[摘 要] 目的：基于干性相关基因鉴定食管鳞状细胞癌（ESCC）干性相关分子亚型，并构建亚型分类器，以期为预测ESCC患者治疗反应提供参考。方法：从StemChecker数据库获取26个干性相关基因集，对源自TCGA-ESCC及GSE53625数据库的259例ESCC样本转录组数据采用单样本基因集富集分析算法进行量化，随后通过一致性聚类法鉴定ESCC干性亚型，并系统评估了不同亚型在预后特征、肿瘤微环境、干性生物学过程及治疗反应等方面的差异。通过加权基因共表达网络分析（WGCNA）鉴定ESCC干性亚型核心基因集，并基于随机森林、XGBoost和神经网络三种机器学习算法构建并验证ESCC干性亚型分类器。结果：基于26个干性基因集的单样本基因集富集分析量化结果，将ESCC划分为两种干性亚型（命名为C1与C2），259例ESCC样本中，109例归为C1亚型，150例归为C2亚型，二者在细胞分子特征、免疫微环境及治疗反应方面呈现显著差异。与C1亚型相比，干性C2亚型表现为不良预后[Kaplan-Meier分析显示C2亚型总生存期显著短于C1亚型（log-rank P = 0.028）]、更强干性特征、更高水平的M2型巨噬细胞浸润、癌症相关成纤维细胞含量及间质评分；治疗策略方面，TIDE算法预测C1亚型免疫治疗应答率为54.13%（59/109），显著高于C2亚型的24.00%（36/150）（P < 0.01），表明C1亚型患者更可能从免疫治疗获益；而C2干性亚型患者对顺铂、吉西他滨及多西他赛的敏感性更高。WGCNA在TCGA-ESCC队列中鉴定出蓝色模块，在GSE53625队列中筛选出黑色模块，这两个核心基因模块与C2干性亚型最具相关性。整合双队列模块基因集后，最终确定7个基因作为C2干性亚型的核心基因。基于7个基因转录组数据在训练集构建了机器学习分类模型，并在独立验证集中通过混淆矩阵结果证实了相较于XGBoost和神经网络模型，建立的随机森林干性分型模型准确率达86.92%，AUC为0.91（95% CI：0.86～0.96），显著优于XGBoost（P < 0.001）和神经网络（P < 0.01）。结论：揭示了ESCC干性异质性，所构建的随机森林干性亚型分类器有助于实现ESCC患者的分子分型及个体化治疗方案的精准选择。

OBJECTIVE To investigate the effects and potential mechanism of Yiqi wenyang huwei decoction （YQWY） in improving airway inflammation and remodeling in rats with bronchial asthma （BA） based on the Toll-like receptor 4 （TLR4）/myeloid differentiation primary response protein 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway. METHODS Male SD rats were randomly divided into the normal group， the model group， the dexamethasone group （positive control， 0.5 mg/kg）， and YQWY low-， medium- and high-dose groups （5， 10， 20 g/kg， calculated by the crude drug）， with 8 rats in each group. Except for the normal group， rats in all other groups were sensitized twice with ovalbumin combined with aerosol challenge to establish a BA model. From day 14 to day 34 of the experiment， the rats in each group were administered the corresponding drug solution or normal saline intragastrically， once a day， 1 hour before aerosol challenge. At 24 hours after the final aerosol challenge， asthma symptom scores were assessed， serum levels of immunoglobulin E （IgE） were measured， and the levels of inflammatory cytokines （interleukin-4， interleukin-5， interleukin-13 and tumor necrosis factor-α） and the numbers of inflammatory cells （white blood cell， eosinophil， neutrophil， lymphocyte， monocyte and basophil） in bronchoalveolar lavage fluid were determined. Pathological changes in lung tissue were observed. The mRNA expressions of TLR4， MyD88 and NF-κB， as well as the protein expressions of TLR4， MyD88， NF-κB p65 and phosphorylated NF-κB p65 in lung tissue， were detected. RESULTS Compared with the model group， the pathological changes， such as inflammatory cell infiltration， abnormal deposition of collagen fibers， and goblet cell hyperplasia in the lung tissue of rats in each drug group， were alleviated to varying degrees. The asthma symptom scores （except for the YQWY low-dose group）， the levels of IgE and inflammatory cytokines （except for interleukin-5 in the YQWY medium-dose group）， the number of inflammatory cells （except for monocyte and basophil in the YQWY low-dose group）， the mRNA expression of TLR4， MyD88 and NF-κB， as well as the protein expressions of TLR4， MyD88， NF-κB p65 and phosphorylated NF-κB p65 （except for MyD88 and NF-κB p65 proteins in the YQWY low-dose group as detected by Western blo t） were all significantly reduced or down-regulated （ P ＜0.05 or P ＜0.01）. CONCLUSIONS YQWY can alleviate asthma-like manifestations in BA rats and improve their airway inflammation and remodeling； these effects may be related to the formula’s inhibition of the abnormal activation of the TLR4/MyD88/NF-κB signaling pathway.

ObjectiveTo investigate the role of Ras-GTPase-activating protein SH3 domain-binding protein 2 （G3BP2） in regulating the activation， proliferation， and migration of hepatic stellate cells （HSCs）. MethodsThe mouse HSCs （JS-1 cell line） were treated with 5 μg/L transforming growth factor-beta 1（TGF-β1） for 24 hours to establish an HSC activation and proliferation model. A G3BP2 knockdown system was constructed using siRNA interference technology. The experiment was divided into four groups： Control， TGF-β1 treatment， TGF-β1+si-NC， and TGF-β1+ G3BP2-siRNA. The expression levels of key fibrosis indicators， including type I collagen （Collagen I）， α-smooth muscle actin （α-SMA）， and G3BP2， were detected by Western blot and RT-qPCR. Cell proliferation activity was assessed using the CCK-8 proliferation assay kit and EdU fluorescence labeling technology. Cell migration ability was analyzed by scratch wound healing assay and Transwell migration assay. The formation level of stress granules was quantified by immunofluorescence microscopy to investigate the effects of G3BP2 on stress granule formation in activated HSCs. ResultsStimulation with TGF-β1 upregulated the expression of G3BP2 in JS-1 cells （RT-qPCR： P0.000 1； Western blot： P0.000 1）， while a downward trend in its expression was observed in the G3BP2‑silenced group （RT-qPCR： P0.01； Western blot： P0.000 1）. Compared with the control group， the TGF-β1 group exhibited increased protein expression levels of α-SMA and Collagen I （RT-qPCR： both P0.01； Western blot： P0.01 and P0.05， respectively）， concomitant with an increased number of stress granules and enhanced cell proliferation and migration capacity （all P0.001）. The experimental results demonstrated that G3BP2 knockout effectively reversed the aforementioned phenotypes， with the G3BP2-silenced group showing reduced expression of fibrotic markers （all P0.01）， decreased stress granule formation （P0.01）， and reduced cell proliferation and migration capacity （all P0.05）， compared to the negative control group. ConclusionG3BP2 enhances the activation， proliferation， and migration of HSCs by promoting the formation of stress granules， thereby accelerating the pathological progression of liver fibrosis. This suggests that stress granules may serve as important regulators in controlling the activation， proliferation， and migration of HSCs.

ObjectiveTo understand the mental health literacy levels and influencing factors among middle school students in Minhang District, Shanghai, and to provide a basis for formulating mental health promotion strategies. MethodsA multi-stage stratified cluster sampling method was adopted. From September to October 2023, middle school students (including junior and senior high school) from 14 streets, towns, and industrial zones in Minhang District, Shanghai, were recruited to participate in a questionnaire survey. The survey collected demographic information and employed the Adolescent Mental Health Literacy Assessment Scale. This scale comprises four dimensions (knowledge, recognition ability, attitude, and behavior) with a total of 22 items, using a Likert 5-point scale (1‒5 points), giving a maximum total score of 110 points. Reverse-scored items were inverted, and the sum of all item scores constituted the total scale score, with higher scores indicating better mental health literacy. A total score of ≥88 points was defined as having adequate mental health literacy. Multiple linear regression was used to analyze the factors influencing mental health literacy. ResultsThe average mental health literacy score of the 3 963 middle school students in Minhang District of Shanghai City was (85.42±11.27) points, with 45.22% of students having adequate mental health literacy. Univariate analyses showed that female students, junior high school students, and those without stressful events or physical illnesses in the past three months had higher total scores of mental health literacy. Statistically significant differences in total scores were also observed among students with different family economic statuses, parental education levels, frequency of physical exercise, parental relationships, father‑child relationships, and mother‑child relationships (all P<0.05). Multiple linear regression analyses showed that middle school students who were female, had better family economic conditions, higher maternal education levels (university degree or above), and harmonious mother-child relationships had higher mental health literacy scores. In contrast, high school students and those middle school students who participated in less physical activity had lower mental health literacy scores. Multivariate logistic regression analyses indicated that students who were female (OR=1.336, 95%CI: 1.174‒1.520), had superior family economic status (OR=2.000, 95%CI: 1.101‒3.725), had mothers with a university education level (OR=1.501, 95%CI: 1.217‒1.856), had lost one parent (OR=2.189, 95%CI: 1.176~4.158), or reported harmonious mother‑child relationships (OR=2.052, 95%CI: 1.432‒2.987) were more likely to meet the criteria for mental health literacy, whereas those who rarely engaged in physical exercise (OR=0.502, 95%CI: 0.358‒0.694) were less likely to have adequate mental health literacy. Stratified analyses showed that mental health literacy levels among junior high school students were positively correlated with being female, having a mother with a university education level, and having a mother‑child relationship that was average or harmonious and having a harmonious father‑child relationship, and negatively correlated with occasional or rare participation in physical exercise. Among senior high school students, mental health literacy levels were positively correlated with being female, having good or superior family economic status, having a mother with a university education level or above, and having a harmonious mother‑child relationship. ConclusionThe rate of adequate mental health literacy among middle school students in Minhang District, Shanghai, was approximately 45.22%. Gender, grade level, family economic status, maternal education level, physical activity participation, and mother-child relationship are independent factors associated with the level of mental health literacy among middle school students. Mother-child relationship and physical activity are potential intervention entry points. It is recommended to implement targeted health promotion initiatives focusing on key groups, such as high school boys, students from economically disadvantaged families, and those with insufficient physical activity.

Diarrhea-predominant irritable bowel syndrome （IBS-D） exhibits typical characteristics of psychosomatic comorbidity. Its core pathogenesis is considered to involve simultaneous disorders of both the body and the spirit， for which the former is attributed to liver constraint and spleen deficiency， and dysfunction of large intestine conduction， whereas the latter is induced by spirit restlessness of zang （脏） organs， and gate insecurity of the corporeal soul. Based on this understanding， the therapeutic principle of "simultaneous regulation of body and spirit" is established. For regulating the body， the methods include soothing the liver， fortifying the spleen， consolidating the intestines， and stopping diarrhea， with emphasis on the front-mu （募） points of the related zang-fu （脏腑） organs and acupoints of the foot yangming （阳明） stomach channel and foot taiyin （太阴） spleen channel. For regulating the spirit， the methods include calming the brain spirit， tranquilizing the zang organs spirit， and securing the corporeal soul gate， mainly selecting acupoints of Governer Vessel （督脉） and the back-shu （背俞） points of the corresponding zang-fu organs. Needle manipulation techniques for supplementation and drainage are flexibly applied according to the deficiency or excess nature of the syndrome. In addition， comprehensive application of moxibustion， electroacupuncture， and auricular therapy is emphasized， with the aim of providing clinical insights for diagnosis and treatment.

BACKGROUND:Magnetic nanomaterials,as a hot topic in the biomedical field in recent years,are often used to enhance the targeted delivery of drugs to the affected area.OBJECTIVE:To investigate the effects of magnetic nano drug carriers on skeletal muscle injury markers and inflammatory responses in rats with sports injuries.METHODS:Magnetic nanoparticles were prepared.A total of 88 male SD rats were randomly divided into a blank group(n=8),an injury control group(n=32),a Yunnan Baiyao group(n=24),and a magnetic nano-drug carrier group(n=24)by using a random number table method.The latter three groups were modeled with exercise-induced muscle injury(treadmill slope of-16°,running speed of 16 m/min,and training time of 120 min).Immediately after exercise,after verifying the success of the model,Yunnan Baiyao patch was applied to the gastrocnemius muscle of the rats in the Yunnan Baiyao group.Yunnan Baiyao patch loaded with magnetic nanoparticles was applied to the gastrocnemius muscle of the rats in the magnetic nano-drug carrier group.At 24,48,and 120 hours after exercise,blood was drawn from the abdominal aorta of rats to detect the activities of creatine kinase and lactate dehydrogenase,as well as the levels of myoglobin,interleukin-6,and tumor necrosis factor-α.Hematoxylin-eosin staining was used to observe the infiltration of inflammatory cells in the gastrocnemius muscle.RESULTS AND CONCLUSION:(1)Compared with the blank group,the levels of myoglobin,creatine kinase,lactate dehydrogenase and tumor necrosis factorα in the injury control group at 24,48 and 120 hours after exercise were increased(P＜0.05),and the level of interleukin 6 at 24 and 120 hours after exercise was increased(P＜0.05).Compared with the injury control group,the level of myoglobin in the Yunnan Baiyao group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and lactate dehydrogenase at 24,48 and 120 hours were decreased(P＜0.05),and the levels of interleukin 6 and tumor necrosis factor α at 120 hours after exercise were decreased(P＜0.05).Compared with the Yunnan Baiyao group,the level of myoglobin in the magnetic nano-drug carrier group at 24 and 48 hours after exercise was decreased(P＜0.05),the activities of creatine kinase and tumor necrosis factor α at 48 and 120 hours after exercise were decreased(P＜0.05),and the lactate dehydrogenase activity was reduced(P＜0.05).(2)Hematoxylin-eosin staining showed that a large number of inflammatory cells infiltrated in the muscle fibers of the injury control group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the local damaged muscle fibers began to regenerate 120 hours after exercise.A large number of inflammatory cells infiltrated in the muscle fibers of the Yunnan Baiyao group and the magnetic nano-drug carrier group 24 hours after exercise,and then the inflammatory cell infiltration gradually decreased,and the damaged muscle fibers were regenerating 120 hours after exercise,and there was no significant difference from the blank group.(3)The results show that Yunnan Baiyao patch combined with magnetic nanoparticles can accelerate the recovery of exercise-induced muscle injury in rats,and the effect is better than that of Yunnan Baiyao alone.

BACKGROUND:3D-printed bone tissue engineering scaffolds have obvious advantages in the research and clinical treatment of bone defect repair.As one of the important raw materials for 3D printed bone scaffolds,poly-L-lactic acid has a great potential for application in performing bone defect repair,but clinical patients with different bone defect causative factors have different requirements for the comprehensive performance of poly-L-lactic acid bone scaffolds.OBJECTIVE:To summarize and review the development of 3D printing technology and poly-L-lactic acid scaffolds and the design strategies chosen for scaffolds for bone repair in the setting of bone diseases such as osteomyelitis,bone tumor,osteonecrosis,and osteoporosis.METHODS:Literature from CNKI,WanFang,PubMed,Science Direct,and Web of Science databases were searched and screened from 1994 to 2024.Search terms were"3D printing,polylactic acid,bone tissue engineering scaffold,osteomyelitis,bone tumor,osteonecrosis,osteoporosis,bone defect"in Chinese and English.The screened 62 articles were systematically summarized and analyzed.RESULTS AND CONCLUSION:(1)Poly-L-lactic acid is considered to be an ideal raw material for artificial bone scaffold design due to its non-toxicity,processability,biocompatibility,and ability to self-degrade in the human environment.The application of 3D printing technology has enabled poly-L-lactic acid bone scaffolds to meet the multilayered and porous structural design requirements of biomimetic artificial bone repair materials,and to optimize the mechanical properties for better bone repair.(2)According to different bone disease microenvironments,timely adjustment of the functional design of poly-L-lactic acid scaffolds is important for the comprehensive osteogenic efficacy of the scaffolds.The article discusses the application of poly-L-lactic acid scaffolds in bone disease environments such as osteomyelitis,bone tumor,osteonecrosis,and osteoporosis,and highlights the importance of rationally grasping the timing of bone disease treatment and bone tissue regeneration for bone defects caused by different bone diseases.(3)Although poly-L-lactic acid scaffolds show potential in bone repair,there are still some problems,such as the need to further optimize the structural design of the scaffolds to fit new bone regeneration,enhance the bioactivity of the scaffolds,and take into account other functions(e.g.,antimicrobial,anti-tumor,and anti-osteoporosis)in order to adapt to the needs of bone tissue repair in different pathological environments.

Recent research from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) indicates that breast cancer is the most prevalent malignant tumor among women, posing a significant threat to women's health. Surgery remains the primary therapeutic modality for breast cancer. Recently, endoscopic and robotic breast surgical techniques have gained acceptance among both surgeons and patients. However, considerable variation exists in surgical approaches and outcomes. To standardize these techniques, facilitate their broader clinical adoption, and ultimately improve patient care, the Endoscopic-robotic Breast Surgery Clinical Trials Consortium (ErBSCTC) of China has developed this guideline. This document encompasses the technologies and instrumentation utilized in endoscopic and robotic breast surgery, surgical techniques, perioperative management, complication handling, long-term follow-up, and oncologic outcomes, aiming to provide evidence-based guidance for healthcare professionals involved in the prevention, diagnosis, and treatment of breast diseases.

Breast cancer is the most common malignant tumor among women in China, with surgery being one of the primary treatment modalities. Endoscopic/robotic breast surgery (ErBS) is gaining widespread acceptance among patients and surgeons alike due to its advantages of minimal invasiveness, superior cosmetic outcomes, and accelerated recovery. However, substantial heterogeneity currently exists across China regarding patient selection, standardized operative techniques, perioperative management, and complication handling, underscoring the urgent need for evidence-based consensus guidelines. To promote standardization and ensure consistent quality of ErBS, the Chinese Endoscopic-Robotic Breast Surgery Clinical Trials Consortium (CErBSCTC) has systematically reviewed the latest high-quality evidence and formulated the "Protocol for China Endoscopic and Robotic Breast Surgery Guidelines (2026 edition)", which outlines a comprehensive methodology for guideline development.

Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+endoscopic ultrasound+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve circulating tumor DNA and radiomics for risk stratification to advance precise organ-preserving strategies.