The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published s...The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.展开更多
Mesenchymal stem cells(MSCs)have emerged as a highly promising strategy in regenerative medicine due to their self-renewal,pluripotency and immunomodulatory properties.MSCs are nonhematopoietic,multipotent stem cells ...Mesenchymal stem cells(MSCs)have emerged as a highly promising strategy in regenerative medicine due to their self-renewal,pluripotency and immunomodulatory properties.MSCs are nonhematopoietic,multipotent stem cells that can differentiate into various mesodermal lineages and modulate the immune system.The therapeutic potential of MSCs from different tissues has been widely explored in preclinical models and clinical trials for human diseases,ranging from autoimmune diseases and inflammatory disorders to neurodegenerative diseases and orthopedic injuries.The therapeutic effects of MSCs can be mediated through the release of bioactive molecules,including growth factors,cytokines,and extracellular vesicles,which play crucial roles in modulating the local cellular environment,promoting tissue repair,angiogenesis,and cell survival,and exerting anti-inflammatory effects.MSCs can also interact with various immune cells,such as T cells,B cells,dendritic cells,and macrophages,modulating the immune response through both direct cell‒cell interactions and the release of immunoregulatory molecules.This review delves into the molecular mechanisms,signaling pathways,and regulatory factors that underpin the therapeutic effects of MSCs.This review also highlights the clinical applications and challenges associated with the use of MSC-based drugs to promote the safety and efficacy of MSC-based therapies.Overall,this comprehensive review provides valuable insights into the current state of MSC research and its potential for transforming the field of regenerative medicine as well as immune-mediated inflammatory diseases.展开更多
Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and...Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.展开更多
Osteoarthritis(OA)is a degenerative joint disease with significant clinical and societal impact.Traditional diagnostic methods,including subjective clinical assessments and imaging techniques such as X-rays and MRIs,a...Osteoarthritis(OA)is a degenerative joint disease with significant clinical and societal impact.Traditional diagnostic methods,including subjective clinical assessments and imaging techniques such as X-rays and MRIs,are often limited in their ability to detect early-stage OA or capture subtle joint changes.These limitations result in delayed diagnoses and inconsistent outcomes.Additionally,the analysis of omics data is challenged by the complexity and high dimensionality of biological datasets,making it difficult to identify key molecular mechanisms and biomarkers.Recent advancements in artificial intelligence(AI)offer transformative potential to address these challenges.This review systematically explores the integration of AI into OA research,focusing on applications such as AI-driven early screening and risk prediction from electronic health records(EHR),automated grading and morphological analysis of imaging data,and biomarker discovery through multi-omics integration.By consolidating progress across clinical,imaging,and omics domains,this review provides a comprehensive perspective on how AI is reshaping OA research.The findings have the potential to drive innovations in personalized medicine and targeted interventions,addressing longstanding challenges in OA diagnosis and management.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to ...Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.展开更多
Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to...Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinical research progress.In response,our research team has embarked on the development of a specialized clinical research database for cardiology,thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors.Methods The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021.It included comprehensive data on patients'basic information,medical history,non-invasive imaging studies,laboratory test results,as well as peri-procedural information related to interventional surgeries,extracted from the Hospital Information System.Additionally,an innovative artificial intelligence(AI)-powered interactive follow-up system had been developed,ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up,thereby achieving comprehensive data management throughout the entire care continuum for highrisk patients.Results This database integrates extensive cross-sectional and longitudinal patient data,with a focus on higher-risk acute coronary syndrome patients.It achieves the integration of structured and unstructured clinical data,while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency.It creates a comprehensive patient view,thereby improving diagnostic and follow-up quality,and provides high-quality data to support clinical research.Despite limitations in unstructured data standardization and biological sample integrity,the database's development is accompanied by ongoing optimization efforts.Conclusion The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research,which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes.It supports clinical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.展开更多
Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock...Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.展开更多
Any new report on the anticancer properties of natural products always awakens new satisfaction and hope about the role of the international scientific community in its continuous contributions to human health,particu...Any new report on the anticancer properties of natural products always awakens new satisfaction and hope about the role of the international scientific community in its continuous contributions to human health,particularly when those reports contribute to both the understanding and therapeutics of cancer.For many de-cades,natural products have been pivotal in drug discovery programs because they offer a diverse array of anticancer therapeutic possibilities.Recently,two manuscripts published in the World Journal of Gastrointestinal Oncology added new data to the already extensive body of anticancer preclinical evidence for resvera-trol and senegenin,two compounds widely present in herbal preparations used in traditional Chinese medicine.The first one,with comprehensive and recognized anticancer properties,and the second one,shows a compelling body of evidence supporting its neuroprotective effects,but with emerging anticancer activities.Natural products have become key elements in the expanding and dynamic field of anticancer drug discovery.However,urgent and collective efforts are still needed to bridge the gap between preclinical and clinical research and thus bring new anticancer therapeutic breakthroughs.展开更多
The article by Granjeiro et al provided a thorough review of the role of stem cell models in the development of advanced therapy medicinal products.It emphasized the potential of stem cell models to refine preclinical...The article by Granjeiro et al provided a thorough review of the role of stem cell models in the development of advanced therapy medicinal products.It emphasized the potential of stem cell models to refine preclinical studies and align with regulatory requirements for clinical applications.This article introduced a new perspective on enhancing the transition of stem cell research into clinical practice,focusing on the importance of international regulatory harmonization and the need for standardization in stem cell-based therapies.展开更多
Fibroblast activation protein(FAP)is overexpressed in cancer-associated fibroblasts across various cancer types.Numerous radiolabeled FAP inhibitors(FAPIs)(Fig.S1A)currently under clinical investigation have shown rem...Fibroblast activation protein(FAP)is overexpressed in cancer-associated fibroblasts across various cancer types.Numerous radiolabeled FAP inhibitors(FAPIs)(Fig.S1A)currently under clinical investigation have shown remarkable potential in cancer theranostics.展开更多
Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may...Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.展开更多
Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the p...Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the past decades,these infections have proven to be a significant challenge to health systems worldwide,particularly following the considerable geographic expansion of the dengue virus(DENV)and its most recent outbreak in Latin America as well as the difficult-tocontrol outbreaks of yellow fever virus(YFV),chikungunya virus(CHIKV),and Zika virus(ZIKV),leaving behind a substantial portion of the population with complications related to these infections.Currently,the world is experiencing a period of intense globalization,which,combined with global warming,directly contributes to wider dissemination of arbovirus vectors across the globe.Consequently,all continents remain on high alert for potential new outbreaks.Thus,this review aims to provide a comprehensive understanding of the pathogenesis of the four main arboviruses today(DENV,ZIKV,YFV,and CHIKV)discussing their viral characteristics,immune responses,and mechanisms of viral evasion,as well as important clinical aspects for patient management.This includes associated symptoms,laboratory tests,treatments,existing or developing vaccines and the main associated complications,thus integrating a broad historical,scientific and clinical approach.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we exa...Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.展开更多
Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promi...Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promising avenues for therapeutic interventions.Exos derived from mesenchymal stem cells(MSCs)have significant immunomodulatory properties.They effectively regulate immune responses by modulating both innate and adaptive immunity.These Exos can inhibit excessive inflammatory responses and promote tissue repair.Moreover,they participate in antigen presentation,which is essential for activating immune responses.The cargo of these Exos,including ligands,proteins,and microRNAs,can suppress T cell activity or enhance the population of immunosuppressive cells to dampen the immune response.By inhibiting lymphocyte proliferation,acting on macrophages,and increasing the population of regulatory T cells,these Exos contribute to maintaining immune and metabolic homeostasis.Furthermore,they can activate immune-related signaling pathways or serve as vehicles to deliver microRNAs and other bioactive substances to target tumor cells,which holds potential for immunotherapy applications.Given the immense therapeutic potential of MSC-derived Exos,this review comprehensively explores their mechanisms of immune regulation and therapeutic applications in areas such as infection control,tumor suppression,and autoimmune disease management.This article aims to provide valuable insights into the mechanisms behind the actions of MSC-derived Exos,offering theoretical references for their future clinical utilization as cell-free drug preparations.展开更多
Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1])...Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1]) Therefore,although AP is primarily a localized disease with systemic consequences in a subset of patients,its clinical manifestations extend beyond digestive system symptoms to encompass a variety of additional symptoms,particularly during disease progression from mild AP(MAP) to severe AP(SAP).展开更多
Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affec...Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affected sites.Bletilla striata,a traditional Chinese medicinal herb,contains diverse chemical constituents and exhibits multiple pharmacological effects.As a key component in various traditional Chinese medicine compound formulations,it has demonstrated notable clinical efficacy.Moreover,it has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases.This paper systematically elaborates on the clinical efficacy and mechanisms of action of Bletilla striata in the treatment of PUs,drawing from ancient medical literature and traditional formula applications to provide support for clinical use.展开更多
BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD....BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.展开更多
Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods s...Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods such as acupuncture and tuina.Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China,there is a poor understanding of the extent to which TCM diagnostic methods are used,how different treatment modalities are deployed in general,and what major factors may affect the integration of TCM and Western medicine.This study aimed to fill this void in the literature.Methods In the 2021 National Healthcare Improvement Evaluation Survey,we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities,investigating the frequency of their deployment of TCM diagnostic methods,and predominant TCM treatment methods.Our empirical analysis included descriptive statistics,intergroup chi-square analysis,and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns.Results A total of 7618 clinical physicians comprised our study sample.Among them,84.27%have integrated TCM and Western medicine in their clinical practice,and 80.77%of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice.Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians(used by 88.49%of respondents),compared with the Chinese patent medicine and non-pharmacological TCM methods,which were used by 73.14%,and 69.39%,respectively.Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice,recommended by 29.43%of physicians.Significant variations exist across certain institutions,departments,and individual practitioners.Conclusion Given that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices,the practice of“pure TCM”appears to be obsolete in China’s tertiary healthcare institutions.Notably,remarkable variation exists in the use of different TCM modalities across institutions and among individuals,which might be related to and thus limited by the practitioners’experience.Future research focusing on the efficacy and safety of TCM interventions for specific diseases,the development of standardized clinical guidelines,and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.展开更多
文摘The Chinese Society of Clinical Oncology Non-small Cell Lung Cancer(CSCO NSCLC)guidelines were first published in 2016,ranking among the earliest-released guidelines within the CSCO series.In 2020 the CSCO published separate guidelines for NSCLC and small cell lung cancer(SCLC)for the first time to improve clinical usability.
基金supported,in part,by the Shenzhen Fundamental Research Program(JCYJ20220818100617036)the Shenzhen Medical Research Funds(B2402033)+3 种基金the National Natural Science Foundation of China(82261160395,82430078,82230081,82250710175,and 82004395)the Guangdong Provincial Science and Technology Innovation Council Grant(2017B030301018)the Shenzhen Key Laboratory of Cell Microenvironment Grant(ZDSYS20140509142721429)the Guangdong Provincial Bureau of Traditional Chinese Medicine Project(20212203)。
文摘Mesenchymal stem cells(MSCs)have emerged as a highly promising strategy in regenerative medicine due to their self-renewal,pluripotency and immunomodulatory properties.MSCs are nonhematopoietic,multipotent stem cells that can differentiate into various mesodermal lineages and modulate the immune system.The therapeutic potential of MSCs from different tissues has been widely explored in preclinical models and clinical trials for human diseases,ranging from autoimmune diseases and inflammatory disorders to neurodegenerative diseases and orthopedic injuries.The therapeutic effects of MSCs can be mediated through the release of bioactive molecules,including growth factors,cytokines,and extracellular vesicles,which play crucial roles in modulating the local cellular environment,promoting tissue repair,angiogenesis,and cell survival,and exerting anti-inflammatory effects.MSCs can also interact with various immune cells,such as T cells,B cells,dendritic cells,and macrophages,modulating the immune response through both direct cell‒cell interactions and the release of immunoregulatory molecules.This review delves into the molecular mechanisms,signaling pathways,and regulatory factors that underpin the therapeutic effects of MSCs.This review also highlights the clinical applications and challenges associated with the use of MSC-based drugs to promote the safety and efficacy of MSC-based therapies.Overall,this comprehensive review provides valuable insights into the current state of MSC research and its potential for transforming the field of regenerative medicine as well as immune-mediated inflammatory diseases.
文摘Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.
基金supported by the National Natural Science Foundation of China(82302757)Shenzhen Science and Technology Program(JCY20240813145204006,SGDX20201103095600002,JCYJ20220818103417037,KJZD20230923115200002)+1 种基金Shenzhen Key Laboratory of Digital Surgical Printing Project(ZDSYS201707311542415)Shenzhen Development and Reform Program(XMHT20220106001).
文摘Osteoarthritis(OA)is a degenerative joint disease with significant clinical and societal impact.Traditional diagnostic methods,including subjective clinical assessments and imaging techniques such as X-rays and MRIs,are often limited in their ability to detect early-stage OA or capture subtle joint changes.These limitations result in delayed diagnoses and inconsistent outcomes.Additionally,the analysis of omics data is challenged by the complexity and high dimensionality of biological datasets,making it difficult to identify key molecular mechanisms and biomarkers.Recent advancements in artificial intelligence(AI)offer transformative potential to address these challenges.This review systematically explores the integration of AI into OA research,focusing on applications such as AI-driven early screening and risk prediction from electronic health records(EHR),automated grading and morphological analysis of imaging data,and biomarker discovery through multi-omics integration.By consolidating progress across clinical,imaging,and omics domains,this review provides a comprehensive perspective on how AI is reshaping OA research.The findings have the potential to drive innovations in personalized medicine and targeted interventions,addressing longstanding challenges in OA diagnosis and management.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
文摘Objectives:This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs)for neurogenic bladder(NB)care.We aimed to identify research trends,evidence gaps,and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods:A systematic search of electronic databases and guideline repositories was conducted,included PubMed,Web of Science,Embase,Guidelines International Network(GIN),ect.Eligible NB guidelines underwent dual-researcher screening and extraction,and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation II(AGREE II)and Evaluation-Recommendations Excellence(AGREE-REX)instruments.Five researchers independently evaluated recommendation specificity,evidence grading systems,and implementation consistency.Discrepancies were resolved through consensus discussion or third-party arbitration.Results:Analysis of 19 CPGs(2006–2023)from 11 countries/regions revealed that 78.95%(15/19)incorporated evidence grading systems and 68.42%(13/19)specifiedrecommendation strength.The AGREE II evaluation identifiedcritical methodological deficiencies,with three domains scoring below the acceptable thresholds:Rigor of Development(41.70%),Editorial Independence(43.30%),and Applicability(30.00%).The AGREE-REX results showed moderate performance in Clinical Applicability(55.56%)and implantability(41.67%)but severe gaps in Values and Preferences(25.00%).A systematic synthesis identified40 recommendations:90%(36/40)demonstrated consensus and 10%(4/40)contradictions.These studies addressed the following six clinical themes:1)nursing assessment,2)manipulation-assisted voiding,3)behavioral therapy,4)intermittent catheterization,5)indwelling catheterization,and 6)other therapies.Conclusions:The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability.Therefore,there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.
基金Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0503906)。
文摘Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinical research progress.In response,our research team has embarked on the development of a specialized clinical research database for cardiology,thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors.Methods The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021.It included comprehensive data on patients'basic information,medical history,non-invasive imaging studies,laboratory test results,as well as peri-procedural information related to interventional surgeries,extracted from the Hospital Information System.Additionally,an innovative artificial intelligence(AI)-powered interactive follow-up system had been developed,ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up,thereby achieving comprehensive data management throughout the entire care continuum for highrisk patients.Results This database integrates extensive cross-sectional and longitudinal patient data,with a focus on higher-risk acute coronary syndrome patients.It achieves the integration of structured and unstructured clinical data,while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency.It creates a comprehensive patient view,thereby improving diagnostic and follow-up quality,and provides high-quality data to support clinical research.Despite limitations in unstructured data standardization and biological sample integrity,the database's development is accompanied by ongoing optimization efforts.Conclusion The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research,which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes.It supports clinical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.
文摘Traditional Medicine(TM),particularly Traditional Chinese Medicine(TCM),is an indispensable component of the global healthcare system,offering unique insights to modern medical science.Clinical efficacy is the bedrock for the inheritance and development of TM.To meet the growing demand for high-quality healthcare,it is imperative to integrate TM with modern technology to address the issue of insufficient evidence for the efficacy of TM.
文摘Any new report on the anticancer properties of natural products always awakens new satisfaction and hope about the role of the international scientific community in its continuous contributions to human health,particularly when those reports contribute to both the understanding and therapeutics of cancer.For many de-cades,natural products have been pivotal in drug discovery programs because they offer a diverse array of anticancer therapeutic possibilities.Recently,two manuscripts published in the World Journal of Gastrointestinal Oncology added new data to the already extensive body of anticancer preclinical evidence for resvera-trol and senegenin,two compounds widely present in herbal preparations used in traditional Chinese medicine.The first one,with comprehensive and recognized anticancer properties,and the second one,shows a compelling body of evidence supporting its neuroprotective effects,but with emerging anticancer activities.Natural products have become key elements in the expanding and dynamic field of anticancer drug discovery.However,urgent and collective efforts are still needed to bridge the gap between preclinical and clinical research and thus bring new anticancer therapeutic breakthroughs.
文摘The article by Granjeiro et al provided a thorough review of the role of stem cell models in the development of advanced therapy medicinal products.It emphasized the potential of stem cell models to refine preclinical studies and align with regulatory requirements for clinical applications.This article introduced a new perspective on enhancing the transition of stem cell research into clinical practice,focusing on the importance of international regulatory harmonization and the need for standardization in stem cell-based therapies.
基金supported by the grants provided by Zhuhai People's Hospital,China(Grant No.:2021KYQD-03)the National Natural Science Foundation of China(Grant No.:22176016).
文摘Fibroblast activation protein(FAP)is overexpressed in cancer-associated fibroblasts across various cancer types.Numerous radiolabeled FAP inhibitors(FAPIs)(Fig.S1A)currently under clinical investigation have shown remarkable potential in cancer theranostics.
基金supported partly by the National Natural Science Foundation of China,No.82071332the Chongqing Natural Science Foundation Joint Fund for Innovation and Development,No.CSTB2023NSCQ-LZX0041 (both to ZG)。
文摘Some studies have confirmed the neuroprotective effect of remote ischemic conditioning against stroke. Although numerous animal researches have shown that the neuroprotective effect of remote ischemic conditioning may be related to neuroinflammation, cellular immunity, apoptosis, and autophagy, the exact underlying molecular mechanisms are unclear. This review summarizes the current status of different types of remote ischemic conditioning methods in animal and clinical studies and analyzes their commonalities and differences in neuroprotective mechanisms and signaling pathways. Remote ischemic conditioning has emerged as a potential therapeutic approach for improving stroke-induced brain injury owing to its simplicity, non-invasiveness, safety, and patient tolerability. Different forms of remote ischemic conditioning exhibit distinct intervention patterns, timing, and application range. Mechanistically, remote ischemic conditioning can exert neuroprotective effects by activating the Notch1/phosphatidylinositol 3-kinase/Akt signaling pathway, improving cerebral perfusion, suppressing neuroinflammation, inhibiting cell apoptosis, activating autophagy, and promoting neural regeneration. While remote ischemic conditioning has shown potential in improving stroke outcomes, its full clinical translation has not yet been achieved.
基金Supported by the Permanecer Program(part of the actions of the Office of Affirmative Actions)Education and Diversity of the Dean of Student Assistance at the Federal University of Bahia(UFBA)and CNPq Research Productivity Fellow.
文摘Arboviral diseases are viral infections transmitted to humans through the bites of arthropods,such as mosquitoes,often causing a variety of pathologies associated with high levels of morbidity and mortality.Over the past decades,these infections have proven to be a significant challenge to health systems worldwide,particularly following the considerable geographic expansion of the dengue virus(DENV)and its most recent outbreak in Latin America as well as the difficult-tocontrol outbreaks of yellow fever virus(YFV),chikungunya virus(CHIKV),and Zika virus(ZIKV),leaving behind a substantial portion of the population with complications related to these infections.Currently,the world is experiencing a period of intense globalization,which,combined with global warming,directly contributes to wider dissemination of arbovirus vectors across the globe.Consequently,all continents remain on high alert for potential new outbreaks.Thus,this review aims to provide a comprehensive understanding of the pathogenesis of the four main arboviruses today(DENV,ZIKV,YFV,and CHIKV)discussing their viral characteristics,immune responses,and mechanisms of viral evasion,as well as important clinical aspects for patient management.This includes associated symptoms,laboratory tests,treatments,existing or developing vaccines and the main associated complications,thus integrating a broad historical,scientific and clinical approach.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金funded by the National Key Research and Development Program of China(Grant No.2022YFB4700904 to Wang L)the Shanghai Shenkang Hospital Development Center's project for the Promotion of Clinical Skills and Clinical Innovation Three-Year Action Plan(Project No.SHDC2022CRT006 to Wang L and SHDC2022CRS010B to Tang S).
文摘Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.
基金Supported by the National Natural Science Foundation of China,No.82072537the General Project of Hunan Natural Science Foundation,No.2022JJ30412 and No.2021JJ30464.
文摘Exosomes(Exos)are extracellular vesicles secreted by cells and serve as crucial mediators of intercellular communication.They play a pivotal role in the pathogenesis and progression of various diseases and offer promising avenues for therapeutic interventions.Exos derived from mesenchymal stem cells(MSCs)have significant immunomodulatory properties.They effectively regulate immune responses by modulating both innate and adaptive immunity.These Exos can inhibit excessive inflammatory responses and promote tissue repair.Moreover,they participate in antigen presentation,which is essential for activating immune responses.The cargo of these Exos,including ligands,proteins,and microRNAs,can suppress T cell activity or enhance the population of immunosuppressive cells to dampen the immune response.By inhibiting lymphocyte proliferation,acting on macrophages,and increasing the population of regulatory T cells,these Exos contribute to maintaining immune and metabolic homeostasis.Furthermore,they can activate immune-related signaling pathways or serve as vehicles to deliver microRNAs and other bioactive substances to target tumor cells,which holds potential for immunotherapy applications.Given the immense therapeutic potential of MSC-derived Exos,this review comprehensively explores their mechanisms of immune regulation and therapeutic applications in areas such as infection control,tumor suppression,and autoimmune disease management.This article aims to provide valuable insights into the mechanisms behind the actions of MSC-derived Exos,offering theoretical references for their future clinical utilization as cell-free drug preparations.
基金Science and Technology Planning Project of Xi’an,China (No. 22YXYJ0111, to LFP)。
文摘Acute pancreatitis(AP) is not a disorder limited to a single organ,the pancreas,but often results in transient or sustained dysfunction,and even failure,of multiple organs,particularly as the disease progresses.^([1]) Therefore,although AP is primarily a localized disease with systemic consequences in a subset of patients,its clinical manifestations extend beyond digestive system symptoms to encompass a variety of additional symptoms,particularly during disease progression from mild AP(MAP) to severe AP(SAP).
基金Supported by National Science and Technology Major Project,No.2024ZD0521002The Innovation Team Project of Traditional Chinese Medicine of Liaoning Province,No.LNZYYCXTD-CCCX-003+1 种基金General Program of the National Natural Science Foundation of China,No.82074296Construction Project of Inheritance Studios of Famous Chinese Medicine Experts in China,No.[2022]No.75.
文摘Peptic ulcer(PU)is characterized by inflammation,necrosis,and erosion of the gastrointestinal mucosa caused by various pathogenic factors,leading to ulcer formation.The stomach and duodenum are the most commonly affected sites.Bletilla striata,a traditional Chinese medicinal herb,contains diverse chemical constituents and exhibits multiple pharmacological effects.As a key component in various traditional Chinese medicine compound formulations,it has demonstrated notable clinical efficacy.Moreover,it has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases.This paper systematically elaborates on the clinical efficacy and mechanisms of action of Bletilla striata in the treatment of PUs,drawing from ancient medical literature and traditional formula applications to provide support for clinical use.
文摘BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.
基金The Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences——A Strategic Study on Healthy China Development and Health System Reform(2021-I2M-1-046).
文摘Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods such as acupuncture and tuina.Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China,there is a poor understanding of the extent to which TCM diagnostic methods are used,how different treatment modalities are deployed in general,and what major factors may affect the integration of TCM and Western medicine.This study aimed to fill this void in the literature.Methods In the 2021 National Healthcare Improvement Evaluation Survey,we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities,investigating the frequency of their deployment of TCM diagnostic methods,and predominant TCM treatment methods.Our empirical analysis included descriptive statistics,intergroup chi-square analysis,and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns.Results A total of 7618 clinical physicians comprised our study sample.Among them,84.27%have integrated TCM and Western medicine in their clinical practice,and 80.77%of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice.Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians(used by 88.49%of respondents),compared with the Chinese patent medicine and non-pharmacological TCM methods,which were used by 73.14%,and 69.39%,respectively.Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice,recommended by 29.43%of physicians.Significant variations exist across certain institutions,departments,and individual practitioners.Conclusion Given that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices,the practice of“pure TCM”appears to be obsolete in China’s tertiary healthcare institutions.Notably,remarkable variation exists in the use of different TCM modalities across institutions and among individuals,which might be related to and thus limited by the practitioners’experience.Future research focusing on the efficacy and safety of TCM interventions for specific diseases,the development of standardized clinical guidelines,and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.
