Objective: To investigate the characteristics and potential risk factors associated with HIV infection among newly reported HIV positive male student cases in Jiangsu Province from 2023 to 2024, so as to provide evidence for targeted intervention strategies. Methods: Data were obtained from the China CDC Surveillance System on newly reported HIV positive male student cases from 2023 to 2024. A survey was conducted to collect information on demographic characteristics, knowledge of AIDS prevention, education and training history, HIV testing history, behavioral and substance use patterns, and other relevant factors prior to HIV diagnosis among 343 newly reported HIV positive male student cases in Jiangsu Province. Multivariate Logistic regression analysis was used to assess the risk factors of HIV infection among male students. Results: Among the HIV positive male student cases, homosexual behavior accounted for 93.88% of transmission routes, while 10.20% involved heterosexual contact, as well as 4.08% for two sexual hehaviors. Awareness of HIV prevention knowledge was 97.08%, and 66.76% had previously undergone HIV testing. Among the respondents, 10.50% had used rush poppers as enhancers, and 72.30% had received HIV prevention education within the past year. Among students cases with homosexual behavior, the median time from first homosexual contact to HIV diagnosis was ≤2 years, with 54.66% of cases falling into this category; the most common way of finding same sex partners was through social software, accounting for 88.20% of cases, while the proportion of those via "Blued" app reached 87.07% ; the proportion of using condoms every time during sexual activity in the past six months was 12.27%. Among the student cases with homosexual behavior, the results of multiple Logistic regression analysis showed that student cases aged 18 to 24 ( OR =4.52) and >24 ( OR = 19.23 ), without receiving education on HIV prevention in the past year ( OR =1.86), having consistent condom use ( OR =2.73) and not using condoms ( OR =2.12) during the last sexual activity were more likely to had the first same sex sexual activity for more than 3 years before being diagnosed as HIV positive cases (all P <0.05). Student cases who were uncertain about their partner s sexual identity ( OR =0.33), and who primarily identified same sex partners through "other" means ( OR = 0.23 ) were more likely to avoid HIV testing; in contrast, student cases with consistent condom use during the last homosexual encounter ( OR =7.20) was significantly associated with increased likelihood of HIV testing (all P <0.05). Conclusions Newly reported HIV positive male student cases in Jiangsu Province exhibit serious discrepancies between knowledge and practice regarding HIV prevention. Measures are needed to accelerate the optimization of campus based HIV prevention education content and delivery methods. Simultaneously, enhanced management of extracurricular male populations is essential to effectively control the spread of HIV.

Objective To evaluate the short-term effects of comprehensive health management interventions for stroke high-risk population screening on the prevention and treatment of ischemic stroke, and to provide reference and basis for improving and exploring health management and prevention strategies for stroke high-risk population. Methods From 2018 to 2022, 13 community health service centers in Jiading District, Shanghai were selected in the present study. Based on information push platform, stroke risk assessment and health intervention follow-up were conducted for community residents through convenience sampling. The residents were divided into a full course intervention group (intervention group) and a routine intervention group (control group) according to different health intervention measures and forms. The incidence of ischemic stroke in the two groups of survey subjects was tracked within 36 months. Results A total of 52144 subjects were included in the study. The total number of patients in the full course intervention group was 14227, with an incidence density of 577.32/100 000 (556.49/100 000-598.12/100 000), which was lower than that of the conventional intervention group (37 917), with an incidence density of 1 485.47/100 000 (1 464.99/100 000-1 505.94/100 000) (χ²=2490.212, P<0.001). The relative risk of the full course intervention group was 0.39, and the relative risk of stroke risk factors in the full course intervention group from low to high was 0.33, 0.43, 0.45, and 0.49, respectively. The incidence density of males in the full course intervention group was 660.76 (627.46/100 000 - 694.05/100 000), with a relative risk of 0.43, and the incidence density of female patients was 509.71/100 000 (483.37/100 000 - 536.05/100 000), with a relative risk of 0.35. The overall incidence density of the population under 62 years old gourp, 62-75 years old group and over 75 years old group was 197.45/100 000 (173.09/100 000 -221.80/100 000), 608.36/100 000 (580.19/100 000-636.54/100 000), and 1 025.06/100 000 (958.51/100 000-1 091.61/100 000), with relative risks of 0.51, 0.44, and 0.38, respectively. Conclusion Comprehensive health management measures can effectively reduce the short-term risk of ischemic stroke, and should be further promoted and improved to enhance the effectiveness of stroke prevention and control.

ObjectiveThis paper aims to find the identified and validated clinical biomarker data building upon a clinical study of early-phase phase Ⅱ and investigate the correlation analysis of Huanglian Jiedu Wan on syndrome improvement and clinical biomarkers in the treatment of "excess heat-toxicity" based on a machine learning model. Additionally， the effective prediction of clinical biomarker values for the main symptoms of the "excess heat-toxicity" syndrome was assessed. MethodsA total of 229 patients meeting the inclusion criteria for "excess heat-toxicity" syndrome were randomly divided into the Huanglian Jiedu Wan group and the placebo group. Syndrome score transition matrices were constructed for the Huanglian Jiedu Wan group and the placebo group based on three main symptoms of "excess heat-toxicity" syndrome， such as oral ulcers， sore throat， and gum swelling and pain. Data from the patients with these three syndromes were also integrated for an overall analysis. The corresponding syndrome score transition matrices were further constructed to visualize symptom change trends of the patients in the two groups via heatmaps. Based on the identified and validated clinical biomarkers related to inflammation， oxidative stress， and energy metabolism in the early phase， Spearman correlation analysis was employed to analyze and evaluate the associations between clinical biomarkers and syndrome improvement. Key clinical biomarkers reflecting the effect of Huanglian Jiedu Wan were screened through the comparison of differences between groups. An extreme gradient boosting （XGBoost） algorithm was used to develop a prediction model for main symptom classification， with classification performance evaluated through 10-fold cross-validation. Feature importance analysis was applied to identify variables with the greatest contribution to the prediction result. ResultsThe syndrome transition matrix results indicated that the Huanglian Jiedu Wan group showed a superior effect to the placebo group in improving oral ulcers， sore throat， and overall symptoms， with significant effects observed especially in sore throat and overall symptom analyses （P<0.01）. Spearman correlation analysis revealed that several clinical biomarkers positively correlated with "excess heat-toxicity" syndrome and its main symptom improvement， were also called "heat-related biomarkers"， including succinic acid， α-ketoglutaric acid， glycine， lactic acid， adenosine monophosphate （AMP）， tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin-1β （IL-1β）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， and so on. Conversely， clinical biomarkers negatively correlated with symptom severity， were also called "heat-clearing related biomarkers" after administration of Huanglian Jiedu Wan， including malic acid， fumaric acid， cis-aconitic acid， adrenocorticotropic hormone （ACTH）， IL-1β， IL-4， IL-8， succinic acid， and citric acid. The XGBoost classification model using all 52 biomarkers as variables achieved an average test accuracy of 0.754 and an average F1 score of 0.777. Feature importance analysis identified the scores of glutamic acid in saliva and IL-6 were the highest in all the variables， with importance scores of 0.081 and 0.080， respectively. After screening out 14 key variables and optimizing the parameters， model performance improved to an average accuracy of 0.758 and an F1 score of 0.798. Feature importance analysis further determined that the glutamic acid in saliva and IL-6 showed obvious changes after screening the variables， confirming the good syndrome prediction ability of the model constructed by these key clinical biomarkers. ConclusionThis study systematically elucidates the correlation between syndrome improvement and clinical biomarkers of Huanglian Jiedu Wan in the treatment of "excess heat-toxicity" syndrome. An XGBoost classification model based on key clinical biomarkers is successfully established， achieving effective prediction of the symptoms related to the "excess heat-toxicity" syndrome such as oral ulcers and sore throat and providing a new insight for objective identification of traditional Chinese medicine syndromes.

ObjectiveThis paper aims to find the identified and validated clinical biomarker data building upon a clinical study of early-phase phase Ⅱ and investigate the correlation analysis of Huanglian Jiedu Wan on syndrome improvement and clinical biomarkers in the treatment of "excess heat-toxicity" based on a machine learning model. Additionally， the effective prediction of clinical biomarker values for the main symptoms of the "excess heat-toxicity" syndrome was assessed. MethodsA total of 229 patients meeting the inclusion criteria for "excess heat-toxicity" syndrome were randomly divided into the Huanglian Jiedu Wan group and the placebo group. Syndrome score transition matrices were constructed for the Huanglian Jiedu Wan group and the placebo group based on three main symptoms of "excess heat-toxicity" syndrome， such as oral ulcers， sore throat， and gum swelling and pain. Data from the patients with these three syndromes were also integrated for an overall analysis. The corresponding syndrome score transition matrices were further constructed to visualize symptom change trends of the patients in the two groups via heatmaps. Based on the identified and validated clinical biomarkers related to inflammation， oxidative stress， and energy metabolism in the early phase， Spearman correlation analysis was employed to analyze and evaluate the associations between clinical biomarkers and syndrome improvement. Key clinical biomarkers reflecting the effect of Huanglian Jiedu Wan were screened through the comparison of differences between groups. An extreme gradient boosting （XGBoost） algorithm was used to develop a prediction model for main symptom classification， with classification performance evaluated through 10-fold cross-validation. Feature importance analysis was applied to identify variables with the greatest contribution to the prediction result. ResultsThe syndrome transition matrix results indicated that the Huanglian Jiedu Wan group showed a superior effect to the placebo group in improving oral ulcers， sore throat， and overall symptoms， with significant effects observed especially in sore throat and overall symptom analyses （P<0.01）. Spearman correlation analysis revealed that several clinical biomarkers positively correlated with "excess heat-toxicity" syndrome and its main symptom improvement， were also called "heat-related biomarkers"， including succinic acid， α-ketoglutaric acid， glycine， lactic acid， adenosine monophosphate （AMP）， tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin-1β （IL-1β）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， and so on. Conversely， clinical biomarkers negatively correlated with symptom severity， were also called "heat-clearing related biomarkers" after administration of Huanglian Jiedu Wan， including malic acid， fumaric acid， cis-aconitic acid， adrenocorticotropic hormone （ACTH）， IL-1β， IL-4， IL-8， succinic acid， and citric acid. The XGBoost classification model using all 52 biomarkers as variables achieved an average test accuracy of 0.754 and an average F1 score of 0.777. Feature importance analysis identified the scores of glutamic acid in saliva and IL-6 were the highest in all the variables， with importance scores of 0.081 and 0.080， respectively. After screening out 14 key variables and optimizing the parameters， model performance improved to an average accuracy of 0.758 and an F1 score of 0.798. Feature importance analysis further determined that the glutamic acid in saliva and IL-6 showed obvious changes after screening the variables， confirming the good syndrome prediction ability of the model constructed by these key clinical biomarkers. ConclusionThis study systematically elucidates the correlation between syndrome improvement and clinical biomarkers of Huanglian Jiedu Wan in the treatment of "excess heat-toxicity" syndrome. An XGBoost classification model based on key clinical biomarkers is successfully established， achieving effective prediction of the symptoms related to the "excess heat-toxicity" syndrome such as oral ulcers and sore throat and providing a new insight for objective identification of traditional Chinese medicine syndromes.

BackgroundPain is one of the most common physical symptoms in patients with major depressive disorder （MDD）. The high comorbidity rate of MDD and pain aggravates patients' physical and psychological distress， undermines their treatment adherence， and contributes to poor clinical outcomes， posing a critical challenge for the clinical management of MDD. Anxiety symptoms are strongly associated with the pain severity in patients with MDD， yet the underlying mechanisms of the association remain poorly elucidated. Accumulating evidence have indicated that depressive symptoms and pain vigilance and awareness are involved in the modulation of pain perception. Nevertheless， few studies have incorporated these variables into an integrated analytical framework to clarify their parallel mediating effects on the relationship between anxiety symptoms and pain severity. ObjectiveTo explore the mediating pathways linking anxiety symptoms to pain severity via depressive symptoms and pain vigilance and awareness in patients with MDD， so as to provide insights for precise intervention for MDD accompanied by pain symptoms. MethodsA total of 249 patients who met the diagnostic criteria for MDD specified in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from Beijing Huilongguan Hospital from May to September 2025. Hamilton Depression Scale-17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pain Vigilance and Awareness Questionnaire （PVAQ） and Numerical Rating Scale （NRS） were used for assessment. Partial correlation analyses were performed to examine correlations among these variables. Parallel mediating effects were tested using model 4 of the Process macro for SPSS， with depressive symptoms and pain vigilance and awareness as parallel mediators linking anxiety symptoms to pain severity. ResultsA total of 135 patients （54.22%） reported pain， comprising 59 （43.70%） with mild pain， 43 （31.85%） with moderate pain， and 33 （24.45%） with severe pain. Partial correlation analyses revealed significant positive correlations among HAMD-17， HAMA， PVAQ， and NRS scores in patients with MDD （r=0.198–0.424， P<0.05 or 0.01）. Anxiety symptoms positively predicted pain severity， with a direct effect of 0.128 （95% CI： 0.065–0.190）. Both depressive symptoms and pain vigilance and awareness acted as partial mediators linking anxiety symptoms to pain severity. The indirect effects were 0.057 （95% CI： 0.029–0.089） and 0.042 （95% CI： 0.016–0.079）， accounting for 25.22% and 18.58% of the total effect， respectively. ConclusionIn patients with MDD， anxiety symptoms exert a positive predictive effect on pain severity， which is partially mediated through the parallel roles of depressive symptoms and pain vigilance and awareness.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

lumbar fusion surgery is one of the commonly used surgical interventions and treatments for lumbar degenerative diseases.A small proportion of patients still experience complications such as low back pain after lumbar fusion surgery.Spinal-pelvic parameters are closely related to the occurrence of complications in patients after lumbar fusion surgery.This article reviews the commonly used lumbar fixation and fusion surgical techniques and mainstream sagittal spinal-pelvic parameters.Additionally,it summarizes the research progress and current status regarding the relationship between sagittal spinal-pelvic parameters and various postoperative complications,including low back pain.

Objective:To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy.Methods:This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results:The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin ( P < 0.001), lateral pelvic sidewall invasion ( P=0.014), and vascular invasion ( P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions:It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Objective To evaluate the clinical efficacy of selective expansive open-door laminoplasty(SEOLP)with preservation of C7 spinous process in the treatment of multisegmental cervical spondylotic myelopathy and its impact on changes in sagittal parameters of cervical spine.Methods A retrospective analysis was conducted on the clinical data and radiological information of 73 patients who underwent expansive open-door laminoplasty(EOLP)for cervical spondylotic myelopathy in our department between March 2018 and June 2022.Patients were divided into the SEOLP group(n=35)and the EOLP group(n=38)based on the surgical method.Follow-up was conducted for one year.The operation time,blood loss,axial symptom scores,JOA scores,VAS scores and neck disability index(NDI)were recorded in two groups of patients.Radiological data were also recorded for both groups during the perioperative period,and the C2-7 Cobb angle,C2-7 SVA and T1 slope were measured.The cervical curvature index(CCI)and cervical range of motion(ROM)were calculated.The perioperative clinical outcomes and changes in cervical sagittal parameters were observed,and their correlations were analyzed.Results There were no significant differences in blood loss,operation time,JOA scores at various follow-up time points between the two groups(P＞0.05).During postoperative follow-up,axial symptoms were observed in 5 patients in SEOLP group and 14 patients in EOLP group.There were statistically significant differences in axial symptom scores,incidence and severity of axial symptoms between the two groups(P＜0.05).The NDI indices at one year after operation were 21.1±2.3 for SEOLP group and 24.8±3.5 for EOLP group respectively(P＜0.01).There were no statistically significant differences in T1 slope and C2-7 Cobb angle at various follow-up time points after surgery between the two groups(P＞0.05).One year after operation,CCI indices for two groups were(13.4±2.7)and(12.1±2.4),respectively,with a statistically significant difference(t=2.178,P＜0.05).The C2-C7 SVA values for two groups at one year after operation were(22.4+3.8)mm and(26.7±5.9)mm,respectively(t=3.667,P＜0.01).The results of the correlation analysis showed that there was a significant negative correlation between clinical functional improvement(NDI)and changes of the radiological parameter C2-C7 SVA in both groups of patients.Conclusion After SEOLP,the recovery of C2-C7 SVA is faster and has less impact on cervical spine function,and the occurrence degree and incidence of axial symptoms are lower.

Objective To investigate the value of low tube voltage and low dose contrast agents combined with artificial intelligence iterative reconstruction(AIIR)in upper limb CT angiography(CTA)for displaying arteriovenous fistula(AVF).Methods Totally 65 patients with chronic renal failure and suspected AVF stenosis who underwent upper limb CTA were prospectively enrolled and randomly divided into conventional-dose group(CD group,n=30)and low-dose group(LD group,n=35).In CD group,CTA was acquired using conventional tube voltage(100 kVp)and contrast agents dosage(1.0 ml/kg body mass),and conventional hybrid iterative reconstruction(HIR)was used to reconstruct images(group A),while in LD group,CTA was collected using 80 kVp and contrast agent dosage of 0.6 ml/kg body mass,and images were reconstructed with HIR(group B)and AIIR(group C),respectively.Then subjective and objective assessment of imaging quality were performed,respectively,the results were compared among groups,while the radiation dose and dosage of contrast agents were compared between CD and LD groups.Results No significant difference of subjective score of imaging quality nor confidence for diagnosing AVF stenosis was found between group A and group C(both P＞0.017),and all the above scores were higher than those in group B(all P＜0.017).Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of subclavian artery,brachial artery and radial artery in group C were all higher than those in groups A and B(all P＜0.017),while no significant difference of SNR nor CNR was found between group A and B(all P＞0.017).The volume CT dose index,dose length product and dosage of contrast agent in LD group were all lower than those in CD group(all P＜0.001).Conclusion Low tube voltage and low dose contrast agents combined with AIIR in upper limb CTA for displaying AVF could reduce radiation dose and contrast agents dosage under the condition of ensuring imaging quality.