Abstract:Objective：To evaluate the usability of a portable soft hand rehabilitation robot in clinical and home-based upper limb rehabilitation for stroke patients. Methods：Thirteen stroke patients with hemiplegia were recruited to participate in a usability evaluation of the hand rehabilitation robot. Participants first received two weeks of supervised in - hospital training to learn device operation，followed by six weeks of unsupervised home -based rehabilitation（33 minutes per session，twice daily）. After training，the system usability scale（SUS）and semi - structured interviews were used to assess usability of the robot. In addition，the Fugl -Meyer assessment upper extremity（FMA-UE），action research arm test（ARAT），and activities of daily living（ADL）scale were applied before and after the intervention，as well as during training，to assess patients’upper limb motor function and ability to perform activities of daily living. Results：The mean SUS score of the 13 participants was 85.8 ± 10.5，indicating an“Excellent”level of usability. Semi-structured interviews revealed that the device was easy to operate and portable，while highlighting areas requiring improvement，such as device connectivity，hardware stability，and training module diversity. After the intervention，several participants demonstrated improvements in FMA-UE，ARAT，and ADL scores compared with baseline，reaching the mini clinical important difference（MCID）. Conclusion：The soft hand rehabilitation robot demonstrates high usability and safety for both clinical and home - based upper limb rehabilitation in stroke survivors with hemiplegia，suggesting its potential as a promising tool for post-stroke hand rehabilitation.

Abstract:Objective：To investigate guideline adherence to preventive pharmacotherapy in patients with migraine，quantify the extent of undertreatment and potential overtreatment，and analyze the associated influencing factors. Methods：In this cross-sectional study，2 028 patients with migraine who attended the specialized headache clinic of the First Affiliated Hospital of Nanjing Medical University between January 2020 and August 2025 and fulfilled the diagnostic criteria of the International Classification of Headache Disorders，3rd edition（ICHD-3）were enrolled. According to the Chinese Guidelines for the Diagnosis and Treatment of Migraine（2023 edition）and the International Headache Society’s global practice recommendations for preventive pharmacological treatment of migraine，≥4 monthly migraine days was defined as the indication for preventive treatment. Based on treatment indications and actual medication use，patients were categorized into four groups：indication - comforming group（Group A），potential overtreatment group （Group B），appropriate acute treatment group（Group C），and inappropriate medication use group（Group D）. Clinical characteristics and medication patterns were compared among the groups. Multivariable logistic regression was performed to identify factors associated with undertreatment in Group A. Results：Among the 2 028 patients，685（33.8%）were assigned to Group A，of whom 21.2%（145/685） were undertreated. Groups B，C，and D comprised 446（22.0%），619（30.5%），and 278（13.7%）patients，respectively. Preventive medications in Groups A and B were mainly calcium channel blockers and antiepileptic drugs，with a significantly higher use of calcium channel blockers in Group B than in Group A（71.3% vs. 40.6%，P ＜ 0.001）. For acute medications，triptans，acetaminophen， nonsteroidal anti-inflammatory drugs，and calcitonin gene-related peptide receptor antagonists were used most frequently in Group C. Multivariable logistic regression showed that the use of acute migraine-specific medications（adjusted OR=1.90，95%CI：1.27-2.82，P= 0.002）and a greater number of monthly migraine days（adjusted OR=1.02，95%CI：1.00-1.03，P=0.036）were significantly associated with undertreatment in Group A. Conclusion：Preventive treatment of migraine demonstrated a clear pattern of bidirectional nonadherence，characterized by undertreatment among patients with indications for preventive therapy and potential overtreatment among those without such indications. In clinical practice，stricter adherence to indications for preventive treatment is needed，along with strengthened evaluation of preventive therapy among users of migraine - specific acute medications and more standardized drug selection and headache subtype diagnosis，in order to improve guideline adherence.

Abstract:Huntington’s disease（HD）is an autosomal dominant genetic disorder caused by the abnormal CAG repeat expansion in the Huntingtin（HTT）gene. It is clinically characterized by choreiform movements，progressive cognitive impairments，and psychiatric symptoms，with no cure currently available. Although the research based on traditional animal models and human tissues has revealed key pathological features such as mutant HTT protein aggregation and selective striatal neuron loss，significant limitations remain in understanding human - specific disease mechanisms. The development of human induced pluripotent stem cell（hiPSC）and brain organoid technology has enabled the construction of human - specific HD models，providing revolutionary platforms for elucidating pathological mechanisms and developing novel therapeutic strategies. This review summarizes the developmental trajectories of both HD patient -derived induced pluripotent stem cell（HD -iPSC）and human brain organoid technology，highlights the research findings and significance of HD - iPSC - derived cells，various brain organoids，and assembloids in HD research，and discusses the current challenges and future prospects of brain organoid applications.

Abstract:Post - stroke cognitive impairment（PSCI），as a common and highly disabling complication following stroke，not only severely impairs patients’quality of life but also significantly increases the risk of stroke recurrence and mortality. In the exploration of its pathogenesis，amino acid metabolic disorder has gradually been recognized as one of the key pathophysiological factors. Against this backdrop，this paper systematically reviews the research progress on major amino acid metabolic disorders in the core pathogenesis of PSCI in recent years，covering their underlying mechanisms，potential as biomarkers，and relevant interventional strategies，while highlighting their critical roles in neuroinflammation，oxidative stress，neurotransmitter imbalance，and other related aspects. These studies help deepen the understanding of the pathological mechanisms of PSCI，and also provide new insights and tools for early diagnosis，precise treatment，and prognostic evaluation of the disease，thus holding important clinical significance and potential application value.

Abstract:Neurodegenerative diseases（NDDs）are a group of chronic diseases characterized by progressive neuronal loss and functional decline，including Alzheimer’s disease（AD），Parkinson’s disease（PD），amyotrophic lateral sclerosis（ALS），and spiny cerebellar ataxia type 3（SCA3）. Ataxin - 3 is an important deubiquitinating enzyme，which participates in the regulation of protein homeostasis by editing the ubiquitin chain configuration of the substrate. In the physiological state，Ataxin-3 is composed of Josephin domain，ubiquitin binding motif and polyglutamine（polyQ）sequence. Ataxin-3 regulates the ubiquitin-proteasome system，autophagy- lysosomal pathway and endoplasmic reticulum associated degradation by deubiquitination function to maintain cell homeostasis. However，when the CAG repeat of ATXN3 gene is abnormally expanded（＞40 times），the polyQ segment of Ataxin - 3 is extended， which leads to protein misfolding，aggregation，and formation of toxic inclusion body，driving the occurrence of SCA3. In addition， Ataxin-3 dysfunction is closely related to other NDDs：in AD，it promotes with abnormal aggregation of tau protein and oxidative stress； Ataxin-3 mutant aggravated the toxic aggregation of α-synuclein by interfering with the Parkin-mediated ubiquitin-proteasome pathway in PD. Ataxin-3 plays a neuroprotective role in ALS by hydrolyzating the K63 ubiquitin chain of SOD1 and promoting its autophagic clearance. This“duality”suggests that Ataxin-3 is both a causative agent of SCA3 and a potential therapeutic target for other NDDs. In the future，it is necessary to further analyze the molecular network of Ataxin - 3 in NDDs and develop small molecule drugs or gene therapies targeting its functional regulation，so as to provide new strategies for precise intervention of NDDs.

Abstract:Objective：To establish classification and grading models for gastric cancer pathological sections based on deep learning technology，and to evaluate the performance of these models. Methods：Classification and grading datasets for gastric cancer and noncancerous tissues were collected from public online resources. Data augmentation was performed，and the dataset were divided into training，validation，and test sets. In the initial stage，17 convolutional neural network（CNN）architectures were constructed，and the initial training parameters were uniformly set to train these 17 models for the classification of gastric cancer and non-cancerous tissues. After training，the recognition accuracy on the test set and the training time were used as evaluation indicators to comprehensively assess the efficacy of different model architectures. Based on these indicators，the optimal architecture was selected for further optimization and training to construct the gastric cancer classification model. After the completion of the classification model，the gastric cancer grading model was built based on the foundation of the classification model. During the training of the gastric cancer grading model，17 grading networks were trained，and suitable base models were selected according to performance indicators. After the base model was determined，voting and stacking methods were applied for ensemble learning and compared with single models to explore the impact of ensemble learning on performance improvement and to construct the gastric cancer grading model. Results：In the training of the gastric cancer classification model，the Xception network was selected as the final classification model after comparison. After parameter adjustment and training，the final gastric cancer classification model achieved an accuracy of 98.13%， sensitivity of 98.11%，specificity of 98.11%，F1 score of 98.12%，and AUC of 0.998 on the test set. In the training of the gastric cancer grading model，the stacking method represented by random forest showed significant improvement compared to the voting method represented by hard voting. The ensemble model based on random forest was selected as the final grading model，with an accuracy of 95.06%，sensitivity of 94.77%，specificity of 98.36%，and F1 score of 94.82%. The area under the receiver operating characteristic （ROC - AUC）curve values were 0.999 for benign，0.981 for poorly differentiated tubular adenocarcinoma，0.990 for moderately differentiated tubular adenocarcinoma，and 0.995 for well - differentiated tubular adenocarcinoma. Conclusion：Both models demonstrated excellent recognition performance，proving the feasibility of using CNN to achieve high - precision classification and grading of gastric tumor pathological images. The transfer-learning and ensemble-learning framework was successfully applied to the grading of gastric tumor images and holds promise for integration into hospital intelligent diagnostic assistance systems.

Abstract:Objective：To explore HPV vaccine adverse reactions in Pudong New Area，Shanghai，from 2017 to 2024，and to provide scientific basis for the safety evaluation of HPV vaccine. Methods：Data on suspected adverse events following immunization（AEFI）to HPV vaccines in Pudong New Area from 2017 to 2024 were collected to analyze the incidence of AEFI reports following HPV vaccination. Results：From 2017 to 2024，a total of 1 436 659 doses of HPV vaccine were administered in Pudong New Area，with 1 610 AEFI cases reported and an overall AEFI reporting rate of 112.07 per 100 000 doses administered. The respective numbers of reports for general reactions，abnormal reactions，psychogenic reactions，and coincidental events were 1 578 cases（109.84 per 100 000 doses），24 cases（1.67 per 100 000 doses），5 cases（0.35 per 100 000 doses），and 3 cases（0.21 per 100 000 doses），respectively. The AEFI reports for bivalent，quadrivalent，and nonavalent HPV vaccines were 208 cases（193.30 per 100 000 doses administered），457 cases（107.10 per 100 000 doses administered），and 945 cases（104.72 per 100 000 doses administered），respectively. During 2017- 2024，the highest AEFI incidence rates for bivalent，quadrivalent，and nonavalent HPV vaccines were 530.50/100 000 doses，190.56/ 100 000 doses，and 194.38/100 000 doses，respectively. Statistically significant differences in AEFI incidence rates were observed among different HPV vaccine types（P ＜ 0.05）. The number of AEFI reports for bivalent liquid cillin，bivalent liquid pre - filled， quadrivalent liquid pre -filled ，nonavalent liquid cillin ，and nonavalent liquid pre -filled vaccines were 53 cases（101.90 per 100 000 doses），155 cases（278.82 per 100 000 doses），457 cases（107.10 per 100 000 doses），41 cases（198.26 per 100 000 doses）， and 904 cases（102.53 per 100 000 doses），respectively. The incidence rates of AEFI differed significantly among different specifications of the bivalent and nonavalent HPV vaccines（P ＜ 0.05）. The peak period for HPV vaccine -associated AEFI occurred within 0-0.5 days post -vaccination，with 854 cases（59.44/100 000 doses administered）reported. The temporal distribution of AEFI varied significantly among different HPV vaccine types（P ＜ 0.05）. The distribution of local redness and swelling as a common reaction differed significantly among HPV vaccine types（P ＜ 0.05）. Conclusion：HPV vaccine has a low incidence of AEFI，and the monitoring of AEFI after HPV vaccination should continue to be strengthened.

Abstract:Objective：Coronary slow flow phenomenon（CSFP）is a pathological condition characterized by delayed coronary blood flow in the absence of significant stenosis on coronary angiography，which predisposes patients to angina pectoris and cardiovascular events. Current diagnosis relies heavily on invasive investigations，and simple，effective non-invasive predictive tools are lacking. This study aimed to investigate the expression levels of serum growth differentiation factor-15（GDF-15）in CSFP and evaluate its predictive value，with the goal of providing an alternative to the current diagnostic paradigm dependent on invasive coronary angiography（the gold standard）. Methods：Patients undergoing coronary angiography at the Affiliated Hospital of Qingdao University were enrolled between December 2023 to June 2024. Those with angiographically normal coronary arteries were assigned to the normal group（n=42），while patients exhibiting delayed coronary flow without significant stenosis comprised the CSFP group（n=69）. The serum GDF - 15 levels from the day before the surgery were measured using enzyme-linked immunosorbent assay（ELISA）. Logistic regression was performed and collinearity was examined；diagnostic efficacy was assessed by using receiver operating characteristic（ROC）curves and crossvalidated with Bootstrap internal validation. Results：GDF - 15 levels were significantly higher in the CSFP group versus controls [957.01（716.27，1 373.16）ng/L vs. 745.14（585.43，812.41）ng/L；z=- 4.14，P ＜ 0.001]. Both univariate and multivariate logistic regression adjusted for body mass index（BMI）and other confounders showed that each 1-unit increase in ln（GDF-15）（corresponding to a 2.718-fold increase in raw concentration）was associated with a 14.06-fold higher CSFP risk（95% CI：1.82-68.76，P ＜ 0.05）. Conversely，for each 1 mmol/L increase in high-density lipoprotein cholesterol（HDL-C），the risk was reduced by 16%（OR=0.16， 95%CI：0.07-0.34，P ＜ 0.05）. ROC analysis indicated that GDF-15 alone had an AUC of 0.791 for diagnosing CSFP. Combining GDF -15 with HDL -C increased the AUC to 0.953，improving sensitivity from 57.97% to 91.30%；furthermore，cross -validation and Bootstrap indicated cut-off generally stable. Conclusion：Elevated serum GDF-15 level in CSFP patients establishes its potential as a non-invasive early warning biomarker. The combined GDF-15/HDL-C diagnostic model demonstrates substantially improved accuracy， suggesting its utility as a practical clinical screening tool. This approach could reduce dependence on invasive coronary angiography for CSFP detection.

Abstract:Objective：To investigate the impact of obesity on cardiac reverse remodeling in patients with heart failure with reduced or mildly reduced ejection fraction（HFrEF/HFmrEF）receiving guideline-directed medical therapy（GDMT）. Methods：A retrospective analysis was conducted on heart failure patients with a left ventricular ejection fraction（LVEF）＜50% treated at the First Affiliated Hospital of Nanjing Medical University between January 2022 and October 2024. All patients received GDMT and underwent baseline cardiac magnetic resonance（CMR）imaging at baseline. Myocardial fibrosis was assessed via late gadolinium enhancement（LGE）and extracellular volume fraction（ECV）. Obesity was defined as a body mass index（BMI）≥28 kg/m² . Cardiac reverse remodeling was evaluated by echocardiography at baseline and after 6 months of GDMT. Treatment response was defined as an absolute increase in LVEF ≥5%. Results：A total of 80 patients were included（31 in the obese group and 49 in the non-obese group）. Compared to the nonobese group，the obese group showed a smaller improvement in LVEF and a lower treatment response rate[ΔLVEF：（14.45 ± 2.08）% vs.（20.80 ± 1.81）%，P=0.024；response rate：76.80% vs. 93.58%，P=0.036]. Multivariable regression analysis confirmed that BMI was an independent negative predictor of LVEF improvement（β=-0.90，P=0.004）. Both LGE（OR=0.68，P=0.025）and ECV（OR=0.89，P= 0.012）were independent predictors of reduced treatment response. A predictive model combining BMI and ECV demonstrated the highest accuracy for identifying poor responders，with an area under the curve（AUC）of 0.923，which was significantly superior to the baseline model（P=0.043）. Conclusion：In HFrEF/HFmrEF patients，obesity is associated with attenuated cardiac reverse remodeling and reduced responsiveness to GDMT. The combination of BMI and ECV improves the identification of patients at risk for diminished treatment response.

Abstract:Objective：To analyze the clinical features，treatment，outcomes，and risk factors influencing fever duration in children and adolescents with histiocytic necrotizing lymphadenitis（HNL）. Methods：A retrospective analysis was conducted on the clinical data of 35 pediatric HNL patients admitted to the First Affiliated Hospital of Nanjing Medical University. The clinical characteristics and risk factors were compared between the two groups：the short-duration fever group（≤2 weeks，n=17）and the long-duration fever group（＞2 weeks，n=18）. Results：Among the 35 patients，the mean age was（14.69±2.42）years，with a male-to-female ratio of 1.06∶1. All cases presented with lymphadenopathy，with cervical lymphadenopathy accounting for 85.7%，tenderness in 74.3%，and fever in 97.14%. Common laboratory abnormalities included elevated lactate dehydrogenase（65.7%），increased erythrocyte sedimentation rate （65.7%），leukopenia（62.86%），neutropenia（51.43%），elevated high-sensitivity C-reactive protein（54.29%），and elevated ferritin （45.71%）；17.1% of patients tested positive for antinuclear antibody. The long-duration fever group had higher proportions of extracervical lymphadenopathy，leukopenia，neutropenia，antinuclear antibody positivity，and elevated inflammatory markers（P ＜ 0.05）. Logistic regression indicated that elevated ferritin was an independent risk factor for prolonged fever duration. Antibiotics were ineffective in all 27 treated patients. In 22 patients，the median time to defervescence after glucocorticoid therapy following biopsy was 2 days，with the short-duration fever group showing faster fever resolution（P ＜ 0.05）. During follow-up ranging from 6 months to 2 years，2 patients experienced recurrence，and none progressed to autoimmune diseases. Conclusion：HNL in children and adolescents primarily manifests with fever，painful cervical lymphadenopathy，leukopenia，and an elevated erythrocyte sedimentation rate. Elevated ferritin is an independent risk factor for prolonged fever duration. Diagnosis relies on lymph node biopsy，antibacterial therapy is generally ineffective，and glucocorticoid treatment demonstrates favorable efficacy.

Abstract:Objective：To analyze the related factors influencing serum 1，5 - anhydro - D - glucitol（1，5 - AG）levels and establish reference intervals. Methods：A total of 873 participants，aged 20 to 72 years，were enrolled from an epidemiological survey conducted between August and November 2021 in Nanjing，Jiangsu Province，and surrounding areas. Questionnaire survey，physical examination， and detection of routine clinical blood indicators including serum 1，5-AG were performed. Participants were categorized into different disease groups according to inclusion and exclusion criteria. Student’s t-test was used to compare serum 1，5-AG levels among these groups. Pearson correlation analysis and multivariate linear regression were employed to assess associations between serum 1，5-AG and various clinical parameters. The reference interval for 1，5-AG was determined based on the 5th percentile among the apparently healthy population. Results：Serum 1，5-AG levels were significantly associated with sex，body mass index（BMI），body roundness index（BRI），fasting blood glucose，fasting insulin，2 - hour postprandial blood glucose，glycated hemoglobin（HbA1c），estimated glomerular filtration rate（eGFR），total cholesterol，and carbohydrate-derived energy intake（all P ＜ 0.05）. Nine groups were screened from the study subjects：apparently healthy group，diabetes mellitus group，hypertension group，hyperlipidemia group，impaired fasting glucose group，impaired glucose tolerance group，hepatic dysfunction group，renal dysfunction group，and obesity group. Significant differences in 1，5-AG levels were observed between the apparently healthy group and the hyperlipidemia，hepatic dysfunction，and obesity groups. Based on the 5th percentile，the reference intervals of 1，5-AG were set as ＞ 99.8 μmol/L for males and ＞ 62.9 μmol/L for females. Conclusion：Serum 1，5-AG levels are associated with individual glycemic status，lipid metabolism，and dietary patterns， and are influenced by age，sex，renal function，and dietary composition. The sex - specific reference intervals for serum 1，5 - AG established in this study provide a valuable tool for monitoring glycemic variation and guiding the clinical management of diabetes.

Abstract:Objective：To explore the correlation between pathological indicators of renal allograft biopsy and abnormal renal allograft function at different stages，to evaluate the diagnostic value of pathological indicators in abnormal renal allograft function，and to establish a model for predicting the prognosis of renal allografts. Methods：This study retrospectively analyzed the clinical data and pathological indicators of kidney transplant recipients who underwent renal allograft biopsy at the First Affiliated Hospital of Nanjing Medical University between 2015 and 2018. The total sample was statistically analyzed based on different post-biopsy times（at biopsy， 1 year after biopsy，3 years after biopsy，and 5 years after biopsy）. Univariate analysis was conducted to screen for indicators that affect abnormal renal allograft function. The model was established using binary logistic regression to draw a nomogram. Mixed - effects logistic regression was further applied to investigate the dynamic effects of factors consistently associated with abnormal renal allograft function across all stages. According to receiver operating characteristic curve（ROC），corresponding Area under the curve（AUC）and calibration curve，the discriminant validity and consistency of the model with the actual situation were judged. Results：A total of 121 patients were included in this study. According to the time after biopsy of the transplanted kidney，the total samples were divided into four groups：at the time of biopsy，1 year after biopsy，3 years after biopsy，and 5 years after biopsy. The i score ≥1 was significantly correlated with renal function at the time of biopsy and at 1，3，and 5 years after biopsy. The dynamic effects analysis indicated that i-score ≥ 1 was associated with renal function deterioration within five years after kidney transplantation. A nomogram was constructed based on the above statistical results. The AUC indicated that the model had good discriminative validity. The calibration curve showed that the predicted probability of abnormal renal allograft function was in good agreement with the actual probability. Conclusion：This study constructed a nomogram model capable of predicting abnormal renal allograft function at different time points which demonstrated a good predictive ability and could effectively improve the precision of post - biopsy patient management for renal transplant recipients.

Abstract:Tumor drug resistance is the primary cause of treatment failure in cancer therapy，with its underlying mechanisms closely related to cancer cells’adaptive responses to environmental stress during treatment. As the central hub of cellular energy metabolism and stress responses，mitochondria drive drug resistance by enhancing the metabolic plasticity and survival of cancer cells. This is mediated through mechanisms such as activation of oxidative phosphorylation，regulation of reactive oxygen species homeostasis， aberrant metabolite accumulation，and alterations in mitochondrial dynamics，positioning mitochondria as pivotal contributors to therapeutic resistance. Targeting mitochondrial metabolism has demonstrated significant potential to reverse drug resistance in contemporary oncology. This article reviews the adaptive mitochondrial changes in tumor cells under therapeutic stress，explores the multifaceted mechanisms by which mitochondrial metabolism induces resistance across various treatment modalities，and summarizes ongoing research on mitochondria - targeted metabolic therapies. Therefore，future mitochondria - targeted interventions are poised to transition from foundational mechanistic studies to clinical applications，offering novel perspectives for advancing personalized cancer treatment.

Abstract:Phosphofructokinase，muscle type（PFKM）is a key rate-limiting enzyme in the glycolytic pathway，and its expression and activity are regulated by multiple signaling pathways，including hypoxia-inducible factor-1 alpha（HIF-1α），myelocytomatosis oncogene （Myc），phosphoinositide 3-kinase/protein kinase B（PI3K/AKT），and adenosine 5′ -monophosphate（AMP）-activated protein kinase （AMPK）. Recent studies have demonstrated that PFKM reprograms macrophage functions through both the canonical glycolytic pathway and“non-canonical”functions. Physicochemical factors in the microenvironment，including mechanical forces，glucose，and citrate，can shift the equilibrium between the tetrameric and dimeric conformations of PFKM，thereby facilitating the switch between its classical and non - classical functions. While current research has largely focused on the classical glycolytic role of PFKM，its non - canonical functions and the underlying molecular mechanisms remain to be fully elucidated. This review summarizes the classical and non-canonical roles of PFKM in macrophages，its upstream regulatory signals，and its implications in infectious diseases and cancer， aiming to provide a theoretical foundation and insights for PFKM-targeted immunometabolic therapeutic strategies.

Abstract:Population aging is a major global challenge today，in which inflammaging，as one of the core features of aging，is closely associated with the development of various age-related diseases. Myeloid-biased differentiation of hematopoietic stem cell（HSC）is a key manifestation of immunosenescence，characterized by enhanced differentiation of HSC into myeloid cells and reduced lymphoid differentiation，leading to immune dysfunction and driving chronic inflammation. This review systematically elucidates the interaction mechanisms between HSC myeloid-biased differentiation and inflammaging，including bone marrow microenvironment inflammation， epigenetic alterations，and mitochondrial dysfunction. Furthermore，it summarizes targeted intervention strategies，such as blocking the interleukin - 1 signaling pathway，modulating epigenetic modifications，remodeling the bone marrow microenvironment，and clearing senescent cells，which have shown potential in animal models to reverse myeloid-biased differentiation and improve immune function.

Abstract:Lower extremity major vascular injury is a common critical emergency in clinical practice，accounting for approximately 15% -20% of all vascular injuries. The core goal of managing limb arterial injuries is rapid hemostasis and restoration of peripheral arterial blood flow. Temporary vascular shunting（TVS），as an essential component of damage control surgery（DCS），by establishing a temporary vascular shunt，distal blood supply can be effectively maintained，achieving the objective of damage control and repair. this creates favorable conditions for subsequent definitive repair. TVS plays a key role in the management of such injuries. The timing and technique of insertion and removal directly impact the final outcome of vascular repair and the patient’s prognosis. Timely identification and effective management of complications are key to improving the success rate of treatment and enhancing the patient’ s quality of life. This article provides a comprehensive review of the history，efficacy，indications and contraindications，types and procedures，postoperative management，and future development directions of TVS technology，aiming to offer new insights for emergency care in limb vascular trauma.

Abstract: