As the central metabolic organ, the liver coordinates fundamental biological processes through its specialized cellular architecture and regulatory networks, encompassing metabolism, immunity, and regeneration. Kupffer cells (KCs), the liver-resident macrophages, exhibit functional heterogeneity beyond classical polarization paradigms. Currently, multiple classification systems for KCs have been established utilizing distinct surface markers. However, there is no systematic theoretical framework for the classification of KCs. The strategic positioning of KCs within the hepatic Disse space enables intricate intercellular communication networks with neighboring hepatocytes for coordinated physiological regulation. Their functional plasticity critically regulates systemic iron and metabolic homeostasis, with KC-driven metabolic reprogramming directly influencing hepatic pathophysiology. Furtherly, KC activity shows spatiotemporal regulation by circadian rhythms and nutrient signals, reshaping the liver microenvironment to affect function. This review summarizes advances in liver macrophage biology, highlighting the classification challenges of KCs and their roles in hepatic physiology. Additionally, we discuss how circadian rhythms, aging, diet, and exercise dynamically influence KC functionality, which provides a framework to interpret their regulatory logic and dysfunction in disease.

Objective To observe hierarchical differences in brain functional networks in unilateral mesial temporal lobe epilepsy(mTLE)patients with different outcomes after surgery.Methods A total of 69 unilateral mTLE patients who underwent resection of epileptogenic lesion on the affected side were retrospectively enrolled.Based on Engel classification 1 year after surgery,the patients were divided into seizure free(SF)group and non-seizure free(NSF)group.Functional connectivity gradient analysis was employed to extract principal gradient explaining the highest variance on preoperative resting-state functional MRI(rs-fMRI),then the whole-brain gradient characteristics and principal gradient values within specific functional networks were compared between groups.Results Principal gradient connected default mode network(DMN)with sensorimotor network(SMN)along a continuous axis.Compared to SF group,NSF group showed a contracted gradient range at both ends(DMN and SMN)of the functional network and weakened hierarchical differentiation,and principal gradient value of DMN was higher,while that of SMN was lower than those in SF group(both P＜0.05).Conclusion Hierarchical differences in brain functional networks in unilateral mTLE patients with different outcomes after surgery mainly present as enhanced DMN and weakened SMN in NSF ones,and the latter two might serve as important neuroimaging markers for evaluating postoperative seizure recurrence.

BACKGROUND: China has made significant progress in medical accessibility and quality over the past decades, and quality improvements in gastroenterology and digestive endoscopy have been consistent. The study aimed to describe the status quo of gastroenterology and digestive endoscopy in the Chinese mainland based on the data from the National Clinical Improvement System (NCIS) and the Hospital Quality Monitoring System (HQMS). METHODS: Data were extracted from the NCIS and the HQMS. Data analysis included general information from the Department of Gastroenterology and Endoscopy centers, management of inpatients and outpatients, and annual volume and quality indicators of digestive endoscopy. Acute pancreatitis, gastrointestinal bleeding, inflammatory bowel disease, and cirrhosis were identified as priority diseases and were subjected to detailed analysis. RESULTS: Data from 4620 and 7074 hospitals were extracted from the NCIS and HQMS, respectively. In 2023, 9.6 gastroenterologists, 6.7 endoscopists, and 37.3 gastroenterology beds per hospital nationwide were observed, achieving 19,252.4 outpatient visits, 1615.2 hospitalizations (97.0 for acute pancreatitis, 146.1 for gastrointestinal bleeding, 40.2 for inflammatory bowel disease, and 111.4 for cirrhosis), and 9432.7 digestive endoscopic procedures per hospital. Overall, the quality of practice improved significantly. The proportion of early cancer among gastrointestinal cancers increased from 11.1% in 2015 to 23.4% in 2023, and the adenoma detection rate during colonoscopy increased from 19.3% in 2019 to 26.9% in 2023. Regarding priority diseases, hospitalizations increased, and 31-day unplanned readmission rates decreased between 2019 and 2023. The median hospitalization costs and median proportion of medication costs decreased for acute pancreatitis, gastrointestinal bleeding, and cirrhosis. However, it increased for inflammatory bowel disease. CONCLUSION This report evaluates the status quo and development of gastroenterology and digestive endoscopy in the Chinese mainland, providing guidance for future quality improvements.
Humans ; China ; Gastroenterology/statistics & numerical data* ; Gastrointestinal Hemorrhage ; Endoscopy, Gastrointestinal/statistics & numerical data* ; Endoscopy, Digestive System/statistics & numerical data*

Objective To investigate the relationship between serum peroxiredoxin 6(PRDX6)and annexin A1(ANXA1)levels and the severity and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)compli-cated with type II respiratory failure.Methods A total of 257 patients with AECOPD complicated with type II respiratory failure(respiratory failure group),130 patients with stable COPD(stable COPD group)and 130 healthy subjects(control group)were selected from the Panzhihua University Affiliated Hospital from December 2021 to December 2023.According to the oxygenation index,AECOPD patients with type II respiratory failure were divided into mild respiratory failure group(n=101),moderate respi-ratory failure group(n=80)and severe respiratory failure group(n=76).According to the 28-day prognosis,they were divided into death group(n=62)and survival group(n=195).Serum PRDX6 and ANXA1 levels were detected by enzyme-linked immu-nosorbent assay(ELISA).The correlation between serum PRDX6,ANXA1 levels and oxygenation index in AECOPD patients with type II respiratory failure was analyzed by Spearman correlation coefficient.Multivariate Logistic regression model was used to analyze the influencing factors of poor prognosis in patients with AECOPD complicated with type II respiratory fail-ure,and receiver iperating characteristic(ROC)curve was drawn to evaluate the predictive value of serum PRDX6 and ANXA1.Results The serum PRDX6 level in the respiratory failure group(41.54±4.28 pg/ml)was lower than that in the stable COPD group(61.38±4.94 pg/ml)and the control group(80.65±8.93 pg/ml),and the ANXA1 level(3.35±0.69 μg/L)was higher than that in the stable COPD group(2.13±0.61 μg/L)and the control group(1.03±0.14 μg/L),the differences were statistically sig-nificant(t=-33.894～21.727,all P<0.001).The serum level of PRDX6 in severe respiratory failure group(34.54±5.05 pg/ml)was lower than that in moderate respiratory failure group(43.90±4.72 pg/ml)and mild respiratory failure group(54.28±6.34 pg/ml),the serum level of ANXA1 in severe respiratory failure group(3.94±0.43 μg/L)was higher than that in moderate respi-ratory failure group(3.57±0.46 μg/L)and mild respiratory failure group(2.70±0.43 μg/L),the differences were statistically sig-nificant(t=-19.018～22.338,all P<0.001).Oxygen index was positively correlated with serum PRDX6(r=0.815,P<0.001)and negatively correlated with ANXA1(r=-0.781,P<0.001)in AECOPD patients with type II respiratory failure.The mortality rate of 257 AECOPD patients with type II respiratory failure was 24.12%(62/257)after 28 days of follow-up.Increase forced expi-ratory volume in the first second(FEV1)as a percentage of the predicted value,increased oxygenation index and increased PRDX6 were independent protective factors for the poor prognosis of AECOPD patients with type II respiratory failure(Wald χ2=-0.154,-0.014,-0.173,all P<0.05),increased ANXA1 was an independent risk factor(Wald χ2=0.250,P<0.05).The area un-der the curve of serum PRDX6 and ANXA1 combined to predict the poor prognosis of AECOPD patients with type II respiratory failure was 0.906,which was greater than 0.788 and 0.781 predicted by the two indicators alone,and the differences were statisti-cally significant(Z=4.243,4.224,all P<0.001).Conclusion The decrease of serum PRDX6 level and the increase of ANXA1 level are related to the aggravation and poor prognosis of AECOPD patients with type II respiratory failure.The value of serum PRDX6 combined with ANXA1 in predicting the prognosis of AECOPD patients with type II respiratory failure is high.

Objective To observe hierarchical differences in brain functional networks in unilateral mesial temporal lobe epilepsy(mTLE)patients with different outcomes after surgery.Methods A total of 69 unilateral mTLE patients who underwent resection of epileptogenic lesion on the affected side were retrospectively enrolled.Based on Engel classification 1 year after surgery,the patients were divided into seizure free(SF)group and non-seizure free(NSF)group.Functional connectivity gradient analysis was employed to extract principal gradient explaining the highest variance on preoperative resting-state functional MRI(rs-fMRI),then the whole-brain gradient characteristics and principal gradient values within specific functional networks were compared between groups.Results Principal gradient connected default mode network(DMN)with sensorimotor network(SMN)along a continuous axis.Compared to SF group,NSF group showed a contracted gradient range at both ends(DMN and SMN)of the functional network and weakened hierarchical differentiation,and principal gradient value of DMN was higher,while that of SMN was lower than those in SF group(both P＜0.05).Conclusion Hierarchical differences in brain functional networks in unilateral mTLE patients with different outcomes after surgery mainly present as enhanced DMN and weakened SMN in NSF ones,and the latter two might serve as important neuroimaging markers for evaluating postoperative seizure recurrence.

Objective:To screen the evidence related to perioperative pain management in thoracic surgery and summarize the best evidence, so as to provide evidence-based basis for clinical nursing practice.Methods:Databases such as Cochrane Library, International Association for the Study of Pain, American Pain Society, Wanfang Database, and China National Knowledge Infrastructure were systematically searched for guidelines, clinical decisions, evidence summaries, best practices, systematic reviews, and expert consensus related to perioperative pain management in thoracic surgery patients. The retrieval time limit was from the establishment of the database to December 31, 2023. Two researchers conducted quality evaluation and evidence extraction.Results:A total of 12 articles were included, including 6 guidelines, 4 systematic reviews, and 2 expert consensuses. Thirty pieces of evidence covering six aspects including organizational management, planning, education, assessment, implementation, and evaluation were summarized.Conclusions:The best evidence summarized in this study can provide evidence-based basis for standardizing the perioperative pain management of thoracic surgery patients.

Objective To investigate the relationship between serum peroxiredoxin 6(PRDX6)and annexin A1(ANXA1)levels and the severity and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)compli-cated with type II respiratory failure.Methods A total of 257 patients with AECOPD complicated with type II respiratory failure(respiratory failure group),130 patients with stable COPD(stable COPD group)and 130 healthy subjects(control group)were selected from the Panzhihua University Affiliated Hospital from December 2021 to December 2023.According to the oxygenation index,AECOPD patients with type II respiratory failure were divided into mild respiratory failure group(n=101),moderate respi-ratory failure group(n=80)and severe respiratory failure group(n=76).According to the 28-day prognosis,they were divided into death group(n=62)and survival group(n=195).Serum PRDX6 and ANXA1 levels were detected by enzyme-linked immu-nosorbent assay(ELISA).The correlation between serum PRDX6,ANXA1 levels and oxygenation index in AECOPD patients with type II respiratory failure was analyzed by Spearman correlation coefficient.Multivariate Logistic regression model was used to analyze the influencing factors of poor prognosis in patients with AECOPD complicated with type II respiratory fail-ure,and receiver iperating characteristic(ROC)curve was drawn to evaluate the predictive value of serum PRDX6 and ANXA1.Results The serum PRDX6 level in the respiratory failure group(41.54±4.28 pg/ml)was lower than that in the stable COPD group(61.38±4.94 pg/ml)and the control group(80.65±8.93 pg/ml),and the ANXA1 level(3.35±0.69 μg/L)was higher than that in the stable COPD group(2.13±0.61 μg/L)and the control group(1.03±0.14 μg/L),the differences were statistically sig-nificant(t=-33.894～21.727,all P<0.001).The serum level of PRDX6 in severe respiratory failure group(34.54±5.05 pg/ml)was lower than that in moderate respiratory failure group(43.90±4.72 pg/ml)and mild respiratory failure group(54.28±6.34 pg/ml),the serum level of ANXA1 in severe respiratory failure group(3.94±0.43 μg/L)was higher than that in moderate respi-ratory failure group(3.57±0.46 μg/L)and mild respiratory failure group(2.70±0.43 μg/L),the differences were statistically sig-nificant(t=-19.018～22.338,all P<0.001).Oxygen index was positively correlated with serum PRDX6(r=0.815,P<0.001)and negatively correlated with ANXA1(r=-0.781,P<0.001)in AECOPD patients with type II respiratory failure.The mortality rate of 257 AECOPD patients with type II respiratory failure was 24.12%(62/257)after 28 days of follow-up.Increase forced expi-ratory volume in the first second(FEV1)as a percentage of the predicted value,increased oxygenation index and increased PRDX6 were independent protective factors for the poor prognosis of AECOPD patients with type II respiratory failure(Wald χ2=-0.154,-0.014,-0.173,all P<0.05),increased ANXA1 was an independent risk factor(Wald χ2=0.250,P<0.05).The area un-der the curve of serum PRDX6 and ANXA1 combined to predict the poor prognosis of AECOPD patients with type II respiratory failure was 0.906,which was greater than 0.788 and 0.781 predicted by the two indicators alone,and the differences were statisti-cally significant(Z=4.243,4.224,all P<0.001).Conclusion The decrease of serum PRDX6 level and the increase of ANXA1 level are related to the aggravation and poor prognosis of AECOPD patients with type II respiratory failure.The value of serum PRDX6 combined with ANXA1 in predicting the prognosis of AECOPD patients with type II respiratory failure is high.

Objective:To screen the evidence related to perioperative pain management in thoracic surgery and summarize the best evidence, so as to provide evidence-based basis for clinical nursing practice.Methods:Databases such as Cochrane Library, International Association for the Study of Pain, American Pain Society, Wanfang Database, and China National Knowledge Infrastructure were systematically searched for guidelines, clinical decisions, evidence summaries, best practices, systematic reviews, and expert consensus related to perioperative pain management in thoracic surgery patients. The retrieval time limit was from the establishment of the database to December 31, 2023. Two researchers conducted quality evaluation and evidence extraction.Results:A total of 12 articles were included, including 6 guidelines, 4 systematic reviews, and 2 expert consensuses. Thirty pieces of evidence covering six aspects including organizational management, planning, education, assessment, implementation, and evaluation were summarized.Conclusions:The best evidence summarized in this study can provide evidence-based basis for standardizing the perioperative pain management of thoracic surgery patients.

AIM:To explore the synergistic sensitization effect of human umbilical cord mesenchymal stem cell culture supernatant(hUMSC-CM)combined with temozolomide(TMZ)on various glioma cell lines,and to elucidate the underlying mechanisms.METHODS:The hUMSC-CM was harvested using two different serum deprivation tech-niques at 24 and 48 h,and was converted into freeze-dried powder,which was then given to rat malignant glioma cell line RG-2,human astrocytoma cell line U251 and human glioblastoma cell line LN-428 at 5 concentrations(0,1,3,6 and 9 g/L).The effectiveness and sensitivity of hUMSC-CM for inhibiting growth of glioma cells at 24,48 and 72 h were as-sessed using CCK-8 assay.Hematoxylin-eosin(HE)staining combined with CCK-8 assay was employed to evaluate the chemotherapy sensitivity of glioma cells after 48 h of treatment with TMZ at 6 concentrations(0,25,50,100,200 and 400 μmol/L).Two concentrations(3 and 9 g/L)of hUMSC-CM and 3 concentrations(50,100 and 200 μmol/L)of TMZ were chosen for concurrent treatment of glioma cells to assess the proliferation and pathological alterations.TUNEL staining was utilized to detect apoptosis.Flow cytometry was utilized to analyze cell cycle modifications.The expression alterations of apoptosis-inducing proteins,cleaved caspase-3,cleaved caspase-8 and cleaved PARP1,as well as autophagy-inducing proteins beclin-1 and LC3,were examined using Western blot to investigate the synergistic sensitization mechanism of hUMSC-CM combined with TMZ in vitro.RESULTS:The susceptibility of glioma cell lines to hUMSC-CM and TMZ varied,with RG-2 showing the highest sensitivity,followed by U251,and then LN-428.The inhibitory effect of hUMSC-CM(3 and 9 g/L)and TMZ(50,100 and 200 μmol/L)combined treatment on glioma cells was significantly greater than that that of single-agent treatments(P＜0.05),demonstrating a dose-and concentration-dependent enhancement.Notably,the combination of 9 g/L hUMSC-CM(C9)with 50 μmol/L TMZ(T50)effectively suppressed glioma cell growth.CCK-8 as-say indicated a significant reduction of cell viability in C9+T50 group compared with either C9 or T50 alone(P＜0.05).HE staining and TUNEL staining revealed pronounced morphological changes and significant apoptotic features in glioma cells treated with C9+T50.Flow cytometric analysis confirmed that C9+T50 induced cell cycle arrest in glioma cells.Fur-thermore,compared with control group,the levels of cleaved caspase-3,cleaved caspase-8,cleaved PARP1,beclin-1,and LC3-Ⅱ/LC3-Ⅰ were significantly elevated in the C9+T50-treated glioma cells(P＜0.01).CONCLUSION:(1)The concomitant administration of hUMSC-CM and TMZ exerts a broad inhibitory effect on glioma cells,with a synergistic sen-sitization observed across different cell lines.(2)The enhancement of glioma cell sensitivity to TMZ by hUMSC-CM may be attributed to the modulation of caspase-8/caspase-3/PARP1 signaling pathway and the induction of both apoptosis and autophagy in glioma cells.

Artificial intelligence (AI) has important significance and great promise in the pathological diagnosis,imaging diagnosis,prognosis prediction,and molecular subtyping of prostate cancer (PCa). This review focuses on the progress of AI for the diagnosis and molecular classification of PCa,and briefly introduces the application of AI in the pathological diagnosis of needle biopsy and Gleason grading,pathological diagnosis and grading after prostatectomy,and prognosis prediction of PCa patients based on pathological sections. For the pathological diagnosis of needle biopsy and Gleason grading,AI has already comparable to general pathologists;for the pathological diagnosis and grading after prostatectomy,AI can accurately grade and classify tumors;and for the prognosis prediction of PCa patients,AI can directly extract relevant prognostic information from pathological tissue sections for prognosis prediction. In addition,AI can also predict gene mutations in PCa patients and suggest the probability of gene mutation by analyzing the pathological sections.