Abstract:Severe asthma accounts for 5%-10% of the overall asthma population, resulting in a substantial decline in patients’ quality of life and a significant financial burden. Despite there are some treatment options, such as combining high-dose inhaled corticosteroids with long-acting β₂ agonists or oral corticosteroids, some patients continue to struggle with symptom control; in addition, prolonged steroid use can lead to various adverse effects. Recent years have witnessed continuous advancements in the diagnosis and treatment approaches for severe asthma, offering clinicians numerous novel alternatives. This article reviews their research progress encompassing disease assessment, medication therapy, and bronchoscopic interventions.

Abstract:Gastric cancer (GC) is one of the most common malignant tumors, and most GC patients in China are diagnosed as progressive GC at their first visit and late stage patients fail to have surgical treatment. The effects of conventional treatments, including chemotherapy, radiotherapy and targeted therapy, are limited and may induce poor prognosis. As a new treatment in hematological malignancy, chimeric antigen receptor (CAR)-T cell (CAR-T) immunotherapy is indicated as a promising treatment for advanced GC, which paves a new way for the GC immunotherapy. However, there are still some obstacles to overcome, such as the heterogeneity of GC, immunosuppression of tumor microenvironment, tumor target antigen escape and off-target toxicity. In this review, the CAR structure, therapeutic principle of CAR-T, and the main targets and treatment status of CAR-T immunotherapy for advanced GC are reviewed; the challenges faced by CAR-T immunotherapy in GC are discussed, so as to provide new ideas for the clinical immunotherapy of advanced GC.

Abstract:Objective To investigate the role of sodium-glucose cotransporter 1 (SGLT1) inhibitor mizagliflozin (MIZA) in autosomal dominant polycystic kidney disease (ADPKD). Methods Western blotting, quantitative polymerase chain reaction (qPCR), and immunofluorescence staining were used to determine the expression and distribution of SGLT1 in kidney tissues of PKD1^-/- and PKD1^+/+ mice, human renal cancer adjacent tissue and ADPKD tissue. Renal cyst lining epithelial cells OX161 and renal tubular epithelial cells UCL93 were treated with MIZA, incubated at 37 ℃ for 24, 48, and 72 h, and then were subjected to methyl thiazolyl tetrazolium and colony formation assay to observe cell proliferation. The qPCR method was used to determine the mRNA levels of collagen 1α1, collagen 3α1, and fibronectin 1 in OX161 cells treated with 100 μmol/L MIZA for 48 h. The Madin-Darby canine kidney (MDCK) cell 3D cyst formation assay verified the effect of MIZA on cyst formation. The mRNA-seq technology was used to detect differentially expressed genes between UCL93 cells and OX161 cells, and between OX161 cells and OX161 cells treated with 100 μmol/L MIZA for 48 h, and then the differentially expressed genes were analyzed with Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Results The expression level of SGLT1 was significantly increased in the tissues of ADPKD patients and PKD1^-/- mice compared to those in normal kidney tissues (P＜0.05, P＜0.01). Immunofluorescence staining revealed that SGLT1 was mainly expressed in the cystic lining epithelial cells. Additionally, MIZA inhibited the proliferation and fibrosis of polycystic kidney cells in a concentration- and time-dependent manner, and also inhibited cyst formation in 3D formation assay in vitro. The mRNA-seq analysis and KEGG enrichment analysis showed that differentially expressed genes between OX161 cells and OX161 cells cultured in 100 μmol/L MIZA for 48 h were mainly enriched in the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (Akt) and mitogen-activated protein kinase (MAPK) signaling pathways, which were the same as those between OX161 cells and UCL93 cells. Conclusion The SGLT1 inhibitor MIZA may inhibit the proliferation and fibrosis of polycystic kidney cells through signaling pathways such as PI3K-Akt and MAPK, delaying the growth of polycystic kidney, and it is a potential therapeutic target for ADPKD.

Abstract:Objective To investigate the effect of radiation on cardiomyocyte apoptosis and its related mechanism. Methods Rat H9C2 cardiomyocytes were divided into blank control group, X-ray irradiation group (X-ray group), X-ray irradiation＋microRNA (miRNA)-134-5p inhibitor group (X-inhibitor group) and X-ray irradiation＋miRNA-134-5p inhibitor negative control group (X-NC group). H9C2 cardiomyocytes were irradiated with 6 Gy X-ray, and the changes of various indexes were detected 48 h after irradiation. Cell viability was detected by cell counting kit 8 assay. The apoptosis rate was detected by flow cytometry and Hoechst 33342 staining. The level of reactive oxygen species (ROS) in cells was detected by DCFH-DA fluorescence probe. The mitochondrial membrane potential was detected by JC-1 method. The activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in cells were measured by kits. The expression of miRNA-134-5p was detected by quantitative polymerase chain reaction. The protein expression of brain-derived neurotrophic factor (BDNF), protein kinase B (Akt), phosphorylated Akt (p-Akt), Bcl2 and Bax was detected by Western blotting. Results Compared with the blank control group, in the X-ray group the levels of ROS and MDA were significantly increased, the activity of SOD was significantly decreased, the decreased percentage in mitochondrial membrane potential was significantly increased, the number of micronuclei of DNA damage was significantly increased, and the apoptosis rate was significantly increased (all P＜ 0.01). Compared with the X-ray group, all the indexes of the X-inhibitor group were reversed (P＜0.05 or P＜0.01), while there was no significant difference in the above parameters in the X-NC group (all P＞0.05). Compared with the blank control group, the X-ray group had a significant increase in the miRNA-134-5p level and significant reductions in the protein level of BDNF, Bcl2/Bax ratio, and p-Akt/Akt ratio (all P＜0.01). Compared with the X-ray group, the X-inhibitor group had a significant reduction in the level of miRNA-134-5p and significant increases in the protein level of BDNF, Bcl2/Bax ratio, and p-Akt/Akt ratio (all P＜0.01), and there was no significant difference in all parameters in the X-NC group (all P＞0.05). Conclusion X-ray irradiation can induce oxidative stress, mitochondrial damage, and DNA damage, eventually leading to apoptosis in rat cardiomyocytes, and the mechanism may involve miRNA-134-5p/BDNF/Akt signaling pathway.

Abstract:Objective To propose a classification method for ultrasound images of pedicle screw canals based on radiomics analysis, and to evaluate the integrity of the screw canal. Methods With thoracolumbar spine specimens from 4 fresh cadavers, 50 pedicle screw canals were pre-established and ultrasound images of the canals were acquired. A total of 2 000 images (1 000 intact and 1 000 damaged canal samples) were selected. The dataset was randomly divided in a 4∶1 ratio using 5-fold cross-validation to form training and testing sets (consisting of 1 600 and 400 samples, respectively). Firstly, the optimal radius of the region of interest was identified using the Otsu’s thresholding method, followed by feature extraction using pyradiomics. Principal component analysis and the least absolute shrinkage and selection operator algorithm were employed for dimensionality reduction and feature selection, respectively. Subsequently, 3 machine learning models (support vector machine ［SVM］, logistic regression, and random forest) and 3 deep learning models (visual geometry group ［VGG］, ResNet, and Transformer) were used to classify the ultrasound images. The performance of each model was evaluated using accuracy. Results With a region of interest radius of 230 pixels, the SVM model achieved the highest classification accuracy of 96.25%. The accuracy of the VGG model was only 51.29%, while the accuracies of the logistic regression, random forest, ResNet, and Transformer models were 85.50%, 80.75%, 80.17%, and 75.18%, respectively. Conclusion For ultrasound images of pedicle screw canals, the machine learning model performs better than the deep learning model as a whole, and the SVM model has the best classification performance, which can be used to assist physicians in diagnosis.

Abstract:Objective To establish and validate a risk prediction model based on multiple blood routine parameters for preliminary differential diagnosis of influenza A and influenza like illness (ILI) in children. Methods Children with influenza A (n＝2 686) and ILI (n＝1 369) who were treated in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jul. 1, 2022 to Jun. 30, 2023 were enrolled, and their clinical and laboratory features were collected for retrospective analysis. According to age, patients were divided into 2 subgroups: 1 year≤age≤6 years and 6 years＜age≤16 years. Patients in each subgroup were randomly divided into training set (70%) and internal validation set (30%). Children with influenza A (n＝204) and ILI (n＝404) who were treated in Department of Pediatrics of The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) and Naval Hospital of PLA Eastern Theater Command from Jul. 1, 2022 to Jun. 30, 2023 were selected as the external validation set. Multivariate logistic regression analysis was performed on the training set to obtain the independent influencing factors of influenza A. The prediction model based on these factors were displayed as a nomogram. Receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) were used to evaluate the performance of the model from 3 aspects: discrimination, calibration, and clinical practicality, respectively. The diagnostic performance of the model was verified in both internal validation set and external validation set. Results In the subgroup of 1 year≤age≤6 years, age, white blood cell count, lymphocyte count and C reactive protein were the independent influencing factors of influenza A (all P＜0.01); the area under the curve (AUC) value of the established nomogram prediction model for identifying influenza A was 0.746 in the training set, 0.771 in the internal validation set, and 0.753 in the external validation set; the predicted probability of the model was highly consistent with the actual probability (P＝0.216); and taking intervention measures within a threshold probability range of 16%-60% could yield net benefits. In the subgroup of 6 years＜age≤16 years, gender, white blood cell count and lymphocyte count were the independent influencing factors of influenza A (all P＜0.01); the AUC value of the established nomogram prediction model for identifying influenza A was 0.733, 0.747 in the internal validation set, and 0.753 in the external validation set; the predicted probability of the model was highly consistent with the actual probability (P＝0.06); and taking intervention measures within a threshold probability range of 12%-58% could yield net benefits. Conclusion This risk prediction model based on easily obtainable blood routine parameters shows good diagnostic performance for influenza A, with high accuracy and clinical practicality.

Abstract:Objective To investigate the anticoagulation status of patients with atrial fibrillation (AF)-related acute ischemic stroke (AIS) after revascularization therapy in the real world. Methods A retrospective study was performed on patients diagnosed as AIS and AF from Jan. 2019 to Jan. 2022 at The Second Affiliated Hospital of Nanchang University. Patients treated with intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or both were enrolled. Clinical information, timing of anticoagulation initiation, treatment regimens, and outcomes were documented and statistically analyzed. Additionally, a questionnaire was administered to the primary physicians to understand reasons for delaying or not initiating anticoagulation. Results A total of 189 patients with AF-related AIS met the screening criteria, including 86 (45.5%) cases in the IVT group, 63 (33.3%) cases in the EVT group, and 40 (21.2%) cases in the IVT＋EVT group. The mean age of 189 patients was (72.90±9.23) years old. There were 93 (49.2%) female patients. Anticoagulation was initiated within 14 d after revascularization therapy in 36.0% (68/189) of patients, with the highest rate in the IVT group (58.8%, 40/68), followed by the EVT group (22.1%, 15/68) and IVT＋EVT group (19.1%, 13/68). A significant difference was found in the proportion of patients receiving anticoagulation within 14 d among the 3 groups (P＝0.020). Univariate analysis was performed on the clinical data of patients who initiated anticoagulation within 14 d after revascularization therapy (68 cases) and those who delayed or did not initiate anticoagulation (121 cases). The results showed that there were significant differences in the stroke history, National Institutes of Health stroke scale (NIHSS) score before revascularization therapy, Alberta Stroke Program early computed tomography score, modified Rankin scale (mRs) score before revascularization therapy, imaging characteristics (lesions near cortex, large infarction, severe stenosis or occlusion of major intracranial arteries), revascularization therapy method, NIHSS score 3 d after revascularization therapy, and intracranial hemorrhagic transformation after revascularization therapy between the 2 groups (all P＜0.05). Multivariate logistic regression analysis indicated that higher NIHSS scores 3 d after revascularization therapy (odds ratio ［OR］＝1.113, 95% confidence interval ［CI］ 1.053-1.176, P＜0.001) and the presence of intracranial hemorrhage after revascularization therapy (OR＝6.098, 95% CI 2.004-18.193, P＝0.001) were significant factors that contraindicated the initiation of anticoagulation. Large infarcts (40.8%), infarct location (35.8%), and hemorrhagic transformation after stroke (40.8%) were the common reasons cited by physicians for not initiating anticoagulation. In the 90-d prognosis of patients with AF-related AIS, 6 patients had bleeding events, and 116 patients had a good prognosis (mRS score of 0-2). The 90-d good prognosis rate in the initiated anticoagulation group within 14 d after revascularization therapy (89.7%, 61/68) was significantly higher than that in the delayed or non-anticoagulation group (45.5%, 55/121; P＜0.001). Conclusion For patients with AF-related AIS who receive IVT, EVT or IVT＋EVT, it is safe to initiate anticoagulation early after revascularization therapy, but the timing of anticoagulation in most patients is later than the currently recommended anticoagulation timing.

Abstract:Objective To evaluate the long-term safety of related kidney donors after unilateral nephrectomy. Methods A total of 91 related donors who received nephrectomy in our hospital from 2006 to 2011 were followed up for at least 10 years by outpatient, telephone, or WeChat. During the follow-up period, the serum creatinine, serum uric acid, blood urea nitrogen, estimated glomerular filtration rate (eGFR), hematuria, urinary protein, blood pressure, blood glucose and blood lipids of the donors were detected, and the changes before and after nephrectomy were analyzed. Results At 1 month after operation, the levels of serum creatinine, blood urea nitrogen and serum uric acid of the donor were significantly higher than those before operation (all P＜0.05), but still within the normal range. The patients were followed up for 1, 3, 5 and 10 years after operation. Compared with 1 month after operation, the serum creatinine, blood urea nitrogen and serum uric acid were relatively stable (all P＞0.05). The eGFR of donors of different ages remained relatively stable for a long time after operation. There were 3 cases of endoscopic hematuria and 4 cases of proteinuria after surgery, and these symptoms were relieved after rest and symptomatic treatment. Ten (11.0%) donors developed hypertension 5 (5.5%) developed hyperlipidemia, and 5 (5.5%) developed diabetes mellitus. No patient died. Conclusion Nephrectomy is safe and feasible for healthy related donors. To ensure the safety of the donors, comprehensive evaluation before nephrectomy and regular follow-up after nephrectomy are essential.

Abstract:Objective To explore the relationships between headache and pulmonary function, chronic lung disease (CLD) in middle-aged and elderly people in China. Methods This cross-sectional study collected data from participants aged 45 and above in the 2015 China Health and Retirement Longitudinal Study (CHARLS). Headache was diagnosed based on self-report, and CLD and asthma were defined by self-reported doctor diagnoses or a combination of health assessments and medication use. Peak expiratory flow (PEF) was used as an indicator of pulmonary function. Multivariable logistic regression model was used to analyze the correlations between PEF, asthma, CLD, and headache. Relationship between PEF and headache was analyzed by restricted cubic spline (RCS) analysis and subgroup analysis. Results Among 12 661 middle-aged and elderly participants, the prevalence of headache was 14.42% (1 826/12 661), with a prevalence of 9.07% (558/ 6 151) in males and 19.48% (1 268/6 510) in females. After full adjustment for covariates, each 1 L/s increase in PEF was associated with a 7% reduction in the risk of headache (odds ratio ［OR］＝0.93, 95% confidence interval ［CI］ 0.90-0.96, P＜ 0.001). Categorizing PEF into quartiles (Q1-Q4), as the increase of PEF, the risk of headache significantly decreased (ORs for Q2, Q3, and Q4 were 0.92, 0.82, and 0.72, respectively, P_trend＜0.001). Additionally, asthma (OR＝1.78, 95% CI 1.43-2.20, P＜0.001) and CLD (OR＝2.21, 95% CI 1.92-2.53, P＜0.001) were positively associated with the risk of headache. RCS analysis indicated a negative linear correlation between PEF and the risk of headache (P_overall＜0.001, P_non-linear＝ 0.57). Subgroup analysis revealed that a history of hypertension had a significant impact on the negative association between PEF and headache (P_interaction＜0.001). Conclusion There is a significant negative correlation between PEF and headache among middle-aged and elderly people in China, while asthma and CLD are positively associated with headache. Improving lung function in middle-aged and elderly populations may be an effective strategy for preventing or alleviating headache.

Abstract:Objective To analyze the incidence and mortality of lung cancer in 2022 globally and in China by combining gender, age, and human development index (HDI) based on the Global Cancer Statistics 2022 issued by the International Agency for Research on Cancer. Methods Lung cancer data from 185 countries and territories worldwide were obtained from the GLOBOCAN 2022 database, and the HDI was organized based on data from the Human Development Report 2021 published by the United Nations Development Program. Cancer data were stratified by age, gender, and HDI to describe the prevalence of lung cancer globally and in China. Pearson correlation analysis was used to assess the correlations between age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (M/I) and HDI. Results In 2022, the total number of global lung cancer incidence was 2 481 000, ranking the 1^st among all cancers, and the ASIR (23.6/100 000) ranked the 3^rd among all cancers; the total number of global lung cancer deaths was 1 817 000, ranking the 1^st among all cancers, and the ASMR (16.8/100 000) ranked the 1^st among all cancers. In 2022, the total number of lung cancer incidence in China was 1 061 000, ranking the 1^st among all cancers in China, accounting for 42.8% of the global lung cancer, and the ASIR (40.8/100 000) ranked the 1^st among all cancers in China. The total number of lung cancer deaths was 733 000, ranking the 1^st among all cancers in China, accounting for 40.4% of the global lung cancer deaths, and the ASMR (26.7/100 000) ranked the 1^st among all cancers in China. The number of lung cancer incidence and deaths, ASIR, and ASMR in men were higher than those in women both globally and in China. The incidences of lung cancer, ASIR, deaths and ASMR in the world and China showed an upward trend with age, and then rapidly increased in the group older than 40-44 years group. ASIR and ASMR were positively correlated with HDI (r＝0.739 3, 0.686 5, both P＜0.000 1), while M/I was negatively correlated with HDI (r＝－0.688 1, P＜ 0.000 1) in different countries and territories. Conclusion The burden of lung cancer is serious in the world and China, and the prevalence varies among countries and territories with different HDI levels, genders, and ages.

Abstract:Sex-determining region Y-related high-mobility group box 11 (SOX11) was initially considered as one of the trans-acting factors supporting the differentiation of stem cells and the survival of neural precursors. However, in recent studies, it was found that SOX11 played an important role in the transcriptional regulation of the development, shaping and regeneration of neurons, and it was expected to be a target for the regeneration of injured nerves. This article reviews the physiological and pathophysiological functions of SOX11 in the central nervous system and its role in nerve regeneration.

Abstract:Acute pancreatitis is the most common adverse event after endoscopic retrograde cholangiopancreatography (ERCP), and it remains a challenging clinical issue despite the use of various preventive measures. In recent years, the role of calcineurin in the pathogenesis of pancreatitis has received attention, and its specific inhibitors provide a new and promising direction for preventing post-ERCP pancreatitis. This article reviews the basic and clinical progress on the relationship between calcineurin and its inhibitors and the prevention of post-ERCP pancreatitis in recent years, hoping to provide more ideas for future research.

Abstract:Ultrasound-stimulated microbubble cavitation (USMC) is a cavitation phenomenon triggered by oscillating microbubbles in ultrasound field, and this effect has led to breakthroughs in improving the permeability of cell membranes, enhancing the sensitivity of tumor cells to chemotherapy or immunotherapy, and increasing the penetration of thrombolytic drugs into blood clots and vascular recanalization. In recent years, the cross-fertilization of ultrasound medicine and materials science have given rise to the study of ultrasound-responsive multifunctional nanobubble to enhance USMC treatment. This article reviews the application and research progress of USMC in improving tissue perfusion in ischemic diseases, tumor chemotherapy and immunotherapy, ultrasonic thrombolysis, and other treatments.

Abstract:Objective To develop a full system to monitor G-induced loss of consciousness (G-LOC) of pilots caused by continuous positive acceleration and wake up them in time, so as to shorten the airborne unconsciousness time of pilots. Methods The system used MPU6050 sensor and SICHIRAY muscle sensor to obtain the head posture and electromyogram (EMG) characteristics of the pilot’s environment in real time. After system hardware design, main program design, head posture monitoring module design, EMG signal acquisition and processing module and upper computer interface display design, the system test and centrifuge test were carried out. The system test set the threshold of the EMG signal and the head posture angle by collecting the EMG signals of the subjects 2 min at rest and under muscle contraction and the head posture angle of the human body looking forward and bowing as hard as possible, and the acceleration threshold was the gravity acceleration in the test environment. The centrifuge test simulated the process of raising and bowing of the human body by placing the position of the attitude angle on the animal centrifuge. The acceleration threshold was set at 3 G, and the positive acceleration of this test environment was 4, 6, and 8 G. Results The system could capture the head posture and the physiological characteristics of EMG signals in real time, send out voice reminders in time, and could immediately enter the alarm wake-up mode when failed to receive feedback (head up, EMG recovery) within fixed time. And it could be used on centrifuges. Conclusion This system has complete function, complete logic and strong practicability. It is possible for practical application after further experimental improvement.

Abstract:Objective To investigate the influencing factors of health literacy of young naval officers and soldiers, and provide a basis for formulating precise health promotion education policies and improving the health literacy level of naval officers and soldiers. Methods The data of young naval officers and soldiers (aged 18-45 years) were randomly extracted from the Navy Health Literacy Monitoring Database, including general demographic data (gender, age, height, body weight, nationality, marital status, education level, only-child or not, registered residence), health self-assessment status (good, average, poor) and health literacy level (obtained through the national residents health literacy monitoring questionnaire ［2018］). The influencing factors of health literacy level of young naval officers and soldiers were analyzed by multivariate logistic regression analysis. Results Gender, age, nationality, marital status, educational level, and health self-assessment status were independent influencing factors for the overall health literacy level of young naval officers and soldiers (all P＜0.05). Among them, being female, aged 25-45 years, Han nationality, married, having a college degree or above, and having a “good” self-assessed health status were protective factors for health literacy (all P＜0.05). Conclusion Health education and health promotion should be strengthened for young naval officers and soldiers, especially for unmarried youth and people with low educational level. It is also necessary to improve the accessibility of health education, so as to continuously improve the health literacy level of naval officers and soldiers.

Abstract:Objective To propose diagnostic criteria for radicular lumbar disease (RLD) and evaluate its surgical outcomes. Methods A retrospective study was conducted on 31 patients with RLD who were admitted to Department of Spinal Surgery of our hospital from Mar. 2020 to Oct. 2023. The nerve root tension during the operation was recorded, and the surgical complications, visual analog scale (VAS) score, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, and modified MacNab score were statistically analyzed. Results There were 13 males and 18 females, with an average age of (56.39±9.96) years. All the patients underwent modified transforaminal lumbar interbody fusion (TLIF), including 2 cases of single-level operation, 22 cases of two-level operation, 4 cases of three-level operation, 2 cases of four-level operation, and 1 case of six-level operation. The follow-up duration was (15.29±4.34) months. The nerve root tension during the operation was higher (25.00［22.00, 28.25］g), while it decreased immediately after the operation (2.00 ［0.00, 3.00］g), with significant differences (P＜0.01). The VAS score, ODI and JOA score after operation were improved compared with those before operation (all P＜0.01). At the last follow-up, there were 24 cases of “excellent”, 5 cases of “good”, 2 cases of “fair”, and no “poor” in the modified MacNab score, and the excellent and good rate was 93.55% (29/31). Surgical complications (including cerebrospinal fluid leakage and incision infection) were occurred in 1 case each. Conclusion The remarkable clinical feature of patients with RLD is high tension of nerve. These patients can be treated by modified TLIF to improve the nerve hypertonia; early and accurate diagnosis and timely intervention are the keys to a good prognosis.

Abstract:Objective To investigate the clinical and magnetic resonance imaging (MRI) features of Trousseau’s syndrome (TS) with acute cerebral infarction, so as to improve the accuracy of diagnosis of this disease. Methods Fifty-three cases of TS with clinically confirmed acute multiple brain infarction (AMBI) and 52 cases of TS without AMBI were enrolled, and the head MRI, primary tumor imaging and clinical data of the patients were retrospectively analyzed. The clinical and MRI features and thrombus types of the 2 groups were compared. Results There were significant differences in the types of thrombus between the 2 groups (P＝0.001), while there were no significant differences in gender, age, whether they had hypertension, diabetes mellitus, hyperlipidemia, basic cardiovascular diseases or not, preventive medication use, abnormal coagulation function, or D-dimer level (all P＞0.05). The primary tumor type of 105 TS patients was mainly adenocarcinoma. MRI of the head of 53 TS with AMBI patients showed that the distribution area of acute and subacute infarct foci was bilateral anterior circulation in 16 cases, bilateral anterior circulation＋bilateral posterior circulation in 17 cases, bilateral anterior circulation＋unilateral posterior circulation in 4 cases, and unilateral anterior circulation in 16 cases. Enhancement scans were performed in 23 cases, of which 11 cases showed some infarct foci appeared enhanced and 12 cases did not show significant enhancement. Twenty-eight cases did not show meaningful stenosis of the cerebral arteries, 4 cases showed stenosis occlusion of the cerebral arteries, and all lesions did not conform to cerebrovascular distribution. Twenty-four cases of arterial thrombosis (10 cases of carotid artery thrombosis, 3 cases of lower-extremity arterial thrombosis, 5 cases of cerebral arterial ring thrombosis, 1 cases of pulmonary artery thrombosis, 1 case of renal artery thrombosis, and 4 cases of subclavian artery thrombosis) and 3 cases of venous thrombosis (deep vein thrombosis of the lower extremities) were found among the patients with visualized thrombosis. The D-dimer level was increased in different degrees. Conclusion Multiple speckled and patchy acute anterior and posterior cerebral infarcts involving bilateral cerebral and cerebellar cortex, subcortical areas and hemi-oval centers with lesions not conforming to cerebrovascular distribution are the characteristic manifestations of MRI of the head in the combination of malignant tumors with TS. Adenocarcinoma is the main malignant tumor, and the combination of D-dimer index can improve the accuracy of diagnosis.

Abstract:Objective To explore the clinical characteristics of laparoscopic cholecystectomy (LC) in the elderly and evaluate the safety of LC. Methods A total of 182 patients who underwent LC in our hospital from Jan. 2020 to Jan. 2022 were enrolled. The clinical data of the course of disease, underlying diseases, operation time, blood loss, complications, length of hospital stay and other clinical data of the elderly group (age≥60 years) and the non-elderly group (age＜60 years) were compared, and the characteristics of gallbladder diseases and the experience of safe operation in the elderly were summarized. Results There were 80 elderly patients, including 34 males and 46 females; there were 102 non-elderly patients, including 53 males and 49 females. Compared with the non-elderly group, the operation time in the elderly group was significantly longer (［69.04±31.57］ min vs ［55.29±21.22］ min, P＜0.05), with more underlying diseases (71.25%［57/80］ vs 20.59%［21/102］, P＜0.05), more patients with previous upper abdominal surgery［7.50% (6/80) vs 0 (0/102), P＜0.05］, more intraoperative blood loss (30.00［10.00, 30.00］mL vs 20.00［20.00, 50.00］mL, P＜0.05), and greater total length of hospital stay (［6.10±3.97］ d vs ［4.89±2.53］ d, P＜0.05). There was no significant difference in postoperative complications or postoperative hospital stay between the 2 groups (all P＞0.05). Postoperative pathology showed that 2 cases in the elderly group were gallbladder adenomatous hyperplasia with high-grade intraepithelial neoplasia, without gallbladder malignant tumor. Conclusion There are many underlying diseases in elderly patients. Controlling the surgical indications properly, careful operation and nursing are important factors for the success of LC in the elderly.

Abstract:Objective To explore the relationship between anxiety sensitivity and psychological stress before parachuting training among parachuting trainees and the mediating role of resilience between them. Methods Anxiety sensitivity index scale (version 3), resilience scale, psychological stress self-evaluation test and self-compiled general information questionnaire were employed for 258 parachuting trainees before training. Pearson correlation analysis was used to analyze the correlations among anxiety sensitivity, resilience and psychological stress. A multiple linear regression analysis was conducted with anxiety sensitivity and resilience as independent variables and psychological stress as dependent variable to explore the relationships among these 3 factors. The mediating effect of resilience on the relationship between anxiety sensitivity and psychological stress was examined using the Hayes Process macro program and bias corrected non-parametric percentile Bootstrap method. Results Before parachuting training, the prevalence of psychological stress among parachuting trainees was 5.0% (13/258). The correlations between anxiety sensitivity, resilience and psychological stress were significant (all P＜0.01). Anxiety sensitivity was positively associated with psychological stress among parachuting trainees (b＝0.412, t＝7.062, P＜0.01), while resilience was negatively associated with psychological stress (b＝－0.187, t＝－3.722, P＜0.01). Anxiety sensitivity and resilience were found to explain 31.4% of the total variance. Resilience partially mediated the effect of anxiety sensitivity on psychological stress, accounting for 20.48% of the total effect. Conclusion Parachuting trainees are at a relatively low stress level, with good psychological adaptation. Resilience plays a partial mediating role in the association between anxiety sensitivity and psychological stress. More attention should be paid to parachuting trainees with high anxiety sensitivity, enhancing their resilience, and reducing psychological stress before parachuting training.

Abstract: