ObjectiveTo investigate the expression patterns of key steroidogenic enzymes （CYP11A1， HSD3B1， and CYP19A1） in placental tissues from preeclampsia （PE） patients and evaluate​ their potential as biomarkers for PE. MethodsA case-control study was conducted using placental tissues from PE patients （PE group， n=3） and normotensive pregnant women （control group， n=3）. RNA sequencing was performed to identify differentially expressed genes （DEGs）， followed by validation of target gene expression using Western blot， qRT-PCR， and immunohistochemistry. Steroid hormone levels in placental tissues and serum were measured by ELISA. Spearman correlation analysis was used to assess associations between protein expression and clinical parameters， and receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive value of target genes for PE. ResultsThe results showed that 501 DEGs （P<0.05 and |Log₂Fold Change| >1） were identified in PE placental tissues， with KEGG enrichment analysis revealing significant involvement in steroid hormone biosynthesis pathways. Compared with the control group， PE placental tissues exhibited significantly decreased protein and mRNA expression of HSD3B1 and CYP19A1 （P<0.01）， while CYP11A1 expression was upregulated （P<0.05）. Serum estradiol （E2） and progesterone （P4） levels were significantly reduced in the PE group （P<0.01）， whereas testosterone （T） levels were elevated （P<0.05）. Correlation analysis demonstrated that CYP11A1 expression was positively associated with systolic blood pressure （SBP）， diastolic blood pressure （DBP）， and soluble fms-like tyrosine kinase-1 （sFlt-1） （P<0.01）， but negatively correlated with placental growth factor （PLGF） （P<0.01）. Conversely， HSD3B1 and CYP19A1 expression showed inverse correlations with these clinical parameters （P<0.01）. ROC analysis revealed that CYP11A1， HSD3B1， and CYP19A1 each had an area under the curve （AUC） of 0.778 for predicting PE， with 95%CI ranging from 0.614 to 0.942 （P=0.004）. The sensitivity was 94.4%， and the specificity was 66.7%. ConclusionThese findings suggest that dysregulated expression of steroidogenic enzymes in PE placental tissues contributes to hormonal imbalance， thereby playing a role in PE pathogenesis. Furthermore， CYP11A1， HSD3B1， and CYP19A1 may serve as potential diagnostic biomarkers for PE.

Kynurenine pathway (KP) is a major catabolic route of tryptophan, generating a series of bioactive metabolites including kynurenine, kynurenic acid (KA), quinolinic acid, and 3-hydroxykynurenine. Beyond its fundamental role in amino acid metabolism, KP exerts critical regulatory functions in neurodevelopment, synaptic plasticity, and immune modulation. Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with onset in early childhood, characterized by persistent deficits in social communication and restricted, repetitive behaviors. Despite extensive research, the etiological mechanisms underlying ASD remain highly complex and incompletely understood, involving genetic, environmental, and immunological factors. Emerging clinical evidence has consistently revealed a significant imbalance in KP metabolites in individuals with ASD, often accompanied by altered ratios of neuroprotective versus neurotoxic byproducts. However, the primary drivers of this metabolic dysregulation and its causative contribution to ASD pathogenesis are not yet fully elucidated. In this review, we systematically review the enzymatic steps of KP and the principal physiological functions of its major metabolites, with particular emphasis on their dual roles in neuroprotection and neurotoxicity. We then analyze the potential pathogenic mechanisms through which KP dysfunction may contribute to ASD, focusing on two interconnected etiological dimensions. First, KP imbalance can promote oxidative stress, which in turn triggers chronic inflammatory responses via microglial activation and release of pro-inflammatory cytokines, thereby disrupting neuronal homeostasis. Second, aberrant KP metabolism affects neurotransmitter systems, particularly glutamatergic and dopaminergic signaling, leading to impaired neural circuit development and synaptic pruning. By integrating current findings on the KP-ASD association, this review offers a comprehensive etiological framework and a clinically relevant paradigm. Furthermore, we highlight that specific KP metabolites, such as the KA/quinolinic acid ratio, hold promise as peripheral biomarkers for early diagnosis and disease stratification. Finally, we discuss the therapeutic potential of targeting KP enzymes or receptors for personalized intervention strategies, while acknowledging the challenges in translating these findings into clinical practice.

ObjectiveTo investigate the contamination status of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) in commercially available aquatic products in Shanghai and their distribution characteristics among different categories of aquatic products, and to assess the dietary exposure levels and non‑carcinogenic health risks of As, Cd, Pb, and Hg through aquatic product consumption among different age groups, so as to provide a scientific basis for food safety surveillance of aquatic products and dietary risk management for residents in Shanghai. MethodsFrom October to November 2021, a total of 90 aquatic product samples, including marine fish, freshwater fish, freshwater shrimp, marine crab, freshwater crab, and mollusks, were randomly collected from 16 districts of Shanghai. Sample pretreatment was performed according to GB 5009.268‒2016 (National Food Safety Standard—Determination of Multi‑elements in Foods). The concentrations of As, Cd, and Pb in aquatic products were determined by inductively coupled plasma mass spectrometry (ICP‑MS), and Hg was determined by direct mercury analyzer. Inorganic arsenic (iAs) was estimated as 3.5% of total As according to the method recommended by the European Food Safety Authority (EFSA). The contamination levels of As, Cd, Pb, and Hg in aquatic products were evaluated according to GB 2762‒2017 (National Food Safety Standard—Maximum Levels of Contaminants in Foods). A combined approach of point assessment and probabilistic assessment was applied to estimate the estimated daily intake (EDI) and non‑carcinogenic risk indicators—hazard quotient (HQ) and hazard index (HI)—for different age groups. ResultsThe detection rates of As and Hg were both 100.00% in all samples, while those of Cd and Pb were 74.44% and 25.56%, respectively. The arithmetic means (wet weight) of the four elements and estimated iAs were: As (1.432 9±3.736 5) mg·kg^-1, iAs (0.050 2±0.130 8) mg·kg^-1, Cd (0.082 5±0.197 8) mg·kg^-1, Pb (0.006 1±0.005 5) mg·kg^-1, and Hg (0.021 9±0.016 7) mg·kg^-1. According to the relevant maximum residue limits, 2 out of 7 mollusk samples (28.57%) and 3 out of 20 marine fish samples (15.00%) exceeded the limit for iAs, and 2 out of 8 marine crab samples (25.00%) exceeded the limit for Cd. The estimated daily intake (EDI, μg·kg^-1·d^-1, by body weight) of iAs, Cd, Pb, and Hg via aquatic product consumption varied among different age groups, with the highest levels observed in children aged 3‒4 years, decreasing gradually with age to the lowest level at 12 ‒ <15 years, with a slight rebound thereafter. The point assessment results showed that the HQs of iAs, Cd, Pb, and Hg ranged from 0 to 0.25, and the cumulative HI ranged from 0.27 to 0.48, all below 1, indicating a relatively low overall risk. The probabilistic assessment results revealed that under the high‑exposure scenario (P_97.5), the HQs of iAs (1.101‒1.281) and Cd (1.175‒1.366) exceeded 1 in children aged 3‒9 years, suggesting potential health risks, while the HQs of Pb and Hg were all below 1, indicating relatively lower risks. ConclusionHg and As are ubiquitously detected in commercially available aquatic products in Shanghai, while the detection rates of Cd and Pb are relatively low. The overall non-carcinogenic risk is at an acceptable level, but children aged 3‒9 years may have potential health risks from iAs and Cd under high-percentile exposure levels. It is recommended to strengthen the monitoring of toxic elements in key aquatic products such as marine fish, mollusks, and marine crabs, and to implement targeted dietary risk management measures for sensitive populations, including children.

Diabetic macular edema(DME), a serious complication of diabetic retinopathy(DR), is a chronic condition caused by multiple factors. Throughout its progression, inflammatory factors and vascular endothelial growth factor(VEGF)play a critical role. Anti-VEGF drugs have shown significant effectiveness in the treatment of DME; however, some patients may experience persistent DME after injection or require frequent injections. Dexamethasone intravitreal implants(DEX implants)serve as a sustained-release implant characterized by a reasonable release profile and high bioavailability. They offer safe, effective, and prolonged anti-inflammatory effects, aiding in the repair of retinal barrier and reduction of exudation. To further enhance patients' visual quality, exploring the efficacy of DEX implants in combination with existing treatment regimens has great clinical significance. This review primarily discusses the research advancements in DEX implants, focusing on their pharmacological properties, indications for use, and their combination with existing drugs and treatment methods. It also evaluates the advantages and disadvantages of combination therapy or switching to DEX implants compared to current standard treatments, aiming to provide guidance for personalized treatment options for patients with DME.

Objective:To investigate the efficacy of Saussurea involucrata injection (SII) in alleviating rheumatoid arthritis (RA) and to explore the mechanism of action of SII in alleviating RA through the Toll-like receptor 4 (TLR4)/nuclear factor-kappaBp65 (NF-κBp65) pathway-mediated M1 macrophage polarization.Methods:In vivo experiments were conducted using a collagen-induced arthritis (CIA) rat model. After successful modeling, the CIA rats were randomly assigned into five groups ( n=10 per group): CIA control group, MTX group, low-dose SII (L-SII) group, medium-dose SII (M-SII) group, and high-dose SII (H-SII) group. The efficacy of SII in alleviating RA was evaluated using arthritis index scores, histopathology, and ELISA to measure serum levels of nitric oxide (NO), interleukin 1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α). Subsequently, Western blot analysis was used to detect the expression of inducible nitric oxide synthase (iNOS) and CD86 proteins in synovial tissue. In vitro experiments involved first isolating and inducing rat bone marrow-derived macrophages (BMDMs). Then, BMDMs were polarized toward the M1 phenotype using lipopolysaccharide (LPS) combined with interferon-γ (IFN-γ). Concurrently, cells were treated with SII and the TLR4 inhibitor TAK242. Subsequently, ELISA was used to detect NO, IL-1β, TNF-α levels in the cell culture supernatant via ELISA. RT-qPCR was used to detect the expression of IL-1b, IL-6, and TNF-α genes in each group of cells. Western blot analysis was performed to detect the expression of iNOS, CD86, TLR4, myeloid differentiation primary response 88 (MyD88), and p-NF-κBp65/NF-κBp65 proteins in the cells. Data analysis between multiple groups was performed using one-way analysis of variance, and between pairs using LSD- t-tests. Results:In vivo experimental results showed that compared with the CIA group(7.90 ± 0.70), MTX and SII both improved the pathological symptoms of rats and reduced the ankle joint pathological score [MTX (4.40 ± 0.92), L-SII (7.00 ± 0.89), M-SII (5.10 ± 1.30), H-SII (4.90 ± 0.94), t=33.86, P<0.001; t=9.10, P<0.001; t=2.38, P=0.029; t=5.69, P<0.001; t=7.66, P<0.001], while downregulating serum levels of NO, IL-1β, IL-6, and TNF-α levels in serum, as well as iNOS [ t=30.01, P<0.001; t=6.17, P=0.003; t=10.86, P<0.001; t=28.95, P<0.001; t=19.03, P<0.001] and CD86 [ t=65.61, P<0.001; t=8.76, P<0.001; t=13.18, P<0.001; t=13.22, P<0.001; t=18.91, P<0.001] expression. In vitro experimental results showed that compared with BMDMs treated with LPS and IFN-γ, SII and TAK242 treatment reduced the levels of NO, IL-1β, IL-6, and TNF-α in the supernatant and decreased the expression of IL-1b, IL-6, and TNF-α genes. Additionally, SII and TAK242 treatment downregulated the expression of iNOS and CD86 proteins in cells, and simultaneously downregulated TLR4, MYD88, and p-NF-κBp65/NF-κBp65 expression ( t=35.84, P<0.001; t=15.69, P<0.001; t=21.99, P<0.001; t=23.64, P<0.001; t=22.50, P<0.001). Additionally, compared with the TAK242 group alone, TAK242 + H-SII showed no significant differences in the modulation of M1 macrophage polarization and TLR4/NF-κBp65 pathway-related indicators. Conclusion:SII exerts anti-inflammatory and anti-RA effects by inhibiting TLR4/NF-κBp65-mediated M1 macrophage polarization.

Objective To investigate the interaction relationship among symptoms in middle-aged patients during the recovery period of stroke and explore its correlation with rehabilitation confidence,providing a reference for the implementation of precise rehabilitation nursing.Methods A cross-sectional study was conducted,and 365 middle-aged patients in the recovery period of stroke who were hospitalized in 4 tertiary general hospitals in Wuhan from April 20 to August 31,2024 were conveniently selected as the subjects of the investigation.Data were collected using the General Information Questionnaire,Stroke Symptom Experience Scale,and Confidence after Stroke Measure Questionnaire.Symptom network analysis was conducted using R software,and a network structure model of symptoms-rehabilitation confidence was constructed;meanwhile,the stability of the network structure was evaluated.Results Finally,350 middle-aged stroke patients in the recovery period were included.The most common symptom was"limb weakness"(81.1％).Symptom network analysis showed that"limited limb movement"was the core symptom(rs=1.118).The symptoms strongly associated with recovery confidence were"limited physical movement","annoyance at not being able to do what you want to do"and"slow reaction times".Stability tests suggest that the model results are all good.Conclusion Symptoms of middle-aged patients in the recovery period after stroke are interrelated,and the mechanisms by which different symptoms affect rehabilitation confidence are also different.It is recommended that healthcare professionals prioritize interventions based on core symptoms and inter-symptom relationships in order to accurately enhance patient outcomes and improve recovery outcomes.

Objective:To analyze the prevalence, trends in disease burden, and risk factors of esophageal cancer in various provinces of China from 1990 to 2019.Methods:Utilizing data from the 2019 global burden of disease study, the disease burden of esophageal cancer of 31 provinces, municipalities, and autonomous regions, as well as Hong Kong Special Administrative Region and Macao Special Administrative Region of China from 1990 to 2019 were analyzed. The disease burden of esophageal cancer in China was described with the number (and incidence) of cases, the number (and mortality) of death, and disability-adjusted life year (DALY) and their age-standardized rates. Joinpoint regression analysis and t-test were used to evaluate the annual percent change and the average annual percent change (AAPC). Scatter plots and Spearman correlation coefficients were performed to analyze the correlation between the disease burden of esophageal cancer and the socio-demographic index (SDI), as well as DALY in each province. Results:In 2019, there were 278 121 new cases of esophageal cancer and 257 316 deaths in China, increased by 60.13% and 45.70% respectively compared with 1990. The top 3 provinces with the highest age-standardized incidence of esophageal cancer were Sichuan Province (25.96/100 000), Jiangsu Province (23.80/100 000), and Fujian Province (21.98/100 000). From 1990 to 2019, except for Jiangsu Province and Sichuan Province, the age-standardized incidence in other provinces showed a declining trend. The age-standardized mortality and DALYs of esophageal cancer decreased in all provinces as well as in Hong Kong and Macao Special Administrative Regions of China. The attributable risk factors of esophageal cancer caused deaths in China mainly included smoking, alcohol consumption, high body mass index, and low fruit intake, accounting for 91.38% of all the cases. With the increase of the SDI, the age-standardized rates of DALY in high incidence areas of esophageal cancer (Sichuan Province, Jiangsu Province, Fujian Province, Henan Province, Chongqing City, Xinjiang Uygur Autonomous Region, Shanxi Province, and Anhui Province) demonstrated a trend of initially decline and then an upward. In contrast, the age-standardized rates of DALY of esophageal cancer in other provinces, as well as in Hong Kong and Macao Special Administrative Regions of China, showed a trend of initially upward and then decline. The age-standardized rate of DALY of esophageal cancer showed a negative correlation with SDI ( r=-0.315, P<0.001). From 1990 to 2019, the age-standardized incidence and mortality of esophageal cancer generally demonstrated a downward trend. The AAPC was -1.43% ( t=-19.16, P<0.001) for incidence and -1.83% ( t=-29.63, P<0.001) for mortality, respectively. It is projected that by 2044, the actual number of new esophageal cancer cases in China will increase from 278 121 in 2019 to 291 206 in 2044, and the actual number of deaths will increase from 257 316 to 275 856. Conclusions:In recent years, the disease burden of esophageal cancer in China remains a serious status, with significant differences in geography and gender. It is projected that by 2044, the number of new esophageal cancer cases and deaths in China will continue to increase. Effective strategies and policies are urgently needed to reduce the disease burden.

Objective To explore the clinical significance of pulse pressure variability(PPV)in early prevention and diagnosis of prostate resection syndrome by observing the changes in PPV during transurethral resection of the prostate.Methods Eighty patients undergoing transurethral resection of the prostate(TURP)under general anesthesia from March to April 2023 were randomly divided into a control group and an observation group,with 40 patients in each group.The control group underwent routine monitoring of invasive blood pressure,while the observation group continued to monitor PPV in addition to invasive blood pressure monitoring.Observe and record the hemodynamic parameters,electrolyte Na+,K+,CL-,Changes in hemoglobin(Hb)and hematocrit(Hct),recording surgical time,intraoperative lavage fluid dosage,and occurrence of dilutive hyponatremia(TURS).Results One patient in the observation group experienced two unexplained drops in blood pressure and heart rate during surgery,and was diagnosed with TURS based on blood gas analysis.Among them,the observation group showed a decreasing trend in PPV with the prolongation of surgery time.PPV gradually decreased at 45～60 minutes after surgery,and at 90 minutes after surgery,PPV decreased significantly compared to preoperative levels.Among them,6 patients had a 50%decrease in PPV compared to preoperative levels.For patients with significantly reduced PPV,immediate treatment was given 10～20 mg of furosemide and 10 mg of dexamethasone.By the end of surgery,PPV had basically recovered to preoperative levels.Both groups of patients showed varying degrees of decrease in Na+,K+,Hct,and Hb levels.Conclusions PPV can reflect the volume status of patients.When PPV decreases by more than 50%compared to preoperative levels and there are unexplained hemodynamic changes and abnormal clinical manifestations during surgery,it is necessary to be vigilant and handle them promptly to reduce and prevent the occurrence of TURS.

Objective To design a digital intelligence-driven critical treatment platform to implement integrated treatment procedure inside and outside the hospital and intelligent whole-course managment from pre-hospital emergency care to discharge for critically ill patients.Methods The platform was designed with 5G,IoT,big data and aritificial intelligence techniques and developed with Java language,which adopted Oracle database-based data management and front-end and back-end separation mode,with the front end realized by Vue.js framework and the back end by microservice architecture.There were five functional modules for pre-hospital emergency care,multidisciplinary joint diagnosis and treatment,critical care,quality control management and post-discharge follow-up involved in the platform.Results The platform developed simplified the treatment procedure,enhanced the timeliness of emergency care,decreased the workload of nursing staffs and improved medical service efficiency and working efficiency effectively.Conclusion The platform increases first aid quality and treatment efficiency and provides critically ill patients with high-quality medical experience.[Chinese Medical Equipment Journal,2025,46(1):38-43]

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.