中南大学学报(医学版)最新文献

Pneumothorax during pediatric laparoscopic surgery is a potentially fatal complication that may not be promptly recognized. It can occur due to congenital anatomical abnormalities, pre-existing pulmonary disease, or operative factors during laparoscopy. Clinical presentation may range from asymptomatic to acute respiratory distress, pleuritic chest pain, and even life-threatening circulatory collapse. Here, we report a case of sudden intraoperative pneumothorax accompanied by extensive subcutaneous emphysema of the neck and chest wall during laparoscopic high ligation of the hernial sac in a child. The child presented with a reducible left lower abdominal mass and mild pain 3 days prior but did not seek medical attention. Symptoms worsened 1 day prior to admission, with difficulty reducing the mass. On April 8, 2021, the patient was admitted to the Department of Anesthesiology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine of Central South University, with a diagnosis of "left inguinal hernia." On the second day of hospitalization, laparoscopic high ligation of the left inguinal hernia sac was performed under general anesthesia. During the procedure, the patient developed a sudden increase in airway pressure, marked hemodynamic fluctuations, crepitus in the neck and right anterior chest regions, and significantly diminished breath sounds in the right lung. Emergent bedside chest X-ray confirmed a right-sided pneumothorax. Immediate intervention including thoracic needle decompression, closed thoracic drainage, the lung re-expansion was performed. The patient was discharged on the 7th postoperative day with full recovery. This case highlights the need for clinicians to remain vigilant for iatrogenic pneumothorax during pediatric laparoscopic surgery. Close intraoperative monitoring of vital signs is crucial for early detection, recognition, and timely management of pneumothorax to ensure patient safety during minimally invasive procedures.

During long-duration manned space missions, the complex and extreme space environment exerts significant impacts on astronauts' physiological, psychological, and cognitive functions, thereby posing direct risks to mission safety and operational efficiency. As a key bridge between the brain and external devices, brain-computer interface (BCI) technology enables precise acquisition and interpretation of neural signals, offering a novel paradigm for human-machine collaboration in manned spaceflight. Non-invasive BCI technology shows broad application prospects across astronaut selection, mission training, in-orbit task execution, and post-mission rehabilitation. During mission preparation, multimodal signal assessment and neurofeedback training based on BCI can effectively enhance cognitive performance and psychological resilience. During mission execution, BCI can provide real-time monitoring of physiological and psychological states and enable intention-based device control, thereby improving operational efficiency and safety. In the post-mission rehabilitation phase, non-invasive BCI combined with neuromodulation may improve emotional and cognitive functions, support motor and cognitive recovery, and contribute to long-term health management. However, the application of BCI in space still faces challenges, including insufficient signal robustness, limited system adaptability, and suboptimal data processing efficiency. Looking forward, integrating multimodal physiological sensors with deep learning algorithms to achieve accurate monitoring and individualized intervention, and combining BCI with virtual reality and robotics to develop intelligent human-machine collaboration models, will provide more efficient support for space missions.

Digital cognitive behavioral therapy (DCBT) is an online form of cognitive behavioral therapy delivered through digital means. It utilizes interactive online, electronic, mobile, and internet-based media, offering treatment through simple operational procedures and highly structured, interactive formats such as animations, videos, audio, and text. DCBT has become an important tool for adolescent psychological intervention due to its high accessibility, low treatment cost, strong privacy protection, and efficient data collection capacity. Several Western countries have achieved significant progress in addressing adolescent mental health problems, particularly in the design and implementation of DCBT intervention programs. DCBT holds promising feasibility and application value in interventions for adolescent depression, anxiety, and post-traumatic stress disorder. However, limitations remain, including small sample sizes, heterogeneity in intervention protocols, short follow-up durations, and constraints in adherence management. Future research in China should include more high-quality studies with long-term follow-up, as well as improvements in the integration of technologies and therapeutic protocols, to promote the standardized and evidence-based application of DCBT in adolescent mental health services.

Objectives: Atypical low back and leg pain represents a diagnostic and therapeutic challenge in spinal-related disorders. This study aims to explore the underlying causes of atypical low back and leg pain in patients whose imaging findings do not correspond to clinical symptoms and signs, and to evaluate the accuracy of preoperative diagnosis methods and the effectiveness of minimally invasive surgical treatment.

Methods: A retrospective analysis was conducted on the clinical data of 174 patients with atypical low back and leg pain, characterized by inconsistencies between symptoms, physical signs, and imaging findings, who were treated in the Department of Spine Surgery and Orthopaedics of Xiangya Hospital between May 2016 and May 2023. Comprehensive imaging evaluation, literature review, selective nerve root block, and discography were utilized preoperatively to achieve precise diagnosis and segment localization. Patients underwent spinal endoscopic discectomy. Paired-sample t-tests were used to compare Visual Analogue Scale (VAS) pain scores and Oswestry disability index (ODI) scores before surgery, at 1 month postoperatively, and at final follow-up.

Results: The mean age of the 174 patients was (47.2±7.9) years; 76 were male and 98 female. The cohort included 29 patients with discordance between the side of lumbar disc herniation on imaging and symptomatic side, 46 with imaging severity inconsistent with symptom severity, 23 with mismatch between imaging lesion level and neurologic localization signs, and 76 with multilevel lumbar degeneration complicating localization. The follow-up duration ranged from 4 to 28 (13.3±6.7) months. Paired-sample t-test results showed significant improvements in VAS pain scores and ODI at 1 month postoperatively and at final follow-up compared with baseline (P<0.001).

Conclusions: Management of atypical low back and leg pain caused by lumbar degenerative disease requires an integrated physical signs, and imaging findings. Employing multiple methods for preoperative precision diagnosis and localization is essential to achieve optimal surgical outcomes.

Polygonatum polysaccharides are the major active components of the traditional Chinese medicinal herb Polygonatum. They exhibit marked structural heterogeneity with diverse glycan types and possess a broad spectrum of biological activities, including anti-inflammatory, immunomodulatory, antioxidant, and glucose-lipid metabolic regulatory effects. These properties have made them a research hotspot in the fields of medicine and health. Modern pharmacological studies have shown that Polygonatum polysaccharides can modulate multiple biological targets by regulating several signaling pathways, such as nuclear factor kappa-B (NF-κB), mitogen-activated protein kinase (MAPK), and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt). Through these pathways, they influence inflammatory cytokine release, immune cell activation, oxidative stress responses, and glucose-lipid metabolism, thereby exerting synergistic multi-target and multi-pathway effects. This enables their promising application in the prevention and treatment of inflammatory diseases, metabolic disorders, cancers, and other conditions. Although numerous in vivo and in vitro studies have validated the wide-ranging biological activities of Polygonatum polysaccharides, challenges remain in their clinical translation. Future research should focus on the precise elucidation of structure-activity relationships, characterization of metabolic processes in vivo, and acquisition of rigorous evidence from clinical research to support the translation of Polygonatum polysaccharides from basic research to clinical application.

Objectives: Gut microbiota (GM) and blood metabolites are associated with the development of urticaria, yet their specific causal relationships in East Asian populations remain unclear. This study aims to elucidate the causal and mediating relationships among GM, blood metabolites, and urticaria in East Asians using Mendelian randomization (MR) analysis.

Methods: Summary-level statistics for 500 GM taxa, 112 blood metabolites, and urticaria were obtained from publicly available Genome-Wide Association Studies (GWAS) datasets. Bidirectional MR analyses were performed to examine causal associations among the GM, blood metabolites, and urticaria. The inverse variance weighted (IVW) method served as the primary analytical approach, supplemented by MR-Egger, weighted median, simple mode, and weighted mode methods. Sensitivity analyses included heterogeneity tests, horizontal pleiotropy assessments, and leave-one-out analyses. Mediation analysis was conducted to evaluate the potential mediating effects of blood metabolites on the causal pathways between GM and urticaria.

Results: MR analyses identified 12 GM taxa exhibiting significant causal effects on urticaria susceptibility. Nine taxa, such as MF0017_galactose_degradation (OR=1.461, 95% CI 1.098 to 1.944, P=0.009), were associated with increased urticaria risk. Three taxa, such as MF0001_arabinoxylan_degradation (OR=0.846, 95% CI 0.737 to 0.973, P=0.019), showed protective effects with increased abundance. Additionally, 6 blood metabolites demonstrated causal associations with urticaria. Notably, the risk of developing urticaria increases with rising fasting plasma glucose (FPG) levels (OR=1.971, 95% CI 1.089 to 3.567, P=0.025). Mediation analysis further demonstrated that FPG partially mediated the protective effect of MF0001_arabinoxylan_degradation on urticaria, accounting for 11.30% of the total effect.

Conclusions: This study has delineated specific GM taxa and blood metabolites that hold causal relevance to urticaria in East Asian populations. Notably, arabinogalactan degradation potentially mitigates urticaria risk via reducing FPG concentrations, offering genetic evidence to support therapeutic strategies targeting GM modulation and glucose regulation.

Objectives: Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and young adults with mood disorders. This study aims examine the occurrence and motivation of NSSI behavior in real-life contexts, as well as the dynamic characteristics of associated emotional changes.

Methods: An observational study was conducted among 135 adolescents and young adults with a history of NSSI urges and/or behaviors. Participants completed a 14-day ecological momentary assessment (EMA), with 3 random assessments per day capturing NSSI behavior, environmental factors, and mood states through a WeChat-based EMA mini-program, yielding a total of 3 976 assessments. According to whether NSSI behavior occurred during the EMA monitoring period, the participants were divided into the NSSI behavior (NSSI+) group and the non-NSSI behavior (NSSI-) group. Linear mixed-effects models were used to analyze trajectories of emotional change.

Results: A total of 31.9% of participants engaged in at least 1 episode of NSSI during the study period. Among NSSI behaviors, cutting was the most common (56.8%), followed by biting (15.2%). Regarding settings, most (68.6%) behaviors occurred at home, primarily during rest or inactivity (38.1%), and 44.9% of behaviors occurred when alone. Approximately 74.6% of behaviors followed non-interpersonal life events. The primary motivation was self-induced negative reinforcement. The NSSI group had a significantly younger age of first self-injury than the non-NSSI group (14.0 years vs 16.0 years, P<0.001). Linear mixed-effects analyses revealed that prior to NSSI episodes, negative affect increased significantly (P<0.05), while positive affect decreased significantly (P<0.05). Following NSSI, negative affect gradually declined, and positive affect progressively rebounded. The overall emotional trajectory resembled a quadratic curve.

Conclusions: NSSI behavior is closely associated with fluctuations in negative affect, and the accumulation of negative emotions may serve as a critical precursor to NSSI. Emotion regulation is the primary motivation for engaging in NSSI, suggesting that interventions targeting emotional processes may help reduce the occurrence of NSSI.

Chronic urticaria (CU) is a persistent immune-mediated skin disease with an incompletely understood pathogenesis. As the largest micro-ecosystem in the human body, the gut microbiota participates in complex metabolic processes and produces a wide range of metabolites. The gut microbiota-metabolism axis plays a crucial role in the onset and progression of CU. Patients with CU commonly exhibit gut dysbiosis, characterized by a reduction in beneficial bacteria and an increase in opportunistic pathogens, accompanied by alterations in key metabolites. These changes may disrupt the intestinal barrier and modulate the function of immune cells such as mast cells and T cells, thereby triggering or aggravating distal cutaneous inflammation and contributing to CU pathophysiology. Certain bacterial taxa and metabolites hold promise as potential biomarkers for CU diagnosis, therapeutic response, and prognosis, while interventions targeting gut microbiota have demonstrated potential in ameliorating CU symptoms. Elucidating the characteristics and mechanistic roles of gut microbiota and metabolism in CU could provide a theoretical basis for developing novel individualized diagnostic and therapeutic strategies.