Objective To investigate the causal relationship between immune cells and various molecular subtypes of breast cancer (BC) by using two-sample Mendelian randomization (MR). Methods This study employed a two-sample MR analysis, with 731 immune cell types from the GWAS catalog as the exposure factors and four BC molecular subtypes (HR+/HER2−, HR+/HER2+, HR−/HER2+, and HR−/HER2−) from the BCAC Consortium as the outcome variables. For causal inference, inverse variance weighting (IVW) was employed as the primary analytical method, alongside multiple consistency validation approaches, including MR-Egger, weighted median, weighted mode, simple mode, and Bayesian weighted Mendelian randomization. Reverse MR and sensitivity analyses were employed to effectively evaluate and exclude potential biases and interference from reverse causality. Results Significant causal associations were identified for specific immune cell phenotypes across subtypes. In HR+ BC, the HER2+ subtype was associated with seven immunophenotypes (five protective and two risk increasing), whereas the HER2− subtype was associated with eight immunophenotypes (four protective and four risk increasing). In HR− BC, the HER2+ subtype was associated with five immunophenotypes (one protective and four risk increasing), and the HER2− subtype (triple-negative BC) was associated with seven immunophenotypes (six protective and one risk-increasing). CD28+CD45RA−CD8+ T cells and naive CD8+ T cells have a bidirectional causal relationship with HR+/HER2+ breast cancer, Whereas the expression of CD8 on CD39+CD8+ cells also has a bidirectional relationship with HR+/HER2− breast cancer. Furthermore, CD4−CD8− NKT cells exhibited opposing effect directions in HER2+ versus HER2− subtypes. Conclusion From a genetic perspective, this study confirms the existence of subtype-specific causal associations between immune cell phenotypes and distinct molecular subtypes of BC, revealing heterogeneity in immune regulation.

Intra-abdominal Hernia with Bowel Obstruction Triggering Multi-organ Failure: The Role of Preoperative Enteritis This report details the clinical course of a 41-year-old male who developed fulminant multiple organ dysfunction syndrome following emergency surgery for a strangulated intra-abdominal hernia. Preoperative manifestations, including diarrhea and marked leukocytosis, pointed towards an underlying infectious enteritis. We posited that surgical release of the obstructed, ischemic bowel segment precipitated a massive systemic influx of endotoxins and inflammatory mediators, triggering septic shock and rapid sequential organ failure. This case underscored the critical need to suspect concomitant gastrointestinal infection in patients presenting with mechanical bowel obstruction accompanied by infectious signs. Aggressive perioperative sepsis management encompassing early empiric antimicrobial therapy, vigilant hemodynamic monitoring, and preparedness for advanced organ support is essential to mitigate this severe complication.

The establishment of endometrial receptivity is a critical prerequisite for successful embryo implantation and early pregnancy. However, current clinical methods for assessing receptivity are insufficiently validated, and their reliability is inadequate for guiding precision medicine. Although microfluidic organ-on-a-chip models have emerged as promising in vitro platforms garnering significant academic interest, their practical clinical translation has been hindered by challenges in accurately replicating patient-specific microenvironments and the lack of standardized quantitative evaluation systems. Recently, Lee et al. published a groundbreaking study in Nature Communications, which effectively addresses these critical limitations by integrating a patient-derived vascularized endometrium-on-a-chip (EoC) with a newly developed endometrial receptivity scoring system (ERS²). This commentary offers a comprehensive analysis of the key findings from this work, systematically examining the design, construction, dynamic simulation validation, and translational potential of the EoC-ERS² platform. This innovative approach successfully transforms conventional subjective assessments of endometrial receptivity into a digitized, objective, and quantitative evaluation framework. As a result, it establishes a robust foundation for a paradigm shift toward personalized infertility management and precision medicine in reproductive health.

ObjectiveTo investigate the mechanism underlying the effects of three formulas of the method of warming Yang and relieving depression on anxiety- and depression-like behaviors in the mice subjected to a two-hit paradigm of maternal separation （MS） combined with restraint stress （RS）. MethodsNeonatal mice were randomly assigned into the following groups： Blank control， MS alone， model （MS+RS）， warming Yang （WY，5.85 g·kg^-1）， relieving depression （RD，12.03 g·kg^-1）， warming Yang and relieving depression （WYRD，16.71 g·kg^-1）， and fluoxetine groups （2.6 mg·kg^-1）. MS was conducted on postnatal day 5 （PD5）. Weaning and preventive drug administration were carried out on PD21， and restraint stress was applied on PD90. Anxiety- and depression-like behaviors were assessed using the open field test （OFT）， the elevated zero maze test and tail suspension test （TST）. High-performance liquid chromatography with electrochemical detection （HPLC-ECD） was employed to measure the levels of neurotransmitters， including 5-hydroxytryptamine （5-HT） and dopamine （DA）， in the hippocampus. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression levels of 5-HT_1A receptor （5-HT_1AR）， serotonin transporter （SERT）， monoamine oxidase A （MAOA）， glucocorticoid receptor （GR）， adrenocorticotropic hormone （ACTH）， corticotropin-releasing hormone （CRH）， brain-derived neurotrophic factor （BDNF）， and tyrosine kinase receptor B （TrkB）. Immunohistochemistry （IHC） was applied to assess the protein expression levels of 5-HT_1AR， 5-HT_2A receptor （5-HT_2AR）， 5-HT_2C receptor （5-HT_2CR）， GR， and CRH receptor 1 （CRHR1）. The protein expression levels of BDNF and TrkB in the hippocampus were measured using the fully automated protein expression analysis system （Simple Wes）. ResultsIn the behavioral tests， compared with the blank control group， the model group exhibited significant increases in locomotor distance and central area crossings （P<0.05， P<0.01）in OFT， as well as a significant increase in immobility time in the TST （P<0.05）. Compared with the model group， the RD， WYRD， and fluoxetine groups all showed significantly reduced central area crossings （P<0.05， P<0.01）. Regarding neurotransmitter levels， compared with the blank control group， the model group had significantly decreased hippocampal epinephrine （E） and dopamine （DA） content （P<0.05， P<0.01）. Compared with the MS group， the model group showed significant decreases in hippocampal norepinephrine （NE）， E， and 5-HT content （P<0.05， P<0.01）. Compared with the model group， the WY group decreased hippocampal NE， DA， and 5-HT content （P<0.01）， while the RD， WYRD， and fluoxetine groups exhibited significantly increased hippocampal E content （P<0.01）. At the molecular level， compared with the blank control and MS groups， the model group showed significant increases in mRNA levels of 5-HT_1AR， SERT， MAOA， ACTH， and CRH （P<0.01）， and significant decreases in mRNA levels of tryptophan hydroxylase （TPH）， GR， BDNF， and TrkB （P<0.01）. Protein expression of 5-HT_1AR， 5-HT_2AR， and 5-HT_2CR was also significantly elevated （P<0.05， P<0.01） in the model group. Compared with the model group， the RD group showed significant decreases in SERT， MAOA， and CRH mRNA （P<0.05， P<0.01）， significant increases in TPH， BDNF， and TrkB mRNA （P<0.01）， significantly reduced protein expression of 5-HT_1AR， 5-HT_2AR， and 5-HT_2CR （P<0.05）， and significantly increased GR protein expression. The WY group showed a significant increase in ACTH mRNA expression （P<0.01）. The fluoxetine group exhibited significant decreases in MAOA and CRH mRNA （P<0.05， P<0.01）， significant increases in TPH， BDNF， and TrkB mRNA （P<0.01）， significantly reduced 5-HT_2AR protein expression （P<0.01）， and significantly increased GR protein expression（P<0.05）. ConclusionThe method of warming Yang and relieving depression can ameliorate anxiety- and depression-like behaviors in two-hit mice. Its mechanism may be associated with the BDNF/TrkB signaling pathway， as well as the HPA axis and serotonergic system.

Renal fibrosis is the common pathological endpoint of many forms of chronic kidney disease (CKD), yet the mechanisms determining effective repair versus persistent fibrotic remodeling remain incompletely understood. Peritubular capillaries (PTCs) are not merely passive targets of fibrotic injury, but form a dynamic vascular microenvironment linking regional perfusion, oxygen delivery, tubular metabolism, endothelial barrier integrity, pericyte support, immune-cell trafficking, and extracellular matrix (ECM) remodeling. We propose that PTC abnormalities should not be interpreted simply as reduced capillary density, but as a multidimensional disturbance of microvascular structure and function. Structural vascular preservation does not necessarily indicate effective microcirculation: anatomically detectable capillaries may still exhibit impaired perfusion, barrier dysfunction, abnormal endothelial-pericyte interactions, disturbed oxygen metabolism, or reduced network connectivity. Conversely, increased angiogenesis does not necessarily signify successful vascular repair if vessels remain immature, poorly perfused, or inadequately integrated into the existing network. To organize these abnormalities, we conceptualize PTC remodeling into four predominant but nonexclusive states: endothelial barrier disruption with inflammatory adhesion; endothelial-pericyte uncoupling with no-reflow; dysregulated angiogenesis with network simplification; and capillary rarefaction with fibrotic matrix locking. These states are not sequential stages of CKD. They may coexist within the same kidney, overlap within the same anatomical region, and vary with disease etiology, injury phase, vascular compartment, and treatment exposure. We further propose six dimensions for evaluating PTC status—structural presence, functional perfusion, barrier integrity, pericyte coupling, oxygen metabolism, and network connectivity—so that vascular quantity, function, and reparative capacity are assessed separately rather than inferred from a single endothelial marker or capillary-density measurement. Mechanistically, these states converge on a bidirectional microvascular-fibrotic feedback loop. Barrier disruption facilitates leukocyte recruitment and alters vascular paracrine signaling. Endothelial-pericyte uncoupling compromises capillary stability, whereas abnormal pericyte contraction may increase local vascular resistance and contribute to no-reflow before overt capillary loss. Dysregulated angiogenesis may generate vessels that fail to mature or connect to an effective perfusion network. Progressive capillary rarefaction compromises oxygen delivery, while sustained tubular transport demand and mitochondrial dysfunction may aggravate regional oxygen supply-demand mismatch. Injured tubules, immune cells, endothelial cells, pericytes, and fibroblasts communicate through soluble mediators, extracellular vesicles, direct cell contact, and cell-matrix signaling. Importantly, fibrosis is not merely a downstream consequence of microvascular injury. Altered ECM may increase diffusion distance, modify mechanotransduction, impair endothelial survival and migration, and restrict capillary reopening and regeneration. We use the term matrix locking to describe this sustained constraint on vascular repair, while emphasizing that current evidence does not establish irreversible disease in humans. This framework also has therapeutic implications. PTC-directed treatment should not be reduced to increasing vessel number or uniformly promoting angiogenesis. Instead, intervention should be matched to the dominant and potentially reversible abnormality: preserving endothelial barrier function; restoring endothelial-pericyte stability and reducing pathological microvascular resistance; normalizing angiogenesis so that vascular growth is accompanied by maturation, barrier competence, network integration, and effective perfusion; and, in advanced rarefaction, relieving matrix-related constraints while supporting vascular regeneration. The context- and time-dependent effects of signaling through VEGF, Tie2, PDGF-B/PDGFRβ, eNOS/NO, and related pathways indicate that the same molecular signal may exert different effects depending on disease context and timing. Therapeutic efficacy should therefore be evaluated by restoration of effective microcirculation and tissue function rather than by isolated molecular changes or capillary counts alone. Despite increasing mechanistic evidence, the translational basis for this framework remains limited. Most causal and interventional data derive from animal or cell models, whereas human evidence is largely limited to pathological observations, patient-sample associations, and prognostic studies. Currently available circulating and urinary candidate biomarkers generally lack sufficient specificity for PTC injury or state assignment, and no standardized quantitative thresholds have been externally validated. The four-state model should therefore be regarded as a hypothesis-generating analytical framework rather than a clinicopathological classification system. Future studies should integrate spatially resolved tissue phenotyping, blood and urine biomarkers, and dynamic microcirculatory assessment in longitudinal cohorts. They should test reproducibility, assess prognostic value beyond conventional pathology, estimated glomerular filtration rate, and proteinuria, and determine whether changes in PTC status precede or mediate therapeutic benefit. Linking reproducible microvascular phenotypes to defined mechanisms, treatment response, and long-term renal outcomes will be essential to determine whether state-directed assessment and restoration of the PTC microenvironment can ultimately inform patient stratification and therapeutic decision-making.

The recombinant human thyroid-stimulating hormone (rhTSH) can be used for differentiated thyroid cancer (DTC) preparation before ¹³¹I therapy, and follow-up. Since its approval by the American Food and Drug Administration (FDA) in 1998, rhTSH has been clinically used in European countries, the United States, and other countries for nearly 30 years. In April 2024, China’s first independently developed rhTSH agent was approved. Based on clinical experience and evidence from domestic and international studies, an expert consensus on the application of rhTSH has been developed following thorough consultations among experts. The consensus offers evidence-based recommendations to guide the appropriate use of rhTSH in clinical practice.

Objective To investigate the effects of auricular point seed-pressing and earpoint scraping on sleep quality,sleep structure index and neurotransmitter in patients with sleep disorders in neurology department.Methods A total of 110 patients with sleep disorders treated in the Department of Neurology at Nanjing Hospital Affiliated to Nanjing Medical University from June 2022 to June 2024 were selected as the study subjects.The patients were randomly divided into an observation group and a control group using a random number table,with 55 cases in each group.The control group was treated with Estazolam Tablets,while the observation group received auricular point seed-pressing therapy combined with ear scraping therapy.The treatment course lasted for 4 weeks.After treatment,the clinical efficacy of the two groups was evaluated.Changes in the Pittsburgh Sleep Quality Index(PSQI)scores were observed before and after treatment,as well as sleep structure indicators,including total sleep time(TST),sleep latency(SL),arousal index(AI),non-rapid eye movement sleep time(NREM)[light sleep stage(S1),light to moderate sleep stage(S2),moderate sleep stage(S3),deep sleep stage(S4)],actual sleep time(AST),sleep efficiency(SE),and rapid eye movement sleep time(REM).The serum levels of norepinephrine(NE),5-hydroxytryptamine(5-HT),and gamma-aminobutyric acid(GABA)were compared before and after treatment,as well as changes in the Quality of Life Scale(SF-36)scores.The safety and incidence of adverse reactions in the two groups were also evaluated.Results(1)The total effective rate in the observation group was 96.61%(53/55),while it was 81.82%(45/55)in the control group.The efficacy of the observation group was superior to that of the control group,with a statistically significant difference(P＜0.05).(2)After treatment,the PSQI scores of both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in PSQI scores compared to the control group,with a statistically significant difference(P＜0.05).(3)After treatment,the sleep structure indicators in the observation group,including TST,SL,AI,S1,S2,S3,S4,AST,SE,and REM,were significantly improved,and the differences were statistically significant compared to the control group(P＜0.05).(4)After treatment,the serum levels of NE,5-HT,and GABA in both groups were significantly improved,and the observation group showed significantly better improvement in these levels compared to the control group,with a statistically significant difference(P＜0.05).(5)After treatment,the SF-36 scores of both groups were significantly improved,and the observation group showed significantly better improvement in SF-36 scores compared to the control group,with a statistically significant difference(P＜0.05).(6)The total incidence of adverse reactions in the observation group was 0.00%(0/55),while it was 10.91%(6/55)in the control group.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,with a statistically significant difference(P＜0.05).Conclusion Auricular point seed-pressing therapy combined with ear scraping therapy for the treatment of sleep disorders at the Department of Neurology can significantly improve patients'sleep quality,enhance sleep structure-related indicators,regulate neurotransmitter levels,thereby improving patients'quality of life with high safety and efficacy.

Objective Melatonin has been shown to have neuroprotective effects.This study is aimed at observing the effects of copper deposition on cognitive function in a toxic milk(TX)mouse model of Wilson disease(WD),and investigating the effects and mechanisms of action of Gandou Bushen Decoction(GDBSD)on melatonin synthesis and pineal function in the WD model mice.Methods A total of 30 homozygous TX mice were randomly assigned to 3 groups(n=10 in each group),including a WD group,a GDBSD group,and a dimercaptosuccinic acid(DMSA)group.A total of 10 DL mice were included in the normal control(NC)group.The structure and copper content of pineal gland tissues,oxidative stress and apoptosis-related markers,and serum melatonin levels were evaluated using hematoxylin-eosin(HE)staining,enzyme-linked immunosorbent assay(ELISA),flow cytometry,and Western blot.Results Compared with the NC group,the WD group exhibited decreased learning and cognitive abilities(P＜0.05),damaged pineal gland structure,increased copper content,reactive oxygen species(ROS)levels,and mitochondrial damage rate in the pineal gland(P＜0.01),altered levels of melatonin and oxidative stress-related markers(P＜0.05),upregulated expression levels of pro-apoptotic proteins Bax and Caspase-3,and decreased expression of the anti-apoptotic protein Bcl-2(P＜0.01).After treatment with GDBSD and DMSA,the SIRT3/FOXO3α signaling pathway was activated,the copper content in the pineal gland was reduced,and oxidative stress and apoptosis-related damages were improved,leading to an improvement in learning and memory abilities(P＜0.05).Conclusion GDBSD can alleviate cognitive impairments in WD mice caused by pineal gland copper deposition by inhibiting oxidative stress and apoptosis in the pineal gland.The underlying molecular mechanism is associated with the regulation of the SIRT3/FOXO3α signaling pathway.

Obesity and overweight remain major global public health challenges.In this paper,we examine current applications of digital nutrition technologies in weight management using the scoping review framework of Arksey and O'Malley.Visual recognition technologies have evolved from early-stage food image recognition into more advanced systems,although the vast diversity of food types continues to pose challenges for accuracy and generalizability.The combination of wearable devices and non-wearable sensors has increased the diversity of collected data and improved user comfort.Data integration and analysis tools,such as digital virtual twins,support personalized interventions by integrating multidimensional data.In addition,emerging applications have demonstrated encouraging clinical outcomes.However,existing studies have limitations,such as small sample sizes,high levels of information bias,and low evidence quality.Barriers,such as limited accessibility and high initial costs,further constrain the scalability of digital nutrition tools.Future studies should focus on expanding sample sizes,improving population diversity,and developing effective assessment methods and adjustments for specific target populations.Privacy and data security concerns must also be addressed to ensure safe implementation.Overall,digital nutrition technologies offer a promising approach to weight management,but continuous efforts in research and cost reduction are needed to fully realize their potential in weight management and to promote health for all.

Objective To investigate the application value of peripheral blood soluble human leukocyte antigen-G(sHLA-G)combined with immune cytokines in the differential diagnosis of renal transplant rejection.Methods This case-control study retrospectively analyzed 81 renal transplant patients hospitalized in the Department of Organ Transplantation,the Second Affiliated Hospital of Naval Medical University from April 2020 to December 2023,due to elevated serum creatinine.Among them,32 patients were diagnosed with acute rejection(acute rejection group),29 with chronic rejection(chronic rejection group),and 20 with elevated creatinine due to non-rejection causes(non-rejection group).Fifty renal transplant inpatients and outpatients with normal and stable serum creatinine were selected as control group during the same period.Clinical data such as gender,age,serum creatinine,estimated glomerular filtration rate(eGFR),and urine protein positive rate,etc.were collected.Peripheral blood of patients was sampled to measure the levels of plasma sHLA-G and immune cytokines[interferon-γ(IFN-γ),tumor necrosis factor-β(TNF-β),interleukin(IL)-2,IL-4,IL-10,IL-5,IL-6,IL-17]using enzyme-linked immunosorbent assay(ELISA).Stratify and compare the differences in sHLA-G levels among different groups and all renal transplant inpatients by gender.Results Compared with control group,serum creatinine levels and urine protein positive rate were significantly higher in acute rejection group,chronic rejection group,and non-rejection group,while eGFR was significantly lower,serum creatinine levels in chronic rejection group and non-rejection group were higher than those in acute rejection group,while eGFR was lower than that in acute rejection group,with statistically significant differences(P<0.05).No statistically significant differences were observed in gender,age,blood type,body mass index,transplantation duration,and immunosuppressive agent use among acute rejection,chronic rejection,non-rejection,and control groups(P>0.05).Plasma sHLA-G levels in acute rejection and chronic rejection groups were significantly lower than those in control group[(19.665±11.233)U/ml vs.(24.785±21.668)U/ml vs.(44.918±39.898)U/ml,P<0.05].The sHLA-G/IL-2 ratio in chronic rejection group was significantly higher than that in acute rejection group(5.844±6.248 vs.1.825±1.574,P<0.05),and the sHLA-G/IFN-γ ratio in non-rejection group was significantly higher than that in chronic rejection group(3.452±3.283 vs.1.543±2.030,P<0.05).Among 131 renal transplant inpatients,female sHLA-G levels were significantly higher than male(P<0.05).Within each group,female sHLA-G levels in chronic rejection group were significantly higher than male(P<0.05).Although female sHLA-G levels in acute rejection,non-rejection,and control groups were higher than those of male,the gender difference was not statistically significant(P>0.05).Conclusions Peripheral blood sHLA-G levels are correlated with renal transplantation rejection.The application of sHLA-G/IL-2 and sHLA-G/IFN-γ ratios has potential value in the diagnosis and differentiation of elevated creatinine caused by acute/chronic rejection,chronic rejection and non-rejection causes,respectively.