Coronary CT-derived fractional flow reserve (CT-FFR) is a noninvasive alternative to invasive FFR for assessing the hemodynamic significance of coronary artery stenosis. CT-FFR uses routinely acquired coronary CT angiography (CCTA) with artificial intelligence and computational fluid dynamics to estimate pressure gradients, thereby supporting clinical decisionmaking without procedural risk. Adoption and implementation vary widely across regions. In Asia, South Korea exclusively uses HeartMedi+, which enables rapid analysis, streamlined workflow integration, and high user satisfaction. Japan relies primarily on FFR CT, which has national reimbursement and significantly influences treatment strategies, reducing unnecessary invasive procedures. Hong Kong, Singapore, Taiwan, Thailand, and Vietnam remain in early or exploratory phases due to cost, reimbursement, and infrastructure barriers. In the United States, CT-FFR is guideline-endorsed and reimbursed, where HeartFlow is the most widely used, supported by robust clinical validation and outcome data. Despite regional variability, CTFFR offers a noninvasive solution that enhances patient management, reduces unnecessary invasive testing, and is poised for broader clinical integration as technology and validation advance.

Background/Aims: Natural killer (NK) cell function is generally considered dampened in chronic hepatitis B virus (HBV) infection; however, the NK cell pool exhibits phenotypic and functional heterogeneity, and the antibody--mediated effect of NK cells remains less characterized. This study evaluated the dynamic changes in antibody-mediated NK cell responses and the involvement of distinct NK subsets across disease stages and during antiviral treatment. Methods: A T-cell receptor-like antibody specific for the HBV core 18–27 peptide (cTCRL-Ab) was used to determine the antibody-mediated effect of NK cells, and an array of NK cell surface markers were analyzed in cross-sectional and longitudinal cohorts of patients with chronic HBV infection. Single-cell RNA sequencing (scRNA-seq) was performed to identify the heterogeneity of NK subsets. Results: The cTCRL-Ab enabled the detection of NK cell cytolytic activity and IFNγ production. Notably, cTCRL-Ab-mediated NK cell responses were compromised in chronically HBV-infected patients, particularly in those receiving pegylated interferon-α (Peg-IFNα), which was associated with the downregulation of CD16 expression. Correspondingly, Peg-IFNα inhibited cTCRL-Ab-mediated NK cell function by reducing CD16 expression in vitro. scRNA-seq revealed that CD16 downregulation occurred mainly within a dysfunctional CD16hi NK subset exhibiting exhaustion properties. In contrast, an activated CD16hiNK subpopulation (CX3CR1⁺KLRC2–CD16hi) with high cytotoxicity was enriched in patients who experienced favorable treatment responses. Furthermore, the intrahepatic CX3CR1+KLRC2–CD16hi subset tended to exhibit functional restoration in HBsAg-loss individuals. Conclusions Our data contribute to the understanding of antibody-mediated responses of NK cells in chronic HBV infection, and highlight a previously unappreciated functional CX3CR1+KLRC2–CD16hiNK subset as a potential therapeutic target.

ObjectiveMigraine is a leading neurological disorder and the fourth most common cause of years lived with disability worldwide, affecting nearly 116 million individuals. Although pharmacological treatments are available, their efficacy is often limited by side effects and variable response rates. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers a safe, non-invasive alternative for migraine management. However, the neurophysiological mechanisms, particularly how rTMS modulates local cortical excitability and distributed pain-related circuits, remain poorly understood. Elucidating these mechanisms is essential for optimizing treatment protocols and improving clinical outcomes. MethodsThis study employed concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) to investigate neuroplastic and neurocircuitry mechanisms of DLPFC-rTMS in migraine. Study 1 compared 30 migraineurs and 28 healthy controls to identify abnormalities in TMS-evoked potentials (TEPs) and significant current density (SCD) within sensory-discriminative regions including the primary somatosensory cortex (S1) and posterior insula (pINS), cognitive-affective regions including the anterior insula (aINS) and midcingulate cortex (MCC), and a descending modulatory region, the periaqueductal gray (PAG). Study 2 used a single-blind, crossover, sham-controlled design in 34 healthy participants. Each participant received both active (10 Hz, 80% RMT, 1 500 pulses) and sham DLPFC-rTMS in counterbalanced order. TMS-EEG and cold pain tolerance were assessed before and after each session. ResultsIn Study 1, migraineurs showed a significantly less negative N120 amplitude compared to healthy controls (P=0.027, Cohen’s d=0.60), indicating local intracortical disinhibition. No group differences were observed for N40, P60, or P180 components. At the source level, migraineurs exhibited significantly higher SCD in the S1, pINS, aINS, and MCC (allQ<0.05), but not in the ventroposterior thalamus (vpTHAL), mediodorsal thalamus (mdTHAL), or PAG. In Study 2, active rTMS significantly reduced SCD from pre- to post-stimulation in the S1, aINS, and MCC (all Q<0.05). Sham stimulation also reduced SCD in the S1 (Q<0.05) but not in the aINS or MCC. Although no significant group-level analgesic effect was observed between active and sham conditions (P=0.107), correlation analyses revealed that greater SCD reductions in the S1 and MCC were significantly associated with higher post-rTMS pain tolerance (R=-0.487 and -0.495, both Q<0.01) and larger improvements in pain tolerance(R=-0.487 and -0.451, both Q<0.05). No such correlations were found following sham stimulation, suggesting that the behavioural relevance of neural changes is specific to active rTMS. ConclusionThis study provides novel evidence that migraineurs exhibit both local neuroplastic abnormalities (reduced N120 amplitude) and hyperactivity in key pain-processing regions (S1, pINS, aINS, MCC). A single session of DLPFC-rTMS reduced hyperactivity in the aINS, MCC, and S1. Notably, greater reductions in the S1 and MCC were associated with improved pain tolerance. These findings identify distinct cortical circuitries, particularly within the cognitive-affective pain network, that may serve as potential biomarkers for optimizing rTMS treatment in migraine and other chronic pain conditions. Future studies should validate these results in patient populations experiencing spontaneous migraine attacks and explore multi-session or accelerated rTMS protocols.

Objective To enhance the gamma spectrometry analysis and detection capabilities of personnel in measuring radionuclides in bio-ash, and ensure the accuracy and precision of gamma spectrometer in our laboratory for the analysis of radionuclides in bio-ash. Methods The laboratory participated in the 2024 national interlaboratory comparison for radionuclide measurement in bio-ash. Radionuclides ²⁴¹Am, ¹³⁷Cs, and ⁴⁰K in four different bio-ash samples were measured. Based on the measurement methods specified in GB/T 16145—2022, sample measurement, result calculation, and uncertainty evaluation were performed using spectrometry analysis software and sourceless efficiency calibration software. The measurement results and performance evaluation of the laboratory in the comparison were analyzed, and factors affecting gamma-spectrometry measurement and result interpretation were discussed. Results The relative deviation (D) of the measurement results for radionuclides ²⁴¹Am and ¹³⁷Cs in the four bio-ash samples ranged from −10.2% to 2.0% and −1.7% to 0.3%, respectively. The P statistic ranged from 7.0% to 12.5% and 5.0% to 10.8%, respectively. These results met the criteria of |D| ≤ 20% (MARB), |D| ≤ 2.58P, and P ≤ 20% (MARB). The ζ-scores for the measurement of ⁴⁰K in the four bio-ash samples ranged from 0.8 to 1.3, satisfying the criterion of |ζ| < 2. All measurement results in this laboratory in the comparison were satisfactory. Conclusion The laboratory uses a high-purity germanium gamma spectrometer to measure radionuclides in bio-ash. The self-absorption correction method, analysis method, and uncertainty evaluation are appropriate, which can ensure the accuracy and precision of the measurement results. The measurement results are accurate and reliable.

Objective To propose a framework for risk assessment and stepwise management of pulmonary nodules based on existing guidelines and key studies, and to clarify the boundaries for triage, workup escalation, and referral in different detection scenarios. Methods A problem-oriented evidence synthesis approach was used, prioritizing Chinese expert consensus, Fleischner Society Guidelines, British Thoracic Society (BTS) Guidelines, and Lung-RADS. This was supplemented by studies on risk models, imaging measurements, liquid biopsy, tissue sampling, and surgical treatments. This paper is not presented as a formal consensus or a validated clinical pathway. Results A three-tiered framework consisting of basic non-invasive assessment, advanced assessment, and invasive diagnosis was established. It specified the applicable populations, boundaries for the use of risk models, imaging review, management of conflicting results, evaluation of histopathological consistency, and post-intervention follow-up. Liquid biopsy, genetic testing, and artificial intelligence were defined as investigational or adjunctive tools. Conclusion This framework can serve as a preliminary reference for multidisciplinary teams in developing local protocols. It cannot replace applicable guidelines, pathological diagnosis, shared decision-making with patients, or real-world validation.

Diabetic nephropathy （DN） is one of the most common and serious microvascular complications of diabetes mellitus and represents a major cause of chronic kidney disease progression and end-stage kidney disease， thereby constituting a major public health problem that adversely affects the prognosis and quality of life of patients with diabetes mellitus. The pathogenesis and progression of DN are complex and involve multiple pathological processes， including insulin resistance， inflammation， oxidative stress， lipid deposition， podocyte injury， and renal fibrosis. Although current clinical therapies can delay the progression of DN to some extent， their effectiveness remains limited by marked interindividual variability in therapeutic response and the difficulty of fully reversing renal injury. Therefore， further elucidation of the key molecular mechanisms underlying DN and the exploration of effective therapeutic strategies are of considerable importance. In recent years， with advances in the understanding of DN pathogenesis， peroxisome proliferator-activated receptor γ （PPARγ）， an important nuclear receptor transcription factor involved in the regulation of insulin resistance， inflammation， oxidative stress， and fibrotic processes， has attracted increasing attention for its role in the development and progression of DN. Traditional Chinese medicine （TCM）， characterized by multi-component， multi-target， and multi-pathway synergistic regulation， may ameliorate pathological processes including metabolic abnormalities， inflammation， oxidative stress， lipid deposition， and renal fibrosis in DN by targeting PPARγ and its associated signaling networks. This review systematically summarizes the mechanisms by which PPARγ and its related signaling pathways regulate DN and reviews recent advances in TCM interventions targeting the PPARγ signaling pathway in DN. Such TCM interventions encompass single herbs such as Coptidis Rhizoma， active constituents such as quercetin， astragaloside Ⅳ， and trigonelline， extracts of herbs such as Plantaginis Herba and Dendrobii Nobilis Caulis， and formulas such as Huangkui capsules， Shenshuaining granules， and Mudan granules. This review aims to provide a theoretical basis for the prevention and treatment of DN with TCM.

Objective: To analyze the trend in disease burden attributable to insufficient physical activity among residents in Zhejiang Province from 1990 to 2021, so as to provide evidence for developing targeted prevention and control strategies. Methods: Data on years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) due to insufficient physical activity among residents of Zhejiang Province were collected from the Global Burden of Disease (GBD) 2021 database. The average annual percentage change was used to analyze the trends in YLL, YLD, and DALY rates from 1990 to 2021. Results: YLL, YLD, and DALY rates attributable to insufficient physical activity among residents of Zhejiang Province increased from 42.65/105, 11.12/105, and 53.77/105 in 1990 to 85.67/105, 31.56/105, and 117.23/105 in 2021, respectively, showing an upward trend (AAPC=2.267%, 3.428%, and 2.517%, all P<0.05). From 1990 to 2021, the YLL, YLD, and DALY rates attributable to insufficient physical activity were consistently higher in females than in males. Both males and females demonstrated upward trends in YLL (AAPC=2.631%, 2.031%), YLD (AAPC=3.711%, 3.268%), and DALY (AAPC=2.840%, 2.303%) rates (all P<0.05). From 1990 to 2021, the YLL, YLD, and DALY rates were highest in the ≥70 years age group. From 1990 to 2021, 15-<50 and ≥70 years age groups showed upward trends in YLL (AAPC=0.439%, 0.818%), YLD (AAPC=3.102%, 1.351%), and DALY (AAPC=1.749%, 0.932%) rates (all P<0.05). The 50-<70 years age group exhibited an increasing trend in YLD rate (AAPC=1.222%), while declining trends in YLL (AAPC=-1.400%) and DALY (AAPC=-0.663%) (all P<0.05). In both 1990 and 2021, the top five diseases attributable to insufficient physical activity in Zhejiang Province were stroke, diabetes, colorectal cancer, ischemic heart disease, and chronic kidney disease. Compared to 1990, the DALY rates for these five diseases increased in 2021, with change rates of 89.20%, 164.84%, 110.67%, 223.40%, and 80.95%, respectively. Conclusions From 1990 to 2021, the overall disease burden attributable to insufficient physical activity in Zhejiang Province showed an upward trend. The disease burden was relatively high among females, the elderly, and for chronic diseases such as stroke, while premature mortality burden declined among residents aged 50-<70 years.

AIM To establish a UPLC-MS/MS method for the simultaneous content determination of liquiritin,liquiritin apioside,verbascoside,narirutin,isoacteoside,apigetrin,hesperidin,isoliquiritin,ononin,liquiritigenin,glycyrrhizic acid,isoliquiritigenin,honokiol,obovatol,pogostone and magnolol in Jiawei Huoxiang Zhengqi Soft Capsules.METHODS The analysis was performed on a 40 ℃ thermostatic ZORBAX Eclipse Plus C18 column(2.1 mm×100 mm,1.8 μm),with the mobile phase comprising of 0.1％formic acid-acetonitrile flowing at 0.4 mL/min in a gradient elution manner,and electron spray ionization source was adopted in positive and negative ion scanning with multiple reaction monitoring mode.RESULTS Sixteen constituents showed good linear relationships within their own ranges(r＞0.990 0),whose average recoveries were 83.74％-105.12％with the RSDs of 1.10％-4.8％.CONCLUSION This accurate,sensitive,stable and reproducible method can provide a reference for the overall quality control of Jiawei Huoxiang Zhengqi Soft Capsules.

Objective To explore the risk factors of early myocardial injury in patients with acute carbon monoxide poisoning(ACOP)and the effect of myocardial injury on prognosis.Methods A total of 176 patients with ACOP who were hospitalized in Changde Hospital Affiliated to Xiangya School of Medicine,Central South University from January 2020 to November 2024 were selected.According to the highest value of MB isoenzyme of creatine kinase(CK-MB)within 72h after poisoning,the patients were divided into early myocardial injury group(CK-MB ≥ 75 U/L,32 cases)and non-early myocardial injury group(CK-MB＜75 U/L,144 cases).The clinical data of two groups were collected and compared,and independent influencing factors of early myocardial injury in patients with ACOP were explored by applying the multivariate Logistic regression model.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of its risk factors for early myocardial injury.Results The neutrophil to lymphocyte ratio,monocyte to lymphocyte ratio,alanine aminotransferase,aspartate aminotransferase(AST),blood urea nitrogen and C-reactive protein(CRP)of patients with early myocardial injury group were significantly higher than those of non-early myocardial injury group(P＜0.05).Multivariate Logistic regression analysis showed that both AST and CRP were independent risk factors for early myocardial injury in patients with ACOP(P＜0.05).The sensitivity of AST combined with CRP in predicting early myocardial injury in patients with ACOP was 78.1％,the specificity was 93.1％,and area under the curve was 0.931.The incidence of delayed encephalopathy in early myocardial injury group was significantly higher than that in non-early myocardial injury group(x2=19.055,P＜0.001).Conclusion AST and CRP are independent risk factors for early myocardial injury in ACOP patients,and AST combined with CRP has a certain predictive value for early myocardial injury in ACOP patients.The incidence of delayed encephalopathy was higher in patients with early myocardial injury,suggesting that myocardial injury is closely related to the poor prognosis of patients.

Based on the target recognition ability of split aptamer and intelligent analytical capability of molecular logic gate,in this work,two split aptamers were integrated into"AND"logic gate to construct a novel ortho-nucleic acid fluorescence sensor for simultaneous detection of thrombin and myoglobin.When there was one target,the response of the signal was only a single fluorescence output signal,which was used as an evaluation standard for early low-risk judgment.When two targets coexisted,the split aptamer bound to the target to form a ternary complex and led to the head and tail ortho-nucleic acid effect respectively,and triggered the G4 chain to enhance the fluorescence signal of thioflavin T and the fluorescence signal quenching of Cyanine 3,which could be used as an evaluation criterion for early high-risk judgement.Under the optimal conditions,the linear range for detection of thrombin was 3-200 nmol/L,with a correlation coefficient of 0.9931 and a detection limit of 0.97 nmol/L,and the linear range for detection of myoglobin was 6-400 nmol/L,with a correlation coefficient of 0.9933,and a detection limit of 2.14 nmol/L.The method was applied to simultaneous determination of thrombin and myoglobin in clinical serum samples,and the recoveries were 85.4%-118.3%and 85.8%-119.9%,respectively,with relative standard deviations of less than 6.5%.Compared with the standard method,the relative error range was from-8.8%to 5.6%.In addition,the logical diagnosis results of 4 serum samples were high-risk of acute myocardial infarction in 2 cases and low-risk in 2 cases.The ″AND″ logic gate ortho-nucleic acid fluorescence sensing method showed many advantages such as high selectivity,rapidity,accuracy and simultaneous detection,which offered important reference for early diagnosis of acute myocardial infarction,and also provided a general detection design strategy and platform for simultaneous detection of biomarkers.