Abstract:Objective To analyze the clinical epidemiological characteristics of critically ill patients with respiratory failure,utilizing spatial epidemiological methods to investigate the relationship between disease onset and seasonal variations,as well as the impact of meteorological factors.Methods A retrospective analysis was conducted on the demographic and clinical data of critically ill patients with respiratory failure admitted to the Emergency Intensive Care Unit of a hospital in Shijiazhuang City from January 2022 to December 2023.The Joinpoint regression model and Cox proportional hazards model were utilized to investigate the relationship between seasonal variations and the incidence of respiratory failure in these patients,as well as to explore the correlation with meteorological factors.Results A total of 268 critically ill patients with respiratory failure were included in this study,comprising 54.10％male and 45.90％female,with a median age of 66 years.The most prevalent season for disease onset was winter,followed by autumn.A statistically significant correlation was found between seasonal changes and disease onset in patients(P=0.029).Six meteorological factors—monthly average maximum temperature,monthly average temperature,monthly average precipitation,monthly average wind speed,monthly average minimum temperature,and monthly average relative humidity—were all associated with respiratory failure in critically ill patients.Among these,monthly average maximum temperature and monthly average temperature showed strong correlations,monthly average precipitation showed a moderate correlation,and the others showed weak correlations.Conclusion The incidence of respiratory failure among critically ill patients exhibits distinct seasonal patterns,potentially influenced by various meteorological factors.Identifying the primary meteorological risk factors affecting the onset of respiratory failure in different seasons can provide a theoretical foundation for the prevention,control,and treatment of such cases in the emergency department.This understanding is crucial for optimizing patient management strategies and enhancing treatment outcomes and prognosis.

Abstract:General practitioners are the backbone of primary health care,responsible for the diagnosis and treatment of common diseases,the rational diversion of medical resources and continuous medical services.The"5+3"model adopted in the training of general practitioners in China has limitations in addressing the problems of insufficient clinical experience,inadequate communication skills,and the improvement of diagnostic abilities among new general practitioners.This study organically integrates the outpatient teaching and digital means,and constructs the independent practical and progressive outpatient teaching mode.The construction of this mode provides a reference for exploring the new general practice outpatient training and learning channels,and improving the quality of professional degree master training.

Abstract:Objective To assess the changes in the disease burden and risk factors of type 2 diabetes mellitus(T2DM)globally and in China from 1990 to 2021 and predict their future trends.Methods Based on the Global Burden of Disease 2021 database,the age-standardized incidence rate(ASIR),age-standardized prevalence rate(ASPR),age-standardized disability-adjusted life years(DALY)rate(ASDR),age-standardized mortality rate(ASMR),and their estimated annual percentage changes(EAPC)were used to analyze the disease burden of T2DM globally and in China from 1990 to 2021.The auto-regressive integrated moving average model(ARIMA)was applied to predict trends in disease burden.Results From 1990 to 2021,the global T2DM ASIR[EAPC=1.74％,95％CI(1.72％,1.76％)],ASPR[EAPC=2.12％,95％CI(2.08％,2.16％)],ASMR[EAPC=0.21％,95％CI(0.15％,0.27％)]and ASDR[EAPC=1.04％,95％CI(1.00％,1.08％)]showed increasing trends.In China,T2DM ASIR[EAPC=1.10％,95％CI(1.01％,1.19％)],ASPR[EAPC=1.65％,95％CI(1.56％,1.75％)],and ASDR[EAPC=0.69％,95％CI(0.54％,0.84％)]showed an upward trend,while ASMR[EAPC=-0.22％,95％CI(-0.49％,0.04％)]showed no significant change.The prevalence,DALY rate,and mortality of T2DM among the elderly were higher than those among young and middle-aged adults globally and in China,while the incidence rate among individuals aged 15 to 24 is notably elevated.Globally and in China,all four rates were higher in males than in females.From 1990 to 2021,high fasting plasma glucose and high body mass index(BMI)remained the top two risk factors for T2DM-related deaths globally and in China,while environmental particulate matter pollution showed the largest rise in ranking among risk factors.It is projected that by 2040,the global and China T2DM ASIR will rise to 385.85/100,000 and 305.10/100,000,respectively;ASPR to 8,619.18/100,000 and 7,509.98/100,000,respectively;ASDR to 975.50/100,000 person years and 636.63/100,000 person years,respectively;global ASMR will increase to 18.83/100,000,while China's ASMR will decrease to 8.64/100,000.Conclusion The disease burden of T2DM was heavier in males and the elderly,and the onset age tended to be younger among adolescents.High fasting plasma glucose and high BMI were important risk factors for T2DM-related deaths globally and in China.China has achieved notable results in prevention and control,but the predicted disease burden remains severe.It is necessary to strengthen the three-level prevention strategy and strictly control relevant risk factors.

Abstract:Retinal neovascularization(RNV)diseases are one of the leading causes of visual impairment and blindness,including diabetic retinopathy,retinopathy of prematurity,retinal vein obstruction,and wet age-related macular degeneration.In recent years,fibroblast growth factor 21(FGF21),a multifunctional metabolic regulator,has been found to exert a significant inhibitory effect on RNV.Therefore,this article systematically reviews the biological characteristics of FGF21,its molecular regulatory mechanisms in RNV diseases,and its potential therapeutic applications,aiming to provide a theoretical basis for developing novel FGF21-based treatment strategies for retinal diseases.

Abstract:Objective To investigate the efficacy and safety of Sintilimab combined with SOX regimen in the treatment of patients with advanced gastric cancer.Methods The clinical data of patients with advanced gastric cancer in Wuxi Branch,Ruijin Hospital,Shanghai Jiaotong University School of Medicine from January 2020 to January 2024 were retrospectively collected.According to the treatment methods,the patients were divided into two groups.The treatment group was treated with Sintilimab combined with SOX regimen,while the control group was treated with SOX regimen alone.The objective response rate(ORR),median progressionfree survival(PFS),median overall survival(OS),incidence of adverse reactions and quality of life were compared between the two groups.Results A total of 115 patients with advanced gastric cancer were included,52 in the treatment group and 63 in the control group.The ORR of the treatment group was significantly higher than that of the control group(59.62％vs.38.10％,P<0.05).Stratified analysis showed that in patients with PD-L1 CPS≥5,the ORR of treatment group was significantly higher than that of control group(73.91％vs.37.50％,P<0.05).The median follow-up time was 37.0 months.Survival analysis showed that the median PFS(9.3 months vs.8.1 months)and the median OS(16.0 months vs.12.8 months)in the treatment group were significantly better than those in the control group(P<0.05).In patients with PD-L1 CPS≥5,the median PFS(10.2 months vs.7.0 months)and median OS(17.2 months vs.11.0 months)in the treatment group were more obvious than those in the control group(P<0.05).The improvement rate of quality of life in the treatment group was significantly higher than that in the control group(51.92％,vs.23.81％,P<0.05).There was no statistical difference in the incidence of grade Ⅲ～Ⅳ side effects between the two groups(P>0.05).Conclusion In patients with advanced gastric cancer,the Sintilimab combined with the SOX regimen has higher clinical efficacy,significantly prolonging the PFS and OS of patients,improving prognosis,and enhancing quality of life.However,adverse effects have not increased significantly.

Abstract:Hepatic venous outflow obstruction(HVOO)is a rare but life-threatening complication after liver transplantation.This article reports a 71-year-old male patient who developed localized stenosis of the infrahepatic inferior vena cava after piggyback liver transplantation for primary liver cancer.The patient experienced ascites and bilateral lower limb edema postoperatively,which did not improve significantly with diuretic therapy and peritoneal drainage.After being diagnosed by digital subtraction angiography,the patient underwent vascular stent implantation on the 105th day after surgery,and the symptoms were significantly alleviated.This article discusses the specific indications and timing for vascular stent placement in the management of HVOO,providing a reference for optimizing the treatment strategy of HVOO.

Abstract:Objective To analyze the prevalence of sleep disorders among patients with coronary heart disease(CHD)and identify their associated influencing factors,thereby providing evidence to improve sleep quality in this patient population.Methods Systematic retrieval of Cochrane Library,PubMed,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),VIP Database,WanFang Database,and Chinese Biomedical Literature Database was conducted to obtain relevant research on the current situation and influencing factors of sleep disorders in patients with CHD,with the retrieval time from the inception of the database to March 2025.Meta-analysis was performed using R Studio 4.3.3 software.Results A total of 14 articles were included,with a total sample size of 3,252 cases.The incidence rate of sleep disorders in patients with CHD was 58％[95％CI(46％,69％)],among which female[OR=1.76,95％CI(1.55,2.01)],urban medical insurance coverage[OR=1.83,95％CI(1.03,3.27)],elderly[OR=1.21,95％CI(1.05,1.41)],anxiety[OR=2.17,95％CI(1.29,3.66)],depression[OR=3.23,95％CI(1.53,6.80)],and pain[OR=1.83,95％CI(1.23,2.73)]were the main risk factors of sleep disorders in patients with CHD.In contrast,good social support[OR=0.86,95％CI(0.84,0.89)]serves as a protective factor.Conclusion Sleep disorders are highly prevalent among patients with CHD.Being female,having urban health insurance,elderly,anxiety,depression,pain interference,and lack of social support are significant risk factors for sleep disturbances in this population.

Abstract:Objective To understand the perceptions and needs of target users of the public-facing diabetes knowledge platform,and to provide support and guidance for the construction and optimization of the platform.Methods Using convenience sampling and employing a descriptive qualitative research methodology,semi-structured individual interviews and focus group discussions were conducted with the platform's target users.Data analysis and thematic extraction were performed according to Colaizzi's seven-step analysis method.Results In-depth interviews were conducted with 27 participants,and four major themes were elicited:deficiencies in the diabetes platform,the design of platform functionalities,the frequency of platform updates,and the prospective role of the platform.Conclusion The study clarified that the platform should have the key functions of dynamic updating of recommendations and efficient and convenient retrieval.The construction of the platform will facilitate the dissemination and implementation of living guidelines,enhance the convenience of accessing recommendation,satisfy users'information needs,promote the scientific and standardized approach to the diagnosis and treatment of diabetes.Moreover,it holds significant importance in improving the comprehensive level of diabetes management.

Abstract:Objective To investigate the impact and predictive value of bilateral umbilical artery(UA)pulsatility index(PI)abnormalities on perinatal outcomes in fetuses with fetal growth restriction(FGR).Methods FGR fetuses and their mothers who delivered at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2022 to June 2024 were included in this study.Based on the UA-PI at the last prenatal examination,the mothers were divided into three groups:normal bilateral UA-PI group,abnormal unilateral UA-PI group,and abnormal bilateral UA-PI group.General information,ultrasound characteristics,and neonatal perinatal outcomes were compared among the three groups,and the association between neonatal perinatal outcomes and bilateral UA-PI abnormalities was analyzed.Results A total of 516 maternal pairs and FGR fetuses were included.Among them,91 cases with unilateral abnormal UA-PI(17.64％),349 cases with normal bilateral UA-PI(67.64％),and 76 cases with abnormal bilateral UA-PI(14.73％).Compared with the group with normal bilateral UA-PI,the groups with abnormal unilateral and bilateral UA-PI had poorer ultrasound parameters and perinatal outcomes,especially the group with abnormal bilateral UA-PI.The predictive AUC values of UA-PI for adverse perinatal outcomes of 8 fetuses ranged from 0.670 to 0.778,with relatively high predictive value for preterm birth<34 weeks of gestation and cesarean section due to fetal distress.Conclusion The number of abnormal UA-PI values showed a dose-response relationship with adverse perinatal outcomes and had a certain predictive power for adverse perinatal outcomes.

Abstract:Colorectal cancer(CRC)is the third most common cancer globally,with an incidence rate ranked just behind lung cancer and breast cancer in women.Epithelial-mesenchymal transition(EMT)enhances the migratory and invasive abilities of tumor cells but is also closely associated with tumor recurrence and drug resistance.MicroRNAs(miRNAs)are a class of non-coding RNAs that regulate the EMT process through various mechanisms and pathways.Therefore,this review aims to summarize the roles and research progress of miRNAs in the regulation of EMT in CRC,providing new insights into the complex regulation of EMT and offering potential strategies for the prevention and treatment of CRC metastasis.

Abstract:Objective Explore the influencing factors of depression in elderly people with activities of daily living(ADL)disorders,and construct a depression risk prediction model for elderly people with ADL disorders in China based on machine learning(ML)algorithms.Methods Based on the fifth round of data from the China Health and Retirement Longitudinal Study(CHARLS)project,the Boruta algorithm and Lasso regression algorithm were used to screen depression risk factors in elderly people with ADL disorders.The 9 ML methods of random forest,light gradient boosting machine,extreme gradient boosting,Logistic regression,K-nearest neighbor,support vector machine,artificial neural network,decision tree,and Elastic Net regression algorithm were used to construct a depression risk prediction model,and SHAP algorithm was used to explain the final model.Results A total of 3,167 elderly individuals with ADL disorders were included,with a depression detection rate of 60.69％.The random forest model has the best predictive performance,with AUCs of 0.804[95％CI(0.788,0.820)]and 0.779[95％CI(0.752,0.806)]on the training and testing sets,respectively.The SHAP algorithm results showed that the impact of life satisfaction,pain and discomfort,self-rated health status,satisfaction with child relationships,gender,whether any falls have occurred since 2018,the number of outpatient visits to medical institutions in a month,age,education level,and whether the internet has been used in the past month on the depression risk prediction model for elderly people with ADL disorders decreased in order.The calibration curve indicates that the predicted performance of the model is basically consistent with the actual results,and the decision curve shows that the model has good clinical applicability.Conclusion Early age,female,low educational level,declining self-evaluation of health status,low life satisfaction,low child relationship satisfaction,increased number of outpatient clinics in medical institutions,falls,physical pain,and inability to use the internet significantly increased the risk of depression among the elderly with ADL disorders.Among the depression risk prediction models constructed based on ML algorithm,the random forest model achieved the optimal prediction performance.

Abstract:Objective To examine the relationship and interaction effects between exercise duration,sleep duration,and depressive symptoms among Chinese adults.Methods Data from the 2022 China Family Panel Studies(CFPS)were used,restricted cubic spline(RCS)and multiple linear regression models were applied to analyze the relationship between exercise duration,sleep duration,and depressive symptoms.Results A total of 18,838 participants were included.Multivariate linear regression analysis showed that,each one-standard-deviation increase in weekly exercise duration was associated with a 0.12-point decrease in depressive scores[β=-0.12,95％CI(-0.19,-0.05)].Each standard deviation increase in daily sleep duration was associated with a 0.40-point decrease in depression scores[β=-0.40,95％CI(-0.47,-0.34)].RCS model analysis showed that,after controlling for demographic and socioeconomic variables,weekly exercise duration was significantly and non-linearly negatively correlated with depression scores.Depression scores decreased rapidly with increasing exercise time,leveling off after approximately 150～300 minutes per week,with no rebound in depression observed due to excessive exercise.Daily sleep duration showed a weak U-shaped association with depression scores,with the lowest depression scores observed at approximately 8 hours of sleep.Interaction effect analysis further indicated a significant exercise-sleep interaction effect[β=0.08,95％CI(0.03,0.13)].Under conditions of insufficient sleep,the mental health benefits of exercise were significantly reduced,while sufficient sleep significantly enhanced the antidepressant effects of moderate exercise.Conclusion Exercise and sleep exert nonlinear dose-response effects and synergistic interactions on depression.Individuals with sleep deprivation should prioritize sleep improvement before integrating exercise interventions to achieve optimal mental health benefits.Public health strategies should advocate for integrated"sleep-exercise"intervention models.

Abstract:With social development and increased life pressures,prenatal stress has become a significant physical and mental challenge for women during the perinatal period.Research indicates that prenatal stress may affect fetal developmental programming through epigenetic regulatory mechanisms,thereby interfering with neurodevelopment and increasing the risk of emotional disturbances,behavioral abnormalities,and cognitive impairments in offspring.Epigenetic modifications such as DNA methylation(DNAm),histone modifications,and non-coding RNAs(ncRNAs)are likely to mediate the long-term effects of prenatal stress on offspring cognitive function.This article summarizes the mechanisms of epigenetic regulation in prenatal stress-induced cognitive impairments in offspring,with a focus on analyzing the associations of DNAm,histone modifications,and ncRNAs with cognitive deficits in offspring,aiming to provide references for the development of relevant clinical intervention strategies.

Abstract:Objective To analyze the influencing factors for anti-tuberculosis drug-induced liver injury(ATB-DILI)and construct a prediction model.Methods Clinical data were retrospectively collected from patients who received anti-tuberculosis(TB)treatment and completed follow-up from January 2019 to October 2022 at Rugao People's Hospital.Patients from January 2019 and December 2019 were included in the training set,and patients from January 2020 to October 2022 were included in the testing set.A nomogram was constructed,and its predictive performance was evaluated using the receiver operating characteristic(ROC)curve and its area under the curve(AUC),calibration curve,decision curve analysis,and clinical impact curve and verified in the testing set.Packages such as DynNom were used to publish nomograms to the network and develop dynamic nomograms that predicted ATB-DILI risk.Results A total of 1,396 TB patients were included,with an ATB-DILI incidence rate of 10.03%(140/1,396),comprising 872 in the training set and 524 in the testing set.The results of the multivariate Logistic regression analysis revealed that older age[OR=1.03,95%CI(1.01,1.05)],diabetes[OR=2.66,95%CI(1.40,5.07)],smoking history[OR=1.98,95%CI(1.09,3.59)],liver-related diseases[OR=2.07,95%CI(1.05,4.10)],high aspartate aminotransferase(AST)levels[OR=1.03,95%CI(1.02,1.05)],high gamma-glutamyl transferase(GGT)levels[OR=1.18,95%CI(1.06,1.30)],and high total bilirubin(TBil)levels[OR=1.22,95%CI(1.16,1.29)]were independent risk factors for ATB-DILI,while high albumin(Alb)levels[OR=0.87,95%CI(0.81,0.93)]were an independent protective factor(P<0.05).The nomogram for both the training set and testing set showed a high degree of fit with the ideal curve,and both demonstrated significant net benefit characteristics,with an AUC of 0.88、0.86 and high clinical impact gains.Conclusion In this study,the dynamic nomogram developed based on age,diabetes,smoking,liver-related diseases,Alb,AST,GGT and TBil can effectively identify patients with high ATB-DILI risk,and provide theories and methods for patients to implement more active prevention strategies.

Abstract:Objective To analyze the expression characteristics of CD226 in placental tissues from preeclampsia(PE)patients and its biological function in trophoblast cells.Methods CD226 mRNA transcript levels and protein expression in placental tissues from the PE patients and women with normal pregnancies were detected by qRT-PCR and immunohistochemical staining.In the trophoblast cell lines HTR8/SVneo and JAR,CD226 gene was knocked down or overexpressed,respectively,to evaluate the impact of its expression changes on cell proliferation,apoptosis,migration,and invasion.Western blot analysis was used to detect the effects of CD226 on the protein expression of TNF-α and NF-κB p65.Results Compared with the normal pregnancy group,the expression level of CD226 was significantly up-regulated in the placental tissues of the PE group.Knockdown of CD226 enhanced the proliferation,migration,and invasion,and suppressed apoptosis in HTR8/Svneo cells.Conversely,the overexpression of CD226 significantly inhibited the proliferation,migration,and invasion of JAR cells,while promoting apoptosis in these cells.Furthermore,Western blot analysis revealed that CD226 overexpression promoted the protein expression of TNF-α and NF-κB p65 in trophoblast cells.Conclusion The expression level of CD226 in placental tissues of PE is higher than that in normal pregnancy group.CD226 exerts the inhibitory effects on the proliferation,migration,and invasion,and promotes apoptosis in trophoblast cells.

Abstract:Objective To analyze the application status of bioinformatics on Chinese medical graduate students.Methods Available academic thesis was filtered with a topic of bioinformatics medical research ranging from 2003 January 1st to 2023 December 31st in CNKI and WanFang Database.The VOSviewer software was used to analyze the research hotspots of the academic thesis of Chinese medical graduate students,taking oncology as an example,the application status of bioinformatics in clinical practice was investigated.Results A total of 22,298 theses were included,comprising 14,036 master's theses(62.95%)and 8,262 doctoral theses(37.05%).In the last two decades,the number of bioinformatics-related thesis for Chinese medical student has been increasing continuously.The research hotspots of academic thesis mainly focused on expression analysis,mechanistic study,database and oncology.Notably,oncology-related research accounted for 45.72%of the theses.For lung cancer,application of bioinformatics has provided data support for pharmacological target investigation,diagnosis assistance and therapeutic effect monitoring in preclinical research.In addition,bioinformatics has been employed to aid clinical decision making,such as diagnosis and determination of therapeutic strategies.Conclusion The application of bioinformatics in the theses of medical postgraduates in China is increasing rapidly,particularly in the field of oncology.In clinical oncology practice,bioinformatics plays a pivotal role in early diagnosis,personalized therapy,and prognostic evaluation.

Abstract:Objective To analyze the association between exercise level,sleep quality,and blood glucose in patients with type 2 diabetes mellitus(T2DM),and to explore the mediating role of sleep quality between exercise level and blood glucose.Methods Using convenience sampling,T2DM patients from the Department of Endocrinology at Shandong Provincial Hospital from August 2022 to March 2023 were selected as research subjects.Daily exercise levels and sleep quality scores were collected via a 5-day consecutive diary,and daily average blood glucose(MG)was measured using a continuous glucose monitoring system.A multilevel structural equation modeling(MSEM)was used to analyze the association between daily exercise level,sleep quality scores,and MG at both the individual and within-individual levels,as well as the mediating effect.Results A total of 80 T2DM patients were enrolled,with 400 valid data points collected.Correlation analysis showed that daily exercise level,daily sleep quality,and MG were significantly correlated at both the individual and within-individual levels.Multilevel mediation effect analysis showed that at the individual level,daily exercise levels affect MG through daily sleep quality;while within individuals,daily exercise level had both a direct association with MG and an indirect association through daily sleep quality.Conclusion The roles of exercise and sleep should be emphasized in blood glucose control for T2DM patients.In clinical practice,personalized intervention measures can be developed for exercise and sleep to strengthen personalized management of diabetes.

Abstract:Objective To analyze the clinical characteristics of AIDS complicated with heterogeneous multiple primary malignant tumors(MPMTs),and to provide clinical accumulation for the diagnosis and treatment of AIDS complicated with malignant tumor and improve prognosis.Methods The clinical features,treatment and prognosis of 6 cases of AIDS complicated with heterogeneous MPMTs were analyzed retrospectively.Results The first primary malignant tumor of the 6 AIDS patients was non-Hodgkin lymphoma(2 cases),skin cancer(2 cases),cervical cancer(1 case)and laryngeal cancer(1 case),respectively.The median age was 49(43,58)years old,and the median CD4 cell count was 100(55,306)/μL.The second primary tumor was lung cancer(2 cases),colon cancer(2 cases),gastric cancer(1 case),and parotid gland malignancies(1 case),with an average CD4 cell count of(354±177)cells/μL.The mean interval between the two primary malignancies was(67±53)months,and three patients with gastrointestinal malignancies died at the end of follow-up,with a survival time of 3-9 months.Conclusion The AIDS patients with malignant tumors should be followed up regularly for a long time and be vigilant about the occurrence of MPMTs.Regular gastroenteroscopy can reduce the risk of malignant tumors of digestive tract and is expected to improve the prognosis.

Abstract:Existing risk of bias assessment tools are primarily designed for traditional pairwise Meta-analysis and fail to comprehensively evaluate the unique sources of bias risk inherent in network Meta-analysis.Therefore,Lunny and others developed a tool the Risk of Bias in Network Meta-analysis(RoB NMA),designed specifically to evaluate potential biases in network Meta-analysis arising from aspects such as intervention selection and network structure,effect modifiers,and statistical analysis.This article aims to interpret the development background,item content,and evaluation process of the RoB NMA tool,providing reference and guidance for domestic researchers of its application.