Search Results (422)

Background: China is currently developing standards for Food for Special Medical Purposes (FSMP) targeting for oncology patients. However, substantial challenges remain in defining optimal fortification levels of omega-3 polyunsaturated fatty acids (ω-3 PUFAs). Accumulating evidence suggests that ω-3 PUFA intake improves postoperative prognosis by modulating oncological parameters in colorectal cancer (CRC) patients. This meta-analysis aimed to evaluate the therapeutic efficacy of ω-3 PUFA supplementation in enhancing postoperative safety and recovery stability following CRC surgery, to address critical gaps in nutritional interventions for optimizing clinical outcomes. These findings are expected to FSMP standard development, clinical nutrition protocols and product innovation. Methods: A systematic literature search was conducted, in accordance with PRISMA guidelines, across major databases until June 16, 2025. Data were analyzed using RevMan v5.4 (Cochrane Collaboration). Results: Thirty-four randomized controlled trials (RCTs) (n = 2889) were included. Compared to controls, the ω-3 PUFAs group showed significantly increased levels of nutritional markers: total protein (p < 0.00001), albumin (p = 0.001); immunological parameters: CD3⁺/CD4⁺/CD8⁺ T-cells, CD4⁺/CD8⁺ ratio (all p < 0.0001); Karnofsky Performance Status (KPS) scores (p = 0.04); and serum ω-3 PUFA concentrations (p = 0.0004). Significant reductions were observed in inflammatory markers, such as procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) (p = 0.004 to < 0.00001); and clinical outcomes, such as hospitalization duration (p < 0.00001), infectious complications (p < 0.00001), anastomotic leakage (p = 0.0005), surgical site infections (p = 0.03). No significant intergroup differences were detected for white blood cells, transcription factor activity, mortality, or crypt cell proliferation indices (p = 0.06–0.55). Conclusions: Overall, ω-3 PUFA supplementation significantly attenuates postoperative inflammation, enhances immune function, shortens hospitalization, and improves the quality of life in CRC patients, though without mortality benefit. Notably, post hoc dose–response analysis identified a supplementation range of 0.16–0.30 g/kg/day as a potentially optimal supplementation range for Chinese CRC populations, providing foundational evidence for clinical practice and FSMP standardization. Full article

Background: Patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) have poor prognosis after surgery. Neoadjuvant chemoimmunotherapy (nCIT) and neoadjuvant chemoradiotherapy (nCRT) may improve outcomes, but their long-term efficacy remains unclear. Methods: This multicenter study analyzed LA-ESCC patients from three Chinese hospitals (2015–2024) who received nCIT or nCRT followed by surgery. Primary endpoint was 3-year overall survival (OS); secondary endpoints included objective response rate (ORR), pathologic complete response (pCR), disease-free survival (DFS), and adverse events. Propensity score matching balanced baseline characteristics. Results: Among 225 patients (87 nCRT, 138 nCIT), matched cohorts (87 per group) showed that nCRT had higher ORR (85.06% vs. 45.98%), T/N downstaging rates (78.16% vs. 58.62%; 85.06% vs. 45.98%), and pCR (37.90% vs. 14.90%) (all p < 0.01). After median follow-up (nCIT: 44.5 months; nCRT: 35.1 months), nCIT improved 3-year OS (75.90% vs. 55.60%) and DFS (66.40% vs. 47.30%) (p < 0.05). Subgroup analysis favored nCRT in N+ or non-cT4 disease. Clinical N stage independently predicted survival. Conclusion: nCIT demonstrates superior survival benefits in LA-ESCC, while nCRT may be more effective for N+ or non-cT4 patients. Further randomized trials are warranted. Full article

Objective: This study aimed to assess the impact of the number of metastatic lymph nodes (LNs) on survival and propose a subdivision of the N2b category in colorectal cancer (CRC) patients. Methods: We retrospectively analyzed from two sources: clinicopathologic data of CRC patients with stage pTxN2bM0 who initially underwent radical surgery at Cancer Hospital, Chinese Academy of Medical Sciences/National Cancer center (NCC), and patients with stage pTxN0-2bM0-1 in the Surveillance, Epidemiology and End Results (SEER) database from January 2010 to December 2015. The optimal cutoff value of the number of positive lymph nodes (PLNs) was determined based on the principle of maximum chi-square value. We constructed survival curves using the Kaplan–Meier method, assessed survival differences with the log-rank test, and conducted univariate and multivariate analyses using the Cox proportional hazard regression model. Results: A total of 68,335 CRC patients were included: 240 from the NCC cohort, and 68,095 from the SEER cohort. Within the SEER cohort, 65,189 patients had M0 stage disease and 2,906 had M1 stage disease. The optimal PLN cutoff value determined by X-tile software (Version 3.6.1) was 13. According to PLN, stage N2b patients were divided into two groups: stage N2b# (7 ≤ PLN < 13) and stage N3 (PLN ≥ 13). In the NCC cohort, the 5-year overall survival (OS) rates of stage N2b# and N3 patients were 66.0% and 45.7%, respectively (p < 0.001). In the SEER cohort, the 5-year cancer-specific survival (CSS) rate was 57.1% for stage N2b# patients compared with 40.2% for stage N3 patients (p < 0.001). The results of multivariate Cox analysis demonstrated that modified stage pN was the independent prognosis factor of OS in the NCC cohort (HR = 1.869, 95%CI:1.253–2.787, p = 0.002); modified stage pN was also the independent prognosis indicator of CSS in the SEER cohort (N3:N0, HR = 8.170, 95%CI: 7.298–9.146, p < 0.001). There was no survival difference between TxN3M0 and TxN0-2b#M0 (5-year CSS rate: 40.2% vs. 30.1%, p = 0.050; 5-year OS rate: 35.3% vs. 27.8%, p = 0.358). Conclusions: The N category served as a strong independent prognostic indicator in CRC patients. Furthermore, PLN emerged as an independent prognostic factor specifically in stage N2b CRC patients. These findings suggest that clinicians may utilize PLN for prognostic stratification and tailor adjuvant therapeutic strategies accordingly for patients diagnosed with stage N2b CRC. Full article

This study investigates FLNC mutations in Chinese cardiomyopathy patients. Background: Inherited cardiomyopathies, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC) are major heart failure causes. FLNC, critical for muscle structure, is implicated in myofibrillar myopathy and isolated DCM (3–4% cases) with ventricular arrhythmias. Missense variants are linked to HCM and protein aggregation. A cohort of 25 patients with pathogenic/likely pathogenic FLNC mutations (2022–2025, Beijing Anzhen Hospital) underwent whole-exome sequencing (WES) using IDT kit 1.0/Hiseq 4000. Variants were classified via the American College of Medical Genetics and Genomics (ACMG) guidelines. Clinical data (echocardiography, CMR, labs) and follow-up data (prognosis, meds, and family history) were collected. The statistics used SPSS (p < 0.05). The mean age was 38 ± 14.6 years (13 males). There were 25 FLNC mutations: 12 single nucleotide polymorphisms (SNPs), 5 deletions, 2 duplications, and 3 deletion-insertions, classified as 6 pathogenic, 16 likely pathogenic, and 3 variants of uncertain significance (VUS). Diagnoses: 24% dilated cardiomyopathy (DCM), 8% hypertrophic cardiomyopathy (HCM), and 4% left ventricular non-compaction. Nonsense mutation carriers exhibited significantly higher tricuspid regurgitation prevalence compared to frameshift mutation carriers (6/9 vs. 2/10; p = 0.04). Echocardiography revealed reduced left ventricular ejection fraction (LVEF) (41.5 ± 14.1%), with statistically significant differences in fractional shortening (p = 0.024) and aortic root diameter (p = 0.028). Pedigree analysis confirmed that a frameshift mutation (LP) co-segregated with familial DCM and was associated with severe phenotypes, including sudden cardiac death. Furthermore, nonsense FLNC mutations correlated with increased tricuspid regurgitation severity, smaller aortic root dimensions, and reduced pulmonary artery flow velocity. Full article

Background/Objectives: Lactoferrin, a key bioactive component in human milk, may bridge functional gaps in infant formula; however, its long-term effects on growth and the gut microbiota in term infants remain underexplored, particularly in real-world settings. Methods: This real-world evidence (RWE) study assessed the impact of lactoferrin-fortified formula (LF) on infant growth, the gut microbiota, and feeding tolerance compared with control formula (CF) and exclusive breastfeeding (BF). After propensity score matching (PSM) for maternal education level and infant age, 111 matched Chinese infants (37 per group: LF, CF, and BF; age: 6–12 months) were analyzed. Growth was evaluated using WHO Z-scores (WAZ, LAZ, WLZ, and zBMI). The gut microbiota was profiled via 16S rRNA sequencing (n = 81). Feeding challenges were quantified using the Montreal Children’s Hospital Feeding Scale (MCH-FS). Results: The LF group exhibited significantly higher length-for-age Z-scores (LAZ) compared with both the BF and CF groups (p < 0.001), indicating superior linear growth. LF infants also showed reduced MCH-FS scores (18.0 vs. 36.2 in CF; p < 0.001), signifying fewer feeding difficulties. Gut microbiota analysis revealed enrichment of Bifidobacterium breve and butyrate-producing taxa (e.g., Faecalibacterium and Ruminococcaceae), higher alpha diversity, and metabolic divergence, involving enhanced lysine fermentation to acetate/butyrate in LF infants, suggesting a higher level of short-chain fatty acid (SCFA) production. Beta diversity analysis demonstrated that the LF microbiota clustered close to BF. Conclusions: Lactoferrin-fortified formula was associated with improved linear growth and feeding tolerance while shaping a healthy gut microbiota, showing similarities to breastfed infants’ microbiota. These findings support LF fortification as a strategy to improve functional outcomes in formula-fed infants. Full article

Background: To ensure smooth surgical procedures, patient safety, and quality of perioperative care, perceived perioperative competence (PPC) is a daily and urgent requirement for operating room (OR) nurses. Understanding the status of PPC among OR nurses and its associated factors is essential for OR nurses/people in charge/researchers to pinpoint weaknesses and formulate interventions. Therefore, we aim to investigate the status of PPC and its associated factors. Furthermore, we explore the relationship between PPC, self-efficacy, and job burnout among OR nurses. Methods: Tertiary-A hospitals in various districts of Chengdu, China, were recruited using a stratified convenience sampling method. A cross-sectional survey was then administered to OR nurses in the selected hospitals. Data analysis included descriptive analysis, T-tests, one-way analysis of variance (ANOVA), multiple linear regression analysis, correlation analysis, and mediation analysis. Results: A survey of 640 OR nurses across 18 hospitals (with a 98.00% valid response rate) revealed an average PPC score of 3.66 ± 1.12/124.55 ± 26.54. Marital status, OR specialty education, and age significantly influenced PPC levels (p < 0.05). Self-efficacy was positively correlated with PPC, while job burnout was negatively correlated with PPC. Self-efficacy fully mediated the relationship between these two variables. Conclusions: The performances of PPC among Chinese OR nurses were acceptable. Marital status, OR specialty education, and age significantly influenced PPC levels. Self-efficacy fully mediates the relationship between job burnout and PPC. Full article

Background/Objectives: Mild Encephalopathy with Reversible Splenial Lesion (MERS) is a potential complication of certain viral infections, but adult cases involving influenza are rare in the literature. Here, we report a case of a 31-year-old Chinese gentleman with an atypical presentation of Influenza B-associated mild encephalopathy with reversible splenial lesion (MERS). Methods: This is a case report with a detailed chronology followed by a discussion of pathophysiology. Results: The patient presented acutely to the tertiary hospital with a severe headache and a peculiar automatism pattern of behaviour involving intermittent screaming, involuntary jerking movements of the upper limbs, and incoherent speech, which culminated in an episode of tonic–clonic seizure lasting 3 min. Symptoms started on the day that the patient was diagnosed with Influenza B and given the antiviral Baloxavir by his GP. Clinically, there was high anion gap metabolic acidosis with hyperlactatemia, rhabdomyolysis, hepatitis transaminitis and absolute lymphopenia. Nasopharyngeal swab PCR and immunofluorescence was positive for Influenza B. EEG was normal, but an MRI of the brain showed a cytotoxic lesion of the splenium of the corpus callosum. The patient was started on Oseltamivir and made a complete neurological recovery, with a repeat MRI showing resolution of the splenial lesion at 3 months. MERS is a rare clinic-radiological syndrome characterized by a transient encephalopathy and a reversible lesion in the splenium of the corpus callosum, which has been reported mostly in the pediatric population. Conclusions: This case report of an influenza B-triggered MERS in an adult highlights the importance of maintaining MERS as a differential for acute encephalopathy in adults with a viral prodrome. Full article

This study focuses on doctor recommendation mechanisms for online consultation platforms (OCPs), and aims to develop a lightweight multi-criteria decision framework that enhances doctor–patient matching efficiency by mitigating patients’ disproportionate preference for renowned physicians from tertiary hospitals. The proposed framework operates in two stages. In the first stage, symptom-related keywords provided by patients in their consultation comments are extracted using a text presentation model selected through comparative experiments. Based on these extracted features, a pool of candidate physicians is constructed by matching patient symptoms with physicians’ professional expertise, utilizing both historical consultation records and physicians’ background information. In the second stage, the recommendation priority is determined using an entropy-weighted TOPSIS model, which evaluates multiple criteria including the alignment between physician competencies and patient needs, while simultaneously promoting the utilization of underused medical resources. Experiments conducted on historical data from HaoDaiFu, a representative Chinese OCP, demonstrate that the proposed framework significantly increases the exposure opportunities for lower-usage and newly registered physicians, alleviates consultation congestion around highly reputed doctors, and maintains comparable recommendation accuracy. Consequently, the developed multi-criteria decision framework effectively improves doctor–patient matching efficiency and contributes to more balanced medical resource allocation and enhanced service accessibility. Full article

Background: Pediatric heart failure (PHF) is a heterogeneous syndrome with high morbidity, but existing classification systems inadequately capture its developmental and pathophysiological complexity due to reliance on adult-centric parameters. Using machine learning, we aimed to identify clinically distinct PHF phenotypes with unique outcomes and therapeutic implications. Methods: In this multicenter retrospective study, we analyzed 2903 consecutive PHF patients (≤18 years) from 30 Chinese tertiary centers from 20 provinces (2013–2022). Unsupervised machine learning (k-means clustering with PCA) evaluated 99 clinical, biomarker, and echocardiographic variables to derive phenotypes, which were compared for mortality, hospitalization, and treatment responses. Results: Three phenotypically distinct clusters emerged. Cluster 1 (Chronic Hypertensive and Cardiorenal Profile, 30.1%) predominantly affected older children (78%) with hypertension (54.4%), renal dysfunction (creatinine 45.8 μmol/L), and ventricular tachycardia (53.8%). This cluster showed the lowest in-hospital mortality (2.5%) but frequent 7–14 day hospitalizations (35.8%) and the highest beta-blocker use (54.5%). Cluster 2 (Preterm and CHD-Associated HF, 43.4%) comprised preterm infants (71.4%) with congenital heart disease (72.2%) and preserved LVEF (67%), demonstrating the highest mortality (5.1%) and prolonged stays (>30 days: 10.6%) with predominant diuretic (40.6%) and antibiotic use (54.3%). Cluster 3 (Fulminant Myocarditis Profile, 26.5%) exhibited cardiogenic shock with severely reduced LVEF (33%) and elevated BNP (3234 pg/mL), showing bimodal outcomes (4.8% LOS < 3 days vs. 32.2% LOS 15–30 days) and the highest IVIG utilization (46.5%) with intermediate mortality (3.8%). The majority of between-group differences were statistically significant (p < 0.001). Conclusions: Machine learning identified three PHF phenotypes with distinct in-hospital risk profiles and therapeutic implications, challenging current classification systems. These findings highlight the potential for phenotype-specific management strategies and provide a rationale for future research into arrhythmia prevention in hypertensive profiles and early immunomodulation in fulminant myocarditis, while highlighting the need for specialized care pathways for preterm/CHD patients. Prospective validation is warranted to translate this framework into clinical practice. Full article

Background/Objectives: Ustekinumab (UST) is an effective and safe drug for treating Crohn’s disease (CD), but data on disease progression after UST treatment is limited. This study aimed to develop a clinical decision support tool (CDST) to identify Chinese patients with CD less likely to experience disease progression during UST treatment. Methods: A multicenter, retrospective observational study was conducted among Chinese patients with CD who started UST treatment between 1 May 2020 and 20 October 2022. Baseline characteristics, defined as the measurements taken closest to, and prior to, the first dose of UST, were collected. Disease progression, defined as CD-related surgery, hospitalization, and complications, was evaluated by week 52 (±4 weeks). Predictors were identified using logistic regression, and a UST-specific CDST (UST-CDST) was developed. The UST-CDST was then internally and externally validated using the area under the receiver operating characteristic curve (AUC). Results: Among 602 enrolled patients, 533 were included in the analysis. Four factors were suggestively associated with disease progression: prior biologics usage, baseline disease severity, baseline C-reactive protein, and baseline hemoglobin. The prediction model demonstrated an AUC of 0.88 in internal validation and 0.66 in external validation. The UST-CDST effectively stratified patients into low-risk or high-risk groups for disease progression within one year. Conclusions: A UST-CDST was developed and validated to identify patients with CD less or more likely to experience disease progression around week 52 under UST therapy. The scoring system promises to facilitate clinical decision-making and personalized treatment. Full article

Introduction: Major depressive disorder (MDD) is a mental disorder with a high prevalence rate and a high recurrence rate. Therefore, identifying and intervening in the core symptoms of MDD patients is of great significance. Anhedonia is manifested as an individual losing interest in activities or experiencing a significant decrease in the sense of pleasure, which is one of the two core symptoms of MDD. Episodic Future Thinking (EFT) training refers to the process of stimulating individuals’ hope for positive future scenarios and encouraging them to take purposeful actions, which may have an effect in alleviating anhedonia. However, the perception of anhedonia of MDD patients among Chinese healthcare professionals is still unclear, and there has been no exploration of the views of healthcare professionals regarding the implementation of EFT training for MDD patients led by psychiatric nurses in a clinical setting. Aim: This study aimed to understand the attention paid by Chinese healthcare professionals to the symptom of anhedonia in patients with MDD, as well as their previous coping strategies. This study further explored the views of healthcare professionals regarding the implementation of EFT training for MDD patients led by psychiatric nurses with a psychological therapist certificate in China, as well as suggestions for future implementation. Methods: This qualitative descriptive study adopted a phenomenological approach. Using purposive sampling, 15 healthcare professionals (psychiatrists, psychiatric nurses and psychological counselors) were recruited from the psychiatry department of a public tertiary hospital in Wuhan, Hubei Province, China. Using the NVivo 12 Plus software, the semi-structured interviews and analyses were conducted by applying Colaizzi’s seven-step phenomenological method. Rigor was ensured through checks of credibility, dependability, and confirmability during data collection and analysis. Results: A thematic analysis revealed that, while psychia-trists and psychological counselors viewed anhedonia as a significant treatment target, nurses were more focused on immediate patient safety concerns. Participants recognized the potential of EFT training to alleviate anhedonia but identified several implementation challenges, including patient resistance, cognitive limitations, and the need for tailored interventions. Conclusions: The research results indicated that psychiatric nurses had relatively poor ability to identify anhedonia. Therefore, it is necessary to enhance the awareness of psychiatric nurses regarding the clinical significance of anhedonia, and incorporate knowledge related to anhedonia into routine nursing training. It is suggested that communication and collaboration among psychiatrists, psychiatric nurses and psychological counselors should be strengthened, and an assessment and feedback process for the lack of anhedonia in patients with MDD should be established, so as to assist these patients in achieving faster psychological recovery. Given the sufficient staffing conditions in the field of psychiatry nursing in China, the design concept and curriculum of EFT training for psychiatry nurses with a psychological therapist certificate should be promoted. Encourage psychiatry nurses with a psychological therapist certificate to conduct offline and online group EFT training intervention forms for MDD patients in the hospital wards during their hospitalization periods, as well as after discharge at home. Full article

Objective: To identify distinct subtypes of ICU patients with Acute Kidney Injury (AKI) using serum electrolyte data and assess their associations with in-hospital mortality risk. Methods: This study used the eICU Collaborative Research Database (eICU-CRD) as its primary data source. AKI patients were identified according to the KDIGO clinical practice guidelines. Using K-Medoids clustering, we identified distinct AKI subtypes based on the first serum electrolyte measurements taken within 24 h of AKI diagnosis in the ICU. Logistic regression analysis was then employed to assess associations between these subtypes and in-hospital mortality risk. Within each subtype, we further examined the relationship between two AKI-related treatments, diuretics and renal replacement therapy (RRT), and mortality risk. Finally, to validate the identified subtypes, we replicated the entire analysis using a critical care dataset from a grade A tertiary hospital in Beijing, China. Results: We identified three distinct AKI subtypes from 15,838 eligible patients in the eICU-CRD. Subtype 1 (6364 patients, 40.2%) showed the lowest risk of in-hospital death and had all serum electrolyte levels within normal ranges. Subtype 2 (6624 patients, 41.8%) carried a moderate death risk and was characterized by abnormally high chloride levels. Subtype 3 (2850 patients, 18.0%) had the highest death risk, presenting with high serum phosphate and low bicarbonate levels. Importantly, the associations between treatments and mortality risk differed significantly by subtype. In the high-risk Subtype 3, both diuretics (OR = 0.71, p = 0.010) and RRT (OR = 0.78, p = 0.045) were associated with a lower risk of in-hospital death. However, in Subtype 2, both diuretics (OR = 1.30, p = 0.044) and RRT (OR = 1.56, p = 0.003) were associated with an increased risk. Neither treatment showed a significant association with death risk in Subtype 1. These findings were validated in the critical care database (431 AKI patients) from a Chinese local hospital, where the same three subtypes emerged with consistent electrolyte patterns, death risk profiles, and associations between treatments and mortality risks, validating the stability of the identified subtypes. Conclusions: Serum electrolyte data can help identify ICU AKI subtypes with different mortality risks. Additionally, associations between treatments (diuretics and RRT) and mortality risk vary significantly across these subtypes. These results generate the hypothesis that AKI subtyping could potentially inform personalized management strategies. Full article

Background: Effective shared decision-making (SDM) for life-sustaining treatment (LST) requires alignment between physicians and surrogates. However, discrepancies in perceptions and communication may hinder ethically sound decisions. This study aimed to compare the perceptions and attitudes of physicians and surrogates toward SDM for LST in a Chinese hospital setting. Methods: This pre-planned secondary analysis included data from two cross-sectional surveys administered to physicians and surrogates. Participants were 325 surrogates of critically ill adult patients admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital and 351 physicians from hospitals in Beijing. Survey items assessed triggers and preferred models of decision-making, disclosure practices, perceived decisional capacity, and factors influencing LST decisions. Statistical comparisons were performed using appropriate tests for categorical data. Results: Although a majority in both groups nominally preferred SDM (physicians: 52.7%; surrogates: 44.3%; p = 0.155), significant discrepancies emerged across other domains. Physicians were more likely than surrogates to initiate LST discussions earlier (88.0% vs. 75.3%; p < 0.001). Perceived understanding differed markedly: 87.7% of surrogates rated their comprehension as “good” or “excellent”, whereas 73.8% of physicians rated surrogate understanding as “fair” or “poor” (p < 0.001). Surrogates expressed a stronger preference for receiving quantitative prognostic information and decision-support tools. Most physicians (94.9%) reported directing consent discussions primarily to families, with limited patient involvement. Priorities for LST decisions diverged: physicians emphasized clinical indicators such as prognosis (96.0%) and comorbidities (91.7%), whereas surrogates emphasized patient age (72.0%). Conclusions: Marked discordances exist between physicians and surrogates in their perceptions and practices regarding SDM for LST in China. Differences in communication strategies, informational expectations, and decision-making priorities underscore the need for contextually adapted interventions, such as structured communication tools and culturally sensitive clinician training, to bridge these gaps and support ethically aligned decision-making. Full article

Background: This study aimed to explore the application value of magnetic resonance imaging (MRI)-based three-dimensional segmentation and reconstruction technology for spatial structural identification and volumetric quantification of glandular and adipose tissues in bilateral gynecomastia (GM) patients undergoing surgical treatment, hoping to provide precise imaging data to support clinical surgical decision-making. Methods: A retrospective analysis was performed on preoperative MRI images and general clinical data of 52 patients with bilateral gynecomastia at the patient level (bilateral totals, N = 52) who underwent surgical treatment in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, from March 2023 to September 2024. All images were acquired using a SIEMENS Aera 1.5 T MRI scanner with T1-weighted three-dimensional fat-suppressed sequence (t1_fl3d_tra_spair). Semi-automatic segmentation and active contour modeling (Snake model) using ITK-SNAP 4.0 software were employed to independently identify glandular and adipose tissues, reconstruct accurate three-dimensional anatomical models, and quantitatively analyze tissue volumes. Results: The MRI-based three-dimensional segmentation and reconstruction method accurately distinguished glandular and adipose tissues in male breasts, establishing precise three-dimensional anatomical models with excellent reproducibility and operational consistency. Among the 52 patients with bilateral gynecomastia, glandular tissue volume exhibited a markedly non-normal distribution, with a median of 6.11 cm³ (IQR, 3.03–12.98 cm³). Adipose tissue volume followed a normal distribution with a mean of 1348.84 ± 494.97 cm³. The total breast tissue volume also showed a normal distribution, with a mean of 1361.97 ± 496.83 cm³. The proportion of glandular tissue in total breast volume was non-normally distributed with a median of 0.50% (IQR, 0.27–1.21%), while the proportion of adipose tissue was also non-normally distributed with a median of 99.50% (IQR, 98.79–99.73%). Conclusions: MRI combined with computer-assisted three-dimensional segmentation and reconstruction technology efficiently and accurately achieves spatial identification, three-dimensional modeling, and volumetric quantification of glandular and adipose tissues in patients with bilateral gynecomastia. It objectively reveals the spatial compositional characteristics of male breast tissues. This approach provides precise, quantitative data for clinical decision-making regarding surgical treatment of gynecomastia, featuring robust standardization and strong clinical applicability. Full article

Background: The continuous expansion of the National Reimbursement Drug List has led to an increasing cost disparity among alternative drugs for the same indications. Under the current proportional reimbursement mechanism, choosing higher-cost treatments often results in higher compensation. Given the lack of empirical evidence on whether income affects the medication choices of insured individuals in the Chinese context, this study aims to evaluate the impact of income levels on drug selection, providing a basis for optimizing the medical insurance reimbursement policy. Methods: This study extracts data from hospitalized patients enrolled in basic medical insurance from the China Health and Retirement Longitudinal Study (CHARLS) database and preprocesses it in Excel. Subsequently, SPSS is used to conduct descriptive statistics, difference analysis, correlation analysis, and regression analysis on the processed data to explore the impact of income levels on drug selection. Results: After controlling for length of hospitalization and hospitalization costs, the regression coefficient for urban employee basic medical insurance participants is β = 0.505 (p < 0.01), and the regression coefficient for new rural cooperative medical insurance participants is β = 0.195 (p < 0.01). This means that, regardless of whether participants are enrolled in urban employee basic medical insurance or new rural cooperative medical insurance, an increase in income will lead to higher hospitalization drug costs. Conclusions: Compared to low-income insured individuals, high-income participants in the basic medical insurance are more likely to choose higher-cost drugs among alternatives, which leads to unfair reimbursement under the current proportional reimbursement system. Full article