[摘 要] 目的：探讨m6A调控因子在宫颈癌预后评估、免疫微环境特征及治疗反应中的作用，构建基于m6A调控因子的预后风险模型，并分析其与免疫浸润、药物敏感性及细胞间通信的关系。方法：基于TCGA和GEO数据库中宫颈鳞癌及腺癌（CESC）转录组数据，分析22个m6A调控因子的表达与突变情况；采用LASSO‑Cox回归构建m6A相关预后风险模型，并依据风险评分将患者分为高、低风险组。利用CIBERSORT和ESTIMATE算法评估两组免疫细胞浸润及微环境特征；通过oncoPredict预测抗肿瘤药物敏感性。整合单细胞转录组数据（E-MTAB-12305），采用CellChat分析细胞间通信网络。结果：共鉴定出12个在宫颈癌中差异表达的m6A调控因子。高风险组患者总生存期缩短（P < 0.05），免疫评分降低，且对紫杉醇、氟尿嘧啶、多柔比星等抗肿瘤药物敏感性较差（IC50较高）。单细胞分析显示宫颈癌组织中细胞间通信网络发生改变，其中T细胞与内皮/上皮细胞间的相互作用可能主要由CCL5‑ACKR1和MIF‑（CD74 + CXCR4）配体‑受体介导。在临床样本中，对关键的m6A调控因子进行mRNA和蛋白水平的验证，结果显示部分调控因子在宫颈癌组织中的表达水平高于正常宫颈组织（P < 0.05）。结论：m6A调控因子特征可有效预测宫颈癌患者预后，其风险评分与肿瘤免疫浸润、药物敏感性及细胞通信密切相关，为宫颈癌的预后分层及个体化治疗提供了新的分子依据。

AIM: To evaluate the effects of different corneal cap thicknesses during small-incision lenticule extraction(SMILE)on corneal densitometry(CD), visual quality, and corneal biomechanics during the first postoperative year, and to explore its safety.

METHODS: A prospective randomized contralateral controlled design was employed. Thin cap(110-120 μm)and thick cap(130-140 μm)SMILE procedures were performed on the two eyes of the same myopic patients undergoing surgery, respectively. Postoperative evaluations at 1 wk, 1, 3, 6 mo, and 1 y included CD, uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), contrast sensitivity, wavefront aberrations, and corneal biomechanics. A linear mixed-effects model was used for statistical analysis.

RESULTS:A total of 60 patients(120 eyes, 60 eyes in the thin-cap group and 60 eyes in the thick-cap group)completed the surgery successfully and attended scheduled follow-up visits. The mean age was 26.3±3.8 y, including 34 males(57%)and 26 females(43%).The intended cap thickness was 115.24±3.10 μm in the thin-cap group and 135.28±3.45 μm in the thick-cap group. There were significant intergroup differences in lenticule thickness and ablation depth(P<0.001), whereas the residual stromal bed(RSB)thickness was comparable between groups(P=0.301). Central 0-6 mm CD significantly decreased over time(P<0.001), and the thin-cap group had overall higher densitometry values than the thick-cap group(P<0.001), with significant differences persisting from 1 wk to 1 y postoperatively(Bonferroni-corrected P<0.05). At 1 y, significant CD differences were most pronounced in the anterior and central layers(both P<0.05), with no significant differences in posterior layers. The thick-cap group showed a significant improvement in UDVA(P=0.002)and better contrast sensitivity(corrected P<0.05), while the thin-cap group had higher values of total root mean square of higher-order aberrations(HOA-RMS), spherical aberration, and coma(all P<0.05). No statistical differences were observed between groups in corneal biomechanical parameters(DA, CBI, SSI)(all P >0.05), and the incidence of safety events was also comparable between the two groups(P≥0.5).

CONCLUSION: Given an equivalent RSB thickness, thicker corneal caps can reduce anterior-layer CD, improve contrast sensitivity and higher-order aberration outcomes, without obvious increases in biomechanical risks or safety concerns.Therefore, it warrants consideration as a preferred intraoperative strategy for SMILE.

As one of the common systemic vasculitides in children， IgA vasculitis is closely associated with the interaction of "Wind pathogen" and "turbid stasis" in its pathogenesis. Based on the blood turbidity theory， this paper proposes "wind agitating blood turbidity and collateral damage" as the core pathogenesis. Regarding treatment， the sequential therapeutic principle of "stanch bleeding， activating blood circulation， and nourishing blood" is adopted， and combined with the dynamic application of wind-dispelling medicinals to "expel， search， and guard against wind"， turbidity-removing method is applied throughout all stages. In the acute stage，it is recommended to clear heat and purify turbidity， stanch bleeding and secure the collaterals. In the prolonged stage， the method of dissipating stasis and clearing up turbidity should be used， as well as activating blood circulation and unblocking the collaterals. In the recovery stage， it is advised to nourish blood to flourish the collaterals， reinforce healthy qi and resolve turbidity. This therapeutic system integrates the elimination of pathogens and the reinforcement of healthy qi to clear and resolve blood turbidity， ultimately achieving holistic collateral repair through securing， unblocking， and nourishing the collaterals， which provides new insights into the treatment of this disease in traditional Chinese medicine.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To investigate the relationship between microRNA(miR)-425-5p/patched homolog 1(PTCH1)axis molecules and clinical pathological parameters and prognosis in cancer tissues of primary laryngeal cancer(PLC)patients.Methods 102 PLC patients admitted to Mianyang Central Hospital from March 2020 to March 2021 were selected.The relative expression level of miR-425-5p and PTCH1 positive expression rate in PLC cancer tissues and adjacent normal tissues were compared,and the relationship between miR-425-5p relative expression level,PTCH1 positive expression rate and PLC clinical pathological parameters was analyzed.Kaplan-Meier curve and Log-Rank were used χ2 tests were conducted to analyze the 3-year cumulative survival rate of miR-425-5p and PTCH1 positive/negative expression groups,and COX regression model was used to analyze the influencing factors of PLC prognosis.Results Compared with normal tissue adjacent to cancer,the relative expression level of miR-425-5p in PLC cancer tissue was significantly increased(2.12±0.52 vs 0.98±0.17),and the positive expression rate of PTCH1 was significantly reduced(27.45%vs 61.76%),with statistical significance(t/χ2=21.045,24.302,all P＜0.05).Compared with patients with T1-T2,N0,and high differentiation of tumors,patients with T3-T4,N1-N3,and low differentiation of tumors showed a significant increase in the relative expression of miR-425-5p(t=3.647,2.900,3.029),and a significant decrease in the positive expression rate of PTCH1(χ2=5.842,4.011,5.136),the differences were statistically significance(all P<0.05).The 3-year cumulative survival rate of the miR-425-5p high expression group was 64.52%(20/31),which was significantly lower than that of the low expression group at 84.06%(58/69).The 3-year cumulative survival rate of the PTCH1 high expression group was 80.00%(28/35),which was significantly higher than that of the low expression group at 64.62%(42/65),and the differences were statistically significant(Log-Rank χ2=4.287,4.548,all P<0.05).Elevated T taging,cervical lymph node recurrence,elevated N staging,pharyngeal recurrence,elevated miR-425-5p,and negative PTCH1 expression were risk factors for poor prognosis of PLC(all P<0.05).Conclusion High expression of miR-425-5p and low expression of PTCH1 in cancer tissues of primary laryngeal cancer patients are significantly correlated with elevated T stage,low tumor differentiation,elevated N stage,and low 3-year cumulative survival rate.

This paper reports a case of a 59-year-old female patient who presented with sudden aphasia and left-sided weakness.After emergency cerebral angiography and intracranial artery thrombectomy,the left subclavian artery was accidentally punctured during left subclavian vein catheterization.Three-dimensional reconstruction and preoperative simulation using Mimics software and 3dsMAX were performed to determine the subcutaneous tunnel length and the applicability of the Angioseal closure device.Preoperative simulation showed a tunnel length of 74.6 mm,satisfying the condition of subcutaneous tunnel＜compression tube＜Angioseal introducer.Angioseal closure was then performed.Postoperative angiography showed satisfactory occlusion,and the patient had no complications.This paper discusses the challenges in managing accidental subclavian artery punctures and the application conditions of the Angioseal closure device,emphasizing the importance of preoperative three-dimensional reconstruction and simulation for ensuring surgical success.For accidental subclavian artery punctures with tunnel lengths not exceeding 88 mm,the Angioseal closure device is a safe and effective method.

Objective To develop and validate a risk prediction model for non-cuffed catheter(NCC)dysfunction in hemodialysis patients,aiming to provide a reference for early clinical identification and warning.Methods A prospective study design was adopted.A total of 569 patients with indwelling NCC from the hemodialysis center of a tertiary hospital in Nanchang between December 1,2023 to May 20,2024,were included as a modeling cohort.An additional 172 patients from the hemodialysis center of a tertiary hospital in Changsha,enrolled between May 30 to October 20,2024,formed a validation cohort.Data were collected on general patient characteristics,dialysis information,catheterization details,and clinical parameters.The risk prediction model was constructed using a combination of variables identified through univariate analysis,Lasso regression,logistic regression,and the Boruta algorithm.Model performance was evaluated accordingly.Results The incidence of NCC dysfunction in hemodialysis patients was 44.94％.A total of 5 common predictors were identified by both algorithms,including age,ultrafiltration volume,catheter insertion site,catheter indwelling time,and C-reactive protein.The area under the receiver operating characteristic curve(AUC)was 0.720 for internal validation and 0.766 for external validation.The Brier scores for curve calibration were 0.213 and 0.203,respectively.The decision curve analysis showed clinical benefit within risk threshold ranges of 22％～82％and 22％～96％,respectively.Conclusion The risk prediction model developed in this study demonstrates good predictive performance and can serve as a screening and assessment tool for identifying the risk of NCC dysfunction in hemodialysis patients.

Retinopathy caused by myopia is the first cause of irreversible blinding eye disease in China.The TCM methods to prevent and control myopia mainly include Chinese materia medica and TCM appropriate techniques,which have the advantages of good efficacy,simple operation,and few adverse reactions.This paper believed that internal and external pathogenic factors act on the brain and eyes,breaking their homeostasis,leading to rhythmic disorders,and imbalance of essence,qi and blood is the main pathogenesis of myopia.Based on the idea of"nature and human in the same rhythm"and"the same treatment for common diseases",targeting the above pathogenesis,the method of"brain-eye synchronization"was proposed to restore the homeostasis of the brain and eyes to prevent and control myopia in children and adolescents,and the treatment rules were to regulate the rhythms of the time,harmonize the qi and blood,nourish the blood to soften the tendons,and replenish the essence and blood,so as to achieve the effect of brain-eye synchronization and the treatment of the spirit and the body together.This article summarized the theoretical basis of"brain-eye synchronization"and its clinical application in traditional Chinese and Western medicine,with a view to providing new ideas for the prevention and control of myopia in children and adolescents.

Objective:To analyze the symptoms,diagnosis and treatment of upper urinary tract calculi patients combined with mild and moderate benign prostatic hyperplasia(BPH)after ureteral stent implantation.Methods:One hundred and six BPH pa-tients who were hospitalized for upper urinary tract calculi and had ureteral stents retained from January 2019 to December 2022 were selected and divided into 2 weeks group and 4 weeks group according to the time of removal of ureteral stents after surgery.Their gener-al clinical data were analyzed and compared.International Prostatic Symptom Scale(IPSS),postoperative ureteral Stent Symptom Questionnaire(USSQ),and incidence of adverse events after ureteral stent removal were recorded before and after removal.Results:The scores of IPSS were significantly increased in all patients,and symptoms in urinary tract had improved significantly after discharge(P＜0.05).Compared with the 2 weeks group,the USSQ score of the 4 weeks group was significantly increased(P＜0.05).And no significant adverse event was observed in the 2 weeks group after the removal of ureteral sten.Conclusion:IPSS score and USSQ score increased significantly during stent implantation in BPH patients with lithiasis.And complications increased sig-nificantly over time.Following thorough clinical assessment,early ureteral stent removal demonstrates both safety and efficacy,repre-senting an optimal therapeutic approach in selected cases.

Aim To explore the material basis and un-derlying mechanism of Qingre Huoxue Formula(QRHXF)in the treatment of non-small cell lung cancer(NSCLC)by applying network pharmacology,molecular docking technology and bioinformatics com-bined with animal experiments.Methods TCMSP,ECTM,and BATMAN databases were used to obtain active components and corresponding targets of QRHXF;GEO and DisGeNENT databases were con-ducted to acquire NSCLC-associated differential expres-sion genes.By intersecting them,the common targets were obtained.It was chosen to construct a herb-com-ponent-disease network and protein-protein interaction(PPI)network.Furthermore,DAVID database was used to perform gene ontology(GO)function and Kyo-to encyclopedia of genes and genomes(KEGG)path-way enrichment analyses.The molecular docking was presented by adopting Autodock Vina program to verify key targets.RNA-seq datawere downloaded from TC-GA database to obtain differential gene expression.Ka-planMeier(KM)analysis was performed to analyze the relationship between gene expression and overall sur-vival.Mouse subcutaneous tumor model of LLC was established.The effects of QRHXF on body weight,tumor volume and weight were monitored for pharmaco-dynamic analysis.Tumor tissues slides were stained with hematoxylin and eosin(HE)for histopathological examination.Immunohistochemistry(IHC)staining was employed for detecting Ki67 and EP300.Western blot was performed to measure the protein expression of TP53,CDK1 and NTRK1.Results The results of net-work pharmacology showed that a total of seven com-mon targets were screened from NSCLC and QRHXF,and the effect of QRHXF on anti-NSCLC may occur via multiple signaling pathways,including cell cycle.The results of molecular docking indicated that the main ac-tive components of QRHXF had low binding energy and stable docking conformation with the molecular target for treating NSCLC.According to bioinformatic analy-sis,there were significant differences in BRCA1,CDK1 and NTRK1 mRNA expression between tumor tissues and normal tissues,which were also prognostic factors for overall survival.Animal experimental research showed QRHXF inhibited subcutaneous tumor growth(P＜0.01)and improved the quality of life in mice with NSCLC.After QRHXF intervention,the density of tumor cells was significantly reduced,and necrotic are-as were increased.The expressions of Ki67 and EP300 were significantly decreased.Compared with the model group,Western blot showed up-regulation of TP53 and NTRKA(P＜0.05),whereas CDK1 were down-regu-lated(P＜0.05).Conclusion QRHXF exerted anti-NSCLC effects by regulating NTRK1,EP300,TP53,CDK1 and inducing cell cycle,cell cycle arrest and in-hibiting tumor growth,metastasis and angiogenesis.