Objective To evaluate the effect of remimazolam on the incidence of postoperative delirium(POD)in elderly lung cancer patients undergoing thoracoscopic surgery.Methods A total of 114 elderly patients who underwent unilateral thoracoscopic lung surgery at the Affiliated Hospital of Xuzhou Medical University from October 2024 to April 2025 were recruited in this trial.Patients were randomly assigned to remimazolam group(group R)and propofol group(group P).Anesthesia induction and maintenance were performed with remimazolam and propofol,respectively.In R group,0.5 mg of flumazenil was intravenously injected at the end of the surgery for specific antagonism.The incidence of delirium and Quality of Recovery-15(QoR-15)scores on the first and third postoperative days were compared between the two groups.Intraoperative hemodynamic parameters,total opi-oid dosage,fluid balance,tracheal tube extubation time after surgery,and the incidence of adverse reactions were recorded.Results There were no statistically significant differences between the groups in the incidence of POD or in QoR-15 scores(P>0.05).Compared with group P,patients in group R had a shorter extubation time(P<0.05),more stable hemodynamics,lower incidences of intra-operative hypotension and bradycardia,and reduced requirement for vasoactive drugs(P<0.05).The consumption of rescue analgesics in the post-anesthesia care unit(PACU)was also lower in group R(P<0.05).No significant differences were observed between the groups in the amounts of sufentanil and remifentanil administered,fluid balance,bispectral index(BIS)values,or the inci-dence of nausea and vomiting(P>0.05).Conclusion In elderly patients undergoing elective thoracoscopic sur-gery,remimazolam-based induction and maintenance of anesthesia did not significantly alter the incidence of POD or compromise postoperative recovery quality compared with propofol.However,the remimazolam group required fewer vasoactive agents and exhibited a shorter tracheal extubation time.

Objective To evaluate the effect of remimazolam on the incidence of postoperative delirium(POD)in elderly lung cancer patients undergoing thoracoscopic surgery.Methods A total of 114 elderly patients who underwent unilateral thoracoscopic lung surgery at the Affiliated Hospital of Xuzhou Medical University from October 2024 to April 2025 were recruited in this trial.Patients were randomly assigned to remimazolam group(group R)and propofol group(group P).Anesthesia induction and maintenance were performed with remimazolam and propofol,respectively.In R group,0.5 mg of flumazenil was intravenously injected at the end of the surgery for specific antagonism.The incidence of delirium and Quality of Recovery-15(QoR-15)scores on the first and third postoperative days were compared between the two groups.Intraoperative hemodynamic parameters,total opi-oid dosage,fluid balance,tracheal tube extubation time after surgery,and the incidence of adverse reactions were recorded.Results There were no statistically significant differences between the groups in the incidence of POD or in QoR-15 scores(P>0.05).Compared with group P,patients in group R had a shorter extubation time(P<0.05),more stable hemodynamics,lower incidences of intra-operative hypotension and bradycardia,and reduced requirement for vasoactive drugs(P<0.05).The consumption of rescue analgesics in the post-anesthesia care unit(PACU)was also lower in group R(P<0.05).No significant differences were observed between the groups in the amounts of sufentanil and remifentanil administered,fluid balance,bispectral index(BIS)values,or the inci-dence of nausea and vomiting(P>0.05).Conclusion In elderly patients undergoing elective thoracoscopic sur-gery,remimazolam-based induction and maintenance of anesthesia did not significantly alter the incidence of POD or compromise postoperative recovery quality compared with propofol.However,the remimazolam group required fewer vasoactive agents and exhibited a shorter tracheal extubation time.

Objective To explore the differences in positive psychological resources among elementary and secondary school students with and without non-suicidal self-injury(NSSI)behaviors.Methods Between September and October 2023,the assessment data of 56 870 students aged 9 to 18 years in Chengdu,Sichuan Province were collected.The R software package was used to evaluate the network structure and symptom centrality,and the global strength and structural differences of the networks of students with and without NSSI behaviors in elementary,junior high,and senior high schools were compared.Results The prevalence of NSSI among elementary and secondary school students stands at 12.21%.Specifically,it peaks in junior high school students,reaching 14.22%,followed by that in senior middle school students at 13.66%,and is lowest in elementary school students at 10.17%.Regarding the network structure in elementary school students,irrespective of the presence or absence of NSSI behavior,subjective support exhibits the strongest network strength,and family functioning demonstrates the highest closeness centrality.Among junior high school students without NSSI behaviors,the strongest network strength was observed in subjective support,whereas for those with NSSI behaviors,self-esteem showed the strongest network strength.In addition,subjective support exhibited the highest closeness centrality in both groups.In senior high school students,self-esteem was the factor with the strongest network strength for students with or without NSSI behaviors.For senior high school students without NSSI,subjective support had the highest closeness centrality,while for those with NSSI,expressive suppression showed the highest closeness centrality.The edge weights differed significantly among elementary school students in family functioning-self-esteem(E=0.093)and family functioning-objective support(E=0.087).For junior high school students,significant differences were found in objective support-subjective support(E=0.131)and family functioning-impulse control(E=0.109).Among senior high school students,significant differences were observed in impulse control-family function(E=0.133)and subjective support-utilization of support(E=0.130)(P<0.05).Conclusion Excessive family involvement in elementary school students and expressive suppression in senior high school students may be important influencing factors for NSSI behaviors.The lack of social support has a greater impact on junior and senior high school students.The strength of the connection among subjective support,objective support,and utilization of support is an important indicator.

Objective:To explore the clinical symptoms, imaging characteristics, cerebrospinal fluid (CSF) features, as well as the treatment and prognosis of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.Methods:Sixty-one patients with anti-GFAP astrocyte antibody (GFAP-IgG) single-positive autoimmune encephalitis who were treated at the Third Affiliated Hospital, Sun Yat-sen University between January 2017 and September 2023 were retrospectively collected. The demographic characteristics (age at onset, sex), clinical symptoms (core symptoms, neurological deficits, psychiatric behavioral abnormalities, and autonomic dysfunction), imaging features [brain/spinal cord/optic nerve magnetic resonance imaging (MRI) lesion distribution and enhancement patterns], and CSF parameters were analyzed. Acute-phase treatments, including methylprednisolone pulse therapy, intravenous immunoglobulin (IVIG), etc, along with the follow-up outcomes [modified Rankin Scale (mRS) score] were recorded.Results:The onset age was 40 (30, 55) years, and 68.9% (42/61) of the patients were male. The most common clinical manifestations were fever (65.6%, 40/61), headache (60.7%, 37/61), and urinary/defecatory abnormalities (45.9%, 28/61). Brain MRI revealed lesions predominantly in the cerebral cortex and subcortical white matter (57.4%, 35/61), periventricular white matter (50.8%, 31/61), and basal ganglia (36.1%, 22/61). Periventricular linear-radiating enhancement was the predominant MRI enhancement pattern (55.7%, 34/61). Spinal MRI showed lesions mainly in the cervical (42.6%, 26/61) and thoracic spinal cord (32.8%, 30/61), with leptomeningeal enhancement (31.1%, 19/61) and scattered punctate/patchy enhancements (21.3%, 13/61). Optic neuropathy was observed in 6 cases (9.8%). CSF analysis demonstrated a pressure of 180 (133, 240) mmH 2O (1 mmH 2O=0.009 8 kPa), white blood cell count of 29 (4, 156)×10?/L, and protein level of 0.72 (0.40, 1.44) g/L. Nineteen patients (31.1%) experienced rapid progression of meningoencephalitis or myelitis within 3 days of admission. All patients received methylprednisolone pulse therapy, with 47.5% (29/61) additionally treated with IVIG. At a follow-up of 12 (3, 28) months, 12 cases (19.7%) relapsed, and 75.4% (46/61) had favorable outcomes (mRS score 0-2). Poor prognosis (mRS score>2) was observed in 4 cases, including 3 with cervical spinal cord involvement and status epilepticus, 1 elderly patient with lung cancer. Conclusions:GFAP astrocytopathy predominantly affects young adults, with a male predominance. Spinal cord involvement is common, manifesting as myelitis and myelopathy. Rapid progression of meningoencephalitis or myelitis may occur early in the disease course. Periventricular linear-radiating enhancement on brain MRI is a key diagnostic clue. Leukocyte and protein levels in the cerebrospinal fluid are generally mildly to moderately elevated. Most patients respond well to corticosteroids and immunotherapy, with favorable outcomes. However, advanced age and cervical spinal cord involvement are associated with poor prognosis.

Immune-mediated inflammatory diseases (IMIDs) represent a heterogeneous group of disorders characterized by chronic inflammation. Their long disease duration and relapsing nature often necessitate long-term, sometimes lifelong, pharmacotherapy. However, the adverse effects associated with these medications cannot be overlooked, with particular attention warranted for the potential risk of malignancy. This article reviews the current evidence regarding the oncogenic risk of major therapeutic agents used for IMIDs, aiming to enhance clinicians' comprehensive understanding of these drugs. For IMIDs patients with a history of malignancy or those possessing other risk factors for cancer, this knowledge may encourage more deliberate deliberation and a more thorough assessment when selecting appropriate treatment options, thereby facilitating better management of drug-associated malignancy risks.

Adverse drug reactions (ADRs) significantly impact clinical medication safety. The timely identification and prediction of ADRs rely on the efficient analysis of real-world data, such as electronic health records, social media, and spontaneous reporting databases. In recent years, the rapid advancement of artificial intelligence, particularly large language models, in natural language processing, causal reasoning, and complex data mining has provided new technological means for real-time ADRs monitoring and individualized prediction. This paper summarizes the latest research achievements in AI-driven ADRs monitoring. Focusing on diverse data sources, including structured databases and electronic health records, it elaborates on the advantages andchallenges of AI in ADRs event extraction, relationship identification, causal analysis, and risk prediction. The aim is to provide a theoretical reference for constructing more intelligent and efficient ADRs monitoring systems.

Inflammatory bowel disease (IBD), a chronic inflammatory condition of the gastrointestinal tract, is associated with a significantly increased risk of both venous and arterial thromboembolism. Common risk factors for thrombosis include disease activity, surgery, older age, central venous catheterization, etc. However, thrombotic events related to pharmacological treatment are often under-recognized, despite their potential for severe consequences. With the rapid expansion of therapeutic options for IBD in recent years, it has become increasingly important to acknowledge that different agents carry varying levels of thrombotic risk. This review summarizes current evidence on the thrombotic risks associated with IBD therapies and outlines preventive strategies, aiming to optimize the thrombosis risk management and reduce treatment-related thrombotic events in IBD patients.

Objective:To explore the clinical symptoms, imaging characteristics, cerebrospinal fluid (CSF) features, as well as the treatment and prognosis of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.Methods:Sixty-one patients with anti-GFAP astrocyte antibody (GFAP-IgG) single-positive autoimmune encephalitis who were treated at the Third Affiliated Hospital, Sun Yat-sen University between January 2017 and September 2023 were retrospectively collected. The demographic characteristics (age at onset, sex), clinical symptoms (core symptoms, neurological deficits, psychiatric behavioral abnormalities, and autonomic dysfunction), imaging features [brain/spinal cord/optic nerve magnetic resonance imaging (MRI) lesion distribution and enhancement patterns], and CSF parameters were analyzed. Acute-phase treatments, including methylprednisolone pulse therapy, intravenous immunoglobulin (IVIG), etc, along with the follow-up outcomes [modified Rankin Scale (mRS) score] were recorded.Results:The onset age was 40 (30, 55) years, and 68.9% (42/61) of the patients were male. The most common clinical manifestations were fever (65.6%, 40/61), headache (60.7%, 37/61), and urinary/defecatory abnormalities (45.9%, 28/61). Brain MRI revealed lesions predominantly in the cerebral cortex and subcortical white matter (57.4%, 35/61), periventricular white matter (50.8%, 31/61), and basal ganglia (36.1%, 22/61). Periventricular linear-radiating enhancement was the predominant MRI enhancement pattern (55.7%, 34/61). Spinal MRI showed lesions mainly in the cervical (42.6%, 26/61) and thoracic spinal cord (32.8%, 30/61), with leptomeningeal enhancement (31.1%, 19/61) and scattered punctate/patchy enhancements (21.3%, 13/61). Optic neuropathy was observed in 6 cases (9.8%). CSF analysis demonstrated a pressure of 180 (133, 240) mmH 2O (1 mmH 2O=0.009 8 kPa), white blood cell count of 29 (4, 156)×10?/L, and protein level of 0.72 (0.40, 1.44) g/L. Nineteen patients (31.1%) experienced rapid progression of meningoencephalitis or myelitis within 3 days of admission. All patients received methylprednisolone pulse therapy, with 47.5% (29/61) additionally treated with IVIG. At a follow-up of 12 (3, 28) months, 12 cases (19.7%) relapsed, and 75.4% (46/61) had favorable outcomes (mRS score 0-2). Poor prognosis (mRS score>2) was observed in 4 cases, including 3 with cervical spinal cord involvement and status epilepticus, 1 elderly patient with lung cancer. Conclusions:GFAP astrocytopathy predominantly affects young adults, with a male predominance. Spinal cord involvement is common, manifesting as myelitis and myelopathy. Rapid progression of meningoencephalitis or myelitis may occur early in the disease course. Periventricular linear-radiating enhancement on brain MRI is a key diagnostic clue. Leukocyte and protein levels in the cerebrospinal fluid are generally mildly to moderately elevated. Most patients respond well to corticosteroids and immunotherapy, with favorable outcomes. However, advanced age and cervical spinal cord involvement are associated with poor prognosis.

Objective To investigate the role and existing dilemmas of policies related to traditional Chinese medicine talents in China in terms of their growth paths and attitudes towards existing policies.Methods A questionnaire survey was conducted to investigate the current situation of the development of traditional Chinese medicine talents and their views on the existing policies.Results 278 valid questionnaires were collected.In general,traditional Chinese medicine talents are quite satisfied with the current talent policy,the interviewees with senior professional titles have a better understanding of the talent policy,and the young members and members of the Chinese society of traditional Chinese medicine have a more positive and urgent attitude towards building a talent policy and evaluation index system with traditional Chinese medicine characteristics.Respondents generally believe that the current financial support for talent projects of traditional Chinese medicine is average,but it can stimulate the growth of young scholars.The title of talents and the achievements of scholars'scientific research complement each other.Conclusion In the process of the development of the field of traditional Chinese medicine,we should speed up the training of innovative talents of traditional Chinese medicine,establish talent evaluation indicators with traditional Chinese medicine characteristics,improve the evaluation and project management system of traditional Chinese medicine talents,and reasonably optimize the incentive mechanism brought by the title of talents.

  Objective  To investigate the clinical features of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.  Methods  We collected and analyzed the clinical and laboratory data and obtained the clinical characteristics of diagnosis and treatment from fifteen patients with positive GFAP antibody tested by cerebrospinal fluid and diagnosed autoimmune GFAP astrocytopathy by the multi-centers.  Results  The mean age of the first onset of autoimmune GFAP astrocytopathy was 39.73 years old (range 4-65 years), with no significant gender difference. In terms of clinical manifestations, we found the whole brain symptoms including abnormal mental behavior, disturbance of consciousness, epileptic attack accounting for more than 50, , meningitis accounting for 66.7%, myelitis (53.3%), limb tremor (53.3%), vision loss (33.3%); systemic symptoms including fever(100%) and fatigue(86.7%). 46.7% of patients were initially diagnosed with tuberculous meningoencephalitis and were treated with diagnostic antituberculous therapy. The MRI showed 46.7% of patients showed brain linear perivascular radial gadolinium enhancement in the white matter perpendicular to the ventricle.  Conclusions  Autoimmune GFAP astrocytopathy are acute or subacute dieases and the main clinical features include encephalitis, meningitis, myelitis and optic neuritis. They are likely to be misdiagnosed as tuberculous meningoencephalitis and can manifest progressive loss of consciousness in early phase, which is even life threatening.