Objective: To analyze the global literature related to functional cure of hepatitis B from 2019 to 2023 by using bibliometric analysis methods, so as to help researchers understand the research hotspots and trends in this field. Methods: The literature related to the topic of functional cure of hepatitis B included in the Science Citation Index Expanded (SCI-Expanded) of the Web of Science Core Collection from 2019 to 2023 was searched. By using VOSviewer and CiteSpace visual analysis tools, analyses were conducted from the perspectives of publication trends, international research cooperation networks, and keyword emergence, and were elaborated with the specific contents of the related literature to elucidate research hotspots and trends. Results: A total of 600 eligible papers in this field were included. Keyword co-occurrence and thematic clustering suggested that the main research directions of functional cure were: serum biomarkers for prediction and monitoring of functional cure, functional cure and immunity, nucleoside analog discontinuation, interferon therapy, and long-term prognosis of functional cure. The research contents of the ESI highly cited original research papers were similar to the clustering of the above, but showed more attention on the novel agents for functional cure. The content of the keyword emergence map showed that hotspots of interest changed from virologic mechanisms and serum markers, to nucleoside analog discontinuation and interferon therapy, and finally to immunologic mechanisms and new drug. Conclusion: The research hotspots and trends of functional cure of hepatitis B were focused on virological mechanism, serum markers, immunological mechanism, nucleoside analog discontinuation, interferon therapy, and long-term prognosis after cure.

Objective: To investigate the effect of cordyceps sinensis (CS) on the activation of fibroblasts through IL-6 trans-signaling pathway and its specific mechanism in the treatment of renal fibrosis. Methods: Renal fibrosis mouse model was established by unilateral ischemia/reperfusion (UIR), and the mice were administered intragastrically CS, soluble glycoprotein 130 Fc (sgp130Fc) or Hyper-IL-6. Masson's trichrome staining was utilized to identify tubulointerstitial fibrosis. PAS staining was utilized to assess the extent of renal injury. Western blot was employed to analyze the expression levels of fibrosis markers [alpha-smooth muscle actin (α-SMA), fibronectin (FN)] and proteins associated with IL-6 trans-signaling pathway [phosphorylated signal transducer and activator of transcription 3(p-STAT3), soluble interleukin-6 receptor (sIL-6R)]. The expression and localization of proteins were additionally detected by immunohistochemistry, immunofluorescence and qPCR. The effect of cordyceps sinensis extract cordycepin on IL-6 trans-signaling in fibroblasts was further investigated in vitro. Results: The results from in vivo experiments showed that administration of CS during the chronic phase demonstrated a beneficial protective impact on inflammation and fibrosis in the affected kidney, and serum creatinine levels and collagen deposition were decreased. Western blot analysis revealed a decrease in the expression levels of α-SMA, FN, as well as IL-6 trans-signaling pathway protein p-STAT3, sIL-6R in the treatment group. Additionally, the mRNA expression levels of chemokines monocyte chemoattractant protein-1 (MCP-1) and C-X-C motif chemokine ligand 12 (CXCL12) were also decreased in the CS treatment group. Additionally, Hyper-IL-6 can partially counteract the therapeutic effects of CS. In vitro experiments further demonstrated that cordycepin inhibited the secretion of IL-6 from NRK-52E. Combined treatment of recombinant IL-6 and sIL-6R protein activated NRK-49F, leading to a significant increase in α-SMA, FN, and p-STAT3 expression levels. Cordycepin or sgp130Fc treatment significantly inhibited the proliferation of fibroblasts induced by IL-6 trans-signaling pathway. Conclusion: CS can significantly reduce IL-6 secretion by renal tubular epithelial cells and inhibit the activation of IL-6 trans-signaling pathway in fibroblasts, thereby ameliorating renal interstitial fibrosis.

Objective: To develop an MRI-based habitat radiomics model for the preoperative prediction of endometrial cancer (EC) molecular subtypes. Methods: Patients with pathologically proven EC from two hospitals were included in the training (n=270) and testing (n=70) cohorts. All patients had preoperative MRI and histological and molecular diagnoses. First, the tumor was divided into habitat subregions based on diffusion-weighted imaging (DWI) and contrast-enhanced (CE) images. Subsequently, habitat radiomic features were extracted from different subregions of T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), DWI, and CE images. Three machine learning classifiers, including logistic regression, support vector machines, and random forests, were applied to develop predictive models for p53-abnormal endometrial cancer, with model performance validated. The model demonstrating the best overall predictive performance was selected as the habitat radiomics model. Using the same procedure, a whole-region radiomics model based on T1WI, T2WI, DWI, and CE sequences and a clinical model were constructed. The performance of the models was evaluated using receiver operating characteristic curves, and DeLong's test was employed to compare differences between the models. Decision curve analysis was used to assess the clinical benefits of the models' application. Results: After feature selection, eight habitat radiomic features were retained to construct the habitat radiomics model, ten features for the whole-region radiomics model, and three clinical features for the clinical model. The habitat radiomics model achieved the highest area under the curve (AUC), with 0.855 (0.788-0.922) in the training cohort and 0.769 (0.631-0.907) in the testing cohort. DeLong's test showed that the habitat radiomics model outperformed the whole-region radiomics model in the training cohort (P=0.001), but there was no significant difference in the testing cohort (P=0.543). In both cohorts, the habitat radiomics model outperformed the clinical model (P=0.007, training cohort; P=0.038, testing cohort). Decision curve analysis (DCA) demonstrated that this model provided clinical benefit for diagnosis within a threshold probability range of approximately 0.2-0.8. Conclusion: The MRI-based habitat radiomics model can accurately predict p53-abnormal EC, outperforming both the whole-region radiomics model and the clinical model, and is useful for the non-invasive molecular subtyping of endometrial cancer before surgery.

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

Objective: To elucidate the potential mechanisms by which mesothelin (MSLN) contributes to chemotherapy resistance in high-grade serous ovarian cancer (HGSOC). Methods: A Meta-analysis utilizing public ovarian cancer databases was performed to evaluate the correlation between MSLN expression levels and overall survival (OS) in ovarian cancer patients. Pathway enrichment analysis was employed to identify key signaling pathways regulated by MSLN and their roles in chemotherapy resistance. Additionally, the TCGA-HGSOC database was analyzed to examine genomic features associated with MSLN-mediated chemotherapy resistance. To validate the biological function of MSLN in chemotherapy resistance, an intraperitoneal metastasis model was established using MSLN-knockdown ID8 ovarian cancer cells in mice. Results: Elevated MSLN expression was significantly associated with poor patient prognosis (HR: 1.42, 95%CI: 1.16-1.74). Differential gene expression and pathway enrichment analyses revealed that high MSLN expression upregulates resistance-associated genes and pathways involved in drug metabolism and DNA-binding signaling. Genomic association analysis showed a negative correlation between high MSLN expression and chromosomal instability features, specifically CX3, CX11, and CX13 scores. In vivo studies demonstrated that MSLN knockdown enhanced the tumor-suppressive effects of cisplatin. Conclusion: High MSLN expression represents a potential biomarker for poor prognosis and chemotherapy resistance in HGSOC patients, suggesting MSLN as a promising target for therapeutic intervention.

Small cell neuroendocrine cervical carcinoma (SCNECC) is a rare gynecological malignancy characterized by early invasion and metastasis, resulting in a poorer prognosis compared to cervical squamous cell carcinoma and adenocarcinoma. The clinical management of SCNECC remains in the exploratory phase. Recently, as this uncommon tumor has garnered increasing attention both domestically and internationally, some progress has been made in improving its prognosis. This article summarizes the advancements in combined modality therapy for SCNECC, discussing and providing insights into key issues related to current treatment strategies of surgery, radiotherapy and chemotherapy, as well as targeted and immunotherapies.

Objective: To investigate the role of the GPR120 gene in the progression of sepsis, explore the molecular mechanisms through which GPR120 gene regulates NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome activation and macrophage polarization. Methods: The blood and pleural fluid samples were collected from the sepsis patients and the control group. The expression of inflammatory factors and the associated proteins were detected by flow cytometry and ELISA. C57BL/6 mice and monocyte-macrophage cell line (Raw264.7) were treated with lipopolysaccharide (LPS) to construct the sepsis models. After the intervention of GPR120 agonist TUG891, the expression of GPR120 gene, NLRP3 inflammasome protein and macrophage polarization protein were detected between the control group and the sepsis group. Results: The expression of inflammatory factors, such as IL-1β in the serum of septic patients, significantly increased compared with the control (P < 0.001). And the expression of inflammasome proteins such as NLRP3, Caspase-1 and IL-1β in the pleural fluid also increased (all P < 0.05). In vivo, LPS could induce severe inflammation in lung tissue, the GPR120 gene expression decreased in lung tissue, and inflammatory factors were up-regulated in mouse serum (P < 0.01). The inflammasome-associated protein and M1 type polarization of macrophages were enhanced, the TUG891 could reduce the inflammatory response, inhibit the NLRP3 inflammasome activating, and promote the M2 polarization of macrophages (P < 0.01). In vitro, LPS could inhibit the intracellular GPR120 expression. The inflammatory factors secreted more in LPS-induced sepsis cells. TUG891 could promote the up-regulation of GPR120 protein and alleviate the secretion of inflammatory factors (P < 0.05). Conclusion: In sepsis, GPR120 gene activation could inhibit the NLRP3 inflammasome activation, promote macrophage polarization, and reduce the inflammatory damage, thereby delay the rapid progression of sepsis.

Drug clinical trial is a method of experimental epidemiology to evaluate the effectiveness and safety of medicines. This article introduced the types and design thought of innovation in drug clinical trial design, and provided methodological reference for related researches. Adaptive design is a complex and innovative clinical trial design, which can be divided into group sequential design, sample size re-estimation, seamless trial, enrichment design and master protocol design (basket trial, umbrella trial, platform trial, etc.) according to the purpose of adaptability. The adaptive design has greater adjustment flexibility, which overcomes the shortcomings of conventional clinical trials to a certain extent, then improves the validity of the trial results and the strength of the evidence. The design innovation and remodeling of drug clinical trials will provide more powerful evidence-based evidence for the realization of precision medicine.

Objective: To investigate the epidemiological and demographic characteristics of Mycoplasma pneumoniae (Mp), respiratory syncytial virus (RSV), influenza A (FluA), and influenza B (FluB) in a single center in Minhang District, Shanghai after the end of the COVID-19 pandemic. Methods: A retrospective analysis of data from Apr 2023 to Jul 2024 of patients who underwent testing for Mp, RSV, FluA, and FluB due to respiratory tract infections in Minhang Hospital, Fudan University was conducted. Differences in pathogen infections were analyzed among different seasons and age groups. Results: A total of 39 103 individuals of respiratory tract infections with simultaneous testing for all four pathogens were included in this analysis, with a total detection rate of 44.7% (17 490/39 103). The detection rates were as follows: Mp 25.2%, FluA 13.1%, FluB 10.9%, and RSV 1.5%. Co-infections accounted for 5.9%, predominantly with Mp and FluA. The detection rate of Mp was > 38% in children under 14 years old, gradually decreasing with age. In the child group (≤14 years), both FluA and FluB had the highest detection rates in the 7-14 years age group (FluA, 16.5%; FluB, 10.4%). In the adult group (≥15 years), the highest detection rates for FluA and FluB were found in the 15-24 years age group (12.5%) and the 35-44 years age group (15.9%), respectively. The detection rates of pathogens varied significantly across different months (P < 0.001), with an increasing trend in the total number and overall detection rate of the four pathogens after Sept 2023 (P < 0.001). Conclusion: After the end of the COVID-19 pandemic, there was an abnormal increase in Mp in a single center in Minhang District, Shanghai. Mp, along with influenza viruses, became the main pathogens causing respiratory tract infections. Targeted prevention and control measures based on the epidemiological characteristics of infections should be implemented to guide clinical diagnosis and treatment.

Gallbladder adenoma, a benign tumor of mucosal epithelial origin, is considered to be a pre-cancer to gallbladder cancer (GBC), and its malignant transformation may occur in a relatively short time. The pathological process and molecular mechanism of gallbladder adenoma carcinogenesis are still controversial; ultrasound and CT are widely used to examine gallbladder diseases, and the application of contrast-enhanced ultrasound (CEUS) and high-frame-rate contrast-enhanced ultrasound (H-CEUS) has improved the diagnostic accuracy. In this paper, we summarize the literature on the clinicopathological features, imaging manifestations, gene expression, treatment, and clinical prognosis of gallbladder adenoma carcinogenesis.

Bronchopulmonary dysplasia (BPD) is a detrimental respiratory complication associated with prematurity that still lacks effective treatment. BPD is a multifactorial disease with a pathogenesis involving alveolar simplification and impaired vascularization. Alveolar epithelial cells are the main components of alveoli including alveolar type Ⅰ (AT1) and alveolar type Ⅱ (AT2) epithelial cells. AT1 cells are involved in constructing the air-blood barrier and facilitating gas exchange, while AT2 cells, characterized by proliferative and differentiated stem cell properties, maintain lung homeostasis and contribute to lung injury. The transdifferentiation of AT2 cells into AT1 cells is a core mechanism in the repair of lung injuries, although the key signaling pathway activating transdifferentiation remains unclear. This article introduces the key signaling pathways and research progress in alveolar epithelial cell transdifferentiation through literature retrieval and classification summary, providing a foundation for elucidating the pathogenesis of BPD and exploring new therapeutic regimens for BPD.

Objective: To explore the potential categories of health risk behaviors among students aged 11 to 18 years in Minhang District, Shanghai in order to identify the influencing factors of health risk behaviors among different categories of students. Methods: Using stratified cluster sampling techniques, a random selection of 1 690 middle school students from Minhang District, Shanghai, were chosen as the study sample. Data was collected using the "Shanghai Adolescent Health-Related Behavior Survey Questionnaire" to assess participants' scores on six categories of health risk behaviors. Latent profile analysis (LPA) was employed to cluster students' health risk behaviors, and a multifactorial Logistic regression model was used to analyze the related influencing factors. Results: The health risk behaviors of students aged 11 to 18 in Minhang District, Shanghai, were categorized into 3 groups: Class 1, comprising 915 students (54.14%), with moderate to low scores in health risk behaviors, named "the group with moderately low levels of various health risk behaviors"; Class 2, comprising 539 students (31.89%), with higher scores in psychological addiction, named "the group with psychological addiction as the prominent health risk behavior"; Class 3, comprising 236 students (13.97%), with higher scores in substance addiction, named "the group with substance addiction as the prominent health risk behavior". The results of the univariate analysis for the three potential categories of student health risk behaviors show that there are statistically significant differences in the 3 potential categories of health risk behaviors among students of different schools, ages, ethnicities, and boarding situations (P < 0.05). The analysis results of the multivariate Logistic regression indicate that compared to junior high school students, both senior high school students and vocational high school students have a higher risk of exhibiting unhealthy behaviors characterized by psychological addiction and substance addiction, with all differences being statistically significant (P < 0.05). Conclusion: The latent profile analysis reveals three distinct categories of health risk behaviors among students aged 11 to 18 years in Minhang District, Shanghai, with significant distribution differences among students from diverse backgrounds. Consequently, it is recommended that tailored health education and intervention measures be implemented for students with different school characteristics and at various educational stages.

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

Pulmonary alveolar proteinosis (PAP) is a rare progressive respiratory dysfunction disease of the lung characterized by insidious onset and non-specific clinical manifestations, often leading to misdiagnosed and mistreated. Herein, we reported a case of PAP patient admitted to Jiading District Central Hospital with an atypical appearance of alveolar lavage fluid and whose condition improved significantly after treatment with subcutaneous injection of recombinant human granulocyte-macrophage colony stimulating factor (GM-CSF). Additionally, we have reviewed and summarized the relevant literature to enhance the understanding of the diagnosis and treatment of this disease.

Objective: To introduce how to import and analyze data using the Research Electronic Data Capture(REDCap) system, taking a multi-center randomized controlled clinical research of total knee arthroplasty as an example. Methods: Various tools within the REDCap system, including data import tools, data export functions, reports and statistics, project dashboards, and coding manuals, were used to systematically process and analyze the multi-center randomized controlled clinical trial data for total knee arthroplasty. Initially, electronically collected clinical data were adjusted and standardized, then uploaded in bulk to the system using the REDCap data import tool. Subsequently, the data were organized through REDCap's data export feature, and basic descriptive statistical analysis was performed using its reporting and statistical functions to ensure data quality and completeness. Results: An electronic data collection and management platform for clinical research on knee osteoarthritis wase successfully created by the REDCap system. The platform enabled real-time data collection from multiple centers, and ensured data accuracy and consistency through built-in data management and quality control mechanisms. With the statistical analysis features of REDCap, the research team could monitor the progress of data in real time, conduct effective quality assessments, and perform dynamic analysis for further in-depth statistical evaluations. Conclusion: The REDCap system can be used not only to build a new clinical research project, but also to import and analyze data that has been previously digitized of ongoing clinical researches into the system, which improved the scientificity of data management and research efficiency.

Objective: To investigate the latent classes of mental workload and related factors among cardiovascular nurses. Methods: A convenience sample of 664 cardiovascular nurses were surveyed from Jun to Jul 2023. General information questionnaire, the Nurse Workload Index Scale and the Nursing Interruption Event Scale were conducted in the investigation. Latent class analysis and multiple Logistic regression analysis were employed to analyze the latent classes of nurses' mental workload and its related factors. Results: Two latent classes were identified, named low mental workload group (25.90%) and a high mental workload group (74.10%). Multiple Logistic regression analysis revealed that educational qualifications (OR=1.641, 95%CI: 1.036-2.598), nursing interruption event scores (OR=1.060, 95%CI: 1.044-1.076), and the region of nurses (OR=0.688, 95%CI: 0.542-0.874) were the influencing factors for cardiovascular nurses' mental workload. Conclusion: There are obvious categorical characteristics of cardiovascular nurses' mental workload, nurses with higher education, frequent interruption events, and from the eastern region have higher mental workload. Nursing managers need to focus on human resource allocation and optimize processes to reduce the occurrence of nursing interruptions.

Objective: To explore the feasibility and clinical effects of a novel hysteroscopic levonorgestrel-releasing intrauterine system (LNG-IUS) fixation at the fundus of uterus. Methods: From Aug 2023 to Jan 2024, a prospective and novel hysteroscopic LNG-IUS fixation at the fundus of uterus surgery was performed at Obstetrics and Gynecology Hospital, Fudan University. The patient's clinical symptoms, surgical time, surgical complications, postoperative LNG-IUS expulsion, and other follow-up information were recorded. Results: A total of 21 patients were included in this study, with an average age of (37.8±6.8) years old. The average uterine depth was (9.06±0.74) cm. Among them, 8 cases had a history of LNG-IUS expulsion (uterine depth > 8.5 cm in 5 cases, uterine depth≤8.5 cm in 3 cases, but the cervical canal was relatively loose), and other 13 cases had no history of LNG-IUS expulsion, but the uterine depth was all deeper than 8.5 cm. The average surgical time was (14.0±4.3) minutes, and the average intraoperative blood loss was (4.5±3.3) mL. All patients did not experience complications such as uterine perforation, massive bleeding, fluid overload, or postoperative infection. The average follow-up time after surgery was (3.2±0.8) months, and there was no LNG-IUS expulsion occured. The pain assessment and mean menstrual flow after operation were less than those before operation, and the endometrial thickness and mean uterine volume after operation were lower than those before operation, with statistically significant differences. For patients with dysmenorrhea, the postoperative relief rate was 95.0% (19/20), and for those with excessive menstruation, the postoperative effective rate reached 94.4% (17/18). The main adverse reaction was irregular vaginal bleeding, with an incidence rate of 57.1% (12/21). Conclusion: Hysteroscopic LNG-IUS fixation at the fundus of uterus is safe and effective. The procedure is simple, minimally invasive, has a short surgical time, minimal bleeding, and fast recovery. It is suitable for patients with dysmenorrhea, excessive menstruation, or large uterine cavity who have previously experienced LNG-IUS expulsion.

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

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

Objective: To investigate the prevalence of post-traumatic stress disorder (PTSD) in patients during the postoperative period following cardiac surgery and to identify its influencing factors. Methods: Post-cardiac surgery patients hospitalized during Sep to Nov, 2023 were surveyed using questionnaires consisting of a general information questionnaire, PTSD checklist, resilience scale, social support rating scale, anxiety and depression self-rating scale, and simple coping style questionnaire. Then we analyzed the factors influencing PTSD symptoms after cardiac surgery. Results: A total of 267 cases were enrolled.The mean PTSD score of the post-cardiac surgery patients was 16.51±12.31, with 29 patients at high risk for developing PTSD. Stepwise regression analysis revealed that low educational level, use of cardiopulmonary bypass, long stay in ICU, high pain scores, low levels of psychological resilience and social support, as well as high depression score were associated with higher PTSD scores in post-cardiac surgery patients (P < 0.05). Conclusion: The occurrence of PTSD symptoms in patients after cardiac surgery is common and varies in severity. The influencing factors include the patient's educational level, use of extracorporeal circulation during surgery, length of ICU stay, duration of ventilator use, pain, patient's depression score, psychological resilience, and social support. Medical staff should pay more attention to the mental health level of high-risk patients and take targeted intervention measures in a timely manner.

This paper introduces a transfer learning approach based on regression models and demonstrates its application in the medical field through an example. Using data from the 2013-2014 U.S. National Health and Nutrition Examination Survey, the study investigates the association of sleep duration with depression levels and depressive disorder. It employs demographic characteristics and lifestyle factors as predictor variables to predict depression levels and depressive disorder across different racial groups. Compared to models built solely on target racial groups, transfer learning enhances the accuracy of estimating the effect of sleep duration in the target group and improves the prediction accuracy for depression levels and depressive disorder. The results illustrate that transfer learning effectively integrates source data to significantly improve estimation and prediction capabilities of target models, especially in situations with limited target data and heterogeneous data sources.

Objective: To investigate the value of pre-treatment MRI features in predicting cachexia in hepatocellular carcinoma (HCC). Methods: A retrospective analysis was conducted on 399 patients with hepatocellular carcinoma, recording their pre-treatment clinical and MRI data. All patients underwent MRI plain and enhanced scan, and their weight was followed up 6 months after the MRI examination. According to the diagnostic criteria for cachexia, patients were divided into cachexia group and non-cachexia group. They were randomly divided into the training set (n=279) and the validation set (n=120). Univariable and multivariable logistic regression analyses were used to screen variables associated with cachexia in hepatocellular carcinoma and to establish a predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of different models. The DeLong test was used to compare the AUC values of different models, and the best-performing model was used to establish a predictive nomogram for cachexia in hepatocellular carcinoma. Results: Multivariable logistic regression analysis showed that serum albumin < 40 g/dL, serum alpha-fetoprotein > 100 ng/mL, tumor diameter > 5 cm, portal vein tumor thrombus, intratumoral arterial enhancement, and arterial phase peritumoral enhancement were independent predictors of cachexia in hepatocellular carcinoma. The clinical-imaging model showed the best predictive performance, with an AUC of 0.843 in the training set and 0.854 in the validation set. Conclusion: The nomogram based on MRI features can predict cachexia in hepatocellular carcinoma 6 months earlier than clinical diagnosis, which has important clinical guidance significance.

Helicobacter pylori (HP), a well-established carcinogenic factor, is implicated in the pathogenesis of gastric ulcer, gastric cancer, and other related diseases. Recent studies have unveiled a significant association between HP infection and an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Furthermore, it has been observed that eradication of HP can ameliorate metabolic disorders and relieve NAFLD. Some studies have explored the possible mechanism, which may be related to energy metabolism disorder and gut microbiota imbalance caused by HP. This review outlined the current research status regarding the association between HP and NAFLD, as well as elucidated the potential mechanisms through which HP promoted the onset and progression of NAFLD.

Objective: To establish a mouse model of human Escherichia coli (E. coli) colonization in early mammalian intestines, and to explore the trend and influencing factors of E. coli colonization in mouse intestines. Methods: A wild-type E. coli strain LFYP5, derived from an infant, was inoculated into the SPF mice via gavage. The abundance change curves of E. coli were plotted by collecting intestinal contents or fecal samples from the mice and utilizing plate counting colony forming unit (CFU) methods. This study investigated the effects of different intestinal locations, inoculation ages, weaning time, and cage-changing time on the colonization abundance of E. coli. Additionally, 16S rRNA sequencing was used to explore the changes in the microbial composition of the mouse gut after inoculation with E. coli. Results: E. coli LFYP5 was able to colonize the intestinal tract of mice before the weaning age. Its abundance decreased rapidly at the weaning stage, independent of the inoculation age, and whether to change the cages. When weaning occurred too early, the abundance of E. coli declined correspondingly earlier. Mice inoculated with E. coli LFYP5 had a lower alpha diversity of the gut microbiota composition and higher relative abundance of the lactobacillus genus compared to mice without E. coli LFYP5 inoculation. Conclusion: A mouse model of human E. coli colonization in the early mammalian gut has been successfully established. This model may be used to study the colonization mechanisms of human E. coli in the mammalian gut in the future.

Objective: To compare the therapeutic efficacy of a self-locking zero-notch interbody fusion device for long-segment cervical spondylosis in elderly patients with traditional titanium plate combined with interbody fusion device. Methods: From Jan 2019 to Jan 2021, elderly patients (> 60 years) with 3-4 segments (C3-C7) radiculopathy, myelopathy, or mixed-type cervical spondylosis underwent anterior cervical discectomy and fusion (ACDF) using a zero-notch interbody fusion device (Group A, n=24) and ACDF using a titanium plate combined with an interbody fusion device (Group B, n=18). We recorded the surgery duration, blood loss, incision length and hospital stay, measure preoperative and postoperative intervertebral height, functional segment height and cervical lordosis, and also observe treatment outcomes and postoperative complications between the two groups. Results: There were no statistically significant differences between the two groups in terms of gender, age, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of upper limb, Neck Disability Index (NDI), preoperative intervertebral height, functional segment height and cervical lordosis. Blood loss, surgery time and hospital stay were similar in both groups, but Group A had shorter incision length (P < 0.01) compared with Group B. There were no significant differences between the two groups in JOA scores, upper limb VAS and postoperative NDI, and even in postoperative intervertebral height, functional segment height and cervical lordosis recovery. Conclusion: The zero-notch interbody fusion device is effective for treating long-segment cervical spondylosis. Compared with the traditional titanium plate combined with an interbody fusion device, it can avoid postoperative dysphagia with smaller incision and shorter surgery time, which makes it more suitable for elderly patients.

Objective: To explore the clinical and pathological characteristics and oncological outcomes of clear cell borderline ovarian tumor (CCBOT), and provide guidance for the diagnosis and treatment of this disease in the future. Methods: A total of 23 CCBOT patients who underwent surgical treatment in our hospital from May 2011 to Aug 2022 were enrolled, and the clinical information of 19 CCBOT patients in the Ricotta's cohort was integrated. The clinical pathological characteristics and oncological outcomes of these 42 patients were retrospectively analyzed. Results: This study enrolled 42 CCBOT patients, including 23 from our cohort and 19 from the Ricotta G's cohort. Compared with the Ricotta's cohort, the proportion of CCBOT patients with endometriosis in our cohort (34.8%) was significantly higher than that in the Ricotta's cohort (5.3%) (P < 0.05). In our cohort, 22 patients had information on intraoperative frozen section evaluation, and the accuracy of intraoperative frozen section evaluation was 50% (11/22). The other 50% (11/22) of patients were underestimated by intraoperative frozen section evaluation. The merged cohort indicated that the median age of the patients was 60 years old, occuring more common in postmenopausal women (66.7%). Most cases presented with pelvic masses (59.5%) and abdominal pain or distension (19.0%). This disease mostly involved unilateral ovaries (90.5%). Information on preoperative tumor markers was largely missed, making it difficult to draw an accurate evaluation for them. Ten cases (23.8%) underwent fertility sparing surgery, and 32 cases (76.2%) underwent radical surgery. The pathologic report indicated that all patients were stage Ⅰ patients and 21.4% patients had endometriosis. Among these patients, 32 patients underwent total hysterectomy, of which 10 (31.3%) had concurrent endometrial lesions. The median follow-up time was 68 months, with a minimum follow-up of one month and a maximum follow-up of 231 months, and no recurrence or death was observed. Conclusion: CCBOT patients usually had an good prognosis with a low recurrence rate. Fertility sparing surgery was safe and feasible, but attention should be paid to exclude concurrent endometrial lesions. Given the rarity of CCBOT, future multicenter prospective studies are needed to better elucidate the clinical pathological features and prognosis of patients with CCBOT.

Objective: To provide a comprehensive description and summary of the clinical characteristics of eosinophilic granulomatosis with polyangiitis (EGPA) in order to enhance understanding of this disease. Methods: A total of 33 EGPA patients treated in Zhongshan Hospital, Fudan University, between Jan 2017 and Aug 2022 were included in this retrospective analysis. The diagnosis was based on the 1990 American College of Rheumatology (ACR) classification criteria for EGPA. Clinical manifestations, laboratory examinations, and treatment outcomes of the patients were analyzed. Results: Among the 33 EGPA patients, there were 22 males (66.7%) and 11 females (33.3%), with an average age of diagnosis being (47.42±15.83) years old. The most common initial department visited by patients was the rheumatology department (23 cases, 69.7%), followed by the respiratory medicine department (6 cases, 18.2%). Skin involvement manifested as rash, ulcers, necrosis or gangrene was observed in most cases (23 cases, 69.7%), followed by asthma (17 cases, 51.5%), infiltrative pneumonia (14 cases, 42.4%), peripheral neuropathy (9 cases, 27.3%), thrombosis formation (9 cases, 27.3 %).The mean absolute value of eosinophils in all patients was measured as (3.43±3.52)×10⁹/L, with eight patients (24.2%) testing positive for antineutrophil cytoplasmic antibody (ANCA). Compared with ANCA-negative patients, ANCA-positive individuals exhibited significantly higher Birmingham Vasculitis Activity Score (BVAS) and eosinophil count, as well as a higher incidence rate of renal involvement (P < 0.05). Glucocorticoid therapy was administered in thirty-two patients (97%), while biologics or tofacitinib were given to eleven patients (33.3%), among them six received tofacitinib treatment, of which five achieved disease remission. Conclusion: EGPA exhibits a wide range of clinical manifestations, and ANCA-positive patients tend to exhibit higher disease activity levels. A multidisciplinary diagnosis and treatment system for EGPA should be established.

Objective: To analyze the impact of tandem mass spectrometry (MS/MS) screening compared to the indanone-fluorescence method (hereinafter referred to as fluorescence analysis) on finance or health insurance in screening newborn genetic metabolic diseases in Shanghai, and provide policy recommendations for MS/MS reimbursement. Methods: A budget impact analysis model was constructed using Microsoft Excel 2019, with a study period of 3 years (2025‒2027). Newborns of 2025 to 2027 were predicted based on the birth data of newborns in Shanghai and the average decrease of newborns in Shanghai. Clinical screening data and cost data were derived from relevant statistical websites, literature, and hospital survey data. Additionally, consultations with experts were conducted to understand national and Shanghai-specific screening and reimbursement policies. Among these, the fluorescence-based analysis method is primarily used for screening phenylketonuria, while MS/MS can be used for screening a variety of newborn genetic and metabolic disorders. So we separately calculated the impact of MS/MS screening compared to the fluorescence-based method on Shanghai's fiscal budget and health insurance fund. Results: The budget impact analysis on fiscal expenditures indicates that from 2025 to 2027, the fiscal expenditures for fluorescence analysis will be 1.58 million, 1.48 million and 1.39 million yuan, respectively. In contrast, MS/MS fiscal expenditures will be 22.75 million, 21.37 million, and 20.06 million yuan, respectively; compared with fluorescence analysis, the increased fiscal expenditures for MS/MS will be 21.18 million, 19.88 million, and 18.67 million yuan, respectively, showing a decreasing trend annually. The budget impact on health insurance funds shows that from 2025 to 2027, the expenditures for fluorescence analysis will be 1.11 million, 1.04 million and 0.97 million yuan, respectively; MS/MS health insurance fund expenditures will be 15.93 million, 14.96 million and 14.04 million yuan, respectively. Compared with fluorescence analysis, the additional health insurance fund expenditures for MS/MS will be 14.82 million, 13.92 million and 13.07 million yuan, respectively, also showing a decreasing trend annually. Policy-wise, the costs for tandem mass spectrometry screening are typically covered by fiscal payments or out-of-pocket by patients, with commercial insurance, charitable foundations, and other organizations serving as supplementary sources of funding. Conclusion: The overall cost of expanding newborn screening for genetic metabolic diseases in Shanghai is controllable. To unify the payment standards and facilitate centralized management, it is recommended that the costs for tandem mass spectrometry screening in Shanghai be covered by government funding.

Objective: To construct trajectory models of care-seeking patterns for type 2 diabetes mellitus (T2DM) patients, analyze the influencing factors of different trajectories, and explore the fasting blood glucose control levels of T2DM patients with different trajectories. Methods: A retrospective cohort study was carried out on 18 088 T2DM patients who had health records and been involved in the diabetic management in Community Health Service Center of Minhang District, Shanghai from 2006 to 2009. Starting from Jan 1, 2010, participants were followed up until Dec 31, 2019, with complete follow-up information. Group-based trajectory modelling (GBTM) was employed to identify and construct the fluctuation trajectory of fasting blood glucose in the patients. Bayesian information criterion (BIC), average posterior probability (AvePP) and other evaluation indicators were used to select the optimum subgroup number model. Then the differences in demographic characteristics, health status, family history, fasting blood glucose, BMI, etc were compared among different categories. Multinational logistic regression model was constructed to explore the influencing factors of different fluctuation trajectories. Cox regression analysis was used to examine the relationship between the long-term trajectories of care-seeking patterns and fasting blood glucose control level. Results: Using GBTM analysis, we constructed the optimal Model 4 to categorize 18 088 T2DM patients with community health records into five distinct trajectory subgroups: continuous non-attendance group (22.29%), low-level increasing group (15.09%), high-level slowly decreasing group (14.18%), high-level rapidly decreasing group (14.90%), and continuous regular attendance group (33.54%). With the continuous regular attendance group serving as the reference, gender, age, place of residence, baseline comorbidity of hypertension, baseline fasting plasma glucose level, and BMI were found to influence the community attendance trajectories of T2DM patients (P < 0.05). After adjusting for confounding factors, Cox regression analysis revealed that compared to the continuous non-attendance group, the low-level increasing group, high-level slowly decreasing group, and continuous regular attendance group had better glycemic control, with HRs of 0.37 (95%CI: 0.34-0.39), 0.72 (95%CI: 0.67-0.78), and 0.78 (95%CI: 0.73-0.84), respectively. The glycemic control level in the high-level rapidly decreasing group was comparable, with an HR of 1.06 (95%CI: 0.99-1.12). Conclusion: Based on the optimal model, the community medical treatment trajectories of T2DM patients showed different dynamic characteristics. Factors such as gender, residence, hypertension, and weight loss may influence these varying trajectories. Regular community visits and follow-up may help control blood glucose levels.

Objective: To conduct a bibliometric analysis of relevant literature on liver failure caused by viral hepatitis from the past five years, and to help researchers understand the current status and hotspots in this field, and to provide insights into future research trends. Methods: Based on the Science Citation Index Expanded (SCI-Expanded) data from Web of Science Core Collection, visualization analysis and mapping were conducted through VOSviewer and CiteSpace software to generate visual representations of international research collaboration networks, keyword co-occurrence clustering, and keyword bursts. Results: From 2019 to 2023, a total of 873 relevant literature were included, with a total citation frequency of 7 364 and an average citation frequency of 8.44. Among them, China had the highest number of publications (458 articles, 52.46%) and had the most cooperation with the United States. The research hotspots of viral hepatitis induced liver failure were mainly divided into three categories: basic and clinical research on liver failure caused by non-hepatitis B virus (HBV), the pathogenesis of HBV related liver failure, and treatment and prediction models of liver failure. The keyword time overlay map and burst map showed that the research hotspots had gradually shifted from the prevention and control of new infections to the treatment and prognosis assessment of patients with chronic infection. Conclusion: China is a major international research entity in liver failure caused by viral hepatitis and actively participates in international scientific collaborations. The research hotspots on liver failure caused by viral hepatitis have gradually shifted from preventing viral hepatitis infections and expanding treatment options to the treatment of chronic infection patients and prognostic prediction.

Objective: To study the trend of stroke mortality in Minhang District, Shanghai from 2012 to 2022 and to predict stroke mortality from 2023 to 2027. Methods: Annual percentage change (APC) of stroke deaths in Minhang District, Shanghai from 2012 to 2022 was calculated, and then Joinpoint linear regression model was used to analyze the time trend of stroke deaths. A grey GM(1, 1) model was constructed based on the stroke mortality rate in Minhang District, Shanghai from 2012 to 2022. The model was used to predict and analyze the stroke mortality rate in Minhang District, Shanghai from 2023 to 2027. The fitting effect of the model was evaluated using relative error and grade deviation. Results: From 2012 to 2022, the overall mortality rate of stroke in Minhang District, Shanghai was on the rise for both males and females (total population: APC=2.50%, P < 0.001; male: APC=3.41%, P < 0.001; female: APC=1.46%, P=0.008). The grey GM (1, 1) model was used to predict the increasing trend of stroke mortality rate in Minhang District from 2023 to 2027. The crude mortality rate of stroke in the entire population in 2027 would be 97.55/100 000, with 112.31/100 000 for males and 83.33/100 000 for females. The fitting effect of the model was tested and evaluated to meet high requirements. Conclusion: In the past decade, the mortality rate of stroke in Minhang District, Shanghai has shown a significant upward trend. The 5-year prediction results showed that the mortality rate will still on the rise year by year.

Objective: To establish a renal cell co-culture system to simulate the renal barrier system, and to test its responsiveness to different glucose concentrations, and to investigate the regulatory effect of miR-29b-3p on osteopontin (OPN)/transforming growth factor β (TGF-β) pathway and the changes of this pathway under high glucose condition. Methods: The three-cell co-culture system consisting of human renal podocytes, human glomerular mesangial cells and human renal tubular epithelial cells was established to test the cell viability and glucose consumption value at glucose concentrations of 5, 8, 12 and 16 mmol/L. The content of TGF-β and OPN in cell supernatant was measured. The recombinant plasmid and siRNA of OPN were transfected, and the expressions of TGF-β and OPN were detected by Q-PCR and Western blot. Results: The mRNA expressions of OPN, TGF-β and miR-29b were significantly increased at 12 mmol/L glucose conditions. Western blot results showed that the protein expression of OPN increased in high glucose conditions, while the protein expression of TGF-β did not change significantly. After adding miR-29b-3p activator, the mRNA levels of OPN and TGF-β in the cell supernatant were significantly increased. After adding miR-29b-3p inhibitor, the mRNA levels of OPN and TGF-β in the cell supernatant were significantly decreased. Western blot results showed that compared with 5 mmol/L glucose, the protein expressions of OPN and TGF-β were increased by miR-29b-3p activator, and the protein expressions of OPN and TGF-β were decreased by miR-29b-3p inhibitor. After transfection with OPN recombinant plasmid, the content of TGF-β in the cell supernatant was significantly increased, and the mRNA expressions of OPN and TGF-β in the cells were significantly increased. After transfection with OPN siRNA, the content of TGF-β in the cell supernatant was decreased, and the expression of OPN mRNA in the cells was significantly decreased, but the expression of TGF-β mRNA was not significantly increased. Conclusion: The renal cell co-culture system can mimic the complex renal environment in vivo. When induced by high glucose, cell proliferation is inhibited, glucose consumption is increased, and the content of TGF-β in the cell supernatant is increased, and miR-29b-3p has a regulatory effect on OPN/TGF-β signaling pathway in the co-culture system.

Objective: To observe the clinical effect of pressing needle in preventing and reducing nausea and vomiting in patients after gynecological laparoscopic surgery. Methods: A total of 199 patients undergoing gynecological laparoscopic surgery from May to Nov 2023 at Obstetrics and Gynecology Hospital, Fudan University were randomly divided into research group (n=99) and control group (n=100). The observation group was given Tanzhong, zanzhu and Taichong pressing needles on the basis of the control group. The postoperative nausea and vomiting were observed in the two groups. Results: There were significant differences in the incidence and duration of postoperative nausea, the incidence of postoperative vomiting between the two groups (P < 0.05), but there was no significant difference in the duration of postoperative vomiting. The incidence of nausea and vomiting in the observation group was lower than that in the control group. Conclusion: Pressing needle can effectively prevent the occurrence of nausea and vomiting after gynecological laparoscopic surgery, and reduce the degree of nausea and vomiting, and reduce the duration of nausea.

Objective: To investigate the associations of reproductive health indicators with lung function and chronic obstructive pulmonary disease (COPD) among women aged 40 years and above. Methods: From Jul to Sep, 2021, female subjects aged 40 years and above were randomly selected from the Shanghai Suburban Adult Cohort and Biobank for COPD screening. A questionnaire was used to obtain information on demographic characteristics and reproductive health indicators. Linear regression was used to analyze the effects of reproductive health indicators on forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). Logistic regression was also used to analyze the effects of reproductive health factors on FVC as a percentage of the predicted value (FVC%Pred) and FEV1%Pred as well as on COPD. Results: A total of 1 876 women aged 40 years and above were enrolled with mean age of (62.1±8.2) years old, among them, 78.1% were menopausal, and 40.9% had been pregnant ≥3 times. Multivariate analysis showed that FVC and FEV1 decreased in postmenopausal women, but menopause was not associated with a decrease in their percentage of predicted values. Pregnancies ≥3 times was a risk factor for COPD (for 3 times, OR=4.92, 95%CI: 1.48-19.95, P < 0.05;for≥4 times, OR=9.06, 95%CI: 2.32-41.57, P < 0.01), while pregnancies of 2 times did not increase the risk of COPD. Conclusion: In women aged 40 years and above, menopause is associated with poorer FVC and FEV1, and excessive pregnancy (≥3 times) is a risk factor for COPD.

Objective: To identify the latent profile of physical and psychological symptoms in postpartum women and examine the associations of the latent class membership with individual characteristics, based on a latent profile analysis. Methods: A cross-sectional survey study was conducted. With convenience sampling, 157 postpartum women who had delivered at the Obstetrics and Gynecology Hospital, Fudan University from Dec 2023 to Mar 2024 were selected. The participants were surveyed with patient-reported outcomes measurement information system (PROMIS) Anxiety, Depression, Fatigue, Sleep Disturbance, and Pain interference short forms. LPA and multinomial Logistic regression model were performed to identify subgroups based on physical and psychological symptoms in postpartum women and population heterogeneity. Results: LPA results suggested that there existed three distinct classes of postpartum physical and psychological symptoms: severe symptoms distress class (10.2%), moderate symptoms distress class (50.3%), and mild symptoms distress class (39.5%). Postpartum women's age, living arrangements, newborn's birthweight, newborn's feeding method, newborn's medical background, prenatal pregnancy risk assessment, mode of delivery, and postpartum complications had significant associations with the latent class membership (P < 0.05). Conclusion: There are 3 latent profiles of postpartum physical and psychological symptoms. Healthcare providers could provide targeted intervention to postpartum women according to the characteristics of different subgroup population characteristics, so as to improve the postpartum experience of women.

Objective: To investigate the role of Sneathia sanguinegens (S.sanguinegens) in the development of unexplained recurrent spontaneous abortion (URSA). Methods: A case-control study was conducted to analyze the vaginal flora characteristics of 65 patients with URSA and 18 healthy controls through 16S rRNA gene sequencing. Toxicity profile of S.sanguinegens on human cervical cancer cells (ME-180), human umbilical vein endothelial cells (HUVEC) and human placental choriocarcinoma cells (JEG-3) was analyzed at the cellular level to assess the mechanism of it in adverse pregnancy outcomes. And S.sanguinegens was used to infect C57BL/6J mice to explore the toxic effect on living organisms. Results: The relative abundance of Sneathia was increased in patients with URSA compared with healthy controls. It was positively correlated with the number of miscarriages, and was attributed to S.sanguinegens. We also found that S.sanguinegens damaged ME-180, JEG-3 and HUVEC cells. The degree of cellular damage was related to the level of S.sanguinegens added. Intravenous infection with S.sanguinegens caused inflammatory damage in several organs and extramedullary hematopoiesis in the spleen. Conclusion: S.sanguinegens is closely related to URSA and should be emphasized in patients with high vaginal bacterial load.

Objective: To investigate the peripheral blood cytokine levels in patients with acute myocardial infarction (AMI), and to analyze its correlation with Killip classification, N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), creatine kinase isoenzymes (CK-MB), and to provide a theoretical basis for assessing the severity and prognosis of the disease. Methods: A total of 312 patients with AMI admitted to Minhang Hospital, Fudan University from Jul 2021 to Oct 2023 were enrolled as the case group, and 201 patients with unstable angina pectoris were selected as the control group. General clinical data of the subjects were collected, and the concentrations of cytokines (IL-5, IFN-α, IFN-γ, IL-10, IL-12p70, IL-17, IL-1β, IL-2, IL-4, IL-6, IL-8, and TNF-α) in peripheral blood were detected by multiplex bead-based flow cytometry. NT-proBNP, cTnI and CK-MB were measured by chemiluminescence methods. The levels of cytokines between the two groups were compared, and their correlations with Killip classification, NT-proBNP, cTnI and CK-MB were analyzed. The predictive efficacy of cytokines for AMI was evaluated by receiver operating characteristic (ROC) curves. Results: There were no significant differences in baseline data between the AMI group and the control group (P > 0.05), with the exception of age. The levels of IL-6, IL-8 and TNF-α in the AMI group were higher than those in the control group (all P < 0.01). The correlation analyses showed that IL-6 was positively correlated with Killip classification, NT-proBNP, cTnI and CK-MB (all P < 0.01). ROC analyses showed that IL-6 levels had good predictive efficacy for AMI (AUC=0.882 9, P < 0.01). Conclusion: The expression of IL-6 was significantly increased in patients with AMI, and it was positively correlated with Killip classification, NT-proBNP, cTnI and CK-MB, suggesting that IL-6 may serve as a potential biomarker for assessing the severity of AMI.

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.

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

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