ObjectiveTo develop an exercise intervention program for patients undergoing total knee arthroplasty based on the daily goal management pathway, and preliminarily verify its clinical feasibility and effectiveness. MethodsThe intervention program was formulated based on the daily goal management pathway and hope theory, combined with literature analysis, qualitative interviews and expert consultation. Feasibility evaluation was conducted among orthopedic nurses and patients in Beijing Bo'ai Hospital from September to November, 2025. A controlled pilot study was performed with 15 patients in each group: the control group received routine rehabilitation care, while the experimental group received the developed intervention program. The Hospital for Special Surgery Knee Score (HSS), range of motion (ROM) of knee, functional exercise compliance score, Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared between two groups. ResultsThe program covered three themes from admission to three weeks postoperatively, including seven training methods and 32 specific recommendations. Feasibility results showed 100% patient recruitment rate, 93.75% retention rate and 96.94% program acceptance rate. A total of 21 orthopedic nurses scored ≥ 4.5 on all four dimensions of the program. After intervention, HSS score and knee ROM significantly increased (|t| > 6.205, P < 0.001), while WOMAC and VAS score decreased (t = 9.127, Z = -3.415, P < 0.01) in the experimental group; in the control group, VAS score decreased (Z = -3.122, P = 0.002), and knee ROM reduced (t = -2.622, P = 0.015), with no significant improvement in other indicators (P > 0.05); all the indexes were better in the experimental group than in the control group (|t| > 7.949, |Z| > 2.990, P < 0.01), including the functional exercise compliance (t = -8.565, P < 0.001). ConclusionThe exercise intervention program based on the daily goal management pathway is scientific, feasible and preliminarily effective, which can provide a new structured and humanized nursing for early exercise training of patients during hospitalization for total knee arthroplasty.

Objective To explore the application value of Laennec's membrane space in dealing with complex anatomical variations and dense adhesions during repeated liver transplantation (Re-LT). Methods The clinical data of 8 cases of Re-LT recipients treated in the Department of Hepatobiliary Surgery of the First Hospital Affiliated to Harbin Medical University were retrospectively analyzed. During the operation, based on the Laennec's membrane anatomical concept, the remaining Laennec space and the free technique within the hepatic portal plate were flexibly applied for dissection. Specifically, the first hepatic portal main ducts (biliary and portal veins) were dissected by lowering the hepatic portal plate inside the Laennec's membrane space, and the second hepatic portal was exposed to perform the modified piggyback liver transplantation to avoid the injury to the right adrenal gland and right kidney caused by the free inferior vena cava below the liver. Moreover, the dense adhesions between the liver and hollow organs were separated by a combination of blunt and sharp dissection within the subcapsular space of the liver capsule (Glisson capsule). Results All 8 cases of recipients successfully completed the surgery. Among them, 7 cases underwent end-to-end biliary anastomosis with a T-tube left in place, and 1 underwent choledochoenteric anastomosis, 2 cases underwent modified piggyback reconstruction, 2 cases used the subcapsular dissection technique to handle organ adhesions. One recipient died of generalized drug-resistant Klebsiella pneumoniae infection combined with septic shock after the operation, while the remaining 7 cases were discharged after the main complications (such as delayed graft function recovery, pulmonary infection, bile leakage, etc.) were cured or significantly improved. Two cases of recipients who used the subcapsular dissection technique effectively avoided the secondary injury of hollow organs, and no digestive tract leakage complications occurred after the operation. Conclusions By flexibly applying Laennec's membrane space and the intrahepatic portal plate free technique in Re-LT, it may effectively cope with the loss of anatomical layers and vascular dense adhesions, reducing the surgical difficulty and the risk of secondary injury, providing important technical support for improving the prognosis of recipients.

Marine work environment is associated with unique risk factors,such as high salinity,high humidity,noise and vibration,and chemical pollution.Males make up the majority of marine workers.Prolonged exposure to these environmental factors may have adverse effects on male fertility,resulting in sperm quality reduction,endocrine disorder,and reproductive organ damage.Therefore,the potential harm of marine work environment to male reproductive health deserves attention.This review focused on the key exposure factors in marine work environment,and systematically explored the factors affecting male fertility,mechanisms,and physiological pathways.The aim is to provide scientific evidences to improve marine work environment,develop protective measures,and safeguard the reproductive health of workers,while also offering guidance for future research in this field.

Objective:To construct classification models of traumatic brain injury (TBI) based on the injury data collected at the scene of the accidents and validate its efficacy.Methods:A retrospective cohort study was conducted to analyze the pre-hospital treatment data of 368 TBI patients admitted to the Second Affiliated Hospital of Army Military Medical University from January 2019 to December 2023, including 243 males and 125 females, aged 18-82 years [(48.1±20.8)years]. The patients′ Glasgow coma scale (GCS) scores were 3-15 points [11.0(3.0, 15.0)points] at emergency medical service arrival. The patients were randomly assigned to the training set ( n=257) and test set ( n=111) at a ratio of 7∶3. According to the admission diagnosis, the patients fell into the mild TBI group ( n=62), medium TBI group ( n=137), severe TBI group ( n=120), and extremely severe TBI group ( n=49). In the training set, 44 patients fell into mild TBI group, 98 into medium TBI group, 82 into severe TBI group and 33 into extremely severe TBI group, while in the test set, 18 patients fell into mild TBI group, 39 into medium TBI group, 38 into severe TBI group and 16 into extremely severe TBI group. The following 12 kinds of injury data, including MARCH [massive hemorrhage (M), airway obstruction (A), respiratory failure (R), circulatory failure (C) and hypothermia (H)], GCS, pre-hospital index (PHI), shock index (SI), reverse SI multiplied by GCS (rSIG), optic nerve sheath diameter (ONSD) measured by ultrasound, scalp and skull injuries were collected at the scene of the accidents. Three machine algorithm including random forest (RF), support vector machine (SVM) and logistic regression (LR) were used to construct scene data-based TBI classification models. The accuracy rate, precision rate, recall rate, F1 value and area under receiver operating characteristic (ROC) curve (AUC) of the 3 models were used to verify the efficiency of the models for TBI classification. Shapley additive explanations (SHAP) method was used to interpret the results of the optimal model. The 12 kinds of injury data in the models were sorted according to their contribution to the TBI classification and the injury data with greater contribution were selected. Results:In the test set, the accuracy rate of the RF, SVM and LR models was 0.93, 0.92 and 0.87, respectively; the precision rate was 0.93, 0.92 and 0.89, respectively; the recall rate was 0.93, 0.92 and 0.87, respectively; the F1 value was 0.93, 0.92 and 0.87, respectively. In the mild, medium, severe and extremely severe TBI groups in the test set, the AUC of the RF model was 0.96 (95% CI 0.92, 0.98), 0.98 (95% CI 0.94, 0.99), 0.97 (95% CI 0.95, 0.98), and 0.97 (95% CI 0.96, 0.98), respectively; the AUC of the SVM model was 0.90 (95% CI 0.88, 0.94), 0.95 (95% CI 0.92, 0.97), 0.96 (95% CI 0.94, 0.98), and 0.95 (95% CI 0.92, 0.99), respectively; the AUC of the LR model was 0.90 (95% CI 0.83, 0.96), 0.90 (95% CI 0.84, 0.95), 0.96 (95% CI 0.95, 0.98), and 0.95 (95% CI 0.94, 0.97), respectively. The RF model demonstrated optimal discriminative performance for TBI classification. As the SHAP′s interpretation of the RF model indicated, among the 12 kinds of injury data, those with greater contributions to the TBI classification were GCS, rSIG, SI, PHI, respiratory failure, ONSD, and circulatory failure in sequence. Conclusions:Of the scene data-based TBI classification models, the RF model achieves good predictive performance for TBI classification when compared with the SVM model and LR model. Besides, GCS, rSIG, SI, PHI, respiratory failure, ONSD and circulatory failure contribute significantly to the classification of TBI in the RF model, which may assist emergency medical personnel in field triage and management of TBI at accident scenes.

Objective:To evaluate the diagnostic performance of fecal calprotectin (FC) in predicting endoscopic activity of ulcerative colitis (UC), and to compare it with high-sensitivity C reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) .Methods:A cross-sectional stydy was conducted. UC patients diagnosed at Peking Union Medical College Hospital between May 2023 and July 2025 were retrospective enrolled. Patients were divided into the endoscopically active group and endoscopic remission group according to endoscopic activity. FC levels were measured using latex-enhanced turbidimetric immunoassay (LETIA). Receiver operating characteristic (ROC) curves and logistic regression models were used to assess diagnostic efficacy. Subgroup analyses were conducted according to disease extent.Results:A total of 166 UC patients were enrolled, including 92 males and 74 females with the age of 40.00 (32.00, 52.00) years old and disease course 5.00 (2.00, 10.75) years. Forty-six patients were assigned to the active group, while the remaining 120 were assigned to the remission group. FC levels were significantly higher in the active group than in the remission group (620.72 μg/g vs. 29.00 μg/g, P < 0.001), with an AUC of 0.894 at a cutoff value of 122.54 μg/g. hsCRP and ESR had lower AUC (0.712 and 0.736, respectively). The combination of FC, hsCRP, and ESR slightly improved specificity (AUC 0.898). FC was strongly correlated with the endoscopic activity ( r =0.669, P < 0.001) but not with disease extent. Conclusions:FC measured by latex-enhanced turbidimetric immunoassay had comparable diagnostic accuracy to ELISA-based methods commonly used abroad, and provided a reference cutoff value of 122.54 μg/g. FC outperforms hsCRP and ESR in assessing intestinal inflammation in UC and it is less affected by disease extent, making it a reliable non-invasive biomarker for UC monitoring.

Objective:To evaluate the predictive efficacy of fecal calprotectin (FC) for endoscopic activity in patients with Crohn's disease (CD) .Methods:A cross-sectional study was conducted and patients diagnosed as CD at Peking Union Medical College Hospital from June 2023 to September 2025 were enrolled consecutively. Data was collected including general information, laboratory tests [hemoglobin (HGB), platelet (PLT), FC, high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR) and so on], and endoscopic results. FC levels were measured by latex-enhanced turbidimetric immunoassay (LETIA). Endoscopic activity was defined as the simplified endoscopic score for Crohn's disease (SES-CD) > 2. Patients were divided into the endoscopically active group and endoscopic remission group according to endoscopic activity, and the differences in clinical data between the two groups were compared. Spearman correlation analysis was used to assess the correlation between FC and endoscopic activity, and receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of FC, hsCRP and ESR for endoscopic activity, and the differences were compared.Results:A total of 90 CD patients were enrolled, including 65 males and 25 females with the age of 30 (22, 41) years old and disease course 4.0 (0.5, 8.0) years. Seventy-one patients (78.9%) had ileocolonic disease involvement (L3), and 55 patients (61.1%) were using biologics. Sixty-nine patients in endoscopic active phase were assigned to the endoscopically active group, while the remaining 21 were assigned to the endoscopic remission group. There were no statistically significant differences in general characteristics such as age and gender between the two groups (all P > 0.05). Compared with endoscopic remission group, HGB was significantly lower in the endoscopically active group, while PLT, hsCRP, ESR, and FC were moderataly higher (all P < 0.05). Among the 90 CD patients, FC levels were moderatly correlated with endoscopic activity (ρ = 0.494). ROC curve analysis indicated that the area under the curve for FC in predicting endoscopic activity was 0.836 (95% CI: 0.737-0.935), with a sensitivity of 0.725, specificity of 0.952, and accuracy of 0.778 at the optimal FC cutoff value of 153.8 μg/g. FC outperformed hsCRP and ESR. Conclusion:FC measured by LETIA demonstrates certain efficacy in predicting endoscopic activity in CD and will assist in efficient clinical monitoring of CD patients.

Objective:To explore the impacts of different frequencies of orthogonal image-guided verification on set-up error correction and the reference values of planning target volume (PTV) margins in postoperative radiotherapy for breast cancer, in order to provide recommendations of the verification frequency in clinical practice.Methods:A total of 80 breast cancer patients who received postoperative intensity-modulated radiotherapy for breast cancer at the Affiliated Union Hospital of Fujian Medical University from January 2021 to January 2022 were enrolled. Orthogonal image-guided verification was conducted before each radiation treatment to determine initial and residual set-up errors. The error data were statistically analyzed by categorizing patients into groups A, B, C, D, E, and F, based on assumed verification frequencies (daily, every 2, 3, 4, and 5 d, and no correction). The magnitude, distribution, and differences of set-up errors of various groups were analyzed, and the PTV margins were calculated using a reference formula.Results:The collected initial set-up errors of the 80 patients were (3.49±3.43), (2.87±2.88), and (2.75±2.35) mm, in x, y, and z directions, respectively. The residual set-up errors decreased gradually with increasing verification frequency. In the case of daily image-guided verification, the residual set-up errors in x, y, and z directions decreased to (1.63±0.90), (1.63±0.93), and (1.55±0.90)mm, respectively. The reference values of PTV margins calculated under different verification frequencies decreased with an increase in the verification frequency. Under daily verification, the reference values of PTV margins calculated based on set-up errors decreased from initial 6.60, 6.29, and 4.22 mm (without correction) to 1.27, 1.37, and 1.28 mm, respectively. Differences in the reference values under verification frequencies every 3, 4, and 5 d were less than 0.81 mm. Conclusions:Daily image-guided verification (including correction) can effectively reduce set-up errors in image-guided radiotherapy for breast cancer. The set-up errors differ under varying verification frequencies, with a higher frequency corresponding to better correction effects and smaller PTV margins required.

Psoriasis is a chronic inflammatory skin disease with worldwide prevalence,primarily characterized by epidermal hyperplasia,abnormal keratinization,and immune cell infiltration,with a significant negative impact on patients' quality of life and mental well-being.The onset of psoriasis is closely associated with genetic susceptibility,immune dysregulation,and environmental factors.Despite research progress into the pathogenesis of psoriasis,existing treatment method still face problems including limited efficacy and obvious side effects.There is thus an urgent need for an in-depth analysis of its pathological network and the development of novel interventional strategies.The imiquimod-induced psoriasis animal model has accordingly become a crucial tool for studying psoriasis owing to its high reproducibility and excellent pathological simulation.This review systematically summarizes the core mechanism of action of the imiquimod-induced psoriasis model,expounds on the molecular basis of its action via pathways such as the cascade reaction of the core immune-inflammatory axis,the multi-regulatory network of downstream synergistic mechanisms,and the interaction between host and environmental factors.Research based on this model has successfully verified the therapeutic effects of various targeted therapies and natural products on psoriasis,demonstrating its important application value in therapeutic interventional research.We also discuss the limitations of the imiquimod-induced psoriasis model,and indicate future research directions,with the aim of providing references for further in-depth research and the treatment of psoriasis.

Objective To investigate the causal relationship between psychiatric and psychological disorders(depression,bipolar dis-order,and schizophrenia)and non-alcoholic fatty liver disease(NAFLD).Methods The two-sample Mendelian randomization(MR)method was adopted,with depression,bipolar disorder,and schizophrenia as exposure variables and NAFLD as the outcome variable.The single nucleotide polymorphisms(SNPs)independently associated with exposure variables were obtained from the summary data of the genome-wide association study(GWAS)as instrumental variables for MR analysis.The analysis results of the inverse-variance weighted(IVW)were used as the primary outcome indicators,while those of the MR Egger regression method,weighted median,and weighted mode as supplementary results.The Cochran's Q test,MR-Egger intercept,and"leave-one-out"method were used for sensi-tivity analysis.Results The results of IVW analysis showed that depression was positively correlated with the incidence risk of NAFLD(OR=1.21,95％CI:1.01-1.44,P＜0.05),while bipolar disorder was negatively correlated with the incidence risk of NAFLD(OR=0.91,95％CI:0.84-1.00,P＜0.05).No causal relationship was found between schizophrenia and NAFLD.The heterogeneity and sen-sitivity analysis supported the robustness of the results of the study.Conclusion Depression and bipolar disorder are causally associat-ed with the incidence of NAFLD.Depression is associated with an increased risk of NAFLD,while bipolar disorder is associated with a reduced risk of NAFLD.

Objective The reference interval of venous whole blood red cells and related parameters of healthy children preschool stage 3 to 6 years in Panzhihua was established to provide practical experimental basis for pediatric clinical diagnosis and treatment.Methods From January to July 2023,1 467 eligible healthy children from 3 to 6 years old for physical examination were collected as study subjects,including 762 boys and 705 girls.Red blood cell(RBC),hemoglobin(Hb),hematocrit(HCT),mean red blood cell volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular hemoglobin concentration(MCHC)and red cell volume distribution width(RDW)were measured by Sysmex XN-1000 automatic blood analyzer.According to sex and age groups,the differences of the above indexes between different gender and age groups were compared,and the reference interval of venous whole blood red cells and related parameters of healthy children aged 3 to 6 years old in Panzhihua was established.At the same time,25 samples(including 13 boys and 12 girls)were selected to verify the newly established reference interval.Results HCT and RDW-SD reference intervals between boys and girls preschool stage 3～6 in the Panzhihua area,and the differences were not statistically significant(U=0.000,0.795,all P>0.05).The reference intervals for RBC,MCV,MCH and RDW-CV show statistically significant differences between boys and girls(U=2.829～5.753,all P＜0.05).There were gender and age differences in the reference intervals of Hb and MCHC(U=2.599,4.368,all P＜0.01).In the 3～6 years,the basal levels of RBC,HGB and HCT tended to increase gradually with age,while the overall base levels of RBC,HGB,MCHC,and RDW-CV in boys were higher than those in girls.And there were different degrees of difference with the reference range of industry standards.Also verify through the new reference interval.Conclusion With differences in RBC and related reference intervals of preschool stage children in different regions,it is necessary to establish a reference interval suitable for special population in Panzhihua.