Objective:To investigate the surgical efficacy of the modified areolar triangular dermal-glandular composite flap in correcting moderate to severe congenital nipple inversion.Methods:A retrospective analysis was performed on clinical data collected from patients with moderate to severe congenital nipple inversion treated at the Department of Plastic and Aesthetic Surgery, the First Affiliated Hospital of Hainan Medical University, between August 2018 and January 2023. Patients were divided into two groups based on the month of admission: the control group, treated with conventional areolar triangular flap, and the observation group, treated with the modified areolar triangular dermal-glandular composite flap. Postoperatively, nipple appearance, maintenance of nipple height, and incidence of complications were assessed in both groups. At six months after surgery, surgeons evaluated the therapeutic efficacy as good, fair, or poor; the total effective rate was calculated as (number of good + fair cases) / total number of cases ×100%. Patient satisfaction was rated as very satisfied, satisfied, fair, or dissatisfied; the satisfaction rate was calculated as (number of very satisfied + satisfied cases) / total number of cases ×100%. Nipple height (measured as the distance from the areolar plane to the apex of the nipple) was recorded before and after surgery. Measurement data were analyzed using the t-test, and categorical data were analyzed using the χ2 test. A P-value < 0.05 was considered statistically significant. Results:A total of 60 female patients (94 sides) were included in the study. In the control group (28 patients), the mean age was 28.5±5.2 years; 11 cases were unilateral, and 17 cases were bilateral; 22 sides were classified as moderate, and 23 sides as severe. In the observation group (32 patients), the mean age was 29.1±4.8 years; 15 cases were unilateral, and 17 cases were bilateral; 23 sides were moderate, and 26 sides were severe. There were no statistically significant differences between the two groups regarding age, severity of nipple inversion, or the ratio of unilateral to bilateral nipple inversion (all P>0.05). Postoperative follow-up lasted 6 to 15 months, with 28 patients (43 sides) in the observation group and 24 patients (39 sides) in the control group completing follow-up. No severe complications, such as nipple necrosis, occurred in either group, and nipple morphology and appearance were generally normal. The total effective rates based on surgeons' efficacy evaluations were 94.87% (37/39) in the control group and 100.00% (43/43) in the observation group, with no statistically significant difference ( P>0.05). Patient satisfaction rates were 76.92% (30/39) in the control group and 93.02% (40/43) in the observation group, showing a statistically significant difference ( P<0.05). There was no significant difference in preoperative nipple height between the two groups [-3.2±1.1 mm vs. -3.5±0.9 mm, P>0.05]. At 6 months post-surgery, nipple height in the observation group was significantly greater than in the control group [10.9±2.0 mm vs. 9.5±1.9 mm, P < 0.05]. Conclusion:The modified triangular dermal-glandular composite flap technique for correcting nipple inversion is relatively simple, demonstrates low long-term recurrence rates, and provides stable maintenance of nipple height. It is one of the preferred methods for treating moderate to severe congenital nipple inversion.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Objective:To investigate the effectiveness and safety of fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins during sublobar resection for the treatment of early-stage non-small cell lung cancer (NSCLC).Methods:This is a prospective cohort study. Patients with early-stage NSCLC who underwent fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins for sublobar resection in the Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, from January to April 2024 were included. Based on whether the artery or vein was blocked during surgery, the patients were divided into the arterial group and the venous group. The surgical time, intraoperative blood loss, distance from the lesion to the resection margin, and boundary duration were collected and compared between the two groups. Independent sample t test, Mann-Whitney U test, or χ2 test was used to compare the data between the two groups. Results:A total of 64 patients were enrolled. There were 25 males and 39 females, aged (57.3±12.1) years (range: 34 to 80 years). The tumor diameter was (9.8±2.9) mm (range: 5 to 16 mm). The distance between the surgical margin and the lesion was (16.5±3.9) mm (range: 10 to 30 mm) and the surgical time was (61.5±13.9) minutes (range: 30 to 120 minutes). Pathological examination of the surgical specimens showed that all margins met pathological requirements. The chest drainage tube retention time ( M(IQR)) was 2 (1) days (range: 1 to 7 days), and no serious postoperative complications occurred. The boundary duration for the arterial group ( n=23) and venous group ( n=41) was (147.9±22.2) seconds (range: 119 to 188 seconds) and (40.9±8.0) seconds (range: 20 to 60 seconds), respectively ( t=27.935, P<0.01). Conclusion:Fluorescence thoracoscopy-assisted temporary occlusion of pulmonary arteries and veins can effectively and accurately delineate surgical resection boundaries, ensuring sufficient margin width to meet oncological requirements.

Objective:To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus.Methods:This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age ( M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results:Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy ( P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively ( P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively ( P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions:HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients′ survival.

Objective To investigate whether the application of automated software for computed tomography angiography(CTA)and computed tomography perfusion imaging(CTP)can improve in-hospital workflow for endovascular treatment(EVT)in acute ischemic stroke patients.Methods We included patients with acute ischemic stroke who received CTA and CTP evaluation followed by EVT through the stroke emergency pathway at the Affiliated Hospital of Southwest Medical University between January 1,2020 and December 30,2022.The patients were divided into two groups:control group and artificial intelligence(Al)group based on whether automated software was used for assessment.The control group consisted of patients who underwent manual post-processing of multimodal imaging before June 2021,while the AI group was composed of patients whose imaging was processed with automated software from July 2021 onwards.The primary outcome was door-to-puncture time(DPT),and the secondary outcome was the 90-day modified Rankin Scale(mRS)score.Results A total of 312 patients were included,with 145 in the control group and 167 in the AI group.The median age of all the patients was 68 years(range:58-74 years),and 55.4％(173 patients)were male.The median National Institutes of Health Stroke Scale(NIHSS)score at presentation was 16 scores(range:12-19 scores).The median DPT was reduced from 110 min(range:80-150 min)before the use of automated software to 95 min(range:65-125 min)after its implementation(P＜0.001).However,there was no significant difference in the proportion of patients achieving functional independence(mRS score of 0-2)between the two groups(39.3％vs.41.3％,P=0.719).Conclusion The application of multimodal CT automated software improves the in-hospital workflow for acute ischemic stroke patients by reducing the time to EVT.However,the software did not significantly impact neurological functional outcomes as measured by the mRS.

Objective:To analyze the development trend of medical institution bed allocation in OECD countries and provide insights for optimizing bed resources allocation in China.Methods:Data on indicators of bed allocation and related factors from 1991 to 2022 were collected from the OECD online database.Bed allocation impact dimensions were identified based on health needs and demand theories.The random effect model and correlation analysis were used to explore influencing pathways of bed allocation.Results:The number of beds per 1 000 population and average life expectancy showed a significant positive correlation in countries below the average bed level,while an inverse trend was observed in countries above the average level.The number of long-term care beds per 1000 population showed positive correlation with average life expectancy.Multidimensional factors such as the disease spectrum and bed utilization efficiency were significant correlated with the bed allocation levels.The greater the gap in inpatient and outpatient reimbursement rations,the higher the demand for hospitalization among patients with chronic disease.Conclusions:An optimal number of beds is essential for achieving higher health outcomes.The bed classification planning system should be designed to adapt to demographic changes and strengthen the medical security support system.

Objective:To investigate the association between fibroblast growth factor 21(FGF21)and chronic kidney disease(CKD)in a prediabetic population by conducting a 4-year prospective cohort study among community-dwelling residents aged≥40 years in Guangzhou,China.Methods:A total of 1505 subjects who met the criteria for prediabetes and had complete baseline data were col-lected from the 2012 REACTION cohort,and they were followed up for 4 years to observe newly-onset CKD and the changes in urinary albumin-to-creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR).Results:Among the 1 505 subjects with predia-betes,142 reached the diagnostic criteria for CKD during follow-up,yielding an overall incidence rate of 9.43%(95%CI=7.895%-10.902%).According to baseline serum FGF21 level,the subjects were divided into Q1-Q4 groups,with the lowest level of FGF21 in the Q1 group,and the Q4 group had a significantly higher eGFR than the other groups(P<0.05).After a mean follow-up time of 4 years,UACR was increased by 0.87 mg/g(P<0.001)and eGFR was reduced by 4.8 mL/(min·1.73 m2)(P<0.001).After stratification by FGF21 quartiles,there were differences in the declines of eGFR across groups,with the lowest degree of reduction in the Q2 group.In the multivariate regression model,the serum level of FGF21 was significantly negatively associated with the onset of CKD.When FGF21 was analyzed as a continuous variable in the multivariate lo-gistic regression analysis,FGF21 was still significantly negatively associated with the risk of CKD,which was consistent with the re-sults of the quartile-based analysis.However,restricted cubic spline curves showed an L-shaped non-linear relationship between FGF21 level and the risk of CKD,i.e.,the incidence rate of CKD de-creased with the increase in FGF21 level,but when FGF21 level reached a certain threshold,the risk of CKD no longer changed with FGF21.The linear regression analysis showed that FGF21 was positively associated with UACR and eGFR.Conclusion:In this pro-spective cohort study,FGF21 level might be potentially associated with the future risk of CKD among adults with prediabetes,while fur-ther studies are needed to clarify related mechanisms and clinical value.

Nano/microplastics(NMPs),due to their environmental persistence and resistance to degradation,have emerged as a major contributor to global pollution.NMPs are capable of adsorbing various hazardous chemicals and heavy metals,thereby posing threats to aquatic ecosystem health,which may ultimately cause potential risks to human health.Conventional analytical methods suffered from limited resolution,insufficient chemical information,or destruction of sample,invalidating these assays for on-site detection of NMPs.Surface-enhanced Raman scattering(SERS)offers distinct advantages such as high sensitivity,superior specificity,rich fingerprint information,and non-destructive analysis,thus facilitating the on-site analysis of NMPs in complex matrices.This review summarized recent advances in SERS substrates for detection of NMPs,discussed the construction and applications of SERS-based multimodal detection strategies,and introduced the research progress of SERS detection of NMPs in food safety,environmental pollution,and bioanalysis.Moreover,the main challenges and future directions of SERS-based NMP detection were outlined.

Due to the poor ionization efficiency and the weak mass spectrometry(MS)intensity of weakly polar substances,direct analysis using the traditional electrospray ionization mass spectrometry(ESI-MS)is a big challenge.In this study,a novel rapid on-site detection method of four prohibited sex hormones in cosmetics was proposed using online derivatization strategy coupled with a miniature mass spectrometer.The target substances in the samples were extracted by a custom-made polyaniline/multi-walled carbon nanotube solid-phase microextraction(SPME)probe.The stirring speed was 200 r/min,the extraction temperature was 40℃,and the extraction time was 2 min.A pulled dual-channel θ borosilicate glass capillary emitter was used as the nano-ESI ion source.The SPME probe was inserted into the channel containing methanol in theθborosilicate glass capillary.When the spray voltage was applied,the four sex hormones were desorbed and formed spray microdroplets,which then collided with the hydroxylamine microdroplets generated from the other channel.The microdroplets of reaction product entered into the miniature mass spectrometer for direct analysis.The limits of detection(LOD)and limits of quantification(LOQ)for the four sex hormones were 10-20 ng/mL and 20-50 ng/mL,respectively.The recoveries were from 84.6%to 107.8%with the relative standard deviations(RSD)from 4.1%to 11.6%.Compared to detection without derivatization,the MS signals of the four target substances were increased by 3 to 15 times.This method was simple,rapid,highly efficient and sensitive,and suitable for on-site rapid analysis of weakly polar sex hormones in cosmetics.

Objective:To investigate the efficacy and toxicity of blinatumomab in the first-line and second-line treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL).Methods:A multi-center retrospective cohort study was conducted to analyze clinical data from 323 pediatric B-ALL patients treated with blinatumomab across 14 hospitals in China from May 2021 to July 2023. Patients were divided into four groups based on the treatment phase and disease status when blinatumomab was used: relapsed/refractory group, post-consolidation minimal residual disease (MRD)-positive group, early MRD-positive group, and MRD-negative group. Blinatumomab for the relapsed/refractory group was considered as second-line treatment, while the other 3 groups as first-line treatment. The MRD negativity rate after treatment, the survival rates and the incidence of severe adverse events were compared across these groups. Patients who received blinatumomab for more than 7 days were included in the efficacy analysis. Survival analysis was performed using the Kaplan-Meier method, and Log-Rank test was used to compare the survival rates among groups.Results:Among the 323 patients, 191 (59.1%) were male, with the age of 6.2 (3.9, 10.5) years. There were 117 patients in the relapsed/refractory group, 62 cases in the post-consolidation MRD-positive group, 43 cases in the early MRD-positive group, and 101 cases in the MRD negative group. In the relapsed/refractory group, the complete remission rate and MRD negativity rate after one course of blinatumomab were 71.4% (35/49) and 81.5% (75/92) for the 49 children without complete remission and the 92 children with flow cytometry-positive MRD, respectively. In the post-consolidation MRD-positive group, the MRD negativity rates after one course of blinatumomab were 100.0% (27/27), 12/16 and 9/19 for patients with MRD positivity detected by flow cytometry, polymerase chain reaction and next-generation sequencing, respectively. In the early MRD-positive group, the MRD negativity rates were 96.7% (29/30) and 9/9 for flow cytometry and next-generation sequencing, respectively. The 2-year overall survival rate and event-free survival rate for the 319 children evaluable for efficacy were (90.6±1.7)% and (87.6±1.9)%, respectively, with the relapsed/refractory group showing significantly lower overall survival rates and event-free survival rate compared to the other groups ( χ2=21.40, 26.21,both P<0.001). Grade 3 or higher adverse events occurred in 128 cases (39.6%), with hematological toxicity observed in 101 cases, while cytokine release syndrome (CRS), infection, and neurotoxicity occurred in 11, 26 and 8 cases, respectively. In addition, there were statistically significant differences in the grade 3 or higher CRS among the four groups ( χ2=8.03, P<0.05). Conclusion:Blinatumomab can clear MRD more effectively and achieve superior survival outcomes when used as first-line treatment for pediatric B-ALL, with less CRS.