The recombinant human thyroid-stimulating hormone (rhTSH) can be used for differentiated thyroid cancer (DTC) preparation before ¹³¹I therapy, and follow-up. Since its approval by the American Food and Drug Administration (FDA) in 1998, rhTSH has been clinically used in European countries, the United States, and other countries for nearly 30 years. In April 2024, China’s first independently developed rhTSH agent was approved. Based on clinical experience and evidence from domestic and international studies, an expert consensus on the application of rhTSH has been developed following thorough consultations among experts. The consensus offers evidence-based recommendations to guide the appropriate use of rhTSH in clinical practice.

AIM:To investigate the protective ef-fect of osthole(Ost)on APAP-induced liver injury in mice and its molecular mechanism.METHODS:We established the APAP-induced liver injury model in mice,and Ost was used to intervene.The expres-sion of AST,ALT,SOD,ROS,MDA,LDH,GSH-PX in mice plasma were detected by biochemical meth-od.HE staining was used to observe the changes of liver tissue structure.Immunofluorescence assay was used to detect the expression of Tif1γ and Smad4 in liver tissue.The mRNA expression of IL-1β,IL-6,TNF-α,Smad4,and Tif1γ were detected by qRT-PCR.Western blot was applied to assess the protein expression of Smad2/3 and pSmad2/3 in liver tissue.RESULTS:Compared with the control group,the liver structure destruction and hepato-cyte death was increased,ALT,AST,ROS,MDA and LDH were increased,while SOD and GSH-PX were decreased,and the mRNA expressions of IL-1β,IL-6 and TNF-α were increased in the model group.Compared with the model group,the Ost interven-tion group had improved liver structure and de-creased liver cell death;decreased ALT,AST,ROS,MDA and LDH,increased SOD and GSH-PX,and de-creased expression of IL-1β,IL-6 and TNF-α mRNA.Compared with the control group,liver tissues of model mice showed increased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and de-creased Tif1γ protein and mRNA.Compared with the model group,the liver tissues of the Ost inter-vention group showed decreased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and in-creased expression of Tif1γ protein and mRNA.CONCLUSION:Ost can improve liver function,re-duce oxidative stress and inflammatory reaction,and protect hepatocyte damage induced by APAP in mice,which may be related to the up-regulation of Tif1γ and inhibition of TGF-β1/Smad signaling pathway.

OBJECTIVE To explore the effect and mechanism of Prunus mume against hepatic fibrosis(HF).METHODS Male SD rats were randomly divided into normal control group(n=10)and modeling group(n=50).The modeling group established HF model using carbon tetrachloride.The modeled rats were randomly divided into model group(normal saline),positive control group[colchicine,0.09 mg/(kg·d)],and P.mume low-dose,medium-dose and high-dose groups[1.35,2.70,5.40 g/(kg·d)],with 9 rats in each group.They were given the corresponding drug/normal saline intragastrically,once a day,for 8 consecutive weeks.After the last medication,the liver index was calculated,while liver function indexes,liver fiber indexes,oxidative stress indicators and inflammatory factors of rats were measured.HE staining was used to observe the pathological changes in liver tissue of rats;Masson staining was used to observe the degree of HF in liver tissue of rats;transmission electron microscopy was used to observe the ultrastructure of liver tissue in rats;TUNEL staining was used to detect liver cell apoptosis in each group of rats.Western blot method was used to detect the protein expressions of transforming growth factor-[31(TGF-[3i)and platelet-derived growth factor(PDGF)in liver tissue of rats.RESULTS Compared with normal control group,the levels of alanine transaminase,alkaline phosphatase,aspartate transaminase,total bilirubin,malondialdehyde,procollagen type Ⅲ protein,IV-type pre collagenase,laminin,hyaluronic acid,interleukin-6,tumor necrosis factor-α,as well as the protein expressions of TGF-β1and PDGF in model group were increased significantly,while the levels of superoxide dismutase and glutathione peroxidase were significantly reduced(P＜0.01);the HE,Masson staining and transmission electron microscopy observation results showed obvious HF characteristics in rats of model group.Compared with model group,varying degrees of improvement in above indexes were observed in P.mume groups,and the above indicators of rats in P.mume medium-dose and high-dose groups were reversed significantly(P＜0.05 or P＜0.01).CONCLUSIONS P.mume has an anti-HF effect,which may be achieved through mechanisms such as antioxidation,anti-inflammation,reduction of collagen production,inhibition of PDGF protein expression,and regulation of TGF-β1 signaling pathway.

Objective To explore the clinical efficacy of evolocumab combined with bare metal stents in treating stenosis at the vertebral artery ostium and its impact on restenosis.Methods A retrospective analysis was conducted on 81 patients with ostial vertebral artery stenosis undergo-ing implantation of bare mental stents in our department from January 2022 to May 2024.Based on postoperative lipid-lowering regimens,they were divided into a statin group(51 cases,atorvas-tatin alone)and a combination group(30 cases,atorvastatin combined with evolocumab).All pa-tients were followed up for 6 months postoperatively,the changes in low-density lipoprotein cho-lesterol(LDL-C)level(△LDL-C)and total cholesterol(TC)level(△TC)as well as the rate of vascular restenosis(△restenosis rate)were compared between the two groups.Results After treatment,the combination group had significantly lower LDL-C and TC levels than the statin group(P＜0.01).The △LDL-C and △TC levels were obviously higher(1.85±1.01 mmol/L vs 1.18±0.68 mmol/L,P=0.001;1.64±0.94 mmol/L vs 1.19±0.67 mmol/L,P=0.018),and the△restenosis rate was notably lower(13.3％vs 35.3％,P=0.032)in the combination group than the statin group.Conclusion Combined evolocumab and metal bare stents demonstrates good effi-cacy in treating stenosis at the origin of the vertebral artery,and can effectively lower lipid levels and helps to reduce the occurrence of vascular restenosis.

Objective:To analyze the clinical characteristics of the Chikungunya fever outbreak in Shunde District, Foshan City, Guangdong Province in July 2025 and the risk factors associated with delayed viral RNA clearance.Methods:A total of 562 patients with Chikungunya fever admitted to three designated hospitals in Shunde District from July 10 to 30, 2025 were enrolled. Demographic data, clinical manifestations, and laboratory findings were collected. Patients were categorized into four age groups including minors (<18 years), young adults (18 to 39 years), middle-aged adults (40 to 64 years) and elderly adults (≥65 years). The differences of clinical characteristics among these age groups were analyzed. Intergroup comparisons were performed using chi-square test, one-way analysis of variance, or Kruskal-Wallis H test. Pairwise comparisons between groups were conducted using the Bonferroni or Games-Howell or Dunn method. Binary logistic regression was employed to analyze risk factors associated with delayed viral RNA clearance (>7 days). Results:The mean age of the 562 enrolled Chikungunya fever patients was (44.8±21.3) years. Fever, arthralgia and rash were the three core symptoms, with incidence rates of 87.5% (492/562), 88.4%(497/562) and 69.6%(391/562), respectively. At discharge, only 54.1%(304/562) of patients achieved complete symptom resolution, while 26.5%(149/562) still had arthralgia and 36.1%(203/562) had residual rash. Significant differences were observed among age groups in the incidence of fever ( χ2=9.43, P=0.024), peak body temperature ( F=6.54, P<0.001), incidence of arthralgia ( χ2=26.89, P<0.001), duration of arthralgia ( F=12.68, P=0.001), incidence of rash ( χ2=68.99, P<0.001), rate of residual rash at discharge ( χ2=32.37, P<0.001), lymphocyte count ( F=12.94, P<0.001), platelet count ( F=14.95, P<0.001), and C-reactive protein levels (CRP) ( H=94.18, P<0.001). Further pairwise comparisons revealed that compared to the middle-aged and elderly groups, the minor group had a higher incidence of fever and a lower incidence of arthralgia, and the duration of arthralgia was shorter than the elderly group (all P<0.008 3). Compared with the other three groups, the elderly group had lower incidence and residual rate of rash, and lower platelet counts (all P<0.008 3), and higher levels of CRP (all P<0.05). The elderly group had lower lymphocyte counts compared to the minor and young adult groups (both P<0.05). Significant differences were found among age groups in the time to viral RNA clearance ( F=5.77, P=0.003) and length of hospital stay ( F=11.64, P<0.001), with the elderly group having significantly longer duration for both compared to the other three groups (all P<0.05). Multivariate analysis showed that advanced age (odds ratio ( OR)=1.049, 95% confidence interval ( CI) 1.015 to 1.083), longer duration of fever ( OR=1.529, 95% CI 1.086 to 2.155) and longer duration of arthralgia ( OR=1.927, 95% CI 1.318 to 2.817) were independent risk factors for delayed viral RNA clearance (all P<0.05). Conclusions:Patients with Chikungunya fever in Shunde District primarily present with fever, arthralgia and rash. The incidence and characteristics of these three core symptoms show age-related variations. Elderly patients and those with longer durations of fever or arthralgia are more likely to experience delayed viral clearance.

Objective To investigate the significance and clinical value of preoperative three-dimensional CT reconstruction of the whole abdomen guiding preserving the left colonic artery during laparoscopic radical resection of rectal cancer. Methods Patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer in our hospital from January 2021 to January 2022 were selected,then 87 patients with left colonic artery were screened out through three-dimensional CT reconstruction of the whole abdomen before surgery,who were randomly divided into the observation group (received intraoperative low ligation of the inferior mesenteric artery,with preservation of the left colonic artery) with 40 cases and the control group (received intraoperative high ligation of the inferior mesenteric artery without preservation of the left colonic artery) with 47 cases. The perioperative indexes and postoperative pathological results of the two groups were compared. Results The intraoperative blood loss in the observation group was higher than that in the control group,and the operation time was longer than that in the control group,with statistically significant differences (P<0.05). The incidences of postoperative intestinal obstruction and anastomotic leakage in the observation group were lower than those in the control group,and the first postoperative discharge time was earlier than that in the control group,with statistically significant differences (P<0.05). There was no significant difference in the degree of tumor differentiation,tumor size,adenocarcinoma classification,number of lymph nodes dissected at the root of the inferior mesenteric artery,or the stage of intestinal wall invasion depth of tumor between the two groups (P>0.05). Conclusion The application of the three-dimensional CT reconstruction of the whole abdomen before surgery can understand the branch classification of the inferior mesenteric artery in advance,determine the location of the tumor and its adjacent relationship with the surrounding tissues,and determine the resection extent of intestinal segment. Intraoperative preservation of the left colonic artery can reduce the occurrence of postoperative complications in patients,which has positive clinical significance.

Transcatheter edge-to-edge repair has become the most important and widely recognized method for the treatment of patients with severe mitral regurgitation who are at high risk for surgery.At present,TEER is developing rapidly in China,the operation process tends to be standardized and standardized,and various domestic Clip devices are also constantly developing and improving,but the operation process of this technology is very dependent on the guidance and monitoring of transesophageal echocardiography,and many surgeons often only pay attention to the repair effect of TEER on MR,and ignore the damage of TEE probe to the esophagus.This study reports a case of esophageal erosion occurring in a patient after mitral valve clipping for mitral regurgitation,aiming to enhance awareness among colleagues regarding esophageal injury caused by transesophageal echocardiography probes.

Objective:To explore the application effects of a four-in-one blended teaching model integrating artificial intelligence, virtual reality, 3D printing, and case-based learning (CBL) in the clinical teaching of spinal tumors.Methods:We divided 89 students on training in the Department of Orthopedics of Peking University Third Hospital from September 2022 to August 2024 into control group ( n=47) and experimental group ( n=42). The control group adopted traditional teaching, and the experimental group adopted the four-in-one teaching model. At the end of clinical teaching, an artificial intelligence test and a questionnaire survey were administered to the students to evaluate the teaching effects. The two groups were compared using the independent samples t-test with the use of SPSS 27.0. Results:The experimental group was superior to the control group with significant improvements in the answer accuracy rate (66.67%, χ2=9.44, P=0.002), learning interest [(4.50±0.63), t=2.75, P=0.007], theoretical knowledge mastery [(4.64±0.69), t=7.74, P<0.001], clinical thinking [(4.48±0.71), t=9.08, P<0.001], practical skills [(4.13±0.89), t=2.69, P=0.009], scientific research innovation [(4.71±0.59), t=9.28, P<0.001], teacher-student interaction [(4.74±0.54), t=12.76, P<0.001], and classroom attention [(4.69±0.52), t=12.64, P<0.001]. At the same time, the students in the experimental group put forward numerous constructive feedback. Conclusions:The four-in-one blended teaching model combining artificial intelligence, virtual reality, 3D printing, and CBL can help undergraduate medical students better recognize and diagnose spinal tumors with a correct clinical thinking path, achieving good teaching effects.

AIM:To investigate the protective ef-fect of osthole(Ost)on APAP-induced liver injury in mice and its molecular mechanism.METHODS:We established the APAP-induced liver injury model in mice,and Ost was used to intervene.The expres-sion of AST,ALT,SOD,ROS,MDA,LDH,GSH-PX in mice plasma were detected by biochemical meth-od.HE staining was used to observe the changes of liver tissue structure.Immunofluorescence assay was used to detect the expression of Tif1γ and Smad4 in liver tissue.The mRNA expression of IL-1β,IL-6,TNF-α,Smad4,and Tif1γ were detected by qRT-PCR.Western blot was applied to assess the protein expression of Smad2/3 and pSmad2/3 in liver tissue.RESULTS:Compared with the control group,the liver structure destruction and hepato-cyte death was increased,ALT,AST,ROS,MDA and LDH were increased,while SOD and GSH-PX were decreased,and the mRNA expressions of IL-1β,IL-6 and TNF-α were increased in the model group.Compared with the model group,the Ost interven-tion group had improved liver structure and de-creased liver cell death;decreased ALT,AST,ROS,MDA and LDH,increased SOD and GSH-PX,and de-creased expression of IL-1β,IL-6 and TNF-α mRNA.Compared with the control group,liver tissues of model mice showed increased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and de-creased Tif1γ protein and mRNA.Compared with the model group,the liver tissues of the Ost inter-vention group showed decreased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and in-creased expression of Tif1γ protein and mRNA.CONCLUSION:Ost can improve liver function,re-duce oxidative stress and inflammatory reaction,and protect hepatocyte damage induced by APAP in mice,which may be related to the up-regulation of Tif1γ and inhibition of TGF-β1/Smad signaling pathway.

Objective To explore the clinical efficacy of evolocumab combined with bare metal stents in treating stenosis at the vertebral artery ostium and its impact on restenosis.Methods A retrospective analysis was conducted on 81 patients with ostial vertebral artery stenosis undergo-ing implantation of bare mental stents in our department from January 2022 to May 2024.Based on postoperative lipid-lowering regimens,they were divided into a statin group(51 cases,atorvas-tatin alone)and a combination group(30 cases,atorvastatin combined with evolocumab).All pa-tients were followed up for 6 months postoperatively,the changes in low-density lipoprotein cho-lesterol(LDL-C)level(△LDL-C)and total cholesterol(TC)level(△TC)as well as the rate of vascular restenosis(△restenosis rate)were compared between the two groups.Results After treatment,the combination group had significantly lower LDL-C and TC levels than the statin group(P＜0.01).The △LDL-C and △TC levels were obviously higher(1.85±1.01 mmol/L vs 1.18±0.68 mmol/L,P=0.001;1.64±0.94 mmol/L vs 1.19±0.67 mmol/L,P=0.018),and the△restenosis rate was notably lower(13.3％vs 35.3％,P=0.032)in the combination group than the statin group.Conclusion Combined evolocumab and metal bare stents demonstrates good effi-cacy in treating stenosis at the origin of the vertebral artery,and can effectively lower lipid levels and helps to reduce the occurrence of vascular restenosis.