Objective To construct and validate an interpretable machine learning model integrating contrast-enhanced venous phase CT radiomics and clinical features for preoperative prediction of central lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods A case-control study was conducted on 243 histologically confirmed PTC patients.Among them,196 patients from the First Affiliated Hospital of Army Medical University were randomly allocated into a training set(n=137)and an internal validation set(n=59)at a 7:3 ratio,while the left 47 patients from No.958 Hospital of PLA Army were assigned into an external validation set.All participants completed standardized preoperative contrast-enhanced neck CT scanning.Quantitative radiomic features were systematically extracted from venous phase CT images through an open-source big data AI platform.Six machine learning classifiers,eXtreme Gradient Boosting(XGBoost),Support Vector Machine(SVM),Random Forest(RF),Logistic Regression(LR),k-Nearest Neighbors(KNN),and Decision Tree(DT)were implemented to construct clinical-radiomics integration models.The predictive performance was quantitatively assessed through receiver operating characteristic(ROC)curve analysis,with area under the curve(AUC)values calculated for training,internal validation,and external validation sets.Model interpretability was achieved using Shapley additive explanations(SHAP)framework,with particular focus on elucidating feature contributions in the best-performing model.Results The XGBoost model had an AUC value of 0.936(95%CI:0.895～0.976),0.832(95%CI:0.724～0.941),and 0.772(95%CI:0.632～0.912)in training,internal and external validation sets,respectively.SHAP analysis revealed age as the most influential clinical predictor,with younger patients showing higher CLNM risk(OR=0.968,P=0.042).Conclusion Our machine learning-based clinic-radiomic prediction model demonstrates satisfactory performance in predicting CLNM of PTC,providing valuable references for clinical decision-making.

Objective To explore the difference of efficacy and safety between denosumab and zoledronic acid in the treatment of patients with postmenopausal osteoporosis (PMOP), and to optimize the medication regimen for PMOP patients. Methods A total of 123 PMOP patients with high risk of fracture at the Second Affiliated Hospital of Naval Medical University from September 2021 to March 2024 were selected and randomly divided into two groups: the denosumab group (n=63) and the zoledronic acid group (n=60). Both groups underwent one-year treatment and follow-up, bone metabolism indexes, lumbar vertebrae, femoral neck, and total hip bone mineral density (BMD) were monitored, and any adverse reactions were documented. Results After treatment, the lumbar vertebrae and total hip BMD of patients in the denosumab group and the zoledronic acid group were significantly improved (P＜0.05); the femoral neck BMD of patients in the zoledronic acid group was also significantly improved (P＜0.05). The improvement of lumbar vertebrae BMD in the denosumab group was significantly better than that in the zoledronic acid group, while the improvement of femoral neck and total hip BMD in the zoledronic acid group was significantly better than that in the denosumab group (P＜0.05). Bone metabolism indicators were significantly improved in both groups (P＜0.05), and no significant liver and kidney dysfunction were observed. A total of 7 patients in the zoledronic acid group had mild adverse reactions and 5 patients in the denosumab group had mild adverse reactions. Conclusions Denosumab significantly increased lumbar vertebrae BMD and improved bone metabolism markers in PMOP patients, thus reducing risk of fracture and demonstrating good safety.

Objective:To reveal the effect of β-sitosterol on cerebral ischemia-reperfusion injury (CIRI) in rats and whether its mechanism is related to endoplasmic reticulum stress (ERS).Methods:Fifty-three CIRI rats (CIRI models established by modified Longa method) were randomly divided into model group ( n=14), β-sitosterol low-dose group ( n=13), β-sitosterol medium-dose group ( n=13) and β-sitosterol high-dose group ( n=13); 12 rats underwent the same operation without blocking the middle cerebral artery were selected as sham-operated group. Rats in the sham-operated group and model group were given intragastric administration of 1 mL 5 g/L sodium carboxymethyl cellulose daily. Rats in the β-sitosterol low-dose group, β-sitosterol medium-dose group and β-sitosterol high-dose group were given intragastric administration of 1 mL β-sitosterol at 10, 20 and 40 mg/kg/d (dissolved in 5 g/L sodium carboxymethyl cellulose), respectively, for 14 consecutive d. Neurological function was evaluated according to Zea Longa 5 method. Rats were sacrificed and brain tissues were collected. Volume of cerebral infarction was measured by 2,3,5-triphenyl tetrazolium chloride (TTC) staining. Brain injury and neuronal apoptosis were evaluated by HE staining, Nissl staining and TUNEL. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) contents were detected by water-soluble tetrazolium 1 (WST-1) method, colorimetric method or thiobarbituric acid (TBA) method, respectively. The mRNA and protein expression levels of protein kinase R-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme-1 (IRE-1), activated transcription factor-6 (ATF-6), glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP) and Caspase-12 in the brain tissues were detected by qRT-PCR or Western blotting. Results:Compared with the sham-operated group, the model group had significantly increased neurological function score, cerebral infarction volume and TUNEL positive rate, decreased SOD and GSH-Px content, increased MDA content, and increased mRNA and protein expressions of PERK, IRE-1, ATF-6, GRP78, CHOP and Caspase-12 ( P<0.05). Compared with the model group, the β-sitosterol low-dose group, β-sitosterol medium-dose group and β-sitosterol high-dose group had significantly decreased neurological function score, cerebral infarction volume, and TUNEL positive rate, increased SOD and GSH-Px content, and decreased MDA content ( P<0.05); the β-sitosterol low-dose group, β-sitosterol medium-dose group and β-sitosterol high-dose group had significantly decreased mRNA and protein PERK expressions (mRNA: 2.17±0.17, 1.79±0.07 and 1.33±0.07; protein: 5.11±0.52, 2.91±0.26 and 1.98±0.17), IRE-1 expressions (mRNA: 1.75±0.18, 1.65±0.08 and 1.32±0.08; protein: 5.00±0.31, 4.05±0.27 and 1.98±0.14), ATF-6 expressions (mRNA: 2.24±0.12, 1.77±0.14 and 1.37±0.13; protein: 4.93±0.45, 4.04±0.30 and 3.10±0.20), GRP78 expressions (mRNA: 2.67±0.16, 2.11±0.16 and 1.69±0.11; protein: 5.02±0.38, 2.97±0.26 and 2.05±0.22), CHOP expressions (mRNA: 2.01±0.16, 1.70±0.19 and 1.40±0.10; protein: 4.92±0.39, 4.02±0.27 and 3.08±0.22) and Caspase-12 expressions (mRNA: 1.85±0.09, 1.61±0.09 and 1.30±0.09; protein: 3.03±0.20, 2.19±0.11 and 1.82±0.11) compared with the model group (mRNA: 2.99±0.28, 2.27±0.12, 2.57±0.21, 3.46±0.20, 2.50±0.23 and 2.35±0.16; protein: 6.98±0.48, 6.03±0.58, 5.98±0.63, 7.10±0.45, 6.00±0.53 and 5.02±0.43, P<0.05). Conclusion:β-sitosterol attenuates CIRI in rats, whose mechanism may be related to inhibition of ERS signal pathway.

Background: The stem of Syringa pinnatifolia is used as traditional Mongolian medicine for the treatment of cardiopulmonary diseases, in which sesquiterpenes are regarded as the primary medicinal compounds. However, only S. pinnatifolia from natural stands is able to produce medicinal-grade stems when compared with that from cultivated stands. Despite the need to develop an effective technique to promote sesquiterpene accumulation in cultivated stands to ensure sustainable resource production, studies on the potential use of fungal endophytes as fungal elicitors were limited. Objective: This study explored the potential of selected endophytic fungi isolated from the stems of wild and cultivated S. pinnatifolia and further examined their efficacy in promoting sesquiterpene production in S. pinnatifolia calli. Results: Among the 11 fungal groups, Valsa sp, isolated from wild S. pinnatifolia, emerged as a promising fungal elicitor for promoting sesquiterpene accumulation in S. pinnatifolia. This conclusion is drawn from the production of a humulane-type sesquiterpene, known to be one of the most prevalent subtypes of sesquiterpenes in S. pinnatifolia. In addition, it was demonstrated that methyl jasmonate and salicylic acid displayed little effect on sesquiterpene accumulation in S. pinnatifolia. Conclusions: The findings of this study lay a foundation for using fungal endophytes to promote sesquiterpene production in S. pinnatifolia. This contribution could subsequently advance the development of the local traditional medicine industry and aid in the protection of wild S. pinnatifolia.

Traditional Chinese medicine （TCM） has certain advantages in the treatment of chronic kidney disease-mineral and bone disorder （CKD-MBD）. In recent years， there have been many studies on the treatment of CKD-MBD by Chinese medicinal compounds and monomers. As revealed by literature retrieval， the research on the mechanism of Chinese medicine in intervening in signaling pathways related to CKD-MBD was mainly based on self-made Chinese medicinal compounds， and the action pathways involved fibroblast growth factor 23/Klotho （FGF23/Klotho） signaling pathway， Wnt/β-catenin signaling pathway， receptor activator of nuclear factor-κB/receptor activator of nuclear factor-κB ligand/osteoprotegerin （RANK/RANKL/OPG） system， and other signaling pathways. TCM can improve calcium and phosphorus metabolism and bone metabolism disorder， and regulate inflammatory reaction， oxidative stress， apoptosis， and autophagy by regulating this series of signaling pathways for the treatment of CKD-MBD. This paper introduced the research results of these signaling pathways and the mechanism of TCM in the treatment of CKD-MBD in order to provide ideas and references for the related research of Chinese medicine in the treatment of CKD-MBD.

For decades, the molecular and cellular mechanisms that govern tooth development have been extensively investigated. However, most of the studies are based on mice, whose teeth are quite different from human teeth in morphological and developmental aspects. Mice are not the ideal model for understanding the development of permanent teeth as they have only one set of dentition. Thus, using of diphyodont mammals is a better model to study the deciduous and permanent tooth development and to understand the process of tooth replacement. Several diphyodont mammal models have been established including minipig, ferret, house shrew and rabbit. Studies based on the diphyodont mammals have characterized the morphological changes involved in tooth replacement and molecular mechanisms of tooth replacement. However, few developmental stages were studied on ferret due to the presence of seasonal estrus and the difficulty to obtain ferret embryos at the correct stage. The house shrew is limited as a model because their deciduous tooth germs become vestigial in the embryonic period. The main disadvantage of the rabbit is an incomplete dentition with the lack of canines. Compared to the above mentioned animal models, the miniature pig has proven to be a valuable animal model for diphyodont development due to its dentition similarities, including the morphology, number and size of teeth, to human′s, and particularly its heterodont dentition consisting of incisors, canines, premolars and molars. The present article reviews the current knowledge on the development of the primary and successional teeth in minipig modle and briefly summarizes the studies based on other diphyodont mammal models.

Tricalcium phosphate (TCP) is one of the most widely used bioceramics for constructing bone tissue engineering scaffold. The three-dimensional (3D) printed TCP scaffold has precise and controllable pore structure, while with the limitation of insufficient mechanical properties. In this study, we investigated the effect of sintering temperature on the mechanical properties of 3D-printed TCP scaffolds in detail, due to the important role of the sintering process on the mechanical properties of bioceramic scaffolds. The morphology, mass and volume shrinkage, porosity, mechanical properties and degradation property of the scaffold was studied. The results showed that the scaffold sintered at 1 150℃ had the maximum volume shrinkage, the minimum porosity and optimal mechanical strength, with the compressive strength of (6.52 ± 0.84) MPa and the compressive modulus of (100.08 ± 18.6) MPa, which could meet the requirements of human cancellous bone. In addition, the 1 150℃ sintered scaffold degraded most slowly in the acidic environment compared to the scaffolds sintered at the other temperatures, demonstrating its optimal mechanical stability over long-term implantation. The scaffold can support bone mesenchymal stem cells (BMSCs) adherence and rapid proliferation and has good biocompatibility. In summary, this paper optimizes the sintering process of 3D printed TCP scaffold and improves its mechanical properties, which lays a foundation for its application as a load-bearing bone.

Objective:To improve the quality and efficiency of pharmaceutical care of clinical pharmacists by standardizing phar-maceutical care process using tracking table design for clinical drug therapy. Methods: The experience and skills of pharmaceutical care performed by clinical pharmacists in endocrinology department were summarized and the tracking table for clinical drug therapy was designed, which could provide information for patients clearly and concisely, and make the process of pharmaceutical care more system-atical. Results:After using the tracking table, clinical pharmacists improved work efficiency significantly. In addition, the average hospitalization, average hospitalization expenses and drug proportion significantly reduced resulting in higher satisfaction of patients. Conclusion:The standardized pharmaceutical care process performed by clinical pharmacists in endocrinology department makes phar-maceutical care more specific, comprehensive and convenient.

Objective: To investigate the survival and individualized therapy of metastatic colorectal cancer (mCRC) patients who achieved a stable disease state after induction chemotherapy. Methods:Data were reviewed from 204 metastatic colorectal cancer pa-tients, who presented a stable disease state after first-line and second-line chemotherapy at Tianjin Medical University Cancer Insti-tute and Hospital. The clinical and pathological characteristics were analyzed. Moreover, we analyzed the significance of maintenance treatment in patients with certain mCRC characteristics. Results:Univariate analysis indicated that the line of chemotherapy, levels of CA724, CEA, and CA19-9, and platelet-to-lymphocyte ratio (PLR) were considered prognostic factors of treatment after induction che-motherapy. According to the multivariate analysis, first-line chemotherapy, as well as low levels of CA19-9 and PLR, with maintenance treatment after the induction chemotherapy was significantly associated with better survival. Among the patients with high levels of PLR, those who underwent maintenance treatment achieved a progression-free survival of 13.43 months (versus 10.63 months in pa-tients from the observation group, P=0.003). Conclusion:The levels of CA19-9 and PLR, and treatment after chemotherapy were signif-icant prognostic factors for mCRC patients who achieved a stable disease state after induction chemotherapy. These patients, especial-ly those with high PLR, could benefit from the maintenance treatment.

The growing trend of childhood obesity has attracted much attention globally.Overweight and obesity are not only popular in developed countries,but have spread to developing countries.China has entered an overall epidemic stage of childhood obesity.Studies have shown that obesity does not only impairs children's health,but also leads to health hazards in adult stage.Diabetes,coronary heart disease and other cardiovascular diseases may take place sooner or the incidence may become higher.The causes of obesity include genetic,early life events,physical activity patterns,diet and social psychological factors.This article reviews the current epi-demic status and the influencing factors of childhood obesity worldwide.