Objective Construct a light gradient boosting machine （LightGBM） model based on ultrasonic and clinical features， and perform shapley additive explanation （SHAP） on the model for assessing its value in predicting cervical lymph node metastasis （CLNM） of medullary thyroid cancer （MTC）． Methods A retrospective analysis included the ultrasonic and clinical characteristics of 88 patients pathologically diagnosed with MTC. The Random Forest-based Recursive Feature Elimination （RF-RFE） algorithm with repeated cross - validation was applied to screen independent predictive variables for cervical lymph node metastasis in medullary thyroid carcinoma （MTC-CLNM）， and a LightGBM model was developed to predict MTC-CLNM. Receiver Operating Characteristic （ROC） curves， calibration curves， and decision curve analysis （DCA） were plotted to assess the predictive performance of the model. Additionally， SHAP values were introduced to conduct interpretability analysis for the predictive model， and the five-fold cross-validation method was applied to perform internal validation. Results A LightGBM model was constructed to predict MTC-CLNM， achieving a predictive accuracy of 0.795 and an AUC value of 0.852. The SHAP values analyzed the decision weights of each feature in the model， with the order from largest to smallest being： Ctn， age， and capsular invasion. The model was internally validated using the five - fold cross - validation method， and the average AUC was 0.831. Further Bootstrap validation showed that the median AUC reached 0.820， indicating good stability of the model. Conclusion The LightGBM model based on ultrasonic and clinical characteristics exhibits high diagnostic performance for predicting MTC-CLNM， and the intuitive interpretation of SHAP becomes an effective tool for guiding clinical decisions.

Objective This study aims to investigate the value of a combined model integrating conventional ultrasound and radiomics for the preoperative prediction of the Luminal molecular subtype and Ki-67 expression status in patients with Luminal breast cancer. Methods A retrospective analysis was performed on ultrasound imaging data obtained from 375 patients diagnosed with breast cancer. Univariate and multivariate regression analyses were implemented first to identify independent predictive factors， and radiomic features were screened independently. Next， an integrated prediction model based on LightGBM was constructed by combining clinical ultrasound characteristics and radiomic features， to differentiate the Luminal molecular subtype of breast cancer and predict the Ki-67 expression status in patients with Luminal breast cancer. The performance of the established model was evaluated via receiver operating characteristic （ROC） curves and decision curve analysis （DCA）， and the SHapley Additive exPlanations （SHAP） method was applied to interpret the contribution of individual features to the model's prediction output. Results The combined model for Luminal molecular subtype discrimination achieved areas under the receiver operating characteristic curve （AUCs） of 0.836 and 0.776 in the training set and validation set， respectively. For the Ki-67 expression status prediction model constructed for patients with Luminal breast cancer， the AUC values reached 0.854 and 0.822 in the training cohort and validation cohort， respectively. Both models exhibited satisfactory predictive performance. Decision curve analysis demonstrated that the two models delivered substantial net clinical benefits across a broad range of threshold probabilities. SHAP （SHapley Additive exPlanation） analysis revealed that original_glcm_InverseVariance and wavelet.LH_firstorder_Median were the most impactful features for the two models respectively， confirming their critical contributions to the predictive performance of the models. Conclusion The stratified visualization model based on conventional ultrasound combined with radiomics shows potential clinical value for differentiating the Luminal molecular subtype and predicting Ki-67 expression status in breast cancer.

Objective This study aims to investigate whether preoperative cardiology consultation is associated with a reduced risk of perioperative cardiovascular events among patients scheduled for gastrointestinal tumor resection who present with elevated preoperative high-sensitivity cardiac troponin I （hs-cTnI） in the absence of detectable myocardial ischemia. Methods We retrospectively enrolled 93 consecutive patients hospitalized with gastrointestinal tumors who had a preoperative hs-cTnI level > 0.028 ng/mL and no evidence of myocardial ischemia. Among these patients， 8 were recommended to delay surgery following cardiology consultation. Ultimately， the remaining 85 patients who underwent surgery were included in the outcome analysis. We compared the incidence of perioperative cardiovascular events （including death， acute myocardial infarction， cardiac arrest， ventricular fibrillation， atrial fibrillation， and acute decompensated heart failure）， the requirement for intensive care unit （ICU） admission， and the length of hospital stay between the cardiology consultation group and the non-consultation group. Results Patients who underwent preoperative cardiology consultation exhibited a higher proportion of individuals with a Lee index ≥ 2， elevated hs-cTnI levels， and impaired cardiac structure and function. Following consultation， surgery was deferred for 8 patients. After excluding all patients with deferred surgery， the consultation group and non-consultation group still differed significantly in the proportion of participants with a Lee index ≥ 2 and LVEF values， while no significant between-group differences were observed in perioperative cardiovascular events， ICU management indicators， or length of hospital stay. Univariate logistic regression analysis identified that reduced LVEF was significantly associated with the occurrence of perioperative cardiovascular events. Conclusions Among patients with preoperatively elevated hs-cTnI without myocardial ischemia undergoing gastrointestinal tumor surgery， although the cardiology consultation cohort presented higher baseline cardiovascular risk and accordingly higher expected perioperative risk， the observed perioperative cardiovascular risk in this cohort was not significantly higher than that of the non-consultation cohort. This finding indicates that preoperative cardiology consultation may offset the expected excess risk in high-risk patients， which demonstrates its potential clinical value for preoperative risk stratification and management.

Objective To explore the predictive value and influencing factors of peripheral blood transforming growth factor β1 （TGF-β1）/Smad protein family （Smads） signaling pathway proteins on infection after modified radical mastectomy for breast cancer. Methods From January 2023 to June 2025， the clinical data of 419 patients with breast cancer in the hospital were retrospectively selected as the research object， all of them were treated by modified radical mastectomy， and they were divided into the infection group （62 cases） and the non-infection group （357 cases） according to their postoperative infection. The general data and the levels of TGF-β1/Smads signaling pathway related proteins were compared between the two groups， and the influencing factors of infection after modified radical mastectomy and the predictive value of TGF-β1/Smads signaling pathway protein for infection after modified radical mastectomy were analyzed. Results The proportion of patients with diabetes mellitus and the levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells in the infected group were higher than those in the non-infected group， and the postoperative intubation time was longer than that in non-infected group （P < 0.05）. Complication of diabetes mellitus， long postoperative intubation time and high levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells are all influencing factors of infection after modified radical mastectomy （OR = 3.751， 1.244， 1.422， 1.411， 1.449， P < 0.05）. The area under infection curve （AUC） value of TGF-β1， Smad2 and Smad3 combined in predicting patients after modified radical mastectomy was higher than that of the three alone （P < 0.05）， and their sensitivity and specificity were 72.58% and 89.64% respectively. Conclusions The influencing factors of infection after modified radical mastectomy for breast cancer included diabetes mellitus， long postoperative catheterization time and higher levels of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells. At the same time， the combined detection of TGF-β1， Smad2 and Smad3 protein in peripheral blood mononuclear cells to evaluate the infection of patients after modified radical mastectomy for breast cancer could maintain a high sensitivity （72.58%） and significantly improve the specificity （89.64%）.

Objective This study aimed to investigate the association between metabolic score for visceral fat （METS-VF） and the risk of heart failure （HF） in adults with diabetes or prediabetes. Methods Based on data from the National Health and Nutrition Examination Survey （NHANES） in the United States from 1999 to 2018， adults aged ≥ 20 years with diabetes or prediabetes were included. Participants were grouped according to their METS-VF quartiles. Multivariate logistic regression analysis was used to analyze the association between METS-VF and HF. Restricted cubic spline （RCS）， subgroup， and receiver operating characteristic （ROC） curve analyses were further performed. Results A total of 12 090 participants were included， of whom 504 had HF. Higher METS-VF was significantly associated with HF ［highest quartile vs. lowest quartile： OR = 2.998， 95%CI： 1.645 ⁃ 5.465， P < 0.001］. RCS analysis showed a significant non-linear relationship between METS-VF and HF （overall P < 0.001， non-linear P < 0.05）， with a potential inflection point of 7.024. Subgroup analysis revealed a significant interaction in individuals with a history of cancer or myocardial infarction （interaction P < 0.05）. ROC curve analysis showed that METS-VF achieved an AUC of 0.701 （95%CI： 0.677 ⁃ 0.724） for identifying HF， outperforming METS-IR and WHtR. Conclusions In adults with diabetes or prediabetes， higher METS-VF is significantly associated with HF， and a non-linear threshold effect exists. METS-VF may serve as a practical indicator for identifying individuals with HF.

Objective To investigate the clinical symptom scoring and improvement of small airway function in children with moderate to severe allergic asthma and allergic rhinitis treated with omalizumab. Methods This prospective study enrolled 120 children with moderate-to-severe allergic asthma and comorbid allergic rhinitis who attended the Department of Pediatrics at Wuhan First Hospital between May 2023 and June 2025. All patients received standard baseline therapy. The control group was treated with budesonide/formoterol， while the study group received additional omalizumab on top of the control regimen. We compared inflammatory factors， cytokine levels， small airway function， and lung function before and after treatment， assessed symptom improvement at baseline， 6 months， and 12 months post-treatment， and evaluated clinical outcomes and adverse events during the 12-month treatment period. Results After 12 months of treatment， the study group showed a significantly higher C-ACT score and a lower TNSS score than the control group （P < 0.05）. Repeated-measures ANOVA revealed significant time， group， and interaction effects for both scores （P < 0.05）. Regarding lung function， the study group had higher FEV1%pred and PEF%pred values， as well as lower nasal nitric oxide （nNO） and nasal resistance （P < 0.05）. Small airway function parameters—FEF50%， FEF75%， and MMEF—were also superior in the study group （P<0.05）. Inflammatory and immune markers differed significantly： the study group exhibited lower levels of IL‑4， IL‑6， IL‑17A， IgE， eosinophils （EOS）， and fractional exhaled nitric oxide （FeNO）， but higher IFN‑γ levels （P < 0.05）. Finally， the study group scored higher across all domains of the Pediatric Asthma Quality of Life Questionnaire （PAQLQ）—including symptoms， activity limitation， and emotional function—as well as the total PAQLQ score （P < 0.05）. In the study group， serum total IgE levels were higher， while EOS counts and FeNO levels were lower than those in the control group （P < 0.05）. The study group also demonstrated superior scores across all PAQLQ domains—symptoms， activity limitation， and emotional function—as well as in the total score （P < 0.05）. Over the 12-month treatment period， the rates of asthma exacerbation and hospitalization were significantly lower in the study group than in the control group （P < 0.05）， whereas no significant difference was observed in the overall incidence of adverse events between the two groups （P > 0.05）. Conclusions In addition to budesonide/formoterol treatment， combination with omalizumab effectively controls clinical symptoms in children with moderate‑to‑severe allergic asthma and comorbid allergic rhinitis， improves airway function and small airway function， and by modulating inflammatory cytokine levels， contributes to the restoration of the T helper 1/T helper 2 （Th1/Th2） immune balance， suppresses allergic inflammatory responses， and enhances quality of life.

Atrial fibrillation （AF） is one of the most common arrhythmias encountered in clinical practice， and its population-level disease burden is growing globally， while conventional management strategies have multiple limitations. Artificial intelligence （AI） has opened new technological avenues for the comprehensive management of AF. This narrative review summarizes the current applications， recent research advances of AI in the comprehensive management of AF， as well as the key challenges for its clinical translation. Specifically， AI-enhanced electrocardiography （ECG） integrated with wearable devices enables opportunistic screening across diverse clinical settings； AI-assisted fully automated ECG analysis achieves accuracy and efficiency that match or even exceed those of conventional manual analysis； AI-based predictive models outperform traditional clinical risk scoring systems in predicting the risk of new-onset AF， thromboembolic events， and recurrence after catheter ablation， although improvements in bleeding risk prediction remain limited； AI-assisted personalized anticoagulation， intraprocedural ablation navigation， and clinical decision-making for rhythm control versus rate control have all demonstrated promising clinical application potential. However， the clinical translation of AI for AF management still faces multiple challenges at the technical， practical application， and policy levels. From a technical perspective， the most prominent issues include insufficient model interpretability， widespread data silos， inadequate multimodal data fusion， the gap between model performance and clinical utility， and noise interference in data collection. In terms of practical application， real-world implementation is constrained by fragmented healthcare information systems， superficial integration of AI tools into existing workflows， delayed coverage of AI-related technologies by medical insurance reimbursement， limited AI-related capabilities in primary healthcare settings， the absence of closed-loop disease management systems enabled by AI， and the existing digital divide. At the policy level， regulatory approval pathways for AI-enabled medical devices， liability attribution for AI-assisted clinical decisions， and standardized data governance frameworks still require systematic improvement. Moving forward， priority should be given to integrating explainable AI with domestically developed medical devices， establishing a standardized framework for cross-institutional data sharing and multimodal fusion， developing a clinical validation system oriented to hard clinical endpoints， and optimizing high-robustness signal quality sensing and processing technologies. We also need to facilitate cross-platform data interoperability， deepen the integration of AI tools into standard clinical workflows， and improve supporting mechanisms including health insurance reimbursement coverage， primary care capacity building， and AI-enabled closed-loop disease management. Only by establishing a full-cycle regulatory system for AI medical products， clarifying the boundaries of authority and liability for AI-assisted clinical practice， and developing unified national data governance standards can we advance the translation of AI from mere technological feasibility to universal accessible healthcare， thereby effectively reducing the overall disease burden of AF at the population level.

Objective This study aimed to investigate the association between intestinal ultrasound （IUS） parameters obtained at week 14 and endoscopic healing status at week 54 in pediatric patients with Crohn's disease （CD） undergoing their first course of infliximab （IFX） treatment. Methods This single-center retrospective study enrolled 31 pediatric patients with CD who initiated their first IFX treatment at the Department of Pediatrics of the Sixth Affiliated Hospital of Sun Yat-sen University between January 2023 and July 2025. IUS examinations were conducted at baseline， week 14， and week 54， and the following parameters were documented： bowel wall thickness （BWT， defined as abnormal thickening when exceeding 3 mm）， Limberg grade （classified as abnormal when grade ≥ 2）， bowel wall stratification （classified as abnormal when stratification is lost）， and perienteric fat （classified as abnormal when thickened）. Colonoscopy was performed at week 54. Endoscopic healing was defined as a Simple Endoscopic Score for Crohn's Disease （SES-CD） ≤ 2， while non-healing was defined as SES-CD > 2. We compared the proportion of abnormal ultrasound parameters at each time point between the endoscopic healing group and the non-healing group， and calculated the diagnostic performance of week 14 BWT and Limberg grade for predicting endoscopic non-healing at week 54. Generalized estimating equations （GEE） were applied to analyze the longitudinal trends of ultrasound parameters. Results Endoscopic healing was achieved in 15 out of 31 patients （48.4%） at week 54. At baseline， no statistically significant between-group differences were observed in the proportion of patients with abnormal ultrasound parameters （all P > 0.05）. At week 14， the rates of BWT thickening and abnormal Limberg grading in the non-healing group were both 93.8% （15/16）， which was significantly higher than the 40.0% （6/15） observed in the healing group （P = 0.002）. For predicting endoscopic non-healing at week 54， BWT thickening measured at week 14 yielded a sensitivity of 93.8% （95%CI： 69.8% - 99.8%）， a specificity of 60.0% （95%CI： 32.3% - 83.7%）， a positive predictive value of 71.4% （95%CI： 47.8% - 88.7%）， and a negative predictive value of 90.0% （95%CI： 55.5% - 99.7%）. Among patients with both normal BWT and normal Limberg grade at week 14， the endoscopic healing rate at week 54 reached 90.0% （9/10）， while this rate was only 28.6% （6/21） in patients with at least one abnormal parameter. GEE analysis revealed significant group effects for BWT thickening and abnormal Limberg grade （both P < 0.05）. After adjusting for time-varying ln（CRP + 1）， the group effect remained statistically significant （OR = 7.93， 95%CI： 1.56 - 40.27， P = 0.013）， while the week 14 × group interaction was not statistically significant （P = 0.370）. No significant group effects or interaction terms were identified for loss of bowel wall stratification or perienteric fat thickening （all P > 0.05）. Conclusions In pediatric patients with CD receiving IFX therapy， elevated bowel wall thickness and abnormal Limberg classification detected via intestinal ultrasound at week 14 were correlated with endoscopic non-healing at week 54. This association exhibited a high negative predictive value， and remained statistically significant after adjustment for C-reactive protein.

Succinate， the only metabolite that directly links the tricarboxylic acid cycle to the mitochondrial respiratory chain， acts not only as a core substrate for cellular energy metabolism but also as a critical signaling molecule that regulates key biological processes including immunity， post-translational modification， inflammation， and tumorigenesis. Physiological concentrations of succinate are indispensable for maintaining normal renal function. In multiple acute and chronic kidney diseases， succinate levels are consistently upregulated. This accumulated succinate activates the succinate receptor， which in turn triggers the renin-angiotensin-aldosterone system or downstream signaling cascades that modulate energy metabolism， mitochondrial homeostasis， oxidative stress， renal tubular epithelial cell apoptosis， phenotypic transition， and macrophage M2 polarization. Additionally， succinate accumulation regulates T cell-mediated immune responses and HIF-1α signaling. Collectively， these molecular events promote the development of tubulointerstitial injury， inflammation， and fibrosis. Furthermore， both urinary and circulating succinate levels are significantly correlated with disease progression， indicating its promising potential as a clinically applicable diagnostic and prognostic biomarker. Preclinical studies have confirmed that interventions targeting succinate accumulation and its downstream effector pathways exert significant renoprotective effects， opening new avenues for the development of novel therapeutic strategies for kidney diseases. This review summarizes the biological roles and underlying mechanisms of succinate， its potential as a disease biomarker， and current intervention strategies targeting succinate in the context of kidney disease， with the aim of providing novel insights for the identification of new therapeutic targets for kidney diseases.

Invasive fungal infection （IFI） is an important infectious complication in patients with hematologic malignancies， hematopoietic stem cell transplantation， solid organ transplantation， and long-term immunosuppression. Conventional diagnosis mainly relies on host risk factors， chest high-resolution computed tomography （CT）， culture， histopathology， serological biomarkers， and molecular testing. However， in the context of neutropenia， prophylactic antifungal therapy， or disseminated multi-site involvement， microbiological evidence is often delayed， negative， or difficult to localize.18F-fluorodeoxyglucose （18F-FDG） positron emission tomography/computed tomography （PET/CT） can reflect the activity of inflammatory responses through whole-body metabolic imaging. It provides important complementary information for detecting occult lesions， assessing the extent of dissemination， selecting biopsy targets， monitoring treatment response， and evaluating pre-transplantation risk.This review summarizes the clinical value， implementation considerations， and limitations of PET/CT in the diagnostic and therapeutic pathway of IFI， based on recent clinical cohort studies， guidelines， consensus statements， and advances in novel fungal-specific probes. It should be emphasized that PET/CT is not intended to replace microbiological evidence. Rather， it provides functional imaging evidence that can be translated into clinical decision-making at key diagnostic and therapeutic time points， thereby offering a reference for early identification， accurate assessment， and timely intervention in IFI.

Objective To investigate the effects of MST1/2 inhibitor XMU-MP-1 blocking the Hippo signaling pathway on hyperoxia-induced lung injury neonatal rats with bronchopulmonary dysplasia （BPD）. Methods Neonatal rats were randomly divided into four groups： control group， XMU-MP-1 group， BPD model group， and BPD + XMU-MP-1 group， with 10 rats in each group. Rats in the BPD model group and BPD + XMU-MP-1 group were exposed to 85% O₂ in a hyperoxia chamber for 14 consecutive days to establish the BPD model， while those in the control group and XMU-MP-1 group were kept in normal air. From the first day of modeling， rats in the XMU-MP-1 group and BPD + XMU-MP-1 group received daily intraperitoneal injections of the MST1/2 kinase inhibitor XMU-MP-1 （1 mg/kg）， whereas those in the control group and BPD model group received equal volumes of normal saline， for 7 consecutive days. Body weight was monitored during the modeling period. At the end of the modeling period， lung tissue sections were stained with hematoxylin and eosin （HE） for histopathological evaluation， and the extent of alveolarization was quantified by radial alveolar count （RAC）. Western blot and immunofluorescence staining were used to detect the expression levels of Hippo signaling pathway proteins （MST1/2， p-YAP）， epithelial-mesenchymal transition-related markers （E-cadherin， Vimentin）， and the fibroblast activation marker Thy-1. TUNEL staining was employed to detect pulmonary cell apoptosis， and Sirius Red staining was used to assess pulmonary collagen deposition. Results Compared with the control group， the BPD model group exhibited significantly decreased body weight （P < 0.05）； typical BPD pathological changes， characterized by significantly decreased RAC （P < 0.05）； significantly increased pulmonary cell apoptosis rate and collagen deposition area （all P < 0.05）； and significantly upregulated protein expression of MST1/2， p-YAP and Vimentin， as well as significantly downregulated expression of E-cadherin and Thy-1 （all P < 0.05）. Compared with the BPD model group， the BPD + XMU-MP-1 group showed significantly restored body weight （P < 0.05）， and the aforementioned pulmonary pathological damage， protein expression abnormalities， cell apoptosis， and collagen deposition were all significantly ameliorated （all P < 0.05）. Conclusions The Hippo signaling pathway is abnormally activated in hyperoxia-induced BPD model of neonatal rats， participating in lung cell apoptosis， epithelial⁃mesenchymal transition and collagen deposition. Blocking this pathway with the MST1/2 inhibitor XMU-MP-1 alleviates BPD lung injury， suggesting that the Hippo pathway is a potential therapeutic target for BPD.

Objective To define the "small acrosomal area sperm phenotype" using the acrosomal area ratio as an indicator， to compare differences in routine semen parameters and sperm functional indices， and to analyze the correlations between this phenotype and the sperm DNA fragmentation index （DFI） and other relevant parameters. Methods （1）Semen samples were collected from the male outpatient clinic between June 2023 and June 2025. Using a 30% cut-off for the percentage of small acrosomal area sperm out of the total sperm evaluated（R）sperm morphology analysis was performed on 75 samples in the small acrosomal area group （R > 30%） and 75 normal samples （R ≤ 30%）. （2）Semen quality parameters， sperm survival rate， and sperm penetration capacity through cervical mucus were assessed simultaneously in all 150 samples. SPAT scores， DFI， and other functional tests were performed， and conventional transmission electron microscopy was used for ultrastructural observation， followed by correlation analysis. （3）Samples were divided into the small acrosomal area phenotype group and the control group according to the predefined threshold. Between-group comparisons were conducted using Student's t-test or the Mann⁃Whitney U test， as appropriate； Pearson correlation analysis was used to evaluate the relationship between R and each parameter. Results Compared with the control group， the small acrosomal area phenotype group exhibited significantly lower progressive motility （PR）， viability， and SPAT scores， while DFI was significantly elevated. No statistically significant difference was observed in sperm concentration between the two groups. R was significantly negatively correlated with PR， normal morphology rate， viability， and SPAT score， and significantly positively correlated with DFI. Conclusion The proportion of the small acrosomal area phenotype is significantly correlated with sperm motility， membrane integrity， penetration capacity， and DNA integrity， suggesting that it may serve as a supplementary quantitative indicator to conventional morphological reporting for male fertility evaluation and risk stratification.

Objective Based on the COM-B model， this study analyzed the factors influencing vision therapy recommendation intention and recommendation behavior among optometric practitioners in China， and to explore the potential mechanisms underlying the translation of intention into behavior. Methods A national cross-sectional questionnaire survey was conducted from June to October 2024， and enrolled a total of 1 750 optometric practitioners. According to the COM-B （Capability，Opportunity，Motivation-behaviour） model， the capability dimension included knowledge assessment scores and professional qualifications； the opportunity dimension included institution type and vision therapy implementation barriers； the motivation dimension referred to recommendation intention； and the behavior dimension was measured by cumulative clinical recommendation volume levels. Reflective motivation was constructed （including perceived familiarity， perceived clinical effectiveness， and perceived effectiveness of external promotion）， and its influence on recommendation intention was analyzed. Quantile regression was used to examine factors affecting recommendation intention. Ordered logistic regression models were employed to analyze recommendation behavior. These models also assessed the changes in model fit following the incorporation of the intention variable. Results Optometric practitioners demonstrated high intention to recommend vision therapy 9.0（8.0， 10.0）. However， 49.8% of practitioners were classified in the lowest recommendation volume category （< 500 cases）. Reflective motivation was significantly positively associated with recommendation intention （full sample β = 0.857， optometric physician subgroup β = 0.769， both P < 0.001）. Capability factors showed no significant effect on intention. In the ordered logistic regression models， after adding recommendation intention， the Nagelkerke R² increased by 0.120 in the full population and by 0.058 in the physician subgroup. Every 1-point increase in recommendation intention was associated with higher odds of being in higher recommendation volume levels （full sample： OR = 1.50， 95%CI： 1.42 - 1.59， P < 0.001； optometric physician subgroup： OR = 1.42， 95%CI： 1.24 - 1.63， P < 0.001）. Years of work experience in the capability dimension positively influenced behavior in both groups. The main barriers were lack of unified clinical guidelines （76.9%）， irregular market order （75.9%）， and insufficient medical insurance coverage （70.7%）. Conclusions Reflective motivation is the core factor influencing vision therapy recommendation intention. The translation of high intention into behavior is structurally constrained by the opportunity dimension. Strengthening expert consensus guidelines， optimizing insurance reimbursement policies， and regulating market practices may facilitate the conversion of recommendation intention into clinical implementation.

Objective To investigate the characteristics of early blood glucose fluctuations in premature infants of different gestational ages and to further analyze the value of early blood glucose fluctuation characteristics in assessing periventricular-intraventricular hemorrhage （PIVH）. Methods A retrospective study was conducted， and the medical records of 175 premature infants admitted to Nantong First People's Hospitalfrom January 2023 to December 2025 were collected. They were divided into the early premature infant group （27 - 31 weeks） and the middle-late premature infant group （32 - 36 weeks）. Blood glucose was monitored on the day of admission and within 72 hours. The main parameters were the first blood glucose （ABG）， mean blood glucose （MEBG）， standard deviation of blood glucose （SDBG）， coefficient of variation of blood glucose （CV）， mean amplitude of blood glucose fluctuation （MAGE）. The characteristics of early blood glucose fluctuations in the two groups were compared. Head ultrasound examinations were performed at least twice within 2 weeks of hospitalization. The occurrence of PIVH was classified into the PIVH group and the non-PIVH group. Baseline data of the two groups were collected. Univariate and Logistic regression multivariate analyses were conducted to identify independent predictors of PIVH occurrence. A model was constructed， and the predictive value of single independent predictors and the model for PIVH occurrence was analyzed using the receiver operating characteristic curve （ROC）. Results Compared with the middle-late premature infant group， the ABG、MEBG， SDBG， CV， and MAGE were higher in the early premature infant group， and the differences were statistically significant （P < 0.05）. Compared with the non-PIVH group， the early premature infant group with a gestational age of 27 - 31 weeks， gestational diabetes， gestational hypertension， and the use of vasoactive drugs within 24 hours before delivery were higher， the use of prenatal glucocorticoids was lower， the birth weight， 1-minute Apgar score， 5-minute Apgar score， and hemoglobin level were lower， and ABG， MEBG， SDBG， CV， and MAGE were higher. The differences were statistically significant （P < 0.05）. Logistic regression multivariate analysis showed that the independent predictors of PIVH occurrence in premature infants were gestational age （OR：2.834；95%CI：1.016 - 7.904）， gestational diabetes（OR：2.575；95%CI：1.018 - 6.514）， and CV（OR：1.047；95%CI：1.001 - 1.095）. The ROC curve analysis showed that the AUC values of single independent predictors and the model for predicting PIVH occurrence ranged from 0.630 to 0.760， with the model having the highest predictive value for PIVH occurrence， with an AUC value of 0.760， and the sensitivity and specificity were 60.00% and 80.70%. Conclusions The more intense early blood glucose fluctuations in low-gestational-age premature infants， and a high CV value are independent predictors of PIVH occurrence along with low gestational age， and gestational diabetes. The construction of a model based on early blood glucose fluctuation indicators is helpful for predicting PIVH occurrence and providing important guidance for clinical decision-making and prognosis assessment of premature infants.

Objective To evaluate the efficacy and safety of an infrared thermal therapy device for cervical high-risk human papillomavirus （HR-HPV） infection. Methods A prospective， multicenter， randomized， non-treatment-controlled， superiority trial was conducted. Patients with nucleic acid test-confirmed cervical HR-HPV infection and normal ThinPrep Cytology Test （TCT） results were enrolled and randomly assigned in a 2∶1 ratio to the treatment group （infrared thermal therapy device， 44 ℃， 30 min per session， 10 sessions over approximately 7 weeks） or the control group （no intervention）， with follow-up through 6 months after the initial treatment. The primary endpoint was the HR-HPV clearance rate at 6 months， defined as the conversion of at least one baseline-positive HR-HPV subtype to negative. Secondary endpoints included HPV subtype clearance rates at each visit， clinical cure rate （clearance of all baseline-positive subtypes）， life satisfaction， treatment compliance， Visual Analogue Scale （VAS） pain scores， and device performance. Statistical analyses were performed on the Full Analysis Set （FAS） and Per Protocol Set （PPS）. A superiority margin of 10% was used for superiority testing： the rate difference between groups and its 95% confidence interval （CI） were calculated using the stratified Newcombe method adjusting for center effects， with superiority declared if the lower bound of the 95%CI for the rate difference exceeded 10%. Between-group comparisons were performed using the Cochran-Mantel-Haenszel （CMH） chi-square test adjusting for center effects for difference testing， and Fisher's exact test was used when expected cell frequencies were < 5 in 2 × 2 tables. The 95% CIs for rates within each group were calculated using the Clopper-Pearson exact method. Results A total of 97 patients were enrolled （65 in the treatment group， 32 in the control group）， with 96 included in the FAS （64 treatment， 32 control）. At 6 months， FAS analysis showed a viral clearance rate of 73.4% （47/64， 95%CI： 60.9% ⁃ 83.7%） in the treatment group versus 31.3% （10/32， 95%CI： 16.1% ⁃ 50.0%） in the control group， with a rate difference of 42.2% （95%CI： 18.6% ⁃ 60.1%）. The lower bound of the 95% CI for the rate difference （18.6%） exceeded the 10% superiority margin， confirming superiority （CMH χ² = 17.51， P < 0.001）. PPS results were consistent ［77.0% （47/61） vs. 32.3% （10/31）， rate difference 44.8% （95%CI： 21.9% ⁃ 62.9%）， superiority confirmed］. Secondary endpoints： the clinical cure rate at 6 months was 68.8% （44/64） in the treatment group versus 28.1% （9/32） in the control group （χ² = 14.24， P < 0.001）； the HPV52 subtype clearance rate was 80.0% （12/15） versus 12.5% （1/8）， with a statistically significant difference （Fisher's exact test， P = 0.005）； life satisfaction rates in the treatment group （95.3% ⁃ 100.0%） were higher than those in the control group （78.1% ⁃ 93.8%） at all visits， with statistically significant differences at D0， D45， and month 3 （P < 0.001， P = 0.038， and P = 0.038， respectively）， but not at months 4 and 6 （P = 0.186 and P = 0.762， respectively）. Treatment compliance was excellent， with a completion rate of 96.9% （62/64） at D45 and 95.3% （61/64） at 6 months. Mean VAS scores across treatment sessions ranged from 0.28 to 0.37， with a maximum of < 2.5， all below the mild pain threshold of 3. Device performance was rated as excellent （5 points） at all visits. Regarding safety， no device-related serious adverse events occurred； all adverse events reported in the treatment group were mild， except for one moderate SAE （acute pyelonephritis） assessed as unrelated to the device. No local complications or device-related adverse reactions occurred. Conclusions The infrared thermal therapy device significantly improves HR-HPV clearance rates in patients with cervical HR-HPV infection， with mild pain， high patient compliance， and a favorable safety profile. It may serve as an effective intervention for the clinical management of cervical HR-HPV infection.

Objective To investigate the efficacy of combined electromyographic biofeedback and pelvic floor pulsed magnetic stimulation in elderly women with nocturia and to evaluate its impact on sleep quality. Methods A retrospective study was conducted involving 328 elderly women with nocturia who received treatment in the First Affiliated Hospital of Xi′an Medical University between January 2021 and February 2026. According to the treatment modality， patients were assigned to either the intervention group （combined electromyographic biofeedback and pelvic floor pulsed magnetic stimulation） or the control group （conventional behavioral intervention combined with pelvic floor muscle training）. Propensity score matching （PSM） was performed to balance baseline characteristics between the two groups. Changes in nocturnal voiding frequency， the Pittsburgh Sleep Quality Index （PSQI）， the Overactive Bladder Symptom Score （OABSS）， and pelvic floor functional parameters were compared before and after treatment. Multivariable logistic regression analysis was performed to identify factors associated with treatment efficacy in patients with nocturia. Results After propensity score matching， 86 patients were included in the final analysis. No significant differences were observed between the two groups regarding age， body mass index （BMI）， years since menopause， duration of nocturia， comorbidities， nocturnal voiding frequency， PSQI score， OABSS score， or pelvic floor functional parameters at baseline （all P > 0.05）. Following treatment， both groups showed significant improvements in nocturnal voiding frequency， PSQI score， and OABSS score compared with baseline （all P < 0.05）. Compared with the control group， the intervention group demonstrated significantly greater reductions in nocturnal voiding frequency and PSQI score， as well as significantly better pelvic floor functional outcomes （all P < 0.05）. Multivariable logistic regression analysis identified combined electromyographic biofeedback and pelvic floor pulsed magnetic stimulation as an independent factor associated with favorable clinical efficacy in patients with nocturia （OR = 7.245， 95%CI： 1.785 - 29.404， P = 0.006）. Conclusions Combined electromyographic biofeedback and pelvic floor pulsed magnetic stimulation effectively reduced nocturnal voiding frequency， nocturnal urine volume， the number of nocturnal awakenings， PSQI scores， and OABSS scores in elderly women with nocturia， thereby alleviating clinical symptoms and improving sleep quality. As a non-invasive， repeatable， and comprehensive rehabilitation approach， this combined therapy represents a promising treatment option for elderly women with nocturia.

Objective To analyze the effects of multimodal analgesia combined with health empowerment theory nursing on pain， hemodynamics and negative emotions of patients after anterior cruciate ligament reconstruction （ACLR）. Methods A total of 122 patients who underwent ACLR in the First Affiliated Hospital of Nanjing Medical University from February 2025 to February 2026 were selected as the study subjects. They were divided into the control and study groups by random number table method， with 61 cases in each group. The control group was given routine analgesia combined with routine nursing program， and the study group was given multimodal analgesia combined with health empowerment theory nursing on the basis of the control group. Both groups were intervened until discharge and followed up for 2 months. The cumulative dosage of sufentanil during operation， the rescue rate of analgesic drugs at 24 h after operation， the hospitalization time， the hemodynamics after entering the operating room， at the end of operation and at extubation， the pain degree at 6， 12 and 24 h after operation， the negative emotion and self-care ability before operation and 2 months after operation， and the compliance of rehabilitation exercise at 2 months after operation， the nursing satisfaction at discharge and the postoperative safety were compared between the two groups. Results Compared with the control group， the cumulative dosage of sufentanil in the study group was less， and the rescue rate of analgesic drugs at 24 h after operation was lower （P < 0.05）. From entering the operating room to extubation， the heart rate， systolic blood pressure and diastolic blood pressure of the two groups decreased first and then increased， and those of the study group were lower than the control group， and the increase of heart rate， systolic blood pressure and diastolic blood pressure at extubation in the study group was lower than that at the end of operation （P < 0.017 after correction）. The scores of numerical rating scale （NRS） of the study group at 6， 12 and 24 h after operation were lower than those of the control group （P < 0.017 after correction）. Compared with before operation， the scores of self-rating depression scale （SDS） and self-rating anxiety scale （SAS） at 2 months after operation in the two groups decreased， the study group was lower； the score of self-care ability measurement scale （ESCA） of the two groups increased， the study group was higher （P < 0.05）. Compared with the control group， the scores of active learning， psychological and physical exercise compliance in the study group were higher at 2 months after operation （P < 0.05）. There was no significant difference in the rate of nursing satisfaction between the two groups at discharge （100.00% vs. 95.08%， P > 0.05）. There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups （3.28% vs. 8.20%， P > 0.05）， and no serious adverse events such as respiratory depression and nerve block-related complications occurred in the two groups. Conclusions The multimodal analgesia combined with health empowerment theory nursing could reduce the amount of opioids used during operation and the need for postoperative remedial analgesia in patients with ACLR， reduce postoperative pain and stabilize perioperative hemodynamics. At the same time， it could relieve patients negative emotions， improve self-care ability and rehabilitation exercise compliance， and the nursing satisfaction and safety was good.

Objective To construct and validate a predictive model for postoperative pulmonary complications （PPCs） following craniotomy in patients with spontaneous intracerebral hemorrhage （sICH）. Methods A total of 308 sICH patients who underwent emergency craniotomy for hematoma evacuation under general anesthesia at Brain Hospital Affiliated to Nanjing Medical University from June 2023 to June 2025 were retrospectively enrolled as the training cohort. Additionally， 132 sICH patients who received the same surgical procedure at Nanjing First Hospital during the same period were included as the validation cohort. Patients were divided into PPCs and non-PPCs groups based on the occurrence of PPCs within 7 postoperative days. LASSO regression and multivariate Logistic regression were performed on the training cohort to screen risk factors and develop a nomogram prediction model. Model performance and clinical applicability were evaluated using receiver operating characteristic （ROC） curve and area under the curve （AUC）， calibration curve， and decision curve analysis （DCA）. Results This study enrolled 440 patients， with a PPCs incidence of 60.0% （264/440）. Multivariate Logistic regression analysis identified age ≥ 65 years， preoperative hypoxemia， dysphagia， low Glasgow Coma Scale （GCS） score， and elevated systemic immune-inflammation index （SII） as independent risk factors for PPCs in sICH patients （all P < 0.05）. The developed nomogram demonstrated an AUC of 0.876 （95%CI： 0.793 ⁃ 0.958） in the training cohort， with sensitivity of 91.3% and specificity of 66.7%； and an AUC of 0.817 （95%CI： 0.749 - 0.885） in the validation cohort， with sensitivity of 90.2% and specificity of 72.0%. Calibration curve and Hosmer-Lemeshow test （training cohort： χ² = 2.621， P = 0.955； validation cohort： χ² = 2.212， P = 0.973） indicated good model fit. DCA revealed positive net benefit within threshold probabilities of 17% ⁃ 91% in the training cohort and 16% ⁃ 99% in the validation cohort， suggesting favorable clinical utility. Conclusions Age ≥ 65 years， preoperative hypoxemia， dysphagia， low GCS score， and elevated SII are independent risk factors for PPCs in sICH patients. The nomogram model constructed based on these factors demonstrates good predictive performance and clinical application value.

Objective To investigate the effects of wrist-ankle needle combined with multimodal analgesia on pain after posterior lumbar interbody fusion （PLIF）. Methods 90 patients with degenerative lumbar spinal stenosis were divided into routine group， control group and experimental group， with 30 cases in each group. The routine group was treated with multimodal analgesia. The control group was treated with additional sham needle. The experimental group was treated with additional wrist-ankle needle. The control group received sham needle and the experimental group received wrist-ankle needle starting on the day of surgery. Visual analogue scale （VAS） score of incision and lower limb rebounding pain， analgesic drugs intervention times， laboratory indexes and the scores of Japanese Orthopaedic Association （JOA） score were compared among the three groups. Results The experimental group showed a lower incidence of lower limb rebounding pain when compared with that of routine group and control group （P < 0.05）. Significant time and intergroup effects were observed for three groups with lower limb rebounding pain （P < 0.05）. VAS scores of experimental group were lower when compared with that of the routine group and control group at 48 hours after wound drainage tube removal （P < 0.05）. Additionally， the JOA scores and satisfaction scores of patients in the experimental group at 7 days postoperatively were significantly higher than those in routine group and control group （P < 0.05）. Conclusions Wrist-ankle needle combined with multimodal analgesia significantly reduced the incidence of lower limb rebounding pain after PLIF， while alleviating lower limb rebounding pain at 48 h after removal of the wound drainage tube. It also improved early postoperative lumbar function， increased patient satisfaction， and promoted patient recovery.

Objective This study was conducted to investigate the associations between intensive care unit （ICU） day 1 （D1） levels of thrombin-antithrombin complex （TAT）， soluble thrombomodulin （sTM）， plasmin-α₂-antiplasmin complex （PIC）， and tissue plasminogen activator-plasminogen activator inhibitor-1 complex （t-PAIC） and day 5 （D5） sepsis-induced coagulopathy （SIC）， as well as to evaluate the incremental discriminative value of sTM for SIC prediction. Methods This observational analysis was conducted based on a single-center prospective cohort. Consecutive enrollment was performed for adult patients with sepsis admitted to the ICU between August 2024 and July 2026. The primary analysis cohort included patients who did not meet the criteria for SIC on D1 and had evaluable SIC status on D5. We compared D1 levels and discriminative performance of the four candidate biomarkers between patient subgroups， followed by exploratory logistic regression and incremental discrimination analysis focusing on sTM. Results A total of 166 patients were enrolled in this study， among whom 57 （34.3%） met the diagnostic criteria for SIC on D5. The D1 levels of all four biomarkers were significantly higher in the D5 SIC group compared to the non-SIC group， and these differences remained statistically significant after Benjamini-Hochberg multiple testing correction. After adjusting for the SOFA coagulation subscore and APACHE Ⅱ score， each 1-standard-deviation increment in sTM concentration remained independently and significantly associated with D5 SIC （OR = 8.93， 95%CI： 3.91 - 20.41， P < 0.001）. Among the 156 patients with complete data for all four biomarkers， sTM yielded the highest area under the receiver operating characteristic curve （AUC） of 0.830. Among the 163 patients with complete data for sTM， PLT， and INR， the AUCs of sTM alone， PLT+INR， and PLT+INR+sTM were 0.839， 0.785， and 0.888， respectively； the AUC of the combined PLT+INR+sTM model was significantly higher than that of PLT+INR （P = 0.002） and sTM alone （P = 0.023）. Conclusions Elevated D1 sTM was significantly associated with D5 systemic inflammatory response SIC， and demonstrated good discriminatory performance when used as an independent indicator. In the study cohort analyzed herein， integrating D1 sTM into the routine scoring system based on PLT and INR further improved the discriminatory capacity of the model.