ObjectiveTo explore the incidence of major low anterior resection syndrome （LARS） within six months after sphincter-preserving surgery for rectal cancer and to analyze its associated factors. MethodsClinical records， postoperative rehabilitation data and LARS scores were collected from 889 patients at 3 months postoperatively and from 844 patients at 6 months postoperatively. Patients were divided into a major LARS group and a non-major LARS group. Multivariable Logistic regression was used to analyze factors associated with major LARS at 3 and 6 months postoperatively， and the predictive value of the models was assessed using the Hosmer-Lemeshow goodness-of-fit test and the receiver operating characteristic （ROC）. ResultsAmong patients undergoing sphincter-preserving surgery for rectal cancer， 247 patients （27.8%） had major LARS at 3 months postoperatively and 181 patients （21.4%） at 6 months postoperatively. Multivariable Logistic regression showed that Kegel exercises， preoperative radiotherapy， anastomotic leakage， a tumor distance from the anal verge of ≤5 cm， and an anastomotic distance from the anal verge of ≤5 cm were independent factors for major LARS at 3 months postoperatively （P<0.05）. At 6 months postoperatively， occasional Kegel exercises during 0~3 months， Kegel exercises during 4~6 months， hydrotherapy during 4~6 months， preoperative chemotherapy， a tumor distance from the anal verge of ≤5 cm， and an anastomotic distance from the anal verge of ≤5 cm were independent factors （P<0.05）. The models at 3 and 6 months postoperatively showed goodness-of-fit test P values of 0.986 and 0.517 and area under the curve （AUCs） of 0.843 and 0.870， indicating good predictive value. ConclusionThe incidence of major LARS within six months after sphincter-preserving surgery for rectal cancer is relatively high， and greater attention should be paid to patients who receive preoperative chemoradiotherapy， develop anastomotic leakage， or have tumor and anastomotic distances from the anal verge of ≤5 cm. Patients should also be advised that early postoperative Kegel exercises and hydrotherapy may reduce the incidence of major LARS.

Objective: To explore the relationship between life skills, psychological resilience and subjective well-being among primary and secondary school students, so as to provide evidence for targeted adolescent mental health education. Methods: From September to November, 2025, a total of 5 831 primary and secondary school students from five cities (Beijing, Guangzhou, Shenzhen, Chongqing, Urumqi) were selected by convenience sampling. The Adolescent Subjective Well being Scale, School based Adolescents Life Skills Scale, and Adolescent Psychological Resilience Scale were used for investigation. Data were analyzed using t-tests, one way ANOVA, and linear regression. Results: The total mean score of students subjective well being was (5.46± 0.91) ; the total mean score of life skills was (3.69±0.64); the total mean score of psychological resilience was (3.66±0.69). Statistically significant differences in subjective well being scores were found among students grouped by gender, grade, school stage, residential city, living with parents or living with siblings ( t/F =4.14, 53.92, 14.53, 49.99, 13.49, 2.18, all P <0.01). Stratified regression analyses were performed by gender (adjusting for school stage, residential city and living arrangement) and by school stage (adjusting for gender, residential city and living arrangement), the regression results indicated that life skills of boys, girls, primary school students and junior high school students( β =0.54, 0.53, 0.50, 0.57) and their psychological resilience ( β = 0.56 , 0.60, 0.56, 0.60) were positively associated with subjective well being (all P <0.01). Conclusions Life skills and psychological resilience may be important protective factors for subjective well being among primary and secondary school students. School based mental health education should emphasize life skills training and resilience building to promote students subjective well being.

Objective: To explore the association between parental subjective well-being and subjective well-being among primary and secondary school students, so as to provide evidence for promoting adolescent mental health from a family perspective. Methods: From September to November 2025, a convenience sampling method was used to recruit 4 612 students in grades 4-8 from 12 primary and secondary schools in five cities—Beijing, Guangzhou, Shenzhen, Chongqing, and Urumqi—along with their parents. Students completed the Adolescent Well being Survey Questionnaire, while parents completed the Parental Well being Survey Questionnaire. Data were analyzed using t-test, one way analysis of variance, multiple linear regression, Logistic regression, and stratified subgroup analyses. Results: The maximum score of the subjective well-being scale for primary and secondary school students was 301, with a total score of (224.07±46.63), representing 74.4% of the full score; the maximum score of the parental subjective well-being scale was 120, with a total score of (92.35±15.10), representing 77.0%. Multiple linear regression analysis showed that parental subjective well-being was positively associated with students overall subjective well-being, positive affect, and satisfaction in each domain (friendship, family, school, environment, freedom, and academics), and negatively associated with negative affect ( β =0.45, 0.08, 0.06, 0.07, 0.05, 0.04, 0.05, 0.04, -0.05, all P <0.01). Logistic regression and stratified analysis showed that parental subjective well-being was positively associated with students high subjective well-being ( OR =1.03), and the association existed in subgroups of different gender, grade and family structure ( OR =1.02-1.04) (all P <0.05). Conclusions Parental subjective well-being is positively associated with students subjective well-being. Future interventions should incorporate an integrated strategy featuring family-school collaboration to promote adolescent well-being.

Objective:To compare the clinical features of severe Mycoplasma pneumoniae pneumonia (SMPP) in pediatric intensive care units (PICU) before and after the COVID-19 pandemic.Methods:A retrospective study was conducted in the PICU of Shanghai Children's Hospital. Clinical and laboratory data were collected from medical records of SMPP patients admitted to the PICU before (January to December 2019) and after (March 2023 to February 2024) the COVID-19 pandemic. Patients admitted in 2019 were categorized as the pre-COVID-19 group, while those admitted in 2023-2024 were classified as the post-COVID-19 group.Results:A total of 287 children with SMPP were included, comprising 155 males and 132 females. The pre-pandemic group consisted of 180 cases, while the post-pandemic group had 107 cases. Macrolide-resistant Mycoplasma pneumoniae (MRMP) was detected in 270 cases (94.1%), with no significant difference in MRMP prevalence between the two groups [101 cases (94.4%) vs. 169 cases (93.9%), Z= 0.031, P = 0.861]. The median age of the post-pandemic group was higher than that of the pre-pandemic group [72 (42, 108) months vs. 42 (24, 68) months, Z= 6.438, P < 0.001].Comparisons of complications between the post-pandemic and pre-pandemic groups were as follows: pleural effusion [20 cases (18.7%) vs. 81 cases (45.0%), χ2=20.365, P< 0.001], shock [4 cases (3.7%) vs. 79 cases (43.9%), χ2=52.628, P< 0.001], gastrointestinal dysfunction [2 cases (1.9%) vs. 24 cases (13.3%), χ 2=9.359, P=0.002], liver dysfunction [9 cases (8.4%) vs. 46 cases (25.6%), χ2=12.733, P< 0.001], and renal injury [0 cases vs. 10 cases (5.6%), P=0.015].There was no significant difference in the incidence of respiratory failure [102 cases (95.3%) vs. 172 cases (95.6%), χ2=0.008, P=0.928]. However, the number of cases requiring high-flow oxygen therapy and mechanical ventilation was significantly lower in the post-pandemic group compared to the pre-pandemic group [14 cases (13.3%) vs. 48 cases (26.7%), 21 cases (20.3%) vs. 122 cases (67.8%), all P<0.05].The time from symptom onset to the initiation of tetracycline/quinolone therapy was shorter in the post-pandemic group compared to the pre-pandemic group [7 (3, 10) days vs. 9 (6.3, 11) days, χ2=-3.565, P< 0.001]. The proportion of patients who had already received tetracycline/quinolone therapy before admission to the PICU was significantly higher in the post-pandemic group compared to the pre-pandemic group [25 cases (23.4%) vs. 2 cases (1.1%), χ 2=10.009, P=0.002].Both the total hospital stay and PICU stay were shorter in the post-pandemic group compared to the pre-pandemic group [10.0 (8.0, 14.0) days vs. 15.5 (12.0, 22.0) days, 5 (3.0, 8.0) days vs. 7.0 (5.0, 10.0) days, all P=0.000]. All 7 deaths occurred in the pre-pandemic group, including 5 cases with co-infections and 2 cases with underlying diseases. Conclusions:In the post-COVID-19 era, SMPP cases in the PICU were predominantly observed in children over 5 years old, with a lower incidence of shock, gastrointestinal disorders, liver injury, and kidney injury compared to the pre-pandemic period. Patients with macrolide-resistant Mycoplasma pneumoniae who received timely treatment with tetracycline/quinolones exhibited favorable outcomes.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

ObjectiveTo explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). MethodsData were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis. ResultsA total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality. ConclusionThe ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

Objective:To evaluate the trustworthiness of generative artificial intelligence technology of Chinese large language mod-els(LLMs)in addressing issues related to anterior tooth aesthetic restoration and to explore the way to enhance the reliability of existing LLMs when answering questions in the field of oral health care through relevant artificial intelligence technologies.Methods:4 top-tier Chinese LLMs,BaiChuan 3.0(A),ZhiPu QingYan GLM-4(B),Wenxin Yiyuan 3.5(C),and QianWen(D)were used to analyze 10 items of anterior teeth aesthetic restoration.Standards were set using scholarly data and expert consensus,the model's recall and hallucination rates were compared.CoT technique was applied to gauge the effect on enhancing answer accuracy in dental queries.A and B models were tested for the effect of retrieval-augmented generation(RAG)in the improvement of their performance.Results:The recal rate of model A,B,C and D was 0.416 7±0.13,0.350 5±0.20,0.358 7±0.01 and 0.561 9±0.04 respective-ly,the hallucination rate was 0.465 1±0.04,0.694 6±0.13,0.501 8±0.08 and 0.311 9±0.09 respectively(between A and D groups,t≈15.53,P＜0.05).After integrating Chain-of-Thought(CoT),overall recall improved but some models'hallucination rates rose.Applying RAG features in A and B significantly enhanced answer recall and reduced hallucination rates(P＜0.05).Con-clusion:The methods or features employed by the QianWen LLM demonstrated significant advantages in enhancing answer accuracy and reducing misinformation,thus showing higher credibility in addressing anterior aesthetic restoration issues.Application of the CoT technique may boost correct response rates in some models and increase hallucination rates.In contrast,the RAG strategy can improve the correctness of the LLMs and decreased spurious outputs.

Objective:To explore facilitators and impediments to home glucose management for patients undergoing bariatric surgery based on the consolidated framework for implementation research (CFIR), so as to inform the development of a glucose management pathway after bariatric surgery.Methods:This study was a descriptive phenomenological study. Using purposive sampling method, seven healthcare professionals and 11 patients undergoing bariatric surgery from the General Surgery·Metabolic and Bariatric Center of China-Japan Friendship Hospital were selected from November 2023 to January 2024 for semi-structured interviews. Targeted content analysis was used for the data analysis.Results:A total of six facilitators and six impediments related to the five dimensions of CFIR were distilled. Facilitators included the personalized glucose management program, regular long-term follow-up, multidisciplinary management team, support from family and friends, complication distress, and information technology platform. Impediments involved patterned follow-up, poor accessibility and convenience of resources, role conflict, herd mentality, poor behavioral compliance, and low utilization of digital equipment.Conclusions:Glucose management needs vary in patients after bariatric surgery, with a gradual decline in management compliance. Healthcare professionals should build an "Internet +"home glucose management service model, carry out targeted multidisciplinary team follow-up, and promote the formation of a standardized pathway for patients' home glucose management.

Objective:To evaluate the effect of the integrated physician-nurse management model on postoperative care in preschool children undergoing laparoscopic appendectomy (LA) .Methods:A total of 64 preschool children who underwent LA were selected by convenience sampling from the pediatric surgery department of Xuzhou Children's Hospital Affiliated to Xuzhou Medical University between November 2023 and June 2024. They were randomly assigned to either the intervention group or the control group (32 cases in each). The control group received routine postoperative care, while the intervention group received additional care based on the integrated physician-nurse management model. Postoperative pain scores at 4, 8, 12, 24, and 36 hours after surgery, as well as parental satisfaction, were compared between the two groups.Results:A total of 60 children completed the study, with 30 in each group. Post-intervention, the intervention group had lower pain scores at all five postoperative time points (4, 8, 12, 24, and 36 hours) compared to the control group, and the differences were statistically significant ( P<0.05). Additionally, the parental satisfaction rate in the intervention group was higher than that in the control group with statistically significant difference (χ 2=6.667, P<0.05) . Conclusions:The integrated physician-nurse management model effectively reduces postoperative pain in preschool children undergoing LA and improves parental satisfaction, supporting its clinical promotion and application.

Objective:To evaluate the trustworthiness of generative artificial intelligence technology of Chinese large language mod-els(LLMs)in addressing issues related to anterior tooth aesthetic restoration and to explore the way to enhance the reliability of existing LLMs when answering questions in the field of oral health care through relevant artificial intelligence technologies.Methods:4 top-tier Chinese LLMs,BaiChuan 3.0(A),ZhiPu QingYan GLM-4(B),Wenxin Yiyuan 3.5(C),and QianWen(D)were used to analyze 10 items of anterior teeth aesthetic restoration.Standards were set using scholarly data and expert consensus,the model's recall and hallucination rates were compared.CoT technique was applied to gauge the effect on enhancing answer accuracy in dental queries.A and B models were tested for the effect of retrieval-augmented generation(RAG)in the improvement of their performance.Results:The recal rate of model A,B,C and D was 0.416 7±0.13,0.350 5±0.20,0.358 7±0.01 and 0.561 9±0.04 respective-ly,the hallucination rate was 0.465 1±0.04,0.694 6±0.13,0.501 8±0.08 and 0.311 9±0.09 respectively(between A and D groups,t≈15.53,P＜0.05).After integrating Chain-of-Thought(CoT),overall recall improved but some models'hallucination rates rose.Applying RAG features in A and B significantly enhanced answer recall and reduced hallucination rates(P＜0.05).Con-clusion:The methods or features employed by the QianWen LLM demonstrated significant advantages in enhancing answer accuracy and reducing misinformation,thus showing higher credibility in addressing anterior aesthetic restoration issues.Application of the CoT technique may boost correct response rates in some models and increase hallucination rates.In contrast,the RAG strategy can improve the correctness of the LLMs and decreased spurious outputs.