BACKGROUND:Previous studies have found that neuronal damage caused by continuous excessive fluoride exposure is related to Ca2+overload,but the mechanism of Ca2+flow conversion between intracellular calcium stores and cell apoptosis damage is still unclear.OBJECTIVE:To investigate the effect of fluoride exposure on Ca2+transport channel proteins and apoptosis levels in the mitochondria-associated endoplasmic reticulum membrane of primary cultured neural cells.METHODS:Primary nerve cells of neonatal SD rats were cultured in vitro and identified by immunofluorescence staining with neuronal nucleus-specific antibody up to day 7.The nerve cells were divided into control group(containing 0 mmol/L sodium fluoride),low fluoride group(containing 0.5 mmol/L sodium fluoride),and high fluoride group(containing 1 mmol/L sodium fluoride).The cell morphological changes were observed by light microscope 24 hours after fluorine exposure.The expression levels of apoptosis-related protein BAX/BCL-2 and calcium transfer-related pathways VDAC1,GRP 75,and IP3R were detected using western blot assay.The expression levels of VDAC1,GRP 75,and IP3R mRNA were detected by RT-PCR.Ca2+levels were detected by Rhood-2AM Ca2+probe.Mitochondrial membrane potential detection kit was used to detect the change in mitochondrial membrane potential.The level of apoptosis was determined by flow cytometry and TUNEL staining.RESULTS AND CONCLUSION:(1)The purity of neurons cultured on day 7 had been determined to be over 90％,with few impurities,good growth status,and tight cell network connections,meeting the requirements of subsequent experiments.(2)Compared with the control group,growth of neural cell clusters in the low-fluoride group and the high-fluoride group increased;the processes were broken;the cell body was rounded,and the connection network between cells was destroyed.Compared with the low-fluoride group,the cell damage changes in the high-fluoride group were more obvious.(3)Compared with the control group,the protein expressions of VDAC1,GRP75,and IP3R were increased in the low-fluoride group and the high-fluoride group(P＜0.05),and the ratio of apoptosis-related protein BAX/BCL-2 was increased(P＜0.05).Compared with the control group,the expression of VDAC1 and GRP75 mRNA in the low-fluoride group was significantly increased(P＜0.05);the expression levels of VDAC1,GRP75,and IP3R mRNA in the high-fluoride group were significantly increased(P＜0.01).(4)The level of cell apoptosis increased significantly after fluoride exposure,and the high-fluoride group was significantly higher than the control and low-fluoride groups(P＜0.01).(5)After fluoride exposure,the concentration of mitochondrial Ca2+in nerve cells increased significantly(P＜0.05),the mitochondrial membrane potential decreased(P＜0.01),and the degree of damage in the high-fluoride group was more obvious(P＜0.05).The results show that fluoride exposure impairs the morphological structure of primary neural cells,resulting in upregulation of Ca2+transfer pathway protein expression between the endoplasmic reticulum and mitochondria,mitochondrial Ca2+overload,mitochondrial damage,and increased levels of apoptosis.

BACKGROUND:Previous studies have found that neuronal damage caused by continuous excessive fluoride exposure is related to Ca2+overload,but the mechanism of Ca2+flow conversion between intracellular calcium stores and cell apoptosis damage is still unclear.OBJECTIVE:To investigate the effect of fluoride exposure on Ca2+transport channel proteins and apoptosis levels in the mitochondria-associated endoplasmic reticulum membrane of primary cultured neural cells.METHODS:Primary nerve cells of neonatal SD rats were cultured in vitro and identified by immunofluorescence staining with neuronal nucleus-specific antibody up to day 7.The nerve cells were divided into control group(containing 0 mmol/L sodium fluoride),low fluoride group(containing 0.5 mmol/L sodium fluoride),and high fluoride group(containing 1 mmol/L sodium fluoride).The cell morphological changes were observed by light microscope 24 hours after fluorine exposure.The expression levels of apoptosis-related protein BAX/BCL-2 and calcium transfer-related pathways VDAC1,GRP 75,and IP3R were detected using western blot assay.The expression levels of VDAC1,GRP 75,and IP3R mRNA were detected by RT-PCR.Ca2+levels were detected by Rhood-2AM Ca2+probe.Mitochondrial membrane potential detection kit was used to detect the change in mitochondrial membrane potential.The level of apoptosis was determined by flow cytometry and TUNEL staining.RESULTS AND CONCLUSION:(1)The purity of neurons cultured on day 7 had been determined to be over 90％,with few impurities,good growth status,and tight cell network connections,meeting the requirements of subsequent experiments.(2)Compared with the control group,growth of neural cell clusters in the low-fluoride group and the high-fluoride group increased;the processes were broken;the cell body was rounded,and the connection network between cells was destroyed.Compared with the low-fluoride group,the cell damage changes in the high-fluoride group were more obvious.(3)Compared with the control group,the protein expressions of VDAC1,GRP75,and IP3R were increased in the low-fluoride group and the high-fluoride group(P＜0.05),and the ratio of apoptosis-related protein BAX/BCL-2 was increased(P＜0.05).Compared with the control group,the expression of VDAC1 and GRP75 mRNA in the low-fluoride group was significantly increased(P＜0.05);the expression levels of VDAC1,GRP75,and IP3R mRNA in the high-fluoride group were significantly increased(P＜0.01).(4)The level of cell apoptosis increased significantly after fluoride exposure,and the high-fluoride group was significantly higher than the control and low-fluoride groups(P＜0.01).(5)After fluoride exposure,the concentration of mitochondrial Ca2+in nerve cells increased significantly(P＜0.05),the mitochondrial membrane potential decreased(P＜0.01),and the degree of damage in the high-fluoride group was more obvious(P＜0.05).The results show that fluoride exposure impairs the morphological structure of primary neural cells,resulting in upregulation of Ca2+transfer pathway protein expression between the endoplasmic reticulum and mitochondria,mitochondrial Ca2+overload,mitochondrial damage,and increased levels of apoptosis.

ObjectiveTo construct a prediction model for high responsiveness to short-term aerobic training in patients with Parkinson's disease (PD) based on dual-task gait assessment, and to provide evidence for identifying individuals who are most likely to benefit from such interventions. MethodsA total of 42 patients with PD who visited the outpatient clinic of Tianjin Huanhu Hospital between August 29, 2023 and December 19, 2024 were enrolled. All participants completed a 4-week home-based aerobic cycling training program and underwent dual-task gait assessments pre- and post-training. Patients were classified into high-response group (n = 12) and low-response group (n = 30) according to whether the improvement in gait speed reached the minimal clinically important difference of 0.1 m/s. The clinical validity of this grouping was verified by comparing differences in cardiopulmonary exercise testing parameters and dual-task gait indicators between the two groups pre- and post-training. Based on baseline characteristics, Firth's penalized maximum likelihood logistic regression was applied to construct a predictive model for high responsiveness, and the discriminative performance of the model was assessed preliminarily. ResultsThe high-response group showed significantly greater improvement in gait speed, step length, cadence and the anaerobic threshold to maximal oxygen uptake ratio after training compared with the low-response group (P < 0.05), confirming the clinical validity of the grouping. The baseline anaerobic threshold to maximal oxygen uptake ratio (OR = 3.348), body mass index (OR = 2.229) and age (OR = 0.428) demonstrated certain discriminative ability in the present sample. The area under the receiver operating characteristic curve was 0.831, with an overall prediction accuracy of 81.0%, specificity of 83.3% and sensitivity of 75.0%. Robustness of the model was confirmed via internal validation using the Bootstrap method, which suggested that the results were informative, but further validation was still required. ConclusionThe anaerobic threshold/maximal oxygen uptake ratio, body mass index and age may predict the response to short-term aerobic training in patients with PD.

Surgery is the most important and effective way to treat thyroid cancer. How to reduce surgical complications while completely treating tumor has always been the focus and difficulty of thyroid surgery. Carbon nanoparticles suspension injection is the third generation lymph node tracer, with strong staining specificity, rapid development, long staining time, simple use, harmless to human body and other characteristics, showing unique clinical value in lymph node tracing, parathyroid identification and protection. However, the application of carbon nanoparticles in thyroid surgery is still controversial. After literature review, the authors address the clinical application of carbon nanoparticles in thyroid cancer surgery.

China's Medical Service Price(MSP)reform has entered a new phase,implementing management measures.The compilation,implementation,and coordination of MSP item guidelines and the existing contradictions and problems were reviewed.It proposes strengthening price item management in planning under the background of the new era,itemizing in the alignment particle size,and comparing prices in the same coordinate system.This can offer systematic approaches and innovative strategies for improving the quality and efficiency of deepening MSP reform.

Surgery is the most important and effective way to treat thyroid cancer. How to reduce surgical complications while completely treating tumor has always been the focus and difficulty of thyroid surgery. Carbon nanoparticles suspension injection is the third generation lymph node tracer, with strong staining specificity, rapid development, long staining time, simple use, harmless to human body and other characteristics, showing unique clinical value in lymph node tracing, parathyroid identification and protection. However, the application of carbon nanoparticles in thyroid surgery is still controversial. After literature review, the authors address the clinical application of carbon nanoparticles in thyroid cancer surgery.

Thyroid cancer has become one of the fastest-growing malignancies in recent years,with a significant improvement in the 5-year relative survival rate among Chinese patients.Accurate diagnosis,standardized treatment,and effective follow-up are essential to improve clinical outcomes,while the promotion and implementation of clinical guidelines are critical for achieving standardized and homogeneous management.In 2022,the China Anti-Cancer Association(CACA)released the 2022 Chinese Guidelines for Integrated Diagnosis and Treatment of Tumors(CACA)—Thyroid Cancer,which systematically applied the concept of multidisciplinary integrated management to the entire care continuum of thyroid cancer,reflecting both Chinese characteristics and local experience.Building upon this,the 2025 edition of the guidelines was updated and revised based on the latest evidence and clinical practices.This article provides a systematic interpretation of the 2025 CACA guidelines,focusing on the diagnosis,treatment,and follow-up of thyroid cancer,with the aim of offering practical guidance for clinicians and promoting standardized,integrated management of thyroid cancer in clinical practice.

Background and Aims:As a core data source in the development of medical informatization,the front page of inpatient medical records plays a crucial role in determining the usability of research data and the scientific quality of clinical decision-making.Given the relatively standardized diagnostic and treatment protocols for thyroid malignancies,this disease serves as a representative model for evaluating the data quality of medical record front sheets.This study aimed to systematically assess the accuracy of diagnostic and surgical procedure coding for thyroid malignancies on the medical record front page,identify existing problems,and explore strategies for improvement and the potential for future application in clinical research.Methods:A total of 3 361 patients who underwent initial surgical treatment and were pathologically confirmed with thyroid cancer at the Department of Thyroid Surgery,the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 were retrospectively included.Postoperative pathology reports and surgical records were used as reference standards to evaluate the accuracy of primary and secondary diagnosis codes,as well as primary and secondary surgical procedure codes on the medical record front page.Results:The accuracy rate of primary diagnosis coding reached 98.8%.However,among 1 368 patients with cervical lymph node metastasis,only 31.2%had correctly recorded secondary diagnosis codes and metastatic sites,with an omission rate as high as 67.8%.The overall accuracy rate for primary surgical procedure coding was 90.4%,with thyroid lobectomy(TL)and total thyroidectomy(TT)coding accuracies of 85.5%and 96.0%,respectively.Among the coding errors,70.0%involved TL procedures being incorrectly coded as TT.Secondary surgical procedure codes—mainly for lymph node dissection—were highly inconsistent,with up to 14 different coding types,reflecting a lack of standardization and unified input criteria.Notably,the error rate for primary surgical coding in 2020 increased significantly compared with the previous two years,suggesting subjectivity and variability in manual data entry.Conclusion:This study highlights major accuracy deficiencies in surgical procedure coding for thyroid malignancies on the medical record front page,which may compromise the scientific validity of real-world data.Going forward,leveraging artificial intelligence technologies to support structured documentation and automated coding,alongside establishing a proactive quality control system through multidisciplinary collaboration,may significantly improve data accuracy.These efforts are essential for strengthening data foundations for precision treatment,performance evaluation,insurance payment,and clinical research on thyroid cancer.

Thyroid cancer has become one of the fastest-growing malignancies in recent years,with a significant improvement in the 5-year relative survival rate among Chinese patients.Accurate diagnosis,standardized treatment,and effective follow-up are essential to improve clinical outcomes,while the promotion and implementation of clinical guidelines are critical for achieving standardized and homogeneous management.In 2022,the China Anti-Cancer Association(CACA)released the 2022 Chinese Guidelines for Integrated Diagnosis and Treatment of Tumors(CACA)—Thyroid Cancer,which systematically applied the concept of multidisciplinary integrated management to the entire care continuum of thyroid cancer,reflecting both Chinese characteristics and local experience.Building upon this,the 2025 edition of the guidelines was updated and revised based on the latest evidence and clinical practices.This article provides a systematic interpretation of the 2025 CACA guidelines,focusing on the diagnosis,treatment,and follow-up of thyroid cancer,with the aim of offering practical guidance for clinicians and promoting standardized,integrated management of thyroid cancer in clinical practice.

China's Medical Service Price(MSP)reform has entered a new phase,implementing management measures.The compilation,implementation,and coordination of MSP item guidelines and the existing contradictions and problems were reviewed.It proposes strengthening price item management in planning under the background of the new era,itemizing in the alignment particle size,and comparing prices in the same coordinate system.This can offer systematic approaches and innovative strategies for improving the quality and efficiency of deepening MSP reform.