Objective This study aims to explore the efficacy of tetrahydrocurcumin （THC）， the major active metabolite of curcumin， on high glucose （HG）-induced human platelet aggregation and activation as well as to clarify the underlying mechanisms in vitro. Methods Purified platelets prepared from healthy subjects were pre-incubated with various concentrations of THC （0.5 μmol/L， 1 μmol/L or 10 μmol/L） or vehicle control （0.05% DMSO） for 40 min at 37°C， followed by the stimulation of normal glucose （NG， 5 mmol/L） or HG （25 mmol/L） for additional 90 min. The maximal aggregation rate was determined by an aggregometer. Flow cytometry was used to measure platelet surface expression of CD62P （a typical marker of platelet activation） and generation of total intraplatelet reactive oxygen species （ROS）. Meanwhile， the phosphorylation level of platelet p53 was detected by Western blot assay. Results Compared with NG group， HG intervention significantly increased platelet aggregation （P < 0.05） and CD62P expression （P < 0.001）， which were greatly inhibited by different concentrations of THC （P < 0.05）. Mechanistically， when compared with solvent control， THC significantly decreased the level of total ROS production （P < 0.001） and p53 phosphorylation （P < 0.05）. In addition， HG-induced total intraplatelet ROS generation （P < 0.001） and p53 phosphorylation （P < 0.05） were greatly attenuated by adding a ROS scavenger N-acetyl-L-cysteine （NAC）. The combination of NAC with THC （10 μmol/L） showed no additive inhibitory effects （P > 0.05）. Moreover， platelet aggregation and activation induced by HG were greatly decreased by NAC and a p53 specific inhibitor PFT-μ （P < 0.05）. The combination of THC （10 μmol/L） and NAC resulted no additive inhibitory effects on HG-increased platelet aggregation and activation （P > 0.05）. THC （10 μmol/L） exhibited additive inhibitory effects on platelet aggregation （P < 0.05） but no additive inhibitory effects on platelet activation when combined with PFT-μ （P > 0.05）. Conclusions THC exerts a protective effect on HG-induced platelet aggregation and activation possibly through down-regulating ROS/p53 signaling pathway in human platelets in vitro. The current study may provide potential value for THC to improve thrombosis in diabetes mellitus and the related chronic metabolic diseases.

Objective To investigate the role of Toll-like receptor 4 （TLR4） in the regulation of homocysteine （Hcy）-induced ferroptosis in macrophages. Methods Mouse macrophage cells RAW264.7 were cultured and divided into control group， Hcy intervention group （Hcy group）， and Hcy plus ferroptosis inhibitor group （Hcy+Fer-1 group）. After transfection with interference fragments， macrophages were treated with Hcy， and then divided into control group， Hcy intervention group （Hcy group）， TLR4 interference negative control plus Hcy intervention group （si-NC+Hcy group）， and TLR4 interference plus Hcy intervention group （si-TLR4+Hcy group）. Macrophages were transfected with overexpression lentivirus and treated with Hcy， then were divided into control group， Hcy intervention group （Hcy group）， a TLR4 overexpression negative control plus Hcy intervention group （OE-NC+Hcy group）， and a TLR4 overexpression plus Hcy intervention group （OE-TLR4+Hcy group）. After 48 hours of intervention， real-time fluorescent quantitative PCR and western blot were used to detect the expression levels of TLR4 in macrophages treated with Hcy； western blot was used to detect the expression levels of ferroptosis-related proteins ACSL4， GPX4， and FTH1 in macrophages， and ferrous ion assay kit to detect the concentration of Fe²⁺ in macrophages； reactive oxygen species （ROS） assay kit and laser confocal microscopy were used to detect the content of intracellular reactive oxygen species. Results Compared with those in the control group， the expression level of the pro-ferroptosis protein ACSL4 was increased in the Hcy group （P < 0.05）， while the expression levels of anti-ferroptosis proteins GPX4 and FTH1 were decreased （P < 0.05）； the concentration of Fe²⁺ was increased （P < 0.05）， and the content of ROS was increased. Meanwhile， the protein and mRNA expression levels of TLR4 were both increased in the Hcy group （P < 0.05）. After macrophages were transfected with TLR4 interference fragments， compared with those in the si-NC+Hcy group， the expression levels of GPX4 and FTH1 were increased （P < 0.05）； the expression level of ACSL4 was decreased （P < 0.05）； the concentration of Fe²⁺ was decreased （P < 0.05）， and the content of ROS was reduced in the si-TLR4+Hcy group. After macrophages were transfected with TLR4 overexpression lentivirus， compared with those in the OE-NC+Hcy group， the expression levels of GPX4 and FTH1 were decreased （P < 0.05）， and the expression level of ACSL4 was increased （P < 0.05） in the OE-TLR4+Hcy group. Conclusion Hcy induces the occurrence of ferroptosis in macrophages， and Toll-like receptor 4 has a positive feedback regulatory effect on ferroptosis in macrophages.

Objective To investigate the effects of electroacupuncture （EA） at “Baihui （GV 20），”“Pishu （BL 20），” and “Zusanli （ST 36）” on the learning and memory functions of rats with Alzheimer′s disease （AD） induced by Aβ1?42. Additionally， the mechanism of EA in treating AD was explored from the perspective of the inflammatory cascade mediated by the NF?κB/NLRP3/Caspase?1 signaling pathway. Methods A rat model of Alzheimer′s disease was established by bilateral injection of Aβ1?42 solution into the C1 region of the hippocampus. According to the random number table method， 32 male SPF?grade rats were divided into four groups （n = 8 per group）： a sham?operated group， a model group， an electroacupuncture （EA） group， and a Western medicine group （donepezil hydrochloride）. The EA group received electroacupuncture at the “Baihui”， “Pishu”， and “Zusanli” acupoints； the Western medicine group received donepezil hydrochloride via gavage. After the treatment period， Morris water maze experiments were conducted to evaluate learning and memory abilities. Hematoxylin and eosin （HE） staining was used to examine morphological changes in hippocampal tissues. Enzyme?linked immunosorbent assay （ELISA） was employed to measure serum levels of TNF?α and IL?1β. Western blotting and immunofluorescence staining were utilized to assess the co?expression levels of NF?κB p65， NLRP3， and Caspase?1 proteins in the hippocampal region. Results Compared with the sham?operated group， rats in the post?modeling group exhibited significantly prolonged escape latency （P < 0.05）， reduced crossings of the original platform location， and decreased time spent in the target quadrant （P < 0.05）. Additionally， nuclear morphology was altered， neurons surrounding the hippocampus displayed necrosis， vacuolar degeneration， and chromatin marginalization. Serum levels of TNF?α and IL?1β were elevated （P < 0.05）， and protein expression levels as well as fluorescent positivity for NF?κB p65， NLRP3， and caspase?1 in the hippocampus were increased （P < 0.05）. Compared with the model group， rats in both the EA and Western medicine groups showed a trend toward shorter escape latency （P < 0.05）， increased crossings of the original platform location and time spent in the target quadrant （P < 0.05）. Cell structures were largely intact， with only a few nuclei showing slight irregularities and some chromatin accumulation at the edges. Serum levels of TNF?α and IL?1β were reduced （P < 0.05）， and protein expression levels and fluorescence positivity for NF?κB p65， NLRP3， and caspase?1 in the hippocampus were also decreased （P < 0.05）. Conclusion EA enhances the learning and memory capabilities of AD rats， potentially by downregulating the NF?κB/NLRP3/Caspase?1 + signaling + pathway and decreasing the release of neuroinflammatory factors， thereby alleviating cognitive dysfunction in AD rats.

Objective To explore the effect of exenatide on oxidative stress in the hypothalamus of diabetes mice and its potential mechanism. Methods After one week of adaptive feeding， C57BL/6J mice were randomly divided into the CON group （normal chaw diet）， the T2DM group （high-fat diet， HFD）， and the T2DM+Exe group （HFD+ exenatide）. After 8 weeks of HFD， mice in the T2DM+Exe group were intraperitoneally injected with exenatide ［24 nmol/（kg·d）］ for 8 weeks.The weight and glucose and lipid metabolism levels of the mice were measured， and the levels of inflammatory and adipokine factors in mice were detected using the ELISA method. Western Blot was used to detect the expression of melanocortin receptor-4 （MC4R） and proopiomelanocortin （POMC） in the hypothalamus. Hypothalamic mitochondria were extracted， and the content of mitochondrial reactive oxygen species （ROS） was measured using a flow cytometer. The content of malondialdehyde （MDA） and the activities of superoxide dismutase （SOD） in the mitochondria were detected using assay kits. Changes in the ultrastructure of mitochondria were observed using a transmission electron microscope. In vitro experiments， palmitic acid （PA） and exenatide were used to treat hypothalamic GT1-7 cells， and short hairpin RNA （shRNA） was used to silence the melanocortin 4 receptor （MC4R）， and observe the cellular oxidative stress and lipid deposition. Results Compared with the CON group， the T2DM group mice showed a significant increase in glucose and lipid metabolism indicators， pro-inflammatory factors， and adipose factor levels （P < 0.05）， the expression of MC4R and POMC proteins in the hypothalamus were decreased （P < 0.05）， and the mitochondrial ROS and MDA content in the hypothalamus significantly were increased （P < 0.05）， while SOD and CAT activities were decreased （P < 0.05）. Mitochondrial morphology was abnormal. After intervention with exenatide， the above indicators were significantly improved. After inhibiting MC4R expression in vitro experiments， compared with the intervention group with exenatide， the ROS and MDA content was significantly increased （P < 0.05）， SOD activity was decreased （P < 0.05）， and lipid deposition occurred in the cells. Conclusions Exenatide exhibits a protective effect on hypothalamic oxidative stress injury in diabetic mice， and this mechanism may be associated with the upregulation of MC4R expression.

Objective To investigate the effects of miR-483-3p on hypoxia/reoxygenation （H/R）-induced apoptosis and pyroptosis of H9c2 cardiomyocytes and its possible mechanism. Methods Rat H9c2 cardiomyocytes were cultured in vitro，adeno-associated virus-infected H9c2 and the H/R model were constructed by triple-air incubator， and the cells were randomly divided into blank control （Sham） group， model （H/R） group， AAV-miR-483-3p mimic+H/R （AAV-miR-483-3p） group， AAV-miR-483-3p negative control+H/R （AAV-NC） group. The growth status of cells in each group was observed using an inverted microscope； cell proliferation activity was detected by cell counting kit-8 （CCK-8）； LDH release by lactate dehydrogenase （LDH） kit； apoptosis rate by flow cytometry； apoptosis by notched end labeling （TUNEL）.Western blot （WB） was used to detect the expression levels of IL-1β and GSDMD proteins in each group. Results Compared with the Sham group， the H/R group showed abnormal cell status and increased cell death， decreased cell activity， increased LDH release， increased apoptosis rate and apoptosis level， and increased expression levels of IL-1β and GSDMD proteins （P < 0.05）； compared with the H/R group， the AAV-miR-483-3p group showed improved cell status and less cell death， increased cell proliferation activity， increased LDH release， and increased IL-1β and GSDMD protein expression levels （P < 0.05）. Compared with the H/R group， the AAV-miR-483-3p group showed improved cell status and less cell death， increased cell proliferation activity， decreased LDH release， decreased apoptosis rate and apoptosis level， and decreased expression of IL-1β and GSDMD proteins （P < 0.05）. Conclusion Over-expression of miR-483-3p can improve H/R-inducedH9c2 cardiomyocyte injury by enhancing cell activity and cell metabolism， and inhibiting apoptosis and cell charring.

Objective To investigate whether there are gender differences in the relationship between fasting blood glucose levels and non-alcoholic fatty liver disease （NAFLD）. Methods A retrospective analysis was conducted on 1，584 participants aged ≥ 40 who underwent health screening at Wuhan Union Hospital between January 2020 and November 2021. The cohort included 1，143 men and 441 women. Health screening indicators， including general demographic information and routine biochemical test data， were collected. Based on routine abdominal B-ultrasound scan results， participants were classified into NAFLD and non-NAFLD groups. The generalized additive model based on smooth curve fitting was used to describe the dose-response relationship between fasting blood glucose （FBG） and the risk of NAFLD in different genders. A two-stage logistic model was employed to reveal potential non-linear relationships， and threshold effect analysis was performed to determine the non-linear inflection point. Results FBG levels were significantly higher in the NAFLD group compared to the non-NAFLD group for both men and women. After adjusting for covariates such as age， BMI， smoking， alcohol consumption， hypertension， ALT， AST， TC， TG， HDL-C， and LDL-C， a positive linear correlation between FBG and NAFLD was observed in women， indicating that increased FBG was associated with a higher risk of NAFLD （OR = 1.29， 95% CI： 1.02 ~ 1.64）. In men， the relationship between FBG and NAFLD was non-linear. When FBG was ≤ 5.61 mmol/L， increased FBG was associated with a higher risk of NAFLD （OR = 1.58， 95% CI： 1.17 ~ 2.13）. However， when FBG exceeded 5.61 mmol/L， the risk of NAFLD plateaued. Conclusion There is a positive association between FBG and NAFLD in women. In men， NAFLD risk increases with FBG levels up to 5.61 mmol/L， beyond which the risk stabilizes， indicating a saturation effect.

Objective To examine the association between lymphocyte subsets and renal clinicopathological characteristics as well as prognosis in patients with IgA nephropathy （IgAN）. Methods The retrospective analysis included general clinical data and pathological examination results of IgAN patients diagnosed by renal biopsy at the Fourth Hospital of Hebei Medical University from January 2018 to January 2022. Correlation tests were conducted to examine the relationship between lymphocyte subsets and other significant clinicopathological parameters. The optimal cut?off value of CD4⁺ T determined using the Youden index， and patients were grouped accordingly. Kaplan?Meier survival curves and Cox regression analyses were employed to compare the low and high CD4⁺ T lymphocyte groups among IgAN patients， identifying factors influencing renal function progression. The endpoint event was defined as a decrease in estimated glomerular filtration rate （eGFR） of ≥ 30% from baseline， progression to end?stage renal disease （ESRD） ［eGFR < 15 mL/（min·1.73 m²） or initiation of renal replacement therapy］， or all?cause mortality. Results Low CD4⁺ T lymphocytes were significantly positively correlated with blood IgA levels and the proportion of glomerular crescents in IgAN patients （all P < 0.05）. This study included a total of 53 IgAN patients， divided into two groups based on CD4⁺ T lymphocyte counts： 20 patients in the low CD4⁺ T lymphocyte group and 33 patients in the high CD4⁺ T lymphocyte group. In the low CD4⁺ T lymphocyte group， there was a higher proportion of males and a lower proportion of glomerular crescents （P < 0.05）. Kaplan?Meier survival analysis revealed that patients with low CD4⁺ lymphocytes had a significantly lower cumulative renal survival rate （Log?Rank test χ² = 4.188， P = 0.041）. Cox regression analysis indicated that low CD4⁺ lymphocytes were an independent risk factor for the progression of renal function decline in IgAN patients （HR = 2.614， 95% CI： 1.006 ~ 6.788， P = 0.048）. Conclusions Patients with higher levels of CD4⁺ T lymphocytes exhibit a lower risk of adverse renal outcomes. In contrast， patients with IgA nephropathy and low CD4⁺ T lymphocyte counts tend to have poorer renal survival rates.

Objective To explore the clinical efficacy of modified anteromedia approach with superior extensor retinaculars and traditional anteromedia combined with posterolateral approach in the treatment of Rüedi-Allg?wer type Ⅲ Pilon fractures. Methods In this study selected 56 patients with Rüedi-Allg?wer type Ⅲ Pilon fractures treated in our hospital from January 2020 to January 2022， all of whom met the inclusion and exclusion criteria， 27 in the experimental group and 29 in the control group. Both groups underwent open reduction and internal fixation of Pilon fractures. The experimental group used a modified anteromedial approach to preserve the supraspinatus， while the control group used a traditional anteromedial combined with posterolateral approach to cut off the supraspinatus. The general clinical data， operation time， intraoperative blood loss， postoperative drainage volume， fracture reduction quality， early pain VAS score， complications and ankle function evaluation of the experimental group and the control group were compared in detail， and the early clinical efficacy of the two surgical methods was analyzed and compared. Results There were no significant differences in age， gender， body mass index （BMI）， complications， injury mechanism and the time from admission to operation between the experimental group and the control group （P > 0.05）. Experimental group： operation time （115.92 ± 12.23）min， intraoperative blood loss（129.25 ± 16.15）mL， postoperative drainage volume （82.44 ± 25.57）mL， fracture healing time （17.89 ± 2.39）w；Control group： operation time （172.75 ± 15.09）min， intraoperative blood loss （177.24 ± 14.36）mL， postoperative drainage volume（115.06 ± 21.95）mL， fracture healing time（19.93 ± 3.75）w. The operative time and fracture healing time of the experimental group were less than those of the control group（P < 0.05）， and the intraoperative blood loss and postoperative drainage volume of the experimental group were less than those of the control group， the difference was statistically significant（P < 0.05）. The Buewell-Charnley fracture reduction radiological evaluation criteria were used to evaluate the fracture reduction， and the rate of good reduction was 96.29% in the experimental group and 93.10% in the control group. There was no statistical significance in the anatomical reduction between the two groups （P > 0.05）. Visual analog scale （VAS） was used to evaluate postoperative pain， and pain VAS scores of the experimental group were lower than those of the control group at 3 days， 1 week and 4 weeks after surgery （P <0.05）. Both groups were followed up for at least 12 months after surgery， and the incidence of postoperative complications in the experimental group was lower than that in the control group（P < 0.05）. The AOFAS score of the experimental group was higher than that of the control group at 3 months， 6 months and 12 months after surgery （P < 0.05）. Conclusion Improvement on the medial approach retains the superior extensor retinaculum， relative to the combined surgical approach to cut off the superior extensor retinaculum treatment Rüedi-Allg?wer Ⅲ Pilon fractures， with shorter operation time， less intraoperative blood loss， less postoperative complications and other advantages. The functional recovery of the ankle joint in the modified anteromedial approach preserving the superior extensor retinaculum was better than that in the combined approach cutting the superior extensor retinaculum.

Objective To investigate the safety and efficacy of Tigio capsules combined with intensity-modulated radiation therapy （IMRT）， followed by sequential sintilimab immunotherapy in elderly patients with locally advanced esophageal cancer. Methods From December 2020 to December 2023， 96 elderly patients with locally advanced esophageal cancer treated in Wuxi People's Hospital and Suzhou Hospital affiliated to Nanjing Medical University were selected. Using a random number table method， patients were divided into reference group （n = 48） and combination group （n = 48）. The reference group received concurrent chemoradiotherapy， while the combination group received sequential sintilimab immunotherapy combined with concurrent chemoradiotherapy. The clinical efficacy， changes in tumor markers （CEA， CA199， AFP， CYFRA21-1）， immune levels （CD4⁺， CD8⁺， CD16⁺ CD56⁺ NK）， quality of life （QLICP-ES）， and the incidence of radiation esophagitis， and immune pneumonitis， and other toxic effects were analyzed. Results After three months of treatment， the combination group showed higher ORR and DCR than the reference group （P < 0.05）. Levels of CEA， CA199， AFP， and CYFRA21-1 were lower in the combination group， whereas CD4⁺， CD16⁺ CD56⁺ NK levels were higher （P < 0.05）. Additionally， common and esophageal cancer-specific scores of the Quality of Life Instruments for Cancer Patients-Esophagus Cancer（QLICP-ES） were lower in the combination group （P < 0.05）. The incidence of radiation esophagitis， and immune pneumonitis， and related toxic effects showed no significant difference between the two groups （P > 0.05）. Conclusion Concurrent chemoradiotherapy followed by sequential sintilimab immunotherapy significantly improves clinical efficacy in elderly patients with locally advanced esophageal cancer and does not increase significant treatment-related toxicity. This approach enhances patients' immune function and is worthy of further clinical application.

Objective To investigate the clinical treatment effect and safety of 3D microscopy technology for adjuvant neuraxial tumor resection on neuraxial tumor diseases. Methods A total of 37 patients with neuraxial tumors treated from January 2019 to July 2023， 15 patients treated with 3D microscope tumor resection （3D group）， and 22 patients treated with general microscope tumor resection （ordinary group） were analyzed. The perioperative indexes， clinical efficacy indexes and safety indexes were compared between the two groups. Results The operation time was （223.78 ± 46.46） min in the ordinary group and （182.93 ± 39.28） min in the 3D group， which was significantly lower than that in the ordinary group （P < 0.05）， and there was no significant difference in other perioperative indicators between the two groups （P > 0.05）. All patients had significantly reduced their postoperative pain symptoms and recovered their neurological function to a certain extent. There were statistically significant differences between the two groups （P < 0.01）， but there was no statistical difference between the two groups （P > 0.05）， and the McCormick spinal cord function rating was grade I. at one year after surgery. Conclusion The use of 3D microscopy and general microscopy for neuraxial tumor surgery has good clinical efficacy. However， the operation time can be significantly shortened under 3D microscopy， thereby reducing the risk of surgical complications and has better clinical safety.

Objective To analyze the expression levels of TIPE2 and Ki67 in endometrial carcinoma （EC） and their relationship with clinicopathological parameters and prognosis. Methods Tissue samples and clinical data of 96 patients with EC who underwent surgical resection， 120 patients who underwent total hysterectomy due to uterine fibroids and 120 patients who underwent total hysterectomy or curettage admitted to our hospital from February 2020 to February 2022 were retrospectively collected as the research objects， which were divided into the EC group， the normal endometrial group and the atypical hyperplasia endometrial group， respectively. All 3 groups were followed up until March 28， 2023. Immunohistochemistry was used to detect the expression levels of TIPE2 and Ki67 in tissue samples of the three groups， and to analyze the relationship between the levels of TIPE2 and Ki67 and clinicopathological parameters and prognosis. Receiver operating characteristic curve （ROC） was used to analyze its diagnostic value for poor prognosis. Results The expression levels of TIPE2 and Ki67 in cancer tissues of the EC group were higher than those of the normal endometrial group and the atypical hyperplasia endometrial group， and those of the atypical hyperplasia endometrial group were higher than those of the normal endometrial group （P < 0.05）. The expression levels of TIPE2 and Ki67 in EC tissues were higher in patients with FIGO stage Ⅲ， lymph node metastasis， postmenopausal status， and ER and PR negative than patients with stage Ⅱ， no lymph node metastasis， premenopausal status， and ER and PR positive （P < 0.05）. Moreover， the expression level of Ki67 in EC tissues was higher in p53 positive patients than in p53 negative patients （P < 0.05）， and there was a positive correlation between the both expression levels of TIPE2 and Ki67 in EC tissues （r = 0.569， P < 0.05）. Compared with the poor prognosis group， the expression levels of TIPE2 and Ki67 in EC tissues in the good prognosis group were downregulated （P < 0.05）， and the AUC value of the combined detection of TIPE2 and Ki67 expression levels was 0.905， which was significantly higher than that of the single detection （P < 0.05）， sensitivity was 86.67% and specificity was 87.88%， and the predictive value was higher. Conclusion TIPE2 and Ki67 were highly expressed in EC tissues， and there was a positive correlation between the two， and their high expressions were related to clinicopathological features， and their combined detection had high predictive value for poor prognosis of EC.

Objective To explore the expression levels of ribonucleic acid （miR）-127-5p， miR-127 and miR-155 in elderly patients with pneumonia infection by multidrug-resistant bacteria and their correlation with immune-related cytokines. Methods 65 elderly patients with pneumonia infection by multidrug-resistant bacteria， 80 healthy physical examination persons and 80 elderly patients with common pneumonia in our hospital from June 2020 to June 2022 were retrospectively selected as the observation group， the control group A and the control group B， respectively. The expression levels of miR-127-5p， miR-127， miR-155， interferon-γ （IFN-γ）， interleukin （IL-4）， IL-17， and transforming growth factor-β （TGF-β） in serum samples were detected and compared among the three groups. Pearson correlation analysis analyzed the correlation between miR-127-5p， miR-127， miR-155 and IFN-γ， IL-4， IL-17， TGF-β， and the Receiver operating characteristic curve （ROC） analyzed the diagnostic value of miR-127-5p， miR-127， miR-155 alone or in combination. Results The serum levels of miR-127-5p and IFN-γ in the control group B and the observation group were lower than those in the control group A， and the both in the observation group were lower than the both in the control group B （P < 0.05）. The serum levels of miR-127， miR-155， IL-4， IL-17， and TGF-β in the control group B and observation group were higher than those in the control group A， and those in the observation group were higher than those in the control group B （P < 0.05）. There was a positive correlation between serum miR-127-5p and serum IFN-γ levels （r = 0.463， P < 0.05）， serum miR-127 and IL-4， IL-17 or TGF-β levels （r = 0.306， 0.273 or 0.330， P < 0.05）， and serum miR-155 and IL-4， IL-17 or TGF-β levels （r = 0.410， 0.453 or 0.385， P < 0.05）， and as well as a negative correlation between serum miR-127-5p and IL-4， IL-17 or TGF-β （r = -0.378， -0.396 or -0.408， P < 0.05）， serum miR-127 or miR-155 and IFN-γ levels （r = -0.267 or -0.513， P < 0.05）. Serum miR-127-5p， miR-127 and miR-155 expression levels alone and in combination have a certain diagnostic value in elderly patients with pneumonia infection by multi-drug resistant bacteria， and the area under ROC curve （AUC） values were 0.811， 0.733， 0.817 and 0.906， and the sensitivities were 90.77%， 60.00%， 67.69%， 84.62%， and the specificities were 66.87%， 80.62%， 83.75%， 83.18%. Conclusion MiR-127-5p， miR-127 and miR-155 were differentially expressed in the elderly patients with pneumonia infection by multi-drug resistant bacteria， and were correlated with immune-related cytokines to a certain extent， and the combination of the three has a good diagnostic value， thus may providing a new target for clinical diagnosis of this disease.

Objective To evaluate the clinical efficacy of stellate ganglion block （SGB） combined with intranasal dexmedetomidine for the treatment of insomnia. Methods A total of 64 patients aged 18 to 75 with insomnia were randomly assigned to either the experimental group （DS group） or the control group （S group）. The S group received SGB treatment for 14 consecutive days， whereas the DS group received an additional intranasal dexmedetomidine spray at a dose of 100 μg， administered 30 minutes before bedtime on days 1 through 6， in conjunction with SGB. We measured and recorded the Pittsburgh Sleep Quality Index （PSQI）， Self?Rating Depression Scale （SDS）， Self?Rating Anxiety Scale （SAS） scores， and Psychomotor Vigilance Test （PVT） results for both groups at three time points： baseline （T₁）， the day after treatment （T₂）， and one month after treatment （T₃）. Results Intra?group Comparison： In both the DS and S groups， PSQI scores and dimensionspecific scores at T₂ and T₃ were significantly lower compared to T₁ （P < 0.05）. SAS and SDS scores in both groups showed a significant reduction at T₃ compared to T₁ and T₂ （P < 0.05）， while PVT results exhibited no significant changes（P > 0.05）. Inter?group Comparison： The PSQI scores and dimensionspecific scores in the DS group at T₂ （8.44 ± 2.99） and T₃ （8.22 ± 2.60） were significantly lower than those in the S group at T₂ （10.88 ± 2.56） and T₃（10.88 ± 2.84） （P < 0.05）. However， no significant differences were observed in SDS and SAS scores between the DS and S groups at T₂ and T₃ （P > 0.05）. Conclusion Compared to standalone SGB， the combination of SGB with intranasal dexmedetomidine significantly enhances sleep quality in patients with insomnia， while not impacting their levels of anxiety， depression， or alertness.

Objective To observe the effects of dagliflozin combined with levosimendan on soluble growth-stimulated expressed gene 2 protein （sST2）， angiopoietin Ⅱ （Ang-Ⅱ） and cardiac function in elderly patients with heart failure after percutaneous coronary intervention （PCI）. Methods Eighty patients with acute myocardial infarction （AMI） admitted to the Department of Cardiology of the Affiliated Hospital of Jiangnan University from January 2021 to October 2023 were selected and divided into two groups using the lottery method. Both groups were treated with conventional therapy. The conventional group was treated with levosimendan， and the combination group with dagliflozin combined with levosimendan. Cardiac function indexes， sST2， amino-terminal brain natriuretic peptide precursor （NT-pro BNP）， renin-angiotensin-aldosterone system indexes， cardiac myosin-binding protein-C （cMyBP-C）， cardiac troponin I （cTnI）， myoglobin （MyO）， 6-minute walking distance， heart failure scoring system （Lee） score， and the Seattle Angina Scale （SAQ） score were compared between the two groups. The cumulative major adverse cardiovascular event （MACE） rate at 6-month follow-up was counted in both groups. Results The comparison of cardiac function indexes， sST2， NT-proBNP， cMyBP-C， cTnI， MyO， and renin-angiotensin-aldosterone system indexes before treatment between the two groups showed no statistical significance （P > 0.05）. Left ventricular ejection fraction （LVEF） of the two groups was higher than that before treatment， and the indexes of the renin-angiotensin-aldosterone system， end-systolic left intraventricular diameter （LVEDD）， sST2， NT-proBNP， end-diastolic left intraventricular diameter （LVESD）， cMyBP-C， cTnI， MyO， and left ventricular mass index （LVMI） were lower （P< 0.05）. LVEF was higher in the combination group than that in the conventional group after treatment， and the indexes of the renin-angiotensin-aldosterone system， sST2， cMyBP-C， LVEDD， NT-proBNP， LVESD， cTnI， MyO， and LVMI were lower than those in the conventional group （P < 0.05）. There was no statistically significant difference between the two groups in terms of 6-minute walking distance， Lee score， and SAQ score before treatment （P > 0.05）. The 6-minute walking distance and SAQ score after treatment in both groups were longer and higher than those before treatment， and the Lee score was lower （P < 0.05）. The 6-minute walking distance and SAQ score after treatment in the combination group were longer and higher， and Lee score was lower than those in the conventional group （P < 0.05）. The cumulative incidence of MACE at 6-month follow-up in the combination group was lower than that in the conventional group， and the difference was statistically significant （P < 0.05）. Two cases of gastrointestinal reactions were found in the conventional group， and one case of hypotension and three cases of gastrointestinal reactions in the combination group. Conclusion Dagliflozin combined with levosimendan improves cardiac function， modulates the renin-angiotensin-aldosterone system， and improves exercise tolerance and quality of life in patients with heart failure after PCI.

Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate. Methods Patients aged 18 ~ 65 years who underwent elective surgery under general anesthesia were selected and divided into a day group （7：00 ~ 19：00） and a night group （19：00 ~ 7：00 the following day） based on the start time of anesthesia induction. Each group comprised 70 patients， further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11， 0.13， 0.16， 0.18， and 0.22 mg/kg， with 14 patients in each subgroup. The Modified Observer's Assessment of Alertness/Sedation （MOAA/S） score and Bispectral Index （BIS） value were recorded 3 minutes post?administration， and the correlation coefficient between these two parameters was calculated. The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was ≤ 1. Additionally， the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded. The half effective dose （ED50）， 95% effective dose （ED95）， and 95% confidence interval （CI） for both the day and night groups were also calculated. Results When MOAA/S ≤ 1， the induced dose of remazolam in the night group （12.34 ± 3.51） mg was significantly lower than that in the day group （13.98 ± 4.21） mg. Additionally， the dose per unit body weight of remazolam in the night group （0.20 ± 0.049） mg/kg was also significantly lower than that in the day group （0.22 ± 0.056） mg/kg. Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups （P < 0.05）. The correlation coefficient between BIS and MOAA/S was 0.902 （95%CI： 0.876 ~ 0.925） in the day group and 0.905 （95%CI： 0.879 ~ 0.929） in the night group， indicating a strong correlation between MOAA/S and BIS in both groups. However， there was no significant difference in the correlation coefficients between the two groups （P > 0.05）. The correlation coefficients between BIS and MOAA/S were 0.763 （95%CI： 0.726 ~ 0.799） in the daytime group and 0.777 （95%CI： 0.739 ~ 0.808） in the nighttime group. In a separate analysis， the correlation coefficients were 0.768 （95% CI： 0.723 ~ 0.804） for the daytime group and 0.771 （95% CI： 0.723 ~ 0.811） for the nighttime group. A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night， with no significant difference in correlation coefficients between groups （P > 0.05）. However， BIS values were significantly lower in the nighttime group compared to the daytime group （P < 0.05）. Additionally， male patients required a higher total induced dose of remazolam than female patients during both day and night， with this difference being statistically significant （P < 0.05）. Furthermore， female patients exhibited a significant decrease in BIS values at night （P < 0.05）. Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia?induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate. Specifically， the sedation effect is more pronounced in nighttime procedures， and there is a notable gender difference， with female patients exhibiting better sedation outcomes during nighttime surgeries.

Objective To investigate the expression of LncRNA RMST in gastric cancer and its value in diagnosis and prognosis. Methods Tumor and adjacent normal tissues were collected and analyzed from 92 gastric cancer patients. The expression of LncRNA RMST in these tissues was measured using RT-qPCR. ROC curve analysis was performed to evaluate the diagnostic value of LncRNA RMST for gastric cancer. Survival curves were plotted to assess the prognostic significance of LncRNA RMST in gastric cancer. Results LncRNA RMST expression was significantly lower in gastric cancer tissues than in normal tissues. Further analysis revealed that LncRNA RMST expression levels decreased progressively with advancing cancer stages and were significantly correlated with tumor size， TNM staging， and lymph node metastasis （P < 0.05）， with no significant correlation with patient age or gender. Additionally， ROC curve analysis indicated that LncRNA RMST has substantial diagnostic value in gastric cancer， with AUC of 0.76 （95% CI： 0.69 ~ 0.83， P < 0.01）， sensitivity of 70.31%， and specificity of 71.56%. Survival analysis showed that patients with high LncRNA RMST expression had significantly higher overall survival rates than those with low expression. Conclusion LncRNA RMST plays a critical role in the occurrence， progression， and prognosis of gastric cancer. It may serve as a potential biomarker for the diagnosis and prognosis of gastric cancer， offering new insights for clinical screening and therapeutic strategies.

Objective To evaluate the left ventricular systolic function of patients with type 2 diabetes mellitus （T2DM） combined with renal insufficiency （CKD） by applying automated myocardial motion quantification （aCMQ） and to investigate its correlation with clinical biochemical indexes. Methods 80 patients with T2DM were enrolled， divided into DM group （without CKD， n = 40） and DN group （with CKD， n = 40）， and 40 healthy volunteers were selected as the control group. The general clinical data of all subjects were recorded， and routine echocardiography and aCMQ were performed to obtain routine ultrasonographic measurements and aCMQ-related parameters. Results Comparison of aCMQ-related parameters： The differences in LV global longitudinal strain （LVGLS）， LV apical 2-chamber longitudinal strain （LVAP2LS）， LV apical 3-chamber longitudinal strain （LVAP3LS）， and LV apical 4-chamber longitudinal strain （LVAP4LS） among the three groups were all statistically significant （P < 0.05）. The differences in LV global circumferential strain （LVGCS） between the DN group and the other two groups were statistically significant （P < 0.05）. The differences in LV short-axis basal segment cyclic strain （LVSAXBCS）， LV short-axis middle segment cyclic strain （LVSAXMCS）， and LV short-axis apical segment cyclic strain （LVSAXACS） were not statistically significant （P > 0.05）. LV strain was negatively correlated with Hs- CRP， GA， HbA1c， creatinine， urea， and uric acid， and positively correlated with eGFR. Correlation. High-sensitivity C-reactive protein （Hs-CRP）， glycated albumin （GA） and eGFR showed good correlation with LV strain parameters. Conclusion The aCMQ technique can detect the deterioration of left ventricular function in patients with type 2 diabetes mellitus combined with renal insufficiency at an early stage， and the correlation between left ventricular strain parameters and hs-CRP， GA and eGFR can help to better assess their cardiac involvement.

Objective To assess the efficacy of tandem mass spectrometry?specific indicators in diagnosing β?ketothiolase deficiency （BKD） and to elucidate the associated gene variations contributing to the corresponding pathogenic phenotype， thereby facilitating rapid and accurate diagnosis of BKD. Methods Data from tandem mass spectrometry （MS/MS） screening of dried blood spots collected from 16，071 children between January 2018 and December 2021， along with results from gas chromatography?mass spectrometry （GC?MS） analysis and high?throughput sequencing of positive cases， were analyzed retrospectively. The study aimed to evaluate the contribution of specific MS/MS indicators in the clinical diagnosis of BKD and to trace the genetic etiology of this disease. Results Among the 16 071 subjects screened by MS/MS， 37 cases （2.30‰） exhibited elevated C5OH levels， 41 cases （2.55‰） showed increased C5∶1 levels， and 2 cases were diagnosed with BKD based on GC?MS analysis. When diagnosing BKD using C5OH as a single indicator， the false positive rate was 0.22%， which is lower than that of C5∶1 （0.24%）. The positive predictive value for C5OH was 5.40%， higher than that of C5∶1 （4.88%）. Among the 16 071 pediatric patients， only 2 cases were diagnosed with BKD due to elevated C5OH combined with increased C5∶1 levels， resulting in a positive predictive value of 100%. Whole exome sequencing of these two BKD patients revealed that both carried acetyl?CoA acetyltransferase 1 （ACAT1） gene double allele missense heterozygous mutations. The four previously unreported mutation sites were c.949G > C （p.Asp317His）， c.1063G > A （p.Ala355Thr）， c.146G > A （p.Arg49Lys）， and c.700G > A （p.Glu234Lys）. These findings provide novel insights into the genetic basis of BKD. Conclusions The MS/MS screening indicator C5OH demonstrates superior diagnostic efficacy compared to C5∶1 in diagnosing BKD， as evidenced by lower false positive rates and higher positive predictive values. When diagnosing BKD， the use of combined indicators significantly enhances the accuracy of biochemical diagnosis compared to single indicators. Exome sequencing revealed that all BKD patients carried previously unreported mutations in the ACAT1.

Objective To explore the application value of Kaiqiao Xingshen acupuncture combined with Buyang Huanwu decoction in the treatment of patients with cerebral hemorrhage in the recovery period （Qi deficiency and blood stasis syndrome）， and to observe its impact on inflammatory indicators and neurokines. Method A total of 166 patients with cerebral hemorrhage in the recovery period （Qi deficiency and blood stasis syndrome） treated in Hongdu Traditional Chinese Medicine Hospital from September 2021 to October 2023， were randomly divided into control group （83 cases treated with conventional western medicine）， and observation group （83 cases treated with a combination of Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction）. The therapeutic effect in the two groups was compared after 8 weeks of treatment. Results After treatment， the serum levels of matrix metalloproteinase-9 （MMP-9）， endothelin-1 （ET-1）， interleukin-2 （IL-2）， homocysteine （Hcy）， and Bcl-2-associated X protein （bax） decreased in both groups， while brain-derived neurotrophic factor （BDNF） increased， and the improvement was more significant in the observation group， showing statistical significance （P < 0.05）； the average cerebral vascular flow and flow velocity in the observation group increased， while peripheral vascular resistance decreased， and the improvement in the observation group was more significant （P < 0.05）； the total symptom score of traditional Chinese medicine in the observation group decreased， while the Fuel Meyer functional score （FMA score） increased， and the improvement in the observation group was more significant （P < 0.05）； The total effective rate of the observation group was 93.98% （78/83）， which was higher than that of the control group （80.72%， 67/83） （P < 0.05）. Conclusion For patients with cerebral hemorrhage in the recovery period （Qi deficiency and blood stasis syndrome）， Kaiqiao Xingshen acupuncture and Buyang Huanwu decoction help alleviate inflammatory reactions， promote the recovery of the blood-brain barrier， improve cerebral blood flow， promote neurological function recovery， and enhance clinical efficacy.

Objective To explore the application effect of the "ASK-T" aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease （COPD） complicated by dysphagia. Methods 196 of 409 COPD patients with aspiration risk admitted to the Respiratory Disease Department of Guangdong Provincial Hospital of Chinese Medicine， Higher Education Mega Center Hospital from July 2021 to June 2024 were selected as the study object， and 102 COPD patients with aspiration risk admitted from July 2021 to December 2022 were set as the pre-improvement group. The patients in this group received the original nursing process and management mode of the department during hospitalization. 94 COPD patients with aspiration risk admitted from January 2023 to June 2024 were set as the improved group， and the patients in this group were introduced into the department and implemented an innovative improvement project： "ASK-T" anti-aspiration management mode and then received nursing management. Patients in both groups were observed and followed up for 4 weeks. The risk grade of aspiration， SSA score， DHI score， aspiration pneumonia and aspiration pneumonia， nutritional status and satisfaction after intervention were compared between the two groups. Result The comparison showed that after the implementation of improvement measures， the aspiration risk grade of patients in the improved group was significantly lower than that in the pre-improvement group （P < 0.05）， and the SSA score， DHI score and total DHI score of patients in the 2 groups were significantly lower than that before intervention （P < 0.05）. The SSA score， DHI score and DHI total score in the improved group were lower than those in the pre-improved group （P < 0.05）. The results of 4-week follow-up showed that the scores of NRS-2002 for nutritional risk screening in 2 groups were lower than before intervention （P < 0.05）， and the scores of NRS-2002 for nutritional risk screening in the improved group were significantly lower than those in the pre-improvement group （P < 0.05）. The comparison showed that the incidence of aspiration and aspiration pneumonia in the improved group was lower than that in the pre-improved group （P < 0.05）， and the satisfaction score of patients with the relevant preventive measures was higher than that in the pre-improved group （P < 0.05）. Conclusion The "ASK-T" aspiration prevention management model， when applied in the nursing of elderly patients with COPD complicated by dysphagia， can significantly reduce the risk of aspiration and the incidence of aspiration pneumonia， effectively improve patients' swallowing function and quality of life， and enhance their nutritional status. Furthermore， this model significantly improves patient satisfaction with intervention measures， providing a scientific and effective management strategy for clinical nursing of elderly patients with COPD complicated by dysphagia. It is worthy of promotion and application in clinical practice.

Derived from adipose tissue， stromal vascular fraction （SVF） contains heterogeneous cell populations including adipose-derived stem cells （ADSCs）， adipose precursor cells， endothelial cells， and macrophages， which can be isolated manually or in an automated closed system by enzymatic and non-enzymatic technique. SVF has been widely applied in various fields because of its role in wound healing and tissue repair， and in recent years， SVF has been applied to promote their pair of scar， skin rejuvenation and hair regeneration， and improve the survival of fat grafting， which has achieved significant efficacy. However， there is a lack of effective integration of clinical research on SVF in the field of plastic surgery. This paper provides a systematic review of the definition， mechanism and applications of SVF in order to investigate the potential of SVF as a novel strategy for tissue regeneration and repair treatment in the field of plastic surgery and to point out the direction for further advancements in SVF research.

Colitis is a common inflammatory bowel disease whose pathogenesis is related to immune regulation and intestinal microbial homeostasis. Exosomes are membrane vesicles secreted by cells that contain proteins， lipids， and other substances. Stem cells and macrophages can participate in the regulation of related diseases by secreting exosomes. It has been found that exosomes of stem cell and macrophage origin are closely involved in the regulation of colitis， and exosomes derived from stem cells， especially mesenchymal stem cells， play an important role in anti-colitis. This article reviews the role and possible mechanisms of mesenchymal stem cell-based and macrophage-derived exosomes in the regulation of colitis， aiming to provide ideas for in-depth study of colitis and new strategies for its treatment.

Ultrasonic microbubbles are vesicles withgas core stabilized by a shell comprised of lipids， proteins， and polymer materials. It can be used not only as a contrast agent to diagnose the disease and monitor the pathological process at the molecular level， but also as a carrier of non-invasive treatment， carrying drugs or genes to the region of interest through blood circulation， thereby exerting therapeutic effects. Compared with traditional diagnosis and treatment methods， ultrasound microbubbles show great potential. Targeted imaging and treatment can identify specific types of tumors in the early stage， and improve the prognosis by reducing the systemic toxicity of chemotherapy drugs while enhancing the anti-tumor efficacy. This provides a new idea and strategy for future diagnosis and treatment of thyroid cancer. This article reviews the application of ultrasound microbubbles in the diagnosis and treatment of thyroid cancer.