BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

ObjectiveTo investigate the current professional competency among full-time and part-time personnel of the nosocomial infection control administration in Shanghai, so as to provide a scientific basis for future training programmes. MethodsIn December 2024, a questionnaire survey was conducted by the Shanghai Nosocomial Infection Quality Control Center among full-time and part-time personnel of the nosocomial infection control administration across medical institutions at various levels and types in Shanghai using convenience sampling method. The questionnaire consisted of two parts: demographic information and professional competency assessment. The professional competency scale comprised four dimensions: fundamental cognition, basic skills, professional expertise, and personal qualities, totaling 35 items. ResultsA total of 1 179 questionnaires were distributed, with 1 144 valid responses collected, yielding an effective response rate of 97.03%. Statistically significant differences were observed among full-time and part-time personnel of the nosocomial infection control administration in terms of age (t=5.32, P=0.021), professional background (χ²=9.90, P=0.019), educational qualifications (χ²=19.10, P<0.001), professional titles (χ²=12.60, P=0.002), and the levels of medical institutions (χ²=111.08, P<0.001). The scores of full-time personnel of the nosocomial infection control administration in fundamental cognition [92 (82, 99) points] and basic skills [88 (78, 96) points] were significantly higher than those of part-time personnel(Z=-2.21, P=0.027;Z=-2.74, P=0.006). Statistically significant differences were found in fundamental cognition scores between full-time and part-time personnel of the nosocomial infection control administration regarding occupational safety protection, definition of healthcare-associated infection outbreaks, types of drug-resistant bacteria and their prevention and control strategies, and transmission routes of different infectious diseases (all P<0.05). Statistically significant differences were also observed in basic skills scores including proficient use of monitoring platforms, formulation and revision of standard operating procedures (SOPs), independent completion of targeted surveillance, guidance on basic infection control skills, guidance for key departments, and follow-up of personnel with occupational exposure (all P<0.05). However, no statistically significant differences were found in scores of professional knowledge and personal qualities (P>0.05). ConclusionThere are certain differences in professional competency between full-time and part-time personnel of the nosocomial infection control administration in Shanghai in terms of fundamental cognition and basic skills. Part-time personnel can effectively improve their professional competency through systematic training on basic infection control knowledge and practical skills, thereby comprehensively enhancing the overall quality of the nosocomial infection administration team.

Idiopathic pulmonary fibrosis （IPF） can be classified as pulmonary collateral disease，and its pathogenesis is mainly characterized by the loss of Qi meridian nourishment，the loss of Yin meridian nourishment，and the formation of blood stasis in the blood vessels. Qi Yin deficiency is the pathological basis that runs through IPF，and obstruction of meridians and collaterals is a key element in the development of the disease. The dysfunction of "spleen being in charge of the defensive function" is closely related to the formation of the pathological pattern of "lung deficiency and collateral stasis" in IPF. The term "spleen being in charge of the defensive function" originated from the Yellow Emperor's Inner Canon. If the spleen is healthy，the Qi will be filled with vitality. Positive energy is stored inside，evil cannot be dried up. Its concept is quite similar to the immune defense function in modern medicine. If the principle of "spleen being in charge of the defensive function" is lost，the key structure and function of the IPF alveolar epithelial barrier may be abnormal，and it can interact with various innate immune cells to promote inflammation and fibrosis processes. Therefore，this article explains the imbalance of immune homeostasis in IPF alveolar epithelium from two aspects：the barrier function of alveolar epithelial cells（AECs） and their interaction with innate immune cells. And based on the theory of "spleen being in charge of the defensive function"，using traditional Chinese medicine for strengthening the spleen and nourishing Qi to treat IPF from the perspective of the spleen. This not only strengthens the scientific connotation of "spleen being in charge of the defensive function" in the pathogenesis of IPF，but also provides new research directions and ideas for its future clinical prevention and treatment.

Copper death plays a significant regulatory role in biological processes. An increasing number of studies have revealed the mechanism, function, and potential clinical application value of copper death in bladder cancer. The emergence of copper death can provide new ideas for the treatment of bladder cancer. This article summarizes the role and regulation mechanism of copper death in bladder cancer, and reviews the research progress of copper-related proteins, copper death-related signaling pathways, copper nanoparticles, and copper carriers in bladder cancer, which is expected to provide new ideas and directions for the treatment of bladder cancer.

Pyroptosis is a form of programmed cell death that differs from classical apoptosis and passive necrosis.It plays a crucial role in activating innate immune responses,driving local inflam-matory reactions,regulating immune cell activation and infiltration,and remodeling the tumor immune microenvironment.In recent years,the role of pyroptosis in the initiation,progression,and treatment response of urological tumors has garnered increasing attention.Current studies have demonstrated that pyroptosis exhibits dual regulatory effects in various tumors:on the one hand,it exerts anti-tumor effects by inducing lytic death of tumor cells;on the other hand,under specific microenvironmental conditions,the chronic inflammatory response mediated by pyroptosis may promote immune escape,thereby driving tumor progression.This review systematically summarized the similarities and differ-ences in the molecular mechanisms of pyroptosis in three common urological tumors,namely renal cell carcinoma,bladder cancer,and prostate cancer.It also summarized the regulatory networks and po-tential therapeutic targets during tumor initiation and progression.Furthermore,it elucidated the re-search progress on enhancing the efficacy of immune checkpoint inhibitors by modulating pyroptosis pathways,aiming to provide novel strategies and theoretical foundations for the precise treatment of u-rological.

Objective:To investigate the clinical effect of percutaneous transhepatic cholangial drainage (PTCD) combined with percutaneous transhepatic papillary balloon dilatation (PTPBD) in the treatment of choledocholithiasis.Methods:The clinical data of patients treated with PTCD combined with PTPBD under digital subtraction angiography for choledocholithiasis in the Interventional Department of the Second Affiliated Hospital of Nantong University from June 2021 to May 2024 were retrospectively analyzed, and a total of 90 patients were enrolled, including 58 males and 32 females, aged (56.6±4.3) years. The changes of liver function, postoperative complications, and prognosis were analyzed.Results:Of 90 patients were successfully treated with PTCD, and 3 patients (3.3%) died after PTCD operation, mainly due to old age combined with a variety of underlying diseases. 85(97.7%) of the remaining 87 patients were successfully treated with PTPBD, while 2 cases (2.3%) experienced technical failure due to excessive stone size (>20 mm). Among the 90 cases after the procedure, there were 6 cases (6.7%) of abdominal pain, 3 cases (3.3%) of bleeding, 4 cases (4.4%) of fever, and no serious complications such as bile duct perforation, intestinal perforation or pancreatitis occurred. The symptoms of 87 patients were improved within 3 to 7 days after PTCD. The changes of leukocyte, total bilirubin, alanine aminotransferase and C reactive protein before and after surgery were statistically significant (all P<0.001). Conclusions:PTCD combined with PTPBD is a minimally invasive treatment for common bile duct stones with obvious advantages in high success rate, safety, and effectiveness, which is especially suitable for elderly patients with multiple underlying diseases, inability to tolerate surgical procedures, or no suitable endoscopic pathways.

Lung cancer is one of the most prevalent malignancies globally,with the highest incidence and mortality rates.Non-small cell lung cancer(NSCLC)accounts for 85%of all lung cancer cases.In China,both the incidence and mortality of lung cancer rank first among all ma-lignancies.Interstitial lung abnormalities(ILA)are non-dependent abnormalities incidentally detected on chest computed tomography(CT)scans.Some NSCLC patients may present with concurrent ILA at diagnosis,and ILA may significantly impact survival outcomes and treatment-related complications in NSCLC patients.However,the relationship between ILA and NSCLC remains under investigation.The integration of artificial intelligence(AI)technologies with multimodal data to develop novel and efficient comprehensive assessment models for ILA repres-ents a promising research frontier.This review aims to provide a comprehensive analysis of the correlation between ILA and NSCLC,the pro-gnostic implications of ILA in NSCLC patients,and the current advancements in AI-based technologies for ILA evaluation.The findings may of-fer valuable insights to guide future research directions on ILA in China.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.