OBJECTIVE To provide reference for medical institutions to establish the record management mode and review rules of off-label use of 5-aminolevulinic acid （ALA） in photodynamic therapy based on the level of evidence. METHODS All ALA-containing outpatient prescriptions in the rational drug use system in our hospital from January 1， 2024 to December 31， 2025 were retrospectively collected. Based on the drug instructions， the current status of off-label use of ALA in photodynamic therapy was identified . The relevant studies in Micromedex， PubMed， CNKI， Wanfang Data and other databases were systematically searched as the relevant evidence-based evidence of ALA off-label use. According to the Off-label Drug Use Filing Standard of the hospital，the evidence-based evaluation method was used to evaluate the evidence-based evidence of ALA off-label use and carry out hierarchical management. RESULTS A total of 1 803 effective prescriptions were included， of which 676 （37.49%） were off-label use， distributed in the dermatology department （564 prescriptions，83.43%） and the plastic surgery department （112 prescriptions，16.57%）. All 676 prescriptions were off-indications medication， involving ten types of skin diseases， primarily including moderate to severe acne （39.94%）， skin warts （25.44%）， Bowen’s disease （11.98%）， and others. According to evidence-based evidence，off-label uses such as moderate to severe acne， actinic keratosis， and Bowen’s disease were managed according to the evidence categoryⅠ orⅡ.The uses of extramammary Paget’s disease and rosacea were managed according to the evidence category Ⅲ.The uses of lichen sclerosus and keloids were managed according to the evidence category Ⅳ.The results of evidence-based evaluation showed that 92.01% of off-label use in our hospital had high-level evidence-based support （ evidence category was gradeⅠ-Ⅱ）. CONCLUSIONS Off-label uses supported by high-level evidence， such as moderate to severe acne， skin warts， and Bowen’s disease， can be managed under filing category Ⅰ or Ⅱ. For the use of lichen sclerosus and keloids， evidence-based evidence is insufficient and should be strictly restricted.The vast majority of ALA off-label use in our hospital has sufficient evidence-based basis.

Macrophages are closely related to tumor progression,and can promote tumor growth and pro-liferation by promoting inflammation,angiogenesis and immunosuppression and so on,as well as killing tumors by directly killing tumor cells and triggering specific immune responses.Iron death,as an iron-depend-ent cell death caused by lipid peroxidation,can effectively kill tumor cells when regulated from the perspective of iron homeostasis,and can also release pro-inflammatory factors,trigger inflammatory reactions,change the survival environment of tumors as well as reduce the immune susceptibility of tumor cells.In recent years,more and more studies have shown that macrophages and iron death are closely related.In this paper,the rela-tionship between macrophages and iron death in terms of their functional properties and targeting of tumors are mainly introduced,and an overview of the functional properties of the two differentiated phenotypes of macrophages for the treatment of iron death in tumors is provided.

Objective To investigate the clinical efficacy of platelet-rich plasma (PRP) therapy for interstitial cystitis/bladder pain syndrome (IC/BPS). Methods This single-center prospective study involved 97 IC/BPS patients treated in our hospital during Sep.2023 and Apr.2025, who underwent transurethral bladder injection of PRP. The injections were administered once a month for four sessions. The global response assessment (GRA) score,24-hour urinary frequency, maximum single voiding volume, visual analogue scale (VAS) score, O'Leary score, pelvic pain, urgency and frequency (PUF) score, and Zung self-rating anxiety scale (SAS) score were analyzed. Results All 97 patients completed four injections. The GRA score,24-hour urinary frequency, VAS score, O'Leary score and PUF score were improved significantly after treatment (P<0.007). Intraoperative bladder capacity with significant improvement were observed after the first injection (P<0.01), and the maximum urine output were observed after the fourth injection (P<0.007). The SAS score was not significantly improved. Conclusion Repeated PRP injections can effectively alleviate bladder pain, improve frequent and urgent urination symptoms, and increase the bladder capacity.

Crohn's disease (CD) is a refractory and recurrent chronic inflammatory bowel disease with an unclear etiology. In addition to intestinal symptoms, the disease is often accompanied by various extraintestinal manifestations. Studies have found that abnormalities in central nervous system activity in CD patients are closely related to the brain-gut axis, which may be one of the reasons for the high incidence of adverse emotions such as anxiety and depression. Functional magnetic resonance imaging (fMRI) has been widely used in the field of neurogastroenterology due to its non-invasiveness, high spatial resolution, and whole-brain coverage. This article reviews the application and progress of fMRI in CD brain functional study, aiming to comprehensively analyze and integrate the impact of the disease on brain function and provide a reference for clinical diagnosis, treatment, and future research.

Objective:To explore the clinical application value of optical navigation system（ONS）-guided sacral neuromodulation（SNM）electrode implantation for precise puncture.Methods:?This study was a randomized，controlled trial. Patients who underwent SNM electrode implantation at the Gongli Hospital，Pudong New Area，Shanghai，from February 2024 to March 2025 were included. Inclusion criteria：aged 18?80 years，meeting the indications recommended by the Chinese expert consensus on the clinical application of sacral neuromodulation or expanded applications，and having completed pelvic CT and MRI examinations to ensure image quality for navigation system use. Exclusion criteria：progressive neurological diseases，severe urinary tract infections，urinary tract obstruction，or other conditions that may affect surgical outcomes and safety. Patients were randomly divided into two groups using a random number table and a single-blind design was implemented. The two groups underwent different puncture guidance methods in the stage Ⅰ surgery，but other treatments and follow-up measures were consistent.The experimental group used ONS-guided puncture with preoperative pelvic CT and MRI scans for multimodal image fusion and 3D reconstruction and software-based puncture path planning for real-time intraoperative guidance. The control group used X-ray-guided cross-positioning，determining the S3 sacral foramen for puncture based on anatomical landmarks with a metal positioning ruler under fluoroscopy. The puncture path was planned using software to achieve real-time intraoperative guidance. Intraoperative indicators（number of punctures，puncture time，electrode contact points，minimum effective voltage，X-ray fluoroscopy time，radiation dose，total surgical time）and postoperative outcomes（complications，pain scores，stage Ⅱ permanent implantation rates）were compared between the two groups to assess the advantages and feasibility of ONS-guided sacral nerve electrode implantation.Results:?A total of 35 patients were included in each group. The experimental group had fewer intraoperative puncture attempts［2.0（2.0，3.0）vs. 5.0（4.0，7.0）］and shorter puncture procedure time［7.5（6.0，10.0）min vs. 14.0（12.0，18.0）min］，indicating more accurate and efficient ONS-guided puncture. There was no statistical difference in the number of electrode contact points between the two groups［3.0（3.0，4.0）vs. 3.0（3.5，3.8）， P = 0.374］，but the experimental group had a lower effective voltage［1.8（1.8，2.5）V vs. 2.5（1.8，3.0）V］and shorter stimulator adjustment time［10.0（8.0，12.0）min vs. 16.0（13.0，20.0）min］. The experimental group had shorter intraoperative X-ray fluoroscopy time［1.6（1.1，2.2）min vs. 4.6（3.8，6.0）min］，lower radiation dose［165.8（107.6，205.3）mGy vs. 427.4（325.1，636.5）mGy］，shorter total surgical time［52.0（49.0，57.8）min vs. 68.0（62.0，74.0）min］，less intraoperative blood loss［4.0（4.0，5.0）ml vs. 6.0（5.0，7.0）ml］，and a lower proportion of patients requiring supplemental local anesthesia［14.3%（5/35）vs. 40.0%（14/35）］. The postoperative wound infection rates were not statistically different between the two groups［0 vs. 2.9%（1/35）， P = 1.000］，but the experimental group had significantly lower pain scores on postoperative day 1［（1.9 ± 1.1）vs.（3.2 ± 1.4）］and a higher stage Ⅱ permanent implantation rate［85.7%（30/35）vs. 65.7%（23/35）］，with statistically significant differences（ P < 0.05）. Conclusions:?ONS-guided SNM electrode implantation reduces the number of puncture attempts，surgical time，and X-ray radiation，effectively lowers the effective voltage，and increases the stage Ⅱ permanent implantation rate.

Objective:To explore the feasibility and clinical outcomes of transperineal prostate multimodal image fusion-targeted biopsy under the day surgery model.Methods:Clinical data of 258 patients who underwent transperineal prostate biopsy at the Second Affiliated Hospital of Xi’an Jiaotong University between December 2022 and June 2024 were retrospectively analyzed. Patients were divided into two groups，and the experimental group（ n = 141）underwent transperineal prostate multi-modal image-fusion targeted biopsy in the day-surgery mode，with age of（70.0 ± 8.8）years，median prostate-specific antigen（PSA）level of 11.10（7.63?17.06）ng/ml，and median Prostate Imaging Reporting and Data System（PI-RADS）score of 4（3，5）. The control group（ n = 117）underwent traditional transperineal systematic biopsy，with age of（69.3 ± 7.4）years，median PSA of 25.20（16.18-54.40）ng/ml，and median PI-RADS score of 4（3，5）. The experimental group was given the day surgery mode：preoperatively，multiparametric magnetic resonance imaging（mpMRI）of the prostate was multimodally fused with ultrasound images，the location of target lesions in the prostate was manually mapped，and a targeted biopsy plan was developed. Intraoperatively，under ultrasound guidance，precise puncture was performed at the lesion sites，followed by systematic biopsy. After the operation，the patients were observed for 4-6 hours，and could be discharged if there were no obvious abnormalities，with the total hospitalization time within 24 hours. For the control group，the conventional biopsy mode was used. Intraoperatively，under ultrasound guidance，the standard 12-core transperineal systematic biopsy protocol was adopted，and sampling was conducted according to the anatomical regions of the prostate（base，midportion，apex，transition zone，and peripheral zone）to cover the entire gland. Patients in this group required routine hospitalization，with a hospital stay of 3-5 days. Operative time，intraoperative pain Numerical Rating Scale（NRS）score，complications within one week postoperatively，treatment costs，overall prostate cancer detection rate，and clinically significant prostate cancer（csPCa，defined as Gleason score ≥ 7 or pathological stage ≥ T 2b）detection rate were compared between the two groups. Results:All procedures were successfully completed without special incidents. The operative time was（13.49 ± 2.00）min in the experimental group and（13.05 ± 2.89）min in the control group，showing no significant difference（ P > 0.05）. The intraoperative pain NRS scores were（3.01 ± 1.17）and（3.10 ± 1.25）in the experimental and control groups，respectively，with no significant difference（ P > 0.05）. Pathological examination revealed that the overall prostate cancer detection rates were 46.8%（66/141）in the experimental group and 42.7%（50/117）in the control group，while the csPCa detection rates were 35.5%（50/141）and 31.6%（37/117），respectively. The differences were not statistically significant（ P > 0.05）. The complication rate was 6.4%（9/141）in the experimental group（including 2 cases of acute urinary retention，3 hematuria，3 fever，and 1 sepsis）and 6.0%（7/117）in the control group（including 3 acute urinary retention，1 hematuria，2 fever，and 1 sepsis），with no significant difference（ P > 0.05）. All complications improved after symptomatic treatment. The treatment costs were（4 063.25 ± 67.26）yuan in the experimental group and（5 185.14 ± 469.15）yuan in the control group，demonstrating a statistically significant difference（ P < 0.05）. Conclusions:Transperineal prostate multimodal image fusion-targeted biopsy can be safely performed under the day surgery model，offering advantages including a relatively high detection rate for csPCa，low complication rate，and better cost-effectiveness.

Objective:To explore the correlation and predictive value of the blood urea nitrogen to serum albumin ratio (BAR) in the development of sepsis among patients with acute-on-chronic liver failure (ACLF).Methods:A total of 410 patients diagnosed with ACLF who were admitted to Wuxi Fifth People′s Hospital between January 1st, 2020 and December 31st, 2024 were enrolled in this study. Demographic information, laboratory test indicators, and other clinical data were retrospectively analyzed. Participants were stratified into two groups using a 6∶4 allocation ratio, comprising a training set of 246 patients and a validation set of 164 patients, the clinical data of two groups were compared. Logistic regression was employed to evalute the influencing factors of sepsis during hospitalization in ACLF patients. Additionally, the predictive value of different factors for sepsis occurrence was evaluated using receiver-operating characteristic curve analysis. DeLong test was used to compare the area under the curve.Results:The comparison of baseline data between the training set and the validation set revealed no statistically significant differences (all P>0.05). A total of 197 sepsis cases were observed during the study period. Multivariate logistic regression analysis revealed that both BAR and the sequential organ failure assessment (SOFA) score were independent influencing factors for sepsis development in ACLF patients (odds ratio ( OR)=1.274, 95% confidence interval (95% CI) 1.075 to 1.510, P=0.005; OR=1.142, 95% CI 1.038 to 1.256, P=0.006). In the training set, the area under the curve (AUC) of BAR for predicting sepsis in ACLF patients was 0.802, which was superior to that of the SOFA score (AUC=0.706) ( Z=2.16, P=0.031). The validation set showed the predictive ability of BAR with an AUC of 0.726, which was superior to the SOFA score′s performance (AUC=0.606) ( Z=2.28, P=0.023). Conclusions:BAR could independently predict sepsis development in ACLF patients with significant prognostic value. BAR could be used as a clinically useful biomarker for sepsis risk stratification.

Objective:To explore the effect of ultrasound bone knife combined with high-speed gas turbine method in mandibular impacted third molar extraction surgery,and conduct relevant analysis for bleeding situation.Methods:A total of 152 patients who underwent mandibular impacted third molar extraction surgery at Beijing First Hospital of Integrated Traditional Chinese and Western Medicine from April 2023 to April 2024 were retrospectively selected.They were divided into an observation group and a control group based on the different types of used instruments during the operation,with 76 cases in each group.The observation group used ultrasound bone knife combined with high-speed gas turbine method,while the control group only used high-speed gas turbine.The general information,incidence of intraoperative complications,surgical time,visual analogue scale(VAS)for pain assessment,degree of alveolar damage,patient's satisfaction,the number of patients with postoperative complications,intraoperative bleeding volume,postoperative bleeding time,and hemostatic effect were compared between two groups.Results:The incidence of complications included loosening of adjacent tooth,fracture or displacement of adjacent tooth,root fracture,and fracture of lingual bone plate in the observation group was 11.84%,which was lower than 23.68%in the control group,and the difference was statistically significant(x2=3.958,P＜0.05).Both the surgical time and VAS score of the observation group were lower than those of the control group(t=-7.875,-3.222,P＜0.05),and the degree of alveolar damage and the number of patients with postoperative complications in the observation group were significantly lower than those in the control group,with statistically significant differences(t=-6.500,x2=4.417,P＜0.05).The average score of patients'treatment satisfaction in the observation group was significantly higher than that in the control group(t=4.242,P＜0.05).Both the intraoperatively blooding loss and the time of postoperative bleeding in the observation group were significantly lower than those in the control group(t=-3.636,-9.191,P＜0.001),and the score of hemostasis effect in the observation group was also better than that in the control group(t=11.744,P＜0.001).Conclusion:The effect of ultrasound bone knife combined with high-speed gas turbine method is better for mandibular impacted third molar extraction surgery,which performance is better in the amount of intraoperative bleeding loss,the time of postoperative bleeding,and hemostatic effect.

During orthodontic treatment, clinical monitoring of patients is a crucial factor in determining treatment success. It aids in timely problem detection and resolution, ensuring adherence to the intended treatment plan. In recent years, digital technology has increasingly permeated orthodontic clinical diagnosis and treatment, facilitating clinical decision-making, treatment planning, and follow-up monitoring. This review summarizes recent advancements in digital technology for monitoring orthodontic tooth movement, related complications, and appliance-wearing compliance. It aims to provide insights for researchers and clinicians to enhance the application of digital technology in orthodontics, improve treatment outcomes, and optimize patient experience. The digitization of diagnostic data and the visualization of dental models make chair-side follow-up monitoring more convenient, accurate, and efficient. At the same time, the emergence of remote monitoring technology allows orthodontists to promptly identify oral health issues in patients and take corresponding measures. Furthermore, the multimodal data fusion method offers valuable insights into the monitoring of the root-alveolar relationship. Artificial intelligence technology has made initial strides in automating the identification of orthodontic tooth movement, associated complications, and patient compliance evaluation. Sensors are effective tools for monitoring patient adherence and providing data-driven support for clinical decision-making. The application of digital technology in orthodontic monitoring holds great promise. However, challenges like technical bottlenecks, ethical considerations, and patient acceptance remain.

ObjectiveTo establish an educational intervention framework of electronic picture books for children with autism spectrum disorder (ASD) based on Creative Problem Solving (CPS) model, and observe the effect on social function. MethodsElectronic picture books were designed using CPS model, including the program of reading, interactive animation design and associated artistic activities. From March to June, 2023, 24 children with mild to moderate ASD were recruited from Maanshan Institute of Special Education, and randomly assigned into experimental group 1 (CPS-based cognitive picture book interventions, n = 8), experimental group 2 (CPS-based social picture book interventions, n = 8) and control group (Bloom's Taxonomy-based picture book interventions, n = 8), and received the interventions for four weeks, with a total of twelve times. They were assessed with speech, social, perceptual and health behavior using Autism Treatment Evaluation Checklist (ATEC) before and after treatment, and the differences were calculated. ResultsThere was a significant difference among the groups in the social and perceptual scores differences (F > 4.344, P < 0.05) and a near-significant difference in the health behaviour score difference (F = 2.921, P = 0.076). Post Hoc test showed that the differences in social scores were higher in both experimental groups than in the control group (P < 0.05); the difference in perceptual scores was significantly higher in experimental group 1 than in experimental group 2 (P < 0.01), but there was no significant difference with the control group (P > 0.05); the difference in health behavior scores was higher in experimental group 2 than in the control (P < 0.05), and the difference in experimental group 1 was slightly higher than in the control group (P = 0.072). ConclusionElectronic picture book interventions based on the CPS model may be more effective in enhancing social, perceptual and health behavior in children with ASD, but there may be differences among models.