Barely Significant

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Notably, TNF-α serum levels and number of comorbidities showed a trend toward significance in this model (OR = 1.239; 95%CI: 0.998 - 1.539; OR = 0.960; 95%CI: 0.916 - 1.006, respectively), suggesting a potential but weaker contribution among cytokines and clinical aspects ( Figure 3 ).
Volcano plot analysis across all patients identified TOX2 (log 2 FC = 0.605, −log 10 (padj) = 2.57) and PDCD1 (log 2 FC = 0.810, −log 10 (padj) = 2.59) as reaching both the fold-change (|log 2 FC| > 0.3) and significance (padj < 0.05) thresholds; CD274, LAG3, and IDO1 also approached significance ( Figure 2b ).
Immune infiltration analysis showed that neutrophils, macrophages, and some T cell subsets were significantly enriched in samples with high ASS, while dendritic cells and B cells showed a decreasing trend ( Figure 7D ), suggesting a strong link between ASS and immune microenvironment activation.
Mechanistically, Semen Cuscutae remodeled the osteoimmune microenvironment by suppressing pro-inflammatory cytokines (IL-6) and bone resorption markers (TRACP, CTX, RANKL), while ALP showed an increasing trend and osteogenic or reparative factors, including OPG, IGF, and TGF-β, were significantly upregulated.
Although parameters such as VI did not show differences in this study—possibly related to the sensitivity of the detection technique, the heterogeneity of the PCOS patient population, or sample size—the difference in blood flow patterns, together with elevated uterine artery resistance, points to an overall trend of poor blood flow perfusion in the uterine-endometrial complex.
Despite the absence of a clear trend, the Grey Zone patient exhibited a markedly elevated IL-6 level (221.30 pg/mL), comparable to the highest value in the VL-HLH group (167.40 pg/mL), and also showed the highest splenic SUVmax (9.85), suggesting an inflammatory and metabolic phenotype more closely aligned with the VL-HLH group.