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- 摘要：ObjectiveTo meet the new requirements of digital and intelligent medical talent development under the "New Medical Science" initiative, this study aimed to establish the "Cloud-Track-AI-Collaborative" training model and validate its feasibility and effectiveness.MethodsIntegrating three core elements, namely an educational cloud platform, dual-track teaching (problem-based learning plus team-based learning), and artificial intelligence assistance, we developed an integrated "Cloud-Track-AI-Collaborative" training model. A total of 120 professional master's degree students in clinical medicine rotating through the Department of Thoracic Surgery at Tangdu Hospital, Air Force Medical University, from January to December 2025 were selected as participants. These students were divided into 12 batches and randomly assigned to either the experimental group ("Cloud-Track-AI-Collaborative" model, n=60) or the control group (dual-track teaching only, n=60). After the rotation period, learning outcomes and evaluations were compared between the two groups. SPSS 26.0 was used for statistical analysis.ResultsThe experimental group scored higher than the control group in theoretical knowledge [(44.18±3.12) vs. (40.13±3.48) points], procedural skills [(43.82±3.01) vs. (39.52±3.42) points], specialty competency [(42.87±3.24) vs. (38.73±3.58) points], all dimensions of professional practice competency [e.g., clinical reasoning (22.93±1.11) vs. (20.85±1.16) points], all dimensions of thesis defense, and all items of teaching evaluation (all P<0.001).ConclusionsThe "Cloud-Track-AI-Collaborative" training model effectively enhances the comprehensive competencies and learning satisfaction of professional master's degree students in medicine, providing a feasible and systematic pathway for the training of AI-empowered medical professionals.关键词：Medical education;Cloud-Track-AI-Collaborative model;Educational cloud platform;Artificial intelligence;Dual-track teaching1|0|0更新时间：2026-11-02
- 摘要：ObjectiveTo investigate the key factors influencing satisfaction with journal club (JC) activities among professional master's students in anesthesiology and provide data to support the optimization of activity organization strategies and the improvement of research training effectiveness.MethodsThis retrospective study included 383 JC activity records collected from the School of Anesthesiology, Xuzhou Medical University. Satisfaction scores were used as the outcome measure, and the records were divided into high- and low-satisfaction groups according to the median total satisfaction score. Data processing and statistical analyses were performed using the Python 3.12 programming environment. All continuous variables exhibited skewed distributions and were expressed as medians and interquartile ranges, while categorical variables were expressed as frequencies and percentages. Between-group comparisons were performed using the Mann-Whitney U test or the chi-square test according to the type of variable. A multivariable logistic regression model was constructed with group assignment based on the median total satisfaction score as the dependent variable. In addition, a light gradient boosting machine model combined with SHapley Additive exPlanations analysis was used to provide supplementary interpretation of variable importance and the direction of effects.ResultsBetween-group comparisons showed significant differences in activity duration (Z=8.35, P<0.001), literature quality score (Z=-2.81, P=0.005), and participation of interdisciplinary mentors (χ2=53.41, P<0.001) between the high- and low-satisfaction groups. Multivariable logistic regression analysis showed that activity duration (odds ratio [OR]=0.98, 95%CI: 0.98-0.99, P<0.001), literature quality score (OR=1.03, 95%CI: 1.00-1.06, P=0.040), and participation of interdisciplinary mentors (OR=1.39, 95%CI: 1.26-1.53, P<0.001) were significant factors influencing satisfaction. Activity duration was negatively associated with high satisfaction, whereas literature quality score and participation of interdisciplinary mentors were positively associated with high satisfaction. The light gradient boosting machine model combined with SHapley Additive exPlanations analysis confirmed these regression findings: activity duration, participation of interdisciplinary mentors, and literature quality score ranked among the most important variables, and their primary directions of effect were generally consistent with those identified by the regression analysis.ConclusionsActivity duration, literature quality, and participation of interdisciplinary mentors are key factors associated with satisfaction with JC activities. An activity duration of 100-110 min may serve as a reference range for optimizing activity organization. Establishing a mechanism for inviting interdisciplinary mentors and prioritizing high-quality literature may help enhance the participation experience and improve the effectiveness of research training among professional master's students in anesthesiology.关键词：Journal club;Satisfaction;Influencing factor;Multivariable logistic regression;SHapley Additive exPlanations analysis1|0|0更新时间：2026-10-28
- 摘要：The application of large language models (LLMs) to generate medical multiple-choice questions (MCQs) has become one of the research hotspots in medical education assessment abroad. This article reviews the current application status, influencing factors, and evaluation methods of using LLMs for MCQ generation. Existing studies show that LLMs have clear advantages in shortening the item-writing cycle and generating structurally standardized first drafts of questions, and some generated questions have approached the level of expert-written ones in terms of content accuracy and authenticity. However, limitations still remain in the assessment of higher-order clinical reasoning, factual accuracy, distractor quality, and the stability of psychometric properties. Prompt design, model selection, and the introduction of external authoritative knowledge sources are all important factors affecting the quality of generated questions. On this basis, this paper proposes an artificial intelligence prompt framework for question generation and a preliminary quality evaluation framework for artificial intelligence-generated questions, along with a model of expert-artificial intelligence collaborative item writing, in order to provide a reference for LLM-assisted medical MCQ generation.关键词：Large language model;Multiple-choice question;Item writing;Medical education;Prompt1|0|0更新时间：2026-10-28
- 摘要：ObjectiveTo explore the latent classes of error orientation among nursing interns, analyze the differences and influencing factors of each class, and provide empirical evidence for improving the safety of clinical nursing practice.MethodsFrom September to November 2024, a total of 550 nursing interns from a tertiary grade A teaching hospital in Zhengzhou, Henan Province, were selected as research subjects by convenience sampling. The General Information Questionnaire, Error Orientation Scale, General Self-Efficacy Scale, Safety Sense Scale, Achievement Motivation Scale, Competence-Based Self-Esteem Scale, and Relation-Based Self-Esteem Scale were used for the investigation. Latent profile analysis was adopted to explore the latent profile characteristics of error orientation among nursing interns, and a logistic regression analysis was used to identify the influencing factors of different latent classes.ResultsA total of 550 nursing interns were included in the final analysis, and three latent classes of error orientation were identified, namely the candid prediction group (n=240, 43.64%), the passive avoidance group (n=234, 42.55%), and the active risk-taking group (n=76, 13.82%). Multinomial logistic regression analysis showed that self-efficacy (odds ratio [OR]=1.138, 95%CI: 1.043-1.242), safety sense (OR=1.043, 95%CI: 1.018-1.069), motivation to pursue success (OR=1.077, 95%CI: 1.004-1.155), motivation to avoid failure (OR=1.124, 95%CI: 1.057-1.195), competence-based self-esteem (OR=1.120, 95%CI: 1.040-1.206), and understanding of error events (OR=0.890, 95%CI: 0.854-0.928) were the influencing factors of latent profiles of error orientation among nursing interns (all P<0.05).ConclusionsError orientation among nursing interns presents heterogeneous characteristics. Nursing educators should promptly identify the latent class of error orientation and its influencing factors for nursing interns, and guide them to refuse error concealment, conduct standardized error reporting, learn from error cases, and improve professional competence. This approach is expected to promote the improvement of teaching quality and nursing quality, and safeguard patient safety.关键词：Nursing intern;Error orientation;Latent profile analysis;Influencing factor;Nursing education1|0|0更新时间：2026-10-28
- 摘要：ObjectiveTo construct a competency-based evaluation index system for standardized training of resident physicians in traditional Chinese medicine oncology, and to provide a theoretical framework for subsequent development of evaluation standards.MethodsFrom August to October 2025, a preliminary evaluation index system was constructed through literature analysis. The Delphi method was then applied, involving two rounds of consultation with 14 experts from traditional Chinese medicine oncology clinical practice, medical education, and hospital management. Kendall's W and coefficient of variation were used to assess the coordination and convergence of expert opinions.ResultsThe effective questionnaire response rates for both rounds were 100%, and the expert authority coefficients were both 0.79. The Kendall's W values were 0.20 and 0.22, respectively (P<0.01). The final competency-based evaluation index system for resident physicians in traditional Chinese medicine oncology comprises 6 first-level indicators (patient care, knowledge and skills, professionalism, communication and collaboration, teaching ability, and lifelong learning), 13 second-level indicators, and 37 third-level indicators.ConclusionsBy constructing the competency-based evaluation index system for resident physicians in traditional Chinese medicine oncology, this study provides a preliminary theoretical framework for the subsequent establishment of relevant evaluation standards. In the future, the analytic hierarchy process will be used to determine the weights of indicators at various levels, and multicenter empirical studies will be conducted to validate its scientific validity and application value.关键词：Competency;Traditional Chinese medicine oncology;Resident physician;Standardized training;System construction1|0|0更新时间：2026-10-28
- 摘要：ObjectiveTo evaluate the effectiveness of a whole-process model for cultivating scientific research thinking ability based on the Kirkpatrick model.MethodsFrom July 2024 to July 2025, 54 in-service nurses at the General Hospital of Eastern Theater Command were selected as the research participants. They were divided into an intervention group (n=27) and a control group (n=27) using the random number table method. The control group adopted the form of online course self-learning. The intervention group adopted the nurse research competence training program based on the whole-process teaching model. The teaching effects of both groups were evaluated using the reaction level, learning level, behavior level, and results level of Kirkpatrick's evaluation model. SPSS 27.0 was used to perform the chi-square test, t-test, and Mann-Whitney U test.ResultsAt the reaction level, the overall satisfaction score of the intervention group after training was higher than that of the control group [(85.26±6.17) points vs. (66.81±11.32) points, P<0.001]. At the learning level, the total score for research ability among nurses in the intervention group was higher than that of the control group [(61.31±22.02) points vs. (41.54±16.55) points, P=0.002]. At the behavior level, the intervention group's scores for innovative behavior [(38.12±8.16) points vs. (32.54±7.85) points, P=0.015] and self-efficacy [(27.00±7.29) points vs. (20.80±3.52) points, P<0.001] were both higher than those of the control group. At the results level, the difference in the number of research outputs between the two groups was statistically significant (P=0.006).ConclusionsThe step-by-step and comprehensive evaluation of the whole-process scientific research thinking ability training model through the Kirkpatrick model can effectively improve the scientific research thinking ability of nurses.关键词：Research competence;Nurse;Kirkpatrick model;Training program;Effect evaluation1|0|0更新时间：2026-10-28
- 摘要：ObjectiveTo investigate the effectiveness of augmented reality（AR）-assisted ultrasound in precise puncture of complex arteriovenous fistulas.MethodsA total of 75 Patients with complex arteriovenous fistulas who received regular hemodialysis treatment in The First Affiliated Hospital of Ningbo University from January to December 2023 were enrolled and divided into control group（using the traditional method for blind puncture），ultrasound intervention group，and AR-assisted ultrasound intervention group using a random number table，with 25 patients in each group. The three groups were compared in terms of baseline data，puncture outcomes，satisfaction score，and puncture pain score. A difference-in-differences model was used to analyze the satisfaction score and puncture pain score of the three groups. A Cox regression analysis was used to assess the impact of different interventions on the risk of complications in patients.ResultsCompared with the control group and the ultrasound intervention group，the AR-assisted ultrasound intervention group had a significantly shorter operation time，a significantly lower number of needle adjustments，and a significantly higher first-attempt success rate of puncture（P<0.05）. At 3 and 6 months of follow-up，the AR-assisted ultrasound intervention group had a significantly higher satisfaction score and a significantly lower puncture pain score than the other two groups（P<0.05）. The difference-in-differences analysis showed that compared with the ultrasound intervention group and the control group，AR-assisted ultrasound intervention significantly improved satisfaction score and reduced puncture pain score，and this intervention effect was further enhanced at 6 months of follow-up，with the improvement significantly greater than that in the control group and the ultrasound intervention group. At 6 months of follow-up，the AR-assisted ultrasound intervention group had a significantly lower overall incidence rate of complications than the control group（P<0.05）. The Cox regression analysis showed that with the control group as a reference and after adjustment for relevant confounding factors，AR-assisted ultrasound intervention still significantly reduced the risk of complications（P<0.05）.ConclusionAR-assisted ultrasound-guided puncture can significantly improve the success rate of puncture for complex arteriovenous fistulas，reduce the risk of puncture-related complications，and improve patient experience and long-term vascular prognosis，and therefore，it is a safe and effective strategy for precise puncture intervention.关键词：complex arteriovenous fistulas;augmented reality technology;Ultrasound;puncture;effectiveness3|0|0更新时间：2026-10-27
- 摘要：Motor dysfunction following stroke is a common sequela that significantly impairs the mobility and quality of life of patients. Conventional rehabilitation therapies primarily address motor deficits through repetitive training. However，patients often rely excessively on the unaffected limb，which may lead to suboptimal recovery. Constraint-induced movement therapy（CIMT） is a rehabilitation technique based on neuroplasticity that restricts use of the unaffected limb and promotes repeated use of the affected limb，thereby overcoming “learned nonuse” and serving as an effective approach for motor function improvement. Because the pathophysiological mechanisms differ considerably across the various phases of stroke，the therapeutic strategies and intervention outcomes of CIMT also vary by phase. Existing evidence suggests that CIMT can improve the structural and functional plasticity of the brain tissue，thereby improving motor function. However，CIMT still faces challenges such as the lack of unified standards for core parameters and insufficient evidence regarding its efficacy. This article provides a narrative review of the application of CIMT in the recovery of motor function in patients with stroke during the acute，subacute，and chronic phases，with a focus on its mechanisms of action，intervention parameters，and efficacy at each phase.关键词：stroke;constraint-induced movement therapy;motor function;different phases2|0|0更新时间：2026-10-27
- 摘要：With the successive approval and launch of lecanemab and donanemab in China，the first cohort of patients with Alzheimer’s disease who received these anti-amyloid-β monoclonal antibodies have gradually completed their predefined treatment courses or met the criteria for treatment discontinuation. However，existing domestic and international appropriate-use recommendations focus primarily on pretreatment screening and monitoring during treatment，while a systematic and practical framework for post-treatment stratified management，dynamic monitoring，and switching between antibodies remains lacking. In 2026，the Renji Cognitive Center published an experience-based protocol that systematically addresses this gap. Using quantitative Centiloid values obtained from amyloid positron emission tomography as an objective basis，the protocol establishes a two-axis stratified management framework based on amyloid clearance status and clearance rate to guide individualized adjustments to maintenance dose. It also proposes a two-step dynamic monitoring strategy after treatment discontinuation，consisting of initial screening with plasma phosphorylated tau 217 followed by confirmatory amyloid positron emission tomography，and provides practical recommendations for the interval for switching between antibodies based on their pharmacokinetic half-lives. Together，these measures establish a complete management pathway from treatment initiation to discontinuation，providing a valuable reference for the clinical practice of anti-amyloid-β monoclonal antibody therapy and for future consensus development in China.关键词：Alzheimer’s disease;β-amyloid;monoclonal antibody;sequential-like therapy;guideline interpretation2|0|0更新时间：2026-10-27
- 摘要：Ovarian cancer remains one of the gynecologic malignancies with the poorest prognosis. The 5-year survival rate of patients with advanced ovarian cancer has long remained at 40%-50%，with platinum resistance and recurrence representing the primary obstacles to improving treatment outcomes. In recent years，iron metabolic reprogramming has been recognized as an important metabolic feature of ovarian cancer. Ovarian cancer cells commonly exhibit increased expression of transferrin receptor，reduced expression of ferroportin，and expansion of the intracellular labile iron pool. This state of “iron addiction” supports rapid tumor proliferation and contributes to the development of chemoresistance. Moreover，iron signaling molecules regulate the polarization of tumor-associated macrophages，thereby contributing to the formation of an immunosuppressive microenvironment. Iron chelation therapy was initially used to treat hereditary hemochromatosis and transfusion-related iron overload. In recent years，its potential antitumor effects have been rediscovered. Agents such as deferiprone，deferasirox，and deferoxamine exert antitumor effects by depleting the iron available to tumor cells，inducing ferroptosis，and regulating iron metabolism in macrophages. This review summarizes the role of iron metabolic reprogramming in the development and progression of ovarian cancer and examines how iron signaling regulates the immune microenvironment. It also summarizes recent advances in iron chelation therapy and its prospects for clinical translation. In addition，this review systematically delineates the continuous regulatory network linking iron metabolic reprogramming，ferroptosis regulation，immune microenvironment remodeling，and therapeutic translation. This article integrates the relevant evidence from three dimensions，namely tumor cells，immune cells，and therapeutic strategies，and identifies the key issues that remain to be addressed in this field.关键词：ovarian cancer;iron metabolism;iron chelation therapy;ferroptosis;immune microenvironment2|0|0更新时间：2026-10-27
- 摘要：The prevalence of overweight and obesity among Chinese adults has increased annually and currently exceeds 50%. Beyond its substantial negative impact on patients’ quality of life，obesity is a well-established major risk factor for over 200 chronic conditions，including diabetes mellitus，hypertension，cardiovascular disease，and malignancies. This growing epidemic imposes a substantial and escalating burden on public health systems. In response to this challenge，the National Health Commission of China，in collaboration with 16 national departments including the Ministry of Education and the General Administration of Sport，launched the national “Weight Management Year” initiative to raise public awareness and promote clinical standardization of weight management across the country. In Chongqing，the prevalence of obesity and its associated metabolic diseases has continued to rise，representing a pressing public health challenge. According to the 2024 Annual Report on Resident Health Status in Chongqing published by the Chongqing Health Commission，in 2023，the overweight prevalence among adults aged 18 years and older in Chongqing was 35.48%，and the obesity prevalence was 16.42%. Along with the rising obesity prevalence，the prevalence of obesity-related metabolic diseases continues to increase，creating an urgent need to develop scientific，systematic weight management strategies tailored to the epidemiological characteristics of the local Chongqing population. In alignment with the national initiative，and to promote the standardization and normalization of clinical weight management，under the guidance of the Chongqing Health Commission，the Western China Alliance for Endocrine and Metabolic Obesity Diagnosis and Treatment，in partnership with the Endocrinology Branch and Diabetes Branch of the Chongqing Medical Association，organized a multidisciplinary panel of regional experts to develop the Expert Consensus on Standardized Clinical Pathway for Weight Management of Residents in Chongqing. This initiative aims to provide clinically practical，locally adapted guidance for clinical weight management practice in the region. This consensus defines obesity as a chronic disease requiring long-term，systematic management. Its scope covers core clinical domains including comprehensive weight assessment，lifestyle intervention，pharmacotherapy，bariatric metabolic surgery，management of weight regain，long-term weight maintenance，and multidisciplinary collaborative care. By establishing standardized，normalized clinical pathways for obesity management，this consensus aims to address the growing public health challenge posed by the obesity epidemic in Chongqing and ultimately improve the overall health level of the regional population.关键词：Chongqing;weight management;clinical pathway;expert consensus24|2|0更新时间：2026-10-27
- 摘要：Growth hormone plays a crucial role in human growth and development，and it also plays an important role in regulating fat metabolism. In recent years，an increasing number of clinical reports and research findings have shown that metabolic dysfunction-associated steatotic liver disease（MASLD） is closely associated with growth hormone deficiency（GHD），but the specific mechanism remains unclear. Therefore，this article mainly focuses on the pathophysiological mechanism of GHD in the development of MASLD，so as to provide a theoretical basis for the treatment of GHD-related MASLD.关键词：growth hormone;growth hormone deficiency;metabolic dysfunction-associated steatotic liver disease;etiology15|15|0更新时间：2026-10-27
- 摘要：ObjectiveTo investigate the safety and efficacy of a renal function-stratified insulin algorithm based on continuous glucose monitoring（CGM） in patients with diabetic kidney disease（DKD）.MethodsThis multicenter was conducted among the DKD patients with an estimated glomerular filtration rate eGFR of 15-60 mL/min/1.73 m2 who were treated in Shanxi Bethune Hospital，The First Hospital of Shanxi Medical University，the Second Hospital of Shanxi Medical University，Taiyuan Central Hospital，Yuncheng Central Hospital from January 2022 to December 2023，and at a ratio of 1∶1，the patients were randomly divided into algorithm intervention group and control group，with 78 patients in each group. The patients in the algorithm intervention group received a renal function（G3a/G3b/G4）-stratified insulin dosing algorithm based on CGM data，while those in the control group received standard insulin therapy. The primary outcome was the incidence rate of severe hypoglycemia（<3.0 mmol/L），and the secondary outcomes included time in range（TIR，3.9-10.0 mmol/L） and annual rate of eGFR decline.ResultsAll 156 patients completed the 24-week follow-up. Compared with the control group，the algorithm intervention group had a significantly lower incidence rate of severe hypoglycemia （0.35 vs. 1.12 events per person-year，IRR=0.31，Z=4.320，P<0.001），a significantly higher TIR［（68.3±7.5）% vs. （62.1±8.2）%，t=3.150，P=0.002］，and a significantly lower annual rate of eGFR decline （0.7 mL/min/1.73 m2，t=2.050，P=0.043）. The stratified analysis showed enhanced benefits in the patients with stage G3b renal function（Pinteraction=0.021）.ConclusionThe renal function-stratified insulin algorithm based on CGM can effectively reduce the risk of hypoglycemia，improve glycemic control，and delay renal function deterioration in DKD patients，especially in those with moderate-to-severe renal impairment（stage G3b）.关键词：diabetic kidney disease;continuous glucose monitoring;renal function stratification;insulin algorithm;safety11|6|0更新时间：2026-10-27
- 摘要：Metabolic dysfunction-associated fatty liver disease（MAFLD） has become the most prevalent chronic liver disease worldwide，with substantial heterogeneity in its clinical manifestations，disease progression，and treatment response. With the development of multi-omics technologies in recent years，the core role of lipid metabolism in the development and progression of MAFLD has gradually been clarified. With a focus on the heterogeneity in lipid metabolism mechanisms in MAFLD，this article systematically summarizes the variations of five major lipid metabolic pathways across patients with different MAFLD subtypes，i.e.，fatty acid uptake，de novo lipogenesis，lipid droplet homeostasis，very-low-density lipoprotein secretion，and fatty acid oxidation，and it also elaborates on how lipid metabolic pathways help to shape functional subtypes of MAFLD and drive clinical phenotyping based on genetic factors，immune-inflammatory responses，and spatial transcriptomic patterns. Based on current evidence，this article further summarizes precise treatment strategies for each metabolic subtype，including acetyl-CoA carboxylase/stearoyl-CoA desaturase 1 inhibitors，peroxisome proliferators-activated receptor agonists，farnesoid X receptor regulators，antioxidants，and anti-inflammatory agents，and the article also emphasizes the basic role and synergistic effect of lifestyle interventions in different metabolic subtypes. In the future，multi-omics typing models should be established based on related mechanisms to promote the application of individualized management strategies in clinical practice.. A deep understanding of the heterogeneity mechanism of lipid metabolism may lay a solid foundation for precise typing and intervention of MAFLD.关键词：metabolic dysfunction-associated fatty liver disease;heterogeneity;lipid metabolism;multi-omics;subtyping8|5|0更新时间：2026-10-27
- 摘要：Osteoporosis（OP） is a systemic bone disease closely associated with aging，and it is characterized by low bone mass，deterioration of bone tissue microarchitecture，and increased bone fragility. With the exacerbation of population aging in China，there has been a rapid increase in the prevalence rate of OP，and OP has become a serious public health concern. Recent studies have confirmed that cell senescence and mitochondrial dysfunction are two core mechanisms driving age-related OP，with the presence of profound crosstalk between them. The senescence of bone marrow mesenchymal stem cells disrupts the bone microenvironment through an “osteogenic-adipogenic” differentiation shift and the paracrine effect of the senescence-associated secretory phenotype（SASP），while mitochondrial dysfunction regulates osteoblast and osteoclast function through energy metabolism disorders，oxidative stress，impaired autophagy，and imbalance in mitochondrial dynamics. Mitochondrial dysfunction-associated senescence（MiDAS） acts as a critical hub，mediating the formation of a vicious cycle of “mitochondrial dysfunction→MiDAS→cell senescence→SASP→further mitochondrial impairment”，which accelerates bone metabolic imbalance. This article systematically reviews the mechanism of action of cell senescence and mitochondrial dysfunction in OP，with a focus on dissecting the MiDAS-mediated crosstalk，in order to provide a clear theoretical framework and potential targets for developing novel anti-OP therapies that target senescent cells or improve mitochondrial function.关键词：osteoporosis;cell senescence;mitochondrial dysfunction1|0|0更新时间：2026-10-27
- 摘要：ObjectiveTo investigate the efficacy of nutritional intervention in elderly patients with frailty，and to construct a predictive model for the outcome after nutritional intervention based on inflammatory factors and gut microbiota dysbiosis.MethodsThis prospective randomized controlled trial was conducted among 301 elderly patients with frailty who were treated in The First Affiliated Hospital of Air Force Medical University from June 2023 to May 2025，and the patients were divided into observation group（151 patients receiving systematic nutritional management） and control group （150 patients receiving routine nutritional support） using a random number table. Both groups received intervention for 3 months. Clinical data were collected，and the two groups were compared in terms of serum nutritional indices，nutritional and functional scores，and frailty status. The univariate and multivariate logistic regression analyses were used to identify the influencing factors for the efficacy of nutritional intervention，and a basic model（clinical features） and a complete model（clinical features+inflammatory factors+gut microbiota dysbiosis） were constructed. The receiver operating characteristic（ROC） curve was used to assess the predictive performance of the models，and the DeLong test was used for comparison of the area under the ROC curve（AUC）. A nomogram was constructed，and the Bootstrap method was used for internal validation. Calibration and decision curves were used to assess model performance.ResultsAfter intervention，compared with the control group，the observation group had significantly higher levels of serum total protein（STP），prealbumin（PA），albumin（Alb），and transferrin（TF） and significantly higher scores of Mini-Nutritional Assessment（MNA） and Activities of Daily Living（ADL）（P<0.05），as well as significantly lower Tilburg Frailty Indicator（TFI） scores for physical，social，and psychological frailty and total TFI score（P<0.05）. After intervention for 3 months，the patients were divided into good outcome group（219 patients with an MNA score of ≥24） and poor outcome group （82 patients with an MNA score of <24） according to their outcome after nutritional intervention. The logistic regression analysis showed that age ≥75 years（odds ratio［OR］=1.943，95%CI=1.039-3.631，P<0.05），cognitive impairment（OR=2.451，95%CI=1.069-5.618，P<0.05），gut microbiota dysbiosis（OR=4.658，95%CI=1.336-16.244，P<0.05），Charlson Comorbidity Index ≥3（OR=2.501，95%CI=1.257-4.976，P<0.05），elevated serum C-reactive protein （CRP） （OR=1.226，95%CI：1.142-1.316，P<0.05），and elevated serum interleukin-6（IL-6）（OR=1.141，95%CI=1.080-1.205，P<0.05） were independent risk factors for the outcome after nutritional intervention in elderly patients with frailty，whereas an increase in body mass index（BMI）（OR=0.577，95%CI=0.481-0.692，P<0.05） and systematic nutritional management（OR=0.330，95%CI=0.178-0.615，P<0.05） were independent protective factors. The ROC curve analysis showed that the complete model（AUC=0.982，95%CI=0.965-0.998） had a significantly better predictive performance than the basic model（AUC=0.825，95%CI=0.771-0.879） （DeLong test P<0.001），with a sensitivity of 0.951 and a specificity of 0.959. Internal validation of the nomogram prediction model yielded a corrected C-index of 0.982（95%CI=0.975-0.984），suggesting that the model had good calibration and a high net clinical benefit across a wide range of threshold probabilities.ConclusionSystematic nutritional management improves nutritional status，frailty status，and activities of daily living in frail elderly patients. Independent risk factors for poor efficacy of nutritional intervention include age ≥75 years，cognitive impairment， gut microbiota dysbiosis，Charlson comorbidity index ≥3，and elevated CRP and IL-6 levels；whereas higher BMI and systematic nutritional management are independent protective factors. A predictive model constructed based on these factors can be used for early risk assessment of treatment efficacy.关键词：inflammatory factors;gut microbiota dysbiosis;elderly frailty;nutritional intervention;outcome;predictive model1|0|0更新时间：2026-10-27
- 摘要：ObjectiveTo investigate the independent risk factors for pulmonary arterial hypertension（PAH） in patients with systemic sclerosis-related interstitial lung disease（SSc-ILD），and to construct a visualized nomogram prediction model based on these factors.MethodsA single-center retrospective cohort study was conducted among 118 patients with SSc-ILD who were diagnosed and treated at Department of Rheumatology and Immunology and Department of Respiratory and Critical Care Medicine，Hebei General Hospital，from January 2017 to October 2025，and related data were analyzed，including clinical data，laboratory tests，imaging data，and pulmonary function data. According to the results of echocardiography，the patients were divided into PAH group with 40 patients and non-PAH group with 78 patients. The univariate analysis，the LASSO regression analysis，and the multivariable logistic regression analysis were used to identify independent risk factors for PAH. A nomogram prediction model was constructed based on the results of regression analyses. The receiver operating characteristic（ROC） curve was plotted to assess the discriminatory ability of the model，the calibration curve was used to assess its calibration，and decision curve analysis was used to assess its clinical practicability.ResultsThe multivariable logistic regression analysis identified five independent risk factors for PAH in SSc-ILD，i.e.，right ventricular end-diastolic basal diameter（RV） measured by echocardiography（odds ratio［OR］=1.20，95%CI=1.05-1.37，P=0.007），SSc score（OR=1.33，95%CI=1.12-1.57，P=0.001），diffusing capacity of the lung for carbon monoxide percentage of predicted（DLCO%） measured by pulmonary function tests（OR=0.93，95%CI=0.89-0.97，P<0.001），honeycomb shadow on chest CT（OR=3.45，95%CI=1.08-11.04，P=0.037），and erythrocyte sedimentation rate（ESR） （OR=1.04，95%CI=1.01-1.07，P=0.005）. The calibration curve of the nomogram model constructed based on these 5 factors fit well with the ideal curve，suggesting that the nomogram model has high prediction accuracy. The nomogram model had an area under the ROC curve of 0.909，suggesting that it has good discriminatory ability but requires external validation.ConclusionRV，SSc score，DLCO%，honeycomb shadow，and ESR are independent risk factors for concurrent PAH in patients with SSc-ILD，and the nomogram model constructed based on these factors has good discriminatory ability and calibration. However，given that the value of events per variable was below the recommended threshold，the model carries a potential risk of overfitting，and thus external validation is needed to confirm its discriminatory ability. This model can be used to facilitate early and individualized risk assessment in clinical practice，thereby providing a basis for formulating prospective screening and intervention strategies.关键词：systemic sclerosis-related interstitial lung disease;pulmonary arterial hypertension;nomogram;predictive model1|0|0更新时间：2026-10-27
- 摘要：ObjectiveTo report a case of severe carotid artery stenosis comorbid with profound orthostatic hypotension（OH） after radiotherapy for nasopharyngeal carcinoma（NPC），and to investigate its underlying pathophysiological mechanisms.MethodsThe diagnosis and treatment process and long-term follow-up results of a patient with recurrent dizziness and orthostatic intolerance after radiotherapy for NPC were summarized，and related articles were searched to analyze the potential pathophysiological mechanisms of this case.ResultsIn this case，neck radiotherapy for NPC led to radiation-induced carotid artery stenosis （RICS） and baroreceptor failure in the carotid sinus region，and consequently，internal carotid artery stenting at the left side alone failed to alleviate orthostatic intolerance. After admission，the patient was diagnosed with OH and hyponatremia and was treated with intravenous sodium supplementation for volume expansion and oral administration of midodrine hydrochloride tablets before activity. The symptoms of dizziness and orthostatic intolerance were significantly improved，and the patient was discharged successfully. Long-term follow-up showed that although orthostatic dizziness persisted，there was a reduction in its severity，and no pre-syncope episodes occurred.ConclusionRadiation-induced arterial stenosis and autonomic baroreceptor failure often act synergistically to cause disease，and for the diagnosis and treatment of patients with cerebral infarction or dizziness and a history of head-and-neck radiotherapy，active supine-to-standing blood pressure monitoring and cerebral hemodynamics assessments should be performed as routine screening modalities to guide comprehensive intervention.关键词：nasopharyngeal carcinoma;orthostatic hypotension;baroreflex failure;carotid artery stenosis1|0|0更新时间：2026-10-27
- 摘要：Atherosclerosis （AS）-related cerebrovascular injury is an important link between vascular lesions and Alzheimer’s disease （AD）. Clinical cohort，imaging，and pathological studies suggest that increased carotid intima-media thickness，carotid plaques，AS of the circle of Willis，arterial stiffness，and cerebral hypoperfusion are associated with cognitive decline，risk of dementia，and AD-related pathological burden. Potential mechanisms include an imbalance between β-amyloid production and clearance，microtubule-associated protein tau abnormalities，lipid dysregulation，apolipoprotein E ε4-related susceptibility，blood-brain barrier and neurovascular unit dysfunction，chronic inflammation，and oxidative stress. Current evidence supports the application of vascular risk factor management，such as blood pressure，blood lipids，and blood glucose，as well as lifestyle interventions for the management of the risk of cognitive decline. Apolipoprotein E ε4 carrier status may reflect genetic susceptibility to AD and is associated with AS-related vascular risk； however，its value in clinical identification of the risk of AS when used alone or in prediction of the risk of AD when used in combination with vascular risk indicators still needs to be validated. Strategies targeting β-amyloid/microtubule-associated protein tau，inflammation，and β-amyloid transport across the blood-brain barrier are still mainly preclinical or in early exploration. This article reviews the relationship between AS-related cerebrovascular injury and AD from three aspects：evidence of association，potential common mechanisms，and implications for risk identification and intervention，and distinguishes different outcomes and levels of evidence to avoid overinterpretation of existing findings.关键词：atherosclerosis;cerebrovascular injury;Alzheimer’s disease;neurovascular unit;cognitive decline1|0|0更新时间：2026-10-27
- 摘要：ObjectiveTo investigate the clinical characteristics，diagnostic process，and key points for differential diagnosis of hereditary β2-microglobulin amyloidosis.MethodsThe clinical data of a patient with hereditary β2-microglobulin amyloidosis were retrospectively analyzed. The clinical manifestations，auxiliary examination findings，diagnostic process，and genetic testing results were systematically summarized and discussed in conjunction with relevant literature.ResultsThe patient initially presented with progressively worsening gastrointestinal dysfunction，accompanied by prominent autonomic dysfunction mainly manifested as orthostatic hypotension and abnormalities in urination and defecation，together with peripheral nerve involvement characterized by numbness and sensory impairment of the extremities. Genetic testing ultimately identified a pathogenic variant in the B2M gene，confirming the diagnosis of hereditary β2-microglobulin amyloidosis.ConclusionHereditary β2-microglobulin amyloidosis is a clinically rare entity with an insidious onset and multisystem involvement，rendering it susceptible to misdiagnosis or missed diagnosis. For patients predominantly presenting with progressive gastrointestinal dysfunction accompanied by autonomic disturbances such as orthostatic hypotension，clinicians should be alert to the possibility of hereditary β2-microglobulin amyloidosis. Early genetic testing may facilitate the early diagnosis and standardized management of the disease.关键词：hereditary β2-microglobulin amyloidosis;autonomic dysfunction;orthostatic hypotension;gastrointestinal dysfunction1|0|0更新时间：2026-10-27
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