Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide. Coupled with the substantial workload, the clinical management of lung cancer is challenged by the critical need to efficiently and accurately process increasingly complex medical information. In recent years, large language models (LLMs) technology has undergone explosive development, demonstrating unique advantages in handling complex medical data by leveraging its powerful natural language processing capabilities, and its application value in the field of lung cancer diagnosis and treatment is continuously increasing. The paper systematically analyzes that the exceptional potential of LLMs in lung cancer auxiliary diagnosis, tumor feature extraction, automatic staging, progression/outcome analysis, treatment recommendations, medical documentation generation, and patient education. However, they face critical technical and ethical challenges including inconsistent performance in complex integrated decision-making (e.g., TNM staging, personalized treatment suggestions) and "black box" opacity issues, along with dilemmas such as training data biases, model hallucinations, data privacy concerns, and cross-lingual adaptation challenges ("data colonization"). Future directions should prioritize constructing high-quality multimodal corpora specific to lung cancer, developing interpretable and compliant specialized models, and achieving seamless integration with existing clinical workflows. Through dual drivers of technological innovation and ethical standardization, LLMs should be prudently advanced for holistic lung cancer management processes, ultimately promoting efficient, standardized, and personalized diagnosis and treatment practices.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Outer membrane vesicle (OMV) secreted by Klebsiella pneumoniae are nanoscale spherical proteoliposomes (20-400 nm) primarily composed of outer membrane components. OMV, initially considered byproducts of bacterial cell lysis, are now recognized as part of a unique bacterial secretion pathway known as the type 0 secretion system. OMV can deliver their cargo proteins, lipids, DNA, and toxins to target cells in a centralized, protected, and targeted manner, eliminating the need for direct contact between bacterial cells and target cells. In summary, OMV play a role in various biological processes, including intercellular communication, nutrient acquisition, horizontal gene transfer, bacterial competition, and virulence. This review focuses on the composition of Klebsiella pneumoniae OMV, their potential roles in bacterial survival and pathogenesis, and their promising applications as vaccine candidates for the prevention and treatment of Klebsiella pneumoniae infections.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Acute urinary retention(AUR)occurs frequently among astronauts on orbit.The current treatment is complex and easy to damage the urethra,which seriously affects the life and work of astronauts.In contrast,acupuncture,a traditional Chinese remedy,has shown promising results in managing urinary retention.However,the specific acupoints that could potentially prevent AUR remain uncertain due to the unique physiological conditions experienced by individuals in space compared to those on Earth.To address this gap,our research delved into the mechanisms of AUR and acupuncture within both traditional Chinese medicine and modern medical practices.We conducted a thorough literature review from Pubmed,Web of Science,CNKI,Wanfang database,VIP database and Chinese Medical Code database.A hierarchical evidence-scoring approach was utilized to analyze the included literatures,thus devised acupuncture protocols for the treatment of AUR.The outcomes of our study aim to establish a foundation for the application of acupuncture in managing AUR.

Objective To observe the clinical efficacy and safety of hydrocortisone injection combined with continuous blood purification in the treatment of sepsis patients.Methods Sepsis patients were randomly divided into control group and treatment group.The control group received continuous blood purification treatment;on the basis treatment of control group,the treatment group received hydrocortisone 200 mg,qd,intravenous infusion.Two groups were treated for 1 week.The clinical efficacy,levels of inflammatory cytokines,cellular immune function indicators,and safety were compared between two groups.Results Fifty-six cases were enrolled in the treatment group,5 cases were excluded,and ultimately 51 cases were included in the statistical analysis.Fifty-five cases were enrolled in the control group,4 cases were excluded,and ultimately 51 cases were included in the statistical analysis.After treatment,the total effective rates of the treatment and control groups were 94.12％(48 cases/51 cases)and 74.51％(38 cases/51 cases)with statistical significant difference(P＜0.05).After treatment,the levels of C-reactive protein in the treatment and control groups were(12.21±2.35)and(15.18±2.25)mg·L-1,the levels of procalcitonin were(0.49±0.13)and(0.78±0.21)ng·mL-1,the levels of CD3+were(58.72±5.13)％and(54.21±4.47)％,the CD4+/CD8+ratios were 1.71±0.23 and 1.43±0.17,respectively.The differences were statistically significant(all P＜0.05).The adverse drug reactions of treatment group were chest tightness,nausea,and vomiting,while those in the control group were hypotension,nausea,and vomiting.The total incidences of adverse drug reactions in the treatment and control groups were 9.80％and 5.88％,without significant difference(P＞0.05).Conclusion Hydrocortisone injection combined with continuous blood purification have a definitive clinical efficacy in the sepsis patients,which can improve the patients'immune function,reduce inflammatory reactions,without increasing the incidences of adverse drug reactions.

Objective To study the effects from varying stenosis degrees of the mesencephalic aqueduct on intracranial cerebrospinal fluid(CSF)flow field.Methods Based on the clinical magnetic resonance image sequences of a male volunteer,a complete normal CSF circulation model was reconstructed by using semi-automated image segmentation technique.Subsequently,eight ideal models representing different stenosis degrees of the mesencephalic aqueduct were manually created.Computational fluid dynamics(CFD)was then performed to simulate the CSF flow field in the nine models.Results The stenosis degree of the mesencephalic aqueduct was positively correlated with the maximum pressure difference between the aqueduct upstream and downstream and the maximum velocity of CSF within the stenosed aqueduct.In the normal model,the maximum pressure difference was 0.84 Pa and the maximum velocity was 11.4 mm/s.While in the maximum stenosed model,the maximum pressure difference and velocity were 21.36 Pa and 60.3 mm/s,respectively.Compared to the normal model,the maximum pressure difference and velocity were approximately increased by 25 times and 5 times,respectively.Moreover,the maximum pressure difference was inversely proportional to the stenosis area square of the aqueduct,and there was a linear relationship between the pressure difference and the quadratic of the maximun CSF velocity.Conclusions The pressure difference and velocity of the stenosed mesencephalic aqueduct was not apparently increased with mild stenosis with respect to the normal aqueduct,while the great aqueductal stenosis increased the risk of hydrocephalus.This study provides a theoretical framework which contributes to understanding the development of obstructive hydrocephalus and intracranial hypertension.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Objectives:To investigate the predictive value of epicardial fat volume(EFV)and atrioventricular groove fat thickness(AVGT)—morphological biomarkers of epicardial adipose tissue—for major adverse cardiovascular events(MACE)in patients with dilated cardiomyopathy(DCM).Methods:This study enrolled 216 DCM patients.EFV and AVGT were obtained from cardiac magnetic resonance imaging(CMR).Patients were divided into event-free group(n=142)and event group(n=74)based on MACE occurrence during follow-up.Receiver operating characteristic(ROC)curve analysis was used to determine optimal cutoff values.Survival differences were assessed using Kaplan-Meier analysis,Cox proportional hazards regression analysis was used to identify independent risk factors,and restricted cubic spline(RCS)models were used to evaluate dose-response relationships.Results:AVGT and EFV were significantly higher in the event group than in event-free group(both P<0.05).ROC analysis identified optimal MACE-predicting cutoffs as follows:AVGT≥7.74 mm(area under the curve[AUC]=0.57)and EFV≥78.6 ml(AUC=0.62).Kaplan-Meier analysis revealed significantly lower MACE-free survival rates in patients with AVGT≥7.74 mm and EFV≥78.6 ml(both P<0.05).Cox regression analysis confirmed that AVGT(HR=2.18,95%CI:1.34-3.54)and EFV(HR=1.81,95%CI:1.11-2.96)were independent MACE risk factors(both P<0.05)in this patient cohort.RCS models demonstrated the significant linear associations between EFV/AVGT and MACE risk(bothoverall P<0.05).Conclusions:EFV and AVGT,the non-invasive imaging biomarkers quantifying and characterizing fat distribution,are independently correlated with elevated MACE risk in DCM patients.These metrics serve as potential prognostic indicators,enriching risk stratification indicators for early identification of high-risk patients and guiding personalized medication strategies.