Abstract:Objective To investigate the influencing factors of arteriovenous fistula(AVF)maturation failure in hemodialysis patients,and to construct a risk prediction model for AVF maturation failure based on machine learning algorithms.Methods Patients who underwent initial AVF formation at Kaifeng People's Hospital from January 2021 to January 2025 were selected as the study subjects.Relevant medical records were collected,and patients were divided into a normal group and a maturation failure group based on whether maturation failure occurred within 12 weeks after AVF formation.The patients were then split into training and validation sets in a 7∶3 ratio.Logistic regression,extreme gradient boosting(XGBoost),random forest(RF),and gradient boosting machine(GBM)algorithms were used to identify factors influencing AVF maturation failure.A predictive nomogram,calibration curve,and receiver operating characteristic curve were plotted.Results A total of 260 patients undergoing initial AVF formation were included,with 143 in the normal group and 117 in the maturation failure group,182 in the training set and 78 in the validation set.Multivariate Logistic regression results indicated that age and ALB were independent influencing factors.The XGBoost,RF,and GBM algorithms identified 20,21,and 19 risk factors for AVF maturation failure,respectively.Age,ALB,GLU,and Hb were common variables across all models.The nomogram model constructed based on these variables demonstrated high predictive accuracy the AUCs of the training set and validation set were 0.881[95％CI(0.829,0.933)]and 0.912[95％CI(0.838,0.986)],respectively.Conclusion Age,ALB,Hb,and GLU are the key factors affecting AVF maturation failure in hemodialysis patients.The risk prediction model developed using these indicators exhibits excellent predictive performance and may assist clinicians in selecting vascular access strategies and preventing complications.

Abstract:Objective Investigating the relationship between the interactive and combined effects of depression and sarcopenic obesity(SO)and the risk of stroke in Chinses middle-aged and older adults.Methods Based on the China Health and Retirement Longitudinal Study(CHARLS)data,middle-aged and older people who participated in the three surveys in 2015,2018 and 2020 were selected.The Kaplan-Meier cumulative incidence curve was used to analyze the cumulative incidence risk among subjects in different groups.Cox proportional hazards regression models were employed to separately examine the associations between depression and SO,and their interaction,and combined effects with the risk of stroke in middle-aged and older individuals.Sensitivity analyses were conducted to validate the robustness of the results.Results A total of 10,694 study participants were enrolled in this study,and a total of 698(6.53％)of them experienced stroke during the 5-year follow-up period.Results showed that after adjusting for confounding factors including gender,age,education level,and marital status,compared with the control group,the risk of stroke increased by 52％[HR=1.52,95％CI(1.28,1.81)]in the depression group and 47％[HR=1.47,95％CI(1.08,1.99)]in the SO group respectively.No interaction effect was observed between depression and SO,but a significant combined effect was identified.Compared with the non-depressed-normal group,the depressed-SO group exhibited a 126％[HR=2.26,95％CI(1.51,3.38)]increased risk of stroke.Conclusion The combined effect of depression and SO significantly increases the risk of stroke in middle-aged and older individuals.Enhanced psychological counseling,nutritional guidance,and exercise training should be provided to this population to reduce their risk of stroke.

Abstract:Objective To evaluate the effectiveness of artificial intelligence(AI)-assisted teaching in medical education through Meta-analysis.Methods PubMed,Web of Science,Embase,Wanfang,CNKI,and VIP databases were searched from database creation to April 1,2025,to identify relevant studies on the application of AI-assisted teaching in medical education.The risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias.Meta-analysis was performed using R software.Heterogeneity tests,subgroup analyses,and sensitivity analyses were used to verify the robustness of the results.Results A total of 17 randomized controlled trials were included.Compared with traditional teaching,AI-assisted teaching significantly improved medical education participants' theoretical scores[SMD=1.35,95％CI(0.78,1.92)],practical/operational skills[SMD=2.45,95％CI(0.89,4.02)],and teaching satisfaction[RR=1.39,95％CI(1.20,1.61)].The differences were statistically significant(P＜0.05).Subgroup analysis showed that,compared with traditional teaching,AI-assisted medical education improved theoretical performance across different medical education groups(junior college students,undergraduate students,graduate students,and physicians)and practical/operational skills across some groups(junior college students,undergraduate students,and physicians).Sensitivity analysis showed robust results,except for publication bias in theoretical performance,and the conclusions were unchanged after trimming and filling correction.Conclusion AI can effectively empower medical education,significantly improving learning outcomes and teaching satisfaction,and contributing to the cultivation of clinical medical talent.

Abstract:Lung cancer is one of the deadliest malignant tumor globally,with non-small cell lung cancer(NSCLC)accounting for approximately 85％of cases.Given the heterogeneous nature of NSCLC and the unclear mechanisms underlying compensatory survival,there is an urgent need to explore novel molecular regulatory nodes to overcome treatment bottlenecks.The leucine-rich pentatricopeptide repeat-containing protein(LRPPRC),a crucial RNA-binding protein,plays pivotal roles in NSCLC development,drug resistance,recurrence,and immunotherapy responses.This review was focusing on LRPPRC's regulatory mechanisms and therapeutic strategies in NSCLC,aiming to provide theoretical foundations and reference bases for clinical diagnosis and treatment of NSCLC.

Abstract:Objective To clarify the expression level of Aurora-B in drug-resistant ovarian cancer(OC)and its impact on the proliferation,apoptosis,invasion,and migration abilities of OC cisplatin(DPP)resistant cells.Methods Immunohistochemistry was used to detect the levels of Aurora-B protein in ovarian tissues from patients with epithelial ovarian cancer(EOC)and uterine fibroids.Overexpression plasmids and siRNA were employed to construct OC drug-resistant cell models with overexpression and knockdown of the Aurora-B gene.The expression levels of Aurora-B protein and mRNA were detected using Western blot and qPCR.CCK-8 assay and EDU experiment were used to assess the proliferation ability of OC cells.Transwell and invasion assays were performed to evaluate the changes in migration and invasion abilities of OC cells.YF 647A-Annexin V/PI dual staining method was used to detect cell apoptosis.Results Compared with normal tissues,Aurora-B expression was significantly increased in EOC tissues and further elevated in DDP-resistant tissues(P＜0.05).qPCR and Western blot showed that both mRNA and baseline protein levels of Aurora-B were higher in SKOV3/DDP cells than in SKOV3 cells(P＜0.05).The CCK-8 assay and EDU proliferation assay demonstrated that Aurora-B upregulation significantly promoted SKOV3 cell proliferation,while Aurora-B knockdown markedly inhibited SKOV3/DDP cell proliferation(P＜0.05).Transwell assays revealed that Aurora-B upregulation enhanced the migration and invasion abilities of SKOV3 cells,whereas Aurora-B knockdown reduced these abilities in SKOV3/DDP cells(P＜0.05).Apoptosis assays indicated that Aurora-B upregulation suppressed cell apoptosis,while Aurora-B knockdown promoted it.Conclusion Aurora-B is highly expressed in DDP-resistant OC tissues and cells.High Aurora-B expression enhances OC cell proliferation,invasion,and migration while inhibiting apoptosis.This confirms the promoting role of Aurora-B in drug-resistant OC.

Abstract:The gut microbiota plays a pivotal role in maintaining and regulating the intestinal microenvironment,characterized by its complexity and diversity.With the advancement of genomics and metabolomics technologies,increasing attention has been directed toward the involvement of gut microbiota in tumor initiation,progression,and therapeutic response.Emerging evidence suggests that the gut microbiota not only contributes to tumor development but also modulates the host immune system,thereby influencing antitumor immune responses and enhancing immunotherapy efficacy.A growing body of studies has demonstrated close associations between the gut microbiota,tumor immunotherapy,and related adverse events.Consequently,the gut microbiota holds great potential as a predictive biomarker for tumor occurrence and as a critical regulatory factor affecting immunotherapy outcomes.This review summarizes recent advances in the field,highlighting the interplay between the gut microbiota and tumor immunity,and provides novel perspectives for leveraging gut microbiota to optimize cancer immunotherapy.

Abstract:Objective This study aimed to identify high-risk factors associated with high resource consumption during hospitalization among tumor patients using machine learning(ML)models,and to screen high-risk patients for pre-admission management to evaluate its impact on length of stay and hospitalization costs.Methods The date were retrospectively collected from inpatients treated at First Hospital of Shanxi Medical University between April 2021 and October 2022.Lasso regression was applied for feature selection,and multiple ML models were constructed to identify key factors influencing length of stay and hospitalization costs.SHAP values were used to interpret model results.Based on the modeling results,a risk factor screening and pre-admission management program was established between November and December 2022.The program was implemented from January to June 2023,and data were collected from patients who received or did not receive pre-admission management.Propensity score matching(PSM)was used to control baseline differences between groups,and causal forest(CF)analysis was performed to assess the effects of pre-admission intervention on hospitalization duration and costs.Results A total of 5,211 patients were included.The CatBoost model had the best results among the nine ML models constructed,and the prediction results showed that tumor type,preoperative waiting time,and age were the main high-risk factors affecting hospital resource utilization.Based on the model,698 patients received pre-admission management.After PSM,563 matched pairs were analyzed.CF analysis showed that the pre-admission group had a mean reduction in length of stay of 3.004[95％CI(-3.334 to-2.675)]days compared with the control group and a mean reduction in hospitalization costs of 1,473.124[95％CI(-2,166.09 to-780.16)]CNY,indicating that pre-admission management effectively improved hospital resource utilization efficiency.Conclusion Implementing pre-admission management for high-risk patients identified by ML models can significantly reduce length of stay and hospitalization costs for tumor patients,and may positively contribute to optimizing hospital workflows and resource allocation.

Abstract:Objective To explore the application value of high-fidelity simulators in the clinical teaching of transthoracic echocardiography(TTE).Methods Residents receiving standardized training who rotated in the Department of Ultrasound Medicine,Zhongnan Hospital of Wuhan University,from November 2023 to November 2024,were selected as the research objects and divided into an experimental group and a control group.Both groups received theoretical and practical skill video learning of 10 key sections of TTE.The experimental group received practical training using high-fidelity simulators,while the control group received training through the traditional mode.After training,the training effects of the two groups were compared through assessment scores and questionnaires.Results A total of 24 residents were included,with 12 in each group.Before training,there was no statistically significant difference in the theoretical assessment scores between the two groups(P＞0.05).After training,the experimental group achieved better results in the practical skills exam than the control group(82.08±5.03 vs.71.83±0.83),and the difference was statistically significant(P＜0.05).The residents in the experimental group generally held a positive attitude towards the practicality,simulation effect and teaching effect of the high-fidelity simulators.Conclusion The high-fidelity simulation teaching method can effectively improve the TTE examination skills of the residents and can be used as a beneficial supplement to traditional teaching.

Abstract:Objective To investigate the application effectiveness of discharge preparation services based on the information-motivation-behavior(IMB)model on patients undergoing metabolic and bariatric surgery(MBS).Methods Patients who underwent MBS in April 2022 at the Obesity and Metabolic Disease Surgery Center in Zhongnan Hospital of Wuhan University were selected as the control group,and patients who underwent MBS in September 2022 were selected as the observation group.The control group received the conventional perioperative management model for patients undergoing MBS,while the observation group received the discharge preparation services based on the IMB model.The discharge readiness and discharge guidance quality scores,the awareness rate of MBS postoperative knowledge and the effect of rapid rehabilitation of the two groups of patients were compared.Results A total of 98 patients were included,including 52 in the observation group and 46 in the control group.After the intervention,compared with the control group,the observation group demonstrated higher scores in discharge readiness and discharge guidance quality,improved awareness of postoperative knowledge,shorter hospital stays,earlier postoperative ambulation initiation,and faster return of bowel function,along with lower 1-month unplanned readmission rates,and the differences were statistically significant(P＜0.05).Conclusion The use of discharge preparation service baseds on IMB model can significantly improve the awareness rate of patients' weight loss professional knowledge after MBS,improve the patient's discharge preparation and discharge guidance quality,accelerate the postoperative rehabilitation of patients,reduce the unplanned readmission rate of patients.The intervention model has certain application value in clinical practice.

Abstract:Objective To analyze the burden and attributable risk factors of depression among Chinese adolescents aged 10～24 years from 1990 to 2021.Methods Based on the data of the Global Burden of Disease Study 2021,the incidence rate,prevalence,disability adjusted life year(DALY),and it's average annua percentage change(AAPC)and attributable risk factors of depression among Chinese adolescents aged 10 to 24 years from 1990 to 2021 were analyzed.Joinpoint regression model was used to analyze the time trend of indicators of the burden of depression.Auto regressive integrated moving average(ARIMA)model predicted the trend of depression among adolescents aged 10 to 24 years from 2022 to 2035.Results In 2021,the number of new cases of depression among Chinese adolescents aged 10 to 24 was 3.247 million,with a total of 2.9614 million affected individuals and a DALY of 511,200 person years.Compared with 1990,these figures decreased by 61.76％,57.50％,and 59.92％,respectively.Joinpoint regression analysis found that the incidence rate[AAPC=-1.716％,95％CI(-1.958％,-1.474％)],prevalence[AAPC=-1.375％,95％CI(-1.585％,-1.165％)],and DALY rate[AAPC=-1.563％,95％CI(-1.842％,-1.283％)]of depression in Chinese adolescents aged 10 to 24 years from 1990 to 2021 showed a downward trend.Comparing gender subgroups,it was found that adolescent females have a higher disease burden than males.In 2021,the attribution factors for adolescent depression DALY were ranked as bullying victimization,intimate partner violence,and childhood sexual abuse.ARIMA predicts that from 2022 to 2035,the incidence rate of depression among adolescents aged 10 to 24 in China will decline,and the prevalence rate and DALY rate will rise first and then decline.Conclusion The burden of depression among adolescents aged 10～24 years in China has shown a decreasing trend from 1990 to 2021,with females having a higher disease burden than males.The incidence rate of depression among adolescents aged 10～24 in China is expected to show a decreasing trend from 2022 to 2035,while the prevalence rate and DALY rate are expected to first increase and then decrease.

Abstract:Objective To investigate the inhibitory effect of melittin combined with photodynamic therapy(PDT)on the biological behavior of melanoma cells(B16-F10).Methods Nano-drug bee venom peptide photosensitive lipid nanoparticles(α-melittin-PPIX-NP)were prepared and characterized by hydrolysis method.The red blood cell hemolysis experiment verified the hemolytic side effects of melittin.CCK-8 was used to detect its ability to kill B16-F10 cells in combination with PDT.Western Blot was used to detect the expression of SR-B1 receptor protein in different cells.Flow cytometry was used to detect cell apoptosis,drug uptake by different cells,and in vitro activation of bone marrow-derived dendritic cells(BMDCs).Results The prepared α-melittin-PPIN-NP had uniform morphology and concentrated hydrated particle size distribution,which significantly reduced the side effects of erythrocyte hemolysis.α-melittin-PPIX-NP can efficiently target B16-F10 cells and inhibit the proliferation of tumor cells by activating BMDCs,and its effect is better when combined with near-infrared light(NIR).Conclusion PDT with α-melittin-PPIX-NP combined with NIR can promote the apoptosis of B16-F10 cells,activate BMDC,and effectively increase the anti-tumor immune effect.

Abstract:Objective To provide formative evaluation training for clinical teachers on Mini-Clinical Evaluation Exercise(Mini-CEX)and Direct Observation of Procedural Skills(DOPS)method,and analyze the training effect.Methods Clinical teachers were selected as the research subjects.The experimental group received Mini-CEX and DOPS training,while the control group did not receive training.Before and after the training,the experimental group were investigated the mastery of the training content through questionnaire.During the training,the experimental group rated the teaching videos.After the training,the experimental group were investigated for satisfaction with the training.After one month of training,the experimental group and control group received a formative assessment of the implementation ability.Results 112 clinical teachers were included,including 56 in the experimental group and 56 in the control group.After the training,the 56 teachers in the experimental group showed a significant improvement in their self-evaluation scores for Mini-CEX and DOPS when compared with before training(P＜0.05),and the Kendall's W coefficient of the Mini-CEX teaching video rating of the experimental group increased,indicating an improvement in rating consistency.The formative assessment implementation ability score of experimental group[(86.67±6.67)vs.(70.67±15.00)points for Mini-CEX,(89.41±5.97)vs.(77.39±5.50)points for DOPS]were higher than those in the control group.The overall satisfaction of the experimental group teachers with the training is relatively high[(4.04±0.50)points].Conclusion Formative assessment is effective in deepening clinical teachers' understanding of formative assessment,improving the accuracy and consistency of formative assessment,and enhancing their ability to implement formative assessment.

Abstract:Neutrophil extracellular traps(NETs)are extracellular fibrous network structures released by activated neutrophils,mainly composed of DNA,histones,and antimicrobial proteins.The process of neutrophil releasing NETs is called neutrophil extracellular traps-osis(NETosis),including suicidal NETosis,energetic NETosis,and mitochondrial-associated NETosis.NETs play a dual role in tumor progression:on the one hand,they can promote tumor progression by reshaping the tumor micro environment,enhancing tumor cell proliferation,metastasis,and drug resistance.On the other hand,under specific conditions,NETs can also exert anti-tumor effects.Research has shown that the distribution of NETs is closely related to the malignancy of tumors and may serve as prognostic markers.In addition,treatment strategies targeting NETs,such as inhibiting their formation or promoting their degradation,are emerging as new research directions.This article reviews the formation mechanism of NETs,their distribution characteristics in tumors,their impact on tumor progression and prognosis,as well as related treatment strategies,providing new perspectives and potential targets for tumor treatment.

Abstract:Objective To analyze the disease burden of infertility in China from 1992 to 2021.Methods Data for this study were derived from the 2021 Global Burden of Disease Study.Joinpoint regression model was used to analyze the prevalence and disability-adjusted life-year(DALY)rate of infertility in China and their average annual percentage change(AAPC)to assess the changing trend of the disease.Age-period-cohort models were used to explore age,period,and cohort effects.Results From 1992 to 2021,the prevalence of infertility decreased for both men[AAPC=-0.39％,95％CI(-0.43％,-0.35％)]and women[AAPC=-0.39％,95％CI(-0.40％,-0.32％)].The DALY rate also decreased for both men[AAPC=-0.41％,95％CI(-0.46％,-0.38％)]and women[AAPC=-0.41％,95％CI(-0.44％,-0.37％)].Age-effect results showed that the prevalence and DALY rates of infertility in both men and women in China increased first and then decreased with age from 1992 to 2021.Period-effect results showed that the risk of infertility and DALY risk decreased for both men and women in China from 1992 to 2021.Cohort-effect results showed that later birth cohorts had lower risks of infertility and DALYs.Conclusion From 1992 to 2021,both the prevalence and DALY rates of infertility in China showed a downward trend,with later birth cohorts exhibiting lower risks.Targeted prevention and treatment efforts for different age groups and the active promotion of assisted reproductive technologies can reduce the burden of infertility in China.

Abstract:Objective To investigate the causal relationship between inflammatory factors and inflammatory bowel disease(IBD),including Crohn's disease(CD)and ulcerative colitis(UC),using Mendelian randomization(MR).Methods Inflammatory factors data were obtained from the University of Bristol database and the GWAS Catalog database,and IBD data were obtained from the FinnGen database.Inverse-variance weighted was used as the primary analysis method,supplemented by weighted median estimator,weighted mode,and MR-Egger analysis methods.Sensitivity analyses such as heterogeneity and pleiotropy further validated the robustness of the results,multivariate Mendelian randomization(MVMR)analysis was performed to enhance the reliability of the final results.Results Forward MR analysis found that a total of 24 inflammatory factors were causally associated with IBD,while reverse MR analysis did not find a causal relationship between the two.MVMR analysis showed that AXIN1 and CD6 were positively correlated with IBD;IL10,CXCL5,and TRANCE were negatively correlated with UC,while IL-1α was positively correlated with UC;b-FGF,AXIN1,CD6,and IL-1ORα were positively correlated with CD,while TGF-βl was negatively correlated with CD.Conclusion Some inflammatory factors have a causal relationship with IBD and may play a role in its pathogenesis.

Abstract:Objective To explore the relationship between serum levels of nuclear factorκB(NF-κB),CXC motif chemokine ligand 13(CXCL13),and a disintegrin and metalloprotinase-17(ADAM17)in children with primary immune thrombocytopenia(ITP)and their prognosis.Methods Children with ITP and those who were physically healthy,admitted to Wuhan First Hospital from September 2022 to September 2024,were selected as the subjects.They were divided into ITP group and control group.Based on the prognosis of the children after 4 weeks of treatment,the ITP group was further divided into the treatment-effective group and the treatment-ineffective group.The levels of serum NF-κB,CXCL13,and ADAM17 were measured using the ELISA method.Multivariate Logistic analysis was used to identify the factors affecting the treatment ineffectiveness in ITP patients.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to evaluate the predictive value of NF-κB,CXCL13,and ADAM17 levels in predicting treatment ineffectiveness in ITP patients.Results A total of 276 subjects were included in the study,with 138 in the ITP group and 138 in the control group,93 in the treatment-effective group and 45 in the treatment-ineffective group.The serum levels of NF-κB,CXCL13,and ADAM17 in children in the ITP group were significantly higher than those in the control group(P＜0.05).Elevated levels of NF-κB,CXCL13,ADAM17,and Th17/Treg were risk factors for ineffective treatment in ITP patients(P＜0.05).ROC curve analysis showed that the AUCs for predicting ineffective treatment in ITP patients using the levels of NF-κB,CXCL13,and ADAM17 were 0.833,0.816,and 0.837,respectively.The AUC for predicting ineffective treatment using any one of these three markers was significantly lower than the AUC for predicting ineffective treatment using all three markers together(0.937).Conclusion The expression of serum NF-κB,CXCL13 and ADAM17 was upregulated in ITP children,which were the risk factors for ineffective treatment.The combined prediction value of these three factors was better than that of ITP children with ineffective treatment.

Abstract:Objective To conduct a systematic review and Meta-analysis for the association between polycyclic aromatic hydrocarbons(PAHs)exposure and blood pressure.Methods The CNKI,WanFang,CBM,VIP,OVID,PubMed,Web of Science,and EBSCO databases were systematically searched for collecting literature on the relatimship between PAHs exposure and blood pressure,from inception to July 25,2025.After two researchers independently screened the literature,extracted data,and assessed the risk of bias in the included studies,a quantitative and qualitative summary was conducted.Results A total of 41 papers were included,involving 9 cohort studies and 32 cross-sectional studies.The results of Meta-analysis based on 3 cross-sectional studies showed that benzo[a]pyrene exposure was a risk factor for hypertension among coke oven workers[OR=1.44,95％CI(1.15,1.80)].Consistently,3 included cohort studies demonstrated PAHs exposure as a risk of hypertension.In addition,a total of 11 studies reported the positive association between PAHs exposure and systolic blood pressure,and 10 studies reported the a positive association between PAHs exposure and diastolic blood pressure,and the remaining studies reported the negative association or found no association between PAHs and blood pressure.Conclusion PAHs exposure was associated with blood pressure and increased the risk of hypertension.

Abstract:Objective To investigate the effect and underlying mechanism of fork-head box protein 1(FOXP1)on the viability and apoptosis of cisplatin(DDP)resistant cervical cancer cells.Methods Construction of FOXP1 interference DDP-resistant cervical cancer cell models using siRNA.Cell viability was assessed using CCK-8 assay,apoptosis was measured by flow cytometry,autophagy levels were detected via LC3 immunofluorescence,and changes in autophagy-related proteins and Wnt/β-catenin signaling pathway components were analyzed by Western blot.Functional rescue experiments were performed using the autophagy activator rapamycin(RAPA)or the Wnt pathway activator SKL2001 in FOXP1-silenced HeLa/DDP cells.Results Compared to normal cervical cancer cells,FOXP1 was highly expressed in DDP-resistant HeLa/DDP and SiHa/DDP cells.Inhibition of FOXP1 significantly reduced the cellular activity of HeLa/DDP and SiHa/DDP,elevated the sensitivity of cells to DDP,and promoted apoptosis.Additionally,FOXP1 silencing downregulated LC3-Ⅱ and Beclin-1 protein expression while upregulating LC3-I and p62,indicating suppressed autophagy and Wnt/(3-catenin signaling activation.These effects were partially reversed by RAPA or SKL2001 treatment.Conclusion FOXP1 can elevate autophagy to reduce the sensitivity of cervical cancer DDP-resistant cell lines HeLa/DDP and SiHa/DDP to DDP by activating the Wnt/β-catenin signalling pathway.

Abstract:Objective To analyze the breast cancer disease burden in Sinosphere countries from 1990 to 2021,and to provide evidence for the development of breast cancer prevention and control policies.Methods Using data from the Global Burden of Disease Study 2021,the incidence,mortality,disability-adjusted life years(DALYs),and average annual percent change(AAPC)were analyzed to assess the breast cancer burden in six Sinosphere countries(China,Japan,South Korea,Singapore,Vietnam,and North Korea)and globally.Joinpoint regression was used to evaluate temporal trends,age-period-cohort(APC)models to assess the independent effects of age,period,and birth cohort,and Bayesian APC models to project the burden from 2022 to 2036.Results In 2021,China reported the highest absolute numbers of new cases(402,800),deaths(91,500),and DALYs(3,029,400 person-years)among Sinosphere countries.Japan had the highest age-standardized incidence rate(ASIR,31.93 per 100,000),Vietnam the highest age-standardized mortality rate(ASMR,6.23 per 100,000),and North Korea the highest age-standardized DALY rate(ASDR,201.05 per 100,000 person-years).From 1990 to 2021,ASIR increased in all Sinosphere countries,with the greatest increase observed in South Korea[AAPC=3.47％,95％CI(3.26％,3.68％)].Japan showed the largest increases in ASMR[AAPC=1.00％,95％CI(0.78％,1.21％)]and ASDR[AAPC=0.75％,95％CI(0.55％,0.95％)].The results of the APC model showed that the age effects of breast cancer incidence,mortality,and DALY rates in Sinosphere countries are all on the rise.The risk of developing breast cancer continued to increase among younger cohorts,while mortality and DALY risks in younger generations remained stable or declined in most countries.In contrast,Vietnam showed increasing mortality and DALY risks in younger cohorts.From 2022 to 2036,it is predicted that the breast cancer ASIR will continue to rise in China,Vietnam,and North Korea,while only China will show an increasing trend in breast cancer ASMR and ASDR.Conclusion Breast cancer burden varies across the Sinosphere countries,with China carrying the highest absolute burden and showing the most pronounced upward trend over the next 15 years.Strengthened preventive strategies,enhanced public awareness,effective screening programs,and accelerated advances in medical technology are urgently needed to reduce disability and mortality rates in China.Lessons learned from successful experiences in other Sinosphere countries should be actively applied to mitigate the rising breast cancer burden.

Abstract:Objective To clarify the incidence and risk factors of postoperative pulmonary infection in patients undergoing craniotomy,and to provide a basis for early identification and prevention of postoperative pulmonary infection.Methods The literature related to the incidence and risk factors of postoperative pulmonary infection in patients undergoing craniotomy was searched from January 1,2014,to September 3,2025,in domestic and foreign databases.Meta-analysis was performed using Stata 18 software.Results A total of 26 articles were included,with a total sample size of 64,568 cases,3,619 positive cases,and the incidence of postoperative pulmonary infection was 29.6％[95％CI(24.8％,34.4％)].Among them,increasing age,age≥60 years,age≥70 years,smoking history,male,GCS score＜8 points,preoperative hyperglycemia,emergency surgery,intraoperative bleeding,intraoperative blood loss＞50 mL,intraoperative blood transfusion,second operation,operation duration≥3 hours,tracheostomy,mechanical ventilation,mechanical ventilation duration≥7days,mechanical ventilation duration≥ 14days,the use antimicrobial drugs,bed rest time＞14 days,ICU admission＞7 days,diabetes mellitus,tumors located lateral to the brainstem and at the base of the skull,high Hunt grade were risk factors for postoperative lung infection in patients undergoing craniotomy(P＜0.05).Conclusion Based on the above risk factors,clinical practice can identify the patients with a high incidence of postoperative lung infection in the early stage and take targeted measures in time to improve the prognosis of patients.