ObjectiveTo investigate the associations of multiple glycolipid metabolic indicators and their cumulative abnormality burden with incident colorectal cancer risk in a general population-based prospective cohort, and to examine the mediating role of glycolipid metabolic abnormalities in the relationships between smoking, alcohol consumption, physical activity, and colorectal cancer incidence. MethodsA total of 17 897 eligible participants recruited from the Taizhou Cohort between 2011 and 2014 were included. Cox proportional hazards regression models were used to assess the associations of conventional and derived glycolipid indicators, as well as a glycolipid abnormality index constructed from total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and insulin, with incident colorectal cancer risk. Restricted cubic spline models were applied to evaluate dose-response relationships for major indicators. Receiver operating characteristic curves were generated to compare predictive performance across indicators. Mediation analyses were conducted to assess the mediating effects of the glycolipid abnormality index on the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence. ResultsDuring a median follow-up of 11.2 years, 102 incident colorectal cancer cases were identified, with an incidence density of 51.2 per 100 000 person-years. After adjustment for potential confounders, Cox proportional hazards regression analyses showed that decreased high-density lipoprotein cholesterol was associated with a 1.74-fold higher risk of colorectal cancer (HR=1.74, 95%CI: 1.03‒2.95), elevated low-density lipoprotein cholesterol was associated with a 1.78-fold higher risk (HR=1.78, 95%CI: 1.05‒3.02), and abnormal fasting plasma glucose was associated with a 1.86-fold higher risk (HR=1.86, 95%CI: 1.15‒3.02). Triglycerides and fasting plasma glucose showed an approximately linear increasing association with colorectal cancer risk in multivariable restricted cubic spline models. The glycolipid abnormality index showed a clear gradient association with colorectal cancer risk; participants with three or more abnormal indicators had a 3.08-fold higher risk than those without abnormalities (HR=3.08, 95%CI: 1.60‒5.92). The area under the curve was 0.795, higher than that of individual glycolipid indicators and other combined indices, and gender-stratified analyses showed generally consistent patterns. Glycolipid metabolic abnormalities partially mediated the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence, with mediation proportions of 8.33%, 9.45%, and 9.04%, respectively. ConclusionGlycolipid metabolic abnormalities are associated with an increased risk of incident colorectal cancer. The glycolipid abnormality index shows an increasing relationship with colorectal cancer risk and demonstrates better discrimination, and it partially mediates the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence in the overall population.

OBJECTIVE: To evaluate the effectiveness of free medial femoral condyle (MFC) functional chimeric perforator flap (FCPF) transplantation in reconstructing joint function by repairing concomitant osteochondral defects and soft tissue defect in hand and foot joints. METHODS: A retrospective analysis was performed on 6 patients (5 males, 1 female; mean age of 33.4 years, range 21-56 years) with traumatic osteochondral joint defects and associated tendon, nerve, and soft tissue defects treated between January 2019 and November 2024. Defect locations included metacarpal heads (n=2), metacarpophalangeal joint (n=1), first metatarsal head (n=1), base of first proximal phalanx (n=1), and talar head (n=1), with soft tissue defects in all cases. Osteochondral defect sizes ranged from 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm, and skin defects ranged from 4 cm×3 cm to 13 cm×4 cm. The stage Ⅰ treatment included debridement, antibiotic-loaded bone cement filling of bone-cartilage defects, fracture internal fixation, and coverage with vacuum sealing drainage. Stage Ⅱ involved harvesting a free MFC- FCPF included an osteochondral flap (range of 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm), gracilis and/or semitendinosus tendon grafts (length of 4-13 cm), saphenous nerve graft (length of 3.5-4.0 cm), and a perforator skin flap (range of 6 cm×4 cm to 14 cm×6 cm), each with independent vascular supply. The flap was transplanted to reconstruct joint function. Donor sites were closed primarily or with skin grafting. Flap survival was monitored postoperatively. Radiographic assessment was used to evaluate bone/joint healing. At last follow-up, the joint function recovery was assessed. RESULTS: All 6 MFC-FCPF survived completely, with primary healing of wounds and donor sites. All patients were followed up 6-44 months (mean, 23.5 months). The flaps at metacarpophalangeal joint in 1 case and at ankle joint in 1 case were treated with degreasing repair because of their bulky appearance, while the other flaps had good appearance and texture. At 3 months after operation, the visual analogue scale (VAS) score for pain during joint movement of recipient site was 0-2, with an average of 0.7; at last follow-up, the VAS score of the donor site was 0-1, with an average of 0.3. According to the Paley fracture healing scoring system, the osteochondral healing of all the 6 patients was excellent. The range of motion of the metacarpophalangeal joint in 3 cases was 75%, 90%, and 100% of contralateral side respectively, the range of motion of the metatarsophalangeal joint in 2 cases was 65% and 95% of contralateral side respectively, and the range of motion of the ankle joint in 1 case was 90% of contralateral side. The hand function was evaluated as excellent in 2 cases and good in 1 case according to the upper limb function evaluation standard of the Chinese Medical Association Hand Surgery Society, and the foot function was evaluated as excellent in 2 cases and fair in 1 case according to the Maryland foot function score of 93, 91, and 69, respectively. The International Knee Documentation Committee (IKDC) score of 6 knees was 91-99, with an average of 95.2. CONCLUSION The free MFC-FCPF enables precise anatomical joint reconstruction with three-dimensional restoration of tendon, nerve, capsule, and soft tissue defects, effectively restoring joint function and improving quality of life.
Humans ; Male ; Adult ; Female ; Middle Aged ; Retrospective Studies ; Plastic Surgery Procedures/methods* ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Femur/surgery* ; Young Adult ; Foot Joints/injuries* ; Treatment Outcome

Abstract To investigate the effects of exercise on gut microbiota(GM) among children with autism spectrum disorder(ASD)，the review provides an in depth summary of the three core biological pathways through which exercise modulates the GM: repairing the integrity of the intestinal barrier to inhibit lipopolysaccharide mediated neuroinflammation; optimizing key metabolites, such as short chain fatty acids, to reshape gut-brain communication; synergistically regulating the tryptophan-kynurenine metabolic pathway and vagus nerve signaling to balance neurotransmitters. These interconnected pathways not only alleviate gastrointestinal discomfort but also provide a solid biological foundation for improving the core behavioral symptoms of ASD, such as social deficits and repetitive behaviors. Future research should focus on establishing standardized exercise intervention protocols, validating the efficacy of these key biological pathways using multi omics approaches, and exploring combined intervention strategies. The results of corollary studies will provide a more robust scientific basis for precision rehabilitation of children with ASD.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective: To analyze the prevalence trends and associated factors of overweight and obesity among children and adolescents in Macao from 2005 to 2020, so as to provide evidence for developing health promotion strategies. Methods: Data were obtained from the Macao Citizen Physical Fitness Monitoring Database for the years 2005, 2010, 2015, and 2020 for participants aged 6-22 years. The χ 2 test was employed to analyze trends in detection rates, while univariate and multivariate Logistic regression analyses were conducted to identify influencing factors. Results: The overweight rate among Macaos children and adolescents increased from 10.4% in 2005 to 14.8% in 2020. The obesity rate rose from 6.8% to 12.1%, with the total detection rate increasing from 17.2% to 26.9%, and the differences were statistically significant ( χ 2 trend =46.7, 87.5, 145.9, P <0.01). Notably, the overweight/obesity rate among boys showed rapid growth ( χ 2 trend = 118.6, P <0.01), while girls exhibited a declining inflection point in 2020. Multivariate Logistic regression analysis revealed that children and adolescents with the following characteristics faced higher risks of overweight/obesity: a physical education performance score of 3 points (overweight: OR=2.34, 95%CI =1.10-4.96; obesity: OR=2.39, 95%CI =1.19-4.81), paternal obesity (overweight: OR=2.07, 95%CI =1.38-3.11; obesity: OR=1.51, 95%CI = 1.01-2.27), and maternal obesity (overweight: OR=1.69, 95%CI =1.08-2.63; obesity: OR=1.77, 95%CI =1.16- 2.71 ) ( P <0.05). Conversely, lower risks were observed in those who performed appropriate warm-up activities before exercise (obesity: OR=0.37, 95%CI =0.15-0.95), participated in two academic/non-sports extracurricular classes (obesity: OR=0.46, 95%CI =0.24-0.88), and reported moderate physical exertion during extracurricular exercise (obesity: OR=0.60, 95%CI =0.36-0.98) ( P <0.05) . Conclusions Overweight and obesity among Macao s children and adolescents remain severe, particularly among boys, while girls show early signs of improvement. It is recommended to establish a multi-sectoral collaborative prevention and control system to reduce childhood and adolescent obesity.

This review summarizes the applications and advancements of artificial intelligence(AI)in the analysis of retinal vascular parameters. Retinal vascular parameters, including vessel diameter, fractal dimension, vascular tortuosity, branching angles, and vessel density, are important indicators for assessing changes in the retinal vascular network structure. These parameters are not only related to various ophthalmic diseases but also reflect the conditions of systemic diseases such as diabetes and Alzheimer's disease. This article provides a detailed discussion on the advantages of AI technology in the automated identification and quantification of retinal vascular parameters, particularly in improving measurement efficiency and accuracy, and enabling the early detection and monitoring of various diseases. Additionally, the challenges faced by AI in the analysis of retinal vascular parameters were discussed, such as data standardization and insufficient sample diversity, and proposes directions for future research. By thoroughly analyzing the application of AI in retinal vascular parameter analysis, this article aims to offer new perspectives and methods for clinical diagnosis and early intervention of diseases, holding significant clinical significance and application prospects.

BACKGROUND: To evaluate the efficacy and safety of the first cohort of people in China treated with a responsive neurostimulation system (Epilcure TM , GenLight MedTech, Hangzhou, China) for focal drug-resistant epilepsy in this study. METHODS: This multicenter, before-and-after self-controlled study was conducted across 8 centers from March 2022 to June 2023, involving patients with drug-resistant epilepsy who were undergoing responsive neurostimulation (RNS). The study was based on an ongoing multi-center, single-blind, randomized controlled study. Efficacy was assessed through metrics including median seizure count, seizure frequency reduction (SFR), and response rate. Multivariable linear regression analysis was conducted to explore the relationships of basic clinical factors and intracranial electrophysiological characteristics with SFR. The postoperative quality of life, cognitive function, depression, and anxiety were evaluated as well. RESULTS: The follow-up period for the 19 participants was 10.7 ± 3.4 months. Seizure counts decreased significantly 6 months after device activation, with median SFR of 48% at the 6th month (M6) and 58% at M12 ( P  <0.05). The average response rate after 13 months of treatment was 42%, with 21% ( n  = 4) of the participants achieving seizure freedom. Patients who have previously undergone resective surgery appear to achieve better therapeutic outcomes at M11, M12 and M13 ( β  <0, P  <0.05). No statistically significant differences were observed in patients' scores of quality of life, cognition, depression and anxiety following stimulation when compared to baseline measurements. No serious adverse events related to the devices were observed. CONCLUSIONS: The preliminary findings suggest that Epilcure TM exhibits promising therapeutic potential in reducing the frequency of epileptic seizures. However, to further validate its efficacy, larger-scale randomized controlled trials are required. REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR2200055247).
Humans ; Female ; Male ; Drug Resistant Epilepsy/therapy* ; Adult ; Young Adult ; Middle Aged ; China ; Adolescent ; Treatment Outcome ; Quality of Life ; Single-Blind Method ; Seizures ; Electric Stimulation Therapy/methods*

Background and purpose:Accurately locating pulmonary nodules is the key to the success of thoracoscopic surgery.This study aimed to investigate the strategy and evaluate the feasibility,safety,and clinical value of thoracoscopic surgical treatment for pulmonary nodules located beneath the interlobar pleura and close to the pulmonary hilum.Methods:The patients who underwent pulmonary nodule surgery at Liaocheng Tumor Hospital from May 2023 to November 2024 were enrolled,and the patients who did not meet the inclusion criteria were excluded.This study was approved by the Ethics Committee of Liaocheng Tumor Hospital(EC-20240112-1020)and informed consent was obtained from the patients.The research was designed as a prospective single-arm study.The patients were treated with wedge resection,which was performed following CT-guided localization,where the location needle was inserted through the interlobar pleura.The feasibility of the procedure was evaluated by analyzing the success rate of preoperative localization and perioperative complications.Results:A total of 28 patients who met the inclusion criteria were included in this study.There were 5 male and 23 female patients with an average age of(56.0±8.5)years(range 38-69 years).In all,28 patients with 28 nodules underwent thoracoscopic wedge resection,and the preoperative CT-guided localization was successfully performed in all patients,without urgent complications.The mean operation time of thoracoscopic surgery was(15.6±4.0)min,intraoperative bleeding was(20.9±14.3)mL,and postoperative drainage was(214.3±62.2)mL.No cases of postoperative air leaks or conversion to thoracotomy were observed.The average length of hospital stay was(5.4±0.9)days.The postoperative histological diagnosis revealed 3 benign lesions(pulmonary fibrosis in 2 cases,atypical adenomatous hyperplasia in 1 case)and 25 malignant lesions(adenocarcinoma in situ in 5 cases,minimally invasive adenocarcinoma in 16 cases,and invasive adenocarcinoma in 4 cases).Conclusion:Thoracoscopic wedge resection following CT-guided nodule localization through the interlobar pleura is a feasible approach for nodules located beneath the interlobar pleura and close to the pulmonary hilum.The method ensures precise tumor localization,adequate margin,and minimal loss of normal lung tissue,with a low incidence of postoperative complication,which has important guiding significance for the surgical treatment of pulmonary nodules in such special locations.

Objective:To investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

OBJECTIVE To investigate the regulatory effects of salvianolic acid C(SAC)on the level of cuproptosis and inflammatory injury in cardiomyocytes after myocardial infarction(MI).METHODS①C57BL/6 mice were divided into a sham group,an MI model group,and SAC(5,10 and 20 mg·kg-1)groups,with 10 mice in each group.Mice in the SAC groups were pretreated with oral gavage of SAC for 1 week,while those in the sham and model groups received an equal volume of saline.One week later,an MI model was established in the model and SAC groups by ligating the left anterior descending coronary artery,while the sham group underwent thoracotomy without ligation.MI size was assessed using triphenyltetrazolium chloride(TTC)staining.Cardiomyocyte apoptosis was evaluated by TUNEL staining.The ultrastructure of cardiomyocyte mitochondria was observed under a transmission electron microscope.② Mouse cardiomyocytes HL-1 were divided into a control group,an oxygen-glucose deprivation(OGD)model group,OGD+SAC 1,5 and 10 μmol·L-1 groups,and a OGD+SAC(5 μmol·L-1)+nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385(2 μmol·L-1)group.Cells in the OGD+SAC groups were pretreated with SAC for 24 h while those in the OGD+SAC+ML385 group were pretreated with both SAC 5 μmol·L-1 and ML385 2 μmol·L-1 for 24 h.Except for the control group,an OGD model was established in HL-1 cells.ELISA was used to detect the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-1β in mouse serum and HL-1 cell culture supernatants.The Cu+detection kit was used to measure Cu+levels in myocardial tissue and HL-1 cells.Cell viability was assessed using the CCK-8 kit.Apoptosis rates of HL-1 cells were detected by flow cytometry.Reactive oxygen species(ROS)levels in HL-1 cells were measured using a ROS detection kit.Western blotting analysis was performed to detect the expression levels of Nrf2,heme oxygenase-1(HO-1),and cupro-ptosis markers,ferredoxin 1(FDX1)and solute carrier family 31 member 1(SLC31A1)in myocardial tissue and HL-1 cells.RESLUTS ① Compared with the sham group,the MI model group exhibited increased myocardial infarction size,elevated cardiomyocyte apoptosis rates,mitochondrial swelling,vacuolation,and cristae rupture in cardiomyocytes,increased serum levels of TNF-α,IL-6,and IL-1β,elevated Cu+levels and expressions of FDX1 and SLC31A1 in myocardial tissue,and decreased expressions of Nrf2 and HO-1(P<0.01).Compared with the model group,the SAC 5,10 and 20 mg·kg-1 groups showed reduced MI size,decreased cardiomyocyte apoptosis rates,alleviated mitochondrial swelling,vacuola-tion,and cristae rupture,lower serum levels of TNF-α,IL-6 and IL-1β,decreased Cu+levels and expres-sions of FDX1 and SLC31A1 in myocardial tissue,and increased expressions of Nrf2 and HO-1(P<0.05,P<0.01).② Compared with the cell control group,the OGD model group demonstrated signifi-cantly decreased HL-1 cell viability,increased cell apoptosis rates,Cu+and ROS levels,expressions of FDX1 and SLC31A1,elevated levels of TNF-α,IL-6 and IL-1β in cell culture supernatants,and decreased expressions of Nrf2 and HO-1(P<0.01).Compared with the OGD model group,the SAC 1,5 and 10 μmol·L-1 groups showed increased HL-1 cell viability,decreased cell apoptosis rates,Cu+and ROS levels,expressions of FDX1 and SLC31A1,reduced levels of TNF-α,IL-6 and IL-1β in cell culture supernatants,and increased expressions of Nrf2 and HO-1(P<0.05,P<0.01).Compared with the SAC 5 μmol·L-1 group,the SAC 5 μmol·L-1+ML385 2 μmol·L-1 group exhibited decreased cell viability,increased cell apoptosis rates,Cu+and ROS levels,expressions of FDX1 and SLC31A1,elevated levels of TNF-α,IL-6,and IL-1β in cell culture supernatants,and decreased expressions of Nrf2 and HO-1(P<0.01).CONSLUSION SAC can activate the Nrf2/HO-1 signaling pathway,alleviate cuproptosis in cardiomyocytes after MI,and reduces inflammatory damage.