Objective To investigate the regulatory role of the programmed cell death protein 1 (PD-1) and its ligand programmed cell death protein ligand 1 (PD-L1) signaling on the subtypes and functions of natural killer (NK) cells at the maternal-fetal interface during the second trimester in mice following Toxoplasma gondii infection during the first trimester. Methods Twelve 6- to 8-week-old female mice of the C57BL/6J strain were divided into a control group and an infection group, of 6 mice in each group. On the 6.5th day of pregnancy (Gd6.5), each pregnant mouse in the infection group was intraperitoneally injected with 150 tachyzoites of the Toxoplasma gondii PRU strain, while mice in the control group were injected with an equal volume of physiological saline. On the 12.5th day of pregnancy (Gd12.5), uterus and placenta tissues were sampled from pregnant mice for pathological observations, and the mRNA expression levels of PD-1, PD-L1, and tumor necrosis factor-α (TNF-α) were quantified in uterus and placenta tissues. The PD-1 and DX5 expression was measured on NK cells at the maternal-fetal interface using flow cytometry. In addition, the in vitro JEG-3 trophoblast cells and NK-92MI cells co-culture system was established as the control group, and the addition of T. gondii tachyzoites in the co-culture system served as the infection group. The PD-1, PD-L1, and DX5 mRNA expression was quantified in cells using real-time fluorescence quantitative reverse transcription PCR (RT-qPCR) assay, and the TNF-α concentration was measured in the cell culture supernatant using enzyme-linked immunosorbent assay (ELISA). Results On Gd12.5, clear and intact cellular structures of placental decidual tissues were seen in pregnant mice in the control group, with no remarkable abnormal changes found in the uterine columnar epithelial cells, and inflammatory cell infiltration and blood stasis at varying degrees were found in uterine and placental tissues from pregnant mice in the infection group. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.004 ± 0.004), (1.001 ± 0.001), and (1.001 ± 0.001) in uterine tissues from pregnant mice in the control group and (2.480 ± 0.720), (3.355 ± 0.920), and (2.391 ± 0.073) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was (1.007 ± 0.010), (1.006 ± 0.006), and (1.001 ± 0.001) in the uterine tissues in the control group and (6.948 ± 1.918), (3.225 ± 1.034), and (1.536 ± 0.150) in the infection group, respectively. The relative PD-1, PD-L1, and TNF-α mRNA expression was higher in both the uterine (t = 3.55, 4.43 and 33.02, all P values < 0.05) and placental tissues (t = 5.36, 3.72 and 6.18, all P values < 0.05) in the infection group than in the control group. Flow cytometry showed that the proportions of PD-1⁺ NK cells, PD-1⁺ DX5⁺ NK cells, and DX5⁺ NK cells were (12.200 ± 1.082)%, (9.373 ± 7.728)%, and (44.000 ± 4.095)% in uterine tissues from pregnant mice in the control group, and (21.733 ± 1.630)%, (18.767 ± 1.242)%, and (73.367 ± 0.611)% in the infection group, respectively. The proportions of PD-1⁺ NK cells, PD-1⁺ DX5⁺ NK cells, and DX5⁺ NK cells were (1.100 ± 0.510)%, (2.277 ± 1.337)%, and (96.167 ± 2.831)% in placental tissues from mice in the control group, and (26.867 ± 9.722)%, (23.433 ± 6.983)%, and (82.467 ± 2.248)% in the infection group, respectively. The proportions of PD-1⁺ NK cells (t = 8.45, P < 0.05) and DX5⁺ NK cells (t = 12.29, P < 0.05) were higher in uterine tissues from pregnant mice in the infection group than in the control group, and no significant difference was seen in the proportion of PD-1⁺ DX5⁺ NK cells (Z = -1.09, P > 0.05). The proportions of PD-1⁺ NK cells (t = 4.58, P < 0.05) and PD-1⁺ DX5⁺ NK cells (t = 5.15, P < 0.05) were higher in placental tissues from pregnant mice in the infection group than in the control group, while the proportion of DX5⁺ NK cells was lower in the infection group than in the control group (t = -6.56, P < 0.05). RT-qPCR assay revealed that the relative PD-1, PD-L1, and DX5 mRNA expression was (1.010 ± 0.005), (1.002 ± 0.003), and (1.001 ± 0.001) in the JEG-3 cells and NK92MI cells co-culture system and (3.638 ± 1.258), (0.397 ± 0.158), and (4.267 ± 1.750) in the control group, and ELISA measured that the TNF-α concentration was higher in the cell culture supernatant in the infection group [(22.056 ± 3.205) pg/mL] than in the control group [(12.441 ± 0.001) pg/mL] (t = 5.20, P < 0.05). The PD-1(t = 3.62, P < 0.05) and DX5 mRNA expression (t = 3.23, P < 0.05) was higher in the infection group than in the control group, and the PD-L1 mRNA expression was lower in the infection group than in the control group (t = -6.63, P < 0.05). Conclusions Following T. gondii infection, both PD-L1 expression and PD-1 expression on DX5⁺ NK cells at the maternal-fetal interface are upregulated in mice during the second trimester; however, the proportion of DX5⁺ NK cells decreases. These findings suggest that PD-1/PD-L1 signaling may suppress NK cell functions by modulating DX5⁺ NK cell subsets.

Objective:To compare the clinical efficacy and safety of nanomicroneedle- versus ultrasound-mediated delivery of tranexamic acid for the treatment of melasma.Methods:A prospective, randomized, controlled study was conducted. Patients with melasma were collected from the Department of Dermatology, Guangzhou Dermatology Hospital from March 2023 to May 2024, and divided into a nanomicroneedle group (receiving nanomicroneedle-mediated delivery of tranexamic acid) and an ultrasound group (receiving ultrasound-mediated delivery of tranexamic acid) using the random number table method. Both groups underwent the treatment once a week for a total of 8 sessions. At week 12, outcomes including melasma area and severity index (MASI) scores, treatment response rates, VISIA brown spot scores, pain scores, and adverse reactions were evaluated and compared between the two groups. Statistical analyses were carried out using two-independent-sample t test, Mann-Whitney U test, and chi-square test. Results:A total of 80 patients with melasma were included, with 40 in each group. In the nanomicroneedle group, the patients were aged 40.35 ± 7.39 years (range: 25 - 55 years), with the disease duration being 8.45 ± 4.77 months (range: 1 - 16 months) ; in the ultrasound group, the patients were aged 40.25 ± 7.76 years (range: 25 - 55 years), and their disease duration was 10.45 ± 5.07 months (range: 2 - 17 months) ; there were no significant differences in ages or disease duration between the two groups (both P > 0.05). At week 12, both groups demonstrated reduced MASI scores compared to baseline scores, and the MASI scores were significantly lower in the nanomicroneedle group ( M[ Q1, Q3]: 5.80[4.20, 9.35]) than in the ultrasound group (8.65[5.70, 10.80], Z = 2.50, P = 0.012). The overall response rate was significantly higher in the nanomicroneedle group (97.5%, 39/40) than in the ultrasound group (55.0%, 22/40; χ2 = 19.95, P < 0.001). The lateral facial VISIA brown spot scores were also significantly lower in the nanomicroneedle group (left side: 126.18 ± 36.54 points; right side: 138.50 ± 40.76 points) than in the ultrasound group (left side: 142.37 ± 32.40 points; right side: 157.13 ± 39.59 points; t = -2.10, -2.07, P = 0.039, 0.041, respectively). In the nanomicroneedle group, the pain scores were 4.12 ± 1.47 points, and varying severity of adverse reactions such as erythema, edema and dryness occurred after operation, all of which resolved spontaneously within 48 hours. No marked adverse reactions were observed in the ultrasound group. Conclusion:Nanomicroneedle-mediated delivery of tranexamic acid demonstrated superior clinical efficacy and favorable safety profiles compared to the ultrasound-mediated delivery, providing more options for the treatment of melasma.

Objective:To summarize endorectal ultrasound（ERUS）findings of rectal lymphoma（RL）and evaluate its clinical value for preoperative diagnosis.Methods:Nine RL patients between Jan 2015 and March 2025 in the Sixth Affiliated Hospital of Sun Yat-Sen University were included in this retrospective study. ERUS findings including lesion location，size，echogenicity，mucosal integrity，depth of infiltration，and blood flow characteristics were reviewed. The diagnostic performance of ERUS was evaluated using pathology as the gold standard.Results:ERUS features of RL included extensive bowel wall involvement（≥1/2 circumference in 8/9 cases），intact mucosa（7/9），homogeneous markedly hypoechoic echogenicity（6/9），and Adler grade 3 blood flow（9/9）. No case presented bowel obstruction；three cases involved multi- segmental bowel. All four cases who received ultrasound-guided biopsy reached conclusive diagnosis，while 2 of them were infeasible for endoscopic biopsy.Conclusions:Typical ERUS findings of RL include extensive infiltration，preserved mucosa，and homogeneous markedly hypoechoic echogenicity. ERUS could clearly show the submucosal infiltration pattern and bowel wall layers，and significantly improve preoperative diagnostic accuracy in combination with ultrasound-guided biopsy.

Objective:To explore the value of endorectal echodefecography（EDF）in the evaluation of functional anorectal disorders（FAD）.Methods:A total of 67 patients clinically diagnosed with FAD who underwent EDF at the Sixth Affiliated Hospital of Sun Yat-Sen University from September 2021 to August 2024 were retrospectively collected. EDF was performed using a combination of transrectal and transperineal scans. XRD was used as the reference standard.Results:The diagnostic accuracy，sensitivity，specificity，positive predictive value，and negative predictive value of EDF for common FADs were as follows：for rectocele，85.1%，84.6%，85.4%，78.6%，and 89.7%；for rectal intussusception，79.1%，50.0%，93.3%，78.6%，and 79.2%；for external rectal prolapse，94.0%，71.4%，100%，100%，and 93.0%；for anismus，82.1%，66.7%，82.8%，15.4%，and 98.1%；for perineal descent，65.7%，54.2%，72.1%，52.0%，and 52.0%.Conclusions:EDF is valuable for evaluating FAD，especially for external rectal prolapse and rectocele. It can serve as an effective complement to XRD and provide a non-invasive and safe imaging method for FAD diagnosis.

BACKGROUND:Stand-alone oblique lateral interbody fusion has a high rate of complications of fusion segment sink.Oblique lateral interbody fusion with posterior fixation can provide stable support,but intraoperative position changes and double incisions weaken the advantages of this technique.Oblique lateral interbody fusion combined with lateral plate fixation can achieve one-stage decompression in the same incision,while the lateral internal fixation provides stable support. OBJECTIVE:To analyze the short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in the treatment of single-level lumbar degenerative disease. METHODS:The clinical data of 34 patients with single-level lumbar degenerative disease treated with oblique lateral interbody fusion combined with lateral plate fixation were collected from May 2020 to October 2022.Among them,14 were males and 20 were females aged from 41 to 72 years at the mean age of(58.6±9.9)years.There were 11 cases of lumbar spondylolisthesis(Ⅰ°),7 cases of lumbar disc herniation with segmental instability,and 16 cases of lumbar spinal stenosis.Operation time,blood loss,and complications were recorded.Visual analog scale scores of lumbago,radiative pain of both lower limbs,and Oswestry disability index scores were evaluated before surgery,3 months after surgery,and the last follow-up.Dural sac cross-sectional area,intervertebral height,and intervertebral fusion were measured and observed. RESULTS AND CONCLUSION:(1)The 34 patients were followed up for 14-36 months,with an average of(21.3±5.2)months.(2)The operation time ranged from 50 to 92 minutes,with an average of(68.5±11.1)minutes.Intraoperative blood loss was 50-170 mL,with an average of(71.6±25.3)mL.(3)Compared with the preoperative results,the visual analog scale scores and Oswestry disability index scores were significantly decreased at 3 months after surgery and at the last follow-up(P<0.001),and the maximum Oswestry disability index scores were improved by nearly 50％.(4)Bone fusion was achieved in all patients during half-year follow-up.The overall complication rate was 21％(7/34),including 1 case of plate displacement,3 cases of cage subsidence,1 case of psoas weakness,and 2 cases of anterior thigh pain.(5)It is concluded that oblique lateral interbody fusion combined with lateral plate fixation for the treatment of lumbar degenerative diseases has the characteristics of less blood loss,short operation time,rapid postoperative recovery,and significant short-term clinical efficacy with the stable support to a certain extent.The long-term curative effect needs further follow-up observation.

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndromes in intrahepatic cholestasis of pregnancy （ICP） and its association with perinatal outcomes， and to provide a basis for precise treatment based on TCM syndrome differentiation. MethodsA cross-sectional study was conducted among 275 patients with ICP who were admitted to The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from April 2023 to April 2025. A hierarchical cluster analysis was used to summarize TCM syndromes. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. A multivariate Logistic regression analysis was used to identify the clinical features significantly associated with TCM syndrome. ResultsThe cluster analysis identified three core TCM syndromes among the 275 patients with ICP， i.e.， liver-gallbladder damp-heat syndrome （45.8%）， syndrome of blood deficiency generating wind （30.9%）， and liver depression and spleen deficiency syndrome （23.3%）. There was a significant difference in the distribution of TCM syndromes between different groups stratified by maternal age at delivery， parity， history of ICP recurrence， gestational weeks at disease onset， total bile acid （TBA）， alanine aminotransferase （ALT）， and comorbidity with gestational diabetes mellitus （GDM） （all P<0.05）. The multivariate Logistic regression analysis showed that<34 gestational weeks at disease onset was significantly associated with all three syndromes （damp-heat： odds ratio ［OR］=3.769， P<0.001； blood deficiency： OR=4.031， P<0.001； liver stagnation： OR=3.552， P<0.001）. Liver-gallbladder damp-heat syndrome was associated with maternal age ≥35 years at disease onset （OR=2.048， P=0.014）， parity ≥2 times （OR=1.921， P=0.034）， history of ICP recurrence （OR=2.404， P=0.030）， ALT ≥200 U/L （OR=2.051， P=0.018）， comorbidity with GDM （OR=1.944， P=0.029）， and TBA ≥40 μmol/L （OR=2.542， P=0.024）. The syndrome of blood deficiency generating wind syndrome was associated with maternal age ≥35 years （OR=2.939， P=0.003）， parity ≥2 time （OR=3.222， P=0.003）， history of ICP recurrence （OR=3.809， P=0.010）， ALT ≥200 U/L （OR=2.889， P=0.006）， comorbidity with GDM （OR=3.711， P=0.001）， and comorbidity with hypertensive disorders of pregnancy （OR=4.472， P=0.011）. Liver depression and spleen deficiency syndrome was associated with TBA ≥40 μmol/L （OR=2.995， P=0.044）. The analysis of perinatal outcomes showed that there were significant differences in mode of delivery， gestational weeks at the time of delivery， postpartum blood loss， and neonatal birth weight between the three groups with different TCM syndromes （all P<0.05）. ConclusionLiver-gallbladder damp-heat syndrome， syndrome of blood deficiency generating wind， and liver depression and spleen deficiency syndrome are the main TCM syndrome types in ICP， and the distribution of TCM syndromes is closely associated with clinical factors and perinatal outcomes， which provides a basis for precise TCM syndrome differentiation and individualized treatment.

Objective To observe the clinical efficacy of Dulongneedling in the treatment of vertigo in cervical spondylosis of vertebral artery(CSA).Methods A total of 46 cases of patients with definitive diagnosis of vertigo in CSA admitted to the outpatient clinic of the Acupuncture,Muxibustion and Rehabilitation Department of Guangdong Second Traditional Chinese Medicine Hospital from June to October 2024 were selected for the study.The patients were randomly divided into observation group and control group according to the random number table method,with 23 cases in each group.The observation group was treated with Dulongten-needling in shoulder and neck,and the control group was given conventional acupuncture treatment,the course of treatment for the two groups covered two weeks.After two weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes in the scores of Evaluation Scale For Cervical Vertigo(ESCV)before and after treatment were observed in the patients of the two groups.Three dimensional pseudo-continuous arterial spin labeling(3D-pCASL)technique was applied to determin the changes in cerebral blood flow(CBF)values in the region of region of interest(ROI),and the changes in CBF values in the patients of the two groups were compared.Results(1)The total effective rate of the observation group was 91.30%(21/23),and that of the control group was 78.26%(18/23),and the efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the ESCV scores of patients in the two groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(3)After treatment,the CBF change values of each ROI in the two groups showed elevated(positive),and the CBF change values of the right middle cerebral artery(R-MCA)in the control group showed decreased(negative).After treatment,the CBF change values of the observation group in the blood supply areas of the right posterior inferior cerebellar artery(R-PICA),right anterior inferior cerebellar artery(R-AICA),right anterior cerebral artery(R-ACA),branches from vertebral arteries(VA)and basilar arteries(BA),bilateral superior cerebellar arteries(SCA),and bilateral posterior cerebral arteries(PCA)were significantly elevated,and the observation group was significantly superior in improving the above ROIs in the CBF change value to that of the control group,the difference being statistically significant(P<0.05).Conclusion Dulongneedling in the treatment of vertigo in CSA can significantly improve the CBF of patients,reduce the clinical symptoms such as vertigo,neck and shoulder pain,headache.

Diabetic foot ulcer(DFU)is one of the severe complications of diabetes mellitus,which often leads to amputation and seriously impairs patients' quality of life.It has complex etiology,involving vascular disease,neuropathy,and infection,etc.,and western medical treatment options are limited.In traditional Chinese medicine(TCM),DFU is classified as"tuoju"(gangrene of the extremities).Simiao Yong'an Decoction,a commonly used formula,has demonstrated clinical effects in improving blood flow,repairing nerves,controlling infection,and promoting wound healing.This article reviewed the TCM pathogenesis of DFU and the clinical and experimental research progress of Simiao Yong'an Decoction,aiming to provide a scientific basis for its treatment.

The rapid development of information technology has brought new opportunities and challenges to medical educa-tion.As one of the key technologies leading the future,artificial intelligence(AI)is becoming a crucial force to promote the high-quality development of education.Host Defense and Immunity teaching team actively explores and practices the teaching innovation,and takes measures such as building a knowledge graph,constructing a learning map,forming a ideological and political map,introducing AI teaching assistants,using AI tools,and analyzing student conditions.As a result,the students'enthusiasm increased,and the average mastery rate of the knowledge points reached as high as 86.13%.Meanwhile,this paper further considers the thoughts and prospects of digital intelligence empowerment courses in aspects such as teacher development,industry-education integration,safety norms,and the relationship with human intelligence,with the aim of better serving the cultivation of innovative medical talents.

Gastroblastoma (GB) is a rare gastric epithelial tumor without special clinical manifestations, whose histologic origin and pathogenesis remain unclear due to less related reports.Low-grade cell forms with biphasic differentiation are typical histological characteristics of GB.Immunohistochemistry and molecular tests can help with its differential diagnosis.GB is an invasive low-grade malignant tumor and the first treatment is surgical resection.However, there is no uniform standard treatment plan at present and most patients have a good prognosis.In this article, the histopathology, diagnosis and identification diagnosis of GB was reviewed to provide a theoretical basis for its origin, development, treatment and patient prognosis.