Postoperative pulmonary complications （PPCs） represent a frequent and severe challenge following surgery， particularly in patients undergoing thoracic or abdominal procedures that necessitate tracheal intubation and mechanical ventilation. PPCs typically manifest within 7 days post-surgery. Effective perioperative management， encompassing optimization of lung-protective ventilation strategies， real-time monitoring of pulmonary ventilation status， and timely interventions， can substantially decrease the incidence of PPCs. As an emerging non-invasive imaging modality， electrical impedance tomography （EIT） has garnered significant attention in recent years for its clinical applications， especially in perioperative lung-protective ventilation. EIT enables real-time and dynamic visualization of lung ventilation distribution， providing a critical foundation for developing personalized ventilation strategies. This significantly enhances the safety and efficacy of mechanical ventilation while improving patient outcomes. The aim of this article is to elucidate the fundamental principles and advantages of EIT， explore its role in perioperative lung protection， and examine its future development prospects， thereby offering additional reference and guidance for clinical practice.

The incidence of social anxiety disorder （SAD） among adolescents is increasing annually. However， traditional cognitive behavioral therapy （CBT） struggles to meet practical needs due to high dropout rates and uneven resource distribution. Digital therapeutics （DTx）， leveraging technologies such as mobile internet， virtual reality （VR）， and artificial intelligence （AI）， offers new solutions for adolescent SAD intervention. This article systematically analyzes the application of digital therapeutics in adolescent SAD intervention from three perspectives： theoretical compatibility， technical feasibility， and clinical transformation efficacy. It focuses on the application scenarios and effectiveness of technologies such as virtual reality exposure therapy （VRET）， chatbots， ecological momentary assessment （EMA） with micro-intervention techniques， and gamified digital therapeutics. Research indicates that digital therapeutics show significant short-term effects， particularly in alleviating physiological arousal and improving avoidance behaviors. Nevertheless， challenges remain， including individual differences in efficacy， insufficient cultural adaptability， and limitations in comorbid intervention. Future directions include multimodal neural feedback， AI-based psychological interventions， metaverse therapy， and the integration of digital therapeutics with traditional treatments. This article aims to provide a theoretical foundation for building an intervention ecosystem that integrates "evidence-based practice， technological development， and policy regulation，" promoting the precision and personalization of adolescent SAD interventions.

Objective To investigate the effects of rectus abdominis area （RAA）， visceral fat area （VFA）， and the ratio of visceral to subcutaneous fat area （V/S ratio） on the risk of surgical site infection （SSI） following open radical surgery for hepatocellular carcinoma （HCC） and their predictive value in the perioperative period and potential utility for intervention. Methods In this retrospective case-control study， 280 patients who underwent open radical HCC surgery between December 2019 and October 2024 were included. After excluding 17 patients due to incomplete data or other exclusion criteria， the remaining 263 patients were categorized into two groups： 66 in the SSI group and 197 in the non-SSI group. VFA， subcutaneous fat area （SFA）， and RAA were quantified using preoperative abdominal computed tomography （CT） scans. Propensity score matching was performed to create two well-balanced cohorts， each consisting of 59 patients. Multivariate logistic regression analysis and receiver operating characteristic （ROC） curve analysis were conducted to identify and evaluate potential risk factors for SSIs. Additionally， a nomogram was developed to assess the predictive performance of these risk factors through ROC curve analysis， calibration plots， and decision curve analysis. Results Preoperative laboratory results revealed significantly elevated white blood cell counts， C-reactive protein levels， and procalcitonin in the SSI group， along with reduced hemoglobin and serum albumin levels compared to the control group （P = 0.003）. Imaging analyses demonstrated markedly increased RAA （P = 0.032）， VFA （P = 0.015）， and V/S ratio （P = 0.002） in the SSI group. Univariate and multivariate logistic regression analyses identified RAA， VFA， and the V/S ratio as critical risk factors for SSIs. ROC curve analyses further confirmed the robust predictive capacity of the V/S ratio （AUC = 0.88） and RAA （AUC = 0.79）. A nomogram constructed based on these indicators achieved an AUC of 0.836， indicating excellent discrimination ability， strong concordance between predicted and observed outcomes， and clinically significant net benefit across a range of common threshold probabilities. Conclusions RAA， VFA， and the V/S ratio are critical predictors of SSI following open radical HCC surgery. The nomogram constructed based on these factors exhibits robust discrimination， calibration， and clinical utility， allowing clinicians to accurately identify high-risk patients and implement targeted interventions to reduce SSI incidence and enhance patient outcomes.

Objective To investigate the efficacy and safety of lobaplatin in promoting liver wound healing following hepatectomy for patients with primary hepatocellular carcinoma. Methods From January 2019 to June 2024， 120 patients with primary hepatocellular carcinoma （HCC） at CNLC stages Ia to IIa were randomly divided into an observation group （n = 60） and a control group （n = 60）. The observation group underwent hepatectomy and received lobaplatin application on the liver wound during surgery， while the control group underwent hepatectomy alone without lobaplatin application. All patients were followed up for 66 months. Postoperative levels of ALT， AST， blood creatinine， white blood cells， and platelets were compared between the two groups. Additionally， the incidence of hemorrhage and bile leakage was compared， as well as the recurrence-free survival time after surgery. Results There were no significant differences between the two groups in terms of postoperative ALT， AST， blood creatinine， white blood cell count， or platelet levels（P > 0.05）. Additionally， no significant differences were observed in the incidence of postoperative hemorrhage and bile leakage between the two groups（P > 0.05）. However， a significant difference was noted in recurrence-free survival time between the groups（P > 0.05）， with the recurrence-free survival curve indicating a higher recurrence-free survival rate in the observation group compared to the control group（P > 0.05）. Conclusions Lobaplatin application for liver wound healing in hepatectomy of patients with primary hepatocellular carcinoma represents a feasible， safe， and effective adjuvant therapy. This approach can decrease the early recurrence rate in patients with early-stage primary hepatocellular carcinoma， making it worthy of clinical promotion.

Objective To analyze the predictive value of bispectral index （BIS） dynamic changes for hypotension after laparoscopic surgery in elderly patients with primary liver cancer. Methods 197 elderly patients with primary liver cancer who underwent laparoscopic surgery in the hospital from November 2021 to July 2024 were selected as the research subjects， and all patients received general anesthesia， and their perioperative BIS was monitored. The patients were divided into a hypotension group and a non hypotension group based on the occurrence of hypotension after laparoscopic surgery. The general information and the BIS at 5 minutes before anesthesia induction （T0）， 5 minutes after anesthesia induction （T1）， 30 minutes after the start of surgery （T2） and the end of surgery （T3） in the two groups were compared. The influencing factors of hypotension after laparoscopic surgery in elderly patients with primary liver cancer were analyzed through Logistic regression analysis， and the predictive value of BIS for hypotension after laparoscopic surgery in elderly patients with primary liver cancer were analyzed through receiver operating characteristic （ROC） curve. Results 51 patients were experienced hypotension after laparoscopic surgery among 197 elderly patients with primary lung cancer， and the incidence rate was 25.89%. The proportion of hypertension and operative time in the hypotension group were higher than those in the non hypotension group （P < 0.05）， while the levels of albumin （ALB） and BIS at T2 and T3 were lower than those in the non hypertension group （P < 0.05）. logistic regression analysis showed that hypertension， long operative time， low ALB level， low BIS value at T2 and low BIS value at T3 were all risk factors for hypotension after laparoscopic surgery in elderly patients with primary liver cancer （P < 0.05）. The sensitivity， specificity and area under curve （AUC） of BIS combined prediction of hypotension after laparoscopic surgery in elderly patients with primary liver cancer at T2 and T3 were 92.16%， 78.08% and 0.902% respectively， and the sensitivity and AUC were higher than those single prediction （P < 0.05）， but the specificity was similar to that of single prediction. Conclusion The predictive value of BIS at 30 minutes after the start of surgery and the end of surgery for hypotension after laparoscopic surgery in elderly patients with primary liver cancer are good， and the joint prediction of this two can further enhance the predictive value.

Objective To investigate the factors affecting the achievement of the textbook outcome for liver surgery （TOLS） in patients undergoing laparoscopic liver resection for hepatic lesions. Methods A retrospective cohort study was conducted to collect data from patients who underwent laparoscopic partial liver resection at the hospital between January 2021 and January 2024， followed by comprehensive statistical analysis. Results Among 211 patients with liver lesions， 170 （80.6%） successfully achieved TOLS postoperatively. The achievement of TOLS in patients undergoing laparoscopic liver resection was significantly associated with the proportion of hepatitis B carriers， body mass index （BMI）， total bilirubin levels， aspartate aminotransferase （AST）， platelet count， intraoperative blood loss， whether blood transfusion was administered during surgery， operation duration， lesion characteristics， and extent of liver resection （P < 0.05）. Notably， total bilirubin levels， American Society of Anesthesiologists （ASA） score， intraoperative blood transfusion， intraoperative blood loss， and extent of liver resection were identified as independent factors influencing the attainment of TOLS （P < 0.05）. Conclusions Serum total bilirubin levels， intraoperative blood transfusion requirements， intraoperative blood loss volume， and the extent of liver resection independently influence the achievement of TOLS. This study introduces a novel method for evaluating the short-term prognosis following laparoscopic liver resection.

Objective To investigate the predictive value of the combination of cell cycle protein-dependent kinase inhibitor 3（CDKN3） and serum chitosanase 3-like protein 1（CHI3L1）， and microRNA-106b（miR-106b） assays in hepatocellular carcinoma metastasis. Methods One hundred patients with hepatocellular carcinoma admitted to the hospital between September 2019 and December 2023 were selected as study subjects and included in the hepatocellular carcinoma group， 87 patients with cirrhosis were included as the cirrhosis group during the same period， 96 patients with chronic hepatitis B as the chronic hepatitis B group， and 98 healthy persons undergoing routine physical examination were included in the healthy control group， and the groups were compared with respect to the serum CHI3L1， the cell-cycle molecule CDKN3， and the miR-106b levels. The hepatocellular carcinoma group was divided into 26 metastatic cases， 63 non-metastatic cases， and 11 cases lost to follow-up according to whether they metastasized during the 1-year follow-up period， and baseline data， cell cycle molecules CDKN3， miR-106b， and serum CHI3L1 levels were compared between the two groups. Risk factors for hepatocellular carcinoma metastasis were analyzed using multifactorial logistic， and the predictive value of the combined detection of miR-106b， the cell cycle molecule CDKN3， and serum CHI3L1 for hepatocellular carcinoma metastasis was analyzed using ROC curves. Results Compared with the healthy control group， the levels of CHI3L1， cell cycle molecule CDKN3， and serum miR-106b were elevated in the hepatocellular carcinoma group， chronic type B group， and cirrhosis group， and the chronic type B group < cirrhosis group < hepatocellular carcinoma group， which showed a tendency to be elevated with the increasing degree of liver disease， and the difference was statistically significant（P<0.05）. Compared with the non-metastatic group， the metastatic group had higher levels of alanine aminotransferase（ALT）， percentage of tumors >3 cm， CHI3L1， cytokinin A2（CCNA2）， percentage of tumors with stage > Ⅲ， the cell cycle molecule CDKN3， abnormal plasminogen， glutamyltransferase（GGT）， miR-106b， total bile acids（TBA）， alpha-fetoprotein（AFP）， number of tumors percentage of multiple occurrences， and glutamyltransferase（AST） levels were elevated， and the difference was statistically significant（P<0.05）. The results of multifactorial logistics analysis showed that the risk factors for hepatocellular carcinoma metastasis included ALT， CCNA2， tumor > 3 cm， AST， GGT， tumor stage > Ⅲ， AFP， CHI3L1， multiple tumors， abnormally high blood plasminogen， miR-106b， cell cycle molecule CDKN3， TBA. the results of the ROC curve analysis showed that miR -106b， serum CHI3L1， cell cycle molecule CDKN3 combined detection sensitivity was 93.65%， accuracy was 84.27%， and AUC value was 0.776 higher than the sensitivity， accuracy， and AUC value of single detection， and the difference was statistically significant（P < 0.05）. Conclusions Elevated levels of cell cycle molecule CDKN3， serum CHI3L1， and miR-106b are risk factors for liver cancer metastasis. It can be used to predict the occurrence of liver cancer metastasis， and the combined detection has significant predictive efficacy.

Objective To investigate the effects of sauchinone （Sch） on the growth and immune escape of liver cancer cells by regulating the Krüppel like factor 5 （KLF5）-erythropoietin-producing hepatocellular receptor A2 （EphA2） pathway. Methods Huh-7 cells were grouped into liver cancer group， Sch low， medium， and high-dose groups （Sch-L group， Sch-M group， Sch-H group）， Sch-H + KLF5 activator negative control group （OE-NC）， and Sch-H + KLF5 activator （OE-KLF5） group. 5-bromo-2-deoxyuracil （EdU） staining， CCK-8， scratch assay， and Transwll were used to detect the proliferation， migration， and invasion of Huh-7 cells， respectively. Western blot was applied to detect proliferative cell nuclear antigen （PCNA）， migration invasion enhancer（MIEN1）， matrix metalloproteinase-2 （MMP-2）， programmed death receptor ligand 1 （PD-L1）， KLF5， and EphA2 proteins in Huh-7 cells. The Huh-7 cells in above 6 groups were co cultured with activated CD8⁺ T cells in a 96 well plate and named as liver cancer co culture group， Sch-L co culture group， Sch-M co culture group， Sch-H co culture group， Sch-H + OE-NC co culture group， and Sch-H + OE-KLF5 co culture group. The killing rate of CD8⁺T cells in the co culture system and the levels of interferon-γ （IFN-γ）， interleukin-4 （IL-4）， and tumor necrosis factor-α （TNF-α） in the supernatant were detected. Results Compared with the liver cancer group， the EdU positive rate， OD₄₅₀ value， cell invasion number， and PCNA， MIEN1， MMP-2， PD-L1， KLF5， and EphA2 proteins in the Sch-L， Sch-M， and Sch-H groups reduced， the migration distance shorten （P < 0.05）. Compared with the Sch-H group and Sch-H + OE-NC group， the EdU positive rate， OD₄₅₀ value， cell invasion number， and PCNA， MIEN1， MMP-2， PD-L1， KLF5， and EphA2 proteins in the Sch-H + OE-KLF5 group increased， the migration distance prolonged （P < 0.05）. Compared with the liver cancer co culture group， the killing rate of CD8⁺T cells on Huh-7 cells and the levels of IFN-γ， TNF-α， and IL-4 in the supernatant in the Sch-L co culture group， Sch-M co culture group， and Sch-H co culture group increased （P < 0.05）. Compared with the Sch-H co culture group and the Sch-H + OE-NC co culture group， the killing rate of CD8⁺ T cells on Huh-7 cells and the levels of IFN-γ， TNF-α， and IL-4 in the supernatant in the Sch-H + OE-KLF5 co culture group decreased （P < 0.05）. Conclusion Sch may inhibit growth and immune escape of liver cancer cells by inhibiting the KLF5-EphA2 pathway.

Objective To investigate the mechanism of Jisuishang Formula on cervical myelopathy based on Wnt/β-catenin signaling pathway. Methods Thirty-six adult male SD rats were randomly divided into sham operation group， model group， positive control group （TAK-715， 50 mg/kg）， Jisuishang Formula low （9.7 g/kg）， medium （19.4 g/kg） and high （38.8 g/kg） dose groups， with 6 rats in each group for 4 weeks. The BBB score and inclined plate test were observed at 1， 2 and 4 weeks after surgery. HE and Nissl staining were used to observe the histopathology and neuronal condition of the spinal cord. Immunofluorescence was used to detect the protein expressions of BDNF， β-catenin， Bax and Bcl-2. Western blot and qRT-PCR were used to detect the expression of Wnt/β-catenin signaling pathway-related proteins and mRNAs. Results Compared with the sham group， the BBB score and inclined plate test score were significantly decreased （P < 0.05）， the expressions of BDNF， β-catenin and Bcl-2 decreased （P < 0.05）， the expression of Bax increased （P < 0.05）， the expressions of β-catenin， LRP-6 and p-GSK-3βdecreased （P < 0.05）， and the expressions of Caspase-3 and Caspase-9 increased （P < 0.05）. Compared with the model group， the BBB score and inclined plate test score were significantly increased in the high-dose Jisuishang Formula group （P < 0.05）， the expressions of BDNF， β-catenin and Bcl-2 increased （P < 0.05）， the expression of Bax decreased （P < 0.05）， the expressions of β-catenin， LRP-6 and p-GSK-3βincreased （P < 0.05）， and the expressions of Caspase-3 and Caspase-9 decreased （P < 0.05）. Conclusion Jisuishang Formula prescription can inhibit neuronal apoptosis， improve spinal cord microenvironment， and promote neurological function recovery by activating the Wnt/β-catenin signaling pathway.

Objective To establish animal models by implanting Gynemesh polypropylene mesh and Mersilene tape into the abdominal walls of rats， followed by conducting mechanical experiments and performing HE staining on abdominal wall tissues at 30 and 90 days post-implantation， respectively， in order to evaluate the biomechanical properties and histocompatibility of the two types of meshes. Methods The Gynemesh mesh and Mersilene tape were implanted into the abdominal wall of adult female rats （n = 10） using W6977M polyester non-absorbable sutures and V-Loc absorbable sutures. The rats were randomly assigned to either a 30-day group or a 90-day group （n = 5 per group） based on different experimental time points. Mechanical tests were conducted at these time points to evaluate the ultimate load required for avulsion of the meshes from the abdominal wall. Following the mechanical experiments， the tissues surrounding the meshes were harvested for hematoxylin and eosin （HE） staining. The inflammatory response， neovascularization， and fibroblast proliferation in the tissues were scored to compare the histocompatibility of the two types of meshes. Results （1） In the 30-day group， the ultimate load values were as follows： Gynemesh + 6977 （14.96 ± 2.22）N， Gynemesh + V-Loc （12.73 ± 1.11）N， Mersilene + 6977 （10.65 ± 0.91）N， and Mersilene + V-Loc （8.70 ± 1.18）N. No statistically significant difference was observed in the ultimate load between the Gynemesh + 6977 and Gynemesh + V-Loc groups （P = 0.12）， whereas statistically significant differences were noted among the other groups （P < 0.05）. （2） In the 90-day group， the ultimate load values were as follows： Gynemesh + 6977 （18.97 ± 0.59）N， Gynemesh + V-Loc （18.18 ± 0.54）N， Mersilene + 6977 （13.87 ± 0.67）N， and Mersilene + V-Loc （10.41 ± 0.73）N. No statistically significant difference was observed in the ultimate load between the Gynemesh + 6977 and Gynemesh + V-Loc groups （P = 0.06）， while statistically significant differences were noted among the other groups （P < 0.05）. （3） The ultimate load at 90 days for each group was significantly greater than that at 30 days， with statistically significant differences observed across all groups （P < 0.05）. （4） In the 30-day group， Gynemesh exhibited a lower inflammatory response compared to Mersilene tape （2.0 ± 0.69 vs. 3.10 ± 0.71， P < 0.05）， with no statistically significant differences in neovascularization or fibroblast proliferation （2.37 ± 0.61 vs. 2.40 ± 0.62， P = 0.84； 2.43 ± 0.73 vs. 2.63 ± 0.67， P = 0.27）. In the 90-day group， Gynemesh demonstrated a lower inflammatory response score （1.10 ± 0.66 vs. 2.00 ± 0.74， P < 0.05）， reduced fibroblast proliferation （2.87 ± 0.68 vs. 3.27 ± 0.67， P < 0.05）， and no significant difference in neovascular proliferation （2.20 ± 0.55 vs. 2.13 ± 0.68， P = 0.68） compared to Mersilene tape. （5） The inflammatory response for both mesh types was higher in the 30-day group compared to the 90-day group （Gynemesh group： 2.0 ± 0.69 vs. 1.10 ± 0.66， P < 0.05； Mersilene group： 3.13 ± 0.73 vs. 2.0 ± 0.74， P < 0.05）. Additionally， the degree of fibroblast proliferation was lower in the 30-day group than in the 90-day group （Gynemesh group： 2.43 ± 0.73 vs. 2.87 ± 0.68， P < 0.05； Mersilene group： 2.63 ± 0.67 vs. 3.27 ± 0.69， P < 0.05）. However， there was no statistically significant difference in neovascularization proliferation between the two groups （Gynemesh group： 2.53 ± 0.74 vs. 2.47 ± 0.74， P = 0.81； Mersilene group： 2.40 ± 0.62 vs. 2.13 ± 0.68， P = 0.12）. Conclusion Compared with Mersilene tape， Gynemesh polypropylene mesh exhibits superior tensile strength and enhanced biocompatibility.

Objective To explore the characteristics and prognosis of follicular lymphoma （FL） with bulky disease under rituximab-based first-line treatment. Methods A retrospective analysis was conducted on 525 FL patients diagnosed between September 2009 and September 2021 who received rituximab as a first-line treatment ［342 patients received rituximab combined with chemotherapy （R-chemo）， 183 patients received rituximab plus lenalidomide （R2）］. The clinicopathologic characteristics， gene mutations， and prognosis of bulky FL patients were analyzed. Results Compared to non-bulky FL patients， bulky FL patients had a significantly higher proportion of lymph node ≥ 5 sites， ≥2 extranodal involvement， bone marrow involvement， elevated LDH， and a higher proportion in the high-risk group of FLIPI1 and FLIPI2. Gene sequencing revealed a significantly higher mutation rate of ZNF608 in bulky FL patients compared to non-bulky FL patients. In patients receiving R-chemo as the first-line treatment， there was no significant difference in progression-free survival （PFS） and overall survival （OS） between bulky and non-bulky FL patients. However， in patients treated with R2， the PFS and OS of bulky FL patients was significantly shorter. Conclusions Bulky FL patients compared to non-bulky FL patients have a significantly higher proportion of high-risk baseline characteristics. For bulky FL at diagnosis， chemo-free regimens require further exploration on the basis of R2.

Objective To compare the clinical efficacy of different urinary diversions， specifically exploring whether the flap embedding technique can improve bladder cancer patients' quality of life and reduce the incidence of related complications. Methods 63 bladder cancer patients undergoing radical cystectomy with urinary diversion， between December 2022 and December 2023， were divided into three groups： Ileal conduit group （n = 21）， flap embedding technique group （n = 21）， and traditional cutaneous ureterostomy group （n = 21）. General clinical data， surgical data， preoperative and postoperative renal function indicators， incidence of complications within 6 months postoperatively， and quality of life scores were compared among the groups. Results The operative time in the ileal conduit group was longer than that in the other two groups （P < 0.05）. The quality of life scores in the flap embedding technique group were superior to those in the traditional cutaneous ureterostomy group （P < 0.05）， but no significant difference was found compared to the ileal conduit group （P > 0.05）. In terms of postoperative complications， the incidence of intestinal obstruction in the flap embedding technique group was lower than that in the ileal conduit group （P < 0.05）， and the rate of reinsertion of a single-J stent for hydronephrosis in the flap embedding technique group was lower than that in the traditional cutaneous ureterostomy group （P < 0.05）. Postoperative serum creatinine levels in the traditional cutaneous ureterostomy group were significantly higher than preoperative levels （P < 0.05）， while no significant differences in renal function indicators were observed in the other two groups （P > 0.05）. Conclusion The flap embedding technique significantly improves patients' quality of life and reduces the incidence of postoperative complications. It is worthy of further promotion in clinical practice.

Objective To evaluate the efficacy of four-dimensional traction in elderly patients with degenerative lumbar spinal stenosis （DLSS）， focusing on changes in lumbar muscle morphology and mechanical properties. Methods Elderly patients with DLSS admitted to the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2022 to February 2024 were enrolled. Based on the treatment method， they were categorized into the study group （muscle exercise combined with four-dimensional traction， n = 40） and the control group （routine muscle exercise， n = 40）. All participants underwent a 4-week treatment regimen and subsequently received multimodal ultrasound examinations. The morphology and mechanical properties of the lumbar muscle group， lumbar range of motion， walking distance in intermittent claudication， Visual Analogue Scale （VAS）， and Oswestry Disability Index （ODI） scores were compared between the two groups. Results After treatment， the study group exhibited significantly greater improvements in multifidus muscle thickness， circumference， cross-sectional area， pressure pain threshold， and lumbar range of motion （P < 0.05）. In contrast， the shear wave velocity （SWV）， Young's modulus， muscle tension， and flexion-extension ratio of the multifidus muscle were significantly lower in the study group （P < 0.05）. Additionally， the walking distance in intermittent claudication for the study group was markedly longer （P < 0.05）. During the 12-month follow-up period after treatment， the VAS and ODI scores of the study group remained significantly lower （P < 0.05）. Conclusion Four-dimensional traction in combination with muscle exercise can effectively alleviate clinical symptoms， enhance muscle function， and improve mechanical properties in elderly patients with DLSS.

Objective To construct a predictive model for delayed neurological sequelae （DNS） following acute carbon monoxide poisoning （ACMP） and to verify its efficacy. Methods A retrospective analysis of the general data of 183 patients with ACMP was conducted. The factors influencing the occurrence of DNS were analyzed using a multivariate Logistic regression model. A corresponding predictive model was then established and its efficacy was verified. Results The multivariate logistic regression model showed that age， smoking history， severe poisoning， blood lactate， time from poisoning to hyperbaric oxygen therapy， and pulmonary infection were independent risk factors for DNS following ACMP （P < 0.05）. The area under the curve （AUC） of the model for predicting DNS in the development set was 0.933， with a sensitivity of 94.12% and specificity of 89.77%. In the validation set， the AUC was 0.906， with a sensitivity of 90.00% and specificity of 92.68%. The Hosmer-Lemeshow test showed that the predicted probabilities of DNS in both the development and validation sets were not significantly different from the actual probabilities （P > 0.05）. The predictive model achieved clinical net benefit within the risk threshold ranges of 0.11 ~ 0.98 for the development set and 0.12 ~ 0.92 for the validation set. Conclusions Age， smoking history， severe poisoning， blood lactate， time from poisoning to hyperbaric oxygen therapy， and pulmonary infection are independent risk factors for DNS following ACMP. The corresponding predictive model has been verified to have good clinical efficacy.

Objective To investigate the expression levels of serum fibronectin （FN） in patients with non-small cell lung cancer （NSCLC） and evaluate its clinical diagnostic significance. Methods Firstly， the gene and tissue protein expression levels of FN in NSCLC were assessed using the TIMER2.0 database， GTEx database， and Human Protein Atlas （HPA） database. Secondly， from January 2021 to June 2023， a total of 154 patients with lung space-occupying lesions or shadows at the First Affiliated Hospital of Anhui University of Chinese Medicine were enrolled. Based on medical history， clinical manifestations， imaging tests， and pathological histological findings， these patients were categorized into two groups： 81 patients with NSCLC and 73 patients with benign lung diseases. The serum concentration of FN was measured by immunoturbidimetry， while the serum levels of CEA， SCC， and CYFRA21-1 were determined using chemiluminescence. Results The bioinformatics analysis results demonstrated that the gene expression and tissue protein levels of FN were significantly reduced compared to normal tissues. In serological evaluations， serum FN concentrations in patients with advanced NSCLC （Stage Ⅲ-Ⅳ） and early-stage NSCLC （Stage Ⅰ-Ⅱ） （249.50 ng/mL and 305.00 ng/mL， respectively） were markedly lower than those observed in the benign lung disease group （429.16 ng/mL） （P < 0.001）. Univariate and multivariate logistic regression analyses indicated that serum FN could serve as a significant predictor for the presence of NSCLC. The area under the receiver operating characteristic curve （ROC） for serum FN in diagnosing early-stage NSCLC was 0.790， which outperformed CEA （0.618）， SCC （0.653）， and CYFRA21-1 （0.601）. The optimal critical concentration of serum FN for distinguishing early-stage NSCLC from benign diseases was determined to be 347.6 ng/mL， with a sensitivity of 71.93%， surpassing that of CEA （19.30%）， SCC （12.28%）， and CYFRA21-1 （8.77%）. Conclusion Serum FN is significantly downregulated in NSCLC and may serve as a potential biomarker for the early diagnosis of NSCLC.

Objective To explore the clinical efficacy of applying exoskeleton robots in lower limb functional rehabilitation for patients after minimally invasive surgery for cervical spondylotic myelopathy （CSM）. Methods A retrospective analysis was conducted on the clinical data of 56 patients who underwent spinal endoscopic minimally invasive surgery between April 2021 and October 2022. Based on the rehabilitation methods， patients were divided into the observation group （robot-assisted rehabilitation group） and the control group （conventional rehabilitation group）. The Japanese Orthopaedic Association （JOA） scores for cervical spinal cord function， lower limb somatosensory evoked potential amplitudes， and gait analysis indicators （step frequency， walking speed， and stance phase ratio） were assessed preoperatively， 4 weeks postoperatively， and 8 weeks postoperatively. Results In 4 and 8 weeks after surgery， both groups showed significant improvements in JOA scores， lower-limb somatosensory evoked potential amplitudes， and gait parameters （step frequency， walking speed， and stance phase ratio） compared with preoperative data（P < 0.05）. Furthermore， the improvements in JOA scores， somatosensory evoked potential amplitudes， and gait parameters in the observation group were significantly greater than those in the control group at both 4 and 8 weeks postoperatively （P < 0.05）. However， at the 2-year follow-up， there were no statistically significant differences （P > 0.05） between the two groups in any of these measures. Conclusions Rehabilitation using lower limb exoskeleton robots can accelerate spinal cord function recovery and improve lower limb walking ability in patients after minimally invasive surgery for CSM， demonstrating superior short-term clinical efficacy compared to conventional rehabilitation. However， no significant differences were observed between the two methods during long-term follow-up.

Objective To investigate the effects of normal-high blood pressure and Grade 1 hypertension during early pregnancy on preeclampsia （PE） and adverse pregnancy outcomes in pregnant women. Methods A retrospective cohort study was conducted， enrolling 2，562 postpartum women who delivered at the Shiyan Maternal and Child Health Hospital from March 2020 to November 2023 as study participants. Prenatal examination data and delivery medical records were collected for analysis. Women were categorized into three groups based on blood pressure measurements taken before 20 weeks of gestation： normal blood pressure （n = 2 029）： systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg； normal high blood pressure （n = 375）： systolic blood pressure 120 ~ 139 mmHg or diastolic blood pressure 80 ~ 89 mmHg； and Level 1 hypertension （n = 158）： systolic blood pressure 140 ~ 159 mmHg or diastolic blood pressure 90 ~ 99 mmHg. The incidence rates of PE and adverse pregnancy outcomes （including cesarean section， placental abruption， spontaneous preterm delivery ［before 37 weeks］， postpartum hemorrhage， stillbirth after 20 weeks of gestation， Apgar score < 7， neonatal admission to the NICU， small for gestational age， macrosomia， and neonatal death within 28 days of birth） were compared and analyzed across the three groups. Cox regression analysis was performed to investigate the impact of early pregnancy blood pressure levels on the risk of PE and adverse pregnancy outcomes. Results （1） Women with normal high blood pressure had a 2.163-fold increased risk of PE compared to women with normal blood pressure （95%CI： 1.228 ~ 3.809， P = 0.007）. However， there were no statistically significant differences in the rates of cesarean section （OR = 1.341， 95%CI： 0.528 ~ 3.405， P = 0.537）， placental abruption （OR = 1.016， 95%CI： 0.925 ~ 1.115， P = 0.740）， Apgar score <7 （OR = 1.422， 95%CI： 0.976 ~ 2.071， P = 0.066）， spontaneous preterm birth （OR = 1.027， 95%CI： 0.925 ~ 1.140， P = 0.617）， postpartum bleeding （OR = 1.141， 95%CI： 0.873 ~ 1.491， P = 0.334）， stillbirth after 20 weeks of gestation （OR = 1.276， 95%CI： 0.980 ~ 1.661， P = 0.070）， neonatal admission to NICU （OR = 1.301， 95%CI： 0.674 ~ 2.511， P = 0.432）， small for gestational age （OR = 1.089， 95%CI： 0.927 ~ 1.279， P = 0.299）， macrosomia （OR = 1.336， 95%CI： 0.824 ~ 2.166， P = 0.240）， or neonatal death within 28 days of birth （OR = 1.275， 95%CI： 0.918 ~ 1.770， P = 0.147）. （2） Compared to women with normal blood pressure， women with grade 1 hypertension had a significantly higher risk of preeclampsia （OR = 3.829， 95%CI： 1.749 ~ 8.385， P < 0.001）， cesarean section （OR = 2.414， 95%CI： 1.298 ~ 4.489， P = 0.005）， and placental abruption （OR = 2.537， 95%CI： 1.196 ~ 5.384， P = 0.015）. Additionally， they had a higher rate of Apgar score < 7 （OR = 1.829， 95%CI： 1.069 ~ 3.130， P = 0.027）. No statistically significant differences were observed for spontaneous preterm birth （OR = 1.404， 95%CI： 0.713 ~ 2.764， P = 0.326）， postpartum bleeding （OR = 1.236， 95%CI： 0.845 ~ 1.807， P = 0.274）， stillbirth after 20 weeks of gestation （OR = 1.076， 95%CI： 0.902 ~ 1.283， P = 0.415）， neonatal admission to NICU （OR = 1.346， 95%CI： 0.873 ~ 2.075， P = 0.178）， small for gestational age （OR = 1.417， 95%CI： 0.926 ~ 2.168， P = 0.108）， macrosomia （OR = 1.235， 95%CI： 0.629 ~ 2.424， P = 0.539）， or neonatal death within 28 days of birth （OR = 1.275， 95%CI： 0.918 ~ 1.770， P = 0.147）. （3）ROC analysis shows that when the sample combination was normal high blood pressure（n = 375）， the predictive/evaluative efficacy AUC of early pregnancy blood pressure values （threshold 139/89） for PE was 0.757. When the sample combination was level 1 hypertension（n = 158）， the predictive/evaluative efficacy AUC of early pregnancy blood pressure values （threshold 159/99） for four adverse outcomes， including PE， cesarean section， placental abruption， and Asperger's score < 7， were 0.789， 0.717， 0.709， and 0.742， respectively. Conclusion Compared with pregnant and parturient women with normal blood pressure， having a normal high blood pressure or grade 1 hypertension before 20 weeks of pregnancy will significantly increase the risk of PE； in addition， grade 1 hypertension is also associated with a higher incidence of adverse pregnancy outcomes， including cesarean section， placental abruption， and low Apgar score of the newborn.

Objective To evaluate the clinical efficacy and safety of bumetanide in comparison with other diuretics for the prevention and management of postoperative pleural effusion in patients undergoing hepatobiliary surgery. Methods A total of 168 patients undergoing routine hepatobiliary surgery were randomly assigned to either the bumetanide group or the control group （other diuretics）. Patients in the bumetanide group received bumetanide injection at a dose of 1 mg intravenously once daily. In contrast， the control group received one of the following treatments： furosemide injection at 20 mg intravenously once daily， furosemide tablets at 40 mg orally twice daily， or a combination of furosemide tablets （40 mg orally twice daily） and spironolactone tablets （60 mg orally twice daily）. All treatments were administered for three days postoperatively. The incidence of postoperative pleural effusion， length of hospital stay， and drug-related adverse reactions were compared between the two groups. Additionally， multivariate logistic regression analysis was conducted to identify independent risk factors for moderate-to-severe pleural effusion after surgery. Results A total of 82 patients were enrolled in the bumetanide group and 86 in the control group. No significant differences were observed in the general demographic and clinical characteristics between the two groups （P > 0.05）， except for sex and ALT levels （P < 0.05）. The incidence of moderate-to-severe pleural effusion was higher in the control group than in the bumetanide group， with rates of 9.3% and 1.2%， respectively （all P < 0.05）. Additionally， the length of hospital stay was significantly longer in the control group （19.94 ± 0.90 days） compared to the bumetanide group （17.15 ± 1.06 days） （all P < 0.05）. Thoracentesis was performed in 2 cases in the bumetanide group and 8 cases in the control group， but this difference was not statistically significant （P > 0.05）. The primary adverse drug reactions in both groups included hypokalemia， hypochloremia， hyponatremia， and hypocalcemia. The overall incidence of adverse drug reactions was 35.4% in the bumetanide group and 34.9% in the control group， showing no significant difference （P > 0.05）. Multivariate regression analysis revealed that a history of hepatitis B， cirrhosis， and the use of bumetanide were independent predictors of moderate-to-severe pleural effusion during routine hepatobiliary surgery （all P < 0.05）. Conclusions Bumetanide demonstrates superior efficacy compared to other conventional diuretics in the prevention and management of postoperative pleural effusion in hepatobiliary surgery， suggesting potential clinical application value.

Objective To explore the application value of glucocorticoid in the treatment of elderly patients with severe pneumonia （SP） and respiratory failure （RF）. Methods A retrospective analysis was performed on the clinical data of 208 elderly patients with SP and RF in the hospital between January 2022 and December 2023. According to use of glucocorticoid or not， patients were divided into non-hormone group （n = 83） and hormone group （n = 125）. According to propensity score matching method， there were 71 patients in each group. The clinical indexes， disease improvement， blood gas indexes， laboratory biochemical indexes and prognosis were compared between the two groups. Results The ventilator use time and length of hospital stay in hormone group were shorter than those in non-hormone group （P < 0.05）. After 7 d of treatment， score of Glasgow coma scale （GCS）， oxygenation index （P/F）， blood oxygen saturation （SaO₂） and lymphocyte count （TLC） in hormone group were higher than those in non-hormone group， while scores of acute physiological and chronic health evaluation Ⅱ （APACHE Ⅱ） and sequential organ failure assessment （SOFA）， partial pressure of carbon dioxide （PaCO₂）， blood lactic acid （LAC） and procalcitonin （PCT） were lower than those in non-hormone group （P < 0.05）. The survival curves showed that 28 d survival rate in hormone group was higher than that in non-hormone group （P < 0.05）. Cox proportional hazard model showed that no use of glucocorticoids was an independent risk factor of 28d death in elderly patients with SP and RF （P < 0.05）. Conclusion Glucocorticoid can shorten ventilator use time and length of hospital stay， alleviate disease severity， promote the recovery of blood gas indexes， improve biochemical indexes and increase survival rate in elderly patients with SP and RF.

Objective To evaluate the predictive value of patent ductus arteriosus （PDA） for the incidence and mortality of neonatal pulmonary hemorrhage （NPH） in infants with a gestational age （GA） of ≤32 weeks. Methods Retrospective analysis of clinical data from premature infants with GA ≤32 weeks consecutively admitted between January 2021 and June 2024. The analyzed clinical characteristics included GA， birth weight （WT）， mode of delivery， diseases experienced by the infants， and maternal perinatal factors. Infants were categorized based on the presence or absence of NPH， and the clinical features of both groups were compared. Furthermore， infants with NPH and hemodynamically significant patent ductus arteriosus （hsPDA） were subdivided according to in-hospital mortality for additional analysis. Results The study included a total of 511 pediatric patients， of whom 92 cases were diagnosed with NPH. NPH was strongly correlated with mechanical ventilation （MV）， high-frequency oscillation （HFO）， hsPDA， disseminated intravascular coagulation （DIC）， and intraventricular hemorrhage （IVH） （r = 0.443， 0.407， 0.352， 0.325， 0.310， respectively； all P < 0.001）. Neonatal respiratory distress syndrome （NRDS） （grades 3-4）， IVH， MV， HFO， DIC， and hsPDA were identified as independent risk factors for NPH in infants ≤ 32 weeks of GA （OR = 2.641， 2.097， 1.065， 2.298， 5.550， 3.820， respectively； all P < 0.05）. GA， WT， PDA diameter， PDA velocity， left ventricular output （LVO）， velocity of the late diastolic a' wave in the left ventricle （LV a'）， and neonatal asphyxia （NA） were significant factors influencing NPH combined with hsPDA （all P < 0.05）. The PDA severity score （PDAsc） was determined to be a risk factor for mortality in infants ≤ 32 weeks of GA with NPH and hsPDA （OR = 1.265， 95%CI 1.031–1.553， P = 0.024）. A strong correlation was observed between the predicted probability of death in infants with NPH and PDA and PDAsc （r = 0.901， P = 0.001）. The ROC curve analysis demonstrated that PDAsc served as an ideal predictor of mortality in infants with NPH and PDA （AUC = 0.687， P = 0.002）. Conclusions hsPDA is an independent risk factor for the development of NPH in infants ≤ 32 weeks of GA. Additionally， PDAsc serves as a significant risk factor for mortality in infants ≤ 32 weeks of GA who have both NPH and PDA， indicating a strong correlation and potential predictive value.

Objective To investigate the efficacy of Huoxue Zhuanggu formula in combination with percutaneous vertebroplasty （PVP） for the treatment of osteoporotic vertebral compression fractures （OVCF）. Methods A total of 114 patients with OVCFs were randomly assigned to three groups： the percutaneous vertebroplasty （PVP） group， the PVP group with routine postoperative treatment （55 cases）， and the Huoxue Zhuanggu formula combined with additional supportive therapy group （56 cases）. All patients received a 4-week course of treatment following surgery and were followed up for 6 months. Results After 6 months of follow-up， the total effective rate in the Huoxue Zhuanggu group was significantly higher than that in the PVP group （P < 0.05）. At 4 weeks postoperatively， serum levels of N-terminal osteocalcin， total type I collagen amino-terminal telopeptide， and β-collagen degradation product were lower in the Huoxue Zhuanggu group compared to the PVP group. Additionally， serum bone morphogenetic protein-2 levels were significantly higher in the Huoxue Zhuanggu group than in the PVP group （P < 0.05）. After 6 months of follow-up， bone mineral density in Ward's triangle， lumbar spine， and femoral neck， as well as anterior vertebral height percentage and neurological function scores， were significantly higher in the Huoxue Zhuanggu group compared to the PVP group （P < 0.05）. Conversely， the sagittal kyphosis Cobb angle， anterior vertebral height loss rate， and Oswestry Disability Index score were significantly lower in the Huoxue Zhuanggu group than in the PVP group （P < 0.05）. Conclusion The combination of Huoxue Zhuanggu recipe and PVP in the treatment of OVCF can regulate patients' bone metabolism indices， enhance bone mineral density， improve vertebral function as well as nerve and lumbar function， thereby achieving a satisfactory therapeutic effect.

The extracellular matrix is an important component of articular cartilage， and in previous studies it was more commonly recognized as a scaffolding structure supporting chondrocytes that provides protection from mechanical loading and elastic compression. As research continues to progress， a large body of literature suggests that the extracellular matrix is dynamic in nature. It degrades， deposits， and releases components in response to changes in its local microenvironment， which in turn dynamically regulates chondrocyte function and fate. Therefore， this review outlines the impact of matrix-chondrocyte interactions on chondrocyte behavior and joint homeostasis in osteoarthritis. It is hoped that the systematic elucidation of matrix-cell reciprocal relationships will provide new insights into the pathological mechanisms of osteoarthritis and the design and construction of cartilage tissue engineering. Specifically， we first summarize the typical molecular components that make up the extracellular matrix and the mechanical properties they confer in the matrix and the mechanotransduction functions they exert in chondrocytes. Next， we discuss the negative impact of chondrocytes on the synthesis and breakdown of matrix components during the osteoarthritic process in response to abnormal mechanical loading in the local microenvironment or disturbance by trauma. Finally， we focus on the impact of an abnormally remodeled extracellular matrix on chondrocyte signaling and the pathological progression of osteoarthritis by mediating the generation of bioactive catabolic fragments， modulating cytokine release， and altering mechanical properties.

As the lifestyle of modern people changes， genetic factors continue to become more prominent， and the impact of environmental and water pollution， the incidence of intestinal diseases （colorectal cancer， inflammatory bowel disease， irritable bowel syndrome， chronic constipation， etc.） is increasing. It not only seriously endangers the health of the population， but also consumes a large amount of medical resources. Paeonol， as a class of small molecule phenolic compounds， has a wide range of biological activities， such as anti-inflammatory， anti-viral， anti-tumor， anti-allergic， immune regulation， cardiovascular and cerebrovascular protection， etc. The mechanism and experimental research on the effect of paeonol in preventing and treating intestinal diseases based on the "Brain-Gut-Bacteria axis" are also in-depth. This article aims to systematically review and sort out the latest progress in this field， with a view to providing certain ideas and methods for the precise treatment of intestinal diseases and the development of new drugs.