Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

ObjectiveTo investigate the mechanism of Xiezhuo Jiedu prescription in the treatment of ulcerative colitis （UC） by inhibiting ferroptosis and alleviating intestinal mucosal injury based on the nuclear factor E₂ related factor 2/solute carrier family 7 member/glutathione peroxidase 4 （Nrf2/SLC7A11/GPX4） signaling pathway. MethodsA total of 60 male SD rats were divided into a normal group， a model group， high- and low-dose Xiezhuo Jiedu prescription groups （26.64 and 13.32 g·kg^-1， respectively）， a ferroptosis inhibitor group （Ferrostatin-1， 0.005 g·kg^-1）， and a mesalazine group （0.27 g·kg^-1）， with 10 rats in each group. A UC rat model was established by intrarectal administration of trinitrobenzene sulfonic acid （TNBS）-ethanol. The normal group and the model group were intragastrically administered normal saline. The other groups were given intragastric administration according to the corresponding dosage for 7 d. The general condition， disease activity index （DAI） score， colon length， and mucosal injury index （CDMI） score were observed in each group. The pathological changes of colon tissue in each group were observed by hematoxylin-eosin （HE） staining. The intestinal mucosa and mitochondrial morphology in each group were observed by transmission electron microscopy. The expression levels of Occludin， Claudin-1， mucin 2 （MUC2）， and E-cadherin in intestinal tissue were detected by immunofluorescence （IF）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the expression levels of serum tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in each group， and a lactic acid assay kit or ELISA was employed to detect the expression levels of reactive oxygen species （ROS）， ferrous ions （Fe²⁺）， glutathione （GSH）， malondialdehyde （MDA）， 4-hydroxynonenal （4-HNE）， diamine oxidase （DAO）， and D-lactate （D-LA）. Real-time quantitative polymerase chain reaction （Real-time PCR） was applied to detect the mRNA expression levels of Nrf2， SLC7A11， GPX4， Occludin， Claudin-1， MUC2， and E-cadherin in each group， and Western blot was adopted to detect the protein expression levels of Nrf2， p-Nrf2， SLC7A11， and GPX4 in each group. ResultsCompared with the normal group， rats in the model group exhibited listlessness， sluggish response， and mucopurulent and bloody stools. The model group also showed significantly increased DAI score， colon length， CDMI score， and expression levels of TNF-α， IL-6， ROS， Fe²⁺， MDA， 4-HNE， DAO， and D-LA （P<0.01）. In addition， it presented significantly decreased IF values of Occludin， Claudin-1， MUC2， and E-cadherin and mRNA and protein expression levels of IL-10， GSH， Nrf2， p-Nrf2， SLC7A11， and GPX4 （P<0.01）. There were different degrees of improvement in each administration group after treatment， and the improvement was the most significant in the high-dose Xiezhuo Jiedu prescription group （P<0.01）. ConclusionXiezhuo Jiedu prescription may alleviate intestinal mucosal injury by inhibiting ferroptosis of intestinal epithelial cells via regulating the Nrf2/SLC7A11/GPX4 signaling pathway， thereby exhibiting efficacy in the treatment of UC.

Objective This study aims to develop a guideline for assessing and maintaining intrinsic capacity in older adults,offer recommendations to professionals regarding these assessments,and encourage the implementation of evidence-based clinical practices across various settings,including communities,hospitals,nursing homes,and other geriatric care environments.Methods An evidence-based approach guided the collection of questions through a lit-erature review.Preliminary recommendations were developed through a systematic search of domestic and interna-tional guideline networks,professional association websites,and comprehensive databases.Subsequently,the recom-mendations were revised,and the consensus was achieved through a round of expert consensus meetings and 3 rounds of expert correspondence,culminating in the formation of the guidelines.Results The developed guideline encompasses 2 aspects and 5 dimensions of assessment and maintenance,comprising a total of 28 questions and 39 recommendations.Specifically,6 questions and 9 recommendations were formulated for the cognitive dimension,5 questions and 7 recommendations for the locomotion dimension,6 questions and 7 recommendations for the vitality dimension,6 questions and 9 recommendations for the psychological dimension,and 5 questions and 7 recommenda-tions for the sensory dimension.Among these,34 are classified as strong recommendations,while 5 are categorized as weak recommendations.Conclusion The guideline offers scientifically robust,acceptable,and comprehensible rec-ommendations that equip the professionals with a foundation for decision-making aiming at preserving the intrinsic capacity of older adults.

Objectives:To investigate the clinical efficacy of Schroth scoliosis-specific exercises combined with three-dimensional traction therapy in spinal-pelvic remodeling for adolescents idiopathic scoliosis(AIS).Methods:80 AIS patients who received treatment at our hospital from June 2021 to June 2024 were en-rolled.They were randomly divided into a control group(n=40,received Schroth spinal scoliosis-specific cor-rection exercises alone)and a research group(n=40,underwent a combination of Schroth spinal scoliosis-spe-cific correction exercises and three-dimensional traction therapy)using a random number table method.The general demographic data of the two groups were well-balanced(P＞0.05).The clinical overall response rates of the two groups were compared,and spinal-pelvic remodeling indicators,including Cobb angle,angle of trunk inclination(ATI),angle of trunk rotation(ATR),C7 plumb line to the center sacral vertical line(C7-CSVL),api-cal vertebral translation(AVT),as well as median frequency(MF),mean power frequency(MPF),and average electromyography(AEMG)of the surface electromyography of the erector spinae muscles on the concave and convex sides,pelvic tilt(PT),pelvic incidence(PI),and sacral slope(SS),were assessed before treatment,at 1 month and 3 months after treatment.Repeated measures analysis of variance was conducted to test the main effects of spinal-pelvic remodeling indicators during the treatment period for both groups.Pearson correlation analysis was performed to examine the relationship between the Oswestry disability index(ODI)score and spinal-pelvic remodeling indicators.Results:The total effective treatment rate was significantly higher in the research group than in the control group(97.50％vs 67.50％,P＜0.001).Compared with the pre-treatment val-ues,the Cobb angle,ATI,and ATR of both groups decreased at 1 month and 3 months post-treatment(P＜0.05).Moreover,when compared with the control group,the research group showed a more pronounced de-crease in Cobb angle,ATI,and ATR at 1 month and 3 months post-treatment(P＜0.05).Both groups exhibited a decrease in PI and SS,along with an increase in PT at 1 month and 3 months post-treatment(P＜0.05).In comparison with the control group,the research group demonstrated a more significant decrease in PI and SS,and a more pronounced increase in PT at 1 month and 3 months post-treatment(P＜0.05).The C7-CSVL and AVT of both groups decreased at 1 month and 3 months post-treatment(P＜0.05),and the research group showed a more significant decrease in C7-CSVL and AVT compared with the control group at 1 month and 3 months post-treatment(P＜0.05).Both groups experienced an increase in MF,MPF,and AEMG of the sur-face electromyography of the erector spinae muscles at 1 month and 3 months post-treatment(P＜0.05),with the research group showing a more significant increase compared with the control group at 1 month and 3 months post-treatment(P＜0.05).The main effect tests revealed statistically significant time effects,inter-group effects,and interaction effects for the spinal-pelvic remodeling indicators during the treatment period(P＜0.05).The Cobb angle,ATI,ATR,C7-CSVL,AVT,MF,AEMG,MPF,PI,PT,and SS were all found to be corre-lated with the ODI score before and after treatment(P＜0.05).The decrease in the ODI score of study group after treatment was significantly better than that of control group(β=-6.178,P＜0.001).Conclusions:Schroth scoliosis-specific exercises combined with three-dimensional traction therapy significantly improve spinal-pelvic remodeling in AIS patients,effectively reducing spinal curvature and enhancing pelvic symmetry.

Objectives:To investigate the clinical efficacy of Schroth scoliosis-specific exercises combined with three-dimensional traction therapy in spinal-pelvic remodeling for adolescents idiopathic scoliosis(AIS).Methods:80 AIS patients who received treatment at our hospital from June 2021 to June 2024 were en-rolled.They were randomly divided into a control group(n=40,received Schroth spinal scoliosis-specific cor-rection exercises alone)and a research group(n=40,underwent a combination of Schroth spinal scoliosis-spe-cific correction exercises and three-dimensional traction therapy)using a random number table method.The general demographic data of the two groups were well-balanced(P＞0.05).The clinical overall response rates of the two groups were compared,and spinal-pelvic remodeling indicators,including Cobb angle,angle of trunk inclination(ATI),angle of trunk rotation(ATR),C7 plumb line to the center sacral vertical line(C7-CSVL),api-cal vertebral translation(AVT),as well as median frequency(MF),mean power frequency(MPF),and average electromyography(AEMG)of the surface electromyography of the erector spinae muscles on the concave and convex sides,pelvic tilt(PT),pelvic incidence(PI),and sacral slope(SS),were assessed before treatment,at 1 month and 3 months after treatment.Repeated measures analysis of variance was conducted to test the main effects of spinal-pelvic remodeling indicators during the treatment period for both groups.Pearson correlation analysis was performed to examine the relationship between the Oswestry disability index(ODI)score and spinal-pelvic remodeling indicators.Results:The total effective treatment rate was significantly higher in the research group than in the control group(97.50％vs 67.50％,P＜0.001).Compared with the pre-treatment val-ues,the Cobb angle,ATI,and ATR of both groups decreased at 1 month and 3 months post-treatment(P＜0.05).Moreover,when compared with the control group,the research group showed a more pronounced de-crease in Cobb angle,ATI,and ATR at 1 month and 3 months post-treatment(P＜0.05).Both groups exhibited a decrease in PI and SS,along with an increase in PT at 1 month and 3 months post-treatment(P＜0.05).In comparison with the control group,the research group demonstrated a more significant decrease in PI and SS,and a more pronounced increase in PT at 1 month and 3 months post-treatment(P＜0.05).The C7-CSVL and AVT of both groups decreased at 1 month and 3 months post-treatment(P＜0.05),and the research group showed a more significant decrease in C7-CSVL and AVT compared with the control group at 1 month and 3 months post-treatment(P＜0.05).Both groups experienced an increase in MF,MPF,and AEMG of the sur-face electromyography of the erector spinae muscles at 1 month and 3 months post-treatment(P＜0.05),with the research group showing a more significant increase compared with the control group at 1 month and 3 months post-treatment(P＜0.05).The main effect tests revealed statistically significant time effects,inter-group effects,and interaction effects for the spinal-pelvic remodeling indicators during the treatment period(P＜0.05).The Cobb angle,ATI,ATR,C7-CSVL,AVT,MF,AEMG,MPF,PI,PT,and SS were all found to be corre-lated with the ODI score before and after treatment(P＜0.05).The decrease in the ODI score of study group after treatment was significantly better than that of control group(β=-6.178,P＜0.001).Conclusions:Schroth scoliosis-specific exercises combined with three-dimensional traction therapy significantly improve spinal-pelvic remodeling in AIS patients,effectively reducing spinal curvature and enhancing pelvic symmetry.

Objective:To develop and validate a Self-care Ability Scale for Arteriovenous Fistula (AVF) in Maintenance Hemodialysis (MHD) patients.Methods:Guided by Orem's self-care theory, the initial item pool of the scale was developed through a literature review, semi-structured interviews, and group discussions. The initial scale was finalized after two rounds of expert consultation using the Delphi method. A convenience sampling method was used to recruit 418 MHD patients using AVF in January 2024 for item analysis, exploratory factor analysis and reliability testing. Another 293 MHD patients using AVF were recruited in March 2024 for confirmatory factor analysis.Results:The self-care ability scale for AVF in MHD patients included four dimensions: knowledge and skills of AVF self-care, willingness and attitude toward AVF self-care, recognition and prevention of AVF complications, and patient self-adjustment and adaptation, comprising 38 items. The content validity index at the scale level was 0.98. Exploratory factor analysis extracted four common factors with a cumulative variance contribution rate of 84.706%. Confirmatory factor analysis indicated good model fit, strong convergent validity, and ideal discriminant validity. The total Cronbach's α coefficient of the scale was 0.987; the split-half reliability coefficient was 0.902, and the test-retest reliability coefficient was 0.979.Conclusions:The Self-care Ability Scale for AVF in MHD patients demonstrates excellent reliability and validity, making it a suitable tool for assessing patients' ability to self-care for their AVF.

Milk-derived exosomes are nanoscale extracellular vesicles naturally present in mammalian milk and are rich in proteins,lipids,nucleic acids,and bioactive metabolites.They exhibit biological activities such as anti-inflammatory,antioxidant,and immunomodulatory effects.Owing to their unique advantages of low immunogenicity,excellent biocompatibility,stability,and natural targeting ability,milk-derived exosomes have emerged as promising natural nanocarriers,garnering significant attention in disease treatment and nutritional interventions.Sarcopenia,characterized by reduced skeletal muscle mass and diminished strength,is closely associated with aging,chronic inflammation,and oxidative stress.Recent studies have highlighted the potential role of milk-derived exosomes in combating sarcopenia.These exosomes can increase myotube diameter,enhance muscle mass and fiber cross-sectional area,and improve exercise performance metrics such as grip strength.Potential mechanisms may include promoting muscle anabolism,improving mitochondrial function through antioxidant mechanisms,and modulating the inflammatory microenvironments.However,challenges remain in their application for sarcopenia at present,such as the unclear mechanisms of key bioactive components[e.g.,microRNAs(miRNAs),L-ornithine,and milk fat globule-epidermal growth factor 8(MFG-E8)],and the targeting and stability of delivery systems need to be optimized.Future research should focus on the functional analysis of components in exosomes,optimization of delivery systems,and preclinical validation to promote their practical application in managing age-related muscle health.

Objective This study aims to develop a guideline for assessing and maintaining intrinsic capacity in older adults,offer recommendations to professionals regarding these assessments,and encourage the implementation of evidence-based clinical practices across various settings,including communities,hospitals,nursing homes,and other geriatric care environments.Methods An evidence-based approach guided the collection of questions through a lit-erature review.Preliminary recommendations were developed through a systematic search of domestic and interna-tional guideline networks,professional association websites,and comprehensive databases.Subsequently,the recom-mendations were revised,and the consensus was achieved through a round of expert consensus meetings and 3 rounds of expert correspondence,culminating in the formation of the guidelines.Results The developed guideline encompasses 2 aspects and 5 dimensions of assessment and maintenance,comprising a total of 28 questions and 39 recommendations.Specifically,6 questions and 9 recommendations were formulated for the cognitive dimension,5 questions and 7 recommendations for the locomotion dimension,6 questions and 7 recommendations for the vitality dimension,6 questions and 9 recommendations for the psychological dimension,and 5 questions and 7 recommenda-tions for the sensory dimension.Among these,34 are classified as strong recommendations,while 5 are categorized as weak recommendations.Conclusion The guideline offers scientifically robust,acceptable,and comprehensible rec-ommendations that equip the professionals with a foundation for decision-making aiming at preserving the intrinsic capacity of older adults.

Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

Milk-derived exosomes are nanoscale extracellular vesicles naturally present in mammalian milk and are rich in proteins,lipids,nucleic acids,and bioactive metabolites.They exhibit biological activities such as anti-inflammatory,antioxidant,and immunomodulatory effects.Owing to their unique advantages of low immunogenicity,excellent biocompatibility,stability,and natural targeting ability,milk-derived exosomes have emerged as promising natural nanocarriers,garnering significant attention in disease treatment and nutritional interventions.Sarcopenia,characterized by reduced skeletal muscle mass and diminished strength,is closely associated with aging,chronic inflammation,and oxidative stress.Recent studies have highlighted the potential role of milk-derived exosomes in combating sarcopenia.These exosomes can increase myotube diameter,enhance muscle mass and fiber cross-sectional area,and improve exercise performance metrics such as grip strength.Potential mechanisms may include promoting muscle anabolism,improving mitochondrial function through antioxidant mechanisms,and modulating the inflammatory microenvironments.However,challenges remain in their application for sarcopenia at present,such as the unclear mechanisms of key bioactive components[e.g.,microRNAs(miRNAs),L-ornithine,and milk fat globule-epidermal growth factor 8(MFG-E8)],and the targeting and stability of delivery systems need to be optimized.Future research should focus on the functional analysis of components in exosomes,optimization of delivery systems,and preclinical validation to promote their practical application in managing age-related muscle health.