Objective:To investigate the clinicopathological features and differential diagnosis of eosinophilic vacuolated tumor (EVT).Methods:Seven cases of EVT with characteristic morphology and unequivocal diagnosis from the Affiliated Hospital of Qingdao University (6 cases), Qingdao, China and the 971 Hospital of PLA Navy (1 case), Qingdao, China between January 2010 and December 2021 were subject to morphological and immunohistochemical analyses. Additionally, whole exome sequencing (WES) was performed in two cases. Twenty-two cases of renal oncocytoma (RO) and 17 cases of eosinophilic chromophobe renal cell carcinoma (eChRCC) diagnosed at the same time were used as controls.Results:Four males and three females with a mean age of 42 years (range: 29-61 years) were included in the study. The tumors were nodular and well-circumscribed, with sizes ranging from 1.5 to 4.5 cm. On cross-section, they appeared gray-red or gray-white, solid, and soft. Tumor cells were arranged in nests, solid sheets, and acinar or small vesicular structures. These cells exhibited eosinophilic cytoplasm with large, prominent clear vacuoles and round nuclei with prominent nucleoli. Perinuclear halos were focally present in four cases, while small tumor cells with sparse cytoplasm and hyperchromatic nuclei were seen in one case. No necrosis or mitosis was noted. Edematous stroma was detected in three cases. All tumors were positive for CD117 and Cathepsin K, but negative for vimentin and CK7. CK20 was positive in scattered individual cells, and Ki-67 positivity ranged from 1% to 4%. Point mutations in MTOR were identified in both patients who were subject to the molecular analysis. Statistical differences in the expression of Cathepsin K, CD10, S-100A1, and Cyclin D1 between EVT and RO ( P<0.05) were significant, so were the differences in the expression of Cathepsin K, CD10, CK7 and claudin 7 between EVT and eChRCC ( P<0.001). Seven patients were followed up for 4 to 96 months (mean, 50 months), with no recurrences or metastases. Conclusions:EVT is a rare renal tumor that shares morphological and immunophenotypic features with RO and eChRCC, and it is closely linked to the TSC/MTOR pathway. The presence of large prominent transparent vacuoles in eosinophilic cytoplasm along with conspicuous nucleoli is its key morphological characteristics. The use of combined immunohistochemical stains greatly aids in its diagnosis. Typically, the tumor exhibits indolent biological behaviors with a favorable prognosis.

Objective: To learn the status and influencing factors of development among infants at ages of 0 to 36 months in Xiaoshan District, Hangzhou City, so as to provide the reference for promoting healthy development of infants. Methods: Infants at ages of 0-36 months who underwent physical examination in Child Health Clinic of Xiaoshan District Community Health Service Center were selected in 2022. General data of infants and their mothers were collected through questionnaires, and the development status of infants was screened by Age and Stages Questionnaire (third edition). Factors affecting the development status were identified using a multivariable logistic regression model. Results: A total of 2 519 infants were investigated, including 1 339 males (53.16%) and 1 180 females (46.84%). There were 608 infants with abnormal development of at least one functional area of communication (CM), gross motor (GM), fine motor (FM), problems solving (CG) and personal-social (PS). The abnormal rate was 24.14%, and the abnormal rates of the above functional areas were 9.77%, 6.59%, 7.98%, 6.39% and 9.33%, respectively. Multivariable logistic regression analysis showed that gender (male, OR=1.563, 95%CI: 1.191-2.052), mother's childbearing age (≥35 years, OR=1.411, 95%CI: 1.001-1.988), mother's educational level (lower than junior college, OR=1.460, 95%CI: 1.116-1.912) were factors affecting abnormal development of CM; preterm birth (OR=2.323, 95%CI: 1.315-4.103) was factors affecting abnormal development of GM; gender (male, OR=1.654, 95%CI: 1.225-2.232) was factors affecting abnormal development of FM; gender (male, OR=1.511, 95%CI: 1.086-2.102) and mode of delivery (cesarean section, OR=1.460, 95%CI: 1.060-2.010) were factors affecting abnormal development of CG; gender (male, OR=1.340, 95%CI: 1.019-1.763) and birth weight (low birth weight, OR=1.985, 95%CI: 1.149-3.432) were factors affecting abnormal development of PS. Conclusions The rate of abnormal development among infants at ages of 0 to 36 months in Xiaoshan District is 24.14%. Gender, preterm birth, mode of delivery, birth weight, mother's childbearing age and mother's educational level could affect the development status of infants.

Objective: To reveal the molecular mechanism underlying the compatibility of Salvia miltiorrhiza Bge (S. miltiorrhiza, Dan Shen) and C. tinctorius L. (C. tinctorius, Hong Hua) as an herb pair through network pharmacology and subsequent experimental validation. Methods: Network pharmacology was applied to construct an active ingredient-efficacy target-disease protein network to reveal the unique regulation pattern of S. miltiorrhiza and C. tinctorius as herb pair. Molecular docking was used to verify the binding of the components of these herbs and their potential targets. An H9c2 glucose hypoxia model was used to evaluate the efficacy of the components and their synergistic effects, which were evaluated using the combination index. Western blot was performed to detect the protein expression of these targets. Results: Network pharmacology analysis revealed 5 pathways and 8 core targets of S. miltiorrhiza and C. tinctorius in myocardial protection. Five of the core targets were enriched in the hypoxia-inducible factor-1 (HIF-1) signaling pathway. S. miltiorrhiza-C. tinctorius achieved vascular tone mainly by regulating the target genes of the HIF-1 pathway. As an upstream gene of the HIF-1 pathway, STAT3 can be activated by the active ingredients cryptotanshinone (Ctan), salvianolic acid B (Sal. B), and myricetin (Myric). Cell experiments revealed that Myric, Sal. B, and Ctan also exhibited synergistic myocardial protective activity. Molecular docking verified the strong binding of Myric, Sal. B, and Ctan to STAT3. Western blot further showed that the active ingredients synergistically upregulated the protein expression of STAT3. Conclusion The pharmacodynamic transmission analysis revealed that the active ingredients of S. miltiorrhiza and C. tinctorius can synergistically resist ischemia through various targets and pathways. This study provides a methodological reference for interpreting traditional Chinese medicine compatibility.

Objective To analyze the research status of job competence in domestic public hospitals,provide directions for the construction of the talent pool in public hospitals,and promote their high-quality development.Methods Relevant litera-ture on job competence in domestic public hospitals from 2009 to 2023 was retrieved from the China National Knowledge Infra-structure(CNKI)database.Citespace software was used to analyze the selected literature in terms of publication timeline,author co-occurrence,institution co-occurrence,keyword co-occurrence,keyword clustering,and keyword burst analysis.A visualized knowledge map was constructed.Results A total of 501 valid articles were included.Research on job competence in domestic public hospitals showed an upward trend from 2009 to 2023.The research hotspots were mainly in the areas of resident physicians and nursing.The burst analysis of keywords indicated that targeted research on job competence in specific professional fields will be a future trend.Conclusion Research on job competence in domestic public hospitals is developing,but it still faces issues such as a loose network structure of author and institution co-occurrence and a lack of cooperation,as well as insufficient subdivi-sion of job competence research in specific professional fields.Therefore,it is necessary to further subdivide professional fields,expand research on job responsibilities,talent cultivation,and performance evaluation in different fields,and encourage collabo-ration among scholars and institutions.Continuous innovation and strategic responses are needed to promote the high-quality de-velopment of public hospitals.

Objective To investigate the clinical application value of wrist joint ulnar deviation supination 45° palmar oblique posi-tion in the diagnosis of scaphoid waist fracture and displacement.Methods The imaging and clinical data such as digital radiography(DR),CT of 93 wrist joint trauma patients were analyzed.The four position views including wrist joint anteroposterior+lateral view,scaphoid position,wrist joint ulnar deviation supination 45° palmar oblique position,scaphoid position+wrist joint ulnar devia-tion supination 45° palmar oblique position were analyzed by three readers.The consistency of the evaluation among different readers and the diagnostic efficiency of the diagnosis of scaphoid fracture and displacement were compared.Results The inter-observer agreement,sensitivity,specificity,accuracy,and other diagnostic efficiency of scaphoid waist fracture and displacement was evaluated,wrist joint ulnar deviation supination 45° palmar oblique position+scaphoid position and wrist joint ulnar deviation supination 45° palmar oblique position were better than those of scaphoid position and wrist joint anteroposterior+lateral view.The combination of wrist joint ulnar deviation supination 45° palmar oblique position+scaphoid position obtained the best diagnostic efficiency.Conclusion The wrist joint ulnar deviation supination 45° palmar oblique position shows the long axis of the scaphoid,which has a high diagnostic efficiency in the diagnosis of scaphoid waist fracture and displacement and would be used as a useful supplement to other scaphoid imaging.

Objective To investigate the optimal scanning parameters for cone beam computed tomography(CBCT)of the nasal bone,to achieve low-dose scanning of the nasal bone CBCT.Methods Utilizing Prangmerka CBCT 3D single-tooth sequence,nasal bone scans were performed on two human-equivalent phantoms using two dose protocols,five body types,and five resolutions,resul-ting in 50 scanning sequences.The dose area product(DAP)and volume CT dose index(CTDIvol)were recorded.Objective image quality assessment was conducted by calculating the contrast-to-noise ratio(CNR),signal-to-noise ratio(SNR),noise,and figure of merit(FOM)in region of interest(ROI)set on sagittal images.Subjective scoring was performed using a five-point Likert scale.Differences in radiation dose and image quality among various scanning parameters were compared and analyzed.Results(1)Signifi-cant differences in DAP were observed among different dose modes,body types,and resolutions(P＜0.05),with the lowest DAP values recorded for the XS body type.(2)Statistically significant differences in CNR,SNR,noise,and FOM were found among differ-ent dose modes and resolutions(P＜0.05).The XS body type exhibited the highest SNR and FOM values and the lowest noise.The 200 μm resolution demonstrated the higher CNR value and the highest SNR value,with moderate noise and FOM value.(3)Signifi-cant differences in image quality,contrast,sharpness,and noise were observed among different dose modes,body types,and resolu-tions(P＜0.05).Higher subjective scores were assigned to the 200 μm and 150 μm resolutions,indicating clear anatomical details.Conclusion The scanning parameters of 200 μm resolution combined with an ultra-low-dose protocol for the XS body type achieve a balance between low radiation dose and high image quality,making them suitable for low-dose nasal bone CBCT examinations.

Objective:To systematically evaluate the qualitative research on experience of fear of falling in the elderly, so as to provide theoretical basis for nursing practice.Methods:Qualitative researches on the fear of falling among the elderly were systematically searched in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc. The search period was from database establishment to November 5, 2023. The quality of literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center, and the results were integrated using the Meta-synthesis.Results:A total of 13 articles were included, 44 themes were extracted, categorized into 12 categories, and refined into four integrated results, namely perception of fear of falling, influencing factors of fear of falling, coping strategies in attitude and behavior, and multidimensional needs for rehabilitation nursing.Conclusions:Medical and nursing staff should pay attention to and understand the fear of falling among the elderly, evaluate their fear of falling from multiple dimensions and dynamically, provide personalized guidance based on coping behaviors, create support systems to alleviate their fear of falling and meet their multidimensional needs, so as to improve their quality of life.

Procurement management is an important part of the operation and management of public hospitals. Compliance and high-quality procurement management is of great significance to the development of high-quality hospitals. Based on the practical experience of Renmin Hospital of Wuhan University, this paper introduced in detail how to build a procurement management system with rule system as the cornerstone, quality and risk management as the core, learning training and assessment as the starting point, information as the support, and continuously improving. This system empowered procurement management to improve quality, increase efficiency, and reduce costs. The hospital has successfully completed its procurement tasks from 2021 to 2023, with an average cost saving rate of 11.65% for procurement projects, an effective questioning rate of 0.55%, and a zero litigation rate. The rate of bid rejection for procurement projects has been decreasing year by year. The ability level of procurement management personnel has significantly improved, and their industry influence continues to increase. This approach has certain reference significance for solving the common management problems in the hospital procurement management.

Objective Atrial fibrillation(AF)is a disease of high heterogeneity,and the association between AF phenotypes and the outcome of different catheter ablation strategies remains unclear.Conventional classification of AF(e.g.according to duration,atrial size,and thromboembolism risk)fails to provide reference for the optimal stratification of the prognostic risks or to guide individualized treatment plan.In recent years,research on machine learning has found that cluster analysis,an unsupervised data-driven approach,can uncover the intrinsic structure of data and identify clusters of patients with pathophysiological similarity.It has been demonstrated that cluster analysis helps improve the characterization of AF phenotypes and provide valuable prognostic information.In our cohort of AF inpatients undergoing radiofrequency catheter ablation,we used unsupervised cluster analysis to identify patient subgroups,to compare them with previous studies,and to evaluate their association with different suitable ablation patterns and outcomes.Methods The participants were AF patients undergoing radiofrequency catheter ablation at West China Hospital between October 2015 and December 2017.All participants were aged 18 years or older.They underwent radiofrequency catheter ablation during their hospitalization.They completed the follow-up process under explicit informed consent.Patients with AF of a reversible cause,severe mitral stenosis or prosthetic heart valve,congenital heart disease,new-onset acute coronary syndrome within three months prior to the surgery,or a life expectancy less than 12 months were excluded according to the exclusion criteria.The cohort consisted of 1 102 participants with paroxysmal or persistent/long-standing persistent AF.Data on 59 variables representing demographics,AF type,comorbidities,therapeutic history,vital signs,electrocardiographic and echocardiographic findings,and laboratory findings were collected.Overall,data for the variables were rarely missing(<5% ),and multiple imputation was used for correction of missing data.Follow-up surveys were conducted through outpatient clinic visits or by telephone.Patients were scheduled for follow-up with 12-lead resting electrocardiography and 24-hours Holter monitoring at 3 months and 6 months after the ablation procedure.Early ablation success was defined as the absence of documented AF,atrial flutter,or atrial tachycardia>30 seconds at 6-month follow-up.Hierarchical clustering was performed on the 59 baseline variables.All characteristic variables were standardized to have a mean of zero and a standard deviation of one.Initially,each patient was regarded as a separate cluster,and the distance between these clusters was calculated.Then,the Ward minimum variance method of clustering was used to merge the pair of clusters with the minimum total variance.This process continued until all patients formed one whole cluster.The"NbClust"package in R software,capable of calculating various statistical indices,including pseudo t2 index,cubic clustering criterion,silhouette index etc,was applied to determine the optimal number of clusters.The most frequently chosen number of clusters by these indices was selected.A heatmap was generated to illustrate the clinical features of clusters,while a tree diagram was used to depict the clustering process and the heterogeneity among clusters.Ablation strategies were compared within each cluster regarding ablation efficacy.Results Five statistically driven clusters were identified:1)the younger age cluster(n=404),characterized by the lowest prevalence of cardiovascular and cerebrovascular comorbidities but the highest prevalence of obstructive sleep apnea syndrome(14.4% );2)a cluster of elderly adults with chronic diseases(n=438),the largest cluster,showing relatively higher rates of hypertension,diabetes,stroke,and chronic obstructive pulmonary disease;3)a cluster with high prevalence of sinus node dysfunction(n=160),with patients showing the highest prevalence of sick sinus syndrome and pacemaker implantation;4)the heart failure cluster(n=80),with the highest prevalence of heart failure(58.8% )and persistent/long-standing persistent AF(73.7% );5)prior coronary artery revascularization cluster(n=20),with patients of the most advanced age(median:69.0 years old)and predominantly male patients,all of whom had prior myocardial infarction and coronary artery revascularization.Patients in cluster 2 achieved higher early ablation success with pulmonary veins isolation alone compared to extensive ablation strategies(79.6% vs.66.5%;odds ratio[OR]=1.97,95% confidence interval[CI]:1.28-3.03).Although extensive ablation strategies had a slightly higher success rate in the heart failure group,the difference was not statistically significant.Conclusions This study provided a unique classification of AF patients undergoing catheter ablation by cluster analysis.Age,chronic disease,sinus node dysfunction,heart failure and history of coronary artery revascularization contributed to the formation of the five clinically relevant subtypes.These subtypes showed differences in ablation success rates,highlighting the potential of cluster analysis in guiding individualized risk stratification and treatment decisions for AF patients.