ObjectiveThis study aimed to investigate the action mechanism by which Banxia Xiexintang （BXT） inhibits epithelial-mesenchymal transition （EMT） in chronic atrophic gastritis （CAG） rats by regulating the interleukin-17（IL-17）/extracellular regulated protein kinases（ERK）/CCAAT enhancer binding protein β（C/EBPβ）signaling pathway， thereby providing new theoretical evidence for the treatment of CAG with classic traditional Chinese medicine formulas. MethodsA CAG rat model was established by using the combined factor method. After successful modeling， the rats were randomly divided into the model group， low-， medium-， and high-dose groups （0.549， 1.098， 2.196 g·kg^-1， respectively） of BXT， and the positive drug group （vitacoenzyme， 0.3 g·kg^-1）. A normal control group was also set up. After 8 weeks of intervention， the pathological changes of gastric tissue were evaluated. The enzyme-linked immunosorbent assay （ELISA） was used to detect the contents of IL-17， tumor necrosis factor-α （TNF-α）， cyclooxygenase-2 （COX-2）， and C/EBPβ in serum， as well as the contents of EMT markers in gastric mucosal tissue including E-cadherin， N-cadherin， and vimentin. The immunohistochemistry method was employed to determine the localization and protein expression levels of IL-17， p-ERK， and C/EBPβ in gastric mucosal tissue. Western blot was used to detect the protein expressions of C/EBPβ， ERK， and its phosphorylated form （p）-ERK in gastric mucosa. Real-time polymerase chain reaction （Real-time PCR） was applied to measure the mRNA expression levels of ERK， COX-2， and C/EBPβ in gastric mucosa. ResultsCompared with those in the normal control group， the rats in the model group showed gastric mucosal glandular atrophy and inflammatory cell infiltration. The protein and their related mRNA expressions of C/EBPβ， ERK， and p-ERK in gastric mucosa were significantly increased （P<0.05，P<0.01）. The levels of IL-17， TNF-α， COX-2， and C/EBPβ in serum were significantly increased （P<0.01）. The contents of N-cadherin and vimentin in gastric mucosal tissue were significantly increased， while the content of E-cadherin was significantly decreased （P<0.01）. Compared with the model group， after intervention with different doses of BXT， the pathological damage of the gastric mucosa was improved to varying degrees. The protein and mRNA expressions of C/EBPβ， ERK， and p-ERK in gastric mucosa were significantly reduced （P<0.05，P<0.01）. The levels of IL-17， TNF-α， COX-2， and C/EBP β in serum were significantly decreased （P<0.01）. The contents of N-cadherin and vimentin in gastric mucosa tissue were decreased， while the content of E-cadherin was increased （P<0.05，P<0.01）. ConclusionBXT can effectively improve the pathological damage of gastric mucosal tissue in CAG rats. Its action mechanism may be related to reducing the levels of IL-17 and TNF-α in serum， regulating the IL-17/ERK/C/EBPβ signaling pathway and inhibiting the EMT process.

Objective: To investigate the technical considerations and clinical value of plasma exchange (PE) in the treatment of cardiohepatic syndrome (CHS). Methods: A 76-year-old male patient with CHS was treated. The patient’s underlying conditions included valvular heart disease (severe mitral and tricuspid regurgitation), chronic heart failure (cardiac function class IV) complicated with liver failure [total bilirubin (TBIL) up to 590.6 μmol/L; alanine aminotransferase (ALT) up to 325.4 IU/L; aspartate aminotransferase (AST) up to 190.4 IU/L]. Due to poor response to conventional anti-heart failure and hepatoprotective therapy, three sessions of stepwise PE (total volume 6 400 mL) were performed. A "calcium-fluid balance-hemodynamics“ trinity monitoring system was established during treatment, comprising:1) prophylactic calcium supplementation (continuous calcium infusion at 5 mL/h initiated before PE); 2) dynamic blood gas monitoring (ionized calcium measured every 30-60 min with calcium dose adjusted accordingly); 3) individualized fluid balance setting (75%-90%); 4) standby norepinephrine (0.02-0.1 μg/kg/min). Results: Complications such as hypocalcemia (lowest 0.83 mmol/L) and hypotension (lowest 65/38 mmHg) occurred during treatment. Hemodynamics were stabilized by adjusting calcium supplementation, regulating fluid balance, and concomitant use of vasoactive agents. After treatment, B-type natriuretic peptide (BNP) decreased by 42.0% (from 7 122.53 pg/mL to 4 128.77 pg/mL), TBIL decreased by 69.7% (from 590.6 μmol/L to 178.7 μmol/L), ALT decreased by 91.8% (from 325.4 IU/L to 26.7 IU/L), and AST decreased by 83.2% (from 190.4 IU/L to 31.9 IU/L). Conclusion: PE based on the "calcium-fluid balance-hemodynamics" trinity monitoring system can improve cardiac and liver function in patients with CHS.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To investigate the clinical application value of whole brain computed tomography perfusion(CTP)imaging combined with computed tomography angiography(CTA)on head and neck in treating chronic ischemic cerebrovascular disease(ICVD)by superficial temporal artery-middle cerebral artery(STA-MCA)bypass.Methods:Fifty patients with suspected chronic ICVD who admitted to Chengdu Second People's Hospital and Deyang People's Hospital(29 cases from Chengdu Second People's Hospital and 21 cases from Deyang People's Hospital)from May 2020 to October 2024 were selected.All patients underwent whole-brain CTP examination and CTA examination on head and neck before the surgery,and then,the preoperative assessment efficacy of the combination of the two examination for patients with STA-MCA surgical indication was analyzed.The changes of the CTP parameters[cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT),time to drain(TTD),and time to maximum(Tmax)]between the affected side and the healthy side before surgery,and between them after surgery,and these parameter of affected side between before and after surgery were compared respectively.The course and the anastomosis conditions of the bypass vessels were analyzed through CTA images.The CTP parameters of patients with postoperative cerebral hyperperfusion syndrome(CHS)were statistically analyzed.Then,the relationship between the changes of cerebral perfusion values on the affected side after surgery and CHS,as well as the follow-up situation,were analyzed.Results:In 50 patients with suspected chronic ICVD,34 patients with surgical indication of STA-MCA bypass were screened out by CTA combined with CTP,who existed severely narrowed or occluded blood vessels accompanied by reduced CTP,and other 16 cases who did not meet surgical indication of STA-MCA bypass were excluded.In 34 patients with chronic ICVD,the preoperative CBF value of affected side was lower than that of healthy side,and the preoperative MTT,TTD and Tmax values of affected side were all higher than those of the healthy side,and the differences were statistically significant(t=6.648,6.030,10.638,14.063,P<0.05),while there was not significant difference in CBV value between two sides(P>0.05).In the affected side,the postoperative CBF value was higher than preoperative CBF value,and the postoperative MTT,TTD and Tmax values were lower than preoperative these indicators,and the differences were statistically significant(t=8.578,7.166,11.321,11.912,P<0.05).There was no significant difference in the CBV value between before and after surgery(P>0.05).In 34 patients with chronic ICVD,there was not significant difference in CTP parameters between the affected side and the healthy side in 28 patients with chronic ICVD after 6 patients with CHS were excluded(P>0.05).The results of CTA showed that the diameter size and course of superficial temporal artery of all patients were clearly displayed,and the bypass vessels of them were unblocked,and the anastomoses of them were well developed.All 34 patients with chronic ICVD successfully completed unilateral STA-MCA bypass surgery.After the surgery,based on the clinical symptoms and the CTP reexamination results of the patients,it was determined that 6 patients(17.7%)were CHS,whose appearances were the CBF value of affected side was(60.81±5.79)ml/100(g·min),which was significantly higher than that[(53.30±5.21)ml/100(g·min)]of the healthy side.The MTT value of affected side was(2.9±0.82)s,which was significantly lower than that of the healthy side(4.2±1.1)s,and the differences were statistically significant(t=2.358,2.341,P<0.05).In the postoperative follow-up of 2 to 17 months for patients,there was not dead case,and the clinical symptoms of the most of patients were improved significantly,and there was no serious adverse events.Conclusion:Whole-brain CTP combined with CTA examination on head and neck is conducive to accurately determine the degree of vascular stenosis and cerebral perfusion before surgery,and screen patients with chronic ICVD who occurred indications of STA-MCA surgery,and can also assess the patency of bypass vessels,the recovery degree of cerebral perfusion,and the possibility of occurring CHS after surgery,which has important clinical guiding value.

The need for suitable interventions for progressive pulmonary vascular lesions has become a bottleneck and a consequent focus in the prevention and treatment of clinical pulmonary hypertension.Plexiform lesions in pulmonary arterioles are the typical pathological manifestation of irreversible abnormal pulmonary vascular remodeling and the criterion for stage Ⅳ pulmonary vascular remodeling.There is currently no effective clinical intervention for such pathophysiological lesions,highlighting the need for corresponding animal models.This review considers new progress in the stereology of plexiform lesions and highlights plexiform-lesion models in mice and rats induced by multifactor stimulation,such as two-hit models and genetic engineering.It also evaluates the characteristics and applications of these models to provide a reference for animal experimental studies and to clarify the mechanism of pulmonary hypertension with pulmonary vascular plexiform lesions.

The phenomenon of adolescent suicide has become a serious challenge to global public health, and suicidal behavior can directly threatening the lives of adolescents.Attempted suicide during adolescence has long-term negative impacts on their health in adulthood.With the continuous development of artificial intelligence technology, machine learning has demonstrated markedly superior performance compared to traditional assessment tools in predicting the risk of suicide among adolescents.Therefore, this article reviews the application and significance of machine learning in predicting suicidal behavior among adolescents.It mainly focuses on machine learning-related concepts, the utilization of multimodal data such as text and voice, as well as the in-depth analysis of algorithmic performance.However, this learning technology continues to encounter challenges pertaining to data quality, overfitting, model interpretability as well as ethical considerations.In future practical applications, various factors, including data characteristics, problem requirements, time costs and algorithm performance, should be comprehensively considered to develop a more accurate predictive model for adolescent suicidal behavior, thereby safeguarding the mental health of adolescents.

Objective: For patients with elevated hematocrit (Hct), platelet-rich plasma (PRP) apheresis is prone to red blood cell contamination—commonly referred to as “flushing” or erythrocyte carryover—which compromises product quality and therapeutic efficacy. This study reports two clinicaly derived measures to mitigate this issue. Methods: For 21 patients with Hct ≥53%, intravenous 0.9% sodium chloride infusion before apheresis process (replacement method, n=13) or 0.9% sodium chloride fluids hemodilution within the centrifuge bowl during PRP apheresis process (dilution method, n=8) were given, respectively. The collection time, adverse reactions, and the celluar composition of PRP—including white blood cells, red blood cells, and platelet counts—were recorded and compared. Results: Neither method resulted in visible RBC contamination (“flushing”). The red blood cell counts [(0.021±0.014)×10 /L vs (0.019±0.011)×10 /L, P>0.05], white blood cell counts [(2.258±3.288) ×10 /L vs (0.557 5±1.203) ×10 /L, P>0.05], and platelet counts [(1 140±308.2)×10 /L vs (1 105±309.9)×10 /L, P>0.05] in the PRP products obtained by two methods all met the control standards of PRP. There was no significant difference [(2.268±0.927) vs (2.438±0.762) mL/min, P=0.669 2] between the two methods in terms of the speed of PRP collection. One case of adverse reaction occurred with the fluid replacement method, while no adverse reaction occurred with the dilution method. Conclusion: For patients with elevated Hct, both fluid replacement and dilution methods can effectively prevent RBC contamination during PRP collection, yielding products that meet clinical quality standards.

With the continuous development of messenger RNA (mRNA) technology, mRNA-based drugs have shown broad application prospects in recent years. Since mRNA is easy to be degraded and difficult to enter cells directly, the mRNA delivery vectors have always been one of the focuses in the development of mRNA-based drugs. Although lipid nanoparticles (LNPs) have been widely used for the delivery of mRNA, they tend to accumulate in the liver, and repeated administration can easily induce inflammatory response which leads to tissue damage. Compared with LNPs, virus-like particles (VLPs) have the advantages of high biocompatibility and safety, being expected to offer new solutions for mRNA delivery. Based on the practical application requirements, this review summarized the research progress in VLPs according to the mRNA delivery steps: particle assembly, delivery into cells, and intracellular release. We hope to provide a basis and design ideas for the development of new VLPs as delivery vectors, promote the application of VLPs in mRNA delivery, and provide new possibilities for the research and application of mRNA-based therapeutics.
RNA, Messenger/administration & dosage* ; Humans ; Nanoparticles/chemistry* ; Genetic Vectors ; Lipids/chemistry* ; Drug Delivery Systems/methods* ; Virion ; Animals ; Gene Transfer Techniques ; Liposomes

Objective:To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH).Methods:This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH.Results:A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m2). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal ( OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion:A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.

Thyroid masses are uncommon in children，and thyroid nodules as a result of ectopic thymus tissue are even rarer. Here a case of ectopic thymus within the thyroid gland in an 11-year-old child was presented from Peking Union Medical College Hospital. The ultrasonic imaging showed hypoechoic nodules in both lobes of the thyroid gland with dot echogenic foci. Since the ultrasonic imaging posed a malignancy risk，an ultrasound-guided fine needle aspiration biopsy was performed. The fine-needle aspiration pathology and immunohistochemistry diagnosed it as an ectopic thymus within the thyroid gland. After two years of follow-up，there were no apparent changes in the ultrasonic imaging. Accurately diagnosing thymic tissue within the thyroid gland in children is of great significance for avoiding unnecessary surgeries.