This study makes an in-depth exploration of the core pathogenesis of chronic atrophic gastritis,Qi Deficiency with Stagnation,to systematically interpret it within the theoretical framework of Achieving Central Harmon...This study makes an in-depth exploration of the core pathogenesis of chronic atrophic gastritis,Qi Deficiency with Stagnation,to systematically interpret it within the theoretical framework of Achieving Central Harmony,and to provide a treatment plan.Professor Li Tingquan believes that the occurrence and development of chronic atrophic gastritis(CAG)is fundamentally a process of harmony imbalance of the spleen and stomach.Its specific manifestation lies in the interaction between qi deficiency and stagnation,namely,spleen deficiency as the root cause,and qi stagnation,phlegm-dampness,and blood stasis obstructing the middle energizer as the secondary manifestations.These factors are mutually causal and interact with one another.Based on this,he proposed a four-step method to treat the disease:eliminating pathogenic factors,harmonizing the spleen and stomach,activating blood circulation to resolve stasis,and tonifying the kidney to generate blood(metaphorically described as"closing the mountains to cultivate forests and thicken the soil,breeding seeds and irrigating for stomach recovery").This approach aims to restore the harmonious state of the middle energizer,providing a complete clinical framework of theory,principle,formula,and herbs for the prevention and treatment of CAG.展开更多
Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted th...Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted therapy;however,their clinical benefits are limited.Therefore,developing new models to evaluate the therapeutic potential of novel molecules is essential.Fingolimod and Dimethyl Fumarate(DMF),currently used to treat multiple sclerosis,have recently been shown to have anti-cancer effects in several preclinical tumor models.This study aims to evaluate the therapeutic potential of Fingolimod and DMF in pancreatic cancer by investigating their respective in vitro cytotoxicity and in vivo antitumor effects.Methods:In this study,we evaluated for the first time these two drugs in pancreatic preclinical models in vitro using 3D spheroid tumor models and in vivo,which are compared to two standard-of-care consisting of Gemcitabine and Erlotinib.Results:In vitro,both Fingolimod and DMF induced cytotoxicity in spheroids from two pancreatic cell lines.Additionally,Fingolimod and DMF displayed anticancer effects in two subcutaneous xenograft models using PANC-1 and CFPAC-1 cells.Conclusions:Although the responses observed with Fingolimod and DMF were similar to those of Gemcitabine and Erlotinib,these findings indicate a potential emerging interest in Fingolimod and DMF for the treatment of pancreatic cancer.However,further work is still necessary to fully characterize how these drugs affect tumor progression.展开更多
Brain lesions,such as those caused by stroke or traumatic brain injury(TBI),frequently result in persistent motor and cognitive impairments that significantly affect the individual patient's quality of life.Despit...Brain lesions,such as those caused by stroke or traumatic brain injury(TBI),frequently result in persistent motor and cognitive impairments that significantly affect the individual patient's quality of life.Despite differences in the mechanisms of injury,both conditions share a high prevalence of motor and cognitive impairments.These deficits show only limited natural recovery.展开更多
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
Tumor metabolic reprogramming is a core hallmark of cancer,characterized by pathways such as aerobic glycolysis,aberrant lipid metabolism,and glutaminolysis that support rapid proliferation and immunosuppressive micro...Tumor metabolic reprogramming is a core hallmark of cancer,characterized by pathways such as aerobic glycolysis,aberrant lipid metabolism,and glutaminolysis that support rapid proliferation and immunosuppressive microenvironments.Circular RNAs(circRNAs)are highly stable,evolutionarily conserved non-coding RNAs that have emerged as critical modulators of these metabolic shifts.This review aims to systematically elucidate the roles and mechanisms of circRNAs in reprogramming tumor metabolism,and to discuss their clinical potential as biomarkers and therapeutic targets.Through mechanisms including miRNA sponging,protein interactions,regulation of mitochondrial dynamics,and modulation of metabolic enzymes,circRNAs influence key metabolic pathways by targeting glycolytic enzymes,lipid synthesis regulators,and glutaminolysis-related molecules to either facilitate or inhibit their expression.This review systematically summarizes the unique contributions of circRNAs to tumor metabolic reprogramming,highlighting key mechanisms such as regulation of peptide-encoding protein translation,mitochondrial localization function,gene promoter-targeted transcriptional regulation,and cross-pathway metabolic mediation,which underscore their distinct biological advantages and regulatory roles in tumor metabolism.The stability and tissue specificity of circRNAs make them promising diagnostic biomarkers,while their role in drug resistance mediated by metabolic reprogramming highlights their potential as therapeutic targets.Strategies such as circRNA inhibitors,mimics,and nanoparticle-based delivery systems are being explored to modulate tumor metabolism.Despite challenges including complex regulatory networks and limited manipulation tools,advances in high-throughput technologies and clinical trials hold promise for translating circRNA research into novel cancer therapies.展开更多
Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological change...Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.展开更多
Background:Brain volume measurement serves as a critical approach for assessing brain health status.Considering the close biological connection between the eyes and brain,this study aims to investigate the feasibility...Background:Brain volume measurement serves as a critical approach for assessing brain health status.Considering the close biological connection between the eyes and brain,this study aims to investigate the feasibility of estimating brain volume through retinal fundus imaging integrated with clinical metadata,and to offer a cost-effective approach for assessing brain health.Methods:Based on clinical information,retinal fundus images,and neuroimaging data derived from a multicenter,population-based cohort study,the Kai Luan Study,we proposed a cross-modal correlation representation(CMCR)network to elucidate the intricate co-degenerative relationships between the eyes and brain for 755 subjects.Specifically,individual clinical information,which has been followed up for as long as 12 years,was encoded as a prompt to enhance the accuracy of brain volume estimation.Independent internal validation and external validation were performed to assess the robustness of the proposed model.Root mean square error(RMSE),peak signal-tonoise ratio(PSNR),and structural similarity index measure(SSIM)metrics were employed to quantitatively evaluate the quality of synthetic brain images derived from retinal imaging data.Results:The proposed framework yielded average RMSE,PSNR,and SSIM values of 98.23,35.78 d B,and 0.64,respectively,which significantly outperformed 5 other methods:multi-channel Variational Autoencoder(mcVAE),Pixelto-Pixel(Pixel2pixel),transformer-based U-Net(Trans UNet),multi-scale transformer network(MT-Net),and residual vision transformer(ResViT).The two-(2D)and three-dimensional(3D)visualization results showed that the shape and texture of the synthetic brain images generated by the proposed method most closely resembled those of actual brain images.Thus,the CMCR framework accurately captured the latent structural correlations between the fundus and the brain.The average difference between predicted and actual brain volumes was 61.36 cm~3,with a relative error of 4.54%.When all of the clinical information(including age and sex,daily habits,cardiovascular factors,metabolic factors,and inflammatory factors)was encoded,the difference was decreased to 53.89 cm~3,with a relative error of 3.98%.Based on the synthesized brain magnetic resonance images from retinal fundus images,the volumes of brain tissues could be estimated with high accuracy.Conclusion:This study provides an innovative,accurate,and cost-effective approach to characterize brain health status through readily accessible retinal fundus images.展开更多
Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic re...Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic review aims to outline the gut microbiome composition in individuals with CRC undergoing the same therapeutic regimen and evaluate interindividual microbiome profile variations to better understand how these differences may influence therapeutic outcomes.Methods:Key studies investigating the microbiome’s role in therapeutic approaches for CRC were searched in both PubMed and Cochrane databases on 12 and 22 March 2025,respectively.Eligible studies included free full-text English-language randomized clinical trials and human observational studies reporting on gut microbiome composition and treatment outcomes.RoB 2 and ROBINS-I were employed in the evaluation of bias for randomized trials and observational studies,respectively.Data extracted was narratively analyzed.Results:Six studies involving a total of 361 individuals were included.Therapeutic interventions,either standard treatments and/or those targeting the gut microbiome,generally increased probiotic taxa and reduced pro-carcinogenic bacteria.However,no consistent pattern of improved clinical outcomes was observed,suggesting that treatment mechanisms,the tumor’s nature,and individual characteristics play critical roles in microbiome modulation.Conclusion:The gut microbiome holds significant potential in clinical settings.Nonetheless,further research is needed to better understand its functional aspects and to consider the influence of treatment mechanisms,the tumor’s nature,and individual characteristics as modulators,in order to optimize clinical outcomes.展开更多
The growing recognition of the role of genetics in the development of amyotrophic lateral sclerosis is evident.However,there has yet to be a comprehensive analysis of the clinical characteristics and genetics of famil...The growing recognition of the role of genetics in the development of amyotrophic lateral sclerosis is evident.However,there has yet to be a comprehensive analysis of the clinical characteristics and genetics of familial amyotrophic lateral sclerosis in an Asian population.This study aimed to provide an in-depth analysis of the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinic-based cohort of patients from the Chinese mainland.Enrollment of 302 amyotrophic lateral sclerosis families from 28 provinces was undertaken from January 2008 to September 2023.A group-based trajectory model for disease progression based on amyotrophic lateral sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores was validated using bootstrap internal validation in patients with familial amyotrophic lateral sclerosis,as well as patients with sporadic amyotrophic lateral sclerosis(matched at a 1:4 ratio,with replacement).DNA samples from 244 index patients were screened for variants in the pathogenic genes SOD1,FUS,TDP43,and C9ORF72,of which 146 were also subjected to genome-wide next-generation sequencing.Gene-level burden analysis was used to evaluate the distribution of rare variants in the cohort.We found that rapid dynamic disease progression was associated with an older age at onset,shorter diagnostic delay,lower body mass index,bulbar onset,and≥1 affected first-degree relative.Certain attributes,such as age at onset and time from onset to diagnosis,had comparable impacts on the clinical progression trajectories of both familial amyotrophic lateral sclerosis and sporadic amyotrophic lateral sclerosis.Harboring pathogenic/likely pathogenic variants in amyotrophic lateral sclerosis-causative genes reduced the age of onset of familial amyotrophic lateral sclerosis.Among the patients with familial amyotrophic lateral sclerosis,17.8%possessed≥2 pathogenic/likely pathogenic variants.Sequencing kernel association test analysis showed that the SOD1 rare variant burden(P=1.3e-15)was associated with a significant risk of familial amyotrophic lateral sclerosis.Our findings conclusively confirmed the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinical cohort from China,contributing to a deeper understanding of genotype-phenotype relationships in familial amyotrophic lateral sclerosis.This comprehensive evaluation of specific clinical characteristics,clinical prognosis,and genetic variants of amyotrophic lateral sclerosis based on detailed clinical and genetic information may lead to the development of genotype-specific treatment approaches.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
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
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
Enrolling in clinical trials could be time-sensitive and time-demanding tasks for the research site, especially if it is a private research organization compared to the research conducted at an academic or medical cen...Enrolling in clinical trials could be time-sensitive and time-demanding tasks for the research site, especially if it is a private research organization compared to the research conducted at an academic or medical center. Every study differs in various aspects, such as phases, study indication, eligibility criteria, etc. In terms of meeting the enrollment deadline, typically, the study indication and availability of the patient’s population at the geographical area of the research site would decide if the trial could be time-consuming. Patient recruitment and retention are critical for the success of every clinical trial;however, worldwide, this area is facing tremendous pressure and challenges. Globally 55% of clinical trials terminated due to low recruitment, with an average enrollment success rate of 40% for Phase III and IV trials. Over 80% of clinical trial attempts fail to enroll, extending the study and adding new study sites. In the United States, more than 80% of clinical trials fail to achieve targeted patient enrollment, and 30% of study participants discontinue participation. This article reviewed various factors hindering clinical trial recruitment and retention and suggested strategies to make the research site successful.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
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
BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated l...BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.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
Malaria is considered one of the major causes of travel-related morbidity and mortality,especially among non-immune travelers from non-endemic countries to the endemic regions.According to a multicenter study from the...Malaria is considered one of the major causes of travel-related morbidity and mortality,especially among non-immune travelers from non-endemic countries to the endemic regions.According to a multicenter study from the GeoSentinel surveillance network,malaria was the most frequent cause of fever in 21%of returning travelers,followed by dengue,typhoid fever,chikungunya and rickettsiosis[1].Individuals traveling from regions without malaria transmission to areas where it is endemic face a heightened risk of contracting the disease due to their lack of immunity.Despite the official malaria-free status of the Russian Federation since 2010,annual cases of severe Plasmodium(P.)falciparum malaria continue to be reported[2].This underscores the necessity for heightened clinical vigilance and improved preventive strategies especially in non-endemic settings.展开更多
Hepatitis B virus(HBV)is a serious global public health concern.Although nucleoside drugs and interferons can significantly inhibit HBV replication,issues such as drug resistance and low clinical cure rates remain.Tra...Hepatitis B virus(HBV)is a serious global public health concern.Although nucleoside drugs and interferons can significantly inhibit HBV replication,issues such as drug resistance and low clinical cure rates remain.Traditional Chinese medicine(TCM)is widely used in the treatment of chronic hepatitis B(CHB)in China,with anti-inflammatory,anti-fibrotic,and liver-protective effects;however,reports on its antiviral effects are still inconsistent.We retrieved multicenter clinical studies and meta-analyses of TCM treatment for CHB over the past two decades.The results revealed that TCM has a certain anti-HBV effect,and when combined with antiviral drugs,it can significantly improve antiviral efficacy.It was demonstrated that TCM most effectively promotes serum HBV e antigen conversion to negative,followed by the ability to reduce HBV DNA levels,facilitating HBV surface antigen loss,and improving the treatment of CHB.展开更多
BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chine...BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.展开更多
基金Supported by General Project of Shanxi Administration of Traditional Chinese Medicine(2023ZYYA007&2024ZYY2D009)Young Scientists Project of Shanxi Provincial Department of Science and Technology(202203021212026)Scientific and Technological Innovation Capacity Cultivation Program for Basic and Clinical Cooperative Research Project of Shanxi University of Chinese Medicine(2024PY-JL-23-01).
文摘This study makes an in-depth exploration of the core pathogenesis of chronic atrophic gastritis,Qi Deficiency with Stagnation,to systematically interpret it within the theoretical framework of Achieving Central Harmony,and to provide a treatment plan.Professor Li Tingquan believes that the occurrence and development of chronic atrophic gastritis(CAG)is fundamentally a process of harmony imbalance of the spleen and stomach.Its specific manifestation lies in the interaction between qi deficiency and stagnation,namely,spleen deficiency as the root cause,and qi stagnation,phlegm-dampness,and blood stasis obstructing the middle energizer as the secondary manifestations.These factors are mutually causal and interact with one another.Based on this,he proposed a four-step method to treat the disease:eliminating pathogenic factors,harmonizing the spleen and stomach,activating blood circulation to resolve stasis,and tonifying the kidney to generate blood(metaphorically described as"closing the mountains to cultivate forests and thicken the soil,breeding seeds and irrigating for stomach recovery").This approach aims to restore the harmonious state of the middle energizer,providing a complete clinical framework of theory,principle,formula,and herbs for the prevention and treatment of CAG.
基金supported by Porsolt SAS,https://www.porsolt.com/.
文摘Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted therapy;however,their clinical benefits are limited.Therefore,developing new models to evaluate the therapeutic potential of novel molecules is essential.Fingolimod and Dimethyl Fumarate(DMF),currently used to treat multiple sclerosis,have recently been shown to have anti-cancer effects in several preclinical tumor models.This study aims to evaluate the therapeutic potential of Fingolimod and DMF in pancreatic cancer by investigating their respective in vitro cytotoxicity and in vivo antitumor effects.Methods:In this study,we evaluated for the first time these two drugs in pancreatic preclinical models in vitro using 3D spheroid tumor models and in vivo,which are compared to two standard-of-care consisting of Gemcitabine and Erlotinib.Results:In vitro,both Fingolimod and DMF induced cytotoxicity in spheroids from two pancreatic cell lines.Additionally,Fingolimod and DMF displayed anticancer effects in two subcutaneous xenograft models using PANC-1 and CFPAC-1 cells.Conclusions:Although the responses observed with Fingolimod and DMF were similar to those of Gemcitabine and Erlotinib,these findings indicate a potential emerging interest in Fingolimod and DMF for the treatment of pancreatic cancer.However,further work is still necessary to fully characterize how these drugs affect tumor progression.
基金supported by the Defitech Foundation(Morges,CH)to FCHthe Bertarelli Foundation-Catalyst program(Gstaad,CH)to FCH+2 种基金the Wyss Center for Bio and Neuroengineering the Lighthouse Partnership for AI-guided Neuromodulation to FCHthe Fonds de recherche du Quebec-Sante(FRQS#342969)to CEPthe Neuro X Postdoctoral Fellowship Program to CEP。
文摘Brain lesions,such as those caused by stroke or traumatic brain injury(TBI),frequently result in persistent motor and cognitive impairments that significantly affect the individual patient's quality of life.Despite differences in the mechanisms of injury,both conditions share a high prevalence of motor and cognitive impairments.These deficits show only limited natural recovery.
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funded by National Natural Science Foundation of China(82360801).
文摘Tumor metabolic reprogramming is a core hallmark of cancer,characterized by pathways such as aerobic glycolysis,aberrant lipid metabolism,and glutaminolysis that support rapid proliferation and immunosuppressive microenvironments.Circular RNAs(circRNAs)are highly stable,evolutionarily conserved non-coding RNAs that have emerged as critical modulators of these metabolic shifts.This review aims to systematically elucidate the roles and mechanisms of circRNAs in reprogramming tumor metabolism,and to discuss their clinical potential as biomarkers and therapeutic targets.Through mechanisms including miRNA sponging,protein interactions,regulation of mitochondrial dynamics,and modulation of metabolic enzymes,circRNAs influence key metabolic pathways by targeting glycolytic enzymes,lipid synthesis regulators,and glutaminolysis-related molecules to either facilitate or inhibit their expression.This review systematically summarizes the unique contributions of circRNAs to tumor metabolic reprogramming,highlighting key mechanisms such as regulation of peptide-encoding protein translation,mitochondrial localization function,gene promoter-targeted transcriptional regulation,and cross-pathway metabolic mediation,which underscore their distinct biological advantages and regulatory roles in tumor metabolism.The stability and tissue specificity of circRNAs make them promising diagnostic biomarkers,while their role in drug resistance mediated by metabolic reprogramming highlights their potential as therapeutic targets.Strategies such as circRNA inhibitors,mimics,and nanoparticle-based delivery systems are being explored to modulate tumor metabolism.Despite challenges including complex regulatory networks and limited manipulation tools,advances in high-throughput technologies and clinical trials hold promise for translating circRNA research into novel cancer therapies.
基金supported by the National Key Research and Development Program of China,No.2019YFA0111200the National Natural Science Foundation of China,Nos.U23A20436,82371047+3 种基金Key Research Project in Shanxi Province,No.202302130501008Shanxi Provincial Science Fund for Distinguished Young Scholars,No.202103021221008Key Research and Development Program in Shanxi Province,No.202204051001023Shanxi Medical University Doctor’s Startup Fund Project,No.SD22028(all to YG)。
文摘Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.
基金supported by the National Natural Science Foundation of China(62522119 and 62372358)the Beijing Natural Science Foundation(7242267)+2 种基金the Beijing Scholars Program([2015]160)the Natural Science Basic Research Program of Shaanxi(2023-JC-QN-0719)the Guangdong Basic and Applied Basic Research Foundation(2022A1515110453)。
文摘Background:Brain volume measurement serves as a critical approach for assessing brain health status.Considering the close biological connection between the eyes and brain,this study aims to investigate the feasibility of estimating brain volume through retinal fundus imaging integrated with clinical metadata,and to offer a cost-effective approach for assessing brain health.Methods:Based on clinical information,retinal fundus images,and neuroimaging data derived from a multicenter,population-based cohort study,the Kai Luan Study,we proposed a cross-modal correlation representation(CMCR)network to elucidate the intricate co-degenerative relationships between the eyes and brain for 755 subjects.Specifically,individual clinical information,which has been followed up for as long as 12 years,was encoded as a prompt to enhance the accuracy of brain volume estimation.Independent internal validation and external validation were performed to assess the robustness of the proposed model.Root mean square error(RMSE),peak signal-tonoise ratio(PSNR),and structural similarity index measure(SSIM)metrics were employed to quantitatively evaluate the quality of synthetic brain images derived from retinal imaging data.Results:The proposed framework yielded average RMSE,PSNR,and SSIM values of 98.23,35.78 d B,and 0.64,respectively,which significantly outperformed 5 other methods:multi-channel Variational Autoencoder(mcVAE),Pixelto-Pixel(Pixel2pixel),transformer-based U-Net(Trans UNet),multi-scale transformer network(MT-Net),and residual vision transformer(ResViT).The two-(2D)and three-dimensional(3D)visualization results showed that the shape and texture of the synthetic brain images generated by the proposed method most closely resembled those of actual brain images.Thus,the CMCR framework accurately captured the latent structural correlations between the fundus and the brain.The average difference between predicted and actual brain volumes was 61.36 cm~3,with a relative error of 4.54%.When all of the clinical information(including age and sex,daily habits,cardiovascular factors,metabolic factors,and inflammatory factors)was encoded,the difference was decreased to 53.89 cm~3,with a relative error of 3.98%.Based on the synthesized brain magnetic resonance images from retinal fundus images,the volumes of brain tissues could be estimated with high accuracy.Conclusion:This study provides an innovative,accurate,and cost-effective approach to characterize brain health status through readily accessible retinal fundus images.
基金supported by FCT/MCTES UIDP/05608/2020(https://doi.org/10.54499/UIDP/05608/2020)UIDB/05608/2020(https://doi.org/10.54499/UIDB/05608/2020).
文摘Background:The Colorectal Cancer(CRC)pathogenesis and therapeutic efficacy are influenced by the gut microbiome,making it a promising biomarker for predicting treatment responses and adverse effects.This systematic review aims to outline the gut microbiome composition in individuals with CRC undergoing the same therapeutic regimen and evaluate interindividual microbiome profile variations to better understand how these differences may influence therapeutic outcomes.Methods:Key studies investigating the microbiome’s role in therapeutic approaches for CRC were searched in both PubMed and Cochrane databases on 12 and 22 March 2025,respectively.Eligible studies included free full-text English-language randomized clinical trials and human observational studies reporting on gut microbiome composition and treatment outcomes.RoB 2 and ROBINS-I were employed in the evaluation of bias for randomized trials and observational studies,respectively.Data extracted was narratively analyzed.Results:Six studies involving a total of 361 individuals were included.Therapeutic interventions,either standard treatments and/or those targeting the gut microbiome,generally increased probiotic taxa and reduced pro-carcinogenic bacteria.However,no consistent pattern of improved clinical outcomes was observed,suggesting that treatment mechanisms,the tumor’s nature,and individual characteristics play critical roles in microbiome modulation.Conclusion:The gut microbiome holds significant potential in clinical settings.Nonetheless,further research is needed to better understand its functional aspects and to consider the influence of treatment mechanisms,the tumor’s nature,and individual characteristics as modulators,in order to optimize clinical outcomes.
基金supported by the Natural Science Foundation of Beijing,Nos.7244428(to WZ)and 7222215(to JH)the Peking University Medicine Sailing Program forYoung Scholars’Scientific and Technological Innovation,No.BMU2023YFJHPY034(to WZ)+4 种基金the National Natural Science Foundation of China,Nos.81873784,82071426(to DF),and81974197(to JH)the Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(to DF)Beijing Physician-Scientist TrainingProgram,No.BJPSTP-2024-03(to JH)the China Postdoctoral Science Foundation,Nos.2022TQ0014(to LX),2022M720284(to LX)the E-Town Cooperation&Development Foundation,No.YCXJ-JZ-2023-017(to LX).
文摘The growing recognition of the role of genetics in the development of amyotrophic lateral sclerosis is evident.However,there has yet to be a comprehensive analysis of the clinical characteristics and genetics of familial amyotrophic lateral sclerosis in an Asian population.This study aimed to provide an in-depth analysis of the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinic-based cohort of patients from the Chinese mainland.Enrollment of 302 amyotrophic lateral sclerosis families from 28 provinces was undertaken from January 2008 to September 2023.A group-based trajectory model for disease progression based on amyotrophic lateral sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores was validated using bootstrap internal validation in patients with familial amyotrophic lateral sclerosis,as well as patients with sporadic amyotrophic lateral sclerosis(matched at a 1:4 ratio,with replacement).DNA samples from 244 index patients were screened for variants in the pathogenic genes SOD1,FUS,TDP43,and C9ORF72,of which 146 were also subjected to genome-wide next-generation sequencing.Gene-level burden analysis was used to evaluate the distribution of rare variants in the cohort.We found that rapid dynamic disease progression was associated with an older age at onset,shorter diagnostic delay,lower body mass index,bulbar onset,and≥1 affected first-degree relative.Certain attributes,such as age at onset and time from onset to diagnosis,had comparable impacts on the clinical progression trajectories of both familial amyotrophic lateral sclerosis and sporadic amyotrophic lateral sclerosis.Harboring pathogenic/likely pathogenic variants in amyotrophic lateral sclerosis-causative genes reduced the age of onset of familial amyotrophic lateral sclerosis.Among the patients with familial amyotrophic lateral sclerosis,17.8%possessed≥2 pathogenic/likely pathogenic variants.Sequencing kernel association test analysis showed that the SOD1 rare variant burden(P=1.3e-15)was associated with a significant risk of familial amyotrophic lateral sclerosis.Our findings conclusively confirmed the clinical features and genetic spectrum of familial amyotrophic lateral sclerosis over 15 years in a clinical cohort from China,contributing to a deeper understanding of genotype-phenotype relationships in familial amyotrophic lateral sclerosis.This comprehensive evaluation of specific clinical characteristics,clinical prognosis,and genetic variants of amyotrophic lateral sclerosis based on detailed clinical and genetic information may lead to the development of genotype-specific treatment approaches.
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 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.
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Enrolling in clinical trials could be time-sensitive and time-demanding tasks for the research site, especially if it is a private research organization compared to the research conducted at an academic or medical center. Every study differs in various aspects, such as phases, study indication, eligibility criteria, etc. In terms of meeting the enrollment deadline, typically, the study indication and availability of the patient’s population at the geographical area of the research site would decide if the trial could be time-consuming. Patient recruitment and retention are critical for the success of every clinical trial;however, worldwide, this area is facing tremendous pressure and challenges. Globally 55% of clinical trials terminated due to low recruitment, with an average enrollment success rate of 40% for Phase III and IV trials. Over 80% of clinical trial attempts fail to enroll, extending the study and adding new study sites. In the United States, more than 80% of clinical trials fail to achieve targeted patient enrollment, and 30% of study participants discontinue participation. This article reviewed various factors hindering clinical trial recruitment and retention and suggested strategies to make the research site successful.
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.
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.
基金Supported by the Foundation of Health Commission of Hubei Province,No.WJ2019H053Natural Science Foundation of Hubei Province,No.2023AFB169+1 种基金Foundation of Health Commission of Hubei Province,No.ZY2021Q019Open Fund Hubei Provincial Clinical Research Center for Umbilical Cord Blood Hematopoietic Stem Cells,Taihe Hospital,No.2024SCOF008.
文摘BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.
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Malaria is considered one of the major causes of travel-related morbidity and mortality,especially among non-immune travelers from non-endemic countries to the endemic regions.According to a multicenter study from the GeoSentinel surveillance network,malaria was the most frequent cause of fever in 21%of returning travelers,followed by dengue,typhoid fever,chikungunya and rickettsiosis[1].Individuals traveling from regions without malaria transmission to areas where it is endemic face a heightened risk of contracting the disease due to their lack of immunity.Despite the official malaria-free status of the Russian Federation since 2010,annual cases of severe Plasmodium(P.)falciparum malaria continue to be reported[2].This underscores the necessity for heightened clinical vigilance and improved preventive strategies especially in non-endemic settings.
基金Supported by The Funding of Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences,No.CI2021A00810The Escort Project of Guang’anmen Hosital,China Academy of Chinese Medical Science-Backbone Talent Cultivation Project,No.9323013。
文摘Hepatitis B virus(HBV)is a serious global public health concern.Although nucleoside drugs and interferons can significantly inhibit HBV replication,issues such as drug resistance and low clinical cure rates remain.Traditional Chinese medicine(TCM)is widely used in the treatment of chronic hepatitis B(CHB)in China,with anti-inflammatory,anti-fibrotic,and liver-protective effects;however,reports on its antiviral effects are still inconsistent.We retrieved multicenter clinical studies and meta-analyses of TCM treatment for CHB over the past two decades.The results revealed that TCM has a certain anti-HBV effect,and when combined with antiviral drugs,it can significantly improve antiviral efficacy.It was demonstrated that TCM most effectively promotes serum HBV e antigen conversion to negative,followed by the ability to reduce HBV DNA levels,facilitating HBV surface antigen loss,and improving the treatment of CHB.
基金supported by the National High Level Hospital Clinical Research Funding(2025-GSP-QN-31&2022-GSP-QN-1)the Young Talent Program of the Academician Fund(YS-2022-002)the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)(2023-I2M-1-002)。
文摘BACKGROUND As the global population ages,the number of elderly patients with acute coronary syndrome(ACS)rises.However,prognostic assessment tools for elderly patients with ACS remain lacking,particularly in the Chinese population.This study aimed to develop and validate a nomogram to predict 2-year major adverse cardiovascular and cerebrovascular events(MACCE)in elderly Chinese patients with ACS.METHODS A retrospective analysis was conducted using two independent cohorts of ACS patients aged≥65 years who underwent percutaneous coronary intervention:the derivation cohort(n=1674)and the validation cohort(n=2333).Candidate predictors were selected using multivariable Cox proportional hazards regression and the Akaike information criterion.A final nomogram incorporating ten variables was constructed.Model performance was evaluated in terms of discrimination[concordance index(C-index)and area under the receiver operating characteristic curve(AUC)]and calibration(calibration plots).RESULTS The 2-year incidence of MACCE was 12.5%(n=210)in the derivation cohort and 15.6%(n=364)in the validation cohort.The nomogram demonstrated good discrimination,with C-index values of 0.727 and 0.661 and AUCs of 0.723 and 0.699 in the derivation cohort and the validation cohort,respectively;significantly outperforming the GRACE risk score(P<0.001).Calibration plots showed good agreement between the predicted and observed outcomes.Patients classified as the high-risk group by the nomogram had a significantly higher MACCE incidence compared to that of the low-risk group(log-rank P<0.001).CONCLUSIONS This newly developed nomogram provides a reliable tool for individualized prediction of the 2-year MACCE risk in elderly Chinese patients with ACS who underwent percutaneous coronary intervention.It outperformed the GRACE score in both discrimmination and calibration and may help improve clinical decision-making and personalized risk stratification in this vulnerable population.
