Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To explore the application prospect of robot-assisted surgery in the treatment of urolithiasis. Methods A retrospective analysis was performed on the clinical data of 1 patient with renal calculi complicated with a giant renal calyx who underwent robot-assisted laparoscopic right nephrolithotomy combined with partial nephrectomy, and the clinical diagnosis and treatment were discussed in conjunction with relevant literature.Results The patient first underwent percutaneous nephrolithotomy (PCNL) and then retrograde intrarenal surgery (RIRS) for left renal calculi.One month after left RIRS, robot-assisted laparoscopic right nephrolithotomy combined with partial nephrectomy was performed for right renal calculi.Imaging reexamination showed residual calculi in the left kidney and no obvious calculi in the right kidney.Conclusion Robot-assisted surgery provides a new minimally invasive option for complex, refractory calculi complicated with anatomical abnormalities difficult to treat with conventional PCNL/RIRS techniques.

Objective Based on data from the Global Burden of Disease Study 2023 (GBD 2023), this study analyzes the trends in disease burden and years lived with disability (YLD) of bladder cancer in China from 1990 to 2023. Methods Epidemiological data on bladder cancer in China were obtained from the GBD 2023 database.The age-standardized prevalence rate (ASPR), YLD and population attributable fraction (PAF) of risk factors were calculated.Temporal trends were evaluated using the estimated annual percentage change (EAPC), and Joinpoint regression was applied to compute the annual percent change (APC) and average annual percent change (AAPC) for trend analysis. Results Between 1990 and 2023, the number of bladder cancer patients requiring rehabilitation services increased from 213 568 cases to 587 191 cases, representing a 175.0% increase.The YLD rose from 22 158 to 56 620, marking a 155.6% growth.The ASPR increased from 22.6/100 000 to 25.7/100 000 (EAPC=0.06), indicating a stable trend.The age-standardized YLD rate (ASYR) remained at 2.5/100 000 (EAPC=-0.32), indicating a downward trend.Notably, gender disparities in disease burden were evident, with male patients and YLD being 4.63 times and 4.25 times higher than their female counterparts, respectively.Risk factor analysis showed that smoking and high fasting plasma glucose were the main risk factors for bladder cancer.The ASYR attributable to high fasting plasma glucose showed an increasing trend in males (EAPC=0.13) but a decreasing trend in females (EAPC=-1.41). Conclusion The demand for rehabilitation and disease burden of bladder cancer in China have significantly increased, with particularly heavy burdens among males and the elderly population.It is urgent to formulate targeted interventions, strengthen tobacco control, occupational protection, and weight management, and establish an integrated rehabilitation service system to address the increasingly severe disease burden caused by bladder cancer.

ObjectiveTo explore the potential mechanism by which Huoxue Wentong prescription （HXWT） ameliorates post-myocardial infarction （MI） ventricular remodeling by regulating endothelial-to-mesenchymal transition （EndMT） via the hypoxia-inducible factor-1α （HIF-1α）/transforming growth factor-β₁ （TGF-β₁）/periostin （POSTN） signaling pathway. MethodsEighty SPF-grade male Sprague-Dawley rats were randomly assigned to a sham-operated group （n=10） and a modeling group （n=70）. The MI model was established by left anterior descending coronary artery ligation. Successfully modeled rats were further randomized into a model group， a sacubitril/valsartan （Entresto， 0.021 g·kg^-1） group， and low， medium， and high-dose （4.15， 8.30， and 16.60 g·kg^-1， respectively） HXWTF groups （n=10 per group）. From postoperative day 2， rats received HXWTF or sacubitril/valsartan by gavage once daily for 4 weeks， and those in sham and model groups received an equal volume of normal saline. After intervention， general conditions were assessed. Echocardiography was performed to measure the left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end diastolic diameter （LVEDD）， and left ventricular end systolic diameter （LVESD）. Hematoxylin and eosin （HE） staining was employed to evaluate myocardial histopathology， and Masson's trichrome staining to assess myocardial fibrosis. Serum levels of B-type natriuretic peptide （BNP）， interleukin （IL）-6， IL-10， and matrix metalloproteinase-9 （MMP-9） were determined by enzyme-linked immunosorbent assay （ELISA）. Collagen type Ⅰ （ColⅠ） expression was assessed by immunohistochemistry. Immunofluorescence double staining was adopted to detect the expression of platelet endothelial cell adhesion molecule-1 （CD31） and α-smooth muscle actin （α-SMA）. Western blot was performed to quantify the expression of collagen type Ⅰ α2 （Col1A2）， VE-cadherin， CD31， α-SMA， HIF-1α， TGF-β₁， and POSTN. ResultsCompared with the sham group， the model group exhibited thinning and collapse of the left ventricular wall， decreased LVEF and LVFS and increased LVEDD and LVESD （P<0.01）， disrupted myocardial fibers with marked inflammatory cell infiltration， increased collagen deposition， enhanced ColⅠ immunoreactivity， elevate serum BNP， IL-6， and MMP-9 levels， a reduced IL-10 level （P<0.01）， downregulated expression of CD31 and VE-cadherin， and upregulated expression of α-SMA， Col1A2， HIF-1α， TGF-β₁， and POSTN （P<0.05，P<0.01）， accompanied by increased CD31/α-SMA co-localization. Compared with the model group， the sacubitril/valsartan group and all HXWTF groups showed improved ventricular wall structure， increased LVEF and LVFS， decreased LVEDD and LVESD， attenuated myocardial injury with reduced inflammatory infiltration and collagen deposition， declined serum BNP， IL-6， and MMP-9 levels， an elevated serum IL-10 level， upregulated expression of CD31 and VE-cadherin， downregulated expression of α-SMA， Col1A2， HIF-1α， TGF-β₁， and POSTN， and reduced CD31/α-SMA co-localization （P<0.05，P<0.01）. No significant differences were observed between the sacubitril/valsartan group and the medium- and high-dose HXWTF groups. ConclusionHXWTF may regulate the HIF-1α/TGF-β₁/POSTN pathway to inhibit EndMT， thereby ameliorating post-MI ventricular remodeling.

Objective:To investigate the characteristics of pathogen spectrum and the clinical significance of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)in malignant tumor patients with pulmonary infections.Methods:A retrospective analysis was performed for the patients with malignant tumor who were admitted to department of oncology,the Second affiliated hospital of army medical university,from January 2021 to December 2024.All patients developed respiratory symptoms dur-ing treatment and were diagnosed with pulmonary inflammation based on lung imaging findings,and BALF mNGS and sputum cul-ture were used for pathogen detection.A descriptive analysis was used to summarize the clinical data of patients and the distribution of pathogens,which was compared between patients with different cancer types and metastatic statuses.BALF mNGS and sputum cul-ture were compared in terms of diagnostic performance.Results:A total of 127 patients were enrolled,among whom 70.9%had non-small cell lung cancer,15.0%had small cell lung cancer,and 14.1%had other malignancies.The patients with distant metastasis ac-counted for 48.0%.A total of 145 BALF mNGS tests were performed,among which 84 tests(57.9%)yielded positive results for patho-gens,and 13 tests detected polymicrobial infections,accounting for 15.5%(13/84).A total of 121 pathogenic strains were identified,with fungi(41.3%)and Gram-negative bacteria(39.7%)as the main pathogens,and common pathogens for infection included Pneumo-cystis jirovecii(16.5%),Candida albicans(11.6%),Haemophilus influenzae(11.6%),Klebsiella pneumoniae(10.7%),Pseudomonas ae-ruginosa(10.7%),and Staphylococcus aureus(8.3%).There was a significant difference in the distribution of pathogens between the pa-tients with different types of cancer and statuses of distant metastasis,but Pneumocystis jirovecii remained the most common pathogen for opportunistic infection across all subgroups.A total of 70 patients underwent both sputum culture and BALF mNGS,and the posi-tive rate of sputum culture was only 16.0%,which was significantly lower than that of BALF mNGS(χ2=35.52,P<0.001).The concor-dance rate between sputum culture and BALF mNGS was 48.1%.Conclusion:BALF mNGS can accurately reveal the complex patho-gen spectrum in malignant tumor patients with pulmonary infections,especially the high-risk opportunistic pathogens such as Pneumo-cystis jirovecii.For patients with negative results of sputum culture,BALF mNGS can significantly improve the detection rates of patho-gens and polymicrobial infections.

Objective: To explore the changes of mechanosensitive channels Piezos (Piezo 1 and Piezo 2) in neurogenic bladder (NB) of young rats and their effects，so as to provide reference for clinical search of new therapeutic targets. Methods: A total of 30 female young SD rats were divided into 5 groups based on random number table method：sham operation group (sham)，2-week nerve transection group (NB-2W)，6-week nerve transection group (NB-6W)，2-week nerve transection + Piezos inhibitor group (NB-P-2W) and 6-week nerve transection + Piezos inhibitor group (NB-P-6W)，with 6 rats in each group.The NB models were constructed by transecting the L6 and S1 spinal nerves of young rats.The NB-2W and NB-6W groups were not intervened after modeling，while the NB-P-2W and NB-P-6W groups were intraperitoneally injected with Piezos inhibitor GsMTx4 (10 mg/kg) every 2 days after modeling.Bladder cystometry and ultrasound were performed after 2 and 6 weeks of transection.The expressions of Piezos and fibrosis-related indexes (Collagen Ⅰ and α-smooth muscle actin) were detected in bladder tissues. Results: The results of bladder cystometry showed that the basal bladder pressure in NB-2W group was significantly increased，while it was slightly decreased but was still higher in NB-6W group than in the sham group (P<0.05).Basal bladder pressure was lower in NB-P-2W group than in NB-2W group，but was higher than that in the sham group; basal bladder pressure was lower in NB-P-6W group than in NB-6W group，but higher than that in the sham group (P<0.05).Compared with the sham group，the NB-2W and NB-6W groups had firstly increased and then decreased maximum cystometric capacity (MCC) (P<0.05).Compared with NB-2W group，NB-P-2W group had lower bladder leakage point pressure (BLPP)，but higher MCC and bladder compliance (BC) (P<0.05).Compared with NB-6W group，NB-P-6W group had significantly lower BLPP but higher MCC and BC (P<0.05).HE and MASSON staining and ultrasound results showed that，with the extension of nerve transection time，bladder fibrosis gradually worsened，the bladder wall became rough and thickened，calculi were visible inside，and hydronephrosis gradually appeared; the degree of fibrosis in NB-P-2W and NB-P-6W groups was less than that in NB-2W and NB-6W groups，and no hydronephrosis was observed in the upper urinary tract.In addition，Western blotting and immunohistochemical results showed that NB-2W and NB-6W groups had significantly higher relative expression levels of Piezos，Collagen Ⅰ and α-SMA than the sham group (P<0.01)，while NB-P-2W and NB-P-6W groups had lower relative expression levels of Piezos,Collagen Ⅰ and α-SMA than NB-2W and NB-6W groups (P<0.01). Conclusion: The increased expressions of mechanosensitive channels Piezos in NB young rats may be involved in the progression of bladder fibrosis，but its mechanism needs further study.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To explore the clinicopathological and molecular genetic characteristics of anaplastic lymphoma kinase (ALK)-rearranged renal cell carcinoma (RCC), including a rare case with the TPM1-ALK gene subtype.Methods:Three cases of ALK-rearranged RCC diagnosed in the Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from January 2020 to December 2024 were collected. Their clinical pathological and next-generation sequencing (NGS) data were analyzed. Relevant literature was also reviewed, and follow-ups were carried out.Results:Among the three patients, there were 1 female (case 1) and 2 males (cases 2 and 3), with the ages of 29,41 and 44 years, respectively. All of them were presented with space-occupying renal lesions. Case 1 (KIAA1217-ALK RCC) showed mixed cystic and solid components under the microscope, with tubular, papillary, and cribriform arrangements. The tumor cells had clear boundaries, and were cubic or low columnar, arranged in a single layer, pseudostratified or in sheets. The cytoplasm was abundant and eosinophilic, and part of the cytoplasm was vacuolated, as if there was accumulation of mucoid substances. The tumor cell nuclei were oval with prominent nucleoli. A large amount of mucus and inflammatory cell infiltration were noted in the stroma. Case 2 (TPM1-ALK RCC) showed a papillary growth pattern, with small, slender papillae accompanied by branches. The cells were arranged in a single layer, and the cytoplasm was either eosinophilic or clear. Foamy cells were aggregated in the stroma, accompanied by psammoma body-like calcifications. Case 3 (EML4-ALK RCC) was characterized by papillary and tubulocystic structures. The cytoplasm was abundant and eosinophilic. The tumor cell nuclei were large, with prominent nucleoli. There was conspicuous infiltration of lymphocytes and neutrophils in the fibromuscular stroma. The tumor cells all expressed epithelial markers, PAX8, GATA3, P504s and FH. ALK (5A4) staining showed diffuse strong expression in the cytoplasm, while TFE-3 was positive (nuclear stain) only in case 1 and case 3. The fluorescence in situ hybridization showed that ALK gene rearrangement was present in all three cases, while TFE-3 gene rearrangement/mutation was not detectable in case 1 and case 3. NGS showed the KIAA1217::ALK fusion (the fusion site in the exon 11 of KIAA1217 and exon 18 of ALK) in case 1, the TPM1::ALK fusion (the exon 8 of TPM1 and exon 20 of ALK) in case 2, and the EML4::ALK fusion (the exon 2 region of EML4 and the exon 20 region of ALK) in case 3.Conclusions:ALK-rearranged RCC has unique molecular characteristics. Its histological morphology is easily confused with that of papillary RCC and TFE3-rearranged RCC. Both immunohistochemistry and gene rearrangement tests should be used to confirm the diagnosis.