Objective : To investigate the expression of genes and proteins in the peripheral blood mononuclear cell ( PBMC) cystine / glutamate antiporter system (System Xc-) / glutathione ( GSH) / glutathione peroxidase 4 ( GPX4) ferroptosis pathway and its influence on inflammatory factors in patients with rheumatoid arthritis ( RA) ． Methods : 30 patients with RA and 30 healthy participants were enrolled．PBMCs were isolated using Ficoll-hypaque density gradient centrifugation．The cells were categorized into the healthy control，RA，ferroptosis inhibitor，ferroptosis in- ducer group．The cell viability was checked using the cell counting kit-8 ( CCK-8) method．Intracellular Fe2 + rela- tive fluorescence intensity and reactive oxygen species (ROS) levels were detected using the FerroOrange and Di- hydroethidium (DHE) fluorescent probes，respectively．Western blot and real-time quantitative PCR (qPCR) de- tected the expression of nuclear factor erythroid 2-related factor 2 ( Nrf2 ) ，solute carrier family 7 member 11 (SLC7A11) ，GPX4 proteins and mRNA．And the flow cytometry quantified the levels of tumor necrosis factor α (TNF-α) ，Interleukin (IL) -1，and IL-6 in the supernatant of each cell group. Results : Compared to the healthy control group，the RA group showed a significantly increased Fe2 + concentration and elevated ROS levels，reduced expression of Nrf2，SLC7A11 and GPX4 proteins and mRNA，and increased contents of TNF-α , IL-1 and IL-6 in PBMC supernatant，and the differences were statistically significant．The concentration of Fe2 + and ROS levels in the inhibitor group were lower than those in the RA group，the proteins expressions of Nrf2，SLC7A11 and GPX4 increased，the mRNA expressions of SLC7A11 and GPX4 increased，the content of IL-6 in the PBMC supernatant decreased but the content of TNF-α increased，and the differences were statistically significant．In contrast，the in- ducer group，when compared to the RA group，displayed increased ROS levels，reduced expression of SLC7A11 protein and mRNA and decreased expression of Nrf2 protein，and the contents of TNF-α and IL-1 in the PBMC su- pernatant increased，but the expression of GPX4 protein increased ，and the differences were statistically signifi- cant．The inducer group，compared to the RA group，showed increased cell viability，and the difference was statis- tically significant (P＜0. 000 1) ． Conclusion The presence of ferroptosis in PBMC in RA patients，inhibiting or inducing PBMC ferroptosis in RA patients，will inhibit or promote the secretion of inflammatory factors．Inhibition of PBMC ferroptosis in RA patients may be helpful in the treatment of RA.

Objective:This study aims to investigate the expression levels of α-synuclein(α-synuclein)and apolipoprotein A-1(ApoA1)in elderly patients with cerebral small vessel disease(CSVD)and their association with cognitive function.Methods:A total of 176 elderly patients diagnosed with CSVD and admitted to Huludao Central Hospital between September 2022 and February 2024 were retrospectively selected as research subjects.Based on their cognitive function at the time of admission, patients were categorized into a disorder group comprising 71 cases and a normal group consisting of 105 cases.General information was collected from the patients, and the serum expression levels of α-synuclein and ApoA1 were measured.Pearson correlation analysis was employed to assess the relationship between the expression levels of α-synuclein and ApoA1 and the Montreal Cognitive Assessment(MoCA)scores.Furthermore, multi-factor logistic regression analysis was conducted to identify influencing factors, and receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic value of serum levels.Results:Patients in the disorder group were older than those in the normal group.Additionally, the MoCA score and serum α-synuclein levels were significantly higher in the disorder group, while ApoA1 levels were lower(all P<0.05).Pearson correlation analysis indicated that the MoCA score was negatively correlated with α-synuclein expression and positively correlated with ApoA1 expression(all P<0.05).Multivariate logistic regression analysis revealed that age, smoking history, and α-synuclein levels are risk factors for cognitive dysfunction in patients with CSVD, whereas ApoA1 is identified as a protective factor for cognitive function in this population.Furthermore, ROC curve analysis demonstrated that serum α-synuclein and ApoA1 levels possess diagnostic value for cognitive dysfunction in patients.The area under the curve(AUC)for the combined predictions was 0.836, with sensitivity and specificity rates of 76.14% and 78.14%, respectively. Conclusions:Elderly patients with CSVD and cognitive dysfunction exhibit abnormally high levels of α-synuclein and abnormally low levels of ApoA1.Both factors are influential in the context of cognitive dysfunction among elderly patients with CSVD and contribute to improved diagnostic efficiency.

Objective: To investigate the incidence trend of tuberculosis in Haidong City, Qinghai Province from 2006 to 2020, and the effects of age, period, and cohort on tuberculosis incidence, so as to provide the basis for enhancing the prevention and control for tuberculosis. Methods: Data of tuberculosis cases in Haidong City from 2006 to 2020 were collected from the Chinese Disease Prevention and Control Information System. Incidence rates were calculated and standardized using data from the Sixth National Population Census in 2010. The trends in incidence of tuberculosis were analyzed by annual percent change (APC). Effects of age, period and cohort on the incidence of tuberculosis were analyzed by an age-period-cohort model. Results: The crude incidence rates of tuberculosis in Haidong City from 2006 to 2020 ranged from 37.69/105 to 100.93/105, and the standardized incidence rates ranged from 42.85/105 to 115.24/105. The standardized incidence rates from 2006 to 2015 showed a decreasing trend (APC=-7.148%, P<0.05), while there was no significant trend observed from 2015 to 2020 (all P>0.05). The age-period-cohort model analysis showed that the highest incidence risk of tuberculosis in Haidong City from 2006 to 2020 was observed in the age group of 20-<25 years (RR=2.973, 95%CI: 2.353-3.756), followed by the age group of 80-<85 years (RR=2.785, 95%CI: 2.206-3.516). The incidence risk of tuberculosis was higher in the period from 2016 to 2020 (RR=1.253, 95%CI: 1.203-1.306) compared to the period from 2011 to 2015 (RR=0.796, 95%CI: 0.770-0.823). Tuberculosis incidence risk was the highest in the birth cohort from 1936 to 1940 (RR=3.050, 95%CI: 2.356-3.949), and then gradually decreased over time thereafter. Conclusions The incidence of tuberculosis in Haidong City showed a decreasing trend from 2006 to 2015, while there was no significant trend observed from 2015 to 2020. The incidence risk of tuberculosis was higher in the age groups of 20-<25 years and 80-<85 years, and the risk decreased for those born in more recent years.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective:To investigate the short-term efficacy of left-sided three-port total laparoscopic distal gastrectomy (TPTLDG).Methods:The prospective randomized controlled study was conducted. The 68 patients undergoing laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Medical University from March 2022 to March 2023 were collected. All patients were randomly assigned to the TPTLDG group with a double number, and to the five-port laparoscopic distal gastrectomy (FPLDG) group with a single number, respectively. Observation indicators: (1) grouping situations of the enrolled patients; (2) comparison of perioperative condition; (3) comparison of complications during postoperative 30 days; (4) comparison of pathological examination. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or continuous correction chi-square test. Comparison of ordinal data was analyzed using the non‐parameter rank sum test. Results:(1) Grouping situations of the enrolled patients. A total of 59 patients of gastric cancer were selected for eligibility. There were 40 males and 19 females, aged 59.00(52.00, 67.00)years. The gender (male, female), age, body mass index (BMI), Caprini score (≤2, ≥3), nutritional risk screening 2002 (<3, ≥3), Eastern Coopera-tive Oncology Group performance status (0, 1), preoperative hypersensitive C-reactive protein, preoperative IL-6, preoperative white blood cell count, preoperative albumin were 19, 11, 59.00(51.25,65.25)years, 21.92(20.93,22.73)kg/m 2, 7, 23, 24, 6, 18, 12, 0.78(0.78,1.46)mg/L, 3.07(1.50,10.56)μg/L, 6.07(4.94,7.19)×10 9/L, 44.30(40.83, 46.15) g/L in the 30 patients of TPTLDG group, versus 21, 8, 57.00(51.00, 67.00)years, 21.90(20.95, 23.35)kg/m 2, 11, 18, 24, 5, 17, 12, 1.13(0.78,11.40)mg/L, 5.56(1.88,15.12)μg/L, 5.54(4.71,6.70)×10 9/L, 43.55(40.25,44.88)g/L in the 29 patients of FPLDG group, showing no significant difference in the above indicators between the two groups ( χ2=0.557, Z=-0.444, -0.805, χ2=1.482, 0.074, 0.012, Z=-1.259, -1.262, -0.819, -1.199, P>0.05), confounding bias ensured comparability between the two groups. (2) Comparison of perioperative condition. The length of incision, time to removing drainage tube, IL-6 at postoperative day 3, cost of hospital stay were 6.65(6.48,6.93)cm, 3.00(0,3.00)days, 29.18 (13.67, 43.53)μg/L, 84 164.15(73 084.72, 96 782.14)yuan in the TPTLDG group, versus 8.00(7.50,8.35)cm, 3.00(3.00,4.00)days, 47.56(21.31,85.79)μg/L, 92 120.43(87 069.33, 113 089.74)yuan in the FPLDG group, showing significant differences in the above indicators between the two groups ( Z=-11.065, -2.141, -2.940, -2.220, P<0.05). (3) Comparison of complications during postoperative 30 days. The incidence rate of complications during postoperative 30 days was 30.00%(9/30) and 24.14%(7/29) in the TPTLDG group and FPLDG group, respectively, showing no significant difference between the two groups ( χ2=0.256, P>0.05). (4) Comparison of pathological examination. Cases with pathological N staging as 0 stage, 1 stage, 2 stage, 3 stage were 22, 2, 4, 2 in the TPTLDG group, versus 13, 7, 4, 5 in the FPLDG group, showing a significant difference between the two groups ( Z=-2.021, P<0.05). Conclusion:TPTLDG is safe and feasible for gastric cancer, with a good short-term efficacy.

BACKGROUND: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH. METHODS: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded. RESULTS: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]; left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF]; LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH. CONCLUSIONS: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02164526.
Coronary Artery Disease/epidemiology* ; Creatinine ; Heart Failure/complications* ; Humans ; Hypertension, Pulmonary/complications* ; Nitrates ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Risk Factors ; Stroke Volume ; Ventricular Function, Left

Objective:To analyze the clinical features and surgical outcomes of petrous bone cholesteatomas (PBCs).Methods:Data from 39 PBCs patients treated in the Department of Otorhinolaryngology, Xijing Hospital from September 2011 to December 2017 were reviewed retrospectively, including 23 males, 16 femals, aged 12-71 years old, with the median age of 37. Clinical classifications, surgical methods, facial and hearing function, and intraoperative and postoperative complications were made summary analysis.Results:In this study, five patients were congenital PBCs and 34 patients were acquired PBCs. The common clinical symptoms were hearing loss (100%, 39/39), ear discharge/pus (89.7%, 35/39) and facial paralysis (46.2%, 18/39). According to Sanna′s classification, 14 cases were supralabyrinthine, including three cases underwent transcochlear (TC) approach, six cases underwent transotic (TO) approach and five underwent translabyrinthine (TL) approach. 10 cases were infralabyrinthine, including eight cases underwent subtotal petrosectomy, one case underwent TO approach and one underwent TL approach.10 cases were massive, including seven cases underwent TC approach, three cases underwent TO approach. Five cases were infralabyrinthine-apical, including two cases underwent TC approach, two cases underwent TO approach, and one case underwent endoscope assisted infratemporal fossa type B. The degree of facial nerve (FN) dysfunction from high to low was massive (6/10), supralabyrinthine (8/14), infralabyrinthine-apical (2/5) and infralabyrinthine (2/10). 19 cases involved in facial nerve operation, three cases underwent FN decompression, four cases underwent FN rerouting, four cases underwent nerve grafting, and one case underwent facial-hypoglossal anastomosis. Preoperative FN involvement in 18 cases, and the FN function was improved in 14 cases after surgery. The improved rate of postoperative FN function was 77.8%. The bone conducted hearing retained 50.0% (14/28) postoperatively. Five cases with cerebrospinal fluid leak were managed by inserting free muscle plugs and cavity obliteration. Two cases with the cholesteatomas matrix involved the sigmoid sinus and the jugular bulb, and occlusion of the sigmoid sinus was performed. Postoperatively, two patients presented with synkinesis. The patients were followed up for 40 to 115 months, and there was no recurrence.Conclusions:There are no specific clinical manifestations for PBCs, thus, it is difficult in early diagnosis and treatment. According to Sanna′s classification, preoperative FN and hearing function, the best surgical approach should be selected with minimal recurrences and perioperative morbidity.

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

Objective:To investigate the effect of bilateral repetitive transcranial magnetic stimulation (rTMS) on the pre-attentive processing of methamphetamine addicts.Methods:Forty methamphetamine addicts were screened and equally divided into the intervention group and the control group by random number table method.The intervention group was treated with bilateral simultaneous stimulation with 10 Hz on the left DLPFC and 1 Hz on the right DLPFC with 7 days of continuous intervention.The same scheme was used to intervene the control group, but with pseudo-stimulation. The changes of amplitude and latency of mismatch negative wave(MMN) before and after intervention were compared. SPSS 24.0 software was used for statistical analysis. Independent sample t-test was used for inter group comparison, and paired sample t-test was used for intra group comparison before and after intervention. Results:Before rTMS, there were no significant differences in MMN(F3, Fz, F4) amplitude (intervention group: (-0.90±0.28)μV, (-0.98±0.19)μV, (-0.96±0.19)μV; control group: (-0.92±0.21)μV, (-0.89±0.20)μV, (-0.94±0.16)μV)and latency(intervention group: (184.16±33.07)ms, (179.20±25.35)ms, (184.95±28.22)ms; control group: (184.91±26.96)ms, (180.99±25.29)ms, (181.55±23.19)ms) between the two groups (all P>0.05). After the intervention, there were significant differences in MMN(Fz, F4) amplitude(intervention group: (-1.38±0.16)μV, (-1.17±0.19)μV; control group: (-0.91±0.17) μV, (-0.99±0.16)μV) between the two groups (both P<0.01), but there were no significant differences in MMN (F3) amplitude(intervention group: (-1.01±0.59)μV; control group: (-0.80±0.50)μV), and in MMN (F3, Fz, F4) latency(intervention group: (177.38±26.45)ms, (172.17±23.87)ms, (179.84±23.60)ms; control group: (182.08±24.95)ms, (177.94±21.30)ms, (179.18±21.62)ms)between the two groups (all P>0.05). There were statistically significant differences in MMN( Fz, F4) amplitude (before-intervention: (-0.98±0.19)μV, (-0.96±0.19)μV; after-intervention: (-1.38±0.16)μV, (-1.17±0.19)μV)before and after intervention in the intervention group (both P<0.05), but there was no significant difference in MMN(F3) amplitude(before-intervention: (-0.90±0.28)μV; after-intervention: (-1.01±0.59)μV)before and after intervention in the intervention group ( P>0.05), and there were statistically significant differences in MMN(F3, Fz, F4) latency (before-intervention: (184.16±33.07)ms, (179.20±25.35)ms, (184.95±28.22)ms; after-intervention: (177.38±26.45)ms, (172.17±23.87)ms, (179.84±23.60)ms)before and after intervention in the intervention group(all P<0.05). After pseudo-stimulation, there were no statistically significant differences in MMN( F3, Fz, F4) amplitude(before-intervention: (-0.92±0.21)μV, (-0.89±0.20)μV, (-0.94±0.16)μV; after-intervention: (-0.80±0.50)μV, (-0.91±0.17)μV, (-0.99±0.16)μV)and latency (before-intervention: (184.91±26.96)ms, (180.99±25.29)ms, (181.55±23.19)ms; after-intervention: (182.08±24.95)ms, (177.94±21.30)ms, (179.18±21.62)ms) before and after intervention in the control group (all P>0.05). Conclusion:After repeated transcranial magnetic stimulation, the pre-attentive processing of the intervention group is improved, which shows that bilateral simultaneous stimulation of the rTMS program is effective.

Alzheimer's disease (AD) is one of the major diseases that harmful to healthy elderly, and mild cognitive impairment (MCI) is the early clinical stage of AD. There is a lag in the clinical diagnosis of both diseases. An objective and reliable auxiliary diagnostic method is urgently needed to provide early diagnosis and differential indicators for AD and MCI, to predict the probability of individuals suffering from AD and MCI transforming into AD, and to reduce the overall incidence of AD and reduce the huge medical and economic burden for the country and society. Event-related potential is widely used in AD and MCI, and the resolution at the millisecond level can truly reflect the time course of cognitive processing and the degree of impairment of cognitive function in patients. In this study, we investigated the differences in the amplitude and latency of ERP components in healthy elderly, MCI and AD patients, and the correlation between ERP components and cognitive impairment. Early N170 and P200 showed high sensitivity and specificity in differentiating MCI from healthy elderly or MCI from AD. The late perception-related ERPs also showed high sensitivity and specificity in differentiating healthy elderly from MCI/AD. The differences in ERPs between MCI and AD may be related to the etiology, the degree of disease progression and the site of brain damage. The specific brain mechanism still need to be further explored and will be the focus of future research. With the progress of the research, the relationship between the specific ERP manifestations and the mechanism of brain injury as well as the impairment of cognitive function will be more clear. It is believed that the application of ERP in clinical will bring more benefits to AD and its early clinical MCI.