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Objective To explore the efficacy and safety of endovascular treatment (EVT) combined with eptifibatide in the treatment of acute ischemic stroke. Methods This study enrolled the 102 acute ischemic stroke patients at 15 centers in China received EVT combined with eptifibatide from April 2019 to March 2020. The primary efficacy outcome was the reperfusion rate of blood vessels within 24 h after treatment [modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b], while the secondary efficacy outcomes were the complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment and the 3-month neurological function prognosis [modified Rankin Scale (mRS) score ≤ 2]; the incidence of symptomatic intracranial hemorrhage (sICH) within 48 h after treatment was the primary safety outcome, while the incidence of intracranial hemorrhage (ICH), parenchymal hemorrhage (PH), hemorrhagic infarction (HI), remote parenchymal hemorrhage (rPH), intraventricular hemorrhage (IVH), and subarachnoid hemorrhage (SAH) within 48 h, and 3 - month mortality after treatment were secondary safety outcomes. Univariate and multivariate stepwise Logistic regression analyses were used to screen for the influencing factors of prognosis after EVT combined with eptifibatide for acute ischemic stroke. Results The successful reperfusion (mTICI grade ≥ 2b) rate and complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment were 86.27% (88/102) and 68.63% (70/102), respectively. The good prognosis (mRS score ≤ 2) rate at 3-month after treatment was 54.90% (56/102). The incidence of sICH within 48 h after treatment was 4.90% (5/102). The incidence of ICH was 19.61% (20/102), PH was 11.76% (12/102), HI was 5.88% (6/102), rPH was 1.96% (2/102), IVH was 3.92% (4/102), and there was no SAH within 48 h after treatment. The mortality rate at 3-month after treatment was 16.67% (17/102). Logistic regression analysis showed that an admission National Institutes of Health Stroke Scale (NIHSS) score of > 15 was a risk factor for poor prognosis in patients with acute ischemic stroke after EVT combined with eptifibatide (OR = 0.118, 95%CI: 0.046-0.307; P = 0.000), while an Alberta Stroke Program Early CT Score (ASPECTS) of ≥ 6 was a protective factor for good prognosis (OR = 5.871, 95%CI: 1.812-19.020; P = 0.003). Conclusions The combined regimen of eptifibatide and EVT studied in this trial was effective and safe. Optimal administration method and randomized controlled trial are need to be further justified. [ABSTRACT FROM AUTHOR]

Passive smoking is considered a major public health issue in China. Prospective evidence regarding the link between secondhand smoke (SHS) and ischemic stroke in China is scarce. The China Kadoorie Biobank (CKB) study in Liuzhou City recruited 50,174 participants during 2004–2008. Of these 30,456 never-smokers were included in our study. The median follow-up period was 10.7 years. The incidence of ischemic stroke was obtained through the China Disease Surveillance Points (DSP) system and the Health Insurance (HI) database. Cox proportional risk models were used to evaluate the association between SHS exposure and ischemic stroke. During 320,678 person-years of follow-up, there were 2059 patients with ischemic stroke observed and the incidence of ischemic stroke was 6.42 per thousand person-years. Participants exposed to SHS daily faced a 21 % higher risk of ischemic stroke (HR = 1.21, 95 % CI : 1.09–1.34) compared to those exposed to SHS less than once a week. Subgroup analyses revealed that daily SHS exposure was linked to heightened risk of ischemic stroke among women, non-employed, and non-weekly tea drinkers. Daily SHS exposure was associated with higher risks of ischemic stroke. Proactive tobacco control strategies are necessary to decrease the risk of ischemic stroke in never smokers. [ABSTRACT FROM AUTHOR]

Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience. The prospective cohort design was conducted in the study from February to June 2023, a total of 222 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n = 106) or the lithotomy position cohort (n = 116). The pre-designed questionnaire and Childbirth Experience Questionnaire (CEQ) were used for data collection during hospitalisation. Chi-square, Fisher's exact test, t-tests, or the Mann–Whitney U test were utilised to assess differences between groups. Multivariate linear regression and logistic regression were employed to control possible confounders. The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates, and a better childbirth experience (p < 0.01). After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1 min and 5 min postpartum less than 7 or a Cord artery pH less than 7.00, regardless of parity. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care. [ABSTRACT FROM AUTHOR]

Background: Implementing medication reconciliation (MR) was complex and challenging because of the variability in the guidance provided for conducting. The processes of MR adopted in China were different from that recommended by the World Health Organization. A pilot study to inform the design of a future randomized controlled trial to determine the effectiveness of these two workflows was undertaken.Methods: Patients taking at least one home/regular medication for hypertension, diabetes, or coronary heart disease were recruited at admission, and then were randomized using a computer-generated random number in a closed envelope. In the study group, the pharmacist reviewed electronic medical record systems before communication with patients. In the control group, pharmacists communicated with patients at patient's admission. The time investment of pharmacists for MR process, the number of unintended medication discrepancies, and physician acceptance were tested as outcome measures.Results: One hundred and forty adult patients were randomized, of which 66 patients in the intervention received MR within 24 hours, while 58 patients in control received MR at some point during admission. The most common condition in the study group was hypertension (coronary heart disease in the control group). The workflow of the study group can save an average 7 minutes per patient compared with the WHO recommended process [17.5 minutes (IQR 14.00, 28.25) vs 24.5 minutes (IQR17.75, 35.25), p = 0.004]. The number of unintended discrepancies was 42 in the study group and 34 in the control group (p = 0.33). Physicians' acceptance in the study and control groups were 87.5% and 92.3%, respectively (p = 0.87).Conclusion: The results suggest that changes in outcome measures were in the appropriate direction and that the time limit for implementing MR can be set within 48 hours. A future multi-centre RCT study to determine the effectiveness of MR is feasible and warranted. [ABSTRACT FROM AUTHOR]

Dyslipidemias may emerge during the fetal period. However, the association between prenatal pyrethroid pesticides (PYRs) exposure and neonatal lipid metabolism remains uncertain. To explore the association of prenatal PYRs exposure and neonates' lipid metabolism, pregnant women were recruited in rural Yunnan, China, and their urine samples in the first, second, and third trimester and their neonates' cord blood samples were collected to obtain urinary PYRs metabolites (3PBA, 4F3PBA, and DBCA), cord blood TC, TG, HDL-C, LDL-C, and Non-HDL-C, AIP, CRI-I, CRI-II, AC, and LCI. We found the total PYRs detection during pregnancy was 99.6 %. High-level DBCA in the first and third trimester and high-level 3PBA in the second trimester increased risks of high AIP. High-level ∑PYRs in the third trimester enhanced risks of high levels of TG, LDL-C, Non-HDL-C, AIP, and LCI. Repeated high-level 3PBA in two trimesters and above elevated risks of high levels of TG, LDL-C, CRI-I, AIP, AC, and LCI. Repeated high-level DBCA group in two trimesters and above increased the risk of high AIP. Repeated high ∑PYRs in three trimesters intensified risks of high levels of TC, LDL-C, Non-HDL-C, and AIP. Thus, our study suggests high PYRs exposure during the whole pregnancy may increase the risk of neonate abnormal lipid metabolism. The third trimester is the most sensitive window of high prenatal PYRs exposure. The adverse effects on neonate lipid metabolism increased as the increasing of trimesters repeated high-level PYRs exposure during pregnancy. Different kinds of PYRs exposure may induce different cord blood abnormal lipids., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interest., (Copyright © 2024. Published by Elsevier B.V.)

Background and Objective: It is unclear whether variation in covert cerebrovascular disease prevalence is attributable to ethnic differences or to other factors. We aimed to examine the associations of country of residence with covert vascular brain injury (VBI) and cognitive dysfunction among Chinese adults residing in Canada and China., Methods: This was a multisite cross-sectional study of Chinese adults aged 40-80 years in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM; January 1, 2014, to December 31, 2018) and Prospective Urban Rural Epidemiological-Mind (PURE-MIND; November 1, 2010, to July 31, 2015) cohorts living in Canada and China. The exposure was country of residence. The co-primary outcomes were covert VBI (defined as MRI findings of high white matter hyperintensities or covert brain infarct) and cognitive dysfunction (defined as a Montreal Cognitive Assessment [MoCA] score <26). We used generalized linear models to describe the association between country of residence and each outcome, adjusting for selected covariates., Results: We included 884 adults living in Canada (mean age 57.3 years, 55.4% female) and 473 living in China (mean age 56.8 years, 60.3% female). Participants in Canada had a lower prevalence of covert VBI (age 65-79 years: male, 11.5%; female, 12.2%) than those living in China (age 65-79 years: male, 62.9%; female, 52.1%). Prevalence of MoCA score <26 was lower among men and women in Canada (age 65-79 years: 40.2% and 30.0%, respectively) than among men and women in China (age 65-79 years: 74.3% and 79.2%). Living in China was associated with a 6-fold increase in the odds of covert VBI (5.85, 4.06-8.45), which remained significant after covariate adjustment. Living in China was associated with a 7-fold increase in the odds of MoCA score <26 (6.98, 5.38-9.04), which was no longer significant after covariate adjustment., Discussion: Despite sharing a similar ethnicity, the prevalence of covert VBI and cognitive dysfunction varied substantially by country of residence. Disparities in cognitive dysfunction were completely explained by differences in education and traditional cerebrovascular risk factors, whereas disparities in covert VBI prevalence were only partially explained by differences in such factors, suggesting a role for other environmental factors.

Background and Aim: Discriminating between idiosyncratic drug-induced liver injury (DILI) and autoimmune hepatitis (AIH) is critical yet challenging. We aim to develop and validate a machine learning (ML)-based model to aid in this differentiation., Methods: This multicenter cohort study utilised a development set from Beijing Friendship Hospital, with retrospective and prospective validation sets from 10 tertiary hospitals across various regions of China spanning January 2009 to May 2023. Different ML algorithms were tested using 24 routine laboratory parameters. The Shapley Additive exPlanations (SHAP) analysis was used to evaluate the contribution of each parameter in the ML model., Results: A total of 2554 patients (1750 for DILI and 804 for AIH) were included. Using Gradient Boost Decision Tree algorithm, five key parameters-aspartate transaminase, globulin, prealbumin, creatinine and platelet count-were selected to construct the ML model. Consequently, a web-based tool named Beijing-AID (BJ-AID) was developed (http://43.143.153.225:5000/). The BJ-AID model demonstrated excellent discrimination performance, with an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI, 0.902-0.975) in the development set, 0.91 (95% CI, 0.900-0.928) in all external validation sets and 0.93 (95% CI, 0.889-0.974) in a prospective validation set. Notably, the BJ-AID model also effectively discriminated atypical cases, including drug-induced autoimmune-like hepatitis and AIH with the history of drug consumption, achieving an AUROC = 0.85 (95% CI, 0.742-0.949)., Conclusions: We successfully developed and validated a machine learning-based model, BJ-AID, which exhibits a strong discrimination performance. BJ-AID can assist practitioners and hepatologists in diagnosing both typical and atypical cases of DILI and AIH., Trial Registration: ClinicalTrials.gov identifier: NCT05532345., (© 2025 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: Betaine is connected to various cardio-metabolic outcomes, yet its relationship with hyperuricemia remains uncertain. We aimed to longitudinally investigate the association between serum betaine levels and the risk of hyperuricemia in middle-aged and older adults., Methods: This study utilized data from the Guangzhou Nutrition and Health Study (GNHS). Participants were enrolled between 2008 and 2010, with follow-ups conducted every three years, comprised an analysis sample of 2204 adults aged 40-75. Baseline serum betaine levels were assessed using high-performance liquid chromatography-tandem mass spectrometry. Serum uric acid (SUA) levels were measured at baseline and every three years thereafter. Linear mixed-effects models (LMEMs) and generalized estimating equations (GEEs) were employed to examine the longitudinal association between serum betaine levels and SUA levels, as well as hyperuricemia risk, respectively., Results: LMEMs indicated that compared to individuals in the lowest quartile (Q1) of serum betaine levels, those in the highest quartile (Q4) exhibited the lowest SUA levels (Q4 vs. Q1: β -8.19, 95% CI -16.32 to -0.06, P-trend = 0.023). Each standard deviation increase in betaine (16.5 µmol/L) was associated to SUA levels decrease of -3.28 (-6.10, -0.45). Results from the GEE model suggested a 19% reduction in the odds of hyperuricemia (OR = 0.81; 95% CI: 0.68, 0.95, P-trend = 0.051) in the Q4 group compared to the Q1 category., Conclusion: Our findings highlight a negative association between serum betaine levels and SUA levels, as well as the risk of hyperuricemia in middle-aged and older adults, which is more pronounced in individuals with better dietary quality., Trial Registration: This trial was registered at clinicaltrials.gov as NCT03179657. Website: https://clinicaltrials.gov/ct2/show/NCT03179657., Competing Interests: Declarations. Ethics approval: This study was approved by the Ethics Committee of the School of Public Health at Sun Yat-sen University and was registered at clinicaltrials.gov as NCT03179657. Consent to participate: Written informed consent was obtained from all the participants at enrollment. Source of support: This work was supported by the National Natural Science Foundation of China (no. 82204021). Conflict of interest: The authors declare that they have no conflict of interest., (© 2025. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor., Methods: This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log 10  MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test., Results: A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log 10  SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log 10  SV MoM and log 10  CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log 10  HR MoM was not significantly different between the study groups. Mean log 10  CO MoM and log 10  SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%., Conclusions: Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., (© 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)

Background: Modifiable lifestyle behaviors significantly influence the risk of cognitive impairment. However, the cumulative effects of multidimensional lifestyle profiles on cognitive function remain poorly understood, as most studies examine individual lifestyle behaviors in isolation. This study aimed to identify distinct profiles of individuals based on healthy lifestyle behaviors and to examine associations between these profiles and cognitive function in older Chinese adults., Methods: We used a prospective cohort, including 5381 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018, aged 65 years and older with normal cognition at baseline. Questionnaires were used to collect self-reported data on healthy diet, sleep quality, physical activities, cognitive activities, and social activities. Repeated measures of the Mini-Mental State Examination (MMSE) were utilized to assess cognitive function. Latent Profile Analysis (LPA) was conducted to identify profiles characterized by similar characteristics of lifestyle behaviors. The resultant profiles, were then used to further explore associations with cognitive function using cox proportional hazard regression and linear mixed models., Results: During a 10-year follow-up period, 2017 (37.5%) out of 5381 participants developed cognitive impairment. Three latent profiles were identified: (1) "active engagement" (n = 347, 6.4%); (2) "moderate engagement" (n = 627, 11.7%); and (3) "negative engagement" (n = 4407, 81.9%). Compared to negative engagement, the active profile had the lower risk of cognitive impairment (HR = 0.693, 95% CI: 0.553-0.868), longer years to develop cognitive impairment (mean = 7.818, range: 6.701, 8.935) and slower rate of annual cognitive decline (0.407 points per year). Similarly, the moderate engagement profile had the lower risk of cognitive impairment (HR = 0.781, 95% CI: 0.664-0.919), longer years to develop cognitive impairment (mean = 7.541, 95%CI: 6.464, 8.619) and slower rate of annual cognitive decline (0.297 points per year) compared to negative profile. Subgroup analysis revealed that there were no significant differences observed across any of the subgroups, including age, gender, year of schooling, marital status, residence, live alone, family economic status., Conclusions: These findings imply the likelihood of an inverse correlation between the levels of engagement in healthy lifestyle behavior and the risk of cognitive impairment. Even adopting a few healthy lifestyle habits is superior to none at all, underscoring the value of lifestyle modifications for cognitive health., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2025 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Aims: This study aimed to identify the distinct change trajectories of the Chinese visceral adiposity index (CVAI) over time and to investigate their associations with risk of type 2 diabetes mellitus (T2DM)., Materials and Methods: This study included 52 394 participants from the prospective project, the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). The CVAI was calculated using measures of age, body mass index, waist circumference, triglycerides and high-density lipoprotein cholesterol. Latent mixture modelling was conducted to fit distinct trajectory patterns. The logistic regression model was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of T2DM with various CVAI trajectory patterns., Results: Four distinct CVAI trajectory patterns were identified: low-increasing, moderate-increasing, moderate high-increasing and high-increasing. Compared with low-increasing CVAI, participants with moderate-increasing (OR 1.73, 95% CI 1.49-2.00), moderate high-increasing (3.48, 3.01-4.03) and high-increasing CVAI (5.50, 4.67-6.47) had a significantly increased risk of T2DM. Similar trajectory patterns were identified in both men and women. The ORs (95% CI) for moderate-increasing, moderate high-increasing and high-increasing groups were 3.28 (2.56-4.19), 7.85 (6.09-10.13) and 13.21 (9.98-17.49) in women respectively, and 1.20 (0.99-1.45), 2.18 (1.82-2.62) and 3.60 (2.93-4.43) in men respectively, when compared to the low-increasing CVAI group. Further, significant effect modifications for age, smoking and physical activity (all P interaction  <0.05) were observed in the relationship between CVAI trajectory patterns and T2DM., Conclusions: Initially high and persistently elevated CVAI is significantly associated with an increased risk of T2DM, with a particular focus on women, younger people, nonsmokers and physically inactive individuals. Continuous monitoring of CVAI levels will benefit effective identification, early intervention and management of individuals at high risk of T2DM., (© 2024 John Wiley & Sons Ltd.)

Study Objective: To determine whether individualized fraction of inspired oxygen (iFiO 2 ) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO 2 ., Design: This was a single-center, prospective, randomized study., Setting: This study was conducted in a single tertiary care hospital in China., Patients: A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study., Interventions: The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO 2 group) or individualized FiO 2 based on physiological SpO 2 (iFiO 2 group)., Measurements: The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO 2 , oxygenation index, alveolar-arterial oxygen tension gradient (A-aDO 2 ), and pulmonary shunt fraction (Qs/Qt) were considered., Main Results: The LUS was significantly lowered in the iFiO 2 group (5 [4, 7]) compared with the fFiO 2 group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO 2 group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO 2 group (P = 0.025). At the end of surgery, PaO 2 , A-aDO 2 , and Qs/Qt were significantly reduced in patients in the iFiO 2 group compared with those in the fFiO 2 group., Conclusions: The use of iFiO 2 during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia., Clinical Trial Registration: ChiCTRT2100049615., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The safety of extracorporeal shock wave lithotripsy for pancreatic stones (P-ESWL) and adverse events were not evaluated and classified within large sample population. This study aimed to evaluate the safety and classify the adverse events of P-ESWL based on a large sample cohort., Methods: This is an observational study based on the large prospective chronic pancreatitis (CP) cohort. Patients with painful pancreatic stones over 5 mm who underwent P-ESWL between March 2011 and June 2018 at Shanghai Changhai Hospital were included. Adverse events after P-ESWL including complications and transient adverse events (TAEs) were recorded. Risk factors of adverse events were analyzed through univariable and multivariable logistics regression analysis. Sensitivity analysis was conducted to test the stability of the study., Results: Totally 2,071 patients underwent 5,002 sessions of P-ESWL were included. The overall complication rate and TAEs rate after all P-ESWL procedures were 5.2% and 20.9%. The complications and TAEs rate decreased obviously within the first 6 sessions. Several independent risk factors for adverse events after P-ESWL were identified. Sensitivity analysis suggested the stability of the results., Conclusions: P-ESWL is a safe treatment for pancreatic stones. Multiple P-ESWL sessions did not increase the complications and TAEs rate. ClincialTrials.gov number, NCT05916547., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students., Method: A total of 636 college students (80 % female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs., Results: At baseline, the prevalence of IA and PLEs was 11.3 % and 16.8 %, respectively. Higher baseline IADQ scores (Adjusted odds ratio = 1.035; 95 % confidence interval = 1.002-1.069; p = 0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β = 0.082, p = 0.043), whereas baseline PLEs did not predict IA (β = 0.049, p = 0.255). Specifically, IA predicted unusual thoughts (β = 0.122, p = 0.003) and negative PLEs (β = 0.111, p = 0.008), but not perceptual abnormalities (β = 0.040, p = 0.301)., Conclusion: IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that there is no conflict of interest, and manuscript is approved by all authors for submission and publication. This study did not receive any funding., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Limited evidence exists regarding the efficacy of preoperative exercise in reducing short-term complications after minimally invasive surgery in patients with non-small cell lung cancer. This study aims to investigate the impact of preoperative exercise on short-term complications after minimally invasive lung resection., Methods: In this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (September 2020 to February 2022), patients were randomly assigned to a preoperative exercise group with 16-day alternate supervised exercise or a control group. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days postsurgery., Results: A total of 124 patients were recruited (preoperative exercise group n = 62; control n = 62). Finally, 101 patients (preoperative exercise group; n = 51 and control; n = 50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control group, the preoperative exercise group showed fewer postoperative complications (preoperative exercise 3/51 vs control 10/50; odds ratio, 0.17; 95% CI, 0.04-0.86; P = .03) and shorter hospital stays (mean difference, -2; 95% CI, -3 to -1; P = .01). Preoperative exercise significantly improved depression, stress, functional capacity, and quality of life (all P < .05) before surgery. Furthermore, preoperative exercise demonstrated a significantly lower minimum blood pressure during surgery and lower increases in body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all P < .05). Exploratory research on lung tissue RNA sequencing (5 in each group) showed downregulation of the tumor necrosis factor signaling pathway in the preoperative exercise group compared with the control group., Conclusions: Preoperative exercise training decreased short-term postoperative complications in patients with non-small cell lung cancer., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To identify the associations between gestational cholesterol levels and the risk of postpartum hypercholesterolemia, and to establish trimester-specific reference values., Methods: Serum lipids at gestational weeks 6-8, 16, 24, and 36, and 42 days postpartum were derived from 905 pregnant women of a prospective cohort. The major outcome was postpartum hypercholesterolemia. Logistic regression and restricted cubic splines were conducted to estimate the associations between cholesterol levels at specific gestational ages and postpartum hypercholesterolemia. Associations of the trend of changes in cholesterol levels during pregnancy with postpartum hypercholesterolemia were evaluated by linear mixed-effect model and linear or logistic regression. Reference values were computed by the receiver operating characteristic curves., Results: Serum concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and the ratios of TC/HDL-C and LDL-C/HDL-C all increased during pregnancy and decreased at 42 days postpartum. The elevated levels of TC and LDL-C, decreased levels of HDL-C in pregnancy, and their rapid change rates were positively associated with higher risks of postpartum hypercholesterolemia. The established reference values from the first to the third trimester were below 5.47, 6.35, and 7.22 mmol/L for TC; below 2.83, 3.82, and 4.21 mmol/L for LDL-C; and more than 1.50, 1.55, and 1.50 mmol/L for HDL-C, respectively., Conclusion: Maternal cholesterol levels and their trend of change during pregnancy were predictors of postpartum hypercholesterolemia. Trimester-specific reference values were established in a Chinese population., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Short sleep duration is common in the pediatric population and is associated with an increased risk of high carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis. However, little is known regarding whether changes in sleep duration status over time can alter the risk of high cIMT in children., Objectives: To examine the association between changes in sleep duration status and high cIMT in a cohort study of Chinese children., Methods: A total of 1115 children aged 6-11 years were enrolled in 2017 and then followed up in 2021 in the Huantai Childhood Cardiovascular Health Cohort Study. Children were categorized into four groups based on their sleep duration status (short vs. normal) at baseline and follow-up: persistent normal sleep duration, incident short sleep duration, resolved short sleep duration, and persistent short sleep duration. High cIMT was defined as cIMT levels ≥ age- and sex-specific 90th percentile values of this population., Results: Compared with children who maintained normal sleep duration, those with incident short sleep duration (odds ratio [OR]: 1.71, 95 % confidence interval [CI]: 1.05-2.77) or persistent short sleep duration (OR: 4.07, 95 % CI: 2.10-7.89) had a significantly increased risk of high cIMT at follow-up. Conversely, children who had short sleep duration at baseline but normal sleep duration at follow-up did not have an increased risk of high cIMT (OR: 1.08, 95 % CI: 0.47-2.49)., Conclusion: The development or persistence of short sleep duration is associated with an increased risk of high cIMT in children, whereas the resolution of short sleep duration may reduce such risk. These findings underscore the importance of preventing and managing short sleep duration to promote cardiovascular health in children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to evaluate the clinical effectiveness of combined aerosolized (AER) and intravenous (IV) polymyxin B in managing patients with hospital-acquired pneumonia (HAP) caused by carbapenem-resistant gram-negative organism (CRO)., Methods: This multicenter prospective cohort study was conducted across six intensive care units in municipal and above-municipal hospitals in Shaanxi, China, from January 1, 2021 to December 31, 2022. Patients with CRO pneumonia were categorized into the intravenous group (IV polymyxin B alone) and the combination group (AER plus IV polymyxin B). Primary outcomes included ICU mortality, 28-day mortality and bacterial clearance, while secondary outcomes included the duration of mechanical ventilation and length of ICU stay., Results: A total of 64 patients were included in the study, with 29 receiving AER plus IV polymyxin B and 35 receiving IV polymyxin B alone. On the seventh day of treatment, the combination group showed a significant reduction in the APACHE II score (17.86 ± 5.03 vs. 19.17 ± 11.02, P = 0.041) and procalcitonin levels (1.27 ± 0.20 vs. 3.18 ± 0.69, P < 0.001) compared to the intravenous group. Additionally, the combination group exhibited a higher bacterial eradication rate (62.1% vs. 42.9%), lower ICU mortality (27.6% vs. 37.1%), shorter duration of mechanical ventilation (371.39 ± 68.97 h vs. 563.94 ± 100.25 h), and reduced ICU stay (34.41 ± 17.87 d vs. 35.03 ± 21.66 d), although the differences were not statistically significant., Conclusions: In patients with CRO pneumonia, combination therapy resulted in significant reductions in APACHE II scores and procalcitonin, but did not lead to statistically significant improvements in clinical outcomes, compared to IV polymyxin B alone., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study aimed to evaluate the effectiveness of single-field fundus photography for diabetic retinopathy (DR) screening and monitoring versus six-field imaging in community settings., Methods: Adults aged ≥30 years with Type 2 diabetes from 15 communities in Northeast China were recruited for this prospective cohort study (n = 2,006 at baseline and n = 1,456 at follow-up). Participants underwent both single-field and six-field digital fundus photography at baseline and follow-up visits (mean duration of 21.2 ± 3.2 months). Photographs were graded using international standards. Agreement in DR severity grading, referral recommendations, and detection of DR progression were compared between single-field and six-field fundus photography., Results: Single-field grading showed substantial agreement with multifield grading in classifying DR severity (81.9% identical at baseline, 80.6% at follow-up, Gwet AC1 0.79 and 0.77). For referring eyes with moderate nonproliferative DR or worse, single-field grading had ∼70% sensitivity and 100% specificity compared with six-field grading. Single-field grading identified 74.9% or 79.7% of eyes progressing or regressing by six-field grading, respectively., Conclusion: Single-field fundus photography demonstrated reasonable effectiveness for DR screening and monitoring in a community setting, supporting its use for improving access to DR detection. However, reduced sensitivity compared with multifield imaging should be acknowledged.

The potential health effects of exposure to rare earth elements (REEs) remain largely unexplored. This prospective cohort study aimed to elucidate the association between early pregnancy REE exposure and maternal thyroid function, as well as neonatal birth outcomes, in a cohort of pregnant women in Beijing, China. Additionally, the study explored the mediating role of thyroid homeostasis in the effects of REE exposure. Serum concentrations of fifteen REEs, along with Free Thyroxine (FT4), Thyroid Stimulating Hormone (TSH), and Thyroid Peroxidase Antibodies (TPOAb), were measured in 195 pregnant women. Multivariable linear regression analyses identified significant correlations between REE exposure and disruptions in maternal thyroid homeostasis. Specifically, Praseodymium (Pr) and Lutetium (Lu) were positively associated with FT4 levels, while Gadolinium (Gd) showed a positive correlation with TSH levels. Conversely, Thulium (Tm) was negatively associated with FT4 levels, and Yttrium (Y) was negatively correlated with TSH levels, indicating distinct interactions of specific REEs with thyroid regulation. Notably, Lu remained positively correlated with FT4 levels (β = 1.39, 95% CI = 0.55, 2.22) after adjusting for multiple comparisons. Regarding neonatal birth outcomes, Dysprosium (Dy) was found to be negatively associated with infant birth weight (β = -0.09, 95% CI = -0.170, -0.002). Furthermore, gender-specific analyses revealed significant associations between REE exposure and TPOAb levels among female neonates. Mediation analyses indicated that TSH significantly mediated the relationships between Terbium (Tb) and Y exposure and neonatal birth outcomes. The study suggests that REEs may disrupt endocrine function, particularly thyroid hormones, which could adversely affect neonatal growth, highlighting the need for further research on their impact in vulnerable populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Emerging data have explored early life fine particulate (PM 2.5 ) exposure and its relationship with offspring neurodevelopment. However, the findings remain inconsistent, and the roles of specific PM 2.5 components are unclear. We investigated these associations and explored the potential interactive role of children's physical activity (PA). A total of 1547 mother-child pairs from the Shenzhen Birth Cohort were included. Neurodevelopment was assessed at seven time points (1, 3, 6, 8, 12, 18, and 24 months) using the Ages and Stages Questionnaire. An established spatiotemporal model was used to estimate early life exposure to PM 2.5 and five components [sulfate (SO 4 2 ), nitrate (NO 3 - ), ammonium (NH 4 + ), organic matter (OM), and black carbon (BC)]. Associations of individual and joint exposure to components with neurodevelopment were analyzed using generalized estimating equation and quantile-based g-computation models with a binomial distribution. Most mothers (79.1%) were under 35 at delivery, and 43.6% of the children were boys. During the early postnatal period, a 5 μg/m 3 increase in PM 2.5 was associated with higher adjusted odds ratios (aORs) for developmental delays in gross motor (1.24, 95%CI:1.12, 1.37), fine motor (1.11, 95%CI:1.04, 1.20), and problem-solving (1.12, 95%CI:1.03, 1.22) domains. Similar associations were observed for individual PM 2.5 components. Each quintile increase in early postnatal exposure to PM 2.5 mixtures was correlated with higher aORs for these domains, with NO 3 - constituting the largest weight. No significant associations were found for the prenatal period. The children's PA showed no interaction. These findings underscore the need to reduce PM 2.5 exposure, particularly its toxic components, to minimize developmental risks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance., Methods: We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex-specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease., Results: In total, 17 510 participants aged 38-88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013-2014 and followed up until 31 December 2018. During a median follow-up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14-1.51) for low grip strength and 1.25 (1.09-1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%-34%) and 14% (95% CI: 7%-22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index., Conclusion: Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle-related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials., (© 2025 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

This study aimed to develop and validate prediction models for incident reversible cognitive frailty (RCF) based on social-ecological predictors. Older adults aged ≥60 years from China Health and Retirement Longitudinal Study (CHARLS) 2011-2013 survey were included as training set ( n = 1230). The generalized linear mixed model (GLMM), eXtreme Gradient Boosting, support vector machine, random forest, and Binary Mixed Model forest were used to develop prediction models. All models were evaluated internally with 5-fold cross-validation and evaluated externally via CHARLS 2013-2015 survey ( n = 1631). Only GLMM showed good discrimination (AUC = 0.765, 95% CI = 0.736, 0.795) in training set, and all models showed fair discrimination (AUC = 0.578-0.667, 95% CI = 0.545, 0.725) in internal and external validation. All models showed acceptable calibration, overall prediction performance, and clinical usefulness in training and validation sets. Older adults were divided into three groups using risk score based on GLMM, which could assist healthcare providers to predict incident RCF, facilitating early identification of high-risk population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Previous studies indicated that metabolic heterogeneity of obesity would affect the risk of cardiovascular disease (CVD). However, the alterations in CVD risk associated with transitions between various metabolic health statuses influenced by obesity status remain unclear., Methods: We utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal cohort study involving Chinese residents aged 45 years and older. Baseline data were collected in 2011-2012, with follow-up surveys conducted up to 2020. Participants in the study were categorized into four body mass index-metabolic phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHOO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOO). Transitions in these phenotypes over 4 years were analysed. Cox regression models were used to assess the associations of these phenotypes and their transitions with CVD incidence., Results: Among 7721 participants, 1353 (17.5%) developed CVD during the follow-up period. Both overweight/obese and metabolically unhealthy statuses were associated with increased CVD risk. The highest risk was observed in the MUOO group (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.50-2.09, p < 0.0001), followed by the MUNW (HR 1.35, 95% CI: 1.13-1.66, p < 0.001) and MHOO (HR: 1.29, 95% CI: 1.08-1.56, p = 0.002) groups compared to the MHNW group. The deteriorations of obesity and metabolic health status elevated the incidence of CVD, whereas improvements in these statuses reduced the risk of CVD. Additionally, alterations in metabolic health status conferred greater benefits in overweight/obese individuals compared to those with normal weight., Conclusion: The study highlights the importance of maintaining and promoting metabolic health, particularly in overweight/obese individuals, to reduce CVD risk. Metabolic health status plays a more crucial role than obesity status in predicting CVD incidence., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

The epidemiological evidence from studies on the impact of exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy on child neurodevelopment is inconclusive. This study aimed to assess the associations of PAHs exposure in early pregnancy and neurodevelopmental outcomes in children aged 6-12 months in a prospective cohort. In this study, we included 172 mother-child pairs with complete data in Tianjin City, China. Ten PAH metabolites were determined in early-pregnancy urine using gas chromatography and tandem mass spectrometry (GC-MS/MS). Child neurodevelopment was measured using the Griffiths Development Scales-Chinese (GDS-C) when children were between 6 and 12 months old. We employed multivariable linear regression, Weighted Quantile Sum (WQS) regression, and Bayesian Kernel Machine Regression (BKMR) to assess the relationships of individual PAH metabolites and mixtures of these metabolites with child neurodevelopment. Multiplicative interactions were analyzed to examine effect modification by child sex. In the multivariable linear regression analysis, six PAH metabolites were found to be negatively associated with personal social scores, while three PAH metabolites showed a negative association with language scores. The WQS model revealed that the PAHs mixture was linked to decreased personal social scores (β = - 4.18, 95% CI = -7.56, - 0.80) and language scores (β = - 4.17, 95% CI = -7.98, -0.37). Furthermore, the BKMR models also indicated the negative associations between the PAHs mixture and personal social scores and language scores. Notably, three PAH metabolites (1-hydroxynaphthalene(1-OHNap), 3-hydroxyfluorene(3-OHFlu), 3+9-hydroxyphenanthrene(3+9-OHPhe)) were identified as important contributors to these associations. All analyses of interactions were null. Exposure to PAHs during early pregnancy, whether individually or as a mixture, demonstrated a negative association with child neurodevelopment outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: This study sought to evaluate the correlation between waist-to-height ratio (WHtR) and heart failure (HF) outcomes across different ejection fraction (EF) categories., Methods and Results: A prospective cohort study was conducted at a comprehensive tertiary hospital in China. The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow-up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all-cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all-cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 ± 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (≥0.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 ± 1.55 vs. 3.36 ± 0.90 mmol/L), TG (1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L), and LDL-C (2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L) compared with patients with low WHtR (<0.50). NT-proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow-up period. The incidence of all-cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30-2.58), 1.96 (1.34-2.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF/low WHtR exhibited a markedly elevated risk of all-cause mortality [HR = 2.31; (95% CI: 1.24-4.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92-8.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19-17.76)] compared with patients with HFrEF/high WHtR. WHtR has a negligible effect on the risk of all-cause and cardiovascular mortality in heart failure patients with preserved EFs., Conclusions: The obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Evidence on the potential effects of midday napping on risk of stroke in Chinese populations remains limited., Objectives: We aimed to prospectively investigate the association between midday napping and risk of subsequent stroke and stroke subtypes in the Kailuan study., Methods: Midday napping duration was obtained from a self-reported questionnaire. Incident stroke cases from baseline (2014) to December 31, 2020 were confirmed by review of medical records. The association of midday napping duration with risk of incident stroke and subtypes was examined using a Cox regression model, adjusting for potential confounders. We further investigated the joint effects of nocturnal sleep duration and midday napping on the risk of stroke., Results: A total of 96,899 individuals (21.0 % women; 51.9 ± 14.0 years) were included. During an average follow-up of 5.62 ± 0.69 years, 2539 incident stroke cases were documented. After adjusting for potential confounders, we found that participants with a midday napping duration of >60 min/day had higher risk of incident stroke (adjusted HR: 1.23; 95 % CI: 1.07, 1.42), compared with those without midday napping. Furthermore, significant joint effects were found in both nocturnal sleep duration (P-interaction=0.04) and snoring status (P-interaction= 0.005) on the association between midday napping duration and the risk of incident stroke, especially for participants who napped >60 min/day and slept ≤7 h/night compared with those who slept 7-8 h/night and did not take a nap, or those who napped >60 min/day and snored compared with those who did not take a nap and snore., Conclusions: We found that prolonged midday napping (>60 min/day) was associated with higher risk of stroke and the association was stronger among those with shorter nocturnal sleep duration or those who snored., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background:  We sought to examine the dose-response relationship between high-density lipoprotein cholesterol (HDL-C) and bleeds in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI)., Methods:  All the 15,250 participants were from the Personalized Antiplatelet Therapy According to CYP2C19 Genotype in Coronary Artery Disease (PRACTICE) study, which is a large, single-center, prospective cohort study based on case records and a follow-up registry performed in the First Affiliated Hospital of Xinjiang Medical University from December 2016 to October 2021. We divided all the patients into five groups according to their HDL-C levels: the ≤35 mg/dL group ( n  = 4,732), 35 to 45 mg/dL group ( n  = 6,049), 45 to 55 mg/dL group ( n  = 2,826), 55 and 65 mg/dL group ( n  = 1,117), and >65 mg/dL group ( n  = 526). The incidence of bleeds, mortality, ischemic events, and net adverse clinical events (NACEs) among the five groups was compared., Results:  A total of 713 bleeds, 1,180 ischemic events, 456 deaths, and 1,893 NACEs were recorded during the up to 60-month follow-up period. After adjusting for confounders, we observed a nonlinear relation for bleeds, with the highest risk at intermediate HDL-C levels (45-55 mg/dL). We also identified a dose-response relationship for ischemic events. A threshold value of HDL-C ≤35 mg/dL (adjusted hazard ratio = 0.560, 95% confidence interval: 0.360-0.872, p  = 0.010) was associated with a decreased risk for bleeds in the multivariable Cox regression model. The results were consistent in multiple sensitivity analyses and propensity score-matching analysis., Conclusion:  In the present study, a nonlinear association was identified between HDL-C levels and bleeds in CAD patients who underwent PCI, with a higher risk at intermediate levels. However, further multicenter studies are warranted., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: To evaluate the impact of short-term scleral lens (SL) wear on anterior chamber (AC) dimension and central corneal thickness (CCT) in healthy Chinese people., Methods: This is a prospective, daily wear study. Eligible participants were dispensed SLs to correct refractive errors. Anterior segment (AS) parameters were measured by AS optical coherence tomography (AS-OCT) before, during, and after 2 and 4 hours of lens wear. Repeated-measures analysis of variance (ANOVA) was used to analyze the changes in AS parameters over time., Results: Twelve subjects (10 females and 2 males) with a mean age of 25.3 ± 3.8 years (ranging from 21 to 34 years) were recruited. The AC parameters, including anterior chamber depth (ACD) from the endothelium (endo-ACD), angle opening distance at 500 μm (AOD500), and trabecular-iris space area at 500 μm (TISA500), significantly decreased after wearing SLs for 4 hours (P<0.05). CCT increased by 12 μm (2.29 %) after wearing SLs for 4 hours (P=0.013)., Conclusion: This study suggests that SL wear has a significant impact on AS dimensions in patients with healthy corneas in the short term with SL in situ, but tend to recover quickly after SL removal. Further research is needed to determine whether the change in AS dimensions during SL wear affects aqueous humor (AH) outflow and causes changes in intraocular pressure (IOP)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Background: Bipolar disorder (BD) is a chronic, severe mental illness with a significant socio-economic burden. The early recognition of BD requires reliable and valid instruments., Objective: We evaluated the psychometric attributes of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP)-Chinese version., Methods: Altogether, 129 participants, aged 16-35 years meeting DSM-5 criteria for major depressive disorder (MDD, n = 27) or BD (n = 76), and 26 healthy controls were recruited. Subjects were evaluated with the BPSS-FP Chinese version, Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Cyclothymic-Hypersensitive Temperament questionnaire (CHT). Internal consistency, interrater reliability, criterion validity, and discriminant validity of the BPSS-FP-Chinese version were assessed., Results: Cronbach alpha indices were 0.87, 0.86, and 0.66 for the manic, depressive, and general subscales of BPSS-FP-Chinese version, respectively. Interrater correlation was high, with total agreements of 0.94, 0.95, and 0.94 for the manic, depressive, and general index, respectively. Significant correlations (r ≥ 0.50) were noted between the BPSS-FP manic subscale and both the YMRS and CHT, the depressive subscale and the MADRS, and the general symptom subscale and the CHT. Moderate correlations were detected between the BPSS-FP general symptoms and both the YMRS and CHT (r = 0.40 ∼ <0.50). Furthermore, the BPSS-FP mania index demonstrated a moderate correlation with the MADRS, while the depression index had a small correlation with the YMRS (r = 0.10 ∼ <0.40)., Conclusions: The BPSS-FP-Chinese version has good psychometric properties and can be applied in both clinical and research settings for screening subjects with a risk for BD., Competing Interests: Declaration of competing interest The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. CU Correll has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Adock Ingram, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Maplight, Mylan, Neumora Therapeutics, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Saladax, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, Tolmar, Vertex, Viatris and Xenon Pharmaceuticals. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, Denovo, Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Mindpax, and Quantic. Dr. Xin Yu has been an adviser or in speaker's bureau to or has received honoraria from: Xian Janssen, Lundbeck, Pfizer China, Eisai China, Boehringer-Ingelheim China and Teva China. The other authors declare no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

With the global rise in advanced maternal age (AMA) pregnancies, the risk of gestational diabetes mellitus (GDM) increases. However, few GDM prediction models are tailored for AMA women. This study aims to develop a practical risk prediction model for GDM in AMA women. Data were obtained from a prospective observational cohort of AMA pregnant women from the Obstetrics and Gynecology Hospital in Shanghai, China. Singleton pregnancies with complete OGTT results at 24-28 weeks were selected and divided into training (70%) and validation (30%) sets. First-trimester predictors, including demographic, metabolic parameters, and clinical history, were evaluated for statistical significance. A multivariate logistic regression model was developed, with performance evaluated using receiver operating characteristic (ROC) curves and calibration plots. Predictors were primarily incorporated as categorical variables in a nomogram to enhance model convenience. A model using continuous predictors was also tested for comparison. A total of 1904 AMA women were included, with GDM incidence rates of 18.3% (243/1333) in the training set and 19.3% (110/571) in the validation set. Significant predictors for GDM diagnosis at 24-28 weeks included maternal age, GDM history, first-trimester fasting plasma glucose, mean arterial pressure, and triglyceride levels. The categorical model achieved an area under the ROC curve of 0.717 (95% CI: 0.682-0.753) in the training set and 0.702 (95% CI: 0.645-0.758) in the validation set. The Hosmer-Lemeshow test indicated good calibration (p = .97 in the training set; p = .66 in the validation set). The model with category and continuous predictors exhibited similar performance. This study developed and validated a practical early risk prediction nomogram for GDM in AMA women, using commonly available clinical data. The model shows good predictive performance and is resource-efficient, making it suitable for real-world clinical implementation., (© 2025 Federation of American Societies for Experimental Biology.)

To report the results of a single-arm, prospective partial breast irradiation (PBI) trial from China mainland using a dose of 40.05 Gy in 15 fractions delivered with intensity-modulated radiation therapy (IMRT) technique for patients with early stage breast cancer. Patients aged ≥ 50 years who underwent breast-conserving surgery for unifocal non-lobular invasive breast cancer, with pathological T1 disease, clear margins, negative axillary nodes, and positive hormonal receptors, were recruited. The primary endpoint was 3-year cosmetic deterioration, and secondary endpoints included adverse events, ipsilateral breast tumor recurrence (IBTR), regional recurrence, and survivals. This trial is registered with ClinicalTrials.gov (registration No. NCT03411174). From Jan of 2015 to July of 2018, 208 out of 222 patients recruited were evaluable and included in final analysis. The median follow-up was 66.3 (range: 42.0-105.4) months. The 3-year overall cosmetic deterioration rate was 3.5%. The rates of grade 2 radiation dermatitis and breast induration was 5.8% and 1.5%, respectively. No one experienced ≥ grade 2 breast pain, edema, or telangiectasia. The 5-year cumulative incidence of IBTR and RR was 0.5%. No one developed DM. The 5-year DFS was 99.0%. Four patients died from non-breast cancer causes, and the 5- year OS was 97.9%. In conclusion, we observed lower rates of cosmetic deterioration, IBTR, and ≥ grade 2 acute/late normal tissue effects following PBI with a moderately hypofractionated regimen delivered with IMRT technique. Therefore, this regimen represents an attractive option when an external beam PBI approach is chosen to treat a patient with low-risk early breast cancer., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Postoperative pulmonary complications (PPCs) following cardiac valvular surgery are characterized by high morbidity, mortality, and economic cost. This study leverages wearable technology and machine learning algorithms to preoperatively identify high-risk individuals, thereby enhancing clinical decision-making for the mitigation of PPCs., Methods: A prospective study was conducted at the Department of Cardiovascular Surgery of West China Hospital, Sichuan University, from August 2021 to December 2022. We examined 100 cardiac valvular surgery patients, where wearable technology was utilized to collect and analyze nocturnal physiological data at the 24-hour admission, in conjunction with clinical data extraction from the Hospital Information System's electronic records. We systematically evaluated three different input types (physiological, clinical, and both) and five classifiers (XGB, LR, RF, SVM, KNN) to identify the combination with strong predictive performance for PPCs. Feature selection was conducted using Recursive Feature Elimination with Cross-Validated (RFECV) for each model, yielding an optimal feature subset for each, followed by a grid search to tune hyperparameters. Stratified 5-fold cross-validation was used to evaluate the generalization performance. The significance of AUC differences between models was tested using the DeLong test to determine the optimal prognostic model comprehensively. Additionally, univariate logistic regression analysis was conducted on the features of the best-performing model to understand the impact of individual feature on PPCs., Results: In this study, 22 patients (22%) developed PPCs. Across classifiers, models combining both physiological and clinical features performed better than physiological or clinical features alone. Specifically, including physiological data in the classification model improved AUC, ACC, F1, and precision by an average of 8.32%, 1.80%, 3.28% and 6.06% compared to using clinical data only. The XGB classifier, utilizing both dataset, achieved the highest performance with an AUC of 0.82 (± 0.08) and identified eight significant features. The DeLong test indicated that the XGB model utilizing the both dataset significantly outperformed the XGB models trained on the physiological or clinical datasets alone. Univariate logistic regression analysis suggested that surgical methods, age, nni&#95;50, and min&#95;ven&#95;in&#95;mean are significantly associated with the occurrence of PPCs., Conclusion: The integration of continuous wearable physiological and clinical data significantly improves preoperative risk assessment for PPCs, which helps to optimize surgical management and reduce PPCs morbidity and mortality., Competing Interests: Declarations. Ethics approval and consent to participate: All participants provided written informed consent. This study was approved by the Ethics Committee of the West China Hospital of Sichuan University, Ethics No.20211023, Clinical Registration No. ChiCTR2100050005 ( http://www.chictr.org.cn ). Consent for publication: Not applicable. Competing interests: This work was done during ZY’s internship at Beijing SensEcho Science and Technology Co., Ltd., Beijing, China, when he was a Ph.D. candidate at University of California, Davis, CA, United states, and now he works in PAII Inc., Palo Alto, CA, United States. The authors declared that the sleep feature calculation algorithm described in this article is covered by a patent (Patent Title: Sleep Apnoea Event Detection Method, Patent Number: ZL 202110167659.6X, Holder: Chinese PLA General Hospital). Zhengbo Zhang is named as inventors on this patent. The remaining authors declared that they have no conflict of interest., (© 2025. The Author(s).)

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high mortality rate that is often underdiagnosed due to the limitations of current laboratory testing. Timely diagnosis and early identification of severe cases are crucial to improving patient outcomes and overall survival rates. This study aimed to evaluate the efficacy of two transcripts, IFI44L and PI3, in the early differentiation between SFTS virus (SFTSV) infection and bacterial sepsis, as well as in the prompt identification of severe cases during epidemic seasons. In a prospective study conducted between 1 May 2021 and 30 September 2022, we enrolled 225 patients who presented with acute fever and thrombocytopenia at four hospitals in Shandong Province, China. The two-transcript signature provided a clear distinction between SFTS and bacterial infection, achieving an area under the receiver operating characteristic curve of 0.961 (95% confidence interval [95% CI] 0.916-0.986), outperforming C-reactive protein (0.810 [95% CI 0.738-0.870]) and procalcitonin (0.764 [95% CI 0.687-0.830]). Importantly, the relative expression of the IFI44L gene was significantly elevated in fatal SFTS cases, with an area under the curve (AUC) of 0.820 (95% CI 0.727-0.914), indicating its potential as an early prognostic marker. Additionally, IFI44L and PI3 were identified as potential biomarkers for distinguishing SFTS patients with and without invasive pulmonary aspergillosis, with AUC values of 0.817 and 0.753, respectively. Our findings demonstrate that the two-transcript signature effectively distinguishes SFTSV infection from bacterial sepsis and helps identify high-risk individuals, guiding appropriate treatment during SFTS outbreak., Competing Interests: The authors declare no conflict of interest.

Background: Thoracic aortic pathologies involving the aortic arch are a great challenge for vascular surgeons. Maintaining the patency of supra-aortic branches while excluding the aortic lesion remains difficult. Thoracic EndoVascular Aortic Repair (TEVAR) with fenestrations provides a feasible and effective approach for this type of disease. The main purpose of this trial is to assess the safety and validity of extracorporeal fenestration and in situ fenestration in patients with aortic disease involving the left subclavian artery., Methods: This is a prospective, single-center, randomized controlled study. A total of 170 eligible patients will be recruited from The Fourth Affiliated Hospital, Zhejiang University School of Medicine in China and randomized on a 1:1 basis either to the group A (extracorporeal fenestration) or the group B (in situ fenestration). The primary outcome will be the all-cause mortality (30 days). The secondary outcomes will include incidence of secondary intervention (30 days, 6 months, 1 year), incidence of endoleak (30 days, 6 months, 1 year), incidence of major adverse events (MAE) (i.e., immediate procedural success and complications) (30 days, 6 months, 1 year), immediate technical success rate, and all-cause mortality (6 months, 1 year)., Discussion: Suppose extracorporeal fenestration non-inferior to in situ fenestration in patients with aortic disease involving the left subclavian artery. This trial aims to demonstrate the safety and validity of extracorporeal fenestration and in situ fenestration in patients with aortic disease involving the left subclavian artery, which is expected to provide a reference for Thoracic EndoVascular Aortic Repair (TEVAR) with fenestrations., Trial Registration: ClinicalTrials.gov NCT06256757. Registered on February 5, 2024. https://clinicaltrials.gov/study/NCT06256757 ., Competing Interests: Declarations. Ethics approval and consent to participate {24}: The study has been approved by the Ethical Committee of The Fourth Affiliated Hospital Zhejiang University School of Medicine (Approval No: K2024031). Consent for publication {32}: Not applicable. Competing interests {28}: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Background: The relationship between serum ferritin levels and the risk of gestational diabetes mellitus (GDM) remains unclear. This study aimed to investigate the association between serum ferritin levels and the incidence of GDM., Methods: We conducted a prospective cohort study involving 10,871 pregnant women from the China Birth Cohort Study. Serum ferritin levels were measured using the direct chemiluminescence method in the first and second trimesters. Baseline serum ferritin levels were categorized into five groups according to quintiles in the first trimester, and trimester-specific median values were used to divide serum ferritin levels into four subgroups. GDM was determined by a 75 g oral glucose tolerance test at 24-28 weeks of gestation. Multivariate modified Poisson regression was performed to estimate the independent relationship between serum ferritin levels and the incident GDM., Results: The median serum ferritin level in the first trimester was 57.7 ng/mL, and 13.5% of participants developed GDM. After multivariate adjustment, the RRs and 95% CIs for incident GDM across baseline serum-ferritin quintiles were 1.099 (0.940-1.285), 1.228 (1.055-1.430), 1.186 (1.018-1.383) and 1.179 (1.017-1.367), respectively. Furthermore, participants with low serum ferritin levels in the first trimester that increased to high levels in the second trimester (RR = 1.376, 95% CI: 1.169-1.612) and those with consistently high serum ferritin levels in the first and second trimesters (RR = 1.351, 95% CI: 1.185-1.541) had a significantly increased risk of GDM., Conclusions: Changes in serum ferritin levels are independent risk factors for GDM. These findings underscore the importance of maintaining iron metabolism at an appropriate level during early to mid-pregnancy to reduce the risk of developing GDM., Competing Interests: Declarations. Ethics approval and consent to participant: Ethics approval was provided by Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital (approval number: 2018-KY-003-02). Informed, written consent was obtained from of all the participants. CBCS adhered to the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: Currently, most studies only focus on the glucose management level and self- management behavior of pregnant women with gestational diabetes mellitus, but lack analysis and discussion on their decision-making behavior and influencing factors during glucose management., Aim: This study aimed to investigate the decision-making behavior of blood glucose management and its influencing factors among pregnant women with gestational diabetes mellitus in China., Methods: This was a prospective study. A convenience sampling method was used to select pregnant women with gestational diabetes mellitus. A total of 1,405 pregnant women with gestational diabetes mellitus from eight hospitals in China were included between June 1 and December 31, 2023. Three types of questionnaires on knowledge, protection motivation, and decision-making behavior regarding blood glucose management were administered to participants. Multivariable logistic regression was conducted to determine the decision-making behavior of blood glucose management and its influencing factors (P<0.05)., Results: The mean score of the glucose management knowledge was 39.56 ± 8.45 points (standard score 65.9%). The score for decision-making behavior was 70.05 ± 9.85 points (standard score 93.4%). Most dimensions of protection motivations were higher than 20 points (standard score 80.0%)., Conclusions: The mean score for glucose management knowledge was at a medium score level. Most dimensions of protection motivations were at a high or medium score level. The decision-making behavior was at a high score level. The pregnant women with rich glucose management knowledge and protection motivation are more likely to take active decision-making behaviors and actively manage their blood glucose levels. The influencing factors of decision-making behavior included length of time after diagnosed with gestational diabetes mellitus, gestational diabetes mellitus history, self-efficacy, severity, susceptibility, response efficacy, and response costs (P<0.05, for all)., Competing Interests: Declarations. Human Ethics and Consent to Participate: This study adhered to the principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of the Affiliated Hospital of Qingdao University, China (QYFYWZLL27887). All participants agreed to participate in this study voluntarily with the informed consent of participation. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To examine the associations of single-nucleotide polymorphisms (SNPs) within interleukin-6 (IL6) and IL-6 receptor (IL6R) as well as several potential SNPs revealed in a genome-wide association study (GWAS) with clinical response to tocilizumab (TCZ) in Chinese rheumatoid arthritis (RA) patients., Methods: A total of 23 SNPs were genotyped in 68 RA patients receiving intravenous TCZ, who were prospectively followed for 6 months to determine the clinical response based on several criteria, including clinical disease activity index (CDAI) low disease activity (LDA) and remission, disease activity score in 28 joint counts - erythrocyte sedimentation rate (DAS28-ESR) LDA and remission, European League Against Rheumatism (EULAR) good response and change in DAS28-ESR (ΔDAS28-ESR)., Results: The patients were on average 51.16 (13.23) years, and 55 were female (80.88%) and 47 were bDMARD-naïve (69.12%). After adjusting potential confounding factors, IL6R rs35717427 and GALNT18 rs4910008 were significantly associated with CDAI LDA, and IL6R rs11265621, rs6690230 were significantly associated with EULAR good response, DAS28-ESR LDA and remission. In addition, IL6 2069840 was found to be significantly associated with DAS28-ESR remission, and rs10108210, CLEC2D rs1560011 and KCNMB1 rs703505 were found to be significantly associated with ΔDAS28-ESR., Conclusion: Genetic polymorphisms hold the potential as predictive biomarkers for clinical response to TCZ, which might aid in individualized treatment with TCZ in Chinese patients with RA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Insulin resistance (IR) is often present in diabetes, which imposes a heavy burden on the prevention and treatment of diabetes. Triglyceride glucose index (TyG) is simple, reliable and reproducible in detecting IR, and has great advantages in predicting the risk of diabetes. The aim of this study was to analyze the potential association between TyG and the risk of diabetes in Chinese middle-aged and older adults using a prospective cohort study design., Methods: This study used longitudinal data from five waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, 2018, and 2020, involving 5886 participants. We used Cox proportional risk regression modeling to investigate the association between TyG index and the risk of new-onset diabetes, and decision tree analysis to identify high-risk groups for diabetes. Finally, ROC curves were applied in order to construct a predictive model for diabetes., Results: A total of 1054 (17.9%) participants developed diabetes throughout the 9-year follow-up. Our study utilized a multivariate Cox proportional risk regression model and found a significant correlation between TyG index and diabetes risk. The analysis also revealed a nonlinear relationship between TyG index and diabetes risk.Receiver Operating Characteristic(ROC) curve analysis showed that the Area under the curve(AUC) area of TyG index in predicting the risk of new-onset diabetes was 0.652 (P < 0.05)., Conclusions: TyG index can be used as a risk factor for predicting new-onset diabetes in the middle-aged and elderly population in China. In addition, there was a nonlinear relationship between TyG index and diabetes. Improving insulin resistance by regulating glucose and lipid metabolism plays an important role in the primary prevention of diabetes., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted and approved by the Biomedical Ethics Review Committee of Peking University in accordance with the principles of the Declaration of Helsinki. In addition, all participants provided written informed consent to participate in the study (IRB approval number IRB00001052-11015). This study does not disclose any personal privacy of the participants and does not violate data protection laws.The research has been performed in accordance with the Declaration of Helsinki. Consent for publication: Inapplicability. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The prognostic value of Chlamydia pneumoniae (Cpn) infection in postoperative lung cancer patients remains unclear. This study aimed to evaluate the association between Cpn infection and survival in lung cancer patients., Methods: This study included 309 newly diagnosed primary lung cancer patients from three hospitals in Fuzhou, China. Chlamydia pneumoniae IgG and IgA antibodies were detected using a micro-immunofluorescence kit and a unified questionnaire was used to collect demographic and clinical information. Follow-up was conducted every six months until August 25, 2022, or death. Patients were followed up for a median duration of 74 months. Overall survival was compared between Cpn IgA and IgG positive/negative patients. Statistical analysis included the χ2 test, Kaplan-Meier method, Log-rank test, and Cox proportional hazards regression model., Results: Cpn IgA infection status was found to be associated with lymph node metastasis in lung cancer patients. The overall survival of patients with Cpn IgA(++) was shorter compared to negative and positive patients(with IgA(-) group as the control group, P < 0.001, HR = 5.441, 95%CI: 2.341-12.645). Serum IgA positivity indicated chronic infection and was associated with poor prognosis. Multivariate analysis confirmed that Cpn IgA(++) infection was an independent risk prognostic factor for operable lung cancer patients (with IgA(-) group as the control group, HR = 3.39, 95%CI: 1.41-8.17)., Conclusion: This study suggests that Cpn infection is an independent prognostic factor in lung cancer patients. Further research is needed to understand the underlying mechanisms and explore the potential of Cpn as a biomarker or therapeutic target for lung cancer., Competing Interests: Declarations. Ethics approval and consent to participate: Approval was obtained from the ethics committee of Fujian Medical University (Fuzhou, China). The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: Triglyceride-glucose (TyG) index was regarded as a cost-efficient and reliable clinical surrogate marker for insulin resistance (IR), which was significantly correlated with cardiovascular disease (CVD). However, the TyG index and incident CVD in non-diabetic hypertension patients remains uncertain. The aim of study was to explore the impact of TyG index level and variability on risk of CVD among non-diabetic hypertension patients., Methods: A total of 9313 hypertensive patients without diabetes aged 30-70 years in Jiangsu Province who participated in the baseline survey from January 2010 to December 2010 and were followed up to May 2020 were included in this study. The TyG index was calculated as ln [fasting triglyceride (TG) (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2] and variation degree was calculated as the TyG index at first year follow-up (2011) minus that at baseline (2010). Cox proportional analysis regression and restricted cubic spline were used to investigate the association between TyG index level as well as variability and CVD risk., Results: Of 9313 included participants, 5423(58.23%) were female. During a mean follow-up of 8.32 ± 1.43 years, 890(9.56%) CVD events was identified. Cox regression analysis showed that with the highest TyG index in Q4 group at baseline, the incidence of CVD risk increased by 33.6% after adjustment for multiple confounders compared to Q1 group. Compared with TyG index variation degree 0 ~ < 1, the hazard ratios (HR) and 95% confidence interval (CI) respectively in < 0, 1 ~ < 2 and 2 ~ were 0.326(0.276, 0.384), 3.216(2.697,3.835) and 4.225(3.359,5.314). The restricted cubic spline indicated that there was a non-linear dose-response relationship between the change degree of TyG and risk of CVD. Similar results were obtained by subgroup analysis and sensitivity analysis., Conclusion: Elevated TyG index may be used as a surrogate for IR and help optimize risk stratification of CVD as well as prevention and management., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the ethical review committee of the Jiangsu Provincial Center for Disease Control and Prevention (SL2015-B004-01). All respondents were informed about the purpose of the study and consented to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk., Methods: Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011-2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011-2015) and new stroke incidence (2015-2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings., Results: In the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09-1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05-2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01-1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21-2.24) in T2 and 1.54 (95% CI: 1.08-2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups., Conclusions: Elevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical permission was granted by Peking University Institutional Review Board (IRB00001052-11015), and signed informed consent was obtained from each subject prior to inclusion. The data were extracted for secondary analysis, thereby obviating the need for additional ethical approval. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The safety of the COVID-19 inactivated vaccine on pregnancy outcomes in couples undergoing assisted reproductive technology remains uncertain due to limited and speculative evidence. Existing studies primarily focus on the vaccination status of females, with scant information available regarding the vaccination status of male partners. Moreover, there is minimal research tracking live birth outcomes., Objective(s): The objective of this study was to evaluate the impact of COVID-19 inactivated vaccine administration on the outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in infertile couples in China., Methods: This prospective cohort study involved couples undergoing IVF treatment at Sichuan Jinxin Xinan Women & Children's Hospital from August 2021 to September 2022. Based on whether they received vaccination before ovarian stimulation, the couples were divided into the vaccination group and the non-vaccination group. We compared the laboratory parameters and pregnancy outcomes between the two groups., Results: After performing propensity score matching (PSM), we observed similar live birth rates (41.23% vs. 44.08%, P = 0.555), clinical pregnancy rates (52.61% vs. 54.98%, P = 0.625), biochemical pregnancy (62.56% vs. 63.98%, P = 0.762), and ongoing pregnancy rates (49.76% vs. 51.18%, P = 0.770) between the vaccinated and unvaccinated women. Also, no significant disparities were found in terms of embryo development and laboratory parameters between the groups. Moreover, male vaccination had no impact on patients' pregnancy outcomes in assisted reproductive technology (ART) treatments (all P > 0.05). Additionally, there were no observable effects of vaccination on embryo development and pregnancy outcomes among couples undergoing ART (all P > 0.05)., Conclusion(s): The findings suggest that COVID-19 vaccination did not have a significant effect on patients undergoing IVF/ICSI with fresh embryo transfer. Therefore, it is recommended that couples should receive COVID-19 vaccination as scheduled to help mitigate the COVID-19 pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The Cardiovascular-kidney-metabolic (CKM) syndrome, a concept recently proposed by the American Heart Association (AHA), highlights the intricate connection between metabolic, renal, and cardiovascular illnesses. Furthermore, the Atherogenic Index of Plasma (AIP), a useful biomarker for evaluating the risk of Cardiovascular Diseases (CVDs), has been associated with the risk of Adverse Cardiovascular Events (ACEs). Nonetheless, its precise function in populations in CKM syndrome Stages 0-3 remains unknown., Methods: This prospective study analyzed the data of 7,708 eligible participants (aged ≥ 45 years) from the Chinese Longitudinal Research of Ageing (CHARLS), particularly the 2011-2012 baseline survey (Wave 1). The primary exposure variable was AIP-a natural logarithm of the ratio of Triglycerides (TGs) to High-Density Lipoprotein Cholesterol (HDL-C). On the other hand, the primary endpoint was CVD incidence, which was determined based on self-reported past diagnoses. The relationship between AIP and CVD risk in the population in CKM syndrome stages 0-3 was examined using a Cox proportional risk model. Subgroup and mediation analyses were performed to further elucidate the interactions among these factors., Results: This study involved 7,708 participants in the CKM syndrome stages 0-3 [Mean age = 58.00 years; Interquartile Range (IQR) = 52.00-65.00 years]. The risk of developing CVD increased significantly with higher AIP levels. Specifically, the risk ratio for each unit increase in AIP was 1.31 (95% CI 1.11-1.55), while the Hazard Ratio (HR) for the group with the highest AIP levels compared to the group with the lowest AIP levels was 1.22 (95% CI 1.08-1.39). Mediation analysis revealed that metabolic syndrome accounted for 12.3% of the association between AIP levels and CVD risk (p = 0.024), highlighting its significance in CVD risk assessment., Conclusion: Herein, AIP levels correlated significantly positively with CVD risk in individuals in CKM stages 0-3, with metabolic syndrome as a key mediating factor. These findings suggest that AIP levels could be valuable not only for CVD risk assessment but also for clinical screening., Competing Interests: Declarations. Ethical approval: The research was approved by the Peking University Institutional Review Board and carried out in compliance with the ethical standards outlined in the Declaration of Helsinki. Field personnel performed standardized, verified interviews in compliance with the Declaration of Helsinki’s ethical norms and with approval from the Peking University Institutional Review Board, and all participants gave their informed permission. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: During the first wave of the COVID-19 outbreak in China, the surge of COVID-19 cases was rapid and drastic. Emerging evidence suggests that beyond the acute phase, patients with COVID-19 may experience a wide range of postacute or long COVID sequelae. However, the mechanism and burden of COVID-19, especially long COVID, have not yet been comprehensively clarified. To fill this knowledge gap, this large prospective follow-up study aims to investigate the short-term and long-term effects of COVID-19, explore the underlying biological mechanism and identify predictive neuroimaging and haematological biomarkers associated with these effects., Methods and Analysis: This multicentre study will recruit patients infected during the first wave of COVID-19 in China and healthy controls (HCs) with no history of COVID-19 infection from nine participating hospitals. Confirmed patients with mild or moderate COVID-19 will complete the following programmes during the acute infection phase and at 3, 12 and 24 months after infection: (a) blood test at the local laboratory, (b) multimodal brain and spine MRI scan and (c) the neuropsychological scales and questionnaires. Similarly, the uninfected HCs will complete the same programmes as the infected group mentioned above at the time of inclusion. At the first time point, 501 participants (418 patients and 83 HCs) from nine recruiting hospitals have been observed. Ultimately, all of these results will be analysed to explore the short-term and long-term effects of COVID-19., Ethics and Dissemination: Ethics approval was granted by Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2023LSK-013). Findings will be presented at national and international conferences, as well as published in peer-reviewed scientific journals., Trial Registration Number: NCT05745805., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

We assessed the safety and efficacy of rhFSH-CTP, a novel long-acting FSH agent, in controlled ovarian hyperstimulation for patients undergoing ART. A multi-center, open-label, randomized, positive-control, non-inferiority clinical trial was conducted. The study consisted of a phase III randomized design, with a 1:1 ratio favoring the rhFSH-CTP group over the control group. Eligible patients in the rhFSH-CTP group received a single dose of rhFSH-CTP at 100-150 µg for the first 7d of stimulation following a gonadotropin-releasing hormone antagonist protocol. In total, 142 and 141 patients received rhFSH-CTP and rhFSH, respectively. At a confidence interval of 95%, the difference in the number of oocytes (1.13-4.22, 2.67) suggested that rhFSH-CTP was not inferior to rhFSH. Additionally, the top-quality embryos, implantation rates, and pregnancy outcomes were similar between the two groups (P > 0.05). In the rhFSH-CTP group, no cases of severe OHSS were observed, which was a significant improvement compared to the 1.4% incidence in the rhFSH group. With regard to another safety endpoint, no patients tested positive for adenosine deaminase (ADA) in the rhFSH-CTP group. The results demonstrated that the product had a comparable safety profile to pregnancy outcomes and newborn information in the control group, indicating its suitability for use., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The studies were approved by the Ethics Committee of all the 13 Hospital in China, including The First Affiliated Hospital of Anhui Medical University (PJ2019-17-07(6)), The First Hospital of Peking University (SZSJ-2019-001), Beijing Obstetrics and Gynecology Hospital, Capital Medical University (2020-YW-013-03), Tianjin Central Obstetrics and Gynecology Hospital (2020YS007-01), The Sixth Affiliated Hospital of Sun Yat-sen University (2021ZSLYEC-427), The First Affiliated Hospital of Hainan Medical University (2021-YW-123),Wuhan Tongji Reproductive Medicine Hospital (2020(65)-3), The Third Affiliated Hospital of Guangzhou Medical University(2021 − 157), The Affiliated Hospital of Inner Mongolia Medical University (NO.SY(2022017)), Nanchang Reproductive Hospital (2021-003), Shengjing Hospital of China Medical University (2021PS117), Women’s Hospital School of Medicine Zhejiang University (IRB-20220001-D) and Suzhou municipal Hospital (Y-2021-038-H01). The patients/participants provided their written informed consent to participate in this study., (© 2025. The Author(s).)

Purpose: NHHR, the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, is a novel lipid marker associated with the risk of heart diseases and various health conditions. However, there is limited evidence regarding the relationship between NHHR and the onset of hypertension and heart diseases. The aim of this study was to investigate the association between NHHR and the new-onset hypertension and heart diseases among the Chinese middle-aged and older general population., Methods: This prospective cohort study utilized data from a nationally representative sample of Chinese residents aged 45 and older, sourced from the China Health and Retirement Longitudinal Study (CHARLS). The primary outcomes of the study were new-onset hypertension and heart diseases. To investigate the relationship between the NHHR and the risk of new-onset hypertension and heart diseases, multivariate logistic regression models and the restricted cubic spline (RCS) method were employed. Additionally, the mediating effects of hypertension on the association between NHHR and heart diseases were assessed using the bootstrap method., Results: A total of 5349 participants were included in the final analysis and three groups of NHHR were identified, including low-stable, medium-stable, and high-stable NHHR. By 2020, 1,631 participants (30.5%) had been newly diagnosed with hypertension, while 1233 (23.1%) developed heart diseases. Compared to those with a low-stable NHHR, individuals in the other two groups showed a significantly increased risk of developing hypertension and heart diseases. The findings remained consistent across various sensitivity analyses. According to the RCS analysis, a partial U-shaped relationship existed between the NHHR and the risk of developing hypertension and heart diseases (P for nonlinear < 0.001). Furthermore, hypertension was found to partially mediate the association between NHHR and heart diseases., Conclusion: The NHHR was closely associated with an increased risk of developing hypertension and heart diseases. In addition, the NHHR partially mediated the development of heart diseases by promoting hypertension progression. In the prevention and treatment of heart diseases, managing both lipid levels and blood pressure is crucial., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: After the coronavirus disease 2019 (COVID-19) pandemic, no studies on bacterial and atypical pathogens were conducted in primary care. We aimed to describe the etiological composition of acute respiratory tract infections (ARTIs) presenting to primary care with limited resources after the pandemic., Methods: 1958 adult patients with ARTIs from 17 primary care clinics were recruited prospectively from January 2024 to March 2024. 17 and 62 pathogens in throat swab samples were tested using polymerase chain reaction (PCR) and targeted next-generation sequencing (tNGS), respectively. We analyzed the pathogen spectrum and co-infectious pattern of viral, bacterial or atypical pathogens. Then, the associations between clinical characteristics and pathogens were investigated., Results: In PCR test, the positive rate of any pathogens was 80.3%, consisting of 60.2% for viruses, 41.8% for bacteria and 21.7% for viral-bacterial co-infection. In tNGS test, the positive rate was 89.1%, consisting of 64.7% for viruses, 55.2% for bacteria and 30.9% for viral-bacterial co-infection. Influenza virus B (18.2%), influenza virus A (16.8%) and severe acute respiratory syndrome coronavirus 2 (14.1%) were the three leading viral pathogens, and H. influenzae (36.1%), S. anginosus (15.7%) and S. pneumoniae (8.4%) were the three leading bacterial pathogens. Few M. pneumoniae (1.6%) were detected. The mixed bacterial or mixed viral-bacterial co-infections were the most common co-infectious patterns. The mixed bacterial or mixed viral-bacterial co-infections were the most common co-infectious patterns. Overall, patients with viral infection or viral-bacterial co-infection had more clinical symptoms, and patients with bacterial infection had higher inflammatory indicators., Conclusions: After the COVID-19 pandemic, the main viral pathogens of ARTIs were unevenly distributed, and less bacterial and atypical pathogens were detected in primary care. The microbiological evidences can optimize the precision diagnosis and treatment of ARTIs in primary care with limited resources., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Review Committee at Shenzhen People’s Hospital (LL-KY-2024127-02). At recruitment, all participants gave informed consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Background: Critical care nurses are vulnerable to depression, which not only lead to poor well-being and increased turnover intention, but also affect their working performances and organizational productivity as well. Work related factors are important drivers of depressive symptoms. However, the non-liner and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses has not been adequately analyzed. Understanding these relationships would be helpful for reducing depression, increasing nurses' well-being and retain healthcare forces., Methods: This was a cross-sectional study using baseline data from the Nurses' mental health study (NMHS), a prospective cohort study on nurses from 67 tertiary hospitals in 31 province-level administrative regions in China. Only clinical nurses working in the ICU were included (n = 13,745). Data were collected using online questionnaires, and analyzed using network analysis and structural equation model. Job demands (average working hours per week, average number of night shifts per month, paperwork burden and work-life balance), job resources (supervisor support, co-worker support, leader justice, organizational climate satisfaction, work meaning, and career prospect), personal resource (resilience) and depressive symptoms were main variables in the networks, while demographic data and social health (social-emotional support and loneliness) were covariates., Results: The prevalence of severe, moderately severe, moderate, mild, and none or minimum depressive symptoms in critical care nurses of this study were 1.21, 3.42, 9.76, 42.88, and 42.07% respectively. In the final network, 132 of 210 possible edges (62.8%) were not zero. "Fatigue" had the highest expected influence, followed by "Motor", and "Appetite". Meanwhile, in terms of job demands-resources and personal resources, the node with the highest expected influence was "Supervisor support", followed by "Work meaning" and "Co-worker support". Three bridge variables were identified: "Resilience-adaptation", "Average working hours per week", and "Co-worker support". The final structural equation model basically supported the results of network analysis with an acceptable model-fit (GFI = 0.918, AGFI = 0.896, PCFI = 0.789, PNFI = 0.788, NFI = 0.909, IFI = 0.911, CFI = 0.911, SRMR = 0.040, and RMSEA = 0.064)., Conclusions: There was a rather strong interconnectedness between depressive symptoms and job demands-resources. Fatigue, motor, and appetite were core depressive symptoms of critical care nurses. Close attention to those symptoms could help recognize depression in critical care nurses. Supervisor support, work meaning, and co-worker support played vital roles as job resources in reducing depression, while negative impact of long average working hours per week were more contagious. Resilience, as personal resources, could help mediate the associations between job demands-resources and depression. In clinical practice, it's recommended for nursing managers to (1) encourage critical care nurses to find their "meaning in work", (2) implement resilience enhancing programs for nurse, (3) build and maintain meaningful relationships with nurses and support them in daily work, and (4) create a harmonious and dedicated working environment where co-workers are willing to help and support each other. Improvements in those modifiable aspects could help reduce risk and prevent exacerbations of depressive symptoms in critical care nurses., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval for the NMHS study (Ethics approval number: LYF20230048) was obtained from the Ethics Committee of the Second Xiangya Hospital of Central South University, the leading institute of the whole project. Participants were informed about the aims of the NMHS study, the data collection process, the benefits and risks of participation, confidentiality, the use of data for research purposes only, and the ability to withdraw from the study at any time. Informed consent was obtained from each participant. The NMHS study has been registered in the Chinese Clinical Trial Registry (No: ChiCTR2300072142). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Acute type A aortic dissection (AAD) and acute type A intramural hematoma (AIMH) are life-threatening conditions with high mortality rates, and prognostic indicators are critical for guiding urgent treatment decisions. We assessed the prognostic significance of admission D-dimer levels in patients with AAD and AIMH., Methods and Results: The prospective, multicenter, observational study in China recruited participants from 2013 to 2019. Patients with AAD and AIMH were respectively categorized into quartiles based on admission D-dimer levels. Cox regression analysis was used to assess the association between D-dimer levels and mortality. A total of 3132 patients with AAD (mean age: 50.63 years [SD, 12.56]) and 353 patients with AIMH (mean age: 59.63 years [SD, 11.00]) were included. In patients with AAD, overall mortality rates increased across D-dimer quartiles: 13.7% (Q1, ≤0.72 mg/L), 16.7% (Q2, 0.72-1.91 mg/L), 22.8% (Q3, 1.91-4.21 mg/L), and 28.5% (Q4, 4.21-20.00 mg/L). In patients with AIMH, mortality rates by quartile were 3.4% (Q1, ≤0.51 mg/L), 5.7% (Q2, 0.51-1.25 mg/L), 4.6% (Q3, 1.25-3.44 mg/L), and 10.2% (Q4, 3.44-20.00 mg/L). After adjusting for confounders, D-dimer was an independent predictor of overall mortality (hazard ratio [HR], 1.42 [95% CI, 1.11-1.80]) and in-hospital mortality (HR, 1.47 [95% CI, 1.13-1.92]) in patients with AAD. D-dimer levels were not significantly associated with the overall (HR, 2.61 [95% CI, 0.70-9.73]) or in-hospital mortality (HR, 1.78 [95% CI, 0.44-7.24]) of patients with AIMH by multivariable adjustment., Conclusions: Elevated admission D-dimer levels are independently associated with higher mortality in patients with AAD but are not significantly associated with prognosis in patients with AIMH. Our findings suggest that D-dimer may serve as a useful prognostic marker in patients with AAD., Registration: www.chictr.org.cn. Unique identifier: ChiCTR230006854.