ObjectiveTo decipher the mechanism by which Zuoguiwan （ZGW） treat hyperthyroidism in rats with kidney-Yin deficiency based on the dopamine receptor D4 （DRD4）/nicotinamide adenine dinucleotide phosphate （NADPH） oxidase 4 （NOX4） signaling pathway. MethodsThe rat model of kidney-Yin deficiency was induced by unilateral intramuscular injection of dexamethasone （0.35 mg·kg^-1）. After successful modeling， the rats were randomized into model， methimazole （positive control， 5 mg·kg^-1）， low-， medium-， and high-dose （1.85， 3.70， 7.40 g·kg^-1， respectively） ZGW， and normal control groups. After 21 days of continuous gavage， the behavioral indexes and body weight changes of rats were evaluated. The pathological changes of the renal tissue were observed by hematoxylin-eosin staining. The serum levels of thyroid hormones ［triiodothyronine （T₃）， thyroxine （T₄）， thyroid-stimulating hormone （TSH）］， renal function indexes ［serum creatine （Scr） and blood urea nitrogen （BUN）］， energy metabolism markers ［cyclic adenosine monophosphate （cAMP） and cyclic guanosine monophosphate （cGMP）］， and oxidative stress-related factors ［superoxide dismutase （SOD）， malondialdehyde （MDA）， and NADPH）］ were measured by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to analyze the expression of DRD4， NOX4， mitochondrial respiratory chain complex proteins ［NADH：ubiquinone oxidoreductase subunit S4 （NDUFS4） and cytochrome C oxidase subunit 4 （COX4）］， and inflammation-related protein ［tumor necrosis factor-alpha （TNF-α）， interleukin-6 （IL-6）， p38 mitogen-activated protein kinase （MAPK）］ pathway in the renal tissue. ResultsCompared with the normal group， the model group showed mental malaise， body weight decreases （P<0.01）， inflammatory cell infiltration in the renal tissue， a few residual parotid glands in the thyroid， elevations in serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA， and NADPH （P<0.01）， down-regulation in protein levels of TSH， SOD， and DRD4 （P<0.05， P<0.01）， and up-regulation in expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.01）. Compared with the model group， ZGW increased the body weight （P<0.05， P<0.01）， reduced the infiltration of renal interstitial inflammatory cells， restored the thyroid structure and follicle size， lowered the serum levels of T₃， T₄， Scr， BUN， cAMP， cAMP/cGMP， MDA and NADPH （P<0.05， P<0.01）， up-regulated the expression of TSH， SOD and DRD4 （P<0.05， P<0.01）， and down-regulated the expression of NOX4， p-p38 MAPK/p38 MAPK， and inflammatory factors （P<0.05， P<0.01）. Moreover， high-dose ZGW outperformed methimazole （P<0.05）. ConclusionBy activating DRD4， ZGW can inhibit the expression of NOX4 mediated by the p38 MAPK pathway， reduce oxidative stress and inflammatory response， thereby ameliorating the pathological state of hyperthyroidism due to kidney-Yin deficiency. This study provides new molecular mechanism support for the clinical application of ZGW.

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.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective To investigate the safety of robotic single-site hysterectomy(RSSH)for benign diseases.Methods We retrospectively analyzed data of patients who underwent RSSH or traditional transumbilical laparoendoscopic single-site hysterectomy(LESSH)for benign indications from May 2024 to May 2025.The study was comprised of 24 patients in the RSSH group and 42 patients in the LESSH group.Perioperative indicators were compared between the two groups.Results All the surgeries were successfully completed in both groups without conversion or intraoperative/postoperative blood transfusion.The RSSH group had a longer operation time than the LESSH group[161.5(131.3,179.5)min vs.97.5(76.5,123.3)min,Z=-5.226,P＜0.001].However,there were no significant differences in intraoperative blood loss,pre-postoperative hemoglobin difference,postoperative pain score,maximum postoperative temperature,time to flatus,indwelling catheter duration,or postoperative hospital stay(P＞0.05).Conclusion RSSH for benign diseases has a safety profile comparable to traditional LESSH.

Objective To investigate the clinical characteristics,distribution of traditional Chinese medicine(TCM)syndrome types,and the anxiety and depression status in patients with colorectal polyps.Methods From January 2022 to December 2023,a total of 200 cases of patients with colorectal polyps(polyp group)and 100 patients without intestinal abnormalities(non-polyp group)under colonoscope who received colonoscopy or treatment at the Endoscopy Center of Dongguan Hospital,Guangzhou University of Chinese Medicine were enrolled.The relevant medical information of the patients in the two groups were collected,and then TCM syndrome differentiation of patients with colorectal polyps were carried out,the general infromation including gender,age,body mass index(BMI),smoking history and alcohol-intake history was recorded,and Hospital Anxiety and Depression Scale(HAD)score was calculated for assessing their anxiety and depression status.Results(1)The investigation of clinical characteristics showed that between the polyp group and the non-polyp group,the differences in the general information of gender,age,BMI,smoking history and alcohol-intake history were statistically significant(P<0.05 or P<0.01).As for the gender,the polyp group was predominated by the male(63.5%),while the non-polyp group was predominated by the female(58.0%),indicating that male patients were more likely to suffer from colorectal polyps.In terms of the age,the age group of 51-60 years old accounted for a higher percentage(36.0%)in the polyp group,while the age group of 41-50 years old accounted for a higher percentage(38.0%)in the non-polyp group,indicating that the polyp group had an elder average age than the non-polyp group.In addition,the percentages of patients with obesity(BMI≥28.0 kg/m2),smoking history,and alcohol-intake history in the polyp group were higher than those in the non-polyp group.(2)The analysis of features of colorectal polyps showed that the polyps were mostly seen in the left colon,accounting for 53.5%in the polyp group;adenomatous polyps accounted for 57.0%of all polyps;the size of colorectal polyps was usually less than one centimeter,accounting for 81.5%of all polyps;single colorectal polyps accounted for 45.5%,and multiple colorectal polyps accounted for 54.5%,indicating that colorectal polyps were usually multiple.(3)Among the 200 patients with colorectal polyps,there were 93 cases of syndrome of stagnation dampness due to spleen deficiency(46.5%),59 cases of dampness-heat in large intestine syndrome(29.5%),27 cases of liver depression and qi stagnation syndrome(13.5%),and 21 cases of dampness and blood stasis obstruction syndrome(10.5%).There were no statistically significant differences in the distribution of TCM syndrome types among colorectal polyp patients with different genders,ages,BMIs and alcohol consumption(P>0.05).The difference in the distribution of TCM syndrome types among colorectal polyp patients with or without smoking history was statistically significant(P<0.05).No statistically significant differences were shown in the distribution of TCM syndrome types among the colorectal polyp patients with various foci,number of polyps,and pathological types(P>0.05).The difference in the distribution of TCM syndrome types in colorectal polyp patients with different polyp sizes was statistically significant(P<0.05).In the patients with the polyp size0.05).In addition,the differences of anxiety scores and depression scores in the patients with various TCM syndrome types were not statistically significant(P>0.05).Conclusion(1)The distribution of TCM syndrome types of colorectal polyps is predominated by the syndrome of stagnation dampness due to spleen deficiency and dampness-heat in large intestine syndrome.The distribution of TCM syndrome types has no correlation with anxiety and depression,and the polyp foci,number of polyps,and pathological types of polyps,but has certain correlation with the size of the polyps.(2)Anxiety and depression may be the risk factors for colorectal polyps,but the polyp foci,number of polyps,and pathological types of polyps have no correlation with anxiety and depression,and the size of polyps may have certain correlation with anxiety.(3)Gender,age,smoking history and alcohol-intake history may be the risk factors for colorectal polyps.

With the popularization of 5G communication technology and the continuous upgrade of robot-assisted surgery system,telesurgery has developed rapidly.However,there are few of reports about this technique in single-port laparoscopic gynecological surgery.On April 19,2024,the surgeons at the Second Affiliated Hospital of Naval Medical University in Shanghai successfully implemented robot-assisted single-port laparoscopic bilateral adnexectomy for a patient who was admitted to the Naval Hospital of the Eastern Theater Command in Zhoushan,Zhejiang Province through 5G communication technology.The operation time was 90 min,intraoperative bleeding was 20 ml,and no intraoperative complications occurred.There were no adverse events caused by robots such as robot system failure and instrument failure,or adverse events caused by remote communication such as network interruption and network attack.Intraoperative user datagram protocol(UDP)real-time monitoring data showed an average delay of 108 ms(range,105-111 ms)and a packet loss rate of 0.04%.The surgeons had a slight sense of delay when the operation amplitude was too large.There was no obvious stalling which affected the process of the operation.The patient was able to move around on the first day after surgery,and the catheter was removed.No postoperative complications occurred.The patient was discharged from the hospital on the second day after surgery.Postoperative pathological results revealed left fallopian tube ovarian serous cystadenofibroma,fallopian tubal tissue;right fallopian tube ovarian,sent for examination as ovarian and fallopian tube tissue.There were no complaints of discomfort during reexamination one month after surgery,and the umbilical incision healed well.This case is an attempt of telesurgery in the field of gynecology,and provides experiences for the further development of this technique.

Polycythemia vera(PV)is a type of BCR∷ABL1 negative myeloproliferative neoplasms(MPN),which is a chronic myeloid tumor caused by gene mutations in hematopoietic stem cells.PV has a certain risk of progressing to myelofibrosis or acute myeloid leukemia.At present,the goal of PV treatment is still to prevent thrombosis.With the deepening of PV research,it is possible to trans-form the lifelong treatment to prevent the progres-sion of the disease from alleviating the symptoms of patients.This article reviews the mechanism of traditional cytoreductive therapy drugs and the lat-est clinical trial results,as well as the early clinical trial data and their mechanism of action of new PV drugs and combination of drugs,in order to pro-vide help for researchers who pay attention to PV treatment.

Aim To investigate the predictive value of the Murray law-based quantitative flow ratio(μQFR)after target vessel pretreatment for vascular-related adverse events in patients with de novo coronary lesions treated with drug-coated balloon.Methods This retrospective study included 223 lesions from 223 patients who underwent drug-coated balloon-only strategy and completed 2-year clinical follow-up.Coronary angiographic images of target vessels pre-procedure,post-balloon and post-procedure were collected,and analyzed using a novel Murray's law-based algorithm.The μQFR analysis of each target vessel included not only the μQFR value of the target vessel,but also the length of the target vessel,the degree of vessel diameter stenosis,the reference lumen diameter,the minimum lumen diameter and blood flow velocity.The primary endpoint was defined as the postoperative vessel-oriented composite endpoint(VOCE).Results During the2-year clinical follow-up period,a total of 25 patients(11.2%)experienced VOCE events.Com-pared with the control group,patients with VOCE events after pretreatment showed a decrease in μQFR(P<0.001).Multivariate Logistic analysis showed that a lower target vessel μQFR after pretreatment(OR=0.931,95%CI:0.894～0.969,P<0.001)was an independent predictor of VOCE events.ROC curve analysis showed that the cut-off value for predicting 2-year VOCE events using preprocessed μQFR was 0.83(95%CI:0.727～0.840),with a sensitivity of 72.7%and a specificity of 84.0%(AUC=0.773,95%CI:0.676～0.870,P<0.001).Survival analysis showed that compared with patients with μQFR>0.83,patients with μQFR≤0.83 had a significantly higher incidence of VOCE events at 1 and 2 years,increasing to 3.909 times(16.9%vs.4.6%,HR=3.909,95%CI:1.539～9.930,P=0.004)and 2.867 times(19.7%vs.7.2%,HR=2.867,95%CI:1.301～6.316,P=0.009).After adjusting for potential con-founds,patients with pretreated μQFR≤0.83 had a 2.567 times in 2-year incidence of VOCE events(HR=2.567,95%CI:1.151～5.727,P=0.021)and a 3.712 times in 1-year incidence of VOCE events(HR=3.712,95%CI:1.478～9.810,P=0.006)compared to patients with good pretreatment.Conclusions For patients with in situ coronary artery disease,a lower μQFR after pretreatment increases the risk of postoperative adverse clinical events.μQFR≤0.83 may be used to evaluate the effectiveness of lesion pretreatment.

Objective To investigate the neuroprotective effect of ligustilide(LIG)-mediated phosphatase and tensin homolog(PTEN)-induced putative kinase 1(PINK1)/Parkin pathway on mitophagy in rats with cerebral ischemia-reperfusion injury.Methods 161 male Sprague Dawley(SD)rats were randomly divided into sham operation(Sham)group,model group,LIG low-dose group,LIG high-dose group,mitophagy inhibitor(Mdivi-1)group,LIG high-dose+Mdivi-1 group,and the positive drug Nimodipine(NMDP)group,each with 23 rats.A modified middle cerebral artery wire thrombus method was used to construct a cerebral ischemia/reperfusion model in rats,and the neurobehavioral scores of rats in each group were compared by Longa's five-point scale;the volume of cerebral infarction was detected by 2,3,5-triphenyltetrazolium chloride(TCC)staining,the histopathology and ultrastructure of the hippocampus were examined by hematoxylin-eosin(HE)staining and transmission electron microscope(TEM).And the Na+-K+-Adenosine Triphosphate was measured by enzyme-linked immunosorbent assay(ELISA);double immunofluorescence staining for translocase of the outer membrane of mitochondrion 20(TOMM20)and Microtubule-associated protein 1 light chain 3(LC3)co-localized area percentage.Flow cytometry assay(FCM)to test the level of reactive oxygen(ROS);real-time fluorescence quantitative PCR(qRT-PCR)was used to measure the relative content of mitochondria in hippocampal neurons;and Western blot was performed to test the level of autophagy and the PINK1/Parkin pathway related protein expression.Results Compared with the Sham group,the neurological function score and cerebral infarction volume of the model group were increased,the hippocampal neurons showed pathological damage such as disordered arrangement,nucleolus disappearance and partial shrinkage of the nucleus and plasma,nuclear membrane rupture,swelling,membrane rupture and crista reduction of some mitochondria,a large number of autophagosomes were observed,and the colocalization area percentage of TOMM20 and LC3 was increased.TOMM20 and cytochrome C oxidase subunit IV isoform 1(COX4I1)in hippocampus and selective autophagy adaptor protein 62(p62)protein expression,mitochondrial encoded ATP synthase 6(mt-ATP6)/Ribosomal protein L13(Rpl13)ratio and Na+-K+-ATPase content decreased,while PINK1 and Parkin protein expression,LC3-II/I ratio and ROS relative content increased,and the differences were statistically significant(t=4.602～52.012,all P<0.01).Compared with the model group,the neurological function score,cerebral infarction volume,pathological and ultrastructural damage of hippocampal neurons were significantly improved in the LIG low,high dose and NMDP groups,and the differences were statistically significant(t=4.851～12.525,all P<0.01).The colocalization of TOMM20 and LC3 and the content of Na+-K+-ATPase were increased,while the expression of TOMM20,COX4I1 and p62 proteins and the mt-ATP6/Rpl13 ratio were decreased in the high-dose LIG group.The protein expression of PINK1 and Parkin,LC3-II/I ratio and ROS relative content were increased,and the differences were statistically significant(t=4.087～33.211,all P<0.01).Compared with the LIG high-dose group,the Mdivi-1 and LIG+Mdivi-1 groups had significantly decreased colocalization of TOMM20 and LC3 and Na+-K+-ATPase content,and significantly increased expression of TOMM20,COX4I1 and p62 proteins and mt-ATP6/Rpl13 ratio.The protein expression of PINK1 and Parkin,LC3-II/I ratio and ROS relative content were decreased,and the differences were statistically significant(t=4.008～43.415,all P<0.01).However,the percentage of TOMM20 and LC3 co-localization area,PINK1 and Parkin protein expression,LC3-II/I ratio and Na+-K+-ATPase content in the hippocampus of the LIG+Mdivi-1 group were higher than those of the Mdivi-1 group.The protein expression of COX4I1 and p62,mt-ATP6/Rpl13 ratio and ROS level were lower than those in MDIV-1 group,and the differences were statistically significant(t=3.721～21.513,all P<0.01).Conclusion LIG may activate mitophagy by regulating PINK1/Parkin signaling pathway to protect neurons from cerebral ischemia-reperfusion injury in rats.

Objective:To investigate the effects of toosendanin(TSN)on the proliferation,apoptosis,migration and invasion of esophageal squamous cell carcinoma(ESCC)KYSE150 cells,and to elucidate its underlying molecular mechanisms.Methods:CCK-8 assay,colony formation assay,and EdU assay were used to assess the effects of varying TSN concentrations(0.062 5,0.125,and 0.25 μmol/L)on KYSE150 cell proliferation.The impacts of TSN on the apoptosis,migration,and invasion of KYSE150 cells were evaluated using flow cytometry,wound healing assay,and Transwell chamber assay,respectively.The expression of hypoxia-inducible factor 1 alpha(HIF1A)in esophageal cancer tissues was analyzed using the GEPIA database.qPCR was used to detect the expression level of HIF1A mRNA in human esophageal epithelial Het-1A and KYSE150 cells,and in TSN-treated KYSE150 cells.Western blot(WB)was performed to detect the effects of TSN on the upstream signaling pathway AKT/mTOR of HIF1A and the expression of downstream proteins related to cell migration,invasion,and apoptosis.Results:TSN of varying concentrations significantly inhibited proliferation,migration,and invasion of KYSE150 cells and promoted apoptosis in a dose-dependent manner(P<0.05 or P<0.01).HIF1A mRNA was highly expressed in KYSE150 cells,and its expression was significantly downregulated after TSN treatment(P<0.05 or P<0.01).TSN markedly downregulated the expression of HIF1A and key upstream signaling proteins p-AKT and p-mTOR.In addition,TSN significantly suppressed the expression of downstream proteins associated with cell migration,invasion,and apoptosis,including N-cadherin,vimentin,Bcl-2,and caspase-3,while upregulating the expression of E-cadherin(P<0.05 or P<0.01).Conclusion:TSN inhibits the proliferation,migration,and invasion,and induces apoptosis in ESCC KYSE150 cells by down-regulating HIF1A expression through suppression of the AKT/mTOR signaling pathway.