Introduction The clinical–epidemiological profile of Chagas disease (CD) has changed over the past decades, leading to decreased levels of physical activity (PA), which may be associated with changes in markers of subclinical atherosclerosis. This study aimed to investigate the association between PA levels and carotid intima–media thickness (CIMT), the presence of carotid atherosclerotic plaque (CAP), and the amount of epicardial adipose tissue (EAT) in patients with chronic CD. Methods This cross-sectional study included patients with chronic CD. The PA level was determined using the short version of the International Physical Activity Questionnaire (IPAQ-short). CIMT and CAP were assessed using Doppler ultrasound of the carotid arteries. The amount of EAT was assessed using transthoracic echocardiography. Linear and binomial logistic regression models were used. Results The median age of the 349 participants was 62 years (54.0–69.0), 56.5% were women, and 79.5% were non-white, with 67.6% having <9 years of schooling. The most common clinical form of CD was the cardiac form without heart failure (HF) (53.9%). Median CIMT values were 0.65 mm (left) and 0.66 mm (right). CAP was present in 46.4% of participants, and the median EAT was 5.0 mm. No statistically significant association was observed between PA levels and CIMT, the presence of CAP, or the amount of EAT. Conclusion PA levels were not associated with the markers of subclinical atherosclerosis in individuals with chronic CD.

Background Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that progresses with age, making effective early intervention crucial to avoid surgical treatment. Traditional Chinese Medicine (TCM) Manual therapy (MT) offers the advantage of relaxing muscles and correcting biomechanical imbalances, thereby assisting patients in performing postural correction exercises under proper biomechanical alignment. However, evidence supporting the use of TCMMT for AIS remains limited. Objective This study aims to elucidate the biomechanical changes in AIS patients by comparing with healthy individuals, and investigate the clinical efficacy and biomechanical mechanisms of combining TCMMT with Schroth method in the treatment of AIS. Methods This study is a randomized controlled trial. Sixty eligible AIS patients will be randomly allocated in a 1:1 ratio to either the experimental group (EG) or the control group. All patients will undergo Schroth method for 60 min, five times per week. The EG will additionally receive TCMMT for 20 min, three times per week. The treatment course will be 8 weeks. Furthermore, fifteen age-matched healthy volunteers will be included. The primary outcome measure is the Cobb angle assessed before and after treatment. Secondary outcome measures include plantar pressure and 3D gait parameters, surface electromyography and muscular temperature. Adverse events will be recorded throughout the trial. All patients randomly allocated in this study will be included in the intention-to-treat analysis. Conclusion This study will provide multi-dimensional evidence for the efficacy of TCMMT as an adjunctive treatment for AIS, advance the development of manual therapy within the field of rehabilitation, and facilitate its application in clinical decision which making by both physicians and patients. Study protocol registration http://itmctr.ccebtcm.org.cn , identifier ITMCTR2025002392.

Objectives Artificial intelligence (AI)–enhanced virtual patient simulations are increasingly used in health professions education to improve clinical communication and diagnostic reasoning. However, the effectiveness of these technologies for psychiatric interview training has not been systematically quantified. This study aimed to systematically review and meta-analyze the existing literature evaluating the impact of AI-enhanced virtual patients on psychiatric interview performance, knowledge acquisition, and learner confidence in health professions education. Materials and methods A systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines. Electronic database searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar to identify relevant studies published between January 2000 and March 2026. Studies were included if they evaluated AI-enhanced virtual patient simulations for psychiatric interview training among medical students, psychiatry residents, clinicians, or other health professions trainees. Data extraction included study characteristics, participant populations, intervention types, and educational outcomes. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Quantitative synthesis was performed using random-effects meta-analysis models, and effect sizes were calculated as standardized mean differences (SMD) with 95% confidence intervals (CI) using R statistical software. Results A total of 560 records were identified through database searches and additional sources. After removal of duplicates and screening procedures, 10 studies met the inclusion criteria and were included in the final analysis. The studies involved approximately 450 participants, including medical students, psychiatry residents, clinicians, nursing students, and psychology trainees. AI-enhanced virtual patient interventions included conversational AI systems, virtual human simulations, large language model–based simulated patients, and AI–virtual reality training environments. The pooled analyses indicated improvements in psychiatric interview performance, knowledge acquisition, and learner confidence following AI-supported virtual patient training. Subgroup analysis demonstrated positive educational outcomes across both student and clinician populations. Risk-of-bias assessment revealed variable methodological quality across studies, with several pilot and non-randomized designs. Conclusion AI-enhanced virtual patient simulations appear to be effective educational tools for improving psychiatric interview training in health professions education. These technologies provide scalable and standardized simulation environments that support communication skill development, diagnostic reasoning, and learner confidence. Although the findings suggest promising educational benefits, further large-scale randomized controlled trials and standardized outcome assessments are needed to confirm the long-term educational impact of AI-supported virtual patient training in psychiatry.

Colonoscopy combined with polypectomy is a well-established strategy for the prevention of colorectal cancer, and endoscopic mucosal resection (EMR) serves as one of the primary therapeutic modalities for colorectal neoplastic lesions. While EMR is generally safe, severe complications may occasionally occur. Herein, we report a rare case of rectal submucosal abscess in a 74-year-old female patient who underwent EMR for rectal polyps. Initial endoscopic fenestration and drainage of the abscess failed to achieve a satisfactory therapeutic effect, and the patient ultimately underwent sigmoidostomy for further management. This case highlights the necessity of considering phlegmon or abscess formation in the differential diagnosis of patients presenting with unexplained acute abdomen after EMR for rectal lesions, especially in those with compromised immunity. Timely identification and intervention are crucial to avoid adverse clinical outcomes.

Background Lymph node metastasis (LNM) is a major prognostic determinant in early-stage cervical squamous cell carcinoma (SCC); however, conventional preoperative imaging has demonstrated sensitivities below 60% for sub-centimeter metastases, resulting in treatment misallocation for approximately 20–30% of patients. Purpose This study aimed to develop and validate a minimal gene expression signature that can be performed on routine biopsy specimens to predict preoperative LNM in cervical SCC. Methods This retrospective biomarker discovery and validation study had a two-phase design. In the discovery phase, we analyzed transcriptomic data from 116 The Cancer Genome Atlas (TCGA) cervical SCC samples and identified differentially expressed genes (DEGs) using Benjamini–Hochberg (BH) false discovery rate correction (FDR < 0.10). Then, we refined them using the least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis. The locked signature was independently validated in a prospectively collected cohort of 202 patients (101 LNM-positive patients and 101 LNM-negative patients) from the Fudan University Shanghai Cancer Center using quantitative reverse transcription–polymerase chain reaction (qRT-PCR), with histopathological lymphadenectomy confirmation as the reference standard. Performance was assessed based on area under the curve (AUC), sensitivity, specificity, predictive values, and bootstrap internal validation. Decision curve analysis and a combined molecular-clinical model were also evaluated. Results Of the 231 DE genes, a three-gene signature (LOC494141, GLOD5, and GML) was identified by sequential filtering. In the independent validation cohort, the signature achieved an AUC of 0.745 (95% CI: 0.676–0.814), with a sensitivity of 62.38%, a specificity of 64.36%, a positive predictive value of 63.64%, and a negative predictive value of 63.11%. Bootstrap validation confirmed model robustness (optimism-corrected AUC: 0.722; calibration slope: 0.913; Hosmer–Lemeshow p = 0.387). A combined model integrating the signature with tumor size and lymphovascular space invasion achieved an AUC of 0.789 (95% CI: 0.724–0.854), with a significant incremental value [net reclassification improvement (NRI) = 0.42, p = 0.001; integrated discrimination improvement (IDI) = 0.065, p < 0.001]. Decision curve analysis demonstrated net clinical benefit across threshold probabilities of 20–70%. At a 20% population prevalence, the adjusted negative predictive value reached 87.3%. Conclusion This three-gene expression signature provides clinically informative preoperative risk stratification for LNM in cervical SCC. Intended as a complementary tool within integrated clinical assessment frameworks rather than a standalone diagnostic tool, this affordable qRT-PCR-based assay holds particular promise for resource-limited settings, pending prospective multicenter validation.

Background This study aimed to evaluate the predictive value of the Fibrosis-4 (FIB-4) index for 28-day mortality in patients with acute pancreatitis and to develop a comprehensive prognostic model. Methods This retrospective study included 467 adult patients admitted to the intensive care unit. Risk factors for 28-day mortality were identified through univariate and subsequent multivariate logistic regression analyses. Based on the significant independent predictors, a predictive logistic regression model was formulated. Results Multivariate analysis revealed that age, APACHE II score, WBC, serum sodium, and the FIB-4 index were independent predictors of 28-day mortality. The combined model incorporating these five factors achieved an area under the receiver operating characteristic curve (AUC) of 0.80, which was significantly higher than that of the FIB-4 index alone (AUC = 0.69, Z = 3.65, p < 0.01) and the APACHE II alone (AUC = 0.73, Z = 3.84, p < 0.01). Conclusion This study confirms the independent prognostic value of the FIB-4 index, and its integration into a multivariable model provides a practical tool to improve early mortality risk stratification in acute pancreatitis patients.

Next-generation metagenomic sequencing (mNGS) enables the direct and unbiased detection of pathogens from clinical samples, overcoming the limitations of standard methods. It is particularly valuable in immunocompromised patients and in cases of complex infections. We report the case of a man in his 40s, born in North Africa, who was admitted with progressive skin and soft-tissue lesions after a minor foot trauma. The initially localized infection rapidly worsened, leading to bilateral pneumonia, acute respiratory failure, disseminated intravascular coagulation, and death. Histopathological examination revealed granulomatous inflammation with alcohol-resistant bacilli and an undiagnosed cutaneous T-cell lymphoma associated with hemophagocytic syndrome. Conventional microbiological tests identified multiple pathogens, including influenza A virus, herpes simplex virus 1 (HSV-1), Candida albicans , Enterococcus faecalis , Proteus mirabilis , and Pseudomonas aeruginosa ; however, their heterogeneous distribution and isolation from non-sterile sites hindered etiological interpretation. Cultures and molecular assays for Mycobacterium species were negative despite findings of histological examination suggestive of granulomatous inflammation with alcohol-resistant bacilli. To clarify the diagnosis, mNGS was performed on blood, serum, and lymph node samples using host DNA depletion and Illumina sequencing. Bioinformatic analysis revealed a diverse microbial landscape, with the detection of Fusarium pseudograminearum , Mycobacterium canettii, and Ralstonia sp., alongside low-level viral sequences [Epstein–Barr virus ( EBV ) and HSV-1 ]. These results reflected the patient’s severe immune deficiency, characterized by a marked depletion of CD8 + T cells and NK cells. Although the results became available too late to influence treatment, mNGS provided crucial diagnostic insights, demonstrating its ability to uncover hidden or rare pathogens. Early application of mNGS could significantly improve diagnostic precision and therapeutic decisions in critically ill immunocompromised patients.

Background Hyponatremia is a prevalent electrolyte disorder in patients with acute spinal cord injury (SCI), which can significantly increase the risk of adverse complications and impair long-term prognosis. Despite its clinical significance, the existing evidence on the factors associated with hyponatremia in this patient population remains fragmented and inconsistent, leading to uncertainties in clinical prevention and management. Methods Systematic searches were conducted in PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases including CNKI, Wan fang, and VIP, retrieving relevant studies from the inception of each database up to December 20, 2025. Included observational studies reporting factors associated with hyponatremia in patients with acute spinal cord injury. Two researchers independently performed literature screening, data extraction, and quality assessment. Results were synthesized using a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI), with assessments of heterogeneity, publication bias, and sensitivity analyses. Results Twelve eligible studies involving 2,355 patients were included in the meta-analysis. The results indicate an association between upper cervical spine injury [OR = 6.05, 95%CI (2.79, 13.10)], complete SCI [OR = 5.35, 95%CI (3.15, 9.07)], hypoproteinemia [OR = 2.96, 95%CI (1.10, 7.92)], infection [OR = 2.20, 95%CI (1.67, 2.90)], and hyponatremia in patients with SCI. Conclusion This meta-analysis demonstrates that hyponatremia in patients with acute SCI is closely related to the level and severity of spinal cord injury, with upper cervical spine injury and complete SCI being potential major risk indicators. Additionally, hypoproteinemia and infection are important associated factors. These findings highlight the need for targeted monitoring and intervention of high-risk patients to reduce the incidence of hyponatremia and improve clinical outcomes.

Background Acute respiratory distress syndrome (ARDS) secondary to severe acute pancreatitis (SAP) is associated with high mortality; however, dependable biomarkers for early risk assessment remain scarce. The lactate-to-albumin ratio (LAR), reflecting both metabolic stress and nutritional status, may serve as a useful prognostic indicator in critical illness. Methods This retrospective study included 351 SAP patients with ARDS who were admitted to the intensive care unit of a tertiary hospital from 2016 to 2024. Clinical and laboratory data within 24 h of admission were collected. The primary outcome was in-hospital mortality. A logistic regression analysis was performed to identify independent predictors, and receiver operating characteristic (ROC) curves were used to compare the prognostic performance of LAR, lactate, albumin, and Sequential Organ Failure Assessment (SOFA) scores. Results In-hospital mortality was 23.6% (83/351). Non-survivors had significantly higher LAR levels than survivors ( p < 0.001). After adjusting for confounders, LAR remained independently associated with mortality (OR = 1.32, 95% CI: 1.04–1.67, p = 0.024). ROC analysis showed that LAR outperformed albumin and achieved accuracy comparable to lactate and SOFA. High LAR (≥1.32) was associated with lower 28-day survival ( p < 0.001). A threshold effect was identified at LAR = 1.78. Conclusion LAR is an independent predictor of in-hospital mortality in SAP patients with ARDS. As a simple, rapid, and cost-effective biomarker, LAR may facilitate early risk stratification and clinical decision-making.

Objective To compare the effects of routine and enhanced intraoperative warming strategies on perioperative hypothermia, coagulation function, and length of hospital stay in severely injured emergency surgery patients. Methods A retrospective cohort study was conducted on 134 severely injured emergency surgery patients (January 2023–December 2024), divided into a routine warming group ( n = 87) and an enhanced warming group ( n = 47). The primary outcome was hypothermia incidence at 1 h postoperative (T3), defined as core body temperature < 36.0 °C. Secondary outcomes included activated partial thromboplastin time (APTT) and prothrombin time percentage (PT%) at 12–24 h postoperative (C3), and length of hospital stay. Core body temperature was monitored at preoperative (T1), end of surgery (T2), and T3. Coagulation parameters were measured at 1 h preoperative (C1), 2–3 h postoperative (C2), and C3. Multivariable regression analyses adjusted for age, sex, injury severity score, operative duration, intraoperative blood loss, and red blood cell transfusion volume. Results Baseline characteristics were comparable between groups (all p > 0.05). The enhanced warming group had significantly higher core body temperature at T2 and T3 ( p < 0.05), with a lower hypothermia incidence at T3 ( p < 0.05). After multivariable adjustment, enhanced warming remained independently associated with reduced hypothermia risk at T3 (adjusted OR = 0.37, 95% CI 0.16–0.84, p = 0.018) and lower APTT at C3 ( β = −4.62, p = 0.033), while the PT% difference did not retain significance after adjustment ( p = 0.076). Fibrinogen was significantly lower in the enhanced warming group at all time points including baseline, indicating a pre-existing difference unrelated to the intervention. The enhanced warming group had a significantly shorter length of hospital stay after adjustment ( β = −3.42 days, p = 0.036). Conclusion Enhanced intraoperative warming was associated with lower postoperative hypothermia incidence, reduced APTT, and shorter hospital stay after confounder adjustment. Prospective trials with baseline coagulation stratification are needed to confirm these findings.