Abstract:Objective: To investigate the expression of homeobox gene B4(HOXB4) in glioma tissues and cells, as well as its effects on glioma cell proliferation and invasion, and to explore the upstream regulatory mechanisms of HOXB4 expression. Methods: Based on the Chinese Glioma Genome Atlas (CGGA) database, the expression level of HOXB4 in glioma tissues and its correlation with patient prognosis were analyzed. RT-PCR and Western blot were used to detect HOXB4 expression in U251, U373, and U87 glioma cell lines. The effects of HOXB4 overexpression and silencing on the proliferation and invasion of U87 and U251 cells were assessed using CCK-8 and Transwell assays. U87 cells were treated with inhibitors of AMPK, p38 MAPK, and JNK. The expression of HOXB4 was detected by RT-PCR and Western blot. The cell proliferation and invasion levels were examined by CCK-8 and Transwell assays. HOXB4 was overexpressed in U87 cells in the presence of a JNK inhibitor, and the HOXB4 expression, cell proliferation and invasion were determined by RT-PCR, Western blot, CCK-8, and Transwell assays. Results: HOXB4 was highly expressed in glioma tissues and was associated with tumor malignancy and poor patient prognosis. HOXB4 was expressed in U251, U373, and U87 cell lines, with the highest expression in U87 cells. Overexpression of HOXB4 obviously enhanced the proliferation and invasion of U87 and U251 cells, whereas silencing HOXB4 markedly inhibited these phenotypes. JNK inhibitor significantly downregulated HOXB4 expression in U87 cells, whereas AMPK inhibitor and p38 MAPK inhibitor had no significant effect. JNK inhibitor attenuated the proliferation and invasion of U87 cells, and HOXB4 overexpression antagonized these effects. Conclusion: JNK activation upregulates HOXB4 expression in glioma cells, thereby promoting cell proliferation and invasion.

Abstract:Objective: To explore the role and mechanism of 3-hydroxy-kynurenine(3-HK), a key neurotoxic metabolite in the kynurenine pathway, in bisphenol F(BPF)-induced depressive-like changes in mice and evaluate the intervention effect of leucine by intervening this pathway, thereby providing experimental evidence for identifying potential intervention targets. Methods: The BPF exposure mouse model was established to investigate its neurotoxic effects, and the depression-like behaviors were assessed through behavioral tests such as the tail-suspension test, forced swimming test, and open-field test. Concurrently, the levels of depression-related neurotransmitters, including 3-HK, 5-hydroxytryptamine(5-HT), and kynurenine were measured in the hippocampus and prefrontal cortex. Alterations in the expression levels of pro-inflammatory cytokines, including interferon-gamma(IFN-γ) and interleukin-1β(IL-1β), as well as kynurenine 3-monooxygenase(KMO), were also detected. Furthermore, a leucine combined intervention group was established to assess whether BPF-induced depression-like behaviors improved, with additional measurements of neurotransmitter levels, pro-inflammatory factors, and KMO expression. The role of 3-HK in BPF-induced reactive oxygen species(ROS) generation in primary neurons was investigated using a fluorescent probe assay. Results: BPF exposure induced depressive-like behaviors in mice. While 5-HT levels in the hippocampus and cortex showed no significant change, the content of kynurenine was markedly reduced. BPF exposure significantly increased the expression levels of KMO in the hippocampus and cortex, and promoted the accumulation of 3-HK, which facilitated the production of pro-inflammatory factors such as IFN-γ and IL-1β by activating the inflammatory pathway. Leucine intervention alleviated BPF-induced depressive-like behavior, significantly reversing the abnormal expression of KMO and pro-inflammatory factors, and notably reducing 3-HK levels, though other neurotransmitter levels remained largely unchanged. Meanwhile, competitive inhibition of 3-HK transport or inhibition of KMO significantly reversed the ROS caused by BPF. Conclusion: BPF exposure upregulates KMO expression in the hippocampus and cortex, leading to abnormal accumulation of 3-HK, which subsequently triggers excessive ROS generation and neuroinflammation. These pathological changes may collectively contribute to neural damage and depression-like behaviors. In contrast, leucine inhibits this metabolic shift, alleviates oxidative stress and inflammation, thereby mitigating depression-like behaviors.

Abstract:Objective: To investigate the effect of bupivacaine (BPV) lipid on cognitive function of elderly anesthesia patients through mitochondrial calcium signal axis modulation. Methods: Sixty-one patients who underwent total hip replacement in our hospital from January 2022 to December 2024 were selected as the research objects and divided into POCD group (n=15) and non-POCD group (n=46). Anesthesia methods were spinal anesthesia combined with bupivacaine liposome for pericapsular nerve block of hip joint. The activity levels of respiratory chain complexes Ⅰ , Ⅱ , Ⅲ , and Ⅳ in mitochondrial membrane of peripheral blood leukocytes were detected by ELISA kit. Forty-eight 18-month-old C57BL/6 male mice were randomly divided into control group, ASM981 group, POCD group and POCD+ASM981 group with 12 mice in each group. Morris water maze was used to evaluate the spatial memory and learning ability of mice. Primary neurons were divided into three groups: blank (Con) group, BPV group, ASM981 group, and BPV+ASM981 group. The expressions of AMP-dependent protein kinase (AMPK) and dynamic related protein 1 (Drp1) were analyzed by western blotting, and MitoTracker Red labeling was used to observe the mitochondria of neurons. Results: The activities of leukocyte mitochondrial membrane respiratory chain complexes Ⅰ , Ⅱ , Ⅲ and Ⅳ in non-POCD group were higher than those in POCD group (P < 0.05). Compared with the POCD group, mice in the POCD+ASM981 group spent less time to escape the incubation period, crossed the platform more times, stayed in the original platform area longer, and greater distance traveled in the target quadrant (P < 0.05). The levels of p-AMPK, mito-Drp1 protein and calcineurin in primary neurons of the BPV+ASM981 group were lower than those of the BPV group (all P < 0.05), while the level of p-Ser637-Drp1 protein was higher than that of the BPV group and the length of mitochondrial branches was longer than that of the BPV group (all P< 0.05). Conclusion: ASM981 has protective effect on cognitive dysfunction induced by BPV in aged mice, and the mechanism may be to improve mitochondrial dysfunction by inhibiting mitosis mediated by AMPK signaling pathway.

Abstract:Objective: To explore the correlation between plasma neuropathological proteins and inflammatory factors with constipation in patients with Parkinson's disease(PD). Methods: A total of 88 patients with PD were recruited from the Department of Neurology at the Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University. Motor and non-motor symptoms were assessed using the unified Parkinson's disease rating scale(UPDRS), the Hamilton anxiety scale(HAMA), the Hamilton depression scale(HAMD), and other validated scales. According to the Wexner constipation score, PD patients were divided into PD patients with constipation(PD-C) and PD patients without constipation(PD-NC). During the same period, 30 healthy individuals matched in age and sex were enrolled as the control group(HC). Plasma levels of α-synuclein(α-syn), phosphorylated α-syn(p-α-syn), neurofilament light chain(NfL), glial fibrillary acidic protein(GFAP), S100 calcium-binding protein B(S100B), tumor necrosis factor(TNF)-α, interleukin(IL)-18, and IL-1β were measured by ELISA. Statistical analyses were performed using SPSS 29.0 and R software. Group differences were compared using t-tests and Mann-Whitney U tests. Binary Logistic regression was used to identify risk factors for constipation, and receiver operating characteristic curves were constructed to evaluate the predictive performance of biomarker combinations based on GFAP. Results: Plasma levels of GFAP, S100B, TNF-α, IL-18, and IL-1β were significantly higher in the PD-C group(all P < 0.05). After adjusting for age and lifestyle, multivariate analysis identified GFAP, S100B, and IL-1β as independent risk factors for constipation in PD. The combined predictive model based on these factors exhibited favorable diagnostic performance. Conclusion: Constipation in PD patients may be related to inflammatory reaction mediated by activation of peripheral neuroglial cells.

Abstract:Objective: To explore the longitudinal patterns and influencing factors of depression and cognitive impairment in patients with Parkinson's disease (PD), verify their bidirectional predictive relationship, and preliminarily analyze the modifying effects of medication on depression and cognitive impairment. Methods: A total of 86 de novo drug-naïve patients with idiopathic PD were enrolled and assessed for motor and non-motor symptoms at initial consultation (baseline) and follow-up, including the Unified Parkinson's Disease Rating Scale part Ⅲ for motor symptoms, Hamilton Depression Rating Scale for depressive symptoms, and Montreal Cognitive Assessment for cognitive function. Spearman correlation analysis was used to preliminarily screen clinical characteristics associated with depressive and cognitive impairment in PD, and generalized linear models were used to analyze the associations between longitudinal changes in cognitive impairment and depressive symptoms. Results: Patients' motor symptoms significantly deteriorated, while depressive symptoms exhibited dynamic conversion characteristics. Motor symptoms and other non-motor symptoms (anxiety, sleep disturbances) demonstrated statistically significant differences across groups stratified by varying degrees of depression severity. Patients with mild cognitive impairment primarily exhibited impairments in visuospatial and executive functions and delayed memory. Dopaminergic medication showed no significant effects on depression or cognitive function. Cognitive impairment and depressive symptoms progressed synchronously and had bidirectional predictive effects. Conclusion: Depressive symptoms in PD patients exhibit dynamic progression patterns. Anxiety and sleep disturbances may serve as critical indicators for depression screening in PD. There exists a bidirectional predictive relationship between cognitive impairment and depressive symptoms. Dopaminergic drug therapy fails to improve cognitive function and depressive symptoms.

Abstract:Objective: To investigate the effect of music therapy on eye movement characteristics of joint attention (JA) in children with autism spectrum disorder (ASD), providing an objective basis for clinical intervention. Methods: A randomized crossover design was employed. Twenty-six ASD children aged 3-10 years were enrolled and randomly assigned to group A or B. They first received either a music therapy intervention or a quiet-sitting control condition, and after a 7-day washout period, crossed over to the alternate condition. Eye-tracking technology was used to record the time to first fixation (TFF) during a joint attention paradigm task (comprising three conditions: Eye Gaze, Eye-Head, and Eye-Head-Gesture). Paired sample t-tests were applied to compare the effects of the music intervention. Results: Following music therapy, the TFF for the total score across all conditions was significantly shorter compared to the quiet-sitting control condition (t=-2.24, P=0.035, Cohen's d=-0.458). Specifically, the TFF in the Eye-Head-Gesture condition was significantly shorter than in the control condition (t=-2.32, P=0.030, Cohen's d=-0.485). Although the TFF in the Eye Gaze and Eye-Head conditions alone showed no statistically significant difference, the mean TFF was shorter than in the control condition. Conclusion: Music therapy can significantly shorten the time to first fixation on joint attention targets in children with ASD, suggesting that it may improve core social deficits by enhancing neural information processing efficiency. Eye movement characteristics may serve as an objective indicator for evaluating the efficacy of music therapy.

Abstract:Depression is characterized by an insidious onset and marked symptom heterogeneity. Current diagnostic practice still mainly relies predominantly on clinical interviews and rating scales, which are constrained by substantial subjectivity, limited capacity for early identification, and insufficient performance in subtype differentiation and prognostic evaluation. With the growing availability of objective data, including neuroimaging, electroencephalography, speech and digital behavioral features, clinical scales, and multi-omics profiles, machine learning has opened new avenues for the objective identification of depression. Focusing on this central issue, the present review summarizes recent advances in the application of machine learning to neuroimaging and other unimodal objective data, further discusses the integrative value of multimodal data in the diagnosis, subtyping, disease-course assessment, and treatment-response prediction of depression, and provides a systematic overview of common fusion strategies, model interpretability, and issues related to clinical translation.

Abstract:Objective: This study focused on the same split vaccine antigen system to compare the protective efficacy of two immunization strategies: intramuscular injection with aluminum adjuvant-CpG oligodeoxynucleotide (Alum-CpG) and intranasal delivery with sugar-based lipid nanoparticles (SNP). Methods: Eight-week-old female BALB/c mice were randomly assigned into different experimental groups: Alum-CpG group, SNP group, intramuscular unadjuvanted split vaccine group, and unimmunized control group. All mice received two immunizations 14 days apart. On day 14 after the booster immunization, serum and nasal lavage fluid(NLF) were collected. Antibody levels were measured by hemagglutination inhibition (HI) assay and indirect enzyme-linked immunosorbent assay. Mice were then challenged with heterologous virus A/Scotland/P2/2015(H1N1) to evaluate body weight changes, survival rate, lung viral load, and pulmonary pathological changes. Results: Under equivalent antigen doses, intramuscular administration of the split vaccine adjuvanted with Alum-CpG significantly elevated serum HI antibody titers. Following viral challenge, mice in this group achieved a 100% survival rate, accompanied by marked reductions in lung viral loads and substantial alleviation of influenza-associated inflammatory lung pathology. Although the SNP group induced detectable serum HI antibodies and secretory IgA (sIgA) responses, and conferred partial protection against influenza virus challenge, its serum HI titers, survival rates, and viral clearance capacity were all inferior to those observed in the Alum-CpG group and the split vaccine group. Moreover, higher levels of viral replication were still detectable in the lung tissues of some mice in the SNP group. Conclusion: The intramuscular vaccination strategy employing Alum-CpG adjuvant markedly enhanced both the immunogenicity and protective efficacy of the split vaccine, demonstrating superior immune-enhancing effects compared to the intranasal SNP delivery. SNP have potential as an intranasal delivery platform, but their formulation design requires further optimization to improve protective efficacy.

Abstract:Objective: To explore the application value of a multidisciplinary collaborative model based on the enhanced recovery after surgery(ERAS)concept in the management of patients with diabetic neurogenic bladder(DNB). Methods: This was a prospective randomized controlled trial. Ninety DNB patients were randomly assigned to a control group and an experimental group, with 45 cases in each group. The control group received routine management, while the experimental group received the ERAS multidisciplinary model. The primary outcomes were blood glucose levels [glycated hemoglobin(HbA1c), fasting plasma glucose(FPG), and 2-hour postprandial glucose(2hPG)] and urodynamic parameters [residual urine volume(RUV), maximum flow rate(Qmax), maximum detrusor pressure(Pdetmax), and maximum cystometric capacity(VMCC)] measured before treatment and at 3 and 6 months after treatment. Secondary outcomes included length of hospital stay and hospital costs, scores on the American Urological Association Symptom Index(AUA-SI), Patient Health Questionnaire-9(PHQ-9), and Short Form Qualiveen(SF-Qualiveen), and DNB-related complications(urinary tract infection, urolithiasis, hydronephrosis). Repeated measures analysis of variance(ANOVA)and generalized estimating equations(GEE)were used to evaluate the management effects. Results: Repeated measures ANOVA showed that, except for the interaction effect of FPG(P>0.05, with a significant time effect), the time, group, and interaction effects for 2hPG, urodynamic parameters, and AUA-SI and SF-Qualiveen scores were all statistically significant(P < 0.05); the time and interaction effects for HbA1c and PHQ-9 scores were also statistically significant(P<0.05). GEE analysis revealed that for urinary tract infection, both time and group effects were significant(P < 0.05); for urolithiasis and hydronephrosis, the time effects were significant(P < 0.05). The length of hospital stay and hospital costs in the experimental group were significantly lower than those in the control group(P<0.05). Conclusion: The ERAS multidisciplinary model can improve glycemic control, bladder function, and quality of life in DNB patients, reduce length of hospital stay and medical costs, and has a positive effect on reducing certain complications

Abstract:Objective: To investigate the expression of protein arginine methyltransferase 1 (PRMT1) in breast cancer and to evaluate its clinical significance. Methods: Bioinformatics databases, including TIMER3.0, GEPIA2, and UALCAN, were utilized to analyze PRMT1 mRNA expression levels in breast cancer tissues. Tissue microarray and immunohistochemistry were employed to detect PRMT1 protein expression in breast cancer tissues and to explore its correlation with clinicopathological features. Survival analysis based on Gene Expression Omnibus (GEO) datasets using the OSdream online tool was performed to assess the association between PRMT1 expression levels and recurrence-free survival (RFS) and metastasis-free survival (MFS) in breast cancer patients. The diagnostic value of PRMT1 for breast cancer was evaluated by receiver operating characteristic (ROC) curve analysis. Results: Multi-database bioinformatics analysis revealed that, compared to normal tissues, PRMT1 mRNA expression was significantly elevated in breast cancer tissues (P < 0.01). Elevated PRMT1 mRNA levels were closely associated with advanced clinical stage and lymph node metastasis (P < 0.01). Immunohistochemical staining of tissue microarrays confirmed that PRMT1 protein expression was significantly higher in breast cancer tissues compared to adjacent normal tissues (P < 0.01). High PRMT1 expression was positively correlated with advanced clinical stage and lymph node metastasis in breast cancer patients(P < 0.01). Survival analysis indicated that breast cancer patients with high PRMT1 expression had a significantly shorter RFS and MFS compared to those with low PRMT1 expression (P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.927(95%CI: 0.887-0.967, P < 0.001). At the optimal cutoff value of 1.167, the sensitivity and specificity were 82.5% and 90.0%, respectively, indicating robust diagnostic performance of PRMT1 for breast cancer. Conclusion: PRMT1 is highly expressed in breast cancer tissues, and elevated PRMT1 expression is associated with advanced clinical stage, lymph node metastasis, and poor prognosis in breast cancer patients. PRMT1 demonstrates excellent diagnostic efficacy for breast cancer. Therefore, PRMT1 may serve as a potential biomarker for the diagnosis and prognostic evaluation of breast cancer.

Abstract:Objective: To develop a combined prediction model that integrates multi-phase contrast-enhanced imaging, intratumoral heterogeneity (ITH) , time-series radiomics (TSR) and delta-radiomics (DR) features for assessing the therapeutic response of hepatocellular carcinoma (HCC) to immuno-combination therapy, and to build a clinical decision support system (CDSS) upon it. Methods: Sixty-two HCC patients who received immuno-combination therapy at the First Affiliated Hospital of Nanjing Medical University between January 2021 and December 2024 were retrospectively enrolled. Traditional radiomics, ITH, TSR, DR, and clinical test index density (CTId)features were extracted from arterial, portal-venous and delayed-phase images. A three-stage feature selection pipeline was employed to identify the optimal feature set, and multiple machine-learning classifiers were trained to construct the combined model, based on which a CDSS was subsequently developed and evaluated. Results: The combined model yielded a validation AUC of 0.821 (95%CI: 0.629–0.987) for predicting disease progression, significantly outperforming single-phase radiomics models (0.706–0.738), the ITH-only model (0.752) and the clinical model (0.685), with all differences statistically significant via Delong test (all P < 0.05). The AUC values for predicting grade ≥Ⅱ and ≥Ⅲ complications reached 0.803 and 0.845, respectively. Radiomics-based risk stratification independently predicted both progression-free survival (HR=4.36, 95%CI: 1.94–9.80, P < 0.001) and overall survival (HR=4.23, 95%CI: 1.78–10.08, P=0.001). In the early-stage (TNM Ⅰ-Ⅱ)subgroup, PFS stratification remained robust(χ²=14.60, P < 0.001), whereas the OS difference did not reach statistical significance (P=0.341), likely owing to the limited subgroup sample size. The established CDSS completed stratification for a single case within 60 seconds, achieving 100% consistency with manual analysis. Conclusion: The combined radiomics model integrating multi-phase and longitudinal dynamics accurately characterises therapeutic response and complication risk in HCC immuno-combination therapy, and the accompanying CDSS offers a quantitative decision-support tool for individualised clinical management.

Abstract:Objective: To explore the safety and efficacy of postoperative adjuvant targeted therapy combined with immunotherapy in patients of biliary tract carcinoma with high-risk factors for recurrence. Methods: A retrospective analysis was performed on the clinical data of 24 patients with biliary tract carcinoma complicated with high-risk factors for recurrence, who underwent surgical resection in the First Affiliated Hospital of Nanjing Medical University from January to December 2023, declined adjuvant chemotherapy, and voluntarily opted for targeted therapy combined with immunotherapy. The clinicopathological characteristics, relapse-free survival(RFS), overall survival(OS), and incidence of adverse events(AE) of the enrolled patients were recorded. Survival analysis was performed using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to analyze the factors affecting RFS. Results: During the follow-up of the 24 patients, 12 patients(50.00%) developed recurrence and 7 patients(29.17%) died. The median RFS was 12 months, and the median OS was not reached. Among them, the median RFS and median OS were not reached in patients with R0 resection and high-risk factors for recurrence, while the median RFS was 8 months and the median OS was not reached in patients with R1 resection. The RFS rate and OS rate of patients with R0 resection and high-risk factors for recurrence were significantly higher than those of patients with R1 resection. Prognostic factor analysis showed that age < 60 years, single tumor, R0 resection, no lymph node metastasis, no vascular invasion, and single high-risk recurrence factor were prognostic factors affecting RFS(all P < 0.05). In terms of safety, the incidence of all-grade AE was 79.17%(19/24), and the incidence of grade 3 AE was 8.33%(2/24). No treatment-related death occurred. Conclusion: Postoperative adjuvant targeted therapy combined with immunotherapy shows certain efficacy and controllable safety in biliary tract carcinoma patients with high-risk factors for recurrence. Age <60 years, single tumor, R0 resection, no lymph node metastasis, no vascular invasion, and single high-risk recurrence factor are prognostic factors affecting RFS in this research.

Abstract:Objective: To investigate the risk factors for pulmonary infection during chemotherapy in patients with small cell lung cancer(SCLC)and to develop and validate a risk prediction model. Methods: Patients with SCLC who received chemotherapy at the First Affiliated Hospital of Nanjing Medical University from April 2020 to March 2022 were retrospectively enrolled as the training cohort(n=251), and a prospective cohort of SCLC patients was consecutively included as the validation cohort(n=112). According to follow-up outcomes, patients were divided into the pulmonary infection and non-infection groups. In the training cohort, univariate and multivariate logistic regression analyses were performed to identify independent risk factors and to construct a scoring model. The discriminative ability of the model was evaluated using the receiver operating characteristic(ROC)curve, and calibration was assessed using calibration curves. The model was compared with previously reported nomogram models and further validated in the validation cohort. Results: Multivariate logistic regression analysis showed that smoking history, pleural effusion, hoarseness, single-agent chemotherapy, and albumin <35 g/L after the first cycle of chemotherapy were independent risk factorsfor pulmonary infection in patients with SCLC(all P < 0.05). Based on these five variables, the SCLC-PIR scoring model was established. In the training cohort, the area under the curve(AUC)was 0.870(95% CI: 0.818-0.922), with an optimal cutoff value of 5 points, yielding a sensitivity of 71.7% and a specificity of 89.4%. The calibration curve demonstrated good consistency between the infection risks predicted by this model and the actual risks. The predictive performance of the model remained stable when applied to the validation cohort, with an AUC of 0.896(95% CI: 0.832-0.961). Furthermore, the predictive efficacy of this model outperformed previous nomogram models. Conclusion:The SCLC-PIR scoring model, based on smoking history, pleural effusion, hoarseness, single-agent chemotherapy, and post-chemotherapy albumin <35 g/L, shows good discrimination and calibration in predicting pulmonary infection during chemotherapy in patients with SCLC, and may be useful for early identification of high-risk patients.

Abstract:Objective: To investigate whether triglyceride-glucose (TyG) index, a marker of insulin resistance, can predict the clinical outcome of patients with locally advanced and advanced non-small cell lung cancer (NSCLC) treated with tislelizumab combined with chemotherapy. Methods: We retrospectively analyzed data from 243 patients who were treated with tislelizumab combined with chemotherapy with locally advanced and advanced NSCLC, dividing them into high and low TyG index groups based on an optimal cut-off value of 9.3, determined using the X-tile software. Cox proportional hazards regression analysis identified independent prognostic factors for overall survival (OS), and a prediction nomogram model was developed based on them. Results: The study cohort included 160 patients with a high TyG index and 83 with a low TyG index. The median progression-free survival and OS in the low TyG index group were significantly longer than in the high TyG index group. The objective response rate was 55.42% in the low TyG index group and 30.63% in the high TyG index group, while the respective disease control rates were 95.18% and 56.88%. Multifactorial regression analysis identified pre-treatment maximum tumour diameter, proportion score for programmed death ligand 1 (PD-L1) positivity, body mass index (BMI), and TyG index as independent prognostic predictors of OS. The nomogram model emphasized the importance of the TyG index (hazard ratio: 2.99, 95% CI: 1.73–5.16, P < 0.001) as a major prognostic predictor, followed by the PD-L1 tumor proportion score, pre-treatment tumour diameter, and BMI. Conclusion: TyG index is a long-term predictor of the efficacy of combined immunotherapy and chemotherapy in patients with locally advanced and advanced NSCLC, and low TyG index has a better prognosis.

Abstract:The reporting and data systems(RADS),established by the American College of Radiology(ACR),serve as structured risk-stratification frameworks designed to mitigate subjectivity and enhance consistency in radiological interpretation. Despite their widespread adoption,RADS still face methodological challenges in real-world practice,including limited inter-observer consistency,insufficient feature quantification,and suboptimal cross-center reproducibility. In recent years,the evolution of artificial intelligence(AI),particularly large language models(LLMs),has offered novel pathways to address these limitations. This paper systematically reviews the structural characteristics and practical constraints of major RADS frameworks and synthesizes empirical progress regarding AI in lesion identification,risk re-stratification,and workflow standardization. Current evidence suggests that AI is best positioned as an "augmentative layer" for RADS to bolster objectivity and reproducibility. Furthermore,this article explores the potential of LLMs in semantic understanding,automated reasoning,and quality control,while projecting the evolution of human-computer collaboration from a regulatory perspective. This trend holds significant implications for promoting the homogenization of diagnostic imaging,empowering primary healthcare services,and establishing intelligent regulatory systems in China.

Abstract:Multiple myeloma(MM) is a hematologic malignancy characterized by high heterogeneity in both its clinical presentation and biological behavior. The prognosis for patients with MM is closely associated with the presence or absence of high-risk cytogenetic abnormality(HRCA). In recent years, although the widespread application of proteasome inhibitors and immunomodulatory drugs in MM has significantly improved survival, high-risk patients with HRCA continue to face challenges such as drug resistance, early disease progression, and poor prognosis. The exploration and optimization of treatment strategies for these patients remain a clinical challenge. In the relapsed or refractory disease state, the choice of subsequent treatment is crucial for high-risk patients. With the advent of the immunotherapy era in MM treatment, the continuous emergence of new drugs has brought hope to patients. This article focuses on patients with relapsed or refractory MM accompanied by HRCA, reviewing the efficacy of monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, and chimeric antigen receptor T cells in these patients, aiming to explore optimal treatment strategies and provide guidance for clinical decision-making.

Abstract:Atrial cardiomyopathy (ACM) is a pathological condition characterized by structural remodeling, electrophysiological abnormalities, and fibrosis of the atria. It is closely associated with atrial fibrillation (AF) recurrence following catheter ablation. Diffuse atrial fibrosis and electrical remodeling induced by ACM create a pro-arrhythmic substrate that not only perpetuates AF but also serves as a key structural determinant of post-ablation recurrence. Studies have indicated that while ablation effectively isolates pulmonary veins, it fails to eliminate the underlying ACM substrate. Consequently, residual fibrotic regions persist, harboring non-pulmonary vein triggers and zones of slow conduction, which ultimately lead to recurrent AF or atrial tachycardia. This review systematically elucidates the pathological mechanisms linking ACM to post-ablation recurrence. By integrating multimodal non-invasive technologies, including echocardiography, cardiac magnetic resonance, and circulating biomarkers, we establish a comprehensive assessment system encompassing structural, functional, and molecular dimensions. We evaluate the synergistic role of combining these multidimensional non-invasive parameters in risk prediction and propose an ACM-guided peri-procedural management strategy to optimize AF ablation outcomes.