Digital therapy shows promise in providing precise assessments and enhancing the efficacy of treatments for mental illness， offering advantages such as convenience， flexibility， and the potential to reduce costs by shifting towards preventive care. This article reviews the development and benefits of digital therapy in mental health care and discusses the challenges it faces， including concerns over privacy， ethics， security， accessibility issues， digital divides， and the lack of sufficient clinical validation and standardization. It also highlights specific risks to mental health patients and explores potential future developments such as integration with brain-computer interfaces and neurofeedback， the use of robot therapists based on large language models， applications of virtual reality or the metaverse， and combinations with traditional physical treatments and medications. The author calls for urgent policy recommendations to refine regulations， establish unified evidence standards， enhance training and education for healthcare providers and patients， and to build multidisciplinary collaborative mechanisms to advance personalized and effective digital therapy in mental health.

Metabolic acidosis is a prevalent complication in patients undergoing maintenance hemodialysis （MHD）. The maintenance of acid-base balance in MHD patients primarily relies on the total alkali supply in the dialysate. Achieving an optimal concentration of dialysate bicarbonate （DBIC） is crucial to prevent metabolic acidosis before subsequent hemodialysis sessions while avoiding metabolic alkalosis after the current session. Inadequate correction or overcorrection of pre-dialysis metabolic acidosis has been associated with unfavorable patient outcomes； however， there is currently a lack of guidelines or expert consensus regarding DBIC concentration. This study addresses the epidemiology of metabolic acidosis in MHD patients， explores the relationship between DBIC concentration and acid-base disorders， and discusses recent advancements in determining the ideal DBIC concentration， providing valuable insights for formulating scientifically sound and personalized DBIC dialysis prescriptions.

"Metaflammation，" proposed by Hotamisligil in 2006， refers to a chronic low-grade inflammation triggered by metabolic factors such as excessive nutrition and energy， persisting at subacute levels over an extended period. Immune cells infiltrate the inflammatory site， leading to enhanced expression or activity of various inflammatory molecules and subsequent inflammatory damage. Recent research on metabolic-related fatty liver disease has revealed that modern metaflammation plays a pivotal role in the pathogenesis of NAFLD. The associated inflammatory pathways offer promising prospects for the development of targeted drugs. This article provides an updated review on the advancements in metaflammation within NAFLD.

Objective To investigate the protective effects of Sulforaphane （SFN） against high glucose （HG）?induced human platelet apoptosis and elucidate the underlying mechanisms in vitro. Methods Purified platelets obtained from healthy individuals were pre?incubated with various concentrations of SFN （5， 10， or 20 μmol/L） or a vehicle control （0.05% DMSO） for 40 minutes at 37 ℃. Subsequently， the platelets were stimulated with normal glucose （NG， 5 mmol/L） or high glucose （HG， 25 mmol/L） for an additional duration of 90 minutes. Flow cytometry was employed to assess platelet mitochondrial membrane potential depolarization （Δψm）， exposure of phosphatidylserine （PS）， and generation of total intraplatelet reactive oxygen species （ROS）. Phosphorylation levels of PI3K and Akt were determined using Western blot. Results Compared to NG?treated human platelets， HG significantly induced depolarization of platelet Δψm and exposure of PS （P < 0.001）. These effects of HG were markedly attenuated by various concentrations of SFN （P < 0.001）. Mechanistically， SFN down?regulated the phosphorylation levels of PI3K （P < 0.01） and Akt （P < 0.05）， which were increased by HG when compared to the vehicle control， and substantially reduced total intracellular ROS levels （P < 0.001）. The inhibitory effects of SFN on HG?induced phosphorylation of PI3K and Akt， as well as its efficacy on total intracellular ROS generation， Δψm depolarization， and PS exposure in HG?stimulated human platelets were completely reversed by a specific agonist for PI3K， 740 Y?P. Conclusions The current study demonstrates that SFN exerts a protective effect on platelet apoptosis induced by HG， potentially through the down?regulation of the PI3K/Akt?mediated pathway in human platelets in vitro. These findings suggest that SFN may hold promise for improving thrombosis in diabetes mellitus and related chronic metabolic diseases.

Objective To explore the effects of mechanical ventilation and mechanical ventilation combined with phrenic nerve electrical stimulation on the morphology of the phrenic nerve-diaphragm neuromuscular junction in rats. Methods The rats were divided into a control group （CON group， n = 6）； an 18-hour mechanical ventilation group （MV group， n = 6）； an 18-hour ventilation combined with sham electrical stimulation group （S-MS group， n = 6）； and an 18-hour ventilation combined with electrical stimulation group （MS group， n = 6）， in which the diaphragm contraction force was detected through the biological signal acquisition system， the stimulation frequency-contraction curve was fitted， and the muscle fatigue index was calculated. The muscle fiber cross-sectional area （CSA） of the diaphragm specimen was observed through HE staining； the endplate membrane area of the neuromuscular junction （NMJ） was observed through immunohistochemistry （IHC） staining of the diaphragm combined with laser confocal technology. Results As compared with the CON group， the contractility of isolated diaphragm muscles in the MV group and S-MS group decreased； the fatigue resistance of isolated diaphragm， as compared with the CON group （0.686 8 ± 0.049 42）， decreased in the MV group （0.360 3 ± 0.066 89） and the S-MS group （0.367 9 ± 0.034 94）， with a greater decline in the MS group （0.536 2 ± 0.054 38）； as compared with the CON group ［674.3（523.9，863.6）］， diaphragm CSA was reduced in the MV group ［374.5（293.3，522.7）］ and S-MS group ［392.8（309.5，542.6）］， with a relatively lower reduction in the MS group ［592.7（425.1，820.0）］； as compared with the CON group ［393.7（293.5，471.3）］， the diaphragm endplate membrane area decreased in the MV group ［289.7（227.0，354.2）］ and S-MS group ［243.1（190.8，331.7）］， with a lower degree of reduction in the MS group ［331.0（262.8，413.7）. Conclusions Mechanical ventilation causes diaphragm dysfunction in rats and decreases the endplate membrane area of the diaphragm NMJ. Bilateral phrenic nerve electrical stimulation for 10 min/h can improve diaphragm dysfunction and changes in the endplate membrane area of the diaphragm NMJ caused by mechanical ventilation.

Objective To investigate the effect of long non-coding RNA （lncRNA） macrophage migration inhibitory factor antisense RNA1 （MIF-AS1） on the malignant biological behavior of prostate cancer （PC） cells by regulating the miR-423-5p/pyrroline-5-carboxylic acid reductase 1 （PYCR1） axis. Methods PC3 cells were cultured in vitro to knock down the expression of MIF-AS1 or down-regulate the expression of miR-423-5p. The expression of MIF-AS1， miR-423-5p and PYCR1 mRNA in tumor tissues and adjacent tissues and cells of PC patients were detected. The cell proliferation， apoptosis， migration， and invasion were detected and the expression of PYCR1 protein was detected by Western blot. The relationships between miR-423-5p， IF-AS1 and PYCR1 were verified. Results The MIF-AS1 and PYCR1 mRNA were observed to be highly expressed in the tumor tissues， while miR-423-5p was lowly expressed. Silenced MIF-AS1 inhibited the proliferation， migration and invasion of PC3 cells and up-regulated miR-423-5p induced cell apoptosis （P < 0.05）. Inhibition of miR-423-5p expression reversed the inhibitory effect of silencing MIF-AS1 on malignant behavior of PC3 cells （P < 0.05）. miR-423-5p was correlated with MIF-AS1 and PYCR1 by targeted regulation. Conclusion Silencing MIF-AS1 may inhibit the expression of PYCR1 by up-regulating miR-423-5p， thereby inhibiting the malignant behavior of PC cells.

Objective The aim of this study was to explore the influencing factors of orthostatic intolerance in adolescent idiopathic scoliosis patients after surgery for the first time out of bed movement. Methods A retrospective analysis was conducted on the clinical data of 226 adolescent idiopathic scoliosis patients admitted to Nanjing Drum Tower Hospital from June 2021 to June 2023. Based on whether upright intolerance occurred during the first postoperative ambulation， patients with upright intolerance were included in the upright intolerance group， and patients without upright intolerance were included in the non upright intolerance group. Collect general data of two groups of patients， as well as their blood pressure at different positions during their first postoperative out of bed activity. Conduct univariate and multivariate logistic regression analysis on the influencing factors of upright intolerance during their first postoperative out of bed activity in adolescent idiopathic scoliosis patients. Results Out of 226 patients who underwent their first postoperative ambulation， 102 experienced orthostatic intolerance， accounting for 45.13% （102/226） of the cases. The systolic and diastolic blood pressure in both sitting and standing positions were lower in the orthostatic intolerance group than in the non orthostatic intolerance group （P < 0.05）. Through univariate analysis， it can be seen that the postoperative bed rest time， sitting pain score， standing pain score， postoperative hospitalization time， and proportion of posture adaptation training in the orthostatic intolerance group were significantly different from those in the non orthostatic intolerance group （P < 0.05）. Through multiple logistic regression analysis， it can be seen that long postoperative bed rest time， degree of sitting pain， degree of standing pain， and lack of posture adaptation training are risk factors for upright intolerance （P < 0.05）. Conclusion Long postoperative bed rest time， sitting pain， standing pain， and lack of posture adaptation training are the main risk factors affecting upright intolerance of adolescent idiopathic scoliosis patients after surgery for the first time out of bed activity.

Objective To analyze the effect of endoscopic tumor resection by submucosal tunnel （STER） on recurrence in patients with submucosal tumors （SMT） around cardia. Methods A total of 92 patients with SMT around cardia were selected and divided into the treatment group（n = 46） and the control group（n = 46） using random number table method. The treatment group and the control group were treated with STER and endoscopic submucosal dissection （ESD）， respectively， and both groups were followed up for 12 months after surgery. Perioperative indexes， therapeutic effects， quality of life， sleep， inflammatory indexes， immune indexes before and 1 week after surgery， complications 1 week after surgery， recurrence 12 months after surgery were compared between the two groups. Results Compared with the control group， the surgery time of the treatment group was longer， the hospital stay was shorter and treatment cost were lower， and the stripping speed was faster （P < 0.05）. Compared with before surgery， scores of Pittsburgh sleep Quality index （PSQI）， serum levels of interleukin-8 （IL-8）， interleukin-6 （IL-6）， high-sensitive C-reactive protein （hs-CRP） and whole blood levels of CD8⁺ decreased in the two groups 1 week after surgery， and the levels were lower in the treatment group （P < 0.05）. Compared with the preoperative results， the levels of whole blood CD4⁺ and CD4⁺/CD8⁺， scores of Quality of Life Core 46 Questionnaire （QLQ-C46）， Karnofsky Score （KPS） were higher in the two groups 1 week after surgery， those in the treatment group was higher （P < 0.05）. 1 week after surgery， the complication rate of the two groups was lower in the treatment group （P < 0.05）， and 12 months after surgery， the recurrence rate of the two groups was not statistically significant （P > 0.05）. Conclusion STER treatment for SMT around cardia was highly effective， resulting in superior perioperative outcomes， enhanced life and sleep quality， reduced systemic inflammation， and bolstered immune function. Moreover， it significantly lowered the risk of complications without raising the rates of recurrence.

Objective To explore the relationship between blood uric acid levels and non-alcoholic fatty liver disease in patients with type H hypertension. Methods The clinical data of 284 patients with type H hypertension admitted to the Cardiovascular Department， Xianyang Hospital， Yan'an University in 2022 were collected and retrospectively reviewed. The patients were divided into NAFLD group （n = 88）and normal group （n = 196） according to whether they had NAFLD. The general information and laboratory indicators were compared between the two groups. Multivariate logistic regression analysis was conducted to explore the influencing factors of NAFLD in H-type hypertension patients. The draw ROC curves were plotted to observe the role of SUA in predicting NAFLD and select the optimal cutoff value based on the maximum Youden index. Results The NAFLD group demonstrated higher levels in body mass index， systolic blood pressure， diastolic blood pressure， total cholesterol， triglycerides， low-density lipoprotein cholesterol， SUA， γ-Glutamyl transpeptidase and alanine aminotransferase compared to the normal group， but significantly lower levels at age and high-density lipoprotein cholesterol（P < 0.05）. The multivariate logistic regression analysis showed that elevated levels of BMI（OR= 1.173，95%CI：1.066 ~ 1.291）， SUA（OR= 1.005，95%CI：1.001 ~ 1.010）， and TG（OR= 1.929，95%CI：1.042 ~ 3.574）were risk factors for NAFLD in patients with type H hypertension （P < 0.05）. The ROC curves showed that the area under the curve （AUC） of SUA， TG， BMI， and their combination were 0.709， 0.707， 0.750， and 0.796， respectively. Conclusion type H hypertensive NAFLD patients have high levels of BMI， SUA， TG compared to non-NAFLD patients. Elevated SUA is a risk factor for type H hypertensive NAFLD patients， with SUA > 337 μmol/L as a significant value for predicting NAFLD.

Objective To investigate the impact of nociceptive level （NOL） index on cellular immunity and HIF-1α in patients with radical breast cancer. Methods A total of 80 patients undergoing radical mastectomy between December 2022 and December 2023 were randomly assigned into an experimental group and a control group using a random number table method. The NOL index in the experimental group was maintained within the range of 30 to 50， with corresponding adjustments made to achieve the target concentration of remifentanil. In contrast， the control group initially received remifentanil at a target controlled infusion rate of 4 ng/mL， which was adjusted based on hemodynamics. The average target concentration of remifentanil was recorded for both groups. Venous blood samples were collected from all participants one day before and one day after surgery to measure CD4⁺， CD8⁺ cell counts， NK cell activity， as well as serum levels of HIF-1α. Results There were no significant differences observed in anesthesia time， operation time， intraoperative mean arterial pressure （MAP）， heart rate （HR）， and postoperative visual analog scale （VAS） scores between the two groups. The average target concentration of remifentanil in the experimental group was significantly lower than that in the control group （P < 0.05）. Moreover， the experimental group exhibited higher values of CD4⁺， CD4⁺/CD8⁺ ratio， and NK cells compared to the control group， while demonstrating a lower level of HIF-1α expression （P < 0.05）. In addition， within the experimental group， there was a decrease in CD4⁺ count and CD4⁺/CD8⁺ ratio one day after surgery compared to one day before surgery； meanwhile， HIF-1α expression increased significantly after surgery when compared to preoperative levels （P < 0.05）. Similarly， within the control group， there was a decrease observed in CD4⁺， CD8⁺， CD4⁺/CD8⁺ ratio as well as NK cell values one day after surgery when compared to preoperative levels； additionally， HIF-1α expression showed a significant increase after surgery when compared to preoperative levels（P < 0.05）. Conclusion The implementation of NOL monitoring during radical mastectomy under general anesthesia can effectively lower the required remifentanil concentration， thereby mitigating its suppressive effects on T lymphocytes， preserving NK cell activity， and reducing elevated levels of HIF-1α. Consequently， this approach exerts minimal impact on the tumor immune microenvironment （TIME） in patients.

Objective To analyze the impact of mini plate and cannulated screw internal fixation on joint function recovery in patients with posterior malleolus fracture. Methods A total of 150 patients with posterior malleolus fractures， treated at our hospital from March 2021 to June 2023， were included in this study. They were divided into two groups using the odd-even number method. The control group consisted of 75 patients who underwent cannulated screw internal fixation， while the study group comprised 75 patients who received mini plate internal fixation. Clinical indicators， ankle range of motion， ankle function， and health status were compared and analyzed between the two groups. Additionally， levels of inflammatory factors， postoperative complications， and clinical efficacy were assessed. Results In terms of operation time and intraoperative blood loss， there was no statistically significant difference between the two groups （P > 0.05）. However， the study group exhibited shorter ambulation days， fracture healing time， and hospitalization days compared to the control group （P < 0.05）. Moreover， the study group demonstrated significantly improved ankle dorsiflexion， ankle plantar flexion， foot varus and foot valgus range of motion compared to the control group （P < 0.05）. Additionally， higher AOFAS score and KPS score were observed in the study group as compared to the control group （P < 0.05）. Furthermore， levels of IL-6， IL-8 and CRP were lower in the study group than in the control group （P < 0.05）. The incidence of postoperative complications was also lower in the study group than in the control group （P < 0.05）. Conclusion Mini plate internal fixation for posterior malleolus fracture yields ideal outcomes by promoting improvement in clinical indicators and ankle range of motion while effectively enhancing ankle function， reducing inflammatory reaction as well as minimizing postoperative complications.

Objective Toobserve the clinical efficacy of arthroscopic superior fulcrum reconstruction versus superior capsule reconstruction in the treatment of irreparable massive rotator cuff tears， in order to provide more therapeutic choices. Methods A total of 28 patients with irreparable massive rotator cuff tears， who had been admitted to the Department of Orthopedics， the Third Affiliated Hospital of Anhui Medical University from September 2021 to July 2023 were selected， 14 of whom underwent arthroscopic superior fulcrum reconstruction（superior fulcrum reconstruction group）and 14 underwent arthroscopic superior capsule reconstruction（superior capsule reconstruction group）. The observation indexes were operative time， intraoperative blood loss， shoulder joint active range of motion， the university of California at Los Angeles shoulder rating scale（UCLA）， American Shoulder and Elbow Surgeons′ score （ASES）， the shoulder score of Constant-Murley（CMS） and Visual Analogue Scale （VAS）. Results All patients had a successful surgery and a postoperative follow-up was at least 12 months. The postoperative shoulder joint active range of motion， UCLA， ASES and CMS between the two groups， which were statistically significant （P < 0.05）， superior fulcrum reconstruction group was better than superior capsule reconstruction group. There was no significant difference in postoperative VAS， operative time or intraoperative blood loss between the two groups （P > 0.05）. Conclusions Arthroscopic superior fulcrum reconstruction outperforms superior capsule reconstruction in the treatment of irreparable massive rotator cuff tears.

Objective The aim of this study was to explore the impact of implant robots on the oral function and aesthetic effects of immediate implant patients in the aesthetic area of anterior teeth. Methods A total of 68 patients with single anterior tooth defects admitted to the hospital from January 2021 to January 2023 were enrolled and divided into a study group of 34 cases and a control group of 34 cases randomly. In the study group， anterior tooth immediate implantation was performed with the assistance of an oral implantation robot， while the control group underwent conventional immediate anterior tooth implantation. The implantation accuracy， postoperative bite function， aesthetic restoration， and occurrence of complications were compared between the two groups， and complications were all recorded. Results After final restoration， all patients were followed up for 2 years， and the implant success rate was 100% （68/68 cases）. The study group exhibited significantly lower postoperative apical point error and implant angle error compared to the control group （P < 0.05）. There was no significant difference in speech clarity， bite pressure， and pain intensity between the two groups （P > 0.05）. The ratio of implant bite pressure to that of the contralateral homonymous tooth was higher in the study group than in the control group （P < 0.05）. The postoperative pink esthetic score （PES） and white esthetic score （WES） in the study group were higher than those in the control group （P < 0.05）. There was no statistically significant difference in the incidence of complications between the two groups （P > 0.05）. Patient satisfaction in the study group was higher than that in the control group （P < 0.05）. Conclusion The use of oral implantation robots for immediate implantation in the aesthetic zone of anterior teeth resulted in higher intraoperative positioning accuracy and yielded favorable outcomes in postoperative restoration of bite function and aesthetics.

Objective To assess the effectiveness of enhanced tibial transverse transport （TTT） in conjunction with vacuum-assisted closure （VAC） therapy for managing recalcitrant diabetic foot ulcers. Methods A retrospective analysis was conducted on data from diabetic foot patients with Wagner grade ≥2 who were treated at Beijing Chaoyang Hospital and Beijing Chaoyang Hospital of Integrated Traditional Chinese and Western Medicine between July 2020 and December 2022. The patients were categorized into three groups based on their treatment regimen： VSD treatment （VSD group）， modified TTT treatment （TTT group）， and combined application of TTT and VSD （combined group）. A one-year follow-up was performed to assess general data， ulcer area before and three months after surgery， ankle brachial index， visual analog pain score， as well as adverse events within one year post-surgery among the three groups. Results The VSD group consisted of 43 patients， while the TTT group consisted of 43 patients， and the combined group consisted of 42 patients. There were no statistically significant differences in baseline characteristics among the three groups （P > 0.05）. Patients in the VSD group had longer ulcer healing time， higher pain scores， lower ankle brachial index （P < 0.05）， larger ulcer area （P = 0.029）， and higher one-year ulcer recurrence rate compared to those in the TTT group. On the other hand， patients in the combined group had shorter ulcer healing time compared to those in the TTT group （P = 0.046）. However， there were no significant differences observed between these two groups regarding ulcer area （P = 0.362）， pain scores （P = 0.932）， ankle brachial index （P = 0.671）， and one-year ulcer recurrence rate （P = 0.710）. Conclusions The efficacy of modified TTT surpasses that of VSD in promoting ulcer healing， alleviating pain， and enhancing lower limb circulation. Furthermore， the combination of VSD with modified TTT demonstrates a potential to further expedite wound healing time.

Objective To investigate the real-world factors influencing the clinical outcome of Febrile neutropenia （FN） in oncology patients. Methods We conducted a retrospective analysis of clinical data from 130 FN patients admitted to our hospital between January 2020 and December 2022. The patients were categorized into three groups based on their clinical efficacy： cured group， effective group， and ineffective group. A comparison was made among the three groups regarding general data and laboratory examination results. Univariate and ordered multicategorical logistic regression analyses were performed to identify factors affecting the clinical efficacy of FN. Results The overall effective rate of FN in our hospital was 86.15%. Univariate analysis revealed statistically significant differences among the three patient groups regarding the duration of granulomatous defects， Physical Status Score （PS Score）， procalcitonin （PCT） levels， and timing of administration （P < 0.05）. Ordinal multicategorical logistic regression analysis demonstrated that patients with PS scores < 2， granulomatous defects lasting less than 7 days， and PCT levels below 0.5 ng/mL exhibited better clinical treatment outcomes. Conclusion In the management of FN， it is crucial to prioritize patients with high PS scores and elevated PCT levels while optimizing drug utilization to enhance clinical efficacy. Timely intervention should be implemented to address granulopathy and improve overall clinical outcomes.

Objective To observe the clinical efficacy of dynamic joint mobilization combined with core stability training in the treatment of nonspecific low back pain. Methods 60 patients with nonspecific low back pain were randomly assigned into either the treatment group or control group. Each group had 30 patients. The treatment group received a therapeutic regimen combining dynamic joint mobilization and core stability training， while the control group only received core stability training. Both groups were evaluated for therapeutic effectiveness using the Visual Analogue Scale （VAS） for pain， the Oswestry Disability Index （ODI）， and the range of motion （ROM） of the lumbar spine before treatment， and at the 1st， 3rd， and 6th weeks after treatment. At the conclusion of the treatment， a thorough assessment of the overall therapeutic efficacy was performed. Results At the 1st， 3rd， and 6th weeks post-treatment， both groups showed statistically significant differences in VAS scores， ODI scores， and ROM scores over time （P < 0.05）. The improvements in these indices were significantly greater in the treatment group compared to the control group （P < 0.05）. The treatment group had considerably higher therapeutic effectiveness compared to the control group （P < 0.05）. Conclusions Dynamic joint mobilization combined with core stability training is effective in treating nonspecific low back pain. It can help with pain relief， lumbar and back function restoration， and lumbar and back mobility improvement. This approach is worthy of clinical application and promotion.

Objective To investigate the effect of individual exercise training on the rehabilitation of patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods A total of 81 patients between January 2021 and December 2023 were randomly allocated into an observation group （n = 41） and a control group （n = 40） using a simple random number Tab.method. The control group received routine postoperative rehabilitation intervention， while the observation group received individualized exercise training as the core component of cardiac rehabilitation intervention. The study compared the effects of rehabilitation， cardiac function parameters ［left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVEDD）］， exercise endurance measures ［6-minute walking distance （6MWD）］， and quality of life assessed by Seattle Angina Pecina Scale （SAQ） scores between the two groups before and after a three-month intervention period. Results The total recovery response rate in the observation group was higher than that in the control group （P < 0.05）. LVEF， LVEDD， 6 MWD， maximum exercise load and SAQ scales （P > 0.05）， LVEF were higher than before intervention （t = 3.345，2.480，3.165，5.016，2.059，4.582，4.443，3.353， P < 0.05）， and LVEDD was lower than before intervention （t = 3.335， P < 0.05）. Conclusion The individualized exercise training-based cardiac rehabilitation program demonstrates potential for enhancing cardiac function and exercise endurance in patients with CHD following PCI， thereby improving their overall quality of life. This finding holds significant clinical implications.

Objective To investigate the current status of frailty in patients on maintenance hemodialysis （MHD）， and explore the correlation of frailty with anxiety and depression. Methods General information， clinical data and blood biochemical data of 101 cases who underwent MHD in Department of Nephrology， Shunde Hospital Affiliated to Jinan University from January 2023 to January 2024 were collected. FRAIL scale was applied to evaluate the frailty of the patients， and they were accordingly classified into frailty group and non?frailty group （including pre?frail and non?frail participants）. Anxiety and depression were evaluated by GAD?7 and PHQ?9 scale. Univariate analysis and logistic regression were used to explore the association of frailty with anxiety， depression and other possible influencing factors. Results Among the 101 cases， 29 cases （28.71%） were includedin frailty group and 72 cases （71.29%） in non?frailty group. There were 42 patients with depression （41.58%） and 25 with anxiety （24.75%）. In the frailty group， the prevalence of depression was 65.52% and that of anxiety 55.17%。 There were significant differences in age， grip strength， exercise， stroke and coronary heart disease， anxiety and depression， ferritin and CRP between the two groups （P < 0.01）. Multivariate regression analysis showed that depression， anxiety， no exercise， stroke and high ferritin concentration were independent risk factors for frailty in MHD patients （P < 0.05）. Conclusion In patients on MHD， frailty is closely associated with depression， anxiety， and lack of exercise， and stroke as well as high ferritin concentration are independent risk factors for frailty。

Objective To investigate the clinical utility of ultrasound parameters in diagnosing neonatal annular pancreas. Methods A total of 56 neonates with descending duodenal obstruction underwent saline?contrast ultrasound examination. Ultrasonic parameters， including dilated duodenum diameter （DDD）， dilated duodenum thickness （DDT）， and stenosis duodenum diameter （SDD）， were measured. The cases were categorized into three groups： annular pancreas （group A， n = 28）， descending duodenal atresia （group B， n = 3）， and descending duodenal septum （group C， n = 25）. One?way ANOVA was employed to compare statistical differences among the three ultrasonic parameters across the groups， followed by LSD?t test for pairwise comparisons between two groups showing significant differences. Receiver operating characteristics analysis was conducted to calculate the area under the curve and determine the cut?off value if there were statistically significant differences observed. Results In group A， group B， group C， the diameters of DDD were measured as（23.2 ± 2.4）mm， （25 ± 1.0）mm， （19.4 ± 2.6）mm， respectively. When comparing these three groups， there was a statistically significant difference between group A or group B and group C in terms of DDD diameter measurements （t = 5.7， P < 0.05； t = 3.793， P < 0.05）. However， no statistically significant difference was observed between group A and group B for DDD diameter measurements （t = 1.232， P > 0.05）. The corresponding values for DDT were measured as （3.0 ± 0.6）mm， （3.2 ± 0.4） mm，and（2.4 ± 0.3） mm，respectively. When comparing these three groups，the results showed a statistically significant difference between either Group A or Group B compared to Group C in terms of DDT measurement （t = 4.695， P < 0.05； t = 2.778， P < 0.05）. However，no statistically significant difference was found between Group A and Group B regarding the measurement of DDT （t = 0.666， P > 0.05）. The SDD measurements in the three groups were （1.9 ± 0.3） mm， （3.6 ± 0.8）mm， （5.5 ± 0.7）mm， respectively. Statistical analysis using LSD?t test revealed significant differences between the three groups （t = 5.521， P < 0.05； t = 6.142， P < 0.05； t = 25.828， P < 0.05）.The sensitivity， specificity， positive predictive value， and negative predictive value for detecting annular pancreas at a cutoff of 2.3 mm were determined to be 96.4%， 100%， 100%， and 96.6%， respectively， with an area under the receiver operating characteristic curve of 0.999. Conclusion SDD could be employed for the diagnosis of neonatal annular pancreas.

Objective To investigate the clinical utility of iFlow color flow coding imaging technology in the diagnosis of lower extremity arteriosclerosis obliterans （LEASO）. Methods A total of 106 patients diagnosed with LEASO between March 2022 and October 2023 were included as the LEASO group， while 80 volunteers without arterial disease but matched with LEASO were selected as the control group. Both groups underwent digital subtraction angiography （DSA）， and iFlow color flow coding imaging technology was employed to assess time to peak （TTP） in the femoral head and ankle regions. The difference value of TTP between these two regions was calculated， along with measurement of ankle-brachial index （ABI）. Results There were no significant differences in age， sex， body mass index， smoking history， hypertension history， diabetes history， coronary heart disease history and TTP in the femoral head between the two groups （P > 0.05）. However， the TTP in the ankle area and the difference values of TTP in the LEASO group were significantly higher than those in the control group （P < 0.05）. The comparison of TTP in the femoral head region among patients with different Rutherford classifications and between patients with left and right lesions in the LEASO group showed no statistical significance （P > 0.05）. Furthermore， a negative correlation was observed between Rutherford classification and both TTP values in ankle joint region as well as TTP difference value （P < 0.05）， indicating that higher Rutherford classification is associated with lower TTP values. Pearson test results revealed a significant negative correlation between TTP values and ankle joint region/TTP difference value of LEASO patients with ABI （ P < 0.05）. Receiver operating characteristic curve analysis demonstrated that both TTP values in ankle joint region and TTP difference value are effective diagnostic indicators for LEASO； moreover， Delong test indicated that area under ROC curve for TTP difference value was significantly higher than that for TTP value alone （P < 0.05） Conclusion iFlow color flow coding imaging technology enables quantitative assessment of both TPP values within ankle joint region as well as their differences which can be utilized for diagnosis of LEASO.

Objective To investigate the diagnostic value of skeletal muscle and diaphragm muscle in the extremities， as assessed by bedside ultrasound， for ICU?acquired weakness in elderly patients. Methods A total of 47 elderly patients with severe illness， admitted to the intensive care unit （ICU） of the Second People's Hospital of Yuhang District from March 2023 to April 2024， were included in this study. The average age of the patients was 74.51 years. Medical Research Council （MRC） scores were assessed twice within a 24?hour interval. Among them， when MRC score < 48， 20 cases were classified into the ICU?AW group， while the remaining 27 cases formed the non?ICU?AW group with MRC score ≥ 48. Ultrasound measurements for lower extremity skeletal muscle thickness and diaphragm parameters were conducted on the first day， third day， and seventh day after ICU admission. The rate of shrinkage in upper and lower extremity skeletal muscle thickness at different time points was calculated. Differences in ultrasound parameters between the two groups were compared， and ROC curve analysis was performed to evaluate the diagnostic value of upper and lower extremity skeletal muscle as well as diaphragm parameters for ICU?AW. Results Significant differences were observed in gender， age， BMI， APACHEⅡ score， SOFA score， number of mechanical ventilation cases， and number of sepsis cases between the two groups （P < 0.05）. Compared to the non?ICU?AW group， the ICU?AW group exhibited higher rates of atrophy in quadriceps femoris （RF） and total quadriceps femoris （QF） on day 3 and a lower degree of diaphragm displacement （DE） （P < 0.05）. On day 7， the ICU?AW group showed higher rates of atrophy in quadriceps femoris ［rectus femoris （RF）， intermedius femoris （VI）， and total quadriceps femoris （QF）］ along with lower diaphragm parameters ［diaphragm displacement degree （DE） and diaphragm thickness fraction（DTF）］ （P < 0.05）. According to ROC curve analysis， the critical value of ICU?AW predicted by ΔRF?MLT atrophy rate on day 7 was 9.9%， AUC was 0.743， sensitivity was 75.0% and specificity was 77.8%. On day 7， the critical value of ICU?AW was 5.69%， AUC was 0.828， sensitivity was 80.0%， and specificity was 77.8%. On day 7， the critical value of ICU?AW was 16.96%， AUC was 0.835， sensitivity was 60.0%， and specificity was 88.9%. On day 7， DE predicted that the critical value of ICU?AW was 1.67 cm， AUC was 0.818， sensitivity was 75.0%， and specificity was 85.2%. On day 7， DTF predicted that the critical value of ICU?AW was 33.96%， AUC was 0.889， sensitivity was 80.0%， and specificity was 85.2%. On day 7， the AUC of ICU?AW was 0.976， the sensitivity was 80.0%， and the specificity was 100%. Conclusion The quadriceps atrophy rate and diaphragm parameters measured by bedside ultrasound can identify and diagnose ICU?AW as early as possible.

Objectives To enhance occupational safety for medical practitioners involved in acupuncture procedures within the field of Chinese medicine， it is imperative to thoroughly investigate and analyze the current incidence of accidental punctures. Subsequently， effective strategies can be proposed to prevent such occurrences. Methods Through retrospective analysis， this study investigates the occupational exposure data of a tertiary hospital specializing in traditional Chinese medicine from 2020 to 2022. The demographic characteristics （age and gender）， professional experience， occupational category， pre-service training， type of acupuncture tools used， puncture session details， and exposure sources of the individuals involved are collected and organized for analyzing the risk factors associated with accidental needlestick injuries. Corresponding preventive measures are proposed accordingly. Results In this survey， a total of 5 069 medical staff from 12 clinical departments were included， among whom 63 experienced accidental puncture with an incidence rate of 1.24% （63/5 069）. The likelihood of puncture was found to be significantly higher in individuals aged between 25 ~ 30 years compared to those under the age of 25 （OR = 18.556， P < 0.05）. Similarly， the probability of puncture was also higher in individuals aged over 30 years compared to those under the age of 25 （OR = 14.311， P < 0.05）. Conversely， individuals with at least three years of experience had a lower probability of experiencing punctures compared to those with less than three years （OR = 0.025， P < 0.05）. Furthermore， interns exhibited a higher likelihood of puncture incidents compared to physicians （OR = 2.212， P < 0.05）. Regarding the puncture session， the highest probability of occurrence is 58.73% at the time of needle removal （χ² = 106.222， P < 0.05）. Regarding the type of acupuncture tools， acupuncture needles have the highest probability of occurrence at 41.27% （χ² = 45.095， P < 0.05）. Concerning the exposure source， "unknown exposure source" has the highest prevalence at 42.86% （χ² = 57.476， P < 0.05）， while "exposure source is hepatitis B patient" accounts for 20.63% （χ² = 57.476， P < 0.05）. Regarding pre-service training， individuals who have received pre-service training exhibit a higher likelihood of puncture incidents （69.84%） （χ² = 38.000， P < 0.05）. Conclusions The serological status of patients should be obtained in advance， and strict adherence to infection prevention control measures such as "standard precautions" and "contact isolation" is necessary. Effective pre-service training must be implemented， with particular attention given to the risk of puncture when using specialized acupuncture tools for occupational safety.

Chimeric antigen receptor T-cell immunotherapy （CAR-T） represents a novel approach in cancer treatment that harnesses the anti-tumor immune response. In comparison to traditional immunotherapy， CAR-T exhibits enhanced tumor antigen specificity and cell cytotoxicity independent of major histocompatibility complex molecules. Recent advancements in CAR-T cell research have demonstrated remarkable clinical responses in patients with advanced leukemia and lymphoma by targeting CD19. Given the rising incidence of colorectal cancer， the success observed in hematological malignancies has prompted further investigation into the application of CAR-T therapy for solid tumors， including colorectal cancer. Regrettably， several clinical studies have failed to meet expectations. This article provides an overview of CAR-T cells' definition and structure， highlights existing challenges in solid tumor treatment， and specifically discusses the application and future prospects of CAR-T cell therapy for colorectal cancer.

Long non-coding RNAs （lncRNAs）， a group of non-coding RNAs with lengths exceeding 200 nucleotides， play a crucial role in the human transcriptome， particularly in various types of cancers， where they are pivotal in regulating the tumor immune microenvironment and tumor cell immune evasion.However， there is currently a lack of systematic literature review. Myeloid-derived suppressor cells （MDSCs）， a subset of myeloid cells with immunosuppressive functions， play a significant role in cancer by directly and indirectly suppressing T cell activity， promoting the expansion of regulatory T cells， modulating the tumor microenvironment， and facilitating tumor metastasis. This review emphasizes the importance of in-depth investigation into the regulatory mechanisms of MDSCs for the discovery of effective tumor therapeutic targets and the development of novel treatment strategies. With further understanding and research into the relationship between lncRNAs and MDSCs， it is anticipated that more targets and new therapeutic approaches will be identified for cancer treatment， thereby improving clinical outcomes for patients.

In recent decades， the advent of coronaviruses has engendered multiple large-scale infectious outbreaks， leading to profound human casualties and posing a significant menace to global public health. At the crux of the coronavirus lifecycle， the assembly and release phases emerge as pivotal processes， necessitating meticulous investigation into the underlying mechanisms. This paper systematically expounds upon the intricate assembly and packaging mechanisms intrinsic to coronaviruses， scrutinizes the diverse release pathways employed by these viruses， and delves into the discourse surrounding targeted antiviral drugs. The comprehensive insights encapsulated in this exposition serve as valuable reference points for formulating effective strategies in the prevention and treatment of coronavirus infections.

Heart rate recovery， a widely used indicator in clinical evaluation of the autonomic nervous system， refers to the difference between maximum heart rate during exercise and the heart rate after 1 or a few minutes of cessation. It possesses advantages of being noninvasive and repeatable. Currently， heart rate recovery is extensively applied in cardiovascular diseases for evaluating disease severity， prognosis， risk of cardiovascular events， and mortality. This article primarily discusses the application value and current research progress of heart rate recovery in cardiovascular diseases.