These guidelines are designed to implement the National Tuberculosis Prevention and Control Plan （2024‐2030）， facilitating the transition of China's tuberculosis control model from passive case-finding based on symptomatic presentation to active screening. The guidelines also aim to systematically integrate evidence-based medical practices with control strategies， so as to offer scientific， systematic， and actionable recommendations. As a result， the early detection rates can be enhanced， control strategies can be strengthened， and the continuous optimization of the tuberculosis prevention and control system can be promoted. This guideline identifies four priority screening groups： individuals with suspected tuberculosis symptoms who have not yet sought medical care； populations at high risk of developing tuberculosis； key populations； and community members in high pulmonary tuberculosis incidence areas. The guideline systematically evaluates the sensitivity and specificity of various techniques， including symptom screening， imaging examinations， immunological and molecular biological testing， and C-reactive protein testing. Evidence-based recommendations are provided for implementing active tuberculosis screening approaches tailored to different populations.Based on an evidence-decision framework， the guidelines put forward a multi-step， combined screening strategy that emphasizes differentiated pathways. It highlights specific considerations for children as opposed to adults， and immunocompromised individuals compared to the general population. This approach is aimed at maximizing early detection and control effectiveness in resource-limited situations. Moreover， monitoring and evaluation mechanisms are suggested to guarantee screening quality， enhance case-finding efficiency， and allocate resources efficiently. The guideline also pinpoints future research directions， concentrating on the application of novel screening technologies， precise risk stratification， and digital management models. These endeavors are intended to propel the evolution of active screening strategies from “broad coverage” towards “precision and efficiency”. This guideline offers an actionable evidence-based reference for health authorities and tuberculosis control institutions at all levels， ultimately leading to increased early detection rates， reduced diagnostic delays， and decreased community transmission risks.

Pregnancy complicated by tuberculosis refers to the development of tuberculosis during pregnancy or pregnancy in women of childbearing age who have not fully recovered from tuberculosis. Clinically， pregnancy complicated by tuberculosis is not an uncommon condition. According to the World Health Organization （WHO）， approximately 200 000 pregnant women develop active tuberculosis annually， and the majority of them are from high-burden countries. With the extensive application of in vitro fertilization-embryo transfer （IVF-ET）， the number of patients with pregnancy complicated by disseminated tuberculosis has increased significantly. In recent years， numerous studies have confirmed that early diagnosis and standardized treatment of tuberculosis during pregnancy can notably improve maternal and infant outcomes. In contrast， delayed treatment may result in severe forms of the disease， such as hematogenous disseminated pulmonary tuberculosis or tuberculous meningitis. Owing to ethical concerns， it is challenging to carry out large-scale randomized controlled trials， which leads to a shortage of corresponding evidence-based medical data. To further standardize the clinical diagnosis and treatment of pregnancy complicated by tuberculosis， the Jiangxi Branch of the National Clinical Research Center for Infectious Diseases， the Tuberculosis Society of Jiangxi Medical Association， and the Nanchang Medical College Innovative Team for the Diagnosis and Treatment of Refractory Tuberculosis have assembled experts to deliberate and formulate this consensus. This consensus integrates the latest research progress from both domestic and international sources， with the aim of offering systematic guidance for clinical practice.

The Mycobacterium abscessus complex （MABC） stands as the most prevalent clinically pathogenic rapidly-growing nontuberculous mycobacterium， with a distinct preference for the respiratory tract. Its rapid growth and substantial disparities in drug resistance among subspecies make the treatment of drug-resistant infections arduous. This article conducts a comprehensive review of the molecular mechanisms of drug resistance in MABC. These mechanisms include erm（41）-mediated inducible macrolide resistance， acquired macrolide resistance resulting from rrl gene mutations， and the mechanisms behind aminoglycoside resistance， such as target mutations， inactivation by modifying enzymes， and efflux pumps. It further details the subspecies-specific differences in drug resistance and the characteristics of geographical distribution. Moreover， it summarizes the principles of clinical drug susceptibility testing， highlighting the integrated application of subspecies identification， phenotypic detection， and molecular typing. Integrating the latest research advances， it presents multidrug combination therapy strategies and experimental therapeutic approaches for drug-resistant MABC infections. The aim is to offer references for clinical precision diagnosis and individualized treatment， and to contribute to enhancing the level of diagnosis and treatment of drug-resistant MABC infections.

Objective To determine the prevalence and identify the risk factors of latent tuberculosis infection （LTBI） among close contacts of active pulmonary tuberculosis， and to evaluate the diagnostic performance of the domestic AIMTB fluorescent immunochromatographic reagent in detecting LTBI within this population. Methods A prospective study design was employed to continuously recruit 267 adult family close contacts of patients with active pulmonary tuberculosis in the tuberculosis department from January to October 2024. After enrollment， eleven cases were excluded because of age mismatch or the inability to provide compliant testing samples， leaving 256 eligible subjects for the study. General demographic information and clinical data were gathered， and chi-square tests and association strength analyses were carried out. Blood samples were examined for AIMTB and QFT-Plus by trained laboratory personnel， and data analysis was carried out. Results In this study， a total of 97 males and 159 females participated， with an average age of （48.47 ± 14.96） years. The LTBI detection rate was significantly higher among individuals with middle school education or below compared to those with high-school education or above. Moreover， the detection rate was significantly higher in smokers than in non-smokers and in drinkers than in non-drinkers. The results of multivariate logistic regression indicated that age ≥ 60 years （OR = 1.800， 95%CI： 1.00-3.241） and smoking （OR = 3.182， 95%CI： 1.676-6.041） are independent risk factors for LTBI. The positive rate of the QFT-Plus test was 33.6%（86/256）， and that of the AIMTB test was 38.3%（98/256）. The positive agreement rate between the two testing methods reached 93.68%， the negative agreement rate was 93.02%， and the overall agreement rate was 90.63%. The consistency strength evaluated by Cohen's Kappa coefficient was 0.797， suggesting high diagnostic consistency between the two testing methods. A further subgroup analysis of the groups with significant differences in detection rates revealed that both methods showed high consistency across different genders， age stratifications， and education levels， with kappa values greater than 0.75， except for the age group ≥ 60 years（0.740）. Under ROC curve analysis， the area under the curve was 0.989. Conclusions In populations with close contact， smoking serves as a risk factor for LTBI， and a certain proportion of LTBI cases in this population can be ascribed to smoking. The AIMTB and QFT-Plus tests demonstrate a high level of consistency in LTBI screening among close contacts， featuring high sensitivity and specificity. Moreover， the AIMTB test holds specific clinical value and public health significance in the screening of LTBI.

Objective To analyze the fecal metabolic profile of active tuberculosis（ATB） patients in order to explore novel non-invasive diagnostic biomarkers. Methods A total of 33 treatment-naive ATB patients（TB group） and 30 healthy controls（HC group） were recruited. Fresh fecal specimens from both groups were examined using UHPLC-MS-based untargeted metabolomics. Differential metabolites were selected by partial least squares discriminant analysis（PLS-DA） with the thresholds of variable importance in projection（VIP） ≥ 1.0， |log? FC| ≥ 0.585 （1.5-fold change）， and P ≤ 0.05. Potential biomarkers were recognized through KEGG pathway enrichment and clustering analyses， and their diagnostic effectiveness was assessed via receiver operating characteristic（ROC） curves. Results A total of 515 differential metabolites were identified （312 in ESI-； 203 in ESI+）， which were primarily enriched in purine metabolism， bile secretion， and nicotinate/nicotinamide metabolism. In the ESI- mode， 16 out of the top 20 metabolites were significantly down-regulated in the TB group， whereas PGE?， N-｛3-［（3，5-difluorophenyl）oxy］pyridin-2-yl｝-4-pentylbenzenesulfonamide， N'-2-acetylpyridine-2-carbohydrazone， and 5-hydroxyindole-2-carboxylic acid were up-regulated. In the ESI+ mode， 18 out of the top 20 metabolites were up-regulated， while 3-acetyl-2，5-dimethylfuran and fumaric acid were down-regulated. Metabolic pathway analysis combined with functional prediction identified three potential biomarkers—prostaglandin E₂（PGE₂）， trans-2-Butene-1，4-dicarboxylic Acid， and 5-hydroxyindole-2-carboxylic acid， with areas under the curve（AUC） of 0.911， 0.859， and 0.824， respectively. The logistic regression model integrating these three biomarkers achieved an AUC of 0.957 for combined diagnosis. Conclusions Differential metabolites in patients with active pulmonary tuberculosis were mainly enriched in purine metabolism， bile secretion， and nicotinate and nicotinamide metabolism pathways. Both PGE₂， trans-2-Butene-1，4-dicarboxylic acid， 5-hydroxyindole-2-carboxylic acid， and their combined diagnostic model showed good diagnostic efficacy for pulmonary tuberculosis.

Objective To develop a predictive model for differentiating lung cancer and pulmonary tuberculosis， machine learning methods were employed. Methods A retrospective analysis was conducted on the clinical data of 585 patients who visited Guangxi Chest Hospital from July 2020 to May 2023. The patients' ages ranged from 14 to 90 years old， with 457 males and 128 females. Based on the final clinical diagnosis results， the 585 cases were divided into the lung cancer group and the pulmonary tuberculosis group. The differences in tumor marker test results between the two groups of cases were compared. Lasso and single-factor logistic regression analysis were used to screen feature variables for differentiating lung cancer from pulmonary tuberculosis. A random forest model was constructed， and the important predictive variables were ranked. A Lasso-logistic regression model was constructed. The predictive efficacy of the random forest model and the Lasso-logistic regression model was compared through ROC curve analysis. Results The levels of serum tumor markers CA125， CEA， CYFRA21-1， NSE， and SCCA in the lung cancer group were significantly higher than those in the pulmonary tuberculosis group， showing statistically significant differences（P < 0.05）. Lasso and single-factor logistic regression analysis was conducted to identify the following characteristic variables for differentiating lung cancer from pulmonary tuberculosis： sex， age， CA125， CEA， CYFRA21-1， NSE， and SCCA. A random forest model was used to rank these variables by importance as follows： CYFRA21-1， CEA， SCCA， NSE， CA125， age， and sex. The results of Lasso-logistic regression analysis indicated that the levels of CYFRA21-1， CEA， NSE， and age were independent risk factors for differentiating lung cancer from pulmonary tuberculosis（P < 0.05）. The AUC， sensitivity， specificity， accuracy， and Youden index of the Random Forest model and the Lasso-logistic regression model for the differential diagnosis of lung cancer and pulmonary tuberculosis were 0.938， 90.38%， 87.50%， 0.888， 0.779 and 0.958， 86.54%， 92.19%， 0.879， 0.787， respectively. Conclusions The tumor markers CA125， CEA， CYFRA21-1， NSE， and SCCA hold significant clinical value in the differential diagnosis of lung cancer and pulmonary tuberculosis. The random forest model and Lasso-logistic regression model developed in this study can effectively discriminate between lung cancer and pulmonary tuberculosis. The Lasso - logistic regression model identified that the levels of CYFRA21-1， CEA， NSE， and age were independent risk for differentiating lung cancer from pulmonary tuberculosis.

The updated histopathological classification of thyroid tumors recognizes follicular cell-derived thyroid neoplasms （FDN） as consisting of benign， low-risk， and malignant subtypes. Malignant FDN， mainly follicular thyroid carcinoma and oncocytic carcinoma， are linked to significantly poorer clinical outcomes when compared with benign lesions. However， conventional ultrasound risk stratification systems and fine-needle aspiration biopsy still have limitations in accurately differentiating benign from malignant FDN. In recent years， the incorporation of advanced ultrasound modalities， such as contrast-enhanced ultrasound and elastography， has offered promising ways to enhance preoperative diagnostic accuracy. A burgeoning body of research has aimed to tackle this long-standing challenge in FDN classification. This review outlines current diagnostic limitations and emphasizes recent advancements in the application of ultrasound techniques for the assessment of FDN.

Objective To evaluate the application value of smartphone level meter combined with laser guidance device in CT-guided percutaneous lung puncture. Methods A historical control study was conducted， and enrolling 60 patients who underwent CT-guided lung puncture at the Fourth Affiliated Hospital of Anhui Medical University from October 2023 to July 2025. A total of 60 patients （45 males， 15 females） with a mean age of （72.90 ± 8.82） years were included. 30 patients who underwent CT-guided lung puncture， and 30 patients who received smartphone level meter-assisted procedures as the experimental group. The following parameters were compared between the two groups： coaxial needle insertion attempts， pneumothorax incidence， bleeding severity， puncture duration， and achievable puncture angle. Results The experimental group demonstrated significantly fewer coaxial needle insertion attempts ［1.00 （1.00， 2.00） vs. 2.00 （2.00， 3.00）， P < 0.001］， lower pneumothorax incidence （13.3% vs. 36.6%， P = 0.037）， shorter puncture duration ［（24.90 ± 4.68）min vs. （29.93 ± 10.11）min， P = 0.02］， and larger achievable puncture angles ［19.50° （7.75°， 41.00°） vs. 7.00° （1.75°， 25.25°）， P = 0.04］ compared to the control group. No statistically significant difference was observed in bleeding severity （P = 0.481）. Conclusions The combination of a smartphone level meter and laser guidance device effectively reduces the number of coaxial needle insertion attempts， lowers the incidence of pneumothorax， shortens the procedure duration， and enables a wider achievable puncture angle in CT-guided percutaneous lung puncture. This technique shows promising clinical application value for improving the safety and efficiency of the procedure.

Objective To explore the application value of the modified Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System （CEUS LI-RADS） in the diagnosis of hepatocellular carcinoma （HCC） with the diameter of ≤ 5 cm. Methods A retrospective analysis was performed on contrast-enhanced ultrasound （CEUS） data from 461 liver nodules in high-risk HCC patients， with pathological results serving as the gold standard. The nodules were classified according to the 2017 CEUS Liver Imaging Reporting and Data System （LI-RADS） and then modified based on the following two criteria： （1） nodules with arterial phase hyper-enhancement and a washout time of 45-60 s were re-classified as LR-5； （2） If LR-4 and LR-M nodules were combined with positive alpha-fetoprotein （AFP） or des-gamma-carboxy prothrombin （DCP）， they were re-judged as LR-5. The diagnostic efficacy of LR-5 before and after modification was compared. Results Among 379 HCC lesions， after modification， the proportion of HCC cases classified as LR-M decreased from 32.70% to 4.70% （χ2 = 97.367， P < 0.001）. In the overall group， the ≤ 3 cm group， the 3-5 cm group， the 0-2 cm group， and the 2-3 cm group of the tumor maximum diameter， the modified classification significantly improved the sensitivity ［（92.61%， 92.41%， 93.33%， 90.30%， 95.04%） vs. （62.27%， 61.24%， 65.56%， 58.79%， 64.46%）］， accuracy ［（90.5%， 89.52%， 91.84%， 87.78%， 91.60%） vs. （62.38%， 60.38%， 67.35%， 58.89%， 63.36%）］， and the area under the curve value （AUC） ［（0.766， 0.742， 0.842， 0.752， 0.726） vs. （0.630， 0.586， 0.765， 0.594， 0.572）］. The positive predictive value （PPV） was more than 96%. Conclusions The modified CEUS LI-RADS classification significantly enhanced the sensitivity， accuracy， and AUC of ≤ 5 cm HCC diagnosis without compromising the PPV. The same applies to ≤ 2 cm HCC diagnosis， which would provide more reliable evidence for clinical decision-making.

Objective To explore the relationship between the levels of serum MicroRNA （miR）-145， miR-934， Alpha-fetoprotein （AFP）， and Thymidine kinase 1 （TK1） in patients with primary liver cancer， as well as their associations with the clinicopathological characteristics and prognosis. Methods From September 2021 to September 2023， 202 cases of primary liver cancer patients admitted to Qingdao Central Hospital， University of Health and Rehabilitation Sciences were selected as the liver cancer group. Meanwhile， 205 patients with liver cirrhosis during the same period were selected as the liver cirrhosis group， and 213 healthy individuals undergoing physical examinations were selected as the control group. Among them， the liver cancer group was further divided into the poor-outcome group and the good-outcome group according to the prognosis 3 months after surgery， with 56 cases in the poor-outcome group and 146 cases in the good-outcome group respectively. After discharge， patients were followed up every three months， and the follow-up period ended in September 2025 or upon the patient's death. The clinical data of all the research subjects were statistically analyzed. The levels of serum miR-145， miR-934， AFP， and TK1 were compared among the liver cancer group， liver cirrhosis group， control group， poor-outcome group， good-outcome group， and patients with primary liver cancer with different clinicopathological characteristics. The predictive value of combined detection of different serum indicators for the poor prognosis of patients with primary liver cancer was analyzed using the receiver operating characteristic curve （ROC）. Additionally， the Kaplan-Meier survival curve was drawn to analyze the overall survival of patients with primary liver cancer at different expression levels of serum indicators. Results The serum miR-145 level in the liver cancer group was significantly lower than those in the liver cirrhosis group and the control group. In contrast， the levels of miR-934， AFP， and TK1 were higher than those in the liver cirrhosis group and the control group （P < 0.05）. Moreover， the levels of each index in the liver cirrhosis group were intermediate between those in the liver cancer group and the control group. The serum miR-145 level in patients with TNM stage Ⅲ and poorly differentiated primary liver cancer was lower than that in patients with TNM stage Ⅰ—Ⅱ and moderately to highly differentiated primary liver cancer （P < 0.05）. The levels of serum AFP and TK1 in patients with TNM stage Ⅲ and poorly differentiated primary liver cancer were higher than those in patients with TNM stage Ⅰ—Ⅱ and moderately to well-differentiated primary liver cancer （P < 0.05）. The serum miR-934 level in patients with TNM stage Ⅲ primary liver cancer was higher than that in patients with TNM stage Ⅰ—Ⅱ primary liver cancer （P < 0.05）. The serum miR-145 level in the poor-outcome group was lower than that in the good-outcome group， whereas the other three indicators were higher （all P < 0.05）. ROC curve analysis demonstrated that the area under the curve （AUC） for the combined prediction of poor prognosis by the four indicators was 0.897 （95%CI： 0.846 ~ 0.935）， with a sensitivity of 83.93% and a specificity of 86.99%， which was superior to any single indicator （P < 0.05）. The median follow-up time was 35 months （range： 3 to 48 months）. Survival analysis indicated that the overall survival period was longer in the miR-145 high-expression group （hazard ratio 0.669， 95%CI： 0.475 ~ 0.943， P = 0.022）， while the overall survival periods were longer in the miR-934， AFP， and TK1 low-expression groups （hazard ratio 0.707， 95%CI： 0.506 ~ 0.987； hazard ratio 0.700， 95%CI： 0.501 ~ 0.978； hazard ratio 0.627， 95%CI： 0.428 ~ 0.917； all P < 0.05）. Conclusions miR-145 exhibited low expression in the serum of patients with primary liver cancer， whereas miR-934， AFP， and TK1 showed high expression in the serum of these patients. These four indicators were closely associated with the clinicopathological characteristics and poor prognosis of patients with primary liver cancer. Furthermore， the combined detection of these four indicators holds high predictive value for the poor prognosis of patients with primary liver cancer and may offer a new biomarker combination for prognosis assessment.

Objective This study aims to integrate ultrasound radiomics， the O-RADS （v2022） classification system， and clinical risk factors to develop and validate an intelligent diagnostic model for improving the accuracy of differentiating between benign and malignant ovarian tumors. Methods A multicenter， retrospective study design was adopted. A total of 596 patients who underwent surgery at our institution were enrolled and randomly split into a training set （n = 418） and an internal validation set （n = 178） at a 7：3 ratio. Additionally， 110 patients from an external hospital were recruited as an external test set. Model construction consisted of three core components： （1） extraction of 12 radiomics features from standardized ultrasound images； （2） O-RADS classification results derived from blinded assessments and consensus among three physicians； （3） clinical predictors （age， maximum tumor diameter， CA125， HE4， and menopausal status） identified through univariate and multivariate logistic regression screening. Three models were developed and compared： a standalone O-RADS model， a combined clinical-O-RADS model， and an integrated radiomics-clinical-O-RADS model. Results The integrated model exhibited the optimal diagnostic performance， with area under the curve （AUC） values of 0.95 in the training set， 0.92 in the internal validation set， and 0.89 in the external test set （P < 0.05）. Decision curve analysis （DCA） further confirmed that this model achieved a higher clinical net benefit across a wide range of threshold probabilities. Feature importance analysis revealed that radiomics features contributed the most to the model’s predictive power （approximately 60%）. Conclusions The integrated model combining ultrasound radiomics， O-RADS classification， and clinical factors significantly improves the preoperative diagnostic accuracy for distinguishing between benign and malignant ovarian lesions. It demonstrates good generalization ability and clinical utility， providing an objective and precise auxiliary tool to support clinical decision-making in ovarian tumor management.

Objective To explore the predictive efficacy of serum expression levels of collagen type X alpha 1 （COL10A1）， microRNA （miRNA）-21， and miRNA-320c in peritoneal metastasis and prognosis of gastric cancer. Methods The clinical data of 120 patients diagnosed with gastric cancer and admitted to our hospital between July 2023 and September 2024 were retrospectively analyzed. Post-treatment， the prognostic outcomes of these patients were tracked through outpatient and telephone follow-up. Based on the occurrence of peritoneal metastasis， the patients were classified into the peritoneal metastasis group and the non-peritoneal metastasis group. According to the prognostic outcomes， they were further divided into the poor prognosis group and the good prognosis group. Enzyme-linked immunosorbent assay （ELISA） was employed to detect the expression of serum COL10A1. Quantitative real-time polymerase chain reaction （qRT-PCR） was utilized to measure the expression levels of miRNA-21 and miRNA-320c. A comparison was made regarding the clinical characteristics， serum levels of COL10A1， miRNA-21， and miRNA-320c between the peritoneal metastasis group and the non-peritoneal metastasis group. Additionally， the serum expression levels of the aforementioned indicators were also compared among gastric cancer patients with different prognostic outcomes. Cox univariate and multivariate stepwise regression analyses were carried out to identify the factors influencing the prognosis of gastric cancer. Receiver operating characteristic （ROC） curve analysis was performed to assess the predictive efficacy of serum COL10A1， miRNA-21， and miRNA-320c for the prognosis of gastric cancer. Results Among the 120 gastric cancer patients， 31 cases presented with peritoneal metastasis while 89 cases did not. The TNM stage of the peritoneal metastasis group was notably higher than that of the non-peritoneal metastasis group （P < 0.05）. The serum expression levels of COL10A1， miRNA-21， and miRNA-320c in the peritoneal metastasis group were all elevated compared to those in the non-peritoneal metastasis group （P < 0.05）. Out of the 120 patients， 42 cases belonged to the poor prognosis group and 78 cases to the good prognosis group. The serum levels of COL10A1， miRNA-21， and miRNA-320c in the poor prognosis group were significantly higher than those in the good prognosis group （P < 0.05）. Cox univariate analysis demonstrated that TNM stage， peritoneal metastasis， lymph node metastasis， serum levels of COL10A1， miRNA-21， and miRNA-320c were all associated with the prognosis of gastric cancer patients （all P < 0.05）； multivariate analysis disclosed that TNM stage， peritoneal metastasis， serum levels of COL10A1， miRNA-21， and miRNA-320c were independent risk factors influencing the prognosis of gastric cancer patients （all P < 0.05）. ROC curve analysis suggested that the combined detection of serum COL10A1， miRNA-21， and miRNA-320c for predicting the prognostic outcomes of gastric cancer had a sensitivity of 89.45% and a specificity of 92.34%， with the area under the curve （AUC） reaching 0.921， which was significantly higher than that of single detection of COL10A1 （P = 0.011）， miRNA-21 （P = 0.023）， and miRNA-320c （P = 0.015）. Conclusion Serum COL10A1， miRNA-21， and miRNA-320c are highly expressed in gastric cancer patients with peritoneal metastasis and poor prognosis. These indicators are independent risk factors for the poor prognosis of gastric cancer patients， and their combined application demonstrates high predictive efficacy for the prognostic outcomes of gastric cancer patients.

Objective To investigate the molecular mechanism by which Yes-associated protein （YAP） regulates glycolysis during pulmonary arterial smooth muscle cell （PASMC） proliferation， and to identify potential therapeutic targets. Methods Primary cultured PASMC were stimulated with sphingosine-1-phosphate （S1P）. YAP phosphorylation and pyruvate kinase （PKM2） protein expression were determined by Western blot. Cellular glycolytic function was assessed by measuring the glycolysis rate with a seahorse metabolic analyzer and quantifying lactate production using a lactate assay kit. Cell proliferation was analyzed by a BrdU incorporation assay. Results Compared with the control group， the S1P group showed significantly reduced p-YAP level， increased PKM2 protein expression， enhanced glycolytic capacity， and elevated lactate production in the culture medium （P < 0.05）. Knockdown of YAP with specific siRNA attenuated S1P-induced PKM2 upregulation， as well as the enhancement of glycolytic capacity and lactate production （P < 0.05）. Furthermore， activation of AMPK by metformin inhibited YAP activity， thereby reversing S1P-induced upregulation of PKM2， enhanced glycolysis， and lactate production （P < 0.05）. Finally， interventions with YAP siRNA transfection， the glycolysis inhibitor 2-DG， and the AMPK activator metformin mitigated S1P-induced PASMC proliferation （P < 0.05）. Conclusion S1P promotes PASMC proliferation through the YAP/PKM2/glycolysis signaling pathway， while metformin activates AMPK to inhibit this pathway， thereby suppressing PASMC proliferation.

Objective To investigate the potential effects of glycemic fluctuation on copper homeostasis and blood–brain barrier （BBB） function in hCMEC/D3 human brain microvascular endothelial cells. Methods hCMEC/D3 cells were conventionally cultured and divided into a control group （glucose 25 mmol/L for 4 days） and a fluctuating glucose group （FG group： glucose 25 mmol/L for 8 h followed by glucose 55 mmol/L for 8 h， repeatedly for 4 days）. Cell viability was assessed using the CCK-8 assay， and cell morphology was observed under an light microscope. A Transwell system was used to construct a monolayer cell model， and transendothelial electrical resistance （TEER） was measured daily. Monolayer permeability was evaluated using the phenol red assay. Intracellular copper levels and reactive oxygen species （ROS） levels were detected. The mRNA expression levels of copper transporter 1 （SLC31A1）， copper-transporting ATPase β chain （ATP7B）， cytochrome c oxidase copper chaperone 17 （COX17）， and antioxidant 1 copper chaperone （ATOX1） were determined by qPCR. The protein expression levels of SLC31A1， ATP7B， COX17， ATOX1， zonula occludens-1 （ZO-1）， occludin， and Claudin-1 were analyzed by Western blot. Results Cell viability in the FG group was significantly lower than that in the control group （P < 0.05）. Cells in the control group exhibited robust growth and formed a dense network with extensive intercellular connections， whereas cell growth in the FG group was inhibited， with markedly reduced cell numbers and diminished intercellular contacts. The TEER value in the FG group was significantly lower than that in the control group （P < 0.05）， and the phenol red permeability assay revealed increased permeability and disrupted monolayer integrity in the FG group （P < 0.001）. Both the copper ion detection kit and copper-specific fluorescent probe showed a significant reduction in intracellular copper levels in the FG group. Intracellular ROS levels were markedly elevated on day 4 in the FG group （P < 0.05）. qPCR results demonstrated that， compared with the control group， the mRNA expression of ATOX1， COX17， and SLC31A1 was significantly decreased， whereas ATP7B expression was significantly increased （P < 0.05）. Western blot analysis showed that the protein expression of ZO-1， occludin， and Claudin-1 was significantly reduced in the FG group （P < 0.05）. The protein expression of SLC31A1 （P < 0.05）， ATOX1， and COX17 was decreased， while ATP7B expression was increased （P < 0.05）. Immunofluorescence analysis further confirmed that， compared with the control group， SLC31A1 expression was reduced and ATP7B expression was elevated in the FG group（P < 0.05）. Conclusion Glycemic fluctuation may impair the structure and function of the BBB in hCMEC/D3 cells by inducing damage to barrier-related structures， increasing cellular permeability， and promoting ROS accumulation. This pathological process may be closely associated with intracellular copper homeostasis imbalance， providing new insights into the mechanisms underlying BBB dysfunction in conditions characterized by glycemic instability.

Objective To construct a prediction model based on clinical data， explore the factors influencing the efficacy of biofeedback treatment for spastic pelvic floor syndrome， and provide a basis for guiding individualized treatment through early identification of patients with poor treatment outcomes. Methods A total of 175 patients who underwent one course （10 sessions） of biofeedback treatment in the Department of Gastrointestinal Surgery， Third Hospital of Hebei Medical University， from June 2020 to June 2025， were selected for analysis. Clinical data before and after the treatment were collected. The dataset was partitioned into a training set （70%， n = 122） and a validation set （30%， n = 53）. Efficacy was defined as a reduction of over 50% in the ODS score and the normalization of the anorectal manometry defecation pattern. Based on the efficacy， patients were categorized into the treatment-effective group（TE） and treatment-ineffective group（TIE）. Feature variables were selected step-by-step through univariate logistic regression， Lasso regression， and multivariate logistic regression. A nomogram was constructed， and the discriminatory ability， calibration， fit， and clinical value of the model were evaluated using the receiver operating characteristic（ROC） curve， calibration curve， Hosmer-Lemeshow test， and decision curve analysis（DCA）. Results Multivariate logistic regression analysis revealed that anal resting pressure， digital evacuation， use of laxatives， use of enemas， sensation of incomplete evacuation， and patient satisfaction were independent risk factors influencing treatment efficacy. The area under the curve （AUC） values for the training and validation sets were 0.959 （95%CI： 0.921-0.996） and 0.971 （95%CI： 0.918-1.000）， respectively. The calibration curve indicated good calibration， and the Hosmer-Lemeshow test demonstrated no statistically significant difference between the actual and predicted probabilities in both the training and validation sets （P > 0.05）. DCA curves and 5-fold cross-validation suggested that the model provided clinical net benefits within a probability range of 0.1-0.8. Conclusions This study comprehensively integrates the clinical symptoms and diagnostic indicators of SPFS patients， thereby providing a reliable prediction model for the efficacy of BFT. This integration not only aids in the identification of high-risk patients but also offers valuable evidence for clinical decision-making.

Objective Guided by the empowerment theory framework， this study aimed to investigate the relationship between empowerment levels in older adults with disabilities and their quality of life （QoL）， as well as the mediating roles of health literacy and self-efficacy in this association. Methods A questionnaire survey was conducted using convenience sampling from March 2022 to May 2023. Data were collected through the following validated instruments： the Sociological Data Questionnaire， Katz Activities of Daily Living （ADL） Scale， Chinese Simplified Elders' Health Empowerment Scale， Chinese version of the Short Form-36 （SF-36） Health Survey， Health literacy Scale for chronic disease patients and General Self-Efficacy Scale. Following data collection， a parallel mediating model was constructed and statistically validated. Results 313 valid questionnaires were returned， for a valid response rate of 96.31%. The empowerment score of 313 older adults with disabilities was （27.47 ± 3.99）； quality of life score was （244.91 ± 102.98）； health literacy score was （83.21 ± 19.83）； and self-efficacy score was （21.39 ± 7.26）. Empowerment， health literacy， self-efficacy and quality of life were positively correlated in older adults with disabilities （r value： 0.279 - 0.639， P < 0.01）. Older adults with disabilities' empowerment level cannot directly affect their quality of life， but empowerment level can positively affect their quality of life through their health literacy and self-efficacy， with effect values of 0.065 and 0.113， respectively， and the parallel mediated effects is statistically significant. Conclusion The level of empowerment， self-efficacy， health literacy and quality of life of older adults with disabilities needs to be improved. The level of empowerment of older adults with disabilities does not directly affect their quality of life， but can positively influence it through health literacy and self-efficacy.

Objective To investigate the diagnostic value of uric acid/high-density lipoprotein cholesterol ratio （UHR）， monocyte count/high-density lipoprotein cholesterol ratio （MHR）， and 25-hydroxyvitamin D ［25（OH）D］ levels in lower extremity artery disease （LEAD） of type 2 diabetes mellitus （T2DM）. Methods This retrospective study analyzed 166 T2DM patients hospitalized at the Department of Endocrinology， Second Affiliated Hospital of Zhengzhou University from April 2024 to September 2025. Patients were categorized into T2DM with LEAD （82 cases） and T2DM without LEAD （84 cases） based on the presence of lower extremity artery disease. General demographics and biochemical markers were compared between groups. Logistic regression was used to identify risk factors for LEAD development， while Pearson correlation analysis evaluated the relationships between UHR， MHR， 25（OH）D， and other biochemical indicators. ROC curves were constructed to assess diagnostic value. Results The T2DM with LEAD group showed statistically significant differences （P < 0.05） compared to the T2DM without LEAD group in male proportion， age， disease duration， uric acid levels， monocyte count， UHR， and MHR， whereas high-density lipoprotein cholesterol （HDL-C） and 25（OH）D levels were lower in the former group. Pearson correlation analysis revealed negative associations between UHR and 25（OH）D， low-density lipoprotein cholesterol （LDL-C）， and total cholesterol （P < 0.05）， while showing positive correlations with serum creatinine and monocyte count （P < 0.05）. MHR exhibited negative correlations with LDL-C， total cholesterol， and non-HDL cholesterol （P < 0.05）.Univariate logistic regression analysis showed that gender， age， disease duration， UHR， MHR， and 25（OH）D were independent risk factors for LEAD in patients with T2DM. After adjusting for confounding factors such as gender， age， and disease duration. Multivariate logistic regression analysis identified UHR， MHR， and 25（OH）D as significant predictors of LEAD development in T2DM patients. ROC curve analysis demonstrated that the area under the curve （AUC） for diagnosing T2DM with LEAD using UHR， MHR， and 25（OH）D levels was 0.822，0.774， and 0.784 （P < 0.05）， respectively， with the combined use of these three markers yielded a significantly higher AUC reaching 0.927 （P < 0.05）， After internal validation by Bootstrap resampling， the corrected AUC was 0.921. Conclusion UHR， MHR， and 25（OH）D levels are key factors influencing LEAD development in T2DM patients， and their combined use significantly improves early diagnostic accuracy timely screening and intervention for LEAD complications.

Objective To compare the clinical efficacy of drug-eluting stents （DES） with that of drug-coated balloons （DCB） in patients with GLASS stage 3 femoropopliteal atherosclerotic disease. Methods A retrospective analysis was conducted on the clinical data of 104 patients with GLASS stage 3 femoropopliteal atherosclerotic disease who underwent endovascular intervention at the Guangdong Provincial Hospital of Chinese Medicine from December 2020 to December 2023. Among these patients， 52 were treated with Eluvia DES （DES group）， and another 52 were treated with paclitaxel-coated DCB （DCB group）. The primary patency rate and the rate of freedom from clinically driven target lesion revascularization （CD-TLR） at 6， 12， and 24 months were assessed using Kaplan-Meier survival curves. The occurrence of adverse events， such as death and amputation， was also monitored. Results All 104 patients successfully completed the procedure. Kaplan-Meier estimates demonstrated that the primary patency rates at 6， 12， and 24 months after the procedure were 94.1% vs. 94.1%， 84.3% vs. 74.5%， and 76.3% vs. 54.9% for the DES and DCB groups， respectively. Log-rank tests indicated a statistically significant difference in the primary patency rates between the two groups postoperatively （P = 0.030）. The rates of freedom from CD-TLR at 6 months were the same for the DES and DCB groups （98.0% vs. 98.0%）. The rates of freedom from CD-TLR at 12 and 24 months were higher in the DES group than in the DCB group （92.2% vs. 84.3%， 86.1% vs. 66.7%）. Log-rank tests showed a statistically significant difference in the distribution of survival curves for freedom from CD-TLR between the two groups （P = 0.023）. No statistically significant difference was detected in the ankle-brachial index （ABI） between the two groups before the procedure and at 6 months after the procedure. At 12 and 24 months after the procedure， the ABI in the DES group was significantly higher than that in the DCB group （P = 0.033， 0.003）. At 24 months after the procedure， the proportion of patients with an improvement in Rutherford classification of ≥ 2 grades compared to pre-procedure was 72.0% （36/52） in the DES group， significantly higher than the 50.0% （25/50） in the DCB group， and this difference was statistically significant （P = 0.024）. Conclusion In patients with GLASS stage 3 femoropopliteal atherosclerotic disease， DES demonstrate superior mid-term clinical efficacy compared to DCB treatment.

Objective To explore and compare the efficiency of early identification of acute large vessel occlusion （LVO） ischemic stroke in the emergency department using the Vision， Aphasia， Neglect （VAN） assessment and the National Institutes of Health Stroke Scale （NIHSS） score. Methods A retrospective analysis was conducted on the clinical data of 189 patients with acute ischemic stroke who received treatment in the emergency department of the hospital from January 2023 to March 2024. The VAN and NIHSS scores were determined by trained emergency physicians upon admission. Two trained emergency physicians （with a title of attending physician or above） independently and retrospectively scored all patients based on emergency medical records without being aware of the vascular imaging results. In case of inconsistent evaluations， a consensus was reached through consultation. Using head-neck CTA or MRA as the gold standard for LVO diagnosis， the independent predictors of LVO were analyzed via multivariate logistic regression analysis， and the diagnostic efficiency of the two scoring methods for LVO was assessed by receiver operating characteristic （ROC） curves. Results Among the 189 patients with acute ischemic stroke， the gold-standard method （CTA/MRA） indicated that 91 cases （48.15%） had LVO， including 59 cases （64.84%） with anterior circulation LVO and 32 cases （35.16%） with posterior circulation LVO. Multivariate logistic regression analysis revealed that after adjusting for confounding factors such as age and atrial fibrillation， a positive VAN （OR = 12.541， 95%CI： 4.800 ~ 32.766， P < 0.05） and the NIHSS score （OR = 1.319， 95%CI： 1.115 ~ 1.561， P < 0.05） were both independent predictors of LVO. ROC curve analysis demonstrated that the area under the curve （AUC） of the NIHSS score for the diagnosis of LVO was 0.863 （95%CI： 0.805 ~ 0.921）. Using the optimal cut-off value （10 points） as the criterion， its sensitivity， specificity， positive predictive value， and negative predictive value were 82.42%， 87.76%， 86.21%， and 84.31%， respectively. The AUC， sensitivity， specificity， positive predictive value， and negative predictive value of VAN for the diagnosis of LVO were 0.857 （95%CI： 0.799 ~ 0.915）， 84.62%， 86.73%， 85.56%， and 85.86%， respectively. The DeLong test showed that there was no significant difference in the AUC between the two scoring methods （Z = 0.166， P = 0.869）. Regarding anterior circulation LVO， the diagnostic efficiency of VAN was higher than that of the NIHSS score ［（AUC = 0.851， 95%CI： 0.795 ~ 0.908） vs. （AUC = 0.760， 95%CI： 0.682 ~ 0.839）， Z = 2.013， P = 0.044］. For posterior circulation LVO， the diagnostic efficiency of the NIHSS score was significantly higher than that of VAN ［（AUC = 0.839， 95%CI： 0.766 ~ 0.912） vs. （AUC = 0.618， 95%CI： 0.512 ~ 0.724）， Z = 3.814， P < 0.001］. Conclusions Both the VAN and NIHSS score are independent predictors of LVO， which can effectively assess the occurrence of acute LVO ischemic stroke. Furthermore， the VAN demonstrates superior identification efficiency for anterior circulation LVO， whereas the NIHSS score exhibits better identification efficiency for posterior circulation LVO.

Objective To explore the association between the risk of high residual cholesterol （RC） and thyroid hormone sensitivity among elderly osteoporosis （OP） women with normal thyroid function. Methods This retrospective study recruited 937 hospitalized female OP patients aged 60 years or older with normal thyroid function from January 2021 to December 2023. Among them， 703 cases were assigned to the normal RC level group （Group A）， whose RC levels were in the lower three quartiles， and 234 cases were assigned to the high RC level group （Group B）， whose RC levels were in the upper quartile. Liver function， kidney function， electrolyte levels， blood lipid profiles， and thyroid function indicators were measured. The FT3/FT4 ratio， thyroid feedback quantile index （TFQI）， thyroid-stimulating hormone thyroid resistance index （TT4RI）， thyroid-stimulating hormone index （TSHI）， and RC were calculated. Binary logistic regression analysis and restricted cubic spline （RCS） were employed to explore the risk factors of high RC in elderly women with osteoporosis and its relationship with thyroid hormone sensitivity. Results （1） When compared with the normal RC level group， the levels of TG， TC， LDL-C， FT4， TFQI， and TSHI in the high RC level group were elevated， whereas the levels of HDL-C and the FT3/FT4 ratio were reduced in the high RC level group compared with group A （P < 0.05）. （2） TFQI and the FT3/FT4 ratio were identified as risk factors for high RC in elderly women with OP， and the odds ratios （ORs） were 1.50 （95%CI： 1.04-2.16） and 0.02 （95%CI： 0.00-0.76）， respectively， with P < 0.05. （3） TFQI stratification analysis indicated that as its level rose， the risk of high RC also increased. In the third stratum， for each unit increase in TFQI， the risk of high RC increased the most， reaching 2.28-fold， with an OR of 2.28 （95%CI： 1.47-3.54）， P < 0.05. （4） Restricted cubic spline analysis revealed an inverted U-shaped correlation between TFQI and RC content， with a cut-off point of 0.304， and an inverted U-shaped relationship with the risk of high RC. When TFQI was between -0.021 and 0.772 （inclusive）， the risk of high RC increased. Conclusion Impaired thyroid hormone sensitivity serves as a risk factor for high RC in elderly women with osteoporosis. The TFQI exhibits an inverse U-shaped correlation with RC content and the risk of high RC.

Objective To investigate the differential effects of semaglutide on gonadal function between men with male obesity-associated secondary hypogonadism （MOSH） and those with simple obesity. Methods A total of 37 obese male patients， with a body mass index （BMI） of 28 kg/m2 or higher and a waist circumference exceeding 90 cm， were recruited and divided into the MOSH group and the simple obesity group based on their baseline total testosterone levels. All patients underwent a 24-week intervention with semaglutide. The changes in the International Index of Erectile Function-5 （IIEF-5） score， sex hormone levels， and semen parameters were compared between the two groups both before and after treatment. Results After treatment， the BMI， waist circumference， and visceral fat area in both groups were significantly reduced compared to the baseline values. In the MOSH group， the IIEF-5 score， total testosterone level， and progressive sperm motility all showed significant increases （all P < 0.05）. Meanwhile， no significant alterations were detected in the follicle-stimulating hormone （FSH） or luteinizing hormone （LH） levels （both P > 0.05）. Correlation analysis indicated that in the MOSH group， the increase in total testosterone was significantly and positively correlated with the reduction in visceral fat area （r = 0.406， P = 0.013）. In the simple obesity group， only the LH level decreased significantly after treatment （P < 0.05）， and there were no significant changes in other gonadal function indicators or semen parameters （all P > 0.05）. Multiple linear regression analysis demonstrated that the baseline total testosterone level was an influencing factor for the change in total testosterone after treatment. Conclusions Semaglutide effectively enhances gonadal function and sperm quality in patients with MOSH. However， it has limited impacts on the hypothalamic-pituitary-gonadal axis in men with simple obesity without hypogonadism. Semaglutide can potentially be a therapeutic option for patients with MOSH.

Objective To evaluate the clinical efficacy of ultrasound-guided myofascial trigger point acupuncture in combination with conventional Western medicine for the treatment of primary dysmenorrhea. Methods A total of 112 patients with primary dysmenorrhea who were admitted to the Department of Anesthesiology of Zigong Fourth People’s Hospital from January 2023 to August 2024 were enrolled in the study. These patients were randomly divided into two groups （n = 56 each） by using a random number table. The control group was treated with ibuprofen granules， whereas the observation group received ultrasound-guided myofascial trigger point acupuncture in addition. Therapeutic efficacy， pain intensity， dysmenorrhea symptoms， uterine microcirculation， and serum pain-related mediators were compared between the two groups. Results The total effective rate in the observation group was 94.64%， which was significantly higher than that in the control group （80.36%， P < 0.05）. After treatment， both groups experienced reductions in scores on the Short-Form McGill Pain Questionnaire （SF-MPQ）， Visual Analog Scale （VAS）， resistance index （RI）， pulsatility index （PI）， systolic/diastolic ratio （S/D）， prostaglandin E2， and substance P levels （all P < 0.05）. Moreover， the observation group exhibited lower values than the control group in all these aspects （all P < 0.05）. Beta-endorphin levels increased in both groups after treatment， and the levels in the observation group were significantly higher （P < 0.05）. Conclusion Ultrasound-guided myofascial trigger point acupuncture， when combined with conventional Western medicine， significantly enhances clinical outcomes in primary dysmenorrhea， alleviates pain， improves uterine microcirculation， and regulates serum pain-related mediators.

Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation（TEAS） wristband on postoperative nausea and vomiting（PONV） in ambulatory hysteroscopic surgery patients. Methods A total of 250 patients who underwent ambulatory hysteroscopic surgery at our hospital from May 2024 to August 2025 were randomly divided into an observation group and a control group. In the observation group， a TEAS wristband was applied 30 minutes before surgery to deliver continuous stimulation at the unilateral Nei-guan acupoint， and removed after 6 h. The control group wore an identical TEAS wristband but received no electrical stimulation. Follow-up assessments were performed in the post-anesthesia care unit （PACU）， and at 6， 24， and 48 h postoperatively. The incidence and severity of PONV， pain scores， time to first flatus， and TEAS-related adverse reactions were recorded in both groups. Results Compared with the control group， the total incidence of PONV within 48 h postoperatively was significantly lower in the observation group （32.77% vs. 51.24%， P < 0.01）. This beneficial effect was most prominent within the first 6 h postoperatively， during which both the incidence and severity of PONV in the observation group were significantly reduced compared with the control group （P < 0.01）. No significant differences in the incidence and severity of PONV were noted between the two groups after 6 h postoperatively （P > 0.05）. The incidence of vomiting in the observation group was significantly lower than that in the control group during the period from PACU discharge to 6 h postoperatively （P < 0.05）， while no significant intergroup differences were found in other time periods （P > 0.05）. The time to first flatus in the observation group was significantly shorter than that in the control group （P < 0.01）. There were no significant differences in NRS pain scores at various postoperative time points or the usage rate of rescue antiemetic medications between the two groups （P > 0.05）. No serious TEAS-related adverse events occurred during the study period. Conclusion TEAS wristbands can safely and effectively prevent PONV in patients undergoing ambulatory hysteroscopic surgery， shorten the time to first postoperative flatus， and promote rapid postoperative recovery. These findings support the favorable application prospects of TEAS wristbands in ambulatory surgical settings.

Tacrolimus（TAC） serves as a cornerstone immunosuppressive therapy following liver transplantation（LT）. However， its narrow therapeutic window， combined with significant inter- and intra-individual pharmacokinetic variability， often leads to blood concentrations deviating from target range， posing a major challenge for precision dosing. In recent years， with the widespread adoption of therapeutic drug monitoring（TDM）， research on individualized dosing strategies based on TAC blood concentrations has achieved substantial progress. This article provides a systematic review of the latest advances in personalized TAC dosing for adult LT recipients， with a focus on the clinical application value and current status of pharmacogenomics， population pharmacokinetics（PPK）， and machine learning（ML）. It further compares and summarizes the strengths and limitations of different modeling strategies. Studies demonstrate that model-informed precision dosing（MIPD） tools can not only significantly enhance the accuracy of blood concentration predictions but also generate patient-tailored dosing regimens， thereby contributing to the optimization of therapeutic outcomes and long-term prognosis in LT patients.