Background In 2021, chronic obstructive pulmonary disease (COPD) emerged as the forth leading cause of death in the world. However, the impact of air pollutants on COPD is still inconsistent across current studies. Objective To analyze the relationship between ambient sulfur dioxide (SO₂) exposure and hospital admissions for COPD in Lanzhou, and to examine the modified effects of SO₂ across different genders, age groups, and seasons. Methods A total of 20718 hospital admission records for COPD were collected from Lanzhou between 2016 and 2020, alongside synchronized data on SO₂ concentration and meteorological variables. A generalized additive model integrated with a distributed lag nonlinear model was used to assess the relationship and the lag effects between SO₂ exposure and COPD admissions. Potential confounders, including meteorological factors, day-of-the-week effect, and holidays, were controlled for, with a maximum lag period set at 7 d. Two-pollutant models and sensitivity analyses were conducted to ensure robustness. Results are expressed as relative risks (RR) with 95% confidence intervals (95%CI). Results During the study period, the average daily number of COPD admissions was 11.34±7.03. The average mass concentration of SO₂ was (23.72±12.35) μg·m⁻³. SO₂ exposure was positively correlated with COPD admissions; specifically, each 10 μg·m⁻³ increase in SO₂ concentration was associated with an RR of 1.440 (95%CI: 1.317, 1.573). Stratified analyses found that at a cumulative lag of 7 d, the RRs were higher among females, individuals aged ≥65 years, and during the cold season. Conversely, no significant increase in COPD admission risk related to SO₂ was observed during the warm season. For every 10 μg·m⁻³ increase in SO₂ concentration, the RR was 1.483 (95%CI: 1.311, 1.678) for females, 1.441 (95%CI: 1.311, 1.583) for those aged > 65 years， and 1.595 (95%CI: 1.313, 1.937) during the cold season. Conclusion Short-term exposure to ambient SO₂ exposure in Lanzhou is associated with an increased risk of COPD admission. The association is more pronounced among females, the elderly (aged> 65 years) and during the cold season.

Objective To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy(SMP)and standard percutaneous nephrolithotomy(sPCNL)in the treatment of 2-4 cm renal calculi, so as to provide reference for the management of medium-sized renal calculi. Methods A retrospective analysis was conducted on 168 patients with 2-4 cm renal calculi who underwent either SMP or sPCNL at our hospital during Sep. 2020 and Mar. 2025. The patients were divided into the SMP group(n=85)and sPCNL group(n=83). The baseline characteristics, stone features, operation time, perioperative complications, transfusion rate, postoperative hemoglobin drop, pain score, hospital stay, and stone-free rate(SFR)were compared between the two groups. Results There were no significant differences in baseline characteristics, stone features, and SFR between the two groups(P＞0.05). Compared to the sPCNL group, the SMP group had a longer operation time [(71.76±22.49)vs.(64.22±15.01)min, P=0.034]. However, it had lower postoperative pain score [(2.51 ±0.85)vs.(4.11±0.47), P＜0.001], shorter hospital stay [(3.16±1.45)vs.(4.30±1.06)days, P＜0.001], lower hospitalization costs [(19982.67±4267.80)vs.(21688.53±4575.74)RMB, P=0.004], a slighter decrease in hemoglobin [(6.64±10.56)vs.(12.22±11.50)g/L, P=0.032], and a significantly higher tubeless rate(83.53% vs. 0%, P＜0.001). There was no statistically significant difference in the overall complication rate between the two groups(P＞0.05). Conclusion For 2—4 cm renal calculi, SMP achieves a comparable SFR as sPCNL. Although the operation time with SMP is slightly longer, it offers significant advantages, including reduced postoperative pain, shorter hospitalization, lower costs, less bleeding, and a higher tubeless rate. SMP is a valuable technique worthy of broader clinical application.

OBJECTIVE This study aims to investigate the epidemiological characteristics and influencing factors of skin diseases among soldiers performing duties and working in tunnel environments,and to propose targeted pre-ventive and therapeutic measures.METHODS A cross-sectional survey was conducted on 537 soldiers from multi-ple sites within a military unit from Nov.2022 to Oct.2023.The survey collected data on general information,liv-ing habits,and details of current skin diseases,including types,symptoms,duration and treatment status.Logis-tic regression analysis was applied to identify risk factors for the skin diseases observed.RESULTS A total of 21 types of skin diseases were identified,with dermatophyte infections being the most prevalent(59.96％,322/537),followed by acne(26.82％,144/537).Further analysis revealed that the incidence of dermatophyte infec-tions was closely associated with the region where the soldiers were stationed[OR(95％CI)=1.694(1.062,2.693),P=0.032]and the frequency of sock washing[OR(95％CI)=1.734(1.023,2.988),P=0.043],but no significant correlation was found between the prevalence of dermatophyte infections and the frequency of washing feet[OR(95％CI)=1.520(0.836,2.824),P=0.175].CONCLUSIONS This study highlights the epidemiological char-acteristics and key risk factors for skin diseases among soldiers in tunnel environments.Targeted prevention strategies are proposed,providing valuable scientific evidence for the prevention and control of skin diseases in similar environments.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Objective:To systematically evaluate the predictive value of the reverse shock index multiplied by the Glasgow coma scale score (rSIG) for mortality of trauma patients.Methods:A comprehensive literature search was conducted to identify studies on the predictive value of rSIG for mortality of trauma patients in the following databases from inception to April 2025, including CNKI, Wanfang Data, SinoMed, PubMed, Cochrane Library, Web of Science, and Embase. Two investigators independently screened the literature, extracted data, and assessed study quality according to predefined inclusion and exclusion criteria. The Quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool was used to evaluate the risk of bias in the included studies. Meta analysis was performed using Stata 17.0 software with a bivariate mixed-effects model. The following metrics were used to assess the predictive value of rSIG for mortality in trauma patients, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC). The influence of various factors on the predictive performance of rSIG was examined, including injury type, study design, region, sample size, cut-off value, rSIG measurement time, and outcome measures. Additionally, sensitivity analysis, Fagan′s nomogram, and Deeks′ funnel plot were employed to assess the robustness of the findings, clinical applicability, and publication bias.Results:A total of 15 studies involving 710 612 trauma patients were included, 26 105 of whom were deceased. Meta analysis results showed that rSIG had a pooled sensitivity of 0.78(95% CI 0.71, 0.84), a pooled specificity of 0.78(95% CI 0.68, 0.86), a pooled PLR of 3.60(95% CI 2.46, 5.27), a pooled NLR of 0.28(95% CI 0.22, 0.36), a pooled DOR of 12.70(95% CI 8.10, 19.91), and an AUC of 0.85(95% CI 0.81, 0.87) for predicting mortality of trauma patients. Subgroup analysis identified injury type as one of the major sources of heterogeneity, and the predictive specificity of rSIG was significantly higher in patients with multiple trauma (0.82) than in those with isolated traumatic brain injury (0.65) ( P<0.05). Sensitivity analysis indicated that the findings were robust and stable. Fagan′s nomogram showed that when the pre-test probability was 7%, the post-test probability of death increased to 21% in patients with low rSIG and decreased to 2% in those with high rSIG. Deeks′ funnel plots suggested no significant publication bias among the included studies ( P>0.05). Conclusion:Low rSIG has good predictive performance for mortality of trauma patients and can serve as an effective tool for early and rapid prognosis assessment with superior predictive performance in patients with multiple trauma compared to those with traumatic brain injury.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To explore the value of 18F-FDG PET brain imaging in the auxiliary diagnosis of autoimmune encephalitis (AE) before treatment, and to analyze the regional and course-related characteristics of brain metabolic changes. Methods:The 18F-FDG PET brain imaging data of 49 AE patients (26 males, 23 females, age 48.0(29.0, 61.0) years) who did not receive first-line immunotherapy were retrospectively analyzed. Patients were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine, between July 2015 and December 2023. Forty-nine age- and gender-matched healthy subjects who underwent routine physical examination at the same time period were selected as the healthy controls (HC). The statistical parametric mapping (SPM) 8 two-sample t test ( P<0.001, k=50) was used to compare the imaging results of AE patients with those of HC. The screening results were adjusted by the cluster-level family-wise error rate (FWER) for P<0.05. Metabolic abnormalities associated with AE were identified, and differences in metabolic patterns at different stages of the disease course (short: ≤1 month; medium: >1 month and ≤3 month; long: >3 month) were compared by subgroup analysis. Mann-Whitney U test was used to analyze the data. Results:In the included AE patients, regions with elevated metabolism were mainly located in the limbic lobe, insula, putamen, and amygdala ( t values: 3.18-5.07, Z values: 3.17-4.76), while local metabolic reduction was observed in the frontal, parietal, and occipital lobes ( t values: 3.18-5.43, Z values: 3.23-5.06), with most of these regions passing FWER correction. In patients with anti- N-methyl- D-aspartate receptor (NMDAR) encephalitis, local metabolism increased in the right superior temporal gyrus ( t values: 3.55-4.79, Z values: 3.67-3.86) and decreased in the left middle temporal gyrus and inferior frontal gyrus ( t values: 3.55-5.43, Z values: 3.45-4.21), but the results did not pass the FWER correction. Subgroup analysis showed that in patients with short disease course ( n=17), regions with locally elevated metabolism included the brainstem, limbic lobe, and cerebellum ( t values: 3.37-5.27, Z values: 3.52-4.44), while regions with reduced metabolism were mainly located in the frontal, parietal, and occipital lobes ( t values: 3.37-6.77, Z values: 3.34-5.30), and these abnormal results all passed FWER correction. In patients with medium ( n=7) to long ( n=25) disease course, the regions with metabolic abnormalities were significantly reduced and did not pass FWER correction. Conclusions:18F-FDG PET can accurately identify brain metabolic abnormalities in AE patients, demonstrating significant regional and course-related characteristics. Metabolic abnormalities are more pronounced in patients with short disease course, while they are relatively less obvious in patients with medium to long disease course.

Objective:To explore the impact of phosphatase and tensin homologue deleted on chromosome 10 (PTEN)/tumor protein 53 (TP53) expression on the 68Ga-prostate specific membrane antigen (PSMA)-11 and 18F-FDG molecular imaging phenotypes in primary prostate cancer. Methods:A retrospective study was conducted on 75 prostate cancer patients (age (67.9±6.3) years) who received both 68Ga-PSMA-11 and 18F-FDG PET/CT imaging on initial diagnosis and subsequent radical prostatectomy at Renji Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, between Auguest 2018 and July 2022. The correlation between PTEN and TP53 expression in prostate cancer and molecular imaging phenotype was analyzed by χ2 test, Kruskal-Wallis rank sum test and Bonferroni method based on the uptake of imaging agents in primary lesions and the results of immunohistochemical analysis of surgical specimens. Results:In prostate cancer tissues with PTEN expression loss, the positive rates of 18F-FDG uptake and 68Ga-PSMA uptake were 14/14 and 11/14, with the SUV max of 7.70(6.15, 11.05) and 15.55(6.75, 23.49) respectively. In prostate cancer tissues with TP53 expression loss, the positive rates of 18F-FDG uptake and 68Ga-PSMA uptake were 10/10 and 6/10, with the SUV max of 7.70(6.95, 8.05) and 9.50(5.38, 19.89) respectively. In prostate cancer tissues with different expression patterns of PTEN and TP53, there were significant differences in the positive rates of 18F-FDG uptake ( χ2=20.45, P< 0.001), 68Ga-PSMA-11 uptake ( χ2=14.97, P=0.002), and the SUV max of 68Ga-PSMA-11 uptake ( H=9.62, P=0.022). Additionally, patients with concurrent loss of PTEN and TP53 expression in the primary tumor had significantly lower SUV max of 68Ga-PSMA-11 uptake compared to those with expression of both PTEN and TP53 (5.70(4.40, 11.70) vs 20.95(13.73, 37.58); P=0.003 (Bonferroni method corrected)). Conclusion:PTEN/TP53 expression is associated with the 68Ga-PSMA-11 and 18F-FDG molecular imaging phenotype in primary prostate cancer.

Objective:To compare the diagnostic efficacy of 18F-fibroblast activation protein inhibitor (FAPI) PET/MR and contrast-enhanced CT in detecting metachronous ovarian metastasis after gastric signet-ring cell carcinoma (GSRCC) surgery, and to evaluate its impact on clinical decision-making. Methods:This study employed a diagnostic test design. A retrospective analysis was conducted on 26 female patients with suspected metachronous ovarian metastasis following GSRCC resection between January 2023 and June 2025 in Renji Hospital, Shanghai Jiao Tong University School of Medicine. All patients underwent both 18F-FAPI PET/MR and contrast-enhanced CT within 2 weeks. Using histopathology or clinical imaging follow-up (≥6 months) as the reference standard, the diagnostic performance of both modalities was compared (McNemar test, Fisher exact test and Delong test), and changes in clinical management were analyzed. Results:Metachronous ovarian metastasis was confirmed in 12 patients (22 lesions). 18F-FAPI PET/MR showed significantly higher sensitivity (90.9%(20/22) vs 72.7%(16/22); χ2=4.10, P=0.043), specificity (100%(30/30) vs 50.0%(15/30); χ2=13.01, P<0.001), and accuracy (96.2%(50/52) vs 59.6%(31/52); χ2=15.43, P<0.001), compared to contrast-enhanced CT, with a significantly higher AUC (0.964 vs 0.815; Z=2.85, P=0.015). It also demonstrated superior detection of extraovarian metastases, including anastomotic recurrence, peritoneal spread, and lymph node involvement ( P values: 0.004-0.031), and identified 5 additional rare-site metastases in 3 patients that were missed by contrast-enhanced CT. Based on 18F-FAPI PET/MR findings, clinical management was adjusted in 6 patients with metastasis. Conclusion:18F-FAPI PET/MR outperforms contrast-enhanced CT in diagnosing metachronous ovarian metastasis and performing whole-body restaging in post-surgical GSRCC patients, therapy provides critical evidence for informing decision-making.

Objective:To construct a model of mitochondria-related genes (Mito-RGs) in hepatocellular carcinoma (HCC), and predict the immune, prognostic and therapeutic characteristics of HCC based on the model, so as to provide a new idea for the diagnosis and treatment of HCC.Methods:The expression profiles of HCC and corresponding clinical information were obtained from the Cancer Genome Atlas (TCGA) database. Univariate Cox regression, Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate Cox regression were used to construct a prognostic model of HCC based on Mito-RGs, and the International Cancer Genome Consortium-Liver Cancer-RIKEN-Japan ICGC-LIRI-JP dataset were used for validation. GO and KEGG analyses were performed to investigate the signaling pathways enriched for differentially expressed genes in the high- and low-risk groups. Immune infiltration was assessed using CIBERSORT. Single-cell data were used to study the proportion of immune cells in high- and low-risk groups of HCC samples and the relationship with cell proliferation. Cellminer was used to assess the relationship between risk score models and drug sensitivity.Results:A risk-prognostic model of HCC containing seven Mito-RGs ( DTYMK, ACADS, HMGCS2, CYP27A1, TOMM40L, STOM, and AKR1B10) was constructed. High-risk HCC patients had a worse prognosis. Genes upregulated in the high- and low-risk groups of differentially expressed genes were enriched in cell cycle and metabolism-related pathways. Single-cell data showed higher proportions of CD8 + T cells, macrophages and monocytes, and proliferating cells in the high-risk group. CIBERSORT analysis suggested that Treg cells and M0 macrophages were more abundant in the high-risk group, whereas CD8 + T cells and CD4 + memory T cells were less abundant. Patients in the high-risk group were more sensitive to myeloid cell leukemia sequence 1 inhibitor, vincristine, phosphatidylinositol kinase beta subunit inhibitor, and aurora kinase A, while trametinib, selumetinib, extracellular regulated protein kinase, and mitogen-activated extracellular signal-regulated kinase were more effective in the low-risk group. Conclusion:The constructed Mito-RGs model is capable of providing a more accurate assessment of the prognosis and the degree of immune cell infiltration in HCC patients.