Multiple myeloma （MM） is a prevalent hematological malignancy. Despite the availability of various therapeutic agents， disease relapse remains inevitable. In recent years， B cell maturation antigen （BCMA）?targeted chimeric antigen receptor T （CAR?T） cell therapy has demonstrated remarkable success in treating relapsed/refractory （R/R） MM， offering new hope for RRMM patients. Currently， four types of BCMA?CAR?T products are available on the global market， and their application in RRMM is becoming increasingly widespread. However， RRMM patients who receive BCMA?CAR?T treatment still exhibit a high relapse rate. Research on maintenance therapy following BCMA?CAR?T treatment is currently limited， and multiple strategies exist for managing post?relapse RRMM after BCMA?CAR?T therapy.

Objective The study aimedto investigate the effects and metabolic mechanisms of Gegen Qinlian Decoction （GQD） containing serum on hypoxia?induced glucose metabolism in L02 cells. Methods The effects of five hypoxia durations （6， 12， 18， 24， and 48 hours） on glucose consumption and cell viability of L02 cells were examined under hypoxic conditions to determine the optimal hypoxia time. Normal hepatocytes served as the normal control group. L02 cells with hypoxia?induced reduction in glucose consumption were divided into several groups： hypoxia group， metformin 2 mmol/L group， and 25 g/kg GQD groups treated with 5%， 10%， and 15% GQD containing serum. Glucose consumption was used as an indicator of drug efficacy. High?resolution liquid chromatography tandem quadrupole time?of?flight mass spectrometry （UPLC?Q?TOF?MS） was employed to collect metabolite signals from each group. Data were analyzed by using Progenesis QI software， and potential biomarkers were identified through online databases such as HMDB. Finally， metabolic pathways of potential biomarkers were analyzed via the Metabo Analyst 5.0 website. Results An 18 hour hypoxia period was identified as the optimal duration for the replication of the hypoxia?induced L02 cell model. GQD containing serums at 5% and 10% significantly increased glucose consumption in hypoxia?induced L02 cells after 18 hours. 14 biomarkers of hypoxia?induced L02 cells were identified， with the levels of 13 biomarkers significantly increased and 1 biomarker significantly decreased. GQD containing serum notably regulated the levels of 3 biomarkers. Conclusion GQD containing serum might improve hypoxia?induced abnormal glucose metabolism in L02 cells and enhance glucose consumption by modulating glycerophospholipid metabolism， glycosylphosphatidylinositol biosynthesis， and sphingolipid metabolism.

Objective To investigate the effect of Modified Renshen Wumei Decoction on the TLR4/MyD88/pNF?κBp65 signaling pathway and elucidate the potential mechanism by which this formula repairs the intestinal mucosal barrier in diarrheal rats. Methods Twelve rats were randomly selected from a total of 48 rats to serve as the blank control group （CK）， while the remaining 36 rats were used to establish a disease model via a compound method. After 14 days of model preparation， the rats were randomly divided into three groups： the model group （MC）， the western medicine group （MV）， and the traditional Chinese medicine group （MRWD）. Each of the four groups （including CK） received corresponding interventions for 7 days. The concentrations of serum diamine oxidase （DAO）， D?lactic acid （D?Lac）， interleukin?1β （IL?1β）， IL?6， IL?10， tumor necrosis factor?α （TNF?α）， mucin 2 （MUC2）， MUC4， MUC6， and colonic homogenate secretory immunoglobulin A （SIgA） were measured using ELISA. Additionally， the protein and gene expressions of colonic toll?like receptor 4 （TLR4）， myeloid differentiation primary response 88 （MyD88）， phosphorylated nuclear factor kappa?light?chain?enhancer of activated B cells p65 （pNF?κBp65）， occludin， claudin?1， and zonula occludens?1 （ZO?1） were analyzed by Western blot and RT?PCR. Results （1） Intestinal mucosal injury markers： Compared with the blank group， the serum levels of DAO and D?Lac in the model group were significantly increased （P < 0.05）. Compared with the model group， both the Chinese medicine group and Western medicine group significantly decreased the serum levels of DAO （P < 0.001）， while the traditional Chinese medicine group also significantly reduced the serum levels of D?Lac （P < 0.05）. There was no significant difference in the changes of DAO and D?Lac serum levels between the Chinese medicine group and Western medicine group （P > 0.05）. （2） Inflammatory indicators： Compared with the blank group， the model group exhibited significant upregulation of TLR4， MyD88， pNF?κBp65 protein and gene expression， as well as serum levels of IL?1β， IL?6， and TNF?α （P < 0.05）， along with a significant decrease in IL?10 serum levels （P < 0.05）. Compared with the model group， both the Chinese medicine group and Western medicine group significantly downregulated TLR4， MyD88， pNF?κBp65 protein and gene expression， as well as serum levels of IL?1β， IL?6， and TNF?α （P < 0.05）， and significantly upregulated IL?10 serum levels （P < 0.05）. There was no significant difference in serum levels of TLR4， MyD88， pNF?κBp65 protein， gene expression， and IL?1β， IL?6， IL?10， and TNF?α between the Chinese medicine group and Western medicine group （P > 0.05）. （3） Intestinal mucosal barrier factors： Compared with the blank group， the model group exhibited significant downregulation in MUC2， MUC6， SIgA content， as well as Claudin?1， ZO?1 protein and gene expression， and Occludin protein expression （P < 0.05）. Compared with the model group， both Chinese and Western medicine groups significantly upregulated the content of MUC2 and SIgA， as well as the protein and gene expression of Claudin?1 and ZO?1 （P < 0.05）. The traditional Chinese medicine group also significantly increased the content of MUC6 and Occludin protein expression （P < 0.05）. No significant differences were observed between the Chinese and Western medicine groups in terms of MUC2， MUC6， SIgA serum content， and Claudin?1 and ZO?1 gene expression （P > 0.05）. However， the Western medicine group showed better Claudin?1 protein expression than the Chinese medicine group （P < 0.05）， while the ZO?1 protein expression was higher in the traditional Chinese medicine group compared to the Western medicine group （P < 0.05）. Conclusion Modified Renshen Wumei Decoction exerts an intestinal mucosal barrier repair effect in diarrhea rats by modulating the TLR4/MyD88/pNF?κBp65 signaling pathway.

Objective To investigate the efficacy of ferro?based magnetic starch?loaded gel beads， composed of MgFe₂O₄ and cassava starch， in the treatment of colorectal cancer. Methods Sixteen SPF?grade 6?week?old male Balb/c mice were randomly assigned to four groups （n = 4 per group）： control， CMCS SA@MgFe₂O₄， doxorubicin， and CMCS SA@MgFe₂O₄@Dox. Mice in each group received normal saline， CMCS SA@MgFe₂O₄， doxorubicin， or CMCS SA@MgFe₂O₄@Dox on days 4， 6， 8， 10， 12， and 14 post?implantation of colorectal tumor cells （HCT116）. Tumor volume changes were monitored following treatment. TUNEL staining was performed to assess tumor tissue apoptosis. Immunohistochemistry was used to evaluate the expression levels of Ki67 and Caspase?3 in tumor tissues. Western blot was employed to determine the protein expression levels of Caspase?3， Bcl?2， and Bax. Results Mice in the Control and CMCS SA@MgFe₂O₄ groups exhibited the largest tumour volumes， with intact major organ structures， tightly arranged cells， normal nuclear morphology， and no significant inflammatory cell aggregation. In contrast， mice in the Dox group displayed shrunken tumour tissues， disorganized cardiac muscle fibres， enlarged interstitial spaces in splenic tissues， and inflammatory cell infiltration in liver， lung， and kidney tissues. Mice in the CMCS SA@MgFe₂O₄@Dox group showed minimal tumour tissue， well?aligned cardiac muscle fibres， and reduced inflammatory responses in the remaining organs. Compared to the Control group， mice in both the Dox and CMCS SA@MgFe₂O₄@Dox groups demonstrated significantly decreased tumour volume and final weight （P < 0.05）， increased interstitial inflammatory cell aggregation， decreased collagen fibres， and enhanced apoptosis. Additionally， there was a significant decrease in Ki67 expression （P < 0.05） and an increase in Caspase?3 expression （P < 0.05）. The expression of Bcl?2 protein was also significantly reduced （P < 0.05）， while the expression of Caspase?3 and Bax proteins was significantly increased （P < 0.05）. Compared to the Dox group， mice in the CMCS SA@MgFe₂O₄@Dox group exhibited significantly smaller tumour volume and final weight （P < 0.01）， more pronounced tissue necrosis， further reduction in collagen fibres， and a greater increase in apoptosis. There was also a more significant decrease in Ki67 expression （P < 0.05） and a more substantial increase in Caspase?3 expression （P < 0.05）. Furthermore， the expression of Bcl?2 protein was further decreased， while the expression of Caspase?3 and Bax proteins was further increased （P < 0.05）. Conclusion The iron?based magnetic starch drug delivery system has no therapeutic effect on tumor cells， but the combination with adriamycin can significantly increase the therapeutic effect of adriamycin and reduce its side effects.

Objective To investigate the predictive value of pulmonary artery （Pa） to aortic （Ao） diameter ratio （Pa/Ao） for long?term major adverse cardiovascular events （MACEs） in patients with acute decompensated heart failure （ADHF）. Methods ADHF patients hospitalized in the Department of Cardiology of Nanjing Drum Tower Hospital from January 2018 to January 2023 were consecutively enrolled. The data of gender， age， past medical history， laboratory examination， echocardiography， chest CT and medication were collected. The diameters of Pa and Ao were measured at the bifurcation of main pulmonary artery on chest CT， and Pa/Ao was calculated. The Kaplan?Meier method was used for survival analysis， and the Log?rank test was used to compare the survival rate between the two groups. Cox proportional hazards regression model was used to analyze the association between Pa/Ao and MACEs， and subgroup analysis was performed according to different age， sex， BMI， B?type natriuretic peptide level， and left ventricular ejection fraction. Results A total of 600 ADHF patients were enrolled， with an average age of 69.6 years and 347（57.8%） males. During a median follow?up of 306（127，624） days， 327（54.5%） patients experienced MACEs. The ADHF patients were divided into Pa/Ao < 0.93 group and Pa/Ao≥0.93 group according to the analysis of maximum selection rank statistics. Kaplan?Meier curve showed that the incidence of MACEs in Pa/Ao ≥ 0.93 group was significantly higher than that in Pa/Ao < 0.93 group （PLog?rank < 0.001）. Multivariate Cox regression analysis showed that Pa/Ao was an independent predictor of MACEs in ADHF patients （HR = 11.62， 95%CI： 4.91 ~ 27.50， P < 0.001）. Subgroup analysis showed that Pa/Ao had predictive value for different ADHF populations （all P < 0.05）. Conclusion Elevated Pa/Ao is a predictor of long?term MACEs in ADHF patients.

Objective To address the challenges of accurately capturing critical features in small?sample diabetic retinopathy （DR） recognition models in real?world applications， and the overly smooth distribution of true and false feature coefficients， we propose an enhanced small?sample DR recognition method based on an improved capsule network. Methods Firstly， the method enhances image feature representation by removing redundant boundary information and employing discrete wavelet transform based on the Haar wavelet function， thereby highlighting critical pathological features. Secondly， the convolutional layer of the capsule network is optimized through a multi?branch architecture to extract multi?scale features from retinal images， while incorporating a convolutional block attention module that is subsequently fed into the capsule layer. Finally， the sigmoid function replaces the softmax function in dynamic routing， thereby improving the model's robustness. Result The enhanced neural network model achieved an accuracy of 98.62% on the Kaggle public dataset following a rigorous selection and preprocessing procedure. Conclusion The enhanced capsule network demonstrated superior precision in identifying diabetic retinopathy within small sample sizes compared to other state?of?the?art algorithms currently available.

Objective This study aims to compare the clinical efficacy and complications associated with microwave ablation （MWA） and sublobectomyfor treating stage ⅠA non?small cell lung cancer （NSCLC）. Methods Data from stage ⅠA1?ⅠA3 NSCLC patients treated at Yunnan Cancer Hospital between January 2021 and December 2022 were retrospectively collected. A total of 82 patients who underwent MWA and 82 patients who received sublobectomy were selected through propensity score matching. Periprocedural conditions， short?term efficacy， and complications were compared between the two groups. Progression?free survival （PFS） and Disease?free survival （DFS） were monitored and evaluated. The Kaplan?Meier method was employed to construct survival curves， and logistic regression was utilized to analyze the factors influencing complications. Results The MWA group exhibited shorter procedure times， less intraprocedural blood loss， less postprocedure pain， shorter hospitalization durations， and lower hospitalization costs compared to the sublobectomy group （P < 0.001）. All patients successfully underwent the procedures， with a complete ablation rate of 97.6% and a local control rate of 87.8%in the MWA group. The median follow?up duration was 26.5 months. Survival curve analysis indicated no statistically significant differences in PFS and DFS between the two groups. The primary complications observed were pneumothorax （24.4%， 20/82） and moderate to severe pain （11.0%， 9/82） in the MWA group， while the sublobectomy group experienced moderate to severe pain （41.5%， 34/82） and pulmonary infection （12.2%， 10/82）. Single?factor analysis demonstrated six variables influenced the occurrence of MWA pneumothorax. Multi?factor logistic regression revealed that the shortest distance from the tumor to the pleura （P = 0.021，OR = 15.341，95%CI： 1.699 ~ 24.367） and the number of punctures through the pleura （P = 0.024，OR = 0.068， 95%CI： 0.001 ~ 0.612） were identified as independent risk factors for pneumothorax. Conclusion MWA demonstrates good efficacy for treating stage ⅠA NSCLC due to minimal trauma， low cost， rapid recovery， few and mild complications. Additionally， MWA and sublobectomy exhibit comparable PFS and DFS， making MWA a safe and effective treatment method. Therefore， MWA is worthy of promotion in clinical practice.

Objective To investigate the effects of varying pulse intervals in the programmed intermittent epidural bolus （PIEB） mode on labor analgesia in primiparous and multiparous women， and to evaluate the differences in analgesic outcomes between these two groups. Methods A total of 60 primiparous and 60 multiparous women who met the inclusion criteria were recruited and randomly allocated into two groups： a 45?minute pulse interval group （P45 group， n = 30） and a 60?minute pulse interval group （P60 group， n = 30）. Epidural labor analgesia was initiated when cervical dilation reached 1 ~ 3 cm. The programmed intermittent epidural bolus （PIEB） mode was started 45 minutes after analgesia commencement in the P45 group and 60 minutes after analgesia commencement in the P60 group. Each pulse delivered 10 ml of a solution containing 0.08% ropivacaine and 0.5 μg/ml sufentanil. Pain scores were assessed using the Visual Analog Scale （VAS） at five specific time points： baseline （t0）， 1 hour post?analgesia initiation （t1）， 2 hours post?analgesia initiation （t2）， full cervical dilation （t3）， and delivery （t4）. Secondary outcomes included Bromage scores， the number of patient?controlled analgesia （PCA） button presses， total drug consumption， and adverse reactions. Results In primiparous women， the VAS score at t1 was significantly lower in the P45 group compared to the P60 group （P < 0.05）， whereas no significant differences were observed in VAS scores between the two groups at t2—t4. The median PCA press count was also significantly lower in the P45 group than in the P60 group （P < 0.05）. However， there were no significant differences between the groups in terms of total drug consumption， Bromage scores， or the incidence of adverse events （P > 0.05）. In multiparous women， no significant differences were found in VAS scores， Bromage scores， or PCA press counts between the P45 and P60 groups at any time point （P > 0.05）. Conversely， total drug consumption was significantly higher in the P45 group compared to the P60 group （P < 0.05）. Conclusions For primiparous women， a 45?minute pulse interval in the PIEB mode not only provides superior labor analgesia but also significantly reduces the frequency of PCA presses without escalating the risk or severity of motor block or adverse events. For multiparous women， the pulse interval does not substantially influence the effectiveness of labor analgesia. These findings contribute valuable new evidence for refining clinical labor analgesia protocols.

Objective This study aimed to evaluate the clinical effect of hyaluronic acid（HA） scaffold combined with adipose?derived stem cells（ADSCs） in chronic wound healing of lower limbs and explore its application potential in promoting chronic wound healing. Methods A total of 50 patients were included in this study. They were divided into study and control groups according to the random number table method. There were 25 cases in each of the two groups of patients. HA and ADSCs were mixed in a 1∶1 ratio and evenly injected into the wound base and the subcutaneous tissue around the wound at a rate of 0.1 ml/cm3. In the control group， ADSCs were only injected into the wound base and subcutaneous tissue around the wound. The infection rate， treatment satisfaction， wound healing rate， visual analogue score （VAS）， and wound quantitative score were compared between the two groups at 7 days， 14 days， and 28 days. Results The infection rate in the study group was lower than that in the control group， and the difference was statistically significant （P < 0.05）. Moreover， at 14 days and 28 days after treatment， the wound healing rate in the study group was higher than that in the control group， and the difference was statistically significant （P < 0.05）. On the 7th， 14th， and 28th days after treatment， the VAS scores and the wound quantitative scores were lower than those in the control group， and the difference was statistically significant （P < 0.05）. Furthermore， the treatment satisfaction rate in the research group （92%） was higher than that in the control group （80%）. Conclusion HA scaffold combined with ADSCs could promote the healing of chronic wounds in lower limbs， reduce infection rate， and relieve wound pain， which provides a new idea for the treatment of chronic wounds.

Objective To investigate the effects of Demodex infection on clinical symptoms， signs， and tear MMP?9 levels in patients with meibomian gland dysfunction （MGD）. Methods A total of 680 patients with MGD were selected from our hospital， including 162 males and 518 females， with an average age of （45.05 ± 15.41） years old. The patients were divided into two groups based on the presence of Demodex mite infestation： the Demodex positive group （340 cases） and the Demodex negative group （340 cases）. All patients underwent evaluations using the OSDI questionnaire， SPEED questionnaire， eyelid margin alteration score， corneal fluorescein staining score， tear MMP?9 measurement， meibomian gland orifice score， meibomian gland excretion ability score， meibomian gland secretion score， meibomian gland loss score， tear film breakup time （BUT）， and Schirmer I tear secretion test. The differences in these indicators between the two groups were compared. Results SPEED questionnaire score： Demodex positive group： （7.68 ± 2.80）， Demodex negative group： （6.28 ± 1.99）. There was a statistically significant difference between the two groups （t = 2.582， P = 0.012）. Eyelid margin alteration score： Demodex positive group： （3.63 ± 1.53）， Demodex negative group： （2.85 ± 0.77）. A statistically significant difference was observed （t = 2.861， P = 0.006）. Corneal fluorescein staining score： Demodex positive group： （2.25 ± 1.86）， Demodex negative group： （1.08 ± 1.33）. There was a statistically significant difference （t = 3.247， P = 0.002）. Tear MMP?9 content： Demodex positive group： （30.76 ± 43.14） ng/mL， Demodex negative group： （12.36 ± 12.10） ng/mL. A statistically significant difference was found （t = 2.598， P = 0.013）. No statistically significant differences were observed between the Demodex positive and negative groups in meibomian gland orifice score， meibomian gland excretion ability score， meibomian gland secretion score， meibomian gland loss score， BUT， tear secretion examination， and age comparison （P > 0.05）. Conclusions Demodex mite infestation in patients with MGD exhibits significant differences across various clinical indicators， notably in SPEED questionnaire scores， eyelid margin alterations， corneal fluorescein staining， and tear MMP?9 levels. These changes are associated with mechanisms including inflammatory responses， cellular damage， and immune dysregulation. Demodex mite infestation may significantly influence the clinical progression of MGD by exacerbating inflammation and symptom severity， potentially playing a crucial role in disease development.

Objective To investigate the predictive value of preoperative plasma total cholesterol levels for postoperative delirium （POD） following esophagectomy and to analyze its associated risk factors. Methods The complete perioperative electronic medical records of 187 patients with POD who underwent esophagectomy at the 960 Hospital of the People's Liberation Army between January 2019 and December 2023 were retrospectively analyzed. According to the occurrence of POD within one week postoperatively， the patients were categorized into a delirium group and a non?delirium group. The preoperative plasma total cholesterol levels were used to construct a receiver operating characteristic （ROC） curve for predicting delirium after esophagectomy. The area under the curve （AUC） and its 95% confidence interval （CI） were calculated. Additionally， the plasma total cholesterol level corresponding to the maximum Youden index （sensitivity + specificity?1） was determined as the optimal critical value. Results POD occurred in 24 of 187 patients who underwent esophageal cancer resection， with an incidence rate of 12.83%. Compared to the non?delirium group， the delirium group exhibited older age， lower intraoperative blood pressure， lower plasma total cholesterol and low?density lipoprotein levels， longer anesthesia duration， and a higher prevalence of coronary heart disease， which was identified as a risk factor for POD. Dexmedetomidine administration was associated with a reduced occurrence of POD. The AUC， 95%CI， cut?off value， sensitivity， and specificity of preoperative plasma total cholesterol level for predicting POD were 0.761， 0.657 ~ 0.865， ≤ 4.11 mmol/L， 70.8%， and 77.3%， respectively. Conclusions Among non?hyperlipidemic patients， low preoperative plasma total cholesterol levels and intraoperative hypotension are identified as independent risk factors for POD following esophageal cancer resection. Preoperative plasma total cholesterol levels exhibit moderate predictive value for the occurrence of POD.

Objective This study aimed to investigate the relationship between malnutrition and coronary inflammation， and explore the interaction and mediating effects of coronary inflammation in the association between malnutrition and major adverse cardiovascular events （MACE）. Methods A retrospective analysis was conducted on 428 patients diagnosed with coronary heart disease at the Central China Fuwai Hospital from May 2018 to July 2022. All patients underwent coronary angiography （CAG） and coronary computed tomography angiography （CCTA）. The TCB index （triglycerides × total cholesterol × body weight） and the coronary fat attenuation index around the proximal right coronary artery （RCA?FAI） were used to assess patients' nutritional state and the degree of coronary inflammation， respectively.The study endpoint was MACE. We used linear regression models to analyze the correlation between TCBI and RCA?FAI， cox regression models to assess the correlation of TCBI and RCA?FAI with MACE， and mediation analysis to investigate whether RCA?FAI mediated the relationship between TCBI and MACE. Results A total of 428 patients were included in the study. There was a negative correlation between RCA?FAI and TCBI （r = -0.224， P < 0.001）. After adjusting for potential confounders， each standard deviation decrease in the TCBI index was associated with a 2.20 HU increase in RCA?FAI （95% CI： -3.40 ~ -1.19， P < 0.001）. During a mean follow?up period of 2.15 years， 51 MACE occurred. MACE risk in the low TCBI/high RCA?FAI group was 6.58 times higher than that in the high TCBI/low RCA?FAI group （adjusted HR = 6.580， 95%CI： 2.237 ~ 19.360， P = 0.001）， and the interaction between TCBI and RCA?FAI was identified.Mediation analysis revealed that RCA?FAI mediated 37.5% of the associations between TCBI and MACE. Conclusions In patients with coronary artery disease， malnutrition is associated with increased coronary inflammation. There is a significant interaction between malnutrition and coronary inflammation in the risk of MACE， and coronary inflammation partially mediates the relationship between malnutrition and MACE. The combination of the TCBI index and RCA?FAI can help identify patients at high cardiovascular risk. Improving malnutrition and controlling coronary inflammation may provide additional benefits for patients with coronary artery disease.

Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression （ETMOWD） in conjunction with fat removal orbital decompression （FROD） on restrictive strabismus in patients with thyroid?associated ophthalmopathy （TAO）. Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024. Patients were divided into two groups： the orbital decompression group （OD group） and the non?orbital decompression group （NOD group）， based on whether they underwent orbital decompression surgery. The study compared perioperative data， types of strabismus， degree of ocular motility limitation， extent of posterior migration of ocular muscles， and postoperative outcomes between the two groups. Additionally， the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group. Results A total of 65 participants were included in the analysis， with 40 in the OD group group and 25 in the NOD group. There was no statistically significant difference in baseline characteristics between the two groups. Preoperative strabismus types， including horizontal and vertical strabismus， did not differ significantly between the OD and NOD groups （P > 0.05）. However， the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group. Additionally， the number of surgeries， mean total operated muscles， and number of horizontal muscles were all significantly higher in the OD group than in the NOD group （all P < 0.05）， with a notably different effect on horizontal muscle migration between the two groups. The degree of restriction of eye movement and diplopia improved significantly in all patients， with cure rates of 70% in the OD group and 72% in the NOD group. Furthermore， the OD group underwent ETMOWD combined with FROD orbital decompression surgery， which resulted in a decrease in intraocular pressure （IOP） from （19.43 ± 3.9） mmHg preoperatively to （15.05 ± 2.2 mmHg postoperatively （P < 0.001）. Both horizontal and vertical strabismus increased after surgery. Conclusions Our results demonstrated that， compared with the NOD group， the OD group exhibited increased complexity in strabismus surgery， as evidenced by a higher number of operations， total muscle strips， horizontal muscle strips， and greater migratory effect size of the horizontal muscles. The combination of ETMOWD and FROD effectively reduced exophthalmos， with a more pronounced effect on the medial rectus muscle compared to the vertical muscles. However， the long?term outcomes between the two groups were similar.

Objective The study aimed to compare the efficacy and safety of tislelizumab combined with chemotherapy versus pembrolizumab combined with chemotherapy as first-line treatments for advanced lung squamous cell carcinoma. Methods We retrospectively reviewed and analyzed the medical records of 116 patients with advanced lung squamous cell carcinoma treated with first-line chemotherapy plus tislelizumab or pembrolizumab in Guangzhou Chest Hospital from September 2020 to April 2024. We focused on analysis of time to treatment failure （TTF） and objective response rate （ORR） as well as disease control rate（DCR） and treatment-related adverse events（TRAEs）. Results At a median follow up of 19.7 monyhs， the median TTF was 9.7 months in the tislelizumab group and 7.7 months in the pembrolizumab group （P < 0.05）. In addition，the ORR in the tislelizumab group was significantly higher than that in the pembrolizumab group （77.6% vs. 60.3%， P < 0.05）， with DCRs of 93.1% and 87.9%， respectively（P = 0.342）. Regarding safety， the proportions of grade 3 or higher TRAEs and any-grade TRAEs were comparable between the two groups： 29.3% and 81.0% in the tislelizumab group， and 32.8% and 87.9% in the pembrolizumab group， respectively. The most common TRAEs in both groups were hematological toxicities. Conclusions Tislelizumab plus chemotherapy demonstrated better efficacy and safety compared to pembrolizumab with chemotherapy as first-line treatment for Chinese patients with advanced lung squamous cell carcinoma.

Objective To investigate the effect of dexmedetomidine combined with ropivacaine on postoperative sleep quality in patients undergoing upper abdominal surgery following Oblique Subcostal Transversus Abdominis Plane Block （OSTAPB）. Methods A total of 140 patients who underwent gastric surgery at the Affiliated Hospital of Xuzhou Medical University between September 2024 and November 2024 were enrolled. According to the random number table method， they were randomly allocated into two groups： the simple subcostal transversus abdominis plane block group （Group A） and the dexmedetomidine combined with subcostal transversus abdominis plane block group （Group B）， with 70 patients in each group. The study compared the Asymptomatic Sleep Disturbance Scale （AIS） scores and Self?rating Anxiety Scale （SAS） scores on the night before surgery， AIS scores on the night after surgery and the following day， the amount of remifentanil used during surgery， and the cumulative number of patient?controlled analgesia （PCA） button presses within 3 days postoperatively. Additionally， the Numeric Rating Scale （NRS） pain scores at 2 h， 6 h， 12 h， 24 h， and 48 h post?surgery， as well as the Quality of Recovery?15 （QoR?15） scores on the night of surgery and the second day post?surgery， were evaluated. Results There were no significant differences in anxiety levels or subjective sleep quality scores between the two groups prior to the operation （P > 0.05）. Additionally， there was no significant difference in the usage of remifentanil between Group A and Group B （P > 0.05）. The NRS scores for pain differed significantly between the two groups within the first 48 hours post?operation （P < 0.05）； however， no significant difference was observed in NRS scores between the two groups after 24 hours during rest. Furthermore， the number of patient?controlled analgesia （PCA） activations in Group B was significantly lower than that in Group A at 12 hours post?operation （P < 0.05）. Lastly， both the QoR?15 and sleep quality were significantly higher in Group B compared to Group A （P < 0.05）. Conclusion Dexmedetomidine combined with ropivacaine for subcostal transversus abdominis plane block not only provides superior postoperative analgesia compared to ropivacaine alone but also enhances patients' sleep quality and recovery quality on the night following surgery， thereby contributing to improved overall postoperative recovery.

Objective To assess the long?term prognosis of nonparoxysmal atrial fibrillation （NPAF） patients after radiofrequency catheter ablation （RFCA） and identify influencing factors. Methods A prospective， randomized controlled trial was conducted from October 2021 to June 2023 at our center. A total of 183 consecutive NPAF patients undergoing RFCA were randomly assigned to the ARNI group （n = 91） or control group （n = 92）. Data collected included baseline characteristics， procedure?related parameters， low voltage areas （LVAs）， left atrial mean pressure （LMP）， and clinical outcomes at 12 months. The primary endpoint included freedom from atrial fibrillation recurrence at 12 months post?ablation and secondary endpoints comprised complication rates， mean arterial pressure （MAP）， left atrial diameter （LAD）， and cardiac function. Results The two groups presented no significant differences in baseline characteristics （P > 0.05）. The ARNI group demonstrateda significantly higher rate of freedom from AF recurrence compared to the control group at 12 months （79.12% vs. 66.30%， HR = 0.56， P = 0.039）. Moreover， the ARNI group showed significantly smaller LAD［（40.17 ± 4.72） mm vs. （42.29 ± 6.08） mm， P = 0.013） and a significantly lower N?terminal proB?type natriuretic peptide（NT?proBNP） level ［98.00 （45.00， 456.00） vs. 128.50 （73.50， 586.50）， P = 0.039］. Both groups showed no significant differences in complication rates or MAP post?ablation （P > 0.05）. Cox regression analysis identified ARNI as an independent predictor for maintaining freedom from AF recurrence at 12 months post?ablation（HR = 0.524， P = 0.038）. Subgroup analyses showed that high LMP patients had a lower rate of freedom from AF recurrence than those with normal pressures （51.61% vs. 83.47％， P < 0.001）， and demonstrated significantly improved ARNIoutcomes （64.52% vs. 38.71%， P = 0.042）. Conclusion ARNI improves long?term outcomes for NPAF patients following RFCA， particularly in those with highLMP.

Objective To compare the radiotherapy treatment accuracy between 4D-CT and DIBH following liver SBRT， and to illustrate the relevant factors. Methods A retrospective analysis was conducted on the clinical data of 28 liver cancer patients who underwent SBRT from November 2020 to July 2024， all of whom exhibited and localizedmorphological changes on magnetic resonance imaging （MRI）. Among them， 8 patients used DIBH， and 17 patients used 4D- CT. The areas of localized MRI-morphologic alterations （MMA） were delineated on post-therapeutic MRI. Different isodose structures were generated on the planning CT， and after performing deformation registration based on the liver's region of interest （ROI）， the most suitable isodose structure and MMA contours were compared to obtain quantitative accuracy indices. Correlations between factors such as GTV， PTV， liver volume， and volume changes， and the accuracy indices were analyzed. Results The DSC accuracy for the DIBH group was （0.66 ± 0.17）， range 0.32 ~ 0.90， while the DSC accuracy for the 4D CT group was （0.69 ± 0.10）， range 0.49 ~ 0.80. T-test analysis showed no significant statistical differences in accuracy indices between the DIBH and 4D CT groups （P < 0.05）. Correlation analysis revealed that， in both groups， distance-based indices （HD， MDA， 3D-CoMD） were more strongly correlated with accuracy indices than conformality indices （DSC， CIMI）. Conclusion There was no significant difference in treatment accuracy between the DIBH and 4D-CT groups， although the maximum accuracy in the DIBH group was higher than that in the 4D-CT group. This method can serve as an bench-markingtool for evaluating the accuracy of liver SBRT.It is recommended to prioritize the use of conformality indices， DSC and CIMI， when assessing the treatment accuracy of liver cancer SBRT using this approach.

Objective To investigate and analyze the association between serum microRNA?141?3p （miR?141?3p） and miR?223?3p levels and neonatal necrotizing enterocolitis. Methods Eighty neonates with necrotizing enterocolitis admitted to our hospital between January 2019 and January 2022 were enrolled as subjects. According to the disease stage， they were divided into the stage Ⅱ group （n = 43） and the stage Ⅲ group （n = 37）. Additionally， 80 healthy newborns born during the same period were recruited as the control group. General clinical data were collected and analyzed systematically. The expression levels of miR?141?3p and miR?223?3p were detected using quantitative real?time PCR （qRT?PCR）. Spearman′s correlation analysis was performed to evaluate the relationship between miR?141?3p， miR?223?3p， and the severity of the disease. Multivariate logistic regression analysis was conducted to assess the impact of miR?141?3p and miR?223?3p on the severity of pediatric illness. Furthermore， a Receiver Operating Characteristic （ROC） curve was plotted to determine the diagnostic value of miR?141?3p and miR?223?3p in predicting the severity of the patient′s condition. Results Compared with the control group， the relative expression levels of miR?141?3p and miR?223?3p in the diseased group were significantly decreased （P < 0.05）. Similarly， compared with the stage Ⅱ group， the relative expression levels of miR?141?3p and miR?223?3p in the stage Ⅲ group were also markedly reduced （P < 0.05）. Furthermore， miR?141?3p and miR?223?3p exhibited a negative correlation with disease severity （r = -0.489， -0.496， P < 0.05）. Increased relative expression of miR?141?3p and miR?223?3p was identified as a protective factor influencing disease severity in children （P < 0.05）. The AUC values for diagnosing the severity of necrotizing enterocolitis using miR?141?3p， miR?223?3p， and their combination were 0.806， 0.783， and 0.885， respectively. Combined diagnosis demonstrated significantly better performance than miR?141?3p alone （Z = 2.050， P = 0.040） or miR?223?3p alone （Z = 2.184， P = 0.029）. Conclusion In neonates with necrotizing enterocolitis， the relative expression levels of serum miR?141?3p and miR?223?3p are significantly decreased， which are closely associated with disease progression and provide potential auxiliary diagnostic value for assessing disease severity.

Objective To investigate the correlation between the levels of activated protein C （APC）， thromboxane B2 （TXB2）， and soluble B7?H3 （sB7?H3） in the peripheral blood of elderly patients with pneumonia and the severity as well as prognosis of the disease. Methods One hundred elderly pneumonia patients admitted to our hospital from March 2022 to June 2024 were enrolled as the study group， and 100 healthy volunteers during the same period were selected as the control group. The levels of APC， TXB2， and sB7?H3 in peripheral blood were compared between the two groups. Study group patients were further categorized into low?risk， medium?risk， and high?risk subgroups based on the CURB?65 score （Confusion， Uremia， Respiratory rate， Blood pressure， Age ≥ 65 years）. The levels of APC， TXB2， and sB7?H3 in peripheral blood were compared among patients with varying disease severities. Pearson correlation analysis was performed to evaluate the correlation between the levels of APC， TXB2， and sB7?H3 in peripheral blood and disease severity. The study group was followed up for 30 days and subsequently divided into good prognosis and poor prognosis subgroups according to their clinical outcomes. Clinical data and peripheral blood levels of APC， TXB2， and sB7?H3 were compared between patients with different prognoses. Partial correlation analysis was conducted to assess the relationship between peripheral blood levels of APC， TXB2， and sB7?H3 and prognosis. Finally， the predictive value of these biomarkers was evaluated using the Receiver Operating Characteristic （ROC） curve. Results The level of APC in the peripheral blood of the study group was significantly lower than that of the control group， whereas the levels of TXB2 and sB7?H3 were significantly higher （P <0.05）. The severity of the disease in the study group was assessed using the CURB?65 score， which categorized patients into 33 mild cases， 39 moderate cases， and 28 severe cases. Severe patients exhibited a lower level of APC in peripheral blood compared to moderate and mild patients. Additionally， the levels of TXB2 and sB7?H3 in moderate patients were higher than those in mild patients， while severe patients demonstrated even higher levels of TXB2 and sB7?H3 compared to both moderate and mild patients （P < 0.05）. Pearson correlation analysis revealed that peripheral blood APC was negatively correlated with the CURB?65 score， whereas TXB2 and sB7?H3 were positively correlated with the CURB?65 score （P < 0.05）. During a 30?day follow?up period， the research team identified 79 patients with good prognoses and 21 patients with poor prognoses. Significant differences were observed in diabetes prevalence， disease severity， and APACHEⅡ scores between the poor prognosis subgroup and the good prognosis subgroup （P < 0.05）. The levels of APC in peripheral blood were significantly lower in the poor prognosis subgroup compared to the good prognosis subgroup， whereas the levels of TXB2 and sB7?H3 were significantly higher （P < 0.05）. Partial correlation analysis revealed that peripheral blood APC， TXB2， and sB7?H3 were significantly associated with prognosis （P < 0.05）. The AUC values for predicting the prognosis of elderly pneumonia patients using peripheral blood APC， TXB2， and sB7?H3 were 0.752， 0.738， and 0.761， respectively， with sensitivities of 66.67%， 76.19%， and 66.67%， and specificities of 78.48%， 67.09%， and 78.48%. When combining these three indicators for prognostic prediction， the AUC increased to 0.918， with a sensitivity of 85.71% and a specificity of 87.34%， demonstrating a significant improvement in predictive accuracy compared to each indicator used alone （Z = 2.207， 2.666， 2.109， P = 0.027， 0.008， 0.035）. Conclusion The levels of APC， TXB2， and sB7?H3 in the peripheral blood of elderly patients with pneumonia are significantly associated with the severity and prognosis of the disease. Combined detection of these biomarkers can serve as a reliable predictor of clinical outcomes.

Objective To investigate the value of the absolute number of lymphocyte subpopulations as an early warning indicator for children with SMPP（severe mycoplasma pneumonia， SMPP） and to analyze the characteristics observed via bronchoscopy， thereby providing a valuable reference for the early diagnosis of SMPP. Methods This study included 102 children with Mycoplasma pneumoniae pneumonia （MPP）， comprising 54 cases of common MPP and 48 cases of SMPP. The lymphocyte subpopulations， clinical characteristics， and laboratory indicators were analyzed. Results There were statistically significant differences between the two groups in the absolute number levels of lymphocyte subpopulations CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， CD3^-/CD16⁺CD56⁺NK cells （P < 0.05）. The absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells showed negative correlations with serum ferritin， LDH， CRP， and D?D， respectively （P < 0.05）. Multifactorial logistic regression analysis identified the absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells as independent risk factors for severe Mycoplasma pneumoniae pneumonia （SMPP）. ROC analysis demonstrated that the areas under the curve for diagnosing SMPP based on the absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells were 0.711， 0.887， 0.856， and 0.860， respectively， with sensitivities of 47.4%， 80.8%， 82.1%， and 92.3%， and specificities of 89.7%， 87.2%， 75%， and 70.5%， respectively. The combined ROC curve of the four lymphocyte subsets had an area of 0.983， with a sensitivity of 97.4% and specificity of 92.3%. The proportions of bronchoscopy findings and microscopic examination of mucus plugs in the SMPP group were significantly higher than those in the ordinary MPP group （P < 0.05）. In the mucoid plug subgroup， the absolute numbers of CD3?CD19?T cells and CD4?T cells were significantly lower compared to the non?mucoid plug subgroup， while the percentage of CD8?T cells increased and the CD4?/CD8? ratio decreased （all P < 0.05）. Conclusions The absolute number of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells in peripheral blood serves as a highly sensitive and specific predictor of small airway mucus plugging phenomenon （SMPP） and can thus be utilized as a potential biomarker for SMPP. Microscopic analysis under SMPP conditions reveals a high prevalence of mucus plugs， necessitating proactive bronchoscopic intervention. Furthermore， the significant imbalance in T cell subpopulations is strongly correlated with the formation of mucus plugs observed during bronchoscopy.

Colorectal cancer stands as a leading cause of cancer?related morbidity and mortality globally， with liver metastases being a significant determinant of patient prognosis. Conventional diagnostic methods， including imaging studies and biomarker testing， frequently exhibit inadequate sensitivity and specificity， underscoring the necessity for more advanced technologies. Recent advancements in genomics， transcriptomics， proteomics， metabolomics， and epigenomics have revolutionized our understanding of the biological mechanisms driving colorectal cancer. These methodologies enable comprehensive analyses of genetic mutations， gene expression profiles， protein modifications， and metabolic reprogramming， all of which are pivotal to the metastatic process. This article highlights the advanced capabilities of artificial intelligence （AI） technologies in processing complex multi?omics data， thereby enhancing diagnostic accuracy and supporting personalized treatment strategies. It also addresses the challenges AI encounters in multi?omics analyses， such as ensuring data quality， improving model interpretability， and facilitating clinical translation. Additionally， it explores the potential integration of emerging technologies like single?cell sequencing and spatial omics into large?scale， multicenter studies to further enhance the clinical utility of these tools.

The intestinal mucosal barrier plays a pivotal role in both innate and adaptive immune regulation. Its integrity is essential for maintaining overall health， as it acts as a critical interface between the luminal contents and the host immune system. MicroRNAs （miRNAs）， which are small noncoding RNAs， function as potent genetic regulators by interacting with multiple target genes to modulate entire cellular pathways. Recent studies have demonstrated that miRNAs are intricately involved in regulating the function of the intestinal mucosal barrier. This review examines the role of miRNAs in the intestinal mucosal barrier， encompassing their mechanisms， relevant clinical research findings， and potential directions for future investigation， to elucidate the potential value of miRNAs in the pathogenesis， diagnosis， and treatment of related diseases.

Transient Receptor Potential Vanilloid-1 （TRPV1） is a non-selective cation channel that is widely distributed in the sensory nerve fibers and non-neuronal cells of the gastrointestinal tract. It plays a critical role in mediating visceral hypersensitivity in Diarrhea-Predominant Irritable Bowel Syndrome （IBS-D）. Acupuncture activates TRPV1 receptors at the acupoint area， promoting the transformation of physical stimuli at the body surface into chemical signals within the body. This process coordinates with the nervous， endocrine， and immune systems to inhibit the expression of TRPV1 in the viscera through multiple mechanisms and pathways， demonstrating significant clinical efficacy in the treatment of IBS-D. This article reviews the mechanisms of TRPV1 in IBS-D visceral hypersensitivity， focusing on its relationship with the gut-brain axis imbalance， low-grade intestinal inflammation， and gut microbiota dysbiosis. It also summarizes the current research on acupuncture targeting TRPV1 in the treatment of IBS-D， aiming to provide scientific evidence and clinical insights for acupuncture therapy in functional diseases.