Background: Advances in intensive care have markedly improved survival after severe brain injury, leading to a growing population of patients with prolonged disorders of consciousness (pDOC). Current management of pDOC remains largely supportive, and evidence-based neuromodulatory interventions are limited; moreover, existing guidelines provide insufficiently explicit recommendations regarding mechanisms of action and objective biomarkers of treatment response. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a potential noninvasive intervention; however, its modulatory effects on brain function in pDOC are not yet well characterized, and the paucity of integrative mechanistic evidence has constrained its translation into routine clinical practice. Objectives: Within a multimodal assessment framework, this study aims to systematically elucidate the neurobiological mechanisms by which taVNS modulates brain function and autonomic activity in patients with pDOC, and to evaluate its clinical potential to enhance levels of consciousness. Methods: In this randomized controlled trial, 60 patients with vegetative state/minimally conscious state will be enrolled and randomly allocated to a taVNS group, a transcutaneous nonauricular vagus nerve stimulation group (sham), or a control group (n = 20 per group) for a 4-week intervention. The primary outcome will be changes in the Coma Recovery Scale-Revised scores from baseline to weeks 1, 2, and 4 of treatment. Secondary outcomes will include functional brain activity assessed by electroencephalography and functional near-infrared spectroscopy, as well as autonomic modulation indexed by heart rate variability. Functional prognosis will be evaluated using the Glasgow Outcome Scale-Extended at the end of treatment and at a 6-month follow-up. Safety will be assessed by continuous monitoring and documentation of adverse events throughout the study period. Results and discussion: By integrating electroencephalography–functional near-infrared spectroscopy with heart rate variability, this study will characterize the effects of taVNS on functional brain networks and consciousness recovery in pDOC across complementary behavioral, electrophysiological, hemodynamic, and autonomic domains, while interrogating potential sources of clinical and neurobiological heterogeneity. The findings are expected to provide a mechanistic and evidence-based foundation for the mechanism-driven clinical implementation of taVNS and the optimization of stimulation protocols in pDOC. Clinical trial registration: International Traditional Medicine Clinical Trial Registry, ITMCTR20250021041, https://itmctr.ccebtcm.org.cn.

Objective To construct and validate a nomogram model based on early clinical features to predict the risk of in-hospital cardiac arrest (IHCA) in patients with acute myocardial infarction (AMI). Methods A total of 152 AMI patients who were admitted to Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2023 and experienced IHCA were retrospectively enrolled (IHCA group), with 608 contemporaneous AMI patients free of IHCA matched as the control gropu at a 4∶1 ratio (non-IHCA group). Patients were randomly divided into a training set and a validation set at a 7∶3 ratio. LASSO regression and multivariable logistic regression were used for variable selection and model construction in the training set. A nomogram was constructed based on the final model, and its performance was evaluated in the training set and validation set. Results The proportion of patients with Killip class≥Ⅱ was higher in the IHCA group than that in the non-IHCA group in both the training set and validation set (89.6% vs 34.0%, 95.7% vs 36.3%; P＜0.001). The final model included nine variables: troponin T, triiodothyronine (T₃) uptake, blood glucose, pulmonary artery systolic pressure (PASP), total bilirubin, estimated glomerular filtration rate (eGFR), eosinophil percentage, pre-hospital β-blocker use, and in-hospital P2Y12 inhibitor use. The nomogram model achieved an AUC of 0.975 (95%CI 0.963–0.985) in the training set and 0.959 (95%CI 0.932–0.981) in the validation set, higher than the global registry of acute coronary event (GRACE) score in both datasets (P＜0.001). Conclusion A nomogram model established based on early clinical indicators at admission could provide reference for predicting the risk of IHCA in patients with AMI.

Objective:This study investigated the expression level of phosphatidylserine-specific phospholipase A1(PLA1A)in colorectal can-cer(CRC)and analyzed its correlations with clinicopathological features,prognosis,and immune infiltration.Methods:The expression level of PLA1A in CRC was screened,and the influence of this expression level on patient prognosis was analyzed using bioinformatics methods.A cohort of 192 patients diagnosed with CRC at Shanxi Province Cancer Hospital from January to December 2020 were selected.The PLA1A ex-pression level in those with CRC was determined using immunohistochemistry(IHC)and real-time quantitative reverse transcription PCR(RT-qPCR).The relationship between PLA1A level and the clinicopathological features of the patients with CRC was analyzed using the chi-square test.The expression levels of immune cell markers CD4 and CD8 as well as immunosuppressive checkpoints PD-1,TIM-3,and CTLA-4 in CRC were detected via IHC,and their correlations with PLA1A level were analyzed using the chi-square test.Results:The results of bioinformatics analysis showed that the expression level of PLA1A in CRC tissue was higher than paracancerous tissue,which correlated with overall surviv-al(OS)(P<0.05).The IHC and RT-qPCR results showed that PLA1A expression level was significantly upregulated in CRC tissiue(P<0.05).High PLA1A level was closely associated with the TNM stage,degree of differentiation,and lymph node metastasis(P<0.05).The IHC results demonstrated that PLA1A positively correlated with the infiltrating CD8+T cell level(P<0.05).In addition,the elevated PLA1A levels upregu-lated the expressions of immunosuppressive checkpoints PD-1,TIM-3,and CTLA-4(P<0.05).Conclusions:PLA1A is highly expressed in CRC,which is closely related to immune infiltrating cells and immunosuppressive checkpoints,suggesting that PLA1A plays an important role in immune infiltration in CRC,a finding that provides guidance in the treatment of CRC.

Objective:To explore the effect of triple pre-rehabilitation strategy on improving nutritional status, negative emotions and quality of life in breast cancer patients undergoing neoadjuvant chemotherapy, so as to provide reference for clinical practice.Methods:A quasi experimental research was adopted. A total of 133 patients who underwent neoadjuvant chemotherapy for breast cancer at Gansu Provincial Cancer Hospital between December 2023 and December 2024 were recruited as research participants. Patients were stratified into the experimental group ( n = 66) and control group ( n = 67) according to their admission sequence. The control group received routine health guidance, while the experimental group was provided with a triple pre-rehabilitation strategy based on the control group. The serum albumin, body mass index, anxiety, depression scores and quality of life scores were compared between the two groups before intervention, 3 weeks after intervention and 2 weeks post-surgery. Results:Totally 64 patients in each group completed the study. The age of the experimental group was (49.50 ± 10.46) years, and that of the control group was (50.42 ± 12.50) years. All of them were females. After a 3-week intervention, the serum albumin levels in the experimental group were (42.62 ± 1.56) g/L, compared to (40.50 ± 1.31) g/L 2 weeks post-surgery. In the control group, these values were (40.98 ± 1.35) g/L and (40.00 ± 1.67) g/L, respectively. The differences between groups were statistically significant ( t = -6.38, -1.89, both P<0.05). Additionally, body mass index of the experimental group was (24.02 ± 1.35) kg/m 2 after the 3-week intervention and (23.48 ± 1.72) kg/m 2 2 weeks post-surgery, which were significantly higher than those of the control group (22.98 ± 1.72) kg/m 2 and (22.50 ± 1.31) kg/m 2, respectively ( t = - 3.81, - 3.61, both P<0.05). The anxiety scores in the experimental group were (6.00 ± 2.09) of 3 weeks after intervention and (7.00 ± 2.62) 2 weeks post-surgery, both of which were significantly lower than those in the control group (7.00 ± 2.26) and (8.00 ± 2.76), with statistically significant differences ( t = 2.60, 2.10, both P<0.05). Additionally, the depression scores in the experimental group were (5.00 ± 2.20) of 3 weeks after intervention and (6.00 ± 2.40) 2 weeks post-surgery, which were also significantly lower than those in the control group (6.00 ± 2.02) and (7.00 ± 2.09), with statistically significant differences ( t = 2.68, 2.52, both P<0.05). Furthermore, the quality of life scores in the experimental group were (94.84 ± 18.00) of 3 weeks after intervention and (84.02 ± 17.13) 2 weeks post-surgery, which were significantly higher than those in the control group (82.00 ± 18.75) and (72.03 ± 17.10), with statistically significant differences ( t = - 3.95, - 3.96, both P<0.05). Conclusions:The triple pre-rehabilitation strategy plays a crucial role in mitigating the nutritional risk for breast cancer patients undergoing neoadjuvant chemotherapy, alleviating their negative emotions, and enhancing their quality of life. This approach is anticipated to serve as a valuable reference for preoperative health guidance tailored to breast cancer patients undergoing neoadjuvant chemotherapy.

BACKGROUND:Endometrial injury is a common benign disease in women of reproductive age,which seriously affects their fertility and reproductive health.In recent years,mesenchymal stem cells and their secreted extracellular vesicles,as a new therapeutic strategy,have received much attention in the repair of endometrial injury.OBJECTIVE:To review the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,to comprehensively understand the therapeutic mechanism and efficacy of endometrial injury,and to discuss the potential and challenges of the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,in order to provide theoretical basis for further basic and clinical research.METHODS:Literature searches were conducted in the China National Knowledge Infrastructure(CNKI),Chinese Medical Full-text Database,and PubMed electronic databases using search terms"mesenchymal stem cells,extracellular vesicles derived from mesenchymal stem cells,exosome,endometrial injury,intrauterine adhesion,Asherman's syndrome"in Chinese and English.Articles were selected through manual screening to exclude duplicates and irrelevant studies,resulting in the inclusion of 87 articles.RESULTS AND CONCLUSION:Mesenchymal stem cells and their secreted extracellular vesicles can participate in endometrial damage repair through a variety of molecular mechanisms,such as anti-fibrosis,promoting angiogenesis and cell proliferation,cell homing,immune regulation,and endometrial receptibility regulation.A large number of research results have been achieved in cell and animal experiments,and preliminary results of clinical studies have also achieved certain curative effects,including increased endometrial thickness,improved menstrual volume and fertility.However,difficulty and challenges persist in the application of mesenchymal stem cells and their secreted extracellular vesicles for endometrial injury treatment.During treatment,it is necessary to enhance the quality and stability of mesenchymal stem cells and their secreted extracellular vesicles,as well as clarifying their roles in processes such as cell proliferation,migration,and differentiation.Moreover,large-scale multicenter clinical trials are needed to validate the long-term safety and efficacy of mesenchymal stem cells and their secreted extracellular vesicles in endometrial repair,and to determine optimal dosages and administration routes.Continuous advancements in scientific technologies and the auxiliary application of bioengineering materials offer hope for developing more effective and safer therapeutic methods for endometrial injury treatment and the above problems will be solved in the future.

Objective:To analyze the clinical characteristics, treatment, response to treatment, prognosis, and the importance of early recognition and treatment of pediatric systemic lupus erythematosus (SLE) complicated with thrombotic microangiopathy (TMA).Methods:A retrospective summary of the clinical data of 5 children diagnosed with SLE complicated by TMA at Beijing Children′s Hospital, Capital Medical University, from November 2024 to January 2025.Results:Among the 5 children (1 boy and 4 girls, male-to-female ratio of 1∶4), the age of onset ranged from 11 years and 9 months to 14 years and 9 months. All cases had acute onset, rapid disease progression, severe illness, and involvement of multiple organs and systems. The disease activity of SLE was moderately to severely active when TMA was diagnosed. During the course of TMA, all 5 children exhibited varying degrees of hemolytic anemia, thrombocytopenia, renal dysfunction, and proteinuria. Elevated sC5b-9 levels were observed in all 5 children, with 3 showing severely reduced ADAMTS13 activity and 2 with elevated ADAMTS13 inhibitors. Two children had elevated sC5b-9, severely reduced ADAMTS13 activity, and elevated ADAMTS13 inhibitors simultaneously. Four children had newly diagnosed SLE with TMA and achieved stable condition within 2-3 weeks after aggressive treatment, including methylprednisolone pulse therapy, immunosuppressive agents, biologics, plasma infusion, plasma exchange, or dialysis. One child, who had been diagnosed with SLE for 8 years and had irregular oral medication for half a year, suddenly developed TMA with refractory hemolytic anemia and severe thrombocytopenia. This child responded poorly to methylprednisolone pulse therapy, cyclosporine, and eculizumab but showed improvement with plasma exchange. However, the condition was prone to relapse when the interval between plasma exchanges was prolonged. The child eventually responded well to low-dose rituximab and was discharged after 6 weeks of combined treatment. Four children were diagnosed with TMA within 1 week of admission and achieved stable condition after 3 months of follow-up, with no anemia or thrombocytopenia, negative proteinuria, normal complement C3 and C4 levels, and an SLE disease activity score of 0. One child, who had been treated with high-dose glucocorticoid, multiple immunosuppressive agents, and biologics at another hospital, was transferred and diagnosed with TMA 2 weeks after admission. The condition gradually stabilized after treatment with methylprednisolone pulse therapy, immunosuppressive agents, biologics, and plasma exchange. However, at 3-month follow-up, the child still had alopecia and proteinuria, with an SLE disease activity score of 6, indicating mild disease activity.Conclusion:For children with moderate to severe active SLE, especially those with acute onset, rapid disease progression, and prominent manifestations of anemia, thrombocytopenia, renal dysfunction, and poor response to high-dose methylprednisolone pulse therapy, the risk of TMA should be vigilantly monitored. Early diagnosis and aggressive treatment are crucial.

Objective:To compare arthroscopic versus open Brostr?m-Gould repair of the anterior talofibular ligament (ATFL) in the treatment of chronic ankle instability (CAI) in young men undergoing high intensity exercise.Methods:A retrospective study was conducted to analyze the 61 young male patients with CAI undergoing high-intensity exercise who had been treated at Department of Trauma and Orthopedics, 947th Army Hospital of Chinese People’s Liberation Army from January 2016 to July 2020. Their age was (25.9±2.7) years and their disease duration (13.9±2.8) months. According to their different treatment methods, they were divided into an arthroscopic group ( n=26) in which their ATFL was repaired by arthroscopic Brostr?m-Gould surgery and a Brostr?m-Gould group ( n=35) in which their ATFL was repaired by open Brostr?m-Gould surgery. The 2 groups were compared in terms of operation time and intraoperative bleeding, as well as the ankle-hindfoot scores of American Orthopaedic Foot & Ankle Society (AOFAS), Karlsson ankle functional (KAF) scores and visual analogue scale (VAS) pain scores at postoperative 3, 6, 12, and 24 months. Results:There were no significant differences in the preoperative general data between the 2 groups, indicating comparability ( P > 0.05). The operation time [(35.8±3.9) min] and intraoperative bleeding [(6.6±2.6) mL] in the arthroscopic group were significantly less than those in the Brostr?m-Gould group [(52.1±4.6) min and (16.1±4.0) mL] ( P < 0.05). The AOFAS ankle-hindfoot scores and KAF scores in the arthroscopic group were significantly higher than those in the Brostr?m-Gould group at postoperative 3 and 6 months, but the AOFAS ankle-hindfoot score and KAF score at postoperative 24 months were significantly lower than those in the Brostr?m-Gould group ( P < 0.05). There was no statistically significant difference in AOFAS ankle-hindfoot score or KAF score between the 2 groups at postoperative 12 months, as well as in VAS pain scores at postoperative 3, 6, 12, and 24 months between the 2 groups ( P > 0.05). Conclusions:In young men undergoing high intensity exercise, compared with open Brostr?m-Gould surgery, arthroscopic Brostr?m-Gould surgery may lead to better clinical outcomes in a short-term (3 months after surgery). However, open Brostr?m-Gould surgery may result in better long-term efficacy than arthroscopic Brostr?m-Gould surgery (24 months after surgery).

Objective:This study investigated the expression level of phosphatidylserine-specific phospholipase A1(PLA1A)in colorectal can-cer(CRC)and analyzed its correlations with clinicopathological features,prognosis,and immune infiltration.Methods:The expression level of PLA1A in CRC was screened,and the influence of this expression level on patient prognosis was analyzed using bioinformatics methods.A cohort of 192 patients diagnosed with CRC at Shanxi Province Cancer Hospital from January to December 2020 were selected.The PLA1A ex-pression level in those with CRC was determined using immunohistochemistry(IHC)and real-time quantitative reverse transcription PCR(RT-qPCR).The relationship between PLA1A level and the clinicopathological features of the patients with CRC was analyzed using the chi-square test.The expression levels of immune cell markers CD4 and CD8 as well as immunosuppressive checkpoints PD-1,TIM-3,and CTLA-4 in CRC were detected via IHC,and their correlations with PLA1A level were analyzed using the chi-square test.Results:The results of bioinformatics analysis showed that the expression level of PLA1A in CRC tissue was higher than paracancerous tissue,which correlated with overall surviv-al(OS)(P<0.05).The IHC and RT-qPCR results showed that PLA1A expression level was significantly upregulated in CRC tissiue(P<0.05).High PLA1A level was closely associated with the TNM stage,degree of differentiation,and lymph node metastasis(P<0.05).The IHC results demonstrated that PLA1A positively correlated with the infiltrating CD8+T cell level(P<0.05).In addition,the elevated PLA1A levels upregu-lated the expressions of immunosuppressive checkpoints PD-1,TIM-3,and CTLA-4(P<0.05).Conclusions:PLA1A is highly expressed in CRC,which is closely related to immune infiltrating cells and immunosuppressive checkpoints,suggesting that PLA1A plays an important role in immune infiltration in CRC,a finding that provides guidance in the treatment of CRC.

Objective:To standardize perioperative nursing procedures for autologous tissue breast reconstruction and reduce perioperative complications by formulating the Expert Consensus on Perioperative Nursing Care for Autologous Tissue Breast Reconstruction ( 2024 Edition) (hereinafter referred to as the Consensus) . Methods:Relevant guidelines, systematic reviews, and randomized controlled trials were systematically reviewed and combined with expert clinical experience to draft the initial version of the Consensus. After two rounds of expert consultation, the items were revised and finalized. Results:A total of 24 questionnaires were distributed and returned in both rounds, yielding a 100% valid response rate (24/24). The authority coefficient of the 24 experts was 0.836. The Kendall's coefficient of concordance was 0.836 ( P<0.01). The finalized Consensus includes 5 key components: preoperative care, intraoperative care, postoperative care, management of complications, and discharge guidance with follow-up. Conclusions:The Consensus is scientifically sound and clinically practical. It provides a standardized, evidence-based reference for establishing national protocols for perioperative nursing care in autologous tissue breast reconstruction.

Objective:To investigate the current status of breast reconstruction after breast cancer surgery in hospitals in China.Methods:This study was a cross-sectional study using convenience sampling. A self-designed survey questionnaire was used to investigate nurses of department of breast diseases in China from May to August 2023. The content of the questionnaire included four aspects: identification information, basic hospital information, the implementation situation of breast reconstruction after breast cancer surgery, and the situation of medical and nursing human resources for breast reconstruction, with a total of 39 items. Statistical analysis was performed using SPSS 26.0 software. The non-normally distributed measurement data were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparison between groups. Numeric data were expressed as frequency and percentage, and comparisons between groups were made using the χ2-test or Fisher’s exact probability method. P<0.05 indicated that the difference was statistically significant. Results:A total of 212 public hospitals from 31 provinces, autonomous regions and municipalities participated in the survey. Two hundred and three hospitals (95.8%) returned valid data, including 155 Grade Ⅲ Level A hospitals, 19 Grade Ⅲ Level B and C hospitals, and 29 Grade Ⅱ hospitals. There were 157 general hospitals, 32 specialized cancer hospitals, and 14 other hospitals. Thirty-nine hospitals did not perform breast reconstruction surgery. A total of 164 hospitals (80.8%) had already carried out breast reconstruction surgery, among which the proportion of breast reconstruction in Grade Ⅲ Level A hospitals [90.3% (140/155)] was significantly higher than that in Grade Ⅲ Level B and C hospitals [52.6% (10/19)] and Grade Ⅱ hospitals [48.3% (14/29)] ( P<0.01). The proportion of breast reconstruction in specialized cancer hospitals [96.9% (31/32)] was significantly higher than that in general hospitals [79.0% (124/157)] and other types of hospitals [64.3% (9/14)] ( P<0.05). Among the 164 hospitals, 310 (150, 637.5) patients underwent breast cancer surgery and 30 (10, 100) patients underwent breast reconstruction in 2022. The proportion of patients undergoing breast reconstruction surgery among breast cancer surgery patients was 13.3% (4.0%, 20.0%). The number of patients receiving immediate breast reconstruction was 11 (2.5, 46.5) cases, and the number of those receiving delayed breast reconstruction was 5 (0, 18.5) cases. Among 203 hospitals, the median proportions of breast oncoplastic surgeons and specialized nurses among healthcare providers in breast surgery departments were 28.6% (2/7) and 75.0% (12/16), respectively. In comparison of the 164 hospitals offering breast reconstruction surgery and 39 hospitals not, the median numbers of breast oncoplastic surgeons were 3 (1, 8) versus 1 (0, 3), and qualified breast reconstruction nurses were 12 (6, 16) versus 1 (0, 8), respectively. All differences were statistically significant (all P<0.01). Conclusion:About 80% of hospitals in China have offered breast reconstruction procedures after breast cancer surgery, and the proportion of Grade Ⅲ Level A hospitals and specialized cancer hospitals is higher than that of other types of hospitals. The proportion of patients undergoing breast reconstruction after breast cancer surgery is relatively low, and there is a considerable potential of improvements. Breast oncoplastic surgeons and nurses are insufficient, so it is necessary to strengthen the training of specialized medical staff and improve surgical techniques and the level of nursing services simultaneously, so as to improve the quality of life of breast cancer patients.