Youth forum

• Collateral circulation assessment in acute ischemic stroke: current applications and future directions of deep learning

  WU Yue, ZHANG Xiaoxi, ZOU Chen, LIU Jianmin, YANG Pengfei

  2026,47(4):423-434 ,DOI: 10.16781/j.CN31-2187/R.20260027

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  Abstract:

  In acute ischemic stroke, collateral circulation plays a critical role in maintaining ischemic penumbral perfusion, delaying infarct progression, and improving outcomes after endovascular treatment (EVT). Currently, collateral assessment mostly relies on computed tomography angiography (CTA), multiphase CTA, computed tomography perfusion, magnetic resonance perfusion, or digital subtraction angiography, and still mainly depends on visual grading systems such as the Tan, Maas, and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scores. These approaches are subjective and show limited reproducibility, failing to meet the clinical demand for rapid and objective quantitative evaluation. In the context of increasingly refined reperfusion strategies, accurate evaluation of collateral capacity is essential for explaining heterogeneity in infarct progression and the futile recanalization, defined as successful recanalization without effective tissue reperfusion. In recent years, deep learning methods have been applied to enable automated quantitative assessment of collateral circulation. Existing studies have focused on automated collateral grading, extraction and multiscale quantification of vascular structure, and multimodal predictive models integrating perfusion parameters with clinical information. Despite encouraging progress, challenges remain, including limited data availability, class imbalance, domain shift, and the absence of unified grading standards. This review summarizes recent advances and key bottlenecks of deep learning in the assessment of collateral circulation in acute ischemic stroke and discusses future directions, including multicenter standardization, dynamic blood flow modeling, self-supervised learning, explainable artificial intelligence, and integration into clinical workflows, so as to facilitate more robust and generalizable collateral assessment frameworks.

Norms and consensus

• Expert consensus on innovation and standardized application of nanopore sequencing technology

  Expert Committee of Expert consensus on innovation, standardized application of nanopore sequencing technology, Branch of Bio-Diagnostic Technology of China Medicinal Biotech Association, Clinical Molecular Diagnostic Group of Laboratory Physician Branch of Chinese Medical Doctor Association, Precision Medicine Committee of Chinese Medical Doctor Association

  2026,47(4):435-446 ,DOI: 10.16781/j.CN31-2187/R.20250888

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  Abstract:

  Nanopore sequencing technology, featured by its long read lengths, real-time analysis, direct sequencing, and high portability, shows great potential in pathogen diagnosis and precision medicine. However, its clinical translation is still limited by deficiencies in the standardization of experimental protocols, data analysis pipelines, and the consistency of result interpretation. Based on recent research and evidence-based medicine, this consensus elaborates on the appropriation scope and technical normative requirements of nanopore sequencing technology from 3 aspects: rapid detection of pathogenic microorganisms, application in precision diagnosis, and establishment of standardized procedures and quality control. It clarifies the key value of this technology in the diagnosis of acute and critical infections, detection of microbial resistance genes, methylation analysis, and identification of large nucleic acid fragment variations. Recommendations and prospects are also proposed for laboratory conditions, experimental operations, and bioinformatics analysis processes, aiming to promote the innovation and rational application of nanopore sequencing technology.

人工智能＋医学科研

• Artificial intelligence-driven identification of bifunctional small-molecule therapeutics for triple-negative breast cancer and bone metastasis

  ZHUANG Bingmiao, LIANG Yixue, LIANG Weishan, GU Wenjing, GUO Chengyang, TIAN Saisai

  2026,47(4):447-459 ,DOI: 10.16781/j.CN31-2187/R.20250826

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  Abstract:

  Objective To identify candidate bifunctional drugs that simultaneously modulate molecular features associated with primary triple-negative breast cancer (TNBC) and bone metastasis based on an artificial intelligence (AI)-driven strategy integrating driver gene identification and transcriptomic differentially expressed gene analysis. Methods Based on the Fudan University Shanghai Cancer Center (FUSCC) TNBC cohort and Cancer Cell Line Encyclopedia (CCLE) data, after eliminating the aberrant samples through expression correlation analysis, 2 comparison groups were established according to the research objectives: bone metastasis tissue group (BMTG), including tumor tissue from patients with bone metastasis (n＝17) and the adjacent normal tissue (n＝6); primary tumor group (PTG), including patients with bone metastasis (n＝17) and those without bone metastasis (n＝271) among primary tumor samples. In the FUSCC TNBC cohort, potential driver genes were identified using PhenoDriver in the BMTG and differentially expressed genes were obtained using differential gene analysis in the PTG, and the intersection of both was taken with Landmark genes from the Library of Integrated Network-Based Cellular Signatures (LINCS) 2020 to establish disease-specific gene sets. BMTG was iteratively screened and evaluated by receiver operating characteristic (ROC) curve analysis using the FUSCC TNBC cohort, The Cancer Genome Atlas (TCGA)-TNBC and 3 Gene Expression Omnibus (GEO) datasets; while PTG was validated by ROC curve analysis using FUSCC TNBC cohort. Robust core disease gene sets were obtained for drug reversal prediction. Subsequently, connectivity scores were calculated based on the Connectivity Map (CMap), and candidate bifunctional drugs were screened using a comprehensive ranking metric. Combined with previous literatures and commercial availability of compounds, SB-590885 and PF-431396 were prioritized for cell experimental validation. TNBC cell line MDA-MB-231 and TNBC bone metastatic cell line MDA-BoM-1833 were used to verify the inhibitory activities of the 2 candidate drugs by cell counting kit 8 assay and cell wound-healing assay. Results A total of 72 aberrant samples were excluded. Ultimately, 26 BMTG driver genes and 62 PTG differentially expressed genes were identified as the core disease gene sets. Based on drug repositioning of LINCS perturbation profiles, 46 potential bifunctional drugs were screened. SB-590885 and PF-431396 demonstrated significant dose-dependent inhibitory effects on the proliferation and migration of TNBC cell lines and TNBC bone metastatic cell lines in vitro. Conclusion This study has identified SB-590885 and PF-431396 as potential bifunctional therapeutic candidates, providing new research directions and potential treatment options for TNBC with bone metastasis.

• Performance of domestic large language models and neurologists in question-answering regarding exercise interventions for mild cognitive impairment: a comparative study

  GAO Wenjun, DU Jiarui, YU Longjuan, ZHANG Lingjuan

  2026,47(4):460-465 ,DOI: 10.16781/j.CN31-2187/R.20250578

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  Objective To evaluate the performance of mainstream open-source large language models (LLMs) in medical question-answering related to exercise interventions for mild cognitive impairment (MCI), and to compare their answers with those of neurologists, so as to explore the potential application value of LLMs in clinical decision support. Methods A question bank was constructed based on multi-source data, generating 25 exercise related questions on MCI, covering 3 dimensions: exercise type (questions 1-8), exercise program (questions 9-19), and exercise safety (questions 20-25). First, 12 neurologists with different professional titles (3 each at junior, intermediate, associate senior, and senior levels) independently answered each question. Then, each question was posed 3 times to 5 LLMs. Three senior neurologists scored the answers according to evidence-based best evidence, and the rates of consistency and differences between the answers from LLMs and physicians were analyzed. Results Among the LLMs, Kimi-K2 achieved the highest rate of complete consistency with the best evidence (84%, 21/25). Among clinicians, the rate of complete consistency increased with professional title: chief physicians (96%, 24/25) ranked the highest, followed by associate chief physicians (88%, 22/25) and attending physicians (84%, 21/25). The overall mean score of chief physicians was significantly higher than that of Wenxin Yiyan X1-Turbo, Tongyi Qianwen-max-latest, and DeepSeek-V3.1 (all P＜0.05). In the exercise program dimension, performance varied considerably among different LLMs and physicians at different professional levels. Conclusion The performance of LLMs is comparable to that of junior physicians in question-answering regarding exercise interventions for MCI, but remains significantly inferior to senior physicians, especially in the consistency of developing exercise program. Currently, LLMs cannot yet replace senior physicians in clinical decision-making.

Monographic report: Stroke diagnosis, evaluation and pre-hospital management

• Advances in imaging assessment of thrombus in acute ischemic stroke

  JIN Yun, TIAN Bing*

  2026,47(4):466-474 ,DOI: 10.16781/j.CN31-2187/R.20260079

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  Abstract:

  Acute ischemic stroke (AIS) is the leading cause of adult mortality and disability in China and its treatment lies in rapid revascularization. As the key pathological factor in AIS, thrombus characteristics (such as location, length, composition, permeability, and burden) profoundly influence treatment decisions, interventional strategies, and clinical outcomes. This review systematically summarizes recent advances in imaging assessment for AIS thrombi, highlighting the value of CT and MRI in identifying thrombus signs, as well as the role of thrombus evaluation in differentiating stroke etiology and predicting responses to intravenous thrombolysis and mechanical thrombectomy. It also prospects the promising potential of radiomics and deep learning in characterizing thrombus heterogeneity and developing predictive models. Ultimately, we propose that modern imaging, through multimodal and multiscale refined assessment, is shifting AIS treatment from the traditional “time window”-dependent mode to an individualized paradigm centered on “tissue window” and “thrombus characteristics”, thereby serving as a key driver of precision diagnosis and treatment.

• Sex and gender differences in neuroimaging characteristics of acute ischemic stroke and their clinical implications

  ZOU Chen, ZHANG Xiaoxi, WU Yue, YANG Pengfei, LIU Jianmin

  2026,47(4):475-482 ,DOI: 10.16781/j.CN31-2187/R.20260026

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  Sex and gender differences significantly affect the risk, clinical manifestations, and prognosis of acute ischemic stroke (AIS). Overall, men exhibit higher age-standardized incidence rate of AIS, whereas women bear disproportionate burdens of long-term neurological dysfunction and disability in advanced age. This review synthesizes evidence from Global Burden of Disease Study, population-based cohorts and biobanks, randomized controlled trials, and multicenter mechanical thrombectomy studies, and focuses on sex- and gender-related neuroimaging phenotypes of AIS and their implications for reperfusion therapy. Accumulating data indicate that sex- and gender-related brain structure and cerebrovascular imaging characteristics develop gradually before AIS onset and manifest as differences in ischemic core extent, collateral circulation status, and lesion topography during the acute phase. Although there are sex- and gender-related differences in neurovascular anatomy and pathophysiology, the relative efficacy of intravenous thrombolysis and mechanical thrombectomy is generally comparable between men and women when AIS patients are selected using modern imaging criteria and after adequate adjustment for baseline characteristics. These findings suggest that sex and gender alone should not restrict access to reperfusion therapies; however, such differences remain important contextual considerations for imaging interpretation and prognostic assessment. Incorporating sex- and gender-related neuroimaging features into integrated evaluation frameworks may improve AIS patient stratification and facilitate more precise and equitable stroke care.

• Etiological diagnosis of acute large vessel occlusion ischemic stroke: research progress

  YE Longhui, ZHOU Yu, ZHANG Yongwei

  2026,47(4):483-489 ,DOI: 10.16781/j.CN31-2187/R.20260042

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  Abstract:

  Mechanical thrombectomy has become the standard treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Etiological diagnosis is increasingly a critical determinant for endovascular strategy selection, postoperative antithrombotic regimens, and long-term secondary prevention. The conventional Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification often faces limitations in emergency settings, including overlapping mechanisms, incomplete diagnostic workflows, and inconsistent levels of evidence quality, making it difficult to meet the rapid and reproducible clinical requirements. The ischemic stroke phenotyping system 2025 (ISPS25) emphasizes hierarchical evaluation of etiological evidence using a standardized diagnostic checklist, incorporating underrecognized pathogenic mechanisms (such as occult atrial fibrillation, cancer-related hypercoagulability, and arterial dissection) into a unified framework, thereby providing a more real-world paradigm for etiological assessment of acute LVO and future trial stratification. This review focuses on the major etiological subtypes of LVO and systematically summarizes key evidence for etiological differentiation from multiple dimensions, including clinical-imaging indicators, intraoperative digital subtraction angiography characteristics, artificial intelligence and machine learning-based multimodal inference, and blood- and thrombus-related biomarkers. It further discusses how these factors influence thrombectomy technique selection, rescue balloon angioplasty or stenting strategies, and postoperative antithrombotic protocols. Future research should integrate quantitative features from computed tomography (CT)/CT angiography/CT perfusion, clinical variables, laboratory indicators, and intraoperative parameters under standardized frameworks such as ISPS25, so as to construct an intelligent etiological diagnostic model with rapid inference capability, interpretable outputs and multicenter generalizability, and validate its clinical value in treatment-strategy matching, reducing reocclusion and complication risks, and optimizing secondary prevention strategies via prospective multicenter studies.

• Network analysis of health belief and pre-hospital delay behavioral intention among high-risk population for stroke

  WANG Mengdi, CHEN Mengxia, YU Longjuan, GAN Lifeng, ZHANG Jingwen, YU Bing, PAN Yijie, ZHANG Lingjuan

  2026,47(4):490-496 ,DOI: 10.16781/j.CN31-2187/R.20250824

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  Abstract:

  Objective To investigate the health belief and pre-hospital delay behavioral intention among high-risk population for stroke, construct a joint network to identify core issues, and explore relationships among variables. Methods A total of 449 high-risk individuals for stroke were recruited from The First Affiliated Hospital of Naval Medical University between Jul. 2024 and Mar. 2025 using convenience sampling. A questionnaire survey was done by general information questionnaire, health belief scale, and stroke pre-hospital delay behavioral intention scale. Each dimension of the health belief scale and the stroke pre-hospital delay behavioral intention scale was regarded as a node, and a joint network was constructed using network analysis. Then the core nodes and bridge nodes were identified, and the influence and importance of each node were analyzed. Results The total score of health belief among the participants was 159.8±33.4, indicating an overall medium level; the total score of stroke pre-hospital delay behavioral intention was 70.6±21.7, suggesting a moderate overall possibility. Symptom attribution (strength＝0.88), perceived control (strength＝0.83), and perceived implementation capability (strength＝0.71) were core nodes in the joint network. Perceived threat (bridge strength＝1.56), symptom attribution (bridge strength＝1.08), and perceived resource utilization (bridge strength＝0.89) were key bridge nodes. Conclusion A complex relationship exists between health belief and pre-hospital delay behavioral intention in high-risk population for stroke. Symptom attribution, perceived control, perceived implementation capability, perceived threat, and perceived resource utilization are priority intervention targets for this population.

Original article

• Establishment of an HNF4A-EmGFP-P2A-blasticidin reporter human embryonic stem cell line using CRISPR/Cas9 technology

  ZHANG Jiqianzhu, SUN Pingxin, LU Junyu, ZHU Jiangbo, LI Wenlin

  2026,47(4):497-503 ,DOI: 10.16781/j.CN31-2187/R.20250632

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  Abstract:

  Objective To develop a simple and efficient CRISPR/Cas9-based gene editing strategy to broaden the application of human pluripotent stem cell in basic research and regenerative medicine. Methods A CRISPR/Cas9-mediated gene editing approach was established using the lipofection reagent Lipofectamine^TM 3000. With human embryonic stem cell (hESC) as a model, an emerald green fluorescent protein (EmGFP)-P2A-blasticidin reporter module was precisely knocked into hepatocyte nuclear factor 4 alpha (HNF4A) gene. Transfection conditions were systematically optimized, and a dual antibiotic selection strategy was employed to obtained homozygous edited clones, which were validated by Sanger sequencing. The reporter cell line was then subjected to chemical induction toward hepatic differentiation, during which EmGFP expression was detected. Results The method achieved efficient gene knock-in in hESC and yielded homozygous edited clones. During hepatic differentiation, the reporter cell line specifically activated EmGFP fluorescence signals, and its expression was highly consistent with hepatocyte markers albumin and alpha-fetoprotein. Conclusion This study has established a convenient strategy using liposome-mediated transient transfection of CRISPR/Cas9 and donor plasmid vectors, and has achieved a HNF4A-EmGFP-P2A-blasticidin reporter hESC cell line, which can be used to trace hepatic differentiation of hESC.

• Hyaluronic acid-enhanced piezoelectric poly (L-lactic acid) membranes for constructing tissue-engineered skin to promote cell proliferation and scratch wound repair

  SONG Jian, WANG Jian, CHEN Xiao, SHENG Shihao, ZHOU Qirong, ZHANG Hao, SU Jiacan

  2026,47(4):504-510 ,DOI: 10.16781/j.CN31-2187/R.20250557

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  Abstract:

  Objective To construct a tissue-engineered skin model using hyaluronic acid (HA)-enhanced piezoelectric poly(L-lactic acid) (PLLA) nanofibrous membranes, and to explore its roles in mimicking the epidermal-dermal structure, supporting cell growth, and promoting wound healing. Methods PLLA nanofibrous membranes were fabricated using electrospinning, and HA was dip-coated on one side of the membranes to prepare PLLA/HA membranes with hydrophilicity and cell adhesion. Human immortalized epidermal keratinocytes (HaCaT cells) were seeded on the HA-free side of the PLLA/HA membranes, and human dermal fibroblasts (HDFs) were seeded on the HA-containing side. Cell adhesion and growth on different surfaces were evaluated by cell morphology observation and fluorescence staining. In addition, HaCaT cells were cultured in 12-well plates until a confluent monolayer formed, followed by scratch wounding. The cells were then divided into blank control group, PLLA/HA membrane control group, and tissue-engineered skin model group. The effects of different treatments on the migration ability of HaCaT cells were compared. Results The surface hydrophilicity of the HA-dip-coated PLLA membranes (PLLA/HA membranes) was significantly enhanced (indicated by a decreased contact angle, P＜0.01 vs PLLA membranes), and the adhesion and proliferation of HaCaT cells and HDFs were promoted. Both HaCaT cells and HDFs could spread uniformly on both sides of the PLLA/HA membranes with favorable cell morphology and high viability. The results of the scratch assay showed that the scratch closure rate in the tissue-engineered skin model group was significantly higher than that in the PLLA/HA membrane control group (P＜0.01) and the blank control group (P＜0.01). Conclusion The electrospun PLLA/HA membranes not only exhibit good biocompatibility but also have potential in promoting skin tissue regeneration. This material combined with bicellular co-culture can be used to successfully construct a tissue-engineered skin model with a well-defined stratified structure, providing a reliable experimental basis for skin repair, drug screening, and disease research.

• Effect of metformin on gastric cancer cell proliferation and autophagy

  WANG Han, GE Mingpai, CUI Lu, XU Jun, YIN Kai*

  2026,47(4):511-517 ,DOI: 10.16781/j.CN31-2187/R.20240738

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  Abstract:

  Objective To investigate the effects of metformin on proliferation and autophagy in gastric cancer cells. Methods Human gastric cancer cell lines AGS and HGC-27 were treated with metformin in vitro, and the cell proliferation, apoptosis and protein expression of cysteine aspartic acid specific protease 3 (caspase 3) and microtubule-associated protein 1 light chain 3 (LC3) were detected by cell counting kit 8 assay, flow cytometry and Western blotting, respectively. In vivo, a nude mouse model of subcutaneous xenograft tumor was established using AGS cells. When tumor volume reached approximately 100 mm³, mice were randomly assigned to 4 groups (n＝8): control group, chloroquine group, metformin group, or metformin combined with chloroquine group. Mice were intragastrically administered normal saline, chloroquine (50 mg/kg), metformin (100 mg/kg), and metformin plus chloroquine daily for 3 consecutive weeks, respectively. Tumor volume and weight were measured and recorded regularly during the treatment. Results Metformin inhibited the proliferation of AGS and HGC-27 cells with half inhibitory concentrations of 5.72 and 13.32 mmol/L, respectively, induced apoptosis accompanied by caspase 3 activation, and triggered autophagy indicated by elevated LC3-Ⅱ expression (all P＜0.01). Combined treatment with metformin and chloroquine further reduced cell viability (P＜0.01). In vivo experiments showed that tumor volume and weight were significantly lower in the metformin group than those in the control group (both P＜0.01), and further reduction was observed following combined treatment with chloroquine (both P＜0.01). Conclusion Metformin suppresses gastric cancer growth by inhibiting cell proliferation, inducing apoptosis, and activating protective autophagy, and combined treatment with the autophagy inhibitor chloroquine further enhances its antitumor efficacy in vitro and in vivo.

• Analysis of pathogen surveillance results of acute respiratory infections in sentinel hospitals in Yangpu District,Shanghai,2024

  QIAO Peng, FANG Letian, LIU Wenbin, XIAO Jianwei, XIE Qianru, BAI Jianing, CAO Guangwen

  2026,47(4):518-525 ,DOI: 10.16781/j.CN31-2187/R.20250447

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  Abstract:

  Objective To analyze the epidemiological characteristics and pathogen spectrum of acute respiratory infections in sentinel hospitals in Yangpu District, Shanghai, 2024, and to provide evidence for the development of precise prevention and control strategies. Methods Clinical and laboratory data were collected from outpatient/emergency influenza-like illness (ILI) cases and hospitalized severe acute respiratory infection (SARI) cases in sentinel hospitals of Yangpu District between Jan. 1 and Dec. 31, 2024. Epidemiological characteristics and seasonal epidemic patterns of pathogens of acute respiratory infections were analyzed using descriptive statistics, and intergroup differences were analyzed using χ² test and Fisher exact test. Results A total of 2 514 cases were enrolled, including 1 360 outpatient/emergency ILI cases and 1 154 hospitalized SARI cases, with an overall pathogen detection rate of 46.5% (1 168/2 514). The most common clinical manifestations were fever (99.4%, 2 500/2 514) and cough (93.4%, 2 348/2 514). The top 3 pathogens were Mycoplasma pneumoniae (10.3%, 259/2 514), adenovirus (7.2%, 180/2 514), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 6.8%, 171/2 514). Among outpatient/emergency ILI cases, the elderly aged ＞60 years had the highest detection rate of pathogens (61.4%, 51/83), with SARS-CoV-2 being the predominant (38.6%, 32/83). Among hospitalized SARI cases, children aged ＞4-15 years had the highest detection rate of pathogens (46.1%, 166/360), with Mycoplasma pneumoniae as the primary pathogen (36.9%, 133/360). The most common mixed infections were coinfection with human coronavirus HKU1 and human coronavirus NL63 (44 cases, 41.9%) and coinfection with enterovirus and human rhinovirus (34 cases, 32.4%). Seasonal trends showed that adenovirus infection peaked in summer (May to Aug.), influenza virus infection in winter (Jan. to Feb. and Dec.), SARS-CoV-2 infection exhibited bimodal peaks in late winter to spring (Feb. to Mar.) and in summer (Jun. to Aug.), while Mycoplasma pneumoniae infection persisted epidemic throughout the year among hospitalized SARI patients. Conclusion Acute respiratory infections demonstrate distinct age and seasonal variations in Yangpu District, Shanghai, 2024. Tailored public health prevention and control interventions should be implemented, including adenovirus infection control for children aged ≤15 years and SARS-CoV-2 infection prevention for the elderly aged ＞60 years, as well as enhancing the management of Mycoplasma pneumoniae infection in hospitalized SARI patients.

• Burden,trends and future projections of esophageal cancer among population aged 20-60 years globally,regionally,and nationally from 1990 to 2023

  HE Yun, FAN Huanfang, LI Dehui, WANG Zhendong, HAN Changhui, MA Pan, GU Yiting, LIU Zihui

  2026,47(4):526-537 ,DOI: 10.16781/j.CN31-2187/R.20250810

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  Abstract:

  Objective To investigate the current burden, temporal trends, future projections, and risk factors of esophageal cancer among population aged 20-60 years globally, regionally, and nationally from 1990 to 2023, so as to provide evidence for the prevention and control of esophageal cancer. Methods Based on data from the 2023 Global Burden of Disease Study database, trends in esophageal cancer burden were analyzed using estimated annual percentage change and Joinpoint regression, the influencing factors were examined using age-period-cohort model and breakdown analysis method, and the future projections from 2024 to 2050 were predicted using Bayesian age-period-cohort model. Results From 1990 to 2023, the number of incident cases, the number of prevalent cases, the number of deaths, and disability-adjusted life years of esophageal cancer among population aged 20-60 years showed an increasing trend, while the age-standardized rates presented a decreasing trend; the disease burden was substantially higher in males; the incidence patterns varied across regions and countries; and the incidence significantly increased with age. According to the predictions, the age-standardized prevalence rate of esophageal cancer among population aged 20-60 years was expected to rise continuously from 2024 to 2050, while the other standardized rates were predicted to decrease first and then increase. Smoking, high alcohol consumption, a diet low in vegetables, and chewing tobacco were identified as the main risk factors of esophageal cancer, and the mortality related to these factors had significantly decreased over time, with the most obvious reductions observed for smoking and high alcohol consumption. Conclusion It is necessary to strengthen early screening and intervention of esophageal cancer in areas with a high burden. Primary prevention and health education should be enhanced in combination with risk factors to reduce the incidence risk of esophageal cancer.

• Clinical efficacy of Guizhi Fuling pill combined with dienogest in treating endometriosis: focusing on mechanism of inflammation-epithelial-mesenchymal transition-related serum markers

  ZHANG Yi, WU Lulu, TANG Li, ZHU Shuangquan, WU Li, XIONG Caitong, Lü Xiuwei

  2026,47(4):538-545 ,DOI: 10.16781/j.CN31-2187/R.20250884

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  Abstract:

  Objective To observe the efficacy and mechanism of Guizhi Fuling pill combined with dienogest in the treatment of endometriosis. Methods Sixty patients with blood stasis endometriosis, who visited the outpatient department of The Second Affiliated Hospital of Hunan University of Chinese Medicine from Jan. 2024 to May 2025, were randomly assigned to control group or treatment group, with 30 patients in each group. The control group received oral administration of dienogest, while the treatment group received Guizhi Fuling pill decoction in addition to dienogest. The total symptom score, traditional Chinese medicine (TCM) syndrome score, endometriosis health profile-5 (EHP-5) score and levels of transforming growth factor β1 (TGF-β1), interleukin 10 (IL-10), N-cadherin, vascular endothelial growth factor (VEGF), and carbohydrate antigen 125 (CA125) were compared between the 2 groups before treatment, 1 month after treatment, and 3 months after treatment. Results At 1 month after treatment, the total symptom score, TCM syndrome score, EHP-5 score and levels of TGF-β1, IL-10, N-cadherin, VEGF, and CA125 in the treatment group were significantly lower than those before treatment and in the control group (all P＜0.05). Moreover, all the above indexes in the treatment group remained significantly lower than those in the control group 3 months after treatment (all P＜0.05). Conclusion Guizhi Fuling pill combined with dienogest may alleviate pain and blood stasis symptoms in endometriosis patients and improve the quality of life by targeting the inflammation-epithelial-mesenchymal transition mechanism.

Review

• Brain-bone axis: regulatory mechanisms and translational prospects

  YANG Guanhao, LIU Denghui, HUANG Xuan, WANG Weizhong, LIU Zhongtang

  2026,47(4):546-552 ,DOI: 10.16781/j.CN31-2187/R.20260059

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  Abstract:

  Brain-bone axis is an emerging concept in the interdisciplinary field of neuroscience and skeletal biology, revealing a complex and bidirectional regulatory network between the central nervous system and skeletal system. This article systematically reviews the core insights of the brain-bone axis, and delves into the mechanisms by which brain regulates skeletal homeostasis through neural, endocrine, and immune pathways and the feedback effects of skeleton (functioning as an endocrine organ) on brain function. This review also outlines the spectrum of diseases closely associated with dysfunction of the brain-bone axis, including neurodegenerative disorders, psychiatric conditions, and metabolic bone diseases. Furthermore, the article focuses on the potential clinical intervention strategies derived from brain-bone axis theory, aiming to provide new theoretical foundation and strategic perspective for integrated cross-system therapeutic approaches to related diseases.

• Interplay between exocrine and endocrine functions of pancreas: research progress

  ZHU Huan, LU Jin*

  2026,47(4):553-558 ,DOI: 10.16781/j.CN31-2187/R.20250231

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  The traditional view is that the exocrine and endocrine parts of the pancreas are independent and perform separate functions. In recent years, studies have found that pancreatic exocrine and endocrine are closely related in structure and function. Thus, pancreatic exocrine diseases and pancreatic endocrine diseases (mainly diabetes mellitus) interact with each other. Pancreatic exocrine diseases such as chronic pancreatitis, acute pancreatitis, and pancreatic cancer can cause pancreatic diabetes. Diabetic patients are more likely than non-diabetic patients to develop pancreatic exocrine insufficiency, which can lead to pancreatic exocrine disease, further complicating disease management. This article takes pancreatic endocrine diseases and pancreatic exocrine diseases as the main clues, and reviews the latest research progress on the interaction between pancreatic endocrine and exocrine parts and the underlying mechanisms.

• Neoadjuvant drug therapy for muscle-invasive bladder cancer: applications and progress

  XIE Jiaxin, ZENG Shuxiong, XU Chuanliang

  2026,47(4):559-568 ,DOI: 10.16781/j.CN31-2187/R.20240429

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  Bladder cancer is one of the most common cancers among males worldwide. According to muscle invasion status, bladder cancer is classified into non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. Muscle-invasive bladder cancer has a high risk of recurrence and metastasis. Even after radical cystectomy, the 5-year survival rate of patients remains relatively low. Neoadjuvant therapy aims to eradicate potential micrometastases, reduce tumor volume and stage, improve surgical resection rates, and increase patient survival rate. This review focuses on neoadjuvant drug therapy for muscle-invasive bladder cancer, systematically summarizes the current neoadjuvant chemotherapy, immunotherapy and targeted therapy, and discusses the advantages, limitations, and future of these treatment strategies.

Naval health care

• Prevalence and influencing factors of fatty liver among young and middle-aged workers on tropical islands

  PAN Hui, FANG Liwen, ZHANG Yuanpan, XIAO Yiqun, QIN Qin

  2026,47(4):569-572 ,DOI: 10.16781/j.CN31-2187/R.20250201

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  Objective To analyze the prevalence and risk factors of fatty liver among young and middle-aged workers on a tropical island. Methods Questionnaire survey and physical examination were conducted among young and middle-aged workers on a tropical island. Data on general health status, dietary and lifestyle habits, and other common diseases were collected. Participants were classified into fatty liver and non-fatty liver groups based on hepatic ultrasonography findings. Between-group differences were analyzed, and multivariate logistic regression analysis was performed to identify influencing factors of fatty liver. Results A total of 295 individuals aged 30-45 years were enrolled. Ultrasonography revealed that 82 individuals had fatty liver, yielding a prevalence of 27.80%. Compared with the non-fatty liver group, the fatty liver group was older and had higher proportions of overweight/obesity, salty/oily/sweet/spicy diet, less/occasional exercise, and comorbidities including dyslipidemia, abnormal liver function, and hyperuricemia (all P＜0.05). Multivariate logistic regression analysis showed that overweight/obesity (odds ratio [OR] ＝6.399, 95% confidence interval [95%CI] 3.429-12.797, P＜0.001), salty/oily/sweet/spicy diet (OR＝2.161, 95%CI 1.246-3.826, P＝0.023), less/occasional exercise (OR＝2.001, 95%CI 1.203-3.348, P＝0.025), and hyperuricemia (OR＝3.430, 95%CI 1.866-6.395, P＜0.001) were the independent risk factors for fatty liver. Conclusion The prevalence of fatty liver is high among workers aged 30-45 years on this tropical island. Overweight/obesity, salty/oily/sweet/spicy diet, less/occasional exercise, and hyperuricemia may be risk factors of fatty liver. Regular monitoring and early intervention are recommended for individuals with these risk factors.

Short article

• Value analysis of composite inflammation indicators in predicting retinal vein occlusion

  LIU Songjia, FANG Zhou, SHEN Wei, GAO Yu, ZHANG Yuan, ZHANG Rui*

  2026,47(4):573-577 ,DOI: 10.16781/j.CN31-2187/R.20250374

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  Abstract:

  Objective To explore the predictive efficacy of composite inflammatory indicators for retinal vein occlusion (RVO), so as to identify inflammatory indicators suitable for RVO prediction. Methods A retrospective analysis was conducted on the clinical data of 105 patients with newly diagnosed RVO (RVO group) in our hospital from Jan. 2020 to Mar. 2025, together with 105 age- and gender-matched non-RVO patients (non-RVO group) during the same period. Univariate analysis and multivariate logistic regression analysis were used to evaluate the predictive value of inflammatory indicators for RVO, including white blood cell count, platelet count, hemoglobin, hematocrit, platelet distribution width, monocyte count, lymphocyte count, neutrophil count, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI). The predictive performance of SII and SIRI for RVO was further evaluated using receiver operating characteristic (ROC) curve analysis. Results Univariate analysis showed that neutrophil count, NLR, SII, and SIRI were significantly different between 2 groups (all P＜0.05). Multivariate logistic regression analysis identified SII and SIR as independent risk factors for RVO (odds ratio [OR] ＝1.003, 95% confidence interval [95%CI] 1.000-1.006; OR＝3.986, 95%CI 1.236-12.848). ROC curve analysis demonstrated that SII had an area under curve (AUC) of 0.644 (95%CI 0.570-0.718) for predicting RVO, with a sensitivity of 81.0% and a specificity of 42.9%; SIRI had an AUC of 0.608 (95%CI 0.533-0.648), with a sensitivity of 48.6% and a specificity of 70.5%. Conclusion SII and SIRI cannot be used as definitive indicators for identifying RVO risk, but due to their easy detection and low cost, they can serve as auxiliary tools for RVO screening.

• Dachengqi decoction reduces severe pancreatitis after endoscopic retrograde cholangiopancreatography in high-risk patients

  ZHANG Ruling, ZHANG Yajing, LI Qingtao, ZHAO Hang

  2026,47(4):578-582 ,DOI: 10.16781/j.CN31-2187/R.20250113

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  Abstract:

  Objective To assess the efficacy of Dachengqi decoction (DCQD) in preventing post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) in high-risk patients. Methods Patients with high-risk factors for PEP who underwent ERCP in our hospital from Dec. 2021 to Jun. 2023 were retrospectively enrolled. According to whether DCQD was administered after ERCP, patients were assigned to DCQD group or control group. General clinical data, endoscopic data, and the occurrence of PEP were recorded and evaluated. Results In total, 60 patients with high-risk factors for PEP were enrolled, including 34 in the DCQD group and 26 in the control group. The baseline data were comparable between the 2 groups. A total of 11 (18.33%) patients developed PEP, including 6 (17.65%) cases in the DCQD group and 5 (19.23%) cases in the control group, and there was no significant difference in the incidence of PEP between the 2 groups (P＞0.05). There were 4 (15.38%) cases of severe acute pancreatitis (SAP) in the control group, while no SAP occurred in the DCQD group, and the incidence of SAP in the DCQD group was significantly lower than that in the control group (P＜0.05). The hospital stay of the DCQD group was (2.59±0.18) d, while the control group was (3.27±0.25) d. The hospital stay in the DCQD group was significantly shorter than that in the control group (P＜0.05). Conclusion The administration of DCQD can reduce the risk of severe PEP and shorten the hospital stay after ERCP in patients with high risk factors for PEP.