Depression， with its characteristics of high prevalence， younger onset age， and high suicide rate， has repeatedly become the focus of societal discussion. It severely impairs the quality of life of patients and affects the development of the economy. Currently， treatments for depression are limited and vary in effectiveness. An increasing number of patients are classified as having treatment-resistant depression. In order to improve the cure rate further， numerous non-pharmacological treatments have been explored， among which physical therapies have garnered significant attention. This article provides a brief overview and discussion of recent physical treatments for treatment-resistant depression， offering new prospects for the field and inspiring readers with fresh ideas.

Depression is a frequently?seen mental disorder that profoundly affects the survival and quality of life of individuals. Present clinical medicine therapies for depression are not fully efficacious and novel therapeutic agents and targets remain necessary. Bupleuri Radix?Paeoniae Radix （BR?PRA）， an essential and crucial component of traditional antidepressant compound， possesses the beneficial effect of lowering toxicity and amplifying the antidepressant effect when utilized in combination. The underlying mechanisms of these synergistic effects may involve the suppression of inflammation and oxidative stress， the regulation of monoamine neurotransmitters， brain?derived neurotrophic factors， the modulation of the hypothalamus?pituitary?adrenal axis， and the metabolism of various amino acids and energy. This article summarizes the synergistic effects and antidepressant pharmacological effects of BR?PRA herb?pair， thereby providing valuable insights into the potential advantages of this combination and its potential mechanisms of antidepressant action.

Objective To explore the mechanism of miR-421 affecting the occurrence and development of depression. Methods A depressive rat model was established by single intraperitoneal injection of lipopolysaccharide （LPS）， and depressive behavior was detected by glucose preference test and open-field test. miRNA microarray chips and RT-PCR were used to analyze the expression level of miR-421 in hippocampus of the depressed rats. TargetScan database and mi RDB database were used to predict the target genes of miR-421. Dual luciferase reporter gene assay was used to observe the binding of miR-421 to the target genes. The impact of over-expression and inhibition of miR-421 on target genes was observed， then the influence of over-expression and inhibition of target genes on downstream factors was observed， and the related mechanism of miR-421 on depression was explored. Results miRNA microarray chips and RT-PCR assay showed that miR-421 was highly expressed in the hippocampus of the depressed rats （P < 0.001）， Inhibition of miR-421 expression could significantly restore the body weight and exercise ability of the depressed rats （P < 0.001）. Binding targets of Menin and miR-421 were predicted by TargetScan database， and interaction between Menin and miR-421 was demonstrated by dual-luciferase reporter gene assay. Menin expression was down-regulated while miR-421 was overexpressed （P < 0.001）， whereas it was up-regulated as miR-421 was inhibited （P < 0.001）. qPCR indicated that expressions of Caspase-3 and NF-κB in the hippocampus of the depressed rats was significantly increased （P < 0.001）， and IL-1β expression in the hippocampus was significantly increased （P < 0.01）. When the expression of Menin was inhibited， the expressions of Caspase-3， NF-κB and IL-1β were increased （P < 0.001）， while the expressions of Caspase-3， NF-κB and IL-1β were decreased when Menin was overexpressed （P < 0.001）. Conclusions Inhibition of miR-421 expression can increase Menin expression， decrease Caspase-3 content， and reduce neuroinflammatory response， thereby improving depressive symptoms.

Objective To explore the risk factors of depression and anxiety in adult patients with epilepsy and their relationship with quality of life. Methods From May 2022 to January 2023， patients diagnosed with epilepsy （aged ≥ 18 years） in the department of neurology of our hospital were collected. General demographic data and disease?related information were recorded. Quality of life， depression and anxiety scales were measured in all patients. SPSS26.0 software was used for multiple linear regression analysis， multiple ordered Logistic regression analysis， rank sum test， Pearson correlation analysis， etc. Results Among the 111 patients， 49.5% had depression and 43.2% had anxiety. Depression score and anxiety score were correlated with attack type， attack frequency， quality of life and right temporal lobe， and there was a significant negative correlation between life quality score and anxiety and depression score （P < 0.01）. Seizure frequency， seizure type and right temporal lobe were common risk factors for depression and anxiety in patients with epilepsy （P < 0.05）. Conclusion Epileptic depression and anxiety were affected by seizure frequency and seizure type， and this bad mood further affected the quality of life of patients. No clear link has been found between the lateralization of seizures and the presence of depression and anxiety states， and further research is needed.

Objective To explore the influencing factors of non-suicidal self-injury behavior and motivation in adult patients with depression. Methods A simple random sampling method was used to select 120 adult patients with depression admitted to our hospital from January 2023 to June 2023 as the research objects. The clinical information of the patients was collected， and their loneliness， frustration and self-injury motivation were evaluated. The influencing factors of non-suicidal self-injury （NSSI） behavior and motivation were statistically analyzed. Results Age， ULS-8 score， DS score， marital status and employment status were the influencing factors of NSSI in adult patients with depression （P < 0.05）. ULS-8 score， DS score， marital status （widowed/divorced） and employment status were independent risk factors for NSSI in adult patients with depression （P < 0.05）. The ULS-8 score was an independent risk factor for patients with 'emotion regulation' as NSSI motivation. Age， DS score and employment （unemployment） were independent risk factors for patients with 'interpersonal boundary' as NSSI motivation （P < 0.05）. Conclusion There are many influencing factors of NSSI and NSSI motivation in adult depression patients， and the influencing factors of different NSSI motivations are different. Clinically， the main motivation and related influencing factors of patients implementing NSSI should be clarified through detailed investigation， so as to facilitate the development of targeted intervention strategies for patients.

Objective To analyze the predictive value of serum levels of procalcitonin （PCT） and cytokines on the prognosis of patients with COVID?19 at admission. Methods From November 2022 to February 2023， patients diagnosed with COVID?19 who were admitted to Beijing Chest Hospital were enrolled. Chemiluminescence was used to detect serum PCT levels， and flow microsphere array was used to detect serum cytokines IL?1β， IL ?2， IL?4， IL?5， IL?6， IL?8， IL?10， IL?12p70， IL?17A， IL?17F， IL?22， TNF?α， TNF?β， IFN?γ level. ICU admission， mechanical ventilation and in?hospital death were defined as poor prognosis. After excluding patients with bacterial infection， the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID?19 patients was analyzed. After excluding patients with bacterial infection， the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID?19 patients was analyzed. Results A total of 176 patients with complete data were included， including 134 in the PCT?normal group and 42 in the PCT?elevated group， with a median age of 71.50 years and 71.59% males. Patients in the PCT elevated?group had significantly higher rates of ICU admission （38.41% vs. 13.11%， P < 0.05）， mechanical ventilation （76.92% vs. 24.59%， P < 0.001） and in?hospital mortality （38.46% vs. 6.56%， P < 0.001） were significantly higher than those in the PCT?normal group. Serum levels of cytokines IL?6 （7.40 pg/mL vs. 4.78 pg/mL， P = 0.033 4） and IL?8 （10.97 pg/mL vs. 5.92 pg/mL， P < 0.001） were significantly higher in patients with poor prognosis than in those with good prognosis. The area under the curve for PCT， IL?6， and IL?8 to predict poor prognosis in COVID?19 patients was 0.687， 0.660， and 0.746， respectively； sensitivity was 52.78%， 55.17%， and 72.41%， respectively； and specificity was 81.58%， 74.19%， and 74.19%， respectively， as calculated from the ROC curve. When PCT， IL?6 and IL?8 jointly predict the prognosis of COVID?19 patients， the area under the curve is 0.764， the sensitivity is 70.00%， and the specificity is 80.00%. Conclusion Serum PCT and cytokines IL?6 and IL?8 could be used as predictive markers for poor prognosis in patients with COVID?19.

Objective To investigate the role of lncRNA SNHG1 in homocysteine-induced pyroptosis of podocyte. Methods Cbs ^+/- mice were randomly divided into two groups： a normal diet group （ND） and a high methionine diet group （HMD）. Western blotting was used to detect the protein expression levels of Caspase-1， Cleaved Caspase-1， and NLRP3. Mouse renal glomerular podocytes were cultured in vitro， and then assigned into a control group （Control， 0 μmol/L Hcy） and a homocysteine intervention group（Hcy， 80 μmol/L Hcy）. Western blotting was used to detect the protein expression levels of Caspase-1， Cleaved Caspase-1， and NLRP3. Mouse renal glomerular podocyion group （OE-NC + Hcy） and the lncSNHG1 overexpression + homocysteine intervention group （OE-SNHG1 + Hcy） were also established.After 48 hours of intervention， Real-time fluorescence quantitative PCR was used to detect the expression of lncSNHG1 in podocytes after Hcy intervention. Western blot was used to detect the expressions of Caspase-1，Cleaved Caspase-3 and NLRP3. Immunofluorescence was used to detect the expression levels of GSDMD and GSDMD-N. ELISA was used to detect the contents of IL-1β and IL-18. Results （1）In the animal experiments， the expression levels of pyroptosis-related proteins Caspase-1， Cleaved Caspase-1，NLRP3， GSDMD， and GSDMD-N were all increased in the HMD group compared with the ND group. （2）In the cellular experiments， the expression levels of Caspase-1，Cleaved Caspase-1，NLRP3， GSDMD， and GSDMD-N were all increased in the Hcy group compared with the Control group， and the contents of pyroptosis-mediated inflammatory factors IL-1β and IL-18 were increased as well. （3） In the cellular experiments， the expression of lncSNHG1 was increased in the Hcy group compared with the control group. After transduction with lncSNHG1 lentivirus， the expression of lncSNHG1 was increased in the OE-SNHG1 group，compared with the control group and the OE-NC group. （4）In the cellular experiments， the expressions of pyroptosis-related proteins Caspase-1，Cleaved Caspase-1， NLRP3， GSDMD，and GSDMD-N were increased compared with the OE-NC+Hcy group， and the contents of pyroptosis-mediated inflammatory factors IL-1β and IL-18 were increased in the OE-SNHG1+Hcy group. Conclusion These results indicate that lncSNHG1 may play a role in promoting Hcy induced podocytepyroptosis.

Objective To explore the impacts of long non-coding RNA （LncRNA） GNAS antisense RNA1 （GNAS-AS1） on the proliferation and migration of gastric cancer （GC） cells by regulating the miR-449a/Notch1 axis. Method Tumor tissue and adjacent tissue samples were collected from 30 patients diagnosed with GC at Sichuan Provincial People's Hospital from September 2013 to September 2017； GC cells AGS were randomly divided into Control group， si-NC group， si-GNAS-AS1 group， si-GNAS-AS1+inhibitor NC group， and si-GNAS-AS1+miR-449a inhibitor group. Real-time fluorescence quantitative PCR method was applied to detect the expression of GNAS-AS1， miR-449a， and Notch1 mRNA； MTT experiments and plate cloning experiments were applied to detect the proliferation； wound healing test was applied to detect cell migration； Transwell experiment was applied to detect cell invasion. Western Blot was applied to detect the expression of Notch1， E-cadherin， Vimentin， and N-cadherin proteins. Double Luciferase reporter gene experiment was applied to verify the relationship between GNAS-AS1 and miR-449a， between miR-449a and Notch1， respectively. Results Compared with adjacent tissues， the expression of GNAS-AS1 and Notch1 mRNA in tumor tissue was increased， the expression of miR-449a was reduced （P < 0.05）. Compared with the Control group and si-NC group， the expression of GNAS-AS1， OD₄₉₀ value， number of clones formed， scratch healing rate， number of cell invasions， and the expression of Notch1， Vimentin， and N-cadherin proteins in AGS cells in the si-GNAS-AS1 group reduced， the expression of miR-449a and E-cadherin protein increased （P < 0.05）. Compared with the si-GNAS-AS1 group and the si-GNAS-AS1+inhibitor NC group， the OD₄₉₀ value， scratch healing rate， number of cell invasions， Notch1， Vimentin， and N-cadherin expression in the si-GNAS-AS1+miR-449a inhibitor group increased， the expression of miR-449a and E-cadherin protein reduced （P < 0.05）. GNAS-AS1 targeted and negatively regulated miR-449a expression， while miR-449a targeted and negatively regulated Notch1 expression. Conclusion Silencing GNAS-AS1 may inhibit the expression of Notch1 protein by up-regulating miR-449a， thereby inhibiting the proliferation， migration， and invasion processes of GC cells.

Objective To investigate the effect and mechanism of miR?20a?5p on human nephroblastoma cell line WiT49 transplanted tumor in nude mice. Methods The gene expression chip was downloaded from GEO database， and the differential gene miR?20a?5p was obtained by GEO2R. The NF?κB gene was positively correlated with the expression of miR?20a?5p through cBioPortal database. The target gene of miR?20a?5p was predicted to be NFKBIB of the NF?κB transcription factor suppressor protein family by targetscan database， and was verified by dual luciferase assay. Nephroblastoma cell line WiT49 was cultured in vitro and transfected into WiT49 cells with lentiviral vectors constructed with miR?20a?5p mimics and its suppressor gene. Twelve nude mice were randomly divided into three groups: WiT49 model group， WIT49?miR?20a?5p overexpression group and WIT49?miR?20a?5p knockdown group. The tumor mass and volume of each group were detected by tumor formation experiment in nude mice. real time fluorescent quantitative polymerase chain reaction （qRT?PCR） was used to detect the expression of miR?20a?5p， NFKBIB and NF?κB in each group； CCK?8 cell proliferation assay was used to verify the proliferation of tumor cells in each group. Results miR?20a?5p is highly expressed in nephroblastoma and is positively correlated with the expression of NF?κB. miR?20a?5p and NFKBIB have mutual binding sites and binding effects. In the tumor formation experiment of nude mice， the tumor volume and mass of WIT49?miR?20a?5P overexpression group were significantly increased compared with WiT49 model group， and the difference was statistically significant （P < 0.05）. In the qRT?PCR test， the expressions of miR?20a?5p and NF?κB in the WIT49?miR?20a?5p overexpression group were higher than those in the WiT49 model group， and NFKBIB expression in the WIT49?miR?20a?5p overexpression group was lower than that in the WiT49 model group， with statistical significance （P < 0.05）.CCK?8 cell proliferation assay showed that the absorbance of WIT49?miR?20a?5p overexpression group at 24 and 48 hours was higher than that of WiT49 model group， and the absorbance of WIT49?miR?20a?5p knockdown group at 24， 48 and 72 hours was lower than that of WiT49 model group， and the difference was statistically significant （P < 0.05）. Conclusion miR?20a?5p may promote the growth of human nephroblastoma cell WiT49 transplanted tumor in nude mice by regulating NFKBIB activation of NF?κB pathway.

Objective To investigate the expression of SLC35A2 and PFDN2 in breast cancer and their relationship with clinical indicators and prognosis. Methods TCGA database and TIMER 2.0 database were used to analyze the differences of SLC35A2 and PFDN2 expression in breast cancer tissues and paracancerous tissues； K?M database was used to create the survival curves of patients in the high and low expression groups of the two. qRT?PCR and immunohistochemistry were used to detect the expression of SLC35A2 and PFDN2 in the cancerous and paracancerous tissues， and the expression differences， the relationship between their expression levels and the clinical observation indexes were statistically analyzed， and the independent prognostic factors of breast cancer were screened out； K?M survival analysis was used to compare the prognostic differences between the groups and create the survival curves. Results The expression levels of SLC35A2 and PFDN2 in breast cancer tissues were significantly higher than those in paracancerous tissues according to the results of biopsy， qRT?PCR and immunohistochemistry， and the expression levels of SLC35A2 were significantly correlated with lymph node metastasis， while the expression of PFDN2 was significantly correlated with the diameter of the tumor and the metastasis of lymph nodes， and the expression of SLC35A2 and PFDN2 was an independent prognostic factor for breast cancer. patients had the worst prognosis. Conclusion The expression of SLC35A2 and PFDN2 in breast cancer tissues was closely related to clinical indicators and prognosis of breast cancer， and could be used as a potential target for breast cancer treatment.

Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours （IMT） in middle?aged and elderly patients. Methods The clinical， pathological morphology， immunophenotype and follow?up results of 5 cases of intestinal IMT in middle?aged and elderly patients were retrospectively analyzed. Results 4 cases of IMT occurred in the right half colon and 1 in the ileum. Most patients （3/5） had a history of intestinal injury， starting the digestive tract symptoms and increased leukocytes. The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern， with an infiltrative growth pattern， accompanied by a large number of lymphocytes and plasma cells infiltration， collagen formation and myxedema. One case was atypically large and deformed. Immunophenotype： vimentin （5cases）， SMA （5 cases）， desmin （3 cases）， ALK （3 cases）， CK （2 cases） were positive. Caldesmon， CD34， β?catenin， MC， CD117， DOG1， S?100， BCL?2， CD99， CD68 were negative， and Ki?67 proliferation index was 1.28% to 10.01%. All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months. Among them， 1 patient aged 83 was considered to have tumor recurrence 27 months after surgery. The other patient survived 122 months without tumor and died of other causes. All the others survived without tumor and were in good condition. Conclusion （1） Intestinal IMT in the middle?aged and elderly people in this group was more common in the right half colon， and most of them had a history of intestinal injury， first gastrointestinal symptoms and elevated white blood cells； （2）Vimentin and SMA were positive at the same time， and ALK was more positive； （3）4/5 patients had good surgical resection， and 1/5 patients could relapse 2 ~ 3 years after surgery； old age， ALK?positive， Ki67 up to 10%， atypia may be an important risk factor for intestinal IMT recurrence in the elderly， of which ALK?positive patients may have a recurrence risk of 1/3.

Objective To investigate the factors affecting the number of lymph nodes obtained by unilateral lobectomy and isthmus combined with prophylactic ipsilateral central lymph node dissection for papillary thyroid cancer， and to analyze the pattern of change so as to provide an important basis for clinical treatment of papillary thyroid cancer. Methods Retrospective analysis was performed on the clinical and pathological data of 193 patients admitted to the department of Thyroid Surgery of the First Affiliated Hospital of Jinzhou Medical University from January 2019 to January 2022 for papillary thyroid cancer who underwent unilateral glandular lobe and isthmus resection combined with prophylactic ipsilateral central lymph node dissection. The number of obtained lymph nodes was divided into a group with high number of obtained lymph nodes（n > 6）and a group with low number of obtained lymph nodes（n ≤ 6）. Univariate analysis and multivariate analysis were used to explore the factors affecting the number of obtained lymph nodes. The influence of the number of lymph nodes on the central lymph node metastasis was evaluated by correlation analysis， and the influence of the number of lymph nodes on the quality of life of patients by postoperative complications analysis. Results The number of lymph nodes obtained was positively correlated with the number of lymph node metastases in the central region（r = 0.240，P < 0.05）and the rate of lymph node metastasis（r = 0.161，P < 0.05）， respectively. The number of lymph node metastases controlled remained unchanged，and the rate of lymph node metastasis decreased with the increase of the number of obtained lymph nodes（r = -0.444，P < 0.05）. Univariate analysis of the number of lymph nodes between the two groups showed no significant differences in terms of sex， age， operation duration， BMI， maximum tumor diameter， multifocality， Hashimoto′s thyroiditis， focal location， capsular invasion， contralateral thyroid nodule， parathyroid transplantation and BRAF gene V600E mutation（P > 0.05）. There was statistical significance in the application of nano carbon between the two groups（P < 0.05）. Logistic binary regression analysis showed that the combination of Hashimoto′s thyroiditis and the application of carbon nanoparticles were independent influencing factors for the high number of lymph nodes obtained（P < 0.05）. ROC curve analysis suggested that the area under the curve occupied by carbon nanoscale was 0.658（95%CI：0.580 ~ 0.735， P < 0.05）， and the area under the curve occupied by Hashimoto′s thyroiditis was 0.584（95%CI：0.504 ~ 0.665，P < 0.05）. In addition， there was no significant difference in the incidence of vocal cord paralysis and lymphatic leakage between the two groups （P > 0.05）. Conclusions When the number of lymph nodes in the central region remained unchanged， the higher the number of lymph nodes obtained， the lower the rate of lymph node metastasis. The application of nano?carbon and patients with Hashimoto′s thyroiditis could increase the number of lymph nodes obtained， and there is no significant difference in the incidence of postoperative complications between high and low number of lymph nodes obtained.

Objective To explore the correlation between the expression level of serum Receptor for Advanced Glycation End?Product （RAGE） and High?Mobility Group Protein B1 （HMGB1） expression with the occurrence of acute respiratory distress syndrome （ARDS） and interferon?γ/interleukin?4 （IFN?γ/IL?4） ratio in patients with severe pneumonia （SP）. Methods A prospective investigation was carried out on one hundred children with SP admitted to our hospital from March 2020 to February 2022， and the participants were classified into ARDS group （n = 56） and control group （n = 44） based on the occurrence of secondary ARDS. General informations werecollected. The expression of RAGE， HMGB1， IFN?γ and IL?4 in peripheral blood was measured using Enzyme?Linked Immunosorbent Assay （ELISA）. Then multivariate Logistic regression analysis was conducted to screen the influencing factors of secondary ARDS in SP children， and the correlation with IFN?γ/IL?4 ratio was verified by pearson correlation analysis， moreover， receiver operating characteristic （ROC） curve was plotted to evaluate the value of RAGE and HMGB1 expression in predicting the occurrence of ARDS in SP children. Results There were no statistical difference in gender， age， body temperature and onset season between the two SP groups. The ARDS group had more types of pathogenic bacteria， larger ratio of the partial pressure of oxygen in arterial blood to the inspired oxygen fraction （PaO₂/FiO₂）， higher Acute Physiological Score （APS）， and up?regulated expression of RAGE， HMGB1， IFN?γ and IL?4， as well as larger IFN?γ/IL?4 ratio than those of control group， with statistical difference （all P < 0.05）. Multivariate Logistic regression analysis revealed that pathogen type， PaO₂/FiO₂ ratio， RAGE， HMGB1， IFN?γ， IL?4 and IFN?γ/IL?4 were the influencing factors for the occurrence of ARDS in children with SP. Pearson correlation test denoted that the serum RAGE and HMGB1 expression levels of SP children were positively correlated with IFN?γ， IL?4 and IFN?γ/IL?4 ratio （P < 0.05）. ROC curve found that the AUC of serum RAGE and HMGB1 in predicting the occurrence of ARDS in SP children was 0.707 and 0.750， with a sensitivity of 73.2% and 64.3%， and a specificity of 68.2% and 77.3%. The combined test of RAGE and HMGB1 in predicting the occurrence of ARDS in SP children reached an AUC of 0.848， providing a sensitivity and specificity of 80.4% and 81.8% respectively. Conclusions Serum RAGE and HMGB1 expression levels are elevated in SP children with ARDS， and the two are positively correlated with IFN?γ/IL?4 ratio. Therefore， monitoring serum RAGE and HMGB1 expression in children with ARDS secondary to SP has predictive value for the risk of ARDS in SP children.

Objective To explore the risk factors of supplementary injection after foam sclerotherapy for varicose veins of lower extremities and its impact on blood coagulation function. Methods A total of 185 patients with varicose veins of lower limbs diagnosed in the First People′s Hospital of Zunyi from January 2018 to December 2021 were selected. The corresponding pathological data were collected， and the D-dimer， thrombin time， and fibrinogen level of patients were detected 1 d before and 1 d after the surgery. The postoperative video phone follow-up lasted until 6 months after the surgery. The patients were divided into single treatment group and supplementary treatment group according to whether supplementary injection of foam sclerosing agent was needed during the follow-up. Propensity matching on the data between the two groups was conducted， and the correlation between disease course data， coagulation factors， and the occurrence of supplementary injection was analyzed. A time series model for the incidence of supplementary injection was established， and the therapeutic effect and complications were observed. Results After propensity matching， there was still significant difference in the degree of lesion between the two groups （P < 0.05）. On the first day after surgery， there was significant difference in the D-dimer and fibrinogen groups between the two groups （P < 0.05）， and but no significant difference in thrombin time （P > 0.05）. The occurrence of supplementary injection was significantly correlated with D-dimer， fibrinogen， thrombin time， and first-time injection dose （P < 0.05）， and the incidence of supplementary injection was higher in patients who received first-time injection in January， August， September， and December. Both groups achieved successful treatment 6 months after surgery， and there was no significant difference in the incidence of complications. Conclusion Patients with lower limb varicose veins of C3/C4 are more likely to require supplementary injection compared to patients with other levels. The level of D-dimer and fibrinogen at 1 d after surgery is positively correlated with the occurrence of supplementary injection， while the dose of the first injection is negatively correlated with the occurrence of supplementary injection.

Objective To explore EEG characteristics and the therapeutic effect in children with electrical status epilepticus during slow sleep （ESES）. Methods The eligible ESES cases in our center from 2014 to 2020 were included. The age at diagnosis of ESES， the duration of ESES， spike wave index （SWI） during wakefulness and the distribution of spike wave during the period of ESES， age at seizure onset， the clinical syndromes and the outcomes after treatment were analyzed. The ESES cases were divided into 4 groups according to the distribution of spike wave： focal ESES， unilateral ESES， bilateral asymmetric ESES， multiple foci ESES. The SWI during the awake stage were divided into 3 groups based on the different rates： ≤ 20%， 21% ~ 49%， ≥ 50%. The therapeutic outcomes were classified into three groups： satisfactory response，seizure control and ineffective. Results 50 cases were included， with 32 males and 18 females. The average onset age of ESES was 6 years and 7 months， and the average duration of ESES was 28 months. A significant correlation between the distribution of ESES and the therapeutic effects was found， bilateral asymmetric ESES had a good therapeutic effects， while multiple foci ESES showed a poor therapeutic effects. The duration of ESES was significantly correlated with therapeutic effects，and the efficacy was worse when the duration was longer than 1 year. A significant relationship between the SWI during wakefulness of ESES and the therapeutic effects was detected，the patient with SWI ≤ 20% during wakefulness had a good therapeutic effect.There was a negative correlation between the onset age of ESES and the duration of ESES and SWI index during wakefulness. There was a positive correlation between the duration of ESES and SWI index during wakefulness. Conclusion Our results suggest that onset age，distribution， duration and SWI during wakefulness of ESES were correlated with therapeutic outcomes， The patient with SWI ≤ 20% during wakefulness had a good therapeutic effect and have unfavorable outcomes with ESES last more than 1 year.The earlier onset of ESES， the longer duration of ESES and higher SWI during wakefulness will be showed..

Objective To investigate whether chemokine CCL2 （also known as monocyte chemotactic protein 1 or MCP?1） has a causal relationship with lung cancer. Methods Genetic data of chemokine CCL2 and different pathological subtypes of lung cancer were extracted from genome?wide association studies （GWAS）， and inverse?variance weighted （IVW） analysis was used as main analysis， while weighted median， simple model， MR?Egger regression， and weighted model were chosen as supplementary analyses. Sensitivity analyses were performed to verify the reliability of the data. Results The result of IVW analysis on chemokine CCL2 to lung adenocarcinoma was OR = 1.065， 95%CI （0.919 ~ 1.234）， P = 0.401. The result of IVW analysis on chemokine CCL2 to squamous cell lung carcinoma was OR = 1.059， 95%CI （0.931 ~ 1.205）， P = 0.381. The result of IVW analysis on chemokine CCL2 to small cell lung carcinoma was OR = 0.959， 95%CI （0.760 ~ 1.208）， P = 0.720. Conclusions There is no direct causal relationship between chemokine CCL2 and lung cancer.

Objective To evaluate the effect of remimazolam combined with desflurane and flumazenil antagonism for anesthesia during ophthalmic day surgery. Methods This is a prospective randomized controlled trial. A total of 64 patients undergoing elective general anesthesia with laryngeal mask during ophthalmic day surgery were selected and randomly assigned to propofol group （n = 32） and remimazolam group （n = 32）. The propofol group was given propofol anesthesia induction and propofol combined with diflurane anesthesia maintenance； the remazolam group was given remazolam anesthesia induction and remazolam combined with diflurane anesthesia maintenance， and flumazenil antagonism was given intravenously at the end of the operation. Continuous intravenous infusion of remifentanil was administered during surgery in both groups. The primary outcome was emergence time. The secondary outcome included changes in intraoperative hemodynamic parameters，extubation time，time to leaving the operating room， duration of postoperative recovery room （PACU） stay， and the occurrence of other perioperative adverse reactions. Results Emergence time， extubation time， and time to leaving the operating room in remimazolam group were significantly shorter than those in group propofol （P < 0.05） ［（4.11 ± 1.17） vs. （8.64 ± 2.77）min， （4.61 ± 1.11） vs. （9.90 ± 2.81）min and （6.60 ± 2.01） vs. （11.74 ± 3.11）min， respectively］. The incidences of intraoperative hypotension and bradycardia in the remimazolam group were significantly lower than that in the propofol group （P < 0.05）； There was no statistically difference in the duration of PACU stay and the incidence of postoperative complications between the two groups（P > 0.05）. Conclusion Remimazolam combined with desflurane general anesthesia and flumazenil antagonism for anesthesia management in ophthalmic day surgery could significantly shorten the time of emergence and extubation， help to maintain hemodynamic stability with fewer adverse reactions， and improve the safety of ophthalmic daytime surgery， which is worthy of clinical promotion and application.

Objective The aim of this study was to evaluate the efficacy and side effects of sacubitril/valsartan in the treatment of patients with chronic kidney disease （CKD） at stage 5 with resistant hypertension， and to explore the cardiovascular benefits and security of medical in the patients. Methods Patients with CKD5 resistant hypertension diagnosed and treated in the First Affiliated Hospital of Guangxi Medical University from September 2020 to March 2022 were selected and divided into the observation group （treated with routine treatment of kidney disease at end-stage and sacubitril/valsartan） and control group （include droutine treatment of renal disease at end-stage and ACEI or ARB drugs） according to treatment strategy. The patients in both two groups were treated with adequate dialysis treatment and conventional drug treatment of renal disease at end-stage. The patients were followed up for at least 3 months，the clinical efficacy of three months after treated with sacubitril/valsartan was observed， and the efficacy indicators and security indicators and adverse cardiovascular events were observed， the occurrence of adverse effects during the period of drug use were compared with the control group. Results A total of 110 patients were included in this study and there were 55 cases in each group.There were no significant differences in gender， age， age of dialysis， etiology， dialysis mode and blood pressure between the two groups （P > 0.05）. The Systolic blood pressure （SBP）， diastolic blood pressure （DBP）， b-type urinary natriuretic peptide precursor （Pro-BNP） and cardiac function grade in the observation group after treatment was significantly decreased compared with before treatment. The left ventricular ejection fraction （LVEF） and the ratio of LVEF < 50% in the observation group was significantly reduced after treatment （P < 0.05）. SBP， DBP and Pro-BNP decreased 3 months after treatment compared with the baseline before treatment，and improved significantly in the first month after treatment（P < 0.05）. The decrease of DBP and BNP before and after treatment was significantly different between the two groups， and the decrease of DBP and BNP was more significant in the observation group（P < 0.05）. The difference of LVEF and left ventricular end diastolic diameter （LVEDD）between the two groups before and after treatment was statistically significant， and the improvement was more obvious in the observation group （P < 0.05）. There were no significant differences in the safety indicators of serum potassium， estimated glomerular filtration rate （eGFR） and liver function between two groups before and after treatment （P > 0.05）. In terms of adverse reactions， only 1 case in the control group developed hyperkalemia within 3 months of follow-up， and no hypotension or other adverse reactions occurred in the two groups. Conclusions The treatment of patients with CKD stage 5 hypertension with sacubitril/valsartan has obvious cardiovascular benefits. Sacubitril/Valsartan has efficacy in lowering blood pressure， improving cardiac function and reducing volume load， with less adverse events and higher safety than control group.

Objective To evaluate the accuracy of bioelectrical impedance analysis （BIA） in measurement of appendicular skeletal muscle mass （ASM） of adults. Methods A total of 836 adults aged 18-42 years were recruited in Guangzhou using a convenient sampling method from April 2021 to September 2022. ASM was measured using BIA and Dual?energy X?ray absorptiometry （DXA）. Using DXA as the standard method， the consistency between the BIA and DXA measurements was evaluated by intra?class correlation coefficients （ICCs） and Bland?Altman analysis in logarithmically transformed data， in order to evaluate the accuracy of BIA in ASM measurement. Receiver operating characteristic curve was plotted to evaluate the diagnostic value of BIA for screening low muscle mass. Results A total of 774 individuals were included for analysis finally. ICCs for ASM measured by BIA and DXA were 0.774 and 0.667 in males and females， respectively. Mean ratios （limits of Agreement） of ASM were 0.94 （0.80-1.10） and 0.91 （0.78-1.05） in males and females， respectively. Area under curve of BIA for screening low muscle mass were 0.91 and 0.94 in males and females， respectively. The optimal cut?off values of Z?score by BIA for males and females were -0.57 and -0.66， respectively. Sensitivity and specificity for males were 82.5% and 86.0%， while being 86.8% and 93.8%， for females. Conclusion BIA shows a moderate consistency with DXA for measuring ASM in adults. Furthermore， BIA yields a good diagnostic value in identifying low muscle mass in adults aged 18-42 years.

Objective Evaluation of the efficacy of high?frequency repetitive transcranial magnetic stimulation for chronic disturbance of consciousness after severe craniocerebral injury based on magnetic resonance spectroscopy. Methods The clinical data of 106 patients with chronic disturbance of consciousness after severe craniocerebral injury from January 2018 to December 2022 were retrospectively analyzed， and they were divided into control group （conventional rehabilitation treatment） and observation group （high frequency repetitive transcranial magnetic stimulation treatment） by propensity score matching method （1∶1） ， with 53 cases in each group.Both groups were examined by magnetic resonance spectroscopy （MRS） before and after treatment. The brain metabolic indexes ［N?acetyl aspartate （NAA）/creatine （Cr） value， choline complex （Cho）/Cr value］， Glasgow coma scale （GCS） score， electroencephalogram （EEG） grading， coma recovery scale （CRS?R） score， brainstem auditory evoked potential （BAEP） grading， upper limb sensory evoked potential （SSEP） grading and Cerebral blood flow perfusion index ［cerebral blood volume （CBV）， mean transit time （MTT）， cerebral blood flow （CBF）］ were compared between the two groups. Results After treatment， the NAA/Cr values of the thalamus and brainstem in the two groups increased， while the Cho/Cr values decreased， and the levels of brain metabolic indexes in the observation group were significantly better than those in the control group （P < 0.05）. The two groups' GCS score and CRS?R score increased， and the improvement of the observation group was better than that of the control group （P < 0.05）. The BAEP grading， EEG grading， and SSEP grading of the two groups improved， and those of the observation group were better than the control group （P < 0.05 ）. The CBF and CBV of the two groups increased， and MTT decreased， and the level of cerebral blood perfusion index in the observation group was better than that in the control group （P < 0.05）. Conclusion High frequency repetitive transcranial magnetic stimulation has a significant effect on the recovery of patients with chronic consciousness disorders after severe craniocerebral injury. The mechanism may be related to improving the blood flow velocity of brain tissue and metabolism in the brain.

Objective To explore the effects of the multiple shared decision?making mode using a decision aid manual in conjunction with online labor and delivery decision support on the delivery mode for pregnant women with a scarred uterus. Methods A total of 94 women with scarred uterus who received prenatal care at a tertiary hospital from September 2019 to October 2022 were enrolled and assigned to experimental and control groups using the random number table method. The control group received standard prenatal education， and the experimental group received multiple shared decision?making interventions in addition to standard prenatal education. The degree of conflict in decision?making for delivery， preference for delivery mode， postpartum decision regret， and the final delivery mode between the two groups were compared， respectively. Results Following the multiple shared decision intervention， decision conflict scores in the experimental group were significantly reduced （P < 0.001）. In the survey on delivery mode preferences， there was a reduction in the number of individuals in the experimental group expressing "uncertainty"， and an increase in those choosing vaginal delivery. Ultimately， in the experimental group， 30 women （68.2%） underwent cesarean sections， and 14 （31.8%） had vaginal deliveries. The level of post?decision regret in the experimental group was lower than that in the control group （P < 0.001）. Conclusions Multiple shared decision?making for women pregnant with a scarred uterus could reduce the level of decision?making conflict， increase the willingness for vaginal delivery， and assist them in making rational and scientifically informed decisions regarding childbirth.

Objective To investigate the effect of cognitive-behavioral intervention under the family-centered care （FCC） model on continuing care of patients after aortic dissection surgery. Methods One hundred and six patients undergoing aortic dissection in the Department of Cardiac Surgery of the hospital from January 2021 to December 2022 were evenly divided into control group and observation group by using random number table method， with 53 cases in each group. The control group was given routine continuing care， and the observation group was treated with continuing care with the cognitive behavior intervention under the FCC mode based on the control group， and both groups intervened for 8 weeks. The control group was treated with routine continuity care， while the observation group received continuity care with cognitive-behavioral intervention based on the FCC model in addition to routine continuing care， with a intervention duration of 8 weeks for both groups. The two groups were compared in terms of blood pressure， body mass index （BMI）， self-care ability （measured using the Self-Care Ability Scale-ESCA）， quality of life （measured using the Short Form-36 Health Survey-SF-36）， and levels of depression and anxiety （measured using the Hospital Anxiety and Depression Scale - HADS） before and after the intervention. Results The level of blood pressure， BMI， and level of depression and anxiety after the intervention were all significantly lower than before the intervention （P < 0.05） and the scores by ESCA and SF-36 were significantly higher than before intervention （P < 0.05）. The blood pressure and BMI in the observation group were both significantly better than in the control group ［（116.47 ± 28.23）mmHg vs. （124.48 ± 29.81）mmHg and （25.33 ± 1.11）kg/m²vs. 26.18 ± 1.35）kg/m²， t = 7.193， 2.454， P < 0.01， respectively］. The scores of self-care ability and quality of life in the observation group were higher than in the control group ［（121.15 ± 29.69） vs. （106.68 ± 24.71） and （67.92 ± 13.69） vs. （60.81±10.77）， t = 8.243， 7.436， P < 0.01， respectively］. The scores of depression and anxiety in the observation group were significantly lower than in the control group［（11.07 ± 4.00） vs. （12.20 ± 4.28） and （12.39 ± 3.59） vs. （13.45 ± 4.15）， t = 3.873， 2.852， P < 0.01， respectively］. Conclusion The cognitive-behavioral intervention under the FCC mode can significantly improve blood pressure， BMI， and psychological condition， as well as enhance patients' self-care ability and quality of life， when applied in the continuity of care for patients after aortic dissection. Therefore， it is worth promoting and applying in clinical practice.

Acute respimtory distress syndrome （ARDS） is an acute diffuse inflammatory lung injury caused by various internal and external lung injury factors. It has complex pathogenesis， rapid onset and high mortality， which seriously endangers human life and health. Pulmonary fibrosis is one of the important pathologic processes of ARDS occurrence and development， and it is also an important cause of death in ARDS patients. To a certain extent， the severity of pulmonary fibrosis in ARDS is determined by the dynamic balance of macrophage-fibroblast interactions. Therefore， this article aims to review the interaction mechanism of macrophage-fibroblasts in the process of ARDS pulmonary fibrosis， and provide new methods and ideas for the diagnosis and treatment of ARDS pulmonary fibrosis.

With the advent of an aging society，Alzheimer′s disease （AD） has gradually become a major ailment affecting the elderly. AD is a neurodegenerative disorder associated with cognitive impairments. In AD patients， brain network connections are disrupted， and their topological properties are also affected， leading to the disintegration of anatomical and functional connections. Anatomical connections can be tracked and evaluated using structural magnetic imaging（MRI） and diffusion tensor imaging（DTI）， while functional connections are detected through functional MRI to assess their connectivity status. This review incorporates the findings of previous scholars and summarizes the current research of AD. It mainly discusses the imaging characteristics of large-scale brain network changes in AD patients， so as to provide researchers with scientific and objective imaging markers for AD prediction and early diagnosis， as well as future research.

Bipolar disorder （BD） is a class of common psychiatric disorders， and its high morbidity， disability， and mortality have attracted widespread attention. However， in clinical practice， the initial accurate diagnosis rate of BD is low and easily misdiagnosed as monophasic depression. Many neuroimaging studies have shown that cortical thickness， gray matter， white matter， and functional activities are altered in some brain regions of BD patients. However， their specific neuroimaging indexes have not been clarified， and the specific pathophysiological mechanisms for the onset of BD have not been fully elucidated. Therefore， in this paper， we combed through the recent years of BD patients to study the cortical structure and perfusion of the brain to review the methods in anticipation of more in-depth research at a later stage.

In the ICU， nutritional status is intimately related to the prognosis of critically ill patients and cannot be neglected； nonetheless， between 38% ~ 78% of critically ill patients are malnourished. Individualized nutritional monitoring and therapy is recommended for critically ill patients to improve prognosis. Nutritional treatment includes enteral and parenteral nutrition. Enteral nutrition can be provided by prepyloric feeding through a nasogastric tube， which is simple and generally applicable， or by retropyloric feeding through a nasojejunal tube， which can reduce the risk of reflux aspiration. Parenteral feeding can be administered by creating peripheral venous access for convenient administration or central venous access for the delivery of nutritional solutions with high osmotic pressure. In addition to the patient's condition， the choice of nutrition route should take into account the initiation time， ability to meet nutritional needs， and potential feeding related complications. Current guidelines are not united， and previous research has not fully addressed existing conflicts. In this paper， problems associated with each nutrition pathway are reviewed to provide a clinical reference。