Rheumatoid Arthritis （RA） is an autoimmune disease， with pain being its primary symptom. The mechanisms underlying RA pain involve both inflammatory and neuropathic components. Lidocaine， a classic amido-type local anesthetic， has gained widespread application in treating inflammatory and neuropathic pain due to its analgesic， anti-inflammatory， and immunomodulatory properties when administered intravenously. Given the exact match between the pathogenesis of RA pain and the pharmacological actions of intravenous lidocaine， this review explores the therapeutic potential of intravenous lidocaine infusion for RA pain. It aims to offer new insights into the clinical application of intravenous lidocaine for managing RA-related pain.

Objective To investigate the effect of resveratrol （Res） on fibroblast-like synovial cells of osteoarthritis treated with H₂O₂， and to clarify the regulatory mechanism relationship of the PINK1/Parkin mitochondrial autophagy signaling pathway in the above effects. Methods Fibroblast-like synovial cells （FLSs） were extracted from the synovial membranes of patients undergoing osteoarthritis surgery and divided into the control group and the experimental group. The experimental group was treated with H₂O₂ （5 μmol/L） and then treated with different concentrations of Res （0， 10， 20， 40， 60， 80， 100 μmol/L）. Cell viability assay （CCK-8） was used to detect the inhibition rate of cell proliferation. Cell reactive oxygen species were detected by DCFH-DA fluorescent probe. Mitochondrial reactive oxygen species were detected by MitoSOX Red fluorescent probe. Cell cycle was detected by flow cytometry. The expressions of proteins such as NLRP3， TNF-α， IL-1β， SOD2， Bax， Bcl-2， BNIP3， LC3B， p62， PINK1 and Parkin were detected by Western blot and immunofluorescence experiments. The role of the PINK1/Parkin mitochondrial autophagy signaling pathway in Res' inhibition of abnormal proliferation， inflammation and oxidative stress in FLSs was further verified using PINK1 and Parkin interfering RNA. Results Res significantly inhibited the enhancement of FLSs activity induced by H₂O₂， and reduced the abnormal proliferation， inflammation and oxidative stress levels of FLSs； Res inhibited the expressions of NLRP3， TNF-α， Bcl-2 and p62 proteins， while promoting the expressions of SOD2， Bax， BNIP3， LC3B， PINK1 and Parkin proteins. H₂O₂ inhibited the PINK1/Parkin signaling pathway， while Res activated the PINK1/Parkin pathway. The use of PINK1 and Parkin interfering RNA exacerbated cellular inflammation and oxidative stress. Conclusion Res activates the PINK1/Parkin mitochondrial autophagy signaling pathway by increasing the expression of PINK1 and Parkin proteins， alleviating abnormal proliferation， inflammation and oxidative stress in fibroblast-like synovial cells of osteoarthritis induced by H₂O₂.

Objective To assess the efficacy and safety of Qing Gong′s orthopaedic manipulation （QGOM） for the shoulder on hand-behind-back （HBB） restriction after rotator cuff repair （RCR）. Methods Forty-two patients with post-RCR HBB restriction were randomised into two groups （n = 21 each）： one performing shoulder exercises （control）， and the other receiving thrice-weekly QGOM treatment for 6 weeks （observation）. Results At 6 weeks， the median HBB score increased by 5 （2， 6） in the observation group compared to a 2 （2， 2） in the control group （Z = -3.678， P < 0.001）. The median visual analogue scale score decreased by 3 （2， 4） in the observation group， while it decreased by 1 （1， 2） （Z = -3.652， P < 0.001） in the control group. The mean Constant?Murley score increased by 28.76 and 15.90 in the observation and control groups， respectively. The difference between the two groups was 12.86 （95% confidence interval （CI）： 7.26 ~ 18.45， P < 0.001）. At 6 weeks， active forward flexion （Z = -3.663， P < 0.001）， abduction （t = -4.579， P < 0.001）， extension （Z = -2.281，P = 0.023） and external rotation （t = -2.757， P = 0.009） were significantly greater in the observation group than those in the control group. Shoulder forward flexion and abduction in the observation group increased significantly in the observation group （Z= -2.055， P = 0.041） than those in the control group （Z = -2.450， P = 0.013）. The observation group showed significantly greater improvement than the control group in forward flexion （Z = -3.059， P = 0.002）， abduction （Z = -3.700， P < 0.001）， extension （Z = -2.194， P = 0.028）， and external rotation （Z = -3.003， P = 0.003）. Conclusions QGOM for the shoulder was effective， safe and more beneficial than shoulder exercise alone in improving HBB after RCR.

Objective To observe the effect of vestibular regulation technique combined with conventional musculoskeletal rehabilitation on the foot posture of adolescents with flexible flatfoot. Methods Fifty-eight patients were randomly divided into a control group and an experimental group， with 29 patients in each group. The control group received musculoskeletal rehabilitation， while the experimental group received vestibular regulation combined with musculoskeletal rehabilitation. Both groups were treated for two weeks. Three-dimensional foot scans were conducted before and after the intervention to collect data on arch height， arch type， arch width coefficient， footprint area coefficient， calcaneal valgus angle， and hallux valgus angle. Results （1）Arch height： Both the control and experimental groups showed increased arch height in both feet after the intervention （P < 0.05）， with the experimental group showing better results than the control group （P < 0.05）. （2）Arch type： Both groups showed improvement in arch type in both feet after the intervention （P < 0.05）， with no significant difference in efficacy between the two groups （P > 0.05）. （3）Arch width coefficient： The control group showed improvement in the left foot arch width coefficient after the intervention （P < 0.05）， but no significant improvement in the right foot （P > 0.05）. The experimental group showed improvement in both feet （P < 0.05）， with no significant difference in efficacy between the two groups （P > 0.05）. （4）Footprint area coefficient： Both groups showed improvement in the footprint area coefficient in both feet after the intervention （P < 0.05）， with no significant difference in efficacy between the two groups （P > 0.05）. （5）Calcaneal valgus angle： The control group showed no significant improvement in the calcaneal valgus angle in both feet after the intervention （P > 0.05）， while the experimental group showed improvement （P < 0.05）. （6） Hallux valgus angle： The control group showed no significant improvement in the hallux valgus angle in both feet after the intervention （P > 0.05）， while the experimental group showed improvement （P < 0.05）. Conclusion On the basis of conventional musculoskeletal rehabilitation， the integration of vestibular regulation techniques can effectively improve the height， type， width coefficient of the arch， footprint area coefficient， calcaneal valgus angle， and hallux valgus angle of the foot in adolescents with flexible flatfoot， and improve their foot posture.

Objective To investigate the effect of ursolic acid on liver injury induced by neodymium oxide in rats based on the Nrf2/GPX4 signaling pathway and explore its underlying mechanism. Methods Sixty 6-week-old specific pathogen-free （SPF） grade Sprague-Dawley （SD） rats were randomly allocated into six groups （n = 10 per group）： a blank control group， a neodymium oxide model group， low-dose， medium-dose， and high-dose ursolic acid groups， and a diammonium glycyrrhizinate group. After a 9-week intervention period， the rats were fasted for 12 hours with free access to water prior to sacrifice. Hepatic histopathology was examined using hematoxylin and eosin （HE） staining. Serum biochemical markers of liver function were assayed. The levels of superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-10 （IL-10） were detected by enzyme-linked immunosorbent assay （ELISA）. The Fe2? content in the liver was determined through colorimetry. The protein expression levels of nuclear factor erythroid 2-related factor 2 （Nrf2） and glutathione peroxidase 4 （GPX4） in liver tissue were measured by Western blotting. Results In comparison with the normal control group， the model group exhibited fatty vacuoles of varying sizes and extensive infiltration of inflammatory cells in the liver tissue. The activities of serum alanine aminotransferase （ALT） and aspartate aminotransferase （AST）， the levels of malondialdehyde （MDA）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and the content of Fe2? were significantly elevated （P < 0.05）， whereas the levels of superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）， and interleukin-10 （IL-10） were significantly decreased （P < 0.05）. After the intervention of ursolic acid， hepatic steatosis was remarkably improved， and the infiltration of inflammatory cells was reduced. The activities of serum ALT and AST， the levels of MDA， TNF-α， IL-1β， and the content of Fe2? were significantly decreased （P < 0.05）， while the levels of SOD， GSH-Px， and IL-10 were significantly increased （P < 0.05）. Western blot results indicated that， when compared with the normal control group， the protein expression of nuclear factor erythroid 2-related factor 2 （Nrf2） and glutathione peroxidase 4 （GPX4） in the liver of the model group was significantly reduced （P < 0.05）. Nevertheless， after the intervention of ursolic acid， the expression of Nrf2 and GPX4 proteins was significantly increased （P < 0.05）. Conclusion Ursolic acid exerts a protective effect against neodymium oxide-induced liver injury in rats. Its mechanism may be associated with the regulation of the Nrf2/GPX4 signaling pathway， which can reduce the inflammatory response， alleviate oxidative stress， and consequently inhibit ferroptosis.

Objective To develop a deep learning-based tongue image classification system for psoriasis to improve the objective differentiation between the patterns of Spleen Deficiency with Dampness Retention （SDDR） and Blood Stasis （BS）. Methods A total of 981 tongue images from psoriasis patients diagnosed with SDDR or BS were collected. An improved U-Net model， featuring a ResNet-34 encoder， bilinear interpolation upsampling， and optimized skip connections， was employed for automatic tongue region segmentation. Macenko color normalization and the Albumentations library were applied for data augmentation to mitigate variances from imaging devices and lighting conditions. A two-stage framework was constructed： the first stage precisely extracted the tongue body region， while the second stage utilized a Hybrid Model integrating EfficientNet-B3 and Swin-Tiny architectures for pattern classification. A cross-modal multi-head attention mechanism was introduced to fuse local textural and global structural features. Results The improved U-Net achieved superior performance in tongue segmentation， with a Dice coefficient of 0.98 and an IoU of 0.89， significantly outperforming the original U-Net （Dice 0.85）. For pattern classification， the Hybrid Model demonstrated the best overall performance， achieving a 5-fold cross-validation mean accuracy of 0.9816 and a mean AUC of 0.9993. The F1-score was significantly higher than those of individual models. Macenko normalization contributed to an 8.3% increase in F1-score. The inference time per image was 38 ms on an A10 GPU， meeting the requirement for clinical real-time application. Conclusion The constructed two-stage tongue image classification model effectively and accurately distinguishes between SDDR and BS patterns in psoriasis， significantly enhancing the objectivity of tongue diagnosis. It provides a reliable tool for pattern differentiation in Traditional Chinese Medicine and shows promising potential for clinical application.

Objective To investigate the effect of Qushi Huoxue decoction （QSHXF） on free fatty acid （FFA）-induced HepG2 cells and its underlying mechanism. Methods In vitro cell experiments were conducted. First， the CCK-8 assay was used to determine the effects of different concentrations of QSHXF on HepG2 cells viability to select appropriate concentrations for subsequent experiments. A fatty liver cell model was then established by treating HepG2 cells with a mixture of 250 μmol/L sodium palmitate and 500 μmol/L sodium oleate for 24 h， followed by intervention with different concentrations of QSHXF-containing serum and AMPK inhibitor for another 24 h. Intracellular lipid droplet accumulation was observed using Oil Red O staining and lipid fluorescence staining. The levels of total cholesterol （TC） and triglycerides （TG） were measured using the GPO-PAP enzymatic method. The TBA method and hydroxylamine method were used to detect malondialdehyde （MDA） and superoxide dismutase （SOD）， respectively， while ELISA was used to detect tumor necrosis factor-α （TNF-α） and interleukin 1β （IL-1β）. Furthermore， qRT-PCR， Western blot， and immunofluorescence staining were performed to detect the expression of lipid metabolism-related genes and proteins. Results QSHXF significantly improved the lipid deposition， oxidative stress and inflammatory response of FFA-induced HepG2 cells， markedly reduce the content of TC， TG， MDA， TNF-α and IL-1β in cells and increase the activity of SOD （P < 0.01）. Meanwhile， it increased the mRNA expression of AMPK and the protein ratio of p-AMPK/AMPK， while decreasing the mRNA and protein levels of SREBP1c， FASN， ACC1， and SCD1 （all P < 0.05）. Conclusion QSHXF significantly improved lipid metabolism and alleviated oxidative stress and inflammation in the MASLD cell model， and its mechanism may be associated with the activation of the AMPK/SREBP1c signaling pathway.

Objective To analyze the diagnostic efficacy of the fatty liver index （FLI） in the screening of metabolic dysfunction-associated steatotic liver disease （MASLD） Methods Prospectively， 109 patients diagnosed with MASLD who were admitted to our hospital between June 2023 and June 2025 were selected as the research subjects. They were classified into the diabetes group （n = 42） and the non-diabetes group （n = 67） according to the presence or absence of type 2 diabetes. Additionally， 109 patients without MASLD during the same period were chosen as the control group. The baseline data and Fatty Liver Index （FLI） of different groups were compared. Binary logistic regression analysis was conducted to identify the influencing factors， and the receiver operating characteristic curve （ROC） was employed to assess the screening efficacy. Results The proportions of smoking history， hypertension， and type 2 diabetes in the MASLD group were significantly higher compared to those in the non-MASLD group （P < 0.05）. The levels of systolic blood pressure， diastolic blood pressure， waist circumference， BMI， fasting plasma glucose， HbA_1c， fasting insulin， total cholesterol， triglycerides， hs-CRP， GGT， ALT， AST， TBIL， and FLI in the MASLD group were significantly higher than those in the non-MASLD group， whereas the levels of LDL-C， ALB， and PA were significantly lower than those in the non-MASLD group （P < 0.05）. The prevalence of hypertension in MASLD patients with type 2 diabetes was higher than that in the non-diabetic group （P < 0.05）， and the age， systolic blood pressure， waist circumference， BMI， fasting plasma glucose， HbA_1c， fasting insulin， triglycerides， DBIL， and FLI levels were significantly higher than those in the non-diabetic group （P < 0.05）. Multivariate analysis indicated that FLI， type 2 diabetes， HbA_1c， and hs-CRP were independent predictors for MASLD screening （P < 0.05）； in contrast， FLI， hypertension， HbA_1c， and FINS were independent predictors for MASLD screening in type 2 diabetes patients （P < 0.05）. ROC curve analysis demonstrated that in screening for MASLD， FLI had the best efficacy （AUC = 0.886）， followed by hs-CRP （AUC = 0.755）； the combined prediction model had better efficacy （AUC = 0.916）， with a cutoff value of 0.433， a sensitivity of 88.1%， and a specificity of 81.7%. In type 2 diabetes patients with MASLD， HbA_1c performed best （AUC = 0.802）， followed by FLI （AUC = 0.724）； the combined model had the best efficacy （AUC = 0.876）， with a cutoff value of 0.480， a sensitivity of 95.5%， and a specificity of 77.1%. Conclusions FLI stands out as the most effective single predictor for MASLD screening. Moreover， its efficacy is further enhanced when it is combined with type 2 diabetes， HbA_1c， and hs-CRP. Among patients with type 2 diabetes， the combination of FLI， hypertension， HbA_1c， and FINS yields the optimal screening results for MASLD. As a non-invasive indicator， FLI holds significant application value in the early screening of MASLD.

Objective To investigate the myocardial protective effects and clinical value of lidocaine in cardiopulmonary bypass （CPB） non-arrested （beating-heart） mitral valve replacement surgery. Methods A total of 50 patients who underwent CPB beating-heart mitral valve replacement between January 2023 and September 2025 were randomly divided into two groups： Group A （lidocaine + beating-heart group） and Group B （beating-heart only group）. The two groups received identical anesthesia induction and maintenance protocols. However， Group A additionally received an intravenous infusion of lidocaine at 1.5 mg/kg 10 minutes before anesthesia induction， followed by continuous infusion at a rate of 1.5 mg/（kg·h） until the end of surgery. Group B received only the beating-heart surgical technique without lidocaine. Plasma levels of high-sensitivity cardiac troponin T （TNT-HS）， myoglobin （MYO）， creatine kinase （CK）， and creatine kinase-MB （CK-MB） were measured preoperatively （T₀）， at 6 hours postoperatively （T₁）， and at 12 hours postoperatively （T₂）. Results Compared with Group B， Group A showed significantly lower plasma levels of TNT-HS， MYO， CK， and CK-MB at T₁ and T₂ （P < 0.05）. In both groups， these markers were significantly elevated at T₁ and T₂ compared with T₀ （P < 0.05）. Conclusion Lidocaine demonstrates significant myocardial protection during on-pump beating-heart mitral valve replacement surgery， effectively suppresses hemodynamic fluctuations during endotracheal intubation， and reduces the incidence of perioperative ventricular arrhythmias.

Objective To explore the therapeutic effect of nasal cavity volume expansion surgery combined with modified uvulopalatopharyngoplasty （UPPP） on patients with obstructive sleep apnea-hypopnea syndrome （OSAHS） complicated by multi-level obstruction. Methods A total of 98 patients with moderate-to-severe OSAHS， whose obstructive levels were located in the nasal cavity and pharyngeal cavity and who received treatment in our hospital from August 2023 to May 2025， were selected as the research objects. They were divided into two groups using the random number table method， with 49 cases in the control group and 49 cases in the observation group. The control group was treated with UPPP， whereas the observation group was treated with nasal cavity volume expansion surgery on the basis of the treatment for the control group. Two months after surgery， the clinical efficacy of the two groups was evaluated. Before and after treatment， the apnea-hypopnea index （AHI）， arousal index （AI）， lowest pulse oxygen saturation （LSaO₂）， Epworth Sleepiness Scale （ESS） score， Mini-Mental State Examination （MMSE） score， and PSQI score of patients in the two groups were compared. Pulmonary function before and after treatment was evaluated by FEV1 and PEF. Meanwhile， the occurrence of postoperative complications was recorded. Results The observation group exhibited a significantly higher total treatment efficacy rate than the control group （89.80% vs. 71.43%， P < 0.05）. The Apnea - Hypopnea Index （AHI）， Arousal Index （AI）， Epworth Sleepiness Scale （ESS） score， and Pittsburgh Sleep Quality Index （PSQI） score in the observation group were （10.26 ± 2.48） times/hour， （11.48 ± 3.08） times， （5.04 ± 1.08） points， and （6.89 ± 1.56） points， respectively， all of which were lower than those in the control group. Meanwhile， there were significant differences in the LSaO?， cognitive function， and pulmonary function between the two groups （P < 0.05）. In terms of adverse reactions after treatment， there were 3 cases of cough and 1 case of suffocation in the observation group； in the control group， there were 2 cases of cough， 2 cases of suffocation， 2 cases of bleeding， and 1 case of dysphagia. There was no significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion The combination of nasal cavity volume expansion surgery and UPPP can improve the clinical efficacy for OSAHS patients with multi-level obstruction， enhance their cognitive function and sleep quality， and does not increase the risk of adverse reactions.

Objective To explore the association of multiple abnormal body compositions （sarcopenia， myosteatosis， visceral obesity， osteoporosis） with the risks of moderate-to-severe hepatic steatosis and significant liver fibrosis in patients with metabolic associated fatty liver disease （MAFLD）. Methods A retrospective study was conducted in 392 adult patients with MAFLD admitted to our hospital between June 2022 and June 2023. Based on liver fat content assessed by quantitative CT， the MAFLD patients were divided into a mild steatosis group （210 cases） and a moderate-to-severe steatosis group （182 cases）. General information and hematological indicators of all subjects were collected， and body composition was quantitatively evaluated using AI-based body composition analysis technology. Pearson or Spearman correlation analyses were employed to examine relationships between body composition parameters and hepatic fat content. Multivariate logistic regression analysis was used to determine whether abnormal body composition is an independent risk factor for moderate-to-severe hepatic steatosis and significant liver fibrosis. Results Compared to patients with mild hepatic steatosis， those with moderate-to-severe steatosis exhibited significantly higher prevalence of sarcopenia， visceral obesity， and osteoporosis （P < 0.05）. Skeletal muscle index（r = -0.131， P = 0.009）， muscle attenuation（r = -0.105， P = 0.038）， and bone mineral density （r = -0.135 P = 0.007）demonstrated inverse correlations with hepatic fat content， while intermuscular fat fraction（r = 0.121， P = 0.016）， visceral fat index（r = 0.434， P < 0.001）， and subcutaneous fat index（r = 0.289， P < 0.001）showed positive correlations. After adjusting for multiple confounders， osteoporosis（OR = 2.04， 95%CI ： 1.03 ~ 4.03， P = 0.041）， sarcopenia（OR = 2.19， 95%CI ： 1.37 ~ 3.52， P = 0.001）， and visceral obesity（OR = 1.84， 95%CI ： 1.08 ~ 3.15， P = 0.026） were all independent risk factors for moderate-to-severe hepatic steatosis. Additionally， after bias adjustment， osteoporosis（OR = 2.63， 95%CI ： 1.37 ~ 5.05， P = 0.004），sarcopenia（OR =1.94， 95%CI ： 1.28 ~ 2.94， P = 0.002） and visceral obesity（OR = 2.54， 95%CI ： 1.58 ~ 4.08， P < 0.001）were also independent risk factors for significant liver fibrosis. Conclusion Patients with moderate-to-severe MAFLD are predisposed to concurrent body composition abnormalities， including sarcopenia. Importantly，osteoporosis， sarcopenia and visceral obesity are not only key independent risk factors for moderate-to-severe hepatic steatosis， but also significantly increase the risk of liver fibrosis. Early identification， prevention， and intervention should be implemented.

Objective To explore the evaluation value of soluble CD163 （sCD163）， stress hyperglycemia ratio （SHR）， adrenomedullin precursor （pro-ADM）， and pentraxin 3 （PTX3） in combination with the score of chest computed tomography （CT） in elderly patients with stroke-related pneumonia. Methods A total of 112 elderly patients with stroke-related pneumonia who were admitted to our hospital between March 2023 and March 2025 were selected as the research subjects. After 3 months of treatment， they were divided into the good prognosis group （77 cases） and the poor prognosis group （35 cases）. Additionally， they were classified into the mild group （36 cases）， the moderate group （45 cases）， and the severe group （31 cases） according to the severity of the patients' illness. The serum levels of sCD163， SHR， pro-ADM， and PTX3， as well as chest CT scores， were compared among the groups. Pearson correlation analysis was used to assess the relationships. The poor prognosis group was defined as positive and the favorable prognosis group as negative. Then， the receiver operating characteristic （ROC） curve was plotted to evaluate the predictive value， and the area under the curve （AUC） was obtained. Results The levels of serum sCD163， SHR， pro-ADM， PTX3， and the chest CT score in the severe group were higher than those in the moderate and mild groups， and the levels in the moderate group were higher than those in the mild group （P < 0.05）. Inter-group comparisons between the poor prognosis group and the good prognosis group revealed that the levels of serum sCD163， SHR， pro-ADM， PTX3， and the chest CT score were higher in the poor prognosis group （P < 0.05）. Pearson correlation analysis showed that the levels of serum sCD163， SHR， pro-ADM， and PTX3 were positively correlated with the chest CT score （r = 0.775， 0.615， 0.825， 0.866， P < 0.05）. The levels of serum sCD163， SHR， pro-ADM， PTX3， the chest CT score， and the NIHSS score were positively correlated （r = 0.682， 0.793， 0.847， 0.805， 0.762， P < 0.05）. The ROC analysis showed that the AUC value of the combined detection of the levels of serum sCD163， SHR， pro-ADM， and PTX3 and the chest CT score in predicting the prognosis of elderly patients with stroke-related pneumonia was 0.903， which was higher than that of each individual index （0.803， 0.758， 0.786， 0.787， and 0.752， P < 0.05）. Conclusion Serum levels of sCD163， SHR， pro-ADM， and PTX3， along with chest CT scores， were associated with the condition and prognosis of elderly patients with stroke-related pneumonia. Moreover， the combined detection of these five indicators was more valuable in predicting the prognosis of elderly patients with stroke-related pneumonia.

?Silent mating type information regulation 2 homolog 1（SIRT1）， a highly conserved NAD?-dependent deacetylase， is widely expressed in adipose tissue and plays a critical role in the pathogenesis of obesity and insulin resistance （IR）. In adipose tissue， SIRT1 ameliorates obesity and related metabolic disorders through multiple mechanisms， including suppression of inflammatory responses， regulation of lipid metabolism， promotion of adipose browning and angiogenesis， and restoration of insulin signaling pathways. Targeted delivery of the SIRT1 agonist resveratrol （Res） to adipose tissue further enhances its therapeutic efficacy against obesity and IR. This article systematically reviews the molecular basis of SIRT1's structure， along with its physiological functions across various organ systems， provides a comprehensive elucidation of its multi-target regulatory network in adipose tissue in the context of obesity and IR， and summarizes various adipose-targeting delivery strategies for SIRT1 agonists， with a focus on Res. The aim is to offer new perspectives and research directions for the treatment of metabolic diseases.

Objective To evaluate the safety and feasibility of a novel self-made retractor in subclavian approach endoscopic thyroid surgery. Methods A retrospective analysis was conducted on 180 cases of unilateral papillary thyroid carcinoma surgery performed at the Thyroid Hernia Surgery Department of the First Affiliated Hospital of South Gannan Medical University from January 2023 to April 2025. Among these， 57 cases underwent non-inflated thyroid surgery using the novel non-inflated retractor （subclavian group）， 50 underwent pneumatic transsternal thyroid surgery （transsternal group）， and 73 underwent traditional open thyroid surgery （open group）. Differences in surgical indicators， postoperative complication rates， and postoperative incision satisfaction were compared among the three groups. Results Compared with the open group， patients in the subclavian group were younger ［（40.3 ± 9.4） years vs. （44.8 ± 9.4） years， P < 0.05］ and underwent longer surgery duration ［（81.68 ± 12.08） min vs. （73.01 ± 10.04） min， P < 0.05］. However， the subclavian group exhibited lower postoperative pain scores on the first day ［（2.28 ± 0.92） points vs. （4.19 ± 1.35） points， P < 0.05］ and higher patient satisfaction with postoperative incisions. Compared with the thoracic-mammary group， patients in the subclavian group were older ［（40.3 ± 9.4） years vs. （34.9 ± 8.2） years， P < 0.05］ and had shorter operative times ［（81.68 ± 12.08） min vs. （98.18 ± 15.14） min， P < 0.05］. Additionally， patients in the subclavicular group exhibited lower postoperative pain scores on day 1 ［（2.28 ± 0.92） points vs. （3.12 ± 1.02） points， P < 0.05］ and lower total postoperative drainage volume ［80 （70， 100） mL vs. 120 （100， 150） mL， P < 0.05］. No significant differences were observed between groups in terms of incision satisfaction. There were no statistically significant differences among the three groups in terms of the number of lymph nodes removed， intraoperative blood loss， white blood cell count on postoperative day 1， parathyroid hormone， calcium ion concentration， or postoperative complications（P > 0.05）. Conclusion The novel non-inflatable retractor effectively maintains the necessary surgical space during subclavicular approach thyroid endoscopic surgery， offering high surgical safety. Compared to traditional open surgery and trans-sternal endoscopic approaches， subclavicular endoscopic thyroid surgery demonstrates reliable therapeutic efficacy and excellent cosmetic outcomes.

Objective To analyze the immunophenotypic and genetic characteristics of children with acute megakaryoblastic leukemia （AMKL） and provide relevant evidence for clinical diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical data of 45 children with AMKL who were admitted to the hospital from September 2017 to December 2024， including 23 males and 22 females. Among them， 7 cases were Down syndrome-associated AMKL （DS-AMKL）， and 38 cases were non-DS-AMKL. Flow cytometry was used for immunophenotypic analysis， G-banding for karyotype analysis， and RT-PCR and sequencing for fusion gene detection. Results The most common clinical manifestation of AMKL children at initial diagnosis was skin ecchymosis or petechiae， with a median platelet count of 17（3 ~ 222）× 10⁹/L. All children expressed at least one of the platelet-associated glycoproteins CD41a， CD42b， or CD61 in bone marrow blasts， with CD41a having the highest expression rate （84.4%）. Compared to non-DS-AMKL， DS-AMKL children had significantly higher detection rates of CD7， CD13， and CD36 （P < 0.05）， while CD41a had a significantly higher detection rate in non-DS-AMKL （P < 0.05）. Karyotype analysis was performed in 41 children， and chromosomal abnormalities were detected in 33 cases （80.5%）， including 14 cases （34.1%） with complex karyotypes. Fusion gene testing was performed in 21 non-DS-AMKL children， revealing 6 cases of CBFA2T3：：GLIS2， 2 cases of NUP98：：KDM5A， and 1 case each of NUP98：：ING4， RBM15：：MKL1， and KMT2A：：MLLT3. Children positive for CBFA2T3：：GLIS2 exhibited a characteristic immunophenotype， with high expression of CD56 and no expression of HLA-DR or CD36. Conclusions Pediatric AMKL is a highly heterogeneous disease with relatively characteristic immunophenotypes， a high rate of chromosomal abnormalities， and CBFA2T3：：GLIS2 being the most common fusion gene. Immunophenotypic and genetic molecular testing and analysis can improve the diagnosis and identification of AMKL， enabling better prognostic stratification and treatment selection.

Objective To analyze the independent risk factors for carbapenem-resistant Klebsiella pneumoniae （carbapenem-resistant Klebsiella pneumoniae，CRKP） infection in clinical patients， and further establish a nomogram model applicable for individualized risk prediction. Methods Clinical data of 422 patients with Klebsiella pneumoniae infection admitted to Chaohu Hospital Affiliated to Anhui Medical University from January 2023 to June 2025 were collected retrospectively. Using R software， the data were randomly split into a training set （295 cases） and a validation set （127 cases） at a ratio of 7∶3. LASSO and Logistic regression were used to identify risk factors， and a nomogram for the CRKP infection risk prediction model was further constructed with its performance analyzed. Results Multivariate analysis revealed five independent risk factors for CRKP infection in patients， namely ICU admission （OR = 4.883， 95%CI： 1.842 ~ 12.946）， tracheotomy/tracheal intubation （OR = 4.784， 95%CI： 1.763 ~ 12.981）， sputum aspiration （OR = 2.309， 95%CI： 0.767 ~ 6.954）， carbapenem administration （OR = 4.832， 95%CI： 1.944 ~ 12.009）， and combined antibacterial agent use （OR = 2.239， 95%CI： 0.938 ~ 5.341）. Subsequently， a prediction model was established based on these five variables screened from the training set， with the formula expressed as： Logit（P） = -3.632 + ［ICU admission （yes = 1， no = 0）］× 1.586 + ［Carbapenem use （yes = 1， no = 0）］× 1.575 + ［combined use of antibiotics （yes = 1， no = 0）］× 0.806 + ［sputum suction （yes = 1， no = 0）］× 0.837 + ［tracheotomy/tracheal intubation （yes = 1， n o =0）］× 1.565. The area under the receiver operating characteristic curve （AUC） was 0.921 （95% confidence interval ［CI］： 0.880~0.961） in the training set and 0.914 （95% CI： 0.846 ~ 0.983） in the validation set. The calibration curves generated for both the training set and validation set in this study demonstrated favorable consistency between the probability of CRKP infection predicted by the established model and the actual CRKP infection probability observed in clinical practice. The Hosmer-Lemeshow （H-L） test indicated that the model had a good degree of calibration. Decision curve analysis （DCA） further validated the favorable clinical utility of the constructed model. Conclusion The constructed risk prediction model can well predict high-risk patients with CRKP infection and can be used as a tool to assess the risk of CRKP infection in hospitalized patients.

Objective To explore and analyze the efficacy of different doses of intravenous immunoglobulin （IVIG） combined with aspirin in the treatment of children with Kawasaki disease （KD）， along with its impact on lipid metabolism parameters， DeRitis ratio ［aspartate aminotransferase （AST）/alanine aminotransferase （ALT）］， and platelet parameters. Methods A retrospective analysis was carried out to gather the clinical data of KD children admitted to the pediatrics department of the hospital from January 2021 to January 2025. All the acquired data were sourced from the hospital's electronic medical record database and follow-up database. The children were grouped based on the dosage of IVIG. Specifically， children with KD treated with high-dose IVIG （3 g/kg） in combination with aspirin were assigned to the high-dose group， those treated with conventional-dose IVIG （2 g/kg） in combination with aspirin were assigned to the conventional-dose group， and those treated with low-dose IVIG （1 g/kg） in combination with aspirin were assigned to the low-dose group. To minimize the interference of baseline conditions， the propensity score matching method was employed to balance the baseline data of the three groups. Using the 1∶1∶1 nearest-neighbor matching method with a clamp value set at 0.03， 39 cases of data were ultimately obtained for each group. The therapeutic effects， lipid metabolism ［total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， apolipoprotein A1 （ApoA1）， very-low-density lipoprotein cholesterol （vLDL-C）］， platelet parameters ［platelet distribution width （PDW）， platelet count （PLT）， plateletcrit （PCT）， mean platelet volume （MPV）， large platelet ratio （P-LCR）］， coronary Z-score value， and safety of the three groups were compared. Results The high-dose group exhibited a higher total effective rate compared to the low-dose group （P < 0.05）. After one week of treatment， the levels of HDL-C in both the high-dose group and the conventional-dose group increased when compared to those before treatment （P < 0.05）. In all three groups， the levels of TG decreased （P < 0.05）， and the levels of ApoA1 increased （P < 0.05）. After one week of treatment， the levels of HDL-C and ApoA1 in the high-dose group were higher than those in the other two groups， whereas the ratios of TG and DeRitis were lower （P < 0.05）. After one week of treatment， the values of PDW， PLT， MPV， and P-LCR in all three groups decreased （P < 0.05）. The high-dose group had lower values of PDW， PLT， and P-LCR than the other two groups， and a lower value of MPV than the low-dose group （P < 0.05）. During the 12-week follow-up， the Z-score values of the right coronary artery， left coronary artery， and left anterior descending branch in each group were all lower than those before treatment （P < 0.05）， and the values in the high-dose group were lower than those in the other two groups （P < 0.05）， with no statistically significant difference between the other two groups （P > 0.05）. There was no statistically significant difference in the incidence of adverse reactions and cardiovascular-related complications （P > 0.05）. Conclusions High-dose IVIG combined with aspirin demonstrates a superior therapeutic effect on KD. It offers more advantages in short-term lipid regulation and platelet function regulation. Moreover， it can mitigate liver damage， reduce the DeRitis ratio， and diminish the risk of coronary artery injury.

Objective To explore the mediating role of sleep quality in adolescents between rumination and depressive symptoms. Methods From October 2023 to September 2024， 300 adolescents were selected for investigation and analysis by simple random sampling. All subjects were evaluated using the Pittsburgh Sleep Quality Index （PSQI）， the Redundancy Response Scale （RRS-C）， and the Center for Epidemiological Investigation Depression Scale （CES-D）. Pearson correlation analysis was employed to examine the correlations among the CES-D depression symptoms， PSQI　sleep quality， and RRS-C rumination scores in adolescents. Hierarchical regression analysis was utilized to explore the influencing factors of depressive symptoms in adolescents. Furthermore， the mediating role of sleep quality in the relationship between rumination and depressive symptoms was tested using Model 4 of the mediation model from the SPSS Process program developed by Hayes. The significance of the mediating effect was examined using the Bootstrap sampling method. Results The PSQI， RRS-C and CES-D scores of 300 adolescents were （12.06 ± 2.14） points， （34.03 ± 6.17） points and （24.30 ± 4.37） points respectively. The CES-D score was positively correlated with the RRS-C and PSQI scores （r = 0.513， P < 0.001； r = 0.526， P < 0.001）， and the PSQI score was positively correlated with the RRS-C score （r = 0.440， P < 0.001）. After controlling for confounding factors， the PSQI score could explain 51.3% of the CES-D score. After introducing the RRS-C score， the RRS-C score could explain 50.9% of the CES-D score. In the final model， gender， being an only child， suffering from school bullying， RRS-C score， and PSQI score entered the regression equation. The above influencing factors could explain 60.7% of the CES-D score of adolescents. Rumination could positively predict depressive symptoms and sleep quality. After increasing the mediating variable sleep quality， rumination and sleep quality had a positive predictive effect on depressive symptoms. The mediating effect of sleep quality between rumination and depressive symptoms in adolescents accounted for 31.64%. Conclusion There exists a significant association between rumination and depressive symptoms in adolescents， in which sleep quality serves as a mediating role. This suggests that focusing on and implementing combined interventions targeting both rumination and sleep quality may hold significant potential value in future research.

Objective To explore the relationship between the levels of serum mucin 1 （MuC1）， type Ⅰprocollagen N-terminal propeptide （PINP）， and free light chain （sFLC） in patients with multiple myeloma and their clinical staging， immunophenotyping， and to evaluate their predictive value for prognosis. Methods A total of 220 patients with multiple myeloma admitted to Wuwei People's Hospital between July 2020 and May 2024 were selected as the case group. All patients were clearly staged according to the International Staging System （ISS）： stage Ⅰ （26 cases）， stage Ⅱ （82 cases）， and stage Ⅲ （112 cases）. Based on immunophenotyping， they were further classified into immunoglobulin （Ig） A type （52 cases）， IgG type （96 cases）， light chain type （47 cases）， and non-secreting type （25 cases）. Moreover， according to the patients' prognosis within 12 months of treatment follow-up， they were divided into the poor prognosis group （55 cases） and the good prognosis group （165 cases）. A control group of 220 healthy individuals who underwent physical examinations during the same period was also selected at a ratio of 1∶1. The clinical data and levels of serum MuC1， PINP， and sFLC （including sFLC-κ and sFLC-λ for horizontal κ and λ light chains） were compared between the case group and the control group. The levels of serum MuC1， PINP， and sFLC were also compared among patients with different clinical stages， immunophenotypes， and prognoses. The predictive value of serum MuC1， PINP， and sFLC levels for the prognosis of multiple myeloma patients was evaluated by receiver operating characteristic （ROC） curve analysis. Results The levels of serum MuC1， sFLC-κ， and sFLC-λ in the case group were significantly higher than those in the control group， whereas the level of serum PINP was significantly lower than that in the control group （P < 0.05）. In patients， the levels of serum MuC1， sFLC-κ， and sFLC-λ in stage Ⅲ were significantly higher than those in stages Ⅰ and Ⅱ， and the levels in stage Ⅱ were significantly higher than those in stage Ⅰ （P < 0.05）. Conversely， the level of serum PINP in stage Ⅲ was significantly lower than that in stages Ⅰ and Ⅱ， and the level in stage Ⅱ was significantly lower than that in stage Ⅰ （P < 0.05）. In terms of immunoglobulin types， the levels of serum MuC1， sFLC-κ， and sFLC-λ in patients with IgG type were significantly higher than those in patients with IgA type， light chain type， and non-secreting type， while the level of serum PINP was significantly lower than that in patients with these types （P < 0.05）. Regarding prognosis， the levels of serum MuC1， sFLC-κ， and sFLC-λ in the poor prognosis group were significantly higher than those in the good prognosis group， while the level of serum PINP was significantly lower than that in the good prognosis group （P < 0.05）. When defining poor prognosis as positive and good prognosis as negative， the area under the curve （AUC） for predicting the prognosis of multiple myeloma patients using serum MuC1， PINP， sFLC-κ， sFLC-λ， and their combined detection were 0.765， 0.665， 0.753， 0.710， and 0.914， respectively. The diagnostic sensitivities were 72.73%， 69.09%， 72.73%， 65.45%， and 87.27%， respectively， and the specificities were 69.70%， 62.42%， 72.12%， 73.33%， and 85.45%， respectively. Among these， the combined detection had the highest AUC （P < 0.05）. Conclusion The expressions of serum MuC1， PINP， and sFLC were associated with the occurrence， progression， and immunophenotyping of multiple myeloma， and they had high predictive value for patient prognosis. The combined detection of these four markers had the highest predictive value.

Objective To investigate the efficacy of Xingnao Kaiqiao acupuncture combined with repetitive transcranial magnetic stimulation （rTMS） in promoting arousal in patients with persistent vegetative state （PVS）. Methods A total of 70 eligible PVS patients were randomly assigned to an observation group or a control group， with 35 patients in each group. Both groups received conventional basic treatment and rehabilitation training. The control group was treated with rTMS alone， while the observation group received rTMS plus Xingnao Kaiqiao acupuncture. Treatments were administered once daily， five times per week， with a two-day interval each week， for a total of 6 weeks. The Glasgow Coma Scale （GCS）， Coma Recovery Scale?Revised （CRS-R），and Chinese Vegetative State Scale （CVSS） scores were observed before and after treatment， and the arousal rate after treatment was evaluated. Results After treatment， both groups showed significant increases in GCS， CRS-R， and CVSS scores （P < 0.05）. The observation group demonstrated higher scores on the GCS， CRS-R， and CVSS compared to the control group （P < 0.05）. The arousal rate was 38.70% （12/31） in the observation group， which was significantly higher than that in the control group （15.62%，5/32；P < 0.05）. Conclusion Xingnao Kaiqiao acupuncture combined with rTMS can effectively improve the level of consciousness in patients with PVS.

Objective To investigate the effects of ultrasound-guided bilateral superficial cervical plexus nerve block using ropivacaine or ropivacaine combined with different adjuvants on postoperative analgesia and recovery quality in patients undergoing radical thyroid cancer surgery. Methods A total of 140 patients scheduled for radical thyroid cancer surgery were randomly allocated into 4 groups： the general anesthesia group （Group C）， the general anesthesia + ropivacaine group （Group R）， the general anesthesia + ropivacaine combined with dexmedetomidine group （Group R1）， and the general anesthesia + ropivacaine combined with dexamethasone group （Group R2）. The observation indicators included the intraoperative consumption of sedative and analgesic drugs， postoperative analgesia requirements， postoperative recovery， resting and active Visual Analogue Scale （VAS） scores， Richards-Campbell Sleep Questionnaire scores， QoR-15 scores， and adverse reactions at different time points after anesthesia. Results Compared with Group C， both the resting and activity VAS scores in Group R were lower within 12 hours after surgery （P < 0.05）. Similarly， within 24 hours after surgery， the resting and activity VAS scores in Groups R1 and R2 were lower （P < 0.05）. Moreover， the postoperative RCSQ scores and QoR-15 scores in all three groups （R， R1， R2） were higher （P < 0.05）. When compared with Group R， the VAS scores in Groups R1 and R2 were lower within 6 to 24 hours post-surgery （P < 0.05）， and the postoperative RCSQ scores and QoR-15 scores on the first postoperative day were higher （P < 0.05）. Conclusions Bilateral superficial cervical plexus nerve block with ropivacaine or combined with different adjuvants is superior to general anesthesia in improving intraoperative hemodynamics， reducing the consumption of sedative and analgesic drugs， enhancing analgesic efficacy， and promoting recovery quality in patients undergoing radical thyroid cancer surgery. Ropivacaine combined with adjuvants has better analgesic effects and recovery quality than ropivacaine alone.

Objective To compare the hemodynamic changes and safety of fospropofol disodium and propofol during anesthesia induction in patients undergoing painless endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA）. Methods Sixty-eight patients scheduled for elective painless EBUS-TBNA， aged 40 ~ 65 years with ASA physical status Ⅰ - Ⅲ， were enrolled and randomly allocated （1∶1） to the fospropofol disodium group （F group， n = 34） or the propofol group （P group， n = 34） using a random number table. Anesthesia induction was performed with intravenous sufentanil （0.3 μg/kg）， followed by fospropofol disodium （12.5 mg/kg， F group） or propofol （2 mg/kg， P group） within 1 min. Rocuronium （0.6 mg/kg） was administered when the modified observer′s assessment of alertness/sedation scale （MOAA/S） score was ied observerd observerhen the modified observerd transbronchial needle aventilation. Mean arterial pressure （MAP）， heart rate （HR）， and bispectral index （BIS） were recorded at six time points： entering the operating room （T₀）， 1 min after induction （T₁）， immediately after laryngeal mask insertion （T₂）， bronchoscope passing through the glottis （T₃）， at the end of the EBUS-TBNA procedure （T₄）， and 3 min after extubation （T₅）. Intraoperative sedative and vasoactive drug consumption， sedation success rate， and incidence of adverse events were also assessed. Results Compared with the P group， the F group showed significantly higher MAP at T₁ and T₄ （P < 0.05）， a lower incidence of intraoperative hypotension （P < 0.05）， and reduced total ephedrine use （P < 0.05）. The F group had a significantly longer time to loss of consciousness （P < 0.05）， higher incidence of paresthesia （P < 0.05）， and lower incidence of injection pain （P < 0.01）. No significant differences were observed between groups in BIS，HR， sedation success rate， recovery time， or incidence of bradycardia and tachycardia （all P > 0.05）. Conclusion Compared with propofol， fospropofol disodium provides more stable hemodynamics during general anesthesia for EBUS-TBNA， significantly reducing the incidence of hypotension and injection pain； however， it has a longer induction time and is associated with risks such as skin pruritus and paresthesia.

Objective To explore the value of pressure regulated volume-controlled ventilation mode （PRVC） in cardiac valve surgery based on respiratory mechanics， myocardial injury and postoperative pulmonary complications. Methods A prospective study included patients admitted to the affiliated Hospital of Xuzhou Medical University for elective cardiac valve replacement or repair from January 2024 to October 2025. After strict inclusion and exclusion criteria， a total of 100 cases were finally enrolled. Patients were assigned to the PRVC group （n = 50） and the control group （n = 50， volume-controlled ventilation mode） in a 1∶1 ratio by stratified block randomization. The respiratory mechanics and oxygenation status of the two groups at different times after surgery were compared. The levels of creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， hypersensitive troponin T （hs-cTnT）， and N-terminal pro-brain natriuretic peptide （NT-proBNP） before and after surgery were determined. The occurrence of pulmonary complications within 7 days after surgery was recorded. Results At different time points， the P_peak， P_plat and △P in the PRVC group were all lower than those in the control group， while Cdyn was higher， with intergroup and time effects （P < 0.05）， and with an interaction effect on P_peak （P < 0.05）. At different time points， the PRVC group had higher PaO₂ and OI， while lower RI and P_A-aO₂ were lower， with intergroup and time effects （P < 0.05）， among which there was an interaction effect of PaO₂ and P_A-aO₂ （P < 0.05）. At 6 hours and 24 hours after surgery， the levels of CK-MB， LDH， hs-cTnT and NT-proBNP in both groups were higher than those before surgery in the same group， and those in the PRVC group were lower. There were intergroup， time and interaction effects （P < 0.05）. The extubation time， ICU stay time and total hospital stay in the PRVC group were shorter （P < 0.05）， and the total incidence of postoperative pulmonary complications was significantly lower （P < 0.05）. Conclusions The PRVC mode used in cardiac valve surgery has less impact on respiratory mechanics and oxygenation than the VCV mode， has a significant lung-protective effect， can reduce myocardial injury and decrease pulmonary complications.