Bladder cancer, particularly in older adults, poses significant therapeutic challenges due to its high recurrence rates, metastatic potential, and the toxicity associated with standard treatments. This case report describes a 75-year-old male with advanced muscle-invasive urothelial carcinoma of the bladder, exhibiting metastases to the prostate and lymph nodes. Following intolerance to conventional palliative chemotherapy, the patient underwent a structured integrative oncology protocol (systemic cancer therapies combined with adjuvant complementary therapies) that combined metabolic therapies, oncothermia, high-dose intravenous vitamin C, targeted nutraceutical supplementation, acupuncture, laser therapy, diet therapy, and yoga-based interventions. After initial metabolic optimization, an oral chemotherapy regimen comprising Afatinib, Axitinib, Relugolix, and Abiraterone was initiated. The patient demonstrated excellent tolerance to treatment, significant symptomatic relief, normalization of cancer-related biomarkers, and marked metabolic response with stable residual metabolic activity on PET-CT within six months. Quality of life measures improved substantially, and prognostic indices, including the Chuang Survival Score, reflected enhanced survival potential. This report underscores the potential of systemic cancer therapies along with integrative oncology to improve clinical outcomes, mitigate treatment-related toxicity, and enhance quality of life in advanced bladder cancer. While the findings are encouraging, they warrant validation through larger, controlled studies to better define the role of integrative approaches within the contemporary oncology framework.
Objective: To investigate the effects and safety of harvesting superficial circumflex iliac artery pure skin perforator (PSP) flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet. Methods: This study was a retrospective case series study. From March 2022 to February 2024, 14 patients with 15 skin and soft tissue defect wounds in hands and feet who met the inclusion criteria were admitted to the Department of Wound Repair of the Second Affiliated Hospital of Wenzhou Medical University. There were 9 males and 5 females, aged 6 to 64 years. After debridement, the wound areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Before surgery, the perforators were located using high-frequency ultrasound. During surgery, 15 superficial circumflex iliac artery PSP flaps were harvested via the subdermal approach to repair the wounds. The flap harvesting time ranged from 37 to 140 minutes, and the flap areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Vascular anastomosis was performed between the donor and recipient sites. The donor site wounds were closed by direct suturing. After surgery, the survival of flaps was observed, and the occurrence of complications was recorded. At the final follow-up, the 5-point Likert scale was used to evaluate the flaps from 4 aspects: overall aesthetic appearance, contour similarity to surrounding tissue, color similarity to surrounding tissue, and texture similarity to surrounding tissue. Results: All 15 flaps survived successfully after surgery. One flap developed purple plaque, which stabilized after dressing changes. One flap developed venous crisis, which was alleviated after surgery. One patient experienced wound dehiscence in the donor site, which successfully healed after debridement and dressing changes for one week. At the final follow-up, the overall aesthetic appearance score of the flaps ranged from 3.3 to 5.0, with an average of 4.5; the contour similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.7; the color similarity to surrounding tissue ranged from 3.3 to 5.0, with an average of 4.5; the texture similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.8. Conclusions: Harvesting superficial circumflex iliac artery PSP flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet is a safe and feasible surgery as all the flaps survived after surgery, with favorable aesthetic appearance, contour, color, and texture. 目的： 探讨经真皮下入路切取旋髂浅动脉纯皮肤穿支（PSP）皮瓣修复手足部皮肤软组织缺损的效果和安全性。 方法： 该研究为回顾性病例系列研究。2022年3月—2024年2月，温州医科大学附属第二医院创面修复科收治14例符合入选标准的手足部皮肤软组织缺损患者（共15个创面），其中男9例、女5例，年龄6~64岁。清创后创面面积为5.6 cm×1.9 cm~14.0 cm×7.0 cm。术前通过高频超声定位穿支，术中经真皮下入路切取15个旋髂浅动脉PSP皮瓣修复创面，皮瓣切取时间为37~140 min，皮瓣切取面积为5.6 cm×1.9 cm~14.0 cm×7.0 cm，另进行供受区血管吻合。将皮瓣供区创面直接缝合。术后观察皮瓣成活情况。记录术后并发症发生情况。末次随访时，采用利克特5级量表，从整体美学外观、与周围组织的轮廓相似度、与周围组织的颜色相似度、与周围组织的质地相似度4个方面对皮瓣进行评价。 结果： 15个皮瓣术后均顺利成活。1个皮瓣出现紫斑，经换药后稳定。1个皮瓣发生静脉危象，经手术后恢复正常。1例患者供区缝合口裂开，经清创换药1周后顺利愈合。末次随访时，皮瓣整体美学外观评分为3.3~5.0分（平均4.5分），与周围组织的轮廓相似度评分为3.7~5.0分（平均4.7分），与周围组织的颜色相似度评分为3.3~5.0分（平均4.5分），与周围组织的质地相似度评分为3.7~5.0分（平均4.8分）。 结论： 经真皮下入路切取旋髂浅动脉PSP皮瓣修复手足部皮肤软组织缺损，术后皮瓣均成活且其外观、轮廓、颜色及质地良好，是一种安全、可行的术式。.
Allergic asthma is predominantly driven by type 2 T helper (Th2)-mediated immune responses. In this study, we investigated the therapeutic potential and mechanisms of kirenol (Kr) in mice with ovalbumin (OVA)-induced asthma and T-cell models. In the asthmatic mouse model, oral administration of 3 mg/kg body weight of Kr significantly alleviated OVA-specific IgE production, airway hyperresponsiveness, and levels of Th2 cytokines (IL-4, IL-5, and IL-13) and chemokines (CCL11 and CXCL1). Additionally, Kr treatment attenuated inflammatory cell recruitment and mucus production in the lungs. A reduction in the Th2-mediated immune response was observed without inducing CD4+ T cell apoptosis in Kr-treated mice. Furthermore, the mechanism of the antiallergic effect regulated by Kr was explored in an anti-CD3/CD28-stimulated CD4+ T cell model. Kr at 40 μM suppressed T-cell proliferation by arresting cell cycle progression at the G0/G1 phase. Kr decreased the secretion of IL-2 and Th2 cytokines (IL-4, IL-5, IL-10, and IL-13), while minimally affecting a Th1 cytokine (IFN-γ). Moreover, Kr inhibited Th2 polarization by downregulating expression of the Th2 master transcription factor GATA binding protein 3 (GATA3) gene and reduced T-cell activation markers (CD25, CD71, and CD134). A transcriptomic analysis revealed that Kr influenced the expression of immune-related genes that regulate cell activation, cytokine secretion, cell migration, and inflammatory responses in T cells. However, Kr had no significant immunomodulatory effect on OVA (100 μg/mL)-stimulated bone marrow-derived dendritic cells. These findings suggest that Kr effectively regulates CD4+ T cell proliferation, activation, and differentiation, highlighting its potential as a treatment for allergic asthma.
Diabetic foot ulcer (DFU) is a common and serious chronic complication in patients with diabetes, characterized by high recurrence rates, risks of disability and mortality, which imposes a heavy burden on individual health and the social healthcare system. Mitochondrial dynamics refer to the dynamic balance between mitochondrial fission and fusion that maintains cellular energy metabolism and homeostasis. However, in the pathological environment of diabetes, hyperglycemia and oxidative stress disrupt this balance, leading to mitochondrial dysfunction and further exacerbating the inflammatory response and tissue damage in DFU. In recent years, intervention strategies targeting mitochondrial dynamics have been considered a potential therapeutic approach to alleviate DFU symptoms and promote wound healing. Based on the latest domestic and international research, this article reviews the progress of research on mitochondrial dynamics in DFU, with a focus on exploring its core mechanisms and regulatory factors in the pathological process of DFU, and summarizes the current main intervention strategies. Through systematic analysis, this article aims to deepen the understanding of the mechanisms underlying mitochondrial dynamics in DFU and to provide new ideas for targeted therapy in clinical practice. 糖尿病足溃疡（DFU）是糖尿病患者常见且严重的慢性并发症，具有高复发率、致残和致死风险，给个人健康与社会医疗系统带来沉重负担。线粒体动力学指线粒体通过分裂与融合的动态平衡维持细胞的能量代谢和稳态，而在糖尿病病理环境中，高血糖和氧化应激会破坏这一平衡，导致线粒体功能紊乱，进一步加剧DFU的炎症反应和组织损伤。近年来，靶向线粒体动力学的干预策略被认为是改善DFU症状、促进创面愈合的潜在治疗手段。该文基于国内外最新研究，综述DFU中线粒体动力学的研究进展，重点探讨其在DFU病理过程中的核心作用机制及调控因素，并总结当前主要的干预策略。通过系统分析，该文旨在加深对DFU相关线粒体动力学机制的理解，为临床提供新的靶向治疗思路。.
Objective:This study aimed to evaluate the diagnostic efficacy, clinical feasibility, and performance of PCR-coupled Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry（PCR-MALDI-TOF MS） in screening 20 common mutations across four deafness-associated genes in patients with non-syndromic hearing loss（NSHL）. Furthermore, it investigated the correlation between specific gene mutation types and the severity of hearing loss（genotype-phenotype correlation） was investigated. Methods:A total of 298 patients with NSHL（141 males and 157 females; age range: 3 months to 72 years） presenting to the Department of Otolaryngology Head and Neck Surgery at Xiangya Hospital, Central South University, between July, 2022, and July, 2024, were enrolled. The PCR-MALDI-TOF MS assay was employed to detect 20 hotspot mutations in four major deafness genes（GJB2 , SLC26A4 , GJB3 , and mtDNA 12S rRNA）. Sanger sequencing was used as the "gold standard" for bidirectional validation of all samples to assess performance metrics, including sensitivity, specificity, overall concordance rate, and the Kappa coefficient. Additionally, the audiometric phenotypes of patients carrying different pathogenic mutations were statistically analyzed. Results:Among the 298 subjects, pathogenic mutations were identified in 84 cases by PCR-MALDI-TOF MS, yielding a total detection rate of 28.19%. The mutation spectrum included 13 cases with homozygous variants, 42 with heterozygous variants, 16 with compound heterozygous variants, and 13 with homoplasmic mitochondrial DNA variants. The assay showed complete concordance with Sanger sequencing, with overall sensitivity, specificity, and concordance all reaching 100%. Among the 84 positive carriers, the distribution of hearing loss severity was as follows: mild（n=11）, moderate（n=20）, moderately severe（n=15）, severe（n=13）, and profound（n=25）. Notably, patients with profound hearing loss predominantly carried SLC26A4 mutations（13/25） and GJB2 mutations（8/25）, while those with severe hearing loss were primarily associated with SLC26A4 mutations（7/13）. Conclusion:The PCR-MALDI-TOF MS technology demonstrates high accuracy, sensitivity, and specificity, making it an ideal tool for rapid first-line screening of common deafness gene hotspots in the Chinese population. This study reveals a significant association between GJB2 truncating mutations and SLC26A4 splice site mutations with severe-to-profound hearing loss phenotypes. These findings suggest that early genetic diagnosis is crucial for predicting auditory prognosis and guiding timely clinical intervention for patients with these specific genotypes. 目的：本研究旨在评估PCR-飞行时间质谱法检测非综合征型耳聋患者4个常见耳聋基因20种突变位点的可行性及临床效能，并探讨不同突变基因与听力损失程度之间的关系。 方法：选取2022年7月至2024年7月在中南大学湘雅医院耳鼻咽喉头颈外科就诊的298例非综合征型耳聋患者（男141例，女157例，年龄3个月～72岁）作为研究对象。采用PCR-飞行时间质谱法对4个耳聋基因的20种突变位点进行检测，并以Sanger测序法对所有样本进行双向验证，评估PCR-飞行时间质谱法的灵敏度、特异性、总符合率及Kappa值等检测性能指标。本研究进一步统计了携带不同基因突变患者的听力损失情况。 结果：在298例研究对象中，PCR-飞行时间质谱法共检出携带耳聋基因突变者84例，总检出率为28.19%。其中13例为纯合突变型，42例为杂合突变型，16例为复合杂合突变型，13例为线粒体基因均质性突变型，该方法与Sanger测序完全一致，总体灵敏度、特异性及总符合率均达到100%。在84例阳性携带者中，听力损失程度分布为：轻度11例，中度20例，中重度15例，重度13例，极重度25例。其中，极重度听力损失患者主要携带SLC26A4基因突变（13/25）和GJB2基因突变（8/25）；重度听力损失患者主要分布在SLC26A4基因突变（7/13）。 结论：PCR-飞行时间质谱法在非综合征型耳聋基因突变检测中表现出准确、灵敏和特异的优势，适于中国人群常见耳聋基因热点突变的一线快速筛查。本研究发现GJB2截短型突变及SLC26A4剪接位点突变与重度及极重度听力损失表型密切相关，提示临床对于此类基因型患者应关注其听力预后并及早干预。.
Objective:Use Multimodal Magnetic Resonance Imaging（MM-MRI） to analyze the correlation between olfactory dysfunction（OD） in patients with Chronic Rhinosinusitis（CRS） and the changes in nasal cavity structure. Methods: A retrospective analysis was conducted on 67 patients with chronic rhinosinusitis （CRS） treated at our hospital between January 2022 and December 2024 Based on olfactory function assessment, patients were divided into the observation group（with olfactory dysfunction, n=51） and the control group（without olfactory dysfunction, n=16）. The scores of the Chinese Sniff Identification Test（CSIT）, the width of the olfactory cleft（a nasal cavity structure） and the volume of the olfactory bulb（an olfactory nerve-related structure） were compared between the two groups, Additionally, correlations between these parameters and olfactory dysfunction were analyzed. Results:The CSIT scores of the patients in the observation group were significantly lower than those in the control group. Compared to the control group, the observation group exhibited reduced olfactory cleft width and smaller olfactory bulb volume （P<0.05）. Pearson analysis revealed a certain association between olfactory function and both olfactory cleft width and olfactory bulb volume. Conclusion:Olfactory dysfunction in CRS patients is significantly correlated with olfactory cleft width and olfactory bulb volume. Olfactory cleft width and olfactory bulb volume can serve as potential indicators for evaluating the degree of OD in CRS patients, but their causal relationship with OD requires further research and verification. 目的：利用多模态磁共振成像（multimodal magnetic resonance imaging，MM-MRI），探讨慢性鼻窦炎（chronic rhinosinusitis，CRS）患者嗅觉功能障碍（olfactory dysfunction，OD）与鼻腔结构改变之间的相关性。 方法：回顾性选取2022年1月至2024年12月南京同仁医院耳鼻喉科收治的CRS患者67例。根据嗅觉功能评估结果，将患者分为观察组（伴有OD组51例）与对照组（无OD组16例）。比较2组患者中国人群嗅觉识别测验（chinese sniff identification test，CSIT）评分、嗅裂宽度（鼻腔结构）、嗅球体积（嗅神经相关结构），并分析各指标与OD的相关性。 结果：观察组患者的CSIT评分显著低于对照组，与对照组比较，观察组患者的嗅裂宽度、嗅球体积更小（P<0.05），经Pearson分析发现，嗅觉功能与嗅裂宽度、嗅球体积呈负相关性，嗅裂宽度越窄、嗅球体积越小，患者的OD程度越深。 结论：嗅裂宽度、嗅球体积与CRS患者OD程度呈显著相关，提示二者可作为评估CRS患者OD程度的潜在指标，但二者与OD的因果关系需进一步研究验证。.
Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcomes, but its relationship with bone health in menopause remains unclear. This study examined associations between CONUT scores and osteopenia and osteoporosis in menopausal women. Data from 1188 women aged 45-55 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed, representing 19.5 million U.S. women. Bone mineral density (BMD) at the femur sites was assessed using dual-energy X-ray absorptiometry (DEXA), and T-scores defined osteopenia and osteoporosis. CONUT scores were derived from serum albumin, total cholesterol, and lymphocyte count. Logistic regression evaluated associations between CONUT scores and bone health outcomes, adjusting for confounders. Analyses were stratified by body mass index (BMI > 25 vs. ≤ 25 kg/m2). Women with higher CONUT scores (≥2) had significantly greater odds of osteopenia (adjusted odds ratio [aOR] = 1.82; 95% CI: 1.06-3.13; P = .031). No significant association was observed between CONUT scores and osteoporosis (P = .091). In BMI-stratified analysis, the association between high CONUT scores and osteopenia was stronger among women with BMI > 25 kg/m2 (aOR = 2.66; 95% CI: 1.41-5.01; P = .003). Poor nutritional status, as reflected by higher CONUT scores, is associated with higher likelihood of osteopenia in women undergoing menopausal transition, especially those with higher BMI. Key messages What is already known on this topic: Osteopenia and osteoporosis occur commonly in women undergoing menopausal transition. Use of controlling nutritional status (CONUT) scores to assess nutritional health, has been associated with various health outcomes, but the CONUT role in bone health during menopause has not been explored. What this study adds: This study examined the association between nutritional status, as assessed by the CONUT score, and bone health in women during the menopausal transition. The results demonstrated that poorer nutritional status was significantly associated with a higher likelihood of osteopenia, particularly among individuals with higher BMI. How this study might affect research, practice, or policy: These findings suggest that attention to nutritional status may contribute to strategies aimed at preventing early bone deterioration.
Objective:To identify the independent risk factors for postoperative recurrence of congenital lingual root cysts in infants and to construct and validate a nomogram prediction model for recurrence risk. Methods:A retrospective analysis was conducted on infants with congenital lingual root cysts who underwent surgical treatment in the Department of Otorhinolaryngology Head and Neck Surgery at Hebei Children's Hospital between April 2019 and April 2023. Based on recurrence status during the 2-year follow-up period, children were divided into a recurrence group and a non-recurrence group. The total dataset was split into a training set and a validation set at a ratio of 7∶3. General characteristics between the two groups were compared. The Least Absolute Shrinkage and Selection Operator（Lasso） regression algorithm with 10-fold cross-validation was used to further screen potential predictive variables associated with postoperative recurrence. Multivariate logistic regression was employed to identify independent risk factors for postoperative recurrence, based on which a nomogram model was constructed. Subsequently, the model's discriminatory ability, calibration, and clinical applicability were validated using the receiver operating characteristic（ROC） curve, calibration curve, and decision curve analysis, respectively. Results:A total of 164 infants with congenital lingual root cysts were included. 32 cases （19.5%） experienced recurrence during the 2-year follow-up, while 132 cases did not. Lasso regression identified eight potential predictive variables, including age at surgery, cyst location, surgical approach, intraoperative bleeding, cyst length, preoperative infection, postoperative complications, and surgeon experience. Multivariate logistic regression analysis ultimately identified five independent risk factors for postoperative recurrence: age at surgery（OR=1.446, 95%CI 0.973-2.149, P=0.020）, surgical approach（OR=4.614, 95%CI 1.759-12.101, P=0.002）, cyst length（OR=3.466, 95%CI 1.191-10.087, P=0.020）, preoperative infection（OR=1.839, 95%CI 1.031-3.278, P=0.006）, and postoperative complications（OR=1.808, 95%CI 1.149-2.843, P=0.020）. The predictive performance of the nomogram model was confirmed by the area under the curve（AUC） values（0.899 and 0.882 for the training and validation sets, respectively）, indicating good discriminatory ability. The calibration curves for both cohorts showed good consistency between predicted and observed probabilities. Decision curve analysis demonstrated a positive net benefit within a threshold probability range of 10% to 80%. Conclusion:The nomogram model, constructed based on factors such as age at surgery and surgical approach, demonstrates strong predictive performance and can serve as a practical tool for assessing postoperative recurrence risk and guiding individualized clinical management in infants with congenital lingual root cysts. 目的：探讨婴幼儿先天性舌根囊肿术后复发的独立危险因素，构建复发风险列线图预测模型，并验证其预测效能。 方法：回顾性分析2019年4月至2023年4月于河北省儿童医院耳鼻咽喉头颈外科接受手术治疗的先天性舌根囊肿患儿。根据2年随访期内复发情况将患儿分为复发组和未复发组，将总数据集根据训练集：验证集=7∶3进行划分。比较2组一般资料差异，采用最小绝对收缩和选择运算符（Lasso）回归算法和10倍交叉验证，进一步筛选与舌根囊肿患儿术后复发相关的潜在预测变量。采用多因素logistic回归识别术后复发的独立危险因素，并据此构建列线图模型。随后，通过受试者工作特征（receiver operating characteristic，ROC）曲线、校准曲线及决策曲线分析，分别验证模型的区分能力、校准度与临床适用性。 结果：共纳入164例先天性舌根囊肿患儿，32例（19.5%）在2年随访时复发，132例未复发。Lasso回归共筛选出手术月龄、囊肿位置、手术方式、术中出血、囊肿长径、术前感染、术后并发症、主刀医生手术经验在内的8个潜在预测变量。多因素logistic回归分析最终确定了手术月龄（OR=1.446，95%CI 0.973~2.149，P=0.020）、手术方式（OR=4.614，95%CI 1.759~12.101，P=0.002）、囊肿长径（OR=3.466，95%CI 1.191~10.087，P=0.020）、术前感染（OR=1.839，95%CI 1.031~3.278，P=0.006）、术后并发症（OR=1.808，95%CI 1.149~2.843，P=0.020）是婴幼儿舌根囊肿术后复发的5个独立危险因素。列线图模型的预测能力经AUC得到了证实（训练集和验证集分别为0.899、0.882），提示模型区分度良好。2个队列的校准曲线均提示预测概率与实际概率一致性良好；决策曲线显示，当模型预测阈值为10%~80%时具有较高的正向净获益。 结论：基于手术月龄、手术方式等因素构建的列线图模型具有良好的预测效能，可作为先天性舌根囊肿患儿术后复发风险评估及个体化临床管理的实用工具。.
Objective:Based on the anatomical characteristics and clinical manifestations of congenital ossicular chain anomalies, this study aims to establish a selection strategy for ossiculoplasty and to evaluate surgical outcomes and prognosis, as well as to provide evidence for clinical management. Methods:A retrospective analysis was performed on the clinical data from patients with congenital ossicular chain malformation who underwent surgery at the Provincial Hospital Affiliated to Shandong First Medical University between 2019 and 2025. Patients were classified according to the Teunissen classification system. Surgical approaches, including endoscopic, microscopic, and combined endoscopic-microscopic techniques were selected based on each type, and their respective efficacy and prognosis were analyzed using a postoperative air conduction threshold of ≤25 dB HL as the criterion for therapeutic effectiveness. SPSS 26.0 was used for statistical analysis. Results:A total of 45 patients（46 ears） were included. According to Teunissen classification, patients with under Type Ⅰ（1 ear）, TypeⅡ（12 ears）, Type Ⅲ（31 ears）, and Type Ⅳ（2 ears） underwent endoscopic, microscopic, or combined surgery, respectively. The overall postoperative hearing was improved. Specifically, the air-bone gap（ABG） demonstrated a significant reduction postoperatively across all types, in Type Ⅰpatients, ABG decreased from 38 dB to 20 dB; in Type Ⅱ, from（42.67±13.56） dB to（23.41±11.95） dB; in Type Ⅲ, from（44.61±10.57） dB to（20.48±8.88） dB; and in Type Ⅳ, from（57.00±7.07） dB to（21.10±15.56） dB. The overall mean speech-frequency ABG significantly improved from（44.50±11.37） dB to（21.26±9.72） dB（t=11.343, P<0.001）. Only one patient developed mild postoperative facial nerve paralysis（House-Brackmann grade Ⅲ）. A closed-loop "diagnosis-classification-treatment" pathway was preliminarily established. Conclusion:Integrating anatomical classification with clinical presentation facilitates rational surgical planning. Flexible use of endoscopic, microscopic, or combined techniques improves surgical success and hearing outcomes and offers a systematic clinical pathway for individualized treatment of congenital ossicular chain malformation. 目的：基于先天性听骨链畸形的解剖特征与临床表现，建立听骨链手术重建方式的选择策略，评估其手术疗效及预后。 方法：回顾性分析2019年1月至2025年1月于山东第一医科大学附属省立医院接受手术的先天性听骨链畸形患者的临床资料，根据Teunissen分型进行分类，针对各分型分别采用耳内镜、显微镜、双镜联合入路的手术方式，以术后气导听阈≤25 dB HL为有效标准分析其疗效与预后。采用SPSS 26.0软件对术前术后听力结果进行统计学分析。 结果：共纳入45例患者（46耳）。按Teunissen分型，Ⅰ型（1耳）、Ⅱ型（12耳）、Ⅲ型（31耳）及Ⅳ型（2耳）患者分别接受耳内镜、显微镜或双镜联合手术。术后听力改善总体有效，各型术前-术后气骨导差值分别为：Ⅰ型患者ABG由术前38 dB显著降到20 dB；Ⅱ型由（42.67±13.56） dB显著降至（23.41±11.95） dB；Ⅲ型患者ABG由（44.61±10.57） dB显著降至（20.48±8.88） dB；Ⅳ型患者ABG由（57.00±7.07） dB显著降至（21.10±15.56） dB；患者术后言语频率平均气骨导差总体由术前（44.50±11.37） dB显著降至（21.26±9.72） dB（t=11.343，P<0.001）。1例患者术后发生面瘫（House-Brackmann Ⅲ级）。本研究初步建立了基于分型与术式选择的“诊断-分类-治疗”闭环诊疗路径。 结论：结合解剖分型与临床表现，可在术前制定合理的手术方案，术中灵活选择耳内镜、显微镜或双镜联合入路有助于提高手术成功率，改善患者听力预后，为先天性听骨链畸形的个体化治疗提供了系统性的临床路径。.
Vancomycin-resistant Enterococcus (VRE) infection poses a significant healthcare burden in intensive care units (ICUs), and is preceded by gut colonization. The gut microbiome may influence susceptibility to VRE, but its role in ICU patients remains incompletely defined. We conducted a prospective study of patients admitted to a medical ICU from 2019 to 2021. Stool samples were collected for bacterial 16 S rRNA gene sequencing, anal swabs were screened for VRE by culture, and bile acids were measured in initial stool samples. We enrolled 108 patients. Thirty-four patients were VRE + on initial screen and remained so (VRE+/+) while 74 were initially negative, of whom 23 acquired VRE (VRE-/+) and 51 remained negative (VRE-/-). There was no difference in alpha-diversity initially between VRE-/- and VRE-/+ groups, whereas VRE+/+ patients had significantly lower alpha-diversity (P < 0.001). VRE-/+ patients had a significantly more rapid decrease in alpha-diversity than VRE-/- patients (P = 0.04). Beta-diversity of initial stool differed among groups (P = 0.001), driven mainly by VRE+/+ patients. A lower Bacteroides/Enterococcus ratio (P = 0.049) and low Clostridium scindens abundance (P = 0.031) were associated with VRE acquisition. Initial stool from VRE-/- patients had a higher combined concentration of deoxycholic acid and lithocholic acid than that of VRE-/+ patients (P = 0.034). VRE acquisition in the ICU was associated with an initial gut microbiome characterized by lower Bacteroides/Enterococcus ratios, lower C. scindens abundance, and lower deoxycholic and lithocholic acid concentrations. Our findings are consistent with a possible role of these microbiome features in colonization resistance, as suggested by in vitro and animal models. However, given the single-center design, these associations should be considered hypothesis-generating and require validation before clinical application.
Objective:To evaluate the applicability of tracheostomy tube for patients with cervical or upper thoracic kyphosis, and establish a preoperative imaging evaluation system for tracheotomy in patients population. Methods:The three-dimensional（3D） geometry of the neck were reconstructed using computed tomography scans for patients with cervical or upper thoracic kyphosis. The local kyphosis angle of vertebral body, the total kyphosis angle of cervical spine, the distance between trachea and skin and the height of innominate artery were measured. 3D models of tracheostomy tubes were generated using geometric modeling software. Tracheostomy was simulated in the virtual 3D models. The distance between the tube tip and the inner tracheal wall was measured to analyze whether the tracheostomy tube was suitable for patients with cervical or upper thoracic kyphotic deformity. Results:64% of patients with cervical or upper thoracic kyphosis were not fitted with the tracheostomy tubes. The Pearson coefficient is 0.927 and R² is 0.860 between the angle of cervical kyphosis and the distance between the cannula and tracheal wall. According to the ROC curve analysis, when the angle of cervical kyphosis exceeded 33.32 degree, the tracheostomy tube became unsuitable, with both sensitivity and specificity equal to 1. Conclusion:The tracheostomy tube is not suitable for the majority of patients with cervical or upper thoracic kyphosis. This study established a preliminary preoperative imaging evaluation system for difficult tracheotomy in patients with cervical or upper thoracic kyphosis, and proposed a 33.32 ° cervical total kyphosis angle as a reference standard for tracheostomy tube adaptation during tracheotomy for patients with cervical or upper thoracic kyphosis. In addition, this study provides initial validation that three-dimensional reconstruction and preoperative planning of tracheotomy position can avoid postoperative complications caused by poor position of the tube in these patients. 目的：探讨气管切开套管对颈椎或上胸椎后凸畸形患者的适用性，并初步建立该类患者气管切开术的术前影像学评估体系。 方法：纳入2010年1月至2020年8月北京大学第三医院骨科收治的颈椎或上胸椎后凸畸形患者11例，基于其颈部CT重建颈部三维模型，测量椎体局部后凸成角、颈椎总后凸成角及气管-皮肤距离。进而重建不同型号气管切开套管的三维图像，模拟气管切开术，测量套管尖端与气管内侧壁的距离，以分析套管在该类患者中的适配性。 结果：64%的颈椎或上胸椎后凸畸形患者无法适配预制的气管切开套管。颈椎总后凸成角与套管-气管壁距离呈显著正相关（r= 0.927，R2 = 0.860）。ROC曲线分析显示，当颈椎总后凸成角 > 33.32° 时，气管切开套管无法适配，灵敏度与特异度均为 1.0。 结论：预制气管切开套管在多数颈椎或上胸椎后凸畸形患者中难以适配。本研究初步构建了此类患者困难气管切开术的术前影像评估体系，提出以颈椎总后凸成角 33.32° 作为术中气管套管无法适配的参考阈值；此外，初步证实三维重建联合术前气管切开位置规划有助于减少术后套管位置不佳相关并发症。.
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Intestinal protozoan infections remain a significant public health challenge in resource-limited Pacific Island settings, yet molecular epidemiological data for the Republic of the Marshall Islands (RMI) are scarce. We conducted a cross-sectional molecular epidemiological study of waterborne protozoan infections among 215 primary schoolchildren in Majuro Atoll, RMI. Stool samples were examined using PCR-based assays targeting Cryptosporidium spp., Entamoeba spp., and Giardia lamblia, with species identification and genotyping by PCR-RFLP, nested multiplex PCR, and assemblage-specific PCR. Risk factors were assessed by logistic regression. Molecular detection revealed high prevalences of E. histolytica (97.2%), G. lamblia (87.0%), and Cryptosporidium spp. (2.8%). E. dispar was detected in all samples (100%) and E. moshkovskii in 75.3%. Three Cryptosporidium species were identified: C. parvum (66.7%), C. bovis, and C. felis, indicating zoonotic transmission. Giardia Assemblage B predominated (53.5%). PCR demonstrated substantially higher sensitivity than conventional microscopy, detecting 13-fold more G. lamblia and 35-fold more E. histolytica infections. Risk factor analysis identified significant associations between E. histolytica infection and urban residence, and between Cryptosporidium infection and consumption of food picked from the ground (OR = 6.107; 95% CI: 1.174-31.782; p = 0.032). These findings reveal a previously underestimated burden of intestinal protozoan infections in the Marshall Islands, highlighting the need for molecular surveillance, targeted hygiene education, and improved water sanitation.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells worldwide and typically presents in childhood or early adulthood following exposure to oxidative stressors. Late-life diagnosis is uncommon and may be overlooked in patients without exposure to classic hemolytic triggers. We report the case of a 70-year-old man with intermittent, mild macrocytic anemia who was ultimately diagnosed with G6PD deficiency. This case highlights how G6PD deficiency may remain clinically silent for decades, discusses reasons for delayed diagnosis, and emphasizes the importance of considering inherited hemolytic disorders in older adults with unexplained macrocytic anemia.
Canine parvovirus type 2 (CPV-2) remains one of the most significant viral pathogens causing infectious disease in domestic dogs worldwide, particularly causing severe hemorrhagic gastroenteritis in puppies. In recent years, canine circovirus (CanineCV) has emerged as an additional enteric virus of concern, although its role in co-infection with CPV-2 remains poorly characterized in Southeast Asia. This study determines the prevalence, co-infection rate, and molecular characteristics of CPV-2 and CanineCV co-infections in domestic dogs across three major regions of Vietnam. A total of 254 rectal swab samples were collected from 2023 to 2024 from dogs exhibiting clinical signs consistent with CPV-2 infection. All samples were tested for CPV-2 and CanineCV by real-time PCR, and CPV-2-positive samples were genotyped using a SimpleProbe® assay. CPV-2-only infection resulted in a prevalence of 77.17%, while CPV-2-CanineCV co-infection had a prevalence of 22.83%. Vaccinated canines have 11.36% co-infection, while those with unknown vaccination history has 28.79% and unvaccinated has 19.23%. Genotyping results demonstrated that CPV-2c was the dominant variant, accounting for 93.31% overall and 93.1% in co-infections at a 22.78% co-infection rate, whereas CPV-2a was infrequent, at 6.69% overall and 6.9% in co-infections at a 23.53% co-infection rate, and CPV-2b was not detected. The highest co-infection rate was recorded in the Central region of Vietnam at 50%, compared with 9.38% in the North and 4.55% in the South. Seasonal analysis showed a high co-infection rate during the fall with no significant difference. Age distribution revealed that younger puppies were most affected and vulnerable to co-infection, with 37.50% in < 2 months, 24.24% in 2-3 months, 23.20% in 3-6 months, and 18.18% in 6-12 months. These findings suggest that CanineCV co-circulates extensively with CPV-2, particularly in younger dogs. The results also highlight the continued dominance of CPV-2c in Vietnam and underscore the importance of including CanineCV in diagnostic, vaccines, and epidemiological surveillance of canine enteric diseases.
Objective:To analyze the repeatability of shear wave imaging（SWE） to measure hardness of Hashimoto thyroiditis（HT） complicated with thyroid cancer（TC）, and the relationship between hardness and pathological features. Methods:This study enrolled 90 patients who underwent thyroid surgery and preoperative ultrasound examination at the Department of General Surgery, the First Affiliated Hospital of Naval Medical University between January 2023 and January 2025. Based on postoperative pathological findings, patients were divided into two groups: Hashimoto's thyroiditis with thyroid carcinoma （n=58） and Hashimoto's thyroiditis alone （n=32）. The general data and pathological characteristics of the patients were collected. The receiver operating characteristic（ROC） curve was used to evaluate the value of SWE in the differential diagnosis of HT with TC and its different pathological features. Spearman rank correlation analysis was used to analyze the correlation between lesion stiffness and pathological characteristics of HT combined with TC. The intraclass correlation coefficient（ICC） was calculated to verify the repeatability of the lesion stiffness measured by the operators and among different operators. Results:The hardness value of HT lesions was（25.79±6.14） kPa, and the hardness value of HT combined with TC was（62.34±8.71） kPa, and the difference was statistically significant（t=21.008, P<0.001）. The ROC curve showed that the SWE technique had a good diagnostic efficacy for HT combined with TC（AUC >0.80, P<0.05）. The lesion stiffness was correlated with lymph node metastasis, capsular invasion, tumor diameter and tumor stage, and the difference was statistically significant（P<0.05）, and was positively correlated with tumor diameter（r=0.628, P<0.001） and tumor stage（r=0.850, P<0.001）. The AUC of SWE in identifying tumor stage ≥Ⅱ, tumor stage Ⅳ, tumor diameter≥1 cm, lymph node metastasis and capsular invasion were 0.806（95%CI 0.746-0.839）, 0.815（95%CI 0.758-0.862） and 0.811（95%CI 0.758-0.862）, 0.742（95%CI 0.707-0.796）, 0.795（95%CI 0.724-0.878）. The intra-group ICC and intra-group ICC of lesion stiffness measured by different operators and the same operator were greater than 0.75, and the agreement was very good. Conclusion:The measurement of SWE parameters has high repeatability in the evaluation of the hardness of HT combined with TC lesions, and is closely related to some clinicopathological characteristics, which provides key references for clinical diagnosis and treatment and helps to formulate accurate diagnosis and treatment plans. 目的：分析剪切波成像（shear wave imaging，SWE）对桥本甲状腺炎（Hashimoto thyroiditis，HT）合并甲状腺癌（thyroid cancer，TC）病灶硬度测量的可重复性，以及病灶硬度与病理特征之间的关系。 方法：选择2023年1月至2025年1月期间于海军军医大学第一附属医院普外就诊手术并进行超声检查的90例甲状腺患者为研究对象，根据术后病理区分HT合并TC为研究组（58例），单纯HT为对照组（32例）。收集患者的一般资料和病理特征。运用受试者工作特征（receiver operating characteristic，ROC）曲线评估SWE在HT合并TC及其不同病理特征方面的鉴别诊断价值。通过Spearman秩相关分析法研究病灶硬度与HT合并TC病理特征间的关联性。通过计算组内相关系数（intraclass correlation coefficient，ICC）对操作者及不同操作者间所测量的病灶硬度进行可重复性验证。 结果：HT的组织硬度值为（25.79±6.14） kPa，HT合并TC的病灶硬度值为（62.34±8.71） kPa，二者差异有统计学意义（t=21.008，P<0.001）。ROC曲线显示SWE技术对HT合并TC的诊断效能较好（AUC>0.80，P<0.05）。病灶硬度与HT合并TC病理特征的包膜侵犯、淋巴结转移、肿瘤分期、肿瘤直径相关，差异均有统计学意义（P<0.05），并且与肿瘤直径（r=0.628，P<0.001）和肿瘤分期（r=0.850，P<0.001）呈正相关。SWE技术鉴别肿瘤分期≥Ⅱ期、肿瘤Ⅳ期、肿瘤直径≥1 cm、是否有淋巴结转移、是否有包膜侵犯的AUC分别为0.806（95%CI 0.746～0.839）、0.815（95%CI 0.758～0.862）、0.811（95%CI 0.749～0.861）、0.742（95%CI 0.707～0.796）、0.795（95%CI 0.724～0.878）。不同操作者及同一操作者测量病灶硬度的组内ICC和组内ICC均大于0.75，一致性非常好。 结论：SWE参数测量在HT合并TC病灶硬度评估中具有较高的可重复性，且与部分临床病理特征密切相关，为临床诊疗提供关键参考，有助于制定精准的诊疗方案。.
Banana peel (BP) is an underutilized agricultural byproduct with potential applications in aquaculture. This study aimed to examine BP as a functional dietary additive and biochar material for reducing cannibalism-related mortality, modulating neuroendocrine responses, and eliminating water pollutants in aquaculture systems. Experimental diets containing 0, 10, 30, and 50 g/kg of BP powder were fed to juvenile hybrid grouper for 8 weeks to evaluate growth, survival, cannibalism, size variation, and neuroendocrine responses. Untargeted metabolomics was performed to explore metabolic pathways associated with stress and behavior. BP was also converted into biochar, and its adsorption efficiency for malachite green (MG) and copper ions (Cu2+) in water was examined. Dietary BP powder supplementation increased survival from 41.67% to 66.67%, reduced cumulative cannibalism from 58.33% to 33.33%, and decreased size variation from 13.80% to 3.29%. However, the final weight decreased from 29.15 to 21.90 g, accompanied by lower weight gain and specific growth rate as well as a slightly higher feed conversion ratio. Physiologically, BP supplementation was associated with an increase in brain serotonin levels, rising from 1.67 ng/mL in the control group to 149.03 ng/mL in the BP50 group. Metabolomics suggested changes in amino acid-, lipid-, energy-, and neuroendocrine-related metabolic pathways. Biochar treatment reduced residual MG and Cu2+ concentrations from 200 to 76.56 and 91.39 ppm, respectively. Overall, BP can be valorized as a functional feed additive and a biochar precursor for pollutant adsorption in aquaculture.
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Dysphagia is a prevalent complication associated with a spectrum of neurological disorders and head and neck pathologies, profoundly compromising patients' quality of life. Botulinum toxin（BTX）, through its inhibition of acetylcholine release at the neuromuscular junction, precisely attenuates the tonicity of the upper esophageal sphincter（UES）, thereby emerging as a pivotal minimally invasive intervention for dysphagia. This article offers a comprehensive review of BTX applications in the management of dysphagia and related conditions, covering injection techniques, therapeutic efficacy, and safety profiles, with the aim of providing evidence-based guidance for clinical practice. 摘要: 吞咽困难是多种神经系统疾病和头颈部病变的常见并发症，严重影响患者生活质量。肉毒毒素（Botulinum toxin，BTX）通过抑制神经肌肉接头乙酰胆碱释放，精准降低食管上括约肌张力，成为微创治疗吞咽困难的重要方式。本文综述了BTX在吞咽困难中的应用，包括注射方法、疗效、安全性等，以对临床相关疾病的治疗提供借鉴。.
Objective: To investigate the current status of post-traumatic growth (PTG) among university students, and to explore its mediation pathway with post-traumatic stress symptoms (PTSS). Methods: This study was a multicenter cross-sectional survey. From December 2024 to January 2025, using convenience sampling, 718 university students aged >18 years who met the inclusion criteria and had experienced stressful life events in the past year were selected from two comprehensive universities and one medical university in Chongqing as the study participants. A self-designed demographic questionnaire was used to collect demographic information of the university students, including gender, age, grade level, and family structure, etc. The adolescent self-rating life events checklist was used to assess university students' experiences of stressful life events and whether they were affected by these events. The post-traumatic stress disorder checklist-civilian version, the Chinese-Posttraumatic Growth Inventory, the 10-item Connor-Davidson resilience scale, and the Chinese PERMA-Profiler were used to assess university students' levels of PTSS, PTG, psychological resilience, and well-being, respectively. University students were classified according to demographic information and whether they were affected by stressful life events, and their total PTG scores were compared. Analysis of the correlation among PTG, PTSS, psychological resilience, and well-being in university students was carried out. Independent influencing factors for PTG among university students were identified. A structural equation model was constructed to analyze the mediating effects of well-being and psychological resilience on the transformation between PTSS and PTG. Results: Totally 718 questionnaires were distributed, and 647 valid questionnaires were returned, with a valid response rate of 90.1%. Among the university students, there were 584 males and 63 females, aged 18 to 27 years. There were 84 first-year students, 178 second-year students, 196 third-year students, and 189 fourth-year students. Among them, 582 students were from two-parent families, and 65 students were from single-parent families. Totally 102 students were affected by stressful life events, while 545 students were not affected by stressful life events. The stressful life events experienced by university students included 27 items, such as physical trauma, acute or serious illness, interpersonal tension, and academic pressure. The total scores of PTSS, PTG, psychological resilience, and well-being among university students were 18.00 (17.00, 27.00), 64.00 (41.00, 80.00), 30.00 (21.00, 39.00), and 118.00 (90.00, 135.00), respectively. Comparisons of total PTG scores among university students showed statistically significant differences by different age, family structure, and exposure to stressful life events (with Z values of -3.426, -2.285, and -3.693, respectively, P<0.05). The total PTG score and its subdimension scores of university students were significantly positively correlated with the total psychological resilience score, the total well-being score and its subdimension scores (with r values of 0.377 to 0.653, P<0.05). Age, family structure, whether being affected by stressful life events, well-being, and psychological resilience were independent influencing factors for PTG among university students (with β values of -0.144, 0.109, -0.151, 0.181, and 0.603, respectively, P<0.05). The constructed model was a multiple mediation model. Between PTSS and PTG transformation, both the independent mediating effect of well-being and the chain-mediating effects of well-being and psychological resilience were statistically significant (with β values of -0.140 and -0.287, respectively, 95% CI of -0.224 to -0.075 and -0.381 to -0.214, respectively, P<0.05), and the chain-mediating effect of well-being and psychological resilience was significantly higher than the independent mediating effect of well-being (β=0.146, with a 95% CI of 0.027 to 0.275, P<0.05). Conclusions: PTG among university students is at a moderate level. Well-being and psychological resilience play a chain-mediating role in the transformation between PTSS and PTG among university students. 目的： 调查大学生创伤后成长（PTG）现状，探讨其与创伤后应激症状（PTSS）之间的中介路径。 方法： 该研究为多中心横断面调查。2024年12月—2025年1月，采用便利抽样法，选取重庆市2所综合大学、1所医科大学中符合入选标准的18岁以上近1年经历生活应激事件的718名在校大学生，作为研究对象。采用自编人口学问卷调查大学生性别、年龄、年级、家庭结构等人口学资料；采用青少年生活事件量表调查大学生生活应激事件经历及是否受这些事件影响；采用创伤后应激障碍自评量表平民版、中文版PTG评定量表、简版心理弹性量表及中文版PERMA幸福指数量表，分别评估大学生PTSS、PTG、心理弹性和幸福感水平。将大学生按人口学资料和是否受生活应激事件影响分类，比较其PTG总评分；分析大学生PTG、PTSS、心理弹性及幸福感之间的相关性；筛选大学生PTG的独立影响因素；通过构建结构方程模型，分析幸福感和心理弹性在PTSS与PTG转化间的中介效应。 结果： 共发放问卷718份，回收有效问卷647份，有效回收率为90.1%。大学生中，男584人、女63人，年龄18~27岁，年级为大一年级者84人、大二年级者178人、大三年级者196人、大四年级者189人，家庭结构为双亲家庭者582人、单亲家庭者65人，受生活应激事件影响者102人、未受生活应激事件影响者545人。大学生经历的生活应激事件包括躯体创伤、患急重病、人际关系紧张、学习压力大等27项。大学生PTSS、PTG、心理弹性和幸福感总评分分别为18.00（17.00，27.00）、64.00（41.00，80.00）、30.00（21.00，39.00）、118.00（90.00，135.00）分。不同年龄、家庭结构、生活应激事件影响大学生PTG总评分比较，差异均有统计学意义（Z值分别为-3.426、-2.285、-3.693，P<0.05）。大学生PTG总评分及其各维度评分与心理弹性总评分、幸福感总评分及其各维度评分均呈显著正相关（r值为0.377~0.653，P<0.05）。年龄、家庭结构、是否受应激事件影响、幸福感和心理弹性均是大学生PTG的独立影响因素（β值分别为-0.144、0.109、-0.151、0.181、0.603，P<0.05）。构建的模型为多重中介模型，在PTSS与PTG转化间，幸福感的单独中介效应及幸福感与心理弹性的链式中介效应均具有统计学意义（β值分别为-0.140、-0.287，95%CI分别为-0.224~-0.075、-0.381~-0.214，P<0.05），幸福感与心理弹性的链式中介效应显著高于幸福感的单独中介效应（β=0.146，95%CI为0.027~0.275，P<0.05）。 结论： 大学生PTG呈中等水平，幸福感和心理弹性在大学生PTSS与PTG转化间发挥链式中介作用。.