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摘要：Maxillofacial blast injuries often cause extensive composite defects involving bone, soft tissue, and peripheral nerves, making repair and reconstruction extremely challenging. Reconstruction of the maxillofacial region is not limited to closure of tissue defects but also requires restoration of mastication, speech, facial expression, and appearance. In recent years, substantial progress has been achieved in the management of maxillofacial blast injuries with respect to bony reconstruction, soft-tissue repair, nerve restoration, and functional rehabilitation. Conventional approaches, including internal fixation, nonvascularized autologous bone grafting, vascularized osseous free flaps, skin grafting, free flap transfer, and nerve grafting, remain the mainstay of treatment; however, they are constrained by donor-site morbidity, tissue mismatch, infection risk, and incomplete functional recovery. Emerging techniques such as virtual surgical planning, virtual reality and augmented reality-assisted navigation, tissue engineering, biomaterial-based scaffolds, 3D printing, bioprinting, and nerve conduits have expanded reconstructive options and shown promising potential for improving precision and regeneration. This review systematically summarizes representative studies on reconstruction of bone, soft tissue, and nerve injuries after maxillofacial blast trauma, analyzes the advantages and limitations of conventional methods, highlights recent technical advances, and discusses current controversies and future directions, with the aim of providing references for optimizing reconstructive strategies and improving long-term quality of life in affected patients.关键词：maxillofacial injuries;blast injuries;repair and reconstruction;tissue engineering;facial nerve1|0|0更新时间：2026-07-24 -
摘要：ObjectiveTo investigate the change characteristics of serum uric acid (SUA) in young males after ascending from the plains to plateaus at varying altitude, focusing on the prevalence of hyperuricemia (HUA) and cumulative incidence of gout as well as their influencing factors after different durations of residence at extremely high altitude (>5500 m).MethodsA prospective cohort study design was adopted. Young males scheduled to ascend from the plains to the plateau from April to December 2023 were enrolled. Prior to plateau entry, participant recruitment, informed consent acquisition, structured questionnaires (covering sociodemographic characteristics, lifestyle, and prior plateau exposure history), physical examinations, and fasting venous blood sampling were completed. A total of 651 participants were ultimately enrolled and divided into three groups by actual residential altitude: 3000-4000 m group (n=200), 4000-5500 m group (n=200), and >5500 m group (n=251). Serum uric acid and related biomarkers were re-examined for all participants 3 months after plateau migration; only the >5500 m group was followed up for an additional 3 months until the 6th month post-migration. Psychological status was assessed using the Zung Self-Rating Anxiety Scale (SAS) and Zung Self-Rating Depression Scale (SDS). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for HUA and gout at extremely high altitudes.ResultsAt the plain baseline, the overall HUA prevalence among all participants was 19.1%. Three months after plateau settlement, the HUA prevalence rates of 3000-4000 m, 4000-5500 m, and >5500 m groups were 51.5%, 59.0%, and 68.5%, respectively, with statistically significant intergroup differences (P<0.001); the cumulative incidence of gout was 3.0%, 4.0%, and 6.4%, respectively, also showing significant intergroup disparities (P<0.001). In the >5500 m group, the mean SUA level rose from (475.31±113.50) μmol/L at 3 months to (485.25±109.62) μmol/L at 6 months (P=0.003), and the HUA prevalence rose from 68.5% to 70.1% (P=0.016), while the cumulative incidence of gout increased from 6.4% to 7.2% (P=0.632). Univariate analysis identified altitude, body mass index (BMI), waist circumference, previous plateau ascents, red meat intake, and exercise intensity as candidate variables for multivariate models. Multivariate logistic regression revealed that high altitude (OR=1.028, P<0.001), high BMI (OR=1.237, P<0.001), and high-intensity exercise (OR=5.217, P=0.008) were independent risk factors for HUA; elevated serum uric acid was an independent risk factor for gout (OR=1.014, P<0.001), whereas oxygen inhalation was an independent protective factor against gout (OR=0.284, P=0.004).ConclusionIn young males ascending from plains to high-altitude regions, serum uric acid levels and the risk of HUA and gout increase with higher altitude and longer duration of stay. High altitude, high BMI, and high-intensity exercise are independent risk factors for hyperuricemia. Hyperuricemia is an independent risk factor for gout, and oxygen inhalation exerts an independent protective effect against gout.关键词：hyperuricemia;gout;extremely high altitude;risk factors13|0|0更新时间：2026-07-23 -
摘要：Splicing factor 3B subunit 1 (SF3B1) is a core component of the U2 small nuclear ribonucleoprotein and plays an essential role in the regulation of pre-mRNA splicing. SF3B1 mutations induce aberrant branchpoint recognition and activation of cryptic 3' splice sites, thereby causing abnormal splicing of downstream target genes. These alterations affect multiple pivotal signaling pathways, including erythropoiesis, cell cycle regulation, DNA damage response and metabolic reprogramming. In myelodysplastic neoplasms (MDS), SF3B1 mutations are associated with ring sideroblast phenotypes and favorable clinical prognosis. Conversely, in chronic lymphocytic leukemia (CLL), such mutations correlate with disease progression, drug resistance and poor prognosis. Meanwhile, SF3B1 mutations act as a major driver of age-related clonal hematopoiesis, revealing the molecular link between aging and myeloid neoplasms. Currently, a variety of novel targeted therapies and neoantigen-based immunotherapies targeting the SF3B1K700E variant, which exploit synthetic lethal vulnerabilities caused by SF3B1 mutations, are under intensive investigation and show promising clinical potential. This article systematically reviews the regulatory mechanisms, mutational characteristics, prognostic significance and advances in targeted therapy of SF3B1, aiming to provide insights for basic research and precision clinical management of hematological malignancies.关键词：splicing factor 3B subunit 1;splicing factor;myelodysplastic neoplasms;hematologic malignancies;prognostic biomarker;targeted therapy9|0|0更新时间：2026-07-23 - 摘要：The incidence of asymptomatic hyperuricemia and gout has displayed a prominent younger-onset trend, and the superimposition of multisystem comorbidities poses substantial challenges to routine clinical management. Based on recent domestic and international research advances, this editorial elaborates on foundational interventions including lifestyle optimization and gut microbiota modulation; It further stratifies anti-inflammatory regimens for acute gout flares and urate-lowering therapy for intercritical periods, while comparing the therapeutic efficacy and safety limitations of conventional agents; particular emphasis is placed on dissecting the developmental prospects of innovative pharmaceuticals, such as nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 (NLRP3) inflammasome antagonists, novel selective urate transporter 1 (URAT1) inhibitors, and dual-target compounds with both anti-inflammatory and urate-lowering activities. This work also addresses the medication dilemmas encountered in special populations (adolescents, pregnant and lactating women, and males preparing for conception), as well as core principles for managing gout complicated by cardiovascular, renal and metabolic disorders or upper gastrointestinal bleeding. Current clinical frameworks are hampered by multiple limitations, including sluggish clinical translation of novel drugs, insufficient therapeutic regimens tailored for special populations, and incomplete elucidation of the pathogenetic mechanisms underlying gout-related comorbidities. This article intends to provide evidence-based references for future precise, individualized clinical practice and translational research innovation in asymptomatic hyperuricemia and gout.关键词：hyperuricemia;gout;nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3;urate-lowering therapy;interleukin-110|0|0更新时间：2026-07-15
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摘要：ObjectiveTo investigate how matrix metalloproteinase 8 (MMP-8) and MMP-12 affect long-term axonal regeneration and glial scar formation after optic nerve crush injury in rats.Methods192 male Sprague-Dawley (SD) rats were randomly divided into control group and transfection group, with 96 rats in each group. A unilateral optic nerve crush injury was produced in the right eye of every rat. At the lesion site, rats in transfection group received lentiviral vectors carrying MMP-8 and MMP-12 overexpression constructs. Rats in control group received the same volume of empty-vector lentivirus. Optic nerve tissue was collected on postoperative day 7, 14, 21, and 28. Western blotting and quantitative real-time PCR (qRT-PCR) were used to measure the protein and mRNA expression of MMP-8, MMP-12, glial fibrillary acidic protein (GFAP), and neuroglial antigen 2 (NG2) , respectively. Retinal ganglion cell (RGC) axonal regeneration was evaluated by anterograde tracing with cholera toxin B subunit (CTB).ResultsCTB tracing showed axonal regrowth in transfection group. Labeled axons crossed the lesion site by day 14, reached the optic chiasm by day 21, and extended into the hypothalamus by day 28. In contrast, no CTB-labeled axons beyond the retina were found in control group at any time point. Compared with control group, rats in transfection group showed significant higher expression level of MMP-8 and MMP-12 protein, and significant lower expression level of NG2 mRNA and protein, and GFAP mRNA (P0.05 or P0.01) at postoperative day 7, 14, 21, and 28; and significant lower expression level of GFAP protein (P0.01) at postoperative day 21 and 28.ConclusionsMMP-8 and MMP-12 overexpression reduces glial scar formation by lowering the expression of the scar-associated markers GFAP and NG2, supports long-distance regeneration of RGC axons after optic nerve injury. MMP-8 and MMP-12 may serve as therapeutic targets for optic nerve repair.关键词：optic nerve injury;axonal regeneration;matrix metalloproteinase-8;matrix metalloproteinase-12;glial scar11|0|0更新时间：2026-07-15 -
摘要：ObjectiveTo evaluate whether the addition of hyperbaric oxygen (HBO) to human umbilical cord mesenchymal stem cell (hUCMSC) therapy offers incremental benefits in repairing hypoxic ovarian injury evoked by simulated high-altitude exposure in mice.MethodsA total of 64 female BALB/c mice were randomized into control group, model group, hUCMSCs group, and hUCMSCs+HBO group, with 16 mice in each group. Except for control group, all mice were placed in a hypobaric chamber mimicking an altitude of 6500 m for 15 days to generate ovarian hypoxic lesions. Mice in hUCMSCs group and hUCMSCs+HBO group received 0.2 ml of hUCMSC suspension (1×10⁶ cells) via the tail vein once per week for five consecutive weeks, whereas mice in control group and model group were given sterile saline at matching volumes. Mice in hUCMSCs+HBO group was additionally subjected to 100-min HBO sessions once daily for 30 days. Multiple parameters were recorded, including general health status, body-weight fluctuations, estrous cycle regularity, serum sex hormone concentrations, ovarian wet-weight index, differential follicle counts, ovarian histomorphological features, and protein levels of TGF‑β1 and Smad3 as determined by immunoblotting. Fertility performance and offspring condition were also documented.ResultsAfter 30 days of treatment, compared with control group, mice in model group showed a significant reduction in body weight, bilateral ovarian wet weight, ovarian index, primordial follicle stock, TGF-β1 protein content, and litter production (P0.01 or P0.001), concurrent with a pronounced expansion of fibrotic deposition within the ovarian stroma (P0.05). Compared with model group, mice in hUCMSCs group and hUCMSCs+HBO group showed a significant increase in body weight, ovarian mass, and ovarian index (P0.001), and a notable regression of stromal fibrotic areas (P0.05); and mice in hUCMSCs+HBO group showed a significant increase of TGF-β1 and Smad3 expression (P0.01 or P0.001) and augmented litter size (P0.05). Serum sex hormone assays revealed no significant intergroup differences (P0.05). Other than litter-size variations, all offspring appeared phenotypically unremarkable across four groups.ConclusionsIn the setting of simulated high-altitude-induced ovarian injury, combining HBO with hUCMSCs produces superior restorative outcomes compared with hUCMSC administration alone. The improved efficacy likely arises from coordinated actions involving fibrosis mitigation, TGF-β1/Smad3 pathway engagement, and stimulation of follicular maturation.关键词：plateau;ovarian injury;hyperbaric oxygen;human umbilical cord mesenchymal stem cells;combination therapy9|0|0更新时间：2026-07-13 -
摘要：ObjectiveTo establish an in vitro culture method for vascular stem cells derived from the posterior vena cava of rats, providing suitable seed cells for studies in vascular regenerative medicine.MethodsThe posterior vena cava was aseptically isolated from 1-month-old Sprague Dawley rats. Primary cells were cultured by enzymatic digestion combined with tissue explant adherence method, which were subsequently expanded and purified through differential digestion and low-density passaging. Cell growth was continuously observed and recorded throughout the culture period. Passage 8 (P8) target cells were analyzed via flow cytometry for the expression levels of surface markers CD90, CD73, CD45, CD44, CD34, CD29, and CD11b/c. Adipogenic, osteogenic, and chondrogenic differentiation potentials were assessed through induction, followed by Oil Red O, Alizarin Red, and Alcian Blue staining, respectively. A scratch assay was performed to evaluate cell migration rate, and a tube formation assay was conducted to assess tubulogenesis.ResultsUnder inverted microscopy, fibroblast-like cells were observed migrating from venous tissue explants 3 days after primary culture, with cell clones appearing by day 4. Between days 5 and 8, cell clusters gradually expanded, fused, and exhibited monolayer growth. During passaging, cells proliferated rapidly, requiring subculturing every 2~3 days. By P8, cells exhibited a homogeneous, typical fibroblast-like spindle morphology without signs of senescence or abnormal differentiation. P8 cells highly expressed mesenchymal markers CD90 (99.50±0.10)%, CD73 (97.40±0.61)%, CD44 (96.23±0.60)%, and CD29 (99.43±0.06)%, while showing low expression of hematopoietic/endothelial markers CD45 (1.76±0.25)%, CD34 (0.87±0.41)%, and CD11b/c (1.57±0.38)%. Following induction, lipid droplets, calcium nodules, and cartilage spheroids were observed in adipogenic, osteogenic, and chondrogenic cultures, respectively, with corresponding positive staining results. Scratch wounds healed completely within 24 hours, indicating efficient migration, and cells formed temporally stable tube-like structures on Matrigel.ConclusionVenous-derived vascular stem cells of rat were successfully isolated and expanded, with mesenchymal stem cell characteristics, robust migratory ability, and tube-forming capacity, suitable for vascular regenerative medicine research in venous diseases.关键词：vascular stem cells;vein;culture and expansion;surface markers;multidirectional differentiation potential;vascular regenerative medicine9|0|0更新时间：2026-07-13 -
摘要：Radiomics for colorectal cancer (CRC) is evolving from manual feature modeling toward an evidence-based framework centered on quantifiable imaging phenotypes. Unsupervised, self-supervised, and weakly supervised learning can alleviate the cost and bias of annotation, improve robustness and reproducibility of results, and mitigate instability and overfitting caused by high-dimensional features. By using Shapley additive explanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM) to identify key regions or contributing factors, together with habitat analysis to characterize intratumoral spatial heterogeneity, imaging evidence can be made more verifiable to support diagnostic stratification and treatment decision-making. Integrating multimodal imaging with clinical, pathological, and molecular information enhances the ability to predict treatment response, recurrence risk, and survival outcomes, while strengthening decision support under conditions of missing and imbalanced modalities. Standardized imaging database development, ethically compliant data governance, and real-world evidence platforms provide the foundation for cross-institutional comparability and verification. Looking forward, executable implementation pathways should be established, and findings from retrospective studies should be advanced toward multicenter prospective validation to further enable practical deployment of human–machine collaborative intelligent diagnosis and treatment.关键词：colorectal cancer;artificial intelligence;radiomics;habitat analysis;precision medicine8|0|0更新时间：2026-07-13 - 摘要：ObjectiveTo investigate the differences in clinicopathological features of metabolic dysfunction-associated fatty liver disease (MAFLD) in the context of different metabolic syndrome (MetS) components, aiming to inform and improve clinical management.MethodsA total of 222 patients with MAFLD who underwent liver biopsy and histopathological examination during hospitalization from January 2019 to December 2024 were enrolled. Hepatic steatosis, activity, and fibrosis were assessed using the steatosis, activity, and fibrosis (SAF) scoring system within the fatty liver inhibition of progression (FLIP) algorithm (SAF/FLIP). Based on the components of MetS, patients were stratified into groups with overweight/obesity, hyperglycemia, hypertension, dyslipidemia, and hyperuricemia, as well as their respective control groups (normal BMI, non-hyperglycemia, non-hypertensive, non-dyslipidemic, and non-hyperuricemic). Differences in clinical and pathological characteristics between groups, as well as factors influencing metabolic dysfunction-associated steatohepatitis (MASH) and severe MAFLD, were analyzed.ResultsA total of 96.4% of patients had at least one MetS component, with the detection rates of MASH and severe MAFLD being 91.9% and 66.2%, respectively. Compared to their respective control groups, the SAF/FLIP scores were significantly higher in patients with overweight/obesity, hyperglycemia, and hyperuricemia. Furthermore, patients with hyperglycemia and hypertension exhibited significantly higher aspartate aminotransferase (AST) to alanine aminotransferase ratio, fibrosis-4 index score, proportions of severe MAFLD, as well as higher mean Ridit values for lobular inflammation and liver fibrosis stage (P0.05). Patients who were overweight/obese or had hyperuricemia showed significantly higher mean Ridit values for hepatic steatosis compared to their controls (P0.05). Apart from an interaction between hyperuricemia components and hyperglycemia components [Wald χ²=4.964, OR=0.204, P=0.026, 95% CI (0.051~0.826)], both hypertension components and hyperglycemia components were independently associated with MASH, liver fibrosis, and severe MAFLD (P0.05)), while overweight/obesity was significantly associated with liver fibrosis and severe MAFLD (P0.05)). After adjusting for sex and age, the factors independently associated with MASH were hyperglycemia component [OR=9.036, 95% CI (1.075~75.979)], hypertension component [OR=3.952, 95% CI (1.042~14.984)], and serum AST [OR=1.039, 95% CI (1.008~1.071)]. For severe MAFLD, influencing factors were overweight/obesity [OR=1.848, 95% CI (1.165~2.932)], hyperglycemia component [OR=3.078, 95% CI (1.397~6.782)], hypertension component [OR=2.551, 95% CI (1.219~5.341)], serum ALB [OR=0.856, 95% CI (0.768~0.955)], and serum AST [OR=1.018, 95% CI (1.006~1.030)].ConclusionMetS components are highly prevalent in patients with MAFLD, and their associations with liver pathological damage vary. Among the factors associated with an increased risk of MASH and severe MAFLD, apart from established MetS components (overweight/obesity, hyperglycemia, hypertension) and lower ALB as well as higher AST levels, an interaction between hyperuricemia and hyperglycemia contributes to the progression of severe MAFLD.关键词：metabolic dysfunction-associated fatty liver disease;metabolic syndrome;pathology;steatohepatitis;liver fibrosis;clinical characteristics16|0|0更新时间：2026-07-13
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摘要：ObjectiveTo investigate the association between appendicular skeletal muscle mass index (ASMI) and low ankle-brachial index (ABI) in adults, and to examine the potential mediating role of C-reactive protein (CRP) in this association.MethodsData for this study were drawn from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), including 5,966 participants aged ≥40 years. Low ABI was defined as ABI≤0.90. Weighted multivariable logistic regression models were employed to evaluate the association of ASMI (modeled as a continuous variable and in quartiles) with low ABI, and restricted cubic spline (RCS) analysis was used to characterize the shape of the relationship. Subgroup analyses were performed to assess potential heterogeneity, and bootstrap-based mediation analysis was conducted to quantify the indirect effect through CRP.ResultsIn the unadjusted model, ASMI was significantly inversely associated with the risk of low ABI (OR=0.85, 95%CI 0.77-0.93, P<0.001). After full adjustment for age, sex, race/ethnicity, education level, poverty income ratio, history of hypertension, history of diabetes, smoking status, and body mass index, the association became stronger (OR=0.66, 95%CI 0.54-0.79, P<0.001). When ASMI was categorized into quartiles, the risk of low ABI decreased sequentially from Q2 to Q4 compared with the lowest quartile (Q1); the greatest risk reduction was observed in the highest quartile (Q4) (adjusted OR=0.36, 95%CI 0.19-0.69). Restricted cubic spline analysis demonstrated a linear dose–response relationship (Pnonlinearity=0.794), with the risk of low ABI declining monotonically as ASMI increased. Subgroup analyses confirmed that this protective association was consistent in direction across subgroups defined by sex, age, hypertension, diabetes, and smoking status, with no statistically significant interactions (Pinteraction>0.05). Mediation analysis revealed that the indirect effect of CRP reached statistical significance but the magnitude was small; the mediated proportion was only 3.08% (indirect effect=-0.0041, P<0.001), indicating that the association was driven primarily by the direct pathway.ConclusionHigher ASMI showed a linear inverse association with the risk of low ABI. Mediation analysis demonstrated that CRP explained only 3.08% of the total association, suggesting that maintaining or increasing muscle mass may represent a potential strategy for the prevention of peripheral arterial disease.关键词：sarcopenia;appendicular skeletal muscle mass index;ankle-brachial index;C-reactive protein;peripheral artery disease;mediation analysis19|0|0更新时间：2026-07-06 -
摘要：ObjectiveTo investigate the metabolic characteristics of rats with hypothermia and hemorrhagic shock based on plasma metabolomics, and to screen for specific biomarkers.MethodsA total of 140 Sprague-Dawley rats were randomly divided into control group and hypothermic environment combined with uncontrolled lethal hemorrhagic shock (H-UHS) group (n=70). Following 12 h of exposure to -15 ℃, an uncontrolled hemorrhagic shock model was established in rats of H-UHS group. Vital signs, blood gas, biochemical, and coagulation parameters were subsequently measured. Plasma metabolomic profiling was performed using ultra-high-performance liquid chromatography-tandem mass spectrometry. Differential metabolites were screened by 3D-principal component analysis (3D-PCA), orthogonal partial least-squares discrimination analysis (OPLS-DA), and weighted gene co-expression network analysis (WGCNA). Feature metabolites were further identified through cross-validation with three machine learning algorithms: least absolute shrinkage and selection operator (LASSO), support vector machine with recursive feature elimination (svm-rfe), and random forest (RF). Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.ResultsCompared with control group, the rats in H-UHS group exhibited significant reductions in mean arterial pressure (MAP), heart rate (HR), and respiratory rate (RR), along with elevated blood lactate, decreased bicarbonate, significantly increased hepatic enzymes, cardiac troponin T, and D-lactate, and prolonged coagulation time, with the difference is statistically significant (P<0.05). A total of 1,470 differential metabolites were identified by metabolomic analysis, primarily enriched in fructose and mannose metabolism, steroid hormone biosynthesis, and secondary bile acid biosynthesis pathways. Cross-validation using three machine learning algorithms identified four overlapping characteristic metabolites: prephenic acid, selenocysteine, 2'-deoxyuridine-5'-diphosphate, and phosphoethanolamine, with areas under the receiver operating characteristic curve (AUCs) of 0.945, 0.979, 0.953, and 0.991, respectively.ConclusionPrephenic acid, selenocysteine, 2'-deoxyuridine-5'-diphosphate, and phosphoethanolamine may serve as potential diagnostic biomarkers for hypothermia combined with hemorrhagic shock.关键词：metabonomics;hypothermia;hemorrhagic shock;biomarkers13|0|0更新时间：2026-07-06 -
摘要：ObjectiveTo investigate the prospective association between the Chinese visceral adiposity index (CVAI) and the risk of incident sarcopenia in older adults.MethodsWe conducted an analysis of 4,570 participants from the China Health and Retirement Longitudinal Study (CHARLS) who were free from sarcopenia at baseline (2011), with a mean age of 57.3 years and 46.9% being female. Employing the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, incident sarcopenia was diagnosed at the 4-year follow-up (2015), defined as the concurrent presence of reduced appendicular skeletal muscle mass (assessed by bioelectrical impedance analysis) along with either decreased handgrip strength or impaired physical performance. Multivariable logistic regression was applied to estimate the odds ratio (OR) of incident sarcopenia per interquartile range (IQR) increase in the baseline CVAI, with adjustments for age, sex, education level, residential area, marital status, smoking habits, alcohol consumption, sleep duration, and systolic/diastolic blood pressure. Restricted cubic spline (RCS) analysis was used to explore the dose-response relationship, and the incremental predictive value of CVAI was assessed by calculating Nagelkerke R2. Furthermore, the robustness of the results was examined through sensitivity analysis (excluding participants with CVAI<50) and subgroup analysis, while internal validation was performed using 1,000 bootstrap resamples.ResultDuring the 4-year follow-up period, 287 individuals developed sarcopenia (incidence rate: 6.3%). In the fully adjusted model, a higher CVAI was associated with a significantly lower risk of incident sarcopenia compared to a lower CVAI (OR=0.23; 95%CI 0.18-0.30; P<0.001). RCS analysis indicated an approximately linear inverse association between CVAI and incident sarcopenia (P for non-linearity=0.173). Incorporating CVAI into the traditional covariate model improved predictive performance, with the Nagelkerke R2 increasing from 0.173 to 0.255 (ΔR2=0.081, likelihood ratio test P<0.001). The results remained robust in the sensitivity analysis after excluding participants with CVAI<50 (OR=0.21, 95%CI 0.15-0.28). Bootstrap internal validation yielded results highly consistent with the primary analysis (Bootstrap OR=0.232, 95% BCa CI 0.181-0.304), further confirming the reliability of the findings. Subgroup and interaction analyses revealed that neither sex (P for interaction=0.104) nor age (P for interaction=0.532) significantly modified this association.ConclusionAmong the middle-aged and elderly Chinese population, a higher CVAI, a surrogate indicator of metabolically functional visceral adipose tissue, is independently and negatively correlated with the new-onset risk of sarcopenia. The findings suggest that metabolic reserve, rather than simply being "emaciated", may be associated with organismal resilience during muscle aging. CVAI may serve as a simple and readily accessible tool for early risk identification, providing a reference for sarcopenia prevention through maintaining metabolic health. The results also indicate that evaluating health solely based on body weight or body shape may have limitations, and maintaining sufficient metabolic reserve may be of great significance for preserving muscle function.关键词：sarcopenia;Chinese visceral adiposity index;visceral adiposity;metabolic reserve;prospective cohort study12|0|0更新时间：2026-07-06 -
Research progress in host-directed therapy against respiratory viral pandemics and drug resistance AI导读
摘要：Respiratory viruses such as influenza and SARS-CoV-2 have repeatedly triggered global pandemics, with their rapid evolutionary capacity limiting the efficacy of existing prevention and control measures. Host-directed therapy (HDT), a novel approach targeting host factors essential for viral replication and persistence rather than the virus itself, offers dual advantages: high resistance barriers and broad-spectrum antiviral activity. However, its clinical translation faces multiple challenges, including relatively limited efficacy as monotherapy, safety risks associated with targeting essential host factors, and a narrow therapeutic window for immune modulation. This paper systematically reviews the research progress of HDT in combating respiratory viral infections, focusing on elucidating the mechanisms of action, key host targets, and the current status of candidate drug development for different HDTs. It aims to provide referrence for addressing emerging respiratory infectious diseases and the challenge of drug resistance.关键词：host-directed therapy;broad-spectrum antiviral;influenza virus;SARS-CoV-214|0|0更新时间：2026-07-06 -
摘要：ObjectiveTo explore the clinical characteristics, diagnosis, treatment regimens and prognosis of adult patients with iatrogenic diaphragmatic hernia (IDH) following partial hepatectomy, and to provide evidence for clinical practice.MethodsA retrospective analysis was performed on the clinical data of three adult patients. All patients were admitted to the Department of Gastrointestinal, Colorectal and Anal Surgery of Shulan (Hangzhou) Hospital from January 2021 to December 2025 and diagnosed with IDH after partial hepatectomy. Relevant literature was retrieved from PubMed, CNKI and Wanfang Databases, from which clinical data of an additional 92 IDH patients were extracted for pooled analysis.ResultsIn the 3 IDH cases, the median age at diagnosis was 67 years, with a median interval of 9 months from liver surgery to IDH onset; 1 case was right-sided and 2 left-sided, involving small intestinal herniation in 1 case and gastric and omental herniation in 2 cases. All 3 patients underwent surgery (2 open transabdominal, 1 laparoscopic), including 1 simple diaphragmatic suture repair and 2 repairs with mesh reinforcement. All achieved uneventful postoperative recovery and were followed up for 25 months, with 2 cases free of recurrence and 1 case succumbing to tumor progression. A total of 95 IDH cases were analyzed by integrating literature data, with a median diagnostic age of 44 years. Among them, 56.9% were living donor liver transplant donors or recipients, 87.4% developed secondary to right or extended right hepatectomy, and the median surgery-to-onset interval was 15 months. Additionally, 90.5% were right-sided, and 91.5% involved gastrointestinal herniation. The main clinical manifestation was abdominal pain (53.7%), with 41.1% complicated by intestinal obstruction and 15.8% asymptomatic. Of the 85 surgically treated cases, 43.5% underwent emergency surgery for incarceration/ obstruction, and 18.2% required resection for herniated content necrosis. The transabdominal approach was used in 81.1% of cases, simple diaphragmatic suture repair in 78.4%, with an overall postoperative recurrence rate of 14.0%.ConclusionIDH is a rare delayed complication after partial hepatectomy in adults, with the highest incidence following right hepatectomy. Early surgical repair is recommended for IDH with gastrointestinal herniation. The transabdominal approach serves as the first choice, with primary closure using non-absorbable sutures as the basic repair technique. Mesh reinforcement can be applied for large diaphragmatic defects to reduce the risk of postoperative recurrence. Long-term postoperative imaging surveillance is critical for the early detection of IDH.关键词：hepatectomy;iatrogenic diaphragmatic hernia;hernia repair;postoperative complications8|0|0更新时间：2026-07-06 -
摘要：ObjectiveTo investigate the association between estimated glucose disposal rate (eGDR) and all-cause and cardiovascular mortality in older adults with established atherosclerotic cardiovascular disease (ASCVD), and to develop and validate a prediction model for all-cause mortality.MethodsThis retrospective study enrolled 2,479 hospitalized and outpatient patients aged ≥60 years with established ASCVD at the Second Medical Center of PLA General Hospital from January 2008 to December 2022. Participants were divided into four groups according to the eGDR quartiles: Q1 group (n=617), Q2 group (n=620), Q3 group (n=622), and Q4 group (n=620), to evaluate the dose- response relationship between eGDR and mortality risk. COX proportional hazards models and restricted cubic spline curve analysis were employed to examine the association between eGDR levels and mortality risk. The predictive performance of seven machine learning models (K-nearest neighbours, support vector machines, random forests, LASSO regression, naive Bayes, gradient-boosted regression and decision trees) on all-cause mortality was compared. The SHapley Additive exPlanations (SHAP) method was used to interpret variable importance in the optimal model.ResultsDuring a median follow-up of 8.1 years, 1,101 (44.4%) all-cause deaths and 429 (17.3%) cardiovascular deaths occurred. Compared with patients in the lowest eGDR quartile, those in the highest quartile had a 28% reduction in all-cause mortality (HR=0.72, 95% CI 0.57-0.90) and a 42% reduction in cardiovascular mortality (HR=0.58, 95% CI 0.44-0.78). Restricted cubic spline analysis demonstrated a significant negative association between eGDR and all-cause and cardiovascular mortality (P<0.05). Of the seven machine learning models tested, the random forest model achieved the highest area under the curve (AUC=0.748, 95%CI 0.740-0.756). SHAP analysis identified age, low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR), and eGDR as the four most important predictors of all-cause mortality.ConclusionsLower eGDR levels were independently associated with increased risks of both all-cause and cardiovascular mortality in patients aged ≥60 years with ASCVD. The random forest model incorporating eGDR demonstrated good predictive performance for all-cause mortality risk, suggesting that eGDR may serve as a promising biomarker for mortality risk stratification in this population.关键词：insulin resistance;estimated glucose disposal rate;atherosclerotic cardiovascular disease;mortality;machine learning;risk prediction22|0|0更新时间：2026-06-29 -
摘要：ObjectiveTo investigate the expression profile of adaptor protein complex 1 subunit sigma 3 (AP1S3) in KRASG12D-associated pancreatic ductal adenocarcinoma (PDAC) based on public databases and clinical tissue samples, and to evaluate its relationship with collagen deposition, immune infiltration, and prognosis.Methods(1) Public cohort analysis: Patients in The Cancer Genome Atlas (TCGA)-PAAD cohort were grouped according to KRASG12D mutation status. The limma package was used to screen differentially expressed genes. Core genes were selected by integrating machine learning methods including least absolute shrinkage and selection operator (LASSO) regression, boosted generalized linear model (Boosted GLM), random forest, and stepwise regression, combined with survival analysis to identify AP1S3 as the target gene. AP1S3 expression and its association with overall survival were further validated using Gene Expression Profiling Interactive Analysis (GEPIA) and Gene Expression Omnibus (GEO) cohorts. (2) Functional and collagen-related analysis: Gene Ontology (GO) enrichment analysis was performed based on AP1S3-related genes, and the correlation between AP1S3 and collagen remodeling-related genes was analyzed. (3) Immune infiltration analysis: CIBERSORT was employed to infer immune cell infiltration proportions, and the correlation between AP1S3 and major immune cell infiltration was assessed. (4) Clinical tissue validation: Tissues from 56 PDAC patients were collected for immunohistochemical staining and scoring of AP1S3 and KRASG12D. Collagen deposition was quantitatively evaluated using Picrosirius red staining. Patients were stratified into high- and low-AP1S3 expression groups for Kaplan-Meier survival analysis and multivariate Cox regression analysis.ResultsAP1S3 was highly expressed in pancreatic cancer tissues and associated with poor prognosis (P<0.05). It was enriched in extracellular matrix regions containing collagen and showed positive correlations with the expression of collagen type IV alpha 1 chain (COL4A1) and lysyl oxidase (LOX) (r=0.37 and 0.34, P<0.001). AP1S3 expression was negatively correlated with CD8+ T-cell infiltration (ρ=-0.300, P<0.001) and positively correlated with M0 macrophage infiltration (ρ=0.393, P<0.001). Clinical validation demonstrated that high AP1S3 expression was a risk factor affecting overall survival in pancreatic cancer patients (P<0.001) and was closely associated with collagen area percentage (r=0.6222, P<0.001) and G12D protein expression (r=0.7103, P<0.001). Receiver operating characteristic curve analysis indicated that AP1S3 protein expression had predictive value for survival prognosis in pancreatic cancer patients (AUC=0.7537, P=0.0019). Furthermore, AP1S3 expression was significantly correlated with tumor differentiation (P=0.005). Multivariate Cox regression suggested that high AP1S3 expression (HR=10.33, P=0.004) and N stage (HR=3.84, P=0.031) were independent prognostic factors.ConclusionAP1S3 is highly expressed in PDAC and associated with poor prognosis. It is linked to enhanced collagen deposition and an immunosuppressive infiltration pattern, suggesting its potential as a biomarker for PDAC stratification assessment.关键词：pancreatic ductal adenocarcinoma;KRASG12D;AP1S3;collagen deposition;immune infiltration;prognosis16|0|0更新时间：2026-06-29 - 摘要：This paper discusses the clinical value of transanal total mesorectal excision (taTME) following neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. Conventional laparoscopic TME after nCRT faces limitations, risks, and challenges such as restricted maneuverability, nerve injury, and positive resection margins due to tissue fibrosis and complex pelvic anatomy. The "bottom-up" dual-approach of taTME offers a superior surgical option for patients with low rectal cancer, including those with obesity or challenging pelvic anatomy, significantly improving sphincter preservation rates and negative circumferential resection margin rates. Under the premise of strict selection of indications and operation by experienced teams, existing evidence suggests that taTME has non-inferior oncological outcomes compared with traditional surgery. It also offers advantages in reducing intraoperative blood loss, shortening hospital stays, and lowering complication rates, while better preserving urogenital function and improving patients' quality of life. However, taTME is technically more demanding than conventional laparoscopic surgery, with potential risks such as a a relatively higher incidence of anastomotic leakage. It should be performed by experienced teams in specialized centers. Multidisciplinary collaboration and standardized procedures are essential to ensure its safety and efficacy. With ongoing technical refinement and accumulating evidence, taTME is expected to become an important surgical option for rectal cancer after nCRT.关键词：rectal cancer;neoadjuvant chemoradiotherapy;transanal total mesorectal excision16|0|0更新时间：2026-06-26
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摘要：The growing complexity of biological threats in contemporary and future battlefield environments presents significant challenges to military medical support systems. Microbial infections represent a major cause of non-combat casualties and mortality among injured personnel. Rapid microbial detection is therefore essential for effective control of battlefield-acquired infections and mitigation of biological threats. However, conventional microbial detection methods are often time-consuming and operationally cumbersome, limiting their utility in time-sensitive combat settings. Recent advances in detection technologies, including immunochromatography, molecular diagnostics, and biosensing, have introduced promising solutions for point-of-care microbial identification in austere environments. This article provides a systematic review of the current application status of rapid microbial detection technologies in battlefield contexts, with a focus on their underlying principles, technical characteristics, and specific military use cases. It further examines key challenges associated with their deployment under operational conditions and proposes practical countermeasures. Finally, the paper explores the emerging trend of integrating these detection platforms with artificial intelligence and unmanned systems. The objective is to offer theoretical insights and technical guidance for establishing a rapid, precise, and mobile battlefield microbial detection framework, thereby enhancing the overall effectiveness of military medical support capabilities.关键词：rapid microbial detection;battlefield environment;biological warfare agent;point-of-care testing;biosensing16|0|0更新时间：2026-06-22 -
The dynamic evolution and clinical significance of the tumor microenvironment in colorectal cancer AI导读
摘要：The tumor microenvironment (TME) in colorectal cancer is a dynamic ecosystem composed of immune cells, stromal cells, the extracellular matrix, and the gut microbiota, playing a central role in tumorigenesis, progression, and drug resistance. This review systematically elucidates the remodeling process of the TME, spanning the inflammation-to-carcinoma transition, immune evasion, and the establishment of the pre-metastatic niche. It highlights key driving mechanisms of tumor evolution, including metabolic reprogramming, hypoxic and acidic landscapes, and complex cellular communication. The high heterogeneity of the TME is a core factor underlying the differential responses of "hot" and "cold" tumors to clinical immunotherapy. Based on these insights, this article highlights cutting-edge intervention strategies aimed at remodeling the TME, encompassing immune checkpoint blockade, multimodal combination therapies designed to reverse "cold" tumors, strategies targeting the stroma and metabolic networks, and microecological modulation to reconstruct the "gut microbiota-immunity axis." An in-depth analysis of the evolutionary characteristics of the TME provides crucial theoretical support and translational insights for overcoming therapeutic bottlenecks and advancing personalized precision medicine in colorectal cancer.关键词：colorectal cancer;tumor microenvironment;microenvironment remodeling;gut microbiota12|0|0更新时间：2026-06-17 -
摘要：ObjectiveTo evaluate magnetocardiography (MCG) in differentiating the electromagnetic features of myocardial ischemia caused by aortic stenosis (AS) versus coronary heart disease (CHD).MethodsIn this prospective single-center cohort study, 556 patients with suspected myocardial ischemia were enrolled. After grouping based on echocardiography and coronary angiography findings, 30 patients with AS and 111 patients with CHD were identified. Baseline characteristics were first compared between the two groups. Subsequently, magnetocardiography (MCG) parameters were extracted, the weighted LASSO regression with Bootstrap validation was used to select key features. A binary logistic regression model was then constructed to discriminate AS from CHD. Model performance was assessed by the area under the curve (AUC), 5-fold cross-validation, calibration curve, and the Hosmer-Lemeshow test.ResultsSignificant differences were observed between the AS and CHD groups in age and cardiac function parameters, including N-terminal pro B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) (P<0.05). The model incorporated five MCG parameters: the mean negative magnetic pole eccentricity in the RS segment, the magnetic pole dispersion at the R-wave peak, the magnetic dipole center trajectory distribution in the QR segment, the mean dipole moment in the TT segment, and the magnetic field angle at the T-wave peak. It achieved an AUC of 0.881 (95%CI 0.817–0.946) in the complete dataset, with 84.68% sensitivity and 80.00% specificity. The mean AUC from cross-validation was 0.836. No significant calibration deviation was found (Hosmer-Lemeshow test, P=0.228).ConclusionsA model based on specific MCG parameters effectively differentiates AS from CHD by quantifying distinct electrophysiological patterns, offering a novel insight for the etiological diagnosis of angina pectoris.关键词：aortic stenosis;coronary heart disease;magnetocardiography;myocardial ischemia13|0|0更新时间：2026-06-16
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