Abstract:Objective To explore the evaluation value of soluble CD163(sCD163),stress hyperglycemia ratio(SHR),adrenomedullin precursor(pro-ADM),and pentraxin 3(PTX3)in combination with the score of chest computed tomography(CT)in elderly patients with stroke-related pneumonia.Methods A total of 112 elderly patients with stroke-related pneumonia who were admitted to our hospital between March 2023 and March 2025 were selected as the research subjects.After 3 months of treatment,they were divided into the good prognosis group(77 cases)and the poor prognosis group(35 cases).Additionally,they were classified into the mild group(36 cases),the moderate group(45 cases),and the severe group(31 cases)according to the severity of the patients'illness.The serum levels of sCD163,SHR,pro-ADM,and PTX3,as well as chest CT scores,were com-pared among the groups.Pearson correlation analysis was used to assess the relationships.The poor prognosis group was defined as positive and the favorable prognosis group as negative.Then,the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value,and the area under the curve(AUC)was obtained.Results The levels of serum sCD163,SHR,pro-ADM,PTX3,and the chest CT score in the severe group were higher than those in the moderate and mild groups,and the levels in the moderate group were higher than those in the mild group(P<0.05).Inter-group comparisons between the poor prognosis group and the good prognosis group revealed that the levels of serum sCD163,SHR,pro-ADM,PTX3,and the chest CT score were higher in the poor prognosis group(P<0.05).Pearson correlation analysis showed that the levels of serum sCD163,SHR,pro-ADM,and PTX3 were positively correlated with the chest CT score(r=0.775,0.615,0.825,0.866,P<0.05).The levels of serum sCD163,SHR,pro-ADM,PTX3,the chest CT score,and the NIHSS score were positively correlated(r=0.682,0.793,0.847,0.805,0.762,P<0.05).The ROC analysis showed that the AUC value of the combined detection of the levels of serum sCD163,SHR,pro-ADM,and PTX3 and the chest CT score in predicting the prognosis of elderly patients with stroke-related pneumonia was 0.903,which was higher than that of each individual index(0.803,0.758,0.786,0.787,and 0.752,P<0.05).Conclusion Serum levels of sCD163,SHR,pro-ADM,and PTX3,along with chest CT scores,were associated with the condition and progno-sis of elderly patients with stroke-related pneumonia.Moreover,the combined detection of these five indicators was more valuable in predicting the prognosis of elderly patients with stroke-related pneumonia.

Abstract:Objective To explore the association of multiple abnormal body compositions(sarcopenia,myosteatosis,visceral obesity,osteoporosis)with the risks of moderate-to-severe hepatic steatosis and significant liver fibrosis in patients with metabolic associated fatty liver disease(MAFLD).Methods A retrospective study was conducted in 392 adult patients with MAFLD admitted to our hospital between June 2022 and June 2023.Based on liver fat content assessed by quantitative CT,the MAFLD patients were divided into a mild steatosis group(210 cases)and a moderate-to-severe steatosis group(182 cases).General information and hematological indicators of all subjects were collected,and body composition was quantitatively evaluated using AI-based body composition analysis technology.Pearson or Spearman correlation analyses were employed to examine relationships between body composition parameters and hepatic fat content.Multivariate logistic regression analysis was used to determine whether abnormal body composition is an independent risk factor for moderate-to-severe hepatic steatosis and significant liver fibrosis.Results Compared to patients with mild hepatic steatosis,those with moderate-to-severe steatosis exhibited significantly higher prevalence of sarcopenia,visceral obesity,and osteoporosis(P<0.05).Skeletal muscle index(r=-0.131,P=0.009),muscle attenuation(r=-0.105,P=0.038),and bone mineral density(r=-0.135 P=0.007)demonstrated inverse correlations with hepatic fat content,while intermus-cular fat fraction(r=0.121,P=0.016),visceral fat index(r=0.434,P<0.001),and subcutaneous fat index(r=0.289,P<0.001)showed positive correlations.After adjusting for multiple confounders,osteoporosis(OR=2.04,95%CI:1.03～4.03,P=0.041),sarcopenia(OR=2.19,95%CI:1.37～3.52,P=0.001),and visceral obesity(OR=1.84,95%CI:1.08～3.15,P=0.026)were all independent risk factors for moderate-to-severe hepatic steatosis.Additionally,after bias adjustment,osteoporosis(OR=2.63,95%CI:1.37～5.05,P=0.004),sarcopenia(OR=1.94,95%CI:1.28～2.94,P=0.002)and visceral obesity(OR=2.54,95%CI:1.58～4.08,P<0.001)were also independent risk factors for significant liver fibrosis.Conclusion Patients with moderate-to-severe MAFLD are predisposed to concurrent body composition abnormalities,including sarcopenia.Importantly,osteoporosis,sarcopenia and visceral obesity are not only key independent risk factors for moderate-to-severe hepatic steatosis,but also significantly increase the risk of liver fibrosis.Early identification,prevention,and intervention should be implemented.

Abstract:Objective To investigate the efficacy of Xingnao Kaiqiao acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)in promoting arousal in patients with persistent vegetative state(PVS).Methods A total of 70 eligible PVS patients were randomly assigned to an observation group or a control group,with 35 patients in each group.Both groups received conventional basic treatment and rehabilitation training.The control group was treated with rTMS alone,while the observation group received rTMS plus Xingnao Kaiqiao acupuncture.Treatments were administered once daily,five times per week,with a two-day interval each week,for a total of 6 weeks.The Glasgow Coma Scale(GCS),Coma Recovery Scale-Revised(CRS-R),and Chinese Vegetative State Scale(CVSS)scores were observed before and after treatment,and the arousal rate after treatment was evaluated.Results After treatment,both groups showed significant increases in GCS,CRS-R,and CVSS scores(P<0.05).The observation group demonstrated higher scores on the GCS,CRS-R,and CVSS compared to the control group(P<0.05).The arousal rate was 38.70%(12/31)in the observation group,which was significantly higher than that in the control group(15.62%,5/32;P<0.05).Conclusion Xingnao Kaiqiao acupuncture combined with rTMS can effectively improve the level of consciousness in patients with PVS.

Abstract:Objective To investigate the myocardial protective effects and clinical value of lidocaine in cardiopulmonary bypass(CPB)non-arrested(beating-heart)mitral valve replacement surgery.Methods A total of 50 patients who underwent CPB beating-heart mitral valve replacement between January 2023 and September 2025 were randomly divided into two groups:Group A(lidocaine+beating-heart group)and Group B(beating-heart only group).The two groups received identical anesthesia induction and maintenance protocols.However,Group A additionally received an intravenous infusion of lidocaine at 1.5 mg/kg 10 minutes before anesthesia induction,followed by continuous infusion at a rate of 1.5 mg/(kg·h)until the end of surgery.Group B received only the beating-heart surgical technique without lidocaine.Plasma levels of high-sensitivity cardiac troponin T(TNT-HS),myoglobin(MYO),creatine kinase(CK),and creatine kinase-MB(CK-MB)were measured preoperatively(T0),at 6 hours postoperatively(T1),and at 12 hours postoperatively(T2).Results Compared with Group B,Group A showed significantly lower plasma levels of TNT-HS,MYO,CK,and CK-MB at T1 and T2(P<0.05).In both groups,these markers were significantly elevated at T1 and T2 compared with T0(P<0.05).Conclusion Lidocaine demonstrates significant myocardial protection during on-pump beating-heart mitral valve replacement surgery,effectively suppresses hemodynamic fluctuations during endotracheal intubation,and reduces the incidence of perioperative ventricular arrhythmias.

Abstract:Objective To investigate the effects of ultrasound-guided bilateral superficial cervical plexus nerve block using ropivacaine or ropivacaine combined with different adjuvants on postoperative analgesia and recovery quality in patients undergoing radical thyroid cancer surgery.Methods A total of 140 patients scheduled for radical thyroid cancer surgery were randomly allocated into 4 groups:the general anesthesia group(Group C),the general anesthesia+ropivacaine group(Group R),the general anesthesia+ropivacaine combined with dex-medetomidine group(Group R1),and the general anesthesia+ropivacaine combined with dexamethasone group(Group R2).The observation indicators included the intraoperative consumption of sedative and analgesic drugs,postoperative analgesia requirements,postoperative recovery,resting and active Visual Analogue Scale(VAS)scores,Richards-Campbell Sleep Questionnaire scores,QoR-15 scores,and adverse reactions at different time points after anesthesia.Results Compared with Group C,both the resting and activity VAS scores in Group R were lower within 12 hours after surgery(P<0.05).Similarly,within 24 hours after surgery,the resting and activity VAS scores in Groups R1 and R2 were lower(P<0.05).Moreover,the postoperative RCSQ scores and QoR-15 scores in all three groups(R,R1,R2)were higher(P<0.05).When compared with Group R,the VAS scores in Groups R1 and R2 were lower within 6 to 24 hours post-surgery(P<0.05),and the postoperative RCSQ scores and QoR-15 scores on the first postoperative day were higher(P<0.05).Conclusions Bilateral superficial cervical plexus nerve block with ropivacaine or combined with different adjuvants is superior to general anesthesia in improving intraoperative hemodynamics,reducing the consumption of sedative and analgesic drugs,enhancing analgesic efficacy,and promoting recovery quality in patients undergoing radical thyroid cancer surgery.Ropiva-caine combined with adjuvants has better analgesic effects and recovery quality than ropivacaine alone.

Abstract:Objective To investigate the effect of Qushi Huoxue decoction(QSHXF)on free fatty acid(FFA)-induced HepG2 cells and its underlying mechanism.Methods In vitro cell experiments were conducted.First,the CCK-8 assay was used to determine the effects of different concentrations of QSHXF on HepG2 cells viability to select appropriate concentrations for subsequent experiments.A fatty liver cell model was then established by treating HepG2 cells with a mixture of 250 μmol/L sodium palmitate and 500 μmol/L sodium oleate for 24 h,followed by intervention with different concentrations of QSHXF-containing serum and AMPK inhibitor for another 24 h.Intracellular lipid droplet accumulation was observed using Oil Red O staining and lipid fluorescence staining.The levels of total cholesterol(TC)and triglycerides(TG)were measured using the GPO-PAP enzymatic method.The TBA method and hydroxylamine method were used to detect malondialdehyde(MDA)and superoxide dis-mutase(SOD),respectively,while ELISA was used to detect tumor necrosis factor-α(TNF-α)and interleukin 1β(IL-1β).Furthermore,qRT-PCR,Western blot,and immunofluorescence staining were performed to detect the expression of lipid metabolism-related genes and proteins.Results QSHXF significantly improved the lipid deposition,oxidative stress and inflammatory response of FFA-induced HepG2 cells,markedly reduce the content of TC,TG,MDA,TNF-α and IL-1β in cells and increase the activity of SOD(P<0.01).Meanwhile,it increased the mRNA expression of AMPK and the protein ratio of p-AMPK/AMPK,while decreasing the mRNA and protein levels of SREBP1c,FASN,ACC1,and SCD1(all P<0.05).Conclusion QSHXF significantly improved lipid metabolism and alleviated oxidative stress and inflammation in the MASLD cell model,and its mechanism may be associated with the activation of the AMPK/SREBP1c signaling pathway.

Abstract:Objective To analyze the independent risk factors for carbapenem-resistant Klebsiella pneu-moniae(carbapenem-resistant Klebsiella pneumoniae,CRKP)infection in clinical patients,and further establish a nomogram model applicable for individualized risk prediction.Methods Clinical data of 422 patients with Klebsi-ella pneumoniae infection admitted to Chaohu Hospital Affiliated to Anhui Medical University from January 2023 to June 2025 were collected retrospectively.Using R software,the data were randomly split into a training set(295 cases)and a validation set(127 cases)at a ratio of 7∶3.LASSO and Logistic regression were used to identify risk factors,and a nomogram for the CRKP infection risk prediction model was further constructed with its performance analyzed.Results Multivariate analysis revealed five independent risk factors for CRKP infection in patients,namely ICU admission(OR=4.883,95%CI:1.842～12.946),tracheotomy/tracheal intubation(OR=4.784,95%CI:1.763～12.981),sputum aspiration(OR=2.309,95%CI:0.767～6.954),carbapenem administration(OR=4.832,95%CI:1.944～12.009),and combined antibacterial agent use(OR=2.239,95%CI:0.938～5.341).Subsequently,a prediction model was established based on these five variables screened from the training set,with the formula expressed as:Logit(P)=-3.632+[ICU admission(yes=1,no=0)]×1.586+[Carbapenem use(yes=1,no=0)]×1.575+[combined use of antibiotics(yes=1,no=0)]×0.806+[sputum suction(yes=1,no=0)]×0.837+[tracheotomy/tracheal intubation(yes=1,n o=0)]×1.565.The area under the receiver operating characteristic curve(AUC)was 0.921(95%confidence interval[CI]:0.880～0.961)in the training set and 0.914(95%CI:0.846～0.983)in the validation set.The calibration curves generated for both the training set and validation set in this study demonstrated favorable consistency between the probability of CRKP infection predicted by the established model and the actual CRKP infection probability observed in clinical practice.The Hosmer-Lemeshow(H-L)test indicated that the model had a good degree of calibration.Decision curve analy-sis(DCA)further validated the favorable clinical utility of the constructed model.Conclusion The constructed risk prediction model can well predict high-risk patients with CRKP infection and can be used as a tool to assess the risk of CRKP infection in hospitalized patients.

Abstract:Objective To develop a deep learning-based tongue image classification system for psoriasis to improve the objective differentiation between the patterns of Spleen Deficiency with Dampness Retention(SDDR)and Blood Stasis(BS).Methods A total of 981 tongue images from psoriasis patients diagnosed with SDDR or BS were collected.An improved U-Net model,featuring a ResNet-34 encoder,bilinear interpolation upsampling,and optimized skip connections,was employed for automatic tongue region segmentation.Macenko color normalization and the Albumentations library were applied for data augmentation to mitigate variances from imaging devices and lighting conditions.A two-stage framework was constructed:the first stage precisely extracted the tongue body region,while the second stage utilized a Hybrid Model integrating EfficientNet-B3 and Swin-Tiny architectures for pattern classification.A cross-modal multi-head attention mechanism was introduced to fuse local textural and global structural features.Results The improved U-Net achieved superior performance in tongue seg-mentation,with a Dice coefficient of 0.98 and an IoU of 0.89,significantly outperforming the original U-Net(Dice 0.85).For pattern classification,the Hybrid Model demonstrated the best overall performance,achieving a 5-fold cross-validation mean accuracy of 0.9816 and a mean AUC of 0.9993.The F1-score was significantly higher than those of individual models.Macenko normalization contributed to an 8.3% increase in F1-score.The inference time per image was 38 ms on an A10 GPU,meeting the requirement for clinical real-time application.Conclusion The constructed two-stage tongue image classification model effectively and accurately distinguishes between SDDR and BS patterns in psoriasis,significantly enhancing the objectivity of tongue diagnosis.It provides a reliable tool for pattern differentiation in Traditional Chinese Medicine and shows promising potential for clinical application.

Abstract:Objective To explore the mediating role of sleep quality in adolescents between rumination and depressive symptoms.Methods From October 2023 to September 2024,300 adolescents were selected for investigation and analysis by simple random sampling.All subjects were evaluated using the Pittsburgh Sleep Quality Index(PSQI),the Redundancy Response Scale(RRS-C),and the Center for Epidemiological Investigation Depression Scale(CES-D).Pearson correlation analysis was employed to examine the correlations among the CES-D depression symptoms,PSQI sleep quality,and RRS-C rumination scores in adolescents.Hierarchical regression analysis was utilized to explore the influencing factors of depressive symptoms in adolescents.Furthermore,the mediating role of sleep quality in the relationship between rumination and depressive symptoms was tested using Model 4 of the mediation model from the SPSS Process program developed by Hayes.The significance of the mediating effect was examined using the Bootstrap sampling method.Results The PSQI,RRS-C and CES-D scores of 300 adolescents were(12.06±2.14)points,(34.03±6.17)points and(24.30±4.37)points respectively.The CES-D score was positively correlated with the RRS-C and PSQI scores(r=0.513,P<0.001;r=0.526,P<0.001),and the PSQI score was positively correlated with the RRS-C score(r=0.440,P<0.001).After controlling for confounding factors,the PSQI score could explain 51.3% of the CES-D score.After introducing the RRS-C score,the RRS-C score could explain 50.9% of the CES-D score.In the final model,gender,being an only child,suffering from school bullying,RRS-C score,and PSQI score entered the regression equation.The above influencing factors could explain 60.7% of the CES-D score of adolescents.Rumination could positively predict depressive symptoms and sleep quality.After increasing the mediating variable sleep quality,rumination and sleep quality had a positive predictive effect on depressive symptoms.The mediating effect of sleep quality between rumination and depressive symptoms in adolescents accounted for 31.64%.Conclusion There exists a significant association between rumi-nation and depressive symptoms in adolescents,in which sleep quality serves as a mediating role.This suggests that focusing on and implementing combined interventions targeting both rumination and sleep quality may hold sig-nificant potential value in future research.

Abstract:Objective To explore and analyze the efficacy of different doses of intravenous immunoglobulin(IVIG)combined with aspirin in the treatment of children with Kawasaki disease(KD),along with its impact on lipid metabolism parameters,DeRitis ratio[aspartate aminotransferase(AST)/alanine aminotransferase(ALT)],and platelet parameters.Methods A retrospective analysis was carried out to gather the clinical data of KD chil-dren admitted to the pediatrics department of the hospital from January 2021 to January 2025.All the acquired data were sourced from the hospital's electronic medical record database and follow-up database.The children were grouped based on the dosage of IVIG.Specifically,children with KD treated with high-dose IVIG(3 g/kg)in com-bination with aspirin were assigned to the high-dose group,those treated with conventional-dose IVIG(2 g/kg)in combination with aspirin were assigned to the conventional-dose group,and those treated with low-dose IVIG(1 g/kg)in combination with aspirin were assigned to the low-dose group.To minimize the interference of baseline condi-tions,the propensity score matching method was employed to balance the baseline data of the three groups.Using the 1∶1∶1 nearest-neighbor matching method with a clamp value set at 0.03,39 cases of data were ultimately ob-tained for each group.The therapeutic effects,lipid metabolism[total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),very-low-density lipoprotein cholesterol(vLDL-C)],platelet parameters[platelet distribution width(PDW),platelet count(PLT),plateletcrit(PCT),mean platelet volume(MPV),large platelet ratio(P-LCR)],coronary Z-score value,and safety of the three groups were compared.Results The high-dose group exhibited a higher total effective rate compared to the low-dose group(P<0.05).After one week of treatment,the levels of HDL-C in both the high-dose group and the conventional-dose group increased when compared to those before treatment(P<0.05).In all three groups,the levels of TG decreased(P<0.05),and the levels of ApoA1 in-creased(P<0.05).After one week of treatment,the levels of HDL-C and ApoA1 in the high-dose group were higher than those in the other two groups,whereas the ratios of TG and DeRitis were lower(P<0.05).After one week of treatment,the values of PDW,PLT,MPV,and P-LCR in all three groups decreased(P<0.05).The high-dose group had lower values of PDW,PLT,and P-LCR than the other two groups,and a lower value of MPV than the low-dose group(P<0.05).During the 12-week follow-up,the Z-score values of the right coronary artery,left coronary artery,and left anterior descending branch in each group were all lower than those before treatment(P<0.05),and the values in the high-dose group were lower than those in the other two groups(P<0.05),with no statistically significant difference between the other two groups(P>0.05).There was no statistically significant difference in the incidence of adverse reactions and cardiovascular-related complications(P>0.05).Conclu-sions High-dose IVIG combined with aspirin demonstrates a superior therapeutic effect on KD.It offers more ad-vantages in short-term lipid regulation and platelet function regulation.Moreover,it can mitigate liver damage,re-duce the DeRitis ratio,and diminish the risk of coronary artery injury.

Abstract:Objective To explore the efficacy of sintilimab in combination with concurrent chemoradio-therapy(CCRT)for the treatment of oligometastatic non-small cell lung cancer(NSCLC)and its impact on the levels of serum vascular endothelial growth factor(VEGF),nuclear transcription factor κB(NF-κB),and programmed cell death protein ligand-1(PD-L1)in patients.Methods From April 2020 to July 2024,a total of 150 patients with oligometastatic NSCLC who received treatment at Zhangjiagang First People's Hospital were randomly assigned to the control group(n=75,CCRT)and the observation group(n=75,sintilimab+CCRT)using the random number table method.The short-term therapeutic effects,serum tumor markers,immune function,VEGF,NF-κB,and PD-L1 levels of the two groups were compared before and after treatment.Additionally,the toxic and side effects and prognosis were evaluated.Results The observation group exhibited significantly higher objective response rate and disease control rate(59.72%and 83.33%respectively)compared to the other group(40.00%and 68.57%respectively)(P<0.05).After treatment,the serum levels of tumor markers,including VEGF,NF-κB,and PD-L1,in the observation group were all significantly lower(P<0.05),whereas the levels of CD4+and the ratio of CD4+/CD8+were significantly higher(P<0.05).After treatment,the observation group achieved significantly higher scores in the total health status and functional dimension of the Quality of Life scale developed by the European Organization for Research and Treatment of Cancer than the other group(P<0.05),while having a significantly lower score in the symptom domain(P<0.05).The observation group exhibited a higher incidence of immune-related adverse reactions(15.28%vs.0.00%)(P<0.05).There was no statistically significant difference in other toxic and side effects between the two groups(P>0.05).The observation group demonstrated better overall survival and progression-free survival functions(P<0.05).Conclusions Compared with CCRT,the combination of sintilimab and CCRT can enhance the short-term efficacy in NSCLC patients with oligometastasis,boost their immune function,down-regulate tumor markers as well as the levels of serum VEGF,NF-κB,and PD-L1.This is beneficial for improving the patients'prognosis and does not significantly increase severe adverse effects.

Abstract:Objective To construct an optimal risk prediction model for diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM)based on routine blood indicators combined with the systemic immune-inflammation index(SII)and systemic inflammation response index(SIRI),and to compare the predictive performance of different machine learning models,so as to provide an effective tool for the early screening of DKD.Methods A total of 658 T2DM patients hospitalized in the Affiliated Hospital of Traditional Chinese Medicine of Guangzhou Medical University from January 2023 to November 2024 were retrospectively selected as the research subjects.The patient data were divided into a training set(460 cases)and a test set(198 cases)at a ratio of 7∶3 using the computer simple random sampling method.First,LASSO regression was used to screen 12 potential pre-dictive features including SII and SIRI.Then,based on the screened variables,four machine learning algorithms,namely logistic regression(LR),support vector machine(SVM),random forest(RF),and extreme gradient boosting(XGBoost),were applied to construct risk prediction models for DKD in T2DM patients.Indicators such as AUC value,sensitivity,accuracy,and F1 score were used to comprehensively evaluate the discrimination of the models,and the calibration curve and decision curve analysis(DCA)were used to evaluate the calibration and clinical utility of the models respectively.Finally,the SHAP method was used to conduct interpretability analysis of the optimal model.Results Ten predictive features were screened out by LASSO regression.SHAP values showed that creatinine had high importance in all four risk prediction models.The AUC values of the LR,RF,SVM,and XGBoost models in the test set were 0.914,0.943,0.929,and 0.917 respectively,and the F1 scores were 0.627,0.737,0.474,and 0.772 respectively.The overall accuracies obtained from the confusion matrix heat maps were 90.4%,92.4%,89.9%,and 93.4%respectively.The prediction accuracies of RF and XGBoost for DKD occurrence in the confusion matrix heat maps were relatively high,at 72.4%and 75.9%respectively.DCA showed that all four models had positive clinical net benefits at most threshold probabilities.Conclusion The RF and XGBoost models can accurately predict the risk of DKD in T2DM patients,which is helpful for clinicians to identify high-risk T2DM patients with DKD at an early stage.

Abstract:Objective To evaluate the effects of different antibiotic regimens applied in orthopedic joint surgery through multi-departmental collaboration on optimizing nursing human resource allocation and reducing medical consumables expenditure,and to verify whether its safety in preventing infection is non-inferior to the traditional regimen.Methods A retrospective cohort study was conducted.A total of 1 948 patients from the Department of Knee Surgery between May 10,2021,and May 22,2024,were selected.A subgroup analysis of inflammatory markers was performed on 303 of these patients(44 hip joints,259 knee joints).Patients were divided into a single-dose group(972 cases)and a multiple-dose group(976 cases)based on the antibiotic regimen.The single-dose group received only one postoperative dose of antibiotics,while the multiple-dose group received multiple postoperative doses.The primary outcome was the relationship between the number of antibiotic packages used and the incidence of prosthetic joint infection(PJI)within 12 months postoperatively.Secondary outcomes included inflammatory markers:white blood cell count(WBC),neutrophil count,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR);cost-effectiveness indicators:antibiotic infusion cost(as a single hospital-ization expense);and nursing workload:infusion distance plus needle removal distance.Statistical analyses included logistic regression and the Mann-Whitney U test.Results The overall incidence of prosthetic joint infection(PJI)at 12 months postoperatively was low.The PJI rates in the single-dose and multiple-dose groups were 1.5%(15/972)and 1.3%(13/976),respectively,with no statistically significant difference(OR=1.039,95%CI:0.927～1.164,P=0.512).Subgroup analysis results:For hip arthroplasty patients using cefuroxime sodium,inflammatory markers(WBC,neutrophils,CRP,ESR)showed statistically significant differences at various time points within each group(P<0.05),but no statistically significant intergroup differences were observed(P>0.05).For knee arthroplasty patients using cefazolin sodium,inflammatory markers(WBC,neutrophils,CRP,ESR)showed statistically significant differences at various time points within each group(P<0.05).The intergroup difference for CRP was not comparable(P<0.05),while no statistically significant intergroup differences were found for the remaining markers(P>0.05).For knee arthroplasty patients using cefuroxime sodium,inflammatory markers(WBC,neutrophils,CRP,ESR)showed statistically significant differences at various time points within each group(P<0.05).The intergroup difference for ESR was not comparable(P<0.05),while no statistically significant intergroup differences were observed for the remaining markers(P>0.05).Cost-effectiveness analysis:The median antibiotic cost in the single-dose group was significantly lower than that in the multiple-dose group(74.13 RMB vs.164.16 RMB,Z=-39.090,P<0.001).The nursing workload(infusion distance+needle removal distance)was reduced by a median of 67.1%(298.4 meters vs.907.8 meters,Z=-37.536,P<0.001).Conclusions The single-dose antibiotic regimen is comparable to the multiple-dose regimen in preventing infec-tions,while significantly reducing medical costs(by 55%)and nursing workload(by 67%).Its clinical adoption is recommended.This study is a single-center retrospective investigation,and future multi-center prospective stud-ies are warranted for further validation.

Abstract:Objective To investigate the application of CT perfusion(CTP)parameters,carcinoembryonic antigen(CEA),and alpha-fetoprotein(AFP)in monitoring recurrence after transcatheter arterial chemoemboliza-tion(TACE)in patients with primary hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on 203 HCC patients who underwent TACE at the hospital from September 2022 to September 2023.CTP parameters[blood flow(BF),blood volume(BV),hepatic arterial perfusion index(HAI),portal venous perfusion(PVP)],CEA,and AFP levels were measured before and one month after TACE.Patients were followed up for one year and divided into recurrence and non-recurrence groups based on tumor status.Differences in BF,BV,HAI,PVP,CEA,and AFP levels between the two groups were compared.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of these indicators for post-TACE recurrence,and logistic regression was used to analyze influencing factors.Results Compared with pre-TACE levels,BF,BV,HAI,CEA,and AFP decreased one month after TACE,while PVP increased(P<0.05).Among the 203 patients,75(36.95％)experienced recurrence,while 128(63.05％)remained recurrence-free.Compared with the non-recurrence group,the recurrence group exhibited higher BF,BV,HAI,CEA,and AFP levels and lower PVP(P<0.05).The AUC values for BF,BV,HAI,PVP,CEA,and AFP in predicting recurrence were 0.771,0.787,0.787,0.735,0.771,and 0.795,respectively.The combined detection of these indicators yielded an AUC of 0.968(P<0.05).Logistic regression identified BF,BV,HAI,PVP,CEA,and AFP as independent risk factors for post-TACE recurrence(P<0.05).Conclusion CTP combined with serum tumor markers can effectively predict early recurrence in HCC patients after TACE.

Abstract:In recent years,pancreatic adenosquamous carcinoma(PASC)has drawn growing attention owing to its rarity and highly aggressive characteristics.As a distinct subtype defined by the co-existence of adeno-carcinoma and squamous carcinoma components,PASC is linked to substantially worse prognoses compared to pancreatic ductal adenocarcinoma,with a median survival period of merely six months.This review outlines the key molecular mechanisms underlying PASC,such as the inactivation of the TP53/NOTCH pathways,the up-regulation of the transcriptional regulator ΔNp63 and the transcription factor SRY-box transcription factor 2(SOX2),along with enhancer of zeste homolog 2(EZH2)-mediated epigenetic remodeling,and deliberates on their functions in lineage transdifferentiation and tumor plasticity.We further synthesize findings from high-throughput sequencing and single-cell multi-omics studies to depict the immunosuppressive traits of the PASC tumor microenvironment and their implications for therapeutic resistance.Current challenges are also addressed,including the scarce number of reported cases,the absence of high-level clinical evidence,and the disparity between mechanistic studies and clinical translation.Finally,we suggest that future research ought to concentrate on establishing multicenter clinical cohorts and molecular stratification approaches,and on exploring novel therapeutic strategies like combining epigenetic inhibitors with immunotherapy,with the ultimate aim of enhancing patient outcomes.

Abstract:Objective Comparison of the treatment efficacy between percutaneous lauromacrogol injection(PLI)combined with microwave ablation(MWA)and PLI alone for cystic or predominantly cystic thyroid nodules.Methods This study retrospectively analyzed 90 cystic or predominantly cystic thyroid nodules that were treated with either PLI or PLI+MWA at Shanghai Ninth People's Hospital from January 2021 to March 2025.All cases were confirmed to be benign through preoperative ultrasound and fine-needle aspiration.The size of the nodules was assessed by ultrasound at 1,3,and 6 months after treatment,and the volume reduction rate(VRR)was calculated.Results A total of 81 patients(90 nodules)were incorporated into the analysis,including 20 males(24 nodules)and 61 females(66 nodules).Among these nodules,59 received PLI treatment,whereas 31 underwent PLI+MWA.Both PLI and PLI+MWA treatments led to a significant reduction in the volume of thyroid nodules.Although the baseline nodule volumes in the PLI+MWA group were larger than those in the PLI group[(17.27±10.49)mL vs.(12.12±11.03)mL,P=0.033],there were no significant differences in nodule volumes between the two groups at 1,3,and 6 months after treatment[(4.02±7.95)mL vs.(7.47±6.93)mL;(2.98±6.31)mL vs.(2.43±2.62)mL;(3.64±8.82)mL vs.(1.09±2.10)mL;all P>0.05].Furthermore,at the 3-month[(14.77±8.48)mL vs.(8.36±9.24)mL,P=0.025]and 6-month[(14.53±6.86)mL vs.(4.79±3.99)mL,P=0.001]follow-ups,the PLI+MWA treatment group showed a significantly greater reduction in nodule volume from the baseline compared to the PLI-only group.One month after treatment,the VRR in the PLI group was higher than that in the PLI+MWA group[83.44%(66.97%,93.07%)vs.52.53%(17.62%,90.66%),P=0.011].However,six months after the operation,the VRR in the PLI+MWA group was significantly higher than that in the PLI group[83.44%(66.97%,93.07%)vs.81.68%(58.43%,96.96%),P=0.019].Moreover,six months after treatment,the cure rate(VRR>90%)in the PLI+MWA group was significantly higher than that in the PLI group(87.5%vs.33.3%,P=0.024).Conclusions Both ultrasound-guided PLI and PLI+MWA are effective therapeutic modalities for benign thyroid nodules with cystic or predominantly cystic components.Significantly,at 6 months after treatment,PLI+MWA yielded notably superior therapeutic outcomes compared to PLI monotherapy.

Abstract:The equilibrium of bone homeostasis is crucial for sustaining skeletal health,which depends on the precise regulation between bone formation mediated by osteoblasts and bone resorption mediated by osteoclasts.In recent years,with the progress of osteoimmunology research,more and more attention has been devoted to the role of immune cell-derived factors in bone homeostasis.A growing amount of evidence demonstrates that cytokines such as interleukins(ILs),tumor necrosis factors(TNFs),and interferons(IFNs)not only take part in immune responses but also directly or indirectly regulate bone remodeling by affecting osteoblast differentiation,osteoclasto-genesis,and osteoclast activity.However,systematic summaries that address the relationship between immune cell-derived cytokines and bone homeostasis are still relatively scarce.This is especially true when it comes to the mechanisms of action,signaling pathways,and pathological roles of different cytokines in bone-related diseases such as osteoporosis,rheumatoid arthritis,and osteoarthritis.This review intends to comprehensively investigate the effects of immune cell-derived cytokines,including interleukins,tumor necrosis factors,and interferons,on bone homeostasis,with an emphasis on their regulatory mechanisms in osteoblast and osteoclast function.Moreover,it will incorporate the latest research progress to analyze the participation of these cytokines in the onset and progression of bone homeostasis-related diseases,thus offering a theoretical foundation and potential therapeutic targets for the prevention and treatment of bone metabolic disorders.

Abstract:Objective To investigate the mechanism of minocycline in acne Inflammation by regulating peroxisome proliferator-activated receptor γ(PPARγ)/STAT3 signaling pathway.Methods An acne-like model was established by intradermal injection of Cutibacterium acnes into mice,followed by oral administration of mino-cycline or sterile water.Skin lesions were observed,and hematoxylin-eosin staining,immunohistochemistry,and immunofluorescence were performed to assess inflammatory cell infiltration and pathway-related factor expression.In parallel,SZ95 human sebocytes were stimulated with peptidoglycan(PGN)and treated with minocycline,with or without the PPARγ antagonist T0070907.Inflammatory cytokines(IL-1α,IL-1β,IL-6,IL-8)were quantified,and PPAR γ and STAT3 expression were analyzed.Results Minocycline treatment significantly alleviated skin inflammation in mice,reduced inflammatory cell infiltration,enhanced PPARγ expression,decreased IL-1β and MPO-positive cells,and significantly attenuated p-STAT3 immunoreactivity(P<0.05).In SZ95 sebocytes,PGN induced robust cytokine production and STAT3 phosphorylation.Minocycline treatment significantly suppressed pro-inflammatory cytokines,upregulated PPARγ,and inhibited STAT3 activation,whereas the presence of T0070907 partially reversed these effects.Conclusions Minocycline exerts anti-inflammatory effects in acne by activating the PPARγ/STAT3 pathway,thereby dampening cytokine release and neutrophil infiltration.These findings high-light PPARγ as a potential therapeutic target and provide mechanistic insight into the anti-inflammatory benefits of minocycline in acne management.

Abstract:Objective To explore the effects of the Bushen Huoxue traditional Chinese medicine,the com-pound Shangke Jiuwei Jiangu tablet,on bone healing in the distraction osteogenesis model,and to preliminarily expound its action mechanism at the molecular and cellular levels.Methods The tibial distraction osteogenesis models of rabbits were constructed and then randomly divided into a control group,a low-dose traditional Chinese medicine(TCM)group,a medium-dose TCM group,and a high-dose TCM group.After the intervention,the morphology of the bone callus was evaluated through Micro-CT scanning and three-dimensional reconstruction,and the bone volume fraction(BV/TV)and bone mineral density(BMD)were calculated.HE staining was carried out on tissue sections to observe the histological structure of the callus.In the in-vitro experiment,the effects of drug serum on the migration ability of bone marrow mesenchymal stem cells(MSCs)were detected using the Transwell assay.The tendency of cell directional differentiation was evaluated through osteogenic/adipogenic induction differ-entiation experiments.The expression levels of Sdf-1,Cxcr4,Runx2,and Ocn mRNA in MSCs were detected by RT-PCR.Results Compared with the control group,Micro-CT revealed that the width of the fracture line decreased and the number of calluses increased in all TCM groups.The effect was most significant in the high-dose group,where continuous calluses were observed and the fracture line basically disappeared.BV/TV and BMD detection indicated that the bone healing indexes were significantly improved in the TCM groups(P<0.05),showing a dose-dependent relationship.Histological examination showed that the callus maturity was the highest in the high-dose group,and the transformation from braided bone to lamellar bone was active.In the in-vitro experiment,the migration rate of MSCs was significantly increased in the drug serum group(P<0.000 1).Osteogenic differentiation was enhanced while adipogenic differentiation was inhibited,and the expressions of Sdf-1,Cxcr4,Runx2,and Ocn mRNA were all significantly up-regulated(P<0.000 1).Conclusions Shangke Jiuwei Jiangu tablets may promote the migration of MSCs by activating the Sdf-1/Cxcr4 signaling axis and induce their osteogenic differentiation.Consequently,this can promote the formation,mineralization,and maturation of new bones during the distraction osteogenesis process both in vivo and in vitro.Its mechanism of action highly aligns with the Bushen Huoxue Jiangu method in TCM.

Abstract:Objective To explore and analyze the clinical application of combination of empowerment theory-based intervention model and Baduanjin exercise in patients with chronic pulmonary heart disease(CPHD),and to analyze the influence on health belief and rehabilitation of patients.Methods A retrospective cohort study was conducted on 310 patients with CPHD admitted to the hospital from January 2021 to January 2025.They were grouped according to different intervention methods(propensity score matching method was used to include samples at a 1∶1 ratio,and regression analysis was used to control confounding factors).The conventional group was only given clinical routine intervention.The study group adopted the intervention model based on the empowerment theory combined with Baduanjin training.The two groups were observed after intervention in terms of psychological state,health beliefs,compliance with exercise rehabilitation and rehabilitation conditions.Results After inter-vention,the depression score and anxiety score of hospital anxiety and depression scale were decreased in both groups,and the scores in the study group were lower(P<0.05).The scores of dimensions of Champion health belief scale were increased in both groups,and the above scores were higher in the study group(P<0.05).The scores of dimensions of behavior,psychology and environment of exercise rehabilitation compliance scale were enhanced in the two groups,and the scores in the study group were higher compared to the conventional group(P<0.05).The forced expiratory volume in 1 second in the study group and right ventricular ejection fraction and 6min walking distance in the two groups were elevated,and the above indexes were higher in the study group compared to the conventional group(P<0.05).Conclusion Empowerment theory-based intervention model combined with Baduanjin exercise for CPHD patients can alleviate anxiety and depression,increase rehabilitation belief and rehabilitation exercise compliance,and thus contribute to the rehabilitation of cardiopulmonary function to a certain extent.