Objective To quantitatively assess the exposure-response association between exposure to heatwave and sudden death, estimate the attributable excess deaths, and identify potential vulnerable subgroups. Methods A time-stratified case-crossover study was conducted among residents who died from sudden death in Jiangsu Province, China between 2015 and 2021. Heatwave events in Jiangsu Province, defined using varying relative temperature thresholds and durations, were identified using temperature data from the China Meteorological Administration Land Data Assimilation System (CLDAS V2.0). Individual heatwave exposure was assessed based on each subject's residential address. The exposure-response association between heatwave and sudden death was evaluated using conditional logistic regression model combined with a Distributed Lag Nonlinear Model(DLNM). Heatwave-attributable excess deaths were estimated. Stratified analyses by sex and age were performed to assess potential effect modifications. Results Under all definitions, exposure to heatwave was significantly associated with an increased risk of sudden death, and the risk increased with the intensity of heatwave. Using the P95_3d definition (temperature exceeding the 95th percentile for ≥3 consecutive days), heatwave was significantlyassociated with a 56% increased risk of sudden death (95% CI: 31%, 86%). The population-attributable fraction of sudden death due to heatwave exposure was 1.45% (95% CI: 0.97%, 1.90%). Stratified analyses indicated no statistically significant differences in the association between heatwave exposure and sudden death across age or sex subgroups. Conclusion Heatwave exposure was associated with an increased risk of sudden death. Reducing heatwave exposure during summer may help lower the occurrence of sudden death.

Objective: To explore the association between nap duration with anxiety and depressive symptoms among junior high school students, in order to provide evidence for mental health interventions for adolescents. Methods: From May to June 2022, a combination of convenience sampling and cluster sampling was used to select 2 491 students from 2 junior high schools in Haizhu District, Guangzhou City for questionnaire survey and physical examination. The questionnaire collected nap duration, night time sleep duration, bedtime, physical activity, and sedentary behavior. Anxiety and depressive symptoms were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Log-binomial regression model was used to analyze the association of nap duration with anxiety and depressive symptoms, as well as comorbidity among junior high school students, and a restricted cubic spline (RCS) Log-binomial regression model was employed to analyze the non linear relationship after adjusting for covariates. Results: The detection rates of anxiety symptoms, depressive symptoms and comorbidity among junior high school students were 13.29%,14.65%,9.19%. After adjusting for covariates such as age, gender and nighttime sleep duration, compared with a school day nap duration of <30 min/d, a nap duration of 30-<60 min/d was associated with a reduced risk of anxiety symptoms ( APR =0.68, 95% CI =0.49-0.98) and comorbidity ( APR =0.56, 95% CI =0.39-0.87)(both P < 0.05 ). Compared with no napping on weekends, a nap duration of 30-<60 min/d was associated with a reduced risk of anxiety symptoms ( APR =0.62, 95% CI =0.41-0.88), depressive symptoms ( APR =0.52, 95% CI =0.34-0.75) and comorbidity ( APR = 0.52 , 95% CI =0.30-0.83)(all P <0.05). RCS curves showed a nonlinear relationship between weekend nap duration and the prevalence of anxiety, depressive symptoms and comorbidity among junior high school students(all P non linear <0.05); weekend nap duration of <120 min was associated with a lower risk of anxiety and depressive symptoms, and weekend nap duration of >180 min was associated with an increased risk. Conclusions Appropriate nap duration can help reduce the risk of anxiety, depressive symptoms, and the comorbidity among junior high school students. Adolescents should be guided to reasonably arrange nap duration for promoting physical and mental health.

Objective To develop a predictive model for postoperative pulmonary complications (PPC) following video-assisted thoracic surgery (VATS) in lung cancer patients by integrating cardiopulmonary exercise testing (CPET) parameters and machine learning techniques. Methods A retrospective analysis was conducted on patients with early-stage non-small cell lung cancer who underwent CPET and VATS at Guangdong Provincial People’s Hospital between October 2021 and July 2023. Patients were divided into a PPC group and a non-PPC group. The least absolute shrinkage and selection operator (LASSO) regression was used to select important features associated with PPC. Six machine learning algorithms were utilized to construct prediction models, including logistic regression, support vector machine, k-nearest neighbors, random forest, gradient boosting machine, and extreme gradient boosting. The optimal model was interpreted using SHapley Additive exPlanations (SHAP). Results A total of 325 patients were included, with an average age of 60.36 years, and 55.1% were male. Significant differences were observed between the PPC and non-PPC groups in age, diabetes, coronary heart disease, surgical approach, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FVC% predicted, peak oxygen uptake (peak VO2), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide slope (VE/VCO2 slope) (P<0.05). In the predictive model constructed by selecting 7 key features using LASSO regression, the random forest model demonstrated the best overall performance across various metrics, with an area under the receiver operating curve of 0.930, an F1 score of 0.836, and a Brier score of 0.133 in the training set. It also exhibited good predictive ability and calibration in the test set. SHAP analysis ranked feature importance as follows: peak VO2, VE/VCO2 slope, age, FEV1, smoking history, diabetes, and surgical approach. Conclusion Integrating CPET parameters, the random forest model can effectively identify high-risk patients for PPC and has the potential for clinical application.

Objective: To explore the impact of adverse childhood experiences (ACEs) on health risk behaviors (HRBs) among college students and the mediating role of psychological symptoms, so as to provide a basis for developing intervention strategies. Methods: From March to April 2023, a convenience cluster sample of 1 801 students from 12 universities in Nanning, Liuzhou, Guilin, Wuzhou of Guangxi completed an online survey. A self designed questionnaire, Adverse Childhood Experiences-International Questionnaire (ACE-IQ) and Symptom Checklist-90 (SCL-90) were used for evaluation tools. Binary Logistic regression, structural equation modeling (SEM) and Bootstrap methods were used to analyze the associations and mediating effects. Results: Overall, 71.2% of college students experienced at least one type of ACE, with emotional neglect (40.3%) and emotional abuse ( 25.2 %) having the highest detection rates. The top three HRBs were unhealthy diet (77.8%), physical inactivity (54.1%), and smoking/alcohol use (18.5%). Logistic regression showed that poor family functioning, abuse, and extra familial violence were each associated with an increased risk of smoking/alcohol use ( OR =1.14, 1.11, 1.18) and deliberate self harm ( OR =1.26, 1.19,1.30) (all P <0.05). Experience of abuse increased the risk of high risk sexual behavior and family dysfunction increaded the risk of physical inactivity, respectively ( OR = 1.07 , 1.04, both P <0.05). Mediation analysis revealed that anxiety ( β =0.20) and depression ( β = 0.09 ) partially mediated the pathway from poor family functioning to deliberate self harm; paranoia ( β =0.02) partially mediated the pathway from abuse to high risk sexual behavior; and obsessive-compulsive symptoms ( β =0.26) and depression ( β =0.10) partially mediated the pathway from extra familial violence to deliberate self harm (all P <0.05). Conclusion Psychological symptoms play a mediating role in the association between ACEs and HRBs, and mental health interventions may reduce the risk of HRBs among college students.

BackgroundNon-suicidal self-injury （NSSI） behavior has become a global public health concern affecting the physical and mental health of adolescents. The experiential avoidance model posits that childhood trauma contributes to NSSI behavior through the mediating pathway of emotional dysregulation. However， existing research has predominantly focused on isolated psychological or social factors， with limited attention to their interactive effects of emotional dysregulation and social anxiety， both of which fall within the psychosocial domain. ObjectiveTo examine the relationship between childhood trauma and NSSI among adolescents， and to analyze the mediating role of emotional dysregulation and the moderating role of social anxiety， so as to provide evidence for targeted interventions for NSSI behavior of adolescents. MethodsA total of 282 adolescent inpatients who consecutively admitted to the Department of Psychiatry of Guangdong Provincial People's Hospital from March to December 2025 and met the Diagnostic and Statistical Manual of Mental Disorders，fifth edition（DSM-5）criteria for NSSI were enrolled as study participants. Participants were assessed using the general information questionnaire， the Adolescent Self-Harm Questionnaire， the Childhood Trauma Questionnaire （CTQ）， the Difficulties in Emotion Regulation Scale （DERS）， and the Social Anxiety Scale for Adolescents （SAS-A）. Pearson correlation analysis was used to examine correlations among scale scores. model 4 and model 58 of the Process 4.1 were used to test the mediating effect of emotional dysregulation and the moderating effect of social anxiety， respectively. ResultsCTQ score was positively associated with score of the Adolescent Self-Injury Questionnaire （r=0.279， P<0.01）. Emotional dysregulation significantly partially mediated the relationship between childhood trauma and NSSI behavior， with a mediating effect of 0.112 （95% CI： 0.043–0.208）， accounting for 40.14% of the total effect. Social anxiety moderated the association between childhood trauma and emotional dysregulation，the effect value was 0.102 （95% CI： 0.008–0.196）， as well as the relationship between emotional dysregulation and NSSI behavior， the effect value was 0.130 （95% CI： 0.033–0.226）. ConclusionEmotional dysregulation may mediate the relationship between childhood trauma and NSSI behavior among hospitalized adolescents， while social anxiety moderates both the first and second paths of this mediating process. ［Funded by Guangdong Medical Science and Technology Research Fund Project （number， A2022538）］

Cholangiocarcinoma (CCA) is a malignancy characterized by tumor cells originating in the liver or bile ducts, exhibiting features of cholangiocyte differentiation. It poses a significant clinical challenge due to the limited diagnostic and therapeutic options available. Robust animal models are essential for advancing our understanding of CCA pathogenesis and developing effective treatments. This review provides a comprehensive overview of CCA mouse models, highlighting various approaches, including chemical induction, genetically engineered models, and tumor xenografts. Each model is discussed in terms of its establishment techniques, pathological characteristics, and research significance, with a focus on intrahepatic CCA. Chemical induction models, such as diethylnitrosamine- and azoxymethane-induced models, offer insights into tumorigenesis processes, whereas genetically modified models involving alterations in key genes such as Kirsten rat sarcoma viral oncogene homolog, tumor protein 53, and isocitrate dehydrogenase serve as important tools for studying the molecular mechanisms underlying CCA. Xenograft models, including patient-derived xenografts, bridge the gap between experimental research and clinical applications, allowing for precise therapeutic evaluations. By comparing these models, this review underscores their respective advantages and limitations, paving the way for future studies aiming to optimize and innovate CCA modeling strategies.

ObjectiveTo construct an Enterococcus faecium （Ef）-based recombinant Ef-PA0057 vaccine of Pseudomonas aeruginosa（Pa）and to study its protective immune mechanism in mice. MethodsThe PA0057 gene was cloned from the genomic DNA of PA01 strain ATCC9027 by PCR and inserted into pGEX-1λT to construct pGEX-PA0057. The recombinant plasmid was electroporated into TX0016 strain to construct rEf-PA0057 vaccine. The plasmid was extracted from rEf for PCR. The rEf vaccine was expressed through IPTG induction， and the expression of protein was analyzed by SDS-PAGE and Western blot. BALB/c mice were immunized intragastrically with 5×10⁸ CFU rEf-PA0057 vaccine 3 times per week for 3 weeks. 4 weeks after the first immunization， mice were challenged intranasally with 5×10⁷ CFU of PA01 strain. 2 weeks after challenge， mice were sacrificed， and their lungs were separated. Bacteria in lungs were incubated and colonies were counted. Sera were collected at 0， 4， and 6 weeks after the first immunization. The IgG and its subclasses， and IgE were detected by ELISA. ResultsThe 900 bp PA0057 gene was successfully cloned by PCR. PCR showed that PA0057 gene was amplified when the extracted plasmid from rEf as template； the relative molecular mass （Mr） of the expressed PA0057-GST fusion protein was approximately 58 ku， detected by SDS-PAGE. The amount of the expressed protein was 18% of the total bacterial proteins. Western blot showed that the target protein could be recognized by Pa sera. The colony numbers of lung tissue in rEf-PA0057 vaccine group， blank vector group and Ef control group were （0.297±0.011）×10⁸ CFU， （7.576±0.206）×10⁸ CFU and （7.551±0.185）×10⁸ CFU， respectively， the difference was statistically significant （P0.01）. The levels of IgG， IgG1， IgG2b， IgG3 and IgE increased. At the same time point， there was a significant difference compared with the two control groups （P0.01）. ConclusionThe rEf-PA0057 vaccine is successfully constructed. It may induce mice to produce humoral response against challenge with PA01.

OBJECTIVE To compare the efficacy and prognosis between dapagliflozin and empagliflozin in elderly patients with heart failure （HF） complicated by cardiac pacemaker implantation.METHODS The clinical data of 237 elderly patients with HF complicated by cardiac pacemaker implantation， who were admitted to the Department of Cardiovascular Medicine at the First Affiliated Hospital of Nanyang Medical College from July 1， 2023， to January 1， 2025， were retrospectively collected. According to medication use， the patients were divided into the control group （conventional therapy， n ＝90）， dapagliflozin group （conventional therapy plus dapagliflozin， n ＝77）， and empagliflozin group （conventional therapy plus empagliflozin， n ＝70）. Cardiac function and HF-related indicators were evaluated before treatment and after 6 months of treatment among the 3 groups. The incidence of major adverse cardiovascular events （MACE）， HF rehospitalization rate， and the occurance of adverse reaction were compared among the 3 groups.RESULTS After 6 months of treatment， compared with the same group before treatment， left ventricular ejection fraction was significantly increased， 6-minute walk distance was significantly prolonged， left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly shortened， and N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein levels were significantly decreased in all 3 groups （ P ＜0.05）. The improvements in most of the above indicators were greater in the dapagliflozin and empagliflozin groups than in the control group （ P ＜0.05）， and were all greater in the empagliflozin group than in the dapagliflozin group （ P ＜0.05）. The HF rehospitalization rate was significantly lower in both dapagliflozin and empagliflozin groups than in the control group （ P ＜0.05）， and was significantly lower in the empagliflozin group than in the dapagliflozin group （ P ＜0.05）. There was no statistically significant difference in the incidence of MACE among the 3 groups （ P ＞0.05）， although the incidence was numerically lower in the dapagliflozin and empagliflozin groups than in the control group. There was also no statistically significant difference in the incidence of adverse reactions among the 3 groups （ P ＞0.05）.CONCLUSIONS Both dapagliflozin and empagliflozin can improve cardiac function and HF-related indicators and reduce the risk of HF rehospitalization in elderly patients with HF complicated by cardiac pacemaker implantation on the basis of conventional therapy， without increasing the risk of adverse reactions. Compared with dapagliflozin， empagliflozin shows more pronounced effects.

Against the backdrop of a continuously rising incidence of breast cancer globally， breast reconstruction surgery represents one of the key measures to improve patients’ quality of life. Ethics of care emphasizes paying attention to patients’ actual needs in doctor-patient interactions and advocates creating a decision-making environment that facilitates the explicit expression of these needs. Focusing on the decision-making process of 16 breast cancer patients who underwent breast reconstruction surgery and stemming from the perspective of ethics of care， this paper explored the realization paths of autonomy for breast cancer patients when confronting medical decisions on breast reconstruction from three aspects， including the situatedness， relationality， and practicality of ethics of care. The study found that under the ethics of care， the organic interaction of contextualized practice， relational negotiation， and subjectivity cultivation jointly constructed a dynamically evolving medical decision-making ecosystem. This ecosystem， with situational response capabilities based on embodied cognition， relational adjustment mechanisms linked by ethical negotiation， and dual-track support networks aimed at subject empowerment， ultimately achieved the in-depth integration of technical practice and humanistic care.

ObjectiveTo develop and evaluate an O-RADSbased multiparametric model integratingcontrast-enhanced US （CEUS） and the z-score standardized risk of ovarian malignancy algorithm （ROMA z-score） to improve the diagnostic accuracy for differentiating benign， borderline， and malignant ovarian epithelial tumors （OETs）. MethodsThis retrospective study included 129 patients with pathologically confirmed OETs between May 2018 and December 2024. Clinical variables （age， menopausal status， BMI， HE4， CA125） and sonographic features （conventional US and CEUS） were collected. Tumors were classified as benign， borderline， or malignant according to pathological findings. A random forest algorithm was used to contruct the predictive model. Receiver operating characteristic （ROC） curves were generated tocompare the diagnostic performance of O-RADS， O-RADS+CEUS， O-RADS+ROMA z-score， and O-RADS+ CEUS+ROMA z-score. ResultsAmong the 129 patients， 63 had benign tumors， 25 had borderline tumors， and 41 had malignant tumors. Compared with O-RADS alone， the combined O-RADS+CEUS+ROMA z-score model demonstrated superior diagnostic performance， with an AUC of 0.87 （95% CI： 0.79-0.95） vs. 0.64 （95% CI： 0.51-0.76）， P＜0.001， for differentiating benign from borderline tumors， and 0.90 （95% CI： 0.83-0.97） vs. 0.64 （95% CI： 0.50-0.78）， P＜0.001， for differentiating borderline from malignant tumors. The random forest analysis identified HE4， CA125 and CEUS features as the most important predictors，contributing 11.02， 8.82， 18.1 points， respectively， to the total importance score of 51.94. In the test cohort， the model achieved an overall diagnostic accuracy of 72.97%， with an AUC of 0.89（95%CI：0.77-1.00）， sensitivity of 67.06%， and specificity of 85.01%. ConclusionsO-RADS+CEUS+ROMA z-score multiparametric model demonstrated the highest diagnostic performance for in differentiating benign from borderline and borderline from malignant OETs. HE4， CA125 and CEUS features were identified as key predictive risk factors， supporting the role of this model in improving preoperative risk stratification of OETs.