Plant-derived exosome-like nanovesicles (PELNs), characterized by a natural lipid bilayer membrane, have rapidly emerged as a prominent research frontier in medicine owing to their unique biological properties and robust therapeutic potential. This review comprehensively examines the biological profiles, mechanistic functions, and recent engineering advancements of PELNs. In terms of composition, PELNs are uniquely enriched in plant-specific glycolipids, phosphatidylserine, secondary metabolites, and highly stable 2'-O-methylated miRNAs. This distinct molecular makeup endows them with exceptional biocompatibility, negligible immunogenicity, and the capacity for cross-species molecular communication. Mechanistically, PELNs demonstrate profound anti-inflammatory efficacy by suppressing the NF-κB and NLRP3 inflammasome pathways. They also serve as potent immune modulators, driving macrophage M1/M2 polarization and regulating T cell activity. Additionally, PELNs exhibit promising antitumor capabilities, targeting malignancies via reactive oxygen species (ROS) induction, TRAIL pathway activation, and tumor microenvironment remodeling. Crucially, the plant miRNAs encapsulated within PELNs remain highly stable in the gastrointestinal tract, allowing them to selectively alter gene expression in specific gut microbiota communities. This interaction deeply influences host immunity and metabolism, highlighting the vital role in cross-species regulation. Advancements in bioengineering have further expanded the clinical utility of PELNs. Targeted delivery efficiency can be significantly amplified via surface functionalization (e.g., folate and RGD sequences) and state-of-the-art drug loading technologies such as sonication and electroporation. Consequently, engineered PELNs surpass traditional synthetic nanocarriers in penetrating natural physiological barriers, particularly for oral and transdermal drug administration. Despite these advantages, clinical translation is currently hindered by the lack of standardized isolation protocols, challenges in scalable manufacturing, and the need for robust quality control frameworks. Looking forward, the integration of multi-omics approaches and AI-driven “molecular fingerprinting”—coupled with the design of synthetic biomimetic vesicles—will be instrumental in overcoming these bottlenecks, ultimately establishing PELNs as a next-generation platform for precision medicine and targeted nanotherapeutic delivery.

Hyperthermic intrathoracic chemotherapy (HITHOC) is a localized treatment that combines hyperthermia with medications such as chemotherapy, anti-angiogenic agents, targeted therapy, or immunotherapeutic agents. It has advanced clinical progress for conditions such as malignant pleural mesothelioma, pleural metastasis of lung cancer, and pleural dissemination of thymic tumors. Systematic analyses indicate that as an adjuvant therapy to cytoreductive surgery, HITHOC improves patient survival and effectively controls pleural effusion and pleural metastasis. It exerts antitumor effects by enhancing drug penetration through thermal effects, inducing apoptosis, and modulating the immune microenvironment. HITHOC combined with systemic therapies (e.g., chemotherapy, targeted therapy, and immunotherapy) demonstrates synergistic potential, but its role as a local treatment should be clearly defined as adjunctive within the comprehensive management of advanced-stage patients. Further research is needed to clarify its indications, standardized protocols, and long-term efficacy and to explore optimized regimens and personalized combination treatment strategies. This review delves into the key bottlenecks hindering the development of hyperthermia therapy, such as the lack of high-level evidence-based medicine and the absence of standardized diagnostic and efficacy evaluation criteria, and proposes potential solutions.

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness.Methods Based on the"goal-directed"early mobility concept,a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method,consisting of 3 components:patient inclusion,mobility implementation,and mobility evaluation.Using convenience sampling,patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants.Among them,25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway.25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care.Outcomes including diaphragm excursion,muscle strength,ICU length of stay,and adverse events were compared between the 2 groups.Results The graded early mobility pathway achieved an implementation rate of 70.05％in the experimental group,significantly higher than it in the control group(P＜0.001),without increasing adverse events.Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group(P=0.018).Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality.It provides a reference for the widespread and effective implementation of early mobility in ICUs,standardizing its clinical application.

The single photon counting imaging detector based on microchannel plate(MCP)has the characteristics of high sensitivity and low dark count rate,and has been applied to the optical remote sensing detection of weak ultraviolet spectral signals in space.In this work,by using planar array single photon counting imaging detector as the detector,flat-field concave grating as the splitter,and electrodeless discharge lamp(EDL)as the excitation light source,a dispersion detection system suitable for hydride generation-atomic fluorescence spectrometry(HG-AFS)was developed.The wavelength calibration of the system was carried out,and the negative high pressure and EDL stability time of the planar array single photon counting imaging detector were analyzed and optimized.The characteristic emission spectral lines of As and Bi elements excited in the wavelength range of 180-320 nm were analyzed,and the scattering interference in the wavelength range of 257.3-306.7 nm was discussed.The results showed that the AFS dispersion detection system based on the planar array single photon counting imaging detector could detect and analyze the HG-AFS fluorescence signal initially,and the influence of scattering interference on the detection results was effectively avoided.The system had the advantages including simple structure,no refrigeration and temperature control,no moving parts and simultaneous measurement of multi-band.

Objective To investigate the relationship between serum small dense low density lipoprotein cholesterol(sdLDL-C),systemic inflammatory response index(SIRI),monocyte to high density lipoprotein cholesterol ratio(MHR)and coronary artery injury(CAL)and intravenous immunoglobulin(IVIG)treat-ment response in Kawasaki disease(KD)children.Methods From April 2021 to December 2023,121 KD children(KD group)admitted to our hospital were divided into CAL group(42 cases)and NCAL group(79 cases)according to whether CAL occurred.Another 121 healthy children who underwent physical examina-tions in the hospital during the same period were selected as the control group.All the children in the KD group received IVIG treatment and were divided into the IVIG response group(99 cases)and the IVIG non-response group(22 cases)according to the treatment response.The differences in serum sdLDLC,SIRI and MHR levels among each group were compared.Univariate and multivariate Logistic regression models were used to analyze the factors influencing the non-response of children with KD to IVIG treatment,and the re-ceiver operating characteristic(ROC)curve was used to analyze the value of serum sdLDL-C,SIRI,and MHR in predicting the non-response of children with KD to IVIG treatment.Results Serum levels of sdLDL-C,SI-RI and MHR in the KD group were higher than those in the control group(P＜0.05).Serum levels of sdLDL-C,SIRI and MHR in the CAL group were higher than those in the NCAL group(P＜0.05).Serum levels of sdLDL-C,SIRI and MHR in the IVIG non-response group were higher than those in the IVIG response group(P＜0.05).The fever duration in the IVIG non-response group was longer than that in the IVIG response group(P＜0.05),and the combined proportion of CAL,the proportion of neutrophils,white blood cell count,C-reactive protein(CRP),interleukin-6(IL-6),erythrocyte sedimentation rate,and ferritin level were higher than those in the IVIG response group(P＜0.05).High CRP level,high sdLDL-C level,high SIRI and high MHR were risk factors for response to IVIG treatment in children with KD(P＜0.05).The areas under the curve(AUC)of serum sdLDL-C,SIRI,and MHR for predicting response to IVIG treatment in children with KD were 0.773,0.767,and 0.780 respectively.The combined prediction AUC was 0.948,which was higher than the individual predictions of each index.Conclusion The abnormal increase of serum sdLDL-C,SIRI and MHR in KD children is related to the occurrence of non-response to CAL and IVIG treatment.The combina-tion of the three can effectively predict the response to IVIG treatment.

Objective To explore the effect of evening primrose oil(EPO)on aortic endothelial damage in rats with polycystic ovary syndrome(PCOS),using network pharmacology and in vivo experiments.Methods The potential targets of EPO for improving aortic endothelial injury in PCOS rats were predicted by network pharmacology,and the selected core targets and renin-angiotensin signaling(RAS)pathway were verified by experiments.Fifty-eight female SD rats were divided randomly into a blank group(n=10)and a modeling group(n=48).Rats in the blank group were fed a normal diet and rats in the modeling group received a high-fat diet for 8 weeks.The PCOS model was prepared at week 6 by administration of letrozole(1 mg/(kg·d))for 21 days.Blood was taken from the tail vein after modeling and serum was collected to detect hormone levels.The model rats were then divided randomly into four groups and treated with the corresponding drugs for 6 weeks.Blood,blood vessels,and ovaries were then collected.Tissue morphology was examined by hematoxylin and eosin staining and serum levels of luteinizing hormone(LH),testosterone(T),follicle-stimulating hormone(FSH),endothelin(ET-1),and tumor necrosis factor(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).Serum levels of nitric oxide(NO)were determined by spectrophotometry.Protein expression levels of core targets and RAS pathway-related factors were assessed by western blotting and immunohistochemistry.Results Twenty-five intersection targets of EPO and PCOS were identified by network pharmacological analysis.Kyoto encyclopedia of genes and genomes analysis showed that EPO improved vascular injury in PCOS rats via multiple pathways,including RAS.Serum levels of ET-1,FSH,LH,and T measured by ELISA were significantly decreased after EPO treatment,compared with the model group(P＜0.01).EPO significantly decreased the expression levels of Ang Ⅰ,VEGF-B,AT2R,ET-1,and TNF-α proteins in the aorta(P＜0.01)and significantly increased expression levels of Ang Ⅱ,CD31,and endothelial NO synthase proteins(P＜0.01).Conclusions EPO may ameliorate vascular endothelial injury in PCOS model rats by inhibiting the RAS signaling pathway and by overactivation of the ACE/Ang Ⅱ/AT1 axis.

Objective:To explore the safety and efficacy of intrasaccular flow disruptor in intracranial aneurysms, including wide-necked aneurysms.Methods:A retrospective analysis was performed; 102 patients with intracranial aneurysms treated with intrasaccular flow disruptor at Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from August 2022 to November 2024 were enrolled; their clinical and imaging data were collected. The aneurysm characteristics and perioperative complications were summarized; aneurysm occlusion was evaluated by Woven EndoBridge occlusion scale (WOS) immediately after surgery and during the follow-up period.Results:Among the 102 aneurysms, 33 were anterior cerebral artery aneurysms, 40 were middle cerebral artery aneurysms, 17 were internal carotid artery aneurysms and 12 were basilar artery aneurysms; 73 aneurysms were regular intracranial saccular aneurysms and 29 were irregular saccular ones (17 of them with daughter sacs); 12 aneurysms were ruptured at acute phase. The surgical success rate was 100%: single intrasaccular flow disruptor was implanted into 95 patients, and stent-assisted or salvage treatments were given to 7 patients). Immediately after surgery, WOS grading A was noted in 5 patients, grading B in 7, grading C in 31, and grading D in 59. Two patients suffered severe perioperative complications and passed away: one patient died for ischemic complications that ensued after stent salvage treatment (parent artery being compressed by intrasaccular flow disruptor); the other patient died for hemorrhagic complications triggered by rupture of an initially unruptured aneurysm following intrasaccular flow disruptor implantation. Among them, 52 patients completed postoperative DSA follow-up, with a median follow-up of 205 (168, 292) days; WOS grading A was noted in 31 patients, grading B in 9, grading C in 8, and grading D in 4 at the last follow-up; the full occlusion rate was 92.3%, and no ischemic or hemorrhagic adverse events occurred.Conclusion:Intrasaccular flow disruptor shows high short-term safety and good efficacy in the treatment of intracranial aneurysms.

Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Objective To explore the value of nomogram model based on MR T1WI enhanced radiomics features and clinical fac-tors in predicting the prognosis of gliomas.Methods A retrospective selection was conducted on 135 patients with postoperative pathologically confirmed gliomas,who were categorized into poor prognosis group(n=59)and good prognosis group(n=76)according to survival condition at 20 months postoperatively.All patients were randomly divided into training group(n=94)and validation group(n=41)in a 7︰3 ratio.Radiomics features were extracted by 3D Slicer software,and the extracted radiomics features were downscaled by intraclass correlation coefficient(ICC),t-test,least absolute shrinkage and selection operator(LASSO)regression,and a total of 1 058 features were extracted for each patient,and 10 optimal radiomics features were obtained,to finally get the Radiomics score(Radscore).After combining clinical features and Radscore,a nomogram model was constructed.Results In the training group,Radscore was significantly higher in the poor prognosis group than that in the good prognosis group(t=8.773,P<0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)curve of the training and validation groups of the radiomics model were 0.751[95%confidence interval(CI)0.654-0.849]and 0.606(95%CI 0.426-0.787),respectively.The AUC of the nomogram model were 0.899(95%CI 0.839-0.960)and 0.908(95%CI 0.823-0.994)in the training and validation groups,respectively,with much better predictive efficacy of the nomogram model.Conclusion A nomogram model based on MR T1WI enhanced radiomics features and clinical factors has good predictive efficacy in the prognosis of gliomas after surgery.

Objective:To investigate the impact of flow diverter (FD) malapposition at the aneurysm neck on clinical outcomes and complications of intracranial aneurysms, and identify the influencing factors for intraoperative FD malapposition.Methods:A retrospective study was performed; 153 patients with unruptured saccular aneurysms at the C4-C7 segments of the internal carotid artery accepted single FD implantation at Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from June 2022 to March 2024 were chosen. Intraoperative high-resolution C-arm CT was utilized to assess FD apposition at the aneurysm neck. (1) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into a malapposition group ( n=23, including 16 patients with malapposition being identified as residual malapposition after intraoperative corrective measures such as microwire massage and 7 patients with malapposition being newly detected in this study) and a complete apposition group ( n=130). Perioperative and follow-up complications were recorded. Clinical outcomes were assessed using modified Rankin Scale (mRS) at the final follow-up (mRS score of 0-2 as favorable outcome), and angiographic outcomes were evaluated by DSA at the final follow-up. Differences in clinical and angiographic outcomes and complication rate were compared between the malapposition group and complete apposition group. (2) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into an intraoperative malapposition group ( n=74, including 67 patients with malapposition being detected during surgery and 7 patients with malapposition being newly detected in this study) and an intraoperative complete apposition group ( n=79). Univariate analysis was performed to compare the clinical variables between the intraoperative malapposition group and intraoperative complete apposition group; multivariate Logistic regression was further employed to identify the independent influencing factors for FD malapposition at the aneurysm neck. Results:(1) Four patients (all from the malapposition group) developed perioperative acute in-stent thrombosis. Nine patients experienced ischemic or hemorrhagic stroke during the follow-up, including 6 from the malapposition group and 3 from the complete apposition group; the complication rate in the malapposition group (6/23, 26.1%) was significantly higher than that in the complete apposition group (3/130, 2.3%) during the follow-up ( P<0.05). At the final follow-up, 2 patients (both from the malapposition group) had poor clinical outcome, while the remaining 151 patients had favorable outcome. Proportion of patients with favorable outcome between the two groups was statistically different (91.3%[21/23] vs. 100.0%[130/130], P<0.05). Delayed occlusion was detected in 46 patients (12 from the malapposition group and 34 from the complete apposition group) at the final angiographic follow-up. FD restenosis/re-occlusion was noted in 10 patients, including 6 from the malapposition group and 4 from the complete apposition group. Significant difference in delayed occlusion rate (52.2%[12/23] vs. 26.2%[34/130]) and long-term in-stent stenosis/occlusion rate (26.1%[6/23] vs. 3.1%[4/130]) was observed between the two groups ( P<0.05). (2) Significant difference in aneurysm neck diameter, FD angulation, parent artery stenosis, parent artery diameter ratio>1.2, and presence of branching vessels at the FD implantation site was noted between the intraoperative complete apposition group and intraoperative malapposition group ( P<0.05). Multivariate Logistic regression indicated that aneurysm neck diameter ( OR=1.431, 95% CI: 1.096-1.868, P=0.008), parent artery diameter ratio>1.2 ( OR=2.199, 95% CI: 1.083-4.463, P=0.029), and FD angulation ( OR=1.019, 95% CI: 1.002-1.036, P=0.027) were independent influencing factors for FD malapposition at the aneurysm neck. Conclusion:In FD implantation for intracranial aneurysms, FD malapposition at the aneurysm neck adversely affects delayed occlusion rate and complication rate; aneurysms with wider aneurysm neck diameter, parent artery diameter ratio>1.2, and greater FD angulation are trend to have FD malapposition at the aneurysm neck.