The vagus nerve, as an important "guardian" of the body, is involved in the steady-state regulation of cardiovascular, respiratory, gastrointestinal digestion and endocrine systems. Recent studies have shown that the vagus nerve plays an important regulatory role in inflammatory response via the inflammatory reflex, which is closely related to the fact that the afferent and efferent fibers of the vagus nerve can sense and regulate inflammation, respectively. The pathophysiological mechanism of sepsis is based on the dysregulation of immune response, and it is often initiated by the excessive inflammatory response of the innate immune system. In recent years, in order to expand intervention strategies for the immune dysregulation of sepsis, researchers have made many efforts on regulating the inflammatory response of the vagus nerve in sepsis. This article focuses on the mechanism of vagus nerve-mediated inflammatory reflex and the regulatory role of vagus nerve in inflammatory response of sepsis, in order to reveal new therapeutic strategies for the treatment of sepsis.

Objective:To analyze the prevalence and clinical features of respiratory syncytial virus (RSV) in Chengde city.Methods:From August 2022 to June 2023, throat swabs and clinical data of 478 hospitalized children with respiratory tract infection in the Chengde Central Hospital were collected. Real-time quantitative PCR was used to detect the molecular epidemiology of RSV-A and RSV-B subtypes and analyze the clinical features of patients with RSV infection.Results:Among the hospitalized children, 67.57% (323/478) tested positive for RSV. The outbreak of RSV infection was caused by RSV-A subtype. The peaks of RSV-A infection occurred from November to December, 2022 and May to June, 2023. There were 86.07% (278/323) of the RSV-A-positive cases had mixed infection with other pathogens, primarily bacterial pathogens with Streptococcus pneumoniae being the most common, followed by Klebsiella pneumoniae. Influenza virus A was the most common viral pathogens causing mixed infection. The level of lactate dehydrogenase was higher in the patients with single RSV-A infection than in those with mixed infection ( Z=2.396, P=0.017), and higher than the normal upper limit. Compared with the single infection group, the mixed infection group had higher white blood cell count ( Z=2.417, P=0.016), neutrophil ratio ( Z=3.218, P=0.001), C-reactive protein level ( Z=1.998, P=0.046) and creatinine level ( Z=2.107, P=0.035), and lower lymphocyte ratio ( Z=3.205, P=0.001), but they were all within the normal range. There were no significant differences in the clinical features between RSV-A-positive patients co-infected with bacteria or other viruses (all P>0.05). Conclusions:RSV-A is the leading cause of respiratory tract infection in children in Chengde from 2022 to 2023, and often co-detected with bacteria. The mixed infection with other respiratory pathogens is related to the clinical features of patients with RSV-A infection.

BACKGROUND:After the treatment of femoral shaft fracture with the intramedullary nail,the third fracture open reduction indications are controversial.Some scholars believe that limited open reduction can achieve anatomical reduction,conducive to fracture healing;but some scholars believe that no open reduction of the third fracture still has a high fracture healing rate. OBJECTIVE:To investigate the effect of the circumference and displacement of the third fragment on fracture healing after intramedullary nailing of femoral shaft fractures with the third fragment. METHODS:A retrospective cohort study was conducted to analyze the clinical data of 142 patients suffered a femoral shaft fracture with a third fragment admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from February 2016 to December 2021.The fracture were classified into three types according to the circumference of the third fracture with reference to the diaphyseal circumference at the fracture site:type 1 in 71 cases,type 2 in 52 cases,and type 3 in 19 cases.Referring to the diaphyseal diameter,the fractures were classified into three degrees according to the degree of the third fragment displacement:degree I in 95 cases,degree II in 31 cases,and degree III in 16 cases.All patients were treated with femoral interlocking intramedullary nails,and no intervention was performed for the displaced third fragment during the operation.Postoperative follow-up was performed to compare the fracture healing rate,healing time,and the modified Radiographic Union Scale for Tibia at month 9 after surgery in each group.The effect of third fracture fragment circumference and degree of displacement on fracture healing was assessed. RESULTS AND CONCLUSION:(1)All 142 patients were followed up for at least 12 months,with a mean of(14.7±4.1)months,and the overall healing rate was 73.4%.(2)When the third fragment was displaced by degree I,the healing rate,healing time,and modified Radiographic Union Scale for Tibia score at month 9 were not statistically significant among the three sub-groups of circumference classification.(3)When the third fragments were displaced by degree II or III,the healing rate and healing time were not statistically significant among the three subgroups of circumference classification;the modified Radiographic Union Scale for Tibia score at month 9 in the type 1 group was higher than that in the type 2 and 3 groups(P = 0.017).(4)Logistic regression analysis showed that a greater third fragment displacement and circumference were associated with lower fracture healing rates(P<0.05).(5)These findings indicate that in the treatment of femoral shaft fractures with third fragment by intramedullary nails,when the fracture fragment is displaced to degree I,the circumference size has little effect on fracture healing,and no intervention is required during surgery.When the third fragment is displaced to degree II or III and the circumference of which is type 1,a higher modified Radiographic Union Scale for Tibia score can still be obtained with no intervention of the third fragment.However,when the circumference is of type 2 or type 3,it significantly affects the fracture healing.Consequently,intraoperative intervention to reduce the distance of displacement of the fragment is required to lower the incidence of nonunion.The displacement of the third fracture fragments has a greater impact on fracture healing than their circumference.

Objective:To explore the clinical features of programmed cell death-1 (PD-1) inhibitor-associated hypophysitis and improve the understanding of the disease.Methods:For the present retrospective case series study, the clinical data of patients with PD-1 inhibitor-associated hypophysitis who were treated at the Affiliated Hospital of Hebei University and the 3rd Hospital of Hebei Medical University from January 2020 to May 2023 were collected for analysis of clinical manifestations and prognosis.Results:Fifteen cases of PD-1 inhibitor-induced hypophysitis were included, with 13 males and 2 females. The mean age of onset was (62.1±7.5) years, and the median time of onset was 6.5 (4.7, 11.6) cycles of PD-1 inhibitor. At diagnosis, 14 patients complained of gastrointestinal symptoms, and 12 patients complained of fatigue. There were 12, 1, 1, 5, and 1 cases of hyponatremia, hypokalemia, hypoglycemia, hypotension, and fever, respectively. Secondary adrenocortical insufficiency occurred in all cases. Moreover, four patients had secondary hypothyroidism, and two patients had secondary hypogonadism. Posterior pituitary hypofunction was not found. Pituitary MRI showed one case each of vacuolar sella turcica, pituitary cystic lesion, pituitary stalk slightly shifted to the left, high metabolism in the sella turcica, and pituitary abnormal signal, while no abnormalities were found in 11 cases. The follow-up time was (47.66±11.93) weeks. At the last follow-up, one patient′s serum levels of adrenocorticotropic hormone and cortisol returned to normal.Conclusions:Hypophysitis associated with PD-1 inhibitors occurs later, and gastrointestinal symptoms and fatigue are the most common clinical manifestations. PD-1 inhibitor-associated hypophysitis mainly manifests as adrenocortical hypofunction, and some cases manifest as hypothyroidism and hypogonadism. In addition, patients with PD-1 inhibitor-associated hypophysitis show no obvious imaging changes in the pituitary gland.

Amid challenges of adapting to an aging society and maintaining sustainable healthcare financing, DRG forms a comprehensive suite of healthcare management tools, serving not only as a payment management tool but also encompassing budget management and healthcare quality control. However, further exploration of DRG's potential, which includes stimulating intrinsic motivations, and maximizing its positive incentive effects, requires continuous exploration and implementation. This paper discusses the standardization of clinical practices, localization of guidelines, minimization of iatrogenic harm, and popularization of economic evaluation, with the aiming of optimizing clinical pathways, standardizing medical practices, and balancing the challenges and opportunities of cost control and clinical innovation under the DRG payment model.

Objective To investigate the relationship between serum Adropin level and cystatin C(CysC)level and DKD in patients with diabetic kidney disease(DKD),and to provide an effective basis for the clinical diagnosis and treatment of DKD.Methods The clinical data of 219 patients with type 2diabetes mellitus(T2DM)admitted to Zhengzhou Central Hospital of Zhengzhou University from September 2022 to June 2023 were retrospectively analyzed,they were divided into normal albuminuria group(n=109),microalbuminuria group(n=65),and massive albuminuria group(n=45)according to the urinary albumin/creatinine ratio(UACR).Another 120healthy subjects were selected as healthy control group.The clinical indexes of the four groups were analyzed and compared.Results The serum Adropin level in the healthy control group,normal albuminuria group,microalbuminuria group,and massive albuminuria group decreased in order,and the CysC level increased in order,and the differences between the groups were statistically significant(P＜0.05).Spearman correlation analysis showed that the level of serum Adropin was negatively correlated with age,duration of DM,systolic blood pressure(SBP),UACR,CysC,and β2-microglobulin(β2-MG);the level of CysC was positively correlated with age,duration of DM,SBP,UACR,and β2-MG;the levels of serum Adropin and CysC were negatively correlated with body mass index.The results of receiver operating characteristic curve analysis showed that serum Adropin and CysC had diagnostic value for DKD(P＜0.05).Conclusion The lower the serum Adropin level and the higher the CysC level in DKD patients,the disease is more serious.In predic-ting DKD,serum Adropin and CysC may become serological indicators for diagnosing DKD,providing more and more powerful evidence for the early diagnosis of DKD.

Partial thickness rotator cuff tears(PTRCTs) are a common cause of shoulder pain and dysfunction in adults, which are seen in middle-aged and older adults and young adults in over-the-shoulder sports(throwing sports are the most common). PTRCTs include partial tears on the articular side, partial tears on the bursal side, and intratendinous tears. Tears on the articular side are 2-3 times more likely than on the bursal side, but intratendinous tears are the most common type. The treatment of PTRCTs consists of both conservative and surgical treatments. Conservative treatment is suitable for most patients with PTRCTs, and recommended as the primary treatment for PTRCTs because of its good clinical efficacy and patients′ willingness to accept it. However, there is no genaral consensus on the best treatment and the results reported in the literature are controversial. In this paper, the anatomy, epidemiology, pathogenic factor, diagnosis and treatment progress of PTRCTs are summarized in light of relevant domestic and international studies in recent years to provide reference for clinical diagnosis and treatment.

Objective:To compare the efficacy of single-agent versus multi-agent adjuvant chemotherapy after radical gastrectomy for elderly patients with stage Ⅲ gastric cancer.Methods:The propensity score matching and retrospective cohort study were conducted. The clinicopatholo-gical data of 456 elderly patients with stage Ⅲ gastric cancer who underwent D 2 radical resection in the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2020 were collected. There were 343 males and 113 females, aged 71(range, 65?89)years. Of the 456 patients, 274 cases undergoing single-agent adjuvant chemotherapy after surgery were divided into single-agent chemotherapy group, 182 cases undergoing double-agent or triple-agent adjuvant chemotherapy after surgery were divided into multi-agent chemotherapy group. Observa-tion indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) adverse events during chemotherapy; (3) follow-up. Propensity score matching was done by the 1∶1 ratio, with the caliper value of 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the non-parameter rank sum test. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 456 patients, 306 cases were successfully matched, including 153 cases in the single-agent chemotherapy group and 153 cases in the multi-agent chemotherapy group. The elimination of age, age-adjusted Charlson comorbidity index, pathological TNM staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Adverse events during chemotherapy. In terms of hematological adverse events, 6 cases in the single-agent chemotherapy group and 16 cases in the multi-agent chemotherapy group had neutropenia, showing a significant difference in the neutropenia ( χ2=4.90, P<0.05). In terms of non-hematological adverse events, cases with anorexia and nausea were 77 and 50 for the single-agent chemotherapy group, versus 96 and 69 for the multi-agent chemotherapy group, showing significant differences between the two groups ( χ2=4.80, 4.96, P<0.05). (3)Follow-up. All the 306 patients were followed up for 48(range, 8?61)months. The 5-year overall survival rates of the single-agent chemotherapy group and the multi-agent chemotherapy group were 36.08% and 38.31%, respectively, showing no significant difference between the two groups ( hazard ratio=0.93, 95% confidence interval as 0.70?1.20, P>0.05). Results of further analysis showed that the 5-year overall survival rates were 32.41% and 39.40% for 97 patients of the single-agent chemotherapy group and 97 patients with double-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=1.20, 95% confidence interval as 0.82?1.70, P>0.05). The 5-year overall survival rates were 43.15% and 37.11% for 56 patients of the single-agent chemotherapy group and 56 patients with triple-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=0.81, 95% confidence interval as 0.65?1.00, P>0.05). Conclusions:For adjuvant chemotherapy in elderly patients with stage Ⅲ gastric cancer, there is no significant survival advantage of double-agent or triple-agent chemotherapy over single-agent oral chemotherapy. However, there is a higher incidence of neutropenia, anorexia, ausea.

Objective: To investigate the pulmonary functions among the elderly in Hangzhou City, so as to provide insights into the management of respiratory diseases among the elderly. Methods: Permanent residents at ages of 60 to 75 years were sampled from Hangzhou City from November to December 2020. The pulmonary function was tested using a portable pulmonary function monitor, including large airway function parameters [forced expiratory volume (FVC), forced expiratory volume in a second (FEV1) and FEV1/FVC], and small airway function parameters [maximum expiratory flow rate at 75% vital capacity (MEF75%), the maximum expiratory flow rate at 25% of vital capacity (MEF25%) and the forced expiratory flow rate (FEF25%-75%) at 25% to 75% of vital capacity]. The pulmonary functions were compared among the elderly with different genders, ages and body mass index (BMI). Results : Totally 314 participants were recruited, including 126 men (40.13%), with a mean age of (68.49±4.47) years and mean BMI of (23.51±2.79) kg/m2. The mean FEV1, FVC, FEV1/FVC, MEF25%, MEF75% and FEF25%-75% were (1.97±0.53) L, (2.51±0.72) L, (79.79±11.47)%, (0.98±0.53) L/s, (3.84±1.65) L/s and (1.99±0.91) L/s among the participants, respectively. Higher FEV1 [(2.22±0.55) vs. (1.79±0.43) L, P<0.05], FVC [(2.92±0.75) vs. (2.24±0.55) L, P<0.05], MEF75% [(4.19±1.82) vs. (3.59±1.49) L/s, P<0.05] and FEF25%-75% [(2.14±1.07) vs. (1.90±0.77) L/s, P<0.05] were tested among men than among women, and lower FEV1 [(1.75±0.46) L], FVC [(2.27±0.64) L], MEF25% [(0.88±0.57) L/s], MEF75% [(3.39±1.45) L/s] and FEF25%-75% [(1.79±0.96) L/s] were tested among the elderly at ages of 70 to 74 years. The proportion of large and small airway dysfunctions was 40.45% among the participants. Conclusions The proportion of large and small airway dysfunctions was 40.45% among the elderly in Hangzhou City, and poor pulmonary functions were tested among the women and the advanced elderly.

As a crucial regulatory molecule in the context of vascular stenosis, transforming growth factor-β (TGF-β), plays a pivotal role in its initiation and progression. TGF-β, a member of the TGF-β superfamily, can bind to the TGF-β receptor and transduce extracellular to intracellular signals through canonical Smad dependent or noncanonical signaling pathways to regulate cell growth, proliferation, differentiation, and apoptosis. Restenosis remains one of the most challenging problems in cardiac, cerebral, and peripheral vascular disease worldwide. The mechanisms for occurrence and development of restenosis are diverse and complex. The TGF-β pathway exhibits diversity across various cell types. Hence, clarifying the specific roles of TGF-β within different cell types and its precise impact on vascular stenosis provides strategies for future research in the field of stenosis.
Humans ; Transforming Growth Factor beta/metabolism* ; Constriction, Pathologic ; Signal Transduction ; Cell Differentiation ; Vascular Diseases ; Transforming Growth Factors ; Transforming Growth Factor beta1