Latent autoimmune diabetes in adults （LADA） is a distinct subtype of autoimmune diabetes. This condition is characterized by an autoimmune-mediated progressive decline in β-cell function， with microvascular pathology exhibiting unique pathological progression and clinical features. The development and progression of microvascular complications in LADA patients are associated with various factors， including genotyping， autoimmune mechanisms， and biomarkers. Investigating the underlying mechanisms and clinical characteristics of LADA is of significant clinical importance for early identification of high-risk populations， formulating individualized intervention strategies， and delaying the progression of complications. This review consolidates recent research advances in the field of LADA-related microvascular complications， aiming to systematically elucidate the patterns of their development and progression. It seeks to provide theoretical support and clinical guidance for early risk prediction， personalized treatment， and improved patient outcomes.

Objective To investigate the efficacy of autologous platelet-rich gel （APG） prepared by different methods on diabetic foot wound healing and antibacterial activity in vitro. Methods In the wound healing trial， 80 patients with diabetic foot ulcers admitted to The Third People's Hospital of Yunnan Province from 2024 to 2025 were randomly divided into four groups （n=20 each）： Single centrifugation APG group， double centrifugation APG group， machine-harvested APG group， and debridement gel control group. fasting blood glucose （FBG）， erythrocyte sedimentation rate （ESR）， interleukin-6 （IL-6）， procalcitonin （PCT）， C-reactive protein （CRP）， antithrombin Ⅲ（AT-III）， tumor necrosis factor-α （TNF-α）， homocysteine （Hcy）， and ulcer area reduction rate were compared before and after treatment. In the in vitro antibacterial test， 20 diabetic patients were additionally enrolled. Three types of APG were used as experimental groups， with platelet-poor plasma （PPP） group and saline solution as controls. Antibacterial effects against Staphylococcus aureus， Escherichia coli， extended-spectrum β-lactamase-producing Escherichia coli， and Pseudomonas aeruginosa were observed. Results After treatment， significant differences were found in laboratory parameters among the four groups （P < 0.05）. Pairwise comparisons showed that AT-Ⅲ was higher in the three experimental groups than in the control group， while the other seven indicators were lower （P < 0.05）. After the first and third dressings， significant differences were observed in ulcer area， ulcer area reduction rate， and final efficacy among the four groups （P < 0.05）； the control group was inferior to the experimental groups. The ulcer area reduction rate was significantly lower in the control group than in the three experimental groups at each time point （P < 0.001）， with no significant difference among experimental groups （P > 0.05）. The ulcer area reduction rate increased significantly over time （P < 0.001）， with different temporal patterns between groups； the control group had lower healing rates than experimental groups at all time points. Treatment group， baseline ulcer area， and the aforementioned laboratory parameters were significantly different among groups （P < 0.05）. For more severe Wagner grade 3 ulcers， APG treatment provided definite clinical improvement superior to conventional therapy. Multivariate logistic regression showed that all three experimental groups were strong predictors of marked efficacy （P < 0.05）， whereas baseline ulcer area， fasting blood glucose， and other indicators had no significant effect （all P > 0.05）. All three experimental groups exhibited significant antibacterial activity against Escherichia coli and Staphylococcus aureus at 4 ? 12 hours， with similar levels among groups. None of the five groups showed antibacterial activity against extended-spectrum β-lactamase-producing Escherichia coli or Pseudomonas aeruginosa； the PPP group and control group had no effect on any strain. Antibacterial activity decreased over time and was almost absent at 24 hours. Conclusions APG prepared by the three methods effectively reduces blood glucose， improves clinical parameters， and promotes wound healing in diabetic foot patients. Autologous platelet-rich gel displays a specific antibacterial spectrum， and its antibacterial effect against different bacterial genera is time-dependent.

Objective To explore the clinical value of the combined measurement of soluble vascular endothelial growth factor receptor-1 （sFlt-1）， lipoprotein-associated phospholipase A2 （Lp-PLA2）， monocyte/high-density lipoprotein cholesterol ratio （MHR）， and intercellular adhesion molecule-1 （ICAM-1） in predicting the severity and prognosis of patients with diabetic foot ulcers （DFU）. Methods A total of 415 patients with DFU who were admitted to Qingdao Central Hospital， University of Health and Rehabilitation Sciences （Qingdao Central Hospital） between January 2022 and January 2025 were selected for this study （DFU group）. Meanwhile， 108 patients with type 2 diabetes mellitus but without DFU （T2DM group） and 108 healthy individuals undergoing physical examinations were recruited from the same hospital （control group）. According to the Wagner classification， the patients with DFU were classified into the grade 1 group （155 cases）， the grade 2 group （127 cases）， the grade 3 group （72 cases）， and the grade 4 group （61 cases）. After a 6-month follow-up during which the prognosis was recorded， the patients were further categorized into 303 cases （good prognosis group） and 112 cases （poor prognosis group） based on their prognosis. The levels of sFlt-1， Lp-PLA2， MHR， and ICAM-1 were compared among the DFU group， the T2DM group， and the control group， as well as among different severity groups. The correlations between the levels of these markers （sFlt-1， Lp-PLA2， MHR， and ICAM-1） and the severity of the disease were analyzed. Additionally， multivariate logistic regression analysis was used to identify the risk factors for poor prognosis in patients with DFU. The predictive value of the combined detection of sFlt-1， Lp-PLA2， MHR， and ICAM-1 for poor prognosis in DFU was analyzed using the receiver operating characteristic curve （ROC）. Results The levels of sFlt-1， Lp-PLA2， MHR， and ICAM-1 in both the DFU group and the T2DM group were higher than those in the control group， and the levels in the DFU group were significantly higher than those in the T2DM group （P < 0.05）. The levels of sFlt-1， Lp-PLA2， MHR， and ICAM-1 increased progressively as the Wagner grades increased （P < 0.05）. The results of the correlation analysis indicated that the levels of sFlt-1， Lp-PLA2， MHR， and ICAM-1 were positively correlated with the severity of the disease （r = 0.531， 0.568， 0.624， 0.615， P < 0.05）. In comparison with the group with a good prognosis， the group with a poor prognosis was older， had higher levels of glycosylated hemoglobin， fasting blood glucose， sFlt-1， Lp-PLA2， monocyte count， MHR， and ICAM - 1， and lower HDL-C （P < 0.05）. The results of the multivariate Logistic regression analysis demonstrated that older age （OR = 1.855， 95%CI： 1.261 - 2.730）， higher glycosylated hemoglobin （OR = 1.719， 95%CI： 1.247 - 2.371）， higher fasting blood glucose （OR = 1.747， 95%CI： 1.237 - 2.467）， higher sFlt - 1 （OR = 1.719， 95%CI： 1.227 - 2.409）， higher Lp-PLA2 （OR = 1.921， 95%CI： 1.321 - 2.794）， higher monocyte count （OR = 1.889， 95% CI 1.249 - 2.856）， higher MHR （OR = 1.624， 95%CI： 1.192 - 2.214）， and higher ICAM-1 （OR = 1.948， 95% CI： 1.203 - 3.156） were all risk factors for a poor prognosis in patients with DFU. High HDL-C （OR = 0.652， 95%CI： 0.490 - 0.869） is a protective factor for a poor prognosis in patients with DFU （all P < 0.05）. The area under the curve （AUC） values for diagnosing the poor prognosis of DFU through the combined detection of soluble fms-like tyrosine kinase-1 （sFlt-1）， lipoprotein-associated phospholipase A2 （Lp-PLA2）， monocyte-to-high-density lipoprotein cholesterol ratio （MHR）， intercellular adhesion molecule-1 （ICAM-1）， and Logistic combined detection were 0.742， 0.815， 0.800， 0.811， 0.827， and 0.899， respectively. Among these， the AUC values of the combined detection of the four indicators and Logistic combined detection were relatively higher. Conclusions The levels of sFlt-1， Lp-PLA2， MHR， and ICAM-1 are closely associated with the severity of DFU. Older age， high glycated hemoglobin， high fasting blood glucose， high sFlt-1， high Lp-PLA2， high monocyte count， high MHR， and high ICAM-1 are all independent risk factors for poor prognosis in DFU patients， while HDL-C is a protective factor for poor prognosis in patients with DFU. The combined detection of sFlt-1， Lp-PLA2， MHR， and ICAM-1 has a higher predictive value than individual indicators and may provide a novel perspective for the prognostic assessment of DFU.

Objective To investigate the glycemic profiles and clinical practicality of transitioning hospitalized patients with type 2 diabetes mellitus （T2DM） from continuous subcutaneous insulin infusion （CSII） to insulin degludec （IDeg）， insulin degludec/aspart （IDegAsp）， or insulin degludec/liraglutide （IDegLira）， and to compare the relative advantages of these post-CSII strategies in terms of achieving glucose targets， glycemic stability， and regimen simplification. Methods This retrospective study recruited hospitalized patients with T2DM who were switched from CSII to one of three degludec-based regimens：IDeg， IDegAsp， or IDegLira. Continuous glucose monitoring （CGM） was employed to assess glycemic outcomes before and after the treatment conversion. Alterations in mean glucose （MG）， glucose management indicator （GMI）， time in range （TIR）， time above range （TAR）， time below range （TBR）， and coefficient of variation （CV） were analyzed and compared among groups. Results All three regimens enabled a clinically stable transition subsequent to the discontinuation of CSII and were linked to an overall improvement in CGM-derived metrics. After the treatment conversion， the MG and GMI decreased， while the TIR increased significantly； simultaneously， the CV and TAR were diminished. The TBR remained largely unchanged in the IDegAsp and IDegLira groups， yet it showed a slight increase in the IDeg group （0.00% ［0.00， 0.01］ vs. 0.01% ［0.00， 0.02］， P = 0.009）. Comparisons between groups further demonstrated that IDegAsp and IDegLira outperformed IDeg， presenting more favorable values for TIR， MG， GMI， CV， TAR， and TBR. Suspected hypoglycemic events detected by CGM were not verified through capillary glucose re-checking. Additionally， 58% of patients receiving IDegLira achieved satisfactory glycemic control with no more than one concomitant glucose-lowering agent. Conclusions For hospitalized patients with T2DM who have completed CSII-based intensive therapy， transitioning to a degludec-based regimen can further enhance glycemic management. Among the evaluated options， IDegAsp and IDegLira demonstrated more favorable overall performance than IDeg in terms of glucose control， reduction of glucose variability， and outcomes related to hypoglycemia. Notably， IDegLira may provide an additional benefit by reducing the complexity of treatment， making it a potentially practical choice for the transition of the regimen after discharge.

Objective This study aims to investigate the value of the perimeter-area ratio （PAR） derived from non-contrast cardiac magnetic resonance （CMR） imaging in assessing ventricular remodeling and risk stratification in patients with chronic pulmonary thromboembolism （CPTE）. Methods A total of 53 patients with CPTE were prospectively enrolled，including 16 with chronic thromboembolic pulmonary disease （CTEPD） and 37 with chronic thromboembolic pulmonary hypertension （CTEPH）. Additionally，53 age- and sex-matched healthy volunteers were recruited as controls. All patients underwent CMR and right heart catheterization within 24 hours. Biventricular PAR values were calculated and compared among the three groups at three short-axis levels on end-diastolic and end-systolic cine images. Diagnostic performance was assessed using receiver operating characteristic curve analysis，and associations between PAR and hemodynamic parameters were examined using Spearman’s correlation. Results Compared with CTEPD patients，right ventricular （RV） PAR was significantly lower in CTEPH patients，with the most pronounced difference observed at the apical level （P < 0.05）. At this level，RV-PAR demonstrated excellent diagnostic performance in identifying CPTE and distinguishing its subtypes，with area under the curve （AUC） values ranging from 0.872 to 0.990，along with high sensitivity and specificity. RV-PAR was negatively correlated with afterload indices and positively correlated with perfusion and output parameters （all P < 0.05）. Conclusions CMR-derived PAR sensitively captures microstructural remodeling of the right ventricle in CPTE patients， serving as a potential non-invasive biomarker for disease severity assessment and risk stratification. Notably，the cardiac apex emerges as the most sensitive region for adaptive changes in the right ventricle.

Objective To investigate the prevalence of overweight/obesity and its association with cardiometabolic risk factors among adults in Guangxi and provide evidence for regional weight management and cardiometabolic disease prevention. Methods A cross-sectional study recruited 108，804 adults who underwent health examinations at the People's Hospital of Guangxi Zhuang Autonomous Region from January to December 2024. The participants were classified according to BMI into underweight， normal weight， overweight， and obese groups. Multivariate logistic regression， stratified and interaction analyses， risk factor clustering， and Cochran–Armitage trend tests were carried out. Results The prevalence rates of overweight， obesity， and central obesity were 35.95%， 13.30% （combined 49.25%）， and 26.6%， respectively. Overweight/obesity was independently associated with hypertension， hyperglycemia， dyslipidemia， and fatty liver， and the strongest association was observed for fatty liver （obese group： OR = 25.03， 95%CI： 23.66–26.48， adjusted for age and sex）. The combined analysis of BMI and central obesity indicated that individuals with both overweight/obesity and central obesity had the highest metabolic risks， with odds ratios （ORs） （95% confidence intervals ［CI］） of 3.48 （3.33–3.63） for hypertension， 3.35 （3.17–3.55） for hyperglycemia， 2.76 （2.66–2.86） for dyslipidemia， and 14.18 （13.64–14.74） for fatty liver. Sex-stratified analyses disclosed stronger associations of overweight/obesity with hyperglycemia and fatty liver in women， and with dyslipidemia and hypertension in men （all interaction P < 0.05）. Age-stratified analyses demonstrated the strongest associations in the 18–29 age group， and these associations declined with age （interaction P < 0.001）. From underweight to obesity， the mean number of risk factors increased from 0.32 to 2.22， and the proportion of individuals with ≥3 risk factors rose from 0.45% to 36.92% （trend χ2 = 27753.48， P < 0.001）. Conclusions The prevalence of overweight and obesity is notably high among adults in Guangxi. This high prevalence acts as a crucial driver of cardiometabolic risk factor clustering， and there are significant sex-and age-related differences in these associations. Additionally， the co-occurrence of overweight/obesity and central obesity synergistically exacerbates metabolic risks. Therefore， targeted weight management and comprehensive prevention strategies customized to regional characteristics are necessary.

Objective To explore the changes in immune-inflammatory indicators and the short-term therapeutic effect of laparoscopic cholecystectomy （LC） + laparoscopic transcystic common bile duct exploration （LTCBDE） surgery for the treatment of gallbladder stones combined with common bile duct stones. Methods This study adopted a retrospective analysis method. A total of 803 patients with gallbladder stones and common bile duct stones who underwent surgical intervention at the Department of Hepatobiliary Surgery in the Affiliated Hospital of Chengde Medical University from June 2021 to June 2025 were selected as the research subjects. The patients were grouped and compared according to different surgical methods. They were divided into Group A （treated with LTCBDE + LC surgery）， consisting of 467 cases， and Group B （treated with LC + LCBDE + PDC surgery）， with 336 cases. The perioperative and hospitalization data， liver function indicators， inflammation-related indicators， and the occurrence of complications were compared between the two groups of patients. Results The perioperative and hospitalization data of patients in Group A were significantly lower than those in Group B （P < 0.05）. The levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and alkaline phosphatase （ALP） in Group A after surgery were significantly lower than those in Group B， while the level of serum albumin （ALB） was significantly higher in Group A than in Group B （P < 0.05）. The levels of white blood cell count （WBC）， C-reactive protein （CRP）， and interleukin-6 （IL-6） after surgery in Group A were significantly lower than those in Group B （P < 0.05）. The incidence of postoperative complications was significantly higher in Group A than in Group B （11.56% vs. 8.93%， P < 0.05）. Conclusions Both the LTCBDE + LC surgery and the LC + LCBDE + PDC surgery demonstrate excellent short-term efficacy and safety when treating gallbladder stones combined with common bile duct stones. The LTCBDE + LC surgery is more suitable for patients with relatively simple conditions because of its advantages such as minimal trauma， rapid recovery， and preservation of biliary physiological functions. In contrast， the LC + LCBDE + PDC surgery is characterized by thorough stone removal and fewer long-term complications， rendering it more appropriate for the treatment of complex cases.

Objective To evaluate the association between the PON1-Q192R gene polymorphism and the severity of atherosclerotic lesions in coronary arteries among patients with coronary heart disease，and to analyze the influencing factors of the degree of coronary artery stenosis. Methods Patients diagnosed with coronary heart disease at Northern Jiangsu People's Hospital between January 2024 and December 2024 were enrolled in this study. The PON1-Q192R genotype was detected using PCR-based pyrosequencing. Compare the baseline data of patients with distinct genotypes. Patients were categorized into groups based on the severity of coronary atherosclerosis according to the Gensini score system：mild stenosis group（< 20 points），moderate stenosis group（20 - 39 points），and severe stenosis group（≥ 40 points）．The study examined the correlation between the PON1-Q192R gene polymorphism and Gensini scores，and compared the distribution characteristics of different genotypes across coronary artery stenosis groups in patients with coronary heart disease. Univariate and multivariate logistic regression analyses were employed to investigate the associated factors influencing the degree of coronary artery stenosis. Results The median Gensini score showed that patients with the AG and AA genotypes were significantly higher than those with the GG genotype（P < 0.05）．The proportion of patients with severe stenosis in the AG and AA genotypes was significantly higher than that in the GG genotype（P < 0.05）．Comparing the distribution of the PON1-Q192R G/A alleles across different degrees of coronary artery stenosis also showed statistically significant differences（P < 0.05）．Multivariate logistic regression analysis revealed that the AG genotype（OR = 1.973，95%CI：1.078 - 3.610，P = 0.027），AA genotype（OR = 3.127，95%CI：1.245 - 7.853，P = 0.015），hypertension（OR = 2.234，95%CI：1.233-4.046，P = 0.008），diabetes mellitus （OR = 2.043，95%CI：1.064 - 3.920，P = 0.032），and elevated LDL-C（OR = 1.608，95%CI：1.157 - 2.234，P = 0.005）were identified as risk factors for increased coronary artery stenosis severity. Conclusions The PON1-Q192R gene polymorphism is significantly associated with an increased risk of coronary artery stenosis severity in patients with coronary heart disease. The PON1-Q192R gene polymorphism can serve as an important indicator for predicting the severity of coronary artery stenosis in patients with coronary heart disease.

Objective To explore the relationship between the levels of serum adipocyte fatty acid binding protein （AFABP）， polyadenosine diphosphate ribose polymerase 1 （PARP1）， glucose-regulated protein 78 （GRP78）， and insulin-like growth factor binding protein-7 （IGFBP-7） in patients with chronic heart failure （CHF）， and the relationship between these levels and their clinical classification and prognosis. Methods A total of 259 patients with CHF who were admitted to our hospital from January 2023 to January 2025 （CHF group） and 259 healthy individuals with age- and gender-matching who underwent physical examinations during the same period （control group） were selected. According to the cardiac function classification of the New York Heart Association （NYHA）， CHF patients were divided into grade II （106 cases）， grade III （91 cases）， and grade IV （62 cases）. CHF patients were classified into three clinical subtypes based on left ventricular ejection fraction （LVEF）， namely the heart failure with preserved ejection fraction （HFpEF， LVEF ≥ 50%）， the heart failure with mildly reduced ejection fraction （HFmrEF， LVEF 41% - 49%）， and the heart failure with reduced ejection fraction （HFrEF， LVEF ≤ 40%）， with 114 cases， 91 cases， and 54 cases respectively. These subtypes are respectively referred to as the preservation group， the mild-reduction group， and the reduction group. After the treatment， a 6-month follow-up was carried out. During the follow-up period， 11 cases were lost to follow-up， while a total of 248 cases successfully completed the follow-up. Based on the occurrence of major adverse cardiac events （MACE， including cardiac death or rehospitalization due to heart failure）， the cases were divided into the poor prognosis group （64 cases） and the good prognosis group （184 cases）. The clinical data of all the research subjects were statistically analyzed， and the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 in CHF patients with different cardiac function grades and clinical types were compared among the CHF group， the control group， the poor prognosis group， and the good prognosis group. Spearman correlation analysis was employed to examine the correlations between the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 and the NYHA cardiac function classification and clinical typing. Multivariate logistic regression analysis was utilized to identify the risk factors for poor prognosis in patients with CHF. The predictive efficacy of the combined detection of serum AFABP， PARP1， GRP78， and IGFBP-7 levels for the poor prognosis of CHF patients was evaluated by the receiver operating characteristic curve （ROC）. Results The levels of serum AFABP， PARP1， GRP78， and IGFBP-7 in the CHF group were significantly higher than those in the control group （P < 0.05）. As the NYHA cardiac function classification deteriorated （from grade II to grade IV） and the LVEF decreased （from HFpEF to HFrEF）， the levels of each index exhibited a gradually increasing trend （P < 0.05）. Spearman analysis indicated that the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 were positively correlated with the NYHA cardiac function classification （r = 0.652， 0.570， 0.631， 0.588， P < 0.05） and also positively correlated with the patient's clinical classification （r = 0.496， 0.768， 0.601， 0.608， P < 0.05）. There were statistically significant differences in the levels of serum AFABP， PARP1， GRP78， and IGFBP-7， as well as the proportion of cardiac function classification and clinical classification， between the poor-prognosis group and the good-prognosis group （P < 0.05）. The results of multivariate logistic regression analysis showed that a worse cardiac function classification （OR = 3.086， 95%CI： 1.376 - 6.921）， the HFrEF phenotype （OR = 3.647， 95%CI： 1.921 - 6.923）， a high AFABP level （OR = 2.675， 95% CI 1.248 - 5.734）， a high PARP1 level （OR = 2.713， 95%CI： 1.298 - 5.669）， a high GRP78 level （OR = 2.492， 95%CI： 1.113 - 5.576）， and a high IGFBP-7 level （OR = 2.237， 95%CI： 1.158 - 4.321） were all risk factors for poor prognosis in CHF patients （all P < 0.05）. After drawing the ROC curve， it was found that the combined detection of serum AFABP， PARP1， GRP78， and IGFBP-7 levels had an AUC value for the poor prognosis of CHF patients （0.936， 95%CI： 0.898 - 0.963）， which was higher than that of individual detection of each index （P < 0.05）. The sensitivity and specificity of the combined detection were 90.62% and 80.43%， respectively. Conclusions The levels of AFABP， PARP1， GRP78， and IGFBP-7 are highly expressed in the serum of patients with CHF. These levels are closely related to the cardiac function classification and clinical type of CHF patients. A worse cardiac function classification， the HFrEF phenotype， high levels of AFABP， PARP1， GRP78， and IGFBP-7 are all risk factors for the poor prognosis of CHF patients. The combined detection of AFABP， PARP1， GRP78， and IGFBP-7 has high predictive value for the poor prognosis of CHF patients and is expected to become a new biomarker combination for evaluating the condition and prognosis of CHF.

Objective To explore the relationship between left heart contrast echocardiography indexes， including left ventricular end - systolic volume （LVESV）， left ventricular ejection fraction （LVEF）， and left ventricular end-diastolic volume （LVEDV）， and the grading of cardiac function， as well as their evaluation value for the anti - heart failure effect in patients with chronic heart failure （CHF）. Methods A total of 102 patients with CHF were recruited between May 2021 and May 2025. All patients underwent routine ultrasound examination and left-heart contrast echocardiography. The quality of apical images and the detection of special structures obtained by the two examination methods were compared. Based on the cardiac function grading of the New York Heart Association （NYHA）， the patients were classified into three groups： Grade IV （n = 27）， Grade III （n = 40）， and Grade II （n = 35）. The LVESV， LVEF， and LVEDV measured by routine ultrasound and left - heart contrast echocardiography in these three groups were compared. The relationship between cardiac function grading and LVESV， LVEF， and LVEDV measured by left - heart contrast echocardiography was analyzed using the Spearman coefficient. After 3 months of anti-heart failure treatment， the CHF patients underwent left - heart contrast echocardiography again. According to the treatment efficacy， they were divided into an ineffective group （n = 23） and an effective group （n = 79）. The difference values of LVESV， LVEF， and LVEDV （ΔLVESV， ΔLVEF， ΔLVEDV） before and after treatment measured by left-heart contrast echocardiography in the two groups were compared. The evaluation value of left - heart contrast echocardiography in assessing the anti-heart failure effect was analyzed using receiver operating characteristic （ROC） curves. Results The quality of apical images obtained through left heart contrast echocardiography was superior to that obtained via routine ultrasound （P < 0.05）. The detection rates of apical thrombosis， ventricular aneurysm， and trabecular hyperplasia by left heart contrast echocardiography were 8.82%， 9.80%， and 14.71% respectively， which were higher than those by routine ultrasound （1.96%， 3.00%， 5.88%； P < 0.05）. The LVESV and LVEDV measured by left heart contrast echocardiography were higher than those measured by routine ultrasound， while the LVEF was lower than that measured by routine ultrasound （P < 0.05）. There were significant differences in LVESV， LVEF， and LVEDV measured by routine ultrasound and left heart contrast echocardiography among patients with different cardiac function grading （P < 0.05）. In the grade IV group， grade III group， and grade II group， LVESV and LVEDV gradually decreased， while LVEF gradually increased （P < 0.05）. Spearman analysis indicated that the cardiac function grading of patients with CHF was negatively correlated with LVEF and positively correlated with LVESV and LVEDV measured by left heart contrast echocardiography （P < 0.05）. After 3 months of treatment， the changes in LVESV （ΔLVESV）， LVEF （ΔLVEF）， and LVEDV （ΔLVEDV） in the effective group were higher than those in the ineffective group （P < 0.05）. ROC curve analysis showed that the area under the curve （AUC） values of ΔLVESV， ΔLVEF， and ΔLVEDV for evaluating the anti-heart failure effect were 0.720， 0.976， and 0.696 respectively （P < 0.05）. Conclusions Left heart contrast echocardiography can enhance the quality of apical images and elevate the detection rates of special structures in patients with CHF. The echocardiographic indexes （LVESV， LVEF， LVEDV） are closely associated with cardiac function grading， and ΔLVEF exhibits the best evaluation efficiency for the anti-heart failure effect. This study offers a basis for the accurate grading and individualized treatment of CHF by comparing left ventricular contrast echocardiography with routine ultrasound and analyzing the difference values of core indexes.

Objective To explore the value of the combined detection of soluble urokinase-type plasminogen activator receptor （suPAR） and CD8⁺T lymphocytes in the early diagnosis and prognostic prediction of chronic pulmonary aspergillosis （CPA）. Methods A total of 258 patients with suspected CPA who were admitted to the hospital from June 2021 to June 2024 were enrolled in this study. The serum suPAR levels and the percentages of peripheral blood CD8⁺T lymphocytes were measured in all the subjects. The receiver operating characteristic （ROC） curve was employed to evaluate the diagnostic value of suPAR alone and in combination with CD8⁺T lymphocytes for CPA. All the confirmed CPA patients were followed up for 6 months and then classified into the death group and the survival group based on their prognosis. The clinical data， suPAR levels， and CD8⁺T lymphocyte percentages were compared between the two groups. Cox proportional hazards regression analysis was utilized to identify the independent risk factors for poor prognosis in CPA patients. The ROC curve was applied to assess the prognostic value of the indicators. The Kaplan-Meier method was used to plot the survival curves， and the Log-rank test was carried out to compare the survival differences between the groups. Results Among the 258 patients， 212 were diagnosed with CPA， and 46 were diagnosed with non-CPA. The proportions of solid nodules and cavitary lesions， along with suPAR levels and CD8⁺T lymphocyte percentages in the CPA group， were significantly higher compared to those in the non - CPA group （P < 0.05）. ROC curve analysis indicated that the area under the curve （AUC） of the combined detection of suPAR and CD8⁺T lymphocytes for CPA diagnosis was significantly higher than that of single detection （P < 0.05）. During the 6 - month follow-up， 34 out of the 212 CPA patients died， resulting in a mortality rate of 16.03%. The death group had significantly higher age， proportions of diabetes and hypoproteinemia， suPAR levels， and CD8⁺T lymphocyte percentages than the survival group （P < 0.05）. Cox regression analysis demonstrated that suPAR and CD8⁺T lymphocytes were independent risk factors for poor prognosis in CPA patients （P < 0.05）. The AUC of combined detection for predicting poor prognosis of CPA was significantly higher than that of single detection （P < 0.05）. Kaplan-Meier survival curves showed that patients with suPAR ≤ 8.090 ng/ml or CD8⁺T lymphocytes ≤ 23.846% had significantly longer survival time than those with suPAR > 8.090 ng/ml or CD8⁺T lymphocytes > 23.846% （Log-rank χ2 = 59.004， 16.078， P < 0.001）. Conclusions The combined detection of suPAR and CD8⁺T lymphocytes holds significant clinical value in the early diagnosis and prognostic evaluation of CPA. It can serve as a reliable quantitative indicator for the clinical assessment of CPA patients.

The occurrence and development of post-stroke depression （PSD） are intricately associated with the dysfunction of the brain's reward circuit. When a stroke lesion affects crucial nodes of the reward circuit， including the prefrontal lobe， basal ganglia， and thalamus， it can disrupt their structure and connectivity， resulting in the malfunction of the neural network and the dysregulation of monoamine neurotransmitter systems. Simultaneously， neuroinflammation， the imbalance of neurotrophic factors， and glutamate excitotoxicity collectively exacerbate the damage to the circuit， ultimately presenting as a symptom cluster characterized by lack of motivation and anhedonia. The multi-target effect characteristics of acupuncture align well with the multi-cause and multi-system disorder features of PSD， an emotional disorder. Based on the reward circuit， this article systematically reviews how acupuncture attains an overall improvement of PSD by restoring the function of the neural network， facilitating the secretion of monoamine neurotransmitters and neurotrophic factors， and suppressing neuroinflammation and glutamate excitotoxicity， aiming to offer more reliable theoretical support and practical guidance for clinical treatment.

Objective To investigate the therapeutic effects of Qushi Huoxue decoction on a mouse model of metabolic dysfunction-associated steatotic liver disease （MASLD） and to explore its underlying mechanism associated with the NF-κB/Bcl-2 signaling pathway. Methods MASLD was induced in mice by feeding them a high-fat diet for 12 weeks， while the control mice were fed a standard diet. After successful modeling， the treatment groups were given low， medium， and high doses of Qushi Huoxue decoction for 6 weeks. Hepatic lipid deposition and inflammatory infiltration were evaluated using hematoxylin–eosin （HE） and oil red O staining. The serum levels of ALT， AST， TG， TNF-α， IL-6， and IL-1β， as well as the hepatic levels of MDA， GSH-Px， and SOD， were measured with commercial assay kits. The hepatocyte apoptosis rate was determined by TUNEL assay， and the mRNA expression levels of apoptosis-related genes were measured by RT-qPCR. The protein expression levels of Bcl-2， Bax， and Caspase-3 in liver tissues were detected through immunohistochemistry and Western blot. Results Qushi Huoxue decoction significantly alleviated hepatic lipid deposition， oxidative stress， inflammatory response， and hepatocyte apoptosis. It led to a reduction in the serum levels of ALT， AST， TG， TNF-α， IL-1β， and IL-6， a decrease in the hepatic MDA level， and an increase in the hepatic GSH-Px and SOD levels （P < 0.05， P < 0.01）. Moreover， it also downregulated the protein expression levels of p-NF-κB/NF-κB， Bax， and Caspase-3 in the liver （P < 0.05， P < 0.01）， as well as the mRNA expression levels of Bax and Caspase-3， while upregulating the Bcl-2 mRNA expression （P < 0.05， P < 0.01）. Conclusions Qushi Huoxue decoction effectively enhances liver function， optimizes lipid metabolism， alleviates oxidative stress， and mitigates inflammatory responses in mice with MASLD， consequently decreasing hepatocyte apoptosis. These effects are potentially mediated via the modulation of the NF-κB/Bcl-2 signaling pathway.

Objective To investigate the clinical efficacy of ultrasound-guided multi-target precise injection combined with the shoulder suspension squat exercise method in treating primary adhesive capsulitis of the shoulder， and to analyze its effects on inflammatory factors. Methods A total of 120 patients in Zunyi Municipal Hospital of Traditional Chinese Medicine with adhesive capsulitis were randomly divided into a treatment group （60 cases） and a control group （60 cases）. The control group underwent ultrasound-guided multi-target precise injections， while the treatment group received the same injections combined with the shoulder suspension squat exercise method. Compared the scores of pain and shoulder joint function， passive range of motion， inflammatory levels， treatment efficacy， and safety before and after treatment. Results After intervention， both groups showed reduced （Visual analog scale， VAS） scores and inflammatory levels （C-reactive protein，CRP）， （interleukin-6，IL-6）， （tumor necrosis factor-α，TNF-α）， and the treatment group exhibited significantly lower VAS scores and inflammatory levels compared to the control group （P < 0.05）. Both groups demonstrated improved Constant-Murley shoulder function scores， forward flexion， backward extension， and external rotation range of motion scores after intervention， and the treatment group significantly higher than the control group （P < 0.05）. The overall effective rate of the treatment group was significantly higher than the control group （P < 0.05）. None of the patients experienced serious adverse reactions. Conclusions Compared to ultrasound-guided multi-target precise injections， the combined shoulder suspension squat exercise had superior clinical efficacy in treating primary frozen shoulder. It promoted shoulder joint function recovery， reduced inflammation， and provided a valuable reference for selecting clinical treatment options for frozen shoulder.

Objective To analyze the efficacy of Niantong powder plaster moxibustion combined with the three-step analgesic ladder in the treatment of cancer pain in patients with advanced gastric cancer and its influence on cancer-related fatigue. Methods A total of 152 patients with advanced gastric cancer， cancer pain， and cancer-related fatigue， who were admitted to Qingdao Traditional Chinese Medicine Hospital from January 2023 to June 2025， were selected and randomly divided into a control group and a combined group， with 76 cases in each group. The control group was treated with the three-step analgesic ladder， whereas the combined group received treatment with the three-step analgesic ladder combined with Niantong powder plaster moxibustion. The efficacy was evaluated after 4 weeks of continuous treatment. In the two groups of patients， the efficacy of cancer pain， scores of the numerical rating scale （NRS）， brief pain inventory （BPI）， and revised Piper fatigue scale （PFS-R）， pain mediators ［5-hydroxytryptamine （5-HT）， substance P （SP）， neuropeptide Y （NP-Y）， prostaglandin E2 （PGE2）］， and adverse reactions were observed. Results After treatment， the cancer pain relief rate in the combined group was significantly higher than that in the control group （P < 0.05）. The combined group had lower NRS scores， BPI-pain severity scores， BPI-pain interference scores， and PFS-R scores compared to the control group （P < 0.05）. Additionally， it also presented lower serum levels of SP， 5-HT， NP-Y， and PGE2 （P < 0.05）. The incidence of adverse reactions was comparable between the two groups （P > 0.05）. Conclusions Niantong powder plaster moxibustion， when combined with the three- step analgesic ladder， demonstrates significant efficacy in treating advanced gastric cancer accompanied by cancer pain. Moreover， it can reverse the imbalance of pain factors and alleviate cancer-related fatigue.

Objective The aim of this study is to use functional magnetic resonance imaging （fMRI） technology and double regression analysis method to explore the effect of Tongdu Tiaoshen acupuncture on cognitive network changes in patients with acute ischemic stroke （AIS）. Methods 140 AIS patients hospitalized in the hospital from June 2023 to August 2024 were selected as the research subjects. The patients were randomly divided into an experimental group （n = 70） and an observation group （n = 70） using a central randomization system. 1：1 After matching， there were 48 patients in each group. Both groups received basic medication and rehabilitation treatment. The experimental group was treated with Tongdu Tiaoshen acupuncture on this basis， while the observation group was treated with sham acupuncture on this basis. Obtain brain structure and function data of patients through fMRI technology， and evaluate changes in patients' cognitive networks using double regression analysis method. Results A comparison of clinical data between the two groups of subjects revealed no statistically significant differences in age， gender， history of diabetes， body mass index （BMI）， and history of hypertension （P > 0.05）. After matching， there was no significant difference in clinical data （P > 0.05）. After matching， the histograms tended to be consistent， effectively improving the balance of baseline characteristics. Compared to the observation group， the experimental group scored lower in cognitive function， memory function assessment， language assessment ability， and executive function assessment scales （P < 0.05）； Compared to the experimental group， the observation group scored lower in terms of mental assessment， daily living ability， and emotional state estimation （P < 0.05）. For the comparison of different brain networks between the two groups of subjects， after the experiment， compared with the observation group， the experimental group showed more significant brain network enhancement in the anterior central gyrus， auxiliary motor area， middle frontal gyrus， and posterior central gyrus， but weaker brain network influence in the middle frontal gyrus （P < 0.05， adjusted by Alphasim）. The functional connectivity analysis based on abnormal fALFF values in brain regions showed that the functional connectivity of the right inferior temporal gyrus and left inferior parietal gyrus in the experimental group was enhanced， while the functional connectivity of the right superior frontal gyrus was weakened. In the correlation analysis between different brain regions and clinical indicators in two groups of subjects， Pearson correlation analysis was used to determine that there were significant differences （P < 0.05） between different brain regions in the experimental group and clinical indicators such as the National Institutes of Health Stroke Scale （NIHSS）， Fugl Meyer （FMA） Cumulative Score Scale for Stroke， Barthel Index， and Mini Mental State Examination （MMSE）. The covariance analysis of the differences in brain regions and clinical indicators between the two groups of subjects showed that the functional connectivity of the central anterior gyrus in the trial patients increased， which was positively correlated with MMSE and NIHSS scores Barthel index scores （R = 0.254，P < 0.001；R = 0.309，P < 0.001 R = 0.314， P = 0.018）. Conclusions The dual regression evaluation of fMRI shows that the Tongdu Tiaoshen acupuncture method can significantly enhance the functional connectivity of some brain areas in patients， such as the anterior central gyrus， auxiliary motor area， middle frontal gyrus， and posterior central gyrus， effectively improving NIHSS and MMSE cognitive related scores， providing imaging and multidimensional data support for its clinical application.

Objective To evaluate the clinical efficacy of Xiaozhong Tounong Decoction in combination with antibiotics in patients with periappendiceal abscess of damp-heat syndrome. Methods A total of 64 eligible patients were recruited and randomly allocated into two groups， with 32 patients in each group. The control group underwent conventional treatment using antibiotics， whereas the experimental group received additional treatment with Xiaozhong Tounong Decoction. The primary and secondary outcome measures encompassed the time for abscess resolution， the duration of antibiotic administration， the time to defervescence， traditional Chinese medicine syndrome scores， visual analogue scale pain scores， inflammatory laboratory indicators， overall clinical efficacy， and the incidence of adverse events. Results Compared with the control group， the experimental group exhibited significantly shorter durations in abscess resolution， antibiotic use， and defervescence， along with notably lower scores in traditional Chinese medicine syndromes， visual analogue scale pain， and laboratory parameters （all P < 0.05）. The hierarchical clinical efficacy of the experimental group was significantly superior to that of the control group （P < 0.001）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusions Xiaozhong Tounong Decoction combined with antibiotics yields favorable clinical outcomes in the treatment of periappendiceal abscess with dampness-heat syndrome. This integrated treatment approach effectively shortens the treatment duration and significantly alleviates clinical symptoms.

Objective To explore the antidepressant mechanism of the main active ingredients of Hypericum perforatum L. through network pharmacology data mining and experimental validation. Methods The main active ingredients of Hypericum perforatum L. were retrieved from the literature and the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. Network pharmacology analysis， GO enrichment analysis， and KEGG pathway enrichment analysis were carried out using the GeneCards， STRING， and DAVID databases. The active ingredient–target network of Hypericum perforatum was constructed with Cytoscape 3.8.2 software. Nodes with a degree value of at least 10 and betweenness centrality of at least 0.01 were selected for topological analysis. Meanwhile， cellular and animal experiments were conducted to validate the results. Microglial cells （BV-2） were divided into four groups： Control， lipopolysaccharide （LPS）， hypericin （HY）， and calcineurin inhibitor （CNIS）. Immunofluorescence was employed to detect the positive expression of ionized calcium-binding adapter molecule 1 （IBA-1）， and Western blot was utilized to determine the expression levels of related proteins. Additionally， C57BL/6J mice were randomly assigned to three groups： Control， depression （DP）， and HY groups （n = 15 per group）. Behavioral tests， such as the light-dark box （LDB）， open field test （OFT）， and tail suspension test （TST）， were used to assess the ameliorative effect of hypericin on chronic unpredictable mild stress （CUMS）-induced depression-like behaviors. Western blot was also used to measure the expression levels of the inflammatory factor tumor necrosis factor-α （TNF-α） and proteins related to the calcium signaling pathway. Results Eight active ingredients were screened from Hypericum perforatum， and 80 potential depression-related targets were predicted. Through visualization analysis of the active ingredients and intersecting genes， it was found that HY plays a major role in the antidepressant effect. The “ingredient?pathway?target” network analysis indicated that the calcium signaling pathway was a key pathway. Cell experiments demonstrated that， in comparison with the Control group， the LPS group showed a significant increase in IBA-1 expression （P < 0.05） and a significant increase in the protein expression of pro-inflammatory cytokines and the CaM-CN-NFAT calcium signaling pathway （P < 0.05）. In contrast， compared with the LPS group， the HY group presented a significant decrease in IBA-1 expression （P < 0.05） and a significant decrease in the protein expression of TNF-α and the CaM-CN-NFAT calcium signaling pathway （P < 0.05）. Animal experiments revealed that， when compared with the Control group， the DP group had a significant shortening of the central zone time in the OFT （P < 0.05）， a significant reduction in the number of transitions in the LDB （P < 0.05）， a significant prolongation of immobility time in the TST （P < 0.05）， and a significant increase in the protein expression of TNF-α and calcium signaling pathway proteins （P < 0.05）. All these changes were reversed in the HY group. Conclusion This study has preliminarily revealed the mechanism of antidepressant active ingredients from Hypericum perforatum L. via network pharmacology analysis combined with in vivo and in vitro validation， thus providing a theoretical basis for further pharmacological research.

Objective To investigate the impacts of Atlas and LVIS Jr stents on the neurological function and cerebral blood perfusion in patients with intracranial aneurysms. Methods One hundred and twenty-eight patients with intracranial aneurysms who received treatment at our hospital from August 2023 to August 2024 were selected as the research subjects. Based on the treatment methods， they were divided into the LVIS Jr stent group （65 cases； 4 cases were lost to follow-up after 12 months， and 61 cases were finally included） and the Atlas stent group （63 cases； 2 cases were lost to follow-up after 12 months， and 61 cases were finally included）. Both groups were followed up until 12 months after the operation. A comparison was made between the two groups in terms of intraoperative instrument performance indicators and adverse events， scores of the NIH Stroke Scale （NIHSS）， scores of the Mini - Mental State Examination （MMSE） （pre-operative， 24 h post-operative， and 7 d post-operative）， Raymond classification （immediately post-operative）， Glasgow Outcome Scale （GOS）， recurrence rates （after 12 months of follow-up）， serum levels of tumor necrosis factor-alpha （TNF-α）， C-reactive protein （CRP）， nerve growth factor （NGF）， and brain-derived neurotrophic factor （BDNF） （pre - operative and 3 d post-operative）， cerebral blood perfusion （pre-operative and 6 months post-operative）， and complication incidence （during the study period）. Results The one-time success rate and good adherence rate of the Atlas stent group were higher than those of the LVIS Jr stent group （P < 0.05）. However， there was no significant difference in the support satisfaction rate and the total incidence of adverse events between the two groups （P > 0.05）. The NIHSS scores in both groups gradually decreased from pre-operative to 7 days after the operation， and the scores in the Atlas stent group were even lower （P < 0.05）. The MMSE scores in both groups gradually increased from pre-operative to 7 days post - operation， particularly in the Atlas stent group （P < 0.05）. Immediately after the operation， the proportion of patients with Raymond Grade Ⅰ in the Atlas stent group was higher than that in the LVIS Jr stent group （P < 0.05）. After 12 months of follow-up， there was no significant difference in the GOS scores between the two groups （P > 0.05）. Compared with the pre-operative levels， the serum levels of TNF-α， CRP， NGF， and BDNF in both groups increased 3 days after the operation. The serum levels of TNF-α and CRP in the Atlas stent group were lower than those in the LVIS Jr stent group， while the serum levels of NGF and BDNF were higher than those in the LVIS Jr stent group （P < 0.05）. Compared with the pre-operative state， the regional cerebral blood volume （rCBV） increased in both groups 6 months after the operation， with a higher value in the Atlas stent group and a lower value in the ICP group （P < 0.05）. During the study period， there was no significant difference in the total incidence of complications between the two groups （P > 0.05）. After 12 months of follow-up， the recurrence rate of the Atlas stent group was lower than that of the LVIS Jr stent group （P < 0.05）. Conclusions Compared with the LVIS Jr stent， the Atlas stent demonstrated superior intraoperative positioning performance and adherent performance during the treatment of intracranial aneurysms. This could enhance the embolization effect， improve cerebral blood flow perfusion， regulate the levels of serum TNF-α， CRP， NGF， and BDNF， promote the recovery of cognitive function and neurological function， and reduce the recurrence rate. In terms of support performance， intraoperative adverse events， long-term prognosis， and risk of complications， the two groups were comparable.

Objective To investigate the mechanism by which Maresin1 reduces lower limb ischemia-reperfusion injury through the inhibition of pyroptosis. Methods This study employed a combination of in vivo and in vitro experiments. In the in vivo experiment， 27 C57BL/6 mice were randomly allocated into the Control group， the model group （LL-IRI）， and the treatment group （MaR1）. After successful modeling and drug intervention， the gastrocnemius muscle tissue of 5 mice （n = 5） from each group was collected for transcriptome sequencing and bioinformatics analysis. The remaining samples were utilized to assess histopathological damage and to detect the expression of TLR4/NF-κB p65 and NLRP3/GSDMD proteins. The MDA content and CAT activity in the serum were determined using kits. In vitro， L6 skeletal muscle cells were stimulated with LPS and ATP to establish a pyroptosis model. After modeling， ELISA was applied to measure the content of IL-1β and IL-18 in the supernatant of each group. Results Bulk RNA sequencing analysis demonstrated that， in comparison with the control group， the TLR4/NF-κB/NLRP3 signaling pathway and the expression of pyroptosis-related genes were significantly up-regulated in the LL-IRI group. Moreover， the intervention of MaR1 could reverse the above-mentioned trend， as MaR1 negatively regulated the activation of inflammasomes and the biological process associated with pyroptosis. Immunohistochemistry indicated that the expression of TLR4/NF-κB p65 and NLRP3/GSDMD was significantly enhanced in the LL-IRI group （P < 0.01）， accompanied by an increase in serum MDA content （P < 0.01） and a decrease in CAT activity （P < 0.01）. MaR1 treatment could significantly improve these pathological， molecular， and biochemical parameters. The results of in vitro experiments showed that， compared with the normal group， there was a significant increase in the release of inflammatory factors IL-1β and IL-18 at the end of pyroptosis in the LPS + ATP group （P < 0.01）. After the intervention of MaR1， the release of IL-1β and IL-18 in the LPS + ATP group was significantly reduced （P < 0.01）. Conclusion MaR1 may inhibit pyroptosis by blocking the TLR4/NF-κB/NLRP3 inflammatory cascade， thereby alleviating lower limb ischemia/reperfusion （I/R） injury in mice.

Objective To discuss the clinical value of micro flow imaging （MFI） combined with real-time shear wave elastography （SWE） guided puncture in the precise diagnosis of BI-RADS type 4 breast nodules. Methods A total of 218 patients with breast nodules （224 nodules in total） admitted to the hospital from January 2020 to December 2024 were selected as the research subjects. MFI and SWE examinations were conducted to analyze the imaging features of benign and malignant breast nodules， evaluate the vascular blood flow grade and elastic hardness value of breast nodules， logistic regression was used to analyze the influencing factors of benign and malignant breast nodules， and analyze the diagnostic value of the two methods. Results All 224 nodules were pathologically confirmed， including 65 benign nodules and 159 malignant nodules. The number of malignant nodules with irregular morphology， incomplete edges and microcalcification was higher than that of benign nodules （P < 0.05）. The number of cases with blood flow grades 0 and I of malignant nodules was lower than that of benign nodules （P < 0.05）， while the number of cases with grades Ⅱand Ⅲ was higher than that of benign nodules （P < 0.05）. The SWE elastic ratio Eratio of malignant nodules was 3.25 ± 0.56， which was higher than that of benign nodules at 2.54 ± 0.22（P < 0.05）. The results of Logistic regression analysis showed that irregular nodule morphology， irregular nodule margins， microcalcification， MFI blood flow grade， and SWE elastic hardness value were all independent influencing factors for differentiating benign and malignant breast lesions （P < 0.05）. The consistency between the individual examinations of MFI and SWE and the pathological results was average （P < 0.05）， while the combined examination of MFI and SWE had a better consistency with the pathological results （P < 0.05）. The sensitivity， specificity， accuracy and negative predictive value of MFI combined with SWE in diagnosing benign and malignant breast nodules were higher than those of single detection （P < 0.05）. Conclusion MFI combined with SWE-guided puncture has a relatively high value in the precise diagnosis of BI-RADS type 4 breast nodules.

Objective To compare the effects of remimazolam versus propofol for general anesthesia maintenance on postoperative liver function， quality of recovery， and perioperative safety in elderly patients undergoing video-assisted thoracoscopic lobectomy （VATS）. Methods A total of 117 patients aged ≥ 65 years scheduled for VATS lobectomy were enrolled and randomly assigned to two groups using a random number table： the propofol group （Group P， n = 59） and the remimazolam group （Group R， n = 58）. For anesthesia induction， Group P received propofol 2 mg/kg and Group R received remimazolam 0.25 mg/kg. For anesthesia maintenance， Group P received a continuous infusion of propofol at 8 mg/（kg·h）， and Group R received a continuous infusion of remimazolam at 1.2 mg/（kg·h）. Both groups were combined with target-controlled infusion （TCI） of remifentanil for analgesia. Anesthesia depth was monitored using SedLine to maintain the Patient State Index （PSI） between 25 and 50. Postoperative analgesia was provided via standardized patient-controlled intravenous analgesia （PCIA）. Patient demographics were recorded. The primary outcome was the change in alanine aminotransferase from baseline on postoperative day 1 （ΔALT）. Secondary outcomes included the changes in aspartate aminotransferase （ΔAST） and total bilirubin （ΔTBIL） from baseline on postoperative days 1 and 3， as well as the levels of ALT， AST， and TBIL assessed preoperatively and on postoperative days 1 and 3， and the Quality of Recovery-15 （QoR-15） scores at the same time points.Mean arterial pressure （MAP）， heart rate （HR）， and PSI were recorded at the following time points： before induction （T₁）， when PSI reached 50 （T₂）， during tracheal intubation （T₃）， at skin incision （T₄）， during irrigation （T₅）， during skin suturing （T₆）， and during extubation （T₇）. Postoperative extubation time， post-anesthesia care unit （PACU） stay duration， and the incidences of nausea and vomiting， hypoxemia， and hypotension within 72 hours postoperatively were recorded. Results There were no statistically significant differences in preoperative levels of ALT， AST， and TBIL between the two groups （P > 0.05）. The primary outcome， ΔALT， showed no significant difference between the groups. No significant differences were observed in ΔAST and ΔTBIL on postoperative days 1 and 3 between the two groups （all P > 0.05）. Compared with preoperative values， ALT， AST， and TBIL levels were significantly elevated on postoperative day 1 in both groups （P < 0.05）， with a gradual decrease by postoperative day 3， suggesting a transient elevation of liver function indicators induced by surgical stress. Compared with Group P， Group R had significantly higher QoR-15 scores on postoperative day 3， significantly higher MAP at T₂ and T₃， and significantly higher HR at T₃ （P < 0.05）. Postoperative extubation time and PACU stay duration were significantly shorter in Group R compared with Group P （P < 0.05）. There were no statistically significant differences between the two groups in baseline characteristics （age， sex， ASA grade， BMI）， intraoperative parameters （operation time， anesthesia time， blood loss， urine output， fluid infusion volume， remifentanil consumption）， PSI values at different time points， or the incidence of postoperative nausea and vomiting， hypoxemia， and hypotension （all P > 0.05）. Conclusions In elderly patients undergoing VATS lobectomy with potential risk of liver injury， remimazolam and propofol for general anesthesia maintenance have no significant difference in their overall impact on postoperative liver function. However， remimazolam can improve intraoperative hemodynamic stability， shorten recovery time， and enhance the quality of postoperative recovery.

Objective To explore the potential causal relationship between the gut microbiota and the risk of head trauma. Methods We conducted a two-sample Mendelian randomization （MR） analysis to explore the potential causal relationship between gut microbiota and head injury， utilizing summary statistics from European ancestry cohorts. The inverse-variance weighted （IVW） method was employed as the primary analytical approach. A two-stage discovery-validation design was adopted. To guarantee reliability， significant findings from a training cohort were validated in an independent testing cohort， and then a meta-analysis was carried out. Moreover， multivariable Mendelian randomization （MVMR） was performed to evaluate independent effects， and reverse MR analysis was used to examine the direction of causality. Results In the discovery phase （training cohort）， six bacterial taxa were identified as potentially associated with the risk of head injury. Crucially， the risk effect of the Eubacterium nodatum group was successfully replicated in the independent validation cohort （IVW OR： 1.001， P = 0.012）. The meta-analysis of both cohorts further supported suggestive associations for four taxa. Notably， all the observed effect sizes were small （ORs close to 1）， which warrants a cautious interpretation of the clinical relevance. Conclusions Our study offers preliminary genetic evidence indicating that specific gut microbial taxa might have a causal association with the risk of head injury. These findings imply that dysbiosis could affect injury susceptibility， possibly via neurocognitive or neuromuscular pathways. Nevertheless， considering the small effect sizes and partial replication， these results should be regarded as exploratory and necessitate further validation in larger， multi-ethnic cohorts.

Objective To analyze the association between the disease course， functional status， and hospitalization costs among stroke inpatients. Methods Using the medical record data of 445 stroke inpatients admitted to the Department of Rehabilitation Medicine， Xiangyang Central Hospital， Hubei Province from July 2023 to December 2023， an analysis was conducted on the relationships between the disease course， functional status， total hospitalization costs， and inpatient rehabilitation costs. Results Functional status was significantly and positively correlated with total hospitalization costs. Patients with the worst functional status had the highest costs （￥18，786.13）， and these costs were significantly higher than those of patients with the best functional status （Coef = 0.24， P < 0.001）. Meanwhile， no significant difference was found in rehabilitation costs among functional status groups. The disease course significantly influenced rehabilitation costs， with the group with a disease course of 121-180 days showing significantly higher rehabilitation costs than the group with a disease course of 0-30 days （Coef = 0.18， P = 0.015）， but it had no significant effect on total hospitalization costs. Subgroup analysis indicated that patients with moderate functional status were particularly sensitive to the disease course. Conclusions Functional status shows a positive correlation with total costs but has no correlation with rehabilitation costs. The disease course independently influences rehabilitation costs， and patients with moderate functional status are more sensitive to early rehabilitation.