To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

This study utilized a three-dimensional finite element method to investigate the biomechanical effects of various loading modalities on the intrusion of maxillary posterior teeth using orthodontic miniscrews in a patient with high-angle Class Ⅱ skeletal pattern, aiming to provide guidance for clinical orthodontic practice.

A three-dimensional finite element model was developed for a patient with a high-angle Class Ⅱ skeletal pattern, incorporating the maxillary dentition, alveolar bone, periodontal ligament, and clinical orthodontic appliances for the maxillary posterior teeth. The following loading conditions were configured: Condition 1: One miniscrew was placed on both the buccal and palatal sides between the first and second molars. Condition 2: One miniscrew was placed on the buccal side between the first and second molars, and the left and right first molars were connected via a transpalatal arch. Condition 3: One miniscrew was placed on the buccal side between the first and second molars, the left and right first molars were connected via a transpalatal arch, and a traction hook was designed extending from the palatal bar on the palatal sides of the second molars. Condition 4: One miniscrew was placed at the midpalatal suture region corresponding to the first molars, the left and right first molars were connected via a transpalatal arch, and midpoint traction hooks were designed on both sides of the palatal bar. Condition 5: One miniscrew was placed at the midpalatal suture region corresponding to the first molars, the left and right first molars were connected via a transpalatal arch, a traction hook was designed extending from the palatal bar on the palatal sides of the second molars, and midpoint traction hooks were added on both sides of the palatal bar. The stress distribution in the periodontal ligament and the displacement trends of the posterior teeth were investigated under these conditions.

In Condition 1, the stress gradients (defined as the ratio of mean stress in the cervical region to that in the apical region) for the second premolar, first molar, and second molar were 2.10, 2.09, and 2.26, respectively, the lowest among the five conditions. This setup exhibited the most uniform stress distribution and minimized the buccopalatal and mesiodistal inclination of the posterior teeth to the greatest extent, followed by Condition 4. In Condition 3, the hook designed on the palatal side of the second molar helped restrain its buccal inclinations, whereas in Condition 5, the palatally designed hook aggravated the degree of palatal inclination.

The most ideal method for intruding the maxillary posterior teeth is to place miniscrews on both the buccal and palatal sides between the maxillary first and second molars, followed by the use of a transpalatal arch combined with miniscrews placed in the midpalatal suture. When intruding the maxillary posterior teeth using buccal miniscrews with a transpalatal arch, a hook should be designed on the palatal side of the second molar to restrain buccal inclination. However, when using a midpalatal suture miniscrew with a transpalatal arch, it is unnecessary to design an additional hook on the palatal side of the second molar.

To compare and analyze the efficacy of functional extraction and minimally invasive extraction in the removal of impacted mandibular third molars (IMTM) .

A total of 94 patients who underwent the removal of impacted IMTM in our hospital from July 2024 to June 2025 were prospectively selected and randomly divided into a control group (minimally invasive tooth extraction) and a study group (functional tooth extraction) using a random number table, with 47 cases in each group. Follow-up was conducted at 1 day, 7 days, and 3 months after the operation. The surgical conditions (operation time, operation success rate, bleeding, difficulty of operation, integrity of the extraction socket, root fracture rate, and damage to adjacent teeth), symptoms at 1 day after the operation [bleeding, swelling, pain visual analogue scale (VAS) score, numbness of the lower lip, and mouth opening], symptoms at 7 days after the operation (pain, mouth opening, swelling, numbness of the lower lip, and dry socket), and effects at 3 months after the operation (alveolar bone width and height, numbness of the lower lip, and temporomandibular joint symptoms) were compared between the two groups.

The integrity score of the extraction socket in the study group was (3.64 ± 0.28), which was significantly higher than that in the control group (2.47 ± 0.14), with a statistically significant difference (t = 25.623, P<0.001). At 1 day and 7 days postoperatively, the VAS scores in the study group were (0.83 ± 0.21) and (0.463 ± 0.010), respectively, which were lower than those in the control group (1.56 ± 0.24) and (0.527 ± 0.020), with statistically significant differences (t_{1 d} = 15.693, t_{7 d} = 19.622, P<0.001). At 3 months postoperatively, the alveolar bone height in the study group was (14.1 ± 2.3) mm, which was higher than that in the control group (12.8 ± 2.6) mm, with a statistically significant difference (t = 2.449, P = 0.016). The alveolar bone width in the study group was (6.2 ± 1.7) mm, compared with (5.6 ± 1.1) mm in the control group, and the difference was also statistically significant (t = 2.310, P = 0.023) .

When removing IMTM, functional extraction leads to higher integrity of the extraction socket compared with minimally invasive extraction. It can effectively alleviate short-term postoperative pain and discomfort, reduce the incidence of adverse reactions such as postoperative bleeding and swelling, and achieve better preservation of alveolar bone width and height three months after surgery, but it takes longer and involves more bleeding during the operation, and is more difficult to perform. Therefore, although functional tooth extraction has a long operation time and high difficulty, it offers good postoperative recovery outcomes and has certain clinical feasibility.

To investigate the relationship between oral frailty and physical frailty in elderly residents of Hanzhong communities, and to construct and validate a nomogram model that can predict the risk of physical frailty by using oral function indicators, so as to provide a practical tool for early screening in the community.

A cross-sectional study design was adopted. From August 2024 to April 2025, a total of 615 elderly individuals aged ≥60 years were recruited from 10 communities in Hanzhong, Shaanxi Province by multistage random sampling. Physical frailty was assessed by Chinese modified frailty phenotype (CMFP), and oral function was assessed by Chinese version of oral frailty index-8 (OFI-8) and its specific items. Variables were screened by LASSO regression, and then a multivariate logistic regression model and a nomogram were constructed. The discriminative ability and calibration degree of the model were evaluated by receiver operating characteristic curve area (AUC) and calibration curve.

Multivariable logistic regression analysis showed that advanced age (75-89 years: OR = 1.808, 95% CI: 1.084-3.015; ≥90 years: OR = 9.685, 95% CI: 3.320-28.251), diabetes (OR = 2.073, 95% CI: 1.187-3.619), masticatory difficulty (OR = 2.176, 95% CI: 1.226-3.861), dry mouth (OR = 1.769, 95% CI: 1.016-3.081), and denture use (OR = 1.512, 95% CI: 1.173-1.949) were independent risk factors for physical frailty, while higher body mass index (BMI) was a protective factor (18.5-24.0 kg/m²: OR = 0.249, 95% CI: 0.124-0.500; >24.0 kg/m²: OR = 0.309, 95% CI: 0.149-0.642). The nomogram model constructed based on these variables demonstrated moderate and stable predictive performance in both the training set (AUC = 0.760, 95% CI: 0.706-0.814) and the validation set (AUC = 0.746, 95% CI: 0.675-0.818). The Hosmer-Lemeshow test (P>0.05) and calibration curves indicated good model fit.

There is a significant association between oral frailty and physical frailty. The constructed nomogram integrates key predictors including advanced age, diabetes, BMI, masticatory difficulty, dry mouth, and denture use, providing an intuitive and practical tool for community healthcare workers to conduct initial screening for physical frailty risk. The findings suggest that in community-based health management for the elderly, in addition to focusing on traditional chronic diseases and nutritional indicators, attention should be paid to the assessment and intervention of masticatory function, oral wetness, and denture use, which may help in the early identification of high-risk individuals for frailty and the implementation of targeted measures.

Temporomandibular joint disorder is a chronic disease with high prevalence and difficult treatment in the oral and maxillofacial region, and its pathological mechanism is very complex. Clinically, it often directly manifests as a significant abnormality of mandibular motor function. Traditional diagnosis relies on clinical evaluation and imaging examination, which is subjective and difficult to dynamically quantify joint motor function. The analysis of mandibular movement trajectory can provide an objective and quantitative core evaluation method, which has undergone a technological evolution from mechanical tracing to digital and three-dimensional real-time tracking. This article systematically reviews the development of this technology, deeply discusses its practical application status in clinical diagnosis and efficacy evaluation of TMD, and objectively analyzes the problems faced by current research as well as future directions for breakthroughs.

To investigate the current management status of chronic kidney disease (CKD) in the Tibet region and explore the disparities in diagnosis, treatment, and education among hospitals of different levels and healthcare professionals, so as to provide a basis for formulating prevention and control strategies and standardized management for CKD in high-altitude and alpine regions.

A cross-sectional questionnaire-based survey was conducted among healthcare professionals from the Tibet region who participated in CKD standardized training for primary care physicians in September 2025. The survey covered CKD screening, current status of diagnosis, treatment and management, nursing care, and patient education, as well as the training needs of professionals. Disparities in diagnosis, treatment, and management of CKD between hospitals of different levels and between nephrology and non-nephrology staff were compared.

A total of 54 valid questionnaires were collected. The average altitude of the hospitals where the respondents worked was 3, 650 meters. Of the respondents, 79.6% were from tertiary hospitals, and 68.5% were engaged in nephrology practice. The availability of routine CKD-related tests (complete blood count, blood glucose, blood lipids, serum creatinine, and urinalysis) in hospitals of the Tibet region exceeded 90%, while the availability of the urine microalbumin-to-creatinine ratio (UACR) test was 74.1%. Tertiary hospitals demonstrated superior capability in detecting UACR (χ²=10.864, P<0.01), ferritin (χ²=6.642, P=0.01), and erythropoietin (χ²=5.130, P=0.024) compared to primary care institutions (including secondary and primary hospitals). Calcium channel blockers were the most frequently used antihypertensive agents for renal hypertension (37.4%), followed by renin-angiotensin-aldosterone system inhibitors (29.6%). Regarding anemia management, 31.5% of respondents reported difficulties in diagnosing "true" anemia in high-altitude regions. Nephrologists demonstrated more experience in using intravenous iron (χ²=4.598, P=0.032), erythropoiesis-stimulating agents (χ²=11.977, P<0.01), and hypoxia-inducible factor prolyl hydroxylase inhibitors (χ²=12.362, P<0.01) compared to non-nephrology staff. Deficiencies were observed in patient education. Only 38.9% of healthcare workers were able to provide systematic education, while 51.5% offered verbal guidance. Nursing practice was mainly constrained by a lack of skills training (37.0%) and insufficient manpower (35.2%). In terms of multidisciplinary collaboration, 66.1% of the hospitals had access to online or offline consultation channels. The training needs of healthcare professionals focused primarily on guideline interpretation (75.9%), nutritional management (72.2%), and the standardized management of CKD complications (68.5%).

In the Tibet region, primary care institutions demonstrated relatively limited detection capabilities in CKD management compared to tertiary hospitals. Furthermore, continuing education and nursing resource allocation in local healthcare facilities require further strengthening or optimization.

To investigate whether the high-glucose environment in the distal renal tubule induced by empagliflozin triggers senescence of distal tubular cells as well its potential signaling pathways.

Nine-week-old male C57BL/6 mice were selected and randomly divided into an empagliflozin group [intragastric administration of empagliflozin at 10 mg/(kg·d) and a control group (intragastric administration of an equal volume of normal saline), with six mice in each group. After 4 weeks of consecutive intervention, tissues were harvested, and blood glucose and urine glucose were measured. Immunofluorescence staining and Western blot were performed to detect the expression of senescence-related markers p16, p21, and p53 in distal renal tubules. Transcriptome sequencing was used to screen potential signaling pathways, and gene set enrichment analysis was carried out subsequently. Mouse distal renal tubular epithelial cells were divided into a control group (untreated), a mannitol group (30 mmol/L mannitol), and a high-glucose group (30 mmol/L glucose). After 24 h of incubation, cellular senescence was assessed by senescence-associated β-galactosidase staining. The mRNA expression of the senescence marker p21 and ferroptosis-related genes (Alox15, Ncoa4, Slc11a2, Gpx4) was determined by RT-qPCR. All data were analyzed using GraphPad Prism software.

Compared with the control group, urinary glucose was significantly increased in the empagliflozin group (P<0.05). Immunofluorescence and Western blot analysis showed that the expression levels of p21 and p53 were markedly upregulated in the renal distal tubules of empagliflozin-treated mice (all P<0.05). Transcriptome sequencing and gene set enrichment analysis revealed that ferroptosis-related pathways were significantly activated in the empagliflozin group (adjusted q<0.05). The expression of ferroptosis-related genes Alox15, Ncoa4, and Slc11a2 was upregulated, while Gpx4 expression was downregulated in both mouse renal tissues and cultured mouse distal renal tubular epithelial cells (all P<0.05).

Empagliflozin induced elevation of urinary glucose in mouse renal distal tubules promoted cellular senescence, which may be mediated by the activation of ferroptosis-related pathways.

To construct a diagnostic and prediction model based on machine learning for fatigue status in patients with diabetic kidney disease (DKD), so as to provide a basis for early screening and intervention.

A retrospective analysis was conducted on patients with DKD admitted to the Seventh Affiliated Hospital of Anhui University of Chinese Medicine from January 2023 to June 2025. The patients were divided into a fatigue group (score ≥ 4 points) and a non-fatigue group (score < 4 points) according to the Fatigue Severity Scale (FSS). Demographic, clinical, laboratory, and medication data of the patients were collected. Robust features were screened via LASSO regression. Repeated stratified nested cross-validation was adopted. The predictive performances of LASSO logistic regression, Random Forest (RF), and Light Gradient Boosting Machine (LightGBM) models were compared. And the clinical application value of the models was evaluated using decision curve analysis.

A total of 166 patients with DKD were enrolled, including 78 cases in the fatigue group and 88 cases in the non-fatigue group. The incidence of fatigue among the DKD patients was 46.99% (78/166). Eleven robust features were screened out via LASSO regression, namely estimated glomerular filtration rate, hemoglobin, albumin, urinary albumin/creatinine ratio, age, carbon dioxide combining power, glycated hemoglobin, diuretic use, sleep disorder, heart failure, and sodium-glucose cotransporter 2 inhibitor use. Internal validation results showed that the LightGBM model achieves the best predictive performance, with an area under the receiver operating characteristic curve of 0.836, a Brier score of 0.175, a sensitivity of 0.756, and a specificity of 0.795. The calibration curve indicated that the model had a good calibration effect. And the decision curve analysis revealed that this model yielded good clinical net benefit within the threshold range of 0.05-0.60.

The diagnostic prediction model built based on LightGBM effectively identified the fatigue status in the DKD patients, facilitating early clinical risk stratification and intervention decision-making.

To explore the correlation of serum prealbumin and albumin-globulin ratio with renal function and prognosis in patients with diabetes mellitus complicated with chronic kidney disease.

Patients with diabetes mellitus complicated with chronic kidney disease treated in our hospital from November 1, 2022 to October 31, 2024 were prospectively enrolled. All subjects were followed up for 1 year and divided into good prognosis group and poor prognosis group according to follow-up outcomes. Serum prealbumin, albumin-to-globulin ratio and renal function parameters were compared. Correlation was analyzed using Spearman software, multivariate Cox regression model was adopted to analyze prognostic influencing factors, and receiver operating characteristic curve was used to evaluate its predictive efficiency.

A total of 287 patients with diabetes mellitus complicated with chronic kidney disease were enrolled, including 208 cases in the good prognosis group and 79 cases in the poor prognosis group. The serum albumin-to-globulin ratio was negatively correlated with blood urea nitrogen, serum creatinine, and urinary albumin/creatinine ratio (P<0.05). Serum prealbumin was negatively correlated with blood urea nitrogen and serum creatinine, while positively correlated with eGFR (P<0.05). Compared with the good prognosis group, the poor prognosis group showed lower levels of serum albumin, albumin-to-globulin ratio, serum prealbumin, and eGFR, but higher levels of serum globulin, glycated hemoglobin, triglyceride, blood urea nitrogen, serum creatinine, urinary albumin, and urinary albumin/creatinine ratio (all P<0.05). Serum albumin-to-globulin ratio (HR=0.674), serum prealbumin (HR=0.982), blood urea nitrogen (HR=1.915), and eGFR (HR=0.948) were independent influencing factors for poor prognosis (P<0.05). The area under the curve for poor prognosis in single-item tests of serum albumin-to-globulin ratio, serum prealbumin, blood urea nitrogen, and eGFR was 0.799, 0.722, 0.887, and 0.632, respectively.

The serum prealbumin and albumin-to-globulin ratio in the patients with diabetes mellitus complicated with chronic kidney disease were correlated with the renal function and prognosis, possessing certain predictive value.

To explore the potential effects and mechanisms of Benincasae Exocarpium on arteriovenous fistula maturation based on network pharmacology and bioinformatics.

The AVF vascular tissue gene expression datasets GSE220796 and GSE119296 were downloaded from the Gene Expression Omnibus (GEO). The inflammation response-related gene sets were obtained from the Molecular Signatures Database (MSigDB) matched with the Gene Set Enrichment Analysis (GSEA) software, and differentially expressed inflammation-related genes (DE-IRGs) were screened. Pathway enrichment analysis was conducted via the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). A protein-protein interaction (PPI) network was constructed, and hub genes of the network were screened using seven topological algorithms built into plugins of the bioinformatics visualization software Cytoscape. Chemical constituents contained in Benincasae Exocarpium were retrieved via the High-throughput Experiment- and Reference-guided database of traditional Chinese medicine (HERB) and the Symptom Mapping database (SymMap). The SwissTargetPrediction database was adopted to predict potential target genes corresponding to the active ingredients of Benincasae Exocarpium. The target genes of active ingredients from Benincasae Exocarpium and core genes associated with AVF were screened out, and cavity-detection-guided blind docking software version 2 (CB-DOCK2) was used for molecular docking verification.

A total of 44 DE-IRGs associated with AVF maturation were identified, being mainly enriched in biological processes such as cellular response to bacterial molecules, leukocyte-cell adhesion, and cellular response to biological stimuli, as well as the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway and the tumor necrosis factor (TNF) signaling pathway. PPI network analysis identified hub genes as IL10, SELL, ICAM1, CXCL9, CD69, CCL2, LIF, CXCL8, CCRL2, and IL6, while 14 active chemical constituents of Benincasae Exocarpium were screened out. The SwissTargetPrediction tool was used to predict 448 potential target genes, and the intersection of these target genes and DE-IRGs yielded 5 shared genes as PDE4B, ICAM1, CCL2, HIF1A and NFKBIA. The molecular docking results showed that the binding energies of uralenol and licoflavonol A with HIF1A were -7.8 kcal/mol and -6.9 kcal/mol, respectively. The binding energies of ferulic acid and licoricone with PDE4B were -7.4 kcal/mol and -10.1 kcal/mol, respectively. And the binding energy of uralenin with CCL2 was -8.4 kcal/mol.

Benincasae Exocarpium may promote the maturation of AVF through pathways such as targeted regulation of inflammation genes related to AVF maturation, inhibition of inflammatory responses, and mediation of vascular remodeling.

With its unique advantages in processing massive and complex data, machine learning has opened up new avenues to break through the existing bottlenecks in the treatment and prognostic prediction of IgA nephropathy. In terms of treatment decision-making, reinforcement learning and multi-task learning are capable of simulating the long-term efficacy of different clinical intervention plans, and accurately balance the therapeutic benefits and potential risks. In terms of efficacy evaluation, supervised learning and graph neural networks can effectively screen hormone-sensitive biomarkers and explore the key molecular pathways of IgA nephropathy. In terms of prognosis prediction, deep learning survival analysis models such as ensemble learning and DeepSurv can achieve refined risk stratification for IgA nephropathy, while temporal models including Transformer can dynamically track changes in renal function. This paper reviews the latest research progress of machine learning in the precise treatment of IgA nephropathy, as well as its application status in fields such as pathological image analysis and mobile health platforms, aiming to promote the transformation of IgA nephropathy treatment from traditional empirical therapy to a data-driven precision treatment mode.

To systematically evaluate the awareness, acceptance, and clinical dissemination status of the super minimally invasive surgery (SMIS) concept among senior experts in the digestive field in China, and to provide evidence-based support for its systematic promotion.

A cross-sectional questionnaire survey was conducted from June to July 2025 using purposive sampling among senior experts in the digestive field across 31 provincial-level administrative regions in China.

The awareness rates of the core SMIS concepts (definition, goal, principle) all exceeded 98%, and over 97% of the experts endorsed its value orientation.The implementation of SMIS techniques showed significant gradient differences: the application rate of natural orifice non-full-thickness resection was the highest (87.2%), while that of puncture channel techniques was the lowest (37.3%).Significant differences were observed in theoretical exposure and implementation of complex techniques across hospitals of different levels (P<0.001), whereas awareness of the core concepts remained highly consistent across different departments and professional titles (P>0.05). Inconsistent medical insurance payment policies were identified as the primary barrier to promotion, and 88.6% of the experts called for the establishment of standardized training courses. Notably, 99.7% of the experts expressed willingness to continue advancing SMIS-related clinical work.

The SMIS concept has gained broad awareness and strong acceptance among senior experts in the digestive field. However, its clinical dissemination faces multiple challenges, including technical complexity, medical insurance policies, training systems, and multidisciplinary collaboration.A systematic promotion strategy is urgently needed to facilitate the translation of SMIS from theoretical consensus to widespread clinical practice.

Based on the Scar-ESD (Scar-endoscopic submucosal dissection) classification, this study aims to explore the safety of re-ESD for early esophageal tumors with scars and evaluate the predictive value of this classification for the operative difficulty.

A retrospective analysis was conducted on the data of patients with early esophageal tumors accompanied by scars from previous treatments who underwent re-ESD at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from February 2017 to February 2024.The safety, dissection rate, intraoperative auxiliary methods, muscular layer injury, specimen damage rate, and treatment outcomes were analyzed.

A total of 47 patients were included, with a mean age of 65.51±6.68 years and a male-to-female ratio of 2.6∶1.According to the Scar-ESD classifications, 14 cases (29.79%) were type A0 (without scars), 16 cases (34.04%) were type A1 (with scars), 11 cases (23.40%) were type A2 (with scars), and 6 cases (12.77%) were type A3 (with scars).The median operative time in the A0 group was 17.50 (15.00; 23.75) min, which was significantly shorter than that in the non-A0 group [32.00 (26.00; 45.00)min, P<0.05].The median dissection rate showed no significant difference between the A0 group and the non-A0 group (A1/A2/A3) (P>0.05).Intraoperative traction assistance was used in 14 cases (29.79%) of the non-A0 group (P<0.05), specifically in 5 cases of A1, 5 cases of A2, and 4 cases of A3.Intraoperative muscular layer injury occurred in 22 cases (46.81%), with the highest incidence in types A1 (8 cases) and A2 (8 cases), followed by A3 (5 cases) (P<0.05).Specimen damage occurred in 6 cases (12.77%), with a ratio of 1∶3∶2 in A1/A2/A3 (P=0.05).There were no intraoperative or postoperative perforations or delayed bleeding in all types.The en bloc resection rate was 100% in both the A0 and non-A0 groups.The R0 resection rate and curative resection rate were both 87.23% (41/47).

Re-ESD for early esophageal tumors with scars is safe and effective.Types A2/A3 in the Scar-ESD classification has a higher tendency of specimen damage, types A1/A2 is prone to intraoperative muscular layer injury, and non-A0 types may consider intraoperative traction assistance for dissection.The Scar-ESD classification helps predict the operative difficulty, the need for intraoperative auxiliary methods, and specimen damage risk, which provides high clinical utility.