Objective To investigate the effect of cordyceps sinensis （CS） on the activation of fibroblasts through IL-6 trans-signaling pathway and its specific mechanism in the treatment of renal fibrosis.Methods Renal fibrosis mouse model was established by unilateral ischemia/reperfusion （UIR）, and the mice were administered intragastrically CS, soluble glycoprotein 130 Fc （sgp130Fc） or Hyper-IL-6. Masson’s trichrome staining was utilized to identify tubulointerstitial fibrosis. PAS staining was utilized to assess the extent of renal injury. Western blot was employed to analyze the expression levels of fibrosis markers [alpha-smooth muscle actin （α-SMA）,fibronectin （FN）] and proteins associated with IL-6 trans-signaling pathway [phosphorylated signal transducer and activator of transcription 3（p-STAT3）,soluble interleukin-6 receptor （sIL-6R）]. The expression and localization of proteins were additionally detected by immunohistochemistry, immunofluorescence and qPCR. The effect of cordyceps sinensis extract cordycepin on IL-6 trans-signaling in fibroblasts was further investigated in vitro.Results The results from in vivo experiments showed that administration of CS during the chronic phase demonstrated a beneficial protective impact on inflammation and fibrosis in the affected kidney, and serum creatinine levels and collagen deposition were decreased. Western blot analysis revealed a decrease in the expression levels of α-SMA, FN, as well as IL-6 trans-signaling pathway protein p-STAT3, sIL-6R in the treatment group. Additionally, the mRNA expression levels of chemokines monocyte chemoattractant protein-1 （MCP-1） and C-X-C motif chemokine ligand 12 （CXCL12） were also decreased in the CS treatment group. Additionally, Hyper-IL-6 can partially counteract the therapeutic effects of CS. In vitro experiments further demonstrated that cordycepin inhibited the secretion of IL-6 from NRK-52E. Combined treatment of recombinant IL-6 and sIL-6R protein activated NRK-49F, leading to a significant increase in α-SMA, FN, and p-STAT3 expression levels. Cordycepin or sgp130Fc treatment significantly inhibited the proliferation of fibroblasts induced by IL-6 trans-signaling pathway.Conclusion CS can significantly reduce IL-6 secretion by renal tubular epithelial cells and inhibit the activation of IL-6 trans-signaling pathway in fibroblasts, thereby ameliorating renal interstitial fibrosis.

Objective To investigate the value of pre-treatment MRI features in predicting cachexia in hepatocellular carcinoma （HCC）.Methods A retrospective analysis was conducted on 399 patients with hepatocellular carcinoma, recording their pre-treatment clinical and MRI data. All patients underwent MRI plain and enhanced scan, and their weight was followed up 6 months after the MRI examination. According to the diagnostic criteria for cachexia, patients were divided into cachexia group and non-cachexia group. They were randomly divided into the training set （n=279） and the validation set （n=120）. Univariable and multivariable logistic regression analyses were used to screen variables associated with cachexia in hepatocellular carcinoma and to establish a predictive model. The receiver operating characteristic （ROC） curve was used to evaluate the predictive performance of different models. The DeLong test was used to compare the AUC values of different models, and the best-performing model was used to establish a predictive nomogram for cachexia in hepatocellular carcinoma.Results Multivariable logistic regression analysis showed that serum albumin <40 g/dL, serum alpha-fetoprotein >100 ng/mL, tumor diameter >5 cm, portal vein tumor thrombus, intratumoral arterial enhancement, and arterial phase peritumoral enhancement were independent predictors of cachexia in hepatocellular carcinoma. The clinical-imaging model showed the best predictive performance, with an AUC of 0.843 in the training set and 0.854 in the validation set.Conclusion The nomogram based on MRI features can predict cachexia in hepatocellular carcinoma 6 months earlier than clinical diagnosis, which has important clinical guidance significance.

Objective To analyze the impact of tandem mass spectrometry （MS/MS） screening compared to the indanone-fluorescence method （hereinafter referred to as fluorescence analysis） on finance or health insurance in screening newborn genetic metabolic diseases in Shanghai, and provide policy recommendations for MS/MS reimbursement.Methods A budget impact analysis model was constructed using Microsoft Excel 2019, with a study period of 3 years （2025—2027）. Newborns of 2025 to 2027 were predicted based on the birth data of newborns in Shanghai and the average decrease of newborns in Shanghai. Clinical screening data and cost data were derived from relevant statistical websites, literature, and hospital survey data. Additionally, consultations with experts were conducted to understand national and Shanghai-specific screening and reimbursement policies. Among these, the fluorescence-based analysis method is primarily used for screening phenylketonuria, while MS/MS can be used for screening a variety of newborn genetic and metabolic disorders. So we separately calculated the impact of MS/MS screening compared to the fluorescence-based method on Shanghai’s fiscal budget and health insurance fund.Results The budget impact analysis on fiscal expenditures indicates that from 2025 to 2027, the fiscal expenditures for fluorescence analysis will be 1.58 million, 1.48 million and 1.39 million yuan, respectively. In contrast, MS/MS fiscal expenditures will be 22.75 million, 21.37 million, and 20.06 million yuan, respectively； compared with fluorescence analysis, the increased fiscal expenditures for MS/MS will be 21.18 million, 19.88 million, and 18.67 million yuan, respectively, showing a decreasing trend annually. The budget impact on health insurance funds shows that from 2025 to 2027, the expenditures for fluorescence analysis will be 1.11 million, 1.04 million and 0.97 million yuan, respectively； MS/MS health insurance fund expenditures will be 15.93 million, 14.96 million and 14.04 million yuan, respectively. Compared with fluorescence analysis, the additional health insurance fund expenditures for MS/MS will be 14.82 million, 13.92 million and 13.07 million yuan, respectively, also showing a decreasing trend annually. Policy-wise, the costs for tandem mass spectrometry screening are typically covered by fiscal payments or out-of-pocket by patients, with commercial insurance, charitable foundations, and other organizations serving as supplementary sources of funding.Conclusion The overall cost of expanding newborn screening for genetic metabolic diseases in Shanghai is controllable. To unify the payment standards and facilitate centralized management, it is recommended that the costs for tandem mass spectrometry screening in Shanghai be covered by government funding.

Objective To explore the potential categories of health risk behaviors among students aged 11 to 18 years in Minhang District, Shanghai in order to identify the influencing factors of health risk behaviors among different categories of students.Methods Using stratified cluster sampling techniques, a random selection of 1 690 middle school students from Minhang District, Shanghai, were chosen as the study sample. Data was collected using the “Shanghai Adolescent Health-Related Behavior Survey Questionnaire” to assess participants’ scores on six categories of health risk behaviors. Latent profile analysis （LPA） was employed to cluster students’ health risk behaviors, and a multifactorial Logistic regression model was used to analyze the related influencing factors.Results The health risk behaviors of students aged 11 to 18 in Minhang District, Shanghai, were categorized into 3 groups： Class 1, comprising 915 students （54.14%）, with moderate to low scores in health risk behaviors, named “the group with moderately low levels of various health risk behaviors”； Class 2, comprising 539 students （31.89%）, with higher scores in psychological addiction, named “the group with psychological addiction as the prominent health risk behavior”； Class 3, comprising 236 students （13.97%）, with higher scores in substance addiction, named “the group with substance addiction as the prominent health risk behavior”. The results of the univariate analysis for the three potential categories of student health risk behaviors show that there are statistically significant differences in the 3 potential categories of health risk behaviors among students of different schools, ages, ethnicities, and boarding situations （P<0.05）. The analysis results of the multivariate Logistic regression indicate that compared to junior high school students, both senior high school students and vocational high school students have a higher risk of exhibiting unhealthy behaviors characterized by psychological addiction and substance addiction, with all differences being statistically significant （P<0.05）.Conclusion The latent profile analysis reveals three distinct categories of health risk behaviors among students aged 11 to 18 years in Minhang District, Shanghai, with significant distribution differences among students from diverse backgrounds. Consequently, it is recommended that tailored health education and intervention measures be implemented for students with different school characteristics and at various educational stages.

Objective To compare the therapeutic efficacy of a self-locking zero-notch interbody fusion device for long-segment cervical spondylosis in elderly patients with traditional titanium plate combined with interbody fusion device.Methods From Jan 2019 to Jan 2021, elderly patients （>60 years） with 3-4 segments （C3-C7） radiculopathy, myelopathy, or mixed-type cervical spondylosis underwent anterior cervical discectomy and fusion （ACDF） using a zero-notch interbody fusion device （Group A, n=24） and ACDF using a titanium plate combined with an interbody fusion device （Group B, n=18）. We recorded the surgery duration, blood loss, incision length and hospital stay, measure preoperative and postoperative intervertebral height, functional segment height and cervical lordosis, and also observe treatment outcomes and postoperative complications between the two groups.Results There were no statistically significant differences between the two groups in terms of gender, age, Japanese Orthopaedic Association （JOA） score, visual analogue scale （VAS） of upper limb, Neck Disability Index （NDI）, preoperative intervertebral height, functional segment height and cervical lordosis. Blood loss, surgery time and hospital stay were similar in both groups, but Group A had shorter incision length （P<0.01） compared with Group B. There were no significant differences between the two groups in JOA scores, upper limb VAS and postoperative NDI, and even in postoperative intervertebral height, functional segment height and cervical lordosis recovery.Conclusion The zero-notch interbody fusion device is effective for treating long-segment cervical spondylosis. Compared with the traditional titanium plate combined with an interbody fusion device, it can avoid postoperative dysphagia with smaller incision and shorter surgery time, which makes it more suitable for elderly patients.

Objective To investigate the role of the GPR120 gene in the progression of sepsis, explore the molecular mechanisms through which GPR120 gene regulates NOD-,LRR- and pyrin domain-containing protein 3 （NLRP3） inflammasome activation and macrophage polarization.Methods The blood and pleural fluid samples were collected from the sepsis patients and the control group. The expression of inflammatory factors and the associated proteins were detected by flow cytometry and ELISA. C57BL/6 mice and monocyte-macrophage cell line （Raw264.7） were treated with lipopolysaccharide （LPS） to construct the sepsis models. After the intervention of GPR120 agonist TUG891, the expression of GPR120 gene, NLRP3 inflammasome protein and macrophage polarization protein were detected between the control group and the sepsis group.Results The expression of inflammatory factors, such as IL-1β in the serum of septic patients, significantly increased compared with the control （P<0.001）. And the expression of inflammasome proteins such as NLRP3, Caspase-1 and IL-1β in the pleural fluid also increased （all P<0.05）. Invivo, LPS could induce severe inflammation in lung tissue, the GPR120 gene expression decreased in lung tissue, and inflammatory factors were up-regulated in mouse serum （P<0.01）. The inflammasome-associated protein and M1 type polarization of macrophages were enhanced, the TUG891 could reduce the inflammatory response, inhibit the NLRP3 inflammasome activating, and promote the M2 polarization of macrophages （P<0.01）. In vitro, LPS could inhibit the intracellular GPR120 expression. The inflammatory factors secreted more in LPS-induced sepsis cells. TUG891 could promote the up-regulation of GPR120 protein and alleviate the secretion of inflammatory factors （P<0.05）.Conclusion In sepsis, GPR120 gene activation could inhibit the NLRP3 inflammasome activation, promote macrophage polarization, and reduce the inflammatory damage, thereby delay the rapid progression of sepsis.

Objective To explore the clinical and pathological characteristics and oncological outcomes of clear cell borderline ovarian tumor （CCBOT）, and provide guidance for the diagnosis and treatment of this disease in the future.Methods A total of 23 CCBOT patients who underwent surgical treatment in our hospital from May 2011 to Aug 2022 were enrolled, and the clinical information of 19 CCBOT patients in the Ricotta’s cohort was integrated. The clinical pathological characteristics and oncological outcomes of these 42 patients were retrospectively analyzed.Results This study enrolled 42 CCBOT patients, including 23 from our cohort and 19 from the Ricotta G’s cohort. Compared with the Ricotta’s cohort, the proportion of CCBOT patients with endometriosis in our cohort （34.8%） was significantly higher than that in the Ricotta’s cohort （5.3%） （P<0.05）. In our cohort, 22 patients had information on intraoperative frozen section evaluation, and the accuracy of intraoperative frozen section evaluation was 50% （11/22）. The other 50% （11/22） of patients were underestimated by intraoperative frozen section evaluation. The merged cohort indicated that the median age of the patients was 60 years old, occuring more common in postmenopausal women （66.7%）. Most cases presented with pelvic masses （59.5%） and abdominal pain or distension （19.0%）. This disease mostly involved unilateral ovaries （90.5%）. Information on preoperative tumor markers was largely missed, making it difficult to draw an accurate evaluation for them. Ten cases （23.8%） underwent fertility sparing surgery, and 32 cases （76.2%） underwent radical surgery. The pathologic report indicated that all patients were stage I patients and 21.4% patients had endometriosis. Among these patients, 32 patients underwent total hysterectomy, of which 10 （31.3%） had concurrent endometrial lesions. The median follow-up time was 68 months, with a minimum follow-up of one month and a maximum follow-up of 231 months, and no recurrence or death was observed.Conclusion CCBOT patients usually had an good prognosis with a low recurrence rate. Fertility sparing surgery was safe and feasible, but attention should be paid to exclude concurrent endometrial lesions. Given the rarity of CCBOT, future multicenter prospective studies are needed to better elucidate the clinical pathological features and prognosis of patients with CCBOT.

Objective To investigate the association of endometrial thickness （EMT）with obstetric and neonatal outcomes of monoparous pregnancy in fresh cleavage embryos transfer.Methods A total of 1 845 patients of monoparous pregnancy after fresh cleavage embryos transfer cycles from Jan 2016 to Mar 2022 at Shanghai First Maternity and Infant Hospital,Tongji Universtiy were analyzed retrospectively. Patients were categorized into three groups by EMT on transferation day：≤8 mm （group A）, 8-14 mm （group B） and ≥14 mm （group C）. The primary outcomes were preterm birth （PTB）, birth weight and birth weight z-score, small-for-gestation age, large-for-gestation age, very low birth weight, low birth weight and macrosomia. The second outcomes were pregnancy and perinatal complications. The relationship between EMT and adverse neonatal outcomes was estimated by Logistic regression analysis.Results The rate of ectopic pregnancy was increased significantly in group A. No significant differences were found among the three groups in gestation age, birth weight, birth weight z-score, PTB,small for gestation age, large for gestation age, low birth weight,very low birth weight and macrosomia. Compared with group B, the odds of adverse neonatal outcomes did not show significant differences before and after adjustment in both group A and group C by Logistic regression analysis.Conclusion Thinner EMT in fresh cleavage embryos transfer is associated with higher rate of ectopic pregnancy, while it is not independently associated with adverse perinatal outcomes.

Objective To apply and evaluate the midwifery quality evaluation index system constructed in the early stage and verify its practical value as a midwifery quality evaluation tool.Methods Thirteen hospitals of different grades and natures in the Pan-Yangtze River Delta region were selected as the research objects. Three comprehensive evaluation methods, weighted technique for order preference by similarity to ideal solution （TOPSIS） method, weighted rank sum ratio （WRSR） method and simple additive weighted （SAW） method, were used to rank the quality of midwifery in the 13 hospitals. The results of the 3 methods were comprehensively ranked by the combination evaluation method. Kendall concordance coefficient was used to test the consistency of the three comprehensive evaluation results.Results The 13 hospitals consist of 3 comprehensive hospitals of Grade Ⅲ Class A, 3 obstetrics and gynecology hospitals of Grade Ⅲ Class A, 1 comprehensive hospital of Grade Ⅲ Class B, 2 obstetrics and gynecology hospitals of Grade Ⅲ Class B, 1 comprehensive hospital of Grade Ⅱ Class A, 2 obstetrics and gynecology hospitals of Grade Ⅱ Class A, and 1 obstetrics and gynecology hospital of Grade Ⅱ Class B. Although the ranking results of the 13 hospitals evaluated by the 3 comprehensive evaluation methods were slightly different with the Kendall harmony coefficient W=0.794, which proved that they had high consistency. Top 4 of the 13 hospitals by the combination evaluation on the midwifery quality were H10, H4, H1 and H2. It was basically consistent with the predicted result of the research hypothesis （H1, H2 and H10 should be among the best in midwifery quality）.Conclusion The evaluation results of midwifery quality evaluation index system are stable. The index system can reflect the midwifery quality and has high clinical practical value which can be used as a scientific tool for midwifery quality evaluation.

Objective To provide a comprehensive description and summary of the clinical characteristics of eosinophilic granulomatosis with polyangiitis （EGPA） in order to enhance understanding of this disease.Methods A total of 33 EGPA patients treated in Zhongshan Hospital, Fudan University, between Jan 2017 and Aug 2022 were included in this retrospective analysis. The diagnosis was based on the 1990 American College of Rheumatology （ACR） classification criteria for EGPA. Clinical manifestations, laboratory examinations, and treatment outcomes of the patients were analyzed.Results Among the 33 EGPA patients, there were 22 males （66.7%） and 11 females （33.3%）, with an average age of diagnosis being （47.42±15.83） years old. The most common initial department visited by patients was the rheumatology department （23 cases, 69.7%）, followed by the respiratory medicine department （6 cases, 18.2%）. Skin involvement manifested as rash, ulcers, necrosis or gangrene was observed in most cases （23 cases, 69.7%）, followed by asthma （17 cases, 51.5%）, infiltrative pneumonia （14 cases,42.4%）, peripheral neuropathy （9 cases,27.3%）, thrombosis formation （9 cases, 27.3 %）.The mean absolute value of eosinophils in all patients was measured as （3.43±3.52）×10⁹/L,with eight patients （24.2%） testing positive for antineutrophil cytoplasmic antibody （ANCA）. Compared with ANCA-negative patients,ANCA-positive individuals exhibited significantly higher Birmingham Vasculitis Activity Score （BVAS） and eosinophil count, as well as a higher incidence rate of renal involvement （P<0.05）. Glucocorticoid therapy was administered in thirty-two patients （97%）, while biologics or tofacitinib were given to eleven patients （33.3%）, among them six received tofacitinib treatment, of which five achieved disease remission.Conclusion EGPA exhibits a wide range of clinical manifestations, and ANCA-positive patients tend to exhibit higher disease activity levels. A multidisciplinary diagnosis and treatment system for EGPA should be established.

Objective To observe the early changes of vault after implantation of posterior chamber phakic intraocular lens implantable collamer lens （ICL）, and investigate the effect of different implantation axes on the early vault changes.Methods A prospective, parallel cohort study was performed, enrolling a total of 124 eyes of who underwent ICL （V4c） implantation in the refractive clinic. The changes of vault were observed by scheimpflug tomography （Pentacam） and anterior segment optical coherence tomography （CASIA2） at 1 day, 1 week and 1 month after surgery.Results The ICL vault declined significantly by approximately （108.2±82.4）μm 1 week after surgery with the proportion of 16.6%±12.1% compared with the values 1 day after surgery （P<0.001）, and then remained stable. Within 1 month after surgery, excluding the difference in vault baseline at 1 day after surgery, the proportion of vault decline in the middle vault group （250-749 μm） and the high vault group （≥750 μm） was similar, and there was no statistically significant difference. We analyzed the relationship between ICL axial directions and vault and found that the vault decline of the horizontal ICL group stabilized quickly at 1 week after surgery, and the vault decline of the vertical ICL group was more significant within 1 month after surgery （P<0.05）.Conclusion The vault of the ICL shows a downward trend in the early stage after implantation. The middle vault group and ICL in the horizontal position stabilizes faster, and the downward trend of the high vault group or ICL in the vertical position is more obvious.

Objective To summarize the clinical features, treatment and prognosis of patients with primary central nervous system lymphoma （PCNSL） with clonal bone marrow B cells, and to explore the influence on clinical diagnosis and treatment.Methods PCNSL patients with clonal bone marrow B cells diagnosed by flow cytometry between Jan 2020 and Jul 2023 at Huashan Hospital of Fudan University were enrolled. The auxiliary examination data of these patients were collected, including complete blood count, routine biochemistry, bone marrow aspiration and biopsy, contrast-enhanced brain MRI, and whole-body PET-CT. Kaplan-Meier was used to draw the survival curve, and relevant literature was reviewed.Results A total of 223 newly diagnosed PCNSL patients were included, 187 of whom completed bone marrow puncture and biopsy evaluation. We found clonal bone marrow B cells in 16 of 187 cases （8.56%） by flow cytometry. 2 patients showed B lymphoma involving the bone marrow. All patients received a high-dose methotrexate based chemotherapy. The median progression free survival （PFS） of 16 patients with clonal bone marrow B cells was 11.1 months, and the median PFS of 171 patients with normal bone marrow was 12.6 months. There was no significant difference in the PFS between the two groups.Conclusion PCNSL with clonal bone marrow B cells had no specific clinical features, but bone marrow flow cytometry showed clonal B cells. High-dose methotrexate treatment regimen is effective. There was no significant difference in PFS for PCNSL patients with clonal B cells and normal findings in bone marrow. Clonal B cells in bone marrow may be caused by monoclonal B-cell lymphocytosis （MBL）, lymphoma involves the bone marrow and the presence of common precursor cells. Bone marrow examination should be performed in the initial evaluation of suspected PCNSL.

Objective To investigate the role of Sneathia sanguinegens （S.sanguinegens）in the development of unexplained recurrent spontaneous abortion （URSA）.Methods A case-control study was conducted to analyze the vaginal flora characteristics of 65 patients with URSA and 18 healthy controls through 16S rRNA gene sequencing. Toxicity profile of S.sanguinegens on human cervical cancer cells （ME-180）, human umbilical vein endothelial cells （HUVEC） and human placental choriocarcinoma cells （JEG-3） was analyzed at the cellular level to assess the mechanism of it in adverse pregnancy outcomes. And S.sanguinegens was used to infect C57BL/6J mice to explore the toxic effect on living organisms.Results The relative abundance of Sneathia was increased in patients with URSA compared with healthy controls. It was positively correlated with the number of miscarriages, and was attributed to S.sanguinegens. We also found that S.sanguinegens damaged ME-180, JEG-3 and HUVEC cells. The degree of cellular damage was related to the level of S.sanguinegens added. Intravenous infection with S.sanguinegens caused inflammatory damage in several organs and extramedullary hematopoiesis in the spleen.Conclusion S.sanguinegens is closely related to URSA and should be emphasized in patients with high vaginal bacterial load.

Objective To evaluate the prognosis and safety of patients with advanced pancreatic ductal adenocarcinoma （PDAC） who received I-125 seed implantation in treatment with anti-PD-1 monoclonal antibody+chemotherapy.Methods A retrospective analysis was conducted on patients with stage Ⅳ metastatic PDAC who received anti-PD-1 combined chemotherapy treatment at Yixing Hospital,Jiangsu University from Jan 2021 to Jun 2023. Patients were divided into two groups based on whether they received I-125 seed implantation： the I-125 seed implantation+anti-PD-1 monoclonal antibody+Chemotherapy group （IPC group） and the anti-PD-1 monoclonal antibody+chemotherapy group （PC group）. The follow-up period ranged from 2 to 24 months, with a median follow-up time of 9 months. The prognosis of patients was analysed in combination with peripheral blood biomarkers. The peripheral lymphocyte subsets of patients in different treatment groups were preliminarily analysed by flow cytometry.Results A total of 13 patients were included,with 5 in the IPC group and 8 in the PC group.Progression-free survival （PFS） and overall survival （OS） in the IPC group were significantly longer than those in the PC group. The treatment in the IPC group was relatively safe, adverse reactions were controllable. The neutrophil-lymphocyte ratio （NLR） and CD4/CD8 ratio indicated that the prognosis of the IPC patients was better. The levels of regulatory T cells （Treg） and active regulatory T cells （aTreg） cells in the IPC patients were reduced after treatment compared with those of the PC patients.Conclusion The addition of I-125 seed implantation can improve the prognosis of patients with advanced PDAC who receive anti-PD-1 monoclonal antibody+chemotherapy, the post-treatment levels of patients’ circulating aTreg cells are reduced,and the combination therapy has good safety.

Objective To observe the clinical effect of pressing needle in preventing and reducing nausea and vomiting in patients after gynecological laparoscopic surgery.Methods A total of 199 patients undergoing gynecological laparoscopic surgery from May to Nov 2023 at Obstetrics and Gynecology Hospital,Fudan University were randomly divided into research group （n=99） and control group （n=100）. The observation group was given Tanzhong, zanzhu and Taichong pressing needles on the basis of the control group. The postoperative nausea and vomiting were observed in the two groups.Results There were significant differences in the incidence and duration of postoperative nausea, the incidence of postoperative vomiting between the two groups （P<0.05）, but there was no significant difference in the duration of postoperative vomiting. The incidence of nausea and vomiting in the observation group was lower than that in the control group.Conclusion Pressing needle can effectively prevent the occurrence of nausea and vomiting after gynecological laparoscopic surgery, and reduce the degree of nausea and vomiting, and reduce the duration of nausea.

Objective To introduce how to import and analyze data using the Research Electronic Data Capture（REDCap） system, taking a multi-center randomized controlled clinical research of total knee arthroplasty as an example.Methods Various tools within the REDCap system, including data import tools, data export functions, reports and statistics, project dashboards, and coding manuals, were used to systematically process and analyze the multi-center randomized controlled clinical trial data for total knee arthroplasty. Initially, electronically collected clinical data were adjusted and standardized, then uploaded in bulk to the system using the REDCap data import tool. Subsequently, the data were organized through REDCap’s data export feature, and basic descriptive statistical analysis was performed using its reporting and statistical functions to ensure data quality and completeness.Results An electronic data collection and management platform for clinical research on knee osteoarthritis wase successfully created by the REDCap system. The platform enabled real-time data collection from multiple centers, and ensured data accuracy and consistency through built-in data management and quality control mechanisms. With the statistical analysis features of REDCap, the research team could monitor the progress of data in real time, conduct effective quality assessments, and perform dynamic analysis for further in-depth statistical evaluations.Conclusion The REDCap system can be used not only to build a new clinical research project, but also to import and analyze data that has been previously digitized of ongoing clinical researches into the system, which improved the scientificity of data management and research efficiency.

Small cell neuroendocrine cervical carcinoma （SCNECC） is a rare gynecological malignancy characterized by early invasion and metastasis, resulting in a poorer prognosis compared to cervical squamous cell carcinoma and adenocarcinoma. The clinical management of SCNECC remains in the exploratory phase. Recently, as this uncommon tumor has garnered increasing attention both domestically and internationally, some progress has been made in improving its prognosis. This article summarizes the advancements in combined modality therapy for SCNECC, discussing and providing insights into key issues related to current treatment strategies of surgery, radiotherapy and chemotherapy, as well as targeted and immunotherapies.

Bronchopulmonary dysplasia （BPD） is a detrimental respiratory complication associated with prematurity that still lacks effective treatment. BPD is a multifactorial disease with a pathogenesis involving alveolar simplification and impaired vascularization. Alveolar epithelial cells are the main components of alveoli including alveolar type Ⅰ （AT1） and alveolar type Ⅱ （AT2） epithelial cells. AT1 cells are involved in constructing the air-blood barrier and facilitating gas exchange, while AT2 cells, characterized by proliferative and differentiated stem cell properties, maintain lung homeostasis and contribute to lung injury. The transdifferentiation of AT2 cells into AT1 cells is a core mechanism in the repair of lung injuries, although the key signaling pathway activating transdifferentiation remains unclear. This article introduces the key signaling pathways and research progress in alveolar epithelial cell transdifferentiation through literature retrieval and classification summary, providing a foundation for elucidating the pathogenesis of BPD and exploring new therapeutic regimens for BPD.

Adenoid cystic carcinoma （ACC） of the cervix is a rare and highly aggressive subtype of cervical cancer, accounting for less than 1% of all cervical cancer cases. ACC predominantly affects postmenopausal women over the age of 60, with postmenopausal vaginal bleeding being the most common symptom. Diagnosis of ACC primarily relies on histopathological examination and immunohistochemical analysis. Although there is currently no standard treatment protocol, surgical resection combined with radiotherapy or concurrent chemoradiotherapy is considered to be an effective approach. However, the effectiveness is limited, particularly in advanced cases, which generally have a poor prognosis. The treatment and prognosis of ACC are closely related to tumor staging, perineural invasion, and margin status. This paper discusses the clinical data and follow-up of six ACC patients treated at our institution, and goes through a literature review, examines its clinical features and treatment outcomes, underscores the critical importance of early diagnosis and individualized treatment.

The pregnant woman was 30 years old, G2P0. This singleton pregnancy at 22 weeks of gestation was screened for second-trimester ultrasound malformations,suggesting fetal aortic valve atresia, aortic stenosis with reverse blood flow, mitral valve atresia, and markedly enlarged left ventricle, which was considered for the diagnosis of hypoplastic left heart syndrome （HLHS）. The pregnancy was terminated at our hospital and subsequently underwent genetic testing with results of heterozygous variants in the NOTCH1 gene, which can cause aortic valve disease type 1. The findings of the fetal autopsy were aortic valve atresia, mitral valve widening and thickening, and left ventricular enlargement with myocardial infarction. This report focuses on the ultrasound characteristics of HLHS with left ventricular enlargement and its hemodynamic changes in order to improve clinicians’ understanding of the progressive changes in the disease phenotype of HLHS.

Pulmonary alveolar proteinosis （PAP） is a rare progressive respiratory dysfunction disease of the lung characterized by insidious onset and non-specific clinical manifestations, often leading to misdiagnosed and mistreated. Herein, we reported a case of PAP patient admitted to Jiading District Central Hospital with an atypical appearance of alveolar lavage fluid and whose condition improved significantly after treatment with subcutaneous injection of recombinant human granulocyte-macrophage colony stimulating factor （GM-CSF）. Additionally, we have reviewed and summarized the relevant literature to enhance the understanding of the diagnosis and treatment of this disease.

Drug clinical trial is a method of experimental epidemiology to evaluate the effectiveness and safety of medicines. This article introduced the types and design thought of innovation in drug clinical trial design, and provided methodological reference for related researches. Adaptive design is a complex and innovative clinical trial design, which can be divided into group sequential design, sample size re-estimation, seamless trial, enrichment design and master protocol design （basket trial, umbrella trial, platform trial, etc.） according to the purpose of adaptability. The adaptive design has greater adjustment flexibility, which overcomes the shortcomings of conventional clinical trials to a certain extent, then improves the validity of the trial results and the strength of the evidence. The design innovation and remodeling of drug clinical trials will provide more powerful evidence-based evidence for the realization of precision medicine.