Sonodynamic therapy (SDT) can potentially induce immunogenic cell death in tumor cells, leading to the release of ATP, and facilitating the initiation of an immune response. Nevertheless, the enzymes CD39 and CD73 can swiftly convert ATP into immunosuppressive adenosine (ADO), resulting in an immunosuppressive tumor microenvironment (TME). This study introduced a nanomedicine (QD/POM1@NP@M) engineered to reprogram TME by modulating the CD39/CD73/ADO pathway. The nanomedicine encapsulated sonosensitizers silver sulfide quantum dots, and the CD39 inhibitor POM1, while also incorporating homologous tumor cell membranes to enhance targeting capabilities. This integrated approach, on the one hand, stimulates the release of ATP via SDT, thereby initiating the immune response. In addition, it reduced the accumulation of ADO by inhibiting CD39 activity, which ameliorated the immunosuppressive TME. Upon administration, the nanomedicine demonstrated substantial anti-tumor efficacy by facilitating the infiltration of anti-tumor immune cells, while reducing the immunosuppressive cells. This modulation effectively transformed the TME from an immunologically "cold" state to a "hot" state. Furthermore, combined with the checkpoint inhibitor α-PDL1, the nanomedicine augmented systemic anti-tumor immunity and promoted the establishment of long-term immune memory. This study provides an innovative strategy for combining non-invasive SDT and ATP-driven immunotherapy, offering new ideas for future cancer treatment.

Objective To investigate the causal relationship between dried fruit intake and color-ectal cancer(CRC)by using a two-sample Mendelian randomization(MR)approach.Methods Two-sample MR analysis was conducted utilizing summary data from genome-wide association studies on dried fruit intake and colorectal cancer.Separate analyses were performed using data for colon cancer and rectal cancer for validation.Genetic variants significantly and independently associated with dried fruit intake were selected as instrumental variables.The inverse variance weighted method,MR-Egger regression,weighted median method,simple mode method,and weighted mode method were employed as the primary analytical approaches.Heterogeneity tests,pleiotropy analysis,and sensitivity analysis were conducted to evaluate the reliability of the study.Results A total of 21 single nucleotide poly-morphisms(SNPs)associated with dried fruit intake were included as instrumental variables.The in-verse variance weighted analysis revealed that increased dried fruit intake was associated with a reduced risk of colorectal cancer(OR=0.55,95％CI,0.32 to 0.96,P=3.53 × 10-2),with consistent results observed for both colon cancer and rectal cancer.The findings of this study were not influenced by plei-otropy or heterogeneity,and the reliability of the results was validated by sensitivity analysis.Conclu-sion Increasing dried fruit intake has potential preventive value against colorectal cancer.

Objective To investigate the therapeutic effects and mechanisms of Yishen Shengyang formula in allergic rhinitis(AR)by regulating the transcription factor BTB and CNC homology 2(Bach2)to promote regulatory T cell(Treg cell)differentiation.Methods AR mouse models were established via ovalbumin(OVA)sensitization and randomly divided into control group,AR model group(AR group),Yishen Shengyang formula group and dexamethasone group.Nasal symptoms were evaluated using behavioral scores;Histopathological changes in nasal mucosa were observed via hematoxylin-eosin and periodic acid Schiff stain;Serum levels of OVA-specific immunoglobulin E(sIgE),interleukin-4(IL-4),and transforming growth factor-β(TGF-β)were measured by enzyme linked immunosorbent assay;Splenic Treg proportions were analyzed via flow cytometry;Bach2 protein expression was assessed by Western blot.Results Compared with control group,AR group mice showed significantly increased behavioral scores(P<0.05),goblet cell hyperplasia,inflammatory infiltration,elevated OVA-sIgE and IL-4 levels(P<0.05),reduced TGF-β(P<0.05),and decreased splenic Treg proportions and Bach2 expression(P<0.05).Yishen Shengyang formula treatment alleviated nasal symptoms(P<0.05),mitigated mucosal damage,decreased OVA-sIgE and IL-4,increased TGF-β(P<0.05),and upregulated Treg proportions and Bach2 expression(P<0.05),with efficacy comparable to dexamethasone.Conclusion Yishen Shengyang formula demonstrates potential therapeutic effects on allergic rhinitis by upregulating Bach2 expression and promoting Treg cell differentiation.This study provides a novel strategy and experimental basis for the traditional Chinese medicine treatment of AR.

This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Cost-effectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs);and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.

This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Cost-effectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs);and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.

Objective To investigate the therapeutic effects and mechanisms of Yishen Shengyang formula in allergic rhinitis(AR)by regulating the transcription factor BTB and CNC homology 2(Bach2)to promote regulatory T cell(Treg cell)differentiation.Methods AR mouse models were established via ovalbumin(OVA)sensitization and randomly divided into control group,AR model group(AR group),Yishen Shengyang formula group and dexamethasone group.Nasal symptoms were evaluated using behavioral scores;Histopathological changes in nasal mucosa were observed via hematoxylin-eosin and periodic acid Schiff stain;Serum levels of OVA-specific immunoglobulin E(sIgE),interleukin-4(IL-4),and transforming growth factor-β(TGF-β)were measured by enzyme linked immunosorbent assay;Splenic Treg proportions were analyzed via flow cytometry;Bach2 protein expression was assessed by Western blot.Results Compared with control group,AR group mice showed significantly increased behavioral scores(P<0.05),goblet cell hyperplasia,inflammatory infiltration,elevated OVA-sIgE and IL-4 levels(P<0.05),reduced TGF-β(P<0.05),and decreased splenic Treg proportions and Bach2 expression(P<0.05).Yishen Shengyang formula treatment alleviated nasal symptoms(P<0.05),mitigated mucosal damage,decreased OVA-sIgE and IL-4,increased TGF-β(P<0.05),and upregulated Treg proportions and Bach2 expression(P<0.05),with efficacy comparable to dexamethasone.Conclusion Yishen Shengyang formula demonstrates potential therapeutic effects on allergic rhinitis by upregulating Bach2 expression and promoting Treg cell differentiation.This study provides a novel strategy and experimental basis for the traditional Chinese medicine treatment of AR.

Objective To explore the value of dynamic prediction model based on recurrent neural network(RNN)algorithms for dynamic prediction of clinical outcomes in patients with critical trauma,and to study the feasible construction scheme and path of dynamic strategy and real-time prediction model.Methods The data of this study were derived from the US Medical Information Mart for Intensive Care(MIMIC)-IV 2.0.In order to predict the in-hospital outcomes of critical trauma patients,2 RNN algorithms,long short-term memory(LSTM)and gated recurrent unit(GRU)were used to train dynamic prediction models under the time windows of 4,6 and 8 h,respectively.The performance of the models was evaluated using the sensitivity,specificity,F1 value and area under curve(AUC)value;and the effects of different RNN algorithms and time windows on the performance of the models were analyzed.Hidden Markov model(HMM),random forest(RF)model and logistic model were trained under 8-h time window as the controls to compare the performances and the time trends horizontally with the 2 RNN algorithm models.Results There were significant differences in the 4 performance indexes of the RNN dynamic models including the sensitivity,specificity,F1 value and AUC value(all P＜0.001),and the performance indexes at 8-h time window were higher than those at 6 h and 4 h;there was only significant difference in specificity between different RNN algorithms(LSTM & GRU)(P=0.036).The results of the horizontal comparison showed that there were significant differences in each performance index between the 2 RNN prediction models and other models(all P＜0.001),and each index of the 2 RNN algorithm models was higher than those of the HMM,RF model and logistic model.The intraclass correlation coefficients(ICCs)of each algorithmic model were less than 0.400 for the sensitivity,specificity and F1 value(0 was not included in 95％confidence interval[CI]),while the ICCs for the AUC value were statistically under-evidenced(0 was included in 95％CI).Conclusion The dynamic models based on RNN algorithms have certain performance advantages over those based on other common algorithms,and the time window may have an impact on the model performance.

In order to facilitate systematic reviews and meta-analyses by medical researchers， this paper provides a tutorial-style review of the relevant concepts， necessary steps， and some key considerations in conducting systematic reviews and meta-analyses. Specifically， it offers detailed explanations on literature search， evaluation of study bias， effect size selection， outcomes pooling， and testing and correction of publication bias. Additionally， the paper provides references to softwares and literature for implementing the methods， and concludes with a brief overview of the requirements for writing research papers.

Objective:To compare the predictive performance of different machine learning models using pre-hospital data to predict adverse inhospital outcome in patients with severe trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 100 135 patients with severe trauma from the National Trauma Data Bank (NTDB) from January 2017 to December 2018. There were 69 644 males and 30 480 females apart from 11 patients with missing gender information, with the range age of 16-89 years [(50.1±21.1)years]. Clinical characteristics included demographic information (sex and age), trauma type (blunt or penetrating trauma), pre-hospital time [emergency medical services (EMS) response time, EMS scene time, and EMS transport time], pre-hospital vital signs (systolic blood pressure, pulse rate, respiratory rate, and oxygen saturation), trauma score [Glasgow coma score (GCS) and injury severity score (ISS)]. The original data were divided into the training set (in the year 2017) and the testing set (in the year 2018) according to the year of admission, including 50 429 patients in the training set and 49 706 patients in the testing set. The patients were classified into non-adverse outcome group ( n=94 526) and adverse outcome group ( n=5 609), according to whether they had an adverse outcome or not. There were 2 808 patients with adverse outcome in the training set and 2 801 patients with adverse outcome in the testing set. All models were built based on the training set. Eight machine learning algorithms consisting of neural network (NNET), naive Bayes (NB), gradient boosting machine (GBM), adaptive boosting (Ada), random forest (RF), bagging tree (BT), categorical boosting (CatBoost) and extreme gradient boosting (XGB) were used to construct prediction models for clinical outcomes among patients with severe trauma based on their clinical features. Models were evaluated according to the sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. Results:Of the NNET, NB, GBM, Ada, RF, BT, CatBoost and XGB models in the testing set, the sensitivity was 0.84, 0.83, 0.27, 0.79, 0.83, 0.81, 0.62 and 0.78, respectively; the specificity was 0.79, 0.76, 0.81, 0.79, 0.79, 0.74, 0.83 and 0.79, respectively; the AUC was 0.89 (95% CI 0.88, 0.90), 0.86 (95% CI 0.85, 0.87), 0.54 (95% CI 0.53, 0.55), 0.86 (95% CI 0.85, 0.87), 0.88 (95% CI 0.88, 0.90), 0.83 (95% CI 0.82, 0.85), 0.77 (95% CI 0.76, 0.79) and 0.86 (95% CI 0.85, 0.87), respectively. The NNET model had the best differentiation. In terms of calibration degree, both NNET and NB showed good performance ( P>0.05 for Hosmer-Lemeshow goodness-of-fit test). Conclusion:The NNET model has a favorable predictive performance for adverse inhospital outcome in patients with severe trauma, which may provide a reference for the rapid prediction of prognosis in patients with severe trauma.

Objective:To compair the clinical effect of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot(ENSR) system in the treatment of lumbar disc herniations(LDH).Methods:From March 2021 to December 2021, 73 patients with LDH underwent endoscopic minimally invasive treatment in the Department of Spine Surgery, Limin Hospital of Weihai High District. Thirty-eight patients were treated with endoscopic spine surgery assisted by domestic ENSR system(ENSR group), and 35 patients were treated with endoscopic spine surgery alone(endoscopic group). The patients received follow up regularly by telephone or Wechat. The intraoperative fluoroscopy times, puncture times, upper facet arthroplasty times, operation time, preoperative and postoperative Visual Analogue Scale(VAS), Japanese Orthopaedic Association Scores(JOA), and the MOS item short from health survey(SF-36)were compared between the 2 groups. The early postoperative efficacy was evaluated by modified MacNab criteria at 1 week after surgery. SPSS 26.0 was used to analyse the data. P<0.05 was considered that the difference was statistically significant. Results:The age, gender, body mass index(BMI) and other general data of the 2 groups were basically the same, and there was no statistically significant difference( P>0.05). There was no significant difference in the excellent and good rate of postoperative treatment between ENSR group(97.37%) and endoscopic group(94.29%)( Z=0.90, P>0.05). In terms of operation time, intraoperative fluoroscopy times, puncture times, and plasty times, ENSR group[(67.00±17.00) min, (4±2) times, 1 time, 1 time, respectively] was compared with the endoscopic group[(82.00±16.00] min, (17±6) times, (9±5) times, (5±2) times], and the difference was statistically significant( t=3.87,12.62, 9.87, respectively, P<0.05). There were significant differences in VAS, JOA and SF-36 scores between the 2 groups between before and after surgery( F=106.42, 112.14, 26.88, respectively, P<0.05). There was no significant difference in VAS, JOA and SF-36 scores before and after surgery between the 2 groups( F=0.95, 3.54, 0.97, respectively, P>0.05). Conclusion:The endoscopic spine surgery assisted by the ENSR can achieve satisfactory clinical results and is a safe and effective surgical assistance system. For the endoscopic surgery, assisted by the ENSR has obvious advantages in reducing the times of fluoroscopy, puncture, and facet arthroplasty, and shortening the operation time.