ObjectiveTo observe the effect of M1 bone marrow-derived macrophages （M1-BMDM） with Wnt5a knockdown on liver fibrosis and regeneration in a rat model of liver cirrhosis， and to investigate its gain-of-function effect compared with unmodified M1-BMDM. MethodsPrimary bone marrow-derived macrophages were isolated from rats and were polarized to M1 phenotype to construct M1-BMDM^Wnt5a-KD cells. A rat model of liver cirrhosis induced by CCl₄/2-AAF was established， and at the end of week 8， rats were randomly divided into model group， M1-BMDM group， M1-BMDM Wnt5a-knockdown empty vector group （M1-BMDM^KD-EV group）， and M1-BMDM Wnt5a-knockdown group （M1-BMDM^Wnt5a-KD group）， with 6 rats in each group. On the first day of week 9， the rats in each group were given a single injection of the corresponding cells via the caudal vein， along with an intraperitoneal injection of a CCR2 inhibitor. Six rats without any treatment were used as normal control group. Samples were collected at the end of week 12 to assess liver histopathology， serum liver function parameters， hepatic stellate cell activation， and the expression levels of mature hepatocyte markers. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the model group， all cell treatment groups had significant alleviation of liver inflammatory response and significant reductions in the activities of alanine aminotransferase and aspartate aminotransferase （AST） in serum （all P<0.01）， and the M1-BMDM^Wnt5a-KD group had a significantly lower serum level of AST than the M1-BMDM group （P<0.05）. The semi-quantitative analysis based on immunohistochemical staining showed that compared with the model group， all cell treatment groups had a significant reduction in the percentage of CD68-positive area （all P<0.05）， and compared with the M1-BMDM^KD-EV group， the M1-BMDM^Wnt5a-KD group had a significant reduction in the percentage of CD68-positive area and a significant increase in the percentage of CD163-positive area （both P<0.05）. Compared with the model group， all cell treatment groups had significant reductions in the mRNA expression levels of CD68 and tumor necrosis factor-α （all P<0.05） and the protein expression level of CD68 （all P<0.01）； compared with the M1-BMDM^KD-EV group， the M1-BMDM^Wnt5a-KD group had significant increases in the protein and mRNA expression levels of CD163 （both P<0.05）， significant reductions in the protein and mRNA expression levels of CD68 （both P<0.05）， and a significant reduction in the protein expression level of tumor necrosis factor-α （P<0.01）. Sirius Red collagen staining and alpha-smooth muscle actin （α-SMA） immunohistochemical staining showed that compared with the model group， all cell treatment groups had significant alleviation of liver collagen deposition and α-SMA-positive area， with the most significant changes in the M1-BMDM^Wnt5a-KD group， and compared with the M1-BMDM^KD-EV group， the M1-BMDM^Wnt5a-KD group had significantly smaller Sirius Red-positive area and α-SMA-positive area and a significantly lower content of hydroxyproline in liver tissue （all P<0.05）. Compared with the M1-BMDM^KD-EV group， the M1-BMDM^Wnt5a-KD group had significant reductions in the protein and mRNA expression levels of α-SMA and the mRNA expression level of COL-I and TGF-β （all P<0.05）. Compared with the model group， all cell treatment groups had a significant increase in the protein expression level of HNF-4α in liver tissue （all P<0.05）， and the M1-BMDM^Wnt5a-KD group had significantly higher protein and mRNA expression levels of HNF-4α and hepatocyte specific antigen than the M1-BMDM^KD-EV group （both P<0.05）. The M1-BMDM^Wnt5a-KD group had a significantly higher serum level of albumin than the M1-BMDM^KD-EV group （P<0.01）. Immunofluorescence co-staining showed that compared with the model group， all cell treatment groups had a significant increase in the number of cells stained positive for HNF and HNF-4α and Ki67 （all P<0.01）， and the M1-BMDM^Wnt5a-KD group had a significantly higher number of such cells than the M1-BMDM^KD-EV group （P<0.05）. ConclusionInhibition of Wnt5a expression enhances the therapeutic effect of M1-BMDM on rats with liver cirrhosis induced by CCl₄/2-AAF， which provides new ideas for enhancing the anti-cirrhotic effect of M1-BMDM through genetic modification.

Objective To compare the performance of 7 Chinese-developed GenAI models (DeepSeek, Wenxin Yiyan, Tongyi, Doubao, Kimi, Hunyuan, and iFLYTEK Spark) in responding to common diseases of the pediatric genitourinary system and to explore their potential applications.Methods A total of 80 questions covering basic disease information, diagnosis, treatment, and prognosis related to “hypospadias, hydronephrosis, and cryptorchidism” were developed as prompts.The models were tested under 3 modes:“quick thinking, ”“deep thinking, ” and “deep thinking + internet access.” The results were evaluated in a blinded review by two pediatric urologists.The responses were graded into 4 levels—A, B, C, and D—based on accuracy, completeness, and relevance.The proportions of responses rated as A and A+B were statistically analyzed and compared across the different models/modes.Results The “deep thinking” mode of DeepSeek demonstrated the best performance, with 88% of responses rated as A and 96% rated as A+B.DeepSeek (deep thinking + internet access), Doubao (quick thinking), Hunyuan (deep thinking), and Doubao (deep thinking + internet access) followed closely, also showing excellent response capabilities.Among the top 5 models/modes, significant differences were observed in the proportion of Alevel responses (P＜0.05), while differences in the proportion of A+B-level responses were not statistically significant (P＞0.05).Conclusion Certain Chinese-developed GenAI models, represented by DeepSeek (deep thinking), demonstrate significant application potential.However, they still cannot consistently provide recommendations rated at the A+B level (recommended grade or higher) with 100% accuracy.In clinical practice, both doctors and patients should view GenAI as an auxiliary tool for education and information acquisition rather than as a final decision-making authority.All information must be reviewed and confirmed by professional physicians.

Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

The incidence of type 2 diabetes mellitus (T2DM) has been continuously rising, severely impacting health and increasing the medical burden. With the development of medical big data and artificial intelligence, research into constructing T2DM and its complications prediction models using machine learning methods based on multidimensional data such as genetic information, health records and laboratory testing data have increased, providing new ideas and means for the prevention and control of T2DM. This article reviewed the research progress in prediction models related to the risk of T2DM to understand the classification, modeling methods and applications by retrieving literature on T2DM and its complications prediction models from domestic and international databases including CNKI, Web of Science, and PubMed from 2003 to 2024, so as to provide the reference for early screening and intervention of T2DM.

Objective To investigate the impact of continuous nebulization therapy after lung transplantation on pulmonary function and related complications in lung transplant recipients. Methods A retrospective analysis was conducted on the general data of 71 recipients who underwent allogeneic lung transplantation at the Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, from June 2013 to December 2024. Recipients were divided into observation group (those who continued nebulization therapy for more than 3 months after discharge) and control group (those who discontinued nebulization therapy on their own). The main observation indicators were pulmonary function indicators at 6 months after surgery, including forced expiratory volume in the first second as a percentage of predicted value (FEV₁% pred), forced vital capacity as a percentage of predicted value (FVC% pred), ratio of forced expiratory volume in the first second to forced vital capacity as a percentage of predicted value (FEV₁/FVC% pred), forced expiratory flow at 25%, 50% and 75% of forced vital capacity as a percentage of predicted value, and the percentage of predicted value of corrected carbon monoxide diffusion capacity measured by single-breath method, as well as the ratio of corrected carbon monoxide diffusion capacity to alveolar volume as a percentage of predicted value. Additionally, the annual incidence of postoperative pulmonary infections, survival rate and the rate of no severe airway complications were analyzed. Results At 6 months after lung transplantation, the FEV₁% pred and FVC% pred of the observation group were better than those of the control group [FEV₁% pred was 76% (60%, 91%) vs. 67% (62%, 78%), FVC% pred was (75 ± 13)% vs. (69 ± 11)%, both P<0.05]. The observation group had a lower annual incidence of pulmonary infections compared to the control group (P = 0.023), with a risk of 0.485 times that of the control group. There were no statistically significant differences between the two groups in median survival time and the rate of no severe airway complications (both P>0.05). Conclusions Continuous nebulization therapy after lung transplantation may effectively improve pulmonary function, reduce the annual incidence of pulmonary infections, and play a positive role in the long-term maintenance of pulmonary function.

Objective: To investigate the implementation and evaluate the effectiveness of health management services for patients with type 2 diabetes mellitus (T2DM) in Urumqi City from 2017 to 2021, so as to provide the reference for enhancing T2DM patients management. Methods: Data on the rates of record establishment, health management and standardized management for T2DM patients, and blood glucose control rate in managed patients in Urumqi City from 2017 to 2021 were collected through the quarterly reports on basic public health service management from the Weining Health Platform System. The trends in the four management indicators, and the differences between urban and rural areas were analyzed. Results: The rates of record establishment, health management and blood glucose control rate in managed patients in Urumqi City were 46.94%, 38.37% and 59.92%, respectively, showing upward trends from 2017 to 2021 (all P<0.05). The rate of standardized management was 75.89%, showing a downward trend (P<0.05). The rate of record establishment was higher in urban areas than in rural areas (47.76% vs. 40.56%, P<0.05). The rates of standardized management and blood glucose control in managed patients were lower in urban areas than in rural areas (75.18% vs. 81.46%, 58.93% vs. 67.64%, both P<0.05). The rate of health management was 38.39% in urban areas and 38.24% in rural areas, with no statistically significant difference (P>0.05). The trends in the rates of record establishment, health management and standardized management in both urban and rural areas were consistent with those in the overall population. Conclusions From 2017 to 2021, the rates of record establishment, health management and blood glucose control in managed patients in Urumqi City showed upward trends, while the rate of standardized management exhibited a downward trend. There were urban-rural differences in the rates of record establishment, standardized management and blood glucose control in managed patients.

Objective To explore the effect of community pharmacy outpatient service on patients with type 2 diabetes mellitus. Methods A non-randomized controlled study was conducted, and type 2 diabetes patients managed in the community were divided into an intervention group of 112 cases and a control group of 110 cases. The control group received routine medication guidance during general practice outpatient visits, while the intervention group received comprehensive pharmacy outpatient service intervention based on routine medication guidance in general practice. Follow-up visits were conducted every 3 months. Repeated measurement analysis of variance and multivariate linear regression analysis were used to evaluate the intervention effect of the pharmacy outpatient service. Results Fasting blood glucose and glycosylated hemoglobin levels in the intervention group showed a decreasing trend with the increase of intervention time compared to pre-intervention time （P<0.01）, with increased duration of weekly exercise, decreased staple food intake, increased vegetable intake, and increased medication adherence score （P<0.01）. After adjusting for confounding factors through multivariate linear regression model, pharmacy outpatient intervention was found to be an independent protective factor for fasting blood glucose level （β=−0.891, P<0.01） and glycosylated hemoglobin level （β=−0.760, P<0.01） in the study subjects. Conclusion The community pharmacy outpatient service could enhance the self-management ability of patients with type 2 diabetes mellitus, and effectively improve patients’ fasting blood glucose and glycosylated hemoglobin.

Objective:To compare the treatment time stability, inter- and intra-fraction errors, and clinical target volume (CTV) to planning target volume (PTV) margin expansions under different gated window settings in deep inspiration breath hold (DIBH) radiotherapy for breast cancer, and to analyze the correlation between organ at risk (OAR) dose optimization and changes in lung volume.Methods:A retrospective analysis was conducted on 65 patients with left-sided breast cancer who received DIBH radiotherapy after modified radical mastectomy. CT simulation positioning was performed using 2 mm or 3 mm gated window for DIBH, followed by target delineation, treatment planning, and dose verification. During treatment, setup errors guided by cone beam CT (CBCT), intra-fraction monitoring errors, and treatment times were recorded. The coefficient of variation (CV) of treatment time was calculated for both gated window settings. Based on inter- and intra-fraction error distributions, the expansion distance of the CTV were determined using the van Herk formula. Dosimetric differences between DIBH and free-breathing (FB) plans for the left lung, heart, and left anterior descending coronary artery (LAD) were compared. Spearman correlation analysis was performed between the relative increase in left lung volume and the relative reduction in OAR dose. Paired t-tests were used for inter-group comparisons. Results:The mean CV of the 3 mm gated window group was 0.08±0.03, which was lower than that of the 2 mm group (0.10±0.04; t=-3.91, P<0.001). The setup errors of the 2 mm group in the X, Y, and Z directions were (1.27±1.03), (1.68±0.94), (1.90±1.25) mm, respectively-significantly smaller than those of the 3 mm group [(1.81±1.41), (2.07±1.69), (2.93±1.90) mm; t=-5.80, -2.33, -5.33; P<0.001,=0.014,<0.001). Setup errors for both groups were within the 25%-75% range and all below 5 mm. The intra-fraction deviations of the 2 mm group in the X, Y, and Z directions were (0.54±0.33), (0.79±0.44), (0.70±0.53) mm, respectively, significantly smaller than those of the 3 mm group [(0.62±0.43), (0.93±0.66), (0.87±0.67) mm; t=-3.87, -3.46, -2.71,all P<0.001). The mean intra-fraction errors of both groups were within 1 mm, with greater deviations in the Y and Z directions than those in the X direction. The CTV expansion margins for the 2 mm group in the X, Y, and Z directions were 4.21, 5.35, 5.99 mm, respectively, while those for the 3 mm group were 5.81, 6.89, 9.06 mm. Compared with FB, DIBH significantly reduced the doses to the left lung, heart, and LAD (all P<0.01). The increase in left lung volume was moderately negatively correlated with the reduction in left lung D mean ( r=-0.43, P=0.028), and highly negatively correlated with the dose reductions to the heart and LAD (both P<0.001). Conclusions:The variability in respiratory gated window settings can lead to differences in treatment time stability as well as inter- and intra-fraction errors, consequently affecting CTV-to-PTV margins. The DIBH technique demonstrates significant dosimetric benefits in reducing radiation exposure to the left lung, heart, and LAD. Volumetric expansion of the left lung is strongly and inversely correlated with the reduction in radiation dose to both the heart and LAD.

Objective To explore the predictive value of serum levels of CXC chemokine ligand 4(CXCL4),CXC receptor 3 chemokine(CXCR3)for postoperative cerebral vasospasm(CVS)in patients with ruptured intracranial aneurysms.Methods The clinical data of 106 patients with intracranial aneurysms rupture who under went craniotomy and clipping surgery at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from October 2020 to December 2022 were collected.The incidence of CVS was observed.Serum CXCL4 and CXCR3 levels were compared at 1,3,7 days after surgery between patients without CVS and patients with CVS.Spearman correlation coefficient was used to analyze the relationship between serum CXCL4,CXCR3 levels and CVS degree.ROC curve was used to analyze the value of serum CXCL4 and CXCR3 levels in predicting postoperative CVS.Results Among 106 patients with ruptured intracranial aneurysms,a total of 38 cases(35.85%)developed CVS after surgery,and 68 cases(64.15%)did not develop CVS.There was no statistically obvious difference in preoperative serum levels of CXCL4 and CXCR3 between the CVS group and the non CVS group(t=0.104,0.141,all P>0.05).The serum levels of CXCL4 and CXCR3 in the non CVS group were lower than those before surgery 1,3,and 7 day after surgery,and the differences were statistically significant(q=14.867,17.525,24.384;16.274,20.251,34.237,all P<0.05).Compated with preoperative levels,the levels of serum CXCL4 and CXCR3 in the CVS group decreased on postoperative 1 and 7 days,and the differences were statistically significant(q=9.486,4.858;10.760,9.104,all P<0.05).Compared with the mild CVS group,the serum levels of CXCL4 and CXCR3 in the moderate and severe CVS groups were obviously increased(q=2.982,5.992;2.961,3.465),and the serum levels of CXCL4 and CXCR3 in the severe CVS group were higher than those in the moderate CVS group(q=3.564,4.036),and the differences were statistically significant(all P<0.05),respectively.Spearman results showed that serum levels of CXCL4 and CXCR3 were positively correlated with the severity of CVS(r=0.491,0.483,all P<0.05).The ROC curve results showed that the AUC of CXCL4 and CXCR3 combined in predicting postoperative CVS in patients with intracranial ruptured aneurysms was higher than that of CXCL4,CXCR3 alone,and the differences were statistically significant(Z=2.937,2.750,all P<0.05).Conclusion The serum levels of CXCL4 and CXCR3 in ruptured intracranial aneurysms patients with postoperative CVS are obviously elevated,and the combined detection of the two can effectively predict the occurrence of CVS.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.