant growth among females (ASR reaching 100). Conclusion:High-BMI-attributable to OA DALYs in China shows a significant upward trend, and is expected to continue. This trend is more pronounced among females and elderly populations than males, highlighting the urgency of implementing preventive measures for high-risk groups, particularly in weight management.

Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.