Flap transplantation is a critical surgical strategy for the reconstruction of tissue defects caused by trauma, tumor resection, and congenital malformations, and its survival rate directly determines surgical efficacy and patient prognosis. Following transplantation, flaps inevitably undergo ischemia-reperfusion (I/R) injury, during which oxidative stress, inflammatory responses, and metabolic disturbances are intricately intertwined, ultimately leading to cellular injury and tissue necrosis. Recent studies have demonstrated that multiple forms of programmed cell death—including apoptosis, pyroptosis, ferroptosis, necroptosis, and PANoptosis—play central roles in flap I/R injury. The extensive crosstalk and molecular interactions among these pathways form a highly complex cell death network. Specifically, apoptosis is mediated by the imbalance of Bcl-2 family proteins and the activation of cysteine-dependent aspartate-specific protease (caspase) cascades; pyroptosis is driven by the NLRP3-caspase-1-GSDMD axis, resulting in membrane pore formation and the release of pro-inflammatory cytokines; ferroptosis is characterized by iron-dependent lipid peroxidation and dysfunction of glutathione peroxidase 4 (GPX4); necroptosis is triggered by the receptor-interacting serine/threonine-protein kinase 1 (RIPK1)-RIPK3-MLKL signaling complex, leading to membrane rupture; and PANoptosis represents an integrated form of inflammatory cell death that coordinates multiple death pathways. Importantly, these forms of programmed cell death are not independent but are interconnected through extensive signaling crosstalk. Key regulatory molecules, including caspase-8, reactive oxygen species (ROS), nuclear factor-κB (NF-κB), and nuclear factor erythroid 2-related factor 2 (Nrf2), collectively modulate the dynamic balance among these pathways. Therefore, the multidimensional interplay and spatiotemporal dynamics of programmed cell death constitute a fundamental pathological basis of flap I/R injury. This review systematically summarizes the latest advances in the mechanisms and interactions of various programmed cell death pathways in flap I/R injury, aiming to elucidate the underlying regulatory network. These insights may provide novel theoretical foundations for optimizing flap protection strategies, improving flap survival, and promoting tissue repair.

Psychological factors have become significant contributors to the onset and progression of insomnia. This article explored the treatment of insomnia from the perspective of “liver governs wei qi （defensive qi）”. The concept of “liver governs wei qi （defensive qi）” is summarized in three aspects， firstly， the liver assists the spleen and stomach in transformation and transportation， governing the generation of wei qi； secondly， the liver aids lung qi diffusion and dispersion， governing the distribution of wei qi； thirdly， the liver regulates circadian rhythms， governing the circulation of wei qi. It is proposed that the clinical treatment of insomnia should focus on the following methods： for regulating the liver to harmonize the five viscera， and facilitate the circulation of wei qi， medicinals entering the liver channel include Chaihu （Bupleuri radix）， Baishao （Paeoniae Radix Alba）， Zhizi （Gardeniae Fructus）， and Suanzaoren （Ziziphi Spinosae Semen） could be commonly used； for nourishing the liver， the treatment should align with the day-night rhythm， and herbs such as Baihe （Lilium）， Hehuan （Albizia julibrissin）， and Yejiaoteng （Polygoni multiflori caulis） are commonly used； for soothing the liver and address both mental and physical health to calm wei qi， treatment should advocate verbal counseling， psychological regulation， and health education. Ultimately， this treatment approach can free liver qi to flow， soothe qi movement， restore the motion of wei qi， regulate during day and night， balance yin and yang， and resolve insomnia effectively.

Objective To summarize and evaluate the treatment strategies and clinical outcomes of bladder inflammatory myofibroblastic tumor(IMT),so as to provide reference for the diagnosis and treatment of this rare entity.Methods A retrospective analysis was conducted on the clinical data of two patients with bladder IMT treated at Shandong Provincial Hospital Affiliated to Shandong First Medical University.In combination with literature analysis,the clinical characteristics,treatment methods and prognosis of this disease were analyzed.Results Both patients presented with painless terminal macroscopic hematuria.Patient 1 was a 42-year-old male with a 6 cm bladder mass detected by cystoscopy,with no muscular involvement.Transurethral en bloc resection with a 1470 nm diode laser was performed,followed by a second transurethral resection.Patient 2 was a 21-year-old male with a 5 cm bladder mass visualized on cystoscopy,with no muscular invasion.Transurethral en bloc resection using a 1470 nm diode laser was conducted,followed by transurethral laser marking the margin of the wound and laparoscopic partial cystectomy.Preoperative cystoscopic biopsy and postoperative pathology diagnosed it as IMT,which invaded the superficial muscular layer and the margin was negative.Patient 1 was followed for 40 months and patient 2 for 15 months.Follow-up cystoscopy performed every 3 months showed no evidence of recurrence.This article also summarized the relevant literature on bladder IMT over the past five years.Conclusion Bladder IMT is an extremely rare neoplasm with nonspecific clinical manifestations,posing challenges in both diagnosis and treatment.However,early recognition and definitive pathological diagnosis,combined with bladder-sparing surgical strategies such as en bloc resection,often result in favorable outcomes,with reduced risk of recurrence and improved quality of life.

Objective To explore the distribution of common TCM syndromes and symptoms of insomnia;To prepare for the construction of the theoretical framework and item pool of syndrome diagnosis and efficacy evaluation scale.Methods TCM guideline standards of insomnia,textbooks and journals over the years were retrieved,the information of TCM syndromes,syndrome elements and symptoms was extracted,the guideline textbook and journal database were established,and descriptive statistics,association rules,systematic clustering,factor analysis,potential categories and implicit structure analysis were carried out.Results Totally 116 guide standards and textbooks over the years were included,and 454 articles of journals were included.The high-frequency symptoms accounted for≥3%of the guide textbooks and journal databases were 87 and 79 categories,respectively,and the cumulative proportion was 87.48%and 87.75%,respectively.According to the analysis results,five common TCM syndromes and their characteristic symptom classification of insomnia were finally deduced.According to the frequency/person time distribution,they were heart and spleen deficiency syndrome,yin deficiency and fire hyperactivity syndrome,liver fire disturbing heart syndrome,phlegm heat disturbing heart syndrome,heart and gallbladder qi deficiency syndrome.Conclusion There are five common TCM syndromes of insomnia,and the characteristic symptoms of each TCM syndrome provide a reference source for the theoretical framework of syndrome diagnosis and efficacy evaluation scale and the establishment of item pool.

Objective To explore the effect of collateral status on prognosis in elderly patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)after Solitaire stent retriever in combination with the intracranial support catheter aspiration for mechanical thrombectomy(SWIM),and construct a prediction model for prognosis.Methods A retrospective analysis was performed on 240 elderly AIS-LVO patients who underwent SWIM technique in our hospital be-tween February 2019 and February 2024.According to gender,age,occlusion sites and TOAST classifications,they were divided into a modeling group(180 cases)and a verification group(60 cases)in a ratio of 3∶1.Based on the results of modified Rankin scale(mRS)at 3 months after surgery,the patients in the modeling group were further divided into good prognosis subgroup(mRS score:0-2,97 cases)and poor prognosis subgroup(mRS score:3-6,83 cases).Multivari-ate logistic regression analysis was applied to evaluate the relationship between preoperative col-lateral circulation status and prognosis and to identify the influencing factors for prognosis.Then a prediction model for prognosis was constructed,and its performance was evaluated by ROC curve analysis.Results In the modeling group at 3 months of follow-up,the poor prognosis subgroup had significantly larger proportions of posterior circulation occlusion,cardiogenic embolism,ASITN/SIR grades 3-4 and hemorrhage transformation,higher NIHSS score at admission and longer interval from onset to vascular recanalization,while lower ASPECTS score at admission when compared with the good prognosis subgroup(P＜0.01).Multivariate logistic regression analysis showed that occlusion site,TOAST classification,NIHSS score at admission,interval from onset to vascular recanalization and hemorrhage transformation were independent risk fac-tors for poor prognosis,while ASPECTS score at admission and collateral circulation were protec-tive factors of good prognosis in the elderly AIS-LVO patients after SWIM technique(P＜0.01).Hosmer-Lemeshow test showed that the regression equation obtained goodness of fit in the mod-eling group(P=0.435).ROC curve analysis revealed that the AUC,sensitivity and specificity of then constructed prediction model for poor prognosis was 0.855[95％CI(0.797-0.913)],81.93％and 79.38％,respectively.The model was further verified in the data of the verification group(34 cases in good prognosis and 26 cases with poor prognosis),the AUC value,sensitivity and speci-ficity was 0.839[95％CI(0.732-0.947)],84.62％and 79.41％,respectively.Conclusion Our pre-diction model constructed based on screened risk factors for poor prognosis has good validity in patients with AIS-LVO after SWIM technique,which can identify the patients at high risk for poor prognosis.

Objective To evaluate the effect of exercise on freezing of gait in Parkinson's disease.Methods After constructing a PICO framework,randomized controlled trials(RCTs)about exercise for freezing of gait in Parkinson's disease were systematically retrieved from Web of Science,PubMed,Cochrane Library,Embase,CNKI,VIP and Wanfang Data,from the establishment of the databases to March,2025.The PEDro scale was used to evaluate the quality of literature,Stata 17.0 was used for meta-analysis,and GRADE was used to assess the evidence quality.Results A total of twelve RCTs involving 463 patients were included,with PEDro scale scores of five to eight.Exercise improved the scores of Freezing of Gait Questionnaire(FOGQ)(SMD=-0.61,95%CI-0.85～-0.36,P<0.001)and Unified Parkinson's Disease Rating Scale Ⅲ(UPDRSⅢ)(SMD=-0.84,95%CI-1.27～-0.41,P<0.001).Subgroup analysis revealed that the patients aged 59 to 68 years,the course of disease

Objective To explore the effect of collateral status on prognosis in elderly patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)after Solitaire stent retriever in combination with the intracranial support catheter aspiration for mechanical thrombectomy(SWIM),and construct a prediction model for prognosis.Methods A retrospective analysis was performed on 240 elderly AIS-LVO patients who underwent SWIM technique in our hospital be-tween February 2019 and February 2024.According to gender,age,occlusion sites and TOAST classifications,they were divided into a modeling group(180 cases)and a verification group(60 cases)in a ratio of 3∶1.Based on the results of modified Rankin scale(mRS)at 3 months after surgery,the patients in the modeling group were further divided into good prognosis subgroup(mRS score:0-2,97 cases)and poor prognosis subgroup(mRS score:3-6,83 cases).Multivari-ate logistic regression analysis was applied to evaluate the relationship between preoperative col-lateral circulation status and prognosis and to identify the influencing factors for prognosis.Then a prediction model for prognosis was constructed,and its performance was evaluated by ROC curve analysis.Results In the modeling group at 3 months of follow-up,the poor prognosis subgroup had significantly larger proportions of posterior circulation occlusion,cardiogenic embolism,ASITN/SIR grades 3-4 and hemorrhage transformation,higher NIHSS score at admission and longer interval from onset to vascular recanalization,while lower ASPECTS score at admission when compared with the good prognosis subgroup(P＜0.01).Multivariate logistic regression analysis showed that occlusion site,TOAST classification,NIHSS score at admission,interval from onset to vascular recanalization and hemorrhage transformation were independent risk fac-tors for poor prognosis,while ASPECTS score at admission and collateral circulation were protec-tive factors of good prognosis in the elderly AIS-LVO patients after SWIM technique(P＜0.01).Hosmer-Lemeshow test showed that the regression equation obtained goodness of fit in the mod-eling group(P=0.435).ROC curve analysis revealed that the AUC,sensitivity and specificity of then constructed prediction model for poor prognosis was 0.855[95％CI(0.797-0.913)],81.93％and 79.38％,respectively.The model was further verified in the data of the verification group(34 cases in good prognosis and 26 cases with poor prognosis),the AUC value,sensitivity and speci-ficity was 0.839[95％CI(0.732-0.947)],84.62％and 79.41％,respectively.Conclusion Our pre-diction model constructed based on screened risk factors for poor prognosis has good validity in patients with AIS-LVO after SWIM technique,which can identify the patients at high risk for poor prognosis.

Based on the"brain-heart-kidney-seminal chamber"axis theory to understand the pathogenesis of coronary heart disease(CHD)complicated with erectile dysfunction(ED),it is considered that the dysfunction of the"brain-heart-kidney-seminal chamber"axis is closely related to the occurrence of CHD complicated with ED,in which kidney deficiency is the initial factor;heart brain disorder,loss of consciousness is the key to the pathogenesis;the loss of seminal chamber is an important link in the pathogenesis.Under the guidance of the concept of"brain-heart-kidney-seminal chamber"axis,Cistanches Herba-Rehmannize Radix et Praeparata-Cuscutae Semen were used to invigorate the kidney and regulate the essence of the brain,heart,kidney and seminal chamber;Salviea Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Schisandrae Chinensis Fructus can reach the heart and brain,calm the heart and calm the mind;Cyathulae Radix-Scolopendra-Spatholobi Caulis can adjust and restore the seminal chamber,moistening the tendons and vibrating the flaccidity.In clinical practice,the whole medication should be used to make the brain,heart and kidney in harmony with the seminal chamber at the same time,and the drugs should be flexibly added and subtracted according to the specific symptoms of patients to enhance the curative effect of CHD patients with ED.

Based on the"brain-heart-kidney-seminal chamber"axis theory to understand the pathogenesis of coronary heart disease(CHD)complicated with erectile dysfunction(ED),it is considered that the dysfunction of the"brain-heart-kidney-seminal chamber"axis is closely related to the occurrence of CHD complicated with ED,in which kidney deficiency is the initial factor;heart brain disorder,loss of consciousness is the key to the pathogenesis;the loss of seminal chamber is an important link in the pathogenesis.Under the guidance of the concept of"brain-heart-kidney-seminal chamber"axis,Cistanches Herba-Rehmannize Radix et Praeparata-Cuscutae Semen were used to invigorate the kidney and regulate the essence of the brain,heart,kidney and seminal chamber;Salviea Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Schisandrae Chinensis Fructus can reach the heart and brain,calm the heart and calm the mind;Cyathulae Radix-Scolopendra-Spatholobi Caulis can adjust and restore the seminal chamber,moistening the tendons and vibrating the flaccidity.In clinical practice,the whole medication should be used to make the brain,heart and kidney in harmony with the seminal chamber at the same time,and the drugs should be flexibly added and subtracted according to the specific symptoms of patients to enhance the curative effect of CHD patients with ED.

Objective To investigate the diagnostic and therapeutic value of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis therapy in the treatment of acute uncomplicated appendicitis.Methods A retrospective analysis was conducted on the clinical data of 39 patients with acute uncomplicated appendicitis who underwent single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment at the Endoscopy center of the hospital from September 2022 to September 2024.Observe the endoscopic manifestations,the rate of maternal and child basket stone removal,the rate of appendiceal stent implantation,the technical success rate,the clinical success rate,the operation time,the hospital stay,the incidence of complications,the visual analogue scale(VAS)score 6 hours after the operation,and the inflammatory indicators 24 hours after the operation.Results In 28 cases(71.8%),congestion and edema could be seen at the opening of the appendix under colonoscopy.In 10 cases(25.6%),pus could be seen flowing out of the opening of the appendix under colonoscopy.In 32 cases(82.1%),a large amount of pus could be seen in the lumen of the appendix under subscopy.In 20 cases(51.3%),appendiceal fecalith could be seen in the lumen of the appendix under subscopy.The technical success rate of single-use mother-baby choledochoscope-assisted endoscopic retrograde appendicitis treatment was 100.0%(39/39).The operation time was(21.08±7.49)min;Hospital stay:(3.97±2.08)days;Eight cases(20.5%)of patients underwent endoscopic maternal basket stone removal.Appendiceal stent implantation was performed in 14 cases(35.9%)of patients.The clinical success rate is 97.4%(38/39).One patient's clinical symptoms and inflammatory indicators did not improve after the operation,and was transferred to the surgery department for appendectomy.The VAS score of 38 patients was less than 3 points 6 hours after the operation,and the abdominal pain symptoms were significantly relieved.The white blood cell count and the percentage of neutrophils 24 hours after the operation decreased significantly compared with those before the operation,and the differences were statistically significant(P<0.05).None of the 39 patients had complications.The postoperative follow-up was(5.94±4.03)months,and recurrence occurred in 3 cases(7.7%).Conclusion single-use mother-baby choledocoscope-assisted endoscopic retrograde appendicitis therapy is safe and effective in the diagnosis and treatment of acute uncomplicated appendicitis,which is worthy of further promotion and popularization in clinical practice.