Background: While advanced age is a known risk factor for postoperative complications following hip arthroplasty, its role as an independent predictor versus a surrogate for comorbidity remains unclear, particularly in developing countries. This study aimed to investigate the independent impact of age on postoperative outcomes and explore the mediating role of key comorbidities in a resource-limited setting. Methods: We retrospectively reviewed 769 adult patients undergoing hip arthroplasty at a Vietnamese tertiary hospital (2021–2024), categorized into three groups: younger adults (18–64 years), older adults (65–79 years), and oldest old (≥80 years). The primary outcome was a composite of major postoperative complications. Multivariable logistic regression and structural equation modeling were used to identify independent predictors and assess mediation effects. Results: Among 769 patients, 363 were younger (47.2%), 241 older adults (31.3%), and 165 oldest old (21.5%). Complication rates increased significantly with age (18.7%, 36.9%, and 60.0%, respectively; p<0.001). However, multivariable adjustment showed that age was not an independent predictor. Instead, heart failure (adjusted odds ratio [aOR]=5.49, 95% confidence interval [CI] 2.19–13.74) and preoperative anemia (aOR=1.77, 95% CI 1.21– 2.59) were identified as independent risk factors. Mediation analysis revealed that the effect of age on complications was significantly mediated through preoperative anemia. Conclusion Increased postoperative risk in older adults is driven by comorbidity burden rather than chronological age. Preoperative anemia and heart failure are critical, independent predictors, with anemia acting as a key mediator for the effects of age. Individualized correction of modifiable comorbidities may be more beneficial than using age alone to assess surgical risk.

Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, largely because of challenges in early diagnosis and the limited sensitivity of conventional biomarkers. Therefore, reliable molecular tools for early detection, prognostic stratification, and individualized treatment predictions are urgently required. Methods: This retrospective study analyzed publicly available gene expression datasets. Candidate biomarkers were identified from the GSE14520 cohort using a multistep screening workflow that integrated differential expression analysis, diagnostic performance, and prognostic relevance. A 10-gene diagnostic model was constructed using least absolute shrinkage and selection operator logistic regression and subsequently validated across multiple independent cohorts. Survival outcomes were evaluated using the Kaplan-Meier analysis and treatment responses to sorafenib and transarterial chemoembolization (TACE) were assessed using receiver operating characteristic analysis. Results: A 10-gene signature (TOP2A, CDK1, CYP3A4, MASP2, EPHX2, HAO1, RACGAP1, GLYAT, ADH1B, and CYP4A11) was established. The model demonstrated robust internal performance and consistent accuracy across external validation cohorts (area under the curve [AUC], >0.9). This signature effectively identified early-stage HCC and distinguished malignancy from cirrhosis. High-risk scores were significantly associated with poor overall survival and recurrence-free survival (p<0.05). Furthermore, the model could predict treatment sensitivity, with higher risk scores associated with better outcomes for sorafenib (AUC, 0.791), whereas lower risk scores correlated with an improved response to TACE (AUC, 0.768). Conclusion Our gene expression-based machine learning model provides a robust tool for HCC diagnosis, prognosis, and treatment response prediction, with potential as a supportive system for personalized clinical decision-making.

Objective To investigate the expressions of annexin A2 and glycogen synthesis kinase-3β(GSK-3β)in cutaneous squamous cell carcinoma(CSCC)tissues,and to analyze their correlation with CSCC as well as their clinical pathological diagnostic value.Methods The pathological tissues of 68 patients with CSCC and 40 patients with keratoacanthoma(KA)who underwent surgical treatment in the Department of Dermatology of the Second Hospital of Nanning from October 2020 to May 2024 were collected,and the surrounding normal skin tissues of 32 patients with benign skin diseases were used as controls.The expressions of annexin A2,GSK-3β and β-catenin were detected by immunohistochemistry and Western blotting.Spearman was used to evaluate the correlation between the expressions of annexin A2 and GSK-3β and the pathological characteristics in CSCC.The receiver operating characteristic(ROC)curve was drawn to analyze the clinical diagnostic value of annexin A2 and GSK-3β in CSCC.Results Compared with the normal skin tissues,the expressions of annexin A2 and β-catenin in CSCC increased,and GSK-3β decreased(P＜0.05);Compared with the KA tissues,the expression of annexin A2 in CSCC tissues increased(P＜0.05).The expression of annexin A2 was negatively correlated with that of GSK-3β in CSCC(r=-0.3901,P＜0.01).GSK-3β expression was related to tissue differentiation,with lower expression in poorly differentiated patients'cancer tissues(P＜0.05).The sensitivity of annexin A2 and GSK-3β for diagnosis of CSCC was 85.3%and 41.2%,respectively,with specificities of 46.9%and 84.4%respectively.The sensitivity of annexin A2 for distinguishing between CSCC and KA was 85.3%,with a specificity of 40.0%.Conclusion Annexin A2 and GSK-3β may be used as potential biomarkers for the early diagnosis or differential diagnosis of CSCC,and play important roles in the development of CSCC.Their mechanism may be related to the activation of Wnt/β-catenin signaling pathway.

Objective To investigate the dietary intakes and weight retention status of postpartum women in Wuhan and explore the influence of dietary intervention on postpartum weight retention,providing scientific basis for rational dietary guid-ance to prevent excessive postpartum weight retention.Methods A total of 184 postpartum women at 42 days postpartum were included from September 2022 to April 2024 as participants and randomly divided into the control group(91 cases)and the inter-vention group(93 cases).Basic information on sociodemographic and lifestyle of the subjects were investigated,and body mass change was measured.The dietary intake was evaluated by the Da Ying Jia Intelligent Dietary Management System 2.0,and the overall dietary quality was evaluated by the alternate healthy eating index(AHEI).Individualized nutritional meal planning was provided to the intervention group,and follow-up was conducted to evaluate weight retention and the effect of dietary interven-tion at 3-month and 6-month postpartum.Results Compared with the body weight at inclusion,the average weight loss in the intervention group at 3-month postpartum was(0.95±2.38)kg,while the average weight loss in the control group was(0.14±1.44)kg.The average weight loss in the intervention group at 6-month postpartum was(2.29±3.64)kg,while the average weight loss in the control group was(0.04±2.99)kg.The weight retention rate in the intervention group(21.0％)was signifi-cantly lower than that in the control group(36.8％)(P＜0.05).Dietary analysis showed that at 3-month postpartum,the intake of egg and aquatic products in the intervention group was significantly higher than that in the control group(P＜0.05),and the AHEI score of white meat/red meat in the intervention group was significantly higher than that in the control group(P＜0.05).The intervention group would pay more attention to the intake of white meat when choosing meat.The intake of vegeta-bles and fungi/algae in both groups decreased at 6-month postpartum,but the decrease in the vegetables and fungi/algae score in the intervention group was significantly less than that in the control group,indicating that the intervention group was able to maintain healthy eating habits.Conclusion Dietary intervention for postpartum women can effectively reduce postpartum weight retention,promote postpartum recovery,and have a long-term improvement effect on their diet quality.

BACKGROUND:Neuroinflammation is a major cause of exacerbation after spinal cord injury.In recent years,pyroptosis has received much attention due to its remarkable pro-inflammatory features.Some of these natural products can significantly inhibit the inflammatory response and improve the damaged nerve function by regulating the level of pyroptosis after spinal cord injury,which provides a new therapeutic idea for spinal cord injury.OBJECTIVE:To summarize the mechanism of action of natural products in regulating pyroptosis for the treatment of spinal cord injury,with a view to providing lessons and references for future research on the treatment of spinal cord injury.METHODS:The search terms"spinal cord injury,pyroptosis,inflammasome,natural products,natural compounds,traditional Chinese medicine"in Chinese and English were used to search for relevant literature since the establishment of the database up to September 2024 in the databases of PubMed,Web of Science,WanFang,and CNKI.According to the inclusion and exclusion criteria,75 relevant articles were finally obtained.RESULTS AND CONCLUSION:(1)Pyroptosis is an important pro-inflammatory pathway in spinal cord injury,and controlling pyroptosis is an effective way to improve damaged nerve function.(2)Some natural products can regulate pyroptosis via the NLRP3/Caspase-1 classical pyroptosis pathway,the NF-κB-related pathway,other upstream pathways such as Nrf2/HO-1,and autophagy,thereby affecting the level of tissue inflammation and accelerating neurological recovery after spinal cord injury.(3)The anti-pyroptosis effects of these natural products are mostly dependent on the NLRP3 classical pyroptosis pathway,and there is a lack of studies on other pyroptosis pathways.(4)There are still many problems in this field,such as the fact that these natural products are not currently supported by evidence from appropriate clinical studies.(5)The natural product has great potential in regulating pyroptosis and is expected to be a powerful weapon in the treatment of spinal cord injury.

Objective To investigate the predictive value of dual-energy computed tomography(DECT)quantitative parameters in the diagnosis and pathological aggressiveness of lung adenocarcinoma.Methods A total of 174 patients with lung cancer were pro-spectively selected.All patients underwent DECT examination,and the types of lung cancer were determined according to the patho-logical tissue.According to the pathological classification,they were divided into lung adenocarcinoma group(n=99),lung squamous cell carcinoma group(n=47)and small cell lung cancer group(n=28).According to whether the lung adenocarcinoma patients had pathological aggressiveness,they were divided into invasive group(n=34)and non-invasive group(n=65).Receiver operating char-acteristic(ROC)curve was used to diagnose the predictive value of DECT quantitative parameters in the diagnosis and pathological aggressiveness of lung adenocarcinoma.Results The normalized iodine concentration(NIC)and k in venous phase of lung adenocar-cinoma group were higher than those in lung squamous cell carcinoma group and small cell lung cancer group(P<0.05).ROC curve analysis showed that the combined diagnosis value of NIC and k in venous phase was higher(P<0.05).The lobular proportion,vac-uolar proportion,pleural indentation proportion,vascular cluster proportion,effective atomic number(Eff-Z),NIC and k in arterial phase,and NIC and k in venous phase in invasion group were higher than those in non-invasion group(P<0.05).Logistic regression analysis showed that pleural indentation,NIC in arterial phase and NIC in venous phase were risk factors for pathological aggerssive-ness in lung adenocarcinoma patients(P<0.05).ROC curve analysis showed that the combination of NIC in arterial phase and NIC in venous phase had higher value in predicting the pathological aggressiveness of lung adenocarcinoma(P<0.05).Conclusion The combination of NIC and k in venous phase is effective in the diagnosis of lung adenocarcinoma,while NIC in arterial phase and NIC in venous phase have high predictive values for the aggressiveness of lung adenocarcinoma.

Objective : To explore whether chrysophanol(CHR) affects macrophage polarization by promoting mitochondrial biosynthesis through AMPK/PGC-1α pathway. Methods : The molecular docking and binding ability of CHR with AMPK and PGC-1α were predicted by Autodock vina software. Human monocytes(THP-1) were induced to M0 macrophages by phorbol myristate acetate(PMA), and to M1 macrophages by lipopolysaccharide(LPS) combined with interferon-γ(IFN-γ), which were set as Control group. M1 macrophages treated with CHR were set as CHR group. M1 macrophages treated with CHR combined with AMPK inhibitor(Compound C) were set as CHR+Compound C group. The mRNA expression levels of M1 macrophage markers(iNOS, CD86) and mitochondrial biosynthesis related genes(PGC-1α, NFR-1, TFAM) were detected by Quantitative real time polymerase chain reaction(qRT-PCR). The expression level of M1 macrophage marker iNOS was detected by immunofluorescence. The protein expression levels of AMPK, p-AMPK and PGC-1α were detected by Western blot. Results : The docking results showed that the binding energies of CHR with AMPK and PGC-1α were-8.4 kcal/mol and-7.4 kcal/mol, respectively. qRT-PCR results showed that the in vitro model of M1 macrophages was successfully established. Compared with the Control group, CHR treatment significantly increased the mRNA expression of mitochondrial biosynthesis-related genes PGC-1α, NFR-1, and TFAM(P<0.001). Compared with CHR treatment group, CHR combined with Compound C treatment significantly decreased the mRNA expression levels of mitochondrial biosynthesis-related genes PGC-1α, NFR-1, and TFAM(P<0.05). Immunofluorescence results showed that CHR treatment inhibited the protein expression of iNOS compared with the Control group(P<0.001). Compared with CHR treatment group,CHR combined with Compound C treatment reversed the inhibitory effect of CHR on i NOS protein expression(P<0.05). Western blot results showed that compared with the Control group,the CHR treatment group had significant increase in the protein expression levels of p-AMPK and PGC-1α(P<0.001).Compared with CHR treatment group,CHR combined with Compound C treatment significantly decreased the protein expression levels of p-AMPK and PGC-1α(P<0.05). Conclusion Chrysophanol may inhibit macrophage polarization to M1 by activating AMPK/PGC-1α signaling pathway to promote mitochondrial biosynthesis.

Background: Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period. Methods: This single-center retrospective study included KTRs aged ≥18 years diag-nosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI);moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness. Results: Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006–1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155–1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212–0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956–0.986). Conclusions KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.

Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.

Methods: This study included 41 patients with single-level grades 1 or 2 LS from February 2023 to February 2024. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI). Bridwell fusion grades were evaluated via lumbar spine computed tomography performed 6 months postoperatively. Results: Over a mean follow-up period of 10.6 months (range, 7–18 months), significant improvements were observed in VAS scores for low back pain (from 7.8±0.8 to 2.1±1.4) and leg pain (from 8.1±1.3 to 1.9±1.5) as well as ODI scores (from 50.4±15.4 to 14.8±10.5). The cohort consisted of patients with grades 1 (73.2%) and 2 LS (26.8%) at L4–L5 (58.6%), L5–S1 (34.1%), and L3–L4 (7.3%) levels. The mean operation time was 182.8±36.4 minutes, with a mean intraoperative blood loss of 190.5±81.3 mL and a mean hospital stay of 7.2±3.6 days. Successful fusion (Bridwell grades I/II) was achieved in 82.9% of the cases, with a 4.9% incidence of cage subsidence. Minor complications included durotomies in two patients (4.9%), whereas no major complications, such as nerve root injury, hardware-related issues, or postoperative infections, were reported. Conclusions The described BE-LIF technique, using HA bone grafts, which are an autologous bone from the preserved IAP, and a TLIF cage, is a viable, safe, and effective option for treating low-grade LS. This approach achieves favorable clinical outcomes and high fusion rates, which provides a cost-effective alternative to advanced surgical implants.