Objective To explore the influence of ambroxol hydrochloride combined with fiberoptic bronchoscopy alveolar lavage （BAL） on the clinical symptoms， the absorption of lung consolidation， and the levels of mucin 5AC （MUC5AC）， phosphatidylinositol 3-kinase （PI3K）， and soluble programmatic death factor ligand-2 （sPD-L2） in children with mycoplasma pneumoniae pneumonia （MPP） accompanied by mucus thrombus in the airway. Methods A total of 102 children diagnosed with MPP accompanied by airway mucus thrombus， who were admitted to the hospital from June 2024 to October 2025， were randomly assigned to the study group （n = 51， receiving conventional comprehensive treatment plus bronchoscopy BAL with ambroxol hydrochloride mixed in normal saline） and the control group （n = 51， receiving conventional comprehensive treatment plus bronchoscopy BAL with simple normal saline） using the random number table method. The disappearance time of high fever， cough， pulmonary rales， and mucus plugs， the length of hospital stay， and the absorption of pulmonary consolidation were compared between the two groups. Respiratory mechanics， including lung volume （LV）， lung static compliance （Cstat）， and airway plateau pressure （Pplat）， as well as the levels of serum C-reactive protein （CRP）， white blood cell count （WBC）， interleukin-6 （IL-6）， and interferon-γ （IFN-γ） were detected and compared between the two groups before treatment and 10 days after treatment （post-treatment）. Bronchoalveolar lavage fluid （BALF） was collected during the first bronchoscopy BAL and on the 3rd day after the last BAL treatment， and the levels of MUC5AC， PI3K， and sPD-L2 in the BALF of the two groups were measured and compared. Meanwhile， the adverse reaction rates during the treatment period in both groups were statistically analyzed. Results The disappearance times of high fever， cough， pulmonary rales， and mucus plugs， as well as the length of hospital stay， were all shorter in the study group than those in the control group （P < 0.05）. Moreover， the classification of lung consolidation absorption area was more favorable （P < 0.05）. In comparison with the pre-treatment status， both LV and Cstat increased in both groups after treatment （P < 0.05）， whereas the levels of Pplat， serum CRP， WBC， IL-6， and IFN - γ decreased （P < 0.05）. When compared with the results of the first bronchoscopy BAL， the levels of MUC5AC， PI3K， and sPD-L2 in the BALF of both groups decreased on the 3rd day after the last BAL treatment （P < 0.05）. Additionally， the extent of decrease or increase of the above-mentioned indicators was greater in the study group than that in the control group （P < 0.05）. There was no statistically significant difference in the adverse reaction rates between the two groups （15.69% vs. 21.57%） （P > 0.05）. Conclusions Ambroxol hydrochloride combined with bronchoscopy BAL can effectively promote the relief of clinical symptoms and signs and the absorption of lung consolidation in children with MPP accompanied by mucus thrombus in the airway， and improve their respiratory mechanics. The mechanism of action may be related to the down - regulation of MUC5AC， PI3K， and sPD-L2 levels in BALF.

Objective To compare the effects of liposomal bupivacaine and ropivacaine in thoracoscopy-guided intercostal nerve block （TINB） on postoperative analgesia and recovery quality in patients undergoing video-assisted thoracoscopic lobectomy （VATS）. Methods A total of 120 patients who were scheduled for VATS lobectomy under general anesthesia from January to June 2025 were recruited and randomly allocated into the liposomal bupivacaine group （Group L， 266 mg/20 mL， n = 60） and the ropivacaine group （Group R， 100 mg/20 mL， n = 60）. In both groups， thoracic intercostal nerve block （INB） at the T₄—T₈ level was performed under direct thoracoscopic visualization， followed by 72-hour patient-controlled intravenous analgesia （PCIA）. The resting and activity Numeric Rating Scale （NRS） scores at 2， 6， 12， 24， 48， and 72 hours post-surgery were recorded. The total sufentanil consumption， the time to the first PCIA demand， the rescue analgesia rate， the time to the first ambulation， the duration of chest tube placement， the total effective PCIA presses within 72 hours， the Quality of Recovery-15 （QoR-15） scores at 24 hours before surgery and 24/72 hours after surgery， as well as the incidences of nausea/vomiting， pulmonary complications， and INB-related adverse events were documented. Results Compared with Group R， Group L exhibited significantly lower resting NRS scores at 12， 24， 48， and 72 h and activity NRS scores at 12， 24， and 48 h （P < 0.05）. Additionally， it showed significantly reduced total sufentanil consumption， a prolonged time to the first PCIA demand， a shorter time to the first ambulation， a reduced rescue analgesia rate， decreased effective PCIA presses during the 0 ~ 24， 24 ~ 48， and 48 ~ 72 h intervals （P < 0.05）， higher QoR-15 scores at 24/72 h （P < 0.05）， and a significantly lower nausea/vomiting incidence （P < 0.05）. There were no inter-group differences in the chest tube duration or the incidences of pulmonary complications and other adverse events （P > 0.05）. Moreover， neither group encountered nerve block-related complications. Conclusion Liposomal bupivacaine TINB offers 72-hour prolonged analgesia， significantly decreases opioid consumption， improves the quality of early recovery with fewer adverse effects， and thus represents an optimized option for postoperative analgesia in VATS.

Objective To investigate the relationship between the CURB-65 score， serum interleukin-6 （IL-6） level， procalcitonin/albumin （PCT/ALB） ratio and the prognosis of patients with severe pneumonia. Methods A retrospective analysis was conducted on the clinical data of 110 patients with severe pneumonia （severe group） admitted to the Department of Respiratory and Critical Care Medicine， Huangshan City People's Hospital between June 2022 and July 2025. Simultaneously， 55 patients with mild pneumonia （mild group） were recruited. General clinical data， CURB-65 scores upon admission， serum IL-6 levels， and PCT/ALB ratio were gathered. Pearson′s method was employed to analyze the correlation between the CURB-65 score and serum IL-6 as well as the PCT/ALB ratio. Patients with severe pneumonia were classified into the low-risk group （n = 34）， intermediate-risk group （n = 53）， and high-risk group （n = 23） according to the CURB-65 score. Based on the 28-day prognosis， they were categorized into the favorable prognosis group （n = 80） and unfavorable prognosis group （n = 30）. The CURB-65 scores， serum IL-6 levels， and PCT/ALB ratios were compared among patients with different severities and prognoses. Binary logistic regression analysis was employed to identify prognostic factors， and receiver operating characteristic （ROC） curves were plotted to assess the prognostic value of the CURB-65 score， IL-6， and PCT/ALB ratio. Results Upon admission， patients in the severe group exhibited higher CURB-65 scores， serum IL-6 levels， PCT levels， and PCT/ALB ratios， but lower ALB levels compared to those in the mild group （P < 0.05）. Pearson correlation analysis indicated that in patients with severe pneumonia， serum IL-6， PCT， and PCT/ALB ratios were positively correlated with the CURB-65 score， whereas ALB was negatively correlated with the CURB-65 score （P < 0.05）. High-risk patients had higher serum IL-6 levels and PCT/ALB ratios than both low-risk and intermediate-risk patients. Moreover， significant differences were also observed between low-risk and intermediate-risk patients （P < 0.05）. At admission， the unfavourable prognosis group had higher CURB-65 scores， serum IL-6 levels， and PCT/ALB ratios but lower ALB levels than the favourable prognosis group （P < 0.05）. Binary logistic regression analysis revealed that the CURB-65 score， serum IL-6 level， and PCT/ALB ratio were independent risk factors for the prognosis of patients with severe pneumonia （P < 0.05）. ROC curve analysis indicated that the area under the curve （AUC） of the combination of the CURB-65 score， serum IL-6 level， and PCT/ALB ratio for predicting death in severe pneumonia was 0.944 （95%CI： 0.878 - 0.980）， which was greater than that of each individual indicator （Z = 2.162， 6.931， 2.168； P < 0.05）. The sensitivity and specificity of the joint prediction were 92.59% and 95.77%， respectively. The cut-off values of the CURB-65 score， serum IL-6 level， and PCT/ALB ratio were 4， 26.45 pg/mL， and 0.79， respectively. Conclusions An elevated CURB-65 score， serum IL-6 level， and PCT/ALB ratio are all associated with the severity and poor prognosis of severe pneumonia. The combination of these three indicators holds predictive value for the prognosis and can be employed to screen high-risk patients， thus facilitating timely intervention and enhancing the prognosis.

Objective To explore the efficacy of imipenem/cilastatin （IPM/CS） in combination with thymalfasin in the treatment of elderly patients with severe pneumonia （SP）， and to analyze its impact on the pulmonary oxygenation function and the levels of serum soluble hemoglobin scavenger receptor 163 （sCD163）， soluble CD40 ligand （sCD40L）， and amyloid A （SAA） in these patients. Methods A total of 102 elderly patients with SP （senile pneumonia， presumably， though not clearly defined in this context） who were admitted to Qingdao Central Hospital， University of Health and Rehabilitation Sciences between January 2024 and August 2025 were randomly divided into the study group （n = 51， treated with IPM/CS + thymalfasin） and the control group （n = 51， treated with IPM/CS） using the random-number table method. The therapeutic effects were evaluated two weeks after the treatment. The regression time of symptoms and signs， the clinical pulmonary infection score （CPIS） before and after treatment， pulmonary oxygenation function ［including peripheral blood oxygen saturation （SpO2）， arterial partial pressure of oxygen （PaO2）， and oxygenation index （OI）］， immune function （CD3⁺， CD4⁺， CD4⁺/CD8+）， serum levels of C-reactive protein （CRP）， sCD163， sCD40L， SAA， and adverse reactions were recorded and compared. Results The study group exhibited a higher total effective rate （94.12% vs. 80.39%） （P < 0.05）， along with an earlier regression time of symptoms and signs （P < 0.05）. When compared with the pre-treatment values， the CPIS score， serum CRP， sCD163， sCD40L， and SAA levels in both groups decreased after treatment， whereas SpO₂， PaO₂， OI， CD3⁺， CD4⁺， and CD4⁺/CD8⁺ increased. Furthermore， the extent of decrease or increase in the above-mentioned indicators in the study group was more significant than that in the control group， and these differences were statistically significant （P < 0.05）. There was no significant difference in adverse reactions between the two groups （P > 0.05）. Conclusions The treatment of elderly patients with SP using IPM/CS in combination with thymalfasin is both safe and effective. This treatment approach can effectively enhance the pulmonary oxygenation function and immune function of patients， reduce the levels of serum sCD163， sCD40L and SAA， and shorten the regression time of symptoms and signs.

Objective To investigate the mental health status， including depression， anxiety， and loneliness， of patients with multidrug-resistant/rifampicin-resistant tuberculosis （MDR/RR-TB） and its association with treatment adherence. Methods From October 2024 to July 2025， a total of 900 MDR/RR-TB patients managed in 12 designated tuberculosis hospitals and 60 community health service centers in Guangzhou， Shenzhen， Dongguan， and Zhongshan were enrolled. Psychological status was assessed using the Patient Health Questionnaire-9 （PHQ-9）， Generalized Anxiety Disorder-7 （GAD-7）， and UCLA Loneliness Scale-3 （UCLA-3）. Logistic regression analysis was performed to identify factors influencing treatment adherence. Results Patients were classified into an adherence group （n = 612； 68.00%） and a poor-adherence group （n = 288； 32.00%）. Compared with the adherence group， the poor-adherence group had higher scores on PHQ-9 （12.49 ± 3.85 vs. 5.26 ± 2.16）， GAD-7 （10.23 ± 2.77 vs. 4.88 ± 1.99）， UCLA-3 （6.69 ± 1.17 vs. 4.33 ± 1.06）， and PSQI （10.42 ± 3.17 vs. 6.17 ± 2.38）， and lower scores on SSRS （34.22 ± 5.86 vs. 42.33 ± 6.30）， with all differences being statistically significant. Multivariable logistic regression indicated that higher PHQ-9 （OR = 2.190； 95%CI： 1.699 - 2.823）， GAD-7 （OR = 1.562； 95%CI： 1.266 - 1.927）， UCLA-3 （OR = 2.812； 95%CI： 1.753 - 4.509）， and PSQI scores （OR = 1.267； 95%CI： 1.065 - 1.507）， as well as self-payment as the primary payment method （OR = 15.699； 95%CI： 2.765 - 89.135）， were independent risk factors for poor adherence. Higher monthly household income （OR = 0.183； 95%CI： 0.056 - 0.600）， stronger social support （SSRS： OR = 0.666； 95%CI： 0.602 - 0.736）， and better knowledge of MDR/RR-TB—both general （OR = 0.114； 95%CI： 0.029 - 0.439） and comprehensive （OR = 0.032； 95%CI： 0.007 - 0.154）—were protective factors. Conclusions Depression， anxiety， and loneliness are significantly associated with treatment adherence in MDR/RR-TB patients. Mental health assessment provides a valuable tool for identifying patients at risk of poor adherence and offers evidence for more refined management and targeted interventions.

Esophageal squamous cell carcinoma （ESCC） is a malignant tumor with high global incidence and mortality. Its tumor immune microenvironment （TIME） is highly heterogeneous， which is a core reason for the varied efficacy and resistance to immune checkpoint inhibitors （ICIs）. This article systematically analyzes the multi-dimensional heterogeneity of the ESCC TIME across several aspects： spatial distribution， temporal dynamics， cellular composition， functional states， and molecular expression. To address the mechanisms of this heterogeneity， we focus on innovative and practical combination strategies. These include combining immunotherapy with chemotherapy， radiotherapy， anti-angiogenic therapy， and novel approaches targeting Tregs， macrophages. These strategies can reshape the TIME， reverse immunosuppression， and convert "cold" tumors into "hot" tumors. Additionally， we emphasize the critical role of biomarker-based individualized treatment strategies in overcoming heterogeneity and improving therapeutic outcomes. This review offers a novel perspective for understanding the complexity of the ESCC immune microenvironment. It also provides a theoretical foundation and direction for developing precise combination immunotherapy regimens in clinical practice.

Objective To explore the therapeutic effect of meticulous capsule dissection technique （MCDT） combined with recurrent laryngeal nerve （RLN） protection in patients with differentiated thyroid cancer （DTC）. Methods The research subjects were selected from patients with DTC who were admitted to the First Affiliated Hospital of Soochow University. The inclusion period for the cases was from December 2023 to December 2024. According to a 1∶1 ratio and different surgical methods， 58 cases were assigned to Group A （conventional surgical procedure combined with exposure of the recurrent laryngeal nerve via the inferior thyroid artery）， and 58 cases were assigned to Group B （MCDT combined with RLN）， making a total of 116 cases. Both groups were followed up for 6 months after surgery. The short-term efficacy （follow-up for 6 months）， perioperative indicators （including vocal cord function and thyroid function before and 6 months after surgery）， trauma stress indicators （before and 1 day after surgery）， and complications （during the follow-up period） of the two groups were compared. Results After 6 months of follow-up， the total effective rate of group B was 94.83%， which was higher than that of group A （79.31%， P < 0.05）. The length of hospitalization in group B was shorter than that in group A （P < 0.05）. Compared with the pre-surgery state， 6 months after surgery， both groups showed a decrease in amplitude perturbation， fundamental frequency perturbation， normalized noise energy （NNE）， and serum levels of thyroid stimulating antibody （TSAb）， thyroid stimulating blocking antibody （TSBAb）， and thyroid stimulating hormone receptor antibody （TRAb）， with lower values in group B. Both groups showed an increase in harmonic noise ratio （HNR） and a decrease in serum parathyroid hormone （PTH） levels， with higher values in group B （P < 0.05）. Both groups showed a decrease in serum thyroid stimulating hormone （TSH） levels， but there was no significant difference between the two groups （P > 0.05）. Compared with the pre-surgery state， the levels of serum trauma stress indicators increased in both groups 1 day after surgery， but the values in group B were lower （P < 0.05）. During the follow-up period， the incidence of complications in group B was lower （P < 0.05）. Conclusion The combination of MCDT and RLN can help shorten the hospitalization time， reduce traumatic stress， improve the vocal cord function and thyroid function in patients with DTC， thereby enhancing the clinical efficacy and ensuring high safety.

Objective The BTZ@PLGA-RGD nanoparticles that target integrin αvβ3 and are loaded with bortezomib （BTZ） were prepared to achieve targeted therapy for multiple myeloma （MM）. Methods The emulsion solvent evaporation method and carbodiimide chemistry method were used to form BTZ@PLGA-RGD nanoparticles. The characterization of BTZ@PLGA-RGD nanoparticles was confirmed with scanning electron microscopy （SEM）， dynamic light scattering （DLS）， and fourier-transform infrared （FTIR）. BTZ@PLGA-RGD nanoparticles were evaluated in terms of stability， encapsulation efficiency， release profile， and blood compatibility. The localization and cytotoxicity of BTZ@PLGA-RGD were determined using confocal laser scanning microscopy （CLSM） and the CCK-8 experiment. Results BTZ@PLGA-RGD nanoparticles were in a spherical shape with a uniform size distribution. The mean particle size of BTZ@PLGA-RGD nanoparticles was （113.7 ± 3.1） nm， accompanied by a positive surface charge of （+6.4 ± 1.3） mV. The entrapment efficiency of the BTZ@PLGA-RGD nanoparticles was 73.32%. These nanoparticles exhibited good long-term stability and blood compatibility. BTZ@PLGA-RGD nanoparticles had pH-responsive drug release properties， and the cumulative drug release （%） over 48 h was （82.34 ± 0.12）%. FTIR analysis indicated that BTZ was successfully loaded into the BTZ@PLGA-RGD nanoparticles， and RGD was successfully immobilized on the surface of the nanoparticles. The localization analysis showed that the active targeting effect mediated by the RGD peptide enabled the BTZ@PLGA - RGD nanoparticles to be taken up by RPMI8226 cells more efficiently， and these nanoparticles could achieve lysosome escape. The CCK-8 experimental results indicated that BTZ@PLGA-RGD nanoparticles exhibited stronger cytotoxicity against RPMI8226 cells. Conclusion BTZ@PLGA-RGD demonstrates outstanding stability， water solubility， targeting ability， controlled drug-release properties， and biological safety， offering a novel research strategy for MM targeted therapy.

Objective To explore the short-term and long-term efficacy of rezvilutamide combined with androgen deprivation therapy （ADT） in treating metastatic hormone-sensitive prostate cancer （mHSPC）， as well as its influence on the blood expression of free prostate specific antigen percentage （FPSAR） and progastrin releasing peptide （proGRP）. Methods Clinical data of 102 patients with mHSPC who were admitted to the hospital from August 2022 to February 2024 were retrieved from the hospital's electronic medical record database and follow-up database. These patients were classified into the rezvilutamide group （n = 44， treated with rezvilutamide combined with ADT） and the bicalutamide group （n = 58， treated with bicalutamide combined with ADT） based on the treatment methods. Propensity score matching （PSM） method was employed to balance the baseline data of the two groups. A 1∶1 nearest-neighbor matching approach was utilized， with a caliper value set at 0.2. Eventually， 41 pairs of data without baseline differences were acquired. The short-term and long-term therapeutic effects of the two groups were compared， including the alterations in serum prostate-specific antigen （PSA）， lactate dehydrogenase （LDH）， FPSAR， proGRP， neutrophil-to-lymphocyte ratio （NLR）， and platelet count-to-lymphocyte ratio （PLR） before and after treatment， adverse events， and survival prognosis. All patients were grouped according to their prognosis outcomes， and the Cox regression analysis method was applied to analyze the prognostic factors of mHSPC patients. Results Following 24 weeks of treatment， the short-term disease control rate in the rezvilutamide group was higher than that in the bicalutamide group， and this difference was statistically significant （P < 0.05）. Post-treatment， the serum levels of PSA， LDH， NLR， PLR， and proGRP in the rezvilutamide group were significantly lower than those pre-treatment within the same group and post-treatment in the bicalutamide group， whereas the FPSAR was higher. All these differences were statistically significant （P < 0.05）. Both groups experienced manageable adverse reactions， and there was no statistically significant difference between them （P > 0.05）. The median progression-free survival （PFS） and median overall survival （OS） in the rezvilutamide group were longer than those in the bicalutamide group （P < 0.01）. Cox multivariate regression analysis indicated that high tumor burden， multiple metastatic sites， and high baseline proGRP were risk factors for the survival prognosis of mHSPC patients （P < 0.05）， while rezvilutamide + ADT treatment and high baseline FPSAR levels were protective factors （P < 0.05）. Conclusions The combination of rezvilutamide and ADT demonstrates a higher disease control rate and superior survival prognosis in mHSPC. It significantly upregulates FPSAR， reduces blood proGRP levels， and presents controllable adverse reactions. mHSPC patients with multiple metastases， high tumor burden， and elevated baseline proGRP exhibit a poorer survival prognosis. Rezvilutamide and high FPSAR serve as protective factors. Special attention should be given to the prognosis monitoring of mHSPC patients with the aforementioned factors.

Objective To explore the effect of conversion therapy with sintilimab combined with the TP chemotherapy regimen in locally advanced unresectable esophageal squamous cell carcinoma （ESCC） and its influence on prognosis. Methods A total of 82 patients with locally advanced unresectable ESCC who were admitted to Zhangjiagang Hospital Affiliated to Suzhou University between July 2022 and August 2024 were retrospectively analyzed. Based on different treatment regimens， they were categorized into the control group （receiving the TP regimen， 29 cases） and the combination group （receiving sintilimab in combination with the TP regimen， 53 cases）. After 4 cycles of basic treatment （3 weeks per cycle）， the combination group was administered sintilimab monotherapy until disease progression or intolerable toxicity occurred. The success rate of conversion therapy， objective response rate （ORR）， disease control rate （DCR）， progression - free survival （PFS）， overall survival （OS）， levels of serum tumor markers ［carcinoembryonic antigen （CEA）， cytokeratin 19 fragment 21-1 （CYFRA21-1）， squamous cell carcinoma antigen （SCC-Ag）， programmed death-1 （PD-1）， and programmed death-ligand 1 （PD-L1）］ before and after treatment， incidence of adverse reactions， and major pathological response （MPR） were compared between the two groups. Results The success rate of conversion therapy in the combination group was significantly higher than that in the control group （35.85% vs. 13.79%， P < 0.05）. The ORR and DCR in the combination group were 60.38% and 88.68% respectively， which were significantly higher than those in the control group （34.48% and 68.97% respectively， P < 0.05）. The median PFS in the combination group was significantly longer than that in the control group （9.6 months vs. 6.2 months， Log-rank χ² = 9.872， P = 0.002）， and the median OS was also significantly longer than that in the control group （17.8 months vs. 12.1 months， Log-rank χ² = 12.543， P < 0.001）. After treatment， the levels of serum CEA， CYFRA21-1， and SCC-Ag， the proportions of cases with abnormal conditions and PD-L1 in the combination group were significantly lower than those in the control group （P < 0.05）. The incidence of MPR in the combination group was significantly higher than that in the control group （63.16% vs. 25.00%， P < 0.05）. Conclusion Sintilimab combined with paclitaxel liposome and cisplatin can significantly increase the success rate of conversion therapy， improve the short-term curative effect and long-term survival of patients with locally advanced unresectable ESCC， and it has good safety.

Objective To investigate the predictive value of dynamic changes in thyrotropin receptor antibody （TRAb） titers combined with ultrasound elastography parameters for predicting recurrence risk in Graves' disease （GD）. Methods A total of 306 patients with GD admitted between January 2019 and November 2021 were enrolled. All patients received standard antithyroid drug treatment and were followed up. Dynamic changes in TRAb titers during treatment were monitored and the patients were divided into a continuously decreasing group and a dynamically increasing group based on the trend of change. Ultrasound elastography was used to measure thyroid volume， elasticity score， mean strain value （MEAN）， and blue area percentage （%AREA）. Independent risk factors for GD recurrence were identified via multivariate logistic regression analysis， and the predictive performance of indicators was evaluated using receiver operating characteristic （ROC） curves. Results A total of 14 cases were lost to follow-up， and 292 cases were eventually included to complete follow-up， including 103 cases in the dynamic increase group and 189 cases in the continuous decrease group. TRAb levels diverged significantly between groups starting at 12 months of treatment. The persistent-decrease group maintained a downward trend， remaining low at follow-up termination. In contrast， the dynamic-increase group showed a slow decline， reaching a nadir at 18 months before rising again， with sustained elevation during follow-up. By the end of follow-up， 87 patients （29.79%） experienced recurrence. The recurrence rate was significantly higher in the dynamic-increase group （66.02%， 68/103） than in the persistent-decrease group （10.05%， 19/189； χ² =99.831， P < 0.05）. Multivariate logistic regression identified TRAb titer elevation， elasticity score （3 ? 4）， elevated %AREA， and increased thyroid volume as independent risk factors for recurrence （P < 0.05）. ROC analysis showed area under the curve （AUC） values of 0.823 for TRAb dynamic elevation， 0.652 for elasticity score （3 ? 4）， 0.801 for %AREA elevation， and 0.724 for thyroid volume enlargement. The ultrasound-combined model achieved an AUC of 0.888， while the four-indicator combined model demonstrated the highest predictive accuracy （AUC = 0.913）. Conclusions Dynamic TRAb elevation and ultrasound elastography parameters are independent predictors of GD recurrence. Their combination enhances the accuracy of recurrence risk prediction.

Objective To investigate the effect of lateral ventricle injection of miR-203a-3p antagonist（antagomir）on collateral circulation recanalization and its underlying mechanisms in rats with cerebral ischemia-reperfusion injury（CIRI）. Methods Sprague-Dawley rats were randomly allocated into four experimental groups： the sham group， the model group， the antagomiR-NC group， and the antagomiR-203a-3p group. CIRI was induced in the model， antagomiR-NC， and antagomiR-203a-3p groups using the thread embolization technique to establish the CIRI model. Twenty-four hours prior to CIRI induction， rats in the antagomiR-NC and antagomiR-203a-3p groups received a stereotaxic injection of antagomiR-NC and miR-203a-3p antagomir， respectively， into the lateral ventricle. Rats in the sham and model groups were administered an equivalent volume of sterile saline via the same route and at the same time point.Behavioral assessments were conducted using the Zea-Longa scoring system. Cerebral infarction volume was measured using TTC staining. Collateral circulation status and microcirculatory blood perfusion （MBPU） in the rat cerebral cortex were monitored using laser speckle imaging. Cortical pathological morphology was observed through hematoxylin and eosin staining. RT-qPCR was employed to analyze the expression of miR-203a-3p， PIK3CA， PI3K， AKT， and Survivin mRNA in rat brain tissue. Western blotting was employed to detect the expression of PIK3CA， p-PI3K， PI3K， p-AKT， AKT and Survivin proteins. Results In comparison to the model group and the antagomiR-NC group， rats in the miR-203a-3p group demonstrated significantly reduced neurological deficit scores， notably decreased cerebral infarct volumes，substantially more collateral circulation anastomoses could be seen， and increased MBPU in the cerebral cortex. Pathological damage in cortical regions was mitigated， with miR-203a-3p mRNA expression levels markedly decreased， while mRNA expression levels of PIK3CA， PI3K， Akt， and Survivin were significantly elevated. Correspondingly， protein expression levels of PIK3CA， p-PI3K/PI3K、p-AKT/AKT and Survivin were markedly increased. Conclusions The inhibition of miR-203a-3p expression enhances cortical MBPU and the opening of collateral circulation in rats with CIRI， thereby reducing pathological damage and improving neurological function. This mechanism may be associated with the activation of the PIK3CA/PI3K/AKT/Survivin signaling pathway by the miR-203a-3p antagomir， which facilitates the reconstruction of collateral circulation.

Objective To evaluate the diagnostic performance of ultrasound attenuation analysis （USAT） for quantifying hepatic steatosis in metabolic dysfunction-associated steatotic liver disease （MASLD）， the CT liver-to-spleen attenuation ratio （CT_L/S） was used as the reference standard. Methods In this prospective study， we consecutively enrolled adult participants who were clinically suspected of having MASLD and healthy control volunteers. All participants underwent both USAT imaging and non-contrast CT during the same visit. The repeatability of USAT measurements was evaluated using Bland-Altman analysis and the intraclass correlation coefficient （ICC）. The association between USAT values and the grade of hepatic steatosis was analyzed by means of Spearman′s rank correlation. Factors influencing USAT values were explored through linear regression analysis. The diagnostic accuracy of USAT was determined via receiver operating characteristic （ROC） curve analysis and compared with a clinical prediction model using the DeLong test. Results Among the 268 enrolled participants， CTL/S grading identified 64 individuals with normal liver and 204 with MASLD， which included 78 cases of mild， 69 cases of moderate， and 57 cases of severe steatosis. Bland-Altman analysis and ICC assessment demonstrated excellent agreement for USAT measurements. USAT values were strongly inversely correlated with CTL/S （r = -0.850， 95%CI： -0.880 - -0.813） and strongly positively correlated with steatosis grade （r = 0.846， 95%CI： 0.807 - 0.878； both P < 0.001）. The median USAT value increased progressively as the severity of steatosis increased： 0.55 dB/cm/MHz （normal liver）， 0.67 dB/cm/MHz （mild steatosis）， 0.77 dB/cm/MHz （moderate steatosis）， and 0.86 dB/cm/MHz （severe steatosis）， with significant inter-group differences （all P < 0.001）. Based on simple and multiple linear regression analyses， fatty liver grading was found to be the determining factor for USAT. The optimal USAT cut-off values for detecting mild， moderate， and severe steatosis were 0.61， 0.71， and 0.82 dB/cm/MHz， respectively， yielding areas under the curve （AUCs） of 0.90， 0.88， and 0.87， which were significantly superior to those of the clinical prediction model （DeLong test， all P < 0.01）. Conclusions USAT， a non-invasive， practical， and novel technique， offers both qualitative and quantitative assessment of hepatic steatosis in MASLD. It has significant potential for broad adoption in screening and quantifying hepatic fat content.

Objective To explore the application value of detecting serum osmotic pressure （SOSM） in combination with serum N-terminal pro-brain natriuretic peptide （NT-proBNP） and homocysteine （Hcy） in patients with coronary heart disease and hypertension who suffer from acute heart failure. Methods A retrospective study was carried out on 130 patients with coronary heart disease and hypertension who visited the Second People's Hospital of Hefei from January 2023 to December 2024. Based on clinical diagnosis， they were divided into an acute heart failure （AHF） group consisting of 58 cases and a non-acute heart failure group with 72 cases. A control group of 64 patients with simple hypertension was selected during the same period. Serum NT-proBNP， Hcy， and LDL-C were measured in the three groups of patients. SOSM was calculated using serum sodium （Na）， potassium （K）， glucose （GLU）， and urea （UREA） levels， and then a comparison was made to determine whether there were statistical differences in SOSM， NT-proBNP， LDL-C， and Hcy among the three groups. A binary logistic regression analysis was performed on the 130 observation subjects with coronary heart disease complicated by hypertension， and a good diagnostic indicator for acute heart failure in patients with coronary heart disease complicated by hypertension was obtained. The application value of Receiver Operating Characteristic （ROC） curve analysis of various indicator levels in acute heart failure in patients with coronary heart disease and hypertension was also explored. Results The differences in SOSM， Hcy， NT-proBNP， and LDL-C levels among the three groups were statistically significant （P < 0.05）. The levels of NT-proBNP， SOSM， and Hcy in the AHF group were higher than those in the non-AHF group and the control group （P < 0.05）. The ROC curves of the AHF group and the non-AHF group showed that the area under the ROC curve of the combined detection was 0.927， which was higher than that of each individual indicator. The sensitivity increased， and the specificity was high. Conclusion The combined detection of serum NT-proBNP， SOSM， and Hcy plays a crucial role in the early diagnosis and assessment of acute heart failure in patients with coronary heart disease and hypertension.

Objective To explore the predictive value of combining type 2 innate lymphoid cell （ILC2） proportion and soluble suppression of tumorigenicity 2 （sST2） protein level for postoperative recurrence in refractory chronic rhinosinusitis with nasal polyps （CRSwNP）. Methods We retrospectively reviewed the clinical data of 324 patients with refractory CRSwNP admitted to the hospital from January 2021 to December 2023， who constituted the training set. All patients underwent endoscopic sinus surgery and were followed up for 12 months， with examinations every 3 months. Based on recurrence status， they were divided into a recurrence group （n = 125） and a non-recurrence group （n = 199）. Clinical data， ILC2 proportion， and sST2 levels were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify factors influencing postoperative recurrence. The predictive value was assessed using receiver operating characteristic （ROC） curves. Additionally， 138 patients meeting the same criteria admitted from January to September 2024 were enrolled as the validation set. A nomogram prediction model was constructed and evaluated using ROC curves， calibration curves， and decision curve analysis in both sets. Results The recurrence group showed significantly higher age， olfactory function score， Lund-Mackay score， Davos score， neutrophil count （NEUT）， ILC2 proportion， and sST2 level compared to the non-recurrence group （all P < 0.05）. Significant differences were also observed in allergic rhinitis history， rhinosinusitis subtype， and operation duration （all P < 0.05）. Multivariate logistic regression identified type Ⅲ rhinosinusitis， ILC2 proportion and sST2 level as independent early postoperative predictive indicators for recurrence （both P < 0.05）. The combined prediction of ILC2 and sST2 demonstrated superior value for postoperative recurrence compared to either marker alone， with a higher area under the curve （AUC） （Z_{ILC2~combined} = 3.367， Z_{sST2~combined} = 4.464， P < 0.05）. The nomogram model showed good predictive performance， with AUCs of 0.88 （0.84 ~ 0.93） and 0.78 （0.68 - 0.89）， The calibration curve indicated good agreement between predicted and actual outcomes （P > 0.05）. Decision curve analysis revealed a high net benefit at threshold probabilities between 40% and 90%. Conclusion The combination of ILC2 cell proportion and sST2 protein level holds significant predictive value for postoperative recurrence in refractory CRSwNP， providing a potential reference for clinical risk stratification and targeted intervention.

Objective To observe the impact of the Congqi Shoushen Tuina method on the emotional state and sleep quality of patients with generalized anxiety disorder （GAD）. Methods 80 patients diagnosed with generalized anxiety disorder were randomly allocated into an experimental group and a control group， with 40 patients in each group. The experimental group received treatment using the Congqi Shoushen Tuina method， whereas the control group was treated with conventional Tuina manipulation. Each treatment session lasted approximately 40 minutes， was administered once a day， and was carried out 5 times a week for two consecutive weeks. A comparison was made between the two groups regarding the changes in Hamilton Anxiety Rating Scale （HAMA） scores and Pittsburgh Sleep Quality Index （PSQI） scores before and after treatment， along with the alterations in the serum levels of brain-derived neurotrophic factor （BDNF）， vasoactive intestinal peptide （VIP）， and neuropeptide Y （NPY）. Additionally， the clinical efficacy and safety of the two groups after treatment were also compared. Results After treatment， the HAMA scores and PSQI scores of the two groups of patients decreased （P < 0.05）. The experimental group showed better results than the control group （P < 0.05）. Specifically， the experimental group was significantly more effective than the control group in improving sleep quality， sleep latency， and daytime dysfunction scores （P < 0.05）. After treatment， the serum BDNF and NPY levels in both groups increased （P < 0.05）， while the VIP levels decreased （P < 0.05）. The degree of improvement in the experimental group was greater than that in the control group （P < 0.05）. The total clinical effective rate of the experimental group was significantly higher than that of the control group （92.50% vs. 82.50%）. No adverse reaction events were observed in either group. Conclusion Congqi Shoushen Tuina method can regulate the levels of serum BDNF， VIP， and NPY factors in patients with GAD， regulate the functional activities of the nervous system， effectively alleviate the patients' anxiety emotions， improve their sleep quality， produce remarkable therapeutic effects， and is safe without any adverse reactions.

Objective To analyze the cumulative assisted reproductive outcomes and influencing factors of different assisted reproductive protocols in female patients aged 38 years or older who are undergoing their first fertility treatment with available embryos on day 3 after oocyte retrieval. Methods This study was a retrospective cohort study. It included elderly women （aged ≥ 38 years） who underwent their first cycle of either preimplantation genetic testing for aneuploidy （PGT-A） or in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） for assisted reproduction at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between January 2019 and June 2023， and had usable embryos available on the third day after oocyte retrieval. The participants were divided into two groups according to the protocol they selected： the PGT-A group and the IVF/ICSI group. A 1∶1 propensity score matching was performed to match the two groups （PGT-A group vs. IVF/ICSI group）. The primary observation indicator was the cumulative live-birth rate per oocyte retrieval cycle， and the influencing factors of cumulative live birth were further investigated through Cox regression. Results After PSM， there were 192 cases in both the PGT-A group and the IVF/ICSI group. The PGT-A group experienced a greater number of miscarriages （2 vs. 1， P < 0.001）， and the proportion of non-transplantable cycles was relatively high （24.48%）. The PGT-A group also showed higher clinical pregnancy rates and live birth rates per embryo transfer cycle （59.42% vs. 32.96%， P < 0.001； 44.93% vs. 19.63%， P < 0.001）. In comparison with the PGT-A group， the optimistically-estimated cumulative pregnancy rate for each oocyte retrieval cycle in the IVF/ICSI group was higher （65.62% vs. 51.56%， P = 0.005）. Subsequently， subgroup analyses were carried out according to age （categorized as 38 - 40， 41 - 42， and ≥ 43 years）， AMH level （< 1.2 ng/mL vs. ≥ 1.2 ng/mL）， and number of prior miscarriages （< 2 vs. ≥ 2）， as indicated by the Cox regression findings. Among these three subgroups， the PGT-A group presented significantly higher clinical pregnancy and live birth rates compared to the IVF/ICSI group in all subgroups （P < 0.05）， except for patients aged ≥ 43 years. In the subgroup of women aged ≥ 43 years， the IVF/ICSI group had a significantly higher early miscarriage rate （77.78% vs. 18.18%， P = 0.012）. Additionally， in this subgroup， the proportion of cycles with no transplantable embryos in the PGT-A group reached as high as 56.76%. Among patients with AMH < 1.2 ng/mL or ≥ 2 prior miscarriages， the optimistically estimated cumulative pregnancy rate per oocyte retrieval cycle was significantly higher in the IVF/ICSI group compared to the PGT-A group （47.22% vs. 30.56%， P = 0.040； 65.17% vs. 51.54%， P = 0.045， respectively）. Among women aged 41 to 42 years， the optimistically estimated cumulative live birth rate per oocyte retrieval cycle was significantly higher in the PGT-A group （47.50% vs. 23.40%， P = 0.018）. Conclusions For infertile women aged 41 - 42 years， the cumulative live birth rate per oocyte retrieval cycle is significantly higher with PGT-A-assisted reproduction compared to IVF/ICSI. Consequently， PGT-A is more strongly recommended for this population.

Objective Exploring the effects of different concentrations of ropivacaine on the postoperative analgesic efficacy and stress response in patients undergoing laparoscopic total hysterectomy using the arcuate ligament lumbar muscle block. Methods Between January 2023 and December 2024， a total of 285 patients undergoing elective laparoscopic total hysterectomy were selected from the hospital. These patients were randomly divided into three groups （Group A， Group B， Group C） with the application of a random number table， with 95 patients in each group. Prior to anesthesia in Group A， bilateral arcuate ligament lumbar muscle block was performed， and 0.25% ropivacaine was administered； Group B was given 0.375% ropivacaine； Group C was given 0.5% ropivacaine. Compare three sets of surgical indicators， pain scores， stress indicators， hemodynamic indicators， and incidence of adverse reactions. Results The dose of sufentanil administered via infusion to patients in Groups B and C was lower than that given to those in Group A （P < 0.05）； After surgery， the pain scores of Group B and Group C were lower than those of Group A （P < 0.05）； On postoperative day 1， the levels of cortisol （Cor）， C-reactive protein （CRP）， and adrenocortical hormone （ACTH） in groups B and C were lower than those in group A （P < 0.05）； The average arterial pressure and heart rate of the three groups were compared pairwise at 30 minutes after surgery and after surgery， and the differences were statistically significant. The changes in average arterial pressure and heart rate of groups B and C were smaller than those of group A （P < 0.05）； The differences among the three groups were not statistically significant （P > 0.05）. Conclusions 0.375% and 0.5% ropivacaine have equal analgesic effects and are both superior to 0.25% concentration. Therefore， it is recommended to use 0.375% as the preferred clinical concentration to ensure excellent analgesia while the incidence of adverse reactions is low.

Objective To analyze the correlation between intracranial hemorrhage and coagulation function， platelet count in preterm infants younger than 32 weeks. Methods A total of 101 preterm infants under 32 weeks who were admitted to Fuyang People's Hospital Affiliated to Anhui Medical University from May 2020 to July 2024 were selected. Within 3 days after birth， all the children were divided into the non-occurrence group （59 cases） and the occurrence group （42 cases） based on whether intracranial hemorrhage occurred in preterm infants less than 32 weeks.The influencing factors of intracranial hemorrhage in preterm infants less than 32 weeks was analyzed. he predictive value of coagulation function index and platelet count for intracranial hemorrhage in preterm infants less than 32 weeks was analyzed. Results The birth weight and gestational age of the occurrence group were lower than non-occurrence group （P < 0.05）.Fibrinogen （FIB） and D-dimer （D-D） in the occurrence group were higher than non-occurrence group （P < 0.05）， and the prothrombin time （PT） and activated partial thromboplastin time （APTT） in the occurrence group were longer than non-occurrence group （P < 0.05）， and platelet count in occurrence group was lower than non-occurrence group （P < 0.05）. FIB （OR = 4.272， 95%CI： 2.154 ? 8.472）， D-D （OR = 3.607， 95%CI： 1.819 ? 7.155）， APTT （OR = 3.056， 95%CI： 1.541 ? 6.060） was an independent risk factor for intracranial hemorrhage in preterm infants less than 32 weeks （P < 0.05）， and platelet count （OR = 0.282， 95%CI： 0.142 ? 0.560） was a protective factor for intracranial hemorrhage in preterm infants less than 32 weeks （P < 0.05）. The AUC values of FIB， D-D， APTT， platelet count and the combined prediction of intracranial hemorrhage in preterm infants less than 32 weeks were 0.799， 0.803， 0.845， 0.796 and 0.911， respectively （P < 0.05）， and the AUC values of the combined four groups were higher （P < 0.05）. Conclusion FIB， D-D， APTT and platelet count have important value in predicting intracranial hemorrhage in preterm infants less than 32 weeks， and the combined value of the four is higher.

Objective To develop a prediction model for identifying carbapenem-resistant Enterobacteriaceae （CRE） as the causative pathogen in bloodstream infections （BSI） using a DynNom dynamic nomogram， and to validate its predictive performance. Methods Patients with Enterobacteriaceae BSI admitted to the First Affiliated Hospital and the Fourth Affiliated Hospital of Soochow University between January 2021 and January 2024 were enrolled. Based on antimicrobial susceptibility， patients were classified into a CRE group （n = 173） and a carbapenem-susceptible Enterobacteriaceae （CSE） group （n = 102）. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for a CRE （vs. CSE） etiology among these patients. A DynNom dynamic nomogram prediction model was subsequently constructed based on these factors. Results Malignancy， indwelling central venous catheter， prior use of carbapenem antibiotics， higher Pitt bacteremia score， and an absolute neutrophil count （ANC） < 0.5 × 10?/L were identified as independent risk factors for CRE BSI （P < 0.05）. Internal validation of the model yielded a C-index of 0.812 （95% CI： 0.787 - 0.837）. The calibration curve closely approximated the ideal line. The area under the receiver operating characteristic （ROC） curve was 0.817 （95% CI： 0.788 - 0.846）. Decision curve analysis indicated a positive net benefit of the model across a threshold probability range of 23% to 100%. Conclusions Malignancy， indwelling central venous catheter， prior carbapenem use， higher Pitt bacteremia score， and ANC < 0.5 × 10?/L are independent risk factors for a CRE etiology in patients with Enterobacteriaceae BSI. The DynNom dynamic nomogram developed based on these factors demonstrates good predictive value for discriminating between CRE and non-CRE pathogens in this patient population.

Objective To explore the application and imaging characteristics of transrectal real-time tissue elastography （TRTE） combined with magnetic resonance imaging （MRI） in the diagnosis of benign and malignant prostate lesions. Methods A total of 154 patients with suspected prostate cancer were collected and received TRTE and MRI. The imaging characteristics were analyzed， and the diagnostic value of TRTE and MRI on benign and malignant prostate lesions was evaluated with the pathological result of needle biopsy as the gold standard. Results Among the 154 patients， 79 malignant cases （prostate cancer， 51.30%） and 75 benign cases （benign prostatic hyperplasia， 48.70%） were pathologically diagnosed by needle biopsy. The malignant prostate lesions in the TRTE image were mainly manifested as lesions with a predominantly blue core （high stiffness， low strain）， often with green margins or transitions （moderate strain， moderate stiffness）. In MRI images， the lesions primarily exhibited low signal intensity on T2WI， high signal intensity on DWI， and low signal intensity on ADC， and early and obvious enhancement on DCE. Compared with patients with benign lesions， those with malignant lesions exhibited significantly older age and higher mean biopsy frequency， total prostate specific antigen （tPSA）， prostate-specific antigen density （PSAD）， SR scores and PI-RADS score （P < 0.05）. Compared with clinicopathological diagnosis （gold standard）， the diagnostic efficiency of TRTE and MRI based on binary classification showed no statistically significant difference in distinguishing benign from malignant prostate lesions （P > 0.05）. Multivariate logistic regression analysis revealed that after adjusting for age and PSAD， TRTE elasticity score and MRI PI-RADS score were predictive factors for prostate malignancy （P < 0.05）. Consequently， a prostate malignancy risk model was constructed as logit（P） = -0.421 + 0.072 × age + 0.087 × PSAD + 0.181 × elasticity score + 0.358 × PI-RADS V2.1 score. Taking the pathological diagnosis result as the gold standard， the sensitivities of TRTE， MRI and logistic regression model constructed by TRTE combined with MRI in the diagnosis of benign and malignant prostate lesions were 81.01%， 84.81% and 94.94%， and the specificities were 88.00%， 82.67% and 85.33%. The logistic regression model constructed by TRTE combined with MRI had the best diagnostic efficiency （area under the curve of 0，933）. Conclusions The TRTE signs of lesions with a predominantly blue core and the MRI signs of T2WI low signal， DWI high signal， ADC low signal， DCE “fast in and fast out” enhancement are helpful to the diagnosis of benign and malignant prostate lesions. TRTE combined with MRI is helpful to enhance the diagnostic efficiency.

Objective To explore the relationship between serum ischemia-modified albumin （IMA）， soluble growth stimulation expressed gene 2 protein （sST2）， apolipoprotein B （ApoB）/ApoA1 and poor ST segment regression in electrocardiogram after percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 102 STEMI patients who received PCI treatment in the emergency department of the Second Affiliated Hospital of Anhui Medical University between September 2022 and September 2025 were selected. These patients were then divided into the poor regression group （with an ST-segment regression rate < 50%， n = 31） and the good regression group （with an ST-segment regression rate ≥50%， n = 71） based on the ST-segment regression rate of the postoperative electrocardiogram. The levels of serum IMA， sST2， and ApoB/ApoA1 were compared between the two groups before PCI and 2 hours after PCI. Demographic data， medical history data， and PCI-treatment-related data of the two groups were collected to screen for the influencing factors of poor ST-segment regression after STEMI. The predictive value of preoperative serum IMA， sST2， and ApoB/ApoA1 for poor ST-segment regression was analyzed. Results Among the 102 patients， 31 （30.39%） exhibited poor electrocardiogram regression 2 hours after the operation， and 71 （69.61%） showed good regression. The percentages of patients with a time from onset to admission > 6 hours， left anterior descending coronary artery infarction， and Killip grade ≥ Ⅱ were higher in the poor-regression group， whereas the percentage of TIMI blood flow grade 3 was lower （P < 0.05）. When comparing the same group before and 2 hours after the operation， serum IMA， sST2， and ApoB/ApoA1 levels decreased in both groups （P < 0.05）. The levels of serum IMA， sST2， and ApoB/ApoA1 in the poor-regression group before and 2 hours after the operation were higher （P < 0.05）. The area under the curve， sensitivity， and specificity of preoperative serum IMA for predicting poor ST-segment regression in STEMI patients after PCI were 0.818， 80.65%， and 73.24%， respectively； those of sST2 were 0.778， 64.52%， and 95.77%， respectively； those of ApoB/ApoA1 were 0.866， 70.98%， and 90.14%， respectively； and those of the combined prediction were 0.931， 77.42%， and 98.59%， respectively. Among them， the combined prediction had the highest efficacy （P < 0.05）. Left anterior descending coronary artery infarction （OR = 2.962）， preoperative IMA （OR = 2.354）， preoperative sST2 （OR = 2.517）， and preoperative ApoB/ApoA1 （OR = 2.863） were risk factors influencing ST-segment regression after PCI in STEMI patients （P < 0.05）. A multi-factor logistic regression model was constructed： logit（P） = -2.568 + 0.245 × Time from Onset to Admission （h）+1.086 × Infarction of the Left Anterior Descending Coronary Artery + 0.702 × Killip Classification + 0.935 × TIMI Flow Grade + 0.856 × Preoperative IMA + 0.923 × Preoperative sST2 + 1.052 × Preoperative ApoB/ApoA1. The area under the curve of this model for predicting poor ST-segment resolution after PCI in STEMI patients was 0.956 （95% CI： 0.897 - 0.987）， with a sensitivity of 87.10% and a specificity of 92.96%， Z = 22.366， P < 0.001. The goodness-of-fit test of the model yielded a χ² value of 5.971， with P > 0.05， which indicates good calibration of the model. The DCA curve showed that when the threshold probability was between 6% and 92%， using the model as a reference could achieve high clinical benefits. Conclusions Infarction of the left anterior descending coronary artery， preoperative high ratios of IMA， sST2， and ApoB/ApoA1 are all associated with poor ST-segment regression after PCI in STEMI patients. Moreover， the combined model shows relatively high feasibility in predicting the occurrence of adverse events related to ST-segment regression.

Objective To analyze the influencing factors for adjacent vertebral compression fractures （AVCF） after percutaneous kyphoplasty （PKP） in patients with osteoporotic vertebral compression fractures （OVCF）， taking into account the sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features. Methods The research subjects were selected from OVCF patients admitted to the hospital between November 2020 and August 2023. A total of 240 cases were included， and their clinical data were retrospectively analyzed. All the patients underwent PKP surgery and were followed up for 2 years. Based on whether the selected patients experienced AVCF during the follow-up period， they were divided into the occurrence group （54 cases） and the non-occurrence group （186 cases）. The clinical data and spinal pelvic sagittal plane parameters of the two groups were compared， and the risk factors were analyzed by multivariate Logistic regression analysis. The predictive value of the regression equation was analyzed by receiver operating characteristic （ROC） curves. Results The proportions of patients with diabetes， Ⅱ/Ⅲ degree fracture compression， initial fracture site T₁₀-L₂， bone cement intervertebral disc leakage， multi-segment fracture， and intervertebral disc injury in the occurrence group were 53.70%， 62.96%， 72.22%， 40.74%， 44.44%， and 33.33%， respectively， which were higher than those of 24.19%， 47.31%， 45.70%， 13.44%， 19.35%， and 13.98% in the non-occurrence group. The recovery rate of vertebral body height was lower than that in the non-occurrence group， and the TK， SVA， and TPA were higher than those in the non-occurrence group （P < 0.05）. Diabetes （OR = 2.408）， Ⅱ/Ⅲ degree fracture compression （OR = 2.838）， bone cement disc leakage （OR = 1.547）， multi-level fracture （OR = 2.155）， disc injury （OR = 3.043）， elevated TK （OR = 2.081）， elevated SVA （OR = 2.298）， and elevated TPA （OR = 1.636） were independent risk factors for AVCF in OVCF patients after PKP （P < 0.05）. The increased vertebral height recovery rate （OR = 0.328） was an independent protective factor （P < 0.05）. A regression equation was constructed： logit （P） = -7.087 + diabetes × 0.879 + fracture compression degree × 1.043 + bone cement intervertebral disc leakage × 0.436 + multi-level fracture × 0.768 + intervertebral disc injury × 1.113 - vertebral height recovery rate × 1.114 + TK × 0.733 + SVA × 0.832 + TPA × 0.436. The construction of the Logistic multiple regression diagnostic regression equation is effective. The ROC curve shows that when logit （P） > 0.174， the area under the curve （AUC） value is 0.898， and the diagnostic sensitivity and specificity are 83.33% and 82.80%， respectively. Conclusions Diabetes， Ⅱ/Ⅲ degree fracture compression， bone cement disc leakage， multi-level fracture， disc injury， elevated TK， elevated SVA， and elevated TPA were identified as independent risk factors for AVCF in OVCF patients after PKP， the increased vertebral height recovery rate was an independent protective factor. The regression equation constructed exhibited a high predictive value.

Long-term hypoxia induces central nervous system damage and cognitive decline （e.g.， memory impairment， delayed reaction， and reduced executive function）， representing a critical medical challenge threatening human health. However， the underlying mechanisms of such impairment remain unclear. In recent years， functional magnetic resonance imaging （fMRI） has emerged as a core tool for investigating abnormal brain functional activity， owing to its non-invasive nature and high spatial resolution. This review systematically summarizes the advances of resting-state fMRI （rs-fMRI） in studies of hypoxia-related cognitive impairment. It further explores in depth how various brain function analysis methods delineate changes in brain functional metrics， which in turn provides insights into the neural mechanisms underlying hypoxia-induced cognitive impairment. Additionally， this review confirms that rs-fMRI-derived brain functional metrics can serve as early diagnostic biomarkers for hypoxia-related diseases， offering quantitative evidence for screening high-risk populations. Meanwhile， by identifying key brain regions affected by hypoxia， the review provides precise targets for preventing hypoxic cognitive impairment and establishes a scientific basis for formulating brain health strategies. Notably， the integration of artificial intelligence （AI） techniques into multi-center studies is anticipated to further enhance diagnostic accuracy and intervention efficacy. This approach will ultimately provide critical technical support for alleviating the public health burden of hypoxia-related diseases.