Irritable bowel syndrome （IBS） is a functional bowel disorder characterized primarily by abdominal pain and altered defecation habits. In recent years， traditional Chinese medicine （TCM） has made progress in multiple aspects of IBS research and treatment， including syndrome distribution， development of TCM formulas， clinical efficacy evaluation， external therapies， and psychosocial regulation. However， it still faces challenges such as over-reliance on symptomatic manifestations rather than biomarkers for diagnostic criteria， and the lack of high-quality evidence-based data supporting the efficacy of TCM formulas in treating IBS. This paper proposed that TCM diagnosis and treatment of IBS should adhere to the strategy of integrating the holistic concept with syndrome differentiation and treatment， combining TCM external therapies such as acupuncture， moxibustion and acupoint application）， and emphasizing individualized diagnosis and treatment for psychosomatic abnormalities. Future research should integrate multi-omics technologies， artificial intelligence and other methods to deepen the understanding of the pathogenesis of IBS and the mechanisms of TCM formulas， so as to promote the standardization and internationalization of TCM in the diagnosis and treatment of IBS.

AIM: To explore the clinical therapeutic effect of teprotumumab combined with glucocorticoid pulse therapy for thyroid-associated ophthalmopathy(TAO), and its impacts on thyroid function, levels of inflammatory factors, and adverse reactions in patients. METHODS: Active TAO patients admitted to the Ophthalmology Department were enrolled and randomly divide into the steroid group and the combined group. Then the steroid group was treated with glucocorticoid pulse therapy, while the combined group was combined with intravenous infusion of teprotumumab on the basis of the steroid group. The clinical therapeutic effect, the CAS, OSDI, M-C-TAO-QOL scores, ocular sign indicators(fissure width, proptosis), levels of inflammatory factors(TNF-α, CRP, IL-17), thyroid function(TSH, FT3, FT4)before and after treatment, and occurrence of adverse reactions were compared between two groups.RESULTS:Totally 96 TAO patients(192 eyes)were included, with 48 cases(96 eyes)in each group. In the combined group, there were 17 males and 31 females, with an average age of 51.85±3.53 y; in the steroid group, there were 14 males and 34 females, with an average age of 51.26±3.84 y. The total effective rate of the combined group(94%)was higher than that of the steroid group(79%)(P<0.05). After treatment, the CAS score, OSDI score, fissure width, proptosis, levels of TNF-α, CRP, and IL-17 in the combined group were all lower than those in the steroid group, and the M-C-TAO-QOL score was higher than that in the steroid group(P<0.05). However, there was no difference in thyroid function indicators and adverse reactions between two groups after treatment(P>0.05). CONCLUSION: The combination of teprotumumab and glucocorticoid pulse therapy for TAO has a prominent therapeutic effect. Meantime, it can more effectively control ocular inflammation, improve ocular signs and quality of life of patients, and has no obvious adverse effect on thyroid function, with controllable safety.

Endoscopic transforaminal lumbar interbody fusion (TLIF) offers substantial advantages in the management of degenerative spinal diseases, including accelerated postoperative recovery. However, its technical complexity and steep learning curve pose risks for nerve root injury. Optimizing nerve root protection in full-endoscopic facet-sparing TLIF (FE fs-TLIF) and full-endoscopic facet-resecting TLIF (FE fr-TLIF) is essential for enhancing surgical safety. This study aimed to improve the nerve root protection in FE fs-TLIF and FE fr-TLIF by optimizing cage glider selection and insertion techniques based on the specific cage shape—banana-shaped or bullet-shaped. The goal was to ensure safe cage positioning and mitigate nerve root injury during discectomy, endplate preparation, and cage insertion. These strategies were validated through cadaveric simulations and clinical implementation. In FE fr-TLIF utilizing bullet-shaped (straight) cages, one-tip and two-tip cage gliders effectively protected the traversing nerve root by facilitating medial cage entry, thereby minimizing irritation of the exiting nerve root. Conversely, in FE fr-TLIF with banana-shaped cages, the lateral tilt of the cage holder during implantation required the use of a two-tip cage glider to protect the traversing and exiting nerve roots, thereby mitigating the potential risk of nerve irritation. In FE fs-TLIF, a one-tip cage glider is preferred for safeguarding the exiting nerve root, while the traversing root is inherently protected by the medial wall of the facet joint. The use of a two-tip cage glider in FE fs-TLIF can cause injury to the nerve root during glider insertion. In addition to the selection of cage gliders, improper cage insertion steps can also contribute to postoperative neurapraxia. The appropriate selection of cage gliders with corresponding insertion techniques is critical for nerve root protection in endoscopic TLIF. Tailoring these choices to the specific approach (FE fs-TLIF or FE fr-TLIF) and cage type (banana or bullet) enhances surgical safety and clinical outcomes.

Objective:To explore the evaluation value of blood routine derived indicators[derived neutrophil to lymphocyte ratio(dNLR),red blood cell distribution width to platelet ratio(RPR)]combine with serum C-reactive protein(CRP)and procalcitonin(PCT)detection for the clinical outcomes of children with Mycoplasma pneumoniae pneumonia(MPP).Methods:149 children with MPP who were admitted to our hospital from April 2022 to August 2024 were included,they were divided into good prognosis and poor prognosis groups based on their clinical outcomes 28 d after admission.The blood routine derived indicators,serum CRP,and PCT levels between the good prognosis group and the poor prognosis group were compared.The influencing factors of clinical outcomes in children with MPP were analyzed by Multiple logistic regression analysis,the value of blood routine derived indicators,serum CRP,and PCT testing alone and in combination to evaluate the clinical outcomes of children with MPP were analyzed by receiver operating characteristic(ROC)curves.Results:Among 149 children with MPP,113 had good prognosis and 36 had poor prognosis 28 d after admission,with a poor prognosis incidence rate of 24.16％(36/149).dNLR,RPR,CRP,and PCT levels in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).Univariate analysis showed that,the clinical outcome of children with MPP was related to pleural thickening,pleural effusion,severity disease and peak body temperature(P＜0.05).Multivariate Logistic regression analysis showed:Pleural thickening,pleural effusion,severity disease was severe,elevated dNLR,elevated RPR,elevated CRP and elevated PCT were risk factors for poor prognosis in children with MPP(P＜0.05).The area under the Curve(AUC)of dNLR,RPR,CRP and PCT combined to predict the prognosis of children with MPP was higher than that evaluated by the four indicators alone.Conclusion:Pleural thickening,pleural effusion,severe disease severity,elevated dNLR,elevated RPR,elevated CRP and elevated PCT are risk factors for poor prognosis in children with MPP.Moreover,the combined evaluate value of dNLR,RPR,CRP,and PCT is relatively high.

Objectives:To investigate the predictive value of Murray's law-based quantitative flow ratio(μQFR)in side branches for long-term clinical prognosis in patients with non-left main bifurcation lesions who underwent simple main branch stenting,and to provide a potential functional assessment standard for intervention decision-making on coronary bifurcation lesions.Methods:A retrospective analysis was conducted in 408 patients with non-left main bifurcation lesions who underwent simple main branch stenting at Lianyungang First People's Hospital and Nanjing First Hospital between July 2018 and January 2021.The study utilized third-generation QFR software to analyze pre-and post-procedure anatomical and functional parameters of the target lesion's main branch and key branches.The primary endpoint was target vessel failure(TVF)events during the 3-year follow-up.Patients were stratified into TVF and non-TVF groups.Baseline characteristics,procedural data,and pre-/post-procedural parameters of target vessels were compared between groups.Multivariable Cox regression was performed to identify predictors of TVF.Diagnostic efficacy of predictors was evaluated using area under the receiver operating characteristic(ROC)curve(AUC)with DeLong's method for comparison.Patients were dichotomized based on the optimal cutoffof post-procedural side branch μQFR,with TVF incidence rates compared via Cox regression and Kaplan-Meier analysis.Results:During 3-year follow-up,54 patients(13.2%)experienced TVF(TVF group),data were compared with 354 patients(86.76%)without TVF(non-TVF group).The TVF group showed higher post-procedural side branch diameter stenosis([32.93±17.80]%vs.[22.62±11.96]%,P<0.001)and lower μQFR(0.80±0.10 vs.0.89±0.07,P<0.001).Multivariate Cox regression identified higher post-procedural side branch μQFR as an independent protective factor against 3-year TVF(per 0.01 increase:HR=0.903,95%CI:0.850-0.959,P<0.001).ROC curves indicated that post-procedural side branch μQFR had moderate diagnostic efficacy for predicting 3-year TVF(AUC=0.769,95%CI:0.678-0.861,P<0.001),with a significantly higher AUC value than post-operative side branch area stenosis and minimal lumen diameter(both P<0.001),the optimal cutoffvalue was 0.84.Multivariate Cox regression and Kaplan-Meier survival analysis revealed markedly higher 3-year TVF rates in patients with μQFR≤0.84 compared to patients with μQFR>0.84(HR=4.007,95%CI:2.342-6.855,P<0.001;28.3%vs.7.9%,log-rank P<0.001).Conclusions:For patients with bifurcation lesions not involving the left main,the immediate post-procedural side branch μQFR could better predict 3-year TVF than anatomical indices.Maintaining post-stenting side branch μQFR>0.84 may optimize clinical outcomes when using a single-stent strategy.

Objective:This study aimed to integrate RNA-seq data to identify key genes associated with macrophage-ferroptosis and develop a prognostic model for hepatocellular carcinoma(HCC).Methods:We retrieved a dataset from the GEO database containing transcriptome data and clinical information for 163 samples.Macrophage-related genes were identified using WGCNA and immune infiltration analyses.Ferroptosis-related genes from the FerrDbV2 database were intersected with differentially expressed genes to obtain significant macrophage-ferroptosis-related genes.Hub genes were screened via protein interaction network construction,and key genes were identified using four machine learning algorithms.These genes exhibited significant expression differences between cancer and normal tissues and were closely linked to patient prognosis.ROC curve and KM survival analyses were performed,and expression levels were validated at the transcriptome and proteome levels.Results:Four key genes RRM2,KIF20A,PCK2,and PDK4 were identified and evaluated.RRM2 and KIF20A demonstrated high importance in classification prediction models and reliable performance in ROC and KM analyses(AUC＞0.9,P＜0.05).These genes regulate cancer cell proliferation/survival and macrophage polarization/function,influencing the tumor microenvironment and HCC progression.Conclusion:RRM2 and KIF20A regulate cancer cell proliferation and survival,modulate macrophage polarization and function,and influence the immune response in the tumor microenvironment.They can serve as prognostic biomarkers and potential immunotherapy targets for hepatocellular carcinoma.

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Objective:To explore the evaluation value of blood routine derived indicators[derived neutrophil to lymphocyte ratio(dNLR),red blood cell distribution width to platelet ratio(RPR)]combine with serum C-reactive protein(CRP)and procalcitonin(PCT)detection for the clinical outcomes of children with Mycoplasma pneumoniae pneumonia(MPP).Methods:149 children with MPP who were admitted to our hospital from April 2022 to August 2024 were included,they were divided into good prognosis and poor prognosis groups based on their clinical outcomes 28 d after admission.The blood routine derived indicators,serum CRP,and PCT levels between the good prognosis group and the poor prognosis group were compared.The influencing factors of clinical outcomes in children with MPP were analyzed by Multiple logistic regression analysis,the value of blood routine derived indicators,serum CRP,and PCT testing alone and in combination to evaluate the clinical outcomes of children with MPP were analyzed by receiver operating characteristic(ROC)curves.Results:Among 149 children with MPP,113 had good prognosis and 36 had poor prognosis 28 d after admission,with a poor prognosis incidence rate of 24.16％(36/149).dNLR,RPR,CRP,and PCT levels in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).Univariate analysis showed that,the clinical outcome of children with MPP was related to pleural thickening,pleural effusion,severity disease and peak body temperature(P＜0.05).Multivariate Logistic regression analysis showed:Pleural thickening,pleural effusion,severity disease was severe,elevated dNLR,elevated RPR,elevated CRP and elevated PCT were risk factors for poor prognosis in children with MPP(P＜0.05).The area under the Curve(AUC)of dNLR,RPR,CRP and PCT combined to predict the prognosis of children with MPP was higher than that evaluated by the four indicators alone.Conclusion:Pleural thickening,pleural effusion,severe disease severity,elevated dNLR,elevated RPR,elevated CRP and elevated PCT are risk factors for poor prognosis in children with MPP.Moreover,the combined evaluate value of dNLR,RPR,CRP,and PCT is relatively high.

The aging trend is intensifying currently,but there is still a lack of standardized diagnosis and treat-ment schemes for severe infections in elderly people.This paper focuses on the recommendations for immune-related clinical diagnosis and treatment routes as well as the idea of risk stratified diagnosis and treatment for elderly peo-ple,aiming to effectively prevent infectious diseases in elderly people and perform stratified management through systematic and scientific means of immune function monitoring and regulation,so as to enhance the standardized level of diagnosis and treatment as well as clinical treatment effect of infection in elderly people.

Objective:To investigate the relationship between peripheral blood amyloid protein A(SAA),C-reactive protein(CRP)/prealbumin(PA),vascular endothelial growth factor(VEGF)and the severity,pulmonary function,and prognosis of children with Mycoplasma pneumoniae pneumonia(MPP).Methods:106 children with MPP who were admitted to Huichang County Maternal and Child Health Hospital of Ganzhou from February 2023 to August 2024 were selected as the study subjects(MPP group),they were divided into good prognosis group(n=77)and poor prognosis group(n=29)according to the 28 days prognosis,they were divided into mild group(n=61)and severe group(n=45)according to the disease severity.Another 90 healthy children who underwent physical examinations during the same period were selected as the control group.The peripheral blood SAA,CRP/PA,VEGF,and pulmonary function indicators between the control group and MPP group were compared,and the peripheral blood SAA,CRP/PA,and VEGF levels between the mild group and severe group were compared,Pearson and Spearman correlation analysis was used to investigate the correlation between peripheral blood SAA,CRP/PA,VEGF and pulmonary function indicators and disease severity in children with MPP.The levels of peripheral blood SAA,CRP/PA,and VEGF between poor prognosis group and good prognosis group were compared.Receiver operating characteristic(ROC)curve was used to analyze the value of peripheral blood SAA,CRP/PA,VEGF detection alone and in combination for evaluating the 28 days prognosis in children with MPP.Results:The peripheral blood SAA,CRP/PA,and VEGF levels in the MPP group were higher than those in the control group,while the forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),and forced vital capacity(FVC)were lower than those in the control group(P＜0.05).Peripheral blood SAA,CRP/PA,and VEGF levels in the severe group were higher than those in the mild group(P＜0.05).Peripheral blood SAA,CRP/PA,VEGF were negatively correlated with FEV1,PEF,FVC,but positively correlated with the severity of the disease(P＜0.05).Peripheral blood SAA,CRP/PA,and VEGF in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).The area under the curve(AUC)values of peripheral blood SAA,CRP/PA,and VEGF for evaluating the 28 days prognosis of MPP patients were 0.514,0.562,and 0.585,respectively,the AUC of 28 days prognosis evaluation in children with MPP by combined detection of peripheral blood SAA,CRP/PA,and VEGF was 0.725,significantly higher than that of individual detection.Conclusion:Abnormal elevation of peripheral blood SAA,CRP/PA,and VEGF levels is involved in the progression of MPP,the injury of pulmonary function,and poor prognosis.combined detection of peripheral blood SAA,CRP/PA,and VEGF levels can effectively evaluate the short-term prognosis of MPP patients.