Background Neck-related work-related musculoskeletal disorders (WMSDs) are a major type of musculoskeletal disorders with a relatively high proportion. Shanghai has a large number of occupational populations; however, the occurrence of WMSDs at neck among the occupational populations across industries in this city has not been reported, and needs to be addressed. Objective To understand the occurrence of neck-related WMSDs and their influencing factors among occupational populations in 8 industries in Shanghai, and to provide a scientific basis for the prevention and control of WMSDs in this population. Methods From February 2024 to February 2025, a cross-sectional survey employed stratified cluster sampling to select 7829 employed workers from 48 enterprises across 8 industries in Shanghai. The study investigated the occurrence of neck-related WMSDs among the participants over the preceding 12 months. Logistic regression analysis was employed to examine the relationships between WMSDs and various occupational factors. Results A total of 7770 questionnaires were collected, yielding an effective response rate of 99.2%. Overall, the positive rate of neck-related WMSDs among the participants was 11.89% (924/7770). Among different industries, the environmental sanitation industry (19.48%), pharmaceutical manufacturing industry (14.57%), and cigarette manufacturing industry (13.66%) had higher prevalence of neck-related WMSDs. Univariate analysis showed that the risk of neck-related WMSDs was higher in the following groups: those with a job tenure ≥5 years in the current position (OR=1.50–1.70), females (OR=1.77), those with higher education levels (master’s degree or above, OR=2.27), and those with worse self-rated health (very poor health, OR=4.38) (P＜0.05). Multivariate logistic regression analysis identified the following independent risk factors for neck WMSDs: environmental sanitation industry (OR=7.30, 95%CI: 4.72, 11.87), higher educational attainment (master’s degree or above: OR=2.16, 95%CI: 1.36, 3.35), worse self-rated health status (very poor: OR=1.95, 95%CI: 1.31, 2.85), work performed in a single workshop (OR=1.36, 95%CI: 1.13, 1.64), understaffing (OR=1.46, 95%CI: 1.25, 1.70), slight neck forward flexion (OR=1.64, 95%CI: 1.32, 2.06), severe neck forward flexion (OR=2.55, 95%CI: 1.97, 3.30), and maintaining a fixed neck posture for a prolonged period (OR=2.28, 95%CI: 1.93, 2.70). Conversely, work rotation (OR=0.75, 95%CI: 0.65, 0.87), adequate rest (OR=0.70, 95%CI: 0.60, 0.82), and severe back flexion (OR=0.63, 95%CI: 0.46, 0.85) were protective factors against neck-related WMSDs. For the nomogram, the area under the curve (AUC)=0.75 (95%CI: 0.74, 0.77), Hosmer-Lemeshow test P=0.764, and Brier score=0.094, indicating that the model had good discrimination and calibration. Conclusion Among the occupational populations in Shanghai, the environmental sanitation industry, pharmaceutical manufacturing industry, and cigarette manufacturing industry are identified as high-risk industries for neck-related WMSDs. Industry affiliation, educational level, work organization patterns, and awkward neck working postures are confirmed as the core influencing factors for the development of neck-related WMSDs. Targeted and comprehensive intervention measures should be formulated focusing on the aforementioned high-risk industries and key influencing factors. Multi-dimensional collaborative efforts, including ergonomic optimization, improvement of labor management systems, and strengthened health education and promotion, should be implemented to effectively control the risk of neck-related WMSDs in the occupational population, and to provide robust statistical evidence for the advancement of regional occupational health prevention and control strategies.

ObjectiveTaking classical herbal pair compatibility research as the entry point， this study aimed to deeply investigate the material basis and compatibility rules underlying the antidepressant effects of the traditional Chinese medicine （TCM） formula Zhizi Houpotang， and to elucidate its antidepressant mechanism， with a particular focus on its regulation of neuroinflammatory responses mediated by the NOD-like receptor protein 3 （NLRP3）/gasdermin D （GSDMD） signaling pathway and the consequent improvement of neuronal synaptic plasticity. MethodsC57BL/6J mice were randomly divided into a blank control group， a chronic unpredictable mild stress （CUMS） depression model group， a Zhizi Houpotang full-formula group （6 g·kg^-1·d^-1）， a Magnoliae Officinalis Cortex （MOC）-Aurantii Fructus Immaturus （AFI） herbal pair group （4.2 g·kg^-1·d^-1）， a Gardeniae Fructus （GF）-MOC herbal pair group （4.2 g·kg^-1·d^-1）， a GF-AFI herbal pair group （3.6 g·kg^-1·d^-1）， and a positive drug group （fluoxetine， 12 mg·kg^-1·d^-1）. Depressive-like behaviors in mice were evaluated using behavioral tests. Immunofluorescence staining was used to label and quantify the expression of the microglial marker ionized calcium-binding adaptor molecule 1 （Ibal） and the purinergic receptor P2X ligand-gated ion channel 7 （P2RX7） in the prefrontal cortex （PFC）. Enzyme-linked immunosorbent assay （ELISA） was applied to detect the levels of inflammatory cytokines interleukin-1β （IL-1β） and interleukin-18 （IL-18） in serum and PFC tissues. Western blot was employed to determine the expression of pannexin 1 （Panx1）， P2RX7， NLRP3， apoptosis-associated speck-like protein containing a CARD （ASC）， Caspase-1， GSDMD， postsynaptic density protein 95 （PSD95）， and the presynaptic protein Synapsin 1 in PFC tissues. Golgi staining was used to assess dendritic spine density of neurons in the PFC. ResultsCompared with the blank control group， the depression model group exhibited significant depressive-like behaviors. In addition， the immunofluorescence areas of Ibal and P2RX7 in the PFC were significantly increased （P<0.01）， the levels of IL-1β and IL-18 in serum and the PFC were significantly elevated （P<0.01）， and the protein expression levels of Panx1， P2RX7， NLRP3， ASC， Caspase-1， and GSDMD in the PFC were significantly upregulated （P<0.01）. In contrast， the protein expression levels of PSD95 and Synapsin 1 were significantly downregulated （P<0.01）， and neuronal dendritic spine density was significantly reduced （P<0.01）. Compared with the model group， the Zhizi Houpotang full-formula group and the GF-MOC herbal pair group showed significant improvement in all the above indicators （P<0.01）. The GF-AFI herbal pair group improved all the above indicators except P2RX7， Caspase-1， GSDMD， and PSD95 （P<0.05， P<0.01）. In contrast， the MOC-AFI herbal pair group showed no statistically significant improvement in any of the above indicators compared with the model group. ConclusionZhizi Houpotang and its key herbal pair， GF-MOC， can effectively ameliorate CUMS-induced depressive-like behaviors in mice. Its core antidepressant mechanism may involve inhibition of P2RX7/Panx1 signaling， thereby blocking the NLRP3/GSDMD-mediated pyroptosis pathway and significantly reducing the release of inflammatory cytokines IL-1β and IL-18. Simultaneously， it upregulates the expression of synapse-related proteins PSD95 and Synapsin 1 and increases dendritic spine density， promoting the recovery of synaptic plasticity. These results suggest that GF plays a key role in the antidepressant effects of this formula， and that the compatibility of GF with MOC may represent the principal herbal pair combination responsible for its core therapeutic action.

As an exclusive Miao medicine of Honwing Pharma （Guizhou） Co. Ltd.， Yifei Zhike capsules are both a prescription drug and an over-the-counter （OTC） drug. Its main ingredients include Ranunculus ternatus and Panax notoginseng. With the effects of nourishing Yin and moistening the lungs， as well as relieving cough and reducing phlegm， Yifei Zhike capsules are often used in the treatment of acute and chronic bronchitis， pulmonary tuberculosis， and other diseases. However， there is insufficient understanding of their efficacy， suitable syndromes， and safety in clinical practice， with a lack of relevant expert consensus on clinical application. To standardize their clinical application， 30 experts from the fields of respiratory medicine， pharmacy， and evidence-based medicine were invited to develop an Expert Consensus on the Clinical Application of Yifei Zhike Capsules （Consensus for short） through evidence-based medicine methods. The Consensus clarified the syndrome characteristics， disease stages， dosages， treatment courses， combined medication， and other norms in the treatment of acute/chronic bronchitis and pulmonary tuberculosis and could be applicable to clinical physicians and pharmacists in medical and health institutions at all levels. In disease diagnosis， it provided diagnostic criteria for traditional Chinese medicine and Western medicine and clarified that the suitable traditional Chinese medicine syndrome was the syndrome of Qi-Yin deficiency with intermingled phlegm-blood stasis. Clinical studies have confirmed that Yifei Zhike capsules combined with standard anti-tuberculosis therapy can effectively improve the symptoms of pulmonary tuberculosis patients， increase the sputum smear conversion rate， and promote the absorption of lesions. When treating acute cough caused by respiratory tract infections， Yifei Zhike capsules can increase the markedly effective rate and the seven-day disappearance rate of cough symptoms. Meanwhile， recommendations for specific usage， dosages， and treatment courses were given for different diseases， and it was pointed out that long-term medication required key monitoring of adverse reactions. In safety， the adverse reactions of Yifei Zhike capsules involved multiple aspects such as the digestive system and allergic reactions， and pregnant women and women during menstruation were prohibited from using it. In addition， modern research has shown that Yifei Zhike capsules have an adjuvant therapeutic effect on tuberculous pleurisy and may be effective for inflammatory and benign pulmonary nodules. However， further research should be conducted on the toxicological safety of long-term medication. The formulation of the Consensus provides a scientific basis for the rational clinical application of Yifei Zhike capsules， which helps to improve clinical efficacy and reduce medication risks.

As an exclusive Miao medicine of Honwing Pharma （Guizhou） Co. Ltd.， Yifei Zhike capsules are both a prescription drug and an over-the-counter （OTC） drug. Its main ingredients include Ranunculus ternatus and Panax notoginseng. With the effects of nourishing Yin and moistening the lungs， as well as relieving cough and reducing phlegm， Yifei Zhike capsules are often used in the treatment of acute and chronic bronchitis， pulmonary tuberculosis， and other diseases. However， there is insufficient understanding of their efficacy， suitable syndromes， and safety in clinical practice， with a lack of relevant expert consensus on clinical application. To standardize their clinical application， 30 experts from the fields of respiratory medicine， pharmacy， and evidence-based medicine were invited to develop an Expert Consensus on the Clinical Application of Yifei Zhike Capsules （Consensus for short） through evidence-based medicine methods. The Consensus clarified the syndrome characteristics， disease stages， dosages， treatment courses， combined medication， and other norms in the treatment of acute/chronic bronchitis and pulmonary tuberculosis and could be applicable to clinical physicians and pharmacists in medical and health institutions at all levels. In disease diagnosis， it provided diagnostic criteria for traditional Chinese medicine and Western medicine and clarified that the suitable traditional Chinese medicine syndrome was the syndrome of Qi-Yin deficiency with intermingled phlegm-blood stasis. Clinical studies have confirmed that Yifei Zhike capsules combined with standard anti-tuberculosis therapy can effectively improve the symptoms of pulmonary tuberculosis patients， increase the sputum smear conversion rate， and promote the absorption of lesions. When treating acute cough caused by respiratory tract infections， Yifei Zhike capsules can increase the markedly effective rate and the seven-day disappearance rate of cough symptoms. Meanwhile， recommendations for specific usage， dosages， and treatment courses were given for different diseases， and it was pointed out that long-term medication required key monitoring of adverse reactions. In safety， the adverse reactions of Yifei Zhike capsules involved multiple aspects such as the digestive system and allergic reactions， and pregnant women and women during menstruation were prohibited from using it. In addition， modern research has shown that Yifei Zhike capsules have an adjuvant therapeutic effect on tuberculous pleurisy and may be effective for inflammatory and benign pulmonary nodules. However， further research should be conducted on the toxicological safety of long-term medication. The formulation of the Consensus provides a scientific basis for the rational clinical application of Yifei Zhike capsules， which helps to improve clinical efficacy and reduce medication risks.

Temporomandibular joint osteoarthritis(TMJOA)is a chronic degenerative disorder.Although current clinical interven-tions can effectively mitigate disease progression,they remain limited in fully reversing formed pathological structural alterations.Mesenchymal stem cell-derived exosomes(MSC-Exos),which mimic the primary therapeutic functions of mesenchymal stem cells,exhibit advantages such as excellent biocompatibility,low immunogenicity,and absence of cytotoxicity.In TMJOA,MSC-Exos exert therapeutic effects by modulating chondrocytes,immune cells,and the cartilage matrix.However,the clinical application of MSC-Exos still faces certain limitations.Enhancing their therapeutic efficacy has become a central research focus in this field.This review summarizes existing therapeutic strategies for TMJOA and explores the potential applications of MSC-Exos in TMJOA management,aiming to provide insights for future research.

Primary immune thrombocytopenia(ITP)is an acquired autoimmune hemorrhagic disease characterized by reduced isolated peripheral blood platelet counts for which pathogenesis and etiology are not well defined.Present diagnosis of ITP is to be excluding other diseases,whose pathogenesis generally involves multiple aspects of immunology,biology,epigenetics and environ-mental factors.Recognition of epigenetic alterations in dysregulation of immune tolerance and autoimmune diseases has been deepened in recent years with progress by molecular biology.DNA methylation,an important epigenetic modification,has been shown to play a role in pathogenesis of ITP.Abnormal DNA methylation leads to cellular abnormalities in proliferation,differentiation,apoptosis and immune response in body,induces immune intolerance to autologous platelet antigens in patients,resulting in abnormal activation of immune cells which makes excessive platelet destruction or insufficient platelet production.Therefore,this article reviews latest research progress of DNA methylation genes in ITP to provide a reference for further recovery of immune tolerance of patients.

Objective:To evaluate the effect of cognitive behavioral therapy (CBT) on reducing anxiety and promoting rapid postoperative recovery in patients undergoing induced abortion surgery.Methods:Non-randomized controlled trials were adopted, a total of 480 patients scheduled for induced abortion between January 2024 and January 2025 were consecutively enrolled and allocated to the intervention group ( n=240) or control group ( n=240). The control group received conventional education, whereas the intervention group implemented cognitive behavioral therapy on the basis of control group. The Hamilton anxiety scale (HAMA), the self-rating anxiety scale (SAS) and the 36-item short-form health survey (SF-36) were the main observed outcome measures. The anxiety, pain degree 24 h after the intervention, postoperative recovery, postoperative complications and changes in quality of life after the intervention were compared between the two groups of patients. Taking the baseline characteristics of the patients as independent variables and the scores of HAMA, SAS and SF-36 as dependent variables, multiple linear regression analysis was conducted. Results:After the intervention, the scores of HAMA and SAS in the intervention group were 5.76±1.13 and 40.98±3.76 respectively, which were lower than those in control group (7.08±1.42; 46.42±4.14), and the differences were statistically significant (all P<0.001). The score of the visual analogue scale 24 h after the operation was lower than that in control group (1.64±0.48 vs. 2.83±0.76), and the difference was statistically significant ( P<0.001). The duration of vaginal bleeding, the time of menstrual resumption and the recovery time of daily activities in the intervention group were all shorter than those in control group [(8.23±2.36) d vs. (10.87±2.16) d; (28.34±3.65) d vs. (33.47±4.18) d; (18.98±5.24) d vs. (25.42±4.16) d], and the differences were statistically significant (all P<0.001). Six weeks after the operation, the total incidence of complications in the intervention group was 5.0% (12/240), which was lower than that in control group [12.9% (31/240)], and the difference was statistically significant ( P=0.002). After the intervention, the total score of each dimension of SF-36 was higher than that in control group (334.68±5.79 vs. 305.46±5.93), and the difference was statistically significant ( P<0.001). Multiple linear regression analysis showed that higher educational attainment (bachelor's degree and above compared with junior high school and below HAMA β=-0.52, 95% CI: -0.85--0.19, P=0.002; SAS β=-0.75, 95% CI: -1.31--0.19, P=0.008) and higher household income (HAMA β=-0.15, 95% CI: -0.22--0.08, P<0.001; SAS β=-0.18, 95% CI: -0.28--0.08, P<0.001) were protective factors for reducing anxiety levels. Married was the protection factor in SAS scores ( β=-0.68, 95% CI: -1.22--0.14, P=0.013), and higher number of pregnancies was a risk factor for SAS scores ( β=0.19, 95% CI: 0.07-0.31, P=0.002). Age increase was a protective factor for HAMA score ( β=-0.03, 95% CI: -0.05--0.01, P=0.001). Higher educational attainment (junior college: β=3.25, 95% CI: 0.60-5.90, P=0.016; bachelor's degree and above: β=5.02, 95% CI: 2.33-7.71, P<0.001), higher household income ( β=1.25, 95% CI: 0.55-1.95, P<0.001), and married status ( β=2.81, 95% CI:0.28-5.34, P=0.030) were all significant positive predictors of quality of life. Conclusion:Cognitive-behavioral therapy effectively alleviates anxiety, reduces post-operative complications, accelerates recovery, and improves the quality of life in women undergoing induced abortion.

Objective:To explore the association between the systemic immune-inflammation index (SII) and obesity metabolic phenotypes, as well as metabolic features in children and adolescents.Methods:A cross-sectional study was conducted using the random cluster sampling method from March 2023 to May 2024. Children and adolescents aged 9-17 years in Guangzhou were surveyed through questionnaires, physical measurements, and blood tests. According to BMI and metabolic status, participants were classified into normal-weight groups [metabolically healthy normal weight (MHNW) and metabolically unhealthy normal weight (MUNW)] and overweight/obese groups [metabolically healthy overweight/obese (MHO/O) and metabolically unhealthy overweight/obese (MUO/O)]. After natural log-transformation of SII values (lnSII), multinomial logistic regression was used to assess the association between SII and obesity metabolic phenotypes, while binary logistic regression was applied to assess the relationship between SII and metabolic phenotypes in the overweight/obese subgroup. Linear regression model and restricted cubic spline (RCS) were employed to examine the relationship between SII and metabolic features among the entire population.Results:A total of 3 749 participants were included. After adjusting for covariates, for every unit increase in lnSII, the risk of MHO/O and MUO/O increased by 93% ( OR=1.93, 95% CI: 1.56-2.40, P<0.001) and 156% ( OR=2.56, 95% CI: 2.02-3.25, P<0.001), respectively. In the overweight/obesity subgroup, for every unit increase in lnSII, the risk of MUO/O increased by 37% ( OR=1.37, 95% CI: 1.01-1.87, P=0.045). Linear regression model and RCS showed that lnSII was positively correlated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) (SBP: β=1.39, 95% CI: 0.67-2.11, P<0.001; DBP: β=1.27, 95% CI: 0.79-1.75, P<0.001). lnSII also had a non-linear relationship with triglyceride ( Pnonlinear=0.032) and high-density lipoprotein cholesterol ( Pnonlinear=0.002). Conclusion:Elevated SII levels are associated with unfavorable obesity metabolic phenotypes, higher blood pressure, and altered lipid profiles in children and adolescents. SII may be a potential driving factor for metabolic heterogeneity in children and adolescents.

Objective:To evaluate the relationship between postoperative delirium (POD) and concentrations of phosphatidylethanolamine-binding protein 1 (PEBP1) in cerebrospinal fluid (CSF) of elderly patients undergoing total knee and hip arthroplasty.Methods:In this case-control study, 375 elderly patients of both sexes, aged ≥65 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective total knee and hip arthroplasty under combined spinal-epidural anesthesia at Haian Hospital Affiliated to Nantong University from November 2022 to June 2024, were selected. The perioperative clinical data were collected. CSF was drawn before anaesthesia for determination of the concentrations of PEBP1, Abeta 42 (Aβ 42), total tau (t-tau) and phosphorylated tau (p-tau) by enzyme-linked immunosorbent assay. The occurrence of postoperative delirium was evaluated using the Confusion Assessment Method at 1-7 days after operation. The severity of POD was assessed using a Memorial Delirium Assessment Scale. The patients were divided into POD group and non-POD group based on whether POD occurred. The influencing factors of POD were analyzed using multivariate logistic regression. Mediating effects were assessed to determine whether the levels of Aβ 42, p-tau and t-tau in CSF mediated PEBP1′s effect on POD. The accuracy of CSF PEBP1 concentration in predicting POD was evaluated using the receiver operating characteristic curve. Results:Decreased concentration of Aβ 42 in CSF, decreased ratios of Aβ 42/p-tau and Aβ 42/t-tau in CSF, and increased concentrations of PEBP1, p-tau and t-tau in CSF were independent risk factors for POD ( P<0.05). The results of mediation analysis showed that the relationship between PEBP1 and POD was partially mediated by CSF Aβ 42 (15.0%) and Aβ 42/t-tau ratio (14.9%). The receiver operating characteristic curve showed that the accuracy of CSF PEBP1 concentrations in predicting the occurrence of POD was high (AUC=0.846, P<0.001). Conclusions:Preoperative elevated CSF PEBP1 concentration is a risk factor for POD. CSF Aβ 42 concentration and Aβ 42/t-tau ratio serve as key mediators in the the association between PEBP1 and POD. PEBP1 concentration is more accurate in predicting POD.

Objective:To compare the changes in fracture displacement under different vertical loadings between the 2 different internal fixation modalities for vertically unstable femoral neck fractures of Pauwels type Ⅲ by a mechanical study and a finite element analysis.Methods:Twelve biomimic bones were transversely dissected from 10 cm below the lesser trochanter of the femur to create femoral neck fracture models with a Pauwels angle of 70° using a swing saw. The models were equally divided into 2 groups ( n=6): group A was fixed with 3 cannulated screws after fracture reduction (scheme A), and group B with 3 cannulated screws plus a self-designed anteromedial support plate after fracture reduction (scheme B). Continuous vertical force was applied using a mechanical testing machine. Changes in displacement were recorded and load-displacement curves were plotted. One volunteer (female, 28 years old, 168 cm in height and 65 kg in weight) was selected for finite element analysis of her CT images of both lower limbs to examine the maximum displacement and the maximum Mises stress in scheme A and scheme B respectively. Results:In groups A and B respectively: All the 6 biomimic mimetic bones had similar load and displacement curves, and similar fracture displacements (Dx) at different loading points (N X); the curves of 6 biomimic bones were highly fitted with S-shaped curve equation (the r-square value was close to 1). At the initial loading stage (0 N0.05). When the load was 100 N