OBJECTIVES: To develop and validate a preoperative clinical-radiomics model for predicting overall survival (OS) and disease-free survival (DFS) in patients with extrahepatic cholangiocarcinoma (eCCA) undergoing radical resection. METHODS: In this retrospective study, consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included. The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations. Least absolute shrinkage and selection operator (LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables. The selected features and variables were incorporated into a Cox regression model. Model performance for 1-year OS and DFS prediction was assessed using calibration curves, area under receiver operating characteristic curve (AUC), and concordance index (C-index). RESULTS: This study included 123 patients (mean age 64.0 ± 8.4 years, 85 males/38 females), with 86 in the training cohort and 37 in the validation cohort. The OS-predicting model included four clinical variables and four radiomic features. It achieved a training cohort AUC of 0.858 (C-index = 0.800) and a validation cohort AUC of 0.649 (C-index = 0.605). The DFS-predicting model included four clinical variables and four other radiomic features. It achieved a training cohort AUC of 0.830 (C-index = 0.760) and a validation cohort AUC of 0.717 (C-index = 0.616). CONCLUSIONS The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.
Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Cholangiocarcinoma/mortality* ; Prognosis ; Bile Duct Neoplasms/mortality* ; Tomography, X-Ray Computed/methods* ; Aged ; Radiomics

Recent studies have indicated that the expression of ubiquitin-specific protease 51 (USP51), a novel deubiquitinating enzyme (DUB) that mediates protein degradation as part of the ubiquitin‒proteasome system (UPS), is associated with tumor progression and therapeutic resistance in multiple malignancies. However, the underlying mechanisms and signaling networks involved in USP51-mediated regulation of malignant phenotypes remain largely unknown. The present study provides evidence of USP51's functions as the prominent DUB in chemoresistant triple-negative breast cancer (TNBC) cells. At the molecular level, ectopic expression of USP51 stabilized the 78 kDa Glucose-Regulated Protein (GRP78) protein through deubiquitination, thereby increasing its expression and localization on the cell surface. Furthermore, the upregulation of cell surface GRP78 increased the activity of ATP binding cassette subfamily B member 1 (ABCB1), the main efflux pump of doxorubicin (DOX), ultimately decreasing its accumulation in TNBC cells and promoting the development of drug resistance both in vitro and in vivo. Clinically, we found significant correlations among USP51, GRP78, and ABCB1 expression in TNBC patients with chemoresistance. Elevated USP51, GRP78, and ABCB1 levels were also strongly associated with a poor patient prognosis. Importantly, we revealed an alternative intervention for specific pharmacological targeting of USP51 for TNBC cell chemosensitization. In conclusion, these findings collectively indicate that the USP51/GRP78/ABCB1 network is a key contributor to the malignant progression and chemotherapeutic resistance of TNBC cells, underscoring the pivotal role of USP51 as a novel therapeutic target for cancer management.

In recent decades, the prevalence of hyperuricemia and gout has increased dramatically due to lifestyle changes. The drugs currently recommended for hyperuricemia are associated with adverse reactions that limit their clinical use. In this study, we report that berberine (BBR) is an effective drug candidate for the treatment of hyperuricemia, with its mechanism potentially involving the modulation of gut microbiota and its metabolite, succinic acid. BBR has demonstrated good therapeutic effects in both acute and chronic animal models of hyperuricemia. In a clinical trial, oral administration of BBR for 6 months reduced blood uric acid levels in 22 participants by modulating the gut microbiota, which led to an increase in the abundance of Bacteroides and a decrease in Clostridium sensu stricto_1. Furthermore, Bacteroides fragilis was transplanted into ICR mice, and the results showed that Bacteroides fragilis exerted a therapeutic effect on uric acid similar to that of BBR. Notably, succinic acid, a metabolite of Bacteroides, significantly reduced uric acid levels. Subsequent cell and animal experiments revealed that the intestinal metabolite, succinic acid, regulated the upstream uric acid synthesis pathway in the liver by inhibiting adenosine monophosphate deaminase 2 (AMPD2), an enzyme responsible for converting adenosine monophosphate (AMP) to inosine monophosphate (IMP). This inhibition resulted in a decrease in IMP levels and an increase in phosphate levels. The reduction in IMP led to a decreased downstream production of hypoxanthine, xanthine, and uric acid. BBR also demonstrated excellent renoprotective effects, improving nephropathy associated with hyperuricemia. In summary, BBR has the potential to be an effective treatment for hyperuricemia through the gut-liver axis.

OBJECTIVES: 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. CONCLUSIONS 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.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To compare the efficacy of biplanar fixation combined with bone grafting and proximal femoral nail anti-rotation (PFNA) in the treatment of critically complicated osteoporotic intertrochanteric femoral fracture .Methods:A retrospective cohort study was conducted to analyze the clinical data of 28 patients with critically complicated osteoporotic intertrochanteric femoral fracture, admitted to Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2020 and December 2022, including 3 males and 25 females, aged 70-91 years [(79.4±6.3)years]. T score for bone mineral density was -2.5~-4.1 SD［（-3.3±0.6）SD］. All the patients were found with type A2.2-A3.3 fracture based on AO classification, and were complicated with trochanteric lateral wall fracture. Among them, 16 patients underwent biplanar fixation combined with bone grafting (biplanar fixation group), while 12 underwent PFNA internal fixation (PFNA group). All the patients received anti-osteoporosis therapy after surgery. The two groups were compared in terms of the operative time, intraoperative blood loss, hemoglobin levels at 3 days postoperatively, and time to weight-bearing. The visual analogue scale (VAS) scores and Harris hip scores at 1, 3, 6 months postoperatively, and at the last follow-up and the incidence of complications were also detected in the two groups.Results:All the patients were followed up for 12-16 months [(14.1±1.4)months]. In the biplanar fixation group, the operative time was (75.1±15.3)minutes, significantly longer than (45.6±14.2)minutes in the PFNA group ( P<0.01); the intraoperative blood loss was (234.1±11.8)ml, significantly more than (170.0±13.4)ml in the PFNA group ( P<0.01); the hemoglobin level at 3 days postoperatively was (82.6±9.3)g/L in the biplanar fixation group, higher than (64.8±6.8)g/L in the PFNA group ( P<0.01). The time to weight-bearing was (1.1±0.7)weeks in the biplanar fixation group, significantly shorter than (3.2±1.2)weeks in the PFNA group ( P<0.01). There were no statistically significant differences between the two groups in VAS scores and Harris hip scores at 1, 3, 6 months postoperatively, and at the last follow-up ( P>0.05). The VAS scores and Harris hip scores in the two groups were gradually improved with the prolongation of postoperative time ( P<0.05 or 0.01). No complications such as neurovascular injuries were observed in either group. One patient in the biplanar fixation group developed lower extremity deep vein thrombosis (DVT), with a complication rate of 6.3%, while 2 patients in the PFNA group developed lower extremity DVT and 4 hypostatic pneumonia, with a complication rate of 50.0% ( P<0.05). Conclusion:Compared with PFNA internal fixation, biplanar fixation with bone grafting has the advantages of less postoperative blood loss, earlier weight-bearing exercises and lower incidence of complications in the treatment of critically complicated osteoporotic intertrochanteric femoral fracture, despite longer operative time and more intraoperative blood loss.

By reconstructing the integrated Chinese and western medicine diagnostic and treatment system， the "Two Reconstructions" theoretical framework establishes a standardized pathway of "classification-staging-syndrome differentiation"， which improves the accuracy of disease identification and strengthens the capacity for full-course intervention； in addition， by reconstructing the modern materia medica system， it innovatively integrates the traditional properties and efficacy of Chinese herbal medicinals with modern pharmacological mechanisms， forming a "state-target co-regulation" precise medication model， and builds a dose-effect theoretical system for prescriptions and medicinals， thereby enhancing both the targeting accuracy and dosage precision of therapeutic interventions. The "Two Reconstructions" theorecitcal framework is a key strategy for enhancing clinical efficacy. It can precisely identify "states" and "targets" for directed intervention， shift the focus of prevention and treatment earlier to enable full-cycle management， establish standardized paradigms for reproducible and evaluable efficacy， and expand the scope of clinical practice to address conditions without typical syndromes and critical illnesses. As a systematic pathway for innovation in TCM， this theoretical framework provides valuable insights and references for promoting the high-quality development of integrative Chinese and western medicine.

Objective To compare the application effect of platelet rich fibrin(PRF)prepared at different centrifugal speeds in tooth extraction wounds using network meta-analysis statistical method.Methods PubMed,Co-chrane Library,Embase,Web of Science,CNKI,Wanfang,VIP and China Biology Medicine disc(CBM)databases were searched to collect the randomized controlled trials on the effect of PRF in tooth extraction from January 1,2024.Note-Express software was used to select literatures,RevMan5.3 was used to evaluate the quality of the included literatures,and Stata14.0 software was used to perform mesh meta-analysis on outcome indicators such as bone mineral density,bone height loss,visual analog scale of pain(VAS),dry groove,and bleeding after tooth extraction.Results A total of 31 randomized controlled trials were included,including 2 824 extraction sites,involving 7 rotational speeds for PRF preparation(3 000,2 800,2 700,2 300,1 500,1 400,1 300 r/min).The results of cu-mulative sequencing showed that PRF prepared by 2 700 r/min centrifugation had the best effect in improving bone mineral density.In terms of improving the buccal bone height,the PRF prepared by 2 700 r/min centrifu-gation had the best effect.In terms of pain improvement,PRF prepared by 1 500 r/min centrifugation had the best effect;PRF prepared by 2 500 r/min centrifugation had the best effect in reducing the incidence of dry trough.PRF prepared by 2 500 r/min centrifugation was the most effective in reducing bleeding.Conclusion Based on the available evidence,PRF prepared with 2 700 r/min has the best effect on improving bone density and bone height after tooth extraction.In terms of pain improvement,1 500 r/min was the most effective;2 500 r/min was the most effective in improving the incidence of dry trough and bleeding.

Objective:To investigate the impact of early invasive arterial blood pressure (IBP) monitoring on survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR).Methods:This retrospective cohort study analyzed 44 OHCA patients receiving ECPR between January 2021 and January 2023. Patients were divided into: Early intervention group : IBP established within 3 min of ECMO initiation; Late intervention group : IBP established after ICU admission. Baseline characteristics, ECMO parameters, and clinical outcomes were compared. Multivariable logistic regression (adjusted for age, initial rhythm, etc.) and Spearman's correlation were used.Results:This study included a total of 44 patients treated with OHCA and ECPR, divided into an early intervention group of 23 cases and a late intervention group of 21 cases. The early intervention group showed significantly higher: Survival to discharge (43.5% vs. 9.5%, P<0.05), Good neurological recovery (CPC 1-2: 34.8% vs. 9.5%, P<0.05).Early intervention independently predicted survival (adjusted OR=18.84, 95% CI:1.97-179.98, P=0.01). Stratified analysis by pH (cutoff 7.0) demonstrated consistent benefits in both pH>7.0 ( aOR=0.392, 95% CI:0.106-0.678) and pH≤7.0 subgroups ( aOR=0.385, 95% CI: 0.075-0.695; interaction P=0.183). Early IBP positively correlated with CPC scores ( ρ=0.40, P=0.007). Conclusions:Early IBP monitoring significantly improves survival and neurological outcomes in OHCA-ECPR patients, supporting its integration into standardized protocols.