Gastric cancer constitutes a significant global health burden, and its clinical management is undergoing a critical transition from a traditional experience-driven paradigm toward the deep integration of precision medicine and artificial intelligence (AI). At present, the main bottleneck has shifted from a lack of therapeutic options to insufficient capacity for precise clinical decision-making. In recent years, diagnostic approaches have seen marked advances through the application of AI-augmented endoscopy, radiomics, molecular subtyping, and liquid biopsy, reflecting progress in both precision and intelligence. Therapeutically, notable strides have been made in function-preserving strategies for early-stage disease, multimodal perioperative management for locally advanced cancer, and biomarker-guided stratified therapy for advanced gastric cancer. However, challenges persist, including low early-detection rates, inaccurate staging, difficulties in treatment personalization, and delayed assessment of therapeutic response. The future of gastric cancer care lies in the synergistic combination of precision medicine and AI technologies: leveraging multi-omics and other precision tools to delineate tumor biology, while deploying intelligent systems across the entire continuum from screening and diagnosis to treatment selection and follow-up. This integrated approach is key to establishing a more efficient clinical framework and ultimately improving patient survival outcomes.

With the continuous update and iteration of minimally invasive techniques, artificial intelligence and big data, the surgical treatment of early gastric cancer has gradually entered an era of indivi-dualization, precision and intelligence. Function-preserving surgeries represented by sentinel lymph node navigation surgery have gradually become the mainstream surgical options for early gastric cancer. How-ever, a great deal of controversy remains in sentinel lymph node navigation surgery regarding the definition of sentinel lymph nodes, the selection of tracers, the time of visualization, the scope and strategy of surgery, pathological examination, and the indications for supplementary radical surgery after surgery. Based on the current research progress and practical experience, it is suggested to comprehensively determine the sentinel lymph node area based on the lymph node metastasis pattern and the tracer imaging situation, thereby redefining the sentinel lymph nodes of early gastric cancer; It is recommended to select indocyanine green as the tracer for sentinel lymph node navigation surgery in early gastric cancer, and the definition of the imaging time of indocyanine green still needs further research for confirmation; Regarding the intraoperative frozen pathological examination of the incision margin, it is necessary to pay attention to the complete preservation of the gastric mucosa and try to avoid the ablation margin of the ultrasonic scalpel or electrocautery; Regarding the frozen pathological examination of sentinel lymph nodes during the operation, it is recommended to adopt different sampling methods based on whether the short diameter of the lymph nodes exceeds 4 mm; Based on the previous practical experience, our team has put forward suggestions in aspects such as the sentinel lymph node dissection strategy, the scope and strategy of local gastrectomy, and the indications for supplementary surgery after initial surgery. Therefore, high-quality evidence-based medical research is still needed to verify the safety and effectiveness of sentinel lymph node navigation surgery, thereby improving the surgical treatment level of early gastric cancer in China and even globally.

Currently, oral health field in our country faces numerous challenges, such as the persistently high prevalence of oral diseases, the heavy burden on medical insurance payments and there are significant regional differences in the level of dental care, so far the full medical equity across society has not yet been achieved. Health management is a key strategy to cope with these challenges. Health management consists of four components: information collection, risk factor assessment, health education and health intervention.The collection of information is the foundation of health education and health interventions. Effective health education and interventions, in turn, promote the conduct of information collection. Health management and medical care overlap in terms of service recipient, practitioner, location, and means of service, but there are different goal, focus point, service model and time span between them. The real rise of health management in our country has appeared since the year 2000. The oral health management is just beginning in our country. It is of significant realistic importance to set up an oral health system in China. It is recommended to carry out top-level design for oral health management and promote its progress from four aspects: changing concepts, cultivating talent, strengthening policy intervention and developing appropriate technique.

The treatment paradigm for locally advanced rectal cancer is undergoing a fundamental transformation from the traditional fixed triad of "radiotherapy-surgery-chemotherapy" to a holistic eco-system centered on precision stratification and multidisciplinary collaboration. This review synthesizes the current landscape and future perspectives of this evolution across four key dimensions. First, in surgical innovation, robotic-assisted surgery has demonstrated superiority over conventional laparoscopy in the narrow pelvis. High-quality evidence indicates that robot-assisted surgery (RAS) not only ensures better oncological outcomes, such as lower circumferential resection margin positivity, but also significantly improves functional recovery, including urinary and sexual functions. The field is further advancing towards the integration of intraoperative navigation, fluorescence imaging, and 5G remote collaboration. Second, molecular-guided immunotherapy is reshaping neoadjuvant strategies. While patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) status achieve high rates of clinical complete response with immune checkpoint inhibitors, creating opportunities for organ preservation strategies like "Watch and Wait", research in the proficient mismatch repair/microsatellite stable (pMMR/MSS) population is pivoting towards synergistic radio-immunotherapy combinations to overcome immune-cold microenvironments. Third, artificial intelligence and radiomics are enabling non-invasive quantitative risk stratification and treatment response prediction. Beyond preoperative assessment, computer vision is entering the operating room to identify critical anatomical structures (e.g., nerves, ureters) in real-time and objectively assess surgical quality. Finally, liquid biopsy, particularly circulating tumor DNA, has emerged as a critical biomarker for minimal residual disease. Dynamic monitoring complements morphological imaging to guide decisions on treatment intensification or de-escalation. Collectively, these advances are driving locally advanced rectal cancer management towards a "biologically-driven" and "function-preserving" model. Future efforts must focus on establishing standardized protocols for these technologies and validating their long-term benefits in survival and quality of life through high-quality, multi-center clinical trials.

Tumor angiogenesis is a crucial determinant of breast cancer progression and therapeutic response. This review first traces the proposal and evolutionary course of the tumor angiogenesis theory, and systematically collates its diverse occurrence patterns, including sprouting angiogenesis, intussusceptive angiogenesis, vascular mimicry and vascular co-option, while conducting an in-depth analysis of the heterogeneous characteristics of different patterns and their biological significance at various stages of tumor progression. At the molecular regulatory mechanism level, this paper focuses on summarizing the mechanisms of core regulatory networks, such as the hypoxia-inducible factor-1 axis, vascular endothelial growth factor/vascular endothelial growth factor receptor, platelet-derived growth factor/platelet-derived growth factor receptor, angiopoietin/angiopoietin receptor, and Delta-like ligand 4/Notch receptor signaling pathway. In addition, this paper comprehensively reviews the clinical exploration of anti-angiogenic therapy for breast cancer, and discusses the practical challenges faced by this therapeutic strategy, including unstable efficacy, drug resistance, the lack of precise stratification biomarkers and treatment-related toxicities. Finally, this paper proposes future research directions oriented toward precision therapy, including optimizing the vascular normalization window, developing patient stratification strategies based on multidimensional biomarkers, and deciphering tumor vascular heterogeneity by using spatial omics. These findings provide a theoretical reference for the optimization and innovation of anti-angiogenic therapy for breast cancer.

Alpha-fetoprotein-producing gastric cancer (AFPGC) represents a distinct clinical entity within the landscape of gastric malignancies, characterized by its aggressive biological behavior and unique clinicopathological profile. Most cases are classified under the chromosomal instability (CIN) subtype, featuring a molecular signature often marked by TP53 and MUC16 mutations, as well as significant amplifications of genes like ERBB2 and the cell cycle regulator CCNE1. As a serum tumor marker, alpha-fetoprotein (AFP) is typically highly elevated in AFPGC and correlates closely with tumor T-stage and patient prognosis. However, discordant expression is observed in some cases, characterized by positive intra-tumoral AFP expression in the presence of normal serum AFP levels. Moreover, intra-tumoral AFP plays an important role in both tumor invasiveness and immune evasion. It may promote tumor pro-liferation and metastasis by modulating immune cell activity. The high malignant potential of AFPGC may be attributable to its capacity to actively remodel the tumor milieu toward an immunosuppressive phenotype. Clinical studies have shown that the co-elevation of AFP with other markers, such as carcinoembryonic antigen (CEA), human chorionic gonadotropin (HCG), and protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) often indicates a high malignant potential and a poor prognosis in gastric cancer, particularly in patients with advanced disease. Such concurrent detection of two or more biomar-kers facilitates the assessment of tumor aggressiveness as well as provides a clinical basis for early diagnosis and prognostic evaluation. Currently, there are no standardized guidelines for AFPGC treatment, and strategies often rely on individual pathological profile, tumor staging, and biomarker levels. In addition, immune checkpoint inhibitors (ICIs) have shown preliminary efficacy in some cases. Immunotherapy has demonstrated potential in AFPGC treatment, but the overall therapeutic outcomes and underlying mechanisms of resistance warrant further clinical validation and investigation. Individualized and multimodal therapeutic approaches are fundamental to improving clinical outcomes due to the high degree of heterogeneity in AFPGC. Therefore, a comprehensive evaluation of serum AFP levels, radiological findings, and pathological characteristics is essential for the development of personalized treatment regimens.

Esophageal squamous cell carcinoma (ESCC) is a highly prevalent and lethal malignancy in China and other East Asian countries. For patients with locally advanced disease, neoadjuvant chemotherapy or chemoradiotherapy followed by surgery has become the standard treatment paradigm. However, despite improvements in local tumor control and surgical outcomes, long-term survival remains unsatisfactory, largely due to the high incidence of distant metastasis and systemic disease progression. Therefore, optimizing perioperative systemic therapy represents a critical unmet clinical need in ESCC. In recent years, the introduction of immune checkpoint inhibitors (ICIs) has profoundly reshaped the perioperative treatment landscape of ESCC. This review comprehensively summarizes recent clinical advances in perioperative immunotherapy for ESCC, including neoadjuvant immunotherapy alone, neoadjuvant immunotherapy combined with chemotherapy, neoadjuvant immunotherapy combined with chemoradiotherapy, and postoperative adjuvant immunotherapy. Current data indicate that neoadjuvant chemoradiotherapy remains highly effective in improving local control, downstaging tumors, and increasing the rate of R0 resection. Nevertheless, its ability to translate these advantages into durable survival benefit is limited, and distant recurrence remains a major cause of treatment failure. In contrast, neoadjuvant immunotherapy combined with chemotherapy has demonstrated a marked improvement in pathological complete response (pCR) rates across multiple early-phase trials. More importantly, this strategy appears to provide supe-rior systemic disease control, thereby reducing the risk of distant metastasis and offering a promising avenue for improving long-term survival. Neoadjuvant immunotherapy combined with chemoradiotherapy has shown further enhancement of local response and tumor regression; however, this approach is asso-ciated with increased treatment-related toxicity, and robust evidence supporting a clear survival advantage is still lacking. As a result, the optimal integration of radiotherapy into immunotherapy-based perioperative regimens remains an area of active investigation. Given the heterogeneity of ESCC, perioperative treatment strategies should evolve toward individualized, risk-adapted approaches. For patients with a high local tumor burden (advanced T stage), the incorporation of radiotherapy may be beneficial to reinforce local control and improve resectability. Conversely, for patients with extensive lymph node involvement (advanced N stage) and a high risk of distant relapse, immunotherapy-based systemic treatment should be prioritized. In the postoperative setting, adjuvant immunotherapy has been shown to improve outcomes in patients who fail to achieve pCR after neoadjuvant chemoradiotherapy. Looking forward, the integration of dynamic biomarkers, such as circulating tumor DNA (ctDNA), along with the identification of novel immune targets and predictive biomarkers, is expected to further refine patient selection and optimize precision perioperative treatment strategies for ESCC.

Cranio-maxillofacial bone defects resulting from trauma, tumors, infection, or congenital malformations not only severely impair patients' physiological functions, but also impose a profound psychological burden, constituting a major public health issue that affects overall health and quality of life. Conventional reconstructive approaches, including autologous grafting and allogeneic implantation, can partially restore tissue morphology; however, limitations, such as donor-site morbidity, immune rejection, and long-term resorption prevent the achievement of true biological functional reconstruction. These challenges are particularly pronounced in the repair of complex and large-scale bone defects. The underlying cause lies in the insufficient understanding of the complex cellular behaviors, signaling networks, and material-host interactions involved in bone regeneration, which hampers precise regulation of the repair process. Therefore, the development of new theories, technologies, and materials grounded in mechanistic insights has become a key strategic direction in cranio-maxillofacial bone regeneration research. Supported by the National Natural Science Foundation of China, the Beijing Natural Science Foundation, and National and Provincial Major Talent Programs, our research group has addressed critical clinical challenges in cranio-maxillofacial bone defect repair by proposing an innovative concept of "regulating cell fate, designing intelligent biomaterials, and achieving functional reconstruction". Centered on this key scientific question, we have systematically carried out a full-chain research strategy spanning "fundamental theory-technological breakthroughs-product translation", overcoming multiple bottlenecks and achieving a series of original outcomes. (1) At the level of fundamental theory, we elucidated the epigenetic and ubiquitination regulatory networks governing skeletal stem cell fate determination, and precisely defined functional stem cell subpopulations using single-cell technologies. We also pioneered apoptotic vesicles as a new paradigm for cell-free therapy and clarified their functional diversity. (2) In terms of technological breakthroughs, we established 4D printing technologies with dynamically tunable morphology and function, developed metal surface engineering strategies that integrate controllable degradation with biofunctional regulation, and built artificial intelligence-driven intelligent design and manufacturing platforms. (3) Regarding translational applications, we developed a series of apoptotic vesicle-based biotherapeutics, smart responsive bone-repair scaffolds, and next-generation biofunctionalized biodegradable metal implants. Collectively, these achievements have advanced the fundamental theory of regenerative medicine, overcome key technological barriers, established new clinical strategies for cranio-maxillofacial tissue defect repair, and significantly enhanced core competitiveness in this field.

Tumors in the oral and maxillofacial region present significant clinical challenges due to anatomical complexity and high individual variability, with the traditional experience-dependent model often lacking three-dimensional visualization, precise intraoperative navigation, and quantitative postoperative assessment. This article comprehensively reviews over a decade of research and clinical advances in "digital and intelligent surgery" developed by our team at Peking University School and Hospital of Stomatology, systematically documenting its transformative impact on tumor management. In digital surgery, we have established multimodal image fusion techniques integrating CT, MRI, and PET/CT to achieve detailed three-dimensional preoperative visualization, enabling accurate delineation of tumor boundaries and relationships with critical anatomical structures, such as nerves and vessels. We further developed personalized surgical planning methods including virtual design for jaw reconstruction using vascularized fibula or iliac crest flaps, computer-aided pre-forming of orbital titanium mesh, 3D-printed patient- specific plates manufactured via electron beam melting, soft-tissue flap simulation and volumetric planning for the anterolateral thigh flap, and implant-guided rehabilitation for complex maxillary defects. For surgical execution, navigation systems and mixed reality technologies have been implemented to enable accurate tumor resection, osteotomy guidance, and precise positioning of reconstructed bone segments, thereby enhancing surgical accuracy and safety while reducing operative time. In parallel, artificial intelligence has been integrated to enhance diagnostic and planning efficiency through deep learning-based tumor segmentation and classification from enhanced CT and MRI, automated reconstruction planning based on shape completion and morphometric descriptors, postoperative facial contour prediction using surface mesh deformation models, and machine learning-driven prognostic modeling for salivary gland malignancies based on clinicopathological data. The synergistic integration of these digital and intelligent technologies, collectively termed "digital and intelligent surgery", has shifted clinical practice from an experience-driven to a data-driven paradigm, significantly improving precision, safety, and efficiency while enabling truly personalized treatment pathways. This review also identifies current limitations such as the need for further automation in soft-tissue simulation and broader clinical validation of AI tools, and outlines future directions including the development of integrated surgical platforms and real-time adaptive planning systems, emphasizing the role of intelligent surgical systems in shaping the next generation of oral and maxillofacial oncology care toward more predictive, preventive, and patient-centered outcomes.

Craniofacial tissue regeneration remains a pivotal challenge in oral and regenerative medicine. Mesenchymal stem/stromal cells (MSCs) are central effector cells in this process, and their functions are regulated by a sophisticated, multidimensional network. This article provides a comprehensive overview of the regulatory mechanisms governing MSCs in craniofacial regeneration. We highlight the interactive roles of metabolism, epigenetics, and immunity in precisely controlling MSC stemness, lineage-specific differentiation, and immunomodulatory capabilities. Key regulatory dimensions are explored in detail. Metabolic reprogramming, such as serine one-carbon metabolism and mitochondrial dynamics under hyperosmotic stress, couples energy production with epigenetic modifications to dictate MSC fate. The gasotransmitter hydrogen sulfide (H₂S) exerts tissue-specific effects, modulating immunoregulation via the Fas/FasL axis in gingival MSCs and promoting odontogenic differentiation in dental pulp stem cells (DPSCs) via the transient receptor potential action channel subfamily vanilloid member 1 (TRPV1)/β-catenin pathway. Epigenetic mechanisms, including DNA demethylation by ten-eleven translocation (TET) enzymes and chromatin remodeling by special AT-rich sequence-binding protein 2 (SATB2), finely tune MSC homeostasis and differentiation potential. Crucially, MSCs do not function in isolation. Their bidirectional crosstalk with immune cells, mediated by exosomes and soluble factors, is essential for bone homeostasis. Mechanical overloading can trigger MSCs to promote T helper 17 (Th17) cell polarization via metabolic reprogramming, exacerbating bone destruction. Conversely, H₂S-modified exosomes from M2 macrophages can enhance MSC osteogenesis, demonstrating a synergistic metabolic-immune axis for bone regeneration. Exosomes themselves serve as versatile therapeutic carriers, capable of delivering miRNAs (e.g., miR-125a/b) or functional mitochondrial DNA to modulate immunity or repair cellular metabolism. The clinical translation of MSCs holds great promise for treating conditions like periodontitis and temporomandibular joint disorders. Advances in engineered exosomes and biomaterial carriers (e.g., hydrogels) offer strategies for targeted delivery and enhanced efficacy. Future research must focus on developing tissue-specific delivery systems, refining exosome engineering for precise cargo loading, and leveraging multi-omics technologies to decipher the complex stem cell niche. This progression from empi-rical application to rationally designed, precision therapies will be critical for addressing clinical challenges in craniofacial reconstruction.

Objective: To identify independent clinicopathological and molecular risk factors for metachronous liver metastasis and to construct a novel multicenter nomogram for predicting 1-, 3-, and 5-year liver metastasis-free survival (LMFS). Methods: In this multicenter retrospective cohort study, we analyzed clinical data from 865 patients with stages Ⅰ-Ⅲ CRC who underwent curative resection between January 2020 and December 2024. The population was derived from two institutions: Beijing Shijitan Hospital (n=746) and Jiangsu Cancer Hospital (n=119). Patients from the primary center were randomly assigned to a training cohort (n=523) and an internal validation cohort (n=223) at a 7 ∶3 ratio, while patients from the second center served as an independent external validation cohort (n=119). Candidate variables included demographics, tumor markers, pathological features, and molecular biomarkers [KRAS/BRAF mutation and microsatellite instability (MSI)]. Multivariable Cox proportional hazards regression analyses were utilized to identify independent predictors. Model performance was evaluated using the concordance index (C-index), time-dependent area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results: Baseline characteristics were balanced across cohorts (P>0.05). Multivariable analysis identified nine independent prognostic factors: age, differentiation, T stage, N stage, vascular invasion, perineural invasion, and molecular markers. Notably, KRAS mutation (HR=1.42, 95%CI: 1.27－1.63) and BRAF mutation (HR=1.53, 95%CI: 1.29－1.84) were associated with significantly increased risk, whereas micro-satellite instability-high (MSI-H) status (HR=0.71, 95%CI: 0.54－0.92) served as a protective factor. The nomogram demonstrated robust discrimination with C-indices of 0.85 (95%CI: 0.82－0.89) in the training cohort, 0.81 (95%CI: 0.77－0.83) in the internal validation cohort, and 0.75 (95%CI: 0.71－0.79) in the external validation cohort. In the training set, AUCs for predicting 1-, 3-, and 5-year LMFS were 0.81 (95%CI: 0.77－0.86), 0.83 (95%CI: 0.80－0.89), and 0.85 (95%CI: 0.78－0.92), respectively. Calibration curves showed excellent agreement, and DCA indicated higher net clinical benefit than the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. Conclusion: We established and externally validated a nomogram integrating clinicopathological features with KRAS, BRAF, and MSI status. This model exhibited enhanced predictive accuracy and generalizability compared with conventional staging systems. It serves as a valuable tool for identifying high-risk patients and guiding individualized postoperative surveillance strategies to improve long-term survival outcomes.

Objective: To investigate the clinical efficacy and safety of totally laparoscopic radical subtotal gastrectomy with preservation of the cardia and partial gastric fundus in the treatment of middle-upper gastric cancer. Methods: A retrospective cohort study was conducted on 41 patients with middle and upper gastric cancer admitted to Fudan University Shanghai Cancer Center from January to June 2025. The patients were divided into an observation group (n=21) and a control group (n=20) according to the surgical method. The observation group underwent totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation, while the control group received laparoscopic total gastrectomy. Perioperative surgical indicators, postoperative recovery, complications, pathological results, and follow-up data on nutritional status were observed and compared between the two groups. Results: All patients in both groups successfully completed the surgery without conversion to open surgery or surgical modification during the operation. The average total operative time in the observation group was (156.1±14.2) min, which was significantly shorter than (169.8±6.7) min in the control group (P < 0.05). There were no significant differences in the time of digestive tract reconstruction and intraoperative blood loss between the two groups (P>0.05). The average time to first oral water intake, first liquid diet intake and postoperative hospital stay in the observation group were (2.1±0.4) d, (3.4±0.5) d and (6.3±0.5) d, respectively, all significantly shorter than those in the control group (2.9±0.6) d, (3.9±0.5) days and (7.1±1.0) d, all P < 0.05. No perioperative complications such as anastomotic leakage or postoperative bleeding occurred in either group. Pathological results showed no significant differences in postoperative pathological stage and number of dissected lymph nodes between the two groups (P>0.05). No tumor recurrence or metastasis was identified during the postoperative follow-up period.The proportion of patients with decreased body mass index (BMI) compared with preoperative level in the observation group was 23.8%, which was significantly lower than 50.0% in the control group (P=0.046). The serum vitamin B12 level in the observation group 3 months after surgery was (416.0±145.3) ng/L, significantly higher than (315.0±128.2) ng/L in the control group (P=0.026). Conclusion: Totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation can ensure the radicality of tumor resection for middle and upper gastric cancer. Compared with laparoscopic total gastrectomy, it has the advantages of shorter operative time, faster postoperative recovery, better maintenance of postoperative nutritional status and quality of life in patients, with reliable safety. It may serve as a novel individualized therapeutic option for patients with middle and upper gastric cancer.

Objective: To analyze the related factors of rheumatoid arthritis (RA) patients with anemia of chronic disease (ACD) and to guide the clinical diagnosis and treatment. Methods: A retrospective study was used to analyze the patients admitted to Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018. Clinical data (including general conditions, joint lesions, extra-articular manifestations, and comorbidities), laboratory examinations, and treatment were collected to analyze the differences in clinical characteristics between group RA with ACD (RA-A) and group RA without ACD (RA-nA). Univariate and multivariate Logistic regression analysis was conducted to screen for relevant factors of RA with ACD. Results: A total of 468 RA patients were included, including 194 cases (41.5%) in RA-A group and 274 cases (58.5%) in RA-nA group. There were no significant differences in age, gender, onset age, or course of disease between the two groups (P>0.05). The RA-A group had more joint swelling [13 (2, 14) vs. 10 (2, 11)], more tenderness [10 (2, 12) vs. 7 (2, 10)], and higher 28 joint disease activity scores (DAS28) [DAS28-CRP (C-reactive protein): 5.2±1.4 vs. 4.6±1.5; DAS28-ESR (erythrocyte sedimentation rate): 5.9±1.5 vs. 5.1±1.8] compared with the RA-nA group (P < 0.05). The incidence of pleural effusion (4.6% vs. 1.1%) and venous thrombosis (5.7% vs. 1.5%) were higher in RA-A group (P < 0.05). The platelet count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, ESR, CRP, immunoglobulin G (IgG) in RA-A group were significantly higher than those in RA-nA group (P < 0.05). Elevated ESR and CRP levels, DAS28 > 5.1 were relevant factors for anemia in the RA patients. Conclusion: RA patients with ACD had more severe joint involvement, higher inflammatory indicators, and more active conditions, making them more prone to pleural effusion and venous thrombosis. High disease activity, high inflammatory status, and venous thrombosis were risk factors for RA with ACD.

Objective: To analyze the incidence of small intestinal bacterial overgrowth (SIBO) in patients with asymptomatic hyperuricemia (HUA) and the serum levels of C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients with asymptomatic HUA and SIBO. Methods: A total of 87 asymptomatic HUA patients and 40 healthy controls from Shanxi Fenyang Hospital from June 2023 to June 2024 were selected as the study subjects, and the baseline data, laboratory indicators were collected. Lactulose methane-hydrogen breath test (LHBT) was used to detect the occurrence of SIBO, and the asymptomatic HUA patients was divided into SIBO-positive group and SIBO-negative group according to the test results of LHBT. The positive rate of SIBO in the asymptomatic HUA patients was analyzed, and the concentrations of H₂ and CH₄, the levels of CRP, IL-1β, IL-6 and TNF-α at each time point between the asymptomatic HUA patients and the healthy controls were compared, and the levels of CRP, IL-1β, IL-6 and TNF-α were compared between the SIBO-positive group and the SIBO-negative group. Multivariate Logistic regression analysis was performed to analyze the influencing factors of SIBO in asymptomatic HUA. Spearman rank correlation analysis was used to analyze the correlation between CRP, IL-1β, IL-6 and TNF-α levels and SIBO in asymptomatic HUA patients. Results: The positive rate of SIBO in the asymptomatic HUA patients was 58.62%, which was higher than that in the healthy controls (20.00%), and the difference was statistically significant (χ²=16.431, P < 0.001). There were significant differences in exhaled H₂ concentration between the asymptomatic HUA patients and the healthy controls at 0, 30, 60 and 90 min (P < 0.05), and there was no significant difference in exhaled CH₄ concentration at each time point (P>0.05). The levels of CRP, IL-1β, IL-6 and TNF-α in the asymptomatic HUA patients were significantly higher than those in the healthy controls (P < 0.05). The serum levels of CRP, IL-1β and IL-6 in the SIBO-positive group were significantly higher than those in the SIBO-negative group (P < 0.05), while the levels of TNF-α were not significantly different between the two groups (P>0.05). Multivariate Logistic regression ana-lysis of the influencing factors of SIBO in the asymptomatic HUA showed that increased IL-1β (OR=1.332, 95%CI: 1.005-1.764, P=0.046) and increased IL-6 (OR=1.586, 95%CI: 1.216-2.069, P=0.001) were independent risk factors for SIBO in the HUA patients. In asymptomatic HUA patients with SIBO, the LHBT set value was positively correlated with serum IL-1β (r=0.594, P < 0.001). Conclusion: Asymptomatic HUA patients are more likely to develop SIBO than healthy people, and SIBO in asymptomatic HUA patients is closely related to the level of inflammatory factors, so attention should be paid to the detection and intervention of SIBO in asymptomatic HUA patients.

Objective: To investigate the relationship between body fat rates and skeletal muscle rates with depression among patients undergoing assisted reproductive technology (ART) treatments. Methods: A total of 885 infertility patients who underwent ART treatment at the Center for Reproductive Medicine of the First Affiliated Hospital of Anhui Medical University from July to October, 2022 were selected using the convenience sampling method. The basic information of the patients was investigated, depression was investigated using the patient health questionnaire-9 (PHQ-9), and human adiposity and body skeletal muscle rate data were measured using the InBody instrument with the principle of bioelectrical impedance analysis (BIA). Multiple linear regression, generalized linear model, and trend test were used to investigate the association between adiposity, skeletal muscle mass, and depression in the assisted reproduction population, as well as the dose-response relationship using restricted cubic spline (RCS) analysis. Results: The mean detection rate of depression in the ART population was 52.0%, with 55.5% in women and 45.5% in men. The average body fat rate was 28.01%, and the average body skeletal muscle rate was 39.73%. After correcting for confounders, the body fat rate was observed to be positively associated with depression (β=0.07, 95%CI: 0.01, 0.14), and the body skeletal muscle rate was negatively associated with depression (β=-0.12, 95%CI: -0.24, -0.01). Trend-based tests showed a highly significant monotonically increasing trend in depression with the increasing body fat rate and the decreasing body skeletal muscle rate. These associations were significant (P < 0.05) in the male population and in the assisted reproduction population aged >30 years. No significant non-linear associations were found between the body fat rate, the skeletal muscle rate and depression in the overall ART-treated population (P_non-linear>0.05). Conclusion: The patients undergoing ART have a higher rate of depression detection, and their body fat and skeletal muscle rates are associated with the risk of depression in ART patients. Interventions, such as weight control, body fat reduction, and an exercise diet that increases skeletal muscle and other body components are expected to reduce the incidence of depression in assisted reproduction.

Objective: To analyze the clinical phenotype characteristics and genetic testing data of idiopathic hypogonadotropic hypogonadism (IHH) female patients, aiming to improve the understanding of genetic etiology and inheritance patterns among female patients. Methods: This study recruited twenty-one female patients and their clinical data were collected and analyzed. Based on the olfaction function, the patients were divided into normosmic IHH group and Kallmann syndrome (KS) group. Whole exome sequencing and Sanger sequencing were performed to screen for underlying genetic etiology including genetic variants of known pathogenic genes and PLEXIN pathway genes. Alphafold2 was used for mutant protein structure prediction of PLXNA1 missense mutation. Results: Normosmic IHH patients and KS patients had no difference in baseline clinical data. Among the 21 recruited patients, 17 patients and their immediate family members' peripheral blood was collected for sequencing, and four patients were found carrying pathogenic variants involving FGFR1 and PROKR2, and the pathogenic variant carrying rate was 23.5%. The remaining 13 patients didn't obtain a specific genetic diagnosis. Two KS patients withoutknown pathogenic variants carried the same heterozygous variant PLXNA1: c.3401G>A but no other PLEXIN pathway gene variants. The missense mutation caused hydrophobicity change of the 1134 amino acid loci of PLXNA1. Four patients with family history carried relevant gene variants involving FGFR1, CHD7 and POLR3B. However, the genetic diagnosis of some patients wasn't reached because the pathogenicity of these variants only reached variants of unknown significance based on American College of Medical Genetics and Genomics (ACMG) guidelines and the genotype-phenotype co-segregation within family was inconsistent. Female IHH patients could only maintain secondary sex characteristics and artificial menstruation through hormone replacement treatment and gain fertility by gonadotropin ovulation sti-mulating therapy. Conclusion: Female IHH patients have complex genetic etiology and polygenic inheri-tance mode. Both hereditary and sporadic patients may have various degrees of genetic inheritance risk. The missense variant PLXNA1: c.3401G>A might be a potential risk variant of KS.

Objective: To investigate the proportion of pseudo-elevated testosterone levels detected by chemiluminescent immunoassay (CLIA) in female patients and to evaluate the application value of liquid chromatography-tandem mass spectrometry (LC-MS/MS) in improving the accuracy of testosterone detection in this population. Methods: A retrospective analysis was conducted on data collected from female patients who presented at Peking University People' s Hospital from January 1, 2020 to May 1, 2024. These patients were initially identified with elevated testosterone levels through CLIA and subsequently underwent additional blood sampling for confirmatory testing using LC-MS/MS. Based on LC-MS/MS results, the patients were categorized into the pseudo-elevated group and the true-elevated group. Dif-ferences in the testosterone levels between the two groups were compared, the false-positive rate of CLIA was calcula-ted, and further evaluations conducted in the pseudo-elevated group were analyzed. Results: A total of 287 female patients with elevated testosterone levels detected by CLIA were included in the study. According to the LC-MS/MS results, 178 cases (62.0%) were classified into the pseudo-elevated group, while 109 cases (38.0%) were classified into the true-elevated group. The mean testosterone levels measured by CLIA were (3.63±1.60) nmol/L in the pseudo-elevated group and (4.13±2.20) nmol/L in the true-elevated group, showing a statistically significant difference (P < 0.05). The false-positive rate of CLIA in detecting testosterone levels in women was 62.0%, and the area under the receiver operating characteristic (ROC) curve (AUC) for CLIA was 0.601 (95%CI: 0.534-0.668) indicating low diagnostic accuracy. Among the pseudo-elevated group, 40.45% of patients underwent multiple CLIA retests, and some patients were subjected to unnecessary clinical evaluations, including imaging and hormonal testing, which significantly increased patient burden. Conclusion: This study highlights the high false-positive rate of CLIA in detecting testosterone levels in female patients, which can result in misdiagnosis, repeated testing, and unnecessary clinical evaluations, thereby increasing patient burden and resulting in inefficient use of medical resources.LC-MS/MS significantly enhances the accuracy of testosterone detection in women and is strongly recommended as the confirmatory test for female patients with elevated testosterone levels initially detected by CLIA.

Objective: To evaluate the efficacy of tension-free vaginal tape-Abbrevo (TVT-Abbrevo, TVT-A) in the treatment of female stress urinary incontinence (SUI). Methods: A retrospective analysis was conducted on patients who underwent TVT-A surgery for SUI in the Department of Obstetrics and Gynecology of Peking University First Hospital from April 2014 to December 2021. Perioperative data were collected, and various questionnaire scores were obtained from the patients before and after the operation, including the International Consultation on Incontinence questionnaire-short form (ICI-Q-SF), the pelvic organ prolapse/urinary incontinence sexual questionnaire-12 (PISQ-12), and the incontinence quality of life questionnaire (I-QOL). A 1-hour pad test was also performed. The efficacy of TVT-A and its impact on the patients' postoperative quality of life and sexual life were analyzed. Results: In this comprehensive study, a total of 130 patients with SUI underwent TVT-A, among whom 111 patients completed the follow-up. The median age of the patients was 60 (51, 66) years, and the median follow-up time was 58.5 (15-105) months. Among the 111 patients, for the 10 patients who solely received TVT-A, the operative duration was (32.25±8.75) min, and the blood loss volume was (12.75±8.48) mL. No intraoperative complications occurred in the 111 patients. Among the postoperative complications, groin pain (8 cases, 7.2%) was the most common, followed by new-onset urinary frequency and urgency (11 cases, 9.9%) and urinary tract infection (4 cases, 3.6%). There were no cases of dysuria, sling erosion, or persistent groin pain. Subjectively, 106 cases (95.5%) were cured and 5 cases (4.5%) were relieved; Objectively, 109 cases (98.2%) were cured and 2 cases (1.8%) were relieved. The ICI-Q-SF scores before and after the operation were 16.00 (11.00, 19.00) and 0.00 (0.00, 5.00), respectively; the PISQ-12 scores were (11.49±3.86) and (13.91±3.96), respectively; and the total I-QOL scores (involving behavioral limitations, psychological impact, and social impairment) were (84.19±15.36) and (106.36±8.93), respectively. All scores improved significantly after the operation compared with those before the operation (P < 0.05). Conclusion: TVT-A has fewer intraoperative and postoperative complications, and it has a good therapeutic effect on female SUI. Compared with TVT-obturator, the incidence of groin pain after surgery is lower, which can significantly improve the quality of life and sexual life of the patients.

Objective: Primary gastric lymphoma (PGL) is a rare form of lymphoma that arises within the gastric mucosa-associated lymphoid tissue (MALT), often linked to Helicobacter pylori (Hp) infection. The endoscopic features of PGL are heterogeneous, and understanding these characteristics could help distinguish between different lymphoma subtypes. This study aims to systematically assess the endoscopic features of PGL and explore the role of complement receptor type 2/B-cell lymphoma 6 protein (CD21/BCL6)-based grading of lymphoid follicular disruption in predicting the effectiveness of Hp eradication (HPE) treatment in gastric MALT lymphoma. Methods: A retrospective study was conducted involving 100 patients diagnosed with PGL at Peking University Third Hospital between January 2010 and January 2025. Patients were divided into two groups based on histopathological findings: indolent and aggressive lymphoma. The clinical and endoscopic characteristics of these two groups were compared. Survival analysis, including overall survival (OS) and progression-free survival (PFS), was performed using Kaplan-Meier curves and Log-rank tests. A subgroup of 25 patients with gastric MALT lymphoma and known HPE outcomes was selected for further analysis. Diagnostic biopsies were immunohistochemically stained with CD21 and BCL6 and graded from G0 to G4 based on follicular disruption. Logistic regression analysis was used to identify factors associated with HPE failure. Results: Among the 100 patients, the average age was 63.0 (55.8, 71.0) years, with 47 men and 53 women. Aggressive lymphoma showed a significantly higher incidence of B symptoms compared with indolent lymphoma (49.0% vs. 19.6%, P= 0.004). Endoscopically, aggressive lymphoma presented more frequently with ulcerative or mixed morphologies (P < 0.001) and exhibited higher rates of mucosal erosion, ulceration with white slough, lesion friability, bleeding tendency, gastric stenosis, and impaired peristalsis (P < 0.001 for all). Aggressive lymphoma also had significantly worse OS and PFS (OS: P=0.009; PFS: P=0.003). In the subgroup of 25 MALT lymphoma patients, those with ineffective HPE were more likely to be Hp-negative (P=0.049) and had a significantly higher degree of follicular disruption (P=0.015). Multivariable Logistic regression revealed that follicular disruption grading was independently associated with HPE failure (AOR=3.63, 95%CI: 1.14-11.58, P=0.021), while Hp infection status was not (P=0.240). Conclusion: PGL demonstrates considerable variability in its endoscopic presentation. Features, such as ulcerative/mixed morphology, friability, bleeding tendency, stenosis, and impaired peristalsis are indicative of more aggressive disease and correlate with poorer survival outcomes. The CD21/BCL6-based grading of lymphoid follicular disruption provides a valuable tool for identifying patients at high risk of HPE failure, supporting early intervention and risk stratification for gastric MALT lymphoma treatment.

Objective: To explore the risk factors associated with ventilator-associated pneumonia (VAP) in the patients with chest trauma in the intensive care unit (ICU). Methods: A retrospective analysis was conducted on the clinical data of 124 adult trauma patients admitted to the surgical ICU of Peking University People' s Hospital between June 2019 and June 2023. These patients underwent tra-cheal intubation within 24 hours of admission and received mechanical ventilation for more than 48 hours. Based on whether VAP occurred during hospitalization, the patients were divided into a VAP group (46 cases) and a non-VAP group (78 cases). Lasso regression analysis was employed for variable selection, followed by Logistic regression analysis to determine the risk factors for VAP in these patients with chest trauma in the ICU. Results: The multivariate regression analysis indicated that the injury severity score (ISS) (OR=1.08, 95%CI: 1.02-1.14, P=0.007) and tracheostomy (OR=4.61, 95%CI: 1.74-13.11, P=0.003) were independent risk factors for VAP in the patients with chest trauma (P < 0.05). Among all VAP cases, early-onset VAP was observed in 19 patients, while late-onset VAP was observed in 27 patients. The most common pathogen in all VAP cases was Klebsiella pneumoniae, identified in 18 cases (39.1%). In early-onset VAP, Klebsiella pneumoniae was the most frequently detected pathogen, found in 10 cases (52.6%). Conversely, in late-onset VAP, Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent pathogens, each appearing in 10 cases (37.0%). Conclusion: The occurrence of VAP in the patients with chest trauma in the ICU was influenced by multiple factors. This study identified that a higher ISS and the presence of a tracheostomy were independent risk factors for VAP in these patients. These findings suggest that in clinical practice, special attention should be given to the chest trauma patients with high ISS scores, and the timing and necessity of tracheostomy should be carefully considered to reduce the incidence of VAP and improve patient outcomes. Furthermore, the study highlights the importance of early identification and appropriate management of the patients at higher risk for developing VAP. By recognizing the significance of these risk factors, healthcare providers can implement targeted interventions and preventive measures, such as optimizing ventilation strategies and enhancing infection control practices. Future research should further explore additional factors that may influence the occurrence of VAP and verify these findings to provide stronger evidence for the prevention and treatment of VAP. Additionally, multicenter studies with larger sample sizes are recommended to validate these results and develop comprehensive guidelines for managing the chest trauma patients in the ICU.

Objective: To investigate the differential efficacy of super-microsurgical lymphaticovenular anastomosis (LVA) for limb lymphedema stratified by International Society of Lymphology (ISL) stage and indocyanine green (ICG) lymphographic Yamamoto pattern, and to provide evidence-based guidance for patient selection. Methods: A retrospective analysis was performed on 32 patients with unilateral limb lymphedema admitted between December 2023 and April 2025. Preoperatively, the patients were classified into ISL stage Ⅰ-Ⅱ (30 cases) and stage Ⅲ (2 cases), and into ICG patterns of splash (6 cases), stardust (14 cases), and diffuse (12 cases). The primary endpoint was percentage reduction of limb volume (%REV) and limb circumferential reduction at 6 months postoperatively; secondary endpoints included anastomotic patency rate, cellulitis recurrence rate, compression garment downgrade rate, and patient satisfaction. One-way ANOVA with Bonferroni correction was used to compare %REV between ISL stages Ⅰ-Ⅱ and different ICG patterns; effect size was calculated with Cohen's d; multi-variate linear regression identified independent predictors of %REV; descriptive analysis was only performed for stage Ⅲ patients. All statistical tests were two-tailed. Results: (1) ISL stratification: the overall %REV of the patients with stages Ⅰ-Ⅱ was 53%±9%, including 63%±8% for stage Ⅰ and 50%±7% for stage Ⅱ; the %REV of the patients with stage Ⅲ was 36%±5% (descriptive result). (2) ICG stratification: %REV was 63%±6% for splash, 56%±7% for stardust, and 36%±4% for diffuse patterns (P < 0.001, d=3.5). (3) A clinically observed trend of efficacy attenuation was found between diffuse pattern and stage Ⅲ (not included in the statistical model under two-tailed test). Anastomotic patency at the end of 1 year was 92.2 %. Cellulitis recurrence decreased from 28.1 % to 0.0 % (P=0.01). Compression garment was downgraded in 26 patients (81.3%), and overall satisfaction reached 96.9%. Conclusion: LVA efficacy was significantly associated with both ISL stage and ICG pattern. The patients with splash pattern or at stage Ⅱ and below could achieve > 55% volume reduction and should be considered the primary indications for LVA. The patients with diffuse pattern or at stage Ⅲ disease might require adjunctive liposuction or vascularized lymph node transfer to improve outcomes. Preoperative evaluation combining ISL staging and ICG lymphography can provide a reliable basis for the selection of LVA surgical indications and the formulation of treatment plans.

Objective: To evaluate the positional accuracy of dynamic navigation-assisted trephine bone harvesting in the symphysis and external oblique ridge. Methods: Ten standardized mandibular models were 3D-printed using polyetheretherketone (PEEK), mimicking natural mandibular mechanical properties. Pre-operative cone beam CT (CBCT) scans (70 kV, 70 mA, 0.25 mm×0.25 mm ×0.25 mm voxel) were acquired, and data were imported into dynamic navigation software (Dcarer, China). Two donor sites were designed in both the symphysis (≥15 mm from anterior teeth) and external oblique ridge (≥6 mm from molars), with 8 mm-diameter, 6 mm-deep cylindrical osteotomy tracts planned for each site.After calibrating the navigation system with 20 mm and 50 mm spherical burs, an 8 mm outer-diameter trephine prepared 40 tracts under real-time guidance. Post-operative CBCT scans were taken, and Mimics 20.0 software fitted actual tracts to standard cylinders. Superimposing actual and designed tracts via metal registration markers, we measured coronal/apical center point deviation, depth deviation, and axis angle deviation in order to compare site-specific accuracy. Results: Deviations of the dynamic navigation-assisted trephine method for bone harvesting was (1.91±0.69) mm at the coronal center point, (1.54±0.66) mm at the apical center point, (－0.83±0.77) mm at the depth of the apical center point and 3.02°±0.38° at the axis angle. The four deviations in symphysis and external oblique ridge were (1.32±0.36) mm and (2.50±0.35) mm at the coronal center point (P < 0.01), (1.06± 0.31) mm and (2.02±0.56) mm at the apical center point (P < 0.01), (－0.30±0.52) mm and (－1.38±0.57) mm at the depth of apical center point (P < 0.01), 3.03°± 0.38° and 3.00°± 0.39° at axis angle (P=0.80). Conclusion: Within the limitations of this study, dynamic navigation-assisted trephine harvesting shows good accuracy. The symphysis exhibits higher accuracy than the external oblique ridge, possibly due to surface morphology and operability differences. These findings support its clinical potential, but future clinical studies are needed to validate results.

Objective: To evaluate the potential of concentrated growth factors (CGF) to enhance the regenerative efficacy of guided tissue regeneration (GTR) when combined with bone graft in the treatment of grade Ⅱ furcation defects in mandibular molars. Methods: This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology. A total of 16 patients (aged 20-60 years) with chronic periodontitis requiring periodontal surgical intervention were enrolled. All the participants had completed initial periodontal therapy. This involved a total of 20 mandibular molars, which comprised 36 instances of grade Ⅱ furcation lesions located on the buccal or lingual aspects. The 36 furcation lesions were randomly assigned to two groups, with each group containing 18 lesions. The experimental group received treatment with CGF combined with GTR and bone grafting, while the control group was treated with GTR and bone grafting alone. Clinical examinations and cone beam CT (CBCT) assessments were conducted on the affected teeth prior to the surgery, 6 months and 1 year post surgery. Clinical parameters recorded included probing depth (PD), vertical clinical attachment level (CAL-V), horizontal clinical attachment level (CAL-H). CBCT scans were acquired. The radiographic outcomes assessed included bone loss in the vertical direction (BL-V) and horizontal direction (BL-H). Changes in both clinical parameters and CBCT data at baseline and 1 year post surgery were compared between the experimental group and control group. Results: At baseline, no statistically significant differences were observed between the two groups in terms of PD, CAL-V, CAL-H, and BL-V, BL-H as assessed by CBCT (P>0.05), indicating good baseline balance. Six months and 1 year post surgery, both groups demonstrated significant improvements in clinical indicators compared with baseline (P < 0.01). Notably, one year post surgery, the enhancement observed in the experimental group was significantly greater than that of the control group (P < 0.05): the reduction in PD was (4.75±1.87) mm in the experimental group versus (3.43±1.76) mm in the control group; the decrease in CAL-V was (5.55±1.04) mm in the experimental group versus (4.41±1.08) mm in the control group; the decrease in CAL-H was (3.89±1.22) mm in the experimental group versus (3.07±1.02) mm in the control group. One year post surgery, CBCT results demonstrated that the reduction in BL-V was (4.05±1.37) mm in the experimental group compared with (3.17±1.09) mm in the control group, and the reduction in BL-H was (4.02±1.32) mm versus (3.27±1.08) mm. Conclusion: The one-year observational findings demonstrate that CGF enhances the regenerative efficacy of GTR combined with bone graft in the treatment of grade Ⅱ furcation defects in mandibular molars.

Objective: To explore the method of establishing benign esophageal stricture in rabbits by using argon plasma coagulation under endoscopy, and to provide a convenient and stable animal model for subsequent research on the prevention of esophageal stricture. Methods: Twenty-two male New Zealand rabbits were randomly divided into three groups after completing esophageal radiography under X-ray. The blank control group (n=4) only received endoscopic examination. In the experimental group Ⅰ (n=9) and experimental group Ⅱ (n=9), argon knife was performed on the esophagus at 30 W and 50 W power, respectively, under endoscopy. Endoscopy was performed 1, 2, and 4 weeks after the operation to observe the changes in the esophagus, and the body weight and mental state were recorded. Four weeks after the operation, esophageal radiography under X-ray was performed to measure the inner diameter of the esophageal stricture and calculate the stricture index. All the experimental animals were sacrificed and esophageal specimens were obtained for histopathological examination and detection of hydroxyproline content in esophageal tissue. Results: In the blank control group, the body weight significantly increased 4 weeks after the operation compared with that before the operation [(4.13±0.25) kg vs. (3.10±0.39) kg, P < 0.05], and there was no significant change in the esophageal inner diameter [(12.89±0.83) mm vs. (12.83±1.07) mm, P>0.05]. In the experimental group Ⅰ, there was no significant change in the body weight and esophageal inner diameter 4 weeks after the operation compared with that before the operation [(2.91±0.28) kg vs. (2.91±0.54) kg; (11.19±0.97) mm vs. (12.06±0.32) mm; P>0.05]. In the experimental group Ⅱ, the body weight and esophageal inner diameter significantly decreased 4 weeks after the operation compared with that before the operation [(2.02±0.31) kg vs. (3.51±0.37) kg; (10.49±1.76) mm vs. (12.58±1.11) mm; P < 0.05]. The esophageal stricture index 4 weeks after the operation was significantly higher in the experimental group Ⅱ than in the experimental group Ⅰ (1.242±0.148 vs. 1.083±0.104, P < 0.05). The histopathological score and hydroxyproline content in the experimental group Ⅰ [2.55±0.52, (182.90±72.75) μg/g] and experimental group Ⅱ [4.55±0.52, (210.81±54.28) μg/g] were significantly higher than those in the blank control group [0, (91.37±29.74) μg/g] (P < 0.05). Conclusion: The induction of esophageal stricture in male New Zealand rabbits using 50 W argon knife under endoscopic guidance is a feasible, depth-controllable, and reproducible method. This animal model provides a reliable platform for the development and evaluation of novel therapeutic strategies for esophageal stricture.

Objective: To evaluate the feasibility and safety of the suture-mediated vascular closure device in the closure of the left brachial artery access site after thoracic endovascular aortic repair (TEVAR). Methods: Data from 91 patients receiving TEVAR with left brachial artery puncture from January 2021 to May 2023 were retrospectively collected and analyzed. In 27 cases whose brachial artery was over 5 mm, a suture-mediate vascular closure device (Perclose ProGlide, Abbott) was used to deal with the left brachial artery access, and in the other 64 cases with brachial artery < 5 mm, manual compression was used. The primary outcomes were the incidence of perioperative access-related complications and long-term outcomes. Results: In the suture-mediate device group, the access-site compression time was significantly reduced than that in the manual compression group (P < 0.001). The proportion of discomforts, such as numbness, pain, and swelling of the compression-related limbs was significantly lower than that in the compression-alone group (3.70% vs. 42.19%, P < 0.001). One case with brachial artery access-related complications occurred in the suture-mediate device group during hospitalization, which was acute brachial artery occlusion and required reinterventions. In the manual compression group, 4 cases of brachial artery puncture point complications occurred during hospitalization, including 3 cases of pure hematoma with conservative management and 1 case of pseudoaneurysm requiring reintervention. There was no significant difference in the incidence of early puncture point complications between the two groups (3.70% vs. 6.25%, P=0.625). During an average follow-up of (14±6) months, no access-related complications of the left brachial artery occurred. Conclusion: It is effective to use the suture-mediated vascular closure in the left brachial artery access site after TEVAR, and the long-term effect is satisfactory. For patients with >5 mm brachial artery, it is reasonable to use suture-mediated vascular devices to deal with brachial artery access.

Objective: To investigate the expression of the fatty acid binding protein 6 (FABP6) long transcript in clear cell renal cell carcinoma (ccRCC), its correlation with tumor biological behavior, and further analyze its potential as a biomarker and therapeutic target. Methods: Following bioinformatics analysis of the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases, the FABP6 gene associated with ccRCC development and prognosis was screened. The existence and expression patterns of FABP6 long and short transcripts were further confirmed experimentally. In the experimental section, reverse transcription quantitative real-time PCR (RT-qPCR) and Western blot were used to detect the differential expression levels of the FABP6 long and short transcripts in ccRCC cell lines and tissue samples. ccRCC cell lines with overexpression and knockdown of the FABP6 long transcript were constructed. The impact of the FABP6 long transcript on the proliferation capacity of ccRCC cells was assessed using the 5-ethynyl-2'-deoxyuridine proliferation assay and the colony formation assay, respectively. Results: Bioinformatics database analysis revealed that the expression of the FABP6 gene was higher in ccRCC cell lines and tissue samples compared with their normal counterparts (P=0.02), with FABP6 long transcript being the predominant form (P=0.02). RT-qPCR and Western blot results further confirmed that the expression level of the FABP6 long transcript was higher than that of the FABP6 short transcript in ccRCC cell lines such as 769P, A498, CAKI1, OSRC2, and 786O. In in vitro functional experiments, overexpression of the FABP6 long transcript promoted the proliferation of ccRCC cells. Conversely, knockdown of the FABP6 long transcript significantly inhibited the proliferation of ccRCC cells. This suggested that the FABP6 long transcript might play an oncogenic role in the development and progression of ccRCC, potentially by driving cell cycle progression or regulating related proli-ferative signaling pathways. Conclusion: This study systematically reports the specific high expression of the FABP6 long transcript in ccRCC. Gain-of-function and loss-of-function experiments confirmed its crucial role in promoting ccRCC cell proliferation. This reveals an important new function of the FABP6 gene, particularly FABP6 long transcript, in the malignant progression of ccRCC.

Hepatoid adenocarcinoma of the stomach (HAS) is a rare and highly malignant variant of gastric cancer, distinguished by histological features resembling hepatocellular carcinoma and frequent elevation of serum alpha-fetoprotein (AFP). It demonstrates aggressive biological behavior, early metasta-tic potential, and intrinsic resistance to conventional platinum-based chemotherapy, resulting in poor outcomes. No standard systemic therapy exists for initially unresectable HAS, making conversion strategies a critical therapeutic goal. We present a 56-year-old male with biopsy-proven locally advanced HAS and markedly elevated AFP (1 729.53 μg/L). Imaging revealed bulky lymphadenopathy (largest node: 39 mm×27 mm), rendering the tumor unresectable. Molecular profiling confirmed human epidermal growth factor receptor 2 (HER2) amplification. First-line conversion therapy with oxaliplatin, fluoropyrimidine, sintilimab (a programmed death-1 inhibitor), and later trastuzumab yielded only transient stabilization followed by clear progression: After six cycles, AFP rose to 1 546.07 μg/L and target lymph nodes enlarged to 46 mm×31 mm on CT. Given treatment failure and persistent HER2 positivity, a second-line, biology-informed regimen was initiated: Disitamab vedotin (an HER2-targeted antibody-drug conjugate delivering monomethyl auristatin E), lenvatinib (a multi-targeted tyrosine kinase inhibitor blocking vascular endothelial growth factor receptor and other pro-angiogenic pathways), tislelizumab (a programmed death-1 inhibitor), and short-course capecitabine (discontinued after 7 days due to grade 3 thrombocytopenia). This combination produced rapid and sustained antitumor activity. Serum AFP declined drama-tically to 102.3 μg/L after two cycles. Radiological reassessment showed progressive shrinkage of metastatic lymph nodes (from 46 mm to 25 mm after cycle two, and further to 14 mm after cycle three) consistent with partial response according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET-CT) confirmed reduced metabolic activity in residual lesions. These results enabled successful R0 radical distal gastrectomy in June 2024. Final pathology revealed minimal residual disease (ypT1bN1) with hepatoid morphology and positive immunostaining for AFP, glypican-3, Sal-like protein 4, and HER2 (2 +). The patient received two adjuvant cycles of the same targeted-immunotherapy backbone before transitioning to observation due to cumulative toxicity. Eighteen months postoperatively, he remained free of recurrence. This case underscores that in HER2-positive, chemotherapy-refractory HAS, a rationally designed, multimodal regimen integrating an HER2-directed antibody-drug conjugate, antiangiogenic agent, and immune checkpoint blockade can overcome therapeutic resistance, achieve meaningful downstaging, and enable long-term disease control. Early molecular characterization and aggressive, persona-lized intervention are essential for improving outcomes in this rare malignancy.

Thrombocytopenia is one of the most common hematological complications of systemic lupus erythematosus (SLE). In severe cases, it can lead to life-threatening complications such as intracranial hemorrhage, significantly affecting the prognosis of patients. Clinically, after treatment with standard-dose glucocorticoids combined with immunosuppressants (e.g., cyclophosphamide, mycophenolate mo-fetil, etc.), the platelet count of most patients can rapidly increase and remain stable. However, there are still some refractory patients who do not respond to traditional treatment and require advanced therapeutic regimens such as biological agents or thrombopoietin receptor agonists (TPO-RAs). This article reports a case of a 38-year-old young female patient with SLE. By the 17th week of her pregnancy, severe thrombocytopenia (9×10⁹/L) was detected. Laboratory tests showed an antinuclear antibody (ANA) titer of 1 ∶ 320, decreased complement C3, and elevated antiphospholipid antibodies. Additionally, she had a popliteal vein thrombosis in the right lower extremity. Bone marrow aspiration indicated a disorder in the differentiation and maturation of megakaryocytes. The patient was diagnosed with SLE, secondary immune thrombocytopenia, and antiphospholipid syndrome. At the end of 21 weeks of gestation, the patient underwent a cesarean section to terminate the pregnancy due to concurrent asymptomatic pulmonary embolism and pulmonary hypertension. During the entire disease course, the patient only had a transient response (duration no more than 1 week) to intravenous immunoglobulin (IVIG) or high-dose glucocorticoid pulse therapy. She showed no response to conventional-dose glucocorticoids (methylprednisolone 40-80 mg/d), immunosuppressants (such as tacrolimus, mycophenolate mofetil, and sirolimus), rituximab, and TPO-RAs (e.g., eltrombopag). The platelet count persistently fluctuated between 1×10⁹/L and 10×10⁹/L, accompanied by intermittent gingival and vaginal bleeding. Intermittent IVIG infusions and subcutaneous injection of leuprolide acetate for artificial amenorrhea were required for treatment. Finally, after the patient received avatrombopag 20 mg once daily for 5 days, the platelet count rapidly increased to the normal range and remained stable for a relatively long period. This case suggests that TPO-RAs can be an effective treatment option for patients with refractory SLE complicated by thrombocytopenia who are unresponsive to traditional therapies. Additionally, there are differences in response among different TPO-RAs, and switching to another TPO-RA may yield favorable therapeutic effects. This provides a new practical reference for the individualized treatment of such refractory cases in clinical practice.

Gastric cancer is one of the malignant tumors with high incidence and mortality rates globally, with China ranking among the top 5 in both case numbers and deaths. With the popularization of laparoscopic technology and surgical robotic systems, gastric cancer surgery has entered the era of minimally invasive procedures. Robotic gastrectomy (RG) demonstrates unique value in complex lymph node dissection and digestive tract reconstruction, outperforming laparoscopic gastrectomy (LG) in terms of intraoperative blood loss, recovery speed, and certain complications. However, the longer operation time and higher costs remain disadvantages of RG. Currently, both domestic and international guidelines include RG in the treatment indications for early and some locally advanced gastric cancer, emphasizing that it should be performed in experienced medical centers. Meanwhile, new technologies such as indocyanine green (ICG) near-infrared imaging-guided lymph node dissection, reduced-port/single-port surgery, 5G remote surgery and integration with artificial intelligence are continuously emerging, driving RG towards precision and intelligence. This article systematically reviews clinical research and guideline consensus from both domestic and international sources, focusing on evaluating the technical characteristics, learning curve, short-term/long-term efficacy and expansion of indications for RG. It analyzes its main limitations and provides a prospective discussion on future development directions.

Malignant tumors, a class of diseases characterized by abnormal proliferation and aggressive growth, pose a severe threat to human health. A hallmark of tumor cell biology is the pervasive presence of the Warburg effect, wherein cells undergo high-rate glycolysis leading to substantial lactate production, even under aerobic conditions. Traditionally regarded merely as a metabolic waste product, lactate has been re-evaluated through recent research, which reveals it to be not only a crucial metabolite but also a significant signaling molecule. It exerts core regulatory functions in gene expression and cellular activity through a novel post-translational modification: Protein lactylation. The seminal discovery of histone lactylation unveiled a direct and novel mechanistic link between cellular metabolic states and epigenetic regulation. Subsequent proteomic studies have substantiated that lactylation is a widespread modification existing across various types of non-histone proteins, establishing it as an important regulatory mechanism. The process of lactylation modification is dynamic and reversible, orchestrated by specific "writer" enzymes that catalyze its addition and "eraser" enzymes that facilitate its removal. Within the context of malignant tumors, lactylation modification participates extensively in tumorigenesis and progression by targeting two primary classes of substrate proteins: Histones and non-histone proteins. At the epigenetic level, histone lactylation remodels chromatin state and reprograms gene expression profiles. At the functional level, lactylation of non-histone proteins directly modulates the activity of key signaling pathway components, metabolic enzymes, and DNA repair factors. The synergistic action of these two facets collectively drives core malignant phenotypes, including remodeling of the tumor immune microenvironment, facilitation of metastasis and dissemination, induction of therapy resistance, and dysregulation of metabolism. This review provides a systematic overview of the discovery, molecular mechanisms, and recent advances concerning the roles of lactylation in tumor metabolism, immunity, and treatment resistance. It further explores potential therapeutic strategies targeting lactylation, such as modulating lactate metabolism, intervening in the enzymatic machinery of the modification system, and developing specific blocking agents. Although challenges remain regarding the specificity of the involved enzymes and the functional validation of these modifications, in-depth research on lactylation offers a fresh perspective for understanding the crosstalk between tumor metabolism and epigenetics. It also lays a theoretical foundation for the development of innovative strategies for cancer diagnosis and therapy.

Pancreatic adenosquamous carcinoma (PASC) is a rare exocrine malignancy of the pancreas with an increasing incidence, histologically defined by the coexistence of adenocarcinoma and squamous carcinoma components. Current pathological diagnosis typically requires the squamous component to comprise at least 30% of the tumor. However, this threshold remains controversial given the unconfirmed independent prognostic value of the extent of squamous differentiation. Compared with pancreatic ductal adenocarcinoma (PDAC), PASC exhibits greater aggressiveness and heterogeneity, contributing to a poorer prognosis with a median survival of approximately 9 months. Despite its distinct biological behavior, specific preoperative diagnostic methods and targeted therapeutic strategies remain elusive. Diagnostically, while PASC lacks specific molecular markers, the ring-enhancement sign observed in the arterial phase of contrast-enhanced CT may aid distinction from PDAC. Owing to the lack of standardized therapeutic strategies, treatment largely follows guidelines established for PDAC, offering limited survival benefits, though platinum-based chemotherapy and radiotherapy show potential efficacy. Notably, the rationale for immunotherapy lies in the high programmed death-ligand 1 (PD-L1) expression in the squamous component and an immunosuppressive microenvironment characterized by specific checkpoint interactions, such as the TIGIT-CD155 axis. Furthermore, the cellular origin and evolutionary trajectory of PASC remain debated. While monoclonal origin is the prevailing theory, it remains unclear whether the squamous component arises from adenocarcinoma transdifferentiation or from pancreatic pluripotent stem cells. At the molecular level, PASC shares genomic and transcriptomic features with PDAC yet maintains a distinct identity. Concurrently, its tumor microenvironment (TME) displays unique landscapes, differing significantly from PDAC in immune and stromal components like T cells, macrophages, and fibroblasts. Moreover, marked intratumoral heterogeneity is observed between the adenocarcinoma and squamous carcinoma regions within the same tumor. Future efforts should prioritize multi-omics and laser microdissection technologies to establish a refined molecular classification system, alongside the integration of liquid biopsy and artificial intelligence (AI)-assisted radiomics for accurate preoperative diagnosis. This comprehensive strategy is essential to shift clinical practice from empirical treatment to personalized precision medicine, ultimately improving outcomes for this refractory disease. This article systematically reviews the epidemiology and clinicopathological features of PASC, and specifically explores the therapeutic potential of platinum-based chemotherapy, radiotherapy, and immunotherapy. Furthermore, special attention is given to recent advances in monoclonal origin patterns, unique genomic and transcriptomic alterations, and TME heterogeneity.