In medical follow-up studies, there is often an intrinsic association between longitudinal observations (e.g., repeatedly measured biomarkers or symptom scores) and time-to-event data (e.g., disease progression or mortality). Traditional approaches that analyze these two data types independently may lead to biased statistical inference, as they neglect this inherent association and measurement errors. Joint models (JMs) address this limitation by linking longitudinal and survival sub-models through shared random effects, thereby correcting measurement errors in repeated measurements and improving estimation efficiency and statistical power. While traditional frequentist approaches are feasible in simple scenarios, they face computational and theoretical challenges when handling high-dimensional, nonlinear, or complex missing data mechanisms. In contrast, Bayesian JMs leverage Markov chain Monte Carlo (MCMC) methods, incorporating prior distributions and posterior sampling techniques to enhance robustness in parameter estimation, model flexibility, and dynamic prediction performance. This article introduces the methodological framework of Bayesian joint models, including: (1) Specification of longitudinal sub-models (e.g., linear mixed-effects models) and survival sub-models (e.g., Cox proportional hazards models); (2) Three common association structures (current value, current slope, and cumulative area); (3) Bayesian parameter estimation via MCMC; (4) Personalized dynamic prediction and model performance evaluation. Using primary biliary cirrhosis (PBC) as a case study, we demonstrate the practical application of Bayesian JMs, ranging from the selection of predictive indicators, fitting and comparison of single/multi-indicator JMs to the predictive performance using time-dependent ROC curves. The case study indicates that Bayesian JMs can effectively integrate longitudinal trajectory information, dynamically update individual survival probabilities, and provide quantitative support for clinical decision-making.

Supraventricular tachycardia is the most common type of fetal tachycardia, often presenting as persistent tachycardia, with a fetal atrial rate of 220-300 beats per minute and normal atrioventricular conduction (1∶1). This article reports one case of fetal supraventricular tachycardia admitted to Obstetrics and Gynecology Hospital, Fudan University, sharing the diagnosis and treatment experience of supraventricular tachycardia. The patient was 33 years old, and had an upper respiratory tract infection in the fifth month of pregnancy. At 23⁺³ weeks of pregnancy, fetal supraventricular tachycardia and a small amount of tricuspid regurgitation were found. At 27⁺³ weeks of pregnancy, fetal pericardial effusion and peritoneal effusion were found on the basis of fetal supraventricular tachycardia. The cardiothoracic ratio increased, and there was regurgitation at the atrioventricular valve opening. The A-wave of the venous catheter decreased, indicating the possibility of fetal heart failure. After admission, the patient was treated with oral digoxin and sotalol hydrochloride. Regular follow-up was conducted on digoxin concentration and high-risk ultrasound, and medication dosage was adjusted based on the results. An infant weighing 3 440 g was born naturally at 39⁺² weeks of pregnancy, Apgar rating of 9'-9'. The electrocardiogram of the newborn was generally normal, the echocardiogram showed no significant abnormalities, and the heart rhythm was normal.

Intestinal endometriosis is relatively rare. The diagnosis of this disease poses a challenge to clinicians, especially endoscopists. A 51-year-old female patient with intermittent lower abdominal pain was found to have "colon polyps" during colonoscopy. In the second colonoscopy examination, it was planned to perform lesion resection under colonoscopy, which showed a negative lifting sign of the lesion and did not support the diagnosis of intestinal polyps. After multidisciplinary discussions and communication with the patient, we ultimately chose laparoscopic combined with colonoscopic localization for segmental intestinal resection. Postoperative immunohistochemistry results showed ER (±), PR (+), CD10 (+), vimentin (+), SMA (-), and CDX2 (-). Pathologic diagnosis was colonic endometriosis. Our article discusses the diagnosis strategies of intestinal endometriosis through this case, and emphasizes the importance of endoscopic technology in diagnosis of this disease.

Objective: To establish a novel scoring system based on transrectal ultrasound to prospectively predict prostate cancer. Methods: In this retrospective study, we recruited 206 patients who underwent prostate biopsy in Minhang Hospital, Fudan University and collected information of them. Five possible indexes for predicting prostate cancer were obtained: structure of the internal and external glands, echo of the internal and external glands, hypoechoic mass, contour of the prostate and calcification. Transrectal ultrasound scoring system (TUSS) was created based on three ultrasound features, i.e., structure of the internal and external glands, hypoechoic mass and contour of the prostate, through t-test and linear regression equation. In the prospective study, 187 patients with indications for prostate biopsy who had undergone magnetic resonance imaging (MRI) examination before biopsy were recruited. The patients were scored according to the proposed TUSS based on ultrasound images and the existing prostate imaging reporting and data system (PIRADS) based on MRI. ROC curve analysis was performed to compare the two scoring systems. Results: In the retrospective study, three ultrasound features, including structure of the internal and external glands, hypoechoic light mass and the regularity of the contour and shape of the prostate were found to have independent diagnostic values. ROC curves were used to analyse these three features and evaluate the effectiveness of the diagnosis results by integrating the three features. In the prospective study, the AUC of PIRADS was 0.811, while the AUC of the proposed ultrasound scoring system was 0.899 (P=0.002 4). Conclusion: In this study, we established a novel scoring system named the TUSS, which can predict prostate cancer better than PIRADS.

Objective: To analyze the risk and protective factors for respiratory adverse events (RAEs) during the recovery period in children aged ≤2 years undergoing cochlear implantation. Methods: A retrospective analysis was conducted on 140 children aged ≤2 years who underwent cochlear implantation at Eye & ENT Hospital, Fudan University from May 2021 to Aug 2024. Preoperative baseline characteristics and anesthesia-related data were collected. Univariate and multivariate analyses were used to evaluate risk factors for RAEs during the recovery period, including poor laryngeal mask airway ventilation, laryngospasm, bronchospasm, coughing, and hypoxic episodes defined as oxygen saturation ≤90% and lasting ≥10 s. Results: The mean age of the 140 children was (14.6±6.1) months. Univariate analysis showed that preoperative use of sedative drugs (P=0.034) and intraoperative use of proseal laryngeal mask airway (P=0.012) significantly reduced the incidence of adverse respiratory events during the recovery period. Multivariate analysis revealed that the use of proseal laryngeal mask airway was an independent protective factor (OR=0.234, 95%CI: 0.069-0.791, P=0.019). Conclusion: In children aged ≤2 years undergoing cochlear implantation, the use of proseal laryngeal mask airway during surgery and preoperative sedative drugs may reduce the incidence of RAEs during the recovery period.

Objective: To explore children's medical treatment mode and its influencing factors, and provide a theoretical basis for the rational allocation of children's medical resources, the optimization of grassroots medical services construction and the improvement of children's willingness to visit community hospitals. Methods: Online survey was conducted during Sept to Oct in 2024, using the questionnaire including basic information of the child and family, medical-care-seeking behavior, and impression of community hospitals. Children aged 3-14 years old in Minhang District were recruited as research subjects. In order to collect appropriate information, the questionnaire was completed by one of their parents. A total of 5 384 valid questionnaires were analyzed. Chi-square test or Fisher's exact probability method was utilized to compare the differences between groups, while binary Logistic regression analysis was applied to explore influencing factors of choice on healthcare services among the surveyed children. Results: Totally, 31.45% of the surveyed children went to community hospitals for medical care as often as or more often than they went to second-tier and third-tier hospitals in the last year. Surveyed individuals with three kids in their household (OR=1.711, 95%CI: 1.211-2.417), kids aged 6 years old and older (OR=1.171, 95%CI: 1.023-1.314), and those who live further away from second-tier and third-tier hospitals (OR=1.046, 95%CI: 1.016-1.076) were more inclined to visit community hospitals, while those without family contracted doctors (OR=0.748, 95%CI: 0.652-0.858) were more inclined to visit second-tier and third-tier hospitals. In addition, guardians' educational level and family monthly income were also influencing factors for children's medical treatment choices. About 48.22% of the respondents were satisfied with their community healthcare experiences, and 25.22% were highly satisfied. Limited selections of medications (28.96%), lack of equipment (22.45%), and low technical proficiency of doctors (16.72%) were the top three subjective criteria considered during visits. Conclusion: In general, children's choice on healthcare services is influenced by multiple factors, and is the result of combined effects of seeking treatment at higher-level and nearby hospitals. Family doctor contract services, geographical accessibility of medical institutions, age of children and parents' recognition of community pediatric outpatient service are the key variables affecting children's medical treatment choices.

Objective: To investigate the value of thoracic bioimpedance-based non-invasive hemodynamic monitoring in assessing intraoperative distension fluid loss during hysteroscopic myomectomy under general anesthesia, and to provide a new method and reference for clinical monitoring of distension fluid loss. Methods: Patients with uterine fibroids who underwent hysteroscopic myomectomy under general anesthesia in Obstetrics and Gynecology Hospital, Fudan University from May to Dec 2024 were enrolled. Thoracic bioimpedance-based non-invasive hemodynamic monitoring was used to monitor heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume variation (SVV), and thoracic fluid content (TFC) at three time points: after entering the operating room (T₀), after anesthesia induction and before surgery (T₁), and at the end of surgery (T₂). The changes in HR (ΔHR=HR₂-HR₀), CO (ΔCO=CO₂-CO₀) and TFC (ΔTFC=TFC₂-TFC₀) were calculated. Results: Patients were divided into two groups based on whether the distension fluid loss at the end of surgery was ≥2 500 mL: MORE group (8 cases) and LESS group (36 cases). Compared with the LESS group, the MORE group had longer operation time, more blood loss, and greater distension fluid loss (all P < 0.05). The HR₂, ΔHR, CO₂, TFC₂ and ΔTFC at T₂ in the MORE group were significantly higher than those in the LESS group (all P < 0.05). Correlation analysis showed that the distension fluid deficit was positively correlated with TFC₂ and ΔTFC (all P < 0.05), but not with ΔHR or CO₂. ROC curve analysis indicated that ΔTFC had a sensitivity of 100% and a specificity of 83.3% for diagnosing a distension fluid loss ≥2 500 mL, with a cutoff value of 8.2. Conclusion: TFC and ΔTFC measured by thoracic bioimpedance-based non-invasive hemodynamic monitoring are well correlated with the distension fluid loss during hysteroscopic myomectomy. ΔTFC has good sensitivity and specificity for diagnosing a distension fluid loss ≥2 500 mL, providing a useful reference for determining the appropriate time of surgical termination.

Objective: To investigate the effect of nicotinamide adenine dinucleotide (NAD⁺) precursor molecule in drinking water on lesion of thoracic aortic aneurysm (TAA) in mice. Methods: TAA mouse model was induced by β-aminopropionitrile (BAPN) and supplemented with NAD⁺ precursors, nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR), to enhance NAD⁺ levels in the model mice. Three-week-old male C57BL/6J mice were treated with BAPN, BAPN+NMN, and BAPN+NR in drinking water for 4 weeks, respectively, and mice treated with oral saline served as the control group. The death events of mice were recorded during the experiment, and the aorta was dissected to determine the cause of death. At the end of the experiment, the surviving mice were monitored by aortic ultrasound, and the thoracic aorta was dissected for histopathological analysis. Three-week-old male SoNar mice were treated with the same method for 2 weeks. The aorta was dissected and sectioned, and the NADH/NAD⁺ ratio was measured by fluorescence quantitative method. Results: Compared with the group receiving BAPN alone, the mortality rate of mice treated with NMN or NR decreased, but there was no significant difference. BAPN induced significant dilation of the thoracic aorta in mice (P < 0.001) and resulted in more severe TAA pathological phenotypes. However, NMN or NR treatment could reduce the degree of dilation and alleviate the pathological manifestations of the tissues. There was no significant difference in the ratio of free NADH/NAD⁺ in aortic tissue among these groups. Conclusion: Oral supplementation of NAD⁺ precursors had a certain therapeutic effect on thoracic aortic dilatation and lesions in BAPN model mice, reducing the incidence of fatal TAA events.

Objective: To investigate the survival outcomes and identify prognostic factors among patients with primary liver cancer (PLC) in Huangpu District of Shanghai, and to provide evidence for future prevention, treatment and prognosis improvement. Methods: A total of 523 cases diagnosed with PLC from Jan 2010 to Dec 2014, registered in the Shanghai Tumor Registry System (STRS) and cause-of-death surveillance system residing in Huangpu District were retrospectively collected. The endpoint of follow up was in Jun 2023. Survival status was analyzed using Kaplan-Meier method to estimate survival rate and median survival time. Differences in survival rates between groups were analyzed using Log-rank test. Cox proportional hazards regression was applied to identify independent prognostic factors. Results: The one-year, five-year and ten-year observed survival rates of the 523 cases were 25.9%, 18.4% and 15.8%, respectively. The male-to-female ratio was 2.5:1. Males were diagnosed and died at significantly younger ages than females (t=6.919, P < 0.001; t=6.921, P < 0.001). Univariate analysis revealed significant associations between overall survival and age (HR=1.339, P=0.004), hepatitis B virus infection (HR=1.320, P=0.004), chronic hepatitis B (HR=1.283, P=0.037), hepatitis C virus infection (HR=1.482, P=0.013), liver cirrhosis (HR=1.437, P=0.020) and level of healthcare (secondary vs. tertiary, HR=1.593, P < 0.001)and clinical stages (HR=2.013, P=0.004). Multivariate analysis identified age (HR=1.300, P=0.010), hepatitis B virus infection (HR=1.367, P=0.002), hepatitis C virus infection (HR=1.392, P=0.045), level of healthcare (secondary vs. tertiary, HR=1.591, P < 0.001) and clinical stage (HR=1.851, P=0.011) as independent prognostic factors. Conclusion: Age, hepatitis B virus infection, hepatitis C virus infection, level of healthcare and clinical stages are significant risk factors affecting survival in patients with PLC in Huangpu District. PLC remains a major public health priority for cancer prevention and control in this region.

Objective: To identify independent prognostic risk factors for overall survival (OS) in patients with newly diagnosed primary central nervous system lymphoma (PCNSL), to develop a nomogram prediction model and to evaluate its predictive performance for risk stratification. Methods: A total of 289 newly diagnosed PCNSL patients treated in Huashan Hospital, Fudan University between Jan 2014 and Mar 2024 were enrolled. Prognostic risk factors for OS were identified using LASSO Cox regression and multivariable Cox regression analysis. A nomogram prediction model was then constructed. Kaplan-Meier survival curves were drawn to evaluate the model's risk stratification ability. The new prognostic model was evaluated using time-dependent receiver operating characteristic curves (ROC) and calibration curves. Results: Age, ECOG-PS score, D-dimer levels, and the neutrophil-to-lymphocyte ratio (NLR) were identified as predictors of poor OS (P < 0.05). Kaplan-Meier survival analysis demonstrated excellent risk stratification by the novel prognostic model, with statistically significant differences in OS among the distinct risk groups (P < 0.000 1). The time-dependent area under the ROC curve (AUC) for the nomogram at 1-year, 3-year and 5-year survival were 0.700, 0.725 and 0.742, respectively, indicating consistently stable predictive performance across time points. Calibration curves showed good agreement between predicted and actual survival probabilities. Conclusion: Age, ECOG-PS score, D-dimer levels, and NLR are prognostic factors for poor long-term outcomes in PCNSL patients. The nomogram based on these factors may assist clinicians in risk stratification and in optimizing therapeutic strategies for newly diagnosed PCNSL patients.

Objective: To evaluate the intraoperative ventilation efficacy and safety of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) combined with manually controlled jet ventilation (MCJV) in pediatric patients undergoing bronchoalveolar lavage under general anesthesia, and to verify non-inferiority to laryngeal mask airway (LMA) in maintaining adequate oxygenation, and to compare surgical field visualization, as well as intraoperative and postoperative ventilation and gas exchange parameters. Methods: A single-center, prospective, randomized controlled non-inferiority trial was conducted. Children aged 2-12 years scheduled for bronchoalveolar lavage under general anesthesia from Jan to Jun 2024 were enrolled and randomly allocated at a 1∶1 ratio to either THRIVE+MCJV group (n=40) or LMA group (n=40). The primary outcome was the intraoperative lowest transcutaneous oxygen partial pressure (TcPO₂). Secondary outcomes included intraoperative average and the lowest peripheral oxygen saturation (SpO₂), the average and peak of transcutaneous carbon dioxide partial pressure (TcPCO₂), surgical field exposure satisfaction scores, the incidence of procedural interruption, duration of the ventilation device removal, and rate of postoperative complications. Results: The lowest intraoperative TcPO₂ values were (202.08±69.17) mmHg in THRIVE+MCJV group and (227.95±67.26) mmHg in the LMA group. There was no statistically significant difference between THRIVE+MCJV group and LMA group in the mean intraoperative SpO₂ (99.35%±1.44% vs. 99.34%±1.66%). Compared to the LMA group, the intraoperative peak TcPCO₂ was higher in the THRIVE+MCJV group [(70.3±12.66) mmHg vs. (60.18±13.07) mmHg, P=0.000 7], shorter duration to the removal of the ventilation device [(4.74±1.57) min vs. (5.83±1.68) min, P=0.002 9], and superior surgical field exposure satisfaction scores [4.83(5, 5) vs. 4.53(4, 5), P=0.034]. No significant differences were observed in either procedural interruption incidence or postoperative complications (agitation, severe cough, nausea/vomiting). Conclusion: In pediatric bronchoalveolar lavage under general anesthesia, the combination of THRIVE and MCJV demonstrated non-inferiority to LMA in maintaining intraoperative oxygenation. It also improved surgical field visualization and enabled earlier extubation. Although associated with higher TcPCO₂, this approach may serve as a viable alternative to LMA ventilation when managed by experienced anesthesiologists.

Objective: To construct a prediction model integrating donor and recipient genetic information for classifying the elimination rate of tacrolimus (FK506) during the early postoperative period in allogeneic liver transplant recipients, with the aim of optimizing individualized dosing strategies in the early postoperative phase. Methods: This was a single-center retrospective cohort study. A total of 174 liver transplant recipients from Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from Oct 2016 to Jul 2021 was involved. Dosage and concentration of FK506, liver and kidney function, rejection reactions, infection, serum albumin, and hematocrit were collected. Genotypes of donor and recipient CYP3A5 rs776746, donor FMO3 rs1800822, and recipient SLCO1B1 rs4149015 were determined by sequencing. Factors influencing FK506 elimination speed were screened by multiple linear regression analysis. Accuracy evaluation of prediction model for classification of FK506 elimination was assessed by ROC curve analysis. Results: The median alanine aminotransferase level returned to the normal range (< 40 U/L) on postoperative day 13. The median total bilirubin level decreased below the upper limit of normal (23 μmol/L) after postoperative day 15. Concurrently, the dose-corrected trough concentration (C/D ratio) of tacrolimus (FK506) reached a plateau around postoperative day 9 (83.30-108.80 ng·mL^-¹·mg^-¹·kg^-¹). According to the C/D ratio during 2 weeks after operation, phenotypes of FK506 elimination could be divided into fast elimination, intermediate elimination and slow elimination. Significant differences were observed among the 3 groups in terms of body mass-standardized daily dose and trough concentration. The median daily dose in the fast elimination group (0.082 mg/kg) was 3.1 times that in the slow elimination group (0.026 mg/kg), while its median trough concentration (5.0 ng/mL) was significantly lower than that in the slow elimination group (9.0 ng/mL). Both the bacterial infection rate (65.1%) and elevated urea nitrogen rate (41.9%) in the slow elimination group were significantly higher than those in the other two groups (all P < 0.05). Multiple linear regression analysis showed that donor and recipient CYP3A5 rs776746 (P < 0.001), and recipient SLCO1B1 rs4149015 (P=0.033) were independent influencing factors on the C/D ratio. ROC curve analysis showed that the AUC of fast elimination and slow elimination predicted by the combination of the 3 genotypes were 0.828 (P < 0.001) and 0.727 (P < 0.001), respectively. Conclusion: The combination of donor and recipient genotype testing might accurately predict the FK506 elimination phenotypes in liver transplant patients, providing a basis for individualized treatment strategies and reducing adverse drug reactions.

Objective: To explore the diagnostic value of urine hexokinase2(HK2) test and liquid based thin-prep cytology test (TCT) in urothelial carcinoma (UC) by urine specimen. Methods: We conducted a retrospective review of clinical data of 124 patients treated at Huashan Hospital, Fudan University from Jan 2021 to Jan 2023. HK2 test and TCT were performed prior to ureteroscopic biopsy or surgical treatment. The diagnostic results of the two methods alone or in combination were compared with the histological results. Results: HK2 testing exhibited higher sensitivity in the diagnosis of urothelial carcinoma (UC) than TCT.The sensitivity and specificity of HK2 for the diagnosis of UC were 79.52% (66/83) and 80.49% (33/41), respectively; the sensitivities for high-grade UC and low-grade UC were 90.00% (45/50) and 63.64% (21/33), respectively.Conventional TCT testing showed relatively low sensitivity: the sensitivity and specificity of TCT for the diagnosis of UC were 51.81% (43/83) and 95.12% (39/41), respectively; the sensitivities for high-grade UC and low-grade UC were 56.00% (28/50) and 45.45% (15/33), respectively.Combined detection of the two assays improved diagnostic sensitivity: the sensitivity and specificity of combined TCT and HK2 testing for UC were 84.34% (70/83) and 80.49% (33/41), respectively; the sensitivities for high-grade UC and low-grade UC were 92.00% (46/50) and 72.73% (24/33), respectively. Conclusion: The sensitivity of urine HK2 test in diagnosing UC is higher than that of TCT; the combination of both tests can significantly improve the sensitivity in diagnosing UC, especially low-grade UC.

Objective: To develop a highly sensitive method for detecting peripheral blood G-quadruplex (G4) based on rolling circle amplification (RCA) technology, establish a non-invasive molecular diagnostic system for ATRX-mutant gliomas, and provide a novel liquid biopsy strategy for clinical early screening. Methods: ATRX knockdown glioma cell lines (ATRX KD) were constructed via shRNA lentiviral infection. Thioflavin T (ThT) fluorescence spectroscopy was employed to detect G4 levels in the supernatant. An orthotopic ATRX knockdown glioma mouse model was established. RCA was applied to compare G4 abundance in peripheral blood circulating cell-free DNA (cfDNA) between model and control groups, with optimization of RCA amplification protocols. Serum samples from clinically confirmed ATRX-mutant gliomas, wild-type gliomas, and healthy volunteers were collected. After cfDNA extraction, G4 quantification was performed using optimized RCA protocols with further procedural refinement. Results: In vitro experiments demonstrated that ATRX knockdown significantly promoted the formation of G4 structures, with the ThT fluorescence intensity in the supernatant of ATRX KD cells being significantly higher than that in wild-type cells. The experimental conditions for detecting G4 structures in cfDNA from the peripheral blood of ATRX-mutant glioma mouse models using RCA temperature-variable amplification were established: starting with 50 ng of cfDNA as the template and performing 10 amplification cycles. Clinical sample validation showed that the optimized RCA temperature-variable amplification protocol improved efficiency compared to traditional isothermal amplification and effectively distinguished ATRX-mutant glioma patients from wild-type patients and healthy individuals. Conclusion: This study successfully developed a highly sensitive peripheral blood G4 detection system based on RCA. This technology pioneers liquid biopsy-based molecular subtyping of ATRX mutation status, offering a clinically promising non-invasive diagnostic approach for early glioma screening.

Objective: To investigate the occurrence rate of catastrophic health expenditure (CHE) among patients with multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in the Yangtze River Delta, and to identify high-risk groups and risk time points for CHE. Methods: A stratified cluster sampling method was used to select 10 designated hospitals for MDR/RR-TB across three provinces and one municipality in the Yangtze River Delta region. The study population consisted of patients diagnosed with MDR/RR-TB who were registered for treatment at the selected hospitals between July 2017 and June 2019. A self-designed questionnaire was used to collect patients' demographic information, while TB diagnosis, treatment-related information, and medical expenses were extracted from hospital medical information and billing systems. The economic burden of MDR/RR-TB was assessed using total direct medical costs, reimbursement amounts, and the incidence of CHE. A binary logistic regression model was employed to analyze the factors influencing CHE, and the cumulative incidence of CHE was calculated monthly to identify risk points. Results: A total of 387 questionnaires were distributed, with 344 valid responses, resulting in an effective response rate of 88.89%. The incidence of CHE among the respondents was 62.79%. Patients in region C (OR=4.50, 95%CI: 1.08-18.76) and region D (OR=10.22, 95%CI: 1.70-61.39) were more likely to experience CHE compared with those in region A. Higher total annual household income (OR=0.01, 95%CI: 0.01-0.05) and medical insurance coverage (OR=0.17, 95%CI: 0.04-0.62) were protective factors against CHE, whereas hospitalization during treatment (OR=8.06, 95%CI: 3.26-22.68) was a risk factor. The occurrence rate of CHE increased most rapidly during the first 4 months of anti-TB treatment, reaching a cumulative incidence of 60.47% by the end of the fourth month. It further rose to 61.63% between the fifth and sixth months and then gradually slowed and stabilized thereafter. Conclusion: MDR/RR-TB patients still face a heavy economic burden, with low education levels, low total annual household income, lack of medical insurance, and hospitalization during treatment identified as high-risk factors for CHE. Strengthening financial protection is essential, particularly during the first 4 months of treatment. Optimizing medical insurance and exemption policies tailored to different patient groups is necessary to reduce the occurrence rate of CHE.

Severe asthma is defined as asthma that remains uncontrolled after continuous, standardized treatment with medium-to-high-dose inhaled corticosteroids (ICS) plus long-acting β₂-agonists (LABA) for three months or more, together with management of comorbidities and environmental factors, or that worsens when the high-dose ICS/LABA regimen is stepped down. Chronic rhinosinusitis with nasal polyps (CRSwNP) and atopic dermatitis are common comorbidities of severe asthma, and type-2 inflammation is the common pathophysiology of all three disorders. We present a patient with severe asthma, CRSwNP and atopic dermatitis whose disease was inadequately controlled by topical ICS plus bronchodilators. Sequential therapy with omalizumab and dupilumab, together with endoscopic sinus surgery, was required. The diagnostic and therapeutic course and its outcomes are described in detail to provide clinicians with a reference for managing co-existing type-2 inflammation.

This study retrospectively analyzed the diagnosis and treatment of a patient with eosinophilia accompanied by pleural effusion and reversible restrictive pulmonary ventilation dysfunction. The patient presented with cough and phlegm, with scattered patchy lesions observed in both lungs on chest CT images. Then pleural effusion occurred with increased eosinophils observed in both peripheral blood and pleural effusion. Chest tightness and shortness of breath gradually worsened, and lung function showed moderate to severe restrictive pulmonary dysfunction. The patient was treated with oral corticosteroids and inhaled preparations after the diagnosis of eosinophilia, and then all symptoms were completely relieved and lung function improved significantly.

Objective: To analyze the depression and anxiety situation in asthmatic patients and their relationship with asthma symptom control and allergic comorbidities, and to evaluate the effects of psychological interventions on mental health and asthma control. Methods: Between Dec 2020 and Jul 2024, 231 asthmatic patients were enrolled and underwent mental assessment in Zhongshan Hospital, Fudan University. Data on demographics, asthma characteristics, allergic comorbidities, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores were collected via questionnaires. The Wilcoxon rank-sum test and chi-square test were used to compare clinical characteristics of patients with different anxiety and depression statuses. Multivariate logistic regression was employed to analyze the associations of anxiety and depression with asthma control, acute exacerbations, and allergic comorbidities. Fifty-two patients received psychological interventions provided by psychiatrists, and improvements in asthma control and mental health were evaluated before and after treatment. A linear mixed-effects model was applied to evaluate the improvement after psychological interventions. Results: Among 231 asthmatic patients, 16 cases (6.93%) had depression alone, 28 cases (12.12%) had anxiety alone, and 72 cases (31.17%) exhibited comorbid anxiety and depression. Patients with anxiety or depression were younger, more likely to be unmarried, reported chest tightness, experienced frequent acute exacerbations, and had more allergic comorbidities (all P < 0.05), though no significant differences were observed in asthma duration, lung function, or fractional exhaled nitric oxide (FeNO). Multivariate Logistic regression indicated that both anxiety and depression were significantly associated with poor asthma control (anxiety: OR=1.93, 95%CI: 1.03-3.63, P=0.040; depression: OR=3.77, 95%CI: 2.01-7.19, P < 0.001), and acute exacerbations (anxiety: OR=4.30, 95%CI: 1.78-10.38, P < 0.001;depression: OR=1.22, 95%CI: 1.08-1.61, P=0.003). Allergic comorbidities were significantly associated with anxiety (OR=1.80, 95%CI: 1.15-2.82, P=0.010) but not with depression. After psychological interventions, the 52 patients showed significant improvements in Asthma Control Test (ACT), mini Asthma Quality of Life Questionnaire (miniAQLQ), PHQ-9 and GAD-7 scores (all P < 0.001). Conclusion: Anxiety and depression are prevalent in asthmatic patients and are strongly associated with acute exacerbations, suboptimal symptom control, and reduced quality of life. Allergic comorbidities are significantly linked to the increased risk of anxiety. Psychological interventions represent a feasible strategy to improve asthma control and mental well-being outcomes.

Objective: To investigate the origin and expression of lactoperoxidase (LPO) in distinct nasal polyp subtypes and the impact of Staphylococcus aureus (S. aureus) infection on its expression. Methods: Published single-cell RNA sequencing data of nasal polyp tissues and control nasal mucosa tissues from both American and Chinese cohorts were analyzed to identify the cellular origin of LPO and its differential expression across chronic rhinosinusitis with nasal polyps (CRSwNP)subtypes. Clinical samples were collected to validate LPO expression at the mRNA (RT-qPCR) and protein (immunohistochemistry, IHC) levels. A mouse S. aureus nasal infection model was established to detect the effect of bacterial colonization on LPO expression. Results: LPO was primarily produced by submucosal glandular cells. Its expression was significantly lower in nasal polyp tissues compared to control nasal mucosa in both cohorts, with the lowest expression observed in non-ECRSwNP. The proportion of glandular cells was markedly reduced in nasal polyps, particularly in non-ECRSwNP, which was positively correlated with LPO expression levels. RT-qPCR and IHC confirmed LPO expression was decreased in polyp tissues. The murine model demonstrated that S. aureus colonization significantly suppressed LPO expression. Conclusion: LPO is predominantly produced by nasal submucosal glandular cells; its expression is significantly lower in CRSwNP-especially in non‑ECRSwNP- than in non‑polyp nasal mucosa, and is directly associated with submucosal glandular loss. S. aureus colonization downregulates LPO expression in the mouse nasal mucosa, suggesting that reduced LPO expression may contribute to mucosal barrier dysfunction in CRSwNP.

Objective: To establish and evaluate a house dust mite (HDM)-specific subcutaneous allergen immunotherapy (AIT) mouse model for allergic rhinitis (AR). Methods: Thirty female C57 mice were randomly divided into control group, AR group and AIT group, with 10 mice in each group. In AR group, mice were sensitized with HDM, followed by nasal challenge with HDM. Mice in the AIT group received HDM sensitization, followed by subcutaneous injection of HDM on the lateral back as immunotherapy, and then received nasal challenge with HDM. Body weight, nasal symptoms, inflammation status of nasal and lung tissue, the number of total cells, eosinophils, neutrophils, lymphocytes and macrophages in bronchoalveolar lavage fluid (BALF), serum HDM-sIgE, IL-4, IL-5, IL-6, IL-10 and IFN-γ levels among three groups of mice were measured and compared. Results: Compared with control group, AR group showed significant weight loss, worsening of nasal scratching and sneezing symptoms, thickening of nasal mucosa, significant increase in nasal goblet cells and eosinophils, obvious increase in pulmonary inflammatory cells and goblet cells, and significant increase in total cells, eosinophils, neutrophils, and lymphocytes in BALF (all P < 0.05). Serum HDM-sIgE, IL4, IL5, IL6, IL10 AND IFN-γ levels were significantly elevated (all P < 0.05). Moreover, compared with AR group, AIT group showed significant weight gain, relief of AR symptoms, reduction in nasal mucosa thickness, decrease in nasal goblet cells and eosinophils, significant reduction in pulmonary inflammatory cell infiltration and goblet cell metaplasia, significant reduction in total cells, eosinophils, neutrophils, and lymphocytes in BALF, significant decrease in serum IL-4, IL-5, IL-6 and IL-10, and significantly elevated serum IFN-γ level (all P < 0.05). Conclusion: Establishment of the mouse model for HDM-specific subcutaneous immunotherapy in AR was successful, it can be used as an efficient, convenient and feasible animal model to further explore immunotherapy.

Asthma shares common immunopathological mechanisms with allergic rhinitis (AR) and chronic rhinosinusitis (CRS), often presenting as comorbidities. This necessitates a comprehensive evaluation of severity across both upper and lower airways, adopting a stepwise and sequential approach. Treatment should adhere to the principle of integrated management of coexisting upper and lower airway diseases, employing combined therapeutic strategies, including environmental control as the foundation, pharmacotherapy as the core, biologics as the breakthrough, immunotherapy as the etiological treatment, and long-term follow-up as the safeguard. The combined use of corticosteroids, antihistamines, leukotriene receptor antagonists, and biologics can effectively control inflammatory responses in both upper and lower airways, alleviating symptoms, improving quality of life, and preventing disease recurrence, progression, and acute exacerbations. Allergen immunotherapy, as a long-term etiological treatment, induces immune tolerance in responders, reduces sensitivity to allergens and thereby prevents the onset and progression of asthma. Although biologics have demonstrated promising efficacy in treating asthma comorbid with AR and CRS, challenges remain. Endoscopic sinus surgery is the fundamental surgical treatment for CRS. In patients with comorbid asthma, surgical risks should be thoroughly evaluated and perioperative management enhanced. Future research should focus on precise phenotyping and personalized interventions to achieve dual goals of symptom control and disease modification, optimize treatment regimens, and enhance patients' quality of life.

Multi-state models represent a critical methodological framework for analyzing longitudinal medical data, enabling precise characterization of dynamic disease progression across discrete health states. This article provides a concise introduction to the theoretical foundations of multi-state models, encompassing: (1) principles for defining the state space; (2) methods for quantifying transition intensities and transition probabilities; and (3) key modeling assumptions such as Markov property and time homogeneity. Through a case study on cardiac allograft vasculopathy (CAV) progression after heart transplantation, we illustrate the essential steps in constructing a multi-state model: translating clinical questions into state structures (e.g., CAV severity grades), statistical approaches for handling irregular follow-up intervals, and multivariable analysis of covariate effects. The case study demonstrates that multi-state models can precisely quantify transition patterns across multiple disease stages, offering robust methodological support for dynamic risk assessment and personalized interventions. Given their clinical relevance and analytical flexibility, multi-state models hold significant potential for broader application in medical research.

Non-ST-elevation myocardial infarction (NSTEMI) is a type of acute coronary syndrome (ACS), typically presenting with chest pain or tightness, ST-segment depression on electrocardiogram (ECG), and elevated levels of cardiac biomarkers. Meanwhile, myocarditis or inflammatory myopathies can also cause elevated levels of cardiac biomarkers and nonspecific electrocardiogram abnormalities, potentially leading to misdiagnosis. Polymyositis (PM) is an idiopathic inflammatory myopathy (IIM) classified as a systemic autoimmune disease, primarily affecting striated muscles. Pathologically, it is characterized by inflammatory infiltration, degeneration, and necrosis of muscle fibers, mainly involving proximal limb muscles and neck flexors, it may involve respiratory and swallowing muscles in severe cases. This paper reports the diagnosis and treatment process of a case of PM misdiagnosed as NSTEMI in Huashan Hospital, Fudan University, and summarizes the characteristics of cardiac manifestations of PM, so as to provide a reference in differentiating PM and myocardial infarction.

This article reports the multidisciplinary team (MDT) management of a pregnant patient with ulcerative colitis (UC). The patient was diagnosed with total colonic UC before pregnancy, achieved remission through infliximab (IFX) induction therapy, and subsequently conceived through assisted reproductive technology. During pregnancy, an MDT was established, led by the Department of Obstetrics and including the Department of Nutrition, Gastroenterology, and Neonatology, to implement comprehensive management. The team's practice involved: the Department of Nutrition formulating and implementing a low-fat, low-fiber diet with enteral nutritional support; the Department of Gastroenterology dynamically monitoring calprotectin and C-reactive protein levels to guide IFX dosage adjustments; the Department of Obstetrics managing maternal weight, regularly monitoring fetal growth, and determining the timing and mode of delivery; and the Department of Neonatology providing vigilant monitoring, which detailed postnatal care and a personalized immunization strategy. Through this structured MDT approach, the patient maintained sustained disease remission throughout pregnancy and delivered a healthy infant girl at 38⁺⁴ weeks of gestation, with favorable maternal and neonatal outcomes. This case exemplifies the practical workflow of the MDT model in managing UC during pregnancy, demonstrating that dynamic management and individualized interventions based on clear role allocation are essential for ensuring the safety of both the mother and the infant.

Cribriform-morular thyroid carcinoma (CMTC) is a rare malignant thyroid tumor with unique genetic characteristics. It is often an extracolonic manifestation of familial adenomatous polyposis (FAP). In this case, a 26-year-old female was found to have multiple bilateral thyroid nodules. She underwent radical surgery for bilateral thyroid carcinoma in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The routine pathology and immunohistochemistry after surgery confirmed CMTC. This is a rare case of multifocal CMTC. The ultrasonography showed multifocal nodules, which were dominated by isoecho and varied in morphology. There was no obvious calcification inside the multifocal nodules. This article highlights the ultrasonographic manifestations and pathological features of CMTC to enhance its understanding.

Bariatric surgery remains an effective and long-lasting treatment for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is currently the most widely used surgical procedure, but it has the disadvantages of suboptimal medium- and long-term weight loss effects and weight regain. The problem of weight regain after LSG has drawn increasing attention from bariatric physicians. In revision surgery, single-anastomosis duodena-ileal bypass with sleeve gastrectomy (SADI-S) achieves satisfactory weight loss with lowest risk of weight regain and fewest complications. In this case, a patient with type 2 diabetes and morbid obesity regained weight four years after LSG underwent SADI-S revision, resulting in further weight loss and stable maintenance during a 3-year follow-up period.

To evaluate the intervention effects of a modified hypertension extended prescription service program on community-dwelling hypertensive patients, we included 202 hypertensive patients who signed contracts with family doctors at the Liuzhao Community Health Service Center in Shanghai from Sept 2023 to Dec 2023. We used a self-controlled pre-post intervention design. The mean age of the patients was (70.78±10.94) years. All of them received the modified hypertension extended prescription service program for 6 months. Outcomes were assessed before and after the intervention, included subjective satisfaction (via a self-designed questionnaire), medication satisfaction (via the Treatment Satisfaction Questionnaire for Medication, version 2 [TSQM-Ⅱ]), medication adherence (via the Medication Adherence Scale), and blood pressure (systolic and diastolic). After the intervention, patients showed significant improvements in subjective satisfaction. TSQM-Ⅱ scores increased significantly in the domains of effectiveness, side effects, overall satisfaction, and total score, while no significant change was observed in convenience. Medication adherence scores did not improve significantly. Both systolic blood pressure [(139.54±14.18) mmHg vs. (132.00±8.90) mmHg, P < 0.001] and diastolic blood pressure [(80.81±6.88) mmHg vs. (77.28±7.32) mmHg, P < 0.001] decreased significantly. The modified hypertension extended prescription service program demonstrated favorable intervention effects on community-dwelling hypertensive patients, and its long-term effect deserves further attention.

Acquired immunodeficiency syndrome (AIDS) is a severe disease caused by human immunodeficiency virus (HIV) infection. Although antiretroviral therapy (ART) has significantly reduced mortality, HIV-associated malignancies remain a major complication. HIV drives tumorigenesis through two main mechanisms: the first is the remodeling of immunometabolism, such as causing an imbalance between glycolysis and oxidative phosphorylation in CD4⁺ T cells and inducing high expression of programmed cell death protein 1 and functional exhaustion in CD8⁺ T cells, and the second is the establishment of a chronic inflammatory microenvironment. This review systematically delineates the synergistic oncogenic mechanisms underlying HIV and various oncogenic viruses coinfection with a focus on the central role of immunometabolic crosstalk, in order to provide a reference for developing precise interventions aimed at reducing cancer risk in HIV-infected individuals.

Lung cancer is one of the most common cancers globally, accounting for about one-tenth of all cancer cases, and it is also one of the leading causes of cancer-related deaths, representing approximately one-fifth of such deaths. In recent years, early screening has become one of the reliable strategies to reduce the mortality of lung cancer. With the widespread application of low-dose computed tomography (LDCT) in lung cancer screening, many countries and regions have carried out large-scale screening programs and made positive progress. The development of lung cancer screening programs are related to many factors such as smoking history, air pollution, gender, age and so on. At the same time, the continuous development of computer-aided diagnosis (CAD), artificial intelligence (AI) and comprehensive pulmonary nodule planning are of great significance for improving the accuracy of early diagnosis of lung cancer. This article reviews the research status and progress of early screening for lung cancer, with a key comparison of the similarities and differences in screening policies among China, the United States, and the United Kingdom, as well as how lung cancer-related factors influence the screening policies in these countries. All three countries use LDCT as the main screening method, but there are differences in population selection, screening frequency, policy support and public compliance.

Objective: To explore the association between healthy lifestyle index (HLI) and cognitive decline, as well as the mediating effect of blood routine derived inflammatory indexes in community-dwelling elderly people. Methods: A multistage random sampling method was used to enroll 1 181 older persons aged ≥65 years with normal cognition in Songjiang District, Shanghai at baseline from May 2020 to Dec 2021, and they were followed up from Jun 2023 to Oct 2023. The Mini-Mental State Examination (MMSE) was used to examine their cognitive function. HLI was computed as a composite score reflecting adherence to six factors: non-smoking, abstinence from alcohol, sufficient fruit consumption, adequate vegetable intake, good sleep quality, and engagement in regular physical activity. Based on the distribution of total scores, study subjects were classified into tertiles and designated as high HLI (75-100) group, moderate HLI (58-74) group and low HLI (0-57) group. Cox proportional hazards regression model was used to assess the association between HLI, blood routine derived inflammatory indexes, and cognitive decline. Multiple linear regression model was used to assess the association between HLI and blood routine derived inflammatory indexes. The mediation analysis was used to examine the mediating effect of blood routine derived inflammatory indexes between cognitive decline and HLI. Results: During the follow-up period, 225 out of 1 181 cases experienced cognitive decline. Compared with low HLI group, the risk of cognitive decline in moderate HLI group and high HLI group was reduced by 29% (HR=0.71, 95%CI: 0.51-1.00) and 38% (HR=0.62, 95%CI: 0.44-0.87); the monocyte counts in moderate HLI (β=-0.032, 95%CI: -0.056, -0.008) group and high HLI (β=-0.050, 95%CI: -0.076, -0.024) group were significantly reduced. The monocyte had a significant partial mediating effect on the association between HLI and cognitive decline. Conclusion: Healthy lifestyles were associated with a lower risk of cognitive decline, and this association may be partially mediated by monocyte.