Emergence agitation （EA） is a common complication after general anesthesia， especially in children and adolescents. Remifentanil， as a short-acting μ-receptor agonist， has become an important drug for the prevention and treatment of EA due to its rapid recovery and low risk of respiratory depression. This article reviews the mechanism of action and clinical research progress of remifentanil in the prevention and treatment of EA. Its mechanism of action involves the inhibition of pain signals mediated by traditional μ-receptor activation and potential new mechanism based on neural-endocrine-immune network， including regulation of microglial inflammatory pathways， and the modulation of cytokines and chemokines，etc. Clinical studies have shown that remifentanil can significantly shorten the recovery time， reduce the incidence of EA， and further optimize the analgesic effect and recovery quality by combining with other drugs （such as local anesthetics， sedatives， and opioid drugs）. Future research should further explore the mechanism of action of remifentanil， optimize clinical treatment strategies， and conduct large- scale clinical trials to standardize the drug use plan， while paying attention to its long-term effects and the development of multimodal treatment plans to promote the further development of EA prevention and treatment plans.

As a potential vectored vaccine,Newcastle disease virus(NDV)has been subject to various studies for vaccine development,while relatively little research has outlined the immunomodulatory effect of the virus in antigen presentation.To elucidate the key inhibitory factor in regulating the interaction of infected dendritic cells(DCs)and T cells,DCs were pretreated with the NDV vaccine strain LaSota as an inhibitor and stimulated with lipopolysaccharide(LPS)for further detection by enzyme-linked immunosorbent assay(ELISA),flow cytometry,immunoblotting,and quantitative real-time polymerase chain reaction(qRT-PCR).The results revealed that NDV infection resulted in the inhibition of interleukin(IL)-12p40 in DCs through a p38 mitogen-activated protein kinase(MAPK)-dependent manner,thus inhibiting the synthesis of IL-12p70,leading to the reduction in T cell proliferation and the secretion of interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),and IL-6 induced by DCs.Consequently,downregulated cytokines accelerated the infection and viral transmission from DCs to T cells.Furthermore,several other strains of NDV also exhibited inhibitory activity.The current study reveals that NDV can modulate the intensity of the innate?adaptive immune cell crosstalk critically toward viral invasion improvement,highlighting a novel mechanism of virus-induced immunosuppression and providing new perspectives on the improvement of NDV-vectored vaccine.

Objective:To investigate the effectiveness and feasibility of a 3D U-Net in conjunction with a three-phase CT image segmentation model in the automatic segmentation of GTVnx and GTVnd in nasopharyngeal carcinoma.Methods:A total of 645 sets of computed tomography (CT) images were retrospectively collected from 215 nasopharyngeal carcinoma cases, including three phases: plain scan (CT), contrast-enhanced CT (CTC), and delayed CT (CTD). The dataset was grouped into a training set consisting of 172 cases and a test set comprising 43 cases using the random number table method. Meanwhile, six experimental groups, A1, A2, A3, A4, B1, and B2, were established. Among them, the former four groups used only CT, only CTC, only CTD, and all three phases, respectively. The B1 and B2 groups used phase fine-tuning CTC models. The Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD95) served as quantitative evaluation indicators.Results:Compared to only monophasic CT (group A1/A2/A3), triphasic CT (group A4) yielded better result in the automatic segmentation of GTVnd (DSC: 0.67 vs. 0.61, 0.64, 0.64; t = 7.48, 3.27, 4.84, P < 0.01; HD95: 36.45 vs. 79.23, 59.55, 65.17; t = 5.24, 2.99, 3.89, P < 0.01), with statistically significant differences ( P < 0.01). However, triphasic CT (group A4) showed no significant enhancement in the automatic segmentation of GTVnx compared to monophasic CT (group A1/A2/A3) (DSC: 0.73 vs. 0.74, 0.74, 0.73; HD95: 14.17 mm vs. 8.06, 8.11, 8.10 mm), with no statistically significant difference ( P > 0.05). For the automatic segmentation of GTVnd, group B1/B2 showed higher automatic segmentation accuracy compared to group A1 (DSC: 0.63, 0.63 vs. 0.61, t = 4.10, 3.03, P<0.01; HD95: 58.11, 50.31 mm vs. 79.23 mm, t = 2.75, 3.10, P < 0.01). Conclusions:Triphasic CT scanning can improve the automatic segmentation of the GTVnd in nasopharyngeal carcinoma. Additionally, phase fine-tuning models can enhance the automatic segmentation accuracy of the GTVnd on plain CT images.

Objective:To investigate the impact of age,various hormonal levels,and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction(ED).Me-thods:A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography(CDDU)and intracavernosal injection test(ICI)at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023.Data were managed and processed using SPSS 29.0,and a multivariable Logistic regression analysis was conducted.Results:A total of 700 ED patients were included,with 380 showing negative ICI results and 320 positive.In the study,84 patients had a peak systolic velocity(PSV)＜25 cm/s,while 616 had PSV ≥ 25 cm/s;202 patients had end-diastolic velocity(EDV)＞5 cm/s,and 498 had EDV ≤5 cm/s.264 patients had ab-normal PSV and/or EDV results,and 436 had normal results for both.Patients with vascular ED had sig-nificantly lower estrogen levels(t=-3.546,P＜0.001),lower testosterone levels(t=-2.089,P=0.037),and a higher rate of hyperglycemia(x2=12.772,P=0.002)compared with those with non-vascular ED.The patients with arterial ED were older(t=3.953,P＜0.001),had a higher rate of hyperglycemia(x2=9.518,P=0.009),and a higher estrogen/testosterone ratio(t=2.330,P=0.020)compared with those with non-arterial ED.The patients with mixed arteriovenous ED had higher age(t=3.567,P＜0.001),lower testosterone levels(t=-2.288,P=0.022),a higher rate of hyperglycemia(x2=12.877,P=0.002),and a larger estrogen/testosterone ratio(t=2.096,P=0.037)compared with those with normal findings.Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED(OR=1.009,95％CI:1.004-1.014),and glucose 7.0 mmol/L was a risk factor(OR=0.381,95％CI:0.219-0.661).Older age was a risk factor for arte-rial ED(OR=0.960,95％CI:0.938-0.982).Additionally,older age(OR=0.976,95％CI:0.958-0.993)and glucose levels of 5.6-6.9 mmol/L(OR=0.591,95％CI:0.399-0.876)were also risk fac-tors for mixed arterio-venous ED.Conclusion:Hyperglycemia and aging may impair penile cavernous body vascular function,while higher levels of estrogen may have a protective effect on it.

As we all known,lipid metabolism participate in various diseases extensively.Abnormal lipid metabolism may contribute to hepatic adipose infiltration,diabetes,atherosclerosis and so forth.Accordingly,it is urgent to find chemicals that regulate lipid metabolism.A large number of experimental studies have shown that flavonoids in fructus aurantia are the active components of lowering blood lipids.This article will describe the concept,structure and classification of flavonoids.It will also introduce the mechanism of action of flavonoids in lipid metabolism from various diseases such as atherosclerosis,hypertension and type 2 diabetes.

OBJECTIVE To explore mecha-nisms of imperatorin on regulating P-glycoprotein(P-gp)in blood-brain barrier(BBB)based on net-work pharmacology combined with in vitro experi-ment.METHODS Drug targets were predicted using the Pharmapper and Swiss targets data-bases;disease targets were obtained through the Genecards database;intersections between drugs and disease targets were screened by Cytoscape software;the obtained core targets were used to construct protein-protein interaction(PPI)network,gene ontology(GO)functions,and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis.The effects of imperatorin(20,50,100 μ mol·L-1)on P-gp activity were monitored in hCMEC/D3in vitro BBB model,and the effects of imperatorin on the expression of target proteins were verified using Western blot method.RESULTS 55 drug targets and 3102 disease targets were obtained from the network pharmacology screening,and 37 core targets were obtained after the combination.Enrichment analysis showed that core targets were closely related to chemical synaptic trans-mission regulation,neurotransmitter receptor activity,proteinkinaseregulationactivity,G protein-coupled receptor signaling pathway,neural active ligand receptor interaction pathway,PI3K-Akt sig-naling pathway,VEGF signaling pathway,etc..In vitro experimental validation suggested that all tested concentration groups of imperatorin signifi-cantly reduced the activity and expression of P-gp,which were achieved by significantly downregu-lating the phosphorylation levels of PI3K and Akt,and repressing the expression of VEGFR2 pro-tein.CONCLUSION Network pharmacology was used to predict the core targets and signaling pathways of imperatorin on regulating P-gp in BBB and relevant validation was conducted through in vitro experiments,providing a refer-ence basis for further exploration of the mecha-nisms of imperatorin on regulating P-gp in BBB.

OBJECTIVE: To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients. METHODS: Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT). RESULTS: Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs. (84.0±30.6) months, P=0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs. (28.6±20.7) mg, P=0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs. (355.7±219.6) mg, P=0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs. (108.3±72.2) months, P=0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs. (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs. (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs. (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration (OR=1.229, 95%CI: 1.062-1.522, P < 0.05), high serum uric acid level (OR=1.137, 95%CI: 1.001-1.213, P=0.01), low 24 h urinary citrate (OR=0.821, 95%CI: 0.659-0.952, P=0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration (OR=1.201, 95%CI: 1.101-1.437, P=0.005), high serum creatine uric level (OR=1.145, 95%CI: 1.001-1.182, P=0.04), low 24 h urinary citrate (OR=0.837, 95%CI: 0.739-0.931, P=0.02) were all risk factors of kidney uric acid stones by DECT. CONCLUSION Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.
Humans ; Urinary Calculi ; Uric Acid/analysis* ; Citric Acid ; Kidney Calculi/diagnostic imaging* ; Gout/diagnostic imaging* ; Citrates ; Oxalates

Lubricin is widely expressed in tissues in the musculoskeletal system, including articulate cartilage, tendon and synovium, which shows a close relationship with the structure and pathology of these tissues. Lubricin plays an important role in lubrication, anti-adhesion, proliferation inhibition and inflammation regulation, which may facilitate the healing of impaired tissues in the musculoskeletal system. This article reviews the research progress on expression and regulation of lubricin as well as its structure and function in wound repair of the musculoskeletal system, so as to provide theoretical evidences for further researches on the role of lubricin in the musculoskeletal system with its related mechanisms and the clinical application of lubricin.

Objective: To compare the accuracy of two automatic segmentation softwares (Smart Segmentation and MIM Atlas) in organs at risk (OARs) contouring for nasopharyngeal carcinoma (NPC). Methods: Totally 55 NPC patients were retrospectively reviewed with manually contoured OARs on CT images, in which 30 cases were randomly selected to create a data base in the Smart Segmentation and MIM Atlas. The remaining 25 cases were automatically contoured with Smart Segmentation and MIM as test cases. The automatic contouring accuracies of two softwares were evaluated with Dice coefficient(DSC), Hausdorff distance(HD), and absolute volume difference(△V) using manual contours as a golden standard. Results: The overall DSC, HD and △V of all organs contoured by MIM Atlas and Smart Segmentation were (0.79±0.13) vs. (0.62±0.24) (t=14.06, P<0.05), (5.50±3.84)mm vs.(8.38±4.88)mm (t=-11.40, P<0.05), and (1.52±2.46) cm³ vs. (2.38±3.57) cm³ (t=-4.70, P<0.05), respectively. The average DSC of 11 organs (brain stem, optic chiasm, bilateral lens, bilateral optic nerve, bilateral eyeballs, bilateral parotid gland, spinal cord) delineated by MIM Atlas was statistically greater than that of Smart Segmentation (t=5.27, 4.41, 6.34, 5.70, 10.62, 7.45, 3.96, 4.26, 6.25, 5.42, 7.23, P<0.05). The average HD of 10 organs (brain stem, optic chiasm, bilateral lens, bilateral optic nerve, bilateral eyeballs, left parotid gland, spinal cord) delineated by MIM Atlas was statistically less than that of Smart Segmentation (t=-4.51, -4.49, -3.92, -3.45, -5.36, -5.56, -3.89, -3.90, -3.60, -3.68, P<0.05). The average △V of 6 organs (brain stem, optic chiasm, left len, bilateral optic nerve, right eyeball) delineated by MIM Atlas was statistically less than that of Smart Segmentation (t=-2.83, -3.39, -2.56, -2.27, -2.43, -2.51, P<0.05). Conclusions Both softwares have reasonable contouring accuracy for larger organs. The accuracy decreased with the decrease of organ volumes and blurred boundary. Generally, MIM Atlas′s performs better than Smart Segmentation does.

Objective To investigate the dosimetric differences among three types of breath hold mode ( free breath:FB, thoracic deep inspiration breath hold: T-DIBH, abdomen deep inspiration breath hold:A-DIBH) and to explore the optimal breath hold method in the postoperative radiotherapy of left-side breast cancer patients with minimum dose to normal tissues and organs at risk. Methods A total of eighteen patients with left-side breast cancer patients who underwent postoperative radiotherapy were enrolled in this study. Three CT simulation scans with three different breath hold method ( FB, T-DIBH, and A-DIBH ) were performed for each patient. Dosimetric differences were compared among plans generated on these three different CT image sets. Results There was no significant difference in the volume, mean dose, and homogeneity of planning target volume ( PTV) among plans generated from three different image sets (P>0. 05). The mean heart dose, mean LAD dose and mean ipsilateral lung dose in plans generated from CT image sets with FB, T-DIBH and A-DIBH were (3. 21 ± 1. 02), (1. 74 ± 0. 51), (1. 31 ±0. 41) Gy (W =171, P <0. 05), (34. 61 ± 13. 51), (14. 38 ±10. 20), (9. 21 ± 6. 53) Gy (W=171, P<0. 05), and (8. 31 ±2. 75), (7. 46 ±1. 96), (6. 89 ±1. 79) Gy (W=171, P<0. 05), respectively. Conclusions Compared with plans with FB, plans with DIBH ( T-DIBH and A-DIBH ) achieved lower cardiac, LAD and pulmonary doses. A-DIBH achieved a better normal dose reduction than T-DIBH.