The catalytic activity of 3-mercaptopyruvate (3MP) sulfurtransferase (MPST) converts 3MP to hydrogen sulfide (H₂S). However, the regulatory mechanisms governing MPST and its impact on the brain remain largely unexplored. Our study reveals the neuroprotective role of endothelial MPST-generated H₂S, regulated by protein phosphatase 2A (PP2A). Bioinformatics analysis and RNA sequencing demonstrated that endothelial PP2A is associated with neurodegenerative disease pathways. Cerebral ischemic mice exhibited significant inactivation of endothelial PP2A, evidenced by the reduction of PP2Acα in the brain endothelium. Mice with endothelium-specific null PP2A (PP2A^EC-cKO) exhibited neuronal loss, cognitive dysfunction, and long-term potentiation deficits. Postnatal inactivation of endothelial PP2A also contributes to cognitive dysfunction and neuronal loss. However, regaining endothelial PP2A activity by overexpressing Ppp2ca rescued neuronal dysfunction. Mechanistically, PP2A deficiency is intricately linked to the MPST-H₂S signaling pathway. A robust reduction in endothelial MPST-dependent H₂S production followed PP2A deficiency. Exogenous H₂S treatment and AAV-mediated overexpression of MPST in brain endothelial cells significantly mitigated neuronal dysfunction in PP2A^EC-cKO mice. Furthermore, PP2A deficiency promotes an increase in calcium influx and calpain2 phosphorylation, subsequently leading to MPST degradation. The PP2A activator (FTY720) and MPST activator (3MP sodium) both remarkably restored endothelial MPST-dependent H₂S production, subsequently rescuing ischemia-induced neurological deficits. In conclusion, our study demonstrates that endothelial PP2A deficiency leads to MPST degradation by activating calpain2, thus damaging neuronal function.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective: To evaluate the long-term effectiveness of an intelligent blood transfusion system in intraoperative blood management by comparing its performance with clinicians' decisions. Methods: A retrospective analysis of 26 760 surgical cases (2017-2024) was conducted, comparing pre- and post-implementation (2017-2019 vs 2020-2024) metrics, including transfusion prediction accuracy, rationality of blood use, and clinical outcomes. The system, powered by XGBoost, integrated patient demographics, laboratory results, and surgical data to predict red blood cell transfusion needs. Results: The intelligent blood transfusion systems achieved an accuracy of 80.62% in predicting transfusion necessity, significantly outperforming clinicians (24.83%, P<0.001). Its blood-use rationality rate was 83.92% vs 18.02% for clinicians (P<0.001). Post-implementation, major surgeries (grades Ⅲ-Ⅳ) increased while the requested blood units decreased. High physician compliance (>75%) correlated with 88.18% rationality. Conclusion: The intelligent blood transfusion system significantly improves the accuracy of transfusion decision-making, reduces excessive red blood cell use, optimizes perioperative transfusion management, and enhances the utilization of blood medical resources.

ObjectiveTo determine the prevalence and determinants of Mycobacterium tuberculosis latent infection among primary and secondary school students in Cixi City, Zhejiang Province, so as to provide references for the prevention and control of tuberculosis in school settings. MethodsInterferon-γ release assay (IGRA) testing was performed to fourth-grade primary school students , as well as to those grade 7 and grade 10 students of the academic year 2024‒2025 in Cixi City. Individuals tested positive for IGRA were subsequently subjected to chest X-ray examination and sputum tests (including three smear microscopy examinations and one mycobaterial culture), and epidemiological investigations were carried out for confirmed cases. Infection rates were compared across student categories by χ² tests, while factors influencing infection were analysed through multivariate logistic regression. ResultsA total of 36 214 students completed tuberculosis screening, with an infection rate of 0.72% (260/36 214). The tuberculosis infection rates among fourth-grade primary school students, non boarding grade 7 students, boarding grade 7 students, grade 10 students of senior high school and of vocational high school were 0.68% (89/13 139), 0.75% (86/11 501), 0.51% (13/2 553), 0.76% (52/6 819), and 0.91% (20/2 202), respectively. Multivariate logistic regression analyses indicated that students with a history of close contact with tuberculosis patients (OR=21.435, P<0.001) had a higher risk of tuberculosis infection, students with a geographic origin outside Zhejiang Province (OR=1.485, P=0.002) had a higher risk of infection than those within Zhejiang Province. Furthermore, students from ethnic minority classes (OR=4.232, P<0.001) might be high-risk groups for tuberculosis infection in high school settings. One IGRA-positive student was confirmed as bacteriologically positive pulmonary tuberculosis by liquid culture of sputum collected one month later. ConclusionSchools should prioritize tuberculosis screening. Students with a history of close contact, those with a geographic origin outside Zhejiang Province, and those enrolled in minority classes should be taken as priority targets for future tuberculosis screening programmes. A tracking and follow-up system must be established for IGRA-positive students to prevent persistent transmission of Mycobacterium tuberculosis within the school settings.

Objective:To compare the efficacy of various machine learning models in predicting renal function decline after robot-assisted partial nephrectomy(RAPN),and to provide evidence for clinical risk stratification.Methods:This study retrospectively in-cluded the clinical data of 733 patients with renal cell carcinoma undergoing RAPN at the Urology Department of The First Affiliated Hospital of Chongqing Medical University from January 2019 to December 2023.Demographic characteristics,laboratory indicators,and perioperative parameters were integrated to construct seven machine learning models.Key predictors were interpreted using Shap-ley additive explanations(SHAP).Model performance was evaluated using the area under the receiver operating characteristic curve(AUC).Results:The random forest model demonstrated the best predictive performance(AUC=0.84).SHAP analysis identified neutrophil-to-lymphocyte ratio,tumor diameter,the international normalized ratio of prothrombin time,white blood cell count,and in-traoperative blood loss as significant factors influencing postoperative renal function decline.Conclusion:This study provides a poten-tial predictive tool for clinical practice,aiding in identifying high-risk patients and optimizing postoperative management strategies.

Objective To explore and establish a technical pathway for size-specific dose estimate (SSDE) in pediatric CT patients of different age groups based on structured dose files and DICOM files, and to provide an effective method for precise monitoring of medical radiation exposure in pediatric CT scans. Methods Structured radiation dose reports (SR files) for pediatric patients aged 15 and under, who underwent CT scans between January and December 2023, were exported from the hospital information system. Scanning parameters and dose information were extracted using specialized software, and SSDE was calculated based on the patient body size parameters. The data were grouped by age (0- < 1 year, 1- < 5 years, 5- < 10 years, and 10-15 years) for statistical analysis. Results From January to December 2023, a total of 2706 pediatric CT scans were performed at the hospital, including 385 (14.23%) head scans, 1990 (73.54%) chest scans, 143 (5.28%) abdominal scans, 112 (4.14%) limb scans, and 76 (2.81%) other scans. The typical volume CT dose index (CTDI_vol) for head CT in the age groups of 0- < 1 year, 1- < 5 years, 5- < 10 years, and 10-15 years were 36.21, 35.29, 37.27, and 41.18 mGy, respectively; the corresponding SSDE values were 41.27, 32.82, 30.56, and 28.41 mGy, respectively. For chest CT scans, the typical CTDI_vol for the age groups of 1- < 5 years, 5- < 10 years, and 10-15 years were 1.91, 2.11, and 2.51 mGy, respectively; the corresponding SSDE values were 2.36, 2.21, and 3.50 mGy, respectively. For abdominal CT scans, the typical CTDI_vol for the age groups of 1- < 5 years, 5- < 10 years, and 10-15 years were 3.94, 4.33, and 6.26 mGy, respectively; the corresponding SSDE values were 5.77, 7.10, and 9.79 mGy, respectively. Conclusion This study developed a technical pathway to estimate the medical radiation doses of pediatric CT patients of different ages based on structured dose files and DICOM files. The feasibility of this approach was validated using data collected over a one-year period.

A 13-year-old boy was admitted to the hospital due to 1 month after trauma in a traffic accident on September 29，2017. After admission，due to a large amount of pleural effusion through the chest tube，thoracoscopic exploration and fiberboard dissection were performed，and the postoperative pleural effusion was not significantly reduced. The creatinine of pleural effusion was 913 μmol/L，CT showed that left hydronephrosis and perirenal encapsulated effusion were closely related to the ureter，so ureteral injury and urinothorax were considered. Retrograde ureterography revealed a defect of left ureter，approximately 6 cm in length，and left nephrectomy + left kidney rupture repair + renal autotransplantation was performed. 7 years later，the patient recovered well and the renal blood supply was good，no left hydronephrosis was found by MRU. Early diagnosis of ureteral injury is challenging，especially when accompanied by urinothorax. When life is stable，early diagnosis and treatment can reduce the loss of renal function after combined trauma. Renal autotransplantation is safe and effective for the treatment of long segmental ureteral defects.

Objective:To investigate and compare the clinical effect of anterolateral thigh perforator flap (ALTPF) with a pedicle of the oblique branch and a pedicle of the descending branch of lateral circumflex femoral artery in treatment of wounds in limbs.Methods:From December 2020 to December 2021, a retrospective analysis was performed on 53 patients who received reconstruction of wound with free ALTPF. Patients were divided into a group of ALTPF with oblique branch of lateral circumflex femoral artery (oblique branch group) and a group of ALTPF with descending branch of lateral circumflex femoral artery (descending branch group) according to the vascular pedicle. Of the blique branch group ( n=28): 12 patients had the wound in wrist, 3 in forearm, 7 in ankle and foot, and 6 in calf. The time for ALTPF reconstructive surgery after admission ranged from 0 to 25 days, with an average of 15.3 days. Among the patients, 6 received emergency treatment. The size of soft tissue defect was 5.0 cm×8.0 cm-21.0 cm×10.0 cm, and the size of flap was 6.0 cm×8.5 cm-22.0 cm×10.0 cm. Of the descending branch group ( n=25): 7 patients had the wound in wrist, 3 in forearm, 2 in upper arm, 10 in ankle and foot, and 3 in calf. The time for ALTPF reconstructive surgery after admission ranged from 0 to 22 days, with an average of 14.7 days. Among the patients, 4 received emergency treatment. The size of soft tissue defect was 12.0 cm×4.0 cm-28.0 cm×10.0 cm, and the size of flap was 13.0 cm×5.0 cm-28.0 cm×10.0 cm. The donor sites were directly sutured in layers after the surgery. The number of perforating branches in anterolateral thigh was detected by high-frequency CDU and recorded before surgery. The number, calibre, type of perforating branches observed during surgery and the size of flaps, length of the vascular pedicles of the flaps and the time for flap harvesting were recorded. Postoperative follow-up was conducted through outpatient visits, WeChat and other means. The survival of the flap, the healing of the donor site and complications were observed. The outcomes of flap reconstructive surgery were evaluated by the comprehensive score scale during follow-up. The data were analyzed using SPSS 22.0 statistical software. P<0.05 was considered statistically significant. Results:There is no significant difference in general information between the 2 groups ( P>0.05). In the oblique branch group, the length of vascular pedicle of the flaps was 5.0-15.0 (9.89±2.66) cm, the ratio of intermuscular perforator was 56.52%(26/46), and the inner diameter of perforators was 0.3-1.1 (0.67±0.20) mm and the time for flap harvesting was 22.5 (6.0-75.0) minutes. In the descending branch group, the length of vascular pedicle of the flaps was 7.0-16.0 (11.52±2.67) cm, the proportion of intermuscular perforator was 34.69%(17/49), the inner diameter of perforators of the flap was 0.3-1.2(0.70±0.23) mm and the time for flap harvesting was 35.0 (9.0-78.0) minutes. In comparison with the 2 groups, it was found that the oblique branch group had a shorter length of vascular pedicle, a higher proportion of intermuscular perforating branches and a shorter time in flap harvesting. The difference was statistically significant ( P<0.05). No statistically significant was found in the number and inner diameter of the perforating branches between the 2 groups ( P>0.05). Altogether, 51 flaps in the 2 groups survived. One flap in each group had partial necrosis at the distal end of flap, with the necrotic sizes of 5.0 cm×5.0 cm and 5.0 cm×4.0 cm, respectively, and they healed after skin grafting without obvious vascular. The survival rates of the 2 groups of flaps were 96.43% and 96.00%, respectively. The postoperative follow-up lasted for 6-18 months, with an average of 12 months. The appearance of the flaps in 10 patients was slightly bloated, and flap thinning and plastic surgery were carried out at 4-6 months after the primary flap surgery. Else, all the flaps regained protective sensation, all the donor sites and recipient sites healed well, and the donor sites of the thigh was good without pain, numbness or other discomfort. Comprehensive evaluations of the flaps were conducted at the final follow-up with the comprehensive evaluation scale for flaps. The scores of 28 patients in the oblique branch group achieved 73-98 with an average of 86.3. Twelve patients had the scores in comprehensive evaluation of excellent, 14 of good, and 2 of fair, with the excellent and good rate of 92.86%(26/28). The scores of 25 patients in the descending branch group ranged from 72-97 with an average of 85.8, of which 11 patients had the scores of comprehensive evaluation in excellent, 12 in good and 2 in fair, with the excellent and good rate of 92.00% (23/25). There was no statistically significant difference in the survival rate and comprehensive evaluation scales between the 2 groups of flaps ( P>0.05). Conclusion:ALTPF pedicled with oblique branch of lateral circumflex femoral artery has a higher number of perforating branch, a shorter harvesting time and less damage to the donor site than those of the ALTPF pedicled with descending branch of lateral circumflex femoral artery. When both oblique and descending branches of lateral circumflex femoral artery are present or with the absence of a descending perforating branch, the oblique branch of lateral circumflex femoral artery is the preferred perforating vessel for pedicle in harvesting of an ALTPF.

Objective To explore the diagnostic value of non-contrast chest CT in acute pulmonary thromboembolism(APTE).Methods A total of 187 patients with suspected APTE who underwent non-contrast chest CT and computed tomography pulmonary angiography(CTPA)within 2 h were included.Among 187 patients,there were 89 patients with APTE(APTE group)and 98 patients without APTE(control group).The clinical characteristics and chest CT features between the APTE group and the control group were compared.The sensitivity and specificity of non-contrast chest CT findings in the diagnosis of central APTE and peripheral APTE were analyzed.Results Chest CT showed pulmonary artery hyperdensity sign in 35 cases in the APTE group and none in the control group,with the difference was statistically significant(χ2=47.414,P<0.001);Subpleural shadow appeared in 33 cases in the APTE group and 11 cases in the control group,with the difference was statistically significant(χ2=17.327,P<0.001).The sensitivity and specificity of pulmonary artery hyperdensity sign in the diagnosis of central APTE and peripheral APTE were 72.92%,100%and 0%,100%,respectively.The sensitivity and specificity of sub-pleural shadow in the diagnosis of central APTE and peripheral APTE were 39.58%,88.78%and 34.15%,88.78%,respectively.The difference was not statistically significant in pleural effusion,pulmonary artery diameter,or pulmonary artery diameter to aorta diameter ratio between the two groups.Conclusion The pulmonary artery hyperdensity sign on non-contrast chest CT is a useful sign of APTE,which can avoid CTPA examination.