Volume 105 · Issue 07 · 2025

Traditional research on skin diseases has mainly focused on biological characteristics for a long time. Recently, the integration of biomechanics and mechanobiology has introduced mechanical factors into skin disease research. The interaction between mechanical factors and skin′s physiological and pathological changes has gradually been transformed in clinical diagnosis and treatment. The two emerging fields, mechanodiagnostics and mechanotherapy, have been developed to address clinical needs. However, clinicians often lack a comprehensive understanding of skin mechanical characteristics and the mechanobiological mechanisms in dermatology. Thus, we propose the concept of "skin mechanomedicine". By summarizing relevant research at home and abroad, this paper systematically elucidates the multiscale mechanical characteristics of skin diseases and their impact on biological behavior from four perspectives: skin biomechanics, skin mechanobiology, skin mechanodiagnostics, and skin mechanotherapy. Meanwhile, in-depth exploration was conducted on the potential application of mechanical factors in the diagnosis and treatment of skin diseases, aiming to provide new research perspectives and solutions for the diagnosis and treatment of skin diseases.

Takayasu arteritis presents as a systemic vasculitis; however, there remains a dearth of effective evaluation methodologies. To establish standardized protocols for selecting imaging modalities as well as interpreting their findings in Takayasu arteritis comprehensively, an expert panel comprising members from Chinese Rheumatology Association along with Rheumatological Immunology Committee of Primary Health Care Foundation of China meticulously reviewed both domestic and international guidelines, consensus statements alongside pertinent clinical research on 16 key issues. Employing Oxford University Evidence-Based Medicine Center grading system facilitated rigorous assessment of evidence quality leading to formulation of 17 recommendations following extensive deliberation among experts. The primary objective revolves around streamlining utilization of imaging techniques by clinicians during diagnostic procedures while treating Takayasu arteritis thereby enhancing overall standards in clinical diagnosis and management.

Although medical nutritional therapy affects the prognosis of sepsis patients, there is controversy over its clinical implementation process. To further standardize the medical nutrition therapy of sepsis patients, the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) organized more than 50 experts from critical care medicine, clinical nutrition, evidence based medicine and statistics to formulate the guidelines. The guideline was based on grading of recommendations, development and evaluations (GRADE) standards and procedures, through systematic retrieval and evidence sorting, and combined with the practical experience of clinical experts. The guidelines provide recommendations on nutritional risk screening in medical nutrition therapy for sepsis patients, early medical nutrition therapy (enteral nutrition, parenteral nutrition, energy intake, optimal target for protein delivery), enteral nutrition infusion mode, traditional Chinese medicine and protecting intestinal function, nutritional supplements (vitamin, glutamine, omega-3 fatty acids, selenium), probiotics, and the use of proton pump inhibitors. Ultimately, 14 questions and 14 recommendations were formed in order to improve the medical nutrition therapy process for sepsis patients.

To explore the clinical characteristics and related risk factors of intracerebral hemorrhage (ICH) lesions identified on susceptibility-weighted imaging (SWI) sequences in patients with recent subcortical small infarct (RSSI).

The patients with lenticulostriate artery territory RSSI admitted to the Department of Neurology, the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 was retrospectively collected. Demographic information, past medical history, laboratory, and imaging data were collected. Observe the ICH lesions in patients on the brain SWI sequence and divide RSSI patients into the coexisting-ICH group (n=37) and the non-ICH group (n=324) according to whether they have ICH. At the same time, the hemorrhage-related imaging features coexisting such as cerebral microbleeds (CMBs), cerebral surface siderosis (cSS), and probable cerebral amyloid angiopathy (CAA). Multifactorial logistic regression model was used to analyze the associated factors of ICH lesions in RSSI patients.

A total of 361 patients with RSSI in the lenticulostriate artery territory area were included. The mean age was (60±12) years, with 243 male patients (67.3%). Among them, 37 patients (10.2%) had coexisting ICH lesions, mainly presenting as strict deep type [29 cases (78.4%)], with others including strict lobar type [2 cases (5.4%)], infratentorial type [2 cases (5.4%)], and mixed type[ 4 cases (10.8%)]. 30 cases (8.3%) had concomitant strict lobar CMBs, 5 cases (1.4%) had cSS, and 23 cases (6.4%) met the Boston 2.0 criteria for probable CAA. Multivariate logistic regression model analysis revealed that the high-grade enlargement of perivascular spaces in the basal ganglia (HEPVS) (OR=3.356,95%CI:1.208-9.320,P=0.020) were associated with the presence of ICH lesions. When the total cerebral small vessel disease (CSVD) burden score was used to represent other CSVD imaging markers for analysis, the CSVD total burden score (OR=2.319,95%CI:1.596-3.372,P<0.001) was also found to be associated with the presence of ICH lesions.

Among patients with RSSI, 10.2% have ICH lesions visible on SWI, primarily manifesting as non-strict lobar types. The total burden of CSVD, particularly the HEPVS in the basal ganglia region, is associated with coexisting ICH.

To analyze the correlation between the systemic inflammation score (SIG) and plaque stability in patients with carotid artery stenosis, and to evaluate the predictive value.

The clinical data of 149 patients with carotid artery stenosis who were hospitalized in Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2019 to October 2023 were retrospectively analyzed, including 124 males and 25 females, aged (68.2±8.9) years. According to the results of pathological analysis of specimens after carotid endarterectomy, the patients were divided into plaque stable group (n=70) and plaque vulnerable group (n=79). After preoperative blood biochemical indexes were collected and neutrophil-lymphocyte ratio and modified glasgow prognostic score(mGPS) were calculated, the SIG was calculated together. The multivariate logistic regression model was used to analyze the correlative factors of plaque stability in patients with carotid artery stenosis, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of SIG for plaque stability in patients with carotid artery stenosis.

The proportion of patients with a history of diabetes in the plaque vulnerable group [36.7% (29/79) vs 20.0% (14/70)] and IL-6 [0.43 (0.31, 0.64) vs 0.34 (0.17, 0.44) ng/L] were higher than those in the plaque stabilization group(both P<0.05). The mGPS score and SIG score of the plaque vulnerable group were higher than those of the plaque stabilization group (both P<0.05). The results of the multivariate logistic regression model showed that diabetes history (OR=2.82, 95%CI: 1.23-6.48), high interleukin-6 (IL-6) level (OR=1.16, 95%CI: 1.01-1.33), and high SIG scores [with SIG=0 as the reference, OR (SIG=1)=1.76,95%CI:1.21-2.41;OR (SIG=2)=2.21,95%CI:1.51-3.01;OR (SIG=3)=4.47,95%CI:2.42-6.52;OR (SIG=4)=3.19,95%CI:2.01-4.36] were risk factors for plaque instability in patients with carotid artery stenosis. The results of ROC curve analysis showed that when the SIG cut-off value was 1.5 points, the sensitivity and specificity of predicting plaque stability in patients with carotid artery stenosis were 70.0%, the specificity was 74.3%, and the area under the curve was 0.745 (95%CI: 0.666-0.825, P<0.001).

High SIG score is a risk factor for plaque stability in patients with carotid artery stenosis and has a good predictive value.

To investigate the effect of injectable adipose tissue stem cell-derived exosome-encapsulated hydrogel on the tendon healing in rats and to evaluate the temporal and spatial expressions of periphery neuropeptides at healing site.

To generate the injectable exosome-encapsulated hydrogel, the methacryloylchloride solution (GelMA) and the photoinitiator were mixed first, then the exosome solution was added and oscillated together. Followed with exposing in the ultraviolet light in a wave length 405 nm for 30 seconds to form an injectable hydrogel. The Sprague Dawley (SD) rats were performed with full thickness transection and surgical repair administration of Achilles tendon to establish the animal model, including 4 groups: intact control (C group, selected the contralateral side of tendon transection with surgical repair group), tendon transection with surgical repair group (S group), tendon transection with surgical repair and hydrogel implantation group (H group) and tendon transection with surgical repair and exosome-encapsulated hydrogel group (E group). The samples were harvested on Day 7, 14 and 28 after the operation, respectively. Histopathological examination was performed with hematoxylin-eosin staining (HE staining) and immunohistochemistry staining of tenogenesis marker (Tenomodulin, TNMD), periphery neuropeptide markers (growth associated protein-43, GAP43; S100 calcium-binding protein B, S100B; neuropeptide Y, NPY; calcitonin gene-related peptide, CGRP; Substance P, SP). Morphological property was characterized with tendon length, cross-sectional area (CSA), and gastrocnemius weight ratio. Biomechanical testing was measured with maximum failure load, stiffness and tensile modulus.

The results of the quantitative polymerase chain reaction (qPCR) showed that the expression level of the TNMD gene in the E group was 2.12±0.43, which was significantly higher than that in the H group (1.26±0.28) and the S group (1.21±0.39) (both P<0.05). Based on the immunohistochemistry staining, the expression of GAP43 can be detected with an significant enhancement in the E group (11.20%±0.53% positive area) relative to H group (7.25%±0.22% positive area) and S group (8.68%±0.45% positive area) (both P<0.001) on day 28 post-surgery; whilst the expression of CGRP exhibited a depressed variation with a positive area of 7.62%±0.50% in E group relative to a positive area of 11.16%±1.33% in H group and a positive area of 10.16%±0.22% in S group on day 28 post-surgery, respectively (both P<0.001). Besides, the E group showed that the morphological characterization with a superior restoration of tendon length to (11.67±0.58) mm and CSA to (5.97±0.72) mm² and biomechanical property of healed tendon with an improvement of maximum failure load to (71.06±2.48)N and tensile modulus to (9.24±1.56) MPa when compared with those in S and H groups (all P<0.01).

Injectable Exos-encapsulated hydrogel promotes tendon healing in SD rats with enhancing temporal periphery neuropeptides expression and reducing the nerve sensitization during tendon healing.

In 14 patients from 10 families with X-linked charcot-marie-tooth disease type 1 (CMTX1) who were admitted to the hospital between December 2018 and April 2024, 11 presented with weakness and atrophy of distal extremities or both feet without superficial sensory impairment, and 3 children presented with paraphylastic limb numbness and weakness, slurred speech, and intracranial lesions shown by head MRI. In 10 cases, the motor sensory nerve was demyelinated with axonal damage in the limbs, and 1 child patient had no obvious abnormality and the sensory nerve damage was more serious than the motor nerve. Statistical analysis of 10 patients' neurophysiology showed that CMTX1 had more severe sensory nerve damage than motor nerves, more severe motor and sensory nerve damage in the lower limbs than in the upper limbs, and more severe sural nerve damage than in the upper limbs. GJB1 gene variation was found in 10 families, among which c.176G > C (p.G59A), c.350T > C (p.L117P) and c.386G > A (p.G129E) were newly reported mutations. CMTX1 may present as peripheral neuropathy and/or episodic central nervous system dysfunction. There are several new mutations in CMTX1 in China.

In the 21st century, brain function localization has developed into a brain network concept. Relying on the rapid development of advanced neuroimaging, artificial intelligence, computational neuroscience and modern neurosurgery composite operating room technology platform, a century-old neurosurgery has entered the era of network neurosurgery. In order to further understand the development and technical application of network neurosurgery, this paper reviews the history of brain function localization and the application of network neurosurgery techniques in brain tumors, epilepsy, cerebrovascular diseases and Parkinson's disease, and summarizes the latest research progress of brain-computer interface in the field of dysfunction caused by neuropsychiatric diseases.

Primary hyperaldosteronism (PA) is a secondary hypertensive disease caused by abnormal increase of aldosterone secretion, which is harmful. The classification of PA is not only the basis of choosing treatment plan, but also an important problem in the diagnosis of PA. In recent years, the value of 1 mg dexamethasone inhibition combined with adrenocorticotropic hormone (ACTH) stimulation test in the diagnosis of PA typing has been gradually recognized. It is not only high diagnostic efficacy, but also safe, economical and simple. However, in many studies, the methods, results, sensitivity and specificity of this test vary greatly. In this paper, the principle, methods, interpretation of results and future prospects of this test are reviewed, and a simplified diagnostic process of PA typing based on 1 mg dexamethasone inhibition combined with ACTH excitation test is proposed, which is convenient for clinical application.