ObjectiveTo investigate the effects of Liuwei Dihuangwan on mammalian target of rapamycin （mTOR）-mediated synaptic plasticity in the prefrontal cortex-hippocampus circuit in the rat model of valproic acid （VPA）-induced autism spectrum disorder （ASD） and to explore its potential mechanism for reducing behavioral abnormalities in ASD rats. MethodsThirteen SD pregnant rats were randomized into the VPA group （10 rats） and the control group （3 rats）. On gestational day 13， the VPA group was intraperitoneally injected with VPA solution （600 mg·kg^-1）， while the control group was injected with an equal volume of normal saline. Male pups of 21 days old from both groups underwent behavioral tests to screen the ASD model rats （32 rats）. These rats were then randomly assigned to the model （distilled water）， vitamin D （1 480 U·kg^-1）， low-dose （0.75 g·kg^-1） Liuwei Dihuangwan， and high-dose （1.5 g·kg^-1） Liuwei Dihuangwan groups， and normal male pups were selected as the blank group （distilled water）， with 8 rats in each group. Each group was treated with the corresponding drug or an equal volume of distilled water via gavage daily. After drug administration， behavioral tests were conducted again， followed by anesthesia and tissue collection. Nissl staining was carried out to observe the morphological changes of neurons in the prefrontal cortex and hippocampus. Transmission electron microscopy was used to observe changes in hippocampal synaptic structure. Immunohistochemistry and Western blot were employed to determine the expression of mTOR， phosphatidylinositol 3-kinase （PI3K）， and protein kinase B （Akt） in the prefrontal cortex， as well as synaptophysin-1 （SYP-1）， postsynaptic density 95 （PSD95）， and N-methyl-D-aspartate receptors （NMDARs） in the hippocampus. ResultsCompared with the control group， the model group exhibited severe growth retardation and developmental deformities， with abnormal behavioral performance and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus. Compared with the model group， all treatment groups showed reduced behavioral abnormalities and pathological damage to neurons and synapses in the prefrontal cortex and hippocampus， with the most significant effects in the high-dose Liuwei Dihuangwan group. Immunohistochemistry and Western blotting results showed that compared with the control group， the model group exhibited significantly increased protein levels and phosphorylation ratios of p-mTOR， p-Akt， and p-PI3K in the prefrontal cortex （P<0.05， P<0.01）， and decreased protein levels of SYP-1 and PSD95 and increased protein level of NMDARs in the hippocampus （P<0.01）. Compared with those in the model group， the protein levels of p-mTOR， p-Akt， and p-PI3K in the prefrontal cortex decreased in the vitamin D and high-dose Liuwei Dihuangwan groups （P<0.05）， and the p-mTOR/mTOR， p-Akt/Akt， and p-PI3K/PI3K ratios in the prefrontal cortex declined in the vitamin D group （P<0.05）. The high-dose Liuwei Dihuangwan group showed a reduction in p-PI3K/PI3K ratio （P<0.05）. The protein level of SYP-1 and PSD95 in the hippocampus increased in the vitamin D， low-dose Liuwei Dihuangwan， and high-dose Liuwei Dihuangwan groups （P<0.05， P<0.01）， while the protein level of NMDARs decreased in the vitamin D and high-dose Liuwei Dihuangwan groups （P<0.01）. ConclusionLiuwei Dihuangwan significantly reduces VPA-induced ASD-like behaviors and enhances the regeneration and repair of neurons in the prefrontal cortex and synaptic structures in the hippocampus by downregulating of PI3K/Akt/mTOR expression in the prefrontal cortex， upregulating SYP-1 and PSD95 expression in the hippocampus， and inhibiting NMDARs expression.

ObjectiveTo establish a narrative nursing program for patients with advanced liver cancer based on the framework of Snyder’s hope theory， and verify its effectiveness. MethodsThe Johns Hopkins evidence-based nursing model and the Delphi method were employed to construct the narrative nursing program for patients with advanced liver cancer. Utilizing the convenience sampling method， 70 patients with advanced liver cancer hospitalized in the department of hepatobiliary surgery from May 2024 to May 2025 were selected and divided into the control group and the intervention group using the random number table method， with 35 patients in each group. The control group received routine nursing care， while the intervention group received the narrative nursing program based on Snyder’s hope theory for patients with advanced liver cancer. The Herth Hope Index， Connor-Davidson Resilience Scale （CD-RISC）， Self-Rating Anxiety Scale （SAS）， and Morisky Medication Adherence Scale-8 （MMAS-8） were used to compare the hope level， psychological resilience， anxiety， and medication adherence between the two groups before and after the intervention. Furthermore， nursing satisfaction was also compared. ResultsThe Delphi expert consultation results demonstrated high consistency among expert opinions， with an expert positive coefficient of 100%. Meanwhile， the authority coefficients （0.902， 0.912） and Kendall’s concordance coefficients （0.260， 0.283） were all satisfactory. Ultimately， a narrative nursing program was established， consisting of 3 primary indicators， 10 secondary indicators， and 19 tertiary indicators. Compared with the control group， the intervention group exhibited significant improvements in scores of the three dimensions regarding the hope level， the total score of psychological resilience， medication adherence， and nursing satisfaction after the intervention， and the anxiety score was markedly reduced. All differences were statistically significant （P<0.05）. ConclusionThe narrative nursing program for patients with advanced liver cancer developed in this study is scientific and reliable. Its clinical application can effectively improve the psychological status and treatment behaviors of patients with advanced liver cancer， profoundly reflect the ethical care for the humanistic needs of patients， and provide an evidence-based basis for optimizing the psychological support for this population.

Metabolic dysfunction-associated fatty liver disease （MAFLD） is currently the most prevalent chronic liver disease worldwide， and its disease spectrum encompasses simple steatosis， metabolic-associated steatohepatitis， hepatic fibrosis， liver cirrhosis， and hepatocellular carcinoma. Recent studies have shown that hepatic macrophages play an important regulatory role in the development and progression of MAFLD. Hepatic macrophages mainly consist of resident Kupffer cells and monocyte-derived macrophages， which participate in the pathophysiological processes of the disease by regulating inflammatory response， lipid metabolism， fibrogenic process， and cell death pathways. This article summarizes the diversity and functional plasticity of hepatic macrophages in MAFLD， reviews their interactions with hepatocytes and gut microbiota， elaborates on the core mechanism of hepatic macrophages and related signaling pathways in the progression of MAFLD， and further discusses novel therapeutic strategies targeting hepatic macrophages. An in-depth understanding of the mechanism of action of hepatic macrophages in MAFLD may provide a crucial theoretical basis for developing precise therapeutic approaches for this disease.

Objective:To investigate the differences in clinical characteristics and antibiotic resistance of neonatal sepsis（NS）caused by different Gram-staining pathogens.Methods:A retrospective study was conducted on confirmed NS cases admitted to the Neonatal Ward of the Pediatric Department at The First Affiliated Hospital of Dali University，from June 1，2014，to May 31，2024.Patients were divided into Gram-positive and Gram-negative groups based on blood or cerebrospinal fluid（CSF）culture results.Clinical characteristics，pathogen distribution，and antibiotic resistance were compared between the two groups.Results:A total of 98 cases were included，with 81 in the Gram-positive group and 17 in the Gram-negative group.Multivariate logistic regression analysis revealed that NS cases with a high neutrophil percentage（ OR=0.933，95% CI：0.899-0.969）or hemorrhagic symptoms/signs（ OR=0.059，95% CI：0.008-0.458）were less likely to have Gram-positive pathogens detected in blood or CSF cultures（ P<0.05）.Common Gram-positive pathogens included Staphylococcus epidermidis with 35 strains（33.65%）and Staphylococcus hominis with 22 strains（21.15%）.The predominant Gram-negative pathogen was Escherichia coli with 14 strains（13.46%）.Gram-positive pathogens exhibited high resistance to oxacillin（91.30%），erythromycin（90.91%），and penicillin G（90.00%），but low resistance to tigecycline（0），linezolid（0），and vancomycin（0）.Gram-negative pathogens showed high resistance to ampicillin（92.31%），cefazolin（90.00%），and ampicillin/sulbactam（75.00%），but low resistance to amikacin（6.25%），latamoxef（0），and ertapenem（0）.The incidence of concurrent purulent meningitis was lower in the Gram-positive group than in the Gram-negative group（9.88% vs.47.06%， χ2=11.628， P<0.05），and there was significant difference. Conclusion:NS cases with high neutrophil percentages or hemorrhagic symptoms/signs are less likely to be caused by Gram-positive pathogens.Staphylococcus epidermidis and Staphylococcus hominis are common Gram-positive pathogens，while Escherichia coli is the predominant Gram-negative pathogen in NS.Both Gram-positive and Gram-negative pathogens exhibit resistance to specific antibiotics.NS caused by Gram-positive pathogens is less likely to be complicated by purulent meningitis compared to those caused by Gram-negative pathogens.

Liquid biopsy,as an emerging minimally invasive early detection method for tumors,has shown great potential;however,several challenges limit its application in tumor diagnosis.Tetrahedral framework nucleic acids(tFNAs)have garnered significant attention in the biomedical field due to their structural stabili-ty,programmability,and superior intracellular endocytosis and tissue penetration capabilities.These properties make tFNAs an ideal candidate for constructing advanced biosensing platforms for liquid biopsy applications.tFNAs significantly enhance the binding efficiency of circulating tumor cells(CTCs),circulating tumor DNA(ctDNA),and extracellular vesicles(EVs),thereby improving the sensitivity and detection capability of the liquid biopsy biosensing platform.This review provides a comprehensive overview of tFNAs-based biosensors in the liquid biopsy field.It elaborates on the synthesis,characteristics,and applications of tFNAs in detecting CTCs,ctDNA,and EVs.Additionally,it discusses the diverse strategies and advantages of tFNAs in biosens-ing applications,highlighting how these features significantly enhance the performance and reliability of bio-sensors.Finally,this review addresses the current challenges faced by tFNAs in liquid biopsy and explores their future prospects,aiming to facilitate early screening,precise diagnosis,and integrated diagnostic-treat-ment approaches for tumors.

Objective:To construct an evaluation index system for rural order-oriented general practice residents based on Entrustable Professional Activities (EPAs) and conduct an empirical analysis. ?Methods:A mixed-methods study design was adopted (November 2022-April 2023). The preliminary draft of the index system was developed through literature review and group discussions, then refined and improved via two rounds of expert consultation using the Delphi method. The analytic hierarchy process (AHP) was applied to determine the weight of each index. Meanwhile, questionnaires were distributed to 181 participants, including general practitioners from general hospitals, general practitioners from community hospitals, and general practice residents. The scores of the three groups regarding the importance and feasibility of the indices were compared. Ten general practitioners of the above three types were selected for semi-structured interviews on their cognitive and practical aspects of the system. ?Results:The positive coefficients of the two rounds of expert consultation were 16/17 and 16/16, respectively. The expert authority degree was >0.70, and the test of coordination coefficient was statistically significant ( P<0.05). Finally, an index system consisting of 20 first-level indices and 56 second-level indices was established. In terms of weight, among the first-level indices,"EPA1: Information Acquisition"had the highest weight (0.11), while"EPA12: Clinical Research"had the lowest (0.02). Among the second-level indices, "Medical History Taking" and "Physical Examination" under EPA1 had the highest weight (both 0.056), while "Healthcare for Patients with Severe Mental Illness" and "Healthcare for Disabled and Handicapped Populations" under EPA15 had the lowest (both 0.003). The 181 participants gave scores ranging from 4.49 to 4.92 for the importance of the 20 first-level indices and from 4.16 to 4.81 for their feasibility. Only for" EPA19: Common Diseases in Primary Care and Health Management", the feasibility score given by general practitioners from community hospitals was higher than that from general hospitals ( t=2.157, P=0.032); no statistically significant differences were observed among the groups for the other indices ( P>0.05).The interview results showed that general practitioners have a relatively high level of recognition for this system, but there is still room for improvement in its practical application.? Conclusions:The evaluation index system for rural order-oriented general practice residents constructed based on EPAs has high reliability, and it is consistently recognized by different types of general practitioners. It can provide a reference for the cultivation of post competency of this group.?

Objective:To investigate the link between the geographical distribution, serum aquaporin 4-immunoglobulin G (AQP4-IgG) status and clinical features of neuromyelitis optica spectrum disorder (NMOSD) patients in Xinjiang.Methods:A total of 107 NMOSD patients diagnosed at the People′s Hospital of Xinjiang Uygur Autonomous Region from April 2015 to March 2024 were recruited. Clinical data such as gender, age, ethnicity, residence at onset, serum AQP4-IgG status, disease duration, and annual relapse rate were collected. The clinical features of Xinjiang′s NMOSD patients were analyzed based on antibody status and geographical distribution.Results:Among the 107 NMOSD patients, 20 are male, 87 are female. They were divided into AQP4-IgG positive (77 cases, 72.0%) and AQP4-IgG negative (30 cases, 28.0%) groups by initial antibody status, and no statistically significant differences were found in gender, first symptoms, ethnicity, Expanded Disability Status Scale (EDSS) scores, annual relapse rate, and disease duration between the 2 groups (all P>0.05). Compared to AQP4-IgG negative patients, AQP4-IgG positive patients had a higher late-onset (age>50 years) proportion [35.1% (27/77) vs 16.7% (5/30), χ2=3.486, P<0.05] and preferred traditional immunosuppressants ( P<0.05). Divided by the Tianshan Mountains, there were 32 southern Xinjiang patients (29.9%,32/107) and 75 northern Xinjiang patients (70.1%,75/107), with statistically significant difference in ethnic distribution ( P<0.001). Although myelitis was the most common initial symptom in both groups, patients in southern Xinjiang had a higher proportion of optic neuritis [31.3% (10/32) vs 17.3% (13/75)], while those in northern Xinjiang showed a higher proportion of brain and brainstem involvement [24.0% (18/75) vs 6.3% (2/32)], with a statistically significant difference ( χ2=5.857, P<0.05). Conclusions:AQP4-IgG-positive NMOSD patients had a higher proportion of late-onset disease and a greater tendency to use conventional immunosuppressants. Although myelitis was the predominant initial symptom in all Xinjiang NMOSD patients, patients in southern Xinjiang presented with optic neuritis more frequently, while those in northern Xinjiang had a higher proportion of symptoms involving the brain and brainstem.

Objective To quantitatively assess the correlation between the skeletal muscle index(SMI)of patients and the occur-rence of anastomotic leakage(AL)in rectal cancer patients after surgery,and to analyze the risk factors for AL in rectal cancer patients and the influencing factors of sarcopenia.Methods The clinical,pathological,and related imaging data of 362 patients who under-went radical surgery for rectal cancer were retrospectively analyzed.All patients underwent pelvic MRI and abdominal CT scans(plain/enhanced)within one month before surgery,and the third lumbar vertebra skeletal muscle area(L3-SMA)was measured from the images.All patients were divided into AL group(56 cases)and control group(306 cases)based on the presence or absence of postoperative complications.The differences in clinical characteristics and imaging parameters between the two groups were analyzed.A logistic risk prediction model was established.Results Significant differences were observed between the two groups in sarcopenia,type of surgery,surgical approach,serum albumin level,operation duration,stoma type,and extramural vascular invasion(EMVI)(P＜0.05).These factors were incorporated in a multivariate logistic regression analysis model,the area under the curve(AUC)of receiver operating characteristic(ROC)curve of the model was 0.810[95％confidence interval(CI)0.743-0.876,P＜0.001],with a sensitivity of 0.865 and specificity of 0.669.Conclusion Sar-copenia is a significant risk factor for AL after rectal cancer surgery.It enhances the predictive efficacy for postoperative AL and serves as a basis for identifying high-risk populations for AL in clinical practice.

Objective:To investigate the relationship between the morphology of bone marrow plasma cells, the identification of M protein, and the detection of minimal residual disease(MRD)by flow cytometry in elderly patients with multiple myeloma(MM).Additionally, the impact on progression-free survival(PFS)is analyzed.Methods:A total of 60 elderly MM patients with bone marrow morphology reports and corresponding flow MRD detection, collected from February 1, 2017, to January 31, 2022, at Beijing Chaoyang Hospital Affiliated to Capital Medical University, were included in this study.We collected data on plasma cells from morphological examination and flow cytometry-based MRD detection. By combining these findings with M-protein identification results from 35 cases, we analyzed the correlations among these three parameters. Patients were stratified into two groups based on median values of: flow cytometry MRD(0.246% of nucleated cells), morphological plasma cell percentage(3.5%), and M-protein quantification(2.5 g/dl).This stratification enabled evaluation of their prognostic value for PFS.Results:A total of 60 elderly MM patients were enrolled, including 41 males with age of 65.0(63.0, 68.5)years and 19 females with age of 67.0(64.0, 72.0)years The morphology of bone marrow in 60 elderly patients with MM revealed 10 cases of primitive plasma cells(16.67%), 48 cases of immature plasma cells(80.00%), and 2 cases with no plasma cells(3.33%).A positive correlation was observed between the proportion of bone marrow plasma cells and the corresponding flow MRD in terms of both the proportion of nuclear cells and the proportion of plasma cells.Specifically, the proportion of the morphological protoplasma group showed a strong correlation with flow MRD(proportion of plasma cells)( r=0.82, P<0.01), while the proportion of the morphological immature plasma group exhibited moderate correlations with flow MRD(proportion of nuclear cells)( r=0.74, P<0.05)and flow MRD(proportion of plasma cells)( r=0.70, P<0.01).No significant correlation was found between the type and quantity of M protein and flow MRD( P>0.05).The PFS time for the flow MRD ≥0.246%(nucleated cells)group was shorter than that of the<0.246% group( P<0.05).There was no significant difference in PFS between the groups with plasma cell ratios ≥3.5% and<3.5%( P=0.15).Additionally, no significant difference in PFS was observed between patients with M protein quantitation ≥2.5 g/dl and those with M protein quantitation<2.5 g/dl( P=0.94). Conclusions:The proportion of bone marrow plasma cells correlates with flow MRD in elderly patients with MM, and a high MRD load indicates a poor prognosis.However, no significant correlation was found between M protein levels and flow MRD or PFS.Clinical attention should focus on the dynamic monitoring of plasma cell morphology and flow MRD.Nevertheless, the morphological detection of plasma cells remains crucial for auxiliary diagnosis due to its intuitiveness, cost-effectiveness, and broad applicability.

Langerhans cell sarcoma(LCS)is a rare malignant tumor derived from Langerhans cell histiocytes with unique clinicopathological,immunophenotypic,ultrastructural and molecular genetic features.Most studies on LCS are case reports,and the immunohistochemical features,biological mechanisms and molecular basis of the tumor remain to be further elucidated.A large body of literature suggests that LCS is extremely aggressive and presents many difficulties in clinical diagnosis,so it is important to accurately diagnose LCS.In this paper,we will review the clinical,patholog-ical and molecular features of LCS to provide more ideas for the definitive diagnosis of LCS and providing a basis for the selection of treatment regimens for LCS.