With the rapid advancement of hemodynamic indices and monitoring technologies, their classification methods and application processes have become increasingly complex. Currently, no unified standard hasbeen established, making it difficult to fully meet the clinical requirements for hemodynamic management. To assist in hemodynamic monitoring assessment and therapeutic decision-making in critically ill patients, the Critical Hemodynamic Therapy Collaborative Group, in conjunction with the Critical Ultrasound Study Group, has jointly developed the Standard for the Application of Hemodynamic Monitoring Techniques in Critical Care. The first part of this standard systematically categorizes hemodynamic indicators into flow indicators, pressure and its derivative indicators, and tissue perfusion indicators, while elaborating on the clinical application of each. The second part establishes a standardized clinical implementation pathway for hemodynamic monitoring. It proposes a tiered monitoring strategy-comprising basic, advanced, indication-specific, and special scenario monitoring-tailored to different clinical settings. It emphasizes the central role of critical care ultrasound across all levels of monitoring and establishes hemodynamic assessment standards for organs such as the brain, kidneys, and gastrointestinal tract. This standard aims to provide a unified framework for clinical practice, teaching, training, and research in critical care medicine, thereby promoting standardized development within the discipline.

Metabolic associated fatty liver disease （MAFLD） is a common chronic liver disease worldwide， and timely and precise intervention can delay disease progression and significantly reduce the risk of serious complications such as liver fibrosis， liver cirrhosis， and liver cancer. Although traditional liver biopsy combined with metabolic markers is the gold standard， it may cause complications such as pain and bleeding as an invasive examination， which has promoted scientific research to shift its focus to the construction of noninvasive assessment systems. In recent years， noninvasive diagnostic technologies based on multi-dimensional detection strategies have been continuously updated， including serological models， imaging techniques， and clinical algorithms. This article systematically reviews the screening methods for MAFLD during the fibrotic stages F1—F3， especially deep learning models based on artificial intelligence， in order to provide ideas for the early screening of MAFLD， as well as a scientific reference for optimizing disease management strategies.

GPR126, also known as ADGRG6, is one of the most deeply studied aGPCRs. Initially, GPR126 was thought to be a receptor associated with muscle development and was primarily expressed in the muscular and skeletal systems. With the deepening of research, it was found that GPR126 is expressed in multiple mammalian tissues and organs, and is involved in many biological processes such as embryonic development, nervous system development, and extracellular matrix interactions. Compared with other aGPCRs proteins, GPR126 has a longer N-terminal domain, which can bind to ligands one-to-one and one-to-many. Its N-terminus contains five domains, a CUB (complement C1r/C1s, Uegf, Bmp1) domain, a PTX (Pentraxin) domain, a SEA (Sperm protein, Enterokinase, and Agrin) domain, a hormone binding (HormR) domain, and a conserved GAIN domain. The GAIN domain has a self-shearing function, which is essential for the maturation, stability, transport and function of aGPCRs. Different SEA domains constitute different GPR126 isomers, which can regulate the activation and closure of downstream signaling pathways through conformational changes. GPR126 has a typical aGPCRs seven-transmembrane helical structure, which can be coupled to Gs and Gi, causing cAMP to up- or down-regulation, mediating transmembrane signaling and participating in the regulation of cell proliferation, differentiation and migration. GPR126 is activated in a tethered-stalk peptide agonism or orthosteric agonism, which is mainly manifested by self-proteolysis or conformational changes in the GAIN domain, which mediates the rapid activation or closure of downstream pathways by tethered agonists. In addition to the tethered short stem peptide activation mode, GPR126 also has another allosteric agonism or tunable agonism mode, which is specifically expressed as the GAIN domain does not have self-shearing function in the physiological state, NTF and CTF always maintain the binding state, and the NTF binds to the ligand to cause conformational changes of the receptor, which somehow transmits signals to the GAIN domain in a spatial structure. The GAIN domain can cause the 7TM domain to produce an activated or inhibited signal for signal transduction, For example, type IV collagen interacts with the CUB and PTX domains of GPR126 to activate GPR126 downstream signal transduction. GPR126 has homology of 51.6%-86.9% among different species, with 10 conserved regions between different species, which can be traced back to the oldest metazoans as well as unicellular animals.In terms of diseases, GPR126 dysfunction involves the pathological process of bone, myelin, embryo and other related diseases, and is also closely related to the occurrence and development of malignant tumors such as breast cancer and colon cancer. However, the biological function of GPR126 in various diseases and its potential as a therapeutic target still needs further research. This paper focuses on the structure, interspecies differences and conservatism, signal transduction and biological functions of GPR126, which provides ideas and references for future research on GPR126.

Objective:To development a deep learning（DL） model based on conventional MRI for automatic segmentation and differential diagnosis of nasopharyngeal carcinoma（NPC） and nasopharyngeal lymphoma（NPL）. Methods:The retrospective study included 142 patients with NPL and 292 patients with NPC who underwent conventional MRI at Renmin Hospital of Wuhan University from June 2012 to February 2023. MRI from 80 patients were manually segmented to train the segmentation model. The automatically segmented regions of interest（ROIs） formed four datasets: T1 weighted images（T1WI）, T2 weighted images（T2WI）, T1 weighted contrast-enhanced images（T1CE）, and a combination of T1WI and T2WI. The ImageNet-pretrained ResNet101 model was fine-tuned for the classification task. Statistical analysis was conducted using SPSS 22.0. The Dice coefficient loss was used to evaluate performance of segmentation task. Diagnostic performance was assessed using receiver operating characteristic（ROC） curves. Gradient-weighted class activation mapping（Grad-CAM） was imported to visualize the model's function. Results:The DICE score of the segmentation model reached 0.876 in the testing set. The AUC values of classification models in testing set were as follows: T1WI: 0.78（95%CI 0.67-0.81）, T2WI: 0.75（95%CI 0.72-0.86）, T1CE: 0.84（95%CI 0.76-0.87）, and T1WI+T2WI: 0.93（95%CI 0.85-0.94）. The AUC values for the two clinicians were 0.77（95%CI 0.72-0.82） for the junior, and 0.84（95%CI 0.80-0.89） for the senior. Grad-CAM analysis revealed that the central region of the tumor was highly correlated with the model's classification decisions, while the correlation was lower in the peripheral regions. Conclusion:The deep learning model performed well in differentiating NPC from NPL based on conventional MRI. The T1WI+T2WI combination model exhibited the best performance. The model can assist in the early diagnosis of NPC and NPL, facilitating timely and standardized treatment, which may improve patient prognosis.
Humans ; Nasopharyngeal Carcinoma/diagnostic imaging* ; Deep Learning ; Magnetic Resonance Imaging ; Retrospective Studies ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Lymphoma/diagnostic imaging* ; Diagnosis, Differential ; ROC Curve ; Male ; Female ; Middle Aged ; Adult

OBJECTIVE To analyze the clinical characteristics of Stevens-Johnson syndrome （SJS） and toxic epidermal necrolysis （TEN） induced by tislelizumab， providing evidence for clinical medication safety. METHODS Case reports of tislelizumab-related SJS/TEN were retrieved from CNKI， VIP， Wanfang Data， PubMed， ScienceDirect， and Embase. Descriptive analysis was performed. RESULTS Seventeen cases from 17 publications were included （SJS 4 cases， TEN 13 cases）. Among them， there were 10 males and 7 females. Twelve patients were aged between 70 and 79 years. The predominant tumor type was lung cancer （10 cases）. Thirteen patients received combination therapy with chemotherapeutic drugs. The median onset time of SJS/ TEN was 26 （4， 104） days. Nine patients developed SJS/TEN after the first administration of the drug. Sixteen patients exhibited prodromal rash symptoms， primarily characterized by severe skin damage such as skin detachment， accompanied by mucosal injury. Sixteen patients improved after symptomatic treatment， while one patient died. CONCLUSIONS Tislelizumab-associated SJS/TEN risk is higher in elderly patients， males， those with lung cancer and those receiving combination chemotherapy. Mucosal lesions and atypical rashes may indicate the early onset of SJS/TEN. During clinical use， pharmaceutical care can be carried out through measures such as identifying high-risk populations， closely monitoring skin symptoms from the first administration to the fifth treatment cycle， and enhancing patient education. When relevant symptoms occur， the medication should be promptly discontinued and symptomatic treatment should be administered to ensure the patient’s medication safety.

ObjectiveTo investigate the quality markers of Xiaoqinglong granules（XQLG） for treating bronchial asthma using the analytic hierarchy process（AHP）-entropy weight method（EWM）， network pharmacology and high performance liquid chromatography（HPLC） content determination. MethodsEffectiveness， testability and peculiarity component data of XQLG in treating bronchial asthma were constructed through database retrieval， literature review， and network pharmacology. Subsequently， AHP-EWM was used to quantitatively identify and weight the control layer and element layer， the relevant compounds were selected as candidate quality markers based on comprehensive scores. Further comparison of reference substances and establishment of HPLC content determination method were used to determine the potential quality markers of XQLG， which were verified by molecular docking with disease targets. ResultsA total of 13 components， including glycyrrhizic acid， paeoniflorin， schisandrol A， isoliquiritigenin， 6-gingerol， ephedrine， liquiritin， albiflorin， liquiritigenin， 6-shogaol， pseudoephedrine， cinnamic acid and cinnamaldehyde， were identified as potential quality markers of XQLG by AHP-EWM. Quantitative analysis indicated that all aforementioned quality markers could be detected in 13 batches of XQLG， indicating that it had stable testability as a quality marker. Among these 13 batches of samples， ephedrine and paeoniflorin exhibited good consistency in content， while pseudoephedrine and cinnamaldehyde showed poor consistency. Molecular docking analysis revealed that the 13 compounds exhibited binding energies with the core targets -2.11 kcal·mol^-1， indicating that the 13 compounds could spontaneously bind to the disease targets， which may be the material basis for the treatment of bronchial asthma with XQLG. ConclusionIn this study， 13 compounds were screened by AHP-EWM combined with network pharmacology and HPLC as quality markers for the treatment of bronchial asthma by XQLG， laying the foundation for enhancing the quality standards of this preparation.

Objective To investigate the antibacterial activity of the antifungal peptide Mt6-21DLeu derived from Musca domestica against Acinetobacter baumannii (AB) and unravel its underlying mechanisms, so as to provide insights into development of novel agents against AB. Methods The minimum inhibitory concentrations (MICs) of Mt6-21DLeu, M. domestica-derived antifungal peptide-1 (MAF-1A), and polymyxin B were determined against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and AB using the broth microdilution assay, and the antibacterial activity of Mt6-21DLeu and polymyxin B was dynamically assessed against AB over 24 hours with time-kill curves. The inhibitory effects of Mt6-21DLeu and polymyxin B on biofilm formation in AB at concentrations of 1/4 × MIC, 1/2 × MIC and MIC, and the eradication effects of Mt6-21DLeu and polymyxin B on mature biofilms in AB at concentrations of MIC, 2 × MIC, and 4 × MIC were evaluated using crystal violet staining. Structural changes in the cell membrane of AB were observed 3 hours post-exposure to Mt6-21DLeu at concentrations of MIC and 2 × MIC using scanning electron microscopy, and alterations in the cell membrane permeability of AB were analyzed 3 hours post-treatment with Mt6-21DLeu at concentrations of MIC and 2 × MIC by means of fluorescence microscopy and propidium iodide (PI) staining. Intracellular reactive oxygen species (ROS) levels in AB were measured 3 hours post-treatment with Mt6-21DLeu at concentrations of MIC, 2 × MIC, and 4 × MIC using flow cytometry. The survival of Caenorhabditis elegans exposed to Mt6-21DLeu at concentrations of MIC, 2 × MIC, and 4 × MIC was monitored for 7 consecutive days, and survival curves were plotted to evaluate the in vivo toxicity of Mt6-21DLeu. In addition, C. elegans infected with AB and treated with Mt6-21DLeu at a concentration of 4 × MIC served as the treatment group, and uninfected C. elegans served as the control group, while infected but untreated C. elegans served as the infection group. The in vivo antibacterial efficacy of Mt6-21DLeu at a concentration of 4 × MIC was evaluated by comparing the survival curves and bacterial load among the three groups. Results The MICs of MAF-1A were all >128 μg/mL against S. aureus, B. subtilis, E. coli, K. pneumoniae, P. aeruginosa, and AB. In contrast, the MICs of Mt6-21DLeu were >128, 32, 8, 8, 16, and 4 μg/mL against these strains, respectively, and the MIC of Mt6-21DLeu against AB was close to that of polymyxin B (2 μg/mL). Time-kill curve analysis showed that both Mt6-21DLeu at concentrations of MIC and 2 × MIC and polymyxin B at a concentration of MIC inhibited AB growth over the 24-hour study period. The biofilm biomass in AB was (52.38 ± 6.92)%, (40.88 ± 9.17)% and (14.77 ± 6.00)% post-exposure with Mt6-21DLeu at concentrations of 1/4 × MIC, 1/2 × MIC and MIC, (61.58 ± 7.35)%, (47.42 ± 5.51)% and (20.85 ± 10.48)% post-treatment with polymyxin B at concentrations of 1/4 × MIC, 1/2 × MIC and MIC, and (100.00 ± 15.92)% in the control group (only bacterial suspension), respectively (F = 68.38, P < 0.001), and pairwise comparisons indicated that Mt6-21DLeu and polymyxin B at all concentrations significantly inhibited biofilm formation as compared to the control group (all P values < 0.001). The mature biofilm biomass in AB was (73.44 ± 11.41)%, (72.56 ± 13.08)% and (49.65 ± 9.23)% post-exposure to Mt6-21DLeu at concentrations of MIC, 2 × MIC, and 4 × MIC, (84.38 ± 8.60)%, (72.31 ± 9.63)% and (58.85 ± 4.96)% post-treatment with polymyxin B at concentrations of MIC, 2 × MIC, and 4 × MIC, and (100.00 ± 6.36)% in the control group (F = 35.63, P < 0.001), and pairwise comparisons revealed that Mt6-21DLeu at all concentrations significantly eradicated biofilm biomass (all P values < 0.05); however, polymyxin B showed no clear-cut eradication effect at a concentration of MIC (P > 0.05). Scanning electron microscopy revealed pore formation and content leakage in the cell membrane of AB 3 hours post-treatment with Mt6-21DLeu at concentrations of MIC and 2 × MIC. Fluorescence microscopy showed that the proportions of PI-stained AB were (24.79 ± 11.51)% and (68.44 ± 15.80)% post-treatment with Mt6-21DLeu at concentrations of MIC and 2 × MIC, and (0.96 ± 0.94)% in the phosphate-buffered saline (PBS) treatment group (F = 105.90, P < 0.001), with the highest proportion of PI-stained AB seen post-treatment with Mt6-21DLeu at a concentration of 2 × MIC (P < 0.05). Flow cytometry revealed that the relative intracellular ROS levels in AB were (652.00 ± 141.90), (694.33 ± 14.19), and (974.33 ± 160.02) 3 hours post-treatment with Mt6-21DLeu at concentrations of MIC, 2 × MIC and 4 × MIC, and (403.67 ± 86.56) in the PBS treatment group, respectively (F = 12.27, P < 0.05), with the highest intracellular ROS level measured following treatment with Mt6-21DLeu at a concentration of 4 × MIC (P < 0.05). Survival curve analysis revealed that Mt6-21DLeu posed no impact on C. elegans survival at concentrations of MIC (χ² = 0.02, P > 0.05), 2 × MIC (χ² = 0.06, P > 0.05) or 4 × MIC (χ² = 0.16, P > 0.05), and there was a significant difference in the survival period of C. elegans among the control group, the infection group, and the treatment group (χ² = 82.66, P < 0.05), with a significantly longer survival period in the treatment group than in the infection group (χ² = 45.00, P < 0.05). In addition, the log-transformed bacterial colony counts in C. elegans were (0.00 ± 0.00), (5.46 ± 0.03), and (3.91 ± 0.47) CFU/mL in the control group, the infection group, and the treatment group, respectively (F = 324.80, P < 0.001), and the log-transformed bacterial colony counts in C. elegans were significantly lower in the treatment group than in the infection group (P < 0.05). Conclusions Mt6-21DLeu exerts potent antibacterial effects through disrupting the cell membrane integrity of AB and promoting intracellular ROS accumulation in AB, and exhibits promising potential for treatment of AB infections both in vivo and in vitro, which may serve as a candidate drug molecule against multidrug-resistant AB infections.

OBJECTIVE To explore the diagnostic value of combined detection of droplet digital polymerase chain reaction(ddPCR),C-reactive protein(CRP),procalcitonin(PCT)and neutrophil-to-lymphocyte ratio(NLR)for bacterial bloodstream infections.METHODS Patients with suspected bloodstream infections admitted to Jiangbin Hospital of Guangxi Zhuang Autonomous Region from Jan.2023 to Jun.2024 were selected as the study subjects,with a total of 993 specimens from 543 patients included.Based on ddPCR and blood culture(BC)results,the pa-tients were divided into BC+and/or ddPCR+group(424 specimens)and ddPCR-/BC-group(569 specimens).The bacterial species detected by ddPCR were further classified into single infection group(258 speci-mens),mixed infection group(160 specimens)and ddPCR-group(575 specimens).The levels of CRP,PCT and NLR were compared among the groups.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of ddPCR,CRP,PCT and NLR separately and in combination for bacterial bloodstream in-fections.RESULTS The levels of CRP,PCT and NLR in the BC+and/or ddPCR+group were 71.61(37.00,108.81)mg/L,1.74(0.47,7.93)ng/ml and 9.82(5.53,18.07),respectively,which were higher than those in the ddPCR-/BC-group(P＜0.001).I n the ddPCR mixed infection group,the levels of CRP and PCT were 88.02(42.90,112.39)mg/L and 2.83(0.89,12.35)ng/ml,respectively,which were higher than those in the single infection group(P＜0.05).The qualitative results of ddPCR were better at predicting bloodstream infec-tions(OR=15.279,95％CI:6.525～35.776,P＜0.001).According to ROC curve analysis,ddPCR had the lar-gest area under the curve(AUC)among the single detection indicator(0.759),followed by PCT(0.732).The AUC for the combination of ddPCR qualitative results with CRP,PCT and NLR was 0.830,indicating that the di-agnostic performance of the combined detection was better than that of any single indicator.CONCLUSIONS The combination of ddPCR with PCT,CRP and NLR can improve the accuracy of diagnosing bacterial bloodstream in-fections.Compared with BC,ddPCR has higher sensitivity and can quickly identify the types and concentrations of pathogens in bloodstream infections.

Conventional surgical management of pelvic fractures entails incision and reduction with internal fixation, a procedure associated with significant bleeding, trauma, and a high surgical risk. The advent of advanced imaging techniques and sophisticated surgical instruments has led to a paradigm shift towards minimally invasive surgery as the prevailing treatment modality for such injuries. The efficacy of reduction is pivotal in determining the clinical prognosis of pelvic fractures, underscoring the importance of enhancing the quality of reduction in the minimally invasive surgery. The advent of 3D printing technology, intelligent orthopaedic surgical robots, mixed reality augmentation technology and high-precision optical localization tracking has catapulted minimally invasive pelvic fracture reduction to the forefront of research in the field of orthopaedics. Studies have demonstrated encouraging outcomes. This paper reviews relevant literature, mainly focusing on the evaluation and measurement, open reduction techniques, minimally invasive closed reduction techniques, and surgical robot assisted reduction techniques in treatment of pelvic fractures, to summarize the technical research progress in minimally invasive closed surgical reduction for pelvic fractures.

Pelvic fractures, the most severe bone trauma, account for approximately 3% of all fractures. As they are caused by high-energy injuries, their rates of mortality and disability are high. Over the past two centuries, the treatment strategies for these fractures have evolved from conservative therapy to open reduction and plate fixation, then to closed reduction and percutaneous screw fixation, and recently to screw fixation assisted by artificial intelligence. In the past 40 years, constant progress has been made in the treatment of pelvic fractures. It is generally acknowledged that a personalized treatment plan should be formulated based on each patient's age, fracture type, comorbidities, functional requirements and other factors when an appropriate treatment mode is chosen. The primary aim of treatment is to accelerate functional recovery, decrease the rate of disability after injury, and improve the quality of daily life of the patient. This paper reviews the treatment history of pelvic fractures, discusses the advantages and disadvantages of current treatment options, and looks ahead to future prospects, aiming to offer valuable references for related clinical practice.