Mendelian randomization (MR) is an epidemiological method that uses genetic variants as instrumental variables (Ⅳs). This article begins by elucidating the basic principles of IVs through causal diagrams, directed acyclic graph (DAG), and then systematically reviews the key assumptions, common challenges, and practical considerations in MR studies by comparing them with randomized controlled trials (RCTs). As an observational study, MR can theoretically help avoid confounding, but its validity in practice critically depends on confirming (ⅰ) a strong association between the genetic instrument and the exposure, (ⅱ) independence of the instrument from confounders, and (ⅲ) exclusion of alternative pathways from the instrument to the outcome; over-interpretation of findings should therefore be avoided. The paper also highlights the value of MR in drug target discovery and in exploring disease mechanisms, while reminding investigators that common issues in observational studies, such as the temporal order of exposure and outcome, still require rigorous attention.

The impact of hypertensive disorders of pregnancy (HDP) on maternal and fetal outcomes is well-established. However, the relationship between high-normal blood pressure (BP) and HDP, as well as its association with adverse maternal-fetal outcomes, remains unclear. This retrospective study analyzed singleton pregnancies delivered at Obstetrics and Gynecology Hospital, Fudan University from Jan 2021 to Dec 2021. Participants were categorized into a normal BP group (BP < 130/80 mmHg before delivery admission) and two high-normal BP groups (BP: 130-139/80-89 mmHg) with subgroup analysis based on gestational week of BP elevation before and after 20 weeks. Maternal characteristics, HDP incidence and adverse outcomes were compared across groups. The results demonstrated that compared with the normal BP group, both high-normal BP groups showed significantly increased HDP incidence, with more pronounced risk in the high-normal BP (after 20 weeks) group. The high-normal BP (before 20 weeks) group was associated with elevated risks of iatrogenic preterm birth and small for gestational age (SGA). This study provides a theoretical basis for implementing stricter BP monitoring strategies to reduce adverse maternal and neonatal outcomes.

To explore the mediating effect of resilience between sleep quality index and quality of life in lung cancer patients, we used General data questionnaire, Pittsburgh Sleep Quality Index, Connor-Davidson Resilience Scale, Chinese version Memorial Symptom Assessment Scale and functional Assessment of Cancer Therapy-Lung to investigate 218 lung cancer patients in the Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University during Nov 2023 to Feb 2024. A structural equation model was constructed to analyze the mediating effect of resilience between sleep quality index and quality of life. The sleep quality of lung cancer patients was in mild sleep disturbance. There was a negative correlation between sleep quality index and quality of life. Resilience of the patients partly mediated the relationship between sleep quality index and quality of life with an effect of 0.826, accounting for 28.47% of the total effect. Doctors and nurses should pay attention to enhancing the resilience level of lung cancer patients and improving their impact of sleep disturbance on the quality of life.

The data from outpatient prescriptions of small-size aspirin enteric-coated tablets (25 mg/tablet) in a community hospital were analyzed to provide reference for rational clinical drug use. Patients' medication information of 1 325 prescriptions was collected and analyzed by defined daily dose system (DDDs) and drug utilization index (DUI), and the rationality of drug use was analyzed according to drug instructions and literature. The mean age of males and females were (73.70±8.33) years old and (72.95±8.34) years old, respectively. The top 3 DDDs age groups were women aged 60-79 years, men aged 60-79 years and women aged 80-99 years. The proportion of prescriptions in female patients was 59.62%. DUI ranges from 0.75 to 0.85. Irrational drug use was found in 123 prescriptions, including 89 prescriptions (72.35%) of inappropriate drug selection, 19 prescriptions (15.45%) with low dose, 6 prescriptions (4.88%) with contraindication, 5 prescriptions (4.06%) with inconsistent frequency of administration, 2 prescriptions (1.63%) of out-of-indication drug use, and 2 prescriptions (1.63%) of high dose. For the phenomenon of irrational drug use, it is necessary to conduct real-time intervention to ensure the safety and effectiveness of drug use.

With the continuous development of perinatal medicine and neonatology, although the survival rate of infants with low gestational age and low birth weight has improved, the incidence of neurodevelopmental morbidities remains high. Breast milk is the preferred source of enteral nutrition for preterm infants, playing an important role in growth, development, immunity, metabolism, and other functions. Of particular note is its effect on the nervous system, not only promoting brain development and maturation in preterm infants, but also effectively reducing the incidence and severity of brain injury, thereby improving long-term neurological outcomes. This review aims to explore the effects of breast milk on brain injury and repair, brain structural maturation, and neurodevelopmental outcomes in preterm infants, in order to further enhance the understanding of the importance of breast milk for the neurodevelopment of preterm infants.

In elderly patients with malignant tumor, sarcopenia frequently co-occurs, which is largely attributed to the cachexia state observed in cancer patients. Although both sarcopenia and cachexia involve muscle loss, there are significant distinctions between the two conditions. Current research indicates that sarcopenia is a multifactorial condition, influenced by factors such as aging, endocrine dysfunction, motor neuron loss, cachexia, inflammation, and malnutrition. With the increasing depth of research into the correlation between sarcopenia and the nervous and immune systems, this article reviews the research progress on sarcopenia in patients with malignant tumors, with a focus on neuroimmunological aspects. It systematically analyzes the mechanisms underlying its onset and progression, as well as the influencing factors and potential intervention strategies for sarcopenia in this patient population.

p120-catenin (p120ctn) is one of the crucial members of armadillo family, which is well known as a core stabilizing factor for vascular endothelial cadherin (VE-cadherin). Throughout the entire process of vascular development, p120ctn plays multiple roles. From neovascularization to endothelial barrier, the presence of p120ctn is indispensable. It participates in regulating the normal development of vertebrate embryo vasculature and promoting endothelial cell proliferation. Additionally, p120ctn contributes to the maintenance and remodeling of adherens junctions and can modulate adhesion strength by altering cell morphology. This review summarized the latest research progress on p120ctn from neovascular development and endothelial barrier function.

Transthoracic echocardiography (TTE) is the preferred noninvasive modality for screening and diagnosing pulmonary hypertension (PH). By measuring parameters such as tricuspid regurgitation velocity (TRV), TTE can estimate pulmonary artery systolic pressure (PASP) and evaluate right heart function. TTE plays a critical role in the early screening, risk stratification, and prognostic assessment of PH, particularly in large-scale epidemiological studies. Furthermore, in percutaneous valvular interventions (e.g., transcatheter aortic valve replacement, mitral valve edge-to-edge repair), TTE provides essential hemodynamic data for patient selection, intraoperative decision-making, and postoperative follow-up. This review summarizes recent advances in TTE for PH evaluation and its application in valvular interventions in order to support clinical practice.

Autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A) is an autoimmune-mediated central nervous system disease. Its symptoms and cerebrospinal fluid changes are often similar to those of central nervous system infectious diseases, particularly tuberculous meningitis (TBM), making it clinically challenging to differentiate between them. This article collects data on the clinical manifestations, auxiliary examinations, diagnosis and treatment of four patients with A-GFAP-A, who were suspected as TBM and subsequently admitted to Department of Infectious Diseases, Huashan Hospital, Fudan University from Jan 2020 to Sep 2023. Additionally, relevant literature is reviewed and the key points of differential diagnosis is discussed in order to enhance clinicians' understanding of A-GFAP-A.

Objective: To develop and validate a fast Monte Carlo (MC)-based patient-specific quality assurance (PSQA) tool using the treatment log files that is suitable to be used in the online adaptive radiotherapy for pencil beam scanning proton therapy (PBSPT-ART). Methods: The proposed tool first used the delivery log file of a PBSPT plan to reversely reconstruct the PBSPT (rPBSPT) plan, and then used an in-house developed graphic processing unit (GPU)-accelerated virtual particle MC (VPMC) dose engine to calculate the dose distribution of the rPBSPT plan. The rPBSPT dose calculated by VPMC was then compared to the rPBSPT dose calculated by another independent MC dose engine (MCsquare), using 3D gamma analysis to verify the accuracy of VPMC calculation. As a demonstration of the feasibility of developed log file-based PSQA, the VPMC calculated dose of the rPBSPT plan was compared to the pre-delivery second check dose of the corresponding PBSPT plan calculated by MCsquare, using 3D gamma analysis. 3D gamma analysis employes a criterion of 2 mm/2%/10%. Twenty patients with different disease sites were representatively selected to validate the efficiency and accuracy of the tool. Results: The average calculation time of a rPBSPT plan by VPMC was (5.88±4.00)s in the accuracy verification. Compared to MCsquare, the passing rate of the 3D gamma analysis was 99.47%±0.72%. In the proposed PSQA tool demonstration, the passing rate of comparing the VPMC calculated rPBSPT dose to MCsquare calculated second check dose of the corresponding PBSPT plan was 98.91%±0.92%. Conclusion: The accuracy and efficiency of the tool can meet the requirements of PSQA in the online PBSPT-ART workflow.

Objective: To investigate the learning curve of real-life vaginal delivery, including its difficult steps and influencing factors, to optimize the future training of vaginal delivery for residents in department of obstetrics and gynecology. Methods: From 25 Sep 2020 to 12 Mar 2022, OBGYN residents without previous experiences in vaginal delivery were prospectively enrolled in Obstetrics and Gynecology Hospital, Fudan University. Residents performed normal vaginal delivery under the supervision of senior obstetricians and midwives. The performance score (PS) of vaginal delivery and its 9 steps were evaluated via a questionnaire fulfilled by the supervisor once each delivery was finished. Logistic regression models were performed for univariate and multivariate analyses to evaluate the factors that might be correlated with the PS. Results: Eventually, 233 deliveries performed by 60 residents were analyzed. Results showed that more than 10 deliveries were needed for 70% of residents to obtain minimal competence of vaginal delivery. Perineal protection, delivery of the fetal head, delivery of the fetal shoulders and repair of episiotomy or laceration were found to be the most difficult steps, which required more practices to achieve minimal competence level. Univariate analyses showed the delivery experience, the times of observation/simulation/training, and humanistic care skills might influence the total PS (P < 0.05). However, only delivery experience (OR=1.43, 95%CI: 1.22-1.67) and the times of observation (OR=1.02, 95%CI: 1.00-1.04) were found to be independently correlated with the total PS in multivariate analyses. Conclusion: More than 10 real-life practices were required to achieve the minimal competence of normal vaginal delivery. Enhancing the training on the four difficult steps of vaginal delivery might improve the learning efficiency when delivery opportunities are limited.

Objective: To investigate the one-year postpartum weight retention for patients with gestational diabetes mellitus (GDM) and analyze its related influencing factors, so as to improve the postpartum weight retention. Methods: GDM women who were diagnosed and gave birth at the Obstetrics and Gynecology Hospital, Fudan University from Oct 2022 to May 2023 were selected as the research subjects. The GDM postpartum weight status survey questionnaire was used to conduct a survey of one-year postpartum weight retention status and analyze relevant influencing factors. Results: A total of 150 GDM postpartum women were included, with a weight retention rate of 46.7% one year after delivery, including a high weight retention rate of 25.3%. The follow-up rate of postpartum glucose tolerance was 36.0%, and the influencing factors of postpartum weight retention were excessive gestational weight gain (OR=2.883, 95%CI: 1.226-6.779)and the presence of dietary risk (OR=4.604, 95%CI: 1.065-19.903). Conclusion: The one-year postpartum weight retention after GDM is relatively high. The possible influencing factors are excessive weight gain during pregnancy and dietary risk after delivery. Attention should be paid to the weight and healthy diet management of GDM during pregnancy and postpartum from multiple dimensions.

Objective: To observe the efficacy and safety of Baduanjin combined with acupuncture in treating neck-type cervical spondylopathy (NTCS) patients. Methods: Eighty patients were randomly divided into an intervention group and a control group in a 1∶1 ratio. The intervention group was treated with a combination of Baduanjin and acupuncture. Patients underwent Baduanjin exercise daily and acupuncture treatment twice a week for a total of 8 consecutive weeks. The control group received routine acupuncture twice a week for a total of 8 consecutive weeks. After the end of the treatment course, the effective rates of the two groups, as well as the visual analogue scale (VAS), neck disability index (NDI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and general comfort questionnaire (GCQ) assessment before and after treatment were compared, then safety evaluations was assessed. Results: After intervention, the total effective rates of the intervention group and the control group were 91.4% and 76.31%, respectively, with a statistically significant difference (P < 0.05); Compared within the group, the VAS, NDI, SAS, SDS scores of both groups were significantly lower than before treatment (all P < 0.01), and the GCQ scores were higher than before treatment(both P < 0.01); After intervention, inter-group comparison showed that the improvement of VAS, NDI, SAS, SDS, and GCQ scores in the intervention group was more significant than that in the control group (all P < 0.05). Conclusion: The combination of Baduanjin and acupuncture treatment can improve the clinical efficacy of NTCS patients and has good safety, which is worthy of clinical promotion and application.

Objective: To explore the pregnancy outcomes and prognosis following in vitro fertilization, and tumor prognosis of infertility patients with borderline ovarian tumor (BOT) after fertility-sparing surgery (FSS). Methods: A retrospective study was conducted and 35 infertility patients with BOT after FSS from Shanghai Jiai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University were enrolled. The pregnancy outcomes and tumor prognosis were analyzed. Results: Among the patients, serous BOT accounted for 62.9%. Twenty-five cases were International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ, 2 stage Ⅱ, and 8 stage Ⅲ. Twelve patients experienced borderline tumor recurrence before assisted reproductive therapy, of which 5 patients were stage Ⅲ and 7 stage Ⅰ. After FSS, the 35 patients firstly underwent controlled ovarian stimulation (COS) at an average interval of (47.3±32.6) months. A total of 79 ovulation induction cycles were taken and mild stimulation protocol was adopted first (41.8%), followed by the natural cycle protocol (25.3%). Twenty-seven patients underwent embryo transfer in 37 cycles, resulting in 21 clinical pregnancies in 19 patients. The clinical pregnancy rate was 56.8%, with a cumulative pregnancy rate of 54.3%. The live birth rate was 43.2%, and the cumulative live birth rate was 42.9%. For patients with anti-Müllerian hormone levels < 1.0 ng/mL (n=13), the pregnancy rate was 42.9%, and the cumulative clinical pregnancy rate was 23.1%. Among 30 patients, 4 (13.3%) patient with stage Ⅲ BOT experienced recurrence, and none had malignant transformation at the median follow-up period of 61 months after the first COS. Conclusion: Assisted reproductive technology was safe and could improve pregnancy rates in infertile women with BOT.

Objective: To explore the association between psychological resilience and internet addiction among senior primary school students, so as to provide a scientific basis for formulating strategies for preventing internet addiction and enhancing psychological resilience in this group. Methods: A stratified cluster sampling method was employed. In May 2021, a total of 1 618 fourth- and fifth- grade students from 5 primary schools in Jiading District, Shanghai were surveyed on psychological resilience and internet addiction through questionnaires. Independent sample t-tests, chi-square tests, and Logistic regression models were used for data analysis. Results: Among the 1 618 students, the prevalence rate of internet addiction was 8.8%(142 students). The total score of psychological resilience (t=6.215, P < 0.001) and the scores of three dimensions, namely family support (t=3.509, P < 0.001), goal focus (t=6.965, P < 0.001), and positive perception (t=5.887, P < 0.001), of those reported with internet addiction were all significantly lower than those without internet addiction. Multivariate logistic regression analysis showed that compared with individuals with low psychological resilience, those with moderate (aOR=0.395, 95%CI: 0.267-0.584, P < 0.001) and high psychological resilience (aOR=0.167, 95%CI: 0.077-0.365, P < 0.001) had a lower probability of internet addiction. The three sub-dimensions of psychological resilience, namely goal focus, positive perception and family support, also showed a statistically significant negative association with internet addiction in these students. Conclusion: Nearly one-tenth senior primary school students in Jiading District self-reported internet addiction. Higher levels of psychological resilience were associated with a lower probability of internet addiction among senior primary school students. Focusing on enhancing the goal focus, positive perception and family support dimensions in psychological resilience may be of great significance for preventing internet addiction among senior primary school students.

Objective: To explore the efficacy of "internet +" family doctor contract service model on controlling risk factors related to atherosclerotic cardiovascular disease (ASCVD) such as hypertension, dyslipidemia, and diabetes in young and middle-aged patients in the community. Methods: A total of 231 young and middle-aged patients with ASCVD who were contracted and treated regularly in Shanghai Yangpu District Xinjiangwancheng Community Health Service Center from Jan to Dec 2020. According to the different intervention models, they were divided into the traditional group receiving the conventional family doctor contract service and the Internet group taking "internet +" family doctor contract service mode for intervention. The systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), low density lipoprotein (LDL-C), triglyceride (TG) and total cholesterol (TC) were compared within and between the two groups before intervention, three months after intervention, and one year after intervention, to evaluate the control effects of the two intervention modes. Results: The 231 patients, of which 113 cases in traditional group and 118 cases in Internet group, were recruited in the study. there were no significant differences in gender, age and proportions of hypertension, diabetes and dyslipidemia between the two groups. Before intervention, there were no significant differences in systolic blood pressure, diastolic blood pressure, FPG, LDL-C, TG and TC between the two groups. Three months after intervention, the systolic blood pressure, diastolic blood pressure, FPG, LDL-C, TG and TC of the two groups were significantly lower than those before the intervention (all P < 0.05), and the systolic blood pressure and diastolic blood pressure of the Internet group were significantly lower than those of the traditional group (all P < 0.05), but there was no significant difference between the two groups in FPG, LDL-C, TG and TC. One year after the intervention, the systolic blood pressure, diastolic blood pressure, FPG, LDL-C, TG and TC of the patients in the two groups decreased significantly compared with those before intervention (all P < 0.05), while the Internet group decreased more significantly (all P < 0.05). Conclusion: Compared with the traditional contract model, "internet +" family doctor contract service had better management effect on ASCVD-related risk factors in young and middle-aged patients in the community, and benefits the patients to a higher degree.

Objective: To investigate the changes in the concentration of endothelial cell-specific molecule-1 (ESM-1) in cerebrospinal fluid during the acute phase of patients with moderate to severe traumatic brain injury (TBI) and its relationship with injury severity and outcomes. Methods: Eighty-four patients with moderate to severe TBI who underwent ventriculostomy for intracranial pressure (ICP) monitoring at Department of Neurosurgery, Jinshan Hospital, Fudan University from Jan 2020 to Dec 2023 were selected as the study subjects, and their clinical data were collected. Based on the Glasgow Coma Scale (GCS) upon admission, TBI patients were divided into moderate TBI group (GCS 9-12, n=48) and severe TBI group (GCS 3-8, n=36). According to the Glasgow Outcome Scale (GOS) at three months post-injury, the moderate to severe TBI patients were categorized into poor outcome group (GOS 1-3) and good outcome group (GOS 4-5). Patients were also classified based on ICP monitoring values into a normal ICP group (ICP ≤ 15 mmHg), a mildly elevated ICP group (15 mmHg < ICP < 25 mmHg), and a refractory elevated ICP group (ICP ≥ 25 mmHg). Cerebrospinal fluid samples from patients undergoing lumbar puncture for hemorrhoids or urinary calculi during the same period were collected as a control group. The concentration of ESM-1 in the cerebrospinal fluid was detected using a liquid phase protein chip method, and comparative analysis was performed. Results: Compared with the control group[(259.42±37.07) pg/mL], the concentrations of ESM-1 in the cerebrospinal fluid of both the moderate and severe TBI groups[(305.08±53.3) pg/mL and (345.79±69.11) pg/mL, respectively) were significantly increased (P < 0.01); the concentration of ESM-1 in the severe TBI group was significantly higher than that in the moderate TBI group (P < 0.01). The concentration of ESM-1 in the cerebrospinal fluid positively correlated with the number of days TBI patients spent in the NICU and the total hospital stay, while it negatively correlated with the GCS score at admission. Compared with the group of normal ICP (n=16), the levels of ESM-1 in cerebrospinal fluid of both the elevated ICP group (n=43) and the refractory elevated ICP group (n=25) were significantly higher (P < 0.01), with the refractory elevated ICP group showing significantly higher levels than the elevated ICP group. The level of ESM-1 in cerebrospinal fluid of the poor outcome group (n=21) was significantly higher than that of the good outcome group (n=63, P < 0.01). The concentration of ESM-1 in cerebrospinal fluid had an area under the curve (AUC) of 0.817 (95%CI: 0.713-0.922) for predicting poor outcomes in TBI patients, with a cutoff value of 339.25 pg/mL, a sensitivity of 80.95%, and a specificity of 76.19%. Conclusion: In patients with moderate to severe TBI, there is a significant elevation of ESM-1 in cerebrospinal fluid during the acute post-injury phase, which may be closely associated with the severity of TBI, the difficulty in controlling ICP, and poor outcomes. ESM-1 in cerebrospinal fluid is expected to be a potential biomarker for assessing the severity of TBI and predicting outcomes.

Objective: To develop a precise and efficient single-disease management model to reduce the intensity of antibiotic use. Methods: Data was collected from surgical inpatient admissions at the Shanghai Pulmonary Hospital between Jan 2022 and Mar 2024. The study focused on the six most prevalent types of malignant tumors within single-disease management. Surgical patients who did not receive single-disease quality management from Jan 2022 to Jun 2023 were designated as the control group, while surgical patients who received single-disease quality management from Jul 2023 to Mar 2024 served as the management group. By formulating and implementing standardized policies and guidelines for antibiotic use, supervision and effect evaluation were conducted across departments. Results: A total of 21 746 individuals were included in the control group and 15 635 in the management group. Following the introduction of the single-disease management model, the proportion of non-restricted antibiotics used in various single diseases increased from 73.2%-77.0% before management to 78.3%-84.4% after management, while the usage of restricted antibiotics significantly decreased (P < 0.001). The intensity of antibiotic use, measured in defined daily doses (DDDs), fell significantly from 113.0-159.9 before management to 36.0-44.0 after management (P < 0.001). Moreover, compared with the control group, the average length of stay in the intervention group did not change considerably, although the length of stay increased for some diseases, possibly due to more precise medication adjustments. Conclusion: The single-disease management model optimizes antibiotic use, reduces the intensity of antibiotic use, and enhances overall medical quality and patient safety.

Objective: To investigate abnormalities in striatal resting-state functional connectivity (rsFC) and their relationship with negative symptoms in schizophrenia patients with predominant negative symptoms (PNS). Methods: Fifty-four schizophrenia patients with PNS and sixty-one healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) scans. Data were collected on general demographic information, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), and the Temporal Experience of Pleasure Scale (TEPS). Twelve striatal subregions were selected as regions of interest (ROIs) to analyze the rsFC between each ROI and whole-brain voxels. The rsFC values of areas with significant differences were extracted for Pearson correlation analysis with negative symptoms. Results: Compared with healthy controls, schizophrenia patients with PNS exhibited decreased rsFC between the right dorsal caudal putamen (DCP) and right insula, left middle frontal gyrus (MFG), right median cingulate and paracingulate gyri (MCC); between the left DCP and right putamen, left insula, left MFG; between the right dorsal rostral putamen (DRP) and bilateral MFG, left insula, right MCC; between the left DRP and right insula, left rolandic operculum; between the right ventral rostral putamen (VRP) and bilateral putamen, left MFG, right MCC; between the left VRP and right insula, left putamen, bilateral MFG, right MCC, left inferior parietal gyrus, excluding supramarginal and angular gyri. Decreased rsFC was also observed between the left ventral caudate/nucleus accumbens (inferior) and right insula, left anterior cingulate cortex, supracallosal, bilateral precuneus (a threshold of P < 0.001 in voxel-level with P < 0.05 in cluster-lever, corrected for family-wise error, P_FWE < 0.05/12=0.004). No regions showed increased rsFC in schizophrenia patients with PNS relative to healthy controls. And no significant correlations were found between striatal rsFC and negative symptoms (P_Bonferroni > 0.05). Conclusion: Schizophrenia patients with PNS exhibited widespread cortical-striatal functional connectivity abnormalities, particularly reduced rsFC between the putamen and the MFG, MCC and insula.

Objective: To investigate the prevalence of chronic somatic comorbidities in schizophrenic patients in Shanghai communities, and to explore the factors influencing comorbidities. Methods: Based on Shanghai community-based severe mental disorders cohort, 5 422 patients with schizophrenia(SCZ) were included in the study. 12 common chronic somatic diseases, defined by patients'self-report, were selected to analyze the prevalence of comorbidity, and Logistic regression model was used to analyze the factors influencing the number of somatic comorbidities. Results: The total prevalence of somatic comorbidity was 37.0% in 5 422 patients with SCZ, with the highest prevalence of hypertension(22.6%) and diabetes mellitus (13.1%) among 12 somatic diseases selected. Older age was the main factor associated with chronic somatic comorbidities in community schizophrenic patients. The risk of 1-2 comorbidities in patients aged ≥60 years was 3.34(95%CI: 2.74-4.07)times higher than those aged < 45 years, while the risk of ≥3 comorbidities was 3.27(95%CI: 2.11-5.09)times higher, correspondingly. Female gender, marriage, smoking, and longer duration of illness were also risk factors for comorbidity. Women after menopause had higher risk of comorbidity than perimenopausal women. Conclusion: Cardiovascular and metabolic diseases were common somatic comorbidities among schizophrenic patients in Shanghai communities. Older age, female gender, marriage, smoking, and longer duration of illness were risk factors for increasing number of comorbidities.

Objective: To investigate the effect of the structure of 3D-printed silk fibroin/hydroxypropyl methylcellulose (SF/HPMC) scaffolds on the growth of tracheal epithelial cells in vitro. Methods: Six types of SF/HPMC scaffolds with different surface topography, pore size, and porosity were fabricated using a 3D printer by adjusting the concentration of SF/HPMC solutions and printing parameters, combined with freeze-drying. Normal human bronchial epithelial cell lines BEAS-2B were cultured on these scaffolds for 7 days. The cell proliferation was detected by CCK-8 assay and live/dead cell staining, and the cell morphology was observed by scanning electron microscopy (SEM). Results: The porosity of 20% (weight percentage) SF/HPMC scaffolds with rough surface and smooth surface were 70.5%±2.0% and 65.5%±6.1%, respectively, and the porosity of 30% (weight percentage) SF/HPMC scaffolds with rough surface and smooth surface were 63.9%±2.1% and 59.6%±2.1%, respectively. The two pore sizes of the rough-surfaced 20% SF/HPMC scaffolds were (443.9±104.1) μm and (681.1±115.1) μm. BEAS-2B cells spread better on the rough-surfaced scaffolds, and their proliferation was higher on scaffolds with higher porosity and smaller pore sizes compared to those with lower porosity and larger pore sizes. Conclusion: The 3D-printed SF/HPMC scaffolds are suitable for bronchial epithelial cell growth. Scaffolds with rough surfaces, higher porosity, and appropriate pore sizes might facilitate BEAS-2B cell growth.

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.