BACKGROUND:The prevalence of osteoporosis is high in postmenopausal women,but muscle mass,grip strength,and how these factors affect osteoporosis are understudied,and the exact link between them has not been clarified.OBJECTIVE:To investigate the correlation between muscle mass,grip strength,appendicular skeletal muscle index and bone mineral density in postmenopausal women with osteoporosis and to assess the potential values of these indices in predicting and diagnosing postmenopausal osteoporosis.METHODS:Eighty-three postmenopausal women were collected from the outpatient clinic of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2023 to January 2024.General data were collected.Bone mineral density was detected.T-value,muscle mass of each part,grip strength were recorded.The body mass index and appendicular skeletal muscle index were calculated.The patients were categorized into non-osteoporosis group(n=17)and postmenopausal osteoporosis group(n=66)according to T value and fracture history,and were statistically analyzed accordingly.RESULTS AND CONCLUSION:(1)The body mass,body mass index,bone mineral density of the overall lumbar spine,muscle mass and appendicular skeletal muscle index were higher in the non-osteoporosis group than the osteoporosis group(P＜0.05).(2)Muscle mass was positively correlated with bone mineral density of the overall lumbar spine and individual vertebrae(P＜0.05).(3)Multiple stepwise linear regression analysis showed that body mass and grip strength were linearly and positively correlated with muscle mass;body height and muscle mass were linearly and positively correlated with grip strength,and body mass was linearly and negatively correlated with grip strength.Body mass index was linearly and positively correlated with bone mineral density,and age was linearly and negatively correlated with bone mineral density.(4)Analysis by receiver operating characteristic curve showed that:muscle mass(the area under the curve,sensitivity,specificity and critical value of muscle mass were 0.744,76.50％,74.20％and 36.50 kg,respectively,with P=0.002)and appendicular skeletal muscle index(the area under the curve,sensitivity,specificity and critical value of appendicular skeletal muscle index were 0.739,82.40％,62.10％and 5.81 kg/m2,respectively,and P=0.002)had good predictive value for postmenopausal osteoporosis.To conclude,a reduction in muscle mass and appendicular skeletal muscle index can help to predict the risk of postmenopausal osteoporosis,and the possibility of osteoporosis should be taken into account in postmenopausal women when muscle mass is＜36.50 kg or appendicular skeletal muscle index is＜5.81 kg/m2,in order to prevent the occurrence of postmenopausal osteoporosis.

BACKGROUND:Although previous studies have reported associations between lipids and the risk of osteoporotic pathological fractures,the specific causal relationships between lipid level and osteoporotic pathological fractures remain unclear.OBJECTIVE:To elucidate the causal relationship between lipids and osteoporotic pathological fractures using a two-sample bidirectional Mendelian randomization analysis.METHODS:The data for 178 lipid metabolites were obtained from the IEU-GWAS database(developed by the MRC Integrative Epidemiology Unit at the University of Bristol,UK,which provides extensive summary data from genome-wide association studies),while osteoporotic pathological fracture data(from 173 619 European participants)were acquired from the FinnGen database(constructed by the Finnish national gene research program,focusing on investigating relationships between genomics and health/disease in the Finnish population).Osteoporotic pathological fracture data were used as the outcome variable,with lipids serving as exposures,for the bidirectional Mendelian randomization study to evaluate the causal effects of different lipids on osteoporotic pathological fractures.The UK Biobank database was employed as a validation set by switching the outcome variable to verify the findings horizontally.RESULTS AND CONCLUSION:(1)The inverse variance weighted analysis indicated that each unit increase in sterol ester(27∶1/20∶2)levels was associated with a 25.55％increase in the risk of osteoporotic pathological fractures(odds ratio=1.256,95％confidence interval:1.001-1.575,P=0.049),suggesting a significant positive correlation between elevated sterol ester levels and increased fracture risk.Reverse Mendelian randomization analysis revealed a significant negative association between osteoporotic pathological fractures and three types of phosphatidylcholine.Horizontal validation yielded consistent results,confirming sterol ester as a risk factor for osteoporotic pathological fractures.(2)The results indicate that sterol ester is a risk factor for osteoporotic pathological fractures,while phosphatidylcholine serves as a protective factor.These findings strengthen the evidence supporting the effect of lipids on the risk of osteoporotic pathological fractures.Although the GWAS data used in this study were derived from European populations,given the broad commonality of human genetics,the results provide valuable reference significance for improving osteoporosis in Chinese populations through lipid regulation.

Radiotherapy is a crucial treatment modality for head and neck tumors. However, while effectively killing tumor cells, it significantly disrupts the homeostasis of the oral microecology, which is closely associated with various complications such as radiation-induced oral mucositis. Literature review indicates that as radiotherapy doses accumulate and treatment durations extend, the richness and diversity of the oral microbiota show a declining trend, with the genus Streptococcus decreasing most markedly. In contrast, radiotherapy selectively promotes the proliferation of bacterial phyla such as Proteobacteria and Bacteroidetes, which are rich in opportunistic pathogens. Mechanistically, radiotherapy activates the nuclear factor-kappa B pathway, triggering chronic inflammation and oxidative stress, damaging the epithelial barrier, suppressing local immunity, and causing damage to organs such as the salivary glands. It can also induce systemic diseases via the oral-gut axis, forming a multi-level, interconnected pathogenic network. In terms of interventions, treatment strategies including probiotics and prebiotics have shown promising efficacy against side effects such as radiation-induced oral mucositis. Saliva-based oral microbiota transplantation is an emerging strategy that is expected to become widely utilized for restoring oral microecological balance. Existing interventions provide preliminary pathways for clinical practice, but this field still faces several key scientific questions. The association between oral microecology and systemic diseases remains largely correlative, lacking causal evidence. Furthermore, critical parameters for oral microbiota transplantation, such as donor screening criteria, transplantation protocols, and long-term safety, are not yet well-defined. Therefore, future research should focus on conducting large-scale clinical trials to establish standardized protocols and safety evaluation systems for oral microecological interventions, and explore combined treatment therapies such as probiotics, prebiotics, and microbiota transplantation to advance the development of personalized precision modulation. These will enable more effective management of radiotherapy-induced oral microecological dysbiosis and improve treatment outcomes and quality of life for patients with head and neck tumors.

Background: Influenza A virus (IAV) is a negative-sense RNA virus of the Orthomyxoviridae family and is the etiological agent of a highly contagious acute respiratory disease that can lead to acute lung injury. Objective: To elucidate the molecular mechanisms of IAV infection, an integrative research approach combining gene expression profiling, multinetwork analysis, and in vivo experimental validations was employed. Methods: First, a series of network-based analyses were performed, including protein-protein interaction network construction, weighted gene co-expression network analysis, and subsequent gene set enrichment analysis, to identify the major underlying mechanisms of IAV infection. Following gene expression analysis, core targets, both direct and indirect regulators, were screened. An IAV (H1N1) strain A/PR/8/34-induced acute lung injury mouse model was constructed for in vivo validations. Batch one included two groups to evaluate findings from the multi-network analysis: Mock (n = 10; 5 males and 5 females) and IAV (n = 10; 5 males and 5 females). Batch two included three groups to assess the role of toll-like receptor 3 (TLR3) in IAV infection: Mock (n = 6; 3 males and 3 females), IAV (n = 6; 3 males and 3 females), and TLR3 inhibitor (n = 6; 3 males and 3 females). Body weight was measured on days 0, 3, and 5 after infection. On day 5, lung tissues were collected to assess viral load and histopathological changes. Key targets were examined using enzyme-linked immunosorbent assay, Western blotting, and immunofluorescence staining, both in sera and lung tissues. Results: IAV infection was significantly associated with dysregulation of the immune-inflammation system, such as the LTR, nucle-otide-binding oligomerization domain-(NOD) like receptor, retinoic acid-inducible gene I-like receptor, and nuclear factor kappa-B signaling pathways. Gene set enrichment analysis further indicated that the TLR and necroptosis signaling pathways played crucial roles in the progression of IAV infection (TLR signaling pathway normalized enrichment score = 2.3941, P = 1.00 × 10 ⁻¹⁰; necroptosis normalized enrichment score = 1.9421, P = 6.21 × 10 ⁻⁷). Among the core targets, TLR3 and mixed lineage kinase domain-like protein (MLKL) may regulate gene expression at the transcriptional level (all P < 0.05). In vivo validation using an IAV (PR8) infected acute lung injury mouse model demonstrated increased viral load and lung index, alveolar structural damage, and inflammatory cell infiltration. Immunofluorescence staining exhibited large gaps in Lamin B1 staining and breaches in Emerin signals following IAV-PR8 infection. Expression levels of TLR3, p-receptor-interacting serine/threonine-protein kinase 3 (RIPK3)/RIPK3, and p-mixed lineage kinase domain-like protein (MLKL)/MLKL proteins in lung tissues, as well as proinflammatory factors and mediators in sera, were significantly elevated after IAV infection. Moreover, enhanced neutrophil infiltration (myeloperoxidase) and citrullinated histone H3 (a neutrophil extracellular trap-specific marker), both established indicators of neutrophil extracellular trap formation, were observed. Notably, treatment with a TLR3 inhibitor significantly ameliorated IAV-induced acute lung injury by regulating necroptosis-related targets. Conclusion: Our study provides network-based in vivo evidence that TLR3-receptor-interacting serine/threonine-protein kinase 3-MLKL-mediated necroptosis may underlie IAV-induced acute lung injury and could serve as a potential therapeutic target in severe influenza cases.

The study focuses on the concept of multifunctional traditional Chinese medicine (TCM) formulas and aims to evaluate the efficacy of the classical formula Xiaoyao San (逍遥散). Study employs the integrated evidence chain (Eff-iEC) method to organize, integrate, and evaluate its therapeutic efficacy in treating different diseases with the same therapy, and to investigate the feasibility of using Eff-iEC to evaluate the multifunctionality of TCM formulas. The evaluation covered Xiaoyao San's therapeutic effects on depression, premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Concurrently, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for evaluation, and authoritative medical documents were incorporated to corroborate the recognition of Xiaoyao San within the medical community. Depression and menopausal syndrome received higher ratings than other conditions in the Eff-iEC, GRADE, and Medical Community Recognition assessments. The Eff-iEC evidence grade for Xiaoyao San was rated as "High" or above for chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Premenstrual syndrome received a "Moderate ⁺" rating. The GRADE evidence level was "Low-〇〇⨁⨁" for depression, premenstrual syndrome, and chronic hepatitis; "Moderate-〇⨁⨁⨁" for dyspepsia and menopausal syndrome; and "Very Low-〇〇〇⨁" for irritable bowel syndrome. Depression and menopausal syndrome had the highest inclusion frequency, appearing in all 4 categories. Premenstrual syndrome, chronic hepatitis, and dyspepsia are not recommended in Western medical guidelines, but they are included in TCM guidelines, the China National Basic Medical Insurance Drug List, and the China National Essential Drug List. Irritable bowel syndrome appears only in the China National Basic Medical Insurance Drug List and China National Essential Drug List. The evaluation results obtained using the Eff-iEC method align with Medical Community Recognition, providing an objective and comprehensive assessment of Xiaoyao San's efficacy. The findings suggest that Xiaoyao San has strong evidence for treating depression and menopausal syndrome. However, further experimental and clinical trials are needed to assess its efficacy in treating premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, and dyspepsia. These results support the clinical efficacy and rational use of Xiaoyao San, expand the application scope of the Eff-iEC method, and offer valuable insights and methodological references for the comparative evaluation of multifunctional TCM formulas.

Oral and maxillofacial tumor surgery is characterized by complex anatomical structures, extensive surgical trauma, and high demands for postoperative functional reconstruction. Perioperative complications and functional impairments significantly affect patients’ recovery process, quality of life, and long-term prognosis. Enhanced recovery after surgery (ERAS), grounded in evidence-based medicine, optimizes perioperative management through multidisciplinary collaboration and demonstrates substantial application potential in oral and maxillofacial surgery. Multiple prospective studies have confirmed that standardized airway management, goal-directed fluid and temperature management, and specialized ward-based care can shorten hospital stays, facilitate early enteral nutrition and ambulation, and reduce intensive care unit admission rates and postoperative complications. However, existing ERAS studies mainly focus on traditional clinical outcomes, with insufficient attention paid to functional recovery specific to patients with oral and maxillofacial tumors after surgery, including speech, swallowing, mastication, facial expression, and psychosocial function. Based on the structure-process-outcome quality evaluation model, this review summarizes the implementation pathways and evaluation framework of ERAS in oral and maxillofacial tumor surgery. Furthermore, integrating current international evidence and a large cohort study from our team evaluating a delayed extubation strategy in patients undergoing free flap reconstruction, we demonstrate that perioperative management aligned with ERAS principles can significantly shorten hospital stays, reduce postoperative complications, and decrease medical costs while maintaining safety. Future efforts should focus on specialized pathways for oral and maxillofacial surgery, strengthening long-term functional and quality-of-life follow-up, and exploring digital and precision rehabilitation tools to promote the transition of ERAS toward a comprehensive recovery model emphasizing functional restoration and social reintegration.

Objective To construct a lung cancer surgery-oriented disease-specific database covering the entire perioperative care pathway, thereby improving the quality and usability of key surgical data elements. Methods Real-world clinical data were extracted from a single-center thoracic surgery department. A standardized data model was established based on the open electronic health record (openEHR) standard. Large language model (LLM), optical character recognition (OCR), and artificial intelligence (AI)-driven techniques were employed to extract, structure, and perform quality control on unstructured clinical narratives, imaging reports, and radiological data, with a focus on capturing surgically relevant perioperative indicator. Results A multimodal database comprising 19 917 patients was established, including 7 930 males and 11 987 females, with ages ranging from 15 to 97 (61.7±9.7) years. The database includes 582 structured data variables, textual report data corresponding to 69 clinical indicators, 13 000 pulmonary function test PDF reports, and chest CT imaging data from 16 884 patients. This database comprehensively covers major information relevant to surgical diagnosis and treatment of lung cancer, significantly improving the completeness and granularity of surgical detail data. Large language models (LLMs) and optical character recognition (OCR) technologies enhanced the efficiency of converting unstructured data into structured formats, while a multi-level manual verification process ensured data accuracy and traceability. The database supports real-world research including comparisons of surgical procedures, prediction of postoperative complications, prognosis assessment, and multimodal data association analyses.

ObjectiveTo evaluate the efficacy and safety of Janus kinase （JAK） inhibitors combined with Chinese herbal medicine （CHM） in treating rheumatoid arthritis （RA）. MethodsClinical data from 169 RA patients were retrospectively collected. Among them， 71 cases received JAK inhibitors as the control group， while 98 cases received JAK inhibitors plus CHM as the observation group， both treated for 24 weeks. The rheumatoid factor （RF）， cyclic citic peptide antibody （anti-CCP）， erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）， and white blood cell count （WBC） were recorded before and after treatment. Databases including CNKI， Wanfang， VIP， PubMed and Web of Science were searched from inception till August 31st， 2025 for randomized controlled trials （RCTs） on the combined use of JAK inhibitors and CHM for RA. The methodological quality of the included studies was evaluated using the risk of bias assessment tool. Meta-analyses were performed for RF， anti-CCP， ESR， CRP， 28-joint disease activity score （DAS28）， overall clinical effective rate， and incidence of adverse events. Sensitivity analysis were also performed. ResultsThe retrospective study demonstrated that after treatment， ESR， CRP， and anti-CCP levels decreased in the observation group， while ESR and CRP levels decreased in the control group （P＜0.05）. Moreover， ESR and RF levels in the observation group were lower than those in the control group （P＜0.05）. A total of 9 RCTs involving 770 patients were included in the meta-analysis. The results indicated that the JAK inhibitors plus CHM group was superior to the JAK inhibitors group in reducing RF （MD=-8.97， 95%CI -15.01 to -2.94， P=0.004）， CRP （MD=-3.34， 95%CI -3.82 to -2.86， P＜0.001）， ESR （MD=-5.33， 95%CI -7.98 to -2.69， P＜0.001）， and DAS28 score （MD=-0.54， 95%CI -0.74 to -0.34， P＜0.001）， as well as in improving the overall clinical effective rate （OR=4.53， 95%CI 2.55 to 8.03， P＜0.001）. No statistically significant differences were observed between groups in anti-CCP levels （SMD=-2.08， 95%CI -4.41 to 0.24， P=0.080） or incidence of adverse events （OR=0.93， 95%CI 0.55 to 1.57， P=0.790）. ConclusionThe combination of JAK inhibitors and CHM demonstrates remarkable efficacy in treating RA， contributing to improved disease activity and reduced inflammatory markers with a favorable safety profile.

BackgroundAddictive non-suicidal self-injury （NSSI） behaviors among adolescents have become increasingly prominent， although previous studies have identified multiple related risk factors and have examined the association between screen time and NSSI behaviors， the impact of screen time on NSSI behaviors addiction， as well as the mediating role of family dysfunction in this relationship， remain to be further clarified. ObjectiveTo investigate the mediating role of family dysfunction in the relationship between screen time and NSSI behaviors addiction among adolescent female patients with depression disorder， with the aim of providing references for reducing NSSI behaviors addiction. MethodsFrom September 2024 to November 2025， a total of 652 adolescent female patients with depression disorder were enrolled from both outpatient and inpatient departments of Xiamen Xian-yue Hospital， all of whom met the diagnostic criteria for depressive episode （F32） or recurrent depressive disorder （F33） according to the International Classification of Diseases， tenth edition （ICD-10）. Assessments included a self-developed demographic questionnaire， screen use questionnaire， Chinese Family Assessment Instrument （C-FAI）， and Ottawa Self-injury Inventory Chinese Revised version （OSIC）. Among participants with NSSI behaviors， Spearman correlation analysis was used to examine the correlation between screen time and scale scores. Model 4 of the Process 4.1 for SPSS 26.0 was then applied to test the mediating role， and Bootstrapping procedure involving 5 000 replicates was employed to confirm the statistical significance. ResultsAmong the 652 patients， 569 （87.27%） exhibited NSSI behaviors. Among them， 398 cases （69.95%） belonged to the addictive NSSI group， and 171 cases （30.05%） belonged to the non-addictive NSSI group. The OSIC addiction dimension score was positively correlated with screen time and C-FAI scores （r_s=0.114， 0.224， P<0.01）. Family dysfunction mediated the relationship between screen time and NSSI addiction， with an indirect effect value of 0.036 （95% CI： 0.016–0.062）， accounting for 35.88% of the total effect. ConclusionScreen time may affect the NSSI behaviors addiction in adolescent female patients with depression disorder through family dysfunction. ［Funded by Joint Funds for the Innovation of Science and Technology， Fujian Province （number， 2025Y9762）］

ObjectiveTo explore the effect of blood flow restriction training (BFRT) under different intensities combined with low-intensity resistance training (LIRT) on motor function in stroke patients with frailty. MethodsFrom August, 2024 to August, 2025, 200 elderly ischemic stroke patients with frailty from Affiliated Hospital, North China University of Science and Technology were randomized into control group and observation groups 1, 2 and 3, with 50 cases in each group. All the groups received 30% 1RM resistance training. In addition, the observation groups received BFRT of 40%, 50% and 60% arterial occlusion pressure (AOP), respectively. Before training, and four and eight weeks after training, their motor function was evaluated with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Fugl-Meyer Assessment-Lower Extremities (FMA-LE), grip strength, 10-Metre Walk Test (10MWT) and Berg Balance Scale (BBS); Fried Frailty Phenotype (FFP) was used to assess frailty status; and the score of modified Ashworth Scale (MAS), blood pressure and resting heart rate were recorded. ResultsOne case dropped out in each group. For the scores of FMA-UE and FMA-LE, the grip strength of both hands, the time of 10MWT and the score of BBS, the main effects of group and time, and interaction effect were all significant (F > 2.745, P < 0.05); four weeks after training, the above indexes were better in the observation groups than in the control group (P < 0.05); eight weeks after training, the scores of FMA-UE and FMA-LE, the grip strength of both hand and the score of BBS were better in the observation group 3 than in the observation groups 1 and 2 (P < 0.05), and the time of 10MWT was better in the observation group 3 than in the observation group 1 (P < 0.05). For the score of FFP, the main effect of group was significant (F = 688.360, P < 0.001), however, the effects of time and interaction were not significant (P > 0.05). For the score of MAS, the main effect of group was significant (F = 7.171, P = 0.008), however, the effects of time and interaction were not significant (P > 0.05). For the blood pressure and resting heart rate, the main effects of group and time, and interaction effect were not significant (P > 0.05). ConclusionBFRT under different intensities combined with LIRT can safely improve the motor function, grip strength, walking ability in elderly stroke patients, and 60% AOP may be more effective.