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

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.

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

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

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.

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.

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.

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

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

Objective: To rescue a strain of Chikungunya virus (CHIKV) using reverse genetics system. Methods: Molecular cloning experiments, including PCR, agarose gel electrophoresis and homologous recombination were employed to generate an infectious cDNA clone (pFK-CHIKV-LN) derived from the isolated Caribbean Chikungunya strain (Caribbean strain, isolate M100, Genbank LN898083.1). The mRNA obtained from vitro transcription were transfected into BHK-21 to rescue the CHIKV. The viral titer was determined by 50% tissue culture infection dose (TCID50), with calculations performed using the Reed-Muench method. Western blot (WB) and real time quantitative polymerase chain reaction (RT-qPCR) were employed to assess the levels of viral protein and mRNA at various time points during infection. Results: The full-length cDNA clone of CHIKV was successfully constructed, enabling the rescue of CHIKV progeny. RT-qPCR and WB confirmed the significant increasing expression levels of NS1 mRNA and proteins (NS3, E1) of BHK-21 during the infection process. Conclusion: The full-length infectious clone of CHIKV has been constructed successfully, which provides a good tool for subsequent studies on the gene structure, protein function and pathogenic mechanism of CHIKV.

The mode of cell death as well as the role of necroptosis in inflammatory diseases has gained importance in recent years. Chronic airway inflammatory diseases are common respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, which are often accompanied by persistent airway inflammation, and the pathogenesis of these diseases is complex and involves cell death pathways. The involvement of necroptosis in their pathogenesis is getting more and more attention. This review introduces reviewed the important pathways and factors of necroptosis, as well as its advances in mechanism of chronic airway inflammatory diseases, aiming to provide new ideas and targets for the research and treatment of chronic airway inflammatory diseases.

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.

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

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 differences in coronary-based and lesion-based fat attenuation index (FAI) in patients with coronary artery disease (CAD) across different risk stratifications, and to compare the diagnostic efficiency of coronary-based and lesion-based FAI in stable CAD patients with myocardial ischemia. Methods: The patients with CAD, who underwent preoperative coronary CT angiography (CCTA) and invasive coronary angiography (ICA) with coronary fractional flow reserve (FFR) measurement between Apr 2019 and Oct 2022 in Zhongshan Hospital, Fudan University, were retrospectively collected. There were 57 cases of acute coronary syndrome (ACS) patients and 206 cases of stable CAD patients included following inclusion criteria. The coronary-based and lesion-based FAI were measured, and the differences in these indices were recorded and analyzed among ACS patients, ischemic and non-ischemic groups of stable CAD patients (FFR=0.8 as the threshold). ROC curves were utilized to assess the diagnostic efficiency of coronary-based and lesion-based FAI for myocardial ischemia in stable CAD patients. Results: The coronary-based FAI and lesion-based FAI in ACS patients were significantly higher than those in stable CAD patients [coronary-based FAI: (-72.40±6.83) HU vs. (-76.82±9.01) HU, P < 0.001; lesion-based FAI: (-65.65±4.79) HU vs. (-77.48±8.64) HU, P < 0.001]. Among stable CAD patients, the lesion-based FAI in the ischemic group was significantly higher than that in the non-ischemic group [(-69.28±5.65) HU vs. (-80.10±7.75) HU, P < 0.001]. The diagnostic efficiency of lesion-based FAI for predicting myocardial ischemia in stable CAD patients was superior to coronary-based FAI (AUC: 0.892 vs. 0.525, Z=9.803, P < 0.001). Conclusion: Coronary-based and lesion-based FAI tended to be higher in ACS patients than in stable CAD patients, suggesting a potential for stratifying CAD patients with different risks. Lesion-based FAI showed some promise in evaluating myocardial ischemia among stable CAD patients.

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

Objective: To evaluate the diagnostic value of MRI in fetal microcephaly and microcephaly with simplified gyral pattern (MSGP) by comparing with ultrasonography. Methods: Prenatal MRI manifestations of 24 cases of fetal microcephaly and MSGP in Obstetrics and Gynecology Hospital, Fudan University from Sept 2023 to Feb 2025 were retrospectively studied and compared with fetal ultrasonography findings on the same day. All cases were confirmed by follow-up and induced labor. Results: Twenty-four fetuses were 23.6 to 36.6 gestational weeks with a average of 27.7 gestational weeks. Fourteen cases of fetal microcephaly and 10 cases of MSGP were diagnosed by prenatal MRI. Among those diagnosed with MSGP, 1 case was accompanied by Dandy-Walker variant, and 2 cases were accompanied by Dandy corpus callosum agenesis. Prenatal ultrasound diagnosed microcephaly in 21 cases, among which 1 case was accompanied by Dandy-Walker variant, and MSGP in 3 cases. Seven cases of MSGP and 2 cases of concomitant corpus callosum agenesis were missed diagnosed. MRI and ultrasound findings of fetal microcephaly showed a head circumference less than three standard deviations (-3SD) from the mean value. MRI findings of MSGP were head circumference less than -3SD from the mean value, decreased cranio facial ratio, slanted and small frontal lobe, fewer and shallow cerebral sulci and gyri, the development of sulci and gyri is delayed by about 2 to 4 weeks compared to the normal gestational age, but with normal thickness of the cortex, and normal cerebral gray and white matter. The diagnostic rate of MRI for prenatal MSGP was 100%. Ultrasound findings of MSGP were head circumference less than -3SD from the mean value, and cerebral sulci and gyri were shallow and few. The diagnostic rate of ultrasonography for prenatal MSGP was 30%. Conclusion: MRI is more advantageous than ultrasonography in the evaluation of sulci and gyri, as well as the display of cortex, and can make a definite diagnosis for fetal microcephaly and MSGP, also has a higher diagnostic accuracy for other intracranial concomitant malformations. For fetuses with clinically suspected microcephaly, fetal brain MRI assessment is required to determine whether it is MSGP, or to detect possible intracranial concomitant malformations.

Objective: To summarize the perioperative nursing experience for patients undergoing high-risk complex percutaneous coronary intervention (PCI) with the support of the percutaneous transvalvular left-ventricular assist system (SynFlow 3.0), and to explore the role of nursing interventions in improving procedural success and promoting patient recovery. Methods: A retrospective analysis was conducted on the clinical data of 26 patients who underwent SynFlow 3.0-assisted high-risk complex PCI in Zhongshan Hospital, Fudan University between Aug 2022 and Jul 2024. Stage-specific comprehensive nursing interventions were implemented throughout the perioperative period: Preoperatively, personalized nutritional support and cardiac function optimization were provided for patients with nutritional risk (NRS≥3), hypoalbuminemia (Alb < 30 g/L), or an early warning score≥4. Intraoperatively, the SynFlow 3.0 operational procedures were standardized, with reinforcement of aseptic techniques and hemodynamic monitoring. Postoperatively, patients were transferred to the ICU for continuous monitoring of circulatory parameters (blood pressure, central venous pressure, urine output, etc.) and hemolysis-related indicators, alongside active prevention of vascular complications, vagal reflex, and thrombotic events. Results: The procedural success rate was 100% in all 26 patients, with no severe complications occurring. Nursing interventions effectively maintained an intraoperative mean arterial pressure≥60 mmHg. Postoperative circulatory parameters remained stable (systolic blood pressure 90-130 mmHg, urine output > 50 mL/h), and no thrombotic or hemolytic events were reported. The left ventricular ejection fraction significantly increased from 32.44%±4.46% preoperatively to 38.55%±5.42% at 30 days postoperatively, and the difference was statistically significant (t=16.065, P < 0.001). Conclusion: The implementation of a full-process comprehensive nursing strategy for patients undergoing SynFlow 3.0-assisted high-risk complex PCI effectively stabilizes perioperative hemodynamics, reduces the risk of complications, ensures procedural safety, and promotes cardiac function recovery.

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 possible association between cross-domain associative memory (AM) impairment and hippocampal subfield volumes in patients with schizophrenia (SCZ). Methods: We enrolled 28 SCZ patients from Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, and 28 healthy controls (HCs) between 2019 and 2021. Based on an innovative AM paradigm and automated segmentation, 3D-T1 weighted data of the objects were processed with PhiPipe and FreeSurfer. Differences in subfield volums between the two groups were analyzed using ANCOVA, while their relationship with AM scores was assessed using Pearson correlation. Results: SCZ patients exhibited significantly poorer AM performance across three conditions compared with HCs. Marginally significant reductions were observed in the total volume of bilateral hippocampus, encompassing both the hippocampal head and body. Significant volume reductions were identified in the bilateral presubiculum and parasubiculum. The volumes of bilateral presubiculum head (r=0.273, P=0.042), parasubiculum (r=0.397, P=0.002), and CA1 head (r=0.382, P=0.004) exhibited positive correlations with cross-domain AM performance. Conclusion: The bilateral presubiculum and parasubiculum, as hippocampal subregions significantly associated with cross-modal AM deficits in SCZ, may play a crucial role in the pathology of AM.

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

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 summarize and analyze the clinicopathological characteristics, imaging manifestations, treatment and prognosis of anaplastic lymphoma kinase (ALK)-positive histiocytosis (APH) involving the central nervous system (CNS), so as to enhance understanding of this rare disease. Methods: A retrospective analysis was conducted on 5 cases of CNS-involved APH diagnosed in Huashan Hospital, Fudan University between 2019 and 2023. Clinical, imaging and pathological data were collected, and supplemented by immunohistochemical staining (IHC), fluorescence in situ hybridization (FISH) and high-throughput sequencing for auxiliary diagnosis and molecular characterization. The findings were summarized and integrated with previous literature for a comprehensive analysis. Results: All five patients were male, with a mean age of 27.6 years, in which 2 cases exhibited multi-system involvement, while 3 cases exhibited single system involvement. Imaging revealed multiple intracranial lesions in multi-system cases and solitary lesions in single system cases, with well-defined boundaries and homogeneous enhancement. Histologically, tumor cells were intermingled with lymphocytes, displaying an alternating "light and dark" pattern in 1 case. Granuloma-like structures were observed in 4 cases, along with frequent nuclear grooves, indentations and convolutions. Tumor cells usually infiltrated surrounding tissues. IHC demonstrated that tumors expressed histiocytic markers (CD68/CD163) and ALK predominantly expressed in the cytoplasm. FISH confirmed ALK gene rearrangements in all patients, while high-throughput sequencing identified KIF5B-ALK fusions in 2 cases. All single system CNS cases achieved complete remission after surgical resection with or without adjuvant chemotherapy/ALK inhibitors. Among multi-system cases, one achieved partial remission, and one experienced relapse and progression. Conclusion: CNS APH is prone to preoperative misdiagnosis. Its histopathological features, ALK immunohistochemical expression, and ALK gene fusions are critical for diagnosis. Patients with single system involvement demonstrate overall superior outcomes compared to multi-system cases. Total resection is effective for localized disease, while multi-system cases require systemic therapy. Multidisciplinary collaboration is crucial for precise diagnosis and treatment.

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: The optimal ventilation mode for patients with obesity undergoing laparoscopic surgery remains unclear. We aimed to compare the effects of pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) on perioperative oxygenation and respiratory mechanics in patients undergoing laparoscopic bariatric surgery. Methods: In this prospective randomized controlled study, 114 subjects who underwent laparoscopic bariatric surgery from Jan 2017 to Mar 2020 were randomly divided into PCV-VG group (n=56) or PCV group (n=54), with 4 lost to follow-up. The perioperative pulmonary mechanics and arterial blood gas results were compared between the two groups. Postoperative extubation time, the incidences of postoperative pulmonary complications (PPCs) and abnormal radiographic changes (ARCs) were also recorded. Results: During intraoperative pneumoperitoneum, the pulmonary dynamic compliance (Cdyn) was significantly lower in PCV-VG group than that in PCV group (T₂: P=0.022;T₃: P=0.039). There were no significant differences in perioperative oxygenation index and respiratory peak pressure (Ppeak) between the two groups. Eighty-six patients (78.2%) had ARCs on the 1^st day after surgery, and 10 cases (9.1%) developed PPCs. There was no significant difference in extubation time, ARCs or PPCs between the two groups. After adjustment, anesthesia duration and oxygenation index before anesthesia induction were significantly associated with extubation time. Anesthesia duration of more than 2 hours was a risk factor for postoperative ARCs. Conclusion: Compared with PCV-VG mode, PCV mode provides better pulmonary Cdyn during intraoperative pneumoperitoneum for patients undergoing laparoscopic bariatric surgery.

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

Objective: To analyze the characteristics of capsule endoscopy (CE) in small intestinal diseases and the effect of prokinetic agents on CE, and to explore the diagnostic value of CE in small intestinal diseases. Methods: Clinical data were collected from 332 patients who underwent CE in Jinshan Hospital, Fudan University between May 2020 and Mar 2024, and the etiology and endoscopic characteristics of small intestinal diseases were analyzed. Patients were categorized based on the administration of metoclopramide into the non-use group (Group A) and use group (Group B). Group A was further subdivided based on whether the CE reached the cecum, forming the non-reach group (Group c) and the reach cecum group (Group d). Then we compared the capsule gastric transit time, small intestine transit time, completion rate of the entire small intestine examination, and lesion detection rate across these groups. Additionally, the detection rates of CE were compared with those of colonoscopy, small bowel enteroscopy-CT (SBE-CT), and double-balloon enteroscopy (DBE). Results: The most prevalent small intestinal lesions identified were erosions and ulcers, with Crohn's disease (CD) being the primary cause of ulcers, endoscopic ulcers exhibited atypical and diverse presentations, including aphthous and irregular ulcers. In comparison to Group A, Group B demonstrated a shorter small bowel transit time (P < 0.05) and a higher lesion detection rate (P < 0.05), while no significant difference was observed in the completion rate of the entire small bowel examination. Gastric emptying time and small intestinal transit time were prolonged in Group c compared with Group d (P < 0.05). There was no significant difference in the diagnostic rate of terminal ileum lesions between CE and colonoscopy, while the diagnostic rate of CE was higher in patients with terminal ileum lesions under colonoscopy (P < 0.05). The diagnostic rate of CE was higher than that of SBE-CT(P < 0.05), and the detection rate of CE and DBE was comparable. Conclusion: The morphology of small intestinal ulcers varies, and the endoscopic findings are not specific. Metoclopramide administered in real time after capsule ingestion can shorten the intestinal transit time and improve the diagnostic rate of CE. Positive lesions found during colonoscopy should be further evaluated with CE examination, the diagnostic accuracy of CE is higher than that of SBE-CT, CE and DBE have the same diagnostic value for small intestinal diseases.

Objective: To investigate the practical effects of pediatric rapid sequence intubation (RSI) nursing coordination training based on the LSPPDM (learn, see, practice, prove, do, maintain) framework in order to provide evidence for optimizing pediatric RSI nursing training programs. Methods: Nurses from the intensive care unit (ICU) of Children's Hospital, Fudan University during Feb 2023 and Jan 2024 were divided into the experimental group (n=35) and the control group (n=35) by block randomization. The experimental group received LSPPDM framework-based training, while the control group underwent conventional training with theoretical lectures and procedural demonstrations. Outcomes included training satisfaction, theoretical knowledge and procedural skill assessment scores, team collaboration compliance and RSI procedure time were compared between the two groups. Results: The experimental group demonstrated significantly higher training satisfaction (123.80±2.04 vs. 117.26±9.82, P < 0.05), superior post-training theoretical knowledge and procedural skills (P < 0.05), enhanced team collaboration compliance (P < 0.05), and shorter RSI completion time (P < 0.05) compared with the control group. Conclusion: Pediatric RSI nursing coordination training based on the LSPPDM framework can effectively increase training satisfaction, promote theoretical and procedural skills and reduce completion time in nurses.

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.

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 investigate the effect of Nde1 gene knockout on early neural development of zebrafish by visualizing the development of neural networks in zebrafish. Methods: Transgenic zebrafish Tg (Nde1^-/-; HuC: RFP^+/-) was constructed by crossing Nde1^-/- with Tg (HuC: RFP^+/-). The HuC promoter was employed to drive the expression of red fluorescent protein in neurons, which allowing the visualization of zebrafish neural networks and tracking of neural development. Furthermore, by using Image J and Prism to compare the average fluorescence intensity of neurons and the expression level of fluorescent reporter proteins between Nde1 deficiency zebrafish and wild type zebrafish, the effect of Nde1 gene knockout on zebrafish neural development was analyzed. Results: From 48 hours post-fertilization (hpf) to 7 days dpf, the average fluorescence intensity of red fluorescence expressed by trigeminal sensory neurons and spinal cord neurons in Nde1 deficiency zebrafish was lower than that in wild type zebrafish. RT-qPCR results also showed that the mRNA expression level of red fluorescent reporter protein in Nde1 deficiency zebrafish was significantly lower than that in the wild type zebrafish. Conclusion: Nde1 gene deletion may lead to abnormal development of trigeminal sensory neurons and spinal cordneurons by affecting neural progenitor cell differentiation and increasing apoptosis.

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.

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 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 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 compare the capture performance differences between TruSeq^® Exome and NimbleGen SeqCap EZ Human Exome kits in children with cerebral palsy (CP), and to provide a technical selection basis for clinical genetic research and diagnosis. Methods: Peripheral blood samples from 48 sporadic CP patients were included. Exome libraries were constructed using TruSeq (DNA probes) and NimbleGen (RNA probes), followed by sequencing on the Illumina HiSeq 2000 platform. Bioinformatics analysis was applied to evaluate mapping rate, target region coverage, variant concordance, and clinical relevance based on a CP-related gene set (2 293 genes). The statistical analysis was performed using a paired t-test with a significance threshold of α=0.05. Results: The results showed no significant differences between NimbleGen and TruSeq exome capture kits in basic data quality (alignment rate, insert size) and GC content. However, they exhibited complementary characteristics in key performance metrics: NimbleGen demonstrated superior performance in specific depth coverage (1×coverage rate, P=1.84×10^-5; 20×coverage rate, P=1.49×10^-20). TruSeq, on the other hand, showed higher sensitivity in Indel detection (TruSeq vs. NimbleGen: 11 371±1 689 vs. 11 274±1 670, P=3.24×10^-7) and rare variant capture (TruSeq vs. NimbleGen: 3 164±766 vs. 3 072±774, P=1.20×10^-4), successfully identifying all 11 pathogenic variants (including 2 missed by NimbleGen). Conclusion: TruSeq, with its superior variant detection rate, is more suitable for clinical diagnostic applications, while NimbleGen's coverage stability may be advantageous for research-oriented projects.

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.