Objective: To investigate the distribution, the innervation pattern, and the long-range input of the axo-axonic cells (AACs) within the claustrum (CLA). Methods: Unc5b-CreER:Nkx2.1-Flp:Ai65 mouse intersectional genetic strategy was applied to specifically label AACs in the CLA. By serial sections, the cell density and innervation patterns of AACs from the anterior to the posterior of CLA were analyzed. The monosynaptic retrograde rabies virus (RV) tracing was employed to unveil the synaptic input pattern of AACs in the CLA, revealing the long-range synaptic input patterns of AACs in the CLA. Finally, the layer analysis and immunofluorescent staining was conducted to explore the cell types of these presynaptic projection neurons. Results: The result from intersectional strategy (Unc5b-CreER:Nkx2.1-Flp:Ai65 mouse) indicated that the AACs were densely distributed in the CLA and the cell density of the AACs increased along the anterior-posterior axis, yet the percentage of neurons innervated by the AACs, approximately 67.72%, remained unchanged. Retrograde monosynaptic tracing of long-range input to AACs unveiled a synaptic input pattern from various regions, including olfactory, prefrontal, sensorimotor cortices and numerous subcortical structures. The exploration of the cell types of these presynaptic projection neurons revealed that the neurons projecting from the cortex to the AACs in CLA were mainly distributed in layer 5 of the cortex, with a small number of cells located in layers 2/3 and 6. Additionally, the neurons projecting from the ventral pallidum (VP) to the AACs in CLA mainly included GABAergic neurons and glutamatergic neurons. Conclusion: The AACs were densely and widely distributed in the CLA with a distinct feature of distribution pattern and projection connectivity, which reflects the potential differences in the structure of the claustrum along the anterior-posterior axis and the cellular specificity of its connection patterns.
Objective: To investigate the metabolic profiles changes of inguinal white adipose tissue (iWAT) in mice induced by every-other-day fasting (EODF) under a high-fat diet (HFD) conditions, and to identify differential metabolites and metabolic pathways to provide potential candidate metabolites for obesity intervention. Methods: Eight-week-old male C57BL/6J mice were randomly assigned to either an ad libitum HDF feeding group (AL group) or an HFD with EODF group. After 8 weeks, iWAT was collected for metabolomic and transcriptomic analyses. Results: EODF significantly alleviated HFD-induced obesity in mice. Metabolomics analysis showed that amino acids, carbohydrates, and organic acids comprised 76.03% of the detected metabolites in iWAT. A total of 71 differential metabolites were identified, primarily enriched in aminoacyl-tRNA biosynthesis, neutral/aromatic amino acid metabolism, and arginine/proline metabolism. Gene ontology and gene set enrichment analysis enrichment analyses demonstrated that EODF treatment-induced differential genes were significantly enriched in amino acid import across plasma membrane and ribosome cellular components. In addition, EODF significantly promoted glucose metabolism in iWAT, influenced the initial phase of glycolysis, inhibited the pentose phosphate pathway, enhanced the tricarboxylic acid cycle, and promoted the mitochondrial oxidative phosphorylation. Conclusion: EODF ameliorated obesity in mouse and remodeled amino acid and carbohydrate-related metabolic pathways in their iWAT, suggesting that it may maintain metabolic homeostasis by enhancing energy expenditure.
Objective: To investigate the role of deoxycytidylate deaminase (DCTD) gene (Dctd) deletion in mouse embryonic development. Methods: Cas9 mRNA and sgRNA were synthesized via in vitro transcription and microinjected into zygotes to generate a Dctd knockout (Dctd-/-) mouse model. Fertility was assessed by quantifying the number of viable offspring from various breeding combinations. Post-implantation Dctd-/- embryos were examined morphologically and histologically using paraffin sections stained with HE. Embryos collected at E0.5d were cultured in vitro to evaluate the rate of development to the blastocyst stage. Results: Breeding between heterozygous Dctd (Dctd+/-) parents produced offspring numbers comparable to wild-type (Dctd+/+) controls. Crosses between Dctd+/+ females and Dctd-/- males resulted in an approximately 9% reduction in average litter size compared to controls, while crosses between Dctd-/- females and Dctd+/+ males showed a 48% reduction. When both parents were Dctd-/-, the average number of offspring declined to 40% of the wild-type level, and around 60% of post-implantation embryos exhibited developmental delays or resorption. In vitro culture of E0.5d embryos from this group revealed significant developmental arrest at the 2- to 4-cell stage and a markedly lower blastocyst formation rate compared to controls. Conclusion: Loss of Dctd in female mice leads to reduced fertility, highlighting the critical role of Dctd in supporting normal embryonic development in mice.
Objective: To revise the Chinese version of the Mental Health Literacy Scale (MHLS) and validate its reliability and validity, aiming to develop a measurement tool suitable for assessing mental health literacy in the Chinese population. Methods: A convenience sampling method was employed to collect valid data from 341 community residents via the Wenjuanxing online survey platform between Oct 2019 and Apr 2020. The measurement instruments included the MHLS, the Simplified Coping Style Questionnaire (SCSQ), the Self Help Strategies for Subclinical Depression (SHS), the Help-Seeking Questionnaire (HSQ), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to examine the scale's reliability and validity. Internal consistency and stability were assessed using Cronbach's α and test-retest reliability, while construct validity, convergent validity, discriminant validity, and criterion-related validity were evaluated to verify the psychometric properties. Results: EFA extracted five common factors: disease knowledge, information-seeking, attitudes toward mental illness, attitudes toward help-seeking, and stigma, with a cumulative variance explanation rate of 43.297%. CFA indicated a good fit for the five-factor model (χ2/df=1.754), comparative fit index (CFI) was 0.903, incremental fit index (IFI) was 0.905, goodness-of-fit index (GFI) was 0.884, root mean square error of approximation (RMSEA) was 0.047, and root mean square residual (RMR) was 0.053. The Cronbach's α coefficients for the total scale and subscales ranged from 0.701 to 0.877, and test-retest reliability ranged from 0.617 to 0.882 (P < 0.01). Additionally, the total score of the MHLS showed significant positive correlations with the positive coping subscale of the SCSQ (r=0.213, P < 0.01), the HSQ score (r=0.248, P < 0.01), and the SHS score (r=0.302, P < 0.01), demonstrating good criterion-related validity. The results of group difference analysis revealed that males, individuals with lower educational attainment, and those without prior mental health knowledge training exhibited significantly lower levels of mental health literacy compared with other demographic groups. Conclusion: The Chinese version of the MHLS demonstrates good reliability and validity in a Chinese sample, serving as a scientific measurement tool for assessing individual mental health literacy and providing insights into the public's understanding of mental health. Additionally, it is recommended to enhance mental health awareness among males and individuals with lower educational attainment through multi-channel educational initiatives.
Objective: To analyze cases and colposcopic images of cervical adenocarcinoma in situ (AIS) to identify reasons for colposcopic missed diagnosis, summarize typical colposcopic features of AIS, and reduce the colposcopic missed diagnosis rate, so as to provide enhanced guidance for clinical diagnosis and treatment. Methods: We retrospectively analyzed data from patients treated in Obstetrics and Gynecology Hospital, Fudan University from Jan 2019 to Dec 2023. Patients pathologically diagnosed with AIS following colposcopic examination were included. We collected the age, cytology, human papilloma virus (HPV) test results, colposcopic images, colposcopic diagnoses, and pathological outcomes. We also collected the post-LEEP pathology report if patients underwent loop electrosurgical excision procedure (LEEP) in our hospital. Results: A total of 181 patients pathologically diagnosed with AIS following colposcopic examination were included, with an average age of 40.62 years. Cytology was negative for intraepithelial lesion or malignancy in 46.4% of the patients, atypical glandular cells or AIS in 17.1% of the patients, and HPV 16/18 positive in 84.5% of the patients. The missed diagnosis rate of colposcopy was 45.3% [diagnosed as inflammation/low-grade squamous intraepithelial lesion (LSIL)]. Review of colposcopic images revealed prominent signs: acetowhite epithelium, columnar epithelial changes (Feature 1 was columnar epithelium appeared dark red with short granular changes before acetic acid application, and focal or diffuse acetowhite changes with villi elevation after application; Feature 2 was fused columnar epithelium, thickened, elevated, edematous, and acetowhite on the surface), atypical vessels and abnormal glandular openings. Further analysis of 82 missed cases showed that 24% were due to unclear vision and secretion obstruction, and 44% due to a lack of recognition of typical features. In cases missed by colposcopy (diagnosed as inflammation/LSIL), cytology was normal in 57.3%, and cytology > LSIL accounted for 22.0%; while in correctly diagnosed cases [diagnosed as high-grade squamous intraepithelial lesion (HSIL)/AIS/cancer], cytology was normal in 37.4%, and cytology > LSIL accounted for 38.4%. There was a statistically significant difference between the two groups. Further analysis of lesion location revealed that AIS lesions were only present in the endocervical curettage samples in 26.8% of the colposcopically missed diagnosis cases, significantly higher than the 6.1% in the non-missed cases. Conclusion: We summarized 5 typical colposcopic features of AIS, and identified that the main reasons for colposcopic missed diagnosis were unclear visual fields and insufficient recognition of these typical features. Notably, 26.8% of the missed diagnosis cases had AIS detected only in endocervical curettage samples. We recommend enhancing the recognition of typical colposcopic features, optimizing visual fields during colposcopy, and emphasizing the importance of endocervical curettage to reduce the missed diagnosis rate of AIS by colposcopy.
Objective: To evaluate the diagnostic value of MRI in fetal microcephaly and microcephaly with simplified gyral pattern (MSGP) by comparing with ultrasonography. Methods: Prenatal MRI manifestations of 24 cases of fetal microcephaly and MSGP in Obstetrics and Gynecology Hospital, Fudan University from Sept 2023 to Feb 2025 were retrospectively studied and compared with fetal ultrasonography findings on the same day. All cases were confirmed by follow-up and induced labor. Results: Twenty-four fetuses were 23.6 to 36.6 gestational weeks with a average of 27.7 gestational weeks. Fourteen cases of fetal microcephaly and 10 cases of MSGP were diagnosed by prenatal MRI. Among those diagnosed with MSGP, 1 case was accompanied by Dandy-Walker variant, and 2 cases were accompanied by Dandy corpus callosum agenesis. Prenatal ultrasound diagnosed microcephaly in 21 cases, among which 1 case was accompanied by Dandy-Walker variant, and MSGP in 3 cases. Seven cases of MSGP and 2 cases of concomitant corpus callosum agenesis were missed diagnosed. MRI and ultrasound findings of fetal microcephaly showed a head circumference less than three standard deviations (-3SD) from the mean value. MRI findings of MSGP were head circumference less than -3SD from the mean value, decreased cranio facial ratio, slanted and small frontal lobe, fewer and shallow cerebral sulci and gyri, the development of sulci and gyri is delayed by about 2 to 4 weeks compared to the normal gestational age, but with normal thickness of the cortex, and normal cerebral gray and white matter. The diagnostic rate of MRI for prenatal MSGP was 100%. Ultrasound findings of MSGP were head circumference less than -3SD from the mean value, and cerebral sulci and gyri were shallow and few. The diagnostic rate of ultrasonography for prenatal MSGP was 30%. Conclusion: MRI is more advantageous than ultrasonography in the evaluation of sulci and gyri, as well as the display of cortex, and can make a definite diagnosis for fetal microcephaly and MSGP, also has a higher diagnostic accuracy for other intracranial concomitant malformations. For fetuses with clinically suspected microcephaly, fetal brain MRI assessment is required to determine whether it is MSGP, or to detect possible intracranial concomitant malformations.
Objective: To identify effective preoperative predictors of concurrent endometrial pathology in patients with ovarian adult granulosa cell tumor (AGCT), to provide reference for subsequent clinical diagnosis and treatment. Methods: This retrospective study included patients with newly diagnosed ovarian AGCT who underwent initial treatment at Obstetrics and Gynecology Hospital, Fudan University from Jan 2010 to Dec 2022. Based on postoperative endometrial pathological results, patients with endometrial hyperplasia (of any subtypes) or endometrial carcinoma were assigned to the abnormal endometrium group; those with benign endometrial lesions or normal endometrium were categorized into the normal endometrium group.Screening high-risk factors for concurrent endometrial lesions in AGCT patients through regression analysis. Results: Among the enrolled 101 patients with AGCT, 14 cases (13.9%) had simple endometrial hyperplasia, 7 cases (6.9%) had complex endometrial hyperplasia, 5 cases (5.0%) had complex atypical endometrial hyperplasia, and 8 cases (7.9%) had grade I endometrial adenocarcinoma. These 34 cases (33.7%) were classified into the abnormal endometrium group, while the remaining 67 cases (including normal endometrium, endometrial polyps, and atrophic endometrium) were assigned to the normal endometrium group. Comparison of clinical parameters between the two groups revealed that the age at onset, BMI, endometrial thickness, postmenopausal duration, the proportions of postmenopausal patients, postmenopausal bleeding, and CA125≥35 U/mL in the abnormal endometrium group were significantly higher than those in the normal endometrium group (P < 0.05). Multivariate logistic regression analysis showed that age (OR=1.3, 95%CI: 1.1-1.6, P=0.004), CA125≥35 U/mL (OR=8.6, 95%CI: 1.4-54.1, P=0.022), and endometrial thickness (OR=1.3, 95%CI: 1.1-1.6, P=0.014) were positively correlated with the development of endometrial lesions. Conclusion: For preoperative patients with AGCT, advanced age, increased endometrial thickness, and elevated CA125 levels may be associated with a higher risk of concurrent endometrial neoplasms. Therefore, comprehensive preoperative evaluation of the endometrium is recommended to guide subsequent treatment.
Objective: To explore the integrated application of artificial intelligence (AI) technologies in intelligent triage, pre-consultation, and online patient accompaniment navigation systems at a children's hospital in order to build an efficient and precise smart medical service system. Methods: Integrating natural language processing and machine learning technologies, the "DS-Dr. XiaoBu 2.0" intelligent system was designed. It utilized patients' pre-consultation waiting time to collect structured medical history information via the hospital's WeChat official account and interfaces in real-time with the Hospital Information System (HIS). Simultaneously, online patient accompaniment navigation function was developed, optimizing in-hospital diagnosis and treatment path planning based on indoor positioning technology. Operational trial data was used to iteratively optimize the algorithm, and a multi-level verification mechanism was established to minimize information errors. Results: Since the implementation of the intelligent triage system in Children's Hospital, Fudan University, usage reached 190 800 patient visits. Within 3 months of operating the "DS-Dr. XiaoBu 2.0" version, usage reached 14 500 visits, with 85.17% of intelligent inquiries focused on consultation procedures and guidance. Related inquiries to the manual hotline decreased by 31.32% and 4.21%, respectively (P < 0.05). The implementation of intelligent pre-consultation significantly reduced the average waiting time before consultation from (21.06±3.90) minutes to (11.88±2.83) minutes (P < 0.05). After deploying the online patient accompaniment navigation, the total consultation time for patients requiring medication prescriptions decreased from (149±23) minutes to (134±20) minutes (P < 0.05). Conclusion: The AI-driven service model encompassing "pre-consultation-intelligent triage-online patient accompaniment navigation function" can optimize resource allocation, reduce waiting times and enhance doctor-patient interaction efficiency, which provided a replicable technical solution for the construction of technology-enhanced pediatric outpatient clinics.
Objective: To investigate the risk factors for post-induction hypotension during general anesthesia in elderly patients in consideration of lipid parameters in order to provide reference for the prevention and management of post-induction hypotension in this population. Methods: A retrospective analysis was performed on elderly patients who underwent elective non-cardiac surgery with general anesthesia in Qingpu Hospital, Fudan University from Feb 2019 to Apr 2023. After excluding missing data, patients were divided into the hypotension group and the control group based on hypotension criteria. General data, laboratory test results, hemodynamic indices, etc., were collected. Univariate and multivariate Logistic regression analyses were used to identify risk factors, and sensitivity analysis (excluding hypertensive patients) was conducted to validate the results. Results: When unexcluding hypertensive patients, univariate analysis showed that high total cholesterol (TC), high non-high-density lipoprotein (non-HDL), high mean arterial pressure (MAP) at baseline and concomitant use of midazolam were associated with hypotension. Multivariate analysis indicated that high MAP at baseline and high TC were risk factors, while concomitant use of midazolam was a protective factor. After excluding hypertensive patients (sensitivity analysis), univariate analysis showed that high TC, high non-HDL, high MAP at baseline and concomitant use of midazolam were associated with hypotension; multivariate analysis showed that high TC was a risk factor, while concomitant use of midazolam was a protective factor. Conclusion: High baseline mean arterial pressure and high total cholesterol are risk factors for post-induction hypotension in elderly patients undergoing general anesthesia, while concomitant use of midazolam during induction may act as a protective factor.
Objective: To compare the effect of propofol alone and propofol combined with dexmedetomidine in treating emergence agitation in adult patients after middle ear or skull base surgery. Methods: We retrospectively evaluated a total of 580 patients who aged 18-65 years and received elective middle ear or skull base surgery under general anesthesia in Eye and ENT Hospital, Fudan University from Feb 2023 to Apr 2024. Emergence agitation was defined as a Richmond Agitation-Sedation Scale (RASS) score ≥2 with inability to follow commands for laryngeal mask airway (LMA) removal. In the 580 patients, 52 cases who developed emergence agitation were randomly assigned to the propofol group (P group, n=26, 1 mg/kg propofol iv.) or the propofol-dexmedetomidine group (PD group, n=26, 0.5 mg/kg propofol iv. followed by slow injection of 0.3 μg/kg dexmedetomidine). The primary outcome was the success rate of agitation control after a single dose. Secondary outcomes included time to LMA removal and length of stay in the post-anesthesia care unit (PACU). Results: Agitation was relieved after a single dose in 92.3% of patients in the PD group, compared with 24.3% in the P group (P < 0.001). The mean time to LMA removal (18.6 min vs. 24.9 min, P=0.014) and PACU stay (46.2 min vs. 52.2 min, P=0.044) were shorter in the PD group compared to the P group with statistically significant differences. Five patients in the PD group developed transient bradycardia, which resolved without treatment. Conclusion: In adult patients with emergence agitation after middle ear or skull base surgery, propofol combined with low-dose dexmedetomidine was more effective than propofol alone and did not cause serious adverse events.
Objective: To explore the association between healthy lifestyle index (HLI) and cognitive decline, as well as the mediating effect of blood routine derived inflammatory indexes in community-dwelling elderly people. Methods: A multistage random sampling method was used to enroll 1 181 older persons aged ≥65 years with normal cognition in Songjiang District, Shanghai at baseline from May 2020 to Dec 2021, and they were followed up from Jun 2023 to Oct 2023. The Mini-Mental State Examination (MMSE) was used to examine their cognitive function. HLI was computed as a composite score reflecting adherence to six factors: non-smoking, abstinence from alcohol, sufficient fruit consumption, adequate vegetable intake, good sleep quality, and engagement in regular physical activity. Based on the distribution of total scores, study subjects were classified into tertiles and designated as high HLI (75-100) group, moderate HLI (58-74) group and low HLI (0-57) group. Cox proportional hazards regression model was used to assess the association between HLI, blood routine derived inflammatory indexes, and cognitive decline. Multiple linear regression model was used to assess the association between HLI and blood routine derived inflammatory indexes. The mediation analysis was used to examine the mediating effect of blood routine derived inflammatory indexes between cognitive decline and HLI. Results: During the follow-up period, 225 out of 1 181 cases experienced cognitive decline. Compared with low HLI group, the risk of cognitive decline in moderate HLI group and high HLI group was reduced by 29% (HR=0.71, 95%CI: 0.51-1.00) and 38% (HR=0.62, 95%CI: 0.44-0.87); the monocyte counts in moderate HLI (β=-0.032, 95%CI: -0.056, -0.008) group and high HLI (β=-0.050, 95%CI: -0.076, -0.024) group were significantly reduced. The monocyte had a significant partial mediating effect on the association between HLI and cognitive decline. Conclusion: Healthy lifestyles were associated with a lower risk of cognitive decline, and this association may be partially mediated by monocyte.
Lung cancer is one of the most common cancers globally, accounting for about one-tenth of all cancer cases, and it is also one of the leading causes of cancer-related deaths, representing approximately one-fifth of such deaths. In recent years, early screening has become one of the reliable strategies to reduce the mortality of lung cancer. With the widespread application of low-dose computed tomography (LDCT) in lung cancer screening, many countries and regions have carried out large-scale screening programs and made positive progress. The development of lung cancer screening programs are related to many factors such as smoking history, air pollution, gender, age and so on. At the same time, the continuous development of computer-aided diagnosis (CAD), artificial intelligence (AI) and comprehensive pulmonary nodule planning are of great significance for improving the accuracy of early diagnosis of lung cancer. This article reviews the research status and progress of early screening for lung cancer, with a key comparison of the similarities and differences in screening policies among China, the United States, and the United Kingdom, as well as how lung cancer-related factors influence the screening policies in these countries. All three countries use LDCT as the main screening method, but there are differences in population selection, screening frequency, policy support and public compliance.
Acquired immunodeficiency syndrome (AIDS) is a severe disease caused by human immunodeficiency virus (HIV) infection. Although antiretroviral therapy (ART) has significantly reduced mortality, HIV-associated malignancies remain a major complication. HIV drives tumorigenesis through two main mechanisms: the first is the remodeling of immunometabolism, such as causing an imbalance between glycolysis and oxidative phosphorylation in CD4+ T cells and inducing high expression of programmed cell death protein 1 and functional exhaustion in CD8+ T cells, and the second is the establishment of a chronic inflammatory microenvironment. This review systematically delineates the synergistic oncogenic mechanisms underlying HIV and various oncogenic viruses coinfection with a focus on the central role of immunometabolic crosstalk, in order to provide a reference for developing precise interventions aimed at reducing cancer risk in HIV-infected individuals.
To evaluate the intervention effects of a modified hypertension extended prescription service program on community-dwelling hypertensive patients, we included 202 hypertensive patients who signed contracts with family doctors at the Liuzhao Community Health Service Center in Shanghai from Sept 2023 to Dec 2023. We used a self-controlled pre-post intervention design. The mean age of the patients was (70.78±10.94) years. All of them received the modified hypertension extended prescription service program for 6 months. Outcomes were assessed before and after the intervention, included subjective satisfaction (via a self-designed questionnaire), medication satisfaction (via the Treatment Satisfaction Questionnaire for Medication, version 2 [TSQM-Ⅱ]), medication adherence (via the Medication Adherence Scale), and blood pressure (systolic and diastolic). After the intervention, patients showed significant improvements in subjective satisfaction. TSQM-Ⅱ scores increased significantly in the domains of effectiveness, side effects, overall satisfaction, and total score, while no significant change was observed in convenience. Medication adherence scores did not improve significantly. Both systolic blood pressure [(139.54±14.18) mmHg vs. (132.00±8.90) mmHg, P < 0.001] and diastolic blood pressure [(80.81±6.88) mmHg vs. (77.28±7.32) mmHg, P < 0.001] decreased significantly. The modified hypertension extended prescription service program demonstrated favorable intervention effects on community-dwelling hypertensive patients, and its long-term effect deserves further attention.
Bariatric surgery remains an effective and long-lasting treatment for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is currently the most widely used surgical procedure, but it has the disadvantages of suboptimal medium- and long-term weight loss effects and weight regain. The problem of weight regain after LSG has drawn increasing attention from bariatric physicians. In revision surgery, single-anastomosis duodena-ileal bypass with sleeve gastrectomy (SADI-S) achieves satisfactory weight loss with lowest risk of weight regain and fewest complications. In this case, a patient with type 2 diabetes and morbid obesity regained weight four years after LSG underwent SADI-S revision, resulting in further weight loss and stable maintenance during a 3-year follow-up period.
Cribriform-morular thyroid carcinoma (CMTC) is a rare malignant thyroid tumor with unique genetic characteristics. It is often an extracolonic manifestation of familial adenomatous polyposis (FAP). In this case, a 26-year-old female was found to have multiple bilateral thyroid nodules. She underwent radical surgery for bilateral thyroid carcinoma in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The routine pathology and immunohistochemistry after surgery confirmed CMTC. This is a rare case of multifocal CMTC. The ultrasonography showed multifocal nodules, which were dominated by isoecho and varied in morphology. There was no obvious calcification inside the multifocal nodules. This article highlights the ultrasonographic manifestations and pathological features of CMTC to enhance its understanding.
This article reports the multidisciplinary team (MDT) management of a pregnant patient with ulcerative colitis (UC). The patient was diagnosed with total colonic UC before pregnancy, achieved remission through infliximab (IFX) induction therapy, and subsequently conceived through assisted reproductive technology. During pregnancy, an MDT was established, led by the Department of Obstetrics and including the Department of Nutrition, Gastroenterology, and Neonatology, to implement comprehensive management. The team's practice involved: the Department of Nutrition formulating and implementing a low-fat, low-fiber diet with enteral nutritional support; the Department of Gastroenterology dynamically monitoring calprotectin and C-reactive protein levels to guide IFX dosage adjustments; the Department of Obstetrics managing maternal weight, regularly monitoring fetal growth, and determining the timing and mode of delivery; and the Department of Neonatology providing vigilant monitoring, which detailed postnatal care and a personalized immunization strategy. Through this structured MDT approach, the patient maintained sustained disease remission throughout pregnancy and delivered a healthy infant girl at 38+4 weeks of gestation, with favorable maternal and neonatal outcomes. This case exemplifies the practical workflow of the MDT model in managing UC during pregnancy, demonstrating that dynamic management and individualized interventions based on clear role allocation are essential for ensuring the safety of both the mother and the infant.
Non-ST-elevation myocardial infarction (NSTEMI) is a type of acute coronary syndrome (ACS), typically presenting with chest pain or tightness, ST-segment depression on electrocardiogram (ECG), and elevated levels of cardiac biomarkers. Meanwhile, myocarditis or inflammatory myopathies can also cause elevated levels of cardiac biomarkers and nonspecific electrocardiogram abnormalities, potentially leading to misdiagnosis. Polymyositis (PM) is an idiopathic inflammatory myopathy (IIM) classified as a systemic autoimmune disease, primarily affecting striated muscles. Pathologically, it is characterized by inflammatory infiltration, degeneration, and necrosis of muscle fibers, mainly involving proximal limb muscles and neck flexors, it may involve respiratory and swallowing muscles in severe cases. This paper reports the diagnosis and treatment process of a case of PM misdiagnosed as NSTEMI in Huashan Hospital, Fudan University, and summarizes the characteristics of cardiac manifestations of PM, so as to provide a reference in differentiating PM and myocardial infarction.
Multi-state models represent a critical methodological framework for analyzing longitudinal medical data, enabling precise characterization of dynamic disease progression across discrete health states. This article provides a concise introduction to the theoretical foundations of multi-state models, encompassing: (1) principles for defining the state space; (2) methods for quantifying transition intensities and transition probabilities; and (3) key modeling assumptions such as Markov property and time homogeneity. Through a case study on cardiac allograft vasculopathy (CAV) progression after heart transplantation, we illustrate the essential steps in constructing a multi-state model: translating clinical questions into state structures (e.g., CAV severity grades), statistical approaches for handling irregular follow-up intervals, and multivariable analysis of covariate effects. The case study demonstrates that multi-state models can precisely quantify transition patterns across multiple disease stages, offering robust methodological support for dynamic risk assessment and personalized interventions. Given their clinical relevance and analytical flexibility, multi-state models hold significant potential for broader application in medical research.
