Glioma is the most common primary malignant tumor of the central nervous system in adults. Despite the standard treatment of surgery combined with radiotherapy and chemotherapy, the prognosis for high-grade glioma patients remains poor, highlighting the urgent need to further explore its pathogenesis and develop new therapeutic strategies. This article reviews the research progress in the field of glioma in China in 2024, covering tumorigenesis mechanisms, tumor immune microenvironment composition, advances in imaging techniques and novel imaging agents, improvements in surgical approaches, mechanisms of radio- and chemoresistance, and explorations of new therapeutic modalities. These studies provide a solid theoretical foundation for advancing clinical diagnosis and treatment of gliomas and may offer new opportunities to improve patient outcomes.

In recent years,artificial intelligence(AI)has been widely used in the medical field.Research shows that medical AI can not only improve diagnosis and treatment efficiency,but also enable personalized health management and optimize the allocation of medical resources,demonstrating enormous potential.However,while"technology empowers",medical AI is also accompanied by a series of ethical paradoxes,mainly manifested as the conflict between technological innovation and the protection of humanistic value.Based on the AI ethical framework proposed by Italian philosophy and ethicist Floridi,this paper systematically analyzes paradoxical manifestations of medical AI and the possible causes in 5 core ethical principles:respecting autonomy,not harming,doing good,fairness,and interpretability.It also explains the causes of these paradoxes from technical,social,and philosophical levels,and puts forward the following coping strategies:first,to improve explainability,algorithm audit technology,differentiated data collection technology,privacy protection technology,and human supervision and control technology,strengthening technical governance;second,to improve ethical regulations and establish a dynamic ethical governance mechanism that adapts to the pace of technological development,a hierarchical management model,and a responsible innovation mechanism,further improving the legal and regulatory frameworks in terms of data security,algorithm ethical responsibility recognition,etc;and third,to establish a global collaborative system,build a global governance framework for medical AI,establish unified development and application standards,and promote cross-border policy coordination and technical standard docking.

Objective:Exploring the effect of radiofrequency ablation treatment to restore sinus rhythm on the improvement of functional mitral regurgitation (FMR) and cardiac structure in patients with atrial fibrillation combined with moderate or severe FMR, compared with drug therapy alone.Methods:This retrospective cohort study consecutively enrolled patients diagnosed with persistent atrial fibrillation and moderate or severe FMR who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2021. Forty-eight patients who were treated with radiofrequency ablation and maintained sinus rhythm were enrolled in the ablation group, and 63 patients who were treated with medication alone during the same period were in the medicine group. Patients in the ablation group and medicine group were matched in a 1∶1 ratio using a propensity score, and 41 patients were finally included in each of the 2 groups. All patients reexamined echocardiography after 3-month of treatment. The proportion of patients with FMR improvement and the differences in changes of cardiac structural and functional parameters were compared between groups.Results:After propensity score matching, the ablation group was aged (69.3±7.1) years with 21 males (51.2%) and the medicine group was aged (71.3±9.4) years with 21 males (51.2%). The echocardiography after 3-month of treatment showed the rate of FMR improvement was significantly higher in the ablation group than in the medicine group (19 (46.3%) vs. 33 (80.5%), P<0.001), and patients in the ablation group showed a significant decrease in FMR extent (Δmitral regurgitation area: (-1.30±2.64) cm 2 vs. (-3.55±2.50) cm 2, P<0.001), left atrial size (Δleft atrial diameter: (-0.17±3.78) mm vs. (-2.46±4.01) mm, P=0.009) and E/e′ (ΔE/e′:-2.54±7.34 vs.-6.34±7.08, P=0.021) compared with the medicine group. There was also a significant decrease in left ventricular size (Δleft ventricular end diastolic diameter: (-3.12±6.62) mm vs. (-0.73±3.62) mm, P=0.046) and significant increase in left ventricular ejection fraction (Δleft ventricular ejection fraction: (2.73±9.69) % vs. (-0.93±5.41) %, P=0.038) in ablation group. Conclusion:Performing radiofrequency ablation to restore sinus rhythm can effectively reduce the severity of mitral regurgitation and improve left atrial and left ventricular remodeling and cardiac function in patients with atrial fibrillation and FMR.

Perioperative neurocognitive disorders(PND)is one of the common complications in the perioperative period,especially in elderly patients,and the incidence of PND is high and it is closely related to the prognosis of surgery.The currently accepted pathogenesis of PND includes central nervous sys-tem inflammation,synaptic dysfunction,apoptosis,oxidative stress,and neurofibrillary tangles,etc.Mi-croRNAs(miRNAs),as key gene expression regulators of neurological development and function,are not only directly involved in these processes,but also indirectly affect PND development through the modulation of the microbiota-gut-brain axis,perioperative mood regulation,and postoperative pain.In this paper,we review the role of miRNA in regulating perioperative neurocognitive disorders,with the aim of providing new ideas for the diagnosis and prevention of PND,as well as for the development of targeted therapies for this disease.

Objective:To investigate the effect of subacute exposure of Di(2-ethylhexyl)phthalate(DEHP)on endometrial decidualization and early pregnancy miscarriage in mice.Methods:CD1 mice were orally administrated with 300(low-dose group),1000(medium-dose group),or 3000 mg·kg-1·d-1 DEHP(1/10 LD50,high-dose group)for 28 days,respectively.An early natural pregnancy model and an artificially induced decidualization model were established.The uterine tissues were collected on D7 of natural pregnancy and D8 of artificially induced decidualization,respectively.The effects of a subacute exposure to DEHP on the decidualization of mice were detected by HE staining,Masson staining,TUNEL assay,and Western blotting.A model of spontaneous abortion was constructed in mice after subacute exposure to 300 mg·kg-1·d-1 DEHP,and the effect of impaired decidualization on pregnancy was investigated by observing the pregnancy outcome on the 10th day of gestation.Results:Compared with the control group,the conception rate was significantly decreased in the high-dose DEHP subacute exposure group(P＜0.05).HE staining showed that,compared with the control group,the decidual stromal cells in the low-and medium-dose exposure groups were disorganized,the nuclei of the cells were irregular,the cytoplasmic staining was uneven,and the number of polymorphonuclear cells was significantly reduced.Masson staining showed that compared with the control group,the collagen fibers in the decidua region of the DEHP low-dose group and the medium-dose group were more distributed,more abundant and more disorderly.TUNEL assay showed increased apoptosis in the decidua area compared to the control group.Western blotting showed that the expression of BMP2,a marker molecule for endometrial decidualization,was significantly reduced(P＜0.05 or P＜0.01).The abortion rate and embryo resorption rate were increased,and the number of embryos,uterine wet weight,uterine area and placenta wet weight were decreased in DEHP low-dose group compared to the control group stimulated by mifepristone,an abortifacient drug(P＜0.05 or P＜0.01).Conclusion:Subacute exposure to DEHP leads to impaired endometrial decidualization during early pregnancy and exacerbates the risk of adverse pregnancy outcomes in mice.

Intensity-modulated radiotherapy (IMRT) is a radical treatment for oropharyngeal carcinoma. The 5-year overall survival (OS) is approximately 60%, and 80% for human papillomavirus (HPV)-related oropharyngeal carcinoma patients. Late toxicities after IMRT, including xerostomia, dysphagia, hypothyroidism, trismus, osteoradionecrosis and caries, and lower cranial neuropathy, seriously affect the quality of life of long-term survivors. The research on treatment de-intensification for HPV-related oropharyngeal cancer has been widely carried out at home and abroad, but there is little research focusing on late toxicity. In this article, related research progress in the incidence, treatment, prediction of late toxicity after IMRT was reviewed, aiming to provide reference for research on radiation-induced injury in de-intensification therapy research, thereby further optimizing comprehensive treatment strategies.

Objective:To compare the efficacy and safety of internal fixation using the olecranon osteotomy approach versus the bilateral triceps approach for the treatment of AO type C distal humeral fractures.Methods:We conducted a systematic search of China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese Medical Journal Full-Text Database, PubMed, Embase, Web of Science, and Cochrane Library for clinical studies comparing the olecranon osteotomy approach with the bilateral triceps approach for the treatment of AO type C distal humeral fractures. The search period was from January 2017 to March 2023. A meta-analysis was performed on the included studies. Random-effects models were used for analyses with high inter-group heterogeneity, while fixed-effects models were applied for those with low inter-group heterogeneity.Results:A total of 15 studies were included in the meta-analysis, comprising 480 cases treated via the olecranon osteotomy approach and 443 cases via the bilateral triceps approach. Meta-analysis results showed that the olecranon osteotomy approach was associated with longer operative time [ SMD=0.96, 95% CI(0.23, 1.70), P=0.010] and more intraoperative blood loss [ SMD=1.00, 95% CI(0.22, 1.78), P=0.012]compared to the bilateral triceps approach. There were no statistically significant differences between the two groups in postoperative Mayo Elbow Performance Score [ SMD=0.55, 95% CI(-0.23, 1.32), P=0.167], excellent and good reduction rate [ OR=0.98, 95% CI(0.75, 1.27), P=0.856], postoperative complication rate [ OR=1.27, 95% CI(0.77, 2.09), P=0.344], healing time [ SMD= -0.13, 95% CI(-0.37, 0.11), P=0.280], and range of motion of the elbow joint [ SMD=-0.02, 95% CI(-0.29, 0.26), P=0.891]. Conclusion:The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach. The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach.

Objective To design a mobile personnel radiation protection equipment for operation in environments with high radiation such as spent fuel reprocessing plants, to achieve simultaneous protection against γ radiation, neutron radiation, and radioactive aerosol, to reduce the internal and external exposure dose of radioactive workers, and to meet the requirement of operation for two hours. Methods The core parts of the mobile personnel radiation protection equipment included a shielding chamber and a respiratory maintenance system. An automated chassis was used for the movement and lifting of the shielding chamber. MCNP software was used to simulate and calculate the protective effects of shielding chamber made of different materials and material thicknesses. Experimental verification of the shielding chamber design was conducted. Mathematical models were established to describe the variations in the content of various gases in the chamber with personnel operation time. A respiratory maintenance system, a harmful gas absorption device, and an automated mobile chassis were designed. Results The shielding chamber made of polyethylene with a thickness of 80 mm achieved an 80% neutron shielding rate. The respiratory maintenance system could support workers for 2 hours of operation inside the equipment. The mobile chassis allowed operation of the equipment with one person. Conclusion This mobile personnel radiation protection equipment can solve the problem in simultaneous protection against γ radiation, neutron radiation, and radioactive aerosol. The equipment can provide radiation protection for radioactive workers, reduce exposure dose, and reduce personnel burden. This system provides technical means for the operation and maintenance of equipment in high-radiation sites such as spent fuel reprocessing plants.

Objective To investigate the feasibility of low-voltage,automatic tube current adjustment(ATCM)and low contrast agent concentration,dose and injection rate combined with full-model iterative re-construction(IMR)in vertebral artery V3-segment three-dimensional CT angiography(3DCTA).Methods A total of 60 patients with suspected upper cervical spine,craniocervical junction lesions undergoing cervical vertebral artery V3 segment 3DCTA in this hospital from November 2019 to May 2020 were selected and divided into the group A and B by adopting the random number table method,30 cases in each group.The group A adopted the ATCM technology of 80 kV,average tube current of 50 mAs,25 mL of contrast agent io-hexol(iodine content 300 mg/mL)combined IMR technology with an injection rate of 3 mL/s,while the group B adopted 120 kV,150 mAs fixed tube current,50 mL injection rate of 5 mL/s contrast agent iopamidol(iodine content 370 mg/mL)combined filter back projection(FBP)reconstruction technology.CT value,noise,signal-to-noise ratio(SNR),contrast noise ratio(CNR)and image sensitivity(FOM)were measured and compared between the two groups and the quality of the resulting images was evaluated.The CT volumet-ric dose index(CTDIvol)and dose-length product(DLP)were recorded,and the effective dose(ED)was cal-culated.Results There was no statistically significant difference in the vertebral arterial CT value between the two groups(P＞0.05),but the noise of the group A was lower than that of the group B(P＜0.05),SNR,CNR and FOM of the group A were greater than those of the group B(P＜0.05).The image quality of the two groups met the requirements of clinical diagnosis[(4.78±0.41)points vs.(4.85±0.35)points],and there was no statistically significant difference in the subjective evaluation of image quality(P＞0.05).The CTDIvol,DLP and ED levels in the group A were lower than those in the group B(P＜0.05).The iodine in-takes of contrast medium in the group A and group B were 7.5 g and 18.5 g,respectively,and the iodine flow rates of contrast agent were 0.9 and 1.85 mg/s,respectively,and compared with group B,the iodine intake and iodine flow rate of the group A were decreased by 59.5％and 51.4％,respectively.Conclusion Low tube voltage ATCM and low contrast concentration,dose and injection rate combined with IMR technology can not only ensure the 3DCTA image quality of vertebral artery V3 segment,but also reduce the radiation dose re-ceived by the patients,and reduce the iodine intake and iodine flow rate of contrast agent.

Objective To assess the feasibility of employing chip resistors for retrospective dose reconstruction following nuclear accidents, to examine the effects of storage temperature and storage time on the optically stimulated luminescence (OSL) characteristics of the chip resistors, and to explore measures to mitigate these effects. Methods Chip resistors were analyzed using automated instruments for measuring thermoluminescence and OSL manufactured by Risø in Denmark with various parameters to understand the impact of storage temperature and storage time on OSL signals. Results The OSL signals of chip resistors exhibited exponential attenuation within 10 min after irradiation, and then stabilized (count change < 10%) within 2-7 days of storage. The chip resistors exhibited linear dose responses within 1-3 days of storage after 0.1-2 Gy irradiation. OSL signals diminished as the storage temperature increased. However, preheating at 130 ℃ for 1 min effectively eliminated the differences caused by temperatures between 25 ℃ and 45 ℃. Conclusion The OSL signals of chip resistors are influenced by storage temperature and storage time. When preheated at 130 ℃ for 1 min, chip resistors stored for 1-7 days and at 25-45 ℃ exhibited OSL signal errors of 10% or less. This result emphasizes the importance of preheating for measurements in practical applications, thus providing a scientific approach and a solid foundation for the use of chip resistors in retrospective dose reconstruction.