Abstract:Objective To evaluate the clinical value of adjunctive vitamin D therapy in children with Mycoplasma pneumoniae pneumonia(MPP)and to assess its effects on inflammatory response,immune function,and clinical out-comes.Methods A total of 348 pediatric inpatients diagnosed with MPP from January 2024 to June 2025 were enrolled.Using stratified randomization,patients were assigned to a vitamin D supplementation group or a non-supplementation group.Based on baseline vitamin D status(deficient/non-deficient),four subgroups were created:non-supplemented deficient(n=78),non-supplemented non-deficient(n=83),supplemented deficient(n=97),and supplemented non-deficient(n=90).All patients received standard anti-MP therapy;the supplementation group additionally re-ceived 400 IU of vitamin D daily.Changes in inflammatory markers(CRP,LDH,IL-6),T-lymphocyte subsets(CD4+/CD8+ratio),pulmonary function(FEV1,FVC,PEF),and length of hospital stay were compared before and af-ter treatment.Results Following treatment,CRP,LDH,and IL-6 levels were significantly lower and CD4+/CD8+ra-tios were significantly higher in both supplementation subgroups compared with the two non-supplementation subgroups(P＜0.05).Pulmonary function indices(FEV1,FVC,PEF)improved to a greater extent in the supplementation group than in the non-supplementation group,while hospital stay was significantly shorter(P＜0.05).Multivariate linear re-gression analysis identified vitamin D supplementation as an independent protective factor associated with reduced hospital-ization duration(B=-2.15,P＜0.05).Conclusion For non-severe MPP children aged 5-10 years(as defined by guideline criteria),adjunctive vitamin D-regardless of baseline vitamin D status-effectively suppresses inflammation,modulates cellular immunity,improves pulmonary function,and shortens hospital stay when added to standard therapy.

Abstract:Objective To evaluate the differential effects of Laparoscopic Sleeve Gastrectomy(LSG)on cardiac structure and function in obese patients with Heart Failure with preserved Ejection Fraction(HFpEF),Heart Failure with mildly reduced Ejection Fraction(HFmrEF),and Heart Failure with reduced Ejection Fraction(HFrEF).Methods A prospective cohort study was conducted,enrolling 26 obese patients with HF who underwent LSG between January and De-cember 2024.According to preoperative left ventricular ejection fraction(LVEF),they were classified into HFpEF(n=12),HFmrEF(n=6),and HFrEF(n=8)groups.Changes in body mass index(BMI),body surface area(BSA),and echocardiographic parameters from baseline to the last follow-up(median follow-up:7.0 months)were compared,and the degree of change(Δ)between groups was analyzed.Results Among the 26 enrolled patients,73.1％were male,with a mean age of(32.8±8.5)years,mean BMI of(57.1±12.7)kg/m2,and mean BSA of(2.83±0.36)m2.All groups showed significant reductions in weight,BMI,and BSA after surgery(P＜0.05).At the last follow-up,the HFpEF group showed significant reductions in left atrial volume index(LADi),left ventricular end-diastolic internal diameter(LVIDd),interventricular septal thickness(IVSTd),left ventricular posterior wall thickness(PWTd),left ventricular end-diastolic volume(LVEDV),right atrial short-axis diameter(RAD2),and right ventricular diameter(RVD);the HFmrEF group showed a significant reduction in left ventricular end-systolic volume(LVESV);and the HFrEF group showed significant reductions in left atrial diameter(LAD),LVIDd,LVESV,and right atrial long-axis di-ameter(RAD1).LVEF and left ventricular fractional shortening(LVFS)significantly increased in the HFmrEF and HFrEF groups,while pulmonary artery systolic pressure(PASP),tricuspid regurgitation velocity(TRv),and cardiac output(CO)significantly decreased.Intergroup comparison showed that the reductions in LVIDd,LVEDV,LVESV,and LVEDVi were significantly greater in the HFrEF group than in the HFpEF group(P＜0.05).Conclusion LSG can rap-idly and effectively reduce weight,BMI,and BSA in obese patients with different types of HF,and significantly improve their cardiac structure and function in the short term.LSG produces the most pronounced reverse remodeling of both atrial and ventricular structures and improves left ventricular systolic function in obese patients with HFrEF,while in HFpEF pa-tients,it mainly reduces left ventricular hypertrophy and improves right heart structure.LSG may provide a potential thera-peutic option with cardiac benefits for obese patients with HF,especially those with HFrEF.

Abstract:Objective To implement best evidence regarding preoperative fasting and drinking management for pediatric patients undergoing day surgery with general anesthesia,and to evaluate the effectiveness of its clinical applica-tion.Methods Following an evidence-translation framework,the best evidence for fasting and drinking management was identified through literature retrieval,critical appraisal,and synthesis.A baseline audit was conducted among 212 children undergoing day surgery under general anesthesia from September 1 to 15,2024,to assess barriers and facilitators and to develop an implementation plan.Two rounds of quality audits were then performed among 187 and 218 children,respectively,from October 7 to November 2,2024.Process and outcome indicators were collected before and after practice implementation.Comparisons were made regarding healthcare staff knowledge scores,compliance with audit criteria,pre-operative fasting and drinking duration,pre-and postoperative thirst and hunger scores,incidence of crying,postopera-tive fever and vomiting,length of stay,and preoperative anxiety levels of children and parents.Results After implemen-tation,staff knowledge scores increased from 45-75(61.4±9.9)to 80-100(94.14±6.0).Compliance with audit criteria 3,4,7,12,13,14,15,and 16 increased from 0-51.24％to 86.87％-100％.Median preoperative fasting duration decreased from 14.1(12.2,15.8)hours to 10.9(8.9,11.9)hours,and drinking restriction decreased from 5.7(4.0,12.0)hours to 2.6(2.6,3.4)hours.Levels of pre-/postoperative thirst,hunger,crying incidence,and preoperative anxiety in both children and parents improved significantly(P＜0.001).Conclusion Conclusion Evidence-based practice for preoperative fasting and drinking restrictions in pediatric day-surgery patients under general anesthesia effectively enhances staff compliance with audit criteria,improves knowledge levels,shortens fasting and drinking times,and alleviates discomfort such as thirst,hunger,and crying associated with preoperative restrictions.

Abstract:Objective To explore the correlation between Ascertain Dementia 8(AD8)and clock drawing test(CDT)and fall risk in patients with Parkinson's disease,and to provide a rapid and effective cognitive assessment tool for fall risk assessment in patients with Parkinson's disease.Methods From June 2023 to December 2024,a total of 45 in-patients with Parkinson's disease in the First Affiliated Hospital of Kunming Medical University were enrolled.The number of falls within half a year was retrospectively recorded.The time of up and go in three meters was tested.And the fall effi-cacy score,clock drawing test(CDT)and memory impairment self-rating scale(AD8)were used to evaluate the fall ef-ficacy.The correlation between fall and cognitive function was analyzed.Results The scores of fall efficacy,CDT and AD8 showed significant differences(P＜0.05),with the characteristics of normality.The average score of CDT and three meter up-and-go time could explain 12.5％of the variation of fall history.And the score of AD8 and fall efficacy could explain 29.7％of the variation of fall history.Conclusion The results of AD8 combined with CDT are correlated with the risk of falls,which can quickly and effectively evaluate the cognitive function of patients with Parkinson's disease,provide a basis for predicting the risk of falls in patients with Parkinson's disease,and improve work efficiency.

Abstract:Lung cancer remains a leading cause of death both in China and globally.Surgery represents the most curative treatment option for early-stage non-small cell lung cancer(NSCLC)patients,yet the 5-year survival rate re-mains poor and inconsistent,with a high risk of recurrence post-resection.For advanced NSCLC,the 5-year survival rate is only approximately 4％.Since the U.S.FDA approved immunotherapy in 2015,immuno-oncology has revolution-ized NSCLC treatment.Numerous landmark clinical trials have revised treatment guidelines for early-stage resectable NSCLC,establishing immunotherapy as the optimal choice for perioperative/neoadjuvant/adjuvant therapy.Immune checkpoint inhibitors(ICIs),either alone or combined with chemotherapy,have become first-line treatments for meta-static NSCLC.Despite progress in survival outcomes,patient prognosis still warrants further improvement.Combination therapies show promise in overcoming resistance and enhancing efficacy.This review elaborates on the advancement of im-munotherapy in the NSCLC treatment paradigm,focusing on combination strategies with chemotherapy,anti-angiogenic agents,novel immune checkpoints,and emerging approaches such as vaccines and CAR-T therapy,supported by clini-cal trial evidence.It comprehensively analyzes the advantages and challenges of immunotherapy.Furthermore,it explores the potential of biomarkers in personalizing treatment and optimizing immunotherapy outcomes.

Abstract:Obesity,characterized by excessive or abnormal fat accumulation,is a chronic metabolic disease and a major risk factor for cardiovascular diseases.Emerging evidence suggests that obesity also contributes to the occurrence and progression of aortic dissection.Shared pathophysiological mechanisms include adipokine imbalance,chronic inflam-mation,oxidative stress,and insulin resistance.This review summarizes the epidemiological association between obesity and aortic dissection,underlying pathophysiological mechanisms,and preventive and therapeutic interventions.The aim is to provide insights for precision prevention and management of aortic dissection.

Abstract:Objective To propose an improved Swin-Unet network model incorporating frequency-domain en-hancement and multi-scale attention for high-precision automatic segmentation of uterine fibroids in MRI,supporting personalized and precise HIFU treatment.Methods In the Swin-Unet architecture,wavelet convolution was introduced after Patch Merging and Patch Expanding to capture multi-frequency details.The encoder employed a multi-scale dilat-ed convolution pyramid to enhance contextual awareness.Additionally,spatial-channel combined attention was embedded in the skip connections to adaptively refine high-level semantic features.Results Using a dataset of 1 582 T2-weigh-ted MRI images,the proposed model outperformed other deep learning methods,including Attention UNet,demonstrating superior accuracy and stability.Performance metrics were excellent,with mean recall,mean Dice coefficient,and mean Jaccard coefficient reaching 91.17,91.33,and 86.23,respectively.Conclusion The improved Swin-Unet with wave-let convolution and self-attention mechanism enables automated segmentation of uterine fibroids in MRI for HIFU treat-ment.It achieves better performance across multiple evaluation metrics compared with existing methods,offering a reliable tool for individualized treatment planning.

Abstract:Objective To explore the clinical application value of artificial intelligence(AI)assisted analysis system in cervical liquid-based cytology(LBC)and analyze its advantages and limitations.Methods The AI-assis-ted system analyzed 19 057 LBC samples collected from patients at Guangdong Women and Children's Hospital between November 10,2023,and May 20,2024.Cytological interpretations included cervical intraepithelial lesions and microbial infections.AI results were compared with manual reading,pathological biopsy,and HPV testing.Results AI reading showed a total positive detection rate of 41.32％,significantly higher than manual reading(10.50％),especially in ASC-US and ASC-H categories,though with higher false-positive rates.AI's negative predictive value for LSIL and higher-grade lesions was high.Both AI and manual reading showed high sensitivity for CIN1+cases,but manual read-ing had slightly higher sensitivity.For HSIL+cases,manual reading specificity was higher.HPV testing showed 92.55％positivity among positive samples,with HPV52 most common,followed by 16,58,51,53,56,and 39.AI sensitivity for microbial detection was low overall,slightly better for bacterial vaginosis,but poor for Candida and Trichomonas.AI also had blind spots in glandular epithelial lesion detection.Conclusion AI-assisted LBC reading has high potential in rul-ing out negative cases,reducing cytologists' workload and improving efficiency,but misdiagnosis and missed diagnosis re-main issues.AI is limited in detecting microbial infections and glandular lesions,requiring further deep learning improve-ment.Wider application and refinement of AI systems could significantly advance cervical cancer screening.

Abstract:Objective To explore the application value of machine learning models in predicting the risk of ve-nous thrombosis in pregnant and postpartum women.Methods A total of 1 580 singleton pregnant women who underwent prenatal examinations at our hospital from January 2018 to December 2024 were enrolled.The participants were randomly divided into a training set and a test set at a 7∶3 ratio.In the training set,the women were grouped into a venous thrombo-sis group and a non-thrombosis group according to whether venous thrombosis occurred.Multiple machine learning mod-els were developed using the training set with cross-validation to compare model accuracy.The importance of each clini-cal indicator within the models was analyzed.Both the machine learning models and a logistic regression model were used to predict thrombosis risk in the test set,and receiver operating characteristic(ROC)curves were applied to assess clini-cal performance.Results Among the 1,580 women,395(25.00％)were diagnosed with venous thrombosis.There were statistically significant differences between the thrombosis and non-thrombosis groups in cesarean delivery,BMI,TG,LDL-C,TC,D-D,TAT,PIC,t-PAIC,and sTM levels(all P＜0.05).Correlation analysis showed that BMI,cesarean delivery,TG,LDL-C,TC,D-D,TAT,PIC,t-PAIC,and sTM were highly correlated with venous throm-bosis risk,while correlations among these indicators themselves were low.A total of 14 models from 8 machine learning al-gorithms were developed,among which the neural network model had the highest accuracy during training and validation.D-D,t-PAIC,PIC,and sTM had the highest feature importance,whereas TAT,LDL-C,age,cesarean delivery,BMI,TG,APTT,FIB,TC,platelet count,hemoglobin,and PT had lower importance.The AUC of the machine learning model(0.999)was significantly higher than that of the logistic regression model(0.752)in predicting venous thrombosis risk.Conclusion BMI,cesarean delivery,TG,LDL-C,TC,D-D,TAT,PIC,t-PAIC,and sTM are associated with the risk of venous thrombosis in pregnant and postpartum women.Machine learning models built on these indicators demonstrate superior predictive value for thrombosis risk compared with logistic regression.

Abstract:Objective To investigate the effects of early enteral nutrition(EEN)on nutritional indicators,im-mune function,and inflammatory factors in patients with severe traumatic brain injury(TBI).Methods A total of 240 patients with severe TBI admitted between March 2022 and May 2023 were randomly assigned into an observation group and a control group(n=120 each)using a random number table.The control group received parenteral nutrition,while the observation group received early enteral nutrition within 24 hours post-surgery.Nutritional indicators,inflammatory factors,immune function,gastrointestinal barrier function,and incidence of complications were compared before and after intervention.Results After intervention,levels of total protein(TP),prealbumin(PA),hemoglobin(HB),and albu-min(ALB)were significantly increased in both groups(t=5.766,3.749,5.025,10.547,P＜0.05),with higher lev-els observed in the observation group compared to the control group(P＜0.05).CD4+/CD8+,IgM,IgG,and IgA levels increased post-intervention(P＜0.05),with higher values in the observation group(t=15.200,13.186,6.418,7.305,P＜0.05).Inflammatory markers TNF-α,CRP,and PCT decreased in both groups(P＜0.05),with lower levels in the observation group(t=12.677,25.205,31.882,P＜0.05).Gastrointestinal barrier indicators,including diamine oxidase(DAO),endotoxin,and D-lactate,were reduced post-intervention(P＜0.05),with the observation group showing better improvement(t=15.219,28.722,11.773,P＜0.05).No significant differences were observed in the incidence of pulmonary infection or abdominal distension(P＞0.05),but electrolyte imbalance occurred less fre-quently in the observation group(5.00％vs.19.17,x2=11.335,P＜0.05).Conclusion Early enteral nutrition in patients with severe TBI can effectively improve nutritional status,enhance immune function,reduce inflammatory respon-ses,and maintain gut mucosal integrity,thereby reducing the occurrence of complications.

Abstract:Objective To investigate the impact of the controlling nutritional status(CONUT)score on perioper-ative outcomes in esophageal cancer patients with chronic obstructive pulmonary disease(COPD)undergoing thoracoab-dominal McKeown surgery and to explore possible underlying mechanisms.Methods A total of 134 esophageal cancer patients were included.The optimal CONUT cutoff value was determined using receiver operating characteristic(ROC)curve analysis.Patients were divided into Group A(CONUT score 4-12)and Group B(CONUT score 0-3).Perioper-ative outcomes,including postoperative pulmonary infection,respiratory failure,drainage tube retention time,antibiotic usage duration,average length of hospital stay,and perioperative neutrophil-to-lymphocyte ratio(NLR),were com-pared between groups.Multivariate stepwise regression analysis was used to identify factors affecting postoperative pulmo-nary infection.Results The incidence of postoperative pulmonary infection and respiratory failure was significantly higher in Group A than in Group B(P＜0.05).Group A also had longer durations of antibiotic usage,drainage tube retention,and hospital stay compared to Group B(P＜0.05).Perioperative NLR was significantly higher in Group A than in Group B(P＜0.01).Multivariate regression analysis showed that the CONUT score was an independent risk factor for postopera-tive pulmonary infection(P＜0.05).Conclusion The CONUT score is a significant predictor of perioperative infectious complications in esophageal cancer patients with COPD undergoing thoracoabdominal McKeown surgery.Higher CONUT scores are associated with increased risk of postoperative pulmonary infection,prolonged antibiotic therapy,longer drain-age tube retention,and extended hospital stay.

Abstract:Objective To investigate the early predictive value of Syndecan-1(SDC-1)combined with S100 calcium-binding protein β(S100β)for the development of neuropsychiatric sequelae(NS)in patients with acute carbon monoxide poisoning(ACMP).Methods A total of 290 patients with ACMP from November 2021 to May 2024 were en-rolled.Patients were divided by poisoning severity into mild(n=30),moderate(n=50),and severe(n=210)groups,and further classified into the NS group(n=48)and non-NS group(n=242)based on the occurrence of neuropsychiat-ric sequelae.At admission and on day 5,levels of high-density lipoprotein cholesterol(HDL-C),S100β,SDC-1,su-peroxide dismutase(SOD),malondialdehyde(MDA),endothelin-1(ET-1),and nitric oxide(NO)were measured,and the monocyte-to-HDL-C ratio(MHR)and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score were calculated.Logistic regression analysis identified risk factors for NS,and receiver operating characteristic(ROC)curves assessed the predictive performance of SDC-1 combined with S100β.Results No significant differences in age,sex,or body weight were observed among the three severity groups(P＞0.05).Severe cases showed significantly longer exposure times and higher APACHE Ⅱ scores than mild or moderate cases(P＜0.05).At both admission and day 5,patients in the severe group had higher MHR,SDC-1,S100β,MDA,and ET-1 levels and lower SOD and NO lev-els than the mild-to-moderate groups(P＜0.05).From admission to day 5,severe cases exhibited increases in MHR,SDC-1,S100β,MDA,and ET-1 and decreases in SOD and NO,while the opposite trends were observed in mild and moderate cases(P＜0.05).NS patients had higher MHR,SDC-1,S100β,MDA,and ET-1 and lower SOD and NO compared with non-NS patients(P＜0.05).SDC-1 correlated positively with S100β and APACHE Ⅱ scores.Logistic regression identified increased MHR,SDC-1,S100β,MDA,ET-1,and APACHE Ⅱ and decreased SOD and NO as independent risk factors for NS(P＜0.05).ROC analysis showed that SDC-1 combined with S100β predicted NS with an area under the curve(AUC)of 0.776 at admission and 0.804 at day 5.Conclusion Elevated SDC-1 levels in AC-MP patients reflect blood-brain barrier disruption.Combined detection of SDC-1 and S100β provides valuable early predictive information for the development of neuropsychiatric sequelae following acute carbon monoxide poisoning.

Abstract:Objective To investigate the effects and mechanisms of peroxisome proliferator-activated receptor-γcoactivator 1α(PGC-1α)on cerebral ischemia-reperfusion injury after resuscitation of cardiac arrest.Methods Eighteen Sprague-Dawley rats with stable vital signs were acclimated for one week and randomly divided into two groups by envelope method:a resuscitation group and a PGC-1α group.A cardiac arrest model was established in all rats,and after successful cardiopulmonary resuscitation(CPR),rats in the PGC-1α group received intravenous injection of a PGC-1α activator via the femoral vein,while the resuscitation group received saline.Time of death was recorded.After 24 hours of survival,rats were euthanized under anesthesia and brain tissue samples were collected.Hematoxylin-eosin(HE)staining was used to observe brain pathology;ATP levels in brain tissue were measured using an ATP assay kit;RT-PCR was used to detect mRNA expression of IL-6 and TNF-α;and Western blot(WB)was performed to assess the protein levels of IL-6 and TNF-α in brain tissue.Results In the resuscitation group,brain tissue showed disor-ganized structure,extensive vacuole formation,cytoplasmic shrinkage,nuclear pyknosis,and significant inflammatory cell infiltration.In contrast,the PGC-1α group exhibited relatively intact brain structure,fewer vacuoles,and reduced in-flammation.The ATP content in brain tissue was significantly higher in the PGC-1α group than in the resuscitation group(F=2.80,P＜0.001).Expression of inflammatory cytokines IL-6 and TNF-α,both at the mRNA and protein levels,was significantly lower in the PGC-1α group(F=3.95,P=0.001 9;F=1.67,P＜0.001;t=23.78,P＜0.000 1;t=146.8,P＜0.000 1).Conclusion PGC-1α plays a protective role in cerebral ischemia-reperfusion injury following cardiac arrest and resuscitation,possibly by enhancing mitochondrial energy metabolism and reducing inflammatory responses.

Abstract:Objective To investigate the prevalence and risk factors of anxiety and depression in hemodialysis(HD)patients,and to study their relationship with quality of life.Methods A retrospective analysis was conducted on the clinical data of 150 patients undergoing maintenance HD at the Blood Purification Center of Minda Hospital from June to October 2024.Record social demographic,clinical,and laboratory data.Use the Hospital Anxiety and Depression Scale(HADS)to assess anxiety and depression.In addition,the quality of life of patients was evaluated by completing the Kidney Disease Quality of Life 36.Results This study included 150 HD patients(38.7％male)with an average age of(57.67±14.20)years.49.3％of patients were diagnosed with anxiety disorder,and 26.0％of patients were diag-nosed with suspected anxiety disorder.Patients with depression and suspected depression account for 55.3％and 28.7％,respectively.In the suspected anxiety disorder and anxiety disorder groups,the proportion of female patients(66.7％and 75.7％,respectively)and unemployed patients(71.8％and 79.7％,respectively)significantly increased.The propor-tion of women,unemployed,inactive lifestyle,and smokers in the suspected depression and depression group was higher than that in the normal group,while the serum phosphorus and serum ferritin indices were lower than those in the normal group.The duration of HD in patients with depression and anxiety is significantly longer than the other two groups.The quality of life of patients with anxiety and depression is worse than that of normal patients.Conclusion Anxiety and de-pression are common in HD patients and are associated with multiple social demographic and clinical risk factors.In addi-tion,these mental disorders are associated with poor quality of life.

Abstract:Objective The Pfirrmann grade,lumbar MRI parameters and pain sensitivity questionnaire(PSQ)scores of patients with lumbar disc herniation(LDH)were observed to investigate the value of their prediction of the effi-cacy of endoscopic surgery for LDH.Methods A total of 122 patients with LDH who were treated in our hospital from January 2022 to March 2024 were selected as the research subjects.All patients underwent endoscopic surgery.The pa-tients were followed up for 12 months.According to the Oswestry Disability Index efficacy evaluation criteria,the patients were divided into the effective group(n=109)and the ineffective group(n=13).The Pfirrmann grades,lumbar MRI parameters and PSQ scores of the two groups of patients were compared,and their predictive value for surgical efficacy was analyzed.Results The Pfirrmann grading ratio,△ lumbar muscle cross-sectional area,△ lumbar multifidus cross-sectional area,and PSQ score of the ineffective group were all higher than those of the effective group(P＜0.05).The results of logistic regression analysis showed that Pfirrmann grading,△ lumbar muscle cross-sectional area,△ lumbar multifidus muscle cross-sectional area,and PSQ score were all independent risk factors for poor postoperative efficacy in LDH patients(P＜0.05),and were positively correlated with them.According to ROC curve analysis,the cross-sec-tional area of the erector spinae muscle,the cross-sectional area of the lumbar multifidus muscle,PSQ score,and com-bined diagnosis all have high predictive value for the postoperative efficacy of LDH patients,with AUC values of 0.869,0.890,0.797,and 0.984,respectively.Pfirrmann grading can be used as an auxiliary indicator to predict the postopera-tive efficacy of LDH patients,with an AUC value of 0.721.Conclusion The Pfirrmann grading,△ lumbar muscle cross-sectional area,△ lumbar multifidus cross-sectional area,and PSQ score are closely related to the efficacy of endoscop-ic surgery in LDH patients.The combination of these four factors has a high predictive power for the postoperative efficacy of LDH patients.

Abstract:Objective To investigate the relationship and predictive value of serum L1 cell adhesion molecule(L1 CAM),fatty acid-binding protein 4(FABP4),and NADPH oxidase 2(NOX2)levels in patients with valvular heart disease(VHD)undergoing cardiac valve replacement(CVR)who develop postoperative atrial fibrillation(POAF).Methods A total of 127 patients with VHD who underwent CVR between January 2023 and March 2025 were enrolled as the observation group.Based on electrocardiographic monitoring,they were divided into the POAF group(n=57)and non-POAF group(n=70).An additional 127 healthy volunteers were included as the normal control(NC)group.Ser-um levels of L1CAM,FABP4,and NOX2 were measured using ELISA.Multivariate logistic regression was applied to identify independent risk factors for POAF.Receiver operating characteristic(ROC)curves were used to evaluate the pre-dictive value of these biomarkers.Results Compared with the NC group,serum L1CAM levels were significantly de-creased,while FABP4 and NOX2 levels were significantly increased in VHD patients(P＜0.05).Compared with the non-POAF group,the POAF group showed larger left atrial diameter,higher proportion of NYHA class Ⅳ,increased FABP4 and NOX2 levels,and decreased L1CAM levels(all P＜0.05).High L1CAM expression was an independent pro-tective factor,whereas high FABP4 and NOX2 expression were independent risk factors for POAF(P＜0.05).The pre-dictive AUCs of L1CAM,FABP4,and NOX2 for POAF were 0.810,0.820,and 0.807,respectively,while their com-bined detection yielded a higher AUC of 0.950,superior to individual predictors(all P＜0.05).Conclusion Serum L1CAM is downregulated,whereas FABP4 and NOX2 are upregulated in VHD patients undergoing CVR.These three bio-markers are important determinants of POAF,and their combined detection demonstrates superior predictive value for post-operative risk stratification.

Abstract:Objective To investigate the effects of acupuncture anesthesia and cheek acupuncture as postopera-tive adjunct analgesic interventions in elderly patients undergoing hip surgery,and to evaluate their influence on stress re-sponse,analgesic efficacy,and postoperative complications.Methods A total of 126 elderly patients who underwent u-nilateral hip surgery under spinal anesthesia at Zhongshan Hospital,Guangzhou University of Chinese Medicine from Janu-ary to October 2024 were enrolled and randomly assigned to three groups:BA group,FA group,and NA group(42 pa-tients each).Ultimately,115 patients completed the study(BA:38,FA:39,NA:38).Postoperatively,all patients were monitored in the post-anesthesia care unit.The BA group received acupuncture at Baihui,bilateral Neiguan,Qu-chi,Hegu,and Zusanli;the FA group received cheek acupuncture on the surgical side at facial points corresponding to the lumbar,sacral,and hip regions;the NA group received no acupuncture.Serum norepinephrine(NE),epinephrine(EPI),cortisol(COR),and blood glucose(BG)levels were measured at 6 h(T0),12 h(T1),24 h(T2),and 48 h(T3)postoperatively.Cumulative sufentanil dosage and visual analog scale(VAS)pain scores were recorded,along with time to bowel function recovery and incidence of postoperative complications.Results Postoperative levels of NE,EPI,COR,and BG were significantly lower in the BA and FA groups compared with the NA group at all time points(P＜0.05).The BA and FA groups also exhibited significantly reduced sufentanil consumption and lower VAS scores at 48 h postoperatively(P＜0.05),with earlier bowel function recovery(P＜0.05).The incidence of postoperative complica-tions was significantly lower in both BA and FA groups than in the NA group(P＜0.05).Conclusion Both acupuncture anesthesia and cheek acupuncture effectively attenuate postoperative stress responses and pain in elderly patients after hip surgery,reduce the need for analgesics,promote bowel function recovery,and lower postoperative complication rates,thereby facilitating enhanced recovery after surgery.

Abstract:Objective To explore the implementation and clinical effectiveness of the multidisciplinary team(MDT)model in the management of hepatobiliary and pancreatic tumors in a prefecture-level hospital.Methods A retrospective analysis was conducted on patients with malignant hepatobiliary and pancreatic tumors who received MDT management at Ganzhou People's Hospital from January 2022 to December 2023.Key evaluation indicators included diag-nostic correction rate,optimization of treatment plans,treatment adherence rate,patient satisfaction,and progression-free survival(PFS).Results A total of 274 patients were included,of whom 87.2％had hepatocellular carcinoma(HCC).Following MDT discussion,diagnoses were revised in 54 patients(19.7％).Among those with treatment recom-mendations,237 patients(86.5％)underwent therapy according to MDT guidance,with a treatment adherence rate of 98.8％in the HCC subgroup.Overall,98.5％of patients or their families reported being"satisfied"or"very satisfied"with the MDT process.The median PFS among HCC patients was 13.8 months(95％CI:11.2-16.5 months).Conclusion The MDT model significantly improves diagnostic accuracy,treatment standardization,and multidisciplinary collaboration efficiency for hepatobiliary and pancreatic malignancies in prefecture-level hospitals.It enhances patient compliance and clinical outcomes and demonstrates strong potential for broader implementation and promotion.

Abstract:Medical artificial intelligence(AI),as a transformative technology,holds the potential to significantly improve patient outcomes while reducing healthcare costs.Despite numerous breakthroughs in research,only a limited number of AI products have been validated for clinical application.This article aims to systematically review the critical gap in translating medical AI from technical performance to clinical utility,analyze the primary barriers to such transla-tion,and identify four core conditions essential for successful clinical implementation:precision medicine orientation,sci-entific reproducibility,reliable data and trustworthy algorithms,and causal inference capability.Based on these condi-tions,we further propose specific actionable strategies to facilitate the deep clinical translation of medical AI algorithms,ultimately enhancing the quality and efficiency of patient care.

Abstract:Objective To investigate the expression characteristics of lysyl oxidase-like protein 4(LOXL4)in patients with laryngeal squamous cell carcinoma(LSCC)and to evaluate its significance in assessing chemotherapy effica-cy and prognosis.Methods A total of 212 patients with pathologically confirmed LSCC admitted between January 2021 and July 2023 were included.All patients completed at least four cycles of combination chemotherapy and were followed for 12 months at 1-2-month intervals.Based on outcomes,patients were classified into a good-prognosis group and a poor-prognosis group.Clinical and pathological features,chemotherapy parameters,LOXL4 transcription and protein lev-els in tumor tissues,and serum LOXL4 concentrations were compared between groups.Multivariate logistic regression was used to identify independent risk factors for poor prognosis.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of LOXL4 alone and in combination with other variables.Results Among the 212 patients(age 40-74 years,median 62 years;145 males,67 females),102(49.1％)had poor prognosis within 1 year after chemotherapy.Compared with the good-prognosis group,the poor-prognosis group had higher mean age,smoking his-tory rate,diabetes comorbidity rate,proportion of supraglottic tumors,maximum tumor diameter,stage Ⅳ disease,poorly differentiated tumors,lymph node metastasis,tumor LOXL4 transcription level,LOXL4-positive rate,and serum LOXL4 level,while receiving fewer chemotherapy cycles(all P＜0.05).Multivariate logistic regression identified smoking history(OR=2.665,95％CI:1.299-5.466),tumor maximum diameter(OR=2.559,95％CI:1.477-4.433),lymph node metastasis(OR=2.460,95％CI:1.154-5.245),tumor LOXL4 transcription level(OR=6.973,95％CI:2.877-16.900),LOXL4 positivity/strong positivity(OR=1.632,95％CI:1.093-2.439),and serum LOXL4 level(OR=1.110,95％CI:1.050-1.174)as independent risk factors for poor prognosis(all P＜0.05).ROC analysis showed that the AUCs for predicting poor prognosis using smoking history,tumor size,lymph node metastasis,tumor LOXL4 transcrip-tion,LOXL4 positivity,and serum LOXL4 were 0.572,0.648,0.575,0.699,0.616,and 0.667,respectively,while combined prediction yielded an AUC of 0.831(Z=4.532,3.896,4.527,3.701,4.032,3.794,P＜0.05),with a sensitivity of 70.46％and specificity of 85.35％.Conclusion Elevated LOXL4 expression in tumor tissues and serum is an independent risk factor for poor chemotherapy prognosis in LSCC patients.The combination of LOXL4 level with smok-ing history,tumor size,and lymph node metastasis provides a robust predictive model for chemotherapy outcomes.