Langhuan Yang,1,* Huimei Zeng,2,* Yan Yang,2 Jin Gao,2 Bo Wang,2 Yongkang Zhang,2 Mo Chen,2 Yourui Chen,2 Shiyu Zhang,2 Jikun Zheng,1 Xuesong Yang21Department of Radiology, The First Affiliated Hospital of Yunnan University of Chinese Medicine (Yunnan Provincial Hospital of Traditional Chinese Medicine), Kunming, Yunnan, People’s Republic of China; 2Department of Dermatology, The First Affiliated Hospital of Yunnan University of Chinese Medicine (Yunnan Provincial Hospital of Traditional Chinese Medicine), Kunming, Yunnan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jikun Zheng, Email zjkyj2006@126.com Xuesong Yang, Email yangxuesong@ynucm.edu.cnAbstract: Psoriasis functions as a systemic inflammatory disorder associated with accelerated atherosclerosis via the Skin-Vascular Axis, conferring a cardiovascular (CV) risk frequently underestimated by conventional calculators. In this narrative review, we elucidate the mechanistic role of the IL-23/IL-17 pathway in vascular remodeling and highlight a critical clinical challenge: cutaneous-vascular dissociation, wherein profound skin clearance may not reflect internal vascular homeostasis. We evaluate the systemic CV impact of targeted therapies, highlighting the vasculo-protective potential and real-world observational evidence of biologics, the neutral-to-favorable cardiometabolic profile of oral PDE4 inhibitors, and the safety landscape of TYK2/JAK inhibitors. Furthermore, we assess the emerging clinical potential of Artificial Intelligence (AI) in cardio-dermatology, detailing how deep learning radiomics and novel multimodal fusion models incorporating biomarkers like GlycA can identify subclinical, vulnerable phenotypes. However, current evidence is largely derived from general cardiovascular cohorts, underscoring the need for disease-specific validation. Ultimately, we propose that AI-augmented tools should complement clinical judgment within an interdisciplinary framework to precisely stratify risk and potentially guide interventions to improve cardiovascular outcomes in psoriasis.Keywords: psoriasis, cardiovascular risk, skin–vascular axis, artificial intelligence, multimodal fusion, radiomics, biologics
Xuanfu Peng,1 Yao Wang,2 Xuelan Yang,3 Weijiang Xiong41General Surgery Department of Mianyang Hospital of Traditional Chinese Medicine, Mianyang City, Sichuan Province, 621000, People’s Republic of China; 2Department of Cardiovascular Medicine, Mianyang Hospital of Traditional Chinese Medicine, Mianyang City, Sichuan Province, 621000, People’s Republic of China; 3Department of Internal Medicine, Mianyang Hospital of Traditional Chinese Medicine, Mianyang City, Sichuan Province, 621000, People’s Republic of China; 4Department of General Surgery, Nanchong Hospital of Traditional Chinese Medicine, Nanchong City, Sichuan Province, 637000, People’s Republic of ChinaCorrespondence: Xuanfu Peng, General Surgery Department of Mianyang Hospital of Traditional Chinese Medicine, No. 14, Fucheng Road, Fucheng District, Mianyang City, Sichuan Province, 621000, People’s Republic of China, Tel +86 13550808590, Email pengxuanfu2025@126.com Yao Wang, Department of Cardiovascular Medicine, Mianyang Hospital of Traditional Chinese Medicine, No. 14, Fucheng Road, Fucheng District, Mianyang City, Sichuan Province, 621000, People’s Republic of China, Email wang_yao335@21cn.comObjective: This study aimed to (1) evaluate, in a propensity-score-weighted retrospective cohort, the effectiveness and safety of a standardised perioperative Buyang Huanwu-based traditional Chinese medicine (TCM) decoction combined with standard low-molecular-weight heparin (LMWH) prophylaxis on the 30-day incidence of symptomatic and asymptomatic venous thromboembolism (VTE), (2) characterise the longitudinal trajectories of coagulation (D-dimer, fibrinogen) and inflammatory (C-reactive protein [CRP]) biomarkers and (3) quantify the net clinical benefit of this integrative approach.Methods: We conducted a retrospective cohort study of 1847 adult patients undergoing major general-surgical or gynaecological procedures between January 2020 and December 2024 at a tertiary integrative-medicine centre. Patients receiving a standardised perioperative TCM decoction based on the modified Buyang Huanwu Tang in addition to standard LMWH prophylaxis (n = 892) were compared with patients receiving standard prophylaxis alone (n = 955). The TCM decoction comprised seven herbal components dispensed at fixed daily doses (Huangqi, 60 g; Danggui, 9 g; Chishao, 6 g; Chuanxiong, 6 g; Honghua, 3 g; Taoren, 6 g; Dilong, 9 g) supplemented with 15 g of Danshen; granules were prepared as a single-batch good manufacturing practice-certified concentrated formulation, with the principal bioactive markers astragaloside IV, ferulic acid, paeoniflorin and salvianolic acid B quantified by high-performance liquid chromatography and required to fall within ± 10% of the label content to ensure dose standardisation. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. The primary outcome was 30-day VTE confirmed by duplex ultrasonography or computed tomography pulmonary angiography, with symptomatic and asymptomatic events recorded separately. Secondary outcomes included major bleeding, length of stay, patient-reported pain and 90-day all-cause mortality. Linear mixed-effects models were used to analyse longitudinal trajectories of D-dimer, fibrinogen and CRP measured at baseline and on postoperative days 1, 3 and 7.Results: After IPTW adjustment, TCM intervention was associated with significantly reduced 30-day VTE incidence (hazard ratio [HR]: 0.58, 95% confidence interval [CI]: 0.41– 0.82, p = 0.002), with consistent protection observed for both symptomatic VTE (HR: 0.55, 95% CI: 0.34– 0.89) and ultrasound-detected asymptomatic distal deep-vein thrombosis (HR: 0.61, 95% CI: 0.39– 0.94). Landmark analysis revealed sustained protection during both hospitalisation (HR: 0.52, 95% CI: 0.33– 0.81) and the post-discharge period (HR: 0.67, 95% CI: 0.42– 0.93). Linear mixed-effects modelling demonstrated significant group-by-time interactions for D-dimer (p < 0.001) and CRP (p = 0.003), indicating accelerated biomarker clearance in the TCM group: 42% faster D-dimer resolution and 38% faster CRP normalisation than in controls. No significant difference was observed for major bleeding (2.1% vs 2.4%, p = 0.68) or 90-day all-cause mortality (1.6% vs 2.0%, p = 0.51). Decision-curve analysis confirmed superior net clinical benefit across the clinically relevant threshold-probability range.Conclusion: Perioperative Buyang Huanwu-based TCM combined with standard LMWH prophylaxis significantly reduces postoperative VTE risk – for both symptomatic and ultrasound-detected asymptomatic events – through accelerated resolution of coagulation and inflammatory cascades, without increasing bleeding or 90-day all-cause mortality. These findings support the integration of standardised TCM into enhanced-recovery-after-surgery protocols, particularly for moderate- to high-risk surgical patients in whom anticoagulation intensification may be contraindicated.Keywords: venous thromboembolism, Buyang Huanwu Tang, perioperative care, propensity score weighting, coagulation–inflammation crosstalk, enhanced recovery after surgery
Hangbo Hu,1 Jin Qian,2 Hongsheng Deng,1 Kun Chen,1 Xinyong Liu11Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China; 2Department of Nursing, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of ChinaCorrespondence: Xinyong Liu, Department of Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, People’s Republic of China, Email liuxinyongwz@163.comAbstract: Sepsis-associated acute respiratory distress syndrome (SA-ARDS) is a heterogeneous syndrome in which systemic inflammation, vascular dysfunction, altered fluid balance, chest-wall loading, and respiratory effort may produce regional abnormalities not captured by global respiratory variables. Electrical impedance tomography (EIT) provides continuous bedside assessment of regional ventilation and, increasingly, regional perfusion. This review summarizes EIT-derived measures relevant to SA-ARDS and examines how key sepsis-associated mechanisms may influence regional ventilation, perfusion, and mechanics. Six candidate functional patterns are proposed: collapse-shunt dominance, overdistension-dead-space dominance, perfusion-defect dominance, diffuse low aeration with limited recruitability, abdominal pressure-diaphragm interaction, and effort-related regional asynchrony. These patterns are neither mutually exclusive nor specific to SA-ARDS and may evolve over time.Keywords: sepsis-associated acute respiratory distress syndrome, electrical impedance tomography, regional ventilation, regional perfusion, ventilation-perfusion mismatch, functional phenotyping
Mengmeng Fan,1 Xueping Zhang,1 Xianwei Tian,1 Keli Li,2 Zhiqiang Liu11Department of Cardiology, Xinxiang Central Hospital, Xinxiang, Henan, People’s Republic of China; 2Department of Cardiology, Huangshan City People’s Hospital, Huangshan, Anhui, People’s Republic of ChinaCorrespondence: Zhiqiang Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang, Henan, People’s Republic of China, Email ljlzq2001@126.comBackground: The composite index of inflammation and insulin resistance (IR), the C-reactive protein (CRP)–triglyceride–glucose (TyG) index (CTI), has been suggested to be closely associated with cardiovascular disease. However, the relationship between the CTI and kidney injury (KI), including its subtypes [declined kidney function (DKF) and proteinuria], remains unclear in patients with coronary heart disease (CHD), and whether sex differences exist is unknown.Methods: This two-center cross-sectional study enrolled 3793 patients with CHD between September 2021 and May 2026. Multivariable stepwise-adjusted logistic regression assessed associations of the CTI with KI and its subtypes. Restricted cubic spline (RCS) analysis identified dose-response relationships and threshold effects, followed by piecewise comparisons. Subgroup analyses stratified by sex were performed to evaluate consistency across sexes. The area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and the Boruta algorithm compared the discriminative performance of the CTI versus CRP and TyG alone for KI and its subtypes.Results: Multivariable logistic regression showed that the CTI was significantly associated with KI and its subtypes in CHD patients. The overall prevalence of KI was 814/3,793 (21.5%). RCS revealed that CTI exceeding 4.8, 4.7, and 4.55, respectively, significantly increased risks of KI, DKF, and proteinuria. Notably, the increased risk of KI was particularly evident when CTI exceeded 4.45 in females and 4.96 in males. AUC, DCA, and Boruta rankings all confirmed stronger discriminative performance of the CTI than CRP or TyG alone for KI and its subtypes.Conclusion: Elevated CTI was independently associated with KI and its subtypes in CHD patients, with clear threshold effects that differed by sex and superior discriminative performance to single indicators. These associations were more pronounced in overweight/obese patients. Although CTI may help identify individuals at higher risk, the sex-specific thresholds should be regarded as exploratory threshold estimates and require external validation before clinical application.Keywords: coronary heart disease, C-reactive protein-triglyceride-glucose index, kidney injury, declined kidney function, proteinuria
Serge Chooklin, Serhii ChuklinDepartment of Surgery, Saint Paraskeva Medical Center, Lviv, UkraineCorrespondence: Serge Chooklin, Email chooklin_serge@hotmail.comBackground: Interleukins 27 (IL-27), 33 (IL-33), 35 (IL-35) and 37 (IL-37) occupy potentially important but biologically non-equivalent positions at the interface between inflammatory amplification, tissue protection and immune restraint in acute pancreatitis (AP). This narrative review critically synthesizes AP-specific evidence, distinguishing mechanistic participation from biomarker association and defining translational priorities.Methods: PubMed/MEDLINE, Scopus and Google Scholar were searched through July 2026. The review was structured with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). Of 215 records identified, 43 underwent full-text assessment and 35 were included in the narrative synthesis (32 original studies and 3 reviews). Primary AP studies were prioritized, with landmark mechanistic studies used to interpret cytokine biology.Results: IL-33/ST2 was the most extensively studied axis and showed phase-, compartment- and molecular-form-dependent effects. Soluble ST2 correlated with severity but has not been validated for incremental prediction. IL-37 had the strongest direct protective evidence, inhibiting NLRP3–caspase-1–gasdermin D-mediated acinar-cell pyroptosis experimentally and showing an inverse association with pancreatic necrosis in patients; however, this clinical association derived from a single cohort and requires external validation. IL-35 findings were contradictory, with both severity-associated increases and reduced concentrations reported; assay characteristics may limit reliable distinction of intact bioactive IL-35 from free subunits or related complexes. Evidence for IL-27 was sparse and largely indirect. Across all four cytokines, clinical evidence remains limited by small or heterogeneous cohorts, inconsistent timing and analytical methods, and insufficient independent validation.Conclusion: These cytokines should not be considered a uniform anti-inflammatory group. IL-33/ST2 is context-dependent, IL-37 is a promising but preclinical cytoprotective candidate, and IL-35 and IL-27 remain hypothesis-generating. None is validated as a stand-alone biomarker or therapeutic target for routine AP care. Further progress requires standardized assays, longitudinal sampling and independent clinical validation.Keywords: acute pancreatitis, interleukin-27, interleukin-33, ST2, interleukin-35, interleukin-37
