Objective This meta-analysis aimed to systematically summarize the risk factors associated with preterm birth in twin pregnancies. Methods We comprehensively searched the following electronic databases from inception to August 2025: China National Knowledge Infrastructure (CNKI), WanFang Database, VIP Database, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science. Literature published on the risk factors for preterm birth in twin pregnancies was included. Two researchers independently performed data extraction and quality assessment. Meta-analysis was conducted using RevMan 5.4 and Stata 17.0 software. Results A total of 10 studies involving 4, 993 participants were included. The meta-analysis identified the following significant risk factors for preterm birth in twin pregnancies: monochorionicity (OR=2.34, 95%CI: 1.58-3.48), gestational hypertension (OR=3.10, 95%CI: 2.48-3.87), premature rupture of membranes (OR=3.68, 95%CI: 1.06-12.81), uterine scar (OR=1.96, 95%CI: 1.51-2.53), chorioamnionitis (OR=2.72, 95%CI: 1.50-4.93), abnormal amniotic fluid (OR=3.29, 95%CI: 2.11-5.13), umbilical cord abnormalities (OR=3.21, 95%CI: 1.43-7.23), and vaginitis (OR=3.40, 95%CI: 1.74-6.66). Body mass index (BMI) was found to be a protective factor (OR=0.88, 95%CI: 0.81-0.95). Conclusion Monochorionicity, gestational hypertension, premature rupture of membranes, uterine scar, chorioamnionitis, abnormal amniotic fluid, umbilical cord abnormalities, and vaginitis are identified as risk factors for preterm birth in twin pregnancies. It is recommended that clinicians actively screen for these high-risk factors in twin pregnancies and implement timely interventions to prevent preterm birth.

Objective To identify risk factors for stroke-associated pneumonia (SAP) among stroke (cerebrovascular accident, CVA) patients with swallowing dysfunction using early quantitative swallowing assessment indices, and to build a decision-tree model for predicting SAP. Methods From January 2022 to December 2023, 80 CVA patients with swallowing dysfunction treated at our hospital were enrolled and divided into an SAP group (n=29) and a non-SAP group (n=51). Clinical and laboratory data were collected. Univariate analysis and multivariable logistic regression were used to identify independent predictors of SAP. A decision-tree model was constructed using the CHAID (chi-square automatic interaction detection) algorithm. Model performance was evaluated by receiver operating characteristic (ROC) curves (AUC), sensitivity, and specificity; the DeLong test compared AUCs between models. Results Significant between-group differences were observed in Standardized Swallowing Assessment (SSA) scores, presence of an abnormal swallowing-evoked cough reflex, WST (Watanabe Water Swallow Test) grading, presence of an indwelling gastric tube, and neutrophil-to-lymphocyte ratio (NLR) (all P<0.05). Multivariable logistic regression identified the following independent risk factors for SAP: higher SSA score (OR=1.555; 95%CI:1.190-2.033; P=0.001), abnormal swallowing-evoked cough reflex (OR=10.036; 95%CI: 1.889-53.306; P=0.007), WST grade V (OR=7.499; 95%CI: 1.124-50.030; P=0.037), presence of an indwelling gastric tube (OR=5.814; 95%CI: 1.117-30.263; P=0.036), and elevated NLR (OR=3.031; 95%CI: 1.378-6.669; P=0.006). Using the CHAID algorithm, the decision-tree models elected five explanatory variables: SSA score, NLR, presence of an indwelling gastric tube, abnormal swallowing-evoked cough reflex, and WST grade. The tree comprised four levels with six terminal nodes, and SSA score emerged as the strongest predictor. The decision-tree model achieved an AUC of 0.925(95%CI: 0.844-0.972), with sensitivity 79.30% and specificity 92.20% for predicting SAP in CVA patients with dysphagia. By comparison, the multivariable logistic regression modelyielded an AUC of 0.847(95%CI:0.749-0.918), sensitivity 69.00%, and specificity 86.30%. The difference in AUCs between the two models was statistically significant (DeLong test: Z=2.022, P=0.043). Conclusion SSA score, NLR, presence of an indwelling gastric tube, abnormal swallowing-evoked cough reflex, and WST grade are independent predictors of SAP in CVA patients with swallowing dysfunction. The CHAID decision-tree model based on early quantitative swallowing assessment demonstrates strong predictive performance and may be useful for early identification and prevention of SAP.

Objective To investigate the potential of an early initiation of anticoagulation therapy versus conventional initiation in effectively reducing the risk of stroke recurrence and improving functional prognosis without increasing the bleeding risk in patients with atrial fibrillation-related acute cerebral infarction. Methods A total of 80 patients with atrial fibrillation-related acute cerebral infarction admitted within 24 hours of onset were prospectively allocated. Patients were randomly assigned to the early group (anticoagulation initiated on day 3) and conventional group (initiated on day 6), with 40 cases in each group. The 90-day recurrence rate of cerebral infarction, severe bleeding events (intracranial/gastrointestinal hemorrhage), functional independence (the modified Rankin Scale [mRS]≤2), and adverse event incidence were observed. Results Patients in the early group demonstrated a significantly lower 90-day recurrence rate of cerebral infarction than the conventional group (15.0% vs 50.0%, P<0.01). Additionally, the proportion of patients achieving functional independence (mRS≤2) was significantly higher in the early groupthan the conventional group (75.0% vs 50.0%, P<0.05). No significant difference was observed in the incidence of major bleeding events between the two groups (5.0% vs 7.5%, P>0.05). Subgroup analysis indicated that patients with a high stroke risk (CHA₂DS₂-VASc≥4) benefited more from an early anticoagulation therapy. Conclusion An early initiation of anticoagulation therapy (day 3) in patients with atrial fibrillation-related acute cerebral infarction demonstrated significant clinical benefits, including reduced risk of stroke recurrence and improved functional recovery, without significantly increased the bleeding risk.

Objective To evaluate the systemic immune inflammation index (SII) as a novel predictor of major adverse cardiovascular events (MACE) in patients with heart failure with reduced ejection fraction (HFrEF). Methods This retrospective cohort study enrolled 304 consecutive HFrEF patients admitted to the Department of Cardiology, Anshan Central Hospital between June 2022 and June 2024. Patients were followed until June 2025 and categorized according to MACE occurrence during followup into a MACE group (n=94) and a non-MACE group (n=210). Laboratory parameters and related indices were recorded. Univariate and multivariate binary logistic regression analyses were used to identify factors associated with MACE. The discriminative performance of SII for MACE was assessed by receiver operating characteristic (ROC) curve analysis and quantified by the area under the curve (AUC). Results Baseline characteristics, including sex, age, body mass index (BMI), hypertension, diabetes, prior percutaneous coronary intervention (PCI), white blood cell count, and liver and renal function tests, did not differ significantly between groups (P>0.05). Compared with the non-MACE group, the MACE group had higher smoking prevalence, higher neutrophil counts, platelet count, higher neutrophiltolymphocyte ratio (NLR), elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), and higher SII (all P<0.05), while lymphocyte counts and serum albumin were significantly lower (P<0.05). In multivariate logistic regression, smoking history and SII remained independently associated with MACE risk in HFrEF patients (P<0.05). Conclusion SII is an independent predictor of MACE in patients with HFrEF. Measurement of SII may facilitate early identification of patients at high risk of adverse cardiovascular outcomes and inform targeted preventive strategies.

Objective To examine the dynamic trajectory patterns of quality-of-life (QOL) decline in elderly patients with chronic heart failure (CHF) and to identify associated risk and protective factors. Methods From January 2023 to January 2025, 217 elderly CHF patients treated in the Department of Cardiovascular Medicine, the 989th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, were enrolled. QOL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at four time points: baseline (admission), and 1, 3, and 6 months after discharge. A latent growth mixture model (LGMM) was employed to identify heterogeneous QOL trajectory classes. Univariate and multivariate logistic regression analyses were performed to determine factors associated with trajectory membership. Results A total of 197 patients completed the entire follow-up (dropout rate 9.22%, completion rate 90.78%). LGMM identified three distinct QOL-decline trajectories: a persistently low-QOL group (n=35), a slowly declining group (n=121), and a rapidly declining group (n=41). Multivariate logistic regression showed that age ≥75 years, New York Heart Association (NYHA) class IV, left ventricular ejection fraction ≤35%, comorbid renal dysfunction, anemia, and depression were independent risk factors for belonging to the rapid-decline trajectory (all P<0.01). Adherence to prescribed medication and regular aerobic exercise were independent protective factors (both P<0.01). Conclusion Elderly CHF patients exhibit marked heterogeneity in QOL-decline trajectories. Early identification and targeted intervention for patients at high risk of rapid QOL deterioration, through enhanced medication management, promotion of regular exercise, and attention to psychological health, may help delay the decline in quality of life.

Objective To examine the clinicopathological characteristics and the prevalence of KRAS, NRAS, and BRAF mutations in colorectal cancer (CRC) patients stratified by microsatellite instability (MSI) status. Methods We performed a retrospective analysis of 204 consecutive CRC patients treated at Nanyang Central Hospital between April 2020 and April 2025. MSI status and KRAS, NRAS, and BRAF mutations were determined. Patients were classified as MSI-high (MSI-H; ≥2 unstable loci, n=31) or MSI-low/stable (MSI-L/MSS; <2 unstable loci, n=173). Clinicopathological variables and mutation frequencies were compared between groups. Multivariate logistic regression was used to identify independent predictors of MSI-H status. Associations between MSI status and gene mutations were assessed by Spearman correlation. Results Significant differences were observed between MSI-H and MSI-L/MSS groups in patient age, tumor differentiation, primary tumor site, and tumour node metastasis (TNM) stage (all P<0.05). NRAS mutation frequency did not differ between groups (P>0.05). MSI-H tumors showed a significantly lower frequency of KRAS mutations and a higher frequency of BRAF mutations compared with MSI-L/MSS tumors (P<0.05). In multivariate analysis, younger age, right-sided primary tumor location, TNM stage II, poor tumor differentiation, lower KRAS mutation frequency, and higher BRAF mutation frequency were independently associated with MSI-H status (P<0.05). Spearman correlation confirmed a negative correlation between KRAS mutation and MSI status and a positive correlation between BRAF mutation and MSI status (P<0.05). Conclusion MSI status in colorectal cancer is associated with distinct clinicopathological features and mutation profiles. MSI-H tumors are more likely in younger patients, to arise in the right colon, to present at stage II, and to be poorly differentiated; they are also characterized by lower KRAS mutation prevalence and higher BRAF mutation prevalence.

Objective To characterize changes in lymphocyte subsets across different disease stages of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and to evaluate their utility throughout the course of treatment. Methods This retrospective study included 70 AAV patients who attended the Affiliated Hospital of Qingdao University between January 1, 2015 and June 30, 2024 and who had lymphocyte-subset testing performed both at initial presentation during active disease and after induction therapy. We analyzed lymphocyte subset profiles and their dynamics during active disease, remission, and episodes of infection, and explored associations with disease activity (BVAS), infection events, and clinical outcomes. Results Compared with initial active presentation, patients at after induction therapy had significantly lower blood CD4⁺ T-cell counts and lower proportions of natural killer (NK) cells; both parameters were negatively correlated with BVAS (P=0.006 and P<0.001, respectively). Peripheral B-cell proportion was lowered during active disease and correlated positively with BVAS (P<0.001).The active disease phase had the highest infection rate (52.8%), predominantly pulmonary infections (71.4%). Multivariable logistic regression identified age (OR=1.092,95%CI:1.024-1.163, P=0.007), B-cell proportion (OR=1.077, 95%CI: 1.021-1.136, P=0.007), and C-reactive protein (CRP) level (OR=1.069, 95%CI: 1.033-1.107, P<0.001) as independent risk factors for infection in AAV patients. During follow-up, patients presenting with the composite profile of low CD4⁺ T-cell count, low NK-cell proportion, high B-cell proportion, elevated CRP, and elevated erythrocyte sedimentation rate (ESR) were more likely to experience adverse renal outcomes (P=0.042); this association was confirmed in an independent validation cohort (P=0.014). Conclusion Lymphocyte subset profiling is informative for assessing disease activity and infection susceptibility in AAV. A combined biomarker approach incorporating lymphocyte subsets, ESR, and CRP can help stratify disease status and guide more precise therapeutic decisions.

Objective To investigate the risk factors for sleep disorders in patients undergoing maintenance hemodialysis (MHD), and to develop a risk prediction model, thus providing references for the early clinical identification of high-risk individuals. Methods A total of 222 patients who received MHD between June 2024 to June 2025 were enrolled. Demographic characteristics, clinical data, and laboratory indicators were collected. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with PSQI ≥7 indicating the presence of sleep disorders. Candidate predictors were first screened using univariate analysis, followed by variable shrinkage and selection via the least absolute shrinkage and selection operator (LASSO) regression. Variables retained in the LASSO model were subsequently entered into a multivariable logistic regression analysis to construct a nomogram. Prediction performance of the nomogram, including discrimination, calibration, and clinical utility, was comprehensively evaluated using the receiver operating characteristic (ROC) curve, C-index, bootstrap internal validation, calibration curve, and decision curve analysis (DCA). Results The incidence of sleep disorders in this study was 56.31% (125/222). LASSO-logistic regression showed that age, dialysis duration, anxiety, depression, uremic pruritus, and restless legs syndrome were independent risk factors for sleep disorders in patients treated with MHD, whereas higher serum calcium levels played a protective role (all P<0.05). The nomogram constructed based on these factors yielded an area under the curve (AUC) of 0.928(95%CI: 0.894-0.962). The calibration curve showed good agreement between predicted and observed values, and the Hosmer-Lemeshow test (χ²=4.14, P=0.844) indicated good calibration performance. DCA demonstrated that the nomogram provided a considerable net clinical benefit across a threshold probability range of 0.05-0.75. Conclusion The nomogram constructed based on age, dialysis duration, anxiety, depression, uremic pruritus, restless legs syndrome, and serum calcium level can effectively predict the risk of sleep disorders in MHD patients, facilitating early identification and intervention for high-risk groups.

Objective To examine the clinical characteristics and diagnostic-therapeutic approach for young-onset stroke presenting as seizure-like episodes, with the aim of aiding clinicians in accurate diagnosis and reducing the risk of misdiagnosis. Methods We retrospectively analyzed the diagnostic and treatment course of a single case of young stroke that began with seizure-like activity and performed a literature review of related reports. Results The patient was a 19-year-old male admitted for generalized convulsions with impaired consciousness lasting 5 hours. The event began during sleep with sudden convulsions and loss of consciousness, characterized by bilateral upper limb extension, bilateral lower limb flexion and tremor, clenched jaw, and tongue/cheek bite. The convulsive episode self-limited after approximately 10 minutes, but the altered consciousness persisted. The patient had a recent history of fever following an upper respiratory tract infection. Initial cranial CT showed no parenchymal lesion. Cerebrospinal fluid (CSF) routine testing, biochemistry, acid-fast and India ink stains were unremarkable; CSF metagenomic next-generation sequencing (PIM) was negative. Continuous video EEG did not reveal epileptiform discharges. On hospital day 2, repeat head CT raised suspicion for basilar artery occlusion; subsequent digital subtraction angiography confirmed occlusion of the mid-upper basilar artery. The patient underwent percutaneous superselective endovascular thrombectomy. At discharge he was in a minimally conscious state; at 1-year follow-up he had regained clear consciousness. Conclusion Seizure-like events may clinically mimic decerebrate rigidity and sympathetic overactivity, particularly in young patients without head trauma or conventional cerebrovascular risk factors. When new-onset seizure-like episodes (especially those preceded or accompanied by infection) are associated with abnormal neuroimaging, clinicians should actively pursue vascular and other etiologies to avoid misdiagnosis or delayed diagnosis. Prompt identification and timely intervention can improve patient outcomes.

Objective To describe the clinical features of the hyaline-vascular and plasma-cell variants of Castleman disease (CD) and to raise clinical awareness of their presentation and management. Methods We retrospectively analyzed two cases of different CD subtypes and reviewed the relevant literature to summarize key diagnostic and therapeutic points. Results Case 1 presented with bilateral painless inguinal lymphadenopathy and achieved clinical stabilization with systemic glucocorticoids combined with tocilizumab. Case 2 had generalized lymphadenopathy, low-grade fever, and marked elevation of serum IgE; inflammatory activity was effectively controlled with siltuximab plus immunomodulatory therapy. Both patients experienced diagnostic delay. Definitive diagnosis required histopathological examination and ancillary testing, including interleukin-6 (IL-6) measurement and assessment of immunoglobulin G4 (IgG4)-related markers, to differentiate CD from lymphoma and IgG4-related disease. Conclusion Unicentric CD can often be cured by surgical excision or managed with therapies targeting the IL-6 pathway, while multicentric CD typically requires prolonged multidisciplinary care with emphasis on infection control and immune modulation. Precise subtyping based on pathology and molecular markers is essential to guide individualized treatment plans and to monitor for recurrence and comorbidities.

This expert consensus establishes a comprehensive framework and practical roadmap for applying artificial intelligence (AI) diagnostic models to support electroencephalogram (EEG) analysis in epilepsy. In light of the current drawbacks of manual EEG interpretation, primarily subjectivity and limited efficiency, the consensus frames AI as a clinical decision-support tool that augments, rather than replaces, physician expertise. It issues standardized, full-lifecycle recommendations spanning data acquisition and annotation, algorithm development and validation, clinical integration and workflow implementation, and governance covering safety, ethical considerations, and regulatory oversight. The objective is to enable the scientific, safe, and effective incorporation of AI into epilepsy care, thereby enhancing diagnostic accuracy, efficiency, and inter-rater consistency, and to provide practical guidance for researchers, clinicians, developers, and regulators.

Population aging is a global phenomenon. To meet its multifaceted challenges, China has adopted an active aging strategy that stresses older adults' social participation and contribution. Framed within this perspective, the present paper proposes practical pathways to advance medical humanities, aiming to inform efforts to improve the health and well-being of older adults. The paper also engages with relevant positions in Professor Liu Yun's Theory and Practical Exploration in Medical Humanism, particularly her humanistic readings of eldercare policy.