Objective To investigate the incidence trends and influencing factors of non-alcoholic fatty liver disease (NAFLD) -related cirrhosis in China, predict future disease burden, and provide evidence for public health prevention strategies. Methods Based on the Global Burden of Disease (GBD) 2021 database, we employed joinpoint regression analysis to analyze NAFLD-related cirrhosis trends in China from 1990 to 2021, quantified influencing factors using age-period-cohort modeling, and predicted future incidence through Bayesian age-period-cohort analysis. Results The age-standardized incidence rates (ASIRs) of NAFLD-related cirrhosis showed a persistent increase from 1990 to 2021, with annual percentage changes (APCs) of 0.70% for male and 0.79% for female(both P<0.05). Age-effects revealed a U-shaped variation pattern, peaking in the 60-69 age group. Period effects indicated an incidence peak during 2017-2021. Cohort effects showed the most prominent risk in the 1992-1996 birth cohort. Projections suggested ASIR would further increase to 578.40 and 930.61 per 100 000 population for males and females, respectively, by 2030. Conclusions The disease burden of NAFLD-related cirrhosis continues to worsen in China, with future incidence rates projected to keep rising. Priority attention should be given to middle-aged and elderly populations and sex differences, with targeted prevention and control measures needing to be developed.

OBJECTIVE: To investigate the detection patterns, clinical phenotypic characteristics, and differences in diagnostic timeliness of Klinefelter syndrome (KS) across prenatal and postnatal stages, with an aim to provide a basis for optimizing strategies for early screening, diagnosis, and intervention. METHODS: A retrospective study was conducted to analyze data from two phases. The prenatal diagnosis group included 33,302 pregnant women who underwent amniocytic karyotyping due to advanced maternal age, abnormal ultrasound findings, or high-risk non-invasive prenatal testing (NIPT). The postnatal diagnosis group included 52,101 patients who underwent peripheral blood karyotyping due to primary infertility, abnormal external genitalia, or growth and developmental abnormalities. Additionally, medical histories of adult diagnosed patients were reviewed retrospectively to identify early occult symptoms. This study was approved by the Medical Ethics Committee of Chengdu Women's and Children's Central Hospital (Ethics No.: LCYJ-2025-030). RESULTS: In the prenatal group, 96 cases of KS were detected (detection rate 0.29%). The primary indications for referral were NIPT indicating sex chromosome abnormalities (45.83%), advanced maternal age (16.66%), and ultrasound abnormalities (17.70%). In the postnatal group, 128 cases of KS were detected (detection rate 0.25%). Clinical presentations were primarily primary infertility/azoospermia (77.34%), and the patients were predominantly adults (84.40%). Retrospective analysis revealed that adult patients presented with specific physical signs that had been overlooked during childhood. CONCLUSION As KS lacks typical early clinical manifestations, diagnosis is often delayed until adulthood when reproductive needs arise, showing a pattern of "passive detection" and resulting in missed opportunities for optimal intervention. By conducting a comparative analysis of prenatal diagnostic data and postnatal retrospective data, a risk association model linking prenatal screening indications with childhood-specific signs was developed. This study has provided empirical evidence for establishing a multidisciplinary, full life-cycle management system of "screening ~ diagnosis ~ monitoring ~ intervention" helping to shift from "passive detection in adulthood" to "proactive management across the entire life course," and laid a foundation for improving early diagnosis rate and long-term quality of life for patients.
Humans ; Klinefelter Syndrome/genetics* ; Female ; Adult ; Pregnancy ; Retrospective Studies ; Prenatal Diagnosis/methods* ; Male ; Phenotype ; Karyotyping ; Young Adult ; Adolescent ; Middle Aged

Objective To establish an optimized diagnostic model for hepatocellular carcinoma(HCC),designated as G-GADA,in chronic hepatitis B(CHB)patients based on the parameters of age,sex,alpha-fetoprotein(AFP),des-γ-carboxy prothrombin(DCP),and Golgi protein 73(GP73),to address the problems of low sensitivity and specificity in the early diagnosis of hepatitis B virus(HBV)-related liver cancer,and to assess the value of this model in the diagnosis of HCC.Methods A retrospective analysis was performed for 201 CHB patients(CHB group),137 patients with HBV-related liver cirrhosis(LC group),and 111 treatment-na?ve patients with newly diagnosed HCC(HCC group)who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from June 2015 to June 2020.Serological markers(AFP,DCP,alpha-fetoprotein L3%[AFP-L3%],and GP73)were compared between groups and were analyzed in terms of their differences from the clinical and tumor characteristics of HCC patients,and the Spearman correlation analysis was used to assess the correlation between different markers.A Logistic regression analysis was used to establish a diagnostic model for liver cancer,and the receiver operating characteristic(ROC)curve was used to assess the diagnostic performance of each marker.Results Comparison of clinical features between CHB,LC,and HCC patients showed that HCC patients had significantly higher age,proportion of male patients,and serum levels of DCP,AFP,GP73,and AFP-L3%(all P<0.05).In HCC patients,DCP levels are associated with tumor size and microvascular invasion;AFP levels are related to patient age,tumor size,tumor number,distant metastasis,and microvascular invasion;AFP-L3%levels are associated with patient age,tumor size,tumor number,distant metastasis,Milan staging,and microvascular invasion;GP73 levels are linked to tumor number,distant metastasis,and microvascular invasion(all P<0.05).The correlation analysis of the serum markers showed a strong positive correlation between AFP and AFP-L3%(r=0.71,P<0.05)and a moderate positive correlation between AFP and GP73(r=0.33,P<0.05)and between AFP-L3%and GP73(r=0.41,P<0.05).Based on the features of age,sex,DCP,AFP,and GP73,the multivariate Logistic regression analysis was used to establish a G-GADA diagnostic model for HCC,and for all patients,the G-GADA model had an area under the ROC curve(AUC)of 0.915(95%confidence interval[CI]:0.875-0.945)in the derivation cohort and 0.913(95%CI:0.862-0.950)in the validation cohort for the diagnosis of HCC.In the AFP-negative patients,the G-GADA model achieved an AUC of 0.884(95%CI:0.833-0.924)in the derivation cohort and 0.851(95%CI:0.779-0.907)in the validation cohort,and in the patients with liver cirrhosis,the G-GADA model achieved an AUC of 0.901(95%CI:0.841-0.944)in the derivation cohort and 0.885(95%CI:0.806-0.940)in the validation cohort.Conclusion The G-GADA diagnostic model based on multiple variables significantly improves the detection rate of HCC,and demonstrates superior diagnostic performance in patients with low AFP expression and those with liver cirrhosis.The G-GADA model has a better clinical application value in the noninvasive diagnosis of HCC.

Objective To establish an optimized diagnostic model for hepatocellular carcinoma(HCC),designated as G-GADA,in chronic hepatitis B(CHB)patients based on the parameters of age,sex,alpha-fetoprotein(AFP),des-γ-carboxy prothrombin(DCP),and Golgi protein 73(GP73),to address the problems of low sensitivity and specificity in the early diagnosis of hepatitis B virus(HBV)-related liver cancer,and to assess the value of this model in the diagnosis of HCC.Methods A retrospective analysis was performed for 201 CHB patients(CHB group),137 patients with HBV-related liver cirrhosis(LC group),and 111 treatment-na?ve patients with newly diagnosed HCC(HCC group)who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from June 2015 to June 2020.Serological markers(AFP,DCP,alpha-fetoprotein L3%[AFP-L3%],and GP73)were compared between groups and were analyzed in terms of their differences from the clinical and tumor characteristics of HCC patients,and the Spearman correlation analysis was used to assess the correlation between different markers.A Logistic regression analysis was used to establish a diagnostic model for liver cancer,and the receiver operating characteristic(ROC)curve was used to assess the diagnostic performance of each marker.Results Comparison of clinical features between CHB,LC,and HCC patients showed that HCC patients had significantly higher age,proportion of male patients,and serum levels of DCP,AFP,GP73,and AFP-L3%(all P<0.05).In HCC patients,DCP levels are associated with tumor size and microvascular invasion;AFP levels are related to patient age,tumor size,tumor number,distant metastasis,and microvascular invasion;AFP-L3%levels are associated with patient age,tumor size,tumor number,distant metastasis,Milan staging,and microvascular invasion;GP73 levels are linked to tumor number,distant metastasis,and microvascular invasion(all P<0.05).The correlation analysis of the serum markers showed a strong positive correlation between AFP and AFP-L3%(r=0.71,P<0.05)and a moderate positive correlation between AFP and GP73(r=0.33,P<0.05)and between AFP-L3%and GP73(r=0.41,P<0.05).Based on the features of age,sex,DCP,AFP,and GP73,the multivariate Logistic regression analysis was used to establish a G-GADA diagnostic model for HCC,and for all patients,the G-GADA model had an area under the ROC curve(AUC)of 0.915(95%confidence interval[CI]:0.875-0.945)in the derivation cohort and 0.913(95%CI:0.862-0.950)in the validation cohort for the diagnosis of HCC.In the AFP-negative patients,the G-GADA model achieved an AUC of 0.884(95%CI:0.833-0.924)in the derivation cohort and 0.851(95%CI:0.779-0.907)in the validation cohort,and in the patients with liver cirrhosis,the G-GADA model achieved an AUC of 0.901(95%CI:0.841-0.944)in the derivation cohort and 0.885(95%CI:0.806-0.940)in the validation cohort.Conclusion The G-GADA diagnostic model based on multiple variables significantly improves the detection rate of HCC,and demonstrates superior diagnostic performance in patients with low AFP expression and those with liver cirrhosis.The G-GADA model has a better clinical application value in the noninvasive diagnosis of HCC.

Non-inferiority clinical trials are a research paradigm that employs randomized controlled methods to evaluate whether the treatment effect of the experimental group is not inferior to that of the active control group within a predefined acceptable margin. This article systematically summarizes the applicable conditions, key design elements, and statistical analysis methods for non-inferiority trials. By integrating representative case studies in the field of oncology, it elucidates the unique value of non-inferiority designs in balancing benefits and risks and in optimizing therapeutic decisions. Through reviewing theoretical frameworks and addressing common misconceptions in methodological practices, this study aims to provide clear guidance for the standardized design and scientific interpretation of non-inferiority trials, thereby promoting their high-quality application in clinical research.

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

Objective:To investigate the causal relationship between plasma proteins and spontaneous abor-tion using a two-sample Mendelian randomization method.Methods:Using genome-wide association study(GWAS)data from an Icelandic population as an exposure factor and spontaneous abortion data from the Finn-ish Genetic Research Project(FinnGen)as an outcome,the causal relationship between plasma proteins and the risk of developing spontaneous abortion was analyzed using a Mendelian randomization(MR)study.The inverse variance weighting(IVW)method was used as the primary study method,with MR-Egger,weighted median and weighted mode complementing the results;and sensitivity analyses were performed using Cochrane's Q test,MR-Egger intercept testand leave-one-out method to validate the reliability of the data.Results:Seven plasma proteins were identified as potentially correlated with the risk of spontaneous abortion of which fucosyltransferase 10(FUT10)(OR 0.955,95％CI 0.915-0.996,P=0.034),plexin B2(PLXNB2)(OR 0.947,95％CI 0.902-0.995,P=0.030),and interleukin-11 receptor alpha(IL-11Rα)(OR0.905,95％CI 0.848-0.966,P=0.003)were associ-ated with a reduced risk of SA development,while plasma proteins soluble L-selectin(SL-selectin)(OR 1.076,95％CI 1.021-1.134,P=0.006),Cripto protein(OR 1.039,95％CI 1.008-1.071,P=0.012),dendritic cell-specif-ic intercellular adhesion molecule 3-grabbing non-integrin(DC-SIGN)(OR 1.051,95％CI 1.022-1.082,P=0.001),and protein Z-dependent protease inhibitor(ZPI)(OR 1.035,95％CI 1.001-1.071,P=0.045)levels were positively associated with the risk of developing SA.No heterogeneity or horizontal pleiotropy was detected(Co-chrane's Q test and MR-Egger intercept test,P＞0.05),and leave-one-out analysis showed that there were no individual single-nucleotide polymorphisms that had a large impact on the overall data.Conclusions:This Mende-lian randomization analyses confirmed the causal relationship between multiple plasma proteins and spontaneous abortion,which is potentially clinically valuable for studying the correlation between plasma proteins and spontane-ous abortion.

Objective To evaluate the efficacy of stellate ganglion block(SGB)on postoperative sleep quality in the patients undergoing general anesthesia operation.Methods The randomized controlled trials(RCT)of the effect of SGB on postoperative sleep quality in the patients undergoing general anesthesia were searched from PubMed,Cochrane Library,Embase,CNKI,CBM,VIP and Wang Fang Data.The retrieval limi-tation was from the database establishment to July 21,2023.The screened literatures were evaluated by using the Cochrane 5.1.0 bias risk assessment tool,and then the meta analysis was performed by using Rev Man 5.4 software.Results A total of eight literatures were screened and included.The results of meta analysis showed that the incidence rate of sleep disorders in the first night after surgery in the SGB group was lower than that in the control group(OR=0.26,95％CI:0.15-0.45,P＜0.001),and the postoperative total sleep duration in the SGB group was higher than that in the control group(MD=69.06,95％CI:53.69-84.44,P＜0.001),the sleep efficiency of the SGB group was higher than that of the control group(MD=13.59,95％CI:10.70-16.49,P＜0.001);the postoperative Assens Insomnia Scale(AIS)scores(MD=-1.73,95％CI:-2.43 to-1.03,P＜0.001)and Pittsburgh Sleep Quality Index Scale(PSQI)scores(MD=-3.26,95％CI:-5.40 to-1.12,P＜0.003)in the SGB group were lower than those in the control group.Conclusion SGB could reduce the incidence rate of sleep disturbances at the postoperative first night,extend the postoperative total sleep time,increase the postoperative sleep efficiency,reduce the postoperative sleep quality score,and improve the postoperative sleep quality,which is a non-pharmacological method with good effect and high safety,has good clinical application prospect and is worth promoting.

Objective:To investigate the causal relationship between plasma proteins and spontaneous abor-tion using a two-sample Mendelian randomization method.Methods:Using genome-wide association study(GWAS)data from an Icelandic population as an exposure factor and spontaneous abortion data from the Finn-ish Genetic Research Project(FinnGen)as an outcome,the causal relationship between plasma proteins and the risk of developing spontaneous abortion was analyzed using a Mendelian randomization(MR)study.The inverse variance weighting(IVW)method was used as the primary study method,with MR-Egger,weighted median and weighted mode complementing the results;and sensitivity analyses were performed using Cochrane's Q test,MR-Egger intercept testand leave-one-out method to validate the reliability of the data.Results:Seven plasma proteins were identified as potentially correlated with the risk of spontaneous abortion of which fucosyltransferase 10(FUT10)(OR 0.955,95％CI 0.915-0.996,P=0.034),plexin B2(PLXNB2)(OR 0.947,95％CI 0.902-0.995,P=0.030),and interleukin-11 receptor alpha(IL-11Rα)(OR0.905,95％CI 0.848-0.966,P=0.003)were associ-ated with a reduced risk of SA development,while plasma proteins soluble L-selectin(SL-selectin)(OR 1.076,95％CI 1.021-1.134,P=0.006),Cripto protein(OR 1.039,95％CI 1.008-1.071,P=0.012),dendritic cell-specif-ic intercellular adhesion molecule 3-grabbing non-integrin(DC-SIGN)(OR 1.051,95％CI 1.022-1.082,P=0.001),and protein Z-dependent protease inhibitor(ZPI)(OR 1.035,95％CI 1.001-1.071,P=0.045)levels were positively associated with the risk of developing SA.No heterogeneity or horizontal pleiotropy was detected(Co-chrane's Q test and MR-Egger intercept test,P＞0.05),and leave-one-out analysis showed that there were no individual single-nucleotide polymorphisms that had a large impact on the overall data.Conclusions:This Mende-lian randomization analyses confirmed the causal relationship between multiple plasma proteins and spontaneous abortion,which is potentially clinically valuable for studying the correlation between plasma proteins and spontane-ous abortion.

Objective To evaluate the current situation of disease control in middle-aged and elderly patients with chronic obstructive pulmonary disease (COPD) and analyze the relationship with disease cognition. Methods Among the 360 middle-aged and elderly COPD patients diagnosed and treated in our hospital from January 2022 to June 2024 were retrospectively selected as research subjects, and the COPD Assessment Test Questionnaire (CAT), COPD Patient Knowledge Questionnaire (BCKQ) and the hampion Health Belief Model Scale were used to evaluate disease control, disease cognition and health beliefs in COPD patients. The Pearson chi-square test was used to analyze the relationship between disease control level and disease cognition and health beliefs in older patients with COPD. Results A total of 360 middle-aged and elderly COPD patients, 112 were in the complete control group, 189 were in the partial control group, and 59 were in the uncontrolled group, the disease control rate was 83.61%. The differences in disease cognitive scores, severity cognition, susceptibility cognition, disorder cognition, benefit cognition, health motivation, self-efficacy score and total health belief scores in middle-aged and elderly COPD patients with different disease control conditions are statistically significant. The scores of the complete control group were higher than those of partial control group and uncontrolled group, and the scores of partial control group were higher than those of the uncontrolled group (P <0.05). The disease control level of middle-aged and elderly patients with COPD is positively correlated with disease cognitive level and health belief in all dimensions. The higher the disease control level, the higher the disease cognitive level and health belief in the patient . Conclusions Middle-aged and elderly COPD patients still have insufficient awareness of the disease, and the level of disease control needs to be improved. There is a significant correlation between disease cognition, health beliefs and the level of disease control, and the improved cognitive level may help to improve the disease management and control effect. For middle-aged and elderly COPD patients, the community can provide health education courses, personalized health guidance and self-management training to enhance their awareness of diseases, so as to improve the long-term management of COPD and the quality of life of patients.