Objective To explore the visiting behavior and health management strategy of patients with cardiovascular disease (CVD) and the industry management strategies under the family doctor contract service model. Methods A total of 351 patients with CVD from January 2022 to January 2025 were included in the case investigation by random sampling. Taking the number of visits in community health service institutions/total number of visits ≥90% as high compliance, the influencing factors of the visiting behavior of CVD patients were analyzed. Results Finally, 344 valid questionnaires were collected, with an effective recovery rate of 98.01%. The study subjects were categorized into high compliance group (271 cases) and low compliance group (73 cases). The scores of policy cognition understanding, institutional trust and medical service understanding in the high compliance group were higher compared with those in the low compliance group (P<0.05). There was no significant difference in the understanding of medical expenses between the two groups (P>0.05). Multivariate logistic regression model analysis revealed that CVD duration [OR (95% CI): 1.72 (1.21-2.44)], policy cognition understanding [OR (95% CI): 2.16 (1.20-3.89)] and institutional trust [OR (95% CI): 1.88 (1.08-3.25)] were independently associated with medical treatment behavior in CVD patients (P<0.05). Conclusion Enhancing the policy cognition understanding and institutional trust of CVD patients on family doctor contract service can promote patients to seek medical treatment and promote the high-quality development of family doctor contract service.

Objective:Papillary thyroid carcinoma with a maximum tumor diameter of ≤1 cm was defined as papillary thyroid carcinoma (PTC). To explore the clinical risk factors of central lymph node metastasis (CLNM) in PTC at different locations.Methods:The clinical and pathological data of 1383 cases with solitary PTC in Hangzhou First People’s Hospital were retrospectively analyzed, and they were divided into isthmus group (175 cases), near-isthmus group (95 cases) and lateral lobe group (1113 cases) according to their tumor location. Univariate and multivariate analyses were used to analyze the relationship between gender, age, tumor maximum diameter, Hashimoto’s thyroiditis (HT) and CLNM, and the threshold for the occurrence of CLNM in each group of age and tumor maximum diameter was determined by the area under the receiver operating characteristic (ROC) .Results:The proportion of CLNM in the isthmus group, near-isthmus group and the lateral lobe group were 39.4% (69/175), 35.8% (34/95) and 29.6% (329/1113), respectively ( χ2=7.84, P=0.020). The intra-group comparison showed that there were statistical differences between the isthmus group and the lateral lobe group ( χ2=6.90, P=0.011), and there were no statistical differences between the isthmus group and near-isthmus group ( χ2=0.35, P=0.601), and near-isthmus group and the lateral leaf group ( χ2=1.62, P=0.313). Univariate and multivariate analysis showed that male ( OR: 3.697) and age < 38.5 years ( OR: 4.727) were independent risk factors for CLNM in PTC in the Isthmus Group, while male ( OR: 2.193), without HT ( OR: 1.702), tumor maximum diameter > 6.5 mm ( OR: 2.535) and age < 45.5 years ( OR: 3.030) were independent risk factors for CLNM in PTC in the lateral lobe group. Conclusions:Male sex and age are independent risk factors for CLNM in isthmus and lateral lobe PTC, and uncomplicated HT and tumor maximum diameter are also independent risk factors for CLNM in lateral lobe PTC. The incidence of CLNM in PTC in the isthmus, near-isthmus and lateral lobes decreased sequentially, and PTC in the near isthmus can not be simply regarded as the isthmus or lateral lobe PTC, and the lymph nodes in the central area should be fully evaluated before surgery to provide individualized treatment.

Objective:Papillary thyroid carcinoma with a maximum tumor diameter of ≤1 cm was defined as papillary thyroid carcinoma (PTC). To explore the clinical risk factors of central lymph node metastasis (CLNM) in PTC at different locations.Methods:The clinical and pathological data of 1383 cases with solitary PTC in Hangzhou First People’s Hospital were retrospectively analyzed, and they were divided into isthmus group (175 cases), near-isthmus group (95 cases) and lateral lobe group (1113 cases) according to their tumor location. Univariate and multivariate analyses were used to analyze the relationship between gender, age, tumor maximum diameter, Hashimoto’s thyroiditis (HT) and CLNM, and the threshold for the occurrence of CLNM in each group of age and tumor maximum diameter was determined by the area under the receiver operating characteristic (ROC) .Results:The proportion of CLNM in the isthmus group, near-isthmus group and the lateral lobe group were 39.4% (69/175), 35.8% (34/95) and 29.6% (329/1113), respectively ( χ2=7.84, P=0.020). The intra-group comparison showed that there were statistical differences between the isthmus group and the lateral lobe group ( χ2=6.90, P=0.011), and there were no statistical differences between the isthmus group and near-isthmus group ( χ2=0.35, P=0.601), and near-isthmus group and the lateral leaf group ( χ2=1.62, P=0.313). Univariate and multivariate analysis showed that male ( OR: 3.697) and age < 38.5 years ( OR: 4.727) were independent risk factors for CLNM in PTC in the Isthmus Group, while male ( OR: 2.193), without HT ( OR: 1.702), tumor maximum diameter > 6.5 mm ( OR: 2.535) and age < 45.5 years ( OR: 3.030) were independent risk factors for CLNM in PTC in the lateral lobe group. Conclusions:Male sex and age are independent risk factors for CLNM in isthmus and lateral lobe PTC, and uncomplicated HT and tumor maximum diameter are also independent risk factors for CLNM in lateral lobe PTC. The incidence of CLNM in PTC in the isthmus, near-isthmus and lateral lobes decreased sequentially, and PTC in the near isthmus can not be simply regarded as the isthmus or lateral lobe PTC, and the lymph nodes in the central area should be fully evaluated before surgery to provide individualized treatment.

In recent years, mesenchymal stem cell-derived exosomes (MSC-EXO) have garnered increasing attention in the field of stomatology and have become an established research area in biomedical research. This article reviews the engineering of exosomes derived from mesenchymal stem cells and their application in the field of stomatology, in order to provide new ideas for the development of stomatology. Exosomes are nanoscale membrane vesicles secreted by cells and contain a variety of proteins, RNAs, lipids, and other biomolecules. They are transported through the circulatory system and can interact with other cells to regulate their biological behavior and participate in a variety of physiological and pathological processes. In the treatment of oral diseases, exosomes have shown great potential due to their natural biological activity and versatility. However, studies have found that relying solely on the function of natural exosomes may not fully meet the complex clinical requirements. Therefore, the concept of engineered exosomes has emerged. Engineered exosomes can be modified by bioengineering technology to enhance their targeting, allowing them to reach the lesion site more accurately. At the same time, engineered exosomes can also be surface modified or loaded internally to carry specific therapeutic molecules, such as drugs, gene editing tools or signaling molecules to improve the therapeutic effect. In addition, this engineered treatment can also confer greater stability to exosomes, making them better able to resist clearance by the immune system when circulating in the body, extending their half-life, and improving the effectiveness of treatment. Although engineered exosomes have attracted extensive attention in the fields of stomatology and other fields, their application is still mainly in the stage of basic research. To promote the clinical application of engineered exosomes, it is necessary to provide more sufficient evidence of biocompatibility and clarify their therapeutic effect and mechanism.

Objective To discuss the effect of interleukin-17A(IL-17A)and transforming growth factor-β1(TGF-β1)on the benign tracheal stenosis after tracheal injury in experimental dogs.Methods The trachea stenosis model of healthy Beagle dogs was established by burning the middle part of trachea with electric snare under bronchoscopy guidance.A total of 21 dogs were divided into normal group(n=3,receiving normal feeding),molding group(n=12,after airway modeling every 3 dogs were sacrificed each week for 4 weeks),IL-17A suppression group(n=3,receiving Secukinumab after airway modeling),and IL-17A inhibitor+TGF-β1 inhibitor group(n=3,receiving Secukinumab and SB43154 after airway modeling).Bronchoscopy and CT scan were performed once a week,and the stenosis degree was calculated.RT-qPCR,immunohistochemistry,and HE staining of the obtained tracheal tissues were performed.Results Within 1-4 weeks after molding,in module-making dogs the degree of stenosis of the injured trachea gradually increased,and the expressions of ECM-related proteins,TGF-β1 and IL-17A were up-regulated.After treatment with IL-17A inhibitors,the inflammatory infiltration and granulation tissue hyperplasia were reduced and the early tracheal stenosis was improved(P＜0.05).The combination use of IL-17A inhibitor and TGF-β1 inhibitor had a better remission effect(P＜0.05).Conclusion IL-17A and TGF-β1 may synergistically affect the formation of tracheal stenosis.

Objective:To compare the dosimetric differences between a 3D-printed non-coplanar multi-channel applicator and traditional single-channel/co-planar multi-channel applicators in postoperative vaginal brachytherapy for early-stage endometrial cancer.Methods:CT scan data of 66 patients with stage I endometrial cancer, encompassing 100 3D brachytherapy CT imaging datasets, admitted to Department of Gynecologic Oncology of the Fourth Hospital of Hebei Medical University from December 2021 to June 2024 were retrospectively analyzed. Based on CT images and delineated structures, offline reconstructions of radiotherapy plans were performed for single-channel, coplanar multi-channel, and 3D-printed non-coplanar multi-channel applicators. These 3 radiotherapy plans were optimized, and the high-risk clinical target volume (HR-CTV) coverage (V 100 ≥90%) and doses to organs at risk (rectum, bladder) were compared. The prescription dose was standardized at 600 cGy, with constraints of rectal D 2 cm3 ≤420 cGy and bladder D 2 cm3 ≤480 cGy. Comparison among multiple groups was conducted by ANOVA. Bonferroni method was used to correct P-values for comparison between two groups. Results:When defined as HR-CTV D 90%≥600 cGy, bladder D 2 cm3 was (398.29±76.13)cGy and rectum D 2 cm3 was (402.10±49.77)cGy of the 3D-printed non-coplanar multi-channel group,which were significantly lower than those in the single-channel group [bladder D 2 cm3 (424.09±131.52) cGy, rectum D 2 cm3 (493.11±115.17) cGy] and coplanar group [bladder D 2 cm3 (461.28±134.84) cGy, rectum D 2 cm3 (508.75±119.02) cGy], respectively. When limiting bladder D 2 cm3≤480 cGy, rectal D 2 cm3 was (446.81±78.53 cGy) of the 3D-printed non-coplanar multi-channel group, which was significantly lower than those in the single-channel group [(589.71±153.91) cGy] and the coplanar group [(545.51±122.00) cGy], respectively. Meanwhile, HR-CTV V 100% (94.53%±3.42%) was higher than (91.19%±7.63%) in the coplanar group. When the rectal D 2 cm3 was ≤ 420 cGy, HR-CTV V 100% was (91.92%±4.04%) of the 3D-printed non-coplanar multi-channel group,which was significantly better than (79.23%±13.95%) in the single-channel group and (85.88%±6.86%) in the coplanar group, respectively. Conclusions:The 3D-printed non-coplanar multi-channel applicator significantly reduces bladder and rectal doses while enhancing target coverage, outperforming traditional single-channel and co-planar multi-channel applicators. This innovation provides an optimized solution for individualized precision radiotherapy.

Objective: To explore the association of physical activity and sugar sweetened beverage consumption with psychological sub health among middle school students in Bao an District, Shenzhen, so as to provide a reference for adolescent mental health promotion. Methods: A questionnaire survey was conducted in November 2024 by a stratified cluster random sampling method to select 6 926 junior and senior middle school students from 5 middle schools in Shenzhen. The questionnaire from Youth Risk Behavior Surveillance System was used to assess the consumption of sugar sweetened beverages, and physical activity Rating Scale was used to assess the level of physical activity, and Brief Instrument on Psychological Health of Youths was used to evaluate the psychological sub health status. The Chi -square test was used to analyze the differences in the detection rates of psychological sub health among different groups of middle school students, and a multivariate Logistic regression model was established to analyze the effects of physical activity and sugar sweetened beverage consumption and their combined effects on the psychological sub health of middle school students. Results: The detection rate of psychological sub health among middle school students in Bao an District, Shenzhen was 18.93%. Multivariate Logistic regression analysis showed that, after controlling for confounding factors such as gender, school stage, family residence, family economic status, parental literacy, academic stress and number of friends, lack of physical activity or excessive sugar sweetened beverage consumption were associated with increased risks of psychological sub health among middle school students ( OR =1.36, 1.45); and the highest risk of psychological sub health was found in middle school students who were lack of physical activity and excessive sugar sweetened beverage consumption ( OR =2.59) ( P <0.01). Further analysis by school stages showed that junior high school students with sufficient physical activity and excessive intake of sugary drinks ( ROR =2.10), lack of physical activity and excessive intake of sugary drinks ( ROR =2.31) were at higher risks of psychological sub health than senior high school students( P <0.05). Conclusions Insufficient physical activity and excessive sugar sweetened beverage consumption are closely associated with an increased risk of psychological sub health among middle school students. Effective interventions should be targeted to reduce the risk of psychological sub health problems among middle school students.

Objective To explore the effects of combined exposure to bisphenol A (BPA) and high-fat diet on liver lipid metabolism and hepatocyte senescence in mice, and to elucidate the potential mechanisms of the onset and development of non-alcoholic fatty liver disease (NAFLD). Methods Specific pathogen free C57BL/6J mice were randomly divided into six groups, with 10 mice with equal numbers of each sex in each group. The mice in the control group and the simple BPA group were fed with regular diet, while others four groups of mice were fed with high-fat diet. At the same time, the mice in the simple BPA group were intragastric administered with BPA at a dose of 50 μg/kg body weight, while the mice in the low-, medium- and high-dose BPA+high-fat groups were intragastric administered with BPA at doses of 5, 50 and 500 μg/kg body weight respectively. The mice in the control group and the high-fat group were intragastric administered with the same volume of corn oil once per day for 90 consecutive days. Liver tissues were subjected to hematoxylin-eosin (HE) and Oil Red O staining. Liver coefficients and lipid-stained area ratios were calculated. Serum level of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined using an automatic biochemical analyzer. The hepatic tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10 levels were quantified by enzyme-linked immunosorbent assay. The relative expression of cholesterol regulatory element binding protein 1 (SREBP1), CCAAT enhancer binding protein α, P16, and phosphorylated histone H2AX (γ-H2AX) in liver tissues was detected using Western blotting. The interaction effect of the combined exposure to BPA and high-fat diet was observed based on the result of mice in the control group, the simple high-fat group, the simple BPA group, and the medium-dose BPA group+high-fat group (the combined exposure group) using a 2×2 factorial design. The results of mice in the simple high-fat group and the low-, medium-, and high-dose BPA+high-fat groups were used to observe the effect of BPA exposure dose under high-fat diet conditions. Results i) The interactive effect of combined exposure to BPA and high fat. The HE and Oil Red O staining results indicated that the combined exposure to BPA and high-fat diet successfully established NAFLD in mice. The interactive effect of combined exposure to BPA and high-fat diet on serum ALT activity and the relative expression of P16 in the liver tissue of female mice, as well as the serum ALT and AST activities and the relative expression of SREBP1 in the liver tissue of male mice was significant (all P<0.05). Specifically, the serum ALT activity of male mice in the combined exposure group was higher than that in the simple high-fat group (P<0.05), while the ALT activity in the serum of female mice in the combined exposure group was lower than that in the simple BPA group (P<0.05). The relative expression of SREBP1 protein in the liver tissue of male mice in the combined exposure group was higher than that in the control group, the simple high-fat group, and the simple BPA group (all P<0.05). For the other indicators, there were no significant differences in the interactive effect of combined exposure to BPA and high-fat diet (all P>0.05). ii) Dose effects of BPA exposure. The HE and Oil Red O staining result showed that the degree of vacuolar steatosis in the liver of female and male mice of medium- and high-dose BPA + high-fat groups was aggravated, and the range of inflammatory cell infiltration was expanded when compared with same-sex mice in the simple high-fat group. The serum ALT activity and the fat stained area ratio, as well as the relative expression of P16 in liver tissue of female mice in high-dose BPA + high-fat group increased (all P<0.05), while the level of IL-10 in liver tissue decreased (P<0.05), compared with the female mice in simple high-fat group. The serum ALT activity, the TNF-α level in liver tissue, and the relative expression of SREBP1, P16 and γ-H2AX proteins in liver tissue of male mice in high-dose BPA + high-fat group increased (all P<0.05), while the IL-6 level in liver tissue decreased (P<0.05), compared with the male mice in simple high-fat group. For the female or male mice in the low- and medium-dose BPA + high-fat groups, only some of the above indicators showed significant changes (all P<0.05). Conclusion The combined exposure to BPA and high-fat diet has a synergistic effect on the onset and development of NAFLD. The mechanism may be related to inducing cellular senescence and modulation of lipid synthesis pathways, thereby affecting liver steatosis. The exposure dose of BPA may affect the synergistic effect.

ObjectiveTo investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange （LPE） in patients with acute-on-chronic liver failure （ACLF）. MethodsA prospective cohort study was designed， and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients. In addition to comprehensive medical treatment， the patients in the DPMAS+LPE group received DPMAS and LPE treatment， and those in the CA280+LPE group received CA280 and LPE treatment. The two groups were observed in terms of routine blood test results， liver function parameters， renal function markers， electrolytes， coagulation function parameters， cytokines， adverse events， and 28-day prognosis before surgery （baseline）， during surgery （DPMAS or CA280）， and after surgery （after sequential LPE treatment）. The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group， and the independent-samples t test was used for comparison between groups； the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group， and the Mann-Whitney U test was used for comparison between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman test was used for correlation analysis. ResultsAfter CA280 treatment， the ACLF patients had significant reductions in the levels of cytokines （IL-6， IL-8， IL-10， TNF-α， and IFN-γ）， liver function parameters （ALT， AST， ALP， TBil， DBil， Alb， and glutathione reductase）， and the renal function marker urea nitrogen （all P<0.05）， and in terms of coagulation function parameters， there were significant increases in prothrombin time， activated partial thromboplastin time （APTT）， thrombin time， and international normalized ratio （INR） and significant reductions in prothrombin activity （PTA） and fibrinogen （FIB） （all P<0.05）. Compared with the DPMAS+LPE group， the CA280+LPE group showed better improvements in the serum cytokines IL-8 （Z=-2.63， P=0.009）， IL-10 （Z=-3.94， P<0.001）， and TNF-α （Z=-1.53， P=0.023）， and the two artificial liver support systems had a similar effect in improving liver function （ALT， AST， GGT， GR， TBil， and DBil） （all P >0.05）， but the CA280+LPE group showed a significantly greater reduction in Alb （Z=-2.08， P=0.037）. CA280+LPE was more effective in reducing uric acid （Z=-2.97， P=0.003）. Compared with DPMAS+LPE， CA280+LPE treatment resulted in a significant reduction in INR （Z=-4.01， P<0.001）， a significant increase in APTT （Z=-2.53， P=0.011）， and significant greater increases in PTA （Z=-6.28， P<0.001） and FIB （Z=-3.93， P<0.001）. There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups （all P>0.05）. The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC （r=0.22， P=0.042）， TBil （r=0.29， P=0.005）， and FIB （r=-0.33， P=0.003）； IL-8 was positively correlated with APTT （r=0.37， P<0.001） and INR （r=0.25， P=0.013）； TNF-α was significantly correlated with WBC （r=0.40， P<0.001） and TBil （r=0.34， P<0.001）. ConclusionCompared with DPMAS， CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients， but it has a certain impact on Alb and coagulation function. This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients， but further studies are needed to verify its long-term efficacy.

Objective To explore the influencing factors of the failure in trial of labor after cesarean(TOLAC),construct and verify a prediction model for the risk of TOLAC.Methods The clinical data of 273 pregnant women who underwent TOLAC in The First Affiliated Hospital of Naval Medical University from 2019 to 2022 were retrospectively analyzed.Logistic regression was used to analyze influencing factors of the failure in TOLAC,and a nomogram model was established for individualized risk assessment.The best threshold of failure risk of TOLAC was evaluated by the decision-making curve and clinical influence curve.Results There were statistically significant differences in the age,gestational week,body mass index(BMI)before delivery,time to the last cesarean,cervical Bishop score and delivery times between the successful trial delivery group and the failed trial delivery group.The best intervention threshold was 0.72,that is,vaginal trial delivery should to be stopped when the risk of TOLAC failure was more than 72%as evaluated by the prediction model.Conclusion Age,gestational week,BMI before delivery,time to the last cesarean,Bishop score of cervix and delivery times are influencing factors for TOLAC failure.The prediction model based on these factors can provide a quantifiable TOLAC risk for pregnant women.