Metastasis is a pivotal and intricate process in the progression of malignant tumors,strongly correlating with poor prognosis.Approximately 90%of cancer-related mortality is attributed to metastasis,with the five-year survival rate for patients with metastatic solid tumors ranging from 5%to 30%.Consequently,a comprehensive understanding of the underlying biological mechanisms driving metastasis is essential for unraveling its core processes and developing novel therapeutic strategies.The metastatic cascade involves tumor cells navigating numerous biological barriers,including detachment from the primary tumor,invasion of blood vessels or lymphatics,survival in circulation,extravasation into distant organs and subsequent adaptation to the microenvironment.To surmount these challenges,tumor cells undergo phenotypic changes,genetic mutations and dysregulating signaling pathways.Additionally,microenvironmental factors(such as angiogenesis,matrix remodeling and immune evasion)play a critical role,orchestrating the initiation and growth of metastatic lesions in an interdependent manner.Organ-specific metastasis,a distinct subset of metastasis,involves dynamic bidirectional interactions between tumor cells and the microenvironment of target organs.These interactions determine the selectivity of metastatic spread and drive the adaptive evolution of both the tumor and the organ,which encompasses multiple layers of cellular interactions,including cell-cell and cell-matrix signaling.Tumor cell mutations,the release of specific signaling molecules,the capacity to withstand circulatory pressures,and signaling exchanges with target organs collectively govern the selective nature of organ-specific metastasis.Furthermore,factors intrinsic to the target organ-such as its regenerative potential,metabolic profile,immune surveillance mechanisms and matrix stiffness-further facilitate the adaptive remodeling of metastatic cells within these environments.Thus,the bidirectional selection and adaptation between tumor cells and target organs form a dynamic,complex system that reshapes our understanding of metastatic tumor development.While current research emphasizes shared biological features in metastasis,the successful formation of metastatic tumors depends not only on these common mechanisms but also on the unique characteristics governing organ-specific metastasis.The interplay between generalizable and organ-specific mechanisms profoundly influences the metastatic outcome.This review aimed to consolidate our current knowledge of these shared and distinct processes,analyze the evolving understanding of the bidirectional selection between tumor cells and target organs,and assess the current status of metastatic risk prediction models for patients without metastasis.Furthermore,the paper discussed the challenges and opportunities in managing advanced-stage metastatic tumors,offering new insights and potential clinical strategies to improve prognosis and treatment outcomes.

Emotional blunting leads to significant declines in cognitive function and activities of daily living in patients with Parkinson's disease, thereby impacting their quality of life and increasing the caregiver burden. Emotional blunting is a progressive condition, and early detection and intervention can slow its progression, making it necessary to assess emotional blunting in patients early. Currently, there are various tools for assessing emotional blunting, but there is a lack of evidence to guide tool selection. This review discusses the impact of emotional blunting on patients with Parkinson's disease and reviews existing assessment tools for emotional blunting, including their content, applications, advantages, and limitations. It also summarizes issues in the application of these tools and offers future directions, aiming to provide a basis for the identification and assessment of emotional blunting in Parkinson's disease patients.

Emotional blunting leads to significant declines in cognitive function and activities of daily living in patients with Parkinson's disease, thereby impacting their quality of life and increasing the caregiver burden. Emotional blunting is a progressive condition, and early detection and intervention can slow its progression, making it necessary to assess emotional blunting in patients early. Currently, there are various tools for assessing emotional blunting, but there is a lack of evidence to guide tool selection. This review discusses the impact of emotional blunting on patients with Parkinson's disease and reviews existing assessment tools for emotional blunting, including their content, applications, advantages, and limitations. It also summarizes issues in the application of these tools and offers future directions, aiming to provide a basis for the identification and assessment of emotional blunting in Parkinson's disease patients.

Metastasis is a pivotal and intricate process in the progression of malignant tumors,strongly correlating with poor prognosis.Approximately 90%of cancer-related mortality is attributed to metastasis,with the five-year survival rate for patients with metastatic solid tumors ranging from 5%to 30%.Consequently,a comprehensive understanding of the underlying biological mechanisms driving metastasis is essential for unraveling its core processes and developing novel therapeutic strategies.The metastatic cascade involves tumor cells navigating numerous biological barriers,including detachment from the primary tumor,invasion of blood vessels or lymphatics,survival in circulation,extravasation into distant organs and subsequent adaptation to the microenvironment.To surmount these challenges,tumor cells undergo phenotypic changes,genetic mutations and dysregulating signaling pathways.Additionally,microenvironmental factors(such as angiogenesis,matrix remodeling and immune evasion)play a critical role,orchestrating the initiation and growth of metastatic lesions in an interdependent manner.Organ-specific metastasis,a distinct subset of metastasis,involves dynamic bidirectional interactions between tumor cells and the microenvironment of target organs.These interactions determine the selectivity of metastatic spread and drive the adaptive evolution of both the tumor and the organ,which encompasses multiple layers of cellular interactions,including cell-cell and cell-matrix signaling.Tumor cell mutations,the release of specific signaling molecules,the capacity to withstand circulatory pressures,and signaling exchanges with target organs collectively govern the selective nature of organ-specific metastasis.Furthermore,factors intrinsic to the target organ-such as its regenerative potential,metabolic profile,immune surveillance mechanisms and matrix stiffness-further facilitate the adaptive remodeling of metastatic cells within these environments.Thus,the bidirectional selection and adaptation between tumor cells and target organs form a dynamic,complex system that reshapes our understanding of metastatic tumor development.While current research emphasizes shared biological features in metastasis,the successful formation of metastatic tumors depends not only on these common mechanisms but also on the unique characteristics governing organ-specific metastasis.The interplay between generalizable and organ-specific mechanisms profoundly influences the metastatic outcome.This review aimed to consolidate our current knowledge of these shared and distinct processes,analyze the evolving understanding of the bidirectional selection between tumor cells and target organs,and assess the current status of metastatic risk prediction models for patients without metastasis.Furthermore,the paper discussed the challenges and opportunities in managing advanced-stage metastatic tumors,offering new insights and potential clinical strategies to improve prognosis and treatment outcomes.

The amino-terminal pro-C-type natriuretic peptide(NT-proCNP)is a diagnostic inflam-matory marker clinically used for diagnosing bacterial infections.This study aims to establish a phage display library of single-chain variable fragment(scFv)antibodies against canine NT-proC-NP and to screen for scFvs with high binding affinity to NT-proCNP.Initially,NT-proCNP was prepared using prokaryotic expression system and was used to immunize New Zealand White rab-bits.Upon achieving the desired serum titer,total RNA was extracted from the splenocytes of rab-bits and reverse transcribed into cDNA.Using this cDNA as a template,degenerate primers were employed to amplify the genes of the rabbit antibody light chain variable region(VL)and heavy chain variable region(VH).The VL and VH regions were spliced together to form a complete scFv fragment via overlap extension PCR.The scFv was then ligated into the phagemid pComb3XSS and electroporated into competent E.coli TG1 cells to construct a rabbit-derived anti-NT-proCNP scFv immunological library.This library underwent four rounds of enrichment and screening to isolate specific single-chain antibodies.The selected antibody was subsequently ex-pressed in a soluble form within a prokaryotic system,and its immunological activity was evalua-ted.Using phage display technology,this study successfully identified a single-chain antibody scFv-1-CNP with strong antigen-binding activity and genetic sequence characteristics of scFvs,providing a research direction for further exploration of scFv applications in the detection of NT-proCNP.

The amino-terminal pro-C-type natriuretic peptide(NT-proCNP)is a diagnostic inflam-matory marker clinically used for diagnosing bacterial infections.This study aims to establish a phage display library of single-chain variable fragment(scFv)antibodies against canine NT-proC-NP and to screen for scFvs with high binding affinity to NT-proCNP.Initially,NT-proCNP was prepared using prokaryotic expression system and was used to immunize New Zealand White rab-bits.Upon achieving the desired serum titer,total RNA was extracted from the splenocytes of rab-bits and reverse transcribed into cDNA.Using this cDNA as a template,degenerate primers were employed to amplify the genes of the rabbit antibody light chain variable region(VL)and heavy chain variable region(VH).The VL and VH regions were spliced together to form a complete scFv fragment via overlap extension PCR.The scFv was then ligated into the phagemid pComb3XSS and electroporated into competent E.coli TG1 cells to construct a rabbit-derived anti-NT-proCNP scFv immunological library.This library underwent four rounds of enrichment and screening to isolate specific single-chain antibodies.The selected antibody was subsequently ex-pressed in a soluble form within a prokaryotic system,and its immunological activity was evalua-ted.Using phage display technology,this study successfully identified a single-chain antibody scFv-1-CNP with strong antigen-binding activity and genetic sequence characteristics of scFvs,providing a research direction for further exploration of scFv applications in the detection of NT-proCNP.

Frailty in elderly patients undergoing arthroplasty increases the risk of postoperative complications, prolongs hospital stays, delays the rehabilitation process, and aggravates the economic burden. Frailty is a dynamic condition, and early detection and effective intervention can delay its progression. Therefore, early assessment of frailty status in patients is necessary. Currently, there are numerous frailty assessment tools, but the selection of these tools lacks a solid basis. This paper reviews the impact of frailty on the physical condition of elderly arthroplasty patients, as well as the content, application, advantages, and limitations of existing frailty assessment tools at home and abroad. Furthermore, it summarizes the problems in the process of frailty assessment and puts forward prospects, aiming to provide reference for the identification and assessment of frailty in elderly arthroplasty patients in the future.

Objectives:To investigate the current willingness of depressive outpatients and their doctors in China to engage in shared decision-making (SDM), and to analyze the factors influencing this willingness.Methods:A questionnaire survey was conducted among doctors and patients with depression in 12 tertiary psychiatric hospitals and general hospitals by scanning two-dimensional code and filling in the questionnaire on the mobile terminal. The questionnaire covered patient demographics, emotional state scores, initial diagnosis and treatment, treatment expectations and concerns, symptom improvement needs, medication safety requirements, and diagnosis details (completed by the attending physician). Doctors provided basic information, current depression diagnosis and treatment status, and concerns regarding medications. Logistic regression analysis (univariate and multivariate) was used to identify factors influencing patients′ and doctors′ willingness to engage in SDM.Results:A total of 622 valid patient questionnaires and 45 valid physician questionnaires were collected. Both patients and doctors had a strong willingness to make shared decisions (80.39% (500/622) vs. 60.00% (27/45)). Multivariate binary logistic regression analysis showed that residential location (town versus rural areas: OR (95% CI)=1.895 (1.087-3.305)), acceptable monthly medical expenses (≥1 000-<2 000 CNY vs.<300 CNY: OR (95% CI)=0.194 (0.088-0.427);≥2 000 CNY vs.<300 CNY: OR (95% CI)=0.267 (0.094-0.754)), acceptance of online treatment and consultation (accept versus not accept: OR (95% CI)=3.196 (2.024-5.046)), and knowing about psychotherapy (yes versus no: OR (95% CI)=1.711 (1.003-2.921)) were the factors influencing the willingness of shared decision-making in patients (all P<0.05). For the doctors, the time spent on initial consultation was the factor influencing the willingness to engage in SDM ( OR (95% CI)=1.090 (1.004-1.184), P=0.040). Conclusions:Both depression patients and doctors in tertiary outpatient clinics in China show a strong willingness to engage in SDM, providing a solid foundation for clinical application. However, it is necessary to pay attention to the influence of residential location, acceptable monthly medical expenses, acceptance of online treatment and consultation, and knowledge of psychotherapy should be considered for patients, while the time spent on initial consultations should be considered for doctors.

Objectives:To investigate the current willingness of depressive outpatients and their doctors in China to engage in shared decision-making (SDM), and to analyze the factors influencing this willingness.Methods:A questionnaire survey was conducted among doctors and patients with depression in 12 tertiary psychiatric hospitals and general hospitals by scanning two-dimensional code and filling in the questionnaire on the mobile terminal. The questionnaire covered patient demographics, emotional state scores, initial diagnosis and treatment, treatment expectations and concerns, symptom improvement needs, medication safety requirements, and diagnosis details (completed by the attending physician). Doctors provided basic information, current depression diagnosis and treatment status, and concerns regarding medications. Logistic regression analysis (univariate and multivariate) was used to identify factors influencing patients′ and doctors′ willingness to engage in SDM.Results:A total of 622 valid patient questionnaires and 45 valid physician questionnaires were collected. Both patients and doctors had a strong willingness to make shared decisions (80.39% (500/622) vs. 60.00% (27/45)). Multivariate binary logistic regression analysis showed that residential location (town versus rural areas: OR (95% CI)=1.895 (1.087-3.305)), acceptable monthly medical expenses (≥1 000-<2 000 CNY vs.<300 CNY: OR (95% CI)=0.194 (0.088-0.427);≥2 000 CNY vs.<300 CNY: OR (95% CI)=0.267 (0.094-0.754)), acceptance of online treatment and consultation (accept versus not accept: OR (95% CI)=3.196 (2.024-5.046)), and knowing about psychotherapy (yes versus no: OR (95% CI)=1.711 (1.003-2.921)) were the factors influencing the willingness of shared decision-making in patients (all P<0.05). For the doctors, the time spent on initial consultation was the factor influencing the willingness to engage in SDM ( OR (95% CI)=1.090 (1.004-1.184), P=0.040). Conclusions:Both depression patients and doctors in tertiary outpatient clinics in China show a strong willingness to engage in SDM, providing a solid foundation for clinical application. However, it is necessary to pay attention to the influence of residential location, acceptable monthly medical expenses, acceptance of online treatment and consultation, and knowledge of psychotherapy should be considered for patients, while the time spent on initial consultations should be considered for doctors.

Objective:To evaluate the clinical efficacy of omalizumab in the treatment of patients with chronic spontaneous urticaria accompanied by other allergic diseases.Methods:Clinical data were retrospectively collected from 74 patients, who were clinically diagnosed with chronic spontaneous urticaria and other allergic diseases, and received subcutaneous injections of omalizumab in the Department of Allergy, Tianjin Medical University General Hospital from June 2020 to September 2022. Types of allergic diseases, serum total IgE (tIgE) and allergen-specific IgE (sIgE) levels before treatment, treatment outcomes and adverse drug reactions were analyzed. Differences before and after treatment were assessed using paired t-test and Wilcoxon signed-rank sum test. Results:A total of 74 patients with chronic spontaneous urticaria were involved, including 29 with complicated allergic asthma (39.2%) , 61 with complicated allergic rhinitis (82.4%) , 6 with complicated atopic dermatitis (8.1%) , and 4 with food allergy (5.4%) . Before treatment, elevated serum tIgE or sIgE levels were observed in 44 (59.5%) patients. After the first omalizumab treatment, the urticaria control test (UCT) score significantly increased compared with that before treatment (16.00 [13.0.0, 16.00] vs. 6.00 [5.75, 9.00], Z = 7.39, P < 0.001) ; after 4 sessions of the omalizumab treatment, 82.5% (33/40) of the patients achieved complete control of urticaria symptoms or showed complete response. After omalizumab treatment, asthmatic attacks were decreased in 29 patients with allergic asthma, and asthma control test (ACT) scores significantly increased compared with those before treatment (21.07 ± 2.88 points [after the first treatment] vs. 18.48 ± 3.20 points [before treatment], t = 8.87, P < 0.001) ; among 61 patients with allergic rhinitis, global rhinitis symptom-based visual analog scale (VAS) scores (before treatment: 5.89 ± 1.29 points; after the first treatment: 3.28 ±1.46 points) and rhinoconjunctivitis quality of life questionnaire (RQLQ) scores (before treatment: 60.10 ± 20.53 points; after the first treatment: 37.26 ± 18.83 points) both significantly decreased after the first treatment ( t = 15.04, 10.01, respectively, both P < 0.001) , and rhinitis symptoms were relieved at the same time; skin itching was relieved in 4 patients with atopic dermatitis, and allergic symptoms after contact with food allergens were also relieved in the 2 patients with food allergy after omalizumab treatment. During the treatment, only 1 patient experienced erythematous swelling, induration, and pain at the injection site. Conclusions:In the treatment of chronic spontaneous urticaria accompanied by allergic diseases, the use of omalizumab not only effectively improved urticaria symptoms, but also well controlled allergic diseases, with a good safety profile. Multiple benefits may be achieved by the use of omalizumabin in patients with chronic spontaneous urticaria accompanied by other allergic diseases.