Hospitals In China Research Articles

Metabolic Dysfunction-Associated Steatotic Liver Disease at Quantitative US: International Prospective Study.

Background Quantitative US is promising in assessing metabolic dysfunction-associated steatotic liver disease (MASLD), but prospective multicenter studies are lacking. Purpose To evaluate the diagnostic performance of quantitative US in assessing MASLD and metabolic dysfunction-associated steatohepatitis (MASH). Materials and Methods This prospective study included participants with MASLD from tertiary hospitals in China and Korea, undergoing multiparametric US from August 2021 to December 2023. Diagnostic performance of tissue attenuation imaging (TAI), tissue scatter-distribution imaging (TSI), and two-dimensional shear-wave elastography (SWE) parameters for assessment of MASLD and MASH was evaluated using area under the receiver operating characteristic curve (AUC) analysis, with histopathologic analysis as a reference. Univariable and multivariable analyses identified clinical factors associated with each US parameter. Results A total of 114 participants (median age, 40 years; IQR, 31-50 years; 67 female participants) were evaluated, 76 participants (67%) with MASH and 39 participants (34%) with high-risk MASH (fibrosis score ≥F2). Multivariable analysis indicated TAI and TSI were independently associated with steatosis and SWE was independently associated with fibrosis (all P < .001). TAI and TSI showed excellent performance for assessing steatosis grades S1 or higher, S2 or higher, and S3 (AUCs for TAI: 0.90, 0.93, and 0.78, respectively; AUCs for TSI, 0.94, 0.89, and 0.80, respectively), with TSI demonstrating good performance for inflammation grade I1 or more (AUC, 0.84; 95% CI: 0.75, 0.92; sensitivity, 79%; specificity, 79%). SWE exhibited excellent performance for staging fibrosis scores of F1 or higher, F2 or higher, F3 or higher, and F4 (AUCs: 0.81, 0.96, 0.89, and 0.97, respectively; sensitivities: 75%, 90%, 87%, and 100%, respectively; specificities: 80%, 93%, 83%, and 96%, respectively). The combined TSI and SWE model showed diagnostic advantages for MASH (AUC, 0.92; 95% CI: 0.85, 0.98) and high-risk MASH (AUC, 0.82; 95% CI: 0.74, 0.90) compared with TSI (P = .72 for MASH; P = .002 for high-risk MASH) and SWE (P < .001 for MASH; P = .31 for high-risk MASH). Conclusion TAI, TSI, and SWE helped provide accurate assessment of MASLD, and combining TSI and SWE showed good discrimination for predicting MASH and high-risk MASH. ClinicalTrials.gov Identifier: NCT04985188 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Dighe and Dhyani in this issue.

Prognosis, risk factors and prediction modeling of recurrent pseudomonas aeruginosa infections.

Prognosis, risk factors and prediction modeling of recurrent pseudomonas aeruginosa infections.

Electroacupuncture Reduces Duration of Postoperative Ileus After Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Randomized Trial.

Electroacupuncture Reduces Duration of Postoperative Ileus After Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Randomized Trial.

Tongue swab-based molecular diagnostics for pulmonary tuberculosis and drug resistance in adults: A prospective multicenter diagnostic accuracy study.

Tongue swab-based molecular diagnostics for pulmonary tuberculosis and drug resistance in adults: A prospective multicenter diagnostic accuracy study.

Emotional symptom networks in ICU nurses: a comparative network analysis of tertiary-A and tertiary-B hospitals in China

BackgroundIntensive Care Unit (ICU) nurses experience significant psychological distress due to the high-stakes and high-intensity nature of their work environments. This study aims to explore the differences in emotional symptom networks between tertiary-A and tertiary-B hospital ICU nurses using network analysis to identify central symptoms and inform targeted interventions.MethodA total of 498 ICU nurses were divided into two groups based on hospital level: the tertiary-A hospital group (n = 174) and the tertiary-B hospital group (n = 324). Mood states were measured using the Profile of Mood States-Short Form (POMS-SF). Network analysis was employed to estimate and compare the symptom networks between the two groups, identify central symptoms that link distinct symptom clusters, and conduct network comparison tests to assess differences in overall and local network structures.ResultsIn the tertiary-A hospital group, the most prominent symptoms were POMS4 (Depression-Dejection), POMS1 (Tension-Anxiety), and POMS2 (Anger-Hostility), with the expected influence value indicating that POMS4 (Depression-Dejection) was the most significant. In the tertiary-B hospital group, the most significant central symptoms were POMS1 (Tension-Anxiety), POMS2 (Anger-Hostility), and POMS4 (Depression-Dejection), where POMS1 (Tension-Anxiety) had the highest expected influence value. The network comparison test revealed significant differences in the network invariance test (M = 0.345, P = 0.003) and the Global expected influence invariance test (S = 0.173, P = 0.020).ConclusionThis study identifies distinct emotional symptom networks in ICU nurses across tertiary-A and tertiary-B hospitals, with depression-dejection (POMS4) central in tertiary-A hospitals and tension-anxiety (POMS1) more prominent in tertiary-B hospitals. These findings highlight the need for tailored interventions and hospital-tier-specific mental health support to address the unique emotional challenges faced by ICU nurses, ultimately improving nurse well-being and patient care quality.Clinical trial registrationNot applicable.

Construction of a quality evaluation indicator system for extended care in patients with chronic obstructive pulmonary disease: a cross-sectional study.

The aim of this study was to construct a quality evaluation indicator system for extended care in patients with chronic obstructive pulmonary disease (COPD), provide beneficial references for quality evaluation and practice standardisation of extended care. This study was conducted from April to November 2023. Based on the three-dimensional quality structure model of 'structure-process-result', we used literature review and Delphi method to form the quality evaluation indicator system for extended care in patients with COPD and determined the weight of each indicator by analytic hierarchy process (AHP). Zhengzhou Central Hospital Affiliated to Zhengzhou University and School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China. 20 experts from different universities and hospitals in China participated in the study. They all had profound attainments in clinical treatment, nursing and extended care of COPD. Effective questionnaire response rate, coefficient of expert authority, arithmetic mean, proportion of maximum score, Kendall harmony coefficient, scores of importance, variation coefficient and weight were used to evaluate the quality evaluation indicator system for extended care. In the two rounds of Delphi expert consultation, the effective questionnaire response rates were both 100%. The coefficients of expert authority were 0.83 and 0.89, respectively. Kendall harmony coefficients were 0.088 and 0.215, respectively. The final formed quality evaluation indicator system for extended care included 3 primary indicators, 10 secondary indicators and 40 tertiary indicators. For each indicator, the variation coefficient was 0.063-0.151 and the weight was 0.001-0.065. The quality evaluation indicator system for extended care based on mature theoretical basis and scientific method is scientific and reliable. And the weight of each indicator is set reasonably and accurately, which could provide a basis for quality evaluation and continuous quality improvement of extended care.

Sustainability in action: How green hospitals foster ecological behavior through social and normative pathways

This study explores the effect of sustainability communication on employee ecological behavior in green hospitals in China, with the mediating effects of communal relationships and ecological norms and the moderating effect of green warm glow. The study design was a cross-sectional survey conducted with 428 employees of several green hospitals. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze the data in testing the hypothesized relationships. The results show that sustainability communication has a direct positive influence (β = 0.238, p < 0.001), and an indirect positive influence on ecological behavior through communal relationships (β = 0.095, p < 0.001) and ecological norms (β = 0.074, p < 0.001). Furthermore, green warm glow significantly buffers the relationship between communal relationships and ecological behavior (β = 0.107, p < 0.001), while failing to significantly buffer the relationship through ecological norms (β = 0.009, p = 0.831). These results reinforce the importance of effective sustainability communication strategies in developing ecological behavior, via psychological and relational pathways, with the potential to increase sustainability practices in the healthcare sector.

Parenting styles and adolescent coping methods: a comparative study of non-suicidal self-injury and distinct groups

BackgroundThe global incidence rate of Non-Suicidal Self-Injury (NSSI) is increasing year by year, especially in the adolescent population, where it is highly correlated with parental rearing patterns and adolescent coping styles. Exploring this correlation is crucial for understanding and intervening in NSSI behaviour.ObjectiveThis study investigates the nuanced impact of parental parenting styles on coping strategies in adolescents, specifically contrasting these effects between NSSI and non-NSSI populations.MethodsA cross-sectional survey was conducted on NSSI patients diagnosed at Ningbo Kangning Hospital in China from June 2020 to December 2021, as well as healthy adolescents from three junior high schools and three high schools in Ningbo City. The total sample consisted of 622 adolescents, aged 11 to 18, including 311 in the NSSI group (280 females, 31 males) and 311 in the non-NSSI group (269 females, 42 males). Data including family background, parenting styles, and adolescent coping strategies were collected. Descriptive statistics, chi-square test, independent samples t-test, correlation analysis, and stepwise regression analysis were used to analyse the data.ResultsThe study found significant correlations between family disharmony, parental education level, and NSSI behaviour. In non-NSSI adolescents, excessive maternal preference was negatively linked to problem-solving abilities, while in NSSI adolescents, negative parenting styles were associated with emotional-oriented coping strategies.ConclusionThe findings highlight critical differences in how parenting styles influence coping strategies in NSSI versus non-NSSI adolescents. This underscores the importance of positive parenting in preventing NSSI and suggests that psychological interventions should focus on enhancing emotional support and understanding from parents to foster healthier coping mechanisms in adolescents.

Assessing Developmentally Supportive Care in Neonatal Nursing in China.

Developmentally supportive care (DSC) is a pivotal care model for preterm infants, with significant implications for their long-term health and well-being. This study aimed to assess the prevalence and determinants of DSC practices among neonatal nursing staff in a hospital in China, thereby informing strategies to enhance clinical nursing interventions and training. A cross-sectional survey was conducted among neonatal nurses at our institution from August 1 to August 16, 2023. Participants provided demographic data, and their DSC practices were evaluated using a validated self-rating scale. A stepwise multiple regression analysis was employed to identify factors associated with DSC behaviors. During the survey period, data were collected from 128 neonatal nurses. Analysis of the data revealed DSC scale behavior scores ranging from 44 to 92, with a mean (SD) of 72.95 (15.34). The mean (SD) score for individual items was 1.56 (0.52). The most highly implemented dimension of DSC involved interventions to reduce detrimental environmental stimuli in the neonatal intensive care unit. The lowest scores were associated with observing the suggestive behavior of premature infants and implementing family-centered care. Correlational analysis demonstrated significant associations between DSC scores and several variables, including marital status (r = 0.560), childbirth experience (r = 0.422), years working on the neonatal unit (r = 0.406), and prior DSC training (r = 0.584) (all P < 0.05). Logistic regression analysis confirmed these factors as significant predictors of DSC behavior scores (all P < 0.05). The current level of DSC behavior among neonatal nurses appears to be suboptimal and is influenced by personal marital status, childbirth experience, tenure on the neonatal unit, and exposure to DSC training. It is imperative for hospital administrators to prioritize and foster the implementation of DSC measures by neonatal nurses in the clinical setting by developing targeted education programs and providing ongoing support.

A case series of overnight orthokeratology-related Acanthamoeba keratitis in Northwest China: Clinical presentation, management, and outcomes.

A case series of overnight orthokeratology-related Acanthamoeba keratitis in Northwest China: Clinical presentation, management, and outcomes.

Development and Validation of a Nomogram for Predicting the Probability of Postpartum Chronic Hypertension in Women With Hypertensive Disorders of Pregnancy: A Multicenter, Cross-Sectional Study.

Women with hypertensive disorders of pregnancy (HDP) have a higher risk of developing chronic hypertension (CHT) postpartum, which can lead to increased cardiovascular events. Therefore, we aimed to develop and validate a nomogram to predict the probability of CHT in HDP women by analyzing traditional characteristics and pregnancy-related indices. A total of 688 HDP women who delivered at the three designated hospitals in China, during the period of January 2011 to June 2021, were randomly divided into 70% (n = 482) as the training set and the remaining 30% (n = 206) as the validation set. Predictors for CHT were extracted to establish a nomogram based on multivariate logistic analysis of the training set. The performance of the nomogram was evaluated by an internal validation. In total, 207 (30.1%) patients developed CHT after delivery. Maternal age, highest systolic blood pressure (SBP), highest diastolic blood pressure (DBP), peak alkaline phosphatase (ALP) levels, peak uric acid (UA) levels, and urine protein during pregnancy were independent predictors of the nomogram. Area under the curve (AUC) of the training set was 0.819 (95% CI: 0.778-0.860, p < 0.001) and 0.800 (95% CI: 0.739-0.862, p < 0.001) in the validation set. A good consistency between the nomogram model and standard diagnostic criteria was obtained (p > 0.05). Decision curve analysis (DCA) also showed a net benefit in the nomogram when the risk thresholds were 10%-90%. In conclusion, we developed a novel clinical nomogram to predict CHT risk in women with HDP, which was a useful and easy tool to identify high-risk individuals and performed well on internal validation.

The Perception of Career Planning and Development Among Senior Clinical Nurses: A Qualitative Analysis.

To investigate the perception of career planning and development among senior clinical nurses and identify factors that facilitate or hinder their career development in a tertiary hospital setting in China. Career planning and development are important aspects of contemporary nursing roles. However, there is limited literature that comprehensively explores the challenges and motivations nurses encounter in their career development through self-reported career planning. As career paths for nurses continue to diversify, it remains unclear whether nurses can adapt their career plans effectively to achieve greater job satisfaction and support their individual career growth. The study was conducted in October 2023 in a tertiary hospital in China. Fifty-three senior clinical nurses were recruited using purposive sampling. Participants were asked to indicate their perceptions of career planning and development, including their career preferences, self-assessed strengths and weaknesses, and perceived facilitators and barriers. They were invited to indicate their future career preferences across four domains: clinical practice, education, management, and research. Thematic analysis was employed to analyze the qualitative data. Additionally, participants were instructed to develop personal career development road maps using a provided framework. Most participants (94.34%, n = 50) favored career development in clinical practice, aspiring to roles such as advanced practice nurse (APN) or specialist nurse, while fewer preferred education (37.74%, n = 20), research (22.64%, n = 12), or management (18.87%, n = 10). Four key themes emerged: (1) Helping others through a good job, reflecting a desire to help others through meaningful work; (2) Multifaceted drive for self-improvement, influenced by personal growth, economic incentives, and professional recognition; (3) Insufficient sense of autonomy, with restricted decision-making power acting as a barrier; and (4) Challenges in time planning and allocation, highlighting difficulties in balancing work, life, and career goals. This study explores the career development of senior clinical nurses, highlighting their strong preference for clinical pathways such as APN and specialist nursing. Facilitators include economic incentives, moral values, family support, and organizational culture, while barriers encompass lack of autonomy, skill gaps, time constraints, and work-life conflicts. Strengthening team support, streamlining non-direct care tasks, and safeguarding personal time are essential for fostering senior clinical nurses' career development. Policymakers should implement clear advanced practice nursing frameworks, standardize credentialing processes, and allocate adequate resources to make clinical pathways both appealing and accessible. By addressing these factors, nurses can more effectively pursue advanced roles, ultimately enhancing patient outcomes and the broader healthcare system.

Frailty: An Important Determinant Influencing Glycaemic Control in Elderly Chinese Patients Diagnosed With Type 2 Diabetes.

Few studies have investigated blood glucose levels and complication management in elderly patients with type 2 diabetes (T2D) at community hospitals in China. The objective of this study was to investigate the factors influencing blood glucose control in elderly patients with T2D. One thousand one hundred and fifty elderly patients (age ≥ 65 years) with T2D were involved in the study to assess blood glucose control, health status (including comorbidities and cognitive status), complication management, and adherence to medication according to the guidelines of the American Diabetes Association. The FRAIL scale was used to screen for frailty syndrome in the elderly patients. Univariate and multivariate logistic regression analyses were used to investigate the factors affecting glucose control. Among the 1150 participants, 351 (30.52%) had poor glucose control. Frailty (odds ratio [OR]:2.546; 95% confidence interval [CI]: 1.267-5.117; p = 0.009), male sex (OR:0.679; 95% CI: 0.522-0.884; p = 0.004), and insulin treatment (OR: 0.229; 95% CI: 0.165-0.317; p < 0.001) were significantly independently associated with poor blood glucose control. In conclusion, for elderly patients with T2D, more attention should be paid to men, insulin therapy initiation and screening for frailty.

Remimazolam tosylate or propofol and delirium in frail elderly patients after hip surgery: A randomised controlled clinical trial.

Remimazolam tosylate, a novel short-acting benzodiazepine, is increasingly being used in general anaesthesia, but its role in the incidence of postoperative delirium is uncertain, particularly in frail elderly patients. To compare the effects of remimazolam tosylate with propofol on the incidence of postoperative delirium in frail elderly patients undergoing hip surgery. Randomised, single-centre, single-blind controlled trial. A tertiary teaching hospital in China, conducted from March to December 2023. Frail elderly patients (Reported Edmonton Frail Scale Score ≥ 6) undergoing hip surgery under general anaesthesia. Patients were randomly assigned to either the propofol or remimazolam group. Both groups received total intravenous anaesthesia following a standardised protocol with either propofol or remimazolam tosylate for induction and maintenance. The primary outcome was the incidence of postoperative delirium within three postoperative days, assessed twice daily using the 3D Confusion Assessment Method (3D-CAM). The secondary outcomes included the quality of postoperative recovery and adverse events. A total of 136 patients were enrolled. The incidence of postoperative delirium was significantly lower in the remimazolam group than in the propofol group [3 of 68 (4.4%) vs. 12 of 68 (17.6%), risk differece (RD) -13.2%, 95% CI -23.5% to -2.9%, relative risk (RR) 0.25, 95% CI 0.074 to 0.847, NNT 7.6, P = 0.0143]. The incidence of hypotension after induction was also lower in the remimazolam group [16 of 68 (23.5%) vs. 32 of 68 (47.1%), RD -23.5%, 95%CI -39.1% to -8.0%, RR 0.5, 95% CI 0.304 to 0.822, NNT 4.3, P = 0.004], with fewer patients requiring vasopressors [55 of 68 (80.9%) vs. 66 of 68 (97.1%), RD -16.2%, 95% CI -26.3 to -6.0, RR 0.8, 95% CI 0.737 to 0.942, NNT 6.2, P = 0.003]. Notably, the remimazolam group exhibited significantly less burst suppression compared with the propofol group, both in terms of burst suppression time (2.2 s [0 to 17.6] vs. 21.9 s [2.3 to 115.3] median difference = 11.98 s, 95% CI 2.44 to 27.90, P < 0.001) and its proportion relative to the total surgery time (0.3‰ [0 to 2.1] vs. 2.8‰ [0.2 to 14.7], median difference 1.30‰, 95% CI 0.27 to 3.34, P < 0.001). In frail elderly patients, remimazolam tosylate was associated with a lower incidence of postoperative delirium compared with propofol. Chinese Clinical Trial Registry, Chictr.org.cn, identifier: ChiCTR2300068632.

Efficacy and Safety of Plecanatide in Chinese Patients with Functional Constipation: A Phase III Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.

Plecanatide is a novel guanylate cyclase-C agonist for the treatment of functional constipation (FC). Its efficacy may vary across different racial populations. This study aimed to comprehensively evaluate the efficacy, safety, and pharmacokinetics of plecanatide in Chinese patients with FC. This phase III, randomized, double-blind, placebo-controlled trial was conducted across 40 hospitals in China. A total of 648 patients with FC were randomly assigned in a ratio of 1:1 to receive either plecanatide 3 mg or placebo for 12 weeks, followed by a 2-week follow-up. The primary efficacy endpoint was the durable overall complete spontaneous bowel movement (CSBM) response rate. Data on adverse events were collected. A post hoc logistic regression analysis was performed to identify predictors of durable overall CSBM response. After 12weeks of continuous treatment, the durable overall CSBM response rates were 23.5% in the plecanatide group and 10.2% in the placebo group (p<0.001). Plecanatide significantly increased the mean weekly frequency of CSBM (1.89 vs 0.9) and SBM (2.33 vs 1.03) compared with placebo throughout the treatment period. In addition, all other secondary efficacy endpoints showed statistically significant improvements with plecanatide compared with placebo. The most common treatment-related emergent adverse event was diarrhea, which occurred in 4.3% of plecanatide-treated patients and 0.6% of placebo-treated patients (p=0.002). Plasma concentrations of plecanatide and its metabolite SP-338 remained below the lower limit of quantification (0.500 ng/ml) at all assessed time points. Weekly CSBM response at week 2 (odds ratio 43.476; 95% confidence interval 18.274-103.432) and baseline stool consistency (odds ratio 0.550; 95% confidence interval 0.366-0.827) were identified as effective predictors of durable overall CSBM response. Even among plecanatide non-responders, a significant improvement in SBM frequency compared with placebo was observed over the 12-week treatment period. Plecanatide 3 mg was effective and well tolerated in the treatment of Chinese patients with FC. A weekly CSBM response at week 2 may serve as a predictor of 12-week durable overall efficacy. Patients who did not achieve the primary endpoint may still benefit from plecanatide treatment. GOV: NCT0515132.

Utidelone Plus Bevacizumab for ERBB2-Negative Metastatic Breast Cancer and Active Brain Metastases: The U-BOMB Phase 2 Nonrandomized Clinical Trial.

Patients with ERBB2 (formerly HER2 or HER2/neu)-negative metastatic breast cancer (MBC) and brain metastases have poor prognosis, and effective treatment options are limited. To investigate the activity and safety of utidelone plus bevacizumab in patients with ERBB2-negative MBC and active brain metastases. This nonrandomized clinical trial was conducted at 5 hospitals in China. Adult patients with ERBB2-negative MBC who had untreated or progressive brain metastases were enrolled between May 5, 2022, and October 25, 2023. The data cutoff date was May 20, 2024; data were analyzed from September 15, 2022, to July 20, 2024. Patients received bevacizumab (15 mg/kg on day 1) and utidelone (30 mg/m2 on days 1-5) every 3 weeks until disease progression or unacceptable toxic effects. The primary end point was central nervous system (CNS) objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. A total of 47 female patients (median age, 53 years [IQR, 45-59 years]) were recruited. Of these, 35 patients had untreated brain metastases and 12 had brain metastases that had progressed after local radiotherapy. The CNS ORR was 42.6% (95% CI, 28.3%-57.8%) per RECIST version 1.1 and 40.4% (95% CI, 26.4%-55.7%) per Response Assessment in Neuro-Oncology Brain Metastases criteria. The median follow-up duration was 11.0 months (range, 2.3-23.6 months). The median progression-free survival (PFS) was 7.7 months (95% CI, 5.6-9.7), median CNS-PFS was 10.6 months (95% CI, 8.4 months to not reached), and median overall survival was 15.1 months (95% CI, 12.0 months to not reached). The most common grade 3 or higher treatment-emergent adverse events were decreased lymphocyte count in 5 patients (10.6%) and decreased white blood cell count in 3 patients (6.4%). No serious or fatal adverse events occurred. The findings of this nonrandomized clinical trial suggest the potential of utidelone plus bevacizumab for the treatment of patients with ERBB2-negative MBC and active brain metastases. This treatment approach warrants further validation in a randomized clinical trial. ClinicalTrials.gov Identifier: NCT05357417.

Generation of Fundus Fluorescein Angiography Videos for Health Care Data Sharing

Medical data sharing faces strict restrictions. Text-to-video generation shows potential for creating realistic medical data while preserving privacy, offering a solution for cross-center data sharing and medical education. To develop and evaluate a text-to-video generative artificial intelligence (AI)-driven model that converts the text of reports into dynamic fundus fluorescein angiography (FFA) videos, enabling visualization of retinal vascular and structural abnormalities. This study retrospectively collected anonymized FFA data from a tertiary hospital in China. The dataset included both the medical records and FFA examinations of patients assessed between November 2016 and December 2019. A text-to-video model was developed and evaluated. The AI-driven model integrated the wavelet-flow variational autoencoder and the diffusion transformer. The AI-driven model's performance was assessed through objective metrics (Fréchet video distance, learned perceptual image patch similarity score, and visual question answering score [VQAScore]). The domain-specific evaluation for the generated FFA videos was measured by the bidirectional encoder representations from transformers score (BERTScore). Image retrieval was evaluated using a Recall@K score. Each video was rated for quality by 3 ophthalmologists on a scale of 1 (excellent) to 5 (very poor). A total of 3625 FFA videos were included (2851 videos [78.6%] for training, 387 videos [10.7%] for validation, and 387 videos [10.7%] for testing). The AI-generated FFA videos demonstrated retinal abnormalities from the input text (Fréchet video distance of 2273, a mean learned perceptual image patch similarity score of 0.48 [SD, 0.04], and a mean VQAScore of 0.61 [SD, 0.08]). The domain-specific evaluations showed alignment between the generated videos and textual prompts (mean BERTScore, 0.35 [SD, 0.09]). The Recall@K scores were 0.02 for K = 5, 0.04 for K = 10, and 0.16 for K = 50, yielding a mean score of 0.073, reflecting disparities between AI-generated and real clinical videos and demonstrating privacy-preserving effectiveness. For assessment of visual quality of the FFA videos by the 3 ophthalmologists, the mean score was 1.57 (SD, 0.44). This study demonstrated that an AI-driven text-to-video model generated FFA videos from textual descriptions, potentially improving visualization for clinical and educational purposes. The privacy-preserving nature of the model may address key challenges in data sharing while trying to ensure compliance with confidentiality standards.

Development and validation of a risk prediction model for severe acute pancreatitis induced by hypertriglyceridemia

Objective: To investigate the risk factors for patients with hypertriglyceridemia-related acute pancreatitis (HTG-AP) developing into severe acute pancreatitis or experiencing organ failure. Methods: This retrospective cohort study collected clinical data from 2 429 patients diagnosed with acute pancreatitis from five hospitals in China between January 2019 and December 2023 using a pre-designed data collection form. The cohort included 1 516 males and 913 females,with an age of (50.2±16.5)years(range: 11 to 99 years). Among them,353 patients (16.1%) had HTG-AP,while 1 846 (83.9%) had non-HTG-AP. HTG-AP was defined as serum triglyceride levels>500 mg/dl with other etiologies excluded. Intergroup comparisons were performed using t-tests,Mann-Whitney U test or χ² tests,respectively. Univariate and multivariate logistic regression analyses were conducted to assess risk factors for severe acute pancreatitis after adjusting for potential confounders,and a predictive model was developed and validated. Results: Compared with other etiologies,HTG-AP patients had a higher risk of progressing to SAP (OR=1.415,95%CI: 0.866 to 2.312, P=0.017) and organ failure (OR=1.256,95%CI: 1.015 to 1.554, P=0.036). Among HTG-AP patients,risk factors for SAP included body mass index (OR=1.856,95%CI: 1.742 to 1.987, P=0.033),fasting blood glucose (OR=1.128,95%CI: 1.036 to 1.229, P=0.006),white blood cell count(OR=1.162,95%CI: 1.055 to 1.281, P=0.002),and the presence of pleural effusion (OR=13.151,95%CI: 4.330 to 19.946, P<0.01). A nomogram prediction model for SAP in HTG-AP was constructed based on these risk factors,demonstrating good discriminative ability with area under the curve values of 0.877 in the training set and 0.894 in the validation set,along with satisfactory calibration. Conclusions: HTG-AP patients are at higher risk of developing SAP and organ failure. The risk prediction model incorporating body mass index,fasting blood glucose,white blood cell count,and pleural effusion shows good predictive value for SAP.

Development and Validation of a Score-Based Model for Estimating Esophageal Squamous Cell Carcinoma and Precancerous Lesions Risk in an Opportunistic Screening Population.

Background: Opportunistic screening is one major screening approach for esophageal squamous cell carcinoma (ESCC). We aimed to develop a score-based risk stratification model to assess the risk of ESCC and precancerous lesions in opportunistic screening and to validate it in an external population. Methods: The study was a secondary analysis of a published esophageal cancer screening trial. The trial was conducted in 39 secondary or tertiary hospitals in China, with 14,597 individuals including 71 high-grade intraepithelial neoplasia (HGIN) and 182 ESCC, enrolled for opportunistic screening. Additionally, questionnaires and endoscopy were performed. The primary outcome was histology-confirmed high-grade esophageal lesions, including HGIN and ESCC. The predictors were selected using univariable and multivariable logistic regression. Model performance was primarily measured with the area under the receiver operating characteristic curve (AUROC). Results: The score-based prediction model contained 8 variables on a 21-point scale. The model demonstrated an AUROC of 0.833 (95% CI, 0.803-0.862) and 0.828 (95% CI, 0.793-0.864) for detecting high-grade lesions in the training and validation cohorts, respectively. Using the cut-off score determined in the training cohort (≥9), the sensitivity reached 70.0% (95% CI, 50.6-85.3%), 81.3% (95% CI, 63.6-92.8%), and 81.1% (95% CI, 64.9-92.0%) in the validation cohort for detecting HGIN, early ESCC, and advanced ESCC, respectively, at a specificity of 76.4% (95%CI, 75.4-77.4%). The score-based model exhibited satisfactory calibration in the calibration plots. The model could result in 75.6% fewer individuals subjected to endoscopy. Conclusions: This score-based model demonstrated superior discrimination for esophageal high-grade lesions. It has the potential to inform referral decisions in an opportunistic screening setting.

Prospective multicenter validation of preoperative plasma ceramides as novel predictive biomarkers for clinically relevant post-hepatectomy liver failure.

Circulating ceramides (CERs) are associated with liver diseases and dysfunction. The utility of plasma CERs in predicting post-hepatectomy liver failure (PHLF) remains unclear. This study aimed to evaluate the clinical utility of preoperative plasma CERs for predicting clinically relevant PHLF (CR-PHLF). This study included 736 patients who underwent hepatectomy across four independent hospitals in China. The training set included 392 patients from 2019 to 2021, and the prospective internal and external validation sets included 195 patients from 2022 to 2024 and 149 patients from 2023 to 2025, respectively. Preoperative plasma CERs were measured using targeted lipidomics. Grade B/C PHLF was classified by the criteria of the International Study Group of Liver Surgery and defined as CR-PHLF. Predictors for CR-PHLF were identified by least absolute shrinkage and selection operator (LASSO) logistic regression and receiver operating characteristic (ROC) analysis. The study is registered on ClinicalTrials.gov (NCT********) and the Research Registry (******). Plasma CER(d18:1/20:1) demonstrated a positive correlation with preoperative liver dysfunction and superior predictive power for CR-PHLF, with an AUROC of 0.837 (95% CI: 0.782-0.892; P < 0.001). Major hepatectomy, direct bilirubin, and CER(d18:1/20:1) were identified as independent PHLF predictors and integrated into an innovative CR-PHLF prediction model (Hpx-CER model). The model exhibited commendable discrimination in the training set (AUROC=0.896; 95% CI: 0.851-0.941; P < 0.001), and the prospective internal (AUROC=0.907; 95% CI: 0.845-0.970; P < 0.001) and external validation sets (AUROC=0.862; 95% CI: 0.707-1.000; P < 0.001). Across all high-risk subgroups of CR-PHLF, including major hepatectomy, difficult hepatectomy, cirrhosis, malignant liver diseases, and preoperative liver dysfunction, our model consistently outperformed conventional models in predicting CR-PHLF. Plasma CER(d18:1/20:1) is a novel predictor of CR-PHLF. The Hpx-CER model performs commendably in predicting CR-PHLF and provides reliable preoperative risk estimations.