Objective: To investigate the status of heat illness, knowledge awareness and adaptive behaviors of heat wave knowledge among food delivery riders, so as to provide a basis for optimizing heat wave response measures for food delivery riders. Methods: In November 2022, food delivery riders from a large food delivery platform in Ningbo City, Zhejiang Province were selected as survey subjects using a cluster sampling method. A self-designed electronic questionnaire was used to select demographic information, work status, lifestyle behaviors and disease history, heat illness status, knowledge awareness and adaptive behaviors of heatwave. Results: A total of 911 questionnaires were distributed, and 830 valid questionnaires were recovered, resulting in a valid response rate of 91.11%. Among the respondents, 796 (95.90%) were male, and 818 (98.55%) worked full-time. The mean age was (27.75±8.00) years. A total of 470 respondents (56.63%) had a work tenure of less than 1 year. The primary working hours were 8-<12 hours, with 504 people accounting for 60.72%. There were 108 cases of heatstroke, with an occurrence rate of 13.01%. And 286 people reported heat-related symptoms, with an occurrence rate of 34.46%. The overall awareness rate of heat wave knowledge was 73.22%, while the awareness rate of heat warning signal classification was relatively low at 9.04%. The heat wave cognition score was (5.86±1.31) points. There were statistically significant differences in heat wave cognition scores among food delivery riders of different ages, educational levels, family annual income, work tenures, and work durations (all P<0.05). Regarding positive adaptive behaviors, the number of riders paying attention to weather forecasts and actively learning about preventive measures was higher (734 people each, accounting for 88.43%). Regarding negative adaptive behaviors, the number of riders who often drank ice-cold beverages was higher (509 people, accounting for 61.33%). The heat wave adaptive behavior score was (6.88±1.77) points. There were statistically significant differences in adaptive behavior scores among riders with different educational levels, family annual income, work tenures, and smoking frequency (all P<0.05). Conclusions The occurrence rates of heatstroke and heat-related symptoms among food delivery riders are relatively high. The knowledge awareness and adaptive behaviors regarding heat wave are at a moderate level. It is suggested to strengthen health education, reinforce risk cognition of heat wave, and promote positive adaptive behaviors among food delivery riders.

Spinal cord injury （SCI） is a prevalent neurological disorder that often results in motor， sensory， cognitive， balance， and walking impairments， and can even lead to pain， significantly affecting the physical and mental health and quality of life of patients. Conventional treatment methods， primarily conducted in hospital settings， tend to be monotonous and lack engagement， leading to low patients’ compliance， motivation and cooperation. In contrast， virtual reality （VR） technology can serve as an effective adjunctive therapeutic approach， immersing patients in simulated virtual environments for functional training in specific contexts and tasks， thereby providing a sense of real experience to achieve assessment and therapeutic outcomes. The interactive and engaging nature of VR technology markedly enhances patients’ interest and motivation in treatment， offering new possibilities for home-based rehabilitation and presenting patients with alternative treatment options. This review systematically introduces the application of VR technology in the treatment of patients with SCI， focusing on its roles in assessing functional impairments， improving motor function， enhancing balance and walking abilities， alleviating pain， and promoting recovery from cognitive and psychological disorders， as well as its impact on other functional impairments and its combined use with other technologies. Furthermore， this article delves into the current advantages and limitations of VR technology， aiming to deepen the understanding of VR among physicians and therapists， promote its widespread clinical application， advance the field of rehabilitation medicine， provide theoretical foundations and directions for future research， and offer new insights and references for clinical practice.

Objective: To explore the clinical and imaging characteristics of patients with regional odontodysplasia accompanied by hypodontia and to provide a reference for clinical diagnosis and treatment. Methods: This report presents the imaging manifestations, diagnosis, and treatment of a case of regional odontodysplasia (RO) accompanied by hypodontia. It includes a retrospective summary of the dynamic changes in the imaging characteristics of the affected teeth over a 5-year period, along with a comparative analysis of the literature. The patient was a 9-year-old female who presented to the Clinic of Oral Rare and Genetic Diseases of our hospital with the chief complaint of “discomfort for over seven months following the extraction of the teeth in the left mandibular region.” Based on her clinical manifestations and imaging findings, she was diagnosed with RO in the left mandible and with hypodontia of permanent teeth 12 and 34. A treatment plan was formulated, and long-term follow-up was conducted. The current radiographic images were compared with previous imaging data to summarize the developmental changes in her teeth, and a comparative analysis was also performed with the literature to identify similarities and differences with previously reported RO dental characteristics. Results: During the follow-up period, the patient's symptoms did not worsen, and a conservative observation approach was adopted; the treatment plan was decided after the eruption of the affected teeth. By comparing and analyzing imaging data from three ages (4.5, 8.5, and 9 years old), it was determined that the deciduous and permanent teeth in the left mandible of this patient exhibited typical “ghost” radiographic features, alongside hypodontia of teeth 12 and 34, as well as the delayed development of tooth 35. A literature review and analysis indicated that RO manifests clinical characteristics such as delayed tooth eruption, reduced tooth size, and yellow crowns, along with typical “ghost” radiographic appearances. Treatment requires a personalized approach based on the patient’s specific condition. To date, only five cases of RO patients with hypodontia have been reported, while the delayed development of permanent tooth buds has not yet been documented. Conclusion For patients with RO, dynamic imaging evaluation plays a critical role in early diagnosis. RO is associated with hypodontia and delayed tooth germ development. Long-term follow-up and personalized treatment plans are the key to RO treatment.

Chronic obstructive pulmonary disease （COPD） is a common clinical chronic airway disease with high morbidity， high mortality， a heavy disease burden， and complex mechanisms that have not been fully elucidated. Clinical problems promote the continuous progress of basic research. The establishment and evaluation of animal models is an important way to delve into the pathogenesis and treatment strategies of COPD. On the basis of the etiology， pathogenesis， diagnostic criteria， and syndrome differentiation of COPD in traditional Chinese medicine （TCM） and Western medicine， this paper summarizes the establishment methods and characteristics of existing animal models of COPD and analyzes the fitting degree of the models with the disease characteristics in Western medicine and syndrome characteristics in TCM. The results showed that the animal models of COPD in Western medicine were mainly induced by single factors and compound factors， and the model with the highest fitting degree was established by cigarette smoke combined with lipopolysaccharide and hormone. The model showed a fitting degree of 84% with the disease characteristics in Western medicine and 70% with the syndrome characteristics in TCM， being consistent with the clinical characteristics of COPD induced by multiple factors. Most of the animal models of COPD in TCM were established on the basis of disease models and combined with TCM etiology and pathogenesis characteristics， and prepared by syndrome differentiation. Among them， the model of accumulation of cold and water retention in lung had the highest fitting degree of 92% with the TCM diagnostic criteria. The models of phlegm-heat obstructing lung and phlegm-stasis obstructing lung had the fitting degree of 94% with clinical manifestations in Western medicine and the highest fitting degree with the diagnostic criteria in Western medicine. Different animal models of COPD have their own advantages and disadvantages， and most of them simply replicate the manifestations of COPD at a certain stage， failing to reflect the multiple causes and the dynamic changes of TCM etiology and pathogenesis. Moreover， the syndromes of these models fail to match the clinical syndromes in TCM. Therefore， establishing the animal models reflecting clinical characteristics of COPD in TCM and Western medicine and improving the model evaluation criteria are important contents to promote the overall development of integrated traditional Chinese and western medicine for COPD.

OBJECTIVE To systematically evaluate the efficacy and safety of different chemotherapy combination regimens for first-line treatment of metastatic colorectal cancer （mCRC）. METHODS PubMed， Cochrane Library， Embase and Web of Science were electronically searched to collect randomized controlled clinical trial （RCT） on first-line treatment for mCRC from January 1， 2000 to February 16， 2025. Two reviewers independently screened literature， extracted data and assessed the risk of bias of the included studies. Network meta-analysis was performed by using R4.4.3 and Stata 17.0 software. RESULTS A total of 28 RCTs， involving 16 intervention measures， were included. In terms of prolonging progression-free survival （PFS） and overall survival （OS）， FOLFOX （5-fluorouracil+oxaliplatin+calcium folinate regimen）+cetuximab had the highest probability of ranking first. In terms of improving objective response rate （ORR）， FOLFOXIRI （5-fluorouracil+oxaliplatin+irinotecan+calcium folinate regimen）+ bevacizumab and FOLFOX+bevacizumab+nivolumab had the highest probability of ranking first； in terms of the incidence of grade 3 or higher adverse reactions， FOLFOXIRI+panitumumab had the highest probability of ranking first； in subgroup analysis of KRAS wild-type patients， FOLFIRI （5-fluorouracil+irinotecan+calcium folinate regimen）+panitumumab and FOLFIRI+bevacizumab had the highest probability of ranking first in terms of prolonging PFS and OS， respectively； in terms of ORR， FOLFOXIRI+ cetuximab had the highest probability of ranking first. CONCLUSIONS In first-line treatment for mCRC， FOLFOX combined with targeted therapy has advantages in terms of efficacy and safety. However， individualized treatment strategies should be formulated based on the KRAS gene status and tumor location of patients.

Objective To investigate the effects of cucurbitacin B (CucB) on alleviating skin lesions and inflammation in psoriasis mice via the cGAS-STING signaling pathway. Methods The expression of genes associated with the cGAS-STING signaling pathway in psoriatic lesions and non-lesional skin was analyzed, and hallmark gene set enrichment analysis was performed. The cytotoxicity of CucB on BMDMs was evaluated using the CCK-8 assay. The expression levels of genes and proteins related to the cGAS-STING signaling pathway, along with the secretion of inflammatory cytokines, were measured at different concentrations of CucB using quantitative PCR, Western blotting, and ELISA. Imiquimod-induced psoriasis BALB/c mice were divided into four groups: normal group, model group, low-dose CucB group [0.1 mg/ (kg.d)], and high-dose CucB group [0.4 mg/ (kg.d)], with five mice per group. PASI scoring was performed to assess the severity of psoriasis after 6 days of treatment, and HE staining was conducted to observe pathological damage. Meanwhile, the mRNA levels of inflammatory cytokines and their secretion were detected by qPCR and ELISA. Results Most cGAS-STING signaling-related genes were upregulated in lesional skin of psoriasis patients, and the hallmark gene set enrichment analysis revealed that the most significantly upregulated genes were primarily associated with immune response signaling pathways. CucB inhibited dsDNA-induced phosphorylation of interferon regulatory factor 3 (IRF3) and STING proteins in both bone-marrow derived macrophages(BMDMs) and THP-1 cells. CucB also suppressed dsDNA-induced mRNA expression of IFNB1, TNF, IFIT1, CXCL10, ISG15, and reduced the secretion of cytokines such as IFN-β, IL-1β, and TNF-α in THP-1 cells. In the imiquimod-induced psoriasis mouse model, CucB treatment reduced psoriatic symptoms, alleviated skin lesions, and attenuated inflammation. ELISA and qPCR results showed that CucB significantly reduced serum secretion levels of IL-6, TNF-α, and IL-1β, as well as the mRNA levels of IL23A, IL1B, IL6, TNF, and IFNB1. Conclusion CucB inhibits cytoplasmic DNA-induced activationc of the GAS-STING pathway. CucB significantly attenuates skin lesions and inflammation in IMQ-induced psoriatic mice, and the potential molecular mechanism may be related to the down-regulation of the cGAS-STING pathway.
Animals ; Psoriasis/pathology* ; Signal Transduction/drug effects* ; Membrane Proteins/genetics* ; Mice ; Nucleotidyltransferases/genetics* ; Disease Models, Animal ; Mice, Inbred BALB C ; Skin/metabolism* ; Triterpenes/therapeutic use* ; Humans ; Cytokines/metabolism* ; Inflammation/drug therapy* ; Male

AIM: To analyze the clinical utility and value of the ultra-wide-field swept-source optical coherence tomography angiography(UWF-SS-OCTA)technique in changes of blood flow density and thickness in the central and peripheral regions of the retina and choroid in patients with nonproliferative diabetic retinopathy(NPDR)with or without diabetic kidney disease(DKD).METHODS: Cross-sectional study. Totally 50 cases(50 eyes)of diabetes mellitus(DM)that visited our hospital between June 2023 and June 2024 were included. They were divided into three groups: NPDR combined with DKD group(DKD group, n=20), NPDR without DKD group(NDKD group, n=20), and DM without retinopathy group(DM group, n=10, which served as control). In order to investigate the impact of DKD on ocular microangiopathy in NPDR patients, the retina and choroid within 24 mm×20 mm of the scan were separated into central and peripheral areas using the 3×3 nine-grid partition option that comes with UWF-SS-OCTA, and the parameters were then quantitatively assessed.RESULTS:The central and peripheral blood flow density of the choroidal capillary layer(CCP)was statistically significant between the DM group and the DKD group(t=3.93, P=0.0003; t=3.34, P=0.0016), and between the NDKD group and the DKD group(t=-3.06, P=0.003; t=-2.55, P=0.013), but there was no statistically significant difference between the DM group and the NDKD group(t=1.44, P=0.157; t=1.26, P=0.21). The mid-large choroidal vessel(MLCV)showed a progressive decline in central and peripheral blood flow density in the DM, NDKD, and DKD groups(F=13.74, 19.03, all P<0.0001). The DM, NDKD, and DKD groups saw a progressive decrease in central and peripheral choroidal thickness(CT; F=10.72, P=0.0001; F=13.12, P<0.001).CONCLUSION:CCP, MLCV, and CT can be used as visual indicators to identify impaired renal function in patients with NPDR. UWF-SS-OCTA can support the development of precise and noninvasive monitoring and treatment technology for diabetic ocular microangiopathy, while also offering a scientific foundation for the joint management of DR and DKD.

Objective:To assess the association of single nucleotide polymorphisms (SNPs) of interleukin-23 receptor ( IL-23R) gene with susceptibility to psoriasis. Methods:Two hundred and ten psoriasis patients admitted to Xinxiang Central Hospital from January 2019 to December 2024 were selected as the study group, and 210 healthy individuals undergoing physical examination during the same period were selected as the control group. 3 mL of peripheral venous blood sample was collected from each individual from the two groups, and PCR - Restriction fragment length polymorphism (PCR-RFLP) assay was used to determine the polymorphisms of the IL-23R gene at rs2201841, rs1004819, rs10889677, rs1343151 and rs1495965 loci. Genotypic and allelic distribution of each SNP locus was calculated to assess the association between SNPs of the IL-23R gene with the onset of psoriasis, and the difference in serum IL-23 levels among patients with different genotypes at each locus was compared. This study was approved by the Medical Ethics Committee of Xinxiang Central Hospital (Ethic No. 2024-749). Results:The results showed that the frequency of CC genotype at rs1004819 locus of the study group was significantly higher than that of the control group (26.19% vs. 18.10%, P<0.05), and the frequency of C allele was also significantly higher than that of the control group (54.05% vs. 42.62%, P<0.05). There was no significant difference in allelic and genotypic frequencies between the two groups at rs2201841, rs10889677, rs1343151, and rs1495965 loci ( P>0.05). The dominant and recessive inheritance patterns at the rs1004819 locus are associated with susceptibility to psoriasis ( P<0.05), while the different inheritance patterns at rs2201841, rs10889677, rs1343151, and rs1495965 loci are not associated with psoriasis ( P>0.05). The serum IL-23 levels of patients with CC genotype at the rs1004819 locus were higher than those with CT and TT genotypes ( P<0.05). No significant difference was detected in the serum levels of IL-23 between patients with different genotypes for the rs2201841, rs10889677, rs1343151, and rs1495965 loci ( P>0.05). Conclusion:The polymorphism at the rs1004819 locus of the IL-23R gene is associated with susceptibility to psoriasis, and individuals carrying the CC genotype and C allele have a higher risk of developing the disease.

Objective:To determine the median effective dose (ED 50) of oliceridine inhibiting responses to insertion of the gastroscope when combined with propofol in obese patients. Methods:In this prospective study, American Society of Anesthesiologists Physical Status classification I or Ⅱ patients of either sex, with a body mass index of ≥28 kg/m 2, undergoing elective painless gastroscopy, were selected. Propofol 1.5 mg/kg was slowly injected intravenously 2 min after intravenous injection of oliceridine. Gastroscopy was performed after the patient′s eyelash reflex disappeared and the jaw was relaxed. The optimal dose was determined by modified Dixon′s up and down method. The initial dose of oliceridine was 0.015 mg/kg, and the ratio between the two successive concentrations was 1.0∶1.2. If the patient had a positive response that affected the examination operation such as swallowing, bucking and body movement during insertion of the gastroscope, the next patient received a higher dose, or conversely if negative, a lower dose was given in the next patient. This process was repeated until the 7th turning point occurred. The ED 50 and 95% confidence interval of olicerdine inhibiting responses to insertion of the gastroscope were calculated by probit method. Results:A total of 21 patients were included in this study, the ED 50 of olicerdine inhibiting responses to implantation of the gastroscope was 0.016 mg/kg, and the 95% confidence interval was 0.010-0.023 mg/kg when combined with propofol 1.5 mg/kg in obese patients. One patient developed hypoxemia. One patient had mild dizziness after operation. Conclusions:The ED 50 of olicerdine inhibiting responses to implantation of the gastroscope is 0.016 mg/kg when combined with propofol 1.5 mg/kg in obese patients.

Objective:To analyze the clinical characteristics of patients with pregnancy-related chronic pain visiting the pain clinic.Methods:The number of pregnant patients who completed a pregnancy registration at the Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from 2022 to 2024 was collected. The medical records were reviewed to identify the patients who visited the department of pain of our hospital due to chronic pain related to pregnancy. The clinical characteristics such as the visiting situation, gestational weeks, age and types of pain were analyzed.Results:From 2022 to 2024, the total number of registered pregnant patients was 64, 818, of which, 2, 224 cases visited the pain clinic, and the annual proportions of pregnancy-related chronic pain visits were 2.540%, 3.836% and 3.889% respectively. Among the patients who attended the clinic, 77.97% were pregnant (5.82% in early pregnancy, 41.93% in mid-pregnancy, and 52.25% in late pregnancy), and 21.03% were postpartum patients. A total of 83.72% were aged 20-34 yr. The types of pain were pelvic girdle pain (40.96%), limb joint pain (28.82%), low back pain (14.16%), cervical spondylosis (3.64%), peripheral nerve entrapment syndrome (3.42%), headache (2.97%), chest and back pain (2.79%), pelvic and perineal pain (1.66%), neuralgia (0.94%) and other pains (0.63%).Conclusions:From 2022 to 2024, the proportion of registered pregnant women at our hospital who visited to the pain clinic due to pregnancy-related chronic pain increases year by year. The common types of pain are pelvic girdle pain, limb joint pain and low back pain.