Objective To investigate the association between arterial diameter discrepancy （ADD） and the incidence of in-stent stenosis （ISS） following flow diverter （FD） placement. Methods This retrospective analysis utilized data from a prospectively maintained multicenter registry across six advanced stroke centers in China. Patients who underwent FD treatment with the Pipeline Embolization Device （PED） or Tubridge Flow Diverter （TFD） between January 2020 and January 2024 were enrolled. Multivariable logistic regression models with progressive covariate adjustment and restricted cubic spline （RCS） analyses were used to evaluate the association between ADD and ISS at the 6-month angiographic follow-up. Sensitivity analyses assessed significant ISS as a secondary outcome. Subgroup analyses were performed to determine whether the association varied across patient characteristics. Results A total of 439 patients were included （53.5 ± 10.5） years. At the 6-month follow-up， the rates of complete aneurysm occlusion and ISS were 81.8% and 15.0%， respectively. Multivariable analysis revealed that each unit increase in ADD was associated with a 2.4-fold increase in the odds of ISS （OR = 2.42， 95% CI： 1.53 ~ 3.82， P < 0.001）. These findings remained robust in sensitivity analyses. Subgroup analyses showed no significant effect modification across patient characteristics. RCS analysis demonstrated a threshold effect， with the risk of both ISS and significant ISS increasing markedly when ADD exceeded 0.30. Conclusions Higher arterial diameter discrepancy is independently associated with an increased risk of ISS following FD placement. These findings may aid neurointerventionalists in preprocedural risk stratification and device selection， highlighting the potential clinical value of tapered FDs for treating vessels with significant diameter mismatches.

Objective To explore the clinical efficacy and practical application value of repetitive transcranial magnetic stimulation （rTMS） combined with medium-frequency electrotherapy in the rehabilitation management of patients with post-stroke neurogenic bladder. Methods From October 2024 to December 2025， patients with PSNB were randomly assigned to a control group （n = 30， receiving conventional treatment， rehabilitation， and medium-frequency electrotherapy） and an observation group （n = 30， receiving conventional treatment， rehabilitation， rTMS， and medium-frequency electrotherapy）. Both groups underwent treatment for 2 weeks and were then followed up for 1 month. The clinical indicators of the two groups were compared before and after treatment， including urodynamic parameters ［initial urge volume （FDV）， maximum bladder capacity （MCC）， filling phase bladder pressure （P_{ves at MCC}）， maximum urine flow rate （Q_max）， maximum detrusor pressure at maximum urine flow rate （P_detQmax）］， residual urine volume （RUV）， voiding diary （average daily voiding frequency， average daily leakage frequency， single void volume）， neurogenic bladder symptom score （NBSS）， and quality of life index score （Qualiveen scale）. The efficacy and safety of the two groups of patients were also evaluated. Results After treatment， the FDV， MCC， Q_max， P_detQmax， and the average daily single urine volume of both groups increased. Statistically， the levels in the observation group were higher than those in the control group （all P < 0.05）. Meanwhile， P_ves， RUV， the average daily urine volume， the number of leakage episodes， the NBSS score， and the Qualiveen scale score all decreased. Significantly， the values in the observation group were lower than those in the control group （all P < 0.05）. The total effective rate in the observation group （93.33%） was significantly higher than that in the control group （73.33%） （P < 0.05）. During the entire intervention period， neither group experienced serious adverse events. Conclusions The combination of rTMS and medium-frequency electrotherapy has demonstrated remarkable efficacy in the rehabilitation treatment of patients with PSNB. It plays a positive role in enhancing clinical symptoms， bladder function， and the quality of life. Moreover， it is highly safe， bringing substantial benefits to patients.

Objective To develop and validate a combined diagnostic model for aortic dissection （AD） by integrating artificial intelligence （AI）?derived prediction probabilities with interpretable imaging features from non-contrast computed tomography （CT）， thereby enhancing its clinical utility for AD evaluation. Methods We conducted a retrospective study of 221 patients with suspected AD who underwent non-contrast chest and abdominal CT at our institution between July 2020 and February 2024. Patients were randomly allocated at a 7∶3 ratio into a training cohort （n = 153， 76 AD cases） and a validation cohort （n = 68， 33 AD cases）. Clinical variables and CT imaging features were extracted. Independent predictors of AD were identified using multivariate logistic regression. The final model incorporated younger age as the sole clinical predictor， alongside key imaging features. Three diagnostic models were constructed： a traditional feature-based model， a standalone AI model， and a combined model integrating both imaging features and AI-derived prediction probabilities. Diagnostic performance was evaluated using receiver operating characteristic （ROC） curve analysis， with area under the curve （AUC） values compared via the DeLong test. Model calibration was assessed using the Hosmer-Lemeshow test and calibration plots. Results Multivariate analysis identified younger age， ascending aortic dilation， crescentic high-attenuation intramural density， and an intimal flap as independent predictors of AD （all P < 0.05）. In the training cohort， the combined model yielded a significantly higher AUC than both the traditional model and the standalone AI model （0.921 vs. 0.897 vs. 0.779， respectively， all P < 0.05）. This advantage was confirmed in the validation cohort， where the combined model achieved an AUC of 0.841， with a sensitivity of 84.8% and specificity of 77.1%. All models demonstrated adequate calibration （Hosmer-Lemeshow P > 0.05）， and the calibration plot for the combined model showed strong agreement between predicted probabilities and actual AD diagnoses confirmed by aortic CTA. Conclusions Integrating AI-derived probabilities with interpretable non-contrast CT imaging features significantly enhances AD detection accuracy. This combined model offers a robust， non-invasive tool to aid in the rapid diagnosis and clinical triage of suspected AD.

Objective To evaluate the association of serum pannexin-1 （Panx-1） and stress-induced protein 2 （Sestrin2） levels with neurological severity and 30-day functional outcome in patients with acute intracerebral hemorrhage （AICH）. Methods A prospective observational cohort study was conducted involving 208 consecutive adult patients diagnosed with spontaneous AICH admitted to our center between February 2023 and April 2024. Patients were stratified by baseline National Institutes of Health Stroke Scale （NIHSS） score into mild （n = 63）， moderate （n = 94）， and severe （n = 51） neurological deficit subgroups. Two hundred age- and sex-matched healthy volunteers served as controls. Serum Panx-1 and Sestrin2 concentrations were quantified using validated ELISA kits. Group comparisons were performed using one-way ANOVA with Tukey’s post hoc test （for ≥ 3 groups） or independent-samples t-test （for two-group comparisons）. Pearson correlation coefficients assessed linear associations between biomarker levels， NIHSS score， and Glasgow Coma Scale （GCS） score. Multivariable logistic regression-adjusted for age， sex， hematoma volume （measured on baseline CT）， GCS， NIHSS， ICU length of stay， and comorbidities （cerebral herniation， pulmonary infection， deep vein thrombosis） was used to identify independent predictors of poor 30-day functional outcome （defined as modified Rankin Scale score ≥ 4）. Receiver operating characteristic （ROC） curve analysis determined the discriminatory accuracy of Panx-1， Sestrin2， and their combination for predicting poor outcome. Results Compared to control group， the levels of Panx-1 and Sestrin2 were significantly higher in AICH group （P < 0.05）. The serum levels of Panx-1 and Sestrin2 in severe defect subgroup were higher than those in mild and moderate defect subgroup （P < 0.05）. The serum levels of Panx-1 and Sestrin2 were positively correlated with NIHSS score， and negatively correlated with GCS score. Panx-1， Sestrin2， hematoma volume， GCS score， NIHSS score， ICU length of stay， concurrent cerebral herniation， concurrent pulmonary infection， and concurrent deep vein thrombosis were risk factors for poor prognosis in patients with AICH. ROC curve showed that the AUC value of combined diagnosis of Panx-1 and Sestrin2 was significantly higher than that of single diagnosis of Panx-1 and Sestrin2. Conclusions Serum Panx-1 and Sestrin2 levels are robust， severity-dependent biomarkers in AICH， independently associated with baseline neurological impairment and 30-day functional prognosis. Their synergistic integration enhances prognostic stratification accuracy beyond conventional clinical and radiological parameters， supporting their potential utility as adjunctive tools for early risk assessment and personalized therapeutic decision-making.

Objective This study was aimed at investigating the clinical characteristics of diverse blood pressure circadian rhythms and exploring the correlation among blood pressure circadian rhythm， nocturnal blood pressure decline rate， and coronary slow flow phenomenon （CSFP）. Methods A total of 275 patients who presented with chest tightness or chest pain and underwent coronary angiography （CAG） showing no significant stenosis （≤ 40%） at the Department of Cardiology， the Second Hospital of Lanzhou University from 2019 to 2024 were included in the study. The cohort was composed of hypertensive patients， CSFP patients， and patients with both conditions. According to the nocturnal blood pressure decline rate， all patients were classified into four groups： dipper， reverse-dipper， non-dipper， and extreme-dipper. General clinical data， CAG findings， and ambulatory blood pressure monitoring （ABPM） data were collected. Comparisons were carried out on the 24-hour， daytime， and nighttime mean blood pressure （BP）， morning BP surge， and nocturnal BP decline rate. Linear correlation analysis and linear regression analysis were employed to investigate the correlation between CSFP and the nocturnal BP decline rate. Results Correlation analysis indicated that the corrected TIMI frame count （cTFC） was significantly and negatively correlated with the nocturnal systolic blood pressure （SBP） decline rate （r = -0.186， P < 0.001） and the diastolic blood pressure （DBP） decline rate （r = -0.206， P < 0.001）. Multiple linear regression analysis verified that the nocturnal BP decline rate was an independent influencing factor for CSFP （P < 0.05）， and this correlation remained significant after adjusting for confounding factors such as gender， age， body mass index， smoking， diabetes， and cerebral infarction. Conclusions Both the decline rates of systolic and diastolic nocturnal blood pressure are independently correlated with the coronary slow flow phenomenon. Ambulatory blood pressure monitoring in hypertensive patients can assist in the detection of CSFP.

Objective This study aims to assess the lipid-lowering efficacy of Inclisiran and proprotein convertase subtilisin/kexin type 9 （PCSK9） monoclonal antibodies （PCSK9mAbs） in patients with Acute Coronary Syndrome （ACS） by utilizing real-world clinical data. Methods This study adopted a single-center retrospective cohort design， enrolling patients with ACS who were treated with Inclisiran or PCSK9 monoclonal antibodies （mAbs， including evolocumab and alirocumab） at the Cardiology Department of Tianjin Chest Hospital from January 2022 to March 2024. All enrolled patients were those who failed to reach the low-density lipoprotein cholesterol （LDL-C） targets after at least 30 days of stable moderate-intensity statin therapy. By using propensity score matching at a 1∶2 ratio， the patients were divided into an Inclisiran group （n = 31） and a PCSK9 monoclonal antibody group （n = 55）. Lipid profiles were collected and analyzed at the start of treatment and during three follow-up visits （1 ~ 3 months， 3 ~ 9 months， and 9 ~ 12 months after discharge）. The differences between the two groups were compared in terms of the percentage reduction of LDL-C from the baseline， the LDL-C target achievement rates， the trend of LDL-C changes， and the cumulative LDL-C exposure during the follow-up period. The differences in LDL-C variability between the two groups were evaluated by the standard deviation （SD） and the average successive variability （ASV）. Results The LDL-C reduction in the Inclisiran group was significantly superior to that in the PCSK9 mAbs group at all three follow-up visits （P < 0.05）. In terms of the attainment rate， the Inclisiran group demonstrated a higher LDL-C target attainment rate than the PCSK9 monoclonal antibody group at each visit （P < 0.05）， and up to 80.65% of patients achieved sustained attainment （with a target value of 1.8 mmol/L）. After adjusting for baseline LDL-C levels， the Inclisiran group showed a more substantial reduction in LDL-C than the PCSK9 monoclonal antibody group （β = -0.300， 95%CI： -0.535 to -0.064， P = 0.013）. The trends of LDL-C changes over time were similar between the two groups. Moreover， the Inclisiran group had lower lipid variability （between-group P for SD = 0.034； between-group P for ASV = 0.029） and lower cumulative LDL-C exposure （P < 0.01） compared to the PCSK9 monoclonal antibody group. Conclusion In statin-treated ACS patients， inclisiran demonstrated superiority over PCSK9 monoclonal antibodies （mAbs） in reducing LDL-C levels， enhancing target achievement rates， decreasing cumulative LDL-C exposure， and maintaining LDL-C stability.

Objective The aim of this study was to quantitatively evaluate the volume of epicardial adipose tissue （EAT） in patients with muscular dystrophy（MD）-associated cardiomyopathy using cardiac magnetic resonance （CMR） and to explore its correlation with the total body composition measured by dual-energy X-ray absorptiometry （DXA）. Methods Male children diagnosed with MD-associated cardiomyopathy， who simultaneously underwent 3.0 T CMR and whole-body DXA at Sun Yat-sen Memorial Hospital from January 2018 to December 2023， were retrospectively included in this study. Healthy male children matched for age and body mass index （BMI） served as controls. The EAT volume， anterior septal fat thickness， and left and right atrial septal fat thickness were calculated by manually delineating the pericardium on CMR short-axis cine sequences using dedicated post-processing software. DXA was used to measure fat mass （FM）， fat fraction （FF）， and lean body mass （LBM）. All the above parameters were divided by the square of height and normalized to obtain relevant indexes， namely the epicardial adipose tissue volume index （EATVI）， whole-body fat mass index （FMI）， FF， and whole-body lean body mass index （LBMI）. Pearson correlation analysis was employed to assess the correlation between EAT and DXA. Results A total of 55 children with MD-associated cardiomyopathy ［age （12.42 ± 2.65） years］ and 21 healthy controls ［age （12.67 ± 2.15） years］ were recruited. There was a statistically significant difference in the epicardial adipose tissue volume index between children with MD-associated cardiomyopathy and healthy controls ［（28.0 ± 3.3） mL/m2 vs. （19.2 ± 2.9） mL/m2， P < 0.05］. For the anteroventricular septal fat thickness index ［（2.75 ± 2.15） mm/m2 vs. （2.27 ± 2.24） mm/m2， P > 0.05］， the left atrioventricular septal fat thickness index ［（2.83 ± 2.20） mm/m2 vs. （2.78 ± 2.64） mm/m2， P > 0.05］， and the right atrioventricular septal fat thickness index ［（4.97 ± 2.59） mm/m2 vs. （4.42 ± 3.60） mm/m2， P > 0.05］， no significant differences were found. There were significant differences in the total body fat mass index ［（3.93 ± 2.49） kg/m2 vs. （2.73 ± 1.38） kg/m2， P < 0.05］， the percentage fat fraction ［（18 ± 8） vs. （16 ± 5）， P > 0.05］， and the total body lean mass index ［（14.59 ± 1.90） kg/m2 vs. （15.99 ± 1.83） kg/m2， P < 0.05］. Correlation analysis indicated that the epicardial adipose tissue volume index was positively correlated with the body fat mass index （r = 0.62， P < 0.05） and the body fat fraction （r = 0.47， P < 0.001） measured by DXA. The epicardial adipose tissue volume index was negatively correlated with the total lean body mass index （r = -0.61， P < 0.001）. Conclusions In patients diagnosed with myodystrophic cardiomyopathy， the volume of EAT quantified via CMR exhibits a strong correlation with the trunk and whole-body fat content measured by DXA. This implies that the accumulation of EAT might mirror a distinct visceral fat distribution pattern among patients with MD. Furthermore， the EAT volume was found to be correlated with muscle atrophy， which underscores a potential interplay between the impaired fat metabolism and muscle wasting in these patients.

With the continuous development of society and the progress of medical science， the treatments for orthopedic diseases are gradually evolving towards precision medicine. As natural nanovesicles， exosomes possess outstanding biocompatibility and targeting abilities. Through functional modifications including genetic engineering， drug loading， and surface modification， exosomes can precisely facilitate bone regeneration， regulate bone metabolism， and reshape the immune micro-environment. They show remarkable potential in the treatment of orthopedic disorders such as fractures， osteoarthritis， and osteoporosis. Nevertheless， there are still challenges in standardized preparation， efficacy evaluation， safety assessment， and clinical translation. This article systematically reviews the most recent advances in functionalized exosomes for the treatment of orthopedic diseases， encompassing their sources， preparation methods， functionalization strategies， and mechanisms of action. It summarizes the application progress of functionalized exosomes in orthopedic therapy， discusses the current technical challenges and future development directions， and is of great significance for the translation of functionalized exosomes from laboratory research to clinical application in orthopedics.

Objective To identify independent risk factors for acute cerebral infarction （ACI） in elderly patients with hip fracture and to develop a clinically applicable nomogram for individualized risk prediction. Methods This retrospective study included 603 elderly patients with hip fracture admitted to the Third Department of Traumatic Hip Surgery， Tianjin Hospital， China， between January 2023 and June 2025. Patients were randomly allocated to a training cohort （n = 400） and a validation cohort （n = 203） and categorized based on the occurrence of ACI. Clinical and laboratory variables were collected. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of ACI. A nomogram was constructed using R software based on these predictors， and its performance was evaluated in terms of discrimination， calibration， and clinical utility. Results In the training cohort， 27 of 400 patients （6.75%） developed ACI. Multivariable logistic regression identified seven independent predictors： prior cerebral infarction， lower lymphocyte count， lower albumin level， elevated serum homocysteine， higher cystatin C， elevated glycated hemoglobin （HbA_1c）， and prolonged prothrombin time （all P < 0.05）. The nomogram based on these factors demonstrated excellent discrimination， with an area under the ROC curve （AUC） of 0.896 （95%CI： 0.843 ? 0.949） in the training cohort and 0.830 （95%CI： 0.737 ? 0.923） in the validation cohort. Calibration plots showed good agreement between predicted and observed probabilities of ACI. Decision curve analysis confirmed the model's favorable clinical net benefit across a range of threshold probabilities. Conclusions Prior cerebral infarction， lymphopenia， hypoalbuminemia， hyperhomocysteinemia， elevated cystatin C， higher HbA1c， and prolonged prothrombin time are independent predictors of ACI in elderly hip fracture patients. The developed nomogram exhibits robust discrimination， calibration， and clinical utility， offering a practical tool to facilitate early identification and targeted prevention of ACI in this high-risk population.

Dipeptidase 3 （DPEP3） is a testis-specific GPI-anchored metallopeptidase and a typical cancer-testis antigen（CTA）， which exerts vital functions in male reproductive regulation and tumorigenesis. This article systematically summarizes the gene location， molecular structure， tissue expression profile and biological functions of DPEP3. It elaborates the roles of DPEP3 in spermatogenesis and maintenance of testicular microenvironmental homeostasis， as well as its expression changes and evaluation value in infertility-related diseases including oligoasthenoteratozoospermia， azoospermia and varicocele. Meanwhile， those are summarized about the ectopic activation mechanism， immunogenicity and research progress as a therapeutic target of DPEP3 in multiple malignant tumors in this review. Studies suggest that DPEP3 can serve as a supplementary biomarker for the diagnosis of male infertility， and is also a potential target for tumor immunotherapies including antibody-drug conjugates and CAR-T cell therapy. Further research on the molecular mechanism and clinical transformation of DPEP3 is of great theoretical and clinical significance to promote the precise diagnosis and treatment of male reproductive diseases and targeted immunotherapy of malignant tumors.

Objective To investigate the association between the systemic immune-inflammation index （SII）， C-reactive protein-to-albumin ratio （CAR）， and C-reactive protein-albumin-lymphocyte （CALLY） index and acute exacerbations of gouty arthritis （GA）. Methods This study enrolled 63 patients with GA in the acute phase， 62 patients in clinical remission （absence of acute inflammatory signs such as joint erythema， swelling， and localized heat/pain）， and 62 healthy controls at the Third People's Hospital of Chengdu between February 2023 and May 2025. SII， CAR， and CALLY index levels were compared across the three groups. Logistic regression was used to identify risk factors for acute GA exacerbations. Receiver operating characteristic （ROC） curve analysis evaluated the diagnostic performance of these indices. Multiple linear regression assessed the association between the percentage changes （Δ%） in SII， CAR， and CALLY index following treatment and the change in Visual Analog Scale （VAS） pain scores （ΔVAS）. Results SII and CAR levels were progressively lower across the acute， remission， and healthy control groups （all P < 0.05）， whereas the CALLY index was progressively higher （all P < 0.05）. Logistic regression identified polyarticular involvement and elevated SII and CAR as independent risk factors for acute exacerbations， while regular urate-lowering therapy and a higher CALLY index were independently protective （all P < 0.05）. The CALLY index demonstrated superior diagnostic performance for distinguishing the acute from the remission phase （AUC = 0.861）， significantly outperforming SII （AUC = 0.731） and CAR （AUC = 0.736） （both P < 0.05）. Following treatment， SII and CAR levels significantly decreased， while the CALLY index increased in patients with acute GA （all P < 0.05）. After adjusting for age and baseline VAS， multiple linear regression identified Δ%SII， Δ%CAR， and Δ%CALLY as independent predictors of ΔVAS （all P < 0.05）. Conclusion Elevated SII and CAR， alongside a decreased CALLY index， characterize the acute phase of GA. All three biomarkers effectively track post-treatment inflammatory resolution and clinical improvement， with the CALLY index exhibiting the highest diagnostic accuracy for identifying acute GA exacerbations.

Objective To investigate the expression levels of apoptosis-associated speck-like protein （PYCARD）， nuclear factor κB receptor activator ligand （RANKL）， and chitinase 3-like protein 1 （CHI3L1） in the serum of patients with rheumatoid arthritis （RA）， and to explore the relationship between these proteins and disease activity. Methods A total of 104 patients with rheumatoid arthritis （RA group） who were admitted to Anqing Municipal Hospital from January 2021 to December 2025 were recruited for this study. They were divided into the remission group （51 cases） and the active group （53 cases） based on the 28-joint disease activity score （DAS28）. Additionally， 52 healthy volunteers （control group） were recruited during the same period. The expression levels of serum PYCARD， RANKL， and CHI3L1 were compared between the RA group and the control group， as well as between the remission group and the active group. Moreover， the correlation between the expression levels of these three markers and the DAS28 score was analyzed， along with the evaluation value of the combined detection of serum PYCARD， RANKL， and CHI3L1 for the disease activity of RA. Results In the RA group， the expression levels of serum PYCARD， RANKL， and CHI3L1 were significantly higher than those in the control group （P < 0.05）. In the active group， the expression levels of serum PYCARD， RANKL， and CHI3L1 were significantly higher than those in the remission group （P < 0.05）. The expression levels of serum PYCARD， RANKL， and CHI3L1 were positively correlated with the DAS28 score （r = 0.579， 0.534， 0.602， P < 0.05）. The area under the curve （AUC） value of the combined detection of serum PYCARD， RANKL， and CHI3L1 for the evaluation of RA disease activity was 0.898. The AUC values of the three individual tests were 0.743， 0.730， and 0.767， respectively. The AUC value of the combined detection was significantly higher than those of the individual detections （P < 0.05）. The sensitivity and specificity of the combined detection were 92.45% and 84.31%， respectively. Conclusions The expression levels of PYCARD， RANKL， and CHI3L1 are related to the onset of RA and its disease activity. The combined detection of PYCARD， RANKL， and CHI3L1 has the advantage of collaborative diagnosis and is of high value in evaluating the disease activity of RA， providing a more objective and accurate assessment method for the disease activity status of clinical RA patients.

Objective To explore the correlation between the level of pain catastrophizing and self-efficacy and the recovery of knee function after total knee arthroplasty （TKA）. Methods The clinical data of 124 patients who underwent TKA at the First Affiliated Hospital of Anhui Medical University from January 2021 to June 2025 were retrospectively collected. These data included general information， postoperative pain catastrophizing scale scores， rehabilitation self-efficacy scale scores， and knee joint function. Pearson correlation analysis was conducted to analyze the relationships between the levels of pain catastrophizing and rehabilitation self-efficacy and the recovery of knee joint function after TKA. Structural equation modeling was utilized to examine the mediating effect of rehabilitation self-efficacy between patients' pain catastrophizing and the recovery of knee joint function. Based on the recovery of knee joint function after surgery， the patients were divided into the good recovery group and the poor recovery group. The clinical data and the results of various scales were compared between the two groups. Multivariate logistic regression analysis was applied to screen the influencing factors of knee joint function recovery after surgery. Results The total score of the postoperative Pain Catastrophizing Scale （PCS） for 124 patients was （31.74 ± 4.90） points. The total score of the Self-Efficacy for Rehabilitation Scale （SER） was （81.03 ± 10.86） points， and the total score of the Hospital for Special Surgery Knee Score （HSS） was （77.32 ± 6.81） points. In TKA patients， the postoperative PCS scores， including those for exaggeration， helplessness， rumination， and the overall score， were negatively correlated with the scores of each dimension and the total score of the SER scale， as well as the total score of the HSS scale （P < 0.05）. The scores of each dimension and the total score of the SER scale were positively correlated with the total score of the HSS scale （P < 0.05）. The scores of each dimension of the PCS were positively correlated with the scores of each dimension of the SER scale （P < 0.05）. The PCS score had a direct negative impact on the HSS score （β = -0.762， 95%CI： -1.230 ? -0.392， P < 0.05）， and the PCS had an indirect negative impact on the HSS score through the SER （β = -0.199， 95%CI： -0.393 ? -0.020， P < 0.05）. The specific pathway： A significant increase in the PCS score led to a notable reduction in the SER score. Conversely， a significant increase in the SER score substantially enhanced the HSS score （β = 0.194， 95%CI： 0.037 ? 0.351， P < 0.05）. The overall negative effect of PCS on HSS was significant （P < 0.05）. Among the total negative impact of PCS on HSS， 21.90% was realized through the mediating pathway of reducing SER， and SER played a partial mediating role between PCS and HSS. Out of the 124 patients， 86 cases （69.35%） exhibited good recovery 4 weeks after surgery， whereas 38 cases （30.65%） showed poor recovery. The poor-recovery group had a higher proportion of patients who were over 60 years old， widowed， and self-funded compared to the good-recovery group （P < 0.05）. The PCS score in the poor-recovery group was higher， while the SER score was lower （P < 0.05）. Being over 60 years old and having a PCS score ≥ 30 points were risk factors for poor knee joint function in patients after TKA （P < 0.05）， while high SER scores were a protective factor （P < 0.05）. Conclusions Patients who have undergone TKA exhibit a relatively high level of postoperative pain catastrophizing and a moderate level of rehabilitation self-efficacy. Both of these factors are associated with the recovery of knee joint function after surgery. The level of pain catastrophizing can directly influence the recovery of knee joint function in TKA patients and can also indirectly impact it through the mediating effect of rehabilitation self-efficacy. Being over 60 years old and having high PCS scores are risk factors for poor knee joint function recovery after TKA， whereas high SER scores are protective factors.

Diabetic kidney disease （DKD） stands as one of the most prevalent and severe microvascular complications of diabetes mellitus （DM）， serving as the primary cause of chronic kidney disease （CKD） and end-stage renal disease （ESRD）. This imposes a substantial burden on both patients and society from health and economic perspectives. The gut microbiota represents the aggregate of all microorganisms inhabiting the human intestine， forming an extremely intricate and extensive ecosystem. The organic interplay between the gut microbiota and the kidneys has been verified to directly or indirectly influence human health. Specifically， dysbiosis of the gut microbiota， impairment of the intestinal barrier， and imbalance of gut microbiota metabolites can initiate oxidative stress and immune-inflammatory responses， thereby accelerating the progression of DKD. In recent years， traditional Chinese medicine has manifested unique advantages in the prevention and treatment of DKD， attributed to its multi-target approach， holistic regulation， and minimal side effects. Studies have revealed that various compounds， including monosaccharide glycosides， flavonoids， polyphenols， terpenoids， alkaloids， polysaccharides， as well as traditional Chinese medicine formulas categorized as removing blood stasis and clearing turbidity， tonifying qi and nourishing yin， and clearing heat and detoxifying， can regulate the gut microbiota， target relevant signaling pathways， alleviate renal damage， and delay the progression of DKD. This article systematically reviews the key mechanisms through which the gut microbiota is involved in DKD， analyzes the research achievements in regulating the gut microbiota for the treatment of DKD in recent years， and aims to offer new insights and directions for the prevention and treatment of DKD with traditional Chinese medicine.

Abjective　To investigate the efficacy and safety of finerenone in combination with renin-angiotensin-aldosterone system inhibitors （RAASi） and dapagliflozin in patients with primary membranous nephropathy （PMN）. Methods A total of 40 patients with PMN were randomly assigned to the treatment group （finerenone + RAASi + dapagliflozin） and the control group （RAASi + dapagliflozin）， with 20 patients in each group. Clinical indicators， such as 24-hour urinary protein， endogenous creatinine clearance rate， serum creatinine， serum albumin， and serum potassium， were collected at 0， 1， 3， and 6 months of treatment to compare the efficacy and adverse reactions between the two groups. Results The 24-hour urinary protein levels decreased in both groups when compared to the baseline. At the 1-month mark， the 24-hour urinary protein in the treatment group was lower than that in the control group， though the difference was not statistically significant （P > 0.05）. However， at 3 and 6 months， the 24-hour urinary protein in the treatment group was significantly lower than that in the control group （P < 0.05）. At 6 months， the serum albumin in the treatment group was significantly higher than that in the control group （P < 0.05）， while at 1 and 3 months， it was higher but without statistical significance （P > 0.05）. Throughout all time points， there were no significant differences in serum creatinine and endogenous creatinine clearance rate between the two groups （P > 0.05）. The incidence of adverse events was 40% in the treatment group and 35% in the control group. The difference was not statistically significant （P > 0.05）， and no serious adverse events were reported. Conclusion Finerenone， when combined with RAASi and dapagliflozin， can effectively reduce proteinuria and maintain stable renal function in patients with PMN， and it has good safety.

Objective To compare the clinical efficacy， hematologic response kinetics， immunomodulatory effects， and safety profile of thrombopoietin receptor agonists （TPO-RAs） versus low-dose rituximab in adult patients with immune thrombocytopenia （ITP） refractory to or relapsing after first-line corticosteroid therapy. Methods This was a single-center， retrospective cohort study conducted at our institution between March 2021 and March 2025. A total of 80 adult patients diagnosed with primary ITP who exhibited inadequate response to ≥ 4 weeks of corticosteroid therapy or experienced relapse within 3 months after tapering were enrolled. Patients were stratified into two treatment cohorts based on clinical decision-making： the TPO-RA group （n = 55）， receiving either eltrombopag or romiplostim； And the low-dose rituximab group （n = 25）， receiving 100 mg weekly for four doses. Primary endpoints included overall response rate （ORR； defined as platelet count ≥ 30 × 10?/L and at least twofold increase from baseline） and time to response. Secondary endpoints encompassed platelet count trajectories， coagulation parameters?prothrombin time （PT） and activated partial thromboplastin time （APTT）?and immunophenotyping of peripheral blood T lymphocyte subsets： regulatory T cells （Tregs）， T helper 17 cells （Th17）， and the Treg/Th17 ratio. Adverse events were systematically recorded and graded per CTCAE v5.0. Results The TPO-RA group achieved a significantly higher overall response rate （85.5% vs. 64.0%， P = 0.032） and shorter median time to response （14 d vs. 28 d， P < 0.001） compared with the rituximab group. Post-treatment platelet counts were markedly elevated in the TPO-RA group ［（142.6 ± 48.3） × 10?/L vs. （98.1 ± 36.7） × 10?/L， P = 0.002］. No statistically significant differences were observed in PT （P = 0.417） or APTT （P = 0.352） between groups following therapy. Both regimens significantly increased circulating Treg frequency （P < 0.001 for both） and Treg/Th17 ratio （P < 0.001 for both）； however， the TPO-RA group demonstrated greater magnitude of improvement in both parameters relative to the rituximab group （Treg： 8.2% vs. 6.1%， P = 0.018； Treg/Th17： 2.4 vs. 1.7， P = 0.023）. Th17 cell frequencies did not differ significantly between groups post-treatment （P = 0.674）. The incidence of grade ≥ 2 adverse events was comparable （12.7% vs. 16.0%， P = 0.715）. Conclusions In corticosteroid-refractory or relapsed ITP， TPO-RAs confer superior and more rapid platelet recovery compared with low-dose rituximab， accompanied by more pronounced restoration of Treg-mediated immune homeostasis-without adversely affecting global coagulation function. These findings support TPO-RAs as a preferred second-line therapeutic option in this clinical setting.

Objective To explore the relationship between the levels of periodontal ligament associated protein 1 （PLAP-1） and absent in melanoma 2 （AIM-2） in gingival crevicular fluid， and the clinical stage， periodontal indicators， and prognosis of elderly patients with periodontitis. Methods A total of 104 elderly patients with periodontitis who presented at our hospital between February 2021 and February 2025 were selected as the research subjects. The patients were classified into the stage Ⅰ—Ⅱ group and the stage Ⅲ—Ⅳ group according to the clinical stage of periodontitis. Based on the results of the re-examination of periodontal pocket depth 6 months after periodontal basic treatment， the patients were divided into the good prognosis group and the poor prognosis group. The levels of PLAP-1 and AIM-2 in gingival crevicular fluid were measured by ELISA. The differences in the levels of PLAP-1 and AIM-2 among periodontitis patients at different clinical stages were analyzed. The correlation between the changes in periodontal indicators and the levels of PLAP-1 and AIM-2 was analyzed. The differences in the levels of PLAP-1 and AIM-2， as well as other data， among periodontitis patients with different prognostic conditions were analyzed. Additionally， logistic regression was employed to analyze the related factors influencing the prognosis of patients with periodontitis. The ROC curve was utilized to explore the predictive value of PLAP-1 and AIM-2 levels in gingival crevicular fluid for the prognosis of patients with periodontitis. The H-L test was used to assess the goodness of fit of the combined prediction scheme of the levels of PLAP-1 and AIM-2 in gingival crevicular fluid. Results The level of PLAP-1 in the stage Ⅲ—Ⅳ group was significantly lower than that in the stage Ⅰ—Ⅱ group， while the level of AIM-2 was significantly higher than that in the stage Ⅰ—Ⅱ group （P < 0.05）. The probing depth （PD） and attachment level （AL） of patients with periodontitis were negatively correlated with the level of PLAP-1 in gingival crevicular fluid and positively correlated with the level of AIM-2 （P < 0.05）. The level of PLAP-1 in gingival crevicular fluid in the poor prognosis group was significantly lower than that in the good prognosis group， and the level of AIM-2 was significantly higher than that in the good prognosis group （P < 0.05）. High levels of the deepest PD value and AIM-2， along with a low level of PLAP-1， were identified as risk factors for poor prognosis in elderly patients with periodontitis （P < 0.05）. The areas under the curve （AUC） for predicting the prognosis of elderly patients with periodontitis by the levels of PLAP-1 and AIM-2 in gingival crevicular fluid and their combination were 0.820， 0.832， and 0.895， respectively. The predictive efficiency of combining the two indicators was superior to that of a single indicator （Z_{PLAP-1-combined prediction} = 2.612， Z_{AIM-2-combined prediction} = 2.359， P = 0.009， 0.017）. The Hosmer-Lemeshow test for the goodness-of-fit of the combined test scheme showed χ² = 4.323 and P = 0.823， indicating good consistency. Conclusions The levels of PLAP-1 and AIM-2 in the gingival crevicular fluid of elderly patients with periodontitis are closely associated with their clinical staging， periodontal indicators， and prognosis. For elderly periodontitis patients who present with increased AIM-2 levels and decreased PLAP-1 levels in the gingival crevicular fluid， clinicians should closely monitor their oral condition.

Objective To investigate the protective effects of the probiotic Roseburia intestinalis （Ri） against lung injury induced by heart failure （HF） in mice. Methods This was an experimental study. A total of 24 C57BL/6J mice were randomly assigned to four groups： sham， transverse aortic constriction （TAC）， sham + Ri， and TAC + Ri. A heart failure model was established via transverse aortic constriction. After the surgery， the mice in the sham and TAC groups were given daily oral gavage of phosphate-buffered saline （PBS） for 4 weeks， whereas the mice in the sham + Ri and TAC + Ri groups were administered Ri. Cardiac function was evaluated through echocardiography. Lung histopathological changes were assessed using hematoxylin–eosin （HE） staining. The levels of inflammatory cytokines in bronchoalveolar lavage fluid （BALF） were measured. The expression and localization of E-cadherin and Piezo1 in lung tissues were detected by means of immunohistochemistry and Western blotting. In vitro， human bronchial epithelial 16HBE cells were treated with Yoda1 to induce Piezo1-related changes， followed by Ri intervention. Subsequently， transepithelial electrical resistance （TEER）， E-cadherin expression， and inflammatory cytokine levels were evaluated. Results Compared with the sham group， TAC mice demonstrated a significantly greater reduction in left ventricular ejection fraction （LVEF） and fractional shortening （FS） （both P < 0.05）. Concurrently， there was a notable infiltration of inflammatory cells in the peribronchial regions， along with an elevation in the levels of IL-6， TNF-α， and IL-1β in BALF （all P < 0.05）. Additionally， in the lung tissues， E-cadherin expression was down-regulated， while Piezo1 expression was up-regulated （P < 0.05）.When compared to the TAC group， TAC + Ri mice exhibited a significant improvement in LVEF and FS （both P < 0.05）. There was a reduction in pulmonary inflammatory infiltration and a decrease in the levels of IL-6， TNF-α， and IL-1β in BALF （P < 0.05）. Simultaneously， E-cadherin expression increased， and Piezo1 expression decreased （P < 0.05）.In vitro， treatment with Yoda1 led to an increase in Piezo1 expression （P < 0.05）， a decrease in TEER （P < 0.05）， a reduction in E-cadherin expression （P < 0.05）， and an elevation in the mRNA levels of inflammatory cytokines （P < 0.05）. These alterations were partially reversed by the Ri intervention. Conclusion Ri alleviates heart failure?induced lung injury in mice， potentially due to its modulation of Piezo1-related signaling， preservation of airway epithelial barrier function， and attenuation of inflammatory responses.

Objective To elucidate the molecular mechanism whereby N6-methyladenosine （m6A） RNA methylation regulates Klotho expression and drives renal tubular epithelial cell （RTEC） senescence in septic acute kidney injury （SAKI）. Methods An in vitro SAKI cellular model was established using lipopolysaccharide （LPS）-stimulated human proximal tubular epithelial cells （HK-2）. Cell viability， senescence-associated β-galactosidase （SA-β-gal） activity， and global and gene-specific m6A levels were quantified. Functional gain- and loss-of-function experiments were performed via transient transfection of small interfering RNAs （siRNAs） targeting METTL3 or YTHDF2， and plasmid-mediated overexpression of wild-type Klotho or a Klotho mutant lacking functional m6A consensus sites. Results In the SAKI model， RTECs exhibited significantly reduced viability （P < 0.05）， increased SA-β-gal positivity （P < 0.05）， elevated global m6A abundance， and site-specific hypermethylation of Klotho mRNA （P < 0.05）. Concurrently， METTL3 and YTHDF2 protein expression were upregulated （P < 0.05）， whereas Klotho mRNA and protein levels were markedly suppressed （P < 0.05）. METTL3 or YTHDF2 overexpression enhanced m6A deposition on Klotho mRNA （P < 0.05）， accelerated its YTHDF2-dependent decay （P < 0.05）， and consequently diminished Klotho expression （P < 0.05） and exacerbated cellular senescence （P < 0.05）. Conversely， siRNA-mediated knockdown of METTL3 or YTHDF2， or expression of the m6A-site-deficient Klotho mutant， restored Klotho expression and attenuated senescence phenotypes. Conclusion Dysregulated m6A methylation-mediated by METTL3/YTHDF2 axis-promotes RTEC senescence in SAKI through targeted suppression of Klotho. These findings identify the m6A–Klotho regulatory axis as a mechanistically defined and therapeutically relevant pathway in sepsis-induced renal aging.

Objective To explore the influence of different common bile duct diameters （CBDD） on the clinical efficacy， safety， and postoperative biliary tract-related complications in patients with common bile duct stones who receive laparoscopic common bile duct exploration （LCBDE） combined with primary suture， aiming to provide a reference basis for the selection of clinical surgical indications. Methods The clinical and follow-up data of 103 patients with common bile duct stones who were treated with LCBDE combined with primary suture were retrospectively analyzed in the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Guizhou Medical University from March 2022 to September 2025. Based on the outer diameter of the common bile duct measured by preoperative magnetic resonance imaging （MRI） and intraoperative measurement， the patients were divided into the small-diameter group （Group A， 0.6 cm ≤ CBDD < 1.0 cm， n = 42） and the dilation group （Group B， CBDD ≥ 1.0 cm， n = 61）. The baseline characteristics， surgery-related detailed indicators， postoperative dynamic recovery of liver function， and incidence rates of complications were compared and analyzed between the two groups of patients. Results There were no statistically significant differences in preoperative baseline data between the two groups （P > 0.05）. In comparison with group B， group A had a longer surgical time and a longer postoperative hospital stay （P < 0.05）， as well as a shorter common bile duct incision length （P < 0.05）. The levels of alanine aminotransferase （ALT） and total bilirubin （TBIL） on the 1st day after surgery （POD1） and the 3rd day after surgery （POD3） in both groups decreased significantly compared to the preoperative levels （P < 0.05）， and there were no statistically significant differences between the groups at the same time-points （P > 0.05）. The overall incidence rate of postoperative complications showed no statistically significant difference between the groups （P > 0.05）. Specifically， group A had 3 cases （7.14%） of bile leakage， whereas group B had 2 cases （3.28%）. These 5 cases were classified as ISGLS grade A bile leakage and resolved with conservative treatment， with no statistically significant difference between the groups （P > 0.05）. Conclusions CBDD < 1.0 cm is not an absolute contraindication for primary suture. Although a small-diameter bile duct increases the difficulty of surgery， prolongs the surgical time， and extends the hospital stay， it does not impede the rapid recovery of postoperative liver function and does not significantly increase the risk of complications such as severe bile leakage， with definite clinical efficacy.

Objective To investigate the relationship between inducible nitric oxide synthase （iNOS）， ceruloplasmin （CER）， and the Nod-like receptor protein 3 （NLRP3）/interleukin-1β （IL-1β） signaling pathway and urinary tract infection after bladder cancer surgery. Methods From August 2020 to August 2025， 102 patients who developed urinary tract infection after bladder cancer surgery and were admitted to the People's Hospital Affiliated to Shandong First Medical University were selected as the urinary tract infection group. Meanwhile， 102 patients who did not develop urinary tract infection after bladder cancer surgery during the same period were selected as the non-urinary tract infection group. The distribution of pathogenic bacteria in patients with urinary tract infection after bladder cancer surgery was analyzed. The clinical data， iNOS， CER， and the NLRP3/IL-1β signaling pathway were compared between the two groups. The influencing factors of urinary tract infection after bladder cancer surgery were analyzed using multivariate logistic regression analysis. The evaluation value of serum iNOS， CER， and the NLRP3/IL-1β signaling pathway for urinary tract infection after bladder cancer surgery was analyzed by the receiver operating characteristic （ROC） curve. Results A total of 128 strains of pathogenic bacteria were cultured from 102 patients with urinary tract infection following bladder cancer surgery. Escherichia coli and Klebsiella pneumoniae accounted for 37.50% and 17.97% respectively. The age of the urinary tract infection group was greater than that of the non-urinary tract infection group. Moreover， the proportion of patients with hypertension， diabetes， tumor stage Ⅲ/Ⅳ， operation duration > 360 min， and postoperative indwelling catheter time > 7 d was higher in the urinary tract infection group than in the non-urinary tract infection group （P < 0.05）. The levels of serum iNOS， CER， IL-1β， and peripheral blood NLRP3 in patients with urinary tract infection were higher than those in patients without urinary tract infection （P < 0.05）. Multivariate logistic regression analysis indicated that advanced age， diabetes mellitus， operation duration > 360 min， postoperative indwelling catheter time > 7 d， elevated serum iNOS level， elevated serum CER level， increased peripheral blood NLRP3 mRNA expression， and elevated serum IL-1β level were independent influencing factors of urinary tract infection after bladder cancer surgery （OR = 1.881， 4.773， 1.458， 6.322， 3.640， 2.442， 1.594， 3.677， P < 0.05）. The urinary tract infection group was considered as positive， while the non-urinary tract infection group was considered as negative. The areas under the curve （AUC） of serum iNOS， CER， NLRP3/IL-1β signaling pathway， and combined detection for evaluating urinary tract infection after bladder cancer surgery were 0.713， 0.736， 0.753， 0.747， and 0.939 respectively， and the AUC of combined detection was the highest （P < 0.05）. Conclusions Escherichia coli and Klebsiella pneumoniae were identified as the primary pathogens responsible for urinary tract infections following bladder cancer surgery. Advanced age， diabetes， an operation duration exceeding 360 minutes， a postoperative indwelling catheter time longer than 7 days， elevated serum iNOS levels， high serum CER levels， increased peripheral blood NLRP3 mRNA expression， and elevated serum IL-1β levels were determined to be independent influencing factors for urinary tract infections after bladder cancer surgery. The combination of serum iNOS， CER， and the NLRP3/IL-1β signaling pathway exhibited high evaluation value for urinary tract infections after bladder cancer surgery.

Objective To explore the risk factors associated with acute liver injury in patients with hepatocellular carcinoma （HCC） following hepatic artery chemoembolization （cTACE）. Methods A retrospective analysis was conducted on the clinical data of 252 HCC patients who received cTACE treatment at the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from January 2024 to July 2025. The patients were divided into an acute liver injury group and a non-acute liver injury group based on whether acute liver injury occurred after surgery. Independent risk factors were screened through multiple logistic regression analysis. Results Multivariate analysis indicated that giant hepatocellular carcinoma， Child-Pugh B grade， combined cirrhosis， TACE frequency greater than 2 times， preoperative albumin （ALB） less than 30 g/L， an increase in the preoperative fibrosis factor 4 index （FIB-4）， an increase in the preoperative neutrophil/lymphocyte ratio （NLR）， an increase in the preoperative platelet count index （APRI）， and a decrease in the postoperative liver volume （LV） were all independent risk factors for acute liver injury in HCC patients undergoing cTACE （all P < 0.05）. ROC curve analysis demonstrated that the areas under the curve （AUC） for predicting acute liver injury after cTACE by preoperative FIB-4， NLR， APRI， and postoperative LV were 0.786， 0.704， 0.816， and 0.847， respectively； The sensitivities were 0.716， 0.672， 0.761， and 0.821， respectively； The specificities were 0.708， 0.701， 0.805， and 0.836， respectively. Conclusions The occurrence of acute liver injury after cTACE in HCC patients is influenced by factors including massive HCC， Child-Pugh class B， concurrent liver cirrhosis， more than 2 TACE sessions， preoperative ALB < 30 g/L， preoperative FIB-4， preoperative NLR， preoperative APRI， and postoperative LV.

Objective To investigate the efficacy and mechanism of fiberoptic bronchoscopic alveolar lavage （BAL） in combination with azithromycin and methylprednisolone in the treatment of severe Mycoplasma pneumoniae pneumonia （SMPP） through the Toll-like receptor 2 （TLR2）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway. Methods Eighty-four cases of children with SMPP caused by Mycoplasma pneumoniae （MP） infection， who were admitted to the Pediatrics Department of Wuhan First Hospital from January 2022 to January 2024， were selected as the observation group （n = 84）. All of them received BAL combined with conventional symptomatic treatment， azithromycin， and methylprednisolone treatment. Another 84 cases of children with SMPP caused by MP infection during the same period were selected as the control group. The observation group received BAL combined with conventional symptomatic treatment， azithromycin， and methylprednisolone， whereas the control group received only conventional symptomatic treatment， azithromycin， and methylprednisolone. Both groups were treated for 7 days. Therapeutic efficacy， recovery parameters， lung function， blood gas analysis， and TLR2/MyD88/NF-κB signaling pathway markers were compared between the two groups before and after treatment. Adverse reactions were also monitored during the treatment period. Results After a 7-day treatment period， the total effective rate in the observation group was significantly higher than that in the control group ［97.62% （82/84） vs. 84.52% （71/84）， P < 0.05］. The durations of cough， pulmonary rales， fever resolution， and hospitalization in the observation group were significantly shorter than those in the control group （all P < 0.05）. After treatment， the levels of arterial partial pressure of carbon dioxide （PaCO?）， along with the expression of TLR2 mRNA， MyD88 mRNA， and NF-κB mRNA in peripheral blood mononuclear cells （PBMC）， decreased in both groups compared with the baseline values. Notably， the observation group exhibited significantly lower levels （all P < 0.05）. In contrast， the time to peak tidal expiratory flow as a proportion of expiratory time （TPTEF/TE）， maximum mid-expiratory flow （MMEF）， volume to peak expiratory flow as a proportion of exhaled volume （VPTEF/VE）， oxygenation index （OI）， arterial oxygen saturation （SaO?）， and arterial partial pressure of oxygen （PaO?） increased in both groups after treatment. The observation group showed significantly higher values （all P < 0.05）. The overall incidence of adverse reactions was 5.95% （5/84） in the control group and 8.33% （7/84） in the observation group， and there was no statistically significant difference between the two groups （P = 0.549）. Conclusion BAL， when combined with azithromycin and methylprednisolone， effectively enhances lung function and blood gas parameters， downregulates the TLR2/MyD88/NF-κB signaling pathway， and facilitates clinical recovery in children with MP-induced SMPP， exhibiting favorable efficacy and safety profiles.

Objective To develop and externally validate a multidimensional Early Warning Scoring Scale （SEWS） for pediatric sepsis， grounded exclusively in routinely available laboratory parameters reflecting four pathophysiological domains： infection， coagulation dysfunction， impaired tissue perfusion， and depletion of host physiological reserves. Methods We conducted a retrospective cohort study involving 193 children with confirmed infection admitted to Shenzhen Children′s Hospital between January 2021 and December 2023. Participants were stratified into two clinically defined groups： the sepsis group （n = 92） and the non-sepsis infection group （n = 101）， based on consensus diagnostic criteria （e.g.， International Pediatric Sepsis Consensus Conference definitions）. Comparative analyses of baseline laboratory parameters were performed between groups. Candidate variables were initially selected using univariate analysis and area under the receiver operating characteristic curve （AUC-ROC） evaluation； subsequently， independent predictors of pediatric sepsis were identified via multivariable logistic regression. A weighted scoring scale—the SEWS—was derived directly from regression coefficients. Internal model performance was rigorously assessed， and external validation was carried out using an independent cohort of 40 consecutive cases collected prospectively from January to April 2024. Results Multivariable logistic regression identified six independent predictors of pediatric sepsis： Procalcitonin （PCT）， international normalized ratio （INR）， myoglobin， albumin， hemoglobin （Hb）， and mean platelet volume （MPV） （all P < 0.05）. The composite prediction model achieved an AUC of 0.983 （95%CI： 0.969 - 0.997）， significantly outperforming any single biomarker. The SEWS demonstrated excellent discriminative ability in the derivation cohort： sensitivity = 94.6%， specificity = 92.1%， and AUC = 0.981 （95%CI： 0.967 - 0.995） at an optimal cutoff score of ≥ 6 points. In the external validation cohort （n = 40）， SEWS maintained high sensitivity （100%） and strong specificity （84.0%）. Conclusions The SEWS is a pragmatic， multidimensional clinical tool built solely on routinely measured laboratory parameters. It exhibits robust diagnostic accuracy for early identification of pediatric sepsis， with a score of ≥ 6 conferring high positive predictive value. This evidence supports its integration into clinical workflows to facilitate timely risk stratification and prompt therapeutic intervention.

Objective To investigate the effectiveness and safety of butylphthalide in treating sudden deafness under real-world clinical conditions. Methods A retrospective analysis was conducted on the clinical data of patients with blast-induced deafness admitted to the Department of Otorhinolaryngology Head and Neck Surgery， General Hospital of Southern Theater Command from January 2020 to April 2025. The patients were classified into a butylphthalide group （consisting of 51 patients with 66 affected ears） and a non-butylphthalide group （consisting of 54 patients with 70 affected ears） based on whether butylphthalide was administered during the treatment. All the patients included in the study received a therapeutic regimen centered on glucocorticoids， supplemented with drugs for improving microcirculation and nourishing nerves. On this basis， the patients in the butylphthalide group were additionally administered butylphthalide injection twice a day for 7 consecutive days. The hearing gain and treatment effective rate （defined as effective when the hearing gain was ≥ 15 dB） were assessed by comparing the results of pure-tone audiometry （PTA） before and after the treatment between the two groups. The safety of medication in both groups was also monitored. Results There were no statistically significant differences in baseline characteristics between the two groups. The butylphthalide group demonstrated significantly greater hearing gains in PTA thresholds at 250 Hz， 500 Hz， 1 000 Hz， 2 000 Hz， and 4 000 Hz when compared to the non-butylphthalide group （all P < 0.05）. The overall treatment effective rates in the butylphthalide group were 53.3%， 68.1%， 49.1%， 47.4%， and 52.5% at 250 Hz， 500 Hz， 1 000 Hz， 2 000 Hz， and 4 000 Hz， respectively. These rates were significantly higher than those in the non-butylphthalide group （15.4%， 14.9%， 17.1%， 22.0%， and 27.3%； all P < 0.05）. During treatment， mild pruritus was observed in 2 cases， and mild dizziness with nausea in 1 case. No serious adverse events associated with butylphthalide were reported during the treatment period. Conclusion In real-world clinical practice， the integration of butylphthalide into conventional therapy results in a substantial improvement in the hearing levels of patients with sudden deafness and demonstrates a favorable safety profile， which suggests significant clinical application value.