Objective: To systematically evaluate the clinical efficacy of topical preparations of Mongolian medicine Manggari hot compress therapy (hereafter referred to as Manggari hot compress therapy) in treating cervical spondylotic radiculopathy (CSR) and explore the possible pharmacological material basis in the formula, providing evidence for the clinical application of Mongolian medicine in the treatment of CSR. Methods: The clinical trial employed a randomized, controlled, open-label, and outcome-assessor-blinded design. The CSR patients who were treated at the Department of Traditional Therapeutics Outpatient Clinic, Xilinguole Meng Mongolian General Hospital between July 1, 2024 and August 31, 2025, were enrolled. They were randomly assigned to three groups: an oral control group (administration of oral administration of mecobalamin tablets combined with cervical electric traction), an experimental group (Manggari external hot compress), and a patch control group (flurbiprofen gel plaster). The intervention lasted two weeks. Before and after treatment, the following subjective indicators were recorded: Mongolian Medicine Syndrome (MMS) score, Visual Analog Scale (VAS) score, Northwick Park Neck Pain Questionnaire (NPQ) score, and tongue morphology. Serum levels of inflammatory markers [tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β)] and oxidative stress markers [malondialdehyde (MDA) content, superoxide dismutase (SOD) activity, and glutathione peroxidase (GSH-Px) activity] were measured using enzyme-linked immunosorbent assay (ELISA). Overall therapeutic efficacy was evaluated. One month after treatment completion, a follow-up assessment was conducted, and the MMS, VAS, and NPQ scores were recorded again for all patients. For the pharmacological substance exploration, ultra-high-performance liquid chromatography-Q-exactive orbitrap-mass (UHPLC-QE-MS) was employed to analyze blood-absorbed prototype components of Manggari, under both positive and negative ion modes. The targeting relationship between the core active compounds and the target protein was validated using molecular docking. Results: This study ultimately included 90 patients with CSR for analysis. Baseline characteristics showed no statistically significant differences among the three groups (P > 0.05). (i) Symptom scores. After treatment, the MMS, VAS, and NPQ scores decreased significantly from baseline in all three groups (P < 0.001). At follow-up, there was no significant difference in MMS, VAS, and NPQ scores of the experimental group compared with those at the end of the treatment (P > 0.05). After treatment, the experimental group showed significantly greater reductions in MMS, VAS, and NPQ scores than oral control and patch control groups (P < 0.001). At follow-up, these differences remained significant (P < 0.001). (ii) Inflammatory and oxidative stress markers. After treatment, serum levels of TNF-α, IL-6, and IL-1β, and MDA activity decreased significantly from baseline in all three groups (P < 0.001), and SOD content and GSH-Px activity increased significantly from baseline (P < 0.05). After treatment, the experimental group had significantly lower serum levels of TNF-α, IL-6, and IL-1β than oral and patch control groups. Additionally, it exhibited lower MDA activity and higher SOD content and GSH-Px activity compared with the two control groups. (P < 0.05). (iii) Overall efficacy. The total effective rate was 93.33% in the experimental group, 86.66% in the oral control group, and 83.33% in the patch control group. (iv) Pharmacological substance analysis. A total of 152 compounds were identified in the blood-absorbed components of Manggari. Among them, the core compounds—4-hydroxycoumarin, N-methylanthranilic acid, genistein, and ginsenoside-Rk1—showed binding energies to the key target proteins TNF-α and IL-1β range from − 4.7 to − 7.1 kcal/mol, with the majority of the binding energies being below − 5.0 kcal/mol, suggesting that it generally has a good binding affinity. Conclusion Mongolian medicine hot compress therapy effectively modulates inflammatory and oxidative stress responses through the combined action of its thermal effects and active pharmaceutical ingredients Manggari. It inhibits cervical nerve root inflammation and alleviates radicular pain, improving clinical symptoms, reducing pain severity, and alleviating neck functional disability.

Objective:To establish a complete system for the isolation, purification, identification, and culture of Kaposiform hemangioendothelioma-derived endothelial cells (KHE-ECs), to analyze the phenotype of KHE-ECs, and to explore the possibility of establishing a KHE-EC bank.Methods:A novel digestion solution for KHE tumors (patent number: CN202410500224.2) was formulated using collection fluid, Liberase TM and dispase stock solutions, and was used to process tumor tissues to obtain cells. High-purity KHE-ECs were purified using CD31 + immunomagnetic beads. The EGM-2 complete medium containing 10% fetal bovine serum and 2% penicillin-streptomycin solution was employed for cell culture. To verify the characteristics of KHE-ECs, immunofluorescence assay was conducted to determine the expression of endothelial cell-specific markers CD31 and CD34, KHE disease markers podoplanin (D2-40), prospero-related homeobox 1 (Prox-1), and lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1), as well as an infantile hemangioma-specific diagnostic marker glucose transporter 1 (GLUT-1). Human umbilical vein endothelial cells (HUVECs) served as controls for the phenotype analysis of KHE-ECs, including cell viability, cytoskeleton, proliferation, migration, invasion, tube formation, and sprouting ability. Results:Primary cells were successfully isolated from KHE tumor tissues, and high-purity KHE-ECs were obtained by using CD31 + immunomagnetic beads. The cells exhibited typical spindle-shaped morphology and an adherent growth pattern. Immunofluorescence assay showed that KHE-ECs expressed CD31, CD34, D2-40, Prox-1, and LYVE1, but did not express GLUT-1. There were significant differences in cell morphology, cell viability, and cytoskeletal structures between KHE-ECs and HUVECs. Additionally, the KHE-EC group showed significantly increased percentages of proliferative cells (29.1% ± 2.5%), numbers of migratory cells (114.3 ± 9.4) and invasive cells (110.0 ± 6.1), tube length (32 121.0 ± 892.0 μm), and number of sprouting cells (25.0 ± 3.6) compared with the HUVEC group (13.0% ± 2.2%, 38.0 ± 3.6, 35.3 ± 2.3, 25 345.0 ± 448.1 μm, 5.0 ± 1.0, respectively, all P ≤ 0.001) . Conclusion:An innovative digestion solution specifically for KHE tumors was formulated for the first time, and high-purity and well-growing KHE-EC strains were successfully isolated and purified by using the novel digestion solution in combination with CD31 + immunomagnetic beads, providing a stable and reliable cell source for subsequent experimental studies on KHE and laying the foundation for establishing a KHE-EC bank.

Objective To re-evaluate systematic reviews on the application of virtual reality(VR)technology in limb rehabilitation for stroke patients,providing evidence to support the implementation of VR.Methods Systematic searches were conducted in Web of Science,PubMed,CINAHL,Cochrane Library,Embase,CNKI,CBM,WanFang,and VIP databases from their inception until March 2025,identifying systematic reviews/meta-analyses investigating VR for limb rehabilitation in stroke patients.2 researchers independently screened the literature.Methodological quality was evaluated using the Assessment of Mutiple System Reviews 2(AMSTAR 2)tool;reporting quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines;evidence quality was graded using the Grades of Recommendations Assessment,Development,and Evaluation(GRADE)system;literature overlap was assessed using the Corrected Covered Area(CCA)method.Results A total of 15 articles were included.According to AMSTAR 2,totally 3 reviews were of moderate quality,while the remainder were rated as low or very low quality.PRISMA scores ranged from 19.5 to 27.0 points.Based on GRADE,a review was classified as high quality,6 as moderate quality,and the remainder as low or very low quality.The CCA was 5.3％,indicating slight overlap.Conclusion VR contributes to the improvement of indicators such as upper limb motor function/mobility and lower limb balance in stroke patients.However,methodological limitations,including weak control of bias and inadequate handling of heterogeneity among included studies,restrict the overall quality of evidence.Further standardized,high-quality studies are needed to provide more reliable evidence to support clinical decision-making.

Objective:To investigate clinicopathologic characteristics and molecular genetic profiles of embryonal rhabdomyosarcoma (ERMS) of the middle ear.Methods:A total of 11 cases of primary middle ear ERMS diagnosed and treated at the Fudan University Affiliated Eye and ENT Hospital between January 2016 and June 2024 were collected. Their clinicopathologic features, immunophenotypes, and molecular genetic alterations were analyzed. Relevant literature was reviewed.Results:There were 8 male and 3 female children. The mean age was 6 years, median age, 6 (5, 7) years, with a range of 1 to 11 years. Clinical manifestations included otorrhea, ear pain, ear fullness, tinnitus, and hearing loss, with some patients also presenting with facial paralysis, hoarseness, and choking on drinking. Otoscopic examination revealed granulomatous neoplasms in the external auditory canal. Imaging studies showed irregular soft-tissue masses in the middle ear region, accompanied by bony destruction and invasion of adjacent structures. Histologically, 10 of the tumors were composed of primitive small round cells, stellate cells, and short spindle-shaped cells, with an alternating loose and dense distribution pattern, and varying degrees of rhabdomyoblastic differentiation in some areas. One tumor exhibited the classic botryoid subtype morphology. Immunohistochemistry supported the diagnosis of rhabdomyosarcoma, and the Ki-67 proliferation index ranged from 40% to 80%. Next-generation sequencing (DNA-seq) was performed on 9 cases, revealing copy number variations of chromosome 7 in 4 cases, PDE4DIP mutations in 5 cases, and C19orf69::TPM3 gene fusions in 6 cases. HPV PCR testing showed HPV11 positivity in 2 cases. All 11 patients underwent surgical treatment, with 4 patients receiving adjuvant chemoradiotherapy. Follow-up until February 2025 revealed 8 deaths, among which 4 cases harbored both C19orf69::TPM3 fusions and PDE4DIP mutations and one had C19orf69::TPM3 fusions alone.Conclusions:ERMS of the middle ear is a rare type of malignant tumor with a relatively poor prognosis. Our study indicates that the concurrence of PDE4DIP mutation and C19orf69::TPM3 gene fusion may indicate poor prognosis in middle ear EMRS, providing a potential target for subsequent individualized treatment.

Purpose To analyze the impact of early renal complication on brain function in diabetes using the amplitude of low frequency fluctuations(ALFF)and functional connectivity(FC).Materials and Methods A total of 39 early diabetic kidney disease patients and 49 diabetic patients without kidney disease were included at the First Affiliated Hospital of Army Medical University from September 2023 to June 2024.Cognitive assessments were conducted using the Montreal cognitive assessment(MoCA)and mini-mental state examination(MMSE).All subjects underwent resting-state functional magnetic resonance imaging.Differences in brain function between the two groups were analyzed by ALFF and FC.In the early diabetic kidney disease group,the correlation and stepwise multiple linear regression analysis were performed between imaging difference indicators and clinical variables.Results In the early diabetic kidney disease patients,there was a decrease in ALFF values in the left calcarine(P<0.05,corrected for FWE),but an increase in FC with the left putamen(P<0.05,corrected for FWE).The ALFF values showed a negative correlation with urinary albumin-to-creatinine ratio and total cholesterol(r=-0.595,-0.351,both P<0.05)and a positive correlation with MoCA and MMSE scores(r=0.596,0.591,both P<0.001).The FC values were positively correlated with urinary albumin-to-creatinine ratio(r=0.552,P<0.001),while negatively correlated with MoCA and MMSE scores(r=-0.497,P=0.011;r=-0.529,P<0.001).Conclusion Early renal complications can affect changes in brain function and cognitive abilities in diabetic patients;alterations in the ALFF of the left calcarine and its FC with left putamen may serve as imaging biomarkers for monitoring cognitive impairment and brain injury in early diabetic kidney disease.

With the development of echocardiographic technology,the evaluation of left atrial function has become increasingly crucial in predicting cardiovascular risks in minors.The conventional two-dimensional and Doppler ultrasound can assess the left atrial volume and diastolic function,while have limited accuracies.In recent years,the emerging ultrasound two-dimensional speckle tracking echocardiogra-phy(2D-STE)has made it possible to evaluate the three phases of left atrial function(reservoir,conduit,booster pump),which is more sensitive and suitable for high-risk minors with cardiomyopathy,obesity,or undergoing chemotherapy.This article reviews the progress of 2D-STE in evaluating left atrial function in minors,and discusses its potential and challenges in early clinical diagnosis and prognosis assessment,with the aim of providing a reference for clinical practice.

The success of"New Medical Sciences"in higher education requires effective tools in evalua-ting students'performance in courses.Previously,we reported a teamwork(T),critique(C)and ap-preciation(A)(TCA)ideological and political model,a teaching model widely applied in Basic Medical courses.TCA is an abbreviation derived from Tricarboxylic Acid Cycle in Biochemistry as an analogy for nurturing the abilities of thinking and teamwork(T),critique(C)and appreciation(A),which hope-fully could provide students with moral norms for cognition,science and life.This paper further explores the tools to assess the educational outcomes of the TCA model,by which teachers can collect feedback and reflect on teaching quality and effectiveness.Addressing the challenges of individual differences in large classes,fragmented learning feedback,and the difficulty of measuring meta-cognition in educational evaluation,this study employs strategies of value-added assessment,matrix assessment and norm-transfer-able assessment to evaluate the TCA abilities from the aspects of thinking quality,thinking creativity,co-operation ability,iterative thinking,dialectical thinking and job responsibility.By modifying/using 18 e-valuation tools in Education and Psychology,we have established a rubric system composed of 30 primary indicators(with 11 newly designed,10 partly modified and 9 directly adopted),along with 49 secondary indicators and 98 tertiary indicators to enhance the feasibility of the evaluation process.This rubric sys-tem was applied to Biochemistry teaching among the five-year-program undergraduates at Air Force Medi-cal University.Specifically,thinking and teamwork are evaluated by creative works from"the magic bio-chemical-circle",while critiques are assessed in large classes under the guidance of basic and clinical teachers,coupled with appreciation measured by job responsibility in a task-driven virtual reality(VR)project.The results indicate that Biochemistry teaching not only accumulates knowledge in students,but also achieves the goals in nurturing values and cognition.The inclusion of creative performance evalua-tion,cooperative learning and clinical case studies,can enhance students'interpersonal skills,coopera-tion,quality of thinking,creative thinking,iterative thinking and dialectical thinking to varying degrees.TCA-based Biochemistry teaching has a long-lasting impact on character education,and is capable of in-ducing positive long-term changes in students'cognition and lifestyle.Taken together,with the help of this rubric system,teachers can promptly acknowledge the effectiveness of their teaching,thereby facilita-ting their teaching strategies.

Objective:To explore the application strategies and clinical effects of superior gluteal artery perforator tissue flaps in repairing stage Ⅳ pressure ulcers in the sacrococcygeal region.Methods:This study was a retrospective observational study. From July 2019 to April 2024, 89 patients with stage Ⅳ pressure ulcers in the sacrococcygeal region who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 59 males and 30 females, aged 21 to 84 years. There were 89 sacrococcygeal pressure ulcers, with an area of 5.0 cm×4.0 cm-21.0 cm×21.0 cm after debridement. According to the shape, size, and depth of the wounds after debridement, combined with the elasticity and texture of the skin around the wounds, and the principle of minimizing damage to the donor area, the appropriate forms of superior gluteal artery perforator tissue flaps were cut for wound repair in the following three conditions. (1) For wounds with a round shape, an area of 5.0 cm×5.0 cm-21.0 cm×21.0 cm, and a depth of 1.0-3.5 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, bilobed superior gluteal artery perforator relay flap, and bilateral superior gluteal artery perforator rotational flap were used. (2) For wounds with an oval shape, an area of 5.0 cm×4.0 cm-18.5 cm×10.5 cm, and a depth of 1.0-3.0 cm, the superior gluteal artery perforator propeller flap or myocutaneous flap, unilateral superior gluteal artery perforator propeller flap combined with contralateral superior gluteal artery perforator V-Y advanced flap or keystone flap were used. (3) For wounds with a fusiformis shape, an area of 7.0 cm×4.0 cm-17.5 cm×6.0 cm, and a depth of 1.5-5.0 cm, the unilateral or bilateral superior gluteal artery perforator V-Y advanced flap, superior gluteal artery perforator keystone flap, or superior gluteal artery perforator keystone flap combined with gluteus maximus muscle flap were used. In this group of patients, a total of 40 superior gluteal artery perforator propeller flaps (with an resection area of 11.0 cm×6.0 cm-17.0 cm×11.0 cm), 22 superior gluteal artery perforator propeller myocutaneous flaps (with an resection area of 10.0 cm×5.0 cm-14.0 cm×8.0 cm), 7 bilobed superior gluteal artery perforator relay flaps (with a main flap resection area of 5.5 cm×5.5 cm-18.0 cm×11.5 cm and a side flap resection area of 4.5 cm×3.0 cm-11.0 cm×6.5 cm), 5 bilateral superior gluteal artery perforator rotational flaps (with a total resection area of 20.0 cm×16.0 cm-26.0 cm×21.0 cm on both sides), 14 superior gluteal artery perforator V-Y advanced flaps (with an resection area of 12.0 cm×10.0 cm-18.0 cm×18.0 cm), 13 superior gluteal artery perforator keystone flaps (with an resection area of 13.0 cm×6.5 cm-19.0 cm×18.0 cm), and 3 gluteus maximus muscle flaps (with an resection area of 8.0 cm×3.0 cm-15.0 cm×4.5 cm). The donor area wounds were all directly sutured. The survival of tissue flaps was observed and the incidence rate of delayed wound healing in the reception area was calculated, and wound healing in the donor area was observed. The appearance and texture of tissue flaps and recurrence of pressure ulcers were followed up.Results:After surgery, all bilateral superior gluteal artery perforator rotational flaps, superior gluteal artery perforator V-Y advanced flaps, superior gluteal artery perforator keystone flaps, and gluteus maximus muscle flaps survived well. There were 6 cases of delayed wound healing in the reception area after surgery, with an incidence rate of 6.7% (6/89). Two patients had incision dehiscence in the donor area wounds due to postoperative bleeding, the wounds healed after debridement, vacuum sealing drainage, and dressing change. The wounds in the donor area of the remaining patients healed well. Six patients were lost to follow-up. Eighty-three patients were followed up for 3-48 months, of whom 4 patients died. Among the remaining 79 patients, 3 cases had pressure ulcers recur due to improper nursing, while the rest of the patients had tissue flaps with good appearance and soft texture and no recurrence of pressure ulcers.Conclusions:Based on the characteristics of wound shape, size, and depth after debridement of stage Ⅳ pressure ulcers in the sacrococcygeal region, individualized selection of flap, myocutaneous flap, or a combination of flap and gluteus maximus muscle flap based on the perforating branch of the superior gluteal artery perforator can achieve good clinical repair results. The postoperative tissue flap survived well, with a good appearance, soft texture, and less recurrence of pressure ulcers.

Objective:To investigate the optimal timing of oral propranolol treatment for proliferative infantile hemangiomas (IH) .Methods:A bidirectional cohort study was conducted. Infants with proliferative IH receiving oral propranolol treatment were collected from the Department of Pediatric Surgery, West China Hospital, Sichuan University between June 2015 and May 2019, and their general information and IH-related clinical data were analyzed. The primary outcome was the satisfactory regression rate of IH during 6-12 months of continuous oral propranolol treatment; secondary outcomes included the time to achieve satisfactory regression, incidence of adverse reactions, incidence of IH ulceration, and IH recurrence rate. Multivariate logistic regression was performed to identify factors influencing the satisfactory regression of IH after propranolol treatment, and a receiver operating characteristic (ROC) curve was employed to determine the optimal age for initiating propranolol therapy.Results:A total of 122 IH infants were enrolled in the study, including 32 males (26.2%) and 90 females (73.8%), with ages ( M[ Q1, Q3]) of 8.6 [6.3, 12.3] weeks. IH was located on the head and face in 56 cases (45.9%). There were 57 cases (46.7%) of localized IH, 53 (43.4%) of segmental IH, and 86 (70.5%) of mixed-type IH. Ulceration occurred in 17 cases (13.9%). After 6 months of propranolol treatment, 8 patients (6.6%) experienced treatment failure, and 12 (9.8%) experienced relapse within 6 months after discontinuation of propranolol. During 6 months of oral propranolol treatment, 56 infants (45.9%) experienced mild to moderate adverse reactions, with no drug-related deaths observed. Multivariate logistic regression analysis revealed that the age at initiation of propranolol treatment was an independent factor influencing satisfactory regression of IH ( OR = 0.879, 95% CI: 0.808 - 0.957). ROC curve analysis revealed that the optimal age for starting propranolol therapy was 9.9 weeks, with a sensitivity of 75.7% and a specificity of 61.5%. Infants aged ≤ 9.9 weeks (73 cases) had a significantly higher satisfactory regression rate (72.6% [53/73]) compared with those aged > 9.9 weeks (49 cases, 34.7% [17/49]; χ2 = 17.23, P < 0.001) ; the time to achieve satisfactory regression of IH was significantly shorter in the infants aged ≤ 9.9 weeks ( M[ Q1, Q3]: 46.0 [38.5, 48.0] weeks) than in those aged > 9.9 weeks (57.0 [40.0, 73.5] weeks; Z = -2.01, P = 0.045) . Conclusion:For IH infants requiring systemic therapy, initiation of oral propranolol before the age of 10 weeks appeared to improve the satisfactory regression rate of IH.

Objective To re-evaluate systematic reviews on the application of virtual reality(VR)technology in limb rehabilitation for stroke patients,providing evidence to support the implementation of VR.Methods Systematic searches were conducted in Web of Science,PubMed,CINAHL,Cochrane Library,Embase,CNKI,CBM,WanFang,and VIP databases from their inception until March 2025,identifying systematic reviews/meta-analyses investigating VR for limb rehabilitation in stroke patients.2 researchers independently screened the literature.Methodological quality was evaluated using the Assessment of Mutiple System Reviews 2(AMSTAR 2)tool;reporting quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines;evidence quality was graded using the Grades of Recommendations Assessment,Development,and Evaluation(GRADE)system;literature overlap was assessed using the Corrected Covered Area(CCA)method.Results A total of 15 articles were included.According to AMSTAR 2,totally 3 reviews were of moderate quality,while the remainder were rated as low or very low quality.PRISMA scores ranged from 19.5 to 27.0 points.Based on GRADE,a review was classified as high quality,6 as moderate quality,and the remainder as low or very low quality.The CCA was 5.3％,indicating slight overlap.Conclusion VR contributes to the improvement of indicators such as upper limb motor function/mobility and lower limb balance in stroke patients.However,methodological limitations,including weak control of bias and inadequate handling of heterogeneity among included studies,restrict the overall quality of evidence.Further standardized,high-quality studies are needed to provide more reliable evidence to support clinical decision-making.