Endoscopic transforaminal lumbar interbody fusion (TLIF) offers substantial advantages in the management of degenerative spinal diseases, including accelerated postoperative recovery. However, its technical complexity and steep learning curve pose risks for nerve root injury. Optimizing nerve root protection in full-endoscopic facet-sparing TLIF (FE fs-TLIF) and full-endoscopic facet-resecting TLIF (FE fr-TLIF) is essential for enhancing surgical safety. This study aimed to improve the nerve root protection in FE fs-TLIF and FE fr-TLIF by optimizing cage glider selection and insertion techniques based on the specific cage shape—banana-shaped or bullet-shaped. The goal was to ensure safe cage positioning and mitigate nerve root injury during discectomy, endplate preparation, and cage insertion. These strategies were validated through cadaveric simulations and clinical implementation. In FE fr-TLIF utilizing bullet-shaped (straight) cages, one-tip and two-tip cage gliders effectively protected the traversing nerve root by facilitating medial cage entry, thereby minimizing irritation of the exiting nerve root. Conversely, in FE fr-TLIF with banana-shaped cages, the lateral tilt of the cage holder during implantation required the use of a two-tip cage glider to protect the traversing and exiting nerve roots, thereby mitigating the potential risk of nerve irritation. In FE fs-TLIF, a one-tip cage glider is preferred for safeguarding the exiting nerve root, while the traversing root is inherently protected by the medial wall of the facet joint. The use of a two-tip cage glider in FE fs-TLIF can cause injury to the nerve root during glider insertion. In addition to the selection of cage gliders, improper cage insertion steps can also contribute to postoperative neurapraxia. The appropriate selection of cage gliders with corresponding insertion techniques is critical for nerve root protection in endoscopic TLIF. Tailoring these choices to the specific approach (FE fs-TLIF or FE fr-TLIF) and cage type (banana or bullet) enhances surgical safety and clinical outcomes.

Objective:To evaluate the cost-effectiveness and impact on mortality of health management services for the elderly aged 65 years and older in national essential public health service project.Methods:Based on the data of county-level medical institutions in Henan Province from 2019 to 2024,the Random Forest Method was used to construct a counterfactual framework to predict the hospitalization expenses under the unmanaged scenario,and then the cost-benefit ratio(BCR)and net income were calculated.Time-dependent Cox proportional hazards model was used to evaluate the effect of health management on all-cause mortality and cardiovascular and cerebrovascular disease mortality in the elderly.Results:A total of 962 955 elderly patients were included,451 119(46.85%)were included in the management group.The average hospitalization cost of the management group was significantly lower than that of the non-management group(P<0.05).Except for 2020-2021,BCRS in 2019 and 2022-2024 were 6.34,2.05,4.45 and 6.60,respectively.The risk of all-cause death was reduced by 76.96%,and the risk of cardiovascular and cerebrovascular death was reduced by 75.57%in the elderly patients included in the management group compared with those not included in the management group.Suggestions:It is necessary to establish a health outcomes-based evaluation system and promote the transformation and upgrading of the service model from single chronic disease management to"integrated health services with multi-disease management".

Objective:To construct a decision tree model to predict the risk of breast cancer in patients with pathological nipple discharge.Methods:A total of 157 patients with pathological nipple discharge,who were diagnosed and treated at Weifang Municipal Hospital of Traditional Chinese Medicine from January 2019 to April 2024 and met the inclusion criteria,were selected.A risk prediction model for concurrent breast cancer in patients with pathological nipple discharge was developed using Logistic regression analysis.A decision tree was then constructed,and the predictive performance of the model was assessed based on the area under the receiver operating characteristic curve(AUC).Re-sults:The incidence of concurrent breast cancer among patients with pathological nipple discharge was 24.2%.Accord-ing to the results of binary Logistic regression analysis,elevated CEA and CA 153 levels in nipple discharge,as well as bloody discharge,emerged as independent risk factors for the development of breast cancer in such patients(P<0.05).Based on these findings,a decision tree model was constructed to predict the risk of concurrent breast cancer in patients with pathological nipple discharge.The validation results showed that the Logistic regression model had an AUC value of 0.800,while the decision tree model achieved an AUC value of 0.889.Conclusions:The decision tree model,built upon the identified influencing factors,exhibits strong predictive power for the risk of developing concurrent breast can-cer in patients with pathological nipple discharge,thus facilitating more precise preoperative diagnoses by clinicians for these patients.

Aim To investigate the effect of tetrameth-ylpyrazine(TMP)on neuroinflammation after cerebral ischemia and hypoxia via mannose-binding lectin(MBL).Methods Patients diagnosed with ischaemic stroke at Shanxi Provincial People's Hospital were in-cluded in the study,and their clinicopathological data,as well as blood and urine samples,were collected with the consent of the patients and their families.Using these biological samples,differential proteins and tar-gets were identified by proteomic analysis and subse-quently verified with animal experiments.The mice were divided into the sham,dMCAO,and TMP(10,20,40 mg·kg-1)treatment groups.After seven days of drug administration,the modified neurological sever-ity score(mNSS)was used to assess the neurological function.TTC staining was used to detect the volume of cerebral infarction.Motor function was evaluated be-haviourally,and ELISA was used to detect MASP1,sC5b-9,TNF-α,IL-6,and IL-1β.Western blot was used to determine the expression of relevant proteins,such as MBL2,MASP2,and C3.Results Compared with the sham group,the dMCAO group exhibited in-creased neurological impairment,which was signifi-cantly ameliorated by TMP treatment.The expression levels of MBL2,C3 and MASP2 were elevated in the dMCAO group and were reduced following TMP treat-ment.Additionally,the dMCAO group showed elevat-ed expression of inflammatory factors IL-1 β,IL-6 and TNF-α,which were then suppressed by TMP treat-ment.Conclusion TMP inhibits the inflammatory re-sponse after ischemia and hypoxia by regulating MBL,thus attenuating brain injury.

Objective:To evaluate the cost-effectiveness and impact on mortality of health management services for the elderly aged 65 years and older in national essential public health service project.Methods:Based on the data of county-level medical institutions in Henan Province from 2019 to 2024,the Random Forest Method was used to construct a counterfactual framework to predict the hospitalization expenses under the unmanaged scenario,and then the cost-benefit ratio(BCR)and net income were calculated.Time-dependent Cox proportional hazards model was used to evaluate the effect of health management on all-cause mortality and cardiovascular and cerebrovascular disease mortality in the elderly.Results:A total of 962 955 elderly patients were included,451 119(46.85%)were included in the management group.The average hospitalization cost of the management group was significantly lower than that of the non-management group(P<0.05).Except for 2020-2021,BCRS in 2019 and 2022-2024 were 6.34,2.05,4.45 and 6.60,respectively.The risk of all-cause death was reduced by 76.96%,and the risk of cardiovascular and cerebrovascular death was reduced by 75.57%in the elderly patients included in the management group compared with those not included in the management group.Suggestions:It is necessary to establish a health outcomes-based evaluation system and promote the transformation and upgrading of the service model from single chronic disease management to"integrated health services with multi-disease management".

Objective:To analyze the changes in serum levels of neurofilament light chain(NFL),binding protein S100 β(S100 β),and C-reactive protein(CRP)in patients with cognitive impairment after cardiac surgery,and to analyze the correlation between these indicators and patient prognosis.Methods:124 patients with heart disease who underwent surgical treatment from January 2022 to January 2025 were selected.One week after surgery,the patients were evaluated using the Montreal Cognitive Assessment Scale(MoCA).60 patients with MoCA scores＜26 were divided into the cognitive impairment group,and 64 patients with MoCA scores ≥ 26 were divided into the non cognitive impairment group.Compare the general information of two groups,including changes in serum NFL,S100 β,and CRP levels before and after surgery.Using logistic regression to analyze the influencing factors of cognitive impairment after cardiac surgery.Following a 4-month postoperative follow-up,the cognitive impairment group was assessed using the MoCA score.Patients with a MoCA score＜26 were categorized as having a poor prognosis,while the remaining patients were classified as having a good prognosis.The NfL,S100β,and CRP levels in both groups were compared,and the ROC curve was used to evaluate the predictive value of serum NFL,S100β,and CRP for poor prognosis in patients with postoperative cognitive impairment.Results:There was no significant difference in gender,BMI,education level,comorbidities(hypertension,diabetes),disease type,ASA classification,intraoperative blood loss,intraoperative fluid replacement,and cardiopulmonary bypass time between cognitive impairment group and non-cognitive impairment group(P＞0.05).The cognitive impairment group had a higher incidence of age,anesthesia maintenance time during surgery,no analgesia after operation and agitation during awakening than the non-cognitive impairment group(P＜0.05);There was no significant difference in the levels of serum NFL,S100β,and CRP between the two groups of patients before surgery(P＞0.05).On postoperative day 3,the levels of serum NFL,S100β,and CRP increased in both groups,with the cognitive impairment group being higher than the non cognitive impairment group(P＜0.05);Using cognitive impairment(occurrence=1,no occurrence=0)as the dependent variable,logistic regression analysis showed that age,intraoperative anesthesia maintenance time,agitation during the recovery period,postoperative 3-day NFL,S100 β,CRP were independent influencing factors of cognitive impairment after cardiac surgery(P＜0.05);The serum levels of NFL,S100β,and CRP in the good prognosis group and poor prognosis group were higher than those before surgery,and the NFL,S100 β,and CRP levels in the poor prognosis group were higher than those in the good prognosis group before and after surgery(P＜0.05);Using poor prognosis as positive samples and good prognosis as negative samples,a ROC curve was plotted.The results showed that the sensitivity and specificity of the combined prediction of three indicators before and after surgery for poor prognosis of cognitive impairment in cardiac surgery were higher than those of a single indicator(P＜0.05).Conclusion:The serum levels of NFL,S100β,and CRP are significantly elevated in patients with cognitive impairment after cardiac surgery,and the early postoperative elevation of NFL,S100β,and CRP is a contributing factor to the occurrence of cognitive impairment.Preoperative and early postoperative detection of these indicators can predict the prognosis of patients with cognitive impairment after cardiac surgery.

The integration of science and education is not only an important strategy for promoting social progress and technological development,but also a modern form of higher education aiming at cultivating innovative talents.Conducting scientific research training for undergraduate medical students is one of the important ways to cultivate their innovative abilities and comprehensive qualities.Our team proposed a"teaching,science,and ideology trinity"teaching model to comprehensively cultivate students' scientific research comprehensive abilities under the value orientation of ideological and political education by or-ganically integrating molecular biology experimental teaching with the scientific research training of under-graduate medical students.In this teaching activity,taking the experiment of gene polymorphism as an example,our team selected students with research potential from the whole grade and divided them into 4 project groups that were instructed by 4 teachers.The students were trained in the whole process of scien-tific research,including topic selection,project writing,experimental designing,application for research ethics,and project summary.Our team has always adhered to student-contentedness of educational con-cepts to stimulate students' intrinsic motivation throughout the teaching process.Students are the design-ers and implementers of the project,and teachers are only guides and promoters of learning.After this training,students not only became familiar with the writing and implementation of scientific research pro-jects,but also improved their literature reading,experimental designing,experimental skills,and prob-lem-solving abilities.More importantly,this teaching activity also cultivated students' awareness of re-search ethics and academic moral standards.

Aim To investigate the effect of tetrameth-ylpyrazine(TMP)on neuroinflammation after cerebral ischemia and hypoxia via mannose-binding lectin(MBL).Methods Patients diagnosed with ischaemic stroke at Shanxi Provincial People's Hospital were in-cluded in the study,and their clinicopathological data,as well as blood and urine samples,were collected with the consent of the patients and their families.Using these biological samples,differential proteins and tar-gets were identified by proteomic analysis and subse-quently verified with animal experiments.The mice were divided into the sham,dMCAO,and TMP(10,20,40 mg·kg-1)treatment groups.After seven days of drug administration,the modified neurological sever-ity score(mNSS)was used to assess the neurological function.TTC staining was used to detect the volume of cerebral infarction.Motor function was evaluated be-haviourally,and ELISA was used to detect MASP1,sC5b-9,TNF-α,IL-6,and IL-1β.Western blot was used to determine the expression of relevant proteins,such as MBL2,MASP2,and C3.Results Compared with the sham group,the dMCAO group exhibited in-creased neurological impairment,which was signifi-cantly ameliorated by TMP treatment.The expression levels of MBL2,C3 and MASP2 were elevated in the dMCAO group and were reduced following TMP treat-ment.Additionally,the dMCAO group showed elevat-ed expression of inflammatory factors IL-1 β,IL-6 and TNF-α,which were then suppressed by TMP treat-ment.Conclusion TMP inhibits the inflammatory re-sponse after ischemia and hypoxia by regulating MBL,thus attenuating brain injury.

Objective:To analyze the changes in serum levels of neurofilament light chain(NFL),binding protein S100 β(S100 β),and C-reactive protein(CRP)in patients with cognitive impairment after cardiac surgery,and to analyze the correlation between these indicators and patient prognosis.Methods:124 patients with heart disease who underwent surgical treatment from January 2022 to January 2025 were selected.One week after surgery,the patients were evaluated using the Montreal Cognitive Assessment Scale(MoCA).60 patients with MoCA scores＜26 were divided into the cognitive impairment group,and 64 patients with MoCA scores ≥ 26 were divided into the non cognitive impairment group.Compare the general information of two groups,including changes in serum NFL,S100 β,and CRP levels before and after surgery.Using logistic regression to analyze the influencing factors of cognitive impairment after cardiac surgery.Following a 4-month postoperative follow-up,the cognitive impairment group was assessed using the MoCA score.Patients with a MoCA score＜26 were categorized as having a poor prognosis,while the remaining patients were classified as having a good prognosis.The NfL,S100β,and CRP levels in both groups were compared,and the ROC curve was used to evaluate the predictive value of serum NFL,S100β,and CRP for poor prognosis in patients with postoperative cognitive impairment.Results:There was no significant difference in gender,BMI,education level,comorbidities(hypertension,diabetes),disease type,ASA classification,intraoperative blood loss,intraoperative fluid replacement,and cardiopulmonary bypass time between cognitive impairment group and non-cognitive impairment group(P＞0.05).The cognitive impairment group had a higher incidence of age,anesthesia maintenance time during surgery,no analgesia after operation and agitation during awakening than the non-cognitive impairment group(P＜0.05);There was no significant difference in the levels of serum NFL,S100β,and CRP between the two groups of patients before surgery(P＞0.05).On postoperative day 3,the levels of serum NFL,S100β,and CRP increased in both groups,with the cognitive impairment group being higher than the non cognitive impairment group(P＜0.05);Using cognitive impairment(occurrence=1,no occurrence=0)as the dependent variable,logistic regression analysis showed that age,intraoperative anesthesia maintenance time,agitation during the recovery period,postoperative 3-day NFL,S100 β,CRP were independent influencing factors of cognitive impairment after cardiac surgery(P＜0.05);The serum levels of NFL,S100β,and CRP in the good prognosis group and poor prognosis group were higher than those before surgery,and the NFL,S100 β,and CRP levels in the poor prognosis group were higher than those in the good prognosis group before and after surgery(P＜0.05);Using poor prognosis as positive samples and good prognosis as negative samples,a ROC curve was plotted.The results showed that the sensitivity and specificity of the combined prediction of three indicators before and after surgery for poor prognosis of cognitive impairment in cardiac surgery were higher than those of a single indicator(P＜0.05).Conclusion:The serum levels of NFL,S100β,and CRP are significantly elevated in patients with cognitive impairment after cardiac surgery,and the early postoperative elevation of NFL,S100β,and CRP is a contributing factor to the occurrence of cognitive impairment.Preoperative and early postoperative detection of these indicators can predict the prognosis of patients with cognitive impairment after cardiac surgery.