Table of Content

20 September 2026, Volume 41 Issue 9

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Network meta-analysis of the effects of different exercise types on inhibition, cognitive flexibility, and working memory in adolescents

Li Yongjing, Su Huaiyi, Wang Xinyuan, Zhang Jinlong, Song Shuhua

2026, 41(9):  773-786.  doi:10.3969/j.issn.1004-583X.2026.09.001

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Objective To compare the effects of different exercise types on inhibition, cognitive flexibility, and working memory in adolescents through traditional meta-analysis and network meta-analysis. Methods CNKI, Wanfang, VIP, Baidu Scholar, Web of Science, PubMed, and ScienceDirect were systematically searched from database inception to December 1, 2025. Traditional meta-analysis, network meta-analysis, and graphical plotting were performed using Review Manager 5.4 and Stata 18. Results A total of 15 randomized controlled trials (RCTs) involving 17 289 adolescents were included, covering five exercise types: aerobic exercise, resistance exercise, cognitively engaging physical games, high-intensity interval training, and multicomponent exercise. Subgroup analysis showed that 20 min/session of low-dose exercise significantly improved inhibition function in adolescents compared with the control group (SMD=0.29, 95%CI: [0.01, 0.58]); 45 min/session of moderate-dose exercise significantly improved cognitive flexibility (SMD=1.15, 95%CI: [0.14, 2.15]); and an intervention frequency of 4 times/week (SMD=1.52, 95%CI:[0.56, 2.48]) and a duration of 10-12 weeks (SMD=0.66, 95%CI: [0.04, 1.29]) significantly improved working memory in adolescents compared with the control group. Network meta-analysis showed that: ① the ranking of exercise types for improving adolescent inhibition function was cognitively engaging physical games (SUCRA=98.7%) > resistance exercise (SUCRA=77.8%) > aerobic exercise (SUCRA=51.9%) > multicomponent exercise (SUCRA=34.0%) > no intervention (SUCRA=30.1%) > high-intensity interval training (SUCRA=7.5%), and cognitively engaging physical games showed significant differences compared with aerobic exercise (SMD=2.96, 95%CI: [0.74, 5.19]), multicomponent exercise (SMD=3.47, 95%CI: [1.63, 5.32]), no intervention (SMD=3.56, 95%CI: [1.70, 5.41]), and high-intensity interval training (SMD=4.38, 95%CI: [2.06, 6.71]); ② the ranking of exercise types for improving cognitive flexibility was aerobic exercise (SUCRA=83.5%) > cognitively engaging physical games (SUCRA=59.3%) > multicomponent exercise (SUCRA=44.9%) > high-intensity interval training (SUCRA=21.1%); ③ the ranking of exercise types for improving working memory was aerobic exercise (SUCRA=71.1%) > high-intensity interval training (SUCRA=61.1%) > multicomponent exercise (SUCRA=57.3%) > resistance exercise (SUCRA=21.5%). Conclusion Cognitively engaging physical games show an advantage in improving inhibition function, whereas aerobic exercise ranks first in enhancing cognitive flexibility and working memory in adolescents. In terms of intervention dose, low-dose exercise of 20 min/session shows a positive trend in improving inhibition function, moderate-dose exercise of 45 min/session has a significant effect on cognitive flexibility, and medium-to long-term intervention of 4 times/week for 10-12 weeks can significantly improve working memory in adolescents.

Comparison of the predictive performance of multivariable logistic regression and XGBoost models for 30-day readmission risk in patients with chronic heart failure

Sui Guoxin, Zheng Mingxiu, Li Huidan, Zhao Jinming, Zhao Honglin

2026, 41(9):  787-793.  doi:10.3969/j.issn.1004-583X.2026.09.002

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Objective To compare the predictive performance of multivariable logistic regression and XGBoost models for the risk of 30-day post-discharge readmission in patients with chronic heart failure (CHF). Methods This retrospective study included 288 patients with CHF who were hospitalized in our institution from November 2022 to November 2025. The patients were randomly assigned in a 7∶3 ratio to a training set (n=202) and a validation set (n=86). According to whether readmission occurred within 30 days after discharge because of worsening heart failure, patients were divided into a readmission group (n=62) and a non-readmission group (n=226). Univariate factors associated with 30-day readmission after discharge were analyzed, and multivariable logistic regression and XGBoost models were developed. Internal validation was performed using the validation set. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of the two models. Results Compared with the non-readmission group, the readmission group had higher age, a higher proportion of patients with New York Heart Association (NYHA) class Ⅲ-Ⅳ, higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, longer length of hospital stay, and a higher proportion of patients with irregular medication use after discharge, as well as lower left ventricular ejection fraction (LVEF), serum sodium, and estimated glomerular filtration rate (eGFR) levels (P<0.05). Multivariable logistic regression confirmed that age, NT-proBNP, serum sodium, and irregular medication use after discharge were all factors associated with 30-day readmission after discharge in patients with CHF (P<0.05). The top 8 feature variables ranked by importance in the XGBoost model were NT-proBNP, LVEF, serum sodium, age, eGFR, NYHA class, length of hospital stay, and irregular medication use after discharge. ROC analysis showed that the XGBoost model outperformed the multivariable logistic regression model. Further comparison using DeLong’s test showed that the areas under the curve (AUCs) of the two models were 0.793 and 0.886, respectively, and the difference was statistically significant (Z=2.415, P=0.016). Conclusion Both multivariable logistic regression and XGBoost models can effectively predict the risk of 30-day readmission after discharge in patients with CHF. However, the XGBoost model demonstrated superior predictive performance and may serve as an auxiliary tool for early identification of high-risk patients and clinical intervention decisions.

Differences in the gut microbiota among patients with benign and malignant pulmonary nodules and healthy individuals

Xie Shiliang, Wang Xinyu, Zhao Long, Sun Ruixin

2026, 41(9):  794-806.  doi:10.3969/j.issn.1004-583X.2026.09.003

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Objective To preliminarily investigate differences in the gut microbiota and metabolic pathways among patients with malignant pulmonary nodules, benign pulmonary nodules, and healthy individuals. Methods This study was designed as a small-sample, exploratory investigation. A total of 31 patients with pulmonary nodules who visited Shanghai Tongji Hospital from August to December 2024 were enrolled and divided into a malignant pulmonary nodule group (n=23) and a benign pulmonary nodule group (n=8) according to nodule pathology. In addition, 14 healthy individuals were included as the healthy control group. 16S ribosomal RNA sequencing was used to analyze microbiota diversity, species abundance, community structure, and functional metabolic differences among the three groups. Results Alpha diversity analysis showed that, in terms of species richness, the abundance-based coverage estimator index differed significantly between the malignant and benign pulmonary nodule groups, as well as between the benign pulmonary nodule and healthy control groups (P<0.05). In terms of community evenness and diversity, both the malignant and benign pulmonary nodule groups had lower Shannon and Simpson indices than the healthy control group (P<0.05). Beta diversity analysis showed significant overall differences in community macrostructure among the three groups (P<0.05). Specifically, the malignant pulmonary nodule group demonstrated an independent clustering pattern deviating from healthy homeostasis, whereas the community structure of the benign pulmonary nodule group partially overlapped with and converged toward that of the healthy control group. Linear cliscriminant analysis effect size analysis showed that biomarkers across the three groups exhibited marked pathological cascade differentiation (LDA>3.0, P<0.05). The malignant pulmonary nodule group showed specific enrichment of opportunistic pathogenic bacteria, including the phylum Proteobacteria and its downstream taxaGammaproteobacteria, Enterobacteriaceae, and Escherichia-Shigella. In contrast, the benign pulmonary nodule group exhibited a probiotic-defense pattern characterized by enrichment of Actinobacteriota and Bifidobacterium. Spearman correlation network analysis indicated that microbial dysbiosis was not an isolated event, but was driven by strong antagonistic competition between opportunistic pathogens and core beneficial symbionts. Pairwise Kyoto encyclopedia of genes and genomes functional prediction revealed significant differences in multiple specific metabolic pathways among the three groups (P<0.05). Conclusion The gut microbiota composition differs significantly between patients with malignant pulmonary nodules and healthy individuals. Distinct metabolic pathways were also identified among the malignant pulmonary nodule, benign pulmonary nodule, and healthy control groups. These findings may provide novel biomarkers and strategies for the diagnosis and treatment of lung cancer.

Effect of bedside ultrasound-guided chest physiotherapy combined with fiberoptic bronchoscopy suction on airway clearance in critically ill patients receiving mechanical ventilation

Liu Jia, Liu Fukang, Wang Xiaoqing

2026, 41(9):  807-811.  doi:10.3969/j.issn.1004-583X.2026.09.004

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Objective To investigate the effect of bedside ultrasound-guided chest physiotherapy combined with fiberoptic bronchoscopy suction on airway clearance in critically ill patients receiving mechanical ventilation. Methods A total of 100 critically ill patients receiving mechanical ventilation who were treated at Tianjin Union Medical Center from December 2023 to March 2025 were prospectively enrolled. Using a random number table, the patients were divided into an observation group (50 cases) and a control group (50 cases). The control group received conventional airway clearance measures, whereas the observation group received bedside ultrasound-guided chest physiotherapy combined with fiberoptic bronchoscopy suction. Oxygenation indicators, lung ultrasound scores, airway clearance efficacy, clinical outcomes, and adverse reactions were compared between the two groups. Results After treatment, oxygenation index increased and lung ultrasound scores decreased in both groups. The observation group had significantly higher oxygenation index values and significantly lower lung ultrasound scores than the control group (P<0.05). After treatment, the observation group had significantly greater airway secretion clearance and higher sputum expectoration effectiveness scores than the control group (P<0.05). The observation group had significantly shorter mechanical ventilation time and intensive care unit length of stay than the control group (P<0.05). The incidence of adverse reactions was lower in the observation group than in the control group (P<0.05). Conclusion A bedside ultrasound-guided combined airway clearance strategy can effectively improve oxygenation, promote lung recruitment, shorten the duration of mechanical ventilation in critically ill patients receiving mechanical ventilation, and is safe and worthy of clinical promotion.

Risk factors and development and validation of a prediction model for vision impairment in middle-aged and older adults: A CHARLS database-based study

Mei Baihao, Li Ying, Yang Xingyu, Gao Zhaoyu

2026, 41(9):  812-817.  doi:10.3969/j.issn.1004-583X.2026.09.005

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Objective To predict vision impairment (VI) and identify its risk factors using machine learning algorithms. Methods Data from the 2016-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS) were selected. Eligible participants were screened, and after data cleaning and preprocessing, 19 430 participants were ultimately included. Participants were randomly assigned in an 8:2 ratio to a training set (15 544 cases) and a validation set (3 886 cases), with VI as the outcome variable. Prediction models were constructed using Random Forest (RF), Extreme Gradient Boosting (XGBoost, XGB), CatBoost (CB), Gradient Boosting (GB), and Light Gradient Boosting Machine (LightGBM, LGBM). Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), F1 score, precision, accuracy, and other indicators. SHAP analysis was used to interpret the optimal model. Results Among the 19 430 participants, 5 026 had VI, yielding a prevalence of 25.9%. The AUC values of RF, XGB, CB, GB, and LGBM were 0.748, 0.771, 0.773, 0.778, and 0.779, respectively. Based on a comprehensive comparison of all indicators, the prediction model constructed using the GB algorithm showed the best predictive performance. SHAP analysis showed that key features such as hearing impairment, place of birth, age, education level, cognitive function, living environment, and offspring support had a significant impact on the prediction results. Conclusion A GB-based prediction model for VI in middle-aged and older adults was developed and deployed on a web platform. This model can effectively identify high-risk individuals, thereby facilitating early implementation of targeted intervention and health education strategies.

Effects of early rehabilitation training on neurological recovery and serum neurotrophic factor levels in patients with cerebral infarction at medium-to-high altitudes

Lin Tao, Wu Weijun

2026, 41(9):  818-823.  doi:10.3969/j.issn.1004-583X.2026.09.006

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Objective To investigate the effects of early rehabilitation training on neurological recovery and serum levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in patients with cerebral infarction (CI) at medium-to-high altitudes. Methods This multicenter, prospective, nonrandomized controlled study included 320 patients with acute cerebral infarction (ACI) admitted to Qinghai University Affiliated Hospital (medium altitude, 2, 260 m) and Hainan Tibetan Autonomous Prefecture Hospital (high altitude, 3, 200 m) from January 2022 to December 2023. According to whether they received systematic early rehabilitation training, patients were assigned to the rehabilitation group (n=160) and the control group (n=160). The rehabilitation group began individualized rehabilitation training within 48 h of onset, whereas the control group received routine care. At admission and on days 7, 30, and 90, neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Fugl-Meyer Assessment (FMA), and serum BDNF and VEGF levels were measured. Repeated-measures analysis of variance and logistic regression were used for statistical analysis. Results On days 30 and 90, NIHSS scores were significantly lower in the rehabilitation group than in the control group, whereas BI and FMA scores were significantly higher in the rehabilitation group (interaction P<0.05). Repeated-measures analysis of variance showed statistically significant differences in NIHSS, BI, FMA, BDNF, and VEGF levels between groups, over time, and for the time-by-group interaction (NIHSS: between-group F=18.450, P<0.01; interaction F=8.672, P<0.01; BI: between-group F=32.100, P<0.01, interaction F=11.240, P<0.01; FMA: between-group F=28.960, P<0.01, interaction F=9.870, P<0.01; BDNF: between-group F=41.580, P<0.01, interaction F=15.320, P<0.01; VEGF: between-group F=35.210, P<0.01, interaction F=12.760, P<0.01). Serum BDNF and VEGF levels in the rehabilitation group were significantly higher than those in the control group on days 30 and 90 (P<0.01). Multivariate regression analysis showed that early rehabilitation was an independent protective factor for neurological recovery (OR=0.580, 95%CI: 0.39-0.87). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). Conclusion Early systematic rehabilitation training can significantly improve neurological deficits and activities of daily living in patients with CI at medium-to-high altitudes. Its mechanism may be related to upregulation of serum BDNF and VEGF levels. The approach is safe and worthy of clinical promotion.

Development and validation of a logistic regression model for factors influencing post-stroke emotional disorders after acute ischemic stroke

Zhang Shuaijie, He Chunlei, Cao Aihua

2026, 41(9):  824-830.  doi:10.3969/j.issn.1004-583X.2026.09.007

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Objective To investigate the factors influencing post-stroke emotional disorder (PSED) in patients with acute ischemic stroke (AIS) and to construct a logistic regression model for identifying high-risk patients and guiding individualized clinical interventions. Methods A total of 200 patients with AIS treated at our hospital from November 2022 to November 2024 were enrolled, all of whom received intravenous thrombolysis. According to whether PSED occurred within 1 year after treatment (8 patients lost to follow-up), the patients were divided into a PSED group (102 cases) and a non-PSED group (90 cases). Clinical characteristics were compared between the two groups, and the factors influencing PSED after AIS were analyzed. Based on the multivariate analysis results, a logistic regression model was constructed and its predictive value for PSED after AIS was validated. Results Multivariate logistic regression analysis showed that higher National Institutes of Health Stroke Scale (NIHSS) score at admission, per capita monthly income <3000 yuan, poor ability to perform activities of daily living independently, sleep disorders, low social support, poor family care, and elevated cortisol, homocysteine (Hcy), peroxiredoxin 1 (PRDX1), and glial fibrillary acidic protein (GFAP) levels were independent risk factors for PSED after AIS (P<0.05). The logistic regression model yielded an area under the curve (AUC) of 0.904 for predicting PSED after AIS, with sensitivity and specificity of 82.35% and 82.22%, respectively. The Hosmer-Lemeshow test indicated good model fit (χ²=5.542, P=0.129). Bootstrap validation showed good discrimination, with a concordance index of 0.938. Decision curve analysis showed that the model provided good clinical net benefit when the risk threshold ranged from 0.10 to 0.90. Conclusion Higher NIHSS score at admission, per capita monthly income <3, 000 yuan, poor ability to perform activities of daily living independently, sleep disorders, low social support, poor family care, and elevated cortisol, Hcy, PRDX1, and GFAP levels are independent risk factors for PSED after AIS. The logistic regression model constructed on the basis of these factors has a certain predictive value for PSED after AIS. Clinically, targeted interventions should be implemented to reduce the risk of PSED.

Correlation of serum FCER1G, NRF2, and CXCL13 expression with diabetic peripheral neuropathy in patients with type 2 diabetes mellitus and their auxiliary identification value

Xu Shanshan, Cui Huijuan, Chen Hua, Song Na, Liu Sijia, Wang Saifei, Li Xin

2026, 41(9):  831-836.  doi:10.3969/j.issn.1004-583X.2026.09.008

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Objective To investigate the correlation between serum immunoglobulin E Fc segment high-affinity receptor 1G (FCER1G), nuclear factor erythroid 2-related factor 2 (NRF2), and C-X-C motif ligand 13 (CXCL13) levels and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM), and to evaluate their auxiliary identification value. Methods A total of 171 T2DM patients who visited the Third People’s Hospital of Zhengzhou from August 2023 to August 2025 were enrolled. Based on whether DPN occurred, patients were further divided into a non-DPN (N-DPN) group (n=95) and a DPN group (n=76). Clinical data and serum FCER1G, NRF2, and CXCL13 levels were compared between the two groups. Pearson correlation analysis was used to evaluate the correlations between serum FCER1G, NRF2, CXCL13 levels and clinical characteristics. Multivariate logistic regression was used to identify factors associated with DPN in T2DM patients. Receiver operating characteristic (ROC) curves were used to assess the auxiliary identification value of FCER1G, NRF2, and CXCL13 alone and in combination for DPN in T2DM patients. Internal validation of the combined model was performed using the Bootstrap method with 1, 000 resamples, together with cross-validation. The Hosmer-Lemeshow test was used to evaluate the goodness-of-fit of the combined model. Clinical decision curve analysis was used to assess the clinical utility of the combined model. Results Compared with the N-DPN group, the DPN group had higher duration of diabetes, glycated hemoglobin (HbA₁c), interleukin-6 (IL-6), FCER1G, and CXCL13 levels, and lower NRF2 levels (all P<0.05). FCER1G, NRF2, and CXCL13 levels were correlated with diabetes duration, HbA₁c, and IL-6 levels (all P<0.05). Increased diabetes duration, higher HbA₁c, higher IL-6, higher FCER1G, higher CXCL13 levels, and lower NRF2 levels were associated with DPN in T2DM patients (all P<0.05). The combined detection of FCER1G, NRF2, and CXCL13 had better auxiliary identification performance than any single marker (Zthree-marker combination-FCER1G=3.081, Zthree-marker combination-NRF2=2.815, Zthree-marker combination-CXCL13=2.963, all P<0.05). Internal validation showed good calibration for the combined model (χ²=5.383, P=0.716). Within the high-risk threshold range of 0.07-0.91, the combined model of FCER1G, NRF2, and CXCL13 provided a higher net benefit than the single models. Conclusion Serum FCER1G and CXCL13 levels are elevated, while the level of NRF2 is decreased in T2DM patients with DPN, all the three are significantly correlated with the DPN, and their conjunction exhibited favorable auxiliary recognition value.

A case of type 2 myocardial infarction caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome

Zhang Pengwei, Wang Zhihui, Wen Qianling, Chen Bo, Dong Xiaoli, Yao Chenyang, Li Wenbo, Dang Xiaohong

2026, 41(9):  837-841.  doi:10.3969/j.issn.1004-583X.2026.09.009

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Objective To discuss the clinical manifestations and diagnostic and therapeutic strategies of type 2 myocardial infarction (T2MI) caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome. Methods A retrospective analysis was conducted of the clinical data, diagnosis, and treatment of one patient with T2MI caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome, and relevant literature was reviewed. Results The patient was a 31-year-old young woman with no special past medical history. She was admitted due to “sudden palpitations, syncope, and chest discomfort/ache in the precordial area for 1 hour”. Based on cardiac electrophysiology, clinical manifestations, electrocardiogram, and myocardial enzyme testing, the diagnoses of A-type pre-excitation syndrome, paroxysmal atrioventricular reentrant tachycardia, and T2MI were established. Conclusion When pre-excitation syndrome is complicated by paroxysmal atrioventricular reentrant tachycardia and abnormalities such as chest pain, syncope, and myocardial enzyme elevations are present, T2MI should be considered. Prompt diagnosis and timely treatment are necessary.

Pediatric acute myeloid leukemia with NUP98-NSD1 rearrangement and FLT3-ITD mutation: Two case reports and a literature review

Wang Cheng, Wang Yilin, Jiang Jian, Wang Lingzhen

2026, 41(9):  842-847.  doi:10.3969/j.issn.1004-583X.2026.09.010

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Objective To investigate the clinical characteristics, treatment strategies, and prognosis of pediatric acute myeloid leukemia (AML) with coexisting NUP98-NSD1 rearrangement and FLT3-ITD mutation. Methods A retrospective analysis was performed on two pediatric AML cases with NUP98-NSD1 rearrangement and FLT3-ITD mutation admitted to the Department of Pediatric Hematology, the Affiliated Hospital of Qingdao University. In addition, domestic and international literature was systematically searched, yielding 52 pediatric cases and 26 adult cases. Baseline characteristics, treatment responses, and prognosis were compared between the two groups. Results In the two cases from our center, the white blood cell count at diagnosis was >150.00×10⁹/L in both patients. Neither achieved complete remission (CR) after initial induction chemotherapy. CR was achieved after switching to second-line regimens (fludarabine+cytarabine+G-CSF [FLAG]/cladribine+cytarabine+homoharringtonine+G-CSF, [CHAG]), and CR was maintained after FLT3 inhibitor therapy combined with transplantation. The literature review showed no significant differences between the pediatric and adult groups in sex (P=0.090), +8/9q13/q32 karyotype (P=0.983), WT1 mutation (P=0.705), initial CR rate (30.0% vs 31.3%, P=1.000), transplantation rate (P=0.139), relapse rate (60.0% vs 64.3%, P=0.781), or mortality rate (57.1% vs 68.0%, P=0.394). However, the pediatric group had a significantly higher white blood cell count at diagnosis than the adult group (P=0.003), and the proportion of patients with a white blood cell count ≥150×10⁹/L at diagnosis was also significantly higher in the pediatric group than in the adult group (62.5% vs 16.7%, P=0.003). In contrast, the adult group had a significantly higher proportion of M4/M5 subtypes than the pediatric group (83.3% vs 51.1%, P=0.017). In the pediatric group, the initial remission rate was only 30.0%, the relapse rate reached 60.0%, and the mortality rate was 57.1%. Conclusion Pediatric AML with NUP98-NSD1 rearrangement and FLT3-ITD mutation often presents with marked leukocytosis at diagnosis, shows poor response to conventional induction chemotherapy, and is associated with high relapse and mortality rates, indicating a high-risk subtype. Although pediatric and adult patients are similar in most clinical and prognostic features, children are more prone to extreme leukocytosis, whereas adults more commonly present with M4/M5 subtypes. For both groups, an aggressive treatment strategy involving second-line therapy as a bridge to transplantation and targeted therapy is warranted.