Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objectives: . The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC. Methods: . A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients. Results: . Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected. Conclusion . Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.

With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Uveal melanoma(UM)is a rare but highly aggressive intraocular malignancy. Although it accounts for less than 5% of all melanoma cases, UM is the most common primary intraocular malignancy in adults. In recent years, advances in molecular targeted therapies and immunomodulatory strategies have provided new opportunities for the clinical management of UM. This review summarizes the pathogenesis, molecular biomarkers, and major therapeutic advances in UM, with particular emphasis on analyzing the research achievements and clinical application prospects of signaling pathway-targeted inhibitors, immune checkpoint inhibitors, and combination treatment strategies. The potential value of individualized treatment and the limitations of current therapeutic approaches are also discussed. Current evidence suggest that multidisciplinary intervention and precision molecular diagnosis and treatment may significantly improve the prognosis of patients with UM, providing references for future clinical research and the optimization of therapeutic strategies.

Purpose To explore the clinical and pathological characteristics,diagnostic features,differential diag-nosis,and prognosis of polymorphous low-grade neuroepithelial tumor of the young(PLNTY).Methods Clinical and imaging data from 7 patients with PLNTY were collected.Morphological evaluation was performed using HE staining.Immunohistochemistry with the EnVision method was used to detect the expression of including CD34,BRAF,IDH1,GFAP,Ki67,and other proteins.BRAF gene mutations were detected by real-time PCR,CDKN2A/B and 1p/19q co-deletion were assessed by FISH,and next-generation sequencing(NGS)was performed on selected cases.Results Among the seven patients,six were male and one was female,aged 8-29 years(median age:22 years).Tumors were located in the temporal lobe(5 cases),left insula and anterior temporal lobe(1 case),and frontotemporal lobe(1 case).Six patients had a history of epilepsy.Histologically,all tumors displayed oligodendroglioma-like areas.Two cases exhibited perivascular pseudorosette-like arrangements,and two showed focal cellular pleomorphism.Calcifica-tion and capillary networks were observed in all cases.Immunohistochemically,all tumors were positive for GFAP and Olig-2 and negative for IDH1(R132H).CD34 showed diffuse positivity in all cases.BRAF was positive in five cases.The Ki67 proliferation index ranged from 1％to 5％.Molecularly,all cases were IDH-wild type,with no 1p/19q co-deletion or CDKN2A/B deletion.BRAF V600E mutants were identified in five cases,and FGFR alterations in two.During follow-up(5-48 months),all patients survived;five remained recurrence-free,while two experienced recur-rence.Conclusion As a rare low-grade neuroepithelial tumor,clinicians and pathologists should master the diagnostic key points and differential diagnosis of PLNTY to avoid misdiagnosis and missed diagnosis.

Objective:This study aims to systematically review the current evaluation paradigms of conversational AI in healthcare and provide insights to facilitate the development of a comprehensive evaluation framework and methodological advancements in this field.Methods:A systematic review was conducted by searching the PubMed and Web of Science databases to analyze the existing evaluation paradigms of healthcare conversational AI,including evaluation subjects,assessment metrics,and evaluation methodologies.Results:A total of 60 studies were included in this review.The findings indicate that most evaluation subjects focus on general-purpose large language models.The assessment metrics cover five key dimensions:technical performance,information quality,clinical effectiveness,user experience,and ethics and safety.However,there were significant differences in the evaluation criteria used in existing studies.There were also issues such as a low degree of alignment between the evaluation questions and the application scenarios,as well as a lack of diversity in the roles of the evaluators.Conclusions:The current evaluation framework for healthcare conversational AI remains underdeveloped.Future improvements should focus on broadening model coverage,enhancing the comprehensiveness of evaluation indicators,standardizing evaluation methods,improving the operationalizability of test content,and expanding the scalability of evaluation languages.

Objective To investigate the relationship between the expression levels of serum integrin αMβ2(ITG αMβ2)and gasdermin D(GSDMD)in patients with severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS)and the severity of the disease and its value in predicting prognosis.Methods A total of 147 patients with SAP complicated with ARDS(ARDS group)admitted to the Department of Intensive Care Medicine of the Southwest Jiaotong University Affiliated Hospital(Chengdu Third People's Hospital)from August 2021 to October 2023 were selected.According to the oxygenation index(OI),they were divided into mild group(n=35),moderate group(n=46)and severe group(n=66).According to the 28-day prognosis,they were divided into death group(n=77)and survival group(n=70).Another 147 SAP patients without ARDS at the same time period were selected(non-ARDS group).The expression levels of serum ITG αMβ2 and GSDMD were detected by enzyme-linked immunosorbent assay.Spearman method was used to analyze the correlation between serum ITG αMβ2,GSDMD expression levels and OI in patients with SAP complicated with ARDS.Multivariate Logistic regression was used to analyze the factors of death in patients with SAP complicated with ARDS.Receiver operating characteristic(ROC)curve was used to analyze the value of serum ITG αMβ2,GSDMD expression levels in evaluating the death of patients with SAP complicated with ARDS.Results Compared with the non-ARDS group,the expression levels of serum ITG αMβ2(31.95±8.17 ng/L vs 53.33±12.22 ng/L)and GSDMD(2.25±0.55 ng/ml vs 4.39±1.18 ng/ml)in the ARDS group were increased,and the differences were statistically significant(t=17.637,19.899,all P<0.05).The expression levels of serum ITG αMβ2 and GSDMD in mild group,moderate group and severe group increased in turn,and the differences were statistically significant(F=163.069,194.028,all P<0.05).The expression levels of serum ITG αMβ2 and GSDMD were negatively correlated with OI in patients with SAP complicated with ARDS(r=-0.787,-0.778,all P<0.05).The 28-day mortality rate of 147 SAP patients with ARDS was 52.38%(77/147).Compared with the survival group,the expression levels of serum ITG αMβ2(46.96±10.28 ng/L vs 59.11±10.94 ng/L)and GSDMD(3.74±0.98 ng/ml vs 4.98±1.04 ng/ml)in the death group were increased,and the differences were statistically significant(t=6.920,7.415,all P<0.05).The number of extrapulmonary organ failure≥2,prolonged mechanical ventilation time,increased acute physiological and chronic health assessment II score,and increased ITG αMβ2.and GSDMD were independent risk factors for death in SAP patients complicated with ARDS(Wald χ2=4.297～13.536,all P<0.05),and increased OI was an independent protective factor(Wald χ2=8.346,P<0.05).The combined evaluation AUC of serum ITG αMβ2 and GSDMD expression levels results in a larger area under the curve(AUC)for mortality in SAP patients with ARDS compared to the individual evaluation of SAP complicated with ARDS,which was greater than serum ITG αMβ2 and GSDMD expression levels alone,and the differenes were statistically significant(Z=3.517,3.430,all P<0.05).Conclusion The increase of serum ITG αMβ2 and GSDMD expression levels is related to the progression and poor prognosis of patients with SAP complicated with ARDS.The combined monitoring of serum ITG αMβ2 and GSDMD expression levels has a high evaluation value for the risk of death in patients with SAP complicated with ARDS.

Objective:To evaluate the long-term effectiveness of lingual mucosal graft ureteroplasty (LMGU) for managing long-segment (≥5 cm) ureteral strictures in a multi-institutional cohort of patients.Methods:A multi-center retrospective case series study was conducted on clinical data from 42 patients undergoing LMGU for long-segment ureteral strictures (≥5 cm) across five institutions between February 2017 and June 2024. The cohort comprised 31 males and 11 females, with an age of (43.4±12.0) years (range: 15 to 64 years) and a body mass index of (24.6±2.6) kg/m2 (range: 16.0 to 30.0 kg/m2). Strictures involved the left ureter in 24 cases and right ureter in 18 cases, demonstrating a stricture length of (6.4±1.5) cm (range: 5.0 to 11.5 cm). Surgical interventions included either onlay ureteroplasty or augmented anastomotic ureteroplasty, selected according to intraoperative findings. Intraoperative parameters, postoperative complications, and follow-up outcomes were analyzed.Results:Laparoscopic surgery was performed in 22 cases and robot-assisted surgery in 20 cases. Among the 42 patients, 22 underwent onlay ureteroplasty while 20 received augmented anastomotic ureteroplasty. The graft length was (5.9±1.8) cm (range: 3.0 to 12.0 cm), operative time (191.5±55.6) minutes (range: 105.0 to 350.0 minutes), and intraoperative estimated blood loss (86.7±73.6) ml (range: 10.0 to 400.0 ml). All procedures were successfully completed without conversion to open surgery. The postoperative hospital stay was (7.6±2.0) days (range: 4.0 to 15.0 days), with double-J stent removal at 6 to 8 weeks postoperatively. During a follow-up of (49.1±25.0) months (range: 12.0 to 99.0 months), no stricture recurrence was observed in any patient.Conclusion:LMGU is a safe, feasible, and effective long-term technique for managing long-segment (≥5 cm) ureteral strictures.

In recent years, with the improvement of people's awareness of physical examination and the more accurate detection equipment, the detection rate of pulmonary nodules is getting higher and higher. Surgical resection is the first choice for the treatment of malignant pulmonary nodules, but multiple pulmonary nodules, nodules in complex areas and those with surgical contraindications are not suitable for surgery. As an effective, less invasive and low-cost treatment, ablation has developed rapidly in the treatment of multiple pulmonary nodules. This article introduces the progress of several common ablation techniques (radiofrequency ablation, microwave ablation, cryoablation) in the treatment of multiple pulmonary nodules, the indications and contraindications of ablation techniques, the efficacy evaluation and complications after ablation therapy, and the prospects of ablation techniques in the treatment of multiple pulmonary nodules.

The chemical constituents in dried roots of Atractylodes macrocephala were investigated in this study. Through utilizing normal-phase silica gel and ODS column chromatography, TLC, and semi-preparative HPLC, 4 new sesquiterpenoids were purified from the ethyl acetate extract of A. macrocephala. By various spectroscopic techniques, such as 1D and 2D NMR, HR-ESI-MS, IR, UV, and CD, their structures were identified as atractylmacron A (1), 9β-hydroxyasterolide (2), atractylenolide H (3), atractylenolide J (4). Compound 1 possesses a rare 6/7 bicyclic skeleton.