The spine is the most common site of skeletal metastasis in lung cancer, which frequently leads to severe complications such as pathological fracture and neurological compromise and is associated with poor prognosis. The development and progression of spinal metastasis from lung cancer are linked to the unique local microenvironment and tumor microenvironment (TME) of the vertebral column. During metastatic evolution, the dense vascular network of the spine and a plethora of signaling molecules, together with the complex cellular constituents and their intricate interactions within the TME, all cooperate to facilitate the tumor invasion and colonization of the vertebral compartment. Mechanistic studies delineating the role of the TME in spinal metastasis from lung cancer have markedly expanded, fostering the emergence of innovative therapeutic strategies—including nanomedicines, sono-photodynamic therapy, gene therapy, and combination regimens. These strategies demonstrate remarkably potential for clinical translation and offer new directions for the precision management of spinal metastasis from lung cancer.

Objective To analyze risk factors of acute cardio-cerebrovascular accidents in elderly patients with lower extremity fracture,and to construct a risk prediction diagram model.Methods A retrospective analysis was conducted on the clinical data of 510 elderly patients with lower extremity fractures,and the patients were divided into the occurrence group and the non-occurrence group based on the occurrence of acute cardiovascular and cerebrovascular accidents during the postoperative hospitalization.Univariate and multivariate Logistic regression analysis was used to analyze risk factors affecting acute cardiovascular and cerebrovascular accidents in elderly patients with lower extremity fracture,and the risk prediction model was constructed and verified.Results A total of 52 cases of acute cardio-cerebrovascular accidents occurred during hospitalization in 510 patients(10.20%).Age,ASA grade Ⅲ ratio,preoperative concurrent cerebrovascular disease,postoperative pneumonia ratio and postoperative bed time≥5 days ratio were higher in the occurrence group than those in the non-occurrence group(P＜0.05).Multivariate Logistic regression analysis showed that age,ASA grade Ⅲ,preoperative concurrent cardiovascular and cerebrovascular disease,and postoperative pneumonia were risk factors for acute cardio-cerebrovascular accidents in elderly patients with lower limb fracture(P＜0.05).Multivariate Logistic regression analysis was used to screen risk factors as predictive variables to build a risk early warning histogram model for acute cardio-cerebrovascular accidents.The total score ranged from 103 to 168 points,corresponding to a risk range of 0.1 to 0.9 points.Receiver operating characteristic curve(ROC)curve results showed that the area under the curve(AUC)of this model for predicting acute cardiovascular and cerebrovascular accidents was 0.980(95%CI:0.964-1.000),and discrete choice approach(DCA)showed that when the risk threshold was 0.2-0.6,the prediction model of this column graph had a good clinical advantage.Conclusion The risk diagram model constructed based on risk factors has good predictive value for the occurrence of acute cardio-cerebrovascular accidents after lower extremity fracture in elderly patients.

New Medical Sciences, as a crucial initiative in transforming and upgrading medical education and healthcare services in China, has promoted deep integration of public health with multiple disciplines. However, the public health discipline still faces numerous challenges such as disease prevention system reconstruction, insufficient technological innovation, and the shortage of professional talents. To address these issues, this paper discusses the current status, challenges, and development of the public health discipline in the context of New Medical Sciences, and proposes strategies including reforming talent cultivation models, enhancing practical capabilities, strengthening faculty development, promoting the innovation of scientific research and social service, actively utilizing artificial intelligence technology, and optimizing international cooperation. These measures aim to achieve innovative development in the public health discipline, and better serve the Healthy China strategy and global public health initiatives.

We report a 30-year-old woman who presented with intermittent gross hematuria and left flank pain，and CT revealed a left staghorn stones. The initial percutaneous nephrolithotomy（PCNL）left a 6 mm fragment，and both stone and urine cultures yielded extended-spectrum β-lactamase（ESBL）-producing Escherichia coli. Seven months later，the stone increased to 6 cm and urine culture revealed Proteus mirabilis. Endoscopic combined intrarenal surgery（ECIRS）achieved complete clearance. At 6-month follow-up，the patient remained asymptomatic，culture-negative，and stone-free. This case highlights that small residual fragments after PCNL may rapidly enlarge with secondary urease-producing infection，underscoring the need for early re-intervention and standard follow-up.

We report a 30-year-old woman who presented with intermittent gross hematuria and left flank pain，and CT revealed a left staghorn stones. The initial percutaneous nephrolithotomy（PCNL）left a 6 mm fragment，and both stone and urine cultures yielded extended-spectrum β-lactamase（ESBL）-producing Escherichia coli. Seven months later，the stone increased to 6 cm and urine culture revealed Proteus mirabilis. Endoscopic combined intrarenal surgery（ECIRS）achieved complete clearance. At 6-month follow-up，the patient remained asymptomatic，culture-negative，and stone-free. This case highlights that small residual fragments after PCNL may rapidly enlarge with secondary urease-producing infection，underscoring the need for early re-intervention and standard follow-up.

Purpose To explored the correlation between imaging features and patient's blood markers based on quantitative analysis of urate deposition in acute exacerbations of gouty arthritis of the knee by dual-energy spectrum CT(DECT).Materials and Methods A retrospective analysis was conducted on energy spectrum CT imaging of 72 patients clinically diagnosed with acute gouty knee osteoarthritis and 87 patients with non-gouty knee disease during the acute exacerbation period at the First Hospital of Qiqihar from January 2020 to September 2023.The analysis aimed to evaluate urate deposition in different parts of the knee joints and to analyze the influencing factors of urate deposition combined with the blood test indexes of the patients via receiver operating characteristic curves.Results The neutrophil lymphocyte ratio showed a positive correlation with C-reactive protein,erythrocyte sedimentation rate,and urate concentration at the site of urate deposition in gouty nodules of the knee(r=0.354,0.326,0.260,respectively,all P<0.05).The mean platelet volume was significantly positive correlated with the semi-quantitative data of monosodium urate crystals and urate concentration in the knee(r=0.563,0.257,respectively,P<0.05).In the gout group,C-reactive protein was positively correlated with pararticular soft tissue urate concentration and bone urate concentration(r=0.498,0.166,P<0.05),while erythrocyte sedimentation rate was positively correlated with pararticular soft tissue(tendons,ligaments,etc)urate concentration(r=0.325,P<0.01).Additionally,serum uric acid was positively correlated with gouty nodules in the knee joints and pararticular soft tissue(tendons,ligaments,etc)(r=0.264,0.243,respectively,P<0.05).The cut-off values of neutrophil lymphocyte ratio,platelet lymphocyte ratio and mean platelet volume combined with dual-energy energetic spectroscopic CT imaging data in the diagnosis of gouty knee osteoarthritis points were 2.190,122.96 and 9.049,respectively.Conclusion Energetic spectrum CT can identify and quantify urate crystals at the early stage.And blood test indexes such as mean platelet volume,erythrocyte sedimentation rate and serum uric acid have potential value in evaluating the activity of gout and the degree of migration of the disease in gouty knee osteoarthritis.

Objective:To investigate the prevalence of infectious diarrhea among older adult patients with schizophrenia, identify the influential factors, and construct a nomogram prediction model for infectious diarrhea.Methods:This study is a prospective cohort study that used convenience sampling to select 160 older patients with schizophrenia from three psychiatric hospitals in Wenzhou (85 cases from Wenzhou Seventh People's Hospital, 40 cases from Lucheng Third People's Hospital, and 35 cases from The Affiliated Kangning Hospital of Wenzhou Medical University) who were admitted between January 2022 and December 2023. The prevalence of infectious diarrhea and its influential factors were statistically analyzed. Regression analysis was conducted to develop a risk prediction model for infectious diarrhea, which was presented using a nomogram.Results:A total of 160 older adult patients with schizophrenia were aged between 61 and 79 years, with an average age of (67.82 ± 7.56) years. Among these patients, 53 were female (33.13%), and 107 were male (66.87%). Thirty-four patients experienced infectious diarrhea, with an incidence rate of 21.25%. Univariate analysis revealed significant differences in body mass index ( χ2 = 9.36, P = 0.009), history of diarrhea ( χ2 = 4.52, P = 0.033), disinfection of tableware ( χ2 = 4.16, P = 0.04), handwashing before and after meals ( χ2 = 6.11, P = 0.013), intestinal flora disorder ( χ2 = 19.43, P < 0.001), CD 4+/CD 8+ ratio ( t = 12.37, P < 0.001), interleukin-17 ( t = 15.86, P < 0.001), and fecal secretory IgA ( t = 20.18, P < 0.001) in older adult patients with schizophrenia. Multifactorial analysis indicated that body mass index ( OR = 0.733), disinfection of tableware ( OR = 0.733), handwashing before and after meals ( OR = 0.452), CD 4+/CD 8+ ratio ( OR = 0.359), interleukin-17 ( OR = 0.563), and fecal secretory IgA ( OR = 0.455) were protective factors against infectious diarrhea in older adult patients with schizophrenia (all P < 0.05). Conversely, a history of diarrhea ( OR = 1.774) and intestinal flora disorder ( OR = 1.528) were identified as risk factors for infectious diarrhea in this population (both P < 0.05). Conclusions:The influential factors for the occurrence of infectious diarrhea in older adult patients with schizophrenia include body mass index, history of diarrhea, disinfection of tableware, handwashing before and after meals, intestinal flora disorder, CD 4+/CD 8+ ratio, interleukin-17, and fecal secretory IgA levels. Future studies should conduct longitudinal research to optimize the prediction model and establish a dynamic nomogram model. This will provide nurses with a reliable tool for dynamically predicting the occurrence of infectious diarrhea in older adult patients with schizophrenia, with the aim of reducing the incidence of infectious diarrhea and improving the patients' quality of life.

Objective To explore the application effect of vertebroplasty(PVP)combined with precise personalized vertebral stent implantation based on 3D biomechanical modeling in the repair of thoracolumbar fractures.Methods A total of 98 patients with thoracolumbar vertebral fractures treated at our hospital from September 2021 to December 2022 were selected for this study.Patients were divided into two groups based on the surgical method:the conventional group(n=50)and the combined group(n=48).The conventional group received PVP treatment,while the combined group was treated with PVP combined with 3D-printed personalized vertebral body stents.The length of incision,operation time,blood loss,drainage volume and hospital stay of the two groups were recorded.The Oswestry Disability Index(ODI)was used to assess the improvement of thoracolumbar function in patients before surgery and one month after the surgery.Cobb angle,anterior height of injured vertebra and sagittal position index were measured.Visual Analog Scale(VAS)for pain and Short Form-36(SF-36)questionnaire for quality of life were used to evaluate low back pain,lower extremity pain and quality of life of patients before surgery and one month after surgery.Postoperative complications were also recorded.Results The length of incision,operation time,blood loss,drainage volume and hospital stay were lower in the combination group than those of the conventional group(P＜0.05).ODI score and Cobb angle were lower 1 month after surgery than those before surgery in both groups,and the combined group was lower than the conventional group(P＜0.05).One month after operation,the anterior height and sagittal position index of injured vertebrae were higher than those before surgery,and the combined group was higher than the conventional group(P＜0.05).VAS scores were lower and SF-36 scores were higher in both groups one month after operation compared to those before the operation,with the combined group showing lower VAS scores and higher SF-36 scores compared to the conventional group(P＜0.05).The total complication rate was lower in the combined group(2.08％)than that in the conventional group(16.00％,P＜0.05).There was no significant difference in the overall postoperative satisfaction between the conventional group and the combined group.Conclusion The treatment of thoracolumbar fractures with PVP combined with 3D printed personalized vertebral stenting has a remarkable effect.The pain and quality of life of patients have been significantly improved,and the surgical safety is relatively good.

Background Di(2-ethylhexyl) phthalate (DEHP) is the most prevalent environmental endocrine disruptor among phthalate acid esters (PAEs) worldwide. Previous studies have indicated that exposure to DEHP may disrupt glucose metabolism. Objective To investigate the impact of DEHP on glucose homeostasis in rats, focusing on oxidative stress-induced impairment of autophagy in islet β cells. Methods Forty male SD rats were randomly assigned to four groups, receiving DEHP doses of 0, 187, 375, and 750 mg·kg⁻¹ for 12 weeks. Oral glucose tolerance (OGTT) and insulin tolerance tests (ITT) were conducted 24 h after the final exposure. Pancreatic microstructural alterations were assessed using hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM). Commercial ELISA kits were employed to quantify the levels of insulin, adenosine triphosphate (ATP), and adenosine monophosphate (AMP) in rat serum, as well as the protein expression level of activated caspase-3 in pancreatic tissue. Additionally, commercial microplate kits were utilized to measure the concentration of reduced glutathione (GSH) in serum, the activity of superoxide dismutase (SOD) using water-soluble tetrazolium salt-1, the content of malondialdehyde (MDA) by thiobarbituric acid method, and the level of reactive oxygen species (ROS) in pancreatic tissue by chemical fluorescence method. Reverse transcription polymerase chain reaction (RT-PCR) was used to measure sequestosome1 (SQSTM1/p62), Beclin1, microtubule-associated protein 1 light chain 3 (LC3), and cysteinyl aspartate specific proteinase-8 (Caspase-8) mRNA levels. Western blot analysis was applied to detect the protein relative expression levels of p62, Beclin-1, LC3-I, LC3 II, AMPK, p-AMPK, mTOR, p-mTOR, ULK1, and Caspase-8. Results Compared to the 0 mg·kg⁻¹ DEHP group, the 750 mg·kg⁻¹ DEHP group exhibited a significant increase in fasting blood glucose levels at 2, 4, 6, and 12 weeks (P<0.05). The OGTT showed that, following high-glucose gavage, the 187 mg·kg⁻¹ DEHP group had elevated blood glucose at 30 min (P<0.05), the 375 mg·kg⁻¹ DEHP group showed increased glucose levels at 15, 30, and 180 min (P<0.05), and the 750 mg·kg⁻¹ DEHP group exhibited elevated levels at 15, 30, 60, and 180 min (P<0.05). The 375 and 750 mg·kg⁻¹ DEHP groups demonstrated significantly increased OGTT area under the curve (AUC) values (P<0.05). In contrast, ITT results indicated no significant differences in blood glucose levels or AUC among the DEHP exposure groups at all time points (P>0.05). Compared to the 0 mg·kg⁻¹ DEHP group, the 750 mg·kg⁻¹ DEHP group exhibited significantly higher HOMA-IR levels and markedly lower HOMA-ISI values (P<0.05). HE and TEM showed that in each DEHP exposure group, the number of islet cells decreased, the islet area reduced, and chromatin condensation occurred. The endocrine granules in the cytoplasm of islet β cells decreased, and there were varying degrees of widening of the nuclear membrane gap, flattening and expansion of the Golgi complex, and expansion of the endoplasmic reticulum. Ribosome separation was observed, and autophagosomes were visible. In the 375 and 750 mg·kg⁻¹ DEHP groups, the mitochondria were deformed to varying degrees, and some cristae structures disappeared, presenting vacuolization. Moreover, the chromatin condensation in the nuclei was more severe in the 750 mg·kg⁻¹ DEHP group. The serum SOD activity was significantly elevated in the 750 mg·kg⁻¹ DEHP group (P<0.05). Both the 375 mg·kg⁻¹ and 750 mg·kg⁻¹ DEHP groups exhibited a significant increase in the relative ROS content in pancreatic tissue (P<0.05). In DEHP-treated groups, the MDA content increased (P<0.05), while the GSH content decreased (P<0.05). Additionally, in the 750 mg·kg⁻¹ DEHP group, the AMP/ATP ratio in serum was significantly raised (P<0.05), and the expression of cleaved Caspase-3 protein in pancreatic tissue was also significantly increased (P<0.05). The relative mRNA levels of p62, Beclin-1, LC3, and Caspase-8 in the pancreatic tissue of rats exposed to DEHP were significantly elevated (P<0.05). The relative expression levels of p-AMPK/AMPK, p-ULK1/ULK1, and Beclin-1 proteins in the DEHP-treated groups were significantly increased (P<0.05). In the 375 mg·kg⁻¹ and 750 mg·kg⁻¹ DEHP treatment groups, the relative expression levels of p62, LC3 II/LC1, and Caspase-8 proteins were significantly increased (P<0.05), while the relative expression level of p-mTOR/mTOR was significantly decreased (P<0.05). Conclusion DEHP can disrupt glucose homeostasis by inducing oxidative stress, which subsequently activates autophagy via the ROS/AMPK/ULK1 pathway, impairing autophagic flux and promoting apoptosis of islet β cells, ultimately decreasing their function and number.

Based on the concept of "regulating the five zang organs and harmonizing the spleen and stomach"， globus hystericus is believed to originate from dysfunction of the five zang organs and disharmony of the spleen and stomach. Treatment primarily focuses on regulating the spleen and stomach while also considering other affected organs， with a self-prescribed Anpiwei Jingyan Formula （安脾胃经验方） for harmonizing the spleen and stomach as the foundational treatment. Additionally， syndrome-based modifications are applied according to imbalances in the heart， lung， kidney， or liver. For heart-yang deficiency， modified Linggui Zhugan Decoction （苓桂术甘汤） could be combined； for heart-yin deficiency， modified Tianwang Buxin Pill （天王补心丹） could be combined. For lung failing to disperse and descend and fluid retention， modified Sanao Decoction （三拗汤） could be combined； for lung and stomach yin deficiency， modified Shashen Maidong Decoction （沙参麦冬汤） could be combined. For kidney-yang deficiency with ascending counterflow of cold water， modified Jingui Shensi Pill （金匮肾气丸） could be combined； for kidney-yin deficiency， modified Liuwei Dihuang Pill （六味地黄丸） could be combined. For liver constraint and spleen deficiency， modified Sini Powder （四逆散） could be combined； for liver-yin deficiency or liver stagnation transforming into fire and attacking the stomach， modified Yiguan Decoction （一贯煎） could be combined.