Objective To investigate the differences in demographic characteristics， reproductive health status， and the distribution of pregnancy-related diseases between couples conceived via assisted reproductive technology （ART） and naturally conceived couples， and to analyze the impact of ART treatment on the incidence of preterm birth （PTB） in singleton and twin and multiple pregnancies. Methods We conducted a retrospective analysis of the maternal and infant cohort data of Jing’an District from 2013 to 2020. Based on the conception method， the subjects were categorized into two groups： the ART group and the natural conception group. Chi-square test was applied to compare baseline characteristics and disease distributions differences between the two groups， and logistic regression models were used to evaluate the association between ART and the PTB risks. A causal mediation model was used to evaluate the mediating effect of twin and multiple pregnancy in the relationship between ART and PTB. Results A total of 117 717 parturients were included，6 265 in the ART group and 111 452 in the natural conception group.Compared with the natural conception group， couples in the ART group were significantly older and had a higher prevalence of reproductive system diseases. The incidences of diabetes and hypertensive disorders during pregnancy in ART parturient were 13.76% and 9.99%， respectively， which were significantly higher than 7.88% and 4.75% in the natural conception group （both P<0.001）. The overall PTB rate in the ART group was 14.81%， higher than 5.35% in the natural conceptions group （P<0.001）. The PTB rate in ART for singleton pregnancies in the ART group was 6.40%， higher than 4.83% in the natural conception group （P<0.001）， while the PTB rate in ART for twin and multiple pregnancies in the ART group was 53.97%， lower than 60.42% in the natural conception group （P<0.05）. Mediation analysis showed that 97.99% of the effect of ART on PTB was mediated by twin and multiple pregnancy， with ART increasing the PTB risk by 3.44 times through multiple pregnancy. Conclusion The overall PTB rate of ART recipients is higher than that of natural recipients， but ART does not increase the PTB risk in singleton and twin and multiple pregnancies. Twin and multiple pregnancy is the key mediating factor contributing to PTB in ART-conceived recipients. Compared with naturally conceived couples，ART conception couples own more advanced maternal age， and have higher risks of suffering gestational diabetes， gestational hypertension， and PTB.

Objective To analyze the implementation of MPOWER tobacco control policies in different regions and populations in China， as well as the impact of perceptions of tobacco control policies on individual smoking behavior and quit intentions， to promote the fairness of policy implementation and protection for vulnerable groups. Methods A multivariable regression model was constructed utilizing raw data from the China Adult Tobacco Survey to analyze disparities in perceived MPOWER policy implementation among various social demographics and its impact on smoking behavior and quitting intentions. Results Regarding protection from tobacco smoke （P）， local economic level， urban-rural divide were significantly correlated with awareness of comprehensive smoking bans. For offering help to quit smoking （O）， local tobacco industry revenue and individual age were associated with the doctor’s advice for quitting. As to the warning about the harm of tobacco （W）， economic level， geography and urban-rural disparity were correlated with the visibility of health warnings. About the tobacco advertising， promotion and sponsorship （E）， geography was related to the exposure to tobacco advertisements， local tobacco industry revenue was associated with the tobacco promotion. For tobacco taxes （R）， education level and age were significantly correlated with tobacco affordability. People who perceived comprehensive smoking bans （OR=0.69， 95%CI：0.59-0.81） was associated with less smoking behavior， while people perceiving tobacco promotional activities （OR=2.51， 95%CI：2.00-3.17） were more likely to smoke. Additionally， people who perceived comprehensive smoking bans （OR=1.70， 95%CI：1.25-2.31） and health warning （OR=2.09， 95%CI：1.48-3.01） had higher intention to quit smoking. Conclusion In economically disadvantaged regions and among specific socially vulnerable groups （such as low-income individuals， rural residents， and the elderly） in China， the perception of tobacco control policy implementation is relatively low， the perception of tobacco control policies can influence smoking behavior and quitting intentions. Legislative and enforcement efforts should be increased targeting these groups with lower perceptions of the policies to enhance the fairness of tobacco control measures.

Objective To explore influencing factors in diagnosing stump vaginal lesions by comparing the clinical data of patients with vaginal wall resection after total hysterectomy. Methods This retrospective study included patients who underwent vaginectomy due to stump vaginal lesions [including high-grade intraepithelial lesion （HSIL） or cancer] in Obstetrics and Gynecology Hospital，Fudan University between Jan 1， 2013 and Sep 30， 2022. The diagnosis was confirmed based on pathology results after vaginal stump resection， then patients were categorized into HSIL group and vaginal cancer （VC） group. We analyzed the differences in clinical features between the groups and evaluated the diagnostic value of various indicators for vaginal cancer. Additionally， within the VC group， patients whose colposcopic biopsy showed HSIL while whose pathology upgraded to invasive cancer after stump colpotomy were classified as the high-grade pathologic invasive cancer group （HC group）. We then compared the HSIL group and the HC group to assess the predictive value of each index for pathological escalation. Results Significant differences were observed between the HSIL and VC groups in terms of age， etiology of previous hysterectomy， proportion of clinical symptoms， proportion of abnormal physical examination findings， proportion of abnormal imaging findings， proportion of papillary lesions， proportion of vaginal roof lesions， and squamous cell carcinoma antigen （SCCA） （P<0.05）. However， there were no significant differences in fertility， previous hysterectomy， or HPV infection rate. Abnormal physical examination and imaging findings demonstrated better diagnostic performance （AUC>0.7）. The proportion of vaginal apex lesions was significantly higher in the HC group compared with the HSIL group （P<0.05）. Conclusion Previous hysterectomy for cervical cancer， presence of clinical symptoms， abnormal physical findings， abnormal imaging manifestations， and lesions at the vaginal apex are significant influencing factors in the diagnosis of vaginal stump carcinoma. Although colposcopy remains the primary diagnostic method， vaginal resection should be considered to rule out invasive carcinoma when high-risk factors exist， even if colposcopic biopsy pathology suggests HSIL.

Objective To analyze the association between lifestyle and the risk of type 2 diabetes （T2D） among adult residents. Methods The data was sourced from the Shanghai Suburban Adult Cohort and Biobank. A total of 42 096 adult residents who had not developed T2D were recruited from four districts of Shanghai （Songjiang， Jiading， Minhang， and Xuhui） between 2016 and 2019. The follow-up ended on Feb 28， 2023. A structured questionnaire was used to collect information on six lifestyle-related items， including smoking， alcohol consumption， BMI， waist circumference （WC）， physical activity， and diet. The unhealthy lifestyle scores （UHLS） were calculated by counting the number of all the unhealthy lifestyle items， with a range of 0-6. New-onset T2D events diagnosed by physicians were obtained through the medical information system. Cox proportional hazards regression model and restricted cubic spline model were utilized to evaluate the association between unhealthy lifestyles and the risk of T2D incidence. Results About 28.1% of the participants led 4-6 unhealthy lifestyles. A total of 1 752 new T2D cases were identified during 218 513.4 person-years of follow-up. Analysis of single unhealthy lifestyle showed that abnormal WC （HR=1.5， 95%CI：1.4-1.7） and abnormal BMI （HR=1.3， 95%CI：1.2-1.5） were associated with an increased risk of T2D. Compared with individuals with a UHLS of 0-1， those with a UHLS of 3 and 4-6 had 30% （95%CI：1.1-1.6） and 50% （95%CI：1.2-1.8） higher risks of T2D， respectively. Each additional unhealthy lifestyle was associated with a 10% increase in T2D incidence risk （HR=1.1， 95%CI：1.1-1.2）. Conclusion The risk of T2D in adult residents increases with the cumulative number of unhealthy lifestyles. Adult residents with abnormal WC or BMI， or have three or more unhealthy lifestyles accumulated， will increase the risk of new-onset T2D.

Objective To observe the association between afterschool physical exercise and sleep quality among preschool children， and to explore the proper afterschool physical exercise model for better sleep quality. Methods A cross-sectional study was conducted. From Apr to Jun 2024， a total of 1 430 children from three public kindergartens in Minhang district were enrolled to participate in the survey. Parents were invited to complete the basic sociodemographic information， afterschool physical exercise information and the Children’s Sleep Habits Questionnaire.One-way ANOVA and linear mixed effects models were used to explore the relationship between afterschool exercise and sleep quality. Results A total of 1 430 questionnaires were sent out and 1 384 were recovered with a recovery rate of 96.78%. Among them 1 366 were valid，with an effective rate of 95.52%. The average age of the children was （5.19±0.87） years old with gender ration of 1.07∶1 （male： female）. The prevalence of poor sleep quality was 80.60% （regarding a CSHQ total score>41 as cutoff）. A one-way ANOVA indicated that time on afterschool physical exercise was significantly associated with sleep duration， Night waking， and sleep onset delay （P<0.05）. After adjusting for age， gender， the only child or not， main caregiver， and parental education and occupation， linear mixed effects models showed that engaging in afterschool physical activity for at least 180 mins per week has a statistically significant predictive effect on sleep duration scores （β=-0.50，z=-4.52， 95%CI：-0.72，-0.28， P<0.001）， night waking scores （β=-0.16，z=-2.34， 95%CI： -0.29，-0.02， P=0.020）， and sleep onset delay scores （β=-0.14， z=-2.35， 95%CI： -0.26，-0.02， P=0.019）. Conclusion Afterschool exercise was significantly associated with sleep quality among preschool children in Minhang district of Shanghai. The time≥180 min on afterschool exercise per week in preschool children was significantly positively associated with maintaining sleep duration， reducing night wakings and shortening the latency to fall asleep. The habit of afterschool exercise and the time on afterschool exercise should be emphasized by parents and the society to improve sleep quality among preschool children.

Objective To deeply analyze the free-text comments of patients with cardiovascular disease regarding medical services， in order to identify their concerns and emotional tendencies during the medical journey， and to gain insights into the value elements of medical services from the patient perspective. Methods An open-ended question allowing free-text comments was embedded in the patient satisfaction survey to collect genuine evaluations of medical services from patients hospitalized for cardiovascular disease from Sept 2022 to Jul 2023， forming a large text corpus of patient opinions. Supervised machine learning algorithms and the BERT model were used to conduct topic modeling and sentiment analysis on the text corpus. Logistic regression was employed to analyze the relationship between negative comment themes and patient satisfaction and loyalty. Results A total of 4 693 comments were collected from patients with cardiovascular disease during the study period. The most frequently mentioned subjects in patient comments were nurses （25.1%）， followed by doctors （14.9%）. Sentiment analysis results showed that 3 592 patients （76.5%） made positive comments， 977 patients （20.8%） made negative comments， 102 patients （2.2%） made mixed comments， and 22 patients （0.5%） made neutral comments. Topic analysis results indicated that the five most frequently mentioned themes by patients with cardiovascular disease were humanistic care （14.4%）， information education and communication （9.0%）， technical proficiency （6.6%）， diet （6.2%）， and effectiveness of diagnosis and treatment （4.2%）. Logistic regression analysis showed that negative evaluations of dimensions such as humanistic care， information education and communication and response to needs were significantly associated with lower patients’ satisfaction and loyalty. Conclusion Interpersonal interaction and functionality are dual important dimensions in medical services， especially interpersonal interaction， which often becomes the decisive factor for patients with cardiovascular disease to assess the quality of medical services.

Objective The optimal ventilation mode for patients with obesity undergoing laparoscopic surgery remains unclear. We aimed to compare the effects of pressure-controlled ventilation （PCV） and pressure-controlled ventilation-volume guaranteed （PCV-VG） on perioperative oxygenation and respiratory mechanics in patients undergoing laparoscopic bariatric surgery. Methods In this prospective randomized controlled study， 114 subjects who underwent laparoscopic bariatric surgery from Jan 2017 to Mar 2020 were randomly divided into PCV-VG group （n=56） or PCV group （n=54），with 4 lost to follow-up. The perioperative pulmonary mechanics and arterial blood gas results were compared between the two groups. Postoperative extubation time， the incidences of postoperative pulmonary complications （PPCs） and abnormal radiographic changes （ARCs） were also recorded. Results During intraoperative pneumoperitoneum， the pulmonary dynamic compliance （Cdyn） was significantly lower in PCV-VG group than that in PCV group （T₂：P=0.022；T₃：P=0.039）. There were no significant differences in perioperative oxygenation index and respiratory peak pressure （Ppeak） between the two groups. Eighty-six patients （78.2%） had ARCs on the 1^st day after surgery， and 10 cases （9.1%） developed PPCs. There was no significant difference in extubation time， ARCs or PPCs between the two groups. After adjustment， anesthesia duration and oxygenation index before anesthesia induction were significantly associated with extubation time. Anesthesia duration of more than 2 hours was a risk factor for postoperative ARCs. Conclusion Compared with PCV-VG mode， PCV mode provides better pulmonary Cdyn during intraoperative pneumoperitoneum for patients undergoing laparoscopic bariatric surgery.

Objective To explore the factors leading to early admission for delivery among low-risk and full-term primiparas from both the perspectives of pregnant women and healthcare professionals， and to formulate targeted interventions for reference in ameliorating early admission trend among these primiparas. Methods Using purposeful sampling， we enrolled 11 medical staff members and 13 pregnant women from the Department of Obstetrics， Obstetrics and Gynecology Hospital， Fudan University for semi-structured in-depth interviews. Content analysis was utilized to organize and analyze the collected data. Results From the perspective of pregnant women， the reasons were categorized into personal and environmental factors. Personal factors included cognition related to delivery and variability in the perception of labor contraction pain. Environmental factors included the difficulty in verifying the authenticity of labor-related information on the internet， the transmission of anxiety among family members， the convenience of obtaining medical resources， the lack of clear medical advice， and limited access to auxiliary equipment resources. From the perspective of healthcare professionals， the reasons were categorized into three aspects： factors related to pregnant women， i.e.， anxiety about delivery and fear of unknown pain during delivery； factors related to medical staff， i.e.， differences in medical practice and the provision of excessive information with insufficient pertinence in education； and objective factors，i.e.， primiparas were incapable of utilizing objective criteria to discern the start of delivery， and the convenience of accessing medical resources. Conclusion Factors leading to early admission for delivery among low-risk and full-term primiparas are personal factors， environmental factors ， factors related to medical staff， and objective factors. To standardize the delivery admission timing， enhance prenatal health education， and develop outpatient support system will help assisting pregnant women in choosing an appropriate time for hospital admission.

Objective To survey the free influenza vaccination status and willingness among the elderly in Deqing County， Zhejiang Province， and analyze the influencing factors. Methods Based on population data and the electronic medical system of Deqing County， the influenza vaccine coverage from 2018 to 2022 after the implementation of the free influenza vaccination policy was calculated. A proportional stratified random sampling method was used to select elderly individuals aged 60 and above from six streets/towns in Deqing County. A questionnaire survey was conducted to assess influenza vaccination behaviors from 2020 to 2022 and vaccination willingness for the 2023 influenza season. The chi-square test and logistic regression were used to analyze potential factors associated with vaccination behavior and subsequent willingness among the elderly. Results An average of influenza vaccines for the elderly per year were 56.2 thousand， with influenza vaccination coverage rate of 46.16% in average over the five years. Among 729 subjects， the vaccination rate increased from 69.3% in 2020 to 75.3% in 2022， and 81.9% of them were willing to receive influenza vaccines in the next flu season. Logistic regression analysis revealed that individuals with agricultural household registration （OR=3.05， 95%CI：1.82-8.99）， lower education levels （OR=2.82， 95%CI：1.15-6.93）， awareness of the free vaccine policy （OR=4.65， 95%CI：1.82-11.91），and belief in vaccine efficacy （OR=6.61，95%CI：3.20-13.61） had higher vaccination rates. Factors associated with a more positive vaccination willingness included an annual household income of <150 thousand CNY （OR=1.65， 95%CI：1.04-2.60）， awareness of the free vaccine policy （OR=3.07， 95%CI：1.84-5.12）， perceived vaccine efficacy （OR=4.39， 95%CI：2.77-6.96）， and perceived vaccine safety （OR=1.57， 95%CI：1.01-2.43）. The main reasons for non-vaccination were concerned about the side effects of the vaccine （37.9%）， thoughts that they were in good health and did not need to be vaccinated （30.3%）， and influenza vaccines were ineffective （21.2%）. The main reasons for vaccination were to protect themselves （89.1%）， vaccination was free （65.5%） and to protect their families （60.6%）. Conclusion The elderly in Deqing County had a relatively high influenza vaccination rate and follow-up vaccination willingness rate， but there still existed a gap to reach at target rate recommended by WHO. The local government should strengthen health education related to influenza vaccine knowledge， and publicize free vaccination policy to improve the vaccination rate and willingness in next season.

Objective To analyse the clinical efficacy and safety of acupuncture combined with intermittent catheterisation in treating postoperative urinary retention after radical surgery for cervical cancer， and provide reference for the clinical treatment of postoperative urinary retention. Methods A retrospective analysis was conducted based on the clinical data of patients who underwent radical hysterectomy for cervical cancer at Obstetrics and Gynecology Hospital， Fudan University， from Sept 2019 to Dec 2021 and subsequently developed urinary retention. The patients were treated with a combination of acupuncture and intermittent catheterization. We observed residual urine volume， duration of acupuncture treatment， and urinary tract infection status to evaluate the effectiveness and safety of the acupuncture combined with intermittent catheterization regimen. We examined the relationship between treatment duration and various factors such as age， pathological type， surgical-pathological staging， surgical method， pre-treatment catheter indwelling time， pre-treatment residual urine volume， presence or absence of postoperative radiotherapy and chemotherapy， pre-existing urinary tract infection， and whether ureteral stenting was performed， in order to analyze the factors affecting the treatment duration. Results A total of 156 patients were reviewed. After treatment， 132 cases had a post-treatment residual urine volume <100 mL， 7 cases had a volume of 100-200 mL， and 15 cases had a volume >200 mL. Two cases still had great difficulty in urination after treatment， resulting in an overall effectiveness rate of 89.1%. No significant adverse events occurred in the patients. The treatment duration ranged from 2 to 17 days， with an average treatment time of 6.2 days. The treatment duration was a correlated with the preoperative indwelling catheter duration， residual urine volume and postoperative radiotherapy. Conclusion Acupuncture combined with intermittent catheterisation in treating urinary retention after radical surgery for cervical cancer has good efficacy， short treatment time and no obvious adverse effects， and can be an option for treating postoperative urinary retention.

Objective To organize and summarize the medication rules of GU Nai-fang in treating skin diseases through real-world data. Methods We collected traditional Chinese medicine prescriptions for GU Nai-fang’s treatment of skin diseases from the outpatient medical record system of Shanghai Traditional Chinese Medicine Hospital to establish a database. Statistical analysis of disease types， performance， and efficacy was conducted， and association rules and systematic clustering analysis were performed using SPSS Modeler 18.0 and SPSS 26.0 software， respectively. Results A total of 5 020 patients were included， and 5 020 prescriptions were collected， involving 241 traditional Chinese medicines with a total frequency of 85 758 uses. The frequency of using heat clearing drugs， deficiency tonifying drugs， blood activating and stasis removing drugs， surface clearing drugs， and wind and dampness dispelling drugs was relatively high； most drugs tended to be cold and warm， mainly targeting the heart， lungs， and colon meridians. The top 15 Chinese medicines with the highest frequency of use were Smilacis Glabrae Rhixoma， Cortex Moutan， Radix Paeoniae Rubra， Rehmanniae Radix， Scutellariae Radix， Cynanchi Paniculati Radix et Rhizoma， Schisandrae Chinensis Fructus， Violsse Herba， Mume Fructus， Herba Pyrolae， Hedyotis Diffusae Herba， Lonicerae Japonicae Flos， Cicadae Periostracum， Bombyx Batryticatus， Radix Salviae. Association rule analysis obtained 15 high-frequency combinations of 2 traditional Chinese medicines and 3 traditional Chinese medicines. Cluster analysis resulted in 7 clustered prescriptions. Conclusion GU Nai-fang commonly used heat clearing drugs， deficiency tonifying drugs， blood activating and stasis removing drugs， surface resolving drugs， and wind and dampness dispelling drugs in the treatment of skin diseases， and Smilacis Glabrae Rhixoma， Cortex Moutan， Radix Paeoniae Rubra， Rehmanniae Radix， and Scutellariae Radix were the most frequently used drugs.

Objective To establish a stable liquid chromatography-tandem mass spectrometry （LC-MS/MS） method for detecting gamma-aminobutyric acid （GABA） in plasma， and to evaluate the value of GABA detection in the diagnosis of sleep disorders. Methods GABA was detected using a UPLC Xevo TQs system. The method was pre-validated and its performance was verified to establish a reference range for healthy individuals. The difference in plasma GABA levels between apparently healthy individuals and patients with sleep disorders was compared. Results We employed deuterated compounds as isotopic internal standards and utilized an Amide chromatographic column for separation. The mobile phase was 0.050% formic acid in water and 90% acetonitrile in water containing 0.175% formic acid and 5 mmol/L ammonium acetate with gradient elution in the column temperature of 35 ℃. The linear range for the detection of GABA by LC-MS/MS was 0.05-10.00 μmol/L， with a lower limit of quantification of 0.02 μmol/L， the inter-day CV<3.00% and intra assay CV<4.00%， respectively， and the recovery rate was 101.06%-109.02%. The reference ranges for plasma GABA were established by analyzing 300 healthy controls stratified by age： 18-34 years （0.08-0.15 μmol/L）， 35-49 years （0.10-0.20 μmol/L）， and ≥50 years （0.12-0.23 μmol/L）. Then plasma GABA was used as a biomarker for auxiliary diagnosis of sleep disorders in analyzing 221 patients and 300 healthy controls， which revealed that AUC values were 0.510 （P=0.850）， 0.686 （P=0.002）， and 0.890 （P<0.001） in the groups of 18-34 years， 35-49 years， and ≥50 years， respectively， with optimal cut-off values of 0.09， 0.10 and 0.11 μmol/L. Conclusion A reliable LC-MS/MS method for detecting GABA has been established， which can detect plasma GABA levels sensitively and accurately and can be used in assisting the clinical diagnosis of sleep disorders.

Tumor-associated macrophages （TAMs） are one of the key components of the tumor microenvironment （TME） in gastric cancer. Glucose metabolism reprogramming significantly impacts TAMs’ polarization and immune functions， thereby regulating the onset and the progression of gastric cancer. This review summarizes glucose metabolism reprogramming in TAMs’ polarization and explores its role in gastric cancer-related TAMs through aspects such as signaling regulation， transcription factors， and epigenetic modifications. This review aims to deepen the understanding of TAMs’ role in gastric cancer progression and offer new perspectives for the immunotherapy in gastric cancer.

Tumor microenvironment （TME） is the foundation for tumor survival， which is composed of various types of cells， tumor blood vessels， secretory factors， and extracellular matrix （ECM） within the tumor. The unique regulatory mechanism triggered by the vigorous metabolic demand of tumor plays an important role in its tumorigenesis， metastasis， invasion， and treatment resistance. A deeper understanding of the metabolic transformation and tumor-immune cell interactions in the TME will enable the development of therapeutic technologies that precisely target TME metabolism， facilitate the development of combination treatment strategies， and improve the clinical response rate of existing immunotherapies. This paper reviews the composition， metabolism and regulatory mechanisms of TME， summarizes the research progress of immunotherapy strategies targeting the physiological characteristics of TME， and discusses the prospects for clinical application of precision immunotherapy strategies targeting TME， which are expected to enhance immunotherapy drugs response and infiltration degree.

The femoral vein is the primary venous trunk of the lower limbs and is commonly used for central venous catheterization in clinical practice. Traditional textbooks lack summarizes of the different types of anatomical variations of the femoral vein， making it more challenging for operators to perform punctures. Ultrasound-guided catheterization provides visualization， but there are still frequent instances of failed punctures and various complications. Operators usually use ultrasound equipment according to personal habits， but may not reach its full potential. This review summarizes recent researches on anatomical variations of the femoral vein and ultrasound-guided femoral vein catheterization， offering reference for medical professionals in clinical practice.

To effectively carry out community health education and prevention and control of chronic obstructive pulmonary disease （COPD）， we conducted a questionnaire survey on the awareness of COPD knowledge among residents aged 40 and above in Jiading District of Shanghai by using two-stage sampling method. We included 1 783 permanent residents in 4 districts and collected 1 666 valid questionnaires. The awareness rates of COPD name， pulmonary function test and related knowledge were 15.9%， 11.9% and 17.2%， respectively. For the main symptoms of COPD， the awareness rate of sputum was the lowest （65.2%）， of shortness of breath and dyspnea was the highest （78.4%）. For the risk factors， the awareness rate of severe respiratory tract infection in childhood was the lowest （67.3%）， of smoking was the highest （86.8%）. Multiple response analysis showed that mobile phones and computers accounted for the highest proportion of acquiring knowledge of COPD （66.7%）. Multivariate logistic regression analysis showed that low educational level， low monthly income， engaged in production and manufacturing， never or less exercise， no use of indoor air improvement measures， no wearing of masks in public places and no vaccination of influenza vaccine per year were associated with lower awareness rate of COPD. The community should improve the way and ability of health science popularization， and carry out health education for key groups.

We aimed to explore the value of personalized narrative intervention in the nursing care of elderly patients with stroke hemiplegia （SH）. A total of 68 elderly patients with SH were selected and divided into two groups using the ball-rolling method， with 34 cases in each group. The control group received routine nursing care， while the observation group received routine care and personalized narrative nursing. The nursing outcomes of the two groups were compared. Compared with the control group， the observation group had lower scores in anxiety and depression （P<0.05）， and higher scores in the Functional Evaluation of Cognitive State-Short Screening （FECS-SS） （P<0.05）. The rehabilitation effects of normal rate in the observation group was higher than that in the control group （P<0.05）. Personalized narrative nursing for SH patients can effectively relieve the patients’ negative emotions， enhance their compliance with rehabilitation， and improve the outcomes of rehabilitation.

Accessory cavitated uterine malformation （ACUM） is a rare unique congenital Müllerian duct malformation. Its main clinical manifestations are abdominal pain shortly after menarche and progressive aggravation， also may present as chronic periodic lower abdominal pain or abnormal uterine bleeding.Because it occurs rarely， it is easy to cause misdiagnosis or delay diagnosis.This paper reports the clinical manifestations， diagnosis and treatment of a young patient with ACUM， and reviews the literature to deepen the understanding of this rare genital tract malformation.

Primary aldosteronism （PA） is the most common cause of secondary hypertension， yet its diagnosis remains under-recognized， with a high rate of missed diagnoses. This condition significantly impacts multiple systems， including the cardiovascular， renal， metabolic， and skeletal systems， resulting in notable complications. Patients with Klinefelter syndrome （KS） exhibit a markedly higher prevalence of metabolic disorders， which may further exacerbate cardiovascular and endocrine dysfunction. Here we report a patient who presented with refractory hypertension and an incidentally discovered adrenal mass， and was ultimately diagnosed with a left adrenal aldosterone-producing adenoma combined with KS. We provide a detailed description of the patient’s clinical manifestations， biochemical indices， diagnostic process， and postoperative histopathological findings in order to enhance the understanding of PA and KS and their potential interconnections， which offers diagnostic insights to reduce misdiagnosis and missed diagnoses.

We reported the clinical， imaging， and treatment process of a patient with severe cranial penetrating injury caused by a nail from a nail gun that accidentally shot into the eye and penetrated into the skull while working. The patient was admitted to the Qingpu Branch of Zhongshan Hospital， Fudan University after being injured by the nail gun. The patient was admitted to the hospital 1 hour after injury with coma. After admission， the foreign body was completely removed and part of the hematoma was cleared through emergency surgery. After surgery， there were high-risk complications such as cerebral edema peak， intracranial hypertension， intracranial infection， cerebrospinal fluid leakage， and intracranial pseudoaneurysm. The patient eventually regained consciousness and was transferred to rehabilitation treatment.

With the widespread application of electronic health record （EHR） in medical researches， the problem of multi-source heterogeneity has increasingly become a key challenge affecting the validity of observational studies. Differences in data sources， formats， coding standards， and population coverage in different healthcare systems can easily lead to selection bias， information bias， confounding bias， and immortal time bias， thereby weakening the reliability of causal inference. This paper systematically analyzed the sources and characteristics of EHR heterogeneity， including data structure differences， coding inconsistencies， and population heterogeneity， discussed the mechanism of its role in various biases， and its impact on the research results based on empirical cases. Then integrated data standardization， multiple imputation， sample weighting， propensity score matching （especially high-dimensional propensity score hd-PSM）， instrumental variable analysis and DAG-assisted adjustment， and finally constructed a systematic framework for bias control and validation. A comprehensive framework that integrates standardized data processing processes， rigorous study design， advanced analytical control strategies， and objective validation methods is essential for deriving robust and credible scientific conclusions from EHR data.