Volume 105 · Issue 44 · 2025

Conventional radiomics approaches are constrained by suboptimal diagnostic performance, limited capacity to characterize molecular heterogeneity within the tumor microenvironment, and insufficient capture of critical biological information regarding host immune responses. In response, AI-augmented multi-omics analytics have emerged as a core component throughout the management of lung cancer and pulmonary nodules, decoding intricate tumor biological landscapes to deliver novel dimensions for precision diagnosis and treatment, thereby establishing a foundational component of their comprehensive disease management. This cross-dimensional data synthesis not only transcends the informational limitations inherent in unimodal methodologies but also enables integrative profiling spanning anatomical architecture to molecular mechanisms, thereby substantially propelling the advancement of precision diagnosis and treatment of lung cancer and pulmonary nodules. Nevertheless, persistent challenges including inadequate data standardization and limited model interpretability remain to be addressed. The translational pathway is further impeded by delayed clinical validation and technical complexities in multi-omics data integration. Future research endeavors should prioritize the implementation of prospective trials and the development of novel AI technologies to overcome these obstacles, ultimately enabling early detection and personalized therapeutic interventions for lung cancer and pulmonary nodules.

In recent years, the number of research papers on building disease prognosis prediction models (referred to as modeling) has rapidly increased, but clinical applications are rare, and a vast array of studies and papers failed to improve clinical practice. The reasons for this are worthy of attention. The author proposes that modeling research is a systematic engineering, and the current "one-step" technical approach is the main reason for the above phenomenon. Modeling research can be divided into four stages: topic selection, preliminary preparation, modeling, promotion and application, and re-evaluation. Each stage has a series of clinical and scientific questions that need to be answered, and should be gradually promoted. The paper clarifies from a methodological perspective that modeling research should be guided by clinical problems and needs, and form a series of studies based on clear clinical application scenarios and subsequent solutions. The paper analyzes the objectives and tasks of each research, available research plans, key points and difficulties to be noted, and milestone achievements of each stage. Meanwhile, it is suggested to strive to incorporate modeling research into the framework of scientific community behavior, and empower evidence-based medicine with research results and their promotion and application. Finally, the author points out that modeling research and its subsequent clinical applications face legal, ethical, and management (including potential conflict of interest risks) issues and challenges that need to be addressed through further research.

Oxycodone is an agonist of μ-and κ-opioid receptors which has been commonly used for the management of moderate to severe pain attributing to its distinct pharmacological properties. Due to the lack of unified medication guidance, significant variations exist in the clinical application of oxycodone injection among different medical institutions and healthcare providers, aggravating the standardization and homogenization of pain management. To solve this problem, the Pain Group of the Chinese Society of Anesthesiology has organized a multidisciplinary panel of experts to develop this consensus focusing on 15 key clinical questions. Based on systematic literature review and evidence evaluation, the consensus establishes 15 recommendations covering general anesthesia induction, preventive medication, postoperative analgesia, post-thoracic/abdominal surgery analgesia, epidural anesthesia, procedural sedation and analgesia, special patient use etc. This consensus aims to standardize clinical application and optimize pain management outcomes by providing evidence-based guidance on oxycodone injection.

To explore the effectiveness and safety of anlotinib combination regimens in patients with previously immunotherapy treated advanced non-small cell lung cancer (NSCLC).

This study retrospectively included 85 patients with previously immunotherapy treated advanced NSCLC who received anlotinib combination regimens or single-agent chemotherapy in the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2023. The observation group was consisted of 43 patients who received anlotinib combination regimens, and the control group was consisted of 42 patients who received single-agent chemotherapy. Observation group received anlotinib combined with chemotherapy and anlotinib combined with immunotherapy, while control group received single-agent chemotherapy. The follow-up period ended on May 25, 2024. The baseline characteristics, recent effectiveness, prognosis, and adverse reactions were compared between the observation group and the control group. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the differences.

In observation group, there were 29 males and 14 females with a median age [M (Q₁, Q₃)] of 63 (27, 73) years; in control group, there were 27 males and 15 females, with a median age of 64 (28, 73) years. Objective response rates for the observation group and control group were 23.3% (10/43) and 14.3% (6/42), respectively, with no statistically significant difference (P=0.290). Disease control rates were 83.7% (36/43) and 57.1% (24/42) for the observation and the control groups, respectively, with a statistically significant difference (P=0.007). The median follow-up duration for the observation group and the control group was 14.2 and 9.6 months, respectively. Prognosis results indicated that the median PFS for the observation group and the control group were 6.1 (95%CI: 2.41-9.79) and 2.9 months (95%CI: 2.59-3.21), respectively. The observation group was significantly higher than the control group (P=0.009). The median OS were 15.5 (95%CI: 8.99-22.01) and 10.3 months (95%CI: 7.87-12.74), respectively. The observation group was also significantly higher than the control group (P=0.016). Safety analysis results exhibited that the incidence of adverse reactions of different grades in the observation group and control groups were 88.4% (38/43) and 81.0% (34/42), respectively; The grade ≥3 adverse reactions occurred in 41.9% (18/43) and 33.3% (14/42), respectively, with no statistically significant difference (both P>0.05). The grade≥3 adverse reactions were controlled through dose adjustment and symptomatic treatment.

In patients with previously immunotherapy treated advanced NSCLC, anlotinib combination regimens demonstrates preliminary efficacy and tolerable safety profile compared to single-agent chemotherapy.

To analyze the mutational landscape of primary and acquired mesenchymal to epithelial transition factor (MET) mutations in non-small cell lung cancer (NSCLC) and investigate the impact of co-mutations on the therapeutic efficacy.

A total of 316 pathologically confirmed NSCLC patients with MET gene mutations treated at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and Shanghai Chest Hospital, Shanghai Jiao Tong University, between January 2012 and May 2023 were retrospectively enrolled. Demographics, clinicopathological characteristics, and treatment outcomes were collected. Patients were classified into primary MET mutation and acquired MET mutation groups according to the timing of mutation occurrence, and intergroup differences were compared. Treatment responses were evaluated according to the Response Evaluation Criteria in Solid Tumors criteria. Follow-up data on efficacy and progression-free survival (PFS) were collected through telephone calls and medical record review. The follow-up continued until January 2024. Kaplan-Meier survival curves were generated, and log-rank tests were used to compare PFS between patients with different co-mutations receiving tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) therapy.

Compared to the acquired mutation group, patients with primary MET mutations were significantly older[median (Q₁, Q₃) age: 65 (58, 71) vs 59 (51, 64) years; P<0.001], had a higher proportion of males [62.4% (141/226) vs 48.9% (44/90), P=0.028] and a higher proportion of never-smokers [48.7% (110/226) vs 30% (27/90), P=0.002]. In the primary mutation group, TP53 was the most common co-mutation gene (43%, 51/118), followed by EGFR (32%, 38/118) and KRAS (9%, 11/118). In the acquired mutation group, 89% (69/73) of patients retained the EGFR mutation. Aside from EGFR, the most common co-mutation genes were TP53 (63%, 46/73) and CDK4 (12%, 9/73). Among the 62 patients treated with MET-TKI, those with concurrent EGFR-sensitive mutations had a median PFS of 3.1 (95%CI: 2.4-7.2) months, significantly shorter than that of EGFR wild-type patients [18.2 (95%CI: 9.2-22.1) months, P<0.001]. Patients with TP53 co-mutations had a median PFS of 7.5 (95%CI: 6.4-not reached) months, which was significantly longer than TP53 wild-type patients [3.4 (95%CI: 1.8-4.3) months, P=0.035]. Among the 57 patients treated with ICI, those with EGFR-sensitive mutations had a median PFS of 5.3 (95%CI: 2.0-8.2) months, which was significantly shorter than EGFR wild-type patients [10.4 (95%CI: 5.2-not reached) months, P=0.027]. Patients with TP53 co-mutations had a median PFS of 5.9 (95%CI: 3.8-20.4) months, which was longer than TP53 wild-type patients [3.0 (95%CI: 2.0-4.5) months], although the difference was not statistically significant (P=0.344).

Primary and acquired MET mutations in NSCLC exhibit distinct genomic characteristics. Patients harboring concurrent EGFR mutations in NSCLC may derive less benefit from MET-TKI and ICI, whereas those harboring TP53 co-mutations tend to experience more favorable outcomes compared with TP53 wild-type NSCLC patients when treated with MET-TKI.

To construct and validate a prognostic model for patients with advanced lung squamous cell carcinoma (LUSC) receiving chemotherapy combined with immunotherapy based on quantitative CT features.

A total of 96 patients with advanced LUSC who received chemotherapy combined with immunotherapy at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2020 to October 2023 were retrospectively included. They were randomly divided into a training set (n=72) and an internal validation set (n=24) at a ratio of 3∶1 (random sequence was generated by R Studio 4.4.2 software). Additionally, patients with advanced LUSC who visited Yichang Central People′s Hospital from October 2020 to June 2024 were enrolled as the external validation set (n=58) according to the same criteria. Pretreatment chest CT images were obtained from patients, and quantitative CT features were extracted. Based on the training set data, LASSO regression and univariate and multivariate Cox regression models were used to screen the independent variables, and the model was constructed with the progression-free survival (PFS, progress=1, no progression=0) as the dependent variable. Taking the progression at 180 d as the outcome variable and the quantitative CT score as the evaluation index, the receiver operating characteristic (ROC) curve was drawn. The calibration curve and decision curve were used to evaluate the model efficacy. Based on the optimal cut-off value determined by the ROC curve, patients were divided into high-risk and low-risk groups, and the log-rank test was used to compare the survival differences between the two groups.

A total of 154 patients with LUSC were included, including 147 males and 7 females, with an age of (64.7±8.1) years; there were no statistically significant differences in demographic characteristics and TNM stage among the training set, internal validation set, and external validation set (all P>0.05). Four quantitative CT features were associated with PFS, including the percentage of low attenuation area with CT value < -910 HU in the whole lung (LAA%-910_lung) (HR=0.013, 95%CI: 0.002-0.313), the area percentage of low attenuation area with CT value < -950 HU in the right lower lung (LAA%-950_right_lower) (HR=0.011, 95%CI: 0.001-0.012), the minimum wall thickness of grade 2 airwall (minThicknessOfAirwall_2) (HR=0.117, 95%CI: 0.029-0.463) and the mean diameter of grade 1 airway (meanDiameterOfAirway_1) (HR=0.767, 95%CI: 0.687-0.857), which were used to construct the quantitative CT (QCT) score: QCTscore=-4.346×(LAA%-910_lung)-4.513×(LAA%-950_right_lower)-2.14×(minThicknessOfAirwall_2)-0.265×(meanDiameterOfAirway_1). The optimal cutoff value for the score was -9.45. The areas under the ROC curve (AUC) for predicting 180 d survival was 0.843 (95%CI: 0.773-0.952) in the training set, 0.778 (95%CI: 0.527-0.999) in the internal test set, and 0.762 (95%CI: 0.615-0.921) in the external test set. The Hosmer-Lemeshow goodness-fit test results showed that the model had a good fitting effect (training set: χ²=8.058, P=0.428; internal validation set: χ²=12.883, P=0.116; internal validation set: χ²=3.141, P=0.925). The decision curve shows that when the risk threshold of the training set is 0 to 79%, that of the internal validation set is 0 to 81%, and that of the independent validation set is 0 to 82%, the prediction model has a clinical net benefit. In the three data sets, the 180 d PFS rate of the high-risk group (QCT score ≥ -9.45) was lower than that of the low-risk group (QCT score < -9.45) (training set: 5.1% vs 66.7%; internal validation set: 180 d progression-free survival rate 12.5% vs 75%; external validation set: 180 d progression-free survival rate 68.6% vs 100.0%, all P<0.05).

Based on the QCT image features, a prognostic prediction model for chemotherapy combined with immunotherapy in LUSC was constructed, providing an effective means for predicting the response of chemotherapy combined with immunotherapy in LUSC patients.

This study aimed to comprehensively investigate the regulatory mechanism and clinical value of secreted phosphoprotein 1 (SPP1) in the three-stage progression of "smoking-chronic obstructive pulmonary disease (COPD)-carcinogenesis" in lung squamous cell carcinoma (LUSC) through integrated bioinformatics analysis and machine learning.

The datasets for the three stages of LUSC were downloaded from the Gene Expression Omnibus (GEO) database, including GSE18385 (containing lung tissue samples from 31 healthy smokers and 21 healthy non-smokers), GSE38974 (containing lung tissue samples from 23 smoking COPD patients and 9 healthy smokers), and GSE12472 (containing lung tissue samples from 18 LUSC patients with COPD and 17 smoking COPD patients). The Cancer Genome Atlas (TCGA)-LUSC dataset (comprising 504 samples, including lung tissue samples from LUSC patients and their matched normal lung tissue samples) was downloaded from TCGA database for further analysis. Samples and follow-up information from 208 non-small cell lung cancer patients who underwent radical resection and mediastinal lymph node dissection at Zhongshan Hospital, Fudan University in 2005 were selected for prognostic analysis and validation. Weighted Gene Co-expression Network Analysis (WGCNA) was applied to screen stage-specific module genes. Differentially expressed genes (DEGs) were identified through differential expression analysis. The CIBERSORT algorithm and Gene Set Enrichment Analysis (GSEA) were used to characterize the immune microenvironment. Eight machine learning algorithms and protein-protein interaction (PPI) network analysis were combined to screen for core regulatory targets.

Results from WGCNA and differential analysis of the GEO datasets indicated that SPP1 is consistently highly expressed across the three stages of LUSC. Analysis of the TCGA-LUSC dataset further verified that the relative expression level of SPP1 in lung tissues of LUSC patients was significantly higher than in normal lung tissues (9.13±2.01 vs 4.68±1.64, P<0.001). Furthermore, SPP1 expression was significantly higher in patients with TNM stage Ⅲ than in those with stage Ⅱ (9.59±2.09 vs 8.80±2.15, P=0.045). Male LUSC patients with high smoking exposure exhibited higher SPP1 expression levels than those with low smoking exposure (9.56±2.23 vs 8.60±2.04, P=0.032). Survival prognosis analysis revealed that among male patients, the difference in median overall survival (OS) between the high SPP1 expression group and the low expression group was statistically significant [2.90 (95%CI: 2.11-4.64) years vs 4.69 (95%CI: 2.95-7.34) years, P=0.032). Data validation from Zhongshan Hospital, Fudan University, also showed that the 5-year survival rate of lung cancer patients with high SPP1 expression was lower than that of patients with low SPP1 expression (49.3% vs 62.6%, P=0.042). Results from the CIBERSORT algorithm indicated that high SPP1 expression drives increased infiltration of M2 macrophages (P<0.001). Machine learning combined with PPI network analysis identified NTN1 and CX3CL1 as key regulatory targets of SPP1, which may be associated with the occurrence and development of lung cancer.

SPP1 may promote LUSC progression by mediating M2 macrophage polarization through suppressing NTN1 or activating CX3CL1, suggesting its potential as a prognostic biomarker and therapeutic target for high-risk male smokers.

To explore the clinical effect of different coronary artery flow isolation methods in off-pump coronary artery bypass grafting (OPCABG).

A total of 60 patients who accepted OPCABG in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from June 2021 to June 2024 were randomly divided into three groups by computer. The different coronary flow isolation methods were used in three groups. The coronary artery was occluded with tourniquets in the occlusion group (n=20). The coronary artery was shunted with shunt in the shunt group (n=20). The coronary artery was selectively shunted or occluded according to the different blood flow conditions of each target vessel in the combined group (n=20). The anastomosis time and the amount of bleeding were observed and compared. The serum levels of cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-ProBNP) were detected after eight hours of operation.

Among the 60 patients with coronary artery disease, 48 patients were male and 12 patients were female. The anastomotic time of each anastomosis in the shunt group was longer than that in the occlusion group and the combined group [(18.4±2.8) min vs (12.3±2.2) min, (14.3±2.9) min, both P<0.017]. There was no statistically significant difference in anastomotic time between the occlusion group and the combined group (P=0.176). Postoperative serum cTnT in the occlusion group was higher than that in the shunt group and the combined group [(0.28±0.07) μg/L vs (0.16±0.03) μg/L, (0.17±0.04) μg/L, both P<0.017]. There was no statistically significant difference in postoperative serum cTnT between the shunt group and the combined group (P=0.152). Postoperative serum NT-ProBNP in the combined group was lower than that in the occlusion group and the shunt group [(254±27) ng/L vs (481±19) ng/L, (373±42) ng/L, both P<0.017]. Postoperative serum NT-ProBNP in the shunt group was lower than that in the occlusion group [(373±42) ng/L vs (481±19) ng/L, P=0.001]. There were no significantly differences in the amount of bleeding among the three groups (P=0.191).

The selected method of occlusion or shunting depending on the flow condition of target coronary artery in OPCABG can decrease anastomosis time and myocardial injury.

To analyze the related factors for intestinal contents refluxing into the biliary tract following endoscopic retrograde biliary drainage (ERBD).

A total of 620 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) to remove biliary stents and perform biliary tract cleaning at the Shanghai East Hospital Gallstone Disease Center from March 2019 to October 2024 were included in this study. Patients were divided into a case group and a control group based on the presence or absence of chyme-fibrin reflux into the biliary tract. Clinical data were collected for all patients, and univariate and multivariate logistic regression analyses were performed to identify related factors for intestinal contents reflux into the biliary tract.

A total of 620 patients were included: 397 in the control group, aged 61.0 (51.0, 71.0) years, with 198 males; and 223 in the case group, aged 62.0 (51.0, 70.0) years, with 89 males. The control group had a longer duration of biliary stent placement [3.0 (2.1, 3.5) vs 2.6 (1.8, 3.2) months], a higher proportion of male patients [49.9% (198/397) vs 39.9% (89/223)], history of ERCP procedures [16.4% (65/397) vs 10.3% (23/223)], and hypertension [36.0% (143/397) vs 26.5% (59/223)] compared with the case group (all P>0.05). The proportion of pancreaticobiliary maljunction (PBM)in the case group was higher than that in the control group [10.8% (24/223) vs 4.8% (19/397), P=0.005]. The incidence of endoscopic sphincterotomy (EST) [82.5% (184/223) vs 75.3% (299/397)] and endoscopic papillary balloon dilatation (EPBD) [94.5% (207/223) vs 87.1% (343/397)] was higher in the case group than in the control group (both P<0.05); the total number of biliary stents placed was higher in the control group (10.1% vs 4.9%) than in the case group (P=0.023). Multivariate logistic regression analysis identified PBM (OR=2.00, 95%CI: 1.05-3.81),female gender (OR=1.45, 95%CI: 1.02-2.07), duration of biliary stent placement (OR=0.87, 95%CI: 0.80-0.96) and hypertension (OR=0.61, 95%CI: 0.42-0.89) as related factors for post-ERBD intestinal contents reflux into the biliary tract.

Female gender and PBM are related factors for post-ERBD intestinal contents reflux into the biliary tract.

To evaluate the efficacy and safety of Holmium laser combined with balloon dilation in treating benign bile duct columnar stenosis, a retrospective analysis was performed on the clinical data of 58 patients diagnosed with benign biliary strictures at Sichuan Provincial People′s Hospital from October 2019 to October 2022. Among these patients, 31 patients underwent minimally invasive holmium laser combined with balloon dilation treatment as the study group, with an age of (58.3±5.1) years, including 13 males; 27 patients underwent hepatic segment resection as the control group, with an age of (56.3±4.9) years, including 11 males. The median follow-up time was 17.5 months (range: 12-26 months). The study group showed shorter recovery time of gastrointestinal function [(1.0±0.5) vs (3.2±1.0) d], lower medical costs [(1.2±0.2) vs (2.7±0.6) ten thousand yuan], lower incidence of cholangitis [6.5% (2/31) vs 22.2% (6/27)], lower rates of bile leakage [3.2% (1/31) vs 18.5% (5/27)], shorter hospitalization duration [(5.6±0.5) vs (8.4±1.2) d], shorter operative time [(68.5±20.5) vs (145.2±50.5) min], reduced intraoperative blood loss [(5.0±0.4) vs (80.4±17.1) ml], and lower incision infection rate [3.2% (1/31) vs 14.8% (4/27)], and lower recurrence rate of biliary stricture [6.4% (2/31) vs 33.3% (9/27)] compared to the control group (all P<0.05). The study group achieved a higher biliary stricture relief rate than the control group [96.7% (30/31) vs 85.2% (23/27), P=0.037]. The study results indicate that the combination of holmium laser and balloon dilation is effective in treating benign biliary strictures, reduces the incidence of surgical complications and recurrence of biliary strictures, and is safe and reliable, with potential for clinical application and promotion.

This paper reports two cases of acute skin disease combined with sudden deafness in one ear. Case 1 was a 37-year-old male with hearing loss and tinnitus in the right ear 10 days after the diagnosis of hand-foot-mouth disease; Case 2 was a 34-year-old male who presented with hearing loss and tinnitus in the left ear 6 days after the diagnosis of pityriasis rosea. Audiological examination showed severe flat hearing loss in both cases, and serum inflammatory factor testing showed elevated levels of interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha). After systemic treatment, hearing returned to 64 decibel hearing level (dB HL) in Case 1 and normal hearing in Case 2. These two cases suggest that acute virus-related skin diseases may involve the inner ear and cause sudden deafness. Therefore, patients with such acute skin diseases should be alert to the occurrence of sudden deafness, and audiological examination and intervention treatment should be performed as soon as possible to improve the prognosis.

This paper reports the diagnosis and treatment of a patient with solitary fibrous tumor (SFT) complicated with phospholipase A2 receptor (PLA2R) associated membranous nephropathy. The patient, a 35-year-old male, was admitted to the hospital on March 6, 2024 due to "physical examination found left retroperitoneal mass for more than 2 weeks". The patient's serum anti-PLA2R antibody was elevated, and renal CT showed that the left kidney occupied space (5.0 cm ×4.8 cm), and the arterial phase was significantly enhanced. Radical nephrectomy was performed, and the pathology showed SFT, and the surrounding kidney tissue pathology confirmed that it was PLA2R-related membranous nephropathy. After excluding hepatitis B, tumor and other related secondary factors, SFT was diagnosed with PLA2R-related membranous nephropathy. The membranous nephropathy did not resolve at 2 months postoperatively. Rituximab was given to treat the membranous nephropathy, and partial remission was achieved at follow-up.

This paper reports a case of cystic hamartoma of giant follicle-sebaceous glands of the neck complicated with folliculitis. The patient was a 33-year-old male. He went to Taihe Hospital affiliated to Hubei Medical College for "brown plaque on the left neck with hirsutism for 30 years". Dermatological examination revealed a 5.2 cm ×3.6 cm brown patch on the left neck, with a local reddish nodule, which was penetrated by a large number of hairs. Under the dermoscope, there is a yellow-white oval structure on a pale red background, and multiple thick hairs can be seen in the hair follicles. Histopathological results of skin lesions showed that the tumor was composed of a large number of hair follicles and sebaceous glands, with obvious fissures around it, and inflammatory cells infiltrated around some hair follicles and sebaceous glands. The lesions were surgically removed and followed up for 2 years without recurrence.

Immune checkpoint inhibitors (ICI) have been widely used in the treatment of lung cancer. Some patients have shown significant clinical benefits, but they are often accompanied by immune-related adverse reactions (irAEs). Among them, ICI-associated pneumonia (CIP) is one of the most serious irAEs, and is associated with poor prognosis. Lung cancer is the most common tumor type in which CIP occurs, especially in high-risk groups such as smoking and presence of underlying lung disease. CIP clinical manifestations are heterogeneous and need to be differentiated from other lung diseases. The pathogenesis of CIP is complex, and pulmonary T cell activation and dysfunction are the key links. ICI treatment causes T cells to attack not only tumor cells but also normal lung tissue by enhancing T cell immunity. Pulmonary CD8 in CIP patients⁺T-cell enrichment and activation, CD4⁺T cells differentiated into helper T cells type 1 (Th1) /Th17 cells, and the immunosuppressive effect of regulatory T cells was weakened. At the same time, the release of inflammatory factors and chemokines promoted the occurrence of lung inflammatory response. Overactivated T cells interact with pro-inflammatory monocytes to create positive feedback loops that further exacerbate lung injury. In addition, changes in the host microbiome, lipid metabolism disorders, and gene susceptibility are also involved in promoting the occurrence of CIP. Understanding the immunological mechanism of CIP provides a theoretical basis for the identification and treatment optimization of high-risk patients.

Cervical cancer is one of the malignant tumors that seriously threaten women's health, and surgical treatment is usually the first choice for early patients. Traditional radical cervical cancer surgery covers extensive hysterectomy and pelvic lymph node dissection. Although this surgical method can control the tumor progression to a certain extent, it will inevitably lead to sympathetic and parasympathetic nerve damage that innervate the bladder and rectum because of the large extent of resection of the central area of the pelvic floor. With the continuous progress of medical technology, the treatment of cervical cancer has been continuously developing and evolving in the past 100 years, and the scope of surgery has gradually narrowed. At the same time, nerve-preserving surgery has continued to improve in the past century, bringing new hope to cervical cancer patients. This article aims to summarize the progress of nerve-preserving surgery in cervical cancer, focusing on the historical progress, technical development and challenges faced by nerve-preserving surgery in cervical cancer, so as to provide a summary and prospect for the research and development of this surgery.

Middle urethral suspension (MUS) and retropubic vesicourethral suspension (Burch) are the mainstream surgical methods for the treatment of female stress urinary incontinence (SUI) at present, with high success rate and stable long-term efficacy. However, some patients still develop recurrent SUI (rSUI) after treatment. rSUI has caused a significant negative impact on women's quality of life, which may not only trigger social barriers, but also adversely affect the mental health of patients. As a common and complex problem in the intersection of urology and gynecology, the treatment process of rSUI needs to comprehensively consider the restoration of anatomical structures, the reconstruction of physiological functions and the satisfaction of individual needs of patients. This article reviews the related factors, conservative treatment methods, secondary surgical treatment plans and preventive measures of rSUI, aiming to explore the research progress of rSUI treatment in depth, so that clinicians can formulate more accurate individualized diagnosis and treatment plans for patients.

A 49-year-old male was seen in the emergency department of Liaocheng People's Hospital on August 7, 2022 due to "sudden severe tear-like chest pain after emotional agitation for 1 h". The patient had a 12-year history of hypertension, and the admission physical examination showed a blood pressure of 173/112 mmHg (1 mmHg =0.133 kPa) and a heart rate of 93 beats/min. Transthoracic echocardiography showed aortic sinus dilation and mild to moderate regurgitation of the aortic valve. Multiplanar reconstruction of cardiac CT angiography (Figures 1 and 2) showed linear low-density foci in the aortic sinus wall with free edges (white arrows), ascending aortic intramural hematoma (white arrows) and pericardial effusion (Δ). CT virtual endoscopy (Figure 3) showed a fishmouth-like intimal tear between the left and right aortic sinuses ( ☆ ), the external view of the volume-reproduced 3D post-processed image (Fig. 4) shows that the local tube wall is visible with a band-like mild bulge (). ☆ Based on the imaging findings, the patient is at risk of progression to high-risk complications such as aortic dissection, rupture and cardiac tamponade, and surgical treatment is recommended to prevent deterioration of the condition. The patient then underwent Bentall surgery. Intraoperative exploration confirmed localized intimal tear of the aortic sinus wall, which straddled the left and right sinuses of the aorta and involved the left and right semilunar valves, resulting in leaflet prolapse. The patient was followed up for 2 years, and the patient recovered well without related complications.

The 18-year-old male was seen in the Department of Ophthalmology of Beijing Tongren Hospital because of "4 d occlusion of vision under his left eye". The patient suffered from high myopia in both eyes since childhood, and the equivalent spherical diopter at the time of presentation was-10.0 D for the right eye and-11.0 D for the left eye. History of cleft palate and other systemic diseases denied. The best corrected visual acuity (using a standard logarithmic chart) was 0.4 for the right eye and 0.15 for the left eye. IOP: 14 mmHg (1 mmHg =0.133 kPa) in the right eye and 13 mmHg in the left eye. The anterior segment structure of both eyes was roughly normal. Auborg fundus photography (Figures 1 and 2): membranous degeneration of the vitreous body in both eyes, close adhesion to retinal tissue, and retinal detachment above 10:00~2:00 in the left eye. General physical examination revealed that the elbow and thumb joints of the patient increased mobility. Genetic detection showed that there was heterozygous nonsense mutation c.2794C>T (p.Arg932*) in exon 42 of COL2A1 gene (NM_001844.5), which was classified as pathogenic by American Society of Medical Genetics and Genomics (ACMG) and belonged to a new mutation. Parents and sisters of the patient were all wild type. The patient was clinically diagnosed as rhegmatogenous retinal detachment in the left eye, peripheral retinal degeneration in the left eye, high myopia in both eyes, and Stickler syndrome. After admission, the patient underwent left eye scleral cerclage + external compression + transcleral subretinal fluid discharge, and postoperative retinal repositioning. The right eye underwent laser photocoagulation of peripheral retinal degenerative areas. After 1 year follow-up, the retinal repositioning of the left eye was good, and the laser spot in the peripheral retinal degeneration area of the right eye was visible.