The number of patients with type 2 diabetes （T2DM） is rapidly increasing with the annual rise in obesity rates， placing a serious burden on healthcare systems worldwide. In recent years， the potential of lifestyle interventions（LSI） to prevent and treat T2DM through effective weight loss has been recognized， and their importance in the clinical prevention and treatment of T2DM has grown. However， there are still many challenges to be overcome in order to achieve effective LSI prevention and control of T2DM， from theory to clinical application， including a lack of professional guidance， poor patient compliance， and weight regain. Nevertheless， given the outstanding results of numerous evidence-based medical studies on lifestyle interventions in the prevention and treatment of T2DM， as well as their theoretical feasibility，the shift from a “drug-centric” to an “LSI-centric” bringing new hope and new challenges to the clinical prevention and treatment of T2DM.

Objective To investigate the effect of the mutant of adenovirus?mediated HIF?1α triple mutant (Ad?HIF?1α?Trip) on the apoptosis of H9c2 cardiomyocytes under high glucose and hypoxia conditions. Methods H9c2 cardiomyocytes were cultured under hypoxic conditions in vitro and randomly divided into four groups based on glucose concentration and viral transfection status： low oxygen + normal glucose concentration group （LO + NG group）， low oxygen + high glucose concentration group （LO + HG group）， low oxygen+high glucose + adenoviral null vector group （LO + HG + Ad?Null group）， and low oxygen+high glucose + adenovirus HIF?1α triple mutant group （LO + HG + Ad?HIF?1α?Trip group）. After 12 hours of hypoxia， HIF?1α， PI3K， and Akt expression were measured via qRT?PCR and Western blot， and apoptosis of H9c2 cardiomyocytes was assessed by flow cytometry. Results HIF?1α， PI3K， and Akt expression decreased in cardiomyocytes under high glucose and hypoxia， while Ad?HIF?1α?Trip enhanced their expression. Flow cytometry revealed increased apoptosis under high glucose and hypoxia， which was reduced by Ad?HIF?1α?Trip. Conclusion Ad?HIF?1α?Trip upregulates HIF?1α， PI3K， and Akt in H9c2 cardiomyocytes under high glucose and hypoxia， likely reducing apoptosis via PI3K?Akt pathway activation.

Objective To construct a mindfulness-based self-care intervention program for patients with chronic heart failure （CHF） and their caregivers based on binary disease management theory and explore its small-scale application effect. Methods A prospective study was conducted on 100 pairs of CHF patients admitted to our hospital and their caregivers from January 2024 to October 2024. After excluding those with invalid survey data， 92 pairs were finally included and randomly divided into an observation group and a control group， each consisting of 46 pairs. The control group received routine nursing care， while the observation group received the mindfulness-based self-care program based on binary disease management theory in addition to routine nursing care. The Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale （HAMD）， Self Compassion Scale （SCS）， and Mindfulness Attention Awareness Scale （MAAS） were used to compare the anxiety， depression， self-care， and mindfulness levels of patients and caregivers at three time points： pre-intervention （T₁）， right post-intervention（T₂）， and one month post-intervention （T₃）. The Caregiver Positive Perception Scale （PAC） was used to evaluate the caregiver's positive perception at each time point. Results The HAMA and HAMD scores of patients and caregivers in the observation group were lower than those in the control group at T2 and T3， while the SCS scores were significantly higher （all P < 0.05）. Repeated-measures analysis of variance showed significant differences in HAMA， HAMD， and SCS scores between groups over time， and in the interaction between time and time （all P < 0.05）. The MAAS scores of patients and caregivers in the observation group were also significantly higher at T₂ and T₃ compared to the control group. Repeated analysis of variance showed significant differences in MAAS scores between the two groups， at different times， and in the interaction of time between groups （all P < 0.05）. The PAC scores of caregivers in the observation group were significantly higher at T₂ and T₃， with significant differences in repeated-measures analysis of variance for group， time， and group × time interaction （all P < 0.05）. Conclusions The mindfulness-based self-care intervention program based on binary disease management theory effectively reduces negative emotions in patients and caregivers， and improves mindfulness and self-care， showing clinical application potential.

Objective To investigate the protective effects and potential mechanisms of the preparation of Abelmoschus manihot （L.） Medik （Jiahua Tablet） against acute radiation-induced myocardial injury， based on myocardial injury markers （sST2， cTnI） and oxidative stress damage-related indicators （SOD， MDA）， and to provide new avenues for the prevention and treatment of radiation-induced heart disease （RIHD）. Methods Sixty-nine patients with thoracic malignant tumor who received radiotherapy at the department of radiation oncology in Hospital Affiliated to Nanjing University of Chinese Medicine from December 2023 to November 2024 were enrolled in the study. Participants were randomly divided into control group （n = 38） and observation group （n = 31）. The control group received standard radiotherapy in conjunction with conventional medications for RIHD， while the observation group was additionally administered Jiahua Tablet alongside the same regimen. Both groups took medications continuously for 1 month. Changes in serum levels of sST2， cTnI， SOD， and MDA were compared between the two groups 3 days prior to radiotherapy and 7 days after radiological therapy. Results On day 7 post-radiotherapy， the levels of sST2 and cTnI in the control group were highly elevated， showing statistically significant difference （P < 0.01）. In contrast， the levels of sST2 and cTnI in the observation group showed only mild elevation， and no statistically significant difference was observed （P > 0.05）. Between-group analysis demonstrated that post-treatment sST2 and cTnI levels in the observation group were substantially lower compared to those in the control group， indicating statistically significant difference （P < 0.05）. After treatment， SOD level in the control group was considerably lower compared to its pre-treatment level， and marked statistical significance was observed （P < 0.01）. SOD level in the observation group demonstrated a downward trend compared to baseline value， indicating no statistical significance（P > 0.05）. Between-group analysis demonstrated that post-treatment SOD level in the observation group was substantially elevated compared to that in the control group， indicating a highly significant disparity（P < 0.05）. After treatment， MDA level in the control group was considerably higher compared to its pre-treatment level， and a marked statistical significance was observed （P < 0.05）， whereas MDA level in the observation group showed only a mild increase compared to baseline value， with no statistically significant difference （P > 0.05）.Between-group analysis demonstrated that post-treatment MDA level in the observation group was substantially lower compared to that in the control group， demonstrating a remarkably statistically significant difference （P < 0.01）. Conclusion The preparation of Abelmoschus manihot （L.） Medik （Jiahua Tablet） effectively inhibits acute radiation-induced myocardial injury， with its potential mechanism closely linked to the suppression of oxidative stress responses.

Objective To develop and validate a nomogram model for predicting recurrence after radiofrequency catheter ablation （RFCA） in patients with atrial fibrillation and heart failure using body surface electrocardiogram indicators and clinical indicators. Methods We retrospectively analyzed 305 patients with atrial fibrillation complicated with heart failure who underwent RFCA from January 2019 to January 2024. Patients were randomized into training set （213 cases） and validation set （92 cases） at a ratio of 7∶3 and followed up for at least 1 year. Based on the recurrence status， the patients were divided into recurrence group and non-recurrence group， with body surface electrocardiogram indicators and clinical indicators collected. Multivariate logistic regression analysis identified for risk factors for post RFCA recurrence， which were used to construct a nomogram. Model performance was assessed using the area under the receiver operating characteristic curve （AUC）， Hosmer-Lemeshow test， calibration curves， and decision curve analysis （DCA）. Results Among the 305 patients， 84 （27.54%） experienced recurrence after treatment. In the training set， 61 patients had recurrence and 152 did not. No statistical differences were observed between the training set and the validation set （all P > 0.05）. In the training set， the recurrence group exhibited a higher proportion of persistent atrial fibrillation and significantly higher CHA2DS2-VASc scores， larger left atrial diameter， longer PR interval， and higher levels of NLR and NT-proBNP compared to the non-recurrence group （all P < 0.05）. Multivariate stepwise regression analysis revealed that high CHA2DS2-VASc score， long left atrial diameter， prolonged PR interval， and high NLR were independent risk factors of recurrence after RFCA （P < 0.05） A four-factor prediction model was established as： Ln （P/1-P） = -12.87 + 0.84*CHA2DS2-VASc score + 0.11* left atrial diameter + 0.03*PR interval + 0.31*NLR. The training and validation models showed AUCs of 0.85（95%CI： 0.80 ~ 0.91） and 0.85 （95%CI： 0.76 ~ 0.94）， respectively， suggesting that the model had good predictive efficiency. Hosmer-Lemeshow test results （χ2 = 2.43， P = 0.965 for the training set； χ2 = 5.30， P = 0.725 for the validation set） confirmed model fit， indicating that the fitted probability value was consistent with the actual probability value. Calibration curves after 1 000 times of Bootstrap repeated sampling showed the bias calibration curves of the training set and the validation set had good consistency with the actual curves， both close to the ideal curve. DCA revealed clinical utility across a wide threshold probability range （0.02 ~ 1.0 for the training set； 0.04 ~ 1.0 for the validation set）. Conclusion This nomogram， based on body surface electrocardiogram indicators and clinical indicators， effectively predicts post-RFCA recurrence in atrial fibrillation and heart failure patients， offering a useful tool for early assessment of recurrence risk.

Phototherapy plays a significant role in vitiligo treatment. Narrow-band ultraviolet B （NB-UVB） remains the first-line phototherapy for non-segmental vitiligo in clinical practice. In recent years， visible light has emerged as a novel therapeutic approach for vitiligo. Studies indicate that helium-neon laser demonstrates superior efficacy in segmental vitiligo， blue light is more effective for localized vitiligo， and NB-UVB is better suited for generalized or extensive vitiligo. Different phototherapy modalities exhibit distinct mechanisms of action， involving multiple biological proteins and signaling pathways in melanocyte activation and repigmentation. This review summarizes recent advances in phototherapy for vitiligo treatment.

Objective To develop high-immunogenicity antigens targeting the BA.5 variant of SARS-CoV-2 and to screen for monoclonal antibodies with high neutralizing and blocking activity， providing new strategies for the development of vaccines and diagnostic reagents. Methods The ZP protein gene fragment from zebrafish vitellogenin and the HIS protein tag were inserted into the pCDNA3.4 plasmid to construct the recombinant plasmid pCDNA3.4-RBD（BA.5）-ZP-HIS， which was then transfected into 293F cells to express the RBD-ZP protein. The expression of the protein was verified by SDS-PAGE and its binding capabilities to ACE2 receptor molecules and aluminum adjuvant were detected. The immunogenicity of the fusion protein was evaluated using a BALB/c mouse model， and monoclonal antibodies were prepared through hybridoma technology. Monoclonal antibodies with strong neutralizing and blocking activity were screened and their neutralizing activity was detected by blocking ELISA. Results The ZP gene and HIS protein tag sequence were successfully inserted into the pCDNA3.4 vector and the RBD-ZP protein with a molecular weight of 50 kDa was successfully expressed. The immunogenicity test results showed that the ZP protein effectively enhanced the immunogenicity of the RBD protein and improved its binding capability to the ACE2 receptor. After immunizing mice with the RBD-ZP protein， 8 monoclonal antibodies that specifically bind to both the mutant and wild-type strains were cloned and screened through hybridoma technology， among which 3 could effectively block the binding of the SARS-CoV-2 RBD protein to the human ACE2 receptor. Conclusion This study successfully expressed the RBD-ZP fusion protein， which significantly enhanced the immunogenicity and receptor binding capability of the RBD protein. Three monoclonal antibodies with high neutralizing and blocking activity were screened out， providing strong support for the development of COVID-19 vaccines and diagnostic reagents..

Objective To investigate the role of STK4?AS1 in regulating the proliferation， invasion， and migration of esophageal squamous cell carcinoma （ESCC） cells through the MYG1/Notch signaling pathway. Methods Quantitative real?time PCR （qRT?PCR） was used to detect the expression of STK4?AS1 in ESCC cells. MTS assay， wound healing and Transwell assay were conducted to explore the proliferation， migration， and invasion abilities in each group in Eca109 and Kyse150 cells. mRNA sequencing （mRNA?seq） was used to detect the downstream target genes of STK4?AS1. KEGG functional enrichment analyses were used to predict the possible biological processes and signaling pathways. qRT?PCR and western blot were performed to identify mRNA expression of MYG1 and the key downstream transcription factors HES1， HES5， and HEY1 of the Notch signaling pathway， as well as the protein expression of NICD1. Co?transfection plasmids （for over?expressing STK4?AS1 and MYG1） were used to detect the mRNA expression of HES1， HES5， and HEY1 and the protein expression of NICD1 which acted as the key downstream transcription factors in the Notch signaling pathway， as well as the effects on the proliferation， migration， and invasion abilities of ESCC cells. Results The expression of STK4?AS1 was decreased in ESCC cell lines （P < 0.01）. Over?expression of STK4?AS1 inhibited the proliferation， migration and invasion abilities in Eca109 and Kyse150 cells （P < 0.05）. STK4?AS1 negatively regulated the expression of MYG1 （P < 0.01）， and the expression of MYG1 was increased in ESCC cell lines （P < 0.01）. Over?expression of MYG1 could partially reverse the effect of STK4?AS1 on the malignant biological behavior of Eca109 and Kyse150 cells （P < 0.05）， as well as the mRNA expressions of HES1， HES5， and HEY1 and the protein expression of NICD1 （P < 0.05）. Conclusion STK4?AS1 affects the malignant biological behaviors of ESCC through the MYG1/Notch signaling pathway。

Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation （taVNS） on quality of early postoperative recovery in patients undergoing thoracoscopic lung resection. Methods A total of 168 patients scheduled for elective thoracoscopic lung resection （wedge resection， segmentectomy， lobectomy） under general anesthesia were enrolled and randomly assigned to active?taVNS group （group T） or sham?taVNS group （group S） （n = 84）. Participants received four consecutive 30?minute sessions of active stimulation or sham stimulation at four time points： （1） the afternoon prior to the surgery， （2） the morning of the surgery， （3） following extubation， and （4） the first afternoon post?surgery. The Quality of Recovery?15 （QoR?15） scores of the patients， the Numerical Rating Scale （NRS） scores at rest and during cough at 24， 48， and 72 hours after surgery were recorded； and the usage of opioids within 48 hours after surgery was recorded； the duration of chest tube indwelling， incidence of severe pulmonary complications， postoperative hospital stay and adverse reactions to the stimulation （such as nausea and vomiting， fever， constipation， dizziness and itching） were observed. Results Compared with group S， group T exhibited significantly higher QoR?15 scores at 24， 48， and 72 h postoperatively， lower NRS pain scores during resting and coughing， and reduced opioid consumption within 48 hours postoperatively （P < 0.05）. There were no significant differences between the two groups in the duration of chest tube indwelling， incidence of severe pulmonary complications， hospital stay， and the incidence of adverse reactions to the stimulation （P > 0.05）. Conclusion TaVNS can significantly improve quality of early postoperative recovery in patients undergoing thoracoscopic lung resection， and provide more effective postoperative analgesia without increasing the risk of postoperative complications.

Objective This study aims to investigate the association between remnant cholesterol （RC） and the risk of metabolic-associated fatty liver disease （MAFLD） under the optimal triglyceride （TG） levels recommended by different guidelines. Methods The data were derived from the annual physical examinations of elderly people aged 65 and above in a community in 2023. Regression analysis was used to evaluate the association between RC and MAFLD risk. According to the TG normal level （< 1.7 mmol/L） recommended by the Chinese Lipid Management Consensus and the TG ideal target （< 1.2 mmol/L） proposed by the European Atherosclerosis Society， the individuals were divided into subgroups with different TG levels to explore the association between RC and MAFLD risk in each subgroup. Results A total of 2，800 elderly individuals aged 65 and above were included in this study. The proportion of the individuals meeting the diagnostic criteria for MAFLD was 20.85%， and RC was identified as an independent risk factor for MAFLD （P < 0.001）. In the elderly individuals with TG< 1.7 mmol/L， RC level was not significantly associated with MAFLD risk （P = 0.888）. In contrast， in the elderly individuals with TG ≥ 1.7 mmol/L， RC level was significantly and positively correlated with MAFLD risk （P < 0.001）. Interaction tests revealed no significant interaction between the stratification factor and the effect size of RC （P = 0.115）. In the elderly individuals with TG< 1.2 mmol/L， RC level was not associated with MAFLD risk（P = 0.505）， while in the elderly individuals with TG ≥ 1.2 mmol/L， RC level was significantly associated with MAFLD risk （P < 0.001）. Interaction tests showed a significant interaction between the stratification factor and the effect size of RC （P = 0.011）. Conclusion RC is an independent risk factor for MAFLD in older individuals. To reduce the risk of MAFLD related to RC in the elderly， a triglyceride level of < 1.2 mmol/L can serve as a reference for identifying early-stage risk.

Objective To investigate the impact of immobilization devices and treatment couches on the planned dose in stereotactic body radiation therapy （SBRT）. Methods A retrospective study was conducted involving 23 SBRT patients， all of whom underwent CT simulation with foam padding or vacuum bag immobilization. For each patient， two sets of contours were outlined on CT images： one encompassing only the patient′s skin （Body）， and the other including the skin plus immobilization devices （Body_F）. Initially， a reference plan（noFC） meeting clinical requirements was generated based on the Body contour. Without altering the plan（noFC） parameters and field setups， plan calculations were performed separately based on three different contours： Body_F （with immobilization devices only）， Body + C （with treatment couch only）， and Body_F + C （with both immobilization devices and treatment couch）， yielding plan（F）， plan（C）， and plan（FC）， respectively. By comparing the target and skin dose parameters across these four plans， the effects of immobilization devices and treatment couches on the planned dose were evaluated. Results Compared to plans based solely on the patient′s skin contour， plans incorporating immobilization devices showed reduced high?dose， prescription dose coverage， and average dose in the target volume. Notably， the difference in the percentage of the planning target volume （PTV） receiving 105% of the prescribed dose （PTV/V105%p（%）） between plan（FC） and plan（noFC） could reach 61.86%. Conversely， plans with immobilization devices increased both the maximum and average skin doses. Specifically， the dose to 10 cc of skin within 2 mm of the surface （body 2 mm/D 10 cc（Gy）） showed a 21.36% difference between plan（FC） and plan（noFC）. For all target and skin parameters， no statistically significant differences were observed between plan（C） and plan（noFC）. Among plans with immobilization devices， the minimum distance from the target to the skin correlated inversely with skin dose， indicating greater impact on skin dose with closer proximity. Conclusions Immobilization devices in SBRT lead to beam attenuation and altered build?up effects， significantly reducing target dose parameters while increasing skin dose. The closer the target is to the skin， the greater the impact of immobilization devices on skin dose. It is recommended to incorporate immobilization devices into the contour design during radiotherapy planning.

Objective To compare the effects of quadratus lumborum block at the lateral supra?arcuate ligament （QLB?LSAL） and erector spinae plane block （ESPB） on early postoperative recovery in patients undergoing posterior lumbar surgery. Methods Ninety?three patients， aged 25 ~ 70 years， BMI 18 ~ 30 kg/m2 and ASA physical status Ⅱ or Ⅲ and scheduled for posterior lumbar surgery， were randomly divided into QLB?LSAL combined with general anesthesia （Group Q）， ESPB combined with general anesthesia （Group E）， and general anesthesia alone （Group N）. Postoperatively， all groups received patient?controlled intravenous analgesia （PCIA）. The following parameters were recorded： the scores of Richmond Agitation?Sedation Scale （RASS） and Bergman Comfort Scale （BCS） at awakening， 6 h， 12 h， and 24 h postoperatively； Likert scale score at PCIA cessation； the scores of Pittsburgh Sleep Quality Index （PSQI） and Early Postoperative Quality of Recovery?15 （QoR?15） at 1 day preoperatively and 1 day and 3 days postoperatively. Additionally， postoperative recovery indicators including awakening time， extubation time， PACU stay time， time to first anal exhaust， time to first ambulation， postoperative hospital stay， and adverse reactions within 48 h were recorded. Results （1）Compared with group N， group Q showed significantly lower RASS scores and higher BCS scores at all postoperative time points， with a higher proportion of Likert score grade 1 after PCIA cessation （P < 0.05）. Group E had lower RASS scores at emergence and 24 h postoperatively， and higher BCS scores at emergence， 6 h， and 24 h postoperatively while compared to group N （P < 0.05）. At 12h postoperatively， group Q demonstrated lower RASS scores and higher BCS scores than group E （P < 0.05）. （2） Compared with Group N， group Q exhibited lower PSQI scores and higher QoR?15 scores at 1 and 3 days postoperatively （P < 0.05）. No statistically significant difference in PSQI scores was observed between group E and N （P > 0.05）， while group E had higher QoR?15 score than group N only at 1 day postoperatively （P < 0.05）. Both at 1 and 3 days postoperatively， group Q had lower PSQI scores and higher QoR?15 scores than group E （P < 0.05）. （3） Postoperative awakening time， extubation time， PACU stay time， time to first anal exhaust and time to first ambulation were significantly shorter in group Q than those in group N （P < 0.05）. Group E only showed shorter time to first anal exhaust compared to group N （P < 0.05）. Furthermore， group Q had a significantly shorter PACU stay time than group E （P < 0.01）. （4） There was no statistically significant difference in the incidence of adverse reactions among the three groups of patients. （P > 0.05）. Conclusions Both QLB?LSAL and ESPB effectively improve postoperative analgesia and early recovery quality. However， QLB?LSAL demonstrates advantages in enhancing patient comfort， analgesia satisfaction， sleep quality， and accelerating overall postoperative recovery.

Objective This study aimed to assess the clinical utility of combining the Controlling Nutritional Status （CONUT） score with the Prognostic Nutritional Index （PNI） for evaluating anemia risk in elderly colorectal cancer patients and to establish a risk prediction model. Methods A total of 661 elderly colorectal cancer patients treated at Xinjiang Uygur Autonomous Region People's Hospital from July 2018 to March 2025 were included in this retrospective study. Patients were categorized into anemic and non-anemic groups and randomly assigned to a training set and validation set at a 7∶3 ratio. The XGBoost algorithm was applied to develop a predictive model for anemia risk， and its performance was assessed using the receiver operating characteristic （ROC） curve. SHAP value visualization， and other methods. Results Among the 661 patients， 257 （38.9%） were diagnosed with anemia. Compared with the non-anemic group， patients in the anemic group had significantly lower levels of PNI and albumin， but higher CONUT scores and blood urea nitrogen levels. Additionally， the anemic group had higher proportions of tumor diameter ≥ 5 cm， poorly differentiated tumors， and stage Ⅲ?Ⅳ disease （all P < 0.05）. The XGBoost model demonstrated good discriminatory ability， with an AUC of 0.897 （95%CI：0.868 ~ 0.925）. SHAP value analysis identified PNI， CONUT score， albumin， blood urea nitrogen， TNM stage， tumor differentiation， and tumor size as major contributing variables. PNI and albumin were protective factors， whereas CONUT score， blood urea nitrogen， and tumor-related features were risk factors. Conclusion Nutritional indicators such as PNI and CONUT score， along with tumor characteristics， can effectively predict the risk of anemia in elderly patients with colorectal cancer. The XGBoost-based predictive model demonstrates high discriminatory power and good interpretability， providing valuable support for early screening of high-risk patients and guiding individualized nutritional interventions and anemia management.

Objective To explore the related risk factors for thyroid dysfunction （irTD） after immunotherapy in patients with non?small cell lung cancer （NSCLC） and to construct a predictive model. Methods A retrospective analysis was conducted on 197 NSCLC patients who received immunotherapy at Chaohu Hospital， Anhui Medical University between January 2019 and June 2024. The patients were divided into a training set （n = 137） and a validation set （n = 60） in a 7∶3 ratio. Risk factors were screened through Lasso and logistic regression， and a dynamic nomogram model was constructed. The model's performance was evaluated using ROC curve， calibration curve， decision curve analysis （DCA）， and clinical impact curve （CIC）. Results Multivariate analysis showed that Gender （OR = 0.172， 95% CI：0.047 ~ 0.623）， M stage（OR = 2.919， 95% CI：1.063 ~ 8.015），ln（SII） （OR = 0.167， 95% CI：0.066 ~ 0.423）， ALC （OR = 3.395， 95% CI：1.493 ~ 7.716）， and TSH （OR = 1.464， 95% CI：1.126 ~ 1.904） were independent risk factors for the occurrence of irTD. The model formula based on these factors is： logit（P） = 9.261 - 1.760 × Gender + 1.071 × M stage - 1.787 × ln（SII） + 1.222 × ALC + 0.381 × TSH. The model achieved an AUC of 0.832（95%CI：0.719 ~ 0.945） in the validation set， which was similar to the results in the training set. The calibration curve demonstrated good consistency between the predicted probability and actual observed values. DCA and CIC confirmed that the model has good clinical applicability. Conclusion This study identifies key risk factors for the occurrence of irTD after immunotherapy in NSCLC patients. The dynamic nomogram model developed （web calculator： https：//lingchun.shinyapps.io/dynnomapp/） can effectively identify high?risk populations for irTD， providing a reliable tool for clinical decision?making.

Objective To explore the correlation between central venous oxygen saturation （ScvO₂）， blood lactate （Lac）， arterial oxygen saturation （SaO2） and mechanical ventilation time in infants with congenital heart disease （CHD）. Methods Eighty?four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024. According to postoperative mechanical ventilation time， they were divided into prolongation group （28 cases， mechanical ventilation time ≥ 72 h） and non?prolongation group （56 cases， mechanical ventilation time < 72 h）. The clinical data， score of risk adjustment for congenital heart surgery （RACHS?1）， levels of ScvO₂， and Lac and SaO₂ in the two groups were compared. The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis， and predictive value of ScvO₂， Lac and SaO₂ for prolonged mechanical ventilation time was analyzed by ROC curves. The clinical outcomes in the two groups were recorded. Results There were significant differences in age， preoperative pneumonia， RACHS?1 grading， and levels of ScvO₂， Lac and SaO₂ among children with different mechanical ventilation time （P < 0.05）. Multivariate logistic regression analysis showed that ScvO₂， Lac and SaO₂ were independent influencing factors of postoperative mechanical ventilation time （P < 0.05）. ROC curves analysis showed that area under the curve （AUC） values of ScvO₂， Lac， SaO₂ and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846， 0.863， 0.839 and 0.917， and the best cut?off values were 67.64%， 1.51mmol/L and 96.06%， respectively （P < 0.05）. The failure rate of weaning in the prolongation group was higher， and stay time in PICU and actual length of hospital stay were longer than those in non?prolongation group （P < 0.05）. Conclusion The levels of ScvO₂， Lac and SaO₂ are related to mechanical ventilation time in CHD infants. They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolongation of mechanical ventilation in clinical practice.

Objective To analyze the efficacy of hepatic arterial infusion chemotherapy （HAIC） sequential drug-eluting beads transcatheter arterial chemoembolization （DEB-TACE） in the treatment of liver metastases from colorectal cancer. Methods 86 patients with colorectal cancer liver metastasis admitted to multiple centers from September 2022 to September 2023 were selected and divided into a control group （43 cases） and an experimental group （43 cases） according to the random number table method. The control group was treated with HAIC， and the experimental group was treated with HAIC sequential DEB-TACE. The clinical data and the changes of tumor markers and liver function indexes before and after treatment were compared between the two groups， and the short-term and long-term efficacy was evaluated， and the adverse reactions were recorded. Results After treatment， the levels of carcinoembryonic antigen， carbohydrate antigen 125， carbohydrate antigen 199， carbohydrate antigen 242， aspartate aminotransferase， alanine aminotransferase， alkaline phosphatase and γ-glutamyl transpeptidase in the two groups decreased （P < 0.05）， and those in the experimental group were lower than the control group （P < 0.05）. The proportion of repeated treatment in the experimental group was lower than that in the control group （P < 0.05）. The objective remission rate and disease control rate in the experimental group were 60.00% and 82.50% respectively， which were higher than 30.95% and 61.90% in the control group （P < 0.05）. There was no significant difference in the incidence of adverse reactions between the control group and the experimental group （P > 0.05）. The results of Kaplan-Meier survival curve showed that the overall survival rate and progression-free survival rate of the experimental group were higher than those of the control group （P < 0.05）. Conclusions HAIC sequential DEB-TACE can effectively remove tumor cells and improve liver function in patients with colorectal cancer liver metastasis， and it has good clinical efficacy and can prolong the survival time of patients.

Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation （EA） in patients undergoing laparoscopic hernia repair. Methods Seventy?two male patients who treated with laparoscopic hernia repair under general anesthesia were randomly divided into AS group （subanesthetic esketamine） and control group. In the AS group， 0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended， while the control group was given an equal volume of normal saline. Upon surgery completion， patients were transferred to PACU with endotracheal tube retained， and the time to extubation was recorded. Hemodynamic parameters were measured immediately after extubation and at 10 min， 30 min， 1 h， and 4 h thereafter. Patients′ pain and sedation levels were assessed at the above time points using RASS and VAS， respectively. The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit （CAM?ICU）. Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR?40 and adverse events were recorded. Results Compared to those in the control group， patients in the AS group had higher HR and MAP at 10 min post?extubation， and the changes in HR and MAP over time were more stable（P < 0.05）. The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points（P < 0.05）， both groups showed temporal changes in RASS and VAS scores （P < 0.05）， but the change process in the AS group was more stable（P < 0.05）. Postoperative extubation time， PACU observation duration， and adverse event rates （delirium， respiratory depression， nausea and vomiting） did not differ significantly between the two groups （P > 0.05）， while recovery quality was markedly better in the AS group （P < 0.05）. Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA， supports hemodynamic stability during PACU stay， and enhances recovery quality in patients undergoing laparoscopic hernia repair， demonstrating clinical value.

Objective To analyze the effect of different doses of sufentanil in pediatric tonsil adenoidectomy （referred to as tonsil surgery）. Methods 111 cases of children who underwent pediatric squamous gland surgery were selected， and the cases were included from January 2023 to October 2024， and the collection site was Ganzhou Maternal and Child Health Hospital， the selected children were divided into the group A， B， and C by randomized numerical table method， each with 37 cases. 0.25 μg/kg of sufentanil was given to group A， 0.30 μg/kg of sufentanil was given to group B， 0.35 μg/kg of sufentanil was given to group C. The perioperative times， the pain and agitation conditions in the early postoperative period （Within 30 min after extubation）， the hemodynamics before the induction of anesthesia （T₀）， the immediate moment of endotracheal intubation （T₁）， the immediate start of the surgery （T₂）， and hemodynamics at extubation （T₃）， the adverse effects during observation and the parental satisfaction at discharge of the three groups were compared. Results The times of extubation， autonomic respiration recovery， awakening and anesthesia recovery room stay were shorter in the group A， B than in the group C （P < 0.05）. Early postoperative period， the scores of face legs activity crying consolability （FLACC） and pediatric anesthesia agitation during awakening （PAED） were lower in the groups B， C than in the group A （P < 0.05）； and the incidence of pain and agitation in the groups B， C （5.41%， 8.11%； 2.70%， 5.41%） was lower than in the group A （40.54%， 45.95%） （P < 0.05）. Compared with that at T0， the mean arterial pressure （MAP） and heart rate （HR） at T₁， T₂， and T₃ were elevated in the group A （P < 0.05）； MAP and HR at T₁， T₂ and T₃ were lower in the groups B， C than in the group A （P < 0.05）. During the observation period， the incidence of choking and coughing in the groups B， C（16.22%， 13.51%） was lower than that in the group A（51.35%） （P < 0.05）； the incidence of nausea and vomiting and drowsiness in the groups A， B （2.70%， 16.22%； 5.41%， 18.92%） was lower than that in the group C （24.32%， 62.16%） （P < 0.05）. At the time of discharge， the parental satisfaction score in the group B was （9.12 ± 0.25）， which was higher than that in the groups A and C ［（7.91 ± 0.33）， （7.93 ± 0.41）］ （P < 0.05）. Conclusions The application of 0.30 μg/kg sufentanil in pediatric squamous gland surgery is more effective， which could shorten the time of each perioperative period， maintain hemodynamic stability， reduce the occurrence of postoperative pain， agitation， choking， nausea and vomiting， and somnolence， and improve the safety， as well as enhance the parental satisfaction of the children.

Objective To investigate the effect of two treatment regimens combining Tacrolimus （TAC） with different Rituximab （RTX） dosages， and to provide clinical reference for treatment strategies. Methods A retrospective analysis was conducted on patients diagnosed with idiopathic membranous nephropathy （IMN） and treated with RTX combined with TAC regimen （RTX + TAC group and low?dose RTX + TAC group） in The First Affiliated Hospital of Xinxiang Medical University. Propensity score matching （PSM） was performed at a 1∶1 ratio， and a total of 60 patients were enrolled， with 30 in each group. In low?dose RTX （375 mg/m2 at the first and fifteenth day respectively） + TAC group， if circulating B cells （CD19?） exceeded 5 cells/μL after 3 months， a 200 mg RTX infusion was administered. In RTX （1g at the first and fifteenth day respectively） + TAC group， if complete remission （CR） was not achieved by 6 months， an additional 1000 mg RTX infusion was administered. The incidence of CR， partial remission， and adverse events were followed up for 12 months after medication in both groups. Results （1） Both groups showed significant reductions in 24?hour proteinuria， with the RTX + TAC group demonstrating a notably higher decrease compared to the low?dose RTX + TAC group. Statistical differences were observed between the two groups at the 1st and 3rd months of treatment （P < 0.05）. Albumin levels gradually increased， and there were differences between the two groups at both the 1st and 3rd months （P < 0.05）. The anti?phospholipase A2 antibody levels decreased significantly after one month of treatment ［3.45（1.90， 22.10） vs. 3.28（8.30， 23.08） RU/mL］， P > 0.05. At 3 months of treatment， the overall clinical remission rate was 63.3% for the RTX + TAC group compared to 36.7% for the low?dose RTX + TAC group （P < 0.05）. At 12 months， the RTX + TAC group achieved an overall remission rate of 86.7%， while the low?dose RTX + TAC group reached 83.3%， showing no statistical significance （P > 0.05）. After one month of treatment， the RTX + TAC group achieved a complete serological immunological remission rate of 33.3%， significantly higher than the 3.3% in the low?dose RTX + TAC group （P < 0.05）. （2） The cumulative remission rate of the RTX + TAC group was higher than that of the low?dose RTX + TAC group during the first 6 months of follow?up. The remission rate in the low?dose RTX+TAC group increased significantly after 6 months. Log?rank test showed no statistical difference between the survival curves of the two groups （P = 0.37）. （3） Based on a multifactorial COX regression analysis of factors related to remission in patients with IMN， for every unit increase in serum immunological remission time， the risk of patients achieving remission decreased by 13.5% （HR = 0.87，P = 0.016）. The risk of remission for patients with high titers of anti?PLA2R antibodies decreased by 60.2% （HR = 0.39，P = 0.018）. Conclusions Different RTX dosages yielded comparable overall clinical remission rates without significantly increasing adverse events. RTX + TAC regimen achieves higher early CR rate. Serological remission time and high titer anti?PLA2R antibodies are associated with clinical outcomes.

Objective To investigate the expression of Delta （24）-cholesteryl reductase （DHCR24） proteins in cervical squamous intraepithelial lesions （SILs） tissues and its value in different cervical lesion pathological diagnosis. Methods The expression of DHCR24， p16， and Ki-67 was quantitatively detected by immunohistochemistry in 51 normal cervical tissues， 44 LSILs， and 57 HSILs. The receiver operating characteristic （ROC） curve was drawn to analyze the diagnostic efficacy of DHCR24， p16， and Ki-67 proteins in evaluating the degree of SILs. Results The expression levels of DHCR24， p16 and Ki-67 protein were positively correlated with the progression of SILs （P < 0.05）. ROC analysis showed that the immunohistochemistry score cutoff value for DHCR24 between normal cervical tissue and LSIL was 0.1145， and between LSIL and HSIL was 0.1969. The sensitivity of DHCR24 in diagnosing LSIL was 79.55%， higher than that for p16 and Ki-67， which was 15.91% and 18.08%（P < 0.05）. The area under the ROC curve （AUC） for distinguishing normal cervical tissue from LSIL using a combination of DHCR24 and p16 was 0.932（95%CI：0.878 ~ 0.986）， higher than that for p16 and Ki-67 combined， which was 0.861（95%CI：0.785 ~ 0.936）. The AUC for distinguishing LSIL from HSIL using a combination of DHCR24 and p16 was0.971（95%CI：0.946 ~ 0.997）， higher than that for p16 and Ki-67 combined， which was 0.870（95%CI：0.790 ~ 0.949）. Conclusions Both DHCR24 and p16 protein expression levels can provide reference for the grading of SILs， and their combination can improve the diagnostic efficiency. The cutoff value derived from the ROC curve plotted by DHCR24 immunohistochemical staining intensity can improve the sensitivity of LSIL diagnosis.

Objective To analyze and evaluate the early warning efficacy of D?dimer/albumin ratio （DAR） combined with interleukin?6 （IL?6） and fibrin degradation products （FDP） in the postoperative treatment of acute Stanford type A aortic dissection （ATAAD）. Methods A retrospective cohort study was conducted on 284 ATAAD patients who underwent the Sun′s procedure at our hospital from July 2024 to March 2025. Patients were divided into a non?adverse outcome group （n = 196） and an adverse outcome group （n = 88） based on the occurrence of postoperative complications within 30 days， including acute renal failure requiring dialysis， secondary thoracotomy for hemostasis， severe neurological complications， multiple organ failure， or all?cause mortality. Preoperative baseline data， perioperative parameters， and laboratory indicators were collected via the electronic medical record system. The Mann?Whitney U test was used to compare the differences between groups for continuous variables that did not conform to the normal distribution， and Chi?square test or Fisher's exact test was selected for statistical difference analysis according to the frequency distribution characteristics of categorical variables. On the basis of univariate analysis， multivariate logistic regression analysis was used to screen independent risk factors. Results Statistically significant differences were observed between the non?adverse and adverse outcome group in age， cardiopulmonary bypass time， lactate dehydrogenase （LDH）， IL?6， D?dimer （D?D）， FDP， and DAR levels （P < 0.05）. Multivariate analysis revealed that DAR， IL?6， D?D， FDP， and prolonged cardiopulmonary bypass time were independent risk factors for adverse postoperative outcomes （P < 0.05）. Combined detection analysis demonstrated that the combination of DAR， IL?6， FDP， and cardiopulmonary bypass time yielded the highest predictive efficacy， with an area under the ROC curve of 0.886 （95%CI： 0.846 ~ 0.927）. Conclusion The combination of DAR， IL?6， FDP， and cardiopulmonary bypass time effectively predicts adverse postoperative outcomes in ATAAD patients. This biomarker panel may serve as a robust predictive tool for postoperative risk stratification.

Varicose veins in the lower extremities （VVLEs） are a common vascular disease caused by Chronic Venous Insufficiency （CVI）. Traditional High Ligation and Stripping （HLS） of The Great Saphenous Vein has been largely replaced by minimally invasive techniques due to its greater surgical trauma and slower recovery. Among these techniques， radiofrequency ablation （RFA） has emerged as a preferred treatment option due to its high efficacy and safety. RFA utilizes thermal energy to occlude diseased veins， demonstrating significantly superior short- and long-term closure rates compared to traditional HLS. Additionally， RFA is associated with reduced postoperative pain and a lower incidence of complications. This review comprehensively summarizes the current applications， clinical efficacy， safety profile， and future research directions of RFA in treating VVLEs， aiming to provide a valuable reference for the clinical implementation of this technique.

Vitiligo is a common depigmentation skin disorder， characterized by hypopigmented or depigmented patches on the skin or mucous membranes. The disease can be classified into two stages： the active stage and the stable stage. Accurately determining the disease stage is crucial for developing an appropriate treatment plan. However， there is currently no standardized biological marker to assess the disease stage. This article reviews the progress of research on biological markers for different stages of vitiligo.

Stress hyperglycemia is a common metabolic disturbance observed in critically ill patients during the perioperative period. However， the use of a single blood glucose measurement is susceptible to various confounding factors and may not accurately reflect the patient's stress status. The Stress Hyperglycemia Ratio （SHR）， an emerging biomarker， is calculated by comparing admission blood glucose levels with the individual's estimated chronic average glycemic level， thereby enabling a more accurate differentiation between stress-induced hyperglycemia and hyperglycemia associated with pre-existing diabetes. Accumulating evidence indicates that SHR demonstrates significant predictive value for major adverse clinical outcomes， including cardiovascular events， mortality， and impaired functional recovery， across diverse critically ill populations such as those with acute myocardial infarction， stroke， and sepsis. Moreover， SHR has been shown to outperform traditional single blood glucose measurements in terms of prognostic accuracy. This review aims to systematically summarize the current evidence regarding the predictive utility of SHR in risk assessment for adverse outcomes among critically ill patients. By enhancing our understanding of SHR's clinical relevance， this review seeks to provide insights into novel approaches for risk stratification， individualized patient management， and ultimately， improved clinical outcomes.