AIM: To investigate the influence of pterygium thickness and area on corneal refractive status.METHODS: Prospective longitudinal study. A total of 60 cases(60 eyes)of pterygium patients admitted to our hospital from January 2024 to September 2024 were randomly selected. All patients underwent pterygium excision combined with pedicle conjunctival flap transplantation for treatment. Optical coherence tomography(OCT)was used to measure the preoperative thickness of patient's pterygium, and a digital slit lamp microscope was used to measure the area of pterygium. The corneal refractive status(degree of corneal astigmatism and average curvature)and changes in uncorrected visual acuity of patients before surgery, 1 d, 1, and 3 mo after surgery were compared. The relationship between preoperative thickness and area of pterygium in patients and corneal refractive status indicators at different postoperative time points were analyzed, and Logistic regression was used to analyze the impact of pterygium thickness and area on postoperative visual improvement in patients.RESULTS: All patients completed follow-up after surgery for 3 mo. At 3 mo after surgery, visual acuity improved in 21 eyes(35%). The results of bivariate Pearson correlation analysis showed that the thickness and area of pterygium positively correlated with the degree of corneal astigmatism and uncorrected visual acuity before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05), and negatively correlated with the average corneal curvature before surgery and 1 d, 1, and 3 mo after surgery(all P<0.05). Logistic regression analysis showed that the thickness and area of pterygium before surgery, high degree of corneal astigmatism, and low uncorrected visual acuity(large LogMAR value)were all risk factors for poor postoperative visual improvement in patients(OR>1, P<0.05). The large average corneal curvature before surgery was a protective factor for poor postoperative visual improvement in patients(OR<1, P<0.05).CONCLUSION: The increase in thickness and area of pterygium can, to some extent, improve corneal astigmatism, reduce the average curvature of the cornea, and affect postoperative visual recovery.

Tumor drug resistance is an important problem in the failure of chemotherapy and targeted drug therapy, which is a complex process involving chromatin remodeling. SWI/SNF is one of the most studied ATP-dependent chromatin remodeling complexes in tumorigenesis, which plays an important role in the coordination of chromatin structural stability, gene expression, and post-translation modification. However, its mechanism in tumor drug resistance has not been systematically combed. SWI/SNF can be divided into 3 types according to its subunit composition: BAF, PBAF, and ncBAF. These 3 subtypes all contain two mutually exclusive ATPase catalytic subunits (SMARCA2 or SMARCA4), core subunits (SMARCC1 and SMARCD1), and regulatory subunits (ARID1A, PBRM1, and ACTB, etc.), which can control gene expression by regulating chromatin structure. The change of SWI/SNF complex subunits is one of the important factors of tumor drug resistance and progress. SMARCA4 and ARID1A are the most widely studied subunits in tumor drug resistance. Low expression of SMARCA4 can lead to the deletion of the transcription inhibitor of the BCL2L1 gene in mantle cell lymphoma, which will result in transcription up-regulation and significant resistance to the combination therapy of ibrutinib and venetoclax. Low expression of SMARCA4 and high expression of SMARCA2 can activate the FGFR1-pERK1/2 signaling pathway in ovarian high-grade serous carcinoma cells, which induces the overexpression of anti-apoptosis gene BCL2 and results in carboplatin resistance. SMARCA4 deletion can up-regulate epithelial-mesenchymal transition (EMT) by activating YAP1 gene expression in triple-negative breast cancer. It can also reduce the expression of Ca²⁺ channel IP3R3 in ovarian and lung cancer, resulting in the transfer of Ca²⁺ needed to induce apoptosis from endoplasmic reticulum to mitochondria damage. Thus, these two tumors are resistant to cisplatin. It has been found that verteporfin can overcome the drug resistance induced by SMARCA4 deletion. However, this inhibitor has not been applied in clinical practice. Therefore, it is a promising research direction to develop SWI/SNF ATPase targeted drugs with high oral bioavailability to treat patients with tumor resistance induced by low expression or deletion of SMARCA4. ARID1A deletion can activate the expression of ANXA1 protein in HER2+ breast cancer cells or down-regulate the expression of progesterone receptor B protein in endometrial cancer cells. The drug resistance of these two tumor cells to trastuzumab or progesterone is induced by activating AKT pathway. ARID1A deletion in ovarian cancer can increase the expression of MRP2 protein and make it resistant to carboplatin and paclitaxel. ARID1A deletion also can up-regulate the phosphorylation levels of EGFR, ErbB2, and RAF1 oncogene proteins.The ErbB and VEGF pathway are activated and EMT is increased. As a result, lung adenocarcinoma is resistant to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Although great progress has been made in the research on the mechanism of SWI/SNF complex inducing tumor drug resistance, most of the research is still at the protein level. It is necessary to comprehensively and deeply explore the detailed mechanism of drug resistance from gene, transcription, protein, and metabolite levels by using multi-omics techniques, which can provide sufficient theoretical basis for the diagnosis and treatment of poor tumor prognosis caused by mutation or abnormal expression of SWI/SNF subunits in clinical practice.

OBJECTIVE: To investigate the effect of zedoarondiol on neovascularization of atherosclerotic (AS) plaque by exosomes experiment. METHODS: ApoE^-/- mice were fed with high-fat diet to establish AS model and treated with high- and low-dose (10, 5 mg/kg daily) of zedoarondiol, respectively. After 14 weeks, the expressions of anti-angiogenic protein thrombospondin 1 (THBS-1) and its receptor CD36 in plaques, as well as platelet activation rate and exosome-derived miR-let-7a were detected. Then, zedoarondiol was used to intervene in platelets in vitro, and miR-let-7a was detected in platelet-derived exosomes (Pexo). Finally, human umbilical vein endothelial cells (HUVECs) were transfected with miR-let-7a mimics and treated with Pexo to observe the effect of miR-let-7a in Pexo on tube formation. RESULTS: Animal experiments showed that after treating with zedoarondiol, the neovascularization density in plaques of AS mice was significantly reduced, THBS-1 and CD36 increased, the platelet activation rate was markedly reduced, and the miR-let-7a level in Pexo was reduced (P<0.01). In vitro experiments, the platelet activation rate and miR-let-7a levels in Pexo were significantly reduced after zedoarondiol's intervention. Cell experiments showed that after Pexo's intervention, the tube length increased, and the transfection of miR-let-7a minics further increased the tube length of cells, while reducing the expressions of THBS-1 and CD36. CONCLUSION Zedoarondiol has the effect of inhibiting neovascularization within plaque in AS mice, and its mechanism may be potentially related to inhibiting platelet activation and reducing the Pexo-derived miRNA-let-7a level.
Animals ; MicroRNAs/genetics* ; Exosomes/drug effects* ; Plaque, Atherosclerotic/genetics* ; Neovascularization, Pathologic/genetics* ; Human Umbilical Vein Endothelial Cells/metabolism* ; Humans ; Blood Platelets/drug effects* ; Apolipoproteins E/deficiency* ; Thrombospondin 1/metabolism* ; CD36 Antigens/metabolism* ; Platelet Activation/drug effects* ; Male ; Mice ; Mice, Inbred C57BL

ObjectiveTo analyze the influencing factors of pulmonary dysfunction among community-based population at high-risk for chronic obstructive pulmonary disease (COPD), and to establish a risk assessment model to provide a reference basis for accelerating the beforehand prevention and control of COPD and promoting the respiratory health of community-based residents. MethodsIndividuals aged >35 years old, with at least one risk factor except age illustrated in the Guidelines for Primary Diagnosis and Treatment of Chronic Obstructive Lung Disease (2018), and participated in the early screening for COPD from July 2022 to December 2023 were selected as the research subjects, and their lung function was assessed by the forceful expiratory volume in the first second after inhalation of bronchodilator (FEV₁)/ forced vital capacity (FVC) <70% and/or the ratio of FEV₁ to predicted value (FEV₁%Pred) <80% as the diagnostic criteria. In addition, risk factors related to pulmonary dysfunction were analyzed for the establishment of risk assessment model. ResultsA total of 823 individuals aged between 35‒76 years were included, among which 298 (36.21%) were diagnosed with pulmonary dysfunction, 167 (20.29%) with COPD, and 131 (15.92%) with preserved ratio but impaired spirometry. Logistic regression analysis revealed that male gender, increasing age, more frequent smoking, insufficient physical activity, recurrent wheezing, the presence of post-exercise wheezing or coughing, insensitive to airborne allergens, and history of chronic bronchitis or bronchial asthma were correlated with pulmonary dysfunction. The incidence rate of pulmonary dysfunction was 1.99 times higher in males than that in females, 1.81 times more common in those aged between 70‒76 years than those aged <60 years, 2.42 times more common in those who smoked 50‒200 pack-years than in those who smoked 0‒14 pack-years, 1.78 times higher in those who underwent physical activity <600 MET‑min·week^-1 than in those who underwent physical activity ≥600 MET‑min·week^-1, 2.61 times higher in those suffered recurrent wheezing than in those did not, 1.53 times higher in those with symptoms of post-exercise wheezing or coughing than in those without, 1.61 times higher in those insensitive to airborne allergens than those sensitive, 2.02 times higher in patients with chronic bronchitis than in those without, and 2.41 times higher in patients with bronchial asthma than in those without. The risk assessment model for pulmonary dysfunction constructed on this basis had a total score of 28 points, and the area under the subject operating characteristic (ROC) curve was 0.72, reaching the cut-off point of ROC curve while taking scores ≥10 points as the cut-off value for pulmonary dysfunction. ConclusionIn community-based high-risk COPD population, the incidence rate of pulmonary dysfunction is higher in males than that in females, in addition, which increases with the advancement of age. Smoking,insufficient physical activity,recurrent wheezing,post-exercise wheezing or coughing,insensitive to airborne allergens,and history of chronic bronchitis or bronchial asthma are high risk factors for pulmonary dysfunction. The risk assessment model constructed based on these factors has a good predictive effect in screening high-risk population of COPD, but its effectiveness in screening people at general risk needs to be further validated.

Objective:To assess common errors in head and neck CT angiography (CTA) image reports using four types of large language models (LLM), namely GPT-4, DeepSeek, ERNIE Bot and SparkDesk, and to assess the feasibility of using existing LLMs to support quality control of radiology reports in Chinese.Methods:The study was a cross-sectional study. Totally 1 000 head and neck CTA image reports were randomly selected using the simple random sampling method from Xuanwu Hospital, Capital Medical University in 2023, including 500 primary reports and 500 finalized reports. Two radiologists collaboratively identified six types of errors in the reports: description errors, writing errors, left-right confusion errors, diagnostic omissions, logical sequence errors, and other errors. The overall quality of the reports was assessed using a 5-point Likert scale. Subsequently, GPT-4, DeepSeek, ERNIE Bot and SparkDesk models were employed to detect the same six types of errors in the imaging reports and to provide overall scoring. The results from manual review were considered the gold standard for calculating F1 score to evaluate model performance. Intra-class correlation coefficients ( ICC) were used to assess the consistency between manual scores and the overall scores from the four LLMs. Results:In the primary imaging reports, the proportions of manually detected errors were as follows: descriptive errors 2.6% (13/500), writing errors 0.6% (3/500), left-right confusion errors 0, diagnostic omissions 6.4% (32/500), logical sequence errors 5.2% (26/500), and other errors 0. In the finalized imaging reports, the proportions of errors across the six categories were 0.2% (1/500), 0, 0, 0, 0, and 0.2% (1/500), respectively. For error detection in the primary imaging reports, the F1 scores of GPT-4 for the six error types were 0.992, 0.997, 0.997, 0.967, 0.980, and 0.992, respectively. DeepSeek achieved F1 scores of 0.980, 0.955, 0.981, 0.920, 0.995, and 0.960; ERNIE Bot scored 0.982, 0.990, 1.000, 0.956, 0.976, and 0.999; and SparkDesk achieved 0.985, 0.995, 1.000, 0.961, 0.982, and 1.000. In the detection of errors in finalized imaging reports, GPT-4′s F1 scores were 0.994, 0.995, 0.998, 0.973, 0.989, and 0.993; DeepSeek scored 0.968, 0.965, 0.985, 0.971, 0.991, and 0.983; ERNIE Bot achieved 0.996, 0.992, 1.000, 0.983, 0.999, and 0.997; and SparkDesk achieved 0.999, 0.999, 1.000, 1.000, 1.000, and 0.999. The consistency between GPT-4, DeepSeek, and SparkDesk models and human ratings was moderate, with ICC values of 0.514, 0.560, and 0.515 respectively (all P0.001); in contrast, the overall score of ERNIE Bot showed poor consistency with human ratings, with an ICC of 0.221 ( P0.001). Conclusion:LLMs demonstrate high accuracy in detecting errors in head and neck CTA imaging reports. The overall scoring of report quality shows moderate consistency with manual assessments, indicating a certain feasibility for automated quality control in reporting.

Objective To observe the correlation between brain abnormal glucose metabolism and striatal dopaminergic neuron damage in early-stage Parkinson disease(PD)patients.Methods Thirty-two early-stage PD patients(PD group)and 18 healthy individuals(control group)were prospectively enrolled,and 18F-FDG and 18F-9-fluoropropyl-(+)-dihydrotetrabenazine(18 F-FP-DTBZ)PET/MR brain imaging were performed.The degrees of uptake were compared between groups,and the correlation between brain abnormal glucose metabolism and striatal dopaminergic neuron damage was analyzed.Results Compared with control group,18F-FDG PET showed that in PD group glucose metabolism decreased in bilateral frontal and parietal lobes but increased in bilateral putamen,pons and bilateral cerebellum(all P＜0.05),while18 F-FP-DTBZ PET showed that in PD group glucose metabolism decreased in bilateral caudate nucleus,anterior putamen and posterior putamen(all P＜0.05).In PD group,the mean standard uptake value(SUVmean)of putamen was positively correlated with the standard uptake value ratio(SUVR)of contralateral caudate nucleus(r=0.305,P=0.014),while SUVmean of frontal cortex was positively correlated with SUVR of contralateral and symptomatic caudate nucleus(r=0.352,0.324,both P＜0.05)as well as anterior putamen(r=0.300,0.314,both P＜0.05),SUVmean of the partial cortex in parietal lobe was positively correlated with SUVR of contralateral and symptomatic caudate nucleus and contralateral anterior putamen(r=0.329,0.303,0.330,all P＜0.05).Conclusion Brain abnormal glucose metabolism had certain correlation with striatal dopaminergic neuron damage in early-stage PD patients.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To explore the value of 18F-FDG PET brain glucose metabolism imaging in the subtype differential diagnosis and prognosis evaluation of autoimmune encephalitis (AE). Methods:A retrospective analysis was conducted on PET/CT brain glucose metabolism imaging data from 58 patients with AE (from August 2020 to June 2023, Xuanwu Hospital, Capital Medical University; 31 males, 27 females; age (47.4±16.9) years). Patients were divided into 4 groups: anti-leucine-rich glioma-inactivated protein 1(LGI1) antibody-related encephalitis group, anti- N-methyl- D-aspartate receptor (NMDAR) encephalitis group, anti-γ-amino butyric acid type B receptor (GABA BR) antibody-related encephalitis group, and other types of AE group. In addition, 20 cases were included in control group (6 males and 14 females, age (58.8±7.5) years). Visual assessment was performed to evaluate changes in brain glucose metabolism among patients with different subtypes of AE, and abnormal glucose metabolism brain regions were compared by independent-sample t test between different groups. Spearman rank correlation analysis was conducted between SUV ratio (SUVR) of abnormal brain regions and modified Rankin Scale (mRS) scores at six months later. Results:Among 58 patients, 21 were diagnosed with anti-LGI1 antibody-related encephalitis, 18 were diagnosed with anti-NMDAR encephalitis, 7 were diagnosed with anti-GABA BR antibody-related encephalitis, and 12 were diagnosed with other subtypes of AE. Compared with anti-NMDAR encephalitis group: patients with anti-LGI1 antibody-related encephalitis showed increased glucose metabolism in the right occipital lobe and bilateral hippocampi, and decreased glucose metabolism in the right frontal lobe, right precentral gyrus, and bilateral superior marginal gyrus ( t values: from -5.13 to 4.89, all P<0.001); patients with anti-GABA BR antibody-related encephalitis exhibited increased glucose metabolism in the bilateral hippocampi and right fusiform gyrus, and decreased glucose metabolism in the left middle frontal gyrus ( t values: from -3.82 to 3.91, all P<0.001). Anti-NMDAR encephalitis was characterized by decreased metabolism in the bilateral parietal lobes, occipital lobes, local frontal-temporal lobes, and bilateral thalami, as well as increased metabolism in the limbic lobe and local frontal-temporal-parietal lobes ( t values: from -8.30 to 7.30, all P<0.001), and the SUVR of the right occipital lobe was negatively correlated with mRS score at six months later ( rs=-0.64, P=0.014). Other subtypes of AE showed decreased glucose metabolism in different cerebral lobes. Conclusion:18F-FDG PET/CT can evaluate brain glucose metabolism in different subtypes of AE diseases and prognosis.