eIF3a is a N ⁶-methyladenosine (m⁶A) reader that regulates mRNA translation by recognizing m⁶A modifications of these mRNAs. It has been suggested that eIF3a may play an important role in regulating translation initiation via m⁶A during infection when canonical cap-dependent initiation is inhibited. However, the death of animal model studies impedes our understanding of the functional significance of eIF3a in immunity and regulation in vivo. In this study, we investigated the in vivo function of eIF3a using eIF3a knockout and knockdown mouse models and found that eIF3a deficiency resulted in splenic tissue structural disruption and multi-organ damage, which contributed to severe sepsis induced by Lipopolysaccharide (LPS). Ectopic eIF3a overexpression in the eIF3a knockdown mice rescued mice from LPS-induced severe sepsis. We further showed that eIF3a maintains a functional and healthy immune system by regulating B cell function and quantity through m⁶A modification of mRNAs. These findings unveil a novel mechanism underlying sepsis, implicating the pivotal role of B cells in this complex disease process regulated by eIF3a. Furthermore, eIF3a may be used to develop a potential strategy for treating sepsis.

In this comprehensive review, we delve into the evolution of drug delivery systems in reproductive medicine with a focus on the emerging role of exosomes, a class of extracellular vesicles. Exosomes offer unique advantages in overcoming these challenges due to their inherent biocompatibility, stability, and ability to facilitate targeted delivery. This review provides a detailed examination of exosome biogenesis and their function in cellular communication, setting the stage for understanding their potential as drug delivery vehicles. We explore the mechanisms through which exosomes can be loaded with small molecule drugs and the benefits they offer over synthetic nanoparticles. The review highlights groundbreaking case studies that illustrate the successful application of exosome-mediated drug delivery in reproductive health, including enhancing fertility treatments, supporting gamete and embryo development, and facilitating maternal-fetal communication. This study aims to provide a precise understanding of how exosomal drug delivery can revolutionize treatments for reproductive health disorders, paving the way for future therapeutic applications. Lastly, we touch upon the promising therapeutic implications of exosomal delivery for proteins and genes, offering a window into future treatments for reproductive health disorders.

Objective:To explore the surgical treatment strategies for Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures.Methods:A retrospective analysis was performed on the clinical data of 25 adult patients with Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures, admitted to the Upper Extremity Orthopaedics Department of Zhengzhou Orthopaedic Hospital from June 2013 to June 2023. There were 15 males and 10 females, with an average age of 43.5±14.7 years (range: 20-67 years). Among them, 5 cases were complicated with humeroulnar joint dislocation. The patients were divided into two groups: 17 cases were treated with open reduction and internal fixation (ORIF) of radial head fractures combined with ORIF of proximal ulnar fractures (open reduction group), and 8 cases were treated with radial head replacement combined with ORIF of proximal ulnar fractures (radial head replacement group). At the last follow-up, elbow joint range of motion was recorded, and pain, elbow function, and subjective upper limb function were evaluated using the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder and Hand (DASH) scale. The incidence of complications was also recorded.Results:All 25 patients were followed up for an average of 25.6±9.0 months (range: 12-45 months). At the last follow-up, the affected elbows in the open reduction group had a flexion of 124.47°±12.59° (range, 90°-140°), extension of 21.12°±10.07° (range, 10°-50°), pronation of 48.59°±11.62° (range, 20°-61°), and supination of 48.53°±8.43° (range, 30°-60°). In the radial head replacement group, the affected elbows showed flexion of 128.75°±13.17° (range, 100°-140°), extension of 14.00°±7.71° (range, 0°-25°), pronation of 61.25°±10.26° (range, 60°-80°), and supination of 71.88°±10.33° (range, 60°-80°). The MEPS score in the open reduction group was 82(75, 85) points (range, 55-90 points), the VAS pain score was 1(1, 2) points (range, 0-3 points), and the DASH score was 9(8, 14) points. In the radial head replacement group, the MEPS score was 90(85, 90) points (range, 85-90 points), the VAS pain score was 1(0, 1) points (range, 0-1 points), and the DASH score was 5(5, 6) points. Complications included 5 cases of heterotopic ossification, 1 case of incision infection, 1 case of nonunion, 1 case of ulnar nerve injury combined with traumatic arthritis, and 1 case of proximal radioulnar bone bridge formation.Conclusions:Both radial head replacement and open reduction internal fixation combined with proximal ulnar fracture fixation can effectively treat Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures. There was no significant difference in postoperative flexion and extension, but the radial head replacement group demonstrated better forearm rotation and DASH scores postoperatively.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified inflammatory demyelinating disease of the central nervous system, with strong heterogeneity in clinical manifestations and many challenges in diagnosis and treatment. At present, some international MOGAD diagnosis and treatment guidelines and consensus are mostly based on western population data, so Chinese neuroimmunology experts have been committed to customizing MOGAD diagnosis and treatment guidelines suitable for Chinese population. The Chinese guidelines for diagnosis and treatment of myelin oligodendrocyte glycoprotein antibody-associated disease (2025 edition) has comprehensively revised the disease definition, diagnostic criteria, imaging features, treatment strategies, etc., based on the latest evidence-based research at home and abroad, as well as multi-center clinical research data in China. Some important revisions in the new guideline were interpreted in this article.

Objective:To investigate short-term efficacy of interventional treatment guided by abdominal superficial ultrasound and its impact on immune levels in patients with advanced pancreatic cancer.Methods:A total of 152 patients diagnosed with advanced pancreatic cancer from May 2018 to March 2020 in the People's Hospital of Yuechi were selected as study subjects,with 84 patients treated with combination chemotherapy and 68 patients treated with chemotherapy alone.After 1∶1 propensity score match-ing,a total of 60 patients were included in each group.Clinical data were compared between matched groups,and effect of different treatment methods on short-term efficacy and immune levels in advanced pancreatic cancer were evaluated by generalized estimating equations.Results:There were no statistically significant differences in age,BMI,tumor location,gender,tumor size and tumor stage between matched groups(P>0.05).When comparing efficacy of matched groups,local control rate(LCR)showed a declining trend after treatment(P<0.05),median durations of local progression-free survival(LPFS)and overall survival(OS)in chemotherapy group were higher than monotherapy group(P<0.05).There was no statistically significant difference in CA19-9 level before treatment between combination chemotherapy group and monotherapy chemotherapy group(P>0.05).In combiuation chemotherapy group,CA19-9 level showed a continuous downward trend after treatment,with a significant decrease at 6-month follow-up compared to be-fore treatment;in chemotherapy alone group,CA19-9 level showed an overall decrease followed by an increase,with the lowest point at 1 month,and a significant decrease compared to before treatment,while no significant differences in remaining follow-up periods(P>0.05).There was no significant difference of CA19-9 level at 7 days and 14 days after treatment between monotherapy chemotherapy group and combination chemotherapy group(P>0.05).However,at 1 month,3 months and 6 months after treatment,CA19-9 level in combination chemotherapy group was significantly lower than monotherapy chemotherapy group(P<0.05).Immune levels in combina-tion chemotherapy group showed an initial increase followed by a decrease,reaching the highest point at 1 month,and total T-cell count showed a significant decrease after 6 months of treatment compared to before treatment(P<0.05).CD3+T,NK,IL-2 and IFN-γ immune levels were still higher than before treatment(P<0.05),with no significant differences in remaining indicators compared to before treatment(P>0.05).CD4+T/CD8+T in chemotherapy alone group did not show a significant trend,and remaining indicators showed same trend as combined chemotherapy group(P<0.05);after 6 months of treatment,total T-cell count,CD3+T cell count,NK cell count and IL-2 level were lower than before treatment(P<0.05),with no significant differences in remaining indicators compared to before treatment(P>0.05).During follow-up period,combined chemotherapy group showed higher levels of total T cells,CD3+T cells,NK cells,IL-2,IFN-γ and IL-6 levels compared to single chemotherapy group(P>0.05).CD4+T/CD8+T at 14 days and 3 months of follow-up was significantly higher in combined chemotherapy group than single chemotherapy group(P<0.05),while differences were not significant at other follow-up times(P>0.05).Generalized estimating equation evaluation showed that all indica-tors were statistically significant.Conclusion:Interventional treatment guided by abdominal superficial ultrasound can effectively improve short-term efficacy and immune levels in patients with advanced pancreatic cancer.

Objective:To assess the safety and efficacy of thiotepa, busulfan, and etoposide (TBE) conditioning followed by autologous hematopoietic stem-cell transplantation (TBE auto-HSCT) in primary central nervous system lymphoma (PCNSL) patients.Methods:Clinical data from 27 PCNSL patients who received TBE auto-HSCT at the Fifth Medical Center of PLA General Hospital between November 1, 2021, and April 30, 2024, were retrospectively analyzed.Results:Twenty-seven patients [16 males, 11 females; median age 57 (23–72) years] were included, with 12 (44.4%, 12/27) over 60. Twenty-five had newly diagnosed PCNSL and 2 were relapsed. Median time from diagnosis to transplantation was 6.9 (5.0–10.0) months. TBE auto-HSCT increased complete remission (CR) rate from 63.0 to 96.3% ( P= 0.005), and 9 of 10 patients in partial remission achieving CR post-transplant. Median follow-up was 24.5 months (range 2.0–36.0). Two-year progress-free and OS rates were (87.2±6.9) % and (88.6±6.2) %, respectively. Common grade 3 nonhematologic adverse events were diarrhea (18.5%, 5/27) and bacterial infections (14.8%, 4/27). One patient (64 years old) died from carbapenem-resistant Enterobacteriaceae infection within 2 months post-transplant, yielding a 100-day treatment-related mortality of 3.7% (1/27) . Conclusion:TBE-conditioned high-dose chemotherapy with auto-HSCT is effective, safe, and well-tolerated in PCNSL patients, including the elderly.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective:To investigate the awareness of clinical practice guidelines (referred to as "guidelines") and experts consensus (referred to as "consensus") among otorhinolaryngology head and neck surgery medical staff, and to analyze the effectiveness of the ninth guideline methodology workshop.Methods:Self-designed survey questionnaires were used to conduct two surveys among otorhinolaryngology head and neck surgery medical staff who participated in the ninth guideline methodology workshop held in Chengdu from Jannuary 10 to 11, 2025, both before and after the training, to assess their awareness and knowledge of guideline and consensus development methodology. The effectiveness of the training was evaluated using the paired chi-square test.Results:A total of 77 peoples (95.06%), who participated in the ninth guideline methodology workshop, completed the survey questionnaires both before and after the training. One-third of the respondents reported a relatively good to very good understanding of guideline and consensus development. The overall methodology of the guidelines and consensus they had participated in developing still showed room for improvement. After the methodology training, the score rate for each test question significantly increased compared to before the training ( P<0.05), and the distribution trend of the total scores changed markedly (Before the training, 71 people scored less than 60 points, 4 people scored 60 points, and 2 people scored 70 points. After the training, only 1 person scored less than 60 points, 1 person scored 60 points, and 75 people scored between 70 and 100 points, of which 21 people scored 100 points). Conclusion:The awareness of guideline and consensus development methodology among otorhinolaryngology head and neck surgery medical staff still has room for improvement. The guideline methodology workshop can enhance participants′ mastery of guideline and consensus development methodology.

Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

Objective:To systematically analyze the disease burden of soft tissue and extraosseous sarcomas (STEOS) among individuals aged 15-49 years old worldwide and in the Chinese mainland from 1990 to 2021, and explore the relationship between socio-economic development and disease burden.Methods:Incidence, mortality and disability-adjusted life year (DALY) for STEOS in populations aged from 15 to 49 were collected from the Global Burden of Disease (GBD2021) database. The temporal trends in disease burden were quantified using the average annual percentage change (AAPC). The socio-demographic index (SDI) was employed to examine the socio-economic development.Results:The global incidence rate of STEOS among individuals aged 15-49 remained relatively stable (AAPC=-0.13, 95% CI:-0.23--0.04, P=0.299). In contrast, significant declines were observed in both mortality rate (AAPC=-0.39, 95% CI:-0.47--0.31, P<0.001) and DALY rate (AAPC=-0.46, 95% CI:-0.54--0.38, P<0.001). In the Chinese mainland, the incidence of STEOS among individuals aged 15-49 remained relatively stable (AAPC=-0.10, 95% CI:-0.31-0.10, P=0.314), while the mortality rate (AAPC=-1.42, 95% CI:-1.59--1.25, P<0.001) and DALY rate (AAPC=-1.62, 95% CI:-1.82--1.42, P<0.001) declined steadily from 1990 to 2021. In 2021, high-SDI regions reported high incidence rate (1.38/100 000, 95% UI:1.28/100 000-1.46/100 000), mortality rate (0.42/100 000, 95% UI:0.39/100 000-0.43/100 000) and DALY rate (23.05/100 000, 95% UI:21.84/100 000-24.00/100 000), while low-SDI regions reported high mortality rate (0.36/100 000, 95% UI:0.27/100 000-0.54/100 000) and DALY rate (20.50/100 000, 95% UI:15.46/100 000-30.96/100 000). Conclusion:The disease burden of STEOS worldwide and in the Chinese mainland populations aged from 15 to 49 has declined consistently. Notably, STEOS constitutes a substantial disease burden, particularly among countries and regions with high-SDI and low-SDI in 2021.