Biomaterials provide a reliable and safe treatment for the repair of ear defects， especially microtia. With the continuous promotion of interdisciplinary research， the types and properties of materials used in auricle reconstruction have been greatly expanded and improved. In this paper， the latest research progress of polymer materials and tissue engineering scaffolds in the field of auricle reconstruction was reviewed， and the physical and chemical properties and clinical application effects of these scaffolds in vitro and in vivo were discussed. However， despite significant progress in ear stent research， there are still some challenges and limitations in the application of current polymer materials， such as the hydrophobicity of high-density polyethylene and the uncontrolled differentiation of stem cells in tissue engineering. Therefore， this paper discusses the research and clinical application of new modified materials， especially emphasizing the importance of surface modification technology and innovative synthesis strategies， so that the properties of modified materials are infinitely close to the characteristics of human ear cartilage. In addition， this paper also summarizes the control methods of stem cell differentiation in ear cartilage tissue engineering. The application performance and biocompatibility of different ear scaffolds were reviewed in order to provide guidance for auricle reconstruction.

Cranial bone repair subsequent to decompressive craniectomy holds paramount significance， as the properties of the materials employed directly influence surgical outcomes and patient prognosis. At present， traditional repair materials are beset with limitations， and there exists an urgent clinical imperative to develop novel materials that exhibit bioactivity， mechanical compatibility， safety， and cost-effectiveness. This review comprehensively and systematically summarizes the most recent research advancements in cranial repair materials. It meticulously compares the advantages and disadvantages of traditional materials and emerging technologies， and conducts in-depth analyses of the risk management strategies for repair materials. The objective is to furnish evidence-based decision-making support for neurosurgeons and concurrently offer development recommendations for materials scientists.

Objective To explore whether butorphanol tartrate as an adjuvant of ropivacaine for brachial plexus block can reduce the incidence of rebound pain after brachial plexus block. Methods Based on sample size calculation， 174 patients undergoing upper limb bone surgery were included in this study and randomized into three groups using statistical software： butorphanol tartrate compound local anesthetic （group B1）， brachial plexus block with 0.25% ropivacaine 20 mL （including adjuvant butorphanol 1mg）； intravenous butorphanol group （group B2）， brachial plexus block with 0.25% ropivacaine 20 mL， in addition， 1mg of butorphanol was administered i. v； control （group C）， only 0.25% ropivacaine 20ml for brachial plexus block. The patients were visited the day before operation， and the basic information of the patients was obtained. At the same time， the Douleur Neuropathique 4 questions （DN4） was used to evaluate whether there were neuropathic components （DN4 ≥ 4） in the site to be operated on， and the Numerical rating scale （NRS） was introduced to the patients， and the preoperative NRS value was obtained. 30 minutes before the operation， the same anesthesiologist with rich experience in nerve block completed the ultrasound-guided brachial plexus block （interscalene approach）， and tested whether the block effect was perfect. After entering the operating room， the patients were given general anesthesia， and the duration of operation， vital signs during operation， dosage of analgesics and whether or not using tourniquet were recorded. After the operation， the patients were sent to the postanesthesia care unit， and then sent to the ward when the patients reached the standard of leaving the room. Distribute pain diaries to patients and their families and instruct them to fill in relevant matters. The patients were followed up at 0 h， 6 h， 12 h， 18 h， 24 h and 36 h after operation to obtain the NRS value at each time point after operation， the time when the block disappeared and the highest NRS value within 12 hours， the first use of rescue analgesics， the use of postoperative analgesics， postoperative adverse events and the quality of patient recovery. Results The incidence of rebound pain was 31.6% in B1，48.2% in B2， and 54.4% in C. The pairwise comparison showed statistical difference between B1 and C （P < 0.05）. Rebound pain score in the three groups was B1 group < B2 group < C group and it was statistically different between the three groups（P < 0.05）. The pairwise comparison showed a statistical difference between B1 group and C group （P < 0.05）. Postoperative opioid consumption in Group C was greater than that in Group B1 and was statistically different （P < 0.05）.There was no statistically significant difference in NRS scores at each time point in the three groups and no difference in the area under the curve （NRS-AUC） of the pain curve at 0-6 hours and 6-24 hours after surgery （P > 0.05）. There were no statistical differences in the duration of motor block， sensory block duration， duration of analgesia， time to first request for rescue analgesia， and QoR-15 recovery quality score （P > 0.05）. There was no statistical difference in the incidence of postoperative adverse effects among the three groups （P > 0.05）. Conclusion This study found that brachial plexus block with 1mg butorphanol tartrate as an adjuvant for ropivacaine reduced the incidence of rebound pain and rebound pain scores after upper limb orthopedic surgery and reduced postoperative opioid consumption.

Objective To observe the clinical effects of the stereotaxic oblique-pulling manipulation under different mechanical parameters in the treatment of patients with lumbar disc herniation， and to explore the muscle-relaxing effects of the stereotaxic oblique-pulling manipulation and the traditional lumbar oblique-pulling manipulation in the treatment of lumbar disc herniation under the optimal mechanical parameters. Methods Using a three-factor， three-level orthogonal test method， 27 LDH patients included in this study were randomly divided into 9 parameter groups， with 3 patients in each group， and were treated with different parameters of the stereotactic angled wrench method. 3 factors were set up for the pressing force， the number of times， and the treatment interval， and each factor consisted of 3 levels， i.e.， pressing force： 300 ~ 400 N， 400 ~ 500 N， and 500 ~ 600 N； the number of times pressed 3 levels were set up： 6 times， 9 times， 12 times； 3 levels of treatment interval： 1 day interval， 2 days interval， 3 days interval. After screening the optimal mechanical parameters through VAS， ODI and FDD evaluation indexes， 94 patients were included and randomly divided into two groups； the treatment group was stereotaxic oblique-pulling manipulation under the configuration of optimal mechanical parameters， and the control group was the traditional lumbar oblique-pulling manipulation， and the changes of patients' VAS and ODI scores as well as the thickness of multifidus muscle and cross-sectional area before and after treatment were observed in the treatment of the two groups of patients. Through the comparison of lumbar multifidus muscle between healthy volunteers and patients with lumbar keyboard herniation， the characteristics of lumbar disc herniation multifidus muscle were clarified. The correlation between each observation index and parameter was analyzed by the statistical analysis software SPSS 26.0 to derive the optimal parameters for manipulative treatment. Results Orthogonal test analysis yielded that the order of influence on the efficacy was pressing force > treatment interval > pressing times， and the pressure interval with the best efficacy was： 500 ~ 600 N， the number of times was 12 times， and the Treatment internal of 2 days. The degree of degeneration of lumbar multifidus muscle in patients with lumbar disc herniation was more obvious compared with that of healthy volunteers， and the difference was stati stically significant （P < 0.05）. Observed in both groups of patients with lumbar disc herniation after 6 weeks of treatment time， the VAS and ODI scores of both groups decreased significantly after treatment compared with those before treatment （P < 0.05）， with greater improvement in the treatment group. The results of the multifidus muscle showed that after treatment， the treatment group could significantly increase the resting thickness， contraction thickness， contraction rate and cross-sectional area of the multifidus muscle had significant changes （P < 0.05）， in which the contraction thickness， contraction rate before and after the treatment changes were more significant than the control group. Conclusions The stereotaxic oblique-pulling manipulation is effective in the treatment of lumbar disc herniation， in which the manipulation parameter pressure of 500 ~ 600 N， the number of presses 12 times， and the treatment interval of 2 days once for the treatment of lumbar disc herniation has better analgesia and improves the dysfunction effect. Compared with the traditional lumbar oblique-pulling manipulation， the stereotaxic oblique-pulling manipulation is better in improving the pain symptoms and dysfunction of patients with lumbar disc herniation， as well as the resting thickness of the multifidus muscle， the contraction thickness， the contraction rate of change， and the cross-sectional area.

Objective To explore the clinical effectiveness of full endoscopic lamina fenestration discectomy （Endo-LOVE） in combination with nerve root pulsed radiofrequency （NR-PRF） in the treatment of lumbar degenerative disease （LDD）， along with the amelioration of postoperative residual symptoms. Methods A retrospective analysis was performed on 102 patients with LDD who were treated in our hospital between January 2022 and June 2023. Among them， 53 cases were assigned to the observation group （receiving Endo-LOVE combined with NR-PRF）， and 49 cases were included in the control group （undergoing Endo-LOVE alone）. The mean follow-up period was 15.05 ± 1.15 months. The general data of the two groups were compared. Observations were carried out at preoperative， 1-day， 7-day， 1-month， 3-month， 6-month， and final follow-up time points postoperatively. The perioperative data and follow-up outcomes of the two groups were compared. Results Prior to surgery， no significant disparities were detected in the general conditions and clinical observation indicators （VAS， M-JOA， and ODI scores） between the two groups. Postoperatively， both groups exhibited a notable improvement in clinical indicators when compared to the preoperative levels （P < 0.05）. Within three months after surgery， the observation group showed significantly more pronounced improvement in all clinical indicators than the control group （P < 0.05）. At six months postoperatively and during the final follow-up， no statistically significant differences in clinical indicators were found between the two groups. Moreover， at the final follow-up， there was no statistically significant difference in the Macnab scores between the two groups （P > 0.05）. Conclusion Endoscopic decompression for the treatment of LDD exhibits high safety and reliability. When combined with endoscopic NR-PRF， it enhances the clinical efficacy， reduces the incidence of postoperative residual symptoms， and facilitates rapid postoperative recovery. This complementary combination presents a novel therapeutic strategy for LDD.

Objective The present study was designed to explore the inhibitory effects of the ADC drug Disitamab Vedotin （RC-48） on breast cancer cells with different HER-2 expression levels by utilizing a tumor organoid culture system. Methods Within the framework of the tumor organoid culture system， the breast cancer cell lines MCF-7 （characterized by low HER-2 expression， Luminal A subtype） and BT-474 （exhibiting high HER-2 expression， HER-2 positive subtype） were cultured independently and in various mixed ratios. The histological characteristics， as well as the expression levels and distribution of HER-2 in MCF-7 and BT-474 organoids， were analyzed via immunohistochemistry and immunofluorescence techniques. MCF-7 and BT-474 organoids were separately treated with Vedotin （RC-48）， Disitamab， and Monomethyl auristatin E （MMAE）. Additionally， a drug sensitivity test of Disitamab Vedotin （RC-48） was carried out on mixed MCF-7 and BT-474 cell ratios and on patient-derived breast cancer organoids， with the assessment conducted using the 3D-Glo method. Results In the tumor organoid culture system， immunohistochemistry and immunofluorescence analyses demonstrated that HER-2 was predominantly localized in the cell membrane. Specifically， BT-474 organoids exhibited robust HER-2 expression， while MCF-7 organoids displayed relatively low expression levels. When compared with MCF-7 organoids， RC48-ADC exerted a more pronounced inhibitory effect on BT-474 organoids， with IC₅₀ values of 109.7 μg/mL and 2.792 μg/mL， respectively. The co-culture model further confirmed the bystander effect of RC-48， revealing that the ratio of HER-2-positive to HER-2-negative cells significantly influenced drug efficacy. Additionally， treatment with RC-48 led to a reduction in HER-2 expression in breast cancer organoids with diverse HER-2 expression levels. Conclusions The tumor organoid model can accurately mirror drug sensitivity and bystander effects. Within this model， RC-48 effectively inhibited HER-2 highly-expressing breast cancer cells， augmented the killing effect through the bystander mechanism， and downregulated HER-2 expression， thereby suggesting its potential for targeting HER2-associated breast cancer.

Objective To investigate the mechanism of mitochondrial autophagy regulating the expression of NLRP3 inflammasome in prostate tissue in experimental autoimmune prostatitis（EAP）rats and to provide a theoretical basis for the study of new drug development. Methods A numerical table of 40 SD male rats was randomly divided into 8 groups. Namely， normal group （N）， model group （M）， rapamycin group （RAP）， rapamycin + mitochondrial autophagy inhibitor group （RAP+Mdivi-1）， autophagy inhibitor group （3MA）， mitochondrial autophagy inhibitor group （Mdivi-1）， Caspase1 inhibitor group （Caspase1）， NLRP3 inhibitor group （NLRP3）， 5 animals per group. After drug intervention， HE staining， immunofluorescence， colorimetry， and WB method were used to observe the relevant indexes. Results Compared with group N， the structural damage of prostate gland was obvious in group M. Compared with the M group， the prostate gland structure in RAP group， Caspase-1 group and NLRP3 group were improved. However， that in 3-MA group and Mdivi-1 group was not improved， and even destroyed more obviously. Compared with group N， the co-expression of LC3-II and LAMP-1 was enhanced， mitochondrial membrane potential was decreased， ROS release level was significantly increased in prostate tissue of rats in group M. Compared with the M group， the above indexes in RAP group and NLRP3 group were significantly improved. However， the above indexes in 3-MA group and Mdivi-1 group became worse. Compared with group N， the protein expressions of DRP1， PINK1 and Parkin in prostate mitochondria of rats in group M were increased， and the protein expressions of OPA1 was decreased. Compared with group M， the protein expressions of DRP1， PINK1 and Parkin in RAP group and NLRP3 group were significantly increased， while those in 3-MA group and Mdivi-1 group were significantly decreased. OPA1 protein expression was significantly decreased in the RAP group. The protein expression of Parkin in Caspase-1 group was decreased， but the protein expression of DRP1， OPA1 and PINK1 had no significant difference. Compared with group N， the protein expressions of LC3II/LC3I， Beclin1， NLRP3， ASC， Cleaced-Caspase1， Cleaced-IL-1β， and IL-18 in prostate tissue of rats in group M were increased， while the protein expressions of P62 was decreased. Compared with M group， LC3II/LC3I and Beclin1 protein expressions in RAP group and NLRP3 group were significantly increased， while those in 3-MA group and Mdivi-1 group were significantly decreased. Compared with M group， P62， NLRP3， ASC， Cleaced-Caspase1， Cleaced-IL-1β and IL-18 protein expressions in RAP group and NLRP3 group were significantly decreased， while those in 3-MA group and Mdivi-1 group were significantly increased. Compared with M group， the protein expressions of NLRP3， ASC， Cleaced-Caspase1， Cleaced-IL-1β， and IL-18 in Caspase-1 group were significantly reduced， but the protein expressions of LC3Ⅱ/LC3Ⅰ， Beclin1， and P62 were not statistically significant. Conclusions NLRP3 inflammatosome is involved in the progression of chronic prostatitis in EAP rats. Mitochondrial autophagy mediates the occurrence and development of prostatitis in EAP by regulating the activation of NLRP3 inflammasome in prostate tissue.

Objective To investigate the regulatory effects and molecular mechanisms of PUS3 on GBM cell malignant behaviors （proliferation， apoptosis， invasion） in vitro， providing potential therapeutic targets for GBM. Methods The expression of PUS3 in GBM was analyzed using the GEPIA2 database.Kaplan-Meier survival analysis evaluated the survival difference between PUS3 high- and low-expression patients. qRT-PCR and Western blot were performed to detect PUS3 expression in normal glial cells （HEB） and GBM cell lines （U87， LN229， U251， T98G）. PUS3-stably overexpressing GBM cell lines were constructed. Colony formation， CCK-8 assay， and flow cytometry were used to assess proliferation and apoptosis. Transwell assay evaluated cell invasion. Immunohistochemistry （IHC） detected PUS3 expression in GBM patient tissues. Western blot analyzed tumor-related pathway proteins after PUS3 overexpression. Results The expression level of PUS3 is elevated in GBM patient tissues， and the mRNA and protein expression levels in GBM cells are significantly higher than those in HEB cells （P < 0.01）. After overexpression of PUS3， the proliferation ability of GBM cells was enhanced （P < 0.05）， the apoptosis rate decreased （P < 0.01）， and the number of invasive cells increased （P < 0.001）. Mechanistically， overexpression of PUS3 significantly activates the AKT pathway， and the use of AKT inhibitors in PUS3 overexpressing cells can reverse the pro cancer effect. Conclusion PUS3 is highly expressed in glioblastoma （GBM） and promotes tumor cell proliferation， invasion， and apoptosis inhibition by activating the AKT pathway， suggesting its potential as a therapeutic target for GBM treatment.

Objective To investigate the inhibitory effects of resveratrol （Res） on the growth of hormone-dependent and castration-resistant prostate cancer （PCa） and explore its mechanisms. Methods Subcutaneous xenograft models were established in nude mice using the human prostate cancer cell lines LNCaP （hormone-sensitive） and its castration-resistant derivative LNCaP-B. Thirty nude mice were randomly divided into three groups： control group， Res-treated and docetaxel. Tumor growth was recorded. Quantitative real-time polymerase chain reaction （qRT-PCR） and Western blot were performed to assess androgen receptor （AR） mRNA and protein expression levels in tumor tissues. Results Moderate- and high-dose Res significantly inhibited the growth of both LNCaP and LNCaP-B xenografts in a dose-dependent manner， with statistical significance （P < 0.05）. qRT-PCR and Western blot analyses revealed that Res markedly downregulated AR mRNA expression and protein levels compared to the control group. However， no significant pathological alterations were observed in HE-stained tumor sections. Conclusions Resveratrol suppresses the growth of hormone-dependent and castration-resistant prostate cancer by inhibiting AR expression and signaling pathway activity. These findings highlight its potential as an adjuvant therapeutic agent to androgen deprivation therapy （ADT）， providing a theoretical foundation for its clinical application in PCa treatment.

Objective To explore the association between plasma fibrinogen （FBG） levels and the risk of in-hospital mortality among patients with septic shock. Methods The clinical data of 563 patients diagnosed with septic shock in the Intensive Care Unit （ICU） of Shenzhen Second People's Hospital from August 1， 2018， to December 31， 2020， were collected. Patient demographic information， basic vital signs， and blood routine and biochemical indices upon admission were gathered. Moreover， the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ） scores were calculated. Binary logistic regression analysis was conducted to explore the correlation between plasma fibrinogen levels and in-hospital mortality in patients with septic shock. Additionally， a generalized additive model （GAM） and smoothed curve fitting were employed to investigate the nonlinear relationship between plasma fibrinogen and in-hospital mortality. Receiver operating characteristic （ROC） curves were constructed for FBG and APACHEⅡ scores to predict in-hospital mortality in septic shock patients. The area under the curve （AUC） was computed to compare the predictive efficacies of the two. Furthermore， a segmented linear regression model was utilized for quantification. Results Binary logistic regression analysis demonstrated a significant negative correlation between plasma fibrinogen levels and in-hospital mortality among patients with septic shock （P < 0.05）. GAM modeling and smoothed curve fitting disclosed a nonlinear association between plasma fibrinogen levels and in-hospital mortality， with an inflection point at 5.54 g/L. The segmented linear regression model indicated that， to the left of the inflection point （FBG ≤ 5.54 g/L）， for every 1 g/L decrease in plasma fibrinogen， the risk of death increased by 24.5% （OR = 0.755， P = 0.003）. Conversely， to the right of the inflection point （FBG > 5.54 g/L）， the relationship was not statistically significant （OR = 1.049， P = 0.685）. The findings of the subgroup analyses indicated that the characteristics of the subgroups did not alter the relationship between blood fibrinogen levels and in-hospital mortality. Conclusion There is a nonlinear relationship between FBG levels and in-hospital mortality in patients with septic shock， which has predictive value for evaluating the risk of in-hospital mortality in this patient cohort.

Objective To explore the prognostic implications of coagulation-fibrinolysis biomarkers in intracerebral hemorrhage （ICH） and to construct a multivariable logistic regression model for individualized risk prediction. Methods A total of 101 ICH patients who were admitted to Nanfang Hospital of Southern Medical University from January 2020 to December 2023 were retrospectively enrolled. These patients were stratified into a poor outcome group （ΔGCS ≤ 0） and a good outcome group （ΔGCS > 0） according to the difference in Glasgow Coma Scale （GCS） scores between discharge and admission. Coagulation and fibrinolysis markers collected upon admission were analyzed. The Least Absolute Shrinkage and Selection Operator （LASSO） regression was employed to screen variables. A logistic regression model was constructed using 70% of the cases （the training set）， while the remaining 30% were utilized for validation. The performance of the model was evaluated through receiver operating characteristic （ROC） curves， calibration plots， Hosmer-Lemeshow goodness-of-fit test， and decision curve analysis （DCA）. Results Univariate analysis indicated that thrombin-antithrombin complex （TAT）， D-dimer， and age exhibited significant differences between the two outcome groups （P < 0.05）. These three variables were selected via LASSO regression and incorporated into the logistic model. The final model equation was expressed as： logit（P） = -6.234 + 1.132 × TAT + 0.867 × D-dimer + 0.699 × Age. In the training set， the area under the ROC curve （AUC） was 0.795. The calibration curve demonstrated excellent agreement between the predicted and observed outcomes， with a Hosmer-Lemeshow test P-value of 0.8568. DCA revealed that the model achieved net clinical benefit across a broad range of risk thresholds （0.1 ~ 0.8）. Conclusions TAT， D-dimer， and age are independent predictors of poor prognosis in patients with ICH. The logistic regression model based on these variables demonstrates favorable discriminatory ability and clinical utility. The nomogram derived from this model enables individualized risk assessment and may aid clinicians in early prognostic evaluation and treatment planning.

Objective To assess the clinical effectiveness of Poly（p-dioxanone）（PPDO） bidirectional sawtooth inverted V-shaped wiring and straight wiring in ameliorating nasolabial fold wrinkles within the context of facial rejuvenation. Methods Between March 2023 and January 2024， 60 patients presenting with nasolabial fold wrinkles who underwent PPDO subcutaneous implantation and lifting in the Department of Plastic Surgery at the First Affiliated Hospital of Bengbu Medical University were randomly allocated into an observation group and a control group. At 4 weeks， 12 weeks， and 24 weeks post-surgery， the clinical efficacy was statistically analyzed. The incidence of complications was documented to evaluate the safety of the procedure， and a satisfaction survey was carried out. Results In each time period， the Wrinkle Severity Rating Scale （WSRS） scores of both groups decreased significantly when compared to those prior to the operation （P < 0.05）. At each corresponding time point after surgery， there was a statistically significant difference in the WSRS scores between the two groups in the observation group （P < 0.05）. In both groups， the WSRS score was the lowest at 12 weeks post-surgery， and the score at 24 weeks post-surgery was significantly higher than that at 12 weeks post-surgery （P < 0.05）. The overall effective rate of facial improvement in the observation group was 93.33%， which was significantly higher than that in the control group （73.33%）. The difference was statistically significant （χ² = 4.320， P < 0.05）. No obvious complications occurred in either group. The satisfaction rate in the observation group was 4.067 ± 0.828， which was significantly higher than that in the control group （3.400 ± 0.932）. The difference was statistically significant （t = 2.929， P < 0.05）. Conclusions Both the PPDO two-way sawtooth line inverted V-shaped wiring method and the straight wiring method can effectively improve nasolabial fold wrinkles. Compared with the straight wiring method， the inverted V wiring method demonstrates a more pronounced improvement effect， higher subject satisfaction， and fewer consumables. The optimal results were achieved at 12 weeks after surgery for both wiring methods. Moreover， neither surgical procedure was associated with significant complications.

Objective An innovative transparent full-visualization working channel was developed to investigate the clinical efficacy of applying a transparent full-visualization working channel in percutaneous endoscopic interlaminar discectomy （PEID） for the treatment of lumbar disc herniation. Methods The medical records of 145 patients who underwent PEID for lumbar disc herniation from September 2023 to September 2024 were included. These patients were classified into two groups based on the use of a transparent full-visualization working channel or a metal working channel： 69 cases in the transparent channel group and 76 cases in the metal channel group. A comparative analysis was carried out between the two groups， evaluating differences in baseline characteristics， surgical performance indicators， the incidence of postoperative complications， and overall treatment outcomes. Results The operative time in the transparent channel group was shorter than that in the metal channel group， and the difference was statistically significant （P < 0.05）. Regarding the length of postoperative hospital stays and the frequency of intraoperative fluoroscopy， no significant differences were observed between the transparent and metal channel groups （P > 0.05）. In the transparent channel group， postoperative sensory abnormalities in the lower extremities occurred in one patient， while in the metal channel group， seven patients experienced such issues. Nevertheless， this difference in complication rates did not reach statistical significance （P > 0.05）. Similarly， no significant differences were detected in EMG electrophysiological alerts during the placement of the working channel and nerve exploration between the two groups （P > 0.05）. However， during intraoperative decompression， the transparent channel group had 8 fewer EMG alarms compared to the metal channel group's total of 29， and this difference was statistically significant （P < 0.05）. Conclusions The application of a transparent fully visualized working channel in the transforaminal approach for PEID can achieve the same clinical efficacy as a metal working channel. Moreover， it can significantly reduce nerve root irritation. The microscopic field of view of the transparent working channel is notably superior to that of the metal working channel. This enhanced visibility expands the field of view， facilitating effective nerve observation and protection， and ultimately increasing the safety of the surgical procedure.

Objective To explore the correlation between serum phosphorylated Tau protein-181 （P-Tau181）， gamma glutamyl transpeptidase （GGT）， silent information regulator 1（SIRT1） and sleep disorders in patients with cerebral small vessel disease. Methods A total of 156 patients with cerebral small vessel disease （CSVD） were divided into a sleep disorder group （PSQI ≥ 10） and a normal sleep group （PSQI < 10） based on the Pittsburgh Sleep Quality Index （PSQI） scores. Serum levels of P-Tau181， GGT， and SIRT1 were compared between the two groups， and the predictive value of these biomarkers for the development of sleep disorders in CSVD patients was analyzed. Results Among 156 patients with cerebral small vessel disease （CSVD）， 52（33.33%） were diagnosed with sleep disorders， and their Pittsburgh Sleep Quality Index （PSQI） scores were significantly higher than those of the normal sleep group （P < 0.05）. The serum levels of P-Tau181， GGT， and SIRT1 in the sleep disorder group were elevated compared to the normal sleep group （P < 0.05）. Positive correlations were observed between PSQI scores and P-Tau181， GGT， and SIRT1 levels （P < 0.05）. The areas under the curve （AUC） for predicting sleep disorders in CSVD patients using individual biomarkers （P-Tau181， GGT， SIRT1） and their combined prediction were 0.672， 0.742， 0.749， and 0.843， respectively. Conclusion The abnormal expression of P-Tau181， GGT， and SIRT1 is associated with sleep disorders in patients with cerebral small vessel disease.

Objective To investigate CBX2 and TIM3 in salivary adenoid cystic carcinoma （SACC） tissue and their relationship with clinical pathological features and prognosis. Methods 80 patients with SACC who underwent surgical treatment in the First Affiliated Hospital of Hebei North University from January 2016 to January 2020 were selected. Immunohistochemistry was used to measure CBX2 and TIM3 in tissues. The relationship between CBX2 and TIM3 in SACC tissue and prognosis was discussed though Kaplan-Meier method. The factors influencing the prognosis of SACC were discussed using multivariate Cox regression. Results The positive rates of CBX2 and TIM3 in SACC tissues were clearly higher than those in normal glandular tissues adjacent to cancer （χ² = 11.237， 8.229， P < 0.05）. The CBX2 and TIM3 were associated with nerve invasion and distant metastasis （P < 0.05）. After a 5-year follow-up， 26 cases died and 54 cases survived， with an overall 5-year survival rate of 67.50% （54/80）. The death group had higher positive rates of CBX2 and TIM3 in SACC tissues than the survival group （P < 0.05）. Patients with positive CBX2 and TIM3 in SACC tissues had clearly lower 5-year survival rate than patients with negative CBX2 and TIM3 （Log Rank χ² = 6.564， 5.197， P < 0.05）. CBX2， TIM3 positivity， nerve invasion， and distant metastasis were risk factors affecting prognosis （P < 0.05）. Conclusion The positive expression of CBX2 and TIM3 in SACC tissues is closely related to the clinical pathological features and prognosis of patients.

Objective To investigate the correlation between salivary interleukin-33 （IL-33） and anti-salivary gland protein 1 （SP-1） antibody levels and salivary gland injury in primary Sjogren's syndrome （pSS）. Methods A total of 91 patients with pSS admitted to Yixing People's Hospital from March 2020 to January 2025 were recruited as the observation group. Meanwhile， 42 healthy individuals who were matched for gender and age and visited the same hospital during the same period were selected as the control group. The levels of IL-33 and anti-SP-1 antibodies in saliva， along with clinical data， were compared between the observation group and the control group. Additionally， the levels of IL-33 and anti-SP-1 antibodies in saliva were compared among patients with different salivary gland ultrasound （SGUS） scores. Moreover， the correlations between the levels of IL-33 and anti-SP-1 antibodies in saliva of pSS patients and saliva flow rate， clinical indicators， and SGUS scores were analyzed. Results The levels of IL-33 and anti-SP-1 antibodies in the observation group were significantly higher than those in the control group （P < 0.05）. The dynamic saliva flow rate and static saliva flow rate in the observation group were notably lower than those in the control group （P < 0.05）， while the neutrophil count， CD4⁺ cell count， and immunoglobulin G（IgG） levels in the observation group were significantly higher than those in the control group （P < 0.05）. In patients with a submandibular gland Sj?gren's Ultrasound Scoring （SGUS） score ≥ 2， the levels of salivary IL-33 and anti-SP-1 antibodies were significantly higher than those in patients with a submandibular gland SGUS score < 2 （P < 0.05）. Similarly， in patients with a parotid gland SGUS score ≥2， the levels of salivary IL-33 and anti-SP-1 antibodies were significantly higher than those in patients with a parotid SGUS score < 2 （P < 0.05）. Correlation analysis indicated that the levels of IL-33 and anti-SP-1 antibodies in the saliva of pSS patients were positively correlated with the dynamic saliva flow rate， static saliva flow rate， CD4⁺ cell count， and SGUS score （P < 0.05）. However， the levels of IL-33 and anti-SP-1 antibodies in the saliva of pSS patients were not correlated with the IgG level and neutrophil count （P > 0.05）. Conclusions The levels of IL-33 and anti-SP-1 antibodies in saliva are positively correlated with the saliva flow rate， CD4⁺ cell count， and SGUS score in pSS patients. These findings suggest that these factors can serve as valuable indicators for evaluating salivary gland injury in pSS patients.

Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery. Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Department of General Surgery， Gansu Provincial Central Hospital， from December 2022 to February 2024. The patients were classified into two groups according to the intraoperative tracer employed： the mitoxantrone group and the nanocarbon group. After a 6-month postoperative follow-up， the baseline data of the two patient groups were compared. The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed. Additionally， the hospitalization costs and the incidence of postoperative complications were compared between the two groups. Results In this study， 110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group. The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group （P < 0.05）. The blue staining rate of MHI reached 97.5%， while the black staining rate of CNSI was 98.3%. The difference between them was not statistically significant （P > 0.05）. Regarding the number of central lymph nodes dissected， it was 9.34 ± 0.22 in the Mitoxantrone group and 9.88 ± 0.24 in the nanocarbon group， with no statistically significant difference （P > 0.05）. Similarly， the parathyroid misdissection rates were 1.8% and 0.8% in the two groups respectively， and no significant statistical difference was observed （P > 0.05）. Postoperative blood calcium and PTH levels measured at 1 day， 1 month， and 6 months did not show any statistically significant differences between the two groups （P > 0.05）. The incidence of transient hypoparathyroidism and hypocalcemia was comparable in both groups （P > 0.05）， and no patients developed permanent hypoparathyroidism or permanent hoarseness. None of the patients in one Mitoxantrone group experienced postoperative hemorrhage， coeliac leakage， or skin staining. In contrast， in the nanocarbon group， there was one case of postoperative hemorrhage and one case of coeliac leakage， and two case of skin staining. Conclusions In laparoscopic unilateral thyroid cancer radical surgery， when it comes to lymph node tracing and parathyroid gland protection， no significant disparities were detected between MHI and CNSI. Nevertheless， CNSI exhibits a shorter staining time for central lymph nodes. In contrast， MHI is more manageable， features a faster metabolic rate， and has been demonstrated to be more cost-effective.

Objective To construct a combined model integrating ultrasonic features and radiomics derived from ultrasound images， and to evaluate its diagnostic performance in re - assessing the benign or malignant nature of Bethesda Ⅲ nodules. Methods A retrospective study was carried out on 442 patients with thyroid nodules classified as Bethesda Ⅲ after fine-needle aspiration biopsy （FNAB） between January 2019 and September 2024. All patients had undergone surgical pathology. The patients were randomly allocated into a training set and a testing set at a ratio of 7∶3. Relevant clinical characteristics were gathered， and regions of interest （ROI） were outlined on the most suspicious slice of the lesion prior to biopsy. Ultrasound radiomics features were extracted， key radiomics features were selected， and radiomics scores （Rad-score） were computed. The ultrasound model， radiomics model， and combined model were constructed. Subsequently， the diagnostic efficacy and clinical application value of each model were evaluated using the area under the receiver operating characteristic curve （AUC） and decision curve analysis （DCA）. Results Univariate analysis and multivariate logistic regression analysis findings indicated that microcalcification， irregular margin， and Rad-score were independent risk factors for the malignant transformation of Bethesda Ⅲ nodules. In the testing set， the AUC values of the ultrasound model， radiomics model， and combined model were 0.76， 0.71， and 0.81， respectively. The calibration curve of the combined model revealed a good consistency between the predicted values and the actual outcomes. The DCA of the testing set demonstrated that the combined model exhibited high clinical utility. Conclusion The combined model， established based on ultrasonic features and ultrasound radiomics， provides a higher predictive value for evaluating the malignancy risk of Bethesda Ⅲ nodules.

Objective To assess the effectiveness of the Gasdermin D C-terminal fragment （GSDMD-CT） as a novel plasma biomarker for the clinical diagnosis of sepsis. Methods Between July 2021 and November 2024， 245 patients from Tangshan Gongren Hospital were enrolled in this study. In accordance with the diagnostic criteria for sepsis and the systemic inflammatory response syndrome （SIRS）， patient samples were classified into the sepsis group and the SIRS group. Meanwhile， healthy individuals were selected as the healthy control （HC） group. Sepsis patients were further categorized into the Gram-positive bacterial group， the Gram-negative bacterial group， and the fungal group based on the type of pathogen infection. The levels of GSDMD-CT， C-reactive protein （CRP）， and procalcitonin （PCT） were measured in all subjects. Nonparametric tests were employed to compare the differences in various indices among different groups. The diagnostic value of GSDMD-CT in sepsis was evaluated by constructing the receiver operating characteristic （ROC） curve. Spearman's correlation analysis was used to examine the relationships among GSDMD-CT， CRP， and PCT. Results The plasma GSDMD-CT levels in the sepsis group 23.02（16.71， 33.01） pg/mL and in the SIRS group 16.52（11.26， 22.22） pg/mL were significantly higher than those in the healthy control group 7.02（4.42， 11.43） pg/mL （U = -10.175， -7.890， P < 0.001）. Moreover， the plasma GSDMD-CT levels in the sepsis group were significantly higher than those in the SIRS group （U = -2.941， P < 0.05）. In the Gram-positive bacterial group， the Gram-negative bacterial group， and the fungal group， the GSDMD-CT levels were 23.01（17.16，27.51）pg/mL， 23.41（16.78，35.50） pg/mL， and 16.29 （14.53，56.27） pg/mL， respectively. When compared with the healthy control group， the GSDMD-CT levels in these three groups were all significantly higher （P < 0.05）. However， there were no significant differences in GSDMD-CT levels among these three groups （P > 0.05）. The area under the curve （AUC） of plasma GSDMD-CT for diagnosing sepsis was 0.881 （95％ confidence interval： 0.833 ~ 0.929）， with a Youden index （YI） of 0.695， a sensitivity of 85.0％， and a specificity of 84.5％. Spearman correlation analysis indicated a weak correlation between GSDMD-CT and C-reactive protein （CRP） （r = 0.32， P < 0.001） and a positive correlation between GSDMD-CT and procalcitonin （PCT） （r = 0.65， P < 0.001）. Conclusion GSDMD-CT exhibits significant clinical value in the diagnosis of sepsis and holds great potential as a biomarker in the diagnostic process of sepsis.

Objective To explore the predictive efficiency of serum Dickkopf-1 protein （DKK-1） and C1q tumor necrosis factor-related protein 3 （CTRP3） levels for thoracolumbar fractures in patients with osteoporosis （OP）. Methods Between January 2020 and August 2024， 124 OP patients treated at the hospital were recruited into the OP group. Based on the occurrence of thoracolumbar fractures， these OP patients were divided into a non-fracture group （n = 70） and a fracture group （n = 54）. Additionally， 124 healthy individuals who underwent physical examinations served as the control group. The enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of serum DKK-1 and CTRP3. Multivariate logistic regression analysis was utilized to analyze the influencing factors of thoracolumbar fractures in OP patients. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of serum DKK-1 and CTRP3 for thoracolumbar fractures in OP patients. Results In comparison with the control group， the serum level of DKK-1 was significantly higher， while the serum level of CTRP3 was significantly lower in the OP group （P < 0.05）. When compared with the non-fracture group， the fracture group exhibited prominently higher serum DKK-1 levels， age， duration of OP， and proportion of OP grade Ⅲ， whereas the serum CTRP3 level was significantly lower （P < 0.05）. High expression of DKK-1 was identified as an independent risk factor for thoracolumbar fractures in patients with osteoporosis， while high expression of CTRP3 was found to be an independent protective factor for thoracolumbar fractures in such patients （P < 0.05）. The area under the curve （AUC） values of serum DKK-1 and CTRP3 levels for predicting thoracolumbar fractures in OP patients were 0.790 and 0.753， respectively. The AUC of the combined prediction of the two was 0.888， which was superior to the individual predictions of either one （ZDKK-1 - combined = 3.351， ZCTRP3 - combined = 3.172， both P < 0.05）. Conclusions In the serum of OP patients， the expression of DKK-1 is upregulated， while the expression of CTRP3 is downregulated. Both are factors influencing the occurrence of thoracolumbar fractures in OP patients. The combination of the two has a high predictive value for the occurrence of thoracolumbar fractures in OP patients.

Objective To assess the relationship between environmental pollution and mortality， along with the mediating function of socioeconomic status （SES）. Methods Data sourced from the UK Biobank were utilized， encompassing 318，974 participants. SES was evaluated through the Townsend Deprivation Index （TDI）. Cox regression models were employed to explore the associations between environmental pollution and all-cause mortality， as well as cause-specific mortality. Linear regression analysis was conducted to analyze the mediating role of TDI levels in the relationship between pollution and mortality risk. Results During the follow-up period， 24 909 deaths were recorded， with the participants having an average age of 61.5 years. Except for PM₁₀， all pollutants were found to be associated with all-cause mortality， and PM_2.5 was linked to cause-specific mortality. Higher pollution scores were correlated with elevated all-cause mortality hazard ratios （HRs）， reaching 1.13 （95%CI： 1.09 ~ 1.18） in the highest quintile. Greater socioeconomic deprivation was also associated with higher all-cause mortality HRs， specifically 1.36 （95%CI： 1.24 ~ 1.49） for the most deprived group. Conclusions Environmental pollution constitutes a risk factor for mortality， with SES playing a mediating role. Besides public health interventions and personal behavioral guidance， innovative social policies and financial support mechanisms are requisite to improve the overall environment in impoverished regions.

Objective To explore the associations among smoking behavior， cognitive function， and personality traits in first-episode male patients with schizophrenia， thereby providing theoretical underpinnings for individualized treatment strategies in clinical settings. Methods A total of 140 first-episode male inpatients with schizophrenia admitted to the hospital from January 2022 to December 2023 were recruited. According to their smoking behavior， they were categorized into a smoking group （n = 80） and a non-smoking group （n = 60）. Moreover， healthy controls were recruited and classified into a healthy smoking group （n = 62） and a healthy non-smoking group （n = 67） based on their smoking status. The Positive and Negative Syndrome Scale （PANSS） was employed to evaluate psychiatric symptoms in the schizophrenia groups. Nicotine dependence was measured using the Fagerstr?m Test for Nicotine Dependence （FTND） in the two smoking groups. Cognitive function and personality traits were assessed in all participants using the Repeatable Battery for the Assessment of Neuropsychological Status （RBANS） and the Eysenck Personality Questionnaire （EPQ）， respectively. Results Regarding cognitive function， the smoking group among schizophrenia patients demonstrated significantly higher scores than the non-smoking group in immediate memory， attention， and delayed memory （all P < 0.05）. Among schizophrenia patients， FTND scores were moderately negatively correlated with attention and delayed memory （r = -0.552 and -0.657 respectively； both P < 0.001）. Concerning personality traits， smokers had significantly higher scores in neuroticism and psychoticism compared to non-smokers （both P < 0.001）. Both patient groups had significantly lower lie scale scores when contrasted with healthy controls （P < 0.01）， while the healthy smoking group showed significantly higher extraversion scores than the other groups. Conclusions The smoking behavior of male patients during their first episode of schizophrenia exhibits specific characteristics in relation to cognitive performance and personality traits. Smokers demonstrate relatively superior performance in cognitive domains including attention， immediate memory， and delayed memory. However， higher degrees of nicotine dependence are associated with poorer cognitive function， especially in the aspects of attention and delayed memory. Regarding personality， smoking patients display elevated levels of neuroticism and psychoticism. These findings indicate that smoking behavior may be closely associated with cognitive functioning and personality traits， thus meriting clinical attention in the management of schizophrenia.

As a distinct pathological factor and metastatic route of malignant tumors， perineural invasion （PNI） exhibits a close association with the prognosis of several cancer types. In recent years， the clinical significance and underlying mechanisms of PNI in gynecological malignant tumors have increasingly drawn research attention. Currently， it is recognized that PNI is clinicopathologically and prognostically linked to cervical cancer and vulvar cancer. The exploration of its mechanisms encompasses multiple gynecological tumors and numerous molecular pathways， including the CCL2/CCR2 axis， NGF/TrkA pathway， GluR2， among others. Nevertheless， the existing research models are fragmented， lacking systematicity and in-depth analysis， thus necessitating integration. This paper presents a comprehensive review of the occurrence of PNI in gynecologic malignancies， its correlations with clinicopathology and prognosis， its implications for surgical approaches and postoperative adjuvant therapies， as well as the potential molecular mechanisms. By synthesizing the advancements in both clinical and basic research， this review aims to offer a solid theoretical foundation for further exploration of the mechanisms underlying PNI in gynecologic malignancies and for the optimization of clinical therapeutic strategies.

Vascular cognitive impairment （VCI） is a type of cognitive dysfunction caused by cerebrovascular lesions， and its pathological mechanism includes mitochondrial damage. Therefore， maintaining mitochondrial homeostasis is crucial in the occurrence and progression of VCI. Mitochondrial homeostasis involves multiple levels， including biogenesis， autophagy， ion balance， protein quality control， membrane dynamics， and interactions with other organelles. This study outlines the regulatory mechanisms of mitochondrial homeostasis dysregulation at both the micro and macro levels， delves into the key role of mitochondrial homeostasis in VCI， analyzes potential therapeutic directions， and provides new scientific evidence and perspectives for the early diagnosis and treatment of VCI.