Background: Acute ischemic stroke (AIS) is a primary cause of death and disability worldwide. Four markers that can be readily determined from peripheral blood, namely, the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total bilirubin, were measured in this study. We examined the relationship between the SII and in-hospital mortality after AIS and evaluated which of the above four indicators was most accurate for predicting in-hospital mortality after AIS.Methods: We selected patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database who were aged >18 years and who were diagnosed with AIS on admission. We collected the patients’ baseline characteristics, including various clinical and laboratory data. To investigate the relationship between the SII and in-hospital mortality in patients with AIS, we employed the generalized additive model (GAM). Differences in in-hospital mortality between the groups were summarized by the Kaplan–Meier survival analysis and the log-rank test. The receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of the four indicators (SII, NLR, PLR, and total bilirubin) for predicting in-hospital mortality in patients with AIS.Results: The study included 463 patients, and the in-hospital mortality rate was 12.31%. The GAM analysis showed a positive correlation between the SII and in-hospital mortality in patients with AIS, but the correlation was not linear. Unadjusted Cox regression identified a link between a high SII and an increased probability of in-hospital mortality. We also found that patients with an SII of >1,232 (Q2 group) had a considerably higher chance of in-hospital mortality than those with a low SII (Q1 group). The Kaplan–Meier analysis demonstrated that patients with an elevated SII had a significantly lower chance of surviving their hospital stay than those with a low SII. According to the results of the ROC curve analysis, the in-hospital mortality of patients with AIS predicted by the SII had an area under the ROC curve of 0.65, which revealed that the SII had a better discriminative ability than the NLR, PLR, and total bilirubin.Conclusion: The in-hospital mortality of patients with AIS and the SII were positively correlated, but not linearly. A high SII was associated with a worse prognosis in patients with AIS. The SII had a modest level of discrimination for forecasting in-hospital mortality. The SII was slightly better than the NLR and significantly better than the PLR and total bilirubin for predicting in-hospital mortality in patients with AIS.

Objective: This study aimed to comprehensively compare the efficacy of 12 interventions for diabetic foot ulcer (DFU) using a network meta-analysis (NMA). Methods: The NMA was conducted by PRISMA guidelines, and the protocol was registered in PROSPERO (CRD42023461811). PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched from inception to September 2023. Randomized controlled trials (RCTs) enrolling patients with DFU were included if they compared epidermal growth factor (EGF), platelet-derived growth factor (PDGF), platelet-rich plasma (PRP), stem cells (SC), low-frequency ultrasound (LFU), negative pressure wound therapy (NPWT), low-level laser therapy (LLLT), electric stimulation (ES), extracorporeal shockwave therapy (ESWT), amniotic membrane therapy (AMT), hyperbaric oxygen therapy (HBOT), and topical oxygen therapy (TOT) against standard of care (SOC) or placebo. The primary endpoint assessed was the wound healing rate. Secondary endpoints comprised wound healing time, percentage area reduction (PAR), and amputation rate. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the efficacy of interventions. Results: A total of 99 RCTs involving 7,356 patients were included. Among the 12 interventions analyzed, only LFU (OR = 2.20; 95% CI [0.99–4.91]) and ES (OR = 1.88; 95% CI [0.87–4.05]) did not demonstrate statistically significant improvements in ulcer healing rate compared with SOC. Based on SUCRA rankings, SC (SUCRA = 89.7%; OR = 5.71; 95% CI [2.64–12.34]) and AMT (SUCRA = 89.2%; OR = 5.11; 95% CI [3.12–8.37]) ranked highest in promoting ulcer healing, while LFU (29.4%) and SOC (10.4%) ranked lowest. Regarding wound healing time, AMT (MD = –26.91 days; 95% CI [−44.27 to −9.55]), PRP (MD = –21.65 days; 95% CI [−33.61 to −9.69]), and NPWT (MD = −16.79 days; 95% CI [−31.12 to −2.26]) significantly reduced healing durations compared to SOC. SUCRA rankings indicated that AMT (84.7%) and PRP (74.6%) ranked highest, while LFU (29.4%) and SOC (10.4%) remained lowest. Concerning PAR, LLLT (MD = 34.27; 95% CI [17.35–51.20]) and ESWT (MD = 27.50; 95% CI [11.00–44.00]) showed significant improvements over SOC, with LLLT (SUCRA = 93.9%) and ESWT (SUCRA = 84.0%) ranking highest, while SOC (21.0%) and TOT (18.3%) ranked lowest. For amputation rate, SC (OR = 0.12; 95% CI [0.03–0.55]) and HBOT (OR = 0.35; 95% CI [0.16–0.78]) significantly lowered the risk compared to SOC, with SUCRA rankings placing SC (79.9%) and PRP (73.2%) as most effective, while NPWT (26.4%) and SOC (9.9%) were least effective. Conclusions: SC and AMT emerged as highly effective, demonstrating superior efficacy in improving healing rate compared to PDGF, ES, and HBOT. AMT also showed significant effects in shortening ulcer healing time. LLLT exhibited considerable effectiveness in reducing ulcer areas, and SC therapy was associated with reduced amputation rate.

Alzheimer’s disease (AD) is the most common neurodegenerative disease in the central nervous system, characterized by memory and cognitive dysfunction. Acupuncture is an effective means to alleviate the symptoms of AD. Recent studies have shown that microglia play an important role in the occurrence and development of AD. Acupuncture can regulate the activity of microglia, inhibit neuroinflammation, regulate phagocytosis, and clear Aβ Pathological products such as plaque can protect nerve cells and improve cognitive function in AD patients. This article summarizes the relationship between microglia and AD, as well as the research progress in the mechanism of acupuncture regulating microglia in the treatment of AD. The mechanism of acupuncture regulating microglia in the treatment of AD is mainly reviewed from two aspects: inhibiting neuroinflammatory activity and regulating phagocytic function.

Background: The poor prognosis of diabetic foot ulcers (DFUs) often leads to amputation and high mortality rates, becoming a heavy economic burden on the healthcare system. Several clinical studies have been conducted to investigate the risk factors for DFU mortality and to provide clinical guidance for better prevention and control of DFU mortality.Methods: We used R to organize the mortality data of patients with DFU, collected from the NHANES database during the 1994-2004 period, along with three kidney function indicators including Albumin-to-Creatinine Ratio (ACR), estimated Glomerular Filtration Rate (eGFR) and cystatin C, used to assess chronic kidney disease (CKD). We explored the relationship between CKD and the risk of death in DFU patients through multiple kidney function indicators. Baseline characteristics of the surviving group and the mortality group of patients with DFU were analyzed using the ‘svyby’ function in the ‘survey’ package. We used Kaplan-Meier curves, multivariable logistic regression models, Cox proportional risk regression models, and time-dependent ROC curves to analyze the relationship between CKD and the risk of death in patients with DFU.Results: This study included a total of 112 patients with DFU. The overall sample had an average age of 65 years, with 43 females (38.39%) and 69 males (61.61%). During the follow-up time, 29 survived and 89 died. All-cause mortality in DFU patients was analyzed based on clinical classifications of ACR, eGFR, and cystatin C, with Kaplan-Meier curves illustrating survival variability. Multivariable logistic regression analysis showed no significant correlation between the risk of death in patients with DFU and CKD. However, analysis of Cox proportional risk regression model that accounted for time effects found a significant association between all-cause mortality and cystatin C levels in patients with DFU. Time-dependent ROC curve analysis demonstrated that cystatin C had superior diagnostic accuracy and stability for predicting all-cause mortality in DFU patients.Conclusions: In this study, we found that cystatin C demonstrated greater stability and accuracy in assessing the risk of death and predicting mortality in patients with DFU.

The hypoxic tumor microenvironment and dense extracellular matrix (ECM) are key factors limiting the effectiveness of cancer treatments. Hyperbaric oxygen therapy (HBOT) effectively alleviates hypoxia by increasing the oxygen partial pressure (pO₂) in tumor tissues, enhancing the sensitivity of chemotherapy, radiotherapy, and immunotherapy. In recent years, the rapid development of biomedical engineering technologies such as nanodrug delivery, engineered bacteria, and immunocellular therapy has provided new strategies to address issues like poor drug penetration and immunosuppressive microenvironments. Studies have shown that the combined application of HBOT and biomedical engineering technologies can synergize: on one hand, HBOT induces reactive oxygen species (ROS) generation and regulates matrix metalloproteinase (MMPs) expression, degrading collagen and fibronectin in the ECM, reducing tumor stiffness, increasing nanodrug penetration depth by 1.8 times and immune cell infiltration rate by 2.3 times. On the other hand, biomedical engineering technologies target delivery of chemotherapy drugs (such as temozolomide/porous silicon nanoparticles), photosensitizers, or gene editing tools (such as CRISPR-Cas9) in conjunction with the improved oxygenation microenvironment by HBOT, significantly enhancing the anti-tumor effects. This article provides a systematic review of the mechanisms, clinical translation outcomes, and safety issues of HBOT combined with biomedical engineering technologies, and highlights the future focus on optimizing individualized treatment plans, long-term efficacy evaluation, and molecular mechanism analysis to promote the clinical application of this interdisciplinary treatment model.

Hyperbaric oxygen therapy (HBOT) refers to an intervention in which patients inhale near-100% oxygen at pressures exceeding 1 atmosphere absolute to increase plasma and tissue oxygen partial pressure. HBOT has been applied clinically across a broad range of conditions, including infections, inflammation, hypoxia-related injury, and malignancies. However, its immunological effects are often reduced to a binary notion of “immune enhancement” or “immunosuppression”. Moreover, substantial heterogeneity in treatment parameters and immune endpoints across studies has limited the development of a unified interpretive framework centered on peripheral immune tolerance (PIT). Following the PRISMA 2020 reporting framework, we standardized the presentation of the search and selection process. PubMed, Embase, Web of Science, the Cochrane Library, and Scopus were searched from database inception to November 15, 2025. Two reviewers independently performed study screening and data extraction. Ultimately, 39 relevant articles were included, and a mechanism-oriented qualitative narrative synthesis was conducted along the axes of oxygen tension, immunometabolism, and PIT. Across the included studies, in models of autoimmune and chronic inflammatory disease, HBOT was commonly associated with expansion of regulatory T cells and suppression of T helper 17–related inflammatory pathways, accompanied by a homeostatic recalibration of peripheral tolerance thresholds and improved tissue inflammatory outcomes. Under infectious and hyperinflammatory conditions, pro-inflammatory transcriptional signatures and cytokine responses were attenuated, markers of oxidative damage were reduced, while neutrophil directional bactericidal capacity was enhanced, suggesting synergy with certain antimicrobial therapies. In hypoxic tumor microenvironments, antigen presentation was improved, cytotoxic T-cell infiltration increased, and immunosuppressive myeloid components decreased, collectively indicating potential additive or synergistic benefits with immunotherapy. In summary, we propose an integrated framework in which upstream oxygen tension sensing drives intermediate immunometabolic remodeling, culminating in downstream reprogramming of immune cell lineages and functional states. This framework provides a testable theoretical basis for explaining the context-dependent immunological effects of HBOT across diseases and for guiding prospective study designs incorporating composite immune endpoints and therapeutic windows.