Seventh People's Hospital of Shanghai

Although effective for atrophic acne scars, ablative fractional CO₂ laser (AFCL) causes unavoidable downtime and carries the potential for post-inflammatory hyperpigmentation (PIH). To evaluate the efficacy and safety of hydroxybutyl chitosan (HBC) in wound healing and to investigate the possible molecular mechanisms of HBC. Eighteen participants were enrolled in a split-face study, with each hemiface randomly assigned to receive either HBC or positive control therapy (PC: desonide cream, epidermal growth factor gel, and fusidic acid cream in combination) following AFCL. Clinical assessments included erythema, edema, pain, the time to decrustation, the skin barrier function, and melanin were assessed. In parallel, a mouse skin wound healing model was employed to investigate the effects of HBC. The expression of interferon regulatory factor 7 (IRF7) and cathepsin S (Ctss), as well as M1 and M2 macrophage polarization, was evaluated by immunohistochemistry and Western blot analysis of mouse skin tissues. Although HBC exhibited a slightly delayed onset of wound healing compared to the PC protocol, it achieved comparable outcomes by Days 7 and 28 between the groups. HBC showed more early pain but no steroid-related irritation and better moisturization. In mice, HBC demonstrated effects comparable to PC drugs, promoting macrophage M2 polarization and upregulating IRF7 and Ctss expression. HBC is effective and safe for promoting wound healing post AFCL. HBC upregulates IRF7 and Ctss expression and promotes macrophage M2 polarization. The expression of IRF7/CTSS may be correlated with M2 polarization of macrophages. ChiCTR2200063765.

Immune checkpoint inhibitors and anti-angiogenic targeted therapies have improved outcomes in hepatocellular carcinoma (HCC), but responses remain heterogeneous, creating a need for noninvasive biomarkers to enable early treatment adaptation. We review clinical and translational evidence on nuclear medicine approaches - PET/computed tomography (CT), single-photon emission computed tomography (SPECT), radiomics, machine learning, and theranostics - for response prediction and prognostication in HCC treated with immunotherapy alone or in combination with targeted agents. Metabolic PET/CT, most commonly with 18 F-fluorodeoxyglucose, supports pragmatic risk stratification; volumetric indices such as metabolic tumor volume (MTV) and total lesion glycolysis generally provide stronger prognostic enrichment than single-voxel metrics, and an MTV threshold of greater than or equal to39.65 cm³ has been reported to associate with poorer outcomes. Immune-targeted PET/SPECT extends beyond metabolism by mapping target availability and heterogeneity (e.g. PD-L1) and immune activation or effector function (e.g. CD137, granzyme B), although current studies are often small and retrospective. PET-based radiomics and machine learning can generate imaging surrogates of immune phenotypes and aggressive biology, but reproducibility is limited by acquisition/reconstruction differences, segmentation variability, and scarce external validation. Theranostics offers an image-guided 'select-and-treat' paradigm for radionuclide therapy, yet target heterogeneity, dosimetry standardization, cost, and infrastructure remain barriers. Translation to routine care will require harmonized protocols, multicenter prospective validation, and demonstration of decision impact.

Introduction Proximal humeral fractures are increasingly common, particularly among older people, whereas the prognosis of surgical treatments for these fractures remains substantially uncertain. In China, where the ageing population is rapidly growing, high-quality prospective data on surgical outcomes, complications and cost-effectiveness are lacking. To address this gap, we propose to initiate a prospective, multicentre cohort study on surgical treatment for proximal humeral fractures in China—Cohort of Acute Shoulder Trauma (CAST) study.Methods and analysisThe CAST is a multicentre, prospective cohort study enrolling patients with acute proximal humeral fractures undergoing surgical treatments at eight hospitals in China between May 2024 and December 2029. Patients can receive any of the surgical treatment methods which include percutaneous Kirschner wire fixation, external fixation, open reduction and internal fixation using locking plates or intramedullary nails, suture anchors and shoulder arthroplasty. We will collect patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder and Hand), Constant-Murley, American Shoulder and Elbow Surgeons, EuroQol 5-Dimension and Visual Analogue Scale), physical examination results, imaging assessments (based on X-rays, ultrasound, CT and MRI scans), laboratory tests (including inflammatory cytokines) and data on medical costs. We will follow patients at 1 day, and at 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. The planned sample size is 1500 patients.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University (Approval No. 2024-ky-104(K)). Written informed consent will be obtained from all participants. Findings from the CAST study will be disseminated through peer-reviewed journals and academic conferences.Study registration numberChiCTR2500109651.

Omadacycline is a novel tetracycline with a wide range of antibacterial activity. A comprehensive understanding of the factors influencing its metabolic processes is essential to optimize its therapeutic benefits and minimize any potential negative effects. It was found that the metabolism of omadacycline does not rely on UDP-glucosyltransferase or cytochrome P450 enzymes, which gives it a clear advantage in terms of drug interactions, bioavailability, and metabolic stability. The review offers a thorough analysis of the many elements influencing the pharmacokinetics of omadacycline, including its intrinsic properties, individual differences, dietary influences, and possible drug interactions. To achieve maximum efficacy and safety in clinical practice, a thorough understanding of the pharmacokinetic properties of omadacycline is essential, which helps to better customize dosing regimens and maximize therapeutic outcomes.

Polycystic ovary syndrome (PCOS) is a gynecological endocrine disorder affecting 5%–18% of women of reproductive age worldwide. It is characterized by hyperandrogenemia (HA), anovulation, and polycystic ovarian morphology (PCOM), severely impacting women’s reproductive and metabolic health. Obesity has become increasingly common among PCOS patients in recent years. Obesity can further exacerbate the metabolic and reproductive dysfunctions of PCOS through mechanisms such as insulin resistance (IR) and chronic low-grade inflammation. It may even have adverse effects on mental health. However, the specific pathogenesis and effective therapeutic targets of PCOS with obesity remain incompletely understood. This review presents a narrative review of recent research, focusing on the molecular mechanisms that drive autophagy in the context of obesity associated with polycystic ovary syndrome (PCOS), endoplasmic reticulum stress (ERS), gut microbiota imbalances, and disruptions in the hypothalamic-pituitary-ovarian (HPO) axis. It also explores corresponding therapeutic strategies. The aim is to provide fresh perspectives and insights for future mechanistic research and clinical interventions in this field.

BackgroundThe longitudinal fluctuations in maternal serum ferritin (SF) levels during gestation, acting as indirect indicators of iron supplementation, have not been thoroughly investigated in relation to the incidence of hypertensive disorders of pregnancy (HDP).MethodsA retrospective cohort investigation was carried out at a tertiary maternity hospital in Shanghai, involving women with serum ferritin (SF) measurements at 8.0–13.6 gestational weeks (GW) and at 29.0–31.6 GW. Logistic regression analysis was employed to evaluate the relationship between maternal SF levels, their longitudinal variations, with the risk of HDP.ResultsThe study included 17,472 women, among whom 473(2.71%) developed gestational hypertension (GH) and 560(3.21%) developed preeclampsia (PE). Adjusted odds ratios (ORs; 95% confidence intervals) for HDP across ascending quartiles of SF concentrations were as follows: at 8.0–13.6 GW, 1.00 (reference), 1.043 (0.864–1.258), 1.060 (0.878–1.279), and 1.234 (1.027–1.482); and at 29.0–31.6 GW, 1.00 (reference), 0.973 (0.800–1.181), 1.076 (0.890–1.301), and 1.299 (1.082–1.560). Women with SF levels in the highest quartile at 8.0–13.6 GW exhibited reduced HDP risk when their SF levels declined to the lowest quartile by 29.0–31.6 GW. Conversely, those with SF levels in the lowest quartile early in pregnancy but transitioning to the highest quartile later in pregnancy demonstrated a significantly elevated HDP incidence (8.2%; OR: 1.445, 95% CI: 1.003–2.081).ConclusionMaternal SF levels demonstrated an independent positive association with HDP risk during early and late gestational stages. These findings suggest that routine iron supplementation in iron-replete women may exacerbate HDP risk and warrants careful reconsideration.

Ebstein anomaly (EA) is a congenital heart disease that can cause intrauterine fetal death. Pulmonary valve stenosis or atresia (PS/PA) and retrograde ductus arteriosus flow (RDAF) are important factors leading to a poor prognosis, but the causes of its formation are still unclear. This study aimed to assess the correlation between left and right ventricular function and PS/PA and RDAF in fetuses with EA using MAPSE and TAPSE Z-score values measured by free angle M-mode (FAM) echocardiography. This retrospective cohort study of 34 EA and 68 normal fetuses was enrolled. Differences in Z-score values were compared between the control, EA with and without PS/PA groups, and between EA-PS/PA with and without RDAF group. Correlation analysis was performed between Z-score values with the ratio of inner diameter of the pulmonary to the aortic valve annulus (PA/AO) and RDAF. The differences in Z-score values were significant (p < 0.001) between three groups. Z-score values were lower in EA-PS/PA with RDAF compared to the without RDAF group (p < 0.05). Z-scores were all positively correlated with PA/AO in the EA group (p < 0.05), and negatively correlated with RDAF in the EA-PS/PA group (p < 0.05). Decreased ventricular function of EA fetus is related to the formation of PS/PA. After the formation of PS/PA, the degree of damage to ventricular function is not related to the diameter of the pulmonary artery; it is related to the formation of RDAF.