Myosteatosis is one of the common complications in patients with end-stage liver disease, which is significantly associated with poor outcomes after liver transplantation. Currently, diagnostic criteria of myosteatosis have not been established, and CT is the most commonly used for diagnosis. The pathogenesis of myosteatosis is multifactorial, and the pathophysiological mechanisms linking it to end-stage liver disease are not fully understood. An increasing number of scholars have recognized that the severity of myosteatosis is closely related to its clinical consequences, but there are no effective treatment options available. This article reviews the pathophysiological mechanisms and diagnostic methods of myosteatosis, and its impact on the prognosis of liver transplant recipients, and discusses current treatment strategies to provide references for the perioperative management of liver transplant recipients.

The blood-brain barrier （BBB） is a physical and biochemical barrier that precisely regulates brain homeostasis and plays a central role in controlling the transport of endogenous and exogenous drugs and related metabolites across the blood-brain interface. These functions of the BBB are mediated by its major components， including brain microvascular endothelial cells （BMECs）， tight junction protein complexes， and influx and efflux transporter proteins. One of the pathological features of ischemic stroke （IS） is BBB disruption， which plays an important role in the development of post-stroke brain injury and subsequent neurological dysfunction. Therefore， given the increasing incidence of IS， there is an urgent need to develop new therapeutic strategies to prevent BBB dysfunction and thereby protect injured brain tissue after IS. This study describes the pathological mechanisms by which BMEC injury after IS leads to BBB dysfunction and elucidates the association between BMECs and IS， including the regulation of apoptosis， autophagy， inflammatory responses， oxidative stress， neurotoxic effects， and cerebral edema. In addition， this article summarizes Chinese herbal medicines that may prevent and treat IS by targeting BMECs. These include monomeric compounds and single herbs such as flavonoids， glycosides， phenols， phthalides， terpenoids， and Styrax. Traditional Chinese medicine （TCM） compound formulas and preparations include oral formulations such as Buyang Huanwu decoction， Sailuotong， Naoxintong capsules， Dandeng Tongnao capsules， and Shexiang Tongxin dropping pills， as well as injectable preparations such as Tongluo Jiunao injection， Xingnaojing injection， Danshen polyphenolic acid for injection， Yiqi Fumai injection， and Shuxuetong injection. This study aims to explore the protective effects of TCM against IS through targeted regulation of BMEC function， providing new insights into the mechanisms of IS and endovascular therapeutic strategies.

Purpose: Lung cancer is frequently observed as a second primary malignancy following gastric cancer, yet the genetic causality between them remains uncertain. This study aims to evaluate the causal relationship between gastric and lung cancers using Mendelian randomization (MR) analysis. Materials and Methods: Single nucleotide polymorphisms associated with gastric and lung cancers were selected from genome-wide association study in East Asian and European populations as instrumental variables. The causal effects between gastric and lung cancers were evaluated using univariable and multivariable MR analysis, with the inverse variance weighted (IVW) method serving as the primary criterion. Heterogeneity and sensitivity analyses were performed to ensure the robustness of the findings. Results: Univariable MR analysis demonstrated that genetic susceptibility to gastric cancer in the European population was significantly associated with an increased risk of lung cancer (IVW: odds ratio [OR], 1.285; 95% confidence interval [CI], 1.072 to 1.541; p=6.83E-03), which was consistently validated in the East Asian population (IVW: OR, 1.356; 95% CI, 1.114 to 1.651; p=2.40E-03). Multivariable MR analysis further indicated that the significant positive causal relationship between gastric cancer and lung cancer persisted in both populations after adjusting for confounding factors (all p < 0.05). Conversely, no significant causal relationship was observed for the risk of developing gastric cancer following the diagnosis of lung cancer in either population (p > 0.05). Conclusion This study confirms that genetic susceptibility to gastric cancer increases the risk of lung cancer. This finding provides a theoretical basis for exploring the underlying biological mechanisms and suggests that enhancing lung cancer screening in patients with gastric cancer may be necessary to improve patient prognosis.

Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

Objective:To investigate the feasibility of stapled closure of the internal fistula orifice in anal fistula (SCIA) combined with catheter drainage in the extra-sphincteric space in the treatment of high complex anal fistula.Methods:Methods Surgical procedure: Under combined spinal-epidural anesthesia, a submucosal purse-string suture was placed above the dentate line, and the stapler was inserted to close the internal opening. The fistulous tract was dissected from the external opening toward the cranial side and excised along its path to the level of the levator ani muscle, followed by placement of catheter drainage in the extra-sphincteric space.Results:A retrospective analysis was conducted on the clinical data of a 40-year-old male patient with a high-position complex anal fistula, who underwent SCIA combined with catheter drainage in the extra-sphincteric space at the Department of Colorectal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine in December 2024. The surgery was successful with minimal intraoperative bleeding, a complete anastomosis, and thorough fistula tract dissection. There was no sphincter injury occurred, and the catheter drainage was unobstructed. The patient was discharged on postoperative day 8. Postoperative follow-up visits were conducted at 2 months and 6 months after surgery. The patient had no symptoms such as pain, purulent discharge, or pruritus. MRI scans of the anal canal (both plain and contrast-enhanced) at 2 months and 6 months showed no recurrence of the fistula. The Wexner fecal incontinence score was 0, indicating normal bowel control, and the Garg score was less than 8, suggesting fistula healing and low probability of recurrence.Conclusion:SCIA combined with catheter drainage in the extra-sphincteric space is a safe and feasible procedure for the treatment of high complex anal fistula.

Objective:To identify independent risk factors for early recurrence following curative resection of resectable pancreatic cancer and establish a nomogram prediction model.Methods:Clinical data from 405 patients with resectable pancreatic cancer treated at Renji Hospital, Shanghai Jiao Tong University School of Medicine from February 2010 to December 2020 were retrospectively reviewed. Patients were stratified into a training cohort (265 patients form February 2010 to December 2018) and a validation cohort (140 patients from January 2019 to December 2020) based on surgery dates. Optimal cutoff values for clinical variables were determined using X-tile software. Independent risk factors were identified through univariate and multivariate Cox proportional hazards regression analyses. Kaplan-Meier curves for recurrence-free survival (RFS) were generated across subgroups, and a nomogram was developed to predict early recurrence (within 1 year post-surgery). Time-dependent receiver operating characteristic (tROC) curves was drawn and area under the curve (AUC) metrics were utilized to evaluate predictive accuracy, while model reliability was assessed by calibration curves. Individualized risk scores derived from the nomogram were stratified into high- and low-risk groups using X-tile-derived cutoff values. Survival differences between groups were analyzed via log-rank tests. The clinical application value was judged by decision curve analysis (DCA) compared to TNM staging. Results:In the training cohort, 139 patients (52.45%) experienced early recurrence, with a median RFS of 11.1 months [interquartile range ( IQR): 6.0-26.0]. The validation cohort reported 70 early recurrences (50.00%) and a median RFS of 11.8 months ( IQR: 4.9-21.4). Univariate analysis revealed significant associations between early recurrence and tumor diameter, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), systemic immune-inflammation index (SⅡ), and prognostic nutritional index (PNI). Multivariate analysis identified tumor diameter ≥3.75 cm ( HR=1.718, 95% CI 1.223-2.412, P=0.002), CA19-9≥218 U/ml ( HR=1.567, 95% CI 1.107-2.220, P=0.011), CA125≥20.98 U/ml ( HR=2.501, 95% CI 1.768-3.539, P<0.001), SⅡ≥388.28 ( HR=1.708, 95% CI 1.096-2.662, P=0.018), and PNI<53.18 ( HR=0.596, 95% CI 0.404-0.879, P=0.009) as independent risk factors for early recurrence. The nomogram achieved AUC values of 0.771 and 0.708 in the training and validation cohorts, respectively. Calibration curves demonstrated strong agreement between predicted and observed survival probabilities. Kaplan-Meier analysis revealed significantly lower 1-year RFS rates in high-risk versus low-risk groups for both cohorts (training: HR=3.65, 95% CI 2.45-5.44, P<0.001; validation: HR=2.37, 95% CI 1.39-4.06, P=0.001). DCA indicated superior net benefit of the nomogram over TNM staging across threshold probabilities of 0.2-0.9. Conclusions:The proposed nomogram effectively integrates clinical and serological biomarkers to preoperatively assess early recurrence risk in resectable pancreatic cancer patients, offering enhanced precision for clinical decision-making.

This study investigates the expression pattern and functional significance of EF-hand domain-containing protein 2 (EFHD2) in hepatocellular carcinoma (HCC), with particular focus on its regulatory effects on tumor proliferation, migration, and invasion. Cellular experimental study was completed from June 2024 to January 2025 in the Basic Laboratory of the General Hospital of Southern Theater Command. TCGA database to determine EFHD2 expression and its clinicopathological correlations. GSCA database to assess methylation patterns and immune infiltration. Model of transient overexpression and knockdown of EFHD2 was constructed in hepatocellular carcinoma cells Hep3B, then RT-qPCR and Western blot were applied to verify the transfection efficiency. CCK-8 and colony formation assays for proliferation assessment, Transwell chambers for migration/invasion quantification. Protein-protein interaction networks were constructed via STRING, followed by GO/KEGG enrichment analysis. Statistical analysis was performed using the two independent samples t-test. The results showed that EFHD2 demonstrated significant upregulation in HCC tissues versus normal controls ( P<0.05). Elevated EFHD2 expression correlated with advanced clinical stage ( P<0.05) and poor differentiation ( P<0.05). In the CCK-8 assay, the EFHD2 overexpression group demonstrated significantly higher cell viability than the control group, as evidenced by 450 nm relative absorbance values on Day 1 (0.529±0.019 vs. 0.515±0.016, F=0.041, P=0.320), Day 2 (1.356±0.019 vs. 1.094±0.042, F=3.833, P<0.001), Day 3 (2.817±0.049 vs. 2.143±0.124, F=3.833, P<0.001), and Day 4 (3.848±0.015 vs. 3.430±0.021, F=0.469, P<0.001). The EFHD2 knockdown group showed reduced cell viability compared to controls: Day 1 (0.541±0.020 vs. 0.552±0.015, F=0.098, P=0.423), Day 2 (1.154±0.009 vs. 1.326±0.029, F=2.485, P<0.001), Day 3 (2.453±0.041 vs. 2.653±0.031, F=0.479, P<0.001), and Day 4 (3.685±0.038 vs. 3.836±0.021, F=6.804, P<0.001). In colony formation assays, the overexpression group displayed a significant increase in colony numbers (254.667±23.861 vs. 186.000±16.703, F=0.865, P=0.015), whereas the knockdown group exhibited decreased colony formation (229.000±24.637 vs. 306.667±36.501, F=0.988, P=0.038). In Transwell assays, the EFHD2 overexpression group revealed enhanced migratory capacity [ (605.000±72.670) cells vs. (472.667±28.095) cells, F=2.462, P=0.042] and invasive potential [(767.333±21.221) cells vs. (414.333±16.623) cells, F=0.331, P<0.001]. The knockdown group showed attenuated migration [(311.000±71.084) cells vs. (479.667±50.846) cells, F=0.718, P=0.029] and invasion [(247.667±48.263) cells vs. (345.667±32.130) cells, F=0.727, P=0.043] compared to controls. The network of EFHD2-interacting proteins was further constructed by the STRING database, and the GO and KEGG analysis were used to perform bioinformatics analysis reveal that EFHD2 is mainly involved in actin cytoskeleton regulation. In conclusion, EFHD2 is highly expressed in HCC and is involved in the process of proliferation, migration and invasion of HCC.

Objective:To investigate the relationship between the Myers-Briggs Type Indicator(MBTI)personality traits,empathy ability,and emotion regulation among medical students,and to advocate for medical students to conduct in-depth self-analysis using MBTI,and to enhance their empathy ability in a targeted manner,thereby more effectively building harmonious doctor-patient relationships.Methods:A total of 664 medical students were investigated using the MBTI,the Chinese version of the Emotion Regulation Questionnaire(ERQ),and the Chinese version of the Interpersonal Reactivity Index(IRI).The mediation analysis in SPSSAU employed the product coefficient test method,utilizing Bootstrap sampling for data analysis.Results:The MBTI personality traits of medical students were generally inclined to Introversion-Sensing-Thinking-Judging(ISTJ).Medical students tended to use cognitive reappraisal,and the level of empathy needed to be strengthened.Males exhibited higher expressive inhibition than females,while females experienced greater personal distress than males.Expressive inhibition was also higher in only children compared to non-only children,and only children showed lower emotional empathy than non-only children.Cognitive reappraisal played a partial mediating role in the relationship between introverted/extraverted personality traits and personal distress among medical students(mediating effect=-0.017,accounting for 14.217%of the total effect),and a complete mediating effect between introverted/extraverted personality traits and emotional empathy(mediating effect=0.024,accounting for 100%of the total effect).Cognitive reappraisal partially mediated the relationship between life attitude orientation and emotional empathy(mediating effect=0.017,accounting for 15.727%of the total effect),and served as a partial mediator in the relationship between life attitude orientation and cognitive empathy(mediating effect=0.171,accounting for 25.827%of the total effect).Conclusion:Cognitive reappraisal has a mediating effect on the relationship between medical students'MBTI personality traits and empathy,guiding medical students to improve empathy abilities using cognitive reappraisal.Medical students can further understand their strengths and weaknesses by identifying their MBTI types,and improve their empathy ability in a targeted manner,to better adapt to future medical work.

Objective:To analyze the characteristics and significance of traumatic brain injury-related articles published in Chinese Journal of Trauma (hereinafter referred to as"the Journal") from 1985 to 2024. Methods:Using the CNKI database as the data source, traumatic brain injury-related articles published in the Journal from 1985 to 2024 were retrieved. Key metrics analyzed included total publication count, article types [original articles (including basic and clinical research, with clinical research further categorized as prospective/retrospective and single-center/multicenter studies), case reports, reviews/expert forums, consensus/guidelines], publication timeline, provincial and institutional collaborations, authors, and key words.Results:Among 10 687 total publications, 1 579 articles (14.77%) focused on traumatic brain injury, comprising comprised 1 196 original articles (75.74%), 226 ase reports (14.31%), 151 reviews/expert forums (9.56%), and 6 consensus/guidelines (0.38%). When stratified by decade (1985-1994, 1995-2004, 2005-2014, 2015-2024), the proportion of basic research among original articles was 12.67%, 28.13%, 31.70%, and 37.32%, respectively. Of clinical studies, prospective designs accounted for 23.39%, 34.21%, 34.73%, and 51.69%, respectively and multicenter collaborations accounted for 17.74%, 27.96%, 33.83%, and 47.19%, respectively. The number of case reports was 38, 142, 27, and 19, respectively; the number of reviews/expert forums was 4, 17, 53, and 77, respectively; and the number of consensus and guidelines was 0, 0, 1, and 5, respectively. The regions with more than 150 published articles were Shanghai Municipality, Zhejiang Province and Chongqing Municipality. The top 3 prolific institutions in the last two decades were Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (46 articles), Huashan Hospital Affiliated to Fudan University (26 articles), and Changzheng Hospital Affiliated to Naval Medical University (25 articles). The top 3 prolific authors were Jiang Jiyao (66 articles), Zhang Sai (40 articles), and Zhu Cheng (38 articles). Beyond "brain injury", the top five key words were "treatment", "prognosis", "intracranial pressure", "brain edema", and "therapeutic hypothermia". Among the top 20 key words, "intracranial pressure" was the only specific monitoring metric, while "therapeutic hypothermia" and "decompressive craniectomy" were the most frequently cited specific treatment and surgical procedure, respectively.Conclusion:Over the 40-year period, the Journal′s traumatic brain injury-related articles have demonstrated a rising proportion of basic research among original articles, increased adoption of prospective and multicenter designs in clinical studies, and substantial growth in reviews/expert forums alongside consensus/guidelines in recent years, with research output concentrated among a limited number of institutions and authors.

Objective:To investigate the protective effect of myrislignan（MRL）on concanavalin A（Con A）-induced autoimmune hepatitis（AIH）.Methods:C57BL/6J mice were divided into the following groups using a random number table，with five mice in each group：control group，MRL group，model group（Con A group），and MRL pretreatment group（MRL+Con A group）. MRL was injected intraperitoneally at a dose of 30 μg/g；3 h after pretreatment，Con A（18 μg/g）was administrated by intravenous injection；mouse livers and serum samples were collected 12 h after injection for measuring serum transaminase levels and liver cell apoptosis. The mRNA and protein expression levels of IL-6，IL-12，and TNF-α were measured using qRT-PCR and ELISA. Flow cytometry was performed to detect the proportion and activation status of macrophages in liver tissues. Bone marrow-derived macrophages（BMDMs）were isolated and induced in vitro to analyze the regulatory effect of MRL on macrophages. One-way analysis of variance was used to compare the differences in various indicators among groups. Results:Compared with the Con A group，MRL（30 μg/g）pretreatment significantly reduced alanine aminotransferase（ P<0.05）and aspartate transaminase（ P<0.01）levels，attenuated liver oxidative stress（increased superoxide dismutase activity，while decreased levels of malondialdehyde and myeloperoxidase；all P<0.05），and suppressed hepatocyte apoptosis（ P<0.01）. Both in vivo and in vitro experiments confirmed that MRL（30 μg/g）could reduce the proportion of M1 macrophages（ in vivo： P<0.05； in vitro：all P<0.001）and inhibit macrophage activation（ in vivo： P<0.01； in vitro：all P<0.05）. Conclusion:MRL effectively prevents Con A-induced autoimmune hepatitis by inhibiting liver cell apoptosis，attenuating liver oxidative stress，suppressing M1 macrophage polarization，and reducing inflammatory cytokine expression.