1.Trends and gender differences in height and weight of primary and secondary school students in Shiyan City, 2015-2024
Peidong YANG ; Liang ZHAO ; Weidong HE ; Jie YANG ; Fang XU ; Rongmei WAN ; Feijia CHEN ; Jun ZHAO
Journal of Public Health and Preventive Medicine 2026;37(3):90-93
bjective To analyze the growth trends of height and weight among primary and secondary school students, and explore the developmental characteristics and gender differences at different age groups, and to provide a scientific basis for adolescent health policy formulation. Methods Based on 675 175 health examination records of 227 978 students aged 6-17 years in Shiyan City from 2015 to 2024, a logistic growth model was employed to fit the curves of height and weight changes with age. Results From 2015 to 2024, height and weight showed steady increases across all age groups, exhibiting typical sigmoidal growth patterns. The growth rates varied across age groups: the younger age group (6-9 years) showed a moderate growth (annual height increase of 0.5-1.0 cm, weight increase of 0.03-0.06 kg/year), while the older age group (10-17 years) demonstrated a significant growth (annual height increase of 1.5-2.0 cm, weight increase of 0.22-0.38 kg/year). The growth rate curves displayed a unimodal distribution. The growth inflection points of male students occurred later than that of female students (height inflection point: 9.87 years for males vs. 8.98 years for females; weight inflection point: 10.70 years for males vs. 9.99 years for females). Female students experienced a more concentrated but shorter period of growth and development. The peak height growth rate was 7.40 cm/year at age 9 for females and 7.09 cm/year at age 10 for males, while the peak weight growth rate was 5.04 kg/year at age 10 for females and 5.27 kg/year at age 11 for males. Conclusion The physical development of primary and secondary school students in Shiyan City follows a logistic growth pattern, with significant gender differences and characteristics of adolescent growth spurts. Female students exhibit an earlier and more concentrated growth process.
2.Pre-operative risk assessment of hepatocellular carcinoma recurrence in liver transplant recipients by non-invasive detection of pre-existing genetic lesions
Suqin YANG ; Sunbin LING ; Jianhua LI ; Yan WANG ; Jiapei WANG ; Qiwei HUANG ; Fanming LIU ; Yiqi ZHUANG ; Yingyu ZHENG ; Rui WANG ; Zhe YANG ; Xiaoping ZHENG ; Kai WANG ; Zhikun LIU ; Jun CHEN ; Jianguo WANG ; Haiyang XIE ; Lin ZHOU ; Leiming CHEN ; Guoqiang CAO ; Dandan CHEN ; Junfang JI ; Bin ZHAO ; Chao JIANG ; Di LU ; Xuyong WEI ; Hangjin JIANG ; Qiaonan SHAN ; Hengbo SHI ; Yong-Zhen XU ; Shusen ZHENG ; Zhengxin WANG ; Shengda LIN ; Xiao XU
Clinical and Molecular Hepatology 2026;32(2):884-903
Background/Aims:
Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy.
Methods:
We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues.
Results:
We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts.
Conclusion
Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.
3.Transcranial Focused Ultrasound Stimulation of the Primary Somatosensory Cortex Evokes Hand Tactile Perception: The Effect of Sonication Duration
Xu-Xu CHEN ; Huan-Jun XI ; Zhen LIANG ; Bo WANG ; Xu-Dong ZHAO
Progress in Biochemistry and Biophysics 2026;53(7):1942-1952
ObjectiveTranscranial focused ultrasound (tFUS) has emerged as a promising noninvasive neuromodulation technique capable of modulating neural activity with high spatial specificity. However, whether tFUS stimulation of the primary somatosensory cortex (S1) can reliably evoke conscious tactile perception without external peripheral sensory input remains unclear. Therefore, this study examined the feasibility of inducing hand-related tactile perception through targeted S1 stimulation and further investigated how sonication duration (SD), a key temporal parameter, influences the consistency of this perceptual response. The findings may provide empirical evidence for optimizing tFUS parameters in human somatosensory modulation. MethodsForty-eight healthy adults participated in the study and were assigned to two experiments. Experiment 1 included 24 participants and was designed to preliminarily examine whether S1-targeted tFUS could evoke hand-related tactile sensations. This experiment comprised two sub-experiments, Experiment 1a and Experiment 1b, with 12 participants in each. Specifically, Experiment 1a used a randomized active stimulation protocol targeting the bilateral S1 to assess the initial feasibility of inducing contralateral tactile perception, whereas Experiment 1b employed an alternating hemispheric design incorporating both active and sham stimulation to verify the specificity of the tFUS-induced sensations. Experiment 2 enrolled another 24 participants and used a real-sham dual-probe design to control for spatial tactile cues that might arise from probe-scalp contact. Five SD levels, including 200, 400, 600, 800, and 1 000 ms, were systematically tested to evaluate how stimulation duration influenced the behavioral response. The primary behavioral outcome was the perceptual consistency rate, quantified according to the accuracy of contralateral tactile localization. ResultsIn Experiment 1, 91.7% of participants reported reliable hand-related tactile sensations during active tFUS stimulation, including numbness, tingling, or similar sensory experiences. Contralateral localization accuracy under active stimulation was significantly higher than the0.50 chance level (P<0.05). In contrast, localization performance under sham stimulation did not differ from chance, suggesting that the observed tactile responses were mainly induced by active S1-targeted tFUS stimulation rather than nonspecific stimulation cues. In Experiment 2, perceptual consistency rates significantly exceeded the chance level under the 400 and 1 000 ms SD conditions(P<0.05), whereas no significant effect was observed at 200, 600, or 800 ms. Pairwise comparisons further showed that the 400 and 1 000 ms conditions produced significantly higher perceptual consistency rates than the 200 ms condition (P<0.05). ConclusiontFUS stimulation of S1 can elicit distinct hand-related tactile sensations without peripheral sensory input, demonstrating the feasibility of using targeted cortical ultrasound stimulation to induce conscious somatosensory perception. The reliability of this perceptual effect was modulated by sonication duration, indicating that temporal stimulation parameters play an important role in shaping both the occurrence and consistency of behavioral responses. Among the tested conditions, 400 ms appeared to provide a favorable temporal window for generating stable tactile perception, whereas excessively short stimulation may be insufficient to produce consistent responses. These findings highlight the sensitivity of somatosensory networks to ultrasonic modulation and provide useful parameter guidance for the application of tFUS in noninvasive sensory enhancement and cortical functional mapping.
4.Relationship between shear wave elastography parameters and APRI and Child-Pugh grading in patients with hepatitis B cirrhosis
Wen ZHAO ; Mengsi XU ; Chunfeng YU ; Jun CHEN
Chinese Journal of Radiological Health 2026;35(3):433-438
Objective To investigate the associations of shear wave elastography (SWE) parameters and AST-to-platelet ratio index (APRI) with Child-Pugh grade in patients with hepatitis B cirrhosis. Methods The clinical data of 103 patients with hepatitis B cirrhosis who underwent SWE and APRI testing between July 2022 and October 2024 were retrospectively analyzed. These patients comprised the observation group. The clinical data of 99 non-cirrhotic patients were retrospectively analyzed and the patients were enrolled as control group. Liver stiffness (LS), spleen stiffness (SS), APRI and Child-Pugh score were compared in the two groups. According to Child-Pugh grading, the 103 cirrhosis patients were divided into three groups: Group A (grade A, 5-6 points, n=35), Group B (grade B, 7-9 points, n=38), and Group C (grade C, 10-15 points, n=30). SWE parameters and APRI were compared among the three groups. Pearson correlation analysis was used to examine the correlations of LS, SS, and APRI with Child-Pugh score. Results SWE parameters, APRI, and Child-Pugh scores were significantly higher in the observation group than in the control group (P<0.05). Among the three cirrhosis groups, SWE parameters and APRI were highest in Group C, followed by Group B, and lowest in Group A (P<0.05). SWE parameters and APRI were significantly positively correlated with Child-Pugh score (P<0.05). Conclusion SWE parameters and APRI are positively correlated with Child-Pugh grade and are useful for assessing the severity of liver cirrhosis.
5.Erchentang Alleivates Depression in Obese Mice by Regulating PPAR Signaling Pathway
Qiao YU ; Shiwei HU ; Jinrong ZHANG ; Jun XU ; Min ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(19):22-31
ObjectiveTo observe the therapeutic effect of Erchentang on depression in obese mice and explore the therapeutic mechanism. MethodsC57BL/6J mice were randomized into the control, model, metformin (0.65 g·kg-1), and low-, medium-, and high-dose (3.35, 6.7, and 13.4 g·kg-1, respectively) Erchentang groups. Gavage was initiated simultaneously with modeling and continued for 28 days. The therapeutic effects of Erchentang were evaluated through behavioral tests, liver and brain indices, liver function, lipid indicators, and histopathological changes in the liver and brain tissue. RNA-seq technology was used to conduct transcriptomic analysis of mouse liver tissue, and differentially expressed genes were screened and subjected to Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Key genes were further verified by Western blot and Real-time polymerase chain reaction(Real-time PCR). ResultsBehavioral tests, liver function, lipid indicators, and histopathological changes in the liver and brain tissue all demonstrated that Erchentang had therapeutic effects on depression in obese mice. KEGG pathway enrichment analysis of transcriptomic data indicated that Erchentang treated depression in obese mice mainly through the peroxisome proliferator-activated receptor (PPAR) signaling pathway. Western blot and Real-time PCR results showed that compared with the model group, the low-, medium-, and high-dose Erchentang groups exhibited downregulated expression of fatty acid-binding protein (FABP) 1 (P<0.01) and upregulated expression of acyl-CoA oxidase (ACOX) 1, PPARα, cholesterol 7α-hydroxylase (CYP7A) 1, and phosphoenolpyruvate carboxy kinase (PCK) 1 (P<0.05) in the liver tissue. ConclusionErchentang exerts therapeutic effects on obesity-associated depression by regulating the PPAR signaling pathway and the expression of related genes FABP1, ACOX1, PPARα, CYP7A1, and PCK1.
6.Effects of gene polymorphisms on the efficacy of tofacitinib combined with iguratimod in the treatment of moderate-to-severe rheumatoid arthritis
Jun SHI ; Yang ZHAO ; Rongxue HU ; Shanshan LIU ; Bin JIA ; Jianping XU ; Peihua TIAN
China Pharmacy 2026;37(17):2286-2291
OBJECTIVE To investigate the effects of MIR149 rs2292832 and MIR499 rs3746444 gene polymorphisms on the efficacy of tofacitinib combined with iguratimod in the treatment of moderate‑to‑severe rheumatoid arthritis (RA), to provide genetic reference for individualized treatment of moderate‑to‑severe RA patients.METHODS This was a prospective cohort study, and patients were grouped according to genotyping results. A total of 320 patients with moderate-to-severe RA diagnosed in the department of immunology of our hospital between January 2023 and January 2024 were enrolled. All patients received standardized treatment with tofacitinib (5 mg twice daily) combined with iguratimod (25 mg twice daily) for 24 weeks treatment course. Clinical efficacy outcomes, including American College of Rheumatology (ACR) 20/50/70 responses, disease activity score‑28 based on C‑reactive protein (DAS28-CRP), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were compared among patients with different genotypes. Combined-genotype analysis and multivariate Logistic regression analysis were also performed.RESULTS The MIR149 rs2292832 CC-genotype patients exhibited significantly higher ACR20, ACR50 and ACR70 response rates (88.90%, 67.78%, 45.56%) than those carrying CT- and TT-genotypes ( P <0.05). After 24 weeks treatment, the reductions in DAS28‑CRP, ESR and CRP were significantly greater in CC‑genotype patients than in CT‑ and TT‑genotype patients ( P <0.05), and the 24‑week DAS28‑CRP was significantly lower in the CC‑genotype patients than in CT‑ and TT‑genotype patients ( P <0.05). The MIR499 rs3746444 GG-genotype showed significantly higher ACR20, ACR50 and ACR70 response rates (91.46%, 73.17%, 52.44%) than those carrying AG‑ and AA‑genotypes ( P <0.05). After 24 weeks of treatment, the reductions in DAS28‑CRP, ESR and CRP were significantly greater in GG‑genotype patients than in AG- and AA-genotype patients and the 24‑weeks DAS28‑CRP was significantly lower in the GG‑genotype patients than in AG- and AA-genotype patients ( P <0.05). Among the nine combined‑genotyps, the CC+GG genotype yielded the best treatment response. The MIR149 rs2292832 CC and MIR499 rs3746444 GG genotypes were independent predictors of clinical remission ( P <0.01), whereas baseline DAS28‑CRP ≥ 6.5 served as a negative predictor of clinical remission ( P <0.05).CONCLUSIONS Gene polymorphisms of MIR149 rs2292832 and MIR499 rs3746444 significantly influence the therapeutic effect of tofacitinib combined with iguratimod in patients with moderate-to-severe RA. Patients carrying CC and GG genotypes achieve better treatment responses.
7.Mechanism of Shenji Guben Prescription in Treating Chronic Obstructive Pulmonary Disease in Mice
Zibo SUN ; Jing YAO ; Tingyu PAN ; Qi ZHAO ; Jing WANG ; Jun ZHAO ; Yong XU ; Xianmei ZHOU ; Yu WEI ; Hailang HE
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(22):159-168
ObjectiveTo evaluate the therapeutic effect of Shenji Guben prescription (SJGB) on chronic obstructive pulmonary disease (COPD) in mice and to explore its potential therapeutic mechanism via transcriptomics. MethodsA mouse model of COPD was established by combined exposure to lipopolysaccharide (LPS) and cigarette smoke. C57BL/6J mice were randomly allocated into a control group, a model group, an acetylcysteine (78 mg·kg-1·d-1) group, and low- (7.5 g·kg-1·d-1), medium- (15 g·kg-1·d-1), and high-dose (30 g·kg-1·d-1) SJGB groups. After 13 weeks of modeling, oral administration was initiated and continued for 28 days. The therapeutic effects of SJGB were assessed based on body weight, lung function, lung tissue pathology, and inflammatory factors in bronchoalveolar lavage fluid (BALF). Ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) was employed to identify the active ingredients in SJGB. Transcriptomic profiling of lung tissue was performed by RNA-seq to identify differentially expressed genes (DEGs), followed by gene ontology (GO) enrichment analysis, Kyotoencyclopedia of Genes and Genomes (KEGG) enrichment analysis, Gene Set Enrichment Analysis (GSEA), and protein-protein interaction (PPI) network construction. Key genes were further validated by Western blot and Real‑time polymerase chain reaction (Real-time PCR). ResultsAfter drug intervention, the final body weights of mice in medium- and high-dose SJGB groups were higher than those in the model group (P<0.05). Compared with the model group, SJGB groups demonstrated a significant decrease in expiratory time (Te), along with increases in peak expiratory flow (PEF), 50% expiratory flow (EF50), tidal volume (TV), and expiratory volume (EV) (P<0.05). High-dose SJGB ameliorated pathological changes in the lung tissue, reduced peribronchial inflammation scores, and decreased mean linear intercept (MLI) (P<0.01). Compared with the model group, medium- and high-dose SJGB groups showed reductions in interleukin-6 (IL-6) and interleukin-1β (IL-1β) levels (P<0.01). UHPLC-MS/MS revealed that the five most abundant components in SJGB were (S)-actinidine, ephedrine, pyroglutamic acid, methylephedrine, and coumarin. Transcriptomic analysis revealed 219 DEGs regulated by SJGB, suggesting that the anti-COPD effects of SJGB may be mediated through key genes such as cluster of differentiation 68 (CD68), integrin subunit alpha X (ITGAX), and cathepsin S (CTSS), primarily involved in the lysosomal pathway. Western blot and Real-time PCR results confirmed that SJGB inhibited the expression of CD68, ITGAX, and CTSS compared with the model group (P<0.05). ConclusionSJGB effectively improved the lung function and attenuated lung tissue inflammation in the mouse model of COPD by modulating the lysosomal pathway and related genes including CD68, ITGAX, and CTSS.
8.Chinese expert consensus on the application of jejunal interposition for esophageal reconstruction in complex esophageal cancer surgery (2026 edition)
Wenshu CHEN ; Lilan ZHAO ; Zhaoxian LIN ; Debin OU ; Zhigang LI ; Chengchu ZHU ; Longqi CHEN ; Shuoyan LIU ; Xiangnan LI ; Chao CHENG ; Ni ZHANG ; Songping XIE ; Xufeng GUO ; Xu LI ; Xinyu MEI ; Xuefeng LENG ; Jianqun MA ; Zhijun HUANG ; Guojun GENG ; Lin ZHANG ; Hongyan WANG ; Yi ZHANG ; Weijie WANG ; Jiangbo LIN ; Jinbiao XIE ; Jun GUAN ; Rongqi HE ; Xing LIN ; Xiuhua TU ; Yong LI ; Lijie TAN ; Xiaojie PAN
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(10):1527-1543
Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.
9.Predicting Postoperative Progression of Ossification of the Posterior Longitudinal Ligament in the Cervical Spine Using Interpretable Radiomics Models
Siyuan QIN ; Ruomu QU ; Ke LIU ; Ruixin YAN ; Weili ZHAO ; Jun XU ; Enlong ZHANG ; Feifei ZHOU ; Ning LANG
Neurospine 2025;22(1):144-156
Objective:
This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery.
Methods:
This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression.
Results:
Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability.
Conclusion
Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.
10.Predicting Postoperative Progression of Ossification of the Posterior Longitudinal Ligament in the Cervical Spine Using Interpretable Radiomics Models
Siyuan QIN ; Ruomu QU ; Ke LIU ; Ruixin YAN ; Weili ZHAO ; Jun XU ; Enlong ZHANG ; Feifei ZHOU ; Ning LANG
Neurospine 2025;22(1):144-156
Objective:
This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery.
Methods:
This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression.
Results:
Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability.
Conclusion
Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.


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