最新刊期
卷 51 ， 期 3 ， 2026
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Guideline for the diagnosis and treatment of head-thorax-abdomen (pelvis) polytrauma (2026 edition) AI导读
摘要：Head-thoraco-abdominal polytrauma cases are complex in condition, and their clinical management involves multidisciplinary collaboration, urgently requiring standardized clinical guidance. Therefore, this guideline was led by the Department of Neurosurgery, Chinese PLA General Hospital, and developed by a working group consisting of multidisciplinary experts from thoracic surgery, general surgery, orthopedics, critical care medicine, anesthesiology, radiology, emergency medicine, nursing and other related disciplines. Based on a systematic search of authoritative literature and combining the trauma care characteristics of China's military and civilian medical systems, this guideline was formulated through multiple rounds of expert voting and consensus voting. This guideline covers 22 key clinical issues spanning the core links of polytrauma care, including imaging assessment strategies, damage control resuscitation, decision-making on the priority of craniocerebral and torso injury management, anticoagulation and hemostasis management, intensive care, and early rehabilitation interventions. Addressing common clinical controversies, the guideline presents 22 recommendations based on a synthesis of quality of evidence and implementability, with clear defined implementation points and quality control indicators. This guideline emphasizes a comprehensive trauma care philosophy centered on vital sign stability, guided by damage control, and supported by multidisciplinary collaboration, advocating for the establishment of standardized protocols and a tiered trauma care system. It aims to provide evidence-based foundation and clinical pathways for the diagnostic assessment, damage control, surgical timing selection, and acute phase management of trauma of head-thoraco-abdominal polytrauma, to enhance the consistency and timeliness of multidisciplinary trauma care. By following scientifically validated assessment and decision-making protocols, it is expected to reduce the early mortality of patients with polytrauma and improve their long-term neurological prognosis.关键词：head-thorax-abdomen polytrauma;damage control resuscitation;diagnosis;surgery;guideline for diagnosis and treatment61|0|0更新时间：2026-04-14
Guideline and Consensus
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摘要：ObjectiveTo investigate the clinical value of 1 mg dexamethasone combined with the adrenocorticotropic hormone (ACTH) stimulation test in the differential diagnosis of unilateral and bilateral subtypes of primary aldosteronism (PA).MethodsA retrospective analysis was conducted on the clinical data of PA patients who underwent the ACTH stimulation test at the Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital, between January 1, 2020, and April 30, 2024. A total of 360 patients with PA were definitively diagnosed through a comprehensive evaluation, including surgical pathology, adrenal venous sampling (AVS), imaging features, clinical characteristics, and treatment response. These patients were classified into unilateral primary aldosteronism (UPA, n=167) and bilateral primary aldosteronism (BPA, n=193); and according to ACTH dosage, they were divided into 25 U ACTH group (n=136) and 50 U ACTH group (n=224). The levels of plasma aldosterone (PAC) and the ratio of plasma aldosterone to concurrent plasma cortisol (F) (PAC/F) at 30, 60, 90, and 120 minutes after ACTH stimulation were compared among the different groups. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic performance of the ACTH stimulation test in distinguishing UPA from BPA and other types of PA was analyzed.ResultsNo significant differences were observed in the PAC and PAC/F at each time point during the ACTH stimulation test between 25 U ACTH group and 50 U ACTH group (P>0.05). The area under the ROC curve (AUC) for PAC values used to differentiate UPA from BPA was highest at 90 min (0.94), with an optimal cut-off point of 37.85 ng/dl. In unilateral lesions, the AUC of PAC values for differentiating adrenal adenoma (APA) from unilateral adrenal hyperplasia (UAH) was highest at 120 min (0.826), with an optimal cut-off point of 58.65 ng/dl. The AUC of PAC values for differentiating APA from BPA was highest at 90 min (0.961), with an optimal cut-off point of 39.05 ng/dl. The AUC of PAC values for differentiating UAH from BPA was highest at 60 min (0.889), with an optimal cut-off point of 39.25 ng/dl.ConclusionsThe 1 mg dexamethasone combined with 25 U ACTH stimulation test has similar diagnostic cut-offs for distinguishing UPA from BPA as the 50 U ACTH test. The ACTH stimulation test can be used not only for the differentiation of UPA and BPA but also for the differential diagnosis of various subtypes within unilateral and bilateral PA.关键词：primary aldosteronism;unilateral primary aldosteronism;bilateral primary aldosteronism;ACTH stimulation test;differential diagnosis of subtypes14|99|0更新时间：2026-04-14 -
摘要：ObjectiveTo establish and validate a nomogram prediction model for medium- to long-term adenohypophyseal dysfunction (APD) in postoperative patients with non-functioning pituitary adenoma (NFPA).MethodsThis study was designed as a retrospective cohort study. A total of 305 NFPA patients who underwent surgery at the Second Hospital of Lanzhou University from June 2018 to June 2024 were included. The involvement patterns of various adenohypophyseal axes were analyzed. The dataset was randomly divided into a training set (n=244) and a validation set (n=61) at an 8:2 ratio. Multivariate logistic regression analysis was used to identify risk factors for medium- to long-term postoperative APD and to construct nomogram models. The models' discrimination, calibration, and clinical applicability were assessed using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA).ResultsSingle-axis, dual-axis, and triple-axis involvement of adenohypophyseal function most commonly presented as the growth hormone (GH) axis, GH+thyroid-stimulating hormone (TSH) axis, and GH+TSH+adrenocorticotropic hormone (ACTH) axis combinations, respectively. Multivariate analysis showed that male sex, tumor volume, serum sodium, apolipoprotein B, preoperative triiodothyronine (T3) index, preoperative insulin-like growth factor 1 (IGF-1) index, short-term postoperative IGF-1, and absence of postoperative hormone replacement therapy (HRT) were independent risk factors for APD with ≥1 involved axis (P<0.05). Maximum tumor diameter, serum chloride, serum albumin, preoperative APD with ≥1 involved axis, short-term postoperative T3 and prolactin (PRL), short-term postoperative APD with ≥2 involved axes, and absence of postoperative HRT were independent risk factors for APD with ≥2 involved axes (P<0.05). Visual impairment, maximum tumor diameter, lactate dehydrogenase, preoperative IGF-1 index, short-term postoperative TSH and PRL, and absence of postoperative HRT were independent risk factors for ACTH-axis APD (P<0.05). Maximum tumor diameter, serum chloride, preoperative APD with ≥1 involved axis, short-term postoperative PRL and cortisol, and absence of postoperative HRT were independent risk factors for TSH-axis APD (P<0.05). The AUC values (training set/validation set) for predicting APD with ≥1 involved axis, APD with ≥2 involved axes, ACTH-axis APD, and TSH-axis APD were 0.91/0.82, 0.94/0.98, 0.93/0.82, and 0.88/0.90, respectively, indicating excellent predictive performance of the constructed models. The Hosmer-Lemeshow test and calibration curves demonstrated good consistency between predicted probabilities and actual risks (P>0.05). DCA confirmed that the models provided clinical net benefit across a wide range of threshold probabilities.ConclusionThe constructed nomogram models exhibit good predictive performance, but their generalizability requires further validation with external data.关键词：non-functioning pituitary adenoma;adenohypophyseal dysfunction (APD);risk factors;nomogram;prediction model16|0|0更新时间：2026-04-14 -
摘要：ObjectiveTo explore the risk factors associated with osteopenia in young and middle-aged males based on the health examination dataset, and to develop a predictive model and evaluate its performance.MethodsA total of 989 healthy young and middle-aged male participants who underwent health examination at the 961st Hospital of the Joint Logistics Support Force between May 2022 and May 2024 were included in the retrospective study. The dataset was randomly divided into a training set (n=692) and a validation set (n=297) at a 7:3 ratio. The occurrence of osteopenia in participants was defined as the primary study endpoint. Independent risk factors were selected via LASSO regression. Six machine learning models, including extreme gradient boosting, support vector machine, multivariate logistic regression, K-nearest neighbors, light gradient boosting machine, and random forest, were employed to predict osteopenia in the study subjects. The optimal model was identified based on metrics including the area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and the Brier score. The high-risk probability threshold was determined using the principle of maximizing the Youden index. Calibration and clinical utility of the best-performing model were assessed using calibration curves and decision curve analysis. Finally, the SHAP method was applied to interpret the predictions of the optimal model.ResultsEight independent factors for osteopenia in young and middle-aged male participants were identified: smoking status, high-density lipoprotein cholesterol, triglyceride level, red blood cell count, regular exercise, serum albumin level, hemoglobin level, and uric acid level. Six machine learning models were constructed using different algorithms. Among them, the RF model demonstrated the best predictive performance, achieving the highest validation set AUC of 0.706 (95%CI 0.644-0.769), specificity (0.884), positive predictive value (0.704), negative predictive value (0.708), and accuracy (0.704). It also yielded the optimal Brier score of 0.0301 (0.0283-0.0322). The maximum Youden index was 0.384, corresponding to a sensitivity of 0.579 and a specificity of 0.805. The calibration curve for the validation set showed minimal deviation within the probability range of 0.20-0.65. The decision curve for the validation set indicated a positive net benefit within the risk threshold range of 0.12-0.65, supporting its potential utility in decision-making.ConclusionSmoking status, high-density lipoprotein cholesterol, triglyceride level, red blood cell count, regular exercise, serum albumin level, hemoglobin level, and uric acid level are independent influencing factors for osteopenia in young and middle-aged males. The prediction model constructed based on these factors demonstrates satisfactory predictive performance and can provide evidence-based decision support for clinical diagnosis and treatment.关键词：osteopenia;machine learning;SHAP method;decision support15|265|0更新时间：2026-04-14 -
摘要：ObjectiveTo explore the factors influencing sagittal angle error of the femoral component following total knee arthroplasty (TKA) in patients with advanced knee osteoarthritis.MethodsThis retrospective study enrolled 120 patients with advanced knee osteoarthritis who underwent TKA in the Second Affiliated Hospital of Inner Mongolia Medical University from June 2021 to June 2024. Using a 4:1 ratio, patients were divided into a training set (n=96) and a test set (n=24) via stratified random sampling. Based on the sagittal femoral prosthesis flexion angle (FPFA) on the full-length radiograph at 6 months postoperatively, patients in training set were categorized into well-aligned group (n=42) and malaligned group (n=54). Clinical data, perioperative indicators and imaging parameters at different postoperative time points were compared between the two groups. Repeated measures analysis of variance was used to evaluate the trend of postoperative femoral radiographic parameters at different time points, and to analyze the time-group interaction effect. Six machine learning algorithms, including logistic regression, K-nearest neighbor, support vector machine, naive Bayes, multilayer perceptron, and extreme gradient boosting (XGBoost), were employed in training set to construct prediction models for sagittal angle error of femoral prosthesis after TKA. The performance of 6 machine learning models was evaluated and compared. Summary plots and feature dependence plots were drawn using R software to interpret the constructed machine learning models. Multiple linear regression analysis was used to analyze the relationship between FPFA and various influencing factors.ResultsCompared with well-aligned group, malaligned group had higher visual analogue scale score, whole blood high-shear viscosity, whole blood low-shear viscosity, plasma viscosity, red blood cell (RBC) aggregation index, fibrinogen and D-dimer levels, as well as a longer hospital stay. Conversely, the Hospital for Special Surgery score, range of motion, and RBC deformation index were significantly lower, while prothrombin time (PT) and activated partial thromboplastin time (APTT) were shorter (P<0.05). Compared with the values at 1 month postoperatively, the anterior femoral bowing angle, femoral lateral bending angle, and lateral angle of the femoral mechanical axis were increased in malaligned group at 3 and 6 months postoperatively (P<0.05); compared with 3 months postoperatively, these three angles were further increased in the malaligned group at 6 months postoperatively (P<0.05). Compared with well-aligned group, malaligned group showed a larger anterior femoral bowing angle at both 3 and 6 months postoperatively, and larger femoral lateral bending angle and lateral femoral mechanical axis angle at 6 months postoperatively (P<0.05). Recursive feature elimination with 5-fold cross-validation identified 7 optimal candidate variables for risk factors, namely ROM, RBC aggregation index, PT, APTT, anterior femoral bowing angle, femoral lateral bending angle, and lateral femoral mechanical axis angle. Finally, the XGBoost model was determined as the best machine learning model for predicting postoperative sagittal angle error of the femoral prosthesis, with a sensitivity of 0.845(95%CI 0.789-0.892), specificity of 0.801(95%CI 0.754-0.863), accuracy of 0.814(95%CI 0.762-0.885), and ROC-AUC of 0.812(95%CI 0.765-0.864). The SHAP summary plot showed that the candidate variables with significant effects on malalignment were, in order, anterior femoral bowing angle, ROM, lateral femoral mechanical axis angle, RBC aggregation index, PT, APTT, and femoral lateral bending angle. Analysis of the feature dependence plots of the top 6 SHAP values revealed that the risk of malalignment gradually increased with the increase of anterior femoral bowing angle, lateral femoral mechanical axis angle, and RBC aggregation index, the decrease of ROM, and the shortening of PT and APTT. The results of multiple linear regression analysis showed that anterior femoral bowing angle, lateral femoral mechanical axis angle, RBC aggregation index, and femoral lateral curve angle were independent risk factors for changes in sagittal FPFA on the full-length radiograph at 6 months postoperatively, while ROM, PT, and APTT were independent protective factors (P<0.05).ConclusionAnterior femoral bowing angle, lateral femoral mechanical axis angle, RBC aggregation index, femoral bending angle, ROM, PT, and APTT are influencing factors for sagittal angle error of the femoral prosthesis after TKA in patients with advanced knee osteoarthritis.关键词：advanced knee osteoarthritis;total knee arthroplasty;femoral prosthesis;sagittal angle error11|0|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the impact of X-box binding protein 1 (XBP1) derived from M2-type macrophages on oxaliplatin (Ox) resistance in colorectal cancer (CRC) cells by modulating sterol regulatory element binding protein 2 (SREBP2).MethodsHCT116, SW480, and LoVo cells were cultured in Ox-containing medium for 48 h. The cell line that was most sensitive to Ox was selected, and the CRC-Ox resistant cell line was established by the method of gradually increasing drug concentration. Ox-sensitive parental cells (HCT116-S) and Ox-resistant cells (HCT116-R) were treated with M0-conditioned medium (M0-CM) and M2-CM, respectively, to observe the effects of M0-CM and M2-CM on the cells. According to the treatment conditions, the cells were divided into M0-CM+HCT116-S group, M2-CM+HCT116-S group, M0-CM+HCT116-R group, and M2-CM+HCT116-R group. To study the effect of XBP1 activation in M2-type macrophages on the growth and OX-resistance of HCT116 cells, HCT116-R cells were divided into overexpression negative control (oe-NC) M2-CM group (M2oe-NC-CM group), M2oe-NC-CM+Ox group, XBP1 overexpression M2-CM group (M2oe-XBP1-CM group), and M2oe-XBP1-CM+Ox group. To study the effect of SREBP2 knockdown on HCT116-R cells, HCT116-R cells were divided into normal control group, SREBP2 small interference RNA group (si-SREBP2 group), M2oe-XBP1-CM group, and si-SREBP2+M2oe-XBP1-CM group. CCK-8 assay was used to detect the viability of HCT116 cells in each group. The invasion capacity of CRC cells was detected by Transwell assay. Flow cytometry was used to detect the apoptosis rate. The mRNA level of SREBP2 was detected by qRT-PCR. The protein expression levels of XBP1 and SREBP2 were detected by Western blotting. M2-type macrophages and HCT116 cells transfected with empty vector or oe-XBP1 were subcutaneously inoculated into nude mice to construct a tumor-bearing nude mouse model. The tumor volume and weight were compared among groups, and the expression levels of XBP1 and SREBP2 in tumors were detected by immunohistochemical staining.ResultsThe results of CCK-8 assay showed that, compared with SW480 and LoVo cell lines, Ox could significantly inhibit the viability of HCT116 cells (P<0.05). Compared with M0-CM+HCT116-S group, cell viability and invasion capacity in M2-type-CM+HCT116-S group were significantly increased, while the apoptosis rate was significantly decreased (P<0.05). Compared with M0-CM+HCT116-R group, cell viability and invasion capacity in M2-CM+HCT116-R group were significantly increased, while the apoptosis rate was significantly decreased (P<0.05). Compared with M0-CM+HCT116-R group, the XBP1 protein expression level in cells of M2-CM+HCT116-R group was notably increased (P<0.05). Compared with M2oe-NC-CM group, cell viability and invasion capacity in M2oe-XBP1-CM group were significantly increased, and the apoptosis rate was significantly decreased (P<0.05). Compared with M2oe-NC-CM+Ox group, overexpression of XBP1 significantly increased the expression levels of SREBP2 mRNA and protein (P<0.05). Compared with control group, cell viability and invasion capacity were decreased, while the apoptosis rate was significantly increased in si-SREBP2 group (P<0.05). Compared with M2oe-XBP1-CM group, the cell viability and invasion capacity in si-SREBP2+M2oe-XBP1-CM group were decreased, and cell apoptosis was increased (P<0.05). In vivo experimental results showed that overexpression of XBP1 reversed the inhibition of Ox on tumor growth and upregulated SREBP2 protein expression in nude mice (P<0.05).ConclusionXBP1 derived from M2-type macrophages significantly enhances Ox resistance in CRC cells by activating SREBP2.关键词：M2 macrophages;X-box binding protein 1;colorectal cancer;oxaliplatin13|148|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the association between periodontitis and plasma phosphorylated tau217 (p-tau217), and to assess the mediating effect of serum inflammatory biomarkers in this association.MethodsA cross-sectional study design was adopted. Participants were recruited from March to November 2024 at the Department of Periodontology, First Affiliated Hospital of Shandong Second Medical University. Patients with periodontitis and normal cognitive function were included in the periodontitis group (n=127). Meanwhile, volunteers with normal cognitive function who had gingivitis or were clinically periodontally healthy served as control group (n=61). Clinical data of participants were collected, and clinical periodontal examinations were performed, including probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), bleeding index (BI), plaque index (PLI), and periodontal inflamed surface area (PISA). Plasma p-tau217 levels and serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and IL-1β were measured using enzyme-linked immunosorbent assay (ELISA). Spearman's rank correlation analysis was used to assess correlations between clinical periodontal parameters and blood biomarkers. The association between periodontitis and plasma p-tau217 was evaluated using multiple linear regression, and a mediation analysis was conducted to assess the role of serum inflammatory biomarkers in this association.ResultsThe two groups were comparable in sex, age, years of education, body mass index (BMI), and cognitive scores (P>0.05). The proportion of smokers and all periodontal parameters (PD, CAL, BI, BOP, PISA) were significantly higher in periodontitis group (P<0.05 or P<0.001). Compared with control group, plasma p-tau217 and serum hs-CRP, IL-6, TNF-α, and IL-1β in periodontitis group were significantly elevated (P<0.001). Spearman rank correlation analysis revealed that plasma p-tau217 was positively correlated with all clinical periodontal parameters (PD, CAL, BOP, BI, PLI, and PISA, P<0.001) and with serum hs-CRP, TNF-α, IL-6, and IL-1β (P<0.001). After adjusting for covariates, multiple linear regression analysis revealed a significant positive association between periodontitis and plasma p-tau217 levels (β=2.699, 95%CI 2.172-3.226, P<0.001). Plasma p-tau217 levels increased with the severity of periodontitis (Ptrend<0.001). Mediation analysis demonstrated that, after adjusting for covariates, serum hs-CRP, TNF-α, IL-6, and IL-1β all mediated the association between periodontitis and plasma p-tau217, with mediating effect proportions of 47.32%, 34.24%, 17.53%, and 36.45%, respectively.ConclusionPeriodontitis is associated with elevated plasma p-tau217 levels, and serum inflammatory biomarkers mediate this association.关键词：periodontitis;phosphorylated tau217;inflammatory factors;mediating effect11|219|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the predictive value of the advanced lung cancer inflammation index (ALI) for in-hospital major adverse cardiovascular events (MACEs) following percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).MethodsClinical data of 681 STEMI patients who underwent emergency PCI at the Department of Cardiology, the 904th Hospital of the Joint Logistics Support Force of PLA from November 2016 to March 2022 were retrospectively collected, including general information, laboratory indicators, and imaging parameters. ALI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated. Patients were divided into MACEs group (n=241) and non-MACEs group (n=440) based on the occurrence of in-hospital MACEs. Clinical characteristics were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of ALI for in-hospital MACEs, and then to compare it with those of NLR, PLR, and SII. Spearman rank correlation was employed to analyze the correlation between ALI and the Gensini score. Univariate and multivariate logistic stepwise regression analyses were performed to identify independent factors influencing in-hospital MACEs. A nomogram prediction model was constructed based on the independent factors and internally validated using the Bootstrap method (1000 resamples). The model's discrimination and calibration were assessed using the Hosmer-Lemeshow goodness-of-fit test, calibration curve, decision curve analysis (DCA), and ROC curve.ResultsThe ALI index was significantly lower in MACEs group than in non-MACEs group (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of preoperative ALI for predicting in-hospital MACEs was 0.675 (95%CI 0.638-0.710), with an optimal cut-off value of 188.07, sensitivity of 58.51%, and specificity of 79.55%. The predictive performance of ALI was superior to that of NLR, PLR, and SII (P<0.01). Correlation analysis revealed a negative correlation between the ALI index and the Gensini score (r=-0.149, P<0.001). Univariate logistic analysis identified age, diabetes, Killip class ≥Ⅱ, C-reactive protein, troponin Ⅰ, myoglobin, left main coronary artery lesion, left anterior descending artery lesion, left circumflex artery lesion, right coronary artery lesion, left ventricular ejection fraction (LVEF), Gensini score, ALI>188.07, white blood cell count, and number of vascular lesions ≥2 as influencing factors for in-hospital MACEs (P<0.05). Multivariate logistic analysis demonstrated that age (OR=1.042, 95%CI 1.023-1.062, P<0.001), Killip class ≥Ⅱ on admission (OR=11.023, 95%CI 6.738-18.032, P<0.001), and Gensini score (OR=1.012, 95%CI 1.003-1.020, P=0.006) were independent risk factors for in-hospital MACEs, while LVEF (OR=0.895, 95%CI 0.859-0.933, P<0.001) and preoperative high ALI index (>188.07) (OR=0.249, 95%CI 0.156-0.397, P<0.001) were independent protective factors. The nomogram prediction model, incorporating age, Killip class, LVEF, Gensini score, and ALI index, showed a consistency index (C-index) of 0.892 upon internal validation. The model's AUC was 0.895 (95%CI 0.867-0.923), with a sensitivity of 79.7% and specificity of 87.5%. The Hosmer-Lemeshow test indicated good model fit (χ²=8.02, P=0.43).ConclusionsPreoperative ALI index is an independent protective factor for in-hospital MACEs in STEMI patients after PCI. The nomogram model combining age, Killip class, LVEF, Gensini score, and ALI index demonstrates good predictive performance for in-hospital MACEs.关键词：advanced lung cancer inflammation index;ST-segment elevation myocardial infarction;major adverse cardiovascular events;percutaneous coronary intervention12|0|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the relationship between serum Lipocalin-2 (LCN-2), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), calprotectin (S100A8/A9) and clinical outcomes in elderly patients with acute liver failure (ALF) complicated by hepatic encephalopathy (HE).MethodsClinical data of 242 ALF patients admitted to the Department of Infectious Diseases, Xinyu City People's Hospital from May 2018 to May 2024 were collected for retrospective analysis. After excluding cases with missing key variables exceeding 20%, the propensity score matching method was used to assign patients to HE group (n=100) and non-HE group (n=100) at a 1:1 ratio. Serum levels of LCN-2, sTREM-1, and S100A8/A9 were measured. The clinical outcomes of ALF patients complicated by HE were analyzed, and based on these outcomes, the patients were categorized into poor outcome group (n=55) and good outcome group (n=45). Multivariate logistic regression was used to analyze factors influencing clinical outcomes in ALF patients complicated by HE. The value of LCN-2, sTREM-1, and S100A8/A9 in predicting clinical outcomes was assessed using receiver operating characteristic (ROC) curve analysis. Hosmer-Lemeshow test was employed to evaluate the goodness-of-fit of the model.ResultsSerum levels of LCN-2, sTREM-1 and S100A8/A9 in HE group were higher than those in non-HE group (P<0.05). Among the 100 ALF patients with HE, 45 cases had good outcomes (all showed improvement), while 55 had poor outcomes (36 deteriorated and 19 died). Serum levels of LCN-2, sTREM-1, and S100A8/A9 in poor outcome group were significantly higher than those in good outcome group (P<0.05). West-Haven grade, international standardized ratio (INR), LCN-2, sTREM-1, and S100A8/A9 were identified as risk factors for poor clinical outcomes in ALF patients with HE (P<0.05). The areas under the ROC curve (AUC) for LCN-2, sTREM-1, and S100A8/A9 in predicting clinical outcome were 0.763, 0.784, and 0.757, respectively. The combined prediction model yielded an AUC of 0.937, which was significantly higher than that of any single indicator (P<0.05). Hosmer-Lemeshow test results showed a good model fit (χ²=5.326, P=0.326).ConclusionElevated serum levels of LCN-2, sTREM-1, and S100A8/A9 in elderly ALF patients with HE are associated with adverse clinical outcomes, and the combination of these three biomarkers demonstrates high predictive value for poor outcomes.关键词：acute liver failure;hepatic encephalopathy;elderly;clinical outcome;lipocalin-2;soluble triggering receptor expressed on myeloid cells-1;calprotectin11|75|0更新时间：2026-04-14
Clinical Research
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摘要：ObjectiveTo investigate the neuroprotective effects of total saponins of Trillium tschonoskii Maxim. (TST) on vascular dementia (VD) rats and to explore its effect on the regulation of mitophagy and the hypoxia-inducible factor-1α (HIF-1α)/adenovirus E1B 19 kD-interacting protein (BNIP3) pathway.MethodsSixty SD rats were randomly divided into sham group, model group, TST group [100 mg/(kg·d), 28 d], and donepezil group [0.45 mg/(kg·d), 28 d], with 15 rats in each group. Except for sham group, the VD rat model was established by bilateral common carotid artery occlusion (2-VO). Behavior performance of rats was assessed by Morris water maze and novel object recognition tests. Pathological changes of brain tissue were observed through HE and Nissl staining. The ultrastructural changes of mitochondria in brain tissue were observed by transmission electron microscopy. The expression levels of HIF-1α, Beclin1, and microtubule-associated protein 1 light chain 3B (LC3B) in brain tissue were detected by immunohistochemistry. The protein expression levels of HIF-1α, BNIP3, Beclin1, and LC3B in the hippocampus were detected by Western blotting.ResultsCompared with sham group, model group rats exhibited prolonged escape latency (P<0.01), and fewer platform crossings (P<0.01), and a lower discrimination index (P<0.01). Histopathological analysis revealed disorganized neuronal arrangement, reduced Nissl bodies, and severe neuronal damage. Mitochondria displayed swelling and cristae disruption. The number of HIF-1α-, Beclin1-, and LC3B-positive neurons was significantly reduced in brain tissue. Hippocampal protein levels of HIF-1α, BNIP3, Beclin1, and LC3B were also decreased (P<0.05). Compared with model group, rats in TST and donepezil groups showed shortened escape latency (P<0.01), increased platform crossings (P<0.05), and an increased discrimination index (P<0.01). Neuronal arrangement improved, Nissl bodies increased, and mitochondrial damage was alleviated. The number of HIF-1α-, Beclin1-, and LC3B-positive neurons increased in brain tissue. The protein levels of HIF-1α, BNIP3, Beclin1 and LC3B in hippocampus were markedly upregulated (P<0.05 or P<0.01).ConclusionTST may promote mitophagy and the clearance of damaged mitochondria, thereby alleviating neuronal pathological damage in VD rats by activating the HIF-1α/BNIP3 signaling pathway.关键词：total saponins of Trillium tschonoskii Maxim;vascular dementia;mitochondrial autophagy;HIF-1α/BNIP3 signaling pathway9|322|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the effect of microRNA-375 (miR-375) on proliferation and apoptosis of IL-22-induced human keratinocytes by targeting forkhead box protein M1 (FOXM1).MethodsSkin lesion tissues from psoriasis patients (experimental group, n=35) and normal skin tissues from individuals undergoing plastic surgery (control group, n=35) were collected retrospectively. qRT-PCR was employed to quantify the expression levels of miR-375 and FOXM1 mRNA in tissues and cells. Human keratinocyte HaCaT cells were randomly divided into control group, IL-22 group, miR-NC group, miR-375 group (overexpression of miR-375), miR-375+pcDNA group (overexpression of miR-375), and miR-375+FOXM1 group (overexpression of miR-375 and FOXM1). Except for control group, all other groups were treated with IL-22. Cell proliferation was assessed by MTT assay and EdU staining. Flow cytometry was used to evaluate cell-cycle distribution and apoptosis. Transwell assays were conducted to assess chemotactic capability. ELISA was performed to quantify the levels of IL-6, IL-17A, CXCL1, and CXCL2 in cells. Western blotting was used to measure expression levels of FOXM1, B-cell lymphoma-2 (Bcl-2) protein, and Bcl-2-asociated X protein (Bax). The targeting relationship between miR-375 and FOXM1 was validated by a dual-luciferase reporter assay.ResultsCompared with control group, experimental group exhibited decreased miR-375 expression and increased FOXM1 mRNA expression in skin tissues (P<0.05). Compared with control group, IL-22 group showed decreased expression level of miR-375, the proportion of cells in the G0/G1 phase, apoptosis rate, and Bax protein expression (P<0.05), while showing increased cell viability, EdU staining cell rate, S-phase proportion, number of migrated cells, and the protein expression levels of IL-6, IL-17A, CXCL1, CXCL2, FOXM1, and Bcl-2 in HaCaT cells (P<0.05). Compared with miR-NC group, miR-375 group showed increased expression level of miR-375, the proportion of cells in the G0/G1 phase, apoptosis rate, and Bax protein expression (P<0.05), while showing decreased cell survival rate, EdU staining positive cell rate, S-phase cell proportion, number of migrated cells, and the expression levels of FOXM1, Bcl-2, IL-6, IL-17A, CXCL1, and CXCL2 in HaCaT cells (P<0.05). Compared with miR-375+pcDNA group, miR-375+FOXM1 group showed a decreased proportion of cells in the G0/G1 phase (P<0.05), and an increased S-phase cell proportion and number of migrated cells in HaCaT cells (P<0.05). The dual-luciferase reporter assay showed that miR-375 could bind wild-type FOXM1.ConclusionmiR-375 could inhibit proliferation and promote the apoptosis of IL-22-induced human keratinocytes by targeting FOXM1.关键词：microRNA-375;forkhead box protein M1;keratinocytes;proliferation;apoptosis9|168|0更新时间：2026-04-14 -
摘要：ObjectiveTo investigate the effects of microRNA-22-3p (miR-22-3p) on the proliferation and apoptosis of alveolar epithelial cells induced by Streptococcus pneumoniae (S. pneumoniae), as well as the targeting relationship between miR-22-3p and thioredoxin-interacting protein (TXNIP).MethodsAlveolar type Ⅱ epithelial cells (AEC Ⅱ) were randomly divided into 8 groups: control group, model group, miR-NC group, miR-22-3p mimics group, si-NC group, si-TXNIP group, miR-22-3p mimics+pcDNA3.1 group, and miR-22-3p mimics+pcDNA3.1-TXNIP group. Cells in control group received no treatment, while those in model group were infected with S. pneumoniae. Cells in other groups were transfected with miRNA or DNA prior to S. pneumoniae infection. The expression levels of miR-22-3p and TXNIP mRNA were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation ability was assessed using the cell counting Kit-8 (CCK-8) assay. Cell apoptosis was detected by Annexin V staining. The levels of interleukin (IL)-6 and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA). The protein expression levels of B-cell lymphoma-2 (Bcl-2)-associated X protein (Bax), Bcl-2, Cleaved caspase-3, and TXNIP were determined by Western blotting. A dual-luciferase reporter assay was performed to verify the targeted regulatory relationship between miR-22-3p and TXNIP.ResultsCompared with control group, model group showed decreased cell proliferation ability, as well as reduced expression levels of miR-22-3p, IL-10, and Bcl-2 protein (P<0.05), while exhibiting increased cell apoptosis rate, along with elevated expression levels of TXNIP mRNA, IL-6, Bax, Cleaved caspase-3, and TXNIP protein (P<0.05). Compared with model group and miR-NC group, miR-22-3p mimics group exhibited enhanced cell proliferation ability, and increased expression levels of miR-22-3p, IL-10, and Bcl-2 protein (P<0.05), while the cell apoptosis rate and expression levels of TXNIP mRNA, IL-6, Bax, Cleaved caspase-3, and TXNIP protein were significantly reduced (P<0.05). For si-TXNIP group, there was no significant difference in the expression levels of miR-22-3p compared with model group and miR-NC group (P>0.05), but cell proliferation ability and the expression levels of IL-10 and Bcl-2 protein were increased (P<0.05), and the cell apoptosis rate and expression levels of TXNIP mRNA, IL-6, Bax, Cleaved caspase-3, and TXNIP protein were decreased (P<0.05). Compared with miR-22-3p mimics group and miR-22-3p mimics+pcDNA3.1 group, miR-22-3p mimics+pcDNA3.1-TXNIP group showed no significant change in the expression levels of miR-22-3p expression (P>0.05), but decreased cell proliferation ability and reduced expression levels of IL-10 and Bcl-2 protein (P<0.05), along with increased cell apoptosis rate and elevated expression levels of TXNIP mRNA, IL-6, Bax, Cleaved caspase-3, and TXNIP protein (P<0.05). Dual-luciferase reporter assay confirmed that miR-22-3p could directly bind to TXNIP.ConclusionsOverexpression of miR-22-3p can downregulate the expression of TXNIP, thereby inhibiting the apoptosis and promoting the proliferation of alveolar epithelial cells infected with S. pneumoniae.关键词：microRNA-22-3p;thioredoxin-interacting protein;Streptococcus pneumoniae;alveolar epithelial cells;proliferation;apoptosis11|0|0更新时间：2026-04-14
Basic Research
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摘要：Microglia (MG) is an important and inherently innate immune cell in brain tissue. It can play the roles of phagocytosis of pathogens, killing of target cells, antigen presentation, immunomodulation, anti-inflammatory repair, and promotion of neuronal survival, etc. Cerebral ischemia-reperfusion injury (CIRI) is a severe cerebrovascular disease caused by vascular blood flow recanalization secondary to ischemic stroke. In the early stage of CIRI, over-activated M1-type MGs lead to injuries such as inflammatory storm and blood-brain barrier disruption, and in the later stage, M2-type polarization plays a crucial role in anti-inflammatory and functional repair of tissues. However, the interventional therapeutic mechanisms associated with MG and its reprogramming in CIRI have not been clarified. The aim of this paper is to review the potential therapeutic strategies of CIRI based on MG phenotypic regulation, i.e., MG is involved in alleviating CIRI through phagocytosis and anti-inflammatory and repairing effects, and its anti-inflammatory, anti-oxidative stress, and pro-regenerative abilities are significantly enhanced by metabolic reprogramming and polarization to M2 phenotype, which improves the prognosis by removing cellular debris, inhibiting neuroinflammation, and promoting tissue remodeling, and provides a reference for the in-depth research on MG therapy for CIRI.关键词：cerebral ischemia-reperfusion injury;macrophages;microglia;microglia polarization;metabolic reprogramming12|601|0更新时间：2026-04-14 -
摘要：Neuronal compartmentalized mitochondrial biogenesis is a complex and precise biological process that involves the dynamic generation of mitochondria in different neuronal compartments, such as soma, axons, and synapses. As the "power plants" and metabolic hubs of neurons, mitochondria require their biogenesis to be strictly regulated in a spatiotemporal manner to meet the energy demands and signal transmission needs of neurons in different functional compartments. In recent years, studies have shown that mitochondrial biogenesis is closely related to neuronal survival, neurite plasticity, and the pathogenesis of several neurological diseases. Modulating key signaling pathways governing compartmentalized mitochondrial biogenesis may improve neuronal energy metabolism and function, thereby offering promising intervention strategies for the treatment of neurological diseases. This review summarizes the research progress on mitochondrial biogenesis in soma and axons of neuron, and its role in neurological diseases.关键词：neuron;compartmentalization;mitochondrial biogenesis;peroxisome proliferator-activated receptor gamma coactivator-1α;mammalian target of rapamycin7|129|0更新时间：2026-04-14 -
摘要：The treatment of osteonecrosis of the femoral head (ONFH) is distinctly different depending on whether the femoral head collapses or not. The progression of early ONFH to collapse correlates with the nature and physical parameters of the necrotic focus. Therefore, accurate assessment of the prognosis of necrotic foci in the early stages of the focus is important for the selection of clinical treatment options. Currently, the prediction of collapse in ONFH mainly relies on radiographs and MRI images, and the risk of collapse is predicted by calculating the location, area, volume, and angle of the necrotic focus in the femoral head. Numerous studies have shown that the risk of collapse is higher when the necrotic focus is located in the anterior or lateral part of the femoral head, accounts for a larger proportion of the femoral head's area or volume, occupies the entire femoral head, especially the weight-bearing region, at a larger angle. However, collapse progression is the result of a combination of factors, and past prediction methods only considered the influence of a single factor on collapse progression, resulting in their limited predictive value. To improve the accuracy of collapse prediction, it is necessary to synthesize the effects of various risk factors on collapse progression. By reviewing the characteristics and predictive value of different ONFH collapse prediction methods, this article aims to provide a more reliable basis for clinical prediction of collapse risk and prognosis in patients with ONFH.关键词：osteonecrosis, femoral head;collapse;prediction18|434|0更新时间：2026-04-14 -
摘要：Venous thromboembolism(VTE)includes deep vein thrombosis(DVT) and pulmonary embolism(PE)with high mortality and increasing morbidity. Early recognition and diagnosis of VTE is of great clinical significance. Metabolomics is a new discipline that performs qualitative and quantitative analysis of all low molecular weight metabolites of an organism or cell during a specific physiological period. In recent years, many studies have used metabolomics analysis to determine metabolites in patients and experimental animal models with VTE, and a series of biomarkers with potential early diagnosis value have been obtained. Moreover, according to the pathway enrichment analysis of differential metabolites, it is concluded that the pathophysiological processes of VTE may be related to the imbalance of nutrient and energy metabolism, cell signaling, carnitine metabolism, purine metabolism, intestinal microbial metabolism, inflammation and oxidative stress, and genetic correlation. In addition, metabolomics also has certain value in risk stratification and prognosis, clinical efficacy evaluation and clinical monitoring of PE. However, further studies are needed to implement metabolomics for clinical application of VTE. This review summarizes the progress of metabolomics research on early diagnosis, pathogenesis, risk stratification, and clinical efficacy evaluation of VTE.关键词：pulmonary embolism;deep vein thrombosis;venous thromboembolism;metabolomics7|436|0更新时间：2026-04-14 - 摘要：Organoids are three-dimensional tissue-like structures derived from adult stem cells or pluripotent stem cells through in vitro induction and differentiation. In recent years, organoids have been paid significant attention to in the medical field as in vitro models that are highly similar to human tissues. Currently, organoids are widely applied in gynecological and obstetric disease research, with applications mainly involving drug screening, investigation of physiological and pathological mechanisms, and regenerative medicine. This review is intended to compare traditional models with organoid models in gynecological and obstetric disease research, focus on the recent advances that have been made in the optimization of organoid culture systems, summarize the latest applications and research progress of various organoids (such as endometrial organoids, endometrial cancer organoids, and ovarian cancer organoids), and explore the current limitations and potential future directions for the research and application of organoids in gynecology and obstetrics.关键词：organoids;endometrial cancer;ovarian cancer16|336|0更新时间：2026-04-14
Review
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