Objective: To investigate the molecular mechanism of NOD-like receptor(NLR) signaling pathway induced cellular focal death in mouse kidney tissues under plateau hypoxia based on transcriptomic sequencing technology. Methods: Animal models were constructed in high-altitude kidney test group(HKT group) and plain kidney control group(PKC group),and C57/BL6 mice were bred at an altitude of 4 200 m and 400 m,respectively.Kidney tissues were aseptically taken out after 30 d and used for observation of renal histopathological changes and transcriptomics sequencing,respectively,and then differentially expressed genes(DEGs) were enriched by KEGG and GO analysis.Key gene and protein expression levels were verified by reverse transcription quantitative polymerase chain reaction(RT-qPCR) and Western blot analysis. Results: Hematoxylin-eosin(HE) staining showed that the renal tubules of HKT mice were disorganized,and the tubular epithelial cells were edematous with inflammatory cell aggregation.Transcriptomics sequencing analysis revealed that a total of 3 007 DEGs were identified in the HKT group,and KEGG analysis showed that DEGs were significantly enriched in the NLR signaling pathway.The mRNA expression of the key differentially expressed genes,CASP1,CASP11,GSDMD,IFI16,NAIP5,IRF9,and the downstream inflammatory factors,IL-1β and IL-18,was upregulated,and protein expression of CASP1,CASP11,and GSDMD was up-regulated. Conclusion The plateau hypoxic environment induces cellular pyroptosis by regulating the expression of NLR signaling pathway and releases downstream inflammatory factors to cause inflammatory responses.

Generative Artificial Intelligence ishows a broad application prospect in the field of healthcare and has become an important technical means to promote the development of medical informatization.It addresses the multi-faceted challenges of medical record documentation,including efficiency,quality,and doctor-patient communica-tion.It analyzes the adaptability and feasibility of Generative Artificial Intelligence in different clinical scenarios of intelli-gent medical record generation.Additionally,it explores the issues present in current applications and proposes corre-sponding solutions,providing references for the effective application and continuous optimization of Generative Artifi-cial Intelligence in medical record documentation.This provides a theoretical foundation for further expanding the appli-cation scenarios of automatic medical record documentation in China's healthcare industry.

BACKGROUND:The elastic modulus of bone-cartilage integration scaffolds differs significantly from that of natural bone-cartilage tissue,which can lead to a stress shield effect.As a result,the implants become loose and deformed,affecting the repair of osteochondral tissue.Cell gradient scaffolds made by axial direction three-period minimal surface have the same porosity and elasticity modulus as the human body,which provides a new idea for bone-cartilage scaffold design.OBJECTIVE:To study the effect of cell type and pore size on the mechanical properties of cell gradient scaffolds.METHODS:Three basic cells of Gyroid(G)type,Diamond(D)type,and Primitive(P)type were used.Through mathematical modeling of three-period minimal surface,different sizes and types of cells were used in the gradient region.A total of six kinds of cell gradient scaffolds(G-2P-4D,P-2D-4G,D-2P-4D,G-2D-4P,P-2G-4D,and D-2G-4P)were constructed and mechanical experiments and simulation experiments were conducted to evaluate the mechanical properties of the scaffolds.Flow performance parameters of the fluids in the scaffolds were obtained through computational fluid dynamics simulation.RESULTS AND CONCLUSION:Finite element mechanical simulation and compression experiment showed that P-2G-4D and P-2D-4G with the highest elastic modulus(148.67 MPa and 152.1 MPa),bearing a higher body load,improved the stability of the scaffold.The stress distribution in D-2P-4G was even and effectively reduced stress concentration,so that the connection function area could effectively transfer stress and reduce stress shielding.Flow rate was changing the least in G-2D-4P(0.10-0.48 mm/s).Permeability was higher than other scaffolds so that body fluids were able to flow though the gradient scaffold after implantation.This design method provides a new idea for the design of osteochondral scaffolds,and the simulation analysis results also provide a reference for the prediction of bone integration after implantation of scaffolds.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

AIM: To explore the effects of preoperative anterior segment parameters on the rotational stability of Toric intraocular lens(Toric IOL).METHODS:Prospective study. A total of 41 cataract patients(54 eyes)with combined corneal regular astigmatism from March to December 2023 were included and treated with cataract phacoemulsification combined with plate loop Toric IOL implantation in the Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University. The rotation degree of Toric IOL and uncorrected distance visual acuity(UCDVA)were evaluated at 1 d, 2 wk, and 1 mo postoperatively, the corrected distance visual acuity(CDVA)was evaluated at 2 wk and 1 mo after surgery, and the decentration and tilt of the Toric IOL were assessed at 2 wk postoperatively.RESULTS:A total of 33 patients(40 eyes)were included in this study. The UCDVA(LogMAR)of 1 d, 2 wk and 1 mo postoperatively were 0.10(0.10, 0.30), 0.05(0, 0.10)and 0(0, 0.10), respectively, which was improved compared with the preoperative levels of [0.80(0.49, 1.00)](P<0.001). The CDVA(LogMAR)of 2 wk and 1 mo postoperatively were 0.05(0, 0.15)and 0(0, 0.138), respectively, which was improved compared with preoperative levels of [0.52(0.40, 0.80)](P<0.001). The residual astigmatism of 2 wk and 1 mo postoperatively were 0.625(0.25, 0.75)D and 0.50(0.25, 0.75)D, respectively, which was significantly reduced compared with preoperative astigmatism of [1.82(1.31, 2.59)D](P<0.001). The preoperative anterior segment length(ASL), and lens thickness(LT)were positively correlated with Toric IOL rotation degree at 1 d(rs=0.463, P=0.003; rs=0.340, P=0.032)and 2 wk(rs=0.520, P=0.001; rs=0.409, P=0.009)postoperatively. At 1 mo postoperatively, only ASL was positively correlated with Toric IOL rotation degree(rs=0.463, P=0.003). The results of linear regression analysis showed that preoperative ASL was a predictor of rotation degree at 1 d, 2 wk and 1 mo after surgery(F1 d=10.098, P1 d=0.003; F2 wk=16.915, P2 wk<0.001; F1 mo=10.957, P1 mo=0.002). The rotation degree of Toric IOL was positively correlated with lens decentration(rs=0.360, P=0.043).CONCLUSION:The early postoperative rotation of Toric IOL is positively correlated with ASL, and the rotation is also positively correlated with lens decentration.

Generative Artificial Intelligence ishows a broad application prospect in the field of healthcare and has become an important technical means to promote the development of medical informatization.It addresses the multi-faceted challenges of medical record documentation,including efficiency,quality,and doctor-patient communica-tion.It analyzes the adaptability and feasibility of Generative Artificial Intelligence in different clinical scenarios of intelli-gent medical record generation.Additionally,it explores the issues present in current applications and proposes corre-sponding solutions,providing references for the effective application and continuous optimization of Generative Artifi-cial Intelligence in medical record documentation.This provides a theoretical foundation for further expanding the appli-cation scenarios of automatic medical record documentation in China's healthcare industry.

BACKGROUND:The elastic modulus of bone-cartilage integration scaffolds differs significantly from that of natural bone-cartilage tissue,which can lead to a stress shield effect.As a result,the implants become loose and deformed,affecting the repair of osteochondral tissue.Cell gradient scaffolds made by axial direction three-period minimal surface have the same porosity and elasticity modulus as the human body,which provides a new idea for bone-cartilage scaffold design.OBJECTIVE:To study the effect of cell type and pore size on the mechanical properties of cell gradient scaffolds.METHODS:Three basic cells of Gyroid(G)type,Diamond(D)type,and Primitive(P)type were used.Through mathematical modeling of three-period minimal surface,different sizes and types of cells were used in the gradient region.A total of six kinds of cell gradient scaffolds(G-2P-4D,P-2D-4G,D-2P-4D,G-2D-4P,P-2G-4D,and D-2G-4P)were constructed and mechanical experiments and simulation experiments were conducted to evaluate the mechanical properties of the scaffolds.Flow performance parameters of the fluids in the scaffolds were obtained through computational fluid dynamics simulation.RESULTS AND CONCLUSION:Finite element mechanical simulation and compression experiment showed that P-2G-4D and P-2D-4G with the highest elastic modulus(148.67 MPa and 152.1 MPa),bearing a higher body load,improved the stability of the scaffold.The stress distribution in D-2P-4G was even and effectively reduced stress concentration,so that the connection function area could effectively transfer stress and reduce stress shielding.Flow rate was changing the least in G-2D-4P(0.10-0.48 mm/s).Permeability was higher than other scaffolds so that body fluids were able to flow though the gradient scaffold after implantation.This design method provides a new idea for the design of osteochondral scaffolds,and the simulation analysis results also provide a reference for the prediction of bone integration after implantation of scaffolds.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective: To evaluate the efficacy of immune checkpoint inhibitors (ICIs) for fertility-sparing treatment in Lynch syndrome-associated endometrial cancer (LS-EC). Methods: Four LS-EC cases received programmed cell death protein 1 (PD-1) inhibitors for fertility preservation at the Obstetrics and Gynecology Hospital of Fudan University from 2017 to 2023. The clinical data and long-term outcomes were retrospectively reviewed. Results: Case 1, carrying germline MLH1 mutation, was diagnosed with Stage IIAm MMRd (International Federation of Gynecology and Obstetrics 2023) endometrial cancer (EC) at 38 years old. She received PD-1 inhibitor treatment and achieved a pathological complete response (CR) at 42 weeks. Case 2, carrying MLH1 mutation, underwent colorectal cancer surgery at 22 years and was diagnosed with EC and synchronous ovarian cancer at 39 years.After 24-week PD-1 treatment, CR of EC and ovarian cancer was achieved. Case 3, carrying MSH2 mutation, was diagnosed with endometrial atypical hyperplasia (EAH) at 35 years.After receiving 7-month progestin, she had the progressed disease with Stage IA2mMMRd EC and colon cancer was found soon after. She received PD-1 treatment for 18 weeks and achieved a CR of EC. She conceived naturally with full term delivery. Case 4, carrying MSH2 mutation, had a recurrence of Stage IBmMMRd EC 15 months after CR from EAH treated with progestin at 40 years. She received PD-1 treatment for 18 weeks and achieved CR. No recurrence was found in all cases after 3–41 months of follow-up after CR. Conclusion ICIs might be an effective choice for LS-EC patients desiring fertility preservation.

Objective To screen and validate the key genes involved in hypoxia-induced inflammatory reactions in mice using transcrip-tome sequencing and bioinformatics. Methods C57/BL6 mice were bred at altitudes of 4200 m and 400 m,and mouse models were con-structed for the plateau hypoxia (HKT) group and the plain normoxia (PKC) group. Kidney tissues were aseptically removed after 30 days,renal pathological changes were analyzed by HE staining,blood gas analysis and renal index changes were measured in the mice under hypoxia. The kidney tissues of mice in the HKT and PKC groups were analyzed using transcriptome sequencing,key genes were screened using bioinformatics technology,and these genes were verified using real-time quantitative reverse transcription PCR (RT-qPCR) and Western blotting. Results HE staining showed glomerular atrophy in mice in the HKT group compared with the PKC group,and a decrease in blood gas analysis and renal index occurred in mice exposed to hypoxia. Transcriptome sequencing analysis revealed 3007 differentially expressed genes (DEGs) in the HKT group,of which 123 were inflammation-related DEGs (IR-DEGs). GO and KEGG enrichment analyses of IR-DEGs showed significant enrichment in inflammation-related signaling pathways,such as cytokine-cytokine receptor interactions and chemokines. The results of the protein-protein interaction (PPI) network construction of IR-DEGs showed that six hub genes,STAT3,TLR7,CD68,NFKBIA,LEP,and APOE,were identified,and the mRNA expression of these six genes was upregulated according to RT-qPCR results,which was in agreement with the results of transcriptome sequencing. Western blotting showed that CD68,NFKBIA,LEP,TLR7,and APOE expression was upregulated while STAT3 expression was downregulated. Conclusion STAT3,CD68,NFKBIA,LEP,TLR7,and APOE are the key genes involved in hypoxia-induced inflammatory reactions. A hypoxic environment induced inflammatory reactions in mouse kidney tissues by upregulating the expression of TLR7,CD68,STAT3,LEP,and APOE.