To evaluate the clinical efficacy of the Thopaz digital chest drainage system in managing persistent air leak following pulmonary tuberculosis surgery, in order to provide evidence to support clinical decision-making.

A retrospective analysis was performed on 68 patients who developed persistent air leak following pulmonary tuberculosis surgery between January 2023 and December 2025. Patients were divided into an observation group (n=34) and a control group (n=34) according to the drainage method used. The two groups were comparable in terms of age, gender, lesion scope, surgical approach, and preoperative pulmonary function (P＞0.05). The observation group was managed with the Thopaz digital chest drainage system, while the control group received conventional closed chest drainage. The duration of air leak, chest tube indwelling time, length of hospital stay, treatment effective rate, postoperative complications, VAS pain score, drainage volume, and patient satisfaction were compared between the two groups.

The duration of air leak, chest tube indwelling time, and hospital stay in the observation group were significantly shorter than those in the control group (P＜0.05). The effective rate in the observation group was 94.12%, which was significantly higher than the 73.53% observed in the control group (P＜0.05). The incidences of pulmonary infection, subcutaneous emphysema, and mediastinal emphysema in the observation group were 5.88%, 8.82%, and 2.94%, respectively, all lower than those in the control group (P＜0.05). At 3 days after treatment, the VAS score in the observation group was significantly lower, as was the drainage volume at both 3 and 7 days (P＜0.05). Patient satisfaction n the observation group was 97.06%, higher than the 79.41% in the control group (P＜0.05).

The Thopaz digital chest drainage system is safe and effective in managing persistent air leak after pulmonary tuberculosis surgery. It significantly shortens air leak duration, chest tube indwelling time, and hospital stay, improves treatment success rate, reduces complications, and enhances patient experience. Therefore, it is worthy of clinical promotion.

To investigate the non-invasive diagnostic value and clinical significance of the main pulmonary artery to ascending aorta diameter ratio (MPA/AOr) measured by multi-slice spiral CT in patients with high-altitude pulmonary edema (HAPE).

This retrospective study included 69 patients with clinically diagnosed HAPE who were admitted to a medical center between December 2022 and June 2025. Chest CT images and clinical data were collected for each patient both before and after treatment. Another 69 healthy subjects matched for general clinical characteristics were selected as the control group. The maximum diameter of the main pulmonary artery and the diameter of the ascending aorta were measured on axial mediastinal-window CT images for all subjects, and the MPA/AOr was calculated. Changes in MPA/AOr in the HAPE group before and after treatment were compared, as well as differences between the HAPE group and the control group at each time point. Correlations of pre-treatment MPA/AOr with arterial oxygen saturation (SpO₂) and length of hospital stay were also examined.

The mean MPA/AOr in the HAPE group before treatment was 1.20±0.10, which decreased significantly to 1.01±0.09 after treatment, compared with 0.98±0.13 in the control group. Pre-treatment MPA/AOr was significantly higher than both the post-treatment value (t=19.33, P＜0.01) and that of the control group (t=11.48, P＜0.01). No statistically significant difference was observed in MPA/AOr between the post-treatment HAPE group and the control group (t=1.84, P＞0.05). Pre-treatment MPA/AOr in HAPE patients was significantly negatively correlated with SpO₂ (r=-0.55, P＜0.01) and positively correlated with length of hospital stay (r=0.71, P＜0.01).

Pulmonary artery pressure is significantly elevated in HAPE patients at disease onset and returns to near-normal levels after effective treatment. A higher pre-treatment MPA/AOr is independently associated with more severe hypoxemia and a longer hospital stay. CT-derived MPA/AOr can objectively reflect dynamic changes in pulmonary artery pressure in HAPE patients throughout the treatment course, and thus may serve as a reliable non-invasive imaging biomarker for evaluating both disease severity and therapeutic efficacy in HAPE.

To investigate the structural characteristics of gut microbiota in patients with calcium oxalate urinary calculi and to explore the correlation mechanisms underlying serum metabolic, based on an integrated analysis of gut microbiomics and serum metabolomics.

Patients with imaging-confirmed calcium oxalate urinary calculi and healthy controls were enrolled. Fecal samples and fasting serum specimens were collected from all participants. 16S rRNA high-throughput sequencing was applied to analyze gut microbiota structure, and UHPLC-MS/MS was used for targeted metabolomics profiling. Multivariate statistical analyses were performed to identify differentially abundant microbial taxa and metabolites. Spearman correlation analysis was adopted to construct the microbiota-metabolite correlation network.

Compared with the healthy control group, patients with calcium oxalate calculi presented increased species richness of gut microbiota and significantly distinct microbial community structure. In terms of microbial composition, symbiotic bacteria including Bifidobacterium, Blautia, and Roseburia were markedly decreased, while the relative abundances of Bacteroides, Prevotella, and Akkermansia were increased. Metabolomic results indicated obvious disturbances in serum metabolic profiles of patients, which were predominantly characterized by lipid metabolism disorders, abnormal amino acid metabolism, and reduced levels of oxidative stress-related metabolites. Correlation analysis revealed significant correlations between specific gut microbial taxa and multiple differentially expressed metabolites.

Patients with calcium oxalate urinary calculi exhibit gut microbiota dysbiosis and disrupted serum metabolic profiles. These two layers of alteration may interact through multiple interconnected pathways and jointly contribute to the pathogenesis of the disease.

Generative artificial intelligence (AI) technologies, represented by large language models (LLMs), have gradually permeated various clinical scenarios across medical specialties, including diagnostic and treatment decision-making, research support, and medical education; however, significant challenges remain in terms of optimizing specialty-specific adaptation and validating clinical implementation. Therefore, this study systematically reviews the applications of LLMs in medical specialties, focusing on summarizing performance evidence across various specialty-specific generation tasks, and identifies current challenges and future research directions.

By searching the three core comprehensive databases-PubMed, Scopus, and Web of Science-and manually searching the two world-leading journals, Nature and The Lancet, with a search period limited to 2023 through April 2026, we identified publicly available studies on LLMs in medical specialties. Based on data from the included studies, this study employed a descriptive analysis method to conduct a comprehensive systematic review of LLMs in medical specialties.

Searches of the three core comprehensive databases identified 25 studies meeting the inclusion criteria. Additionally, a manual search of top-tier journals in the field, including Nature, The Lancet, and their subsidiary journals, yielded 11 additional studies meeting the criteria, resulting in a total of 36 included studies. The included studies focused on medical specialty LLMs, covering eight specialties including internal medicine, surgery, ophthalmology, oncology, and traditional Chinese medicine general practice. Monomodal models constituted the majority (75%), while multimodal models accounted for only 25%. Applications were primarily concentrated in clinical diagnosis, treatment assistance, and medical education; however, common issues included insufficient specialty adaptation, inadequate utilization of multimodal data, and a lack of evidence for clinical translation.

LLMs have demonstrated significant application potential in medical specialties. However, issues such as insufficient specialty adaptation, inadequate utilization of multimodal data, and a lack of clinical translation evidence remain prevalent. Future efforts should focus on addressing these core issues by deeply developing specialty-specific LLMs, establishing a unified validation and evaluation framework that is clinically driven, clinician-led, and multimodal, and creating a three-pronged regulatory system that integrates hallucination assessment, explainability, and ethical oversight.

Chronic obstructive pulmonary disease (COPD) has been established as a systemic disorder affecting multiple organ systems, yet its impact on renal function remains frequently underrecognized. A well-documented bidirectional crosstalk exists between the lungs and kidneys. In COPD, chronic inflammation serves as the central pathogenic driver: proinflammatory mediators-including tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)-enter systemic circulation, directly impair renal tissue, activate the NF-κB signaling pathway, and trigger oxidative stress responses. These processes promote renal tubular apoptosis and interstitial fibrosis. Furthermore, persistent hypoxemia and hypercapnia activate endogenous hypoxia-inducible factors, leading to renal vasoconstriction and severe metabolic acidosis, thereby establishing a self-perpetuating cycle of progressive kidney injury. Cigarette smoking exerts dual organ toxicity: beyond its well-known pulmonary effects, it induces direct nephrotoxicity via endothelial dysfunction, oxidative stress, and accumulation of heavy metals such as cadmium. Additionally, therapeutic interventions-including pharmacologic agents and mechanical ventilation-may further elevate the risk of acute r chronic kidney injury in COPD patients. Conventional renal biomarkers, such as serum creatinine and blood urea nitrogen, exhibit limited sensitivity and specificity for early detection of kidney damage, often failing to identify subclinical injury until significant functional decline has occurred. In contrast, novel biomarkers offer superior diagnostic performance: kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and urinary liver-type fatty acid-binding protein (L-FABP) provide rapid, sensitive indicators of proximal tubular injury, whereas cystatin C (CysC) and β-microglobulin (β-MG) reliably reflect subtle alterations in glomerular filtration rate. Moreover, the leukocyte-related inflammatory index model-constructed using readily accessible peripheral blood inflammatory markers-is simple, practical, and highly suitable for clinical implementation. Furthermore, a machine learning model built upon routinely available clinical parameters demonstrates excellent predictive performance for acute kidney injury in COPD patients, achieving an area under the receiver operating characteristic curve of 0.91. Therefore, systematically elucidating the bidirectional crosstalk mechanisms between the lung and kidney, identifying novel biomarkers, and developing associated predictive models-particularly AI-driven early warning systems-hold significant clinical value for the early screening, precise intervention, and improved prognosis of COPD-associated renal injury.

Patent foramen ovale is defined as the failure of the foramen ovale to achieve complete anatomical closure by three years of age. Numerous studies have demonstrated a close association between PFO and the occurrence and prognosis of cryptogenic stroke (CS) in the elderly. This article reviews the epidemiology, pathogenesis, associations, and treatment strategies for elderly CS patients with PFO, along with the latest updates from relevant guidelines, aiming to provide clinicians with diagnostic insights and early intervention strategies.

Osteosarcopenia is defined as the coexistence of osteopenia/osteoporosis and sarcopenia, characterized by concurrent declines in bone mass, muscle mass, and muscle strength. This synergistic condition contributes to functional impairment and adverse outcomes including fatigue, falls, and fractures, and substantially diminishes the health and quality of life of older adults. The prevalence of osteosarcopenia is notably high in the elderly population, with a global estimate of 18.5% (95% confidence interval [CI]: 16.7~20.3%) and a Chinese prevalence of 19.8% (95%CI: 6.5~33.0%). Osteosarcopenia significantly increases the risk of fractures (hazard ratio [HR]=2.13), falls (HR=1.54), and death (HR=1.75) in patients, and is associated with many chronic diseases, imposing a substantial medical, social, and economic burden. Currently, no single screening tool exists for osteosarcopenia; therefore, detection typically requires a combination of sarcopenia-specific instruments (e.g., the SARC-CalF questionnaire) and osteoporosis risk assessment tools (e.g., FRAX®). In terms of systematic management, the primary therapeutic goals are to improve muscle mass and strength, enhance balance and mobility, increase bone density, prevent falls and fractures, and maintain overall quality of life. At present, prevention and treatment rely mainly on nutritional support and exercise interventions, as pharmacological options remain limited. Further research is urgently needed to develop safe and effective pharmacotherapies capable of improving muscle capacity and strength in this population.

Irreversible electroporation (IRE) is a non-thermal ablation modality that employs high-intensity, short-pulsed electric fields to induce irreversible cell membrane damage. It has garnered increasing attention for the treatment of tumors located in anatomically complex locations. For tumors adjacent to critical structures such as major blood vessels, bile ducts, and nerves, conventional surgery often entails substantial trauma and elevated perioperative risks, whereas thermal ablation is constrained by the risk of collateral thermal injury and the heat sink effect, which may compromise both therapeutic efficacy and patient safety. In contrast, IRE slectively eliminates local lesions through permanent membrane permeabilization while preserving the integrity of vascular and ductal structures, thereby offering distinct advantages in challenging regions including the pancreatic head, hepatic hilum, renal hilum, and prostate. Moreover, emerging evidence suggests that IRE may potentiate anti-tumor immune responses by inducing immunogenic cell death and remodeling the tumor microenvironment. This review summarizes the mechanisms of action, technical advantages, clinical efficacy and safety of IRE in tumors arising from various complex anatomical sites, and also discusses current challenges and future directions for this promising technique.