Annals of Translational Medicine

Objective: To describe the clinical characteristics of term neonates with neonatal bacterial meningitis (NBM) and explore the association between different pathogens and imaging complications, providing clinical evidence for early identification and individualized management. Methods: A retrospective study was conducted on 531 term neonates diagnosed with NBM admitted to the Capital Institute of Pediatrics from 2013 to 2025. Demographics, clinical manifestations, laboratory parameters, etiological results, imaging complications and treatment measures were collected. Patients were divided into favorable/adverse discharge outcome groups and pathogen-positive/negative groups. Statistical analyses were performed using appropriate tests, and Cramers V coefficient was used to analyze the association between pathogens and imaging complications. Results: (1) The most common clinical manifestations were abnormal body temperature (79.85%), altered consciousness (55.18%) and jaundice (46.52%). CSF/blood culture was positive in 133 cases (25.05%), with Escherichia coli (27.07%), group B streptococcus (17.29%) and Staphylococcus species (16.54%) as predominant pathogens. The overall incidence of imaging complications was 22.22%, mainly hydrocephalus (5.84%), subdural effusion (4.90%) and encephalomalacia (2.64%). (2) Adverse discharge outcomes occurred in 107 cases (20.15%). Compared with the favorable group, the adverse group had higher incidences of convulsions, altered consciousness, anterior fontanelle bulging, abnormal muscle tone and primitive reflexes (all P<0.001), more obvious laboratory abnormalities (higher CRP, CSF leukocytes and protein, lower CSF glucose, all P<0.05), higher culture positive rates and greater need for adjuvant therapy (all P<0.001). (3) Pathogen-positive patients had higher imaging complication rates. Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates, while Gram-positive infections had higher brain abscess risk. Specifically, Escherichia coli correlated with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; LM with intracranial hemorrhage and brain abscess; negative cultures correlated with no imaging complications (all P<0.05). Conclusion: Term NBM neonates have non-specific manifestations, mainly abnormal body temperature and altered consciousness. Predominant pathogens are Escherichia coli, group B streptococcus and Staphylococcus species, with hydrocephalus and subdural effusion as common imaging complications. Adverse outcomes are associated with severe symptoms, obvious laboratory abnormalities and higher pathogen positivity. Specific pathogens correlate with distinct imaging complications.

BackgroundIt has been demonstrated that stem cell transplantation promotes healing of the infarcted heart through paracrine effects. However, the therapeutic potential of exosomes secreted by hiPSC-derived epicardial cells (hEP-Exos) for treating infarcted hearts remains unclear. Myocardial infarction (MI) can trigger EP activation, increasing EP paracrine function. Therefore, this study aims to determine and compare the cardioprotective effects of exosomes secreted by hEPs under normoxic (Exo-N) and hypoxic (Exo-H) conditions in MI mice and to explore the underlying mechanisms. MethodsTwo types of exosomes were collected by ultracentrifugation and delivered via intramyocardial injection in a murine MI model. The protective effects of Exo-N and Exo-H on the infarcted heart were assessed using echocardiography, histological examination, and immunofluorescence analysis. Additionally, microRNA sequencing, luciferase activity assays, and miRNA gain-and loss-of-function experiments were performed to identify enriched miRNAs and investigate their roles in different exosome populations. ResultsIn vitro, both Exo-N and Exo-H enhanced the migration and tube-formation capacities in human umbilical vein endothelial cells (HUVECs) and reduced the apoptosis in hiPSC-derived cardiomyocytes (hCMs) under oxygen-glucose deprivation (OGD), with Exo-H exhibiting a stronger effect. In vivo, both Exo-N and Exo-H significantly improved contractile function, reduced infarct size, and mitigated adverse remodeling in mouse hearts with MI, accompanied by increased cardiomyocyte survival and angiogenesis, with Exo-H showing superior efficacy. Mechanistically, miRNA sequencing revealed distinct cargo profiles between Exo-N and Exo-H. miR-214-3p was identified as a key mediator of the enhanced therapeutic potency of Exo-H. miR-214-3p promoted EC angiogenesis by suppressing vasohibin-1 and attenuated cardiomyocyte mitochondrial fission and apoptosis by suppressing mitochondrial elongation factor 2 (MIEF2). ConclusionsThis study demonstrates that administration of hEP-Exos, particularly Exo-H, provides robust cardioprotection by enhancing cardiomyocyte survival and angiogenesis, potentially mediated by miR-214-3p. These findings suggest that conditioned hEP-Exos could be a promising and effective acellular therapeutic option for treating MI.

Purpose: To develop an interpretable feature-based Deep Parametric Response Mapping (PRMD) method that combines wavelet scattering convolution networks and machine learning to spatially detect and quantify functional small airways disease (fSAD) and emphysema on paired inspiratory-expiratory CT scans, with enhanced noise robustness. Materials and Methods: In this retrospective analysis of prospectively acquired data (2007-2017), we developed and validated a deep learning-based PRM approach using paired CT scans from 8,972 tobacco-exposed COPDGene participants ([&ge;]10 pack-years; mean age 60.1 {+/-} 8.8 years; 46.5% women), including controls with normal spirometry (n = 3,872; controls), PRISm (n = 1,089), GOLD 1-4 COPD (n = 4,011). Data were stratified into training, validation, and testing sets (24:6:70). PRMD extracts translation-invariant image features using a wavelet scattering network and applies a subspace learning classifier to classify voxels as emphysema or non-emphysematous air trapping (fSAD). PRMD was compared with conventional density-based PRM for voxel-wise agreement, correlation with pulmonary function, robustness to noise, and sensitivity to misregistration using Pearson correlation, Bland-Altman analysis, and paired t tests. Results: PRMD achieved 95% voxel-wise agreement with standard PRM (r = 0.98) while demonstrating significantly greater robustness under noise. PRMD showed stronger correlations with FEV1; (emphysema: r = - 0.54; fSAD: r = - 0.51; P < 0.0001) than standard PRM (r = - 0.42 for both; P < 0.0001). Under simulated high-noise conditions, standard PRM overestimated disease by ~15%, whereas PRMD limited error to < 5% (P < 0.001). Conclusion: PRMD provides an interpretable, feature-driven and noise-resilient alternative to traditional PRM for emphysema and fSAD classification, enhancing the reliability of CT-based COPD phenotyping for multi-center studies and low-dose imaging applications.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can cause serious immune-related adverse events (irAEs), with pneumonitis (ICI-P) being among the most severe. Early identification of high-risk patients before ICI initiation is critical for closer monitoring, timely intervention, and improved outcomes. Purpose: To develop and validate a deep learning foundation model to predict ICI-P from baseline CT scans in patients with lung cancer. Methods: We designed the Checkpoint-Inhibitor Pneumonitis Hazard EstimatoR (CIPHER), a deep learning foundation model that combines contrastive learning with a transformer-based masked autoencoder to predict ICI-P from baseline CT scans in patients with lung cancer. Using self-supervised learning, CIPHER was pre-trained on 590,284 CT slices from 2,500 non-small cell lung cancer (NSCLC) patients to capture heterogeneous lung parenchymal patterns. After pre-training, the model was fine-tuned on an internal NSCLC cohort for ICI-P risk prediction, using images from 254 patients for model development and 93 patients for internal validation. We compared CIPHER with classical radiomic models and further evaluated it on an external NSCLC cohort of 116 patients. Results: In the internal immunotherapy cohort, CIPHER consistently distinguished patients at elevated risk of ICI-P from those without the event, with AUCs ranging from 0.77 to 0.85. In head-to-head benchmarking, CIPHER achieved an AUC of 0.83, outperforming the radiomic models. In the external validation cohort, CIPHER maintained strong performance (AUC = 0.83; balanced accuracy = 81.7%), exceeding the radiomic models (DeLong p = 0.0318) and demonstrating higher specificity without sacrificing sensitivity. By contrast, the radiomic model showed high sensitivity (85.0%) but markedly lower specificity (45.8%). Confusion matrix analysis confirmed the robust classification performance of CIPHER, correctly identifying 80 of 96 non-ICI-P cases and 16 of 20 ICI-P cases. Conclusions: We developed and externally validated CIPHER for predicting future risk of ICI-P from pre-treatment CT scans. With prospective validation, CIPHER may be incorporated into routine patient management to improve outcomes.

Radiation-induced intestinal injury is a widely used model for studying mechanisms regulating tissue injury and regeneration. Traditionally, Cesium (137Cs) radiation has been used in research applications, but over the past decade, X-ray irradiation has become increasingly favored due to its improved safety and non-radioactive profile. Since each type of radiation has distinct physical characteristics that drive its performance, we sought to systematically compare the effects of the X-ray and 137Cs irradiators on intestinal epithelial injury and regeneration. Using established in vitro models, including colorectal cancer cell lines such as HCT116, RKO, and DLD-1, and mouse intestinal organoids, alongside an in vivo model, Bmi1-CreER;Rosa26eYFP, we evaluated differences in transcriptional, protein, and histopathological responses to irradiation. Our results demonstrate that X-ray produced intestinal injury and regenerative responses comparable to those induced by 137Cs, supporting its reliability as an alternative modality for studying intestinal radiation.

Introduction Cervical spondylotic myelopathy (CSM) surgery is frequently associated with residual neurological deficits, partly due to unrecognized dynamic spinal cord compression on conventional MRI. Current static imaging may miss position-dependent stenosis, resulting in insufficient or inappropriate decompression. This study aims to evaluate whether dynamic MRI-guided individualized surgery improves neurological outcomes compared to conventional MRI-based planning. Objectives This study aims to examine the association between dynamic MRI-guided surgical planning and neurological recovery in cervical spondylotic myelopathy, and to evaluate its role in identifying responsible segments, avoiding excessive surgery, and improving clinical outcomes. Methods This single-center retrospective cohort study will include 300 patients who underwent cervical spine surgery between January 2020 and December 2025 at the First Affiliated Hospital of Guangxi University of Chinese Medicine. Patients will be categorized into the dynamic MRI-guided group (n=150) or conventional MRI-based group (n=150) based on preoperative imaging modality. 1:1 propensity score matching will be performed using age, sex, BMI, disease duration, baseline mJOA score, and number of compressed segments. The primary outcome is the rate of improvement in the mJOA score at 6 months postoperatively. Secondary outcomes include VAS, NDI, reoperation rate, and time to first complication. Between-group comparisons will use t-tests/Mann-Whitney U tests for continuous variables, {chi}{superscript 2} tests/Fisher's exact tests for categorical variables, and Kaplan-Meier estimates with the log-rank test for time-to-event outcomes. A two-sided P<0.05 will be considered significant. Analyses will be performed using R software (version 4.4.1). Ethical approval was obtained from the Medical Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine (Approval No. 2025-080-KY-01) from February 06, 2026 to February 05, 2027. Expected outcomes We hypothesize that dynamic MRI-guided surgical planning will improve neurological recovery and decompression accuracy in cervical spondylotic myelopathy, providing evidence for optimized preoperative imaging and precision spine surgery.

Background: Medical imaging, especially computed tomography and magnetic resonance imaging, is essential in clinical care of patients with renal cell carcinoma (RCC). Artificial intelligence (AI) research into computer-aided diagnosis, staging and treatment planning needs curated and annotated datasets. Across literature, The Cancer Genome Atlas (TCGA) datasets are widely used for model training and validation. However, re-annotation is often necessary due to limited access to public annotations, raising entry barriers and hindering comparison with prior work. Methods: We screened 1915 CT scans from three TCGA-RCC databases and employed a segmentation model to annotate kidney lesion. After a meta-data-based exclusion step, we hosted a reader study with all papillary (n=56), chromophobe (n=27) and 200 randomly selected clear cell RCC cases. Two students quality checked and corrected the data as well as annotated tumors and cysts. Uncertain cases were checked by a board-certified radiologist. Results: After data exclusion and quality control a total of 142 annotated CT scans from 101 patients (26 female, 75 male, mean age 56 years) remained. This includes 95 CTs with clear cell RCC, 29 with papillary RCC and 18 with chromophobe RCC. Images and voxel-level annotations of kidneys and lesions are open sourced at https://zenodo.org/records/19630298. Conclusion: By making the annotations open-source, we encourage accessible and reproducible AI research for renal cell carcinoma. We invite other researchers who have previously annotated any of these cohorts to share their annotations.

Purpose: We evaluated healthcare resource utilization (HCRU) and costs in patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods: Patients with newly diagnosed EGPA (2017--2021), [&ge;]12 months' pre-diagnosis health plan enrollment, and [&ge;]1 inpatient or [&ge;]2 outpatient claims with an EGPA diagnosis were included. Follow-up was from EGPA diagnosis until disenrollment or database end. HCRU and health insurer payment costs during follow-up were compared with those for matched cohorts of general insured patients without EGPA (comparison A) and without EGPA but with severe uncontrolled asthma (SUA; comparison B). Results: In comparison A, all-cause HCRU was higher in the EGPA cohort (n = 213) versus matched patients (n = 779) for all clinical encounters/pharmacy claim types; annualized, mean total all-cause costs were 16-fold higher ($117,563/patient) versus matched patients ($7,520/patient). In comparison B, all-cause HCRU was higher for the EGPA cohort (n = 182) versus the matched SUA cohort (n = 640) for all clinical encounters/pharmacy claim types, with 5-fold higher mean total all-cause costs ($118,127/patient vs $22,286/patient). In both EGPA cohorts, HCRU and associated costs increased between the baseline and follow-up periods. Conclusions: These findings highlight the need for more effective treatments to reduce the clinical and economic burden of EGPA.

Purpose: To assess the repeatability of a prototype super acuity test chart for measuring visual acuity at 12.5 cm, and its ability to detect hyperopia in adolescents and young adults. Methods: Repeatability was estimated as within-subject standard deviation of three repeated super acuity measurements performed in 41 university students (19-26 years). Associations between super acuity and cycloplegic refractive errors, ocular biometry, distance visual acuity, accommodation, age, and sex were assessed in 119 high school students (16-18 years) using linear mixed-effects models. ROC curves and Youden index were used to estimate the best super acuity thresholds to detect rest hyperopia. Results: Mean super acuities in the university and high school cohorts were 0.14 {+/-} 0.13 and 0.12 {+/-} 0.11 logMAR, respectively. Repeatability was 0.031. Super acuity was poorer in those with uncorrected hyperopia [spherical equivalent refractive error (SER) [&ge;] 1.00 D] than the others [SER < 1.00 D; P = 0.039]. There were significant associations between poorer super acuity and more positive ametropia (SER; P = 0.026), poorer accommodation amplitude (P < 0.001), shorter axial length (P = 0.013), male sex (P < 0.001), and age (P = 0.037). Sensitivity and specificity for detecting hyperopia (SER [&ge;] 1.00 D) were 63.2% and 64.2%, respectively, at a super acuity threshold of 0.09 logMAR. Discussion: The super acuity prototype shows promise as a screening indicator for hyperopia. Further studies are needed to optimize the test and testing protocol, and to assess its ability to detect uncorrected hyperopia in children.

Background: Even for experienced operators, endovascular treatment of unruptured intracranial aneurysms involves intraoperative uncertainty that may lead to adjustments in strategy, prolong the procedure, and potentially cause inefficiency and device waste. This study aimed to evaluate whether pre-procedural testing (PPT) of endovascular treatment using patient-specific models was associated with increased operator confidence and perceived clinical utility, including improvements in procedural efficiency and reduced resource waste. Methods: We enrolled a cohort of patients who underwent PPT before endovascular treatment for complex unruptured intracranial aneurysms and compared their outcomes with a control group treated without PPT. The primary outcome was the Training Fidelity Score, a composite of three operator-reported Likert items defined a priori. Secondary outcomes included perceived clinical utility, intraoperative strategy changes, procedural time, radiation exposure, device waste and safety. Results: A total of 85 patients met the inclusion criteria (PPT=40; control=45). The Training Fidelity Score was high across the PPT group (median, 4.33/5). Perceived clinical utility was high and further increased significantly after the procedure. A significant reduction was observed in intraoperative strategy changes, with no changes recorded in the PPT group, compared to 6/45 in the control group (RR 0.09; p=0.027). Reductions in treatment time, radiation exposure and device waste were also noted. Conclusion: PPT using patient-specific models was associated with increased operator confidence, fewer intraoperative strategy changes, improved procedural efficiency, and reduced device waste without compromising safety. These findings support its use in pre-interventional preparation, but require prospective multicenter validation.

Purpose To evaluate associations between optical coherence tomography angiography (OCT-A) metrics and diabetic retinopathy (DR) and compare their discrimination against conventional clinical risk factors. Methods In this cross-sectional study, 108 adult eyes (right eye if both eligible) with diabetes were recruited from tertiary ophthalmology/optometry clinics. DR was clinically graded using ETDRS categories and dichotomised as no DR vs >= mild NPDR (primary outcome). Macular 6x6 mm OCT-A (Zeiss AngioPlex) was acquired; scans with signal strength >7 and without major artefact were included. Quantitative metrics from the superficial capillary plexus included vessel density (VD) and perfusion density (PD) (central/inner/outer/full regions); structural OCT measures and FAZ parameters were secondary. Associations with >= mild NPDR were assessed using multivariable logistic regression adjusted for age, sex, HbA1c, and diabetes duration. Discrimination was evaluated with ROC curves/AUC (95% CI) and DeLong comparisons of AUCs. Results DR was present in 63% of eyes. DR was associated with lower VD (central, inner, outer, full) and lower PD (central, inner, full) (all p<=0.04). After adjustment, central VD (OR 0.82, 95% CI 0.68-0.98) and central PD (OR 0.92, 95% CI 0.86-0.99) remained independently associated with DR. The OCT-A model outperformed the clinical model (AUC 0.73 vs 0.60); the combined model yielded AUC 0.76. Conclusion VD and PD from the superficial plexus are independently associated with DR and show superior discrimination versus conventional clinical factors alone, supporting OCT-A as an adjunct for earlier DR detection.

Despite the remarkable progress of artificial intelligence represented by large language models, how AI technologies can contribute to the construction of evidence in evidence-based medicine (EBM) remains an overlooked issue. Now, we need an AI that can be compatible with EBM. In the present paper, we aim to propose an example analysis that may contribute to this approach using variable Vision Transformer.

While vaccination conflicts have become apparent, physicians' attitudes toward those with differing views remain unclear. Through an online survey of 492 physicians and 5,252 members of the general public in Japan in February 2026, we investigated attitudes toward four vaccines (influenza, measles, HPV, and COVID-19). Intergroup bias was assessed as ingroup minus outgroup attitudes using a feeling thermometer. Multilevel regression examined associations with agreement group and physician status. Intergroup bias was significantly positive in both agreement and disagreement groups across all vaccine types, and was higher in the agreement group. Physicians exhibited higher intergroup bias than the general public. These findings indicate that vaccination conflict is bidirectional: physicians, often viewed as targets of hostility from vaccine-hesitant individuals, themselves exhibit greater intergroup bias toward those with opposing views. Interventions to raise physicians' awareness of their own bias, alongside communication strategies for vaccine-hesitant individuals, are needed.

Abstract Background: Acute ischemic stroke (AIS) remains a significant cause of disability worldwide. Current treatments, primarily intravenous thrombolysis (IVT), are limited by narrow time windows and reperfusion injury, leading to suboptimal outcomes for many patients. Chuanzhi Tongluo (CZTL), a traditional Chinese medicine, has been preliminarily recognized as a novel cerebral protection agent in animal models. Objectives: This trial investigates the efficacy and safety of CZTL capsule in patients with AIS who are not eligible for IVT or who experience early neurological deterioration after IVT. Methods and design: The CONCERN trial is an investigator-initiated, prospective, multicenter, double-blind, parallel-control, randomized clinical study in China. An estimated 1,208 eligible participants will be consecutively randomized to receive CZTL capsule therapy or placebo in 1:1 ratio across approximately 70 stroke centers in China. All enrolled patients are orally administered 2 capsules of CZTL or placebo 3 times a day together with antiplatelet agents for 3 months. Outcomes: The primary endpoint is an excellent functional outcome, defined as a score of 0 or 1 on the mRS at 90 days. Lead safety endpoints included 90-day mortality and symptomatic intracranial hemorrhage within 48 hours. Conclusions: Results of CONCERN trial will determine the clinical efficacy and safety of the traditional Chinese medicine CZTL capsule in the treatment of AIS patients. Trial registry number: ChiCTR2300074147 (www.chictr.org.cn).

Purpose To evaluate patient satisfaction and preferences for portable versus table-mounted visual field (VF) devices in a rural telemedicine setting and identify influencing factors. Methods We conducted a sequential explanatory mixed methods study at three Federally Qualified Health Centers (FQHCs) within the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine (AL-SIGHT) study. Participants completed VF testing with table-mounted Humphrey Field Analyzer (HFA), tablet-based Melbourne Rapid Fields (MRF), and virtual reality (VR)-based VisuALL perimeters. Participants rated satisfaction, comfort, ease of use, and future testing preference. Chi-square tests assessed differences in device preferences. Twelve participants completed semi-structured interviews to explore reasons underlying preferences. Qualitative data were analyzed in NVivo 14 using reflexive thematic analysis. Results Among 271 respondents (mean age 60.4 years; 62.4% women), 50.6% preferred VR-based, 35.1% tablet-based, and 14.4% table-mounted for future testing ({chi}2 (2) = 53.52, p<0.001, Cramers V = 0.31). Satisfaction was highest for VR-based (56.9% very satisfied), followed by tablet-based (49.4%), and HFA (38.0%). VR-based perimeter was most frequently selected as the most comfortable (55.7%; {chi}2 (2) = 63.33, p<0.001, V = 0.34) and easiest to use (54.6%; {chi}2 (2) = 71.96, p<0.001, V = 0.36). Preferences did not vary significantly across demographic variables (all p>0.05). Qualitative themes identified four key drivers: comfort and physical experience, visual experience, ease of use and interaction, and psychological and motivational factors. Portability and community suitability were valued. Conclusion Rural underserved patients strongly preferred portable visual field devices, particularly VR-based, over table-mounted HFA. Comfort, ergonomic flexibility, immersive visual experience, and simplicity of interaction were central determinants of preference. Portable perimetry may enhance patient-centered glaucoma monitoring within telemedicine programs and access in resource-limited settings.

IntroductionFamily Constellation Therapy (FCT) has been widely disseminated in clinical, public health, and judicial settings despite persistent concerns regarding its theoretical basis, safety, and the limited availability of rigorous randomised evidence supporting its clinical use. ObjectiveThe aim of this systematic review is to assess the effects of FCT across all clinical conditions, explicitly considering both benefits and harms; and summarise the characteristics of studies and intervention settings used in randomised controlled trials of FCT. MethodsFollowing a prospectively registered protocol (CRD420251136190), we conducted a systematic search of seven databases (PubMed, EMBASE, APA PsycInfo, CENTRAL, BVS, Web of Science, and CINAHL) and grey literature (ICTRP and ProQuest database) without language or date restrictions to identify published and unpublished randomised controlled trials of FCT. Study selection, data extraction, risk of bias (RoB 2), and certainty of evidence (GRADE) were performed in duplicate. Statistical analyses followed a prospectively registered analysis plan with prespecified criteria for data pooling and for handling analytical limitations. ResultsNo reliable evidence was found to support the use of FCT for any condition across both clinical and non-clinical samples. All trials included were judged to be at high risk of bias and all comparisons were rated as very low-certainty evidence. Concerns regarding potential adverse effects were identified, and the available data was insufficient to establish the effectiveness of the intervention, precluding any clinical recommendation. ConclusionClinicians, policymakers, and consumers should reconsider adopting FCT while reliable evidence is not available.

BackgroundLasers have wide applications in medicine and dermatology, but are associated with pain and anxiety, particularly in younger patients. Pain mitigation is often limited to topical anesthetics in the outpatient setting. Distraction techniques are limited by the need for ocular protection, which can include adhesive eye patches that can completely occlude vision. Virtual reality is effective at managing procedural pain and anxiety under other short medical procedures and is a promising tool for this population. ObjectiveThis trial aims to assess the safety, feasibility, and efficacy of Virtual Reality Pain Alleviation Therapeutic (VR-PAT) for pain management during outpatient laser procedures. Methods40 patients requiring outpatient laser therapy for at least two sessions will be recruited from a pediatric hospital in the midwestern United States for this crossover randomized, two-arm clinical trial with a 1:1 allocation ratio. During the first laser visit, the participant will be randomly assigned to either play the VR-PAT game during their procedure or wear the headset with a dark screen. Participants will answer questions about their pain (Numeric Rating Scale (NRS) 0-10), anxiety (State Trait Anxiety Inventory for Children, NRS 0-10, Modified Yale Preoperative Anxiety Scale (mYPAS)), and pain medication usage. Those playing the VR-PAT will additionally report simulator sickness symptoms and their experience playing the game. At their second laser visit, participants will crossover to the opposite intervention from their first visit. The primary outcomes are the difference in self-reported pain and anxiety between the two interventions. Feasibility outcomes include the proportion of screened patients who are eligible, consent, and complete both visits and adverse events reported. To evaluate the efficacy of pain reduction, composite scores of pain score, pain medication will be calculated for each laser visit. To evaluate the efficacy of anxiety reduction, the change of mYPAS scores will be compared between control and VR groups at each visit using Wilcoxon rank sum tests. All statistical analyses will follow the intention-to-treat principle in regard to intervention assignment at each visit. ResultsThe study was funded in January 2023 and began enrollment at that time. A total of n=44 participants were recruited and data collection was completed in November 2025, with n=40 subjects completing both visits. The sample was balanced with n=40 subjects using the intervention and participating in the control condition. The age range of the complete sample was 6 to 21 years at recruitment and was 55% female sex. Data analysis is in progress with final results planned for June 2026. ConclusionsFindings from this innovative randomized clinical trial will provide early evidence on the efficacy of the VR-PAT for reducing self-reported pain and anxiety during outpatient laser procedures. The results from this trial will inform a large-scale, multisite study. Trial RegistrationClinicalTrials.gov: NCT05645224 [https://clinicaltrials.gov/study/NCT05645224]

BackgroundIn computational biology, embedding known physical laws into deep learning models to construct "Physics-Informed Neural Networks" (PINNs) is a mainstream paradigm for enhancing model interpretability and extrapolation capability. However, in complex multi-physics coupling problems, there is a risk of competitive imbalance between the physical term and the flexible artificial intelligence (AI) residual term, causing the model to degenerate into a "black-box" fit and lose the original purpose of being physics-driven. MethodsIn this study, targeting the problem of predicting protein liquid-liquid phase separation (LLPS) behavior in response to environmental factors (temperature, salt concentration), we identified physical distortions, gradient vanishing, and numerical instability in the initial physics-AI hybrid model. Three core correction strategies were proposed: (1) Weight Allocation Logic Reconstruction: Force the physical trunk weight to 1.0 at the output layer, suppressing the AI residual term to the perturbation level of 0.05~0.1, ensuring physics dominance; (2) Robust Physics Formula Construction: Abandon the unstable power function and introduce a combination of Softplus and logarithmic functions to stably simulate the nonlinear effects of charge shielding; (3) Gain Compensation Alignment: Apply gain compensation to the weak signal branch (temperature) to ensure its effective participation in optimization. ResultsThe optimized model maintained a fitting accuracy of R2{approx}0.62 on the test set, while physical consistency was significantly enhanced. The model successfully restored the monotonic increase in solubility with temperature characteristic of UCST-type phase diagrams and correctly captured the nonlinear charge shielding features in the salt concentration response. The weights of key physical parameters (e.g., hydrophobic contribution w_h, net charge contribution w_ncpr) increased from <10-3 to the 10-2 magnitude, demonstrating the reactivation of the physical branch. ConclusionsThe weight control, formula stabilization, and signal gain alignment strategies proposed in this study effectively address the classic problem of "AI hijacking" physics in physics-AI hybrid models. This work provides a universal solution for constructing biophysical predictive models that combine high fitting accuracy with strong physical interpretability.

BackgroundInflammatory bowel disease (IBD) is associated with early structural changes in intestinal epithelial cells; however, the associated molecular alterations remain incompletely understood. The cytoskeletal protein keratin (K) 7 was recently found to be focally expressed in the colonic epithelium in IBD, while absent in the healthy colon. Here, we investigated the applicability of K7 as a noninvasive stool biomarker for pediatric IBD. MethodsIn this case-control study including adolescent patients with IBD (n=27) and healthy controls (n=15), stool lysates were analyzed by proteomics, immunoassay and qPCR to determine K7 protein and mRNA content, respectively. Additionally, stool mRNA levels of the simple epithelial keratins, K8, K18, K19 and K20, were measured. ResultsStool proteomic analysis identified focal K7 and K19 in IBD samples. Additionally, 23 differentially abundant proteins, of which 18 were higher in IBD, were identified and Gene Ontology enrichment analysis highlighted immune and inflammatory pathways. K7 specific immunoassay detected fecal K7 protein in all patients with active IBD, including both ulcerative colitis and Crohns disease, while K7 was near or below the detection limit in controls and IBD patients in remission (area under ROC curve=0.88, p<0.0001). While KRT7 mRNA levels were below the detection limit, KRT8 and KRT18 transcripts were elevated in IBD samples compared to controls (p<0.05). ConclusionsK7 protein is elevated in IBD patient stool, reflecting intestinal de novo expression and increased epithelial cell exfoliation. Fecal K7 may provide a novel, noninvasive marker for IBD diagnosis and monitoring.

Abstract Objective: To compare the safety and efficacy of bridging intravenous thrombolysis (IVT) plus endovascular thrombectomy (EVT) versus direct EVT in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) treated within the 6- to 24-hour time window. Methods: This is a retrospective analysis of prospective EVT registry from 10 comprehensive stroke centers in China and Singapore between 2019 and 2024. Eligible patients had anterior circulation LVO, underwent EVT within 6-24 hours of onset, had ASPECTS 6, NIHSS 6, and pre-stroke mRS 2. Patients were stratified into bridging IVT + EVT (IVT group) versus direct EVT alone (non-IVT group). Propensity score matching (1:2 ratio) was performed to balance baseline covariates. The primary outcome was 3-month favorable functional outcome (mRS 0-2). Secondary outcomes included successful recanalization (mTICI 2b-3), symptomatic intracranial hemorrhage (sICH), hemorrhagic transformation (HT) and 3-month mortality. In the matched cohort, binary outcomes were compared using the Cochran-Mantel-Haenszel test. Results: Of 772 included patients, 110 (14.2%) received bridging IVT and 662 (85.8%) received direct EVT. After propensity score matching, 202 non-IVT patients were matched to 101 IVT patients, with all covariates well-balanced (absolute SMD <0.10). In the matched cohort, bridging IVT was not associated with a significant difference in 3-month favorable outcome (44.55% vs. 47.03%; common OR 0.91; 95% CI 0.56-1.46), successful recanalization (91.09% vs. 90.10%; OR 1.11; 0.51-2.44), sICH (5.94% vs. 9.41%; OR 0.61; 0.24-1.58), HT (23.76% vs. 23.27%; OR 1.03; 0.57-1.85), or 3-month mortality (15.84% vs. 13.37%; OR 1.22; 0.62-2.37). Conclusion: In this large multicenter propensity score-matched analysis, bridging intravenous thrombolysis before endovascular thrombectomy in the 6- to 24-hour time window was not significantly associated with improved efficacy or increased safety risks compared with direct endovascular therapy alone.