Background: The tight junction protein claudin18.2 (CLDN18.2) has been implicated in poor prognosis and suboptimal immunotherapy response in gastric cancer (GC). This study investigates the clinicopathological relevance of CLDN18.2 expression and its association with molecular subtypes in GC patients from a high-incidence region, combining transcriptomic and proteomic approaches to explore how CLDN18.2 contributes to progression and metastasis. Methods: A retrospective cohort of 494 GC patients (2019–2024) underwent immunohistochemical analysis for CLDN18.2, Epstein-Barr virus (Epstein–Barr virus–encoded RNA), p53, human epidermal growth factor receptor 2 (HER2), and mismatch repair proteins (MLH1, MSH2, PMS2, and MSH6). CLDN18.2 positivity was defined as moderate to strong (2+/3+) membranous staining in ≥75% of tumor cells. Clinicopathological correlations, biomarker associations, and survival outcomes were evaluated. Transcriptomic and proteomic sequencing was performed to explore molecular mechanisms. Results: CLDN18.2 positivity was observed in 26.9% (133/494) of gastric adenocarcinomas. CLDN18.2-positive tumors correlated with TNM stage (p = .003) and shorter overall survival (p = .018). No associations were identified with age, sex, HER2 status, microsatellite instability, or Epstein-Barr virus infection. Transcriptomic profiling revealed CLDN18.2-high tumors enriched in pathways involving cell junction disruption, signaling regulation, and immune modulation. Proteomic profiling showed that tumors with high CLDN18.2 were enriched in multiple mechanism-related pathways such as integrated metabolic reprogramming, cytoskeletal recombination, immune microenvironment dysregulation, and pro-survival signaling. These mechanisms may collectively contribute to tumor progression and metastasis. Conclusions CLDN18.2 overexpression is associated with poor prognosis in GC patients. Transcriptomic and proteomic analyses demonstrate that CLDN18.2 promotes tumor progression and metastasis, underscoring its potential as an independent prognostic factor in regions with a high incidence of GC.

Objective: To explore the association role of anxiety and depressive symptoms with Internet gaming disorder (IGD) and emotional-behavioral problems among junior high school students, so as to provide references for preventing the occurrence and progression of emotional-behavioral problems in middle school students. Methods: From September to October 2024, a random cluster sampling method was adopted to select 38 069 students from 28 junior high schools in 14 counties (cities and districts) and functional areas of Jining City, Shandong Province. Surveys were conducted by Nine item Internet Gaming Disorder Scale-Short Form, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Strengths and Difficulties Questionnaire. The correlation of emotional and behavioral issues, online game addiction, anxiety and depressive symptoms among junior high school students was analyzed by Speaman correlation analysis. Mediation analysis was used to explore the role of anxiety and depressive symptoms between IGD and emotional-behavioral problems among junior high school students. Results: The detection rates of emotional-behavioral problems, anxiety symptoms, depressive symptoms, and IGD among junior high school students were 19.24 %, 9.48%, 16.69%, and 19.68%, respectively. The scores of emotional-behavioral problems, anxiety symptoms, depressive symptoms and IGD were 10.00 (6.00, 15.00), 3.00 (0.00, 7.00), and 4.00 (1.00, 8.00), 13.00 (10.00, 19.00), respectively. There were positive correlations between each pair of emotional-behavioral problem, IGD, anxiety symptoms, and depressive symptoms scores ( r =0.51-0.81, all P <0.01). Anxiety and depressive symptoms played mediating roles between IGD and emotional-behavioral problems among junior high school students, with mediating effect values of 0.16 (95% CI =0.15-0.17) and 0.12 (95% CI =0.11-0.14), respectively (both P <0.01). Conclusions Anxiety and depressive symptoms mediate the relationship between IGD and emotional-behavioral problems among junior high school students. It is necessary to identify early signs of IGD among junior high school students, strengthen intervention for anxiety and depressive symptoms, to prevent the occurrence and development of emotional and behavioral issues.

ObjectiveTo perform metabolic associated fatty liver disease （MAFLD） screening among individuals attending community health institutions， to identify the patients at a low， moderate or high risk of advanced liver fibrosis based on fibrosis-4 index （FIB-4） and liver stiffness measurement （LSM） measured by liver transient elastography， and to implement stratified management. MethodsA cross-sectional study was conducted among 630 individuals attending Beijing Baizhifang Community Health Service Center from January to July 2024， and they were divided into MAFLD group and non-MAFLD group. According to body mass index （BMI）， the MAFLD group was further divided into lean MAFLD group （BMI<23 kg/m²） and non-lean MAFLD group （BMI≥23 kg/m²）. The above groups were compared in terms of demographic features， laboratory markers， hepatic steatosis， and LSM. Fibrosis risk stratification was performed for MAFLD patients based on FIB-4 and LSM， and a closed-loop management system involving referral to tertiary hospitals and follow-up at community health institutions was implemented. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThere were 445 individuals （70.6%） in the MAFLD group and 185 individuals （29.4%） in the non-MAFLD group. Compared with the non-MAFLD group， the MAFLD group had a significantly lower proportion of male individuals （χ²=4.299， P<0.05）， a significant reduction in the level of high-density lipoprotein cholesterol （Z=3.484， P<0.05）， and significant increases in body weight （Z=-7.366， P<0.05）， BMI （Z=-9.740， P<0.05）， waist circumference （Z=-6.397， P<0.05）， hip circumference （Z=-6.935， P<0.05）， alanine aminotransferase （ALT） （Z=-2.765， P<0.05）， fasting blood glucose （Z=-3.646， P<0.05）， triglyceride （TG） （Z=-6.569， P<0.05）， total cholesterol （Z=-2.033， P<0.05）， low-density lipoprotein cholesterol （Z=-2.935， P<0.05）， controlled attenuation parameter （CAP） （Z=-19.784， P<0.05）， and LSM （Z=-5.703， P<0.05）. Within the MAFLD group， there were 124 individuals （27.9%） in the lean MAFLD group and 321 individuals （72.1%） in the non-lean MAFLD group. Compared with the non-lean MAFLD group， the lean MAFLD group had significantly lower body weight （Z=-12.414， P<0.05）， BMI （Z=-16.363， P<0.05）， waist circumference （Z=-7.733， P<0.05）， hip circumference （Z=-8.595， P<0.05）， ALT （Z=-2.835， P<0.05）， aspartate aminotransferase （Z=-1.972， P<0.05）， TG （Z=-2.407， P<0.05）， CAP （Z=-4.429， P<0.05）， degree of steatosis （χ²=16.588， P<0.05）， and LSM （Z=-3.908， P<0.05）. Based on the results of FIB-4 and LSM， 76 patients at a moderate or high risk of liver fibrosis should be referred to a higher-level hospital for further management. ConclusionThe detection rate of MAFLD reaches 70.6% among the individuals attending community health institutions， among whom 76 （17.1%） should be referred to a higher-level hospital. Establishing a liver fibrosis risk stratification and management system based on FIB-4 and LSM among MAFLD individuals in communities provides a practical pathway for chronic disease management and referral system construction in community health institutions.

Objective To evaluate the effect of remimazolam premedication on emergence delirium （ED） in children undergoing tonsillectomy and/or adenoidectomy. Methods Children aged 3-6 years who underwent tonsillectomy and/or adenoidectomy with general anesthesia in Zhongshan Hospital Affiliated to Xiamen University from July 2023 to September 2024 were randomly divided into 0.1 mg/kg remimazolam group （group R1）, 0.2 mg/kg remimazolam group group R2） and normal saline group （group P）. Three groups were sedated preoperatively with remimazolam 0.1 mg/kg, remimazolam 0.2 mg/kg and normal saline, respectively. The primary outcome was the incidence of ED. The secondary outcomes included the parental separation anxiety scale （PSAS） score when entering the operating room, the induction compliance checklist （ICC） score at induction, the anesthetic recovery time, the incidence of rescue propofol for ED, the face, legs, activity, cry, and consolability （FLACC） score and the incidence of postoperative pain during the recovery period, the incidence of adverse reactions during the operation and postoperatively, and the incidence of negative postoperative behavioral changes （NPOBCs） at first day, 7th day, 30th day postoperatively. Results A total of 119 children completed the study, including 41 children in group R1, 38 children in group R2, and 40 children ingroup P. The incidence of ED and propofol rescue, the PSAS scores and ICC scores of group R1 and R2 were lower than that of group P （P<0.05）, and the above results in group R2 was better than those in group R1 （P<0.05）. The FLACC score, the incidence of postoperative pain, and the incidence of adverse reactions among the three groups had no difference （P>0.05）. The incidence of NPOBCs at 1st day and 7th day postoperatively in group R1 and group R2 was lower than that in group P （P<0.05）, but no difference was detected at 30th day postoperatively among the three groups （P>0.05）. Conclusion Remimazolam used for preoperative sedation could reduce the incidence of ED in children undergoing tonsillectomy and/or adenoidectomy, and had a positive effect on alleviating the preoperative anxiety and preventing NPOBCs.

OBJECTIVE To compare the short-term efficacy and safety of small-caliber polyvinyl alcohol （PVA） microsphere-based transcatheter arterial chemoembolization （TACE） versus conventional iodized oil emulsion-based TACE in the treatment of unresectable hepatocellular carcinoma （HCC）.METHODS Clinical data of 146 patients with unresectable HCC who underwent TACE at Gansu Provincial Second People’s Hospital （Affiliated Hospital of Northwest Minzu University） from June 1， 2024， to June 30， 2025， were retrospectively collected. According to the treatment strategy， the patients were divided into the control group （conventional iodized oil emulsion-based TACE， n ＝79） and the observation group （small-caliber PVA microsphere-based TACE， n ＝67）. One-to-one propensity score matching （PSM） was performed， and the matched cohort （62 patients in each group） was used for the primary analysis. The objective response rate （ORR） and disease control rate （DCR） at 1 and 3 months post-treatment， serum levels of tumor markers （alpha-fetoprotein， alpha-fetoprotein lectin-binding fraction L3， and protein induced by vitamin K absence or antagonist-Ⅱ） before treatment and at 1 and 3 months post-treatment， the occurrence of adverse events， progression-free survival （PFS）， and overall survival （OS） were compared between the two groups. Sensitivity and interaction analyses were also performed.RESULTS After PSM， the ORRs in the observation group at 1 and 3 months post-treatment were both 59.7%， and the DCRs were 91.9% and 93.5%， respectively， significantly higher than those in the control group （ORRs： 41.9% and 38.7%； DCRs： 77.4% and 75.8%； P ＜0.05）. At 1 and 3 months post-treatment， the serum levels of tumor markers decreased significantly from baseline in both groups， with significantly lower levels in the observation group than in the control group （ P ＜0.05）. No statistically significant differences were observed in the overall incidence of adverse events or the incidence of grade≥3 adverse events between the two groups （ P ＞0.05）. The median PFS was 10.6 months in the control group and 14.3 months in the observation group， with no statistically significant difference [hazard ratio （HR） of 0.69， 95% confidence interval （CI） of 0.44-1.09， P ＝0.111]. During follow-up， 8 and 9 patients died in the control and observation groups， respectively， and the median OS was not reached in either group. The 12-month OS rates were 88.8% and 87.3%， respectively， with no statistically significant difference （HR of 0.88， 95%CI of 0.35-2.24， P ＝0.790）. After adjustment for potential confounding factors in the original cohort， the ORR at 3 months post-treatment remained significantly higher in the observation group than in the control group （adjusted odds ratio of 2.67， 95%CI of 1.28-5.56， P ＝0.009）. Additionally， the interaction between treatment modality and Barcelona Clinic Liver Cancer staging had no statistically significant impact on the ORR at 3 months post-treatment （ P ＝0.391）.CONCLUSIONS For patients with unresectable HCC， compared with conventional iodized oil emulsion-based TACE， small-caliber PVA microsphere-based TACE demonstrates superior efficacy in terms of early radiological response and improvement in tumor markers， and the two regimens are comparable in terms of safety.

Objective To investigate the prognostic factors of acute gastrointestinal injury(AGI)in children with sepsis,and to explore the predictive value of pediatric sequential organ failure assessment(pSOFA)score,AGI grade and their combined for prognosis.Methods A total of 143 children with sepsis complicated with AGI in Inner Mongolia Maternal and Child Health Hospital from January 2020 to January 2022 were selected and divided into sepsis group(n=1 03)and septic shock group(n=40)according to the severity of disease.pSOFA score was obtained on the day when sepsis was diagnosed.AGI was evaluated every day during hospitalization.Multivariate Logistic regression was used to identify independent factors affecting the outcome.Receiver operating characteristic(ROC)curve was used to analyze predictive value of pSOFA score,AGI grade and their combination for poor prognosis.Results The number of patients who received continuous renal replacement therapy,surgery,mechanical ventilation,bloody stool,hypoactive bowel sound and procalcitonin concentration in septic shock group were higher than those in sepsis group(P＜0.05).Red blood cell,hemoglobin and platelet in septic shock group were lower than those in sepsis group(P＜0.05).Multivariate Logistic regression analysis showed that mechanical ventilation,surgery,decrease of hemoglobin,increase of pSOFA score and AGI grade were independent risk factors for poor prognosis in patients(P＜0.05).ROC curve analysis showed that predictive value of pSOFA score combined with AGI grading for prognosis of patients was higher than that of them alone(P＜0.05).Conclusion Mechanical ventilation,surgery,hemoglobin,pSOFA score and AGI grade are prognostic factors of sepsis complicated with AGI in children.pSOFA score combined with AGI grade has a high value in predicting poor prognosis.

Objective To evaluate the efficacy of myopia progression control over a one-year period for defocus in-corporated multiple segments lenses(DIMS),peripheral defocus modifying(PDM)lenes and single vision spectacle lenses(SVL)in a real-world cohort.Methods A total of 188 cases in the DIMS group,116 cases in the PDM group,and 373 ca-ses in the SVL group,all diagnosed with refractive errors and aged 6-16 years,were enrolled in Department of Ophthal-mology,Fujian Provincial Hospital from July 2019 to June 2022.A 1∶1 propensity score matching(PSM)of covariates was used to balance factors between the groups.The changes in spherical equivalent(SE)and axial length(AL)in each patient before and 1 year after wearing glasses were compared without other interventions.The myopia control effects of different groups were compared through the changes in SE and AL.Results After PSM,92 cases were matched between DIMS group and PDM group,163 cases were matched between DIMS group and SVL group,and 99 cases were matched between PDM group and SVL group.The changes in SE and AL in the DIMS group were less than those in the PDM and SVL groups,with statistically significant differences(all P＜0.05).However,there were no statistically significant differences in the changes in SE and AL between the PDM and SVL groups(all P＞0.05).In the age subgroup analysis,in the younger age group(6～＜13)and the older age group(13～16)the changes in SE and AL in the DIMS group were less than those in the PDM group and SVL group,with statistically significant differences(all P＜0.05).In the younger age group,the changes in SE and AL in the PDM group were less than those in the SVL group,with statistically significant differences(all P＜0.05);while in older age group,there were no statistically significant differences in the changes in SE and AL between the PDM and SVL groups(all P＞0.05).Conclusion The myopia control efficacy of DIMS is superior to that of PDM and SVL.In younger children,the myopia control efficacy of PDM is superior to that of SVL.

Objective:To explore the rehabilitation effects of individual computer story-version magnanimous therapy (ICSMT) on patients with end-stage renal disease undergoing maintenance hemodialysis (MHD).Methods:A total of 120 patients with end-stage renal disease receiving MHD treatment at the Department of Nephrology Hemodialysis Center of Huadu District People's Hospital of Guangzhou from August 2022 to April 2024 were selected as the study subjects.They were randomly divided into control group ( n=60, receiving routine clinical treatment) and ICSMT group ( n=60, receiving routine clinical treatment combined with ICSMT for psychological intervention) by random number table method.The patients in the two groups were evaluated by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), enterprising and magnanimous questionnaire (EMQ), the short-form-36 health survey (SF-36), and activity of daily living scale (ADL) before intervention and at 4-week post-intervention.Blood pressure, blood urea nitrogen (BUN), hemoglobin (Hb), and serum albumin (ALB) levels were also measured before the intervention and at the 4-week post-intervention.The clinical global impression scale (CGI) was used to evaluate clinical efficacy before the intervention, at the 2-week post-intervention, and at the 4-week post-intervention.Statistics analysis was performed using SPSS 29.0.1.0(171). Independent-samples t-test, paired t-test, Mann-Whitney U test and Wilcoxon signed-rank test were used for statistical analysis. Results:After 4 weeks of intervention, the SAS and SDS in the ICSMT group (49.0 (48.0, 50.0), 50.0 (49.0, 51.0)) were significantly lower than those in the control group (51.0 (50.0, 52.0), 52.0 (51.0, 53.0)) (both P<0.001). The enterprising subscore of the EMQ in the ICSMT group (35.0 (32.0, 37.0)) was significantly higher than that in the control group (31.0 (29.0, 34.0)) ( P<0.001). Furthermore, the differences of enterprising and magnanimous subscores between the two groups before and after intervention in the ICSMT group (2.0 (1.0, 4.0), 1.0 (-1.0, 2.0))were significantly higher than those in the control group (-1.0 (-1.0, 0), -1.0 (-1.2, 0)) (both P<0.05). Systolic and diastolic blood pressure values in the ICSMT group (130 (126, 134) mmHg, 85 (80, 88) mmHg)were significantly lower than those in the control group (145 (138, 152) mmHg, 93 (88, 99) mmHg)(1 mmHg=0.133 kPa) after 4 weeks of intervention(both P<0.05). After 4 weeks of intervention, the level of BUN in the ICSMT group (5.5 (3.7, 8.4) mmol/L) was significantly lower than that in the control group (9.1 (6.8, 11.4) mmol/L), while the level of Hb and ALB in the ICSMT group ((115.0±10.0)g/L, (38.3±3.2)g/L)were significantly higher than those in the control group ((104.0±12.0)g/L, (37.1±2.9)g/L) (all P<0.05). After 4 weeks of intervention, the physical functioning, role-physical, general health, vitality, social functioning, role-emotional, and mental health subscores of SF-36 in ICSMT group were all significantly higher than those in the control group (all P<0.05). After 4 weeks of intervention, the score of ADL in the ICSMT group (15.42±1.58)was significantly lower than that in the control group (16.78±2.06) ( t=-4.08, P<0.05). At the 2-week post-intervention and the 4-week post-intervention, the severity of illness (SI) and global improvement (GI) in the ICSMT group were significantly lower than those in the control group, while the efficacy index (EI) in the ICSMT group was significantly higher than that in the control group (all P<0.05). Conclusion:ICSMT can effectively promote the physical, psychological, and social functional rehabilitation of end-stage renal disease patients undergoing MHD, significantly improving their quality of life.

Objective To evaluate the clinical efficacy and safety of Huoxue Jiedu Prescription in the treatment of polycythemia vera with heat toxicity and blood stasis syndrome.Methods Totally 155 patients of polycythemia vera with heat toxicity and blood stasis syndrome from 5 hospitals including Langfang Traditional Chinese Medicine Hospital from October 2022 to March 2024 were collected.Patients were divided into an observation group(79 cases)and control group(76 cases)using a random number table method.Both groups received conventional Western medicine treatment.The observation group was given Huoxue Jiedu Prescription,one dosage per day,taken orally twice a day;both groups received one treatment course of one month,and three treatment courses were observed.The efficacy of Western medicine and TCM syndromes was observed,and the total symptom assessment scale of myeloproliferative neoplasms(MPN-10)scores,hematological indicators,coagulation function before and after treatment were compared.The safety indicators of the two groups were monitored.Results The control group and observation group lost 2 and 4 cases,respectively.The total effective rate of Western medicine in the observation group was 90.67%(68/75),while the control group was 67.57%(50/74),with statistical significance(P<0.01).The total effective rate of TCM syndromes in the observation group was 94.67%(71/75),while in the control group was 71.62%(53/74),with statistical significance(P<0.01).Compared with before treatment,the total score of MPN-10 in both groups significantly decreased(P<0.05);after treatment,the total score of MPN-10 in the observation group was lower than that in the control group(P<0.05).Compared with before treatment,both groups showed significant reductions in hemoglobin,white blood cell count,hematocrit and platelet count after treatment(P<0.05);after treatment,the above hematological indicators in the observation group were better than those in the control group(P<0.05).Compared with before treatment,the levels of D-dimer and fibrinogen in both groups significantly decreased after treatment,and the activated partial thromboplastin time and prothrombin time were significantly shortened(P<0.05);after treatment,the observation group showed better improvement in the coagulation function indicators compared to the control group(P<0.05).There were no significant adverse reactions in the two groups.Conclusion Huoxue Jiedu Prescription can improve clinical efficacy of polycythemia vera with heat toxicity and blood stasis syndrome,improve hematological indexes,reduce coagulation indexes,and has good safety.

Objective To explore the effect of adjuvant hydrogen inhalation therapy(AHIT)on postoperative neurological recovery in elderly patients with cerebral hemorrhage.Methods A pro-spective study was conducted on 100 patients with cerebral hemorrhage who underwent surgical treatment in our department between January 2021 and February 2023.They were randomly divid-ed into an observation group(AHIT)and a control group(conventional treatment),with 50 pa-tients in each group.Glasgow Coma Scale(GCS)score,NIHSS score,short from 36-item question-naire(SF-36)score,as well as levels of serum brain-derived neurotrophic factor(BDNF),insulin-like growth factor 1(IGF-1)and calcitonin gene-related peptide(CGRP),and incidence of compli-cations were compared between the two groups.Results The observation group obtained signifi-cantly higher GCS score and SF-36 scores at 4 and 8 weeks after treatment,and lower NIHSS score when compared with the control group(P＜0.01).At 8 weeks after treatment,the serum BDNF,IGF-1 and CGRP levels were notably higher in the observation group than the control group(P＜0.01).There was no statistical difference in the incidence of complications between the two groups(6.00％vs 10.00％,P＞0.05).Conclusion AHIT can significantly improve the neuro-logical recovery and quality of life of patients with cerebral hemorrhage,as well as elevate the lev-els of serum neurofunctional markers.