北京协和医学院

Background: The external oblique intercostal (EOI) plane block is a fascial plane block that targets the unilateral cutaneous branches of intercostal nerves, and spares the sympathetic trunk. We hypothesized that the ultrasound-guided EOI plane block might provide superior analgesia compared to systemic analgesia alone for patients after open liver surgery. Methods: In this double-blind, randomized controlled trial, 74 patients scheduled for open liver surgery were assigned to receive either EOI plane block with 30 mL of 0.375% ropivacaine (n = 37) or no EOI plane block (n = 37). All patients received postoperative standard patient-controlled intravenous analgesia. Primary outcome was the resting numerical rating scale (NRS) pain score at 3 h postoperatively. The key secondary outcomes included opioid consumption, and the total number of analgesia interventions at 3 h, 6 h, 24 h, 48 h, and 72 h postoperatively; opioid-related side effects and block-related complications; postoperative functional recovery outcomes; total ropivacaine plasma concentrations at 5, 10, 30, 60, 120, and 180 min post-block. Results: The primary outcome, the resting NRS pain score at 3 h postoperatively, was significantly lower in the block group than in the control group. The block group showed a shorter length of hospital stay. There were no significant differences in cumulative opioid consumption, frequency of analgesia, or opioid-related side effects. No block-related complications were observed, and total ropivacaine plasma concentrations remained below the toxicity threshold. Conclusions: Ultrasound-guided EOI plane block reduces early postoperative pain. This technique should be regarded as a safe and effective component within a comprehensive postoperative multimodal analgesia regimen.

This systematic review assessed the diagnostic performance of artificial intelligence (AI) for detecting periapical periodontitis on cone-beam computed tomography (CBCT). A systematic literature search of Scopus, PubMed, Web of Science, and Embase was conducted to identify peer-reviewed diagnostic studies involving human participants and published up to August 30, 2026. Studies evaluating the application of AI for the detection of periapical periodontitis on CBCT were deemed eligible for inclusion. Conversely, studies focusing exclusively on periapical cysts, other odontogenic lesions, or root resorption were excluded. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies–Artificial Intelligence (QUADAS-AI) tool, while the certainty of the evidence for the pooled outcomes was evaluated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Of 659 records identified through database searches, 18 studies were included in the systematic review and 6 in the meta-analysis. The exploratory HSROC synthesis yielded a pooled sensitivity of 0.91 (95% CI, 0.84-0.94) and a pooled specificity of 0.94 (95% CI, 0.80-0.98). Substantial between-study heterogeneity was observed, with I² values exceeding 98% for virtually all reported metrics, and the corresponding prediction regions were wide. Consequently, the pooled estimates should be interpreted solely as exploratory descriptive summaries rather than as clinically generalisable estimates of diagnostic performance. The GRADE certainty of evidence was rated as very low for each of the four pooled outcomes. The diagnostic performance and clinical utility of AI for the detection of periapical periodontitis on CBCT remain uncertain, owing to the extreme heterogeneity, wide prediction regions, and very low certainty of evidence identified in this review. These findings support further investigation rather than routine clinical implementation at present. AI warrants further evaluation as a potential adjunct to clinician-led assessment of periapical periodontitis. The current evidence does not establish clinical benefit or justify recommending routine use or replacement of professional judgement.

Background: The intact M-protein Screening-Light Chain Assay (iMS-LC Assay) is a MALDI-TOF mass spectrometry (MS)-based method for M-protein detection without antibody enrichment. This study evaluated its feasibility for M-protein screening in comparison with conventional serum protein electrophoresis (SPE). Methods: We prospectively enrolled 15,068 consecutive individuals aged >= 30 years undergoing routine physical examinations at Peking Union Medical College Hospital between December 2, 2024, and April 10, 2025. Residual serum samples from SPE were subjected to automated iMS-LC Assay screening. Samples positive by either MS or SPE underwent verification by serum immunofixation electrophoresis (IFE), free light chain (FLC) analysis, and MS isotyping. Results: MS screening identified 201 positive cases compared to 70 by SPE (p < 0.001), demonstrating consistently higher detection rates across all age groups and more than a threefold increase among individuals under 60. MS positivity rates increased with age: males 30-39y (0.44%), 40-49y (1.19%), 50-59y (1.60%), 60-69y (2.51%), 70-79y (7.56%), >= 80y (14.29%); females 30-39y (0.44%), 40-49y (1.10%), 50-59y (1.47%), 60-69y (2.46%), 70-79y (3.92%), >= 80y (8.00%). Conclusion: The iMS-LC Assay demonstrated a higher detection yield than SPE for M-protein screening and identified additional low-abundance M-proteins, particularly in younger age groups.

Platinum drugs are used in first-line to treat ovarian cancer, but most of the patients eventually generate resistance after treatment with these drugs. Although both c-Myc and EZH2 have been implicated in regulating cisplatin resistance in ovarian cancer, the interplay between these two regulators is poorly understood. Using RNA sequence analysis (RNA-seq), for the first time we find that miR-137 level is extremely low in cisplatin resistant ovarian cancer cells, correlating with higher levels of c-Myc and EZH2 expression. Further analyses indicate that in resistant cells c-Myc enhances the expression of EZH2 by directly suppressing miR-137 that targets EZH2 mRNA, and increased expression of EZH2 activates cellular survival pathways, resulting in the resistance to cisplatin. Inhibition of c-Myc-miR-137-EZH2 pathway re-sensitizes resistant cells to cisplatin. Both in vivo and in vitro analyses indicate that cisplatin treatment activates c-Myc-miR-137-EZH2 pathway. Importantly, elevated c-Myc-miR-137-EZH2 pathway in resistant cells is sustained by dual oxidase maturation factor 1 (DUOXA1)-mediated production of reactive oxygen species (ROS). Significantly, clinical studies further confirm the activated c-Myc-miR-137-EZH2 pathway in platinum drug-resistant or recurrent ovarian cancer patients. Thus, our studies elucidate a novel role of miR-137 in regulating c-Myc-EZH2 axis that is crucial to the regulation of cisplatin resistance in ovarian cancer.

Silent mating type information regulation 1 (SIRT1), a core molecule bridging energy metabolism and ageing modulation, relies on its nicotinamide adenine dinucleotide (NAD⁺)-dependent deacetylase activity and pathway crosstalk to form a key regulatory network governing ageing. This review focuses on the central regulatory role of SIRT1 in cellular senescence, integrating its multidimensional mechanisms in deoxyribonucleic acid (DNA) damage response, inflammatory microenvironment modulation, autophagic function remodeling, and maintenance of energy metabolic homeostasis. Meanwhile, we summarized the intervention strategies targeting SIRT1 (e.g., small-molecule compounds and natural extracts) and the differences in their action targets, clarifying their translational potential in the prevention and treatment of ageing-related diseases. We further highlight emerging evidence on sex-specific differences, model specificity, and evolutionary conservation that shape SIRT1’s role in ageing. This review aims to provide a systematic perspective for in-depth understanding of the SIRT1-mediated ageing regulatory network, and offer a reference for basic anti-ageing research, optimization of precise intervention strategies, and screening of therapeutic targets for related diseases.