Volume 105 · Issue 28 · 2025

Stillbirth is a serious obstetric event that not only causes physical and psychological harm to the mother, but also brings great burdens to families and social support system. Similar to maternal mortality, the incidence of stillbirth has become a key indicator of the quality of obstetrics in a country or region. In the past decade, perinatal scholars in China have taken many prevention and control measures for stillbirth. The incidence of stillbirth has dropped significantly, but it is far less than the decline in maternal mortality, and there is still a large disparity compared with developed countries. Affected by factors such as economic development, incidence of stillbirth varies greatly between different regions and different medical institutions. So, stillbirth is still the focus of perinatal physicians. We call for a real-world study of fetal deaths through standardized data collection and the construction of a multidisciplinary collaborative etiology research platform, to provide a basis for the precise prevention and control of stillbirths. In addition, the guidelines for standardized management of stillbirth that conform to Chinese conditions should be issued to reduce the incidence of stillbirth.

Improving the management of tuberculosis (TB) patients and controlling the transmission of Mycobacterium tuberculosis are key components of TB prevention and control efforts. Under specific conditions, home-based treatment serves as one of the effective models to address the diverse management needs of TB patients, offering significant advantages in reducing the burden on healthcare systems and enhancing patients′ quality of life. However, the implementation of home-based treatment, particularly home isolation, faces numerous managerial challenges and technical requirements. This paper proposes criteria for evaluating the suitability of patients for home-based care, identifies core technological needs including remote medical management, digital health monitoring systems, and point-of-care testing, and explores solutions for infection control, transmissibility assessment, intelligent medication dispensers, and health education. It also outlines future directions in digital nutritional health management and multi-omics-based treatment evaluation, aiming to inform the refinement of home-based TB care systems and improve their standardization and effectiveness.

To analyze the perinatal outcomes of patients with twin pregnancies complicated with intrahepatic cholestasis (ICP) in pregnancy based on whether they conceived by in vitro fertilization and embryo transfer (IVF-ET).

This was a retrospective cohort study. A total of 1 156 pregnant women with twin pregnancies complicated with ICP who delivered in West China Second Hospital of Sichuan University from January 2014 to July 2022, including 706 in the IVF-ET group and 450 in the natural pregnancy group, were included. According to the peak total bile acid level (TBA) during pregnancy, they were classified as mild (<40 μmol/L), moderate (40~<100 μmol/L), and severe (≥100 μmol/L). Clinical data were collected for both groups, and the diagnosis time of ICP and adverse perinatal outcomes were compared using multivariate logistic regression model. The differences in the termination time of pregnancy in patients with peak TBA in IVF-ET group were compared.

The median (Q₁, Q₃) age of enrolled participants was 31 (28, 34) years, with the median age in IVF-ET group [32 (30, 34) years] being higher than that in natural conception group [29 (26, 32) years] (P<0.001). There were statistically significant differences between the IVF-ET group and the natural conception group in postpartum hemorrhage volume [450 (400, 600) vs 400 (350, 500) ml], the incidence of gestational diabetes [32.29% (228 cases) vs 22.89% (103 cases)], preterm birth [78.47% (554 cases) vs 86.44% (389 cases)], premature rupture of membranes [14.45% (102 cases) vs 19.56% (88 cases)], and fetal growth restriction [0.99% (7 cases) vs 9.33% (42 cases)] (all P<0.05). The multivariate logistic regression analysis results showed that IVF-ET was a risk factor for preeclampsia in patients with twin pregnancies and ICP (OR=1.958, 95%CI: 1.180-3.251, P=0.009). There were statistically significant differences in the time of termination of pregnancy among patients in the IVF-ET group with different peak TBA levels during pregnancy (P<0.001).

IVF-ET is a relevant factor in twin pregnancies among ICP patients with preeclampsia. In twin pregnancies involving ICP patients conceived through IVF-ET, the timing of pregnancy termination differs in those with varying peak TBA levels during different gestational periods.

To explore and validate the predictive cut-off value and effectiveness of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio for forecasting delivery within one week in patients with early-onset pre-eclampsia (PE).

This prospective cohort study enrolled 801 singleton pregnant women diagnosed with early-onset PE between 23⁺⁶ and 33⁺⁶ weeks of gestation at Guangzhou Women and Children′s Medical Center from January 2018 to December 2023. All patients underwent sFlt-1/PlGF testing, and data on gestational age at delivery and adverse perinatal outcomes were collected. Based on the time-to-delivery (TTD) interval after sampling, patients were categorized into two groups: TTD≤1 week and TTD>1 week. A total of 500 patients enrolled from January 2018 to December 2021 were used as the development set to establish a receiver operating characteristic (ROC) curve and determine the optimal cut-off value for predicting TTD≤1 week. The remaining 301 patients enrolled from January 2022 to December 2023 formed the validation set to assess the cut-off value′s positive predictive value (PPV), sensitivity, and specificity. Area under curve (AUC) was calculated.

The mean maternal age of the 801 patients was (32.7±4.8) years. In the development set, the mean age was (32.6±4.7) years, with 235 (47.0%) patients experiencing TTD≤1 week, and 265 (53.0%) patients with TTD>1 week. In the validation set, the mean age was (32.8±5.0) years, with 128 (42.5%) patients having TTD≤1 week, and 173 (57.3%) patients with TTD>1 week. The sFlt-1/PlGF ratio was significantly higher in the TTD≤1 week group than in the TTD>1 week group (all P<0.001). The AUCs of the sFlt-1/PlGF ratio for predicting TTD≤1 week were 0.914 (95%CI: 0.888-0.940) in the development set and 0.933 (95%CI: 0.899-0.959) in the validation set, both higher than those of sFlt-1 [0.904 (95%CI: 0.868-0.931) and 0.920 (95%CI: 0.883-0.948)] and PlGF [0.878 (95%CI: 0.843-0.913) and 0.892 (95%CI: 0.851-0.925)] (all P<0.05). In the development set, the optimal sFlt-1/PlGF cut-off value for predicting TTD≤1 week was 210, with PPV of 95.10%, specificity of 95.36%, and sensitivity of 60.64%. In the validation set, the cut-off value yielded a PPV of 95.81%, specificity of 98.26%, and sensitivity of 63.91%.

An sFlt-1/PlGF ratio≥210 has strong predictive value for delivery within one week in patients with early-onset PE. The cut-off value may serve as a valuable reference for improving risk stratification and clinical management in early-onset PE.

To compare the perinatal outcomes and neonatal complications among pregnant women with early-onset fetal growth restriction (FGR) and absent end diastolic velocity (AEDV) in umbilical artery at different diagnosis time and timing of delivery.

This was a retrospective cohort study based on data from 82 women and newborns with early-onset FGR combined with AEDV in umbilical artery who delivered in Peking University Third Hospital from January 1, 2015 to December 31, 2023. Participants were classified as follows: pregnancy termination group (n=30), diagnosis at<28 week with expectant management 0-3 d group (n=5), diagnosis at<28 week with expectant management>3 d group (n=9), diagnosis at≥28 week with expectant management 0-3 d group (n=21), and diagnosis at≥28 week with expectant management>3 d group (n=17). Perinatal outcomes and neonatal complications were compared among groups.

The maternal age was (33.8±4.3) years. Gestational age at diagnosis, abdominal circumference percentile at diagnosis, and estimated fetal weight (EFW) percentile differed significantly among 5 groups (P<0.05), being lowest in the pregnancy termination group. Among 4 groups which continued pregnancy, gestational age at delivery, neonatal birth weight, and neonatal asphyxia rates differed significantly (P<0.05). The groups of diagnosis at<28 week with 0-3 d or>3 d expectant management had lower gestational ages at delivery [27.6 (27.1, 27.6) and 28.2 (27.9, 28.5) weeks] and lower birth weights [720 (700, 730) and 940 (683, 953) g] compared to the groups of diagnosis at≥28 week with 0-3 d or>3 d expectant management [31.1 (30.4, 31.9) and 31.5 (30.7, 32.4) weeks; 1 130 (1 000, 1 265) and 1 205 (1 048, 1 408) g] (P<0.05). Neonatal asphyxia incidence was lower in the group of diagnosis at≥28 week with expectant management>3 d (0, 0/16) than that in the groups of diagnosis at<28 week with 0-3 d or>3 d expectant management [60.0% (3/5) and 50.0% (4/8)] (P<0.05). Significant differences (P<0.05) were observed in bronchopulmonary dysplasia (BPD) incidence and length of hospital stay among survivors. Both groups of diagnosis at<28 week had longer hospital stays than the two groups of diagnosis at≥28 week (P<0.05). BPD incidence was higher in the group of diagnosis at<28 week with 0-3 d expectant management than that in the two groups of diagnosis at≥28 week (P<0.05).

Neonates diagnosed with FGR and umbilical artery AEDV<28 weeks had higher risks of asphyxia and complications than those diagnosed≥28 weeks. For cases≥28 weeks,>3 d of expectant management under close maternal-fetal monitoring did not increase neonatal asphyxia or complication rates, but the risk of intrauterine fetal death should be kept alert during the expectant process.

To evaluate the effect of donor-recipient age on the postoperative survival of lung transplant recipients (LTR).

This retrospective cohort study included 1 025 patients undergoing lung transplantation between January 1, 2015, to December 31, 2022 at the Affiliated Wuxi People′s Hospital of Nanjing Medical University. Participants were followed up at 30 d, 1, 3 and 5 years after lung transplantation with follow-up until December 2024. All donor lungs came from voluntary donations made by citizens after death. Young donors were defined as <38 years old, older donors as ≥38 years old; young recipients as <55 years old, older recipients as ≥55 years old. Four different donor-recipient age combination groups were formed: Group 1 (young donor and young recipient group, 196 pairs), Group 2 (young donor and older recipient group, 268 pairs), Group 3 (older donor and young recipient group, 234 pairs), Group 4 (older donor and older recipient group, 327 pairs). Kaplan-Meier method was used to draw survival curves, and log-rank test was used to compare survival time differences among the four donor-recipient age combination groups. Restricted cubic spline (RCS) models were used to analyze the dose-response relationship between donor and recipient age, respectively, and the 5-year postoperative mortality risk. Cox proportional hazards regression models were used to analyze the association of donor age, recipient age, and donor-recipient age combination with the mortality risk at 30 days, 1, 3, and 5 years after LTR.

Donor age was (37.8±11.8) years, with 869 males; recipient age was (55.0±12.3) years, with 830 males. All patients were followed up, with a follow-up time ranging from 4.0 days to 60.0 months and a median follow-up time of 24.1 months; 504 deaths occurred. The cumulative survival rates at 30 days, 1, 3, and 5 years postoperatively for LTR in the four donor-recipient age combination groups were all statistically significant (all P<0.05). Donor age showed a non-linear relationship with the 5-year postoperative mortality risk in LTR (P_nonlinear=0.037), while recipient age showed a linear relationship with the 5-year postoperative mortality risk (P_nonlinear=0.763). The association between recipient age and the mortality risk at 30 days, 1, 3, and 5 years after LTR was statistically significant (all P<0.05), but the association between donor age and the mortality risk at the four postoperative time points was not statistically significant (all P>0.05). Using Group 1 as the reference, the HR (95%CI) for 30 d mortality risk in Group 4 was 1.64 (1.01-2.66), HR (95%CI) for 1-year mortality risk in Group 4 was 1.57 (1.11-2.23), HR (95%CI) for 3-year mortality risk in Group 2 and Group 4 were 1.45 (1.06-1.98) and 1.70 (1.25-2.32) respectively. HR (95%CI) for 5-year mortality risk in Group 2 and Group 4 were 1.47 (1.09-1.98) and 1.65 (1.22-2.22) respectively (all P<0.05).

The recipient age was a risk factor for survival after LTR. The donor-recipient age matching affects postoperative survival in LTR, with a higher mortality risk when both the donor and recipient are older.

To evaluate the application and safety of statins in drug-coated balloon (DCB) combined with stenting for long-segment femoropopliteal artery disease.

The patients with long-segment femoropopliteal artery disease (lesion length≥15 cm) treated with DCB combined with stent implantation at Nanjing Drum Tower Hospital from January 2020 to December 2022 were retrospectively enrolled. The patients were divided into statin and non-statin groups according to the use of statins or not, and the two groups were matched by 1∶1 propensity score matching (PSM). With a 2-year postoperative follow-up, the primary efficacy endpoints were primary patency rate and freedom from clinically driven-target lesion revascularization (FCD-TLR), and the primary safety endpoints were amputation-freedom survival (AFS) and all-cause mortality. Secondary endpoints included amputation rate, open bypass rate, and major adverse cardiovascular events (MACEs). The Kaplan-Meier method was used to plot the survival curves of the endpoint events in both groups, and the log-rank test was used to compare the differences between the two groups, and the multivariate Cox regression model was used to analyze the risk factors for postoperative restenosis and amputation. Multivariate Cox regression model was used to analyze the subgroups and draw forest plots to assess the heterogeneity between the subgroups of the main clinical outcomes.

A total of 290 patients were included, 110 in each group after PSM matching, 77 (70.0%) males, age (73.6±10.0) years in the non-statin group, and 76 (69.1%) males, age (72.9±9.3) years in the statin group, and there were no statistically significant differences between the baseline data and lesion characteristics of the patients in the two groups (all P>0.05). Primary patency (46.4% vs 31.8%), FCD-TLR (54.5% vs 33.6%), and AFS (90.9% vs 78.2%) were higher in the statin group than in the non-statin group at 2 years (all P<0.05); The 2-year all-cause mortality (2.7% vs 11.8%) and minor amputation rate (3.6% vs 10.0%) were lower in the statin group than in the non-statin group (all P<0.05). Multivariate Cox regression analysis showed that non-use of statins was a risk factor for postoperative restenosis (HR=1.69, 95%CI: 1.19-2.39) and amputation (HR=2.59, 95%CI: 1.19-5.62). Subgroup analyses suggested an interaction between the use of antiplatelet drugs, hypertension, and diabetes mellitus with statin therapy (all P_interaction<0.05).

Statins enhance patency and safety of DCB combined with stenting for long-segment femoropopliteal artery disease, reducing the risk of amputation and mortality.

To compare the efficacy of peripheral cutting balloon (PCB) versus high-pressure balloon (HPB) in percutaneous transluminal angioplasty (PTA) for autogenous arteriovenous fistula (AVF) stenosis.

The AVF patients who underwent PTA for stenosis at the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2021 were retrospectively included. According to the type of balloon, the patients were divided into the PCB group and the HPB group. Propensity score matching (PSM) was conducted at a 1∶3 ratio, with gender, age, and the location of stenosis included as covariates. The patency of the target lesion and the access were compared between the two groups at 3, 6, 12, and 24 months after treatment, and subgroup analysis was performed.

A total of 295 PTA treatments in 220 patients (132 males and 88 females) aged (51.5±13.6) years were finally included. There were 76 cases in the PCB group and 219 cases in the HPB group, respectively. The primary patency rate of target lesions at 6 months after intervention in the PCB group was superior to that in the HPB group [77.0% (57/74) vs 59.2% (125/211), P=0.006], and the median primary patency time of target lesions after intervention was better in the PCB group than that in the HPB group [11.0 (95%CI: 8.4-13.6) months vs 9.0 (95%CI: 7.0-11.0) months, P=0.015]. In the venous juxta-anastomotic lesion subgroup, the primary patency rate of the target lesion in the PCB group at 6 months after intervention was better than that in the HPB group [80.0% (24/30) vs 54.0% (47/87), P=0.012].

Compared with HPB, PCB can prolong the primary patency time of the target lesion and the patency rate at 6 months after PTA for autogenous AVF stenosis.

To investigate the functional connectivity (FC) characteristics of the raphe nucleus in adolescents with internet gaming disorder (IGD) and its relationship with the neurotransmitter receptor/transporter system.

This retrospective study enrolled adolescent IGD patients (IGD group) at the First Affiliated Hospital of Zhengzhou University between September 2022 and December 2023, and age-, sex-, and education-matched healthy volunteers (control group) were recruited concurrently. The severity of IGD, depression, and anxiety in the IGD group was assessed using the Internet Addiction Test (IAT), 24-item Hamilton Depression Rating Scale (HAMD-24), and 14-item Hamilton Anxiety Rating Scale (HAMA-14), respectively. Whole-brain resting-state functional MRI (rs-fMRI) data were collected for both groups. The dorsal raphe nucleus (DR) and median raphe nucleus (MR) were selected as seed points, with age, sex, and education years included as covariates for comparing FC differences between the IGD and control groups. The cross-modal JuSpace toolbox was used to analyze spatial correlations between altered FC in the IGD group and PET/SPECT-derived maps of various neurotransmitter receptor/transporter systems.

The IGD group comprised 52 participants [43 males, 9 females, age (14.6±2.0) years, years of education (8.7±1.9) years], while the control group consisted of 46 participants [34 males, 12 females, age (16.1±5.9) years, years of education (9.5±4.4) years]. The IAT, HAMD-24, and HAMA-14 of the IGD group were (62.5±10.8) points, (22.5±12.7) points, and (14.6±9.6) points. With the DR as the seed point, the IGD group showed higher FC in the left middle frontal gyrus (t=4.43), left inferior parietal lobule (t=4.25), left supplementary motor area (t=4.60), left precentral gyrus (t=4.12), and left superior frontal gyrus (t=4.00) compared to the control group [Gaussian random field (GRF) corrected, voxel level P<0.005, mass level P<0.05]. With the MR as the seed point, the IGD group showed higher FC in the right cerebellum Crus I compared with the control group [t=5.66, GRF corrected, voxel level P<0.005, mass level P<0.05]. The altered DR-related FC in the IGD group was spatially correlated with the dopamine (D1, D2), serotonin (5-HT1a, 5-HT1b, 5-HT2a), and μ-opioid receptor systems (Bonferroni correction, P<0.05/24).

Adolescent IGD patients displayed abnormal whole-brain FC of raphe nucleus, which is associated with multiple neurotransmitter systems.

To explore the association of Mediterranean diet pattern with all-cause and cancer-specific mortality risks in Shanghai middle-aged and elderly community.

The study prospectively included 45 487 middle-aged and elderly individuals aged≥45 years who completed the baseline survey and had complete dietary and nutritional questionnaires from the Shanghai Suburban Adult Cohort and Biobank (SSACB) project between 2016 and 2019. Follow-up was conducted until December 31, 2023, to collect survival data and cause of death information. The alternate Mediterranean diet (AMED) score was used to evaluate the Mediterranean diet pattern, and participants were grouped into three categories based on their scores: 0-3, 4-5, and 6-9. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare differences in cumulative survival rates among the three groups. The Gray test was utilized to compare differences in cumulative incidence rates of cancer-specific mortality among the three groups. The Cox proportional hazards model and competing risks model were used to analyze the association between the AMED score and all-cause and cancer-specific mortality, respectively. Restricted cubic splines were used to assess the dose-response relationship between the AMED score and the risk of all-cause and cancer-specific mortality.

The mean age of all participants was (60.25±7.36) years, with 17 753 males (39.0%), with a median follow-up time of 6.4 years. During the follow-up period, 1 230 deaths occurred, including 607 (49.3%) cancer-specific deaths. The AMED score was 0-3 in 13 386 participants, with 6 133 males (45.8%); 4-5 in 20 738 participants, with 8 022 males (38.7%); and the 6-9 score group included 11 363 participants, with 3 598 males (31.7%). The cumulative survival rates for all-cause mortality and the cumulative incidence of cancer-specific mortality differed significantly among the three AMED score groups (all P<0.05). Cox proportional hazards regression analysis revealed that for each one-point increase in the AMED score, the risk of all-cause mortality decreased by 7% (HR=0.93, 95%CI: 0.90-0.97). Compared to the 0-3 score group, the 6-9 score group exhibited a 27% reduction in the risk of all-cause mortality (HR=0.73, 95%CI: 0.62-0.87). The competing risks model revealed that for each one-point increase in the AMED score, the risk of cancer-specific mortality decreased by 9% (HR=0.91, 95%CI: 0.87-0.97). Compared to the 0-3 score group, the 6-9 score group exhibited a 29% reduction in the risk of cancer-specific mortality (HR=0.71, 95%CI:0.55-0.91). No nonlinear associations were observed between the AMED score and the risk of all-cause or cancer-specific mortality (both P_non-linear>0.05).

The adoption of the Mediterranean diet pattern among middle-aged and elderly populations in Shanghai is associated with decreased risks of all-cause and cancer-specific mortality.

To investigate the feasibility of using activated partial thromboplastin time (APTT) as a substitute for anti-factor Xa activity (anti-Xa) in monitoring low-molecular-weight heparin (LMWH)-anticoagulated hemodialysis. A total of 68 hemodialysis patients who received LMWH anticoagulation in the Blood Purification Center of Beijing Hospital from December 2020 to January 2021 were prospectively enrolled. LMWH was administered via single intravenous injection before the start of hemodialysis. Venous blood samples anticoagulated with sodium citrate were collected at the start of dialysis (0 h) and at 0.5, 1.0, 2.0, 3.0, and 4.0 h after the start of dialysis to detect anti-Xa and APTT. Simple linear regression was used to fit the relationship between APTT (independent variable) and anti-Xa activity (dependent variable), and the strength of the linear association was evaluated by R² and Pearson correlation coefficient. The intraclass correlation coefficient (ICC) was calculated based on the mixed-effects model. The results showed that the regression equation between anti-Xa and APTT was: anti-Xa (U/ml)=APTT (s)×0.011-0.111, which was statistically significant (R²=0.626, P<0.001). anti-Xa was strongly correlated with APTT (r=0.726, P<0.001). The measurement consistency between anti-Xa and APTT was good (ICC=0.87, 95%CI: 0.82-0.91). This study provides data reference for using APTT to monitor LMWH-anticoagulated hemodialysis.

A total of 19 (11 males and 8 females) patients diagnosed with subclavian artery stenosis at Haidian Hospital in Beijing, the First Affiliated Hospital of Zhengzhou University, and the Second Affiliated Hospital of Kunming Medical University from June 2019 to May 2024 were retrospectively included. The average age of the patients was (65.2±7.9) years (range: 52-86 years). Distal ischemia, insufficient arteriovenous access (AVA) flow, recurrent thrombosis of AVA and persistent weak thrill after percutaneous transluminal angioplasty (PTA) occurred in 36.8% (7/19), 26.3% (5/19), 21.1% (4/19), and 15.8% (3/19) of patients, respectively. There were 18 patients underwent endovascular therapy (17 with PTA+stent placement, and 1 with PTA alone), achieving a technical success rate of 100%, and postoperative symptoms of ischemia, insufficient flow, and weak thrill were all alleviated. The average follow-up duration was 1-65 (27.2±4.3) months, one patient had recurrent ischemic symptoms, while the others did not experience any clinical symptoms related to subclavian artery stenosis. The current study indicates subclavian artery stenosis is a hidden cause of AVA dysfunction, and PTA with stent implantation has good outcomes.

Ultra-high resolution CT and enhanced MRI imaging findings of a patient with CHARGE syndrome were reported. A 31-year-old female was admitted to the hospital on August 2, 2021 due to "hearing loss in both ears for 28 years and aggravation for 10 months". When the patient was 3 years old, he was found to have otitis media in his left ear. He was treated with puncture and anti-inflammatory treatment in the local hospital and wore hearing aids. The hearing improvement effect was not good. This time, due to the obvious decline of hearing on his right side 10 months ago, the genetic test results showed the gene mutation of chromatin domain helicase DNA binding protein 7 (CHD7), so he came to our hospital for further treatment. Ultra-high resolution CT with a thickness of 0.1 mm showed changes after radical mastoidectomy on the left side, deformity of the right stapes, absence of stapes muscle, fixation of the hammer head, atresia of the left cochlear nerve foramen, stenosis of the internal auditory tract, and bilateral permanent petroscale sinus; Bilateral small vestibule, vestibular window atresia, semicircular canal hypoplasia. MRI showed that the left auditory nerve was slender, the cochlear nerve and facial nerve were not shown, and the right superior and inferior vestibular nerves were slender. The final clinical diagnosis was CHARGE syndrome. The patient underwent right cochlear implant in our hospital, and the postoperative vital signs were stable. Re-examination of cone beam CT (CBCT) confirmed that the cochlear electrode was in place.

This paper reports a case of isolated IgG4-associated sclerosing cholangitis with huge intrahepatic mass. A 60-year-old woman was admitted due to "intermittent radiating pain in the right upper abdomen for 2 weeks". CT and MRI examination on admission showed huge intrahepatic occupancy, which was considered intrahepatic cholangiocarcinoma. Laparoscopic partial hepatectomy was planned, but no tumor cells were found in two rapid freezing pathologies during the operation, and immune-related sclerotic diseases were not ruled out, so the operation was completed only after laparoscopic liver biopsy. The postoperative pathological diagnosis was IgG4-associated sclerosing intrahepatic cholangitis. Regular treatment with prednisone and cyclophosphamide was given. After follow-up until May 2025, the patient's abdominal pain was relieved and his condition was stable. IgG4-related sclerosing cholangitis with intrahepatic mass is extremely rare and easy to be misdiagnosed as cholangiocarcinoma. We should deepen our understanding of this disease.

This article reports the diagnosis and treatment of a patient with refractory focal segmental glomerulosclerosis (FSGS) with osmotic nephropathy. A 22-year-old female was admitted to hospital due to "edema of both lower limbs for more than 1 month". She was clinically presented with nephrotic syndrome. The pathological diagnosis was FSGS (apical type) with acute renal tubular injury, complicated with epilepsy, gastrointestinal hemorrhage, septic shock and other complications. After multi-disciplinary difficult case discussion, glucocorticoid resistance caused by osmotic nephropathy was considered. Rational treatment with rituximab and other drugs, and follow-up for more than 1 year. The patient was admitted to intensive care unit (ICU) for a long time in bed to self-care, and all indicators improved.

In recent years, due to the increase of older pregnant women, the premature birth rate in China remains high. At the same time, the current severe birth rate puts forward new requirements for the prevention and treatment of premature birth and maternal and infant health in China. The bottleneck of premature birth intervention lies in the insufficient analysis of molecular mechanism of childbirth initiation, which seriously restricts the early diagnosis and intervention treatment of premature birth. In this paper, the latest research achievements on the mechanism of premature birth in recent years were reviewed from the perspective of maternal decidua, and the mechanism of decidua in the initiation of childbirth was expounded from the perspective of genetic evidence, in order to provide theoretical guidance for the basic research and clinical diagnosis of premature birth.

Lung cancer is a malignant tumor with the highest morbidity and mortality rate in the world, which is a serious threat to human health. Nearly 40% of lung cancer cases in China are non-smokers, which deserve great attention. This article systematically reviews the research progress of lung cancer prevention in non-smokers at home and abroad as of April 2025. Research shows that with the continuous decline of smoking rate, the incidence pattern of lung cancer is changing, and the incidence of lung cancer among non-smokers in China is on the rise. It is clear that the incidence of lung cancer in non-smokers is closely related to indoor and outdoor air pollution, secondhand smoke exposure, living and occupational environment and other factors, which helps to provide scientific basis for formulating effective primary prevention strategies. In addition, based on genome-wide association studies, multiple genetic susceptibility factors related to lung cancer have been discovered, which promotes a deeper understanding of the genetic mechanism of lung cancer and is expected to be used to identify high genetic risk populations and promote the implementation of individualized interventions. Large-scale population screening studies have also shown that early screening can significantly improve the early diagnosis rate of lung cancer and reduce the risk of long-term death.

Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) are common mental disorders in children and adolescents, and they are often comorbid. Although BD and ADHD may share a common neurobiological basis, the pathological mechanisms involved have not been fully elucidated. This paper reviews the progress of MRI in the study of BD and ADHD and their comorbidities, aiming to understand the neuroimaging characteristics of the two disorders from the aspects of brain structure, brain function and brain metabolism, so as to provide reference for future research directions.

T-lymphoblastic lymphoma/leukemia (T-LBL/ALL) is a hematological tumor originating from precursor T lymphocytes, which is highly malignant and has a poor prognosis in adult patients. In LBL/ALL, studies have shown that multiple histone deacetylase (HDAC) subtypes are highly expressed in patient samples, and the high expression of HDAC is significantly correlated with poor prognostic factors, suggesting that targeting HDAC has potential clinical application value for the treatment of LBL/ALL.