Ovarian tumor (OT) is the most lethal form of gynecologic malignancy, with minimal improvements in patient outcomes over the past several decades. Metastasis is the leading cause of ovarian cancer-related deaths, yet the underlying mechanisms remain poorly understood. Psychological stress is known to activate the glucocorticoid receptor (NR3C1), a factor associated with poor prognosis in OT patients. However, the precise mechanisms linking NR3C1 signaling and metastasis have yet to be fully elucidated. In this study, we demonstrate that chronic restraint stress accelerates epithelial-mesenchymal transition (EMT) and metastasis in OT through an NR3C1-dependent mechanism involving nuclear protein 1 (NUPR1). Mechanistically, NR3C1 directly regulates the transcription of NUPR1, which in turn increases the expression of snail family transcriptional repressor 2 (SNAI2), a key driver of EMT. Clinically, elevated NR3C1 positively correlates with NUPR1 expression in OT patients, and both are positively associated with poorer prognosis. Overall, our study identified the NR3C1/NUPR1 axis as a critical regulatory pathway in psychological stress-induced OT metastasis, suggesting a potential therapeutic target for intervention in OT metastasis.

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.

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.

OBJECTIVE: To retrospectively analyze the clinical efficacy of anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex repair and ACL reconstruction combined with ALL reconstruction in the treatment of anterior cruciate ligament injuries with high-grade pivot shift. METHODS: From January 2018 to June 2022, 49 patients combined ACL and ALL injuries with high-grade pivot shift were retrospectively studied from three hospitals, 29 of them underwent ACL reconstruction with anterolateral complex repair (repair group), including 23 males and 6 females with an average age of (27.5±4.8) years old, ranged from 20 to 37 years old;the injured sides were 13 on the left and 16 on the right, and 11 patients were suffered with meniscus injury. The other 20 patients underwent ACL and ALL reconstruction (reconstruction group) including 17 males and 3 females with the mean age of (27.1±4.5) years old, ranged from 20 to 38 years old;the injured sides were 8 on the left and 12 on the right, and 6 patients were suffered with meniscus injury. Knee stability (pivot shift test, KT-2000), range of motion, knee function (Lysholm scoring scale, Cincinnati sports activity scale (CSAS) scoring scale, and Tegner activity level score between two groups were compared. RESULTS: A total of 49 patients were followed up, the repair group receiving 13 to 20(15.3±1.8) months and the reconstruction group receiving 12 to 21(16.0±2.2) months. There was no statistically significant difference in the preoperative pivot shift test grading distribution between two groups (P>0.05). At the last postoperative follow-up, there were 24 patients with grade 0 and 5 patients with grade 1 in the repair group, and there were 18 patients with grade 0 and 2 patients with grade 1 in the reconstruction group, there is no significant difference in the distribution of axial shift test grading between two groups(P>0.05). The preoperative KT-2000 tibial displacement of two groups were (9.39±0.77) mm (repair group) and (9.14±0.78) mm (reconstruction group) respectively, with no statistically significant difference (P>0.05). At the final postoperative follow-up, there were 24 patients with KT-2000 tibial displacement <3 mm and 5 patients with 3 to 5 mm in the repair group, while 18 patients with <3 mm and 2 patients with 3 to 5 mm in the reconstruction group, KT-2000 tibial displacement distribution of two groups was no significant difference (P>0.05), but the KT-2000 tibial displacement in the reconstruction group (1.30±0.86) mm was significantly smaller than that in the repair group (1.99±1.11) mm (P<0.05). The final postoperative follow-up range of motion of the contralateral side knee between two groups was no significant difference (P>0.05). The range of motion of the suffering knee in the repair group was less than that in the reconstruction group (P<0.05). There was no significant difference in preoperative Lysholm and CSAS scores between two groups (P>0.05). At the final postoperative follow-up, both groups showed significant improvement in Lysholm and CSAS scores, while the Lysholm and CSAS scores of the reconstruction group were better than those of the repair group, and the difference was statistically significant (P<0.05). Significant differences was found in Tegner scores between two groups, which 16 patients in the repair group returned to their pre-injury activity level, and 17 patients in the reconstruction group returned to their pre-injury level (P<0.05). CONCLUSION Compared to anterolateral complex repair, combined ACL and ALL reconstruction in the treatment of ACL injuries with high-grade pivot shift results in better knee joint function and stability. This is advantageous in reducing the risk of ACL reconstruction failure.
Humans ; Male ; Female ; Adult ; Anterior Cruciate Ligament Reconstruction/methods* ; Anterior Cruciate Ligament Injuries/surgery* ; Young Adult ; Retrospective Studies ; Anterior Cruciate Ligament/surgery* ; Range of Motion, Articular

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To evaluate the efficacy and safety of the gemcitabine combined with oxaliplatin (GEMOX) regimen in the postoperative adjuvant treatment for the patients with cisplatin-intolerant uroepithelial cancer.Methods:The clinical data of 98 patients with uroepithelial carcinoma intolerant to cisplatin chemotherapy who underwent radical surgery from August 2017 to October 2022 at Drum Tower Hospital of Nanjing University School of Medicine were retrospectively analysed. The patients were divided into the adjuvant chemotherapy group and the observation group according to whether or not they underwent adjuvant chemotherapy after surgery. The adjuvant chemotherapy group received postoperative chemotherapy with the GEMOX regimen (gemcitabine 1 000 mg/m 2 intravenously on days 1 and 8, oxaliplatin 130 mg/m 2 intravenously on day 2, every 3 weeks as a cycle), and the observation group did not undergo postoperative adjuvant chemotherapy. In the adjuvant chemotherapy group, there were 33 males and 10 females, the patients’ age was (67.8±7.3) years old, 33 cases with estimated glomerular filtration rate (eGFR) ≤60 ml/(min·1.73m 2), and 10 cases with a Eastern Cooperative Oncology Group (ECOG) functional status score of >1. The postoperative pathology showed 39 cases were in stage T 3, 4 cases in stage T 4, and lymph node positivity (N+ ) was found in 10 cases. There were 55 cases in the observation group, with 42 males and 13 females and the age of (70.7±7.7) years old. Forty-two of them had an eGFR ≤60 ml/(min·1.73m 2), and 13 of them had a ECOG score of >1. The postoperative pathology showed 48 cases were in stage T 3, 7 cases in stage T 4, and 13 cases of N+. The changes in renal function, ECOG scores, and adverse reactions were observed in adjuvant chemotherapy group. Kaplan-Meier method was used to estimate the survival rate, and the log-rank test was used to compare the survival rate between groups. Multifactorial Cox regression was used to analyse the correlation between age, lymph nodes, whether or not to combine with adjuvant chemotherapy and the survival of patients. Results:All patients in this study were followed up for 3 to 75 months, with a median follow-up time of 22 (14, 34) months. The recurrence rates were 83.6%(46/55) and 65.1%(28/43) in the observation and adjuvant chemotherapy groups, respectively, and the disease mortality rates were 52.7%(29/55) and 27.9%(12/43), respectively. The results of the Kaplan-Meier survival analyses showed that the 1-, 2- and 3-year disease-free survival rates in the adjuvant chemotherapy group were 62.8%, 48.6% and 41.1%, respectively, and the 1-, 2- and 3-year overall survival rates were 86.0%, 79.0% and 76.4%, respectively. The 1-, 2- and 3-year disease-free survival rates of the observation group were 58.2%, 22.6% and 9.6%, respectively, and the 1-, 2- and 3-year overall survival rates were 78.2%, 49.4% and 42.8%, respectively. The adjuvant chemotherapy group had an advantage over the observation group regarding disease-free and overall survival rates (all P<0.05). The results of multifactorial Cox regression analysis suggested that the functional status score and the presence or absence of positive lymph nodes, diabetes mellitus, and co-adjuvant chemotherapy were independent risk factors affecting the survival of the patients ( P<0.05). Forty-three cases had 1 to 6 courses of adjuvant chemotherapy, with a median course of 4 (2, 4). In terms of safety, the most common adverse reaction in the gastrointestinal tract was loss of appetite (53.4%, 23/43), the most common grade 1 to 2 adverse reaction in myelosuppression was a decrease in haemoglobin (51.2%, 22/43), and the most common grade 3 to 4 adverse reaction was thrombocytopenia (9.3%, 4/43). The eGFR of 33 patients with renal insufficiency in the adjuvant chemotherapy group was higher after each administration cycle than before ( P<0.05), and renal function did not deteriorate with the increase in administration cycles. Ten patients with a ECOG score of 2 remained with a score of 2 after chemotherapy. Conclusions:In patients with cisplatin-intolerant uroepithelial cancer, gemcitabine in combination with an oxaliplatin regimen improves the overall survival of patients. At the same time, it is well tolerated without increasing nephrotoxicity, making it an optional postoperative adjuvant treatment for patients with cisplatin-intolerant uroepithelial cancer.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective To establish a rapid screening method for 60 types of natural toxins in whole blood by ultra-high performance liquid chromatography-quadrupole/electrostatic field orbitrap high reso-lution mass spectrometry(UPLC-Q/Orbitrap HRMS).Methods The chromatographic and mass spectro-metric information of 60 standard samples of natural toxins were analyzed and recorded,and a screening database was built.Whole blood was pretreated by protein precipitation method combined with ultrasonic-assisted dispersion,and then a Hypersil GOLDTM C18 column was used with 5 mmol/L ammonium for-mate aqueous solution(containing 0.1%formic acid)and acetonitrile as mobile phase for gradient elu-tion.In the positive ion mode,the data were collected in full scan/data-dependent secondary scan(Full MS/dd-MS2)mode.Based on the established screening library,the rapid screening of 60 types of natural toxins in whole blood was realized by TraceFinder software.Results A UPLC-Q/Orbitrap HRMS method was developed for the screening of 60 types of natural toxins in whole blood.Except for the limit of detection(LOD)of oxymatrine(20 ng/mL)and strophanthidin(40 ng/mL),the LOD for the other 58 natural toxins was in the range of 0.05-5 ng/mL.Conclusion This method has a simple and efficient pretreatment process and can achieve rapid screening of 60 types of natural toxins in whole blood.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To evaluate the efficacy and safety of the gemcitabine combined with oxaliplatin (GEMOX) regimen in the postoperative adjuvant treatment for the patients with cisplatin-intolerant uroepithelial cancer.Methods:The clinical data of 98 patients with uroepithelial carcinoma intolerant to cisplatin chemotherapy who underwent radical surgery from August 2017 to October 2022 at Drum Tower Hospital of Nanjing University School of Medicine were retrospectively analysed. The patients were divided into the adjuvant chemotherapy group and the observation group according to whether or not they underwent adjuvant chemotherapy after surgery. The adjuvant chemotherapy group received postoperative chemotherapy with the GEMOX regimen (gemcitabine 1 000 mg/m 2 intravenously on days 1 and 8, oxaliplatin 130 mg/m 2 intravenously on day 2, every 3 weeks as a cycle), and the observation group did not undergo postoperative adjuvant chemotherapy. In the adjuvant chemotherapy group, there were 33 males and 10 females, the patients’ age was (67.8±7.3) years old, 33 cases with estimated glomerular filtration rate (eGFR) ≤60 ml/(min·1.73m 2), and 10 cases with a Eastern Cooperative Oncology Group (ECOG) functional status score of >1. The postoperative pathology showed 39 cases were in stage T 3, 4 cases in stage T 4, and lymph node positivity (N+ ) was found in 10 cases. There were 55 cases in the observation group, with 42 males and 13 females and the age of (70.7±7.7) years old. Forty-two of them had an eGFR ≤60 ml/(min·1.73m 2), and 13 of them had a ECOG score of >1. The postoperative pathology showed 48 cases were in stage T 3, 7 cases in stage T 4, and 13 cases of N+. The changes in renal function, ECOG scores, and adverse reactions were observed in adjuvant chemotherapy group. Kaplan-Meier method was used to estimate the survival rate, and the log-rank test was used to compare the survival rate between groups. Multifactorial Cox regression was used to analyse the correlation between age, lymph nodes, whether or not to combine with adjuvant chemotherapy and the survival of patients. Results:All patients in this study were followed up for 3 to 75 months, with a median follow-up time of 22 (14, 34) months. The recurrence rates were 83.6%(46/55) and 65.1%(28/43) in the observation and adjuvant chemotherapy groups, respectively, and the disease mortality rates were 52.7%(29/55) and 27.9%(12/43), respectively. The results of the Kaplan-Meier survival analyses showed that the 1-, 2- and 3-year disease-free survival rates in the adjuvant chemotherapy group were 62.8%, 48.6% and 41.1%, respectively, and the 1-, 2- and 3-year overall survival rates were 86.0%, 79.0% and 76.4%, respectively. The 1-, 2- and 3-year disease-free survival rates of the observation group were 58.2%, 22.6% and 9.6%, respectively, and the 1-, 2- and 3-year overall survival rates were 78.2%, 49.4% and 42.8%, respectively. The adjuvant chemotherapy group had an advantage over the observation group regarding disease-free and overall survival rates (all P<0.05). The results of multifactorial Cox regression analysis suggested that the functional status score and the presence or absence of positive lymph nodes, diabetes mellitus, and co-adjuvant chemotherapy were independent risk factors affecting the survival of the patients ( P<0.05). Forty-three cases had 1 to 6 courses of adjuvant chemotherapy, with a median course of 4 (2, 4). In terms of safety, the most common adverse reaction in the gastrointestinal tract was loss of appetite (53.4%, 23/43), the most common grade 1 to 2 adverse reaction in myelosuppression was a decrease in haemoglobin (51.2%, 22/43), and the most common grade 3 to 4 adverse reaction was thrombocytopenia (9.3%, 4/43). The eGFR of 33 patients with renal insufficiency in the adjuvant chemotherapy group was higher after each administration cycle than before ( P<0.05), and renal function did not deteriorate with the increase in administration cycles. Ten patients with a ECOG score of 2 remained with a score of 2 after chemotherapy. Conclusions:In patients with cisplatin-intolerant uroepithelial cancer, gemcitabine in combination with an oxaliplatin regimen improves the overall survival of patients. At the same time, it is well tolerated without increasing nephrotoxicity, making it an optional postoperative adjuvant treatment for patients with cisplatin-intolerant uroepithelial cancer.