Objective: To propose an improved method for constructing the internal quality control (IQC) framework for ELISA assays and validate its efficacy by statistically analyzing IQC data from nine blood center laboratories. Methods: 1) IQC data was collected from nine blood centers and analyzed using a domestic HBsAg ELISA detection kit as an example. 2) Differences between IQC values across batches within Blood Center 1 were assessed. 3) Statistical analyses were performed on batch usage, number of batches used, days of use, number of QC points, batch-specific means, and coefficients of variation (CV) across all nine centers. 4) Using the improved construction method for IQC framework, provisional and permanent frames were established for batches within Blood Center 1 and Blood Center 9, followed by outlier determination. Results: 1) Statistically significant differences were observed in IQC data between batches within Blood Center 1 (P<0.01). It is recommended that both the control material/reagents and the control chart framework be replaced simultaneously. 2) There were substantial differences among 9 blood centers regarding the control material/reagent lot numbers used, the number of QC runs per batch, and the QC values for identical lots. Therefore, individual laboratories should establish their own IQC chart frameworks. 3) The improved IQC framework construction method for ELISA assays is as follows: provisional frames are established via frame-shifting, using the pre-experimental mean and cumulative coefficient of variation (CV) from the preceding batch. For batches used >20 days with >20 QC points, permanent frames are constructed by aggregating in-control data accumulated over ≥20 days with ≥20 points to calculate cumulative mean and standard deviation. The provisional and permanent frames constructed by this method identified all 26 extreme outliers across Blood Centers 1 and 9 as out-of-control. Among the 218 general outliers, 10 were classified as normal by the provisional frames, while the remainder were designated as warnings or out-of-control. This method effectively monitors assay stability. Conclusion: Based on the statistical analysis of IQC practices across blood centers of varying scales, combined with the inherent characteristics of ELISA assays and the batch-to-batch instability of reagents/QC materials, it is recommended to reconstruct QC charts upon lot changes. The proposed method—utilizing frame-shifting for provisional frames and establishing permanent frames based on cumulative data—is applicable to blood center laboratories of differing sizes and effectively monitors the stability of the ELISA assay process.

Objective Objective To analyze the potential spatial factors affecting the genetic differentiation of Oncomelania hupensis robertsoni in Yunnan Province. Methods A total of 13 administrative villages were selected from schistosomiasis-endemic areas of Yunnan Province as O. hupensis snail sampling sites. At least 200 snails were collected in each site, and the spatial variable data of each site were recorded, including longitude, latitude and altitude. Thirty active and Schistosoma japonicum uninfected O. hupensis snails were selected from each sampling site by means of the crawling method and the cercarial shedding method. Genomic DNA was extracted from O. hupensis snails. Following PCR amplification, purification of PCR amplification products and sequencing, the gene sequences of O. hupensis snail samples were spliced and edited using the DNAstar software and the NCBI database to yield the complete mitochondrial sequences of O. hupensis snails at each sampling site, and the mitochondrial genetic distance matrix of O. hupensis robertsoni was calculated at each sampling site. The geographical coordinates of each sampling site were marked using the software ArcGIS 10.2, and the straight-line geographical distance between each sampling site was calculated. The altitude difference, longitude difference and latitude difference between each sampling site were calculated using the Excel software, and the correlation between the mitochondrial genetic distance matrix of O. hupensis robertsoni and each spatial variable matrix was examined by using the Mantel test at 13 sampling sites in Yunnan Province. Results Among the 13 O. hupensis snail sampling sites in Yunnan Province, the largest mitochondrial genetic distance of O. hupensis robertsoni snail populations was seen between Anding Village, Nanjian Yi Autonomous County and Caizhuang Village, Midu County (26.244 2), and the largest geographical distance was seen between Dongyuan Village, Gucheng District and Cangling Village, Chuxiong County (272.64 km). The highest altitude difference was seen between Anding Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1 086.10 m), and the largest longitude difference was found between Qiandian Village, Eryuan County and Cangling Village, Chuxiong County (1.86°), while the largest latitude difference was measured between Leqiu Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1.81°). In addition, the mitochondrial genetic distance of O. hupensis robertsoni snail populations was positively correlated with altitude at 13 snail sampling sites in Yunnan Province (r = 0.542 8, P < 0.001), and showed no significant correlations with geographical distance (r = 0.093 4, P > 0.05), longitude (r = −0.199 5, P > 0.05) or latitude (r = 0.205 7, P > 0.05). Conclusion Altitude may be a potential spatial factor affecting the genetic differentiation of O. hupensis robertsoni in Yunnan Province.

Hepatic alveolar echinococcosis is a highly invasive zoonotic parasitic disease with poor prognosis. Surgical intervention serves as the pivotal approach to achieve radical cure and improve the prognosis of hepatic alveolar echinococcosis patients. In recent years, with the popularization of the concept of precision surgery and the development of the multidisciplinary diagnosis and treatment model, the surgical treatment strategies for hepatic alveolar echinococcosis have been continuously enriched, and the selection of surgical procedures has become increasingly diversified. Although key surgical techniques such as radical hepatectomy, autologous liver transplantation and allogeneic liver transplantation have achieved remarkable progress in clinical application, many insurmountable challenges still remain. Therefore, by sorting out the latest evidence-based advances in the field of surgical treatment for hepatic alveolar echinococcosis, this article focuses on discussing the application status and bottlenecks of radical hepatectomy, autologous liver transplantation and allogeneic liver transplantation in hepatic alveolar echinococcosis, aiming to provide a reference for the clinical treatment of hepatic alveolar echinococcosis.

With the rapid development of large language models and related technologies, various forms of patient modeling have emerged, including virtual patients, synthetic patients, artificial intelligence patients, and digital twin patients. Although these forms all share the core objective of patient simulation, they exhibit significant differences in theoretical ontology, data sources, modeling logic, and application orientation. Based on the abstraction levels of simulation objects and system mapping logic, this study systematically compares five paradigms—standardized patients, virtual patients, synthetic patients, AI patients, and digital twin patients—to clarify their conceptual boundaries and technical positioning. The findings indicate that these paradigms represent distinct modeling pathways: behavioral reproduction, scenario simulation, data generation, cognitive interaction, and individual system mapping, respectively. By constructing a multidimensional comparative framework, this study provides a theoretical foundation for the conceptual standardization of patient modeling and the strategic deployment of intelligent healthcare systems.

Treatment resistance, recurrence, and metastasis of breast cancer remain critical issues affecting long-term patient survival. Chronic psychological stress may act as a host biological driver of breast cancer treatment resistance rather than a mere comorbidity. Through the sustained activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, also referred to as the "brain-tumor axis", stress signaling reshapes inflammatory, immune, and metabolic networks within the tumor microenvironment and thereby influences chemotherapy, endocrine therapy, anti-HER2 therapy, immunotherapy, and radiotherapy. Current evidence indicates that the key pathways with translational potential are mainly the β-adrenergic axis and the glucocorticoid receptor (GR) pathway. The former is more involved in amplifying inflammatory responses, promoting immunosuppression and metastasis, whereas the latter is closely associated with anti-apoptosis, maintenance of tumor stemness, and reprogramming of estrogen receptor function. This review focuses on the discrepancies in evidence regarding these pathways between population-based studies and preclinical models, and discusses clinically operable non-pharmacologic interventions such as cognitive behavioral stress management, nurse navigation and treatment adherence support, and exercise interventions during the neoadjuvant phase. Although high-level evidence for direct survival benefit remains limited, these interventions have shown favorable effects on cortisol levels, depressive symptoms, quality of life, adherence, relative dose intensity, and some biology-related intermediate endpoints, making them valuable complementary approaches in comprehensive breast cancer management.

Objective To investigate the distribution characteristics of Oncomelania hupensis snails in Yunnan Province fol-lowing interruption of schistosomiasis transmission, so as to provide the evidence for assessing the risk of schistosomiasis transmission and scientifically formulating the schistosomiasis surveillance program. Methods According to the requirements of the National Schistosomiasis Surveillance Scheme (2020 Edition), O. hupensis snail surveillance data were collected from 18 schistosomiasis-endemic counties (cities, districts) in Yunnan Province from 2020 to 2024, including area of snail survey, area of snail habitats, area of re-emerging snail habitats, number of frames surveyed, number of frames with O. hupensis snails, number of O. hupensis snails captured, and number of living snails, and the occurrence of frames with snails and mean density of living snails were calculated. Changes in snail status over the 5-year period from 2020 to 2024 and the differences in snail distributions specified by epidemic intensity, environmental type, and vegetation type were analyzed. Results The areas of snail survey increased from 1 727.96 hm² in 2020 to 3 894.45 hm² in 2024 (peak) across 18 schistosomiasis-endemic counties (cities, districts) in Yunnan Province during the period from 2020 through 2024. The areas of snail habitats increased from 70.36 hm² in 2020 to a peak in 2023 (172.04 hm²), followed by a reduction to 132.36 hm² in 2024, and the areas of re-emerging snail habitats increased from 42.71 hm² in 2020 to a peak in 2022 (78.43 hm²), followed by a reduction to 40.21 hm² in 2024. The occurrence of frames with snails and mean density of living snails increased from 1.24% (3 025/244 404) and (0.033 2 ± 0.038 7) snails/0.1 m² in 2020 to peaks at 2.03% (6 231/307 563) and (0.066 9 ± 0.068 4) snails/0.1 m² in 2023, followed by reductions to 1.04% (5 829/559 941) and (0.032 6 ± 0.057 7) snails/0.1 m² in 2024, respectively. There was a significant difference in the occurrence of frames with snails over the 5-year study period (χ² = 1 962.95, P < 0.05), and the occurrence of frames with snails reduced by 48.71% in 2024 relative to in 2023 (χ² = 1 411.05, P < 0.005); however, there was no significant difference in the mean density of living snails over the 5 years (H = 5.310, P > 0.05). There were significant differences in the occurrence of frames with snails (χ² = 481.27, P < 0.05) and mean density of living snails (H = 6.872, P < 0.05) in schistosomiasis-endemic areas with different epidemic intensities. The occurrence of frames with snails (χ² = 25.32 and 38.70, both P values < 0.017) and mean density of living snails (Z = 28.55 and 49.96, both P values < 0.017) were higher in schistosomiasis transmission-interrupted and eliminated areas with snails than in schistosomiasis-eliminated areas without snails, and the occurrence of frames with snails (χ² = 453.54, P < 0.017) and mean density of living snails (Z = −56.97, P < 0.017) were higher in schistosomiasis-eliminated areas with snails than in schistosomiasis transmission-interrupted areas with snails. O. hupensis snails were mainly distributed in paddy fields, dry farmlands and ditches; however, the occurrence of frames with snails (13.40%, 424/3 164) and mean density of living snails [(0.252 8 ± 0.158 7) snails/0.1 m²] were higher in ponds/weirs than in other types of environments (both P values < 0.05). Rice, dry farmland crops and weeds were main vegetations in which O. hupensis snails were distributed, and the occurrence of frames with snails (2.29%, 7 111/310 140) and mean density of living snails [(0.072 3 ± 0.018 9) snails/0.1 m²] were higher in weeds than in other types of environments (both P values < 0.05). Conclusions O. hupensis snails have been effectively controlled in Yunnan Province following implementation of integrated schistosomiasis control measures; however, there are still risk factors for schistosomiasis transmission, including reduced attention to schistosomiasis control and snail re-emergence. Improved control efforts and surveillance system construction and timely identification of risk factors of snail status and timely management are recommended to ensure the achievement of the target of schistosomiasis elimination as scheduled.

ObjectiveTo investigate the independent risk factors for concurrent myocardial injury before intervention in patients with primary hepatic carcinoma （PHC）， to construct and validate a nomogram prediction model for the early identification of such patients， and to provide a basis for early clinical prevention and management. MethodsA retrospective analysis was performed for the clinical data of 1 822 patients with PHC in two medical institutions from January 2019 to June 2025， among whom the 1 518 patients from The Third People’s Hospital of Kunming were used as the training set to construct the nomogram prediction model， and the 304 patients from The Second People’s Hospital of Baoshan were used as the validation set. According to the result of high-sensitivity cardiac troponin T measurement before intervention， the patients with PHC were divided into myocardial injury group and non-myocardial injury group. The univariate analysis， the LASSO regression analysis， and the multivariate Logistic regression analysis were used to identify the risk factors of concurrent myocardial injury in PHC patients before intervention， and then a nomogram prediction model was constructed based on these findings. The independent data of the 304 patients in the validation set were used for external validation， and the area under the receiver operating characteristic curve （AUC）， the Hosmer-Lemeshow test， the calibration curve， decision curve analysis， and clinical impact curve were used to assess model performance. ResultsIn the training set， there were 346 patients in the myocardial injury group and 1 172 patients in the non-myocardial injury group， and the prevalence rate of concurrent myocardial injury was 22.79%. The mean age was 56.44±9.45 years， and the male patients accounted for 81.49%. The patients with drinking， smoking， chronic hepatitis B， chronic hepatitis C， hypertension， diabetes， Child-Pugh class A liver disease， BCLC stage B liver disease， or abnormal electrocardiographic findings accounted for 49.34%， 57.44%， 61.73%， 32.48%， 22.66%， 17.19%， 50.53%， 33.86%， and 62.12%， respectively. The univariate analysis， the LASSO regression analysis， and the multivariate Logistic regression analysis showed that age （odds ratio ［OR］=1.051， 95% confidence interval ［CI］： 1.036 — 1.067， P<0.001）， history of diabetes （OR=1.862， 95%CI： 1.346 — 2.574， P<0.001）， electrocardiographic findings （OR=1.446， 95%CI： 1.077 — 1.940， P=0.014）， hemoglobin （HGB） （OR=0.993， 95%CI： 0.988 — 0.998， P=0.003）， albumin （Alb） （OR=0.951， 95%CI： 0.930 — 0.972， P<0.001）， and creatinine （Cr） （OR=1.021， 95%CI： 1.016 — 1.026， P<0.001） were independent influencing factors for myocardial injury in PHC patients. A regression equation was established as Logit（Y）=-3.406+0.050×age+0.621×history of diabetes+0.369×electrocardiogram－0.007×HGB－0.051×Alb+0.021×Cr， and a nomogram prediction model was constructed based on these factors. The Bootstrap internal validation of the model yielded an AUC of 0.743 （95%CI： 0.707 — 0.778）， and the model had an AUC of 0.766 （95%CI： 0.738 — 0.794） in the training set and 0.730 （95%CI： 0.688 — 0.793） in the validation set. The Hosmer-Lemeshow goodness-of-fit test yielded a P value of 0.716 for the training set and 0.408 for the validation set， suggesting that the model had a good degree of fitting. Calibration curves， decision curve analysis， and clinical impact curves in both the training set and the validation set showed that the model had a good clinical application value. ConclusionAge， history of diabetes， electrocardiographic findings， HGB， Alb， and Cr are independent influencing factors for myocardial injury in patients with PHC， and the nomogram prediction model constructed based on these factors has good discriminatory ability， accuracy， and clinical practicability.

Objective: : Baculovirus inhibitory of apoptosis repeat-containing 5 (BIRC5) is critically implicated in various types of tumors. However, the specific mechanisms by which it operates in glioma are yet to be fully understood. Methods: : The data sourced from The Cancer Genome Atlas and Gene Expression Omnibus were merged and analyzed using the R software to investigate the relationship between BIRC5 expression and prognosis and diagnosis outcomes. This exploration was conducted utilizing various biological information repositories. The correlation between BIRC5 and immunity was obtained based on TIMER and TISIDB databases. Results: : Gliomas displayed a markedly elevated level of BIRC5 expression compared to adjacent tissues. Patients with glioma who exhibit elevated levels of BIRC5 experience poorer prognoses and shorter survival times. Subgroup classification further revealed that heightened expression of BIRC5 led to diminished overall survival. Analysis of logistic regression and COX indicated that expression of BIRC5 serves as a risk factor in glioma development. Functional enrichment pathways showed that the 72 hub genes related to BIRC5 were mainly closely related to nuclear division, spindle, tubulin binding, and cell cycle in glioma patients. BBIRC5 methylation suggested that BIRC5 might influence the immune response regulation and the tumor microenvironment within gliomas. BIRC5 is associated with many chemicals. Additionally, studies conducted using cell experiments and pathological sections have consistently shown that BIRC5 expression is higher in tumor cells compared to normal cells and tissues. Conclusion : BIRC5 holds promise as a valuable tool in the diagnosis, prognosis, and management of gliomas.

Objective To construct a multivariable prediction model for assessing the risk of cardiopulmonary complication after thoracoscopic lobectomy in patients with stage Ⅰ-Ⅱ non-small cell lung cancer(NSCLC).Methods Clinical data of 600 patients with stage Ⅰ-Ⅱ NSCLC who underwent thoracoscopic lobectomy were retrospectively analyzed.Patients were divided into the complication group(84 cases)and the non-complication group(516 cases)based on the occurrence of postoperative complication within 7 days,including atelectasis,pulmonary embolism,respiratory failure,chylothorax,massive pleural effusion,hypoxemia and atrial fibrillation.Demographic characteristics,preoperative pulmonary function assessment,pathological features and perioperative indicators were collected.Multivariate Logistic regression analysis was used to identify independent risk factors influencing postoperative cardiopulmonary complication in patients and construct a predictive model.Internal validation was performed using the Bootstrap resampling method(1 000 iterations)to evaluate the discrimination,calibration and clinical decision-making value of the model.Results Multivariate Logistic regression analysis identified the following independent risk factors of postoperative cardiopulmonary complication,including age(OR=1.832,95%CI:1.537-2.183),history of chronic obstructive pulmonary disease(COPD)(OR=6.782,95%CI:2.685-17.130),Karnofsky performance status(KPS)score(OR=0.926,95%CI:0.888-0.965),the percentage of forced expiratory volume in the first second to the predictive value(FEV1%pred)(OR=0.906,95%CI:0.845-0.972),the percentage of diffusing capacity for carbon monoxide to the expected value(DLCO%pred)(OR=0.901,95%CI:0.832-0.975),intraoperative blood loss(OR=1.025,95%CI:1.014-1.036)and one-lung ventilation time(OR=1.057,95%CI:1.034-1.080).The area under the curve(AUC)of the combined diagnosis was 0.977(95%CI:0.965-0.989),with 96.4%sensitivity and 87.6%specificity.The Hosmer-Lemeshow test indicated excellent calibration(χ2=1.285,P=0.994).Decision curve analysis demonstrated significant clinical net benefit when the risk threshold probability ranged between 20%and 98%.Conclusion The multivariable prediction model for cardiopulmonary complication after thoracoscopic lobectomy in stage Ⅰ-Ⅱ NSCLC patients exhibits strong predictive performance.

AIM: To delineate the specific mutation responsible for retinitis pigmentosa(RP)in a Yi pedigree, and to analyze the correlation of RHO gene mutation with clinical phenotype.METHODS:A comprehensive clinical evaluation was conducted on the proband diagnosed with RP and other familial members, complemented by a thorough ophthalmic examination. Peripheral blood samples were obtained from the proband and familial members, from which genomic DNA was extracte. Subsequent whole exome sequencing(WES)was employed to identify the variant genes in the proband. The identified variant gene was validated through Sanger sequencing, then an in-depth analysis of the mutation genes was carried out using genetic databases to ascertain the pathogenic mutation sites. Furthermore, an exhaustive analysis was performed to delineate the genotype and phenotype characteristics.RESULTS:The RP pedigree encompasses 5 generations with 42 members, including 19 males and 23 females. A total of 13 cases of RP were identified, consisting of 4 males and 9 females, which conforms to the autosomal dominant inheritance pattern. The clinical features of this family include an early onset age, rapid progression, and a more severe condition. The patients were found to have night blindness around 6 years old, representing the earliest reported case of night blindness in RP families. The retina was manifested by progressive osteocytoid pigmentation of the fundus, a reduced visual field, and significantly decreased or even vanished a and b amplitudes of ERG. The combined results of WES and Sanger sequencing indicated that the proband had a heterozygous missense mutation of the RHO gene c.1040C>T:p.P347L, where the 1 040 base C of cDNA was replaced by T, causing codon 347 to encode leucine instead of proline. Interestingly, this mutation has not been reported in the Chinese population.CONCLUSION:This study confirmed that the mutant gene of RP in a Yi nationality pedigree was RHO(c.1040C>T). This variant leads to the change of codon 347 from encoding proline to encoding leucine, resulting in a severe clinical phenotype among family members. This study provides a certain molecular, clinical, and genetic basis for genetic counseling and gene diagnosis of RHO.