Background: and Purpose In patients with large vessel occlusion (LVO), intravenous thrombolysis (IVT) frequently alters thrombus location; however, the clinical impact of this phenomenon remains unclear. We aimed to compare post-IVT thrombus dynamics between tenecteplase and alteplase and to evaluate the association between thrombus dynamics and 3-month outcomes. Methods: This retrospective study analyzed prospectively collected, multicenter data from consecutive patients with LVO who underwent bridging therapy between January 2022 and December 2024. Thrombus dynamics were classified as resolution, migration, or stability. Analyses incorporated propensity score matching with weighting to balance baseline characteristics. Results: Of the 806 initially included patients, 746 were included after matching (373 treated with tenecteplase and 373 treated with alteplase). The incidence of thrombus migration was significantly higher in the tenecteplase group than in the alteplase group (19.3% vs. 11.3%; odds ratio [OR]: 1.92; 95% confidence interval [CI] 1.27–2.91). The advantage of tenecteplase over alteplase was restricted to patients with an IVT-to-puncture time of <60 minutes (18.6% vs. 6.2%; p=0.001) and was no longer significant when the interval ≥60 minutes (19.7% vs. 15.0%; p=0.204; pinteraction=0.043). Additionally, thrombus migration was associated with a better functional outcome (OR: 1.62; 95% CI 1.04–2.53). Finally, tenecteplase was associated with improved functional independence compared with alteplase (OR: 1.43; 95% CI 1.04–1.95). Conclusions Tenecteplase demonstrated superior efficacy in inducing thrombus migration compared with alteplase, particularly within 60 minutes of IVT administration. Thrombus migration independently predicted improved functional independence. These findings support the preferential use of tenecteplase for bridging therapy in patients with LVO.

Objective: To optimize the technology and process for recovering immune cells from discarded leukocyte filter through reverse flushing, and to investigate the effects of different reverse flushing solutions and physical conditions (temperature, soaking, and ultrasound) on the cell recovery rate. Additionally, to evaluate the feasibility and quality of isolating and culturing NK cells from the recovered cells. Methods: Normal saline, PBS, and PBS-EDTA were used as reverse flushing solutions to backwash the filter, and the white blood cell recovery rates were compared. The reverse flushing efficiency was optimized by adjusting the temperature of the reverse flushing solution, filter soaking treatment and ultrasonic treatment. The Ficoll separation method was employed to isolate peripheral blood mononuclear cells (PBMCs) from the elution solution and conduct in vitro expansion and culture. Lymphocyte subsets were identified and quantified using flow cytometry. Results: The physiological saline served as the backflush fluid was the most stable. The reverse temperature had a significant impact on the recovery rate of white blood cell subgroups. The recovery rates of lymphocytes and monocytes at 37℃ were significantly higher than those at 4℃ [(35.56±5.55)% vs (22.88±0.31)%, (32.42±4.82)% vs (8.00±1.6)%, t=5.581 and 5.758, respectively, both P<0.001)], and at 25℃ [(35.56±5.55)% vs (22.42±6.13)%, t=5.904, P<0.001; (32.4±4.82)% vs (21.11±1.23)%, t=2.629, P=0.030)]. The recovery rates of white blood cell subgroups after 37℃ immersion were higher than those after direct reverse flow at 37℃, but the difference was not statistically significant (P>0.05). The recovery rate of cells after ultrasonic immersion at 25℃ was further increased compared to that after immersion at 25℃, but the difference was not statistically significant (P>0.05). The purity of the NK cells obtained through sorting reached (94.2±4.5)%, and the viability was (94.8±0.9)%. After 15 days of culture, the cell count was expanded approximately 450 times, yielding more than 10 /mL highly active NK cells. Conclusion: By optimizing the backflushing process, immune cells can be efficiently recovered from discarded filters. The 37℃ backflow liquid has the best backflow effect; soaking and ultrasonic treatment can be used as auxiliary methods to improve recovery rates. The NK cells from this source have high purity, good activity, and strong expansion ability, and can be used as a reliable cell source for immunotherapy research, and in line with the circular economy concept of resource reuse.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective To explore the clinical,radiological,and arthroscopic outcomes of anterior cru-ciate ligament(ACL)reconstruction combined with posterior tibial slope(PTS)reducing osteotomy in patients with increased PTS and excessive anterior tibial subluxation(ATS)due to primary ACL inju-ry.Methods This retrospective study included patients who underwent ACL reconstruction between 2016 and 2022 in our department.The inclusion criteria were PTS≥15° and ATS≥6 mm,and all pa-tients received ACL reconstruction combined with PTS reducing osteotomy with a follow-up of more than 2 years.Before and after the operation,they were assessed KT-1000 side-to-side difference(KT SSD),pivot shift grade,Lachman test,anterior tibial subluxation of the medial and lateral compart-ments(ASMC and ASLC),magnetic resonance imaging(MRI),and arthroscopic findings of associat-ed injuries.Moreover,graft laxity was defined as graft laxity observed on MRI or arthroscopy,KT SSD>3 mm,or pivot>1+,while graft failure was defined as graft rupture on MRI or arthroscopy,KT SSD>5 mm,or pivot>2+.Meanwhile,clinical outcomes were compared preoperatively and post-operatively,and graft status and associated injuries were described.Results A total of 30 patients were included,with an average age of 31 years,and 23%of female.The inter-observer reliability for mea-surements of PTS and ATS was greater than 0.80.Compared to preoperative values,postoperative PTS(18.2° vs.6.8°,P<0.001),KT SSD(7.8 mm vs.1.2 mm,P<0.001),ASLC(7.5 mm vs.4.5 mm,P=0.002),and ASMC(5.0 mm vs.2.7 mm,P=0.034),all showed significant improvements.In addi-tion,the proportion of patients with postoperative pivot grade of 2+to 3+(73.3%vs.6.7%,P<0.001)and Lachman grades Ⅱ-Ⅲ(70%vs.3.3%,P<0.001)reduced significantly.At the last follow-up,the incidence of graft laxity was 20%,and that of the graft failure was 13.3%.Among all pa-tients,1 patient(3.3%)had graft roof impingement or cyclops lesion,and 3(10%)suffered from concomitant cartilage injury,with 4(13.3%)undergoing intercondylar notchplasty due to intercondylar notch hyperplasia.However,no complications related to osteotomy,such as infection,non-union,or fixation failure,were observed.Conclusion Over a follow-up period of at least 2 years,for primary ACL injury patients with steep PTS and excessive ATS,combined ACL reconstruction with PTS reduc-ing osteotomy improves knee stability,but significantly reduces PTS,the incidence of severe pivot grade,anterior tibial subluxation in both medial and lateral compartments,and delays the occurrence of graft laxity and failure.

Objective To explore the value of ZOOMit intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)technology in assessing renal function in diabetic kidney disease(DKD)and non-diabetic kidney disease(non-DKD).Methods Based on the estimated glomerular filtration rate(eGFR),50 DKD patients and 50 non-DKD patients were enrolled,with each group contained 21 mild cases(mild group)and 29 moderate to severe cases(moderate to severe group).All subjects underwent ZOOMit IVIM-DWI examination and the parameter values of the renal cortex and medulla were measured.The differences of IVIM-DWI parameters in renal cortex and medulla between DKD and non-DKD patients,and the correlation with eGFR,and diagnostic efficacy were compared.Results In the DKD patients,the f value of the medulla,the D value of the cortex,and the D* value of the medulla showed statistically significant differences between mild group and moderate to severe group(t=7.836,3.337,2.515,P<0.05),and all were positively correlated with eGFR(r=0.750,0.375,0.404,P<0.05).In the non-DKD patients,the f value of the medulla and the D* value of the medulla showed statistically significant differences between mild group and moderate to severe group(t=2.619,2.453,P<0.05),and were positively correlated with eGFR(r=0.425,0.360,P<0.05).In both DKD and non-DKD patients,the f value of the medulla showed the best efficacy in distinguishing between mild and moderate to severe DKD,with the area under the curve(AUC)=0.961(DeLong test P<0.05).Conclusion ZOOMit IVIM-DWI technology can be used for renal function in DKD and non-DKD,with the f value of the medulla being more suitable for the assessment of renal function in DKD.

Objective:To investigate the correlation between the expression levels of breast cancer metastasis-like transcriptional repressor (BRMS1L), keratin 19 (KRT19), microRNA-101 (miR-101) in surgical resection specimens and postoperative recurrence and metastasis of differentiated thyroid cancer (DTC) .Methods:A total of 186 DTC patients were selected in Shanxi Province Cancer Hospital from Jan. 2021 to Jan. 2023. Their recurrence and metastasis status were assessed in 2 years after surgery, and they were categorized into the recurrence and metastasis group and the non-recurrence and metastasis group. The clinical data of the two groups, as well as the expression levels of BRMS1L, KRT19, and miR-101 in the surgical resection specimens, were compared. Logistic regression analysis was used to investigate the relationship between BRMS1L, KRT19, miR-101 in the surgical resection specimens and postoperative recurrence and metastasis of DTC. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate the predictive value of BRMS1L, KRT19, and miR-101 in the surgical resection specimens for postoperative recurrence and metastasis of DTC, as well as their gain value in constructing predictive models.Results:Among 186 DTC patients were followed up for 2 years postoperatively, 4 were lost to follow-up. Of these, 137 did not experience recurrence or metastasis, while 45 did, resulting in a recurrence and metastasis rate of 24.73% (45/182). The tumor diameter, proportion of stage Ⅲ-Ⅳ, proportion of multiple lesions, and proportion of lymph node metastasis in the recurrent and metastatic group were all higher than those in the non-recurrent and non-metastatic group, while the proportion of postoperative 131I therapy was lower ( P<0.001, P=0.002, P=0.008, P<0.001). The KRT19 mRNA level in the recurrent and metastatic group was higher than that in the non-recurrent and non-metastatic group, while the BRMS1L mRNA and miR-101 levels were lower (both P<0.001). Logistic regression analysis showed that, before and after adjusting for other factors, BRMS1L, KRT19, and miR-101 were independent factors influencing postoperative recurrence and metastasis of DTC (both P<0.001). ROC curves showed that the AUCs of BRMS1L, KRT19, and miR-101 for predicting recurrent metastasis after DTC were 0.776, 0.802, 0.812, with sensitivities of 84.44%, 73.33%, and 84.44%, and specificities of 62.04%, 72.26%, and 79.56%; the R language package was used to construct a conventional prediction model consisting of clinical factors such as tumor diameter, clinical stage, lesion type, lymph node metastasis, and postoperative 131I treatment, and a new prediction model consisting of tumor diameter, clinical stage, lesion type, lymph node metastasis, postoperative 131I treatment, BRMS1L, KRT19, and miR-101. The test results indicated that both prediction models exhibited good fit ( P>0.05). The ROC curve analysis revealed that the AUCs for predicting postoperative recurrence and metastasis in DTC were 0.928 and 0.854 for the new and conventional prediction models, respectively. The sensitivity was 91.11% and 80.00%, and the specificity was 83.94% and 78.83%, respectively. The predictive value of the new prediction model was significantly better than that of the conventional prediction model ( Z=2.011, P=0.044) . Conclusions:The expression levels of BRMS1L, KRT19, and miR-101 in surgically resected specimens are closely correlated with postoperative recurrence and metastasis of DTC, serving as independent influencing factors with good predictive value. Furthermore, they exhibit significant gain value in constructing predictive models.

Objective To explore the expression significance of serum Kisspeptin and luteinizing hormone(LH)in girls with central precocious puberty(CPP).Methods A total of 98 CPP girls were included as the study group,and 91 healthy girls during the same period were used as the control group.Under the condition of no intervention,CPP girls were followed up for 6 months and assigned into the fast progressive CPP(RP-CPP)group(n=46)and the slowly progressive CPP(SP-CPP)group(n=52)based on their developmental status during the follow-up period.ELISA was applied to detect serum Kisspeptin level.Chemiluminescence method was applied to detect serum LH and follicle stimulating hormone(FSH)levels.The correlation of serum Kisspeptin,LH baseline(B-LH)and growth development and imaging indicators was analyzed.Receiver operating characteristic curve(ROC)was applied to analyze the value of serum Kisspeptin and LH in predicting RP-CPP.Results Compared with the control group,body mass index(BMI),serum levels of Kisspeptin,B-LH,and FSH baseline(B-FSH)were significantly higher in the study group(P＜0.05).Compared with the SP-CPP group,BMI,bone age index(BAI),serum Kisspepti and B-LH levels were higher in the RP-CPP group,and ovarian volume was larger(P＜0.05).Correlation analysis showed that serum Kisspeptin level was positively correlated with BMI,BAI,ovarian and uterine volume of CPP girls(P＜0.05),and serum B-LH level was positively correlated with ovarian and uterine volume of CPP girls(r=0.218,0.381,0.300,P＜0.05).ROC curve showed that the sensitivity and specificity of Kisspeptin combined with B-LH in predicting RP-CPP were 95.65%and 82.69%,respectively.Conclusion Serum Kisspeptin and B-LH levels are higher in CPP girls,and the combined of the two has a high predictive value for RP-CPP,which can provide a certain reference for clinical diagnosis and treatment.

Objective: To investigate the effect of auricular therapy on sleep improvement and the GABAergic system pathway in a rat model of insomnia and to explore its possible mechanism. Methods: According to the random number table, 60 male SD rats were randomly divided into blank control, model, auricular point sticking, auricular bloodletting, and auricular bloodletting combined with sticking groups, with 12 rats per group. Insomnia was induced by intraperitoneal injection of p-chlorophenylalanine. After establishing the insomnia model, 36 rats were treated once a day with auricular point sticking or bloodletting for 5 consecutive days. After the intervention, the general condition and body weight of rats were observed; the righting reflex test was used to detect the sleep latency and duration; HE staining was used to observe the morphology of hypothalamic neuron cells; and an enzyme-linked immunosorbent assay was used to detect the GABA and glutamate content in rat serum. Immunohistochemistry(IHC) and real-time fluorescence quantitative PCR were used to detect GABA ARα1 and GABA ARγ2 protein and mRNA expression in the hypothalamus of rats, and Western blotting(WB) was used to detect GABA ARα1, GABA ARγ2, GAD65/67, GAT-1, and GABA-T protein expression in the hypothalamus of rats. Results: Compared with the blank control group, the model group had a lower body weight, a significantly shorter sleep duration (P<0.05), severe damage to the morphological structure of hypothalamic neurons with disordered cell arrangement, larger intercellular gaps, enlarged cell bodies, and a vacuolated appearance. All the intervention groups had significantly higher body weight and longer sleep duration than the model group (P<0.05). Compared with the other intervention groups, the auricular point sticking group had a longer sleep duration (P<0.05), and the hypothalamic neuron cells in all intervention groups improved, with the auricular point sticking group showing more apparent improvement. The model group had a lower GABA and higher glutamate contents, and GABA ARα1, GABA ARγ2, and GAD65/67 protein expression in the hypothalamus were lower than in the blank control group. In contrast, GAT-1 and GABA-T protein expression was higher, and GABA ARα1 and GABA ARγ2 mRNA expression was lower (P<0.05). The serum GABA content in the auricular point sticking and auricular bloodletting groups was higher, and the serum glutamate content in the auricular point sticking and auricular bloodletting combined sticking groups was lower than in the model group. GABA ARα1 mRNA expression in the hypothalamus of each intervention group was significantly increased, and GABA ARγ2 mRNA expression in the hypothalamus of the auricular point sticking and auricular bloodletting combined sticking groups increased. GABA ARα1(IHC, WB), GABA ARγ2(WB), and GAD65/67 protein expression in the hypothalamus of the auricular point sticking group increased, whereas GAT-1 and GABA-T protein expression decreased. GABA ARα1 and GABA ARγ2 protein expression(IHC, WB) in the hypothalamus of the auricular bloodletting group increased, whereas GABA-T protein expression decreased. GABA ARγ1(IHC) and GABA ARγ2(WB) protein expression in the hypothalamus of the auricular bloodletting combined sticking group increased, whereas GAT-1 and GABA-T protein expression decreased (P<0.05). Compared with in the inventation groups, the serum GABA content in the auricular point sticking group increased, the serum glutamate content decreased, GABA ARα1 and GABA ARγ2 mRNA expression in the hypothalamus increased, and GABA ARα1(IHC), GAD65/67 protein expression increased. In contrast, GABA-T protein expression decreased (P<0.05), and GABA ARγ2 protein expression(IHC) in the hypothalamus of the auricular bloodletting group increased (P<0.05). Conclusion Auricular therapy, particularly auricular point sticking, may have modulated the GABAergic system pathway by upregulating hypothalamic GABA ARα1, GABA ARγ2, and GAD65/67 protein expression while downregulating GAT-1 and GABA-T protein expression to alleviate symptoms in an insomnia rat model.

With the aging of the global population， osteoporosis （OP） is becoming a major public health concern worldwide. Currently， the commonly used anti-osteoporosis drugs in clinical practice have limited application due to many side effects. Therefore， developing more effective and safer strategies for the prevention and treatment of OP has become a research focus in this field. In recent years， the clinical efficacy and advantages of traditional Chinese medicine （TCM） in treating OP have been gradually recognized. With the deepening pharmacological research on TCM for OP prevention and treatment， it is found that the active ingredients of Scutellaria baicalensis can promote bone formation or inhibit bone resorption by regulating signaling pathways， including Wnt/β-catenin， osteoprotegerin （OB）/receptor activator of nuclear factor-κB ligand （RANKL）/RANK （OPG/RANKL/RANK）， and bone morphogenetic protein 2 （BMP-2）/Smad， mitogen-activated protein kinase （MAPK）， and mammalian target of rapamycin （mTOR）. However， existing research on active ingredients of S. baicalensis for OP treatment is scattered， making it difficult for scholars to gain a systematic understanding of its research and application. This review summarized the literature on the active ingredients of S. baicalensis in OP treatment worldwide， clarified their mechanisms of action， and explored some issues， providing references for the integration of TCM in OP prevention and treatment.

With the aging of the global population， osteoporosis （OP） is becoming a major public health concern worldwide. Currently， the commonly used anti-osteoporosis drugs in clinical practice have limited application due to many side effects. Therefore， developing more effective and safer strategies for the prevention and treatment of OP has become a research focus in this field. In recent years， the clinical efficacy and advantages of traditional Chinese medicine （TCM） in treating OP have been gradually recognized. With the deepening pharmacological research on TCM for OP prevention and treatment， it is found that the active ingredients of Scutellaria baicalensis can promote bone formation or inhibit bone resorption by regulating signaling pathways， including Wnt/β-catenin， osteoprotegerin （OB）/receptor activator of nuclear factor-κB ligand （RANKL）/RANK （OPG/RANKL/RANK）， and bone morphogenetic protein 2 （BMP-2）/Smad， mitogen-activated protein kinase （MAPK）， and mammalian target of rapamycin （mTOR）. However， existing research on active ingredients of S. baicalensis for OP treatment is scattered， making it difficult for scholars to gain a systematic understanding of its research and application. This review summarized the literature on the active ingredients of S. baicalensis in OP treatment worldwide， clarified their mechanisms of action， and explored some issues， providing references for the integration of TCM in OP prevention and treatment.