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.

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

Mendelian randomization (MR) is an epidemiological method that uses genetic variants as instrumental variables (Ⅳs). This article begins by elucidating the basic principles of IVs through causal diagrams, directed acyclic graph (DAG), and then systematically reviews the key assumptions, common challenges, and practical considerations in MR studies by comparing them with randomized controlled trials (RCTs). As an observational study, MR can theoretically help avoid confounding, but its validity in practice critically depends on confirming (ⅰ) a strong association between the genetic instrument and the exposure, (ⅱ) independence of the instrument from confounders, and (ⅲ) exclusion of alternative pathways from the instrument to the outcome; over-interpretation of findings should therefore be avoided. The paper also highlights the value of MR in drug target discovery and in exploring disease mechanisms, while reminding investigators that common issues in observational studies, such as the temporal order of exposure and outcome, still require rigorous attention.

Objective: To observe the efficacy and safety of Baduanjin combined with acupuncture in treating neck-type cervical spondylopathy (NTCS) patients. Methods: Eighty patients were randomly divided into an intervention group and a control group in a 1∶1 ratio. The intervention group was treated with a combination of Baduanjin and acupuncture. Patients underwent Baduanjin exercise daily and acupuncture treatment twice a week for a total of 8 consecutive weeks. The control group received routine acupuncture twice a week for a total of 8 consecutive weeks. After the end of the treatment course, the effective rates of the two groups, as well as the visual analogue scale (VAS), neck disability index (NDI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and general comfort questionnaire (GCQ) assessment before and after treatment were compared, then safety evaluations was assessed. Results: After intervention, the total effective rates of the intervention group and the control group were 91.4% and 76.31%, respectively, with a statistically significant difference (P < 0.05); Compared within the group, the VAS, NDI, SAS, SDS scores of both groups were significantly lower than before treatment (all P < 0.01), and the GCQ scores were higher than before treatment(both P < 0.01); After intervention, inter-group comparison showed that the improvement of VAS, NDI, SAS, SDS, and GCQ scores in the intervention group was more significant than that in the control group (all P < 0.05). Conclusion: The combination of Baduanjin and acupuncture treatment can improve the clinical efficacy of NTCS patients and has good safety, which is worthy of clinical promotion and application.

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.

Ovarian clear cell carcinoma (OCCC) typically exhibited high-grade atypia and aggressive chemotherapy resistance, leading to poor prognosis, necessitating continuous exploration of novel therapeutic approaches to enhance patient survival and quality of life. In recent years, with the in-depth study of the biological behavior and molecular characteristics of OCCC, unique molecular features of OCCC were discovered, making it a potential molecular target for personalized biotherapy, with the prospect of improving treatment efficacy and patient prognosis. An increasing number of clinical trials focused on exploring the driver mutations and molecular characteristics of recurrent OCCC in the hope of finding more precise and effective treatment modalities. This article provided a comprehensive review of the molecular characteristics of OCCC and advances in drug therapy.

In elderly patients with malignant tumor, sarcopenia frequently co-occurs, which is largely attributed to the cachexia state observed in cancer patients. Although both sarcopenia and cachexia involve muscle loss, there are significant distinctions between the two conditions. Current research indicates that sarcopenia is a multifactorial condition, influenced by factors such as aging, endocrine dysfunction, motor neuron loss, cachexia, inflammation, and malnutrition. With the increasing depth of research into the correlation between sarcopenia and the nervous and immune systems, this article reviews the research progress on sarcopenia in patients with malignant tumors, with a focus on neuroimmunological aspects. It systematically analyzes the mechanisms underlying its onset and progression, as well as the influencing factors and potential intervention strategies for sarcopenia in this patient population.

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

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.

胡懋廉（1899—1971），字洁民，天津人。医学教育家，国家一级教授，中国现代耳鼻喉科学奠基人之一。1921年毕业于国立北京医学专门学校，1931年赴美国哈佛大学医学院耳鼻喉科深造并获得博士学位。历任上海公济医院院长、上海第一医学院附属眼耳鼻喉科医院首任院长、上海第一医学院副院长。曾当选为第三届全国政协委员、第三届全国人民代表大会代表、第一至第五届上海市人民代表大会代表、上海市人民委员会委员。他从事医疗和教育工作近50年，为我国耳鼻喉科学创建和发展作出了巨大贡献。

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.

Objective: To develop a precise and efficient single-disease management model to reduce the intensity of antibiotic use. Methods: Data was collected from surgical inpatient admissions at the Shanghai Pulmonary Hospital between Jan 2022 and Mar 2024. The study focused on the six most prevalent types of malignant tumors within single-disease management. Surgical patients who did not receive single-disease quality management from Jan 2022 to Jun 2023 were designated as the control group, while surgical patients who received single-disease quality management from Jul 2023 to Mar 2024 served as the management group. By formulating and implementing standardized policies and guidelines for antibiotic use, supervision and effect evaluation were conducted across departments. Results: A total of 21 746 individuals were included in the control group and 15 635 in the management group. Following the introduction of the single-disease management model, the proportion of non-restricted antibiotics used in various single diseases increased from 73.2%-77.0% before management to 78.3%-84.4% after management, while the usage of restricted antibiotics significantly decreased (P < 0.001). The intensity of antibiotic use, measured in defined daily doses (DDDs), fell significantly from 113.0-159.9 before management to 36.0-44.0 after management (P < 0.001). Moreover, compared with the control group, the average length of stay in the intervention group did not change considerably, although the length of stay increased for some diseases, possibly due to more precise medication adjustments. Conclusion: The single-disease management model optimizes antibiotic use, reduces the intensity of antibiotic use, and enhances overall medical quality and patient safety.

Mitochondria are one of the most important organelles in cellular metabolism, and their genomes are prone to mutations and lack damage repair mechanisms. Mitochondrial DNA (mtDNA) mutations and copy number variations play important roles in the occurrence and development of tumors. In recent years, research has found that mtDNA mutations and copy number variations exist in various tumor diseases, and the detection of mtDNA in tumor tissues, especially cell-free mitochondrial DNA in patient fluids, may also serve as important means to indicate tumor diseases. This article aims to summarize and to review the correlation between mitochondrial genome mutations and copy number variations with tumor diseases and their diagnosis, as well as the research progress as tumor biomarkers, in order to provide reference for the clinical diagnosis of tumor diseases.

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

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

The data from outpatient prescriptions of small-size aspirin enteric-coated tablets (25 mg/tablet) in a community hospital were analyzed to provide reference for rational clinical drug use. Patients' medication information of 1 325 prescriptions was collected and analyzed by defined daily dose system (DDDs) and drug utilization index (DUI), and the rationality of drug use was analyzed according to drug instructions and literature. The mean age of males and females were (73.70±8.33) years old and (72.95±8.34) years old, respectively. The top 3 DDDs age groups were women aged 60-79 years, men aged 60-79 years and women aged 80-99 years. The proportion of prescriptions in female patients was 59.62%. DUI ranges from 0.75 to 0.85. Irrational drug use was found in 123 prescriptions, including 89 prescriptions (72.35%) of inappropriate drug selection, 19 prescriptions (15.45%) with low dose, 6 prescriptions (4.88%) with contraindication, 5 prescriptions (4.06%) with inconsistent frequency of administration, 2 prescriptions (1.63%) of out-of-indication drug use, and 2 prescriptions (1.63%) of high dose. For the phenomenon of irrational drug use, it is necessary to conduct real-time intervention to ensure the safety and effectiveness of drug use.

Objective: To investigate the ameliorative effects and mechanisms of six types of tea (green tea, cyan tea, red tea, white tea, black tea and yellow tea) on metabolic disorders in obesity mice induced by high-fat diet (HFD). Methods: Four-week-old male C57BL/6J mice were randomly divided into 8 groups with 7 mice per group. An HFD-induced obese mouse model was established, and the mice in control group maintained on standard diet followed by intragastric administration of different teas for 5 weeks. The body weight, liver weight ratio, fasting blood glucose, and lipid profile of the mice were measured to assess glucose and lipid metabolism. Serum inflammatory factors including IL-6, tumor necrosis factor-alpha (TNF-α) and oxidative stress markers [malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Additionally, liver histopathology and the expression of key glycolipid metabolism-related genes, adenosine monophosphate-activated protein kinase (AMPK) and carnitine palmitoyltransferase 1 (CPT-1), were analyzed to explore underlying mechanisms. Results: Cyan tea significantly suppressed weight gain, demonstrating superior weight control. White tea markedly reduced fasting blood glucose levels and decreased the area under the curve of oral glucose tolerance test (OGTT) and insulin tolerance test (ITT), indicating synergistic improvements in glucose metabolism and insulin sensitivity. Yellow tea exhibited exceptional anti-inflammatory and antioxidant effects, reducing hepatic IL-6 and MDA while enhancing SOD activity. Green tea activated the lipid oxidation pathway by upregulating AMPK/CPT-1 expression. All kinds of tea significantly attenuated hepatic lipid droplet accumulation. Conclusion: All six types of tea alleviated metabolic disorders by reducing hepatic fat content in obesity mice. However, different types of tea exert their unique effects on improving metabolic disorders through differential mechanisms such as glucose metabolism regulation, lipid oxidation, and anti-inflammatory and antioxidant actions.

Objective: To explore the effects of dodecanoylcarnitine (DA) and myristoleic acid (MA) on the function of mouse alveolar epithelial cell line MLE-12 and their underlying mechanisms. Methods: An inflammatory model was established by stimulating MLE-12 cells with IL-4. The expression levels of DA, MA, and sphingosine-1-phosphate (S1P) in the cell supernatant were detected by ELISA. MLE-12 cells were separately intervened with DA and MA. RT-PCR and flow cytometry were used to detect the expression changes of inflammatory factors IL-6 and tumor necrosis factor-α (TNF-α) and the level of intracellular reactive oxygen species (ROS). Additionally, Western blot was performed to detect the expression of key proteins such as p38 mitogen-activated protein kinase (p-38 MAPK) and src homology 2 domain-containing phosphatase 1 (SHP-1). To explore the role of S1PR2 in the effects of DA and MA, MLE-12 cells were pretreated with the S1PR2 inhibitor JTE-013, and the above experiments were repeated. Results: IL-4 stimulation significantly upregulated the levels of DA, MA, and S1P in MLE-12 cells (P<0.05). DA/MA treatment groups exhibited significantly increased expression of IL-6 and TNF-α compared with the control group (P<0.05), along with elevated ROS levels (P<0.05). Western blot analysis revealed that DA/MA promoted SHP-1 dephosphorylation and phosphorylated p38 MAPK activation in MLE-12 cells. Notably, JTE-013 pre-treatment completely reversed these effects (P<0.05). Conclusion: Asthma-related metabolites DA and MA exacerbate the inflammatory and oxidative stress responses of MLE-12 cells by activating the S1PR2 receptor, promoting the dephosphorylation of SHP-1 and the activation of the p-p38 MAPK pathway. This study reveals the core regulatory role of S1PR2 in this pathway as well.

Objective: To explore the association between psychological resilience and internet addiction among senior primary school students, so as to provide a scientific basis for formulating strategies for preventing internet addiction and enhancing psychological resilience in this group. Methods: A stratified cluster sampling method was employed. In May 2021, a total of 1 618 fourth- and fifth- grade students from 5 primary schools in Jiading District, Shanghai were surveyed on psychological resilience and internet addiction through questionnaires. Independent sample t-tests, chi-square tests, and Logistic regression models were used for data analysis. Results: Among the 1 618 students, the prevalence rate of internet addiction was 8.8%(142 students). The total score of psychological resilience (t=6.215, P < 0.001) and the scores of three dimensions, namely family support (t=3.509, P < 0.001), goal focus (t=6.965, P < 0.001), and positive perception (t=5.887, P < 0.001), of those reported with internet addiction were all significantly lower than those without internet addiction. Multivariate logistic regression analysis showed that compared with individuals with low psychological resilience, those with moderate (aOR=0.395, 95%CI: 0.267-0.584, P < 0.001) and high psychological resilience (aOR=0.167, 95%CI: 0.077-0.365, P < 0.001) had a lower probability of internet addiction. The three sub-dimensions of psychological resilience, namely goal focus, positive perception and family support, also showed a statistically significant negative association with internet addiction in these students. Conclusion: Nearly one-tenth senior primary school students in Jiading District self-reported internet addiction. Higher levels of psychological resilience were associated with a lower probability of internet addiction among senior primary school students. Focusing on enhancing the goal focus, positive perception and family support dimensions in psychological resilience may be of great significance for preventing internet addiction among senior primary school students.

Objective: To investigate the effect of rapid maxillary expansion (RME) on sagittal soft and hard maxillofacial tissue in growing children. Methods: In this retrospective study, children aged 6-12 years treated in Shanghai Stomatology Hospital from Jan 2018 to Dec 2020 were employed as subjects. Of the subjects, 40 patients treated with RME were as the experimental group, 27 patients presenting individualized malocclusion were as the control group. Lateral cephalogram was taken before (T0) and 2 years after treatment (T1). The images were imported into Dolphin Imaging's cephalometric measurement software, and the results were statistically analyzed using SPSS 22.0 software. Results: Statistically significant differences were observed in all measurements before and after treatment in both two groups. A comparative analysis revealed that SNB value increased and ANB value decreased in the experimental group after treatment, while the changes in the control group were significantly smaller than those in the experimental group (P<0.05), indicating that RME is beneficial to the growth and development of mandibular in sagittal direction. Among the dentoalveolar measurements, statistically significant differences (P<0.01) were observed in U1-SN (upper incisor to sella-nasion angle), U1-NA (upper incisor to nasion-A point angle), U1-APog (upper incisor to A point-pogonion line distance), and overjet between the two groups. These findings indicate that RME significantly reduces the inclination of the maxillary central incisors, while having no significant effect on the mandibular central incisors. Compared with the control group, RME significantly reduced upper lip prominence, lip space and upper central incisor exposure (P<0.05), but had no effect on nose, chin and their correlation. Conclusion: RME not only improved the prominence of the upper teeth and upper lip, but also facilitate the sagittal growth of mandibular in growing children.

p120-catenin (p120ctn) is one of the crucial members of armadillo family, which is well known as a core stabilizing factor for vascular endothelial cadherin (VE-cadherin). Throughout the entire process of vascular development, p120ctn plays multiple roles. From neovascularization to endothelial barrier, the presence of p120ctn is indispensable. It participates in regulating the normal development of vertebrate embryo vasculature and promoting endothelial cell proliferation. Additionally, p120ctn contributes to the maintenance and remodeling of adherens junctions and can modulate adhesion strength by altering cell morphology. This review summarized the latest research progress on p120ctn from neovascular development and endothelial barrier function.

With the continuous development of perinatal medicine and neonatology, although the survival rate of infants with low gestational age and low birth weight has improved, the incidence of neurodevelopmental morbidities remains high. Breast milk is the preferred source of enteral nutrition for preterm infants, playing an important role in growth, development, immunity, metabolism, and other functions. Of particular note is its effect on the nervous system, not only promoting brain development and maturation in preterm infants, but also effectively reducing the incidence and severity of brain injury, thereby improving long-term neurological outcomes. This review aims to explore the effects of breast milk on brain injury and repair, brain structural maturation, and neurodevelopmental outcomes in preterm infants, in order to further enhance the understanding of the importance of breast milk for the neurodevelopment of preterm infants.

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

Transthoracic echocardiography (TTE) is the preferred noninvasive modality for screening and diagnosing pulmonary hypertension (PH). By measuring parameters such as tricuspid regurgitation velocity (TRV), TTE can estimate pulmonary artery systolic pressure (PASP) and evaluate right heart function. TTE plays a critical role in the early screening, risk stratification, and prognostic assessment of PH, particularly in large-scale epidemiological studies. Furthermore, in percutaneous valvular interventions (e.g., transcatheter aortic valve replacement, mitral valve edge-to-edge repair), TTE provides essential hemodynamic data for patient selection, intraoperative decision-making, and postoperative follow-up. This review summarizes recent advances in TTE for PH evaluation and its application in valvular interventions in order to support clinical practice.

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

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

To explore the mediating effect of resilience between sleep quality index and quality of life in lung cancer patients, we used General data questionnaire, Pittsburgh Sleep Quality Index, Connor-Davidson Resilience Scale, Chinese version Memorial Symptom Assessment Scale and functional Assessment of Cancer Therapy-Lung to investigate 218 lung cancer patients in the Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University during Nov 2023 to Feb 2024. A structural equation model was constructed to analyze the mediating effect of resilience between sleep quality index and quality of life. The sleep quality of lung cancer patients was in mild sleep disturbance. There was a negative correlation between sleep quality index and quality of life. Resilience of the patients partly mediated the relationship between sleep quality index and quality of life with an effect of 0.826, accounting for 28.47% of the total effect. Doctors and nurses should pay attention to enhancing the resilience level of lung cancer patients and improving their impact of sleep disturbance on the quality of life.

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 investigate the prevalence of chronic somatic comorbidities in schizophrenic patients in Shanghai communities, and to explore the factors influencing comorbidities. Methods: Based on Shanghai community-based severe mental disorders cohort, 5 422 patients with schizophrenia(SCZ) were included in the study. 12 common chronic somatic diseases, defined by patients'self-report, were selected to analyze the prevalence of comorbidity, and Logistic regression model was used to analyze the factors influencing the number of somatic comorbidities. Results: The total prevalence of somatic comorbidity was 37.0% in 5 422 patients with SCZ, with the highest prevalence of hypertension(22.6%) and diabetes mellitus (13.1%) among 12 somatic diseases selected. Older age was the main factor associated with chronic somatic comorbidities in community schizophrenic patients. The risk of 1-2 comorbidities in patients aged ≥60 years was 3.34(95%CI: 2.74-4.07)times higher than those aged < 45 years, while the risk of ≥3 comorbidities was 3.27(95%CI: 2.11-5.09)times higher, correspondingly. Female gender, marriage, smoking, and longer duration of illness were also risk factors for comorbidity. Women after menopause had higher risk of comorbidity than perimenopausal women. Conclusion: Cardiovascular and metabolic diseases were common somatic comorbidities among schizophrenic patients in Shanghai communities. Older age, female gender, marriage, smoking, and longer duration of illness were risk factors for increasing number of comorbidities.

The impact of hypertensive disorders of pregnancy (HDP) on maternal and fetal outcomes is well-established. However, the relationship between high-normal blood pressure (BP) and HDP, as well as its association with adverse maternal-fetal outcomes, remains unclear. This retrospective study analyzed singleton pregnancies delivered at Obstetrics and Gynecology Hospital, Fudan University from Jan 2021 to Dec 2021. Participants were categorized into a normal BP group (BP < 130/80 mmHg before delivery admission) and two high-normal BP groups (BP: 130-139/80-89 mmHg) with subgroup analysis based on gestational week of BP elevation before and after 20 weeks. Maternal characteristics, HDP incidence and adverse outcomes were compared across groups. The results demonstrated that compared with the normal BP group, both high-normal BP groups showed significantly increased HDP incidence, with more pronounced risk in the high-normal BP (after 20 weeks) group. The high-normal BP (before 20 weeks) group was associated with elevated risks of iatrogenic preterm birth and small for gestational age (SGA). This study provides a theoretical basis for implementing stricter BP monitoring strategies to reduce adverse maternal and neonatal outcomes.

Objective: To develop and validate a fast Monte Carlo (MC)-based patient-specific quality assurance (PSQA) tool using the treatment log files that is suitable to be used in the online adaptive radiotherapy for pencil beam scanning proton therapy (PBSPT-ART). Methods: The proposed tool first used the delivery log file of a PBSPT plan to reversely reconstruct the PBSPT (rPBSPT) plan, and then used an in-house developed graphic processing unit (GPU)-accelerated virtual particle MC (VPMC) dose engine to calculate the dose distribution of the rPBSPT plan. The rPBSPT dose calculated by VPMC was then compared to the rPBSPT dose calculated by another independent MC dose engine (MCsquare), using 3D gamma analysis to verify the accuracy of VPMC calculation. As a demonstration of the feasibility of developed log file-based PSQA, the VPMC calculated dose of the rPBSPT plan was compared to the pre-delivery second check dose of the corresponding PBSPT plan calculated by MCsquare, using 3D gamma analysis. 3D gamma analysis employes a criterion of 2 mm/2%/10%. Twenty patients with different disease sites were representatively selected to validate the efficiency and accuracy of the tool. Results: The average calculation time of a rPBSPT plan by VPMC was (5.88±4.00)s in the accuracy verification. Compared to MCsquare, the passing rate of the 3D gamma analysis was 99.47%±0.72%. In the proposed PSQA tool demonstration, the passing rate of comparing the VPMC calculated rPBSPT dose to MCsquare calculated second check dose of the corresponding PBSPT plan was 98.91%±0.92%. Conclusion: The accuracy and efficiency of the tool can meet the requirements of PSQA in the online PBSPT-ART workflow.

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

Tumor-associated macrophages (TAMs) are one of the key components of the tumor microenvironment (TME) in gastric cancer. Glucose metabolism reprogramming significantly impacts TAMs' polarization and immune functions, thereby regulating the onset and the progression of gastric cancer. This review summarizes glucose metabolism reprogramming in TAMs' polarization and explores its role in gastric cancer-related TAMs through aspects such as signaling regulation, transcription factors, and epigenetic modifications. This review aims to deepen the understanding of TAMs' role in gastric cancer progression and offer new perspectives for the immunotherapy in gastric cancer.

Objective: To investigate the one-year postpartum weight retention for patients with gestational diabetes mellitus (GDM) and analyze its related influencing factors, so as to improve the postpartum weight retention. Methods: GDM women who were diagnosed and gave birth at the Obstetrics and Gynecology Hospital, Fudan University from Oct 2022 to May 2023 were selected as the research subjects. The GDM postpartum weight status survey questionnaire was used to conduct a survey of one-year postpartum weight retention status and analyze relevant influencing factors. Results: A total of 150 GDM postpartum women were included, with a weight retention rate of 46.7% one year after delivery, including a high weight retention rate of 25.3%. The follow-up rate of postpartum glucose tolerance was 36.0%, and the influencing factors of postpartum weight retention were excessive gestational weight gain (OR=2.883, 95%CI: 1.226-6.779)and the presence of dietary risk (OR=4.604, 95%CI: 1.065-19.903). Conclusion: The one-year postpartum weight retention after GDM is relatively high. The possible influencing factors are excessive weight gain during pregnancy and dietary risk after delivery. Attention should be paid to the weight and healthy diet management of GDM during pregnancy and postpartum from multiple dimensions.

Objective: To assess the dietary quality of preschool children and explore the relationship between feeding practices and dietary quality. Methods: Relying on the Shanghai Maternal-Child Pairs Cohort, 3 177 preschool children were selected as the subjects for this study, and questionnaire were surveyed on their dietary intake and feeding practice. The diet balance index was used to evaluate dietary quality among preschool children. High bound score (HBS), the low bound score (LBS), and the dietary quality distance (DQD) were calculated to respectively reflect overall dietary overconsumption, insufficiency, and imbalance. Logistic regression was utilized to analyze the association between feeding practice and dietary quality in preschool children. Results: The HBS, LBS, and DQD of the subjects were 2 (0, 8), 22.19±10.80, and 26.78±9.57, respectively. Only 7.68% of the children had a balanced dietary intake, with 74.73% and 33.99% of overall dietary intake being inadequate and excessive, respectively. Parental perceived weight were negatively associated with the risk of moderate to high over intake among children (aOR=0.79, 95%CI: 0.63-0.98). The higher the perceived responsibility (aOR=1.19, 95%CI: 1.03-1.37) score, the lower the monitoring score (aOR=0.83, 95%CI: 0.74-0.93), and the higher the likelihood that the child had a moderate to high under intake. The scores of pressure to eat were also positively correlated with the risks of under intake and moderate to high overall unbalance in preschool children (aOR=1.15-1.39, 95%CI: 1.02-1.63). Conclusion: Preschool children commonly experience dietary imbalance, with inadequate and excessive intake coexisting. Parental perceived weight and monitoring were positively associated with preschoolers' dietary quality, whereas perceived responsibility and pressure to eat were negatively associated with it.

Objective: To investigate the longitudinal clinical manifestations of acute radiation dermatitis (ARD) induced by particle therapy in nasopharyngeal carcinoma patients and to analyze associated risk factors. Methods: A longitudinal study design was employed, encompassing nasopharyngeal carcinoma patients who underwent particle therapy at the Shanghai Proton and Heavy Ion Center from Mar to Sept 2023. Participants were assessed weekly (1-12 weeks) following the commencement of radiotherapy and at baseline, prior to the start of treatment. Data collection included the patient demographic questionnaire, the Radiation Therapy Oncology Group (RTOG) grading criteria for acute radiation injury, and the radiation-induced skin reaction assessment scale (RISRAS). Photographic documentation was utilized to capture changes in the irradiated skin area. The enrolled patients with nasopharyngeal carcinoma were grouped according to different particle therapy regimens. Survival data were analyzed by Log-rank and Cox regression methods, while a linear mixed-effects model was applied to repeated measures data. Results: A total of 119 patients with nasopharyngeal carcinoma were enrolled. The overall incidence of ARD was 89.1%, which included 39.5% of grade 1, 45.4% of grade 2 and 4.2% of grade 3. With the extension of time, the severity of ARD peaked at week 7 (RISRAS=13.26±4.512), then began to decrease, ultimately reaching a lower level. Multiple Cox proportional hazards models were constructed, revealing that proton/heavy ion radiotherapy was associated with a lower risk of ARD compared to photon/proton plus heavy ion radiotherapy (HR=0.19, 95%CI: 0.04-0.92, P=0.039). Additionally, concurrent cisplatin/nedaplatin chemotherapy was identified as a risk factor for the development of ARD. Least squares (LS) mean differences were calculated at different time points, and the results demonstrated that the RISRAS scores of the photon/proton plus heavy ion group were consistently and significantly higher from week 5 to week 7 compared with the proton plus heavy ion group, and despite a decrease by week 8, statistical differences remained (week 5: LS mean difference 3.35, 95%CI: 0.94-5.76, P=0.007; week 6: LS mean difference 5.23, 95%CI: 2.20-8.26, P=0.001; week 7: LS mean difference 7.13, 95%CI: 3.67-10.59, P<0.001; week 8: LS mean difference 4.04, 95%CI: 0.74-7.34, P=0.017). Patients undergoing concurrent cisplatin chemotherapy had higher RISRAS scores from week 7 to week 8 of radiotherapy compared with those not receiving chemotherapy [week 7: adjusted mean difference (Adj.MD) 4.20, 95%CI: 1.96-6.57, P=0.006; week 8: Adj.MD 2.79, 95%CI 0.55-5.03, P=0.015]. Similarly, patients on concurrent nedaplatin chemotherapy had higher RISRAS scores from weeks 6 to 7 compared with those not on chemotherapy (week 6: Adj.MD 3.75, 95%CI: 1.54-5.96, P=0.001; week 7: Adj.MD 4.41, 95%CI: 2.12-6.70, P<0.001). Skin care measures during treatment and accompanying symptoms such as weight loss were not statistically associated with the development of ARD. Conclusion: Proton/heavy ion radiotherapy has a lower risk of ARD, while concurrent cisplatin/nedaplatin chemotherapy is a risk factor for ARD.

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

Objective: To develop an objective and precise prognostic model for assessing severity and prognosis in elderly patients with community-acquired pneumonia (CAP) admitted to the emergency department. Methods: A retrospective analysis was conducted on elderly patients with CAP admitted to Department of Emergency, Minhang Hospital, Fudan University between Jun 2018 and Dec 2020. With the primary outcome being the 30-day in-hospital mortality rate of elderly CAP patients, four systemic inflammatory response markers, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were evaluated using univariate and multivariate Logistic regression analyses. The predictive performance of different scoring systems was compared. Results: A total of 421 elderly CAP cases were enrolled. The results of the multivariate Logistic regression analysis demonstrated that NLR was an independent risk factor for elderly inpatients with CAP. We combined NLR with the existing CURB-65 score for joint optimization to construct a scoring system or a clinical prognosis model, by quantifying and assigning optimal cut-off value of 11.4 for NLR, and established the NLR+CURB-65 score. The ROC curve was constructed to compare the areas under the curve of the three different scoring systems (NLR, CURB-65, and NLR+CURB-65). The area under the curve of the NLR+CURB-65 score was significantly higher than that of the CURB-65 score. Based on the optimal cut-off value of 3 for NLR+CURB-65 score, the patients were stratified into high-risk group (n=188) and low-risk group (n=233). The K-M survival curve was utilized and indicated that compared with high-risk group, low-risk group had a lower mortality rate and a higher discharge rate. Conclusion: For elderly emergency hospitalized patients with CAP, the combination of NLR and CURB-65 score showed high predictive value for assessing disease severity and prognosis.

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

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.