ObjectiveTo compare the clinical efficacy of traditional Chinese medicine （TCM） manipulative reduction combined with small splint fixation versus surgical treatment for type A distal radius fracture （DRF） and to explore the factors influencing the choice of treatment. MethodsA multi-center retrospective study was conducted， collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September， 2023 to April， 2025. Among them， 851 patients in the TCM group received manipulative reduction combined with small splint fixation， and 386 patients in the surgical group underwent open reduction and internal fixation. Visual analog scale （VAS） scores for pain and radiographic indicators including palmar tilt， ulnar deviation， and radial height were compared before treatment， 5-7 days after treatment， and 4-6 weeks after treatment. The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded. Subgroup analysis was conducted for the excellent rate of Dienst and Gartland-Werley scores， stratified by age （＜50， 50-59， 60-69， ≥70 years old） and AO subtypes （A1， A2， A3）. A multivariate logistic regression model was used to identify independent factors influencing treatment choice. ResultsOn 5-7 days after treatment， the surgical group had lower VAS scores than the TCM group， while 4-6 weeks after treatment， the TCM group showed lower VAS scores than the surgical group （P＜0.01）. In terms of radiographic indicators， except for the palmar tilt before treatment being higher in the surgical group than in the TCM group （P＜0.01）， there were no significant differences in palmar tilt， ulnar deviation， and radial height at other timepoints （P＞0.05）. Twelve weeks after treatment， the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group （P＜0.01）. Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old， the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group （P＜0.05）. Multivariate logistic regression analysis revealed that age， palmar tilt， ulnar deviation， and the degree of swelling on the affected side were independent factors influencing the choice of treatment （P＜0.05）. ConclusionBoth TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects. TCM manipulative reduction combined with small splint fixation has certain advantages in medium- and long-term pain relief， especially in elderly patients， where wrist joint function recovery is more stable. Age， palmar tilt， ulnar deviation， and swelling degree are the main factors influencing the treatment choice.

To evaluate the application value of the Peyton four-step teaching method in the standardized training of intestinal ultrasound and compare it with traditional teaching methods, so as to provide an optimized approach for clinical ultrasound training.

ObjectiveTo investigate the migration and distribution characteristics of chemical constituents in blood and hippocampal tissues before and after vinegar processing of Citri Reticulatae Pericarpium Viride（CRPV）， and to explore the potential material basis and mechanisms underlying their regulatory effects on emotional disorders by comparing the effects of raw and vinegar-processed products of CRPV. MethodsUltra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） was employed to characterize and identify the chemical constituents of raw and vinegar-processed products of CRPV extracts， as well as their migrating components in blood and hippocampal tissues after oral administration. Reference standards， databases， and relevant literature were utilized for compound annotation， with data processing performed using PeakView 1.2 software. Seventy male C57BL/6 mice were randomly divided into seven groups， including the blank group， model group， diazepam group（2.5 mg·kg^-1）， raw CRPV low/high dose groups（0.6， 1.2 g·kg^-1）， and vinegar-processed CRPV low/high dose groups（0.6， 1.2 g·kg^-1）， with 10 mice per group. Except for the blank group， all other groups underwent chronic restraint stress（2 h·d^-1） for 20 d. Each drug-treated group received oral administration at the predetermined dose starting 10 d after modeling， with a total treatment duration of 10 d. Following model-based drug administration， mice underwent open-field， forced swimming， and elevated plus maze tests. After anesthesia with isoflurane， whole brains were collected from each group of mice， and hippocampi were dissected. Reactive oxygen species（ROS） level in hippocampal tissues was quantified by enzyme-linked immunosorbent assay（ELISA）. Hematoxylin-eosin（HE） staining was used to observe hippocampal tissue morphology. Immunofluorescence was performed to detect neuronal nuclei（NeuN） and peroxisome proliferator-activated receptor alpha（PPARα） expressions in hippocampal tissue. Then， pharmacodynamic evaluations were conducted to assess the effects of raw and vinegar-processed CRPV on mood disorders， exploring the potential mechanisms. ResultsVinegar processing caused significant changes in the chemical composition of CRPV， with 18 components showing increased relative content and 35 components showing decreased relative content. The primary changes occurred in flavonoid compounds， including 20 flavonoids， 20 flavonoid glycosides， 3 triterpenes， 3 phenolic acids， 1 alkaloid， and 6 other compounds. Twenty-one components were detected in blood（15 methoxyflavones， 4 flavonoid glycosides， and 2 phenolic acids）， with 17 shared between raw and vinegar-processed CRPV. Seven components reached hippocampal tissues（all common to both forms）. In regulating emotional disorders， Vinegar-processed CRPV exhibited superior antidepressant-like effects compared to raw products. HE staining revealed that both treatments improved hippocampal neuronal morphology， particularly in the damaged CA1 and CA3 regions. Immunofluorescence and ELISA analyses demonstrated that both raw and vinegar-processed CRPV significantly modulated NeuN and PPARα expressions in hippocampal tissue while alleviating oxidative stress induced by excessive ROS（P<0.05）. ConclusionThe chemical composition of CRPV undergoes changes after vinegar processing， but the migrating components in blood and hippocampus are primarily methoxyflavonoids. These components may serve as the potential material basis for activating the PPARα pathway， thereby negatively regulating ROS generation in the hippocampus， reducing oxidative stress， and promoting the development of NeuN-positive neurons. These findings provide experimental evidence for enhancing quality standards， pharmacodynamic material research， and active drug development of raw and vinegar-processed CRPV.

To develop and validate a model for predicting intensive care unit (ICU) mortality risk in patients with malignant tumors complicated by acute respiratory failure (ARF) based on an explainable machine learning framework.

ObjectiveTo investigate the effects of Maimendong Yinzi （MMDYZ） on cough with Yin deficiency and lung heat syndrome and explore its potential mechanism of action. MethodsForty-eight Institute of Cancer Research （ICR） mice were randomly divided into a control group， a model group， a Baihe Gujin Tablet （BHGJP） group （1.36 g·kg^-1）， and low-dose， medium-dose， and high-dose MMDYZ groups （5， 10， 20 g·kg^-1·d^-1， based on the weight of crude drug）， with eight mice in each group. The mouse model of cough with Yin deficiency and lung heat syndrome was prepared by a combination of smoke exposure， nasal drip of lipopolysaccharide （LPS）， intragastric gavage with thyroxine， and capsaicin atomization. After successful modeling， drug interventions were administered for seven days. During modeling， the mice were observed for changes in general status， anal temperature， fecal water content， and water intake. After medication， the above indicators were evaluated again， along with assessments of spontaneous activity， cough sensitivity， lung function， lung index， and tracheal phenol red secretion. Bronchoalveolar lavage fluid （BALF） was analyzed for cell differential counts， and the level of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， tumor necrosis factor-α （TNF-α）， and interleukin-6 （IL-6） in serum was measured via enzyme linked immunosorbent assay （ELISA）. Lung injury was assessed via hematoxylin-eosin （HE） staining. Network pharmacology was employed to predict the potential mechanism of MMDYZ in alleviation cough with Yin deficiency and lung heat syndrome. Western blot （WB） was used to measure protease-activated receptor1 （PAR1） and GTPhase α_i subunit （Gα_i） protein expressions in lung tissue. ELISA was used to determine lung cAMP content， and immunohistochemistry （IHC） was employed to evaluate transient receptor potential vanilloid subtype 1 （TRPV1） expression. ResultsCompared with the control group， the model group exhibited significantly increased water intake and anal temperature and significantly decreased fecal water content （P<0.05）. The total distance traveled in 5 min and the central zone duration were reduced， while standing frequency significantly increased （P<0.05）. Cough sensitivity and enhanced pause （PenH） were elevated. Peak expiratory flow （PEF） significantly declined （P<0.05）. BALF neutrophil （NEU） and white blood cell （WBC） counts rose. Serum cAMP and cAMP/cGMP ratio significantly increased， and cGMP significantly decreased （P<0.05）. Serum TNF-α and IL-6 levels were significantly elevated （P<0.05）. The lung injury was obvious， and the lung index was significantly elevated （P<0.05）. Compared with the model group， the medium-dose and high-dose MMDYZ groups and the BHGJP group showed significantly improved indicators mentioned above. Additionally， network pharmacology suggested that MMDYZ might alleviate cough with Yin deficiency and lung heat syndrome via cAMP， hypoxia inducible factor-1 （HIF-1）， and TNF signaling pathways. WB， ELISA， and IHC revealed that， compared with the control group， the model group exhibited significantly upregulated PAR1， Gα_i， and TRPV1 expressions and significantly downregulated cAMP in lung tissue （P<0.05）. Compared with the model group， MMDYZ reduced PAR1 （P<0.01）， Gα_i （P<0.05）， and TRPV1 （P<0.01） while increasing cAMP level （P<0.01）. ConclusionMMDYZ may alleviate cough with Yin deficiency and lung heat syndrome by modulating the PAR1/Gα_i/cAMP pathway and TRPV1 expression.

To investigate the effectiveness of a teaching model combining real-case bedside instruction with mixed-level group teaching in intestinal ultrasound training, and to provide reference forestablishing an efficient and practical training system for intestinal ultrasound.

Objective To explore a Bayesian logistic regression model for step－in dosing regimens(eBLRM),which considers the cumulative toxicity probability across different dosing cycles to identify the maximum tolerated schedule(MTS).Methods The Bayesian logistic regression model(BLRM)was extended to obtain a posterior estimate for the cumulative toxicity probability of the last cycle based on accumulated patient data,enabling exploration of dose sequences.Results The performance of eBLRM was evaluated by comparison with the existing methods.Simulation results indicated that eBLRM performed better or equivalent in the proportion of the correct selection of MTS and patients assigned to real MTS under low－toxicity scenarios.In the case of high－toxicity scenarios,eBLRM had a higher proportion of early trial termination due to safety,resulting in slightly inferior performance compared to the existing method.Conclusion The eBLRM method demonstrates relatively good performance,providing a simple and comprehensible dose exploration approach for step－in dosing regimens.

Objective:To study the morphological characteristics and ethnic differences of the chin soft and hard tissue of Han and Uyghur adult females of class Ⅱ 1.Methods:90 Uyghur and Han female subjects of class Ⅱ 1 aged 18-35 years old were enrolled and respectively divided into 3 groups according to the vertical skeletal types:high,average and low angle groups(n=30).The various indexes of the chin soft and hard tissue of the subjects were measured by X-ray lateral cephalic radiographs.The data were statisti-caly analyzed.Results:(1)The Po-Pos of the Han subjects with high angle was higher than that of those with low and average an-gle;the minimum chin thickness,the ratio of the chin thickness to the chin height,the ratio of the minimum chin thickness to the chin thickness and the angle of chin in the high angle group were smaller than those in the average angle group and the low angle group(P＜0.05).The chin height,the chin depression and the cervical-mandibular angle of the Uyghur subjects with high angle were higher than those of the Uyghur subjects with low angle and average angle;the minimum chin thickness,the ratio of the chin thickness to the chin height and the ratio of the minimum chin thickness to the chin thickness in the high angle group were smaller than those in the average and the low angle groups(P＜0.05).(2)In the low angle group,there were significant differences in the angle of chin,cervical-mandibular angle,soft tissue chin angle and Me-Mes between the 2 ethnic groups(P＜0.05).In the average angle group,there were significant differences in the height of chin,LI-LL and Me-Mes between the 2 ethnic groups(P＜0.05).In the high angle group,there were significant differences in the ratio of anterior to posterior chin thickness,in the angle of chin,LL-Pos and Po-Pos between the 2 ethnic groups(P＜0.05).(3)The positive correlation between FH/MP and Po-Pos,cervical-mandib-ular angle,chin depression,chin lip angle,chin height,ratio of anterior and posterior chin thickness and LL-Pos were found in Han and Uyghur subjects(P＜0.05).Mentolabial sulcus,the chin thickness,the ratio of the chin thickness to the chin height,the angle of chin and the ratio of the minimum chin thickness to the chin thickness were negatively correlated with FH/MP in both ethnic groups(P＜0.05).Conclusion:Han and Uy-ghur adult females of class Ⅱ 1 have different chin soft and hard tissue morphology in different vertical skeletal types with certain differences between the ethnic groups in the same vertical skeletal types,and there is a correlation between the chin soft and hard tis-sue morphology of different vertical skeletal types and the vertical skeletal types in Han and Uyghur adult females of class Ⅱ 1.

Objective To investigate the therapeutic effect and mechanism of MCC950 on benzalkonium chloride-in-duced dry eye(DED)in rats.Methods Among 60 male SD rats,50 rats were treated with 20 g·L-1 benzalkonium chlo-ride solution 3 times a day in both eyes to induce DED model,and a significant decrease in tear secretion was regarded as a successful modeling,and the remaining 10 rats were regarded as the control group.DED rats were randomly divided into 5 groups:DED,DED+10MCC950,DED+50MCC950,DED+100MCC950,and DED+500MCC950 groups,and were given 0.2 mL of 0,10,50,100,and 500 μmol·L-1 MCC950 in both eyes for two weeks,and then examined the amount of tear secretion,corneal histopathology(HE staining),reactive oxygen species(ROS),and inflammation factors(NLRP3,Caspase-1,IL-1β,IL-6).Results The tear secretion of rats in the DED group was significantly lower than that of the control group(P＜0.05).Except for the DED+10MCC950 group,the tear secretion of rats in different concentrations of MCC950 treatment groups was increased and positively correlated with the MCC950 dose(all P＜0.05).HE staining of the cornea showed that compared with the control group,the cornea of the DED group was significantly thinner,the arrange-ment of surface cells was disorganized,the number of cells was significantly reduced,and a large number of"vacuole"-like structures appeared;the corneal stroma was disorganized and sparsely structured.The degree of histopathological changes in the cornea of rats treated with different concentrations of MCC950 decreased with the increase of the concentration of MCC950.Compared with the control group,the relative expression level of ROS in the DED group of rats was significantly increased(P＜0.05).In each MCC950 treatment group,as the concentration of MCC950 increased,the relative expression level of corneal ROS staining in rats gradually decreased,showing a concentration-dependent effect(all P＜0.05).Com-pared with the control group,the levels of NLRP3,IL-1 β,Caspase-1 and IL-6 were significantly increased in the DED group(all P＜0.05).The levels of various inflammatory factors were dose-dependently reduced in the MCC950 treatment groups(all P＜0.05).Conclusion MCC950 can reduce oxidative stress and inflammation and improve the symptoms of benza-lkonium chloride-induced DED in rats by inhibiting the activation of NLRP3 inflammatory vesicles.

Non-small cell lung cancer(NSCLC)is one of the most common and deadly malignant tumors worldwide,with surgical resection being the primary treatment for early-stage NSCLC.Tumor spread through air spaces(STAS)is a novel pattern of tumor dissemination into the air spaces in the lung.Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis,making its con-sideration a vital factor in surgical strategy selection and prognostic evaluation.Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients,with molecular mechanisms involving tumor microenvironment remodeling,specific genetic mutations,and epithelial-mesenchymal transition(EMT).Imaging techniques including computed tomography(CT)and positron emission tomography/CT have shown potential for preoperative STAS prediction,although their accuracy and practicality require improvement.This paper reviews the definition,pathological characteristics,and related mechanisms of STAS,with a focus on surgical ap-proach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC.Future research directions include optimization of preoperative diagnostic methods for STAS,exploration of molecular targeted therapies,and development of imaging-based precision prediction models.