Objective: To evaluate the implementation process of a school-family collaborative "online+offline" tobacco control intervention program in junior high school in Beijing and to explore the execution status, influencing factors and sustainability potential of the intervention, so as to provide evidence for optimizing youth tobacco control strategies. Methods: In November 2024, using the random number table method, four first year junior high school classes were selected from three schools each in Fengtai District, Tongzhou District, and Fangshan District of Beijing. One class served as the control group, while the other three classes were designated as intervention groups (one each for online intervention, offline intervention, and combined online offline intervention). The control group received only conventional education.The online intervention group was engaged in WeChat push interventions, including watching micro videos, viewing promotional materials, participating in online quizzes and mini games; the offline intervention group attended knowledge lectures, played peer games, and participated in offline knowledge competitions; the combined online offline intervention group integrated all the aforementioned online and offline intervention measures. The intervention period was from November 2024 to June 2025, spanning a total of 7 months. Based on the Practical, Robust Implementation and Sustainability Model(PRISM) framework, a qualitative research design was employed to conduct semi structured interviews with 48 participants (12 in each of the intervention groups and 12 organizational staff members) from the Centers for Disease Control and Prevention (CDC) in 3 districts and 3 sampled schools. The interview outlines were designed according to the intervention plan. Data was managed using Nvivo 12.0 software and analyzed following Colaizzi s seven step phenomenological analysis method. Theoretical saturation was assessed using a reserved subset of transcripts. Results: Four core themes were identified in the tobacco control intervention process. Overall fidelity of intervention implementation was largely consistent with the original plan, and students showed strong willingness and positive evaluations toward interactive formats such as knowledge contests and peer games, though occasional breakdowns in school-family communication and blurred boundaries between online and offline components were observed; the participants showed a polarized response in terms of satisfaction and participation, most students and parents recognized the significance of the activity, and some parents observed a reduction in smoking behavior; the implementation of internal tobacco control policies in the school was strict, and the atmosphere was favorable, but there was still room for improvement, such as the scarcity of community tobacco control activities and the difficulty in implementing smoke free units; implementation and sustainability infrastructure were preliminarily established, such as through homeroom teacher supervision and training student assistants to assisted in activities, while the sustainability support system required further refinement. Conclusion The school-family collaborative "online+offline" tobacco control intervention has demonstrated significant positive effects, but further optimization of activity design, enhancement of community reward mechanisms, and standardized training are required to improve the efficacy and sustainability of the intervention.

Objective To analyze the disease burden and trends of bladder cancer in China and globally from 1992 to 2021.  Methods Using the GBD 2021 database, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates of bladder cancer in China and globally from 1992–2021 were analyzed. Average annual percentage change (AAPC) was calculated using Joinpoint regression. Subgroup analyses by sex and age were conducted, and a Bayesian age-period-cohort (BAPC) model was used to predict trends in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for the next 15 years.  Results In 2021, China reported 106 000 new cases (ASIR: 5.14/100 000), 571 000 prevalent cases (age-standardized prevalence rate, ASPR: 26.61/100 000), 43 000 deaths (ASMR: 2.34/100 000), and a DALY rate of 45.31/100 000. From 1992–2021, China showed upward trends in ASIR and ASPR but declines in ASMR and DALYs, while global ASIR, ASMR, and DALYs decreased overall with slow ASPR growth. The peak cases in China and globally were both concentrated in the 65-79 age group, with a significantly higher burden on males than females. In China, smoking-related ASMR and ASDR exceeded global averages and rose, whereas high glucose-related indexes were lower and declined. Projections for 2021–2036 indicated that the global incidence and mortality rates would be rising, but ASIR/ASPR would be declining, while in China, the incidence rate would continue to rise, and the mortality rate will stabilize, with a significant increase in ASIR and a gradual decrease in ASPR.  Conclusion From 1992 to 2021, the incidence of bladder cancer in China has shown a continuous upward trend and is projected to persist in the future, with significant gender and age differences. Particular attention should be given to elderly males aged 85-89. The disease burden of bladder cancer attributable to smoking continues to rise, highlighting the urgent need to strengthen tobacco control policies.

Cardiotoxicity induced by antineoplastic agents is an important factor affecting the prognosis of cancer patients. This article systematically summarizes the clinical manifestations of cardiotoxicity caused by chemotherapeutic drugs, molecular targeted cancer therapies, and immunotherapeutic drugs, and identifies the core injury mechanisms, including cardiomyocyte apoptosis, oxidative stress, and mitochondrial dysfunction. In Traditional Chinese Medicine (TCM) theory, anticancer drug-induced cardiotoxicity falls under the category of “heat toxins” characterized by dual deficiency of qi and blood, upward flaming of heart heat, stagnation of the heart vessels, and meridian obstruction induced by phlegm-dampness. Therefore, by reviewing the preventive and therapeutic effects and the underlying mechanisms of tonic medicines, interior heat-clearing medicines, blood-circulating and stasis-resolving medicines, phlegm-transforming, cough-suppressing and panting-relieving medicines, and interior-warming medicines, this paper concludes that TCM prevention and treatment of this condition adheres to the formulation principle of “reinforcing healthy qi, removing toxins, and resolving blood stasis”. Its mechanisms of action—including antioxidation effects, regulation of autophagic balance, antagonism of inflammatory responses, and improvement of microcirculation—are highly consistent with modern medical treatment strategies (e.g., dexrazoxane for inhibiting iron-dependent oxidative stress, statins for anti-inflammatory effects). This study provides theoretical support and practical guidance for the collaborative and precise prevention and treatment of anticancer drug-induced cardiotoxicity through the integration of traditional Chinese and Western medicine.

OBJECTIVE To construct three-class （insufficient， normal， excessive） and two-class （insufficient， normal） models for predicting plasma concentration of valproic acid （VPA）， and compare the performance of these two models， with the aim of providing a reference for formulating clinical medication strategies. METHODS The clinical data of 480 patients who received VPA treatment and underwent blood concentration test at the Xi’an International Medical Center Hospital were collected from November 2022 to September 2024 （a total of 695 sets of data）. In this study， predictive models were constructed for target variables of three-class and two-class models. Feature ranking and selection were carried out using XGBoost scores. Twelve different machine learning algorithms were used for training and validation， and the performance of the models was evaluated using three indexes: accuracy， F1 score， and the area under the working characteristic curve of the subject （AUC）. RESULTS XGBoost feature importance scores revealed that in the three-class model， the importance ranking of kidney disease and electrolyte disorders was higher. However， in the two-class model， the importance ranking of these features significantly decreased， suggesting a close association with the excessive blood concentration of VPA. In the three-class model， Random Forest method performed best， with F1 score of 0.704 0 and AUC of 0.519 3 on the test set； while in the two-class model， CatBoost method performed optimally， with F1 score of 0.785 7 and AUC of 0.819 5 on the test set. CONCLUSIONS The constructed three-class model has the ability to predict excessive VPA blood concentration， but its prediction and model generalization abilities are poor； the constructed two-class model can only perform classification prediction for insufficient and normal blood concentration cases， but its model performance is stronger.

Objective To investigate the effects of gut microbiota regulation combined with exercise rehabilitation on non-motor symptoms and neurological function in Parkinson's disease patients.Methods A total of 154 Parkinson's disease patients admitted to our hospital from January 2022 to January 2024 were selected as the subjects of the study.Using a random number table,these 154 patients were evenly divided into a control group and a treatment group,with 77 patients in each group.Both groups received standard treatments,but the control group also underwent exercise rehabilitation therapy,while the treatment group received probiotic supplementation and exercise rehabilitation therapy.The effectiveness of the two groups was then compared.Results Following the 12 weeks,24 weeks therapeutic regimen,The treatment group showed significantly better outcomes(P<0.05).Clinically meaningful reductions were observed in Hoehn-Yahr staging,alongside decreased scores on standardized instruments assessing psychiatric symptoms HAMA,HAMD,SCOPA-AUT,UPDRS Ⅰ-IV and PDSS(P<0.05).Concurrently,the study group exhibited enhanced MMSE(P<0.05).Fecal microbiome analyses revealed a favorable ecological shift characterized by increased colonization of beneficial genera Bifidobacterium and Lactobacillus,with concomitant suppression of pathobionts Enterococcus and Enterobacteriaceae.Gait analysis revealed increased step length,speed,and frequency in the treatment group(P<0.05).Conclusion Patients with Parkinson's disease who received probiotics combined with exercise rehabilitation treatment could effectively improve non-motor symptoms and neurological function,while promoting the balance of intestinal flora,and reduce clinical symptoms.

The aim of this paper was to investigate the serotypes,virulence factors and drug resist-ance of clinical isolates of Pasteurella rnultocida of porcine origin in recent years.Morphological screening and polymerase chain reaction(PCR)were used to isolate and identify 119 isolates from nasal swabs and lung tissue samples sent from swine farms in Zhejiang Province from 2010 to 2024.The isolates of Pasteurella multocida were subjected to capsular polysaccharide serotyping,lipopolysaccharide serotyping,virulence factor detection and drug resistance analysis by PCR and Kirby-Bauer disc agar diffusion method(K-B).The results showed that there were 64 strains(53.7％)of A-type,54 strains(45.3％)of D-type and 1 strain(0.9％)of F-type among the capsu-lar polysaccharide serotypes,and 10 strains(8.4％)of L1-type,20 strains(16.8％)of L3-type,86 strains(72.2％)of L6-type,and 3 strains(2.6％)of undetermined type among the lipopolysaccha-ride serotypes.The amplification results of 10 virulence genes showed that the detection rate of virulence genes hgbA,higbB and fimA was over 86.0％,the detection rate of toxA was 8.4％,while the virulence gene tbpA was not detected.There were also differences in the distribution vir-ulence genes in different capsular polysaccharide serotypes.Virulence factor pfhA was detected in type A and F but not in type D.The detection rate of adhesin gene tadD in serotype A(92.2％)was significantly higher than that of type D(9.3％),and,on the contrary,the detection rate of ad-hesin gene hsf-l in serotype D(90.7％)was significantly higher than that of type A(20.3％).Drug resistance analysis revealed that Pasteurella multocida showed high susceptibility to antimi-crobial drugs such as amoxicillin,ampicillin,cephalosporins,doxycycline,fosfenicol and ciprofloxa-cin,and showed strong resistance to antimicrobial drugs such as lincomycin,cotrimoxazole,genta-micin and amikacin,and there were 54 multi-drug resistant strains(78.3％).In summary,capsular polysaccharide serotypes were dominated by type A and D,lipopolysaccharide serotypes were dom-inated by L6,the distribution of some virulence genes varied greatly among different serotypes,and the proportion of multi-resistant strains was high,which provide reference for the prevention and control of this disease.

Valvular heart disease(VHD)is a common type of heart disease in adults,with approximately 80 000 VHD surgeries performed annually in China.As the population ages,the number of VHD patients is expected to further increase.To standardize perioperative management of VHD surgeries and improve patient survival and quality of life,the Cardiovascular Anesthesia Committee of the Chinese Society of Cardiothoracic and Vascular Anesthesiology,in collaboration with the Professional Committee of Anesthesiology,National Expert Committee for Cardiovascular Diseases and Anesthesiology Branch of Beijing Medical Association organized a multidisciplinary expert panel develop current consensus.Following the principles and standards for developing clinical practice guidelines,the panel formulated the expert consensus on perioperative management of adult valvular heart disease surgery(2025).This consensus addresses 6 key clinical aspects of adult VHD surgery:preoperative evaluation,perioperative monitoring,intraoperative management,blood conservation,perioperative analgesia,and perioperative management of transcatheter valve intervention.Based on the best available evidence and expert consensus,21 recommendations are formulated to guide perioperative management in VHD surgeries in China.

Objectives:Recently,domestical developed left ventricular assist devices(LVAD)have been frequently introduced into clinical practice.This study aims to report the anesthesia protocol and perioperative outcomes in Chinese patients receiving LVAD implantation surgery.Methods:This retrospective analysis included patients who underwent LVAD implantation at our center from June 2017 to November 2024.During and after separation from cardiopulmonary bypass,we optimized right heart function through careful adjustments in heart rate,rhythm,preload,myocardial contractility,and afterload.Vasoactive agents were administered as needed,and mechanical ventilation parameters were optimized.We implemented blood conservation strategies and established strict transfusion criteria to minimize allogenic blood transfusions.Results:A total of 100 patients were included in the analysis,with 54.0%classified as Interagency Registry for Mechanically Assisted Circulatory Support(INTERMACS)I or II.Before leaving the operating room,the mean arterial pressure(MAP),mean pulmonary arterial pressure(mPAP),central venous pressure(CVP),lactic acid levels,and urinary output after cardiopulmonary bypass were recorded as(74±7)mmHg,(25±7)mmHg,(7±3)mmHg,(2.3±1.9)mmol/L,and(8.2±5.4)ml/(kg·h),respectively.The transfusion rates for red blood cells and fresh frozen plasma were 20.0%and 28.0%.The in-hospital mortality rate was 3.0%,with a low incidence of severe complications including right heart failure(12%).Left ventricular ejection fraction increased from(23.7±4.8)%preoperatively to(25.3±10.5)%prior to discharge.Conclusions:Patients who received LVAD at our center exhibited low rates of postoperative mortality and complications and significant improvement in left heart function before discharge.

Objective To identify potential quality risks of Xiaoer Huatan Zhike Granules(Pediatric Phlegm-Resolving and Cough-Relieving Granules)through National Drug Sampling and Inspection,evaluate their overall quality,and propose improvements to the quality standards.Methods Samples from 34 manufacturers were tested using official standards.Exploratory methods were developed to enhance risk analysis,including thin-layer chromatography(TLC)identification,content uniformity testing,quantitative assays,and screening for unauthorized additives(e.g.,colorants).Results All batches met the official standards(100.0%compliance rate).However,deficiencies were observed:most manufacturers lacked controls for ephedrine hydrochloride content uniformity and quantification,omitted key ingredient identifications(e.g.,herbal components),and exhibited insufficient TLC specificity(e.g.,TLC of Ipecac tincture showed only one spot instead of multiple alkaloid-specific spots).Exploratory studies revealed risks in total emetine/cephaeline content,morroniside A/platycodin D content,ephedrine hydrochloride uniformity,and unauthorized colorant addition.Conclusions The overall quality of this variety is good,but the enterprise should improve the quality control measures throughout the entire process and establish stricter internal control standards;The official standards,unchanged for approximately 30 years,fail to address current regulatory requirements.The statutory quality standards need to be revised and improved.Qualitative or quantitative indicators for all drug flavors in the prescription should be added,and the content uniformity inspection of ephedrine hydrochloride should be increased.

Vulvar lichen sclerosus(LS)is a chronic inflammatory skin and mucosal disease with unknown pathogenesis,which may lead to scar formation of the external genitalia and sexual dysfunction,seriously affecting the quality of life of patients.Genetic factors,autoimmune factors,infections,environment,and hormones are associated with the onset of vulvar LS,and there are also many uncertainties in its clinical diagnosis and treatment.Therefore,based on extensive literatures,this article provides a review of the pathogenesis,diagnosis and evaluation,treatment methods,prognosis and management of vulvar LS.