Objective: To explore the feasibility of constructing a lung cancer early-warning risk model based on facial image features, providing novel insights into the early screening of lung cancer. Methods: This study included patients with pulmonary nodules diagnosed at the Physical Examination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 1, 2019 to December 31, 2024, as well as patients with lung cancer diagnosed in the Oncology Departments of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine and Longhua Hospital during the same period. The facial image information of patients with pulmonary nodules and lung cancer was collected using the TFDA-1 tongue and facial diagnosis instrument, and the facial diagnosis features were extracted from it by deep learning technology. Statistical analysis was conducted on the objective facial diagnosis characteristics of the two groups of participants to explore the differences in their facial image characteristics, and the least absolute shrinkage and selection operator (LASSO) regression was used to screen the characteristic variables. Based on the screened feature variables, four machine learning methods: random forest, logistic regression, support vector machine (SVM), and gradient boosting decision tree (GBDT) were used to establish lung cancer classification models independently. Meanwhile, the model performance was evaluated by indicators such as sensitivity, specificity, F1 score, precision, accuracy, the area under the receiver operating characteristic (ROC) curve (AUC), and the area under the precision-recall curve (AP). Results: A total of 1 275 patients with pulmonary nodules and 1 623 patients with lung cancer were included in this study. After propensity score matching (PSM) to adjust for gender and age, 535 patients were finally included in the pulmonary nodule group and the lung cancer group, respectively. There were significant differences in multiple color space metrics (such as R, G, B, V, L, a, b, Cr, H, Y, and Cb) and texture metrics [such as gray-levcl co-occurrence matrix (GLCM)-contrast (CON) and GLCM-inverse different moment (IDM)] between the two groups of individuals with pulmonary nodules and lung cancer (P < 0.05). To construct a classification model, LASSO regression was used to select 63 key features from the initial 136 facial features. Based on this feature set, the SVM model demonstrated the best performance after 10-fold stratified cross-validation. The model achieved an average AUC of 0.8729 and average accuracy of 0.799 0 on the internal test set. Further validation on an independent test set confirmed the model’s robust performance (AUC = 0.823 3, accuracy = 0.729 0), indicating its good generalization ability. Feature importance analysis demonstrated that color space indicators and the whole/lip Cr components (including color-B-0, wholecolor-Cr, and lipcolor-Cr) were the core factors in the model’s classification decisions, while texture indicators [GLCM-angular second moment (ASM)_2, GLCM-IDM_1, GLCM-CON_1, GLCM-entropy (ENT)_2] played an important auxiliary role. Conclusion The facial image features of patients with lung cancer and pulmonary nodules show significant differences in color and texture characteristics in multiple areas. The various models constructed based on facial image features all demonstrate good performance, indicating that facial image features can serve as potential biomarkers for lung cancer risk prediction, providing a non-invasive and feasible new approach for early lung cancer screening.

An ideal dermal filler should integrate filling, repair, and anti-aging effects, with immediate tissue augmentation, slow degradation, and progressive stimulation of collagen regeneration. However, commonly used hyaluronic acid (HA) hydrogels, while effective for rapid filling, suffer from limited duration of support, weak cell adhesion, and an inability to promote collagen regeneration. Silk fibroin (SF), a natural protein from silkworm cocoons, is known for its excellent cell adhesion and collagen-stimulating abilities. However, its limited gelation capability restricts its potential application as a standalone injectable hydrogel. Based on a complementary strategy, this study combines the rapid gelling properties of HA with the collagen regenerative properties of SF to create a co-crosslinked HA-SF hydrogel. The composite hydrogel merges HA's rapid filling effect with SF's strong tissue adhesion and collagen-stimulating abilities. The formulation, physicochemical properties, degradation, biocompatibility, and filling effects of the HA-SF hydrogel were systematically investigated. HA-SF hydrogel exhibits excellent mechanical properties and ensures long-term support while maintaining injectability. Interestingly, after intradermal injection in the UVB-induced photoaging model, HA-SF hydrogel not only enhances hydrogel-cell interaction but also continues to stimulate collagen regeneration, especially type III collagen. This dual action achieves the biological effects of repair and anti-aging while maintaining the filling effect. Proteomic analysis confirms that repair and anti-aging effects are enhanced by the regulation of skin fibroblasts and modulation of amino acid and lipid metabolism. This composite hydrogel holds strong promise for clinical applications, offering a safer, long-lasting, and more natural injectable filler that combines filling, repair, and anti-aging into one system.

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a severe critical condition marked by rapid progression and high fatality. It results from direct/indirect lung-related or systemic triggers, leading to widespread injury of lung epithelial and endothelial cells. Its pathogenesis involves uncontrolled inflammation and breakdown of the lung's blood-air barrier due to leaky blood vessels and epithelial damage. Current management of ALI/ARDS remains primarily supportive, offering symptomatic relief but limited improvement in prognosis, necessitating deeper exploration of upstream pathogenic mechanisms to identify safer and more effective therapies. Exosomal microRNAs (miRNA), small extracellular vesicles (40-150 nm) containing non-coding single-stranded RNAs, regulate post-transcriptional cellular processes and participate in ALI/ARDS pathophysiology. Studies reveal that exosomes transport proteins, nucleic acids, and miRNAs to recipient cells, mediating intercellular communication. In ALI/ARDS models, exosomal miRNAs delivered to alveolar epithelial cells, endothelial cells, macrophages, and neutrophils critically modulate autophagy, pyroptosis, apoptosis, proliferation, inflammatory signaling, macrophage polarization, and neutrophil activation, either exacerbating or alleviating disease progression. Recent advances in engineering techniques have enhanced the therapeutic potential of exosomal miRNAs by overcoming limitations of natural exosomes. This review focuses on exosomal miRNA-mediated regulation of ALI/ARDS pathogenesis across key cell types, providing insights for novel therapeutic strategies.
Exosomes ; Humans ; MicroRNAs ; Acute Lung Injury ; Respiratory Distress Syndrome ; Animals

Narrative medicine,as an emerging discipline,has rapidly developed in the context of the current era of emphasis on medical humanities.The parallel chart is an essential tool for implementing humanistic practice in narrative medicine,while medical records and medical conversations are the carriers of traditional Chinese medicine(TCM)academic viewpoints and humanistic thoughts.Although there are differences in the textual content between them,the concept of"people-oriented"in TCM aligns with the spirit of narrative medicine.Medical records teaching is an important link for cultivating TCM clinical thinking and medical humanistic thought.Therefore,examining TCM medical records and humanistic education from the perspective of narrative medicine,sorting out the connections and differences between TCM medical records and parallel charts,and emphasizing the educational and guiding value of narrative medicine in the modern TCM diagnosis and treatment process,are of great significance for establishing and promoting TCM-featured parallel charts,thereby guiding the education and teaching of TCM,and cultivating new-era TCM talents with empathy and reflective capabilities.

Objective To investigate the efficacy of Qizhu Bishi Granules combined with methotrexate in the treatment of patients with rheumatoid arthritis (RA). Methods A total of 140 RA patients in the Shijiazhuang City Third Hospital from January to May 2023 were selected as research objects and randomly divided into a treatment group and a control group, with 70 cases in eachgroup. The control group was treated with methotrexate, while the treatment group was treated with Qizhu Bishi Granules combined with methotrexate, and the treatment duration was 3 months for both groups. The total effective rate, score of traditional Chinese medicine (TCM) syndromes, the number of swollen joints, the number of tender joints, the Visual Analogue Scale (VAS) score for pain, the Disease Activity Score in 28 Joints (DAS28), interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), erythrocyte sedimentation rate (ESR), high-sensitivity C reactive protein (hs-CRP), rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP antibody) levels before treatment and at 1 month and 3 months after treatment as well as therapeutic safety were compared between the two groups. Results The total effective rate in the treatment group was 97.14%, which was significantly higher than 87.14% in the control group (P < 0.05). After 1 month and 3 months of treatment, the scores of TCM syndromes, the number of swollen joints, the number of tender joints, the VAS score, DAS28, IL-1, TNF-α, ESR, hs-CRP, RF and anti-CCP antibody levels in the treatment group were significantly lower than those in the control group (P < 0.05). No adverse reactions occurred in both group. Conclusion Qizhu Bishi Granules combined with methotrexate in treating RA can effectively alleviate clinical symptoms, improve TCM syndromes, reduce inflammatory responses, decrease disease activity, and the therapeutic efficacy is reliable and safe.

Objective:To explore the clinical efficacy of disease-modifying drug nusinersen on children with spinal muscular atrophy.Methods:The baseline and longitudinal clinical data of 15 children who were treated with nusinersen in the Children′s Hospital, Zhejiang University School of Medicine from October 2019 to October 2021 were retrospectively collected. The general data (gender, age, genotype, and clinical classification, etc.), motor function, nutritional status, scoliosis and respiratory function were analyzed. Wilcoxon rank-sum test was used for comparing multi-system conditions before and after treatment.Results:The age of 15 cases (7 males, 8 females) was 6.8 (2.8, 8.3) years, with 2 cases of type 1, 6 cases of type 2, and 7 cases of type 3 respectively, and the course of disease was 55.0 (21.0, 69.0) months. After 9.0 (9.0, 24.0) months of treatment, the motor function scale evaluations of the Hammersmith neurological examination section 2 (13.0 (7.0, 23.0) vs. 18.0 (10.0, 25.0) scores, Z=-2.67, P=0.018) of 15 children, the Hammersmith functional motor scale expanded (38.0 (18.5, 45.5) vs. 42.0 (23.0, 51.0) scores, Z=-2.38, P=0.018), and the revised upper limb module (27.0 (19.5, 32.0) vs. 33.0 (22.5, 35.5) scores, Z=-2.52, P=0.012) of children with type 2 and 3 had significantly improved. Thirteen patients achieved clinically significant motor function improvement, and 2 of them had kept stable scale scores. Subjective reports also indicated that the muscle strength and daily exercise ability of these children improved after treatment, and no serious adverse reactions were reported. Supplemented by the multi-disciplinary team management, the levels of some indicators such as Cobbs angle of scoliosis and forced vital capacity all had significantly improved (all P<0.05). Conclusions:Nusinersen can improve the motor function of patients with 5q spinal muscular atrophy, which is also proved safe to be used in children. The drug treatment supplemented by the multi-disciplinary team management is helpful to improve the multi-system function of the children with spinal muscular atrophy.

Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.

Objective To determine the levels of monocyte chemotactic protein-3(MCP-3) and microvessel density (MVD) labeled by CD34 in skeletal muscle of patients with dermatomyositis (DM) and polymyositis (PM),so as to investigate the pathogenesis of DM/PM.Methods The expression of MCP-3 and MVD were detected in DM/PM patients and the healthy controls by using the immunohistochemical method.Results The positive expression rate of MCP-3 in DM group and PM group were higher than that in the control group (P ＜ 0.001,respectively).The microvessel marked by CD34 could be observed in muscle tissue of patients in DM group and PM group,and MVD in DM group and PM group was higher than that in the control group (P ＜ 0.001).No significant differences in the level of MCP-3 and MVD in the muscle tissue were found between the DM group and the PM group.The positive correlation between MCP-3 protein expression and MVD changes in the muscle tissue of patients inDM group and PM group was revealed (r =0.685/0.634,P ＜ 0.05).Conclusion The muscle tissue of DM/PM patients may have a new blood vessel formation,MCP-3 may be involved the process of new blood vessel formation in DM/PM.

Objective By detecting vascular cysteine-rich 61(Cyr61) related factor,connective tissue growth factor (CTGF),vascular endothelial growth factor (VEGF) and CD105 markers of microvascular density (MVD) of muscle tissue in patients with PM/DM,the role and significance of the expression of Cyr61,CTGF,VEGF and CD105 in the process of vascular lesions of dermatomyosits (DM) and polymyosits (PM) were discussed.Methods The expression of Cyr61,CTGF,VEGF and CD105 markers of micro vascular density (MVD) were detected in 10 cases of DM,10 cases of PM and 20 controls by using immunohistochemical Envision two step method.Data were analyzed using Statistical Product and Service Solutions (SPSS) statistical software.Fisher's exact probability analysis and Spearman correlation analysis were conducted.Results Compared with the control group,Cyr61,CTGF,VEGF positive expression rate in muscle tissue of patients with DM and PM group were significantly different (P＜0.01),the positive expression rates of Cyr61,CTGF,VEGF in DM group and PM group were 90％,70％,90％,80％,80％,70％,and the control group (5％,10％,5％) respectively.In the muscle tissue of patients with DM and PM group,CD105 markers of capillaries could be seen,and MVD in DM and PM group were higher than that in the control group,the difference was statistically significant (F=8.103,P=0.001).Cyr61,CTGF and VEGF protein expression levels in muscle tissueof patients with DM and PM were positively correlated with MVD.Conclusion The muscle tissue of PM/DMpatients may have new blood vessels formation.Cyr61,CTGF,VEGF may be involved in the formation of newblood vessels in the PM/DM muscle tissue.The results of this study suggest that microvascular lesion plays animportant role in the immune pathogenesis of inflammatory myopathy such as PM/DM.