Objective: To explore the efficacy of a novel injectable hydrogel (GelMA/P11/IL4@LIP) loaded with P11 bacteriophages and interleukin-4 (IL-4) liposomes (LIP) in preventing relapse after maxillary expansion in mice, providing experimental evidence for its clinical application. Methods: This study was approved by the experimental animal ethics committee of our hospital. First, 15 7-week-old C57BL/6 mice were used to establish a maxillary expansion model and divided into 5 groups (3 mice in each group): a control group, post expansion day 3 group (PED3 group), post expansion day 7 group (PED7 group), retention for 14 days group (RET group), and relapse for 7 days group (REL group). The mice in each group were sacrificed at their designated time points (day 0, 3, 7, 21, 28), and their maxilla and anterior cranial regions were collected. Bone parameters and the inter-crestal distance (ICD) of maxillary incisor mesial alveolar ridge were measured using micro-computed tomography (micro-CT). Histological staining was performed to evaluate bone formation and resorption, while immunohistochemistry (IHC) was performed for macrophage markers (CD86 and CD206), mesenchymal stem cell markers (glioma-associated oncogene homolog 1 [Gli1]), and osteogenic markers (Runt-related transcription factor 2 [Runx2] and Osterix [OSX]). Next, GelMA/P11/IL4@LIP was synthesized and administered to mouse models of maxillary expansion. A total of 24 7-week-old C57BL/6 mice were divided into 4 groups (6 mice in each group): a blank control group, GelMA group, GelMA/P11 group, and GelMA/P11/IL4@LIP group. All mice underwent palatal expansion. On PED7, the expanders of all 24 mice were cemented with resin to initiate the 14-day retention period. On day 1 of the retention phase, the mice in each group received injections of saline, GelMA, GelMA/P11, or GelMA/P11/IL4@LIP at the midpalatal suture. After the 14-day retention period, three mice in each group were randomly selected and sacrificed, while the other three had their expanders removed and underwent a 7-day relapse before being sacrificed on day 28 (REL). Micro-CT, histological staining, and IHC were performed to evaluate the preventive effect of GelMA/P11/IL4@LIP on post-expansion relapse. Results: The mice maxillary expansion model exhibited a decreased ICD at REL compared to RET in micro-CT analysis (P = 0.008). IHC analysis demonstrated prolonged M1 macrophage infiltration, scarce Gli1+ mesenchymal stem cells, and insufficient expression of osteogenic markers (RUNX2 and OSX) (P < 0.001). Compared to the blank control and GelMA groups, GelMA/P11/IL4@LIP hydrogel injection in the midpalatal suture led to increased ICD at REL, promoted the timely M2 polarization of macrophages, recruited Gli1+ mesenchymal stem cells, and upregulated the expression of RUNX2 and OSX (P < 0.05). Conclusion The mechanism of relapse after maxillary expansion involves the persistent infiltration of M1 macrophages, as well as the inadequate recruitment and insufficient osteogenic differentiation of MSCs in the midpalatal suture. The GelMA/P11/IL4@LIP composite enhanced orofacial mesenchymal stem cell recruitment and promoted the M2 polarization of macrophages, thereby enhancing osteogenesis in the midpalatal suture and preventing post-expansion relapse.

摘要 目的 探讨血浆神经胶质细胞原纤维酸性蛋白（GFAP）及同型半胱氨酸（Hcy）水平对肝豆状核变性（又称肝豆状核变性，WD）的诊断及肝脑型鉴别诊断价值。方法 招募安徽中医药大学第一附属医院脑病中心2023年1月—2025年1月收治的WD患者共120例，其中WD脑型63例，WD肝型57例，以及同期在体检中心筛查的30名健康志愿者。采用ELISA法测定纳入对象血浆GFAP、Hcy水平，进行组间差异性比较和ROC曲线分析。并运用Spearman相关分析探讨血浆GFAP、Hcy水平与统一肝豆状核变性评定量表评分（UWDRS）、24 h尿铜及血清铜蓝蛋白（CER）水平的相关性。结果 WD肝型及脑型患者的血浆GFAP水平均显著高于对照组（P<0.05），且WD脑型较WD肝型升高更为显著（P<0.05）。血浆Hcy水平也在WD肝型及脑型患者中明显升高（P<0.05），但在WD肝型、脑型间未表现出显著差异。血浆GFAP诊断WD脑型的曲线下面积（AUC）为0.861，截断值为135.71 pg/ml，敏感度68.3％，特异度82.3％；该指标诊断WD肝型的AUC为0.695，截断值为129.84 pg/ml，敏感度64.7％，特异度83.3％；其在WD肝型及脑型鉴别诊断中的AUC为0.75，截断值为151.12 pg/ml，敏感度73.9％，特异度87.8％。血浆Hcy诊断WD的AUC为0.788，截断值为15.59 μmol/L，敏感性77.9％，特异性66.7％。Spearman相关性分析结果显示，WD肝型及脑型患者血浆GFAP、Hcy水平与UWDRS评分及24 h尿铜水平均呈正相关（P<0.05），与CER水平无显著相关性（P>0.05）。结论 血浆GFAP、Hcy水平与WD神经及肝脏功能受损程度密切相关，且为早期诊断WD以及血浆GFAP对WD各分型的鉴别诊断提供了一定的临床价值。 Abstract Objective To investigate the value of plasma glial fibrillary acidic protein （GFAP） and homocysteine （Hcy） in the diagnosis of hepatolenticular degeneration （also know as Wilson disease， WD） and the differential diagnosis of the hepatic and neurological forms of WD. Methods A total of 120 WD patients who were admitted to Encephalopathy Center of our hospital from January 2023 to January 2025 were enrolled， among whom there were 63 patients with neurological WD and 57 patients with hepatic WD， and 30 healthy volunteers who underwent physical examination during the same period of time were enrolled as control group. ELISA was used to measure the plasma levels of GFAP and Hcy， and the differences between groups were analyzed. The receiver operating characteristic（ROC） curve analysis was performed， and the Spearman correlation analysis was used to investigate the correlation of the plasma levels of GFAP and Hcy with Unified Wilson Disease Rating Scale （UWDRS） score， 24-hour urinary copper， and the serum level of ceruloplasmin （CER）. Results The patients with hepatic or neurological WD had a significantly higher plasma level of GFAP than the control group（P<0.05）， and the patients with neurological WD had a significantly greater increase than those with hepatic WD（P<0.05）. The patients with hepatic or neurological WD also had a significant increase in the plasma level of Hcy（P<0.05）， but with no significant difference between the patients with hepatic WD and those with neurological WD.Plasma GFAP had an area under the ROC curve（AUC） of 0.861 in the diagnosis of neurological WD， with a cut-off value of 135.71 pg/ml， a sensitivity of 68.3%，and a specificity of 82.3%；plasma GFAP had an AUC of 0.695 in the diagnosis of hepatic WD， with a cut-off value of 129.84 pg/ml， a sensitivity of 64.7%， and a specificity of 83.3%； in the differential diagnosis of hepatic and neurological WD， plasma GFAP had an AUC of 0.75， with a cut-off value of 151.12 pg/ml，a sensitivity of 73.9%， and a specificity of 87.8%. Plasma Hcy had an AUC of 0.788 in the diagnosis of WD， with a cut-off value of 15.59 μmol/L， sensitivity of 77.9%， and specificity of 66.7%. The Spearman correlation analysis showed that in the patients with hepatic or neurological WD， the plasma levels of GFAP and Hcy were positively correlated with UWDRS score and 24-hour urinary copper （P<0.05）， but they were not significantly correlated with the level of CER （P>0.05）. Conclusion The plasma levels of GFAP and Hcy are closely associated with the degree of neurological and hepatic impairment in WD， which provides a certain clinical value for the early diagnosis of WD and the differential diagnosis of hepatic and neurological WD.
Homocysteine

ObjectiveTo analyze the development status and research frontiers of repetitive peripheral magnetic stimulation (rPMS) in rehabilitation therapy. MethodsRelevant literatures on rPMS in rehabilitation therapy were retrieved from CNKI, Wanfang data, VIP and Web of Science Core Collection from January, 2005 to December, 2024. CiteSpace 6.4.R1 and VOSviewer 1.6.20 were used for visualization analysis. ResultsA total of 202 publications were included, 81 in Chinese and 121 in English, with an overall increasing trend in annual publications. Japan had the highest number of English publications, while Germany demonstrated the highest centrality. The most productive institution in Chinese publications was Huashan Hospital Affiliated to Fudan University, with the most prolific authors being Xu Liang, Cai Qian and Ma Ming. For English publications, Technical University of Munich was the most productive institution, Schneider Cyril was the most productive author, and Clinical Neurophysiology was the most influential journal. Hotspot keywords in both Chinese and English publications included stroke, spasticity, repetitive transcranial magnetic stimulation, dysphagia, motor function, pain and plasticity, etc. The most bursting words in Chinese and English publications were spasticity and pain, respectively. ConclusionResearches on rPMS in rehabilitation therapy show steady growth, primarily focusing on functional rehabilitation for neurological diseases such as stroke and cerebral palsy, as well as the treatment of painful diseases including low back pain.

ObjectiveTo analyze the development status and research frontiers of repetitive peripheral magnetic stimulation (rPMS) in rehabilitation therapy. MethodsRelevant literatures on rPMS in rehabilitation therapy were retrieved from CNKI, Wanfang data, VIP and Web of Science Core Collection from January, 2005 to December, 2024. CiteSpace 6.4.R1 and VOSviewer 1.6.20 were used for visualization analysis. ResultsA total of 202 publications were included, 81 in Chinese and 121 in English, with an overall increasing trend in annual publications. Japan had the highest number of English publications, while Germany demonstrated the highest centrality. The most productive institution in Chinese publications was Huashan Hospital Affiliated to Fudan University, with the most prolific authors being Xu Liang, Cai Qian and Ma Ming. For English publications, Technical University of Munich was the most productive institution, Schneider Cyril was the most productive author, and Clinical Neurophysiology was the most influential journal. Hotspot keywords in both Chinese and English publications included stroke, spasticity, repetitive transcranial magnetic stimulation, dysphagia, motor function, pain and plasticity, etc. The most bursting words in Chinese and English publications were spasticity and pain, respectively. ConclusionResearches on rPMS in rehabilitation therapy show steady growth, primarily focusing on functional rehabilitation for neurological diseases such as stroke and cerebral palsy, as well as the treatment of painful diseases including low back pain.

ObjectiveTo evaluate the public health governance capacity in Jiangsu Province and provide an optimized pathway for the construction of a “strong, rich, beautiful, and high-quality” new Jiangsu. MethodsA total of 806 policy documents, 658 public information reports, and 148 research literatures related to public health governance capacity in Jiangsu Province from January 1995 to December 2023 were collected. The status of current public health goverance was assessed based on the evaluation criteria suitable for public health systems, and the strengths and the weaknesses of the system were identified. ResultsThe public health governance capability of Jiangsu Province was scored at 738.3 points, ranking 3rd nationally. Maternal health care and emergency response capacities achieved leading positions nationwide, both ranking 2nd. Jiangsu had exhibited a standardized guidance in the strategic level, a well-established management mechanism, an extensive coverage in information collection, and a scientifically established health targets setting. However, bottlenecks remained, including an unclear division of responsibilities across organizational departments, an insufficient public-health workforce, the absence of a stable growth mechanism for government funding investment, and difficulties in promptly identifying public needs. ConclusionJiangsu’s public-health system demonstrates leading nationally, yet several components remain underdeveloped. Future efforts should consolidate advantages while addressing weaknesses, further diversify content and forms, establish a stable funding increase mechanism, and clarify departmental functions, thereby providing solid health support for realizing the developmental goals of a “strong, rich, beautiful and high-quality” new Jiangsu.

ObjectiveTo systematically assess the public health governance capacity in Zhejiang Province, to conduct an in-depth analysis of its strengths and weaknesses, so as to provide scientific basis and strategic recommendations for further enhancement. MethodsA systematic collection of policy documents, public information reports, and research literature related to public health governance capacity in Zhejiang Province from 2002 to 2023 was conducted (encompassing a total of 1 263 policy documents, 138 pieces of information reports and 631 research articles). Based on the evaluation criteria suitable for public health systems previously developed by the research team, the basic status and magnitude of change in public health governance capacity in Zhejiang Province was evaluated. Additionally, normative gap analyses were employed to identify the strengths and weaknesses. ResultsZhejiang Province ranked 4th nationwide in terms of public health governance capacity with a score of 733.4 points (1 000.0-point maximum). The province has effectively implemented the principle of health first (scoring 698.5 points in the assessment of health-first strategy implementation) and attached sufficient importance to health-related goals (scoring 658.2 points in the scientific rationality of goal setting). However, the implementation of inter-departmental coordination and incentive mechanisms only scored 178.7 points, the feasibility of management and monitoring mechanisms scored even lower at only 144.0 points, and the coverage of incentive mechanisms scored 286.0 points. ConclusionZhejiang Province has effectively implemented its health first strategy and attached great importance to health targets, but still needs to strengthen cross-departmental coordination mechanisms and health-oriented incentives.

ObjectiveTo analyze the development status and research frontiers of repetitive peripheral magnetic stimulation (rPMS) in rehabilitation therapy. MethodsRelevant literatures on rPMS in rehabilitation therapy were retrieved from CNKI, Wanfang data, VIP and Web of Science Core Collection from January, 2005 to December, 2024. CiteSpace 6.4.R1 and VOSviewer 1.6.20 were used for visualization analysis. ResultsA total of 202 publications were included, 81 in Chinese and 121 in English, with an overall increasing trend in annual publications. Japan had the highest number of English publications, while Germany demonstrated the highest centrality. The most productive institution in Chinese publications was Huashan Hospital Affiliated to Fudan University, with the most prolific authors being Xu Liang, Cai Qian and Ma Ming. For English publications, Technical University of Munich was the most productive institution, Schneider Cyril was the most productive author, and Clinical Neurophysiology was the most influential journal. Hotspot keywords in both Chinese and English publications included stroke, spasticity, repetitive transcranial magnetic stimulation, dysphagia, motor function, pain and plasticity, etc. The most bursting words in Chinese and English publications were spasticity and pain, respectively. ConclusionResearches on rPMS in rehabilitation therapy show steady growth, primarily focusing on functional rehabilitation for neurological diseases such as stroke and cerebral palsy, as well as the treatment of painful diseases including low back pain.

ObjectiveTo evaluate the clinical efficacy and economic value of the Jiangsu Traditional Chinese Medicine （TCM） Diagnosis and Treatment Protocol for Dominant Diseases （abbreviated as the Diagnosis and Treatment Protocol） in adult patients with non-severe community-acquired pneumonia （CAP） based on real-world clinical data. MethodsA retrospective real-world cohort study was conducted using electronic medical records of adult patients hospitalized for non-severe CAP from September 1st， 2023 to December 31st， 2024 across 10 TCM hospitals in Jiangsu province. Patients were classified into an exposure group and a non-exposure group based on whether they received Chinese herbal medicine （CHM） according to the Diagnosis and Treatment Protocol. The non-exposure group received only conventional western medicine， while the exposure group additionally received differentiated CHM for at least five consecutive days. Outcomes were compared between two patient groups， including cough resolution rate， sputum resolution rate （assessed by volume， color， and consistency）， incidence of abnormal C-reactive protein （CRP）， incidence of abnormal white blood cell （WBC） count， and radiographic resolution rate of pulmonary infiltrates on chest imaging. Multivariable logistic regression was performed to identify factors influencing clinical efficacy. Subgroup analyses were conducted according to age， gender， smoking status， history of hypertension， and pneumonia severity score （CURB-65）， and the efficacy of treatment for cough and sputum was analyzed within each subgroup. Cost-effectiveness analysis was conducted using cough resolution rate as the outcome measure， evaluating the pharmacoeconomics of the two groups. ResultsA total of 1688 patients were included with 1293 in the exposure group and 395 in the non-exposure group. Compared to the non-exposure group， the exposure group demonstrated significantly higher resolution rates of cough， sputum volume， color， and consistency， as well as a significantly lower incidence of abnormal CRP （P＜0.05）. No statistically significant difference was observed between the groups in terms of abnormal WBC count and radiographic resolution rate of pulmonary infiltrates （P＞0.05）. Logistic regression analysis showed that the cough resolution rate in the exposure group was 1.83 times that of the non-exposure group， while the probabilities of resolution in sputum volume， color， and consistency were 1.37， 2.09， and 1.56 times those of the non-exposure group， respectively （P＜0.05）. Subgroup analyses showed that the exposure group achieved significantly higher cough resolution rates across most subgroups except for populations with a CURB-65 score ≥2 or those with a history of hypertension （P＜0.05）. Specifically， among females， patients aged ≥18 and ＜65 years， non-smokers， those without hypertension， and those with a CURB-65 score of 0， the exposure group showed a higher cough resolution rate than the non-exposure group （P＜0.05）. From an economic perspective， total hospitalization cost， length of stay， antibiotic cost， and CHM cost all differed significantly between groups （P＜0.05）. The cost-effectiveness ratio （CER） was 10,788.80 CNY/case in the exposure group， while 22,513.80 CNY/case in the non-exposure group. This implies that， compared with the exposure group， the non-exposure group incurred an additional 17,302.27 CNY to achieve one case of cough resolution. When the willingness-to-pay threshold ranged from 0 to 50,000 CNY， the probability of economic advantage was consistently higher in the exposure group than in the non-exposure group. ConclusionOn the basis of conventional western medicine， the addition of CHM in accordance with the Diagnosis and Treatment Protocol can effectively improve clinical symptoms， reduce inflammatory markers， promote clinical recovery， and is more cost-effective in treating adults with non-severe CAP.

ObjectiveTo observe the real‑world effectiveness and economic outcomes of Weishi Qingjin Formula （苇石清金方， WQF） in the treatment of adult community‑acquired pneumonia （CAP） with phlegm‑heat obstructing the lung syndrome. MethodsBased on a multicenter， real-world retrospective cohort study， clinical data were collected from hospitalized adult patients diagnosed with non‑severe CAP and phlegm‑heat obstructing the lung syndrome in 10 traditional Chinese medicine （TCM） hospitals in Jiangsu province. Patients were divided into an exposure group （those who received oral WQF） and a non‑exposure group （those who did not）. The following outcomes were compared between the two groups before and after treatment， which were remission rates of clinical symptoms including cough， expectoration （sputum volume， color， consistency）， and chest pain， levels of inflammatory markers including C‑reactive protein （CRP） and white blood cell count （WBC）， and the rate of pulmonary inflammatory absorption on chest CT. Subgroup analyses were performed based on age， gender， smoking status， presence of hypertension， and the severity of community-acquired pneumonia （CURB‑65） score， comparing the two groups in terms of cough remission rate， chest pain remission rate， and chest CT absorption rate. For health economic evaluation， cost‑effectiveness analysis was used to calculate the cost‑effectiveness ratio （CER） and incremental cost‑effectiveness ratio （ICER）. Univariate sensitivity analysis and probabilistic sensitivity analysis were performed to test the robustness of the results. ResultsA total of 647 patients in the exposure group and 1491 patients in the non-exposure group were included in the final statistical analysis. There was no statistically significant difference in length of hospital stay， gender， marital status， smoking history， bronchoscopy history， and comorbidities between the groups （P＞0.05）， but age， CURB-65 score， and antibiotic use. The exposure group had significantly higher remission rates of cough and sputum consistency than the non-exposure group （P＜0.05）. After adjusting for confounders using propensity score matching and logistic regression， the cough remission rate in the exposure group was 1.49 times that of the non-exposure group （P＜0.01）. No significant difference was observed between groups in the reduction rates of CRP and WBC， and in the rate of pulmonary inflammatory absorption on chest CT （P＞0.05）. Subgroup analyses revealed that the cough remission rate in the exposure group was significantly better than that in the non-exposure group except for patients aged ≥65 years， smokers， hypertensive patients， those using other type antibiotics or not using antibiotics， and those with a CURB-65 score ≥1 （P＜0.05）. Among smokers， the chest pain remission rate in the exposure group was 4.38 times that of the non-exposure group （P＜0.01）. No significant difference in chest CT absorption rate was found between groups across subgroups of gender， age， hypertension status， or antibiotic type （P＞0.05）. In terms of economic evaluation， CER was 10,877.60 CNY/case in the exposure group and 16,773.10 CNY/case in the non-exposure group. Compared to the exposure group， the non-exposure group incurred an additional 15,034.26 CNY to achieve one case of cough resolution， indicating a more favorable cost-effectiveness profile. Probabilistic sensitivity analysis yielded results consistent with the cost-effectiveness analysis， confirming the robustness of the findings. ConclusionWQF demonstrates significant efficacy in improving cough symptoms in the treatment of adult CAP with phlegm-heat obstructing the lung syndrome， and also exhibits favorable economic benefits.

Myofascial trigger points， as hyperirritable spots within taut bands of skeletal muscle， can induce local or referred pain， and show a high degree of similarity to acupoints in traditional Chinese medicine （TCM）， particularly the so-called sinew knot lesion point. From the perspective of channel sinew theory， and by examining the correlations of myofascial trigger points with acupoints and channel sinew disorders， this study aims to compare the similarities and differences between MTrPs and sinew knot lesion points in terms of pathological mechanisms， needling analgesic mechanisms， and therapeutic approaches. The goal is to deepen the understanding of MTrPs and dry needling， and provide a modern scientific perspective on channel sinew theory and the sinew knot lesion point.