Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease characterized by excess fat accumulation within liver cells. The main causes include obesity, diabetes, and hyperlipidemia. In recent years, NAFLD and other metabolic diseases have become global public health issues. Although some progress has been made in the drug treatment of NAFLD, the efficacy is limited and there are many adverse effects. As a treatment method with high safety and few adverse effects, exercise therapy has good application prospects in the treatment of NAFLD and other metabolic diseases. However, challenges remain in overcoming patients' low exercise compliance and in finding safe and effective exercise therapy drug targets. This article explores the mechanisms and application prospects of exercise therapy in the treatment of NAFLD and other metabolic diseases, summarizes the energy consumption, metabolic pathways, and inter-organ communication induced by exercise, aiming to provide useful references for clinical practitioners.

Tumor neoantigens are antigens encoded by tumor-specific mutated genes, characterized by high specificity, significant exogenous origin, mutation randomness, clonal distribution and correlation with gene mutation. Because these antigens are not negatively screened by the thymus and recognized by T cells as "heterogeneous". They are less easily affected by the immune tolerance mechanism and exhibit strong immunogenicity, making them excellent targets for immunotherapy. Tumor neoantigens can be used to develop therapeutic vaccines, induce and cultivate T cells with stronger targeting capabilities, and are promising for predicting tumor survival prognosis and responses to immune checkpoint blockade therapies. This review summarizes the recent advances in clinical application of tumor neoantigen-based immunotherapy, and prospects for future research directions.

Autophagy is an essential cellular metabolic process that involves clearance of damaged organelles and protein aggregates in cells through lysosomes, providing energy for cells, and maintaining cellular tissue homeostasis. Impaired autophagy is closely related to the pathophysiology of a variety of diseases. In the pathogenesis of atherosclerosis (AS), the dysfunction of autophagy of vascular cells plays a crucial role in the formation and progression of AS. The functional status, survival or death of vascular cells, including endothelial cells, vascular smooth muscle cells and macrophages, can influence the formation and stability of plaques, thereby affecting the progression of AS. This review summarizes the relationship between autophagy and AS, and details the impact of autophagy dysfunction on vascular cell function in the process of AS, as well as the role of mitophagy and inflammasome in the development of AS, aiming to provide novel insights for the prevention and treatment of AS.

Objective To summarize the clinical characteristics of 2 cases of styloid-carotid syndrome(SCS) and review the literature to enhance understanding of the disease. Methods A retrospective analysis was conducted on the clinical manifestations, auxiliary examinations, and diagnosis and treatment of 2 patients with SCS admitted to the Neurology Department of Kaifeng Central Hospital. Additionally, relevant literature was searched through domestic and foreign databases such as PubMed, WOS, Embase, CNKI and VIP. The clinical characteristics of SCS were summarized based on the literature results. Results The 2 cases were diagnosed as transient cerebral ischemia (TIA) combined with SCS through head and neck CT angiography (CTA) and styloid process CT. Apart from the 2 cases treated in our hospital, a total of 11 cases of SCS have been reported in Chinese and English literature up to October 2023. Among the 13 cases, 11 cases (84.6%) started with episodic TIA symptoms, and 11 cases (84.6%) had obvious inducing factors related to specific head position changes. Common clinical manifestations included unilateral limb weakness with or without sensory disturbance (10 cases, 76.9%), slurred speech (7 cases, 53.8%), unilateral limb sensation disorder (4 cases, 30.7%), syncope (3 cases, 23.1%) and amaurosis (2 cases, 15.4%). All 13 cases underwent 64-row head and neck CTA examination, and 6 cases (46.2%) dynamically observed the changes in blood flow velocity through examinations such as transcranial Doppler ultrasound (TCD), cervical vascular ultrasound, and digital subtraction angiography (DSA). All patients were followed up for more than 3 months; and 10 cases (76.9%) achieved clinical cure after treatment, of which 8 cases underwent styloid process shortening surgery; 3 cases (23.1%) achieved clinical symptom improvement after treatment. Conclusions For patients with recurrent TIA and/or cerebral infarction, it is necessary to identify whether there are inducing factors related to specific body position changes. For patients highly suspected of SCS, routine examinations such as styloid process CT and 64-row head and neck CTA should be performed, and if necessary, whole brain DSA, dynamic TCD and/or carotid ultrasound should be conducted to guide the diagnosis and treatment. When non-surgical treatment is ineffective, radical styloid process truncation can be considered as a treatment option.

Objective To explore the incidence and risk factors of perioperative ischemic stroke in non-cardiac and non-neurosurgical surgeries and its correlation with preoperative risk assessment of cerebrovascular events, so as to guide perioperative risk management. Methods A retrospective study was conducted on 40 patients aged ≥18 years who underwent non-cardiac and non-neurosurgical surgeries and experienced perioperative ischemic stroke in the First Affiliated Hospital of Henan University of Science and Technology from January 2015 to January 2022, forming the stroke group. A control group of 160 patients without perioperative ischemic stroke was selected in a 1:4 case-control ratio, matched for gender, age, date of operation, and the surgeon. Clinical data and preoperative risk assessment of cerebrovascular events (including the single or combined application of head CT/MRI, transcranial Doppler ultrasound, carotid ultrasound, and neurological consultation) of the two groups of patients were collected and statistically analyzed. Multiple logistic regression analysis was used to identify risk factors associated with perioperative ischemic stroke. Results The incidence of perioperative ischemic stroke was 0.042%. Multiple logistic analysis results showed that hypertension (OR=7.858, 95%CI 2.175-28.388, P=0.002), hyperlipidemia (OR=4.457, 95%CI 1.320-15.049, P=0.016), renal insufficiency (OR=8.277, 95%CI 1.480-46.282, P=0.016), and intraoperative hypotension (OR=3.862, 95%CI 1.211-12.317, P=0.022) were independent risk factors for perioperative ischemic stroke in non-cardiac and non-neurological surgeries; preoperative cerebrovascular risk assessment (OR=0.130, 95%CI 0.031-0.542, P=0.005) was a protective factor against it. Conclusions The incidence of perioperative ischemic stroke in non-cardiac and non-neurosurgical surgery is low but has a poor prognosis. Hypertension, hyperlipidemia, renal insufficiency, and postoperative hypotension are risk factors for perioperative ischemic stroke, while preoperative cerebrovascular event risk assessment is beneficial to reducing its incidence.

Objective To investigate incidence and modifiable risk factors of postoperative delirium (POD) in patients undergoing cardiac surgery. Methods A prospective observational research method was conducted on 880 cardiac surgery patients admitted to the Department of Cardiovascular Surgery, at the First Affiliated Hospital of Chongqing Medical University from January 2022 to June 2023. Patients' general and clinical data were collected. POD was assessed twice daily from the second day in the ICU using the Confusion Assessment Method of Intensive Care Unit(CAM-ICU) until discharge or transfer from ICU. The patients were divided into two groups based on the presence of POD, and the incidence rate was calculated. Subsequently, a 1:1 propensity score matching (PSM) was applied between the two groups. The differences in general information and clinical characteristics between the two groups of patients before and after PSM were compared. Logistic regression analysis was used to evaluate the modifiable risk factors for POD in patients undergoing cardiac surgery after PSM. Results Of the 880 patients, 278 experienced POD during their stay in the ICU, with an incidence rate of 31.6%. POD occurred between the 2nd and 12th day following ICU admission, with 91.4%(254 patients) experiencing it between the 2nd and 6th day. Univariate analysis identified preoperative factors of POD including gender, age, history of hypertension, history of diabetes, and smoking history; Intraoperative factors were ASA anesthesia grade, operation duration, extracorporeal circulation time, and aortic occlusion time; Postoperative factors included ICU length of stay, mechanical ventilation duration, and VAS score, all of which were statistically significant (P<0.05). After PSM, the distribution of three immutable demographic factors including gender, age, and blood type tended to be consistent among groups (P>0.05). Further multivariate logistic regression analysis showed that surgical time, ICU stay time, mechanical ventilation time, and VAS score were independent modifiable risk factors for POD in cardiac surgery patients (P<0.05), with corresponding OR values of 1.003, 3.117, 1.385, and 1.590, respectively. Conclusions Surgical time, ICU stay time, mechanical ventilation time, and VAS score are independent modifiable risk factors for the occurrence of POD in patients undergoing cardiac surgery. In clinical work, early intervention should be carried out based on the characteristics of the patient's condition and risk factors to further reduce the occurrence of POD.

Objective To investigate the prognosis of patients with hepatitis B virus (HBV)‑related intrahepatic cholangiocarcinoma (ICC) whose HBV DNA was negative before surgical. Methods A retrospective analysis was conducted on the clinical data of 97 ICC patients who underwent surgery resection at the Fifth Medical Center of Chinese PLA General Hospital between October 2010 and January 2017. All patients were divided into HBV-related ICC (HBV-ICC) group (n=62) and non-HBV-related ICC (Con-ICC) group (n=35). HBV-ICC group included 34 patients with HBV core antigen positive (HBcAb⁺) and HBV surface antigen positive (HBsAg⁺), and 28 patients with HBcAb positive and HBsAg negative. Kaplan-Meier analysis was used to plot survival curves and compare the overall survival (OS) and postoperative recurrence-free survival (RFS) among patients in Con-ICC, ICC patients with HBsAg⁺/HBcAb⁺, and ICC patients with HBsAg^-/HBcAb⁺. Univariate and multivariate Cox proportional hazard models were used to analyze independent influencing factor for OS, RFS and early postoperative recurrence among gender, age, pathogenic factor, liver cirrhosis, Child-Pugh grade, carbohydrate antigen 19-9 (CA199), alpha-fetoprotein (AFP), glutamine transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TBil), direct bilirubin (DBil), American Joint Committee on Cancer (AJCC) stage, tumor size, tumor number, tumor differentiation, microvascular invasion, lymph node metastasis, hepatectomy procedure, cholecystectomy, and follow-up treatment. Results Of the 97 patients, the median age was 56 years, and 79 (81.4%) of them were male. The median follow-up time was 92.2 months. Eighty-eight (90.7%) patients presented with tumor recurrence and 73 (75.3%) died. In multivariate analyses, HBV-ICC and CA199>37 kU/L were independent predictors of OS (HR=0.45, 95%CI 0.26-0.77, P=0.003; HR=2.10, 95%CI 1.24-3.57, P=0.006), RFS (HR=0.43, 95%CI 0.27-0.68, P<0.001; HR=1.78, 95%CI 1.12-2.81, P=0.014), and postoperative early recurrence (HR=0.42, 95%CI 0.26-0.70, P=0.001; HR=2.02, 95%CI 1.20-3.39, P=0.008). AJCC stage Ⅲ was an independent risk factor for postoperative RFS (HR=1.81, 95%CI 1.04-3.14, P=0.037). Multiple tumor lesions was an independent risk factor for postoperative RFS and early recurrence (HR=1.73, 95%CI 1.07-2.77, P=0.024; HR=1.90, 95%CI 1.12-3.24, P=0.017). There was no statistically significant difference in OS, RFS, and early recurrence between HBV-ICC patients with HBsAg^-/HBcAb⁺ and Con-ICC patients (P<0.05), whereas HBsAg⁺/HBcAb⁺ was a significant factor affecting postoperative OS (HR=0.32, 95%CI 0.16-0.62, P=0.001), RFS (HR=0.32, 95%CI 0.18-0.55, P<0.001), and early recurrence (HR=0.29, 95%CI 0.15-0.54, P<0.001) in ICC patients. Conclusions The prognosis of HBV-ICC patients with preoperative HBV-DNA^- is better than that of Con-ICC patients. The prognosis of HBV-ICC patients with HBcAb⁺/HBsAg^- is worse than that of HBV-ICC patients with HBcAb⁺/HBsAg⁺, but similar to Con-ICC patients. Therefore, the postoperative stratified management of HBV-ICC patients should be emphasized.

Objective To investigate the relationship between uric acid metabolism and brain injury following cardiopulmonary bypass (CPB) in rats. Methods Healthy male SD rats were randomly assigned to either a Sham group or a CPB group, each comprising 12 rats. The Sham group only underwent vascular puncture and did not perform CPB conversion, while the CPB group was subjected to a CPB procedure with a perfusion duration of 110 min, and the brain tissue was collected post-procedure. Microdialysate was collected 1 h before and after CPB initiation. Apoptosis in the paraventricular nucleus (PVN) was assessed using TUNEL staining, and the expression of Bax mRNA in cerebral cortex and hypothalamus was determined via real-time quantitative PCR. Apoptosis-related protein expression was analyzed by Western blotting. Differentially expressed genes (DEGs) were identified through RNA-sequencing between brain tissues of two groups, and Gene Ontology (GO) analysis was performed to identify enriched pathways among the DEGs. Protein-protein interaction (PPI) networks were constructed using String and Cytoscape softwares to identify key genes. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was employed to analyze differential metabolites in the PVN before and after CPB, with Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis constructed subsequently. Uric acid levels in the hypothalamus was measured using a uric acid assay kit, and the expression of key enzymes of uric acid metabolism [xanthine reductase (XDH), adenosine deaminase (ADA)] and uric acid transporter [organic anion transporter family protein 1 (OAT1), organic anion transporter family protein 3 (OAT3), ATP-binding cassette transporter subfamily G member 2 (ABCG2), glucose transporter 9 (GLUT9)] genes in the hypothalamus was evaluated by real-time quantitative PCR. Results Real-time quantitative PCR revealed a significant upregulation of Bax mRNA in the cerebral cortex and hypothalamus of CPB group compared to Sham group (P<0.05). TUNEL staining indicated a significantly higher apoptosis rate of cells in PVN region in CPB group than that in Sham group (19.0%±5.0% vs. 7.6%±0.8%, P=0.01). Western blotting showed a significantly increased Bcl-2/Bax ratio in the hypothalamus of CPB group compared to Sham group (P<0.05). A total of 2829 DEGs were identified between Sham group and CPB group, with 1374 upregulated genes and 1455 downregulated genes. Uric acid metabolism-related pathways were predominantly enriched in purine nucleoside metabolism and biosynthesis, purine nucleoside monophosphate metabolism, purine nucleoside triphosphate metabolism, purine ribonucleotide metabolism and biosynthesis, purine ribonucleoside monophosphate metabolism and biosynthesis, purine ribonucleoside triphosphate metabolism and biosynthesis, and reaction to purine compounds. Eighteen differential metabolites were identified in the microdialysate, with 13 upregulated and 5 downregulated metabolites. KEGG enrichment analysis identified 7 significantly enriched metabolic pathways, among which the nicotinate and nicotinamide metabolism pathways were closely related to uric acid metabolism. Both RNA-sequencing and LC-MS/MS analysis suggested alterations in uric acid metabolism in CPB groups. Post-CPB, uric acid concentration in the hypothalamic tissue significantly increased (P<0.01), and the expression of XDH and ADA mRNA in the hypothalamus were significantly increased (P<0.05), while the expression of ABCG2, OAT1, OAT3 and GLUT9 mRNA significantly decreased (P<0.001). Conclusion Uric acid metabolism in brain is altered during CPB, which may be an important mechanism for brain injury following CPB.

Objective To explore the clinical characteristics of pediatric patients with cerebral palsy (CP) who also have comorbid epilepsy. Methods A retrospective analysis was conducted on the clinical data of 155 pediatric patients with CP and comorbid epilepsy admitted to the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022. Patients were divided into 4 groups based on CP subtype: spastic diplegia group (n=29), spastic hemiplegia group (n=33), spastic quadriplegia group (n=73), and non-spastic group (n=20). Differences in sex, season of birth, birth weight, gestational age, and the relationship between gestational age and weight were compared among the groups. Additionally, the relationships between perinatal risk factors, MRI classification system (MRICS), gross motor function classification system (GMFCS), and the age of the first onset of epilepsy with respect to CP subtype were analyzed. Results Among the 155 patients, 101 were male and 54 were female. A lower proportion of patients with spastic hemiplegia was observed with a gestational age of 28-31⁺⁶ weeks compared with those with spastic diplegia and spastic quadriplegia (P=0.009). The proportion of patients with a history of asphyxia in spastic hemiplegia group was significantly lower than that in the other 3 groups, and the proportion of patients with hypoxic-ischemic encephalopathy (HIE) in spastic hemiplegia group was significantly lower than in that both spastic quadriplegia group and non-spastic group (P<0.05). The proportion of patients in spastic quadriplegia group who had their first seizure at an age of <1 year was significantly higher than that in spastic diplegic group (P=0.041). The spastic diplegia group exhibited a higher percentage of white matter damage compared with the other 3 groups, and had a lower percentage of gray matter damage compared with both spastic hemiplegic group and non-spastic group (P=0.001). The proportion of patients with GMFCS levels Ⅳ－Ⅴ in spastic quadriplegia group was higher than those in the other 3 groups (P<0.001), and the proportion of patients with levels Ⅰ－Ⅲ in spastic hemiplegia group was significantly higher than those in spastic quadriplegia group and non-spastic group (P<0.001). Conclusion Significant differences were observed among pediatric patients with different subtypes of CP and comorbid epilepsy in factors such as gestational age, history of asphyxia, HIE history, age of first seizure, MRICS classification and GMFCS levels.

Objective To identify the risk factors for postoperative delayed weaning in patients with intracerebral hemorrhage and to establish a predictive model. Methods A retrospective study was conducted on 207 patients who underwent surgery for intracerebral hemorrhage at the intensive care unit (ICU) of Peking University People's Hospital from October 2014 to October 2021. Utilizing the 2007 European Respiratory Society consensus criteria, patients were divided into delayed weaning group (n=66) and non-delayed weaning group (n=141). The demographic and operation-related conditions of the two groups were compared. Multiple logistic regression analysis was employed to identify the risk factors for delayed weaning, and a risk assessment nomogram was constructed and validated. Results Compared with the non-delayed weaning group, the delayed weaning group exhibited a significantly higher proportion of comorbid cardiovascular and cerebrovascular diseases, a lower Glasgow coma scale (GCS) score on admission, a greater incidence of preoperative brain herniation, a higher proportion of patients undergoing emergency surgeries and decompression craniotomies, and higher postoperative APACHE Ⅱ score, GCS score, incidence of atelectasis, weaning failure rate and mortality rate, and longer ICU stay and hospital stay (P<0.05). Multiple logistic regression analysis indicated that emergency surgery, low postoperative oxygenation index, low postoperative score of highest GCS before weaning, and incidence of atelectasis were independent risk factors for postoperative delayed weaning (P<0.05). A nomogram predictive model was established using these four predictors, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.855(95%CI 0.804-0.907), and the Hosmer-Lemeshow test showed good model fit (P=0.659). Conclusions Postoperative delayed weaning is associated with extended durations of mechanical ventilation, ICU stay, and hospital stay, as well as an increased risk of weaning failure and in-hospital mortality rate. The nomogram model provides valuable insights for the early recognition of patients at high risk for postoperative delayed weaning, thereby facilitating timely adjustment in ventilation management strategies.