Objective: To explore the therapeutic effects of different surgical methods for temporomandibular joint disc reduction and anchoring surgery, providing reference for optimizing this surgical procedure. Method: The study was approved by the hospital ethics committee. 173 patients (195 joints) who underwent temporomandibular joint disc repositioning and anchoring surgery were selected for retrospective analysis. Patients were categorized into groups A (traditional preauricular incision-scalpel/tissue scissors anterior attachment release), 35 patients (40 joints), B (traditional preauricular incision-plasma bipolar radiofrequency electrode anterior attachment release), 42 patients (46 joints), C (revised tragus incision - scalpel/tissue scissors anterior attachment release), 50 patients (58 joints), and D (revised tragus incision-plasma bipolar radiofrequency electrode anterior attachment release), 46 patients (51 joints). After a 6-month postoperative follow-up, the differences in maximum mouth opening (MMO), visual analogue scale (VAS), effective rate of joint disc reduction, incidence of preauricular numbness, obvious scars among patients in each group at 1, 3, and 6 months were compared postoperatively. Results: After surgery, the MMO of all four groups of patients initially shrunk and then gradually increased compared to before surgery. At the 1-month follow-up after surgery, the plasma bipolar radiofrequency release (B+D) group had a smaller impact on the patient’s MMO compared to the surgical knife/tissue scissors release (A+C) group (P < 0.05). Postoperative VAS scores for all four groups showed a gradual decrease from pre-operative levels, with the (B+D) group scoring significantly lower in the first month post-surgery compared to the (A+C) group (P < 0.05). Six months post-surgery, the rate of joint disc reduction of the four groups were higher than 95%, with no significant differences observed between the groups (P > 0.05). Patients in the revised tragus incision (C+D) group experienced a lower rate of preauricular numbness compared to those in the traditional preauricular incision (A+B) group (4.59% vs. 12.79%, P < 0.05), The incidence of obvious scars in the (C+D) group was significantly lower than that in the (A+B) group (3.67% vs. 23.26%, P < 0.05). Conclusion The revised tragus incision is superior to traditional preauricular incision in terms of protecting the auriculotemporal nerve and the scars were more inconspicuous. Further, the plasma bipolar radiofrequency electrode is superior to the scalpel/tissue scissors in terms of mouth opening recovery and pain control. For temporomandibular joint disc reduction and anchoring surgery, a modified tragus incision combined with plasma bipolar radiofrequency electrode to release the anterior attachment of the joint disc can be recommended as a surgical option.

Objective To explore the different potential subtypes of psychosocial adaptation among young and middle-aged stroke patients,and analyze the relationship between different potential subtypes and quality of life,so as to provide references for the subsequent development of targeted interventions.Methods A total of 406 young and middle-aged stroke patients in 4 tertiary hospitals in Suzhou from June 2023 to June 2024 were recruited by convenience sampling.The General Information Questionnaire,the Self-Report Psychosocial Adjustment to Illness Scale and the EuroQol five-dimensional questionnaire were conducted for investigation.Latent profile analysis was used to explore the potential subtypes of psychosocial adaptation among young and middle-aged stroke patients.Generalized linear regression analysis was conducted with quality of life as dependent variables.Results A total of 380 young and middle-aged stroke patients were included.The psychosocial adaptation of patients could be classified into 3 potential subtypes:high adaptation level type(23.90％),medium adaptation level with health concerns type(46.40％),and low adaptation level with psychological barriers type(29.70％).The results of generalized linear regression analysis showed that potential subtypes of psychosocial adaptation were the influencing factors for quality of life in young and middle-aged stroke patients(P＜0.05).Conclusion There was group heterogeneity in psychosocial adaptation among young and middle-aged stroke patients,and the potential subtype of psychosocial adaption was an important factor affecting the quality of life of patients.It is suggested that medical staff should focus on patients with low adaptation level with psychological barriers type,and take targeted interventions according to characteristics of different subtypes of patients,so as to improve their quality of life.

MicroRNA(miRNA)serves as a novel regulatory factor in viral and bacterial co-infections,exhibiting dual regulatory roles during pathogen infections.On the one hand,it exerts protective effects by modulating viral replication cycles and host anti-infection immune responses.On the other hand,it can be exploited by pathogens to promote infection progression,including influencing viral replication,antiviral immune responses,and regulating bacterial adhesion and proliferation.Mixed viral and bacterial infections lead to high mortality rates.By binding to specific target gene mRNA,miRNA degrades or inhibits its translation,thereby regulating target gene expres-sion,which may ultimately serve as potential diagnostic and therapeutic targets.This paper reviews recent ad-vances in research on the role of miRNA in viral and bacterial infections,particularly its mechanisms in co-infec-tions,aiming to provide theoretical reference for further research on the infection mechanisms.

In recent years, idiopathic macular hole (IMH) surgery has a very high success rate due to the development of small-gauge vitrectomy, while the recovery of visual acuity is not satisfactory.Current studies have found that continuity of retinal blood vessels in the macular area and changes in retinal and choroidal perfusion are closely related to the formation and healing of MH, and have a significant impact on the visual prognosis in IMH patients.This article reviews the research progress on variations of parameters for retinal and choroidal vessels in IMH patients, as well as their relationship with visual prognosis.For retinal parameters, the changes in the foveal avascular zone, superficial and deep capillary plexus density, paracentral intraretinal cystoid spaces, retinal vessels position are discussed.Relevant research related to choroidal blood flow perfusion changes and the effects of different surgical methods on macular perfusion in patients with IMH are summarized to provide basis for further understanding the etiology and prognosis of IMH.

Background and purpose:In recent years,chimeric antigen receptor T(CAR-T)cell therapy has achieved breakthrough progress in cancer treatment.γδ T cells,with their non-major histocompatibility complex(MHC)-restricted antigen recognition,broad antitumor activity,and low risk of graft-versus-host disease(GVHD),have garnered significant interest in CAR-γδ T cell therapy.However,critical challenges including suboptimal in vitro expansion and low viral transduction efficiency severely hinder the research and clinical application of CAR-γδ T cells.This study aimed to establish an efficient platform for preparing CAR-γδ T cells by optimizing the in vitro expansion conditions of γδ T cells and refining lentiviral transduction strategies.Methods:We first optimized the expansion protocol for γδ T cells by screening various cytokine combinations and the concentrations of individual cytokines within combination,and evaluating cell purity,viability,fold expansion,and expressions of cytotoxicity and exhaustion markers to identify the optimal culture conditions.Subsequently,the transduction conditions for CAR-γδ T cells were improved by determining the optimal activation duration of γδ T cells prior to gene transfer,as well as the optimal multiplicity of infection(MOI)for lentiviral transduction.Finally,CAR-γδ T cells were successfully generated using the optimized protocol,and their cytotoxic activity against target cells was validated via calcein-release assay and flow cytometry,with a preliminary assessment of the potential risk of GVHD induction.Results:Experimental data demonstrated that,compared with the interleukin(IL)-2-only culture,the IL-2+IL-7+IL-15 combination significantly enhanced the expansion capacity of γδ T cells(876.50±238.35-fold vs 1 627.50±472.15-fold),cell purity(73.67%±1.53%vs 90.69%±2.00%),and cell viability(63.01%±7.05%vs 89.00%±3.61%).It also increased the expression of the cytotoxicity marker CD16(4.20%±1.73%vs 14.66%±0.58%)and reduced the expression of the exhaustion marker programmed death-1(PD-1)(35.67%±6.26%vs 21.10%±6.49%).A cytokine concentration gradient orthogonal assay further identified 10 ng/mL IL-7 and 10 ng/mL IL-15 as the optimal concentrations within the IL-2+IL-7+IL-15 combination.Gene transduction performed 96-120 h after activation using a multiplicity of infection(MOI)of 5-10 resulted in the highest transduction efficiency for CAR-γδ T cells(96 h:12.87%±4.35%;120 h:11.37%±2.35%).CAR-γδ T cells generated using the optimized system exhibited specific cytotoxic effects against tumor cells expressing the target antigen,and no evidence of GVHD induction was observed.Conclusion:CAR-γδ T cells produced using the IL-2+IL-7(10 ng/mL)+IL-15(10 ng/mL)regimen combined with a 96-120 h activation period prior to transduction using a multiplicity of infection(MOI)of 5-10 significantly outperformed conventional methods in terms of expansion efficiency,cell purity,and transduction efficiency.The synergistic antitumor effects mediated by both natural immune receptors and CAR-specific recognition,along with the initial absence of GVHD risk,provide critical technical support for the clinical translation of CAR-γδ T cell therapy,establishing a solid theoretical and practical foundation.

Objective To investigate the effects of transcutaneous electrical nerve stimulation(TENS)combined with mobilization with movement(MWM)on clinical efficacy,musculoskeletal ultrasound findings and bone metabolism indicators in patients with knee osteoarthritis(KOA).Methods Ninety KOA patients were collected and randomly divided into the control group(conventional rehabilitation+TENS,n=45)and the observation group(conventional rehabilitation+TENS+MWM,n=45)using a random number table.Clinical efficacy,knee joint function,musculoskeletal ultrasound indices and bone metabolism indices were compared between the two groups.Results The clinical efficacy of the observation group was superior to that of the control group(P＜0.05).At 2 and 6 months post-treatment,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were significantly lower in the observation group than those of the control group,and Lysholm Knee Scoring Scale scores were higher in the observation group than those of the control group(P＜0.05).Additionally,articular cartilage thickness,bone gla protein(BGP)and bone-specific alkaline phosphatase(BALP)were higher in the observation group than those of the control group,and synovial thickness,suprapatellar effusion and tartrate-resistant acid phosphatase 5b(TRACP-5b)were lower in the observation group than those of the control group(P＜0.05).Conclusion TENS combined with MWM in the treatment of KOA patients can not only improve knee joint function but also optimize musculoskeletal ultrasound indices and regulate bone metabolism indices.

Objective:To develop an electronic information platform-based assessment tool for entrustable professional activities (EPAs) of master of nursing specialist (MNS) students.Methods:The study used the content analysis method to construct the draft of the assessment tool, which was finalized using the expert meeting method. An electronic information platform was developed based on the assessment tool. The functions of the platform was optimized using the focus group interview method.Results:Based on previous research on the EPA framework for MNS students, an EPA assessment tool was developed, including an assessment form and an assessment protocol. The assessment form consisted of three parts: description of the EPAs, supervision level, and narrative feedback. The assessment protocol covered the assessment objects, assessment initiation strategy, assessment implementation-entrustment decision making, assessment cycle, and quality control. The electronic information platform includes both web-based and mobile app interfaces, with user roles for clinical instructors, graduate students, and project administrators, and with functions such as assessment application, assessment initiation, historical assessment review, and assessment information management.Conclusions:The study developed an EPA assessment tool for MNS students. The tool relies on the convenience and efficiency of the electronic information platform, facilitates clinical instructors in observing the comprehensive performance of MNS students in multiple competencies, and promotes postgraduate students' professional development. Future research will further explore the effectiveness of this tool in assessing clinical practice competencies of MNS students, with the aim of advancing the practice of EPAs in nursing masters' education.

This paper reviews the current situation of massive open online course (MOOC) construction both domestically and internationally, highlighting the similarities, differences, and limitations of MOOC construction across nations. Based on the full-cycle MOOC construction of the "clinical epidemiology" course at Southern Medical University, including course design, resource integration, online deployment, and teaching evaluation, this study explored the significance, implementation path, and challenges of MOOC construction. This paper also reflects on the activation of teaching content, teacher-student interaction, and teaching mode, aiming to provide a reference for the construction and continuous enhancement of MOOC in China.

Objective To investigate the relationship between prolactin and mild cognitive impairment(MCI)in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods A total of 319 postmenopausal women with T2DM who were hospitalized in the Department of Endocrinology,Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University were enrolled in this study from August 2016 to October 2023.All the patients were divided into two groups according whether they had MCI:T2DM group(n=161)and MCI group(n=158).Differences in clinical characteristics were compared between the two groups.Pearson correlation was used to analyze the correlation between sex hormones and cognitive domains,and Logistic regression analysis was used to evaluate the influencing factors for MCI development.Results Serum prolactin levels were significantly lower in the MCI group than in the T2DM group[(5.5±2.1)vs(7.2±2.9)μg/L,P<0.05].Serum prolactin level was positively correlated with mini-mental state examination score,Montreal cognitive assessment score,immediate memory score,visuopatial constructional score,attention score and hippocampal volume(P<0.05),and negatively correlated with processing speed test(time)and executive function test(time)(P<0.05).Logistic regression analysis demonstrated that serum prolactin level was an influencing factor for the risk of MCI in postmenopausal women with T2DM(OR 0.715,95%CI 0.605～0.845,P<0.01).Conclusions The decrease of serum prolactin level is associated with an increased risk of MCI in postmenopausal women with T2DM.

Objective To investigate the potential role of plasma adiponectin concentration in predicting the response of patients with depression to electroconvulsive therapy(ECT).Methods This study enrolled depressive patients scheduled for ECT at the First Hospital of Shanxi Medical University between January 2022 and March 2024.Patients were categorized as either ECT responders(>50%reduction)or non-responders(≤50%reduction)based on post-ECT reduction rate of the 24-item Hamilton depression scale(HAMD)scores from baseline.Plasma adiponectin levels were measured in all patients before their first ECT treatment.To identify predictors of ECT response in patients with depression,the predictive value of plasma adiponectin was evaluated using receiver operating characteristic(ROC)curve analysis.Results A total of 80 patients with depression were enrolled including 44 in the ECT-responsive group and 36 in the non-responsive group.The plasma adiponectin level was significantly higher in the responsive group than in the non-responsive group[5.67(3.64,10.55)μg/mL vs.4.01(2.59,5.04)μg/mL,P=0.002].Pearson correlation analysis revealed a significant positive correlation between plasma adiponectin levels and the HAMD reduction rate(r=0.300,P=0.007).Multivariate logistic regression analysis showed that plasma adiponectin was independently associated with the response to ECT in patients with depression(OR=1.218,95%CI:1.009-1.470,P=0.040).Furthermore,ROC curve analysis demonstrated that the area under the curve(AUC)for adiponectin in predicting ECT response was 0.748(95%CI:0.583-0.813).Conclusion Pretreatment plasma adiponectin may serve as a potential biomarker for predicting response to ECT in patients with depression.