Table of Content

05 October 2025, Volume 45 Issue 10

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Special Issues:Treatment of elderly cancer patients

Difficulties and experience in the treatment of elderly cancer patients

GUAN Mei

2025, 45(10):  1261-1261.  doi:10.16352/j.issn.1001-6325.2025.10.1261

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Challenges and management strategies of anti-tumor treatment for renal insufficiency in elderly patients with malignant tumors

ZENG Chengyu, QIU Wei, SONG Hua, GUO Xinying, YING Hongyan

2025, 45(10):  1262-1269.  doi:10.16352/j.issn.1001-6325.2025.10.1262

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The incidence of malignant tumors among elderly patients is increasing. Influenced by multiple factors such as aging, tumor, and drug, this population exhibits a high prevalence of renal insufficiency. However, there remains a scarcity of research data and significant challenges in clinical management. This article systematically analyzes the challenges faced in administering anti-tumor therapies to elderly patients with renal insufficiency and proposes management strategies. Optimization approaches include precise assessment of renal function, selection of nephrotoxicity-sparing medications, appropriate dose adjustments, implementation of preventive measures, and emphasis on comprehensive geriatric assessment and multidisciplinary collaboration. Renal injury management should be individualized, with considerations for special populations such as renal transplant recipients and dialysis patients. Future efforts should focus on biomarker discovery and the development of low-nephrotoxicity therapeutic agents to address these complex clinical challenges.

Treatment of antibody-drug conjugates in elderly patients

LIU Fengshuo, GUAN Mei

2025, 45(10):  1270-1276.  doi:10.16352/j.issn.1001-6325.2025.10.1270

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Antibody-drug conjugates(ADCs) are emerging anti-cancer drugs that have been widely applied in the treatment of hematological and solid tumors. ADCs deliver cytotoxic drugs to tumor cells with precision through antibody targeting, enhancing efficacy while reducing side effects. Elderly cancer patients face treatment challenges due to factors such as drug metabolism, multiple comorbidities and decreased physical function. However, ADCs have therapeutic advantages in elderly patients. The article discusses the efficacy, safety, dosing strategies, and adverse reaction management of ADCs in elderly patients, in order to provide effective and safe treatment options for elderly cancer patients.

Impact of a modified CARG model guiding anticancer drug dose adjustments on adverse events in elderly cancer patients

GE Yuping, HUA Yuwei, WANG Lina, HOU Xiufeng, SONG Hua, GUO Xinying, ZHANG Yuan, WANG Yanan, GUAN Mei

2025, 45(10):  1277-1283.  doi:10.16352/j.issn.1001-6325.2025.10.1277

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Objective To evaluate the clinical value of a modified Cancer and Aging Research Group(CARG) model in guiding anticancer drug dose adjustments for elderly cancer patients in China. Methods This prospective study enrolled patients aged ≥65 years with solid tumors at the Department of Oncology, Peking Union Medical College Hospital from September 1, 2022 to October 29, 2023. All patients underwent comprehensive geriatric assessment(CGA) and CARG risk scoring, and were stratified into low-, intermediate-, and high-risk groups. Anticancer drug doses(including chemotherapy, targeted therapy or immunotherapy) were reduced proportionally based on CARG risk stratification and treatment intent(curative vs. palliative). Treatment outcomes and adverse events(AEs) were recorded regularly. Fisher's Exact Test compared AE incidence between the CARG-guided dose adjustment group(experimental) and the physician-experience-guided dose adjustment group(control). Receiver operating characteristic(ROC) curve analysis was used to assess the predictive value of the CARG model for severe toxicity. Results Among 166 enrolled patients(median age: 71 years[range: 65-90]; 78.3% were male; 68.7% had gastrointestinal cancers; 69.3% had stage Ⅳ), 95 were assigned to the experimental group(CARG low-risk: 24[25.3%], intermediate-risk: 51 [53.7%], high-risk: 20[21.0%]) and 71 were included into the control group. By December 31, 2024, 81 patients experienced disease progression and 10 patients died. Overall AE rates was 92.6% in the experimental group and 94.4% in the control group, while grade ≥3 AEs were recorded in 45.3% vs. 43.7%, respectively(both P＞0.05). Conclusions The modified CARG model-guided dose adjustment strategy achieved comparable safety to empirical dose adjustment, which is in line with the individualized treatment paradigm for elderly cancer patients, representing a structured framework for optimizing therapeutic decision-making in geriatric oncology.

Original Articles

Activation of STAU1-mediated mRNA decay pathway in brown adipose tissue of mice by acute cold stress

GUO Zihao, WAN Mengyao, NIE Shiqi, LIANG Xiaodi

2025, 45(10):  1284-1290.  doi:10.16352/j.issn.1001-6325.2025.10.1284

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Objective To investigate the effect of acute cold stimulation on the staufen1-mediated mRNA decay(SMD) pathway in brown adipose tissue of mice and the downstream regulated target genes. Methods Mice were subjected to acute cold stimulation (CS) at 4 ℃. After 48 hours, the brown adipose tissue of mice was extracted to detect the expression of genes including as Stau1, Ucp1 and Pparγ, and compared with mice in room temperature control group (RT). Transcriptomic sequencing was performed on the brown adipose tissue of mice in the CS group and in the RT group, and the functional enrichment analysis of differential genes was performed on the sequencing results. The Stau1 gene was knocked out in the brown adipocytes of mice using CRISPR-Cas9 technology, and the expression of thermogenic genes after knockout was analyzed. Results Acute cold stimulation induced the expression of Stau1 gene and promoted the degradation of downstream target genes Serpineb1, Klf2 and c-Jun in the SMD pathway(P＜0.05). After Stau1 knockout, the glycolipid metabolism pathway of brown adipocytes in mice was significantly up-regulated, and the expression of thermogenesis-related genes Ucp1, Prdm16, ATP5o, Dio2 and Pgc1α was up-regulated (P＜0.05). Conclusions Acute cold stimulation promotes the SMD pathway in brown adipose tissue of mice, and SMD pathway mainly regulates the metabolic and thermogenic pathways in brown adipocytes.

Echinacoside attenuates liver injury in a rat model of hepatitis B

WANG Wei, MU Baolong, ZHANG Wenshuang, WU Qinglei

2025, 45(10):  1291-1297.  doi:10.16352/j.issn.1001-6325.2025.10.1291

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Objective To investigate the effect of Echinacoside (Ech) on liver injury in hepatitis B rats. Methods SD rats were divided into control group, Hepatitis B (HBV, 5 mL/kg HBV virus was injected into the tail vein twice a week for 3 consecutive weeks), low (Ech-L) and high (Ech-H) doses of Ech were injected into the stomach for HBV (8.33 and 33.32 mg/kg, respectively), HBV group was treated with positive drugs (lamivudine, 10 mg/kg) and Ech-H+BKM120 (40 mg/kg BKM120), with 12 animals in each group. The drug was administered once a day for 8 weeks. The activity of ALT and AST in serum of were detected. Serum level of gamma-interferon (IFN-γ) and interleukin (IL-4) was detected by ELISA; Flow cytometry was applied to detect Th1/Th2 in peripheral blood; Chromatin immunoprecipitation was applied to detect HBV DNA expression in liver tissue; HE staining was used to detect the pathological changes of liver tissue and score the damage; Western blot was applied to detect phosphorylated phosphatidylinositol 3 kinase (p-PI3K), phosphorylated protein kinase B (p-AKT) proteins in liver tissue. Results Compared with the control group, hepatocytes in the hepatitis B group were swollen,nuclear staining was excessive, hepatic lobular structure was disorganized, pathological injury score, serum AST, ALT activity, IL-4 level, peripheral blood Th2, HBV DNA expression in liver tissue were all increased. Serum IFN-γ level, Th1, Th1/Th2 in peripheral blood, p-PI3K and p-AKT protein in liver tissue were all decreased (P＜0.05); Treatment with Ech-L, Ech-H and lamivudine reduced the swelling of HBV rat hepatocytes, cleared the structure of some liver cords, reduced pathological injury score, the activity of AST, ALT and IL-4 levels in serum, Th2 in peripheral blood and HBV DNA in liver tissue; The level of serum IFN-γ, Th1, Th1/Th2 in peripheral blood, and protein expression p-PI3K and p-AKT protein in liver tissue were increased (P＜0.05). BKM120 attenuated the ameliorative effect of high-dose Ech on hepatitis B-induced liver injury in rats. Conclusions Ech ameliorates liver injury in rats with hepatitis B, and the mechanism may be related to the activation of the PI3K/AKT pathway.

Silencing LINC00460 inhibits proliferation and migration of human lung adenocarcinoma cell lines via EZH2

ZENG Cimei, HUANG Denggao, WANG Lei, LIANG Haimei, MA Ximiao

2025, 45(10):  1298-1305.  doi:10.16352/j.issn.1001-6325.2025.10.1298

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Objective To investigate the expression of long non-coding RNA LINC00460 in lung adenocarcinoma (LUAD) and its effects on cell proliferation and migration. Methods Quantitative real-time polymerase chain reaction (RT-qPCR) was used to detect the expression of LINC00460 in LUAD cell lines (PC-9,A549,NCI-H1975 and H1299) and normal lung cell line (MRC-5). LINC00460 was silenced in A549 and H1299 cells using small interfering RNA (siRNA), followed by cell proliferation assessment with CCK-8 assay and evaluation of cell migration capacity through the Transwell assay. Fluorescence in situ hybridization (FISH) and RNA immunoprecipitation (RIP) assays were performed to determine the subcellular localization of LINC00460 and its interaction with EZH2. Western blot was applied to examine EZH2 and H3K27me3 expression in cells. Results LINC00460 was highly expressed in LUAD cells, and the expression level was significantly decreased after silencing (P＜0.001). Silencing LINC00460 markedly inhibited the proliferation and migration of A549 and H1299 cells (P＜0.001). LINC00460 was primarily localized in the nucleus. RIP assays confirmed a significant interaction between LINC00460 and EZH2 (P＜0.001). Furthermore, the silencing of LINC00460 resulted in a significant reduction in the expression of EZH2 and its downstream target H3K27me3 (P＜0.001). Conclusions LINC00460 is highly expressed in LUAD cells. Silencing LINC00460 inhibits cell proliferation and migration through EZH2. This mechanism provides a basis for LINC00460 as a potential therapeutic target in lung adenocarcinoma.

Protocatechuic acid alleviates colon injury in ulcerative colitis rats

LI Ercui, LI Weizhi, HAN Ning, CHEN Si, FAN Huijuan

2025, 45(10):  1306-1312.  doi:10.16352/j.issn.1001-6325.2025.10.1306

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Objective To investigate the effect of protocatechuic acid (PCA) on Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signal pathway in rats with ulcerative colitis (UC). Methods After modeling, rats were divided into control group, model group (5% trinitrobenzene sulfonic acid (TNBS) induction), low (L-PCA), middle (M-PCA), high (H-PCA) dose protocatechuic acid group (rats were given with PCA at doses of 20, 40 and 80 mg/kg respectively), and intervention model group (LPS, rats were given with PCA at doses of 80 mg/kg and 0.8 mg/kg LPS solution intraperitoneally), and 12 rats in each group were given the drug continuously for 14 days. After treatment, rats were evaluated by disease activity index (DAI), and the morphology and apoptosis of colon were observed by hematoxylin eosin (HE) staining and TUNEL staining. The protein levels of Occludin, Zona occludens 1 (ZO-1), claudin-1, Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-10, TLR4 and p-p65/p65 in colon were detected by Western blotting. The expression of TLR4 protein in colon was detected by immunohistochemical staining. Results Compared with control group, the colon of model group rat showed obvious injury, DAI score and positive rate of TUNEL were increased (P＜0.05), the relative protein expression of TNF-α, IL-1β, TLR4 and p-p65 were increased (P＜0.05), the relative protein expression of Occludin, ZO-1, claudin-1 and IL-10 were decreased (P＜0.05). Compared with model group, colonic injury was alleviated in L-PCA, M-PCA and H-PCA groups, DAI score and positive rate of TUNEL were decreased (P＜0.05), the relative protein expression of TNF-α, IL-1β, TLR4 and p-p65 were decreased (P＜0.05), the relative protein expression of Occludin, ZO-1, claudin-1 and IL-10 were increased (P＜0.05). Compared with H-PCA group, colon injury was aggravated in LPS group, DAI score and positive rate of TUNEL were increased (P＜0.05), the relative protein expression of TNF-α, IL-1β, TLR4 and p-p65 was increased (P＜0.05), the relative protein expression of Occludin, ZO-1, claudin-1 and IL-10 was decreased (P＜0.05). Conclusions Protocatechuic acid can alleviate TNBS-induced colon injury in UC rats, improve intestinal barrier function, and inhibit colon inflammatory response, the mechanism of which is related to the activation of TLR4/NF-κB signaling pathway.

Distribution difference of T lymphocyte subsets in common and refractory mycoplasma pneumonia and its impact on clinical treatment

ZHU Lin, FU Shuqin, JIA Wanyu, GUO Caili, SONG Chunlan

2025, 45(10):  1313-1317.  doi:10.16352/j.issn.1001-6325.2025.10.1313

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Objective To investigate the distribution difference of T lymphocyte subsets in common and refractory mycoplasma pneumonia and its impact on treatment. Methods Two hundred children with mycoplasma pneumonia hospitalized from October 2023 to January 2024 were retrospectively reviewed and divided into common mycoplasma pneumonia group and refractory mycoplasma pneumonia group (n=100 each) according to the severity of disease and treatment. The distribution of T cell immunophenotypes CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were compared between common mycoplasma pneumonia and refractory mycoplasma pneumonia. The predictive value of CD4⁺, CD8⁺ counting, CD4⁺/CD8⁺ and combined detection on the occurrence of refractory mycoplasma pneumonia were analyzed. Results Compared with the common mycoplasma pneumonia group, the refractory mycoplasma pneumonia group had more school-age children, longer fever duration and hospital stay (P＜0.05). Compared with the common mycoplasma pneumonia group, CD4⁺ expression was slightly decreased in the refractory mycoplasma pneumonia group, but there was no statistical significance between the two groups;CD8⁺ expression was significantly increased while CD4⁺/CD8⁺ expression was significantly decreased (P＜0.05). Receiver operating characteristic curve (ROC) showed that CD4⁺ (AUC=0.532, 95% CI=0.455-0.608), CD8⁺ (AUC=0.592, 95% CI=0.515-0.666), CD4⁺/CD8⁺ (AUC=0.579, 95% CI=0.502-0.653) and combined detection (AUC=0.607, 95% CI=0.531-0.680). Conclusions Compared with the common mycoplasma pneumonia group, CD4⁺ expression is slightly decreased, CD8⁺ expression is significantly increased, and CD4⁺/CD8⁺ expression is significantly decreased in the refractory mycoplasma pneumonia group. All these indicators hold certain value in predicting the occurrence of refractory mycoplasma pneumonia, with combined detection demonstrating higher predictive value.

METTL3 regulates ferroptosis and malignant progression of cervical cancer cells through mediating TRPM7 methylation

FU Miao, LIU Peng, TIAN Wen, WANG Sha, YIN Xiaomei, LIU Hao, WANG Donghai

2025, 45(10):  1318-1325.  doi:10.16352/j.issn.1001-6325.2025.10.1318

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Objective Methyltransferase 3(METTL3) mediated N6-methyladenosine (m6A) methylation modifica-tion of transient receptor potential cation channel subfamily M member 7(TRPM7) regulates ferroptosis and malignant progression in cervical cancer(CESC). Methods Totally 40 patients with cervical cancer were collected. Cervical cancer tissues and adjacent normal tissues(≥3 cm from the edge of the tumor tissue) were sampled at operation and then divided into experimental group and control group, respectively. RT-qPCR and Western blot were used to detect the differences in TRPM7 mRNA and protein expression between the two groups. TRPM7-interfering cell lines were constructed to investigate the effects of TRPM7 on CESC cells. Cell proliferation and apoptosis were assessed using 5-ethynyl-2'-deoxyuridine (EdU) assay and flow cytometry, respectively. Transwell chamber assays were employed to evaluate cell invasion and migration capabilities. The levels of ferroptosis in CESC cells were measured using kits for reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH), and Fe²⁺. Bioinformatics tools were utilized to predict methyltransferases associated with TRPM7. The interaction between METTL3 and TRPM7 was examined through RNA immunoprecipitation (RIP) and methylated RNA immunoprecipitation quantitative PCR (Me-RIP qPCR). The effect of METTL3 on the stability of TRPM7 expression was assessed using actinomycin D assay. Results TRPM7 was highly expressed in CESC tissue and cells. Knockdown of TRPM7 significantly inhibited cell proliferation, promoted cell apoptosis, suppressed cell migration and invasion capabilities, and enhanced ferroptosis levels (P＜0.05). Bioinformatics predictions suggested that METTL3 might act as a methyltransferase for TRPM7. Interference with METTL3 gene expression significantly reduced TRPM7 protein levels, decreased TRPM7 m6A modification levels, and impaired TRPM7 gene stability (P＜0.05). Conclusions METTL3 regulates CESC proliferation, apoptosis, migration, invasion, and ferroptosis by m6A methylation modification of the TRPM7 gene.

Atractylenolide Ⅰ mitigates the inflammatory response in a rat model of dextransulfate sodium-induced chronic colitis

MOU Zhongyan, LIU Zhimin, ZHU Shuguang

2025, 45(10):  1326-1332.  doi:10.16352/j.issn.1001-6325.2025.10.1326

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Objective To investigate the effect of Atractylenolide Ⅰ(AtraⅠ) on chronic colitis rats by regulation of cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA)/ cAMP response binding protein (CREB) pathway. Methods Rats were randomly divided into control group, chronic colitis model group[model, free feeding with 2% dextran sulfate sodium (DSS) followed by 7 days of conventional drinking water alternatively for 42 days], AtraⅠ low (AtraⅠ-L, 8.33 mg/kg AtraⅠ) and high (AtraⅠ-H, 33.32 mg/kg AtraⅠ) intervention model group, positive drug (mesalazine) group (150 mg/kg mesalazine) and high concentration of AtraⅠ+cAMP inhibitor (SQ22536) group (33.32 mg/kg AtraⅠ+ 2.13 mg/kg SQ22536), 18 rats in each group. Disease activity index (DAI) and colon length were measured. HE staining was applied to detect pathological changes in colon tissue. Immunohistochemical staining was applied to detect the expression of zonula occluden-1(ZO-1) and mucin 2(MUC2) in colon tissue. ELISA was applied to detect level of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10 and cAMP in colon tissue. Western blot was applied to detect p-PKA and p-CREB proteins in colon tissue. Results Compared with the control group, the colon wall of the model group was edema and thickened, the number of inflammatory cell infiltration was increased, the colon length was shortened. DAI score and TNF-α and IL-6 level in the colon tissue were increased. The positive expression of MUC2 and ZO-1, the level of IL-10 and the protein of cAMP, p-PKA and p-CREB in colon tissues were decreased (P＜0.05). Compared with model group, the pathological damage of colon tissue in AtraⅠ-L group, AtraⅠ-H group, and mesalazine group was alleviated, the colon length increased, the DAI score reduced, level of TNF-α and IL-6 in colon tissue reduced and the positive expression of MUC2 and ZO-1, level of IL-10, and cAMP, p-PKA, and p-CREB proteins in colon tissue were all elevated (P＜0.05). SQ22536 attenuated the improvement effect of AtraⅠ-H on intestinal mucosal barrier function and the inhibitory effect on inflammatory response in rats with chronic colitis. Conclusions AtraⅠ improves intestinal mucosal barrier function and inhibits inflammation in rats with chronic colitis, and its mechanism may be related to the upregulation of the cAMP/PKA/CREB pathway.

Plantamajoside inhibits proliferation and invasion of human gastric cancer cell line BGC823

DU Honglei, ZHANG Feng, GUO Haiyan, XU Ning, WU Zhen

2025, 45(10):  1333-1340.  doi:10.16352/j.issn.1001-6325.2025.10.1333

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Objective To explore the effects of plantamajoside on the proliferation and invasion of human gastric cancer cell line BGC823. Methods BGC823 cells were randomly separated into a control group, a plantamajoside group, an AAV-NC (transfection of empty plasmids packaged with lentivirus) group and a plantamajoside+AAV-HIF-1α(transfection of HIF-1α overexpression plasmid packaged with lentivirus) group. Cell proliferation, invasion, apoptosis, the numbers of vascular mimicry (VM) lumens and vascular branches, the expression of proliferation, apoptosis, epithelial mesenchymal transition (EMT) related proteins, HIF-1α/VEGF pathway proteins of cells were all examined. Results Compared with control group, the BGC823 cell viability, colony formation number, invasion number,VM lumen number, vascular branch number, and expression of Ki-67, PCNA, vimentin, MMP9, Snail, VEGFA, VE-cadhering, HIF-1α and VEGF protein were all lower in plantamajoside group(P＜0.05). The apoptosis rate, the cleaved Caspase-3, Bax, and E-cadherin protein expression were significantly increased (P＜0.05). Compared with plantamajoside group, the BGC823 cell viability, colony formation number, invasion number, VM lumen number, vascular branch number, and expression of Ki-67, PCNA, vimentin, MMP9, Snail, VEGFA, VE-cadherin, HIF-1α and VEGF protein were higher in the plantamajoside+AAV-HIF-1α group(P＜0.05). The apoptosis rate, the cleaved caspase-3, Bax, and E-cadherin protein expression were lower(P＜0.05). Conclusions Plantamajoside inhibits proliferation, EMT, invasion, and VM of human gastric cancer cell line and induce its apoptosis.

Down-regulation of METTL3 reduces Hcy-induced macrophage M1 polarization and foaminess

LIANG Yu, LI Junhong, WANG Jianqiong, WEI Li, JIANG Jie, WANG Mingyuan, SU Min

2025, 45(10):  1341-1349.  doi:10.16352/j.issn.1001-6325.2025.10.1341

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Objective To investigate the regulation of macrophage polarization and foaminess by homocysteine (Hcy) and its potential underlying mechanisms. Methods ELISA and flow cytometry were used to detect the effect of Hcy treatment on the polarization of macrophages. The contents of various forms of intracellular cholesterol were detected, and the effects of Hcy on intracellular lipid accumulation and ox-LDL uptake were evaluated by oil red O staining and Dil-oxLDL. RT-qPCR and Western blot were used to detect mRNA and protein expression of key genes modified by N6-methyladenosine(m⁶A). Results Hcy promoted M1 polarization of macrophages and ox-LDL-induced foam macrophages and promoted ox-LDL uptake as well as intracellular lipid accumulation. In addition, Hcy upregulated methyltransferase like 3 (METTL3) expression, and the tendency of Hcy to promote macrophage M1 polarization and foaminess was markedly reduced after inhibition or knockdown of METTL3 expression. Conclusions Hcy significantly promotes macrophage M1 polarization and foaminess, an effectthat may be attenuated by METTL3 silencing.

Diagnostic value of T-SPOT.TB combined with XpertMTB/RIF in elderly AIDS patients with Mycobacterium tuberculosis infection

CAO Yawei, ZHOU Baocang, WANG Qian, WANG Cunli, LIU Can, LIU Changli

2025, 45(10):  1350-1355.  doi:10.16352/j.issn.1001-6325.2025.10.1350

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Objective Exploring the diagnostic value of T-cell enzyme-linked immunospot assay (T-SPOT.TB) combined with rifampicin-resistant Mycobacterium tuberculosis real-time fluorescence quantitative nucleic acid amplification detection (XpertMTB/RIF) in geriatric AIDS patients with Mycobacterium tuberculosis(MTB) infection. Methods From May 2022 to May 2024, 86 elderly patients with AIDS suspected MTB in Hengshui Third People's Hospital were gathered and separated into AIDS complicated with MTB (research group) and AIDS without MTB (control group) according to the pathological examination results. MTB culture, T-SPOT.TB and XpertMTB/RIF were performed. Kappa analysis was applied to evaluate the consistency between T-SPOT.TB combined with XpertMTB/RIF and the gold standard for diagnosing MTB coinfection in AIDS patients. ROC curve and four grid table were plotted to analyze the value of the combination of T-SPOT.TB and XpertMTB/RIF in the diagnosis of AIDS complicated with MTB infection. Results The blood γ-interferon, the positive detection rates of T-SPOT.TB and XpertMTB/RIF in the research group were higher than those in the control group (P＜0.05). The AUC of T-SPOT.TB in diagnosing AIDS with MTB infection was 0.810, that of Xpert MTB/RIF in diagnosing AIDS with MTB infection was 0.835, and the AUC of the two in diagnosing AIDS with MTB infection was 0.910. The Kappa values of T-SPOT.TB, Xpert MTB/RIF and their combined diagnosis for AIDS with MTB infection were 0.624, 0.674 and 0.825, respectively. The accuracy of T-SPOT.TB in the diagnosis of AIDS with MTB was 82.56%, the accuracy of XpertMTB/RIF in the diagnosis of AIDS with MTB was 84.88%, and the accuracy of the combined diagnosis for AIDS with MTB was 91.86%. Conclusions T-SPOT.TB combined with XpertMTB/RIF can improve the accuracy of diagnosis of AIDS with MTB, and can be used as a clinical auxiliary diagnosis method for AIDS patients complicated with MTB.

Clinical Sciences

Clinical characteristics of malignant insulinomas and benign insulinomas

LIU Yan, YU Jie, LIU Yiwen, PING Fan, ZHANG Huabing, XU Lingling, LI Yuxiu

2025, 45(10):  1356-1361.  doi:10.16352/j.issn.1001-6325.2025.10.1356

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Objective To analyze the differences in clinical indicators between malignant insulinoma and benign insulinoma, in order to provide diagnostic and therapeutic insights for the early detection and diagnosis of malignant insulinoma. Methods A retrospective analysis was conducted in patients diagnosed and treated for insulinoma at Peking Union Medical College Hospital from January 2018 to June 2022. Among them,10 cases were diagnosed as malignant insulinoma. Twenty cases of benign insulinoma patients matched for age, sex, and body mass index (BMI), were randomly selected. Statistical analysis was performed to compare the differences between malignant and benign insulinomas. Results 1)Compared to benign insulinoma, malignant insulinoma showed significantly elevated C-peptide (CP) and C-peptide to glucose ratio (CPGlu) during hypoglycemia (blood glucose＜3.0 mmol/L) [6.04 (3.40, 6.76) vs 1.68(1.39, 2.47)ng/mL, P＜0.05), 2.25(1.12, 3.58) vs 0.74 (0.54, 1.54), P＜0.05]. The tumor diameter (DIA) was larger (1.9±0.6 vs 1.4±0.3 cm, P＜0.05), and the insulin level at 300 minutes (INS300) during the 5-hour oral glucose tolerance test (5 h OGTT) was significantly elevated(30.47±5.67 vs 9.67 ± 3.32) μIU/mL, P＜0.01). Levels of blood tumor markers AFP, CEA, and CA724 were also increased (P＜0.05). 2)Correlation analysis indicated that CP, CPGlu, DIA, INS300, AFP, CEA, and CA724 were positively correlated with malignant insulinoma during hypoglycemia. 3)The ROC curve analysis suggested that the optimal cut-off points for distinguishing malignant from benign insulinomas were CP 2.49 ng/mL, CPGlu 1.31, DIA 1.85 cm, and INS300 20.22 μIU/mL, respectively. Conclusions In clinical practice, if an insulinoma patient has a CP level higher than 2.49 ng/mL and a tumor diameter larger than 1.9 cm during hypoglycemia, the possibility of malignant insulinoma should be considered, warranting further examinations and enhanced follow-up. Persistent elevation of AFP, CEA, and CA724 may indicate malignant insulinoma.

Single-center retrospective analysis of peritoneal mesothelioma

LIU Qi, NIE Muwen, ZHANG Jingqi, LI Ningning, ZHAO Lin

2025, 45(10):  1362-1367.  doi:10.16352/j.issn.1001-6325.2025.10.1362

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Objective To explore the diagnosis and treatment experience of malignant peritoneal mesothelioma by analyzing the clinical characteristics of patients with single center peritoneal mesothelioma. Methods Retrospectively analyze the clinical data, including age and treatment regimens, of 99 patients with malignant peritoneal mesothelioma admitted to Peking Union Medical College Hospital from June 2012 to July 2023. Kaplan-Meier for survival analysis and Logistic and Cox regression were applied to assess the impact of factors like age and treatment regimens on survival time. Results The median age of diagnosis for 99 patients with peritoneal mesothelioma was 56 years, of which 82 were pathologically diagnosed. Among them, 38 cases (51.4%) underwent tumor cell reduction surgery, and 57 cases (77.0%) underwent systemic or local treatment. The median survival time for all patients was 43 years. The age of diagnosis may affect the prognosis of patients with malignant mesothelioma, and those aged ≥65 at the time of diagnosis have a worse prognosis. Conclusions Malignant peritoneal mesothelioma is a rare but invasive malignant tumor with a poor prognosis. There is still a need to develop novo drugs and comprehensive treatment strategies.

Mini Reviews

Role of macrophage extracellular traps in inflammatory diseases

WU Qianqian, MA Kaiting, CAO Lingfei, WANG Xiaoping

2025, 45(10):  1368-1371.  doi:10.16352/j.issn.1001-6325.2025.10.1368

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Macrophage extracellular traps (METs) are extracellular fibrous web-like structures produced by macrophages. Under physiological conditions, METs capture and kill microorganisms by releasing high concentrations of granular proteins, serving as an innate immune defense mechanism and playing a vital protective role in resisting the progression of inflammatory diseases. Excessive release of METs can also exacerbate the inflammatory response and cause further tissue damage.

Role of m6A methylation modification in bladder cancer

LIU Yonghui, WU Yan, CHENG Bo

2025, 45(10):  1372-1376.  doi:10.16352/j.issn.1001-6325.2025.10.1372

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N6 methyladenosine(m6A) methylation modification is a common form of mRNA modification, which is involved in the regulation of mRNA output, splicing, translation, localization and degradation, and plays an important role in the regulation of gene expression, body growth and development, and the development of tumors. The expression levels of many m6A methylation-related molecules in bladder cancer are altered to varying degrees, thus affecting the clinical treatment and prognosis of bladder cancer. The m6A methylation modification is closely related to the occurrence and development of bladder cancer, and a deeper understanding of the relevant regulatory mechanisms is beneficial to provide more reference for the clinical application of m6A methylation in bladder cancer.

Research progress on mitophagy in the development and treatment of osteosarcoma

NING Kangsheng, YUN Chao, LI Yi, Morigele

2025, 45(10):  1377-1381.  doi:10.16352/j.issn.1001-6325.2025.10.1377

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Mitophagy, as a highly conserved cellular defense mechanism, precisely recognizes and eliminates dysfunctional or excessive mitochondria, thereby maintaining homeostasis of the mitochondrial network and providing a stable energy supply and raw materials for biosynthesis in cells. Mitophagy exerts regulatory effects on the development of osteosarcoma through multiple molecular mechanisms. Targeting this mechanism as a new strategy for therapeutic intervention provides a solid theoretical foundation and set stage for exploring novel targeted therapies, thereby driving the field of osteosarcoma treatment towards more precise and efficient directions.

Role of anti-aging Klotho gene in inflammatory responses and fibrosis

YE Min, GUO Xiuying, WANG Danxin, HE Guangliang

2025, 45(10):  1382-1386.  doi:10.16352/j.issn.1001-6325.2025.10.1382

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The anti-aging Klotho gene can not only delay the aging process but also regulate fibrosis and inflammatory responses by influencing inflammatory cells such as monocytes-macrophages, T cells, and B cells. It can regulate the processes related to fibrosis and inflammatory responses through inflammatory pathways such as fibroblast growth factor (FGF), transforming growth factor-β(TGF-β), Toll-like receptor(TLR), nuclear factor-κB(NF-κB), and the renin-angiotensin system (RAS). Thus, elucidating the molecular mechanisms by which Klotho regulates inflammatory responses and fibrosis, and developing targeted intervention strategies to upregulate Klotho levels based on these mechanisms, may provide new theoretical basis and therapeutic targets for the prevention and treatment of related diseases.

Medical Education

Application of online merge offline mode based on advanced intelligent virtual simulation experimental platform in clinical skills teaching

ZHANG Chao, SHEN Yuanyuan, CHEN Sen

2025, 45(10):  1387-1391.  doi:10.16352/j.issn.1001-6325.2025.10.1387

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Objective To evaluate the application of an online merge offline mode (OMO) based on an advanced intelligent virtual simulation experimental platform in clinical skills teaching. Methods Two classes were randomly selected from the clinical medicine major of Hubei Medical University in 2021 and divided into a control group and an experimental group. The control group adopted the traditional lecture-based learning(LBL) teaching mode, while the experimental group adopted the advanced intelligent virtual simulation experimental platform OMO teaching mode for pilot teaching and effect evaluation. Results After implementing the OMO teaching mode of the advanced intelligent virtual simulation experimental platform, the clinical skill operation level, learning efficiency, and teaching effect satisfaction of the experimental group students were higher than those of the control group(P＜0.05). Conclusions Based on the advanced intelligent virtual simulation experimental platform, the OMO teaching mode deeply integrates information technology and clinical skills training, effectively enhances the practical ability and learning efficiency of medical students, and provides a scalable innovative path for the digital transformation of medical education.

“Integrating theory and practice” facilitates the advancement of undergraduate students' scientific research thinking:based on the “genetic engineering” course

GAO Xinjing, WANG Jiao, LIU Yujia, FENG Chang, GUO Yanan, GUO Xiaolin

2025, 45(10):  1392-1395.  doi:10.16352/j.issn.1001-6325.2025.10.1392

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In the current process of talent cultivation in biology majors, some challenges like teaching content that lags behind the forefront of scientific research, instructional models that deviate from the principles of effective knowledge transmission, and evaluation systems that lack dimensions reflecting scientific innovation. As a strategy of tackling challenges, the Genetic Engineering teaching team, drawing on theoretical analysis and extensive teaching practice, has explored a reform of the instructional model from the perspective of integrating theory with practice. This effort led to the development of a research-oriented teaching model characterized by four iterative stages: knowledge instruction, thinking exercises, practical operation, and feedback evaluation. This model is grounded in five core elements of scientific thinking: criticality, coherence, simplicity, logic, and integrity. Implementation follows the four-step framework, emphasizing structured knowledge delivery, cultivation of analytical thinking, hands-on experimentation, and comprehensive feedback. After one semester of application, it was found that through reconstructed knowledge systems, immersive simulations of research contexts, realistic problem-solving of technical bottlenecks and all-round feedback, this teaching model effectively fosters scientific thinking among both instructors and students, significantly enhances students' scientific research capabilities and improves overall teaching effectiveness.

Teaching practice of oncology internship for eight-year clinical medicine program students

ZHANG Zhiyang, YAN Yifei, WANG Yingyi, JIA Nan

2025, 45(10):  1396-1400.  doi:10.16352/j.issn.1001-6325.2025.10.1396

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Objective To investigate the needs and gains of eight-year clinical medicine program students during their oncology internships, and provide reference for the reform of clinical teaching in oncology. Methods A questionnaire survey was conducted among 52 students from Peking Union Medical College, Tsinghua University School of Medicine, and Peking Union Medical College “4+4” medical doctor program who underwent internships in the Department of Oncology at Peking Union Medical College from July 2023 to June 2024 in order to examine their basic knowledge of oncology, the courses they are interested in, their preference for teaching methods and the gains from the internships. The exam was conducted before and after the internship. Results All 52 students participated in the survey and examination. Most students were interested in clinical diagnosis and treatment, new drug development and progress in basic research. All students acknowledged that their ability to solve actual clinical problems had been improved after the internship in oncology, 51 (98.08%) recognized that their capacity of literature searching and reviewing ,integrating the information and reasoning had improved, while 50 (96.15%) believed that their capacity to read Computed Tomography (CT) images or perform imaging diagnosis had improved. The number of students who were interested in oncology increased from 41 (78.85%) before the internship and up to 47 (90.38%) after the training. The average score of the students before internship was 63.88±8.90, and then significantly increased up to 82.94±9.12 afterwards. Conclusions Eight-year program students of clinical medicine are quite interested in oncology, their learning and training outcomes have been further improved through the clinical training during internship.