ObjectiveTo investigate whether anti-programmed death-1 （PD-1） monoclonal antibody can enhance the efficacy and safety of argon-helium cryoablation combined with targeted therapy in patients with unresectable hepatocellular carcinoma （uHCC） aged 60 years or older. MethodsA retrospective analysis was performed for the clinical data of 124 patients with advanced uHCC aged 60 years or older who were treated at The Fifth Medical Center of Chinese PLA General Hospital from January 2013 to September 2024. After propensity score matching， 57 patients received cryoablation combined with targeted therapy （double combination group）， while 57 received cryoablation combined with targeted therapy and anti-PD-1 monoclonal antibody （triple combination group）. The indicators for efficacy assessment included objective response rate （ORR）， disease control rate （DCR）， progression-free survival （PFS）， overall survival （OS）， and the incidence rate of adverse events. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison between groups. A Cox proportional-hazards regression model analysis was used to investigate the influencing factors for survival prognosis. ResultsThe triple combination group had a significantly higher ORR than the double combination group （59.6% vs 29.8%， χ²=9.083， P=0.003）， while there was no significant difference in DCR between the two groups （87.7% vs 77.2%， χ²=1.516， P=0.218）， and compared with the double combination group， the triple combination group had significantly longer median PFS （9.1 months vs 4.8 months， χ²=7.813， P=0.005） and median OS （26.1 months vs 13.6 months， χ²=14.199， P<0.001）. The multivariate Cox proportional-hazards regression model analysis showed that triple combination treatment was an independent influencing factor for PFS （hazard ratio ［HR］=0.52， 95% confidence interval ［CI］： 0.35 — 0.78， P=0.001） and OS （HR=0.32， 95%CI： 0.20 — 0.51， P<0.001）. There was no significant difference in the incidence rate of adverse events between the two groups （P>0.05）. ConclusionTriple combination treatment with argon-helium cryoablation， targeted therapy， and anti-PD-1 monoclonal antibody can significantly improve survival benefits in uHCC patients aged 60 years or older， with a controllable safety profile.

ObjectiveTo observe the changes in the levels of different subtypes of epidermal growth factor receptor （ErbB）， namely ErbB1， ErbB2， ErbB3， and ErbB4， in the spinal dorsal horn of inflammatory pain model rats， and to explore their mechanism of mediating hyperalgesia as well as the intervention mechanism of electroacupuncture at "Zusanli （ST 36）" and "Kunlun （BL 60）". MethodsThe study was divided into five parts. In experiment 1， 14 Sprague Dawley （SD） rats were randomly divided into control and inflammatory pain group （7 rats each group） to observe the pain behavior and the protein expression of different ErbB receptor subtypes in the spinal dorsal horn. In experiment 2， 30 rats were randomly divided into control group 1， inflammatory pain group 1， and low-， medium-， and high-concentration TX1-85-1 groups， with 6 rats in each group， to observe the effect of inhibiting spinal ErbB3 on inflammatory pain. In experiment 3， 12 rats were randomly divided into control virus group and ErbB3 knockdown virus group， with 6 rats in each group， to observe the effect of knocking down ErbB3 in the spinal dorsal horn on inflammatory pain. In experiment 4， 44 rats were randomly divided into control group 2， inflammatory pain group 2， electroacupuncture group， and sham electroacupuncture group， with 11 rats in each group， to observe the effect of electroacupuncture. In experiment 5， 40 rats were randomly divided into control group 3， inflammatory pain group 3， electroacupuncture group 1， and electroacupuncture + NRG1 group， with 10 rats in each group， to observe the effect of activating ErbB3 on electroacupuncture. A rat model of inflammatory pain was established by subcutaneous injection of 100 μl of complete Freund's adjuvant into the sole of the unilateral hind foot of SD rats. Rats in the low-， medium-， and high-concentration TX1-85-1 groups were intrathecally injected with ErbB3 inhibitor TX1-85-1 on day 5 to day 7 after modeling. Rats in the ErbB3 knockdown virus group were injected with ErbB3 knockdown virus packaged with adenovirus vector-based short hairpin RNA （shRNA） into the spinal dorsal horn in situ 3 weeks before modeling. Rats in each electroacupuncture group received electroacupuncture at bilateral "Zusanli （ST 36）" and "Kunlun （BL 60）" from day 1 to day 7 after modeling， with dense-sparse waves at a frequency of 2 Hz/100 Hz and a current of 0.5-1.5 mA for 30 minutes once a day. Rats in the electroacupuncture + NRG1 group were intrathecally injected with ErbB3 ligand recombinant human neuregulin-1 （NRG1） after electroacupuncture intervention from day 5 to day 7 after modeling. The mechanical withdrawal threshold and thermal withdrawal latency of rats were measured on day 1， 3， 5， and 7 after modeling to evaluate behavior， and Western Blot was used to detect the protein and phosphorylation levels of each ErbB subtype in the spinal dorsal horn. ResultsCompared with the control group， rats in the inflammatory pain group showed decreased mechanical withdrawal threshold and thermal withdrawal latency of rats， and increased expression of phosphorylated ErbB3 （p-ErbB3） protein in the spinal dorsal horn on days 1， 3， 5， and 7 after modeling （P＜0.01）. On day 5 and day 7 after modeling， compared with the inflammatory pain group 1， the mecha-nical withdrawal threshold and thermal withdrawal latency of rats in the medium- and high-concentration TX1-85-1 groups increased， and the expression of p-ErbB3 protein decreased （P＜0.05）. On day 1， 3， 5， and 7 after modeling， compared with the control virus group， the mechanical withdrawal threshold and thermal withdrawal latency of rats in the ErbB3 knockdown virus group increased （P＜0.05）. On day 5 and day 7 after modeling， compared with the inflammatory pain group 2 and the sham electroacupuncture group， the mechanical withdrawal threshold and thermal withdrawal latency of rats in the electroacupuncture group increased， and the expression of p-ErbB3 protein decreased （P＜0.05）. On day 5 and day 7 after modeling， compared with the electroacupuncture + NRG1 group， the mechanical withdrawal threshold and thermal withdrawal latency of rats in the electroacupuncture group 1 increased （P＜0.05）. ConclusionThe p-ErbB3 in the spinal dorsal horn involved in hyperalgesia in rats with inflammatory pain， and electroacupuncture at "Zusanli （ST 36）" and "Kunlun （BL 60）" can alleviate inflammatory pain by inhibiting the expression of p-ErbB3 protein in the spinal dorsal horn of rats.

Diabetes mellitus, characterized by glucose metabolism disorders and marked by insulin deficiency or insulin resistance, has seen a continuous rise in prevalence. In recent years, islet transplantation has matured as a therapeutic approach for diabetes, becoming an important method for glycemic control and the reduction of diabetes-related complications. Donor selection directly influences transplant outcomes, and various research institutions worldwide have proposed multiple scoring systems to optimize donor assessment, such as the University of Alberta scoring system and the North American Islet Donor Score. This article explores the impact of key factors such as donor age, body mass index and ischemia time on islet transplantation. Combining practical experience in pancreatic donor selection from Shanghai Changzheng Hospital, it proposes screening criteria for pancreatic donors suitable for China, aiming to provide new evidence for improving the success rate of islet transplantation.

ObjectiveTo develop a community-family management model for older adults with mild cognitive impairment (MCI) and to formulate detailed application specifications, and to fully leverage the initiative of communities and families under limited resource conditions, for achieving community-based early detection and early intervention for older adults with MCI. MethodsA systematic literature review was conducted to identify pertinent publications. Corpus-based research methodologies were employed to extract, refine, integrate and synthesize management elements, thereby establishing the specific content and service processes for each stage of the management model. Utilizing the 5W2H analytical framework, essential elements such as management stakeholders, target populations, content and methods for each stage were delineated. The model and its application guidelines were finalized through expert consultation and demonstration. ResultsAn expert evaluation of the management model yielded mean scores of 4.84, 4.32 and 4.84 for acceptability, feasibility and systematicity, respectively. By integrating the identified core elements with expert ratings and feedback, the final iteration of the community-family management model for older adults with MCI was formulated. This model comprised of five stages: screening and identification, comprehensive assessment, intervention planning, monitoring and referral pathways to ensure implementation, and enhanced support for communities, family members and caregivers. Additionally, it included 18 specific application guidelines. ConclusionThe proposed management model may theoretically help delay cognitive decline, improve cognitive function and potentially promote reversal from MCI to normal cognition. It may also enhance the awareness and coping capacity of older adults and their families, strengthen community healthcare professionals' ability to early identify and manage MCI.

ObjectiveTo construct a risk prediction model for frequent acute exacerbations of chronic obstructive pulmonary disease （COPD） under disease-syndrome combination， thus providing decision support for precise clinical intervention. MethodsA total of 2 029 patients with acute exacerbations of COPD admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2020 to August 2024 were retrospectively included. These patients were classified into groups of frequent acute exacerbations （≥2 times/year） and infrequent acute exacerbations （<2 times/year） according to the hospitalization times per year. Risk factors were screened by LASSO regression combined with logistic regression， and a nomogram model was constructed. The model performance was assessed based on the area under the curve （AUC）， calibration curves， and decision curve analysis （DCA）. ResultsThe differences in baseline characteristics between the frequent acute exacerbations group （1 196 cases） and infrequent acute exacerbations group （833 cases） were not statistically significant. LASSO regression combined with multivariate logistic regression screened the following independent risk factors： body mass index （BMI）， hospitalization days， number of smoking years， place of residence， use of noninvasive ventilators， oxygen-demanding therapy， liver cirrhosis， use of systemic glucocorticosteroids， and traditional Chinese medicine syndrome （phlegm and stasis obstructing the lung）. The nomogram model showed good discrimination and calibration in both the training set （AUC=0.748） and validation set （AUC=0.774）. ConclusionThe risk prediction model for frequent acute exacerbations of COPD， integrating traditional Chinese medicine syndrome， constructed in this study has high accuracy. It can provide a scientific basis for early clinical identification of high-risk patients and individualized intervention.

Objective:To investigate the current status of occupational stress among electronic manufacturing workers in Qingdao and analyze its effect on depressive symptoms and anxiety symptoms.Methods:From July to September 2022, a cluster random sampling method was employed to select frontline workers from 14 electronic manufacturing enterprises in Qingdao as the study subjects. A total of 1134 questionnaires were distributed, with 1000 valid questionnaires collected, yielding an effective response rate of 88.18%. The Core Occupational Stress Scale (COSS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were adopted to assess occupational stress, depressive symptoms, and anxiety symptoms, respectively. Binary logistic regression was employed to analyze influencing factors of occupational stress and its effects on depressive and anxiety symptoms.Results:The detection rates of occupational stress, depressive symptoms, and anxiety symptoms were 15.1% (15/1000), 7.9% (79/1000), and 13.8% (138/1000), respectively. The influencing factor analysis of occupational stress revealed that female gender ( OR=0.621, 95% CI: 0.434-0.890) and weekly working hours of 45-48 hours ( OR=0.537, 95% CI: 0.309-0.935) were protective factors ( P<0.05), while weekly working hours ≥55 hours ( OR=2.176, 95% CI: 1.290-3.670) and shift work ( OR=2.038, 95% CI: 1.412-2.940) were risk factors ( P<0.05). Spearman correlation analysis showed that the COSS score was positively related with the PHQ-9 score and the GAD-7 score ( rs=0.438, 0.289, P<0.01). Workers judged with occupational stress had 3.596 times (95% CI: 2.181-5.931, P<0.001) and 3.121 times (95% CI: 2.046-4.761, P<0.001) higher risks of detecting depressive and anxiety symptoms compared to those without occupational stress. Conclusion:Electronic manufacturing workers in Qingdao experience a certain level of occupational stress, which may increase the risk of developing depressive and anxiety symptoms. Enterprises should implement appropriate interventions to promote workers' mental health.

Objective:To investigate the clinical efficacy of minimally invasive double anchoring combined with percutaneous kyphoplasty (PKP) for Kümmell disease.Methods:The clinical data of 24 patients with Kümmell disease who were treated with minimally invasive double anchoring combined with PKP in Cangzhou People's Hospital from October 2022 to March 2024 were retrospectively analyzed. Among them, there were 2 T 10 vertebrae, 5 T 11 vertebrae, 7 T 12 vertebrae, 6 L 1 vertebrae, and 4 L 2 vertebrae. There were 6 males and 18 females. The average age was 72.05±4.52 years (range, 66-80 years). The bone mineral density T value was -3.41±0.77 (range, -2.5-4.5). The stages of Li's Kümmell disease included 13 cases of stage II and 11 cases of stage III. The operation time, intraoperative blood loss, and volume of bone cement injected were recorded. The vertebral index, vertebral angle and Cobb angle of diseased segment were measured before and after operation. The visual analogue scale (VAS) was used to assess the degree of pain, the Oswestry disability index (ODI) and the Japanese Orthopaedic Association (JOA) low back pain scale were used to assess spinal function. The Medical Outcome Study short form 36 item health survey (SF-36) was used to assess the general health status of the patients. The postoperative symptom recovery was evaluated by Odom criteria. Results:The mean operative time of the 24 patients was 35.32±6.86 min, the injected volume of bone cement was 4.39±1.72 ml, and the intraoperative blood loss was 16.56±5.21 ml. All patients were followed up for 10 to 14 months, with an average of 11.7 months. Postoperative CT examination showed that the screw positions were satisfactory, and no loosening or displacement of bone cement mass occurred. On the first day after surgery, the vertebral body index, vertebral body angle and Cobb angle of diseased segment were 77.71%±2.75%, 12.40°±1.53° and 25.77°±4.49°, respectively, which represented significant improvements from the preoperative values of 43.09%±5.66%, 22.12°±2.92° and 46.98°±5.68° before surgery ( P<0.05). At the last follow-up, the values were 76.18%±2.32%, 12.41°±2.53°, 26.14°±4.87°, respectively, which were significantly improved compared with those before surgery ( P<0.05), but there was no statistical significance compared with the first day after surgery ( P>0.05). The VAS, ODI and JOA scores on the first day after surgery were 2.11±0.87 points, 22.46±5.49 points and 27.68±2.45 points, respectively, which were significantly improved compared with those before surgery 7.50±0.98 points, 76.25±8.56 points and 14.96±4.91 points ( P<0.05). At the last follow-up, the values were 2.26±0.88, 23.87±3.25 and 26.58±2.77, respectively, which were significantly improved compared with those before surgery ( P<0.05), and there was no statistical significance compared with the first day after surgery ( P>0.05). All 24 patients completed SF-36 scale assessment, and the results showed that there were statistically significant differences in physiological function, physiological role, physical pain, general health status, social function scores and mental health between the patients before surgery and the last follow-up ( P<0.05), while there were no statistically significant differences in vitality and emotional function ( P>0.05). At the last follow-up, the Odom criteria showed excellent results in 18 cases, good in 4 cases, and fair in 2 cases. Conclusions:The application of minimally invasive double anchoring (single nail fixation) combined with PKP in the treatment of Kümmell disease can effectively prevent the loosening and displacement of bone cement masses, and the fixation effect is satisfactory, which can restore the height of the injured vertebrum, reduce kyphosis and improve spinal function. The clinical symptoms of the patients were significantly improved, and the quality of life was enhanced.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:This study aims to develop a rapid identification technique for various genotypes of extended-spectrum β-lactamase (ESBL) producing Escherichia coli using matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) in conjunction with machine learning algorithms. Methods:A total of 158 Escherichia coli strains were isolated from the clinical laboratory of the First Hospital of Jilin University from August 2018 to December 2022. Polymerase chain reaction (PCR) was employed to detect the CTX-M-1, CTX-M-8, CTX-M-9, and SHV genes. Mass spectral data of the bacterial strains were acquired by MALDI-TOF MS with a cooperative matrix of (E)-propyl α-cyano-4-hydroxycinnamate (CHCA-C3). Models based on random forest (RF), logistic regression (LR), and support vector machine (SVM) algorithms were constructed. The performance of the constructed models was evaluated using metrics including accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Mass spectral peaks exhibiting sensitivity and specificity exceeding 80% in the models were designated as characteristic peaks. To validate the efficacy of the cooperative matrix of CHCA-C3, clinical isolates of ESBL-producing Escherichia coli were analyzed by MALDI-TOF MS using the conventional CHCA matrix for comparative purposes. Results:Among the 158 strains of Escherichia coli, 91 strains produced ESBL, all of which were CTX-M genotype. The AUC values for the respective models were as follows: CTX-M-1 genotype exhibited AUC values of 0.98 for LR, 1.00 for RF, and 0.73 for SVM; CTX-M-9 genotype exhibited AUC values of 0.93 for LR, 0.99 for RF, and 0.76 for SVM; for CTX-M-8, all models achieved an AUC of 1.00, indicating excellent classification performance with respect to accuracy, specificity, and sensitivity. The characteristic mass spectral peaks associated with each genotype included: CTX-M-1 genotype at m/z 6 390; CTX-M-8 genotype at m/z 5 224, m/z 5 393, and m/z 9 021; CTX-M-9 genotype at m/z 5 161 and m/z 5 273. In the MALDI-TOF MS analysis conducted with the conventional CHCA matrix, the characteristic peak at m/z 9 021 for CTX-M-8 was the only one detected, with the characteristic peaks for CTX-M-1 and CTX-M-9 remaining undetected. Conclusion:The application of cooperative matrix of CHCA-C3 in conjunction with MALDI-TOF MS and machine learning algorithms facilitates the rapid and precise identification of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. This approach offers a feasible solution for evidence-based clinical therapy and the control of healthcare-associated infections.

Objective:To explore the clinical application value of artificial intelligence（AI）-assisted training in enhancing the accuracy of nuchal translucency（NT）identification，standardization of measurement，and diagnostic efficacy for abnormalities among ultrasound residents.Methods:A retrospective collection of 300 standard fetal NT ultrasound images was conducted at the Center for Medical Ultrasound，Suzhou Hospital Affiliated of Nanjing Medical University from January 2018 to June 2024. The AI model performed NT measurements and diagnoses once. Four sonographers of different seniority levels（including two resident physicians）independently conducted NT measurements and diagnoses twice. Prior to the experiment，the middle-age and resident sonographers had uniformly completed traditional theory training. Following the first independent measurements，the two resident sonographers received additional AI-assisted training，after which all 4 sonographers performed the second independent measurements. A fetal medicine expert evaluated blindly all the results and compared the differences in NT recognition accuracy，measurement standard rate and diagnosis accuracy between the middle-age sonographer（traditional training only）and two resident sonographers（traditional + AI-assisted training）.Results:For the middle-aged sonographer who only received traditional lecture-based training，the accuracy of NT recognition，standardization rate of measurement，or diagnostic accuracy were not significantly improved befroe and after the training，and the diffrence was not statistically significant（ χ2=0.189，1.887，0.326；all P>0.05）. In contrast，the second-year resident（Resident 2）and first-year resident（Resident 1），who received both traditional lecture-based training and AI training，demonstrated some improvements in the accuracy of NT measurement site recognition，though the differences were not statistically significant（ χ2=1.301，2.418；all P>0.05）. However，both residents did significant improvements in the standardization rate of NT measurement（ χ2=25.768，17.035；all P<0.05）. In terms of diagnostic accuracy，Resident 1 did significant improvement（ χ2=10.180， P<0.05），while Resident 2 also did some improvement，though the difference was not statistically significant（ χ2=2.573， P>0.05）. Conclusions:The AI-assisted training system enhances the ability of ultrasound resident sonographers to recognize，measure，and diagnose NT，providing a novel and efficient training model for standardized residency training in ultrasound specialties.