ObjectiveTo evaluate the impact of yang-reinforcing and blood-activating therapy on the long-term prognosis for patients with dilated cardiomyopathy （DCM） of yang deficiency and blood stasis syndrome. MethodsA retrospective cohort study was conducted involving 371 DCM patients with yang deficiency and blood stasis syndrome. The yang-reinforcing and blood-activating therapy was defined as the exposure factor. Patients were categorized into exposure group （186 cases） and non-exposure group （185 cases） according to whether they received yang-reinforcing and blood-activating therapy combined with conventional western medicine for 6 months or longer. The follow-up period was set at 48 months， and the Kaplan-Meier survival analysis was used to assess the cumulative incidence of major adverse cardiovascular events （MACE） in both groups. Cox regression analysis was used to explore the impact of yang-reinforcing and blood-activating therapy on the risk of MACE， and subgroup analysis was performed. Changes in traditional Chinese medicine （TCM） syndrome score， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end-diastolic diameter （LVEDD）， and Minnesota Living with Heart Failure Questionnaire （MLHFQ） score were compared between groups at the time of first combined use of yang-reinforcing and blood-activating therapy （before treatment） and 1 year after receiving the therapy （after treatment）. ResultsMACE occurred in 31 cases （16.67%） in the exposure group and 47 cases （25.41%） in the non-exposure group. The cumulative incidence of MACE in the exposure group was significantly lower than that in the non-exposure group ［HR=0.559， 95%CI（0.361，0.895）， P=0.014］. Cox regression analysis showed that yang-reinforcing and blood-activating therapy was an independent factor for reducing the risk of MACE in DCM patients ［HR=0.623， 95%CI（0.396，0.980）， P=0.041］， and consistent results were observed in different subgroups. Compared with pre-treatment， the exposure group showed decreased TCM syndrome score and MLHFQ score， reduced LVEDD， and increased LVEF and LVFS after treatment （P＜0.05）； in the non-exposure group， TCM syndrome score decreased， LVEF and LVFS increased， and LVEDD reduced after treatment （P＜0.05）. After treatment， the exposure group had higher LVEF and LVFS， smaller LVEDD， and lower TCM syndrome score and MLHFQ score compared with the non-exposure group （P＜0.05）. ConclusionCombining yang-reinforcing and blood-activating therapy with conventional western medicine can reduce the risk of MACE in DCM patients with yang deficiency and blood stasis syndrome， meanwhile improving their clinical symptoms， cardiac function， and quality of life.

Decision making of artificial nutrition and hydration (ANH) for hospice care patients has been recognized as a complex and controversial issue that significantly impacted end-stage comfort and quality of life. This article reviewed the significance, status and influencing factors of decision making of ANH for hospice care patients. By analyzing the shortcomings of existing researches and clinical practices, it put forward the prospects for future research, so as to improve the decision-making dilemmas faced by hospice care patients.

Objective To investigate the current symptom status of maintenance hemodialysis(MHD)patients,analyze the influencing factors from the perspective of multidimensional symptom burden,extract symptom groups,and construct a symptom network.Methods A total of 490 patients who received MHD at the blood purification center of a tertiary hospital in Shanghai from March to April 2025 were selected using a convenience sampling method.30 symptoms of MHD patients were investigated using a modified dialysis symptom index table.SPSS and R software were utilized to analyze the influencing factors,extract symptom groups,and construct a multidimensional symptom network.Results A total of 488 valid questionnaires were collected,with a valid questionnaire recovery rate of 99.59％.The median number of symptoms experienced by patients was 6(interquartile range:4,8),with the top 5 symptoms being dry skin(69.88％),fatigue or tiredness(56.97％),itching(56.97％),worry(50.20％),and dry mouth(46.31％).Multidimensional analysis indicated that age,duration of dialysis,education level,and complications were influencing factors of symptom burden scores across different dimensions.6 stable symptom groups were extracted,namely skin discomfort,fatigue and pain,gastrointestinal tract,sleep disorders,water-electrolyte imbalance,and uremia.The results of the symptom network analysis revealed that difficulty of falling asleep had the highest intensity centrality(rs=2.18,2.25,2.12).Conclusion The symptom association is relatively stable,and difficulty of falling asleep is the core symptom.This finding can assist clinical medical staff in achieving efficiency and precision in symptom group management.

Objective:To verify the efficacy of VELscope autofluorescence examination technology in the early warning of potential oral malignant diseases.Methods:80 patients with suspected dysplasia were included and underwent oral examination,visually en-hanced lesion scope(VELscope)autofluorescence examination and histopathology examination respectively,the fluorescence imaging results were compared with the histopathological results.Results:Pathological reports showed 64 cases with mild or no dysplasia,9 cases with moderate or severe dysplasia,1 case with moderate dysplasia without malignant transformation and 6 cases with cancer.The results of VELscope showed that there were 73 positive cases and negative 7 cases of fluorescence deletion.The sensitivity and specificity of VELscope were 93.75％and 9.37％respectively,and the sensitivity could reach 100％in the cancerous tissue.Con-clusion:As a non-invasive examination method,VELscope is highly sensitive but lowly specific.

IL-32 is a multifunctional cytokine with both pro-inflammatory and anti-inflammatory properties.It has been proved that expression of IL-32 increases with progression of gastric mucosal diseases and severity of gastric cancer(GC),thus participating in process of gastric"inflammation-cancer"transformation.However,how IL-32 affects malignant transformation of gastric"inflamma-tion-cancer"and finally leads to adverse outcome of GC invasion and migration is still controversial.In order to better clarify regulatory effect and possible mechanism of abnormal expression of IL-32 on different histopathological stages of gastric"inflammation-cancer"transformation,and to explore new directions and breakthroughs in molecular mechanism of early truncation and treatment of gastric precancerous lesion(GPL),we searched literatures related to IL-32 in six authoritative databases at home and abroad,such as Pubmed,Web of Science and CNKI,in past 30 years.It was found that pathogenicity or protective function of IL-32 in different histo-pathological stages of gastric"inflammation-cancer"transformation depended on its different subtypes,secretory forms,surrounding cytokine environment,disease status and genetic factors.IL-32 may regulate polarization of macrophages through NF-κB,MAPK,COX2,PR3,IDO,NOD,PKCδ,FAK and STAT3,amplify or inhibit chronic inflammatory stimulation of gastric mucosa,and thus participate in process of gastric"inflammation-cancer"transformation.Our new understanding of role of IL-32 in different stages of Cor-rea cascade may contribute to development of cytokine-directed therapy,and therapy aimed at regulating different alternative splicing subtypes of IL-32 and targeting IL-32 signals can be used as a new strategy for medical treatment of GPL and GC in future.

To summarize the clinical practice of continuous medical service for patients at Shanghai Children′s Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine, from September 2023 to December 2024, following the approval of its extended care qualification. This study utilized a mixed-methods research design that integrates quantitative and qualitative approaches. The quantitative study included a total of 117 subjects, with an age range of 18 to 35 years, an average age of 21.56 years, and a median age of 19 years; there were 59 males and 58 females. The disease types covered four major categories: childhood leukemia and solid tumors (68 cases), congenital structural malformations (25 cases), congenital hereditary metabolic diseases (4 cases), and rare diseases (20 cases). Among the subjects, 57.26% (67 cases) were first-time visitors to SCMC. The patients came from 20 provinces, autonomous regions, and municipalities across the country, with 88.03% (103 cases) from outside Shanghai. The treatment outcomes showed improvement or cure in 80.34% (94 cases) of the subjects, and there were no medical complaints. In addition, a qualitative study was conducted to deeply explore the experiences, confusions, and challenges of receiving or implementing continuous medical services from the perspectives of patients and their families, as well as medical staff. According to the inclusion and exclusion criteria, a total of 44 subjects were included in the study, among them, there were 12 patients, 12 family members who were taking care of the patients in SCMC, and 20 corresponding medical staff members. The results of the qualitative study showed that trust in the attending physicians of the children′s specialty hospital, a good doctor-patient relationship, satisfactory treatment outcomes, and support from medical insurance policies are the main driving forces for patients over 18 years old to receive continuous treatment at children′s specialty hospitals. The medical staff of the hospital also believed that this model can promote patient benefits. In conclusion, under the policy support of the Shanghai Municipal Health Commission, the "Six Fixed" Model for continuous treatment established by SCMC has achieved certain positive results in practice. This provides practical references for the development of continuous treatment in China and offers new strategies for the application of preventive medicine in the field of children′s health.

To investigate the effects ofS-Adenosylmethionine(SAM)on liver injury induced by carbon tetrachloride(CCl4)in mice,In this study,60 C57BL/6 mice were randomly divided into CON group,CCl4 group,low dose group(CCl4+SAM-L,50 mg/kg SAM),medium dose group(CCl4+SAM-M,100 mg/kg)and high dose group(CCl4+SAM-M,200 mg/kg).Except CON group,mice in other groups were intraperitoneally injected with CCl4(10 mL/kg,0.2％),and mice in CON group were injected with equal volume olive oil,3 times a week for 4 weeks,to establish mouse liver injury model.At the same time,mice in low,medium and high dose groups were given 100 μL SAM,CON group and CCl4 group were given equal volume PBS for 4 weeks.The results showed that CCl4 promoted liver fibrosis and increased serum ALT,AST and TBIL levels(P＜0.05).Different doses of SAM significantly alleviated liver fibrosis injury and decreased serum ALT,AST and TBIL levels(P＜0.05).Compared with CON group,CCl4 significantly decreased the liver T-AOC,SOD,CAT and GSH-Px levels(P＜0.05),and increased the liver MDA level(P＜0.05).Compared with CCl4 group,the levels of T-AOC,SOD,CAT and GSH-PX in liver of mice in CCl4+SAM group were significantly increased(P＜0.05),while the level of MDA was significantly decreased(P＜0.05).Compared with CON group,liver levels of IL-6,IL-1β and TNF-α in CCl4 group were significantly increased(P＜0.05).Compared with CCl4 group,different doses of SAM could significantly reduce the levels of IL-6,IL-1β and TNF-α in liver of mice(P＜0.05).Compared with CON group,the expressions of Nrf2,NQO-1 and HO-1 genes in liver of CCl4 group were decreased(P＞0.05),while the expression of Keap1 gene was significantly increased(P＞0.05).Compared with CCl4 group,medium and high doses of SAM significantly increased the expressions of Nrf2,NQO-1 and HO-1 genes in liver of mice(P＜0.05),and decreased the expres-sion of Keap1 gene(P＞0.05).Compared with CON group,the contents of acetic acid,propionic acid and butyric acid in cecum of CCl4 group were significantly decreased(P＜0.05).Compared with CCl4 group,the contents of propionic acid and butyric acid in high-dose SAM group were sig-nificantly increased(P＜0.05).Microbial analysis showed that CCl4 significantly decreased the rel-ative abundance of Akkermansia and Prevotellaceae_NK3B31_group(P＜0.05),and changed the composition of intestinal microorganisms.These results indicate that SAM regulates the gene ex-pression of Nrf2 antioxidant signaling pathway to a certain extent,increases intestinal SCFAs con-tent,regulates intestinal microbial structure,and thus alleviates liver injury,oxidative stress and inflammation caused by CCl4.This study provides reference and theoretical basis for SAM in the treatment and remission of drug-induced liver injury.

Purpose To assess the impact of in vitro fertilization-embryo transfer(IVF-ET)technology on early embryonic development by using early pregnancy ultrasound parameters.Materials and Methods A retrospective study was conducted on 864 pregnant women who had their early pregnancy ultrasounds at the Haidian District Maternal and Child Health Hospital in Beijing from 2020 to 2022.These women had singleton viable pregnancies with no adverse pregnancy outcomes followed up to 13+6 weeks.They were divided into two groups,based on their method of conception,including IVF-ET group and spontaneously conceived(SC)group.Subgroups were further divided according to the gestational age indicated by ultrasound at 6,7 and 8 weeks.A longitudinal study of early pregnancy ultrasound indicators was conducted in the IVF-ET group and compared with the corresponding parameters in the SC group.The ages of the pregnant women were stratified to compare the differences in ultrasound indicators between the two conception methods at different ages.Univariate linear regression analysis was used to assess the correlation between crown-rump length(CRL)and mean gestational sac diameter(mGSD).Results The CRL and mGSD of pregnant women in both groups increased with gestational age(P＜0.05),while the mGSD-CRL did not show significant changes with the increase in gestational age(F=83.592-840.037,P＞0.05).There were no statistically significant differences in CRL,mGSD and mGSD-CRL at each gestational week during early pregnancy between the SC group and the IVF-ET group(t=0.282-1.713,P＞0.05).When comparing the ultrasound parameters stratified by maternal age,there were no statistically significant differences in ultrasound parameters between the elderly and non-elderly subgroups within both groups(P＞0.05).There were also no statistically significant differences in ultrasound parameters between the elderly subgroup of the IVF-ET group and the SC group,as well as between the non-elderly subgroup of the IVF-ET group and the SC group(P＞0.05).Univariate linear regression analysis showed a positive correlation between CRL and mGSD in the early pregnancy period for both the IVF-ET group and the SC group(t=3.586,9.665,11.170,7.690,11.307,12.263,P＜0.05).Conclusion During early pregnancy,the gestational sac and embryo exhibit regular synchronous growth,and IVF-ET technology and age do not affect their growth patterns.

Animal surgery courses are a critical component of medical training;however,teaching practices have demonstrated problems,such as the difficulty of interdisciplinary teaching,students' weak concepts of sterility,poor clinical thinking,insufficient teamwork,shallow emotional investment,and ineffective value guidance.By integrating the characteristics of student learning and utilizing virtual simulation experiments alongside peer role models,an emotional-guidance teaching model has been established to enhance the effectiveness of"life education",through strengthened emotional identification and improved value guidance.The result indicate that this teaching model forms a closed-loop teaching process,aligns with students' cognitive patterns and cultivates their comprehensive abilities,and enhances teaching effectiveness.

Objective To develop an innovative minimally invasive rotary-cutting surgical system for axillary osmidrosis,and conduct clinical validation.Methods The design concept,technical principles and system composition of the innovative minimally invasive rotary-cutting surgical system for axillary osmidrosis were introduced.A total of 73 patients(146 axillae)with axillary osmidrosis were enrolled as subjects,and underwent surgery using the newly developed surgical system.Clinical validation of the system was performed by evaluating postoperative scarring,odor elimination rate,postoperative complication incidence,and patient satisfaction.Results The study demonstrated favorable clinical outcomes in the following aspects:postoperative scarring,odor elimination rate,postoperative complication incidence,and patient satisfaction.Conclusion The minimally invasive rotary-cutting surgical system for axillary osmidrosis is rationally designed.The rotary-cutting puncture device is safe,effective,minimally invasive,and convenient for axillary osmidrosis surgery,warranting further clinical validation and widespread application.