Abstract:Objective To observe the clinical efficacy of Sini powder combined with Guizhi Gancao Longgu Muli decoction in the treatment of polycystic ovary syndrome(PCOS)accompanied by circadian rhythm disorder.Methods A total of 102 patients diagnosed with PCOS and comorbid circadian rhythm disorder,who received treatment at Shanxi Bethune Hospital from March 2023 to March 2025,were randomly assigned to either an observation group or a control group using a random number table,with 51 cases in each group.The control group received Diane-35 along with lifestyle intervention,whereas the observation group was additionally treated with modified Sini powder combined with Guizhi Gancao Longgu Muli decoction.Both groups underwent treatment for three consecutive menstrual cycles.The clinical efficacy was compared between the two groups.Moreover,changes in traditional Chinese medicine syndrome scores,endocrine hormones,glucose and lipid metabolism indices,sleep quality,and circadian rhythm indicators were evaluated both before and after the treatment.Adverse reactions were also documented.Results The total effective rate in the observation group(96.08%)was signifi-cantly higher than that in the control group(80.39%)(P<0.05).After treatment,the observation group showed lower scores of Traditional Chinese Medicine(TCM)syndromes,luteinizing hormone(LH),LH/follicle-stimulating hormone(FSH)ratio,testosterone(T),anti-Müllerian hormone(AMH),fasting blood glucose(FBG),fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),triglyceride(TG),total cholesterol(TC),cortisol(COR),and Pittsburgh Sleep Quality Index(PSQI)scores compared to the control group(P<0.05).In contrast,the levels of follicle-stimulating hormone(FSH)and melatonin(MT)were higher in the observation group than in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the observation group(3.92%)and the control group(5.88%)(P>0.05).Conclusion Sini powder combined with Guizhi Gancao Longgu Muli decoction can effectively regulate sex hormone disorders,improve insulin resistance and abnormal lipid metabolism,and restore the normal sleep-wake rhythm.

Abstract:Breast cancer stands as one of the most prevalent malignant tumors among women globally.Chemo-therapy,being a crucial element in breast cancer treatment,is frequently linked to diverse side-effects,including alopecia and hand-foot syndrome.These adverse reactions can significantly undermine patients'psychological health and quality of life.In response to this issue,international research has indicated that cooling therapy can effectively decrease the incidence of alopecia;however,16%to 84%of patients still encounter hair loss.Clinical practice has proven that combining traditional Chinese medicine with chemotherapy in breast cancer treatment can further reduce the incidence of alopecia and hand-foot syndrome,relieve patient discomfort,improve the quality of life,and offer chemosensitizing and efficacy-enhancing effects.Nevertheless,there is a deficiency of standardized protocols in prac-tical applications.To further standardize and optimize clinical practice,a multidisciplinary expert panel consisting of breast oncology specialists,oncological traditional Chinese medicine experts,and nursing science professionals was assembled.After multiple rounds of deliberation and revision,this consensus document was finally formulated.This consensus standardizes Integrative Medicine Cooling Therapy Management from multiple perspectives,such as scope,terminology and definitions,theoretical bases,implementation procedures,characteristic TCM therapies,and efficacy assessment.It especially emphasizes the implementation procedures during chemotherapy and characteristic TCM treatment methods.The document puts forward seven evidence-based recommendations to offer standardized guidance for clinical practice.

Abstract:Objective To identify prognostic factors in children with severe Mycoplasma pneumoniae pneumonia(SMPP)using lung ultrasound and clinical indicators,and to construct and evaluate a nomogram-based predictive model.Methods A total of 527 children with SMPP treated at Bijie Hospital of Zhejiang Provincial People's Hospital between January 2021 and December 2024 were enrolled and randomly allocated into a training set(n=368)and a testing set(n=159)in a 7∶3 ratio.The training set was categorized into good prognosis group(n=315)and poor prognosis group(n=53)based on the children's post-treatment conditions.Univariate and multivariate logistic regression analyses were performed to assess the correlation between patients'lung ultrasound and clinical indicators;receiver operating characteristic(ROC),calibration curve,and decision curve analysis(DCA)were used to evaluate the constructed nomogram predictive model.Results The poor prognosis group had a longer duration of fever at admission,higher proportion of high fever,higher white blood cell(WBC)count,higher absolute neutrophil count,D-dimer,higher lactate dehydrogenase(LDH),larger consolidation size to body surface area ratio(consolidation size/BSA),liquid-bronchogram sign,and higher proportion of pleural effusion compared to the good prognosis group(P<0.05),while only the air-bronchogram sign was lower in the poor prog-nosis group(P<0.05);the duration of fever during treatment,absolute neutrophil count,DD dimer,LDH levels,and pleural effusion were independent risk factors for poor prognosis in SMPP children.The area under the curve(AUC)for the training set was 0.926(95%CI:0.870-0.982),and for the test set was 0.957(95%CI:0.882-1.000).Calibration curve and DCA curve assessment of the nomogram predictive model showed it had high consis-tency and clinical application value.Conclusion The duration of fever during treatment,absolute neutrophil count,DD dimer,LDH levels,and pleural effusion are independent risk factors for poor prognosis in children with SMPP,and the constructed nomogram predictive model has good predictive performance.

Abstract:Objective To investigate the efficacy of Diyu Shengbai Tablets in combination with granulocyte colony-stimulating factor(G-CSF)in treating neutropenia after chemotherapy in children with acute lymphoblastic leukemia(ALL).Methods This study encompassed 148 children diagnosed with ALL who developed chemotherapy-induced neutropenia.These children were randomly allocated to either receiveG-CSF alone(control group,n=74)or G-CSF in combination with Diyu Shengbai Tablets(observation group,n=74).The dosage and duration of recombinant human granulocyte colony-stimulating factor(rhG-CSF)were meticulously recorded.The counts of white blood cells(WBC),neutrophils(NE),red blood cells(RBC),and platelets(PLT)in the peripheral blood were precisely detected prior to treatment and on the 4th,8th,14th,and 21st days subsequent to treatment.A comparison was made between the two groups regarding alanine aminotransferase(ALT),aspartate aminotransfer-ase(AST),creatinine(Cre),and blood urea nitrogen(Urea)levels before and after treatment.The occurrence of adverse reactions such as bone pain,fever,and rash was also recorded.Results In comparison with the control group,the observation group needed a lower dosage and a shorter duration of rhG-CSF.Moreover,on days 4,8,14,and 21,they exhibited significantly higher counts of WBC,NE,RBC,and PLT,along with lower levels of ALT,AST,Cre,and urea.This indicates enhanced efficacy and an improved safety profile(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Diyu Shengbai Tablets in combination with G-CSF can more rapidly elevate the level of peripheral blood granulocytes during the treatment of chemotherapy-induced neutropenia in children with ALL,and it does not place an additional burden on liver and kidney functions.

Abstract:Objective To investigate the efficacy of continuous blood purification(CBP)combined with imipenem/cilastatin in patients with septic shock complicated by acute kidney injury(AKI).Methods A total of 80 patients with septic shock and AKI admitted to our hospital from January 2022 to June 2024 were enrolled.According to treatment methods,they were divided into the CBP group(n=37),receiving CBP therapy,and the combination group(n=43),receiving CBP plus imipenem/cilastatin therapy.Organ function,hemodynamics,inflammatory markers,prognostic indicators,and survival outcomes were compared between the two groups.Results After treatment,arterial oxygen partial pressure/fraction of inspired oxygen(PaO₂/FiO₂),platelet count(PLT),and mean arterial pressure(MAP)were higher in the combination group than in the CBP group,while serum creatinine(SCr),norepinephrine(NE)dosage,heart rate(HR),lactate(Lac),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score were lower(P<0.05).White blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interleukin-10(IL-10)were also significantly lower in the combination group(P<0.05).The combined treatment group had a shorter ICU length of stay compared to the CBP group,and a higher 28-day renal function recovery rate(P<0.05).However,no statistically significant differences were found in the 7-day or 28-day mortality rates between the two groups(P>0.05).Log-rank analysis revealed no significant difference in the 28-day cumulative survival rate between the groups(P>0.05).Conclusion The combination of CBP and imipenem/cilastatin for septic shock patients with AKI can improve inflammatory response,stabilize hemodynamics,promote renal recovery,and reduce ICU stay.

Abstract:Objective To evaluate the predictive capacity of the baseline serum HBV RNA level for HBeAg seroconversion in patients with chronic hepatitis B(CHB)undergoing nucleos(t)ide analogues(NAs)treatment.Methods A total of 317 HBeAg-positive CHB patients who received nucleos(t)ide analogs(NAs)treatment in the Department of Hepatology,Kunming Third People's Hospital from July 2023 to September 2024 were recruited as the study subjects.These patients were categorized into the seroconversion group and the non-seroconversion group according to the occurrence of HBeAg seroconversion at week 48 of treatment.A retrospective analysis was carried out on the baseline serum HBV RNA levels and other relevant indicators.Variables that showed statistical significance in the univariate analysis were subjected to a multicollinearity test,followed by a multivariate Logistic regression analysis to identify the independent influencing factors for HBeAg seroconversion.The"rms"package in R software was utilized to construct a nomogram risk prediction model.Bootstrap sampling(B=1 000)was applied to generate the calibration curve of the model.The Hosmer-Lemeshow test was adopted to assess the model's goodness-of-fit,and the receiver operating characteristic(ROC)curve was plotted with the calculation of the area under the curve(AUC).Results At the 48th week of NA treatment,23.97%(76/317)of the 317 HBeAg-positive CHB patients achieved HBeAg seroconversion.Baseline HBV RNA(odds ratio[OR]=12.630,95%confidence interval[CI]:6.096～26.167,P<0.001),HBcAb(OR=0.110,95%CI:0.041～0.298,P<0.001),AFP(OR=1.231,95%CI:1.072～1.413,P=0.003),and GGT(OR=1.010,95%CI:1.001～1.019,P=0.034)were identified as independent predictors of HBeAg seroconversion.A nomogram prediction model was developed based on these factors.The calibration curve generated through Bootstrap sampling(B=1 000)demonstrated a high level of consistency between the predicted probability and the actual observed probability of HBeAg seroconversion.The Hosmer-Lemeshow goodness-of-fit test(χ2=4.939,P=0.764)further verified that the model had good calibration.The area under the curve(AUC)of the combined predictors was 0.894.Among them,the AUC of HBV RNA was 0.786,with a sensitivity of 0.913 and a specificity of 0.645.Conclusion The baseline serum HBV RNA level holds a specific predictive value for HBeAg seroconversion in chronic hepatitis B(CHB)patients undergoing nucleoside analogues(NAs)treatment.

Abstract:Objective To explore the level of the serum chemerin/visfatin ratio in patients with polycystic ovary syndrome(PCOS)and its diagnostic value for insulin resistance(IR).Methods 264 PCOS patients admit-ted to the hospital from January 2022 to December 2024 were selected as the subjects.According to the steady-state model evaluation of insulin resistance index(HOMA-IR),the patients were divided into non IR group(HOMA-IR<2.69)and IR group(HOMA-IR≥2.69).Clinical data,glucose-lipid metabolism parameters,sex hormone levels,and serum Chemerin and Visfatin levels were compared between the two patient groups.Multivariate logistic regression identified the risk factors for insulin resistance in PCOS patients.Receiver Operating Curve(ROC)is used to evaluate the value of relevant indicators for the occurrence of IR in PCOS patients.Results A total of 152 patients developed IR in the hospital,with a detection rate of 57.58% in IR samples.According to HOMA-IR,patients were divided into non IR group(n=112)and IR group(n=152);The body mass index(BMI),alanine aminotransferase(ALT),serum creatinine(Scr),C-reactive protein(CRP),fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),luteinizing hormone(LH),and chemerin/visfatin levels in the IR group were higher than those in the non IR group,while follicle stimulating hormone(FSH)levels were lower than those in the non IR group(P<0.05);logistic multiple regression analysis found that FBG,LH,chemerin/visfatin are risk factors for IR in PCOS patients,while FSH is a protective factor(P<0.05);ROC curve analysis showed that the AUC value of combined detection of FBG,FSH,LH,chemerin/visfatin in evaluating the occurrence of IR in PCOS patients was higher than that of single detection(Z=3.923,4.768,4.193,3.427,P<0.05).Conclusion chemerin/visfatin is closely related to the occurrence of insulin resistance in PCOS patients,and the combined use of FBG,FSH,and LH has high value in evaluating the occurrence of insulin resistance in PCOS patients.

Abstract:Stellate ganglion block(SGB)is a neuromodulation technique that temporarily blocks sympathetic nerve conduction in the cervical-thoracic region using local anesthetic drugs.In recent years,this technique has garnered significant attention in the field of insomnia treatment and has demonstrated notable clinical efficacy.Insomnia is a common sleep disorder closely related to overactivity of the sympathetic nervous system,often manifested by core symptoms such as difficulty falling asleep,sleep maintenance disorders,early awakening,and fatigue after awakening.SGB precisely suppresses abnormally heightened sympathetic nervous system excitability,exerting synergistic effects through multiple pathways including regulating neurotransmitter balance,inhibiting inflammatory responses,and modulating neuroendocrine functions.This restores normal sleep architecture and comprehensively enhances sleep quality.Additionally,this therapy helps patients gradually reduce their dependence on sedative medications such as benzodiazepines,thereby lowering the risks of tolerance and adverse reactions associated with long-term medication use.This review systematically summarizes the current clinical application of SGB in primary and secondary insomnia,deeply analyzes its mechanisms of action,and evaluates its safety,providing references for further refining individualized treatment plans,exploring mechanism targets,and promoting standardized clinical application.

Abstract:Objective To explore the clinical curative effect of different timings of closed reduction and percutaneous pinning(CRPP)and its influences on complications in children with humeral supracondylar fractures.Methods In this retrospective study,a total of 100 children with humeral supracondylar fractures who underwent CRPP at the Affiliated Hospital of Xuzhou Medical University between February 2022 and February 2025 were enrolled.Based on the interval from injury to surgery,the children were divided into an early-treatment group(interval≤12 hours,n=58)and a delayed-treatment group(interval>12 hours,n=42).The perioperative indexes and fracture healing time were compared between the two groups.Three months after surgery,the elbow range of motion on the affected side,Baumann angle,and carrying angle were evaluated.The clinical curative effect was assessed using the Flynn elbow scoring standard,and the incidence of complications was recorded.Results The operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency in the early group were all significantly shorter or less than those in the delayed group(P<0.05).However,there was no significant difference in the length of hospital stay or fracture healing time between the two groups(P>0.05).Three months after surgery,there was no significant difference in the elbow range of motion,Baumann angle,or carrying angle between the two groups(P>0.05).The good-outcome rate of the early group was significantly higher than that of the delayed group(94.83%vs.80.95%,P<0.05).The incidence of cubitus varus and the total incidence of complications in the early group were significantly lower than those in the delayed group(P<0.05).The results of univariate logistic regression analysis indicated that surgical timing,operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency were all associated with the curative effect in children with humeral supra-condylar fractures following CRPP(P<0.05).Multivariate logistic regression analysis demonstrated that early surgery was an independent protective factor for a good curative effect in children with humeral supracondylar fractures after CRPP(P<0.05).Conclusion Compared with delayed surgery,early CRPP(interval from injury to surgery≤12 h)can significantly shorten the operation time,reduce the intraoperative blood loss,increase the good rate of elbow function,and reduce the risk of complications in children with humeral supracondylar fractures.

Abstract:Objective To investigate the alterations in the serum levels of neurogulin-1(NRG-1),chitinase 1(CHIT1),gap connexin 43(Cx43),and methyl-CpG-binding protein 2(MECP2)in patients with acute cerebral infarction(ACI),as well as their associations with the severity and prognosis of the disease.Methods A total of 355 patients with ACI admitted to Wuhan First Hospital from September 2023 to November 2024 were selected as the case group.These patients were divided into the severe group(49 cases),the moderate group(126 cases),and the mild group(180 cases)according to their condition.All patients underwent ultra-early intravenous throm-bolysis upon admission.After treatment,they were observed for 3 months and then divided into the poor-prognosis group(81 cases)and the good-prognosis group(274 cases)based on the prognosis.Additionally,355 healthy individuals who underwent physical examinations at Wuhan First Hospital during the same period were selected as the control group at a ratio of 1∶1.The basic data and serum levels of NRG-1,CHIT1,Cx43,and MECP2 were compared among groups.Multivariate Logistic regression analysis was employed to analyze the risk factors of poor prognosis in patients with ACI.The receiver operating characteristic curve(ROC)was plotted to obtain the area under the curve(AUC),and the predictive value of serum NRG-1,CHIT1,Cx43,and MECP2 for poor prognosis in patients with ACI was analyzed.Results When compared with the control group,the serum level of NRG-1 in the case group was significantly lower,whereas the serum levels of CHIT1,Cx43,and MECP2 were signifi-cantly higher(P<0.05).The serum level of NRG-1 gradually declined among the mild,moderate,and severe groups,while the serum levels of CHIT1,Cx43,and MECP2 gradually rose among these three groups(P<0.05).The proportions of patients with a score of the National Institutes of Health Stroke Scale(NIHSS)≥15 points at admission,large-area infarction,a time interval of 3～4.5 h from onset to thrombolysis,and the serum levels of CHIT1,Cx43,and MECP2 in the poor-prognosis group were higher than those in the good-prognosis group(P<0.05),and the serum level of NRG-1 was lower than that in the good-prognosis group(P<0.05).Multivariate Logistic regression analysis indicated that the serum levels of CHIT1,Cx43,and MECP2 were risk factors for poor prognosis in patients with ACI(P<0.05),while the serum level of NRG-1 was a protective factor(P<0.05).ROC analysis demonstrated that the AUC value of the combined detection of serum NRG-1,CHIT1,Cx43,and MECP2 in predicting poor prognosis of patients with ACI was 0.931,which was higher than that of the single detection of each index(0.796,0.801,0.791,0.805,P<0.05).Conclusions The serum level of NRG-1 in patients with acute cerebral infarction(ACI)was low,whereas the serum levels of CHIT1,Cx43,and MECP2 were high.These four factors were associated with the patients' disease severity and poor prognosis.Simultane-ously,the combined detection of serum NRG-1,CHIT1,Cx43,and MECP2 exhibited a higher predictive value for the poor prognosis of ACI patients.

Abstract:Objective Exploring the clinical application value of combining the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation(SAVE)score,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and circulatory biomarkers in predicting 90-day survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock(AMICS)treated with veno-arterial extracorporeal mem-brane oxygenation(VA-ECMO).Methods A total of 136 patients with amics admitted to the hospital from Septem-ber 2020 to September 2024 were selected as the objects.All patients were treated with VA-ECMO,and were followed up for 90 days(the start time of follow-up was the day of VA-ECMO catheterization).The survival status of the patients was observed,and they were divided into survival group and death group according to the survival status.General clinical data,SAVE scores,APACHE Ⅱ scores,and levels of low-density lipoprotein(LDL),lactate,C-reactive protein(CRP),cardiac troponin 1(cTn1),and brain natriuretic peptide(BNP)were compared between the two groups.Multivariate Cox regression analysis was employed to identify factors influencing mortality in AMICS patients treated with VA-ECMO.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the clinical value of relevant indicators in predicting 90-day survival outcomes.Survival curves were generated using the Kaplan-Meier method,and the Log-rank test was used to compare survival differences between groups.Result Among 136 patients,a total of 63 died within 90 days,with a mortality rate of 46.32%;The death group was older than the survival group,with higher levels of APACHE Ⅱ score,low-density lipoprotein,lactate,CRP,cTn1,and BNP compared to the survival group,and lower levels of high-density lipoprotein and SAVE score compared to the survival group(P<0.05);Cox regression analysis showed that SAVE score,APACHEⅡ score,lactate,CRP,and cTn1 were all influencing factors for 90 day mortality in AMICS patients after VA-ECMO treatment(P<0.05);ROC curve analysis showed that the AUC value of the combined detection of SAVE score,APACHE Ⅱ score,lactate,CRP,and cTn1 in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients was higher than that of single detection(Z=5.731,3.573,5.544,5.983,4.807,P<0.05);Kaplan Meier curves showed that patients with SAVE score≤-4.301,APACHE Ⅱ score>25.076,lactate>3.900 mmol/L,CRP>23.752 mg/L,and cTn1>7.755 ng/mL had shorter survival times(Log rank chi square=16.573,4.028,61.746,22.375,28.635,P<0.001).Conclusion The combined detection of SAVE score,APACHE Ⅱ score,lactate,CRP,and cTn1 has a high efficacy in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients.

Abstract:Objective To explore the application value of digital intelligent diagnosis and treatment technology in the diagnosis and treatment of hepatolithiasis following multiple biliary tract operations.Methods A retrospective cohort study was carried out to enroll patients with a history of biliary duct surgery who underwent choledochoscopy combined with hard lithotomy at Zhujiang Hospital of Southern Medical University between January 2017 and December 2024.These patients were then divided into the 3DVT-FI group and the conventional surgery group.Subsequently,the clinical data of the two groups were collected,analyzed,and compared.Results A total of 63 patients were included,with 33 in the 3DVT-FI group and 30 in the conventional surgery group.After inverse probability of treatment weighting(IPTW),there was no statistically significant difference in the general data(P>0.05).The laparotomy rate,intraoperative blood loss,postoperative complication rate,and reoperation rate within 3 months in the 3DVT-FI group were significantly lower than those in the conventional surgery group(all P<0.05).Univariate analysis showed significant differences between the groups with and without postoperative complications in terms of the presence of extrahepatic bile duct stones,year of surgery,and surgical approach(P<0.05).Multivariate analysis indicated that the absence of extrahepatic bile duct stones(OR=0.105)was a protective factor against postoperative complications,whereas the conventional surgical approach(OR=3.952)was a risk factor(all P<0.05).Conclusions The application of 3D visualization in combination with ICG fluorescence imaging technology in the diagnosis and treatment of hepatolithiasis following multiple biliary tract operations can enhance the rate of minimally invasive procedures and decrease the incidence of postoperative complications.The utilization of this technology can improve the safety and effectiveness of surgical treatment for hepatolithiasis in patients with a history of multiple biliary tract operations,which shows significant clinical value.

Abstract:Objective To evaluate the perioperative analgesic efficacy of ultrasound-guided anterior extrapleural space block in patients undergoing robot-assisted thoracoscopic lung surgery.Methods A total of 64 patients scheduled for elective robot-assisted thoracoscopic lung surgery between January 2024 and March 2025 were randomly assigned to two groups:the anterior extrapleural space block combined with general anesthesia group(Group A,n=32)and the general anesthesia-alone group(Group G,n=32).The following parameters were recorded:mean arterial pressure(MAP)and heart rate(HR)at baseline(T0,upon entering the operating room),after anesthesia induction(T1),at skin incision(T2),at the start of lung resection(T3),at the end of surgery(T4),and upon leaving the operating room(T5).Intraoperative consumption of anesthetic,time to first postoperative opioid analgesic requirement,Visual Analog Scale(VAS)scores at 12 h,24 h,and 48 h postopera-tively,anesthesia recovery time,operating room exit time,postoperative hospital stay,and adverse events were also documented.Results At the T2 to T5 time points,Group A exhibited lower MAP and HR values in comparison with Group G(P<0.05).Group A required substantially smaller dosages of ciprofol and remifentanil during the surgical procedure compared with Group G(P<0.05).The time to first postoperative opioid analgesia in Group A was longer than that in Group G(P<0.05).The VAS scores for rest and coughing in Group A were lower than those in Group G at 12 h,24 h,and 48 h following surgery(P<0.05).Group A exhibited shorter anesthesia recovery time,shorter time to leave the operating room,and reduced postoperative hospital stay compared to Group G(P<0.05),with a lower overall incidence of adverse reactions(P<0.05).Conclusion Ultrasound-guided anterior extrapleural space block delivers effective perioperative analgesia in robot-assisted thoracoscopic lung surgery,reduces intraoperative anesthetic requirements,decreases postoperative opioid demand,and facilitates recovery.

Abstract:Objective To assess the potential of GRP78 as a clinical biomarker in asthma by evaluating its relationship with key inflammatory cytokines and pulmonary function.Methods A total of 115 asthma patients(including 57 with mild,47 with moderate,and 11 with severe asthma)and 42 healthy controls were enrolled.Serum levels of GRP78,IL-4,IL-13,IL-17,and IFN-γ were measured using ELISA.Pulmonary function param-eters,including FEV1% and FEV1/FVC%,were also collected for comprehensive analysis.Results The level of serum GRP78 in the asthma patient group was significantly higher than that in the normal control group(P<0.01),and it increased with the severity of the disease.The levels of GRP78 in the mild,moderate and severe asthma groups were(23.42±0.12)ng/mL,(28.01±0.03)ng/mL and(33.33±0.14)ng/mL respectively,all of which were higher than that in the control group(16.38±0.11)ng/mL(P<0.05).The levels of serum IL-4,IL-13 and IL-17 in asthma patients[(2 754.07±7.32)pg/mL,(2 490.72±41.32)pg/mL,(7 080.38±546.32)pg/mL respectively]were significantly higher than those in the normal control group[(1 493.44±344.32)pg/mL,(1 280.18±20.43)pg/mL,(3 668.92±321.51)pg/mL respectively](P<0.01),while the level of IFN-γ[(652.90±42.67)pg/mL]was lower than that in the control group[(1 101.3±111.42)pg/mL](P<0.01).Pearson correlation analysis showed that GRP78 was positively correlated with the levels of IL-13 and IL-17(IL-13:r=0.34,P<0.05;IL-17:r=0.26,P<0.05),and negatively correlated with the levels of IFN-γ,FEV1% and FEV1/FVC%(IFN-γ:r=-0.31,P<0.05;FEV1%:r=-0.21,P<0.05;FEV1/FVC%:r=-0.32,P<0.05).Conclusions Serum GRP78 is elevated in asthma and correlates with disease severity,Th2/Th17 inflammation,and impaired lung function.These findings support its potential utility as a clinically relevant biomarker for asthma evaluation and monitoring.

Abstract:Objective To investigate the incidence,clinical manifestations,and gene mutations of short chain acyl-coenzyme A dehydrogenase deficiency(SCADD)in newborns in the Sichuan area.Methods A total of 113,367 neonatal blood samples that were received by the Neonatal Screening Laboratory of Sichuan Provincial Women's and Children's Hospital from November 2017 to July 2024,along with 6 outpatient children who had positive re-screening results,were included in this study.Tandem mass spectrometry was employed to detect the level of acylcarnitine in dried blood spots.Neonates with positive primary screening results were recalled within 2 weeks,and further confirmation of SCADD was carried out through urine organic acid analysis,blood biochemistry tests,and gene detection.Results Among 113,367 newborns,144 children tested positive in the primary screening,20 were positive in the re-examination,and 7 were diagnosed with SCADD.The prevalence rate was 1/16,195.All 6 outpatient children with positive re-screening results were diagnosed with SCADD,resulting in a total of 13 confirmed cases.All patients showed no clinical symptoms.In 12 cases,blood butyryl-carnitine(C4),the ratio of C4 to acetyl-carnitine(C2),and the ratio of C4 to propionyl-carnitine(C3)were increased.In one case,C4 was normal,but the blood valeryl carnitine(C5),the ratio of C5 to C2,and the ratio of C5 to C3 were increased.Urine organic acid detection revealed an increase in ethyl malonic acid in 8 cases,normal levels in 3 cases,and no detection in 2 cases.Among the 13 confirmed children,2 were homozygous,and the rest were complex heterozygous.A total of 16 types of ACADS gene mutations were identified,including 15 known mutations and 1 unreported muta-tion.The known mutations were:c.989G>A,c.1031A>G,c.1165A>G,c.1054G>A,c.655G>A,c.981-983delGAC,c.974G>A,c.983C>A,c.682G>A,c.802C>G,c.46G>A,c.1192C>T,c.293A>G,c.625G>A,c.1195C>T.The unreported mutation was c.796-7C>A.The high-frequency mutation was c.1031A>G(46%),and there was no significant correlation between the ACADS genotype and the levels of ethyl-malonic acid or C4.After the newborns were diagnosed with SCADD,they were provided with dietary guidance,and L-carnitine and vitamin B2 were supplemented when necessary.During the follow-up period,no clinical symp-toms emerged,and their physical and intellectual developments were normal.Conclusions The prevalence of SCADD in the Sichuan region was 1/16,195.A total of 16 mutation sites in the ACADS gene were detected.Children diagnosed with SCADD through neonatal screening exhibited no obvious clinical symptoms and had a good prognosis.

Abstract:The GOLD 2026 report presents several significant updates in the diagnosis,treatment,man-agement,and prevention of chronic obstructive pulmonary disease(COPD).For the very first time,this report integrates the concept of"disease activity",spotlighting low disease activity as a core treatment objective.In terms of exacerbation risk stratification,patients who have experienced one or more moderate-to-severe exacerbations in the past year are categorized as high-risk,underscoring the significance of early detection and intervention.Vaccina-tion strategies have been revised as well:the lower age threshold for respiratory syncytial virus(RSV)vaccination has been lowered to 50 years,an mRNA vaccine option has been introduced,and the evidence backing influenza vaccination in high-risk populations has been reinforced.The section on biologics demonstrates their effectiveness through evidence-based charts,which support precision-targeted therapy.The chapter on comorbidity management introduces the multimorbidity(syndemics concept)and utilizes the 4Ms framework to comprehensively tackle cardiovascular,respiratory,psychiatric,and metabolic comorbidities,along with clear instructions on corresponding interventions.Moreover,the report officially incorporates artificial intelligence and telemedicine into the clinical workflow.Overall,these updates signify a transition in COPD management towards a more proactive,precise,and comprehensive approach,offering crucial guidance for individualized treatment and optimized long-term care.This article intends to systematically summarize the key updates in GOLD 2026 to inform clinical practice.

Abstract:Objective To evaluate the risk factors for major hemorrhage in patients with residual pregnancy tissue(RPT)combined with uterine arteriovenous fistula(UAVF)following early pregnancy abortion by using a nomogram model based on ultrasonic features.Methods A total of 113 patients who had RPT combined with UAVF after early pregnancy abortion and were admitted to our hospital from January 2019 to January 2024 were selected as the study subjects.All the patients underwent ultrasound examination.According to the occurrence of major hemorrhage,the patients were divided into a major hemorrhage group and a non-major hemorrhage group.The ultrasonic characteristics were compared between these two groups.Logistic multivariate analysis was employed to screen the risk factors for major hemorrhage,and a nomogram model was established.The predictive value of the model for major hemorrhage was evaluated using the receiver operating characteristic(ROC)curve.Results Among the 113 patients,the incidence rate of major hemorrhage was 22.12%(25/113).Ultrasonographic features revealed irregular cysticsolid lesions within the uterine cavity,accompanied by characteristic mosaiclike color flow signals,which suggested RPT combined with UAVF.In the major hemorrhage group,the diameter of dilated vessels,the maximum lesion diameter,the peak systolic velocity(PSV),and the enddiastolic velocity(EDV)were significantly larger than those in the nonmajor hemorrhage group.Conversely,the resistance index(RI)and the thickness of the lower uterine segment myometrium were significantly smaller(all P<0.05).Logistic regression analysis indicated that the diameter of dilated vessels,PSV,and EDV were risk factors for major hemorrhage,whereas the thickness of the lower uterine segment myometrium was a protective factor(all P<0.05).The ROC curve demonstrated that the nomogram model based on multivariate analysis had a sensitivity of 96.0% and a speci-ficity of 86.4%for predicting major hemorrhage.Conclusions An increased diameter of dilated vessels,an elevated blood flow velocity,and a thinning of the lower uterine segment myometrium are independent predictive factors for major hemorrhage in patients with RPT combined with UAVF after early pregnancy abortion.The nomogram model established based on these factors exhibits high predictive efficacy.

Abstract:Objective To investigate the impact of minimally invasive intervention combined with rt-PA on survival rates in patients with massive pulmonary embolism(MPE).Methods Retrospectively,patients who received minimally invasive interventional combined rt-PA treatment in our hospital from October 2021 to October 2024 were included in the study group(103 cases),and propensity score matching(PSM)scoring method was used to match patients who received Nadroparin calcium and rt-PA treatment in our hospital during the same period into the control group(97 cases).Comparisons were made between the two groups regarding overall clinical efficacy,30-day and 90-day post-treatment survival rates,vital signs[heart rate(HR),respiratory rate],blood gas parameters[arterial oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO₂),pulmonary artery pressure(PAP),and peripheral oxygen saturation(SpO₂)],coagulation and fibrinolysis system markers[D-dimer(D-D),plasminogen activator inhibitor-1(PAI-1),tissue plasminogen activator(t-PA),thrombo-modulin(TM),and antithrombin Ⅲ(AT-Ⅲ)],Blood flow dynamics index and total adverse reaction rates.Results After treatment,the overall efficacy rate in the study group was 95.15%,significantly higher than the control group's 81.44%(P<0.05).At 30 days post-treatment,there was no significant difference in survival rates between the two groups(P>0.05).At 90 days post-treatment,the survival rate in the study group was 94.13%,significantly higher than that in the control group(85.57%,P<0.05).Pretreatment HR and respiratory rate showed no significant differences between the two groups(P>0.05);post-treatment,both groups exhibited significant reductions in these parameters,with the study group demonstrating lower values than the control group(P<0.05).Pretreatment PaO₂,PaCO₂,PAP,and SpO₂ showed no significant differences(P>0.05);post-treatment,PaO₂,PaCO₂,and SpO₂ significantly increased in both groups,with the study group outperforming the control group(P<0.05),while PAP significantly decreased,with the study group showing lower values than the control group(P<0.05).Before treatment,there was no significant difference between the two groups in D-D,PAI-1,t-PA,TM and AT-Ⅲ(P>0.05).After treatment,D-D,PAI-1,t-PA and TM showed a significant downward trend in both groups,and the study group was significantly lower than the control group;AT-Ⅲ showed an upward trend,and the study group was higher than the control group(P<0.05).Before treatment,there was no significant difference in RV/LV ratio,sPAP and TAPSE between the two groups(P>0.05);after treatment,RV/LV ratio and sPAP decreased significantly,while TAPSE increased significantly(P<0.001),and the decrease of RV/LV ratio and sPAP and increase of TAPSE in the study group were better than those in the control group(P<0.05).There was no statistical difference in the incidence of overall bleeding events between the two groups(25.77%vs.16.67%,P>0.05),However,according to the BARC classification criteria,the incidence of hemorrhagic events of type 3 or higher was higher in the control group than in the study group.Conclusion Minimally invasive intervention combined with rt-PA effectively improves oxygenation,regulates coagulation-fibrinolysis balance,and enhances clinical efficacy in patients with massive pulmonary embolism.

Abstract:Ulcerative colitis(UC)represents a specific manifestation of inflammatory bowel disease,which is distinguished by the chronic and recurrent inflammation of the colonic mucosa.The pathogenesis of UC encompasses the disruption of the intestinal mucosal barrier,the dysregulation of immune homeostasis,and the activation of multiple stress-related cell death pathways.In recent years,mounting evidence has demonstrated that ferroptosis,a type of regulated cell death propelled by iron-dependent lipid peroxidation,and endoplasmic reticu-lum stress(ERS),mainly mediated by the unfolded protein response(UPR),assume crucial roles in the onset and progression of UC.Research has revealed that colonic tissues obtained from patients with UC and experimental colitis models display dysregulated iron homeostasis,the accumulation of lipid peroxides,the depletion of glutathi-one(GSH),and the inactivation of glutathione peroxidase 4(GPX4),all of which are characteristic hallmarks of ferroptosis.It has been reported that pharmacological or genetic inhibition of ferroptosis can mitigate mucosal injury and inflammatory responses.Meanwhile,the persistent activation of ERS in intestinal epithelial cells is evident,as indicated by the functional exhaustion of the endoplasmic reticulum chaperone glucose-regulated protein 78(GRP78)and the enhanced signaling of C/EBP homologous protein(CHOP)and X-box binding protein 1(XBP1).Dysregulated ERS can directly lead to goblet cell loss and the impairment of epithelial barrier function.Significantly,ferroptosis and ERS are not independent processes but interact with each other within the inflammatory microenvironment of UC.ERS can enhance cellular susceptibility to ferroptosis by depleting GSH and intensifying oxidative stress.Conversely,excessive lipid peroxides and damage-associated molecular patterns produced during ferroptosis may further exacerbate ERS,thus forming a detrimental feedback loop.Therefore,therapeutic strategies targeting the ferroptosis-ERS axis,especially those integrated with nanotechnology-based delivery systems for precise regulation,might represent a promising approach for the treatment of UC.

Abstract:Objective To investigate the enhancing effect of sikuximab in combination with iguratimod on the serum levels of osteopontin(SOST),Dickkopf-1 related protein(DKK-1),type Ⅰ collagen C-terminal peptide(CTX-I),and spinal function in patients with ankylosing spondylitis(AS).Methods A total of 150 patients with AS who were admitted to our hospital from January 2023 to December 2024 were selected as the research subjects.They were randomly assigned to three groups,namely Group A(50 cases),Group B(50 cases),and Group C(50 cases),using the random number table method.Among them,2 cases in Group A,1 case in Group B,and 1 case in Group C were lost to follow-up.Finally,48 cases were included in Group A,49 cases in Group B,and 49 cases in Group C.Group A received iguratimod,Group B received sikuximab,and Group C received sikuximab in combination with iguratimod.All three groups received continuous treatment for 6 months.The clinical efficacy after 6 months of treatment was compared among the three groups,including spinal function before and after treat-ment,duration of morning stiffness,disease activity,magnetic resonance imaging(MRI)sacroiliac joint score,inflammatory response,and levels of serum SOST,DKK-1,CTX-I before and after 6 months of treatment,as well as safety during treatment.Results After 6 months of treatment,the total effective rate of group C was 93.88%,which was higher than those of group A(60.42%)and group B(79.59%).Moreover,the total effective rate of group B was higher than that of group A(P<0.05).Compared with the pre-treatment values,after 6 months of treatment,the Bath AS Functional Index(BASFI),Bartholomew's AS Disease Activity Inventory(BASDAI),MRI sacroiliac joint scores,the levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),DKK-1,and CTX-I in all three groups decreased.The values in group C were lower than those in group A and group B,and the values in group B were lower than those in group A.The duration of morning stiffness in all three groups was shortened.The duration in group C was shorter than those in group A and group B,and the duration in group B was shorter than that in group A.The levels of serum SOST in all three groups increased.The levels in group C were higher than those in group A and group B,and the levels in group B were higher than those in group A(P<0.05).There were no significant differences in the incidences of adverse reactions among the three treatment groups(P>0.05).Conclusions Compared to monotherapy,the combination of sikuximab and iguratimod can significantly alleviate the symptoms of patients with AS,reduce their inflammatory response,effectively regulate the levels of serum SOST,DKK-1,and CTX-I,improve spinal function,and enhance clinical efficacy without increasing the incidence of adverse reactions.Nevertheless,sikuximab monotherapy is more effective than iguratimod monotherapy.