Objective: To understand classroom environmental conditions and their association with spinal curvature abnormalities among students of primary and secondary schools in Guizhou Province, so as to provide a basis for formulating school health policies and scientific prevention and control measures for abnormal spinal curvature in students. Methods: Using a stratified random sampling method, 471 schools (2 811 classrooms) were selected annually across the province from 2022 to 2024 in order to monitor and evaluate classroom environment according to national standards. Spinal examinations were conducted for 196 606 (2022), 194 876 (2023), and 195 048 (2024) students, and χ 2 test was used to analyze the correlation of desk and chair compliance with student spinal curvature abnormalities. Results: The qualified rates of classroom blackboard illuminance uniformity ( 85.41 %) and the blackboard size (82.24%) were the highest in primary and secondary schools in Guizhou Province, while the average blackboard surface illumination qualified rate (20.10%) was the lowest. The average desk illumination (50.11%-58.63%), desk illumination uniformity (61.92%-72.27%) and qualified noise rate (50.04%-51.94%) increased significantly in 3 years; in addition, the compliance rate of desks and chairs decreased from 25.00% to 13.52%, and the differences were all statistically significant ( χ 2=42.48, 80.93, 46.09, 129.72, all P <0.05). Middle school classrooms outperformed primary schools in terms of per capita area, average blackboard illuminance, blackboard illuminance uniformity, average desktop illuminance, desktop illuminance uniformity, and noise compliance ( χ 2=311.55, 12.41, 20.64, 40.76, 10.25, 52.47), but had lower compliance for blackboard size and reflectance ( χ 2=537.29, 7.59) (all P <0.01). Urban schools had higher compliance than suburban schools for per capita area, average blackboard illuminance, average desktop illuminance, and desktop illuminance uniformity ( χ 2=73.71, 17.68, 29.30 , 36.03), but lower compliance for desk-chair suitability, blackboard size, and blackboard reflectance ( χ 2=4.72, 26.02, 5.43 ) (all P <0.05). The spinal curvature abnormality detection rate was 0.83%. A significant association was found between abnormality detection and desk-chair non compliance ( χ 2=223.85, P <0.01). Conclusions Classroom environment hygiene in Guizhou schools is suboptimal. Strengthening school environmental hygiene infrastructure and greater attention to its impact on student s health are essential.

Objective: To understand the epidemiological characteristics of abnormalities spinal curvature among children and adolescents in Karst landform in Guizhou Province, so as to provide a scientific basis for targeted comprehensive intervention. Methods: From September to December 2023, 194 875 children and adolescents aged 6-18 were selected from all countieldistricts of 9 cities (prefectures) in Guizhou Province by stratified random cluster sampling method according to the proportion of Karst landform area in Guizhou Province for carrying out spinal curvature abnormality screening, and a questionnaire survey was conducted on 139 449 students in the fourth grade and above of primary school. Binary Logistic regression was used for multivariate analysis. Results: The detection rate of abnormal spinal curvature among children and adolescents aged 6-18 in Guizhou Province was 1.13%. The detection rates of abnormal spinal curvature in areas with a high proportion of Karst landform, areas with a low proportion of Karst landform, intercalation areas, and nonKarst landform areas were 1.10%, 2.00%, 0.90%, and 0.60%, respectively. Among them, the detection rates of abnormal spinal curvature in female students (2.40%, 1.60%, 0.90%) in areas with a low proportion of Karst landform, intercalation areas and nonKarst landform were higher than those in male students (1.60%, 0.10%, 0.30) (χ2=12.66, 112.69, 30.22, all P<0.05). The detection rates of abnormal spinal curvature among senior high school students (2.00%, 4.30%, 1.40%, 1.30%) in different Karst landform distributions were successively higher than those among junior high school students (1.40%, 3.20%, 1.00%, 0.60%) and primary school students (0.70%, 0.80%, 0.60%, 0.30%) (χ2=306.11, 175.80, 14.24, 39.57, all P<0.05). The results of multivariate Logistic regression analysis showed that the detection rates of abnormal spinal curvature in both highproportion and lowproportion Karst landform areas were higher than those in nonKarst landform areas [OR(95%CI)=1.84(1.05-2.25), 1.60(1.23-2.09), both P<0.05]. Conclusion The detection rate of abnormal spinal curvature in children and adolescents aged 6-18 in Guizhou Province is related to the distribution of Karst landform, so it is necessary to strengthen screening and appropriate comprehensive interventions.

Objective To evaluate the performance of ChatGPT-4.0 and ERNIE Bot-4.0 in the field of laboratory medicine,and ex-plore their application potential and challenges in this professional domain.Methods Using the national clinical medical laboratory technology(intermediate)examination questions as a benchmark,we compared the performance of the two models in mastering labora-tory medicine knowledge and answering consistency.We also and assessed the models'ability in interpreting test results and assisting diagnosis through 30 laboratory medicine cases.Results In the clinical medical examination technology test,both models passed the 60％qualification threshold.ChatGPT-4.0 was superior to ERNIE Bot-4.0 in terms of answering speed and consistency,but its answer-ing accuracy was significantly lower than that of ERNIE Bot-4.0(73.25％vs 80.75％).ERNIE Bot-4.0's accuracy rate was higher than the average accuracy rate of clinical aboratory personnel in this examination(78.03％).In the accuracy analysis of different question types,both performed worst in experimental technology questions(ERNIE Bot-4.0:66.32％,ChatGPT-4.0:60.53％)and best in bas-ic medical knowledge questions(both scoring 86.00％).In the case analysis test,ERNIE Bot-4.0 outperformed ChatGPT-4.0 in all cat-egories.Both models performed well in routine case analysis but made errors in complex case analysis.Conclusion In the field of la-boratory medicine,both large language models have shown certain application potential,especially in a Chinese context,where ERNIE Bot-4.0 significantly outperforms ChatGPT-4.0 in terms of answering accuracy and case analysis ability,indicating its relative advantage in domestic applications.However,both models still need improvement in experimental technical knowledge,complex case analysis ca-pabilities,and the accuracy and consistency of result output.At the current stage,there are still certain risks in directly applying such general large language models to clinical test result interpretation and assisted diagnosis,which provides a new research direction for the interpretation of test reports.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective To explore the correlation between eosinophils(EOS),interleukin-17A(IL-17A),tumor necrosis factor α(TNF-α)and vascular endothelial growth factor(VEGF)in peripheral blood and my-coplasma pneumoniae infection with wheezing in children.Methods A total of 98 children with mycoplasma pneumoniae infection diagnosed and treated in the hospital from January 2022 to May 2023 were selected as the study group.The study group was divided into wheezing group(32 cases)and non-wheezing group(66 ca-ses)according to whether they were accompanied by wheezing,and 30 children with lobar pneumonia without wheezing who were examined by fiberoptic bronchoscopy during the same period were selected as the control group.The levels of EOS,IL-17A,TNF-α and VEGF in peripheral blood of different groups were compared,and the correlation between the four indexes and mycoplasma pneumoniae infection with wheezing in children was analyzed.Results The levels of EOS,IL-17A,TNF-α and VEGF in peripheral blood of the study group were significantly higher than those of the control group,and the differences were statistically significant(P＜0.05).The differences in the levels of EOS,IL-17A,TNF-α and VEGF in the peripheral blood of the three groups were statistically significant(P＜0.05).Specifically,the levels of EOS,IL-17A,TNF-α and VEGF in the wheezing group were significantly higher than those in the non-wheezing group and the control group,and the differences were statistically significant(P＜0.05),and the levels of EOS,IL-17A,TNF-α and VEGF in the non-wheezing group were significantly higher than those in the control group,and the differences were sta-tistically significant(P＜0.05).Pearson correlation analysis showed that the levels of EOS,IL-17A,TNF-α and VEGF in peripheral blood were positively correlated with mycoplasma pneumoniae infection with wheez-ing in children(P＜0.05).Using wheezing as a state variable and plotting the receiver operating characteristic(ROC)curve,it was found that the area under the curve of peripheral blood EOS,IL-17A,TNF-α and VEGF for distinguishing mycoplasma pneumoniae infection with wheezing in children was 0.658,0.960,0.948,and 0.937.Conclusion Peripheral blood EOS,IL-17A,TNF-α,The level of VEGF is positively correlated with Mycoplasma pneumoniae infection with wheezing in children,which could be used for clinical differentiation of mycoplasma pneumoniae infection with wheezing in children.

Objective:To survey the continuing medical education training needs for village doctors in Beijing suburbs.Methods:A qualitative study on the continuing medical education training needs for village doctors was conducted in Beijing Huairou district from March to July 2021. Six township hospital managers, 19 village doctors, 15 village cadres and 30 villagers from 15 villages of 3 townships in the district selected by purposive sampling method attended the face-to-face, individual, in-depth interviews. A semi-structured interview outline was developed based on literature review and expert consultation. The content of the interviews was analyzed by the thematic framework method.Results:Among 19 rural doctors, 11 preferred the full-time training, while 8 were unable to participate in the full-time training. Most of township hospital managers and village doctors thought the ideal form of training was "classroom knowledge teaching teaching" (5/6, 16/19)and "outpatient clerkship"(6/6, 13/19). The training contents for village doctors were basic medical knowledge and skills, including diagnosis and treatment of common diseases, identification of common symptoms and management of chronic diseases; the appropriate techniques of traditional Chinese medicine including acupuncture, moxibustion, cupping and scraping; and public health including epidemic prevention and control, infectious disease detection and reporting.Conclusion:For improving the applicability and practicality of training for village doctors, it is necessary to apply rational training methods and forms, and develop targeted training program and contents based on training needs.

Objective:To explore the current status of the post competency evaluation index systems of Chinese general practitioners (GPs), and to summarize the post competency evaluation index systems of GPs in China.Methods:This study was a systematic review. We searched China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database (CQVIP), SinoMed, PubMed and other databases using "general practitioner" or "family doctor" or "standardized training for residents" or "post competency" or "evaluation system" or "core capability" or "assessment" or "evaluation" etc. as search terms and adding free words. The search was conducted from data establishment to October 2022. Literature screening and data extraction were carried out independently by 2 researchers using strict inclusion and exclusion criteria. The Ekman quality evaluation tool was used to evaluate the quality of the included literature. Excel was used to extract data information, including basic information of literatures, basic information of index systems and index content.Results:A total of 1 284 literatures were retrieved and 33 studies were included. A total of 15 research methods were used, and 28 (84.8%) applied 3 or more methods. There were 14 studies (42.4%) with good reliability and validity, and 17 studies (51.5%) with index weights. There were 12 applied theoretical bases, of which 20 studies (60.6%) used mature foreign competency models as a reference, 14 studies (42.4%) combined the job analysis and position requirements of GPs, and 11 studies (33.3%) interpreted policy documents. The content analysis method yielded 1 537 initial indicators, 1 268 indicators after eliminating repeated indicators, and 6 first-level indicators and 31 second-level indicators after combining and summarizing. Among the first-level indexes, "patient care" appeared most frequently (36.4% (462/1 268)); the secondary index with the highest frequency in this dimension was "master medical theoretical knowledge" followed by "community-oriented care ability" and "treatment and follow-up of common and frequently-occurring diseases"; the indicators "family-based care ability" and "human-centered care concept" reflected the characteristics of general medical practice. The frequency of "professional spirit and moral quality" (16.3%(207/1 268)), "clinical teaching and learning ability" (14.3%(181/1 268)) and "system-based practical ability"(11.1%(141/1 268)) ranked second, third and fourth among the first-level indicators respectively. The frequency of "basic public health service ability" (11.0%(139/1 268)) ranked the fifth, and the secondary indicator "health management of key community groups" reflected the concept of the whole life cycle of residents and the basic principle of continuity of care in general medicine. The frequency of "interpersonal and communication skills"(10.9%(138/1 268)) ranked sixth.Conclusions:There have been numerous researches on the post competency index evaluation system of GPs in China, but more research is still needed. There are many research methods with rich theoretical basis and Chinese characteristics. This study summarized the post competency evaluation index systems of GPs in China, generalized 6 first-level indicators and 31 second-level indicators that reflect the basic principles and characteristics of general medicine.

Objective:To investigate the correlation between the annual professional proficiency test results and the theoretical examination score of completion assessment in standardized residency training, as well as the value of the annual professional proficiency test results in predicting whether a resident passes the theoretical examination of completion assessment.Methods:The residents who participated in the annual professional proficiency test of residency training in Affiliated Hospital 2 of Nantong University in 2019-2021 and the completion assessment of residency training in 2020-2022 were selected as subjects, and related data were collected, including sex, education background, personnel type, training specialty, the results of annual professional proficiency test, and the theoretical examination score of completion assessment. According to whether the resident passed the theoretical examination of completion assessment, they were divided into passed group and failed group. SPSS 19.0 was used to perform the chi-square test, the independent samples t-test, and the binary logistic regression analysis; the Pearson correlation coefficient was used for correlation analysis; the sensitivity analysis was represented by ROC curve. Results:Compared with the residents who passed the theoretical examination of completion assessment, the residents who did not pass the examination had a significant reduction in the proportion of the residents from our hospital and a significant increase in the proportion of the residents commissioned by foreign institutions ( χ 2=7.00, P=0.008). The passed group had a significantly higher national percentile of annual professional proficiency test score than the failed group (43.46%±26.61% vs. 23.40%±18.71%, t=6.02, P<0.001). The national percentile of annual professional proficiency test score was positively correlated with the theoretical examination score of completion assessment ( r=0.43, P<0.05). The source of residents commissioned by foreign institutions and the low percentile of annual professional proficiency test score were independent risk factors for failing the theoretical examination of completion assessment ( P=0.020 and P<0.001). The national percentile of annual professional proficiency test score had an area under the ROC curve of 0.73 (95% CI: 0.65-0.80) in predicting the outcome of theoretical examination and had a certain predictive value with a cut-off value of 15.1%. Conclusions:In addition to strengthening homogenization and professional base management for residency training, it is necessary to make full use of the results of annual professional proficiency test in standardized residency training and timely check the professional knowledge of the residents whose a national percentile of <15.1%, so as to effectively improve the pass rate of theoretical examination and the quality of training.

Objective To investigate the mechanism of iron death induced by TRPC6/NF-κB in glomerular podiocytes mediated by high homocysteine(Hcy).Methods Mouse glomerulopocytes were cultured in vitro and divided into Control group(0 μmol/L Hcy)and Hcy group(80 μmol/L Hcy).After 48h of intervention,Western blot was used to detect the expression levels of iron death related proteins GPX4 and SLC7A11 and TRPC6 and NF-κ B.Real-time quantitative fluorescence PCR(qRT-PCR)and immunofluorescence were used to detect the expression of TRPC6.The level of podocyte apoptosis was detected by flow cytometry.Malondialdehyde(MDA)assay kit was used to determine intracellular MDA levels.After transfection of TRPC6 interference fragment and TRPC6 negative control(NC),qRT-PCR was divided into Control,si-NC and si-TRPC6(Si-TRPC6-1,Si-TRPC6-2,Si-TRPC6-3).Western Blot was divided into Control,Hcy,si-NC+Hcy,si-TRPC6+Hcy.The expression of TRPC6 mRNA was detected by qRT-PCR.The expression levels of GPX4,SLC7A11,NF-κB and TRPC6 were detected by Western Blot.The level of podocyte apoptosis after interference was detected by flow cytometry.Results(1)Compared with Control group,the expression levels of iron death related proteins GPX4 and SLC7A11 in Hcy group were decreased,and the apoptosis rate was increased(P<0.05).(2)Compared with Control group,TRPC6 protein,mRNA levels and immunofluorescence expression were increased in Hcy group.The level of MDA and the expression of NF-κB signaling pathway protein increased in Hcy group,and the comparison between the two groups had statistical significance(P<0.05).(3)Compared with the si-NC group,the mRNA expression level of TRPC6 in si-TRPC6(Si-TRPC6-1,Si-TRPC6-2,Si-TRPC6-3)group was decreased,and the interference effect of Si-TRPC6-3 was the best(P<0.05).After transfecting TRPC6 NC and TRPC6 interference fragment and administering Hcy,there was no difference in GPX4,SLC7A11,NF-κB and TRPC6 expression in si-NC+Hcy group compared with Hcy group.Compared with the si-NC+Hcy group,the si-TRPC6+Hcy group had higher expression of iron death related proteins,GPX4 and SLC7A11,lower expression of NF-κB and TRPC6,and decreased apoptosis rate(P<0.05).Conclusion This study confirmed that TRPC6/NF-κB can regulate iron death of renal podocytes under the induc-tion of Hcy,which is one of the mechanisms leading to kidney injury.

Objective To study the effect of incentive and target assessment mechanism on the operation and manage-ment efficiency of nurse-led clinics.Methods 45 cases in the nurse-led clinic managed by the target assessment mechanism in our hospital from June to December 2021 were selected as the control group,and 46 cases managed by the incentive joint target assessment mechanism in our hospital from February to July 2022 were selected as the observation group.The annual workload,doctors'recognition of nurses,nursing quality and self-efficacy scale(GSES)scores before and after intervention were compared between the two groups,and the satisfaction of nurses in charge of patients was compared between the two groups.Results Be-fore intervention,there was no difference in the annual workload between the two groups(P＞0.05).After intervention,the an-nual workload of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in the scores of recognition degree between the two groups(P＞0.05).After intervention,the scores of communication ability,quality management ability,emergency ability,independent work ability and specialist problem solving ability of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in nursing quality score between the two groups(P＞0.05).After intervention,the quality of nursing cases,the quality of patient safety management,the quality of post work and the total mean score of the two groups were increased,and the observation group was higher than the control group(P＜0.05).Before intervention,there was no difference in GSES scores between the two groups(P＞0.05).After intervention,GSES scores of the two groups increased,and the obser-vation group was higher than the control group(P＜0.05).The total satisfaction rate of patients in observation group was 96.25% ,higher than 86.25% in control group(P＜0.05).Conclusion The incentive and target assessment mechanism can significantly improve nurses'annual workload and nursing quality,doctors'recognition of nurses and patients'satisfaction with nursing.