Objective To investigate the association of serum total testosterone(TT),free testosterone(FT),sex hormone-binding globulin(SHBG),and estradiol(E_2)with all-cause mortality rate(AMR)in males and to evaluate their predictive value. Methods Based on data from the National Health and Nutrition Examination Survey(NHANES)cycles(1999—2004 and 2013—2016),the relationships between different sex hormones and AMR was analyzed with Cox proportional hazards regression models. The dose-response relationships between different sex hormones and male AMR were assessed with restricted cubic splines(RCS). The predictive performances of different sex hormones for male AMR were compared with receiver operating characteristic(ROC)curves and the area under the curve(AUC). The survival differences across varying sex hormone levels were evaluated with Kaplan-Meier survival curves and log-rank tests. Results This study involved 3632 adult male participants with a median follow-up of 6.5 years,during which 320 AMR occurred(8.8%). Cox univariate analysis indicated that TT,FT and SHBG were risk factors for AMR(P＜0.001). Cox multivariate analysis revealed that FT and SHBG were independent risk factors for AMR(FT:HR=0.90,95%CI:0.86-0.94; SHBG:HR=1.01,95%CI:1.01-1.02). RCS revealed a U-shaped nonlinear relationship between TT,FT and AMR(P＜0.001); SHBG showed a positive dose-response relationship with AMR(P＜0.001). The AUCs of FT predicting the 5-year,10-year,and 15-year AMR were 0.78(95%CI:0.73-0.82),0.80(95%CI:0.76-0.84),and 0.84(95%CI: 0.80-0.88),respectively,significantly outperforming other indicators. Subgroup analysis revealed that FT was negatively correlated with male AMR,but this association was modulated by age,race,smoking status and diabetes status(P_(interaction)＜0.05). Kaplan-Meier survival analysis showed that different levels of TT and FT(Q1-Q4)were significantly positively correlated with survival rate(P＜0.001),while different levels of SHBG were significantly negatively correlated with survival rate,with patients in the Q4 group having the highest risk of death(P＜0.001). Conclusion Based on US NHANES,studies have shown that the FT and SHBG are independent risk factors for male AMR,and FT demonstrates greater predictive value for male AMR than TT.

Objective:To investigate the clinical features and prognostic factors of primary tonsil lymphoma(PTL).Methods:The clinical data of 41 patients diagnosed with PTL and treated in the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2022 were collected and retrospectively analyzed.Their clinical features and prognostic factors were analyzed.Results:All the 41 patients were newly diagnosed with PTL,and the median age of onset was 58(19-85)years.Among them,19 patients started with pharyngeal pain,12 patients presented with dysphagia,8 patients presented with pharyngeal mass,and 2 patients presented with blurred articulation.The most common pathological type was diffuse large B-cell lymphoma(24 cases,58.54％).All patients received chemotherapy,and 3 patients were combined with hematopoietic stem cell transplantation.Among 41 patients,11(26.83％)achieved complete response,14(34.15％)achieved partial response,and the total response rate was 60.98％(25/41).The median follow-up time was 37(6-107)months,the 5-year overall survival(OS)rate was 70.81％and 5-year progression-free survival(PFS)rate was 66.20％.Univariate analysis showed that B symptoms,Ki-67,β2-MG and IPI score had significant effects on PFS and OS of patients(all P＜0.05).Multivariate analysis showed that IPI score was an independent risk factor for PFS and OS of patients(P＜0.05).Conclusion:The clinical manifestations of PTL lack specificity,and the prognosis is relatively good.Most patients can achieve long-term survival after treatment.IPI score is related to the prognosis.

Objective:To investigate the effect of infusing different doses of graft cells on viral infections and survival after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 99 patients with hematological diseases who underwent allo-HSCT in Shanxi Bethune Hospital were retrospectively analysed.The proportion of mononuclear cells(MNC)was counted microscopically,the proportions and absolute counts of CD34+cells and lymphocyte subsets(including CD3+T,CD4+T,CD8+T,CD4+CD8+T,B,and NK cells)were detected by flow cytometry,and the infusion dose of each cell types was calculated.The patients were divided into high-dose group and low-dose group based on the median value of the infused cell dose.The effects of different doses of various graft cells on post-transplant viral infections(CMV,EBV,BKV)and survival were analyzed.Results:The low-dose MNC(＜7.97 × 108/kg)and high-dose CD4+CD8+T cell(≥3.02 × 106/kg)groups had a higher Epstein-Barr virus(EBV)infection rate(P=0.031;P=0.020).The high-dose CD34+cell group and low-dose CD3+T,CD8+T and natural killer(NK)cell groups showed a trend toward higher EBV infection rates,but the differences were not statitsically significant(P＞0.05).There was no significant difference in the rates of EBV infection between the high-dose and low-dose groups of CD4+T and B cells(P＞0.05).Multivariate analysis revealed that the doses of MNC and CD4+CD8+T cells in the graft were independent factors influencing EBV infection(P=0.023;P=0.016).The doses of cells in the graft showed no significant impact on CMV and BKV infection,or patient survival(P＞0.05).Conclusion:Infusing a lower dose of MNC and a higher dose of CD4+CD8+T cells increases the risk of EBV infection,but does not affect the survival outcome.

Stroke imposes a tremendous burden on patients'families and society due to its high rates of mortality,disability,and recurrence.Advances in neuroimaging technologies have provided critical theoretical foundations for investigating the pathophysiological mechanisms of stroke,as well as enabling early clinical intervention and personalized rehabilitation.This article reviewed the application of five commonly used magnetic resonance imaging(MRI)techniques in acupuncture therapy for stroke,including functional MRI(fMRI)for cerebral blood oxygen metabolism,magnetic resonance spectroscopy(MRS),diffusion MRI(dMRI),perfusion MRI(pMRI),and structural MRI(sMRI).By examining functional,metabolic,structural,and hemodynamic aspects,these imaging modalities offer evidence to validate the multi-target effect and efficacy of acupuncture in stroke treatment.

Objective:To investigate the clinical efficacy of two-point localized injection of the depressor anguli oris (DAO) muscle combined with pan-platysma microbotox injection of botulinum toxin type A for improving the aesthetic of mouth corner.Methods:A retrospective analysis was conducted on clinical data from patients who received concomitant DAO localized injection and pan-platysma microbotox of botulinum toxin type A for improving drooping mouth corners at the Facial and Neck Plastic Surgery Center and the Limb and Scar Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences, between December 2022 and June 2025. Botulinum toxin type A was reconstituted to two concentrations: 40 U/ml and 20 U/ml for the combined injection. Patients were instructed to repeatedly perform upward puckering motions to identify the trapezoidal outline of the DAO muscle. Two injection points were uniformly marked slightly medial to the midline of the DAO muscle for dual-target injection (1.5 U each at the middle one-third and lower one-third of the muscle belly). The pan-platysma microbotox for the platysma muscle extended superiorly to a line parallel and 3-4 cm above the mandibular border, innerly to 1 cm beyond the lateral edge of the DAO muscle, inferiorly to the submental area and the anterior neck region above the clavicle, and laterally to the anterior border of the sternocleidomastoid muscle. The injection dose was 0.6 U per point, with 1 cm spacing between points, administered at the superficial subcutaneous layer. Complications were recorded. At 1-month postoperatively, efficacy was evaluated using the global aesthetic improvement scale (GAIS, scores ranging from 5 to 1, representing "much worse" to "very much improved" ) and subjective patient satisfaction (categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate was calculated as the percentage of patients reporting very satisfied or satisfied among the total). Patients’ willingness to receive the same treatment in the future was also surveyed. Descriptive statistics were used for analysis.Results:A total of 21 patients were included (1 male, 20 females), with a mean age of (37.1±3.2) years (range: 34-45 years). The treatment procedures were successful. Post-treatment, 4 cases experienced pain and swelling, 8 had neck ecchymosis, and 1 had temporary asymmetry in mouth corner movement, all of which resolved within 2 weeks. The follow-up period ranged from 1 to 6 months (mean: 1.4 months). At short-term follow-up (4-6 weeks after treatment), patients reported a skin "tightening" sensation in the lower face and neck region, noting significant improvement in lower facial and neck contour, sharper bilateral jawlines, and reduced neck wrinkles. Drooping mouth corners were improved. The satisfaction survey showed that 17 patients were "very satisfied" and 5 were "satisfied", resultsing in a subjective satisfaction rate of 100%. Nineteen patients (90.5%) expressed willingness to undergo repeat treatment. The mean GAIS score was 1.45±0.69, with 14 patients achieving "very much improved", 5 patients "much improved", and 2 patients "improved" .Conclusion:The combination of two-point localized injection of the DAO muscle and pan-platysma microbotox injection of botulinum toxin into the platysma muscle effectively improve the aesthetic of mouth corners and lower facial contour through synergistic middle and superficial layer treatment. This approach aligns with anatomical and physiological merits and offers advantages such as minimal invasiveness and rapid recovery, making it applicable for patients with early signs of lower facial aging.

Objective To investigate the effect of Yiqi Wenfei Tongqiao decoction on the inflammatory response in rats with allergic rhi-nitis(AR)of lung qi deficiency and cold type based on the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling pathway.Methods A AR model of lung qi deficiency and cold type was established in rats using ovalbumin(OVA)combined with smoking and cold stimulation.After modeling,the rats were randomly divided into model,loratadine,low-dose Chinese medicine,high-dose Chinese medicine,and high-dose Chinese medicine+RO8191(JAK1/STAT3 signaling pathway activator)groups,with 12 rats per group.Twelve healthy rats were used as controls.After 14 days of drug intervention,the changes in the symptoms of lung qi deficiency and cold syndrome and AR were observed in the rats.Enzyme-linked immunosorbent assay was used to detect the serum levels of tumor necrosis factor α(TNF-α),interleukin(IL)-4,interferon-γ(IFN--γ),and ovalbumin-specific immunoglobulin E(OVA-sIgE).The number of inflammatory cells in the nasal lavage fluid was determined and the eosinophil(EOS)percentage was calculated.Pathological changes in the nasal mucosal tissue were observed after hematoxylin and eosin(HE)staining.Western blotting was used to detect the expression of JAK1/STAT3 signaling pathway-related proteins in nasal mucosal tissue.Results Compared with those in the model group,the AR symptom score,serum IL-4,TNF-α,and OVA-sIgE levels,EOS percentage in nasal lavage fluid,and levels of p-JAK1/JAK1 and p-STAT3/STAT3 in the nasal mucosal tissue of rats in the loratadine,low-dose Chinese medicine,and high-dose Chinese medicine groups were lower,whereas the serum IFN-γ level was higher(P＜0.05).RO8191 weakened the inhibitory effect of Yiqi Wenfei Tongqiao decoction on the inflammatory response in rats with AR of lung qi deficiency and cold type.Conclusion Overall,Yiqi Wenfei Tongqiao decoction can alleviate the inflammatory response in rats with AR of lung qi deficiency and cold type by inhibiting JAK1/STAT3 signaling pathway acti-vation and regulating the balance of Th1/Th2 cytokines.

Objective To develop a risk early warning and stratified nursing model for outpatient clinic and to preliminarily evaluate its impact on nursing efficiency and patient satisfaction in emergencies.Methods A risk early warning and stratified nursing model for outpatient clinic was developed in this study.It comprised four components:specialised training for nurses,quantifiable stratification indices(observation,listening,inquiry and palpation),tiered nursing interventions,and a rapid-response emergency protocol that could be activated immediately and executed efficiently.A total of 98 consecutive patients who visited outpatient clinic with unexpected emergency events from January 2021 to January 2024 were enrolled in the study.Forty-nine patients who visited outpatient clinic with unexpected emergency events between January 2021 and December 2022 were assigned to the control group and received conventional emergency nursing care.While the 49 patients who visited outpatient clinic with unexpected emergency events between January 2023 and January 2024 were assigned to the observation group and received risk early warning and stratified nursing care.The two groups were compared in terms of nursing efficiency and nursing-satisfaction scores.Results There was no statistically significant difference in the general data between the two groups of patients,and they were comparable(all P>0.05).Patients in the observation group showed significantly shorter emergency-activation time,auxiliary-examination time,and length of stay in comparison with those in the control group(all P<0.05).Scores of nursing satisfaction at discharge were also significantly higher in the observation group(P<0.05).Conclusion The risk early warning and stratified nursing model for outpatient clinic improves treatment efficiency for the patients suffering unexpected emergency events and enhances patient satisfaction.

Objective:To investigate the effects of combination therapy with aqueous extract of corn silk(CS)and training on exercise capacity and glycolipid metabolism in mice with metabolic syndrome(MS).Methods:In this study,db/db mice were used as the animal model of MS.The mice were administered aqueous extract of CS via gavage and subjected to different intensities of training for 12 weeks(3 months).The specific experimental design was as follows:24 db/db mice were randomly divided into four groups on average:negative control group(NC),aqueous extract of CS group(CS),aqueous extract of CS+moderate-intensity training group(CS+MT),and CS aqueous extract of CS+high-intensity training group(CS+HT).The maximum running speed,forelimb grip strength,body weight and fasting blood glucose of mice were measured before and after treatment.After the intervention,oral glucose tolerance test(OGTT)and insulin tolerance test(ITT)were conducted to assess glucose metabolism,while serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)levels were measured to evaluate lipid metabolism.Results:After 3 months of intervention,there were significant differences in the maximum running speed and forelimb grip strength among the four groups(P＜0.05).The maximum running speed and forelimb grip strength of CS group,CS+MT group and CS+HT group were higher than those of NC group(P＜0.05).The CS+MT group exhibited higher forelimb grip strength,and the CS+HT group showed higher maximum running speed and forelimb grip strength compared to the CS group(P＜0.05),while no significant difference was found between the CS+MT and CS+HT groups(P＞0.05).Significant differences in body weight were observed among the four groups after 3 months of intervention(P＜0.05).Specifically,the CS+MT and CS+HT groups exhibited significantly lower body weight compared to both the NC and CS groups(P＜0.05),with the CS+MT group having the lowest body weight(P＜0.05).Fasting blood glucose levels also differed significantly among the groups after 2 and 3 months of intervention(P＜0.05).The CS,CS+MT,and CS+HT groups had lower fasting blood glucose levels compared to the NC group(P＜0.05),with the CS+MT and CS+HT groups showing the lowest levels(P＜0.05).No significant difference was found between the CS+MT and CS+HT groups(P＞0.05).After 3 months of intervention,significant differences in the area under the curve(AUC)of OGTT and ITT were observed among the four groups(P＜0.05).The AUC of OGTT and ITT were significantly lower in the CS,CS+MT,and CS+HT groups compared to the NC group(P＜0.05).The CS+MT and CS+HT groups exhibited the lowest AUC values for both OGTT and ITT(P＜0.05),with the CS+MT group showing the lowest AUC for OGTT(P＜0.05).Significant differences in serum lipid levels were observed among the four groups after 3 months of intervention(P＜0.05).TG,TC,and LDL-C levels were significantly lower,while HDL-C levels were higher in the CS,CS+MT,and CS+HT groups compared to the NC group(P＜0.05).The CS+MT group had the lowest TG levels and the highest HDL-C levels compared to the CS+HT group(P＜0.05),with no significant differences in TC and LDL-C levels between these two groups(P＞0.05).Conclusion:Aqueous extract of CS combined with different intensity training can significantly improve the exercise capacity and glycolipid metabolism of MS mice and reduce body weight,especially CS combined with MT treatment is more effective in improving lipid metabolism.In addition,when combined with HT,aqueous extract of CS can also play an auxiliary role in reducing the side effects of high-intensity exercise and improving the therapeutic effect.

Objective To investigate the perioperative management of antithrombotic drugs in patients undergoing non-cardiac surgery.Methods Patients on long-term antithrombotic drugs who underwent non-cardiac surgery in our hospital were included.Through interviews with patients and physicians,perioperative antithrombotic medication regimens were reviewed and compared with the"Multidisciplinary Expert Consensus on Perioperative Management of Antithrombotic Therapy"to evaluate compliance with consensus and analyze influencing factors.Results A total of 372 patients were included in the analysis.Among them,355 patients were on long-term antiplatelet therapy alone,and 17 were on long-term oral anticoagulantion.364(97.8％)discontinued antithrombotic medications prior to surgery.109 patients(29.3％)received low molecular weight heparin(LMWH)bridging therapy.Among the 355 patients on antiplatelet therapy,108(30.4％)had discontinuation durations consistent with the consensus recommendations,while 186(52.4％)discontinued medications for longer periods.Postoperatively,the average hospital stay for antiplatelet therapy patients was 6.64 days,with only 37(10.4％)resuming therapy during hospitalization.The average hospital stay for patients on anticoagulants was 9.94 days,with only 2(11.8％)resuming therapy during hospitalization.Regarding perioperative risk assessment,only 40(10.8％)of patients underwent additional internal medical evaluation for thromboembolic risk after medication discontinuation,with the remainder assessed soly by surgeons.Coronary heart disease was an independent risk factor associated with internal medical evaluation(OR 2.851,95％CI 1.160-7.011,P=0.022).For bleeding risk assessment,surgeons evaluations aligned with the consensus in 68.0％of cases,but surgeons tended to underestimate risk compared to the consensus.Conclusions In this single-center study,perioperative antithrombotic management showed low compliance with expert consensus,characterized by prolonged preoperative medication discontinuation,high rates of LMWH bridging,and low postoperative in-hospital resumption of therapy.A robust multidisciplinary collaboration system should be established to enhance comprehensive patient assessment.

Objective To explore the applications and effects of professional training-based peer support on self-management of women with gestational diabetes mellitus.Methods A total of 96 patients diagnosed with gestational diabetes mellitus in a tertiary A-level women's hospital in Nanjing from March to June 2023 were conveniently selected as the research subjects,among which 48 patients with gestational diabetes mellitus diagnosed from May to June 2023 were divided into an experimental group,and 48 patients with gestational diabetes mellitus diagnosed from March to April 2023 were included into a control group.The experimental group received professional training-based peer support based on routine nursing,and the control group received routine nursing.The status of self-management,health literacy,quality of life and blood glucose in 2 groups were compared and analyzed.Results 45 patients in the experimental group and 48 patients in the control group completed the study.After intervention,the Self-Management Scale score of the experimental group was(115.11±9.48),which was higher than(78.46±6.27)of the control group;the score of Health Literacy Scale was(145.38±5.22),higher than(92.19±5.75)of the control group;the Quality of Life Scale score was(79.47±4.11),higher than(60.85±2.80)of the control group;the fasting blood glucose concentration and two-hour postprandial glucose concentration in the experimental group were lower than those in the control group,and the difference between 2 groups was statistically significant(P＜0.001).Conclusion Nursing intervention of the professional training-based peer support can effectively improve the levels of self-management,health literacy and quality of life,as well as reduce concentration of blood glucose.