[Objective] To analyze the prognostic value of prostate cancer (PCa) pyroptosis-related genes (PRGs) using gene expression databases and to explore the regulatory mechanism of nucleotidebinding oligomerization domain-like receptor containing pyrin domain 1 (NLRP1) in the pyroptosis of PCa cells. [Methods] Fragments per kilobase of exon model per million reads mapped (FPKM) data and clinical information from PCa and adjacent tissues from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were obtained. Differentially expressed PRGs between PCa and adjacent tissues, classified subtypes and plotted survival curves were analyzed. Univariate Cox regression analysis, least absolute shrinkage and selection operator (LASSO) regression analysis were conducted to screen prognosis-related PRGs, risk scores were calculated, and a prognostic risk model was constructed and validated. Patients were divided into high and low risk groups based on the median risk scores from the training and validation sets, and gene ontology (GO) enrichment and kyoto encyclopedia of genes and genomes (KEGG) analysis were conducted on differentially expressed PRGs. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression level of NLRP1 in PCa cell lines, and pyroptosis was induced in DU145 and LNCaP cells while morphological changes were observed. Western blot (WB) was performed to detect the expression of pyroptosis-related molecules. [Results] A total of 6 prognostic-related PRGs were obtained, including CHMP4C, CYCS, GPX4, GSDMB, NLRP1, and PLCG1. The risk score was positively correlated with the risk of recurrence but negatively correlated with the progression-free survival (P<0.001). The area under the receiver operating characteristic curves (AUCs) for the training set at 1, 3, and 5 years were 0.769 (95%CI: 0.652-0.878), 0.804 (95%CI: 0.736-0.882), and 0.772 (95%CI: 0.631-0.905), respectively, while those for the validation set were 0.731 (95%CI: 0.647-0.826), 0.753 (95%CI: 0.674-0.818), and 0.763 (95%CI: 0.626-0.849), respectively. Differences in expression levels of the 6 PRGs were observed between the high and low risk groups in both the training and validation sets (P<0.05). Cox regression analysis showed that T stage, prostate specific antigen (PSA), Gleason grade, and risk score were independent predictors of PCa prognosis (P<0.05). Differences in risk scores were observed among patients of different ages, T stages, and Gleason grades (P<0.05). NLRP1 was found to be lowly expressed in PCa cell lines and was involved in the regulation of pyroptosis in DU145 and LNCaP cells. [Conclusion] The prognostic risk model constructed based on PRGs has a certain predictability for the prognosis of PCa patients, and NLRP1 may be involved in the regulation of pyroptosis in PCa cells.

Objective To explore the role of neogambogic acid in the characteristics of colorectal cancer stem cells (CRC-CSCs) through the Wnt/β-catenin signaling pathway. Methods The colorectal cells SW480 and HCT166 were divided into control group and neogambogic acid groups (1.5, 3, 6, and 12 μmol/L). The viability of CRC-CSCs was determined by MTT method, and spheroid and clone formation assays were used to assess the capacity of spheroid formation and self-renewal ability of the cells. The effects of neogambogic acid on the apoptosis and cell cycle of CRC-CSCs were evaluated by flow cytometry assays. Real-time quantitative PCR was used to detect the mRNA expression levels of relative markers (CD133, CD44, ALDH1, Oct4, and Nanog) of CRC-CSCs, and the protein expression levels of the self-renewal marker (PCNA), apoptosis markers (cleaved caspase-3 and cleaved caspase-9), and Wnt/β-catenin signaling pathway markers (p-GSK3β, GSK3β, β-catenin, and Wnt) were analyzed using Western blot. Results Compared with the control group, after neogambogic acid treatment, the viability of SW480 and HCT116 cells decreased (P<0.05), the spheroid forming ability and the clone numbers of CRC-CSCs decreased (P<0.001, P<0.01) but the cell apoptosis rate increased (P<0.01), and cell cycle was arrested in G₀/G₁ phase. Moreover, neogambogic acid downregulated the mRNA and protein expression of relative markers of CRC-CSCs (CD133, CD44, ALDH1, Oct4, and Nanog), PCNA, p-GSK3β, β-catenin, and Wnt (P<0.05) and upregulated the expression of cleaved caspase-3, cleaved caspase-9, and GSK3β (P<0.01). Conclusion Neogambogic can inhibit the stem cell properties of colorectal cells via inhibition of Wnt/β-catenin signaling pathway. As a result, neogambogic acid may be an attractive agent against colorectal cancer.

Objective:To analyze influencing factors for the clinical efficacy of Perampanel monotherapy in children with focal epilepsy and promote rational clinical use of Perampanel.Methods:Children who were diagnosed with focal epilepsy and treated with Perampanel monotherapy in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from June 2021 to August 2022 were included in this retrospective study.Efficacy at 3, 6 and 12 months after treatment was taken as the dependent variable.The gender, age at onset, age at initiation of Perampanel monotherapy, course of disease, weight, body mass index (BMI), seizure frequency, epilepsy syndrome, etiology, previous clinical history, developmental retardation, starting and maintenance doses, blood concentration, CYP3A4 and CYP3A5 gene mutations were taken as the independent variables.The effects of these factors on the efficacy of Perampanel monotherapy were analyzed using the Cox proportional hazards regression.The random forest and decision tree models were used to sequence the significance of the influencing factors and find the optimal cut-point for classification. Results:A total of 43 children (31 boys and 12 girls) were enrolled in this study.The average age at onset was (7.6±2.1) years, and the average age at initiation of Perampanel monotherapy was (7.8±2.7) years.The Cox proportional hazards regression analysis indicated that the greater the BMI, the worse the efficacy of Perampanel ( HR=0.74, 95% CI: 0.55-0.99, P=0.045). Through machine learning, the BMI was found to be a significant covariate affecting the efficacy, and when BMI≥21.8 kg/m 2, the negative effect was more significant. Conclusions:The clinical efficacy of Perampanel monotherapy in children with focal epilepsy is related to BMI.The dose of Perampanel for obese children with epilepsy may need to appropriately increase.

Objective:To study the influence of electromyographic biofeedback therapy(EMGBFT)combined with mirror therapy(MT)on lower limb motor and balance function in stroke patients. Method:Sixty patients with hemiplegia after stroke were randomly divided into two groups:MT based EMG-BFT group and EMGBFT group,30 patients in each group.On the basis of conventional rehabilitation,the patients in the EMGBFT group received sham MT stimulation combined with EMGBFT,and the patients in the MT based EMGBFT group received MT combined with EMGBFT.Before and after treatment,the lower limb motor function of the patients was evaluated using Fugl-Meyer assessment scale-lower extremity(FMA-LE)and surface electromyography-integrated electromyography(iEMG)of knee flexion and ankle dorsiflex-ion,co-contraction ratio(CR).Plantar pressure-symmetry index(SI)of mean pressure and contact area of both feet,elliptical area of body center of gravity,anteroposterior(AP)and mediolateral(ML)displacement distance of body center of gravity under eye-opening and eye-closed states were calculated to evaluate pa-tients'weight-bearing and balance function. Result:After treatment,FMA-LE,CR and iEMG of biceps femoris and rectus femoris under knee flexion,tibialis anterior and medial gastrocnemius under ankle dorsiflexion were markedly ameliorated in the two groups(P＜0.01).After treatment,in the eye-opening state,the SI of mean pressure and contact area of both feet,elliptical area of body center of gravity,AP and ML displacement distances of body center of gravity were greatly enhanced in the two groups(P＜0.05,P＜0.01),in the eye-closed state,the SI of mean pressure and contact area of both feet,ML displacement distances of body center of gravity were observably ameliorat-ed in the two groups(P＜0.05,P＜0.01).Compared with the EMGBFT group,the FMA-LE,iEMG of biceps femoris and tibialis anterior muscles,elliptical area of body center of gravity,AP and ML displacement dis-tance of body center of gravity with eyes open,SI of contact area of both feet with eyes closed had more significant changes in the MT based EMGBFT group after treatment(P＜0.05,P＜0.01). Conclusion:Electromyographic biofeedback therapy combined with mirror therapy can improve lower limb motor and balance function in stroke patients,the underlying mechanism of which may be the activation of lower limb weak muscle motor units,the relief of lower limb spasm,and the improvement of standing static balance ability.

Objective This study summarized the clinical data of IBD patients receiving upadacitinib treatment in our hospital,and provided more Chinese data to better guide the treatment of upadacitinib in Chinese IBD population.Methods Clinical data of 11 patients with IBD who received upadacitinib treatment at Anhui Provincial Hospital from March 1,2023 to September 8,2024 were retrospectively analyzed.Platelet count,ESR,CRP,disease severity score,endoscopic score,and adverse reactions were compared before treatment,at the 4th and 8th week of treatment,and clinical response rate,clinical response rate,endoscopic response rate,and endoscopic response rate were calculated.SPSS 25.0 software was used for statistical analysis.Results The platelets,ESR and CRP of patients at the 4th and 8th week after upadacitinib treatment were decreased compared with those before treatment,with statistical significance.At the 4th week,the clinical response rate was 72.72％(8/11),the clinical remission rate was 0,the clinical response rate of UC patients was 83.33％(5/6),and the clinical response rate of CD patients was 60％(3/5).At the 8th week of treatment,the clinical response rate was 100％(10/10),the clinical remission rate was 80.00％(8/10),the clinical response rate of UC patients was 100％(6/6),the clinical remission rate of UC patients was 83.33％(5/6),the clinical response rate of CD patients was 100％(4/4),and the clinical remission rate of CD was 75％(3/4).There were no adverse reactions during treatment.Three patients were re-examined by colonoscopy,all of whom were severe UC patients and achieved mucosal healing.Conclusion Upadacitinib can rapidly,effectively and sustainably control the disease in patients with moderate and severe IBD,with high safety.

Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a rare autosomal recessive neurometabolic disease.Pathogenic mutations in ALDH5A1 genes lead to abnormalities in the structure, activity and function of succinic semialdehyde dehydrogenase, resulting in a series of neurological damage.Due to the rarity of SSADHD and the huge differences in its clinical manifestations, it often leads to misdiagnosis or delayed diagnosis, and the treatment is mainly symptomatic.There is no specific drug or treatment.In March 2024, the SSADHD consensus group, composed of SSADHD researchers from 19 institutions in 11 countries and regions, released the " Consensus Guidelines for the Diagnosis and Management of Succinic Semialdehyde Dehydrogenase Deficiency" , which elaborates on the definition, epidemiology, clinical manifestations, diagnosis, and treatment of SSADHD, aiming to standardize and unify the diagnosis and management of SSADHD.This article interprets the key contents of the guidelines, in order to provide guidance for the early screening, diagnosis and treatment of SSADHD in China.

OBJECTIVE: To review the application and research progress of artificial intelligence (AI) technology in trauma treatment. METHODS: The recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked. RESULTS: The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients' situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment. CONCLUSION There is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.
Humans ; Artificial Intelligence ; Operative Time ; Robotic Surgical Procedures ; Technology

Objective:To compare the changes in functional optical zone (FOZ) and corneal morphology in myopes between femtosecond small incision laser lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).Methods:A cohort study was performed.A total of 94 patients (94 eyes) who underwent FS-LASIK or SMILE at Eye Hospital, Wenzhou Medical University from March to December 2021 were enrolled.The selected patients were divided into a SMILE group (46 cases, 46 eyes) and an FS-LASIK group (48 cases, 48 eyes) according to the surgical procedure, and the follow-up period was 6 months.The primary outcome measures were postoperative changes in corneal FOZ and Q-value, and the secondary outcome measures were changes in central corneal thickness (CCT) and mean corneal curvature (Km). Corneal Q-value, horizontal and vertical FOZ diameters, CCT, and Km were recorded before surgery and at 1 day, 1 week, 1 month, and 6 months after surgery using the Pentacam anterior segment analysis system, and the differences in each parameter and the trends of changes between the two groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Eye Hospital, Wenzhou Medical University (No.2021-034-k-27). Written informed consent was obtained from each subject.Results:There were statistically significant overall differences in the postoperative horizontal and vertical FOZ diameters between the two groups (horizontal diameter: Fgroup=7.06, P<0.001; Ftime=64.18, P=0.001; vertical diameter: Fgroup=11.08, P<0.001; Ftime=77.14, P<0.001). The horizontal and vertical FOZ diameters were significantly larger in SMILE group than in FS-LASIK group at various postoperative time points, and the differences were statistically significant (all at P<0.001). In the two groups, the postoperative 1-week, 1-month and 6-month horizontal FOZ diameters and the postoperative 1-week and 1-month vertical FOZ diameters were smaller than the postoperative 1-day ones, and the differences were statistically significant (all at P<0.05). There were significant overall differences in Q-values at different postoperative time points between the two groups ( Fgrouup=53.11, P=0.019; Ftime=29.18, P<0.001). The postoperative 1-day, 1-week, and 1-month Q-values of FS-LASIK group were significantly higher than those of SMILE group (all at P<0.05). The postoperative 1-week Q-value was significantly larger than the postoperative 1-day value in SMILE group ( P<0.001). The postoperative Q-values gradually decreased with time in FS-LASIK group, with significant pairwise differences at all adjacent time points (all at P<0.001). There were significant differences in CCT at various postoperative time points between the two groups ( Ftime=21.43, P<0.01). In FS-LASIK group, the CCT was decreased at 1 week than 1 day after surgery and was increased at 6 months than 1 week after surgery, and the differences were statistically significant (all at P<0.05). In SMILE group, the postoperative 1-week, 1-month and 6-month CCT was increased in comparison with the postoperative 1-day value, and the differences were statistically significant (all at P<0.05). There was no significant overall difference in the Km between the two groups ( Fgroup=27.29, P=0.41). There were significant pairwise differences in the Km at different postoperative time points between the two groups (all at P<0.001). The postoperative 6-month Km was smaller than the postoperative 1-day value in SMILE group, and the postoperative 6-month Km was greater than the postoperative 1-day value in FS-LASIK group (both at P<0.05). Conclusions:The FOZ shows a trend of gradual reduction within a month after SMILE and FS-LASIK.The FOZ is larger after SMILE than after FS-LASIK.The morphologic stability of corneal FOZ is better after SMILE than after FS-LASIK.

The endocrown, a modified overlay or crown, is considered to have the advantages of adhesive retention and mechanical retention. Marginal adaptation and mechanical strength are common criteria for evaluating endocrowns. This review studied these aspects of endocrowns to guide further clinical application. Results from previous academic studies indicate that endocrowns made of different materials, such as glass-based ceramics, zirconia-based ceramics and resin-based ceramics, exhibit clinically acceptable marginal adaptation. Zirconia is a common dental material, but when used in endocrowns, it tends to present a risk of irreparable tooth root fractures. Compared with products manufactured with zirconia, endocrowns manufactured with resin-based ceramics and glass-based ceramics, such as lithium disilicate ceramics, do not tend to cause irreparable results, such as tooth root fracture, but their mechanical strengths are not as good as those of zirconia. At the same time, the tooth prepration design such as the types of endocrowns, the pulp chamber extension depth and angles, the endocrown thickness can influence the mechanical strength of endocrowns as well. Compared with traditional zirconia, self-glazed zirconia, a new type of material used to restore defective teeth, has the similar elasticity modulus（210 GPa）and better aesthetic advantages, and is suitable for short crown patients with insufficient occlusal space. Further study is warranted to improve the performance of endocrowns made from ceramic materials to prevent root fracture.

Objective:To analyze the global research hotspots in the field of pediatrics based on the Essential Science Indicators (ESI) database and explore the inspiration to domestic editors and pediatrics researchers.Methods:The journal distribution, country (region) distribution, cooperation, organization distribution, funding, publication language, hot topic words and other data of highly cited papers in the field of pediatrics in ESI database were collected and analyzed.Results:A total of 682 highly cited pediatrics papers were collected from 77 pediatrics journals included in Science Citation Index(SCI). Most of the highly cited pediatrics papers (182) were found to be published in Pediatrics.All 682 paper were published in English and frequently, characterized by multiple authors, institutions and fund support.Of 682 highly cited pediatrics papers, 435 papers were published in the United States(the first), 123 papers in England(the second) and 86 paper in Canada(the third). Novel coronavirus pneumonia, coronavirus, SARS coronavirus, autism and multiple system inflammatory syndrome are the main frontiers of global pediatric research at present.Specifically, focal pediatric system diseases mainly include respiratory system diseases, digestive system diseases, cardiovascular diseases, etc. Conclusions:ESI-based analysis of global research hotspots in the field of pediatrics provides reference materials for domestic and foreign pediatrics researchers to understand the global academic frontiers and development trends in the field of pediatrics and select topics for future scientific research.More importantly, this analysis can help domestic editors of pediatrics journals to plan topics and organize hot papers, so as to improve the academic quality and international influence of the journals.