Objective To investigate CBX2 and TIM3 in salivary adenoid cystic carcinoma(SACC)tissue and their relationship with clinical pathological features and prognosis.Methods 80 patients with SACC who underwent surgical treatment in the First Affiliated Hospital of Hebei North University from January 2016 to January 2020 were selected.Immunohistochemistry was used to measure CBX2 and TIM3 in tissues.The relationship between CBX2 and TIM3 in SACC tissue and prognosis was discussed though Kaplan-Meier method.The factors influencing the prognosis of SACC were discussed using multivariate Cox regression.Results The positive rates of CBX2 and TIM3 in SACC tissues were clearly higher than those in normal glandular tissues adjacent to cancer(χ2=11.237,8.229,P<0.05).The CBX2 and TIM3 were associated with nerve invasion and distant metastasis(P<0.05).After a 5-year follow-up,26 cases died and 54 cases survived,with an overall 5-year survival rate of 67.50%(54/80).The death group had higher positive rates of CBX2 and TIM3 in SACC tissues than the survival group(P<0.05).Patients with positive CBX2 and TIM3 in SACC tissues had clearly lower 5-year survival rate than patients with negative CBX2 and TIM3(Log Rank χ2=6.564,5.197,P<0.05).CBX2,TIM3 positivity,nerve invasion,and distant metastasis were risk factors affecting prognosis(P<0.05).Conclusion The positive expression of CBX2 and TIM3 in SACC tissues is closely related to the clinical pathological features and prognosis of patients.

Tumor immunotherapy,recognized as the fourth major treatment modality alongside surgery,radiotherapy,and chemotherapy,fundamentally relies on mobilizing and enhancing the body's intrinsic immune system to achieve the precise targeting and elimination of neoplastic lesions.In this therapeutic framework,macrophages derived from blood monocyte differentiation serve as critical components of the innate immune defense system and exert profound impacts within the tumor microenvironment(TME).As the dominant inflammatory cell population infiltrating the TME,tumor-associated macrophages(TAMs)not only perform a key function in immune regulation but also serve as a paradigm for the connection between inflammation and tumors.Therapeutic strategies targeting TAMs aim to reverse the immunosuppressive milieu of the TME through multifaceted regulatory mechanisms,including cellular depletion or functional reprogramming,thereby effectively impeding tumor progression.This review systematically analyzes the intricate immune regulatory mechanisms of macrophages in tumor immunotherapy and synthesizes research advancements in major therapeutic agents targeting TAMs,aiming to provide researchers in the field of tumor immunotherapy and developers of macrophage-modulating pharmaceuticals with novel theoretical insights and practical guidelines.

Tumor immunotherapy,recognized as the fourth major treatment modality alongside surgery,radiotherapy,and chemotherapy,fundamentally relies on mobilizing and enhancing the body's intrinsic immune system to achieve the precise targeting and elimination of neoplastic lesions.In this therapeutic framework,macrophages derived from blood monocyte differentiation serve as critical components of the innate immune defense system and exert profound impacts within the tumor microenvironment(TME).As the dominant inflammatory cell population infiltrating the TME,tumor-associated macrophages(TAMs)not only perform a key function in immune regulation but also serve as a paradigm for the connection between inflammation and tumors.Therapeutic strategies targeting TAMs aim to reverse the immunosuppressive milieu of the TME through multifaceted regulatory mechanisms,including cellular depletion or functional reprogramming,thereby effectively impeding tumor progression.This review systematically analyzes the intricate immune regulatory mechanisms of macrophages in tumor immunotherapy and synthesizes research advancements in major therapeutic agents targeting TAMs,aiming to provide researchers in the field of tumor immunotherapy and developers of macrophage-modulating pharmaceuticals with novel theoretical insights and practical guidelines.

Objective To investigate the effect of an intelligent telerehabilitation developed with reinforcement theory on the postoperative functional recovery and return to sport in patients after reconstructive surgery of anterior cruciate ligament.Methods By using the convenience sampling method,120 patients after reconstructive surgery of anterior cruciate ligament at a tertiary general hospital in Wuhan from June 2022 to June 2023 were selected as the research subjects.Sixty patients admitted to our hospital between June 2022 and December 2022 were assigned to a control group,while another 60 patients admitted to our hospital between January 2023 and June 2023 were assigned to an trial group.The patients in the control group received conventional surgical treatment,nursing care and instructions for rehabilitation,whereas additional rehabilitation based on the intelligent telerehabilitation developed with reinforcement theory was given to the patients in the trial group.The two groups were compared in terms of postoperative knee function and compliance with rehabilitation exercise.Results The compliance of the trial group with home rehabilitation training was higher than that of the control group.The comparison between the two groups showed a statistically significant difference(P<0.05).12 months after surgery,patients in the trial group exhibited higher scores in International Knee Documentation Committee Subjective knee form(IKDC)and Lysholm and Gillquist knee scores compared with those in the control group(both P<0.05.Also,the patients in trial group showed lower incidences of pain,swelling and joint instability compared with those in the control group(all P<0.05).At 12 months after surgery,the patients in trial group showed better capability to perform daily activities and participate in sports in comparison with those in the control group(both P<0.05).Conclusion The intelligent telerehabilitation based on reinforcement theory can improve the compliance of patient with rehabilitation.It therefore is able to reduce incidences of postoperative complications such as pain,swelling,knee instability and locking in patients who had the surgery for reconstruction of anterior cruciate ligament.It also enhances the function recovery of knee,and helps patients to resume the activities in life and sports.

This paper aims to discuss the construction and promotion strategy of medical care capacity framework based on the core literacy of palliative care， combining domestic and foreign research and clinical status. The research results show that it is particularly important to construct a framework of medical care competence based on palliative care. The core competencies required for palliative care include the ability to comprehensively evaluate and formulate personalized programs， effective communication skills， interdisciplinary teamwork skills， and the ability to continuously learn and improve themselves. The quality of care can be further improved if the above abilities are incorporated into the framework of medical care ability based on palliative care. However， there are a series of problems in the process of constructing the framework of palliative medical care capacity， such as difficult implementation of policy support， poor professionalism of talent team， single and irregular service model， low social acceptance， and difficult interdisciplinary cooperation and resource integration. After a detailed analysis of the problems， this paper puts forward the countermeasures to construct the framework of caring ability literacy based on palliative care. Effective countermeasures such as increasing policy support， cultivating comprehensive talents， developing diversified palliative care models， improving social recognition， and strengthening interdisciplinary cooperation and resource integration can effectively improve the core literacy and professional ability of medical care personnel， and then promote the development and improvement of palliative care services. In-depth discussion of the above contents can provide scientific reference for building a care model and literacy framework with palliative care as the core.

AIM: To investigate the changes in serum levels of trefoil factor 1(Tff1)and bone morphogenetic protein 4(BMP4)in patients with diabetic retinopathy, and to evaluate their diagnostic value for diabetic retinopathy.METHODS: From January 2022 to January 2024, 186 patients with type 2 diabetes were selected as the study group and divided into a retinopathy subgroup(52 cases)and a non-retinopathy subgroup(134 cases)based on the presence of retinopathy. Another 186 healthy volunteers who underwent physical examinations during the same period were chosen as the control group. Serum Tff1 and BMP4 levels were measured using the enzyme-linked immunosorbent assay(ELISA). Pearson analysis was used to assess the correlation between serum Tff1, BMP4 levels, and clinical data. Multivariate Logistic regression analysis was performed to identify factors influencing the development of retinopathy in type 2 diabetic patients. Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the diagnostic value of serum Tff1 and BMP4 levels for retinopathy in type 2 diabetic patients.RESULTS: Compared to the control group, serum Tff1 levels were lower and BMP4 levels were higher in both retinopathy and non-retinopathy subgroups(all P<0.05). Specifically, serum Tff1 levels were lower and BMP4 levels were higher in the retinopathy subgroup than in the non-retinopathy subgroup(all P<0.05). Pearson analysis revealed that Tff1 levels in type 2 diabetes patients were negatively correlated with disease duration, glycated hemoglobin levels, and triglyceride levels, while BMP4 levels were positively correlated(all P<0.05). Multivariate Logistic regression analysis identified type 2 diabetes duration, glycated hemoglobin, triglycerides, Tff1, and BMP4 as influencing factors for retinopathy development in type 2 diabetes patients(all P<0.05). ROC curve analysis showed that the combined diagnosis of serum Tff1 and BMP4 had an area under the curve(AUC)of 0.901, which was significantly higher than that of Tff1 alone(Z=2.069, P=0.039)and BMP4 alone(Z=2.072, P=0.038).CONCLUSION: Serum Tff1 levels are decreased and BMP4 levels are increased in patients with diabetic retinopathy, and the combined detection of these two markers offers high diagnostic value for diabetic retinopathy.

ObjectiveTo observe the effect of Yifei Jianpi prescription on the of signal transducer and activator of transcription protein 1 （STAT1）/interferon regulatory factor 3 （IRF3） signaling pathway in a pneumonia model induced by lipopolysaccharide （LPS） and to explore the mechanism of Yifei Jianpi prescription in improving lung immune and inflammatory responses. MethodsSixty male SPF SD rats were used in this study. Ten rats were randomly assigned to the normal control group， and the remaining 50 were instilled with LPS in the trachea to establish a pneumonia model. After successful modeling， the rats were randomly divided into the model group， dexamethasone group （0.5 mg·kg^-1）， and Yifei Jianpi prescription high-dose （12 mg·kg^-1）， medium-dose （6 mg·kg^-1）， and low-dose （3 mg·kg^-1） groups， with 10 rats in each group. Treatment was administered once daily， and the normal control and model groups received the same volume of normal saline. After 14 days， flow cytometry was used to detect the classification of whole blood lymphocytes. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum levels of immunoglobulin G （IgG）， immunoglobulin A （IgA）， immunoglobulin M （IgM）， and the content of tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in alveolar lavage fluid （BALF）. Hematoxylin-eosin （HE） staining was used to observe lung tissue pathology and score the damage. Thymus weight， spleen weight， and wet-to-dry weight ratio （W/D） were recorded. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of STAT1， IRF3， IL-6， and interferon-alpha （IFN-α） in lung tissues， while Western blot was performed to assess the protein expression of STAT1， IRF3， IL-6， and IFN-α. ResultsCompared with the normal control group， the model group showed significantly increased proportion of B lymphocytes in peripheral blood， decreased proportions of NK cells and CD4⁺/CD8⁺ （P<0.05， P<0.01）， decreased serum levels of IgG and IgA， significantly increased IgM levels （P<0.01）， significantly elevated content of TNF-α， IL-6， and IL-8 in BALF， and significantly decreased IL-10 levels （P<0.01）. Lung tissue damage was evident， with significant increases in thymus and spleen weights and a higher W/D ratio （P<0.01）. The mRNA and protein expression of STAT1， IRF3， IFN-α， and IL-6 in lung tissues was significantly upregulated （P<0.05，P<0.01）. Compared with the model group， the Yifei Jianpi prescription groups showed significantly reduced proportions of B lymphocytes in peripheral blood， increased proportions of NK cells and CD4⁺/CD8⁺ ratios （P<0.05， P<0.01）， significantly increased serum levels of IgG and IgA， significantly decreased IgM levels （P<0.05， P<0.01）， significantly reduced levels of TNF-α， IL-6， and IL-8 in BALF， and significantly increased IL-10 levels （P<0.01）. Lung tissue damage was alleviated， thymus and spleen weights were significantly reduced， and the W/D ratio was markedly decreased （P<0.01）. The mRNA and protein expression of STAT1， IRF3， IFN-α， and IL-6 in lung tissues was significantly downregulated （P<0.05， P<0.01）. ConclusionYifei Jianpi prescription can alleviate lung tissue damage and improve immune and inflammatory responses in LPS-induced pneumonia rats. The mechanism may be related to the inhibition of STAT1/IRF3 signaling pathway activation.

Objective To analyze influencing factors of small airway dysfunction(SAD)in children with bronchial asthma,and construct a risk prediction model for SAD.Methods A total of 221 bronchial asthma children with normal pulmonary ventilation function were retrospectively selected as the modeling group.According to the presence of SAD,children were divided into the SAD group(43 cases)and the non-SAD group(178 cases).The related factors affecting the occurrence of SAD were analyzed by univariate analysis and multivariate Logistic regression analysis,and risk prediction model of SAD was constructed.In addition,74 bronchial asthma children with normal pulmonary ventilation function were collected and used as the validation group.Hosmer-Lemeshow test was adopted to evaluate the calibration of the model.Receiver operating characteristic(ROC)curve was drawn and area under the curve(AUC)was calculated to evaluate the predictive efficiency of the prediction model.Results Multivariate Logistic regression analysis showed that poor asthma control(OR=10.722,95%CI:4.044-28.428),allergic rhinitis in the attack stage(OR=4.816,95%CI:1.929-12.023)and long use of inhaled corticosteroids(ICS)or ICS/long-acting β2 receptor agonist(LABA,OR=2.903,95%CI:1.269-6.643)were independent risk factors for SAD in children(P＜0.05),and older age at first onset of suspected asthma symptoms(OR=0.599,95%CI:0.395-0.907)was a protective factor.Hosmer-Lemeshow test showed good calibration(χ2=8.301,P=0.307).The AUC,sensitivity and specificity of the model in the modeling group for predicting the occurrence of SAD in children with bronchial asthma were 0.820(95%CI:0.749-0.892),74.42%and 78.65%,and the AUC,sensitivity,specificity and accuracy of the model in the validation group were 0.849(95%CI:0.718-0.981),75.00%,94.83%and 90.54%(67/74).Conclusion Children with bronchial asthma who are younger at the time of their first suspected asthma symptoms,poor asthma control,allergic rhinitis in the exacerbation phase,and longer duration of use of ICS or ICS+LABA/LTRA are at higher risk of SAD.Therefore,SAD risk prediction model constructed on this basis has good predictive ability.

Objective To explore the effect of music therapy on children with autism spectrum disorder(ASD).Methods A systematic search was conducted in databases including CNKI,Wanfang data,VIP,PubMed,Elsevier Sci-ence Direct and Google Scholar for randomized controlled trials(RCT)on the effect of music therapy on children with ASD.The search period was from database inception to April,2024.The control group received non-music therapy interventions,including medication,educational therapy,cognitive-behavioral therapy,and structured treatment.The observation group received music therapy.Studies were systematically reviewed following the Co-chrane Handbook for Systematic Reviews,with two researchers independently screening literatures,extracting data,and assessing the risk of bias in the included studies.Statistic analysis was performed using Review Manag-er 5.4.Results Nine RCTs were included,involving 828 patients from France,China,Norway,Iran,the United States and Aus-tralia.The intervention types mainly included music therapy,parent-child cooperative music therapy,Orff music therapy,group music therapy,improvisational music therapy,Orff-Schulwerk-based music therapy,music inter-vention and family-centered music therapy.The overall outcomes(SMD=-0.30,95%CI-0.55 to-0.04,P=0.02),language function(MD=-2.09,95%CI-2.89 to-1.30,P<0.001)and physical behavior(SMD=-0.27,95%CI-0.53 to-0.01,P=0.040)improved better in the observation group.Conclusion Music therapy can improve the overall outcome of children with ASD,especially in language function and physical behavior.

Objective To investigate the effect of an intelligent telerehabilitation developed with reinforcement theory on the postoperative functional recovery and return to sport in patients after reconstructive surgery of anterior cruciate ligament.Methods By using the convenience sampling method,120 patients after reconstructive surgery of anterior cruciate ligament at a tertiary general hospital in Wuhan from June 2022 to June 2023 were selected as the research subjects.Sixty patients admitted to our hospital between June 2022 and December 2022 were assigned to a control group,while another 60 patients admitted to our hospital between January 2023 and June 2023 were assigned to an trial group.The patients in the control group received conventional surgical treatment,nursing care and instructions for rehabilitation,whereas additional rehabilitation based on the intelligent telerehabilitation developed with reinforcement theory was given to the patients in the trial group.The two groups were compared in terms of postoperative knee function and compliance with rehabilitation exercise.Results The compliance of the trial group with home rehabilitation training was higher than that of the control group.The comparison between the two groups showed a statistically significant difference(P<0.05).12 months after surgery,patients in the trial group exhibited higher scores in International Knee Documentation Committee Subjective knee form(IKDC)and Lysholm and Gillquist knee scores compared with those in the control group(both P<0.05.Also,the patients in trial group showed lower incidences of pain,swelling and joint instability compared with those in the control group(all P<0.05).At 12 months after surgery,the patients in trial group showed better capability to perform daily activities and participate in sports in comparison with those in the control group(both P<0.05).Conclusion The intelligent telerehabilitation based on reinforcement theory can improve the compliance of patient with rehabilitation.It therefore is able to reduce incidences of postoperative complications such as pain,swelling,knee instability and locking in patients who had the surgery for reconstruction of anterior cruciate ligament.It also enhances the function recovery of knee,and helps patients to resume the activities in life and sports.