BackgroundPrevious studies have identified a close relationship among psychological neglect and abuse， negative affect， different stages of adolescence， and suicidal ideation. However， the mechanisms underlying the impact of psychological abuse and neglect on suicidal ideation among left-behind adolescents remain unclear， and this field of research is still in its relative infancy. ObjectiveTo explore the relationship between psychological neglect/abuse and suicidal ideation among left-behind adolescents， as well as the mediating role of negative affect and the moderating effect of different stages of adolescence， so as to provide insights for preventing and intervening suicidal ideation in this population. MethodsFrom November 2021 to May 2022， a cluster random sampling technique was utilized to select 2 309 left-behind adolescents in western China. Assessments were conducted using the Child Psychological Abuse and Neglect Scale （CPANS）， the Positive and Negative Suicide Ideation （PANSI） and the Positive and Negative Affect Schedule for Children （PANAS-C）. Spearman correlation coefficients were calculated across all samples， and Process 4.1 was employed to test the mediating role of negative affect and the moderating role of different stages of adolescence in the pathway linking psychological abuse/neglect to suicidal ideation. ResultsA total of 2 119 left-behind adolescents （mean age： 14.94±1.20 years） completed the study， with males comprising 51.34% （1 088/2 119） and females 48.66% （1 031/2 119）.Among left-behind adolescents， scores on CPANS psychological neglect subscale showed positive correlations with both psychological abuse subscale scores and PANAS-C negative affect subscale scores （r=0.446， 0.496， P<0.01）. Additionally， CPANS psychological neglect and psychological abuse subscale scores were also positively correlated with PANSI scores （r=0.487， 0.508， P<0.01）. Furthermore， PANAS-C negative affect subscale scores demonstrated a positive correlation with PANSI scores （r=0.499， P<0.01）. Negative affect partially mediated the relationship between psychological abuse/psychological neglect and suicidal ideation， with effect sizes of 0.166 （95% CI： 0.141~0.191） and 0.131 （95% CI： 0.112~0.152）. Different stages of adolescence moderated the latter part （negative emotion → suicidal ideation） of the indirect mediation path from psychological neglect to suicidal ideation through negative affect （β=-0.066， P<0.01）. ConclusionBoth psychological neglect and psychological abuse may influence suicidal ideation among left-behind adolescents via negative affect. Moreover， different stages of adolescence may moderate the indirect path from psychological neglect to suicide ideation through negative affect.

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is a chronic inflammation of the gastrointestinal tract with unknown etiology. The cause of IBD is widely considered multifactorial, with prevailing hypotheses suggesting that the microbiome and various environmental factors contribute to inappropriate activation of the mucosal immune system in genetically susceptible individuals. Although the incidence of IBD has stabilized in Western countries, it is rapidly increasing in newly industrialized countries, particularly China, making IBD a global disease. Significant changes in multiple biomarkers before IBD diagnosis during the preclinical phase provide opportunities for earlier diagnosis and intervention. Advances in technology have driven the development of telemonitoring tools, such as home-testing kits for fecal calprotectin, serum cytokines, and therapeutic drug concentrations, as well as wearable devices for testing sweat cytokines and heart rate variability. These tools enable real-time disease activity assessment and timely treatment strategy adjustments. A wide range of novel drugs for IBD, including interleukin-23 inhibitors (mirikizumab, risankizumab, and guselkumab) and small-molecule drugs (etrasimod and upadacitinib), have been introduced in the past few years. Despite these advancements, approximately one-third of patients remain primary non-responders to the initial treatment, and half eventually lose response over time. Precision medicine integrating multi-omics data, advanced combination therapy, and complementary approaches, including stem cell transplantation, psychological therapies, neuromodulation, and gut microbiome modulation therapy, may offer solutions to break through the therapeutic ceiling.
Humans ; Inflammatory Bowel Diseases/therapy*

Booster vaccinations are highly recommended in combating the SARS-CoV-2 Omicron variant and its subvariants. However, the optimal booster vaccination strategies and related immune mechanisms with different prior vaccinations are under-revealed. In this study, we systematically evaluated the immune responses in mice and hamsters with different prime-boost regimens before their protective efficacies against Omicron were detected. We found that boosting with Ad5-nCoV, S_WT-2P or S_Omicron-6P induced significantly higher levels of neutralization activities against Omicron variants than CoronaVac and ZF2001 by eliciting stronger germinal center (GC) responses. Specifically, S_Omicron-6P induced even stronger antibody responses against Omicron variants in CoronaVac and Ad5-nCoV-primed animals than non-Omicron-specific vaccines but with limited differences as compared to Ad5-nCoV and S_WT-2P. In addition, boosting with a specific vaccine has the potential to remodel the existing immune profiles. These findings indicated that adenovirus-vectored vaccines and mRNA vaccines would be more effective than other types of vaccines as booster shots in combating Omicron infections. Moreover, the protective efficacies of the vaccines in booster vaccinations are highly related to GC reactions in secondary lymphatic organs. In summary, these findings provide timely important information on prime-boost regimens and future vaccine design.

Objective:To establish a quantitative diagnostic standard for Crohn's disease with dampness syndrome based on clinical data using a disease syndrome combination model and conduct bidirectional validation.Methods:256 patients with Crohn's disease from the Department of Spleen and Stomach Diseases at Guangdong Provincial Hospital of Chinese Medicine, the Department of Gastroenterology at the Sixth Affiliated Hospital of Sun Yat-sen University, and the Outpatient Department of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to January 2022 were selected as the observation objects. They were divided into an operation group of 205 patients and a verification group of 51 patients in an 8:2 ratio using a random number table method. The frequency advantage method, χ2 test, and binary logistic regression analysis were used to screen for relevant standard factors. The conditional probability method was used to assign scores to relevant items, and the maximum likelihood method was used to determine the quantitative diagnostic threshold. A quantitative diagnostic standard for Crohn's disease with dampness syndrome based on disease syndrome combination was established, and it was retrospectively analyzed and prospectively verified. Results:On the basis of the 20 candidate quantitative diagnostic criteria items for Crohn's disease dampness syndrome, binary logistic regression analysis was performed to calculate the OR values between each item. The quantitative diagnostic criteria for Crohn's disease with dampness syndrome included tongue coating greasiness (7 points), body heaviness (13 points), waist and knee soreness (8 points), head weight (9 points), bland mouth (6 points), anal heaviness (8 points), uncomfortable bowel movements (8 points), and sticky stools (7 points), with a quantitative diagnostic threshold of 11. Conclusion:The scoring of relevant items in the quantitative diagnostic criteria for Crohn's disease with dampness syndrome is reasonable and has good diagnostic value, which can provide reference for further quantitative research on Crohn's disease syndromes.

Objective To evaluate the impact of traditional Chinese medicine(TCM)syndromes on percutaneous microwave ablation(MWA)treatment in patients with colorectal cancer liver metastases(CRLM)and to construct a multidimensional prediction model prognostic based on TCM syndrome classification.Methods Clinical data were collected from 86 CRLM patients who underwent MWA at Zhongshan Hospital of Traditional Chinese Medicine between October 2012 and October 2023.The clinical information covered TCM syndrome types of qi-blood deficiency and spleen-kidney yang deficiency,tumor characteristics,and treatment parameters.Logistic regression was used to screen feature variables for constructing the prognostic predication model,and cross validation was performed to evaluate the prognostic predictive performance.Results(1)Among the 86 CRLM patients,31(36.05%)had spleen-kidney yang deficiency syndrome,while 55(63.95%)had qi-blood deficiency syndrome.(2)Compared to the patients with spleen-kidney yang deficiency syndrome,patients with qi-blood deficiency syndrome exhibited significantly long progression-free survival(PFS)and high progression-free survival rate(P＜0.01),while no significant differences were presented in the incidences of postoperative adverse events such as pain,fever,infection,liver function impairment,or ascites/pleural effusion among the patients with the two syndrome types(P＞0.05).(3)Multivariate logistic regression analysis revealed that TCM syndrome type,maximum diameter of metastatic liver tumor,timing of liver metastasis,and Ki-67 expression rate of primary tumors were the independent prognostic factors for 1-year PFS(P＜0.05 or P＜0.01).(4)The constructed model demonstrated high predictive accuracy for PFS,with an area under the receiver operating characteristic(ROC)curve(AUC)of 0.905(95%CI:0.830-0.980).Conclusion TCM syndromes have significant influence on the prognosis of CRLM patients undergoing MWA,and the patients with qi-blood deficiency syndrome have favorable prognosis.This study pioneers a multidimensional prognostic prediction model integrating TCM syndromes for MWA-treated CRLM patients,highlighting the unique value of TCM syndromes in assessing disease progression and predicting prognosis.

Objective To compare the discrepancies among results of three commonly used laboratory direct test methods for maximal oxygen uptake(VO2max),explore their linear regression relationships,mutual predictability and comparability.Methods Using a quasi-experimental design of cluster sampling and within-group interaction design,20 male cross-country skiers were tested for VO2max using the Bruce protocol(Method 1),90-second incremental load exercise on power bicycle(Method 2),and 1-minute incremental load exercise on treadmill(Method 3),with an interval of one week.The indepen-dent and dependent variable were the three VO2max test methods and the VO2max,respectively.Results Significant differences were found in the average VO2max of the three test results,with the value mea-sured by Method 1 ranking the first,followed by that assessed by Method 3 and Method 2(P<0.05).Moreover,the frequency of individual differences in the results of the three methods showed that the VO2max of Method 1 was about 6 and 3 ml/min·kg higher than that measured by Method 2 and 3.However,at the same treadmill speed,the average blood lactate evaluated using Method 3 was higher than Method 1,and the speed reached aerobic and anaerobic thresholds about one speed unit(1 km/h)lower than Method 1.Meanwhile,linear regression analyses of the test results between Method 1 and 2,as well as Method 1 and 3 showed that both the regression models and coefficients were statis-tically significant(P<0.001),with the R-squared values of 9.25 and 9.05,respectively.Conclusion The Bruce protocol performs best in assessing the maximum value of the athlete's VO2max phase,whose results have linear regression relationships with the other two methods,and can be used for pre-dicting their results.Moreover,athletes of different events and levels can choose different VO2max test methods accordingly.Lastly,the speed and heart rate ranges corresponding to the aerobic and anaero-bic thresholds can serve as an effective and convenient method to control the training intensity.

Objective To synthesize evidence from systematic reviews on the positive impacts of music interventions on the func-tioning,health and development of children and adolescents with intellectual and developmental disabilities(IDD). Methods Literature was searched across databases including PubMed,EBSCO,PsycINFO,Embase,Web of Science and CNKI,focusing on high-quality systematic reviews published from January,2014 to March,2024.These reviews examined the functioning,health and developmental benefits of music interventions(including therapy and edu-cation)for children and adolescents with IDD. Results Eight English systematic reviews were included,involving 5 308 children and adolescents with IDD,from Chi-na,France,Spain,Canada,the United States and the United Kingdom;mainly from journals in the fields of mu-sic therapy,children and adolescents psychiatry,educational psychology,intellectual disability,autism spectrum disorder(ASD)and health psychology,mainly published between 2018 and 2023.The music therapy interven-tions mainly included music education interventions,improvisation music therapy(creation and performance),in-teractive music therapy(music and movement),mixed music therapy(including singing,dancing and drama),au-ditory-motor mapping training,family music therapy and melody-based communication therapy;involving basic music theory learning,music gesture and language training,music appreciation,improvisation,music ensemble,music cooperative games,etc;ten to 90 minutes a time,one to five times a week,for one to 32 weeks.In terms of cognitive development,music education interventions were beneficial for improving attention in children and ad-olescents with IDD.In terms of psycholinguistic skills,music therapy could significantly improve the articulation and language abilities of children and adolescents with ASD,especially phonological memory,word and sentence comprehension;and language and communication skills of children and adolescents with IDD,and enhance oral expression abilities.Music could also help improve behavioral disorders,including improving physical coordina-tion,reducing repetitive behaviors and controlling hyperactive behaviors.In terms of music education perfor-mance,music therapy could improve amiliarity with song rhythm and melody,phoneme discrimination,master-ing songs and lyrics,and enhance music rhythm perception of children and adolescents with IDD.In addition,music therapy also promoted social and emotional development,improved prosocial behavior and social skills,helped reduce anxiety,enhance emotional control,improve social skills and self-esteem,increase positive emo-tions,and strengthen communication and cooperation with peers and teachers. Conclusion Music intervention has a positive impact on the function,health and development of children and adoles-cents with IDD,which is reflected in cognitive development,psycholinguistic skills,motor skills,music educa-tion performance,and children and adolescents'social and emotional development.

The thinking process of medical diagnosis requires a comprehensive and analytical judgment.However,in both judgment processes,human thinking has inevitable limitations.With the development of artificial intelligence(AI)technology,symbolism and connectionism can effectively compensate for the deficiencies of human thinking in some respects,making more accurate diagnostic judgments,but they also have their limitations.It is conceivable that the integration and development of symbolism and connectionism will assist in enhancing the capabilities of medical-assisted diagnosis.However,there is still a tension between accuracy,transparency,and interpretability regarding the application of connectionism in AI,and many concerns about AI have arisen due to its lack of transparency and interpretability.By sorting out the thought process of medical diagnosis,organizing the differences among various AI paradigms and the changes in semantic philosophy and truth concepts behind AI,ethical concerns about the application of AI can be alleviated to a certain extent,and the practical application of AI in the field of medical diagnosis can be promoted.

Objective:To explore the clinical characteristics and outcomes of type 2 autoimmune pancreatitis (AIP) and compare with type 1 AIP.Methods:Clinical data of the patients diagnosed with type 2 AIP by the International Consensus on diagnostic criteria of AIP at Peking Union Medical College Hospital from January 2001 to December 2022 were retrospectively analyzed, and type 1 AIP patients diagnosed in Peking Union Medical College Hospital from January 1985 to December 2016 were collected as controls. The clinical symptoms, treatments and follow-ups were analyzed.Results:A total of 25 patients with type 2 AIP were included, of which 16 cases (64.0%) were pathologically confirmed cases (13 cases by endoscopic ultrasound puncture, 2 cases by surgery, and 1 case by interventional puncture), and 9 cases (36.0%) were suspected. The average age of onset was 40 years old. Most patients ( n=23, 92.0%) had abdominal pain along with emaciation to a various degree. Among them, 3 cases primarily presented as acute pancreatitis. Two cases were diagnosed after surgery for pancreatic masses. Eighteen cases were complicated with inflammatory bowel disease, including 16 cases with ulcerative colitis, one case with Crohn's disease, and one case with indeterminate colitis. All patients had typical imaging manifestations, including 13 cases (52.0%) with diffuse pancreatic enlargement, 12 cases (48.0%) with focal or multifocal pancreatic lesions, and 5 cases (20.0%) with simultaneous focal pancreatic masses and diffuse enlargement. All patients had normal serum IgG4 levels, anti-neutropil cytoplasmic antibodies (ANCA) positivity rate was 35.3% (6/17), and anti-nuclear antibody (ANA) positivity rate was 29.2% (7/24). Two surgical patients recovered well after surgery, and the other patients all achieved clinical and imaging relief after hormone therapy, and no recurrence was seen during follow-up. Compared with type 1 AIP, type 2 AIP had younger onset age, main manifestation as abdominal pain without jaundice, rare involvement with extra-pancreatic organs, the lesions mainly located in the intestine and normal IgG4 level with statistically significant differences. The recurrence rate of type 2 AIP was lower than that of type 1 AIP (0 vs 16%). Conclusions:Type 2 AIP has different clinical characteristics from type 1 AIP. Due to the lack of specific serum markers, the diagnosis is more difficult. It responds well to glucocorticoids and has a low recurrence rate.

Ulcerative colitis(UC)is a chronic and prolonged condition spanning multiple disciplines.Standardized diagnostics and treatment are paramount for enhancing the therapeutic efficacy and improving the prognosis of UC.In the last a couple of years,substantial progress has been achieved in both basic and clinical research on UC in our country.The integration of novel diagnostic and therapeutic paradigms,new treatment modalities,have necessitated the update of consensus on UC management,offering imperative,evidence-based guidelines for health providers.This guideline,collaboratively developed by the Inflammatory Bowel Disease Group of Chinese Society of Gastroenterology,Chinese Medical Association,and the Inflammatory Bowel Disease Quality Control Center of China,incorporates the latest international consensus,domestic research findings,and practical considerations,as an update based on the 2018 Chinese consensus on diagnosis and treatment in inflammatory bowel disease.The formulation of this guideline aims to reflect the latest concepts and research findings in the clinical diagnosis and treatment of UC,providing standardized guidance for the clinical management of UC.