In observational research,a primary objective is to accurately and reliably assess the causal impact of exposure on outcomes.Identifying and properly adjusting for confounding factors is a key prerequisite and central challenge to achieving this goal.Ineffective management of confounders,whether by neglecting significant ones,(leading to residual confounding),or by over-adjusting for irrelevant factors,(introducing collider bias),can distort effect estimates and lead to erroneous scientific conclusions and clinical decisions.Therefore,it is essential to develop and implement systematic,transparent,and reproducible methods for identifying and selecting confounding factors to enhance the validity and reliability of causal inferences in observational studies.This paper provides a systematic review of directed acyclic graphs(DAGs),a robust visual causal modeling tool,and offers a detailed examination of three prominent criteria for selecting confounding factors based on DAGs:the Pre-exposure criterion,the Common cause criterion,and the Modified disjunctive cause criterion.The aim is to equip researchers with a structured and theoretically grounded framework for identifying and selecting confounding factors,thereby improving the process of estimating causal effects in observational studies.

Objective:To investigate the independent clinical factors of live birth rate of the first frozen-thawed embryo transfer (FET) cycle after transcervical resection of adhesion (TCRA).Methods:A retrospective case-control study was conducted to analyze the clinical data of patients with intrauterine adhesion (IUA) who received FET in Reproductive Center of Reproductive and Genetic Hospital of CITIC-XIANGYA from January 2019 to June 2022 ( n=6 154). According to the severity of intrauterine adhesions in patients, they were classified into mild adhesions ( n=172), moderate adhesions ( n=5 723), and severe adhesions ( n=259). Based on the FET outcome, the patients were divided into live birth group and non-live birth group. The risk factors and protective factors of live birth were analyzed by multivariate logistic regression. Results:1) No independent factor of live birth was found in the mild IUA group. 2) In the moderate IUA group, the protective factors of live birth included secondary infertility ( OR=1.39, 95% CI: 1.07-1.80, P=0.015), hysteroscopic polypectomy ( OR=1.38, 95% CI: 1.05-1.83, P=0.023), No. of high-quality embryos transferred (one embryo: OR=1.58, 95% CI: 1.37-1.82, P<0.001; two embryos: OR=2.55, 95% CI: 1.80-3.64, P<0.001), two embryos transferred ( OR=1.77, 95% CI: 1.48-2.12, P<0.001), embryo stage (blastocyst transferred, OR=4.93, 95% CI: 3.68-6.63, P<0.001; blastocyst+cleavage transferred OR=1.90, 95% CI: 1.11-3.21, P=0.021), preimplantation genetic testing embryo ( OR=1.42, 95% CI: 1.19-1.69, P<0.001), endometrial thickness before transplantation ( OR=1.11, 95% CI: 1.07-1.15, P<0.001). Risk factors of live birth included female age ( OR=0.94, 95% CI: 0.92-0.96, P<0.001), infertility due to male factor ( OR=0.83, 95% CI: 0.71-0.96, P=0.011), combined repeated implantation failure ( OR=0.60, 95% CI: 0.42-0.87, P=0.007), combined unicornuate uterus/uterus didelphys ( OR=0.25, 95% CI: 0.06-0.79, P=0.033), American Fertility Society score ( OR=0.94, 95% CI: 0.89-0.98, P=0.010), No. of TCRA ( OR=0.83, 95% CI: 0.77-0.90, P<0.001), gonadotropin-releasing hormone agonists down-regulation combined with artificial cycle ( OR=0.56, 95% CI: 0.45-0.69, P<0.001), artificial cycle ( OR=0.62, 95% CI: 0.51-0.76, P<0.001). 3) In the severe IUA group, the risk factor of live birth was artificial cycle ( OR=0.25, 95% CI: 0.07-0.80, P=0.027). Conclusion:The clinical factors that affect the live birth outcome of the first FET cycle after TCRA have different results in patients with different degrees of adhesion. In patients with moderate adhesions, there are 17 clinical indicators that affect the live birth rate. In patients with severe adhesions, the artificial cycle is an independent factor affecting the live birth rate.

As the volume of medical research using large language models (LLM) surges, the need for standardized and transparent reporting standards becomes increasingly critical. In January 2025, Nature Medicine published statement titled by TRIPOD-LLM reporting guideline for studies using large language models. This represents the first comprehensive reporting framework specifically tailored for studies that develop prediction models based on LLM. It comprises a checklist with 19 main items (encompassing 50 sub-items), a flowchart, and an abstract checklist (containing 12 items). This article provides an interpretation of TRIPOD-LLM’s development methods, primary content, scope, and the specific details of its items. The goal is to help researchers, clinicians, editors, and healthcare decision-makers to deeply understand and correctly apply TRIPOD-LLM, thereby improving the quality and transparency of LLM medical research reporting and promoting the standardized and ethical integration of LLM into healthcare.

In observational research,a primary objective is to accurately and reliably assess the causal impact of exposure on outcomes.Identifying and properly adjusting for confounding factors is a key prerequisite and central challenge to achieving this goal.Ineffective management of confounders,whether by neglecting significant ones,(leading to residual confounding),or by over-adjusting for irrelevant factors,(introducing collider bias),can distort effect estimates and lead to erroneous scientific conclusions and clinical decisions.Therefore,it is essential to develop and implement systematic,transparent,and reproducible methods for identifying and selecting confounding factors to enhance the validity and reliability of causal inferences in observational studies.This paper provides a systematic review of directed acyclic graphs(DAGs),a robust visual causal modeling tool,and offers a detailed examination of three prominent criteria for selecting confounding factors based on DAGs:the Pre-exposure criterion,the Common cause criterion,and the Modified disjunctive cause criterion.The aim is to equip researchers with a structured and theoretically grounded framework for identifying and selecting confounding factors,thereby improving the process of estimating causal effects in observational studies.

Objective:To investigate the independent clinical factors of live birth rate of the first frozen-thawed embryo transfer (FET) cycle after transcervical resection of adhesion (TCRA).Methods:A retrospective case-control study was conducted to analyze the clinical data of patients with intrauterine adhesion (IUA) who received FET in Reproductive Center of Reproductive and Genetic Hospital of CITIC-XIANGYA from January 2019 to June 2022 ( n=6 154). According to the severity of intrauterine adhesions in patients, they were classified into mild adhesions ( n=172), moderate adhesions ( n=5 723), and severe adhesions ( n=259). Based on the FET outcome, the patients were divided into live birth group and non-live birth group. The risk factors and protective factors of live birth were analyzed by multivariate logistic regression. Results:1) No independent factor of live birth was found in the mild IUA group. 2) In the moderate IUA group, the protective factors of live birth included secondary infertility ( OR=1.39, 95% CI: 1.07-1.80, P=0.015), hysteroscopic polypectomy ( OR=1.38, 95% CI: 1.05-1.83, P=0.023), No. of high-quality embryos transferred (one embryo: OR=1.58, 95% CI: 1.37-1.82, P<0.001; two embryos: OR=2.55, 95% CI: 1.80-3.64, P<0.001), two embryos transferred ( OR=1.77, 95% CI: 1.48-2.12, P<0.001), embryo stage (blastocyst transferred, OR=4.93, 95% CI: 3.68-6.63, P<0.001; blastocyst+cleavage transferred OR=1.90, 95% CI: 1.11-3.21, P=0.021), preimplantation genetic testing embryo ( OR=1.42, 95% CI: 1.19-1.69, P<0.001), endometrial thickness before transplantation ( OR=1.11, 95% CI: 1.07-1.15, P<0.001). Risk factors of live birth included female age ( OR=0.94, 95% CI: 0.92-0.96, P<0.001), infertility due to male factor ( OR=0.83, 95% CI: 0.71-0.96, P=0.011), combined repeated implantation failure ( OR=0.60, 95% CI: 0.42-0.87, P=0.007), combined unicornuate uterus/uterus didelphys ( OR=0.25, 95% CI: 0.06-0.79, P=0.033), American Fertility Society score ( OR=0.94, 95% CI: 0.89-0.98, P=0.010), No. of TCRA ( OR=0.83, 95% CI: 0.77-0.90, P<0.001), gonadotropin-releasing hormone agonists down-regulation combined with artificial cycle ( OR=0.56, 95% CI: 0.45-0.69, P<0.001), artificial cycle ( OR=0.62, 95% CI: 0.51-0.76, P<0.001). 3) In the severe IUA group, the risk factor of live birth was artificial cycle ( OR=0.25, 95% CI: 0.07-0.80, P=0.027). Conclusion:The clinical factors that affect the live birth outcome of the first FET cycle after TCRA have different results in patients with different degrees of adhesion. In patients with moderate adhesions, there are 17 clinical indicators that affect the live birth rate. In patients with severe adhesions, the artificial cycle is an independent factor affecting the live birth rate.

This comprehensive review systematically explores the multifaceted applications, inherent challenges, and promising future directions of artificial intelligence (AI) within the medical domain. It meticulously examines AI's specific contributions to basic medical research, disease prevention, intelligent diagnosis, treatment, rehabilitation, nursing, and health management. Furthermore, the review delves into AI's innovative practices and pivotal roles in clinical trials, hospital administration, medical education, as well as the realms of medical ethics and policy formulation. Notably, the review identifies several key challenges confronting AI in healthcare, encompassing issues such as inadequate algorithm transparency, data privacy concerns, absent regulatory standards, and incomplete risk assessment frameworks. Looking ahead, the future trajectory of AI in healthcare encompasses enhancing algorithm interpretability, propelling generative AI applications, establishing robust data-sharing mechanisms, refining regulatory policies and standards, nurturing interdisciplinary talent, fostering collaboration among industry, academia, and medical institutions, and advancing inclusive, personalized precision medicine. Emphasizing the synergy between AI and emerging technologies like 5G, big data, and cloud computing, this review anticipates a new era of intelligent collaboration and inclusive sharing in healthcare. Through a multidimensional analysis, it presents a holistic overview of AI's medical applications and development prospects, catering to researchers, practitioners, and policymakers in the healthcare sector. Ultimately, this review aims to catalyze the deep integration and innovative deployment of AI technology in healthcare, thereby driving the sustainable advancement of smart healthcare.

Objective:To evaluate the effect of urethral stent tube irrigation in preventing postoperative complications in adolescents with hypospadias.Methods:A retrospective analysis was conducted using the clinical data of adolescents with hypospadias treated at the Department of Urology, Children’s Hospital of Chongqing Medical University, from April 2016 to July 2023. Patients were divided into control group and study group according to whether urethral stent tube was inserted in urethra during operation. All surgeries were performed by the same surgeon. For two days before surgery, patients were instructed to cleanse the surgical site daily with body wash and a 5% povidone-iodine solution. In the control group, patients received postoperative care with an indwelling urinary catheter. In the study group, in addition to the urinary catheter, a urethral stent tube was placed in the posterior urethra, and postoperative urethral irrigation with saline was performed. Postoperative complications, including wound infection, urethral fistula, urethral stricture, and urethral diverticulum, were monitored. Categorical data were expressed as frequencies and percentages and were analyzed using the χ2 test or Monte Carlo-based χ2 test. Continuous data with normal distribution are presented as Mean±SD and were analyzed using the t-test. Non-normally distributed continuous data were expressed as M ( Q1, Q3) and were analyzed using the Wilcoxon rank-sum test. P<0.05 was considered statistically significant. Results:A total of 76 patients were enrolled in the study, with 43 patients in the control group [median age 12.9(12.2, 13.7) years, reconstructed urethral length (3.88±1.86) cm] and 33 patients in the study group [median age 12.5(11.3, 14.1) years, reconstructed urethral length (3.30±1.45)cm]. Postoperatively, 32 patients (74.4%) in the control group experienced complications, including 24 cases (55.8%) of wound infection, 16 cases (37.2%) of urethral fistula, 6 cases (14.0%) of urethral stricture, and 2 cases (4.7%) of diverticulum. In the study group, only 1 patient (3.0%) developed both wound infection and urethral fistula. The incidence of wound infection, urethral fistula, and overall complications was significantly lower in the study group than in the control group (all P<0.01). Conclusion:Postoperative urethral stent irrigation in adolescents with hypospadias significantly reduces the incidence of wound infection and urethral fistula.

Objective To analyze the basic characteristics of 1885 inpatients with rare diseases in a 3A hospital from January 1 to December 31,2023,so as to provide reference for the management of diagnosis and treatment of rare diseases and the formulation of policies.Methods Based on the medical record homepage data of rare disease inpatients in a tertiary hospital in 2023,analyze the basic characteristics and hospitalization cost structure of rare disease inpatients.Results The hospital ad-mitted 1 885 inpatients with rare diseases in 2023,accounting for 0.81％of the total number of discharged patients,with a male-to-female ratio close to 1:1.Patients aged over 60 accounted for 45.57％,followed by patients aged 45-59(26.47％),patients aged 19-44(20.9％)ranked third,and patients under 18 accounted for less.Rare diseases cover 11 disease classification sys-tems and including 80 diseases,which accounts for 38.65％of the rare diseases in the catalogue.The top ten diseases accounted for 70.56％of the total number of patients,and the top three diseases were progressive fibrosing interstitial lung disease,idio-pathic pulmonary fibrosis and primary biliary cholangitis.Patients under 1 year old accounted for 0.08％,patients aged 2-18 years accounted for 5.19％,patients aged 19-44 years accounted for 19.55％,patients aged 45-59 years accounted for 26.62％,and patients over 60 years old accounted for 48.57％.There was a large difference in the male-female ratio in four diseases:idio-pathic pulmonary fibrosis,amyotrophic lateral sclerosis,Takayasu's arteritis,and primary biliary cholangitis.From the perspec-tive of cost structure,the top ten rare diseases account for a high proportion of diagnosis fees,medicine fees and consumables fees.Conclusion Patients account for a high proportion of rare disease inpatients in the hospital and have a wide coverage of disease types.The overall male-female ratio of patients with rare diseases is similar,but the characteristics of the diseases are dif-ferent.The characteristics of rare diseases determine the structural characteristics of hospitalization expenses.Hospitals should improve the discipline construction and provide more resources for the diagnosis and treatment of rare diseases.To make guide-lines for the diagnosis and treatment of rare diseases and strengthen the training of doctors,so as to realize the early diagnosis and treatment of rare diseases.The state should continue to promote access to medication for rare diseases.

Background Schizophrenic patients have metabolic disorders,impaired language and information processing function.Inflammatory factors may play an important role in the occurrence and development of schizophrenia.Objective To explore the relationship of the inflammatory factor levels with metabolic levels,language fluency and information processing function in patients with schizophrenia,so as to provide references for clinical understanding of the neuropathological mechanisms of schizophrenia.Methods A total of 96 patients with schizophrenia were included in the study group,who were hospitalized in the Fourth People's Hospital of Hefei from January 2021 to December 2022 as well as met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)and Mini-International Neuropsychiatric Interview(MINI)6.0.Meanwhile,population who underwent physical examination at the same hospital were included in the control group(n=42).A high-sensitivity multi factor electrochemiluminescence analyzer was used to detect the levels of inflammatory factors IL-4,IL-5,IL-7,IL-8,IL-10 and IL-13.A fully automated biochemical analyzer was used to detect the levels of metabolic indicators such as fasting blood glucose,triglycerides,high-density lipoprotein,apolipoprotein A,creatinine and urea nitrogen.Verbal fluency and information processing function of all participants were assessed by using Verbal Fluency Test(VFT)and Stroop Color Word Test(SCWT).Results There were statistically significant differences in the levels of IL-4,IL-5,IL-7,IL-8,IL-10,IL-13 and IL-15 between the study group and the control group(P<0.05).There were statistically significant differences in BMI,waist circumference,fasting blood glucose,triglycerides,high-density lipoprotein,urea nitrogen,apolipoprotein A and creatinine levels between the two groups(P<0.05).The differences in the correct number of household appliances,animals,fruits,vegetables,names starting with"water"and"self"in VFT between the two groups were statistically significant(P<0.05).The differences in point reaction time,character reaction time and character color reaction time in SCWT between the two groups were statistically significant(P<0.05).Correlation analysis showed that except for creatinine levels,the levels of IL-4 and IL-5 in patients with schizophrenia were correlated with other indicators(P<0.05).IL-7 levels were correlated with creatinine levels,household appliances,animals,fruits,correct number of names starting with"water"in VFT,point reaction time and word reaction time in SCWT(P<0.05).IL-8 levels were correlated with triglyceride levels,household appliances,animals,fruits,vegetables,correct number of names starting with"water"and"self"in VFT and word reaction time in SCWT(P<0.05).Except for creatinine levels and the correct number of names starting with"self",IL-10 levels were correlated with all other indicators(P<0.05).Except for creatinine and urea nitrogen levels,IL-13 levels were correlated with other indicators(P<0.05).Conclusion The levels of inflammatory factors in patients with schizophrenia may be related to their metabolic levels,language fluency and information processing function.

Objective To analyze the basic characteristics of 1885 inpatients with rare diseases in a 3A hospital from January 1 to December 31,2023,so as to provide reference for the management of diagnosis and treatment of rare diseases and the formulation of policies.Methods Based on the medical record homepage data of rare disease inpatients in a tertiary hospital in 2023,analyze the basic characteristics and hospitalization cost structure of rare disease inpatients.Results The hospital ad-mitted 1 885 inpatients with rare diseases in 2023,accounting for 0.81％of the total number of discharged patients,with a male-to-female ratio close to 1:1.Patients aged over 60 accounted for 45.57％,followed by patients aged 45-59(26.47％),patients aged 19-44(20.9％)ranked third,and patients under 18 accounted for less.Rare diseases cover 11 disease classification sys-tems and including 80 diseases,which accounts for 38.65％of the rare diseases in the catalogue.The top ten diseases accounted for 70.56％of the total number of patients,and the top three diseases were progressive fibrosing interstitial lung disease,idio-pathic pulmonary fibrosis and primary biliary cholangitis.Patients under 1 year old accounted for 0.08％,patients aged 2-18 years accounted for 5.19％,patients aged 19-44 years accounted for 19.55％,patients aged 45-59 years accounted for 26.62％,and patients over 60 years old accounted for 48.57％.There was a large difference in the male-female ratio in four diseases:idio-pathic pulmonary fibrosis,amyotrophic lateral sclerosis,Takayasu's arteritis,and primary biliary cholangitis.From the perspec-tive of cost structure,the top ten rare diseases account for a high proportion of diagnosis fees,medicine fees and consumables fees.Conclusion Patients account for a high proportion of rare disease inpatients in the hospital and have a wide coverage of disease types.The overall male-female ratio of patients with rare diseases is similar,but the characteristics of the diseases are dif-ferent.The characteristics of rare diseases determine the structural characteristics of hospitalization expenses.Hospitals should improve the discipline construction and provide more resources for the diagnosis and treatment of rare diseases.To make guide-lines for the diagnosis and treatment of rare diseases and strengthen the training of doctors,so as to realize the early diagnosis and treatment of rare diseases.The state should continue to promote access to medication for rare diseases.