Objective To investigate the association of baseline cerebral blood flow （CBF） and cerebral metabolic rate of oxygen （CMRO2） with sleep structure disorder after thrombolytic therapy in stroke patients， as well as their value in clinical assessment. Methods A total of 145 patients with stroke were enrolled as subjects， and all of them received thrombolytic therapy in our hospital from January 2023 to June 2025. Before thrombolytic therapy， 3.0 T magnetic resonance imaging was used to obtain relative CBF （rCBF） and relative CMRO2 （rCMRO2）， and rCBF/rCMRO2 ratio was calculated. At week 1 after thrombolysis， overnight polysomnography （PSG） was conducted to obtain parameters such as total sleep time， sleep efficiency， the proportion of each NREM stage， and REM sleep duration. According to the presence or absence of sleep structure disorder， the subjects were divided into disorder group and non-disorder group. The Pearson correlation method was used for correlation analysis. A multivariate logistic regression analysis was used to identify the influencing factors for sleep structure disorder in subjects after thrombolytic therapy. The receiver operating characteristic （ROC） curve was plotted to analyze the performance of rCBF/rCMRO2 ratio in predicting sleep structure disorder in subjects after thrombolytic therapy. Results Compared with the non-disorder group， the disorder group had significantly higher age， infarct volume， NIHSS score on admission， and proportion of patients with infarction in the thalamus （P<0.05）. Compared with the non-disorder group， the disorder group had significantly lower rCBF， rCMRO2， rCBF/rCMRO2 ratio， total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.05） and significantly higher proportion of NREM 1 sleep and sleep arousal index （P<0.05）. The Pearson correlation analysis showed that rCBF， rCMRO2， and rCBF/rCMRO2 ratio were positively correlated with total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.001） and were negatively correlated with the proportion of NREM 1 sleep and sleep arousal index （P<0.001）. The Logistic regression analysis showed that age， infarct volume， infarction location （thalamus）， and NIHSS score on admission were risk factors for sleep structure disorder in stroke patients after thrombolytic therapy （P<0.05）， while rCBF， rCMRO2， and rCBF/rCMRO2 ratio were protective factors against sleep structure disorder （P<0.05）. The ROC curve analysis showed that rCBF/rCMRO2 ratio had an area under the ROC curve of 0.901 （95% CI 0.869-0.938） in predicting sleep structure disorder in stroke patients after thrombolytic therapy， with a sensitivity of 95.50% and a specificity of 82.40%. Conclusion Baseline rCBF， rCMRO2， and rCBF/rCMRO2 ratio are closely associated with sleep structure disorder in stroke patients after thrombolytic therapy， among which rCBF/rCMRO2 ratio has excellent performance in predicting sleep structure disorder and can be used as a sensitive indicator for clinical assessment of high-risk patients.
Stroke

ObjectiveTo understand the mental health literacy levels and influencing factors among middle school students in Minhang District, Shanghai, and to provide a basis for formulating mental health promotion strategies. MethodsA multi-stage stratified cluster sampling method was adopted. From September to October 2023, middle school students (including junior and senior high school) from 14 streets, towns, and industrial zones in Minhang District, Shanghai, were recruited to participate in a questionnaire survey. The survey collected demographic information and employed the Adolescent Mental Health Literacy Assessment Scale. This scale comprises four dimensions (knowledge, recognition ability, attitude, and behavior) with a total of 22 items, using a Likert 5-point scale (1‒5 points), giving a maximum total score of 110 points. Reverse-scored items were inverted, and the sum of all item scores constituted the total scale score, with higher scores indicating better mental health literacy. A total score of ≥88 points was defined as having adequate mental health literacy. Multiple linear regression was used to analyze the factors influencing mental health literacy. ResultsThe average mental health literacy score of the 3 963 middle school students in Minhang District of Shanghai City was (85.42±11.27) points, with 45.22% of students having adequate mental health literacy. Univariate analyses showed that female students, junior high school students, and those without stressful events or physical illnesses in the past three months had higher total scores of mental health literacy. Statistically significant differences in total scores were also observed among students with different family economic statuses, parental education levels, frequency of physical exercise, parental relationships, father‑child relationships, and mother‑child relationships (all P<0.05). Multiple linear regression analyses showed that middle school students who were female, had better family economic conditions, higher maternal education levels (university degree or above), and harmonious mother-child relationships had higher mental health literacy scores. In contrast, high school students and those middle school students who participated in less physical activity had lower mental health literacy scores. Multivariate logistic regression analyses indicated that students who were female (OR=1.336, 95%CI: 1.174‒1.520), had superior family economic status (OR=2.000, 95%CI: 1.101‒3.725), had mothers with a university education level (OR=1.501, 95%CI: 1.217‒1.856), had lost one parent (OR=2.189, 95%CI: 1.176~4.158), or reported harmonious mother‑child relationships (OR=2.052, 95%CI: 1.432‒2.987) were more likely to meet the criteria for mental health literacy, whereas those who rarely engaged in physical exercise (OR=0.502, 95%CI: 0.358‒0.694) were less likely to have adequate mental health literacy. Stratified analyses showed that mental health literacy levels among junior high school students were positively correlated with being female, having a mother with a university education level, and having a mother‑child relationship that was average or harmonious and having a harmonious father‑child relationship, and negatively correlated with occasional or rare participation in physical exercise. Among senior high school students, mental health literacy levels were positively correlated with being female, having good or superior family economic status, having a mother with a university education level or above, and having a harmonious mother‑child relationship. ConclusionThe rate of adequate mental health literacy among middle school students in Minhang District, Shanghai, was approximately 45.22%. Gender, grade level, family economic status, maternal education level, physical activity participation, and mother-child relationship are independent factors associated with the level of mental health literacy among middle school students. Mother-child relationship and physical activity are potential intervention entry points. It is recommended to implement targeted health promotion initiatives focusing on key groups, such as high school boys, students from economically disadvantaged families, and those with insufficient physical activity.

With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

Objective To investigate the protective effect and underlying mechanisms of HydroMg, a novel sustained-release hydrogen donor, in a model of doxorubicin (DOX)-induced chronic cardiotoxicity. Methods H9C2 cells were treated with 1 μmol/L DOX and/or 1 μg/mL HydroMg, and mitochondrial membrane potential, reactive oxygen species (ROS) levels, and apoptosis were measured. In the animal experiment, mice were divided into control, HydroMg, DOX, and DOX＋HydroMg groups. The HydroMg group received intraperitoneal injection of HydroMg (100 mg/kg). Chronic cardiotoxicity was established by intraperitoneal injection of DOX (5 mg/kg every week) for four consecutive weeks; In the DOX＋HydroMg group, HydroMg (100 mg/kg) was administered intraperitoneally 4–5 h prior to each DOX injection. Cardiac function and remodeling were evaluated by echocardiography and heart weight index (HWI). The long-term survival of mice were analyzed. Subsequently, transcriptome sequencing was performed on myocardial tissues from the DOX group to identify key molecular alterations compared with controls. Results At the cellular level, HydroMg treatment effectively reversed DOX-induced mitochondrial dysfunction and oxidative stress, as evidenced by restored membrane potential, reductions in total ROS and mitochondrial superoxide levels by approximately 30% and 9%, respectively, and a decrease in the apoptosis rate from 34.13% to 18.27%. In the animal model, compared with the DOX group, HydroMg intervention increased left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) by 9.62% and 5.82%, respectively, attenuated the reduction in HWI (4.41 mg/mm vs 3.53 mg/mm), and improved the 4-week survival rate (80% vs 60%). Transcriptomic analysis revealed that the core molecular features of DOX-induced cardiotoxicity, including widespread suppression of oxidative phosphorylation and antioxidant pathways. Conclusions HydroMg protects against DOX-induced chronic cardiotoxicity by alleviating oxidative stress and improving mitochondrial function, and provides a potential therapeutic strategy against DOX-related cardiotoxicity.

ObjectiveTo observe the effects of modified Longdan Xiegan Tang on wound healing and inflammatory factors after surgery for perianal abscess of heat-toxin accumulation syndrome. MethodsA prospective randomized controlled design was adopted. A total of 110 patients with perianal abscess of heat-toxin accumulation syndrome admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from January 2024 to January 2025 were included and randomly assigned into two groups， each with 55 patients according to the random number table method. The control group received conventional Western medicine treatment + placebo oral administration after surgery， and the observation group received modified Longdan Xiegan Tang oral administration on the basis of conventional Western medicine treatment， with a course of 14 days. Clinical efficacy， Visual Analogue Scale （VAS） score， wound secretion score， TCM symptom score， wound healing rate， wound healing time， wound infection rate， inflammatory factors ［interleukin-6 （IL-6）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α）］， wound healing-related indicators ［fibronectin （FN）， matrix metalloproteinase-9 （MMP-9）， and prealbumin （PA）］ and adverse reactions were determined in both groups. ResultsThree cases in the observation group and three cases in the control group dropped out， with 104 cases actually completing the study. The repeated measures analysis of variance showed that both groups showed decreased VAS scores， wound secretion scores， TCM syndrome scores， and levels of IL-6， IL-8， TNF-α， and MMP-9 and increased levels of PA and FN after treatment （P<0.05）. During treatment and on day 14 after surgery， the observation group had lower VAS score， wound secretion score， TCM syndrome score， and levels of IL-6， IL-8， TNF-α， and MMP-9 and higher levels of PA and FN than the control group （P<0.01）. The observation group showed higher wound healing rate， shorter wound healing time， and lower wound infection than the control group （P<0.01）. The comprehensive efficacy of the observation group was better than that of the control group （χ²=5.216， P<0.05）. No serious adverse events occurred in patients during the study， and there was no significant difference in the incidence of adverse reactions between the two groups. ConclusionModified Longdan Xiegan Tang can ameliorate wound condition， reduce inflammatory response， and promote wound healing in patients with perianal abscess of heat-toxin accumulation syndrome after surgery， with good safety.

ObjectiveTo observe the effects of modified Longdan Xiegan Tang on wound healing and inflammatory factors after surgery for perianal abscess of heat-toxin accumulation syndrome. MethodsA prospective randomized controlled design was adopted. A total of 110 patients with perianal abscess of heat-toxin accumulation syndrome admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from January 2024 to January 2025 were included and randomly assigned into two groups， each with 55 patients according to the random number table method. The control group received conventional Western medicine treatment + placebo oral administration after surgery， and the observation group received modified Longdan Xiegan Tang oral administration on the basis of conventional Western medicine treatment， with a course of 14 days. Clinical efficacy， Visual Analogue Scale （VAS） score， wound secretion score， TCM symptom score， wound healing rate， wound healing time， wound infection rate， inflammatory factors ［interleukin-6 （IL-6）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α）］， wound healing-related indicators ［fibronectin （FN）， matrix metalloproteinase-9 （MMP-9）， and prealbumin （PA）］ and adverse reactions were determined in both groups. ResultsThree cases in the observation group and three cases in the control group dropped out， with 104 cases actually completing the study. The repeated measures analysis of variance showed that both groups showed decreased VAS scores， wound secretion scores， TCM syndrome scores， and levels of IL-6， IL-8， TNF-α， and MMP-9 and increased levels of PA and FN after treatment （P<0.05）. During treatment and on day 14 after surgery， the observation group had lower VAS score， wound secretion score， TCM syndrome score， and levels of IL-6， IL-8， TNF-α， and MMP-9 and higher levels of PA and FN than the control group （P<0.01）. The observation group showed higher wound healing rate， shorter wound healing time， and lower wound infection than the control group （P<0.01）. The comprehensive efficacy of the observation group was better than that of the control group （χ²=5.216， P<0.05）. No serious adverse events occurred in patients during the study， and there was no significant difference in the incidence of adverse reactions between the two groups. ConclusionModified Longdan Xiegan Tang can ameliorate wound condition， reduce inflammatory response， and promote wound healing in patients with perianal abscess of heat-toxin accumulation syndrome after surgery， with good safety.

ObjectiveTo investigate the prevalence of cardiovascular diseases and their influencing factors in community-based schizophrenia patients in Shanghai, and to provide a scientific basis for the early identification and prevention of cardiovascular disease in this population. MethodsBased on the Shanghai community cohort with severe mental disorders in 2022, a total of 3 954 community-based schizophrenia patients were identified and included in this study through a stratified cluster sampling method. Basic information and relevant clinical data (including metabolic index data) were collected through questionnaire survey, physical examination and laboratory testing. Univariate analyses were performed using the chi-square tests, and multivariate logistic regression analyses were employed to identify influencing factors of comorbid cardiovascular diseases. ResultsA total of 3 954 community-based schizophrenia patients were included, of which a total of 1 237 (31.28%) patients had comorbid cardiovascular diseases. Multivariate logistic regression analyses showed that age 60 years old or above (OR=5.524, 95%CI: 3.716‒8.214), smoking behavior (OR=1.328, 95%CI: 1.042‒1.692), overweight (OR=1.900, 95%CI: 1.046‒3.451) or obesity (OR=2.678, 95%CI: 1.439‒4.985), elevated blood pressure (OR=1.546, 95%CI: 1.294‒1.846), abnormal fasting blood glucose (OR=1.552, 95%CI: 1.322‒1.823) and high-density lipoprotein cholesterol abnormalities (OR=1.283, 95%CI: 1.025‒1.606) were positively associated with the risk of comorbid cardiovascular diseases in patients with schizophrenia, while educational attainment of college/bachelor’s degree or above (OR=0.640, 95%CI: 0.450‒0.910) and being unmarried (OR=0.552, 95%CI: 0.457‒0.667) were negatively associated with the risk of cardiovascular diseases comorbidity. ConclusionAdvanced age, unhealthy behaviors and lifestyles, as well as abnormalities in blood pressure, blood glucose, and blood lipids, could all increase the risk of comorbid cardiovascular diseases in community schizophrenia patients. It is suggested to strengthen the monitoring and management of these risk factors in this population in the future, so as to achieve early detection, early diagnosis and early intervention of cardiovascular diseases.

Objective To explore the relationship between the nutritional risk and the risk of frequent acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods The patients with acute exac-erbation of COPD(AECOPD)hospitalized in the respiratory and critical care medicine department of the First Affiliated Hospital of Xiamen University were collected and divided into the frequent acute exacerbation risk group(FE)and non-frequent exacerbation risk group(NE).The nutritional risk was evaluated by the Nutri-tional Risk Screening Scale-2002(NRS-2002)(1-2 points as no nutritional risk,3-7 points as nutritional risk).The relationship between the two was analyzed by statistics and logistic regression.Results The FE group had longer hospital stay(P<0.01)and a higher proportion of hypertension(P<0.01).In terms of in-flammatory indicators,the neutrophil to albumin ratio(P<0.01)and platelet to lymphocyte ratio(P<0.05)in the FE group were significantly increased.In the aspect of nutritional status,the NRS-2002 score in the FE group showed a higher proportion of nutritional risk population(P<0.01),meanwhile the total protein(P<0.01)and albumin(P<0.05)levels were significantly decreased.After adjusting the confounding factors such as gender,hospitalization duration,inflammatory markers and history of underlying diseases,the full fac-tor logistic regression analysis revealed that the frequent acute exacerbation risk in COPD patients with nutri-tional risk was significantly higher that in the patients with no nutritional risk[odds ratio(OR)=2.948;95%confidence interval(95%CI):1.112-7.816;P<0.05].Conclusion The COPD patients with nutritional risk in NRS-2002 scores exhibit a significantly increased risk of frequent acute exacerbation compared to those without nutritional risk.

Objective To investigate the changes and clinical significance of pyroptosis and inflammation in children with acute lymphoblastic leukemia after chemotherapy.Methods A retrospective analysis was con-ducted on the clinical data of 98 children with acute lymphoblastic leukemia who received chemotherapy in the pediatrics and hematology and oncology departments of the hospital from May 2023 to August 2024.Accord-ing to the results of blood culture,the selected children were divided into the Gram-positive bacteria group,the Gram-negative bacteria group,the fungal group and the non-bloodstream infection group,and drug sensitivity tests were conducted.After chemotherapy,the children were divided into the granulocytosis group and the non-granulocytosis group according to the granulocyte level.The relevant indicators were detected and com-pared by methods such as blood routine,flow microsphere array technology,enzyme-linked immunosorbent assay(ELISA),and Western blot.Results After chemotherapy,the pyroptosis related indicators caspase-1,caspase-4,caspase-5,caspase-11,interleukin(IL)-1 β,IL-18,the proportion of pyroptosis cells and the relative expression level of GSDMD protein in children of each infection type were significantly increased compared with those before chemotherapy(P＜0.05).After chemotherapy,the levels of IL-4,IL-6,IL-10 and interfer-on-γ(IFN-γ)in the granulocytosis group were significantly higher than those in the non-granulocytosis group(P＜0.05),and the granulocyte level was negatively correlated with the levels of IL-4,IL-6,IL-10 and IFN-γ(P＜0.05).There were statistically significant differences in the levels of IL-4,IL-6,IL-10 and IFN-γ in dif-ferent infection states after chemotherapy(P＜0.05).Conclusion The number of granulocytes and the levels of serum cytokines can serve as potential indicators of infection in children with leukemia.The regulation of pyroptosis may provide new strategies for the treatment of childhood leukemia.

Objective To investigate the predictive value of serum human epididymis protein 4(HE4)levels in primary Sj?gren's syndrome(pSS)patients for renal injury.Methods A retrospective analysis of 77 pSS patients admitted to the Second People's Hospital of Yichang from September 2021 to August 2023 was performed,including 43 cases of renal injury group 34 instances of non-renal injury group,and 54 healthy physical examination subjects(HCs)as control group.Fasting peripheral venous blood(4ml)was collected to detect the serum levels of HE4,Cys-C,TNF-α,CR,C3,C4,immunoglobulin,Anti-SSA,Anti-SSB and other indicators,and analyzed the value of HE4 in the early diagnosis of kidney injury in pSS patients.Results Compared with HCs,the pSS patients had increased levels of HE4(120.02±103.86 pmol/L vs 57.5±16.52 pmol/L),Cys-C(1.30±0.81mg/L vs 0.87±014 mg/L),and the differences were statistically significant(t=4.382,3.860,all P<0.05).The serum levels of HE4,CR and TNF-α in the renal damage group were higher than those in the non-renal damage group,and the differences were statistically significant(t/χ2=2.552～4.371,all P<0.05).Pearson correlation analysis showed that,the levels of serum HE4,Cys-C,CR and TNF-α were all positively correlated with renal damage in pSS(r=0.287～0.546,all P<0.05).Logistic regression analysis showed that elevated serum HE4 level might be an independent risk factor for inducing renal damage in pSS(Wald χ2=11.932,P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the best cut-offvalue of serum HE4 for the diagnosis of pSS renal damage was 70.46pmol/L,the maximum Youden index was 0.625,AUC(95%CI)=0.876(0.799～0.954).Conclusion The serum HE4 level in patients with pSS is positively correlated with renal injury and has predictive value for the occurrence of renal injury.