Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

Abstract To further differentiate the differentiated effects of emotional responses to social media among adolescents, the study systematically reviews the main current methods for measuring social media emotional responses. It elaborates on the impacts of adolescents emotional responses to social media on their physical health, mental health, and social adaptation, as well as the multiple pathways and potential mechanisms through which adverse health effects are induced. It also highlights the current lack of empirical support for biological mechanisms in existing research, and provides a reference for future in depth exploration of biological mechanisms and the development of effective intervention strategies.

High-throughput sequencing-based high-throughput screening （HTS²） technology， as a new advancement in the field of high-throughput biotechnology， is the world's first technology to integrate high-throughput sequencing into large-scale drug screening and target discovery. The artificially designed DNA probes were bound to the undetermined mRNAs of thousands of genes in cell lysates， and then the probes were ligated with ligases. The large-scale simultaneous detection of gene expression changes in thousands of drug-treated cell samples was performed using barcoding， automated operating platforms， and high-throughput sequencers. This technology enables high-throughput identification of drugs that significantly perturb the gene expression profiles characteristic of diseases. It can also take gene expression signature as the readout and exert great high-throughput advantages in the screening of multi-drug， multi-component， and multi-target drugs， as well as the research on complex mechanisms. Therefore， it is particularly suitable for elucidating the multi-target mechanisms of traditional Chinese medicine and identifying its multi-effective components. Its main technical advantages include high throughput， automation， and low cost. In recent years， HTS² technology has yielded important achievements in the elucidation of the mechanism of action of traditional Chinese medicine formulas， the scientific connotation analysis of the regional characteristics of traditional Chinese medicine， the targeted isolation of active compounds of traditional Chinese medicine， and the discovery of novel pharmacological functions of monomeric compounds of traditional Chinese medicine. In the era of artificial intelligence， HTS² technology will serve as a powerful tool for generating high-quality， original big data of traditional Chinese medicine， providing core data support and promoting AI-driven traditional Chinese medicine research. Ultimately， HTS² technology offers new strategies and critical data support for deeply analyzing the scientific connotation of traditional Chinese medicine and discovering novel traditional Chinese medicine-based drugs， thereby accelerating the modernization and internationalization of traditional Chinese medicine in China.

Objective To analyze the application of NCompass nitinol stone retrieval basket in ureteroscopic holmium laser lithotripsy, and to evaluate its roles in reducing stone retropulsion and improving stone-free rate(SFR)and stone acquisition rate.Methods A retrospective analysis was conducted on the data of patients with upper ureteral stones＞1 cm who underwent ureteroscopic holmium laser lithotripsy at China-Japan Friendship Hospital during Jan.2018 and Dec.2023, including 96 cases were in the NCompass group, and 68 cases in the non-basket group.The operation time, stone retropulsion rate, usage rate of flexible ureteroscopy, SFR and stone acquisition rate were compared between the two groups.Results There were no significant differences in the operation time [(29.2±8.4)min vs.(30.9±7.2)min, P=0.170] and stone retropulsion rate(15.6% vs. 27.9%, P=0.055)between the NCompass group and non-basket group.The NCompass group had significantly lower usage rate of flexible ureteroscopy than the non-basket group(24.0% vs. 47.1%, P=0.002), higher SFR 2 days(80.2% vs. 45.6%, P＜0.001)and 1 month(93.8% vs. 83.8%, P=0.040)after operation, as well as the stone acquisition rates 2 days(100% vs. 44.1%, P＜0.001)and 1 month(100% vs. 58.8%, P＜0.001)after operation. Conclusion The NCompass nitinol stone retrieval basket plays dual roles in ureteroscopic holmium laser lithotripsy, which can effectively intercept stones and extract stone fragments, thus significantly improving the SFR and stone acquisition rate, and reducing stone retropulsion and the use of flexible ureteroscopy.

Gastric cancer remains a highly prevalent malignancy worldwide, with surgical resection currently constituting the cornerstone of treatment aimed at improving long-term patient survival. Owing to their notable advantages, including reduced surgical trauma and accelerated postoperative recovery, minimally invasive procedures are progressively supplanting conventional open surgery and have become the mainstream approach in gastric cancer management. Concurrently, the rapid advancement of artificial intelligence (AI) technologies has enabled real-time intraoperative monitoring of surgical scenes, thereby furnishing novel technical support for adjunctive decision-making, surgical navigation, and skill assessment during gastrectomy. This article provides a systematic review of the current status of AI applications in minimally invasive gastric cancer surgery, with a particular focus on research progress pertaining to instrument recognition, surgical phase identification, delineation of normal anatomical structures, detection of metastatic foci, and early warning of intraoperative adverse events. Furthermore, we discuss the potential value of AI in enhancing surgical efficiency, ensuring patient safety, and optimizing surgical education. On this basis, we further analyze the principal challenges and inherent risks confronting current AI systems, with the aim of informing future technological innovation and facilitating clinical translation.

ObjectiveTo observe the mechanism through which Qige San inhibits tumor angiogenesis in esophageal cancer （EC） by regulating the microRNA-133a （miR-133a）/phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway. MethodsCell experiments were conducted by transfecting miR-133a mimics through liposomes and utilizing PI3K/Akt signaling pathway inhibitors. The effects of 60 mg·L^-1 and 100 mg·L^-1 Qige San on inflammatory factor secretion in the supernatant of EC9706 cells （esophageal cancer cells） were observed. EC9706 cell supernatants were then extracted and used as conditioned media to treat human umbilical vein endothelial cells （HUVECs）. The effects of the conditioned media on the proliferation， migration， tube formation， and apoptosis of HUVECs were examined. Animal experiments involved establishing a subcutaneous tumor model in nude mice with EC9706 cells. After grouping and administration， tumor volumes were measured regularly. At the end of the experiment， tumors were harvested， and histopathological changes were observed under a microscope after hematoxylin-eosin （HE） staining. Real-time polymerase chain reaction （Real-time PCR） was adopted to measure miR-133a expression in the tumor tissue of each group， while Western blotting was employed to analyze the expression of key signaling molecules， such as phosphorylated Akt （p-Akt）， as well as endothelial cell markers， cluster of differentiation 31 （CD31） and cluster of differentiation 34 （CD34）， in the tumor tissue. ResultsCell experiments showed that compared with the blank group， the supernatant of EC9706 cells promoted tube formation of HUVECs （P<0.05）. Both low and high doses of Qige San inhibited tube formation of HUVECs （P<0.05）. All doses of Qige San， PI3K/Akt inhibitor， and the combination reduced the content of interleukin-6 （IL-6） （P<0.05）， while high-dose Qige San， inhibitor， and combination all reduced the content of interleukin-8 （IL-8） （P<0.05）. Compared with the EC9706 blank supernatant group， Qige San-conditioned medium inhibited the proliferation of HUVECs （P<0.05）. Qige San， the inhibitor， and the combination all inhibited the migration and tube formation （P<0.05） and increased the late apoptosis and total apoptosis rates of HUVECs （P<0.05）. In addition， the low-dose combination induced early apoptosis of EC9706 cells （P<0.05）. Compared with the blank supernatant group， the miR-133a mimic combined with Qige San synergistically reduced IL-6/IL-8 （P<0.05）， and enhanced the inhibition on proliferation， migration， and tube formation of HUVECs （P<0.05）. Animal experimental results showed that compared with the model group， both Qige San and cisplatin inhibited the growth of xenograft tumors in nude mice （P<0.05）， promoted tumor cell necrosis， and reduced capillary formation. High-dose Qige San upregulated miR-133a expression （P<0.05）. Moreover， compared with the model group， cisplatin， Qige San， and the combination all downregulated the expression of p-Akt， CD31， and CD34 （P<0.05）. ConclusionQige San upregulates miR-133a expression， inhibit PI3K/Akt signaling pathway activity， and improve the tumor inflammatory microenvironment to suppress the growth and tumor angiogenesis of HUVECs， thereby inhibiting esophageal cancer.

In 2022， Hainan provincial government launched the project for the prevention and control of viral hepatitis with the goals of a hepatitis B screening rate of 90%， a diagnostic rate of 90%， and a treatment rate of 80% among people aged 18 years and above by the year 2025， and the main intervention measures include population-based prevention， case screening， antiviral therapy， and health management. As of December 31， 2024， a total of 6.875 million individuals in the general population had been screened for hepatitis B， with a screening rate of 95.6%. A total of 184 710 individuals with positive HBsAg were identified， among whom 156 772 were diagnosed through serological reexamination， resulting in a diagnostic rate of 84.9%. A total of 50 742 patients with chronic hepatitis B were identified， among whom 42 921 had hepatitis B-specific health records established for health management， with a file establishment rate of 84.6%. A total of 31 553 individuals received antiviral therapy， with a treatment rate of 62.2%. A total of 2.503 million individuals at a high risk of hepatitis C were screened， among whom 4 870 tested positive for HCV antibody and 3 858 underwent HCV RNA testing， resulting in a diagnostic rate of 79.2%， and 1 824 individuals with positive HCV RNA were identified， among whom 1 194 received antiviral therapy， with a treatment rate of 65.5%. In addition， 159 301 individuals with negative HBsAg and anti-HBs and an age of 20 — 40 years were inoculated with hepatitis B vaccine free of charge. Through the implementation of the project for the prevention and control of viral hepatitis， a large number of hepatitis patients have been identified， treated， and managed in the province within a short period of time， which significantly accelerates the efforts to eliminate the crisis of viral hepatitis.

Objective: To evaluate the incremental vaccine effectiveness (VE) of two dose of the mumps containing vaccine (MuCV) in chidren, so as to provide a basis for optimizing mumps immunization strategies. Methods: A 1∶2 frequency matched case-control study was conducted by using reported mumps cases in childcare centers or schools from Lu an, Hefei, Ma anshan and Huainan cities of Anhui Province from September 1, 2023 to June 30, 2024, as a case group(383 cases). And healthy children in the same classroom were selected as a control group(766 cases). The MuCV immunization histories of participants were collected to estimate the incremental VE of the second dose of MuCV against mumps. Group comparisons were performed using the Chi square test or t-test. For matched case-control pairs, the Cox regression model was employed to calculate the odds ratio (OR) with 95% confidence interval (CI) for two dose MuCV vaccination and to estimate the incremental vaccine effectiveness (VE). Results: There were no statistically significant differences between the case and control groups regarding gender, age, dosage of MuCV vaccination and the time interval since the last dose vaccination( χ 2/t=0.05, 0.20, 0.94, -0.02, P >0.05). The proportions of the case and control groups vaccinated with two doses of MuCV were 26.63% and 29.37%, respectively, and the overall incremental VE of the second dose of MuCV was 40.73% (95% CI=3.03%-63.77%, P <0.05). Subgroup analyses revealed that the incremental VE for children with a period of ≥1 year between the two doses of MuCV was 54.13% (95% CI=1.90%-78.56%, P <0.05), while for children with a period of <1 year, it was 30.63% (95% CI=-28.59%-62.58%, P >0.05). The incremental VE of the second dose of MuCV was 30.36% (95% CI=-25.95%-61.50%, P >0.05) in kindergarten children and 66.73% (95% CI=14.92%-86.99%, P <0.05) in elementary and secondary school students. The incremental VE was 28.78% (95% CI=-27.46%-60.21%, P >0.05) within five years of the last dose of MuCV vaccination and 66.07% (95% CI=-41.56%-91.87%, P >0.05) for vaccinations administered beyond five years. Conclusions The second dose of MuCV may offer additional protection for children; however, extending the interval between two dose of MuCV (<1 year) has shown limited incremental protective effects. Therefore, it is crucial to consider optimizing current immunization strategies for mumps.

BACKGROUND: Urolithiasis is a widespread disease with a high prevalence worldwide. This study aims to evaluate the disease burden of urolithiasis and its trends from 1990 to 2021 globally, based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. METHODS: The numbers and age-standardized rates (ASRs) of incidence, disability-adjusted life years (DALYs), and mortality of urolithiasis were extracted from GBD 2021 to represent the disease burden. Joinpoint regression analyses were conducted to assess the temporal trends in the burden of urolithiasis. The male-to-female ASR ratio indices were used to evaluate sex disparities. Additionally, we explored the relationship between the ASR ratio and the sociodemographic index (SDI). RESULTS: The total numbers of incidence, DALY, and mortality of urolithiasis were 105,983,780 cases (95% uncertainty interval [UI] = 88,349,356-128,645,155 cases), 693,444 cases (95% UI = 567,765-850,490 cases), and 17,672 cases (95% UI = 13,932-21,241 cases), respectively, in 2021. There is an increasing trend in the number of these measures globally, whereas the ASRs have decreased over the past 30 years. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were significantly higher in males than in females in 2021. The sex disparities in the age-standardized DALY rate (ASDR) and ASMR of urolithiasis were negatively correlated with the SDI. In 2021, the ASIR of urolithiasis was 964.70 (95% UI = 801.26-1175.09) per 100,000 people in China, which is much lower than the global average (1242.84 [95% UI = 1034.94-1506.99] per 100,000 people). Compared with the global average, a more pronounced decline in ASIR was observed in China from 1793.16 (1446.0-2235.14) in 1990 to 964.70 (801.26-1175.09) per 100,000 people in 2021. CONCLUSIONS Urolithiasis poses a significant healthcare burden worldwide. More robust global and national strategies are warranted to address the prevention and treatment, especially in low SDI countries and regions.
Humans ; Urolithiasis/mortality* ; Male ; Female ; Incidence ; Global Burden of Disease ; Disability-Adjusted Life Years ; Adult ; Middle Aged ; Risk Factors ; Sex Factors

Objective:To investigate the influence of four preoperative CT image characteristics on the outcome of thoracoscopic surgery for chronic tuberculous empyema.Methods:This is a retrospective cohort study. Two hundred and eleven patients of tuberculous empyema who underwent video-assisted thoracic surgery(VATS) decortication at the First Department of Surgery , Wuhan Pulmonary Hospital from June 2020 to June 2023 were retrospectively analyzed. There were 162 male cases and 49 female cases, with an age ( M (IQR)) of 33 (27) years (range: 8 to 76 years). Patients were divided into two groups according to whether low-density lines, mass-patchy density, pleural fusion were observed, and the lesion size. Compare the clinical indicators of two groups of cases. Using the rapeutic efficacy as the dependent variable and four CT features as covariates, cases with cure or improve were included in Logistic regression analysis to calculate OR (95% CI) values. Results:Preoperative chest CT images showed that 127 cases (60.2%) had low-density lines, 102 cases (48.3%) had mass-patchy density, and 88 cases (47.7%) had pleural fusion. The lesions spanned 2 to 11 intercostal spaces, with a median of 7 intercostal spaces. The lesion size was divided into two groups according to <7 intercostal spaces and ≥7 intercostal spaces, with 101 cases (47.9%) and 110 cases (52.1%), respectively. In the intra-group comparison, there were no difference in age, lesion location and pulmonary tuberculosis. In the comparison of gender, except that the proportion of female patients in the group with lesion size <7 intercostal spaces ( χ2=6.064, P=0.010) was higher than ≥7 intercostal spaces, there were no significant difference between other groups. In low-density lines group, there was no difference in the incidence of anemia and hypoproteinemia between the two groups. Compared with the non low-density line group, patients with low-density line group exhibited fewer cases of abnormal elevation in ESR and CRP was lower(all P<0.01), the period of preoperative treatment ( U=7 281.00, P<0.01) was longer than the non low-density line group, while the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours, postoperative drainage duration, lung re-expansion duration, and therapeutic efficacy were all better than the non low-density line group(all P<0.05). In the comparison between the mass-patchy density group, there were fewer cases of anemia, hypoproteinemia, abnormal elevation of ESR and CRP in the without mass-patchy density group(all P<0.05), and the period of preoperative treatmentwas shorter ( U=4 581.50, P=0.026), and the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours, postoperative drainage duration, lung re-expansion duration and therapeutic effect were better too(all P<0.05). In the grouping comparison of pleural fusion, there were no difference in cases of anemia, hypoproteinemia, abnormal elevation of ESR and CRP, and the period of preoperative treatment between the two groups; the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours, postoperative drainage duration, lung re-expansion duration, and therapeutic efficacy of the group without pleural fusion were better than the group with pleural fusion(all P<0.05). The group with <7 intercostal spaces had fewer cases of anemia, hypoproteinemia, abnormal elevation of ESR and CRP (all P<0.05), the period of preoperative treatment was longer ( U=4 295.00, P=0.004), the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours,postoperative drainage duration, lung re-expansion duration and complications were less (all P<0.05), the therapeutic efficacy was better than the group with ≥7 intercostal spaces ( χ2=27.912, P<0.01). The Logistic regression analysis of cured and improved cases showed that mass-patchy density and lesion size were independent risk factors affecting the therapeutic efficacy (all P<0.05). Conclusions:For patients with CT images showing mass-patchy density, pleural fusion, and a large lesion size, the difficulty and risk of surgery may be relatively high.The preoperative CT images can provide objective reference for clinical preoperative evaluation.