Objective: To assess the causal association between specific oral microbiota and the risk of oral leukoplakia (OLK) using a Mendelian randomization (MR) approach, and to elucidate the potential mediating role of immune cells. Methods: Summary statistics from genome-wide association studies (GWAS) of the oral microbiome, GWAS data for immune cell phenotypes, and GWAS summary statistics for OLK from FinnGen were used. The inverse variance weighted (IVW) method was adopted as the primary approach, and it was supplemented by MR Egger regression, simple mode, weighted median, and weighted mode methods for additional analyses, to investigate the causal relationship between 3 117 types of tongue coating and salivary microbiota, as well as 731 immune cell traits, and OLK. Furthermore, a two-step MR approach was applied to explore the potential mediating role of immune cells in the association between oral microbiota and OLK. Results: IVW analysis revealed causal associations between 15 oral microbial genera and OLK. Among these, Streptococcus, Neisseria, and Catonella were associated with a reduced risk of OLK, with Fusobacterium showing the most significant protective effect (OR = 0.41, P = 0.023). In contrast, genera, including Microbacterium, Campylobacter, and Haemophilus_A, were linked to an increased risk of OLK, with Lancefieldella exhibiting the strongest risk effect (OR = 2.66, P = 0.006). Eleven immune cell phenotypes with potential causal associations with OLK were identified, including four protective and seven risk-increasing factors. Mediation analysis further identified four key mediating pathways: pathogenic genera, particularly Campylobacter_A and Lancefieldella, may promote the development and progression of OLK by upregulating highly activated pro-inflammatory immune subsets such as activated monocytes, B cells, and myeloid cells. Conversely, the potentially protective genus Catonella appeared to exert inhibitory effects on OLK by significantly downregulating dendritic cell subsets. Conclusion This study is the first to reveal, at the genetic level, causal pathways through which specific oral microbial genera influence the risk of OLK by mediating immune cell responses. These findings provide novel insights into the immunopathological mechanisms underlying OLK and offer potential targets for intervention strategies aimed at modulating specific microbial genera or immune cell subsets.

Parkinson's disease （PD） is a chronic progressive neurodegenerative disorder primarily characterized by motor dysfunction. The main pathological features include the loss of dopaminergic neurons in the substantia nigra， abnormal aggregation of alpha-Synuclein （α-Syn）， and the formation of Lewy bodies. However， the exact mechanisms remain unclear. In recent years， the PD incidence has gradually increased， while current treatment methods are limited to symptom alleviation， incapable of halting disease progression， and prone to adverse effects， thus making it urgent to search for medicines effective for PD. Modern research indicates that the Kelch-like ECH-associated protein 1 （Keap1）/nuclear factor E₂ related factor 2 （Nrf2）/antioxidant response element （ARE） signaling pathway is closely related to oxidative stress， neuroinflammation， apoptosis， ferroptosis， and mitochondrial dysfunction， playing a crucial role in the pathophysiological development of PD. A large number of studies have further confirmed that traditional Chinese medicine （TCM） can regulate diseases through a holistic view of Syndrome differentiation and microscopic molecular pathways. With unique advantages， such as multiple targets， multiple pathways， and fewer adverse reactions， TCM provides a new strategy for PD treatment. This article elucidates the mechanism of the Keap1/Nrf2/ARE signaling pathway in the occurrence and development of PD， while summarizing the latest research on PD intervention by TCM monomers， active ingredients， and compounds， as well as acupuncture via the precise targeted regulation of the Keap1/Nrf2/ARE pathway， aiming to provide a reference for clinical medicine development to prevent and treat PD.

Existentialist philosophy focuses on human existence， explores subjectivity and uniqueness， and highlights the value of human existence. Advanced cancer patients generally suffer immense existential distress， each with their own modes of appearance and numerous possibilities. From the perspective of existentialist philosophy， targeting the group of advanced cancer patients， this paper clarified the analysis of “Dasein” （holistic phenomenon and modes of appearance）. Through recognition （achieving to deepen the inner scope of the subject and object） and comprehension （seeking appropriate “self-knowledge”）， it introduced the planning of variable possibilities. Subsequently， based on the patients’ pre-possessing， pre-seeing， and pre-grasping， explanatory activities were carried out to complete the “self-formation” in the planning. Ultimately， it facilitated the realization of existential meaning in the presupposition and proposed actionable clinical practices （meaning therapy and emotional touch therapy） to alleviate the existential distress of advanced cancer patients.

AIM: To investigate the differences in morphological structure and retinal blood perfusion between the affected eye and the contralateral healthy eye using optical coherence tomography angiography(OCTA)in patients with idiopathic macular epiretinal membrane(IMEM)before and after surgery, and to evaluate the association of these parameters with functional and anatomical outcomes to inform prognostic assessment. METHODS:A prospective study was conducted at Zhejiang Provincial People's Hospital between January 2023 and December 2024. Consecutive patients diagnosed with unilateral IMEM were enrolled; the fellow eye served as an internal control. All participants underwent standardized ophthalmic evaluations, including optical coherence tomography(OCT), OCTA, and color fundus photography. Key quantitative parameters assessed included best-corrected visual acuity(BCVA), central macular thickness(CMT), foveal avascular zone(FAZ)area, vessel density in the inner capillary plexus(ICP), superficial capillary plexus(SCP), deep capillary plexus(DCP), and choroidal capillary perfusion area(CCPA). Measurements were obtained preoperatively and at 1 and 3 mo postoperatively. Correlation analyses were performed between the above parameters and postoperative BCVA and CMT.RESULTS: This study enrolled 30 patients(60 eyes)diagnosed with IMEM, comprising 14 males and 16 females, with a mean age of 65.4±10.8 y.At baseline, IMEM-affected eyes demonstrated significantly reduced BCVA, DCP density, and FAZ area, alongside significantly increased CMT and CCPA, compared with contralateral controls. Following vitrectomy with membrane peeling, CMT decreased significantly at both 1 and 3 mo(both P<0.05)postoperatively; DCP density and BCVA showed significant improvement(both P<0.05). No significant change in FAZ area was observed postoperatively(P>0.05). At 3 mo postoperatively, BCVA of the affected eye was negatively correlated with CMT(r=-0.549, P=0.022). At 1 mo postoperatively, CMT was negatively correlated with preoperative DCP and FAZ, positively correlated with preoperative CMT, and positively correlated with ICP and SCP at 1 mo postoperatively, and negatively correlated with FAZ at 1 mo postoperatively(all P<0.05). Furthermore, CMT at 3 mo postoperatively was negatively correlated with preoperative DCP(r=-0.498,P=0.042).CONCLUSION:In patients with IMEM, the affected eyes exhibit significantly reduced DCP density and FAZ area, alongside increased CMT and CCPA. Following vitrectomy with membrane peeling, CMT decreased progressively, DCP density demonstrated partial restoration, and vision improved gradually. Preoperatively, smaller CMT larger DCP, and FAZ were associated with more favorable surgical outcomes; postoperatively, smaller ICP and SCP densities—combined with a larger FAZ—also correlated with better functional recovery.

Objective: To explore the application method and clinical efficacy of endoscopic and computerized navigation technology in maxillofacial foreign body removal surgery, and to provide a reference for the clinical application of this technology. Methods: This study, which was approved by the Medical Ethics Committee of the hospital, retrospectively analyzed the data of five patients with maxillofacial foreign bodies who were admitted to Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2018 to December 2024. All patients underwent preoperative CT scanning. Intraoperatively, endoscopic and computer navigation techniques were used in combination or separately according to the location, size, and adjacency of the foreign body to important neurovascular vessels. The foreign body was precisely localized by endoscopic magnification and direct visualization, and the optimal surgical path was designed and verified under the real-time guidance of computerized navigation to accurately remove the foreign body. The type of foreign body, location, length and diameter, duration of surgery, length of incision, success rate of foreign body removal, postoperative complications, and follow-up were recorded and analyzed. Results: The foreign body was successfully removed in all five patients with a success rate of 100%. The intraoperative computerized navigation system was accurate in positioning, and the alignment stability was not significantly affected by mandibular movement; the endoscope provided good illumination and exposure of the operative field. All surgical incisions were small, and no serious complications, such as foreign body residue, important neurovascular injury, or infection, occurred after surgery. One month after the operation, the patients were followed up and recovered well. Conclusion The combination of endoscopy and computer navigation or separately assisted technology can provide a clear field and real-time positioning for maxillofacial foreign body removal, effectively avoiding important anatomical structures, thus realizing safe and complete foreign body removal with minimized trauma. This assistive technology significantly improves the accuracy and safety of the operation and has clinical promotion value.

Based on the theory of collateral disease， the treatment of late-stage sequela of cerebrovascular disease is considered to be primarily associated with deficiency and obstruction of cerebral collaterals and dysfunction of the spirit mechanism. Therefore， the fundamental therapeutic principle is to unblock and supplement the brain collaterals. Clinically， the late-stage sequelae of cerebrovascular disease are classified into four patterns， which are malnourishment， deficiency-heat， stasis obstruction， and phlegm clouding of brain collaterals. These are treated respectively with Tiansui Tongqiao Decoction （填髓通窍汤） to supplement essence and nourish the brain through moistening， unblocking and supplementing， Qingnao Touluo Decoction （清脑透络汤） to enrich yin， regulate spirit， and unblock collaterals through clearing and penetrating， Yiqi Tongluo Decoction （益气通络汤） to tonify qi and resolve stasis while softening tendons and unblocking collaterals， and Xinrun Touqiao Beverage （辛润透窍饮） to unblock and tonify yin and yang while unblocking the collaterals through acrid-moistening medicinals. Flexible modification of prescriptions according to individual symptoms was applied， resulting in favorable therapeutic outcomes.

This article summarizes the clinical experience in diagnosing and treating narcolepsy based on the wei qi theory. The key pathogenesis of narcolepsy is considered to be the disharmony of wei qi. In the initial stage， lung， spleen， and kidney deficiency leads to insufficient generation and propulsion of wei qi. In the progressive stage， phlegm-damp and qi stagnation obstruct sanjiao （三焦）， while the interstice of flesh is unrelaxed， and the skin pores are occluded， causing sluggish circulation of wei qi. In the attack stage， pathogens obstruct the upper jiao （焦）， whereas pectoral qi fails to diffuse， and wei qi becomes constrained and blocked in the yin aspect， which may transform into wind or heat and bind with phlegm and stasis， resulting in sudden excessive sleep， cataplexy， dream disturbance， hallucinations， and sleep paralysis. Accordingly， a three-stage differentiation and treatment strategy is proposed， including reinforcing the root and strengthening wei qi in the initial stage with Peiben Shiwei Decoction （培本实卫汤）， resolving phlegm and unblocking the pathways to smooth the flow of wei qi in the progressive stage with Tongjiao Dawei Decoction （通焦达卫汤）， and diffusing wei qi， awakening the spirit， and opening the upper jiao in the attack stage with Xuanwei Xingshen Decoction （宣卫醒神汤）. Clinically， treatment should distinguish deficiency from excess， the primary from the secondary， administer staged and dynamic treatments， and make good use of light， clear， ascending， dispersing， acrid， and aromatic medicinals to restore the movement of wei qi， thereby providing a reference for differentiation and treatment of narcolepsy in traditional Chinese medicine.

This study explores the pathogenesis characteristics and treatment of somatic symptom disorder （SSD） from the perspective of the mutual influence among mental activities， qi transformation within membrane-striae-three jiao （焦）， and the functions of the five zang （脏） organs. It is proposed that the emotional， cognitive， and somatic perceptual abnormalities observed in SSD are closely associated with dysfunction of the spirit mechanism. Such dysfunction may disturb the ascent and descent of qi movement as well as the distribution of qi， blood， and body fluids， thereby leading to stagnation of membrane-striae-three jiao and disharmony of the five zang organs. Conversely， impaired membrane-striae and dysfunction of the five zang organs may further aggravate emotional abnormalities and somatic discomfort. These three aspects interact with one another and jointly contribute to the onset， progression， and persistence of SSD. Treatment should focus not only on calming the spirit， harmonizing the body， and regulating emotions， but also on unblocking membrane-striae and facilitating qi movement， and take into account the functional imbalances of the five zang organs. The ultimate goal is to achieve tranquility of the spirit， unobstructed membrane， and harmony of the zang organs， thereby addressing both the manifestations and the root causes of the disorder and reducing the risk of recurrence.

This study explores the pathogenesis characteristics and treatment of somatic symptom disorder （SSD） from the perspective of the mutual influence among mental activities， qi transformation within membrane-striae-three jiao （焦）， and the functions of the five zang （脏） organs. It is proposed that the emotional， cognitive， and somatic perceptual abnormalities observed in SSD are closely associated with dysfunction of the spirit mechanism. Such dysfunction may disturb the ascent and descent of qi movement as well as the distribution of qi， blood， and body fluids， thereby leading to stagnation of membrane-striae-three jiao and disharmony of the five zang organs. Conversely， impaired membrane-striae and dysfunction of the five zang organs may further aggravate emotional abnormalities and somatic discomfort. These three aspects interact with one another and jointly contribute to the onset， progression， and persistence of SSD. Treatment should focus not only on calming the spirit， harmonizing the body， and regulating emotions， but also on unblocking membrane-striae and facilitating qi movement， and take into account the functional imbalances of the five zang organs. The ultimate goal is to achieve tranquility of the spirit， unobstructed membrane， and harmony of the zang organs， thereby addressing both the manifestations and the root causes of the disorder and reducing the risk of recurrence.

ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.