OBJECTIVES: To fabricate an injectable composite microsphere hydrogel reinforced with silk fibroin/hyaluronic acid microspheres, achieving synergistic enhance-ment of mechanical robustness and biofunctionality. METHODS: Methacrylated hyaluronic acid (HAMA) and thiolated silk fibroin (TSF) were synthesized. Monodisperse microspheres generated via microfluidics were UV-cured (420 nm) through thiol-ene click reaction. These microspheres were embedded in a TSF/HAMA matrix to form photo-cured composites. The grafting rate of TSF and HAMA was characterized by H1-NMR; particle size distribution of microsphere hydrogels in soybean oil was observed by optical microscopy; gel point of composite microsphere hydrogels was determined by advanced extensional rheometer; microscopic morphology of microsphere hydrogels was observed by scanning electron microscopy; elemental distribution of microsphere hydrogels was detected by X-ray energy dispersive spectroscopy; tunability of composite microsphere hydrogels was observed by inverted confocal microscopy; mechanical properties of composite microsphere hydrogels were tested by compression testing; swelling ratio, degradation rate and water retention rate of composite microsphere hydrogels were measured by gravimetric method. Cytotoxicity of the composite microsphere hydrogels was determined by Calcein-AM/propidium iodide dual staining and CCK-8 assay; cell migration capability was observed by scratch assay. RESULTS: The grafting rates of HAMA and TSF was 48.03% and 17.99%, respectively. Microsphere hydrogels with particle sizes of (43.3±1.2), (78.1±3.0), and (130.8±1.9) μm were prepared. The gel time of the composite microsphere hydrogels was 48-115s. The laser confocal imaging confirmed dynamic regulation characteristics of the composite microsphere hydrogels. The compressive strength of the composite microsphere hydrogels reached 22.7 kPa and maintained structural integrity at 40% strain after 20 compression cycles. The composite microsphere hydrogels exhibited differential deswelling behaviors in simulated physiological environments, and reducing microsphere particle size could significantly enhance its stability under moist conditions. The degradation rate of the composite microsphere hydrogels was (49.1±0.9)% after 200 h, and water retention rate was maintained at 40%-60% after 96 h. Biocompatibility assays confirmed >95% cell viability and unimpaired cell migration abilities. CONCLUSIONS The TSF/HAMA composite microsphere hydrogel developed in this study has characteristics of rapid fabrication, adjustable mechanical properties, enhanced environmental stability and excellent biocom-patibility, thus providing a new material solution for tissue repair and regenerative medicine.
Fibroins/chemistry* ; Hydrogels/chemistry* ; Microspheres ; Hyaluronic Acid/chemistry* ; Humans

Objective To investigate the impact of lipoxin A4(LXA4)on the inflammatory response in airway epithelial cells induced by lipopolysaccharide(LPS),and to further explore its underlying mechanism of action.Methods An in vitro inflammation model was established by stimulating normal human bronchial epithelial cells(BEAS-2B)with LPS.BEAS-2B cells were divided into four groups.Control group:No treatment was applied;LPS group:BEAS-2B cells were incubated with 100 ng/ml LPS for 24 hours.LXA4 group:BEAS-2B cells were pretreated with 100 nmol/L LXA4 for 30 minutes.LPS+LXA4 group:BEAS-2B cells were pretreated with 100 nmol/L LXA4 for 30 minutes in culture medium and then incubated with 100 ng/ml LPS for an additional 24 hours.Cell viability assays were conducted to assess the cytotoxicity of LXA4.Enzyme linked immunosorbent assay was used to measure the concentrations of interleukin(IL)-6,IL-8,and tumor necrosis factor-α(TNF-α)in the cell culture supernatants.Western blot analysis was employed to detect the expression of matrix metalloproteinase-9(MMP-9)protein in the cells.Finally,Western blot analysis was performed to examine the expression of proteins related to the nuclear factor-KB(NF-κB)signaling pathway.Results ①LXA4 exhibited negligible cytotoxicity towards BEAS-2B cells at concentrations below 100 nmol/L.Relative to control group,the exposure of BEAS-2B cells to 100ng/ml of LPS for a period of 24 hours led to a substantial augmentation in the levels of IL-6,IL-8,and TNF-α within the cellular supernatants(P＜0.01).Pretreatment with 100 nmol/L LXA4 for a period of 30 minutes markedly attenuated the levels of IL-6,IL-8,and TNF-α in LPS-stimulated BEAS-2B cells(P＜0.05).②Compared with control group,the expression of MMP-9 protein was significantly increased in LPS group(P＜0.01).When compared to LPS group,the expression of MMP-9 protein was significantly decreased in LPS+LXA4 group(P＜0.05).③The expression of p65 within the cytoplasm of BEAS-2B cells exhibited a notable decline as the duration of LPS stimulation was extended.Specifically,stimulation of BEAS-2B cells with 100 ng/ml LPS induced the degradation of inhibitor of κB-α(IκB-α),with the most pronounced effect observed at 30 minutes.Following a 30-minute pretreatment with 100 nmol/L LXA4,there was a significant reduction in both IκB-α expression and cytoplasmic NF-κB p65 levels,yielding statistical significance(P＜0.05).Conclusion LXA4 exerts inhibitory effects on the production of inflammatory mediators,including IL-6,IL-8,and TNF-α,as well as the expression of MMP-9 in LPS-stimulated airway epithelial cells.The underlying mechanism may involve the suppression of NF-κB signaling pathway.

Objective To evaluate the service efficiency of nursing homes in China from a medical care integration per-spective and analyze influencing factors.Methods The three-stage Data Envelopment Analysis(DEA)model was applied to e-liminate the influence of environmental factors to analyze the efficiency of nursing homes in various provinces in China.Addition-ally,a Tobit model was used to examine the determinants of efficiency.Results During the research period,the traditional DEA model overestimated the comprehensive efficiency and scale efficiency of nursing homes in 31 provinces,municipalities,and au-tonomous regions in China,and underestimated the pure technical efficiency.Environmental factors such as per capita GDP,the elderly dependency ratio,and the proportion of urban population impacted the input variables to significantly different extents,with a comprehensive efficiency score of 0.785,a pure technical efficiency score of 0.870,and a scale efficiency score of 0.901.Key influencing factors of the service efficiency of elderly care institutions included basic elderly care facilities,regional popula-tion size,residents'consumption capacity,degree of disability of the care recipients,quality of human resources,and capacity of medical services.Conclusion After eliminating the influence of environmental factors through the three-stage DEA,the efficien-cy evaluation is more accurate.The service efficiency of nursing homes varies across different regions in China:the eastern region exhibits the highest efficiency,followed by the central region and the western region.

Objective To compare the 12-month efficacy and safety of N-butyl cyanoacrylate (NBCA) versus radiofrequency ablation (RFA) in treating great saphenous vein (GSV) insufficiency. Methods A total of 155 patients with GSV insufficiency from five centers were randomly allocated to the NBCA group or RFA group. Postoperative efficacy and safety outcomes were evaluated. Results Immediate postoperative closure rates of the GSV trunk were 100% in both groups. The closure rates of NBCA and RFA group were 98.6% and 98.5% at 3 months, 97.1% and 98.5% at 6 months, 98.1% and 95.9% at 12 months, with no statistically significant differences (P>0.05). After treatment, CEAP classification improved significantly from baseline in both groups. In terms of safety, 1 case of phlebitis, 1 case of ablation-related thrombus extension (ARTE) and 2 cases of calf muscle venous thrombosis(CMVT) occurred in the NBCA group, while 2 cases of limb numbness, 1 case of persistent thigh pain and 2 cases of CMVT in the RFA group. All reported serious adverse events in both groups were assessed as unrelated to the medical device or the trial procedure. Conclusions NBCA demonstrates non-inferior efficacy and safety compared to RFA for treating GSV insufficiency over 12 months.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Renal carcinoma，a common malignant tumor of the urinary system，poses a significant disease burden . With innovations in artificial intelligence（AI）deep learning algorithms and the expanded clinical use of domestically developed surgical robots，renal carcinoma diagnosis and treatment have seen multi-dimensional breakthroughs. In molecular imaging and pathology diagnosis，AI drives multi-omics fusion diagnosis，while molecular imaging guides precise treatment. In surgical technology，5G-enabled telesurgery transcends geographical limits，and immersive virtual reality technology boosts surgical accuracy. Targeted therapy and immunotherapy revolutionizes advanced renal carcinoma treatment and opens up new therapeutic frontiers. Radiotherapy and energy therapy have become more precise. Despite these advances，bottlenecks persist in diagnosis and treatment. Future progress requires focusing on technological integration，clinical translation，and exploration of energy-based therapies to transition from "precise" to "intelligence" in renal carcinoma diagnosis and treatment.

Objective To evaluate the service efficiency of nursing homes in China from a medical care integration per-spective and analyze influencing factors.Methods The three-stage Data Envelopment Analysis(DEA)model was applied to e-liminate the influence of environmental factors to analyze the efficiency of nursing homes in various provinces in China.Addition-ally,a Tobit model was used to examine the determinants of efficiency.Results During the research period,the traditional DEA model overestimated the comprehensive efficiency and scale efficiency of nursing homes in 31 provinces,municipalities,and au-tonomous regions in China,and underestimated the pure technical efficiency.Environmental factors such as per capita GDP,the elderly dependency ratio,and the proportion of urban population impacted the input variables to significantly different extents,with a comprehensive efficiency score of 0.785,a pure technical efficiency score of 0.870,and a scale efficiency score of 0.901.Key influencing factors of the service efficiency of elderly care institutions included basic elderly care facilities,regional popula-tion size,residents'consumption capacity,degree of disability of the care recipients,quality of human resources,and capacity of medical services.Conclusion After eliminating the influence of environmental factors through the three-stage DEA,the efficien-cy evaluation is more accurate.The service efficiency of nursing homes varies across different regions in China:the eastern region exhibits the highest efficiency,followed by the central region and the western region.

Renal carcinoma，a common malignant tumor of the urinary system，poses a significant disease burden . With innovations in artificial intelligence（AI）deep learning algorithms and the expanded clinical use of domestically developed surgical robots，renal carcinoma diagnosis and treatment have seen multi-dimensional breakthroughs. In molecular imaging and pathology diagnosis，AI drives multi-omics fusion diagnosis，while molecular imaging guides precise treatment. In surgical technology，5G-enabled telesurgery transcends geographical limits，and immersive virtual reality technology boosts surgical accuracy. Targeted therapy and immunotherapy revolutionizes advanced renal carcinoma treatment and opens up new therapeutic frontiers. Radiotherapy and energy therapy have become more precise. Despite these advances，bottlenecks persist in diagnosis and treatment. Future progress requires focusing on technological integration，clinical translation，and exploration of energy-based therapies to transition from "precise" to "intelligence" in renal carcinoma diagnosis and treatment.

Objective To investigate the impact of lipoxin A4(LXA4)on the inflammatory response in airway epithelial cells induced by lipopolysaccharide(LPS),and to further explore its underlying mechanism of action.Methods An in vitro inflammation model was established by stimulating normal human bronchial epithelial cells(BEAS-2B)with LPS.BEAS-2B cells were divided into four groups.Control group:No treatment was applied;LPS group:BEAS-2B cells were incubated with 100 ng/ml LPS for 24 hours.LXA4 group:BEAS-2B cells were pretreated with 100 nmol/L LXA4 for 30 minutes.LPS+LXA4 group:BEAS-2B cells were pretreated with 100 nmol/L LXA4 for 30 minutes in culture medium and then incubated with 100 ng/ml LPS for an additional 24 hours.Cell viability assays were conducted to assess the cytotoxicity of LXA4.Enzyme linked immunosorbent assay was used to measure the concentrations of interleukin(IL)-6,IL-8,and tumor necrosis factor-α(TNF-α)in the cell culture supernatants.Western blot analysis was employed to detect the expression of matrix metalloproteinase-9(MMP-9)protein in the cells.Finally,Western blot analysis was performed to examine the expression of proteins related to the nuclear factor-KB(NF-κB)signaling pathway.Results ①LXA4 exhibited negligible cytotoxicity towards BEAS-2B cells at concentrations below 100 nmol/L.Relative to control group,the exposure of BEAS-2B cells to 100ng/ml of LPS for a period of 24 hours led to a substantial augmentation in the levels of IL-6,IL-8,and TNF-α within the cellular supernatants(P＜0.01).Pretreatment with 100 nmol/L LXA4 for a period of 30 minutes markedly attenuated the levels of IL-6,IL-8,and TNF-α in LPS-stimulated BEAS-2B cells(P＜0.05).②Compared with control group,the expression of MMP-9 protein was significantly increased in LPS group(P＜0.01).When compared to LPS group,the expression of MMP-9 protein was significantly decreased in LPS+LXA4 group(P＜0.05).③The expression of p65 within the cytoplasm of BEAS-2B cells exhibited a notable decline as the duration of LPS stimulation was extended.Specifically,stimulation of BEAS-2B cells with 100 ng/ml LPS induced the degradation of inhibitor of κB-α(IκB-α),with the most pronounced effect observed at 30 minutes.Following a 30-minute pretreatment with 100 nmol/L LXA4,there was a significant reduction in both IκB-α expression and cytoplasmic NF-κB p65 levels,yielding statistical significance(P＜0.05).Conclusion LXA4 exerts inhibitory effects on the production of inflammatory mediators,including IL-6,IL-8,and TNF-α,as well as the expression of MMP-9 in LPS-stimulated airway epithelial cells.The underlying mechanism may involve the suppression of NF-κB signaling pathway.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.