BACKGROUND:As a mainstream surgical technique for the treatment of cervical spondylotic myelopathy through the anterior cervical subtotal decompression and bone graft fusion,it has many advantages.However,due to the high risk of this surgery and the particularity of the cervical anatomy,it is also a challenge for the surgeon.The gradual maturity of 3D printing technology and the continuous development of applications in the medical field are now able to provide more perfect personalized treatment.OBJECTIVE:To investigate the efficacy of 3D printed titanium cage cutting model in anterior cervical vertebrae subtotal decompression and bone graft fusion.METHODS:Medical records of 57 patients undergoing anterior cervical corpectomy decompression and fusion surgery admitted to the Department of Spine Surgery of Affiliated Hospital of Yan'an University from April 2021 to April 2023 were retrospectively analyzed.According to whether the 3D printed titanium cage cutting model was used in the operation,the patients were divided into the traditional titanium cage bone grafting group(control group,n=30)and the 3D printed titanium cage model group(observation group,n=27).The general data,amount of blood loss during operation,number ofC-arm X-ray machine fluoroscopy during operation,operation time,as well as anterior intervertebral edge height(H1),posterior intervertebral edge height(H2)and C2-C7 Cobb angle of the two groups measured on the cervical lateral X-ray films before,3 days and 6 months after operation were recorded and analyzed.The settling degree of the titanium cage was assessed with the distance of the height of the anterior and posterior edges of the vertebral body at 3 days and 6 months after surgery.Visual analog scale was used to evaluate neck pain and Japanese Orthopaedic Association was used to evaluate nerve function.RESULTS AND CONCLUSION:(1)Follow-up was conducted for at least 6 months.(2)The amount of intraoperative blood loss and fluoroscopy times in the observation group were less than those in the control group(P＜0.05).The operative time of the observation group was significantly shorter than that of the control group(P＜0.05).(3)There were no significant differences in C2-C7 Cobb angle,visual analog scale score,Japanese Orthopaedic Association score,anterior vertebral border height(H1)and posterior vertebral border height(H2)before surgery,3 days and 6 months after surgery between the two groups(P＞0.05).(4)There were five patients in the observation group(with severe subsidence rate of 19％)with severe subsidence at the anterior and posterior edges of the surgical segment,and seven patients in the control group(with severe subsidence rate of 23％)with severe subsidence(H1 or H2 subsidence≥3 mm)at the surgical segment 6 months after surgery.There was no significant difference in the rate of severe subsidence of titanium cage between the two groups(P＞0.05).(5)At the last follow-up,bone fusion was achieved at the operative level in both groups,and there was no statistical significance in bone graft fusion rate between the two groups(P＞0.05).(6)The results showed that the application of 3D printed titanium cage cutting model in anterior cervical corpectomy decompression and fusion surgery had the same clinical effect as that of traditional surgery,but the former could effectively reduce the fluoroscopy times of C-arm X-ray machine,the amount of blood loss and the operation time,and had unique advantages in the pruning and implantation of titanium cage during surgery.

Polycystic ovary syndrome （PCOS） is a common endocrine and metabolic disorder among women of reproductive age. Hyperandrogenism （HA）， one of its core pathological features， is closely associated with the clinical manifestations and metabolic complications of the disease. Current western medical treatments for PCOS-HA mainly include anti-androgen therapy and ovulation induction， such as short-acting oral contraceptives like Diane-35 and Yasmin. However， long-term use of these medications may result in adverse reactions like increasing the risk of liver dysfunction and exacerbating lipid metabolism disorders， with unsatisfactory long-term efficacy when used alone. Traditional Chinese medicine offers unique advantages in the treatment of PCOS-HA due to its holistic approach and multi-target regulatory mechanisms. In the view of traditional Chinese medicine， PCOS-HA is classified under the categories such as "delayed menstruation"， "amenorrhea"， and "infertility"， with kidney deficiency as the root， as well as liver stagnation and spleen deficiency as the manifestations. Phlegm and blood stasis are considered to be intertwined throughout the disease course. Modern studies have shown that traditional Chinese medicine is significantly effective in improving the androgen levels， restoring ovulation， and improving insulin resistance in PCOS-HA patients. Representative prescriptions， such as Erxian Tang， Jiawei Xiaoyaosan， Guizhi Fulingwan， and Cangfu Daotantang， exert therapeutic effects through various mechanisms including regulation of the hypothalamic-pituitary-ovarian axis， reduction of ovarian androgen synthase activity， improvement of insulin signaling pathways， and inhibition of inflammation and oxidative stress， which demonstrates the characteristics of comprehensive treatment with traditional Chinese medicine. Based on the perspectives of etiology and pathogenesis of traditional Chinese medicine， modern medical cognition， typical prescriptions， and action mechanisms， this paper reviewed the research progress of traditional Chinese medicine in the treatment of PCOS-HA， aiming to provide a reference for in-depth research and clinical applications in this field.

Polycystic ovary syndrome （PCOS） is a common endocrine and metabolic disorder among women of reproductive age. Hyperandrogenism （HA）， one of its core pathological features， is closely associated with the clinical manifestations and metabolic complications of the disease. Current western medical treatments for PCOS-HA mainly include anti-androgen therapy and ovulation induction， such as short-acting oral contraceptives like Diane-35 and Yasmin. However， long-term use of these medications may result in adverse reactions like increasing the risk of liver dysfunction and exacerbating lipid metabolism disorders， with unsatisfactory long-term efficacy when used alone. Traditional Chinese medicine offers unique advantages in the treatment of PCOS-HA due to its holistic approach and multi-target regulatory mechanisms. In the view of traditional Chinese medicine， PCOS-HA is classified under the categories such as "delayed menstruation"， "amenorrhea"， and "infertility"， with kidney deficiency as the root， as well as liver stagnation and spleen deficiency as the manifestations. Phlegm and blood stasis are considered to be intertwined throughout the disease course. Modern studies have shown that traditional Chinese medicine is significantly effective in improving the androgen levels， restoring ovulation， and improving insulin resistance in PCOS-HA patients. Representative prescriptions， such as Erxian Tang， Jiawei Xiaoyaosan， Guizhi Fulingwan， and Cangfu Daotantang， exert therapeutic effects through various mechanisms including regulation of the hypothalamic-pituitary-ovarian axis， reduction of ovarian androgen synthase activity， improvement of insulin signaling pathways， and inhibition of inflammation and oxidative stress， which demonstrates the characteristics of comprehensive treatment with traditional Chinese medicine. Based on the perspectives of etiology and pathogenesis of traditional Chinese medicine， modern medical cognition， typical prescriptions， and action mechanisms， this paper reviewed the research progress of traditional Chinese medicine in the treatment of PCOS-HA， aiming to provide a reference for in-depth research and clinical applications in this field.

Abstract To explore the benefits and risks of active video games (AVGs) for health promotion among children and adolescents, the study reviews relevant domestic and international literature and details the benefits of AVGs, including increased physical activity and energy expenditure, improved physical fitness, better mental health, enhanced social interaction, improved cognitive function and attention, and heightened body awareness. At the same time, it also addresses potential risks, such as gaming addiction and excessive use, sports related injuries and other risks, thereby providing a theoretical reference for children and adolescents to engage in AVGs in a healthy manner.

BACKGROUND:As a mainstream surgical technique for the treatment of cervical spondylotic myelopathy through the anterior cervical subtotal decompression and bone graft fusion,it has many advantages.However,due to the high risk of this surgery and the particularity of the cervical anatomy,it is also a challenge for the surgeon.The gradual maturity of 3D printing technology and the continuous development of applications in the medical field are now able to provide more perfect personalized treatment.OBJECTIVE:To investigate the efficacy of 3D printed titanium cage cutting model in anterior cervical vertebrae subtotal decompression and bone graft fusion.METHODS:Medical records of 57 patients undergoing anterior cervical corpectomy decompression and fusion surgery admitted to the Department of Spine Surgery of Affiliated Hospital of Yan'an University from April 2021 to April 2023 were retrospectively analyzed.According to whether the 3D printed titanium cage cutting model was used in the operation,the patients were divided into the traditional titanium cage bone grafting group(control group,n=30)and the 3D printed titanium cage model group(observation group,n=27).The general data,amount of blood loss during operation,number ofC-arm X-ray machine fluoroscopy during operation,operation time,as well as anterior intervertebral edge height(H1),posterior intervertebral edge height(H2)and C2-C7 Cobb angle of the two groups measured on the cervical lateral X-ray films before,3 days and 6 months after operation were recorded and analyzed.The settling degree of the titanium cage was assessed with the distance of the height of the anterior and posterior edges of the vertebral body at 3 days and 6 months after surgery.Visual analog scale was used to evaluate neck pain and Japanese Orthopaedic Association was used to evaluate nerve function.RESULTS AND CONCLUSION:(1)Follow-up was conducted for at least 6 months.(2)The amount of intraoperative blood loss and fluoroscopy times in the observation group were less than those in the control group(P＜0.05).The operative time of the observation group was significantly shorter than that of the control group(P＜0.05).(3)There were no significant differences in C2-C7 Cobb angle,visual analog scale score,Japanese Orthopaedic Association score,anterior vertebral border height(H1)and posterior vertebral border height(H2)before surgery,3 days and 6 months after surgery between the two groups(P＞0.05).(4)There were five patients in the observation group(with severe subsidence rate of 19％)with severe subsidence at the anterior and posterior edges of the surgical segment,and seven patients in the control group(with severe subsidence rate of 23％)with severe subsidence(H1 or H2 subsidence≥3 mm)at the surgical segment 6 months after surgery.There was no significant difference in the rate of severe subsidence of titanium cage between the two groups(P＞0.05).(5)At the last follow-up,bone fusion was achieved at the operative level in both groups,and there was no statistical significance in bone graft fusion rate between the two groups(P＞0.05).(6)The results showed that the application of 3D printed titanium cage cutting model in anterior cervical corpectomy decompression and fusion surgery had the same clinical effect as that of traditional surgery,but the former could effectively reduce the fluoroscopy times of C-arm X-ray machine,the amount of blood loss and the operation time,and had unique advantages in the pruning and implantation of titanium cage during surgery.

ObjectiveTo investigate the therapeutic efficacy of Qizhi Tongluo granules on proteinuria in membranous nephropathy （MN） and its potential protective effects and underlying mechanism against endoplasmic reticulum stress. MethodsAfter 70 Sprague-Dawley （SD） rats were adaptively fed for one week， the MN rat model was established by injecting cationic bovine serum albumin （C-BSA） into the tail vein. Rats were divided into the normal group， model group， low-dose Qizhi Tongluo granules group （2.43 g·kg^-1）， medium-dose group （4.86 g·kg^-1）， high-dose group （9.72 g·kg^-1）， and benazepril group （0.01 g·kg^-1）， with 10 rats in each group. Treatment was administered for four weeks. The 24-hour urinary total protein （UTP） content， as well as the levels of reactive oxygen species （ROS）， malondialdehyde （MDA）， and glutathione peroxidase （GPX） in renal tissues， were measured. Renal pathological changes were assessed using immunoglobulin G （IgG） staining， periodic acid-silver methenamine （PASM） staining， and transmission electron microscopy （TEM）. The localization and expression levels of glucose-regulated protein 78 （GRP78）， phosphorylated inositol-requiring enzyme 1α （p-IRE1α）， phosphorylated protein kinase R-like endoplasmic reticulum kinase （p-PERK）， activating transcription factor 4 （ATF4）， nuclear factor erythroid 2-related factor 2 （Nrf2）， and 2'-5' oligoadenylate synthetase-like protein 1 （OASL1） in rat kidneys were detected by immunohistochemistry （IHC）. The mRNA and protein expression levels of Nrf2， thioredoxin 1 （Trx1）， thioredoxin-interacting protein （TXNIP）， and OASL1 in rat kidneys were measured using real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot analysis. ResultsCompared with the normal group， UTP levels were significantly increased in the model rats （P<0.05）， with obvious renal pathological damage. GPX content levels were significantly decreased in renal tissue （P<0.05）， while ROS and MDA content levels were significantly increased （P<0.05）. The expression of GRP78， p-IRE1α， p-PERK， and ATF4 proteins was significantly increased in the kidneys （P<0.05）， while the mRNA and protein expression levels of Trx1 and Nrf2 were significantly decreased （P<0.05）. The mRNA and protein expression levels of TXNIP and OASL1 were significantly increased （P<0.05）. Compared with the model group， the UTP levels of rats in the Qizhi Tongluo granules groups and the benazepril group decreased to varying degrees （P<0.05）， and renal pathological damage was significantly alleviated. The GPX content in renal tissue was significantly increased （P<0.05）， while the ROS and MDA levels were significantly decreased （P<0.05）. The expression of GRP78， p-IRE1α， p-PERK， and ATF4 proteins in the kidney was significantly decreased （P<0.05）. The mRNA and protein expression levels of Trx1 and Nrf2 were significantly increased （P<0.05）， while the mRNA and protein expression levels of TXNIP and OASL1 were significantly decreased （P<0.05）. ConclusionQizhi Tongluo granules alleviates proteinuria in MN rats by modulating the Nrf2/OASL1 signaling pathway in renal tissues to reduce endoplasmic reticulum stress， which represents its underlying mechanism.

Objective To identify core targets of hepatocellular carcinoma (HCC) by using bioinformatics and specific algorithms, explore their relationships with immune cells, and investigate the causal relationships between immune cells and HCC through Mendelian randomization. Methods Relevant genes associated with the development of HCC were screened using the GEO and TCGA databases. Immune infiltration analysis was conducted using GSVA and CIBERSORT algorithms. A bidirectional Mendelian randomization analysis was then performed to explore the causal relationships between immune cells and HCC. Results A total of 284 HCC-related genes were identified, with 120 genes recognized within the protein interaction network. Immune infiltration analysis revealed significant correlations between key genes and immune cells. Mendelian randomization results indicated that HLA DR on CD33⁺ HLA DR⁺ CD14dim (OR=1.097, 95%CI: 1.002–1.201, P=0.045, P_Bonferroni=0.091) and CD8 on CD28⁺ CD45RA⁺ CD8⁺ T cell (OR=1.123, 95%CI: 1.027–1.228, P=0.011, P_Bonferroni=0.022) were the risk factors for HCC. Conversely, HLA DR⁺⁺ monocyte absolute count was identified as a protective factor for HCC (OR=0.812, 95%CI: 0.702–0.938, P=0.005, P_Bonferroni=0.139). Conclusion The occurrence and development of liver cancer may be related to CDK1, CCNB1, and CDC20, showing a high degree of correlation with Th2 cells, T helper cells, Th17 cells, and DCs. Mendelian randomization shows that HLA DR on CD33⁺HLA DR⁺ CD14dim and CD8 on CD28⁺CD45RA⁺CD8⁺T cells are associated with an increased risk of HCC. The risk of hepatocellular carcinoma is associated with a decrease in the level of HLA DR⁺⁺monocyte absolute count.

Objective To explore the impact of"knowledge-attitude-practice"(KAP)training mode on head nur-ses' core competency in healthcare-associated infection(HAI)prevention and control in a tertiary first-class general hospital.Methods Head nurses of 113 departments in a tertiary first-class general hospital were taken as the re-search objects.Guided by problems and demands,HAI training was conducted using the KAP training mode.The training was divided into two stages:a stage with problems of infection control and investigation of knowledge de-mands,as well as a stage with KAP training mode implementation.It included theoretical lectures,visits and lear-ning,and supervision on rectification.Scores of theory,supervision,and core competency of head nurses before training,1 month and 6 months after training were compared by the analysis of variance.SPSS 26.0 statistical soft-ware was used for analysis.Results The top three infection control problems in this hospital were hand hygiene,prevention and control of infection with multidrug-resistant organisms,as well as HAI prevention and control in the wards.The top three training modules required urgently by the head nurses were occupational exposure and self-protection,principles of medical waste disposal,as well as prevention and control of HAI in the wards.Both scores of theory and supervision after training were higher than those before training,with statistically significant diffe-rences(both P＜0.01).The core competencies of the head nurses were at a high level.After implementing KAP training mode,the scores of dimensions in critical thought and research,clinical nursing,leadership,and profe-ssional development,as well as the overall score of core competencies were all higher than before training.Diffe-rences were all statistically significant(all P＜0.05).The overall scores of dimensions in legal and ethical practice,education and consultation,as well as interpersonal relationship were all higher than before training,but the diffe-rences were not statistically significant(all P＞0.05).Conclusion KAP training mode can significantly improve the scores of theory,supervision,and core competencies of head nurses,and can be further promoted and applied in head nurses' infection control training.

Objective To analyze the relationship between the expression of ferroptosis markers in the tumor microenvironment(TME)and the prognosis of transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC).Methods This prospective observational study included 100 HCC patients who received TACE treatment at Langfang Hospital of Traditional Chinese Medicine from March 2019 to June 2021 as the study subjects.The levels of 8-isoprostaglandin F2α(8-iso-PGF2α),4-hydroxy-2-nonenal(4-HNE),8-hydroxy-2'deoxyguanosine(8-OH-dG)and hepcidin in plasma were evaluated by ELISA kit at baseline(1 day before TACE),1 day after TACE and 4～8 weeks.The changes of ferroptosis related markers during TACE treatment were compared.The difference between the level of 8-iso-PGF2α,4-HNE and the baseline 1 day after TACE treatment was recorded as △8-iso-PGF2α,△4-HNE.Results Compared with the baseline,the levels of 8-iso-PGF2α and 4-HNE increased significantly and the level of hepcidin decreased significantly one day after TACE treatment,and the differences were statistically significant(t=8.03,16.29,2.92,all P<0.05).Compared with 1 day after treatment,the levels of 8-iso-PGF2α,4-HNE decreased and the level of 8-OH-dG increased at 4～8 weeks after TACE treatment,and the differences were statistically significant(t=9.12,17.17,2.63,all P<0.05).Multivariate COX analysis showed that △8-iso-PGF2α,△4-HNE and 8-iso-PGF2α 1 day after TACE treatment were independent factors affecting the overall survival after TACE(Wald χ2=5.205,13.801,6.054,all P<0.05).The survival time of patients with △4-HNE>2.01 μg/ml was significantly longer than that of patients with △4-HNE≤2.01 μg/ml(Log-rank=5.718,P=0.017),and that of patients with△8-iso-PGF2α>1.75ng/ml was sig-nificantly longer than that of patients with△8-iso-PGF2≤1.75ng/ml(Log-rank=4.163,P=0.041).Conclusion The prognosis of HCC patients who are in a state of high ferroptosis(4-HNE and 8-iso-PGF2 increased)at 1 day after TACE treatment is better,which indicate that ferroptosis mediated HCC death induced by TACE treatment.

Objective To explore a nomogram of intratumor and peritumor radiomics based on enhanced CT venous phase to pre-operatively predict the pathological grade of poorly differentiated esophageal squamous cell carcinoma(ESCC).Methods A retro-spective selection was made of 266 ESCC patients confirmed by pathology(76 cases of poorly differentiated;190 cases of non-poorly differentiated),and all patients were randomly divided into training set(n=186),validation set(n=80),and full data set(n=266).Tumors were segmented on the enhanced CT venous phase to create three-dimensional region of interest(ROI)of intratumor,peritu-mor 0.3 cm,and intratumor+peritumor 0.3 cm.A total of 2 553 radiomics features were extracted.After feature dimensionality reduc-tion,XGboost machine learning algorithm was utilized to rank the top fifteen features.Stepwise forward multiple logistic regression was employed to identify the most significant features.The radiomics scores of the intratumor,peritumor 0.3 cm,and intratumor+peritu-mor 0.3 cm were calculated.The diagnostic efficacy of the model was evaluated using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA).Results The nomogram constructed based on radiomics scores of intratumor,peritumor 0.3 cm,intratumor+peritumor 0.3 cm in the training set for preoperative prediction of poorly differentiated ESCC had an AUC of 0.899[95％confidence interval(CI)0.846-0.938],and it was well validated in the vali-dation set(AUC 0.869,95％CI 0.775-0.934)and the full data set(AUC 0.889,95％CI 0.845-0.924).Additionally,calibration curves and DCA indicated that the nomogram achieved good calibration ability in the three cohorts and offered greater clinical net benefit.Conclusion The nomogram based on enhanced CT venous phase intratumor and peritumor radiomics achieves a high and stable diagnostic efficacy for preoperatively predicting poorly differentiated ESCC,which may help with individualized surgical selec-tion and management before surgery.