ObjectiveTo investigate the mechanism by which Luoshi Neiyi prescription treats endometriosis （EMs） through the Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB） signaling pathway. MethodsAnimal experiments were conducted with 50 female SD rats， which were randomized into a sham operation group （10 rats） and a modeling group （40 rats）. An autologous endometrial transplantation method was used for the modeling of EMs. The 36 successfully modeled rats were randomly allocated into four groups （n=9 each）： The model group， the low-dose （7.87 g·kg^-1） Luoshi Neiyi prescription group， the high-dose （15.74 g·kg^-1） Luoshi Neiyi prescription group， and the dienogest （0.20 mg·kg^-1） group. The physiological status and ectopic lesion volumes of rats in each group were observed. Hematoxylin-eosin （HE） staining was used to observe the morphology of the eutopic endometrial tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of inflammatory factors including interleukin-1β （IL-1β） and prostaglandin E₂ （PGE₂） in the serum of EMs rats. Immunohistochemistry was used to detect the expression of matrix metalloproteinase-9 （MMP-9） and vascular endothelial growth factor A （VEGFA） in the eutopic endometrial tissue. Western blot was adopted to determine the protein levels of TLR4， myeloid differentiation factor 88 （MyD88）， phosphorylated nuclear factor-κB （p-NF-κB）/NF-κB， MMP-9， and VEGFA in the eutopic endometrial tissue. In the cell experiments， the cell-counting kit-8 （CCK-8） assay was employed to screen the optimal concentration of Luoshi Neiyi prescription-containing serum， and a scratch assay was performed to assess the migration ability of iheESCs cells. Interventions with Luoshi Neiyi prescription-containing serum， resatorvid （TAK-242， a TLR4 inhibitor）， and lipopolysaccharides （LPS， a TLR4 agonist） were conducted， and Western blot was used to detect the expression of proteins related to the TLR4/NF-κB signaling pathway. ResultsThis experiment successfully replicated 36 EMs rat models. Compared with the sham operation group， the model group exhibited visible ectopic lesions on the abdominal wall and an increase in the writhing response score （P<0.01）. Furthermore， HE staining revealed the model group exhibited a thickened eutopic epithelium， stromal cell disarrangement， and evident infiltration of inflammatory cells. In addition， the model group showed elevated serum levels of IL-1β and PGE₂ （P<0.05， P<0.01）， increased positive expression of MMP-9 and VEGFA in the ectopic endometrial tissue （P<0.01）， and up-regulated protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01）. Compared with the model group， all treatment groups exhibited a reduction in the ectopic lesion volume （P<0.01）. Furthermore， the writhing response scores were decreased in the high-dose Luoshi Neiyi prescription group and the dienogest group （P<0.05， P<0.01）. The pathological state of the ectopic endometrial tissue was alleviated to varying degrees in the treatment groups. Low-dose Luoshi Neiyi prescription reduced serum PGE₂ levels， and high-dose Luoshi Neiyi prescription and dienogest decreased serum IL-1β and PGE₂ levels in EMs rats （P<0.05， P<0.01）. The treatment groups showed decreased positive expression of MMP-9 and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01） and down-regulated protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01）. The cell experiments showed that 5%， 10%， and 20% Luoshi Neiyi prescription-containing sera significantly reduced the viability and inhibited the migration of iheESCs. Compared with the control group， 5%， 10%， and 20% Luoshi Neiyi prescription-containing serum groups and the TAK-242 group showed reduced protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA （P<0.01）. Compared with the control group， the LPS group showed increased expression of the above proteins （P<0.01）. Compared with the LPS group， the LPS+5%， 10%， and 20% Luoshi Neiyi prescription-containing serum groups showed reduced expression of the above proteins （P<0.05， P<0.01）. ConclusionLuoshi Neiyi prescription may modulate the TLR4/NF-κB signaling pathway to reduce the inflammatory response and histopathological damage in the eutopic endometrium and suppress the adhesive， invasive， and angiogenic biological processes in the ectopic endometrial tissue， thereby exerting its therapeutic effect on EMs.

Objective:To compare the efficacy and safety of irradiation-incorporated and chemotherapy only-based myeloablative conditioning regimens in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for patients with high-risk myeloid malignancies.Methods:This study retrospectively collected clinical data from 63 high-risk acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) patients who underwent haplo-HSCT at the Fifth Medical Center of the Chinese PLA General Hospital from January 2015 to December 2019. These patients were classified into the irradiation ( n = 17) and chemotherapy ( n = 46) groups based on different conditioning regimens. The differences between the two groups were compared in terms of hematopoietic reconstitution, cumulative incidence of acute/chronic graft-versus-host diseases (aGVHD and cGVHD), non-relapse mortality (NRM), relapse rate (RR), overall survival (OS), and disease-free survival (DFS), followed by the analysis of prognostic factors. Results:The median follow-up time for the irradiation and chemotherapy groups was 78.5 and 72.3 months, respectively. The median time for neutrophil engraftment was 14.0 days in the irradiation group and 14.5 d in the chemotherapy group, and for platelet engraftment was 15.0 and 13.0 d, respectively. As a result, the two groups showed no statistically significant differences in hematopoietic reconstitution ( P > 0.05). The cumulative incidence of aGVHD and cGVHD was higher in the irradiation group compared to the chemotherapy group, yet showing no statistically significant differences ( P > 0.05). Specifically, the cumulative incidence of grade Ⅱ-Ⅳ aGVHD within 100 d was 29.4% and 21.7% for the irradiation and chemotherapy groups, respectively. The cumulative incidence of grade Ⅲ-Ⅳ aGVHD was 23.5% and 13.0%, respectively. The cumulative incidence of severe cGVHD within five years was 11.8% in the irradiation group and 8.7% in the chemotherapy group. In terms of long-term survival, the cumulative 5\|year RR and NRM were 20.2% and 28.4% in the irradiation group, 5.9% and 23.9% in the chemotherapy group, respectively, showing no statistically significant differences ( P > 0.05). The 5-year DFS and OS rates were 73.9% and 47.7% in the irradiation group, and 81.1% and 54.4% in the chemotherapy group, respectively, without statistically significant differences ( P > 0.05). Notably, the irradiation group manifested more favorable DFS and OS survival curves compared to the chemotherapy group. The survival curves indicate that the irradiation-incorporated regimen exhibited better trends in OS, DFS, and cGVHD-free relapse-free survival (GRFS). However, multivariate analysis did not reveal that irradiation conditioning is an independent prognostic factor affecting survival [ HR = 0.532 (0.163-1.735), 0.370 (0.091-1.516), 0.683 (0.248-1.882), P > 0.05]. Conclusions:In haplo-HSCT for high-risk myeloid malignancies, the irradiation-incorporated conditioning regimen demonstrates lower RR and NRM, higher DFS and OS, and potentially superior survival outcomes compared to the chemotherapy only-based regimen. Therefore, the irradiation-incorporated conditioning regimen may be preferentially considered in haplo-HSCT.

Objective To investigate the application effect of cluster management in peri-discharge period of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Using random number table method,90 patients with AECOPD were divided into the observation group(45 cases)and the control group(45 cases).All patients underwent active treatment after admission.During the peri-discharge period,the control group received routine management,while the observation group received cluster management based on internet chronic obstructive pulmonary disease(COPD)management platform.Both groups received 12 weeks of intervention.Comparisons were made between the two groups in terms of the degree of dyspnea[modified British Medical Research Council dyspnoea scale(mMRC)dyspnoea scale],pulmonary function[forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred)],exercise endurance[6-minute walk test(6MWT)],management effect(frequency of emergency infusion or hospitalization due to moderate to severe acute exacerbation,frequency of multidisciplinary outpatient follow-up,compliance with regular home-based rehabilitation and proportions of smokers before and after intervention),and levels of laboratory indices[hemoglobin(Hb)and albumin(Alb)].Results After intervention,mMRC score of the observation group decreased and was lower than that of the control group(P＜0.05).The observation group showed an increase in FEV1%pred and 6 MWT distance,both of which were superior to those in the control group(P＜0.05).The proportion of smokers and number of emergency infusions or hospitalization diagnosis and treatment due to moderate-severe acute exacerbation in the observation group were lower than those in the control group.The proportion of regular home-based rehabilitation and multidisciplinary outpatient follow-up visits were higher/more in the observation group than those in the control group(P＜0.05).The levels of Hb and Alb in the observation group increased compared to those before intervention and were higher than those in the control group.Hb level in the control group decreased compared to that before intervention(P＜0.05).Conclusion Implementing cluster management during the peri-discharge period of patients with AECOPD can effectively alleviate dyspnea,improve exercise endurance,reduce acute exacerbation risk and promote the development of healthy behaviors.

Objective:To investigate the application effect of team-based learning (TBL) versus lecture-based learning (LBL) in the first aid skill training of peacekeeping forces.Methods:A total of 326 officers and soldiers who had not participated in first aid skill training from various peacekeeping units in the Gao area of the Eastern Theater of United Nations Multidimensional Integrated Stabilization Mission in Mali from September 2022 to June 2023 were selected and divided into groups A and B using numerical randomization, with 163 individuals in each group. The individuals in group A received LBL teaching, and those in group B received TBL teaching. Questionnaire survey, theoretical assessment, and operational skill assessment were performed for all officers and soldiers after the end of the course. SPSS 19.0 was used for the t-test and the chi-square test. Results:Compared with the LBL group, the TBL group had significantly better first aid awareness, first aid skills, team collaboration ability, and humanistic concern and a significantly higher degree of satisfaction with the training mode. The LBL group had a slightly higher theoretical assessment score than the TBL group [(86.73±8.57) vs. (85.92±7.66)], with no significant difference between the two groups. Compared with the LBL group, the TBL group had significantly better scores of each operational skill and the total score of operational skill assessment [(86.71±11.25) vs. (81.14±10.05)].Conclusions:As a relatively effective training mode, the TBL teaching method has significant advantages in improving the first aid awareness, team collaboration ability, and practical operation ability of peacekeeping personnel, and therefore, it holds promise for application in Mali and other peacekeeping task areas.

Objective:To compare the efficacy and safety of irradiation-incorporated and chemotherapy only-based myeloablative conditioning regimens in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for patients with high-risk myeloid malignancies.Methods:This study retrospectively collected clinical data from 63 high-risk acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) patients who underwent haplo-HSCT at the Fifth Medical Center of the Chinese PLA General Hospital from January 2015 to December 2019. These patients were classified into the irradiation ( n = 17) and chemotherapy ( n = 46) groups based on different conditioning regimens. The differences between the two groups were compared in terms of hematopoietic reconstitution, cumulative incidence of acute/chronic graft-versus-host diseases (aGVHD and cGVHD), non-relapse mortality (NRM), relapse rate (RR), overall survival (OS), and disease-free survival (DFS), followed by the analysis of prognostic factors. Results:The median follow-up time for the irradiation and chemotherapy groups was 78.5 and 72.3 months, respectively. The median time for neutrophil engraftment was 14.0 days in the irradiation group and 14.5 d in the chemotherapy group, and for platelet engraftment was 15.0 and 13.0 d, respectively. As a result, the two groups showed no statistically significant differences in hematopoietic reconstitution ( P > 0.05). The cumulative incidence of aGVHD and cGVHD was higher in the irradiation group compared to the chemotherapy group, yet showing no statistically significant differences ( P > 0.05). Specifically, the cumulative incidence of grade Ⅱ-Ⅳ aGVHD within 100 d was 29.4% and 21.7% for the irradiation and chemotherapy groups, respectively. The cumulative incidence of grade Ⅲ-Ⅳ aGVHD was 23.5% and 13.0%, respectively. The cumulative incidence of severe cGVHD within five years was 11.8% in the irradiation group and 8.7% in the chemotherapy group. In terms of long-term survival, the cumulative 5\|year RR and NRM were 20.2% and 28.4% in the irradiation group, 5.9% and 23.9% in the chemotherapy group, respectively, showing no statistically significant differences ( P > 0.05). The 5-year DFS and OS rates were 73.9% and 47.7% in the irradiation group, and 81.1% and 54.4% in the chemotherapy group, respectively, without statistically significant differences ( P > 0.05). Notably, the irradiation group manifested more favorable DFS and OS survival curves compared to the chemotherapy group. The survival curves indicate that the irradiation-incorporated regimen exhibited better trends in OS, DFS, and cGVHD-free relapse-free survival (GRFS). However, multivariate analysis did not reveal that irradiation conditioning is an independent prognostic factor affecting survival [ HR = 0.532 (0.163-1.735), 0.370 (0.091-1.516), 0.683 (0.248-1.882), P > 0.05]. Conclusions:In haplo-HSCT for high-risk myeloid malignancies, the irradiation-incorporated conditioning regimen demonstrates lower RR and NRM, higher DFS and OS, and potentially superior survival outcomes compared to the chemotherapy only-based regimen. Therefore, the irradiation-incorporated conditioning regimen may be preferentially considered in haplo-HSCT.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To analyze the incidence of biliary complications in patients with cholecystolithiasis and calculus of common bile duct after laparoscopic common bile duct exploration(LCBDE)with one-stage suture,and explore the high-risk factors of its occurrence,and then put forward targeted prevention strategies.Methods The clinical data of 201 patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture in our hospital from January 2020 to April 2024 were retrospectively analyzed.After 3 months of follow-up,the incidence of postoperative biliary complications was observed,and the clinical data of patients in the biliary complications group and the non-biliary complications group were analyzed.The factors with statistically significant differences were included in the multivariate Logistic regression model to analyze the independent risk factors affecting the occurrence of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture.Results Among the 201 patients,12 had biliary tract infection,5 had common bile duct stenosis,and 13 had bile leakage.The total incidence of biliary complications was 14.93%(30/201).Multivariate Logistic regression analysis showed that diabetes mellitus((OR)=1.092,95%CI:1.040～1.147),common bile duct diameter<1 cm((OR)=1.097,95%CI:1.053～1.144),stone incarceration at the lower end of common bile duct((OR)=1.120,95%CI:1.062～1.180),Calot triangle adhesion((OR)=1.099,95%CI:1.042～1.158),bile turbidity((OR)=1.082,95%CI:1.043～1.123)and operation time≥2 h((OR)=1.090,95%CI:1.044～1.138)were independent risk factors for patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture(P<0.05).Conclusion The risk of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture is high.The occurrence of complications is related to diabetes mellitus,common bile duct diameter<1 cm,stone incarceration at the lower end of the common bile duct,Calot triangle adhesion,bile turbidity and operation time≥2 h.Targeted prevention strategies can be formulated clinically to prevent the occurrence of biliary complications.

Objective To analyze the incidence of biliary complications in patients with cholecystolithiasis and calculus of common bile duct after laparoscopic common bile duct exploration(LCBDE)with one-stage suture,and explore the high-risk factors of its occurrence,and then put forward targeted prevention strategies.Methods The clinical data of 201 patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture in our hospital from January 2020 to April 2024 were retrospectively analyzed.After 3 months of follow-up,the incidence of postoperative biliary complications was observed,and the clinical data of patients in the biliary complications group and the non-biliary complications group were analyzed.The factors with statistically significant differences were included in the multivariate Logistic regression model to analyze the independent risk factors affecting the occurrence of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture.Results Among the 201 patients,12 had biliary tract infection,5 had common bile duct stenosis,and 13 had bile leakage.The total incidence of biliary complications was 14.93%(30/201).Multivariate Logistic regression analysis showed that diabetes mellitus((OR)=1.092,95%CI:1.040～1.147),common bile duct diameter<1 cm((OR)=1.097,95%CI:1.053～1.144),stone incarceration at the lower end of common bile duct((OR)=1.120,95%CI:1.062～1.180),Calot triangle adhesion((OR)=1.099,95%CI:1.042～1.158),bile turbidity((OR)=1.082,95%CI:1.043～1.123)and operation time≥2 h((OR)=1.090,95%CI:1.044～1.138)were independent risk factors for patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture(P<0.05).Conclusion The risk of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture is high.The occurrence of complications is related to diabetes mellitus,common bile duct diameter<1 cm,stone incarceration at the lower end of the common bile duct,Calot triangle adhesion,bile turbidity and operation time≥2 h.Targeted prevention strategies can be formulated clinically to prevent the occurrence of biliary complications.

Objective To investigate the application effect of cluster management in peri-discharge period of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Using random number table method,90 patients with AECOPD were divided into the observation group(45 cases)and the control group(45 cases).All patients underwent active treatment after admission.During the peri-discharge period,the control group received routine management,while the observation group received cluster management based on internet chronic obstructive pulmonary disease(COPD)management platform.Both groups received 12 weeks of intervention.Comparisons were made between the two groups in terms of the degree of dyspnea[modified British Medical Research Council dyspnoea scale(mMRC)dyspnoea scale],pulmonary function[forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred)],exercise endurance[6-minute walk test(6MWT)],management effect(frequency of emergency infusion or hospitalization due to moderate to severe acute exacerbation,frequency of multidisciplinary outpatient follow-up,compliance with regular home-based rehabilitation and proportions of smokers before and after intervention),and levels of laboratory indices[hemoglobin(Hb)and albumin(Alb)].Results After intervention,mMRC score of the observation group decreased and was lower than that of the control group(P＜0.05).The observation group showed an increase in FEV1%pred and 6 MWT distance,both of which were superior to those in the control group(P＜0.05).The proportion of smokers and number of emergency infusions or hospitalization diagnosis and treatment due to moderate-severe acute exacerbation in the observation group were lower than those in the control group.The proportion of regular home-based rehabilitation and multidisciplinary outpatient follow-up visits were higher/more in the observation group than those in the control group(P＜0.05).The levels of Hb and Alb in the observation group increased compared to those before intervention and were higher than those in the control group.Hb level in the control group decreased compared to that before intervention(P＜0.05).Conclusion Implementing cluster management during the peri-discharge period of patients with AECOPD can effectively alleviate dyspnea,improve exercise endurance,reduce acute exacerbation risk and promote the development of healthy behaviors.

Objective:To investigate the application effect of team-based learning (TBL) versus lecture-based learning (LBL) in the first aid skill training of peacekeeping forces.Methods:A total of 326 officers and soldiers who had not participated in first aid skill training from various peacekeeping units in the Gao area of the Eastern Theater of United Nations Multidimensional Integrated Stabilization Mission in Mali from September 2022 to June 2023 were selected and divided into groups A and B using numerical randomization, with 163 individuals in each group. The individuals in group A received LBL teaching, and those in group B received TBL teaching. Questionnaire survey, theoretical assessment, and operational skill assessment were performed for all officers and soldiers after the end of the course. SPSS 19.0 was used for the t-test and the chi-square test. Results:Compared with the LBL group, the TBL group had significantly better first aid awareness, first aid skills, team collaboration ability, and humanistic concern and a significantly higher degree of satisfaction with the training mode. The LBL group had a slightly higher theoretical assessment score than the TBL group [(86.73±8.57) vs. (85.92±7.66)], with no significant difference between the two groups. Compared with the LBL group, the TBL group had significantly better scores of each operational skill and the total score of operational skill assessment [(86.71±11.25) vs. (81.14±10.05)].Conclusions:As a relatively effective training mode, the TBL teaching method has significant advantages in improving the first aid awareness, team collaboration ability, and practical operation ability of peacekeeping personnel, and therefore, it holds promise for application in Mali and other peacekeeping task areas.