Objective To detect the expression of cytochrome c oxidase assembly factor 6(COA6)in breast cancer,study its clinical significance,and analyze the effect of COA6 on immune infiltration in breast cancer.Methods Differential genes were screened by the whole transcriptome sequencing and the expression of COA6 was explored with TCGA(The Cancer Genome Atlas Program)database.The tissues of 125 breast cancer and adjacent tissues were stained by immunohistochemistry to detect COA6 protein expression and analyze the correlation with clinical features.The COA6 mRNA and protein expression in breast cancer cells and tissues were determined by qRT-PCR and Western blot,respectively.The TIMER(Tumor Immune Estimation Resource)database was used to analyze the correlation between high COA6 gene expression and immune cell infiltration.Results The positive expression rate of COA6 in breast cancer tissues was 88％(110/125),which was higher than that of paracarinoma tissues(7.2％,9/125)(P＜0.05)and was positively correlated with tumor size and histological grade.In fresh breast cancer tissues,COA6 protein expression was significantly higher than that in adjacent tissues.Both COA6 mRNA and protein expression were significantly increased in the breast cancer cell lines.COA6 was positively cor-related with the infiltration of helper T cells,NK cells,CD8+T cells,M1 type macrophages,regulatory T cells,dendritic cells,and memory CD4+T cells in the tumor microenvironment.Conclusions The expression level of COA6 is increased in breast cancer and is positively correlated with tumor immune infiltration,which provides a po-tential therapeutic target for breast cancer treatment.

This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Cost-effectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs);and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.

ObjectiveThis study aims to develop and validate a novel multimodal predictive model， termed criss-cross network（CCNet）-directed graph neural network（DGNN）（CGN）， for accurate assessment of pulmonary nodule progression in high-risk individuals for lung cancer， by integrating longitudinal chest computed tomography（CT） imaging with both traditional Chinese and western clinical evaluation data. MethodsA cohort of 4 432 patients with pulmonary nodules was retrospectively analyzed. A twin CCNet was employed to extract spatiotemporal representations from paired sequential CT scans. Structured clinical assessment and imaging-derived features were encoded via a multilayer perceptron， and a similarity-based alignment strategy was adopted to harmonize multimodal imaging features across temporal dimensions. Subsequently， a DGNN was constructed to integrate heterogeneous features， where nodes represented modality-specific embeddings and edges denoted inter-modal information flow. Finally， model optimization was performed using a joint loss function combining cross-entropy and cosine similarity loss， facilitating robust classification of nodule progression status. ResultsThe proposed CGN model demonstrated superior predictive performance on the held-out test set， achieving an area under the receiver operating characteristic curve（AUC） of 0.830， accuracy of 0.843， sensitivity of 0.657， specificity of 0.712， Cohen's Kappa of 0.417， and F₁ score of 0.544. Compared with unimodal baselines， the CGN model yielded a 36%-48% relative improvement in AUC. Ablation studies revealed a 2%-22% increase in AUC when compared to simplified architectures lacking key components， substantiating the efficacy of the proposed multimodal fusion strategy and modular design. Incorporation of traditional Chinese medicine （TCM）-specific symptomatology led to an additional 5% improvement in AUC， underscoring the complementary value of integrating TCM and western clinical data. Through gradient-weighted activation mapping visualization analysis， it was found that the model's attention predominantly focused on nodule regions and effectively captured dynamic associations between clinical data and imaging-derived features. ConclusionThe CGN model， by synergistically combining cross-attention encoding with directed graph-based feature integration， enables effective alignment and fusion of heterogeneous multimodal data. The incorporation of both TCM and western clinical information facilitates complementary feature enrichment， thereby enhancing predictive accuracy for pulmonary nodule progression. This approach holds significant potential for supporting intelligent risk stratification and personalized surveillance strategies in lung cancer prevention.

This article is to evaluate the clinical outcomes and health economics of minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).This review systematically compares clinical efficacy and economic value of three minimally invasive techniques:small bone window microsurgery,neuroendoscopic surgery and stereotactic drainage based on 12 randomized controlled trials(RCTs),7 cohort studies,and 8 economic evaluations 2019-2024.Cost-effectiveness analysis(CEA)and cost-utility analysis(CUA)were employed to assess resource utilization and health outcomes.Minimally invasive approaches overall outperform conventional craniotomy.Stereotactic surgery achieves the shortest hospitalization(5-8 days)and lowest direct costs;neuroendoscopy significantly improves quality of life(quality-adjusted life years(QALYs);and small bone window surgery offers the best postoperative stability.It is recommended to choose the surgical method based on patient characteristics and to optimize healthcare resource allocation through medical insurance payment reform and technology promotion.

BACKGROUND: This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability. METHODS: This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability. RESULTS: STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min. CONCLUSION The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
Reproducibility of Results ; Surveys and Questionnaires ; Practice Guidelines as Topic ; Humans

Objective:To determine the expression of transmembrane protein 45A (TMEM45A) in keloid tissues and fibroblasts, and to evaluate its effect on extracellular matrix (ECM) synthesis by keloid-derived fibroblasts (KFs) .Methods:Samples of surgically excised keloid and normal foreskin tissues were collected from the Department of Dermatology and Department of Urology of Yanbian University Hospital from January 2019 to December 2020, and TMEM45A protein expression was determined in keloid tissues and KFs by Western blot analysis. KFs were divided into TMEM45A-specific small interfering RNA (siRNA) group and control siRNA group to be transfected with the TMEM45A-specific siRNA and control siRNA respectively. Then, Western blot analysis was performed to evaluate the effects of down-regulation of the TMEM45A gene on the expression of myofibroblast marker protein (α-smooth muscle actin) and ECM-related proteins.Results:Compared with normal skin tissues (1.00 ± 0.11) and fibroblasts (1.00 ± 0.20), TMEM45A expression levels significantly decreased in keloid tissues (0.26 ± 0.05) and KFs (0.41 ± 0.09), respectively ( t = 10.76, 4.75, P < 0.001, = 0.009, respectively). The expression levels of α-smooth muscle actin, ECM-related type Ⅰ collagen, type Ⅲ collagen, and fibronectin were significantly higher in the TMEM45A-specific siRNA group than in the control siRNA group ( t = -5.98, -4.57, -4.90, -7.19, P = 0.004, 0.010, 0.008, 0.002, respectively) . Conclusion:Lowly expressed TMEM45A in keloids may play an important role in the pathogenesis of keloids by promoting ECM synthesis.

Objective:To investigate the application value of superb microvascular imagingin monitoring angiogenesis in the treatment of chronic ischemic diseases of lower limbs by tibial transverse transport.Methods:From May 2019 to December 2020, 12 patients with ischemic diseases of lower limbs who received tibial transverse transport therapy were retrospectively analyzed, including 7 male patients and 5 female patients, aged 30-86 years, with an average age of 64.0±16.6 years. Among them, there were 10 patients with diabetic foot, with a disease course of 5-30 years (mean 14.4±8.3 years), and 2 patients with arteriosclerosis obliterans. The results of lower extremity superb microvascular imaging before and after treatment were recorded and compared.Results:After treatment, 12 patients were found to have obvious new vessels around the artery of lower extremity, the number of vessels 1-8, the average number of 3.25±2.73. We found that a total of 12 patients 20 inherent lower limb artery collateral established, collateral circulation was found around 12 dorsal metatarsal artery (DMA) in 11 patients, around 3 dorsal pedis artery (DPA) in 2 patients, around 3 anterior tibial artery (ATA) in 2 patients, and around 1 posterior tibial artery (PTA) in 2 patients. The lateral branches were established in ipsilateral lower limbs in 6 patients, contralateral lower limbs in 2 patients, and bilateral lower limbs in 4 patients.Conclusion:The phenomenon of angiogenesis is obvious in the clinical application of tibial transverse transport. Superb microvascular imaging can effectively reflect the degree of promoting the establishment of collateral circulation by tibial transverse transport.

Objective: Understanding mental health status of students with learning disabilities in Beijing to provide a basis for mental health promotion of students with learning disabilities. Methods: By means of random cluster sampling, 5 787 enrolled students in grade one and grade two of 11 public junior middle schools in Beijing were selected as the survey subjects. A self designed questionnaire was used to investigate the students’ learning disabilities and mental health status through anonymous self filling. Results: About 11.6% students self reported learning disabilities. The proportions of students with learning difficulty in mathematical reasoning and calculation were higher, 44.1% and 40.7% respectively. The reported rate of mental health problems was 38.3%. The top four of the 10 symptoms were obsessive compulsive symptoms, learning pressure, emotional instability and anxiety(2.19±0.77)(2.17±0.99)(2.09±0.90)(2.07±1.08). Compared with students without learning disabilities, students with self reported learning disabilities had poorer mental health status(OR=1.47), and learning disabilities were related to most factors of mental health. Different types of learning disabilities were associated with different mental health factors. Conclusion Mental health problems of students with learning disabilities are higher than that of students without learning disabilities. It is necessary to strengthen the mental health support for students with learning disabilities and improve their mental health.

Objective To develop a self-rating scale of sensitivity of seasickness ( SSSS ) in navy recruits, and also to detect the reliability and validity of the scale. Methods A theoretical model and created entry pool were constructed on the basis of literature review and individual interviews. In the preliminary test, we first investigated 214 naval veterans from the Shantou Coast Guard of the South China Sea Fleet, and then an initial scale was formed following related analysis and exploratory factor analysis. For the large sample test, the initial scale was used to investigate 940 veterans from some of the 3 naval fleets, and then data analysis and exploratory factor analysis were used to form the final formal scale. During the validation test, confirmatory factor analysis and reliability and validity test were performed using the formal scale to investigate 742 recruits from the 3 fleets. Calibration was made by using symptoms and signs of Graybiel motion sickness. In addition, 37 undergraduate students from the Naval Medical Department of the Second Military Medical University of 2016 were tested and a retest was made after a month. Results The formal scale contained 7 factors encompassing 36 items or entries, the cumulative contribution of variance was as high as 72. 031％. The results of confirmatory factor analysis showed that the model fitted well (χ2 =935. 993, df=465,χ2/df=2. 013, GFI=0. 934, AGFI=0. 905, TLI=0. 969, CFI=0. 977, IFI=0. 977 and RMSEA=0. 038). There was a significant positive correlation between the scores of each factor, as well as the scores of each factor and total scores of the scale( r=0. 313-0. 713, P<0. 01;r=0. 529-0. 884, P<0. 01). The total scores and each factor scores of the scale were positively correlated to the scores of the symptoms and signs of Graybiel motion sickness(r=0. 730, P<0. 01;r=0. 365-0699, P<0. 01). The Cronbach'sαof the total scale was 0. 952 and those of various factors were from 0. 797 to 0. 945. The retest reliability of the total scale was 0. 875 and the retest reliability of the 7 factors was from 0. 488 to 0. 837. Conclusion Various indexes of the self-rating scale for the detection of seasickness sensitivity in navy recruits were quite reliable and were suitable for the evaluation of seasickness susceptibility in naval recruits.

Objective To develop a self-rating scale of sensitivity of seasickness ( SSSS ) in navy recruits, and also to detect the reliability and validity of the scale. Methods A theoretical model and created entry pool were constructed on the basis of literature review and individual interviews. In the preliminary test, we first investigated 214 naval veterans from the Shantou Coast Guard of the South China Sea Fleet, and then an initial scale was formed following related analysis and exploratory factor analysis. For the large sample test, the initial scale was used to investigate 940 veterans from some of the 3 naval fleets, and then data analysis and exploratory factor analysis were used to form the final formal scale. During the validation test, confirmatory factor analysis and reliability and validity test were performed using the formal scale to investigate 742 recruits from the 3 fleets. Calibration was made by using symptoms and signs of Graybiel motion sickness. In addition, 37 undergraduate students from the Naval Medical Department of the Second Military Medical University of 2016 were tested and a retest was made after a month. Results The formal scale contained 7 factors encompassing 36 items or entries, the cumulative contribution of variance was as high as 72. 031％. The results of confirmatory factor analysis showed that the model fitted well (χ2 =935. 993, df=465,χ2/df=2. 013, GFI=0. 934, AGFI=0. 905, TLI=0. 969, CFI=0. 977, IFI=0. 977 and RMSEA=0. 038). There was a significant positive correlation between the scores of each factor, as well as the scores of each factor and total scores of the scale( r=0. 313-0. 713, P<0. 01;r=0. 529-0. 884, P<0. 01). The total scores and each factor scores of the scale were positively correlated to the scores of the symptoms and signs of Graybiel motion sickness(r=0. 730, P<0. 01;r=0. 365-0699, P<0. 01). The Cronbach'sαof the total scale was 0. 952 and those of various factors were from 0. 797 to 0. 945. The retest reliability of the total scale was 0. 875 and the retest reliability of the 7 factors was from 0. 488 to 0. 837. Conclusion Various indexes of the self-rating scale for the detection of seasickness sensitivity in navy recruits were quite reliable and were suitable for the evaluation of seasickness susceptibility in naval recruits.