IntroductionMycoplasma pneumoniae (M. pneumoniae) is a leading cause of respiratory infection in school-age children. A global resurgence occurred in 2023-2024, yet whole-genome molecular epidemiology and antimicrobial susceptibility data remains limited.MethodsIn this study, we isolated M. pneumoniae strains from children with respiratory infections in Shanghai, collected clinical record data, and profiled antibiotic susceptibility using the broth microdilution method. Whole-genome sequencing was performed on all isolates and globally available M. pneumoniae genomes from GenBank were incorporated for comparative analysis.ResultsA total of 148 M. pneumoniae strains were isolated, among which 79.7% (118/148) were from patients diagnosed with severe M. pneumoniae pneumonia (SMPP). All isolates were highly resistant to macrolides but remained susceptible to tetracyclines and fluoroquinolones. Of note, P1-2-type strains showed lower resistance levels to azithromycin and 16-membered macrolides compared with P1-1. Although the predominant genotypes were still P1-1 (92.6%), ST3 (88.5%), and M4-5-7-2 (79.7%), several previously uncommon MLVA types—M3-5-7-2, M4-3-7-2, and M4-4-7-2—have increased in frequency since the COVID-19 pandemic and were associated with milder inflammatory responses. Genomic analysis revealed high conservation across strains. Notably, a higher number of hsdS gene homologs, which serve as epigenetic modulators, correlated with reduced SMPP incidence and lower CD3+/CD4+ T-cell counts.DiscussionIn this study we provided the first comprehensive WGS analysis and updated MIC profiles of clinically isolated M. pneumoniae in Shanghai. Our findings highlight the persistent macrolide resistance and the emergence of genomic variations that warrant ongoing surveillance. High virulence carriage and high macrolides resistance may be among the factors contributing to elevated SMPP levels.

Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with progressive, irreversible scarring and a median survival of approximately 3–5 years after diagnosis. Current therapies (nintedanib, pirfenidone) modestly slow progression but do not halt or reverse fibrosis, creating a critical therapeutic plateau and unmet need. Improved human-centric models are essential to dissect how genetic susceptibility and chronic epithelial exhaustion drive aberrant repair in IPF. Lung organoids, as three-dimensional (3D) constructs that recapitulate human lung architecture and cellular responses to pathological cues have increasingly been used as important human-relevant platforms for IPF research. In this review, we summarize recent advances in the application of lung organoids to IPF research, including disease modeling, mechanistic studies, and preclinical drug testing, and we discuss the potential and current limitations of patient-derived organoids (PDOs) in personalized medicine. We also outline ongoing efforts to improve these models through the incorporation of vascular, immune, and mechanical components, such as assembloids and lung-on-a-chip systems. Although important challenges remain, including maturation, standardization, and scalability, lung organoids may provide a valuable complementary platform for future IPF research and translational studies.

[Objective]To analyze the incidence and spatiotemporal distribution of typhus fever in Baoshan City,Yunnan Province from 2005 to 2023,to identify high-risk populations and regions,so as to provide a scientific basis for optimizing the allocation of local prevention and control resources and developing targeted intervention measures.[Methods]Data of typhus fever cases in Baoshan City from 2005 to 2023 were obtained from the Infectious Disease Information Management System of the Chinese Center for Disease Control and Prevention.Descriptive epidemiological methods were used to analyze the temporal,spatial and demographic distribution of typhus fever cases.Spatial clustering was assessed using spatial dynamic window scan statistics(circular and elliptical windows),flexible spatial scan statistics,and local spatial autocorrelation methods(including local Moran's I,local Geary's C,and Getis-Ord Gi*).Retrospective spatiotemporal scan statistics were employed to detect spatiotemporal clusters.[Results]A total of 1 099 typhus fever cases were reported in Baoshan City from 2005 to 2023.The incidence rate peaked at 6.31/100 000 in 2007,followed by a decline until reaching its lowest level at 0.21/100 000 in 2015,and subsequently rebounded during 2016-2023.The highest proportion of cases was among children under 10 years of age(31.12%),and the top three occupations of cases were farmers,students,and children,accounting for 88.62%of all cases.Cases occurred predominantly between June and September each year.The incidence was relatively high in Jiucheng Town(62.58/100 000),Yaoguan Town(57.15/100 000),and Dianyang Town(46.81/100 000)of Shidian County.Spatial clustering analyses indicated that high-risk areas were mainly located in the southern part of Baoshan City,showing a south-to-north trend.Spatiotemporal scan analyses identified five clusters,with the most likely cluster centered around Yaoguan Town,covering ten towns(subdistricts)during the period 2007-2010.[Conclusion]The incidence of typhus fever in Baoshan City exhibits a clear seasonal and spatial clustering pattern,with peak incidence occurring in summer and autumn.Spatially,cases are primarily distributed in the southern part of Baoshan City,and high-risk clusters exhibit a south-to-north trend.Farmers,students,and children are the high-risk groups.

Preterm delivery (PTD) is a major cause of neonatal morbidity and mortality, and maternal C-reactive protein (CRP) may serve as an inflammatory marker linked to its risk, with diabetes potentially influencing this association. To evaluate the association between maternal CRP levels and PTD risk and assess whether diabetes modifies this relationship. This retrospective observational study included 3,089 singleton pregnancies with available CRP and covariate data from 2015 to 2022. Maternal serum CRP was measured using immuno-turbidimetry and categorized into tertiles (cut-points at 2.3 mg/L and 4.7 mg/L). Logistic regression models estimated odds ratios (ORs) for PTD, and stratified analyses evaluated interaction by diabetes status. Among 3,089 pregnancies, 208 (6.7

Although previous cohort studies have examined the association between vegetable and fruit intake and cancer risk, the findings remain inconsistent. Using data from 50,987 participants in the Shanghai Suburban Adult Cohort and Biobank (2016 to 2019), we investigated the relationship between vegetable and fruit intake and the incidence of cancers through linkage with the cancer registry up to June 30, 2024. Participants in the highest quartile of total vegetable and fruit intake had a lower risk of overall cancer (HR: 0.81, 95% CI: 0.72-0.90), with similar inverse associations observed for vegetables and fruits separately. Higher intake was also associated with lower risks of lung and stomach cancers, whereas no associations were observed for colorectal cancer. In continuous analyses, each SD increase in total vegetable and fruit intake was associated with a lower risk of overall cancer (HR: 0.92, 95% CI: 0.88-0.97), and the findings were generally consistent with those from quartile-based analyses. In subgroup analyses, these inverse associations were observed among participants with favorable lifestyles and health conditions. RCS analyses identified nonlinear associations between fruit intake and the risks of overall and lung cancer, with the protective associations becoming less pronounced at excessive intake levels.

Background Schizophrenia is a disabling mental disorder. Quality of life (QoL) reflects patients' social-psychological prognosis in mental health services. Sleep and physical activity relate to symptoms and prognosis closely, but their interplay and link to QoL are unclear. This study aimed to explore their impact on schizophrenia patients' QoL. Methods The samples for this study were derived from Shanghai Community-based Severe Mental Disorders cohort. QoL was assessed using the World Health Organization Quality of Life Assessment Scale Short Form (WHOQOL-BREF); sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); physical activity was assessed using the International Physical Activity Questionnaire Short Form. The statistical analysis was conducted using SPSS 24 and R 4.4.1. We used linear regressions to assess the impact of sleep quality, analysis of variance for PA, and analysis of variance and post-hoc tests for the interaction effect. Results The final sample consisted of 5210 cases, with an average age of 59.0 years. Among them, 2,778 were female (53.3%). The patient scored the lowest on the dimension of social relationships (M = 12.864, SD = 2.254) regarding their QoL. Improvement in sleep and an increase in physical activity (all p < 0.001) both contribute to QoL of patients. For the environmental health (F = 5.013, p = 0.007, ηp2 = 0.002) dimension, the two have a mutual compensatory effect. Conclusions This study emphasizes the significance of sleep and physical activity for the recovery of patients with schizophrenia, particularly highlighting the crucial role of improving sleep.

This study aimed to investigate the independent predictive value of the uric acid-to-HDL-C ratio (UHR) for metabolic syndrome (MS) in the elderly, develop an optimized diagnostic model, and assess whether UHR dynamics reflect inflammatory improvements. A prospective cohort study was conducted including elderly individuals (n = 1064) undergoing health examinations at two hospitals in 2023. MS was diagnosed according to the International Diabetes Federation (IDF, 2005) criteria (central obesity: waist circumference ≥ 90 cm in men, ≥ 80 cm in women). The association between UHR and MS was evaluated using multivariable logistic regression. Predictive performance was assessed by receiver operating characteristic (ROC) analysis, with the optimal cut-off determined by the Youden index. Model robustness was tested by 1000 bootstrap resamplings and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses. Additional analyses included age- and sex-stratified inflammatory profiling (NLRP3, GDF15, SOD) and a quasi-experimental intervention study in participants with UHR ≥ 14.9

Accurate prediction of long-term readmission risk is crucial for early intervention in patients experiencing severe acute exacerbation of chronic obstructive pulmonary disease (s-AECOPD). While the Chronic Respiratory Early Warning Score (CREWS) has demonstrated proficiency in predicting severe outcomes. This study aims to evaluate the effectiveness of CREWS in predicting readmission for s-AECOPD. This study conducted a retrospective cohort analysis of all hospitalized s-AECOPD patients from 2018 to 2019. Follow-up occurred from 2020 to 2021. Clinical parameters were collected. Patients were classified according to hospitalization frequency during the follow-up period and clinical parameters were compared between the groups. Logistic regression, ROC analysis and survival analysis were performed. A total of 301 patients were included in the cohort study, of whom 56 were classified into the non-decreased hospitalization frequency group. High serum uric acid (UA) levels and low free thyroxine (FT4) levels could be independent risk factors associated with s-AECOPD long-term readmission (OR 6.125 (1.775–21.131), p = 0.004 ; OR 2.599 (1.244–5.432), p = 0.010, respectively). The modified CREWS model demonstrated moderate predictive performance for readmission (AUC = 0.716, 95

Interstitial lung disease (ILD) is a serious extra-articular complication of rheumatoid arthritis (RA) and a leading cause of mortality. This meta-analysis aims to comprehensively evaluate the diagnostic utility and clinical relevance of tumor-associated biomarkers in patients with Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD). A systematic literature search was conducted in PubMed, EMBASE, Web of Science, CBM, Wan-Fang, and CNKI databases from inception to April 1, 2025. We included case-control and cohort studies that compared tumor marker levels between RA-ILD and RA-non-ILD patients, following the PICOS framework. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled effect sizes were calculated as standardized mean differences (SMD) with 95

Abstract Background Adolescent mental health issues are increasingly prominent, making early screening essential for intervention. Schools, as the primary environment for adolescents, serve as ideal settings for screening programs. Parents, as key decision-makers, directly influence participation through their willingness. This study aimed to assess parents’ acceptance of school-based mental health screening among Chinese middle school students, identified relevant factors and concerns, with the goal of providing valuable insights for future programs. Methods A cross-sectional survey was conducted in Deqing County, Zhejiang Province, involving parents from three junior high schools. A total of 2,872 valid questionnaires were collected. A self-administered questionnaire assessed sociodemographic characteristics, mental health awareness, screening-related concerns, and willingness. Logistic regression analysis identified associated factors. Results 89.4% of parents expressed willingness for children to participate in screening. Parents of girls (OR = 0.68, 95% CI: 0.53–0.87) and older parents (age group 45 + vs. < 40 years: OR = 0.71, 95% CI: 0.51–0.99) were less willing, whereas those with high school education (high school/vocational school vs. junior high school or below: OR = 1.54, 95% CI: 1.11–2.13) and higher household income (5000–9999 vs. < 5000 RMB/month: OR = 1.77, 95% CI: 1.29–2.43; 10000 + vs. < 5000 RMB/month: OR = 1.71, 95% CI: 1.20–2.44) showed greater willingness. Parents whose children had a history of mental illness (OR = 0.46, 95% CI: 0.22–0.97) or no prior screening (OR = 0.25, 95% CI: 0.18–0.34) were less willing. Cognitive factors were significant: perceiving mental health issues as unimportant (OR = 0.13, 95% CI: 0.07–0.23), not severe (OR = 0.49, 95% CI: 0.35–0.71) or lacking knowledge (OR = 0.37, 95% CI: 0.24–0.57) was associated with lower willingness, whereas awareness of school-based services was associated with higher willingness (1–2 types: OR = 2.75, 95% CI: 1.86–4.05; ≥3 types: OR = 6.88, 95% CI: 3.29–14.41). Key concerns included children’s comprehension of questions, tool validity, and result reliability. Worries that screening content could negatively influence children were associated with lower willingness (OR = 0.66, 95% CI: 0.45–0.96). Conclusions Parents of Chinese junior high school students generally support screening. Willingness is associated with child’s gender, parental age, economic status, mental health awareness and concerns. Enhancing parents’ mental health knowledge and improving tool credibility may be associated with greater parental willingness of children’s mental health screening.

Background Chronic asthma features persistent airway inflammation, airway hyper-responsiveness, and structural remodeling. Macrophages, especially alternatively activated M2 cells, are key drivers of type-2 immunity and fibrosis. Icariside II (ICAII), a flavonoid from Epimedium, exhibits known anti-inflammatory properties, but its precise immunomodulatory effects on M2 macrophages in asthma remain elusive. Objective This work sought to evaluate the potential therapeutic role of ICAII using a mouse model that mimics chronic asthma and define the underlying mechanisms, with emphasis on macrophage polarization and immune-mediated tissue remodeling. Methods Chronic asthma was established in BALB/c mice through ovalbumin (OVA) sensitization and repeated exposure, followed by ICAII administration at various doses. Pulmonary function tests, histological analyses, ELISA, flow cytometry, and immunohistochemistry were employed to assess inflammation, airway remodeling, and macrophage polarization. In vitro experiments using RAW264.7 and MHS macrophage lines further investigated ICAII’s impact on M2 differentiation. Transcriptome sequencing, network pharmacology, molecular docking analyses, and validation were integrated to identify key regulatory pathways. Results ICAII improved airway resistance and compliance, alleviated inflammatory infiltration and collagen deposition, and lowered Th2 cytokines, serum IgE, and pro-fibrotic markers, with the most pronounced effects observed at 40 mg/kg. In vivo, ICAII suppressed M2 macrophage accumulation, and in vitro, it inhibited M2 differentiation, while with a divergent impact on M1 marker expression. Network pharmacology and molecular docking predicted a moderate affinity interaction between ICAII and SIRT1, which was experimentally confirmed by SPR and enzymatic activity assays. Combined with transcriptomic and pharmacological analyses, these results identified the SIRT1/NLRP3 and TGF-β/Smad3/VEGF axes as principal pathways mediating the protective effects of ICAII against chronic asthma. Specifically, the SIRT1/NLRP3 axis refers to Sirtuin1 (SIRT1)-mediated suppression of NLR family pyrin domain containing 3 (NLRP3) inflammasome activation, whereas the TGF-β/Smad3/VEGF axis represents a transforming growth factor beta-driven profibrotic signaling cascade associated with vascular endothelial growth factor. Mechanistically, ICAII enhanced SIRT1 activity, suppressed NLRP3 inflammasome-associated inflammation, and inhibited the profibrotic TGF-β/Smad3 signaling cascade and its remodeling-associated downstream effector VEGF, thereby restraining M2 macrophage polarization and tissue remodeling. Conclusion We provide the first integrated mechanistic evidence in chronic asthma that ICAII reprograms M2 macrophages via a dual-axis strategy, simultaneously activating SIRT1 to suppress the NLRP3 inflammasome and attenuating TGF-β/Smad3/VEGF-driven remodeling. Unlike previous reports that only described the broad anti-inflammatory effects of ICAII, our study uniquely links immune modulation with structural protection and further delivers direct target engagement validation. This drug-target-function continuum not only delineates a macrophage-centered paradigm for chronic asthma pathobiology but also introduces a translationally actionable mechanism to address the long-standing challenge of persistent airway remodeling and T2-high inflammation.

BackgroundThe morbidity and mortality of Pneumocystis pneumonia (PCP) are rising among patients with autoimmune or inflammatory diseases (AID). Prospective studies focusing on severe PCP in this population remain scarce. A better understanding of the disease course and prognostic factors is urgently needed.MethodsA 5-year prospective single-center study in the ICU enrolled AID patients with severe PCP. Clinical, laboratory, radiological, therapeutic, and outcome data were collected prospectively. Multivariable regression was used to identify risk factors for initial treatment failure and 28-day ICU mortality.ResultsAmong 107 enrolled patients, the mean PaO2/FiO2 ratio was 167 mmHg, and 76.6% of patients required mechanical ventilation at ICU admission. Pulmonary coinfection was detected in 46 (43.0%) patients. Initial treatment failure occurred in 48.6% and was associated with underlying connective tissue disease-interstitial lung disease (OR 3.241, 95% CI 1.337-25.147, p = 0.004), coinfection (OR, 5.419; 95% CI, 1.565-38.759; p = 0.008), and severe hypoxemia on ICU admission (OR 6.873, 95% CI 1.746–31.048, p = 0.006). Follow-up pulmonary imaging revealed architectural distortions or worsening fibrosis in over 50% of patients. The 28-day ICU mortality was 57.0%; independently predicted by PaO2/FiO2 ratio < 100 mmHg at PCP onset (OR 8.119, 95% CI 1.543-32.871, p = 0.007), initial treatment failure (OR 10.591, 95% CI 1.926-45.768, p = 0.013), persistent CD4+ T-cell counts < 100 cells/μL (OR 4.137, 95% CI 1.219- 62.152, p = 0.021), fibrosis score > 260 during early follow-up (OR 5.354, 95% CI 1.513-19.756, p = 0.008), and new-onset shock during the ICU stay (OR 2.147, 95% CI 1.237-39.157, p = 0.018).ConclusionsPCP is life-threatening in AID patients. Beyond baseline hypoxemia, early follow-up variables, particularly initial treatment failure and progressive pulmonary fibrosis, are critical prognostic indicators, warranting further research to drive understanding of their causes.

Background Due to insufficient routine surveillance, the nationwide disease burden of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6), an emerging serotype, in China remains unclear. This study aimed to estimate the incidence of CVA6-associated HFMD across the Chinese mainland. Methods CVA6 positive data from 511 locations across the Chinese mainland during 2008-2022 were integrated from the national pathogen surveillance system and literature, and reported HFMD cases during the same period were obtained from the national infectious disease surveillance system. The predicted positivity rate and incidence of CVA6-associated HFMD in children under five years of age across the Chinese mainland were estimated using a Bayesian geostatistical Gaussian model based on positivity data, reported cases, and environmental, socioeconomic, demographic, and vaccination factors. Results The model estimated that the average positivity rate of CVA6 in the Chinese mainland from 2008 to 2022 was 24.1%, with a 95% Bayesian credible interval (BCI) of 11.9-43.3%. The corresponding average annual incidence of CVA6-associated HFMD in children under five years of age was 506 (95% BCI: 272-805) per 100,000. The yearly incidence of CVA6-associated HFMD in children under five years of age peaked in 2018 (873 per 100,000; 95% BCI: 513-1309) before a subsequent decline after 2020. The incidence was highest in South China (1571 per 100,000; 95% BCI: 890-2420) and lowest in Northeast China (208 per 100,000; 95% BCI: 106-340). The estimated CVA6-associated HFMD incidence showed a consistent upward trend across different economic level groups before 2020, and tended to be higher in high-gross domestic product (GDP) per capita regions than in medium- and low-GDP regions. Conclusions Model-based estimates indicate a potentially high incidence of CVA6-associated HFMD on the Chinese mainland, particularly in South China, highlighting the need for enhanced surveillance of CVA6 and targeted control efforts in high-incidence regions.

BackgroundWomen with a history of gestational diabetes mellitus (GDM) are at high risk of long-term metabolic disorders, and postpartum weight retention (PPWR) may further accelerate this progression. However, evidence regarding the independent roles of dietary quality and physical activity in sub-high altitude regions remains limited. This study aimed to evaluate the associations between lifestyle behaviors and PPWR among women with prior GDM living in southwestern China.MethodsThis cross-sectional study included 141 women with a history of GDM who were 1–3 years postpartum and residing in Dali, a sub-high altitude region of China. Dietary quality was assessed using a localized semi-quantitative food frequency questionnaire, and physical activity was evaluated using the International Physical Activity Questionnaire–Short Form. Multivariable linear regression models were used to identify independent correlates of continuous PPWR after adjustment for demographic, obstetric, and lifestyle covariates. Sensitivity analysis was performed using binary logistic regression with clinically significant PPWR (≥5 kg) as the outcome.ResultsHigher dietary quality was independently associated with lower PPWR in the fully adjusted model (B = −0.099, 95% CI: −0.175 to −0.023, p = 0.011). Each one-point increase in dietary quality score was associated with an approximately 0.1 kg lower PPWR; equivalently, a 10-point increase in dietary quality score was associated with an approximately 1.0 kg reduction in PPWR. This association remained stable in sensitivity analysis (OR = 0.937, 95% CI: 0.885–0.991, p = 0.022). Although physical activity showed an inverse association with PPWR in univariate analysis, it was no longer statistically significant after multivariable adjustment. Lower pre-pregnancy body mass index and higher neonatal birth weight were also independently associated with greater PPWR.ConclusionAmong women with prior GDM living in a sub-high altitude region, better dietary quality was independently associated with lower long-term PPWR, whereas self-reported physical activity was not. These findings support region-specific dietary counseling as a potentially important strategy for postpartum metabolic risk reduction in high-risk women.

The rising prevalence of macrolide and fluoroquinolone resistance in human pathogenic mycoplasmas, such as Mycoplasma pneumoniae and Mycoplasma genitalium, threatens global public health. Mutations in 23S rRNA and quinolone resistance-determining regions (QRDR) have compromised the first-line therapies, creating an urgent clinical need for alternatives. Consequently, novel antimicrobial agents (pleuromutilins, novel tetracyclines, topoisomerase inhibitors) have become a top research priority. However, standardized in vitro pharmacokinetic/pharmacodynamic (PK/PD) methodologies for mycoplasmas remain underdeveloped compared to typical bacteria. Key challenges include the lack of a cell wall, slow growth kinetics, and fastidious culture requirements, which invalidate standard colony-counting and susceptibility testing protocols. This review evaluates current in vitro PK/PD models, quantification techniques, and key indices, highlighting the potential of adapting the methodological frameworks established in veterinary mycoplasma research (e.g., Mycoplasma bovis, Mycoplasma hyopneumoniae) to human mycoplasma species. We specifically analyze the utility of propidium monoazide (PMA)-qPCR for viability assessment and hollow-fiber infection models (HFIM) configured for small-cell retention. We conclude that harmonizing these methodologies through a One Health approach is critical for optimizing dosing regimens, reducing resistance, and accelerating the development of novel antimicrobial agents for human use.

OBJECTIVE:To synthesize randomized controlled trials (RCTs) regarding the effectiveness of pre-pregnancy weight loss interventions on the risk of gestational diabetes mellitus (GDM) in women with overweight or obesity. METHODS:Comprehensive literature searches were conducted across nine databases from inception to May 2024. RCTs comparing pre-pregnancy weight loss interventions with blank control or active control among adult women with overweight or obesity were included. Meta-analyses, using a random-effects model, were performed to pool results of RCTs. RESULTS:Six studies, including 1632 participants, were included. The effectiveness of pre-pregnancy weight loss interventions on changes in weight and body mass index (BMI) was statistically significant (mean difference [MD] = -6.02, 95% confidence interval [CI] [-8.94, -3.10], I2 = 98%; MD = -2.22, 95% CI [-3.44, -1.00], I2 = 98%). However, there was no statistically significant difference in the risk of GDM in women receiving pre-pregnancy weight loss interventions compared with controls (Odd Ratio [OR] = 0.70, 95% CI [0.48, 1.03], I2 = 2%). LINKING EVIDENCE TO ACTION:Pre-pregnancy weight loss interventions do not significantly impact the risk of GDM in women with overweight or obesity. Due to the small number of studies, small sample size, and large heterogeneity of pre-pregnancy weight loss interventions, further research is required. TRIAL REGISTRATION:ClinicalTrials.gov identifier: CRD42023482808.

This study aimed to develop an explainable early diagnostic model for Mycoplasma pneumoniae (MP) infection in children and assess clinicians' perceptions before and after its deployment. Data were collected from children with acute fever or cough at Linyi Maternal and Child Healthcare Hospital and Shanghai Children's Medical Center in 2023. Serology-defined MP infection was determined based on a fourfold or greater change in MP-IgM or MP-IgG titers between the acute and convalescent phases. Patients were split into training and test sets at a 7:3 ratio, and temporal validation was performed using data collected in 2024. PCR testing was not systematically available in this cohort and was therefore not used as a comparator or reference standard. Recursive Feature Elimination (RFE) optimized feature selection. Seven models were developed; the best was chosen based on AUC value and interpreted using SHAP. Models were deployed via Streamlit, and clinician feedback was surveyed before and after three months of use. The optimal model, using 11 features, achieved AUCs of 0.89 in the internal test set and 0.84 in the temporal validation cohort for identifying serology-defined MP infection, with TNFβ and IL-2 emerging as high-impact features. Separate models for under and over 60-month-old children also performed well. Clinicians' trust in the model significantly increased after three months (P < 0.001) and was correlated with usage frequency (P < 0.01). We developed explainable models to support the early identification of serology-defined MP infection in children. TNFβ and IL-2 may represent informative immune-related features, although further PCR-based validation and mechanistic studies are needed. Clinician trust and usage increased after model deployment.

ObjectiveThis study aims to provide an overview of systematic reviews and meta-analyses on probiotic adjuvant therapy for allergic rhinitis, with the goal of offering evidence-based support for clinical practice and decision-making.MethodsA comprehensive search was performed in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, WANFANG, and CBM databases from their inception to 5 July 2025, to identify systematic reviews and meta-analyses on probiotic adjuvant therapy for allergic rhinitis. Constructing a literature overlap matrix and calculating the adjusted overlap area for assessing duplication rates in source literature. ROBIS, AMSTAR-2, PRISMA 2020, and GRADE were used to assess bias risk, methodological/reporting quality, and evidence certainty. Quantitative and qualitative analyses of primary outcomes provided comprehensive insights.ResultsFifteen systematic reviews and meta-analyses were included; the adjusted overlap area, calculated from the literature overlap matrix, was 16.939%, all demonstrating low bias risk. Methodological quality assessment identified 9 high-, 5 low-, and 1 critically low-quality study. The evaluation of reporting quality showed 7 high-, 7 moderate-, and 1 low-quality study. Evidence certainty grading yielded 11 high-, 37 moderate-, 35 low-, and 17 critically low-quality outcomes. Quantitative analysis confirmed that probiotic adjunct therapy significantly reduced eosinophil counts in patients with allergic rhinitis. Qualitative synthesis indicated probiotics alleviated symptoms, improved quality of life, and exhibited favorable safety as adjuvant treatment.ConclusionProbiotics show significant adjuvant value in allergic rhinitis, effectively alleviating symptoms and improving quality of life. Their immunomodulatory effects restore Th1/Th2 balance, while demonstrating excellent safety and tolerability for clinical application.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD420251087317.

Introduction Childhood depression is an important public health concern in China, where rapid socioeconomic changes may contribute to earlier onset. However, evidence specific to primary school students remains limited. This study examined temporal trends and associated factors of depressive symptoms among Chinese primary school students. Methods Five survey waves were conducted among primary school students in Taizhou, Zhejiang Province, China, between May 2021 and March 2023. Depressive symptoms were assessed using the Children’s Depression Inventory. The study included 36,116 person-wave observations using a repeated cross-sectional design with a nested longitudinal subsample of 9,212 students. Temporal trends were examined using Cochran-Armitage trend tests, and generalized linear mixed-effects models identified associated factors. Results The prevalence of depressive symptoms decreased significantly from 12.1% in May 2021 to 4.1% in March 2023 (P for trend < 0.001), with the steepest decline between the first two waves. In multivariable analyses, poor parent–child relationships showed the strongest association with depressive symptoms (OR = 6.00, 95% CI: 4.27–8.44), followed by study difficulties (OR = 3.71, 95% CI: 3.23–4.26). Excessive screen time, prolonged study time, and socioeconomic disadvantage were also significant risk factors, while regular physical activity was protective. The association between poor family economic status and depressive symptoms strengthened over time, indicating a time-varying effect of socioeconomic disadvantage. Conclusions Depressive symptoms among primary school students in Eastern China declined substantially from 2021 to 2023. Family relationships, academic difficulties, behavioral factors, and socioeconomic disadvantage remain key correlates, highlighting the need for multilevel interventions targeting family, school, and structural determinants.

INTRODUCTION:Chronic obstructive pulmonary disease (COPD) is a major public health burden in China, but remains underdiagnosed, with most cases identified only after significant lung function decline. Effective, low-cost tools are therefore needed to identify high-risk individuals for targeted spirometry. This study developed risk prediction models and nomograms to guide personalized COPD prevention. METHODS:A community-based cohort of 32,327 adults aged 40-74 years without COPD was enrolled in 2016 and followed until March 2024. COPD diagnosis was obtained from Shanghai Songjiang District Healthcare Information Platform. Stepwise Cox regression analyses were conducted to select predictors, including demographics, lifestyle, disease history, and medical resources use, for overall and sex-specific prediction models. Discrimination and calibration were assessed by C-index, AUC, and Brier score, with 10-fold cross-validation and sensitivity analysis for validation. RESULTS:Over 7.0 years of follow-up, COPD incidence was 7.98 (95%CI: 7.61∼8.23) per 1,000 person-years, higher in men (10.60) than women (6.23). Sex, age, BMI, cooking habits, physical activity, smoking, occupational exposure, family history of respiratory diseases, other respiratory diseases, outpatient visits/year, and antibiotic prescriptions/year were significant predictors in the overall model. Male predictors additionally included central obesity, while female predictors additionally included fruit intake, history of tuberculosis and menopause. C-index was 0.780/0.770/0.781 (overall/male/female); Brier score was 0.035/0.044/0.028; Time-dependent AUCs at 1, 3, and 5 years ranged from 0.783 to 0.813, indicating good predictive performance over short, medium, and long term follow-up periods. Nomograms were created for overall, male and female populations. CONCLUSIONS:The study developed overall and sex-specific COPD risk prediction models with C-indices exceeding 70%. Corresponding nomograms provide practical tools for supporting routine COPD risk prediction to facilitate individualized preventive care.