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.

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.

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.

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.

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.

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.

Objective: To investigate the metabolic profiles changes of inguinal white adipose tissue (iWAT) in mice induced by every-other-day fasting (EODF) under a high-fat diet (HFD) conditions, and to identify differential metabolites and metabolic pathways to provide potential candidate metabolites for obesity intervention. Methods: Eight-week-old male C57BL/6J mice were randomly assigned to either an ad libitum HDF feeding group (AL group) or an HFD with EODF group. After 8 weeks, iWAT was collected for metabolomic and transcriptomic analyses. Results: EODF significantly alleviated HFD-induced obesity in mice. Metabolomics analysis showed that amino acids, carbohydrates, and organic acids comprised 76.03% of the detected metabolites in iWAT. A total of 71 differential metabolites were identified, primarily enriched in aminoacyl-tRNA biosynthesis, neutral/aromatic amino acid metabolism, and arginine/proline metabolism. Gene ontology and gene set enrichment analysis enrichment analyses demonstrated that EODF treatment-induced differential genes were significantly enriched in amino acid import across plasma membrane and ribosome cellular components. In addition, EODF significantly promoted glucose metabolism in iWAT, influenced the initial phase of glycolysis, inhibited the pentose phosphate pathway, enhanced the tricarboxylic acid cycle, and promoted the mitochondrial oxidative phosphorylation. Conclusion: EODF ameliorated obesity in mouse and remodeled amino acid and carbohydrate-related metabolic pathways in their iWAT, suggesting that it may maintain metabolic homeostasis by enhancing energy expenditure.

Objective: To investigate the characteristics of changes in pain-anxiety-depression-fatigue symptom clusters and their possible associated factors in adolescents with acute lymphoblastic leukemia (ALL) during early chemotherapy. Methods: A prospective longitudinal study was conducted from Nov 2019 to Oct 2021, enrolling newly diagnosed adolescent ALL patients from 5 tertiary or pediatric specialty hospitals in Shanghai, Zhejiang Province, Sichuan Province, Anhui Province and Guangdong Province. Patient-reported pain, anxiety, depression, and fatigue were collected at five time points within the first nine weeks of chemotherapy using the PROMIS Pediatric-25 instrument. Latent profile analysis (LPA) and latent transition analysis (LTA) were applied to explore the latent classes of symptom clusters, their transition probabilities over time, and possible risk or protective factors associated with class membership. Results: A total of 134 ALL cases were enrolled, and symptom clusters at all the 5 time points (T₁-T₅) were consistently classified into three groups of mild, moderate and severe symptoms. The severe symptoms group accounted for the largest proportion at each time point (54.5%, 59.7%, 66.4%, 49.3%, and 47.0%, respectively), while the mild and moderate symptoms groups showed an initial decline followed by an increase. Among participants, 40.2% maintained the same symptom status, and 77.4% experienced at least one episode of severe symptom status during the trajectory. Religious affiliation (T₅) and family monthly income > 5 000 Yuan (T₂, T₄ and T₅) served as protective factors against severe symptoms. Higher baseline fatigue (T₁) was associated with membership in the severe symptoms group at subsequent time points. Conclusion: Pain-anxiety-depression-fatigue symptoms in adolescents with ALL during early chemotherapy can be categorized into mild, moderate and severe symptoms with dynamic transitions over time. Higher baseline fatigue was associated with increased risk of severe symptoms, whereas higher family income and religious affiliation appeared protective effects.

Objective: To observe the effect of RAW264.7 cells on calcium sparks in a insulin resistance model of C2C12 cells induced by sodium palmitate. Methods: C2C12 cells and RAW264.7 cells were co-cultured to simulate the in vivo state of skeletal muscle. C2C12 cells were cultured in high-glucose medium containing 2% horse serum to induce differentiation into mature myotubes, and then divided into 5 groups: control (RAW264.7 cells), co-culture of C2C12 with RAW264.7, C2C12 alone, co-culture of C2C12 with RAW264.7 plus sodium palmitate (PA), and C2C12 alone with PA. PA of 5 mmol/L was used to induce insulin resistance in C2C12 cells for 24 hours. Revived and expanded RAW264.7 cells were evenly added to C2C12 cells and co-cultured for two days. Subsequently, cells were maintained in modified suspension culture, and both cell types were loaded with the calcium ion fluorescent probe Fluo-4 AM. Finally, Paraxanthine was used to induce intracellular calcium sparks, which was captured and recorded under a laser confocal microscope. Results: No significant calcium signal change was observed in the control group. Co-cultured C2C12 cells exhibited rapid and pronounced calcium signal changes, whereas calcium signals in C2C12 cells cultured alone increased slowly throughout the observation period without a sharp decline. The peak calcium signal was reached significantly faster in co-cultured C2C12 cells than that in C2C12 cells cultured alone (P < 0.001). With PA induction, calcium signal changes in C2C12 cells were not markedly altered, while distinct calcium fluctuations were still observed in co-cultured C2C12 cells, and the peak calcium signal was reached significantly faster in co-cultured C2C12 cells than that in C2C12 cells cultured alone (P < 0.001). Conclusion: RAW264.7 cells enhance the dynamic responsiveness of calcium signaling in both normal and PA-stimulated C2C12 cells.

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.

To explore an effective health management model for obese students, a comprehensive intervention was carried out for obese students with cardiovascular and metabolic risks, and the effectiveness of this intervention model was evaluated. From Jan to Apr 2024 (excluding the winter vacation), 300 students were selected from 6 primary schools in Qibao Community, Minhang District, Shanghai, to participate in the study (28 students dropped out during the study period). The study subjects were divided into two intervention groups (pilot intervention group: equipped with a health vice principal; general intervention group: not equipped with a health vice principal) and a control group. The intervention group received comprehensive intervention measures such as science popularization, diet, exercise and psychology, while the control group received daily health management. The post-intervention results showed that the intervention group had significant improvements in healthy diet, scientific exercise and positive psychology, with significant differences compared to the control group (P < 0.05). At the same time, the intervention group had a reduced detection rate of obesity (BMI≥P₉₅), and a decreased detection rate of abnormal metabolic indicators such as blood pressure, fasting blood glucose and triglyceride, especially significant differences in fasting blood glucose and triglyceride compared with the control group (P < 0.001). In addition, the pilot intervention group under the operation of health vice principal showed better effects in changing healthy behaviors and improving some metabolic indicators compared with the general intervention group. The implementation of this project provided a scientific basis for the promotion of a comprehensive intervention model for student health under the oprtation of health vice principle.

Objective: To identify effective preoperative predictors of concurrent endometrial pathology in patients with ovarian adult granulosa cell tumor (AGCT), to provide reference for subsequent clinical diagnosis and treatment. Methods: This retrospective study included patients with newly diagnosed ovarian AGCT who underwent initial treatment at Obstetrics and Gynecology Hospital, Fudan University from Jan 2010 to Dec 2022. Based on postoperative endometrial pathological results, patients with endometrial hyperplasia (of any subtypes) or endometrial carcinoma were assigned to the abnormal endometrium group; those with benign endometrial lesions or normal endometrium were categorized into the normal endometrium group.Screening high-risk factors for concurrent endometrial lesions in AGCT patients through regression analysis. Results: Among the enrolled 101 patients with AGCT, 14 cases (13.9%) had simple endometrial hyperplasia, 7 cases (6.9%) had complex endometrial hyperplasia, 5 cases (5.0%) had complex atypical endometrial hyperplasia, and 8 cases (7.9%) had grade I endometrial adenocarcinoma. These 34 cases (33.7%) were classified into the abnormal endometrium group, while the remaining 67 cases (including normal endometrium, endometrial polyps, and atrophic endometrium) were assigned to the normal endometrium group. Comparison of clinical parameters between the two groups revealed that the age at onset, BMI, endometrial thickness, postmenopausal duration, the proportions of postmenopausal patients, postmenopausal bleeding, and CA125≥35 U/mL in the abnormal endometrium group were significantly higher than those in the normal endometrium group (P < 0.05). Multivariate logistic regression analysis showed that age (OR=1.3, 95%CI: 1.1-1.6, P=0.004), CA125≥35 U/mL (OR=8.6, 95%CI: 1.4-54.1, P=0.022), and endometrial thickness (OR=1.3, 95%CI: 1.1-1.6, P=0.014) were positively correlated with the development of endometrial lesions. Conclusion: For preoperative patients with AGCT, advanced age, increased endometrial thickness, and elevated CA125 levels may be associated with a higher risk of concurrent endometrial neoplasms. Therefore, comprehensive preoperative evaluation of the endometrium is recommended to guide subsequent treatment.

Objective: To compare the effect of propofol alone and propofol combined with dexmedetomidine in treating emergence agitation in adult patients after middle ear or skull base surgery. Methods: We retrospectively evaluated a total of 580 patients who aged 18-65 years and received elective middle ear or skull base surgery under general anesthesia in Eye and ENT Hospital, Fudan University from Feb 2023 to Apr 2024. Emergence agitation was defined as a Richmond Agitation-Sedation Scale (RASS) score ≥2 with inability to follow commands for laryngeal mask airway (LMA) removal. In the 580 patients, 52 cases who developed emergence agitation were randomly assigned to the propofol group (P group, n=26, 1 mg/kg propofol iv.) or the propofol-dexmedetomidine group (PD group, n=26, 0.5 mg/kg propofol iv. followed by slow injection of 0.3 μg/kg dexmedetomidine). The primary outcome was the success rate of agitation control after a single dose. Secondary outcomes included time to LMA removal and length of stay in the post-anesthesia care unit (PACU). Results: Agitation was relieved after a single dose in 92.3% of patients in the PD group, compared with 24.3% in the P group (P < 0.001). The mean time to LMA removal (18.6 min vs. 24.9 min, P=0.014) and PACU stay (46.2 min vs. 52.2 min, P=0.044) were shorter in the PD group compared to the P group with statistically significant differences. Five patients in the PD group developed transient bradycardia, which resolved without treatment. Conclusion: In adult patients with emergence agitation after middle ear or skull base surgery, propofol combined with low-dose dexmedetomidine was more effective than propofol alone and did not cause serious adverse events.

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.

Objective: To investigate the distribution, the innervation pattern, and the long-range input of the axo-axonic cells (AACs) within the claustrum (CLA). Methods: Unc5b-CreER:Nkx2.1-Flp:Ai65 mouse intersectional genetic strategy was applied to specifically label AACs in the CLA. By serial sections, the cell density and innervation patterns of AACs from the anterior to the posterior of CLA were analyzed. The monosynaptic retrograde rabies virus (RV) tracing was employed to unveil the synaptic input pattern of AACs in the CLA, revealing the long-range synaptic input patterns of AACs in the CLA. Finally, the layer analysis and immunofluorescent staining was conducted to explore the cell types of these presynaptic projection neurons. Results: The result from intersectional strategy (Unc5b-CreER:Nkx2.1-Flp:Ai65 mouse) indicated that the AACs were densely distributed in the CLA and the cell density of the AACs increased along the anterior-posterior axis, yet the percentage of neurons innervated by the AACs, approximately 67.72%, remained unchanged. Retrograde monosynaptic tracing of long-range input to AACs unveiled a synaptic input pattern from various regions, including olfactory, prefrontal, sensorimotor cortices and numerous subcortical structures. The exploration of the cell types of these presynaptic projection neurons revealed that the neurons projecting from the cortex to the AACs in CLA were mainly distributed in layer 5 of the cortex, with a small number of cells located in layers 2/3 and 6. Additionally, the neurons projecting from the ventral pallidum (VP) to the AACs in CLA mainly included GABAergic neurons and glutamatergic neurons. Conclusion: The AACs were densely and widely distributed in the CLA with a distinct feature of distribution pattern and projection connectivity, which reflects the potential differences in the structure of the claustrum along the anterior-posterior axis and the cellular specificity of its connection patterns.

Objective: To investigate the role of deoxycytidylate deaminase (DCTD) gene (Dctd) deletion in mouse embryonic development. Methods: Cas9 mRNA and sgRNA were synthesized via in vitro transcription and microinjected into zygotes to generate a Dctd knockout (Dctd^-/-) mouse model. Fertility was assessed by quantifying the number of viable offspring from various breeding combinations. Post-implantation Dctd^-/- embryos were examined morphologically and histologically using paraffin sections stained with HE. Embryos collected at E0.5d were cultured in vitro to evaluate the rate of development to the blastocyst stage. Results: Breeding between heterozygous Dctd (Dctd^+/-) parents produced offspring numbers comparable to wild-type (Dctd^+/+) controls. Crosses between Dctd^+/+ females and Dctd^-/- males resulted in an approximately 9% reduction in average litter size compared to controls, while crosses between Dctd^-/- females and Dctd^+/+ males showed a 48% reduction. When both parents were Dctd^-/-, the average number of offspring declined to 40% of the wild-type level, and around 60% of post-implantation embryos exhibited developmental delays or resorption. In vitro culture of E0.5d embryos from this group revealed significant developmental arrest at the 2- to 4-cell stage and a markedly lower blastocyst formation rate compared to controls. Conclusion: Loss of Dctd in female mice leads to reduced fertility, highlighting the critical role of Dctd in supporting normal embryonic development in mice.

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.

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.

Objective: To investigate the risk factors for post-induction hypotension during general anesthesia in elderly patients in consideration of lipid parameters in order to provide reference for the prevention and management of post-induction hypotension in this population. Methods: A retrospective analysis was performed on elderly patients who underwent elective non-cardiac surgery with general anesthesia in Qingpu Hospital, Fudan University from Feb 2019 to Apr 2023. After excluding missing data, patients were divided into the hypotension group and the control group based on hypotension criteria. General data, laboratory test results, hemodynamic indices, etc., were collected. Univariate and multivariate Logistic regression analyses were used to identify risk factors, and sensitivity analysis (excluding hypertensive patients) was conducted to validate the results. Results: When unexcluding hypertensive patients, univariate analysis showed that high total cholesterol (TC), high non-high-density lipoprotein (non-HDL), high mean arterial pressure (MAP) at baseline and concomitant use of midazolam were associated with hypotension. Multivariate analysis indicated that high MAP at baseline and high TC were risk factors, while concomitant use of midazolam was a protective factor. After excluding hypertensive patients (sensitivity analysis), univariate analysis showed that high TC, high non-HDL, high MAP at baseline and concomitant use of midazolam were associated with hypotension; multivariate analysis showed that high TC was a risk factor, while concomitant use of midazolam was a protective factor. Conclusion: High baseline mean arterial pressure and high total cholesterol are risk factors for post-induction hypotension in elderly patients undergoing general anesthesia, while concomitant use of midazolam during induction may act as a protective factor.

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.

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 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.

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.

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 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 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.

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.

This paper builds upon the previously published "guidelines for pulmonary function testing in adults" and "guidelines for the diagnosis of pulmonary function in adults". Integrating the latest scientific evidence and China-specific clinical realities, it systematically addresses unresolved issues in existing guidelines or consensus documents. This document comprehensively elaborates on features and calibration requirements of modern pulmonary function testing devices; standardizes the ventilatory function assessment protocols, including testing requirements, standardized methodologies, quality control measures, and clinical precautions; establishes interpretation frameworks for normal reference values of ventilatory parameters, diagnostic criteria for ventilatory dysfunction, classification of impairment severity, and characterization of specific ventilatory abnormalities.

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.

Artificial intelligence (AI) is becoming deeply embedded throughout clinical research and has substantially improved the efficiency of data processing and analysis in observational studies, including identification of risk factors, risk stratification, and outcome prediction. However, advances in predictive performance do not automatically translate into improved causal identification. Even when AI-assisted high-dimensional covariate processing and target trial emulation allow observational studies to approximate the structure of randomized controlled trials (RCTs), causal interpretation remains strongly dependent on the "ignorability assumption", namely that all key confounders have been accurately measured and included in the model. Such approaches cannot eliminate residual confounding from unmeasured factors and are powerless against unrecognized confounders. By contrast, RCTs use randomized allocation at the design and implementation stages to balance measured and unmeasured confounders across comparison groups, thereby providing an irreplaceable basis for causal identification in intervention evaluation. This article delineates a tripartite, progressive evidence pathway: "AI-driven prediction discovery → approximation of causal inference→confirmation via randomized trials", and analyzes the methodological boundaries and synergistic strategies associated with integrating AI into RCTs. In an era defined by complex data architectures, rapid model iteration, and the highly efficient, prolific generation of research literature, we must remain vigilant against the critical methodological trap of conflating "predictive association" with "causal effect". Upholding the unpredictability of random allocation and the integrity of randomization remains the indispensable methodological cornerstone that secures the RCT's status as the gold standard for evaluating medical interventions.

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 investigate the incidence of prolonged stay in the emergency rescue room among elderly patients and to identify its associated factors, so as to provide evidence for optimizing emergency care processes for elderly patients. Methods: A retrospective study was conducted involving elderly patients admitted to the emergency rescue room of a tertiary hospital from Jan to Jun 2023. Patients were divided into a prolonged-stay group and a non-prolonged-stay group according to whether the length of stay exceeded 72 hours. General demographic characteristics and visit-related information were collected, including age, sex, payment method, consultation time period, accompanying personnel, mode of arrival, primary admitting department, number of diagnoses, triage level, distribution area, diversion direction, and treatment compliance. Univariate analyses were performed to compare differences between the two groups. Variables with statistical significance were further included in a multivariable Logistic regression model to explore factors associated with prolonged stay in the emergency rescue room among elderly patients. Results: A total of 7 768 elderly patients were included, of whom 2 312 had a length of stay longer than 72 hours, yielding a prolonged stay rate of 29.7%. Univariate analysis showed that age, payment method, consultation time period, accompanying personnel, mode of arrival, primary admitting department, number of diagnoses, triage level, distribution area, diversion direction, and treatment compliance were associated with prolonged stay in the emergency rescue room (P < 0.05). Multivariable Logistic regression analysis demonstrated that age, consultation time period, mode of arrival, number of diagnoses, triage level, and treatment compliance remained significantly associated with prolonged stay after adjustment for confounding variables (P < 0.05). Conclusion: The incidence of prolonged stay in the emergency rescue room among elderly patients is relatively high, which suggests that greater attention should be paid to elderly patients who are older, have more complex conditions, or present during specific consultation time periods in future emergency management and process optimization, in order to reduce prolonged stay in emergency rescue room.

The conventional Cox proportional hazards model relies solely on baseline information for "static" prediction, failing to incorporate the dynamic information of time-varying covariates, including disease progression, biomarker trajectories, and treatment modifications. Although independently fitted landmark models enable dynamic prediction, they are limited by low statistical efficiency and discontinuous predicted risk estimates. The presence of competing events further constrains the applicability of the classical landmark framework. The landmark supermodel is a novel approach to dynamic prediction based on stacked data structures. In complex competing risks setting, the model can be further extended to a cause-specific hazard model. Using the multiethnic cohort study (MEC) dataset under a competing risks survival analysis framework, we demonstrate the implementation of the landmark supermodel via the dynamicLM package in R. The key steps in model construction include: (1) specification of landmark time points and prediction windows; (2) stacking of datasets across landmark time points; (3) construction of covariate-by-time interaction terms; (4) fitting a cause-specific hazard model on the stacked dataset. Model evaluation based on the time-dependent AUC, Brier score, and calibration curves demonstrated that the landmark supermodel exhibits satisfactory discriminative ability and predictive accuracy in competing risks scenarios. When applied in clinical practice, individual dynamic risk trajectory curves can be generated, providing quantitative evidence to inform personalized follow-up and screening strategies.

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.

Objective: To investigate the prevalence of depression and anxiety among elderly patients with cardiovascular disease in Shanghai communities, and to explore the associated influencing factors. Methods: A cross-sectional study was conducted from Nov 2022 to Sept 2023 in the communities of Pudong New Area and Minhang District in Shanghai. A total of 499 community-dwelling elderly individuals aged 60 years and above with diagnosed cardiovascular disease were recruited. The presence of depressive and anxiety symptoms was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Logistic regression models were applied to identify factors associated with depression and anxiety. Results: Among the 499 participants, 160 individuals (32.1%) exhibited symptoms of depression and/or anxiety. Not being currently married (OR=2.94, 95%CI: 1.42-6.07) and higher automatic negative thoughts scores (OR=1.10, 95%CI: 1.07-1.13) were significantly associated with depressive symptoms. In contrast, higher levels of social support (OR=0.96, 95%CI: 0.93-1.00) and health-related quality of life utility scores (OR=0.01, 95%CI: 0.001-0.190) were associated with lower risk of depression. Similarly, better health-related quality of life utility scores (OR=0.04, 95%CI: 0.002-0.560) were protective against anxiety, whereas higher negative automatic thoughts score was a strong risk factor (OR=1.17, 95%CI: 1.13-1.22). Conclusion: Depressive and/or anxiety symptoms were relatively common among community-dwelling older patients with cardiovascular diseases in Shanghai, and the comorbidity of depressive and anxiety symptoms warrants attention. Marital status, negative automatic thoughts, level of social support, and health-related quality of life utility scores emerged as critical factors influencing depression and anxiety among community-dwelling elderly patients with cardiovascular disease. Among these, negative automatic thoughts and health-related quality of life utility scores are worthy of particular research and clinical attention.

Objective: To investigate the prevalence of loneliness among community-dwelling elders in Shanghai and analyze its relationship with health-related quality of life. Methods: We conducted face-to-face investigations on the healthy aging surveillance cohort established by the project team in 2 central urban areas, 2 suburban areas, and 2 rural areas of Shanghai from Aug to Dec 2024. The UCLA 3-item Loneliness Scale (UCLA-3) and the EuroQol Five-dimensional Five-level Questionnaire (EQ-5D-5L) were utilized to collect data on loneliness and health-related quality of life. Intergroup comparison of loneliness was conducted using the χ² test or Fisher's exact test. The student's t test and One-way ANOVA analysis were used to compare the differences in health utility values and visual analogue scale (VAS) scores across different subgroups of the elderly population. Based on the data characteristics, Spearman correlation analysis, Tobit regression, and ordinary least squares (OLS) regression models were used to examine the association between loneliness and health-related quality of life. Results: A total of 1 978 community-dwelling elders aged 60 and above were included. The mean UCLA-3 score was 3.42±0.95. Overall, 19.8% reported mild-to-moderate or severe loneliness, with a significantly higher detection rate among those living alone than among those who did not (45.0% vs. 17.0%, χ²=88.82, P < 0.001). Loneliness showed significant negative correlations with utility scores (r=-0.23, P < 0.001) and VAS (r=-0.15, P < 0.001). After adjusting for demographic characteristics, health behaviors, and psychosocial adaptation factors, these associations remained robust (utility scores, β=-0.08, P < 0.001; VAS, β=-1.34, P < 0.001). Perceived economic pressure, multimorbidity, physical inactivity, lack of family interaction, sleep disturbances, and low subjective well-being also showed consistent statistical associations with health-related quality of life in the multivariable models (all P < 0.05). Conclusion: Nearly 20% of the community-dwelling elders in Shanghai suffer from loneliness, which is significantly associated with poorer health-related quality of life.

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 investigate the effects of electrical impedance tomography (EIT) -guided bundled respiratory rehabilitation on the duration of mechanical ventilation and prognosis in mechanically ventilated patients. Methods: A total of 144 severe patients who underwent invasive mechanical ventilation in the Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center from May 2023 to Feb 2025 were recruited via convenience sampling. Patients were allocated to either a control group (n=72), receiving routine respiratory rehabilitation, or an experimental group (n=72), receiving an EIT-guided bundled respiratory rehabilitation program. Outcome measures included duration of mechanical ventilation, arterial partial pressure of oxygen (PaO₂), oxygenation index (OI), clinical pulmonary infection score (CPIS), Lovett muscle strength classification, ICU length of stay (LOS) and hospital LOS. Results: Sixty-five patients in the experimental group and 62 patients in the control group completed the study. The duration of mechanical ventilation was 223.0 (157.0, 285.5) h in the experimental group and 261.0 (168.8, 361.8) h in the control group, with the difference being statistically significant (P < 0.05). The experimental group demonstrated significantly higher PaO₂ and OI, and better Lovett muscle strength classification (all P < 0.05). Conversely, the experimental group had significantly lower CPIS and ICU LOS (all P < 0.05). However, there was no significant difference in hospital LOS between the two groups. Conclusion: EIT-guided bundled respiratory rehabilitation effectively reduced the duration of mechanical ventilation, improved oxygenation status and muscle strength grade, and shortened the ICU stay in mechanically ventilated patients. However, it did not significantly affect the overall hospital length of stay.

Objective: To evaluate the accuracy of the deep learning (DL)-based intracardiac echocardiography (ICE) left atrial mapping technique in constructing left atrial models during radiofrequency ablation for atrial fibrillation, and to analyze the spatial deviation patterns between the model and actual ablation points. Methods: Twenty patients with atrial fibrillation who underwent catheter radiofrequency ablation at the Department of Cardiology, Huashan Hospital, Fudan University between Jun and Aug 2025 were enrolled. Intracardiac echocardiography was used to acquire images at end-expiration and maximum left atrial volume. DL-based Cartosound FAM was employed for left atrial modeling. Parameters including left atrial volume, pulmonary vein ostium circumference and diameter, and bilateral pulmonary vein interspacing were measured and compared with corresponding measurements from Pentaray catheter-based FAM. After ablation, the pulmonary vein isolation (PVI) circle was divided into 12 segments, and the shortest distance from each actual PVI ablation point to the FAM surface was measured to systematically evaluate the spatial deviation between the reconstructed anatomical structures and the true ablation points. Results: Cartosound FAM successfully constructed left atrial models for all patients, with a median of 17.0 (14.8, 20.0) ultrasound sectors used. No significant differences were observed between Cartosound FAM and Pentaray FAM in left atrial volume, bilateral superior and inferior pulmonary vein circumference, left superior and right superior pulmonary vein diameter, or bilateral pulmonary vein interspacing. However, the diameters of the bilateral inferior pulmonary veins were significantly larger than Pentaray FAM [Left: (17.08±2.76) mm vs. (12.96±4.65) mm, P=0.001; Right: (19.38±3.57) mm vs. (16.50±4.46) mm, P=0.030]. Bland-Altman analysis indicated good agreement between the two methods across all measurements. Spatial deviation analysis revealed that ablation points in the left circular area deviated inward in the bottom and left inferior ridge regions, and outward in the top and posterior wall regions relative to the Cartosound FAM model. In the right circular area, most ablation points were close to the boundary or slightly deviated outward. Pearson correlation analysis showed a positive correlation between the upward and inward deviation of ablation points in the left bottom region and the left atrial volume measured by Cartosound FAM (r=0.487, P=0.029). Conclusion: Cartosound FAM demonstrates high accuracy in measuring left atrial volume and pulmonary vein structures. Spatial deviations between actual ablation points and the model exhibit region-specific patterns. The complementary use of Cartosound FAM and Pentaray catheter modeling can enhance the efficiency and precision of atrial fibrillation ablation procedures.