This paper explores the differentiation and treatment strategies for pediatric IgA vasculitis based on the correlation between blood trubidity theory and oxidative stress. It is proposed that pediatric IgA vasculitis follows an evolution of pathogenesis characterized by "deficiency of healthy qi leading to turbidity generation， accumulation of turbid toxin， and toxin damage to the collateral vessels"， which corresponds to the pathological process of oxidative stress， namely decreased antioxidant capacity with accumulation of reactive oxygen species， metabolite deposition， and endothelial cell injury. A staged treatment strategy is proposed. In the acute stage， wind-toxin invading the colla-terals and reckless movement of heat in the blood are the main manifestations， for which the treatment should focus on dispelling wind and venting pathogens， resolving toxins and unblocking the collaterals， with a modified Yinqiao Powder （银翘散） and Xijiao Dihuang Decoction （犀角地黄汤） to regulate oxidative stress burst. In the prolonged stage， intermingling of turbidity and stasis with collateral obstruction is emphasized； treatment should focus on resolving turbidity and dispelling stasis， harmonizing the blood and stabilizing the collaterals， and a modified Simiao Powder （四妙散） and Taohong Siwu Decoction （桃红四物汤） can be used to improve microcirculatory dysfunction. In the remission stage， when healthy qi remains insufficient and residual pathogens persist， treatment should focus on strengthening the root and clearing the source， reinforcing healthy qi and nourishing the collaterals， for which modified Zhibai Dihuang Pill （知柏地黄丸） and Yupingfeng Powder （玉屏风散） is suggested to rebuild the antioxidant defense system.

Objective:To investigate the impact of internationalization at home medical education on clinical medical undergraduate abilities based on value-added assessment, and to provide a reference for deepening education and teaching reform in medical colleges and universities.Methods:The study subjects consisted of undergraduate students enrolled in 2020 at Chongqing Medical University majoring in clinical medicine (five-year program) and clinical medicine (Sino-foreign cooperative education program). The questionnaire in the 2023 China Medical Students Survey, initiated by the National Medical Education Development Center, was used in this study. SPSS 27.0 was used for independent samples t-test and hierarchical linear regression. Results:Compared with the control group, the clinical medical undergraduates who received internationalization at home medical education had higher scores in academic article writing ability [(3.89±0.73) vs. (2.87±0.80)], literature retrieval and information management ability [(3.98±0.64) vs. (3.43±0.65)], and international communication and global health concept [(3.81±0.68) vs. (3.52±0.69)]. Controlling for individual-level student variables, internationalization at home medical education had a positive effect on clinical medicine undergraduate abilities based on value-added assessment ( β=5.003, P<0.001). Conclusions:The internationalization at home medical education in Chongqing Medical University enhances the abilities of clinical medical undergraduates, and provides a reference for the comprehensive improvement of the education quality of medical talents.

Objective:To compare the clinical outcomes of immediate breast reconstruction using latissimus dorsi flap with implant versus mesh with implant based on BREAST-Q evaluation.Methods:From the clinical database of the First Affiliated Hospital of Nanjing Medical University, the patients who underwent immediate breast reconstruction after total mastectomy from January 2020 to December 2023 were selected as the research subjects. All breast reconstruction surgeries were performed by the same surgeon. Patients were divided into two groups according to surgical methods: the latissimus dorsi muscle flap combined with implant immediate breast reconstruction group (LD group) and the mesh combined with implant immediate breast reconstruction group (mesh group). Patients were followed up in outpatient clinics or by telephone one year after surgery. The BREAST-Q was used to evaluate the surgical outcomes of both groups from four dimensions: psychosocial well-being, sexual well-being, chest-physical well-being, and breast satisfaction. The score range for each dimension was 0-100, with higher scores indicating greater patient satisfaction with quality of life and surgical outcomes. Statistical analysis was performed using SPSS 22.0 software. Normally distributed measurement data were expressed as Mean ± SD, and comparisons between the two groups were performed using independent sample t-test. Count data were expressed as number of cases and percentages, and comparisons between groups were performed using chi-square test or Fisher’s exact test. P<0.05 was considered statistically significant. Results:A total of 123 patients were included, with 59 patients in the LD group and 64 patients in the mesh group. In the LD group, the mean age was (37.7±7.0) years, body mass index (BMI) was (22.6±2.6) kg/m 2, and clinical tumor staging showed 2, 22, 30, and 5 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. In the mesh group, the mean age was (39.1±7.0) years, BMI was (22.6±2.8) kg/m 2, and clinical tumor staging showed 1, 25, 38, and 0 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. There were no statistically significant differences between the two groups in baseline characteristics including age, BMI, and clinical tumor staging (all P>0.05). One year after surgery, the BREAST-Q result showed no statistically significant differences between the LD group and mesh group in psychosocial well-being [(83.0±19.8) points vs. (80.8±19.3) points] and sexual well-being [(62.1±30.4) points vs. (65.8±25.6) points] (all P>0.05). However, the LD group had lower chest-physical well-being scores than the mesh group [(40.6±9.7) points vs. (45.1±9.6) points, P<0.05], while breast satisfaction scores were higher in the LD group than in the mesh group [(68.0±17.8) points vs. (59.8±12.6) points, P<0.01]. Conclusion:Immediate breast reconstruction by both latissimus dorsi flap with implant and mesh with implant can improve patients’ psychosocial and sexual well-being by enhancing breast appearance. However, LD technique provides better breast satisfaction, while the mesh technique offers advantages in physical well-being of the chest wall and upper body. Surgeons should select the most appropriate breast reconstruction technique based on patients’ anatomical conditions, treatment history, and individual needs to optimize postoperative quality of life and satisfaction.

Objective:To compare the clinical outcomes of immediate breast reconstruction using latissimus dorsi flap with implant versus mesh with implant based on BREAST-Q evaluation.Methods:From the clinical database of the First Affiliated Hospital of Nanjing Medical University, the patients who underwent immediate breast reconstruction after total mastectomy from January 2020 to December 2023 were selected as the research subjects. All breast reconstruction surgeries were performed by the same surgeon. Patients were divided into two groups according to surgical methods: the latissimus dorsi muscle flap combined with implant immediate breast reconstruction group (LD group) and the mesh combined with implant immediate breast reconstruction group (mesh group). Patients were followed up in outpatient clinics or by telephone one year after surgery. The BREAST-Q was used to evaluate the surgical outcomes of both groups from four dimensions: psychosocial well-being, sexual well-being, chest-physical well-being, and breast satisfaction. The score range for each dimension was 0-100, with higher scores indicating greater patient satisfaction with quality of life and surgical outcomes. Statistical analysis was performed using SPSS 22.0 software. Normally distributed measurement data were expressed as Mean ± SD, and comparisons between the two groups were performed using independent sample t-test. Count data were expressed as number of cases and percentages, and comparisons between groups were performed using chi-square test or Fisher’s exact test. P<0.05 was considered statistically significant. Results:A total of 123 patients were included, with 59 patients in the LD group and 64 patients in the mesh group. In the LD group, the mean age was (37.7±7.0) years, body mass index (BMI) was (22.6±2.6) kg/m 2, and clinical tumor staging showed 2, 22, 30, and 5 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. In the mesh group, the mean age was (39.1±7.0) years, BMI was (22.6±2.8) kg/m 2, and clinical tumor staging showed 1, 25, 38, and 0 cases for stages 0, Ⅰ, Ⅱ, and Ⅲ, respectively. There were no statistically significant differences between the two groups in baseline characteristics including age, BMI, and clinical tumor staging (all P>0.05). One year after surgery, the BREAST-Q result showed no statistically significant differences between the LD group and mesh group in psychosocial well-being [(83.0±19.8) points vs. (80.8±19.3) points] and sexual well-being [(62.1±30.4) points vs. (65.8±25.6) points] (all P>0.05). However, the LD group had lower chest-physical well-being scores than the mesh group [(40.6±9.7) points vs. (45.1±9.6) points, P<0.05], while breast satisfaction scores were higher in the LD group than in the mesh group [(68.0±17.8) points vs. (59.8±12.6) points, P<0.01]. Conclusion:Immediate breast reconstruction by both latissimus dorsi flap with implant and mesh with implant can improve patients’ psychosocial and sexual well-being by enhancing breast appearance. However, LD technique provides better breast satisfaction, while the mesh technique offers advantages in physical well-being of the chest wall and upper body. Surgeons should select the most appropriate breast reconstruction technique based on patients’ anatomical conditions, treatment history, and individual needs to optimize postoperative quality of life and satisfaction.

Objective To analyze the academic literature on sepsis-related microRNA(miRNA)at worldwide,and to dentify thematic hotspots and future research trends.Methods A bibliometric analysis was employed to retrieve the literature on sepsis-related miRNA published in the core collection of China National Knowledge Infrastructure(CNKI),and Web of Science(WOS)databases from January 1,2010,to January 1,2025,which met the article inclusion criteria,and used CiteSpace 6.3.1 software to perform the co-occurrence analysis of keywords,keyword emergence analysis,and cluster analysison;on the basis of these analyses,the keywords were sorted according to time to generate clustering time line figure to explore the current status and hotspot evolution process of sepsis-related miRNA.Results A total of 135 and 1 278 articles were retrieved from CNKI and the core collection of WOS databases,respectively.The frequency and centrality of keywords such as sepsis,prognosis,microRNA,acute lung injury,acute kidney injury,etc.were high in 135 documents in CNKI;in 1 278 documents in WOS core collection,the frequency and centrality of keywords such as expression,sepsis,inflammation,cells,micrornas,etc.were high;The top 10 keywords in the CNKI database in terms of burst intensity were:microRNA,inflammatory response,inflammatory factor,interleukin-10,tumor necrosis factor-α,acute respiratory distress syndrome,interleukin-35,septic shock,rat,tiny microRNA-155(miR-155);the top 10 keywords in the core collection of the WOS database in terms of burst intensity were:expression,NF-κB,microRNA,cells,induction,pathway,mechanisms,septic shock,mortality,cancer.Representative clustering tags in the CNKI are#0 prognosis,#1 miRNA,#2 septic shock;The representative clustering labels in the core collection of WOS database are#0 acute lung injury,#1 cancer,#2 septic shock,and so on.In CNKI and WOS core databases,the early keywords mainly revolve around the study of inflammatory factors and related mechanisms of sepsis,and the research center gradually shifts to the clinical physiological injuries as well as complications and mortality in the later stage,miRNA-126,AMP-activated protein kinase,interleukin-35 and other keywords have emerged.Among the top 10 most-cited English literature,researchers have paid particular attention to studying various miRNA as potential biomarkers of sepsis,including miR-146a,miR-223 and miR-146.Conclusions There are similarities and differences in the direction and hotspots of sepsis-related miRNA research in China and abroad.The research paradigm of sepsis has gradually shifted from the early clinical observation focusing on the overall complications and prognosis of patients to the basic research centered on the molecular mechanisms of inflammatory factors and signaling pathways.In this context,the study of miRNA as novel biomarkers for sepsis has been increasingly emphasized,and miRNA represent a promising direction for sepsis research,with potential applications both in basic research and clinical treatment.

Background and purpose:Intracellular deubiquitylating enzymes,such as ubiquitin-specific peptidase 2(USP2),play a pivotal role in regulating protein degradation and cellular homeostasis by modulating protein ubiquitin deconjugation,which have been implicated in the proliferation and survival of multiple myeloma(MM)cells.Targeting the inhibition of USP2 activity in MM cells might modulate their biological behavior.This study aimed to investigate regulatory effects of the leukotriene receptor antagonist montelukast sodium on USP2 in MM cells and its subsequent biological effects.Methods:An in vitro deubiquitination reaction system was established using purified USP2 protein and its substrate,the glutathione S-transferase(GST)tagged ubiquitin A-52 residue ribosomal protein fusion product(UbA52),known as GST-UbA52 protein.This system was used to characterize inhibitory effects of montelukast sodium on USP2 deubiquitinase activity.The MM cell lines MM1.S and H929 were used as in vitro models.Cellular thermal shift assay(CETSA)was subsequently employed to test interaction mode between montelukast sodium and USP2 in MM cells.Western blot assay was applied to detect expression levels of USP2 and its targeting regulators,including cell cycle supervisors cyclin D1(CCND1)and cyclin A1(CCNA1),classical signaling transducer KRAS and glucose regulated protein 78kD(GRP78),as well as apoptotic molecule C/EBP-homologous protein(CHOP)in MM1.S and H929 cells before and after the treatment with different concentrations of montelukast sodium.MM cells with either overexpression(H929-OE,MM1.S-OE)or knockdown(H929-LE,MM1.S-LE)of USP2 were generated using a lentiviral vector.Cell counting kit-8(CCK-8)and flow cytometry were utilized to detect the proliferation and apoptotic rates of H929-OE,MM1.S-OE,H929-LE and MM1.S-LE cells treated with montelukast sodium.Results:Montelukast sodium was found to inhibit USP2 mediated degradation of GST-UbA52 protein in a concentration-dependent manner,with a half inhibitory concentration(IC50)of 3.814 μmol/L.Additionally,montelukast sodium significantly enhanced the thermal stability of USP2 at temperatures of 49.1,53.2 and 56.4℃.It was also shown that montelukast sodium could down-regulate expressions of CCND1,CCNA1 and KRAS,while increase levels of GRP78 and CHOP in MM1.S and H929 cells.Furthermore,after treating with 40 μmol/L montelukast sodium for 24 h,the proliferation inhibition and apoptotic rate of H929-OE cells reached to(37.68±1.10)%and(18.99±0.26)%,while the proliferation inhibition and apoptotic rate of MM1.S-OE cells reached to(24.48±0.49)%and(33.29±0.75)%,which were significantly lower than those in H929 and MM1.S cells[H929:(57.19±1.93)%and(45.65±0.24)%;MM1.S:(50.04±0.53)%and(40.25±0.91)%;P＜0.05,n=3].Conversely,the proliferation inhibition and apoptotic rates of H929-LE and MM1.S-LE cells were significantly higher[H929-LE-1#:(80.70±1.60)%and(89.08±0.49)%;H929-LE-2#:(75.30±3.80)%and(82.41±1.07)%;MM1.S-LE-1#:(70.64±0.84)%and(67.63±0.21)%;MM1.S-LE-2#:(68.47±1.32)%and(85.90±0.18)%;P＜0.05,n=3].Conclusion:Montelukast sodium can target ubiquitin proteasome regulator USP2 and inhibit its deubiquitylating activity,which may modulate USP2 directing protein and trigger endoplasmic reticulum stress to induce cell cycle arrest and apoptosis in MM cells.

This paper comprehensively discusses on the potential neurobiological mechanisms of acupuncture in the treatment of tobacco dependence， focusing on three important aspects， including acupuncture's regulation of tobacco dependence behavior， effects of acupuncture on withdrawal syndrome， and the role of acupuncture in preventing relapse. It is found that acupuncture can inhibit drug-seeking behavior by regulating the reward pathway and related neurons， such as dopamine， thus modulating tobacco dependence behavior. It also alleviates withdrawal symptoms by improving the oral environment of smokers and reducing negative emotions after quitting. Furthermore， acupuncture can prevent relapse by decreasing brain network activity related to smoking cravings and improving cognitive brain functions like addiction memory. Currently， research on the specific neurobiological mechanism of acupuncture in treating tobacco dependence and the involved neural circuits is limited. Future research directions are proposed， including the evaluation of clinical effects， exploration of specific therapeutic mechanisms， investigation of brain pathology， and strengthening the exploration of brain functions. Additionally， combining modern technologies to clarify the neural circuits involved in acupuncture intervention will provide a basis for acupuncture treatment of tobacco addiction.

Bacteriophages possess the ability to infect and kill bacteria and have now been applied in various oral diseases,providing new insights for the prevention and treatment of oral diseases.They are expected to become a novel biological antibacterial agent for treating oral diseases.This paper comprehensively discusses the application of bacteriophages in oral medicine from six aspects:the concept and application prospects of bacteriophages,four common infectious diseases of the oral cavity and their pathogenic bacteria,existing treatment methods,and the application and outlook of bacteriophages in these diseases.Lay a theoretical basis for the clinical implementation of phage therapy.

This paper reports a case of disseminated intravascular coagulation(DIC) that occurred early after hybrid surgery for type B aortic dissection with an aortic arch aneurysm. Through analyzing the clinical manifestations, imaging findings, and treatment response of the patient, we propose that massive false-lumen thrombosis may serve as a critical trigger for early postoperative coagulation activation leading to DIC. Corresponding treatment strategies are suggested to enhance clinicians' ability to recognize and manage this critical condition.

Objective To investigate the differences in speech recognition in noise between patients with con-genital and acquired single-sided deafness.Methods Sixty-two patients with single-sided deafness were included in this study,which included 31 congenital single-sided deafness(CSSD)cases and 31 acquired single-sided deafness(ASSD)cases according to the onset of deafness.Thirty-one normal hearing(NH)subjects were also included in this study as the control group.The ability of speech recognition in noise were tested and compared among the three groups,meanwhile the differences between patients with left and right single-sided deafness were compared.Results The speech recognition threshold in noise of ASSD patients was significantly higher than that of CSSD patients,and both of them were significantly higher than that of the NH subjects.Under the 0 and-2 dB signal-to-noise ra-tio conditions,the speech recognition score was significantly lower in ASSD patients compared to CSSD patients,but only in ASSD patients it was significantly lower than that of the NH group,with no significant difference be-tween CSSD patients and the NH group.A significant difference in speech recognition thresholds was observed be-tween left and right CSSD patients.Conclusion CSSD have better speech recognition in noise than ASSD patients,suggesting better central function compensation.In addition,the side of deafness affects the speech recognition per-formance of CSSD patients.