Objective To explore the prognostic factors for patients with descending duodenum gastrointestinal stromal tumors (GIST), analyze the impact of different surgical approaches on prognosis, and develop a predictive model for surgical approach selection. Methods This single-center retrospective cohort study included patients with primary descending duodenum GIST treated in Zhongshan Hospital, Fudan University from January 2010 to January 2015, with follow-up until August 2025. The primary outcomes were incidence of postoperative complications, disease-free survival (DFS) rate, and overall survival (OS) rate. Cox regression and logistic regression were used to identify factors influencing prognosis and surgical approach selection, respectively. A nomogram model for selecting the surgical approach was constructed. Results A total of 78 patients with descending duodenum GIST were included, with age of (56.14±11.76) years. The 1-, 5-, and 10-year OS rates were 100%, 98.7%, and 85.7%, respectively, and the corresponding DFS rates were 100%, 90.9%, and 82.3%. Intraoperative blood loss, postoperative gastroparesis, mucosal ulceration, maximum tumor diameter, and Ki-67-positive cell ratio were independent risk factors for DFS, while maximum tumor diameter and mitotic figure were independent risk factors for OS (P＜0.05). The 10-year DFS rate was higher in the local resection group than in the pancreaticoduodenectomy group (89.45% vs 74.24%; HR＝0.300, P＝0.013), but there was no statistical difference in OS between the two groups. The incidence of postoperative complications in the pancreaticoduodenectomy group was higher than that in the local resection group (P＜0.001). Maximum tumor diameter and distance from tumor to the duodenal papilla were independent factors influencing surgical approach selection. The nomogram model based on these two indices demonstrated good discrimination and accuracy upon internal validation. Conclusions The long-term prognosis of patients with descending duodenal GIST is favorable, and surgical treatment achieves satisfactory outcomes. The nomogram model developed in this study can effectively guide individualized surgical approach selection and provide a reference for clinical decision-making.

ObjectiveTo evaluate the clinical efficacy of Shenqi Yangxin decoction in the treatment of ischemic cardiomyopathy （ICM） with Qi and Yin deficiency and blood stasis syndrome and its effect on serum hydrogen sulfide （H₂S） and calcium ion （Ca²⁺）. MethodsA total of 64 ICM patients with Qi and Yin deficiency and blood stasis syndrome who met the inclusion criteria were randomly divided into a control group （n=32） and a treatment group （n=32）. All patients received conventional Western medicine treatment. The treatment group was additionally given Shenqi Yangxin decoction. The TCM syndrome score， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， 6-minute walk test （6MWT）， New York Heart Association （NYHA） cardiac function classification， and serum H₂S and Ca²⁺ levels were compared between the two groups pre- and post-treatment. ResultsTwo cases dropped out from each group during the study. Finally， 30 patients in each group were included in the analysis. There were no significant differences in age， gender， course of coronary heart disease， underlying diseases， and laboratory tests between the two groups. Compared with baseline， the TCM syndrome score， MLHFQ score， and NT-proBNP in both treatment group and control group decreased significantly （P<0.01）， LVEF， 6MWT， and H₂S increased significantly （P<0.01）， and serum Ca²⁺ increased （P<0.05）. Compared with the control group after treatment， the MLHFQ score and NT-proBNP in the treatment group decreased （P<0.05）， the TCM syndrome score decreased significantly （P<0.01）， LVEF， 6MWT， and serum Ca²⁺ increased （P<0.05）， and H₂S increased significantly （P<0.01）. The improvement degree of the NYHA cardiac function classification in the treatment group was higher than that in the control group， but there was no significant difference. ConclusionShenqi Yangxin decoction is effective in treating ICM patients with Qi and Yin deficiency and blood stasis， which could significantly improve cardiac function and quality of life， and its therapeutic effect may be related to the regulation of serum H₂S and Ca²⁺ levels.

The cooccurrence of NPM1, FLT3-ITD, and DNMT3A mutations (i.e., triple mutation) is related to dismal prognosis in patients with acute myeloid leukemia (AML) receiving chemotherapy alone. In this multicenter retrospective cohort study, we aimed to identify whether allogeneic hematopoietic stem cell transplantation (allo-HSCT) could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut AML across four transplant centers in China. Fifty-three patients with triple-mutated AML receiving allo-HSCT in complete remission were enrolled. The 1.5-year probabilities of relapse, leukemia-free survival, and overall survival after allo-HSCT were 11.9%, 80.3%, and 81.8%, respectively. Multivariate analysis revealed that more than one course of induction chemotherapy and allo-HSCT beyond CR1 were associated with poor survival. To our knowledge, this work is the largest study to explore the up-to-date undefined role of allo-HSCT in patients with triple-mutated AML. Our real-world data suggest that allo-HSCT could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut in AML.
Humans ; Nucleophosmin ; Leukemia, Myeloid, Acute/mortality* ; Hematopoietic Stem Cell Transplantation/methods* ; Male ; Female ; DNA Methyltransferase 3A ; Adult ; China ; Retrospective Studies ; DNA (Cytosine-5-)-Methyltransferases/genetics* ; Middle Aged ; Prognosis ; fms-Like Tyrosine Kinase 3/genetics* ; Mutation ; Young Adult ; Transplantation, Homologous ; Nuclear Proteins/genetics* ; Adolescent ; Aged

G protein-coupled receptors (GPCRs) are the largest family of membrane proteins in eukaryotes, with nearly 800 genes coding for these proteins. They are involved in many physiological processes, such as light perception, taste and smell, neurotransmitter, metabolism, endocrine and exocrine, cell growth and migration. Importantly, GPCRs and their ligands are the targets of approximately one third of all marketed drugs. GPCRs are traditionally known for their role in transmitting signals from the extracellular environment to the cell's interior via the plasma membrane. However, emerging evidence suggests that GPCRs are also localized on mitochondria, where they play critical roles in modulating mitochondrial functions. These mitochondrial GPCRs (mGPCRs) can influence processes such as mitochondrial respiration, apoptosis, and reactive oxygen species (ROS) production. By interacting with mitochondrial signaling pathways, mGPCRs contribute to the regulation of energy metabolism and cell survival. Their presence on mitochondria adds a new layer of complexity to the understanding of cellular signaling, highlighting the organelle's role as not just an energy powerhouse but also a crucial hub for signal transduction. This expanding understanding of mGPCR function on mitochondria opens new avenues for research, particularly in the context of diseases where mitochondrial dysfunction plays a key role. Abnormalities in the phase conductance pathway of GPCRs located on mitochondria are closely associated with the development of systemic diseases such as cardiovascular disease, diabetes, obesity and Alzheimer's disease. In this review, we examined the various types of GPCRs identified on mitochondrial membranes and analyzed the complex relationships between mGPCRs and the pathogenesis of various diseases. We aim to provide a clearer understanding of the emerging significance of mGPCRs in health and disease, and to underscore their potential as therapeutic targets in the treatment of these conditions.

Objective:To investigate the clinical effect of percutaneous transhepatic cholangial drainage (PTCD) combined with percutaneous transhepatic papillary balloon dilatation (PTPBD) in the treatment of choledocholithiasis.Methods:The clinical data of patients treated with PTCD combined with PTPBD under digital subtraction angiography for choledocholithiasis in the Interventional Department of the Second Affiliated Hospital of Nantong University from June 2021 to May 2024 were retrospectively analyzed, and a total of 90 patients were enrolled, including 58 males and 32 females, aged (56.6±4.3) years. The changes of liver function, postoperative complications, and prognosis were analyzed.Results:Of 90 patients were successfully treated with PTCD, and 3 patients (3.3%) died after PTCD operation, mainly due to old age combined with a variety of underlying diseases. 85(97.7%) of the remaining 87 patients were successfully treated with PTPBD, while 2 cases (2.3%) experienced technical failure due to excessive stone size (>20 mm). Among the 90 cases after the procedure, there were 6 cases (6.7%) of abdominal pain, 3 cases (3.3%) of bleeding, 4 cases (4.4%) of fever, and no serious complications such as bile duct perforation, intestinal perforation or pancreatitis occurred. The symptoms of 87 patients were improved within 3 to 7 days after PTCD. The changes of leukocyte, total bilirubin, alanine aminotransferase and C reactive protein before and after surgery were statistically significant (all P<0.001). Conclusions:PTCD combined with PTPBD is a minimally invasive treatment for common bile duct stones with obvious advantages in high success rate, safety, and effectiveness, which is especially suitable for elderly patients with multiple underlying diseases, inability to tolerate surgical procedures, or no suitable endoscopic pathways.

Objective:To develop a deep learning model based on super-resolution endorectal ultrasound（ERUS）images for the preoperative prediction of perineural invasion（PNI）in patients with rectal cancer，thereby providing a reference for risk stratification and individualized treatment planning.Methods:A retrospective analysis was conducted on 382 patients with rectal cancer who underwent total mesorectal excision at Fujian Medical University Union Hospital between June 2019 and February 2024. Patients were randomly divided into a training set（ n=305）and a test set（ n=77）at a ratio of 8∶2，and further grouped into PNI-negative group and PNI-positive group subgroups based on pathological results. Super-resolution ultrasound images were generated from original ERUS images using a generative adversarial network（GAN）. Deep convolutional neural networks were developed based on features from intratumoral and peritumoral regions to identify the optimal region of interest（ROI）. The dSR5_ResNet18 and dSR5_ResNet50 models were constructed using the super-resolution images with a 5-pixel peritumoral extension. Representative clinical features were selected for subgroup analysis based on sample size and intergroup statistical differences between PNI-positive and PNI-negative patients. Forest plots were used to evaluate model applicability and robustness across subgroups. Results:The dSR5_ResNet18 model，built using super-resolution images of the tumor combined with a 5-pixel peritumoral region，achieved the best predictive performance，with an AUC of 0.867（95% CI=0.782 - 0.952）in the test set. Decision curve analysis demonstrated that the dSR5_ResNet18 model provided the greatest net clinical benefit. Forest plot analysis indicated strong generalizability of the models across subgroups such as pathological N stage，maximum lesion length，and lymph node enlargement，though relatively weaker performance was observed in the carcinoembryonic antigen（CEA）subgroup. Among all models，dSR5_ResNet18 exhibited the most consistent performance across subgroups，with the narrowest confidence intervals and highest robustness. Conclusions:The deep learning model incorporating ERUS-based super-resolution reconstruction demonstrated excellent performance in the preoperative prediction of PNI in rectal cancer. It offers significant advantages in image quality and generalizability，and may serve as a valuable tool to assist clinicians in formulating personalized treatment strategies.

Objective To investigate the clinical effect of percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone(CBDS).Methods The relevant data of patients treated with PTPBD for CBDS under digital subtraction angiography(DSA)were analyzed retrospectively,and its safety and effectiveness were analyzed.Results Among the 50 patients,there were 3 cases of abdominal pain,2 cases of bleeding,2 cases of fever,and no serious complications related to bile duct or intesti-nal perforation or pancreatitis.45 cases(90.00%)were successfully treated with PTPBD,while other 5 cases experienced technical failure due to excessive stone size(>20 mm).Conclusion PTPBD is a safe,effective,and minimally invasive treatment for CBDS with a high success rate,which is especially suitable for the patients with older age,multiple underlying diseases,inability to toler-ate surgical procedure,and without suitable endoscopic pathways,and the method is worthy of clinical promotion.

Objective To analyze the effect of percutaneous transhepatic cholangial drainage(PTCD)combined with percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone in elderly patients.Methods The clinical data of elderly patients treated with PTCD combined with PTPBD under digital subtraction angiography(DSA)for common bile duct stone were retrospectively collected,the changes in liver function,postoperative complications,and prognosis were analyzed.Results All 70 patients were successfully treated with PTCD,and other 3 patients died after PTCD operation,mainly due to severe infection combined with a variety of underlying diseases.Among the remaining 67 patients,65 cases(97.00%)were successfully treated with PTPBD,while other 2 cases(3.00%)experienced technical failure due to excessive stone size(>20 mm).Among the 70 cases after the pro-cedure,there were 5 cases with abdominal pain,2 cases with bleeding,4 cases with fever,and no serious complications occurred,such as bile duct perforation,intestinal perforation,or pancreatitis.The symptoms of 67 patients were improved from 3 to 7 days after PTCD,and the changes in leukocyte,total bilirubin,alanine aminotransferase and C-reactive protein before and after surgery were sta-tistically significant(P<0.05).Conclusion PTCD combined with PTPBD is a minimally invasive treatment method for common bile duct stone with a high success rate,safety,and effectiveness,which is especially suitable for elderly patients with multiple under-lying diseases,an inability to tolerate surgical and endoscopic treatments.It is worthy of clinical promotion and application.

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Objective The objective of this research was to examine the cardioprotective properties of a SIRT1 agonist in mice afflicted with coronary artery disease(CAD).Methods Using the random number table method,60 male C57BL/6J mice were randomly divided into a control group,a model group,an SRT1 agonist group(Group SRT 1460,30 mg/kg),an Nrf2 inhibitor group(ML385 group,10 mg/kg),and a combined treatment group of SRT 1460+ML385,with 12 mice in each group.The control group mice were fed with normal feed,and the other groups of mice were fed with high-fat feed to create atherosclerosis mouse model.The modeling period was 12 weeks.After the successful construction of the model,ultrasonic parameters were used to detect the myocardial function of mice;two-dimensional ultrasound spot tracking technology was used to detect the strain of each layer of left ventricular myocardium.Pathological alterations in myocardial tissue were detected via HE staining,and the levels of cTnI,LDH and CK were measured using ELISA.Cardiomyocyte apoptosis was evaluated using TUNEL analysis,and levels of ROS in myocardial tissue were measured via DHE fluorescence assay.Additionally,SOD activity and MDA,GSH and Fe2+contents in myocardial tissue were determined using colorimetry.Finally,gene and protein expressions of Nrf2,GPX4,FTH1,and ACSL4 were assessed through qRT-PCR and Western blot analysis.Results A significant decrease in LVEDd and LVPWd levels was observed in the SRT 1460 group(P<0.05),whereas increases in GLSendo,GLSmid,and GCSendo levels were identified.A decrease in collagen fiber deposition was observed in the SRT 1460 group,in which the myocardium space narrowed.In comparison to the control group,the SRT 1460 group showed reductions in serum cTnI,CK,and LDH levels,cardiomyocyte apoptosis rate,ROS,MDA,and Fe2+contents,as well as ACSL4 mRNA and protein levels(P<0.05).An increase in SOD activity and GSH content as well as in Nrf2,GPX4,and FTH1 mRNA and protein levels was observed(P<0.05).By inhibiting the nuclear translocation of Nrf2,ML385 could significantly block the regulatory effect of SRT 1460(P<0.05).Conclusion It has been shown that SRT 1460 enhances GLSendo,GLSmid,and GCSmid,and improves left ventricular remodeling and systolic function in mice with CAD,in part because it regulates the Nrf2-GPX4 ferroptosis pathway.