Journal of Sichuan University (Medical Science Edition)
Journal of Sichuan University (Medical Science Edition) was established in 1959. It is one of the key scientific journals in China and has been awarded the first-rank national and provincial prizes for several times. As the first grade medical journal in China ,we devote to spreading the fresh and dominant medical information of China's western region. The content of the journal covers the domain of scientific researches in medicine, which includes biomedicine, biomedical engineering (e.g. tissue and cellular engineering), medicine genetics, pharmaceutical development, pathogenesis, preventive medicine, and clinical medicine. ISSN 1672-173X (Online) To date, the journal has been successively included in authoritative databases, such as: The Index Medical (IM), Scopus, the Chemical Abstracts (CA), the Biological Abstracts (BA), the Excerpta Medical (EM), the Chinese Science Citation Database (CSCD) and the Chinese BioMedical Literature Database (CBM)) have indexed the journal since 1986. In the past decade, various foundations, including the National Natural Science Foundation of China and the China Medical Board of New York Corporation, supported the large amounts of the articles published in the journal, and authors from the universities and institutes in China, as well as those from the USA, the Netherlands, Canada, Australia, Japan, New Zealand, and Germany contributed these articles. Our Editor in Chief, Prof. WEI Yu-quan, Academian of the Chinese Academy of Sciences who is devoting himself to biotherapy of human diseases. Our editorial committee members are the pioneers in the academic fields, research programs, and scientific activities in the West China Center of Medical Sciences of Sichuan University, and some of them are well-known in the fields of biomedical science and engineering. With the editorial committee 's guidance, we got honor by our exertion and perseverance. We enjoyed the 1989 first Grade Award of Excellent Quality for Editing the Universiy Journal, the 1990 and 1993 First Grade Awards for Excellent Scintific and Techonol Journal in Sichuan Province, the 1997 First Grade National Award for Excellent Scientific and Technological Journal, the 1999 First Nominated Award for Journals in China, the 2002 Awards for One-hundred Outstanding Journals in China., and the 2006 to 2012 National Outstanding Scientific and Technological University Journal in the Ministry of Education. Sponsored by: Sichuan University. Address: 17, Section 3, Renmin Nanlu, Chengdu, Sichuan, 610041, People's Republic of China E-mail: mailbox@jsu-mse.com Tel：028-85501322
Current Applications and Future Prospects of Laparoendoscopic Single-Site Surgery in Urology
In recent years, laparoendoscopic single-site surgery (LESS) has gained growing attention because, compared with conventional multiport laparoscopy, it offers superior cosmetic outcomes, reduced postoperative pain, and faster. However, LESS is technically more challenging and characterized by a steep learning curve. The introduction of robotic surgical systems offers new solutions to overcome the technical limitations of LESS, thereby promoting its further development. This article provides a review of the current applications of LESS in urology, with a focus on the technical progress, clinical outcomes, and challenges of robot-assisted LESS (R-LESS). Additionally, the future trends involving the integration of cutting-edge technologies such as artificial intelligence, telesurgery, and medical big data are discussed. Keywords: Laparoendoscopic single-site surgery, Robotic-assisted surgery, Urology, Review
Copyright (c) 2026 Journal of Sichuan University (Medical Science Edition)
Applying Robot-Assisted Single-Port Laparoscopic Surgery in Gynecology: Technological Paradigm Innovations and Clinical Advances
With the continuous development of robot-assisted single-port laparoscopic surgery in gynecology, its indications have gradually expanded from benign gynecologic diseases to malignant tumors, reflecting an emerging trend toward the integration of robotic technology and single-port minimally invasive surgery. This review primarily discusses the clinical application of robotic systems such as the da Vinci Xi platform and domestically developed single-port robotic systems in various complex surgical procedures, as well as the development of technical strategies for optimizing instrument layout and overcoming operative limitations. From a technical perspective, the use of 3-dimensional high-definition visualization, flexible wristed instrumentation, and tremor filtration, combined with innovative surgical paradigms, has effectively addressed the problem of instrument interference in single-port surgery, thereby enabling precise resection, rapid postoperative recovery, and superior cosmetic outcomes with minimal visible scarring. Although dedicated single-port systems still face technical challenges and long-term outcome data remain limited, the future integration of artificial intelligence and remote technologies will further validate their clinical efficacy and promote the standardized application of this approach in gynecological clinical practice. Keywords: Robot-assisted surgical system, Single-port laparoscopic surgery, Gynecological surgery, Review
A Review of Robotic vNOTES Surgery: Current Applications, Advantages, and Future Directions
Over the past 500 years, the convergence of three distinct paths – vaginal surgery, laparoscopy, and robotic technologies – has enabled the development of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES). The ongoing evolution of vaginal surgery has led to contemporary procedures such as hysterectomy, myomectomy, sacrocolpopexy, adnexal interventions, and oncologic operations, applicable to a wide range of diagnoses and pathologies. This approach offers patients significant benefits, including superior cosmetic outcomes, less pain, lower infection rates, and faster recovery of baseline quality of life. Surgeons benefit from improved ergonomics, better visualization, the ability to use multiple instruments, and enhanced tremor control. Robotic assistance has greatly expanded the ability to safely perform more complex cases, such as excision of stage 4 endometriosis with complete posterior cul-de-sac obliteration, as well as other procedures previously considered contraindicated in traditional vaginal surgery. Here, we present current findings and advances in RA-vNOTES and consider future developments in robotic surgery aimed at further improving minimally invasive techniques. Keywords: Robotic surgery, vNOTES, Gynecology, Minimally invasive surgery, Surgical innovation, Review
Lovell Daniel Y., YANG Qiannan, GUAN Xiaoming
Application of Domestic Robotic Surgical Systems in Gynecologic Surgery
In recent years, domestically developed surgical robot systems have rapidly progressed from laboratory research to clinical applications in gynecological surgery, demonstrating multi-dimensional advancement and accelerated development. Systems such as Toumai, Jingfeng, Surui, Haishanyi, and MicroHand S have been progressively deployed in both routine and complex procedures, including surgeries for uterine fibroids, ovarian cysts, and gynecologic malignancies such as cervical, endometrial, and ovarian cancers. These systems have established a technology pathway characterized by independent research and development, clinical validation, and expanded indications. They generally offer advantages such as 3D high-definition imaging, highly flexible robotic arms, and precise dissection capabilities, enabling refined operations in the deep pelvis and supporting multi-angle tissue dissection with enhanced visualization, stability, and trauma control. Some systems, including the Surui and Jingfeng SP series, have also demonstrated strong adaptability in single-port and natural orifice (e.g., v-NOTES) approaches. Additionally, 5G-based telesurgery has been preliminarily explored, promoting regional medical collaboration and technology dissemination in underserved areas. Although most domestic systems remain in early-stage clinical adoption with limited large-scale comparative studies and long-term follow-up data, initial outcomes are promising in terms of intraoperative safety, postoperative recovery, and patient experience. However, compared to the Da Vinci system, further evidence is needed regarding their precision in highly complex tumor resections, management of intraoperative complications, and long-term oncological outcomes. Therefore, large-sample, multi-center, prospective studies with long-term follow-up are urgently needed to validate their efficacy and safety and to promote standardized application in gynecological oncology. Keywords: Domestically produced robotic surgical systems, Gynecological surgery, Remote surgery, Review
Mid- to Long-Term Urinary Continence Outcomes of Pelvic-Peritoneal Structure-Sparing Techniquein Robot-Assisted Radical Prostatectomy
Objective To evaluate the mid- to long-term effects of the pelvic-peritoneal structure-sparing (PPSS) technique, which aims to preserve the stability of pelvic floor structures, on urinary continence recovery after robot-assisted radical prostatectomy (RARP). Methods This single-center retrospective cohort study included 82 patients who underwent RARP between October 2017 and May 2018, all operated on by the same surgeon. Patients were divided into a PPSS group (n = 53) and a non-PPSS group (n = 29). Standard RARP was performed in the non-PPSS group, whereas the PPSS group involved preservation of pelvic floor structures and cold-knife apical dissection for urethral function protection. Baseline characteristics were comparable between the two groups. Follow-up lasted up to 7 years. Urinary continence was defined as the use of 0-1 pad per day and was assessed at 3, 6, 12, 24 months postoperatively and at the last follow-up (July 2025). Kaplan-Meier analysis and Cox regression were used to compare continence recovery rates and identify influencing factors. Results The median follow-up duration was 1178 days (range: 1-2743 days). The PPSS group had significantly higher continence recovery rates at 3 and 6 months (71.6% and 75.4%) compared with the non-PPSS group (44.8% and 48.2%; P = 0.030 and P = 0.025, respectively), while no significant difference was observed at 12 months and thereafter. Multivariate Cox regression analysis showed that the PPSS technique (hazard ratio [HR] = 2.59, 95% CI: 1.39-4.81, P = 0.002) and age (HR = 0.94, 95% CI: 0.91-0.97, P = 0.001) were independent predictors of continence recovery. Conclusion The PPSS technique improves early postoperative urinary continence without increasing the rate of positive surgical margins. Although it does not significantly enhance long-term continence, it may still contribute positively to patients' postoperative quality of life. Keywords: Prostate cancer, Robot-assisted radical prostatectomy, Pelvic-peritoneal structure, Urinary continence recovery, PPSS technique
YANG Lu, , TU Xiang, LU Guofa, DONG Zeyou, BAO Yige, LIU Zhenhua, WEI Qiang
Clinical Study of Robotic Natural Orifice Specimen Extraction Surgery for Right Colon Cancer
Objective To evaluate the safety and feasibility of robotic natural orifice specimen extraction surgery (NOSES) for right colon cancer. Methods Twenty-two female patients undergoing this procedure between January 1, 2022 and January 31, 2025 were enrolled. Safety and feasibility were assessed by analyzing operative time, intraoperative blood loss, conversion rate to open surgery, postoperative complications, 30-day mortality, and 30-day unplanned surgery-related readmission rate. Results All procedures were completed successfully. The median operative time was 158 min (152-169 min), and the median blood loss was 53 mL (43-75 mL). No conversions to open surgery occurred. The first postoperative flatus occurred at a median of 53.00 h (49.25-57.50 h), and the median postoperative hospital stay was 9.00 d (8.00-11.00 d). Postoperative complications included one case of intestinal obstruction. No anastomotic leakage, anastomotic bleeding, vaginal hemorrhage, vaginal infection, or abdominal infection was observed. There were no deaths within 30 days and no unplanned surgery-related readmissions. Conclusion Robotic NOSES for right colon cancer is safe and feasible. Keywords: Right colon cancer, Robotic surgery. Natural orifice specimen extraction surgery
LIU Dongning, ZHOU Ruichen, XIAO Feng, HU Wenjun, HE Penghui, GAO Gengmei, LIANG Yahang, LI Taiyuan
Establish a Zebrafish Atherosclerosis Model Screening Platform to Evaluate the Therapeutic Effects of Qi-Regulating and Blood-Activating Prescriptions on Atherosclerosis
Objective To systematically identify traditional Chinese medicine (TCM) compound formulas with anti-atherosclerosis (AS) potential using a screening platform based on multi-strain apoeb gene knockout zebrafish models for anti-atherosclerosis TCM compounds Methods Screening was conducted using a formula dictionary database, and compound formulas such as Dan Shen Fang, Shang Ni San, Jin Lingzi San, and Li Qi Hua Liang Tang were selected from 933 blood-activating and stasis-resolving formulas. Five strains of apoeb－/－ zebrafish–AB, Tg(mpeg1:EGFP), Tg(lyzc:dsRed), Tg(gata1a:mCherry), and Tg(flk1:EGFP)—were fed a high-fat diet for 2 days, after which the AS model was established. DMSO (solvent control), rosuvastatin (western medicine positive control), compound Dan Shen Fang (TCM positive control), Shang Ni San, Jin Lingzi San, and Li Qi Hua Liang Tang were administered by bathing for 24 hours. Oil red O staining was used to detect lipid content, oxidative stress indicators, blood flow velocity, vascular endothelial cell damage, and the expression of inflammatory factors in zebrafish. The behavior patterns of inflammatory cells in zebrafish were observed, and the anti-AS efficacy of the Li Qi Hua Liang formulas was comprehensively evaluated. Results Compared with the AS model group, compound Dan Shen Fang and Shang Ni San improved lipid accumulation in the vascular lumen, reduced total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels, decreased oxidative stress response, inhibited the recruitment of neutrophils and macrophages, repaired vascular endothelial damage, improved blood flow velocity, and reduced the expression of inflammatory factors, thereby alleviating AS, with statistically significant differences. Jin Lingzi San and Li Qi Hua Liang Tang had limited effects on AS. Conclusion This platform provides an efficient and targeted tool for the screening and research evaluation of anti-atherosclerosis TCM compound formulas, accelerates the research progress of anti-atherosclerosis TCM compound formulas, and lays a foundation for subsequent drug development and clinical application. Keywords: Atherosclerosis, Zebrafish, Drug screening, Chinese medicine compound formulas
YIN Jiufeng, WANG Hui, WANG Haoyan, JIANG Tong, ZHANG Xinyi, LI Mingkai, ZHANG Dan, ZHAO Feng, YANG Wenqing
Effectiveness Analysis of Cervical Rotation-Traction Manipulation on Cervical and Dorsal Muscle Tone in Patients With Cervical Spondylotic Radiculopathy
Objective To clarify the mechanism of action of the Cervical Rotation-Traction Manipulation in treating cervical spondylotic radiculopathy using shear wave elastography. Methods Thirty patients with cervical spondylotic radiculopathy and 30 volunteers without abnormal cervical conditions in the past three months were included. Patients received manipulation therapy once a week for 15 to 20 minutes, totaling three sessions over two weeks. Volunteers received no treatment. Shear wave elastography was the primary research method (with Young's modulus as the primary outcome measure) to assess the effect of the Cervical Rotation-Traction Manipulation on the neck and back soft tissues in patients with cervical spondylotic radiculopathy. Shear wave elastography was performed on patients three times: before treatment, after the first manipulation session, and after two weeks of treatment. Volunteers underwent one shear wave elastography test as a baseline control. Secondary outcome measures were the visual analogue scale (VAS) and neck disability index (NDI) scores of patients before treatment, after treatment, and two weeks after treatment. Results The Young's modulus values of the cervical muscles in patients before treatment were higher than those in volunteers (P < 0.001), but there was no statistically significant difference after the treatment course. There were statistically significant differences in the Young's modulus of the muscle before and after treatment and before and after the treatment course in patients (P < 0.001). The Young's modulus values of the affected side cervical muscles were higher than those of the healthy side (P = 0.001), but there was no statistically significant difference after treatment. The median Young's modulus was positively correlated with the VAS score (r = 0.741, P < 0.001) and the NDI score (r = 0.591, P < 0.001) in patients with cervical spondylotic radiculopathy. Conclusion The Cervical Rotation-Traction Manipulation can reduce the VAS and NDI scores of patients with cervical spondylotic radiculopathy, lower neck muscle tension, and balance the distribution of cervical muscle tension while reducing it. Young's modulus is a potential indicator reflecting the therapeutic effect of the spinal manipulation. Keywords: Traditional Chinese spinal manipulative therapy, Cervical spondylotic radiculopathy, Cervical rotation-traction manipulation, Shear wave elastography
WANG Xu, FENG Tianxiao, ZHU Yongtao, ZHAO Xiaoqi, SUN Kai, LIU Ning, XIE Rong, ZHU Liguo, LIU Guanghui, WEI Xu
Expert Consensus on the Development of Public Oral Health Culture in China
This expert consensus systematically reviews the current status and future directions of oral health culture in China, providing a clear theoretical framework for "oral health culture," including its conceptual definition, disciplinary perspective, and core values. It analyzes the current state and challenges of oral health culture. The consensus highlights that under the guidance of the "Healthy China" strategy, China's residents have experienced steady improvements in oral health literacy and access to healthcare services, yet still face challenges such as uneven regional development, an incomplete prevention and treatment system, and insufficient integration of oral health into daily cultural practices. Based on multidisciplinary expert discussions and the nominal group technique, the consensus proposes development goals, basic principles, implementation pathways, safeguard measures, and recommendations for oral health culture. First, establish a Chinese-style oral health culture system by integrating oral health culture into public health policies, primary healthcare services, and the national education system. Second, shift the focus from "treatment" to "prevention," strengthening whole-life-cycle oral health management, with particular attention to children, the elderly, and vulnerable groups. Third, leverage digital and new media technologies to innovate health communication formats, creating scientific, accessible, and positive oral health cultural products to foster a societal atmosphere of "caring for teeth." Fourth, incorporate oral health culture indicators into the evaluation systems for healthy cities and communities. The consensus emphasizes that the development of oral health culture is a crucial foundation for achieving universal oral health, requiring collaborative efforts from the government, professional institutions, media, schools, families, and the public. Keywords: Oral health, Cultural education, Science popularization and education, Expert consensus, Nominal group technique
Oral Culture Professional Committee of the China Popular Culture Society
Active Oxygen Influences Foam Macrophage Formation by Regulating Peroxisome Proliferator-Activated Receptor-γ Expression
Objective To investigate the effect of reactive oxygen species (ROS) on foam macrophage formation by regulating the expression of peroxisome proliferator-activated receptor-γ (PPARγ). Methods From June 2018 to December 2021, human blood samples were obtained from 30 healthy donors, and peripheral blood mononuclear cells (PBMCs) were isolated. The PBMCs were differentiated into human monocyte-derived macrophages (HMDMs) and subsequently infected with Mycobacterium tuberculosis H37Ra strain to establish an in vitro human macrophage infection model. ROS production was modulated using N-acetylcysteine (NAC) and emodin, while PPARγ activity was regulated using the PPARγ agonist (BRL49653) or antagonist (GW9662). The effects of H37Ra infection on intracellular ROS production and lipid formation in macrophages, as well as the impact of ROS generation on foam macrophage formation, were assessed using 2', 7'-dichlorodihydrofluorescein diacetate (DCFH2-DA) and Oil Red O staining. The influence of ROS production on PPARγ expression in macrophages was examined by qRT-PCR and Western blot. Furthermore, the involvement of PPARγ activity in ROS-mediated regulation of foam macrophage formation was investigated by modulating PPARγ activity. Results The results of Oil Red O staining and DCFH2-DA detection showed that, compared with the control group, H37Ra infection promoted ROS production in HMDMs and induced foam cell formation, with statistically significant differences (P < 0.01). After treating HMDMs with NAC or emodin for 1 hour and then infecting with H37Ra, NAC treatment reduced intracellular ROS levels and lipid content, while emodin increased intracellular ROS levels and lipid content, both with statistically significant differences (P < 0.01). Western blot analysis indicated that H37Ra infection inhibited PPARγ production, NAC promoted PPARγ expression, and emodin inhibited PPARγ expression, with statistically significant differences (P < 0.05). Pre-treating HMDMs with BRL49653 or GW9662 for 1 hour before H37Ra infection showed that GW9662 promoted lipid accumulation in the cells, with statistically significant differences (P < 0.01). Conclusion ROS can promote the formation of foam macrophages by downregulating the expression of PPARγ. Keywords: Foam macrophages, H37Ra, Reactive oxygen species, Peroxisome proliferator-activated receptor-γ
LIU Jun, , YE Yutao, SU Rigu, HUANG Zikun, LI Junming
circFOXP1 Targets miR-4429 to Regulate Proliferation, Migration and Invasion of Nasopharyngeal Carcinoma 6-10B Cells
Objective To determine whether circular RNA forkhead box protein P1 (circFOXP1) regulates the proliferation, migration and invasion of nasopharyngeal carcinoma 6-10B cells by targeting miR-4429. Methods The correlations of circFOXP1 and miR-4429 with pathological characteristics of nasopharyngeal carcinoma patients were analyzed. Nasopharyngeal carcinoma 6-10B cells were transfected with si-NC, si-circFOXP1, pcDNA, pcDNA-circFOXP1, miR-NC, miR-4429 mimics, or co-transfected with si-circFOXP1 and anti-miR-NC, or si-circFOXP1 and anti-miR-4429. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect circFOXP1 and miR-4429 expression in nasopharyngeal carcinoma tissues. Cell viability, colony formation, migration and invasion abilities were assessed by Cell Counting Kit-8 (CCK-8), colony formation, wound healing and Transwell assays. Western blotting was used to detect E-cadherin and N-cadherin protein expression. A dual-luciferase reporter assay verified the targeting relationship between circFOXP1 and miR-4429. Results The expression level of circFOXP1 in nasopharyngeal carcinoma tissues (4.61 ± 0.31) was significantly higher than that in adjacent tissues (1.00 ± 0.05) (P < 0.001), while the expression level of miR-4429 (0.37 ± 0.03) was significantly lower than that in adjacent tissues (1.00 ± 0.08) (P < 0.001). The expression of miR-4429 was correlated with tumor volume and TNM stage (P < 0.05), while the expression of circFOXP1 was correlated with TNM stage(P < 0.05) but not with tumor volume (P > 0.05). Inhibition of circFOXP1 expression or overexpression of miR-4429 reduced cell viability, colony formation number, wound healing rate, invasive cell number and N-cadherin protein expression, while increased E-cadherin protein expression in nasopharyngeal carcinoma 6-10B cells (P < 0.05). circFOXP1 targeted and negatively regulated miR-4429 expression. Interference with miR-4429 reversed the inhibitory effects of circFOXP1 silencing on proliferation, migration and invasion of nasopharyngeal carcinoma cells (P < 0.05). Conclusion Inhibition of circFOXP1 expression can attenuate the proliferation, migration and invasion of nasopharyngeal carcinoma 6-10B cells by targeting miR-4429. Keywords: Nasopharyngeal carcinoma 6-10B cells, circFOXP1, miR-4429, Proliferation, Migration,Invasion
Study of the Sealing and Antibacterial Properties of Bioceramic Root Canal Sealers Modified With Quaternary Ammonium Salt
Objective To modify the non-antibacterial bioceramic root canal sealant iRoot SP with the quaternary ammonium salt dimethylaminododecyl methacrylate (DMADDM) and to develop a new type of sealant. Methods The cytotoxicity of the modified root canal sealant was evaluated using the cell counting kit-8 (CCK-8). The solubility and flowability of the sealant were tested according to International Organization for Standardization (ISO) methods. The sealing ability and penetrability of the sealant were assessed by micro-computed tomography (micro-CT) and confocal laser scanning microscope (CLSM). The antibacterial activity of the sealant against Enterococcus faecalis biofilm was evaluated by colony-forming unit (CFU) counting, crystal violet staining, scanning electron microscope (SEM), and live/dead staining. Results When the DMADDM mass fraction was 0.625%, the modified sealant demonstrated good biocompatibility (P > 0.0125). The flowability (> 17 mm) and solubility (< 3%) of the sealant modified with 0.625% DMADDM met ISO standards and showed no significant difference compared with iRoot SP. DMADDM modification did not affect the sealing ability or penetrability of the sealant at different positions of the tooth root (P > 0.05). Antibacterial experiments showed that the modified sealant reduced the CFU count (0.518 ± 0.333 vs. 8.156 ± 0.011, P < 0.001) and the amount of biofilm (mean difference of 86.94%, 95% confidence interval: 74.82%-99.07%, P < 0.0001) of Enterococcus faecalis biofilm at the unaged stage. However, after 1 week of aging (7.327 ± 0.068 vs. 7.422 ± 0.035) or 4 weeks of aging (7.479 ± 0.065 vs. 7.581 ± 0.071), the CFU count of the modified sealant showed no significant difference from the iRoot SP group (P > 0.05). Live/dead staining and SEM also showed that the modified sealant could inhibit the formation of Enterococcus faecalis biofilm. Conclusion iRoot SP modified with 0.625% DMADDM exhibited good biocompatibility, sealing ability, and penetrability, and significantly improved resistance to Enterococcus faecalis biofilm, providing a new approach for the antibacterial modification of bioceramic root canal sealants. Keywords: Root canal sealers, iRoot SP, DMADDM, Enterococcus faecalis
Study on the Mechanism by Which Atorvastatin Enhances the Stability of Atherosclerotic Plaques in ApoE－/－ Mice Through Regulation of MMP-7/Gα13
Objective To explore the pleiotropic molecular mechanisms by which atorvastatin (Ator) regulates atherosclerosis (AS) in ApoE－/－ mice. Methods Thirty 8-week-old male ApoE－/－ mice were induced to develop atherosclerosis by a high-fat diet. They were randomly assigned to a control group (normal saline), a low-dose Ator group (5 mg/[kg·d]), and a high-dose Ator group (10 mg/[kg·d]), and received interventions for 10 weeks. The primary outcome indicators were assessed by Oil Red O and HE staining to measure the area of atherosclerotic plaques. Secondary outcome indicators included serum lipid levels detected by a blood chemical analyzer, Masson and Sirius Red staining combined with polarized light to assess plaque stability indicators (collagen fiber content, fibrous cap thickness), immunohistochemistry to detect the expression of α-smooth muscle actin (α-SMA) and CD68, fluorescence microplate reader to measure reactive oxygen species (ROS) levels, Western blot and RT-qPCR to detect protein and gene expression of inflammation, oxidative stress, apoptosis-related molecules, matrix metallopeptidase 7 (MMP-7), and guanine nucleotide-binding protein subunit α-13 (Gα13). Results Blood lipids and plaques: Ator reduced serum low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG) levels (P < 0.05), and dose-dependently decreased the area of aortic lipid deposition and plaque area (Control group: plaque area [1.62 ± 0.15] mm², Low-dose group: [1.13 ± 0.06] mm², High-dose group: [0.83 ± 0.07] mm², P < 0.001). Plaque stability: Ator increased collagen fiber content (P < 0.001), increased fibrous cap thickness, upregulated α-SMA expression, and downregulated CD68 expression (P < 0.001). Oxidative stress: Ator remarkably diminished the levels of ROS in arterial tissue and malondialdehyde (MDA) in serum (P < 0.001). Molecular mechanism: Ator downregulated pro-inflammatory factors (tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]), NLRP3, pro-apoptotic proteins (caspase-3, p53), inducible nitric oxide synthase (iNOS), and MMP-7; and upregulated anti-apoptotic protein Bcl-2, antioxidant proteins [mitochondrial deacetylase 3 (sirtuin 3, SIRT3)/superoxide dismutase 2 (SOD2)], and Gα13 (P < 0.001). The expression trends of these proteins and genes were consistent, with a more significant effect in the high-dose group. Conclusion Atorvastatin exerts its anti-atherosclerotic effects by regulating blood lipids, inhibiting inflammatory responses, reducing oxidative stress, and regulating apoptosis. It also affects the expression of MMP-7 and Gα13. Keywords: Atorvastatin, ApoE－/－ mice, Atherosclerosis, Matrix metallopeptidase 7, Guanine nucleotide-binding protein subunit α-13
LU Xiao, ZHENG Rong, CHEN Yang, FENG Ying
Integrating Bioinformatics and Machine Learning Algorithms to Screen Inflammatory Biomarkers for Atrial Fibrillation and Experimental Validation
Objective To identify potential biomarkers of atrial fibrillation (AF) using bioinformatics, machine learning (ML) and experimental methods. Methods AF transcriptomic data were obtained from the GEO and MSigDB databases to screen for differentially expressed genes (DEGs) and inflammation-related gene sets (IRGs). The overlap between DEGs and IRGs was used to identify the DE-IRGs set. Two machine learning algorithms were used to filter AF-related DE-IRGs. Twelve male SD rats were randomly divided into a control group and an AF group. Rats received acetylcholine (66 μg/mL) and calcium chloride (10 mg/kg) via tail vein injection for five consecutive weeks to establish the AF model. Morphological characteristics of atrial myocytes were assessed with HE staining, while RT-qPCR and immunohistochemistry (IHC) were used to measure changes in mRNA and protein levels. Results In the training set, 119 DEGs were identified, with IRGs showing the highest correlation with two co-expression modules (r = 0.60 and 0.56, P < 0.0001). The intersection of DEGs and IRGs yielded nine DE-IRGs. The SVM-RFE and RF algorithms identified 5-hydroxytryptamine receptor 2B gene (HTR2B), latent-transforming growth factor beta-binding protein 2 gene (LTBP2), matrix remodeling associated protein 5 gene ( MXRA5), and transforming growth factor β-induced protein gene (TGFBI) as highly expressed in both the training and test sets in AF groups with high diagnostic efficacy (AUC > 0.77). The electrocardiogram limb leads of AF rats showed numerous f-waves. HE staining revealed disorganized atrial myocyte arrangement and inflammatory cell infiltration in the AF group. The TUNEL fluorescence assay showed an apoptosis rate of (55.34 ± 4.29)% in the AF group, compared to (8.69 ± 3.12)% in the control group (P = 0.0001). There were statistically significant differences in the relative expression levels of LTBP2 and TGFBI between the AF group (4.97 ± 4.20, 2.62 ± 1.85) and the control group (1.12 ± 0.21, 1.18 ± 0.77) (P = 0.0137, P = 0.0444). IHC revealed positive rates of LTBP2 and TGFBI proteins in the AF group of (36.50 ± 1.31)% and (27.39 ± 4.57)%, respectively, compared to (22.95 ± 2.62)% and (18.26 ± 3.70)% in the control group (P = 0.0008, P = 0.0485). Conclusion The characteristic genes LTBP2 and TGFBI are highly expressed in AF and serve as valuable diagnostic biomarkers. Keywords: Atrial fibrillation, Machine learning algorithms, Biomarkers, Inflammatory response
BU Qi, ZHANG Wei, HUANG Ying, LI Zheng, WANG Yang, ZHAO Xuan, JIA Yunli, FAN Xiaoyan, YANG Yuan, WANG Zhimi
The Role of Cuproptosis Related Key Genes in Ovarian Cancer and the Construction of a Prognostic Model
Objective Using ovarian cancer datasets from public databases, identify copper death-related genes in ovarian cancer tissues and construct a clinical prognostic risk scoring model for ovarian cancer patients based on these genes. Methods We downloaded the OC data of TCGA, the GSE26193, GSE63885 dataset from GEO and retrieved 10 cuproptosis related genes (CRGs) and analyzed their chromosomal localization, expression correlation, and mutation patterns based on the datasets. Using these genes, we clustered the OC samples to identify different molecular subtypes of copper induced death. We analyzed the differential genes and functional enrichment between different subtypes and obtained feature genes with predictive ability for prognosis through survival regression analyses. Based on these feature genes, we constructed a risk scoring model and incorporated the clinical characteristics ofpatients to jointly predict their survival rate. Results In ovarian cancer samples, 10 copper death-related genes can stably divide the samples into two molecular subtypes, and there are significant differences in clinical and immune characteristics and drug sensitivity between them. After further screening, seven prognostic genes (RARRES1、CXCL10、PI3、CXCL11、THEMIS2、GBP2、RPL39L) were obtained, and the risk model based on them combined with age predicted that the AUC of patients' 1-, 3-, and 5-year survival rates were all greater than 0.7, showing good clinical application prospects. Conclusion The mechanism of cuproptosis and its key genes might become therapeutic targets for ovarian cancer. The subtypes of cuproptosis provide a theoretical basis for personalized clinical treatment. The predictive model constructed by key prognostic genes has promising clinical application effects. Keywords: Ovarian cancer, Cuproptosis-related genes, Immune infiltration
WANG Huimin, JIANG Ying, CHEN Jinxin, MU Peng, ZHANG Jingru
Burden of Diabetic Kidney Disease at Global, Regional, and National Levels From 1990 to 2021
Objective Based on the Global Burden of Diseases (GBD) 2021 data, this study systematically analyzed the trends in the disease burden of diabetic kidney disease (DKD) and predicted its burden over the next decade in 204 countries and regions worldwide from 1990 to 2021. Methods Data on DKD from the GBD study spanning 1990 to 2021 were analyzed for trends using age-standardized rates (ASRs) and average annual percentage change (AAPC). The Joinpoint Regression Model (JRM) was applied to identify turning points, and the Autoregressive Integrated Moving Average (ARIMA) model was used to forecast future trends. Statistical analysis was performed using R software. Results The age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of global DKD from 1990 to 2021 showed substantial increases, with cumulative rises of 55.0% (95% CI: 42.3% to 69.8%, P < 0.001) and 57.3% (95% CI: 43.1% to 73.5%, P < 0.001), respectively. The age-standardized prevalence rate (ASPR) declined by 37.5% (95% CI: －45.2% to －28.8%, P < 0.001), while the age-standardized disability-adjusted life years (DALYs) rate rose by 56.2% (95% CI: 42.8% to 71.5%, P < 0.001). Noticeable disparities in disease burden were observed among countries and regions. Greenland experienced the largest increase in ASPR, whereas the United Kingdom had the most substantial decrease. Estonia had the highest rise in ASIR, while Ireland saw the greatest decline. The United States had the most pronounced increase in ASDR, while the Maldives had the largest decrease. East Asia had the highest number of current cases, while South Asia bore the heaviest burden of new cases and DALYs. The increase was more prominent in regions with a low socio-demographic index (SDI). Projections for the next decade (2022–2031) indicate that the global ASPR of DKD will increase by an average of 0.45% per year (95% CI: 0.21% to 0.69%), the ASIR will decrease by an average of 0.23% per year (95% CI: －0.47% to －0.01%), and the age-standardized DALYs rate will increase by an average of 1.12% per year (95% CI: 0.89% to 1.35%). The overall burden of the disease is expected to continue growing. Conclusion The global burden of DKD is steadily increasing, and it is especially severe in regions with low SDI. It is essential to implement targeted prevention and control measures in high-burden areas to provide a scientific basis for allocating public health resources. Keywords: Diabetic kidney disease, Disability-adjusted life years, Disease burden, Socio-demographic index, Age-standardized rates
NING Yaxian, ZHOU Xiaochun, WANG Gouqin, ZHANG Lili, WANG Jianqin
Analysis of Maternal Pregnancy Characteristics and Adverse Neonatal Birth Outcomes at a Single Center From 2017 to 2022
Objective To analyze changes and correlations in the pregnancy characteristics of parturients and adverse birth outcomes of newborns in a tertiary grade A hospital from 2017 to 2022, and provide a basis for targeted prevention of adverse birth outcomes in newborns. Methods Medical records of obstetric deliveries from January 1, 2017, to December 31, 2022, were retrospectively collected. Descriptive analysis was used to examine the pregnancy characteristics of parturients and adverse birth outcomes of newborns. Univariate and multivariate analyses were conducted to explore the relationship between these factors during this period. Results The final analysis included data from 93547 newborns and 88857 corresponding mothers. From 2017 to 2022, the number of mothers and newborns at our hospital showed an overall increasing trend. The main reproductive age for women in this region was concentrated between 30 and 34 years. The proportion of older mothers (≥ 35 years) showed a general downward trend, and this difference was statistically significant (χ2trend = 13.261, P < 0.001). Except for cesarean section, the risks of preterm birth, low birth weight (LBW), macrosomia, small for gestational age infant (SGA), and large for gestational age infant (LGA) in this region showed an overall downward trend, with statistically significant differences (P < 0.05). Multivariate logistic regression analysis showed that, compared with mothers under 30 years, the risk of cesarean section for newborns was 1.339 times higher in the 30-34 age group (adjusted odds ratio [aOR] = 1.339, 95% CI: 1.297-1.382) and 2.646 times higher in the ≥ 35 age group (aOR = 2.646, 95% CI: 2.532-2.765). For LGA risk, only mothers aged ≥ 35 years showed an increased risk for newborns (aOR = 1.111, 95% CI: 1.049-1.178, P < 0.001). The risks of cesarean section, preterm birth, and macrosomia in the multiparous group were 1.151 times (aOR = 1.151, 95% CI: 1.114-1.189), 1.558 times (aOR = 1.558, 95% CI: 1.486-1.633), and 1.595 times (aOR = 1.595, 95% CI: 1.527-1.688) those in the primiparous group, respectively, while the risk of SGA in the multiparous group was lower than in the primiparous group (aOR = 0.684, 95% CI: 0.655-0.715). The risks of cesarean section, macrosomia, and LGA in the in vitro fertilization (IVF) group were 2.295 times (aOR = 2.295, 95% CI: 2.170-2.427), 1.274 times (aOR = 1.274, 95% CI: 1.122-1.447), and 1.300 times (aOR = 1.300, 95% CI: 1.216-1.391) those in the natural conception group, respectively, but the risk of SGA was lower than in the non-IVF group (aOR = 0.774, 95% CI: 0.729-0.821). Conclusion From 2017 to 2022, the characteristics of pregnant women in our hospital changed, and the risk of some adverse neonatal outcomes showed a decreasing trend during this period. Additionally, neonatal birth outcomes among different high-risk groups (women aged 35 or older, multiparous women, and women who conceived with assisted reproductive technology) exhibited distinct characteristics. Keywords: Advanced maternal age, Multiparous women, In vitro fertilization (IVF), Adverse neonatal outcomes
Capacity Management During the Hospital-to-Home Transition Period for Patients With Chronic Heart Failure
Objective Exploring the effects of the hospital-to-home transitional capacity management plan in patients with chronic heart failure. Methods Patients with chronic heart failure who were hospitalized from December 2022 to August 2024 were selected as research subjects and randomly assigned to either a control group or an observation group, with 96 cases in each group. The control group received the conventional nursing plan, while the observation group received the hospital-to-home transitional volume management plan. The main outcome indicator was the rate of achieving dry weight targets two months after discharge. Secondary outcome indicators included self-care ability, and other outcome indicators included 6-minute walking distance and readmission rate. These outcomes were compared between the two groups. Results Two months after discharge, the rate of achieving normal body weight in the observation group was higher than in the control group (P < 0.05), The 6-minute walking distance in the observation group was greater than in the control group (P < 0.05), The scores for self-care maintenance, self-care management, and self-care confidence in the observation group were all higher than those in the control group (P < 0.05), and the readmission rate in the observation group was lower than that in the control group (P < 0.05). Conclusion The hospital-family transitional volume management program enhance the self-capacity management ability of patients with chronic heart failure, stabilize the volume load status, and provide a reference for self-capacity management of patients with chronic heart failure. Keywords: Chronic heart failure, Volume management, Self management, Hospital-family transition period
MENG Guiping, YOU Mei, GUO Zeng, TAO Xiaoyan, CHEN Ju, LI Li
Causal Multiple Mediation Analysis of the Association Between Early and Mid-Pregnancy Body Mass Index Trajectories and Preterm Birth
Objective To investigate the associations between body mass index (BMI) trajectories in early and mid-pregnancy and preterm birth, to examine the mediating effects of gestational diabetes mellitus (GDM) and inflammatory markers, and to provide evidence for early prevention and intervention of preterm birth. Methods A prospective cohort study was conducted and 1221 pregnant women who delivered babies at Chongqing Maternal and Child Health Hospital between 2018 to 2021 were included. Group-based trajectory modeling was used to identify BMI trajectories in early and mid-pregnancy. Logistic regression and causal mediation analyses were performed to evaluate the mediating effects of GDM and inflammatory factors in the associations between BMI trajectories and preterm birth. Results TThree BMI trajectories were identified, and the participants were categorized accordingly into Group 1 (48.98%), Group 2 (38.41%), and Group 3 (12.61%). Group 2 demonstrated a trajectory similar in shape to that of Group 1, with an overall level between those of Group 1 and Group 3. Participants in Group 3 were in the obese range in early pregnancy, with their BMI decreasing slightly along with the progression of pregnancy and stabilizing and then rising slightly in mid-pregnancy. After adjusting for confounders, Group 3 showed higher risks of preterm birth, which were 3.1 times those of Group 1 (odds ratio [OR] = 3.10, 95% CI: 1.59-6.06). Additionally, white blood cell count and monocyte percentage significantly mediated this association, with proportion eliminated of 0.5% and 5.1%, respectively. No mediating effect of GDM was observed. Conclusion Pregnant women with higher BMI during early and mid-pregnancy exhibit a significantly increased risk of preterm birth. White blood cell count and monocyte percentage may serve as key inflammatory mediators linking this association while the mediating effect of GDM is not found. Keywords: Body-mass trajectory, Gestational diabetes mellitus, Inflammation, Premature birth
YANG Tian, CAO Yuheng, ZHOU Wenzheng, XIAO Chenghan, LIU Zhenmi
The Impact of Parents' Autonomous Support on the Self-Identity of Adolescent Patients With Depression
Objective From the perspective of patients' self-identity, this article explores the correlations among coping strategies of adolescent patients with depression, parents' autonomous support, and self-identity, and also examines the mediating role of coping strategies. Methods A total of 240 adolescent patients with depression from the First Hospital of Hebei Medical University were selected between August 2023 and July 2024. Basic information questionnaires, the Simplified Coping Style Questionnaire (SCSQ), the Parental Autonomy Support Scale (PASS), and the Self-Identity Scale (SIS) were used for the survey. Pearson correlation analysis was conducted to examine the relationships among coping styles of adolescent patients with depression, parental autonomy support, and self-identity. The SPSS macro program Process 4.1 was used to analyze the mediating role of coping styles between parental autonomy support and self-identity. Results A total of 240 questionnaires were distributed in this study, and 236 valid questionnaires were collected, resulting in a recovery rate of 98.33%. The mean score for positive coping strategies among 236 adolescent patients with depression was (19.45 ± 2.68) points, while the mean score for negative coping strategies was (18.97 ± 5.04) points. The mean PASS score was (42.73 ± 9.98) points, and the mean SIS score was (48.64 ± 7.73) points. Pearson correlation analysis showed that positive coping strategies were positively correlated with parental autonomous support and self-identity (r = 0.267, 95% CI: 0.154-0.381; r = 0.207, 95% CI: 0.098-0.317). Negative coping strategies were negatively correlated with parental autonomous support and self-identity (r = －0.173, 95% CI: －0.290 to －0.054; r = －0.153, 95% CI: －0.265 to －0.039). Parental autonomous support was positively correlated with self-identity (r = 0.182, 95% CI: 0.052-0.313). The bootstrap method confirmed three mediating paths: Path 1 (parental autonomous support → positive coping → self-identity) had an effect value of 0.070 (95% CI: 0.021-0.162), accounting for 17.68% of the effect; Path 2 (parental autonomous support → negative coping → self-identity) had an effect value of 0.020 (95% CI: 0.005-0.042), accounting for 5.05% of the effect; Path 3 (parental autonomous support → positive coping → negative coping → self-identity) had an effect value of 0.017 (95% CI: 0.005-0.033), accounting for 4.29% of the effect. The 95% confidence intervals did not include 0, indicating that the indirect effects were significant. Conclusion Parental autonomous support can directly affect the self-identity of adolescent patients with depression and can also indirectly influence it through coping strategies. Positive coping strategies mediate the beneficial effect of parental autonomous support on self-identity and play a protective role. Keywords: Depression, Adolescent, Mediating effect
LIU Yanju, LIU Hong, MENG Limin, XIN Bo, YU Ming, LI Yating