Objective: To understand the awareness of chikungunya fever knowledge and its related factors among medical college students in Baise City, so as to provide a scientific basis to offer relevant courses and special education. Methods: From July to August 2025, 7 286 enrolled medical students were selected by a sampling method from a medical college in Baise City to participate in the questionnaire survey. The questionnaire covered epidemiological characteristics, clinical symptoms, and prevention/control knowledge of chikungunya fever. Statistical analyses including the Chi quare test and multivariate Logistic regression models were performed. Results: The overall awareness rate of chikungunya fever knowledge among the medical students was 18.89%. Among the knowledge items, the awareness rate of "the high incidence season" was the highest (84.05%), while that of "the infectious period" was the lowest (17.80%). Multivariate Logistic regression analysis showed that medical students with female (a OR= 1.37 , 95%CI =1.20- 1.57 ), the age for over 25 years old (a OR=1.76, 95%CI =1.05-2.93), whose father had a middle school educational level (a OR=1.18, 95%CI =1.05-1.31), and majored in preventive medicine (a OR=1.54, 95%CI =1.10-1.67) had relatively higher awareness rates of chikungunya fever knowledge (all P <0.05). In contrast, students of Zhuang ethnicity (a OR= 0.87 , 95%CI =0.76-0.98) and majoring in nursing (a OR=0.74, 95%CI =0.61-0.91) or pharmacy (a OR=0.70, 95%CI =0.52-0.95) had relatively lower awareness rates (all P <0.05). Conclusions The awareness rate of chikungunya fever related knowledge among medical college students in Baise City is relatively low. Schools should take targeted publicity measures to improve medical students awareness.

Renal hilar tumors pose significant surgical challenges due to their proximity to major renal vessels and the collecting system. In robot-assisted partial nephrectomy, although both anterior and posterior lip tumors are considered renal hilar tumors, their operative difficulty and complication profiles differ markedly owing to distinct anatomical relationships and vascular adjacency. Anterior lip tumors, often involving tributaries of the renal vein, carry a relatively higher risk of intraoperative and postoperative bleeding. In contrast, posterior lip tumors, closer to the renal artery, are more likely to prolong warm ischemia time, thereby increasing the risk of postoperative renal impairment. Regarding urine leakage, although anterior lip tumors are theoretically closer to the collecting system and may pose a slightly elevated risk, precision reconstruction strategies—such as lip reconstruction based on sinus space anatomy—can effectively mitigate this risk. However, the specific difference in urine leakage risk between anterior and posterior lip tumors warrants further investigation. Both anterior and posterior lip tumors of the kidney can achieve low positive surgical margin rates in experienced centers. Complication risks are affected by multiple factors, including tumor anatomical complexity, warm ischemia time, and surgeon experience. Notably, R.E.N.A.L. score＞8 is associated with significantly increased complication risks. Preoperative meticulous imaging evaluation, selection of an appropriate surgical approach based on tumor location, controlled warm ischemia time, and application of delicate suturing and reconstruction techniques are essential strategies to reduce complications.

This paper summarizes professor XUAN Guowei's clinical experience in treating melasma from the perspective of kidney deficiency with vigorous fire， and scorching the collaterals to form stasis. It is proposed that the core pathogenesis of melasma is kidney deficiency with vigorous fire， along with the scorching of collaterals to form stasis， for which the the core therapeutic principle is enriching the kidney and subduing fire， combined with invigorating blood and dissolving stasis. In clinical practice， the self-formulated Xiaoban Decoction （消斑汤） is utilized as the foundational formula， complemented by external therapies such as acupuncture and moxibustion， acupoint injection， and the external application of Chinese herbal medicine. Furthermore， emphasis is placed on daily care and regulation， including strict sun protection， maintaining a joyful mood， ensuring adequate sleep， and following a healthy diet. This paper aims to provide a clinical reference for the treatment of melasma with traditional Chinese medicine.

Objective:To analyze the expression of serum lysyl oxidase like protein 4(LOXL4)and protein tyrosine phosphatase non receptor type 3(PTPN3)in patients with colorectal cancer and their relationship with postoperative liver metastasis.Methods:Totally 137 patients with colorectal cancer who visited Qingdao Central Hospital,University of Health and Rehabilitation Science from April 2017 to December 2019 were recruited as the cancer group.Complying with whether liver metastasis occurred during the follow-up period of 5 years,the patients were classified into the liver metastasis group(27 cases)and the non liver metastasis group(110 cases).Another 137 healthy individuals who underwent physical check ups were recruited as the control group.The qRT-PCR method was used to detect the ex-pression levels of serum LOXL4 and PTPN3 mRNAs.The serum LOXL4 and PTPN3 mRNAs were compared under dif-ferent clinical pathological data,and the pathological data of liver metastasis group and non liver metastasis group were compared.Cox regression analysis was used to explore the influencing factors of postoperative liver metastasis in pa-tients with colorectal cancer.ROC curve was used to explore the predictive value of serum LOXL4 and PTPN3 for postoperative liver metastasis in patients with colorectal cancer.Results:Compared with the control group,the can-cer group had higher levels of serum LOXL4 and PTPN3 mRNAs expression(P<0.05).Compared with patients with medium to high differentiation,infiltration depth≤1/2 muscle layer,and TNM stage I-II,patients with low differentia-tion,infiltration depth>1/2 muscle layer,and TNM stage III had higher levels of serum LOXL4 and PTPN3 mRNAs ex-pression(P<0.05).Compared with the non liver metastasis group,the liver metastasis group had higher levels of se-rum LOXL4 and PTPN3 mRNAs expression(P<0.05).High expression of serum LOXL4 and PTPN3 mRNAs were risk factors for liver metastasis after colorectal cancer surgery(P<0.05).Compared with the single prediction of serum LOXL4 and PTPN3 mRNAs,the AUC of serum LOXL4 combined with PTPN3 in predicting postoperative liver metasta-sis in colorectal cancer patients was higher(P<0.05).Conclusion:Serum LOXL4 and PTPN3 mRNAs expression lev-els are abnormally elevated in patients with colorectal cancer,which is related to the deterioration of pathological data such as differentiation degree,infiltration depth,and TNM staging.Elevated serum LOXL4 and PTPN3 mRNAs expres-sion levels may increase the risk of postoperative liver metastasis in patients,and the combination has higher predic-tive value for postoperative liver metastasis.

Purpose To investigate the clinical and pathological characteristics of synchronous multiple primary malignancy(sMPM)with lymphoid hematopoietic tissue tumors.Methods A retrospective analysis was conducted on the clinical and pathological data of 20 cases of sMPM associated with lymphoma.Immunohistochemistry using the En-Vision two-step method was performed to detect the expression of relevant proteins,while FISH and next-generation se-quencing technologies were used to identify gene mutations.Relevant literature was also reviewed.Results There were 14 females and 6 males,aged from 30 to 75 years(median 67 years).All of them manifested as solid organ mas-ses complicated by lymphadenopathy.Lymphohematopoietic tissue tumors consisted of:7 cases of Hodgkin lymphoma(6 cases of classic Hodgkin lymphoma,1 case of nodular lymphocyte predominant Hodgkin lymphoma),13 cases of non-Hodgkin lymphoma(4 cases of Follicular lymphoma,2 cases of small lymphocytic lymphoma/chronic lymphocytic leukemia,2 cases of diffuse large B-cell lymphoma,1 case of plasmablastic plasmacytoma,1 case of marginal zone B-cell lymphoma,1 case of B-lymphoblastic lymphoma,2 cases of peripheral T-cell lymphoma,NOS).Solid tumors con-sisted of:9 cases of papillary thyroid carcinoma,1 case of medullary thyroid carcinoma,2 cases of adenocarcinoma of the lung,2 cases of gallbladder adenocarcinoma,2 cases of invasive carcinoma of the breast,2 cases of gastrointestinal adenocarcinoma,1 case of pleomorphic undifferentiated sarcoma of the lower extremity,and 1 case of oropharyngeal squamous cell carcinoma.17 patients underwent surgical resection,and 3 patients were diagnosed by core needle biop-sy or excision biopsy.10 cases of lymphoma involved in the lymph nodes of the tumor drainage area,and 10 cases were found to have lymph node involvement in other areas by imaging examination.Among the 5 cases analyzed by targeted next generation sequencing,no revelent genetic changes were founded,and no germline mutations or chromosomal kar-yotype abnormalities were founded.Based on the tumor types,patients received varying degrees of radiotherapy,chem-otherapy,or follow-up.Follow-up information was available in all cases and ranged from 5 to 96 months,15 were sur-vived and four patients died of the tumor,and 1 case was lost to follow-up.Conclusion MPMs with lymphoid hemato-poietic tissue tumors are rare,clinicians and pathologists should be careful to avoid missing the diagnosis of lymphoma.

Objective:To assess the association between possible sarcopenia and the risk for frailty in middle-aged and elderly adults in China.Methods:A prospective cohort study design was used in this study. Data were from the China Health and Retirement Longitudinal Study during 2011-2018 and the baseline data in 2011, the follow up was conducted in 2013, 2015 and 2018, respectively. Frailty index was used to evaluate frailty status, and grip strength and repetitive sitting-up time were measured to detect possible sarcopenia. Cox proportional hazards regression model was used to estimate the association between possible sarcopenia and the risk for frailty in middle-aged and older adults.Results:In a 44 884 person-years follow-up, a total of 586 cases with frailty were recorded, and the incidence density of frailty was 13.06 per 1 000 person-year. The risk for frailty was also higher in those who were aged 60 years and above ( HR=2.05, 95% CI: 1.71-2.45), had a primary school education level or below ( HR=1.55, 95% CI: 1.29-1.85), had waist-to-height ratio ≥0.5 ( HR=1.39, 95% CI: 1.11-1.75) and had depression ( HR=1.52, 95% CI: 1.28-1.81). Drinking was associated with reduced risk for frailty ( HR=0.76, 95% CI: 0.62-0.94). The risk for frailty increased ( HR=1.73, 95% CI: 1.47-2.05) in those who might has possible sarcopenia. Conclusions:In middle-aged and elderly adults, those with possible sarcopenia, lower education level, central obesity and depression might be at high risk for frailty, and early interventions for high-risk population can be taken to slow the progression of frailty.

Objective:To explore the association of central obesity, pain, their joint effect, and interaction with frailty in middle-aged and old people in China.Methods:A total of 14 359 participants aged ≥45 years in 2011, 2013 and 2015 were selected from the China Health and Retirement Longitudinal Study to construct a cohort database. Cox proportional hazards regression models were used to estimate the association of waist-to-height ratio (WHtR) and pain with the risk for frailty. Joint effect and interaction analyses were performed.Results:In the follow-up of 77 783 person-years, frailty developed in 3 198 participants, with an incidence density of 41.11 per 1 000 person-years. Compared with the Q1 level of WHtR, its Q2, Q3 and Q4 level increased risk for frailty by 17% ( HR=1.17, 95% CI: 1.05-1.31), 24% ( HR=1.24, 95% CI: 1.11-1.40), and 43% ( HR=1.43, 95% CI: 1.25-1.63), respectively. Compared with painlessness, suffering from pain increased the risk for frailty by 97% ( HR=1.97, 95% CI: 1.83-2.11), and having 1, 2, and ≥3 pain sites increased the risk by 42% ( HR=1.42, 95% CI: 1.25-1.61), 86% ( HR=1.86, 95% CI: 1.64-2.11), and 138% ( HR=2.38, 95% CI: 2.18-2.60), respectively. The results of restricted cubic spline showed that WHtR level was associated with the risk for frailty in a J-type dose-response relationship (total P<0.001, nonlinear P<0.001), and pain quantity was positively associated with the risk in a nonlinear dose-response relationship (total P<0.001, nonlinear P<0.001). Threshold effect analysis revealed that the inflection points of WHtR and pain site number were 0.46 and 2.00, respectively ( P<0.001). Joint effect analysis showed that the Q2, Q3 and Q4 levels of WHtR combined with pain increased the risk for frailty by 146% ( HR=2.46, 95% CI: 2.11-2.87), 169% ( HR=2.69, 95% CI: 2.30-3.16), and 157% ( HR=2.57, 95% CI: 2.18-3.03). Conclusions:The risk for frailty increased with the level of WHtR and the number of pain sites in middle-aged and old people, and there was joint effect between WHtR and pain. Comprehensive management and intervention of obesity and pain are significant for the early prevention of frailty.

This article reports a case of membranous nephropathy in an adolescent accompanied by monoclonal IgG1-κ deposition. The 16-year-old female patient was hospitalized for experiencing proteinuria and hematuria for more than 20 days. The patient had a history of mycoplasma infection and acute kidney injury, and renal pathology revealed glomerular membrane lesions accompanied by crescent formation. Electron microscopy showed electron dense deposits in the subepithelial and mesangial regions, and immunofluorescence demonstrated monotypic IgG1-κ deposits in the glomerulus. Bone marrow examination did not find any abnormal plasma cells, nor were there significant abnormalities in serum or urine free light chain κ/λ ratio. The diagnosis was proliferative glomerulonephritis characterized by membranous lesions with monoclonal IgG1-κ deposits. This disease is rare in children and adolescents, and currently there is limited understanding of its mechanism, with limited clinical treatment experience. This article aims to provide clinical insights through case analysis and literature review.

Objective:To observe the clinical efficacy of combined acupuncture and medication therapy in treating cerebral infarction in the acute stage and its impact on cerebral blood flow.Methods:A total of 160 patients with cerebral infarction were divided into 4 groups using the random number table method,with 40 cases in each group.Conventional treatment was given to all groups.Besides,the Chinese medication group received Tong Shen Fu Nao Wan;the acupuncture group received Xing Nao Kai Qiao(mind-refreshing and orifice-opening)needling therapy;the acupuncture-medication group received both Tong Shen Fu Nao Wan and Xing Nao Kai Qiao needling therapy.After 4 weeks of treatment,the clinical efficacy was assessed,and changes in the traditional Chinese medicine(TCM)symptom score and hemodynamics were compared among the four groups,as well as complications and adverse reactions.Results:After treatment,the acupuncture-medication group had a higher total effective rate compared to the other three groups(P<0.05).After the intervention,the National Institutes of Health stroke scale(NIHSS)score dropped in all groups(P<0.05)and was lower in the acupuncture-medication group than in the other three groups(P<0.05);all groups showed a decrease in the TCM symptom score(P<0.05),and the acupuncture-medication group was significantly lower than the other groups(P<0.05).After treatment,the blood flow velocity of the bilateral anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)increased in every group(P<0.05),and the acupuncture-medication group had higher blood flow velocities compared to the other three groups(P<0.05).The acupuncture-medication group had the fewest number of complications among the four groups(P<0.05),and there was no statistical significance when comparing the adverse reactions among the groups(P>0.05).Conclusion:Compared to the separate use,the combined use of acupuncture and medication enhances the clinical efficacy,accelerates cerebral blood circulation,and boosts the recovery in treating cerebral infarction.

OBJECTIVE To explore the intervention mechanism of Shangke Lengtongtie on cold hyperalgesia in KOA mice based on the HMGB1/CXCL12/CXCR4 signaling axis.METHODS Monosodium iodoacetate(MIA)was used for the intra-articular injec-tion into the knee joint to establish mice model of knee osteoarthritis(KOA).Peripheral blood monocytes were extracted from mice,cultured,and then reinfused into the tail vein of the mice.Subsequently,in vivo animal imaging was used to observe the recruitment sites of these monocytes.The cold hyperalgesia threshold was measured at various time points in each group of mice.Hematoxylin and eosin(HE)staining was used to evaluate the level of synovial pathological changes.ELISA was employed to detect the expression of in-flammatory factors IL-1β,TNF-α,and pain mediators CGRP and Substance P in mouse serum.Western blot and qPCR methods were used to detect the protein and gene expression of cold hyperalgesia-related indicators such as TRPA1,TRPM8,HMGB1,CXCL12,CXCR4,Collagen Ⅰ,and Netrin-1 in synovial tissue,as well as DCC in dorsal root ganglia(DRG)tissue.RESULTS In vivo ima-ging showed that after the monocytes were reinfused into KOA mice,they were recruited to the knee joint area,with the HMGB1 group exhibiting a greater recruitment of circulating monocytes at the knee joint.Additionally,compared to the control group,the KOA group and HMGB1 group showed inflammatory pathological changes in the synovium,increased expression of serum inflammatory factors and pain mediators,reduced cold hyperalgesia threshold,and upregulated protein and gene expression of cold hyperalgesia-related indica-tors in synovial and DRG tissues.The changes were more significant in the HMGB1 group compared to the KOA group(P<0.05).Af-ter treatment with Shangke Lengtongtie or GL intervention,synovial inflammation was alleviated,serum inflammatory factors and pain mediators decreased,cold hyperalgesia threshold increased,and the upregulation of cold hyperalgesia-related indicator protein and gene expression levels was significantly reversed(P<0.05).CONCLUSION Shangke Lengtongtie exerts a beneficial effect on the mitigation of synovitis and cold hyperalgesia in KOA mice,a therapeutic mechanism that possibly mediated through the inhibition of the HMGB1/CXCL12/CXCR4 signaling axis.