Volume 106 · Issue 11 · 2026

Compared with other non-cardiac surgeries, patients undergoing cardiac surgery have a high risk of perioperative stroke. Once a stroke occurs, it will have a significant impact on the patients′ prognosis and medical costs. Perioperative stroke after cardiac surgery poses clinical challenges such as complex etiology, multi-factor interaction, and great difficulty in prevention and treatment. Therefore, this article summarizes the epidemiology, risk factors, and etiological mechanisms of perioperative stroke in cardiac surgery. It aims to reduce the risk of stroke and poor prognosis through preoperative risk assessment, intraoperative strategy optimization, and postoperative management, thereby enhancing the understanding of perioperative stroke in cardiac surgery, emphasizing the prevention and treatment of perioperative stroke in cardiac surgery, and improving the prognosis of patients.

Systemic lupus erythematosus (SLE) is a severe autoimmune disease with an incompletely elucidated pathogenesis and multi-organ damage, imposing substantial health and economic burdens on patients. Current treatments exhibit significant unmet needs in disease remission, flare and long-term prognosis. Insufficient adoption of treat-to-target (T2T) strategy, overreliance on glucocorticoids, limited application of innovative therapies such as biological agents, and a lack of precision medicine approaches collectively represent the core challenges in optimizing SLE management in China. This article systematically analyzes the unmet needs in the treatment of SLE in China and proposes a series of recommendations about treat-to-target strategies, aiming to provide references for clinical practice management.

The first-generation tetracyclines were natural products derived from microbial metabolism and approved for the treatment of various bacterial infections. After being widely used in clinical treatment, tetracyclines were found to cause adverse effects such as permanent tooth discoloration and enamel hypoplasia in children<8 years of age. Consequently, for more than half a century, warnings related to tooth discoloration have been included in the labels of all tetracycline-class agents, and they are not recommended for use in children under 8 years of age. Subsequently, the second-generation and third-generation tetracyclines (doxycycline, minocycline, tigecycline) are not recommended for use in children below 8 years of age. The new-generation tetracycline-class antibacterials play an important role in treating infections caused by various special pathogens and drug-resistant bacteria. In recent years, as the clinical demand for using new new-generation tetracyclines for the treatment of pediatric infectious diseases has been increasing, the clinical indications and safety have become issues of concern. A guideline development group composed of experts in pediatric infection and respiratory specialties, clinical pharmacy and guideline methodologist jointly conducted a comprehensive evidence-based research on the clinical issues related to the pediatric indications, safety, and effectiveness of the three new-generation tetracyclines (doxycycline, minocycline, tigecycline) that have been approved for domestic market and recommended for use in children, aiming to provide guidance for rational drug use in pediatrics in China and to address the practical challenges of off-label drug use.

Epilepsy is a common chronic neurological disorder, with approximately one-third of patients showing poor response to antiepileptic drugs. As a key therapeutic strategy for drug-resistant epilepsy, neuromodulation has demonstrated considerable clinical efficacy, yet the treatment outcomes remain inconsistent. There is an urgent need for standardized treatment plan to enhance both efficacy and safety. To address this issue, based on the latest national and international developments, the Electroencephalogram and Epilepsy Group and Neuromodulation Collaboration Group of Neurology Branch of the Chinese Medical Association organized experts and scholars in relevant fields in China to develop Clinical Guidelines for Neuromodulation Therapy in Epilepsy (2026 edition) through Delphi method. The guideline presents 18 recommendations covering multiple aspects of neuromodulation therapy for epilepsy, including treatment efficacy, selection of stimulation targets, improvements in emotional and cognitive functioning as well as quality of life, and adverse reactions. It aims to further guide and standardize the clinical management of epilepsy using neuromodulation therapy in China.

To analyze the mutation characteristics of myeloproliferative neoplasm (MPN) patients with Fanconi anemia (FA) signaling pathway gene mutation.

MPN patients with FA signaling pathway gene mutations (mutation group) diagnosed in the Second Hospital of Tianjin Medical University from September 2017 to October 2024 were retrospectively included. MPN patients without FA signaling pathway gene mutations (non-mutation group) were included by propensity score matching (1∶6 pairing). The patients were followed up to January 31, 2025. The clinical characteristics of the both groups were compared, and the influencing factors of survival time of MPN patients were analyzed by multivariate Cox regression model.

There were 22 patients in the mutation group, 8 males and 14 females, with an age [M (Q₁, Q₃)] of 65 (30, 81) years, including 6, 10 and 6 patients with polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF), respectively; PV patients had the highest proportion of both BRCA2 and FANCD2 mutations (both are 2/6), ET patients had the highest proportion of BRCA2 mutations (3/10), and PMF patients had the highest proportion of FANCD2 mutations (4/6). There were 132 patients in the non-mutation group, 48 males and 84 females, aged 65 (32, 85) years. The proportions of splenomegaly [45.5% (10/22) vs 14.4% (19/132)], secondary myelofibrosis [27.3% (6/22) vs 9.8% (13/132)], secondary myelodysplastic syndrome (MDS) [4.5% (1/22) vs 0], and secondary acute myeloid leukemia (AML) patients [4.5 (1/22) vs 0] in the mutation group were higher than those in the non-mutation group (all P<0.05); There were no statistica differences in age, sex, initial blood routine hemoglobin, hematocrit, white blood cell count, platelet count, chromosome karyotype abnormalities, thrombosis, secondary cancer, and the proportion of deceased patients between the two groups (all P>0.05). The median follow-up time was 4 (2, 9) years. The 10-year overall survival rate of the mutation group was lower than that of the non-mutation group (82.4% vs 96.2%, P=0.037). FA signaling pathway gene mutation (HR=2.646, 95%CI: 0.316-22.178, P=0.017) was the influencing factor of survival time of MPN patients.

The common FA signaling pathway gene mutations in MPN patients are BRCA2, FANCD2; FA signaling pathway gene mutation is an influencing factor for survival of MPN patients.

To develop and validate a predictive model for muscle atrophy (referred to as sarcopenia) in male patients with liver cirrhosis.

A retrospective analysis was conducted on clinical data from male patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University between January 1, 2023 and May 31, 2024. The patients were divided into a modeling cohort and a validation cohort at a 7:3 ratio using a random number table method. Based on the skeletal muscle index derived from CT images at the third lumbar vertebra (L₃-SMI), the patients were divided into sarcopenia group (L₃-SMI<44.77 cm²/m²) and non-sarcopenia group. The logistic regression model was used to analyze and screen the predictors of sarcopenia in the modeling cohort, and verify the interaction, and finally a nomogram model was constructed. The effectiveness and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

A total of 278 male patients with liver cirrhosis, aged (58±13) years, were enrolled in this study. There were 195 patients in the modeling cohort (88 cases in sarcopenia group, 107 cases in non-sarcopenia group) and 83 patients in the validation cohort. Based on the data of the modeling group, age (OR=1.061, 95%CI: 1.027-1.097, P<0.001), dry body mass index (dBMI, OR= 0.695, 95%CI:0.614-0.787, P<0.001), and platelet count (OR=1.009, 95%CI: 1.003-1.015, P=0.004) were predictors of sarcopenia in male patients with liver cirrhosis. No statistically significant interaction effects were observed among these variables (all P>0.05). The constructed column chart shows that the AUC, sensitivity, and specificity of the modeling group are 0.848 (95%CI: 0.795-0.900), 65.9%, and 86.9%, respectively. The AUC, sensitivity, and specificity of the validation group are 0.841 (95%CI: 0.755-0.928), 78.0%, and 83.3%, respectively. Calibration curves indicated column chart has good calibration ability. DCA curves confirmed the model's decision-making has good clinical applicability.

Age, dBMI, and platelet count served as predictors of sarcopenia in male patients with liver cirrhosis, and the column chart model constructed based on the above indicators can effectively predict the risk of sarcopenia in male patients with liver cirrhosis.

To analyze the influencing factors and construct a prediction model for postoperative infections in patients with esophageal cancer.

A retrospective analysis was conducted on the clinical data of 787 esophageal cancer patients who underwent surgical treatment at Liaocheng People′s Hospital from January 2018 to March 2025. There were 599 male patients and 188 female patients, with the age of [M(Q₁, Q₃)] 67(61, 71) years. The patients were divided into a training set (n=552) and a validation set (n=235) at a ratio of 7∶3 using a random sampling function. The training set was further categorized into the non-infected group (n=422) and the infected group (n=130) based on the occurrence of postoperative infection. Influencing factors for postoperative infections in esophageal cancer patients were screened using multivariate logistic regression, and a nomogram for the prediction model was constructed. The predictive performance, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis, respectively.

In the training set, the proportion of patients in the infected group who received neoadjuvant chemoradiotherapy before surgery, along with their levels of carbohydrate antigen 199 (CA199), neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, duration of surgery, and the number of days with thoracic drainage tubes were all higher than those in the non-infected group (all P<0.05). Conversely, the proportion of patients receiving intraoperative antibiotics and the rate of thoracic anastomosis were lower in the infected group than the non-infected group (both P<0.05). Multivariate logistic regression analysis identified preoperative neoadjuvant chemoradiotherapy (OR=2.875, 95%CI: 1.136-7.277), CA199>18.3 kU/L (OR=4.251, 95%CI: 2.484-7.273), longer operative time (OR=1.173, 95%CI: 1.004-1.370), and prolonged chest tube drainage (OR=1.212, 95%CI: 1.107-1.326) as independent risk factors for postoperative infection. Intraoperative antibiotic administration (OR=0.612, 95%CI: 0.379-0.990) and intrathoracic anastomosis (OR=0.565, 95%CI: 0.347-0.922) were identified as protective factors. A nomogram prediction model was constructed using these variables. The model demonstrated an AUC of 0.743 (95%CI: 0.693-0.792) with a sensitivity of 72.3% and specificity of 65.0% in the training set, and an AUC of 0.714 (95%CI: 0.635-0.794) with a sensitivity of 74.5% and specificity of 65.0% in the validation set. Calibration curves for both sets indicated good model calibration (both P>0.05). Decision curve analysis revealed stable net benefits across a clinical decision threshold range of 0.1 to 0.5 in both the training and validation sets.

Preoperative neoadjuvant chemoradiotherapy, CA199>18.3 kU/L, prolonged operative time, and extended duration of chest tube drainage may increase the risk of postoperative infection in esophageal cancer patients, while intraoperative antibiotic administration and intrathoracic anastomosis can reduce such risk. The nomogram prediction model established based on these factors allows for a more intuitive assessment of postoperative infection risk in esophageal cancer patients.

To investigate the early clinical efficacy and safety of metaphyseal metal sleeves in reconstructing Anderson Orthopedic Research Institute (AORI) type 2B/3 bone defects during revision total knee arthroplasty (rTKA).

A retrospective analysis was performed on the 32 patients with severe metaphyseal bone defects who underwent rTKA and received metaphyseal reconstruction using a metal sleeve at West China Hospital, Sichuan University, from July 2018 to December 2023. All patients were followed-up regularly at 1, 3, 6, and 12 months postoperatively, and then annually thereafter. The knee joint range of motion (ROM) was recorded preoperatively, postoperatively, and at each follow-up visit. The pain was evaluated using the visual analogue scale (VAS), the knee function was assessed with the American Knee Society Score (KSS), and the clinical effectiveness was determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The integration quality of the sleeve-bone interface and prosthetic stability were evaluated by reviewing the full-length weight-bearing radiographs of both lower extremities as well as the anteroposterior and lateral radiographs of the knee joint obtained at the final follow-up. Compare the differences in indicators before the operation and at each follow-up.

In this cohort, there were 13 males and 19 females, with a mean age of (65.5±8.8) years; there were 18 cases of left-side and 14 cases of right-side revision. All the patients were followed-up for (36.8±7.7) months. All indicators were significantly improved from preoperative to final follow-up, with statistically significant differences (all P<0.05): the VAS score decreased from (4.8±2.3) points to (1.3±1.3) points; the knee joint ROM increased from 67.8°±14.1° to 98.8°±7.7°; the total KSS increased from (73.0±15.5) points to (177.6±8.2) points, among which the KSS functional score reached (88.0±5.5) points, significantly higher than the preoperative score of (30.5±15.2) points (P<0.001); the WOMAC score decreased from (64.1±20.6) points to (34.4±12.6) points. Radiological examinations confirmed that continuous osseointegration zones formed around the sleeves in 30 patients (93.75%), and all periprosthetic radiolucent lines were less than 2 mm. Postoperative complications included 1 case of incisional infection (cured by debridement) and 1 case of periprosthetic fracture (cured by internal fixation), with no revision cases reported.

Metaphyseal metal sleeves, applied for the reconstruction of AORI type 2B/3 severe bone defects in rTKA, can achieve reliable biological fixation and mechanical support. The osseointegration rate reached 94% at short-term follow-up, with significant pain relief, remarkable improvements in joint function and range of motion observed in patients. Complications were manageable, and the short-term clinical efficacy was definite.

To investigate the impact of preoperative immune-inflammatory indicators on the prognosis of patients with T1a renal cell carcinoma (RCC) undergoing surgery and to construct a prediction model.

Clinical data of patients with pT1aN0M0 RCC who underwent surgical treatment at the Affiliated Hospital of Xuzhou Medical University between January 2007 and December 2021 were retrospectively collected. Patients were followed up at the outpatient clinic at 3, 6, and 12 months post-discharge, and annually thereafter, with a maximum follow-up of 17 years. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). X-tile software was used to determine the optimal prognostic cut-off values for the following preoperative markers: albumin-to-alkaline phosphatase ratio (AAPR), fibrinogen-to-albumin ratio (FAR), neutrophil percentage-to-albumin ratio (NPAR), hemoglobin-albumin-lymphocyte-platelet (HALP) score, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), platelet-to-albumin ratio (PAR), and neutrophil-to-platelet ratio (NPR). Multivariate Cox regression analyses were performed to identify independent risk factors, based on which a prognostic nomogram was constructed. Model performance was evaluated using C-index, time-dependent receiver operating characteristic (Time-ROC) curves with the area under the curve (AUC), and the corresponding sensitivity and specificity at the maximum Youden index. The calibration curves along with the Hosmer-Lemeshow test were employed to assess the accuracy of the predicted probabilities, and the decision curve analysis (DCA) was applied to examine the clinical utility. Internal validation was conducted via the Bootstrap resampling method.

A total of 784 patients were included, with the age of (57±12)years, and 521 were male and 263 were female. The follow-up time [M(Q₁, Q₃)] was 80(51, 116) months. During follow-up, 61 deaths and 51 recurrences occurred. X-tile determined the optimal cut-off values as follows: AAPR 0.50, FAR 0.09, NPAR 16.17, HALP 39.85, NLR 1.87, PLR 179.00, SII 608.00, PAR 6.06, and NPR 0.02. Multivariate Cox regression analysis showed that age≥60 years (HR=5.45, 95%CI: 2.76-10.76) and radical nephrectomy (HR=1.91, 95%CI: 1.07-3.41) were risk factors for OS, while AAPR≥0.50 (HR=0.45, 95%CI: 0.26-0.79) was a protective factor for OS. For RFS, age≥60 years (HR=2.34, 95%CI: 1.30-4.19) and radical nephrectomy (HR=2.17, 95%CI: 1.10-4.27) were risk factors, while female sex (HR=0.48, 95%CI: 0.24-0.96) and AAPR≥0.50 (HR=0.50, 95%CI: 0.28-0.92) were protective factors. The OS prediction model constructed from age, surgical approach, and AAPR achieved a C-index of 0.83 (95%CI: 0.77-0.88). The Time-ROC analysis showed that the AUC values for 3-year OS was 0.80 (95%CI: 0.72-0.88), with a sensitivity of 82.4% and a specificity of 76.1%. For 5-year OS, the AUC values was 0.82 (95%CI: 0.76-0.89), with a sensitivity of 85.2% and a specificity of 78.5%. For 10-year OS, the AUC values was 0.80 (95%CI: 0.73-0.87), with a sensitivity of 79.6% and a specificity of 74.3%. Respectively, the Calibration curves for 5-year OS indicated good agreement between model-predicted probabilities and actual observed probabilities, the Hosmer-Lemeshow test indicated satisfactory calibration accuracy of the prediction model (χ²=5.84, P=0.67). The DCA for 5-year OS demonstrated that the model provided a higher net benefit than the"treat-all"or"treat-none"strategies (P<0.001). After internal validation using the bootstrap method, the calibrated C-index was 0.80 (95%CI: 0.76-0.84) with an overall optimism of 0.03 (95%CI: 0.02-0.04).

Age, surgical approach, and AAPR are significant factors influencing OS in patients with T1a RCC. The prognostic nomogram constructed based on these factors demonstrates favorable predictive performance.

To investigate the biosafety of ureteral stents modified with intrinsically disordered protein family member—fused in sarcoma (IDP_FUS) coating in a rat intravesical stent retention model, and to evaluate its efficacy in preventing encrustation on the stent surface.

An IDP_FUS functional coating was constructed on the surface of polyurethane (PU) stents using a "two-step" method. Eighteen SD rats were randomly assigned to 4 groups: the PU group (n=4), the ethylene-vinyl acetate (EVA) group (n=4), the (PU+polyethylene glycol) (PEG) group (n=5), and the (PU+IDP_FUS) group (n=5). The corresponding stents were implanted into the rat bladders and harvested 14 days postoperatively. The mass of the encrustation on the stent surfaces was measured. Scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) were employed to observe the morphology and chemical composition of the encrustation. Hematoxylin-eosin (HE) staining was performed to evaluate inflammatory cell infiltration in the bladder tissues.

There was no statistically significant difference in body weight among the 4 groups (P>0.05), indicating good tolerance to the materials. Significant differences in encrustation mass were observed across the 4 groups (P=0.005). The (PU+IDP_FUS) group exhibited the lowest encrustation mass［M（Q₁，Q₃）］11 (9, 48) mg, which was significantly lower than that of the PU group 124 (115, 146) mg and the EVA group 172 (121, 218) mg (both P<0.05); however, no statistically significant difference was found between the (PU+IDP_FUS) and (PU+PEG) groups 93 (75, 96) mg (P>0.05). SEM analysis showed only sparse, scattered encrustation on the (PU+IDP_FUS) surface, whereas surfaces in the other groups were heavily covered by mineral deposits. EDS analysis confirmed that the primary component of the encrustation was magnesium ammonium phosphate. HE staining revealed diffuse inflammatory cell infiltration accompanied by reactive epithelial hyperplasia in the PU, EVA, and (PU+PEG) groups. In contrast, the (PU+IDP_FUS) group exhibited a significantly attenuated inflammatory response, characterized by only focal, scattered inflammatory cells, intact mucosal structure, and the absence of significant edema or fibrosis.

In a rat intravesical stent indwelling model, ureteral stents modified with IDP_FUS coating demonstrate excellent biosafety and effectively reduce the formation of magnesium ammonium phosphate encrustation on the stent surface.

To investigate the effects of resveratrol on vascular smooth muscle cell (VSMC) proliferation and neointimal hyperplasia in the rat carotid artery balloon injury model after endovascular intervention, and to explore the underlying mechanisms.

Drug safety assessment: VSMC were assigned to a control group, a low-dose resveratrol group (10 μmol/L), and a high-dose resveratrol group (20 μmol/L). Cell viability was evaluated using the cell counting Kit-8 (CCK-8) assay. Pharmacodynamic assessment: VSMC were divided into a control group, a model group [20 ng/ml platelet-derived growth factor-BB (PDGF-BB)], a PDGF-BB+low-dose resveratrol group (20 ng/ml PDGF-BB+10 μmol/L resveratrol), a PDGF-BB+high-dose resveratrol group (20 ng/ml PDGF-BB+20 μmol/L resveratrol), and a positive control group (20 ng/ml PDGF-BB+20 nmol/L rapamycin). Relative cell proliferation was measured by CCK-8. Additionally, cell migration and Ki-67 expression were evaluated in the control, model, and resveratrol-treated groups (all at the previously described dose) using wound healing assays and immunofluorescence respectively. Mechanistic investigation: Western blotting was performed to quantify mammalian target of rapamycin (mTOR) pathway-related proteins, including mTOR, phosphorylated mTOR (p-mTOR), ribosomal S6 kinase (p70S6K), Cyclin D1, and proliferating cell nuclear antigen (PCNA). Rescue experiment: VSMC were divided into a control group, a model group, a resveratrol treatment group, and a mTOR agonist rescue group (10 μmol/L MHY1485 was added to the resveratrol treatment group). Cell proliferation and mTOR pathway protein levels (mTOR、p-mTOR and p70S6K) were assessed. In vivo study: the rat carotid artery balloon injury model was established. Rats were randomly allocated by a random number table to a sham-operated group, an injury group, and a treatment group (50 mg·kg^-1·d^-1 resveratrol by intragastric administration for 21 days post-injury). On the day 21, hematoxylin-eosin (HE) staining was performed to calculate the intima/media (I/M) ratio. Ki-67 expression and mTOR pathway proteins (mTOR、p-mTOR and p70S6K) in arterial tissue were quantified by immunofluorescence and Western blotting, respectively.

In the drug safety assessment, no significant differences in cell proliferation were observed among the control and resveratrol-only groups (P>0.05). In the pharmacodynamic assessment, compared with the model group, relative cell proliferation, migration rate, and Ki-67 fluorescence intensity were reduced in the PDGF-BB+low-dose and PDGF-BB+high-dose resveratrol groups (all P<0.01). There was no statistically significant difference in cell proliferation between the high-dose resveratrol group and the positive control group (P>0.05). In the mechanistic investigation, the expression of mTOR, p-mTOR, p70S6K, Cyclin D1, and PCNA was lower in the resveratrol-treated groups than the model group (all P<0.01). In the rescue experiment, the level of cell proliferation the expression of p-mTOR and p70S6K were both higher in the mTOR agonist rescue group than the resveratrol treatment group (all P<0.01). In vivo, the treatment group exhibited a lower I/M ratio, reduced Ki-67 fluorescence intensity, and decreased expression of mTOR pathway proteins compared with the injury group (all P<0.01).

Resveratrol may inhibit VSMC proliferation and migration by suppressing mTOR signaling activity, thereby reducing neointimal hyperplasia after carotid balloon injury and alleviating post-intervention restenosis.

This study retrospectively collected the relevant clinical data of patients with lung adenocarcinoma who were initially misdiagnosed as interstitial pneumonia at the First Affiliated Hospital of Zhengzhou University from April 2016 to October 2024. The clinical manifestations, laboratory tests, chest CT, misdiagnosis situations, treatment processes, and outcome in the patients were analyzed. A total of 20 patients were included, with 10 males and 10 females, aged (64.5±11.9) years. All 20 patients presented with cough, 15 had expectoration, 14 had chest tightness, 4 had fever, and 2 had chest pain. Carcinoembryonic antigen levels were elevated in 10 patients. There were 6 cases of the predominantly peripheral pleural type and 14 cases of the whole-lobe type. The lesions mostly manifested as ground-glass opacities, consolidation, or a combination of both. All 20 patients were initially misdiagnosed as interstitial pneumonia in the early stage and were later diagnosed with lung adenocarcinoma through lung biopsy or bronchoscopy biopsy for pathological examination. Four patients requested discharge without receiving treatment; 1 received symptomatic treatment; 1 was treated with a single immune checkpoint inhibitor, and the lesions progressed; 14 patients received chemotherapy-based comprehensive treatment, among them, 1 patient had a Kirsten rat sarcoma viral oncogene homolog (Kras) G12C mutation and was treated with sotorasib orally in combination with bevacizumab, achieving stable disease and remaining under follow-up. The median follow-up time for all patients was [M(Q₁,Q₃)]12.2 (6.8, 13.7) months. Nineteen patients died, and 1 survived. The median progression-free survival was 3.0 (95%CI: 0.3-5.7) months (range: 0.5-9.6 months), and the median overall survival was 12.2 (95%CI: 7.6-16.8) months (range: 0.7-20.4 months). Diffuse interstitial lung adenocarcinoma is clinically rare and prone to misdiagnosis as interstitial pneumonia. Its imaging manifestations mainly include predominantly peripheral pleural or diffuse bilateral lung ground-glass opacities. The diagnosis mainly relies on CT-guided lung biopsy for pathological examination. Patients have a poor prognosis. Kras mutation-related targeted drugs may improve survival, but large-scale clinical studies are needed for verification.

This article reports the diagnosis and treatment of a case of severe pulmonary alveolar proteinosis during pregnancy. The patient was a 42-year-old female, 25-year-old⁺⁵Weeks ago, postactive shortness of breath occurred 1 month before admission, blood oxygen saturation was found to be 84% at prenatal examination 9 days ago, chest CT showed diffuse ground glass shadows in both lungs, bronchoalveolar lavage fluid periodic acid-Schiff staining showed powder-stained substances after admission, anti-granulocyte-macrophage colony stimulating factor antibody was positive, and the diagnosis of alveolar proteinosis was clear. After multi-disciplinary discussion, the whole lung sequential lavage was initiated. After operation, dehydration, anti-inflammatory and prone ventilation were comprehensively treated. On the 6th day after operation, the tracheal intubation was removed and the hospital was successfully discharged. After discharge, the patient inhaled granulocyte-macrophage colony stimulating factor + home oxygen therapy at home for a long time, and delivered a healthy girl successfully 4 months later.

Post-cardiac arrest myocardial dysfunction (PAMD) is an acute, reversible cardiac insufficiency that occurs after the recovery of spontaneous circulation. As a core cardiovascular component of post-cardiac arrest syndrome, it is one of the key causes of early death in patients. The purpose of this article is to systematically comb the epidemiological characteristics, pathophysiological mechanisms, clinical manifestations, current treatment strategies and prognosis of PAMD, in order to provide reference for clinical practice. Existing studies have shown that the pathophysiological process of PAMD involves a "malignant triangle" consisting of ischemia-reperfusion injury, catecholamine myocardial toxicity and inflammatory factor storm, which together lead to myocardial stunning. Clinical management focuses on individualization, including early etiological reversal, refined hemodynamic support, target temperature management, and mechanical circulation support if necessary. Although PAMD is mostly reversible and responds acceptably to supportive therapy, its value as an independent predictor of death remains unclear. Future research needs to deeply analyze its mechanism, optimize individualized treatment strategies and improve the long-term prognosis of patients.

As a serious chronic complication of diabetes, diabetic foot ulcer (DFU) is characterized by difficult healing, high amputation rate and high recurrence rate. The refractory of DFU is closely related to the abnormal epigenetic regulation of many kinds of cells in the wound. The imbalance of DNA methylation and demethylation, disorder of histone modification and disorder of non-coding RNA expression will cause the dysfunction of key immune cells and structural cells of DFU, which will affect the healing process of the wound. This article reviews the mechanisms of epigenetic dysregulation of key cells (macrophages, T cells, keratinocytes, fibroblasts, endothelial cells) in DFU and their corresponding dysfunctions. Current research is mostly limited to the phenomenon level, and the dynamic process of cell subset-specific regulatory network and epigenetic modification in human DFU wounds is not fully understood, which constitutes a research bottleneck from mechanism cognition to clinical transformation. In the future, artificial intelligence and deep algorithms can be used to mine the association between epigenetic modification sites and DFU, and new intervention tools with strong cell selectivity and accurate targeting can be developed.

Colorectal cancer (CRC) is a common malignant tumor of the digestive tract in China. In addition to the classical "adenoma-carcinoma" pathway, 15% ~30% of patients develop through the "serrated polyp (SP) -carcinoma" pathway with independent molecular characteristics. Serrated polyposis syndrome (SPS) is a typical representative of this pathway, with familial clustering and a high risk of carcinogenesis, but its molecular pathogenic mechanism has not been fully elucidated. On the basis of summarizing the epidemiological characteristics and the latest diagnostic criteria of SPS, this paper systematically summarizes the genetic susceptibility and key driving gene abnormalities of SPS with the molecular evolution of serrated pathway as the main line, and focuses on the role of mitogen-activated protein kinase (MAPK) signaling pathway, Wnt signaling pathway, mismatch repair (MMR) function defects and related epigenetic changes in the transformation of SPS to CRC, which provides theoretical basis for early identification, risk stratification and individualized prevention of serrated pathway-related CRC.