Abstract:Objective To explore the possible mechanism of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)on limb function in patients with ischemic stroke(IS)from the perspectives of activation of the brain's motor cortex and serum biomarkers[thrombomodulin(TM),vascular cell adhesion molecule-1(VCAM-1)].Methods A total of 136 patients with ischemic stroke(IS)who were admitted to the hospital from January 2023 to May 2025 were randomly assigned to four groups using the random-number table method:the combined group(n=34,receiving high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)plus butylphthalide),the HF-rTMS group(n=34,receiving HF-rTMS),the butylphthalide group(n=34,receiving butylphthalide),and the control group(n=34,receiving conventional drugs and rehabilitation training interven-tion).The treatment duration was 28 days.Comparisons were made among the four groups regarding neurological functions[assessed by the National Institutes of Health Stroke Scale(NIHSS)],serum markers[including serum S100β,brain-derived neurotrophic factor(BDNF),and neuron-specific enolase(NSE)],motor cortex activation of the brain[evaluated by the latency/amplitude of motor evoked potential(MEP)and central motor conduction time(CMCT)],limb functions[assessed by the Brunnstrom stage and Fugl-Meyer Assessment(FMA)score],Berg Balance Scale(BBS)score,modified Barthel index(MBI)score,and serum levels of thrombomodulin(TM)and vascular cell adhesion molecule-1(VCAM-1)before treatment and 28 days after treatment.The treatment safety of the four groups was evaluated.Pearson correlation analysis was used to analyze the relationship between changes in FMA scores and changes in related indicators.Results After treatment,the NIHSS score,MEP latency,CMCT,and the levels of serum S100 β,NSE,TM,and VCAM-1 in the combined group were lower than those in the HF-rTMS group,the butylphthalide group,and the control group(P<0.05).In contrast,the MEP amplitude,FMA,BBS,MBI scores,and the serum BDNF level were higher(P<0.05).There were no statistically significant differences in the above-mentioned indicators between the butylphthalide group and the HF-rTMS group(P>0.05).There was no statistically significant difference in the incidence of adverse reactions among the four groups(P>0.05).The increase in the total FMA score of IS patients after treatment was positively correlated with the increase in the amplitudes of MEP(P<0.001)and negatively correlated with the decrease in the levels of serum TM and VCAM-1(P<0.001).Conclusions The combination of HF-rTMS and butylphthalide can more effectively restore the neurological function of patients with IS,and promote the improvement of their limb function,balance,and activities of daily living.The synergistic activation of the brain's motor cortex and the down-regulation of serum TM and VCAM-1 levels may serve as its mechanism of action.

Abstract:Myosin heavy chain 9(MYH9)serves as a fundamental regulator of the intestinal epithelial cytoskeletal architecture.Through its coordinated control of cytoskeletal dynamics and intercellular junction organi-zation this molecular motor protein actively maintains epithelial barrier integrity while fine-tuning intestinal stem cell homeostasis-functions that demonstrate distinct dose-responsive characteristics.Under pathological stimuli,MYH9 manifests a context-dependent"double-edged sword"behavior.In inflammatory bowel disease,while com-plete MYH9 ablation compromises barrier function and amplifies inflammatory responses,its partial inhibition para-doxically enhances epithelial repair through activation of regenerative signaling cascades.During colorectal carcino-genesis,MYH9 fuels tumor progression by orchestrating MAPK/AKT signaling networks and synergizing with autophagy-related protein ATG9B to facilitate focal adhesion maturation.Furthermore,in pre-malignant conditions like intestinal metaplasia,MYH9 contributes to β-catenin pathway activation,thereby accelerating malignant trans-formation.This comprehensive review delineates the multifaceted regulatory networks governed by MYH9 in intestinal physiology and pathology,while proposing future investigative directions.Deciphering the context-specific function-ality of MYH9 will not only advance targeted therapeutic development but also illuminate its promising utility as a liquid biopsy biomarker for gastrointestinal disorders.

Abstract:Objective To analyze the impact of low-energy laser in combination with vitamin therapy on burning mouth syndrome and its effects on the levels of salivary amylase(AMS),matrix metalloproteinase-9(MMP-9),and secretory immunoglobulin A(SIgA).Methods A total of 174 patients diagnosed with burning mouth syndrome who were admitted to our hospital between November 2023 and April 2025 were randomly assigned to three groups-the vitamin group(n=58),the low-energy laser group(n=58),and the combined group(n=58)using a random number table.In the vitamin group,patients were treated with oral administration of 100 mg of vitamin E,10 mg of oryvertin,and 10 mg of vitamin B2.The low-energy laser group received low-energy laser treatment,while the combined group was treated with oral vitamins in combination with low-energy laser.Each treatment course spanned 10 days,and all three groups underwent two treatment courses.The efficacy after two treatment courses,salivary flow,pain level,salivary α-AMS,MMP-9,SIgA,serum brain-derived neurotrophic factor(BDNF),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),anxiety,depression,and sleep quality were compared between the three groups both before and after two treatment courses.Additionally,the safety during the treatment period was also compared.Results The overall effective rate of the combined group reached 94.83%,which was significantly higher than the 75.86% in the vitamin group and 79.31% in the low-energy laser group(P<0.05).When compared with the baseline values,the unstimulated and stimulated salivary flow,salivary AMS and SIgA levels,as well as serum BDNF levels,all showed an increase after two treatment courses in the three groups.Among them,the combined group exhibited the most substantial increments(P<0.05).Similarly,the visual analogue scale(VAS)pain scores,salivary MMP-9 levels,serum IL-6 and TNF-α levels,scores of the Generalized Anxiety Disorder-7(GAD-7),Patient Health Questionnaire-9(PHQ-9),and Pittsburgh Sleep Quality Index(PSQI)all decreased in all three groups.The combined group had the most significant reductions(P<0.05).Throughout the treatment period,no serious adverse reactions were reported in either group,and all patients successfully completed the full course of treatment.Conclusions Supplementation with oral vitamins combined with low-level laser therapy can enhance saliva secretion,relieve pain,alleviate anxiety and depression,and improve sleep quality in patients with burning mouth syndrome.This regimen modulates salivary AMS,MMP-9,and SIgA,as well as serum BDNF,IL-6,and TNF-α.Consequently,it improves oral function and reduces neuro-inflammation while ensuring good safety.

Abstract:Objective To evaluate the efficacy of intraoperative spraying of dimethicone as needed,combined with oral sulphate solution(OSS),for bowel preparation,and compare this efficacy with that of conventional oral dimethicone before colonoscopy.Methods A total of 360 patients who underwent colonoscopy at the Affiliated Jiangning Hospital of Nanjing Medical University from January to August 2025 were selected.According to the random number table method,they were divided into two groups:the control group(receiving OSS combined with oral dimethicone before colonoscopy)and the observation group(receiving OSS combined with intraoperative spraying of dimethicone as needed).The differences in intestinal cleanliness,bubble score,examination duration,polyp detection rate,and adverse reactions between the two groups were compared.Results Comparative analysis revealed no statistically significant difference in the intestinal cleanliness of the BBPS score between the two groups(2.42±0.59 vs.2.48±0.54,2.62±0.49 vs.2.64±0.48,2.73±0.46 vs.2.71±0.47,7.78±1.16 vs.7.83±1.14,P>0.05).The bubble score of the observation group demonstrated superior results in all intestinal segments(2.77±0.42 vs.2.27±0.59,2.87±0.34 vs.2.37±0.52,2.92±0.27 vs.2.70±0.50,8.56±0.74 vs.7.34±0.99,P<0.01).In terms of bubble grading,the observation group showed significantly higher proportions of Grade A ratings in all intestinal segments compared to the control group(76.67%vs.34.44%,86.67%vs.38.89%,92.22%vs.70.00%,P<0.01).Regarding the examination duration,the observation group took slightly longer than the control group with no statistically significant difference(12.43±2.52 vs.11.40±2.33,P>0.05).The detection rate of micro-polyps in the observation group was higher than that in the control group(21.6%vs.12.7%,P<0.05).Additionally,patients in the two groups demonstrated good tolerance with mild adverse reactions.Conclusions The application of intraoperative spraying of dimethicone as needed,combined with OSS,achieved a better defoaming effect.This can further improve the quality of intestinal preparation and the detection rate of micro-polyps,providing a reference for optimizing the intestinal preparation scheme and having significant clinical application value.

Abstract:Objective To assess the diagnostic effectiveness of intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),and the triglyceride-glucose index(TyG index)in detecting abnor-malities of carotid artery intima-media thickness(IMT)in elderly hypertensive patients with metabolically associ-ated steatotic liver disease(MASLD).Methods A retrospective analysis was carried out on 189 elderly hypertensive patients with MASLD who were admitted to our institution between June 2021 and July 2023.All the subjects had their carotid IMT measured by color Doppler ultrasound and were classified into two groups:the normal group(IMT<1.0 mm)and the thickened group(IMT≥1.0 mm)according to the ultrasound results.Clinical data collec-tion involved quantifying serum ICAM-1 and VCAM-1 by enzyme-linked immunosorbent assay(ELISA),calcu-lating the triglyceride glucose(TyG)index from fasting glucose and triglyceride levels,and conducting a compara-tive analysis of the differences in relevant parameters between the groups.Multivariate logistic regression was used to identify the independent risk factors for IMT thickening,and Pearson correlation analysis was employed to assess the relationships between serum biomarkers and the IMT status.The diagnostic performance was evaluated through receiver operating characteristic(ROC)curve analysis.Results IMT thickening was detected in 71 patients(37.57%).In comparison with the normal IMT group,the thickened IMT group showed significantly higher levels of systolic/diastolic blood pressure,triglycerides,aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum ICAM-1,VCAM-1,and TyG index(all P<0.05).Logistic regression analysis confirmed that these parameters were independent risk factors for IMT thickening.The levels of serum ICAM-1,VCAM-1,and TyG index were positively correlated with IMT thickening(IMT≥1.0 mm)(all P<0.05).ROC analysis indicated that the combined biomarker assessment had better diagnostic accuracy than individual markers(P<0.05).Conclusions Serum ICAM-1,VCAM-1,and the TyG index exhibit high diagnostic sensitivity and specificity for IMT abnormalities in this patient population,which validates their utility as adjunctive tools for carotid artery lesion risk stratification in elderly hypertensive patients with MASLD.

Abstract:Objective To explore the independent risk factors for aortic valve calcification(AVC)in patients with coronary artery calcification(CAC)and construct a clinical predictive model,thereby providing a basis for the early identification of high-risk patients.Methods This study retrospectively incorporated 1458 inpa-tients who underwent coronary CT angiography(CCTA)at Zhongda Hospital Affiliated to Southeast University from January 2019 to September 2022 and had a CAC score greater than 0.These patients were randomly allocated into a training set(n=1 020)and a validation set(n=438)at a ratio of 7:3.The risk factors of calcific aortic valve disease(CAVD)were analyzed via univariate and multivariate logistic regression.In this research,LASSO regression was employed for variable screening,and a nomogram prediction model was developed based on the screened variables.The excellent discriminatory capacity,prediction precision,and potential clinical application value of the model were verified through receiver-operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA),respectively.Results The incidence of AVC in the training set was 30.6%.Multivariate analysis indicated that age(OR=1.055,95%CI:1.040～1.071),height(OR=0.980,95%CI:0.962～0.997),right ventricular end-diastolic diameter(RVEDd,OR=1.719,95%CI:1.102～2.692),and statin use(OR=1.408,95%CI:1.047～1.899)were independent predictors of AVC.The area under the curve(AUC)of the model in the training set and the validation set were 0.738 and 0.715,respectively.The calibration curve demonstrated that the predicted risk was highly consistent with the actual risk,and DCA verified that its clinical net benefit was significant.Conclusions Age,height,RVEDd and statin use are independent predictors of AVC in patients with CAC.The nomogram model constructed based on these factors demonstrates excellent predictive ability,which is conducive to the early identification and clinical management of high-risk patients.

Abstract:Objective To investigate the effect of dexmedetomidine-assisted deep brain stimulation on the cAMP/PKA signal pathway in elderly patients with Parkinson's disease.Methods A total of 150 elderly patients with Parkinson's disease who underwent deep brain stimulation(DBS)at the Affiliated Brain Hospital of Nanjing Medical University from January 2021 to January 2025 were selected as the study subjects.The enrolled patients were randomly divided into Group A(75 cases)and Group B(75 cases)using the random-number table method.In Group B,dexmedetomidine was pumped before anesthesia induction,while in Group A,an equal-volume of saline was pumped.The patients were observed for 2 weeks after the operation and followed up for 6 months.The perioperative-related indicators of the two groups were compared,including subthalamic nucleus(STN)frequency,length of bilateral subthalamic nucleus physiological signals,coordinate error,perioperative hemodynamics[before anesthesia induction(T0),after general anesthesia intubation(T1),and during anesthesia deepening(T2)],brain injury indicators(1 h before surgery,1 d after surgery),Ramsay sedation score(before entering the operat-ing room,before surgery,during intraoperative localization testing,and at the end of surgery),motor score of the Parkinson's syndrome scoring scale(UPDRS),cognitive function,and cAMP/PKA signaling pathway(1 h before surgery,2 weeks after surgery).Results The recovery times of operation,unconsciousness,and spontaneous breathing in Group B were significantly shorter(P<0.05).There were no significant differences in STN frequency,bilateral STN electrophysiological signal length,and coordinate error between Group B and Group A(P>0.05).The mean arterial pressure(MAP)and heart rate(HR)in the T0～T2 groups showed a decreasing trend.At T1 and T2,the MAP and HR in Group B were higher than those in Group A.Meanwhile,the bispectral index(BIS)in the T0～T2 groups showed a trend of first decreasing and then increasing(P<0.05).There were no significant differences in BIS and SpO2 at different times and between the two groups(P>0.05).Compared with one hour before operation and one day after operation,the levels of serum central nervous system-specific protein(S-100β),neuron-specific enolase(NSE),and homocysteine(Hcy)in both groups were higher,but these levels were lower in Group B.In contrast,the level of serum uric acid(UA)was lower overall,but it was higher in Group B(P<0.05).In both groups,the Ramsay sedation scores gradually increased from the time of entering the operating room until the end of the operation.At the time of the intraoperative localization test and the end of the operation,the Ramsay sedation scores in group B were significantly higher than those in group A(P<0.05).When compared to the scores 1 hour before the operation and 2 weeks after the operation,the Unified Parkinson's Disease Rating Scale(UPDRS)scores in both the unilateral and bilateral switch states were lower,with a more pronounced decrease in group B(P<0.05).Similarly,the scores on the Montreal Cognitive Assessment Scale(MoCA)in both groups were higher when compared to the pre-operation(1 hour before)and 2-week post-operation scores,particularly in group B(P<0.05).Moreover,the levels of serum cyclic adenosine monophosphate(cAMP)and protein kinase A(PKA)in both groups were higher compared to those 1 hour before the operation and 2 weeks after the operation,especially in group B(P<0.05).Conclusions Dexmedetomidine can stabilize the perioperative hemodynamic indexes,regulate the cAMP/PKA signaling pathway,and improve the indexes of brain injury in elderly patients with Parkinson's disease undergoing deep-brain stimulation.Additionally,dexme-detomidine exhibits a favorable target-positioning effect,which shortens the operation time,the time of consciousness disappearance,and the recovery time.It also enhances the degree of sedation and improves the cognitive and motor functions of patients.

Abstract:Objective To explore the therapeutic effect of nasal cavity volume expansion surgery combined with modified uvulopalatopharyngoplasty(UPPP)on patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)complicated by multi-level obstruction.Methods A total of 98 patients with moderate-to-severe OSAHS,whose obstructive levels were located in the nasal cavity and pharyngeal cavity and who received treatment in our hospital from August 2023 to May 2025,were selected as the research objects.They were divided into two groups using the random number table method,with 49 cases in the control group and 49 cases in the observation group.The control group was treated with UPPP,whereas the observation group was treated with nasal cavity volume expansion surgery on the basis of the treatment for the control group.Two months after surgery,the clinical efficacy of the two groups was evaluated.Before and after treatment,the apnea-hypopnea index(AHI),arousal index(AI),lowest pulse oxygen saturation(LSaO2),Epworth Sleepiness Scale(ESS)score,Mini-Mental State Exami-nation(MMSE)score,and PSQI score of patients in the two groups were compared.Pulmonary function before and after treatment was evaluated by FEV1 and PEF.Meanwhile,the occurrence of postoperative complications was recorded.Results The observation group exhibited a significantly higher total treatment efficacy rate than the control group(89.80%vs.71.43%,P<0.05).The Apnea-Hypopnea Index(AHI),Arousal Index(AI),Epworth Sleepiness Scale(ESS)score,and Pittsburgh Sleep Quality Index(PSQI)score in the observation group were(10.26±2.48)times/hour,(11.48±3.08)times,(5.04±1.08)points,and(6.89±1.56)points,respectively,all of which were lower than those in the control group.Meanwhile,there were significant differences in the LSaO₂,cognitive function,and pulmonary function between the two groups(P<0.05).In terms of adverse reactions after treatment,there were 3 cases of cough and 1 case of suffocation in the observation group;in the control group,there were 2 cases of cough,2 cases of suffocation,2 cases of bleeding,and 1 case of dysphagia.There was no sig-nificant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The combination of nasal cavity volume expansion surgery and UPPP can improve the clinical efficacy for OSAHS pa-tients with multi-level obstruction,enhance their cognitive function and sleep quality,and does not increase the risk of adverse reactions.

Abstract:Objective To explore the relationship between the levels of serum mucin 1(MuC1),type Ⅰprocollagen N-terminal propeptide(PINP),and free light chain(sFLC)in patients with multiple myeloma and their clinical staging,immunophenotyping,and to evaluate their predictive value for prognosis.Methods A total of 220 patients with multiple myeloma admitted to Wuwei People's Hospital between July 2020 and May 2024 were selected as the case group.All patients were clearly staged according to the International Staging System(ISS):stage Ⅰ(26 cases),stage Ⅱ(82 cases),and stage Ⅲ(112 cases).Based on immunophenotyping,they were further classified into immunoglobulin(Ig)A type(52 cases),IgG type(96 cases),light chain type(47 cases),and non-secreting type(25 cases).Moreover,according to the patients'prognosis within 12 months of treatment follow-up,they were divided into the poor prognosis group(55 cases)and the good prognosis group(165 cases).A control group of 220 healthy individuals who underwent physical examinations during the same period was also selected at a ratio of 1∶1.The clinical data and levels of serum MuC1,PINP,and sFLC(including sFLC-κ and sFLC-λ for horizontal κ and λ light chains)were compared between the case group and the control group.The levels of serum MuC1,PINP,and sFLC were also compared among patients with different clinical stages,immuno-phenotypes,and prognoses.The predictive value of serum MuC1,PINP,and sFLC levels for the prognosis of mul-tiple myeloma patients was evaluated by receiver operating characteristic(ROC)curve analysis.Results The levels of serum MuC1,sFLC-κ,and sFLC-λ in the case group were significantly higher than those in the control group,whereas the level of serum PINP was significantly lower than that in the control group(P<0.05).In patients,the levels of serum MuC1,sFLC-κ,and sFLC-λ in stage Ⅲ were significantly higher than those in stagesⅠ and Ⅱ,and the levels in stage Ⅱ were significantly higher than those in stage Ⅰ(P<0.05).Conversely,the level of serum PINP in stage Ⅲ was significantly lower than that in stages Ⅰ and Ⅱ,and the level in stage Ⅱ was significantly lower than that in stage Ⅰ(P<0.05).In terms of immunoglobulin types,the levels of serum MuC1,sFLC-κ,and sFLC-λ in patients with IgG type were significantly higher than those in patients with IgA type,light chain type,and non-secreting type,while the level of serum PINP was significantly lower than that in patients with these types(P<0.05).Regarding prognosis,the levels of serum MuC1,sFLC-κ,and sFLC-λ in the poor prognosis group were significantly higher than those in the good prognosis group,while the level of serum PINP was signifi-cantly lower than that in the good prognosis group(P<0.05).When defining poor prognosis as positive and good prognosis as negative,the area under the curve(AUC)for predicting the prognosis of multiple myeloma patients using serum MuC1,PINP,sFLC-κ,sFLC-λ,and their combined detection were 0.765,0.665,0.753,0.710,and 0.914,respectively.The diagnostic sensitivities were 72.73%,69.09%,72.73%,65.45%,and 87.27%,respectively,and the specificities were 69.70%,62.42%,72.12%,73.33%,and 85.45%,respectively.Among these,the combined detection had the highest AUC(P<0.05).Conclusion The expressions of serum MuC1,PINP,and sFLC were associated with the occurrence,progression,and immunophenotyping of multiple myeloma,and they had high predictive value for patient prognosis.The combined detection of these four markers had the highest predictive value.

Abstract:Rheumatoid Arthritis(RA)is an autoimmune disease,with pain being its primary symptom.The mechanisms underlying RA pain involve both inflammatory and neuropathic components.Lidocaine,a classic amido-type local anesthetic,has gained widespread application in treating inflammatory and neuropathic pain due to its analgesic,anti-inflammatory,and immunomodulatory properties when administered intravenously.Given the exact match between the pathogenesis of RA pain and the pharmacological actions of intravenous lidocaine,this review explores the therapeutic potential of intravenous lidocaine infusion for RA pain.It aims to offer new insights into the clinical application of intravenous lidocaine for managing RA-related pain.

Abstract:Objective To assess the efficacy and safety of Qing Gong′s orthopaedic manipulation(QGOM)for the shoulder on hand-behind-back(HBB)restriction after rotator cuff repair(RCR).Methods Forty-two patients with post-RCR HBB restriction were randomised into two groups(n=21 each):one performing shoulder exercises(control),and the other receiving thrice-weekly QGOM treatment for 6 weeks(observation).Results At 6 weeks,the median HBB score increased by 5(2,6)in the observation group compared to a 2(2,2)in the control group(Z=-3.678,P<0.001).The median visual analogue scale score decreased by 3(2,4)in the observation group,while it decreased by 1(1,2)(Z=-3.652,P<0.001)in the control group.The mean Constant-Murley score increased by 28.76 and 15.90 in the observation and control groups,respectively.The differ-ence between the two groups was 12.86(95%confidence interval(CI):7.26～18.45,P<0.001).At 6 weeks,active forward flexion(Z=-3.663,P<0.001),abduction(t=-4.579,P<0.001),extension(Z=-2.281,P=0.023)and external rotation(t=-2.757,P=0.009)were significantly greater in the observation group than those in the control group.Shoulder forward flexion and abduction in the observation group increased signifi-cantly in the observation group(Z=-2.055,P=0.041)than those in the control group(Z=-2.450,P=0.013).The observation group showed significantly greater improvement than the control group in forward flexion(Z=-3.059,P=0.002),abduction(Z=-3.700,P<0.001),extension(Z=-2.194,P=0.028),and exter-nal rotation(Z=-3.003,P=0.003).Conclusions QGOM for the shoulder was effective,safe and more benefi-cial than shoulder exercise alone in improving HBB after RCR.

Abstract:Objective To explore the value of pressure regulated volume-controlled ventilation mode(PRVC)in cardiac valve surgery based on respiratory mechanics,myocardial injury and postoperative pulmonary complications.Methods A prospective study included patients admitted to the affiliated Hospital of Xuzhou Medical University for elective cardiac valve replacement or repair from January 2024 to October 2025.After strict inclusion and exclusion criteria,a total of 100 cases were finally enrolled.Patients were assigned to the PRVC group(n=50)and the control group(n=50,volume-controlled ventilation mode)in a 1∶1 ratio by stratified block randomization.The respiratory mechanics and oxygenation status of the two groups at different times after surgery were compared.The levels of creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),hypersensitive troponin T(hs-cTnT),and N-terminal pro-brain natriuretic peptide(NT-proBNP)before and after surgery were determined.The occurrence of pulmonary complications within 7 days after surgery was recorded.Results At different time points,the Ppeak,Pplat and △P in the PRVC group were all lower than those in the control group,while Cdyn was higher,with intergroup and time effects(P<0.05),and with an interaction effect on Ppeak(P<0.05).At different time points,the PRVC group had higher PaO2 and OI,while lower RI and PA-aO2 were lower,with intergroup and time effects(P<0.05),among which there was an interaction effect of PaO2 and PA-aO2(P<0.05).At 6 hours and 24 hours after surgery,the levels of CK-MB,LDH,hs-cTnT and NT-proBNP in both groups were higher than those before surgery in the same group,and those in the PRVC group were lower.There were intergroup,time and interaction effects(P<0.05).The extubation time,ICU stay time and total hospital stay in the PRVC group were shorter(P<0.05),and the total incidence of postoperative pulmonary complications was significantly lower(P<0.05).Conclusions The PRVC mode used in cardiac valve surgery has less impact on respiratory mechanics and oxygenation than the VCV mode,has a significant lung-protective effect,can reduce myocardial injury and decrease pulmonary complications.

Abstract:Objective To observe the effect of vestibular regulation technique combined with conventional musculoskeletal rehabilitation on the foot posture of adolescents with flexible flatfoot.Methods Fifty-eight patients were randomly divided into a control group and an experimental group,with 29 patients in each group.The control group received musculoskeletal rehabilitation,while the experimental group received vestibular regulation com-bined with musculoskeletal rehabilitation.Both groups were treated for two weeks.Three-dimensional foot scans were conducted before and after the intervention to collect data on arch height,arch type,arch width coefficient,footprint area coefficient,calcaneal valgus angle,and hallux valgus angle.Results(1)Arch height:Both the control and experimental groups showed increased arch height in both feet after the intervention(P<0.05),with the experimental group showing better results than the control group(P<0.05).(2)Arch type:Both groups showed improvement in arch type in both feet after the intervention(P<0.05),with no significant difference in efficacy between the two groups(P>0.05).(3)Arch width coefficient:The control group showed improvement in the left foot arch width coefficient after the intervention(P<0.05),but no significant improvement in the right foot(P>0.05).The experimental group showed improvement in both feet(P<0.05),with no significant difference in efficacy between the two groups(P>0.05).(4)Footprint area coefficient:Both groups showed improvement in the footprint area coefficient in both feet after the intervention(P<0.05),with no significant difference in efficacy between the two groups(P>0.05).(5)Calcaneal valgus angle:The control group showed no significant improve-ment in the calcaneal valgus angle in both feet after the intervention(P>0.05),while the experimental group showed improvement(P<0.05).(6)Hallux valgus angle:The control group showed no significant improvement in the hallux valgus angle in both feet after the intervention(P>0.05),while the experimental group showed im-provement(P<0.05).Conclusion On the basis of conventional musculoskeletal rehabilitation,the integration of vestibular regulation techniques can effectively improve the height,type,width coefficient of the arch,footprint area coefficient,calcaneal valgus angle,and hallux valgus angle of the foot in adolescents with flexible flatfoot,and improve their foot posture.

Abstract:Objective To analyze the diagnostic efficacy of the fatty liver index(FLI)in the screening of metabolic dysfunction-associated steatotic liver disease(MASLD)Methods Prospectively,109 patients diag-nosed with MASLD who were admitted to our hospital between June 2023 and June 2025 were selected as the re-search subjects.They were classified into the diabetes group(n=42)and the non-diabetes group(n=67)accord-ing to the presence or absence of type 2 diabetes.Additionally,109 patients without MASLD during the same period were chosen as the control group.The baseline data and Fatty Liver Index(FLI)of different groups were compared.Binary logistic regression analysis was conducted to identify the influencing factors,and the receiver operating char-acteristic curve(ROC)was employed to assess the screening efficacy.Results The proportions of smoking his-tory,hypertension,and type 2 diabetes in the MASLD group were significantly higher compared to those in the non-MASLD group(P<0.05).The levels of systolic blood pressure,diastolic blood pressure,waist circumfer-ence,BMI,fasting plasma glucose,HbA1c,fasting insulin,total cholesterol,triglycerides,hs-CRP,GGT,ALT,AST,TBIL,and FLI in the MASLD group were significantly higher than those in the non-MASLD group,whereas the levels of LDL-C,ALB,and PA were significantly lower than those in the non-MASLD group(P<0.05).The prevalence of hypertension in MASLD patients with type 2 diabetes was higher than that in the non-diabetic group(P<0.05),and the age,systolic blood pressure,waist circumference,BMI,fasting plasma glu-cose,HbA1c,fasting insulin,triglycerides,DBIL,and FLI levels were significantly higher than those in the non-diabetic group(P<0.05).Multivariate analysis indicated that FLI,type 2 diabetes,HbA1c,and hs-CRP were in-dependent predictors for MASLD screening(P<0.05);in contrast,FLI,hypertension,HbA1c,and FINS were independent predictors for MASLD screening in type 2 diabetes patients(P<0.05).ROC curve analysis demon-strated that in screening for MASLD,FLI had the best efficacy(AUC=0.886),followed by hs-CRP(AUC=0.755);the combined prediction model had better efficacy(AUC=0.916),with a cutoff value of 0.433,a sensi-tivity of 88.1%,and a specificity of 81.7%.In type 2 diabetes patients with MASLD,HbA1c performed best(AUC=0.802),followed by FLI(AUC=0.724);the combined model had the best efficacy(AUC=0.876),with a cutoff value of 0.480,a sensitivity of 95.5%,and a specificity of 77.1%.Conclusions FLI stands out as the most effective single predictor for MASLD screening.Moreover,its efficacy is further enhanced when it is combined with type 2 diabetes,HbA1c,and hs-CRP.Among patients with type 2 diabetes,the combination of FLI,hyperten-sion,HbA1c,and FINS yields the optimal screening results for MASLD.As a non-invasive indicator,FLI holds sig-nificant application value in the early screening of MASLD.

Abstract:Objective To compare the hemodynamic changes and safety of fospropofol disodium and propofol during anesthesia induction in patients undergoing painless endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).Methods Sixty-eight patients scheduled for elective painless EBUS-TBNA,aged 40～65 years with ASA physical status Ⅰ-Ⅲ,were enrolled and randomly allocated(1∶1)to the fospropofol diso-dium group(F group,n=34)or the propofol group(P group,n=34)using a random number table.Anesthesia induction was performed with intravenous sufentanil(0.3 μg/kg),followed by fospropofol disodium(12.5 mg/kg,F group)or propofol(2 mg/kg,P group)within 1 min.Rocuronium(0.6 mg/kg)was administered when the modi-fied observer′s assessment of alertness/sedation scale(MOAA/S)score was ied observerd observerhen the modified observerd transbronchial needle aventilation.Mean arterial pressure(MAP),heart rate(HR),and bispectral index(BIS)were recorded at six time points:entering the operating room(T0),1 min after induction(T1),immediately after laryngeal mask insertion(T2),bronchoscope passing through the glottis(T3),at the end of the EBUS-TBNA procedure(T4),and 3 min after extubation(T5).Intraoperative sedative and vasoactive drug consumption,sedation success rate,and incidence of adverse events were also assessed.Results Compared with the P group,the F group showed significantly higher MAP at T1 and T4(P<0.05),a lower incidence of intraoperative hypotension(P<0.05),and reduced total ephedrine use(P<0.05).The F group had a significantly longer time to loss of consciousness(P<0.05),higher incidence of paresthesia(P<0.05),and lower incidence of injection pain(P<0.01).No significant differences were observed between groups in BIS,HR,sedation success rate,recovery time,or incidence of bradycardia and tachycardia(all P>0.05).Conclusion Compared with propofol,fospropofol disodium provides more stable hemodynamics during general anesthesia for EBUS-TBNA,significantly reducing the incidence of hypotension and injection pain;however,it has a longer induction time and is associated with risks such as skin pruritus and paresthesia.

Abstract:Silent mating type information regulation 2 homolog 1(SIRT1),a highly conserved NAD⁺-dependent deacetylase,is widely expressed in adipose tissue and plays a critical role in the pathogenesis of obesity and insulin resistance(IR).In adipose tissue,SIRT1 ameliorates obesity and related metabolic disorders through multiple mechanisms,including suppression of inflammatory responses,regulation of lipid metabolism,promotion of adipose browning and angiogenesis,and restoration of insulin signaling pathways.Targeted delivery of the SIRT1 agonist resveratrol(Res)to adipose tissue further enhances its therapeutic efficacy against obesity and IR.This article systematically reviews the molecular basis of SIRT1's structure,along with its physiological functions across various organ systems,provides a comprehensive elucidation of its multi-target regulatory network in adipose tissue in the context of obesity and IR,and summarizes various adipose-targeting delivery strategies for SIRT1 agonists,with a focus on Res.The aim is to offer new perspectives and research directions for the treatment of metabolic diseases.

Abstract:Objective To evaluate the safety and feasibility of a novel self-made retractor in subclavian approach endoscopic thyroid surgery.Methods A retrospective analysis was conducted on 180 cases of unilateral papillary thyroid carcinoma surgery performed at the Thyroid Hernia Surgery Department of the First Affiliated Hospital of South Gannan Medical University from January 2023 to April 2025.Among these,57 cases underwent non-inflated thyroid surgery using the novel non-inflated retractor(subclavian group),50 underwent pneumatic transsternal thyroid surgery(transsternal group),and 73 underwent traditional open thyroid surgery(open group).Differences in surgical indicators,postoperative complication rates,and postoperative incision satisfaction were compared among the three groups.Results Compared with the open group,patients in the subclavian group were younger[(40.3±9.4)years vs.(44.8±9.4)years,P<0.05]and underwent longer surgery duration[(81.68±12.08)min vs.(73.01±10.04)min,P<0.05].However,the subclavian group exhibited lower postoperative pain scores on the first day[(2.28±0.92)points vs.(4.19±1.35)points,P<0.05]and higher patient satisfac-tion with postoperative incisions.Compared with the thoracic-mammary group,patients in the subclavian group were older[(40.3±9.4)years vs.(34.9±8.2)years,P<0.05]and had shorter operative times[(81.68±12.08)min vs.(98.18±15.14)min,P<0.05].Additionally,patients in the subclavicular group exhibited lower postoperative pain scores on day 1[(2.28±0.92)points vs.(3.12±1.02)points,P<0.05]and lower total post-operative drainage volume[80(70,100)mL vs.120(100,150)mL,P<0.05].No significant differences were observed between groups in terms of incision satisfaction.There were no statistically significant differences among the three groups in terms of the number of lymph nodes removed,intraoperative blood loss,white blood cell count on postoperative day 1,parathyroid hormone,calcium ion concentration,or postoperative complications(P>0.05).Conclusion The novel non-inflatable retractor effectively maintains the necessary surgical space during subclavicular approach thyroid endoscopic surgery,offering high surgical safety.Compared to traditional open surgery and trans-sternal endoscopic approaches,subclavicular endoscopic thyroid surgery demonstrates reliable therapeutic efficacy and excellent cosmetic outcomes.

Abstract:Objective To investigate the effect of resveratrol(Res)on fibroblast-like synovial cells of osteoarthritis treated with H2O2,and to clarify the regulatory mechanism relationship of the PINK1/Parkin mitochon-drial autophagy signaling pathway in the above effects.Methods Fibroblast-like synovial cells(FLSs)were extracted from the synovial membranes of patients undergoing osteoarthritis surgery and divided into the control group and the experimental group.The experimental group was treated with H2O2(5 µmol/L)and then treated with different concentrations of Res(0,10,20,40,60,80,100 µmol/L).Cell viability assay(CCK-8)was used to detect the inhibition rate of cell proliferation.Cell reactive oxygen species were detected by DCFH-DA fluorescent probe.Mitochondrial reactive oxygen species were detected by MitoSOX Red fluorescent probe.Cell cycle was detected by flow cytometry.The expressions of proteins such as NLRP3,TNF-α,IL-1β,SOD2,Bax,Bcl-2,BNIP3,LC3B,p62,PINK1 and Parkin were detected by Western blot and immunofluorescence experiments.The role of the PINK1/Parkin mitochondrial autophagy signaling pathway in Res'inhibition of abnormal proliferation,inflammation and oxidative stress in FLSs was further verified using PINK1 and Parkin interfering RNA.Results Res signifi-cantly inhibited the enhancement of FLSs activity induced by H2O2,and reduced the abnormal proliferation,inflammation and oxidative stress levels of FLSs;Res inhibited the expressions of NLRP3,TNF-α,Bcl-2 and p62 proteins,while promoting the expressions of SOD2,Bax,BNIP3,LC3B,PINK1 and Parkin proteins.H2O2 inhib-ited the PINK1/Parkin signaling pathway,while Res activated the PINK1/Parkin pathway.The use of PINK1 and Parkin interfering RNA exacerbated cellular inflammation and oxidative stress.Conclusion Res activates the PINK1/Parkin mitochondrial autophagy signaling pathway by increasing the expression of PINK1 and Parkin proteins,alleviating abnormal proliferation,inflammation and oxidative stress in fibroblast-like synovial cells of osteoarthritis induced by H2O2.

Abstract:Objective To investigate the effect of ursolic acid on liver injury induced by neodymium oxide in rats based on the Nrf2/GPX4 signaling pathway and explore its underlying mechanism.Methods Sixty 6-week-old specific pathogen-free(SPF)grade Sprague-Dawley(SD)rats were randomly allocated into six groups(n=10 per group):a blank control group,a neodymium oxide model group,low-dose,medium-dose,and high-dose urso-lic acid groups,and a diammonium glycyrrhizinate group.After a 9-week intervention period,the rats were fasted for 12 hours with free access to water prior to sacrifice.Hepatic histopathology was examined using hematoxylin and eosin(HE)staining.Serum biochemical markers of liver function were assayed.The levels of superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),tumor necrosis factor-α(TNF-α),inter-leukin-1β(IL-1β),and interleukin-10(IL-10)were detected by enzyme-linked immunosorbent assay(ELISA).The Fe²⁺ content in the liver was determined through colorimetry.The protein expression levels of nuclear factor erythroid 2-related factor 2(Nrf2)and glutathione peroxidase 4(GPX4)in liver tissue were measured by Western blotting.Results In comparison with the normal control group,the model group exhibited fatty vacuoles of varying sizes and extensive infiltration of inflammatory cells in the liver tissue.The activities of serum alanine aminotrans-ferase(ALT)and aspartate aminotransferase(AST),the levels of malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and the content of Fe²⁺ were significantly elevated(P<0.05),whereas the levels of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),and interleukin-10(IL-10)were significantly decreased(P<0.05).After the intervention of ursolic acid,hepatic steatosis was remarkably improved,and the infiltration of inflammatory cells was reduced.The activities of serum ALT and AST,the levels of MDA,TNF-α,IL-1β,and the content of Fe²⁺ were significantly decreased(P<0.05),while the levels of SOD,GSH-Px,and IL-10 were significantly increased(P<0.05).Western blot results indicated that,when compared with the normal control group,the protein expression of nuclear factor erythroid 2-related factor 2(Nrf2)and glutathione peroxidase 4(GPX4)in the liver of the model group was significantly reduced(P<0.05).Never-theless,after the intervention of ursolic acid,the expression of Nrf2 and GPX4 proteins was significantly increased(P<0.05).Conclusion Ursolic acid exerts a protective effect against neodymium oxide-induced liver injury in rats.Its mechanism may be associated with the regulation of the Nrf2/GPX4 signaling pathway,which can reduce the inflammatory response,alleviate oxidative stress,and consequently inhibit ferroptosis.

Abstract:Objective To analyze the immunophenotypic and genetic characteristics of children with acute megakaryoblastic leukemia(AMKL)and provide relevant evidence for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical data of 45 children with AMKL who were admitted to the hospital from September 2017 to December 2024,including 23 males and 22 females.Among them,7 cases were Down syndrome-associated AMKL(DS-AMKL),and 38 cases were non-DS-AMKL.Flow cytometry was used for immunophenotypic analysis,G-banding for karyotype analysis,and RT-PCR and sequencing for fusion gene detection.Results The most common clinical manifestation of AMKL children at initial diagnosis was skin ecchymosis or petechiae,with a median platelet count of 17(3～222)×109/L.All children expressed at least one of the platelet-associated glycoproteins CD41a,CD42b,or CD61 in bone marrow blasts,with CD41a having the highest expression rate(84.4%).Compared to non-DS-AMKL,DS-AMKL children had significantly higher detection rates of CD7,CD13,and CD36(P<0.05),while CD41a had a significantly higher detection rate in non-DS-AMKL(P<0.05).Karyotype analysis was performed in 41 children,and chromosomal abnormalities were detected in 33 cases(80.5%),including 14 cases(34.1%)with complex karyotypes.Fusion gene testing was performed in 21 non-DS-AMKL children,revealing 6 cases of CBFA2T3::GLIS2,2 cases of NUP98::KDM5A,and 1 case each of NUP98::ING4,RBM15::MKL1,and KMT2A::MLLT3.Children positive for CBFA2T3::GLIS2 exhibited a characteristic immunophenotype,with high expression of CD56 and no expression of HLA-DR or CD36.Conclusions Pediatric AMKL is a highly heterogeneous disease with relatively characteristic immunophenotypes,a high rate of chromo-somal abnormalities,and CBFA2T3::GLIS2 being the most common fusion gene.Immunophenotypic and genetic molecular testing and analysis can improve the diagnosis and identification of AMKL,enabling better prognostic stratification and treatment selection.