ObjectiveTo compare the clinical features of patients with hepatitis B virus （HBV）-related early-onset liver cancer and those with late-onset liver cancer， to assess the severity of the disease， and to provide a theoretical basis for the early diagnosis and treatment of liver cancer. MethodsA retrospective analysis was performed for 695 patients who were diagnosed with HBV-related liver cancer for the first time in Guangzhou Eighth People’s Hospital， Guangzhou Medical University， from January 2019 to August 2023， among whom 93 had early-onset liver cancer （defined as an age of50 years for female patients and40 years for male patients） and 602 had late-onset liver cancer （defined as an age of ≥50 years for female patients and ≥40 years for male patients）. Related clinical data were collected， including demographic data， clinical symptoms at initial diagnosis， comorbidities， smoking history， drinking history， family history， routine blood test results， biochemical parameters of liver function， serum alpha-fetoprotein（AFP）， virological indicators， coagulation function， and imaging findings. The pan-inflammatory indices neutrophil-to-lymphocyte ratio （NLR）， platelet-to-lymphocyte ratio （PLR）， and lymphocyte-to-monocyte ratio （LMR） were calculated， as well as FIB-4 index， aspartate aminotransferase-to-platelet ratio index （APRI）， S index， Model for End-Stage Liver Disease （MELD） score， Child-Turcotte-Pugh （CTP） score， albumin-bilirubin （AIBL） grade， and Barcelona Clinic Liver Cancer （BCLC） stage. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or Fisher’s exact test were used for comparison of categorical data between two groups. ResultsThere were significant differences between the two groups in the proportion of male patients and the incidence rates of diabetes， hypertension， and fatty liver disease （χ²=6.357， 15.230， 11.467， and 14.204， all P0.05）， and compared with the late-onset liver cancer group， the early-onset liver cancer group had a significantly higher proportion of patients progressing to liver cancer without underlying cirrhosis （χ²=24.657， P0.001） and a significantly higher proportion of patients with advanced BCLC stage （χ²=6.172， P=0.046）. For the overall population， the most common clinical symptoms included abdominal distension， abdominal pain， poor appetite， weakness， a reduction in body weight， edema of both lower limbs， jaundice， yellow urine， and nausea， and 55 patients （7.9%） had no obvious symptoms at the time of diagnosis and were found to have liver cancer by routine reexamination， physical examination suggesting an increase in AFP， or radiological examination indicating hepatic space-occupying lesion； compared with the late-onset liver cancer group， the patients in the early-onset liver cancer group were more likely to have the symptoms of abdominal distension， abdominal pain， and jaundice （all P0.05）. Compared with the late-onset liver cancer group， the early-onset liver cancer group had a significantly larger tumor diameter （Z=2.845， P=0.034）， with higher prevalence rates of multiple tumors and intrahepatic， perihepatic， or distant metastasis （χ²=5.889 and 4.079， both P0.05）， and there were significant differences between the two groups in tumor location and size （χ²=3.948 and 11.317， both P0.05）. Compared with the late-onset liver cancer group， the early-onset liver cancer group had significantly lower FIB-4 index， proportion of patients with HBsAg ≤1 500 IU/mL， and levels of LMR and Cr （all P0.05）， as well as significantly higher positive rate of HBeAg and levels of log₁₀ HBV DNA， AFP， WBC， Hb， PLT， NLR， PLR， TBil， ALT， Alb， and TC （all P0.05）. ConclusionCompared with late-onset liver cancer， patients with early-onset liver cancer tend to develop liver cancer without liver cirrhosis and have multiple tumors， obvious clinical symptoms， and advanced BCLC stage， which indicates a poor prognosis.

Steroid-induced osteonecrosis of the femoral head （SONFH） is a severe musculoskeletal disorder often induced by the prolonged or excessive use of glucocorticoids. Characterized by ischemia of bone cells， necrosis， and trabecular fractures， SONFH is accompanied by pain， femoral head collapse， and joint dysfunction， which can lead to disability in severe cases. The pathogenesis of SONFH involves hormone-induced osteoblast apoptosis， bone microvascular endothelial cell （BMEC） apoptosis， oxidative stress， and inflammatory responses. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway plays a pivotal role in the development of the disease. Modulating the PI3K/Akt signaling pathway can promote Akt phosphorylation， thereby stimulating the osteogenic differentiation of bone marrow mesenchymal stem cells and osteoblasts， promoting angiogenesis in BMECs， and inhibiting osteoclastogenesis. The research on the treatment of SONFH with traditional Chinese medicine （TCM） has gained increasing attention. Recent studies have shown that TCM monomers and compounds have potential therapeutic effect on SONFH by intervening in the PI3K/Akt signaling pathway. These studies not only provide a scientific basis for the application of TCM in the treatment of SONFH but also offer new ideas for the development of new therapeutic strategies. This review summarized the progress in Chinese and international research on the PI3K/Akt signaling pathway in SONFH over the past five years. It involved the composition and transmission mechanisms of the signaling pathway， as well as its regulatory effects on osteoblasts， mesenchymal stem cells， osteoclasts， BMECs， and other cells. Additionally， the review explored the TCM understanding of SONFH and the application of TCM monomers and compounds in the intervention of the PI3K/Akt pathway. By systematically analyzing and organizing these research findings， this article aimed to provide references and point out directions for the clinical prevention and treatment of SONFH and promote further development of TCM in this field. With in-depth research on the PI3K/Akt pathway and the modern application of TCM， it is expected to bring safer and more effective treatment options for patients with SONFH.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:The distribution characteristics of intrathecal drugs and the limitation of current catheterization techniques make traditional intrathecal analgesic treatment nearly useless for refractory craniofacial pain,such as trigemina neuralgia.This technical guideline aims to promote the widespread and standardize the application of intra-prepontine cisternal drug delivery via spinal puncture and catheterization. Methods:A modified Delphi approach was used to work for this guideline.On the issues related to the intra-prepontine cisternal targeted drug delivery technique,the working group consulted 10 experts from the field with 3 rounds of email feedback and 3 rounds of conference discussion. Results:For the efficacy and safety of the intra-prepontine cisternal targeted drug delivery technique,a consensus was formed on 7 topics(with an agreement rate of more than 80%),including the principles of the technique,indications and contraindications,patient preparation,surgical specifications for intra-prepontine cisternal catheter placement,analgesic dosage coordination,analgesic management,and prevention and treatment of complications. Conclusion:Utilizing the intra-prepontine cisternal drug infusion system to manage refractory craniofacial pain could provide advantages in terms of minimally invasive,secure,and effective treatment.This application can not only alleviate the suffering of individuals experiencing the prolonged pain but also support the maintenance of quality of life and dignity in their final moments,justifiing its widespread dissemination and standardized adoption in domestic and international professional fields.

Objective To explore the potential categories of self-efficacy in patients with rheumatoid arthritis(RA),analyze their influencing factors,and provide references for the development of personalized care measures.Methods Patients with RA who visited the rheumatology and immunology outpatient department of a tertiary hospital in Changzhou from March 2022 to March 2023 were selected.A general information questionnaire,the Chinese version of the Rheumatoid Arthritis Self-Efficacy Scale(C-RASE),and Compliance Questionnaire Rheumatology(CQR)were used to investigate RA patients.Latent class analysis was used to classify self-efficacy,and logistic regression analysis was conducted to explore the influencing factors of self-efficacy.Results A total of 219 subjects were included in the survey.The score of C-RASE was(100.68±12.64).The self-efficacy of RA patients was divided into a high efficacy-low support group(105.18±10.18),a moderate efficacy-diverse needs group(93.21±4.16),and a low efficacy-high fatigue group(84.07±13.96).Logistic regression analysis showed that disease duration(OR=1.062,P=0.024),education(OR=5.405,P=0.036;OR=12.347,P=0.021),and erythrocyte sedimentation rate(OR=1.019,P=0.020;OR=1.019,P=0.027)were factors affecting patients'self-efficacy.The treatment compliance scores of the 3 latent class categories(F=10.902,P＜0.001)and the rate of good treatment compliance(x2=16.053,P＜0.001)were statistically significant.Conclusion RA patients exhibit significant heterogeneity in their self-efficacy levels,and there are variations in treatment adherence among patients in different self-efficacy categories.Nurses should prioritize the attention towards the population groups with moderate efficacy-diverse needs,as well as the groups with low efficacy-high fatigue,implementing cognitive behavioral interventions to assist them in setting clear goals and providing specific plans and guidance to improve their health outcomes.

Objective:To investigate the effects of Apelin-13 regulatory peptide on neuronal cell pyroptosis in mice modeled with cerebral ischemia-reperfusion(I/R).Methods:We prepared a mouse cerebral I/R model using middle cerebral artery embolization and Reperfusion(MCAO/R).The HT22 cell injury model was prepared by the oxygen glu-cose deprivation/reoxygenation(OGD/R),and Apelin-13 treatment was also given.Neurological function was assessed by neurological deficit score;hematoxylin-eosin(HE)staining and Nissl staining were used to observe the morphologic changes of the infarcted area of the mice;and 2,3,5triphenyltetrazolium chloride(TTC)staining was used to observe the volume of cerebral infarcts;The expression of NOD-like receptor thermoprotein structural domain-related protein 3(NLRP3),gasdermin D(GSDMD),caspase-1,apoptosis-associated speck-like protein(ASC),interleukin 1β(IL-1β),and interleukin 18(IL-18)in brain tissues from infarcted areas or HT22 cells was detected by Western Blot,and IL-1β and IL-18 were detected by enzyme-linked immunosorbent assay(ELISA)in serum of mice and culture supema-tants;The cell viability and cell damage of HT22 were detected by CCK-8 kit and lactate dehydrogenase(LDH)assay kit,respectively;caspase-1 activity was measured by caspase-1 activity kit in HT22 cells;and the expression of caspase-1 and GSDMD was observed by immunofluorescence staining in HT22 cells.Results:Apelin-13 significantly improved neurological function and cerebral infarct volume in I/R mice,and attenuated pathological damage in the in-farcted area.It also reduced the serum levels of IL-1β and IL-18.In addition,Apelin-13 reduced the expression of mol-ecules such as NLRP3,GSDMD,caspase-1,IL-1β,and IL-18 in the cerebral infarct area of mice.In vitro experiments showed that Apelin-13 significantly increased the viability of OGD/R-treated HT22 cells,decreased caspase-1 activity,and reduced the LDH content,as well as decreased the expression of molecules such as NLRP3,GSDMD,caspase-1,IL-1β,IL-18,and so on,in OGD/R-treated HT22 cells.Conclusion:Apelin-13 inhibits pyroptosis through the NL-RP3/caspase-1/GSDMD pathway in cerebral ischemia/reperfusion mice and thus exerts neuroprotective effects.

Accurate and efficient upper limb movement control is a critical guarantee for astronauts to complete their daily tasks in space.Exploring the laws and mechanisms of the influence of microgravity and nonspecific stressors(isolation,noise,fatigue,etc.)in spaceflight on astronauts'upper limb movement control is an important direction of spaceflight human factors engineering research.This article summarizes the research paradigms and findings of in-orbit upper limb movement control research,revealing patterns such as slowed movements and decreased motor control performance under high cognitive load in spaceflight.It also points out the potential mechanisms underlying the inconsistent research results under various research paradigms.On this basis,the paper addresses existing controversies and shortcomings in previous studies,and puts forward prospects and suggestions for subsequent in-orbit movement control research.

Objective:To investigate whether Lycium barbarum polysaccharides(LBP)can inhibit ferroptosis through the solute carrier family 7 member 11(SLC7A11)/glutathione peroxidase 4(GPX4)pathway and thus alleviate cerebral ischemia-reperfusion(I/R)injury.Methods:The mouse model of cerebral I/R injury was established by mid-dle cerebral artery occlusion(MCAO)and treated with Lycium barbarum polysaccharides(LBP).The mice were ran-domly divided into three groups:sham group,I/R group,and I/R+LBP group.2,3,5triphenyltetrazolium chloride(TTC)staining was used to observe the volume of cerebral infarcts;Neurological function was assessed by neurological deficit score;The superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA),and Fe2+detection kit to detect the changing levels of SOD,GSH,MDA,and Fe2+;Western Blot detects the expression of ferroptosis-related keys GPX4,SLC7A11,and Nrf2.Results:LBP can reduce the cerebral infarction volume and improve the neurological function.LBP increases the content of SOD and GSH and reduces the content of MDA in I/R injured mice.Western Blot results show that the expression levels of ferroptosis-related proteins GPX4,SLC7A11,and Nrf2 in the brain tissue of the I/R group were significantly lower than those of the Sham group.After LBP treatment,the levels of GPX4,SLC7A11,and Nrf2 in the LBP+I/R group were significantly higher than those of the I/R group.Conclusion:LBP at-tenuates cerebral I/R injury by inhibiting ferroptosis through the SLC7A11/GPX4 pathway.LBP has a neuroprotective effect on cerebral I/R injury and is a potential neuroprotective agent.

Objective:To investigate whether Lycium barbarum polysaccharides(LBP)can inhibit ferroptosis through the solute carrier family 7 member 11(SLC7A11)/glutathione peroxidase 4(GPX4)pathway and thus alleviate cerebral ischemia-reperfusion(I/R)injury.Methods:The mouse model of cerebral I/R injury was established by mid-dle cerebral artery occlusion(MCAO)and treated with Lycium barbarum polysaccharides(LBP).The mice were ran-domly divided into three groups:sham group,I/R group,and I/R+LBP group.2,3,5triphenyltetrazolium chloride(TTC)staining was used to observe the volume of cerebral infarcts;Neurological function was assessed by neurological deficit score;The superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA),and Fe2+detection kit to detect the changing levels of SOD,GSH,MDA,and Fe2+;Western Blot detects the expression of ferroptosis-related keys GPX4,SLC7A11,and Nrf2.Results:LBP can reduce the cerebral infarction volume and improve the neurological function.LBP increases the content of SOD and GSH and reduces the content of MDA in I/R injured mice.Western Blot results show that the expression levels of ferroptosis-related proteins GPX4,SLC7A11,and Nrf2 in the brain tissue of the I/R group were significantly lower than those of the Sham group.After LBP treatment,the levels of GPX4,SLC7A11,and Nrf2 in the LBP+I/R group were significantly higher than those of the I/R group.Conclusion:LBP at-tenuates cerebral I/R injury by inhibiting ferroptosis through the SLC7A11/GPX4 pathway.LBP has a neuroprotective effect on cerebral I/R injury and is a potential neuroprotective agent.