Objective To explore the value of a combined model based on high-kilovoltage CT radiomics and clinical factors for predicting monosodium urate (MSU) crystal deposition in gouty arthritis. Methods The clinical data of 136 patients with MSU crystal deposition adjacent to joints confirmed by dual-energy CT (DECT) and 79 patients with non-MSU calcifications adjacent to joints were retrospectively analyzed. The dataset was randomly divided into a training set (n=150) and a validation set (n=65) at a ratio of 7:3 for the construction of predictive models. Radiomic features were extracted from high-kilovolt (135 kV) images, and 20 radiomic features were selected using minimum redundancy-maximum relevance and least absolute shrinkage and selection operator (LASSO) regression. Logistic regression, light gradient boosting machine (LightGBM), and support vector machine models were built based on the selected features, and the best-performing model was identified. Multivariate logistic regression analysis was used to screen for risk factors associated with MSU crystal deposition adjacent to joints. A nomogram model was then constructed by integrating radiomic features and clinical variables. The diagnostic performance of the models was evaluated by means of the receiver operating characteristics (ROC) area under the curve (AUC). Results Multivariate logistic regression analysis revealed that CT value was an independent risk factor for MSU crystal deposition adjacent to joints (P<0.001). Among the three machine-learning models, the LightGBM model demonstrated the best predictive performance and good dataset robustness. Therefore, the nomogram was constructed using the LightGBM model. The AUCs of the nomogram model for predicting MSU crystal deposition in the training and validation sets were 0.932 and 0.856, respectively, both exceeding 0.85 and significantly higher than those of the clinical model (De-long test, P<0.05). No statistically significant difference was observed between nomogram model and radiomics model (De-long test, P>0.05). Conclusions High-kilovoltage CT radiomics analysis can predict MSU crystal deposition adjacent to joints. The nomogram model and the radiomics model both demonstrate high diagnostic performance, which can provide valuable references for clinical decision-making.

Objective To compare the disease burden and evolving trends of major malignant tumors in China and globally from 1990 to 2021, and conduct predictive analysis, so as to provide a reference for formulating prevention and treatment policies for malignant tumor in China. Methods Based on the Global Burden of Disease Database 2021 (GBD 2021), descriptive research methods were used to analyze the incidence and mortality of major malignant tumors in China and globally, as well as the changes in their rankings. The Joinpoint log-linear model was applied to analyze trends in age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) of malignant tumors in China and globally from 1990-2021. A Bayesian age-period-cohort (BAPC) model was constructed using R 4.4.0 to predict the incidence trends of malignant tumor in China and globally from 2022 to 2035. Results In 2021, there were 17.2294 million new cases of malignant tumors (excluding non-melanoma skin cancer) and 9.7763 million deaths globally, with an ASIR of 201.06/100,000 and ASMR of 115.11/100,000. In China, 4.5375 million new cases and 2.7964 million deaths were reported, with ASIR and ASMR of 221.30/100,000 and 136.36/100,000, respectively. Lung cancer ranked first in both incidence and mortality of malignant tumors in China and globally. Female breast cancer had the second-highest ASIR in China. The number of incident cases and deaths from digestive system malignancies included in this study accounted for 42.0% of the total incident cases and 46.8% of the total deaths from all cancers in China, respectively. From 1990 to 2021, the average annual percentage change (AAPC) for overall ASIR of malignant tumors in China was 0.30, while ASMR declined (AAPC: -0.97). Globally, ASIR decreased slightly (AAPC: -0.10), and ASMR declined (AAPC: -0.78). The BAPC model predicted that by 2035, China's ASIR of malignant tumors may rise to 252.44/100,000, whereas the global ASIR is expected to decrease to 183.05/100,000. Conclusions China has achieved some success in cancer prevention and treatment, but still faces a heavy disease burden, with ASIR and ASMR exceeding global averages and ASIR persistently increasing. Cancer prevention and control work such as health education should be strengthened. Precise prevention and control measures should be taken for key cancer types, and preventive interventions should be focused on the elderly population.

Objective To investigate the release of enterogenic and hepatogenic high mobility group protein B1 (HMGB1) through exosomes and its regulatory pathway. Methods We used wild-type (WT) and ASC^-/- mice for this study. We randomly selected five mice per group from each strain and fed them either a normal diet (ND) or a high-fat diet (HFD) for eight weeks. The control group consisted of WT mice fed with the normal diet; the HFD group were WT mice with the HFD; the microflora disturbance (MD) group were ASC^-/- mice fed with the normal diet; the high-lipid microflora disturbance (HLMD) group were ASC^-/- mice with HFD. We used confocal microscopy to detect the co-localization of liver and intestinal exosome markers with HMGB1. We then measured the expression level of HMGB1 content in exosomes by Western blotting and PCR. The AML12 cells were treated with palmitic acid (PA) and lipopolysaccharide (LPS) for 24 h to build an in vitro model. We also detected HMGB1/CD63 levels using Western blotting. To understand the regulatory mechanism of exosome release, we employed siRNA intervention. Results The secretion of exosomes increased significantly in HFD group compared with control group [(3.5±0.2) ng/ml vs. (1.1±0.3) ng/ml, P<0.05], HLMD group compared with those in MD group [(3.2±0.2) ng/ml vs. (1.9±0.4) ng/ml, P<0.05]. Using immunofluorescence detection, we observed increased co-localization of exosome markers (ALP or VPS16) with HMGB1 in HFD group compared with control group. We also observed this in AML12 cells treated with PA and LPS compared with blank control. The PCR data showed that HMGB1 in hepatocyte exosomes was higher in HFD group compared with control group (41.5±10.2 vs. 1.3±0.3, P<0.05), HLMD group was significantly higher than that in MD group (48.6±7.2 vs. 1.5±0.5, P<0.05). TLR4 expression was higher in HFD group compared with control group (13.8±6.2 vs. 2.8±0.9, P<0.05), HLMD group compared with MD group (22.6±4.1 vs. 2.5±1.5, P<0.05). In intestinal mucosal cells, the co-location of HMGB1 and exosome marker CD63 was significantly higher in HFD group compared with control group (0.6±0.2 vs. 0.4±0.1, P<0.05), and HLMD group compared with MD group (0.9±0.2 vs. 0.5±0.1, P<0.05). In vitro, the HMGB1 of exosomes was increased in endotoxin group (5.1±0.8) and high lipid endotoxin group (5.5±0.7) compared with control group (3.8±0.6, P<0.05). On the other hand, the HMGB1 of exosomes in the cell siRNA intervention group was not increased compared with control group (3.7±0.6 vs. 3.8±0.6, P>0.05). Conclusion HMGB1 is released by exosomes in hepatocytes and intestinal cells, and regulated by Toll-like receptor 4 (TLR4) under a high-fat diet and intestinal flora disorder, which may be one of the contributing factors in promoting the development of steatohepatitis.

Autophagy is an essential cellular metabolic process that involves clearance of damaged organelles and protein aggregates in cells through lysosomes, providing energy for cells, and maintaining cellular tissue homeostasis. Impaired autophagy is closely related to the pathophysiology of a variety of diseases. In the pathogenesis of atherosclerosis (AS), the dysfunction of autophagy of vascular cells plays a crucial role in the formation and progression of AS. The functional status, survival or death of vascular cells, including endothelial cells, vascular smooth muscle cells and macrophages, can influence the formation and stability of plaques, thereby affecting the progression of AS. This review summarizes the relationship between autophagy and AS, and details the impact of autophagy dysfunction on vascular cell function in the process of AS, as well as the role of mitophagy and inflammasome in the development of AS, aiming to provide novel insights for the prevention and treatment of AS.

The prothrombin complex concentrate (PCC) is a blood product that mainly contains vitamin K-dependent coagulation factors. PCC has been used clinically for more than 70 years, and its safety has been significantly improved. It has been widely used in the treatment of coagulation disorders or severe bleeding in critically ill patients. If used improperly, it may weaken the hemostatic effect or increase the risk of thrombosis. In order to standardize the rational use of PCC, Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association, People's Liberation Army Professional Committee of Critical Care Medicine, Chinese Society of Thrombosis and Hemostasis, Chinese Research Hospital Association have organized the formulation of this expert consensus, including three parts: definition, indications, and monitoring and evaluation of efficacy, with a total of 10 suggestions, aiming to help clinicians reasonably use PCC and improve the treatment in critical illness.

Since acute respiratory distress syndrome (ARDS) was firstly reported in 1967, the diagnostic criteria and classification standard have evolved continually. Neonatal ARDS has drawn increasing attention in recent years, while research on neonatal ARDS has proceeded slowly, partly because of ambiguity in the definitions and diagnostic criteria of neonatal ARDS. In this comment, we overview the application of the Berlin definition made in 2012, the Montreux definition made in 2017, and the definition of pediatric ARDS update by the Second Pediatric Acute Lung Injury Consensus Conference made in 2023 (PALICC-2 definition) in neonatal ARDS, then compare the similarities and differences among the three definitions. Finally, the differences in classification standard, triggers, morbidity, mortality, poor prognosis, and treatment among the three definitions for neonatal ARDS were analyzed, and the research directions in the future of the definition for neonatal ARDS were proposed.

Objective To analyze the burden and changing trend of testicular cancer in China from 1990 to 2019. Methods Based on the 2019 Global Burden of Disease Database (GBD 2019), analyze the incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and their variation trend of testicular cancer in Chinese population from 1990 to 2019. Evaluating changes in age standardized rate (ASR) by calculating annual estimated percentage change (EAPC). According to the age grouping, analyze the age distribution characteristics of testicular cancer disease burden by age group. Results In 2019, the incident cases, deaths, age-standardized incidence rate, and age-standardized mortality rate of testicular cancer in China were 17.17×10³, 1.21×10³, 2.39/10⁵, and 0.16/10⁵, respectively. Compared to 1990, incident cases, deaths, and age-standardized incidence rate increased obviously in China, which was consistent with the global change trend, while the increase was higher than the global level. However, both Chinese and global age-standardized mortality rate showed a downward trend. From 1990 to 2019, DALYs, YLLs and YLDs of testicular cancer increased by 29.66%, 9.83% and 720.91% respectively in China. The two age groups, 0-15 years group and 30-35 years group, were with highest incidence of testicular cancer, while the highest disease burden of testicular cancer was 30-35 years. Conclusion From 1990 to 2019, the disease burden of testicular cancer in China showed an upward trend. Adolescents and young adults should be the priority population for screening and prevention due to their higher incidence and disease burden.

For axial spondyloarthritis/ankylosing spondylitis, rehabilitation is very important for controlling disease activity, preventing disease progression and improving quality of life. Initiated by China Spine Alliance and jointly formulated by Air Force Specialty Medical Center and Chinese PLA General Hospital, the current guidelines were developed according to World Health Organization Guidelines Development Manual and the Basic Methods and Procedures for the Development/Revision of the Clinical Diagnosis and Treatment Guidelines, Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREEⅡ), Grading of Recommendations Assessment, Development and Evaluation (GRADE). Two basic princlples and 12 suggestions were made for important issues such as diagnosis, rehabilitation assessment, rehabilitation intervention and management for axial spondyloarthritis/ankylosing spondylitis.

Gut microflora (GM) or intestinal microecology (IM) is of great importance in maintaining human homeostasis and health. Cardiovascular disease (CVD) is a global health burden nowadays with high morbidity and mortality, the existing research confirmed that GM/IM metabolic imbalance is closely related to the occurrence and development of CVD, and some GM/IM metabolites can also be used as biomarkers of CVD disease, and their detection or intervention becomes a possible means of diagnosis, prevention or treatment of CVD. Clinical drug metabolism and efficacy evaluation, and superior effect screening from the GM/IM level is also a research direction of clinical pharmacology. With the implementation of the concept of precision medicine and a wide health, GM/IM whole-genome sequencing and metabolomics continue to be researched, the basic research and clinical application of GM/IM and CVD will be a hot topic in the future. The research status of the relationship between GM/IM and CVD has been reviewed in present paper for providing diagnosis and treatment ideas and related references for the prevention and treatment of CVD.

Chronic kidney disease (CKD) commonly used dietary assessments including 24-hour dietary recall (24 h DR)/3-day dietary recall (3DDR), food frequency questionnaire (FFQ), dietary records, and estimation of dietary protein intake based on nitrogen balance. Given the high prevalence of CKD patients in Asian population and the scarcity of research using FFQ method, it is crucial to develop an FFQ suitable for Chinese CKD patients. This review summarizes the advantages and disadvantages of dietary assessment methods for CKD, the current research status, and the content and steps involved in establishing an FFQ, with the aim of providing reference for the modification of FFQ for Chinese CKD patients.