Parkinson's disease （PD） is a complex neurodegenerative disease involving multiple systems and neurotransmitters. Due to the high clinical heterogeneity of PD，it is urgent to establish a comprehensive and long-term traditional Chinese medicine （TCM） management model. In this paper，the conceptual framework of full-cycle management of PD is preliminarily constructed：based on the evolution of the pathophysiological mechanisms of protein deposition and neurotransmitter disorder in PD，the three-stage syndrome characteristics of the prodromal stage （predominant healthy Qi with subtle pathogenic factors），the early clinical stage （declining healthy Qi with growing pathogenic factors） and the middle and late stages （overwhelming pathogenic factors with deficient healthy Qi） are longitudinally described. Through the syndrome differentiation of visceral manifestations，the etiology and pathogenesis of PD motor and non-motor symptoms were comprehensively analyzed，while the matching treatment methods and prescriptions were inferred，and the modular scheme of the combining main symptoms，accompanying symptoms and secondary symptoms was proposed. The conceptual gap of TCM regarding motor complications （'variable syndrome'） and PD-related hyperpyrexia syndrome （'critical syndrome'） was explained. This framework reflects the characteristics of combination of disease and syndrome and overall constant motion，and provides new theories and research ideas for individualized and whole-process management of PD in TCM.

Parkinson's disease （PD） is a complex neurodegenerative disease involving multiple systems and neurotransmitters. Due to the high clinical heterogeneity of PD，it is urgent to establish a comprehensive and long-term traditional Chinese medicine （TCM） management model. In this paper，the conceptual framework of full-cycle management of PD is preliminarily constructed：based on the evolution of the pathophysiological mechanisms of protein deposition and neurotransmitter disorder in PD，the three-stage syndrome characteristics of the prodromal stage （predominant healthy Qi with subtle pathogenic factors），the early clinical stage （declining healthy Qi with growing pathogenic factors） and the middle and late stages （overwhelming pathogenic factors with deficient healthy Qi） are longitudinally described. Through the syndrome differentiation of visceral manifestations，the etiology and pathogenesis of PD motor and non-motor symptoms were comprehensively analyzed，while the matching treatment methods and prescriptions were inferred，and the modular scheme of the combining main symptoms，accompanying symptoms and secondary symptoms was proposed. The conceptual gap of TCM regarding motor complications （'variable syndrome'） and PD-related hyperpyrexia syndrome （'critical syndrome'） was explained. This framework reflects the characteristics of combination of disease and syndrome and overall constant motion，and provides new theories and research ideas for individualized and whole-process management of PD in TCM.

Chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) are both chronic progressive respiratory diseases that cannot be completely cured. COPD is characterized by irreversible airflow limitation, chronic airway inflammation, and gradual decline in lung function, whereas PH is characterized by pulmonary vasoconstriction, remodeling, and infiltration of inflammatory cells. These diseases have similar pathological features, such as vascular hyperplasia, arteriolar contraction, and inflammatory infiltration. Despite these well-documented observations, the exact mechanisms underlying the occurrence and development of COPD and PH remain unclear. Evidence that mitochondrial dynamics imbalance is one major factor in the development of COPD and PH. Mitochondrial dynamics is precisely regulated by mitochondrial fusion proteins and fission proteins. When mitochondrial dynamics equilibrium is disrupted, it causes mitochondrial and even cell morphological dysfunction. Mitochondrial dynamics participates in various pathological processes for heart and lung disease. Mitochondrial dynamics may be different in the early and late stages of COPD and PH. In the early stages of the disease, mitochondrial fusion increases, inhibiting fission, and thereby compensatorily increasing adenosine triphosphate (ATP) production. With the development of the disease, mitochondria decompensation causes excessive fission. Mitochondrial dynamics is involved in the development of COPD and PH in a spatiotemporal manner. Based on this understanding, treatment strategies for mitochondrial dynamics abnormalities may be different at different stages of COPD and PH disease. This article will provide new ideas for the potential treatment of related diseases.
Humans ; Mitochondrial Dynamics/physiology* ; Pulmonary Disease, Chronic Obstructive/metabolism* ; Hypertension, Pulmonary/metabolism* ; Mitochondria/metabolism* ; Animals

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective:To evaluate the efficacy of eculizumab in treating hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) .Methods:This retrospective study included 11 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation and subsequently received eculizumab treatment at Peking University People′s Hospital between June 2018 and May 2024. The incidence of TA-TMA, treatment details, and clinical outcomes were analyzed.Results:Among the 11 included patients [4 males, 7 females; median age: 29 years (range: 9-56) ], underlying diseases were severe aplastic anemia (SAA) in 5 patients, acute lymphoblastic leukemia (ALL) in 3 patients, and acute myeloid leukemia (AML) in 3 patients. The median time to TA-TMA diagnosis was 48 days post-transplantation (range: 4-213 days), and all patients met the diagnostic criteria for high-risk TA-TMA. The median interval from TA-TMA diagnosis to the initiation of eculizumab treatment was 12 days (range: 1-56 days). Patients received a median of 3 doses of eculizumab (range: 1-14). Ten of the 11 patients were assessed as having no response (NR) to eculizumab at the end of treatment or at death. One patient achieved a partial response (PR) but subsequently died after TA-TMA relapsed due to infection. At the last follow-up, all patients were either lost to follow-up or had died. The median follow-up duration was 88 days (range: 33-326 days), and the median time from TA-TMA diagnosis to the last follow-up was 31 days (range: 21-113 days) .Conclusion:Eculizumab demonstrated poor efficacy in this TA-TMA cohort. This might be attributable to the critical and complex condition of the patients, delayed initiation of eculizumab treatment, and insufficient dosage.

Obstructive sleep apnea (OSA) is a common sleep disorder that is closely associated with ocular fundus diseases such as glaucomatous optic neuropathy, nonarteritic anterior ischemic optic neuropathy, diabetic retinopathy, central serous chorioretinopathy and retinal vein occlusion.The main mechanisms by which OSA affects fundus diseases include intermittent hypoxia, activation of sympathetic nervous system, systemic oxidative stress, and inflammatory response, but the specific mechanisms require further investigation.The therapeutic modality such as continuous positive airway pressure can alleviate the symptoms of ocular fundus diseases in the patients with OSA and reduce the risk of disease progression.Therefore, clinicians should recognize the relationship between OSA and fundus diseases, understand the impact of OSA on these diseases, and achieve early diagnosis and treatment of the OSA-associated fundus diseases to reduce the risk of severe visual impairment and blindness.

Obstructive sleep apnea (OSA) is a common sleep disorder that is closely associated with ocular fundus diseases such as glaucomatous optic neuropathy, nonarteritic anterior ischemic optic neuropathy, diabetic retinopathy, central serous chorioretinopathy and retinal vein occlusion.The main mechanisms by which OSA affects fundus diseases include intermittent hypoxia, activation of sympathetic nervous system, systemic oxidative stress, and inflammatory response, but the specific mechanisms require further investigation.The therapeutic modality such as continuous positive airway pressure can alleviate the symptoms of ocular fundus diseases in the patients with OSA and reduce the risk of disease progression.Therefore, clinicians should recognize the relationship between OSA and fundus diseases, understand the impact of OSA on these diseases, and achieve early diagnosis and treatment of the OSA-associated fundus diseases to reduce the risk of severe visual impairment and blindness.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

With the rapid development of artificial intelligence (AI) technology, its applica-tion in diagnosis and treatment of colorectal cancer (CRC) has deepened, covering preoperative diagnosis, surgical assistance, and prognostic evaluation. AI can accurately detect precancerous lesions and tumor characteristics during screening of CRC, improving diagnostic precision.During surgery, AI provides real-time feedback and navigation support, helping surgeons improve precision and reduce complications. After surgery, AI integrates multidimensional data to optimize treatment decisions and resource allocation. However, current AI models still face challenges in accuracy, generalization, and integration with existing medical systems, and societal issues such as privacy and ethics need to be addressed. With ongoing technological advancements, AI is expected to play a greater role in minimally invasive surgeries for CRC, particularly in robotic surgery, offering more precise and personalized treatment options in the future. The authors summarize application and prospect of artificial intelligence in minimally invasive treatment of colorectal cancer, aiming to provide references for clinical practice.

Objectives:To compare the efficacy of unilateral biportal endoscopy(UBE)versus percutaneous endoscopy(PE)for treating cervical spondylotic radiculopathy(CSR)using meta-analysis.Methods:A compre-hensive search was conducted in PubMed,Embase,Cochrane Library,Web of Science,China National Knowl-edge Infrastructure(CNKI),Wanfang Database,and China Biomedical Literature Database for studies published since their inceptions up to June 2025 that reported clinical outcomes and complications of UBE and PE in the treatment of CSR.The Cochrane Risk of Bias tool was used to assess randomized controlled trials,while the Newcastle-Ottawa scale(NOS)was applied to evaluate retrospective studies.Outcome indicators were ex-tracted including visual analogue scale(VAS)scores for neck and upper limb pain,neck disability index(NDI),operative time,intraoperative blood loss,length of hospital stay,incision size,preoperative and postoperative serum creatine kinase(CK)and C-reactive protein(CRP)levels,and postoperative complications.Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 10 literatures were included,all of which were retrospective studies,and six studies were 8 points of NOS scores,three studies were 7 points,and one study was 6 point,indicating moderate to high quality.The total sample comprised 782 patients(UBE:n=388;PE:n=394).Meta-analysis revealed no significant difference in operative time between groups[MD=-6.67,95％CI(-17.47,4.13),P=0.23].Intraoperative blood loss was significantly lower in the PE group[MD=10.86,95％CI(0.64,21.07),P=0.04].No significant difference was observed in postoperative length of hospital stay[MD=0.49,95％CI(-0.00,0.99),P=0.05].Incision size was significantly smaller in the PE group[MD=7.13,95％CI(1.76,12.50),P=0.009].There were no significant intergroup differences in postoperative CK[MD=1.25,95％CI(-5.08,7.75),P=0.70]or CRP levels[MD=-0.03,95％CI(-0.08,0.02),P=0.23].There was no significant difference in neck pain VAS scores at various timepoints between the two groups[MD=-0.07,95％CI(-0.17,0.04),P=0.20].However,the UBE group was significantly lower in upper limb pain VAS scores at 3 months postoperatively[MD=-0.14,95％CI(-0.26,-0.01),P=0.03].No significant differences were found in NDI scores across follow-up periods[MD=-0.24,95％CI(-0.50,0.02),P=0.07]or in complication rates[OR=1.02,95％CI(0.51,2.03),P=0.95].Conclusions:Both UBE and PE operations are effective and safe in the treatment of CSR.The PE technique is associated with less intraoperative blood loss and smaller incisions,while UBE provides superior improvement in upper limb pain at the 3-month follow-up.