Objective To evaluate the impact of modified cesarean section techniques on pregnancy outcomes in cases involving placenta accreta spectrum （PAS）. Methods A retrospective study was conducted to enroll 176 pregnant women with PAS who underwent cesarean delivery at the First Hospital of Shanxi Medical University between January 2016 and January 2025. Patients who received traditional cesarean delivery before January 17, 2021， were assigned to the control group （n = 115）， while those who underwent a modified cesarean procedure after that date were included in the modified group （n = 61）. Clinical data， including gestational age， maternal age， gravidity， and intraoperative blood loss， were collected and compared between the two groups. Subsequently， a random forest algorithm was employed to develop a risk prediction model for adverse pregnancy outcomes in patients with PAS. Results In the modified group， only one patient required a hysterectomy （1.64%）， which was significantly lower than the 19 cases observed in the control group （16.52%）. The modified group also demonstrated a higher intraoperative diagnosis rate of placenta accreta， along with lower incidences of hemorrhagic shock， disseminated intravascular coagulation， and neonatal asphyxia compared to the control group. However， the proportions of patients undergoing uterine compression sutures and uterine artery ligation were higher in the modified group， with statistically significant differences （P < 0.05）. Patients were further classified into low?bleeding and high?bleeding subgroups for subgroup analysis. A significant difference in gravidity was observed between the two subgroups （P < 0.05）， whereas no significant difference was found in the proportion of patients receiving the modified procedure （P > 0.05）. A predictive model for refractory postpartum hemorrhage was developed with high discriminative ability （AUC = 0.938， 95%CI： 0.917 ~ 0.958）. Gini coefficient analysis identified gravidity， number of abortions， and ultrasound diagnosis of placenta accreta as key predictors of refractory postpartum hemorrhage （P < 0.05）. Conclusion Improved cesarean section techniques can effectively reduce intraoperative and postoperative bleeding in cases of PAS， significantly lowering the risk of hysterectomy and thereby improving pregnancy outcomes.

Objective To compare the clinical pregnancy outcomes of tamoxifen （TAM） ， TAM combined with intrauterine perfusion of platelet-rich plasma （PRP）， and hormone replacement therapy （HRT） combined with intrauterine perfusion of PRP for frozen-thawed embryo transfer （FET） in patients with thin endometrium. Methods A retrospective analysis was performed on clinical data of 321 patients with thin endometrium （endometrial thickness ≤ 7 mm in previous cycles） who underwent FET at the Reproductive Medicine Center of Guangdong Provincial Reproductive Hospital from January 2023 to April 2025. According to the treatment protocols，the patients were divided into three groups： TAM group （Group A， n = 98）， TAM + PRP group （Group B， n = 91）， and HRT + PRP group （Group C， n = 132）. General information， endometrial thickness on the conversion day before and after treatment， clinical pregnancy outcomes， andcosts of endometrial preparation treatment were compared among the three groups. Results There were no significant differences in age， duration of infertility， type of infertility， anti-Müllerian hormone （AMH） level， basal follicle-stimulating hormone （FSH） among the three groups（P > 0.05）. After treatment， there were no significant differences in endometrial thickness on the conversion day or the extent of increase among the three groups（P > 0.05）. The clinical pregnancy rates in Group A， Group B， and Group C were 56.1%， 51.6%， and 43.2% respectively， with a significant difference （P = 0.011）； the embryo implantation rates were 43.6%， 45.5%， and 34.6% respectively， showing a significant difference（P = 0.019）. The early abortion rate in Group A （3.64%） was significantly lower than that in Group C （15.79%）（P < 0.01）. In terms of treatment cost of endometrial preparation treatment， the cost in Group A （676.5 ± 494.5 Yuan） was significantly lower than that in Group B （2 401.2 ± 764.2 Yuan） and Group C （3 093.8 ± 758.3 Yuan） （P < 0.01）. Conclusion In FET cycles for patients with thin endometrium， the clinical outcomes of TAM，TAM + PRP and HRT + PRP are comparable， and TAM demonstrates advantages in terms of a lower early miscarrage rate and better cost-effectiveness， thus serving as an option for endometrial preparation in patients with thin endometrium.

Objective To investigate the predictive value of pre-transfer serum fibroblast growth factor 21 （FGF-21）， anti-Müllerian hormone （AMH）， and neuropilin-1 （NRP-1） for early pregnancy loss at 6 weeks following in vitro fertilization-embryo transfer （IVF-ET）， and to establish an early predictive model based on serum biochemical markers. Methods This prospective study consecutively enrolled 322 women who achieved clinical pregnancy after IVF-ET at our center between September 2022 and September 2024. Participants were randomly divided into a modeling cohort （n = 225） and a validation cohort （n = 97） at a 7：3 ratio. According to ultrasound findings at 6 weeks of gestation， patients in the modeling cohort were classified into an early pregnancy loss group （n = 59） and an ongoing pregnancy group （n = 166）. Baseline clinical characteristics and pre-transfer serum levels of FGF-21， AMH， and NRP-1 were collected. Multivariate logistic regression was applied to identify independent risk factors for early pregnancy loss and to construct a predictive model. Model discrimination， calibration， and stability were evaluated using receiver operating characteristic （ROC） curves， the Hosmer-Lemeshow goodness-of-fit test， and bootstrap resampling in both cohorts. Results Univariate analysis revealed that the FSH/LH ratio， antral follicle count， and number of retrieved oocytes were significantly associated with early pregnancy loss （P < 0.001）. Compared with the ongoing pregnancy group， women with early loss showed significantly elevated pre-transfer serum FGF-21 levels， whereas AMH and NRP-1 levels were markedly reduced （P < 0.001）. Multivariate logistic regression demonstrated that an FSH/LH ratio < 1.8 （OR = 1.629， P = 0.002） and higher FGF-21 levels （OR = 1.338， P = 0.002） were independent risk factors， while higher AMH （OR = 0.741， P = 0.010） and NRP-1 levels （OR = 0.874， P = 0.007） were protective. Stratified analysis indicated that among patients with FSH/LH ≥ 1.8， FGF-21 levels were significantly higher and AMH and NRP-1 levels significantly lower （all P < 0.001）. Interaction analysis further suggested that the FSH/LH ratio significantly modified the associations between these biomarkers and pregnancy loss risk （P for interaction < 0.05）. Specifically， in the higher FSH/LH subgroup， the risk effect of FGF-21 was amplified， while the protective effects of AMH and NRP-1 were more pronounced. The combined predictive model achieved C-indices of 0.869 （95%CI： 0.826 ~ 0.926） in the modeling cohort and 0.835 （95%CI： 0.811 ~ 0.907） in the validation cohort. Its AUC for predicting early pregnancy loss was 0.934 in the modeling cohort and 0.909 in the validation cohort， both significantly outperforming individual markers （AUCs： FGF-21 = 0.867， AMH = 0.881， NRP-1 = 0.853； Z = 2.024， 1.831； P < 0.001）. Decision curve analysis showed that the model provided consistent net clinical benefit across threshold probabilities of 0.1 ~ 0.4， underscoring its clinical utility. Conclusions Elevated pre-transfer serum FGF-21 and reduced AMH and NRP-1 levels are strongly associated with early pregnancy loss at 6 weeks after IVF-ET. The predictive model developed in this study demonstrates robust accuracy and stability， offering substantial clinical application value for early risk stratification.

Objective To investigate the therapeutic efficacy of granulocyte colony-stimulating factor in combination with tadalafil in patients with thin endometrium undergoing artificial cycle frozen-thawed embryo transfer （FET）. Methods A prospective randomized clinical trial was conducted involving sixty patients with thin endometrium who underwent artificial cycle FET at the Reproductive Center of Qinhuangdao First Hospital between January 2021 and October 2023. The patients were randomly assigned to two groups： the control group （n = 30） received tadalafil， while the study group （n = 30） received granulocyte colony-stimulating factor in addition to tadalafil. Endometrial ultrasound characteristics， uterine artery blood flow parameters， and pregnancy outcomes were compared between the two groups before and after treatment. Results Before treatment， no significant differences were observed between the research group and the control group in terms of endometrial thickness or endometrial volume （P > 0.05）. Ultrasound assessments were repeated after 8 and 14 days of treatment. Compared with baseline measurements， both endometrial thickness and volume exhibited significant increases in both groups （all P < 0.05）. By day 14 post-treatment， the research group demonstrated significantly greater endometrial thickness and volume compared to the control group （P < 0.05）. With regard to endometrial patterns， no significant differences were noted between the two groups prior to treatment （P > 0.05）. After 14 days of treatment， the proportion of patients exhibiting a Type A endometrial pattern in the research group was significantly higher than that in the control group （P < 0.05）. Prior to treatment， no statistically significant differences were observed between the two groups in terms of pulsatility index （PI）， resistance index （RI）， systolic/diastolic ratio （S/D）， vascularization index （VI）， flow index （FI）， or Vascularization Flow Index （VFI） （all P > 0.05）. Following 14 days of treatment， both groups showed significant increases in VI， FI， and VFI compared to baseline values （all P < 0.05）， along with significant reductions in PI， RI， and S/D （all P < 0.05）. At 14 days post-treatment， the S/D ratio in the research group was significantly lower compared to the control group， while the VFI was significantly higher （P < 0.05）. However， statistical analysis showed no significant differences between the two groups in terms of embryo implantation rate， clinical pregnancy rate， early miscarriage rate， and live birth rate （P > 0.05）. Conclusion For patients with thin endometrium undergoing FET， the combination of granulocyte colony-stimulating factor and tadalafil is more effective than tadalafil alone in improving endometrial receptivity and uterine blood perfusion.

Bladder cancer （BCa） is a common malignant tumor of the urinary system， and its conventional treatment methods have many limitations. Chimeric antigen receptor T cell （CAR-T） therapy， as an emerging immunotherapy method， has achieved significant success in hematological malignancies and has brought new hope for the treatment of solid tumors. This article reviews the research progress of CAR-T cell therapy in the treatment of BCa， including the basic structure of CAR-T cells， potential therapeutic targets in bladder cancer， current challenges and corresponding strategies.

Objective To compare ferroptosis characteristics and motor dysfunction across different mouse models of Parkinson′s disease （PD）. Methods Animal models of PD were divided into five groups： the control group， sham-operated group， 6-hydroxydopamine （6-OHDA） group， 1-methyl-4-phenyl-1，2，3，6-tetrahydropyridine （MPTP） group， and lipopolysaccharide （LPS） group. Differences in ferroptosis-related features and motor dysfunction across these groups were evaluated through behavioral observation， histopathological examination， protein analysis， and assessment of lipid peroxidation and oxidative stress levels. Results In all three model groups， the number of TH-positive neurons in the substantia nigra on the lesioned side was significantly reduced， accompanied by evident neuronal degeneration and a marked decrease in Nissl bodies. Behavioral assessments revealed that the 6-OHDA group displayed the most severe motor deficits. In the substantia nigra， FTH1 protein expression was significantly downregulated in the 6-OHDA， LPS， and MPTP groups （P < 0.01， P < 0.05， P < 0.01）， respectively， while GPX4 expression was also reduced （P < 0.001， P < 0.001， P < 0.01）. Malondialdehyde （MDA） levels were significantly elevated in both the 6-OHDA and MPTP groups （P < 0.05， P < 0.05）. Glutathione （GSH） assays demonstrated markedly reduced levels in the 6-OHDA， MPTP， and LPS groups （P < 0.01， P < 0.001， P < 0.001）. Reactive oxygen species （ROS） detection revealed a significant increase in the MPTP and LPS groups （P < 0.05， P < 0.05）. Conclusion The 6-OHDA model is well suited for studying PD-related behaviors and the underlying mechanisms of motor symptoms， the MPTP model is particularly effective for investigating the ferroptosis pathway， and the LPS model serves as a valuable complement for research on neuroinflammation mechanisms.

Objective To explore the role of secreted phosphoprotein 1 （SPP1） and myeloid differentiation primary response 88 （MYD88） in morphine-induced cardiomyocyte apoptosis. Methods A morphine addiction model was established in Sprague-Dawley （SD） rats. Twelve SD rats were randomly assigned to the normal saline （NS） group or the morphine-dependent （DAM） group. Histopathological analysis was employed to observe and compare myocardial tissue morphology between the two groups. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL） staining was performed to assess the number of apoptotic cells in each group. The expression levels of SPP1 and MYD88 were evaluated using immunohistochemistry. Quantitative real-time poly merase chain reaction （RT-qPCR） and Western blot were used to detect the mRNA and protein expression of SPP1， MYD88， Bax， Bcl2， Caspase-3， and Caspase-9. Simultaneously， Western blot analysis was used to detected the expression of Cleaved Caspase-3 and Cleaved Caspase-9 proteins. In vitro， SPP1 expression was knocked down in primary neonatal rat cardiomyocytes （NRCMs）， and cells were divided into three groups： control （CON）， morphine treated （DA）， and shSPP1#3 + DA. Cell viability was assessed using the CCK-8 assay， and apoptosis rates were determined by flow cytometry. Results HE and TUNEL staining of myocardial tissues from morphine-addicted SD rats revealed that， compared with the NS group， myofibrils in the DAM group exhibited partial disruption and a significant increase in apoptotic cells （P < 0.05）. Western blot and RT-qPCR analyses demonstrated that， relative to the NS group， the mRNA and protein levels of SPP1， MYD88， Bax， Caspase-3， and Caspase-9 were significantly upregulated in the DAM group （P < 0.05）， whereas Bcl2 expression was significantly downregulated at both mRNA and protein levels （P < 0.05）， and the protein expression levels of Cleaved Caspase-3 and Cleaved Caspase-9 were also increased. with all differences being statistically significant. In NRCMs following morphine intervention， cell viability in the DA group was markedly reduced compared to the CON group （P < 0.05）， accompanied by a significant increase in apoptosis rate （P < 0.05）. Consistently， Western blot and RT-qPCR results showed elevated mRNA and protein expression of SPP1， MYD88， Bax， Caspase-3， and Caspase-9 in the DA group （P < 0.05）， along with decreased Bcl2 expression （P < 0.05）. The protein expression levels of Cleaved Caspase-3 and Cleaved Caspase-9 were elevated simultaneously. In contrast， the shSPP1#3 + DA group exhibited opposing trends compared to the DA group， with statistically sig nificant differences （P < 0.05）. Conclusion SPP1 and MYD88 play critical roles in mediating morphine-induced cardiomyocyte apoptosis， and silencing SPP1 has been shown to significantly reduce the extent of cardiomyocyte apoptosis following morphine exposure.

Objective To explore the interplay between MCT1-mediated lactate accumulation and ferroptosis in acute liver failure （ALF）. Methods An ALF mouse model and a hepatocyte injury model were established using lipopolysaccharide （LPS） in combination with D-galactosamine （D-GalN）. The mice were randomly assigned to three groups： a blank control group， an ALF model group， and an ALF + Liproxstatin-1 （Lip-1） treatment group. In vitro experiments included four groups： A blank control， a hepatocyte injury model， a lactate intervention， and an MCT1 overexpression group. Commercial kits were used to measure lactate levels in both mouse liver tissues and cell supernatants， as well as the contents of malondialdehyde （MDA）， ferrous ions （Fe²⁺）， and reduced glutathione （GSH） in liver tissue. Liver histopathology was evaluated using hematoxylin and eosin （HE） staining. Transmission electron microscopy was employed to assess mitochondrial ultrastructure in hepatocytes. Western blot （WB） analysis was performed to determine the protein expression levels of MCT1， glutathione peroxidase 4 （GPX4）， and acyl-CoA synthetase long-chain family member 4 （ACSL4） in both liver tissues and cultured cells. Real-time quantitative PCR and immunofluorescence assays were utilized to detect mRNA expression and fluorescence intensity of GPX4 and ACSL4， respectively. Results HE staining of liver tissue from the ALF mouse model revealed extensive hepatocyte necrosis and partial inflammatory cell infiltration. Both MCT1 and GPX4 protein expression were significantly downregulated （P < 0.001）， whereas ACSL4 protein expression was markedly upregulated （P < 0.000 1）， accompanied by a significant elevation in lactate levels （P < 0.001）. Transmission electron microscopy demonstrated reduced mitochondrial volume and disorganized cristae arrangement in hepatocytes. In contrast to the model group， histological analysis of liver tissue from ALF mice treated with an iron death inhibitor showed attenuated liver injury. GPX4 expression was restored （P < 0.05）， while ACSL4 expression was reduced （P < 0.001）. Levels of lactate， MDA， and Fe²⁺ in liver tissue were significantly lower （P < 0.001）， whereas GSH levels were significantly higher （P < 0.05）. In vitro experiments indicated that lactate treatment suppressed GPX4 expression in hepatocytes in a concentration-dependent manner while promoting ACSL4 expression （P < 0.05）. In the hepatocyte injury model group， MCT1 and GPX4 expression were downregulated， ACSL4 protein expression was upregulated （P < 0.05）， and lactate levels were significantly increased （P < 0.05）. However， MCT1 overexpression effectively reversed these alterations， resulting in increased GPX4 expression （P < 0.05） and decreased ACSL4 expression （P < 0.001）. Furthermore， immunofluorescence results revealed enhanced GPX4 fluorescence intensity （P < 0.001） and reduced ACSL4 signal intensity （P < 0.01）， along with a marked reduction in lactate levels in cell supernatants （P < 0.000 1）. Conclusions This study demonstrates that ferroptosis plays a critical role in cell death during ALF and is closely intertwined with lactate metabolism. MCT1 mitigates LPS/D-GalN-induced ferroptosis by facilitating lactate transport in hepatocytes， thereby reducing lactate accumulation. Conversely， inhibition of ferroptosis leads to decreased lactate levels， indicating a bidirectional 'lactate-ferroptosis' regulatory loop.

Objective To investigate the effects of exosomes derived from hypoxia-treated mesenchymal stem cells on chondrocyte injury. Methods After mesenchymal stem cells were subjected to hypoxic treatment， the secreted exosomes were collected and co-cultured with IL-1β-stimulated chondrocytes. Cell viability was assessed using the CCK-8 assay， while apoptosis was evaluated by flow cytometry and the measurement of Caspase-3 and PARP activities. Intracellular levels of ROS， Fe²⁺， and MDA were quantified using commercial assay kits. The expression of GPX4， SLC7A11， and ACSL4 was analyzed at both mRNA and protein levels via qRT-PCR and Western blot， respectively. Additionally， the secretion of COL2A1， MMP13， ADAMTS5， TNF-α， IL-6， and PGE2 was determined by ELISA. Results Chondrocyte viability was significantly enhanced following the uptake of exosomes derived from hypoxia-treated mesenchymal stem cells （H-Exo） （P < 0.05）. IL-1β treatment reduced chondrocyte viability， increased Caspase-3 and PARP activities， and promoted apoptosis （P < 0.05）； however， H-Exo effectively reversed IL-1β-induced apoptotic effects. Furthermore， IL-1β markedly down-regulated the expression of GPX4 and SLC7A11， up-regulated ACSL4 expression， and elevated intracellular levels of ROS， Fe²⁺， and MDA （P < 0.05）， indicating the induction of ferroptosis. Both the ferroptosis inhibitor and H-Exo significantly attenuated IL-1β-triggered ferroptosis， and H-Exo counteracted the detrimental effects of IL-1β as well as those induced by a ferroptosis inducer. Additionally， IL-1β suppressed the expression of the chondrogenic marker COL2A1， up-regulated the catabolic enzymes MMP13 and ADAMTS5， and enhanced the secretion of pro-inflammatory cytokines TNF-α， IL-6， and PGE2 （P < 0.05）. Notably， H-Exo alleviated IL-1β-mediated inflammation and restored the balance between chondrogenic anabolism and catabolism. Conclusions Exosomes secreted by mesenchymal stem cells under hypoxic conditions can effectively inhibit chondrocyte apoptosis and ferroptosis， thereby alleviating cellular injury. These findings suggest that such exosomes exert a protective effect on chondrocytes and hold promise as a novel therapeutic strategy for cartilage repair.

Objective To investigate the expression levels of Ubiquitin Carboxy-Terminal Hydrolase-L1 （UCH-L1） and Netrin-1 in the serum of patients with spontaneous basal ganglia hemorrhage（ICH） complicated with cerebral edema， and to analyze their impacts on neurological deficits and prognosis. Methods A retrospective analysis was conducted on the clinical data of 173 patients with spontaneous basal ganglia hemorrhage admitted to the Department of Neurosurgery， The First Affiliated Hospital of Bengbu Medical University from September 2023 to January 2025. The serum levels of UCH-L1 and Netrin-1 were measured within 24 hours after the onset. They were divided into three groups according to the size of the cerebral edema volume （CEV）： Group A （CEV < 10 mL）， Group B （CEV 10 ~ 30 mL）， and Group C （CEV > 30 mL）. Pearson′s correlation analysis was used to analyze the correlation between serum expression levels of UCH-L1 and Netrin-1 with hemorrhage， volume of cerebral edema， distance of midline shift， Modified Edinburgh-Scandinavian Stroke Scale （MESSS） score， Modified Rankin Scale （mRS） score， and Glasgow Coma Scale （GCS） score. Logistic regression analysis was performed to identify the risk factors for poor prognosis. Receiver operating characteristic （ROC） curve analysis was used to evaluate the predictive value of UCH-L1 and netrin-1 for poor prognosis. Results Significant differences were observed in the serum levels of UCH-L1 and netrin-1 among patients with different volumes of cerebral edema （P < 0.05）. The larger the volume of cerebral edema， the higher the expression levels of UCH-L1 and netrin-1. The serum levels of UCH-L1 and Netrin-1 were significantly higher in the poor prognosis group compared to the good prognosis group （P < 0.05）. The serum levels of UCH-L1 and Netrin-1 were positively correlated with MESSS score， hemorrhage volume， cerebral edema volume， distance of midline shift， and mRS score （P < 0.05）， and negatively correlated with GCS score （P < 0.05）. Multivariate Logistic regression analysis showed that both UCH-L1 and netrin-1 were independent risk factors for poor neurological prognosis in basal ganglia hemorrhage patients （P < 0.05）. ROC curve analysis indicated that both markers had important predictive value for poor prognosis. The AUC for serum UCH-L1 level predicting poor prognosis was 0.77［95% confidence interval （CI）： 0.69 ~ 0.85， P < 0.01］， with a sensitivity of 84.9% and a specificity of 50.6%. The AUC for serum Netrin-1 level predicting poor prognosis was 0.89 （95%CI： 0.85 ~ 0.94， P < 0.01）， with a sensitivity of 82.1% and a specificity of 68.7%. Conclusions Serum UCH-L1 and Netrin-1 are differentially expressed in patients with spontaneous basal ganglia hemorrhage complicated with different volumes of cerebral edema. They are independent risk factors for poor prognosis and are important predictors of neurological function prognosis in these patients.

Objective To compare the clinical efficacy of the transforaminal endoscopic lumbar discectomy （TELD） approach with that of the interlaminar endoscopic lumbar discectomy （IELD） approach， both performed using a single-channel spinal endoscope， in the treatment of L4-L5 degenerative lumbar lateral recess stenosis （DLLRS）. Methods A retrospective analysis was conducted on 78 patients with L4-L5 DLLRS who underwent single-channel endoscopic spinal surgery at our institution between March 2020 and March 2024. Patients were classified into the TELD group （lateral transforaminal approach， n = 34） and the IELD group （interlaminar approach， n = 44）. Propensity score matching （PSM） was performed in a 1∶1 ratio using age， sex， body mass index （BMI）， and duration of symptoms as covariates， yielding 25 matched pairs for final comparative analysis. Perioperative outcomes were systematically compared between groups. Visual analog scale （VAS） scores for low back pain and leg pain， as well as the Oswestry Disability Index （ODI）， were evaluated preoperatively and at 3 days， 3 months， 6 months， and 1 year postoperatively. Lumbar computed tomography （CT） scans obtained 3 days after surgery were used to measure the lateral recess angle （LRA） and assess the extent of decompression. Spinal stability was evaluated using dynamic lumbar radiographs at 3 months postoperatively. Clinical outcomes were assessed 1 year after surgery based on the modified MacNab criteria. Results Both groups showed significant reductions in VAS scores for low back and leg pain， as well as in ODI scores， at all postoperative time points compared to baseline values （P < 0.05）. However， no statistically significant differences were observed between the two groups （P > 0.05）. Lumbar CT scans performed on postoperative day 3 demonstrated a significant increase in LRA in both groups relative to preoperative measurements （P < 0.05）. Although the magnitude of increase was greater in the IELD group， the intergroup difference did not reach statistical significance （P > 0.05）. At 3 months postoperatively， dynamic lumbar radiographs revealed no deterioration in spinal stability in either group compared to preoperative conditions， with no significant difference between groups （P > 0.05）. According to the modified MacNab criteria at 1 year postoperatively， the excellent and good outcome rate was 88.0% in the TELD group and 92.0% in the IELD group， with no statistically significant difference between the groups （P > 0.05）. Conclusions Both the TELD and IELD techniques are safe and effective for managing L4-L5 DLLRS， yielding comparable clinical outcomes. The selection of surgical approach should be guided by the anatomical location of ventral disc protrusions， as well as the degree of facet joint hypertrophy and neural compression.

Objective To investigate the temporal predictive value of soluble triggering receptor expressed on myeloid cells-1 （sTREM-1）， procalcitonin （PCT）， and myeloid-related protein 8/14 （MRP8/14） for secondary acute respiratory distress syndrome （ARDS） in patients with severe pulmonary tuberculosis. Methods A retrospective cohort study was conducted among patients with severe pulmonary tuberculosis admitted between January 2021 and December 2024. Patients were randomly assigned in an 8∶2 ratio to a training set （n = 148） and a validation set （n = 37）. Serum sTREM-1， PCT， and MRP8/14 were extracted from the electronic medical record at three time points： on admission （day 0）， day 3， and day 7. Multivariable logistic regression was used to identify risk factors， and predictive performance was evaluated using receiver operating characteristic （ROC） curves. Results A total of 185 patients were included. In the training set （n = 148）， 27 developed ARDS and 121 did not； in the validation set （n = 37）， 7 developed ARDS and 30 did not. In the training set， serum sTREM-1， PCT， and MRP8/14 levels showed significant temporal changes （P < 0.05）. At admission， day 3， and day 7， levels of sTREM-1， PCT， and MRP8/14 were higher in the ARDS group than in the non-ARDS group （all P < 0.05）. At each time point， sTREM-1， PCT， and MRP8/14 were independently associated with the development of ARDS （P < 0.05）. In the training set， the combination of sTREM-1， PCT， and MRP8/14 at admission yielded the largest area under the ROC curve ［AUC = 0.976； 95% confidence interval （CI）， 0.952 ~ 1.000］， with a sensitivity of 88.9% and a specificity of 98.3%. In the validation set， the same combination achieved an AUC of 0.957 （95% CI， 0.895 ~ 1.000）， with a sensitivity of 100.0% and a specificity of 86.7%. Conclusion Dynamic changes in sTREM-1， PCT， and MRP8/14 provide temporal predictive value for ARDS in patients with severe pulmonary tuberculosis， and the combined assessment improves early warning accuracy.

Objective To examine the expression levels of inflammatory factors， including IL-6， IL-10， MMP-9， IL-17A， and LDH， in the cerebrospinal fluid （CSF） of patients with spontaneous intracerebral hemorrhage （sICH）， and to investigate their associations with disease severity and clinical outcomes. Methods A total of 168 patients with sICH admitted to Tangshan GongRen Hospital between January 2023 and January 2025 were prospectively enrolled as the study group， while 30 non-sICH patients who underwent lumbar puncture during the same period served as the control group. Levels of inflammatory factors in CSF were compared between the two groups. Spearman′s rank correlation analysis was performed to assess the association between inflammatory factor levels and clinical severity in sICH patients. Binary logistic regression analysis was conducted to identify independent predictors of sICH prognosis. Receiver operating characteristic （ROC） curve analysis was employed to evaluate the prognostic value of these inflammatory factors in sICH. Results The levels of IL-6， IL-10， MMP-9， IL-17A， and LDH in the CSF of patients with sICH were significantly higher than those in non-sICH patients （all P < 0.05）. Furthermore， among sICH patients， these biomarker levels exhibited a graded increase according to disease severity： severe > moderate > mild （all P < 0.05）. Spearman correlation analysis revealed significant positive correlations between CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH and the NIHSS scores， with correlation coefficients （r） of 0.686， 0.553， 0.685， 0.593， and 0.695， respectively （all P < 0.05）. When comparing the prognoses of sICH patients， hematoma size， NIHSS score， and CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH were significantly higher in the deceased group than in the survival group （P < 0.05）， whereas ApoA1 levels were lower in the deceased group （P < 0.05）. Logistic regression analysis revealed that hematoma size， NIHSS score， and elevated CSF levels of IL-6， IL-10， MMP-9， IL-17A， and LDH were independent risk factors for mortality in sICH patients （P < 0.05）. ROC curve analysis showed that the AUC values for CSF IL-6， IL-10， MMP-9， IL-17A， and LDH in predicting sICH prognosis were 0.794， 0.754， 0.670， 0.717， and 0.683， respectively. Notably， the combination of CSF inflammatory markers with hematoma size and NIHSS score yielded an AUC of 0.993， demonstrating significantly greater predictive accuracy than CSF inflammatory markers alone （P < 0.05）. Conclusions The levels of inflammatory factors in the CSF， including IL-6， IL-10， MMP-9， IL-17A， and LDH， were elevated in patients with sICH and positively correlated with disease severity. Combining CSF inflammatory markers with the NIHSS score and hematoma size improved the predictive accuracy for sICH prognosis.

Objective To investigate the effects of different dialysis modalities on serum levels of dephosphorylated-uncarboxylated matrix Gla protein （dp-ucMGP）， lipid profiles， and vascular calcification in maintenance hemodialysis （MHD） patients， and to identify the risk factors associated with vascular calcification in this population. Methods A total of 87 MHD patients admitted to the hospital between January 2019 and December 2022 were enrolled as study participants. Based on their dialysis modalities， they were categorized into three groups： the hemodialysis （HD） group， the HD combined with hemodiafiltration （HD + HDF） group， and the HD， HDF combined with hemoperfusion （HD + HDF + HP） group， with 29 patients in each group. The serum dp-ucMGP levels， lipid profiles， and extent of vascular calcification were compared across the three groups. Patients were divided into a vascular calcification group and a non-vascular calcification group based on the presence or absence of vascular calcification. Univariate analyses and multivariate analysis were performed to identify factors potentially associated with vascular calcification in patients undergoing MHD. Results The results demonstrated that the levels of blood phosphorus， intact parathyroid hormone （iPTH）， serum dp-ucMGP， total cholesterol （TC）， triglycerides （TG）， and low-density lipoprotein cholesterol （LDL-C） were significantly higher in the HD group compared to the HD + HDF and HD + HDF + HP groups. Conversely， high-density lipoprotein cholesterol （HDL-C） levels were significantly lower in the HD group than in the other two groups， and all differences were statistically significant （P < 0.05）. The levels of blood phosphorus， iPTH， and serum dp-ucMGP in the HD + HDF group were significantly higher than those in the HD + HDF + HP group， with statistically significant differences （P < 0.05）. Compared with the HD group， the vascular calcification rate in the HD + HDF + HP group was significantly lower （P < 0.05）. In comparison to the non-vascular calcification group， the vascular calcification group exhibited significant increases in MHD dialysis duration， age， pulse pressure， blood phosphorus， blood calcium， iPTH， LDL-C， TC， and dp-ucMGP （P < 0.05）. Binary logistic regression analysis revealed that dialysis vintage， age， serum phosphorus， calcium， iPTH， and serum dp-ucMGP levels were independently associated with a higher risk of vascular calcification in MHD patients （P < 0.05）. Conclusions Compared with the simple HD or HD + HDF dialysis modalities， the HD + HDF + HP regimen is associated with lower levels of serum phosphorus， iPTH， dp-ucMGP， lipids， and vascular calcification prevalence in MHD patients. However， dialysis modality itself was not an independent predictor of vascular calcification. Instead， factors such as dialysis vintage， age， serum phosphorus， calcium， iPTH， and dp-ucMGP were independently associated with vascular calcification in this population.

Objective To investigate the predictive value of integrating clinical pathological characteristics with genetic testing for occult lymph node metastasis （OLNM） in patients with papillary thyroid microcarcinoma （PTMC）. Methods A total of 104 PTMC patients admitted to our hospital between May 2023 and May 2025 were included in the study. All patients showed no evidence of suspicious lymph node metastasis on preoperative imaging and underwent standard thyroidectomy with central lymph node dissection. Based on postoperative pathological confirmation of central lymph node metastasis status， patients were classified into an OLNM-positive group （n = 53） and an OLNM-negative group （n = 51）. Baseline characteristics， clinicopathological features， BRAF^V600E gene mutation status， and TERT promoter mutation status were compared between the two groups. To identify factors independently associated with OLNM in PTMC patients， multivariate logistic regression analysis was conducted. The area under the receiver operating characteristic curve （AUC） was utilized to assess the predictive performance of a combined model incorporating clinical， pathological， and genetic features for OLNM. Results Compared with the OLNM-negative group， the OLNM-positive group exhibited significantly higher preoperative thyroid-stimulating hormone （TSH） levels （P < 0.05）. Moreover， the OLNM-positive group demonstrated significantly greater proportions of tumors with diameter > 0.5 cm， multifocality， microcalcifications， capsule invasion， extrathyroidal extension， T3 stage， BRAF^V600E mutation， and TERT promoter mutation （all P < 0.05）. Multivariate logistic regression analysis identified preoperative TSH level， tumor diameter > 0.5 cm， multifocal lesions， capsule invasion， extrathyroidal extension， T stage， BRAF^V600E mutation， and TERT promoter mutation as independent risk factors for OLNM in patients with PTMC （all P < 0.05）. ROC curve analysis demonstrated that the integrated model combining clinical pathological features?including tumor diameter， number of lesions， microcalcification， capsule invasion， extrathyroidal extension， and T stage?with genetic markers （BRAF^V600E and TERT promoter mutations） exhibited the highest predictive performance， yielding an AUC of 0.940. This was significantly higher than the model based solely on clinical pathological features （AUC = 0.736） or those relying exclusively on genetic testing （BRAF^V600E： AUC = 0.860； TERT： AUC = 0.882）， with all comparisons reaching statistical significance （P < 0.05）. Conclusions The integration of clinical pathological features with genetic testing significantly improved the predictive accuracy of OLNM in PTMC patients， surpassing models based solely on individual clinical pathological characteristics or genetic tests alone. This multimodal strategy offers a robust， evidence-based foundation for personalized surgical planning and enhances the precision of clinical decision-making in the management of PTMC.

Objective To characterize the expression patterns of serum microRNA-497 （miR-497） in patients with colorectal cancer （CRC） and to investigate its associations with clinicopathological characteristics， diagnostic performance， and long-term prognostic outcomes. Methods This study retrospectively analyzed data from 122 patients with CRC admitted to the hospital between March 2020 and March 2022 （CRC group）， and enrolled 100 healthy individuals undergoing routine physical examinations （healthy control group） for comparison. Serum samples were collected from all participants prior to any surgical intervention， and the expression levels of miR-497 in serum were quantified using real-time quantitative polymerase chain reaction （qRT-PCR）. Simultaneously， the levels of carcinoembryonic antigen （CEA） and carbohydrate antigen 199 （CA199） were measured. To investigate the association between miR-497 expression and clinicopathological characteristics， we evaluated its diagnostic performance using receiver operating characteristic （ROC） curve analysis. Furthermore， Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to assess its impact on patient prognosis. Results Compared to healthy individuals， CRC patients exhibited significantly lower serum miR-497 expression levels （P < 0.001）. Notably， miR-497 expression was strongly correlated with TNM stage progression and lymph node metastasis （P < 0.001）， but showed no significant association with tumor location， patient sex， or age. Diagnostic evaluation using ROC curves demonstrated that miR-497 achieved an AUC of 0.845 for CRC detection， outperforming CEA （AUC = 0.748） and CA19-9 （AUC = 0.702）， with DeLong′s test confirming the statistically significant differences （P < 0.05）. Kaplan-Meier survival analysis revealed a significantly higher 3-year DFS rate among patients with high miR-497 expression （84.06%） compared to those with low expression （64.58%）， with median DFS not reached in the high-expression group versus 36 months in the low-expression group （P = 0.015）. Multivariate Cox regression analysis confirmed that reduced miR-497 expression （HR = 1.923， 95% CI： 1.184 ~ 3.125）， advanced TNM stage （HR = 2.511， 95% CI： 1.421 ~ 4.437）， and lymph node metastasis （HR = 1.753， 95% CI： 1.151 ~ 2.664） were independently associated with poorer disease-free survival outcomes. Conclusions Serum miR-497 is downregulated in patients with CRC and is significantly associated with tumor progression and poor prognosis. It demonstrates high diagnostic accuracy and strong potential for prognostic evaluation， highlighting its promise as a biomarker for auxiliary diagnosis and outcome prediction in CRC.

Objective To evaluate the efficacy， safety and patient compliance of a quadruple therapy containing minocycline compared with the traditional quadruple therapy in the treatment of Helicobacter （H.） pylori. Methods This study included 200 H.pylori positive patients， with 100 assigned to the minocycline-containing bismuth quadruple therapy group （LBMC group） and the other 100 to the amoxicillin-containing bismuth quadruple therapy group （LBAC group）. After matching the two groups of patients using the propensity score matching （PSM） method，there were 86 cases in each group. Telephone follow-up was conducted on the 14^th day after the start of treatment to record patient medication compliance and adverse drug reactions. A ¹³C urea breath test was performed for re-examination at least one month after completing the treatment plan and discontinuing medication.The intention-to-treat （ITT） and per-protocol （PP） analyses were used to compare the H.pylori eradication rates between the two groups， and Chi-square test and t-test were used for intergroup comparison. Results In the ITT analysis， the eradication rates of the LBMC group and the LBAC group were 89.5% （77/86， 95%CI： 82.9% ~ 96.1%） and 82.6% （71/86， 95%CI： 74.4% ~ 90.7%）， respectively. In the PP analysis，the eradication rates were 92.6% （75/81， 95%CI： 86.8% ~ 98.4%） and 88.8% （71/80， 95%CI： 81.7% ~ 95.8%）， respectively. The adverse reaction rate of the LBMC group was 27.9% （24/86）， and that of the LBAC group 31.4% （27/86）， showing no statistically significant difference （P > 0.05）. In terms of compliance， the LBMC group was 94.2% （81/86）， and the LBAC group 93.0% （80/86）， revealing no statistically significant difference （P > 0.05）. Conclusion As a first-line treatment for eradicating H.pylori， regimens containing minocycline demonstrate equivalent eradication rates to those containing amoxicillin， with similar safety and compliance. They can be used as an alternative treatment for patients allergic to penicillin.

Objective This study aims to explore the impact of esketamine combined with hip pericapsular nerve block on perioperative stress reactions， immune function， cognitive function， and postoperative analgesic efficacy in elderly patients undergoing total hip replacement. Methods From February 2022 to February 2025， 110 elderly patients who received total hip arthroplasty in the hospital were enrolled as the research participants. They were allocated into a control group and an observation group by means of a random number table， with 55 cases in each group.? All patients received total hip arthroplasty. Patients in the control group were given 20 mL of ropivacaine combined with pericapsular nerve block anesthesia of the hip joint， while those in the observation group were given esketamine combined with pericapsular nerve block anesthesia of the hip joint. The blood pressure， heart rate （HR）， oxygen saturation （SpO?）， and respiratory rate （RR） of the two groups were compared at admission （T₁）， immediately after anesthesia （T₂）， skin incision （T₃）， 30 minutes after surgery initiation （T₄）， incision suture （T₅）， and immediately after surgery completion （T₆）. Both groups underwent detection， assessment， and comparison of immune function indices， serum stress markers， and cognitive function scores before the operation and 3 days post-surgery. The Visual Analogue Scale （VAS） pain scores at 3， 6， and 9 hours after surgery were contrasted between the two groups. Additionally， statistical analysis was performed on the incidence of adverse reactions in both groups. Results The HR， mean arterial pressure （MAP）， SpO?， RR， and bispectral index （BIS） of the two groups from T1 to T6 were compared using repeated measures analysis of variance. The results showed that： （1）There were statistically significant differences in HR， MAP， SpO?， and BIS at different time points （F = 118.378， 70.002， 44.910， 242.439， all P < 0.001）. （2）There were statistically significant differences in HR， MAP， SpO?， and BIS between the observation group and the control group （F = 206.643， 195.586， 93.077， 3.953， P < 0.001， P < 0.001， P < 0.001， P = 0.049）. （3）There were statistically significant differences in the changing trends of HR， MAP， SpO?， RR， and BIS between the two groups （F = 18.583， 14.158， 23.350， 4.883， 6.698， all P < 0.001）. At 3 days after surgery， the levels of CD4? and CD4?/CD8? in the observation group were lower than those in the control group （P < 0.05）. The levels of malondialdehyde （MDA）， superoxide dismutase （SOD）， and cortisol in the observation group were lower than those in the control group during surgery and immediately after surgery （P < 0.05）. The Montreal Cognitive Assessment （MoCA） scores and Mini-Mental State Examination （MMSE） scores of both groups decreased 3 days after surgery， and those in the observation group were higher than those in the control group （P < 0.05）. The VAS pain scores of the observation group at 3， 6， 9 and 12 hours after surgery were lower than those of the control group. The incidence of adverse reactions in the observation group was lower than that in the control group （12.73% vs. 29.09%， P < 0.05）. Conclusion Esketamine combined with pericapsular nerve block of the hip joint can significantly inhibit the perioperative stress response in elderly patients undergoing total hip arthroplasty， optimize the postoperative analgesic effect， and reduce the incidence of adverse reactions.

Objective To explore the feasibility of a deep learning model based on early fundus lesions without manual segmentation in pan-retinal images for predicting diabetic kidney disease （DKD） and evaluating the enhancing effects of different binocular fusion strategies. Methods A retrospective cohort of 353 patients with type 2 diabetes mellitus （T2DM） admitted to the Endocrinology Department of Jiangdu People′s Hospital Affiliated to Yangzhou University between December 2022 and March 2024 was analyzed. Patients were divided into DKD （n = 114） and non-diabetic kidney disease （NDKD） （n = 239） group based on the presence of DKD. First， a U-Net-based pre-trained automatic segmentation model was developed to process panoramic fundus retinal images. Subsequently， left and right eye deep learning models were constructed using ResNet152 under a five-fold cross-validation framework （70% training， 30% validation）. Three binocular fusion strategies were implemented： result fusion， feature fusion， and image fusion models. Model performance was evaluated using the area under the receiver operating characteristic （ROC） curve （AUC）. DeLong test was used to compare AUC differences among models， while net reclassification index （NRI） and decision curve analysis （DCA） were used to assess clinical utility. Results Six prediction models were developed： clinical parameter model， left fundus model， right fundus model， binocular image fusion model， binocular result fusion model， and binocular feature fusion model. The Transformer-based binocular feature fusion model achieved the highest AUC in both training and validation sets （0.864 and 0.658， respectively）. DeLong tests revealed significant AUC superiority of the Transformer model over the other five models in the training set （all P < 0.001）， though no significant differences were observed in the validation set （all P > 0.05）. NRI analysis showed negative values for all comparisons with the Transformer model （training set： -0.255， -0.244， -0.289， -0.426， -0.163； validation set： -0.060， -0.016， -0.028， -0.105， -0.033， respectively）， indicating its optimal predictive performance. DCA further demonstrated greater net benefit for the Transformer-based fusion model. Conclusions The deep learning model constructed using early fundus lesions without manual segmentation in pan-retinal images can predict DKD. The Transformer-based fusion strategy present the best performance， providing a novel approach for further optimization and development of tools to predict DKD in the future.

Objective To identify potential subtypes of demoralization syndrome among stroke patients undergoing neuroendovascular procedures using latent profile analysis， and to examine differences in death anxiety among these subtypes. Method This cross-sectional study used convenience sampling to recruit 202 stroke patients undergoing neuroendovascular procedures at a hospital from November 2024 to March 2025. Participants completed the General Information Questionnaire， Despair Scale （DS）， and the Chinese version of the Templer's Death Anxiety Scale （CT-DAS）. Using R software， we estimated a series of latent profile models （ranging from 2 to 6 profiles） based on four manifestations of demoralization syndrome： loss of meaning and purpose， dysphoria， helplessness and hopelessness， and sense of failure. Starting from the 2-profile model， we incrementally increased the number of profiles and compared model fit indices to identify the optimal solution. Subsequently， logistic regression analysis was conducted to identify the factors influencing DS scores according to the latent profile classifications. We compared DS scores across subgroups and performed bivariate correlation analysis between DS and CT-DAS subdimensions （Affective， Stress & Pain， Time Awareness， and Cognitive）. Results The DS scores classified stroke patients into two distinct subtypes of demoralization syndrome： A Meaninglessness-Dysphoria Group （51.00%， 103/202） and a Helplessness-Hopelessness Group （49.00%， 99/202）. The HHG demonstrated significantly higher proportions （P < 0.05） of female patients， those hospitalized for 6 ~ 10 days， recipients of arterial stenosis/occlusion surgery， individuals with junior high school or higher education， employed subjects， and rural residents compared to the MDG. Binary logistic regression analysis revealed： Lower probability of HHG membership for urban （OR= 0.159， P < 0.001） and city （OR = 0.224， P = 0.007） residents versus rural counterparts； Higher HHG probability in patients hospitalized 6-10 days versus 1 ~ 5 days （OR = 2.311， P = 0.017）； Elevated HHG risk among junior high school （OR = 4.956， P < 0.001） and high school or above graduates （OR = 5.102， P = 0.001） relative to those with primary education or less； Increased HHG probability in aneurysm embolization （OR = 2.419， P = 0.040） and arterial stenosis/occlusion surgery （OR = 2.733， P = 0.014） recipients compared to cerebrovascular angiography patients. The HHG scored significantly lower on the cognitive dimension of death anxiety than the MDG （t = 2.421， P = 0.016）， while showing no differences in affective， stress & pain， or time awareness dimensions （P > 0.05）. Bivariate Pearson correlations indicated dysphoria （DS） positively correlated with Affective （r = 0.192， P = 0.006）， Time Awareness （r = 0.172， P = 0.015）， and Cognitive （r = 0.139， P = 0.049） of death anxiety. Conclusions Stroke patients undergoing neuroendovascular procedures exhibit elevated levels of death anxiety， with significant variations observed across different subtypes of demoralization syndrome. Residential location， hospitalization duration， anxiety severity， and surgical type constitute significant determinants of demoralization syndrome. Targeted clinical interventions should be implemented to alleviate demoralization severity and mitigate death anxiety.

The pathogenesis and progression of depression are closely associated with functional dysregulation in the brain's reward and emotion-modulating circuits. As the central hub of the reward system， the nucleus accumbens （NAc） forms aberrant neural circuits with multiple brain regions?including the ventral tegmental area （VTA）， medial prefrontal cortex （mPFC）， amygdala （AMY）， hippocampus （HIP）， and paraventricular nucleus of the thalamus （PVT）?which have been empirically linked to depressive symptomatology. Acupuncture， with its multi-target therapeutic profile， aligns well with the multifactorial and multisystem dysregulation characteristic of depressive disorders.This review systematically examines the functional alterations of the NAc-centered neural circuitry in depression and explores the potential mechanisms of acupuncture intervention. Evidence suggests that acupuncture holistically ameliorates depression by： modulating dopaminergic transmission in the VTA-NAc pathway， enhancing neurotransmitter equilibrium in the mPFC-NAc circuit， bidirectionally regulating emotional stability via the AMY-NAc loop， attenuating HIP-NAc glutamatergic hyperactivity， and optimizing excitatory signaling in the thalamus-NAc circuit. Furthermore， this synthesis emphasizes a systems-level integration of circuit mechanisms， highlighting both the clinical applicability of acupuncture in depression treatment and recent advances in mechanistic research. The findings provide robust theoretical foundations and practical guidance for clinical practice， bridging translational neuroscience with therapeutic innovation.

Non-specific low back pain is a major cause of productivity decline and disability worldwide. Its pathogenesis remains unclear， lacking significant organic lesions and imaging features. When the disease course persists for more than three months， it is referred to as chronic non-specific low back pain. Currently， rehabilitation for chronic non-specific low back pain often focuses on a single biomedical model and lacks multi-perspective analysis of its therapeutic mechanism. For such a complex condition with high prevalence and high recurrence rate， a multidimensional analysis of the mechanism of action and application of rehabilitation methods may contribute to more precise treatment.core training is an important method for the rehabilitation of chronic non-specific low back pain. This article reviews the mechanism of action of core training in treating chronic non-specific low back pain from the perspectives of biomechanics， neuromodulation， and psychological adaptation， and explores its combined application with emerging technologies such as virtual reality， thereby potentially improving treatment compliance and efficacy， aiming to provide insights for chronic non-specific low back pain precision rehabilitation and to facilitate the transition toward a multifactorial， multidisciplinary integrated model.