Objective To investigate the regulatory mechanism of transforming growth factor-β1 (TGF-β1) in different types of mitral valvular disease (MVD) with atrial fibrillation (AF). Methods From August 2011 to August 2012, patients with moderate to severe MVD accompanied by AF who required mitral valve replacement at the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, were included. Based on echocardiographic results, patients were divided into two groups: a mitral regurgitation (MR) with AF (MR-AF) group and a mitral stenosis (MS) with AF (MS-AF) group. Left atrial tissue samples were collected during surgery. Techniques such as enzyme-linked immunosorbent assay, real-time fluorescence quantitative polymerase chain reaction, immunohistochemistry, and Western blotting were used to detect key molecules in the TGF-β1/JNK pathway. Results Sixteen patients were enrolled. There were 8 patients in the MR-AF group, including 5 males and 3 females, with an average age of (41.38±11.19) years; and 8 patients in the MS-AF group, including 6 males and 2 females, with an average age of (43.12±5.30) years. The left atrial volume load was higher in MR-AF patients, while the left atrial pressure load was higher in MS-AF patients. In MS-AF patients, the relative expression levels of MAPK9, JUN, CASP3, BAX, and BCL2 mRNA in left atrial tissues were significantly upregulated. The serum TGF-β1 protein level and the relative expression levels of p-JNK, p-c-Jun, and Caspase-3 proteins in the left atrial tissues of the MR-AF group were higher. Myocardial cell damage was more severe in the MS-AF group, and the protein expression level of Bcl-2 was higher. Conclusion Different MVD have distinct hemodynamic characteristics. The myocardium of the left atrium in MR-AF patients is more prone to apoptosis, possibly through the activation of the TGF-β1/JNK signaling pathway.

Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

[Objective] To evaluate the efficacy and practicality of autologous platelet-rich plasma (aPRP) in patients undergoing total aortic arch replacement for aortic dissection. [Methods] A retrospective analysis was performed on 483 patients diagnosed with type A aortic dissection who underwent total aortic arch replacement between January 2016 and November 2023. Patients were categorized into two groups based on whether they received aPRP. Baseline characteristics, intraoperative blood product usage and postoperative outcomes were compared between the two groups. [Results] The aPRP group exhibited reduced usage of allogeneic platelets (1.55±1.04 vs 1.60±1.27)U, allogeneic plasma (480.89±432.49 vs 746.50±508.81)mL, allogeneic RBC (red blood cell)(5.95±1.91 vs 6.17±3.52)U, bivalirudin (2.66±1.51 vs 3.31±1.59)U and coagulation factor Ⅶ (0.67±1.03 vs 1.22±1.43)mg compared to the non-aPRP group (P<0.05). The incidence of postoperative hypoxemia was lower in the aPRP group (43.98% vs 48.41%), and the duration of mechanical ventilation was significantly shorter[median 50.91 (interquartile range 18.71, 113.71) vs 83.40 (37.73, 151.98) hours]. There were no significant differences between the two groups in terms of postoperative mortality, continuous bedside hemofiltration, cerebral infarction, cerebral hemorrhage, paraplegia or re-exploration for hemostasis(P>0.05). [Conclusion] The application of aPRP in total aortic arch replacement effectively diminishes intraoperative blood product usage and the incidence of lung injury-related complications. However, it does not demonstrate significant benefits in terms of mortality, cerebral infarction and other complications.

Recent advances in large models demonstrate significant prospects for transforming the field of medical imaging. These models, including large language models, large visual models, and multimodal large models, offer unprecedented capabilities in processing and interpreting complex medical data across various imaging modalities. By leveraging self-supervised pretraining on vast unlabeled datasets, cross-modal representation learning, and domain-specific medical knowledge adaptation through fine-tuning, large models can achieve higher diagnostic accuracy and more efficient workflows for key clinical tasks. This review summarizes the concepts, methods, and progress of large models in medical imaging, highlighting their potential in precision medicine. The article first outlines the integration of multimodal data under large model technologies, approaches for training large models with medical datasets, and the need for robust evaluation metrics. It then explores how large models can revolutionize applications in critical tasks such as image segmentation, disease diagnosis, personalized treatment strategies, and real-time interactive systems, thus pushing the boundaries of traditional imaging analysis. Despite their potential, the practical implementation of large models in medical imaging faces notable challenges, including the scarcity of high-quality medical data, the need for optimized perception of imaging phenotypes, safety considerations, and seamless integration with existing clinical workflows and equipment. As research progresses, the development of more efficient, interpretable, and generalizable models will be critical to ensuring their reliable deployment across diverse clinical environments. This review aims to provide insights into the current state of the field and provide directions for future research to facilitate the broader adoption of large models in clinical practice.
Humans ; Diagnostic Imaging/methods* ; Precision Medicine/methods* ; Image Processing, Computer-Assisted/methods*

Objective: To investigate an outbreak of acute gastroenteritis at a vocational and technical school in Shaanxi Province in 2024, ao as to provide the reference for the handling of school outbreaks. Methods: The conducted case searches, individual case investigations, and on-site hygienic investigations were established in accordance with the Guidelines on outbreak investigation, prevention and control of Norovirus infection (2015). The potential risk factors were analyzed by case-control study. Anal swab samples from cases and all canteen staff, as well as environmental swab samples were collected to detect common intestinal pathogens. All reserved food samples in canteen were collected to test for common pathogenic bacteria. Results: From October 26 to November 5, 2024, a cumulative total of 53 cases were reported, with an attack rate of 1.47%. The main clinical symptoms included vomiting (83.02%), abdominal pain (56.60%), diarrhea (30.19%), and fever (26.42%). The epidemic curve suggested an intermittent common-source outbreak, with no obvious clustering characteristics in terms of the population and spatial distribution of cases. The case-control analysis revealed that having dinner at the rice-with-dishes-on-top stall on the first floor of the canteen on October 28 was a risk factor for illness (OR=11.025, 95%CI: 2.186-55.601). GⅡ norovirus was detected as positive in anal swab samples from 6 cases and 2 asymptomatic infected canteen staff, as well as in 3 environmental swab samples from the rice-with-dishes-on-top stall. The test results for common pathogenic bacteria in the reserved food samples were all negative. Conclusions This outbreak was caused by an acute gastroenteritis epidemic induced by GⅡ norovirus infection, with a transmission pattern consistent with an intermittent homologous outbreak. The possible source of infection was asymptomatic infected canteen staff mainly through foodborne trasmission, and having meals at the rice-with-dishes-on-top stall was the primary risk factor for this outbreak.

The European Association for Cardio-Thoracic Surgery (EACTS) has recently updated and published the "2024 EACTS guidelines on perioperative medication in adult cardiac surgery". Based on the latest evidence, the guidelines have been updated in multiple aspects including underlying disease management, antithrombotic medication, arrhythmia treatment and other supportive care, etc. This paper aims to summarize and interpret the guidelines, in order to promote clinicians’ understanding and optimize perioperative medical treatment in adult cardiac surgery.

Objective:To summarized the clinical characteristics and surgical management of anterior cervical enterogenic in pediatric patients. Methods:Clinical data were retrospectively analyzed for 9 children with pathologically confirmed anterior cervical enterogenic cysts（including bronchogenic and esophagogenic subtypes） treated at the Children's Hospital of Shandong University（Jinan Children's Hospital） between January 1, 2020, and November 30, 2023. Results:Nine patients（6 males and 3 females） were involved in this study, aged 14 days to 10 years old. There were 4 cases on the left side, 4 on the right side, and 1 in the middle of the neck. All patients presented with neck masses. The patients were followed up from 3 months to 35 months after surgery and recovered well, with no recurrence or complications observed. Conclusion:①Anterior intestinal cysts in children are rare and easy to be misdiagnosed. ②Concurrent branchial cleft fistulas or associated anomalies may coexist, necessitating comprehensive evaluation. ③Preoperative diagnosis is not easy and mainly depends on pathological diagnosis. ④The treatment of anterior cervical enterogenic cysts in children is surgical resection of the lesion.
Humans ; Male ; Female ; Child ; Retrospective Studies ; Child, Preschool ; Infant ; Neck ; Cysts/surgery*

Objective: To establish a progressive research strategy for “colonic components analysis - efficacy verification and mechanism exploration - gut microbiota”, screen pharmacodynamic substances, and investigate their mechanism via gut microbiota. Methods: The pharmacodynamics of Gegen Qinlian decoction (GQD) were assessed using a mouse model of dextran sulfate sodium-induced ulcerative colitis (UC). Ultra-performance liquid chromatography-quadrupole-orbitrap mass spectrometer was used to identify the prototype and metabolic components of GQD in the colon during UC. To analyze the structure and function of characteristic genera of GQD and its active components, 16S rRNA sequencing was performed. Results: We identified 67 prototypic and 14 metabolic components of GQD in the UC colon. The primary prototype components are flavonoids and alkaloids, including puerarin (PUE), baicalin (BAI), and berberine (BER). The metabolism was predominantly sulfonation. Efficacy verification showed that the main active components, puerarin, baicalin, and berberine, had good therapeutic effects on UC. The results of 16S rRNA gene sequencing showed that GQD improved UC by regulating the structure and function of the gut microbiota. The abundance of gut microbiota involved in the metabolism of the prototype components was influenced by the corresponding components. The function prediction results showed that PUE was the most comparable to GQD, with 24 consistent pathways. BAI and BER showed comparable gut microbiota regulation pathways. Characteristic pathways of BER include glucometabolic processes. Conclusion This study focused on the key issues in the gut microbiota pathway and developed a progressive research strategy to understand the transformation mechanisms of colonic components. This research systematically analyzed the active components and metabolic transformation of GQD in the colon during the pathological state of UC, as well as changes in the structure and function of the gut microbiota, clarified the mechanism of GQD and its active components in improving UC via the gut microbiota pathway.

Objective To observe the clinical effect of minimally invasive rotational curettage combined with water-assisted liposuction(WAL)in the treatment of gynecomastia(GYN)patients.Methods The clinical data of 80 GYN patients were retrospectively analyzed.According to different surgical methods,the patients were divided into minimally invasive surgery group(41 cases)and study group(39 cases).The minimally invasive surgery group underwent minimally invasive rotation-al curettage,while the study group underwent minimally invasive rotational curettage combined with WAL.The surgical indicators,pain intensity 24 hours postoperatively,postoperative complications,and subjective satisfaction were observed and compared between the two groups.Results The unilat-eral surgical duration in the study group was shorter than that in the minimally invasive surgery group,with a statistically significant difference(P＜0.05).No statistically significant differences were found in unilateral incision length,intraoperative blood loss,and postoperative hospital stay between the two groups(P＞0.05).No statistically significant difference was found in pain intensity 24 hours postoperatively between the two groups(P＞0.05).The incidence of postoperative complicationsin the study group was 5.13％,which was lower than 21.95％in the minimally invasive surgery group(P＜0.05).The study group had higher satisfaction scores for chest flatness without depression and breast symmetry than the minimally invasive surgery group(P＜0.05).Conclusion Compared with minimally invasive rotational curettage alone,the combination of minimally invasive rotational curet-tage and WAL for GYN patients results in shorter surgical duration,a lower incidence of postoperative complications,and higher patient satisfaction with breast appearance.

Objectives:To evaluate the effect of extended single prone positioning ventilation on survival and weaning rate of acute respiratory distress syndrome (ARDS) patients supported by VV-ECMO.Methods:ARDS patients supported by VV-ECMO admitted to Jinhua Central Hospital, the Fourth Affiliated Hospital of Zhejiang University School of Medicine and the First Hospital of Jiaxing from September 2014 to May 2025 were retrospectively enrolled into the study. The clinical data, ECMO and ventilator related parameters and outcomes of the patients were collected. The patients were divided into the extended prone positioning group and prone positioning group according to whether the duration of prone position ventilation was greater than 24 h. The clinical data of the two groups were compared to explore the effects on 30-day survival in-hospital survival and ECMO withdraw rate of these patients. Multivariate logistic regression analysis was used to explore the relationship between the duration of single prone position ventilation and the success of ECMO weaning, 30-day survival and hospital survival.Results:Total of 163 ARDS patients supported by VV-ECMO receiving prone positioning ventilation were included in study, 64 in extended prone positioning group and 72 in prone positioning group. The 30-day survival (54.7% vs. 52.8%) in-hospital survival (51.6% vs. 48.6%) and ECMO withdraw rate (57.8% vs. 61.1%) between the two groups were not statistically different ( P>0.05) as well as the duration of ECMO support [12(10,15)d vs. 11(10,13)d] the duration of ventilation [16(13,18)d vs. 16(12,18)d] the duration of ICU stay [26(15,32)d vs. 26(19,29)d] and the duration of hospital stay [32(15,42)d vs. 34(28,35)d]. Logistic regression analysis revealed that the duration of each prone position ventilation was not associated with successful weaning ( OR=0.979, 95% CI:0.952-1.006), 30-day survival ( OR=1.015, 95% CI: 0.975-1.056) and hospital survival ( OR=1.014, 95% CI: 0.974-1.055) even after adjusting for the severity of illness, age, and type of pneumonia. Conclusions:For ARDS patients supported by VV-ECMO, extended single prone positioning ventilation for more than 24 hours neither increase 30-day survival in-hospital survival and successful ECMO weaning rate, nor shorten ECMO support duration.