Osteonecrosis of the femoral head （ONFH） is a disabling orthopedic disease， pathologically characterized by progressive collapse of the femoral head accompanied by destruction of the trabecular and articular cartilage structures， leading to hip joint pain and progressive functional impairment. Bone marrow mesenchymal stem cell-derived extracellular vesicles （BMSC-EVs） show great promise in tissue repair and regeneration， with low immunogenicity and tumorigenicity， and play roles in osteogenesis， angiogenesis， and immunomodulation. This review summarizes the therapeutic effects and underlying mechanisms of BMSC-EVs in ONFH， providing a theoretical basis for its treatment.

Objective To investigate the regulatory effects of resistance exercise on Piezo1 in myoblasts within skeletal muscles of aged mice. Methods In animal experiments， thirty 20-month-old male C57BL/6 mice were randomly assigned to one of three groups： an aging control group， an aging exercise group， and an aging exercise inhibitor group. Additionally， ten 3-month-old young mice served as a young control group. The aging exercise group underwent 8 weeks of resistance exercise training， whereas the aging exercise inhibitor group received both 8 weeks of resistance exercise and intraperitoneal injections of GsMTx4. Exercise capacity was evaluated using grip strength tests and rotarod performance assays. Skeletal muscle cross-sectional area was assessed via hematoxylin-eosin staining， fibrosis was examined using Sirius red staining， and the proportion of p16-positive cells was determined by immunohistochemistry. In cellular experiments， senescence in myoblasts was induced with D-galactose （D-gal）， followed by activation of Piezo1 using Yoda1. The percentage of senescent cells was measured by SA-β-Gal staining， while protein expression levels of senescence markers （p16 and p21） and atrophy markers （Atrogin-1 and MuRF1） were quantified by Western blot analysis. Cell immunofluorescence staining was employed to assess the average fluorescence intensity of p21. Results （1）Compared with the aging control group， the aging + exercise group exhibited significant improvements in exercise capacity， quadriceps femoris mass index， skeletal muscle cross-sectional area， reduction in skeletal muscle fibrosis， and a lower p16-positive cell percentage （P < 0.05）； （2）These beneficial effects of exercise on aged skeletal muscle were attenuated following treatment with a Piezo1 inhibitor （P < 0.05）； （3）In vitro experiments demonstrated that activation of Piezo1 reduced the SA-β-Gal positive cell rate in myoblasts， downregulated the expression of senescence markers （p16 and p21） and atrophy-related markers （Atrogin-1 and MuRF1）， and decreased the average fluorescence intensity of p21 （P < 0.05）. Conclusion Resistance exercise suppresses myocyte aging through activation of Piezo1， thereby ameliorating age-related muscle atrophy in the elderly.

Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis. Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023. Five patients were diagnosed and treated before 2020， while 47 were managed from 2020 onward. Patients were divided into two groups： a local debridement group （n = 28） and an en bloc osteotomy group （n = 24）. Perioperative outcomes—including operative time， incision length， intraoperative blood loss， and length of hospital stay—were assessed， along with clinical efficacy at 6 months， 12 months， and final follow-up. Clinical outcomes were evaluated using the Hospital for Special Surgery （HSS） knee score， the American Orthopaedic Foot & Ankle Society （AOFAS） ankle-hindfoot score， joint range of motion （knee flexion-extension and ankle plantarflexion-dorsiflexion）， recurrence rate， and the Paley classification for infectious bone defects. Results The local debridement group exhibited significantly less intraoperative blood loss （P < 0.05）， shorter operative time （P < 0.05）， and reduced hospital stay （P < 0.05）， as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively （P < 0.05）. In contrast， the osteotomy group demonstrated superior Paley classification outcomes at 6 months， 12 months， and final follow-up （P < 0.05）， along with lower rates of infection recurrence. Longitudinal analysis indicated significant improvements in AOFAS scores， HSS scores， and joint mobility over time in both groups （P < 0.05）. However， no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up （P > 0.05）. Conclusion En bloc osteotomy combined with the induced membrane technique （Masquelet technique） enables more comprehensive debridement， minimizes the necessity for repeated surgical interventions， reduces postoperative complications， lowers the risk of recurrence， and promotes enhanced bone healing.

Objective To investigate the clinical efficacy of fire dragon pot comprehensive therapy in patients with knee paralysis due to liver and kidney deficiency following total knee arthroplasty（TKA）. Methods A total of 114 patients undergoing unilateral TKA were randomly assigned to two groups using a random number table. The control group （n = 57） received standard enhanced recovery after surgery （ERAS） nursing care， while the intervention group （n = 57） received high-frequency general massage （HGM） therapy in addition to the standard ERAS protocol. Outcomes including visual analogue scale （VAS） scores， Hamilton Anxiety Scale （HAMA） scores， Hospital for Special Surgery （HSS） knee scores， and serum levels of inflammatory markers［C-reactive protein （CRP）， neutrophil count （NE）， and lymphocyte count （LY）］were compared between the two groups. Results Compared with the control group， the intervention group exhibited significantly lower VAS scores at 3 days postoperatively and at discharge， reduced HAMA scores from the preoperative period through 3 days after surgery， improved HSS scores［specifically in pain， function， range of motion， stability， and total score］at 2 weeks postoperatively， and more pronounced improvements in inflammatory markers， including lower levels of CRP and NE and higher LY levels （all P < 0.05）. Conclusion The comprehensive moxibustion therapy using Huolongjar effectively alleviates postoperative pain following TKA， enhances joint function， reduces anxiety levels， and mitigates inflammatory responses. This intervention is safe， simple to administer， and holds promise for clinical application and wider dissemination.

Objective To investigate the effects of chronic intermittent hypoxia （CIH） on hippocampal neuronal injury in rats， and to clarify the role of endoplasmic reticulum （ER） stress?related apoptotic pathways. Methods Male Sprague?Dawley rats were randomly assigned to a control group （n = 8） or a CIH group （n = 8）. The CIH group was exposed to intermittent hypoxia for 8 h/day over 8 weeks. Hippocampal neuronal morphology was examined by hematoxylin?eosin staining and transmission electron microscopy. Neuronal apoptosis was assessed using the TUNEL assay. Intracellular Ca2? levels were measured by flow cytometry. The mRNA and protein expression of ER stress?related factors （GRP78， CHOP） and the apoptotic effector Caspase-3 were quantified by qPCR and Western blot. Results Compared with controls， rats in the CIH group exhibited marked hippocampal neuronal damage， including disrupted cytoarchitecture， cytoplasmic dissolution， and swollen rough ER. Ultrastructural analysis revealed nuclear deformation and organelle disruption. TUNEL assay demonstrated a significant increase in apoptotic cells （P < 0.05）. Flow cytometry showed elevated intracellular Ca2? levels （P < 0.05）. GRP78， CHOP， and Caspase-3 were significantly upregulated at both mRNA and protein levels in the CIH group （all P < 0.05）. Conclusion CIH induces pronounced hippocampal neuronal injury and apoptosis in rats， associated with Ca2? dysregulation and activation of ER stress?mediated apoptotic pathways. These findings provide experimental evidence for elucidating the mechanisms of OSAHS-related neuronal injury and identifying potential therapeutic targets.

Objective To investigate the mechanism by which blue light irradiation-activated microglia mediate immune cell recruitment and exacerbate retinal damage， and to explore the role of microglial depletion in inhibiting immune infiltration and protecting the retina. Methods SPF-grade C57BL/6J mice were randomly divided into control group， blue light irradiation group， and PLX5622 pretreatment blue light irradiation group. A retinal injury model was established by continuous LED blue light irradiation for 2 days. In the PLX5622 pretreatment group， microglia were specifically depleted before blue light irradiation. After modeling， HE staining and OCT examination were used to examine retinal histomorphological changes； ERG examination was performed to evaluate retinal function； DHE staining and RT-qPCR were used to detect oxidative stress and inflammatory responses， and Iba1， CD68， CD11b immunofluorescence staining and flow cytometry were used to analyze microglial activation status and immune cell infiltration. Results After blue light irradiation， the retinal outer nuclear layer thickness was significantly reduced； ERG a-wave and b-wave amplitudes decreased； expression of oxidative stress-related genes Nrf2， Sod2， and HO-1 was upregulated； expression of inflammatory factors IL-1β， TNF-α， and ICAM-1 increased； the number of Iba1-positive microglia increased and migrated extensively to the outer nuclear layer； the proportion of CD68⁺ cells and CD11b⁺ immune cells was elevated； and activated microglia aggregated around blood vessels to mediate immune cell infiltration. After PLX5622 pretreatment to deplete microglia， immune cell infiltration was significantly reduced； inflammatory responses were alleviated； retinal structural damage was markedly improved， and visual function was protected. Conclusions Blue light irradiation activates microglia and promotes their migration to the injury area. Activated microglia mediate immune cell recruitment and infiltration， exacerbating retinal inflammatory damage. Microglial depletion can effectively inhibit immune infiltration， rescue retinal structure and function， and provide new therapeutic strategies for the prevention and treatment of blue light-related ocular diseases.

Objective To explore the preferences and influencing factors of terminal malignant tumor patients， and to provide a basis for optimizing hospice care. Methods A convenience sampling method was employed to select 485 patients with terminal malignant tumors from the oncology departments of two tertiary， class-A hospitals in Sichuan Province between September 2023 and November 2024. Data on demographic characteristics， decision-making-related information， preferences regarding resuscitation， and cultural belief levels were collected using a structured questionnaire. Results In critical situations， 39.4% of patients opted for active rescue， 33.6% chose to forgo treatment， and 27.0% preferred to maintain current treatment. Acceptance rates for nine specific interventions ranged from 28.9% to 61.2%. Multivariate logistic regression analysis revealed that stronger cultural beliefs， younger age， having a spouse， being the primary caregiver， employee medical insurance coverage， and use of invasive tubes were significantly associated with a tendency toward active or continued treatment （P < 0.05）. Prioritizing quality of life or concerns about economic burden were significantly associated with the decision to forgo life-sustaining interventions （P < 0.05）. Conclusions Patients with terminal malignant tumors exhibit diverse preferences regarding end-of-life resuscitation， significantly shaped by cultural beliefs， demographic factors， and family support. Clinicians should integrate patients’ values， cultural backgrounds， and individual needs to provide tiered decision-making support， thereby facilitating medically appropriate and value-concordant care choices.

Objective To analyze the changes in serum immunoglobulin E （IgE）， interleukin-6 （IL-6）， high-mobility group protein B1 （HMGB1）， β2-microglobulin （β2-M）， and T lymphocyte subsets in patients with secretory otitis media （SOM） and to evaluate their clinical significance. Methods A total of 185 patients with SOM admitted to Wuhan First Hospital between March 2023 and March 2025 were enrolled as the patient group， and 185 healthy individuals who underwent routine physical examinations at our hospital during the same period served as the control group. Serum levels of IgE， IL-6， HMGB1， and β2-microglobulin（β2-M）， as well as peripheral blood T lymphocyte subsets， were compared between the two groups. Based on disease duration， the patients were further classified into acute （n = 43）， subacute （n = 61）， and chronic （n = 81） subgroups. Levels of the serum markers and T lymphocyte subsets were compared across these three subgroups. The diagnostic value of the serum markers for SOM was evaluated， and their correlations with peripheral blood T lymphocyte subsets were analyzed. Results he levels of serum IgE， IL-6， HMGB1， β2-M， and peripheral blood CD8⁺ were significantly higher in the disease group than in the control group， whereas the levels of peripheral blood CD4⁺ and CD4⁺/CD8⁺ were significantly lower （P < 0.05）. Across the acute， subacute， and chronic subgroups， the levels of serum IgE， IL-6， HMGB1， β2-M， and CD8⁺ exhibited a progressive increasing trend， while CD4⁺ and CD4⁺/CD8⁺ levels showed a corresponding decreasing trend （P < 0.05）. The combined measurement of serum IgE， IL-6， HMGB1， and β2-M yielded a higher area under the curve （AUC） for diagnosing SOM compared to each marker alone （P < 0.05）， with a sensitivity of 88.65% and specificity of 76.76%. Furthermore， serum levels of IgE， IL-6， HMGB1， and β2-M were positively correlated with peripheral blood CD8⁺ levels （r = 0.618， 0.578， 0.622， 0.549； P < 0.05）， and negatively correlated with CD4⁺ and CD4⁺/CD8⁺ ratios （r = -0.539， -0.573， -0.519， -0.559 for CD4⁺； r = -0.604， -0.618， -0.559， -0.649 for CD4⁺/CD8⁺； P < 0.05）. Conclusion The progression of SOM is associated with alterations in serum markers and peripheral blood T lymphocyte subsets. Furthermore， the combination of serum IgE， IL-6， HMGB1， and β2-MG demonstrates enhanced diagnostic value in patients with SOM， and a significant correlation exists between these four markers and the levels of peripheral blood T lymphocyte subsets.

Objective To investigate the correlation between serum microRNA-210 （miR-210）， tumor necrosis factor-stimulated gene 6 （TSG-6）， and complement C1q tumor necrosis factor-related protein 3 （CTRP3） and their association with myocardial fibrosis and prognosis in patients with dilated cardiomyopathy （DCM）. Methods A total of 117 patients with DCM admitted to Taizhou People's Hospital between March and August 2024 were enrolled in the DCM group. Based on cardiac magnetic resonance imaging findings， these patients were further classified into a myocardial fibrosis group （n = 96） and a non-fibrosis group （n = 21）. Additionally， according to the occurrence of acute heart failure during one-year follow-up， they were categorized into a heart failure group （n = 47） and a non-heart failure group （n = 70）. Concurrently， 58 age- and sex-matched healthy volunteers were recruited as the control group. Serum levels of miR-210， TSG-6， CTRP3， N-terminal propeptide of type Ⅲ procollagen （PⅢNP）， left ventricular ejection fraction （LVEF）， and N-terminal pro-B-type natriuretic peptide （NT-proBNP） were measured and compared across all groups. Results The DCM group exhibited significantly higher serum levels of miR-210， TSG-6， PⅢNP， and NT-proBNP， lower CTRP3 levels， and reduced LVEF compared to the healthy controls （P < 0.05）. Similarly， the fibrosis group showed elevated serum levels of miR-210， TSG-6， PⅢNP， and NT-proBNP， decreased CTRP3 levels， and impaired LVEF relative to the non-fibrosis group （P < 0.05）. The heart failure group also demonstrated higher serum concentrations of these biomarkers， along with lower CTRP3 and reduced LVEF， compared to the non-heart failure group （P < 0.05）. Serum miR-210 and TSG-6 levels were positively correlated with PⅢNP and NT-proBNP （P < 0.05） and negatively correlated with LVEF （P < 0.05）. Multivariate analysis revealed that elevated serum miR-210 （OR = 2.065， 95%CI： 1.116 ~ 3.821） and TSG-6 （OR = 1.047， 95%CI： 1.013 ~ 1.083） were independent risk factors for heart failure in DCM patients （P < 0.05）， whereas higher CTRP3 levels （OR = 0.911， 95%CI： 0.849 ~ 0.978） were associated with a protective effect （P < 0.05）. The sensitivity of serum miR-210， TSG-6， and CTRP3 in predicting heart failure in DCM patients was 72.34%， 74.47%， and 74.47%， respectively， with specificities of 62.86%， 62.86%， and 68.57%， yielding AUC values of 0.669， 0.712， and 0.759， respectively. Conclusions Serum levels of miR-210 and TSG-6 are elevated， whereas CTRP3 levels are reduced in patients with DCM. These biomarkers are closely associated with myocardial fibrosis and cardiac function impairment. Moreover， miR-210， TSG-6， and CTRP3 exhibit significant predictive value for the prognosis of DCM.

Objective To investigate the effect of baseline atherogenic index of plasma （AIP） on the long-term prognosis of patients with acute myocardial infarction （AMI）. Methods A total of 712 AMI patients admitted to the hospital from January 2018 to December 2019 were continuously included as subjects and divided into a low-value group （AIP < 0.280， n = 237）， a median-value group （AIP 0.280 ~ 0.852， n = 238） and a high-value group （AIP > 0.852， n = 237） according to the baseline AIP tertiles. The primary endpoint was defined as the occurrence of major cardiovascular adverse events （MACEs）. Multivariate Cox regression was used to analyze the independent influencing factors of MACEs. The nonlinear relationship between AIP and the risk of MACEs was analyzed with restricted cubic spline plots. Kaplan-Meier curve was used to analyze survival differences between groups. Subgroup analysis assesses the consistency of AIP's predictive value to MACEs. Results With the increase of AIP tertile groups， the proportion of dyslipidemia and MACEs increased， white blood cell count， fasting blood glucose， triglyceride， total cholesterol， low density lipoprotein and AIP increased， and high-density lipoprotein decreased， with statistical significance （P < 0.05）. Multivariate Cox regression analysis showed that AIP was an independent risk factor for MACEs （HR = 2.024， 95%CI： 1.211 ~ 3.381， P = 0.007）. The results of restricted cubic spline analysis show that there is an L-shaped nonlinear effect relationship between AIP and the risk of MACEs （P-nonlinear = 0.008）. When AIP > 0.613， the risk of MACEs in AMI patients increases with the increase of AIP. Kaplan-Meier survival curve analysis results show： With the increase of AIP， the cumulative incidence of MACEs in AMI patients increased significantly （Log-rank test， P = 0.032）. Compared with the low-value group， the risk of MACEs in the high-value group increased by 131% （HR = 2.311， 95%CI： 1.261 ~ 4.234， P = 0.007）. The results of subgroup analysis showed that the P value of interaction within each subgroup was not significant， and the ability of AIP to predict MACEs was applicable to all subgroups. Conclusion Increased AIP at baseline is an independent predictor of poor long-term prognosis in patients with AMI.

Objective The aim of this study was to investigate the impact of the interaction between diabetes mellitus and anxiety on the risk of developing postherpetic neuralgia in patients with herpes zoster （HZ）. Methods The clinical data of 206 HZ patients admitted to our hospital from December 2020 to December 2024 were retrospectively collected. All patients were followed up for 6 months after treatment and then divided into the occurrence group （n = 47） and the non-occurrence group （n = 159） based on whether postherpetic neuralgia occurred. The clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to explore the relationship between diabetes mellitus， anxiety and the risk of neuralgia in HZ patients. The Excel spreadsheet developed by Andersson was used to calculate the relative excess risk due to interaction （RERI）， attributable proportion due to interaction （AP）， and synergy index （S）. Receiver operating characteristic （ROC） curves were plotted to analyze the value of each indicator alone and in combination in predicting the risk of neuralgia in HZ patients. Results There were statistically significant differences between the two groups in terms of age， coexisting T2DM， skin lesion area， Generalised Anxiety Disorder-7 （GAD-7） score， and Patient Health Questionnaire-9 （PHQ-9） score （P < 0.05）. Multivariate logistic regression analysis revealed that both T2DM and GAD-7 scores were independent risk factors for neuropathic pain in HZ patients （P < 0.05）. Without adjusting for other variables， there was a multiplicative interaction between T2DM and GAD-7 scores ≥ 5 （P < 0.05）. However， after adjusting for confounding factors such as age， skin lesion area， and HAMD scores， no multiplicative interaction was observed between the two （P > 0.05）. There was an additive interaction between T2DM and a GAD-7 score ≥ 5； when both were present， the risk of neuropathic pain in HZ patients was significantly higher than in patients without T2DM and a GAD score < 5. The risk of neuropathic pain in HZ patients with both conditions was higher than the sum of the risks from either condition alone， with a synergistic effect 23.05 times greater than the sum of the effects of either condition alone； When both conditions coexist， 81.70% of the risk of neuropathic pain is attributable to their synergistic effect； the combined predictive value of diabetes and anxiety for the risk of neuropathic pain in HZ patients is higher than that of either condition alone （ZT2DM vs. combination = 2.230， ZGAD-7 score vs. combination = 3.088， P < 0.05）. Conclusion Diabetes mellitus and anxiety have an additive interaction. When both are present， the risk of neuralgia in HZ patients increases， and combined assessment can provide a certain reference for predicting neuralgia in HZ patients.

Objective The aim of this study is to analyze the expression level of cell-free DNA （cf-DNA）， a biomarker of neutrophil extracellular traps （NETs）， in children with Mycoplasma pneumoniae pneumonia （MPP）， and to explore the predictive efficacy of cf-DNA （as a marker of NETs） for the severity of MPP in these children. Methods A total of 115 children with MPP were prospectively selected as the MPP group. Based on the disease severity， the MPP group was categorized into the mild group （n = 75） and the severe group （n = 40）. During the same period， 50 healthy children undergoing physical examinations were selected as the control group. The levels of serum cf-DNA in the MPP group and the control group， as well as the levels of C-reactive protein （CRP）， D-dimer， lactate dehydrogenase （LDH）， interleukin-6 （IL-6）， interferon-γ （IFN-γ）， and tumor necrosis factor-α （TNF-α） in the MPP group were detected. The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared， and the role of serum cf-DNA in evaluating the severity of MPP was analyzed. Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group， with a more significant elevation observed in the severe group （P < 0.05）. The levels of CRP， D-dimer， LDH， IL-6， IFN-γ， and TNF-α were all higher in the severe group than in the mild group （P < 0.05）. Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA， CRP， and IL-6 were closely related to the severity of MPP （P < 0.05）. The results of receiver operating characteristic （ROC） curve analysis showed that the area under the curve （AUC） of the combination of serum cf-DNA， CRP， and IL-6 for predicting severe MPP was 0.981， which was higher than that of each index alone （P < 0.05）. Conclusions Serum cf-DNA （as a marker of NETs） is closely related to the severity of MPP in children. The combined detection of cf-DNA， CRP， and IL-6 is more beneficial for assessing the severity of MPP in children.

Objective The reference range for perfusion index （PI） in healthy newborns was established， and the prognostic value of PI at multiple time points （6 h， 18 h， 24 h， 48 h， and 72 h） in critically ill newborns was evaluated. Methods A total of 100 healthy neonates born at the Hainan Women and Children's Medical Center between July 2022 and September 2024， along with 142 critically ill neonates admitted to the neonatal intensive care unit， were enrolled as study participants. The healthy neonates constituted the control group， while the critically ill neonates were categorized into low-risk （n = 44）， medium-risk （n = 61）， and high-risk （n = 37） groups according to disease severity. The clinical outcomes of the critically ill neonates were recorded and classified into poor prognosis （n = 38） and good prognosis （n = 104） groups. PI values were monitored in all neonates from 6 to 72 hours after birth. Spearman correlation analysis was performed to assess the association between illness severity and PI values during this period， while logistic regression analysis was employed to examine the relationship between PI values and prognosis in critically ill neonates. Receiver operating characteristic （ROC） curve analysis was conducted to evaluate the predictive value of PI for poor prognosis， and the optimal cutoff threshold for prognosis prediction was determined. Results The PI values of healthy neonates between 6 and 72 hours after birth ranged from 2.61 to 3.31. Critically ill neonates exhibited consistently lower PI values than their healthy counterparts during the same period， with statistically significant differences observed across neonates of varying illness severity （P < 0.05）. PI values in all groups gradually increased within the first 72 hours post-birth （P < 0.05）. Neonatal illness severity was negatively correlated with PI values measured at 6， 18， 24， 48， and 72 hours after birth （P < 0.05）. Furthermore， neonates in the poor prognosis group had significantly lower PI values between 6 and 72 hours compared to those in the good prognosis group （P < 0.05）. Reduced PI values were significantly associated with an increased risk of poor prognosis in critically ill neonates （P < 0.05）. The predictive performance of PI values for poor prognosis， as assessed by the area under the curve （AUC）， yielded values of 0.760， 0.779， 0.768， 0.797， and 0.808 at 6， 18， 24， 48， and 72 hours， respectively， with corresponding cut-off values of 0.88， 1.12， 1.25， 1.65， and 1.82. Conclusion The PI values measured between 6 and 72 hours after birth are closely associated with disease severity in neonates， with lower PI values indicating a poorer prognosis. These early postnatal PI measurements demonstrate auxiliary predictive value for the outcomes of critically ill neonates.

Objective To develop a multimodal nomogram for predicting the risk of postoperative metastasis and recurrence in patients with stage Ⅱ colorectal cancer （CRC） who do not receive adjuvant therapy. Methods A total of 424 patients with stage Ⅱ CRC who underwent radical resection without adjuvant therapy at our institution between January 2016 and December 2021 were retrospectively enrolled. Clinicopathological characteristics ［including T stage， carcinoembryonic antigen （CEA） levels， and tumor differentiation］， inflammatory markers （preoperative neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio）， radiomic features （MRI texture entropy）， and molecular biomarkers （KRAS mutation status） were collected. Radiologically confirmed metastasis or recurrence was defined as the primary endpoint. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors and construct a predictive nomogram. The model’s discriminatory performance was assessed using receiver operating characteristic （ROC） curve analysis. Internal validation was conducted via bootstrapping， and model calibration was evaluated using the Hosmer?Lemeshow goodness-of-fit test. Decision curve analysis was applied to assess the clinical utility of the nomogram， and risk stratification was subsequently performed. Results Among the patients， 104 （24.53%） developed metastasis or recurrence within three years after surgery. Multivariate analysis revealed the following independent risk factors （all P < 0.05）： CEA > 5 μg/L， moderate to poor differentiation， presence of lymphovascular invasion， perineural invasion， elevated neutrophil-to-lymphocyte ratio （NLR）， increased radiomic entropy， and KRAS mutation. The nomogram demonstrated strong predictive accuracy （AUC = 0.870， 95%CI： 0.850 ~ 0.930）， and the calibration curve indicated excellent agreement between predicted and observed outcomes. Following risk stratification， the recurrence rate was only 6.1% in the low-risk group， compared to 74.2% in the high-risk group （P < 0.05）. Conclusions This study develops a clinical-inflammatory-radiomic integrated prediction model specifically for stage Ⅱ colorectal cancer patients who do not receive adjuvant therapy. The model effectively identifies the risk of postoperative metastasis and recurrence， enabling the establishment of a risk stratification system to guide subsequent treatment decisions.

Objective To investigate the relationship between serum F2-isoprostaglandin （F2IP）， homocysteine （Hcy）， cytoplasmic phospholipase A2 （cPLA2） and male erectile dysfunction. Methods A total of 198 patients with erectile dysfunction who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2020 to April 2025 were selected as the case group. Meanwhile， 198 physical examinees with normal reproductive and sexual functions who underwent physical examinations in our hospital during the same period were selected as the control group. The levels of serum F2IP， Hcy， cPLA2， sex hormones， and the score of the international index of erectile function （IIEF） were measured and recorded in the two groups. Subsequently， the diagnostic value of serum F2IP， Hcy， and cPLA2 for male erectile dysfunction was analyzed. Based on the IIEF score， the patients with erectile dysfunction were classified into the severe group （45 cases）， the moderate group （88 cases）， and the mild group （65 cases）. The levels of serum F2IP， Hcy， cPLA2， and sex hormones were compared among the three groups， and the correlation between the levels of serum F2IP， Hcy， cPLA2， sex hormones， and the IIEF score in patients with erectile dysfunction was analyzed. Results The levels of serum F2-isoprostane （F2IP）， homocysteine （Hcy）， cytosolic phospholipase A2 （cPLA2）， follicle-stimulating hormone （FSH）， and luteinizing hormone （LH） in the case group were significantly higher than those in the control group， while the serum testosterone level and International Index of Erectile Function （IIEF） score were significantly lower than those in the control group （P < 0.05）. The area under the curve （AUC） of the combined detection of serum F2IP， Hcy， and cPLA2 in the diagnosis of erectile dysfunction was higher than that of each biomarker alone （P < 0.05）， with the sensitivity and specificity being 88.38% and 84.34%， respectively. In the mild， moderate， and severe groups， the levels of serum F2IP， Hcy， cPLA2， FSH， and LH exhibited an increasing trend， whereas the serum testosterone level showed a decreasing trend （P < 0.05）. The levels of serum F2IP， Hcy， and cPLA2 in patients with erectile dysfunction were negatively correlated with the serum testosterone level and IIEF score （r = -0.573， -0.618， -0.549， -0.516， -0.553， -0.581； P < 0.05） and positively correlated with the levels of serum FSH and LH （r = 0.571， 0.650， 0.650， 0.511， 0.648， 0.547； P < 0.05）. Conclusions The occurrence of erectile dysfunction can lead to an increase in the levels of serum F2IP， Hcy， and cPLA2， as well as an abnormality in the levels of serum sex hormones. Moreover， the combination of serum F2IP， Hcy， and cPLA2 can enhance the diagnostic value of erectile dysfunction. Meanwhile， there is a significant correlation between the levels of serum F2IP， Hcy， and cPLA2， the levels of serum sex hormones， and the severity of the disease.

Objective To explore the factors influencing blood drug concentrations of first-line anti-tuberculosis drugs in fixed-dose combinations by analyzing therapeutic drug monitoring data from tuberculosis patients receiving these regimens. Methods This retrospective study enrolled 224 patients who received treatment at Guangzhou Chest Hospital between January 2020 and December 2024. All participants underwent standardized therapy during the intensive phase， with therapeutic drug monitoring of first-line anti-tuberculosis drugs （ANTDs）， including isoniazid （INH） and rifampicin （RFP）. Data collection was completed in January 2025， at which time clinical records and measured INH and RFP plasma concentrations were updated. Data analysis was conducted from January to February 2025. Eight baseline variables—gender， age， hypoproteinemia （serum albumin < 35 g/L）， glomerular filtration rate （GFR）， and others—were collected. Univariate chi-square tests and multivariate logistic regression analyses were performed to identify independent risk factors associated with subtherapeutic INH and RFP plasma concentrations. Results Among the study participants， 71.43% （160/224） exhibited blood drug concentrations below the reference range for INH， compared to 41.07% （92/224） for RFP. The mean blood concentrations （mg/L， ± SD） were 2.532 ± 1.371 for INH and 9.428 ± 4.317 for RFP， respectively. One-way analysis indicated significant associations between male gender， positive etiological test results， and subtherapeutic RFP concentrations （P < 0.05）， suggesting statistically significant differences. Multivariate regression analysis further revealed that male gender （OR = 1.992， 95%CI： 1.094 ~ 3.628） and positive etiological tests （OR = 1.929， 95%CI： 1.058 ~ 3.517） were independent risk factors for low RFP levels. Conclusions This study demonstrates that therapeutic drug monitoring （TDM） frequently identifies subtherapeutic RFP concentrations in tuberculosis patients undergoing treatment. Multivariate analysis reveals that male sex and positive pathogen test results are independent risk factors associated with low RFP plasma levels. Consequently， clinicians should exercise heightened vigilance in patients exhibiting these characteristics， promptly implementing TDM to guide individualized dose adjustments. Such an approach is crucial for optimizing treatment efficacy and minimizing the risk of drug resistance development.

Objective To investigate the expression characteristics of granzyme B （GZMB） and C-X-C motif chemokine ligand 9 （CXCL9） in gastric cancer （GC） tissues， explore their association with the tumor immune microenvironment （TME）， and evaluate their clinical prognostic significance. Methods Bioinformatic analyses were conducted using public databases （TIMER， GEPIA， UALCAN） to validate the expression levels of GZMB and CXCL9 across various cancer types， with a focus on GC. Paired tumor and adjacent normal tissue samples were collected from 89 GC patients who underwent radical gastrectomy at Nanyang First People's Hospital between 2018 and 2019. The mRNA expression levels of GZMB and CXCL9 were measured using quantitative real-time PCR （qRT-PCR）， and their associations with clinicopathological characteristics were statistically analyzed. Immune cell infiltration levels were estimated using the TIMER and GSCA databases. Diagnostic performance was evaluated through receiver operating characteristic （ROC） curve analysis， while survival outcomes were assessed using data from the Kaplan-Meier Plotter database and patient follow-up records. Results Both database analysis and qRT-PCR results demonstrated that GZMB and CXCL9 expression levels were significantly elevated in GC tissues compared to adjacent non-tumor tissues （P < 0.05）. Clinical correlation analysis revealed no significant associations between mRNA expression levels of GZMB and CXCL9 and clinicopathological parameters， including gender， age， pathological type， tumor differentiation， TNM stage， tumor size， or lymph node metastasis （P > 0.05）. Immune infiltration analysis indicated that both genes were significantly positively correlated with CD8⁺ T cell and dendritic cell infiltration （P < 0.05）， while showing a negative correlation with B cell infiltration （P < 0.05）. ROC curve analysis showed that the combined detection of GZMB and CXCL9 yielded an AUC of 0.890 （95%CI： 0.843 ~ 0.936）， which was higher than that of GZMB alone （AUC = 0.832， 95%CI： 0.772 ~ 0.891） or CXCL9 alone （AUC = 0.782， 95%CI： 0.715 ~ 0.850）. Survival analysis further revealed that patients with high expression of GZMB and CXCL9 had significantly improved overall survival compared to those with low expression （P < 0.05）. Conclusion GZMB and CXCL9 are highly expressed in GC and are strongly associated with the infiltration of anti-tumor immune cells. These molecules represent promising diagnostic biomarkers for GC， and their elevated expression is correlated with a more favorable prognosis in patients.

Objective To investigate the therapeutic effects of varying treatment durations of recombinant human brain natriuretic peptide （rhBNP） on heart failure following percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 196 STEMI patients with heart failure （HF） following emergency percutaneous coronary intervention （PCI） were enrolled and randomly assigned to one of four groups： control group （n = 53）， short-course rhBNP group （n = 47）， medium-course rhBNP group （n = 50）， and long-course rhBNP group （n = 46）. The rates of cardiovascular mortality and HF-related rehospitalization were evaluated at 30 days and 6 months post-treatment. Serum levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）， matrix metalloproteinase-9 （MMP-9）， tissue inhibitor of matrix metalloproteinase-1 （TIMP-1）， left ventricular end-diastolic diameter （LVEDD）， and left ventricular ejection fraction （LVEF） were measured at 24 hours， 3 days， 1 week， 30 days， and 6 months after HF treatment initiation. Results Compared with the control group， both the short- and medium-term rhBNP groups showed a significant reduction in cardiovascular mortality and HF-related rehospitalization rates in the long-term rhBNP group at 30 days and 6 months （P < 0.05）. Additionally， the medium-term rhBNP group exhibited lower HF-related rehospitalization rates than both the control and short-term rhBNP groups （P < 0.05）. Serum levels of NT-proBNP， MMP-9， and LVEDD significantly decreased in the short-term rhBNP group within 24 hours compared to the control group （P < 0.05）， while TIMP and LVEF levels increased （P < 0.05）. In comparison with the short-term rhBNP group， the medium-term rhBNP group demonstrated sustained reductions in NT-proBNP， MMP-9， and LVEDD levels at 72 hours， 1 week， 30 days， and 6 months （P < 0.05）， accompanied by increases in TIMP and LVEF （P < 0.05）. Furthermore， the long-term rhBNP group showed greater improvements than the medium-term group， with significantly lower NT-proBNP， MMP-9， and LVEDD levels and higher TIMP and LVEF values at 1 week， 30 days， and 6 months （P < 0.05）. In terms of the adverse reactions， the incidence of hypotension in the control group， short course rhBNP group， medium course rhBNP group and long course rhBNP group increased successively （P < 0.05）. Conclusion The clinical efficacy of rhBNP in STEMI patients with HF following PCI gradually improved as the treatment duration increased， but the incidence of hypotension also rose accordingly.

Objective To investigate the efficacy of externally applied mirabilite combined with infrared irradiation in promoting wound healing following biliary tract surgery. Methods Patients who underwent open surgery for biliary tract disease in our department between January 2022 and April 2025 were randomly assigned to one of three groups： （1） Combination group （n = 60）， which received postoperative wound treatment with mirabilite application combined with infrared irradiation； （2） Mirabilite group （n = 60）， treated with mirabilite application alone； and （3） Infrared group （n = 60）， treated with infrared irradiation alone. The primary outcomes included wound healing grade on postoperative day 7， pain intensity measured on days 3， 5， and 7， and wound healing status up to discharge. For cases with suboptimal healing， the duration required for complete healing following intervention was documented. Secondary outcomes encompassed length of postoperative hospital stay and Vancouver Scar Scale （VSS） scores—assessing scar pigmentation， thickness， vascularity， and pliability—evaluated at 3 months postoperatively. Results The combination group exhibited significantly lower rates of poor wound healing， shorter postoperative hospital stays， improved VSS scores—particularly in terms of scar thickness and pliability—and reduced pain levels on the 3rd and 5th postoperative days compared to the other two groups （P < 0.05）. Conclusions The combined use of mirabilite and infrared irradiation for surgical incisions following biliary tract surgery represents an effective， economical， and readily accessible adjuvant therapy. It significantly reduces the incidence of impaired wound healing and effectively alleviates early postoperative pain， thereby demonstrating strong potential for clinical promotion.

Objective This study aims to provide theoretical support for the formulation of thyroid nodule prevention and treatment strategies in Northwest China and to investigate the characteristics of thyroid nodules and their association with metabolic indicators in this population. Methods A cross-sectional survey was conducted by retrospectively enrolling healthy individuals who underwent routine health examinations at our hospital between January 1 and December 31， 2023. A total of 38 919 participants were included. The detection rate of thyroid nodules was stratified by age and sex. Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for thyroid nodules. Results Among the 38 919 participants， 20 395 were men （52.4%） and 18 524 were women （47.6%）. The overall detection rate of thyroid nodules was 47.1% （18 317/38 919）， including 40.1% （8 187/20 395） in men and 54.7% （10 130/18 524） in women. Across all age groups， women had a significantly higher detection rate than men （P < 0.001）. The detection rate increased with age in both sexes （χ2_trend = 1392.867， P < 0.001 in men； χ2_trend = 1521.215， P < 0.001 in women）. Significant differences were observed between participants with and without thyroid nodules in age， body mass index （BMI）， fasting blood glucose （FBG）， glycated hemoglobin （HbA_1c）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， triiodothyronine （T3）， thyroid-stimulating hormone （TSH）， and anti-thyroglobulin antibodies （TGAB）， anti-thyroid microsomal antibodies， the proportion of hypertension and central obesity （all P < 0.05）. Multivariate binary logistic regression analysis identified female sex （OR = 2.158）， older age （OR = 1.040）， central obesity （OR = 1.144）， elevated FBG （OR = 1.039）， hypertension （OR = 1.095）， elevated TGAB （OR = 1.008）， and elevated T3 （OR = 1.154） as independent risk factors for thyroid nodules （all P < 0.05）. Conclusion Women in Northwest China are at higher risk of developing thyroid nodules. Screening and health management should be prioritized for older individuals， those with central obesity， elevated FBG， hypertension， elevated TGAB， and elevated T3 levels.

Objective To investigate the therapeutic effects of modified Lizhong Decoction on gastric and duodenal ulcers （GDU） of the spleen-stomach cold deficiency type， as well as its influence on gastric function and inflammatory mediators. Methods From April 2023 to May 2025， patients diagnosed with gastric dyspepsia of the spleen and stomach cold deficiency type at Nanyang First People's Hospital were randomly assigned to either the Western medicine group （n = 53） or the combined therapy group （n = 53）. The Western medicine group received oral rabeprazole sodium enteric-coated tablets and sucralfate suspension， while the combined therapy group received the same Western medication regimen plus modified Lizhong Decoction. Both groups underwent a 6-week treatment course. Outcomes including clinical efficacy after 6 weeks， gastric mucosal morphology scores， gastric function， levels of inflammatory mediators， mucosal repair-related factors， oxidative stress markers， quality of life before and after treatment， and treatment safety were compared between the two groups. Results The total effective rate in the combined group after 6 weeks of treatment was significantly higher than that in the Western medicine group （P < 0.05）. After 6 weeks of treatment， both groups showed reduced mucosal thickness， inflammatory cell infiltration， glandular density scores， and decreased serum levels of cholecystokinin （CCK）， motilin （MTL）， gastrin （GAS）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， nuclear factor-κB （NF-κB）， and malondialdehyde （MDA） compared to baseline， with greater reductions observed in the combined group （P < 0.05）. Additionally， serum levels of calcitonin gene-related peptide （CGRP）， trefoil factor 1 （TFF1）， epidermal growth factor （EGF）， epidermal growth factor receptor （EGFR）， and superoxide dismutase （SOD）， as well as quality-of-life scores across multiple domains， were significantly increased from baseline in both groups， with the combined group showing superior improvements （P < 0.05）. During the treatment period， the incidence of adverse reactions was 11.32% in the combined group and 5.66% in the Western medicine group， with no statistically significant difference between the two groups （P > 0.05）. Conclusion Modified Lizhong Decoction demonstrated a definite therapeutic effect on GDU of the spleen and stomach cold deficiency type， effectively improving gastric mucosal morphology， enhancing gastric function， suppressing inflammatory responses and oxidative stress， promoting the secretion of mucosal repair-related factors， improving patients' quality of life， and exhibiting favorable safety.

Neoadjuvant therapy for hepatocellular carcinoma is the frontier and hot topic in the current field of liver cancer research. The fundamental purpose is to reduce the risk of postoperative recurrence through standardized preoperative treatment methods. From the attempts of Transcatheter Arterial Chemoembolization monotherapy for neoadjuvant therapy for hepatocellular carcinoma to systematic treatment represented by “targeted combined with immunotherapy”， the latter has become the most promising neoadjuvant strategy due to its high objective response rate and potential to induce pathological complete remission. However， the field still faces challenges such as lack of evidence of overall survival benefit in Phase Ⅲ randomized controlled trials， treatment-related adverse reactions that may lead to delay in surgery， optimal population screening， and timing of surgery. This article aims to briefly discuss the current research status of the application of neoadjuvant therapy in resectable hepatocellular carcinoma， explore relevant diagnosis and treatment concepts， and further understand neoadjuvant therapy.

The pathogenesis of chronic fatigue syndrome （CFS） remains poorly defined， and while the tryptophan metabolic pathway is closely associated with the development of CFS， the underlying mechanisms are not yet fully understood. This review examines the alterations in tryptophan metabolites and related enzymes in both peripheral and central systems of CFS patients， with a particular focus on the involvement of the tryptophan pathway in the gut-brain axis （GBA）. Furthermore， it provides a comprehensive analysis of the mechanistic roles of tryptophan metabolites in modulating the progression of CFS， aiming to elucidate the current evidence and potential driving mechanisms linking the tryptophan metabolic pathway to CFS， thereby promoting new insights and advancements in this research domain.