Abstract:Objective To investigate serum levels of tumor necrosis factor receptor-associated factor 3(TRAF3)and CXC motif chemokine receptor 7(CXCR7)in patients with acute ischemic stroke(AIS)and their relation-ships with disease severity and prognosis.Methods A total of 198 AIS patients admitted from January 2022 to January 2025 were enrolled as the study group.Patients were stratified by disease severity into mild,moderate,and severe groups and by prognosis into favorable and unfavorable outcome groups.Another 198 healthy volunteers were enrolled as controls.Serum TRAF3 and CXCR7 levels were measured using enzyme-linked immunosorbent assay(ELISA).Pearson correla-tion analysis assessed the relationships between TRAF3,CXCR7,and NIH Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores.Multivariate logistic regression identified independent risk factors for poor prognosis.Receiver oper-ating characteristic(ROC)curve analysis evaluated the predictive value of TRAF3 and CXCR7 for unfavorable outcomes.Results AIS patients exhibited higher serum TRAF3 and lower CXCR7 levels than controls(P＜0.05).TRAF3 in-creased and CXCR7 decreased progressively with stroke severity(P＜0.05).Patients with poor prognosis had higher total cholesterol,triglycerides,LDL-C,NIHSS scores at admission,onset-to-admission time,infarct area,CRP,and TRAF3 levels,and lower HDL-C and CXCR7 compared with those with good prognosis(P＜0.05).TRAF3 positively correlated with NIHSS and mRS scores,whereas CXCR7 negatively correlated(P＜0.05).Multivariate analysis indicated that total cholesterol,triglycerides,onset-to-admission time,infarct area,CRP,TRAF3,and CXCR7 were independ-ent predictors of poor prognosis(P＜0.05).ROC analysis showed that combined TRAF3 and CXCR7 yielded an AUC of 0.920,significantly higher than TRAF3(Z=2.234,P=0.025)or CXCR7(Z=2.594,P=0.009)alone.Conclu-sion Elevated serum TRAF3 and decreased CXCR7 levels in AIS patients are associated with disease severity and poor prognosis.The combination of TRAF3 and CXCR7 provides high predictive value for adverse outcomes,offering potential utility for early risk stratification.

Abstract:Objective To evaluate the sensitivity,specificity,and diagnostic performance of MinION sequencing technology for rapid detection of Mycobacterium tuberculosis complex(MTBC)in sputum specimens,compared with acid-fast staining microscopy and quantitative PCR(qPCR),and to assess its stability and reproducibility for potential clinical application.Methods Sputum samples were spiked with varying concentrations of M.tuberculosis H37Rv stand-ard strain to simulate clinical infection and analyzed using acid-fast staining,qPCR,and MinION sequencing to deter-mine sensitivity.To assess specificity,sputum samples were spiked with different non-tuberculous mycobacteria species,DNA was extracted,and analyzed via MinION sequencing.The minimum detection limit,reproducibility,and cross-re-activity were evaluated.Results MinION sequencing detected MTBC at a minimum concentration of 104 cfu/mL with a specificity of 100％.However,reproducibility was suboptimal,and detection thresholds were relatively high compared to conventional methods.Conclusion MinION sequencing enables direct detection of MTBC in sputum samples with high specificity but exhibits limited reproducibility and sensitivity at lower bacterial loads.Further validation and data are re-quired before routine clinical implementation.

Abstract:Cardiovascular disease(CVD)is one of the major comorbidities of asthma,with a close bidirectional relationship between the two conditions.Asthma may serve as a risk factor for the development of CVD,while poorly con-trolled CVD can lead to more frequent asthma exacerbations.In recent years,increasing attention has been given to the mechanistic links between asthma and CVD,and considerable progress has been achieved.This review summarizes the latest advances in research on the comorbidity of asthma and CVD,aiming to provide new clinical perspectives for develo-ping individualized diagnostic and therapeutic approaches and improving patient outcomes.

Abstract:The incidence and severity of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children have increased in recent years.Macrolide antibiotic resistance contributes to the development of RMPP;however,some patients still benefit from these drugs,and the relationship between resistance and clinical response warrants further investigation.Differential expression of non-coding RNAs has been observed in RMPP patients,influencing multiple biological proces-ses during Mycoplasma pneumoniae(MP)infection,providing a novel perspective for understanding RMPP pathogenesis.In addition to classical biomarkers such as lactate dehydrogenase(LDH),C-reactive protein(CRP),and D-dimer,potential new predictive indicators-including vitamin A,high mobility group box 1(HMGB1),and atopic constitution-are discussed,along with predictive models.These approaches may have clinical applications for early identification of RMPP,prediction of disease severity,and guidance of therapeutic strategies.

Abstract:Iron deficiency is a highly prevalent comorbidity in patients with heart failure and has gained increasing recognition as an independent determinant of disease severity,functional impairment,and adverse clinical outcomes,irre-spective of the presence of anemia.Accumulating evidence indicates that iron deficiency contributes to heart failure pro-gression through multiple pathophysiological pathways,including impaired myocardial energy metabolism,mitochondrial dysfunction,increased oxidative stress,inflammatory activation,and maladaptive cardiac remodeling.At the cellular lev-el,insufficient iron availability compromises oxidative phosphorylation and ATP generation,thereby reducing myocardial contractile efficiency and exercise capacity.Clinically,iron deficiency has been consistently associated with reduced quali-ty of life,diminished functional status,and higher risks of hospitalization in patients with both heart failure with reduced and preserved ejection fraction.Over the past decade,randomized controlled trials have demonstrated that intravenous iron supplementation can significantly improve symptoms,exercise tolerance,and health-related quality of life in iron-defi-cient heart failure patients,even in the absence of anemia.Although the impact of iron repletion on long-term mortality remains under active investigation,current evidence supports routine screening and targeted treatment of iron deficiency as an integral component of comprehensive heart failure management.Continued research is warranted to refine patient selec-tion,optimize therapeutic strategies,and elucidate the long-term prognostic benefits of iron correction in heart failure.

Abstract:Objective To investigate the role of histone deacetylase 3(HDAC3)in pelvic fibrosis and intrauter-ine adhesions in endometriosis(EM),and to explore its regulatory mechanism.Methods From March 2023 to June 2024,30 eutopic endometrium samples and 30 ectopic endometrium samples were collected from EM patients,designated as EM-eutopic and EM-ectopic groups,respectively.The control group included 30 age-matched women without EM undergoing surgery for non-hormone-dependent benign ovarian tumors.Immunohistochemistry was used to detect HDAC3 and TGF-β1 expression.Pelvic adhesions were evaluated using the revised American Fertility Society(r-AFS)scoring system.An EM rat model was established,and HDAC3,TGF-β1,α-smooth muscle actin(α-SMA),colla-gen expression,and fibrosis area were dynamically observed from day 0 to 21.Pearson correlation analysis assessed rela-tionships among these indicators.In vitro,human endometriotic epithelial 12Z cells were subjected to HDAC3 overexpres-sion or inhibition to detect changes in TGF-β1,collagen,and α-SMA.Dual-luciferase reporter assays were per-formed to evaluate the effect of HDAC3 on TGF-β1 promoter activity.Results Compared with controls,the EM-eu-topic group showed significantly higher TGF-β1 expression and r-AFS scores(P＜0.05).EM-ectopic tissues exhibi-ted further upregulation of HDAC3,with increased TGF-β1 expression and r-AFS scores compared to EM-eutopic tis-sues(P＜0.05).HDAC3 was positively correlated with r-AFS score(r=0.782,P＜0.001),and TGF-β1 expres-sion,dysmenorrhea(r=0.721),and infertility(r=0.685)were significantly associated with r-AFS(all P＜0.001).In rats,HDAC3 expression increased from day 0 to 21,accompanied by elevated TGF-β1,collagen deposition,and fi-brosis area(all P＜0.05).HDAC3 levels were positively correlated with TGF-β1(r=0.824)and fibrosis area(r=0.802)(P＜0.001).In 12Z cells,HDAC3 overexpression increased TGF-β1,collagen,and α-SMA expression(P＜0.05),whereas HDAC3 inhibition decreased their expression(P＜0.05).Luciferase activity was enhanced in the HDAC3 overexpression group and reduced in the HDAC3 inhibition group(P＜0.05).Conclusion Upregulation of HDAC3 is significantly associated with pelvic fibrosis severity and TGF-β1 signaling activation in endometriosis.Modula-ting HDAC3 expression effectively alters TGF-β1,collagen,and α-SMA levels,suggesting HDAC3 as a potential ther-apeutic target for EM-related pelvic fibrosis.

Abstract:Objective To evaluate the preservation quality of delayed-refrigerated platelets and their potential clinical applicability,providing evidence for optimizing platelet inventory management in China.Methods Thirty donors provided double apheresis platelet units.One unit was immediately stored under non-agitated refrigeration(continuous refrigeration group),while the other unit was maintained under room-temperature agitation until day 5,then refrigerated(delayed refrigeration group).Samples were collected on days 1,5,8,12,and 16 to assess platelet count,leukocyte count,pH,glucose,lactate dehydrogenase(LDH),and activation/membrane integrity markers(CD62P,CD41,CD61,CD42b).Metabolic activity,membrane integrity,and activation potential were compared between the two groups.Results All platelet units met the quality standards of the Guidelines for Preparation,Use,and Quality Assurance of Blood Com-ponents within the first 12 days.Glucose consumption was significantly higher in the delayed refrigeration group(P＜0.05),yet glucose remained＞8 mmol/L and LDH＜400 U/L at the final sampling.CD62P,CD41,and CD61(days 5,12,16)levels were higher in the continuous refrigeration group(P＜0.05),although both groups exhibited parallel trends.CD42b,reflecting membrane integrity,declined similarly in both groups without significant intergroup differences(P＞0.05).Conclusion Delayed refrigeration can extend platelet shelf-life from 5 to 12 days without compromising current quality standards,reducing waste and offering a feasible storage strategy.This approach also allows platelet func-tionality to be enhanced on-demand before transfusion,providing more flexible clinical treatment options.

Abstract:Objective To elucidate the immunologic mechanisms by which upregulation of chemokine ligand 14(CXCL14)and imbalance of dendritic cell(DC)subsets contribute to the transition from chronic obstructive pulmonary disease(COPD)to non-small cell lung cancer(NSCLC).Methods Clinical participants were recruited into four groups:smoking healthy controls(SmHC),stable COPD(stCOPD),acute exacerbation COPD(exCOPD),and newly diagnosed,treatment-naïve smoking NSCLC(NSCLC),with three subjects in each group.Peripheral venous blood and induced sputum samples were collected.Cytokine profiles in sputum were assessed using antibody microarray chips.Dif-ferential mRNA expression of cytokines was validated by qRT-PCR.Single-cell mass cytometry was applied to profile peripheral blood mononuclear cells(PBMCs),enabling immune-cell quantification,metaclustering,and UMAP-based dimensionality reduction.Flow cytometry validated surface markers of plasmacytoid dendritic cells(pDCs;CD64+DCs),conventional DC1s(cDC1s;CD64+MAR-1+CXCL14+DCs),and conventional DC2s(cDC2s;CD64+CXCL14+DCs),and quantified subset proportions among differentiating DCs in the four study groups.Results Compared with the stCOPD group,the NSCLC sputum samples demonstrated significant upregulation of interleukin 6(IL-6),programmed death ligand 1(PD-L1),CD86,Toll-like receptor 2(TLR-2),programmed death 1(PD-1),lymphocyte activa-tion gene 3(LAG-3),interleukin-1α(IL-1α),bone morphogenetic protein 4(BMP-4),transforming growth fac-tor-β1(TGF-β1),CXCL14,and macrophage colony-stimulating factor receptor(M-CSF)(P＜0.01),as well as cytotoxic T-lymphocyte-associated antigen 4(CTLA-4)and T cell immunoglobulin and mucin-domain-containing-3(TIM-3)(P＜0.05).Bone morphogenetic protein 6(BMP-6)and monokine induced by interferon-γ(MIG)were significantly downregulated(P＜0.01).CXCL14 mRNA levels were elevated in NSCLC compared with exCOPD(P＜0.05).Single-cell mass cytometry identified 12 major immune-cell metaclusters,including pDCs(3.92％),cDC1s(3.85％),and cDC2s(2.63％).PD-1 and PD-L1 exhibited varying degrees of upregulation across these DC sub-sets.Compared with stCOPD,the proportions of cDC1s and cDC2s increased in exCOPD and NSCLC(P＜0.05).Com-pared with exCOPD,NSCLC patients showed higher expression of MAR-1 and CXCL14 in cDC1s(P＜0.05),increased CXCL14 expression in cDC2s(P＜0.05),and elevated CD64 expression in cDC1s,cDC2s,and pDCs(P＜0.05).Proportions of cDC1s and cDC2s were also significantly increased(P＜0.05).Conclusion CXCL14 upregulation and imbalance of DC subsets,particularly cDC1 and cDC2 expansion accompanied by immunoregulatory marker elevation,may play critical roles in driving the immunologic shift from COPD to NSCLC.

Abstract:Objective To analyze neonatal hearing and deafness gene screening results,understand the common gene variants of deafness in Qingyuan,and evaluate the clinical value of combined neonatal hearing and genetic screening in early diagnosis and prevention of hearing impairment.Methods Neonates born at Qingyuan People's Hospital from January 2022 to June 2024 underwent hearing screening using transient evoked otoacoustic emission(TEOAE)and auto-mated auditory brainstem response(AABR).Genetic screening targeted four common deafness-related genes(GJB2,SLC26A4,GJB3,mitochondrial 12SrRNA)covering 23 hotspot loci using a commercial kit.Neonates with normal com-mon gene loci but failed hearing screening had their remaining genomic DNA sent for high-throughput sequencing cover-ing 18 genes and 100 loci.Follow-up and risk stratification were performed based on combined screening results.Results Among 3 000 neonates,the initial hearing pass rate was 88.87％(2 666/3 000),and 334 failed(11.13％).Of 334 retested at 42 days,251(75.15％)passed.Follow-up identified 11 cases with hearing loss:4 unilateral,3 mild bilateral,and 4 moderate-to-severe bilateral.Genetic variants were detected in 790 neonates(26.33％),with GJB2 variants most common(24.67％,740/3 000),followed by SLC26A4(0.97％,29/3 000),and other variants in-cluding mitochondrial 12SrRNA and GJB3 at 0.7％(21/3 000).Conclusion Combined neonatal hearing and deafness gene screening with effective follow-up can identify neonates with congenital hearing loss and those at risk,showing sig-nificant social benefits.The carrier rate of genetic deafness in Qingyuan is relatively high,particularly the GJB2 c.109G＞A variant,which warrants clinical attention.

Abstract:Objective To explore the diagnostic value of immunohistochemical E-cadherin combined with elas-tic fiber staining in detecting pleural invasion of lung adenocarcinoma.Methods Fifty lung adenocarcinoma samples ad-jacent to the visceral pleura were selected.Hematoxylin and eosin(HE)staining,elastic fiber staining,and E-cadherin combined with elastic fiber staining were performed.The accuracy of pleural invasion assessment using the three staining methods was compared.Results In the combined E-cadherin and elastic fiber staining,adenocarcinoma cells exhibited brown-yellow positivity,while elastic fibers were stained Victoria blue,clearly demonstrating the relationship between adenocarcinoma cells and the visceral pleural elastic layer.Single HE staining could not display elastic fibers,and single elastic fiber staining did not clearly highlight adenocarcinoma cells,affecting accurate assessment of pleural invasion.The positive detection rates of pleural invasion in single HE staining and single elastic fiber staining groups showed no signifi-cant difference(P＞0.05),whereas the dual staining method significantly increased the positive detection rate(P＜0.05).Conclusion Compared with single HE staining or elastic fiber staining,E-cadherin combined with elastic fiber staining allows faster and more accurate assessment of visceral pleural invasion in lung adenocarcinoma,providing a new alternative method for pathological evaluation.

Abstract:Objective To investigate the diagnostic value of multiple inflammatory markers combined with Myco-bacterium tuberculosis-specific interferon-γ(IFN-γ)and interleukin-2(IL-2)dual-factor detection in differen-tiating tuberculous pleural effusion(TPE)from malignant pleural effusion(MPE)in elderly patients.Methods A ret-rospective analysis was conducted on 140 patients aged ≥60 years with pleural effusion admitted to Lanzhou Pulmonary Hospital from January 2023 to December 2024.Among them,80 cases were diagnosed as TPE and 60 as MPE.Laboratory parameters including Mycobacterium tuberculosis-specific IFN-γ and IL-2,erythrocyte sedimentation rate(ESR),serum C-reactive protein(CRP),serum lactate dehydrogenase(LDH),serum adenosine deaminase(ADA),and pleu-ral fluid LDH and ADA were collected and compared between the two groups.Diagnostic performance of each indicator and their combinations was evaluated by receiver operating characteristic(ROC)curve analysis.Results There was no significant difference in mean age between the TPE and MPE groups(P＞0.05),but the proportion of males was signifi-cantly higher in the TPE group(P＜0.05).Compared with the MPE group,TPE patients showed significantly higher lev-els of IFN-γ,IL-2,ESR,serum ADA,and pleural ADA(P＜0.05),while serum LDH was significantly lower(P＜0.05).No significant differences were found in serum CRP or pleural LDH(P＞0.05).Using IFN-γ≥7 pg/mL and/or IL-2 ≥20 pg/mL as diagnostic thresholds yielded a sensitivity of 82.5％,specificity of 85.0％,and overall accuracy of 83.6％.In MPE patients,dual IFN-γ and IL-2 positivity demonstrated the highest specificity(98.33％).The area under the curve(AUC)values for IFN-γ,IL-2,and combined dual-factor detection were 0.820,0.807,and 0.823,respectively.The dual-factor AUC was significantly higher than those of ESR(Z=2.094,P=0.036),serum LDH(Z=3.471,P=0.000),and serum ADA(Z=2.500,P=0.012),but not significantly different from pleural ADA(Z=0.535,P=0.592).Moreover,combining dual-factor detection with pleural ADA yielded an AUC of 0.897(95％CI:0.834-0.942),significantly higher than either test alone(Z=2.056,P=0.040;Z=3.082,P=0.002,respectively).Conclusion Combined detection of Mycobacterium tuberculosis-specific IFN-γ and IL-2 provides valuable diagnostic information for differentiating tuberculous pleural effusion from malignant pleural effusion in elderly pa-tients.Dual positivity(IFN-γ/IL-2)offers the highest specificity,and the addition of pleural ADA measurement fur-ther enhances diagnostic accuracy.

Abstract:Objective To investigate the predictive value of visceral fat area(VFA)for operative time in laparo-scopic Roux-en-Y gastric bypass(LRYGB)and to evaluate whether combining VFA with sex improves prediction accu-racy,thereby providing evidence for optimized surgical planning in obese patients with type 2 diabetes mellitus(T2 DM).Methods Clinical data of 47 obese patients with T2DM(BMI ≥27.5 kg/m2)undergoing LRYGB were retrospectively analyzed.Preoperative VFA and related body composition parameters were measured using a bioelectrical impedance ana-lyzer(InBody 230).Operative time and perioperative complications were recorded.Fifteen non-obese T2DM patients(BMI＜27.5 kg/m2)served as controls.Spearman correlation analysis was performed to assess the relationship between VFA and operative time.Multivariate linear regression was used to identify independent influencing factors.Receiver oper-ating characteristic(ROC)curves were constructed to evaluate the predictive performance of VFA alone and in combina-tion with sex.Results VFA was significantly higher in the obese group than in the control group(P＜0.05),and female patients had a higher VFA than male patients[(131.07±34.44)cm2 vs.(112.79±15.44)cm2,P=0.029].Opera-tive time was positively correlated with VFA(r=0.443,P＜0.01).Multivariate linear regression analysis identified VFA as an independent predictor of operative time(P＜0.05).The area under the ROC curve(AUC)for VFA alone in pre-dicting prolonged operative time was 0.689(95％CI:0.538-0.840),with a sensitivity of 91.67％and a specificity of 39.13％.When combined with sex,the AUC increased to 0.808(95％CI:0.684-0.932),with a sensitivity of 66.67％and a specificity of 82.67％.Conclusion Visceral fat area is an independent predictor of operative time in LRYGB.Combining VFA with sex significantly improves predictive accuracy.Incorporating preoperative VFA assessment,particularly in female patients,into risk stratification may facilitate better surgical resource allocation and optimization of clinical pathways.

Abstract:Objective To investigate prognostic factors in critically ill patients with severe fever with thrombocy-topenia syndrome(SFTS).Methods A total of 86 critically ill SFTS patients admitted to our hospital between June 2020 and June 2024 were enrolled,including 62 survivors and 24 non-survivors after treatment.Clinical characteristics,viral load,hematological indices,and T-lymphocyte subsets were compared between groups,and factors associated with mortality were analyzed.Results The incidences of gastrointestinal bleeding and hepatic-renal dysfunction in non-sur-vivors were 70.83％and 91.67％,respectively,significantly higher than those in survivors(P＜0.05).A viral load ≥5 log copies/mL was detected in 91.67％of non-survivors,also higher than in survivors(P＜0.05).Hemoglobin[112.50(106.65,130.05)g/L]and platelet[32.20(19.50,42.25)× 109·L-1]levels in non-survivors were signifi-cantly lower than in survivors(P＜0.05).CD3+[270.80(182.50,405.55)× 103·L-1],CD4+[125.50(90.70,220.05)× 103·L-1],and CD8+[92.25(64.40,160.02)× 103·L-1]T-lymphocyte subsets were also markedly re-duced in non-survivors(P＜0.05).Logistic regression identified gastrointestinal bleeding,viral load,and platelet count as independent predictors of mortality(P＜0.05).Conclusion Prognosis in critically ill SFTS patients is significantly influenced by gastrointestinal bleeding,viral load,and platelet count.

Abstract:Objective To investigate the prognostic value of the serum albumin-to-creatinine ratio(sACR)for in-hospital mortality in patients with acute aortic dissection(AAD)and to explore the nonlinear association between serum creatinine(sCr)and mortality risk.Methods A total of 990 patients diagnosed with AAD were retrospectively enrolled.Cox proportional hazards regression,restricted cubic spline(RCS)analysis,and propensity score matching(PSM)were applied to evaluate the associations between sACR,sCr,and in-hospital mortality.The predictive perform-ance of sACR was assessed using the area under the receiver operating characteristic curve(AUC)and integrated discrim-ination improvement(IDI).Results Patients who died during hospitalization had significantly lower sACR levels than survivors(2.3 vs.3.6,P＜0.001).Multivariable Cox regression identified sACR as an independent protective factor for in-hospital mortality(HR=0.70;95％CI:0.55-0.90,P=0.006).RCS analysis demonstrated a U-shaped rela-tionship between sCr and mortality risk,with increased risk observed at sCr levels＜0.6 mg/dL(HR=3.75)and＞1.1 mg/dL(HR=2.30).Subgroup analyses revealed that sACR was a significant predictor of mortality in patients with type A AAD managed non-surgically(HR=0.62)and in surgically treated type B AAD patients(HR=0.07).The AUC of sACR for predicting in-hospital mortality was 0.697,which was significantly higher than that of serum albumin alone(0.638)or sCr alone(0.675)(P＜0.05).Conclusion The serum albumin-to-creatinine ratio is an independent predictor of in-hospital mortality in patients with acute aortic dissection.Its prognostic value varies across clinical sub-groups and may facilitate early risk stratification and clinical decision-making.

Abstract:Peroxisome proliferator-activated receptor γ(PPARγ),a member of the nuclear hormone receptor su-perfamily,also functions as a tumor suppressor.Upon activation by its ligands,PPARγ can inhibit colorectal cancer cell proliferation and cell-cycle progression,suppress invasion,metastasis,and angiogenesis,and promote apoptosis.Accu-mulating evidence indicates that PPARγ regulates multiple molecular pathways involved in the initiation and progression of colorectal cancer,while its ligands exhibit significant therapeutic potential in this malignancy.PPARγ is therefore consid-ered a promising therapeutic target for colorectal cancer.This review summarizes the antitumor effects of PPARγ and its ligands,along with the underlying regulatory mechanisms implicated in colorectal cancer treatment.

Abstract:Objective To investigate bone age characteristics in children with short stature and to compare the assessment results of two bone age scoring methods,providing reference for clinical diagnosis and management.Methods Clinical data and left-hand X-ray images of children aged 3-12 years with short stature were retrospectively collect-ed.Children were stratified by chronological age(1-year intervals)and sex.Bone age was assessed using two methods:TW-C R series(radius,ulna,metacarpal and phalangeal bones)and TW-C C series(carpal bones).Statistical com-parisons were performed among chronological age,TW-C R bone age,and TW-C C bone age,and pairwise compari-sons were conducted.Results A total of 1,183 children were included(739 boys,444 girls).For boys aged 3-7 and 9-12 years and girls aged 3-8 and 10 years,chronological age,TW-C R bone age,and TW-C C bone age were not equal,with significant differences(P＜0.05).Pairwise comparisons showed that chronological age exceeded TW-C R bone age in boys aged 3,9-12 and girls aged 6-8,10 years(P＜0.05),with the largest difference at 12 years for boys(1.02 years)and 10 years for girls(0.78 years).Chronological age also exceeded TW-C C bone age in boys aged 4-7,9-12 and girls aged 3-8,10 years(P＜0.05),with the largest difference at 12 years for boys(1.34 years)and 10 years for girls(0.78 years).TW-C R and TW-C C bone ages differed significantly in boys aged 3,5-6 and girls aged 3-5 years(P＜0.05),but showed no significant difference in older age groups(P＞0.05).Conclusion Most chil-dren with short stature have bone ages below their chronological age,with greater delays in older children,especially evi-dent in TW-C C series.Individualized management of short stature should prioritize monitoring TW-C C series bone age.

Abstract:Objective To identify independent risk factors for adverse pregnancy outcomes in women with Poly-cystic Ovary Syndrome(PCOS)during late pregnancy,to construct and validate a nomogram model,and to explore the correlation between serum Heat Shock Protein 70(HSP70),Programmed death-ligand 1(PD-L1)levels,vaginal mi-crobiota distribution,and pregnancy outcomes in these patients.Methods A total of 180 late-pregnancy PCOS patients admitted from January 2023 to January 2024 were prospectively enrolled as the modeling group,while 180 late-pregnancy women without PCOS during the same period were selected as the control group.Laboratory indicators and clinical data were collected for both groups,and the occurrence of common adverse pregnancy outcomes(fetal distress,macrosomia,polyhydramnios,postpartum hemorrhage,premature rupture of membranes,etc.)was recorded.The incidence of adverse pregnancy outcomes,vaginal microbiota species distribution,serum HSP70 levels,and serum PD-L1 levels were com-pared between the two groups.Multivariate logistic regression analysis was used to identify independent risk factors for ad-verse pregnancy outcomes in late-pregnancy PCOS patients.A nomogram model was constructed based on the modeling group and validated using an external validation group of 80 pregnant women(recruited between February and August 2024 at a 7∶3 split from the modeling group).Results Serum HSP70 and PD-L1 levels were significantly lower in the mod-eling group than in the control group.The main vaginal microorganisms detected in both groups were Lactobacillus,Esche-richia coli,Staphylococcus epidermidis,and Ureaplasma urealyticum.The detection rates of E.coli(48.89％)and Can-dida albicans(24.44％)in the modeling group were higher than those in the control group(36.11％and 11.67％,re-spectively;both P＜0.05).The modeling group showed higher bacterial density and a higher proportion of vaginal micro-ecological imbalance(both P＜0.05).Among the modeling group,those with vaginal microecological imbalance had sig-nificantly lower serum HSP70 and PD-L1 levels than those with normal vaginal microecology(both P＜0.05).Multivari-ate logistic regression showed that age,BMI,vaginal microecological imbalance,Interleukin 6(IL-6),Tumor necrosis factor alpha(TNF-α),HSP70,and PD-L1 were independent risk factors for adverse pregnancy outcomes in PCOS pa-tients(all P＜0.05).The nomogram model demonstrated good predictive performance.The area under the ROC curve(AUC)was 0.900(95％CI:0.855-0.946,P＜0.05)in the modeling group with sensitivity 0.896 and specificity 0.805,and 0.889(95％CI:0.815-0.962,P＜0.05)in the validation group with sensitivity 0.912 and specificity 0.804.Calibration curves indicated good model fit(all P＜0.05).Conclusion Serum HSP70 and PD-L1 levels in late-pregnancy PCOS patients are strongly correlated with vaginal microecology and pregnancy outcomes.The nomogram-based prediction model for adverse pregnancy outcomes in late-pregnancy PCOS patients shows good predictive per-formance and clinical applicability.

Abstract:Objective To evaluate the impact of early perioperative application of liposomal bupivacaine on post-operative delirium(POD)in elderly patients undergoing total hip arthroplasty(THA).Methods Elderly patients who underwent THA at Quanzhou First Hospital between June 2024 and March 2025 were included and randomly assigned to the liposomal bupivacaine group(observation group)or the lidocaine group(control group)using a random number table.The observation group received general anesthesia combined with liposomal bupivacaine nerve block,and the control group received general anesthesia combined with lidocaine nerve block.Postoperative delirium incidence within 5 days and post-operative pain scores were analyzed.Results The incidence of POD within 5 days postoperatively was significantly lower in the observation group compared with the control group[5 cases(7.7％)vs.15 cases(23.4％),P＜0.05].Preoper-ative(admission)pain scores did not differ significantly between groups(P＞0.05).At all postoperative time points,pain scores were significantly lower in the observation group(P＜0.05).No significant differences were observed in base-line characteristics including sex,age,weight,height,BMI,ASA classification,and years of education(P＞0.05).Conclusion Early perioperative use of liposomal bupivacaine in elderly THA patients reduces the incidence of postopera-tive delirium and effectively alleviates postoperative pain.

Abstract:Objective To investigate the expression levels of advanced oxidation protein products(AOPP)and autocrine motility factor(AXT)in bronchoalveolar lavage fluid(BALF)of children with refractory Mycoplasma pneumoni-ae pneumonia(RMPP)and to evaluate their clinical significance.Methods A total of 118 children diagnosed with My-coplasma pneumoniae pneumonia(MPP)and admitted to Xianyang Central Hospital between January 2022 and February 2025 were prospectively enrolled.According to disease progression,patients were divided into a refractory MPP group(RMPP,n=42)and a non-refractory MPP group(n=76).Levels of inflammatory markers,including C-reactive protein(CRP),interleukin-6(IL-6),and procalcitonin(PCT),as well as AOPP and AXT in BALF were measured.Differences between groups were compared.Spearman correlation analysis was performed to assess the relationships be-tween BALF AOPP and AXT levels and inflammatory markers in children with RMPP.Multivariate logistic regression anal-ysis was used to identify independent risk factors for RMPP.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of BALF AOPP,AXT,and inflammatory markers for RMPP.Results BALF levels of CRP,IL-6,PCT,AOPP,and AXT were significantly higher in the RMPP group than in the non-refractory MPP group(all P＜0.05).Spearman correlation analysis showed that BALF AOPP and AXT levels were positively corre-lated with inflammatory markers.Multivariate logistic regression analysis identified high fever(OR=3.314,95％CI:1.056-10.398),pleural effusion(OR=3.262,95％CI:1.334-7.973),elevated AOPP(OR=1.020,95％CI:1.010-1.030),and elevated AXT(OR=1.348,95％CI:1.182-1.537)as independent risk factors for RMPP.ROC curve analysis demonstrated that the areas under the curve(AUCs)for BALF CRP,IL-6,PCT,AOPP,and AXT in predicting RMPP were 0.730,0.749,0.695,0.835,and 0.863,respectively.The predictive performance of AOPP and AXT was superior to that of CRP,IL-6,and PCT(P＜0.05).Furthermore,the combination of AOPP and AXT yielded a significantly higher AUC than either marker alone(P＜0.05).Conclusion BALF AOPP and AXT levels are markedly elevated in children with RMPP and are closely associated with enhanced inflammatory responses and disease progression.Combined assessment of BALF AOPP and AXT shows good predictive value for RMPP and may be useful for early identifi-cation and risk stratification in pediatric patients.

Abstract:Objective To evaluate the additive therapeutic effects of traditional Chinese medicine(TCM)herbal external application combined with percutaneous endoscopic lumbar discectomy(PELD)on pain relief,functional recovery,and radiological outcomes in elderly patients with lumbar disc herniation(LDH).Methods A total of 150 elderly pa-tients with LDH treated at Baise Hospital of Traditional Chinese Medicine between May 2021 and May 2022 were retro-spectively enrolled and divided into three groups:open lumbar microdiscectomy group(OLM,n=49),PELD group(n=51),and PELD combined with herbal external application group(combined group,n=50).Perioperative parameters,visual analogue scale(VAS)scores for low back and leg pain,Oswestry Disability Index(ODI),Japanese Orthopedic Association(JOA)scores,overall clinical efficacy,and radiological parameters were compared among the three groups during follow-up.Results Significant differences were observed among the three groups in operative time and intraoper-ative blood loss(P＜0.05).Postoperatively,VAS scores for low back pain and leg pain significantly improved in all groups compared with preoperative values(P＜0.05).At 6 months postoperatively,the combined group demonstrated significantly lower low back pain VAS scores and higher improvement rates than the other two groups(P＜0.05),while leg pain VAS scores at 6 and 12 months were also superior(P＜0.05).ODI and JOA scores showed significant improve-ment immediately after surgery in all groups(P＜0.05),with the combined group exhibiting significantly better outcomes from 1 month onward(P＜0.05).Total clinical efficacy rates differed significantly among groups at 1,3,and 6 months postoperatively(P＜0.05).At final follow-up,significant intergroup differences were observed in spinal canal occupa-tion rate,lumbar lordosis,pelvic tilt,thoracic kyphosis,and thoracic pelvic angle(P＜0.05),with the combined group showing superior spinal canal occupation rate and thoracic pelvic angle(P＜0.05).Conclusion Compared with tradi-tional open lumbar microdiscectomy,PELD is associated with reduced operative time and blood loss.The addition of TCM herbal external application further enhances postoperative pain relief,functional recovery,and radiological outcomes.This integrated traditional Chinese and Western medicine approach may provide superior therapeutic benefits for elderly patients with lumbar disc herniation.