Objective To study the risk factors of preoperative deep vein thrombosis(DVT)in middle-aged and elderly patients with lower limb fractures,and establish and evaluate the constructed nomogram model.Methods A retrospective analysis was conducted on the clinical data of totally 240 middle-aged and elderly patients with lower limb fractures at Quanzhou First Hospital Affiliated to Fujian Medical University from July 2023 to June 2024.According to whether the patient had DVT before surgery,they were divided into a DVT group of 75 cases and a non DVT group of 165 cases.The differences in clinical data and some labora-tory indicators levels at the time of initial admission,including platelets(PLT),prothrombin time(PT),ac-tive partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT),D-dimer(D-D),total pro-tein(TP),albumin(ALB),triglycerides(TG),cholesterol(CHOL),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)between two groups were compared.Logistic binary regression was used to analyze the risk factors of DVT and a nomogram model was constructed.Receiver oper-ating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of various risk factors and nomo-gram model in screening DVT.Results Compared age and D-D levels of the DVT group were significantly higher(P＜0.001),while the levels of APTT,TP and ALB were significantly lower(P＜0.05),and the pro-portion of DVT combined with internal diseases and the proportion of fractures in the femur were significantly higher(P＜0.001).The above-mentioned differential indicators were all single risk factors for DVT.ROC curve analysis showed that except for comorbidities of internal medicine,all other risk factors could effectively screen for DVT(P＜0.05),the area under the curve(AUC)was 0.573-0.706,and the constructed nomo-gram model could effectively improve AUC to 0.797.Conclusion The nomogram model constructed based on single risk factors for DVT in this study is helpful for clinical assessment of the risk of DVT occurrence in pa-tients at the early stage of admission,intuitively and effectively.

Objective: To explore the active components, key targets, and mechanism of action of turnip in alleviating pulmonary fibrosis(PF) based on network pharmacology and animal experiments. Methods: The active components and targets of Brassica rapa L. were screened using the traditional Chinese medicine systems pharmacology database and analysis platform database, and PF-related targets were obtained from disease databases such as online mendelian inheritance of man(OMIM) and DrugBank. The intersection targets were used to construct a protein-protein interaction(PPI) network to identify core targets, followed by gene oncology(GO)/Kyoto encyclopedia of genes and genomes(KEGG) pathway enrichment analysis. In the animal experiments, a bleomycin-induced PF mouse model was established. Pathological changes in lung tissue were evaluated using HE and Masson staining. qRT-PCR was used to detect the mRNA expression of tumor necrosis factor-α(TNF-α), phosphatidylinositol 3-kinase(PI3K), and akstrain transforming 1(AKT1), and immunofluorescence staining was used to measure the protein expression of TNF-α, PI3K, and AKT1. Results: The 68 active components identified in Brassica rapa L. may regulate PI3K-Akt signaling pathway by acting on 89 potential targets such as TNF-α and AKT1. The results of animal experiments showed that polysaccharide of Brassica rapa L.(BRPs) could significantly reduce the degree of bleomycin induced pulmonary fibrosis in mice; HE and Masson staining of lung tissue showed that compared with the model group, the damage of alveolar structure, the infiltration of inflammatory cells and the deposition of collagen fibers in the BRPs treatment group were significantly reduced. Further mechanism studies showed that BRPs could significantly down-regulate the mRNA and protein expression levels of TNF-α, PI3K and AKT1 in lung tissue of pulmonary fibrosis mice. Conclusion Brassica rapa L. can synergistically alleviate pulmonary fibrosis through “multi-component, multi-target and multi-channel” approach; BRPs is one of the main active components, and plays an anti-fibrosis role by inhibiting TNF-α/PI3K Akt signaling pathway.

Fracture healing is a complex process that necessitates the synergistic action of various cells and molecules. Macrophages play an indispensable and crucial regulatory role in the process of fracture repair, influencing stages such as inflammatory modulation, angiogenesis, and tissue remodeling. This article delves into the functional characteristics of macrophages and their roles at different stages of fracture healing. Additionally, it explores the impact of aging macrophages on the healing process. Furthermore, the potential of emerging therapies, such as hydrogel-based treatments and exosomes, in modulating macrophage responses is analyzed. This study provides a theoretical foundation for the development of innovative therapies aimed at enhancing the efficacy of fracture healing.

Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Virtual avatar possesses unique advantages such as high degree of realism,immersion and visualization,and the research on applying it to the assessment and treatment of anorexia nervosa is increasing year by year.In terms of assessment,there are mainly avatar versions of the figure rating scales,yes-no tasks and its variations,method of adjustment,and the use of virtual cylinder technique.In terms of treatment,there are mainly intervention methods based on virtual avatar exposure therapy,body swapping illusions,perceptual/attention training and self-empowerment,as well as some new potential interventions.Overall,the current research around anorexia nervosa using virtual avatar techniques is still in its early stages and there is still a lot of room for further exploration.

Objective:To explore the effect of empagliflozin combined with levosimendan on plasma levels of type Ⅰcollagen(Collagen Ⅰ),connective tissue growth factor(CTGF),and α-smooth muscle actin(α-SMA)in patients with coronary heart disease(CHD)and heart failure(HF).Methods:This randomized controlled study enrolled 106 CHD+HF patients admitted to Linfen Central Hospital between June 2022 and June 2023.Patients were divid-ed into control group(n=53,treated with levosimendan)and combined treatment group(n=53,received addition-al empagliflozin).Both groups were treated for 12 weeks.The total effective rate,exercise endurance,cardiac function,levels of HF biomarkers,inflammatory factors,myocardial fibrosis indexes and incidence of adverse reac-tions were compared between two groups.Results:The total effective rate of combined treatment group was signif-icantly higher than that in the control group(94.34％vs.81.13％,P＜0.001).Compared with patients in the con-trol group,those in the combined treatment group had significant higher cardiac output(CO)[(4.62±0.89)L/min vs.(3.90±0.75)L/min],left ventricular ejection fraction(LVEF)[(55.42±6.09)％vs.(48.97±5.74)％]and 6-minute walking distance(6MWD)[(405.69±56.47)m vs.(295.65±41.32)m](P＜0.001 all),and signifi-cant lower levels of N-terminal pro B-type natriuretic peptide(NT-proBNP)[(192.06±29.02)pg/ml vs.(313.58±20.98)pg/ml],soluble suppression of tumorigenicity 2(sST2)[(53.33±5.79)μg/L vs.(60.04±6.88)μg/L],interleukin-1β(IL-1β)[(18.16±5.42)ng/L vs.(21.07±6.31)ng/L],high-sensitive C-reactive protein(hsCRP)[(1.69±0.41)mg/L vs.(1.98±0.56)mg/L],tumor necrosis factor α(TNF-α)[(0.87±0.26)ng/L vs.(1.19±0.32)ng/L],Collagen Ⅰ[(162.58±30.55)μg/L vs.(189.98±41.32)μg/L],CTGF[(114.26±14.89)μg/L vs.(125.87±19.47)μg/L]andα-SMA[(90.63±19.57)μg/L vs.(101.39±23.62)μg/L](P＜0.05 or＜0.01).There was no significant difference in the incidence of adverse reactions between two groups(15.09％vs.16.98％,P=0.791).Conclusion:Empagliflozin combined with levosimendan has a significant therapeutic effect in patients with coronary heart disease and heart failure,which calld significantly improve cardiac function,exercise endurance,reduce levels of heart failure biomarkers and inflammatory factors,and inhibit myo-cardial fibrosis.

Objective:To explore the related factors and independent risk factors of radiation pneumonitis (RP) in breast cancer patients after radiotherapy, and to guide the optimization of treatment plan for BC and reduce the incidence of RP.Methods:A retrospective analysis was conducted on 770 female breast cancer patients who received postoperative radiotherapy at Deyang People's Hospital between July 2021 and September 2024. The occurrence of RP was observed, and potential clinical and dosimetric factors were analyzed. Continuous variables were assessed using the t-test, categorical variables with the chi-square test, and univariate analysis was used to identify factors associated with RP. Multivariate logistic regression analysis was used to find out the independent risk factors of RP, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor. Results:Among 770 patients, 46 developed RP (34 grade 1, 12 grade 2). Univariate analysis showed that surgical method, chemotherapy regimen, interval between chemotherapy and radiotherapy, age, planning target volume, and maximum dose of the ipsilateral lung were not associated with RP (all P>0.05). Clinical stage ( χ2=7.84, P=0.020), chest wall + supraclavicular + internal mammary lymph node irradiation ( χ2=104.50, P<0.001), supraclavicular + internal mammary lymph node irradiation ( χ2=8.90, P=0.003), number of chemotherapy cycles ( t=9.88, P<0.001), and ipsilateral lung V 5 Gy( t=16.47, P<0.001), V 10 Gy( t=18.70, P<0.001), V 15 Gy( t=20.23, P<0.001), V 20 Gy( t=23.39, P<0.001), V 25 Gy( t=21.68, P<0.001), V 30 Gy( t=21.67, P<0.001), V 35 Gy( t=20.67, P<0.001), V 40 Gy( t=19.96, P<0.001), V 45 Gy( t=18.59, P<0.001), V 50 Gy( t=11.69, P<0.001), D mean( t=30.76, P<0.001) were significantly correlated with the occurrence of RP. Multivariate analysis revealed that ipsilateral lung V 5 Gy ( OR=1.258, 95% CI: 1.143-1.384, P<0.001), number of chemotherapy cycles ( OR=2.767, 95% CI: 1.781-4.299, P<0.001), and chest wall + supraclavicular + internal mammary lymph node irradiation ( OR=7.926, 95% CI: 2.943-21.349, P<0.001) were independent risk factors for RP. Using V 5 Gy=51.65% as the diagnostic cutoff, the sensitivity and specificity for predicting RP were 0.870 and 0.804, respectively. Taking the number of chemotherapy cycles=6.50 as the cutoff, the sensitivity and specificity of predicting RP were 0.891 and 0.586, respectively. Taking 0.50 as the diagnostic cutoff point, the sensitivity and specificity of chest wall + supraclavicular + internal mammary lymph node irradiation for RP were 0.870 and 0.797, respectively. Conclusions:The number of chemotherapy cycles, ipsilateral lung V 5 Gy, and chest wall + supraclavicular + internal mammary lymph node irradiation are independent risk factors for RP in postoperative female breast cancer patients.