Chinese Medical Journal[JOURNAL]
Sun
200 papers
Reclassifying renal cell carcinoma with pathologic lymph node metastasis: An approach to refining prognostic stratification in patients with AJCC III and IV stages.
Bai X, Jia T, Zhao H … +14 more , Xu H, Ding X, Li Y, Li L, Mu X, Liu H, Zhang H, Zhang M, Yi S, Ye H, Zhang X, Guo A, Ma X, Wang H
Chin Med J (Engl) · 2026 Jun · PMID 42366489 · Publisher ↗
BACKGROUND: Lymph node metastasis is a well-established prognostic factor in renal cell carcinoma (RCC); however, the prognosis varies among patients with nodal metastases. Subclassification by T category may improve the...
BACKGROUND: Lymph node metastasis is a well-established prognostic factor in renal cell carcinoma (RCC); however, the prognosis varies among patients with nodal metastases. Subclassification by T category may improve the prognostic stratification. METHODS: This study aimed to refine the prognostic stratification of advanced RCC by analyzing the overall survival and cancer-specific survival of patients classified as pT1-3N1M0. We retrospectively analyzed data from 364 patients with American Joint Committee on Cancer (AJCC) stage III and IV RCC who underwent nephrectomy with lymphadenectomy at multiple centers between 2010 and 2023. Five-year survival rates were estimated using Kaplan-Meier analysis, and the concordance index (C-index) was used to assess the stratification ability of the different staging systems. Multivariable analyses were conducted to adjust for potential confounders. Additionally, 194 and 1513 patients from The Cancer Genome Atlas and Surveillance, Epidemiology, and End Results databases were used to validate the prognostic values. RESULTS: Patients with pT1-2N1M0 had significantly better 5-year survival rates than those with pT3N1M0 (overall survival: 62.4% vs. 31.5%, P = 0.003; cancer-specific survival: 62.4% vs. 38.5%, P = 0.008). Reclassifying pT3N1M0 from AJCC stage III to IV improved prognostic discrimination, as reflected by higher C-index values compared to the AJCC staging (8th edition) (ΔC-index: 0.03-0.10, all P values <0.05). The modified staging system demonstrated comparable performance to the previous system while avoiding the over-staging of patients with pT1-2N1M0 (ΔC-index: 0-0.04, most P values >0.05), as confirmed across local and external cohorts. These findings were supported by the Multivariable analyses. CONCLUSION: Reclassifying pT3N1M0 as stage IV improves prognostic stratification in RCC.
Prevalence, trends, and maternal-fetal outcomes in pregnant women with polycystic ovary syndrome in Chinese mainland.
Zhang Y, Xie Y, Mu Y … +13 more , Gong Y, Tan X, Chen P, Zhou S, Wang Y, Li M, Wei X, Liu Z, Chen H, Shi M, Zhu J, Liang J, Zhou R
Chin Med J (Engl) · 2026 Jun · PMID 42351368 · Publisher ↗
BACKGROUND: Epidemiological data and the impact of China's fertility policies on pregnant women with polycystic ovary syndrome (PCOS) are limited. This study aims to investigate the prevalence, trends, and maternal-fetal...
BACKGROUND: Epidemiological data and the impact of China's fertility policies on pregnant women with polycystic ovary syndrome (PCOS) are limited. This study aims to investigate the prevalence, trends, and maternal-fetal outcomes among Chinese pregnant women with PCOS. METHODS: We used nationwide data of 14,083,975 pregnant women (2012-2021) from China's National Maternal Near Miss Surveillance System, spanning 438 hospitals across 30 provinces and covering both urban and rural regions. Interrupted time series analysis was applied to explore trends during the universal two-child policy period. Poisson regression analyses were used to estimate the maternal and fetal risks associated with PCOS. RESULTS: Among these pregnancies, 5.10 per 10,000 pregnant women were diagnosed with PCOS. The prevalence of PCOS increased from 0.79 per 10,000 in 2012 to 19.00 per 10,000 in 2021. Following the universal two-child policy, a relative increase of 0.23% (95% confidence interval 0.16-0.29%) was observed. Prevalence was higher in Eastern China (8.10 per 10,000), multiple pregnancies (34.00 per 10,000), women aged 30-34 years (8.10 per 10,000), and nulliparous women (8.00 per 10,000), with notable upward trends in all groups (Pfor trend <0.001 for all). PCOS was associated with increased risks of diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, hemolysis, elevated liver enzymes, and low platelets syndrome, and cesarean section. Fetal risks included abortion, preterm birth, full-term low-birth-weight babies, macrosomia, and neonatal asphyxia. Subgroup analyses indicated that these risks were particularly pronounced in singleton pregnancies, women aged below 35 years, and nulliparous women. CONCLUSIONS: The prevalence of pregnant women with PCOS increased significantly, with notable regional variations. Women with PCOS had higher risks of adverse maternal-fetal outcomes, highlighting the need for tailored interventions to preserve maternal-fetal well-being for individuals with PCOS.
Niraparib treatment patterns and outcomes in first-line maintenance therapy for ovarian cancer: The RENI-1 study.
Zuo J, Wang K, Cui Z … +25 more , Li Q, Cheng X, Zheng Z, Sun L, Zhang H, Zhang J, Wang S, Cao D, Chen L, Zhao H, Duan W, Zheng M, Shou H, Li J, Wang Y, Chen X, Lin A, Wang H, Zhao L, Hong L, Li L, Wang J, Hu J, Yang H, Wu L
Chin Med J (Engl) · 2026 Jun · PMID 42343699 · Publisher ↗
BACKGROUND: Prospective real-world data on poly(adenosine diphosphate-ribose [ADP]-ribose) polymerase inhibitors (PARPi) as first-line maintenance therapy (1LMT) for ovarian cancer are limited. This study was conducted t...
BACKGROUND: Prospective real-world data on poly(adenosine diphosphate-ribose [ADP]-ribose) polymerase inhibitors (PARPi) as first-line maintenance therapy (1LMT) for ovarian cancer are limited. This study was conducted to evaluate the treatment patterns, efficacy, and safety of niraparib as 1LMT in Chinese patients with ovarian cancer. METHODS: Real-world study of niraparib as first-line maintenance treatment in patients with newly diagnosed ovarian cancer (RENI-1) was a prospective, multicenter, noninterventional, real-world study evaluating niraparib as 1LMT in newly diagnosed ovarian cancer. The primary endpoint was treatment patterns. Secondary endpoints included progression-free survival (PFS), chemotherapy-free interval (CFI), time to first subsequent treatment (TFST), overall survival (OS), safety, and quality of life (QoL). RESULTS: A total of 227 patients were enrolled. The median time to maintenance initiation was 7.4 weeks. Most patients (218/227, 96.0%) received niraparib monotherapy; 95.6% (n = 217) started at 200 mg daily, and 73.6% (n = 167) maintained a stable 200 mg dose. After a median follow-up of 41.5 months, the median PFS was 36.5 months in the intention-to-treat (ITT) population and 25.4 months in patients with The International Federation of Gynecology and Obstetrics (FIGO) stage III-IV disease. Median PFS was not reached (NR) in the BRCA1/2-mutated and homologous recombination deficiency (HRD) positive subgroups, and it was 25.4 and 22.2 months in the BRCA1/2 wild-type and HRD-proficient subgroups, respectively. PFS rates at 36 months were 67.5% in the BRCA1/2-mutated, 58.7% in the HRD-positive, and 50.1% in the ITT population. Median CFI, TFST, and OS were NR; OS rate at 36 months was 80.2%. Factors associated with longer PFS included R0 resection, primary debulking surgery, complete response after chemotherapy, BRCA1/2 mutation, and HRD positivity. No new safety concerns were identified, and QoL remained stable. CONCLUSION: As the first prospective real-world study of niraparib 1LMT in China, RENI-1 provides powerful complementary evidence to pivotal randomized controlled trials conducted in highly selective populations, further supporting niraparib as the first-line maintenance standard treatment.
Mitochondrial quality control in health and disease: Updates 2026.
Liu Z, Hu W, Sun L … +1 more , Liu H
Chin Med J (Engl) · 2026 Jun · PMID 42343697 · Publisher ↗
Mitochondria are central to cellular energy metabolism, and their functional integrity is essential for maintaining cellular homeostasis and life processes. Mitochondrial quality control (MQC) encompasses a complex netwo...
Mitochondria are central to cellular energy metabolism, and their functional integrity is essential for maintaining cellular homeostasis and life processes. Mitochondrial quality control (MQC) encompasses a complex network of mechanisms-including mitochondrial biogenesis, mitochondrial dynamics, mitophagy, mitochondrial proteostasis, and mitochondrial-derived vesicles-that collectively preserve the structural and functional balance of mitochondria. Recent studies have revealed that dysregulation of MQC is closely associated with a broad spectrum of diseases, such as neurodegenerative disorders, cardiovascular diseases, kidney diseases, metabolic syndrome, and cancers, highlighting its critical role in pathological processes. Despite significant progress in elucidating the molecular regulation of MQC, many aspects of its complexity and multilayered regulatory mechanisms remain unresolved. This review provides a comprehensive overview of the major molecular pathways involved in MQC and their functional alterations under physiological and pathological conditions. It emphasizes the abnormalities of MQC in various diseases and explores potential therapeutic targets. Moreover, integrating the latest research advances, this article discusses emerging treatment strategies aimed at restoring and optimizing MQC, with the goal of offering theoretical insights and clinical translation avenues for future disease prevention and management.
Circulating circRNAs at the frontier of cancer detection, prognosis, and therapy.
Zhang Y, Chen G, Liu Z … +2 more , Song X, Song X
Chin Med J (Engl) · 2026 Jun · PMID 42343695 · Publisher ↗
Circular RNAs (circRNAs) are distinguished from other noncoding RNAs by their unique loop structure, without 5' polar ends and 3' polyadenylated tails. They are stable and abundant in a wide range of eukaryotic taxa and...
Circular RNAs (circRNAs) are distinguished from other noncoding RNAs by their unique loop structure, without 5' polar ends and 3' polyadenylated tails. They are stable and abundant in a wide range of eukaryotic taxa and exert functions via interactions with microRNAs (miRNAs), proteins, and DNA, including tumor-suppressive or oncogenic functions. Emerging evidence suggests that circRNAs show specific expression patterns in tumor tissues or circulation and changes in expression with respect to tumor stage; therefore, they possess strong potential as diagnostic, prognostic, and predictive biomarkers. Nevertheless, translating theoretical achievements in circRNA research to clinical practice is challenging. Herein, this review focuses on the important functions of circRNAs, including their roles in cancer, highlighting their utility for early cancer detection, prognosis, and treatment, in addition to a summary of vital detection methods for circulating circRNAs.
Stem cell therapies for treatment of diabetes mellitus.
Guo F, Song Y, Qin G
Chin Med J (Engl) · 2026 Jun · PMID 42343694 · Publisher ↗
The increasing global prevalence of diabetes mellitus (DM) necessitates the development of innovative therapeutic strategies that effectively address its symptoms and alleviate its enduring pathological consequences. Ste...
The increasing global prevalence of diabetes mellitus (DM) necessitates the development of innovative therapeutic strategies that effectively address its symptoms and alleviate its enduring pathological consequences. Stem cells (SCs), which have biological advantages such as multidirectional differentiation capabilities and immune regulatory functions, exhibit tremendous potential for diabetes treatment. Human embryonic SCs or induced pluripotent SC-derived insulin-producing cells offer a promising source for islet cell replenishment in the treatment of insulin-depleted diabetes; however, immune rejection and safety concerns remain significant challenges in further clinical applications. Transplantation of hematopoietic and mesenchymal SCs also shows remarkable potential for the treatment of diabetes. These cells possess the ability to modulate the immune system, stimulate endogenous β-cell regeneration, and preserve residual β-cell function, ultimately leading to enhanced pancreatic islet function and reduced insulin resistance. However, safety and efficacy considerations remain paramount. This review comprehensively summarizes the recent advancements and molecular mechanisms of SCs in the treatment of DM, underscoring the feasibility, benefits, and current limitations of SC therapy for DM, and offering a lucid perspective on their therapeutic possibilities.
A selective BRG1 inhibitor targeting bromodomain sensitizes hepatocellular carcinoma to chemoradiotherapy by disrupting the DNA damage response.
Tao Q, Zhu Z, Chen Y … +7 more , Shu Y, Wu Z, Zeng Y, Liu G, Zhou Y, Guo W, Shi Y
Chin Med J (Engl) · 2026 Jun · PMID 42343692 · Publisher ↗
BACKGROUND: The poor response to ionizing radiation and chemotherapies remains a significant clinical challenge for unresectable hepatocellular carcinoma (HCC). BRG1, the core ATPase subunit of switch/sucrose non-ferment...
BACKGROUND: The poor response to ionizing radiation and chemotherapies remains a significant clinical challenge for unresectable hepatocellular carcinoma (HCC). BRG1, the core ATPase subunit of switch/sucrose non-fermentable (SWI/SNF) complex, is often overexpressed in HCC and represents a potential therapeutic target. Mechanistically, BRG1 facilitates DNA damage repair by assisting the assembly of DNA damage response (DDR) complex via its bromodomain (BRD), which selectively binds to acetylated histone H3. Therefore, pharmacological targeting of the BRG1-BRD represents an innovative strategy to sensitize HCC to conventional chemoradiotherapy. METHODS: To identify specific inhibitors, we employed a high-throughput screening system against a vast library comprising over 2 million bioactive compounds. The binding affinity and selectivity of the leading candidate were comprehensively assessed. In vitro assays were conducted to elucidate its mechanism in disrupting DNA double-strand break (DSB) repair. Furthermore, in vivo tumor sensitization and systemic biosafety were systematically evaluated using HCC xenograft mouse models treated with combination therapies, supplemented by serological liver enzyme profiling and histopathological analyses of major organs. RESULTS: We identified BRGi-39, a novel chemical entity that blocks BRG1-BRD with exceptional selectivity and high affinity. Mechanistically, BRGi-39 profoundly disrupted DNA damage repair by preventing γH2A.X formation and blocking 53BP1 recruitment to DSB sites. At pharmacologically low concentrations, BRGi-39 robustly sensitized HCC cells to both irradiation and chemotherapeutic drugs. In vivo studies demonstrated that low-dose BRGi-39 synergistically enhanced the efficacy of chemo-radiotherapy in HCC xenografts. Notably, toxicological assessments, including hematoxylin and eosin staining and serum enzyme analyses, revealed no obvious injuries in main organs (lung, liver, spleen, and kidney), confirming a highly favorable biosafety profile. CONCLUSIONS: BRGi-39 is identified as a novel and highly selective BRG1-BRD inhibitor that effectively overcomes chemoradioresistance in HCC by dismantling the DDR pathway. Our comprehensive preclinical data highlight BRGi-39 as a promising, safe therapeutic candidate to be combined with chemoradiotherapy for the treatment of unresectable HCC.
Innate immunity in tumors: From mechanisms to therapeutics.
Hu Y, Wang X, Ma H … +1 more , Zheng X
Chin Med J (Engl) · 2026 Jun · PMID 42337247 · Publisher ↗
Cancer immunotherapy has made significant strides, yet current approaches mainly targeting the adaptive immune system yield limited clinical success. Innate immunity, as the first line of defense, directly eliminates tum...
Cancer immunotherapy has made significant strides, yet current approaches mainly targeting the adaptive immune system yield limited clinical success. Innate immunity, as the first line of defense, directly eliminates tumor cells and activates adaptive responses. Emerging therapies focused on innate immunity offer a promising frontier to address these challenges. This review explores the functions of major innate immune cells, including natural killer (NK) cells, dendritic cells (DCs), monocytes, macrophages, neutrophils, myeloid-derived suppressor cells (MDSCs), and γδ T-cells within the tumor microenvironment (TME), where they demonstrate both antitumor activity and protumorigenic plasticity. We examine how the TME impairs innate immunity through multiple mechanisms, including dysregulation of immune checkpoints, metabolic reprogramming, inhibitory cytokine signaling, extracellular vesicles, alterations in the extracellular matrix (ECM), and angiogenesis. To overcome these suppressive influences, we highlight emerging therapeutic strategies, including engineered cellular therapies such as chimeric antigen receptor (CAR)-NK cells, CAR-macrophages, and CAR-γδ T-cells to enhance tumor targeting and persistence, and macromolecular strategies (e.g., antibodies, engineered cytokines) to reverse immunosuppression and reprogram the TME. Enhancing innate immunity is key to transforming "cold" tumors into immunologically "hot" ones. Future progress will rely on integrating single-cell multiomics to explore immune heterogeneity, optimizing engineered therapies, and developing combination treatments that leverage both innate and adaptive immunity for more effective cancer immunotherapy.
Cardiovascular risk of isolated systolic hypertension in young-to-middle-aged adults in China: A prospective cohort study.
Wang H, Zhang Y, Yuan J … +7 more , Du X, Shao Q, Li S, Zeng M, Wu S, Yang W, Yan X
Chin Med J (Engl) · 2026 Jun · PMID 42332996 · Publisher ↗
BACKGROUND: The clinical significance of isolated systolic hypertension (ISH) among young-to-middle-aged adults remains controversial. This study aimed to investigate the association between ISH and cardiovascular diseas...
BACKGROUND: The clinical significance of isolated systolic hypertension (ISH) among young-to-middle-aged adults remains controversial. This study aimed to investigate the association between ISH and cardiovascular disease (CVD) risk in individuals aged 18-49 years. METHODS: Our study included 73,552 Kailuan cohort participants aged 18-49 years without a history of CVD and who were not taking antihypertensive medications between 2006 and 2013. The primary outcome was the occurrence of composite CVD events, including stroke, heart failure (HF), and myocardial infarction (MI). The participants were categorized into five groups by baseline blood pressure (BP): normal, high-normal, ISH, isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). RESULTS: Of the 73,552 participants, 1775 (2.4%) had ISH. Over a median follow-up of 12.1 years, 102 composite CVD events were documented in patients with ISH. Individuals with ISH exhibited a significantly higher risk of CVD than those in the normal group (Hazard eratio [HR], 2.10, 95% confidence interval [CI], 1.67-2.65). The CVD risk remained lower in the high-normal and IDH groups than in the ISH group, whereas SDH conferred a greater risk. Compared to the normal group, the risk of stroke (HR, 2.41, [95% CI, 1.92-3.20]) and HF (HR, 1.89, [95% CI, 1.16-3.08]) were significantly increased in the ISH group, whereas the risk of MI was not (HR, 1.17, [95% CI, 0.63-2.17]). CONCLUSIONS: In Chinese young-to-middle-aged adults, ISH was associated with a significantly higher risk of CVD events than those with normal BP. CLINICAL TRIAL REGISTRATION: ChiCTR-TNRC-11001489 (Chinese Clinical Trial Registry).
Corrigendum: Chinese expert consensus on the application of immune checkpoint inhibitors in liver transplantation for hepatocellular carcinoma.
Chin Med J (Engl) · 2026 Jun · PMID 42332977 · Publisher ↗
Abstract loading — click title to view on PubMed.
Effect of plasminogen activator inhibitor-1 transcriptionally upregulated by C-terminal truncated hepatitis B virus X on the development of hepatocellular carcinoma.
Zhao J, Chen Y, Pu R … +5 more , Liu W, Li P, Li Z, Zhao J, Cao G
Chin Med J (Engl) · 2026 Jun · PMID 42311074 · Publisher ↗
BACKGROUND: C-terminal carboxy-truncated hepatitis B virus X (Ct-HBx) exerts its hepatocarcinogenic effects, at least in part, through the upregulation of plasminogen activator inhibitor-1 (PAI-1). This study aimed to ex...
BACKGROUND: C-terminal carboxy-truncated hepatitis B virus X (Ct-HBx) exerts its hepatocarcinogenic effects, at least in part, through the upregulation of plasminogen activator inhibitor-1 (PAI-1). This study aimed to explore the mechanisms by which Ct-HBx upregulates PAI-1 and determine the effects of PAI-1 functional polymorphisms and expression on the development of hepatitis B virus-related hepatocellular carcinoma (HBV-HCC). METHOD: Transposase-accessible chromatin sequencing was performed to identify chromatin accessibility induced by wild-type HBx (WT-HBx) and Ct-HBx. Functional polymorphisms of PAI-1 and their association with HBV mutations and HCC risk were evaluated in 3472 participants. PAI-1 in the HBV-infected cohort was measured using enzyme-linked immunosorbent assay. Associations between functional polymorphisms, serum PAI-1 levels, and postoperative prognosis in HBV-HCC were assessed in two cohort studies. RESULTS: Compared with WT-HBx, Ct-HBx upregulated the expression of histone acetyltransferases and chromatin-remodeling factors, thereby increasing the chromatin accessibility of the -1kb promoter and the 3'-untranslated region (3'UTR) of PAI-1 and promoting PAI-1 expression. rs2227631-G at the promoter and the rs11178-T and 1050955-A at the 3'UTR of PAI-1 were significantly associated with an increased risk of HCC. The polymorphic genotypes predisposing to higher PAI-1 expression were often associated with higher frequencies of HCC-risk HBV mutations. The interaction between these polymorphic genotypes and the HBV mutations greatly increased HBV-HCC risk. Serum concentration of PAI-1 increased progressively during HBV-induced hepatocarcinogenesis. rs2227631-GG and rs11178-TT genotypes, along with higher PAI-1 expression, were risk factors for poor postoperative prognosis in HBV-HCC. CONCLUSIONS: Ct-HBx upregulates PAI-1 expression by increasing chromatin accessibility. Functional polymorphic genotypes that facilitate PAI-1 expression and their interactions with HCC-risk HBV mutations promote HBV-HCC. PAI-1 is a novel prognostic and predictive factor for HBV-HCC.
Immunotherapy for gynecological tumors: From mechanism to clinical practice.
Liu J, Wu M, Wang H
Chin Med J (Engl) · 2026 Jun · PMID 42311073 · Publisher ↗
Gynecological tumors are a group of prevalent and highly lethal malignancies affecting the female reproductive system. The immunosuppressive tumor microenvironment, characterized by immune cell dysfunction and inhibitory...
Gynecological tumors are a group of prevalent and highly lethal malignancies affecting the female reproductive system. The immunosuppressive tumor microenvironment, characterized by immune cell dysfunction and inhibitory cytokine dysregulation, plays a pivotal role in tumor initiation, progression, and resistance to conventional therapies. Although standard treatments-including surgery, radiotherapy, and chemotherapy-remain the mainstay for early-stage disease, they often fail to manage advanced, recurrent, or drug-resistant tumors. In recent years, immunotherapy has emerged as a transformative approach in cancer treatment, offering new hope for patients with gynecological malignancies. Notably, immune checkpoint inhibitors, adoptive cell therapy, and cancer therapeutic vaccines have exhibited encouraging efficacy across several clinical trials. This review systematically summarizes recent advances in immunotherapy for major gynecological cancers, including cervical cancer, endometrial cancer, and ovarian cancer. We focus on the immunological landscape of these tumors, the underlying mechanisms of immune-based therapies, key clinical findings, and current challenges. In addition, we highlight future research directions and explore prospects for personalized immunotherapy, aiming to provide both theoretical insight and practical guidance for clinical translation.
Cardiac immunity and heart repair: Mechanism, challenge, and future direction.
Liu Y, Ren Q, Wang H … +6 more , Jiang X, Zhao M, Min Q, Xie Y, Cai D, Nie Y
Chin Med J (Engl) · 2026 Jun · PMID 42311068 · Publisher ↗
Immune signaling has emerged as a central regulator of cardiac biology, extending far beyond its traditionally recognized roles in pathology. From embryogenesis to adulthood, immune cells orchestrate key processes, inclu...
Immune signaling has emerged as a central regulator of cardiac biology, extending far beyond its traditionally recognized roles in pathology. From embryogenesis to adulthood, immune cells orchestrate key processes, including coronary vasculature formation, cardiomyocyte maturation, mitochondrial homeostasis, and extracellular matrix (ECM) remodeling. In the setting of myocardial injury, immune responses unfold in tightly choreographed phases, initially clearing necrotic debris and later facilitating scar formation and, in certain contexts, promoting tissue regeneration. Recent advances in single-cell and spatial transcriptomics have revealed the remarkable heterogeneity and plasticity of immune cell populations in the heart, highlighting their metabolic and phenotypic adaptability across developmental and disease contexts. Alongside these biological insights, therapeutic interest has grown in targeting specific immune pathways to modulate inflammation, enhance repair, and restore cardiac function. This review integrates discoveries from developmental immunology, cardiac injury models, and regenerative medicine to illustrate how the immune system underpins cardiac resilience and plasticity. By synthesizing molecular, cellular, and systems-level data, we present a cohesive view of cardioimmune interactions that opens new avenues for precision therapies aimed at heart repair and regeneration.
Pulmonary arterial hypertension from a translational perspective: Bridging pathophysiology and treatment.
Yang T, Chung WJ
Chin Med J (Engl) · 2026 Jun · PMID 42311051 · Publisher ↗
Pulmonary arterial hypertension (PAH) is a rare, progressive disorder defined by elevated pulmonary arterial pressure and vascular resistance, ultimately leading to right ventricular failure and premature death. Once con...
Pulmonary arterial hypertension (PAH) is a rare, progressive disorder defined by elevated pulmonary arterial pressure and vascular resistance, ultimately leading to right ventricular failure and premature death. Once considered a disease of pure vasoconstriction, PAH is now recognized as a complex vasculopathy involving endothelial dysfunction, inflammation, metabolic dysregulation, and genetic susceptibility. The pulmonary vasculature is dynamically narrowed by vasoconstriction, structurally obstructed by smooth muscle and endothelial proliferation, and pathologically stiffened by fibrosis and extracellular matrix deposition. Multiple cell types including endothelial cells, smooth muscle cells, fibroblasts, and immune cells contribute to this remodeling process. At the molecular level, hyperproliferative, apoptosis-resistant phenotypes emerge through mitochondrial dysfunction, oxidative stress, and endothelial-to-mesenchymal transition, which together drive a Warburg-like metabolic shift favoring glycolysis over oxidative phosphorylation. Chronic immune activation, characterized by cytokine release, T-cell and macrophage infiltration, and disrupted immune regulation, further amplifies vascular injury. Genetic studies have identified mutations in BMPR2, TBX4, SOX17 , and other regulators of the bone morphogenic protein (BMP)/transform-ing growth factor-β (TGF-β) pathway as key contributors to heritable and idiopathic forms of PAH, highlighting impaired endothelial repair and aberrant signaling as central mechanisms. Recent translational breakthroughs have yielded novel therapeutic strategies beyond traditional vasodilators. Agents targeting the BMP/TGF-β axis (e.g., sotatercept), growth factor signaling (seralutinib), inflammatory pathways (tocilizumab, rituximab), and metabolic remodeling (pyruvate dehydrogenase kinases [PDK] and fatty acid oxidation [FAO] modulators) are redefining treatment paradigms. Concurrently, large-scale multi-omics initiatives such as PVDOMICS and PHOENIKS enable deep phenotyping, which unravels molecular endotypes and informs precision medicine approaches. This review summarizes the pathophysiology of PAH and the ongoing clinical trials in the PAH field.
Intelligent three-dimensional imaging in pathology: Applications and developments.
Si W, Zhao F, Kuang D … +6 more , Zhao Y, Liu Y, Sun M, Duan Y, Fei P, Wang G
Chin Med J (Engl) · 2026 Jun · PMID 42311028 · Publisher ↗
Conventional two-dimensional (2D) pathology relies on a limited number of tissue sections and therefore provides information from isolated planes, which can introduce sampling bias and lead to the loss of axial details,...
Conventional two-dimensional (2D) pathology relies on a limited number of tissue sections and therefore provides information from isolated planes, which can introduce sampling bias and lead to the loss of axial details, making it difficult to accurately capture the full structural organization of tumors and their microenvironment. In recent years, the integration of three-dimensional (3D) imaging technologies, such as tissue clearing and light-sheet fluorescence microscopy, combined with virtual staining, artificial intelligence, and spatial omics, has enabled the acquisition and analysis of volumetric biological information while preserving the overall architecture of the tissue. Following the theme of "advancing from planar observation to 3D quantitative analysis", this paper outlines the major technical pathways of 3D pathology, from sample clearing and fluorescent labeling to 3D imaging and visualization and then to an analytical framework for 3D pathological data. Based on this, we further examined representative applications, including tumor staging, lesion detection, and immune microenvironment profiling, to illustrate the advantages and potential clinical value of 3D pathology over conventional 2D approaches in precision diagnosis, prognostic assessment, and therapeutic decision-making. We also highlight key challenges that remain for 3D pathology, such as storage and computational costs, workflow and diagnostic standardization, and clinical implementation. Overall, AI-enabled 3D pathological imaging holds promise as an important direction for pathology, although its integration into routine clinical decision-making will require continued technological development and translational research.
The Chinese Medical Journal and the Chinese Medical Association: Centennial legacy and the institutionalization of a scholarly community.
Su J, Zhang D
Chin Med J (Engl) · 2026 Jun · PMID 42310906 · Publisher ↗
Abstract loading — click title to view on PubMed.
Application of hydrogel technologies in the treatment of musculoskeletal disorders.
Li J, Su X, Dong Y … +3 more , Wan W, Tian J, Zhao Y
Chin Med J (Engl) · 2026 Jun · PMID 42304597 · Publisher ↗
Musculoskeletal disorders (MSDs) represent a diverse group of conditions affecting bones, cartilage, intervertebral discs, tendons, muscles, and related structures, and continue to be a leading cause of global disability...
Musculoskeletal disorders (MSDs) represent a diverse group of conditions affecting bones, cartilage, intervertebral discs, tendons, muscles, and related structures, and continue to be a leading cause of global disability. Despite advancements in surgery and pharmacotherapy, issues such as incomplete regeneration, limited longevity, and procedure-related complications remain unresolved. As a result, hydrogel technologies have garnered increasing attention due to their hydrated three-dimensional networks, customizable mechanical properties, and extracellular matrix (ECM)-mimicking features. Hydrogels have been developed in various forms, including injectable systems, scaffolds, and patches, to facilitate tissue regeneration, deliver bioactive molecules, modulate inflammation, and provide mechanical or interfacial support. This review comprehensively examines recent advancements in hydrogel technologies for MSD treatment, focusing on bone and cartilage repair, osteoarthritis management, intervertebral disc regeneration, tendon and muscle healing, and spinal dural repair. It covers laboratory studies, preclinical animal trials, and clinically approved or translational products. By critically evaluating representative materials, design strategies, and disease-specific requirements, this review highlights the therapeutic potential and translational barriers of current hydrogel systems. Challenges such as mechanical durability, spatiotemporal control of bioactivity, scalable manufacturing, and clinically relevant evaluation are addressed, providing insights into the development of next-generation hydrogels for MSDs.
Poriae cutis triterpenes ameliorate metabolic-associated steatotic liver disease by inhibiting PXR/NLRP3 pathways.
Lyu T, Ma W, Zhang C … +9 more , Yu L, Wang R, Peng D, Yu N, Wang L, Yao L, Chen W, Zhang Y, Wang Y
Chin Med J (Engl) · 2026 Jun · PMID 42304579 · Publisher ↗
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[Evaluation of the efficacy of different large language models in solving clinical problems of early gastric cancer].
Feng JX, Guo YB, Wang BL … +4 more , Hong KC, Li JB, Li R, Lei CD
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42303589 · Publisher ↗
To evaluate the effectiveness of different large language models (LLM) in addressing clinical questions related to early gastric cancer (EGC). Select four types of LLM, including ChatGPT-4o, DeepSeek-V3.2, Gemini-2.5, a...
To evaluate the effectiveness of different large language models (LLM) in addressing clinical questions related to early gastric cancer (EGC). Select four types of LLM, including ChatGPT-4o, DeepSeek-V3.2, Gemini-2.5, and Grok-3, and develop 25 EGC professional knowledge questions based on international authoritative guidelines. Ten clinical physicians evaluated the accuracy, relevance, completeness scores of the four LLM' responses. Meanwhile, based on patient interviews, 15 EGC life and health questions were extracted, and 10 EGC patients were asked to rate their understanding of the answers to the 4 LLM; The readability of LLM solution was further evaluated by clinicians. One-way analysis of variance or Friedman test was used for comparison between the groups, and paired test corrected by Bonferroni method or Wilcoxon signed rank test corrected by Bonferroni method was used for comparison between two groups. These analyses were used to compare the accuracy, relevance, completeness, comprehension scores and readability assessment of different LLM solutions in addressing clinical questions related to EGC, thereby enabling a dual assessment of both expertise and accessibility. The accuracy scores of DeepSeek-V3.2 [（， ），78.0 (76.5, 82.0) points], Gemini-2.5 [80.0 (77.0, 82.5) points], and Grok-3 [82.0 (74.0, 83.0) points] evaluated by clinical physicians were lower than those of ChatGPT-4o [86.0 (83.5, 89.0) points] (all <0.05); The relevance scores of DeepSeek-V3.2 [82.0 (77.5, 87.0) points] and Grok-3 [86.0 (82.0, 88.0) points] were both lower than those of ChatGPT-4o [88.0 (87.5, 90.5) points] (both <0.05); The completeness scores of DeepSeek-V3.2 [75.0 (69.5, 80.0) points] and Gemini-2.5 [84.0 (81.0, 88.5) points] were both lower than those of Grok-3 [90.0 (85.5, 91.5) points] (both <0.05). Patients' score for the comprehensibility of DeepSeek-V3.2's responses [79.0 (77.0, 90.0) points] was lower than that for ChatGPT-4o [88.0 (86.0, 90.0) points] (<0.05). In terms of readability assessment, the simple measure of gobbledygook (SMOG) score for DeepSeek-V3.2's responses (14.1±1.6) was lower than that of ChatGPT-4o (16.4±2.3), Gemini-2.5 (15.8±2.0) and Grok-3 (15.8±1.1) (all <0.05). Different LLM have their own advantages and disadvantages in answering clinical questions about EGC. ChatGPT-4o has a better comprehensive evaluation, while DeepSeek-V3.2 has better readability in answering questions.
Neurobiology of cancer: Unraveling the roles of the nervous system in tumor initiation, progression, and therapeutic.
Zhou L, Luo X, Bao T … +4 more , Sun H, He C, Yang Y, Xia Y
Chin Med J (Engl) · 2026 Jun · PMID 42299464 · Publisher ↗
Accumulating evidence highlights a complex interplay between the nervous system and cancer; the nervous system has a significant influence on tumor progression. This review explores the burgeoning field of neuro-oncology...
Accumulating evidence highlights a complex interplay between the nervous system and cancer; the nervous system has a significant influence on tumor progression. This review explores the burgeoning field of neuro-oncology, focusing on the nervous system's role in tumor initiation, growth, invasion, metastasis, and treatment response. In most cases, the nervous system interacts with the tumor microenvironment (TME) through its extensive and highly intricate network at both the local and systemic levels, thereby promoting malignant behaviors such as tumor growth, invasion, and metastasis. Conversely, in certain tumor types, neural-tumor interactions may suppress tumor progression. This bidirectional regulatory phenomenon highlights the complex and diverse role of the nervous system in tumor development. Within the TME, the nervous system influences tumor progression through multiple mechanisms, including synaptic connections, paracrine signaling, and immune regulation. Studies show that in brain tumors, neurons and glial cells can promote tumor growth and treatment resistance through neurotransmitter release, synaptic signaling, and inflammatory modulation, whereas in peripheral tumors, autonomic and sensory nerve activity also regulates tumor progression. Understanding these interactions enhances our comprehension of tumor biology and enables the development of innovative therapeutic strategies targeting neuro-cancer interfaces. This interdisciplinary approach, integrating neuroscience, immunology, and oncology, provides insights into cancer-nervous system dynamics, and holds promising potential to advance the development of effective anticancer therapies.
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