Academic adjustment is essential for medical students facing rigorous academic demands. While individual and instructional factors have been well-studied, the role of family functioning remains underexplored. This study examined the association between family functioning and academic adjustment, explored the mediating role of coping styles, and compared these pathways between at-risk students (those who had failed at least one final examination) and controls. A cross-sectional study was conducted using validated scales for assessment of academic adjustment, family functioning, and coping styles. Structural equation modeling and bootstrap analyses were used to test mediation effects. 1022 Chinese medical students (293 at-risk, 729 controls) were included. Family functioning was significantly and positively associated with academic adjustment (p < 0.001). Positive coping mediated this relationship in both groups (at-risk: β = 0.13, 95% confidence interval [CI] [0.068, 0.218]; controls: β = 0.21, 95% CI [0.182, 0.243]), while negative coping mediated the effect only in at-risk students (β = 0.12, 95% CI [0.090, 0.167]). At-risk students showed significantly lower academic adjustment (t = -6.56, p < 0.001, Cohen's d = -0.45) and relied on distinct coping mechanisms compared to controls. This study reveals distinct mediating pathways of coping styles between at-risk and other students, deepening our understanding of family influences and providing practical guidance for targeted interventions in medical education.

Upper tract urothelial carcinoma (UTUC) accounts for about 31% of urothelial malignancies in China, a markedly higher proportion than in Western countries. Limited molecular understanding hampers diagnosis and therapy. This study aimed to explore molecular mechanisms and identify potential biomarkers through a cohort-based integrative multi-omics analysis. We analyzed 48 paired UTUC tumor and adjacent normal tissues. RNA and whole-exome sequencing were performed to explore difference. Weighted gene co-expression network analysis (WGCNA) was used to identify modules and hub genes associated with pathological traits. Validation included survival analysis within the discovery cohort, cross-cancer evaluation using The Cancer Genome Atlas Bladder Urothelial Carcinoma dataset (TCGA-BLCA) via gene expression profiling interactive analysis, and independent confirmation with a UTUC cohort from cBioPortal (n=32). Protein expression was examined using immunohistochemistry (IHC) data from the Human Protein Atlas. We identified 3968 differentially expressed genes enriched in genitourinary development and calcium signaling pathways. WGCNA revealed four co-expression modules associated with infiltration, with 64 genes linked to pathological traits. Integrative analysis prioritized methionine sulfoxide reductase B3 (MSRB3) and Synaptopodin 2 (SYNPO2) as hub genes. Within the UTUC cohort, both genes showed trends toward poorer progression-free survival; in TCGA-BLCA, their expression and survival patterns provided supportive cross-cancer evidence; and in the independent UTUC dataset, clinicopathological correlations were directionally consistent with the discovery findings. IHC suggested lower protein expression in UTUC compared with normal urothelium. This integrative multi-omics cohort study suggests MSRB3 and SYNPO2 as candidate biomarkers for UTUC progression, offering insights for risk stratification and potential therapeutic development.

To systematically identify immune cell phenotypes causally associated with oral lichen planus (OLP) susceptibility using Mendelian randomization (MR). This two-sample MR study evaluated causal relationships between 731 immune cell phenotypes and OLP risk. Single nucleotide polymorphisms (SNPs) were linkage disequilibrium-clumped (r2<0.001, 10,000kb), filtered by F-statistic (>10), and harmonized across datasets (palindromic SNPs with intermediate allele frequencies removed). Inverse variance weighting was the primary method, complemented by MR-Egger, weighted median, and mode-based estimations. Heterogeneity (Cochran's Q), horizontal pleiotropy (MR-Egger intercept, MR pleiotropy residual sum, and outlier), and leave-one-out analyses were used for sensitivity checks. Associations passing multiple-testing correction were interpreted. Twenty-eight immune phenotypes demonstrated significant causal associations: 19 protective and 9 risk-increasing. Five of six regulatory T-cell (Treg) phenotypes showed protective effects, with odds ratios (ORs) ranging from 0.916 to 0.958, and CD3 on CD4 Tregs showing the strongest effect (OR=0.916). CD8-bright leukocytes showed the strongest risk association (OR=1.487). Eight B cell phenotypes conferred protection, particularly human leukocyte antigen DR (HLA DR) on B cells (OR=0.889). Monocyte phenotypes exhibited divergent effects: Myeloid-derived suppressor cells were protective (OR=0.840), whereas HLA DR-expressing monocytes increased risk (OR range: 1.276-1.281). This study provides genetic evidence that OLP pathogenesis involves immunoregulatory imbalance between protective regulatory mechanisms and pathogenic effector responses. Findings support precision therapeutic strategies targeting specific immune pathways and offer insights for other oral autoimmune diseases.

The authors declare no conflicts of interest.

Authors declare that they have no competing interests. Supporting Table S1: Directory of 68 surveyed Chinese and English journals. Supporting Table S2: Editors’ basic information. Supporting Table S3: Current status of journal editors’ knowledge of reporting guidelines. Supporting Table S4: Status of journal editors’ practice on reporting guidelines. Supporting Table S5:Potential influencing factors and difficulties in introducing reporting guidelines in journals. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Systematic reviews on acupuncture for obesity report conflicting findings, and the certainty of this evidence remains unclear. This umbrella review appraises the evidence to identify which effects on body mass index (BMI) and body weight (BW) are supported by high-quality findings. We conducted an umbrella review by systematically searching PubMed, Embase, and the Cochrane Library through April 28, 2025 to obtain systematic reviews of randomized controlled trials evaluating acupuncture interventions for obesity. Two reviewers independently assessed methodological quality using a measurement tool to assess systematic reviews (AMSTAR) and evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We identified best evidence from high-quality systematic reviews with high or moderate GRADE ratings. Our analysis included 22 systematic reviews encompassing 60 meta-analyses. Seventeen reviews (77.3%) achieved high methodological quality ratings according to AMSTAR criteria. Five meta-analyses provided high-quality evidence consistently demonstrating significant benefits of acupuncture interventions. The strongest evidence supported acupuncture combined with lifestyle interventions compared to lifestyle interventions alone for both BMI and BW outcomes. Additional high-quality evidence demonstrated significant benefits for acupuncture versus no treatment and versus sham acupuncture. Fourteen meta-analyses provided moderate-quality evidence confirming acupuncture effectiveness, with no significant differences between acupuncture and pharmaceutical treatments. Based on high-quality evidence, clinicians can recommend acupuncture to patients with obesity, particularly as adjunctive therapy to lifestyle interventions. For patients unable to tolerate pharmacological treatments, acupuncture represents a reasonable alternative. However, optimal benefits require integration with comprehensive lifestyle modifications rather than standalone use.

China faces a significant burden of gastrointestinal tumors driven by socioeconomic, environmental, and lifestyle factors. Using GBD2021 data, this study analyses epidemiological trends and disease burden for six major gastrointestinal tumor cancers (esophagus, gastric, colorectum, liver, pancreas, gallbladder and biliary tract) in China (1990-2021). The GBD 2021 was used to extract the incidence, mortality, and disability-adjusted life years (DALYs) data of gastrointestinal tumors in China. Age-standardized rates (ASRs) and 95% uncertainty intervals (UIs) were calculated. Temporal trends were assessed by joinpoint regression analysis, and average annual percent change (AAPC) and annual percentage change (APC) were calculated and analyzed stratified by gender and age group. In 2021, China recorded 1.96 million new gastrointestinal cancer cases, with 1.35 million deaths and 33.07 million DALYs. Gastric cancer led in mortality, and colorectal cancer demonstrated the most rapid incidence growth (AAPC = 1.68). Significant reductions were observed in gastric cancer age-standardized mortality rates (ASMR) (AAPC = -2.44) and esophageal cancer age-standardized disability-adjusted life year rates (ASDR) (AAPC = -2.31). Gender disparities were particularly pronounced in esophageal cancer, with the male-to-female mortality ratio (M/F) escalating from 2.50 (1990) to 4.12 (2021). The age group with the highest mortality burden was 70-74, while the age group with the most significant loss of DALYs was 65-69. China has significantly reduced gastrointestinal cancer burden, but gender and age disparities persist, necessitating targeted interventions. Future efforts should focus on tertiary prevention for high-risk groups, especially males and the elderly, while enhancing molecular subtyping and regional data stratification for precision cancer control.

ABSTRACTObjectiveAcupuncture is recognized as an effective migraine treatment, but the comparative long‐term efficacy of different acupuncture methods at identical acupoints remains unclear. This study investigates the prophylactic effects of manual acupuncture (manual penetrating acupuncture, MPA) versus sham acupuncture (non‐penetrating acupuncture, NPA) at the same acupoints.MethodsIn this multicenter, single‐blind randomized controlled trial conducted across four Chinese clinical centers (May 2020 to September 2022), 192 migraineurs without aura (International Classification of Headache Disorders 3rd edition criteria) were randomized 1:1 to 12 sessions of MPA or NPA. Primary outcome was the change from baseline in migraine attack frequency at week 16; secondary outcomes included migraine attack frequency, responder rates, migraine days, and pain intensity (every 4 weeks), etc. Trial registration: No. ChiCTR2000032308.ResultsA total of 198 participants were randomly allocated to either MPA or NPA groups, 99 in each group. At 16 weeks, the change in MPA showed a greater reduction in migraine attacks versus NPA (mean difference [MD] = –0.6, 95% confidence interval [CI] –1.5 to 0.05; p = 0.069). MPA demonstrated superior responder rates (risk difference = 17.2%, 95% CI 5.2 to 29.1; p = 0.007) and pain reduction (MD = –0.6, 95% CI –1.1 to –0.2; p = 0.003) after treatment. At follow‐up, MPA improved all migraine symptoms and some quality of life compared with NPA. Adverse events occurred in 5.1% of MPA participants.ConclusionsAlthough MPA and NPA showed comparable preventive effects, MPA provided sustained symptom relief and quality‐of‐life improvements. Therefore, suitable acupoint selection establishes therapeutic potential, whereas acupuncture methods critically determine long‐term clinical benefits.