BackgroundLow medication compliance among patients with severe mental disorders increases the disease burden on both the patients' families and the society. Medication adherence is influenced by numerous factors. Traditional methods such as Logistic regression struggle to quantify the importance of these factors. By introducing Extreme Gradient Boosting （XGBoost） combined with Shapley Additive Explanations （SHAP）， enables the quantification of the relative contribution weights of each factor， providing support for identifying the core influencing factors. ObjectiveTo explore the influencing factors of medication adherence among patients with severe mental disorders in Zhuhai， aiming to provide references for optimizing patient management strategies. MethodsExtract the data of patients with severe mental disorders who were registered on the mental health system platform in Zhuhai City from January 1， 2023 to March 31， 2025. A total of 9 329 patients were finally included for analysis. Influencing factors were screened using univariate analysis and multivariate logistic regression analysis， and an XGBoost model combined with the SHAP algorithm was constructed to quantify the importance of each influencing factor. ResultsAmong 9 329 patients， 8 446 demonstrated medication adherence， yielding an adherence rate of 90.53%. Multivariable analysis identified several risk factors significantly associated with medication non-adherence， being unmarried （OR=1.237， 95% CI： 1.019–1.502） or divorced （OR=1.389， 95% CI： 1.038–1.832）， a diagnosis of mental retardation with psychiatric disorders （OR=3.025， 95% CI： 2.402–3.796） or paranoid psychosis （OR=5.117， 95% CI： 3.086–8.299）， a disease duration of 2–4 years （OR=1.355， 95% CI： 1.085–1.696）， 4–6 years （OR=2.143， 95% CI： 1.671–2.747）， or >6 years （OR=1.681， 95% CI： 1.365–2.079）， lack of guardian subsidies （OR=1.412， 95% CI： 1.099–1.801）， absence of a disability certificate （OR=1.900， 95% CI： 1.588–2.282）， not being enrolled in care and support groups （OR=1.384， 95% CI： 1.183–1.617） or community services （OR=1.313， 95% CI： 1.042–1.645）， and not cohabiting with a guardian （OR=1.257， 95% CI： 1.048–1.501）. Conversely， the enrollment in special outpatient disease programs （OR=0.716， 95% CI： 0.609–0.842） and a family history of mental illness （OR=0.713， 95% CI： 0.503–0.982） were identified as protective factors. The XGBoost model exhibited robust predictive performance， with a sensitivity of 0.433， specificity of 0.944， accuracy of 0.891， Area Under the Curve （AUC） of 0.837， and F1 value of 0.449. Feature importance ranking indicated that the top three factors were disease duration， diagnosis， and the acquisition of disability certificates. ConclusionPolicy-based support （acquisition of disability certificates， special outpatient disease enrollment） and clinical disease characteristics （disease duration， diagnosis type） are key factors affecting medication adherence among patients with severe mental disorders in Zhuhai City. ［Funded by Zhuhai Medical Research Project （number， 2220009000281）］

Background Work-related musculoskeletal disorders (WMSDs) are a major occupational health concern, particularly among workers exposed to adverse ergonomic conditions. Manganese production involves heavy physical demands, yet research on WMSDs among manganese workers remains limited. Objective To investigate the prevalence and influencing factors of WMSDs among manganese workers in a manganese enterprise in Guangxi. Methods A cross-sectional survey was conducted from May to June 2024 on workers at a manganese factory in Guangxi. The Chinese Musculoskeletal Disorders Questionnaire was used to collect information on demographic characteristics, distribution of musculoskeletal symptoms, and work-related exposures. χ² test was applied to compare differences in positive WMSDs rates across groups, and logistic regression analysis was performed to identify associated factors. Results A total of 1476 workers were enrolled in the study after pre-determined inclusion and exclusion criteria. The overall prevalence of WMSDs was 34.15%. The most commonly affected body regions were the lower back (17.28%), neck (16.67%), and shoulders (13.82%). The results of logistic regression analysis indicated that female, older age, and education level of college or above were associated with a higher risk of WMSDs (P<0.05). Awkward working postures were significantly associated with WMSDs in corresponding body regions; in particular, awkward postures of the neck, upper limbs, trunk, and lower limbs were related to an increased risk of WMSDs in multiple body sites (P<0.05). In addition, poor lighting conditions, high workplace temperature, frequent or sustained arm support during work, and high job demands were associated with an increased risk of overall or site-specific WMSDs (P<0.05). Conclusion The high prevalence of WMSDs among manganese workers is closely associated with demographic characteristics, working postures, and work environment and organizational factors. Targeted ergonomic interventions focusing on high-risk body regions and key ergonomic exposures are warranted to reduce the risk of WMSDs among manganese workers.

Purpose: Our previous study showed that circulating tumor cell (CTC) count combined with gene mutation detection might help differentiate benign and malignant pulmonary nodules (PNs). Herein, we aimed to expand the study cohort and conduct further sequencing analysis. Materials and Methods: Patients with PNs were included, and CTCs were identified before operation. Low-coverage whole-genome sequencing (LC-WGS) and lung cancer-related targeted gene sequencing were performed on CTCs. The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve. The differences in CTC counts among subgroups classified by demographic–clinical characteristics were analyzed. LC-WGS–based copy number variation (CNV) analysis and targeted gene mutation analysis were conducted. Results: A total of 172 patients were included. CTC count of 2.5 was identified by the ROC curves as the optimal diagnostic cutoff. The sensitivity and specificity of CTC count for differentiating benign and malignant PNs were 54.2% and 78.6%, respectively. The diagnostic sensitivity and specificity of combined CTC count, radiological nodule type, and any malignant imaging features were 84.7% and 71.4%, respectively. The CTC counts were significantly greater in patients with aggressive tumors, later stage, and spread through air spaces. CTCs from malignant cases had more CNVs than those from benign cases. Conclusion CTC count can be used in identifying malignant PNs. The diagnostic efficacy can be improved if combined with computed tomography imaging characteristics. Further CNV analysis might help differential diagnosis. Greater CTC count might suggest more aggressive tumors. CTC detection can provide important information and guidance for subsequent management of PNs.

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Objective:To analyze the efficacy of endoscopic nasal surgery for sinonasal squamous cell carcinoma (SNSCC) with orbital invasion, the factors affecting the prognosis of patients, and the treatment strategies for preserving the eyeball.Methods:This was a retrospective cohort study, including 60 cases of SNSCC with orbital invasion treated in the Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Harbin Medical University from October 2009 to October 2019. The cohort comprised 39 males and 21 females, aged 33-72 years. Orbital invasion was graded: Grade Ⅰ (destruction of the orbital bone wall), Grade Ⅱ (involvement of the periorbita/orbital fascia, extraconal fat, or medial lacrimal sac), and Grade Ⅲ (involvement of extraocular muscles, eyeball, orbital apex, or optic nerve). All cases underwent multi-disciplinary treatment (MDT), including otolaryngology, ophthalmology and oncology radiotherapy departments, and endoscopic nasal surgery. Survival curves were calculated by Kaplan-Meier method, Log-rank test and Cox risk model were used for univariate and multivariate analysis, respectively.Results:Primary tumor sites were maxillary sinus in 19 cases (31.7%, including 6 cases of pterygopalatine fossa), ethmoid sinus in 25 cases (41.7%, 5 cases with skull base bone involvement but not dura mater), nasal cavity in 11 cases (18.3%), frontal sinus in 3 cases (5.0%), and sphenoid sinus in 2 cases (3.3%). Clinical stages included stage Ⅲ in 53 (88.3%) and stage Ⅳ in 7 (11.7%). The surgical methods of orbital invasion cases were as follows: 18 cases (30.0%) of grade I underwent orbital bone wall resection with orbital fascia and orbital contents preserved; 36 cases (60.0%) in Grade Ⅱ were resected the involved orbital fascia, extra-cone fat and lacrimal sac and preserved the internal cone structure of extra-ocular muscle. Six cases (10.0%) were grade Ⅲ, of which 2 cases were subjected to selective extraocular muscle resection with preserving eyeballs, and 4 cases were subjected to orbital contents removal. The 3-year and 5-year overall survival (OS) rates of all patients were 76.7% and 63.3%, respectively, and the 5-year survival rate of the local recurrence-free group was significantly higher than that of the recurrence group (69.4% vs. 36.4%, χ2=3.91, P=0.048). The 5-year survival rates were significantly negatively correlated with the degrees of orbital invasions (83.3% for grade Ⅰ, 58.3% for grade Ⅱ and 33.3% for grade Ⅲ, ( χ2=10.49, P=0.005). The effects of T stages (66.7% in stage T3 vs. 33.3% in stage T4, χ2=7.21, P=0.007) and clinical stages (67.9% in stage III vs. 28.6% in stage IV, χ2=11.80, P=0.001) on survival rates were statistically significant. The 5-year survival rate of patients with cervical lymph node metastases was significantly lower than that of patients without metastasis (37.5% vs. 67.3%, χ2=8.32, P=0.004). The tumor-free survival rate was 56.7%. Cox multivariate analysis identified T stage [ HR=3.53 (95% CI: 1.31-9.52)] and clinical stage [ HR=35.14 (95% CI: 1.88-658.62)] as independent prognostic factors (both P<0.05). Conclusions:The outcomes of patients with orbital invasion in SNSCC are associated with T stage and clinical stage. If the muscle cone and the structures within the muscle cone are not invaded, eye-preserving surgery is feasible.

Objective:To evaluate whether the reconstructed image on the basis of deep learning(DL)can improve the success rate and display quality of automatic segmentation of computed tomography(CT)with ultralow dose for chest of children on airway.Methods:The clinical data of 41 consecutive cases who adopted ultralow dose CT to underwent reexamination on chest at Beijing Children's Hospital,Capital Medical University from February 2020 to September 2020 were selected,whose average age was(4.43±1.61 years).The scan protocol of ultralow dose CT was(0.05 mGy).The reconstructed images included 6 groups,which were respectively filtered reflection projection(FBP)image with 0.625 mm thickness,50%adaptive iterative recombination(ASIR-V)images,100%ASIR-V images,low energy DL(DL-L),medium energy DL(DL-M),and high energy DL(DL-H).The automatically segmentation software was used to conduct automatically segmentation for airway,and the success rate of automatic segmentation was recorded.For images that were successful segmented,a 5-point scale was adopted to subjectively evaluate the displayed quality for airway(5 point is the best).In addition,the CT values and noise values of the images of 6 groups for airway were objectively measured.Results:The success rate of automatic segmentation of DL-H image was the highest(60.98%),and that of the 100%ASIR-V was the lowest(39.02%).The subjective score of DL-H image of the automatic segmentation was the highest(4.06±0.55)point,and that of 100%ASIR-V was the lowest(2.44±0.76)point.DL-H can display more fine and small airways.The noise values of objective measurement showed that both of DL-H and 100%ASIR-V had the lowest noise value,and there was no statistical difference in that between them.Conclusion:The use of high energy deep learning iterative reconstruction(DLIR)algorithm can improve the success rate and display effect of automatic segmentation of ultralow dose CT for chest of children on airway,and DLIR is contribute to improve the accuracy of automatic segmentation algorithm of artificial intelligence.

Objective To explore the therapeutic effect of Chaizhu Tiaoshen Dingxuan Fang in the treatment of syndrome of stagnation of liver qi and spleen deficiency in vestibular migraine(VM).Methods A total of 72 VM patients admitted to Jilin Academy of Chinese Medicine Sciences from January to October 2024 were selected and divided into treatment group and control group according to the random number table method,with 36 cases in each group.Patients in control group were treated with flunarizine hydrochloride capsules,while patients in treatment group were treated with Chaizhu Tiaoshen Dingxuan Fang.Both groups of patients were treated continuously for 4 weeks.The therapeutic effect scores of TCM syndromes,visual analogue scale(VAS)scores of vertigo,dizziness handicap inventory(DHI)scores and hospital anxiety and depression scale(HADS)scores of two groups of patients were compared.Results After treatment,the therapeutic effect scores of TCM syndromes in both groups were significantly lower than those before treatment in the same group(P＜0.05),and the therapeutic effect scores of TCM syndromes in treatment group were significantly lower than those in control group(P＜0.05).After the treatment,VAS score of vertigo,HADS scores,DHI scores of each dimension and the total score in treatment group were significantly lower than those in before treatment and control group(P＜0.05).Conclusion Chaizhu Tiaoshen Dingxuan Fang can effectively relieve the dizziness symptoms of patients with syndrome of stagnation of liver qi and spleen deficiency in VM,and reduce their anxiety and depression.

Objective:To explore how one-sided/two-sided brain blood flow affects the occurrence of neurological complications in patients with Stanford type A aortic dissection, as well as to assess the factors that contribute to the development of neurological complications.Methods:A total of 162 patients diagnosed with Stanford type A aortic dissection who had undergone ascending aorta and total aortic arch replacement at Affiliated Hospital of Jining Medical College from August 2020 to December 2023 were retrospectively reviewed. These patients were categorized into two groups based on the presence of postoperative neurological complications: a group with neurological complications comprising 77 cases and a group without neurological complications comprising 85 cases. A comparative analysis was carried out on general clinical data, surgical and brain perfusion characteristics, as well as preoperative test indicators between these two groups in order to investigate the factors influencing the occurrence of postoperative neurological complications in patients with Stanford type A aortic dissection. The data was analyzed using Logistic regression to identify the risk factors associated with postoperative neurological complications and to develop a predictive nomogram model. Calibration curves, receiver operating characteristic (ROC) curves and decision curve (DCA) were generated to assess the accuracy and predictive capability of the nomogram model.Results:In the group of patients who experienced neurological complications, there was a higher prevalence of a history of hypertension, longer operation time, extended periods of cardiopulmonary bypass, cross-clamping, brain perfusion, cooling, and rewarming, as well as increased postoperative drainage volume. Additionally, the levels of preoperative blood urea nitrogen (BUN), creatinine (Cr) and lactic acid (Lac) were elevated compared to those in the non-neurological complications group: 77.9% (60/77) vs. 52.9% (45/85), (409.99 ± 104.26) min vs. (348.29 ± 63.12) min, (223.36 ± 66.86) min vs. (179.25 ± 38.59) min, 112 (94, 133) min vs. 96 (84, 113) min, (35.23 ± 9.89) min vs. (32.14 ± 6.81) min, (82.19 ± 28.69) min vs. (68.76 ± 29.06) min, (79.30 ± 22.60) min vs. (69.54 ± 16.42) min, 806 (529, 1 127) ml vs. 663 (449, 925) ml, 6.78 (5.38, 8.84) mmol/L vs. 6.08 (4.66, 7.76) mmol/L, 86.3 (64.0, 131.9) μmol/L vs. 71.0 (55.6, 84.9) μmol/L, 2.1(1.2, 4.0) mmol/L vs. 1.5 (0.9, 2.3) mmol/L. On the other hand, the percentage of patients who underwent bilateral brain perfusion was lower, and they experienced lower lowest temperature, preoperative platelet count, and ejection fraction levels than those in the non-neurological complications group: 57.1% (44/77) vs. 75.3% (64/85), (25.69 ± 1.04) ℃ vs. (26.04 ± 0.82) ℃, (175.79 ± 58.14) ×10 9/L vs. (213.87 ± 77.29) ×10 9/L, (54.18 ± 3.84)% vs. (55.34 ± 3.56)% ( P<0.05). Multivariate Logistic regression analysis revealed that a prior history of high blood pressure, prolonged cardiopulmonary bypass duration were identified as autonomous risk factors for the development of postoperative neurological issues in individuals with Stanford type A aortic dissection, while simultaneous brain perfusion emerged as an independent protective element ( P<0.05). Subsequently, a predictive nomogram was constructed incorporating these three pivotal factors to assess the likelihood of postoperative neurological complications in patients with Stanford type A aortic dissection. The calibration curve exhibited a noteworthy level of accuracy for the nomogram predictive model ( χ2 = 9.01, P = 0.342). Additionally, the ROC curve analysis displayed an area under the curve of 0.84 (95% CI 0.78 to 0.90) for the nomogram model in predicting postoperative neurological complications in patients with Stanford type A aortic dissection, indicating a high predictive accuracy. Moreover, DCA analysis indicated that the nomogram model provided a net benefit above 0 across the spectrum of 0 to 90%. Conclusions:Postoperative neurological complications in patients with Stanford type A aortic dissection is linked to factors such as a previous history of hypertension, unilateral brain perfusion, an extended cardiopulmonary bypass duration. By developing a nomogram model that incorporates these factors, it becomes feasible to accurately forecast the likelihood of postoperative neurological complications in this patient population. This predictive tool holds significant value in facilitating proactive clinical risk evaluation and preventive measures.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

BACKGROUND: In the interim analysis of MONARCH plus, adding abemaciclib to endocrine therapy (ET) improved progression-free survival (PFS) and objective response rate (ORR) in predominantly Chinese postmenopausal women with HR+/HER2- advanced breast cancer (ABC). This study presents the final pre-planned PFS analysis. METHODS: In the phase III MONARCH plus study, postmenopausal women in China, India, Brazil, and South Africa with HR+/HER2- ABC without prior systemic therapy in an advanced setting (cohort A) or progression on prior ET (cohort B) were randomized (2:1) to abemaciclib (150 mg twice daily [BID]) or placebo plus: anastrozole (1.0 mg/day) or letrozole (2.5 mg/day) (cohort A) or fulvestrant (500 mg on days 1 and 15 of cycle 1 and then on day 1 of each subsequent cycle) (cohort B). The primary endpoint was PFS of cohort A. Secondary endpoints included cohort B PFS (key secondary endpoint), ORR, overall survival (OS), safety, and health-related quality of life (HRQoL). RESULTS: In cohort A (abemaciclib: n  = 207; placebo: n  = 99), abemaciclib plus a non-steroidal aromatase inhibitor improved median PFS vs . placebo (28.27 months vs . 14.73 months, hazard ratio [HR]: 0.476; 95% confidence interval [95% CI]: 0.348-0.649). In cohort B (abemaciclib: n  = 104; placebo: n  = 53), abemaciclib plus fulvestrant improved median PFS vs . placebo (11.41 months vs . 5.59 months, HR: 0.480; 95% CI: 0.322-0.715). Abemaciclib numerically improved ORR. Although immature, a trend toward OS benefit with abemaciclib was observed (cohort A: HR: 0.893, 95% CI: 0.553-1.443; cohort B: HR: 0.512, 95% CI: 0.281-0.931). The most frequent grade ≥3 adverse events in the abemaciclib arms were neutropenia, leukopenia, anemia (both cohorts), and lymphocytopenia (cohort B). Abemaciclib did not cause clinically meaningful changes in patient-reported global health, functioning, or most symptoms vs . placebo. CONCLUSIONS: Abemaciclib plus ET led to improvements in PFS and ORR, a manageable safety profile, and sustained HRQoL, providing clinical benefit without a high toxicity burden or reduced quality of life. TRIAL REGISTRATION ClinicalTrials.gov (NCT02763566).
Humans ; Female ; Fulvestrant/therapeutic use* ; Breast Neoplasms/metabolism* ; Aminopyridines/therapeutic use* ; Benzimidazoles/therapeutic use* ; Middle Aged ; Aromatase Inhibitors/therapeutic use* ; Aged ; Receptor, ErbB-2/metabolism* ; Adult ; Letrozole/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Anastrozole/therapeutic use*