Pregnancy serves as an ideal entry-point for assessing women's risk of cardiovascular disease. Hypertensive disorders in pregnancy （HDP）， which are common complications during pregnancy， substantially elevate the risk of long-term cardiovascular disease in puerperae. As a result， postpartum blood pressure management has emerged as a crucial link for ensuring women's long-term cardiovascular health. Nevertheless， the management and follow-up of postpartum blood pressure in HDP patients encounter core challenges. Firstly， there is a lack of consensus among guidelines， with notable disparities in the thresholds for initiating antihypertensive treatment both at home and abroad. Secondly， the traditional follow-up model is inefficient， causing missed opportunities for risk screening. Recent research has indicated that more stringent postpartum blood pressure control may yield greater cardiovascular benefits， and relevant randomized controlled trials are currently exploring the optimal control target. The management model is also undergoing an active and digital transformation. Interventions centered on home BP monitoring （HBPM） combined with remote medication adjustment can significantly enhance blood pressure control outcomes. In the future， high-quality long-term clinical trials are required to determine the appropriate control targets for different HDP subtypes and to explore the feasibility and cost-effectiveness of integrated HBPM models. Postpartum blood pressure management for HDP should be integrated into the long-term cardiovascular prevention system for women to mitigate the risk of short-term pregnancy complications and long-term cardiovascular burden.

Objective To investigate the clinical efficacy of acupuncture of time acupoint space based on Linggui Bafa in patients with sleep disorders secondary to ischemic stroke， and to evaluate its effects on serum 5-hydroxytryptamine （5-HT） and melatonin （MT） levels， neurological function， and emotional status. Methods A total of 78 patients with ischemic stroke and concurrent sleep disorders treated at our hospital between June 2024 and June 2025 were prospectively enrolled and randomly divided into a control group and a treatment group （n = 39 each）. The control group received conventional treatment and sleep management for ischemic stroke. The treatment group received the same conventional therapy plus Linggui Bafa-based spatiotemporal acupoint selection moxibustion. Both groups received continuous treatment for 3 weeks. The overall clinical efficacy， scores on the Fatigue Severity Scale （FSS）， Pittsburgh Sleep Quality Index （PSQI）， Hospital Anxiety and Depression Scale （HADS）， and National Institutes of Health Stroke Scale （NIHSS）， as well as serum 5-HT and MT levels， were compared between the two groups. Adverse events during the treatment period were also recorded. Results The overall effective rate in the treatment group was significantly higher than that in the control group （P < 0.05）. Repeated-measures analysis of variance （ANOVA） revealed significant main effects of time and group， as well as significant time × group interaction effects， on the FSS， PSQI， HADS， and NIHSS scores， and on serum 5-HT and MT levels （all P < 0.05）. Further simple main effect analysis demonstrated that after 3 weeks of treatment， the scores on all aforementioned scales in the treatment group were significantly lower than those in the control group， whereas serum 5-HT and MT levels were significantly higher （all P < 0.05）. No significant difference in the incidence of adverse events was observed between the two groups （P > 0.05）. Conclusions As an adjunct to conventional therapy， Linggui Bafa-based spatiotemporal moxibustion can effectively improve sleep quality， alleviate fatigue， anxiety， and depression， and promote neurological recovery in patients with sleep disorders following ischemic stroke. The underlying mechanism may be related to the regulation of sleep-associated neurotransmitters， such as 5-HT and MT. The intervention demonstrates a favorable safety profile and holds promise for clinical application.

Objective To evaluate the clinical efficacy of compound Danshen injection in combination with nifedipine for hypertensive disorders of pregnancy and to investigate its regulatory effects on oxidative stress and vascular endothelial function. Methods This prospective， controlled study recruited 90 consecutive patients with hypertensive disorders of pregnancy who were admitted to the Department of Obstetrics at Langfang Maternal and Child Health Hospital from January 2023 to January 2025. The participants were randomly allocated to either a control group （n = 45）， which received nifedipine monotherapy， or an observation group （n = 45）， which was administered nifedipine in combination with compound Danshen injection. The treatment efficacy， serum levels of superoxide dismutase （SOD） and endothelin-1 （ET-1）， 24-hour urinary protein quantification， blood pressure ［systolic blood pressure （SBP）， diastolic blood pressure （DBP）］， and umbilical artery hemodynamic parameters ［systolic/diastolic ratio （S/D）， resistance index （RI）， and pulsatility index （PI）］ were compared both before and after treatment. Adverse pregnancy outcomes were also documented. Results The overall response rate was significantly higher in the observation group than in the control group （95.56% vs. 80.00%， P < 0.05）. After treatment， both groups showed increased SOD levels and decreased ET-1 levels， and the degree of improvement was significantly greater in the observation group （P < 0.05）. The observation group had significantly greater reductions in SBP， DBP， and 24-hour urinary protein levels （P < 0.05）. Moreover， compared with the control group， the observation group had larger decreases in PI， RI， and S/D after treatment （P < 0.05）. The incidence of adverse pregnancy outcomes was significantly lower in the observation group （P < 0.05）. No serious drug-related adverse reactions were observed in either group during the treatment period. Conclusions Treatment with Compound Danshen injection in combination with nifedipine significantly facilitated blood pressure stabilization and enhanced oxidative stress and endothelial function indices in patients with hypertensive disorders of pregnancy. Therefore， this combination therapy may represent a more effective and clinically valuable intervention compared to conventional treatment alone.

Objective To investigate the impact of goal-directed therapy guided by the Hypotension Prediction Index （HPI） on intraoperative hypotension and postoperative acute kidney injury （AKI） in elderly patients undergoing pulmonary surgery. Methods A total of 144 elderly patients who underwent pulmonary surgery and were admitted to our hospital from March 2024 to June 2025 were selected and divided into a conventional group （72 cases） and a study group （72 cases） using the random-number table method. The conventional group received routine blood-pressure monitoring and management， while the study group implemented HPI-guided goal-directed therapy. The perioperative blood-pressure variations， intraoperative hypotension （IOH） profiles ［including incidence， total duration， and time-weighted average of hypotension （TWAH）］， dosages of vasoactive agents （dobutamine and norepinephrine）， and postoperative outcomes ［incidence of AKI， intensive care unit （ICU） stay time， and postoperative hospital stay］ were compared between the two groups. Results Finally， a total of 141 patients were recruited for the study， with 70 in the study group and 71 in the conventional group. Fifteen minutes after one-lung ventilation， during pneumonectomy， and at the time of chest closure， the systolic blood pressure and mean arterial pressure in the study group were higher than those in the conventional group， and these differences were statistically significant （P < 0.05）. The incidence of intraoperative hypotension and the value of TWAH in the study group were 17.14% and （0.25 ± 0.06） respectively， which were lower than 32.39% and （0.37 ± 0.11） in the conventional group， and the differences were statistically significant （P < 0.05）. The dosages of dobutamine and norepinephrine in the study group were greater than those in the conventional group， and the differences were statistically significant （P < 0.05）. The incidence of postoperative AKI in the study group was 1.43%， which was lower than 11.27% in the conventional group， and this difference was statistically significant （P < 0.05）. The total duration of hypotension， ICU stay time， and postoperative hospital stay in the study group were shorter than those in the conventional group， and the differences were statistically significant （P < 0.05）. Conclusions The goal-directed therapy guided by HPI can mitigate intraoperative blood pressure fluctuation， lower the incidence and severity of intraoperative hypotension， diminish the occurrence of postoperative AKI， and facilitate postoperative recovery in elderly patients undergoing pulmonary surgery.

Objective To investigate the association between the weight-adjusted creatinine-to-cystatin C ratio （WCCR） and the risk of incident cardiovascular disease （CVD） among middle-aged and older adults in China. Methods Data were obtained from the China Health and Retirement Longitudinal Study （CHARLS）. A total of 5 994 participants who completed the 2011 baseline survey and were followed up until 2020 were included. Data on sociodemographic characteristics， physical examinations， lifestyle factors， health status， health insurance， and biochemical indicators were collected. The WCCR was calculated using serum creatinine and cystatin C levels， adjusted for body weight， and participants were categorized into sex-specific tertiles. Cox proportional hazards regression models were used to evaluate the association between the WCCR and the risk of CVD. Results Over a median follow-up of 8.92 （7.00， 9.00） years， 1 517 cases of CVD were recorded， including 1 158 cases of heart disease and 521 cases of stroke. The incidence densities of overall CVD， heart disease， and stroke were 33.3/1 000 person-years （95%CI： 31.7 - 35.0）， 25.4/1 000 person-years （95%CI： 24.0 - 26.9）， and 11.4/1 000 person-years （95%CI： 10.5 - 12.5）， respectively. After multivariable adjustment， compared with the lowest WCCR tertile， the highest tertile was associated with a 19.8% （95%CI： 9.2% - 29.1%） reduction in overall CVD risk and a 22.1% （95%CI： 10.3% - 32.3%） reduction in heart disease. In the highest WCCR tertile， overall CVD risk was reduced by 19.5% （95%CI： 2.6% - 33.5%） in men and 20.3% （95%CI： 6.3% - 32.3%） in women， while heart disease risk was reduced by 20.9% （95%CI： 0.6% - 37.1%） in men and 25.0% （95%CI： 9.7% - 37.8%） in women. Conclusions Among middle-aged and older adults in China， the WCCR is inversely associated with the risk of CVD. A lower WCCR is an independent risk factor for cardiovascular events， highlighting its potential utility in improving cardiovascular risk stratification and informing prevention strategies.

Objective This study assessed the analgesic efficacy and safety of liposomal bupivacaine （LB） delivered through direct-vision intercostal nerve block （INB） in comparison with ropivacaine （RO） among patients undergoing Video-assisted thoracoscopic surgery （VATS）. Methods In this randomized， double-blind， parallel-controlled trial， patients scheduled for VATS were randomly assigned to receive thoracoscopic video-assisted INB prior to chest closure. They were divided into two groups： the liposomal bupivacaine group （LB group， 133 mg/10 mL） and the ropivacaine group （RO group， 75 mg/10 mL）. Under direct thoracoscopic vision， 2 mL of the solution was injected transpleurally at the surgical incision level and the adjacent upper and lower intercostal spaces respectively. The remaining solution was used for local wound infiltration. The primary outcome was the incidence of moderate-to-severe pain within 72 hours post-operation. Secondary outcomes included the incidence of breakthrough pain， pain scores at multiple time points， and recovery indicators. Results A total of 80 patients were incorporated into the final intention-to-treat （ITT） analysis （LB group， n = 40； RO group， n = 40）. The incidence of moderate-to-severe pain within 72 h was notably lower in the LB group compared to the RO group （20% vs. 42.5%， P = 0.030）. The incidence of breakthrough pain was also remarkably reduced in the LB group （17.5% vs. 37.5%， P = 0.045）. The per-protocol （PP） analysis （LB group， n = 34； RO group， n = 35）， which functioned as a sensitivity analysis， produced results that were completely consistent with the ITT analysis. No significant disparities were detected in recovery indicators or the incidence of adverse events between the two groups. Conclusions LB administered via direct-vision INB significantly reduces the incidence of moderate-to-severe and breakthrough pain after VATS. By exhibiting a unique “shaving the peak” effect， LB improves early postoperative comfort with a favorable safety profile and serves as a valuable component of multimodal analgesia for thoracic surgery.

Platelets are the second most abundant cellular component in blood after erythrocytes and have traditionally been recognized primarily for their roles in hemostasis and thrombosis. The expression of programmed death-ligand 1 （PD-L1） on the platelet surface enables direct inhibition of T cell function. Moreover， platelets can form a physical barrier by surrounding circulating tumor cells （CTCs）， thereby amplifying immunosuppressive signals synergistically and establishing a mobile immune barrier during hematogenous tumor metastasis. This review systematically summarizes the origin and regulatory mechanisms of platelet PD-L1 （pPD-L1） and proposes a triple-inhibition model of immune evasion mediated by pPD-L1. Furthermore， it highlights the critical role of pPD-L1 as a liquid biopsy biomarker in reversing resistance to immune checkpoint inhibitors （ICIs） and suppressing hematogenous tumor metastasis， providing a theoretical basis for precision therapies targeting pPD-L1.

Objective To investigate the association between the promoter DNA methylation of RUNX3， P16， and DAPK genes and the efficacy of programmed death receptor-1 （PD-1） inhibitors in patients with non-small cell lung cancer （NSCLC）. Methods A total of 73 patients with who NSCLC received treatment with PD-1 inhibitors in our hospital from January 2020 to January 2024 were recruited. These patients were then divided into a disease progression group （characterized by progressive disease） and a disease control group （comprising patients with complete response， partial response， and stable disease） based on the therapeutic response. The promoter DNA methylation status of the RUNX3， P16， and DAPK genes in peripheral blood samples， tumor markers， and pulmonary CT features were compared between the two groups. The influencing factors for the sustained disease progression after PD-1 inhibitor therapy were analyzed. Results Among the 73 patients， 4 achieved a complete response， 29 achieved a partial response， 25 had a stable disease state， and 15 experienced disease progression. The proportion of PD-L1-positive cases was significantly higher in the disease control group compared to that in the disease progression group （P < 0.05）. The expression levels of RUNX3， P16， and DAPK were significantly higher in the disease control group than those in the disease progression group （P < 0.05）. No statistically significant differences were detected between the two groups in CT features such as lesion density， lesion margin， pleura relationship， vascular signs， ground-glass opacity， calcification， or distal obstructive inflammation （P > 0.05）. The serum levels of carcinoembryonic antigen （CEA）， neuron-specific enolase （NSE）， cytokeratin 19 fragment （CYFRA21-1）， and cancer antigen 125 （CA125） showed no significant differences between the groups （P > 0.05）. Logistic multivariate regression analysis indicated that RUNX3 （OR = 0.257， 95%CI： 0.103 - 0.644）， P16 （OR = 0.243， 95%CI： 0.096 - 0.608）， DAPK （OR = 0.217， 95%CI： 0.087 - 0.543）， and PD-L1 positivity （OR = 0.242， 95%CI： 0.096 - 0.607） were independent influencing factors for sustained disease progression in NSCLC patients after PD-1 inhibitor therapy （P < 0.05）. Conclusions Promoter DNA methylation of RUNX3， P16， and DAPK is significantly associated with the efficacy of PD-1 inhibitors in the treatment of NSCLC. Moreover， a hypomethylation status is correlated with more favorable therapeutic responses in patients.

Objective To evaluate the efficacy of an optimized lighting environment combined with a vein visualization device for intravenous puncture in oncology patients undergoing nuclear medicine procedures， thereby providing evidence-based support for venipuncture practices in this specific clinical setting. Methods A prospective randomized controlled study was conducted involving 240 oncology patients undergoing whole-body bone scintigraphy at the Department of Nuclear Medicine， Anyang Tumor Hospital， between January and December 2025. Patients were randomized into four groups （n = 60 per group） using a random number table： Group A underwent conventional puncture under standard lighting （300 - 500 lx， 4 000 K）； Group B underwent conventional puncture under optimized lighting （650 - 750 lx， 5 000 - 75 500 K， with the light source positioned at a 30° - 45° angle to the vein）； Group C underwent vein visualization device-guided puncture under standard lighting； and Group D underwent vein visualization device-guided puncture under optimized lighting. The outcomes compared among the four groups included the first-pass success rate， puncture duration， Visual Analogue Scale （VAS） pain score， operator satisfaction， and complication rates. Results Group D achieved the highest first-pass success rate （98.3%）， which was significantly higher than that of Group A （83.3%， P = 0.004） and Group B （88.3%， P = 0.028）， with no significant difference compared to Group C （96.7%， P = 0.559）. Group D exhibited the shortest puncture duration （median： 78.50 s）， which was significantly shorter than that of the other three groups （all P < 0.001）. The VAS pain score was lowest in Group D （2.00 ± 0.80）， significantly lower than those in Groups A， B， and C （all P < 0.05）. Operator satisfaction was highest in Group D （4.37 ± 0.82）， significantly exceeding that in Groups A and B （both P < 0.001） and Group C （P = 0.030）. Furthermore， Group D demonstrated the lowest overall complication rate （5.0%）， significantly lower than that of Group A （21.7%， P = 0.007） and Group B （18.3%， P = 0.023）， but comparable to Group C （10.0%， P = 0.298）. Conclusion The combination of an optimized lighting environment and a vein visualization device significantly improves the first-pass success rate， shortens puncture duration， alleviates patient pain， reduces the overall complication rate， and enhances operator satisfaction during intravenous puncture in oncology patients undergoing nuclear medicine procedures. This combined strategy is particularly advantageous in nuclear medicine， where the short half-life of radiopharmaceuticals necessitates a successful first-pass puncture to minimize radioactive decay and ensure optimal imaging quality.

Objective To investigate the correlation between the expression levels of kinesin family member 11 （KIF11）， forkhead box protein P3 （FOXP3）， and lymphocyte activation gene-3 （LAG-3） in endometrial cancer tissues， and the clinicopathological characteristics as well as the long-term prognosis of patients. Methods Clinicopathological data and paraffin-embedded tissue specimens from 120 patients with endometrial cancer who were treated between January 2019 and December 2022 were retrospectively collected. Immunohistochemistry was employed to detect the expression of KIF11， FOXP3， and LAG-3 in cancer tissues， and these expressions were scored using the H-score method. Receiver operating characteristic （ROC） curves were plotted， with the lymph node metastasis status serving as the state variable， to analyze the diagnostic efficacy of each marker in differentiating lymph node metastasis. The optimal cut-off values were determined according to the Youden index to classify patients into high-expression and low-expression groups. The associations between the expression of the three markers and clinicopathological parameters were analyzed. Survival curves were plotted by using the Kaplan-Meier method， and the survival differences between groups were compared by using the Log-rank test. Considering the significant positive correlation between FOXP3 and LAG-3， a combined immune score （FOXP3 score + LAG-3 score） was constructed. A Cox proportional hazards regression model was used to identify the independent factors that influence long-term prognosis. Results Among the 120 endometrial cancer tissues， the high-expression rates of KIF11， FOXP3， and LAG-3 were 52.50%， 40.83%， and 45.00%， respectively. High KIF11 expression was significantly associated with advanced FIGO stage， deep myometrial invasion， and positive lymphovascular space invasion （all P < 0.05）. High expression of both FOXP3 and LAG-3 was significantly associated with high pathological grade and positive lymph node metastasis （all P < 0.05）， and their expression levels were positively correlated （r = 0.587， P < 0.001）. The areas under the curve （AUCs） of KIF11， FOXP3， and LAG-3 for predicting lymph node metastasis were 0.819， 0.853， and 0.720， respectively. The combined AUC of the three markers was 0.920， which was higher than that of any single indicator （all P < 0.05）. Survival analysis indicated that the 3-year overall survival and disease-free survival rates in the KIF11， FOXP3， and LAG-3 high-expression groups were lower than those in the corresponding low-expression groups （all P < 0.05）. Multivariate Cox regression analysis revealed that high KIF11 expression （HR = 2.18， 95% CI： 1.32 - 3.60）， a higher combined immune score （HR = 1.98， 95% CI： 1.34 - 2.93）， and advanced FIGO stage （HR = 2.54， 95% CI： 1.48 - 4.36） were independent risk factors for overall survival （all P < 0.05）. Conclusion KIF11， FOXP3， and LAG-3 are all abnormally over-expressed in endometrial cancer tissues. These three markers are closely correlated with multiple adverse clinicopathological features and patient prognosis. The combined detection of these three markers demonstrates high discriminatory power for lymph node metastasis. High expression of KIF11 and a higher combined immune score are independent risk factors for long-term prognosis. The positive correlation between FOXP3 and the combined immune score （FOXP3 + LAG-3） implies a potential synergistic effect within the tumor immunosuppressive microenvironment. The combined targeting of KIF11 and immune checkpoint molecules may serve as a novel strategy for the comprehensive treatment of endometrial cancer.

The dysfunction of the gut microbiota-short-chain fatty acids （SCFAs） axis serves as a crucial microecological mechanism underlying the onset and progression of ulcerative colitis （UC）. As key metabolites of the gut microbiota， SCFAs are involved in the pathological process of UC by maintaining the integrity of the intestinal mucosal barrier， regulating immune and inflammatory responses， restoring microecological homeostasis， and inhibiting inflammatory signaling pathways. Traditional Chinese medicine （TCM） is distinguished by its multi-component， multi-target， and holistic regulatory effects. It can modulate the composition of the gut microbiota， enrich SCFA-producing strains， and increase SCFA levels， thus exerting protective effects on the intestinal mucosa， anti-inflammatory effects， and immunomodulatory effects. The article summarizes the research progress of TCM in intervening in UC through regulating the gut microbiota-SCFA axis， discusses existing problems and future research directions， and offers theoretical evidence for the prevention and treatment of UC with TCM targeting intestinal microecology.

Wilms tumor 1-associated protein （WTAP）， a key regulatory subunit of the N?-methyladenosine （m?A） methyltransferase complex， has attracted significant attention in recent years due to its role in the regulation of cellular metabolism. This review systematically summarizes the functions and underlying mechanisms of WTAP in glucose metabolism， lipid metabolism， and related metabolic diseases. In glucose metabolism， WTAP regulates the expression of multiple key metabolic enzymes （e.g.， HK2， ENO1， and GLUT1） and key transcription factors in an m?A-dependent manner， thereby participating in the Warburg effect of tumor cells， metabolic reprogramming of immune cells， and chemotherapy resistance. In lipid metabolism， WTAP modulates the expression of genes involved in lipid synthesis and oxidation （e.g.， SQLE， ALOX15， and Decr1）， thus affecting adipocyte differentiation， lipid accumulation， and mitochondrial function. In metabolic diseases such as diabetic kidney disease， atherosclerosis， and nonalcoholic steatohepatitis （NASH）， WTAP exhibits tissue-specific changes in expression and subcellular localization and regulates disease progression via either m?A-dependent or m?A-independent pathways （e.g.， nuclear-to-cytoplasmic translocation in NASH）. This review aims to offer insights for a comprehensive understanding of the multiple roles of WTAP in metabolic regulation.

Objective To investigate the factors influencing the characteristics of amniotic fluid sediment following second-trimester amniocentesis for prenatal diagnosis， and to evaluate their impact on amniotic fluid cell culture and pregnancy outcomes， thereby providing a basis for clinical specimen processing， risk assessment， and genetic counseling. Methods A total of 2 489 pregnant women who underwent mid-trimester （18 - 24 weeks） amniocentesis for singleton pregnancies at the Prenatal Diagnosis Center of the First Affiliated Hospital of Anhui Medical University from January 2025 to December 2025 were retrospectively reviewed. Among them， 96 cases with distinct sediment characteristics were ultimately included. Based on the visual characteristics and volume of the sediment from 20 mL centrifuged amniotic fluid aliquots， patients were categorized into four groups： small-volume milky-white sediment （Group A， n = 20）， large-volume milky-white sediment （Group B， n = 24）， small-volume bloody sediment （Group C， n = 29）， and small-volume dark-brown sediment （Group D， n = 23）. Baseline demographics and laboratory parameters were collected. Using the in situ amniotic fluid cell culture method， we recorded the culture duration， number of media changes， and total cell yield. Pregnancy outcomes were subsequently tracked. Statistical analyses were performed using one-way analysis of variance， chi-square tests， and binary logistic regression. Results There were statistically significant differences between the four groups in terms of RBC， CRP， culture cycle， number of fluid changes， cell count， and history of bleeding during pregnancy （all P < 0.05）. Among them， RBC and CRP levels were significantly different among the four groups. Group D had the highest RBC level， which was （4.93 ± 1.55）× 10¹²/L， which was significantly higher than other groups （F = 5.20， P = 0.002）； group B had the highest CRP level， which was （9.63 ± 2.87） mg/L， and the difference between the four groups was statistically significant （F = 5.69， P = 0.001）. In terms of culture-related indicators， there were significant differences among the four groups in terms of culture cycle， number of medium changes， and cell count （all P < 0.001）. Group D had the longest culture period， （13.52 ± 0.88） days； the most number of medium changes， （5.57 ± 0.650） times； and the lowest cell count， （1.09 ± 0.56）× 10⁵/mL. There were no statistically significant differences in conception methods， history of anticoagulant use， twin reduction， and placental position among the four groups （all P > 0.05）. The distribution of history of bleeding during pregnancy was significantly different among the four groups （χ2 = 14.04， P = 0.003）. Binary logistic regression model analysis showed that RBC， culture cycle， number of fluid changes， history of bleeding during pregnancy were significantly related to the occurrence of group D （OR = 2.27， 6.89， 4.25， 4.88 respectively）. Pregnancy outcomes showed that adverse events such as miscarriage， amniotic fluid leakage， and premature birth occurred in group D， while no adverse events occurred in the other three groups. Conclusions Amniotic fluid sediment characteristics exhibit significant variations during the second trimester. Specifically， dark-brown sediment is associated with impaired in vitro cell culture efficiency and an increased risk of adverse pregnancy outcomes. These findings underscore the necessity for early risk assessment， stratified specimen processing， and individualized prenatal management in clinical practice.

Objective To investigate the effects of iron supplementation on thyroid function indices and thyroid-related autoantibodies in pregnant women with thyroid dysfunction under different iron nutritional statuses. Methods This retrospective cohort study recruited 353 pregnant women with thyroid dysfunction who registered for antenatal care at a tertiary Grade-A maternal and child health hospital in Chengdu， China， from November 2024 to August 2025. Based on the baseline iron nutritional status （iron deficiency vs. iron sufficiency） and exposure to iron supplementation， the participants were naturally divided into four groups. The changes in thyroid function indices and autoantibody levels before and after iron supplementation were compared among the groups. Multiple linear regression models were used to analyze the associations between iron supplementation and changes in thyroid function indices and autoantibody levels under different iron nutritional statuses. Results Among iron-deficient pregnant women with thyroid dysfunction， statistically significant differences were detected between the iron-supplemented and non-supplemented groups in free thyroxine （FT4） ［β（95%CI）： -4.75 （-7.73 - -1.76）， P = 0.002］， thyroid-stimulating hormone （TSH） ［β（95%CI）： -1.84 （-3.49 - -0.18）， P = 0.030］， and anti-thyroid peroxidase antibody （TPOAb） ［β（95%CI）： -271.33 （-423.84 - -118.82）， P < 0.001］. Among iron-sufficient pregnant women with thyroid dysfunction， iron supplementation was linked to a reduction in anti-thyroglobulin antibody （TGAb） levels ［β（95%CI）： -41.74 （-75.69 - -7.79）， P = 0.016］. No associations were identified between iron supplementation and triiodothyronine （T3）， thyroxine （T4）， or free triiodothyronine （FT3）. Conclusions In pregnant women with thyroid dysfunction， iron supplementation is associated with specific changes in thyroid function parameters and autoantibody levels. Moreover， prophylactic iron supplementation effectively mitigates thyroid autoimmune responses in iron-sufficient pregnant women.

Objective To develop and preliminarily evaluate the value of an integrated ultrasound model that combines radiomics and deep learning features for the objective assessment of disease activity in rheumatoid arthritis （RA）. Methods A total of 184 affected joints from 92 RA patients were included and then divided into training and testing sets at an 8：2 ratio. After the delineation of the region-of-interest （ROI）， the extraction and screening of features， and the cropping of joint cross-sectional images， three standalone models， namely ultrasound scoring， bioinformatics， and deep learning， were constructed. Additionally， two combined models， ultrasound-bioinformatics and ultrasound-bioinformatics-deep learning， were also built. The performance of the models was evaluated using receiver operating characteristic （ROC） curves， the area under the curve （AUC）， and decision-making analysis （DCA） curves. Results In the test set， when compared with the ultrasound scoring model based on single features （AUC = 0.832， 95% CI： 0.709 - 0.954）， the radiomics model （AUC = 0.824， 95% CI： 0.701 - 0.947）， or the deep learning feature model （AUC = 0.788， 95% CI： 0.642 - 0.933）， the combined ultrasound-radiomics-deep learning model （AUC = 0.901， 95% CI： 0.815 - 0.988） exhibited the best performance. The Hosmer-Lemeshow goodness-of-fit test for the combined ultrasound-radiomics-deep learning model yielded a p-value greater than 0.05， indicating adequate model calibration. Moreover， DCA showed that the combined model provides a higher net clinical benefit within a defined range of threshold probabilities. Conclusion This multimodal fusion quantification model exhibits excellent efficacy in evaluating the activity of RA disease， establishing a methodological basis for the formulation of future stratified treatment strategies and dynamic efficacy monitoring for RA.

Objective To explore the effects of Gujiansan on bone and lipid metabolism in rat models of steroid-induced necrosis of the femoral head. Methods The rats were divided into the control group， the model group， and the low-dose， medium-dose， and high-dose groups of Gujiansan， with 10 rats in each group. Except for the control group， lipopolysaccharide and glucocorticoid were administered to the other groups to establish the steroid-induced necrosis of the femoral head model. The low-dose， medium-dose， and high-dose Gujiansan groups were respectively given 1.05， 2.10， and 4.20 g/kg of Gujiansan via gavage daily. Eight weeks later， the contents of low-density lipoprotein cholesterol （LDL-C）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， and triglycerides （TG） were measured. RT-qPCR and Western blot were employed to detect the relative mRNA and protein expression levels of peroxisome proliferator-activated receptor γ （PPARγ）， CCAAT enhancer binding protein α （C/EBPα）， CCAAT enhancer binding protein β （C/EBPβ）， Runt-related transcription factor 2 （Runx2）， osteopontin （OPN）， and alkaline phosphatase （ALP） in femoral head tissues. Micro-CT was utilized to observe the alterations in the bone mass of the rat femoral head； Hematoxylin-eosin （HE） staining was used to observe the pathological morphological changes of the femoral head tissue. Immunohistochemistry （IHC） was applied to observe the protein expressions of osteocalcin （OCN） and Runx2 in the femoral head. Results Compared with the model group， after treatment with Gujiansan， the contents of serum TC， TG， and LDL-C decreased （P < 0.05）， whereas the content of HDL-C increased （P < 0.05）. Additionally， the mRNA and protein expression levels of peroxisome PPARγ， C/EBPα， and C/EBPβ decreased （P < 0.05）， while those of Runx2， ALP， and OPN increased （P < 0.05）. Moreover， the bone volume fraction， trabecular thickness， trabecular number， trabecular connection density， and bone mineral content increased （P < 0.05）， the trabecular separation degree decreased （P < 0.05）， the rate of empty bone pits in the femoral head tissue decreased （P < 0.05）， and the expression levels of OCN and Runx2 proteins increased （P < 0.05）. Conclusion This study shows that the low-dose， medium and high-dose groups of Gujiansan all have the effect of regulating the homeostasis of bone lipid metabolism， and the high-dose group of Gujiansan has the most significant effect； Gujiansan may improve lipid metabolism disorders in rats with steroid-induced necrosis of the femoral head via the PPARγ signaling pathway， promote osteogenic differentiation， restore the balance of bone-lipid metabolism， and consequently promote the repair of osteonecrosis.

Objective To investigate the effects of Buyang Huanwu Decoction （BYHWD） on the abnormal proliferation and fibrosis of human ligamentum flavum cells （LFCs） induced by transforming growth factor-β1 （TGF-β1）， and to elucidate the underlying molecular mechanisms mediated by the PHLPP1/AKT/mTORC1 signaling pathway. Methods Primary human LFCs were cultured in vitro and stimulated with TGF-β1 to establish a fibrotic cell model， followed by intervention with BYHWD-medicated serum. Cell proliferation was assessed using CCK-8 and EdU assays. Western blotting was performed to detect the protein expression levels of proliferation-related markers （PCNA， Ki-67）， fibrosis-related markers （collagen Ⅰ， collagen Ⅲ， α-SMA， and fibronectin）， and key signaling proteins （PHLPP1， p-AKT， total AKT， p-S6K， total S6K， p-S6， and total S6）. Furthermore， a lentiviral vector carrying shPHLPP1 was constructed to perform PHLPP1 knockdown rescue experiments， thereby verifying the pathway dependence of BYHWD efficacy. Results BYHWD-medicated serum markedly suppressed TGF-β1-induced proliferation of LFCs and downregulated the expression of PCNA and Ki-67. Concurrently， BYHWD reduced the protein levels of collagen I， collagen III， α-SMA， and fibronectin， thereby alleviating cellular fibrosis. Mechanistically， BYHWD upregulated PHLPP1 expression and decreased the ratios of phosphorylated to total proteins （p-AKT/AKT， p-S6K/S6K， and p-S6/S6）， thus blocking the hyperactivation of the AKT/mTORC1 cascade. Notably， PHLPP1 knockdown significantly reversed the inhibitory effects of BYHWD on cell proliferation and fibrosis， as well as its suppressive effect on the AKT/mTORC1 pathway. Conclusions BYHWD attenuates the aberrant proliferation and fibrosis of LFCs by upregulating PHLPP1 and suppressing the hyperactivation of the AKT/mTORC1 signaling pathway. This study provides experimental evidence and identifies potential molecular targets for the clinical application of BYHWD in treating ligamentum flavum hypertrophy and lumbar spinal stenosis associated with Qi deficiency and blood stasis syndrome.

Objective To evaluate the predictive value of serum soluble cluster of differentiation 22 （sCD22） and soluble CD40 ligand （sCD40L） for postoperative delirium （POD） among elderly patients who undergo major orthopedic surgery （MOS）. Methods A total of 225 elderly patients who underwent MOS at our hospital from January 2024 to October 2025 were included in the study. The levels of serum sCD22 and sCD40L were measured using enzyme-linked immunosorbent assay （ELISA）. The patients were divided into the POD group and the non-POD group based on the occurrence of POD within 7 days after the surgery. Multivariate logistic regression analysis was carried out to identify the factors related to POD. Receiver operating characteristic （ROC） curve analysis and decision curve analysis （DCA） were performed to evaluate the predictive performance and clinical utility of serum sCD22 and sCD40L levels. Results POD occurred in 42 out of 225 patients （18.67%）. In comparison with the non-POD group， patients who developed POD were characterized by an older age， a higher American Society of Anesthesiologists （ASA） grade， a greater amount of intraoperative blood loss and fluid administration， a longer operative duration， and higher levels of C-reactive protein （CRP）， sCD22， and sCD40L （P < 0.05）. Multivariate logistic regression analysis identified advanced age （OR = 1.109， 95%CI： 1.014 ? 1.213， P = 0.023）， ASA grade Ⅲ ? Ⅳ （OR = 5.400， 95%CI： 1.345 ? 21.681， P = 0.017）， an increased amount of intraoperative fluid administration （OR = 1.120， 95%CI： 1.007 ? 1.247， P = 0.038）， elevated CRP （OR = 1.197， 95%CI： 1.055 ? 1.358， P = 0.005）， elevated sCD22 （OR = 1.219， 95%CI： 1.094 ? 1.359， P < 0.001）， and elevated sCD40L （OR = 3.328， 95%CI： 2.003 ? 5.529， P < 0.001） as independent risk factors for POD. The areas under the ROC curve for predicting POD were 0.797 for sCD22， 0.804 for sCD40L， and 0.907 for their combined assessment， with corresponding sensitivities of 0.691， 0.548， and 0.762 and specificities of 0.869， 0.978， and 0.940， respectively. The combined model demonstrated significantly greater predictive performance than either biomarker alone （P < 0.05）. DCA further demonstrated that the combined assessment yielded a greater net clinical benefit than either individual marker across a threshold probability range of 0.05 ? 0.10. Conclusions Elevated serum levels of sCD22 and sCD40L are independent risk factors for POD in elderly patients undergoing MOS. A combined assessment of these two biomarkers exhibits superior predictive performance and can serve as a valuable tool for the early identification of patients at high risk of POD.

Objective To investigate the effects of nebulized human interferon alpha-1b in combination with budesonide on the levels of serum chemokine ligand 5 （CCL5） and chemokine ligand 11 （CCL11） and the clinical efficacy in children with severe respiratory syncytial virus （RSV） pneumonia. Methods A total of 270 children with severe RSV pneumonia who were admitted to Ningxia Medical University General Hospital from March 2022 to February 2025 were prospectively included and randomly divided into a control group （n = 135） and an observation group （n = 135） using a random number table. Both groups received basic symptomatic treatment. Specifically， the control group received budesonide nebulization inhalation treatment， while the observation group received human interferon alpha-1b nebulization treatment on the basis of the treatment given to the control group. The improvement time of symptoms after treatment， serum CCL5 and CCL11 levels， Th1/Th2 immune balance indicators， airway remodeling and oxidative stress indicators， blood gas indicators， and adverse reactions before and after treatment were compared. Results The disappearance time of cough， wheezing， and lung rales in the observation group was shorter than that in the control group （P < 0.05）. After treatment， the serum levels of CCL5 and CCL11 in the observation group were lower than those in the control group （P < 0.05）. The levels of interleukin-4 （IL-4） in the observation group were lower than those in the control group， while the levels of interferon gamma （IFN-γ） and the IFN-γ/IL-4 ratio were higher than those in the control group （P < 0.05）. The observation group had lower levels of mucin 5AC （MUC5AC） and 8-hydroxydeoxyguanosine （8-OHdG） and higher levels of superoxide dismutase （SOD） compared to the control group （P < 0.05）. The arterial partial pressure of oxygen （PaO₂）， oxygenation index （PaO₂/FiO₂）， and blood oxygen saturation （SpO₂） in the observation group were higher than those in the control group （P < 0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups （P > 0.05）. Conclusions The combination of human interferon alpha-1b and budesonide nebulized inhalation therapy can remarkably enhance the clinical symptoms in children suffering from severe RSV pneumonia. Through down-regulating the levels of serum CCL5 and CCL11， regulating the levels of Th1/Th2 immune index， inhibiting airway remodeling， lessening oxidative stress damage， and improving blood gas status， this combination therapy demonstrates high safety.

Objective To analyze the clinical efficacy and prognostic impact of ventricular intracranial pressure （ICP） monitoring-assisted stepwise decompression in the treatment of patients with severe craniocerebral injury complicated with cerebral hernia， and to explore the complementary mechanism between these two interventions. Methods A total of 200 patients diagnosed with severe craniocerebral injury complicated with cerebral hernia admitted to our hospital between April 2025 and February 2026 were enrolled in this retrospective study. All patients underwent ICP probe placement and staged decompression. The control group （n = 98） received conventional standalone ICP monitoring， while the observation group （n = 102） received intraventricular ICP monitoring. Intergroup comparisons were performed on ICP control efficacy， mannitol dosage and administration， hospitalization-related indicators， clinical prognosis and the incidence of postoperative complications. Results Statistically significant differences in ICP were detected across time effect， inter-group effect， and interaction effect （all P < 0.05）. Compared with the ICP values obtained on postoperative day 1， ICP in the observation group decreased significantly on postoperative day 3 and postoperative day 7， while ICP in the control group decreased significantly only on postoperative day 7 （all P < 0.05）. Compared with the ICP values on postoperative day 3， ICP in both groups decreased significantly on postoperative day 7 （P < 0.05）. Throughout postoperative day 1， postoperative day 3， and postoperative day 7， ICP in the observation group was consistently lower than that in the control group （all P < 0.05）. Compared with the control group， the observation group exhibited statistically significant reductions in mannitol dosage， duration of mannitol administration， length of intensive care unit （ICU） stay， and total length of hospital stay （all P < 0.05）. The median Glasgow Outcome Scale （GOS） score of the observation group ［4.00 （2.00， 4.00）］ was significantly higher than that of the control group ［3.00 （2.00， 4.00）］ （Z = -3.489， P < 0.001）. Classified by GOS scores， 24 patients in the observation group and 11 patients in the control group achieved favorable prognoses， with the observation group showing a significantly higher proportion of favorable outcomes （P < 0.05）. Postoperative complications assessed in this study included acute encephalocele， intracranial infection， renal dysfunction， and delayed hematoma. The incidence of delayed hematoma， acute malignant encephalocele， and the overall complication rate in the observation group were significantly lower than those in the control group （all P < 0.05）. No statistically significant between-group difference was observed in the incidence of intracranial infection or renal dysfunction （both P > 0.05）. Conclusions The combination of ventricular ICP monitoring and stepwise decompression exerts a synergistic effect， and achieves favorable clinical outcomes in patients with severe craniocerebral injury complicated with cerebral hernia. This combined strategy can effectively control intracranial hypertension， reduce the dosage of mannitol， shorten hospital length of stay， improve patient prognosis， and reduce the incidence of postoperative complications.

Objective To investigate the risk stratification capability and diagnostic performance of a combined clinical， radiological， and electrophysiological model in neonatal acute bilirubin encephalopathy （ABE）. Methods We retrospectively analyzed clinical data， auditory brainstem response （ABR） parameters， amplitude-integrated electroencephalography （aEEG） findings， and cranial magnetic resonance imaging （MRI） features from 275 neonates with hyperbilirubinemia. The neonates were randomly allocated to a training cohort （n = 193） and a validation cohort （n = 82） in a 7∶3 ratio. Independent risk factors identified through univariate and multivariable logistic regression analyses were incorporated to construct a combined predictive nomogram. Model performance was evaluated using the area under the receiver operating characteristic （ROC） curve （AUC）， the Hosmer-Lemeshow （HL） goodness-of-fit test， calibration curves， and decision curve analysis （DCA） to assess discrimination， goodness-of-fit， calibration， and clinical utility， respectively. DeLong’s test was used to compare the AUC of the combined model with those of the individual predictors. Furthermore， the net reclassification improvement （NRI） was calculated to evaluate the incremental predictive value of the combined model. Results Glucose-6-phosphate dehydrogenase （G-6-PD） deficiency， abnormal ABR findings， and the globus pallidus/putamen （G/P） MRI signal intensity ratio were identified as independent risk factors and incorporated into the model. In the training cohort， the combined model achieved an AUC of 0.968， significantly outperforming any individual predictor （all P < 0.05）. In the validation cohort， the model maintained a high AUC of 0.945. Additionally， NRI analysis demonstrated that the combined model significantly improved risk reclassification （NRI = 1.25， P < 0.001）. The HL test （P > 0.05）， calibration curves， and DCA confirmed that the model exhibited satisfactory goodness-of-fit， excellent calibration， and favorable clinical utility in both cohorts. Conclusions The multimodal clinical-radiological-electrophysiological model significantly improves both diagnostic performance and risk stratification capabilities in ABE. It provides a reliable and objective tool for the early identification of high-risk neonates and the formulation of personalized clinical management strategies.

Objective The aims of this study were to compare the differences in fat content between liver segments and liver lobes by utilizing magnetic resonance imaging proton density fat fraction （PDFF）， thereby clarifying the spatial distribution characteristics of liver fat content and providing evidence for the clinical accurate quantitative evaluation of liver fat. Methods A total of 113 patients were retrospectively included. Liver magnetic resonance imaging （MRI） and biochemical data were gathered to ascertain hepatic PDFF values. The Friedman rank-sum test， in combination with the Bonferroni post-hoc test， was employed to analyze the disparities in fat content among liver segments and lobes. The Spearman correlation coefficient was utilized to investigate the correlation between whole-liver PDFF and biochemical indicators. Results There were significant differences in PDFF values among liver segments （P < 0.05）. Pair-wise comparisons indicated significant differences in PDFF values between S1 and S2 - S8， between S2 and S6 - S8， and between S4 and S7 - S8. Additionally， there were significant differences between the caudate lobe， left lobe， right lobe， and the whole-liver mean， as well as between the right lobe， left lobe， and the whole-liver mean （all adjusted P < 0.05）. Correlation analysis revealed that the average whole-liver PDFF was weakly positively correlated with glycated hemoglobin and triglycerides， and weakly negatively correlated with apolipoprotein A. Conclusions There is evident spatial heterogeneity in liver fat content， and the distribution of fat content varies significantly among different liver lobes and segments. Moreover， PDFF is correlated with certain glycolipid metabolism indicators， which can offer a reference for clinical evaluation.

Objective To analyze the risk factors for unfavorable outcomes following vital pulp therapy （VPT） in carious first permanent molars in children and to develop a nomogram-based predictive model. Methods Clinical data from 862 pediatric patients （862 teeth） who underwent VPT for caries-induced pulp exposure in first permanent molars at Suzhou Stomatological Hospital between January 2020 and December 2024 were retrospectively analyzed. Patients were randomly divided into a training set （n = 603） and a validation set （n = 259） in a 7∶3 ratio. The least absolute shrinkage and selection operator （LASSO） regression was applied to identify optimal predictive variables， which were subsequently incorporated into a multivariable logistic regression analysis to construct a nomogram-based prediction model. Model discrimination， calibration， and clinical utility were evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis （DCA）， respectively. Results The incidence of unfavorable outcomes was 12.60% （76/603） in the training set and 12.36% （32/259） in the validation set. LASSO regression identified eight variables with non-zero coefficients： root development， history of spontaneous pain， pulp vitality status， pulp-capping material， cavity classification， timing of restoration， irreversible pulpitis， and hemostasis time > 5 minutes. Multivariable logistic regression analysis revealed that root development （OR = 6.077）， history of spontaneous pain （OR = 5.331）， pulp vitality status （OR = 4.926）， cavity classification （OR = 4.579）， timing of restoration （OR = 3.013）， hemostasis time > 5 minutes （OR = 2.431）， and irreversible pulpitis （OR = 2.392） were independent risk factors for unfavorable outcomes following VPT in carious first permanent molars. Conversely， the use of iRoot BP Plus as a pulp-capping material （OR = 0.440） was identified as a protective factor. ROC curve analysis demonstrated an area under the curve （AUC） of 0.899 （95% CI： 0.872 - 0.926， P < 0.001） in the training set and 0.936 （95% CI： 0.903 - 0.963， P < 0.001） in the validation set. Internal validation using the bootstrap method with 1 000 resampling iterations showed excellent agreement between predicted and observed probabilities on the calibration curves， and DCA confirmed the favorable clinical utility of the model. Conclusion Root development， history of spontaneous pain， pulp vitality status， cavity classification， timing of restoration， prolonged hemostasis time （> 5 minutes）， irreversible pulpitis， and the choice of pulp-capping material are strong predictors of unfavorable outcomes following VPT in carious first permanent molars in children. The developed nomogram provides a valuable tool for the early identification of high-risk patients and guiding clinical decision-making.