Onco-critical care has emerged as an important subspecialty at the intersection of critical care medicine and oncology, attracting increasing attention in recent years. With continuous innovations in cancer therapies, patient survival has improved significantly; however, the incidence of associated critical complications has also increased. The reasons for cancer patients requiring intensive care unit admission are diverse and can be broadly categorized into three groups: progression of the underlying malignancy, treatment-related complications, and coexisting classical critical illnesses. Traditional critical care concepts and practices face limitations in addressing the multidimensional and heterogeneous challenges of onco-critical care. Based on the core mechanism of critical illness development—host/organ unregulated response (HOUR)—this article systematically elaborates on how this framework advances understanding and clinical practice into onco-critical care, with emphasis on its manifestations in neuroendocrine, immune-inflammatory, and coagulation-metabolic pathways. The review summarizes recent advances in clinical assessment and phenotyping systems for onco-critical illness and discusses a multidisciplinary, integrated management strategy centered on the "Disease Control, Host Response Modulation, Organ Support" triad. Finally, major challenges and future directions in this field are outlined. By integrating existing evidence and theoretical insights, this review aims to provide new perspectives and a theoretical foundation for the clinical management of onco-critical illness, thereby promoting its evolution toward precision and standardization.

Cancer immunotherapy, particularly immune checkpoint inhibitors (ICIs), has significantly improved the prognosis of patients with various malignancies. However, the immune-related adverse events (irAEs) and associated organ dysfunction they trigger have become key issues affecting treatment safety and long-term patient survival. Pathophysiologically, irAEs share common features with classical critical illnesses like sepsis, both involving host/organ unregulated response (HOUR). The key distinction lies in irAEs primarily manifesting as overactivation of the immune system. Clinically, differentiating irAEs from infection in ICI-treated patients presenting with new-onset organ dysfunction is often challenging. Building upon the HOUR theoretical framework, this article proposes a PRISM management strategy integrating multi-omics technology, aiming to provide a personalized approach for the diagnosis and treatment of immunotherapy-related organ dysfunction. The PRISM strategy encompasses five key components: Precise etiological differentiation, Regulation of host response, Immunotherapy risk prediction, Support of organ function, and Multidisciplinary collaboration. By integrating multi-omics biomarkers and patient clinical characteristics, the PRISM strategy enables early warning and precise phenotyping of organ dysfunction and offers individualized intervention plans. It holds promise for significantly improving the clinical management of irAEs, enhancing patients' quality of life and long-term prognosis, thereby providing a theoretical foundation and practical guidance for the precise prevention and treatment of critical illnesses associated with immunotherapy.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

AIM: To investigate expression differences and mechanism of action of serine/threonine kinase 1(AKT1), ATP synthase F1 subunit(ATP5F1), and Bcl-2-associated anti-apoptotic gene 3(BAG3)in the occurrence and progression of pterygium.METHODS:Pterygium-related gene expression data were retrieved from GEO database to screen differentially expressed genes(DEGs). String and Cytoscape were used to construct protein-protein interaction(PPI)networks and identify core targets. GO/KEGG enrichment analyzed mitochondrial metabolic pathways. The pterygium samples(head/body)were collected; pathological features were evaluated by HE staining, and the expression of AKT1, ATP5F1, and BAG3 was detected via immunohistochemistry(IHC).RESULTS:A total of 1 264 DEGs were identified(585 upregulated, 679 downregulated). GO analysis showed significant enrichment of mitochondrial pathways regarding to biological processes, cell components and molecular functions; KEGG analysis highlighted oxidative phosphorylation and chemical carcinogenesis-reactive oxygen species(ROS)pathways. The head and body pterygium samples were collected from 28 cases(28 eyes)that received pterygium surgery, including 7 males(7 eyes)and 21 females(21 eyes), with a mean age of 69.32±8.98 years. HE staining showed more severe dysplasia, disordered stroma, and inflammation in the pterygium head versus the body. IHC detection confirmed significantly lower AKT1, ATP5F1, and BAG3 expression in the head compared with the body(all P<0.05).CONCLUSION:GEO-based bioinformatics and experiments confirmed that AKT1/ATP5F1/BAG3(mitochondrial genes)had significant differential expression in pterygium, correlating with pathological progression. They may regulate mitochondrial metabolism to mediate pterygium progression, offering new insights for targeted therapy.

According to the Qi-blood-body fluid theory and the association between the spleen in visceral manifestation theory of traditional Chinese medicine （TCM） and mitochondria in modern cellular biology， it is proposed that the role of the spleen in generating and transforming Qi and blood is analogous to the energy-producing function of mitochondria—both serving as fundamental power sources for vital activities of the human body. The spleen governs transportation and transformation， playing a critical role in energy metabolism and the digestion and absorption of nutrients. Similarly， mitochondria are vital for maintaining physiological functions such as cellular energy supply， cell survival， and overall human metabolism. Furthermore， spleen deficiency is closely linked to mitochondrial dysfunction. Accordingly， mitochondrial energy conversion and substance metabolism are regarded as the microscopic essence of the spleen's function in transportation and transformation. Spleen deficiency and mitochondrial dysfunction contribute to the formation of pathological products such as phlegm-turbidity and blood stasis. This aligns with the pathogenesis of chronic obstructive pulmonary disease （COPD）， with Qi deficiency as the root cause and phlegm-turbidity and blood stasis as the manifestations. Therefore， the integrative treatment of COPD should follow the therapeutic principle of invigorating the spleen and reinforcing healthy Qi， while also resolving phlegm and removing blood stasis to address both root cause and manifestations. This approach can improve the mitochondrial function， regulate energy metabolism， and reduce oxidative stress levels to alleviate COPD symptoms， slow down disease progression， and improve prognosis. By integrating the holistic concept of TCM with molecular mechanisms of modern medicine， this paper explores the pathogenesis and therapeutic principles of COPD from the spleen-mitochondria correlation. It not only provides a new direction for the modern development of TCM and the integration of Chinese and Western medicine but also offers a theoretical foundation for the integrated treatment of chronic， complex age-related diseases.

According to the Qi-blood-body fluid theory and the association between the spleen in visceral manifestation theory of traditional Chinese medicine （TCM） and mitochondria in modern cellular biology， it is proposed that the role of the spleen in generating and transforming Qi and blood is analogous to the energy-producing function of mitochondria—both serving as fundamental power sources for vital activities of the human body. The spleen governs transportation and transformation， playing a critical role in energy metabolism and the digestion and absorption of nutrients. Similarly， mitochondria are vital for maintaining physiological functions such as cellular energy supply， cell survival， and overall human metabolism. Furthermore， spleen deficiency is closely linked to mitochondrial dysfunction. Accordingly， mitochondrial energy conversion and substance metabolism are regarded as the microscopic essence of the spleen's function in transportation and transformation. Spleen deficiency and mitochondrial dysfunction contribute to the formation of pathological products such as phlegm-turbidity and blood stasis. This aligns with the pathogenesis of chronic obstructive pulmonary disease （COPD）， with Qi deficiency as the root cause and phlegm-turbidity and blood stasis as the manifestations. Therefore， the integrative treatment of COPD should follow the therapeutic principle of invigorating the spleen and reinforcing healthy Qi， while also resolving phlegm and removing blood stasis to address both root cause and manifestations. This approach can improve the mitochondrial function， regulate energy metabolism， and reduce oxidative stress levels to alleviate COPD symptoms， slow down disease progression， and improve prognosis. By integrating the holistic concept of TCM with molecular mechanisms of modern medicine， this paper explores the pathogenesis and therapeutic principles of COPD from the spleen-mitochondria correlation. It not only provides a new direction for the modern development of TCM and the integration of Chinese and Western medicine but also offers a theoretical foundation for the integrated treatment of chronic， complex age-related diseases.

In the field of critical care medicine, coagulopathy is no longer viewed as an isolated hemostatic abnormality or thrombotic event, but rather as a core effector of the host/organ unregulated response (HOUR) to severe injury. Conventional monitoring modalities based primarily on plasma coagulation tests exhibit considerable lag and fail to capture the dynamic evolution of hypercoagulability and endothelial injury in the early phase of critical illness. This article systematically proposes the "Critical Care Coagulation ResponseAssessment and Monitoring System" and establishes a novel conceptual framework that "hypercoagulability is the norm, while hypocoagulability is the consequence." We advocate for viscoelastic testing as the cornerstone, deeply integrated with the four thrombus-related molecular biomarkers, and combined with conventional coagulation parameters and platelet function analysis, to constitute a multidimensional phenotypic assessment protocol for coagulation responses.Furthermore, we elaborate on how dynamic monitoring of coagulation responses enables the construction of a temporal profile of coagulopathic evolution, allowing early identification of key pathological processes including endothelial glycocalyx shedding, thrombin burst, and fibrinolysis shutdown, thereby distinguishing physiological coagulation responses from pathological coagulopathy/disease and even disseminated intravascular coagulation. On this basis, we propose phenotype-guided precision anticoagulation, component blood product transfusion, and endothelial protective strategies, aiming to provide clinicians with a complete closed-loop management framework from mechanistic elucidation to bedside decision-making. Importantly, we position coagulation response management as a critical node in HOUR stewardship-not only pivotal for thrombotic and hemorrhagic risk control, but also a key intervention pathway to prevent disease progression, reduce the incidence of multiple organ dysfunction syndrome, and ultimately improve outcomes in critically ill patients.

Cleft lip and palate (CLP) are common congenital craniofacial developmental disorders with a high incidence rate among newborns. Due to the influence of the cleft, an increased frequency of anomalies occurs in cleft-adjacent teeth. This review summarizes the abnormality of tooth development and malposition characteristics of the central incisors, lateral incisors, and canines adjacent to the alveolar cleft in CLP patients and treatment progress in order to provide information for related clinical treatment and research. The literature reveals that central incisors, lateral incisors, and canines adjacent to the alveolar cleft exhibit various types and degrees of abnormalities. The alveolar cleft-adjacent central incisors show significantly smaller mesiodistal diameters, root lengths, and root volumes compared to the non-alveolar cleft side, while the crown-to-root ratio is larger. Further, they are inclined distally and lingually compared to the non-alveolar cleft side. The alveolar cleft-adjacent lateral incisor is the most common missing or impacted tooth and is often affected by microdontia. The total length and root length of the alveolar cleft-adjacent canines are significantly smaller, while the crown-to-root ratio is larger on the alveolar cleft side. In addition, they are inclined mesially and buccally compared to the non-alveolar cleft side. Further, they are higher positioned and located closer to the midline. For developmental anomalies, impacted central incisors can be addressed by orthodontic space preparation to facilitate eruption or surgical crown exposure and orthodontic traction. Treatment of missing lateral incisors can involve orthodontic closure of the gap or preservation of the space for subsequent prosthetic restoration. When lateral incisors present with developmental defects, such as microdontia, peg-shaped teeth, or invaginated teeth, a comprehensive decision is necessary to determine whether to retain and restore or extract the malformed lateral incisors. Treatment of impacted canines after bone grafting involves either extraction or traction to facilitate the eruption of the impacted tooth. For malposition, presurgical orthodontic treatment can correct teeth with excessive inclination or rotation on the cleft side to improve the effectiveness of bone grafting surgery. Postsurgical orthodontic treatment can enhance the stability of bone grafting surgery. Although numerous studies have explored the dental characteristics of patients with CLP, the lack of applicability and specificity still need to be elucidated, thus indicating the need for further research.

Objective To analyze the effects of left bundle branch area pacing(LBBaP)on atrial fibrillation occurrence after dual-chamber pacemaker implantation.Methods The medical records of 87 patients who underwent dual-chamber pacemaker implantation at People's Hospital between May 2021 and September 2022 were retrospectively analyzed.According to different implantation methods,the patients were divided into an observation group(n=45)and a control group(n=42).The control group received traditional right ventricular pacing(RVP),while the observation group received LBBaP.Serum N-terminal pro B-type natriuretic peptide(NT-proBNP),QRS onset-to-end duration(QRSd),echocardiographic parameters,cardiac pacing parameters,complications,atrial high-rate events,and atrial fibrillation incidence were compared between the two groups.Results Twelve months after surgery,serum NT-proBNP levels in the observation group were significantly lower than those in the control group(P＜0.05),and QRS duration(QRSd)was shorter in the observation group than in the control group(P＜0.05).There were no significant differences in left ventricular ejection fraction(LVEF)or left ventricular end-systolic diameter(LVESD)between the two groups at 12 months postoperatively(P＞0.05).Left atrial diameter(LAD)was smaller in the observation group than in the control group at 12 months postoperatively(P＜0.05).No significant differences were observed in sensing levels or the proportion of cardiac pacing between the two groups(P＞0.05).However,the proportion of ventricular pacing was higher in the observation group than in the control group(P＜0.05).Intraoperatively and at 12 months postoperatively,impedance levels were lower in the observation group than in the control group(P＜0.05),while threshold values were higher in the observation group(P＜0.05).Total complication rates did not differ significantly between the two groups(P＞0.05).At 12 months postoperatively,the incidence of atrial fibrillation was similar between the two groups(P＞0.05),but the incidence of atrial high-rate events was lower in the observation group than in the control group(P＜0.05).At 24 months postoperatively,both the incidence of atrial high-rate events and atrial fibrillation were lower in the observation group than in the control group(P＜0.05).Conclusion Compared with traditional RVP implantation,LBBaP implantation can significantly improve left heart function,provide more stable pacing parameters,and reduce the risk of long-term atrial high-rate events and atrial fibrillation.The risk of complications is similar for both groups,but LBBaP implantation increases the pacing threshold.

Objective To analyze the effect of dronedarone and propafenone in preventing postoperative recurrence in patients with atrial fibrillation(AF)and to discuss its influence on inflammatory response and myocardial injury.Methods A total of 113 patients with AF,who were admitted to the Qiandongnan People's Hospital of China from July 2022 to March 2024,were enrolled in this study.By using random number table method,the patients were divided into control group(n=56)and study group(n=57).All patients received circumpulmonary vein electrical isolation.After treatment,the patients of control group were given propafenone orally for three months,while the patients of study group received dronedarone orally for three months.Both the preoperative and postoperative 3-month inflammatory response indicators including hypersensitive C-reactive protein(Hs-CRP),leucolipin,nucleotide-bound oligomeric domain-like receptor protein 3(NLRP3)inflammasome,and tumor necrosis factor α(TNF-α),the echocardiographic indicators including left atrial maximum volume(LAMV),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF),the myocardial injury markers including creatine kinase(CK),cardiac troponin I(cTn I),the central nervous specific protein β(S100β),the creatine kinase isoenzyme(CK-MB),the adverse reactions,and the recurrence of AF were compared between the two groups.Results At 3 months after treatment,the serum levels of hs-CRP,leucolipin,NLRP3 inflammasome and TNF-α were decreased in both groups(all P＜0.01),which in the study group were obviously lower than those in the control group(all P＜0.001);the levels of LAMV and LVESD were decreased in both groups(both P＜0.01),which in the study group were remarkably lower than those in the control group(both P＜0.001);the level of LVEF was increased in both groups(P＜0.01),which in the study group was significantly higher than that in the control group(P＜0.001);the levels of CK,cTn I,S100β,and CK-MB were decreased in both groups(all P＜0.01),which in the study group were strikingly lower than those in the control group(all P＜0.001).The incidence of adverse drug reactions in control group and in the study group was 5.36％(3/56)and 7.02％(4/57 cases)respectively,and the difference was not statistically significant(P＞0.05).Within 3 months after treatment,the recurrence rate in the study group was 5.26％(3/57),which was lower than 19.64％(11/56)in the control group,and the difference was statistically significant(P＜0.05).Conclusion Compared with propafenone,the use of dronedarone after circumferential pulmonary vein electrical isolation in patients with AF can improve the cardiac functions,reduce myocardial injury and inflammatory responses,and lower the risk of postoperative recurrence of AF.