Abstract:Objective To explore the protective effect and mechanism of reduced glutathione(GSH)on a mouse model of pristane-induced systemic lupus erythematosus-associated diffuse alveolar hemorrhage(SLE-DAH).Methods In vivo experiments:Female C57BL/6J mice aged 6 to 10 weeks were selected and used to construct a diffuse alveolar hemorrhage(DAH)model by intraperitoneal injection of 0.5 mL pristane.Subsequently,these mice were intraperitoneally injected with GSH on the third day,the 6th day,the 9th day and the 12th day after constructing the model to observe the gross changes in the lungs,pathological changes in lung tissues,and changes in body weight of the mice.The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interleukin-1β(IL-1β)in the bronchoalveolar lavage fluid(BALF)of the mice were detected.In vitro experiments:Mouse lung epithelial(MLE)-12 cells were treated with β-CD-pristane and the morphology and density of the cells were observed,and the viability of the cells was assessed.The changes in gene expressions were analyzed by using miRNA-sequencing(mRNA-seq),and the cell proliferation and the level of reactive oxygen species(ROS)were detected after GSH intervention.Results After the treatment with pristane,the lungs of the mice showed the changes in different degrees of hemorrhage on the whole,and the percentage of gross lung hemorrhage in the lung tissues and DAH scores were significantly increased(P＜0.05),with disordered lung tissue structure,significant infiltration of inflammatory cells and significantly decreased body weight(P＜0.05),and the levels of TNF-α,IL-6,IL-1β in BALF were significantly increased(P＜0.05).After the treatment with β-CD-pristane,the morphology of MLE-12 cells changed,and their viability was significantly decreased(P＜0.05).The combination of RNA sequencing(RNA-seq)with Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis and Gene Ontology(GO)functional enrichment analysis suggested that β-CD-pristane might cause cell damage through glutathione metabolism pathways and inflammatory response.After the intervention with GSH,the proliferation of MLE-12 cells was restored(P＜0.05),and the intracellular ROS levels were significantly decreased(P＜0.05),and the percentage of gross lung hemorrhage in pristane-induced DAH mice and DAH scores were significantly decreased(P＜0.05),and the body weight was significantly increased(P＜0.05),and the levels of TNF-α,IL-6 and IL-1β in BALF were significantly decreased(P＜0.05).Conclusion GSH intervention can alleviate pristane-induced DAH and inflammatory response in mice.The mechanism of action may be associated with the inhibition of oxidative stress in alveolar epithelial cells and the promotion of proliferation of alveolar epithelial cells.

Abstract:Artificial intelligence(AI),as the core technology leading a new round of scientific and technological revolution,has been deeply integrated into every aspect of clinical medicine.Since its inception in the 1950s,AI has experienced a great-leap-forward development from symbolic logic to deep neural network.At present,it has shown broad application prospects in disease diagnosis,formulation of treatment plan,drug research and development,and hospital management.Regarding international regulation,the US Food and Drug Administration(FDA)has established and continuously updated the AI-Enabled Medical Device List,and applied a risk-based,total product life-cycle regulatory framework to the related softwares and medical devices.In China,the government is actively promoting the"AI+Healthcare"initiative to facilitate the clinical transformation of new technologies.Meanwhile,regulatory authorities are also simultaneously strengthening institutional building.They are gradually improving regulatory requirements in areas such as medical device registration review,risk management of AI medical software,data security and privacy protection,and establishing a regulatory system covering technology access,application implementation and risk prevention and control to provide institutional support for the standardized implementation of AI technology in clinical practice.Under the joint impetus of the above-mentioned international and domestic regulatory frameworks,AI technology is gradually being applied to clinical diagnosis and treatment as well as public health management,demonstrating significant application prospects in enhancing the capacity of primary medical services,early screening of tumors,and epidemiological management.This paper reviews the latest application progress of AI in clinical medicine,covering technical foundations such as computer vision and natural language processing.It systematically analyzes the challenges AI faces in practical applications,including data privacy,algorithmic transparency,and definition of legal liability.It also emphasizes that the application of AI in medical care should adhere to the principles of"people-oriented"and"human-led",and the sustainable development of precision medicine should be promoted through multi-center validation and collaborative supervision.

Abstract:Objective To analyze the clinical efficacy of parent-oriented group and individual cognitive-behavioral therapy(CBT)combined with family-based early intervention training in children with autism spectrum disorder(ASD).Methods A total of 100 pediatric patients with ASD who were admitted to Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from January 2024 to February 2025 were recruited.The pediatric patients were divided into group-CBT group(receiving group CBT combined with family-based early intervention training,34 patients),individual-CBT group(receiving individual CBT combined with family-based early intervention training,33 patients)and control group(receiving family-based early intervention training,33 patients)by random number table method.Family-based early intervention training was conducted once weekly,with a training period of 3 months.CBT was conducted once weekly,for a total of 8 times.Gesell Developmental Schedules(GDS)scores,Autism Behavior Checklist(ABC)scores and Autism Treatment Evaluation Checklist(ATEC)scores were compared among the pediatric patients in the three groups before and after the intervention.Self-Rating Anxiety Scale(SAS)scores and Tool to Measure Parenting Self-Efficacy(TOPSE)scores were compared among the pediatric patients'parents in the three groups before and after the intervention.Results After intervention,the scores of adaptability,fine motor skills,language and personal social domains in the GDS of the pediatric patients in the three groups were significantly higher than those before intervention(P＜0.05),and the scores of adaptability,language and personal social domains in the group-CBT group were higher than those in the individual-CBT group and the control group,with statistically significant differences(P＜0.05).After intervention,the scores of each dimension of ATEC in the pediatric patients in the three groups were significantly lower than those before intervention(P＜0.05),and the scores of language,social interaction and behavior dimensions in the group-CBT group were lower than those in the individual-CBT group and the control group,with statistically significant differences(P＜0.05).After intervention,the scores of ABC in the pediatric patients in the three groups were significantly lower than those before intervention(P＜0.05),and the scores of ABC in the group-CBT group were lower than those in the individual-CBT group and the control group,with statistically significant differences(P＜0.05).After intervention,the scores of SAS in the pediatric patients'parents in the group-CBT group and the individual-CBT group were significantly lower than those before intervention(P＜0.05),while the scores of SAS in the control group showed no significant changes before and after intervention(P＞0.05).After intervention,the scores of SAS in the group-CBT group were lower than those in the individual-CBT group and the control group,with statistically significant differences(P＜0.05).After intervention,the scores of each dimension and the total scores of TOPSE in the pediatric patients'parents in the group-CBT group were higher than those in the individual-CBT group and the control group,with statistically significant differences(P＜0.05).Conclusion CBT intervention for parents of pediatric patients with ASD can improve their mental health status,enhance their self-efficacy in parenting,thereby promoting the behavioral development of the pediatric patients with ASD.Moreover,the intervention effect of group CBT is better than that of individual CBT.

Abstract:Objective To investigate the effects of artificial intelligence(AI)-assisted multidimensional self-efficacy improving nursing care on coping styles,self-efficacy,and treatment adherence in lung cancer patients with chemotherapy-induced myelosuppression.Methods A total of 68 lung cancer patients with chemotherapy-induced myelosuppression,who were admitted to Cancer Hospital Chinese Academy of Medical Sciences,Shenzhen,were recruited and divided into observation group and control group by using random number table method,with 34 patients in each group.The control group received routine nursing care related to myelosuppression,while the observation group received the same routine nursing care as the control group plus AI-assisted multidimensional self-efficacy improving nursing care.The AI tools were mainly used for the patients'risk stratification and nursing decision support.Before and after the intervention,the Simple Coping Style Questionnaire(SCSQ)and the General Self-Efficacy Scale(GSES)were used to evaluate the coping styles and self-efficacy levels of the patients,and the treatment adherence was compared between the patients in the two groups.Results After the intervention,the SCSQ-positive coping style scores and GSES scores in the observation group were higher than those in the control group,while the SCSQ-negative coping style scores in the observation group were lower than those in the control group,with statistically significant differences between the two groups(P＜0.05).The complete adherence rate of the treatment in the observation group was higher than that in the control group,with statistically significant difference between the two groups(P＜0.05).Conclusion AI-assisted multidimensional self-efficacy improving nursing care is conducive to improving the coping styles and self-efficacy levels in lung cancer patients with chemotherapy-induced myelosuppression,and enhances the patients'treatment adherence.

Abstract:Objective To analyze the correlation between plasma polymyxin B concentration and risk of acute kidney injury(AKI).Methods A retrospective analysis was conducted on the clinical data of 53 patients who were hospitalized and treated with polymyxin B in the People's Hospital of Guangxi Zhuang Autonomous Region from April 1 2024 to August 8,2024.After 3 doses of polymyxin B were administered for the patients to reach steady state,2-3 mL of their venous blood was collected 30 minutes before the next dose was administered.A mass spectrometer YS EXACT 9900MD was used to detect plasma polymyxin B concentration.The effect of polymyxin B combined with nephrotoxic antibiotics on the serum creatinine levels of the patients was analyzed.The effect of the use of polymyxin B on the renal function indicators of the patients was analyzed.Multivariate logistic regression was used to analyze the influencing factors for the occurrence of AKI after the administration of polymyxin B.Results Compared with the use of polymyxin B in no combination with nephrotoxic antibiotics,the combination of polymyxin B and nephrotoxic antibiotics did not significantly affect the serum creatinine levels of the patients(P＞0.05).Compared with those of the patients before the administration of polymyxin B,the serum creatinine and urea levels of the patients increased,while the creatinine clearance rate decreased after the administration of polymyxin B,and the differences were statistically significant(P＜0.05).The results of multivariate logistic regression analysis showed that a higher level of plasma polymyxin B concentration was an independent risk factor for the occurrence of AKI after the administration of polymyxin B[OR(95%CI)=1.874(1.220-2.879),P=0.004].The results of receiver operating characteristic(ROC)curve analysis showed that plasma polymyxin B concentration could effectively predict the occurrence of AKI[AUC(95%CI)=0.734(0.599-0.868),P=0.004],with an optimal cut-off value of 3.18 mg/L,a corresponding sensitivity of 65.4%,and a specificity of 77.8%.Conclusion After receiving polymyxin B treatment,the patients' serum creatinine and urea levels increase.The occurrence of AKI is closely related to plasma polymyxin B concentration.Clinicians should conduct monitoring of plasma polymyxin B concentration during the treatment process to precisely adjust the medication regimen.

Abstract:Objective To explore the application effect of different methods of modified Nuss bar fixation for non-thoracoscopic-assisted pectus excavatum(PE)surgery.Methods A retrospective analysis was conducted on the clinical data of 53 patients who underwent PE surgery by using modified Nuss bar in Department of Thoracic Surgery,Xiangya Hospital of Central South University from July 2021 to December 2023.According to whether or not steel wire fixation was used and the fixation methods,the patients were divided into non-steel wire fixation group(11 patients),unilateral fixation group(15 patients),and bilateral fixation group(21 patients),excluding 5 patients with 2 steel bars fixed and 1 patient with steel wire bridge.The overall condition of the patients was analyzed and the clinical data were compared among the three groups.Results Among the 53 patients,45 patients were male and 8 patients were female,with a median age of 15 years and a median Haller index of 3.86.Steel wire fixation was not used in11 patients(20.75%),and unilateral steel wire fixation was used in 15 patients(28.30%),and bilateral steel wire fixation in27 patients(50.94%).The median follow-up time was 17 months.Fifty-one patients had a follow-up period of 1 year,and 15 patients had a follow-up period of 2 years.The incidence of postoperative complications was28.30%,and the proportions of the patients who were satisfied with the orthopedic treatment outcomes at 1 month,1 year and 2 years after surgery were 92.45%,90.20%and80.00%,respectively.There were statistically significant differences in the preoperative Haller index and operation duration among the three groups(P＜0.05),and the operation duration of the non-steel wire fixation group was significantly shorter than that of the bilateral fixation group(P＜0.05).There were no statistically significant differences in the postoperative pain scores,Haller indexes at 1 month and 1 year after surgery,length of hospital stay after surgery,postoperative complications and the proportion of the patients who were satisfied with the orthopedic treatment outcomes at 1 year after surgery among the three groups(P＞0.05).Conclusion The modified Nuss bar fixation has a certain orthopedic effect.The non-wire fixation method is potentially feasible for non-thoracoscopic-assisted PE surgery.

Abstract:Objective To analyze the levels and clinical significance of D-dimer(D-D),25-hydroxyvitamin D[25(OH)D],lymphocyte-to-monocyte ratio(LMR)and interleukin-6(IL-6)in patients with sepsis.Methods Fifty-five patients with sepsis who were admitted to the 73th Group Military Hospital of People's Liberation Army from June 2022 to June 2024 were selected as observation group.Other 50 healthy individuals who underwent physical examination during the same period were selected as control group.The levels of plasma D-D,serum 25(OH)D and serum IL-6 were detected for the patients at admission or for the control group during physical examination and LMR was calculated.According to the survival status of the patients within 3 months after admission,they were divided into death group(15 patients)and survival group(40 patients).Multivariate logistic regression was used to analyze the factors influencing the occurrence of death in the sepsis patients.The efficacy of D-D,25(OH)D,LMR and IL-6 for predicting mortality in the sepsis patients was analyzed by using receiver operating characteristic(ROC)curve.Results The D-D and IL-6 levels in the observation group were higher than those in the control group,while the 25(OH)D level and LMR in the observation group were lower than those in the control group,with statistically significant differences between the two groups(P＜0.05).The Sequential Organ Failure Assessment(SOFA)scores,D-D level and IL-6 level in the death group were higher than those in the survival group,while the 25(OH)D level and LMR in the death group were lower than those in the survival group,with statistically significant differences between the two groups(P＜0.05).Higher SOFA scores,D-D level and IL-6 level were risk factors for death in the sepsis patients,while higher 25(OH)D level and LMR were protective factors for survival in the sepsis patients(P＜0.05).The efficacy of the combined detection of D-D,25(OH)D,LMR and IL-6 for predicting mortality in the sepsis patients[AUC(95%CI)=0.834(0.759-0.909)]was superior to that of the detection of a single indicator(P＜0.05),and the sensitivity and specificity were93.33%and87.50%,respectively.Conclusion The levels of plasma D-D and serum IL-6 in sepsis patients increase,while the levels of serum 25(OH)D and LMR in them decrease.The combined detection of these four indicators can effectively predict the prognosis of the sepsis patients.

Abstract:Objective To construct a prediction model for the survival prognosis of bladder cancer patients based on deep learning features extracted from tumor regions in hematoxylin and eosin(HE)-stained slides.Methods The clinical data of 379 patients with bladder cancer were collected from The Cancer Genome Atlas(TCGA)database[including 450 slices of whole-slide images(WSI)],and the clinical data of 179 patients with bladder cancer who were admitted to the Affiliated Guangdong Second Provincial General Hospital of Jinan University from September 2017 to May 2024 were collected(including 244 slices of WSI).The ResNet50 model was applied for transfer learning to identify tumor regions.The RetCCL model was applied for extracting deep learning features.The extracted deep learning features were screened via univariate Cox regression and LASSO regression,and a risk scoring model was constructed.The maximally selected rank statistics method(MSRSM)was adopted to determine of the risk scores of deep learning features.According to the optimal cut-off values,the patients were divided into high-risk group and low-risk group,and the survival prognosis was compared between the two groups by using Kaplan-Meier survival curve.The factors influencing the survival prognosis of the bladder cancer patients were analyzed by using Cox regression,and a nomogram model was constructed based on the screened risk factor indicators.The calibration accuracy and net clinical benefit of the model were comprehensively evaluated by using calibration curve and decision curve analysis(DCA).Results The RetCCL model was applied to extract the features from all the WSI,and each slice of WSI had 14336 features.Twenty-two features with prognostic predictive value were obtained by using univariate Cox regression analysis.Furthermore,LASSO regression analysis was performed on these 22 features to obtain 16 features with non-zero regression coefficients.Based on this,16 pathological deep learning features and the corresponding regression coefficients were used to construct a risk scoring model for the bladder cancer patients.The results of analyses of TCGA database and clinical data from the Affiliated Guangdong Second Provincial General Hospital of Jinan University showed that based on the risk scores of deep learning features,the overall survival of the high-risk group was significantly shorter than that of the low-risk group(P＜0.05).The results of multivariate Cox regression analysis showed that the risk level of deep learning features and M stage were independent risk factors affecting the survival prognosis of the patients with bladder cancer(P＜0.05).Based on these two indicators,a nomogram model for predicting the survival prognosis of the bladder cancer patients was constructed.The calibration curve showed that the model exhibited a good consistency between the predicted survival rates of the patients at 1 year,3 years and 5 years after surgery and the actual survival rates.The results of DCA showed that the decision-making of the prediction model could achieve good net clinical benefits in terms of survival prognosis at 1 year,3 years and 5 years after surgery.Conclusion The survival prognosis prediction model for bladder cancer patients constructed according to deep learning features extracted from tumor regions in HE-stained slides has good predictive efficacy and can provide precise individualized prognosis assessment tools for clinical practice.

Abstract:Objective To study the differences in serum 25-Hydroxyvitamin D[25(OH)D]and heat shock protein 70(HSP70)levels among female infertility patients with different types of polycystic ovary syndrome(PCOS).Methods A total of 250 female infertility patients who visited the doctors at Department of Reproductive Medicine,the First Affiliated Hospital of Dali University from January 2022 to December 2024 were selected as the research subjects.Among the 250 patients,there were 50 patients with tubal infertility(control group)and 200 patients with infertility due to PCOS(PCOS group).According to the Rotterdam diagnostic and typing criteria for PCOS,the infertile patients with PCOS were classified into PCOS-A type(n=50),PCOS-B type(n=50),PCOS-C type(n=50)and PCOS-D type(n=50).According to different serum 25(OH)D levels,the vitamin D levels of the patients were classified as deficiency(＜20 ng/mL),insufficiency(20-30 ng/mL),and sufficiency(＞30 ng/mL).The levels of serum basic sex hormones,25(OH)D and HSP70 were compared among the groups.Results The levels of 25(OH)D and follicle-stimulating hormone(FSH)in the PCOS group were lower than those in the control group,and the body mass index(BMI)as well as the levels of HSP70,luteinising hormone(LH),testosterone(T)and anti-Müllerian hormone(AMH)in the PCOS group were higher than those in the control group,with statistically significant differences between the two groups(P＜0.05).There was a statistically significant difference in the distribution of 25(OH)D levels between the two groups(P＜0.05).The rate of vitamin D deficiency in the PCOS group was higher.There were no statistically significant differences in the distributions of 25(OH)D levels among the patients with different types of PCOS(P＞0.05).There were statistically significant differences in the levels of LH,FSH,T,AMH and HSP70 among the infertile patients with different types of PCOS(P＜0.05).The LH level of the patients with PCOS-A type was significantly higher than that of the patients with PCOS-B type,PCOS-C type and PCOS-D type(P＜0.05),while the FSH level of the patients with PCOS-A type was significantly lower than that of the patients with PCOS-C type(P＜0.05).The HSP70 levels of the patients with PCOS-A type and PCOS-B type were significantly higher than those of the patients with PCOS-D type(P＜0.05).Conclusion Compared with those in the tubal infertility patients,the levels of serum HSP70,LH,T and AMH in the infertile patients with PCOS are significantly increased,while the levels of 25(OH)D and FSH are significantly decreased in the infertile patients with PCOS.The increase of HSP70 in the infertile patients with PCOS shows significant phenotypic differences,with significantly higher levels in the infertile patients with typical hyperandrogenic phenotypes of PCOS(including PCOS-A type and PCOS-B type)compared with those with non-hyperandrogenic phenotypes of PCOS(PCOS-D type).There are no significant differences in the distributions of vitamin D deficiency among the patients with four phenotypes of PCOS.High expression of HSP70 is associated with hyperandrogenemia features,whereas vitamin D deficiency is a common metabolic alteration in the infertile patients with PCOS patients and is unrelated to specific clinical phenotypes.

Abstract:Objective To observe the application effect of modified ultrasound-guided fine-needle aspiration cytology(US-FNAC)in examination of thyroid nodules.Methods A total of 330 patients with thyroid nodules who received US-FNAC in General Hospital of Central Theater Command from March 2023 to July 2024 were recruited.The patients were divided into control group(treated with conventional US-FNAC)and observation group(treated with modified US-FNAC)by random number table method,with 165 patients in each group.In the control group,3 patients were excluded subsequently due to the previous history of partial thyroidectomy,and 2 patients were excluded after enrollment because they were diagnosed with nasopharyngeal carcinoma and gastrointestinal stromal tumor.Ultimately,160 patients were included in the control group and 165 patients in the observation group.The control group was treated with non-aspiration conventional US-FNAC using a single-needle,intranodular multi-point puncture technique.The puncture method of the observation group was modified as follows on the basis of that of the control group:(1)sequential punctures using a double-needle technique;(2)fine-needle intranodular multi-site rotating and lifting;(3)syringe negative pressure aspiration.The specimen satisfaction rate of cytological examination,pain condition,and incidence of examination-related adverse reactions were compared between the two groups.Results The specimen satisfaction rate of cytological examination in the observation group was significantly higher than that in the control group(92.12%vs 81.88%,χ2=7.578,P=0.006).The results of subgroup analysis showed that the specimen satisfaction rates of cytological examination in the observation group were significantly higher than those in the control group in the following stratifications:age＜60 years,nodules located in the lower pole,maximum nodule diameter＜5 mm,maximum nodule diameter≥10 mm,nodules with microcalcifications and nodules with macrocalcifications,with statistically significant differences(P＜0.05).The pain condition in the control group was milder than that in the observation group,with statistically significant difference(P＜0.05).There were no statistically significant differences in the incidence rates of hypertension,tachycardia and puncture site bleeding between the two groups after the examination(P＞0.05).Conclusion The modified US-FNAC technique can significantly increase the specimen satisfaction rate for cytological examination of thyroid nodules,and has good clinical application value.

Abstract:Objective To explore the protective mechanism of baicalein(BAL)on cardiomyocyte injury caused by iron overload.Methods An iron-overload cell model was constructed by intervening cardiomyocyte H9c2 with 200 μmol/L ferric citrate(FC)for 24 hours.The protective effects of different concentrations of BAL(3,10,and 30 μmol/L)on cardiomyocytes with iron overload were analyzed.The protective effects of BAL on cardiomyocytes by inhibiting the Kelch-like ECH-associated protein1(Keap1)/nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)pathway(treated with HO-1 inhibitor SnPP or Nrf2 inhibitor ML385)were analyzed.Cell viability was detected by using the CCK-8 assay.The expression levels of inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-6(IL-6)were detected by using real-time quantitative polymerase chain reaction(RT-qPCR).The level of reactive oxygen species(ROS)was detected by using 2',7'-dichlorodihydrofluorescein diacetate(DCFH-DA)fluorescent probe.The expression of 4-hydroxynonenal(4-HNE)was detected by using immunofluorescence staining.The expression levels of oxidative stress indicators of malondialdehyde(MDA)and glutathione(GSH),and iron content were detected by using reagent kits.The expression levels of proteins related to the Keap1/Nrf2/HO-1 pathway and ferroptosis were detected by using Western blot assay.Results BAL could enhance the viability of iron-overloaded H9c2 cells,reduce the expression levels of inflammatory factors of TNF-α,IL-1β and IL-6,as well as oxidative stress indicators of ROS and 4-HNE,making the expression level of MDA decrease and the expression level of GSH increase,and the intervention effects were dose-dependent.In addition,after intervention with BAL,iron deposition in the iron-overloaded H9c2 cells decreased,while the expressions of ferroptosia-related protein solute carrier family 7 member 11(SLC7A11),glutathione peroxidase 4(GPx4),and solute carrier family 3 member 2(SLC3A2)protein increased,and the expression of cyclooxygenase-2(COX-2)protein decreased.The results of Western blot assay showed that BAL activated the Keap1/Nrf2/HO-1 pathway,inhibited the expression of Keap1 protein,and promoted the expressions of Nrf2 and HO-1 proteins,and the intervention effects were dose-dependent.After treatment with SnPP or ML385,the protective effect of BAL on iron-overloaded H9c2 cells weakened,and the cell viability decreased,and the expressions of inflammatory factors increased,and the oxidative stress and lipid peroxidation enhanced,and the iron deposition increased,and the ferroptosis intensified.Conclusion BAL may mitigate iron overload-induced cardiomyocyte injury via activating the Keap1/Nrf2/HO-1 pathway.

Abstract:Objective To decode the temporal transcriptional responses of endothelial cells to distinct shear stress patterns,and to construct a low fluid shear stress(LFSS)molecular features,and to assess its clinical value in pan-cancer prognosis,and to explore the application potential of artificial intelligence(AI)for dynamic mechanobiological prediction.Methods Three independent human endothelial transcriptome datasets related to shear stress were integrated by using the Gene Expression Omnibus(GEO).Robust differentially expressed genes(DEGs)were identified using cross-cohort meta-analysis by weighted Stouffer's Z method.Temporal expression patterns under steady shear stress(ST),oscillatory shear stress(OS),and pulsatile shear stress(PS)were decoded by using Theil-Sen regression and k-means clustering.LFSS scoring was constructed based on LFSS-specific upregulated genes and was evaluated in The Cancer Genome Atlas(TCGA)pan-cancer atlas cohort(n=11 160)by using Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression models.A long short-term memory(LSTM)network model was further constructed to predict shear stress-induced gene expression dynamics and compared with random forest(RF)and support vector regression(SVR)models.Results A total of 811 robust DEGs were identified across the datasets.Temporal analysis revealed that OS induced aberrant cell cycle and DNA replication programs via the sustained activation of the YAP/TAZ signaling axis,whereas PS predominantly triggered a physiological protective response via the KLF2/KLF4 pathway.The LFSS scores were significantly correlated with overall survival in13 types of cancers[false discovery rate(FDR)＜0.05]and were positively correlated with hypoxia and pathological angiogenesis pathways in the tumor microenvironment.The LSTM model outperformed RF and SVR models,with a coefficient of determination(R2)of 0.842 and a mean absolute error(MAE)of 0.068,demonstrating that the LSTM model had superior generalization performance.Conclusion LFSS can induce specific endothelial transcriptional remodeling and has significant prognostic implications in a variety of cancers.LSTM-based AI models can effectively capture the shear stress-related temporal dynamics,providing a novel medico-engineering framework for decoding vascular mechanical abnormalities and supporting the assessment of precise treatment for tumors.

Abstract:The incidence of metabolic diseases is on the rise,seriously affecting people's physical health.Adipose tissue phenotype transformation is a key target for regulating metabolic diseases,promoting adipose tissue browning,significantly improving insulin resistance and energy imbalance,while adipose tissue whitening exacerbates inflammatory responses and accelerates disease progression.In this paper,the research progress in the mechanism of adipose tissue phenotype transformation and its role in metabolic diseases is reviewed.

Abstract:This paper reports a patient undergoing preoperative skull traction combined with posterior occipitocervical fixation and fusion for treatment of atlas fracture and dislocation complicated with Klippel-Feil syndrome.

Abstract:Objective To investigate the association of serum D-dimer(D-D),B cell activating factor(BAFF)and estradiol(E2)levels with outcomes of frozen-thawed embryo transfer(FET)in patients with endometriosis(EMs)complicated with infertility.Methods A total of 116 patients with EMs complicated with infertility who were admitted to Department of Reproductive Genetics,Tangshan Maternal and Children Health Hospital from August 2022 to August 2024 were recruited.The patients were divided into pregnancy group(n=64)and non-pregnancy group(n=52)according to their FET outcomes.The general data and the levels of serum D-D,BAFF and E2 on the first day before performing FET were compared between the two groups.Multivariate logistic regression was used to analyze the factors influencing the FET outcomes of the patients with EMs complicated with infertility.The efficacy of serum D-D,BAFF and E2 levels in predicting failure to conceive in the patients with EMs complicated with infertility after receiving FET was analyzed by using receiver operating characteristic(ROC)curve.Results The levels of serum D-D,BAFF and E2 in the non-pregnancy group were significantly higher than those in the pregnancy group(P＜0.05).The results of multivariate logistic regression analysis showed that higher levels of serum D-D[OR(95%CI)=1.346(1.056-1.716)],BAFF[OR(95%CI)=1.439(1.027-2.016)]and E2[OR(95%CI)=1.652(1.121-2.435)]were independent risk factors for failure to conceive in the patients with EMs complicated with infertility after receiving FET(P＜0.05).The results of ROC curve analysis showed that the levels of serum D-D,BAFF and E2 could effectively predict failure to conceive in the patients with EMs complicated with infertility after receiving FET(P＜0.05),and the predictive efficacy of the combination of the three indicators was significantly better than that of a single indicator(Zcombination of the three indicators-D-D=2.875,P=0.004;Zcombination of the three indicators-BAFF=3.205,P=0.001;Zcombination of the three indicators-E2=3.791,P＜0.001).Conclusion The elevated levels of serum D-D,BAFF and E2 are risk factors for FET failure in the patients with EMs complicated with infertility.The combined detection of the three indicators is helpful for the early identification of high-risk patients and active intervention,thereby improving the success rate of FET.

Abstract:Objective To observe the adverse reactions of high-dose methotrexate(HD-MTX)in treatment of childhood acute lymphoblastic leukemia(ALL),and to analyze the influencing factors of delayed methotrexate(MTX)excretion.Methods A retrospective analysis was conducted on the clinical data of 74 pediatric patients with ALL who were admitted to Department of Pediatrics,the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 to December 2020.HD-MTX-based chemotherapy was performed on 321 cases according to Chinese Children's Cancer Group ALL-2015(CCCG-ALL-2015)protocol.The blood drug concentration of MTX greater than 1.0 μmol/L after 44 hours of HD-MTX treatment,or that of MTX greater than 0.3 μmol/L after 68 hours of HD-MTX treatment was defined as delayed MTX excretion.The adverse events were graded according to National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0(NCI-CTCAE v5.0).The grades of adverse events≥gradeⅡwere defined as HD-MTX chemotherapy-related and clinically significant adverse reactions.The correlation between the occurrence of adverse reactions and risk stratification as well as immunophenotypes was analyzed.The factors influencing the occurrence of delayed excretion of MTX at 44 hours and 68 hours after HD-MTX treatment were analyzed.Results Among the 74 pediatric patients with ALL,40 patients were male(54.05%)and 34 patients were female(45.95%),aged from 1 to 14 years old,with a median age of 4 years old.Risk stratification was low-risk in 73 cases(22.74%),intermediate-risk in 217 cases(67.60%),and high-risk in31cases(9.66%).The immunophenotyping results revealed Blineage in304cases(94.70%)and Tlineage in 17 cases(5.30%).Fusion gene types were BCR/ABL1 in 34 cases(10.59%),ETV6/RUNX1 in 42 cases(13.08%),other types in13 cases(4.05%),and fusion gene was negative in232 cases(72.27%).Myelosuppression(62.62%)was the most common in adverse reactions of gradesⅡ-Ⅳin the ALL pediatric patients after HD-MTX chemotherapy,followed by gastrointestinal reactions(including diarrhea and constipation,31.78%)and oral mucositis(30.53%).There was no statistically significant difference in the occurrence of adverse reactions after HD-MTX treatment between the pediatric patients with B lineage ALL and those with T lineage ALL(P＞0.05).There were no statistically significant differences in the incidence rates of myelosuppression,infection,oral mucositis and gastrointestinal reaction among the ALL pediatric patients with different risk stratifications after HD-MTX treatment(P＞0.05).The incidence of liver damage in the pediatric patients with low-risk ALL was significantly lower than that in the pediatric patients with intermediate-risk ALL(P＜0.05),while there was no statistically significant difference in the incidence of liver damage between the pediatric patients with intermediate-risk ALL and those with high-risk ALL(P＞0.05).The results of multivariate logistic regression analysis indicated that age＞7-14 years[OR(95%CI)=13.022(1.396-121.436),P=0.024]and fusion gene type of ETV6/RUNX1[OR(95%CI)=5.863(1.641-20.948),P=0.006]were independent risk factors for promoting delayed MTX excretion at 44 hours after HD-MTX treatment.Conclusion The main adverse reactions of HD-MTX in treatment of childhood ALL are myelosuppression,gastrointestinal reaction and oral mucositis.Age＞7-14 years and fusion gene type of ETV6/RUNX1 are independent risk factors for promoting delayed MTX excretion at 44 hours after HD-MTX treatment.

Abstract:Objective To analyze the effects of the hospital-community collaborative management model on postoperative blood pressure control,neurological function and quality of life in moyamoya disease patients.Methods A total of 247 patients with moyamoya disease who underwent cerebral revascularization in Beijing Tiantan Hospital,Capital Medical University from January 2022 to December 2023 were recruited.The patients enrolled from January 2022 to September 2022 were taken as control group(136 patients),and those enrolled from October 2022 to December 2023 were taken as observation group(111 patients).The control group received the standardized nursing care plan after neurosurgical operation,without intervention of the hospital-community collaborative management.The observation group received a unified management plan of"multi-disciplinary collaboration+community collaborative management".Both groups were intervened for 12 weeks.The systolic blood pressure,diastolic blood pressure,Karnofsky Performance Status(KPS)scores,modified Rankin Scale(mRS)scores,language function scores in Chinese Aphasia Battery(CAB)scale and World Health Organization Quality of Life-BREF Scale(WHOQOL-BREF)(Chinese version)scores were compared between the two groups before and after the intervention.Results Ultimately,183 patients were included in the analysis,with 94 cases in the control group and 89 cases in the observation group,and the exclusion rate was 25.91%.Before the intervention,there were no statistically significant differences in systolic blood pressure and diastolic blood pressure between the two groups(P＞0.05).After the intervention,the systolic blood pressure and diastolic blood pressure in both groups were significantly lower than those before the intervention(P＜0.05),and the systolic blood pressure and diastolic blood pressure in the observation group were significantly lower than those in the control group after the intervention(P＜0.05).The KPS scores in the observation group were significantly higher than those in the control group at 4 weeks after the intervention(T3)and 12 weeks after the intervention(T4)(P＜0.05).At the time points of T3 and T4,the language function scores in CAB scale and the mRS scores in the observation group were significantly lower than those in the control group(P＜0.05).After the intervention,the scores in physiological,psychological,environmental and social relationship dimensions of the WHOQOL-BREF(Chinese version)in both groups were significantly higher than those before the intervention(P＜0.05),and these scores in the observation group were significantly higher than those in the control group after the intervention(P＜0.05).Conclusion The hospital-community collaborative management model can significantly improve the blood pressure control,neurological function and quality of life in moyamoya disease patients after neurosurgical operation.

Abstract:European Society for Medical Oncology(ESMO)guidance on the use of Large Language Models in Clinical Practice(ELCAP),released by ESMO in 2025(the 2025 ELCAP),provides the first international consensus framework for the standardized application of large language models(LLMs)in oncology.This paper aims to deeply interpret the core essence of the 2025 ELCAP from the perspective of experts in the integration of medicine and engineering,and explores the unique challenges faced by the 2025 ELCAP in the clinical application of oncology in China.The 2025 ELCAP utilizes a Delphi consensus process to categorize LLMs applications into three primary systems:patient-facing(type 1),healthcare professional-facing(type 2),and background management(type 3),and establishes 22 key consensus statements.The authors believe that the release of the 2025 ELCAP marks the transition of AI oncology from"spontaneous exploration"toward"standardized governance".Its core value lies in the establishment of risk prevention and control principles based on"human-machine collaboration and human oversight".In light of the clinical environment in China,this paper suggests focusing on the vertical optimization of Chinese medical LLMs,the establishment of hierarchical regulatory systems that align with local ethical requirements,and the development of auxiliary decision-making interfaces featuring Traditional Chinese Medicine(TCM)characteristics.These efforts aim to facilitate the reliable translation of generative AI within precision oncology.

Abstract:Advanced thyroid cancer remains a clinical challenge due to the limited effectiveness of traditional treatments.Although molecular targeted therapy can prolong the progression-free survival of the patients,the problem of drug resistance limits its long-term effectiveness.The combination of immunotherapy with targeted therapy or radioiodine shows potential for synergy,but the overall efficacy still needs further optimization.In this paper,the research progress in precision medicine for advanced thyroid cancer is reviewed.

Abstract:Acute respiratory distress syndrome(ARDS)is a life-threatening critical illness.In recent years,the role of nuclear receptor neuron-derived clone 77(Nur77)in pathogenesis of ARDS has gradually attracted attention.Nur77,as a nuclear transcriptional regulatory protein,is widely distributed in various tissues and cells.The expression of Nur77 is influenced by various external stimuli.Nur77 is involved in the pathophysiological processes of ARDS by regulating multiple mechanisms such as metabolic reprogramming,immune homeostasis balance,and inflammatory signal transduction.In this paper,the research progress in the role of Nur77 in pathogenesis of ARDS is reviewed.