Objective To explore the related risk factors of osteosarcopenia (OS) in elderly patients with type 2 diabetes mellitus (T2DM) and to evaluate their predictive value. Methods We selected 409 elderly patients with T2DM from our hospital between June 2021 and December 2024 as the study subjects, and divided them into an OS occurrence group and a non-occurrence group based on whether they were diagnosed with OS. Results Among the 409 elderly patients with T2DM included, 93 were diagnosed with OS, yielding a prevalence rate of 22.73%. Spearman correlation analysis revealed a significant association between lumbar spine BMD and T-scores with age, history of previous fractures, fasting plasma glucose (FPG), procollagen type I N-terminal propeptide (PINP), osteocalcin (OC), and 25-hydroxyvitamin D (25(OH)D). Gender (OR=0.193), Body Mass Index (BMI) (OR=0.254), history of previous fractures (OR=8.883), FPG (OR=0.543), Total Cholesterol (TC) (OR=3.684), High-Density Lipoprotein Cholesterol (HDL-C) (OR=86.024), PINP (OR=0.818), and OC (OR=0.526) are identified as influential factors for the occurrence of OS in elderly patients with T2DM. The combined prediction of these variables yields a sensitivity of 96.5%, a specificity of 97.8%, and an area under the curve (AUC) of 0.992 for the occurrence of OS in elderly patients with T2DM, indicating an excellent predictive performance. Conclusion The following factors—gender, BMI, history of previous fractures, FPG, TC, HDL-C, PINP, and OC—are influential in the occurrence of OS among elderly patients with T2DM. Formulating intervention measures based on these influencing factors can provide assistance in preventing and treating the occurrence of OS.

Modern cataract surgery has completely moved beyond the traditional vision-restoring model and has fully entered a new era of refractive cataract surgery(RCS)centered on precise refractive correction. Its core objective is to provide patients with personalized visual experiences characterized by full-range, clear, and comfortable vision. Currently, although diagnostic and therapeutic technologies for RCS are rapidly evolving, there remain many bottlenecks in the precise management of the entire perioperative process that urgently need to be addressed. Preoperatively, the measurement consistency among ocular biometry devices based on different detection principles remains poor, and systematic measurement errors cannot be completely eliminated. Moreover, the individualized selection of intraocular lenses(IOLs)relies heavily on surgeons' clinical experience, lacking a standardized quantitative decision-making framework, which makes it difficult to achieve precise personalized matching. Intraoperatively, the quality of continuous curvilinear capsulorhexis is affected by multiple factors such as ocular anatomical characteristics and surgical proficiency, and its stability cannot be reliably ensured. Various intelligent surgical navigation systems are compromised by intraoperative ocular conditions, and their clinical performance fails to meet theoretical expectations. At the postoperative stage, existing IOL optical designs and materials have inherent limitations. The longterm prevention and control of posterior capsule opacification(PCO)remains a core factor restricting patients' long-term high-quality visual outcomes. This article systematically reviews the precise diagnostic and therapeutic challenges and core bottlenecks across the preoperative, intraoperative, and postoperative stages of RCS. It further explores frontier technological directions—including cross-device error compensation models, artificial intelligence-assisted decision-making, preoperative VR-based visual simulation, and the construction of intelligent surgical ecosystem platforms—to delineate targeted solutions and optimization pathways. This review aims to provide references and insights for the standardized clinical implementation, technological innovation, and future research endeavors in precision diagnosis and treatment of RCS.

Phacoemulsification represents the mainstream, efficient, and safe surgical modality for cataract treatment, and continuous technological advances have further improved the safety profile of this procedure in ordinary patients. However, patients with high myopia feature inherent anatomical abnormalities of the eyeball, leading to a fundamental incompatibility with conventional phacoemulsification protocols. Such patients face a markedly elevated risk of both anterior and posterior segment perioperative complications, posing a persistent clinical challenge in cataract surgery. Focusing on the unique ocular anatomical characteristics associated with high myopia, this review systematically summarizes the distinct traumatic effects and pathological impacts of phacoemulsification on the anterior and posterior ocular segments of affected patients. Moving beyond generalized discussions of routine cataract management, it consolidates clinical evidence specific to this special-population patients, aiming to provide refined references for perioperative risk prevention and control in cataract patients complicated with high myopia.

ObjectiveTo identify the direct target proteins for the anti-obesity effect of resveratrol （Res） via chemical proteomic analysis and systematically explore the molecular mechanisms by which Res inhibits lipid accumulation in adipocytes from mitochondrial function regulation， adipocyte browning， and inflammation inhibition， thus providing new targets and experimental evidence for the prevention and treatment of obesity and related metabolic diseases. MethodsThe cell counting kit-8 （CCK-8） assay was adopted to detect the safe and effective doses （7.5， 15， 30 μmol·L^-1） of Res for treating 3T3-L1 cells based on the cell survival rate. After being induced to differentiate into mature adipocytes， the cells were assigned into the blank ［treated with dimethyl sulfoxide （DMSO）］ group and the Res （7.5， 15， 30 μmol·L^-1） groups and treated for 48 h. Oil red O staining and total triglyceride （TG） content were assessed to measure lipid accumulation in adipocytes. Target protein identification of Res was conducted through IAA-P-based chemical proteomics combined with high-resolution mass spectrometry. Target proteins of Res were validated by cellular thermal shift assay （CETSA） combined with Western blot analysis. Furthermore， the expression of browning markers peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α） and mitochondrial uncoupling protein 1 （UCP1）， as well as the target proteins NADH-ubiquinone oxidoreductase core subunit S8 （NDUFS8） and high-mobility group protein B1 （HMGB1） were determined by Western blot. The ATP assay kit was used to measure the ATP concentration. Mitochondrial biogenesis was characterized with MitoTracker Green， on the basis of which the regulatory effect of Res on mitochondrial function was analyzed. The level of the inflammatory cytokine tumor necrosis factor-α （TNF-α） was measured by enzyme-linked immunosorbent assay （ELISA）， on the basis of which the anti-inflammatory effect of Res on adipocytes was evaluated. ResultsCompared with the control group， Res demonstrated safety and efficacy within the range of 7.5-30 μmol·L^-1， without significantly affecting cell viability. Compared with the control group， different concentrations of Res reduced lipid accumulation in 3T3-L1 adipocytes （P<0.01）， promoted the expression of NDUFS8 （P<0.01）， increased the ATP concentration and the protein levels of UCP1 and PGC-1α， elevated the level of TNF-α （P<0.05， P<0.01）. ConclusionNDUFS8 and HMGB1were identified as the target proteins of Res in mitigating obesity. Res promotes mitochondrial biogenesis to induce the browning of 3T3-L1 adipocytes via targeting NDUFS8 and it inhibits the TNF-α-mediated inflammatory signaling via targeting HMGB1， thus inhibiting lipid accumulation and ameliorating obesity.

Objective To analyze the predictive value of serum Ficolin-3 combined with National Early Warning Score(NEWS)score in the prognosis of sepsis patients.Methods A total of 120 sepsis patients ad-mitted in the hospital from February 2021 to February 2024 were selected.Serum Ficolin-3 level was detected with samples collected at the time of admission and NEWS score was counted.According to the short-term prognosis,the patients were included in the survival group(n=82)and the death group(n=38).Serum Fico-lin-3 level and NEWS score of all patients were compared.The factors affecting the prognosis of sepsis pa-tients were explored by Multivariate Logistic regression.Results The serum Ficolin-3 and NEWS score in death group were higher than those in survival group(P<0.05).The area under the curve of serum Ficolin-3,NEWS score,and their combined evaluation for predicting the prognosis of sepsis patients were 0.819(95%CI:0.774-0.864),0.764(95%CI:0.714-0.814)and 0.921(95%CI:0.876-0.971),respectively.Arterial oxygen partial pressure(PO2)in the death group was lower than that in the survival group(P<0.05),se-quential organ failure assessment(SOFA)score at admission,acute physiology and chronic health evaluation(APACHEⅡ)score at admission,the proportion of acute kidney injury after admission and diabetes were higher than those in the survival group(P<0.05).Multivariate Logistic regression analysis showed that PO2<70.30 mmHg(OR=2.399,95%CI:1.182-4.867),SOFA score≥7 points at admission(OR=2.479,95%CI:1.306-4.706),APACHEⅡ score≥24 points(OR=2.557,95%CI:1.355-4.826),serum Ficolin-3≥4.16 mg/L(OR=3.421,95%CI:1.750-6.688),NEWS score≥7.15 points(OR=2.921,95%CI:1.661-5.137)were factors affecting the prognosis of sepsis patients(P<0.05).Conclusion High level of serum Ficolin-3 and high NEWS score are closely related to poor short-term prognosis of sepsis patients,and the combination of Ficolin-3 level and NEWS score could effectively improve the predictive value of short-term prognosis of sepsis patients.

Objective To understand the economic losses due to healthcare-associated infection(HAI)in patients after Da Vinci robotic thoracic surgery,and provide basis for preventing and controlling HAI after robotic surgery.Methods Patients who underwent Da Vinci robotic surgery from April 2019 to April 2023 were retrospective stu-died.Patients were divided into HAI group and non-HAI group based on the occurrence of postoperative infection.Through 1∶1 propensity score matching(PSM),31 cases were included in each group,economic losses of two groups of patients were compared.Results A total of 921 patients who underwent Da Vinci robotic thoracic surgery were included in the study,51 cases with HAI(HAI group)and 870 without HAI(non-HAI group).After 1∶1 PSM,31 cases were included in each group.Four covariates were compared between two groups of patients before PSM,namely gender,age,comorbidities,and the American Society of Anesthesiologists(ASA)grading,all with statistically significant differences(all P＜0.05).After PSM,distribution of the above covariates reached equilib-rium between the two groups(both P＞0.05).The median total expense for HAI group before PSM during hospi-talization was 88 711.72 Yuan,while 78 509.46 Yuan for the non-HAI group.The direct economic losses caused by HAI after Da Vinci robot surgery was 10 202.26 Yuan,mainly increased by expense of medicine,nursing,laborato-ry diagnosis,etc.Difference in western medicine expense was the highest(8 839.12 Yuan),out of which expense of antimicrobial agents accounted for the highest proportion(73.55％).Difference in daily hospitalization expense between HAI-group and non-HAI group was 502.38 Yuan.Length of hospital stay of patients in HAI group and non-HAI group were(21.59±10.62)and(13.92±9.21)days,respectively,with statistical differences(all P＜0.05).Conclusion The occurrence of HAI in patients undergoing Da Vinci robotic thoracic surgery leads to direct economic losses,with obvious increases in expenses of nursing,laboratory diagnosis,western medicine(mainly an-timicrobial agents).Length of hospital stay of patients also prolongs.

Endovascular aneurysm repair(EVAR)is the most common treatment for abdominal aortic aneurysm.However,when the common iliac artery has expansion or aneurysm,there may be internal leakage at the distal end of the stent.In this case,the ideal endovascular repair should ensure the pelvic blood supply on the premise of complete exclu-sion of the aneurysm.It is feasible and safe to use iliac branch devices(IBD)to preserve unilateral or bilateral internal iliac arteries,and its technology and clinical results are equivalent to standard EVAR.But IBD has certain anatomical a-daptability.In this paper,the current status of preservation of internal iliac artery with IBD is systematically reviewed.

Background and Aims:Abdominal aortic aneurysm(AAA)is a common arterial dilation disease in vascular surgery,with aneurysm rupture being its most serious complication,often leading to fatal hemorrhage and posing a severe threat to patients'lives.Endovascular aneurysm repair(EVAR),due to its minimally invasive nature,safety,and rapid recovery,has become the preferred treatment for AAA.However,endoleak,a complication unique to EVAR,remains a major clinical challenge.Persistent endoleak can lead to sustained high pressure within the aneurysm sac,increasing the risk of continued expansion and rupture.It is one of the main causes of the high reintervention rate following EVAR.In particular,the treatment strategy for type Ⅱ endoleaks remains controversial.This study was conducted to evaluate the clinical value of selective sac embolization via the iliac approach combined with standard EVAR in managing intraoperative immediate endoleaks.Methods:The clinical data of AAA patients with a risk of endoleak who underwent standard EVAR at the First Hospital of China Medical University between March 2023 and September 2024 were retrospectively collected.Patients were divided into an intervention group(n=42)and a non-intervention group(n=32)based on whether selective sac embolization via the iliac approach was performed during operation.General clinical data,preoperative anatomical characteristics of the AAA,surgical details,and postoperative follow-up results were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of age,sex,anatomical features,rupture rate,or off-label use(all P>0.05).The technical success rate during surgery was 100%in both groups.One patient in the intervention group experienced transient sigmoid colon ischemia after operation,which resolved with conservative treatment.The mean follow-up period was(6.49±4.68)months.The proportions of aneurysm sac shrinkage,stability,and enlargement in the intervention group were 40.5%,57.1%,and 2.4%,respectively,compared to 59.4%,40.6%,and 0.0%in the non-intervention group,with no statistically significant differences(all P>0.05).The incidence of endoleak during follow-up was also comparable between the two groups(P>0.05).Conclusion:For intraoperative endoleaks during standard EVAR,selective sac embolization via the iliac approach is a technically simple and safe method that provides short-term outcomes comparable to those in patients without intraoperative endoleaks.Its long-term efficacy warrants further investigation through extended follow-up.

Objective To investigate the effect of orthosis design parameters on correction of scoliosis and orthosis-trunk interface pressure.Methods A finite element model of scoliosis was constructed to simulate the assembly effect of the orthosis.The orthosis was divided into four loading areas(left rib,right rib,anterior-left and posterior-right area)to simulate six modification conditions.In Models 1,2 and 3,a fixed modification of 20 mm was applied on the anterior left and posterior right areas,while the displacement loads of 20,25 and 30 mm were applied on both the left rib and right rib areas.In Models 4,5 and 6,a fixed modification of 25 mm was applied on left rib and right rib areas,with the displacement loads of 15,20 and 25 mm applied on both anterior left and posterior right areas.The Cobb angle,apical vertebral rotation(AVR)and interface pressure were calculated.Results The correction of Cobb angle in Models 1,2 and 3 was 8.94°,15.62° and 17.91°,respectively,with AVR correction of 7.53°,6.69° and 5.87°,respectively.In Models 4,5 and 6,the correction of Cobb angle was 14.55°,15.62° and 16.09°,with AVR correction of 5.25°,6.69° and 8.63°,respectively.In Model 6,the correction rate of Cobb angle and AVR was 45.48%and 41.22%,respectively,with a maximum pressure of 26.51 kPa on orthosis-trunk interface,achieving the most significant outcome.Conclusions The modification of orthosis has a significant effect on the correction of Cobb and AVR angles.The loading on the left rib and right rib areas mainly affect the Cobb angle,while the loading on the anterior left and posterior right areas mainly affect the spinal axial-rotation.A modification of 25 mm on all loading areas achieves the optimal spinal correction.This study provides the quantitative data for orthosis design.