The critical role of protein disequilibrium in driving carcinogenesis has long been recognized. Though several inhibitors of heat shock protein (HSP) family members have entered clinical trials, none of them have been approved for clinical use as a result of inevitable toxicity, leading to the identification of safer therapeutic approaches sharing a similar efficacy relevant and urgent. Through delineating the role of HSP90 inhibitors in arresting cancer hallmarks, this paper identified HSP90 inhibition as an effective therapeutic strategy capable of concomitantly targeting multiple key transformed properties of cancers via modulating cellular proteostasis. Through interrogating intrinsic connections between proteostasis and redox homeostasis, this paper proposed cold atmospheric plasma (CAP) as a possible alternative of HSP90 inhibitors with little adverse effects. This paper extended the therapeutic spectrum of HSP90 inhibitors and CAP to inflammation-driven pathologies including autoimmune diseases, as inflammation is a manifestation of failed proteostasis. These insights may conceptually advance our understandings on the driving force of cancers that can be easily extended to other disorders originated from imbalanced proteostasis and abnormal inflammation. Tools proposed here for inhibiting HSP90 including CAP and its possible synergy with HSP90 inhibitors may shift the current treatment paradigm to a new avenue in oncology and other relevant fields.

Objective:To evaluate the feasibility and safety of performing multi-procedure remote urological surgeries by integrating 5G communication technology with domestically manufactured robotic surgical systems.Methods:Patients requiring urological laparoscopic surgery for benign lesions or tumors were prospectively enrolled at Gansu Provincial Hospital from May 2023 to June 2024. Inclusion criteria included age ≥18 years, body mass index (BMI) between 18 and 30 kg/m 2, and American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅲ. Tumor-related surgical indicators were as follows: renal tumors staged ≤T 2, solitary tumors, or maximum diameter ≤10 cm; intermediate- to low-risk prostate cancer (clinical stage ≤T 2b), with preoperative prostate-specific antigen (PSA) ≤20 ng/ml or Gleason score ≤7; adrenal tumors with a diameter ≤7 cm or ≥3 cm for non-functional adenomas; and bladder tumors staged ≤T 2. Exclusion criteria included participation in other investigational drug or device clinical trials within the past 1 month, pregnancy or breastfeeding, and patients requiring emergency surgery. Patients with severe cardiovascular or circulatory diseases contraindicating surgery, and individuals with epilepsy, psychiatric disorders, or cognitive impairments were also excluded. Additionally, patients with active bleeding, coagulation disorders, or platelet counts <80×10 9/L were excluded. A 5G communication link was established between the main campus and the new branch of Gansu Provincial Hospital, approximately 70 km apart. Remote surgeries were performed using the domestically manufactured robotic surgical system (Toumai MT-1000). Perioperative key indicators, intraoperative network conditions, and robotic system performance were systematically recorded. Results:This study involved 14 patients, comprising 3 cases of renal cysts, 3 cases of renal tumors, 3 cases of nonfunctional kidneys, 2 cases of adrenal tumors, 1 case of bladder tumor, 1 case of prostate cancer, and 1 case of ureteral-bladder wall thickening with pelvic ureteral stones. The cohort included 7 male and 7 female patients, with an average age of (57.4±12.3) years, a BMI of (24.6±3.0) kg/m 2, and ASA classifications of grade Ⅱ in 9 cases and grade Ⅲ in 5 cases. All remote surgeries were successfully completed without the need for conversion to alternative surgical methods. Three renal cyst unroofing decompression procedures were performed, with an average console operation time of (32.0±6.6) minutes and intraoperative blood loss of (13.3±2.9) ml. Two partial nephrectomies were conducted, with console operation times of 140 and 160 minutes, intraoperative blood loss of 20 ml each, and warm ischemia times of 19 and 25 minutes, respectively. The preoperative estimated glomerular filtration rates (eGFR) for these cases were 115.2 and 107.3 ml/(min·1.73m 2), and postoperative eGFR were 102.0 and 95.5 ml/(min·1.73m 2), respectively. Four radical nephrectomies were completed, with an average console operation time of (50.2±13.7) minutes and intraoperative blood loss of (20.5±13.2) ml. Two adrenal tumor resections were performed, each with console operation times of 45 and 50 minutes and intraoperative blood loss of 10 ml. Additionally, one partial bladder resection was conducted, requiring a console operation time of 60 minutes and resulting in intraoperative blood loss of 10 ml. A single radical prostatectomy was carried out, with a console operation time of 180 minutes, intraoperative blood loss of 120 ml, and pre- and postoperative PSA levels of 11.7 ng/ml and 0.06 ng/ml, respectively. One ureteral-bladder reimplantation was also performed, with a console operation time of 240 minutes and intraoperative blood loss of 10 ml. The average total delay for the 14 remote surgeries ranged from 194 to 250 ms, while the average network transmission delay ranged from 13 to 55 ms. During the procedures, six instances of sudden large fluctuations in network transmission delay were observed, ranging from 333 to 654 ms. These fluctuations resolved automatically within approximately 10 seconds but resulted in temporary disruptions: 2 cases of master-slave console lock (reset process lasted around 5 seconds) and 1 case of switching to the local console for emergency hemostasis (lasting approximately 7 minutes). These interruptions did not significantly affect the surgical process. Postoperative complications in all patients were classified as Clavien-Dindo grade Ⅰ and were unrelated to the surgical procedures or equipment. No cancer was detected in the resection margins of malignant tumors. Follow-up evaluations at three months, including blood tests, liver and kidney function tests, and CT scans of the surgical sites, revealed no significant abnormalities or adverse events. Conclusions:5G communication technology, with an average total latency of less than 250 ms, enables domestic surgical robots to perform multi-procedural remote urological surgeries effectively. However, during procedures requiring extensive suturing for urological reconstruction or managing unplanned intraoperative bleeding, network latency fluctuations exceeding 333 ms can extend the operation time and may necessitate switching to local control for emergency hemostasis.

Objective To explore the similarities and differences in clinical efficacy and mRNA transcriptomics characteristics between acupuncture and shallow needling at non-acupoints and to provide a basis for determining whether shallow needling at non-acupoints is suitable as a sham acupuncture control in acupuncture clinical trials.Methods Eighty patients with chronic spontaneous urticaria(CSU)who visited the Dermatology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between July 8,2018 and to July 29,2019,were included.The patients were randomly divided into the acupuncture group(n=41)and the sham acupuncture group(n=39)using a computerized complete random design.Additionally,12 healthy individuals were included as the healthy control group.For patients in the acupuncture group,"Baihui(GV20),""Shenting(GV24),""Zhongwan(CV12),"and bilateral"Quchi(LI11),""Tianshu(ST25),""Xuehai(SP10),""Zusanli(ST36),"and"Sanyinjiao(SP6)"were selected for regular acupuncture.The sham acupuncture group received non-acupoint shallow needling at eight non-acupoints on the head,upper limbs,lower limbs,and abdomen.Both groups underwent daily treatment,with five consecutive days constituting one treatment course followed by a two-day interval.A total of two courses were administered.The urticaria activity score(UAS)was used to evaluate wheals and pruritus,whereas the visual analog scale(VAS)score was used to evaluate the degree of pruritus.Blinding effectiveness was also evaluated.Based on clinical evaluation and sample quality,serum samples from six patients in each treatment group before and after the intervention,along with those from six healthy individuals,were selected for RNA sequencing using the BGISEQ-500 sequencer.Differentially expressed mRNAs were identified using the"DEGseq"software package,and the similarities and differences in mRNA expression between the two groups were analyzed.Results UAS and VAS scores decreased in both groups at 1,2,3,and 4 weeks of treatment compared with before treatment(P＜0.01).The decrease in UAS and VAS scores in both groups was time-dependent(P＜0.01)but not related to the grouping or the interaction between grouping and time(P＞0.05).By the end of the second week of treatment,the number of patients in both groups who believed they had received true acupuncture was similar between the two groups,with no significant difference.mRNA transcriptomic sequencing revealed that,before and after treatment,the enrichment types and degrees of differentially expressed mRNA were similar between the acupuncture and sham acupuncture groups at the biological process,cellular component,and molecular function levels.In terms of biological processes,both groups were commonly enriched in coagulation,hematoma,oxygen transport,and gas transport.In terms of cellular components,both groups exhibited enrichment in hemoglobin complexes,platelet alpha granules,extracellular exosomes,extracellular organelles,and extracellular vesicles.At the molecular function level,both groups were commonly enriched in actin filament-binding substances,haptoglobin,peroxidase activity,and oxygen blood binding.In the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis,both groups showed common enrichment in multiple entries such as cytokine-cytokine receptor interaction,ECM-receptor interaction,microRNAs in cancer,proteoglycans in cancer,bladder cancer,and malaria.Conclusion Acupuncture and sham acupuncture exhibited similar clinical treatment effects and mRNA transcriptomics profiles.In the design of acupuncture clinical trials,disease specificity should be carefully considered.Sham acupuncture control using non-acupoint shallow needling may not be suitable for skin diseases such as urticaria.

Objective To explore the similarities and differences in clinical efficacy and mRNA transcriptomics characteristics between acupuncture and shallow needling at non-acupoints and to provide a basis for determining whether shallow needling at non-acupoints is suitable as a sham acupuncture control in acupuncture clinical trials.Methods Eighty patients with chronic spontaneous urticaria(CSU)who visited the Dermatology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between July 8,2018 and to July 29,2019,were included.The patients were randomly divided into the acupuncture group(n=41)and the sham acupuncture group(n=39)using a computerized complete random design.Additionally,12 healthy individuals were included as the healthy control group.For patients in the acupuncture group,"Baihui(GV20),""Shenting(GV24),""Zhongwan(CV12),"and bilateral"Quchi(LI11),""Tianshu(ST25),""Xuehai(SP10),""Zusanli(ST36),"and"Sanyinjiao(SP6)"were selected for regular acupuncture.The sham acupuncture group received non-acupoint shallow needling at eight non-acupoints on the head,upper limbs,lower limbs,and abdomen.Both groups underwent daily treatment,with five consecutive days constituting one treatment course followed by a two-day interval.A total of two courses were administered.The urticaria activity score(UAS)was used to evaluate wheals and pruritus,whereas the visual analog scale(VAS)score was used to evaluate the degree of pruritus.Blinding effectiveness was also evaluated.Based on clinical evaluation and sample quality,serum samples from six patients in each treatment group before and after the intervention,along with those from six healthy individuals,were selected for RNA sequencing using the BGISEQ-500 sequencer.Differentially expressed mRNAs were identified using the"DEGseq"software package,and the similarities and differences in mRNA expression between the two groups were analyzed.Results UAS and VAS scores decreased in both groups at 1,2,3,and 4 weeks of treatment compared with before treatment(P＜0.01).The decrease in UAS and VAS scores in both groups was time-dependent(P＜0.01)but not related to the grouping or the interaction between grouping and time(P＞0.05).By the end of the second week of treatment,the number of patients in both groups who believed they had received true acupuncture was similar between the two groups,with no significant difference.mRNA transcriptomic sequencing revealed that,before and after treatment,the enrichment types and degrees of differentially expressed mRNA were similar between the acupuncture and sham acupuncture groups at the biological process,cellular component,and molecular function levels.In terms of biological processes,both groups were commonly enriched in coagulation,hematoma,oxygen transport,and gas transport.In terms of cellular components,both groups exhibited enrichment in hemoglobin complexes,platelet alpha granules,extracellular exosomes,extracellular organelles,and extracellular vesicles.At the molecular function level,both groups were commonly enriched in actin filament-binding substances,haptoglobin,peroxidase activity,and oxygen blood binding.In the Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis,both groups showed common enrichment in multiple entries such as cytokine-cytokine receptor interaction,ECM-receptor interaction,microRNAs in cancer,proteoglycans in cancer,bladder cancer,and malaria.Conclusion Acupuncture and sham acupuncture exhibited similar clinical treatment effects and mRNA transcriptomics profiles.In the design of acupuncture clinical trials,disease specificity should be carefully considered.Sham acupuncture control using non-acupoint shallow needling may not be suitable for skin diseases such as urticaria.

Objective:To evaluate the feasibility and safety of performing multi-procedure remote urological surgeries by integrating 5G communication technology with domestically manufactured robotic surgical systems.Methods:Patients requiring urological laparoscopic surgery for benign lesions or tumors were prospectively enrolled at Gansu Provincial Hospital from May 2023 to June 2024. Inclusion criteria included age ≥18 years, body mass index (BMI) between 18 and 30 kg/m 2, and American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅲ. Tumor-related surgical indicators were as follows: renal tumors staged ≤T 2, solitary tumors, or maximum diameter ≤10 cm; intermediate- to low-risk prostate cancer (clinical stage ≤T 2b), with preoperative prostate-specific antigen (PSA) ≤20 ng/ml or Gleason score ≤7; adrenal tumors with a diameter ≤7 cm or ≥3 cm for non-functional adenomas; and bladder tumors staged ≤T 2. Exclusion criteria included participation in other investigational drug or device clinical trials within the past 1 month, pregnancy or breastfeeding, and patients requiring emergency surgery. Patients with severe cardiovascular or circulatory diseases contraindicating surgery, and individuals with epilepsy, psychiatric disorders, or cognitive impairments were also excluded. Additionally, patients with active bleeding, coagulation disorders, or platelet counts <80×10 9/L were excluded. A 5G communication link was established between the main campus and the new branch of Gansu Provincial Hospital, approximately 70 km apart. Remote surgeries were performed using the domestically manufactured robotic surgical system (Toumai MT-1000). Perioperative key indicators, intraoperative network conditions, and robotic system performance were systematically recorded. Results:This study involved 14 patients, comprising 3 cases of renal cysts, 3 cases of renal tumors, 3 cases of nonfunctional kidneys, 2 cases of adrenal tumors, 1 case of bladder tumor, 1 case of prostate cancer, and 1 case of ureteral-bladder wall thickening with pelvic ureteral stones. The cohort included 7 male and 7 female patients, with an average age of (57.4±12.3) years, a BMI of (24.6±3.0) kg/m 2, and ASA classifications of grade Ⅱ in 9 cases and grade Ⅲ in 5 cases. All remote surgeries were successfully completed without the need for conversion to alternative surgical methods. Three renal cyst unroofing decompression procedures were performed, with an average console operation time of (32.0±6.6) minutes and intraoperative blood loss of (13.3±2.9) ml. Two partial nephrectomies were conducted, with console operation times of 140 and 160 minutes, intraoperative blood loss of 20 ml each, and warm ischemia times of 19 and 25 minutes, respectively. The preoperative estimated glomerular filtration rates (eGFR) for these cases were 115.2 and 107.3 ml/(min·1.73m 2), and postoperative eGFR were 102.0 and 95.5 ml/(min·1.73m 2), respectively. Four radical nephrectomies were completed, with an average console operation time of (50.2±13.7) minutes and intraoperative blood loss of (20.5±13.2) ml. Two adrenal tumor resections were performed, each with console operation times of 45 and 50 minutes and intraoperative blood loss of 10 ml. Additionally, one partial bladder resection was conducted, requiring a console operation time of 60 minutes and resulting in intraoperative blood loss of 10 ml. A single radical prostatectomy was carried out, with a console operation time of 180 minutes, intraoperative blood loss of 120 ml, and pre- and postoperative PSA levels of 11.7 ng/ml and 0.06 ng/ml, respectively. One ureteral-bladder reimplantation was also performed, with a console operation time of 240 minutes and intraoperative blood loss of 10 ml. The average total delay for the 14 remote surgeries ranged from 194 to 250 ms, while the average network transmission delay ranged from 13 to 55 ms. During the procedures, six instances of sudden large fluctuations in network transmission delay were observed, ranging from 333 to 654 ms. These fluctuations resolved automatically within approximately 10 seconds but resulted in temporary disruptions: 2 cases of master-slave console lock (reset process lasted around 5 seconds) and 1 case of switching to the local console for emergency hemostasis (lasting approximately 7 minutes). These interruptions did not significantly affect the surgical process. Postoperative complications in all patients were classified as Clavien-Dindo grade Ⅰ and were unrelated to the surgical procedures or equipment. No cancer was detected in the resection margins of malignant tumors. Follow-up evaluations at three months, including blood tests, liver and kidney function tests, and CT scans of the surgical sites, revealed no significant abnormalities or adverse events. Conclusions:5G communication technology, with an average total latency of less than 250 ms, enables domestic surgical robots to perform multi-procedural remote urological surgeries effectively. However, during procedures requiring extensive suturing for urological reconstruction or managing unplanned intraoperative bleeding, network latency fluctuations exceeding 333 ms can extend the operation time and may necessitate switching to local control for emergency hemostasis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Myocardial fibrosis （MF） is a prevalent pathological process in a spectrum of cardiac conditions， including myocardial infarction， hypertensive heart disease， and dilated cardiomyopathy. It is marked by an overabundance of extracellular matrix deposition， diminished myocardial compliance， and impaired cardiac function， which can lead to arrhythmias and sudden cardiac death. The current therapeutic approach primarily aims to suppress the progression of fibrosis， yet the therapeutic outcomes are poor. The pathogenesis of MF involves multiple signaling pathways， including the transforming growth factor-beta （TGF-β）/Smads signaling pathway， nuclear factor-kappa B （NF-κB） signaling pathway， phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， and mitogen-activated protein kinase （MAPK） signaling pathway. Traditional Chinese medicine （TCM） boasts a rich history in the treatment of cardiovascular diseases， offering distinctive benefits such as minimal side effects and high safety， and it has demonstrated promising therapeutic effects in the treatment of MF. In recent years， research has turned its attention to the application of TCM in modulating the signaling pathways associated with MF. It has been demonstrated that TCM can modulate the MF-related signaling pathways to exert anti-inflammatory effects， regulate cellular autophagy， cell proliferation， and apoptosis， reduce myocardial oxidative stress and damage， and inhibit the activation of fibroblasts and collagen synthesis， thereby exhibiting the potential to mitigate or even reverse the progression of MF. Experimental research and clinical observations indicate that TCM formulas such as Yixin Futing decoction， Luhong prescription， Zhilong Huoxue Tongyu capsules， and Kangjian Yixin prescription can effectively ameliorate MF and enhance cardiac function through the multi-component regulation of multiple cellular pathways. Specific TCM constituents， including isoliquiritigenin and astragaloside， have been shown to inhibit the expression of TGF-β₁， thereby disrupting the Smad signaling pathway. Compounds like glycyrrhizic acid and allicin can suppress the NF-κB signaling pathway and curtail collagen synthesis in myocardial cells， and forsythoside can activate the PI3K/Akt signaling pathway， contributing to its anti-fibrotic effects.

Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Here we report the diagnosis and treatment of a rare IgG4-related kidney disease with nephrotic syndrome as the first manifestation. A 62-year-old male patient, presented with edema in both lower limbs and foam urine, had a history of "lung malignant tumor with brain and lymph node metastasis". The increase of IgG4 and decrease of glomerular filtration rate were detected at admission, and the pathological consideration of renal biopsy was membranous nephropathy with IgG4-related tubulointerstitial nephritis. After the combination of low-dose glucocorticoids therapy and rituximab treatment, the patient showed good prognosis in a 9 month follow-up.