In 2025， the American Society of Vascular Surgery （SVS） released its first focused update on the 2015 management guidelines for intermittent claudication （IC） in the Journal of Vascular Surgery. This updated guideline set is structured around six key PICO questions， leading to twelve evidence-based recommendations， including two best-practice statements. Significantly， this update is notable because it represents the first incorporation of low-dose rivaroxaban into the management pathway for IC， highlighting the significance of both exercise therapy and pharmacologic treatment as primary strategies. Moreover， the guidelines take a more prudent approach towards indications for revascularization， tibial artery interventions， and the use of drug-coated devices. This article systematically interprets the core updates from the latest guideline text， concentrating on analyzing the strength of the recommendations and the level of evidence backing each suggestion. The objective is to establish a practical framework for clinical decision-making to aid vascular surgeons in their clinical practice.

With the rising incidence of breast cancer， early diagnosis and accurate prognostic evaluation have become pivotal for improving survival rates and optimizing personalized treatment. Multimodal ultrasound， by integrating technologies such as elastography， viscoelastic imaging， contrast-enhanced ultrasound， microflow imaging， and photoacoustic/ultrasound， can provide multi-dimensional information regarding lesion morphology， mechanical properties， blood perfusion， and tissue function in a non-invasive， dynamic， and real-time manner. This compensates for the limitations of conventional grayscale ultrasound in characterizing microvasculature， tissue stiffness， and biomechanical properties. Artificial Intelligence （AI）， particularly deep learning methods， has demonstrated remarkable capabilities in automatic feature extraction from images， multimodal data fusion， and predictive modeling， thereby providing technical support for transforming ultrasound imaging from image acquisition into clinical decision-making support. This paper systematically reviews recent advances in multimodal ultrasound technologies and their integration with AI in the areas of early breast cancer diagnosis， benign-malignant differentiation， prediction of lymph node metastasis， and prediction of molecular subtypes， summarizing both research achievements and existing limitations. Furthermore， it explores the application value of AI in lesion detection， automatic segmentation， radiomics feature fusion， and the construction of prognostic prediction models based on multi-source clinical and imaging data. Key challenges such as model interpretability， data standardization， cross-institution generalization capability， and clinical acceptability are analyzed， and strategic recommendations for promoting clinical translation are proposed. The synergistic development of multimodal ultrasound and AI holds promise for evolving ultrasound from an auxiliary detection tool into a pivotal component of early diagnosis， treatment， and comprehensive management throughout the breast cancer care continuum. However， its widespread application still requires concerted advancement in technological maturity， clinical validation， and policy support.

Objective This study aimed to develop a longitudinal deep learning ultrasound model to achieve two objectives： non-invasive prediction of breast cancer molecular subtypes prior to neoadjuvant therapy（NAT） and identification of the optimal timing for early efficacy assessment during NAT. Methods We enrolled 176 breast cancer patients from Guangzhou First People's Hospital who completed the full NAT course. The cohort was stratified into two analysis subsets： 176 patients for molecular subtyping and 167 for treatment response evaluation. Pathological data and serial ultrasound images were collected. Tumors were categorized into four molecular subtypes via immunohistochemistry. Treatment response was classified as "significant" or "non-significant" based on postoperative Miller-Payne grading. We employed a hybrid U-Net-EfficientNet-B0 architecture integrated with a segmentation-guided attention mechanism （SegAttend-Net）. The model leveraged pre-treatment images and dynamic sonographic feature changes across early NAT stages to predict molecular subtypes and therapeutic response. Confidence intervals were calculated using Clopper-Pearson exact and Bootstrap methods. Performance metrics across treatment cycles were adjusted for multiple comparisons using the Benjamini–Hochberg procedure. Evaluation utilized confusion matrices and longitudinal performance trajectories. Results In molecular subtyping， the model achieved accuracies of 82% （Luminal A）， 88% （Luminal B）， 72% （HER2-overexpressing）， and 96% （triple-negative）. For efficacy prediction， overall accuracy increased from 71% at cycle 1 to 80% at cycle 4， while sensitivity improved markedly from 0.14 to 0.79. The sensitivity improvement between the 3rd and 4th cycles was statistically significant. Conclusions The developed SegAttend-Net model demonstrates efficacy in pre-NAT molecular subtyping and holds clinical value for early efficacy assessment， with optimal predictive performance observed at the fourth treatment cycle.

Objective To investigate the effects of photobiomodulation on the stellate ganglion region in patients undergoing breast cancer surgery， specifically on their postoperative sleep disturbance and pain. Methods A total of 114 patients who were scheduled to undergo modified radical mastectomy for breast cancer under general anesthesia at Baoding First Central Hospital from June 2024 to December 2024 were selected. The participants were aged between 18 and 65 years， with an ASA physical status of Ⅰ - Ⅲ and a body-mass index ranging from 18 - 30 kg/m2. By using a random number table， the patients were randomly allocated into either the control group （Group C） or the intervention group （Group T）. Patients in Group C did not receive any intervention， whereas those in Group T underwent linearly polarized light irradiation over the stellate ganglion region after general anesthesia. The irradiation parameters were set as follows： A power setting of 80%， an irradiation/intermittent cycle of 2 seconds/4 seconds， and a total duration of 40 minutes. Data were recorded for both groups on the day before surgery （D0）， postoperative day 2 （D2）， and postoperative day 5 （D5）， including the Pittsburgh Sleep Quality Index （PSQI） score， total sleep time （TST）， sleep efficiency （SE）， and the number of nocturnal awakenings （NA）. Additionally， the Visual Analog Scale （VAS） scores on D2， the number of effective patient-controlled analgesia （PCA） presses within 48 hours after surgery， the incidence of postoperative adverse events， and patient satisfaction were compared between the two groups. Results Patients in the T group showed significantly lower PSQI scores and a lower incidence of post-operative sleep disorder （PSD） on the D2 and D5 compared to those in Group C （P < 0.001）. In comparison with Group C， the T group had significantly longer TST and higher SE on D2 and D5 （P < 0.001）， as well as a significantly reduced NA （P < 0.001）. When compared to Group C， the T group presented a significantly lower VAS score and a notable reduction in the total number of PCA compressions on D2 （all P < 0.001）. Moreover， the incidence of nausea and vomiting was significantly lower in the T group than in Group C （P < 0.001）， whereas patient satisfaction scores were significantly higher （P < 0.001）. Conclusion Photobiomodulation applied to the stellate ganglion region can reduce the incidence of PSD， improve sleep quality， alleviate pain， and enhance patient satisfaction in breast cancer patients， while maintaining a favorable safety profile.

Objective To compare the clinical outcomes of the partial latissimus dorsi musculocutaneous （pLD-MC） flap and the lateral thoracic artery perforator （LTAP） flap in volume replacement breast-conserving surgery. Methods A total of 49 patients who underwent volume replacement breast-conserving surgery in the Department of Breast Surgery at the Affiliated Tumor Hospital of Guangxi Medical University between July 2020 and July 2024 were included in this study. Based on the type of flap used， the patients were divided into an LTAP group （n=29） and a pLD-MC group （n=20）. Postoperative complication rates， operative time， and BREAST-Q scores were compared between the two groups. Disease-free survival （DFS） and overall survival （OS） was analyzed using the Log-rank test. Results The operative time in the LTAP group was significantly shorter than that in the pLD-MC group （P < 0.05）. Postoperative BREAST-Q scores showed that the LTAP group achieved significantly higher scores in physical well-being and satisfaction with surgical outcomes compared to the pLD-MC group （P < 0.05）. The complication rate was 3.4% （1/29） in the LTAP group and 10.0% （2/20） in the pLD-MC group， with no statistically significant difference between the two groups （P > 0.05）. Analysis of DFS and OS also revealed no statistically significant differences between the groups （P > 0.05）. Conclusion For tumors located in the outer quadrant of the breast， when the lateral thoracic artery perforator is anatomically identifiable and the lateral chest wall can provide sufficient tissue volume， the LTAP flap is associated with a shorter operative time and superior physical well-being scores postoperatively， while maintaining comparable safety profiles to the pLD-MC flap. Therefore， the LTAP flap may be considered the preferred option for volume replacement in breast-conserving surgery.

As a crucial hub that links immune dysregulation and tumor progression， tryptophan metabolism has emerged as a transdisciplinary frontier in cancer research. This review initially delineates the functional heterogeneity of tryptophan-catabolizing enzymes and their molecular pathways that govern immune cell dynamics in the tumor microenvironment （TME） through dual mechanisms： tryptophan depletion and kynurenine （KYN） accumulation. Subsequently， by concentrating on the metabolic characteristics of breast cancer， colorectal cancer， glioma， and epithelial ovarian cancer， we systematically analyze the histotype-specific reprogramming of tryptophan metabolism. Finally， we assess the regulatory effects of traditional Chinese medicine （TCM） active ingredients （monomers and compound formulas） on reshaping the TME by targeting tryptophan metabolic pathways. This review aims to offer mechanistic and translational insights for surmounting tumor metabolic adaptation barriers and enhancing immunotherapy efficacy.

Objective To investigate the role and underlying mechanism of nicotinamide （NAM） in promoting cervical cancer malignant progression and regulating PD-L1 expression via activation of the NAMPT/NAD? metabolic axis. Methods Thirty pairs of cervical cancer tissues and adjacent normal tissues were collected to analyze the expression levels of nicotinamide phosphoribosyltransferase （NAMPT） and programmed death-ligand 1 （PD-L1）. Quantitative real-time polymerase chain reaction （qRT-PCR） and Western blotting were employed to quantify their transcriptional and protein levels， respectively. The specific NAMPT inhibitor FK866 was utilized to block NAMPT activity and verify its pivotal role in metabolic-immune regulation. Furthermore， CCK-8， colony formation， wound healing， and Transwell assays were conducted to evaluate cervical cancer cell proliferation， migration， and invasion capacities. Results Clinical sample analysis revealed that both NAMPT and PD-L1 were significantly upregulated in cervical cancer tissues compared to adjacent normal tissues （P < 0.05）. In vitro experiments demonstrated that exogenous NAM treatment upregulated NAMPT and PD-L1 expression in cervical cancer cells in a concentration-dependent manner （P < 0.05）， while significantly enhancing cell proliferation， migration， and invasion （P < 0.05）. Conversely， treatment with FK866 specifically abrogated these NAM-induced effects （P < 0.05） and reversed the upregulation of PD-L1. Conclusion NAM activates the NAMPT/NAD⁺ metabolic axis to upregulate PD-L1 expression， thereby promoting the malignant biological behaviors of cervical cancer cells. The coordinated upregulation of NAMPT and PD-L1 suggests an intrinsic regulatory link within this metabolic-immune axis.

Objective To investigate the prognostic significance of p16 protein expression in patients with locally advanced laryngeal and hypopharyngeal carcinoma who are undergoing comprehensive treatment. Methods A retrospective analysis was carried out on the clinical data of 118 patients diagnosed with locally advanced （Stage Ⅲ - ⅣA） laryngeal or hypopharyngeal carcinoma， who underwent comprehensive treatment at our institution from January 2021 to January 2024. The p16 protein expression was detected via immunohistochemistry. Patients were stratified according to their p16 protein expression into positive and negative groups to compare their clinicopathological characteristics. The Kaplan-Meier method was employed to plot survival curves and compute overall survival （OS） and progression-free survival （PFS）， and inter-group comparisons were conducted using the Log-rank test. Independent prognostic factors were identified by means of a Cox proportional hazards regression model. Results The p16-positive rate was 26.27% （31 out of 118）. When compared with the p16-negative group， the p16-positive group exhibited a significantly higher proportion of patients with Stage IV disease， poor differentiation， or lymph node metastasis （all P < 0.05）. Patients in the p16-negative group had a shorter median overall survival （OS） of 36.90 months （95%CI： 33.29 - 40.51）， whereas the median OS was not reached in the p16-positive group （Log-rank P = 0.002）. The p16-positive group also demonstrated a superior median progression-free survival （PFS） ［39.12 months （95%CI： 35.88 - 42.39） compared to 34.68 months （95%CI： 31.56 - 37.81）， Log-rank χ2 = 9.347， P = 0.002］. In the concurrent chemoradiotherapy （CCRT） subgroup （n = 66）， p16-positive patients had a better median OS than p16-negative patients （median OS not reached versus 37.5 months， log-rank χ2 = 8.854， P = 0.003）. Multivariate Cox regression analysis revealed that smoking for ≥ 10 years， alcohol consumption ≥ 40 g/day， lymph node metastasis， tumor differentiation grade， and p16 protein expression were independent prognostic factors influencing both OS and PFS. Conclusion The p16 protein expression serves as an independent prognostic factor in locally advanced laryngeal and hypopharyngeal carcinoma. Conducting tests for the p16 protein expression facilitates prognostic stratification and offers a reference for individualized treatment.

Objective To investigate the effects of different hepatic blood flow occlusion methods on the serum levels of high mobility group protein B1 （HMGB1）， thymidine kinase 1 （TK1）， H2A histone family member X （H2AFX）， and the immune function in patients with primary liver cancer during laparoscopic left hemihepatectomy. Methods A total of 141 patients diagnosed with primary hepatocellular carcinoma who underwent laparoscopic left hemihepatectomy at the Rehabilitation University Qingdao Central Hospital from January 2022 to May 2023 were selected. According to the actual hepatic blood-flow occlusion technique employed during the surgery， they were divided into three groups： Group A （Pringle maneuver， n = 57）， Group B （intrahepatic sheath dissection method， n = 45）， and Group C （combined venous occlusion method， n = 39）. All three groups were followed up post-operatively until May 31， 2025， or until the patient's death. Perioperative indicators were compared among the groups. Liver function ［alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， prealbumin （PA）， alkaline phosphatase （ALP）］， immune function （CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺ ratio）， and serum levels of HMGB1， TK1， and H2AFX were evaluated preoperatively and on the third postoperative day. Moreover， the incidence of postoperative complications during the follow-up period， overall survival （OS）， and progression-free survival （PFS） were compared among the three groups. Results Significant differences were detected among the three groups in terms of intraoperative blood loss and postoperative recovery times （including time to first flatus， ambulation， initiation of liquid diet， and hospital stay）. Group C exhibited the most favorable outcomes， followed by Group B， and then Group A （C < B < A， P < 0.05）. When compared to preoperative levels， on the third postoperative day， the levels of ALT， AST， TBIL， ALP， and CD8⁺ increased in all groups. Group A had the highest levels， followed by Group B， and Group C had the lowest （A > B > C， P < 0.05）. Conversely， the levels of PA， CD3⁺， CD4⁺， and the CD4⁺/CD8⁺ ratio decreased. Group A had the lowest values， followed by Group B， and Group C had the highest （A < B < C， P < 0.05）. Compared with preoperative levels， the serum levels of HMGB1， TK1， and H2AFX increased on the third postoperative day in all groups. The smallest increase was observed in Group C， followed by Group B， and the greatest increase was in Group A （C < B < A， P < 0.05）. During the follow-up period， the complication rate in Group C was significantly lower than those in Groups A and B （P < 0.05）， while there was no significant difference between Groups A and B （P > 0.05）. A statistically significant difference in overall OS was identified among the three groups （χ² = 7.189， P = 0.028）. Specifically， Group C had a superior OS compared to Group A （HR = 0.517， 95%CI： 0.325 - 0.824） and Group B （HR = 0.621， 95%CI： 0.387 - 0.996）. Similarly， a statistically significant difference in PFS was found （χ² = 7.493， P = 0.024）， with Group C showing better PFS than Group A （HR = 0.509， 95%CI： 0.319 - 0.814） and Group B （HR = 0.644， 95%CI： 0.400 - 1.038）. Conclusions Compared with the conventional Pringle maneuver or the intrahepatic sheath dissection method used alone， the combined venous occlusion method can more effectively suppress the postoperative elevation of serum HMGB1， TK1， and H2AFX levels induced by laparoscopic left hemihepatectomy. It can mitigate liver function impairment and immunological dysfunction， reduce postoperative complications， and achieve superior short-term efficacy and long-term survival outcomes.

Objective To compare perioperative clinical characteristics and hemodynamic stability between patients with pheochromocytoma （PCC） and abdominal paraganglioma （PGL）， and to provide evidence-based recommendations for individualized perioperative management. Methods This retrospective study analyzed clinical data from 692 patients who underwent surgical resection at Peking University First Hospital between January 2005 and December 2023. Patients were stratified into the PCC group （n = 535） and the abdominal PGL group （n = 157）. Data were collected using a standardized protocol； missing values were addressed via multiple imputation. Multivariate regression analysis was employed to control for confounding factors. Comparisons were made regarding preoperative baseline characteristics， preparation protocols， intraoperative metrics， and postoperative recovery outcomes. Results Compared to the PCC group， patients with PGL presented with larger tumor diameters （P < 0.001）， higher preoperative systolic （P = 0.019） and diastolic blood pressure （P = 0.023）， elevated plasma norepinephrine levels （P = 0.044）， and reduced plasma metanephrine levels （P = 0.006）. PGL patients required a longer duration of α-blockade （P = 0.015） and showed a higher utilization rate of non-selective α-blockers. Intraoperatively， the PGL group underwent open surgery more frequently （P < 0.001）， experienced longer operative times （P < 0.001）， exhibited higher modified hemodynamic instability scores （P < 0.001）， and sustained greater blood loss （P < 0.001）. Postoperatively， the PGL group demonstrated higher rates of ICU admission and mechanical ventilation， along with prolonged ICU stays， ventilation duration， and hospitalization （all P < 0.05）. No significant difference was observed in the incidence of major complications （P = 0.343）. Multivariate analysis identified PGL as an independent risk factor for intraoperative hemodynamic instability. Conclusion PGL patients face greater perioperative challenges than PCC patients， characterized by inferior hemodynamic stability， increased blood loss， and delayed recovery.

Objective To develop a nomogram model based on clinical characteristics， intratumoral ultrasound features， and peritumoral ultrasound features for preoperative prediction of the risk of central lymph node metastasis （CLNM） in papillary thyroid microcarcinoma （PTMC）， and to evaluate its predictive performance and clinical applicability. Methods A total of 534 papillary thyroid microcarcinoma （PTMC） cases that underwent surgical treatment at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2022 to April 2023 were retrospectively included. The cases were randomly allocated in a 7：3 ratio to a training cohort （n = 373） and a validation cohort （n = 161） using computer-generated random numbers. The participants were categorized into central lymph node metastasis （CLNM）-positive and CLNM-negative groups according to postoperative pathological findings. Clinical data and ultrasound imaging features were gathered. Independent risk factors for CLNM were determined using multivariable logistic regression analysis， and a predictive nomogram was developed based on these variables. The performance of the model was evaluated in terms of discrimination， calibration， and clinical utility using receiver operating characteristic （ROC） curves， area under the curve （AUC）， calibration plots， and decision curve analysis （DCA）. Results Multivariate analysis demonstrated that male sex， age less than 46.5 years， tumor heterogeneity， tumor contact with the thyroid capsule equal to or greater than 50%， and peritumoral hyperechoic changes were independent predictors of central lymph node metastasis （CLNM） （P < 0.05）. The nomogram model attained an area under the curve （AUC） of 0.857 （95%CI： 0.820 - 0.894） in the training cohort， with a sensitivity of 79.0% and a specificity of 80.0%. In the validation cohort， the AUC was 0.840 （95%CI： 0.778 - 0.902）， with a sensitivity of 94.1% and a specificity of 66.7%. Calibration plots showed good agreement between predicted and observed probabilities， and decision curve analysis （DCA） indicated a favorable net clinical benefit across a range of threshold probabilities. Conclusions The proposed nomogram， which integrates gender， age， and key ultrasonographic features， can effectively predict the risk of central lymph node metastasis （CLNM） in patients with papillary thyroid microcarcinoma （PTMC） pre-operatively. It demonstrates strong discriminative ability and calibration. This model may serve as a valuable tool for guiding individualized surgical decision-making.

Alzheimer's disease （AD） is a progressive neurodegenerative disorder with currently limited therapeutic options. Early diagnosis is pivotal for delaying disease progression； however， traditional diagnostic methods remain constrained by significant subjectivity and insufficient accuracy， particularly in early-stage or atypical cases. Against this backdrop， this review explores the applications， challenges， and clinical translation pathways of multimodal artificial intelligence （AI） in the early diagnosis of AD. By integrating multidimensional data-including neuroimaging， biomarkers， and clinical assessments-multimodal AI can uncover latent disease patterns， offering a novel， highly sensitive， and objective tool for the early identification and differential diagnosis of AD. Nevertheless， several barriers hinder its clinical translation， including the complexity of AD pathophysiology， data heterogeneity， and the lack of model interpretability. Future efforts must prioritize multidisciplinary collaboration， advance research into explainable AI， and facilitate seamless integration into clinical workflows. Ultimately， these strides will pave the way for precision diagnosis and personalized treatment of AD.

Vascular aging， characterized by increased arterial stiffness， vascular wall remodeling， and endothelial dysfunction， is a crucial factor in the occurrence and development of cardiovascular diseases， such as hypertension， atherosclerosis， and cardiac insufficiency. Palmitoylation， a post-translational modification of proteins that involves the addition of palmitic acid， plays a pivotal role in vascular aging. Protein palmitoylation exerts a regulatory effect on the process of vascular aging by modulating the membrane localization， stability， and signal transduction of key proteins in vascular cells， and by participating in oxidative stress， inflammation amplification， impaired endothelial barrier function， abnormal transformation of smooth muscle phenotype， autophagy， and protein homeostasis imbalance. These effects are interwoven and influence the occurrence and development of various cardiovascular-related disease events. Protein palmitoylation is of great significance in vascular aging and offers an important strategy for the prevention and treatment of related cardiovascular events.

Objective To explore the clinical efficacy of high-dose tofacitinib in combination with methotrexate （MTX） for patients with refractory rheumatoid arthritis （RRA）， and its influence on serum anti-cyclic citrullinated peptide antibody （anti-CCP） and helper T cell 17 （Th17） -related cytokines. Methods The random number table method was used to divide 160 RRA patients treated in Qingdao Traditional Chinese Medicine Hospital from January 2023 to June 2025 into the high-dose group （54 cases）， the low-dose group （53 cases）， and the control group （53 cases）. These patients were respectively treated with high-dose tofacitinib （5 mg/time， twice a day） + MTX （10 mg/time， once a week）， low-dose tofacitinib （5 mg/time， once a day） + MTX （10 mg/time， once a week）， and Etanercept （25 mg/time， twice a week） + MTX （10 mg/time， once a week）， all for a 24-week treatment period. The clinical efficacy was evaluated according to the standards of the American College of Rheumatology （ACR） as the primary endpoint of the study. The secondary endpoints included changes in clinical symptoms， biochemical indicators ［erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）］， serum anti-CCP， Th17-related cytokines， Janus kinase （JAK） 3， signal transducer and activator of transcription （STAT） 3， and safety before and after treatment. Results The proportions of patients achieving ACR50 （76.92% vs. 50.00%） and ACR70 （48.08% vs. 24.00%） in the high-dose group were markedly higher than those in the control group （P < 0.05）. When compared with the pre-treatment state， the clinical symptom-related indicators， serum ESR， CRP， anti-CCP， rheumatoid factor （RF）， Th17 and its related cytokines， JAK3， and STAT3 levels in all three groups decreased significantly after treatment （P < 0.05）. Moreover， the above-mentioned indicators in the high-dose group were significantly lower than those in the other two groups after treatment （P < 0.05）. After treatment in the low-dose group， the pain visual analog score， the disease activity score based on ESR of 28 joints， serum Th17 and its related cytokines， JAK3， and STAT3 levels were significantly lower than those in the control group （P < 0.05）. There was no statistically significant difference in the incidence rates of adverse reactions among the three groups （25.00% vs. 15.38% vs. 20.00%） （P > 0.05）. Conclusions The efficacy of high-dose tofacitinib is superior to that of low-dose tofacitinib or etanercept in combination with MTX in the treatment of RRA. It can alleviate clinical symptoms， reduce the levels of serum anti-CCP， Th17-related cytokines， and JAK3/STAT3， without significantly increasing adverse reactions.

Objective To investigate the impact of galectin-3 （Gal-3） deficiency on lipid metabolism in human immortalized keratinocytes and its role in psoriasis-associated pathology. Methods A combined in vivo and in vitro approach was employed. For the in vivo study， a psoriasis-like dermatitis model was induced by imiquimod （IMQ） in both Gal-3 wild-type （Gal3^+/+） and whole-body Gal-3 knockout （Gal3^-/-） mice. Skin lesions were systematically examined for ultrastructural pathological changes and lipid accumulation. For the in vitro study， Gal-3 knockdown and overexpression were performed in human immortalized keratinocytes （HaCaT cells）. The effects of Gal-3 modulation on psoriasis-related inflammation and lipid metabolism were evaluated using Western blotting， RT-qPCR， EdU proliferation assays， Oil Red O staining， and immunofluorescence. Results Lipid droplets were markedly enriched in the skin lesions of Gal3^-/- mice， showing significantly greater accumulation compared to Gal3^+/+ controls. In HaCaT cells， Gal-3 knockdown significantly upregulated the expression of inflammatory factors IL-17A， TNF-α， and S100A8 （P < 0.001）， increased the proportion of proliferating cells （P < 0.05）， promoted intracellular lipid deposition， and downregulated key lipid metabolism-related genes， including PPARγ （P < 0.05）， FABP4， and E-FABP （P < 0.01）. Conversely， Gal-3 overexpression reversed these alterations in lipid metabolic markers （P < 0.05）. Furthermore， treatment with the PPARγ agonist rosiglitazone （RGZ） alleviated the lipid accumulation induced by Gal-3 deficiency. Mechanistically， Gal-3 deficiency did not affect the nuclear localization of PPARγ， nor was any cytoplasmic co-localization between the two proteins observed. Conclusion Gal-3 deficiency exacerbates psoriasis-associated lipid metabolic disturbances by indirectly regulating the PPARγ signaling pathway， leading to aberrant lipid metabolism in keratinocytes. These findings suggest that Gal-3 plays a protective role in maintaining lipid homeostasis during psoriatic inflammation.

Objective To explore the high-risk factors of senile type 2 diabetes complicated with osteoarthritis， as well as the levels of bone morphogenetic protein-2 （BMP-2）， Galectin-3， and cartilage oligomeric matrix protein （COMP）. Methods The study subjects were selected from elderly patients with type 2 diabetes who were admitted to our hospital during the enrollment period from June 2022 to June 2025. A total of 370 cases were included. Based on whether the selected patients were complicated with osteoarthritis， they were divided into the combined group （163 cases） and the non-combined group （207 cases）. The clinical data， as well as the levels of BMP-2， Galectin-3， and COMP， of the two groups were compared. Multivariate Logistic regression analysis was employed to analyze the risk factors of elderly type 2 diabetes complicated with osteoarthritis. The receiver operating characteristic （ROC） curve was utilized to analyze the predictive value of serum BMP-2， Galectin-3， and COMP for elderly type 2 diabetes with osteoarthritis. Moreover， the regression equation of serum BMP-2， Galectin-3， and COMP in predicting elderly type 2 diabetes patients with osteoarthritis was constructed. The levels of BMP-2， Galectin-3， and COMP under different disease conditions were compared. Results The proportions of females， individuals with a smoking history， and those with hypertension in the combined group were higher than those in the non-combined group. The combined group was older and had a longer duration of type 2 diabetes （P < 0.05）. The level of serum BMP-2 in the combined group was lower than that in the non-combined group， while the levels of serum Galectin-3 and COMP were higher than those in the non-combined group （P < 0.05）. Multivariate logistic regression analysis showed that being female， having a smoking history， having hypertension， being of an older age， having a long duration of type 2 diabetes， having a low level of serum BMP-2， having a high level of serum Galectin-3， and having a high level of serum COMP were independent risk factors for elderly type 2 diabetes with osteoarthritis （OR = 3.043， 3.758， 2.680， 2.472， 2.155， 2.578， 2.375， 2.010， P < 0.05）. A regression equation was constructed： logit （P）= - 8.012 + sex × 1.113 + smoking history × 1.324 + hypertension × 0.986 + age × 0.905 + type 2 diabetes duration × 0.768 + serum BMP-2 level × 0.947 + serum Galectin-3 level × 0.865 + serum COMP level × 0.698. The construction of a logistic multiple regression diagnostic equation is effective. Based on the diagnostic probability logit （P）， an ROC curve was plotted to predict elderly patients with type 2 diabetes and osteoarthritis. When logit （P） > 0.246， the area under the curve （AUC） value was 0.884， the 95% confidence interval （CI） was 0.847 - 0.915， and the χ² value was 22.578. The diagnostic sensitivity and specificity were 82.21% and 80.19%， respectively. The AUC of serum BMP-2， Galectin-3， COMP， and combined detection for predicting elderly patients with type 2 diabetes and osteoarthritis were 0.793， 0.721， 0.792， and 0.843， respectively. The diagnostic sensitivities were 72.39%， 72.39%， 73.62%， and 91.41%， respectively， and the specificities were 73.91%， 62.32%， 77.29%， and 66.18%， respectively. The AUC of the combined detection was the highest （P < 0.05）. The level of serum BMP-2 in the severe group was lower than that in the mild and moderate groups， and the level in the moderate group was lower than that in the mild group. The levels of serum Galectin-3 and COMP in the severe group were higher than those in the mild and moderate groups， and the level in the moderate group was higher than that in the mild group （P < 0.05）. Conclusions Female gender， a history of smoking， hypertension， advanced age， a long duration of type 2 diabetes， a low level of serum BMP-2， a high level of serum Galectin-3， and a high level of serum COMP were identified as independent risk factors for type 2 diabetes accompanied by osteoarthritis in the elderly. Serum BMP-2， Galectin-3， and COMP were， to some extent， associated with the severity of osteoarthritis. They could be utilized for the auxiliary diagnosis of the onset of type 2 diabetes complicated by osteoarthritis in the elderly and the assessment of osteoarthritis. The combined detection of these three markers had the highest predictive value for type 2 diabetes complicated by osteoarthritis in the elderly.

Objective To analyze the age-related changes in muscle mass within the study population aged 6 to 70 years in Guangzhou， and to explore the muscle development patterns among individuals with different weight statuses. Methods A cross-sectional study was carried out， encompassing 3，316 residents aged 6–70 years in Guangzhou. Dual-energy X-ray absorptiometry was employed to measure muscle mass. Subsequently， the skeletal muscle mass index （SMMI） and appendicular skeletal muscle mass index （ASMMI） were computed after adjusting for body height. The LMS method was utilized to fit the sex-and age-specific percentile curves of muscle indices， and a stratified analysis was performed according to body weight status. Results Muscle mass in males was greater than that in females across all age groups. Both genders showed rapid SMMI growth between the ages of 6 and 12 years， with average annual growth rates of 4.6% for males and 3.9% for females. For males， the growth rate of SMMI slowed down after the age of 12 years， with an average annual growth of 1.9% from 13 to 19 years， and then entered a slow-growth phase after the age of 20 years， reaching its peak at the age of 43 years. For females， SMMI increased by an average of 0.8% per year from 13 to 19 years， reached its peak at the age of 47 years， and further decreased after the age of 55 years. The age-related changes in ASMMI were similar to those of SMMI， although the peak ASMMI occurred at an earlier age. When stratified by body weight status， individuals with obesity had the highest peak SMMI but the most rapid decline after the peak age. In contrast， underweight individuals had the lowest muscle mass peak but a much slower decline trend. Conclusions Results indicate a distinct age- and sex-specific pattern of muscle mass development within the study population. The decline of muscle mass during middle and old age exhibits site-specific characteristics， with appendicular skeletal muscle experiencing the earliest decline. The changes in muscle mass among obese individuals follow a pattern of “high peak value – rapid decline”. Owing to the non-random sampling design， the generalizability of the findings is restricted. Nevertheless， the findings can offer preliminary evidence for promoting muscle health.

Objective To analyze the significance of the combined detection of anti-double-stranded DNA （anti-dsDNA） antibody quantification， antinuclear antibody （ANA）， and anti-neutrophil cytoplasmic antibody （ANCA） in the diagnosis and assessment of the severity of systemic lupus erythematosus （SLE）. Methods A total of 154 SLE patients （SLE group， comprising 115 active cases and 39 inactive cases） who were admitted to the Department of Rheumatology and Immunology， the First Affiliated Hospital of Anhui Medical University between May and December 2024， 100 non-SLE patients （non-SLE group）， and 50 healthy volunteers （control group） were simultaneously enrolled in this study. Clinical data as well as the test results of anti-dsDNA， ANA， and ANCA were compared across the groups. The correlation between the positivity of anti-dsDNA， ANA， and ANCA and renal damage， along with the SLE disease activity index （SLEDAI） score in active SLE patients， was analyzed. Binary logistic regression was employed to identify the risk factors for active SLE， and receiver operating characteristic （ROC） curves were plotted to assess the value of anti-dsDNA， ANA， and ANCA in evaluating active SLE. Results The positive rates of anti-dsDNA， ANA， and ANCA in the SLE group were 55.84% （86 out of 154）， 100% （154 out of 154）， and 22.08% （34 out of 154）， respectively. Among the individuals testing positive for ANA， the predominant fluorescent patterns in SLE cases were the homogeneous pattern （42.85%， 66 out of 154）， the nuclear granular pattern （23.38%， 36 out of 154）， and the related mixed pattern （29.22%， 45 out of 154）. The positive rates of anti-dsDNA and ANCA in the SLE group were significantly higher than those in the non-SLE group （P < 0.05）. The incidence of renal damage， SLEDAI scores， IgA， IgM， and IgG levels， as well as the positive rates of anti-dsDNA and ANCA， were notably higher in patients with active SLE compared to those with inactive SLE， whereas the serum complement C3 and C4 levels were lower in active patients （P < 0.05）. In patients with active SLE， the positive rates of anti-dsDNA， ANA， and ANCA were positively and significantly correlated with renal damage and SLEDAI score （P < 0.05）. SLEDAI score， anti-dsDNA positivity， and ANCA positivity were identified as independent risk factors for active SLE （P < 0.05）. The area under the curve （AUC） of the combination of SLEDAI score， anti-dsDNA， and ANCA for predicting active SLE was 0.819 （95%CI： 0.738 ~ 0.900）， which was significantly greater than that of each indicator alone （Z = 2.291， 2.638， 4.848， P < 0.05）. Conclusion Anti-dsDNA， ANA， and ANCA are highly valuable for detection in patients with SLE. Specifically， anti-dsDNA and ANCA are closely associated with disease activity and renal damage. Conducting tests on these markers can effectively assist in the evaluation of the patients'condition.

Objective To explore the efficacy and safety of ultrasound-guided two-point pre-localization-assisted axillary vein puncture in cardiac pacemaker implantation. Methods Sixty-three patients who needed cardiac pacemaker implantation between May 2022 and December 2023 were included in the study and randomly allocated into a conventional surgery group （n = 31） and an ultrasound two-point pre-localization group （n = 32）. The conventional surgery group underwent preparation following routine surgical procedures. In the ultrasound two-point pre-localization group， preoperative ultrasound was employed to conduct a two-point localization of the axillary vein. One point was designated as the skin puncture site， and the other indicated the puncture direction. Additionally， the ultrasound probe was positioned at an angle of 30° to the skin to measure the puncture depth， thus determining the puncture site， direction， and depth. During the surgery， ultrasound was not utilized， and the puncture was carried out based on the preoperative localization. The differences in parameters such as the first-attempt puncture success rate， puncture time， number of punctures， X-ray exposure time and dose， surgical time， pacing threshold， sensitivity， and impedance were compared to evaluate the efficacy. Safety was evaluated by comparing the incidence of pneumothorax， hemothorax， arterial injury， pocket hematoma， infection， electrode dislodgement， and wear. Results There were no statistically significant differences in baseline clinical characteristics， CIED implantation indications， and device types between the two groups （P > 0.05）. When compared with the conventional surgery group， the ultrasound two-point pre-localization group exhibited a higher first-attempt puncture success rate （38.2% vs. 63.2%， P = 0.008）， a shorter puncture time ［36.0（17.5， 79.0） s vs. 20.0（9.0， 34.0） s， P = 0.004］， fewer puncture attempts ［2（1， 4） vs. 1（1， 3）， P = 0.005］， less X-ray exposure time and dose ［12.4（7.1， 20.3） min vs. 6.2（5.5， 9.4） min， P = 0.003； 60.0（24.7， 168.1） mGy vs. 29.0（16.6， 46.4） mGy， P = 0.010］. However， there was no significant difference in the total surgical time ［（149.19 ± 41.81） min vs. （131.90 ± 40.05） min， P = 0.099］. Additionally， there were no statistically significant differences in pacemaker parameters and adverse event rates between the two groups（P > 0.05） Conclusion Ultrasound-guided two-point pre-localization assisted axillary vein puncture is a safe， effective， and highly practical method in cardiac pacemaker implantation.

Objective To evaluate the efficacy of Sivelestat Sodium in mitigating pulmonary injury and inflammatory responses in pediatric patients with congenital heart disease （CHD） following cardiopulmonary bypass （CPB）-assisted open-heart surgery. Methods This randomized controlled trial enrolled 100 children undergoing CPB-assisted CHD surgery at the Department of Pediatric Critical Care Medicine， Guizhou Hospital of Shanghai Children's Medical Center from January to June 2024. Patients were randomly assigned to receive either Sivelestat Sodium （treatment group， n = 50） or normal saline （control group， n = 50）. Baseline characteristics， inflammatory biomarkers， and cardiopulmonary function parameters were dynamically assessed at 0， 24， and 72 hours postoperatively. Results No statistically significant differences were observed between the two groups regarding baseline characteristics， clinical parameters， inflammatory markers， or cardiopulmonary function at 0 and 24 hours postoperatively. Compared with the control group， at 72 hours postoperatively， the treatment group exhibited significantly lower values in the following parameters： lung ultrasound score ［5.0 （4.0， 6.0） vs. 7 （5.5， 8.5）， P < 0.05］， white blood cell count ［8.8 （7.8， 11.1） ×10?/L vs. 11.1 （9.7， 12.0） ×10?/L， P < 0.05］， neutrophil count ［5.4 （4.1， 8.6） ×10?/L vs. 7.3 （6.2， 9.9） ×10?/L， P < 0.05］， interleukin-6 ［35.2 （28.4， 45.6） pg/mL vs. 52.8 （41.3， 68.9） pg/mL， P < 0.05］， C-reactive protein ［21 （12， 38） mg/L vs. 32 （18， 40） mg/L， P < 0.05］， procalcitonin ［1.46 （0.60， 2.29） ng/mL vs. 2.51 （1.80， 3.64） ng/mL， P < 0.05］， and tumor necrosis factor-α ［9.3 （6.4， 12.3） pg/mL vs. 11.7 （9.7， 16.0） pg/mL， P < 0.05］. The PaO?/FiO? ratio was significantly higher in the treatment group at 72 hours postoperatively ［404 （353， 553） mmHg vs. 355 （300， 417） mmHg， P < 0.05］. No statistically significant differences were found between groups at 72 hours for interleukin-10， left ventricular ejection fraction， velocity time integral， or N-terminal pro-B-type natriuretic peptide. Regarding clinical outcomes， the duration of invasive mechanical ventilation was significantly shorter in the treatment group compared with the control group （P = 0.019）. Conclusion Sivelestat Sodium effectively attenuates postoperative pulmonary dysfunction in children with CHD undergoing CPB-assisted surgery by suppressing neutrophil-mediated inflammatory cascades， resulting in reduced ventilator dependence and improved early recovery.

Objective To investigate the impact of transcutaneous auricular vagus nerve stimulation （taVNS） on the postoperative recovery of the gastrointestinal system in patients who have undergone laparoscopic hepatobiliary surgery. Methods A total of 170 patients undergoing elective laparoscopic hepatobiliary surgery were randomly allocated to the taVNS group （n = 85） and the control group （n = 85）. Participants received three consecutive 30-minute sessions of active stimulation or sham stimulation at three time points： （1） one day before the operation， （2） 30 minutes before induction， and （3） upon arrival at the recovery room after the operation. The following parameters were recorded： the time to the first postoperative flatus and bowel movement； Intake-Nausea-Emesis-Examination-Duration （I-FEED） scores on the first， second， and third postoperative days； the incidence of nausea and vomiting within 48 hours after the operation； the pain numerical rating scale （NRS） immediately after extubation and on the first， second， and third postoperative days； the Athens Insomnia Scale （AIS） and the Hospital Anxiety and Depression Scale （HADS） on the first， second， and third postoperative days； the early postoperative quality of recovery （QoR-15）， and the occurrence of postoperative adverse reactions. Results Compared with the control group， the taVNS group exhibited significantly shorter durations until the first postoperative flatus and bowel movement， a reduction in postoperative I-FEED scores， lower NRS scores immediately after extubation and on postoperative day 1， a decreased incidence of postoperative nausea and vomiting at 48 hours， and an improvement in QoR-15 scores on postoperative day 1 （P < 0.05）. No statistically significant differences were detected between the groups in postoperative AIS scores or HADS scores （P > 0.05）. Conclusion TaVNS enhances postoperative gastrointestinal recovery in patients undergoing laparoscopic hepatobiliary surgery， mitigates postoperative nausea and vomiting， alleviates postoperative pain， and facilitates recovery.

Objective To investigate the shaping performance and safety of the WaveOne Gold single-file system in the instrumentation of curved root canals using three-dimensional （3D） digital assessment. Methods From March 2021 to March 2025， 84 extracted single-rooted permanent teeth with canal curvature angles ranging from 20° to 40°， confirmed by cone-beam computed tomography （CBCT）， were selected. The specimens were randomly assigned to two groups： a control group （n = 42）， prepared with the ProTaper Universal system， and an experimental group （n = 42）， prepared with the WaveOne Gold single-file system. Preparation time， canal transportation （at 1， 3， and 5 mm from the apex）， changes in canal volume and surface area， alteration in canal curvature， and apically extruded debris were compared between the groups. Results The preparation time was significantly shorter in the experimental group compared to the control group （P < 0.05）. Canal transportation values at 1， 3， and 5 mm from the apex were significantly lower in the experimental group （P < 0.05）. Furthermore， the increases in canal volume and surface area were significantly less pronounced in the experimental group （P < 0.05）. While no significant difference in initial canal curvature was observed between the groups （P > 0.05）， both groups exhibited a reduction in curvature after instrumentation； however， this change was significantly smaller in the experimental group （P < 0.05）. Additionally， the amount of apically extruded debris was significantly lower in the experimental group than in the control group （P < 0.05）. Conclusion Based on 3D digital evaluation， the WaveOne Gold single-file system demonstrates superior efficiency and safety for instrumenting curved root canals. It significantly reduces preparation time， minimizes canal transportation and apical debris extrusion， and better preserves the original canal curvature compared to the ProTaper Universal system.

Objective To explore the application value of three-dimensional reconstruction of CT angiography （CTA） in guiding the localization and design of free flap perforations for patients with skin and soft tissue defects of the extremities. Methods The clinical data of 51 patients with limb and soft-tissue defects who underwent free flap transplantation repair at the 971 Hospital of the Navy from March 2022 to June 2025 were retrospectively collected. All patients underwent CTA examination prior to the operation. Vascular imaging and perforation location analysis were performed under the guidance of three-dimensional reconstruction. Based on this， flap design was carried out to assess the accuracy of perforation vessel location， flap survival rate， first-stage wound healing rate， limb sensation and function recovery， as well as the occurrence of adverse reactions. Results The positioning of perforated vessels in all patients was completely accurate （100%）. All the flaps of the patients survived （100%）. Except for one case with poor wound healing， the remaining patients achieved primary wound healing， and the primary healing rate was 98.04%. At the last follow-up， in the sensory function assessment of the British Medical Research Council （BMRC） in the donor area， there were 3 cases at grade S2+， 20 cases at grade S3， and 28 cases at grade S3+； in the recipient area， there were 4 cases at grade S2， 7 cases at grade S2+， 17 cases at grade S3， and 23 cases at grade S3+. One month and three months after the operation， the scores of the Fugl-Meyer （FM） assessment scale of the patients were significantly higher than before. Three months after the operation， the score of the FM assessment scale of the patients was higher than that one month after the operation， and the differences were statistically significant （P < 0.05）. One case of arterial crisis occurred after the operation. After symptomatic treatment， the flap survived successfully. Conclusions Before free flap transplantation and repair of skin and soft tissue defects of the extremities， three-dimensional CTA reconstruction can accurately locate the perforating vessels of the donor site and effectively guide the design of the flap. After the operation， patients experience good wound healing， satisfactory recovery of sensation and limb function， and a low incidence of adverse reactions.

Objective High-flow tracheal oxygen （HFTO） often fails to generate effective positive end-expiratory pressure （PEEP） in tracheostomized patients with acute respiratory distress syndrome （ARDS） due to bypassed upper airway resistance. This study evaluated whether a novel high-flow tracheal interface could generate therapeutic PEEP levels and improve pulmonary mechanics in a mechanical lung model of ARDS. Methods In this randomized crossover bench study， an integrated system comprising a high-flow oxygen device， tracheostomy tube， and ARDS-programmed mechanical lung simulator （compliance： 51 mL/cmH?O； resistance： 5.1 cmH?O·s/L） was connected via either the novel or conventional interface. Gas flow was incrementally titrated from 10 to 80 L/min. Primary outcomes included PEEP， functional residual capacity （FRC）， tidal volume （Vt）， and FiO? delivery stability. Results At clinically relevant flow rates （40 ? 60 L/min）， the novel interface generated significantly higher PEEP （3.9 ? 7.3 cmH?O vs. 2.5 ? 5.0 cmH?O， P < 0.001） and FRC （P < 0.01） compared with the conventional interface， with only a modest reduction in Vt. FiO? stability remained comparable between interfaces （P ? 0.05）. PEEP demonstrated a robust power-function relationship with flow rate （R2 = 0.987）， enabling predictable pressure titration. Conclusion By simulating upper airway resistance， the novel high-flow tracheal interface effectively generates therapeutic PEEP levels， potentially facilitating lung recruitment in tracheostomized patients with ARDS.