Since the concept of artificial intelligence (AI) was proposed in 1956, medicine has been one of its core application fields. At present, AI technology has run through the whole diagnosis and treatment process, and has been extended to innovative scenarios such as drug research and development, surgical robots, and clinical trial optimization. Scenario application is the backbone of the technical system. Multimodal data fusion integrates heterogeneous data such as images, medical records, and genes, and federated learning realizes cross-institutional privacy protection and sharing. Deep learning achieved more than 90% sensitivity in imaging diagnosis for lung nodule detection, while generative AI accelerates drug molecule design. The core applications cover four major areas field: AI is more accurate than professional doctors in breast cancer and diabetic retinopathy screening; robotics shortens hospital stays and improves spinal screw placement accuracy; AI shortens the discovery cycle of drug targets; machine learning improves the efficiency of subject screening and enables real-time data monitoring. The application of AI in the medical field is first constrained by data quality and algorithm bias, and the "black box" characteristics of AI models and the ambiguity of responsibility attribution are the core obstacles to clinical implementation. This paper analyzes key technological breakthroughs and typical cases, discusses the application scenarios and challenges of AI in medicine, and aims to provide a reference for the future development of medical intelligence.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune neurological condition characterized by relapsing optic neuritis and longitudinally extensive transverse myelitis. Patients with NMOSD are prone to adverse pregnancy outcomes, intrapartum complications, high relapse rates, and significant disability following pregnancy. This paper analyzes a case of NMOSD experienced exacerbation of symptoms during pregnancy and childbirth, postpartum hemorrhage accompanied by coagulopathy, and ultimately successful resuscitation. We propose that active administration of corticosteroids and intravenous immunoglobulin during labor is an effective and feasible strategy for controlling the disease. Rapid replenishment of coagulation factors and timely correction of coagulation function are essential to prevent adverse outcomes. The paper summarizes the prenatal care and childbirth-related risks for such patients, and provides insights for the optimization of management protocols.

Systemic lupus erythematosus (SLE) complicated refractory immune thrombocytopenia (ITP) is mainly characterized by persistent severe thrombocytopenia and bleeding. Currently, there are no guidelines for treating such ITP. Hereby we reported a patient diagnosed with SLE with more than 10 years history of anemia and thrombocytopenia. This patient had been treated by variousimmunity inhibitors, such as corticosteroids, cyclosporine, mycophenolate mofetil, azathioprine, tofacitinib and telitacicept, but there was no obvious effect. The platelet count continued to be below 50×10⁹/L. However, when serum cyclosporine trough level between 100 and 150 ng/mL, the clinical efficacy was improved and the platelet count was above 100×10⁹/L. The patient was followed up for more than 6 months, and no recurrence of disease was found. Cyclosporine combined with low-dose glucocorticoid is safe and effective for SLE associated ITP. Therapeutic drug monitoring is a powerful tool for improving clinical efficacy and ensuring drug safety.

A 23-year-old pregnant woman, gravida 1, para 0. Single fetus at 34 weeks of gestation, a high-risk ultrasound consultation revealed a cystic-solid mass was found in the lower part of the tongue body, multiple segregations were seen inside, and the mass moved in synchronization with the swallowing movement of the fetal tongue, and was poorly demarcated from the body of the tongue, streaks of colorful blood were seen around the periphery, and the tip of the tongue was located outside of the oral cavity, which was considered to be hemangioma or lymphangioma of the tongue. MRI at 36 weeks of gestation showed a T2WI high-signal mass in the lower part of the fetal tongue, which was considered to be hemangioma or teratoma. The neonate was referred to the Children's Hospital, Fudan University 3 days after birth for cystic fluid extraction and sclerotherapy, which confirmed a lingual lymphangioma. This article focuses on the imaging manifestations and neonatal treatment of fetal tongue lymphangiomas in order to increase clinicians' understanding of lingual lymphangiomas.

Ovarian clear cell carcinoma (OCCC) typically exhibited high-grade atypia and aggressive chemotherapy resistance, leading to poor prognosis, necessitating continuous exploration of novel therapeutic approaches to enhance patient survival and quality of life. In recent years, with the in-depth study of the biological behavior and molecular characteristics of OCCC, unique molecular features of OCCC were discovered, making it a potential molecular target for personalized biotherapy, with the prospect of improving treatment efficacy and patient prognosis. An increasing number of clinical trials focused on exploring the driver mutations and molecular characteristics of recurrent OCCC in the hope of finding more precise and effective treatment modalities. This article provided a comprehensive review of the molecular characteristics of OCCC and advances in drug therapy.

Mitochondria are one of the most important organelles in cellular metabolism, and their genomes are prone to mutations and lack damage repair mechanisms. Mitochondrial DNA (mtDNA) mutations and copy number variations play important roles in the occurrence and development of tumors. In recent years, research has found that mtDNA mutations and copy number variations exist in various tumor diseases, and the detection of mtDNA in tumor tissues, especially cell-free mitochondrial DNA in patient fluids, may also serve as important means to indicate tumor diseases. This article aims to summarize and to review the correlation between mitochondrial genome mutations and copy number variations with tumor diseases and their diagnosis, as well as the research progress as tumor biomarkers, in order to provide reference for the clinical diagnosis of tumor diseases.

Objective: To investigate the effects of ischemia time and storage periods on RNA quality in fresh-frozen breast cancer (BC) and esophageal cancer (EC) tissue samples in order to establish evidence-based protocols for biobank sample management. Methods: The tumor (T) and paired normal (N) tissue samples from 6 cases of BC and 6 cases of EC were collected and cryopreserved in Biobank, Shantou Central Hospital. Mirror paraffin-embedded tissues were simultaneously prepared into sections for morphological analysis. The samples were divided into two groups of < 15 min and 15-30 min according to ischemia time, and RNA quality was analyzed at 4 storage periods of 8-10 months (T₁), 14-16 months (T₂), 26-28 months (T₃) and 38-40 months (T₄). Results: In 96 analyzed samples, 93.8% (90/96) exhibited high quality (RIN≥6), with 89.6% (43/48) in BC and 97.9% (47/48) in EC. Significant differences in RIN were observed between BC group and EC group (8.050 vs. 8.600, P=0.009). In EC group, RIN value was significantly negatively correlated with RNA yield (P < 0.001). Moreover, RIN values of tumor-normal pairs exhibited markedly significant differences (7.550 vs. 9.000, P < 0.001). In contrast, no significant difference was detected in BC group (8.200 vs. 7.700, P=0.348). Statistical analysis showed that RIN value was positively correlated with 28S/18S (P < 0.001), but had no correlation with tumor content (P=0.676) and necrotic content (P=0.055). Neither ischemia time (< 15 min vs. 15-30 min: 8.200 vs. 8.300, P=0.932) nor storage periods (T₁-T₄: 8.400, 7.700, 8.450, 8.600, P=0.163) compromised RNA quality. Conclusion: Organ origin and tissue type could influence RNA quality of fresh-frozen tissue samples. However, limited ischemia time (≤30 min) and long-term storage period (38-40 months) do not adversely affect RNA quality in fresh-frozen breast cancer and esophageal cancer tissue samples.

Objective: To investigate the impact of different cell digestion methods on the binding of a humanized monoclonal antibody targeting CD3L1 (designated as 5H) to tumor cells. Methods: Trypsin solution and a collagenase/neutral protease cocktail, combined with two digestion temperatures (room temperature and 37℃), were used to dissociate, passage, and collect various adherent tumor cell lines. Flow cytometry and confocal microscopy were then employed to compare differences in 5H antibody binding under different cell digestion conditions. Results: Cells dissociated and passaged with trypsin solution at room temperature exhibited only weak binding to the 5H antibody, whereas those treated with the collagenase/neutral protease cocktail at room temperature showed significantly stronger binding. There were notable differences in the binding signal and the proportion of antibody-stained positive cells between the two groups (P < 0.01). Additionally, cells treated with the collagenase/neutral protease cocktail exhibited antibody binding signals that were dependent on the concentration of the 5H antibody, enabling receptor occupancy analysis. Compared to digestion at room temperature, treatment at 37℃ resulted in a slight reduction in the binding of target cells to the 5H antibody, however, this difference was not statistically significant. Conclusion: Trypsin digestion significantly reduces the binding of the anti-CD3L1 antibody to tumor cells, whereas the collagenase/neutral protease cocktail effectively preserves it. With an appropriate choice of digestion enzymes, the impact of digestion temperature is relatively minor. These findings suggest that optimized cell digestion protocols should be employed when studying interactions between antibody drugs and cell surface antigens.

Objective: To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury (MINS) in non-cardiac surgery patients admitted to the intensive care unit (ICU). Methods: A total of 478 postoperative patients admitted to the Department of Intensive Medicine, Minhang Hospital, Fudan University from Jan 2020 to Dec 2023 were selected. They were divided into MINS group (n=302) and normal group (n=176) based on whether myocardial injury occurred within 7 days after surgery. The differences in clinical characteristics between the two groups were compared, and risk factors for perioperative myocardial injury were identified. Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint. Results: The prevalence of acute physiology and chronic health evaluation Ⅱ (Apache Ⅱ) score, coronary artery disease, and chronic kidney disease were all higher in the MINS group than those in the normal group, with statistically significant differences (P < 0.05). The proportion of emergency surgeries, co-infection, and perioperative hypotension were significantly different between the MINS group and the normal group (P < 0.05). Multivariate logistic regression analysis revealed that chronic kidney disease, emergency surgery, co-infection, and intraoperative and postoperative hypotension were risk factors for MINS occurrence. Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients. Conclusion: MINS is closely associated with patients' underlying conditions, timing of surgery, and perioperative hypotension status, and especially perioperative hypotension affects the final outcomes.

Objective: To develop an objective and precise prognostic model for assessing severity and prognosis in elderly patients with community-acquired pneumonia (CAP) admitted to the emergency department. Methods: A retrospective analysis was conducted on elderly patients with CAP admitted to Department of Emergency, Minhang Hospital, Fudan University between Jun 2018 and Dec 2020. With the primary outcome being the 30-day in-hospital mortality rate of elderly CAP patients, four systemic inflammatory response markers, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were evaluated using univariate and multivariate Logistic regression analyses. The predictive performance of different scoring systems was compared. Results: A total of 421 elderly CAP cases were enrolled. The results of the multivariate Logistic regression analysis demonstrated that NLR was an independent risk factor for elderly inpatients with CAP. We combined NLR with the existing CURB-65 score for joint optimization to construct a scoring system or a clinical prognosis model, by quantifying and assigning optimal cut-off value of 11.4 for NLR, and established the NLR+CURB-65 score. The ROC curve was constructed to compare the areas under the curve of the three different scoring systems (NLR, CURB-65, and NLR+CURB-65). The area under the curve of the NLR+CURB-65 score was significantly higher than that of the CURB-65 score. Based on the optimal cut-off value of 3 for NLR+CURB-65 score, the patients were stratified into high-risk group (n=188) and low-risk group (n=233). The K-M survival curve was utilized and indicated that compared with high-risk group, low-risk group had a lower mortality rate and a higher discharge rate. Conclusion: For elderly emergency hospitalized patients with CAP, the combination of NLR and CURB-65 score showed high predictive value for assessing disease severity and prognosis.

Objective: To investigate the clinical characteristics of women with abnormal uterine bleeding (AUB) in sub-plateau regions and analyze the factors affecting their treatment methods. Methods: AUB patients who were hospitalized from Jan 1, 2018 to Dec 31, 2022, in a sub-plateau region (Yongping County People's Hospital of Yunnan Province)with an average altitude of 1 620 meters were selected. The general clinical characteristics of the patients were summarized, and patients were classified into two categories (with or without uterine structural lesion) and nine subtypes (PALM-COEIN) according to the FIGO recommended etiological classification guidelines. Then the patients were divided into groups based on the presence or absence of uterine structural lesions, ethnic group (Han and minority), conservative drug treatment and surgical treatment groups, blood transfusion and non-blood transfusion groups. Binary Logistic regression analysis was used to identify factors affecting treatment methods. Results: A total of 481 AUB patients enrolled, and the delayed consultation rate was as high as 80.46%, and the proportion of overweight and obese patients was 49.90%, which was higher than the average level among Chinese women. The main cause was AUB-O (AUB-ovulatory dysfunction), accounting for 78.59% of cases, the proportion of patients with delayed medical treatment was higher than those without delayed medical treatment (82.17% vs. 74.47%). Patients who received blood transfusion were significantly younger, had lower hemoglobin (HGB) levels, fewer pregnancies, and lower BMI compared to those in the non-blood transfusion group (P < 0.05). Univariate analysis showed that the surgical treatment group had older age, longer onset time, higher HGB levels, more pregnancies and deliveries, higher BMI, a higher proportion of Han ethnicity patients, lower rates of non-blood transfusion, higher rates of hypertension, and more uterine structural lesions compared to the conservative drug treatment group. Multivariate regression analysis revealed that blood transfusion treatment reduced the probability of surgical treatment. Age and uterine structural lesions were risk factors for requiring surgical treatment, for each additional year of age, the risk of undergoing surgical treatment increased by 10%. The risk of requiring surgical treatment for patients with uterine structural lesions was 2.987 times higher than for those without. Conclusion: AUB patients in this sub-plateau regions have a high rate of delayed consultation and a high proportion of overweight and obesity, with AUB-O being the primary cause. Older age and the presence of uterine structural lesions were risk factors for requiring surgical treatment.

Objective: To analyze the applicability of Berg Balance Scale (BBS) in the balance assessment of Parkinson's disease (PD) patients with balancing instrument test as the standard, so as to formulate targeted intervention programs accordingly. Methods: A total of 186 patients with PD admitted to Department of Neurology and Department of Rehabilitation Medicine, Huashan Hospital, Fudan University from Jan 2020 to Sep 2022 were selected as the research objects. The static balance function of the patients was evaluated by balancing instrument. The balance function parameters were analyzed according to BBS and levodopa equivalent dose. Results: The drug dose did not affect the score of balance instrument. There was a good correlation between BBS and balance instrument. The higher the scale score, the lower the balance instrument score (r=-0.333, P < 0.001). There was a positive correlation between levodopa equivalent dose and item 11 of BBS in subjects with BBS total score of 21-40 (r=0.715, P=0.046). There was a significant negative correlation between levodopa equivalent dose and item 6 of BBS in subjects with BBS total score of 51-56 (r=-0.300, P=0.001). The number of people who lost the most points in BBS from large to small was item 14 of standing on one leg (134 cases), item 13 of standing without support with one foot in front (122 cases), item 11 of turning 360 degrees (75 cases), item 8 of reaching forward with outstretched arms (70 cases), and item 12 of placing one feet alternately on a step or a stool (56 cases). Conclusion: In the absence of balancing instrument, BBS has good clinical applicability in the evaluation of PD patients, and some items can be focused on according to the lost points.

Objective: To investigate the ameliorative effects and mechanisms of six types of tea (green tea, cyan tea, red tea, white tea, black tea and yellow tea) on metabolic disorders in obesity mice induced by high-fat diet (HFD). Methods: Four-week-old male C57BL/6J mice were randomly divided into 8 groups with 7 mice per group. An HFD-induced obese mouse model was established, and the mice in control group maintained on standard diet followed by intragastric administration of different teas for 5 weeks. The body weight, liver weight ratio, fasting blood glucose, and lipid profile of the mice were measured to assess glucose and lipid metabolism. Serum inflammatory factors including IL-6, tumor necrosis factor-alpha (TNF-α) and oxidative stress markers [malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Additionally, liver histopathology and the expression of key glycolipid metabolism-related genes, adenosine monophosphate-activated protein kinase (AMPK) and carnitine palmitoyltransferase 1 (CPT-1), were analyzed to explore underlying mechanisms. Results: Cyan tea significantly suppressed weight gain, demonstrating superior weight control. White tea markedly reduced fasting blood glucose levels and decreased the area under the curve of oral glucose tolerance test (OGTT) and insulin tolerance test (ITT), indicating synergistic improvements in glucose metabolism and insulin sensitivity. Yellow tea exhibited exceptional anti-inflammatory and antioxidant effects, reducing hepatic IL-6 and MDA while enhancing SOD activity. Green tea activated the lipid oxidation pathway by upregulating AMPK/CPT-1 expression. All kinds of tea significantly attenuated hepatic lipid droplet accumulation. Conclusion: All six types of tea alleviated metabolic disorders by reducing hepatic fat content in obesity mice. However, different types of tea exert their unique effects on improving metabolic disorders through differential mechanisms such as glucose metabolism regulation, lipid oxidation, and anti-inflammatory and antioxidant actions.

Objective: To evaluate the consumption of opioid and postoperative analgesia of intercostal nerve block (ICNB) and paravertebral block (PVB) for autologuous rib cartilage graft for auricular reconstruction in children with microtia. Methods: A total of 120 patients scheduled for autologuous rib cartilage graft for auricular reconstruction were enrolled. According to randomized blocks, patients were allocated into three groups (n=40 in each group): general anesthesia group (GA group), ultrasound-guided intercostal nerve block group (ICNB group) and ultrasound-guided PVB group (PVB group). GA group only received general anesthesia, while ICNB group and PVB group received single-shot nerve block with lidocaine after induction of general anesthesia. All groups were received patient-controlled intravenous analgesia (PCIA) for 48 hours postoperatively. Intraoperative opioid requirement was recorded. Heart rate (HR) and mean arterial pressure (MAP) were recorded at different time points during surgery. Time of the first visual analogue scale (VAS) obtained and duration of postanesthesia care unit (PACU) stay were evaluated. The VAS scores of chest and ear during deep breath and at rest were recorded during 48 hours postoperatively. Opioid consumption and postoperative analgesia-related adverse events were compared among the three groups during 48 hours after surgery. Results: Compared with those in GA group, intraoperative fentanyl consumption(P=0.02, P < 0.01), time of the first VAS obtained (P < 0.01, P=0.02), duration of PACU stay (P < 0.01, P < 0.01) and HR when harvesting the first rib cartilage (P=0.04, P < 0.01) were statistically lower in ICNB group and PVB group than those in GA group, but no statistical difference was found between these two groups. There were no statistical differences in VAS scores, opioid consumption and analgesia-related adverse events among the three groups. Conclusion: Ultrasound-guided single-shot ICNB and PVB with lidocaine provide similar efficacy of reducing intraoperative opioid consumption, maintaining intraoperative hemodynamic stability and faster awakening, but fail to alleviate postoperative pain.

Objective: To investigate the longitudinal clinical manifestations of acute radiation dermatitis (ARD) induced by particle therapy in nasopharyngeal carcinoma patients and to analyze associated risk factors. Methods: A longitudinal study design was employed, encompassing nasopharyngeal carcinoma patients who underwent particle therapy at the Shanghai Proton and Heavy Ion Center from Mar to Sept 2023. Participants were assessed weekly (1-12 weeks) following the commencement of radiotherapy and at baseline, prior to the start of treatment. Data collection included the patient demographic questionnaire, the Radiation Therapy Oncology Group (RTOG) grading criteria for acute radiation injury, and the radiation-induced skin reaction assessment scale (RISRAS). Photographic documentation was utilized to capture changes in the irradiated skin area. The enrolled patients with nasopharyngeal carcinoma were grouped according to different particle therapy regimens. Survival data were analyzed by Log-rank and Cox regression methods, while a linear mixed-effects model was applied to repeated measures data. Results: A total of 119 patients with nasopharyngeal carcinoma were enrolled. The overall incidence of ARD was 89.1%, which included 39.5% of grade 1, 45.4% of grade 2 and 4.2% of grade 3. With the extension of time, the severity of ARD peaked at week 7 (RISRAS=13.26±4.512), then began to decrease, ultimately reaching a lower level. Multiple Cox proportional hazards models were constructed, revealing that proton/heavy ion radiotherapy was associated with a lower risk of ARD compared to photon/proton plus heavy ion radiotherapy (HR=0.19, 95%CI: 0.04-0.92, P=0.039). Additionally, concurrent cisplatin/nedaplatin chemotherapy was identified as a risk factor for the development of ARD. Least squares (LS) mean differences were calculated at different time points, and the results demonstrated that the RISRAS scores of the photon/proton plus heavy ion group were consistently and significantly higher from week 5 to week 7 compared with the proton plus heavy ion group, and despite a decrease by week 8, statistical differences remained (week 5: LS mean difference 3.35, 95%CI: 0.94-5.76, P=0.007; week 6: LS mean difference 5.23, 95%CI: 2.20-8.26, P=0.001; week 7: LS mean difference 7.13, 95%CI: 3.67-10.59, P<0.001; week 8: LS mean difference 4.04, 95%CI: 0.74-7.34, P=0.017). Patients undergoing concurrent cisplatin chemotherapy had higher RISRAS scores from week 7 to week 8 of radiotherapy compared with those not receiving chemotherapy [week 7: adjusted mean difference (Adj.MD) 4.20, 95%CI: 1.96-6.57, P=0.006; week 8: Adj.MD 2.79, 95%CI 0.55-5.03, P=0.015]. Similarly, patients on concurrent nedaplatin chemotherapy had higher RISRAS scores from weeks 6 to 7 compared with those not on chemotherapy (week 6: Adj.MD 3.75, 95%CI: 1.54-5.96, P=0.001; week 7: Adj.MD 4.41, 95%CI: 2.12-6.70, P<0.001). Skin care measures during treatment and accompanying symptoms such as weight loss were not statistically associated with the development of ARD. Conclusion: Proton/heavy ion radiotherapy has a lower risk of ARD, while concurrent cisplatin/nedaplatin chemotherapy is a risk factor for ARD.

With the important trend of body shape in whole lifecycle management of breast cancer patients and the emergence of new evidence-based medical and nursing data, it is necessary to sort out and update the body shape management of breast cancer patients. Experts of Breast Cancer Integrated Nursing Professional Committee of Chinese Anti-Cancer Association, Breast Cancer Case Manager Branch of Chinese Medical Education Association and Breast Cancer Professional Committee of Chinese Anti-Cancer Association convened domestic experts in the field of breast cancer nursing, including breast surgery, medical oncology, radiotherapy, nursing management and other nursing fields, who jointly discussed and formulated the "expert consensus on body shape management of breast cancer patients". The consensus has elaborated on the management of surgery-related body, comprehensive treatment-related body and other related body management, hoping to provide homogenized suggestions for personnel in various breast specialties to carry out body shape management of patients, and improve the standardization of care.

Objective: To investigate the clinical characteristics of preoperative intestinal symptoms in patients with bowel endometriosis and to compare the effects of shaving versus segmental bowel resection on postoperative intestinal function. Methods: A total of 105 patients diagnosed with bowel endometriosis and treated by the same surgical team at the Obstetrics and Gynecology Hospital, Fudan University between Aug 1, 2013 and Dec 30, 2017 were prospectively enrolled in this study. Clinical data were collected via outpatient visits and telephone follow-ups at four time points: preoperative (T0) and postoperative (T1: Nov 2018; T2: Nov 2020; T3: Apr 2024). The primary outcome was bowel symptoms and gastrointestinal function scores; secondary outcome was pain scores. A generalized estimating equation (GEE) model was used to analyze the interaction effect of surgical approach and follow-up time on outcomes. Results: Ultimately, a total of 89 patients were included (15.24% loss to follow-up), among whom 79 patients (88.76%) underwent shaving excision. Preoperatively, 46 patients (51.68%) presented with bowel symptoms, primarily anus bulge (21 cases, 46.65%) and diarrhea (15 cases, 32.61%) during menstruation. Postoperatively, there was a significant increase in constipation rates (T1:71.43%;T2:50.00%;T3:72.00%). Both surgical groups exhibited significant improvements in dysmenorrhea, gastrointestinal discomfort scores as well as gastrointestinal quality of life index (P<0.000 5). However, the segmental resection group had significantly higher scores for low anterior resection syndrome, constipation compared with the shaving excision group(P=0.02 and P=0.05). Conclusion: Approximately half of the patients with bowel endometriosis exhibit typical bowel symptoms preoperatively, such as anus bulge and diarrhea. Both shaving excision and segmental resection effectively alleviate pain; however, shaving excision demonstrates an advantage regarding preservation of bowel function, whereas segmental resection may elevate risks associated with postoperative constipation or altered defecation patterns due to structural changes. The selection of surgical approach should carefully balance lesion removal and functional preservation, moreover, be sure that potential risks are thoroughly informed to patients prior to surgery.

Objective: To investigate the effect of rapid maxillary expansion (RME) on sagittal soft and hard maxillofacial tissue in growing children. Methods: In this retrospective study, children aged 6-12 years treated in Shanghai Stomatology Hospital from Jan 2018 to Dec 2020 were employed as subjects. Of the subjects, 40 patients treated with RME were as the experimental group, 27 patients presenting individualized malocclusion were as the control group. Lateral cephalogram was taken before (T0) and 2 years after treatment (T1). The images were imported into Dolphin Imaging's cephalometric measurement software, and the results were statistically analyzed using SPSS 22.0 software. Results: Statistically significant differences were observed in all measurements before and after treatment in both two groups. A comparative analysis revealed that SNB value increased and ANB value decreased in the experimental group after treatment, while the changes in the control group were significantly smaller than those in the experimental group (P<0.05), indicating that RME is beneficial to the growth and development of mandibular in sagittal direction. Among the dentoalveolar measurements, statistically significant differences (P<0.01) were observed in U1-SN (upper incisor to sella-nasion angle), U1-NA (upper incisor to nasion-A point angle), U1-APog (upper incisor to A point-pogonion line distance), and overjet between the two groups. These findings indicate that RME significantly reduces the inclination of the maxillary central incisors, while having no significant effect on the mandibular central incisors. Compared with the control group, RME significantly reduced upper lip prominence, lip space and upper central incisor exposure (P<0.05), but had no effect on nose, chin and their correlation. Conclusion: RME not only improved the prominence of the upper teeth and upper lip, but also facilitate the sagittal growth of mandibular in growing children.

Objective: To explore the effects of dodecanoylcarnitine (DA) and myristoleic acid (MA) on the function of mouse alveolar epithelial cell line MLE-12 and their underlying mechanisms. Methods: An inflammatory model was established by stimulating MLE-12 cells with IL-4. The expression levels of DA, MA, and sphingosine-1-phosphate (S1P) in the cell supernatant were detected by ELISA. MLE-12 cells were separately intervened with DA and MA. RT-PCR and flow cytometry were used to detect the expression changes of inflammatory factors IL-6 and tumor necrosis factor-α (TNF-α) and the level of intracellular reactive oxygen species (ROS). Additionally, Western blot was performed to detect the expression of key proteins such as p38 mitogen-activated protein kinase (p-38 MAPK) and src homology 2 domain-containing phosphatase 1 (SHP-1). To explore the role of S1PR2 in the effects of DA and MA, MLE-12 cells were pretreated with the S1PR2 inhibitor JTE-013, and the above experiments were repeated. Results: IL-4 stimulation significantly upregulated the levels of DA, MA, and S1P in MLE-12 cells (P<0.05). DA/MA treatment groups exhibited significantly increased expression of IL-6 and TNF-α compared with the control group (P<0.05), along with elevated ROS levels (P<0.05). Western blot analysis revealed that DA/MA promoted SHP-1 dephosphorylation and phosphorylated p38 MAPK activation in MLE-12 cells. Notably, JTE-013 pre-treatment completely reversed these effects (P<0.05). Conclusion: Asthma-related metabolites DA and MA exacerbate the inflammatory and oxidative stress responses of MLE-12 cells by activating the S1PR2 receptor, promoting the dephosphorylation of SHP-1 and the activation of the p-p38 MAPK pathway. This study reveals the core regulatory role of S1PR2 in this pathway as well.

Objective: To assess the dietary quality of preschool children and explore the relationship between feeding practices and dietary quality. Methods: Relying on the Shanghai Maternal-Child Pairs Cohort, 3 177 preschool children were selected as the subjects for this study, and questionnaire were surveyed on their dietary intake and feeding practice. The diet balance index was used to evaluate dietary quality among preschool children. High bound score (HBS), the low bound score (LBS), and the dietary quality distance (DQD) were calculated to respectively reflect overall dietary overconsumption, insufficiency, and imbalance. Logistic regression was utilized to analyze the association between feeding practice and dietary quality in preschool children. Results: The HBS, LBS, and DQD of the subjects were 2 (0, 8), 22.19±10.80, and 26.78±9.57, respectively. Only 7.68% of the children had a balanced dietary intake, with 74.73% and 33.99% of overall dietary intake being inadequate and excessive, respectively. Parental perceived weight were negatively associated with the risk of moderate to high over intake among children (aOR=0.79, 95%CI: 0.63-0.98). The higher the perceived responsibility (aOR=1.19, 95%CI: 1.03-1.37) score, the lower the monitoring score (aOR=0.83, 95%CI: 0.74-0.93), and the higher the likelihood that the child had a moderate to high under intake. The scores of pressure to eat were also positively correlated with the risks of under intake and moderate to high overall unbalance in preschool children (aOR=1.15-1.39, 95%CI: 1.02-1.63). Conclusion: Preschool children commonly experience dietary imbalance, with inadequate and excessive intake coexisting. Parental perceived weight and monitoring were positively associated with preschoolers' dietary quality, whereas perceived responsibility and pressure to eat were negatively associated with it.

Objective: To investigate the correlation between serum uric acid (SUA) levels and incident chronic kidney disease (CKD) in middle-aged and elderly Chinese population and gender differences. Methods: Based on the longitudinal survey data of China Health and Retirement Longitudinal Study from 2011 to 2015, the CKD-Epidemiology Collaboration cystatin C formula was used to estimate the glomerular filtration rate (eGFR), and 4 119 participants with normal renal function (eGFR≥60 mL·min^-1·1.72 m^-2) at baseline were included. Incident CKD was defined as eGFR<60 mL·min^-1·1.72 m^-2 at the follow-up in 2015. Logistic regression analysis was used to analysis the association of SUA levels at baseline and incident CKD among different genders. Restricted cubic spline analysis was used to analyze the dose-response relationship. Results: After 4-year follow-up, 127 participants developed incident CKD, including 57 males and 70 females. Multivariate Logistic regression analysis showed that elevated SUA levels were independently associated with the risk of incident CKD (OR=1.532, P<0.001). For each 1 mg/dL increase in SUA, the risk of incident CKD increased by 33.6% in males (OR=1.336, P=0.012) and 77.5% in females (OR=1.755, P<0.001). Restricted cubic spline analysis showed a linear positive correlation between SUA levels and incident CKD in both males and females. Participants were divided into four groups according to SUA quartiles (Q1-Q4). Multivariate Logistic regression analysis indicated a significant increase in the risk of incident CKD in Q3 group (3.75 mg/dL<SUA≤4.43 mg/dL) and Q4 group (SUA>4.43 mg/dL) compared with Q1 group in females (Q3 group: OR=2.571, P=0.045;Q4 group: OR=3.666, P=0.005). Conclusion: SUA is an independent risk factor for incident CKD in the middle-aged and elderly population. In females, serum uric acid levels exceeding 3.75 mg/dL are associated with an increased risk of incident CKD.

During sudden outbreaks of major infectious diseases, traditional vaccine clinical trials often fail to deliver timely and meaningful outcomes. To address this, innovative trial designs are essential to accelerate or restructure the traditional three-phase clinical trial process while maintaining adherence to scientific principles of drug candidate safety and efficacy. This paper presents various innovative vaccine clinical trial designs and concepts, along with critical considerations for their application, to serve as a methodological reference for related research. Adaptive designs provide flexibility by dynamically adjusting trial parameters—such as dose selection, population stratification, and sample size reestimation—based on interim analysis results. Bayesian designs incorporate historical data and prior information, reducing sample size requirements. Master protocol designs enable the evaluation of multiple treatments or target populations within a unified framework, significantly improving efficiency. Additionally, real-world data (RWD), including electronic health records vaccination records and insurance claims, supports the creation of virtual control groups, addressing ethical concerns while enhancing trial feasibility. A hybrid design combining randomized controlled trials (RCTs) with RWD is also proposed to leverage the strengths of both methodologies. These innovative designs optimize the research process, accelerating vaccine development and regulatory approval. By integrating these approaches, robust evidence-based insights can be generated, advancing precision medicine goals and strengthening public health responses to emerging infectious diseases.

TAFRO syndrome is a systemic inflammatory disease with unknown etiology. It has low incidence rate and progresses rapidly, which poses a significant challenge for clinicians to make a timely diagnosis and provide reasonable treatment. This article retrospectively analyzed a 65-year-old male patient with iMCD-TAFRO admitted to Minhang Hospital, Fudan University, and visited the Department of Nephrology due to bilateral lower limb edema. The patient exhibited systemic edema, fever, and multiple enlarged lymph nodes. A comprehensive examination showed thrombocytopenia, renal dysfunction, elevated CRP levels, multiple serosal fluid accumulations, and bone marrow reticulin fibrosis. For further diagnosis and treatment, he visited the Hematology Clinic of Zhongshan Hospital, Fudan University. Based on the clinical manifestations, the diagnosis of TAFRO syndrome was considered. After further lymph node pathological consultation, the diagnosis was confirmed as idiopathic multicentric Castleman disease (iMCD)-TAFRO syndrome. Later, the patient was transferred to the hematology department of Minhang Hospital, Fudan University. After 15 days of treatment with methylprednisolone, cyclosporine A, rituximab, and thrombopoietin, there was no significant improvement in the condition. Due to personal reasons, the patient discontinued further treatment and passed away 2 weeks later.

Hypokalemia, a common clinical electrolyte disorder, can affect multiple systems and can be life-threatening in severe cases. Identifying the cause of hypokalemia is crucial for its prevention and treatment. However, the etiology of hypokalemia is complex and often requires detailed differential diagnosis. This article reports a rare clinical case of hypokalemia caused by long-term excessive consumption of strong tea and discusses its pathogenesis. The aim is to raise clinical awareness and understanding of the etiology of such cases of hypokalemia and reduce misdiagnosis and missed diagnosis.

To explore the understanding of the target population regarding the Get Active Questionnaire for Pregnancy (GAQ-P) and the Companion Health Care Provider Consultation Form for Prenatal Physical Activity (cHCP-CF-PPA) in the Chinese context, and to verify the consistency of the Chinese version of the prenatal physical activity dual screening questionnaire with the original version in terms of language expression, 27 pregnant women and 12 healthcare providers were selected from Obstetrics and Gynecology Hospital, Fudan University during Aug and Oct 2023, and were interviewed using purposive sampling. Two rounds of cognitive interviews were conducted. The first round revealed that some respondents experienced ambiguities in understanding the meanings of 5 items in the questionnaire. Following modifications, the second round indicated that the revised items were consistent in meaning with the original questionnaire. Cognitive interviews can facilitate the adaptation of the prenatal physical activity dual screening questionnaire to the Chinese cultural context, improve the understanding of the questionnaire items among the target population, and promote the localization of the screening tool.

Abnormal lipid metabolism and renal ectopic lipid accumulation have been associated with the occurrence and development of kidney diseases, particularly in diabetic nephropathy. However, the drugs commonly used in clinic to treat hypercholesterolemia, such as statins, ezetimibe and proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors, can effectively reduce the blood lipid level, but fail to delay the progress of kidney disease. In recent years, an increasing number of research studies have focused on the impact of free fat acids (FFA) metabolism on kidney function. The profiles and metabolism of fatty acids are altered in chronic kidney disease (CKD), and deregulated fatty acid metabolism contributes to further kidney damage. Furthermore, the role of FFA transporter in the progression of kidney diseases is gradually recognized. Therefore, this review summarizes the recent preclinical researches of fatty acid transporter fatty acid transport protein 2 (FATP2) expressed in proximal renal tubular epithelial cells.

Microphthalmos is a congenital ocular developmental anomaly that manifests as a significant reduction in the size of eyes, and is often combined with various ocular disorders such as cataract. Due to its special intraocular anatomical features, the risk of intraoperative and postoperative complications of cataract surgery in microphthalmos is usually high. Combined with subscleral sclerectomy, peripheral iridectomy, and anterior segment vitrectomy, the incidence of the pre-existing complications in cataract surgery has decreased, meanwhile, the additional procedures may also bring new complications. In-depth understanding of the research progress of cataract surgery in microphthalmos and the prevention of complications is of great guiding significance to improve surgical outcomes, and can reduce the incidence of postoperative complications such as uveal effusion syndrome, secondary glaucoma and corneal edema, and promote personalized treatments for microphthalmos patients who suffered from cataract.

Objective: To develop a simple method for producing mice adipose stem cells with highly efficient adipogenic differentiation capability. Methods: Subcutaneous adipose tissue was extracted from wild-type mice. By strictly controlling the digestion time of collagenase, we compared the number of adipose stem cells and their adipogenic differentiation ability obtained for different digestion times. Further, flow cytometry was used to clarify the differences in mesenchymal cells and vascular components at different digestion times. Results: The adipose stem cells obtained after 40 minutes of digestion by collagenase exhibited over 90% adipogenic differentiation ability in vitro, while those obtained after 60 minutes of digestion only showed 20% adipogenic differentiation ability. The main reason for this discrepancy was the presence of a portion of vascular-related cells in the latter. Conclusion: By controlling the digestion time of collagenase in adipose tissue, we have established an efficient method for preparing adipose stem cells with high adipogenic differentiation potential. The obtained adipose stem cells exhibit over 90% adipogenic differentiation ability in vitro.

Objective: To investigate the characteristics of a novel FANCL mutation identified in a patient with premature ovarian insufficiency (POI) and to explore its potential functional impacts in vitro. Methods: A novel FANCL heterozygous mutation c.1033G > A (p.Glu345Lys) was screened in a patient with POI using whole exome sequencing (WES), which was found to be inherited from a mother who had undergone early menopause. The authenticity of the mutation was identified by Sanger sequencing and the conserved nature of the mutation site was predicted by software. Overexpressing FANCL mutant and wildtype plasmids were constructed and transiently transfected into HEK293T cell lines, and the effect of the mutation was detected by qPCR, immunofluorescence and Western blot. Results: The mutation site of FANCL was located within the Ring domain of FANCL, which was highly conserved across multiple species. The mutant showed no significant change in mRNA expression level, while the protein expression level was significantly down-regulated. In vitro cellular experiments further revealed that the mutation leads to decreased expression levels by reducing protein stability. Conclusion: A FANCL c.1033G > A mutation was found and it may cause disease in the POI patient due to decreased protein stability.

Objective: To compare the pain relief and long-term clinical success rate of vital pulp therapy and root canal treatment in mature permanent teeth with carious irreversible pulpitis. Methods: A total of 90 patients diagnosed with carious irreversible pulpitis in mature permanent teeth were collected at Shanghai Stomatological Hospital from Jan 2021 to Jun 2022. They were randomly divided into two groups: test group (n=45) undergoing vital pulp therapy (VPT) and control group (n=45) undergoing root canal treatment (RCT). Pain scores were recorded before treatment, 24 hours after operation and 7 days after operation. We conducted clinical evaluation and imaging analysis at 1, 6, and 12 months after the surgery, then compared the pain scores and treatment success rates between the two groups. Results: Eighty-one patients, including 39 patients in group VPT aged (31.00±1.43) years old and 42 patients in group RCT aged (30.60±1.54) years old, received follow-up for more than 1 year, and the success rate of the test group and control was 97.44% and 95.24%. The pain degree of the two groups was reduced at 24 hours and 7 days after operation (P < 0.05), and the pain score of the test group was reduced compared with that in the control group 7 days after operation (P < 0.01). Conclusion: Compared with root canal treatment, vital pulp therapy for mature permanent teeth with carious irreversible pulpitis can achieve good results in short-term pain evolution and long-term clinical success.