Abstract:Objective To identify factors associated with postoperative testicular atrophy and to develop and vali-date a prediction model for testicular atrophy after laparoscopic orchiopexy using LASSO-logistic regression.Methods A total of 457 pediatric patients who underwent laparoscopic orchiopexy between June 2020 and June 2024 were retrospec-tively enrolled.Patients were randomly divided into a training cohort(n=320)and a validation cohort(n=137).In the training cohort,patients were further classified into an atrophy group(n=49)and a non-atrophy group(n=271)ac-cording to postoperative outcomes.Clinical variables were collected.Least absolute shrinkage and selection operator(LASSO)regression was applied for variable selection and dimensionality reduction,followed by multivariate logistic re-gression to identify independent risk factors.A nomogram prediction model was constructed and evaluated using receiver operating characteristic(ROC)curves,calibration curves,Hosmer-Lemeshow goodness-of-fit tests,and decision curve analysis(DCA).Results LASSO-logistic regression identified age,testicular position,preoperative testicular volume ratio,associated anomalies,gestational age,and testicular blood supply as independent predictors of postoperative testicular atrophy.The area under the ROC curve(AUC)was 0.920(95％CI:0.882-0.959)in the training cohort and 0.941(95％CI:0.895-0.986)in the validation cohort.Calibration analysis demonstrated good agreement between pre-dicted and observed outcomes,with C-index values of 0.920(95％CI:0.881-0.959)and 0.909(95％CI:0.851-0.966)in the training and validation cohorts,respectively.The Hosmer-Lemeshow test showed good model fit in both cohorts(training:x2=8.436,P=0.392;validation:x2=2.995,P=0.935).Decision curve analysis indicated that the model provided a favorable net clinical benefit across a wide range of threshold probabilities.Conclusion Age,tes-ticular position,preoperative testicular volume ratio,associated anomalies,gestational age,and testicular blood supply are independent risk factors for testicular atrophy after laparoscopic orchiopexy.The LASSO-logistic regression-based no-mogram demonstrates good predictive performance and clinical utility,and may assist clinicians in perioperative risk strati-fication and decision-making.

Abstract:Objective To evaluate the diagnostic value of coronary computed tomography angiography(CCTA)and CT-derived fractional flow reserve(FFR-CT)for detecting myocardial ischemia in patients with coronary artery dis-ease(CAD).Methods A total of 140 patients with CAD admitted between May 2022 and May 2024 were retrospective-ly enrolled.All patients underwent coronary angiography(CAG),invasive FFR measurement,and CCTA,and FFR-CT values were calculated.Myocardial ischemia was defined as FFR ≤0.80,and patients were divided into ischemia and non-ischemia groups.CCTA plaque characteristics-including calcium score,total plaque volume,calcified plaque vol-ume,plaque burden,remodeling index,lesion length,and high-risk plaque features-along with FFR-CT values were compared between groups.Receiver operating characteristic(ROC)curves were constructed to assess the diagnostic per-formance of CCTA and FFR-CT for myocardial ischemia.Results Compared with the non-ischemia group,the ische-mia group showed significantly higher calcium scores,plaque burden,remodeling index,lesion length,and higher propor-tions of positive remodeling and napkin-ring sign(P＜0.05).FFR and FFR-CT values were significantly lower in the ischemia group(P＜0.05).No significant differences were observed in total plaque volume,calcified plaque volume ratio,low-attenuation plaque,or spotty calcification between groups(P＞0.05).ROC analysis demonstrated that,using inva-sive FFR as the reference standard,FFR-CT exhibited significantly higher sensitivity,specificity,positive predictive val-ue,negative predictive value,and area under the curve compared with CCTA(P＜0.05).Conclusion FFR-CT pro-vides superior diagnostic performance over CCTA alone for identifying myocardial ischemia in patients with coronary artery disease and may serve as a valuable noninvasive tool for clinical ischemia screening.

Abstract:Objective To evaluate the influence of surgical resection extent(gross total resection,subtotal resec-tion,or biopsy)and age stratification on survival in elderly patients with newly diagnosed glioblastoma.Methods A ret-rospective analysis was performed on 89 elderly patients(age ≥ 60 years)who underwent initial surgery and were patho-logically confirmed with glioblastoma at the Department of Neurosurgery,Fourth Hospital of Hebei Medical University,be-tween January 2017 and December 2021.Patients were stratified by age into three groups:60-64 years,65-74 years,and ≥75 years.Survival outcomes were analyzed according to the extent of tumor resection.Results Surgical resection extent was identified as a protective factor for survival.Patients undergoing gross total resection,subtotal resection,or bi-opsy exhibited significant differences in survival(P＜0.05).In the 60-64 and 65-74-year age groups,more exten-sive resection was associated with longer survival(P＜0.05).However,in patients aged ≥75 years,the extent of surgi-cal resection did not significantly affect survival(P＞0.05).Conclusion In elderly patients with newly diagnosed glio-blastoma,survival is closely associated with the extent of tumor resection.Gross total resection improves survival for pa-tients aged 60-74 years,whereas for patients aged 75 years and older,resection extent does not appear to significantly in-fluence survival outcomes.

Abstract:Objective Exploring the anti-inflammatory protective effects of Verbascoside(VB)on a mouse model of Parkinson's Disease(PD).Methods A total of 27 male C57/BL mice were randomly divided into three groups:control,model,and experimental.PD was induced in the model and experimental groups by intraperitoneal injec-tion of 30 mg/kg MPTP.The experimental group additionally received 120 mg/kg VB by oral gavage.After successful modeling,the open field test and pole test were used to assess behavioral changes.Hematoxylin-eosin(HE)and Nissl staining were performed to evaluate neuronal density in the substantia nigra.Immunohistochemistry was used to assess the proportion of TH-positive cells.Immunofluorescence staining was employed to detect fluorescence intensity of TH,IBa1,iNOS,and p-NF-κB P65 positive cells in the substantia nigra.Western blotting was used to detect protein expression levels of TH,IBa1,iNOS,and p-NF-κB P65.Transmission electron microscopy was used to observe mitochondrial morphology in dopaminergic neurons.HE staining was used to evaluate potential hepatotoxicity and nephrotoxicity of VB.Results Compared with the model group,the total distance traveled and central zone distance in the open field test were significantly increased in the experimental group(P＜0.001;P=0.044),and the time to descend in the pole test was significantly reduced(P＜0.001).The experimental group showed significantly more HE-and Nissl-positive neurons in the substantia nigra than the model group(both P＜0.001).Immunohistochemistry showed a higher percentage of brown-stained TH-positive pixels in the experimental group(P＜0.001).Immunofluorescence analysis showed higher TH fluorescence intensity(P=0.010)and lower IBa1,iNOS,and p-NF-κB P65 fluorescence intensity in the experi-mental group compared with the model group(P=0.015,P=0.026,P=0.008,respectively).Western blotting con-firmed higher TH protein expression(P=0.028)and lower relative expression of IBa1,iNOS,and p-NF-κB P65 pro-teins in the experimental group(P=0.016,P=0.010,P=0.004,respectively).Mitochondrial swelling and cristae disruption were alleviated in the experimental group compared to the model group.No statistically significant differences were found in liver and kidney cell counts among the three groups(all P＞0.05).Conclusion VB may exert anti-in-flammatory and neuroprotective effects in PD mice by downregulating the expression of p-NF-κB P65 protein and inhibi-ting NF-κB pathway activation.The dosage used appears to be safe and well-tolerated.

Abstract:Obesity has become a major global public health challenge,increasing both individual health risks and societal healthcare burdens.Currently,outpatient interventions remain the preferred approach for non-surgical manage-ment of obesity.In China,the construction of obesity clinics generally follows the process of establishment,clinical treat-ment,and follow-up,featuring"multidisciplinary team management,""individualized treatment plans,"and"Internet-based follow-up,"with specialized programs designed for children,pregnant women,and the elderly.Internationally,developed countries such as the United Kingdom,the United States,and Australia have established distinctive obesity clinics,introducing strategies including"standardized interventions,""tiered management,"and the"Mediterranean diet model."Developing countries such as India have explored weight management models adapted to their local contexts.These domestic and international experiences provide valuable references for the future development of obesity clinics in China.

Abstract:Objective To investigate the feeding characteristics of high-risk neonates in the neonatal intensive care unit(NICU)and to identify associated influencing factors.Methods A cross-sectional study was conducted using a convenience sampling method.From January to September 2024,141 high-risk neonates admitted to the National Re-gional Children's Medical Center NICU were assessed using the Neonatal Eating Outcome Assessment(NEO)scale.The Wilcoxon signed-rank test,Kruskal-Wallis test,and binary logistic regression were applied to analyze feeding charac-teristics and key influencing factors.Results Among the 141 high-risk neonates,52(36.9％)exhibited feeding prob-lems or difficulties.The total NEO score and all dimension scores were significantly lower in the feeding-difficulty group compared with the normal group.Physiological stability(OR=1.119,95％CI:1.114-1.723),sucking initiation(OR=0.945,95％CI:1.015-2.270),non-nutritive sucking(OR=1.105,95％CI:1.269-1.757),sucking qual-ity(OR=1.508,95％CI:1.048-2.169),behavioral response(OR=2.159,95％CI:1.462-3.190),respiratory control(OR=1.335,95％CI:1.097-1.624),state maintenance(OR=1.231,95％CI:1.075-1.410),and con-sumption(OR=1.728,95％CI:1.056-2.827)were identified as the major influencing factors(P＜0.05).Infants with birth weight ≥2 500 g scored higher in tongue movement,non-nutritive sucking,and sucking burst length compared with those weighing 1 500-2 500 g(P＜0.05),and had higher non-nutritive sucking scores than those＜1 000 g(P＜0.05).Current weight 2 501-4 000 g was associated with higher scores in tongue movement,non-nutritive suck-ing,sucking burst length,and fluid loss compared with 1 600-2 500 g(P＜0.05).Infants with gestational age 34-36 weeks showed higher feeding behavioral response scores than those＜28 weeks.Postmenstrual age(PMA)37-40 weeks was associated with higher scores in tongue movement,suck-swallow-breathe coordination,sucking burst length,suck-ing quality,feeding behavior,and post-feeding observation compared with 33-36 weeks(P＜0.05);PMA＞40 weeks had higher non-nutritive sucking,sucking burst length,sucking quality,swallowing,state maintenance,and consump-tion scores(P＜0.05).Sucking burst length correlated positively with birth weight(r=0.400)and PMA(r=0.450),with no other significant correlations observed.Conclusion High-risk neonates in the NICU with greater birth and cur-rent weights(particularly ≥2 500 g)and more advanced postmenstrual age(especially ≥ 37 weeks)demonstrated better core feeding functions such as tongue movement,non-nutritive sucking,and sucking burst length.Targeted and system-atic interventions should be developed based on these influencing factors to improve feeding outcomes in high-risk neo-nates.

Abstract:Objective To investigate the relationship between serum vitamin D levels,visceral fat area(VFA),and urinary albumin-to-creatinine ratio(UACR)in type 2 diabetes(T2DM)patients with different body weights.Methods A total of 140 hospitalized T2DM patients in the Department of Endocrinology from December 2023 to May 2024 were enrolled.Height,weight,and body mass index(BMI)were measured.Laboratory tests included 25-hydroxyvitamin D3(25-OHD),fasting blood glucose,fasting insulin,HbA1C,total cholesterol,triglycerides,LDL-C,HDL-C,and UACR.Patients were grouped by abdominal VFA(＜100 cm2 vs.≥100 cm2)and by BMI.The relation-ships between BMI,25-OHD,VFA,and UACR were analyzed.Results Patients with VFA ≥100 cm2 had higher BMI and LDL-C compared with those with VFA＜100 cm2(P＜0.05).Serum 25-OHD levels were lower in the VFA ≥100 cm2 group(P＜0.05).Multivariate logistic regression analysis showed that VFA was negatively correlated with 25-OHD and positively correlated with BMI(P＜0.05).Compared with normal-weight patients,overweight/obese T2DM patients had increased VFA and decreased 25-OHD levels,with significant differences between groups(P＜0.05).UACR was negatively correlated with vitamin D levels(P＜0.05).Conclusion In hospitalized overweight/obese T2DM patients,VFA is positively correlated with BMI and independently negatively correlated with 25-OHD.UACR is nega-tively correlated with vitamin D levels.Weight reduction and vitamin D supplementation may effectively improve the prog-nosis of diabetic nephropathy in overweight/obese T2DM patients.

Abstract:Objective To identify risk factors associated with postoperative incision infection following retroper-itoneal laparoscopic partial nephrectomy(RLPN)and to develop an individualized risk prediction model.Methods Clinical data of 200 patients with clear cell renal cell carcinoma who underwent RLPN between February 2019 and August 2024 were retrospectively analyzed.Patients were divided into an infection group(n=40)and a non-infection group(n=160).Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of in-cision infection.A nomogram was constructed using R software,and its discrimination,calibration,and clinical utility were evaluated using receiver operating characteristic(ROC)curves,calibration plots,and decision curve analysis(DCA).An external validation cohort of 142 RLPN patients from another institution was used to verify the model's per-formance.Results Compared with the non-infection group,patients in the infection group had higher tumor complexity scores,elevated leukocyte counts,lower hemoglobin levels,and higher levels of urinary leukocytes,erythrocytes,and bacteria(all P＜0.05).Serum creatinine and urea nitrogen were increased,whereas eGFR was reduced(P＜0.05).CRP and PCT levels were markedly elevated in the infection group(P＜0.05).Operative indicators-including tumor in-vasion,operative time,blood loss,perioperative antibiotic use,and transfusion rates-were also significantly higher,while R0 resection rates were lower(P＜0.05).Multivariate analysis identified hemoglobin,urinary leukocytes,urinary bacteria,urinary erythrocytes,creatinine,PCT,CRP,and operative time as independent predictors.A nomogram incor-porating these factors demonstrated excellent discrimination(C-index=1.000).In the external validation cohort(infec-tion incidence 10.56％),the model achieved a C-statistic of 0.940(95％CI:0.85-1.000),sensitivity of 90.00％,and specificity of 88.00％.Calibration analysis revealed good agreement between predicted and observed risks(Brier score=0.065;calibration slope=0.956).DCA showed that use of the model provided substantial net clinical benefit across a broad range of threshold probabilities.Conclusion A reliable and clinically applicable risk prediction model for postoperative incision infection following RLPN was established and externally validated.The model exhibits strong predic-tive performance and offers valuable support for individualized preoperative risk assessment.

Abstract:Objective To compare the postoperative analgesic effects of liposomal bupivacaine and ropivacaine in patients undergoing open posterior lumbar discectomy.Methods A total of 100 patients who underwent open posterior lumbar discectomy between April 2024 and February 2025 were randomly assigned to the liposomal bupivacaine group(n=50)or the ropivacaine group(n=50).The liposomal bupivacaine group received local incision injection of liposom-al bupivacaine combined with patient-controlled intravenous analgesia(PCIA),while the ropivacaine group received lo-cal incision injection of ropivacaine combined with PCIA.Postoperative analgesic outcomes and opioid consumption were assessed.Results Compared with the ropivacaine group,the liposomal bupivacaine group showed no significant differ-ence in visual analogue scale(VAS)score at 1 h postoperatively,but had significantly lower VAS scores at 6,12,24,48,and 72 h(P＜0.05).The liposomal bupivacaine group had a shorter postoperative hospital stay[(3.91±0.20)days vs.(4.16±0.24)days]and lower opioid-equivalent consumption(82.10±6.12 vs.93.00±9.91),both statisti-cally significant(t=5.565,P＜0.05;t=6.614,P＜0.05).Satisfaction with analgesia was higher in the liposomal bupivacaine group(9.1±0.68 vs.8.7±0.86;t=2.578,P=0.013).No significant differences were observed in hour-ly PCIA activation,time to first ambulation,operative time,intraoperative blood loss,or adverse events(P＞0.05).Conclusion Local incision injection of liposomal bupivacaine provides superior postoperative analgesia and higher patient satisfaction compared with ropivacaine in posterior lumbar discectomy.It shortens hospital stay and reduces postoperative opioid consumption,supporting its broader clinical application.

Abstract:Objective To evaluate the clinical efficacy of upper limb robot-assisted rehabilitation in patients af-ter rotator cuff injury surgery.Methods A total of 60 patients who underwent arthroscopic rotator cuff repair between Ju-ly 2023 and July 2024 were randomly assigned into three groups(n=20 each):conventional rehabilitation group,stand-ard robot group,and individualized robot group.All patients received physiotherapy.The conventional group received 50 minutes of conventional exercise therapy.The standard robot group received 30 minutes of conventional exercise plus 20 minutes of fixed-mode robot training.The individualized robot group received 30 minutes of conventional exercise plus 20 minutes of individualized robot training.Outcomes were evaluated using the Constant-Murley Scale(CMS),Visual Ana-logue Scale(VAS),isokinetic muscle strength testing,and range of motion(ROM).Results After 6 weeks of treat-ment,VAS scores significantly decreased in all groups compared with baseline(P＜0.05),while CMS,ROM,and isoki-netic muscle strength improved significantly(P＜0.05).There was no significant difference in VAS scores among the three groups(P＞0.05).CMS,ROM,and muscle strength values in both robot-assisted groups were significantly high-er than those in the conventional group(P＜0.05),but no significant differences were found between the standard and in-dividualized robot groups(P＞0.05).Conclusion Upper limb robot-assisted rehabilitation combined with conventional therapy can effectively improve daily function,muscle strength,and joint mobility in postoperative rotator cuff injury pa-tients.The additional benefit of individualized robot-assisted programs requires further investigation.

Abstract:Metabolic diseases have become a major global public health challenge,and exercise,as a safe and ef-fective non-pharmacological intervention,has been widely applied in the prevention and treatment of obesity,type 2 dia-betes mellitus(T2DM),and nonalcoholic fatty liver disease(NAFLD),yet the underlying regulatory mechanisms remain incompletely understood.Meteorin-like protein(Metrnl),also known as Subfatin,Cometin,IL-39,or IL-41,is a newly identified secreted protein associated with metabolic regulation that enhances insulin sensitivity,alleviates inflamma-tory responses,and modulates energy homeostasis,thereby playing an important role in preventing and treating obesity,T2DM,and related metabolic disorders.Notably,exercise increases Metrnl expression in metabolic tissues such as skele-tal muscle and adipose tissue.This review summarizes recent domestic and international research on the role of Metrnl in exercise-mediated prevention and treatment of metabolic diseases and analyzes its potential mechanisms of action,provi-ding a theoretical basis for novel molecular targets and interventions in the management of metabolic disorders.

Abstract:Objective To identify key genes regulating colorectal cancer(CRC)sensitivity to 5-fluorouracil(5-Fu)using a CRISPR/Cas9 library and to explore the role of microRNA-181d(miR-181d)in mediating this process.Methods A genome-wide CRISPR/Cas9 knockout screening system was established in Ls174t CRC cells.Bioinformatics analysis identified miR-181 d as a key regulator of 5-Fu sensitivity.Loss-of-function(miR-181 d knockout or inhibitor)and gain-of-function(miR-181 d mimic)approaches were applied to evaluate cell viability and apoptosis following 5-Fu treatment.Dual-luciferase reporter assays and Western blotting were used to confirm cAMP re-sponsive element-binding protein 1(CREB1)as a target of miR-181 d.Protein expression levels of CREB1,JUN,and FOS were further examined.Results CRISPR/Cas9 screening showed enrichment of sgRNAs targeting miR-181 d in 5-Fu-treated cells.Suppression of miR-181 d(knockout or inhibitor)significantly promoted CRC cell survival and re-duced apoptosis upon 5-Fu exposure(P＜0.05).Conversely,miR-181 d overexpression inhibited cell survival and en-hanced apoptosis(P＜0.05).Dual-luciferase and Western blot analyses confirmed CREB1 as a direct target of miR-181 d.Overexpression of CREB1 promoted CRC cell survival,suppressed apoptosis,and upregulated JUN and FOS protein levels(P＜0.05).In contrast,miR-181d overexpression downregulated CREB1 and suppressed JUN/FOS expression(P＜0.05).Conclusion miR-181d enhances the sensitivity of CRC cells to 5-Fu by targeting and downregulating CREB1,thereby inhibiting the JUN/FOS signaling pathway,reducing cell survival,and promoting apoptosis.miR-181 d may represent a promising therapeutic strategy to improve chemotherapeutic efficacy in colorectal cancer.

Abstract:Objective To analyze the clinical efficacy of lower limb exoskeleton robot combined with neuromus-cular electrical stimulation(NMES)in the treatment of lower limb motor dysfunction after brain injury.Methods From June 2023 to June 2024,110 patients with lower limb motor dysfunction after brain injury in our hospital were selected and randomly divided into two groups using the random number table method.The control group(n=55)received NMES treatment,while the experimental group(n=55)received additional lower limb exoskeleton robot therapy on the basis of NMES.Clinical efficacy,Berg Balance Scale(BBS),Barthel Index(BI),Fugl-Meyer Assessment(FMA),6-mi-nute walk test(6MWT),Holden walking function classification,coagulation function indicators,and overall complication rate were compared between the two groups.Results The experimental group showed a significantly higher total clinical effective rate,as well as greater post-treatment BBS,BI,FMA scores,6MWT performance,Holden walking function classification,and fibrinogen(Fib)levels compared with the control group(P＜0.05).After treatment,the experimental group had significantly lower D-dimer(D-D),activated partial thromboplastin time(APTT),prothrombin time(PT),and total complication rate compared with the control group(P＜0.05).Conclusion For patients with lower limb motor dysfunction after brain injury,treatment with lower limb exoskeleton robot combined with NMES can effectively improve self-care ability,balance,walking function,and coagulation function,while reducing the incidence of complications,showing significant clinical benefits.

Abstract:Objective To evaluate twelve obesity-and lipid-related indices,including lipid accumulation product(LAP),body mass index(BMI),visceral adiposity index(VAI),Chinese visceral adiposity index(CVAI),abdominal volume index(AVI),body adiposity index(BAI),body roundness index(BRI),a body shape index(AB-SI),triglyceride-glucose index(TyG),and its combined indices(TyG-BMI,TyG-waist circumference[TyG-WC],TyG-waist-to-height ratio[TyG-WHtR]),for screening and predicting fatty liver,and to identify the most suitable predictive factors.Methods A retrospective study was conducted on 3 213 individuals undergoing routine health check-ups,categorized into fatty liver(n=1 455)and non-fatty liver(n=1 758)groups.Binary logistic regression was used to assess the independent association between each index and fatty liver.Receiver operating characteristic(ROC)curves and Delong tests were applied to compare the predictive performance of these indices.Results In the o-verall population and men,all indices were significant risk factors for fatty liver(P＜0.05).In women,all indices except ABSI were significant(P＜0.05).ROC analysis showed that TyG-WHtR was the optimal predictor for the overall popu-lation(AUC=0.856),women(AUC=0.878),and young men(AUC=0.848).TyG-WC was the best predictor for overall men(AUC=0.839),middle-aged and older men(AUC=0.843 and 0.795),and middle-aged women(AUC=0.834).Delong tests indicated that in the overall population,TyG-WHtR outperformed most single indices(P＜0.05),though no significant differences were observed when compared with LAP,TyG-WC,or TyG-BMI(P＞0.05).In men,TyG-WC outperformed most indices(P＜0.05),with no significant difference versus TyG-BMI and TyG-WHtR.In women,TyG-WHtR outperformed most indices(P＜0.05),with no significant difference versus LAP,CVAI,TyG-WC,or TyG-BMI.Conclusion TyG-WHtR and TyG-WC are highly effective non-invasive predic-tors of fatty liver.Gender-specific application is recommended(TyG-WC for men,TyG-WHtR for women),while LAP can serve as a simple screening tool in primary care settings.

Abstract:Objective To investigate the effects of tenofovir alafenamide(TAF)and entecavir(ETV)on fibrosis markers,liver stiffness,and cytokine expression profiles in patients with hepatitis B virus(HBV)-related cirrhosis,ai-ming to identify the more favorable antiviral drug for treatment-naïve patients.Methods Ninety patients with HBV-related cirrhosis admitted to our hospital between January 2021 and July 2023 were enrolled and divided into a TAF group(n=39)and an ETV group(n=51)according to their antiviral regimen.All patients received compound glycyrrhizin to improve liver function in addition to either ETV or TAF.Continuous treatment and follow-up lasted at least 12 months.Liver function parameters[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)],fibrosis markers[hyaluronic acid(HA),laminin(LN),type Ⅲ procollagen N-terminal peptide(PⅢ-NP),type Ⅳcollagen(Ⅳ-C)],liver stiffness,and serum cytokines[interleukin(IL)-2,IL-4,IL-6,IL-8,IL-10,tumor necrosis factor(TNF)-α]were assessed at baseline and at 3,6,9,and 12 months of treatment.HBV DNA clearance rates and adverse events were also evaluated.Results Both groups showed significant reductions in TBIL,ALT,and AST after 3-12 months of treatment compared with baseline(P＜0.05),with no significant between-group differences at each time point(P＞0.05).Levels of HA,LN,P Ⅲ-NP,Ⅳ-C,liver stiffness,IL-2,IL-6,IL-8,and TNF-α decreased significantly,while IL-4 and IL-10 increased significantly after treatment in both groups(P＜0.05).At 3 and 6 months,reductions in fibrosis markers,liver stiffness,and pro-inflammatory cytokines,as well as increases in anti-inflammatory cytokines,were more pronounced in the TAF group compared with the ETV group(P＜0.05),whereas no significant differences were observed at 9 and 12 months(P＞0.05).HBV DNA clearance rates were consist-ently higher in the TAF group than in the ETV group during follow-up,though the differences were not statistically signif-icant(P＞0.05).The incidence of adverse events was significantly lower in the TAF group(P＜0.05).Conclusion Compared with ETV,TAF leads to more rapid reductions in inflammatory cytokines and fibrosis markers in patients with HBV-related cirrhosis,suggesting that TAF may have greater clinical value in this population.

Abstract:Objective To investigate the clinical characteristics and key prognostic factors associated with differ-ent types of venomous snakebites,and to provide evidence for optimizing clinical management and regional medical re-source allocation.Methods A retrospective analysis was performed on 213 cases of venomous snakebite admitted to the Guangdong-Hong Kong-Macao Snakebite Treatment Center from January 2023 to January 2025.Univariate analyses and multivariate generalized linear models(GLM)were applied to identify predictors of clinical outcomes.Results Cobra en-venomation significantly prolonged hospitalization(median 10 days vs.5 days for Trimeresurus stejnegeri,P=0.01).Male patients exhibited longer leukocyte recovery time(7 vs.6 days,P=0.04).Wound necrosis also extended hospitali-zation(median 8 days,P=0.01).Early antivenom administration(≤6 h)reduced coagulation recovery time by 32％(P=0.005,OR=0.028).Multivariate GLM identified prehospital incision and drainage as an extremely high-risk fac-tor(OR=387.882,P＜0.001),non-closure treatment as an independent predictor of delayed D-dimer recovery(OR=1.351,P=0.006),and severe envenomation markedly increased the risk of complications and prolonged hospital-ization(OR approaching 0,P＜0.001).Conclusion Cobra envenomation,male sex,and wound necrosis significantly prolong the clinical course of venomous snakebite.Early antivenom administration(≤6 h)markedly accelerates coagula-tion recovery and reduces complication risk.Multivariate analysis highlights that non-standard prehospital procedures-especially incision and drainage-pose substantial harm and should be strictly avoided.Clinical management should priori-tize early antivenom therapy and wound-closure treatment in high-risk patients,and regional resource planning should consider snake activity patterns to reduce disability and healthcare burden.

Abstract:Obesity,a global public health crisis,is intricately linked to the development and poor prognosis of breast cancer(BC).This article aims to systematically review the complex relationship between obesity and BC,the evi-dence base and core controversies surrounding current weight management interventions,the dilemmas in research and practice,and to explore emerging trends and future directions in precision weight management.Based on existing epidemi-ological,basic research,and clinical intervention evidence,combined with international guidelines and the latest ad-vances,a comprehensive critical analysis and review were conducted.Obesity significantly increases the risk of BC in postmenopausal women and adversely impacts patient prognosis(e.g.,increasing recurrence and mortality risks,reducing efficacy of endocrine therapy).Mechanisms involve dysregulated endocrine function of adipose tissue,chronic inflamma-tion,insulin resistance,and other pathways.Lifestyle interventions(diet,physical activity,behavior)are the cornerstone of weight management,but long-term adherence and sustained effectiveness pose major challenges.Bariatric surgery demonstrates significant potential for risk reduction and improved prognosis in specific populations,yet its application is limited.Current research faces bottlenecks in translating evidence,insufficient strength of guideline recommendations,and a lack of individualized strategies.Weight management is a critical component in both BC prevention and comprehensive survivorship care.Future research should focus on conducting high-quality,long-term intervention trials,delving dee-per into the mechanisms linking obesity to carcinogenesis and prognosis,and vigorously promoting precision,integrated weight management models based on molecular subtypes,metabolic profiles,and digital technologies to optimize survival outcomes and quality of life for BC patients.

Abstract:Objective To identify risk factors for acute ischemic stroke(AIS)in patients with H-type hyper-tension based on traditional Chinese medicine(TCM)syndromes and to develop a predictive nomogram model.Methods A total of 534 patients with H-type hypertension treated at Xinjiang Uygur Autonomous Region People's Hospital from January 2021 to June 2024 were enrolled and randomly divided into a modeling set(n=374)and a validation set(n=160)in a 7∶3 ratio.Patients in the modeling set were further classified into an AIS group and a non-AIS group.Baseline variables-including age,sex,residence,body mass index,homocysteine(Hcy)level,alcohol consumption,smoking history,hypertension grade,malnutrition,coronary artery disease,diabetes,lack of exercise,and TCM syndromes-were collected.Logistic regression analysis was employed to identify risk factors for AIS.A nomogram model incorporating TCM syndromes was constructed using R software(version 4.2.3)and subsequently validated.Results In the modeling set,63 of 374 patients developed AIS,yielding an incidence of 16.84％.Significant between-group differences were ob-served for Hcy levels,smoking history,hypertension grade,coronary artery disease,diabetes,and TCM syndrome types(P＜0.05),whereas other baseline characteristics showed no significant differences(P＞0.05).Logistic regression identified Hcy,smoking history,hypertension grade,coronary artery disease,diabetes,and the TCM syndrome of phlegm-dampness obstruction as independent risk factors for AIS(P＜0.05).The area under the ROC curve(AUC)of the no-mogram was 0.812(95％CI:0.752-0.872)in the modeling set and 0.888(95％CI:0.821-0.955)in the validation set.Calibration curves demonstrated strong agreement between predicted and observed outcomes.Decision curve analysis indicated that the nomogram offered substantial net clinical benefit across threshold probabilities of 1％-78％in the mod-eling set and 1％-96％in the validation set.Conclusion Elevated Hcy,smoking,higher hypertension grade,coronary artery disease,diabetes,and the TCM phlegm-dampness obstruction syndrome are significant risk factors for AIS in pa-tients with H-type hypertension.The TCM-based nomogram demonstrates strong predictive performance and clinical ap-plicability.

Abstract:3D Slicer,an open-source medical imaging analysis platform,has gained broad adoption across car-diovascular,respiratory,and urological specialties owing to its robust functionality,customizability,and extensive commu-nity support.In recent years,its role in neurosurgery has advanced from an auxiliary tool to a core engine supporting diag-nosis and treatment.With its modular architecture and open-source ecosystem,3D Slicer enables rapid integration of cut-ting-edge technologies-including artificial intelligence(AI),augmented reality(AR),and cloud computing-thereby accelerating the evolution of neurosurgery toward multimodal fusion,intelligent decision-making,and real-time surgical interaction.This review summarizes the current applications of 3D Slicer in neurosurgery,including preoperative planning,intraoperative navigation,postoperative assessment,and medical education,and highlights its significance in precision surgery,personalized treatment,and clinical decision support.Moreover,the advantages and limitations of 3D Slicer are discussed,and future directions are proposed regarding its integration with AI,virtual reality,and multimodal imaging,as well as its potential to reshape neurosurgical workflows and research paradigms.

Abstract:Objective Traditional and non-traditional lipid indices have been shown to closely associate with metabolic associated fatty liver disease(MAFLD).This study aimed to analyze the associations between multiple non-traditional lipid indices and MAFLD,and to compare their diagnostic value.Methods A retrospective study was con-ducted on individuals undergoing health examinations from January 2021 to December 2023.Logistic regression models were used to evaluate the associations of body mass index(BMI),fasting glucose to high-density lipoprotein cholesterol ratio(GHR),GHR-BMI,triglyceride-glucose(TyG)index,TyG-BMI,triglycerides(TG),TG/HDL-C,and TG/HDL-C-BMI with MAFLD.Receiver operating characteristic(ROC)curves were employed to assess the diagnostic accuracy of these obesity-and lipid-related indices and their combinations.Results After adjusting for potential con-founders,multivariate logistic regression showed that all indices were independently associated with MAFLD,with TyG demonstrating the strongest correlation.ROC analysis indicated that GHR-BMI had better predictive performance than TyG and TG alone.The combined model of GHR-BMI and TyG-BMI demonstrated the highest predictive performance(overall population:AUC=0.85,95％CI=0.84-0.86;men:AUC=0.83,95％CI=0.82-0.84;women:AUC=0.88,95％CI=0.87-0.89).Notably,all indices exhibited higher predictive ability in women and younger individuals,with GHR-BMI and GHR-BMI combined with TG/HDL-C-BMI reaching an AUC of 0.91 in young women.Conclusion TyG-BMI,GHR-BMI,and their combined models(e.g.,GHR-BMI+TyG-BMI,GHR-BMI+TG/HDL-C-BMI,TyG-BMI+TG/HDL-C-BMI)are effective predictors of MAFLD,with the combination of GHR-BMI and TyG-BMI showing the greatest predictive potential.