Hearing loss (HL) imposes a substantial burden on families and society and is the largest modifiable risk factor for dementia. As a practical and non-invasive approach to managing HL, hearing aid use has been associated with a reduced risk of incident dementia and global cognitive decline. However, high-level evidence on the cognitive benefits of hearing aids among those at high dementia risk is scarce and adherence to hearing aid use remains challenging. Our study aims to explore whether a family-supported hearing aid use behaviour intervention, guided by the integrated framework of self-determination theory, technology acceptance model and family social support theory, can improve cognitive function in Chinese older adults with both HL and mild cognitive impairment (MCI). This study is a two-arm, single-blinded, randomised controlled trial. A total of 150 participants with HL and MCI will be randomly assigned in a 1:1 ratio to either an intervention group (hearing aid use and family intervention) or a control group (hearing aid use and regular health education). All interventions will last for 4 months. Hearing aid use will be delivered by professional audiologists, while family caregivers will deliver the behavioural intervention at home after receiving standardised training from researchers and guidance through structured manuals. Furthermore, family caregivers will be guided through a WeChat group to address unresolved issues related to hearing aid maintenance and intervention skills. The primary outcome is cognitive function measured by the Montreal Cognitive Assessment-Hearing Impairment at baseline and follow-up. Secondary outcomes include adherence score to hearing aid use measured by daily duration and weekly frequency, hearing aid use skills, motivation, activities of daily life, quality of life, depressive symptoms, subjective cognitive decline, social support, self-efficacy, healthcare utilisation, autonomy support and caregiver burden. The study was approved by the Institutional Review Board of Peking University. Research findings will be published in peer-reviewed journals and at national and international conferences. ChiCTR2400091791.

Major depressive disorder (MDD) is a leading cause of disability among adolescents, yet available treatments remain limited. Bright light therapy (BLT) is a non-pharmacological intervention with demonstrated efficacy in adults. However, its clinical utility and underlying neural mechanisms in adolescents remain unclear. This trial aims to evaluate the clinical efficacy, time to onset, safety and applicability of home-based BLT in outpatient adolescents with MDD, and to explore its underlying neural mechanisms using functional near-infrared spectroscopy (fNIRS). This is a randomised, placebo-controlled, three-arm multicentre clinical trial. A total of 126 outpatient adolescents aged 13-17 years with MDD will be randomly assigned to receive high-intensity BLT, medium-intensity BLT or placebo dim red light using a portable light box in a home-based setting for 40 min each morning over 4 weeks, followed by a 2-week follow-up. 42 age-matched and gender-matched healthy controls will also be enrolled for baseline assessments only, serving as normative references for comparison. The primary outcome will be the change in total scores on the 17-item Hamilton Rating Scale for Depression from baseline to week 4. All analyses will follow an intention-to-treat framework to ensure methodological rigour. The primary outcome will be analysed using analysis of covariance and linear mixed-effects models. Secondary outcomes will include response and remission rates, time to onset, maintenance of efficacy, self-reported depressive symptoms, sleep quality, cognitive function, anxiety, irritability, suicidal ideation, non-suicidal self-injury, self-efficacy and the overall safety profile of BLT. Prefrontal cortical activity will be measured using fNIRS at baseline and week 4 to explore potential neural mechanisms. Approximately 15% of participants will additionally take part in a qualitative substudy exploring experiences and acceptability of BLT. The study protocol has been approved by the Ethics Committee of Peking University Sixth Hospital (approval number: 2025-24). Written informed consent will be obtained from all participants and their legal guardians prior to enrolment. Study findings will be disseminated through peer-reviewed journals and conference presentations. NCT06913309.

IntroductionElectronic patient-reported outcome (ePROs)-based symptom monitoring benefits health-related quality of life (HRQoL) in various cancers. However, despite the high disease and economic burden of hepatocellular carcinoma (HCC) and the complex symptom profile during immunotherapy, the effectiveness and implementation of ePROs-based interventions in this population remain unclear. This study aims to evaluate the clinical and implementation outcomes of ePROs-based symptom monitoring among patients with HCC receiving immunotherapy in China.Methods and analysisThe trial is a two-arm randomised controlled trial (RCT). Approximately 238 patients with HCC undergoing immunotherapy in China will be recruited and randomly assigned (1:1) to an intervention or control group. The intervention group will receive an 18 week, weekly ePROs symptom monitoring survey via a WeChat-based platform, featuring reactive alerts that provide patients with automated, evidence-based self-management advice when predefined thresholds are exceeded. The control group will receive usual care. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and normalisation process theory (NPT), the study employs a mixed-methods approach. The primary outcome is the between-group difference in HRQoL at 18 weeks. Secondary effectiveness outcomes include physical function, symptom burden, overall survival, mental health and healthcare utilisation. Key implementation outcomes, assessed quantitatively and qualitatively, include acceptability, feasibility, fidelity, cost-effectiveness and the contextual mechanisms influencing sustainability and scalability.Ethics and disseminationThe study has been approved by the Institutional Review Board of Peking University (IRB No. 00001052-24066). This protocol is based on V2.0, 6 July 2024 of the protocol. Electronic informed consent is obtained from all participants. Findings will be disseminated through peer-reviewed publications and academic conferences, providing evidence to inform scalable integration of digital symptom monitoring into oncology care.Trial registration numberNCT06938945.

Hypertensive disorders of pregnancy (HDP) contribute significantly to maternal and neonatal morbidity. Precision medicine emphasizes individualized risk prediction, while nursing interventions (NIs) address behavioral and psychosocial care. This study evaluated the clinical benefit of a structured NI compared to routine prenatal care in reducing complications among women diagnosed with HDP. This retrospective quasi-experimental study was conducted at Peking University Shenzhen Hospital. Participants were primigravida Chinese women (median age 25 years) with a confirmed diagnosis of HDP. Of 3260 screened women, 265 met the inclusion criteria: gestational hypertension (48%), preeclampsia (31%), or superimposed preeclampsia (21%). Risk was initially assessed via self-reported questionnaires starting at 15 gestational weeks until 7 days postpartum. Participants were allocated to either an NI (Women with hypertensive disorders of pregnancy received prenatal care and NIs sessions until 7 days postpartum [NI cohort], n = 122), receiving structured education and behavioral sessions, or a routine prenatal care (PR cohort, n = 143). This investigation identifies a significant association between a protocolized NI and improved obstetric trajectories, particularly in younger women and those with a higher body mass index (BMI). While these associative findings are encouraging, the non-randomized, retrospective nature of the study necessitates caution, and the results should be viewed as hypothesis-generating rather than evidence of a definitive causal effect. The study population consisted of primigravida women with a median prepregnancy BMI of 23.8 kg/m2. The NI was independently associated with significantly higher odds of spontaneous vaginal delivery (adjusted odds ratios: 2.15; 95% confidence interval: 1.84-2.51; P < .001). The intervention was independently associated with a significant reduction in the risk of neonatal intensive care unit (NICU) admissions (adjusted odds ratios: 0.28; 95% confidence interval: 0.11-0.72; P = .008). Raw delivery outcomes also favored the NI cohort regarding normal delivery rates (45% vs 17%, P < .0001) and labor duration (82% vs 49%, P < .0001). Maternal complications were comparable, and nausea was significantly lower in the NI group (18% vs 29%, P = .032). Secondary neonatal outcomes demonstrated significant reductions in low birth weight (9% vs 15%, P = .048) and respiratory distress syndrome (3% vs 9%, P = .021). A NI was most effective for women aged ≤25 years and those with a BMI>24 kg/m2.

Objective: To summarize the clinical phenotypes, genotypes, and treatment outcomes of restrictive cardiomyopathy (RCM) associated with FLNC gene variants in children. Methods: Case series study. The clinical data of 5 pediatric patients with FLNC gene variant-associated RCM who were admitted to the Department of Pediatrics, Peking University First Hospital, from January 2008 to October 2023, including clinical manifestations, laboratory examinations, echocardiographic findings, genetic testing results, as well as treatment and follow-up outcomes was retrospectively analyzed. Results: Among the 5 patients, there were 4 females and 1 male, with the age of onset ranging from 3 to 5 years. Three patients presented with heart failure symptoms as the initial manifestation, 1 patient with recurrent syncope, and 1 patient was diagnosed asymptomatically via family screening. At initial presentation, 4 patients were graded as class Ⅱ and 1 patient as class Ⅰ according to the modified Ross classification for pediatric heart failure. Three patients had concomitant myopathy, manifesting as decreased muscle strength, spinal deformity and other abnormalities. All 5 patients had electrocardiographic manifestations of conduction block to varying degrees, and 1 patient developed atrial flutter during follow-up. Echocardiography revealed an overlapping phenotype of RCM and hypertrophic cardiomyopathy in 2 patients. All genetic variants were located in the rod domain (ROD) of the FLNC gene. In terms of variant types, 4 patients were missense variants and 1 patient was deletion-insertion variant. The primary treatments included diuretics, β-blockers, and angiotensin-converting enzyme inhibitors. One patient underwent heart transplantation, 3 patients remained clinically stable, and 1 patient was lost to follow-up. Conclusions: FLNC-related RCM typically has an early age of onset, is frequently accompanied by myopathy, and may show conduction block on electrocardiography. Missense variants in the ROD are the predominant type of FLNC gene variant in this disease. Thus, early genetic screening and long-term multidisciplinary follow-up are warranted for affected patients.

Surgical management of the primary tumor in stage M1a-IVA non-small cell lung cancer.

Migrasome-mediated clearance of excess PLK4 defines a targetable vulnerability.

Objective: To automatically estimate children's physiological age from pediatric panoramic radiographs, employing a two-stage approach which involves permanent teeth staging assessment followed by physiological age conversion, as well as an end-to-end approach. Methods: From 3 367 radiographs of children aged 4 to 11 years, collected at Pediatric Dentistry, Peking University School and Hospital of Stomatology, between November 2012 and August 2020, 640 images were randomly assigned into training set-1 (392 images), validation set-1 (118 images), and test set-1 (130 images) using Python (version 3.9) scripts. Using manual annotations of Demirjian's stages for 8 left mandibular teeth as gold standard, a YOLOv5-based deep learning model (staging-judgment-model) was trained and validated, whose performance was assessed using metrics including accuracy and weighted Kappa. Using chronological age as ground truth, random forest models (age-machine-models) were developed based on automatic staging of teeth 31-37 or 31-38. The full dataset (3 367 images) was randomly allocated into training set-2 (2 031 images), validation set-2 (673 images), and test set-2 (663 images) to train a ResNet-50-based deep learning model (age-deep-model). An external test set (907 images) from the Clinical Division Peking University School and Hospital of Stomatology from June 2022 to December 2022 was collected. Performance was assessed using mean absolute error (MAE), root mean square error (RMSE), and coefficient of determination (R²). Class activation maps were used to reveal the areas of concern for the age-deep-model. Images with an absolute difference between inferred and actual ages exceeding 3 standard deviations from the mean difference were selected for manual reviews. Results: The staging-judgment-model achieved an overall accuracy of 75.95%, with a linear-weighted Kappa of 0.87 and quadratic-weighted Kappa of 0.95. In the test set-1, the MAE, RMSE and R² of the age-machine-models based on automatic staging of teeth 31-37 were 0.592 years, 0.757 years and 0.879, while ones of the age-machine-models based on automatic staging of teeth 31-38 were 0.594 years, 0.754 years and 0.879. In the test set-2, the MAE, RMSE and R² of the age-deep-model were 0.621 years, 0.800 years and 0.918 respectively. The gradient class activation map revealed that the areas of concern for age-deep-model gradually shifted from the crown of the posterior deciduous teeth to the apical area of the posterior permanent teeth with increasing age. The staging-judgment-model might mistake later teeth development stages for earlier ones, resulting in an underestimated assessment of physiological age by age-machine-models. Similarly, orthodontic appliance images might lead the age-deep-model to generate an underestimated age estimation. Conclusions: This study enabled fully automated physiological age inference via two complementary approaches, demonstrating potential for preliminary screening of children with dental developmental abnormalities. Further optimization is required prior to clinical implementation.

Objective: To evaluate the long-term survival outcomes of neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy in patients with mismatch repair-proficient (pMMR) rectal cancer. Methods: A retrospective cohort study is conducted. Clinical,pathological,and follow-up data were collected from 140 patients with pMMR rectal cancer who received neoadjuvant immunotherapy at the Gastrointestinal Cancer Center,Unit Ⅲ,Peking University Cancer Hospital,from June 2019 to September 2024. The cohort included 96 males and 44 females,with an age (M (IQR)) of 61 (13) years (range: 29 to 81 years). Among them,120 patients received neoadjuvant immunotherapy combined with CRT,and 20 received immunotherapy combined with chemotherapy. Follow-up was conducted through outpatient reviews and telephone interviews. Survival differences between groups were compared using independent samples t-tests,Mann-Whitney U tests, χ2 tests,or Fisher's exact tests. The prognostic factors of overall survival (OS) and disease-free survival (DFS) were screened by univariate and multivariate Cox analysis. Results: For the 140 patients with pMMR rectal cancer,the median OS and DFS were not reached. The 1-and 3-year OS rates were 98.4% and 92.8%,respectively; the 1- and 3-year DFS rates were 89.7% and 73.2%,respectively. Postoperative pathological examination revealed that 35 patients (29.9%) achieved a pathological complete response,and 57 patients (48.7%) showed tumor regression grade 0 to 1. Univariate and multivariate Cox regression analyses indicated that postoperative lymphovascular invasion was an independent poor prognostic factor for OS in pMMR rectal cancer patients undergoing surgery after immunotherapy (HR=5.58,95%CI:1.36 to 23.0,P=0.017). The 3-year OS and DFS rates for patients achieving complete response (CR) after neoadjuvant therapy were 100% and 95.3%, compared to 88.5% and 60.1% for non-CR patients. The DFS of the CR group was significantly superior to that of the non-CR group (P<0.05). Conclusion: Neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy demonstrates a favorable safety profile and high 3-year survival rates in patients with pMMR rectal cancer.

Lymphovascular space invasion (LVSI) is a high-risk factor for lymph node metastasis, relapse, and poor prognosis in patients with endometrioid endometrial carcinoma (EEC). However, the diagnosis of LVSI still relies on traditional pathological methods. Moreover, the high-risk factors and mechanism for LVSI remain unclear. Thus, this study developed an interpretable machine learning (ML) model to accurately predict LVSI status in patients with EEC. The study collected data from 832 patients with EEC at Peking University People's Hospital. Patients were randomly divided into training (n=582) and internal validation (n=250) cohorts. A prospective external validation cohort included 129 patients with EEC from Nanjing Drum Tower Hospital. Using 21 parameters, 6 ML strategies were used to build prediction models. The global and local interpretation of feature significance was performed using the SHapley Additive exPlanations (SHAP) approach. Data from NanoString nCounter evaluation was subjected to pathway enrichment and Spearman correlation analysis to investigate the mechanistic basis of LVSI. Among the six ML models, the XGBoost model had the best performance. The XGBoost model correctly predicted the risk of LVSI in the training set [area under the curve (AUC): 0.982, 95% confidence interval (95% CI): 0.972-0.991], the internal validation set (AUC: 0.818, 95% CI: 0.776-0.860), and the external test set (AUC: 0.748, 95% CI: 0.618-0.879). The calibration curve indicated that the XGBoost model exhibited favorable consistency between the predicted and actual risks. SHAP analysis identified age, carbohydrate antigen 125 (CA125), low-density lipoprotein (LDL), and neutrophil as the top four variables contributing to XGBoost model predictions. Analysis of NanoString data indicated that LVSI may be closely associated with the PI3K-Akt signaling pathway. We developed an interpretable ML model for preoperative LVSI risk prediction in patients with EEC. This model may aid clinicians by informing individualized clinical decision-making.

Objective: To investigate the disease types, clinical characteristics, and emergency manage ment measures for critical cases in the oral emergency department, and to provide a reference for improving the basic emergency rescue capabilities of dental practitiers. Methods: A retrospellive analysis was conducted on patients with complete medical records who were admitted to the Department of Oral Emergency, Peking University School and Hospital of Stomatology from January 2006 to September 2025. Basic information and rescue data of the patients were collected, and the disease composition, key characteristics of clinical treatment and disease outcome were studied and analyzed. Results: A total of 92 patients were included, with an average age of 47 years (4 to 88 years, median 49 years). There were 62 male patients (67.4%) and 30 female patients (32.6%). Among the critically ill patients who visited the oral emergency department in the past 20 years, 61.9% were diagnosed with maxillofacial hemorrhage and cardiovascular accidents, accounting for 38.0% (35/92) and 23.9% (22/92) of the rescued patients, respectively, which were the most common diagnoses in emergency rescue. The next most common were upper airway obstruction in 17 cases and vasovagal syncope in 13 cases, accounting for 32.6% of the rescued patients. Among the 35 cases of maxillofacial hemorrhage, 20 patients (57.1%) had maxillofacial trauma, and 17 patients (48.6%) developed hemorrhagic shock. The study observed that secondary hemorrhage and airway obstruction caused by maxillofacial tumors were common causes of oral critical rescue, accounting for 34.3% (12/35) and 12/17 of the hemorrhage and airway obstruction cases, respectively. The study observed that 5 patients with airway obstruction caused by space infection received emergency treatment, accounting for 29.4% (5/17) of the airway obstruction patients. In the rescue work of oral emergencies, electrocardiogram monitoring (98.9%, 91/92), oxygen inhalation (96.7%, 89/92), and opening of venous access (78.3%, 72/92) were the most commonly used supportive treatment techniques; tracheal intubation was the main measure for respiratory system emergency rescue, followed by cricothyrotomy and tracheotomy. All 15 patients with cardiac arrest received cardiopulmonary resuscitation treatment, and 8 patients underwent defibrillation. Adrenaline was the most frequently used drug in emergency rescue, mainly applied to patients with cardiac arrest and anaphylactic shock, followed by nitroglycerin, lidocaine, dopamine, aspirin, and midazolam. The rescue success rate of the 92 cases receiving emergency treatment was 91.3% (84/92), and 8 deaths included 3 cases of cardiac arrest caused by airway obstruction and 5 cases of respiratory and circulatory failure. Conclusions: Dental practitioners should be able to quickly identify medical emergencies and immediately carry out emergency rescue. Oral departments should be equipped with relevant emergency drugs and equipment, and medical staff should receive regular emergency skills training to improve their ability to handle medical emergencies and enhance medical safety.

BackgroundHospital nutritional diets significantly impact healthcare service standards, therapeutic outcomes, and patient satisfaction. Traditional manual dietary survey methods suffer from substantial limitations and high resource demands. Despite technological advances, few systems have successfully integrated machine vision, electronic weighing, and standardized databases for real-time nutrient assessment in clinical settings.ObjectiveTo develop and validate an intelligent food nutrition recognition and nutrient intake assessment system for hospital therapeutic diets, enabling precise, large-scale monitoring of patient nutrient intake.MethodsWe developed an AI-based image recognition system integrating RGB-D imaging, the Segment Anything Model (SAM) for food image segmentation, and the SE_ResNet50_vd model for food classification. The system comprised hardware components (food weight collector, image collector, computing host) and software modules (nutritional analysis platform developed in Java/Spring Boot). A comprehensive database was constructed from 204 standardized therapeutic diet varieties from Peking University People's Hospital, incorporating the Chinese Food Composition Table and cooking loss factors. Post-meal intake was calculated by comparing pre- and post-meal food volumes using depth camera imaging and density-based weight estimation. Food type recognition accuracy was tested on 1,000 samples, and volume estimation accuracy was validated against gravimetric measurements across 100 food items.ResultsThe food image recognition model achieved 99.2% accuracy on the test set. Volume estimation accuracy exceeded 90% in 39% of cases and 80–90% in 61% of cases, with a minimum threshold of 80% across all tested items. The SAM model demonstrated robust segmentation performance for diverse food types in standardized meal containers. The integrated system successfully monitored over 20 types of therapeutic diets, matching nutrient compositions to personalized requirements with ≥90% accuracy for meal verification.ConclusionsThis intelligent system provides standardized, real-time nutrient intake assessment with superior accuracy compared to traditional dietary survey methods. By automating therapeutic meal supervision and enabling precision nutrition monitoring, it represents a significant advancement from empirical to precision-based clinical nutrition practice, with substantial potential for improving treatment accuracy, patient outcomes, and healthcare resource optimization in hospital settings.

This study aimed to develop a machine learning-based prediction model for myopia progression using ocular biometric parameters to provide an objective assessment tool for clinical practice. A retrospective analysis was conducted on patients treated at Shanghai Parkway Health Ophthalmology Department as the training set, and myopic individuals from the Optometry Center of Peking University People's Hospital as the validation set. Demographic and biometric data were collected, including central corneal thickness (CCT), axial length (AL), corneal curvature (K-value), anterior chamber depth (ACD), corneal diameter (WTW), and pupil size (PS). Seven machine learning models (e.g., XGBoost, random forest, support vector machine) were employed for modeling, with performance optimized via 5-fold cross-validation. Model accuracy was evaluated using mean squared error (MSE) and the coefficient of determination (R²), and variable importance was analyzed. No statistically significant differences were observed in baseline characteristics between the training and validation sets (all P > 0.05). The XGBoost model demonstrated the best performance, achieving R² = 0.913 (MSE = 0.005) on the training set and R² = 0.766 (MSE = 0.016) on the test set. Variable importance analysis revealed pupil size (score 100) and corneal thickness (40.88) as the key predictors of axial elongation rate, followed by age of onset (17.96). The machine learning-based prediction model effectively utilizes ocular biometric data to assess myopia progression risk, with pupil size and corneal thickness identified as core predictive factors. This model provides a quantitative tool for early clinical intervention. Future studies should expand the sample size and incorporate additional biomarkers to optimize performance.

This study aimed to establish tentative epidemiological cutoff values (TECOFFs) for faropenem against Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae based on minimum inhibitory concentration (MIC) distributions. A total of 2,032 bacterial isolates were collected from Peking University First Hospital, Peking Union Medical College Hospital, Huashan Hospital affiliated with Fudan University, and Sir Run Run Shaw Hospital affiliated with Zhejiang University School of Medicine between 2019 and 2021. The susceptibility of these bacteria to faropenem was determined using the broth microdilution and disk diffusion methods in the clinical microbiology laboratories of these four hospitals. To establish wild-type TECOFFs for faropenem, isolates susceptible to ertapenem for E. coli and K. pneumoniae, those susceptible to oxacillin for S. aureus, and those with unscreened susceptibility for H. influenzae and S. pneumoniae were regarded as wild-type strains. The MIC TECOFF for faropenem against E. coli was determined to be 2mg/L, with MIC ≤2 mg/L indicating wild-type strains and MIC ≥4 mg/L indicating non-wild-type strains. The corresponding inhibition zone diameter TECOFF for E.coli was 19mm, where an inhibition zone diameter ≤18 mm indicates non-wild-type strains and ≥19 mm indicates wild-type strains. For K. pneumoniae, the MIC TECOFF was also 2 mg/L, with similar cutoffs established for the inhibition zones. The MIC TECOFF for faropenem against S. aureus was 0.25 mg/L, for H.influenzae was 1 mg/L, and for S. pneumoniae was 2 mg/L. The corresponding inhibition zone diameter ECOFF for faropenem against S. aureus was 31mm, for H. influenzae was 14mm, and for S. pneumoniae was 33mm. The TECOFFs for faropenem against the tested bacteria were established. These data are useful for clinical microbiologists and clinicians in the interpretation of the results of faropenem susceptibility testing.

Objective: To analyze reflux, esophageal motility, and psychological characteristics of patients with gastroesophageal reflux disease (GERD)-related chest pain and the association with chest pain symptom. Methods: The patients with GERD who underwent 24-hour impedance-pH monitoring and high-resolution esophageal manometry at Peking University Third Hospital from July 2016 to April 2024 were retrospectively included. The psychometric scale, reflux monitoring and esophageal manometry were collected. According to the presence of chest pain, the patients were divided into chest pain group (with chest pain symptom) and non-chest pain group. The reflux, esophageal motility and psychological characteristics were compared between the two groups. Correlation analysis was used to identify the related characteristics of chest pain, and multivariate logistic regression model was used to analyze the risk factors for chest pain symptom. Results: A total of 272 patients with GERD were included, comprising 175 males and 97 females, with a median age[M (Q1, Q3)] of 49 (38, 58) years. There were 153 cases in the chest pain group and 119 cases in the non-chest pain group. The chest pain group exhibited a lower prevalence of hiatal hernia [17.6% (27/153) vs 37.8% (45/119)] and lower esophageal acid exposure time (AET) [2.0% (0.6%, 4.7%) vs 4.3% (1.1%, 8.2%)], compared to the non-chest pain group (all P<0.001). The chest pain group demonstrated significantly higher scores on the Symptom Checklist-90 (SCL-90) [133 (112, 173) vs 108 (99, 134) scores, P<0.001], Self-rating Anxiety Scale (SAS) [44 (38, 49) vs 39 (31, 45) scores, P<0.001], and Self-rating Depression Scale (SDS) [48 (38, 57) vs 43 (34, 54) scores, P=0.014], compared to the non-chest pain group. The occurrence of chest pain showed positive correlations with SAS (r=0.274), SDS (r=0.134), and SCL-90 (r=0.369)scores, whereas negative correlations were observed with hiatal hernia (r=-0.227) and AET (r=-0.215) (all P<0.05). Multivariate logistic regression analysis identified elevated SCL-90 score (OR=1.02, 95%CI: 1.01-1.03) and SAS score (OR=1.05, 95%CI: 1.01-1.10) as the risk factors for GERD-related chest pain. Conclusions: Compared with GERD patients without chest pain, those with chest pain had a lower incidence of esophageal hiatal hernia, lower AET, and increased mental and psychological abnormalities. Elevated SCL-90 and SAS scores were identified as the risk factors for GERD-related chest pain.

Aim: Osteosarcoma remains aggressive with poor prognosis, particularly in chemotherapy-resistant cases. This study aimed to characterize transcriptional features of chemoresistant osteosarcoma cells, establish a prognostic resistance signature, and identify therapeutic vulnerabilities. Methods: Single-cell RNA sequencing (scRNA-seq) was performed on paired pre- and post-neoadjuvant chemotherapy (NAC) specimens from three patients (6 samples; 16,272 cells). Resistance trajectories were reconstructed using Monocle 3 pseudotime analysis. A nine-gene resistance score was validated in the Peking University People's Hospital (PKPH) bulk RNA-seq cohort (n = 70) and Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database (n = 87), with drug sensitivities predicted via oncoPredict. Results: Chemotherapy reduced the malignant cell fraction but triggered expansion of cancer-associated fibroblasts and endothelial cells, creating a stromal-dominant, immune-sparse residual niche. Surviving tumor cells upregulated a nine-gene module along the resistance trajectory: KCNMA1, KIF21A, MIR181A1HG, RPS27, PDPN, ADIRF, PRELP, PHEX, and COL9A2. In an independent unpaired scRNA-seq cohort (two pre- and three post-chemotherapy samples), this signature remained associated with features of chemotherapy resistance. Higher scores correlated with poorer histopathologic response (r = -0.35, P = 0.006) and shorter progression-free survival [PKPH: hazard ratio (HR) = 2.4, 95% confidence interval (CI) 1.2-4.8, P = 0.01; TARGET: HR = 2.1, 95%CI 1.1-4.0, P = 0.02]. Of 198 compounds screened, only Pictilisib, a phosphoinositide 3-kinase (PI3K) inhibitor, showed lower predicted IC50 in the high-score subset across both datasets. However, the paired discovery cohort warrant further validation. Conclusion: Our paired scRNA-seq approach identifies a nine-gene signature linking pre-treatment tumor biology to NAC response and outcome. The enhanced Pictilisib sensitivity in chemoresistant tumors positions PI3K blockade as a strategy meriting prospective testing in refractory osteosarcoma.

Primary gastric lymphoma (PGL) is a rare form of lymphoma that arises within the gastric mucosa-associated lymphoid tissue (MALT), often linked to Helicobacter pylori (Hp) infection. The endoscopic features of PGL are heterogeneous, and understanding these characteristics could help distinguish between different lymphoma subtypes. This study aims to systematically assess the endoscopic features of PGL and explore the role of complement receptor type 2/B-cell lymphoma 6 protein (CD21/BCL6)-based grading of lymphoid follicular disruption in predicting the effectiveness of Hp eradication (HPE) treatment in gastric MALT lymphoma. A retrospective study was conducted involving 100 patients diagnosed with PGL at Peking University Third Hospital between January 2010 and January 2025. Patients were divided into two groups based on histopathological findings: indolent and aggressive lymphoma. The clinical and endoscopic characteristics of these two groups were compared. Survival analysis, including overall survival (OS) and progression-free survival (PFS), was performed using Kaplan-Meier curves and Log-rank tests. A subgroup of 25 patients with gastric MALT lymphoma and known HPE outcomes was selected for further analysis. Diagnostic biopsies were immunohistochemically stained with CD21 and BCL6 and graded from G0 to G4 based on follicular disruption. Logistic regression analysis was used to identify factors associated with HPE failure. Among the 100 patients, the average age was 63.0 (55.8, 71.0) years, with 47 men and 53 women. Aggressive lymphoma showed a significantly higher incidence of B symptoms compared with indolent lymphoma (49.0% vs. 19.6%, P= 0.004). Endoscopically, aggressive lymphoma presented more frequently with ulcerative or mixed morphologies (P < 0.001) and exhibited higher rates of mucosal erosion, ulceration with white slough, lesion friability, bleeding tendency, gastric stenosis, and impaired peristalsis (P < 0.001 for all). Aggressive lymphoma also had significantly worse OS and PFS (OS: P=0.009; PFS: P=0.003). In the subgroup of 25 MALT lymphoma patients, those with ineffective HPE were more likely to be Hp-negative (P=0.049) and had a significantly higher degree of follicular disruption (P=0.015). Multivariable Logistic regression revealed that follicular disruption grading was independently associated with HPE failure (AOR=3.63, 95%CI: 1.14-11.58, P=0.021), while Hp infection status was not (P=0.240). PGL demonstrates considerable variability in its endoscopic presentation. Features, such as ulcerative/mixed morphology, friability, bleeding tendency, stenosis, and impaired peristalsis are indicative of more aggressive disease and correlate with poorer survival outcomes. The CD21/BCL6-based grading of lymphoid follicular disruption provides a valuable tool for identifying patients at high risk of HPE failure, supporting early intervention and risk stratification for gastric MALT lymphoma treatment.

To analyze the related factors of rheumatoid arthritis (RA) patients with anemia of chronic disease (ACD) and to guide the clinical diagnosis and treatment. A retrospective study was used to analyze the patients admitted to Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018. Clinical data (including general conditions, joint lesions, extra-articular manifestations, and comorbidities), laboratory examinations, and treatment were collected to analyze the differences in clinical characteristics between group RA with ACD (RA-A) and group RA without ACD (RA-nA). Univariate and multivariate Logistic regression analysis was conducted to screen for relevant factors of RA with ACD. A total of 468 RA patients were included, including 194 cases (41.5%) in RA-A group and 274 cases (58.5%) in RA-nA group. There were no significant differences in age, gender, onset age, or course of disease between the two groups (P>0.05). The RA-A group had more joint swelling [13 (2, 14) vs. 10 (2, 11)], more tenderness [10 (2, 12) vs. 7 (2, 10)], and higher 28 joint disease activity scores (DAS28) [DAS28-CRP (C-reactive protein): 5.2±1.4 vs. 4.6±1.5; DAS28-ESR (erythrocyte sedimentation rate): 5.9±1.5 vs. 5.1±1.8] compared with the RA-nA group (P < 0.05). The incidence of pleural effusion (4.6% vs. 1.1%) and venous thrombosis (5.7% vs. 1.5%) were higher in RA-A group (P < 0.05). The platelet count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, ESR, CRP, immunoglobulin G (IgG) in RA-A group were significantly higher than those in RA-nA group (P < 0.05). Elevated ESR and CRP levels, DAS28 > 5.1 were relevant factors for anemia in the RA patients. RA patients with ACD had more severe joint involvement, higher inflammatory indicators, and more active conditions, making them more prone to pleural effusion and venous thrombosis. High disease activity, high inflammatory status, and venous thrombosis were risk factors for RA with ACD.

To evaluate the potential of concentrated growth factors (CGF) to enhance the regenerative efficacy of guided tissue regeneration (GTR) when combined with bone graft in the treatment of grade Ⅱ furcation defects in mandibular molars. This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology. A total of 16 patients (aged 20-60 years) with chronic periodontitis requiring periodontal surgical intervention were enrolled. All the participants had completed initial periodontal therapy. This involved a total of 20 mandibular molars, which comprised 36 instances of grade Ⅱ furcation lesions located on the buccal or lingual aspects. The 36 furcation lesions were randomly assigned to two groups, with each group containing 18 lesions. The experimental group received treatment with CGF combined with GTR and bone grafting, while the control group was treated with GTR and bone grafting alone. Clinical examinations and cone beam CT (CBCT) assessments were conducted on the affected teeth prior to the surgery, 6 months and 1 year post surgery. Clinical parameters recorded included probing depth (PD), vertical clinical attachment level (CAL-V), horizontal clinical attachment level (CAL-H). CBCT scans were acquired. The radiographic outcomes assessed included bone loss in the vertical direction (BL-V) and horizontal direction (BL-H). Changes in both clinical parameters and CBCT data at baseline and 1 year post surgery were compared between the experimental group and control group. At baseline, no statistically significant differences were observed between the two groups in terms of PD, CAL-V, CAL-H, and BL-V, BL-H as assessed by CBCT (P>0.05), indicating good baseline balance. Six months and 1 year post surgery, both groups demonstrated significant improvements in clinical indicators compared with baseline (P < 0.01). Notably, one year post surgery, the enhancement observed in the experimental group was significantly greater than that of the control group (P < 0.05): the reduction in PD was (4.75±1.87) mm in the experimental group versus (3.43±1.76) mm in the control group; the decrease in CAL-V was (5.55±1.04) mm in the experimental group versus (4.41±1.08) mm in the control group; the decrease in CAL-H was (3.89±1.22) mm in the experimental group versus (3.07±1.02) mm in the control group. One year post surgery, CBCT results demonstrated that the reduction in BL-V was (4.05±1.37) mm in the experimental group compared with (3.17±1.09) mm in the control group, and the reduction in BL-H was (4.02±1.32) mm versus (3.27±1.08) mm. The one-year observational findings demonstrate that CGF enhances the regenerative efficacy of GTR combined with bone graft in the treatment of grade Ⅱ furcation defects in mandibular molars.

To explore the risk factors associated with ventilator-associated pneumonia (VAP) in the patients with chest trauma in the intensive care unit (ICU). A retrospective analysis was conducted on the clinical data of 124 adult trauma patients admitted to the surgical ICU of Peking University People' s Hospital between June 2019 and June 2023. These patients underwent tra-cheal intubation within 24 hours of admission and received mechanical ventilation for more than 48 hours. Based on whether VAP occurred during hospitalization, the patients were divided into a VAP group (46 cases) and a non-VAP group (78 cases). Lasso regression analysis was employed for variable selection, followed by Logistic regression analysis to determine the risk factors for VAP in these patients with chest trauma in the ICU. The multivariate regression analysis indicated that the injury severity score (ISS) (OR=1.08, 95%CI: 1.02-1.14, P=0.007) and tracheostomy (OR=4.61, 95%CI: 1.74-13.11, P=0.003) were independent risk factors for VAP in the patients with chest trauma (P < 0.05). Among all VAP cases, early-onset VAP was observed in 19 patients, while late-onset VAP was observed in 27 patients. The most common pathogen in all VAP cases was Klebsiella pneumoniae, identified in 18 cases (39.1%). In early-onset VAP, Klebsiella pneumoniae was the most frequently detected pathogen, found in 10 cases (52.6%). Conversely, in late-onset VAP, Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent pathogens, each appearing in 10 cases (37.0%). The occurrence of VAP in the patients with chest trauma in the ICU was influenced by multiple factors. This study identified that a higher ISS and the presence of a tracheostomy were independent risk factors for VAP in these patients. These findings suggest that in clinical practice, special attention should be given to the chest trauma patients with high ISS scores, and the timing and necessity of tracheostomy should be carefully considered to reduce the incidence of VAP and improve patient outcomes. Furthermore, the study highlights the importance of early identification and appropriate management of the patients at higher risk for developing VAP. By recognizing the significance of these risk factors, healthcare providers can implement targeted interventions and preventive measures, such as optimizing ventilation strategies and enhancing infection control practices. Future research should further explore additional factors that may influence the occurrence of VAP and verify these findings to provide stronger evidence for the prevention and treatment of VAP. Additionally, multicenter studies with larger sample sizes are recommended to validate these results and develop comprehensive guidelines for managing the chest trauma patients in the ICU.