ObjectiveThis study aims to identify cuproptosis-related gene biomarkers in Alzheimer's disease（AD） using bioinformatics and machine learning methods， validate them at the clinical specimen level， and predict potential traditional Chinese medicine（TCM）. MethodsDifferentially expressed genes in the AD group and normal group were obtained using the Gene Expression Omnibus （GEO） database， and intersections were taken with reported cuproptosis-related genes to obtain differentially expressed cuproptosis-related genes. Machine learning methods were applied to identify core differential genes of cuproptosis in AD. Peripheral blood's single nucleated cells from clinical AD patients were collected， and the relative gene expression was clinically verified by real-time polymerase chain reaction（Real-time PCR）. Potential TCM regulating cuproptosis for AD were predicted by COREMINE database. ResultsA total of 12 cuproptosis-related genes were obtained， mainly involved in pathways of tricarboxylic acid cycle， 2-oxocarboxylic acid metabolism， and carbon metabolism. Five core cuproptosis-related genes， dihydrolipoamide dehydrogenase （DLD）， glutaminase （GLS）， pyruvate dehydrogenase E1 subunit beta （PDHB）， full name nuclear factor （erythroid-derived 2）-related factor 2 （NFE2L2）， and dihydrolipoamide branched-chain transacylase E2 （DBT） were finally screened using four machine methods. Thirty cases each of normal and AD patients were collected clinically. Compared with those in the normal group， minimum mental state examination （MMSE） and Montreal cognitive assessment （MoCA） were significantly decreased in the AD group （P<0.01）， Homocysteine（Hcy）， interleukin（IL）-6， C-reactive protein（CRP） ， and β amyloid protein（Aβ） indexes were significantly increased （P<0.01）， and malondialdehyde（MDA） indexes were decreased （P<0.05）. Superoxide dismutase（SOD） levels were significantly decreased （P<0.01）. The mRNA relative expressions of NFE2L2 and DBT were up-regulated （P<0.05）， and those of DLD， GLS， and PDHB were significantly down-regulated （P<0.01）. The TCM regulating cuproptosis-related genes for the treatment of AD were mainly based on the four Qi such as warmth， calmness， and cold， and the five flavors including bitterness， sweetness， and pungency， and it was attributed to the meridians of the liver， spleen， stomach， and kidney， with the efficacy of tonifying Qi， activating blood， eliminating phlegm， and resoling dampness. ConclusionDLD， GLS， NFE2L2， PDHB， and DBT can be used as novel diagnostic molecular markers for AD cuproptosis-related genes， and the corresponding potential therapeutic TCM can provide new ideas for the treatment of AD by TCM.

Objective:To compare the mid-term clinical effects of AngioJet rheolytic thrombectomy assisted catheter-directed thrombolysis (ART+CDT) with catheter-directed thrombolysis (CDT) in the treatment of acute deep venous thrombosis of lower extremities.Methods:Ninety-one patients admitted to the Department from Jan 2016 to Dec 2017 were placed with inferior vena cava filters and divided into ART+CDT group (30 cases)and CDT group (61 cases). Total urokinase dosge, thrombolytic time, operative cost, length of hospital stay, detumescence rate, thrombus clearance rate, cumulative patency rate of lower limb veins, Villalta score at 2 years and 5 years, thrombosis recurrence rate and chronic venous insufficiency quality of life questionnaire were compared between the two groups.Results:The success rate of surgery was 100% in both groups, there was no mortality. There were significant differences in the short-term postoperative outcomes between the two groups in terms of total dosage of urokinase, thrombolysis time, total cost of surgery, length of hospital stay, detumescence rate, venous patency scores before and after treatment, and venous patency rate (all P<0.05). For the mid- and long-term postoperative outcomes of 2 and 5 years, there were no significant differences in the incidence of PTS, recurrence rate of thrombus, chronic venous function scale, and cumulative patency rate at 2 years (all P>0.05). Conclusions:ART+CDT has a significant advantage over CDT alone in terms of early efficacy and early reopening of blood flow in patients. Both ART+CDT and CDT have a low incidence of PTS and a low recurrence rate of thrombus in the mid-term follow-up, and both have satisfactory performance in the mid- and long-term efficacy of interventional treatment of deep venous thrombosis of lower limbs.

Objective To investigate the correlations of computed tomography (CT), clinical, and pathological features in patients with invasive lung adenocarcinoma positive and negative for spread through air spaces (STAS). Methods A total of 236 patients with invasive lung adenocarcinoma confirmed by surgery and pathology were selected, including 118 patients in STAS-positive group and 118 patients in STAS-negative group. The clinical data, CT signs, and pathological features of the two groups were collected and analyzed. Results There was a correlation between age and the occurrence of STAS. The age of the positive group was higher than that of the negative group. Smoking history and family history of tumor had no correlation with the occurrence of STAS. CT features signs such as nodule type and shape, tumor-lung interface, lobulation sign, spiculation sign, vacuole/cavity, air-bronchogram, pleural indentation sign, vascular changes, mean diameter of tumor, mean diameter of solid component, and the percentage of tumor solid components were significantly different between patients with and without STAS. The incidence of STAS in patients with solid nodules and partial solid nodules was significantly higher than that in patients with ground glass nodules. Multivariate analysis showed that the percentage of tumor solid components, air-bronchogram sign, lobulation sign, and tumor-lung interface were independent risk factors for predicting the occurrence of STAS. Conclusion The clinical data and CT signs of patients with invasive lung adenocarcinoma are related to the occurrence of STAS. CT signs such as the percentage of tumor solid components, air-bronchogram, lobulation sign, and tumor-lung interface are of great significance to STAS prediction. Our findings provide an important basis for selection of personalized clinical treatment plans.

OBJECTIVE To investigate the effects of the peroxisome proliferator-activated receptors δ （PPARδ） agonist GW501516 on the injury of pulmonary artery endothelial cells （PAECs） induced by hypoxia and its mechanism. METHODS The cytotoxic effects of GW501516 were observed by detecting the relative survival rate of PAECs； the protein expression of PPARδ was determined by Western blot assay. The cellular model of PAECs injury was established under hypoxic conditions； using antioxidant N-acetylcysteine （NAC） as positive control， the effects of GW501516 on cell injury and reactive oxygen species （ROS） production were investigated by detecting cell apoptotic rate， cell viability， lactate dehydrogenase （LDH） activity and ROS levels. Using nuclear factor erythroid 2-related factor 2（Nrf2） activator dimethyl fumarate （DMF） as positive control， PAECs were incubated with GW501516 and/or Nrf2 inhibitor ML385 under hypoxic conditions； the mechanism of GW501516 on PAECs injury induced by hypoxia was investigated by detecting cell injury （cell apoptosis， cell viability， LDH activity）， the levels of superoxide dismutase （SOD）， glutathione peroxidase （GPx）， catalase （CAT）， malondialdehyde （MDA） and ROS， the expressions of Nrf2， heme oxygenase-1 （HO-1） and cleaved-caspase-3 （C-caspase-3） protein. RESULTS The results demonstrated that hypoxia inhibited the protein expression of PPARδ （P＜0.05）， while GW501516 promoted the protein expression of PPARδ in hypoxia- exposed PAECs without obvious cytotoxic effects. GW501516 inhibited the apoptosis of PAECs， improved cell viability， and reduced LDH activity and ROS levels. GW501516 could up-regulate the protein expression of HO-1 in PAECs and the levels of SOD， GPx and CAT， while down-regulated the levels of MDA and ROS by activating the Nrf2 pathway （P＜0.05）； but Nrf2 inhibitor ML385 could reverse the above effects of GW501516 （P＜0.05）. GW501516 exerted similar effects to Nrf2 activator DMF in down-regulating the expression of C-caspase-3 and inhibiting the injury of PAECs under conditions of hypoxia （P＜0.05）. Moreover， Nrf2 inhibitor ML385 reversed the 163.com inhibition effects of GW501516 on PAECs injury （P＜0.05）. CONCLUSIONS GW501516 can relieve the hypoxia-induced injury of PAECs via the inhibition of oxidative stress， the mechanism of which may be associated with activating Nrf2.

Objective To investigate the expression of long non-coding RNA(lncRNA)small nucleolar RNA host gene(SNHG)25 and microRNA(miR)-497-5p in glioma tissues and their relationship with clinical features and prognosis.Methods A total of 157 glioma patients admitted to the hospital from January 2019 to January 2020 were selected as the glioma group,and 100 patients who underwent surgical treatment due to craniocerebral injury in the same hospital during the same period were selected as the control group.The ex-pression levels of lncRNA SNHG25 and miR-497-5p were detected in glioma tissues and normal brain tissues resected during operation.The patients were followed up for 3 years.The correlation between the expression levels of lncRNA SNHG25 and miR-497-5p was analyzed,and the relationship between the expression level of lncRNA SNHG25 and miR-497-5p and the clinical characteristics and prognosis of patients were analyzed.Re-sults Compared with the control group,the expression level of lncRNA SNHG25 in the glioma group was in-creased(P＜0.05),and the expression level of miR-497-5p was decreased(P＜0.05).Compared with the maximum diameter of tumors＜4 cm,World Health Organization(WHO)central nervous system tumor grade Ⅰ-Ⅱ,the expression level of lncRNA SNHG25 was increased and the expression level of miR-497-5p was decreased in glioma tissues with the maximum diameter of tumors ≥4 cm and WHO central nervous sys-tem tumor grade Ⅲ-Ⅳ(P＜0.05).The expression level of lncRNA SNHG25 in glioma patients was nega-tively correlated with miR-497-5p(r=-0.370,P＜0.05).The cumulative survival rate of lncRNA SNHG25 high expression group was lower than that of lncRNA SNHG25 low expression group(P＜0.05),and the cu-mulative survival rate of miR-497-5p low expression group was lower than that of miR-497-5p high expression group(P＜0.05).Grade Ⅲ-Ⅳ of WHO central nervous system tumor grade and high expression of lncRNA SNHG25 were risk factors for poor prognosis of glioma patients(P＜0.05),while high expression of miR-497-5p was a protective factor(P＜0.05).Conclusion The expression of lncRNA SNHG25 is increased and the expression of miR-497-5p is decreased in glioma tissues,which is related to the maximum diameter of tumor and high WHO central nervous system tumor grade,and can lead to poor prognosis of glioma patients.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective:To assess the efficacy of modified arthroscopic lower trapezius transfer with autologous hamstring tendon bridging for irreparable massive posterosuperior rotator cuff tears.Methods:A retrospective analysis was conducted on 59 patients (11 males and 48 females; mean age 66.70±6.10 years, range 55-79 years) treated between June 2019 and November 2022 for posterior superior irreparable massive rotator cuff tears. The treatment involved total arthroscopic oblique muscle transposition combined with partial rotator cuff repair. Shoulder mobility was measured in active supination, forward flexion, posterior external rotation, and abduction external rotation before surgery and at the final follow-up. The Constant-Murley shoulder function score, visual analogue scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively, at 3 months, 6 months postoperatively, and at the final follow-up. MR examinations were conducted preoperatively and at 3, 6, and 12 months postoperatively to evaluate rotator cuff healing and retear rates.Results:All surgeries were successfully completed using an average of 3.2±0.5 anchor nails (range 3-5) per case. The mean follow-up period was 15.9±5.7 months (range 12-37 months). Significant improvements in shoulder mobility were observed postoperatively compared to preoperative measurements. The mean body external rotation angle increased from 12.0°±19.4° preoperatively to 35.3°±19.6° at the final follow-up ( P<0.05), and the mean abduction external rotation angle increased from 33.4°±22.4° to 43.4°±23.1° ( P<0.05). The mean preoperative abduction angle improved from 121.7°±47.9° to 136.4°±40.6° ( P<0.05), and the mean forward flexion supination angle improved from 117.6°±45.8° to 139.5°±33.7° ( P<0.05). Postoperative VAS scores significantly improved from 4.8±1.8 preoperatively to 0.3±0.8 at the final follow-up ( F=104.868, P<0.001). The ASES scores improved from 42.0±14.9 preoperatively to 71.7±14.6 at the final follow-up ( F=47.287, P<0.001). The Constant-Murley scores increased from 54.3±17.1 preoperatively to 76.4±13.0 at the final follow-up ( F=44.082, P<0.001). Postoperative complications included 2 complete tears and 7 partial tears (re-tear rate 15.3%). No serious complications such as shoulder joint infection, joint stiffness, or vascular nerve injury were observed. One patient developed a localized subcutaneous hematoma at the tendon extraction site, and another developed deep vein thrombosis of the lower extremity, which improved with symptomatic anticoagulation. Conclusion:Modified arthroscopic lower trapezius transfer with autologous hamstring tendon bridging effectively reduces shoulder pain, improves shoulder joint activity and function scores, and is associated with a low rate of surgical complications for patients with irreparable massive posterosuperior rotator cuff tears.

Objective Action research methodology was used in a constructed self-management program for diabetic foot amputees to continuously improve the program and ensure the smooth implementation of the program.Methods Using the action research method,from February to June,2023,the self-management program constructed by the author was continuously revised and improved through the cyclic process of"planning-action-observation-reflection"for patients with diabetic foot amputation.Results After 2 rounds of action research,the action research refined the delivery of the program and the timing of the intervention,and the level of patient self-management behaviors increased significantly(P＜0.05).Conclusion Using the action research method,the researchers conducted a comprehensive analysis of the problems that existed in the process of patients'behavioral health interventions,and adjusted the program through feedback from the patients'hospitalization period,transition period,and home period,to ensure that the corresponding indexes at each stage could basically satisfy the patients'self-management needs,and to improve the smooth implementation of the self-management program for patients with diabetic foot amputation.

Objective To explore the dynamics of carers'caregiving dilemmas during different stages of disease progression in patients with diabetic foot ulcers,and to provide a basis for giving precise intervention strategies.Methods Based on the theory of Timing It Right,the phenomenological study was adopted.A purposive sampling method was used to select carers of patients with diabetic foot ulcers who were hospitalised in the Wound Repair Unit of a tertiary hospital in Beijing from March 2023 to February 2024 to conduct semi-structured interviews,and the data were analysed using the Colaizzi 7-step analysis method.Results Combined with the theory of Timing It Right,5 stages of diabetic foot ulcer development were formed,and 5 themes were extracted(①diagnostic period:mixed emotions,facing the dilemma of being unable to do anything;②therapeutic period:lack of knowledge of the disease,and the difficulties of bedside care;③recovery period:contradictions of the desire for rapid healing and the lack of caregiving ability;④transition period:poor patient adherence,and the hope for professional support;⑤adaptation period:the accumulation of negative emotions,and the persistence of caregiving difficulties),and 12 sub-themes.Conclusion At different stages of disease development in patients with diabetic foot ulcers,the caregiving dilemma of caregivers changes dynamically,and healthcare professionals should provide professional,personalised,and high-quality professional support according to their caregiving experience and needs at different stages to improve their quality of care and promote patients'recovery.