Observational studies are important approaches for obtaining real-world evidence. However, due to the lack of randomized allocation, differences in baseline characteristics between groups often introduce confounding bias, which may distort the results. Traditional stratified analyses and multivariable regression models have limited ability to control confounding when multiple covariates are involved. Propensity score matching estimates the probability of receiving an intervention based on observed covariates, then matches individuals with similar propensity scores between treatment and control groups, thereby balancing covariate distributions and reducing confounding. In recent years, propensity score matching has been widely applied in various fields, including chronic disease management and drug effectiveness evaluation, public health policy and health service assessment, vaccine effectiveness studies focusing on population disparities, and evaluations of telemedicine interventions. This review summarizes common matching methods and application scenarios of propensity score matching in observational studies.

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.

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 revise the Chinese version of the Mental Health Literacy Scale (MHLS) and validate its reliability and validity, aiming to develop a measurement tool suitable for assessing mental health literacy in the Chinese population. Methods: A convenience sampling method was employed to collect valid data from 341 community residents via the Wenjuanxing online survey platform between Oct 2019 and Apr 2020. The measurement instruments included the MHLS, the Simplified Coping Style Questionnaire (SCSQ), the Self Help Strategies for Subclinical Depression (SHS), the Help-Seeking Questionnaire (HSQ), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to examine the scale's reliability and validity. Internal consistency and stability were assessed using Cronbach's α and test-retest reliability, while construct validity, convergent validity, discriminant validity, and criterion-related validity were evaluated to verify the psychometric properties. Results: EFA extracted five common factors: disease knowledge, information-seeking, attitudes toward mental illness, attitudes toward help-seeking, and stigma, with a cumulative variance explanation rate of 43.297%. CFA indicated a good fit for the five-factor model (χ²/df=1.754), comparative fit index (CFI) was 0.903, incremental fit index (IFI) was 0.905, goodness-of-fit index (GFI) was 0.884, root mean square error of approximation (RMSEA) was 0.047, and root mean square residual (RMR) was 0.053. The Cronbach's α coefficients for the total scale and subscales ranged from 0.701 to 0.877, and test-retest reliability ranged from 0.617 to 0.882 (P < 0.01). Additionally, the total score of the MHLS showed significant positive correlations with the positive coping subscale of the SCSQ (r=0.213, P < 0.01), the HSQ score (r=0.248, P < 0.01), and the SHS score (r=0.302, P < 0.01), demonstrating good criterion-related validity. The results of group difference analysis revealed that males, individuals with lower educational attainment, and those without prior mental health knowledge training exhibited significantly lower levels of mental health literacy compared with other demographic groups. Conclusion: The Chinese version of the MHLS demonstrates good reliability and validity in a Chinese sample, serving as a scientific measurement tool for assessing individual mental health literacy and providing insights into the public's understanding of mental health. Additionally, it is recommended to enhance mental health awareness among males and individuals with lower educational attainment through multi-channel educational initiatives.

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

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.

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.

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

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

Objective: To 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.

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.

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.

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.

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

The lung is a vital organ that is in direct contact with the external environment. It is extremely susceptible to a variety of exogenous factors, which can trigger a series of inflammatory responses and lead to varying degrees of tissue damage. With the development of genetic engineering technology, silencing specific target genes through RNA interference has become a new strategy for the treatment of lung injury. Small interfering RNA (siRNA) is a crucial role in RNA interference that can bind to the target gene through base complementary pairing to inhibit its expression, thereby producing a corresponding regulatory effect. Due to its specific targeting and low biological toxicity, siRNA is gradually becoming an ideal tool for the treatment of lung injury and other lung diseases. This article reviews the mechanism of action of siRNA and its application progress and research status in the treatment of lung injury.

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

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.

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.

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.

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

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.

Objective: To describe and analyze the current status, changing trend and influencing factors of the disease burden of cervical, endometrial and ovarian cancer in China from 1990 to 2021. Methods: Data on incidence, mortality, disability-adjusted life year (DALY), and other indicators for cervical, endometrial and ovarian cancer were collected from the 2021 Global Burden of Disease database. Joinpoint regression models were used to analyze time trends, and age-period-cohort (APC) models assessed their impact on incidence and mortality. Spearman correlation analysis was performed to evaluate the relationship between the sociodemographic index (SDI) and the cancer indicators. Finally, the attributable risk factors for the disease burden were analyzed. Results: From 1990 to 2021, age-standardized incidence rates of cervical and endometrial cancers in China significantly increased, while ovarian cancer showed no significant change. Age-standardized mortality, DALY, and years of life lost due to premature death (YLL) decreased significantly. The disease burden was heavier in middle-aged and older groups. APC model indicated an increase in cervical cancer incidence and a decrease in mortality over time. Furthermore, the incidence risks of cervical and endometrial cancers were elevated in successive birth cohorts, whereas a lower risk was observed for ovarian cancer. Correlation analysis showed significant associations between cancer incidence and mortality with SDI. Obesity has significantly contributed to the disease burden of common gynecologic cancers in China. Conclusion: Mortality rates of cervical, endometrial and ovarian cancer have declined, while the incidence of cervical and endometrial cancers has significantly increased. The trends in incidence and mortality are influenced by age, period and cohort effects. Future efforts should focus on controlling risk factors like obesity to reduce the disease burden.

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

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

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.

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

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.

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

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.

A 21-year-old unmarried female visited Obstetrics and Gynecology Hospital, Fudan University with the chief complaint, memory decline for more than 20 days and discovery of a pelvic mass for more than 10 days. Through systematic examination, she was diagnosed with teratoma-associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. The patient underwent bilateral ovarian teratoma enucleation, and postoperative pathology revealed immature teratoma grade Ⅰ in the left ovary and mature teratoma in the right ovary. Perioperative combined immunotherapy significantly improved her neuropsychiatric symptoms. The diagnosis and treatment of ovarian teratoma-associated anti-NMDAR encephalitis require multidisciplinary collaboration, with accurate diagnosis, timely surgical resection within 1 month, and early initiation of immunotherapy being critical factors for improving prognosis. Clinicians should remain vigilant to avoid missed or misdiagnosed cases, as this condition can lead to severe outcomes.

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.

Objective: To explore the integrated application of artificial intelligence (AI) technologies in intelligent triage, pre-consultation, and online patient accompaniment navigation systems at a children's hospital in order to build an efficient and precise smart medical service system. Methods: Integrating natural language processing and machine learning technologies, the "DS-Dr. XiaoBu 2.0" intelligent system was designed. It utilized patients' pre-consultation waiting time to collect structured medical history information via the hospital's WeChat official account and interfaces in real-time with the Hospital Information System (HIS). Simultaneously, online patient accompaniment navigation function was developed, optimizing in-hospital diagnosis and treatment path planning based on indoor positioning technology. Operational trial data was used to iteratively optimize the algorithm, and a multi-level verification mechanism was established to minimize information errors. Results: Since the implementation of the intelligent triage system in Children's Hospital, Fudan University, usage reached 190 800 patient visits. Within 3 months of operating the "DS-Dr. XiaoBu 2.0" version, usage reached 14 500 visits, with 85.17% of intelligent inquiries focused on consultation procedures and guidance. Related inquiries to the manual hotline decreased by 31.32% and 4.21%, respectively (P < 0.05). The implementation of intelligent pre-consultation significantly reduced the average waiting time before consultation from (21.06±3.90) minutes to (11.88±2.83) minutes (P < 0.05). After deploying the online patient accompaniment navigation, the total consultation time for patients requiring medication prescriptions decreased from (149±23) minutes to (134±20) minutes (P < 0.05). Conclusion: The AI-driven service model encompassing "pre-consultation-intelligent triage-online patient accompaniment navigation function" can optimize resource allocation, reduce waiting times and enhance doctor-patient interaction efficiency, which provided a replicable technical solution for the construction of technology-enhanced pediatric outpatient clinics.

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

Objective: To 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.

Calpain-mediated fibrosis, a physiological tissue repair process that almost occurs in most of tissues and organs, is closely related to multiple cellular pathways and is widely involved in the progression of diseases. It is believed that the pro- and anti-fibrotic systems are dynamic regulated in vivo, so pathological organ fibrosis still may be controlled and even reversed. This review summarizes the latest researches on the role of Calpain family in different organ fibrosis and the intervention of Calpain inhibitor in fibrosis progression, aiming to providing a reference for the research of Calpain family in fibrotic diseases context.

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

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 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.

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

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