Based on the modern understanding that lipid metabolism disorders mediate tumor microenvironmental imbalance in esophageal carcinoma， this paper proposes that failure of spleen and kidney warming and internal accumulation of phlegm-toxin constitute the core pathogenesis of esophageal carcinoma. Deficiency of spleen and kidney yang qi serves as the root cause， while impaired transformation and transportation of lipids and the accumulation of phlegm-toxin represent the superficial manifestations. Phlegm originates from the transformation of lipids， while toxin arises from and attaches to phlegm. Their interaction forms a sticky and persistent pathological state that runs throughout the entire disease process. The evolution of pathogenesis follows a dynamic and progressive pattern. In the early stage， failure of spleen and kidney warming and dysfunction of lipid metabolism mediate abnormalities in a lipid-enriched microenvironment； in the middle stage， lipid turbidity condenses into phlegm， and phlegm-toxin stasis promotes the formation of an inflammatory and hypercoagulable microenvironment； in the late stage， dysfunction of the sanjiao （三焦） warming function and impaired qi transformation lead to an imbalance in the hypoxic and metabolically dysfunctional microenvironment. Accordingly， a staged therapeutic approach is proposed， including warming the kidney and strengthening the spleen， transforming phlegm and resolving toxin， and warming and unblocking the sanjiao. By regulating lipid metabolism to restore tumor microenvironmental homeostasis， this approach provides a new theore-tical perspective and practical strategy for the intervention of esophageal cancer progression through traditional Chinese medicine.

Based on the modern understanding that lipid metabolism disorders mediate tumor microenvironmental imbalance in esophageal carcinoma， this paper proposes that failure of spleen and kidney warming and internal accumulation of phlegm-toxin constitute the core pathogenesis of esophageal carcinoma. Deficiency of spleen and kidney yang qi serves as the root cause， while impaired transformation and transportation of lipids and the accumulation of phlegm-toxin represent the superficial manifestations. Phlegm originates from the transformation of lipids， while toxin arises from and attaches to phlegm. Their interaction forms a sticky and persistent pathological state that runs throughout the entire disease process. The evolution of pathogenesis follows a dynamic and progressive pattern. In the early stage， failure of spleen and kidney warming and dysfunction of lipid metabolism mediate abnormalities in a lipid-enriched microenvironment； in the middle stage， lipid turbidity condenses into phlegm， and phlegm-toxin stasis promotes the formation of an inflammatory and hypercoagulable microenvironment； in the late stage， dysfunction of the sanjiao （三焦） warming function and impaired qi transformation lead to an imbalance in the hypoxic and metabolically dysfunctional microenvironment. Accordingly， a staged therapeutic approach is proposed， including warming the kidney and strengthening the spleen， transforming phlegm and resolving toxin， and warming and unblocking the sanjiao. By regulating lipid metabolism to restore tumor microenvironmental homeostasis， this approach provides a new theore-tical perspective and practical strategy for the intervention of esophageal cancer progression through traditional Chinese medicine.

Objective To investigate the association between single nucleotide polymorphisms (SNPs) in the nicotinamide adenine dinucleotide phosphate-oxidase (NOX) 2 and NOX4 genes and susceptibility to noise-induced hearing loss (NIHL). Methods A total of 439 noise-exposed workers were recruited using a convenience sampling method. Based on pure-tone air conduction hearing threshold tests, participants were categorized into normal hearing, mild hearing loss, and moderate hearing loss groups, with 147, 154, 138 individuals, respectively. Peripheral venous blood samples of the workers were collected for DNA extraction. Genotyping of nine SNPs loci in NOX2 and NOX4 genes was performed using multiplex polymerase chain reaction, single-base extension, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Results A total of seven of the nine SNPs loci conformed to Hardy-Weinberg equilibrium among the workers in the normal hearing group (all P>0.05). There was no significant difference in the genotype distribution or allele frequencies for these seven SNPs loci among workers in these three groups (all P>0.05). Ordinal logistic regression analysis showed that, after adjusting for confounders including age, sex, cumulative noise exposure, smoking, alcohol consumption, and earplug use, individuals carrying the GG genotype at rs200522762 had a lower risk of NIHL compared with those carrying the TT genotype under the codominant model (P<0.05). In the recessive model, individuals carrying the GG genotype at the rs200522762 locus had a lower risk than those carrying the GT+TT genotypes (P<0.05). Polymorphisms at the other six SNPs loci were not associated with NIHL risk (all P>0.05). Conclusion The NOX4 rs200522762 polymorphism is associated with susceptibility to NIHL.

OBJECTIVE To investigate the improvement effect and mechanism of modified Jinfeicao powder （MJCP） on cough-variant asthma （CVA） in rats.METHODS Network pharmacology was employed to identify the key targets and signaling pathways involved in the therapeutic action of MJCP against CVA. Rats were divided into normal control group， model group， positive control group （prednisone acetate， 0.9 mg/kg）， and MJCP low-， medium-， and high-dose groups （3.5， 7， 14 g/kg）， with six rats in each group. Except for the normal control group， CVA models were established in other groups. From day 14 of the experiment， rats in each group were administered corresponding drugs or normal saline intragastrically once daily for 14 consecutive days. After the final administration， cough frequency， serum levels of immune-inflammatory and oxidative stress-related indicators， pulmonary histopathological changes， and expression of pathway-related proteins were detected and observed.RESULTS Network pharmacology identified five key targets， including tumor necrosis factor-α （TNF-α）， interleukin-6（IL-6）， and protein kinase B（AKT）， as well as signaling pathways such as phosphatidylinositol 3-kinase （PI3K）/AKT/mammalian target of rapamycin （mTOR） and hypoxia-inducible factor-1α （HIF-1α）. Animal experimental results showed that， compared with the model group， cough frequency was significantly reduced in all treatment groups （ P ＜0.05）. Serum levels of immunoglobulin E （IgE）， IL-6， TNF-α， Src family of protein tyrosine kinase， epidermal growth factor receptor， and malondialdehyde （MDA） （except for IgE and MDA in the MJCP low-dose group）， mean pathological scores， the ratio of total airway wall area to basement membrane perimeter， and the expression levels of α -smooth muscle actin， Collagen-Ⅰ， phosphorylated PI3K， phosphorylated AKT （except in the MJCP low-dose group）， phosphorylated mTOR， and HIF-1α protein in lung tissues were all significantly decreased （ P ＜0.05）. Glutathione （except in the MJCP low-dose group） and superoxide dismutase levels in serum were significantly increased（ P ＜0.05）.CONCLUSIONS MJCP may alleviate airway inflammation， airway remodeling， and oxidative stress by regulating the PI3K/AKT/mTOR and HIF-1α signaling pathways， thereby exerting its improvement effects on CVA.

Objective To construct a risk prediction model for venous thromboembolism(VTE)in patients with acute stroke and analyze its predictive value with decision curve.Methods Clinical data of 265 patients with acute stroke admitted to Department of Neurology of Pingxiang People's Hospital between May 2022 and May 2024 were collected,and 185 of them(69.8％)were assigned to a training set and 80 cases(30.2％)into a validation set.Based on the results of color Doppler ultrasound examination,the patients in the training set were divided into the VTE group(72 cases)and the non-VTE group(113 cases).Multivariate logistic regression analysis was used to identify the risk factors for VTE occurrence in the patients.A prediction model was constructed and a nomegram was developed to visually present the logistic regression prediction model.ROC curve and decision curve analyses were applied to evaluate the predictive performance of the logis-tic regression model.Results The VTE group had significantly larger intracranial hemorrhage volume,higher fibrinogen(FIB),D-dimer and C-reactive protein(CRP)levels,and lower Glasgow Coma Scale(GCS)score than the non-VTE group(P＜0.01).Multivariate logistic regression analysis indicated that intracranial hemorrhage volume(OR=1.243,95％CI:1.015-1.522),FIB(OR=3.161,95％CI:1.711-5.841),CRP(OR=1.595,95％CI:1.283-1.981),and D-dimer(OR=6.234,95％CI:2.693-14.434)were independent risk factors for the occurrence of VTE in the patients with acute stroke,while GCS score(OR=0.587,95％CI:0.413-0.834,P=0.003)was an independent protective factor against the occurrence.A VTE prediction model based on these influencing factors obtained a consistency index of 0.978.The calibration curve results showed that the observed values were in good agreement with the predicted values.ROC curve analysis indicated that the AUC value of the prediction model was 0.978(95％CI:0.945-0.994)in the training set and 0.959(95％CI:0.890-0.991)in the validation set.Decision curve analysis revealed that the model achieved higher net benefit when the threshold probability was between 20％and 80％.Conclusion Intracranial bleeding volume,GCS score,CRP,Didimer and FIB are related influencing factors of VTE in patients with acute stroke,and the prediction model of deci-sion curve based on the above factors is of high prediction efficiency.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

Objective:To understand the relationship between sleep duration and cardiovascular and metabolic comorbidities (CMM) in middle-aged and elderly people in China.Methods:This study was a prospective cohort study, based on the data of China Health and Retirement Tracing Survey (CHARLS) from 2011 to 2015, and included middle-aged and elderly people aged≥45 years in the cohort study. Age, gender, marital status, residence, education, smoking status, alcohol status, body mass index, history of diabetes, history of dyslipidemia, history of hypertension, history of stroke, history of heart disease, history of mental illness, depression scale score were collected. Multivariate logistic regression was used to analyze the association between daily sleep duration and the risk of CMM onset and to construct four models with stepwise adjusted covariates. A stratified analysis was established based on demographic factors, lifestyle factors, metabolic factors, cardiovascular and cerebrovascular factors, and psychological factors. Meanwhile, a subgroup analysis was established according to different combinations of cardiovascular and metabolic diseases to explore the association between sleep length and the risk of CMM in different populations.Results:A total of 297 (4.4%) of the 6 788 included participants experienced CMM. In the multivariate logistic regression, the RR value (95% CI) for the risk of CMM for>9 h was 1.99 (1.86-2.08) and 1.78 (1.64-1.92), respectively (all P<0.001). The stratified analysis showed that the risk of CMM incidence between sleep duration<7 h and>9 h was associated in people with different age, sex, residence, smoking status, drinking status, body mass index, hypertension, hypertension, diabetes, heart disease, stroke, dyslipidemia, and depression (all P<0.05). Subgroup analysis showed that sleep duration<7 h with both diabetes, heart disease and stroke had the highest risk of CMM ( RR=1.95, 95% CI: 1.65-2.14). Conclusion:In the middle-aged and elderly group in China, there is a U-shaped association between sleep duration and CMM, that is, insufficient or too long sleep duration throughout the day is related to the increased risk of CMM.

Objective To investigate the regulation of macrophage polarization and foaminess by homocysteine(Hcy)and its potential underlying mechanisms.Methods ELISA and flow cytometry were used to detect the effect of Hcy treatment on the polarization of macrophages.The contents of various forms of intracellular cholesterol were detected,and the effects of Hcy on intracellular lipid accumulation and ox-LDL uptake were evaluated by oil red O staining and Dil-oxLDL.RT-qPCR and Western blot were used to detect mRNA and pro-tein expression of key genes modified by N6-methyladenosine(m6 A).Results Hcy promoted M1 polarization of macrophages and ox-LDL-induced foam macrophages and promoted ox-LDL uptake as well as intracellular lipid accumulation.In addition,Hcy upregulated methyltransferase like 3(METTL3)expression,and the tendency of Hcy to promote macrophage M1 polarization and foaminess was markedly reduced after inhibition or knockdown of METTL3 expression.Conclusions Hcy significantly promotes macrophage M1 polarization and foaminess,an effectthat may be attenuated by METTL3 silencing.