Objective: To evaluate the accuracy of the deep learning (DL)-based intracardiac echocardiography (ICE) left atrial mapping technique in constructing left atrial models during radiofrequency ablation for atrial fibrillation, and to analyze the spatial deviation patterns between the model and actual ablation points. Methods: Twenty patients with atrial fibrillation who underwent catheter radiofrequency ablation at the Department of Cardiology, Huashan Hospital, Fudan University between Jun and Aug 2025 were enrolled. Intracardiac echocardiography was used to acquire images at end-expiration and maximum left atrial volume. DL-based Cartosound FAM was employed for left atrial modeling. Parameters including left atrial volume, pulmonary vein ostium circumference and diameter, and bilateral pulmonary vein interspacing were measured and compared with corresponding measurements from Pentaray catheter-based FAM. After ablation, the pulmonary vein isolation (PVI) circle was divided into 12 segments, and the shortest distance from each actual PVI ablation point to the FAM surface was measured to systematically evaluate the spatial deviation between the reconstructed anatomical structures and the true ablation points. Results: Cartosound FAM successfully constructed left atrial models for all patients, with a median of 17.0 (14.8, 20.0) ultrasound sectors used. No significant differences were observed between Cartosound FAM and Pentaray FAM in left atrial volume, bilateral superior and inferior pulmonary vein circumference, left superior and right superior pulmonary vein diameter, or bilateral pulmonary vein interspacing. However, the diameters of the bilateral inferior pulmonary veins were significantly larger than Pentaray FAM [Left: (17.08±2.76) mm vs. (12.96±4.65) mm, P=0.001; Right: (19.38±3.57) mm vs. (16.50±4.46) mm, P=0.030]. Bland-Altman analysis indicated good agreement between the two methods across all measurements. Spatial deviation analysis revealed that ablation points in the left circular area deviated inward in the bottom and left inferior ridge regions, and outward in the top and posterior wall regions relative to the Cartosound FAM model. In the right circular area, most ablation points were close to the boundary or slightly deviated outward. Pearson correlation analysis showed a positive correlation between the upward and inward deviation of ablation points in the left bottom region and the left atrial volume measured by Cartosound FAM (r=0.487, P=0.029). Conclusion: Cartosound FAM demonstrates high accuracy in measuring left atrial volume and pulmonary vein structures. Spatial deviations between actual ablation points and the model exhibit region-specific patterns. The complementary use of Cartosound FAM and Pentaray catheter modeling can enhance the efficiency and precision of atrial fibrillation ablation procedures.
Objective: To establish a novel operant behavioral model, the controllable stress coping test (CSCT), to quantitatively characterize the active termination of an aversive stimulus in mice, thereby enabling objective differentiation between active and passive coping phenotypes and providing a validated behavioral model for investigating the neural substrates of stress-coping decision-making. Methods: A mild foot-shock (0.25 mA) served as a controllable aversive stimulus. Mice were given the option to actively press a lever to prematurely terminate the shock or to passively endure the shock until its automatic cessation at 40 s. Behavioral performance was analyzed across 120 trials, and unsupervised clustering was applied to classify subjects based on their response patterns. Results: Cluster analysis distinctly segregated mice into active and passive coping groups. The active coping group demonstrated consistent operant shock-termination behavior, whereas the passive coping group exhibited a tolerance-based waiting strategy. Further assessments of pain threshold and the elevated plus maze test revealed no significant inter-group differences in either baseline pain sensitivity or innate anxiety-like behavior. Furthermore, conditioned fear learning and operant reward learning assays indicated comparable learning capacity and task execution between groups. Conclusion: We have developed and validated a novel behavioral paradigm that effectively discriminates between distinct stress-coping strategies in mice. This model provides a robust experimental tool for elucidating the neural mechanisms underlying stress-related psychopathologies and adaptive decision-making.
Objective: To investigate the prevalence of depression and anxiety among elderly patients with cardiovascular disease in Shanghai communities, and to explore the associated influencing factors. Methods: A cross-sectional study was conducted from Nov 2022 to Sept 2023 in the communities of Pudong New Area and Minhang District in Shanghai. A total of 499 community-dwelling elderly individuals aged 60 years and above with diagnosed cardiovascular disease were recruited. The presence of depressive and anxiety symptoms was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Logistic regression models were applied to identify factors associated with depression and anxiety. Results: Among the 499 participants, 160 individuals (32.1%) exhibited symptoms of depression and/or anxiety. Not being currently married (OR=2.94, 95%CI: 1.42-6.07) and higher automatic negative thoughts scores (OR=1.10, 95%CI: 1.07-1.13) were significantly associated with depressive symptoms. In contrast, higher levels of social support (OR=0.96, 95%CI: 0.93-1.00) and health-related quality of life utility scores (OR=0.01, 95%CI: 0.001-0.190) were associated with lower risk of depression. Similarly, better health-related quality of life utility scores (OR=0.04, 95%CI: 0.002-0.560) were protective against anxiety, whereas higher negative automatic thoughts score was a strong risk factor (OR=1.17, 95%CI: 1.13-1.22). Conclusion: Depressive and/or anxiety symptoms were relatively common among community-dwelling older patients with cardiovascular diseases in Shanghai, and the comorbidity of depressive and anxiety symptoms warrants attention. Marital status, negative automatic thoughts, level of social support, and health-related quality of life utility scores emerged as critical factors influencing depression and anxiety among community-dwelling elderly patients with cardiovascular disease. Among these, negative automatic thoughts and health-related quality of life utility scores are worthy of particular research and clinical attention.
Objective: To investigate the status of bone health, the occurrence of osteoporosis and the knowledge and awareness levels of osteoporosis in premature ovarian insufficiency (POI) patients. Methods: This study included patients with POI who visited Obstetrics and Gynecology Hospital, Fudan University between Jan 2022 and Jun 2024. Bone mineral density values were measured using dual-energy X-ray absorptiometry (DXA). Additionally, a questionnaire survey was conducted among POI patients who visited the hospital in 2024 to assess their knowledge and awareness levels of osteoporosis using the Osteoporosis Knowledge Assessment Tool (OKAT). Results: A total of 467 patients with POI were included in this study, of whom 12.85% had osteoporosis and 49.46% had osteopenia. A total of 145 valid questionnaires were collected. The average age of the respondents was (33.62±5.23) years old, and the average OKAT score was (7.83±3.80) points. Based on the OKAT score, the knowledge and awareness levels of osteoporosis were evaluated, and 27.59% were rated as "average", while only 13.79% were rated as "good". The best answer accuracy was "osteoporosis leads to an increased risk of bone fracture", with an accuracy of 93.79%; and the question with the worst accuracy was "osteoporosis usually causes symptoms (e.g., pain) before fractures occur" with only 1.38% accuracy. Further analysis revealed that the differences in OKAT scores across different marital status, educational levels, annual household incomes, vitamin D supplementation, dairy product intake, and outpatient bone health education were statistically significant. Conclusion: POI patients experience significant bone loss and have a high occurrence of osteoporosis. However, they usually lack knowledge about osteoporosis and have inadequate awareness of bone health protection.
Objective: To explore the incidence and influencing factors of stroke in the natural population of Minhang District, Shanghai, in order to provide references for regional stroke prevention and treatment. Methods: A prospective cohort study based on Shanghai Suburban Adult Cohort and Biobank (SSACB) was carried out in selected communities of Minhang District, Shanghai, and a baseline survey was conducted from Jul 2018 to Dec 2019. Data collection comprised questionnaire-based interviews, physical examinations, and biochemical assays. Of the initial cohort, 14 416 individuals with complete follow-up data until Mar 2024 were analyzed for stroke incidence. Influencing factors for stroke were analyzed using a Cox proportional hazards regression model, and a Bayesian network model was constructed to predict stroke risk. Results: After an average follow-up duration of 4.9 years, 234 participants in the cohort developed stroke, with a stroke incidence density of 3.31 per 1 000 person-years. Stratified by gender, the incidence rate was 4.11 per 1 000 person-years for males and 2.81 per 1 000 person-years for females. Cox proportional hazards regression model showed that the risk of stroke increased with age: a significant risk elevation was observed in the 60-69 years group (HR=4.225, 95%CI: 2.226-8.020) and 70-79 years group (HR=6.902, 95%CI: 3.689-12.913). Additionally, comorbidity with hypertension (HR=1.458, 95%CI: 1.116-1.906) and diabetes (HR=1.755, 95%CI: 1.303-2.364) were associated with a higher risk of stroke. Bayesian network prediction model showed that age, diabetes, hypertension, and Alzheimer's disease were identified as the key factors affecting stroke incidence, and the AUC was 0.719. Conclusion: Age and chronic diseases were identified as the principal risk factors for stroke incidence in this population. Therefore, enhancing primary prevention through intensified screening and targeted interventions for high-risk groups, coupled with the effective management of blood pressure and blood glucose, is essential to reduce the incidence and disability rates of stroke.
Objective: To investigate the effects of electrical impedance tomography (EIT) -guided bundled respiratory rehabilitation on the duration of mechanical ventilation and prognosis in mechanically ventilated patients. Methods: A total of 144 severe patients who underwent invasive mechanical ventilation in the Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center from May 2023 to Feb 2025 were recruited via convenience sampling. Patients were allocated to either a control group (n=72), receiving routine respiratory rehabilitation, or an experimental group (n=72), receiving an EIT-guided bundled respiratory rehabilitation program. Outcome measures included duration of mechanical ventilation, arterial partial pressure of oxygen (PaO2), oxygenation index (OI), clinical pulmonary infection score (CPIS), Lovett muscle strength classification, ICU length of stay (LOS) and hospital LOS. Results: Sixty-five patients in the experimental group and 62 patients in the control group completed the study. The duration of mechanical ventilation was 223.0 (157.0, 285.5) h in the experimental group and 261.0 (168.8, 361.8) h in the control group, with the difference being statistically significant (P < 0.05). The experimental group demonstrated significantly higher PaO2 and OI, and better Lovett muscle strength classification (all P < 0.05). Conversely, the experimental group had significantly lower CPIS and ICU LOS (all P < 0.05). However, there was no significant difference in hospital LOS between the two groups. Conclusion: EIT-guided bundled respiratory rehabilitation effectively reduced the duration of mechanical ventilation, improved oxygenation status and muscle strength grade, and shortened the ICU stay in mechanically ventilated patients. However, it did not significantly affect the overall hospital length of stay.
Objective: To examine the effects of time perspective and their latent profiles on sugar-sweetened beverages consumption among children. Methods: In Oct 2024, a multi-stage cluster random sampling method was used to recruit all students in grades 3-5 from four primary schools in Chengdu. Participants completed the revised Children' s Time Perspective Questionnaire and a self-designed frequency questionnaire on sugar-sweetened beverages consumption. Latent class analysis (LCA) was conducted to identify distinct profiles of children's time perspective, and ordered Logistic regression was utilized to explore associations between time-perspective dimensions/profiles and sugar-sweetened beverages consumption frequency. Results: A total of 1 865 children were included, among which 1 630 (87.40%) children reported weekly sugar-sweetened beverages consumption. LCA revealed three latent profiles based on time perspective: past thinking, present hedonistic, and future planning. In ordered Logistic regression, higher scores on the past positive dimension (OR=1.195, 95%CI: 1.057-1.351) and past negative dimension (OR=1.149, 95%CI: 1.040-1.268) were associated with increased risk of sugar-sweetened beverages consumption, while higher scores on the future planning dimension (OR=0.791, 95%CI: 0.684-0.914) were protective. Compared to the future planning group, children in the past thinking group (OR=1.893, 95%CI: 1.494-2.399) and present hedonistic group (OR=1.374, 95%CI: 1.099-1.717) showed significantly higher risk of consuming sugar-sweetened beverages. Conclusion: Time perspective among children exhibits heterogeneity. Orientations toward the past and present are associated with increased frequency of sugar-sweetened beverages consumption, whereas a future-planning orientation is associated with reduced risk. Enhancing children's future-oriented time perspective may be an effective strategy to prevent excessive consumption of sugar-sweetened beverages.
Objective: To investigate the predictive factors for the efficacy of hypomethylating therapy in patients with myelodysplastic syndrome (MDS). Methods: To explore early predictive indicators of the efficacy of demethylation therapy for myelodysplastic syndrome, patients diagnosed with MDS at Huashan Hospital, Fudan University from Jan 2003 to Jul 2021 were collected. The overall response rate (ORR) and overall survival (OS) were used as outcome measures. Kaplan-Meier survival analysis, Cox regression models, and binary logistic regression were employed for multivariate analysis to identify predictive factors influencing HMA efficacy. Results: A total of 86 MDS patients were enrolled.Pretreatment absolute neutrophil count (ANC)≥0.8×109/L, pretreatment mean corpuscular volume (MCV)≥100 fL, platelet doubling after one treatment cycle, and hemoglobin increase≥5 g/L after one treatment cycle were associated with better therapeutic outcomes. Further multivariate analysis confirmed that platelet doubling after one treatment cycle remained statistically significant, indicating its role as an independent predictive factor.Response to hypomethylating therapy was identified as an independent favorable prognostic indicator. Conclusion: Platelet doubling after one treatment cycle is an independent predictive factor for improved efficacy of hypomethylating therapy in MDS patients.
Objective: To explore the association between different subtypes of atypical glandular cells (AGC) in cervical liquid-based cytology and histopathological results, and to evaluate the risk stratification value of high risk human papillomavirus (hrHPV) genotyping for uterine glandular epithelial tumors in AGC patients. Methods: A retrospective analysis was conducted on clinical data of 1 839 patients diagnosed with AGC via cervical cytology examination in Obstetrics and Gynecology Hospital, Fudan University from Jan 2017 to Dec 2021. We collected the data on age, hrHPV test results, and histopathologic findings within 6 months after cytology. Correlations of AGC subtypes, age and hrHPV status with histopathologic findings were analyzed, and multivariate Logistic regression was conducted to identify relevant risk factors. Results: The diagnostic rate of AGC was 0.19% (1 839/964 305), among which atypical endometrial cells (AEM) accounted for the highest proportion (45.5%). Histological follow-up was available for 1 023 patients, among whom 52.2% had positive histopathological results, including 30.7% cervical lesions and 65.4% endometrial lesions. The atypical endocervical cells favor neoplasia (AEC-FN) group presented the highest detection rate of cervical glandular lesions, accounting for 56.8%. Endometrial lesions were detected in more than half of the cases in both the atypical endometrial cells (AEM) group and the atypical glandular cells favor neoplasia (AGC-FN) group. Notably, the detection rate of cervical glandular/glandular squamous lesions was only 1.8% in the atypical glandular cells not otherwise specified (AGC-NOS) group. The overall positive rate of hrHPV was 23.0%, with 73.9% positivity in cervical lesions and 12.3% in endometrial lesions. 31.5% of the cervical glandular epithelial lesions were hrHPV-negative, and 70.6% were gastric-type glandular lesions. Histological positivity rates rose progressively with age. The 35-49 y cohort demonstrated the highest detection rate for cervical lesions (47.6%), whereas the cohort aged ≥50 y presented with the highest detection rate for endometrial lesions (64.5%).Multivariate analysis showed that HPV16/18 positivity and cytologic AEC-FN were high-risk factors for cervical glandular epithelial lesions; age≥50 y, cytologic AEM and AGC-FN were high-risk factors for endometrial lesions. Conclusion: AGC subtype is a core indicator for evaluating uterine glandular lesions. Combining with hrHPV infection status and age, it can realize precise triage and individualized management of AGC patients, providing an evidence-based basis for hierarchical diagnosis and treatment.
Objective: To investigate the predictive value of serum IL-2 receptor (IL-2R) levels in the efficacy and prognosis of immune checkpoint inhibitors (ICIs) combined with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Methods: A retrospective cohort study was conducted, enrolling 168 advanced NSCLC patients who received ICIs combined with chemotherapy at Zhongshan Hospital, Fudan University between Dec 2021 and May 2023. Patients were divided into responders and non-responders based on the Response Evaluation Criteria in Solid Tumors (RECIST). Clinical data were collected, and patient outcomes and prognosis were followed up. The t-test was used to compare intergroup differences, the ROC curve was employed to evaluate the predictive performance of IL-2R, and Cox proportional hazards regression models along with Kaplan-Meier analysis and the log-rank test were used to analyze the correlation between IL-2R levels and progression-free survival (PFS). Results: IL-2R levels were significantly negatively correlated with treatment efficacy (P < 0.001), with high IL-2R levels indicating poorer therapeutic response. ROC analysis revealed that the AUC for IL-2R in predicting efficacy was 0.825 (95%CI: 0.754-0.895), with an optimal cutoff value of 568.5 U/mL (Youden index of 0.530), the sensitivity of 80.2%, and the specificity of 72.2%. Survival analysis showed that the median PFS in the high IL-2R group was significantly shorter than that in the low IL-2R group (9 months vs. 14 months, P=0.011). Multivariate Cox regression confirmed that elevated IL-2R was an independent risk factor for disease progression (P=0.003). Conclusion: Serum IL-2R levels may serve as a potential predictive biomarker for the efficacy and prognosis of immune checkpoint inhibitor combined with chemotherapy in advanced NSCLC patients. High IL-2R level indicates poorer treatment response and shorter PFS.
Objective: To analyze the clinical characteristics of cough following coronavirus disease 2019 (COVID-19) infection caused by the Omicron variant and the impact of COVID-19 vaccination. Methods: A retrospective analysis was conducted on patients who visited at the outpatient clinic of Zhongshan Hospital, Fudan University from Feb to Mar 2023 due to cough after COVID-19 infection. Patients were divided into three groups based on the duration of cough after infection: < 3 weeks group, 3-8 weeks group, > 8 weeks group. Demographic data, clinical symptoms, COVID-19 vaccination status, and other relevant information were collected to analyze cough duration, number of vaccine doses and risk factors for chronic cough. Results: A total of 230 patients with a mean age of (46.6±16.6) years were included, of whom 42.2% were male. The main clinical symptoms were fever (77.4%), fatigue (67.8%), and sputum production (61.3%). According to cough duration, 20% of patients had a cough lasting < 3 weeks, 34.3% had 3-8 weeks, and 45.7% had > 8 weeks. Regarding COVID-19 vaccination, 56.5% of patients received ≥3 doses and 43.4% received < 3 doses. Compared with the vaccination < 3 doses group, the vaccination≥3 doses group had a significantly lower proportion of patients with cough lasting > 8 weeks (36.0% vs. 54.0%, P < 0.05). No differences were observed in other symptoms or pulmonary function parameters between the two groups. Conclusion: A cough persists for more than 3 weeks after COVID-19 infection is a very common phenomenon. Past medical history or comorbidities had no impact on the course of cough. Multiple vaccinations may be effective in reducing the duration of cough.
Objective: To investigate the heterogeneity of ocular axial length growth trajectories and its influencing factors among children and adolescents aged 3-16 in Shanghai, based on the group-based trajectory model (GBTM). Methods: Through cluster sampling, three or more ocular axial length measurement data of 1 285 children from urban and suburban areas of Shanghai between 2013 and 2023 were included. Indicators including axial length, spherical equivalent, uncorrected visual acuity and corneal curvature were analyzed. Optimal grouping was determined by establishing the GBTM model based on Akaike information criterion (AIC), Bayesian information criterion (BIC), entropy value and subgroup proportion, and intergroup differences were subsequently compared. Results: The trajectory model classified children's ocular axial length growth trajectories into four subgroups: the mild type (10.3%), the stable type (12.4%), the progressive type (22.6%), and the rapid progression type (54.8%). Children and adolescents in the rapid progression type exhibited significantly faster ocular axial length growth, with a higher proportion of males (58.38% vs 41.62%, P=0.001). Their uncorrected visual acuity (4.16±0.33) and spherical equivalent refraction [(-4.85±2.23) D] were significantly worse than those in other groups (P < 0.001). The horizontal and vertical curvature values in the stable type [H: (43.04±1.11) D, V: (44.67±1.34) D] were significantly higher than those in the rapid progression type [H: (41.59±1.36) D, V: (43.23±1.61) D]. Conclusion: More than half of the children and adolescents aged 3-16 in Shanghai showed a rapid progression trend in ocular axial length, with gender and corneal curvature being important influencing factors.
Objective: To preliminarily explore the clinical value of ultrasound-guided microwave ablation (MWA)in the treatment of symptomatic abdominal wall endometriosis(AWE). Methods: A retrospective analysis was conducted on the clinical data of 3 patients with typical symptomatic AWE who received ultrasound-guided MWA at Shanghai Hopemill Hospital. The changes in lesion volume before and after ablation were observed, and the therapeutic effect was evaluated using contrast-enhanced ultrasound and the visual analogue scale (VAS). Results: All patients successfully completed MWA. Immediate contrast-enhanced ultrasound after ablation showed that each lesion had obvious filling defects without contrast agent perfusion at all. After the treatment, 2 patients had no obvious symptoms, while 1 patient experienced mild stabbing pain at the puncture site, which resolved spontaneously after 1 month. During follow-up from 12 to 24 months, the patients' clinical symptoms were significantly relieved, and the VAS score decreased from 6-8 points before treatment to 0 point after treatment. At the end of the follow-up, the lesion volume of the patients was significantly reduced or resolved completely (volume reduction rate: 75.5%-100.0%). Conclusion: Ultrasound-guided MWA for symptomatic AWE can reduce lesion volume and relieve abdominal wall pain, and may be a worthwhile treatment option.
Objective: To establish a direct injection ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for the rapid detection of 12 typical pyrethroid insecticides in water. Methods: The water sample to be measured was filtered by filter paper, then added with internal standard working solution, vortexed, centrifuged to take the supernatant, and filtered. The separation was performed on a phenomenex Gemini C18 column with 110 μm (50 mm×3.0 mm, 3 µm). A multi-reaction monitoring model was used to simultaneously determine 12 pyrethroids in water samples. The method was thoroughly validated for selectivity, linearity, accuracy, precision, matrix effect, and recovery. Results: The limits of detection of the analytes in the water samples were 0.2-2.0 ng/mL (or μg/L, the same below), and the lower limits of quantification were 0.5-5.0 ng/mL, showing good linear relationship within their linear ranges (r > 0.99). The accuracies ranged from 89.87%-104.37%, and the intra-day and inter-day precisions ranged from 2.35%-10.58%. The recoveries were 79.79%-101.58%, and the matrix effects were 85.83%-111.51%. Conclusion: We successfully established a sensitive, accurate, and rapid direct injection UPLC-MS/MS method suitable for qualitative and quantitative analysis of 12 pyrethroids in water.
Objective: To develop and validate a robust ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for accurate measurement of norvancomycin concentrations in human cerebrospinal fluid (CSF) samples and preliminarily applied to therapeutic drug monitoring and central nervous system penetration assessment. Methods: Vancomycin was used as internal standard, and the cerebrospinal fluid samples were processed by protein precipitation. The separation process was conducted on an ACQUITY UPLC® BEH C18 column (2.1 mm×50 mm, 1.7 μm) under isocratic conditions. The chromatographic separation employed a binary solvent system consisting of acetonitrile and an aqueous phase modified with 0.1% (v/v) formic acid. The analysis time was 4.5 min at a flow rate of 0.3 mL/min. Mass spectrometry was performed in positive ion multiple reaction monitoring mode with electrospray ionization. Results: The linear ranges of norvancomycin in cerebrospinal fluid were 0.5-50.0 mg/L, and the lower limits of quantification were 0.5 mg/L. The intra-batch and inter-batch precisions of norvancomycin in cerebrospinal fluid samples were less than 10.5% and the accuracy ranged from 85.3% to 108.6%. The normalized matrix effect factors of norvancomycin were 89.0%-103.7% The recovery of norvancomycin was 89.4%-92.7% from cerebrospinal fluid. The analyte was stable when the cerebrospinal fluid samples were stored at -20 ℃ or -70 ℃ for 104 days, placed at room temperature for 24 h or 2-8 ℃ for 72 h, 44 h residence in automatic sampler after pretreatment and treated after 3 freeze-thaw cycles. Quantitative assessment of norvancomycin distribution into CSF across four clinical cases demonstrated penetration efficiencies ranging from 7.2% to 13.9%. Conclusion: The UPLC-MS/MS method established in this study provides a simple and accurate determination of norvancomycin in human cerebrospinal fluid. The method were validated in accordance with the requirements for the quantitative analysis of biological samples. The developed method was successfully applied in the clinical study on therapeutic drug monitoring of norvancomycin.
This report describes a pregnant patient with Fabry disease (FD), a rare X-linked genetic disorder, who developed severe preeclampsia, predominantly manifested as massive proteinuria, along with severe fetal growth restriction (FGR). Despite treatment with antihypertensives and anticonvulsants, her blood pressure remained poorly controlled, leading to placental abruption at 29+4 weeks of gestation and subsequent cesarean delivery. An extremely low birth weight preterm female infant, with normal Apgar scores but carrying the same pathogenic variant as the mother, was delivered. This case highlights the necessity of enhanced genetic counseling and multidisciplinary management during the periconceptional and prenatal periods for such patients to mitigate the risk of adverse maternal and fetal outcomes.
Contactin1 (CNTN1) associated membranous nephropathy (MN) is a rare subtype of secondary MN, often concurrent with chronic inflammatory demyelinating polyneuropathy (CIDP). We reported a female patient who gradually experienced neurological and renal symptoms within 6 months and responded well to the immunosuppressive therapy. Tubuloreticular inclusion (TRI) was found in endothelial cells, providing insights into the underlying mechanism of this association and the mechanism of renal injury.
This paper builds upon the previously published "guidelines for pulmonary function testing in adults" and "guidelines for the diagnosis of pulmonary function in adults". Integrating the latest scientific evidence and China-specific clinical realities, it systematically addresses unresolved issues in existing guidelines or consensus documents. This document comprehensively elaborates on features and calibration requirements of modern pulmonary function testing devices; standardizes the ventilatory function assessment protocols, including testing requirements, standardized methodologies, quality control measures, and clinical precautions; establishes interpretation frameworks for normal reference values of ventilatory parameters, diagnostic criteria for ventilatory dysfunction, classification of impairment severity, and characterization of specific ventilatory abnormalities.
Artificial intelligence (AI) is becoming deeply embedded throughout clinical research and has substantially improved the efficiency of data processing and analysis in observational studies, including identification of risk factors, risk stratification, and outcome prediction. However, advances in predictive performance do not automatically translate into improved causal identification. Even when AI-assisted high-dimensional covariate processing and target trial emulation allow observational studies to approximate the structure of randomized controlled trials (RCTs), causal interpretation remains strongly dependent on the "ignorability assumption", namely that all key confounders have been accurately measured and included in the model. Such approaches cannot eliminate residual confounding from unmeasured factors and are powerless against unrecognized confounders. By contrast, RCTs use randomized allocation at the design and implementation stages to balance measured and unmeasured confounders across comparison groups, thereby providing an irreplaceable basis for causal identification in intervention evaluation. This article delineates a tripartite, progressive evidence pathway: "AI-driven prediction discovery → approximation of causal inference→confirmation via randomized trials", and analyzes the methodological boundaries and synergistic strategies associated with integrating AI into RCTs. In an era defined by complex data architectures, rapid model iteration, and the highly efficient, prolific generation of research literature, we must remain vigilant against the critical methodological trap of conflating "predictive association" with "causal effect". Upholding the unpredictability of random allocation and the integrity of randomization remains the indispensable methodological cornerstone that secures the RCT's status as the gold standard for evaluating medical interventions.
