ObjectiveTo explore the factors influencing home-based rehabilitation exercise and the needs for digital interventions among patients with spinal muscular atrophy (SMA), based on the behavior change wheel (BCW), and to provide evidence for the development of digital home-based rehabilitation interventions. MethodsA two-phase qualitative study was conducted from December, 2024 to March, 2025. Using convenience sampling, 14 participants were recruited, including patients with SMA, primary caregivers, rehabilitation professionals, clinicians, a patient organization representative and a health policy expert. In phase 1, semi-structured individual interviews were conducted with seven participants, including patients, caregivers and a patient organization representative, to identify factors influencing home-based rehabilitation exercise and unmet needs. In phase 2, a focus group involving 12 stakeholders was conducted, including five participants who had participated in phase 1, to explore requirements for the functions, knowledge content and interface design of a digital intervention, five of them had participated in phase 1. Overall, the two phases involved 14 individual participants, accounting for 19 participant-instances. Thematic analysis was performed using both deductive and inductive approaches, guided by the capability-opportunity-motivation-behavior (COM-B) model. ResultsSix themes were identified. phase 1 showed that patients with SMA experienced inadequate continuity of rehabilitation services and limited access to professional rehabilitation resources, with interruptions in institution-based rehabilitation coexisting with declining adherence to home-based exercise. Home-based rehabilitation exercise was jointly influenced by capability-, opportunity- and motivation-related factors, including limited capabilities of patients and caregivers, constraints in time and supportive conditions and insufficient goals, feedback, and incentives. Individualized rehabilitation plans and professional guidance were the major unmet needs. phase 2 showed that the core functions of a digital intervention should include individualized exercise plans, professional guidance and feedback, reminders and incentives, safety monitoring, remote assessment, and privacy and permission management. Core knowledge content should include stratified exercise guidance, caregiving skills, recognition of abnormal conditions, and information on when and how to seek help. The interface should be simple, impose a low user burden and accommodate different types of users. ConclusionHome-based rehabilitation exercise among patients with SMA is jointly influenced by multiple capability-, opportunity- and motivation-related factors. Digital interventions should prioritize individualized rehabilitation plans, professional guidance and sustained behavioral support. These findings may inform the development of a digital home-based rehabilitation intervention prototype for patients with SMA; its feasibility, safety, clinical effectiveness and economic value require further evaluation.

In recent years, the incidence of infertility has been steadily increasing. Obesity, recognized as a chronic inflammatory condition, can not only lead to various chronic diseases such as hypertension and diabetes, but also adversely affects female reproductive health,including rare ovulation, anovulation, menstrual irregularities, and even infertility. The reproductive outcomes of overweight/obese women are not optimistic even among people undergoing assisted reproductive technology (ART).However, the mechanisms of overweight and obesity on ART outcomes remain poorly understood. This review aims to summarize current evidence on the impact of overweight and obesity on ART outcomes in women and explore the potential mechanisms.

Objective:To investigate the safety of the tetravalent meningococcal conjugate vaccine (MPCV-ACYW) in combination with the inactivated poliomyelitis (IPV) vaccine and diphtheria-tetanus-acellular pertussis (DTaP) vaccine for infants aged 3-5 months and provide real-world evidence for the immunization strategy of vaccine combination.Methods:From June to October 2023, a total of 600 3-month-old infants were selected and divided into three groups: control group, mono-vaccination group and combined vaccination group. They were simultaneously or individually vaccinated with MPCV-ACYW, IPV and DTaP vaccines at 3, 4, and 5 months of age, respectively. The incidence rate of adverse reactions within 30 days after each dose was observed.Results:All 600 infants completed at least one vaccination and entered the safety data analysis. The age of the control group (100 infants), the mono-vaccination group (250 infants), and the combination group (250 infants) was (101.20±7.88), (102.26±7.94), and (102.35±7.76) days, respectively. The body lengths were (63.00±3.02), (62.55±3.06), and (63.14±4.02) cm, respectively. The body weights were (6.90±0.77), (6.86±0.94), and (6.99±0.95) kg, respectively. Boys accounted for 49%, 50.4%, and 52.4%, respectively, with no statistically significant differences (all P>0.05). The overall incidence rates of adverse reactions in the control group, mono-vaccination group, and combined vaccination group were 4.00%, 2.80%, and 3.20%, respectively, with systemic adverse reaction rates of 3.00%, 2.40%, and 2.00%. The incidence rates of local adverse reactions were 1.00%, 0.40%, and 1.20%, with no statistically significant differences (all P>0.05). Adverse reactions were mainly grade 1, with incidence rates of grade 1 adverse reactions of 3.00%, 2.00%, and 1.60% in the three groups, and incidence rates of grade 2 adverse reactions of 1.00%, 0.80%, and 1.60%, respectively. No grade 3 or 4 serious adverse reactions occurred, and the differences were not statistically significant (all P>0.05). The adverse reaction symptoms of the three groups were mainly systemic reactions, among which fever and diarrhea symptoms were reported in individual cases in each group, with no statistically significant differences in the incidence rate (all P>0.05). The symptoms of adverse reactions were mostly transient and self-relieved, all of which were cured. Conclusion:The combination of MPCV-ACYW and IPV or DTaP vaccines is safe for infants aged 3-5 months.

AIM:To investigate the role of S100 calcium-binding protein A8(S100A8)in a canine model of atrial fibrillation(AF)induced by obstructive sleep apnea(OSA).METHODS:Ten adult Beagle dogs were randomly as-signed to OSA(n=5)and control(n=5)groups.The OSA model was established by daily tracheal intubation with alternat-ing airway obstruction and ventilation recovery for 4 h per day,sustained over 12 weeks.Model validation was conducted through arterial blood gas analysis,airway pressure monitoring,and esophageal pressure measurements.Open-chest elec-trophysiological studies were performed to assess atrial effective refractory period(ERP),dispersion of ERP(dERP),and AF inducibility.Tandem mass tag-based quantitative proteomics was used to identify differentially expressed proteins in atrial tissue.Key protein expression and localization were verified using immunohistochemistry and immunofluorescence.RESULTS:Compared with the control group,the OSA group exhibited significantly lower arterial blood pH and partial pressure of oxygen,and higher partial pressure of carbon dioxide in arterial blood,confirming successful model establish-ment.Histopathological analysis revealed disorganized cardiomyocyte architecture,fatty degeneration,inflammatory cell infiltration,and a significant increase in myocardial fibrosis in the OSA group(P<0.05).Electrophysiological data showed increased AF inducibility and dERP,and decreased ERP(P<0.05).Proteomic analysis identified 267 differen-tially expressed proteins,including 128 up-regulated and 139 down-regulated proteins.Immunohistochemical analysis showed significant upregulation of S100A8,S100A9,myeloperoxidase,and nuclear factor-κB p65(P<0.05),while im-munofluorescence demonstrated increased expression of matrix metalloproteinase-9 and transforming growth factor-β1 in the OSA group(P<0.01).CONCLUSION:The OSA promotes upregulation of S100A8 in myocardial tissue,enhances atrial electrical remodeling and fibrosis,and increases susceptibility to AF.These findings suggest that S100A8 may play a key role in the pathogenesis and progression of OSA-related AF.

Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Objective:To estimate the incidence of Bordetella pertussis（ Bp）infection by analyzing the seroepidemiological characteristics of pertussis in healthy people aged 1-14 years in Shaanxi Province in 2017. Methods:A stratified random sampling method was used to select healthy people aged 1-14 years from 30 county-level disease surveillance sites in 10 cities of Shaanxi Province in 2017. Serum IgG antibodies against pertussis toxin（PT-IgG）were quantitatively detected by ELISA. The incidence of Bp infection within one year（PT-IgG≥100 IU/ml）and the geometric mean concentration（GMC）of PT-IgG were analyzed. Statistical analysis was performed using Mann-Whitney U test，Kruskal-Wallis test，or Jonckheere-Terpstra test. Results:A total of 1 777 subjects were included. The incidence of Bp infection within one year was 0.84%（15/1 777）and the GMC of PT-IgG was 5.70 IU/ml. The incidence of Bp infection within one year in different age groups ranged from 0 to 3.06%（3/98），and the GMC of PT-IgG was between 2.99 IU/ml and 9.29 IU/ml. People aged 12-14 years showed higher incidence of Bp infection within one year. The estimated incidence of Bp infection in people aged 5-14 years was 6 639.97/100 000，with the lowest incidence in people aged 5-6 years（2 016.85/100 000）and the highest in people aged 13-14 years（15 425.95/100 000）. The estimated incidence of Bp infection increased with age（ χ 2trend=12 090， P<0.01）. Conclusions:The actual incidence of Bp infection in healthy people aged 1-14 years in Shaanxi Province is high，and the duration of antibody responses to vaccination is limited. Children and adolescents are high-risk groups for pertussis，and attention should be paid to people aged 12-14 years. It is recommended to strengthen the routine monitoring of pertussis in order to better adjust and optimize the immunization strategy.

Objective:To study the effect of adipose tissue derived extracellular vesicles (AT-EVs) on nerve regeneration and functional reinnervation after sciatic nerve injury (SNI) in rat.Methods:From April 2023 to April 2024, the experiment was completed by the Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University in the key laboratory of the School of Medical Sciences, Zhengzhou University. AT-EVs were isolated and extracted from subcutaneous adipose tissue of 12 healthy male SD rats using ultracentrifugation. The morphology, size and distribution of AT-EVs were characterised via transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). The effect of AT-EVs on the proliferation ability of pheochromocytoma cells of rat (PC12) and rat Schwann cells (RSC 96) were detected by cell proliferation assay. Twenty-four healthy male SD rats were randomly divided into 3 groups with 8 rats per group, including a sham group, a SNI group and an AT-EVs treatment group. Right sciatic nerves of rat models in sham group were exposed without injury. For the rat models in SNI group and AT-EVs treatment group, right sciatic nerves were injected with phosphate buffered solution (PBS) and AT-EVs under the epineurium of the nerve respectively following sciatic nerve crush. At 28 days after surgery, Sciatic function index (SFI) and pace analysis was performed. Then, rats in all groups were sacrificed, and bilateral gastrocnemius muscles were collected to measure the muscle wet weight ratio. The right sciatic nerves were removed for further exploration of nerve regeneration. The histopathological changes and axon arrangement of sciatic nerve were evaluated by Hematein Eosin (HE) staining and Masson staining. The regeneration efficiency of Myelin forming protein (MBP) and Neuronal marker [β-tubulin (Tuj-1)] were analysed by immunofluorescence staining of sciatic nerve. Statistical analysis was conducted using GraphPad Prism 8.0. P<0.05 were considered statistically significant. Results:The results of TEM and NTA revealed that AT-EVs exhibited a typical disc-shaped bilayer membrane structure with a predominant particle size of 184.5 nm. AT-EVs significantly enhanced the proliferation ability of PC12 and RSC96, and the difference was statistically significant ( P<0.05). At 28 days after surgery, the SFI and muscle wet weight ratio were higher in the AT-EVs treatment group compared to the SNI group, and the difference was statistically significant ( P<0.05). Axons in AT-EVs treatment group were arranged more closely and orderly than those in SNI group at 28 days after surgery, and there were less axon disintegration and vacuolation caused by injury. The immunofluorescence assay indicated that the MBP and Tuj-1 fluorescence intensity in AT-EVs treatment group was significantly higher than those in the SNI group, and the difference was statistically significant ( P<0.05). Conclusion:AT-EVs can enhance the proliferation ability of PC12 and RSC96 to promote axon regeneration and functional reinnervation following SNI.

Objective To investigate the serum diphtheria antibody levels in healthy people aged 1-59 years old in Shaanxi Province.Methods A stratified random sampling method was used to select healthy people aged 1-59 years old from 30 county-level disease surveillance sites in 10 cities of Shaanxi province from November to December 2017.Diphtheria IgG antibody was detected by enzyme-linked immunosorbent assay(ELISA),and the positive rate(IgG≥0.01 IU/mL)and mean geometric concentration(GMC)of diphtheria IgG antibody were analyzed.Results A total of 6 439 subjects completed laboratory testing.The positive rate and GMC of diphtheria IgG antibody were 85.79%and 0.035(0.034-0.036)IU/mL,respectively.The GMC and the positive rate of diphtheria IgG antibody were higher in males than those in females(P＜0.01).The positive rate of diphtheria IgG antibody in different cities was 65.25%-98.23%,and the GMC was 0.021(0.018-0.024)IU/mL-0.046(0.037-0.055)IU/mL,the difference between the groups was statistically significant(P＜0.01).The GMC of the group with DCV immunization history,the group without DCV immunization history and the group with unknown DCV immunization history were 0.097(0.090-0.105),0.018(0.018-0.019)and 0.027(0.026-0.028)IU/mL,respectively,and the positive rates of diphtheria IgG antibody were 92.74%,80.18%and 85.44%,respectively.There were significant differences between the three groups(P＜0.01).Among the 9 age groups,the group with the lowest positive rate of diphtheria IgG antibody was the 40-49 age group(78.39%),and the highest was in the 1-2 age group(95.77%),which decreased with age(χ2=200.612,P＜0.01).It showed a downward trend with age(χ2=200.612,P＜0.01).The lowest GMC(IU/mL)was in the 40-49 age group[0.017(0.016-0.017)],and the highest was in the 7-9 age group[0.190(0.162-0.226)],showing a downward trend with increasing age(P＜0.01).After the whole course of vaccination,the positive rate of diphtheria IgG antibody and the interval between the last dose of vaccination showed a downward trend(P＜0.01).Conclusion The diphtheria immune barrier in whole population has been established in Shaanxi province,but the positive rate of diphtheria antibody and GMC in healthy people aged 1-59 years old show a downward trend with age.

ObjectiveTo observe the effect of Zishen Tiaogan prescription on the oxidative stress injury in the rat model of diminished ovarian reserve （DOR） and explore the role of the Kelch-like ECH-associated protein 1 （Keap1）/nuclear factor E₂-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway. MethodsForty-eight female SD rats were randomly assigned into a normal group （n=12） and a modeling group （n=36）. The rats in the modeling group received subcutaneous injection of galactose （350 mg·kg^-1） combined with immobilization stress daily. After 28 days of modeling， 6 rats in the normal group and 6 rats in the modeling group were sacrificed to examine the modeling results. The successfully modeled rats were assigned into model， estradiol valerate （0.09 mg·kg^-1）， and low-， medium-， and high-dose （6.39， 12.78， 25.56 g·kg^-1， respectively） Zishen Tiaogan prescription groups. The intervention lasted for 4 weeks with 6 animals per group. Hematoxylin-eosin staining was used to observe the estrous cycle and the pathological changes in the ovarian tissue. The ovarian index was calculated. Enzyme-linked immunosorbent assay was employed to measure the serum levels of sex hormones and oxidative stress-related indexes. Western blot and real-time PCR were employed to determine the protein and mRNA levels， respectively， of Nrf2， Keap1 and HO-1 in the ovarian tissue. The positive expression of superoxide dismutase 2 （SOD2） in the ovarian tissue was detected by immunohistochemistry （IHC）. ResultsCompared with the normal group， the model group showed reduced follicles in the ovary， loose arrangement of the follicle granule layer， declined levels of anti-Mullerian hormone （AMH） and estradiol （E₂） in the serum， elevated levels of luteinizing hormone （LH） and follicle-stimulating hormone （FSH） （P<0.01）， lowered levels of superoxide dismutase （SOD）， catalase （CAT）， and glutathione （GSH） （P<0.01）， and increased accumulation of malondialdehyde （MDA） （P<0.01）. In addition， the modeling led to up-regulated protein and mRNA levels of Keap1 （P<0.01）， the expression of Nrf2 and HO-1 protein was significantly decreased （P<0.01）， the mRNA expression of Nrf2 was significantly decreased （P<0.05）， the mRNA expression of HO-1 was significantly decreased （P<0.01）， in the ovarian tissue. Compared with model group， the estradiol valerate and low-， medium-， and high-dose Zishen Tiaogan prescription groups showed increases in the ovarian index （P<0.01） and serum E₂ and AMH levels （P<0.01）， declined levels of FSH and LH （P<0.01）， increased follicles in the ovary， elevated levels of SOD， CAT， and GSH， and reduced accumulation of MDA （P<0.05， P<0.01）. Furthermore， these groups showcased down-regulated protein and mRNA levels of Keap1 （P<0.01）， the expression of Nrf2 protein was significantly increased （P<0.01）， the expression level of HO-1 protein was increased （P<0.05，P<0.01）， and increased positive expression of SOD2 （P<0.01）. ConclusionZishen Tiaogan prescription can regulate the serum levels of hormones， down-regulate the expression of Keap1， up-regulate the expression of Nrf2， HO-1， and SOD2， enhance the antioxidant capacity， and reduce the peroxidation damage in the ovarian tissue to improve the ovarian reserve function in the rat model of DOR. High-dose Zishen Tiaogan prescription demonstrated the best effect and the mechanism is associated with the regulation of the Keap1/Nrf2/HO-1 pathway.