Myelodysplastic syndrome (MDS), a myeloid tumor derived from the malignant clones of hematopoietic stem cells, has an annually increasing incidence. The contemporary research direction has shifted to analyzing the synergistic effect of immune surveillance collapse and abnormal bone marrow microenvironment in the pathological process of MDS. Against this backdrop, the immune checkpoint molecule TIM3 has emerged as a key target because of its persistently high expression on the surface of important immune cells such as T and NK cells. The abnormal activation of the TIM3 pathway is the mechanism by which solid tumors and hematological malignancies achieve immune escape and is a key hub in the formation of immune exhaustion phenotypes. This work integrates the original discoveries of our team with the latest international progress, systematically demonstrating the bidirectional regulatory network of TIM3 between the malignant clone proliferation of MDS and the immunosuppressive microenvironment. Integrating the evidence from emerging clinical trials allows us to consider the clinical significance of TIM3-targeted blocking for MDS, providing a transformative path to overcome the resistance of traditional treatments and marking a new chapter in the active immune reconstitution of MDS treatment.

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation and joint damage, accompanied by the accumulation of plasma cells, which contributes to its pathogenesis. Understanding the genetic alterations occurring during plasma cell differentiation in RA can deepen our comprehension of its pathogenesis and guide the development of targeted therapeutic interventions. Here, our study elucidates the intricate molecular mechanisms underlying plasma cell differentiation by demonstrating that PRDX1 interacts with DOK3 and modulates its degradation by the autophagy-lysosome pathway. This interaction results in the inhibition of plasma cell differentiation, thereby alleviating the progression of collagen-induced arthritis. Additionally, our investigation identifies Salvianolic acid B (SAB) as a potent small molecular glue-like compound that enhances the interaction between PRDX1 and DOK3, consequently impeding the progression of collagen-induced arthritis by inhibiting plasma cell differentiation. Collectively, these findings underscore the therapeutic potential of developing chemical stabilizers for the PRDX1-DOK3 complex in suppressing plasma cell differentiation for RA treatment and establish a theoretical basis for targeting PRDX1-protein interactions as specific therapeutic targets in various diseases.

Hearing loss is one of the most prevalent sensory disorders affecting the human nervous system. Liquid-liquid phase separation (LLPS) is a physiological process that facilitates the reversible and dynamic assembly of biomolecular condensates. Increasing evidence suggests that LLPS plays a significant role in the pathogenesis of hereditary hearing loss. Nevertheless, there is a conspicuous lack of systematic investigations exploring the impact of LLPS abnormalities on the etiology of hereditary hearing loss. In this review, we examine the mechanisms by which dysfunctions in LLPS contribute to hereditary hearing loss, specifically focusing on its effects on mechanoelectrical transduction in hair bundles, transcriptional regulation, post-transcriptional modifications, the actin cytoskeleton, ion homeostasis within the inner ear, and energy and redox homeostasis. Furthermore, we evaluate the considerable potential of targeting LLPS as a therapeutic approach for hearing loss and propose innovative perspectives on LLPS that may guide future research initiatives in the field of auditory disorders.
Humans ; Animals ; Hearing Loss/physiopathology* ; Phase Separation

Objective: To explore the possibility of performing allogeneic platelet-rich plasma (PRP) treatment for patients who were not suitable for autologous PRP collection through case reports of two patients with refractory wounds treated with allogeneic PRP. Methods: The ABO-compatible allogeneic whole blood was centrifuged 3 times to obtain allogeneic PRP within 6 hours of blood collection. Then the qualified allogeneic PRP was applied to 2 cases of refractory wound on the same day. Results: The platelet concentration in allogeneic PRP was higher than 1 000×10 /L, and the test results of infectious diseases, as well as the mixing of red blood cells and white blood cells, met the standard of quality control. Both patients achieved satisfactory wound healing outcomes (3 d). Conclusions: For patients who were not suitable for autologous PRP treatment, allogeneic PRP might be a new option.

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 compare the effect of repeated transcranial magnetic stimulation (rTMS) targeting the M1 hand area, the M1 lower limb area, or the sciatic nerve on the motor functioning and ability in the activities of daily living of persons after a spinal cord injury (SCI).Methods:This was a retrospective analysis of data describing 86 hospitalized SCI patients. They were divided into four groups based on where the rTMS was applied: an M1 hand area group ( n=22), an M1 lower limb area group ( n=20), a sciatic nerve group ( n=24), and a control group ( n=20) who never received rTMS. In addition to conventional medication and rehabilitation training, the M1 hand area group, the M1 lower limb area group and the sciatic nerve group received 10Hz rTMS over the named area for 4 weeks. Before and after the treatment, the Spinal Cord Independence Measure (SCIM) total scores, SCIM indoor activity (SCIM12) sub-scores, Modified Barthel Index (MBI) scores, and lower extremity motor (LEMS) scores were compared among the four groups. Results:After the treatment, the average SCIM, SCIM12, MBI, and LEMS scores had improved significantly in all four groups. The average SCIM [10.00(4.00, 24.75] and MBI scores [12.00(6.75, 31.50)] of the M1 hand area group were then significantly better than the control group′s averages [3.50(0.00, 9.50) and 7.50(1.25, 17.75)]. There was also significantly greater improvement in the average LEMS score of the M1 hand area group [2.00(0.00, 10.00)] compared with both the sciatic nerve group [0.00(0.00, 2.00)] and the control group [0.00(0.00, 1.75)].Conclusions:High-frequency rTMS stimulation of the M1 hand area significantly promotes the recovery of lower limb motor function and self-care ability after an SCI. It is more effective than stimulating the M1 lower limb area or the sciatic nerve.

OBJECTIVE To address the issue of recommending traditional Chinese medicine(TCM)prescriptions,and to utilize the clinical records of lung cancer from TCM experts to automatically generate prescriptions,providing reference for the study of medi-cation rules and TCM clinical decision-making assistance.METHODS This algorithm transformed clinical manifestations,standard-ized tongue diagnosis,and pulse diagnosis into TCM prescriptions through a large model,thereby converting the task of TCM prescrip-tion recommendation into a text generation task.The CHATGLM3 model,based on the GLM structure,was used to enhance the under-standing of lung cancer cases and learn the intrinsic experiential knowledge of TCM experts in treating lung cancer,thereby improving the prescription generation effectiveness of the model.This was compared with traditional generative models.RESULTS The study demonstrated that integrating TCM knowledge from lung cancer cases into large language models effectively improved the model's pre-scription generation capabilities.Particularly in generating commonly used core medications by TCM experts,the model showed a high tendency and provided rich and valuable reference information.The lung cancer TCM prescription recommendation model achieved 64.62%in BLEU,55.78%in ROUGE,and 47.39%in METEOR scores.It also achieved accuracies of 67.79%,63.66%,56.76%,and 51.93%in the top 5,10,15,and 20 TCM prescriptions,respectively,outperforming the baseline model.CONCLUSION The lung cancer TCM prescription recommendation model presented in this paper achieves better prescription generation results com-pared to traditional generative models.It demonstrates the model's ability to learn knowledge about lung cancer diagnosis and treatment from cases,thereby generating TCM prescriptions that align with TCM treatment principles.This also provides a potential direction for future assistance in clinical decision-making.

Objective To construct a traditional Chinese medicine(TCM)knowledge question-answering model with strong reasoning capabilities and reliable results,TCM Q&A datasets and TCM literature were fully utilized.Methods Large-scale TCM corpus and Q&A data were collected and organized,with ChatGLM3 serving as the base model.The PissA method was used for supervised fine-tuning,combined with retrieval-augmented generation(RAG)techniques,to build a TCM knowledge Q&A model that integrates supervised fine-tuning and retrieval-augmented generation.The model was compared with ChatGLM3,SFT,and RAG,with evaluations based on classic metrics such as BLEU,ROUGE1,and F-scores.Results The model in this paper achieved BLEU and ROUGE1 scores of 14.5830 and 34.6730,respectively.After incorporating retrieval-augmented generation,the model attained an F score of 0.6398 in the inference results on a TCM dataset,outperforming the ChatGLM3 baseline model's 0.2654.Conclusion The construction method of a large model in the TCM domain that integrates supervised fine-tuning and retrieval augmentation can effectively enhance the model's reasoning performance and reliability in TCM.

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.