1.The mechanism of epigallocatechin gallate enhancing the sensitivity of hepatocellular carcinoma cells to lenva-tinib
Chuanfang SONG ; Jiang AI ; Chao WEN ; Jie ZHANG ; Jianghe CUI
China Pharmacy 2025;36(18):2256-2261
OBJECTIVE To investigate the potential mechanism of epigallocatechin gallate (EGCG) enhancing the sensitivity of hepatocellular carcinoma (HCC) cells to lenvatinib based on the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway. METHODS Five human HCC cell lines (HepG2, Huh-7, SMMC-7721, SNU-368 and SNU-739) were used to evaluate the effects of lenvatinib alone and in combination with EGCG on survival rates, clone number, proliferation rate, invasion number and the expressions of mRNAs and proteins related to the PI3K/Akt signaling pathway. The PI3K activator insulin-like growth factor-1 (IGF-1) was introduced to investigate the effect of activating the PI3K/Akt signaling pathway on the sensitization effect of EGCG. RESULTS Compared with the control group, lenvatinib (10 μmol/L) and different concentrations of EGCG+ lenvatinib (1, 5 and 10 μg/mL EGCG+10 μmol/L lenvatinib) significantly reduced the survival rates and clone numbers of all five HCC cell lines in a dose-dependent manner (P<0.05). Lenvatinib (10 μmol/L) and EGCG+lenvatinib (10 μg/mL EGCG+10 μmol/L lenvatinib) also markedly inhibited the proliferation rate and invasion numbers of these cells, and decreased the mRNA expressions of PI3K, Akt, mammalian target of rapamycin (mTOR), P70S6K and 4EBP, and the phosphorylation levels of PI3K and Akt, as well as the protein expressions of mTOR and B cell lymphoma-2 (Bcl-2) in HepG2 cells or all five HCC cells; conversely, the mRNA and protein expressions of phosphatase and tensin homologue deleted on chromosome 10(PTEN), and the protein expressions of caspase-3 and cleaved caspase-3 were significantly upregulated, with more pronounced effects observed in the EGCG+lenvatinib group than in the lenvatinib group (P<0.05). Compared with the lenvatinib group and the EGCG+lenvatinib group, the clone number, proliferation rate and invasion number of HepG2 cells in the EGCG+lenvatinib+IGF-1 group (10 μg/mL EGCG+10 μmol/L lenvatinib+50 ng/mL IGF-1) were significantly increased (P<0.05). CONCLUSIONS EGCG can enhance the sensitivity of HCC cells to lenvatinib, and its underlying mechanism may be related to the inhibition of the activation of PI3K/Akt signaling pathway activation.
2.The mechanism of miR-148a inhibiting the proliferation of liver cancer cells by affecting macrophage M2 polarization through Wnt3a/β-catenin.
Guangyu HAN ; Naipeng ZHANG ; Xiufen LAN ; Lili SUN ; Huixin ZHANG
Chinese Journal of Cellular and Molecular Immunology 2025;41(9):790-797
Objective To investigate the mechanism by which miR-148a affects M2 macrophage polarization and inhibits liver cancer cell proliferation through Wnt3a/β-catenin. Methods The mRNA expression levels of miR-148a, CD206 and interleukin-10 (IL-10) in tumor tissues and adjacent non-tumor liver tissues of 84 patients with liver cancer were detected by real-time quantitative PCR. THP-1 cells were separated into blank group (conventional culture), M2 group (200 nmol/L phorbol ester, 20 ng/mL IL-4, 20 ng/mL IL-13), M2 combined with negative control (miR-NC) group (transfected with miR-NC on the basis of M2 group), M2 combined with miR-148a mimics (transfected with miR-148a mimics on the basis of M2 group) group, M2 combined with miR-148a mimics combined with Wnt3a (treated with 100 μg/L Wnt3a on top of M2 combined with miR-148a mimics group) group. The proliferation of HuH7 cells was detected by CCK-8 and EdU methods. Apoptosis and M2 macrophage marker CD206 was detected by flow cytometry. The level of IL-10 in cell supernatant was detected by chemiluminescence method; The mRNA levels of miR-148a, CD206 and IL-10 were detected by real-time quantitative PCR. The protein levels of Wnt3a and β-catenin were detected by Western blot. Results The expressions of CD206, IL-10 mRNA, Wnt3a and β-catenin in tumor tissue were higher than those in non-tumor liver tissues, and the miR-148a level was decreased. The mRNA expression of M2 macrophage markers CD206 and IL-10 were significantly increased. Compared with the blank group, the OD450 value, EdU positive rate, the mRNA expressions of CD206 and IL-10, the level of IL-10 in the supernatant, and the expressions of Wnt3a and β-catenin were increased in M2 group, while the apoptotic rate and miR-148a level were decreased. Compared with M2 group and M2 combined with miR-NC group, the OD450 value, EdU positive rate, the mRNA expressions of CD206 and IL-10, the level of IL-10 in the supernatant, and the expressions of Wnt3a and β-catenin were decreased in M2 combined with miR-148a mimics group, while the apoptotic rate and miR-148a level were increased. Wnt3a reversed the inhibitory effect of miR-148a overexpression on the proliferation of liver cancer cells. Conclusion Overexpression of miR-148a inhibits M2 polarization of macrophages and prevents the proliferation of liver cancer cells, which may be related to the inhibition of the Wnt3a/β-catenin pathway.
Humans
;
MicroRNAs/metabolism*
;
Wnt3A Protein/metabolism*
;
Liver Neoplasms/metabolism*
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Cell Proliferation/genetics*
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beta Catenin/genetics*
;
Macrophages/metabolism*
;
Interleukin-10/metabolism*
;
Apoptosis/genetics*
;
Cell Line, Tumor
;
Female
;
Male
;
Mannose Receptor
;
Lectins, C-Type/metabolism*
;
Mannose-Binding Lectins/metabolism*
;
Middle Aged
;
Receptors, Cell Surface/metabolism*
3.Spermine Synthase : A Potential Prognostic Marker for Lower-Grade Gliomas
Chen LIU ; Hongqi LI ; Xiaolong HU ; Maohui YAN ; Zhiguang FU ; Hengheng ZHANG ; Yingjie WANG ; Nan DU
Journal of Korean Neurosurgical Society 2025;68(1):75-96
Objective:
: The objective of this study was to assess the relationship between spermine synthase (SMS) expression, tumor occurrence, and prognosis in lower-grade gliomas (LGGs).
Methods:
: A total of 523 LGG patients and 1152 normal brain tissues were included as controls. Mann-Whitney U test was performed to evaluate SMS expression in the LGG group. Functional annotation analysis was conducted to explore the biological processes associated with high SMS expression. Immune cell infiltration analysis was performed to examine the correlation between SMS expression and immune cell types. The association between SMS expression and clinical and pathological features was assessed using Spearman correlation analysis. In vitro experiments were conducted to investigate the effects of overexpressing or downregulating SMS on cell proliferation, apoptosis, migration, invasion, and key proteins in the protein kinase B (AKT)/epithelialmesenchymal transition signaling pathway.
Results:
: The study revealed a significant upregulation of SMS expression in LGGs compared to normal brain tissues. High SMS expression was associated with certain clinical and pathological features, including older age, astrocytoma, higher World Health Organization grade, poor disease-specific survival, disease progression, non-1p/19q codeletion, and wild-type isocitrate dehydrogenase. Cox regression analysis identified SMS as a risk factor for overall survival. Bioinformatics analysis showed enrichment of eosinophils, T cells, and macrophages in LGG samples, while proportions of dendritic (DC) cells, plasmacytoid DC (pDC) cells, and CD8+ T cells were decreased.
Conclusion
: High SMS expression in LGGs may promote tumor occurrence through cellular proliferation and modulation of immune cell infiltration. These findings suggest the prognostic value of SMS in predicting clinical outcomes for LGG patients.
4.Spermine Synthase : A Potential Prognostic Marker for Lower-Grade Gliomas
Chen LIU ; Hongqi LI ; Xiaolong HU ; Maohui YAN ; Zhiguang FU ; Hengheng ZHANG ; Yingjie WANG ; Nan DU
Journal of Korean Neurosurgical Society 2025;68(1):75-96
Objective:
: The objective of this study was to assess the relationship between spermine synthase (SMS) expression, tumor occurrence, and prognosis in lower-grade gliomas (LGGs).
Methods:
: A total of 523 LGG patients and 1152 normal brain tissues were included as controls. Mann-Whitney U test was performed to evaluate SMS expression in the LGG group. Functional annotation analysis was conducted to explore the biological processes associated with high SMS expression. Immune cell infiltration analysis was performed to examine the correlation between SMS expression and immune cell types. The association between SMS expression and clinical and pathological features was assessed using Spearman correlation analysis. In vitro experiments were conducted to investigate the effects of overexpressing or downregulating SMS on cell proliferation, apoptosis, migration, invasion, and key proteins in the protein kinase B (AKT)/epithelialmesenchymal transition signaling pathway.
Results:
: The study revealed a significant upregulation of SMS expression in LGGs compared to normal brain tissues. High SMS expression was associated with certain clinical and pathological features, including older age, astrocytoma, higher World Health Organization grade, poor disease-specific survival, disease progression, non-1p/19q codeletion, and wild-type isocitrate dehydrogenase. Cox regression analysis identified SMS as a risk factor for overall survival. Bioinformatics analysis showed enrichment of eosinophils, T cells, and macrophages in LGG samples, while proportions of dendritic (DC) cells, plasmacytoid DC (pDC) cells, and CD8+ T cells were decreased.
Conclusion
: High SMS expression in LGGs may promote tumor occurrence through cellular proliferation and modulation of immune cell infiltration. These findings suggest the prognostic value of SMS in predicting clinical outcomes for LGG patients.
5.Quality evaluation of Euscaphis japonica from different habitats using chemometrics combined with weighted TOPSIS model
Yuqiu GAO ; Shuai ZHENG ; Xue YU ; Guihua ZOU ; Kai ZHANG
China Pharmacy 2025;36(14):1755-1759
OBJECTIVE To evaluate the quality of Euscaphis japonica from different habitats. METHODS The relative correction factors of gallic acid, protocatechuic acid, ellagic acid, isoquercitrin, astragalin and apigenin were calculated with quercetin as the internal reference; the relative correction factors of euscaphic acid, oleanolic acid, stigmasterol and β-sitosterol were also calculated with ursolic acid as the internal reference. The contents of 12 components in 18 batches of samples were calculated by QAMS method and were compared with external standard method. At the same time, the contents of water-soluble extract, alcohol-soluble extract, total ash and acid-insoluble ash were detected. The quality of E. japonica was evaluated by principal component analysis (PCA), orthogonal partial least squares-discriminant analysis (OPLS-DA), and weighted technique for order preference by similarity to ideal solution (TOPSIS) method. RESULTS There was no significant difference between the results of QAMS method and external standard method for the 12 components in the 18 batches of samples. However, notable content variations were observed among different batches of samples. The results of PCA and OPLS-DA showed that S1-S7, S8- S12, and S13-S18 were clustered into one category respectively. Seven key characteristic components variable importance in projection values >1, euscaphic acid, ursolic acid, protocatechuic acid, apigenin, β-sitosterol, isoquercitrin, and oleanolic acid, respectively. The analysis results of the weighted TOPSIS method revealed that the relative closeness for evaluating the quality of 18 batches of samples ranged from 0.283 5 to 0.644 1, with the samples of E. japonica from Fengjie, Chongqing, demonstrating the highest quality. CONCLUSIONS The established method is accurate and feasible, which can be used for the quality evaluation of E. japonica combined with chemometrics and weighted TOPSIS model.
6.Spermine Synthase : A Potential Prognostic Marker for Lower-Grade Gliomas
Chen LIU ; Hongqi LI ; Xiaolong HU ; Maohui YAN ; Zhiguang FU ; Hengheng ZHANG ; Yingjie WANG ; Nan DU
Journal of Korean Neurosurgical Society 2025;68(1):75-96
Objective:
: The objective of this study was to assess the relationship between spermine synthase (SMS) expression, tumor occurrence, and prognosis in lower-grade gliomas (LGGs).
Methods:
: A total of 523 LGG patients and 1152 normal brain tissues were included as controls. Mann-Whitney U test was performed to evaluate SMS expression in the LGG group. Functional annotation analysis was conducted to explore the biological processes associated with high SMS expression. Immune cell infiltration analysis was performed to examine the correlation between SMS expression and immune cell types. The association between SMS expression and clinical and pathological features was assessed using Spearman correlation analysis. In vitro experiments were conducted to investigate the effects of overexpressing or downregulating SMS on cell proliferation, apoptosis, migration, invasion, and key proteins in the protein kinase B (AKT)/epithelialmesenchymal transition signaling pathway.
Results:
: The study revealed a significant upregulation of SMS expression in LGGs compared to normal brain tissues. High SMS expression was associated with certain clinical and pathological features, including older age, astrocytoma, higher World Health Organization grade, poor disease-specific survival, disease progression, non-1p/19q codeletion, and wild-type isocitrate dehydrogenase. Cox regression analysis identified SMS as a risk factor for overall survival. Bioinformatics analysis showed enrichment of eosinophils, T cells, and macrophages in LGG samples, while proportions of dendritic (DC) cells, plasmacytoid DC (pDC) cells, and CD8+ T cells were decreased.
Conclusion
: High SMS expression in LGGs may promote tumor occurrence through cellular proliferation and modulation of immune cell infiltration. These findings suggest the prognostic value of SMS in predicting clinical outcomes for LGG patients.
7.Spermine Synthase : A Potential Prognostic Marker for Lower-Grade Gliomas
Chen LIU ; Hongqi LI ; Xiaolong HU ; Maohui YAN ; Zhiguang FU ; Hengheng ZHANG ; Yingjie WANG ; Nan DU
Journal of Korean Neurosurgical Society 2025;68(1):75-96
Objective:
: The objective of this study was to assess the relationship between spermine synthase (SMS) expression, tumor occurrence, and prognosis in lower-grade gliomas (LGGs).
Methods:
: A total of 523 LGG patients and 1152 normal brain tissues were included as controls. Mann-Whitney U test was performed to evaluate SMS expression in the LGG group. Functional annotation analysis was conducted to explore the biological processes associated with high SMS expression. Immune cell infiltration analysis was performed to examine the correlation between SMS expression and immune cell types. The association between SMS expression and clinical and pathological features was assessed using Spearman correlation analysis. In vitro experiments were conducted to investigate the effects of overexpressing or downregulating SMS on cell proliferation, apoptosis, migration, invasion, and key proteins in the protein kinase B (AKT)/epithelialmesenchymal transition signaling pathway.
Results:
: The study revealed a significant upregulation of SMS expression in LGGs compared to normal brain tissues. High SMS expression was associated with certain clinical and pathological features, including older age, astrocytoma, higher World Health Organization grade, poor disease-specific survival, disease progression, non-1p/19q codeletion, and wild-type isocitrate dehydrogenase. Cox regression analysis identified SMS as a risk factor for overall survival. Bioinformatics analysis showed enrichment of eosinophils, T cells, and macrophages in LGG samples, while proportions of dendritic (DC) cells, plasmacytoid DC (pDC) cells, and CD8+ T cells were decreased.
Conclusion
: High SMS expression in LGGs may promote tumor occurrence through cellular proliferation and modulation of immune cell infiltration. These findings suggest the prognostic value of SMS in predicting clinical outcomes for LGG patients.
8.Effects and mechanism of limonin on renal lesion,glucose metabolism,inflammation and oxidative stress in gestational diabetic rats
Na QU ; Kai ZHANG ; Lisha NA ; Ying CUI
China Pharmacy 2025;36(9):1082-1086
OBJECTIVE To explore the effects of limonin on renal lesions, glucose metabolism, inflammation, and oxidative stress in gestational diabetic rats and its possible mechanisms. METHODS The model of gestational diabetic rats was established by intraperitoneal injection of streptozotocin. The diabetic rats were divided into the model group (intragastrical administration and tail vein injection of equal volume of normal saline), limonin low-, medium-, and high-dose groups (intragastrical administration of limonin, at doses of 12.5, 25.0 and 50.0 mg/kg, and equal volume of normal saline into the tail vein), and combination group [intragastrical administration of limonin 50.0 mg/kg + tail vein injection of c-Jun N-terminal kinase (JNK) activator Anisomycin 2 mg/kg ], with 12 rats in each group. In addition, 12 pregnant rats were selected as the control group (intragastrical administration and tail vein injection of equal volume of normal saline). They were given relevant medicine, once a day, for 14 consecutive days. After the last administration, fasting blood glucose (FBG), the levels of fasting insulin (FINS), interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) in the serum were detected; the levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), blood urea nitrogen (BUN), and creatinine (Cr) in the renal tissue were detected; the pathological changes of renal tissue were observed; the expressions of proteins related to the JNK/nuclear factor-κB (NF-κB) signaling pathway in the renal tissue were detected. RESULTS Compared with control group, in model group, the rats showed pathological injuries in the kidney tissue, such as glomerular atrophy, edema of renal tubular epithelial cells; the levels of FBG, FINS, IL-1β, IL-6, TNF-α, MDA, BUN and Cr, HOMA-IR, as well as the phosphorylation levels of JNK and NF-κB 0453-6602005。E-mail:mcvi45@163.com p65 proteins were increased significantly (P<0.05), while the levels of SOD and GSH-Px were decreased significantly (P<0.05). Compared with model group, in each dose group of limonin, the degree of renal tissue lesions in rats was alleviated, and the above-mentioned indicators were significantly improved (P<0.05), showing an obvious dose-effect relationship (P<0.05). Compared with high-dose limonin group, in the combination group, the degree of renal tissue lesions in rats was relatively aggravated, and the changes in the above-mentioned indicators were significantly reversed (P<0.05). CONCLUSIONS Limonin has a certain improvement effect on renal lesions, glucose metabolism, inflammation, and oxidative stress in pregnant rats with gestational diabetes. Its mechanism may be related to the inhibition of the JNK/NF-κB signaling pathway.
9.Comparative analysis of sporadic and von Hippel-Lindau syndrome-associated intracranial hemangioblastomas:clinical features and survival ending
Lixin XU ; Xuanshi LIU ; Xinru XIAO ; Hongqi ZHANG
Chinese Journal of Cerebrovascular Diseases 2025;22(7):439-452
Objective To investigate the differences in clinical characteristics,surgical outcomes,and prognosis between sporadic intracranial hemangioblastoma(IC-HB)and von Hippel-Lindau(VHL)syndrome-associated IC-HB.Methods A retrospective consecutive series of patients who underwent microsurgical resection at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,between April 2014 and January 2024,with postoperative pathological confirmation of IC-HB,was included.Clinical and imaging data were collected,including demographics(sex,age),preoperative clinical manifestations(asymptomatic,headache,dizziness,vertigo or imbalance,blurred vision or papilledema,nausea or vomiting,other symptoms),number of symptoms,lesion type(solid or solid-cystic),lesion size(volume,longest diameter,anteroposterior diameter,superoinferior diameter,transverse diameter),lesion location(cerebellar region:hemisphere,vermis;brainstem region:medulla oblongata,fourth ventricle;skull base region:cerebellopontine angle,jugular foramen,petroclival region),Karnofsky performance status(KPS)score(preoperative,postoperative;KPS score>70 and 70),surgical information,and follow-up data.Based on past medical history,family history,and VHL gene test results,patients were classified into sporadic IC-HB and VHL syndrome-associated IC-HB groups.Differences in clinical characteristics,surgical outcomes,and follow-up status were compared between the groups.Improved outcomes were defined as increases in KPS scores over 0 at 6-month follow-ups in comparison with preoperative KPS,while non-improved outcomes were defined by unchanged or decreased(>0 point)KPS scores.Survival outcomes,including postoperative recurrence(newly occurring abnormally enhancing nodules at the surgical site or periphery with continuous development during follow-ups.Recurrence could be verified through the combination of imaging enhancement features,clinical manifestations and post-operative pathological examinations),postoperative KPS improvement,and death of any cause during follow-up.The outcomes of postoperative KPS improvement versus non-improvement(unchanged or worsened)were analyzed through univariate analysis with the Firth penalized maximum likelihood Logistic regression model.Variables meeting the criteria(P<0.05 in univariate analysis,clinical importance,statistical model feasibility)were included in a multivariate Logistic regression model to identify independent factors influencing functional outcomes.Survival outcomes were analyzed using Cox proportional hazards regression models.Kaplan-Meier survival analysis was used to assess recurrence-free survival rates between groups with the Log-rank test.Furthermore,univariate and multivariate Logistic regression analyses were performed separately for the sporadic IC-HB and VHL syndrome-associated IC-HB subgroups to explore independent factors for postoperative KPS improvement.Results A total of 82 IC-HB patients(41 male,41 female),aged 11-73 years(mean[42±15]years),were included.Among which,68 had sporadic IC-HB and 14 had VHL syndrome-associated IC-HB.39 patients had improved postoperative KPS and 43 patients showed no improvements in KPS scores.(1)For clinical characteristics,the age of onset was younger in the VHL syndrome-associated IC-HB group([35±14]years vs.[44±15]years,P=0.044).Lesions in VHL syndrome-associated IC-HB patients were more likely to involve the brainstem and adjacent critical structures(8/14 of which involved medulla oblongata),while sporadic IC-HB was more common in the cerebellar hemispheres(70.6%[48/68]).The distribution of lesion location across cerebellar,skull base,and brainstem regions differed significantly between groups(P=0.015),while other characteristics showed no significant differences(all P>0.05).(2)For treatment and follow-ups,all patients underwent gross total microsurgical resection.Preoperative angiography via femoral artery was performed in 22 patients,with partial preoperative embolization in 4 patients.Postoperatively,KPS improved in 39 patients,remained unchanged in 33 patients,and worsened in 10 patients.The change in KPS scores pre-to post-operatively did not differ significantly between groups(P=0.707).The recurrence rate was higher in the VHL syndrome-associated IC-HB group(4/14 vs.5.9%[4/68],P=0.026),but there was no significant difference in mortality(P=0.999).(3)For analysis of factors influencing postoperative KPS improvement,univariate Logistic regression showed preoperative asymptomatic(OR,0.05,95%CI0.00-0.39,P=0.002),preoperative dizziness(OR,2.62,95%CI 1.09-6.47,P=0.031),vertigo/imbalance(OR,3.60,95%CI 1.04-15.45,P=0.043),nausea/vomiting(OR,4.49,95%CI 1.65-13.53,P=0.003),preoperative symptoms(OR,2.27,95%CI 1.46-3.86,P<0.01)and preoperative KPS ≤70(OR,7.65,95%CI 1.60-74.47,P=0.009)were strongly associated with KPS improvement.Multivariate Logistic regression only identified the number of preoperative symptoms as an independent predictor of postoperative KPS improvement(OR,2.44,95%CI 1.04-6.32,P=0.049).(4)For survival outcome analysis,no significant differences in the risk of postoperative recurrence,KPS improvement,or death were observed between the VHL syndrome-associated and sporadic IC-HB patients(recurrence:HR,4.88,95%CI 0.97-24.69,P=0.055;KPS improvement:HR,0.60,95%CI 0.25-1.43,P=0.246;mortality:P=0.999).Kaplan-Meier curves showed no statistically significant difference in recurrence-free survival rate between groups(P=0.053).(5)In the subgroup analysis,in sporadic IC-HB patients,multivariate Logistic regression identified the number of preoperative symptoms as an independent predictor of postoperative KPS improvement(OR,1.97,95%CI 1.14-3.68,P=0.021).Due to the small sample size,reliable parameter estimation was not possible for the VHL syndrome-associated IC-HB subgroup due to the small sample size.Conclusions VHL syndrome-associated IC-HB patients have a higher risk of recurrence in comparison with sporadic IC-HB patients.The number of preoperative symptoms can guide survival ending assessment.
10.Research advances in cerebral proliferative angiopathy
Yi LI ; Yongjie MA ; Ao QIN ; Hongqi ZHANG ; Xin SU
Chinese Journal of Cerebrovascular Diseases 2025;22(11):777-784
Cerebral proliferative angiopathy(CPA)was initially regarded as a variant of arteriovenous malformation.However,its distinct histological,angiographic,and pathophysiological features have led to its reclassification as an independent entity.CPA is an exceptionally rare form of cerebral vascular malformation,its pathogenesis is primarily linked to diffuse vascular proliferation secondary to chronic hypoperfusion.Clinically,CPA presents with a heterogeneous spectrum of manifestations,most commonly severe headaches and epileptic seizures.Neuroimaging(MR)typically reveals a complex interplay of aberrant vessels within the brain parenchyma,which may complicate the clinical management and lead to a higher rate of poor prognosis.This article reviewed current knowledge on the pathogenesis,epidemiology,clinical features,diagnostic approaches,and treatment options for CPA,with the aim of enhancing understanding of its underlying mechanisms and guiding future therapeutic strategy optimizations.

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