Objective:To explore the influencing factors of self-management of first-treatment pulmonary tuberculosis patients based on the random forest model, and to provide a theoretical basis for clinical staff to improve the self-management of pulmonary tuberculosis patients by providing efficient, high-quality, and individualized interventions.Methods:A cross-sectional study was used to select pulmonary tuberculosis patients who were hospitalized in the Department of Respiratory Medicine of the Fourth People′s Hospital of the Ningxia Hui Autonomous Region and who met the inclusion and exclusion criteria from December 2023 to February 2024 by using the convenience sampling method as the study subjects. General information questionnaire, Chronic Disease Patients′ Self-health Management Ability Assessment Scale, Perceived Social Support Scale, Hospital Anxiety and Depression Scale, and a tuberculosis prevention and treatment knowledge questionnaire were used to conduct the survey, and Spearman′s correlation was used to analyze the correlation between variables, and multivariate linear regression and a random forest model were used to analyze the influencing factors of self-management.Results:A total of 204 first-treatment pulmonary tuberculosis patients, 111 males and 93 females, 64 patients aged 18-44 years, 59 patients aged 45-59 years, and 81 patients ≥60 years were finally investigated. The total self-management score of tuberculosis patients was 162.00 (148.00, 176.75), and the total self-management score was positively correlated with the total perceived social support score, family support, friend support, and other support, respectively ( r values were 0.307-0.400, all P<0.01), negatively correlated with the anxiety and depression scores, respectively ( r=-0.195, -0.313, both P<0.01), and positively correlated with the total score of knowledge of tuberculosis control ( r=0.257, P<0.01); the results of multiple linear stepwise regression analysis showed that literacy, family support, other support, anxiety, and knowledge of tuberculosis control were the influencing factors of self-management ability ( t values were -2.89-2.98, all P<0.05), which explained a total of 23.1% of the total variance; and the random forest model ranked the importance of the influencing factors in the order of high to low were other support, family support, knowledge of tuberculosis control, literacy, and anxiety. Conclusions:The self-management of first-treatment pulmonary tuberculosis patients is at an intermediate level, In order to improve the self-management ability of first-treatment pulmonary tuberculosis patients, clinical personnel should establish a "patient-centered" self-management education concept, pay attention to the construction of their social support system, provide adequate, continuous, individualized knowledge education and information support, promote their psychological health, and reduce their negative emotions.

Objective To evaluate the value of ultrasound and magnetic resonance imaging(MRI)in the diagnosis of knee osteoarthritis(KOA)by Meta-analysis.Methods Multiple databases for literature on KOA ultrasound and MRI diagnosis were screened.After data extraction and study quality assessment,14 articles involving 1613 patients were finally included.Meta-analysis were used on the extracted data to comprehensively evaluate the effectiveness of ultrasound and MRI in the diagnosis of KOA.Results All included studies used arthroscopy or surgical pathology as the gold standard for diagnosis.The pooled sensitivity,specificity,and diagnostic odds ratio(DOR)for ultrasound in diagnosing KOA were 0.79,0.82,and 20.30,respectively,with area under the curve(AUC)was 0.89.In comparison,the pooled sensitivity,specificity,and DOR for MRI in diagnosing KOA were 0.88,0.85,and 42.35,respectively,with AUC of 0.92.Conclusion Ultrasound and MRI have good accuracy in the diagnosis of KOA,and MRI is superior to ultrasound.

Cancer-related cognitive impairment(CRCI)refers to cognitive dysfunction that occurs during or after chemotherapy in patients with cancer.However,the pathogenesis of CRCI remains unclear,and effective treatments are lacking in clinical practice.Based on the"toxin damaging brain collaterals"theory,this study systematically explores the traditional Chinese medicine(TCM)etiology,pathogenesis,and treatment strategies of CRCI.In TCM,CRCI is attributed to a"deficiency of brain collaterals"in patients with cancer.Chemotherapy drugs,as exogenous pathogens,invade the brain when the body is weakened and interact with endogenous phlegm,blood stasis,and turbid toxins.This creates a vicious cycle of"toxin,blood stasis,phlegm,deficiency"ultimately leading to the malnourishment of the sea of marrow and the dysfunction of the spiritual mechanism.Modern biological research aligns with this TCM perspective,as neurotoxicity,oxidative stress,and inflammatory responses associated with CRCI correspond to the TCM concepts of"toxin damaging brain collaterals."Pathological changes such as increased microvascular permeability and neuronal network disruption are similar to the TCM pathogenesis characteristics of"toxin and blood stasis blocking the collaterals"and"emptiness of the sea of marrow."Given the progressive nature of CRCI pathogenesis,TCM therapeutic principles focus on strengthening healthy qi,enhancing cognitive function,eliminating toxins,and unblocking collaterals.Acupuncture,moxibustion,and Daoyin serve as supplementary external treatments,forming a comprehensive treatment approach of"treating the viscera through the collaterals and regulating the body to nourish the spirit."This framework provides novel insights for TCM diagnosis and CRCI treatment.

Objective:To summarize the best available evidence for donor and recipient site flap management in head and neck cancer patients undergoing free flap reconstruction.Method:Following the 6S evidence hierarchy model, a comprehensive search was conducted in databases and websites including UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Care Excellence, National Comprehensive Cancer Network, Joanna Briggs Institute Evidence-Based Healthcare Database, Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data. The search period covered all publications up to May 1, 2024.Results:A total of 14 articles were included, comprising two clinical decisions, two guidelines, two systematic reviews, five expert consensuses, two randomized controlled trials, and one prospective cohort study.A total of 28 pieces of evidence were summarized from six aspects: establishing multidisciplinary collaboration, standardized assessment, prehabilitation training, donor site management strategies, recipient site management strategies, and risk identification and management.Conclusions:This study provides a comprehensive summary of evidence regarding donor and recipient site flap management in patients with head and neck cancer undergoing free flap reconstruction, offering an evidence-based foundation for guiding clinical nursing practice.

Objective:To explore the influencing factors of self-management of first-treatment pulmonary tuberculosis patients based on the random forest model, and to provide a theoretical basis for clinical staff to improve the self-management of pulmonary tuberculosis patients by providing efficient, high-quality, and individualized interventions.Methods:A cross-sectional study was used to select pulmonary tuberculosis patients who were hospitalized in the Department of Respiratory Medicine of the Fourth People′s Hospital of the Ningxia Hui Autonomous Region and who met the inclusion and exclusion criteria from December 2023 to February 2024 by using the convenience sampling method as the study subjects. General information questionnaire, Chronic Disease Patients′ Self-health Management Ability Assessment Scale, Perceived Social Support Scale, Hospital Anxiety and Depression Scale, and a tuberculosis prevention and treatment knowledge questionnaire were used to conduct the survey, and Spearman′s correlation was used to analyze the correlation between variables, and multivariate linear regression and a random forest model were used to analyze the influencing factors of self-management.Results:A total of 204 first-treatment pulmonary tuberculosis patients, 111 males and 93 females, 64 patients aged 18-44 years, 59 patients aged 45-59 years, and 81 patients ≥60 years were finally investigated. The total self-management score of tuberculosis patients was 162.00 (148.00, 176.75), and the total self-management score was positively correlated with the total perceived social support score, family support, friend support, and other support, respectively ( r values were 0.307-0.400, all P<0.01), negatively correlated with the anxiety and depression scores, respectively ( r=-0.195, -0.313, both P<0.01), and positively correlated with the total score of knowledge of tuberculosis control ( r=0.257, P<0.01); the results of multiple linear stepwise regression analysis showed that literacy, family support, other support, anxiety, and knowledge of tuberculosis control were the influencing factors of self-management ability ( t values were -2.89-2.98, all P<0.05), which explained a total of 23.1% of the total variance; and the random forest model ranked the importance of the influencing factors in the order of high to low were other support, family support, knowledge of tuberculosis control, literacy, and anxiety. Conclusions:The self-management of first-treatment pulmonary tuberculosis patients is at an intermediate level, In order to improve the self-management ability of first-treatment pulmonary tuberculosis patients, clinical personnel should establish a "patient-centered" self-management education concept, pay attention to the construction of their social support system, provide adequate, continuous, individualized knowledge education and information support, promote their psychological health, and reduce their negative emotions.

Objective To investigate the mediating role of anxiety and depression in social sup-port and burnout among primary caregivers of stroke patients.Methods A convenience sampling method was employed to select 506 primary caregivers of stroke patients as research subjects.The Gen-eral Information Questionnaire,Caregiver Burnout Inventory for Stroke Patients,Multidimensional Scale of Perceived Social Support,and Hospital Anxiety and Depression Scale were used for data col-lection.Results The total scores for caregiver burnout,social support,anxiety,and depression a-mong primarycaregivers of stroke patients were(72.83±14.32),(47.79±7.74),(10.49±3.00),and(10.45±3.06),respectively.Correlation analysis revealed a negative correlation between caregiver burnout and social support(r=-0.245,P＜0.001),and positive correlations with anxiety and depression(r=0.178,0.216,P＜0.001).Anxiety and depression partially media-ted the relationship between social support and caregiver burnout,accounting for 7.9％and 10.7％of the total effect,respectively.Conclusion Social support,anxiety,depression,and burnout are closely interrelated.Social support can directly or indirectly influence the occurrence of burnoutthrough anxiety and depression.Medical staff should pay attention to the anxiety and depression status of primary caregivers of stroke patients and enhance social support levels to reduce the incidence of burnout by alleviating anxiety and depression.

AIM:This study aims to investigate whether vitamin E succinate(VES)induces autophagy in hu-man gastric cancer cells through the promotion of mitochondria-associated endoplasmic reticulum membranes(MAMs).METHODS:Human gastric cancer cell lines MKN28 and MKN45 were cultured in vitro.Cell viability was assessed us-ing the CCK8 assay,and two cell growth curves were plotted to determine the treatment concentration of VES.Control groups,VES dose groups(MKN28:5,10,20,and 40 mg/L;MKN45:10,20,40,and 80 mg/L),an autophagy-posi-tive control group(rapamycin,RAPA,100 nmol/L),and a MAMs-positive control group(oligomycin A,10 mg/L)were set up.Cells were harvested after 24 h of treatment for subsequent experiments.The formation of autophagosomes and MAMs was observed using transmission electron microscopy.The expression levels of autophagy-related proteins,includ-ing beclin-1,LC3-II/LC3-I,and p62,were detected by Western blot.MAMs labeled with split green fluorescent protein(GFP)were visualized by fluorescence microscopy.The expression of mitofusin 2(MFN2),a key molecule of MAMs,was also detected by Western blot.To inhibit MFN2 specifically,the cells were treated with mitochondrial fusion inhibitor 8(MFI8)and simultaneously transfected with an MFN2 plasmid to achieve MFN2 overexpression(OE-MFN2).The cells were divided into control group,MFI8(20 μmol/L)group,VES groups(20 mg/L for MKN28 cells and 40 mg/L for MKN45 cells),VES+MFI8 group,OE-MFN2+MFI8 group and OE-MFN2+VES+MFI8 group.The MAMs were visualized by fluorescence microscopy,and the expression changes of MFN2,beclin-1 and LC3-II/I were detected by Western blot.RESULTS:The results of the CCK8 assay showed that VES significantly inhibited the viability of both human gastric can-cer cell lines(P<0.05).After VES treatment,the formation of typical autophagosomes and MAMs was observed in both cell lines by transmission electron microscopy.Fluorescence microscopy showed a significant increase in GFP signals of MAMs.Western blot analysis showed that with increasing doses of VES,the expression levels of MFN2,beclin-1,and LC3-II/I were significantly up-regulated,while that of p62 was significantly down-regulated(P<0.05).Compared with VES group,the cells pretreated with MFI8 followed by VES exposure showed markedly reduced GFP signals of MAMs and much lower protein levels of MFN2,beclin-1 and LC3-II/LC3-I(P<0.05).Transfection with an MFN2 overexpression plasmid rescued MFN2 expression.Compared with VES+MFI8 group,the cells in OE-MFN2+VES+MFI8 group had much higher protein expression levels of MFN2,beclin-1 and LC3-II/LC3-I(P<0.05).CONCLUSION:The VES may partici-pates in the regulation of autophagy in human gastric cancer cells by promoting the formation of MAMs.

Objective To explore the efficacy of single and combined parameters from 4 non-Gaussian diffusion models for differentiating breast imaging reporting and data system(BI-RADS)MRI category 4 benign and malignant breast tumors.Methods A total of 161 BI-RADS MRI category 4 breast lesions from 159 patients were retrospectively enrolled.Based on pathological results,the lesions were divided into malignant group(n=132)and benign group(n=29).The apparent diffusion coefficient(ADC)values were calculated from diffusion weighted imaging(DWI)sequences.Multi-b-value diffusion imaging data were acquired and fitted using 4 non-Gaussian models to obtain respective parameters,including diffusion kurtosis imaging(DKI),stretched exponential model(SEM),continuous-time random walk(CTRW)and fractional order calculus(FROC)model.Univariable and multivariable logistic regression analyses were employed to identify the diffusion quantitative indicators useful for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.Receiver operating characteristic(ROC)curves were drawn,and the optimal threshold was determined using Youden index.The differentiating performance of ADC value,single parameter and their combination from non-Gaussian diffusion models were assessed and compared according to the area under the curve(AUC)of ROC curves,as well as the sensitivity,specificity and accuracy under the optimal thresholds.Results In malignant group,αCTRW,KDKI and μFROC values were higher,while ADC,DCTRW,DFROC,DDCSEM,αSEM and DDKI values were lower than those in benign group(all P＜0.05).Multivariable logistic regression analysis identified DCTRW and αCTRW values as independent factors for differentiating benign and malignant BI-RADS MRI category 4 breast tumors(both P＜0.05),and a combined model was then constructed.The AUC of the combined model was higher than that of each single parameter including ADC,DCTRW and αCTRW values(all P＜0.05).Conclusion The combined model of DCTRW and αCTRW had better efficacy than each single parameter for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.

OBJECTIVE To explore the diagnostic value of the guanylate binding protein 5(GBP5)gene in pa-tients infected with Mycobacterium tuberculosis(MTB).METHODS Patients who visited the Fifth People's Hos-pital of Suzhou from Jan.2024 to May 2024,as well as individuals undergoing health examinations during the same period,were selected as the study subjects.Based on the diagnostic criteria,the subjects were divided into active tuberculosis(ATB)group(230 cases),pneumonia group(207 cases),latent tuberculosis infection(LTBI)group(48 cases)and healthy control(HC)group(122 cases).Real-time quantitative reverse transcription poly-merase chain reaction was used to detect the expression level of the GBP 5 gene in the whole blood of the subjects,and receiver operating characteristic(ROC)curves were employed to analyze its diagnostic performance.RESULTS There were statistically significant differences in GBP5 gene expression among the four groups(P＜0.001).The area under the ROC curve(AUC)for GBP5 in distinguishing the ATB group from the HC group,LTBI group and pneumonia group was 0.902,0.813 and 0.745,respectively.In the ATB group,the positive de-tection rate of the GBP5 method was 67.39％,higher than that of Gene Xpert MTB/RIF(62.20％),tuberculosis culture(60.00％)and smear acid-fast staining(35.20％)(P＜0.05).When distinguishing between ATB and LTBI patients,the positive prediction value of GBP5 was 95.09％,higher than that of IGRA testing(79.92％)(P＜0.05).The expression level of GBP5 was negatively correlated with the MTB bacterial load(P＜0.001).CONCLUSIONS The detection of the GBP5 gene has important clinical significance in the auxiliary diagno-sis of tuberculosis and can serve as an effective supplement to existing diagnostic methods for tuberculosis.

Background and purpose:Intrathecal chemotherapy is one of the mainstay treatment options for leptomeningeal metastases(LM)from solid tumors.A previous phase Ⅰ study demonstrated the safety and potential efficacy of intrathecal anti-programmed death receptor 1(anti-PD-1)for LM from melanoma.The synergistic efficacy of systemic chemotherapy combined with anti-PD-1 has been widely known.This study aimed to evaluate the safety and feasibility of intrathecal chemotherapy(pemetrexed)and anti-PD-1(toripalimab)for LM patients from solid tumors.Methods:The subjects were patients with LM from solid tumors who were treated at Affiliated Huizhou Hospital of Guangzhou Medical University/Third People's Hospital of Huizhou City.A 3+3 dose de-escalation strategy was implemented to determine the recommended dose with an initial dose of PD-1 inhibitor(toripalimab)40 mg and pemetrexed 15 mg.Pemetrexed was administered twice weekly for the initial 2 weeks of induction therapy,once weekly for the subsequent 4 weeks of consolidation therapy,and once monthly during maintenance therapy.PD-1 inhibitor was initiated at the 4th administration of pemetrexed,administered every 2 weeks for 6 weeks;subsequently,responders continued monthly maintenance therapy alongside pemetrexed.The primary objective was to assess safety based on adverse events and the recommended dose.All participants were observed to investigate the clinical response rate(CRR),disease control rate(DCR)and overall survival(OS).This study was approved by the ethics committee of Affiliated Huizhou Hospital of Guangzhou Medical University/Third People's Hospital of Huizhou City(ethics number:2024-KY-029-01).Results:Seven patients(male:3,female:4,median age:57 years)were enrolled between June and September 2024,including non-small cell lung cancer(6)and breast cancer(1).All patients presented with positive cerebrospinal fluid(CSF)cytology.Six patients presented LM-related neurological dysfunction.Five patients showed LM-related neuroimaging findings.Six patients completed the induction and consolidation therapy,and subsequently received maintenance therapy.One patient,due to bacterial meningitis,did not complete the final administration of toripalimab during consolidation therapy,and maintenance therapy was administered after infection control.Adverse events rate was 100%(7/7),including myelosuppression(100.00%,n=7),elevation of hepatic aminotransferases(42.86%,n=3),fatigue(28.57%,n=2)and hypothyroidism(14.29%,n=1).Three(42.86%)patients had grade 3 adverse events(myelosuppression).The immune-related adverse event(irAE)rate was 14.29%,manifested as hypothyroidism(Grade 2).No dose-limiting toxicity(DLT)was observed.Thus,no de-escalation was applied.The recommended dose was determined to be PD-1 inhibitor 40 mg in combination with pemetrexed 15 mg.Three patients showed improved neurological dysfunction,1 with CSF cytological response,and 2 with neuroimaging improvement.CRR was 57.14%(4/7)by response assessment in neuro-oncology(RANO)proposal criteria.DCR was 100%(7/7).Three patients exhibited abscopal effects with regression of brain metastasis lesions,primary lung lesion and mediastinal lymph nodes,respectively.As of April 10,2025,1 patient died.The median follow-up time was 7.7(5.9-9.3)months.The median OS was not reached with a 6-month OS rate of 85.71%.Conclusion:The combination therapy of intrathecal pemetrexed and a PD-1 inhibitor was well-tolerated and feasible,while also exhibiting potential clinical efficacy in treating LM from solid tumors including non-small cell lung cancer.