ObjectiveMigraine is a leading neurological disorder and the fourth most common cause of years lived with disability worldwide, affecting nearly 116 million individuals. Although pharmacological treatments are available, their efficacy is often limited by side effects and variable response rates. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers a safe, non-invasive alternative for migraine management. However, the neurophysiological mechanisms, particularly how rTMS modulates local cortical excitability and distributed pain-related circuits, remain poorly understood. Elucidating these mechanisms is essential for optimizing treatment protocols and improving clinical outcomes. MethodsThis study employed concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) to investigate neuroplastic and neurocircuitry mechanisms of DLPFC-rTMS in migraine. Study 1 compared 30 migraineurs and 28 healthy controls to identify abnormalities in TMS-evoked potentials (TEPs) and significant current density (SCD) within sensory-discriminative regions including the primary somatosensory cortex (S1) and posterior insula (pINS), cognitive-affective regions including the anterior insula (aINS) and midcingulate cortex (MCC), and a descending modulatory region, the periaqueductal gray (PAG). Study 2 used a single-blind, crossover, sham-controlled design in 34 healthy participants. Each participant received both active (10 Hz, 80% RMT, 1 500 pulses) and sham DLPFC-rTMS in counterbalanced order. TMS-EEG and cold pain tolerance were assessed before and after each session. ResultsIn Study 1, migraineurs showed a significantly less negative N120 amplitude compared to healthy controls (P=0.027, Cohen’s d=0.60), indicating local intracortical disinhibition. No group differences were observed for N40, P60, or P180 components. At the source level, migraineurs exhibited significantly higher SCD in the S1, pINS, aINS, and MCC (allQ<0.05), but not in the ventroposterior thalamus (vpTHAL), mediodorsal thalamus (mdTHAL), or PAG. In Study 2, active rTMS significantly reduced SCD from pre- to post-stimulation in the S1, aINS, and MCC (all Q<0.05). Sham stimulation also reduced SCD in the S1 (Q<0.05) but not in the aINS or MCC. Although no significant group-level analgesic effect was observed between active and sham conditions (P=0.107), correlation analyses revealed that greater SCD reductions in the S1 and MCC were significantly associated with higher post-rTMS pain tolerance (R=-0.487 and -0.495, both Q<0.01) and larger improvements in pain tolerance(R=-0.487 and -0.451, both Q<0.05). No such correlations were found following sham stimulation, suggesting that the behavioural relevance of neural changes is specific to active rTMS. ConclusionThis study provides novel evidence that migraineurs exhibit both local neuroplastic abnormalities (reduced N120 amplitude) and hyperactivity in key pain-processing regions (S1, pINS, aINS, MCC). A single session of DLPFC-rTMS reduced hyperactivity in the aINS, MCC, and S1. Notably, greater reductions in the S1 and MCC were associated with improved pain tolerance. These findings identify distinct cortical circuitries, particularly within the cognitive-affective pain network, that may serve as potential biomarkers for optimizing rTMS treatment in migraine and other chronic pain conditions. Future studies should validate these results in patient populations experiencing spontaneous migraine attacks and explore multi-session or accelerated rTMS protocols.

Objective To explore the value of prenatal ultrasound indicators in diagnosing fetal heart malformation during pregnancy.Methods A case-control study was conducted,and 76 fetuses with confirmed heart malformation during follow-up in the hospital were selected as case group,and another 76 fetuses without any heart malformation were selected as control group.The results of ultra-sound examinations during pregnancy for both groups were compared,including umbilical vein cathe-ter color Doppler ultrasonic blood flow spectral parameters,cardiac axis angle,and myocardial per-formance index(MPI).Receiver operating characteristic(ROC)curve was used to analyze the value of each indicator in auxiliary diagnosis of fetal congenital heart malformation during pregnancy.Results The ventricular systolic velocity,peak atrial systolic velocity,peak ventricular diastolic ve-locity,and maximum A-wave velocity in the case group were significantly lower than those in the con-trol group,while the pulsatility index,venous preload index,and venous peak flow index were signif-icantly higher than those in the control group(P＜0.05).Values of area under the curve(AUC)of ROC curves for ventricular systolic velocity,peak ventricular diastolic velocity,peak atrial systolic ve-locity,maximum A-wave velocity,pulsatility index,venous preload index,and venous peak flow index in diagnosing fetal heart malformation were 0.680,0.753,0.590,0.859,0.674,0.715 and 0.663,respectively.The left ventricular MPI,right ventricular MPI,and cardiac axis angle in the case group were significantly higher than those in the control group(P＜0.05).The values of AUC for left ventricular MPI,right ventricular MPI,and cardiac axis angle in diagnosing fetal heart malformation were 0.502,0.571 and 0.712,respectively.Conclusion Implementation of umbilical vein cathe-ter color Doppler ultrasonic blood flow spectral parameters,cardiac axis angle,and MPI screening during pregnancy has important reference value for auxiliary diagnosis of fetal heart malformation.

Objective To investigate the correlation between apathy and imaging markers in pa-tients with aCSVD.Methods A total of 143 patients diagnosed with aCSVD and hospitalized in the Department of Neurology of the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from August 2023 to August 2024 were continu-ously included as the study objects.According to MAES,they were divided into an apathetic group(MAES score＞14,68 cases)and a non-apathetic group(MAES score ≤14,75 cases).The clinical data and imaging markers were compared between the two groups.Results The apathetic group had significantly older age and larger ratio of hypertension,but shorter years of education and lower MAES score than the non-apathetic group(P＜0.05,P＜0.01).The apathetic group also had notably higher Fazekas score of white matter hyperintensity(WMH),larger recent small sub-cortical infarct(RSSI),lacunar infarct(LI),and perivascular space(PVS)in the basal ganglia and the centrum semiovale,more obvious cerebral atrophy and cerebral microbleed(CMB),and high-er total imaging burden score when compared with the non-apathetic group(P＜0.01).In the aCSVD patients,the MAES score was positively correlated with WMH Fazekas score,RSSI,LI,basal ganglia PVS,centrum semiovale PVS,cerebral atrophy,CMB,and total imaging burden score(P＜0.01).WMH Fazekas score was an independent risk factor for apathy in the aCSVD patients(OR=2.218,95％CI:1.343-3.664,P=0.002).Conclusion The higher the score of ima-ging markers in patients with aCSVD,the more severe the apathy.

Objective:To systematically review the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)on recurrence or metastasis of patients with ovarian cancer whose postoperative serum carbohydrate antigen 125(CA125)occurred abnormal elevation.Methods:A systematic search was conducted in foreign databases,including PubMed,Embase,Cochrane Library(Central)and Web of Science(SCI-Expanded),as well as Chinese databases,such as China National Knowledge Infrastructure(CNKI),VIP Network,Wanfang Database,and China Biology Medicine(CBM),for the studies that were published between January 2010 and January 2023 on the diagnostic value of 18F-FDG PET/CT on recurrence or metastasis of patients with ovarian cancer whose postoperative serum CA125 levels occurred abnormal elevation.The quality of the included studies was assessed by using the QUADAS-2 quality evaluation tool in Review Manager 5.4 software.The effective data were extracted,and effect quantities were merged,and heterogeneity test was conducted through Meta-Disc 1.4 software.Publication bias of the included studies was tested by using Stata 14.0 software.Results:A total of seven literatures were involved in this research,and 290 patients with ovarian cancer were included to conduct heterogeneity test,which revealed I2 values all were greater than 50%.Therefore,the a fixed-effect model was used to merge effect quantity.The results demonstrated that the diagnostic accuracy was higher,and the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio(DOR)of the mergement were respectively 0.95(95%CI:0.91-0.98),0.83(95%CI:0.70-0.92),4.84(95%CI:2.82-8.31),0.07(95%CI:0.04-0.13)and 73.53(95%CI:28.00-187.90).The area under curve(AUC)value of receiver operating characteristic curve(AUC)was 0.9527,and the diagnostic accuracy of 18F-FDG PET/CT for metastasis or recurrence in patients with ovarian cancer,whose postoperative serum CA125 levels occurred elevation,reached to 95.27%.Publication bias testing showed there was no evidence of publication bias.Conclusion:18F-FDG PET/CT exhibits higher accuracy in diagnosing recurrence or metastasis in patients with ovarian cancer whose postoperative serum CA125 levels occurred elevation,which can sensitively and accurately confirmed postoperative recurrence or metastasis of patients with ovarian cancer,and early find the lesions of metastasis or recurrence of ovarian cancer.

Objective:Chimeric antigen receptor T-cell(CAR-T)immunotherapy has made major breakthroughs in the treatment of blood tu-mors.However,current CAR-T therapies face several limitations:they require autologous cells,involve a lengthy and costly production pro-cess,and use lentiviral transduction that carry risk of insertional carcinogenesis due to random integration.Therefore,there is an urgent need to develop a universal cost-effective cancer immunotherapy method generating CAR-T cells for in vivo cancer immunotherapy.Meth-ods:This study successfully established an exosome-mediated,T-cell targeted delivery system,demonstrating both precise design and func-tional efficacy for biomedical applications.To optimize CAR-T cell generation the transfection dose was adjusted,and the kinetics of CAR-T cell percentage were recorded.The cytotoxicity of the resulting CAR-T cells was evaluated in vitro by calcein-AM release.To test the tumor-killing in vivo of engineered exosomes,human PBMCs were injected into NPG mice via the tail vein to establish humanized mice,followed by intravenous injection of tumor cells to induce cancer.Results:To overcome the limitations of conditional autologous CAR-T cells,we de-veloped a T cell-targeted exosome system capable of specifically targeting human CD3+,CD4+,and CD8+T cells.CAR-T production was dose-dependent,with transfection efficiency reaching upto 97.8%at 106 particles/cell.Both in vitro cytotoxicity assays and in vivo animal experi-ments demonstrated that exosome-incubated CAR-T cells effectively eliminated CD19-positive Raji cells,highlighting their specificity and therapeutic potential in antigen-directed applications.Conclusions:We successfully established a CD8-targeting exosome delivery system for CAR-T cell production capable of transforming CD8+T cells into functional CAR-T cells,which showed significant tumor-killing ability in vitro and in mice.Compared with the traditional lentiviral vector for the preparation of CAR-T cells in vitro,in vivo-reprogrammed CAR-T cells us-ing our CD8-targeted exosome delivery system,with higher transfection efficiency,shorter production period,lower cost,and eliminated the risk of insertion carcinogenesis.This strategy promises to bring a new era of universal CAR-T medicine,which can improve cancer immuno-therapy and may hold promise as a therapeutic platform to treat various diseases.

The objective assessment of hearing loss is one of the critical components in forensic clini-cal research.Auditory brainstem response(ABR)is an important method for objectively assessing hearing levels.It is divided into various types based on different stimulus signals,each with its own characteris-tics and applications.Among them,narrow-band Chirp ABR,due to its frequency specificity,fulfills the basic requirements for objective assessment of forensic audiology,promising to be an important method of objective hearing assessment in forensic medicine.This article reviews the development history,charac-teristics and clinical applications of Chirp ABR,and envisions its application prospects in forensic audi-tory identification.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To assess the value of artificial intelligence（AI）assisted system in the diagnosis of malignancy in follicular thyroid tumours，and to compare with the diagnostic results of doctors with different levels of experience.Methods:A total of 101 nodules were retrospectively collected from 86 patients with follicular thyroid tumours who underwent surgical treatment at Peking Union Medical College Hospital，Chinese Academy of Medical Sciences，Peking Union Medical College from May 2016 to January 2018.The nodules were classified into risk group（29 patients，34 nodules，including 15 follicular carcinomas and 19 follicular tumours of indeterminable malignant potential）and benign group（59 atients，67 nodules，including 15 follicular adenomas and 52 nodular goitre adenomatoid hyperplasia）. The sensitivities，specificities and accuracies of the AI system，two doctors of different seniorities（one junior A and one senior B），and guidelines of thyroid ultrasound malignancy risk stratification［including the 2015 American Thyroid Guidelines（ATA），the 2017 American College of Radiology Thyroid Imaging Reporting and Data System（ACR TI-RADS），the 2020 Chinese Society of Ultrasound，Thyroid Imaging Reporting and Data System（C-TIRADS）］（classified by a senior doctor C）for diagnosing follicular tumours in the risk group and follicular carcinomas were calculated and compared.Results:The AI system showed a sensitivity of 46.7%，specificity of 89.6% and accuracy of 81.7% for diagnosing follicular carcinoma；and a sensitivity of 32.4%，specificity of 89.6% and accuracy of 70.3% for diagnosing follicular neoplasms（risk group）. Compared with junior doctor A，the specificity of AI system in diagnosing follicular cancer and follicular neoplasms（risk group）was higher（89.6% vs. 83.6%， P=0.020；89.6% vs. 73.1%， P=0.020），and the differences of sensitivity were not significant（46.7% vs. 32.4%， P=0.181；32.4% vs. 11.8%， P=0.073）. The difference of sensitivity and specificity were not statistically significant between the AI system and senior doctor B（all P＞0.05）.The differences in area under the curve for diagnosis of follicular carcinoma and follicular tumour（risk group）were not statistically significant between the AI system compared to junior doctor A，senior doctor B，the C-TIRADS，ATA guideline，and ACR TI-RADS（all P＞0.05）. Conclusions:Ultrasound-based AI-assisted diagnostic system is similarly efficient in diagnosing follicular thyroid tumours as experienced doctors，and the AI system diagnostic specificity is superior to that of junior doctors.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Aim To investigate the effect of Zhenwu decoction on inflammation,oxidative stress and apopto-sis of human glomerular epithelial cells(HGEC)in-duced by lipopolysaccharide(LPS)based on Nrf2/HO-1 signaling pathway,and to explore the underlying mechanism.Methods HGEC were treated with LPS(1.0 mg·L-1)for 24 h to construct an oxidative damage model.On this basis,2.5％,5％and 10％Zhenwu decoction-containing serum were added to the low,medium and high dose groups of Zhenwu decoc-tion,and a normal group was set up.The changes of cell activity were assessed by MTT method and LDH method.The contents of TNF-α,IL-6,IL-10,SOD,CAT,GSH-Px,ROS and MDA in each group were de-tected by ELISA.The apoptosis of each group was de-tected by flow cytometry.The mRNA and protein ex-pressions of Bax,Bcl-2,caspase-3,caspase-9 and Nrf2/HO-1 pathway were detected by RT-qPCR and Western blot,respectively.Results Compared to the normal group,the model group of HGEC exhibited increased levels of inflammatory cytokines,enhanced oxidative stress response and aggravated apoptosis;after inter-vention with various doses of Zhenwu decoction,the in-flammatory levels in HGEC were reduced,oxidative damage and apoptosis were effectively ameliorated,and the mRNA and protein expression levels of the Nrf2/HO-1 signaling pathway were upregulated.Conclu-sions Zhenwu decoction can protect HGEC from LPS-induced inflammation and oxidative damage and im-prove apoptosis.The mechanism may be related to the activation of Nrf2/HO-1 signaling pathway.