Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Objective:To compare the efficacy of drug-coated balloon (DCB) angioplasty and self-expanding stenting in symptomatic middle cerebral artery stenosis (MCAS).Methods:A retrospective study was performed. Patients with symptomatic MCAS admitted to Department of Cerebrovascular Diseases, Interventional Center, He'nan Provincial People's Hospital from January 2020 to December 2022 were chosen from their prospective study database. They were divided into a DCB group and a stent group based on approaches. Baseline data differences between the two groups were eliminated using 1: 1 propensity score matching (PSM). Then, the technical success rate, immediate restenosis rate, and 6-month restenosis rate, and clinical outcomes within 30 days and 1 year of procedure were compared between the two groups.Results:After PSM, 58 patients were included, with 29 in the stent group and 29 in the DCB group. Technical success rate was 93.1% (27/29) in the DCB group and 96.6% (28/29) in the stent group, without significant difference ( P>0.05). The immediate restenosis rate was 6.9% (2/29) in the DCB group and 3.4% (1/29) in the stent group, without significant difference ( P>0.05). In terms of safety, no stroke or death events were noted in the two groups within 30 days of procedure; ischemic stroke incidence in the offending vessel areas within 1 year of procedure in the DCB group and stent group was 3.7% (1/27) and 11.5% (3/26), without significant difference ( P>0.05); no hemorrhagic stroke or death were noted in the two groups within 1 year of procedure. In terms of efficacy, the modified Rankin scale score of the two groups was both 0 (0, 0) at 1 year of follow-up, without significant difference ( P>0.05); 46 patients in the DCB group and stent group had imaging followe-up for 6 months: the restenosis rate was 8.0% (2/25) and 23.8% (5/21), respectively, without significant difference ( P>0.05). Conclusion:DCB angioplasty is comparable in efficacy and safety with self-expanding stenting in symptomatic MCAS.

Objective:To investigate the clinical manifestations, treatment, and outcomes of Barth syndrome (BTHS).Methods:A retrospective analysis was conducted on 21 pediatric patients diagnosed with BTHS between January 2010 and December 2023 at Beijing Children′s Hospital, Beijing Anzhen Hospital, and Beijing JingDu Children′s Hospital. Clinical data including gender, age at onset, initial symptoms, clinical manifestations, personal history, family genetic history, and laboratory tests (neutrophil count, echocardiography, electrocardiogram and genetic testing) were reviewed.Results:All the 21 patients were male, with the age of onset at 4.1 (1.1, 9.3) months. Main clinical manifestations included heart failure (18 cases), neutropenia (16 cases), respiratory symptoms (15 cases), 3-methylpentenediuria (7 cases),develop retardation (8 cases), gastrointestinal symptoms (7 cases), fatigue and anorexia (6 cases), and recurrent infection (2 cases). Electrocardiogram abnormalities included ST changes (18 cases), flattened T wave and low voltage of limb leads (2 cases), and abnormal Q waves in lead Ⅰ and avL (1 case). Echocardiographic features showed increased trabeculation, interventricular septum and left ventricular wall thickening, and left ventricular enlargement with reduced ejection fraction. Genetic testing identified TAZ gene variations in all 21 patients: 11 missense mutations, 2 nonsense mutations, 2 frameshift mutations, 2 whole code mutations, 2 exon deletions, 1 splicing mutation, and 1 synonymous mutation. Fifteen mutations were maternally inherited, 2 were de novo, and 4 lacked verified variant origin.In terms of treatment, all 18 patients with heart failure received routine heart failure treatment, of whom 11 patients also received intravenous immunoglobulin and corticosteroids. After the follow-up of 91.0 (75.5, 109.5) months, 15 of the 18 patients showed restoration of cardiac function after 4.5 (3.0, 9.8) months of treatment, with one case of significant improvement, while 2 cases suddenly died.Conclusions:BTHS predominantly affects males with early onset, mainly characterized by abnormal cardiac structure and function, along with clinical features including fatigue, delayed growth and development, and neutropenia. Early diagnosis and intervention, including heart failure treatment, intravenous immunoglobulin, and corticosteroids, can lead to significant improvement in cardiac function, though sudden death remains a risk.

Objective To conduct a scoping review of studies related to gamified physical activity interventions for pediatric cancer patients,and to extract the gamification elements and application effects within physical activity intervention programs.Methods A computer-assisted search was conducted in CNKI,Wanfang Data,VIP Database,China Biology Medicine disc,Cochrane Library,PubMed,Embase,and Web of Science for studies on gamified physical activity interventions in pediatric cancer patients,with a search period from database inception to December 31,2023.The included literature was screened,summarized,and analyzed.Results A total of 18 articles were included,including 9 randomized controlled trials,4 quasi-experimental studies,and 5 mixed-method studies.The gamified intervention programs for physical activity in children with cancer integrated 7 gamification elements,including goal setting,capacity to overcome challenges,providing feedback on performance,reinforcement,progress monitoring,social connectivity,and fun and playfulness.The types of physical activity in the intervention programs included aerobic exercise,balance training,strength training,endurance training,etc.The intensity of the activities was mainly low to moderate;the duration was mostly 30～60 minutes per session;the intervention duration ranged from 5 weeks to 1 year.Numerous research findings indicate that gamified physical activity interventions for children with cancer can help improve physical function,quality of life,and fatigue levels.However,there is signi-ficant controversy regarding their impact on improving physical activity levels.Conclusion The gamified inter-vention for physical activity in children with cancer was safe and feasible.It is recommended that in the future,personalized and phased gamified intervention programs should be developed to evaluate the intervention effects.

OBJECTIVES: Accurate identification of risk factors for precocious puberty is essential for clinical diagnosis and management, yet the performance of natural language processing methods applied to unstructured electronic medical record (EMR) data remains to be fully evaluated. This study aims to assess the performance of a prompt engineering method for extracting individual risk factors of precocious puberty from EMRs. METHODS: Based on the capacity and role-insight-statement-personality-experiment (CRISPE) prompt framework, both simple and optimized prompts were designed to guide the large language model GLM-4-9B in extracting 10 types of risk factors for precocious puberty from 653 EMRs. Accuracy, precision, recall, and F1-score were used as evaluation metrics for the information extraction task. RESULTS: Under simple and optimized prompt conditions, the overall accuracy, precision, recall, and F1-score of the model were 84.18%, 98.09%, 81.99%, and 89.32% versus 97.15%, 98.31%, 98.16%, and 98.23%, respectively. The optimized prompts achieved more stable performance across age (<9 years vs ≥9 years) and visit-time (<2023 vs ≥2023) subgroups compared with simple prompts. The accuracy range for extracting each risk factor was 60.03%-97.24%, while with optimized prompts, the range improved to 92.19%-99.85%. The largest performance improvement occurred for "beverage intake" (60.03% vs 92.19%), and the smallest for "maternal age of menarche" (97.24% vs 99.23%). In comparing distributions among simple prompts, optimized prompts, and ground truth, statistically significant differences were observed for snack intake, beverage intake, soy milk intake, honey intake, supplement use, tonic use, sleep quality, and sleeping with the light on (all P<0.001), while exercise (P=0.966) and maternal menarche age (P=0.952) showed no significant differences. CONCLUSIONS Compared with simple prompts, optimized prompts substantially improved the extraction performance of individual risk factors for precocious puberty from EMRs, underscoring the critical role of prompt engineering in enhancing large language model performance.
Humans ; Puberty, Precocious/epidemiology* ; Risk Factors ; Electronic Health Records ; Female ; Child ; Natural Language Processing

Objective:To explore the design and application effect of a home-based pulmonary rehabilitation checklist for postoperative lung cancer patients and to analyze the feasibility of this innovative rehabilitation approach.Methods:A prospective non-concurrent controlled study was conducted. Eighty postoperative lung cancer patients from the Department of Thoracic Surgery, Henan Provincial People's Hospital, were conveniently selected. According to the time of admission, postoperative lung cancer patients from April to June 2024 ( n=40) were assigned to the control group, while those postoperative lung cancer patients from August to October 2024 ( n=40) were assigned to the experimental group. The control group was given routine home-based pulmonary rehabilitation knowledge education upon discharge, while the experimental group was provided with the application of a home-based pulmonary rehabilitation checklist in addition to the routine home-based pulmonary rehabilitation knowledge education. Assessments were performed on the day of discharge and 1-month post-discharge using the Chinese version-Strategies Used by People to Promote Health (C-SUPPH), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30), the six-minute walk test (6MWT) and the Brog score. Results:A total of 40 patients in each group completed this study. Among them, there were 26 males and 14 females in the control group, aged (51.25 ± 11.39) years, and 23 males and 17 females in the experimental group, aged (53.07 ± 12.21) years. One month after discharge, the scores of positive attitude, self-decision making and self-stress reduction on the C-SUPPH in the experimental group were (44.25 ± 10.29), (30.76 ± 8.31) and (9.51 ± 2.17) points, respectively. They were higher than those in the control group (37.02 ± 7.14), (26.61 ± 6.71) and (7.58 ± 1.09) points, and the differences were statistically significant ( t=-3.65, -2.46, -5.03, all P<0.05). The scores of somatic function, role function, cognitive function and emotional function on the EORTC-QLQ-C30 in the experimental group were (65.77 ± 6.41), (71.46 ± 7.21), (70.11 ± 5.61) and (69.59 ± 5.71) points, respectively. They were higher than those in the control group (57.71 ± 7.01), (64.27 ± 5.25), (62.79 ± 7.18), (61.11 ± 6.25) points, and the differences were statistically significant ( t values were -6.34 to -5.08, all P<0.05). The 6MWT distance in the experimental group was (411.31 ± 35.02) m, which was higher than (376.58 ± 30.26) m in the control group, and the difference was statistically significant ( t=-4.75, P<0.05). The Brog score in the experimental group was (2.12 ± 0.68) points, which was lower than (2.50 ± 0.65) points in the control group, and the difference was statistically significant ( t=2.56, P<0.05). Conclusions:The implementation of home pulmonary rehabilitation list can improve the self-management ability of patients after lung cancer surgery, improve the quality of life, and then enhance the exercise ability, which is worthy of clinical promotion.

Objective To conduct a scoping review of studies related to gamified physical activity interventions for pediatric cancer patients,and to extract the gamification elements and application effects within physical activity intervention programs.Methods A computer-assisted search was conducted in CNKI,Wanfang Data,VIP Database,China Biology Medicine disc,Cochrane Library,PubMed,Embase,and Web of Science for studies on gamified physical activity interventions in pediatric cancer patients,with a search period from database inception to December 31,2023.The included literature was screened,summarized,and analyzed.Results A total of 18 articles were included,including 9 randomized controlled trials,4 quasi-experimental studies,and 5 mixed-method studies.The gamified intervention programs for physical activity in children with cancer integrated 7 gamification elements,including goal setting,capacity to overcome challenges,providing feedback on performance,reinforcement,progress monitoring,social connectivity,and fun and playfulness.The types of physical activity in the intervention programs included aerobic exercise,balance training,strength training,endurance training,etc.The intensity of the activities was mainly low to moderate;the duration was mostly 30～60 minutes per session;the intervention duration ranged from 5 weeks to 1 year.Numerous research findings indicate that gamified physical activity interventions for children with cancer can help improve physical function,quality of life,and fatigue levels.However,there is signi-ficant controversy regarding their impact on improving physical activity levels.Conclusion The gamified inter-vention for physical activity in children with cancer was safe and feasible.It is recommended that in the future,personalized and phased gamified intervention programs should be developed to evaluate the intervention effects.

Objective:To investigate the clinical manifestations, treatment, and outcomes of Barth syndrome (BTHS).Methods:A retrospective analysis was conducted on 21 pediatric patients diagnosed with BTHS between January 2010 and December 2023 at Beijing Children′s Hospital, Beijing Anzhen Hospital, and Beijing JingDu Children′s Hospital. Clinical data including gender, age at onset, initial symptoms, clinical manifestations, personal history, family genetic history, and laboratory tests (neutrophil count, echocardiography, electrocardiogram and genetic testing) were reviewed.Results:All the 21 patients were male, with the age of onset at 4.1 (1.1, 9.3) months. Main clinical manifestations included heart failure (18 cases), neutropenia (16 cases), respiratory symptoms (15 cases), 3-methylpentenediuria (7 cases),develop retardation (8 cases), gastrointestinal symptoms (7 cases), fatigue and anorexia (6 cases), and recurrent infection (2 cases). Electrocardiogram abnormalities included ST changes (18 cases), flattened T wave and low voltage of limb leads (2 cases), and abnormal Q waves in lead Ⅰ and avL (1 case). Echocardiographic features showed increased trabeculation, interventricular septum and left ventricular wall thickening, and left ventricular enlargement with reduced ejection fraction. Genetic testing identified TAZ gene variations in all 21 patients: 11 missense mutations, 2 nonsense mutations, 2 frameshift mutations, 2 whole code mutations, 2 exon deletions, 1 splicing mutation, and 1 synonymous mutation. Fifteen mutations were maternally inherited, 2 were de novo, and 4 lacked verified variant origin.In terms of treatment, all 18 patients with heart failure received routine heart failure treatment, of whom 11 patients also received intravenous immunoglobulin and corticosteroids. After the follow-up of 91.0 (75.5, 109.5) months, 15 of the 18 patients showed restoration of cardiac function after 4.5 (3.0, 9.8) months of treatment, with one case of significant improvement, while 2 cases suddenly died.Conclusions:BTHS predominantly affects males with early onset, mainly characterized by abnormal cardiac structure and function, along with clinical features including fatigue, delayed growth and development, and neutropenia. Early diagnosis and intervention, including heart failure treatment, intravenous immunoglobulin, and corticosteroids, can lead to significant improvement in cardiac function, though sudden death remains a risk.

Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Objective:To compare the efficacy of drug-coated balloon (DCB) angioplasty and self-expanding stenting in symptomatic middle cerebral artery stenosis (MCAS).Methods:A retrospective study was performed. Patients with symptomatic MCAS admitted to Department of Cerebrovascular Diseases, Interventional Center, He'nan Provincial People's Hospital from January 2020 to December 2022 were chosen from their prospective study database. They were divided into a DCB group and a stent group based on approaches. Baseline data differences between the two groups were eliminated using 1: 1 propensity score matching (PSM). Then, the technical success rate, immediate restenosis rate, and 6-month restenosis rate, and clinical outcomes within 30 days and 1 year of procedure were compared between the two groups.Results:After PSM, 58 patients were included, with 29 in the stent group and 29 in the DCB group. Technical success rate was 93.1% (27/29) in the DCB group and 96.6% (28/29) in the stent group, without significant difference ( P>0.05). The immediate restenosis rate was 6.9% (2/29) in the DCB group and 3.4% (1/29) in the stent group, without significant difference ( P>0.05). In terms of safety, no stroke or death events were noted in the two groups within 30 days of procedure; ischemic stroke incidence in the offending vessel areas within 1 year of procedure in the DCB group and stent group was 3.7% (1/27) and 11.5% (3/26), without significant difference ( P>0.05); no hemorrhagic stroke or death were noted in the two groups within 1 year of procedure. In terms of efficacy, the modified Rankin scale score of the two groups was both 0 (0, 0) at 1 year of follow-up, without significant difference ( P>0.05); 46 patients in the DCB group and stent group had imaging followe-up for 6 months: the restenosis rate was 8.0% (2/25) and 23.8% (5/21), respectively, without significant difference ( P>0.05). Conclusion:DCB angioplasty is comparable in efficacy and safety with self-expanding stenting in symptomatic MCAS.