Volume 105 · Issue 30 · 2025

Venous thromboembolism (VTE) is one of the most preventable fatal diseases, and accurate risk assessment is crucial for its prevention. Traditionally, VTE risk assessment has been predominantly conducted by healthcare providers, which is time-consuming and laborious. In recent years, research on patient self-assessment has increasingly attracted attention. This article mainly discusses the feasibility, effectiveness, and application prospects of patient self-assessment of VTE risk. Through the collation and analysis of multiple studies, it was found that the the Caprini risk score of venous thromboembolism based on the patient self-assessment model had shown certain effectiveness in different language versions and patient groups. It can significantly improve the efficiency of assessment, promote patients′ attention to health and participation, and can be used as an effective supplement to the assessment of medical staff. However, during the patient self-assessment process, cognitive biases are prone to occur in some assessment options, and it is difficult for patients with special disease conditions to independently complete self-assessment. Therefore, in the future, it is necessary to further optimize assessment tools, leverage new technologies to achieve automated and intelligent assessment, and carry out high-quality multi-center and large-sample studies to improve the accuracy and efficiency of VTE risk assessment, and promote patient participation and improvement of clinical practice.

Human papillomavirus (HPV)-related diseases have become a significant public health issue, posing a serious threat to human health. However, currently, only cervical cancer has well-established prevention measures, primarily based on HPV vaccination and screening. For other HPV-related non-cervical diseases such as vulvar cancer, vaginal cancer, penile cancer, anal cancer, head and neck cancer, genital warts, and recurrent respiratory papillomatosis, there are no specific guidelines or consensus to systematically guide their early prevention strategies and measures in China. Therefore, Cancer Prevention and Control Committee, Chinese Preventive Medicine Association and Vaccine and Immunization Branch, Chinese Preventive Medicine Association comprehensively summarized the etiology and epidemiology of HPV, the disease burden of HPV-related non-cervical diseases, and the evidence for early prevention, and formed 13 recommendations. This consensus aims to comprehensively summarize the etiology and epidemiology of HPV infection, the disease burden of HPV-related non-cervical diseases, and the evidence for early prevention, providing recommendations and references for relevant personnel in disease prevention and control, maternal and child health care, clinical diagnosis and treatment, health management, policy-making, etc., and finally, reducing the risk of HPV infection, promoting early diagnosis and treatment of HPV-related non-cervical diseases, and decreasing the disease burden.

To develop a machine learning diagnostic model for T-shaped uterus based on quantitative parameters from 3D transvaginal ultrasound.

A retrospective cross-sectional study was conducted, recruiting 304 patients who visited the hysteroscopy centre of Fuxing Hospital, Beijing, China, between July 2021 and June 2024 for reasons such as "infertility or recurrent pregnancy loss" and other adverse obstetric histories. Twelve experts, including seven clinicians and five sonographers, from Fuxing Hospital and Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Peking University People′s Hospital, and Beijing Hospital, independently and anonymously assessed the diagnosis of T-shaped uterus using a modified Delphi method. Based on the consensus results, 56 cases were classified into the T-shaped uterus group and 248 cases into the non-T-shaped uterus group. A total of 7 clinical features and 14 sonographic features were initially included. Features demonstrating significant diagnostic impact were selected using 10-fold cross-validated LASSO (Least Absolute Shrinkage and Selection Operator) regression. Four machine learning algorithms [logistic regression (LR), decision tree (DT), random forest (RF), and support vector machine (SVM)] were subsequently implemented to develop T-shaped uterus diagnostic models. Using the Python random module, the patient dataset was randomly divided into five subsets, each maintaining the original class distribution (T-shaped uterus: non-T-shaped uterus ≈ 1∶4) and a balanced number of samples between the two categories. Five-fold cross-validation was performed, with four subsets used for training and one for validation in each round, to enhance the reliability of model evaluation. Model performance was rigorously assessed using established metrics: area under the curve (AUC) of receiver operator characteristic (ROC) curve, sensitivity, specificity, precision, and F1-score. In the RF model, feature importance was assessed by the mean decrease in Gini impurity attributed to each variable.

A total of 304 patients had a mean age of (35±4) years, and the age of the T-shaped uterus group was (35±5) years; the age of the non-T-shaped uterus group was (34±4) years.. Eight features with non-zero coefficients were selected by LASSO regression, including average lateral wall indentation width, average lateral wall indentation angle, upper cavity depth, endometrial thickness, uterine cavity area, cavity width at level of lateral wall indentation, angle formed by the bilateral lateral walls, and average cornual angle (coefficient: 0.125, -0.064,-0.037,-0.030,-0.026,-0.025,-0.025 and -0.024, respectively). The RF model showed the best diagnostic performance: in training set, AUC was 0.986 (95%CI: 0.980-0.992), sensitivity was 0.978, specificity 0.946, precision 0.802, and F1-score 0.881; in testing set, AUC was 0.948 (95%CI: 0.911-0.985), sensitivity was 0.873, specificity 0.919, precision 0.716, and F1-score 0.784. RF model feature importance analysis revealed that average lateral wall indentation width, upper cavity depth, and average lateral wall indentation angle were the top three features (over 65% in total), playing a decisive role in model prediction.

The machine learning models developed in this study, particularly the RF model, are promising for the diagnosis of T-shaped uterus, offering new perspectives and technical support for clinical practice.

To investigate the incidence and risk factors of acute kidney injury (AKI) after aortic dissection surgery.

The data of patients who underwent aortic dissection surgery in the Department of Cardiovascular Surgery of Jiangsu Provincial People′s Hospital from January 2020 to June 2024 were retrospectively collected. The primary endpoint was the incidence of AKI within 7 days postoperatively, and the secondary endpoint was the occurrence of AKI combined with dialysis (AKI-D). Logistic regression was used to analyze the influencing factors of AKI and AKI-D. The Shapley additive explanation (SHAP) method was employed to interpret the results of the multivariate logistic regression analysis and quantify the contribution of each factor.

A total of 850 patients aged [M (Q₁, Q₃)] 56 (48, 66) years were included, with 679 males (79.9%) and 171 females (20.1%). The study identified 490 cases (57.6%) with Stanford type A aortic dissection and 360 cases (42.4%) with type B. The incidence of AKI within 7 days postoperatively was 40.1% (341/850), with the incidence of AKI in type A dissection significantly higher than that in type B dissection [60.8% (298/490) vs 11.9% (43/360), P<0.001]. AKI-D occurred in 19.5% (166/850) of patients, and the in-hospital mortality rate was 8.8% (75/850). The independent risk factors for postoperative AKI, ranked by contribution, were emergency surgery (OR=2.38, 95%CI: 1.39-4.06; SHAP=0.085), surgery duration (per 1-hour increase, OR=1.18, 95%CI: 1.09-1.29; SHAP=0.084), Stanford type A (OR=2.04, 95%CI: 1.09-3.81; SHAP=0.062), baseline serum creatinine (per 10 μmol/L increase, OR=1.12, 95%CI: 1.06-1.18; SHAP=0.058), intraoperative erythrocyte transfusion (for each additional U, OR=1.09, 95%CI: 1.02-1.15; SHAP=0.037), D-dimer (per 1 mg/L increase, OR=1.03, 95%CI: 1.01-1.06; SHAP=0.036). The independent risk factors for AKI-D, ranked by contribution, were surgical duration (per 1-hour increase, OR=1.31, 95%CI: 1.19-1.45; SHAP=0.083), baseline serum creatinine (per 10 μmol/L increase, OR=1.16, 95%CI: 1.09-1.24; SHAP=0.053), emergency surgery (OR=2.60, 95%CI: 1.34-5.01; SHAP=0.045), female gender (OR=2.73,95%CI: 1.57-4.76; SHAP=0.040), D-dimer (per 1 mg/L increase, OR=1.05, 95%CI: 1.02-1.07; SHAP=0.033), poor renal perfusion classification (missing, OR=2.34, 95%CI: 1.34-4.09; SHAP=0.032), intraoperative erythrocyte transfusion (per 1 U increase, OR=1.07, 95%CI: 1.01-1.14; SHAP=0.021).

The incidence of AKI after aortic dissection surgery is high, particularly in patients with type A dissection. Prolonged operation time and elevated preoperative serum creatinine are common risk factors for both AKI and AKI-D.

To systematically describe and analyze the epidemiological characteristics and clinical manifestations of adult pertussis in Zhejiang Province in 2024.

Data on pertussis cases reported in 2024 among individuals aged≥18 years residing in Zhejiang Province were collected from the China Disease Control and Prevention Information System. Additional clinical and hospitalization information was obtained through a specialized survey. Descriptive analysis was conducted on epidemiological and clinical characteristics.

In 2024, a total of 3 994 adult pertussis cases were reported in Zhejiang Province, accounting for 6.67% of all pertussis cases (59 917), with a reported incidence rate of 7.14 per 100 000. Female cases (2 541, 63.62%) outnumbered male cases (1 453, 36.38%). The majority of cases were aged 30-39 years (1 598, 40.01%) and 40-49 years (885, 22.16%). The reported incidence rate varied across different cities, ranging from 3.38 per 100 000 to 14.42 per 100 000. The proportion of adult cases among total cases showed a monthly increasing trend from 1.02% in January to 16.43% in December (P<0.001). The main clinical symptoms included nocturnal cough exacerbation (1 765, 45.42%) and paroxysmal spasmodic cough (1 253, 32.24%). Cases aged≥60 years had higher rates of complications [13.48% (81) vs 8.28% (272), P<0.001] and hospitalizations [20.47% (123) vs 6.06% (199), P<0.001] compared to those aged<60 years.

The incidence of pertussis among adults in Zhejiang Province was significantly increasing in 2024, with the proportion of adult cases rising month by month. Women aged 30 to 49 were the high-risk group, and the elderly bore a relatively heavy disease burden. The clinical manifestations were mainly atypical symptoms such as exacerbated nocturnal coughing.

The data of adult whooping cough pneumonia patients admitted to the Affiliated Hospital of Jining Medical College from January 2023 to December 2024 were retrospectively analyzed, and the Leicester Cough Questionnaire (LCQ) was used to analyze the severity of the patients′ cough and the decline of their quality of life, and to summarize the clinical manifestation, imaging feature, and bronchoscopic manifestation. A total of 24 adult patients with whooping cough, 13 males and 11 females, aged (56.0±15.9) years, were included, and all of them had cough as the cheif complaint. Using fractional exhaled nitric oxide (FeNO) levels, they were divided into the elevated FeNO group [>25 ppb (1 ppb=1×10^-9)) and the normal FeNO group (5-25 ppb).The total LCQ score of the 24 patients was (10.6±3.1) points. The total LCQ score [(8.9±2.8) vs (12.1±2.5) points] and psychological score [(2.8±1.5) vs (4.5±1.7) points] of females were lower than those of males (all P<0.05); the total LCQ score [(8.7±2.3) vs (11.2±3.1) points] and psychological score [(2.6±0.8) vs (4.6±1.6) points] of the FeNO elevation group were lower than those of the FeNO normal group (all P<0.05).Chest CT in the 24 patients showed bronchial wall thickening (79.1%, 19/24), patchy infiltrating shadow (54.2%, 13/24), solid lung shadow (45.8%, 11/24), intrapulmonary striated shadow (29.2%, 7/24), and dendritic sign (16.7%, 4/24) and ground glass density shadow (12.5%, 3/24). Bronchoscopy showed mucosal congestion and edema in all cases (100%, 24/24), and in some cases, purulent secretion (66.7%, 16/24), mucus plug (20.8%, 5/24), inflammatory stenosis of the lumen (8.3%, 2/24), mucosal erosions (4.2%, 1/24), and mucosal leukoplakia (4.2%, 1/24). Whooping cough in adults was characterized by cough as the cheif complaint, decreased LCQ score, lower LCQ score in the elevated FeNO group compared to the normal FeNO group, and imaging manifestations of bronchiolitis, pneumonia, and bronchoscopic lesions of varying severity. Adult patients with cough who do not respond well to conventional treatment need to be alerted to pertussis infection.

The current study aimed to explore the efficacy and safety of excisional goniotomy using the Kahook Dual Blade (KDB-GTE) in refractory glaucoma. A total of 20 eyes from 19 subjects with mild to late-stage refractory glaucoma who underwent standalone KDB goniotomyor combined phacoemulsification plusintraocular lens (IOL) implantation (partially combined withgoniosynechialysis) in Beijing Tongren Hospital from August 2021 to April 2023 were included. There were 9 males and 10 females, with a mean age of (57±17) years and a follow-up time of (19.8±6.4) months.The preoperative intraocular pressure (IOP) decreased from (29.4±11.8) mmHg (1 mmHg=0.133 kPa) to (15.7±2.6) mmHg (P<0.001). The types of preoperativeanti-glaucoma medications were reduced from 4 (3, 4) to 2 (1, 3) (P<0.001). At 12-month follow-up, 70% (14/20) achieved a IOP of≤18 mmHg after medication. No severe complications were reported. This study suggests that KDB-GTE is an effective and minimally invasive surgery for refractory glaucoma, demonstrating significant reductions in both IOP and medication burden, with a favorable safety profile.

To analyze the genomic and disease ecological background of two Salmonellaenterica subsp. diarizonae (S.Ⅲb) isolated from two children with diarrhea. A retrospective analysis was conducted on the clinical data of two pediatric patients who presented to the gastroenterology outpatient clinic of Fudan University Affiliated Children′s Hospital with symptoms of fever and diarrhea and were ultimately diagnosed with bacterial enteritis. Both patients′ fecal samples tested positive for Salmonella infection. Whole-genome sequencing results indicated that the strains were all S.Ⅲb 50:z₅₂:z₃₅/ST8433, which were not recorded in domestic or international databases. Antimicrobial susceptibility testing showed that Salmonella strain isolated from Case 1 was an antibiotic-sensitive strain, susceptible to 28 antimicrobial agents; Salmonella strain isolated from Case 2 was a multidrug-resistant strain, susceptible to only 11 antimicrobial agents, and resistant to β-lactam, quinolone, and macrolide antibiotics. The strain of case 1 carried aac(6′)-Iaa and quinolone parC(T57S) resistance genes. The strain of Case 2 had a unique chromosome encoding the type Ⅲ secretion systems (T3SS) of Yersinia enterocolitica, and the number of invasion protein genes and typhoid toxin secreted by Salmonella type Ⅰ virulence island (SPⅠ-1) in case 2 were two and one more than those in case 1, respectively. Some important virulence factors were predicted in the genome sequences of both strains, including type Ⅵ secretion system (T6SS), protease (IcsP/SopA), temperature-sensitive hemagglutinin (Tsh), non-LEE encoding T3SS effector (NleC), and Iron uptake protein(iucA、iutA). The two strains identified in this study are clones of the same serotype, sequence type, and T6SS, but exhibit different antibiotic resistance profiles, and there is no history of common exposure among the infants with diarrhea. This suggests that S.Ⅲb 50:z₅₂:z₃₅/ST8433 clone possesses high recombination and virulence characteristics.

This paper reports a case of anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis with sudden visual loss as the main manifestation. The patient was an 87-year-old male who was admitted to the hospital mainly for "headache for 10 days with right eye pain for 3 days and right eye blindness for 9 hours". Fundus examination showed edema of the right eye optic disc, fundus angiography showed vasculitis retinal ischemic lesion, ANCA positive, increased erythrocyte sedimentation rate, increased C-reactive protein, and pulmonary interstitial lesions, kidney damage and peripheral nerve damage. He was diagnosed as ANCA-related vasculitis. After 7 days of immunotherapy with glucocorticoid combined with mycophenolate mofetil, the patient had no obvious symptoms of headache and eye pain, and the vision of his right eye returned to light sensation. At the last follow-up in June 2025, the patient's right eye visual acuity returned to index/10 cm.

This paper reports the diagnosis and treatment of a patient with rheumatoid arthritis (RA), membranous nephropathy (phospholipase A2 receptor-related) and non-Hodgkin's lymphoma (NHL). A 60-year-old male went to Guizhou Provincial People's Hospital for "edema of both lower limbs with increased foam in urine for 1 month". Laboratory examination showed that urine protein quantity was 17.7 g/d and serum albumin was 16.1 g/L. Renal biopsy confirmed that he was phospholipase A2 receptor-related membranous nephropathy. After 6 months of traditional immunosuppressive therapy, urinary protein did not improve, and during this period, new epistaxis and dysphagia occurred, and pathology confirmed that it was NHL (middle and low risk group B of stage IE). Switch to rituximab (RTX) in combination with chemotherapy. After 1 month of treatment, the edema resolved, urine protein decreased to 0.25 g/d, albumin increased to 31.1 g/L at 24 h, and blood phospholipase A2 receptor decreased from>1 500 RU/ml to 500 RU/ml. After six months of follow-up, the patient received RTX combined with chemoradiotherapy on schedule, and the symptoms were significantly improved, and the disease did not relapse.

In recent years, therapeutic strategies targeting the peripheral nervous system (PNS) have attracted much attention in the field of oncology neuroscience research, opening up a new path to break through the limitations of traditional therapeutic methods. PNS participates in the formation of tumor microenvironment (TME) by constructing complex neuro-tumor interaction networks. This special microenvironment not only regulates tumor growth and invasion, but also participates in key processes such as tumor metabolic reprogramming, immune escape, and therapy resistance. This paper deeply analyzes the neural remodeling process in TME, reveals the complex and dynamic interaction mechanism between nervous system and TME, focuses on the regulatory role of targeted PNS in tumor treatment and its clinical translational value, and provides important theoretical basis and research ideas for the development of innovative anti-cancer treatment strategies based on neuroregulation.

Visceral obesity is closely related to many diseases, but traditional obesity measurement indexes are difficult to accurately reflect visceral fat function. Visceral fat index (VAI), as a new type of fat evaluation index, can effectively evaluate visceral fat dysfunction. This paper summarizes the mechanism of association between VAI and comorbidity, common comorbidity patterns and potential clinical application value. VAI is closely related to metabolic abnormalities of organ systems such as glucose and lipid metabolism and sex hormone secretion, and is related to insulin resistance and fat metabolism disorders. Common comorbidity patterns associated with VAI include metabolic syndrome, diabetes mellitus and its comorbidities, and their comorbidity patterns have complex etiological relationships. VAI has application value in identifying metabolic syndrome and predicting cardiovascular disease risk. Although VAI exhibits good predictive potential, the relevant research is still in its infancy. In the future, it is necessary to further expand the application scope of VAI and pay attention to the applicability of different groups, so as to optimize its application in multiple fields and provide scientific basis for the prevention and management of comorbidities.

This paper systematically reviews the molecular structure, immunological function and mechanism of human leukocyte antigen-G (HLA-G) in the tumor microenvironment, focusing on the strategies of tumor immunotherapy targeting HLA-G, including monoclonal antibodies, bispecific antibodies and their clinical application prospects in combination with existing immune checkpoint inhibitors. The safety and efficacy of different treatment strategies were evaluated by reviewing new drug clinical trials. Finally, in view of the current technical bottlenecks and clinical translation challenges faced by HLA-G targeted therapy, the optimization direction of future research is proposed, which provides new ideas for expanding tumor immunotherapy strategies.