ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

ObjectiveTo analyze the drug resistance and the molecular typing characteristics through pulsed field gel electrophoresis (PFGE) of Campylobacter spp. isolated from patients with infectious diarrhea in Baoshan District of Shanghai, and to provide a basis for Campylobacter spp. prevention and control and clinical medication. MethodsCampylobacter spp. was isolated, cultured and identified from stool samples of diarrheal patients collected from medical institutions at two monitoring sites in Baoshan District from 2019 to 2022. Antimicrobial susceptibility testing for 12 antibiotics was conducted on the isolated Campylobacter jejuni (C. jejuni) and Campylobacter. Coli (C. coli), and molecular typing was performed using PFGE. ResultsA total of 179 strains of Campylobacter spp. were isolated from 1 786 samples of diarrheal patients, with a positive rate of 10.02%. The highest resistance rate of C. jejuni was to ciprofloxacin (98.63%), followed by tetracycline (97.26%) and nalidixic acid (89.73%). C. coli was completely resistant to ciprofloxacin and nalidixic acid (100.00%), followed by tetracycline (90.91%). The multidrug resistance rates of C. jejuni and C. coli were 89.73% and 100.00%, respectively. 142 strains of C. jejuni produced 122 PFGE bands, while 33 strains of C. coli produced 33 PFGE bands, and the distribution of the bands was relatively dispersed. ConclusionFrom 2019 to 2022, the detection rate of Campylobacter in diarrheal patients was relatively high in Baoshan District of Shanghai, the multidrug resistance rate of Campylobacter isolates from diarrheal patients was relatively serious, in addition, the drug resistance pattern was complex, and the PFGE band pattern displayed a polymorphic distribution.

Objective:To explore the adjustment ranges of auto-segmentation contours for organs at risk (OAR) in patients with nasopharyngeal carcinoma and assess the dosimetric impacts of the contours from varying sources on radiotherapy plans.Methods:Twenty-five patients with early-stage nasopharyngeal carcinoma were investigated. Through expert delineation, deep learning-based automatic delineation, and atlas-based automatic delineation of their spinal cord, brainstem, optic nerves, optic chiasm, parotid glands, oral cavity, hypopharynx, and mandible, as well as expert correction of these automatic delineations, five structure sets were formed. Moreover, the contours delineated by experts (also referred to as the expert contours) of the target volumes and other OARs were copied into the images for subsequent research. The Dice similarity coefficients (DSCs) of the structure sets were calculated. Using the radiotherapy plans optimized based on expert contours as templates, the radiotherapy plans and dose distributions of all the structure sets were established. The expert contours and contours determined using automatic delineation and corrected by experts (also referred to as the corrected contours) were defined as clinical contours. Then, three research objectives were set: the dosimetric effects of inter-observer clinical contour variations, the impacts of contour variations on plan optimization, and the impacts of contour variations on plan evaluation.Results:The average DSC of the visual pathway was 0.62±0.10, lower than that of other OARs (0.86±0.04). After expert correction, the DSCs of contours obtained using deep learning- and atlas-based automatic delineation increased by 7.61% and 10.69%, respectively. For the dosimetric effects of inner-observer contour variations, the Dmax of the optic chiasm was the maximum (3.96±6.02)Gy, while the Dmean of the hypopharynx was the minimum (0.81±0.55 Gy). When the impacts of contour variations on plan optimization were assessed based on expert contours, the dose differences (Δ D) exceeding ±3 Gy accounted for 22%, 14%, 46%, and 42%, respectively for the spinal cord, brainstem, optic nerve, and optic chiasm and accounted for only 2% for other OARs. After expert correction, the Δ D between automatic and expert contours decreased, with Δ D exceeding ±3 Gy decreased by 16% and 14%, respectively for the optic nerves and optic chiasm. When the average distance of the overlap volume histogram (OVH) exceeded 3.5 cm, all Δ Dmax fell within ±3 Gy. When the average distance of OVH was greater than 1.5 cm, all Δ Dmean fell within ±2 Gy. For contours obtained using deep learning and atlas-based automatic delineation, the doses of 50.0%±17.3% and 52.6%±19.3% of patients fell within the dose ranges of clinical contours, respectively. The numbers of patients for whom the Dmax of the spinal cord, optic nerve, optic chiasm and the D1 cm 3 of the mandible in the two types of automatic contours fell within the dose ranges of clinical contours were statistically different ( t = -4.24, -3.99, -3.16, 3.51, P < 0.05). Conclusions:After expert correction, the automatic delineation results from different sources exhibited certain geometric differences. The expert correction reduced the impacts of automatic contours on plan optimization. The average distance of OVH is identified as an important feature used to determine dose differences. For small-volume serial organs close to the target volumes, meticulous corrections are required before applying auto-segmentation to clinical practice.

Objective:To explore the predictive value of the change rate of parathyroid hormone (PTH) after total thyroidectomy (TT) for hypoparathyroid function.Methods:A total of 182 patients with thyroid tumor who underwent TT from Jan. 2018 to Jun. 2023 in the Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Shanxi Medical University were retrospectively selected as the study objects. The clinical and surgical data of the patients were collected, and the key factors associated with postoperative hypoparathyroidism were screened by multi-factor analysis. The change rate of serum PTH was calculated during perioperative period (before operation, at the end of operation, 1 and 3 days after operation). Receiver operator curve (ROC) was used to analyze the predictive value of PTH change rate in all patients.Results:Whether temporary hypoparathyroidism (THP) or permanent hypoparathyroidism (PHP), both were closely related to TT+ bilateral central lymph node dissection ( χ2=33.764, 9.235, P < 0.05) and parathyroid resection ( χ2=6.512, 58.999, P < 0.05). The change rate of PTH in HP patients was significantly higher than that in normal patients ( F=15.993, 16.830, 19.024, P < 0.05), and on the first and third day after surgery, the change rate of PTH in PHP patients was significantly higher than that in THP patients ( t=7.955, 9.023, P < 0.05). The predicted area under curve (AUC) of THP or PHP in different patient populations is different with the change rate of PTH in different periods. For patients with TT+ bilateral central lymph node dissection and parathyroidectomy, the change rate of PTH at the end of surgery was significantly higher than the change rate of PTH at 3 days after surgery for the AUC with PHP ( Z=5.433, 4.923, P < 0.05) . Conclusion:Perioperative PTH has good predictive value for THP and PHP in TT patients, especially in TT+ bilateral central lymph node dissection and parathyroidectomy.

Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective To analyze the metabolic changes of myocardial tissue in rats under acute exposure to macleaya cordata by gas chromatography mass spectrometry(GC-MS),explore forensic identifications of its characteristic metabolites,and verify its toxicological mechanism in poisoning cases.Methods The rats in the exposure group were given 382 mg/kg macleaya extract solution by gavage,and the rats in the control group were given the same dose of solvent.The myocardial samples were analyzed by GC-MS,and pattern recognition was conducted through partial least squares discriminant analysis(PLSDA).The differential metabolites with characteristic changes were identified by variable importance projection(VIP value＞1)and Student's t test(P＜0.01).Results Compared with the control group,21 potential characteristic metabolites were identified.Through KEGG pathway enrichment analysis,it was found that these metabolites were mainly involved in the pathways of glycine,serine and threonine metabolism;pyruvate metabolism and glycerolipid metabolism.Conclusion Through the study of myocardial metabolism in rats exposed to macleaya cordata,we found the information on metabolites closely related to poisoning,which provides new insight and reference for studies on the mechanisms of macleaya cordata poisoning in the field of forensic medicine.

Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective To explore the influence of early high-energy-density milk powder feeding on recovery and nutritional status in infants with congenital heart disease after surgery. Methods A total of 82 infants with congenital heart disease were selected and randomly divided into control group (early routine formula feeding) and study group (early high-energy-density formula feeding), with 41 cases in each group. The recovery outcomes, nutritional status, feeding conditions, and cardiac function were compared between the two groups. Results Mechanical ventilation time, treatment duration in Cardiac Intensive Care Unit (CICU), and hospital stay in the study group were significantly shorter than those in the control group (P < 0.05). Compared with preoperative levels, the levels of prealbumin (PA), retinol-binding protein (RBP), transferrin (TRF) and albumin (ALB) increased significantly in both groups at 3 months after operation (P < 0.05); at 3 months after operation, the levels of PA, RBP, TRF and ALB in the study group were significantly higher than those in the control group (P < 0.05). Compared with preoperative measurements, both groups showed significant improvements in height and body weight at 3 months after operation (P < 0.05); the height and body weight of the study group were significantly higher than those of the control group at 3 months after operation (P < 0.05). Compared with the control group, the study group had a significant lower rate of inadequate feeding and a significant higher rate of appropriate feeding (P < 0.05). Cardiac function of the study group was significantly better than that of the control group (P < 0.05). Conclusion Early high-energy-density milk powder feeding after congenital heart disease surgery in infants can promote faster recovery, improve nutritional status, and result in more appropriate feeding, with a lower incidence of heart failure.

Objective: To investigate the trends in incidence of HIV/AIDS in China from 1990 to 2019 and to examine the effect of age, period and cohort on the incidence of HIV/AIDS, so as to provide insights into the improvements of the HIV/AIDS control measures. Methods: Data pertaining to incidence of HIV/AIDS in China from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 (GBD 2019) datasets, and the trends in incidence of HIV/AIDS in China from 1990 to 2019 was analyzed with annual percentage change (APC) and average annual percentage change (AAPC) using a jointpoint regression model. The effects of age, period and cohort on the incidence of HIV/AIDS in China were examined with an age-period-cohort model. Results: The age-standardized incidence of HIV/AIDS appeared an overall tendency towards a rise in China from 1990 (0.80/105) to 2019 (2.21/105) (AAPC=3.209%, P<0.05), and the incidence of HIV/AIDS showed a tendency towards a rise from 1990 to 1997 (AAPC=9.044%, P<0.05) and from 1997 to 2003 (AAPC=17.598%, P<0.05), a decline from 2006 to 2014 (AAPC=-8.412%, P<0.05) and remained relatively stable from 2003 to 2006 and from 2014 to 2019 (both P>0.05). The incidence of HIV/AIDS appeared a tendency towards a rise with age, and peaked among patients at ages of 25 to 29 years (4.93/105) and 75 to 79 years (7.38/105). The risk of HIV/AIDS appeared a tendency towards a rise followed by a decline with time, and a reduced risk of HIV/AIDS was found from 1990 to 1994 (RR=0.297), from 1995 to 1999 (RR=0.523), from 2005 to 2009 (RR=0.737), from 2010 to 2014 (RR=0.412) and from 2015 to 2019 (RR=0.351) in relative to the period from 2000 to 2004. The risk of HIV/AIDS appeared a tendency towards a rise with the cohort, and a higher risk of HIV/AIDS was found in the 1930-1934 cohort (RR=1.880) and 2000-2004 cohort (RR=2.978) in relative to the 1955-1959 cohort. Conclusions The incidence of HIV/AIDS appeared a tendency towards a rise followed by a decline in China from 1990 to 2019, and remained at a low level since 2014. The adolescents and elderly were high-risk groups of HIV/AIDS. A variety of health education interventions and intensified active HIV/AIDS screening are recommended.