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.

Chronic obstructive pulmonary disease（COPD）， characterized primarily by persistent airflow limitation and chronic airway inflammation， is a major chronic respiratory disease with persistently high morbidity and mortality. In recent years， macrophage pyroptosis， as an inflammatory form of programmed cell death， has been recognized as playing a key role in amplifying inflammatory responses and promoting tissue damage. According to traditional Chinese medicine（TCM） theory， spleen failing to disperse essence constitutes an important pathological basis for various chronic diseases， clinically manifesting as impaired transportation and transformation， internal generation of phlegm-dampness， and accumulation of turbid toxins. Based on a review of classical TCM pathogenesis and modern molecular biological research， this study proposes that there may be a correlation between spleen failing to disperse essence and macrophage pyroptosis in the pathogenesis of COPD. Specifically， metabolic and immune disturbances such as glucotoxicity， lipotoxicity， and enterotoxicity may trigger macrophage pyroptosis through the advanced glycation end products（AGEs）/AGEs receptor（RAGE）/reactive oxygen species（ROS）， fatty acids/Toll-like receptor 4（TLR4）， and lipopolysaccharide（LPS）/nuclear transcription factor-κB（NF-κB）/NOD-like receptor protein 3（NLRP3） signaling pathways. Excessive pyroptosis， in turn， exacerbates metabolic dysregulation and inflammatory responses， forming a vicious cycle. Furthermore， TCM interventions such as strengthening the spleen and tonifying Qi， as well as resolving dampness and detoxifying， have demonstrated potential in modulating pyroptosis-related signaling pathways， including NF-κB， the NLRP3 inflammasome， and autophagy. In summary， this article explores the role of spleen failing to disperse essence-macrophage pyroptosis mechanism in COPD and highlights possible therapeutic strategies of TCM， providing new insights for integrated Chinese and western medical research and clinical practice.

ObjectiveTo analyze the microbial culture positivity rate， pathogen spectrum， prevalence of multidrug-resistant organisms （MDROs）， and differences among donor procurement sources in corneas from the Eye Bank of Guangdong Province， and to provide evidence for eye bank quality control and the prevention of post-keratoplasty infections. MethodsThis retrospective study included 7 442 donor corneas procured by the Eye Bank of Guangdong Province and used for keratoplasty at Zhongshan Ophthalmic Center， Sun Yat-sen University， between 2018 and 2025. During surgery， donor corneoscleral rim tissue was excised for bacterial and fungal culture. Culture-positive specimens underwent microbial identification and antimicrobial susceptibility testing （AST）. Culture-positive corneas were compared across study years， pathogen categories， and donor procurement sources. ResultsOf the 7 442 donor corneas， 251 were culture-positive， corresponding to an overall culture positivity rate of 3.37%， with annual rates ranging from 1.50% to 5.31%. Among culture-positive corneas， 178 （70.92%） yielded bacteria alone， 72 （28.68%） yielded fungi alone， and 1 （0.40%） yielded both bacteria and fungi. Candida spp. and Aspergillus spp. were the predominant fungal isolates. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria. The most common bacterial isolates were Acinetobacter baumannii， Staphylococcus epidermidis， Stenotrophomonas maltophilia， Enterococcus faecium， and Pseudomonas fluorescens. MDROs accounted for 75.47% of bacterial isolates， predominantly Acinetobacter baumannii， Staphylococcus epidermidis， and Enterococcus faecium， and demonstrated an increasing trend over the study period. Donor corneas procured through the Hospital Cornea Retrieval Program （HCRP） had a higher culture positivity rate than those obtained through Organ Procurement Organization （OPO） （P＜0.000 1）. Among culture-positive donor corneas， the proportion of fungal culture-positive corneas was significantly higher in the HCRP group than in the OPO group （P=0.001 5）， whereas the proportion of MDROs among bacterial culture-positive corneas was significantly higher in the OPO group than that in the HCRP group （P=0.005 2）. ConclusionsThe overall culture positivity rate of donor corneas from the Eye Bank of Guangdong Province is relatively low， indicating that the risk of microbial contamination is controlled. However， pathogen profiles and antimicrobial resistance patterns varies by procurement source. Ongoing microbiological and antimicrobial resistance surveillance， together with optimized donor risk assessment and timely reporting of culture results， may further improve eye bank quality management and help inform strategies for preventing post-keratoplasty infections.

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.

ObjectiveTo investigate the incidence， glucolipid metabolism characteristics， and associated factors of postoperative overweight/obesity in children and adolescent with craniopharyngioma. MethodsA retrospective study was conducted using follow-up data from 44 patients （aged 0-18 years） diagnosed with craniopharyngioma who underwent surgical treatment and received follow-up care at Sun Yat-sen Memorial Hospital， Sun Yat-sen University， between January 2006 and February 2024. The incidence and glucolipid metabolism characteristics of overweight/obesity were summarized， and potential influencing factors were analyzed. ResultsA total of 44 patients were enrolled. The mean age at surgery was （8.57 ± 4.25） years， and the mean age at last follow-up was （16.02 ± 5.36 ）years. The mean follow-up duration was （7.45 ± 4.64） years （range， 8 months to 17.5 years）. The preoperative incidence of overweight/obesity was 40.91% （predominantly overweight， 27.27%）， which increased to 68.18% postoperatively （predominantly obesity， 50.00%）. Postoperatively， all patients （44/44， 100%） underwent fasting plasma glucose （FPG） testing， among whom 2 （4.55%） had impaired fasting glucose （IFG）. Fasting insulin （FINS） was measured in 20 patients， and insulin resistance was identified in 11 （55.00%）. Oral glucose tolerance testing （OGTT） with insulin release assessment was performed in 12 patients， and all （100%） exhibited abnormal insulin secretion， including 5 （41.67%） with hyperinsulinemia and 3 （25.00%） diagnosed with diabetes mellitus （DM）. All patients （44/44， 100%） underwent lipid profile assessment. The incidence of dyslipidemia was 81.82% （36/44）， including elevated non-high-density lipoprotein cholesterol （29/44， 65.91%）， hypertriglyceridemia （29/44， 65.91%）， low high-density lipoprotein cholesterol （22/44， 50.00%）， and mixed hyperlipidemia （13/44， 29.55%）. Logistic regression analysis indicated that preoperative overweight/obesity and postoperative abnormal glucose metabolism were significant factors associated with postoperative overweight/obesity. Compared with normal-weight patients， those with postoperative overweight/obesity had higher FINS levels （14.22 mU/L vs. 3.57 mU/L）， higher insulin resistance index（HOMA-IR） （2.88 vs. 0.52）， and a higher incidence of abnormal glucose metabolism （77.78% vs. 23.08%）. However， no significant difference was observed in the incidence of dyslipidemia （94.44% vs. 73.08%）. ConclusionsChildren and adolescent with craniopharyngioma exhibit a higher incidence of overweight/obesity than healthy peers preoperatively， which becomes more pronounced after surgery. This is accompanied by a high incidence of glucolipid metabolic disorders， placing these patients at increased risk of metabolic syndrome， which warrants clinical attention and regular metabolic assessment. In patients who develop postoperative obesity， particular attention should be given to the risk of glucose metabolism abnormalities， and further monitoring of glucose homeostasis is recommended.

ObjectiveTo analyze the microbial culture positivity rate， pathogen spectrum， prevalence of multidrug-resistant organisms （MDROs）， and differences among donor procurement sources in corneas from the Eye Bank of Guangdong Province， and to provide evidence for eye bank quality control and the prevention of post-keratoplasty infections. MethodsThis retrospective study included 7 442 donor corneas procured by the Eye Bank of Guangdong Province and used for keratoplasty at Zhongshan Ophthalmic Center， Sun Yat-sen University， between 2018 and 2025. During surgery， donor corneoscleral rim tissue was excised for bacterial and fungal culture. Culture-positive specimens underwent microbial identification and antimicrobial susceptibility testing （AST）. Culture-positive corneas were compared across study years， pathogen categories， and donor procurement sources. ResultsOf the 7 442 donor corneas， 251 were culture-positive， corresponding to an overall culture positivity rate of 3.37%， with annual rates ranging from 1.50% to 5.31%. Among culture-positive corneas， 178 （70.92%） yielded bacteria alone， 72 （28.68%） yielded fungi alone， and 1 （0.40%） yielded both bacteria and fungi. Candida spp. and Aspergillus spp. were the predominant fungal isolates. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria. The most common bacterial isolates were Acinetobacter baumannii， Staphylococcus epidermidis， Stenotrophomonas maltophilia， Enterococcus faecium， and Pseudomonas fluorescens. MDROs accounted for 75.47% of bacterial isolates， predominantly Acinetobacter baumannii， Staphylococcus epidermidis， and Enterococcus faecium， and demonstrated an increasing trend over the study period. Donor corneas procured through the Hospital Cornea Retrieval Program （HCRP） had a higher culture positivity rate than those obtained through Organ Procurement Organization （OPO） （P＜0.000 1）. Among culture-positive donor corneas， the proportion of fungal culture-positive corneas was significantly higher in the HCRP group than in the OPO group （P=0.001 5）， whereas the proportion of MDROs among bacterial culture-positive corneas was significantly higher in the OPO group than that in the HCRP group （P=0.005 2）. ConclusionsThe overall culture positivity rate of donor corneas from the Eye Bank of Guangdong Province is relatively low， indicating that the risk of microbial contamination is controlled. However， pathogen profiles and antimicrobial resistance patterns varies by procurement source. Ongoing microbiological and antimicrobial resistance surveillance， together with optimized donor risk assessment and timely reporting of culture results， may further improve eye bank quality management and help inform strategies for preventing post-keratoplasty infections.

Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

BACKGROUND: The contraction behaviors of cardiomyocytes (CMs), especially contraction synchrony, are crucial factors reflecting their maturity and response to drugs. A wider field of view helps to observe more pronounced synchrony differences, but the accompanied greater computational load, requiring more computing power or longer computational time. METHODS: We proposed a method that directly correlates variations in optical field brightness with cardiac tissue contraction status (CVB method), based on principles from physics and photometry, for rapid video analysis in wide field of view to obtain contraction parameters, such as period and contraction propagation direction and speed. RESULTS: Through video analysis of human induced pluripotent stem cell (hiPSC)-derived CMs labeled with green fluorescent protein (GFP) cultured on aligned and random nanofiber scaffolds, the CVB method was demonstrated to obtain contraction parameters and quantify the direction and speed of contraction within regions of interest (ROIs) in wide field of view. The CVB method required less computation time compared to one of the contour tracking methods, the LucasKanade (LK) optical flow method, and provided better stability and accuracy in the results. CONCLUSION This method has a smaller computational load, is less affected by motion blur and out-of-focus conditions, and provides a potential tool for accurate and rapid analysis of cardiac tissue contraction synchrony in wide field of view without the need for more powerful hardware.

Background Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent episodes of obstruction of the upper airway during sleep. Given the substantial number of OSA patients, it is urgently in need to address the burden on society. Current available evidence linking outdoor light at night (LAN) to OSA is scarce. Objective To explore the relationships regarding outdoor LAN and OSA among residents in Southern China. Methods A total of 3925 hospitalized patients in Guangdong Provincial People's Hospital Sleep Center were recruited between January 1, 2005 and December 31, 2015. The severity of OSA was determined by apnea-hypopnea index (AHI) using polysomnography or home sleep test. The annual Suomi National Polar-orbiting Partnership Visible Infrared Imaging Radiometer Suite (NPP-VIIRS)-like LAN data with a 500 m spatial resolution were used to evaluate outdoor LAN levels of the participants 1, 3, and 5 years before undergoing sleep monitoring. Generalized linear regression models were utilized to examine the associations of outdoor LAN with OSA. Results The ORs (95%CIs) of OSA, mild OSA, and moderate OSA were 1.175 (1.021, 1.351), 1.215 (1.038, 1.421), and 1.195 (1.003, 1.425) respectively for per interquartile range (IQR) increment in three-year average outdoor LAN. The results of stratified analyses showed a higher OR of 1.933 (95%CI: 1.424, 2.637) in female than male participants (P _interaction < 0.001). Additionally, the ORs of OSA did not substantially change using one-year/ five-year instead of three-year average outdoor LAN. Conclusion Our findings demonstrate that an elevated outdoor LAN is significantly associated with higher odds of OSA (especially mild and moderate OSA) in Southern China, especially in females. An effective outdoor LAN management and policy-making framework has been suggested as potential preventive measures to reduce burden of OSA.

Objective: To evaluate the feasibility of exempting Asian-type DEL pregnant women from anti-D monitoring and RhD immunoglobulin prophylaxis injections by comparing and analyzing the clinical incidence of anti-D alloimmunization between Asian-type DEL pregnant women and true RhD-negative pregnant women. Methods: A total of 165 pregnant women who were initially screened as RhD negative by the saline method and received medical treatment in our hospital from December 2022 to August 2024 were collected as the research subjects. Absorption and elution tests, DEL genotyping, and gene sequencing were used to divide the pregnant women into the Asian-type DEL group and the true negative group. After obtaining informed consent, the following clinical management plan was implemented for pregnant women with Asian-type DEL: exemption from routine anti-D antibody detection, exemption from RhD immunoglobulin prophylaxis, and transfusion of RhD-positive red blood cells. Blood samples of newborns were sent for examination of hemolytic disease of the fetus and newborn (HDFN). The routine management plan was implemented for true negative pregnant women. The incidence of alloimmunization and HDFN was comparatively analyzed between the two groups. Results: Among 165 initially screened RhD negative pregnant women, serological testing and genotyping confirmed 42 as Asian-type DEL, 9 as D variant, and 114 as true negative. Among 42 pregnant women with Asian-type DEL, 3 cases tested positive for HDFN due to receiving RhD immunoglobulin prophylaxis injection. The remaining 39 cases were exempted from anti-D testing after being fully informed of the risk, and did not receive RhD immunoglobulin prophylaxis. The HDFN tests were all negative. In the true negative group, anti-D antibodies were detected in 20 cases, of which 6 cases tested positive for HDFN. A pregnant woman with Asian -type DEL did not show RhD homologous immune response after receiving 2 units of RhD positive red blood cells. Statistical analysis revealed a significantly lower risk of anti-D alloimmunization in Asian-type DEL carriers compared to true D-negative pregnant women (P<0.05). Conclusion: Pregnant women with Asian-type DEL can be exempted from routine anti-D antibody testing and do not require routine RhD immunoglobulin prophylaxis injections.