Sclareol （SCL） is a natural labdane-type diterpene diol isolated from plants including Salvia sclarea L.， with well-documented applications in the fragrance industry， as well as pharmaceutical and medical sectors. Accumulating preclinical evidence indicates that sclareol exerts multi-target， multi-pathway pharmacological activities， encompassing antitumor， antidiabetic， neuroprotective， anti-inflammatory， antioxidant， and anti-infective properties. To date， however， a comprehensive review integrating these bioactivities and their underlying mechanisms remains absent in the literature. This review systematically summarizes recent advances in sclareol research， with a specific focus on its multidimensional bioactivities and the corresponding molecular mechanisms underlying these effects. Our analysis confirms that sclareol exerts therapeutic efficacy across diverse disease models by regulating multiple core signaling cascades， including nuclear factor kappa-B （NF-κB）， mitogen-activated protein kinase （MAPK）， AMP-activated protein kinase （AMPK）， signal transducer and activator of transcription 3 （STAT3）， and protein kinase B （AKT）. These bioactivities involve modulation of energy metabolism， suppression of pro-inflammatory signaling networks， reversal of chemotherapeutic drug resistance， and regulation of calcium channel function. Collectively， existing preclinical data establish a solid foundation for further mechanistic investigation and pharmaceutical development of sclareol. Nevertheless， the clinical translation of sclareol remains hindered by limited pharmacokinetic characterization， overreliance on narrow-spectrum animal models， and insufficient systematic evaluation of sclareol delivery systems.

Objective To investigate the predictive value of retinal vascular features （RVFs） for long-term major adverse cardiovascular events （MACE） in patients with congenital heart disease （CHD）. Methods Clinical data were retrospectively collected from patients with CHD admitted to the Department of Congenital Heart Disease Surgery， Guangdong Provincial People's Hospital， who received systematic ophthalmic examinations between May 2017 and November 2022. A total of 147 CHD patients with available baseline fundus photographs and no history of MACE at baseline were enrolled in this study. An Elastic Net Cox regression model was applied to identify core RVFs while effectively controlling for multicollinearity， based on which a comprehensive RVFs score was constructed. Meanwhile， Ridge regression was used to aggregate multiple well-established clinical baseline characteristics into an integrated clinical risk score. The independent prognostic value and incremental predictive performance of the RVFs score for long-term MACE in CHD patients were comprehensively assessed via bivariate analysis， multivariable Cox regression， time-dependent receiver operating characteristic （ROC） curves， and the Kaplan-Meier method. Results After a median follow-up duration of 53.22 months， 13 major adverse cardiovascular events （MACE， 8.9%） occurred. The model identified 8 core RVFs in the final analysis. After full adjustment for aggregated clinical baseline risk factors， the RVFs-based score was confirmed to be an independent predictor of MACE ［hazard ratio （HR） = 3.92， 95% confidence interval （CI）： 2.23 - 6.92， P < 0.001］， and the bivariate predictive model achieved a C-index of 0.83. When stratified by the optimal cut-off value of the RVFs score， patients in the high-risk group had a significantly higher cumulative incidence of MACE than those in the low-risk group （Log-rank P < 0.001）. Furthermore， incorporating the RVFs score improved 5-year MACE risk prediction： the area under the receiver operating characteristic curve （AUC） increased substantially from 0.62 for the clinical-only model to 0.92 for the combined model. Conclusions RVFs extracted from fundus photographs are independently associated with long-term MACE risk in patients with CHD. The RVFs-based risk score constructed in this study can effectively improve risk stratification performance， and holds promise as a non-invasive， easily accessible adjunctive tool for long-term cardiovascular risk assessment in this population.

Objective To investigate the effects of Qili Qiangxin capsule combined with cardiac rehabilitation on cardiac function and ventricular remodeling in patients with heart failure with reduced ejection fraction （HFrEF） following coronary artery bypass grafting （CABG）. Methods This prospective randomized controlled trial consecutively enrolled 160 patients with HFrEF following CABG between August 2020 and August 2025. Eligible patients were randomly allocated to four groups （40 patients per group）： a control group receiving guideline-directed medical therapy （GDMT）， a rehabilitation group receiving GDMT plus 12-week supervised cardiac rehabilitation， a traditional Chinese medicine （TCM） group receiving GDMT plus Qili Qiangxin capsule， and a combination group receiving GDMT plus both 12-week cardiac rehabilitation and Qili Qiangxin capsule. Outcome assessments including TCM syndrome scores， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， left ventricular ejection fraction （LVEF）， left atrial diameter （LA）， early diastolic mitral inflow velocity to early diastolic mitral annular velocity ratio （E/e’）， 6-minute walk distance （6MWD） and 36-item Short Form Health Survey （SF-36） scores were conducted at baseline， after 12 weeks of intervention， and at 1 month， 3 months， and 6 months after treatment initiation. Results Following intervention， TCM syndrome scores and NT-proBNP levels decreased significantly in all four groups （all P < 0.05）， and the combination therapy group exhibited the lowest NT-proBNP level among all groups （P < 0.05）. Compared with the other three groups， the combination therapy group achieved significantly greater improvements in LVEF and 6MWD （P < 0.05）. Left atrial diameter （LA） and the E/e' ratio in the combination therapy group showed significantly more substantial improvements than those in the control group （P < 0.05）， while no statistically significant differences were detected when compared with the cardiac rehabilitation group and the TCM monotherapy group （all P > 0.05）. SF-36 score showed the most prominent improvement in the combination therapy group （P < 0.05）. No statistically significant difference in the incidence of adverse events was identified among the four groups （P > 0.05）. Conclusion On the basis of GDMT， Qili Qiangxin capsule combined with cardiac rehabilitation can further improve cardiac function， delay ventricular remodeling， and improve the quality of life of post-CABG patients with heart failure， with favorable safety profile.

Objective To investigate the effects of intravenous thrombolysis using tenecteplase combined with mechanical thrombectomy on serum interleukin-6 （IL-6）， interferon-γ （IFN-γ） levels， and neurological function in patients with acute large vessel occlusive stroke （ALVOS）. Methods A total of 132 patients diagnosed with ALVOS treated at our institution between June 2021 and August 2024 were retrospectively enrolled in this study. Using 1∶1∶1 propensity score matching， the patients were stratified into three groups： group A （n = 44， treated with tenecteplase intravenous thrombolysis combined with mechanical thrombectomy）， group B （n = 44， treated with alteplase intravenous thrombolysis combined with mechanical thrombectomy）， and group C （n = 44， treated with mechanical thrombectomy alone）. We compared serum levels of IL-6 and IFN-γ among the three groups at baseline （before treatment） and at 24 hours， 7 days， and 14 days after treatment. We also evaluated stroke severity and functional outcomes using the National Institutes of Health Stroke Scale （NIHSS）， Modified Rankin Scale （mRS）， and Barthel Index （BI）， and documented rates of vascular recanalization， adverse safety events， and total medical costs. Results The puncture-to-recanalization time was significantly shorter in Group A compared with Groups B and C （P < 0.05）， and no significant difference was observed between Groups B and C （P > 0.05）. At 24 hours， 7 days， and 14 days post-treatment， the mean serum levels of IL-6 and IFN-γ were lower in Group A than in Groups B and C， and lower in Group B than in Group C （all P < 0.05）. At 24 hours， 3 days， 7 days， and 14 days post-treatment， the NIHSS scores were significantly lower in Group A than in Groups B and C （P < 0.05）， with no significant difference detected between Groups B and C （P > 0.05）. No significant between-group differences were identified in the proportion of patients with mRS ≤ 2， mRS score distribution， or all-cause mortality across the three groups （all P > 0.05）. The Barthel Index score was significantly higher in Group A than in Groups B and C （P < 0.05）， while no significant difference was found between Groups B and C （P > 0.05）. No significant difference was observed in the total incidence of adverse events among the three patient groups （P > 0.05）. The cost of thrombolytic drugs was higher in Group A than in Group B， but the total hospitalization cost was significantly lower in Group A compared with Group B （P < 0.05）. No significant difference in total cost was detected between Group A and Group C （P > 0.05）， and the total cost of Group B was significantly higher than that of Group C （P < 0.05）. Conclusions For patients with ALVOS， tenecteplase intravenous thrombolysis combined with mechanical thrombectomy can effectively shorten the puncture-to-recanalization time， reduce serum levels of IL-6 and IFN-γ， promote early neurological function recovery， and does not increase bleeding risk. Moreover， the total medical cost of this combined regimen is comparable to that of mechanical thrombectomy alone， indicating that it delivers favorable clinical benefits and economic advantages.

Objective This study aims to investigate the prevalence of hypertension among high-altitude construction workers， compare the predictive performance of traditional and novel anthropometric obesity indicators for hypertension， quantify the dose-response relationship between each obesity indicator and hypertension risk， and ultimately provide an epidemiological basis for developing targeted occupational hypertension screening and weight management strategies for this population. Methods A cross-sectional survey was conducted via convenience sampling among 952 workers from three hydropower station and railway construction sites in Xizang Autonomous Region， in 2020， 2022 and 2025. Binary logistic regression models were applied to analyze the association between obesity-related indicators and hypertension， with confounding factors including age， gender and educational level adjusted for. Restricted cubic spline （RCS） was utilized to explore the dose-response relationship between each indicator and hypertension risk. The area under the receiver operating characteristic （ROC） curve （AUC） was used to evaluate the predictive performance of different obesity indicators for hypertension. The population attributable risk percentage （PAR%） was calculated to quantify the contribution of obesity indicators to hypertension， and subgroup analyses were performed to investigate stratified differences in the association between obesity indicators and hypertension. Sensitivity analyses were conducted to confirm the stability of the study findings. Results The prevalence of hypertension in the study population was 37.5%. After adjusting for confounding factors， BMI （OR = 2.84， 95%CI： 1.84 - 4.37）， WC （OR = 1.75， 95%CI： 1.26 - 2.43）， BRI （OR = 2.30， 95%CI： 1.50 - 3.53）， and WHtR （OR = 2.53， 95%CI： 1.51 - 3.67） were all positively associated with hypertension risk. RCS analysis demonstrated that BMI， WC， BRI， and WHtR all exhibited linear dose-response relationships with hypertension risk （P overall < 0.001， P nonlinear > 0.05）， with no statistically significant non-linear associations detected. ROC curve analysis indicated that the AUC values of BMI， WC， BRI， and WHtR for hypertension risk prediction were 0.629， 0.631， 0.639， and 0.639， respectively； the PAR% of BMI， WC， and WHtR were 25.99%， 11.97%， and 20.68%， respectively. Subgroup analysis revealed that the association between WHtR and hypertension was stronger in the male subgroup （OR = 2.03， 95%CI： 1.51 - 2.73， P < 0.001）， and a significant multiplicative interaction between gender and WC was observed in relation to hypertension （P interaction = 0.029）. Results of sensitivity analysis showed that the positive correlations between hypertension and elevated BMI， abdominal obesity， elevated BRI， and elevated WHtR remained statistically significant across all three sensitivity analyses， confirming the good stability of the study results. Conclusions Workers engaged in high-altitude construction suffer from a high hypertension burden. The visceral fat indicators BRI and WHtR demonstrate superior early warning performance for hypertension， and male workers have a higher susceptibility to hypertension induced by abdominal obesity. It is recommended that BRI and WHtR be incorporated into routine occupational physical examinations at plateau construction sites， stratified screening for high-risk populations be conducted based on the localized optimal cut-off values identified in this study， and targeted weight and fat reduction interventions be implemented for male workers to reduce the risk of hypertension prevalence.

Objective This study aims to investigate the associations among accelerometer-derived activity phenotypes identified via unsupervised machine learning， frailty， and cardiovascular disease risk. Methods A total of 87 824 participants were enrolled from a large-scale European cohort study. Accelerometer-derived physical activity indicators were extracted， including moderate-to-vigorous physical activity （MVPA）， light physical activity （LPA）， sedentary time and overall activity intensity. Gaussian mixture modeling was adopted to identify activity behavior phenotypes. Cox proportional hazards regression models were constructed to analyze the associations between the identified phenotypes and cardiovascular disease risk， and LASSO regression was utilized to screen key metabolites associated with the activity phenotypes. Results Three distinct physical activity behavior phenotypes were identified in this study. Over the follow-up period， 4 832 cardiovascular disease events were documented. Phenotype A was characterized by relatively low MVPA， prolonged sedentary time， and lower overall activity intensity； Phenotype B exhibited an intermediate activity level； and Phenotype C was characterized by relatively high MVPA and LPA， shorter sedentary time， and higher overall activity intensity. Compared with Phenotype A， Phenotypes B and C were associated with a significantly lower risk of cardiovascular disease， with hazard ratios of 0.80 and 0.74 respectively， and both comparisons reached statistical significance （P < 0.001）. This association remained consistent among non-frail and pre-frail participants， and no significant interaction was detected between physical activity behavior phenotype and frailty status. LASSO regression identified 26 core metabolites， which revealed that Phenotype A was mainly characterized by inflammation- and energy metabolism-related abnormalities， while Phenotype C presented relatively elevated levels of fatty acids and HDL-related lipid components. Conclusions Accelerometer-derived physical activity behavioral phenotypes identified via unsupervised machine learning are independently associated with cardiovascular disease risk and are characterized by distinct metabolic profiles. These data-driven phenotypes can provide additional information for cardiovascular disease risk stratification beyond the scope of traditional frailty assessments.

This review systematically reviews existing research on risk prediction for acute exacerbations of chronic obstructive pulmonary disease （AECOPD）， clarifies the inherent evolutionary logic of relevant research paradigms transitioning from macroscopic clinical scoring systems to microscopic biomarkers， and elaborates on the trade-offs between prediction accuracy， clinical accessibility and methodological quality across different prediction strategies. Based on comprehensive literature retrieval， this paper systematically sorts out and summarizes AECOPD risk prediction-related research， covering prognostic scoring systems， inflammatory immune markers， radiomics， and machine learning-based methods. Among multidimensional scoring systems， the DOSE index is primarily used to predict the risk of future acute exacerbations and the frequency of hospitalization， and it is positively correlated with the number of outpatient visits and hospitalization costs （all P < 0.001）. The ADO index is mainly applied to predict 1-3 year all-cause mortality， with a C-statistic of 0.730 for 1-year mortality in external validation. Its predictive performance is further improved after integrating the ADO index with anemia， nutritional status and other indicators. The BODE index achieves an AUC of 0.82 for predicting 3-year mortality， but its high dependence on cardiopulmonary exercise testing limits its popularization in primary medical institutions. In terms of inflammatory and immune markers， the combined AUC of SII， SIRI， NLR， PLR and MLR for the diagnosis of moderate-to-severe AECOPD reaches 0.837， and the nomogram constructed based on these predictors yields an AUC of 0.806 - 0.839 for predicting AECOPD-related respiratory failure. The combined model of radiomics and machine learning achieves an AUC of up to 0.957 for AECOPD identification， but existing systematic reviews show that the pooled AUC of existing AI/ML models only ranges from 0.73 to 0.77， and 57.9% of included studies are assessed as having a high risk of bias. The BLISS score is designed to predict the risk of respiratory-related hospitalization within the next two years， while the PRECISE‑X model predicts the first severe acute exacerbation， enabling a prospective paradigm shift from “post-event assessment” to “diagnosis-based risk stratification”. AECOPD risk prediction is developing towards a multi-modal， dynamic and early-stage direction. The core priority for future research is not to develop more complex individual models， but to construct a hierarchical and progressive validation system： establishing unified testing standards for core indicators， implementing rigorous multi-center external validation， and integrating machine learning methods on the premise of ensuring model interpretability.

Depression is a prevalent chronic and severe mental disorder characterized by structural and functional abnormalities in multiple brain regions that regulate emotion， cognition， and reward processing， alongside multiple molecular pathological alterations. As a non-pharmacological intervention， electroacupuncture has exhibited considerable therapeutic potential for depression treatment. Its antidepressant effects are not limited to a single brain region or molecular target； Instead， it exerts multi-level antidepressant actions by modulating abnormal brain activity and functional connectivity， which in turn influences neuroplasticity， inflammatory responses， and neurotransmitter release. Focusing on brain imaging findings and the molecular mechanisms underlying brain region-specific alterations， this article reviews functional brain abnormalities in depression and the neurobiological mechanisms underlying electroacupuncture intervention， with the aim of providing a theoretical foundation for mechanistic research and clinical application of electroacupuncture for depression treatment.

Osteoarthritis （OA） is a highly prevalent degenerative joint disease that substantially impairs patients' quality of life. As key mediators of intercellular communication， exosomes have emerged as promising candidates for the diagnosis and therapeutic management of OA owing to their unique biological characteristics. This review summarizes the structural architecture and molecular composition of exosomes， appraises their potential as diagnostic biomarkers for OA， and discusses their translational therapeutic value. We also delineate the current challenges encountered in clinical translation and outline future research directions， with the aim of providing a robust reference for advancing further investigation and clinical translation of exosome-based strategies in the OA research field.

Objective To elucidate the role and molecular mechanism underlying dynamin-related protein 1 （DRP1）-mediated mitochondrial fission in the alleviation of alcoholic fatty liver （AFL） by nicotinamide riboside （NR）. Methods An AFL mouse model was constructed via the standard Gao-Binge （National Institute on Alcohol Abuse and Alcoholism， NIAAA） protocol， after which NR intervention was administered. Hepatic injury and mitochondrial morphology were subsequently evaluated. For the in vitro experiments， an AFL cellular model was established in AML-12 hepatocytes via co-treatment with ethanol and palmitic acid. To detect mitochondrial morphology， mitochondrial membrane potential and DRP1 activity in AML-12 cells， we adopted MitoTracker staining， JC-10 staining， and a combined approach of Western blotting， co-immunoprecipitation and cellular immunofluorescence for each detection item respectively. To confirm the functional role of DRP1， pharmacological inhibition of DRP1 was performed using Mdivi-1. Results In vivo experiments demonstrated that NR significantly ameliorated alcohol-induced liver injury and inhibited the formation of megamitochondria. Mechanistic investigations revealed that alcohol exposure reduced DRP1 expression， disrupted its phosphorylation homeostasis， impaired its mitochondrial translocation， and attenuated the binding interaction between DRP1 and mitochondrial fission factor （MFF）， a resident receptor on the mitochondrial outer membrane. Notably， NR supplementation effectively reversed these pathological alterations. Furthermore， the hepatoprotective effect of NR was nearly completely abrogated following Mdivi-1， a pharmacological inhibition of DRP1. Conclusion NR alleviates AFL by activating DRP1-mediated mitochondrial fission to maintain mitochondrial dynamic homeostasis， indicating that DRP1 serves as a key potential target for NR in the prevention and treatment of AFL.

Objective​　To investigate the characteristics of brain network reorganization and its association with clinical symptoms in patients with right-sided trigeminal neuralgia （TN）. Methods 38 patients with right-sided trigeminal neuralgia treated at the Department of Neurosurgery， Guangdong Second Provincial General Hospital between September 2024 and August 2025 were enrolled in this study， along with 40 age-， sex-， and education-matched healthy controls. All participants underwent resting-state functional magnetic resonance imaging （rs-fMRI） scanning and standardized clinical assessments. Whole-brain functional connectivity strength （FCS） analysis was first conducted to identify aberrant functional hub regions. Regions with the most significant between-group differences were then selected as seeds for seed-based functional connectivity （FC） analysis. Finally， the correlations between neuroimaging metrics and clinical variables were assessed. Results​ Compared with healthy controls， patients with right-sided TN exhibited a pattern of abnormal brain functional connectivity predominantly involving the right hemisphere， characterized by increased FCS in the right putamen and decreased FCS in the right middle occipital gyrus （MOG）. Seed-based FC analysis revealed reduced connectivity from the right putamen to the ipsilateral inferior frontal gyrus and ipsilateral postcentral gyrus， as well as reduced connectivity from the right MOG to the ipsilateral calcarine cortex. Clinically， FC between the right MOG and calcarine cortex was significantly positively correlated with pain intensity measured via the Visual Analog Scale （r = 0.655， P < 0.000 1）， while FCS of the right MOG was significantly correlated with depressive symptoms measured via the Hamilton Depression Rating Scale （r = 0.404， P = 0.012） and anxiety symptoms measured via the Hamilton Anxiety Rating Scale （r = 0.337， P = 0.039）. Conclusions​ Patients with right-sided TN exhibited disrupted functional integration within the sensorimotor network， cognitive control network， and visual network in the ipsilateral hemisphere. Moreover， the altered functional connectivity of the visual network was found to be associated with pain perception and emotional regulation in this cohort. These findings provide novel insights into the central pathological mechanisms underlying TN.

Objective To evaluate the safety and feasibility of a modified anesthetic induction protocol that utilizes deep sedation with preservation of spontaneous breathing for tracheal intubation in patients undergoing bariatric surgery. Methods Forty-four patients scheduled for bariatric surgery were randomly allocated to two groups （n = 22 per group）： the deep sedation with spontaneous breathing group （Group DS） and the conventional general anesthesia induction group （Group G）. In Group DS， intravenous administration of 0.3 µg/kg dexmedetomidine， 0.3 mg/kg esketamine， and 0.1 µg/kg sufentanil was combined with laryngotracheal topical anesthesia， after which tracheal intubation was performed with spontaneous breathing maintained. Group G underwent conventional rapid sequence induction and intubation. The primary outcome was defined as safe apnea time， which was measured from the time of peak SpO₂ to the initial decline in SpO₂. Secondary outcomes included mask ventilation grade， patient movement during intubation， and hemodynamic parameters. Results Compared with Group G， Group DS exhibited a significantly longer safe apnea time （P < 0.001）， higher mean arterial pressure （MAP） and diastolic blood pressure （DBP） during intubation （P < 0.05）， decreased sufentanil consumption （P < 0.001）， and a lower incidence of postoperative nausea and vomiting （PONV） （P = 0.021）. In contrast， the incidence of mild body movement during intubation was significantly higher in Group DS （P < 0.05）. Conclusions For patients undergoing bariatric surgery， the modified induction protocol with deep sedation and preserved spontaneous breathing can effectively prolong safe apnea time， stabilize hemodynamics， reduce opioid consumption， and decrease the incidence of postoperative nausea and vomiting （PONV）. This approach is a safe， feasible， and clinically valuable anesthetic implementation.

Objective To analyze the distribution of pathogenic bacteria causing pulmonary infection in elderly chronic kidney disease patients undergoing maintenance hemodialysis， and to evaluate the clinical diagnostic value of serum neutrophil gelatinase-associated lipocalin （NGAL）， soluble P-selectin （sP-selectin）， and monocyte chemoattractant protein-1 （MCP-1）. Methods Clinical data of 243 elderly patients with chronic kidney disease who received hemodialysis at The First Hospital of Changsha between January 2022 and June 2025 were retrospectively collected. The patients were stratified into the infection group （n = 61） and the non-infection group （n = 182） based on the occurrence of pulmonary infection during hemodialysis. The distribution of pathogenic bacteria isolated from patients in the infection group was summarized. Between-group comparisons of baseline clinical characteristics and serum levels of NGAL， sP-selectin， and MCP-1 were performed. Finally， we analyzed the risk factors for pulmonary infection in elderly chronic kidney disease patients undergoing maintenance hemodialysis， and evaluated the diagnostic value of the three serum biomarkers for this complication. Results Among 61 elderly patients with chronic kidney disease undergoing maintenance hemodialysis who developed pulmonary infection， a total of 61 respiratory tract secretion specimens were collected for culture. Of these specimens， 41 yielded positive culture results， corresponding to a positive rate of 67.21% （41/61）. A total of 50 pathogenic strains were isolated， including 8 cases of mixed infection. Among all isolated strains， 34 were Gram-negative bacteria， accounting for 68.00%， and Klebsiella pneumoniae was the dominant pathogen， accounting for 26.00% of all strains； 16 were Gram-positive bacteria， accounting for 32.00%， and Staphylococcus aureus was the dominant pathogen， accounting for 18.00% of all strains. One fungal strain was isolated， accounting for 2.00% of all strains. The proportions of patients with hypoproteinemia and pleural effusion in the infection group were significantly higher than those in the non-infection group， and the neutrophil-to-lymphocyte ratio （NLR） was also significantly higher in the infection group than in the non-infection group （all P < 0.05）. Hypoproteinemia， pleural effusion， and elevated serum levels of NGAL， sP-selectin and MCP-1 were identified as independent risk factors for pulmonary infection in elderly patients with chronic kidney disease undergoing maintenance hemodialysis （OR = 3.589， 3.777， 1.376， 1.525， 1.338， all P < 0.05）. The combined area under the curve （AUC） of serum NGAL， sP-selectin and MCP-1 for diagnosing pulmonary infection in elderly patients with chronic kidney disease undergoing maintenance hemodialysis was significantly higher than the AUC of any single marker （all P < 0.05）， with a combined sensitivity of 80.33% and specificity of 85.71%. Conclusions The dominant pathogens causing pulmonary infections in elderly patients with chronic kidney disease undergoing maintenance hemodialysis were Klebsiella pneumoniae and Staphylococcus aureus. Identified risk factors for pulmonary infection in this cohort include hypoproteinemia， pleural effusion， and elevated serum levels of NGAL， sP-selectin， and MCP-1. Furthermore， combined detection of serum NGAL， sP-selectin， and MCP-1 improves the diagnostic value for pulmonary infection in this patient population.

Objective To evaluate the clinical value of an MRI-based three-dimensional visualization model of the uterosacral ligament （USL） in preoperative decision-making for high uterosacral ligament suspension （HUSLS）. Methods This was a single-center prospective randomized controlled trial carried out at Zhengzhou Central Hospital， which involved 88 patients suffering from stage Ⅱ-Ⅳ pelvic organ prolapse （POP）. A random sequence was generated by means of SPSS 26.0， and allocation concealment was implemented using sequentially numbered， opaque， sealed envelopes. Patients were randomly allocated in a 1∶1 ratio to either the three-dimen⁃sional decision-making group or the conventional assessment group. Both groups underwent pelvic organ prolapse quantification （POP-Q） assessment and preoperative pelvic floor MRI. In addition， the three-dimensional decision-making group underwent three-dimensional USL reconstruction and structured assessment based on preoperative MRI to aid preoperative decision-making for HUSLS. The primary outcome was the consistency between the planned procedure and the actual procedure， which was measured by the intraoperative procedure modification rate. Secondary outcomes included the distribution of procedures， mesh implantation， perioperative factors， hospitalization costs， anatomical and quality-of-life results at six months， and postoperative complications. Analyses were conducted according to the intention-to-treat principle， with P < 0.05 denoting statistical significance. Results All 88 patients successfully completed the study. When compared with the conventional assessment group， the three-dimensional decision-making group exhibited a significantly lower intraoperative procedure modification rate （2.3% vs. 18.2%， absolute risk difference = -15.9%， 95% CI： -29.8% to -3.0%， P = 0.030）， a notably higher proportion of HUSLS （68.2% vs. 38.6%）， a substantially lower mesh use rate （31.8% vs. 61.4%， P = 0.005）， a significantly shorter operative time （P = 0.032）， and significantly lower total hospitalization costs （P = 0.037）. Moreover， there were no statistically significant differences between the two groups in terms of anatomical outcomes， quality-of-life scores， or complication rates 6 months after surgery （P > 0.05）. Conclusions An MRI-based three-dimensional visualization model of the USL can offer clear imaging support for preoperative decision-making related to HUSLS and notably reduce intraoperative procedure modification. It might also decrease potentially avoidable mesh implantation， shorten the operative time， and lower the hospitalization costs without sacrificing short-term postoperative outcomes， thus providing a reference for the individualized selection of pelvic reconstructive procedures in patients with POP.

Objective To investigate the clinical efficacy of Dynamic neuromuscular stabilization （DNS） combined with fascial manipulation （FM） in patients suffering from chronic nonspecific low back pain （CNLBP）， and to offer a reference for clinical diagnosis and treatment. Methods Thirty-two patients diagnosed with CNLBP and admitted to the Department of Rehabilitation Medicine， the Fifth Affiliated Hospital of Guangzhou Medical University， from July 2023 to December 2023 were recruited. They were randomly assigned to three groups using a random number table： A DNS group （n = 11）， an FM group （n = 11）， and a Combination group （n = 10）. All three groups received conventional rehabilitation therapy. On this basis， the DNS group received an additional DNS technique， the FM group received an additional FM technique， and the Combination group received a combination of DNS and FM. All groups underwent the intervention for 2 weeks， with 5 sessions per week. The visual analogue scale （VAS）， Roland-Morris disability questionnaire （RMDQ）， Oswestry disability index （ODI）， gait analysis， plantar pressure testing， and infrared thermography were employed for assessment both before and after treatment. Results Prior to treatment， no statistically significant differences were observed in VAS， RMDQ， or ODI scores among the three groups （P > 0.05）. Post-treatment， all of the aforementioned indicators in the three groups were significantly decreased compared to the pre-treatment values （P < 0.05）. Concerning gait parameters， only the DNS group exhibited significant improvement in walking speed， bilateral step length， and stride length when compared to the pre-treatment state（P < 0.05）， whereas the FM and Combination groups showed no significant alterations. Regarding plantar pressure， only the static left forefoot load in the DNS group increased significantly in comparison to the pre-treatment level （P < 0.05）. There were no statistically significant differences in lumbar infrared thermography temperature before and after treatment across the three groups （P > 0.05）. After treatment， comparisons among the three groups revealed no statistically significant differences in VAS or ODI scores （P > 0.05）. The RMDQ score in the DNS group was significantly lower than that in the Combination group （P < 0.05）， while there were no statistically significant differences between the DNS and FM groups， nor between the FM and Combination groups （P > 0.05）. There were no statistically significant differences in gait parameters or infrared thermography temperature among the three groups （P > 0.05）； however， the static left forefoot load in the DNS group was higher than that in the FM and Combination groups （P < 0.05）. Conclusions Both DNS and FM are capable of effectively alleviating pain and enhancing dysfunctional conditions in patients with CNLBP. When the total treatment time is 30 minutes and half-standard doses of DNS/FM are applied， the combined therapy does not demonstrate better clinical efficacy than monotherapy.