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.

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.

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 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.

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 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.

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.

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

Objective: To 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 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.

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

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

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.

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

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

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.

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.

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.

Objective: To analyze the implementation of MPOWER tobacco control policies in different regions and populations in China, as well as the impact of perceptions of tobacco control policies on individual smoking behavior and quit intentions, to promote the fairness of policy implementation and protection for vulnerable groups. Methods: A multivariable regression model was constructed utilizing raw data from the China Adult Tobacco Survey to analyze disparities in perceived MPOWER policy implementation among various social demographics and its impact on smoking behavior and quitting intentions. Results: Regarding protection from tobacco smoke (P), local economic level, urban-rural divide were significantly correlated with awareness of comprehensive smoking bans. For offering help to quit smoking (O), local tobacco industry revenue and individual age were associated with the doctor's advice for quitting. As to the warning about the harm of tobacco (W), economic level, geography and urban-rural disparity were correlated with the visibility of health warnings. About the tobacco advertising, promotion and sponsorship (E), geography was related to the exposure to tobacco advertisements, local tobacco industry revenue was associated with the tobacco promotion. For tobacco taxes (R), education level and age were significantly correlated with tobacco affordability. People who perceived comprehensive smoking bans (OR=0.69, 95%CI: 0.59-0.81) was associated with less smoking behavior, while people perceiving tobacco promotional activities (OR=2.51, 95%CI: 2.00-3.17) were more likely to smoke. Additionally, people who perceived comprehensive smoking bans (OR=1.70, 95%CI: 1.25-2.31) and health warning (OR=2.09, 95%CI: 1.48-3.01) had higher intention to quit smoking. Conclusion: In economically disadvantaged regions and among specific socially vulnerable groups (such as low-income individuals, rural residents, and the elderly) in China, the perception of tobacco control policy implementation is relatively low, the perception of tobacco control policies can influence smoking behavior and quitting intentions. Legislative and enforcement efforts should be increased targeting these groups with lower perceptions of the policies to enhance the fairness of tobacco control measures.

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

Objective: To observe the association between afterschool physical exercise and sleep quality among preschool children, and to explore the proper afterschool physical exercise model for better sleep quality. Methods: A cross-sectional study was conducted. From Apr to Jun 2024, a total of 1 430 children from three public kindergartens in Minhang district were enrolled to participate in the survey. Parents were invited to complete the basic sociodemographic information, afterschool physical exercise information and the Children's Sleep Habits Questionnaire.One-way ANOVA and linear mixed effects models were used to explore the relationship between afterschool exercise and sleep quality. Results: A total of 1 430 questionnaires were sent out and 1 384 were recovered with a recovery rate of 96.78%. Among them 1 366 were valid, with an effective rate of 95.52%. The average age of the children was (5.19±0.87) years old with gender ration of 1.07∶1 (male: female). The prevalence of poor sleep quality was 80.60% (regarding a CSHQ total score > 41 as cutoff). A one-way ANOVA indicated that time on afterschool physical exercise was significantly associated with sleep duration, Night waking, and sleep onset delay (P < 0.05). After adjusting for age, gender, the only child or not, main caregiver, and parental education and occupation, linear mixed effects models showed that engaging in afterschool physical activity for at least 180 mins per week has a statistically significant predictive effect on sleep duration scores (β=-0.50, z=-4.52, 95%CI: -0.72, -0.28, P < 0.001), night waking scores (β=-0.16, z=-2.34, 95%CI: -0.29, -0.02, P=0.020), and sleep onset delay scores (β=-0.14, z=-2.35, 95%CI: -0.26, -0.02, P=0.019). Conclusion: Afterschool exercise was significantly associated with sleep quality among preschool children in Minhang district of Shanghai. The time≥180 min on afterschool exercise per week in preschool children was significantly positively associated with maintaining sleep duration, reducing night wakings and shortening the latency to fall asleep. The habit of afterschool exercise and the time on afterschool exercise should be emphasized by parents and the society to improve sleep quality among preschool children.

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

Cribriform-morular thyroid carcinoma (CMTC) is a rare malignant thyroid tumor with unique genetic characteristics. It is often an extracolonic manifestation of familial adenomatous polyposis (FAP). In this case, a 26-year-old female was found to have multiple bilateral thyroid nodules. She underwent radical surgery for bilateral thyroid carcinoma in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The routine pathology and immunohistochemistry after surgery confirmed CMTC. This is a rare case of multifocal CMTC. The ultrasonography showed multifocal nodules, which were dominated by isoecho and varied in morphology. There was no obvious calcification inside the multifocal nodules. This article highlights the ultrasonographic manifestations and pathological features of CMTC to enhance its understanding.

Objective: To 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 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 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 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.

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 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 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.

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.

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.

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.