Zhen Lai,1,* Weijia Gao,2,* Xujing Yao,3 Shijie Cao,4 Xinyu Xia,4 Natalie Ann Parry,2 Yan Liang21Department of Acupuncture, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China; 2Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of Acupuncture, Jiangqiao Community Health Service Center, Jiading District, Shanghai, People’s Republic of China; 4Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Liang, Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China, Email dr.liangy@163.comBackground: Whether intensive electroacupuncture (EA) during early nicotine withdrawal improves symptom trajectories remains unclear.Objective: To compare intensive EA with low-density EA and varenicline for withdrawal symptoms and explore withdrawal-related sleep symptoms.Methods: In this single-center, three-arm, open-label randomized trial, 114 participants were allocated equally to intensive EA, low-density EA, or varenicline for 4 weeks. EA was administered daily or every other day during week 1, respectively, and three times weekly during weeks 2– 4. Outcomes were assessed at baseline, weeks 1– 4, and 1 and 3 months after treatment. The main outcome for the present analysis was the week-1 change in Minnesota Nicotine Withdrawal Scale (MNWS) total score. Withdrawal-related sleep symptoms were assessed exploratorily using a score derived from two MNWS sleep-related items. Analyses used analysis of covariance and generalized estimating equations, with exploratory analyses of time-averaged symptom burden and post-treatment changes.Results: Per-protocol analyses included 110 participants. At week 1, intensive EA was associated with lower adjusted MNWS scores than varenicline (mean difference, − 5.75; 95% CI, − 6.95 to − 4.55) and low-density EA (− 5.88; 95% CI, − 7.08 to − 4.67). Exploratory analyses suggested improvements in craving and withdrawal-related sleep symptoms. The proportions with exhaled carbon monoxide ≤ 4 ppm at 3 months after treatment were 29.7%, 18.9%, and 13.9% in the intensive EA, varenicline, and low-density EA groups, respectively (overall p=0.234).Conclusion: Intensive EA may alleviate withdrawal symptoms during early smoking cessation. Exploratory sleep findings require confirmation. The study did not establish a benefit for smoking abstinence, and longer follow-up is needed.Keywords: nicotine dependence, electroacupuncture, smoking cessation, withdrawal symptoms, sleep disturbance, randomized controlled trial
Wenyuan Wei, Rui Zhang, Zhiying ZhangDepartment of Thyroid Breast Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhiying Zhang, Department of Thyroid Breast Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot North Street, Hohhot, Inner Mongolia, 010050, People’s Republic of China, Tel +8618896651057, Email z18896651057@163.comAbstract: Circulating biomarkers, particularly cell-free DNA (cfDNA), are transforming contemporary medicine through their capacity to provide dynamic, minimally invasive assessments of disease dynamics. Their clinical utility has broadened substantially to include oncology, cardiovascular conditions, transplant monitoring, infectious diseases, and persistent inflammatory disorders. Nevertheless, the increasing complexity and volume of biomarker-related data pose substantial challenges, necessitating the integration of artificial intelligence (AI) and machine learning methodologies for improved data interpretation, risk assessment, and clinical decision-making. This review presents a thorough examination of recent progress in the integration of circulating biomarkers with AI within therapeutic contexts and clinical risk management. It outlines the translational trajectory from molecular signatures to precision medicine, addresses present constraints, and explores prospective developments. The objective of this review is to serve as a systematic resource for both clinical practice and research, thereby promoting the evolution of personalized medicine through innovative, biomarker-driven strategies supported by AI.Keywords: circulating biomarkers, cell-free DNA, artificial intelligence, precision medicine, clinical risk management, therapeutics
Pao-Jen Kuo, Pi-Chieh Lin, Ching-Hua HsiehDepartment of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, TaiwanCorrespondence: Ching-Hua Hsieh, Email m93chinghua@gmail.comBackground: Cutaneous scarring after surgery, trauma, and burns carries aesthetic, functional, and psychological morbidity. Nanofat, mechanically emulsified lipoaspirate rich in the stromal vascular fraction, has been proposed to improve scar quality, but its clinical benefit, durability, and specificity relative to conventional fat grafting remain uncertain.Objective: To appraise the clinical outcomes of autologous nanofat injection for cutaneous scars and grade the certainty of the evidence.Methods: Following PRISMA 2020 (PROSPERO CRD420261424355), MEDLINE/PubMed, Embase, Cochrane CENTRAL, and Scopus were searched to 15 April 2026 for clinical studies published from 2021 onward. Two reviewers independently screened records, extracted data in duplicate, and appraised risk of bias with RoB 2 and the NIH tool for before–after studies. Certainty was rated with GRADE. Findings were synthesized narratively and tabulated by effect direction, scar category, and treatment timing.Results: Five studies (two randomized, three uncontrolled; 108 patients) were included. In both randomized trials, which applied nanofat at wound closure, scar scores favored nanofat at 3 to 6 months. At 12 months, observer-rated scores remained better in the split-scar trial (n = 12), whereas patient-rated scores and erythema no longer differed. In the three-arm trial, nanofat-enriched fat did not differ from conventional fat grafting in most outcomes. In one uncontrolled series, mean Vancouver Scar Scale score fell by about 45% (10.0 to 5.5) at 3 months, with reduced pain and pruritus. No serious adverse event was reported, but reporting was incomplete. Certainty was low for short-term scar appearance and serious adverse events and very low for longer-term appearance, symptom relief, and nanofat-specific benefit.Conclusion: Current evidence suggests a possible short-term effect of nanofat on scar remodeling, particularly when applied at surgical wound closure. A durable, nanofat-attributable benefit remains uncertain, and the available data are too limited to exclude uncommon harm. Adequately powered randomized trials with standardized preparation, validated and objective outcomes, and follow-up of at least 12 months are needed.Registration: PROSPERO registration number CRD420261424355.Keywords: nanofat, stromal vascular fraction, adipose-derived stem cells, scar, hypertrophic scar, fat grafting, GRADE
Feige Nian,1,2 Zhehan Chen,3 Yezhou Qian,4 Mingfeng Yang,1,2 Bin Zhang1,21Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, People’s Republic of China; 2Jiaxing Key Laboratory of Osteoporosis and Bone Metabolism, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, People’s Republic of China; 3Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Cardiology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), Jiaxing, Zhejiang, People’s Republic of ChinaCorrespondence: Bin Zhang; Mingfeng Yang, Department of Rheumatology and Immunology, The Affiliated Hospital of Jiaxing University (The First Hospital of Jiaxing), No. 1882 Zhonghuan South Road, Jiaxing, Zhejiang, 314000, People’s Republic of China, Email 00181628@zjxu.edu.cn; 370836140@qq.comAbstract: Rheumatic diseases, including those with an autoimmune etiology (including rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies and systemic vasculitis) represent an independent risk factor for coronary atherosclerosis and atherosclerotic cardiovascular disease (ASCVD). Systemic inflammation plays a multidimensional role in cardiovascular disease (CVD) pathogenesis, and patients with rheumatic diseases face elevated CVD risk and mortality compared with the general population, driven by both traditional cardiovascular risk factors and systemic immune dysregulation. Adequate management of inflammation will be accompanied by improved cardiovascular risk. In 2010, rheumatology introduced the "targeted therapy” strategy, and around the same time, cohort studies showed a significant decrease in cardiovascular mortality. A comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to June 2026. Studies were included if they evaluated the cardiovascular effects of disease-modifying antirheumatic drugs (DMARDs) in patients with the aforementioned rheumatic diseases. These diseases were selected based on their high prevalence, well-established cardiovascular risk, and availability of comparative evidence across DMARD classes; systemic sclerosis was excluded due to its distinct pathophysiology and limited published data on DMARD-related cardiovascular outcomes. We still need to deepen our understanding of the precise pathophysiological mechanism of autoimmune mediated acceleration of atherosclerosis and its clinical manifestations, to enable more appropriate selection of immunotherapies and biological agents for patients with rheumatic diseases, including those with an autoimmune etiology, and ultimately reduce the cardiovascular risk of this population, thereby improving prognosis and quality of life. The aim of this narrative review was to synthesize available evidence regarding the cardiovascular effects of three major classes of DMARDs: conventional synthetic disease‑modifying antirheumatic drugs (csDMARDs), biologic disease‑modifying antirheumatic drugs (bDMARDs), and targeted synthetic disease‑modifying antirheumatic drugs (tsDMARDs), across a stratified spectrum of cardiovascular endpoints ranging from hard clinical outcomes to subclinical surrogate markers. The main findings indicate that different DMARDs classes exhibit heterogeneous effects on cardiovascular outcomes, with csDMARDs such as methotrexate and hydroxychloroquine generally associated with favorable cardiovascular profiles, whereas the cardiovascular safety of certain biologic and targeted synthetic agents remains a subject of ongoing investigation. Limitations of this review include the observational nature of most included studies, heterogeneity across study designs and populations, and the lack of head-to-head randomized trials comparing different DMARDs classes with respect to cardiovascular outcomes. Collectively, these findings underscore the need for individualized cardiovascular risk assessment and tailored DMARDs selection in patients with rheumatic diseases, thereby optimizing both rheumatic and cardiovascular prognosis.Keywords: cardiovascular disease, rheumatic diseases, conventional synthetic disease-modifying antirheumatic drugs, biologic disease-modifying antirheumatic drugs, targeted synthetic disease-modifying antirheumatic drug
Gang Ren, Xin Wang, Zhenjiang LiuDepartment of Orthopedics, Capital Center for Children’s Health, Capital Medical University, Capital Institute of Pediatrics, Beijing, People’s Republic of ChinaCorrespondence: Zhenjiang Liu, Department of Orthopedics, Capital Center for Children’s Health, Capital Medical University, Capital Institute of Pediatrics, Beijing, People’s Republic of China, Tel +8618518955141, Email zhenjiang10001@163.comObjective: To evaluate changes in quality of life (QoL) and psychological outcomes in children with tibial fractures after treatment, stratified by age groups (0-< 6, 6-< 12, ≥ 12 years), and identify age-specific recovery patterns.Methods: This study enrolled 193 children (aged 0– 16 years) with isolated tibial fractures treated at Center for Children’s Health, Capital Medical University from November 2024 to September 2025. Groups: 0-< 6 years (n=39), 6-< 12 years (n=108), ≥ 12 years (n=46). Exclusion criteria included multiple fractures, relevant comorbidities, cognitive impairment affecting assessment, and incomplete data; treatment modality or fixation type was not used as an exclusion criterion. PedsQL assessments were performed before treatment and once at the 3- to 6-month post-treatment follow-up. Data were analyzed with SPSS 26.0 using ANOVA/Kruskal–Wallis tests, chi-square/Fisher’s exact tests, and paired t-tests.Results: No significant differences in demographics, injury mechanisms, severity (AIS/ISS), complications, operative time, hospitalization, weight-bearing time, or immobilization across groups (P> 0.05). All groups showed significant PedsQL improvements post-treatment (P< 0.001): physical (76– 79 to 93– 94), emotional (70– 83 to 91– 95), social (72– 75 to 89– 94), school (71– 74 to 90– 92), psychosocial (69– 77 to 92– 94), total (74– 79 to 93– 95). Younger groups had lower pre-treatment emotional/psychosocial scores but greatest gains; post-treatment differences minimal except emotional/social (P=0.003).Conclusion: Tibial fracture treatment yields substantial QoL and psychological improvements across ages, with younger children showing resilience in emotional/psychosocial recovery. Age-sensitive follow-up that includes rehabilitation guidance and psychosocial screening may help identify children needing additional family, school, or psychological support.Keywords: pediatric tibial fracture, quality of life, psychological outcomes, treatment, PedsQL, age groups
