Objective To propose a framework for risk assessment and stepwise management of pulmonary nodules based on existing guidelines and key studies, and to clarify the boundaries for triage, workup escalation, and referral in different detection scenarios. Methods A problem-oriented evidence synthesis approach was used, prioritizing Chinese expert consensus, Fleischner Society Guidelines, British Thoracic Society (BTS) Guidelines, and Lung-RADS. This was supplemented by studies on risk models, imaging measurements, liquid biopsy, tissue sampling, and surgical treatments. This paper is not presented as a formal consensus or a validated clinical pathway. Results A three-tiered framework consisting of basic non-invasive assessment, advanced assessment, and invasive diagnosis was established. It specified the applicable populations, boundaries for the use of risk models, imaging review, management of conflicting results, evaluation of histopathological consistency, and post-intervention follow-up. Liquid biopsy, genetic testing, and artificial intelligence were defined as investigational or adjunctive tools. Conclusion This framework can serve as a preliminary reference for multidisciplinary teams in developing local protocols. It cannot replace applicable guidelines, pathological diagnosis, shared decision-making with patients, or real-world validation.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Objective To investigate the role of matrix GLA protein(MGP)in the pathogenesis of idiopathic calcium oxalate kidney stones(ICOS),and to find potential biomarkers for early diagnosis and disease evaluation.Methods A total of 120 patients admitted to our hospital from September 2021 to September 2023 were prospectively included,of which 60 patients with ICOS were in the calculus group and 60 patients without calculus were in the control group.Serum biochemical indexes and immunohistochemical scores of the two groups were detected,urinary MGP levels were determined by ELISA,and MGP mRNA and protein expression in renal papilla tissues were detected by qPCR and Western blot.The independent risk factors of ICOS were screened by Logistic regression analysis,and the prediction model was drawn by nomogram.Results Compared with control group,urinary MGP content in calculus group was decreased[(1 805.91±244.44)pg/ml vs.(2 014.79±252.14)pg/mnl,P＜0.05).Expression of MGP mRNA and MGP protein in renal papillae decreased(0.89±0.15 vs.1.00±0.00,P=0.001)and decreased(0.87±0.18 vs.1.00±0.00,P＜0.05).MGP immunohistochemical scores of renal tissue were decreased[4(2-6)scores vs.6(4-8)scores,P＜0.001].Multivariate analysis showed that urinary calcium(OR=1.370),urinary MGP(OR=1.127),renal papilla MGP relative expression level(OR=27.532)and renal tissue MGP immunohistochemical score(OR=1.359)were independent risk factors for ICOS.Area under ROC curve of the nomogram prediction model built based on the above factors is 0.839,indicating that the model has good differentiation ability in risk prediction.Conclusion MGP is closely related to the pathogenesis of ICOS.Urinary and renal tissue MGP levels may be potential biomarkers for early diagnosis and disease assessment of ICOS.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Objective To investigate the role of matrix GLA protein(MGP)in the pathogenesis of idiopathic calcium oxalate kidney stones(ICOS),and to find potential biomarkers for early diagnosis and disease evaluation.Methods A total of 120 patients admitted to our hospital from September 2021 to September 2023 were prospectively included,of which 60 patients with ICOS were in the calculus group and 60 patients without calculus were in the control group.Serum biochemical indexes and immunohistochemical scores of the two groups were detected,urinary MGP levels were determined by ELISA,and MGP mRNA and protein expression in renal papilla tissues were detected by qPCR and Western blot.The independent risk factors of ICOS were screened by Logistic regression analysis,and the prediction model was drawn by nomogram.Results Compared with control group,urinary MGP content in calculus group was decreased[(1 805.91±244.44)pg/ml vs.(2 014.79±252.14)pg/mnl,P＜0.05).Expression of MGP mRNA and MGP protein in renal papillae decreased(0.89±0.15 vs.1.00±0.00,P=0.001)and decreased(0.87±0.18 vs.1.00±0.00,P＜0.05).MGP immunohistochemical scores of renal tissue were decreased[4(2-6)scores vs.6(4-8)scores,P＜0.001].Multivariate analysis showed that urinary calcium(OR=1.370),urinary MGP(OR=1.127),renal papilla MGP relative expression level(OR=27.532)and renal tissue MGP immunohistochemical score(OR=1.359)were independent risk factors for ICOS.Area under ROC curve of the nomogram prediction model built based on the above factors is 0.839,indicating that the model has good differentiation ability in risk prediction.Conclusion MGP is closely related to the pathogenesis of ICOS.Urinary and renal tissue MGP levels may be potential biomarkers for early diagnosis and disease assessment of ICOS.

As China enters the aging era, the incidence rate and prevalence of inflammatory bowel disease(IBD)in the elderly have increased.The relationship between aging and inflammation appears to be more significant in elderly individuals with IBD.However, most current studies focus on describing the clinical characteristics of the disease, with limited research on its pathogenesis and treatment.In this review, we summarize the differences in clinical characteristics and treatment between elderly individuals with IBD and young individuals.We also discuss the impact of aging on elderly IBD and explore the possibility of stem cell transplantation therapy as a new approach for clinical management.Our aim is to provide fresh insights for the treatment of elderly IBD.

Objective To review the application of artificial intelligence in anxiety and depression among children and adolescents. Methods PubMed,Web of Science,CNKI and Wanfang data were searched for literature related to artificial intelligence applied in of anxiety and depression among children and adolescents from January,2014 to January,2024,and a scoping review was conducted. Results A total of ten papers were included,originating from the United States,China,Australia and France.These re-searches were primarily published in journals related to psychology,public health,clinical medicine,neurosci-ence and rehabilitation,involving six cross-sectional researches,three longitudinal researches and one interview,including 10 880 participants aged from three to 18 years.The types of data mainly included questionnaires/scales,interview data and brain imaging data.Features related to anxiety and depression were extracted from the data,and artificial intelligence were employed to develop models for the identification or prediction of anxiety and depression in children and adolescents. Conclusion Artificial intelligence is potential for identifying or predicting anxiety and depression in children and adoles-cents.

Objective To establish the categories and structure of physical activity in children with autism spectrum disorder(ASD),and systematically evaluate the long-term effect of physical activity on the executive function of children with ASD,based on the theoretical and methodological framework of the International Classification of Functioning,Disability,and Health-Children and Youth version(ICF-CY). Methods A search was conducted in databases such as Wanfang data,CNKI,PubMed,Web of Science and ProQuest,to collect literatures about long-term physical activity for executive function of children with ASD published from 2014 to 2023.The literatures were reviewed based on inclusion and exclusion criteria,following PRISMA guide-lines for systematic review,and the quality of the included literatures were assessed with the Physiotherapy Evi-dence Database(PEDro)scale. Results Totally,ten articles were included,consisting of nine randomized controlled trials(RCTs)and one non-random-ized controlled trial,with a total of 351 children diagnosed as ASD,aged three to 18 years,came from Italy,Cana-da,South Korea,China and the United States,published mainly after 2016.Physical activity primarily included sports activities(such as baseball,basketball,table tennis and equine-assisted activities),skill-based activities(such as cycling,cognitive-motor training and active gaming),physical fitness activities(SPARK),as well as combat-related activities(martial arts and karate);30 to 70 minutes a time(mainly 45 minutes),one to five times a week(mainly twice a week),for two to 24 weeks(mainly twelve weeks).Long-term physical activities had been found to improve inhibitory control and cognitive flexibility in children with ASD,although the effect on working memory was inconsistent. Conclusion Long-term physical activity may positively impact on executive function in children with ASD,especially inhibitory control and cognitive flexibility.However,the effect on working memory need more researches.

Objective To review the application of artificial intelligence(AI)in the identification,monitoring and intervention of sleep disorders in the elderly and the effect. Methods A scoping review was conducted by searching relevant literature ahout the application of AI in the field of sleep disorders among the elderly from databases including PubMed,Web of Science,CNKI,and Wanfang data,covering literatures from the establishment to June,2024. Results A total of ten articles were included,originating from seven countries and involving 36 344 elderly participants.The publication dates ranged from 2020 to 2024.The study types included six cross-sectional studies,one pro-spective study,one self-controlled study and two randomized controlled trials.The articles mainly came from the fields of clinical medicine,sleep research,rehabilitation medicine and information engineering.AI was primarily used for monitoring the entire sleep process of the elderly,predicting and identifying sleep disorders,and inter-ventions such as biofeedback,online consultations and cognitive-behavioral therapy based on mobile platforms. Conclusion AI not only improves the accuracy of diagnosing sleep disorders,but also provides robust data support for clinical intervention.Online sleep interventions based on big data and intelligent algorithms can offer effective health management for the elderly.

Objective: To analyse the effects of physical activity on neurocognitive function in children with autism spectrum disorder (ASD),so as to provide a theoretical basis and specific guidance for the clinical cognitive function rehabilitation practice of ASD children. Methods: Relevant literature on the effects of physical activity on neurocognitive function in children with ASD were searched in the China National Knowledge Infrastructure (CNKI), Wanfang, Web of Science, and EBSCO databases from their inception to March 2024 using specific subject terms. Information on authors, countries, publication dates, study populations, diagnostic criterion, interventions, measurement tools and study results were extracted postscreening. The methodological quality of the articles was assessed using the PEDro Scale, followed by a systematic review. Results: A total of seventeen articles and were included in the study and English literature, most of them were of good quality. The study included 10 randomized controlled trials, 4 quasiexperimental designs, and 3 preand posttest designs. The rehabilitative effects of physical activity on children with ASD were primarily observed in enhanced attention and executive function, as well as improvements in brain structure and function. Children with ASD showed varying cognitive effects in physical and skillbased programs, with skillbased activities like basketball and table tennis notably improving cognitive function. Conclusion Physical activity is an effective intervention that enhances cognitive abilities such as attention and executive function, as well as brain structure and function in children with ASD.