Objective To investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed the patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022, and they were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. Results Except for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) days and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; the postoperative pain score in the day surgery group [1.0 (1.0, 1.0) points] was lower than that in the conventional inpatient group [3.0 (3.0, 3.0) points], with a statistically significant difference between the two groups (P<0.001). Additionally, the total hospitalization costs for the day surgery group and conventional inpatient group were 50 656.5 (48 145.3, 62 597.3) RMB and 53 689.3 (50 469.1, 64 826.5) RMB, respectively.The total hospitalization cost in the day surgery group was significantly lower than that in the conventional inpatient group, with a statistically significant difference between the two groups (P=0.001). There was no statistically significant difference in complications between the two groups (all P>0.05). Conclusion Endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe. Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.

Objective: To investigate the efficacy of magnesium-strontium co-doped hydroxyapatite mineralized collagen (MSHA/Col) in improving the bone repair microenvironment and enhancing bone regeneration capacity, providing a strategy to address the insufficient biomimetic composition and limited bioactivity of traditional hydroxyapatite mineralized collagen (HA/Col) scaffolds. Methods: A high-molecular-weight polyacrylic acid-stabilized amorphous calcium magnesium strontium phosphate precursor (HPAA/ACMSP) was prepared. Its morphology and elemental distribution were characterized by high-resolution transmission electron microscopy (TEM) and energy-dispersive spectroscopy. Recombinant collagen sponge blocks were immersed in the HPAA/ACMSP mineralization solution. Magnesium-strontium co-doped hydroxyapatite was induced to deposit within collagen fibers (experimental group: MSHA/Col; control group: HA/Col). The morphological characteristics of MSHA/Col were observed using scanning electron microscopy (SEM). Its crystal structure and chemical composition were analyzed by X-ray diffraction and Fourier transform infrared spectroscopy, respectively. The mineral phase content was evaluated by thermogravimetric analysis. The scaffold's porosity, ion release, and in vitro degradation performance were also determined. For cytological experiments, CCK-8 assay, live/dead cell staining, alkaline phosphatase staining, alizarin red S staining, RT-qPCR, and western blotting were used to evaluate the effects of the MSHA/Col scaffold on the proliferation, viability, early osteogenic differentiation activity, late mineralization capacity, and gene and protein expression levels of key osteogenic markers [runt-related transcription factor 2 (Runx2), collagen type Ⅰ (Col-Ⅰ), osteopontin (Opn), and osteocalcin (Ocn)] in mouse embryonic osteoblast precursor cells (MC3T3-E1). Results: HPAA/ACMSP appeared as amorphous spherical nanoparticles under TEM, with energy spectrum analysis showing uniform distribution of carbon, oxygen, calcium, phosphorus, magnesium, and strontium elements. SEM results of MSHA/Col indicated successful complete intrafibrillar mineralization. Elemental analysis showed the mass fractions of magnesium and strontium were 0.72% (matching the magnesium content in natural bone) and 2.89%, respectively. X-ray diffraction revealed characteristic peaks of hydroxyapatite crystals (25.86°, 31°-34°). Infrared spectroscopy results showed characteristic absorption peaks for both collagen and hydroxyapatite. Thermogravimetric analysis indicated a mineral phase content of 78.29% in the material. The scaffold porosity was 91.6% ± 1.1%, close to the level of natural bone tissue. Ion release curves demonstrated sustained release behavior for both magnesium and strontium ions. The in vitro degradation rate matched the ingrowth rate of new bone tissue. Cytological experiments showed that MSHA/Col significantly promoted MC3T3-E1 cell proliferation (130% increase in activity at 72 h, P < 0.001). MSHA/Col exhibited excellent efficacy in promoting osteogenic differentiation, significantly upregulating the expression of osteogenesis-related genes and proteins (Runx2, Col-Ⅰ, Opn, Ocn) (P < 0.01). Conclusion The MSHA/Col scaffold achieves dual biomimicry of natural bone in both composition and structure, and effectively promotes osteogenic differentiation at the genetic and protein levels, breaking through the functional limitations of pure hydroxyapatite mineralized collagen. This provides a new strategy for the development of functional bone repair materials

Objective:To investigate the impact of different etiologies on the spatial distribution pattern of infarcts and the mapping pattern of focal symptoms in acute ischemic stroke (AIS) using a population-based standardized spatial analysis of MRI.Methods:This was a cross-sectional study. Clinical [age, sex distribution, admission National Institutes of Health Stroke Scale (NIHSS) score and 90-day modified Rankin Scale (mRS) score at discharge, etc.] and imaging data of 2 610 patients with AIS attending 9 Medical Centers from January 2015 to December 2021 were retrospectively analyzed. All patients were categorized into 1 718 cases of large artery atherosclerosis (LAA) type, 335 cases of cardioembolism (CE) type, and 557 cases of small artery occlusion (SAO) type according to TOAST typing. All patients underwent diffusion-weighted imaging, and the detected infarct lesions were segmented and aligned to the standardized space using artificial intelligence-assisted methods, and the spatial distribution frequency heatmaps of lesion locations in patients with different TOAST subtypes were plotted and compared with each other by χ2 test. Lesion-symptom image brain maps with different clinical symptoms were further plotted, and differences of lesion-symptom image relationships among different TOAST subtypes were observed and compared with each other by interaction effect. Results:In all patients, the favored sites of infarct lesions were the bilateral middle cerebral artery region in the anterior circulation and the occipital and brainstem regions in the posterior circulation. Compared with the LAA type, the CE type lesions were more likely to occur in the anterior cerebral artery region, the occipital lobe, and the cerebellum posterior, while the SAO type lesions were more likely to occur in the perforator artery supply area. The lesion-symptom mapping results showed that AIS patients with infarct lesions in the frontoparieto-temporal region in the presence of a left middle cerebral artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the LAA type than for the CE type( P<0.05); AIS patients with infarcted lesions in the brainstem region and some cerebellar regions in the presence of vertebrobasilar artery supply had higher admission NIHSS scores and higher discharge 90-day mRS scores for the CE type than for the LAA type( P<0.05). Conclusion:At the population level, brain mapping reveals specific infarct distribution patterns and differences in lesion-symptom mapping patterns of different etiologies AIS patients, providing imaging evidence for the understanding of AIS pathogenetic mechanisms and clinical management.

OBJECTIVE To explore the association of peripheral blood glucose 6 phosphate dehydrogenase(G6PD),progranulin(PGRN)and neutrophil CD64 index with the disease outcomes of the neonates with septicemia.METHODS A total of 147 neonates with septicemia who were treated in the Second Affiliated Hospital of Wenzhou Medical University from Jun.2021 to Nov.2023 were assigned as the septicemia group,meanwhile,140 healthy neonates were chosen as the healthy group.The neonates of the septicemia group were divided into the early-onset group and the late-onset group according to the type of disease,the non-critically severe group,the critically se-vere group and the extremely critically severe group according to the severity of diseases,the survival group and the death group according to 30-day prognosis.The levels of peripheral blood G6PD,PGRN and neutrophil CD64 indexes were observed and compared among the various types of groups,and the values of the peripheral blood in-dexes in prediction of the prognosis were analyzed.RESULTS The peripheral blood G6PD level of the septicemia group was significantly lower than that of the healthy group,the levels of PGRN and neutrophil CD64 index of the septicemia group were significantly higher than those of the healthy group(P＜0.05).As compared with the pe-ripheral blood G6PD level among the neonates with different illness condition,the result was as follows:the non-critically severe group＞the critically severe group＞the extremely critically severe group(P＜0.05);as com-pared with the levels of PGRN and neutrophil CD64 index,the result was as follows:the non-critically severe group＜the critically severe group＜the extremely critically severe group(P＜0.05).The peripheral blood G6PD level of the death group was significantly lower than that of the survival group(P＜0.05),and the levels of PGRN and neutrophil CD64 index of the death group were significantly higher than those of the survival group(P＜0.05).The area under the curve(AUC)of the joint detection of peripheral blood G6PD,PGRN and CD64 index was 0.831 in prediction of the prognosis of the neonates,significantly higher than that of the single detection of the three indexes(P＜0.05).CONCLUSIONS The neonates with septicemia show the decline of peripheral blood G6PD and the rise of levels of PGRN and CD64 index.The expression levels of the indexes are associated with the severi-ty of disease and,to some extent,can predict the prognosis.

Objective To explore the value of multimodal ultrasound combined with sex hormone detection in evaluating endometrial receptivity in infertile patients.Methods Ninety-five infertile patients who received in vitro fertilization and embryo transfer treatment in Hangzhou Women's Hospital from January 2020 to February 2023 were selected as study objects,and they were divided into pregnant group(55 cases)and non-pregnant group(40 cases)according to the pregnancy status of the first embryo transfer.Sex hormone levels and multimodal ultrasound scores were compared between two groups,and receiver operating characteristic(ROC)curve was drawn to evaluate the value of each indicator in predicting pregnancy of infertile patients individually and in combination.Results The endometrial thickness score,endometrial volume score,vascular blood flow score and multimodal ultrasound score of pregnant group were significantly higher than those of non-pregnant group(P＜0.05).The levels of luteinizing hormone(LH),estradiol(E2)and progesterone(P)in pregnant group were significantly higher than those in non-pregnant group(P＜0.05).ROC curve results showed that the area under the curve(AUC)of LH,E2 and multimodal ultrasound scores in predicting pregnancy in infertile patients were all＞0.7,which had certain predictive value,and the three indicators combined with P had the highest predictive value,with an AUC of 0.889.Conclusion The combination of multimodal ultrasound and sex hormone detection can effectively evaluate the endometrial receptivity of infertile patients,and has certain reference value for predicting the pregnancy status of infertile patients.

OBJECTIVE To investigate the therapeutic effect of Sanhan Huashi Formula(SHF)on respiratory syncytial virus(RSV)-infected mouse models and explore its potential antiviral and anti-inflammatory mechanisms using lipidomics.METHODS Fifty-four BALB/c mice were randomly divided into six groups(n=9):blank group,model group,Ribavirin group(50 mg·kg-1·d-1),and SHF high(15.46 g·kg-1·d-1),medium(7.73 g·kg-1·d-1),and low-dose(3.87 g·kg-1·d-1)groups.A pneumonia model was established by in-tranasal RSV infection,followed by three consecutive days of oral gavage administration.Lung tissues were collected for histopathologi-cal evaluation using hematoxylin-eosin(HE)staining and inflammation scoring.Real-time quantitative polymerase chain reaction(RT-qPCR)was performed to measure mRNA levels of viral gene fusion protein(F),glycoprotein(G),and inflammatory factors tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)to assess lung viral load and inflammation,while immunofluorescence staining was performed to observe the expression of RSV-F protein in lung tissues.Serum lipidomics analysis was conducted using ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry(UPLC-Q Exactive Or-bitrap MS)to identify lipid metabolism changes and differential lipids.RESULTS Compared with the blank group,mice in the model group exhibited marked pulmonary inflammatory cell infiltration and tissue injury,with significantly elevated pulmonary histopa-thology scores and lung index.The lung viral load and the mRNA expression levels of the inflammatory factors TNF-α and IL-6 were significantly increased,and immunofluorescence likewise indicated high expression of RSV-F protein in lung tissue.Relative to the model group,treatment with SHF at all tested doses clearly ameliorated lung tissue injury,effectively suppressed viral gene expression and inflammatory cytokine levels,and reduced the fluorescence signal intensity of RSV-F protein in the lungs.Lipidomics analysis re-vealed that compared with the blank group,the model group exhibited marked disturbances in lipid metabolism-characterized by dys-regulation of triacylglycerol(TG),phosphatidylcholine(PC),lysophosphatidylcholine(LPC),sphingomyelin(SM),diacylglycerol(DG),lysophosphatidylethanolamine(LPE),and phosphatidylethanolamine(PE).High-dose SHF treatment reversed these RSV-induced lipid abnormalities.CONCLUSION SHF effectively alleviates RSV-induced pulmonary inflammation and pathological injury,re-duces pulmonary RSV viral load,and may exert these effects by modulating dysregulated lipid metabolism in peripheral blood.

With the advent of era of tumor immunotherapy,effect of intestinal flora in immunotherapy has attracted much attention.A large number of studies have confirmed the role of traditional Chinese medicine in regulating intestinal flora.Based on this,this paper discusses and summarizes the effect and mechanism of traditional Chinese medicine intervention on tumor immune checkpoint inhibitors(ICIs)treatment,providing a theoretical basis for in-depth understanding of the correlation between traditional Chinese medicine,intestinal flora and immunotherapy,and also providing new ideas for improving the efficacy of tumor immunotherapy and reducing immune-related adverse reactions.

WDFY1 is a member of the protein family containing the WD repeat and FYVE structural domains,acting as a junction that assists the recruitment of downstream molecules by Toll-like receptor 3/4(TLR3/TLR4)and promotes the body's natural anti-viral and anti-bacterial immune response.In recent years,the role of WDFY1 has been successively reported in various disease models,such as neurological diseases,autophagy and tumors.This paper aims to provide a comprehensive review of the current state of WDFY1 research,encompassing its expression distribution,cell biological function and its role in disease development,and take a prospect on the potential of WDFY1 as a target in rheumatoid arthritis.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective: To investigate the occupational health literacy (OHL) level and its influencing factors of key populations in Jinhua City, Zhejiang Province, so as to provide a basis for promoting occupational health. Methods: The front-line workers of 7 secondary industry enterprises (institutions) and 15 tertiary industry enterprises (institutions) in Jinhua City were selected from April to October 2023 using a stratified random cluster sampling method. Date of gender, age, length of service, and OHL were collected using the National Occupational Health Literacy Monitoring Survey for Key Population Personal Questionnaire. Factors affecting OHL level among key populations were identified using multivariable logistic regression model. Results: A total of 3 305 people were investigated, including 1 750 males (52.95%) and 1 555 females (47.05%). The median age and the length of service were 37 (interquartile range, 17) and (interquartile range, 9) years, respectively. The level of OHL was 45.63%. Multivariable logistic regression analysis identified gender (female, OR=1.675, 95%CI: 1.428-1.964), educational level (junior high school, OR=1.499, 95%CI: 1.089-2.063; high school, OR=1.905, 95%CI: 1.361-2.667; junior college, OR=4.065, 95%CI: 2.858-5.782; bachelor degree and above, OR=5.087, 95%CI: 3.597-7.194), personal monthly income (3 000-< 5 000 yuan, OR=1.373, 95%CI: 1.035-1.821; 5 000-<7 000 yuan, OR=1.653, 95%CI: 1.230-2.220; ≥7 000 yuan, OR=1.798, 95%CI: 1.322-2.447) and length of service (2-<6 years, OR=1.265, 95%CI: 1.032-1.551; 6-<11 years, OR=1.517, 95%CI: 1.184-1.943; ≥11 years, OR=1.337, 95%CI: 1.040-1.719) as factors affecting OHL level among key populations. Conclusions The OHL level of the key populations in Jinhua City is related to gender, age, education level, personal monthly income, and length of service. It is necessary to strengthen the occupational health education and health promotion of the key populations.