Objective To identify immune cell-related biomarkers in lung adenocarcinoma (LUAD) using weighted gene co-expression network analysis (WGCNA). Methods Based on data from The Cancer Genome Atlas (TCGA) database, a gene co-expression network was constructed for the TCGA-LUAD dataset using the "WGCNA" R package, and genes were clustered into different modules. Concurrently, the Estimation of STromal and Immune cells in MAlignant Tumours using Expression data (ESTIMATE) algorithm was applied to the tumor samples in the TCGA-LUAD dataset. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to evaluate the biological functions of genes within the most significantly correlated module. Candidate hub genes from the key module were intersected with a protein-protein interaction (PPI) network to identify the final hub genes. The prognostic performance of these hub genes and their correlation with immune cell infiltration were validated using Kaplan-Meier curves and the Tumor IMmune Estimation Resource (TIMER) algorithm. Finally, a multivariate Cox regression analysis was conducted on the identified hub genes to construct a prognostic risk model. Results In the co-expression network, the brown module was found to be highly correlated with the ImmuneScore, StromalScore, and ESTIMATE Score. Five immune-related hub genes were identified: CD53, PLEK, SPI1, IL10RA, and C3AR1. Enrichment analysis of the brown module revealed that its genes were primarily enriched in GO terms such as "regulation of innate immune response" and KEGG pathways like the "NF-kappa B signaling pathway". Furthermore, the expression levels of these five hub genes were significantly and positively correlated with the infiltration abundance of various immune cells. The immune relevance of the model was validated by the Immunophenoscore (IPS) and the Tumor Immune Dysfunction and Exclusion (TIDE) score. Moreover, the established RiskScore demonstrated significant potential in predicting the response to immunotherapy. Conclusion These five immune-related key genes may serve as novel and effective potential therapeutic targets for LUAD immunotherapy, facilitating the development of personalized diagnosis and treatment strategies for patients with LUAD.

Metabolic associated fatty liver disease （MAFLD） is a highly prevalent chronic liver disease worldwide， and the mechanism underlying its progression to metabolic associated steatohepatitis and liver fibrosis remain unclear. Endoplasmic reticulum stress （ERS） and ferroptosis （Fer） are deeply involved in the pathological evolution of MAFLD. This article systematically reviews the core regulatory mechanisms of ERS and its role in regulating lipid metabolism， inflammation response， and cell apoptosis in MAFLD. It also analyzes the core mechanism of Fer and discusses the predisposing factors for Fer in the pathological microenvironment of MAFLD， as well as the role of Fer in exacerbating hepatocyte death and activating the progression of liver fibrosis. This article proposes that the crosstalk between ERS and Fer is a key driver for the progression of MAFLD， which provides new references and ideas for the clinical intervention of MAFLD.

The intestinal mucosal barrier plays a pivotal role in both innate and adaptive immune regulation.Its integrity is essential for maintaining overall health,as it acts as a critical interface between the luminal contents and the host immune system.MicroRNAs(miRNAs),which are small noncoding RNAs,function as potent genetic regulators by interacting with multiple target genes to modulate entire cellular pathways.Recent studies have demon-strated that miRNAs are intricately involved in regulating the function of the intestinal mucosal barrier.This review examines the role of miRNAs in the intestinal mucosal barrier,encompassing their mechanisms,relevant clinical research findings,and potential directions for future investigation,to elucidate the potential value of miRNAs in the pathogenesis,diagnosis,and treatment of related diseases.

Objectives:To evaluate the incidence of neurological complications following left ventricular assist device(LVAD)implantation and to investigate related risk factors.Methods:A retrospective analysis was conducted on 151 patients who underwent LVAD implantation at Fuwai Hospital between June 2017 and September 2024.Clinical characteristics and postoperative survival outcomes were compared between patients with and without neurological complications.Results:Neurological complications occurred in 21 patients(13.9%)postoperatively,15 cases were ischemic strokes,5 cases were symptomatic intracranial hemorrhages or subarachnoid hemorrhages,and 1 case was transient ischemic attack(TIA).The total incidence of neurological complications was 0.08 events per person-year(EPPY),ischemic stroke was 0.06 EPPY and hemorrhagic stroke was 0.02 EPPY.Compared with patients without neurological complications,patients with neurological complications had a higher proportion of preoperative aortic regurgitation and tricuspid regurgitation,lower triglyceride levels,a lower rate of concurrent left atrial appendage resection and a higher rate of concurrent aortic valve replacement surgery.Multivariate cox regression analysis revealed that higher preoperative triglyceride levels(HR=0.21,95%CI:0.08-0.56,P=0.002)were associated with neurological complications.The median follow-up time was 508.0(186.5,931.5)days,12 out of 15 cases of ischemic stroke experienced no long-term sequelae,while 3 patients had varying degrees of residual deficits.All 5 patients with hemorrhagic stroke died,with 2 deaths directly attributed to hemorrhage.Kaplan-Meier survival curve analysis indicated that patients with neurological complications had a significantly lower survival rate(log-rank P=0.005).Conclusions:Neurological complications after LVAD implantation are predominantly ischemic strokes.Although less frequent,hemorrhagic strokes are associated with worse outcomes.Higher preoperative triglyceride levels is associated with neurological complications.

The human gravity line(GL)is a virtual vertical line that passes through the centre of gravity(COG)of the human body and holds significant importance in assessing human biomechanics.Due to the inability to directly determine GL through imaging method,its application in past research and clinical practice has been somewhat limited.However,with the advancement of technology,the measurement and application of GL have made remarkable progress,becoming an essential supplement to traditional radiographic measurements and demonstrating an increasingly broad application prospect in the field of spinal health.This review summarizes the GL's anatomical basis,measurement method,and its relationship with other commonly used vertical lines.Furthermore,the current status of GL's clinical application in the field of spinal health is also summmrzied,and its potential role in the diagnosis and treatment of spinal diseases is discussed.It is hoped that the findings will offer new perspectives for the diagnosis and treatment of spinal diseases,and promote further research and application of GL in the field of spinal medicine.

Objectives:To investigate the coccygeal morphology in adult Chinese without coccydynia using CT scans,and to provide a morphological reference for assessing the risk of coccydynia in Chinese popula-tion.Methods:A retrospective analysis was conducted on 113 patients without coccydynia who underwent pelvic three-dimensional CT scans at the Second Affiliated Hospital of Wenzhou Medical University between August 2018 and August 2023.There were 67 males and 46 females,with a mean age of 53.5±19.1 years(range:18-93 years).The morphological characteristics of the sacrococcygeal anatomical structures,including coccyx number,coccyx type(modified Nathan classification),sacrococcygeal joint fusion,intercoccygeal joint subluxation,coccygeal sacralization,lateral deviation of coccygeal tip,ventral angulation of S5,and coccygeal bony spicule,were analyzed on the three-dimensional reconstructed CT images;And relevant morphological parameters were measured,such as the coccygeal straight length,sacral straight length,sacrococcygeal straight length,sacrolumbar angle,sacrococcygeal angle,sacrococcygeal joint angle,intercoccygeal angle,and first in-tercoccygeal joint angle,with consistency tests conducted for the measurements.The differences in morpholog-ical parameters were compared between different genders and age groups(＜50 years and ≥50 years).Results:Among the 113 asymptomatic adult Chinese subjects,88 cases(77.9％)had a 4-segment coccyx,and type Ⅰcoccyx(modified Nathan classification)was the most common type(53 cases),accounting for approximately 46.9％.The incidence of sacrococcygeal joint fusion,intercoccygeal joint subluxation,coccygeal sacralization,lateral deviation of the coccygeal tip,ventral angulation of S5,and coccygeal bony spicule were 52.2％(59 cases),25.7％(29 cases),20.4％(23 cases),53.1％(60 cases),7.1％(8 cases),and 15.0％(17 cases),respectively.The consistency test showed that the consistency of the measurement data among observers was good.In Chi-nese population,the coccygeal straight length was 3.59±0.72cm,sacral straight length was 10.97±0.92cm,and sacrococcygeal straight length was 12.68(11.99,13.69)cm.The lumbosacral angle,sacrococcygeal angle,inter-coccygeal angle,and first intercoccygeal joint angle were 38.0°±7.3°,110.6°±10.6°,173.1°(164.2°,178.2°),131.5°±21.5°,and 152.8°±17.1°,respectively.Gender comparisons showed that males had greater sacrococ-cygeal straight length and sacrococcygeal angle than females(P＜0.05).Age group comparisons revealed that subjects＜50 years had shorter coccygeal straight length,smaller lumbosacral angle,sacrococcygeal joint angle,and first intercoccygeal joint angle than those ≥50 years(P＜0.05),while the sacral straight length was longer in the＜50 years group(P＜0.01).Conclusions:Among the adult Chinese without coccydynia,4 coccygeal seg-ments and type Ⅰ(modified Nathan classification)are the most common.Sacrococcygeal joint fusion,coccygeal bony spicules,intercoccygeal joint subluxation,and coccygeal sacralization have relatively high incidences.Males have longer and straighter sacrococcygeal structures than females.Compared with those ≥50 years,subjects＜50 years have shorter coccyxes,longer sacra,and smaller lumbosacral angles.

Objective To explore the value of the minimum intensity projection(minIP)images generated by post-processing of susceptibility weighted imaging(SWI)and corrected phase image(CPI)in evaluating the asymmetrical prominent veins sign(APVS)in acute ischemic stroke.Methods A retrospective analysis was conducted on 86 patients with acute ischemic stroke.Group A underwent conventional SWI reconstruction to generate minIP images,while group B used CPI for re-reconstruction to produce minIP images.Both groups used the same scanning method but different post-processing techniques to generate two sets of images,with each group consisted of 86 patients.Two deputy chief physicians of imaging diagnostics scored subjectively with a double-blind 5-point method to compare the ability of the two groups to display APVS and analyze the display rate of APVS.Results The subjective scores of group B were significantly higher than those of group A,with a statistically significant difference(P<0.05).The display rates of APVS in groups A and B were 67.44%and 73.26%respectively.Group B had a higher display rate of APVS below the tentorium cerebelli than above it.Conclusion The minIP images generated by CPI post-processing can achieve the effects similar to phase difference enhanced imaging(PADRE),and is superior to SWI reconstruction method in displaying APVS.It can be used as a supplementary post-processing method when acute stroke shows poor APVS,which has practical clinical application value and can provide more imaging basis for clinical practice.

Objective:To assess the sound localization ability of patients with unilateral sudden hearing loss during the early period of treatment, to explore its changing characteristics and to analyze influencing factors.Methods:A total of 22 patients with unilateral sudden sensorineural hearing loss, with onset within 3 days, who were hospitalized at Shandong Provincial ENT Hospital between January and April 2024, were collected in this study. The cohort included 13 males and 9 females, with a mean age of 36.5 years. Among them, 10 suffered in the right ear and 12 in the left ear. Additionally, 15 healthy individuals (8 males and 7 females, mean age 29.2 years) were selected as controls. Pure tone audiometry and sound localization tests were reviewed on the first day, third day, fifth day of admission; the third week after onset, and the pure tone average and the root-mean-square error(RMSE) were used as indicators, respectively. The improvement of the ability of sound localization and pure tone average were assessed by correlation analyses using SPSS, version 27.0, and multiple regression analysis was employed to explore effects that might influence sound localization ability.Results:The pure tone threshold and sound localization ability on the third week of onset were improved compared with those on the initial three instances(the first, third, and fifth days of admission). 9 of the 22 patients (40.91%, 9/22) presented normal sound localization ability whereas their hearing loss had not recurred yet. The Spearman correlation analysis revealed a significant positive correlation between the improvement of sound localization ability and hearing improvement ( r=0.57, P<0.001). Meanwhile, multiple regression analysis showed that hearing threshold was a significant factor for sound localization when there was audible frequency. Vice versa, at this circumstance, ages and vertigo were significant factors. Conclusions:For most of the patients with unilateral sudden hearing loss, ability of sound localization improves with the decrease of hearing threshold. Notably, some patients can restore normal levels of sound localization for white noise, even in the presence of hearing loss at certain frequencies, by relying on binaural acoustic cues provided by residual hearing.

Objective:To examine the safety and effectiveness of a novel domestic transcatheter aortic valve system in addressing severe aortic valve stenosis.Methods:This prospective, multicenter, single-arm target-value clinical trial enrolled patients with severe aortic stenosis meeting inclusion criteria from 13 Chinese centers between July 2021 and April 2022. The primary endpoint was all-cause mortality at 1-year post-procedure. Secondary endpoints included safety outcomes (30-day all-cause mortality, 1-year major adverse cardiovascular events, device success) and efficacy parameters (transvalvular pressure gradient, paravalvular leak severity, New York Heart Association(NYHA)class improvement, and quality of life). Survival analysis was performed using the Kaplan-Meier analysis.Results:The study included 134 patients, 85 males and 49 females, with an age of (73.6±5.6)years (range: 65.1 to 91.8 years). Bicuspid aortic valve morphology was present in 59.7% (80/134). Device success rate was 99.3%, with one case converted to open surgery due to coronary obstruction. All-cause mortality was 0.8% (95% CI: 0.1% to 5.3%) at both 30-day and 1-year follow-up, significantly lower than the 25% target value ( P<0.01). Permanent pacemaker implantation rates remained 2.2% (3/134) at both timepoints. Stroke incidence was 0.7% (1/134) at 30 days and 1.5% (2/134) at 1 year. Myocardial infarction rates were 0.7% (1/134) at both intervals. The postoperative transvalvular pressure gradient of the aortic valve was (6.6±3.1) mmHg(1 mmHg=0.133 kPa) (range: 4 to 8 mmHg). Among the patients, 32 cases (23.9%) had mild paravalvular leakage, 4 cases (3.0%) had moderate paravalvular leakage, and no severe paravalvular leakage was observed. NYHA class Ⅰ and Ⅱ patients increased from 18.7% preoperatively to 99.3% postoperatively. Conclusion:The novel domestic transcatheter aortic valve system demonstrates satisfactory 1-year safety and efficacy outcomes in treating severe aortic stenosis.

Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.