Volume 105 · Issue 36 · 2025

Female reproductive plastic and rehabilitation, as an emerging interdisciplinary clinical field, focuses on the correction of structural abnormalities, diagnosis and treatment of functional disorders, and aesthetic enhancement of female reproductive organs caused by congenital and acquired factors. Over the past decade, expert teams in China have made significant progress in establishing a professional system in this field, encompassing top-level disciplinary design, expert team cultivation, and the formulation of industry consensus and group standards. Currently, this specialty in China has developed comprehensive definitions and connotations, formed expert teams, filled gaps in clinical research, and established a series of expert consensus documents. However, the field remains in its nascent stage, facing numerous challenges. Such as suboptimal quality and insufficient quantity of clinical data, inconsistent treatment methods between public and private medical institutions, and inadequate professional knowledge among medical practitioners and the general public. This review elaborates on the development of female reproductive plastic and rehabilitation in China over the past decade, covering the contextual background of its emergence, the establishment process of the Female Reproductive Plastic and Rehabilitation Branch under the Chinese Association of Plastic and Aesthetics, the relevant work conducted by expert teams, the existing challenges, and future prospects, while directly addressing current issues and obstacles.

Pelvic organ prolapse (POP) is a common condition among middle-aged and elderly women, and its accurate quantitative assessment is key to optimizing clinical diagnosis and treatment decisions. This review summarizes the current clinical applications, strengths, and limitations of multidimensional POP assessment tools. Contemporary evaluation of POP encompasses symptomatology, physical examination, and imaging modalities. Key instruments include patient-reported outcomes (PRO) and patient-reported goals (PRG) for quantifying symptoms, the pelvic organ prolapse quantification (POP-Q) system for staging anatomical changes, and pelvic floor ultrasonography and magnetic resonance imaging for detailed visualization of pelvic anatomy. While each tool offers unique insights, they also present challenges: PRO/PRG face interpretative complexity, time constraints, and standardization barriers; POP-Q staging is technically demanding, underutilized in primary care, and may not fully reflect clinical presentations; and imaging techniques lack standardized protocols, incur higher costs, and have not yet to demonstrate clear guidance for patient management. We propose that future advancements should focus on enhancing clinician training, establishing standardized imaging protocols, and developing an integrated, multidimensional framework that unites symptom, anatomical, and functional data. Through the coordinated use of these complementary tools and the mitigation of their respective limitations, a more comprehensive and individualized assessment and management of POP could be achieved, thereby advancing clinical practice.

Pelvic floor disorders is a kind of injury, degenerative diseae, although not fatal, but seriously affect the quality of life of patients.The development of the understanding of pelvic floor disorders has a history of thousands of years, from simple descriptions in ancient times to the emergence of new theories in modern times.In the past few centuries, the knowledge and understanding of it have undergone significant changes, and the proposal of new theories has brought new methods, but also brought more challenges.With the development of society and the continuous improvement of people′s requirements for quality of life, people′s awareness and attention to pelvic floor health have gradually strengthened, and more importantly have higher requirements to the quality of treatment.The article aims to review the development of pelvic floor disorders, the evolution of surgery and the current status of treatment, summarize and think about the changes in the understanding and concept of pelvic floor disorders, and think about the future development direction, in order to provide better treatment for patients.

Cancer pain, one of the most prevalent and distressing symptoms in cancer patients, is closely associated with diagnosis, treatment, quality of life, and survival outcomes. Effective cancer pain management necessitates multidisciplinary collaboration and multimodal approaches, implemented through comprehensive and personalized strategies throughout the disease course. To address this imperative, the Cancer Pain Integration Therapy Professional Committee of the China Anti-Cancer Association (CACA) convened domestic experts in cancer pain management. Guided by evidence-based, patient-centered, and system-integrated principles, these experts developed the Chineseguidelines for cancer pain management in adults (2025 edition) from the perspective of integrative medicine. The guidelines provide standardized guidances on pain assessment and diagnostic protocols, pharmacotherapy, minimally invasive analgesic techniques, palliative antitumor therapies, treatment-related pain syndromes, refractory cancer pain syndromes, and related domains. This framework aims to enhance healthcare professionals′ overall competency in cancer pain diagnosis, treatment, and comprehensive management.

Hormone receptor-positive (HR⁺), human epidermal growth factor receptor 2-negative (HER2^-) breast cancer is the most prevalent subtype. When the disease advances to a late stage with visceral metastases or a visceral crisis, patients face a poor prognosis with curative treatment rarely achievable. Moreover, the presence of visceral metastases or visceral crisis plays a critical role in determining appropriate treatment strategies. However, clinical diagnostic criteria and standardized treatment protocols for visceral metastases and visceral crisis in HR⁺/HER2^- advanced breast cancer remain undefined, which presents an urgent clinical challenge. In response, the Health China Research Center′s Expert Committee of Cancer Prevention and Control has reviewed the latest domestic and international research evidence, guidelines, and expert consensus, while incorporating input from experts in various fields. This consensus establishes diagnostic criteria for visceral metastasis and visceral crisis and introduces the concept of an impending visceral crisis. Furthermore, it refines treatment strategies based on patients′ treatment history (treatment-naïve versus pretreated) and recommends standardized treatment protocols for different patient groups, including the use of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with endocrine therapy, chemotherapy, and antibody-drug conjugates. This consensus aims to provide clinical guidance for the diagnosis and treatment of HR⁺/HER2^- advanced breast cancer with visceral involvement, ultimately improving treatment outcomes and patient prognosis.

To investigate urinary, bowel, pelvic floor functions in patients underwent nerve-sparing radical hysterectomy(NSRH) based on CC-PRO137(cervical cancer-patient reported outcome 137 scale,CC-PRO137)scale.

In this retrospective study, we retrospectively enrolled 304 patients with primary cervical cancer who underwent type-C1 radical hysterectomy in the Obstetrics and Gynecology Hospital, Fudan University from Oct, 2018 to Jun, 2021. The CC-PRO137 scale was used to evaluate urinary, bowel, pelvic floor functions at two time points: within 6 months and more than 1 year after surgery. Scores for urinary, bowel, and pelvic-floor functions were compared between the two postoperative intervals.

The average age of 304 patients was (47.1±10.6) years.Postoperative urinary, bowel, and pelvic floor functions scores within 6 months were (4.24±0.70), (4.41±0.42), and (4.67±0.46), respectively, while scores at 1 year or more postoperatively were (4.32±0.66), (4.44±0.38), and (4.69±0.45); within 6 months postoperatively, patients aged≤45 years exhibited higher urinary, bowel, and pelvic floor functions scores [(4.32±0.63) vs (4.15±0.77), (4.48±0.34) vs (4.35±0.47), (4.77±0.35) vs (4.59±0.52)] compared to patients aged >45 years (P<0.05); at 1 year or more postoperatively, patients aged ≤45 years demonstrated higher urinary and pelvic floor functions scores [(4.42±0.56) vs (4.22±0.74), (4.75±0.37) vs (4.64±0.49)] than patients aged >45 years (P<0.05), while no statistically significant difference existed in bowel function scores between groups (P>0.05); within 6 months postoperatively, statistically significant differences were observed in urinary, bowel, and pelvic floor functions scores among FIGO(International Federation of Gynecology and Obstetrics) stage Ⅰ, Ⅱ, and Ⅲ patients (all P<0.05), whereas at 1 year or more, FIGO stage Ⅱ and Ⅲ patients showed lower urinary function scores compared to stage Ⅰ patients (both P<0.05), FIGO stage II patients had lower pelvic floor function scores (P=0.001), but no significant differences existed in bowel function scores across stages (P>0.05); both within 6 months and at 1 year or more postoperatively, statistically significant differences in urinary function scores were found between patients receiving no adjuvant therapy or postoperative chemotherapy only versus those receiving postoperative concurrent chemoradiotherapy (P<0.001); at 1 year or more, significant differences in bowel function scores existed between no adjuvant therapy versus concurrent chemoradiotherapy (P=0.030) and borderline significance between chemotherapy only versus concurrent chemoradiotherapy (P=0.070), while pairwise comparisons of pelvic floor function scores showed no statistical significance (P<0.05).

Nerve-sparing radical hysterectomy for cervical cancer can markedly reduce the complications caused by intraoperative injury to the pelvic autonomic nerves; nevertheless, some patients may still develop urinary frequency, urgency, voiding or defecation difficulties, and pelvic organ prolapse after surgery. Patients older than 45 years, with advanced FIGO stage, or who require postoperative concurrent chemoradiation should undergo regular follow-up to assess urinary, bowel, and pelvic floor functions after surgery.

To explore the therapeutic effect of retropubic tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence (SUI) under day surgery mode.

A retrospective analysis was conducted on 119 patients with moderate-to-severe SUI who underwent the TVT procedure at the Department of Gynecology and the Day Surgery Center, the Second Affiliated Hospital of Soochow University, between March 2018 and March 2024. Based on the perioperative care model, patients were categorized into a day surgery group (n=57) and a traditional inpatient surgery group (n=62). We compared general data of patients, surgical and hospitalization-related indicators, postoperative efficacy evaluation indicators, and surgical complications between the groups.

The 119 patients were aged (56.0±8.7) years. There were no statistically significant differences in age [(56.0±7.1) vs (56.3±9.1) years], body mass index [(23.75±2.98) vs (23.10±2.83) kg/m²], disease duration [(4.77±1.35) vs (4.82±1.50) years], number of vaginal deliveries [(3.24±0.40) vs (3.17±0.39) times], subjective SUI grading, or objective SUI grading between the two groups (all P>0.05). Both groups of patients successfully completed the surgery. No significant differences were found in operative duration, intraoperative blood loss, surgical costs, or anesthesia costs (all P>0.05). However, the duration of indwelling urinary catheter [(16.12±1.34) vs (34.05±6.25) h], nursing costs [(70.79±10.66) vs (498.37±125.83) yuan], total hospitalization costs [ (10 899.63±45.54) vs (18 501.87±41.46) yuan], and hospitalization duration [ (1.08±0.11) vs (5.85±1.21) d] in the day surgery group were significantly lower than those in the traditional inpatient surgery group (all P<0.05), and medical satisfaction in the day surgery group was higher than that in the traditional inpatient surgery group [ (13.19±0.46) vs (9.95±3.06) points, P<0.05]. There were no statistically significant differences in postoperative pain or the global impression of improvement between the two groups (all P>0.05). Compared with preoperative values, the Incontinence Impact Questionnaire-7 (IIQ-7) scores, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores, and 1 h pad test results improved at 6 months postoperatively in both groups (all P<0.05); there were no statistically significant differences in the preoperative or postoperative 6-month IIQ-7 scores, PISQ-12 scores, or 1 h pad test results between the two groups (all P>0.05). The overall incidence rate of surgical complications did not differ significantly between the day surgery group [3.51% (2/57)] and the traditional inpatient surgery group [4.84% (3/62)] (P>0.05).

The application of day surgery mode in TVT for female SUI is feasible and safe. It could significantly shorten hospitalization duration and indwelling urinary catheter time, reduce total hospitalization costs, and increase medical service satisfaction, without increasing the incidence of surgical complications.

To analyze the efficacy of vaginal stent placement and posterior pelvic reconstruction with transvaginal synthetic mesh implantation in the treatment of posterior vaginal wall prolapse with outlet obstruction constipation, and to explore the gynecological treatment strategy for the disease.

Retrospective follow-up study. Totally 205 patients with posterior vaginal wall prolapse and outlet obstruction constipation treated with vaginal stent were selected from Shengjing Hospital Affiliated to China Medical University from September 2018 to August 2023. Among them, 16 patients (7.2%) did not continue the treatment (non-continuation group), and the remaining patients were divided into the continued vaginal stent treatment group (78 cases, 38.0%) and the posterior pelvic reconstruction group (127 cases, 62.0%) according to the subsequent treatment methods. The Pelvic Floor Distress Inventory Short Form (PDFI-20) and Obstructed Defecation Syndrome (ODS) questionnaire were used to evaluate the symptoms of defecation disorders before and after vaginal stent treatment. For the posterior pelvic reconstruction group, follow-up was performed at 3 months and 1, 2, 3, and 5 years after surgery. PDFI-20 and ODS questionnaire were used to evaluate the symptoms of defecation disorders at 3 months after surgery, and POP-Q was used to evaluate the anatomical reduction. Complications related to mesh implantation were followed up at 1, 2, 3, and 5 years after surgery. PDFI-20 and ODS scores before treatment and 1 month after intravaginal stent placement was compared, as well as between POP-Q points before surgery and 3 months postoperatively following posterior pelvic floor reconstruction.

A total of 205 patients, aged 65 (62, 68) years, were treated with vaginal stent. One month after vaginal stent treatment, the PDFI-20 questions 4, 7, 8, total score and ODS questions 1-8, total score of all patients significantly decreased (all P<0.05). In the posterior pelvic reconstruction group, the POP-Q indicator points Ap [2(2, 3) vs -3(-3, -3) cm] and Bp [3(2, 5) vs -3(-3, -2) cm] decreased significantly 3 months after the operation compared with those before the operation (all P<0.05), and the PDFI-20 questionnaire questions 4, 7, 8, total score and ODS questionnaire questions 1-8, total score all decreased compared with those before surgery (all P<0.05). During follow-up at 1, 2, 3, and 5 years after surgery, the anatomical reduction assessed by POP-Q was good, and the PDFI-20 questionnaire indicated satisfactory therapeutic effect. There were 5 cases of mesh exposure, 3 cases of pain and 1 case of prolapse recurrence.

Vaginal stent placement provides experimental diagnosis and conservative treatment for outlet obstruction constipation, and provides a strong indication for posterior pelvic reconstruction surgery. Both vaginal stent placement and posterior pelvic reconstruction are effective for posterior vaginal wall prolapse with outlet obstruction constipation.

To investigate the effect of metformin on the incidence of venous thromboembolism (VTE) during hospitalization in medical inpatients.

Data of 238 342 patients hospitalized in the Department of Internal Medicine of Hunan Provincial People′s Hospital from January 2020 to September 2024 were retrospectively analyzed, of which 137 902 were male and 100 440 were female; age[M (Q₁,Q₃)] was 63 (54, 72) years. Patients were divided into metformin group and control group according to whether metformin was used or not, and the incidence rates of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE) and bleeding events were compared between patients in the metformin group and the control group, and multifactorial logistic regression model was used to analyze the association between the use of metformin and risk of DVT, PTE, gastrointestinal hemorrhage, and bleeding from other parts of the body.

The incidence rates of DVT and PTE were both lower in the metformin group than in the control group [1.27% (226/17 819) vs 2.41% (5 319/220 523) and 0.11% (20/17 819) vs 0.34% (759/220 523), respectively; both P<0.001]. The incidence rates of gastrointestinal bleeding and bleeding from other sites were also lower in the metformin group compared to the control group [0.64% (114/17 819) vs 1.58% (3 488/220 523) and 0.45% (81/17 819) vs 0.60% (1 316/220 523), respectively, both P<0.05]. After adjustment for confounding factors using a multivariable logistic regression model, the risk of DVT remained significantly lower in the metformin group than in the control group (OR=0.558, 95%CI: 0.484 to 0.644). Similarly, the risk of PTE was lower in the metformin group (OR=0.557, 95%CI: 0.350 to 0.885). The risk of gastrointestinal bleeding during hospitalization was also significantly lower in the metformin group (OR=0.496, 95%CI: 0.408 to 0.603). However, the reduction in the risk of bleeding at other sites after adjustment was not statistically significant (OR=0.818, 95%CI: 0.635 to 1.052).

Metformin reduces the risk of VTE during hospitalization in internal medicine inpatients without increasing the risk of bleeding, is protective against VTE, and may be a potential option for VTE prophylaxis in patients at high risk of bleeding.

To evaluate the clinical characteristics, intervention outcomes, and influencing factors for abandonment of infected arteriovenous grafts (AVG).

The data of patients who underwent upper-limb AVG placement at the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University between January 2018 and December 2023 were retrospectively analyzed. Incidence, clinical manifestations, and intervention outcomes of infected AVG were analyzed. Influencing factors associated with post-infection AVG abandonment were identified by multivariate logistic regression analysis.

During a median follow-up of 755 (IQR: 494-1 158) days, 704 patients with upper limb AVG were included. There were 37 functional AVG infection episodes documented in 37 distinct patients (14 males and 23 females), with a mean age of (58.2±11.2) years. The cumulative incidence of AVG infection was 5.3% (37/704), with an incidence density of 2.25 episodes per 100 patient-years. Infection rates at 3, 6, and 12 months post-AVG placement were 0.6% (4/704), 1.1% (8/704), and 2.3% (16/704), respectively. Local graft inflammation was observed in 97.3% (36/37) of cases, and 64.9% (24/37) of patients presented with systemic symptoms. Microbial cultures were performed in 35 patients, yielding positive rates of 84.2% (16/19) for blood cultures and 78.1% (25/32) for tissue/secretions cultures, with Staphylococcus aureus being the most prevalent pathogen [75.0%(12/16)/57.1%(16/28)]. All patients received antimicrobial therapy, with 75.7% (28/37) treated with vancomycin or linezolid. After infection, the AVG was directly abandoned in 18 cases, eight patients underwent conservative management, and 11 received graft interposition. Functional AVG preservation without recurrence within 90 days was achieved in 15 patients. Multivariate logistic analysis identified that female sex (OR=23.065, 95%CI: 1.867-284.878, P=0.014) and the use of early-cannulation arteriovenous grafts (ACUSEAL) (OR=21.097, 95%CI: 1.674-265.831, P=0.018) were risk factors for graft abandonment post-infection.

The overall incidence of AVG infection is relatively low, and functional graft preservation can be achieved through active interventions in appropriately selected cases. Female sex and ACUSEAL are associated with increased risk of post-infection graft abandonment.

To explore the clinical features and dynamic changes of multimodal imaging in patients of Dementia with Lewy Bodies (DLB) through long-term follow-up.

The clinical data of the suspected DBL patients who were admitted to the Neurology Department of the First and Second Centers of the PLA General Hospital from March 2012 to February 2025 were retrospectively collected. Descriptive methods were used to analyze the clinical features, head magnetic resonance imaging (MRI), dopamine transporter (DAT), 11C Pittsburgh compound B (¹¹C-PIB), and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET). The patients were followed up on time from disease onset to bedridden status, time from onset to death, annual cognitive decline rate, extent of cerebral atrophy, regions of hypometabolism, and areas of reduced DAT availability. The last follow-up was conducted in February 2025.

A total of 11 DLB patients (9 males, 2 females) were included. The age at onset was (74.64±9.67) years, with (5.90±3.46) years′ follow-up. The Mini Mental State Examination(MMSE) scores declined annually by (5.19±2.73) points. Time from onset to bedridden status was (4.87±1.47) years, and to death was (7.06±4.09) years. All 11 patients had memory impairment; 2 patients showed attention/executive deficits, and 7 patients had cognitive function fluctuations. Visual hallucinations were present in 10 patients, and rapid eye movement sleep behavior disorder (RBD) in 7 patients, which occured 4.30 (0, 14.00) years earlier than onset. 10 patients had Parkinsonism syndrome: bradykinesia and rigidity in 9 (9/10) each, resting tremor in 5 (5/10). MRI showed 6 patients had early bilateral temporoparietal junction atrophy with medial temporal lobe sparing. FDG-PET revealed 10 patients haddecreased metabolism in the parietal, temporal and occipital junction areas. With the progression of the disease, the FDG in the frontal lobe gradually decreased, and the metabolism in the posterior cingulate gyrus was relatively retained in the middle and late stages of the disease. DAT-PET indicated that all 11 patients presented with decreased DAT distribution in bilateral putamen or caudate nucleus. PIB-PET was positive in all: diffuse retention in 6, temporoparietal frontal cortex in 4, and frontal/occipital lobes in 1.

DLB progresses rapidly with subtle early symptoms, contributing to high misdiagnosis rates. However, clinical and multimodal imaging features with longitudinal follow-up can effectively assist in early differential diagnosis.

Chinese families with hearing loss definitively attributed to OSBPL2 gene variation via whole-exome sequencing at the Molecular Diagnostic Center for Hereditary Hearing Loss, PLA General Hospital from June 2022 to February 2025 were retrospectively analyzed. Meanwhile, a review of OSBPL2-related deafness literature from PubMed and CNKI databases (2014-2025) was performed to analyze the genotype and phenotype of OSBPL2 gene. Among 607 families with deafness, there was only one (0.16%) novel de novo frameshift variation (affecting amino acid 53, p.Gln53), presenting with bilateral, symmetric, late-onset, progressive sensorineural hearing loss starting with high frequencies during late adolescence and gradually involving all frequencies. This patient demonstrated high consistency in genotype and phenotype with six previously reported families and one sporadic case. The current findings reveal that OSBPL2 variants-caused autosomal dominant nonsyndromic hearing loss 67 (DFNA67) is rare, predominantly frameshift variations, and can occur de novo, with p.Gln53 as a mutation hotspot. Therefore, for individuals with progressive sensorineural hearing loss starting with high frequencies and having relatively uniform phenotype, genetic testing for OSBPL2 should be considered.

To investigate the impact of continued antiplatelet therapy on bleeding complications following transrectal ultrasound-guided prostate biopsy (TRUS-PB). This multicenter retrospective study analyzed 296 patients undergoing TRUS-PB between April 2024 and January 2025 at eight centers affiliated with the National Clinical Research Center for Cardiovascular Diseases′ Urology and Cardiovascular Comorbidity Consortium. Patients were categorized into an antiplatelet continuation group (those who continued antiplatelet therapy) and a control group (patients who did not use antiplatelet drugs). Clinical parameters, medication profiles, operative characteristics, postoperative complications, blood routine test and coagulation parameters were compared. A total of 64 patients were included in the treatment group, with an average age of (71.2±9.9) years; 232 patients were included in the control group, with an average age of (72.5±7.0) years. The rectal compression hemostasis time after biopsy was longer in the treatment group than in the control group[(8.1±1.8)min vs (3.7±1.4)min,P<0.05]. No statistically significant differences were observed in terms of age, ECOG score, PSA, prostate volume, number of biopsy needles, and tumor positivity rate (all P>0.05). No severe bleeding events requiring surgical intervention (Grade Ⅲ/Ⅳ) occurred in either group. There were no statistically significant differences between the two groups in terms of complications such as hematuria, rectal bleeding (Grade Ⅰ/Ⅱ), urinary retention (Grade Ⅰ/Ⅱ), and infection (all P>0.05). There were no statistically significant differences between the two groups in terms of blood routine test and coagulation parameters such as white blood cell count, hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen (all P>0.05). Continuation of antiplatelet therapy in cardiovascular patients undergoing TRUS-PB did not increase severe complication risks but necessitated prolonged rectal compression time for hemostasis.

This paper reports a child with primary adrenocortical dysfunction (PAI), presenting with postnatal skin pigmentation, no weight gain, normal girl vulva. Laboratory examination showed hyperkalemia, hyponatremia, metabolic acidosis, significant increase of adrenocorticotropic hormone (ACTH), low cortisol level, low 17-hydroxyprogesterone, progesterone and testosterone. Finally, after genetic testing, it was diagnosed as PAI caused by mutation of nuclear receptor subfamily 5A member 1 (NR5A1) gene. After glucocorticoid and mineralocorticoid replacement therapy, the symptoms improved.

A patient with palisade adenocarcinoma of the left submandibular gland was reported. A 68-year-old female was admitted to hospital due to "painless mass in left submandibular area for 6 years and progressive enlargement". The patient had no family history of salivary gland tumor and underwent left submandibular mass resection in Jining First People's Hospital on April 3, 2025. The postoperative pathological diagnosis was palisade adenocarcinoma. Adjuvant radiotherapy was given postoperatively, and no disease progression was observed during follow-up. The histomorphological characteristics and immunohistochemical phenotype of palisade adenocarcinoma are unique, and they have not been formally included in the WHO classification system. Because there are few cases and few relevant literature reports, the biological behavior and clinical outcome of such tumors are still unclear.

With the deepening of microbiomics research, researchers' understanding of lung microbial environment has changed. Different from traditional cognition, the lungs of healthy people are not a sterile environment, but there are complex and diverse microbial ecosystems. Specific microbial communities in the lungs play a key role in regulating physiological and pathological processes of the organism through sophisticated interactions with host cells. The pulmonary flora of lung cancer patients showed significant dysregulation characteristics, including the decrease of flora diversity and the abnormal enrichment of specific bacteria such as Veloncoccus, Streptococcus and Prevotella. Lung microorganisms can directly or indirectly promote the progression of lung cancer by triggering chronic inflammation, remodeling the immune microenvironment, and regulating metabolism (such as tryptophan metabolism dysregulation). Altered patterns of microbial composition in the lung may be a potential biomarker for early diagnosis of lung cancer. Most of the available evidence comes from cross-sectional studies, and it is difficult to determine whether microbial dysregulation is a driving factor or a secondary outcome of lung cancer. At the same time, the interaction between bacterial flora also complicates the mechanism analysis. In the future, the influence of lung microbes on the progression of lung cancer can be deeply explored from the basic research level. At the same time, from the perspective of clinical research, the complex host-microbial interaction relationship in lung cancer can be further explored, and the key ways of lung microbiota or specific dominant strains affecting lung cancer can be determined. Pathways provide a new entry point for the prevention, diagnosis, treatment and prognosis of lung cancer.

Bipolar disorder (BD) is a common severe mental disorder with unknown etiology and lack of objective biomarkers. Exosomal microRNA (miRNA) plays a key role in cellular communication and exists stably in humoral fluids. Its expression level is closely related to the pathogenesis of BD. This paper reviews the research progress of exosomal miRNA involvement in the pathogenesis of BD, compares the differences of miRNA expression profiles in peripheral blood, brain tissue and cerebrospinal fluid, and the possible molecular mechanisms involved.

A 7-year-old male was admitted to hospital for "nasal congestion with runny nose for 1 week". He had a history of recurrent sinusitis for 2 years and denied craniofacial trauma and developmental abnormalities. Sinus CT axial plain scan (Figure 1) and three-dimensional post-processing image (Figure 2) showed a dense shadow (white arrow) visible in the nasal cavity, with a slightly lower central density, showing pulp-like manifestations. The left inferior turbinate (yellow arrow) was compressed and depressed, suggesting that ectopic teeth may exist for a long time, which has caused nasal cavity obstruction and local structural changes. In addition, the imaging findings suggested left nasal obstruction with sinusitis. Nasal endoscopy showed a pale red mass in the left lower nasal passage, which was hard in texture and firmly adhered to the left nasal floor (Figure 3). The child underwent transnasal endoscopic ectopic teeth resection. During the operation, a tooth-like hard object was removed, with a general shape of crown and part of root shape, which was confirmed to be a tooth structure (Figure 4), supporting the diagnosis of ectopic teeth in the nasal cavity. After 4 months follow-up, there was no recurrence of sinusitis in the children, and no obvious residual or recurrent lesions were found in the imaging examination.