Background: Chronic kidney disease (CKD) affects over 35.5 million US adults. Serum α1-acid glycoprotein (α1-AGP), an acute-phase protein, exhibits anti-inflammatory properties in animal models, but its association with CKD in younger women remains underexplored. This study investigated the relationship between serum α1-AGP and CKD risk in US women aged 20–49 years. Methods: This nationally representative cross-sectional study used data on female adults in the US aged 20–49 years from the National Health and Nutrition Examination Survey 2015–2018 cycles. 2,137 individuals were included in the study after excluding individuals without serum α1-AGP, urine albumin, and creatinine data. Multivariate logistic regression models evaluated the association between serum α1-AGP and CKD. Moreover, we performed stratified and interaction analyses to see if the relationship was stable in different subgroups. Results: Among 2,137 participants (mean age 34.6 years, mean eGFR 111.7 mL/min/1.73 m²), CKD prevalence was 8.8% (n=188). Higher serum α1-AGP levels were associated with lower CKD risk in the fully adjusted model (OR 0.37, 95% CI 0.16–0.84, P = 0.017), with a dose-response trend across quartiles (P = 0.041). The association was stronger in women aged 40–49 years (OR 0.20, 95% CI 0.05–0.76) and Mexican Americans (OR 0.07, 95% CI 0.01–0.56), though interaction terms were not significant (P > 0.05). Conclusions: Higher serum α1-AGP levels are associated with lower CKD prevalence in young women, suggesting a protective role. Longitudinal studies are needed to confirm causality and explore α1-AGP as a biomarker for CKD risk stratification.

Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×10⁹/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p < 0.0001). Subgroup analyses showed the protective effect of higher ALC was consistent across age, sex, BMI, PEG use, and comorbidity strata, with no significant interactions. Conclusions: ALC is an independent, non-linear predictor of mortality in older dysphagic patients and may aid clinical risk stratification across diverse patient subgroups.

High-quality collaborative discourse is essential for deep learning in Problem-Based Learning (PBL). However, novice facilitators frequently struggle with topic drift, which occurs when discussions deviate from core learning objectives. Grounded in Cognitive Load Theory and instructional scaffolding, this paper analyzes the cognitive mechanisms behind topic drift in PBL. It identifies three typical deviation patterns: "Premature Resolution" (bypassing mechanistic deduction), "Detail Fixation" (over-engagement with peripheral details), and "Social Avoidance" (stemming from dysfunctional group dynamics). To address these patterns, this paper presents a literature-based facilitation guide offering specific intervention strategies and discursive prompts. These include mechanistic backtracking, metacognitive monitoring, and cognitive visualization. The study argues that effective pedagogical intervention relies on the strategic timing of facilitation rather than the immediate correction of factual errors. Ultimately, built on a foundation of relational trust, this process requires educators to shift their role from "epistemic authorities" to "cognitive coaches."

Background: Within contemporary medical education systems dominated by the biomedical paradigm, medical students commonly experience a decline in empathy alongside uncertainty in professional identity formation. Narrative medicine, as an educational approach designed to bridge objective technical reasoning and subjective human experience, has been proposed as a response to this humanistic crisis. However, the psychological mechanisms underlying its effects, the boundaries of existing empirical evidence, and strategies for systematic implementation remain insufficiently clarified. Content: Drawing on a comprehensive review of the literature, this article elucidates two core theoretical mechanisms through which narrative medicine operates. First, through the cycle of attention, representation, and affiliation combined with reflective practice, narrative medicine facilitates the coordinated development of cognitive empathy and emotional resonance. Second, through narrative integration, it supports learners in transforming fragmented clinical experiences into coherent professional identities. A synthesis of empirical studies published over the past decade indicates that well designed narrative medicine curricula can enhance reflective capacity, communication skills, and a sense of professional meaning, although their effectiveness is substantially moderated by curricular intensity, pedagogical modality including digital and multimodal approaches, and cultural context. Conclusion: The integration of narrative medicine currently faces structural barriers, including limited curricular space, the scarcity of standardized assessment tools, and insufficient faculty development. Future efforts should adopt implementation science frameworks to shift from isolated elective offerings toward longitudinal spiral curricula, develop multidimensional evaluation strategies, and explore the use of emerging technologies such as artificial intelligence and virtual reality in narrative pedagogy. These efforts may establish narrative medicine as a foundational pathway for cultivating physicians with core humanistic competencies.