Objective To construct a clinical-radiological nomo-gram model for severe mycoplasma pneumoniae pneumonia coinfec-tion with other pathogens(Co-SMPP)in children.Methods The clinical and radiological data of children with severe mycoplasma pneumoniae pneumonia(SMPP)who underwent nucleic acid testing or bronchoalveolar lavage(BAL)were analyzed retrospectively.The data analysis were performed by using SPSS 27.0 software.The group comparison between simple SMPP and Co-SMPP children was conducted by using t-tests,Mann-Whitney U tests,or chi-square tests.Nomogram analysis was performed by using R software and rms packages.The predictive performance of the model was evaluated by using the receiver operating characteristic(ROC)curve.Results A total of 194 SMPP children were included in the study,including 136 cases(70.1％)with simple SMPP,58 cases(29.9％)with Co-SMPP.The fibrinogen and albumin levels were lower in Co-SMPP children[(3.53±0.85)g/L,41.00(39.03,43.68)g/L]than in simple SMPP children[(3.79±0.80)g/L,42.80(41.00,44.40)g/L],with P values of 0.047 and 0.036,respec-tively.The probability of bronchial stenosis and grid shadow were higher in Co-SMPP children than in simple SMPP children,and there were significant differences between the two groups(P＜0.001,P=0.010).The odds ratio of bronchial stenosis in predicting Co-SMPP children was 14.085.The clinical-radiological nomogram model had an area under the curve(AUC)of 0.840,with sensi-tivity and specificity of 0.756 and 0.848,respectively.Conclusion The nomogram model based on clinical-radiological features can effectively predict Co-SMPP.

Objective To explore the risk factors of respiratory failure(RF)in patients with Klebsiella pneumoniae pneumonia(KPN).Methods A total of 79 KPN patients admitted to Jilin Provincial People's Hospital from July 2023 to July 2024 were selected as subjects.Patients were divided into RF group(n=42)and non-RF group(n=37)based on RF comorbidity status.Independent risk factors for RF comorbidity were identified through univariate analysis and multivariate Logistic regression,with model predictive performance evaluated using receiver operating characteristic(ROC)curve.Results Compared to non-RF group,serum procalcitonin(PCT)levels were higher and serum albumin(ALB)and oxygenation index were lower in RF group(P＜0.05).Univariate analysis identified age,bedridden status,number of comorbidities,PCT,oxygenation index,ALB,multi-lobar infiltration,and mechanical ventilation as significant predictors of RF development in KPN patients.Multivariate Logistic analysis showed that elevated PCT levels,decreased oxygenation index,and reduced ALB were independent risk factors for RF in KPN patients,with area under the ROC curve of predictive model being 0.884.Conclusion When blood PCT is elevated,blood ALB is reduced,and the oxygenation index is decreased,the likelihood of RF in KPN patients is significantly increased.

Grounded in the Healthy China strategy,it employs integrated healthcare service theory,collaborative governance theory,and symbiosis theory to systematically analyze the conceptual connotation of medical-preventive integration within county-level medical communities and clarify its seven-dimensional framework of medical-preventive integration.These dimensions encompass resource integration,management integration,information integration,team integration,service integration,assessment integration,and cultural integration.The study delineates its three-phase dynamic evolution characterized by"interaction,coordination,and symbiosis"and outlines future development paths:constructing an intelligent integrated platform,delivering continuous services across the prevention-treatment-rehabilitation continuum,and fostering a multi-stakeholder collaborative governance framework.The findings provide both theoretical foundations and policy recommendations to support the high-quality development of medical-preventive integration in county-level medical communities.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To analyze the impact of lung-protective ventilation strategy on postoperative pulmonary function and prognosis in abdominal surgery patients with a history of coronavirus disease 2019 (COVID-19) infection.Methods:A total of 80 patients with a history of COVID-19 who underwent emergency or elective abdominal surgery at the Central Hospital of Yongzhou from December 2023 to April 2025 were selected. They were divided into the lung-protective group ( n=40) and the traditional ventilation group ( n=40) using a random number table method. The lung-protective group was set with a tidal volume (VT) of 6 ml/kg, positive end-expiratory pressure (PEEP) of 5 cmH 2O, and lung recruitment was performed every 30 minutes; the traditional ventilation group was only set with a VT of 8-10 ml/kg. Blood gas analysis indicators [partial pressure of arterial carbon dioxide (PaCO 2) and partial pressure of arterial oxygen (PaO 2)] and pulmonary function indicators [forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), and FEV 1/FVC] were compared between the two groups before surgery and 3 days after surgery. The modified clinical pulmonary infection score (MCPIS) was calculated, and the incidence of postoperative complications was statistically analyzed in both groups. Results:There were no statistically significant differences in blood gas analysis and pulmonary function indicators between the two groups before surgery (all P>0.05). Compared with preoperatively, PaCO 2 decreased and PaO 2 increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, PaCO 2 in the lung-protective group was lower than that in the traditional ventilation group, and PaO 2 was higher than that in the traditional ventilation group (all P<0.05). Compared with preoperatively, FEV 1 and FVC decreased, and FEV 1/FVC increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, FEV 1, FVC, and FEV 1/FVC in the lung-protective group were all higher than those in the traditional ventilation group (all P<0.05). The MCPIS of the lung-protective group 3 days after surgery was lower than that of the traditional ventilation group, with a statistically significant difference [(2.75±0.45) vs (4.23±0.68), t=11.479, P<0.05]. There was no statistically significant difference in the total incidence of complications between the lung-protective group and the traditional ventilation group ( P>0.05). Conclusions:Lung-protective ventilation strategy can improve postoperative blood gas analysis indicators and pulmonary function in abdominal surgery patients with a history of COVID-19, thereby improving prognosis, with good safety.

Objective To explore the changes in trabecular meshwork cell types and cellular communication patterns in primary open-angle glaucoma(POAG).Methods The POAG single-cell dataset GSE135337(including the trabecular meshwork samples of 3 cynomolgus macaque monkeys with POAG and 3 healthy cynomolgus macaque monkeys,data upda-ted to 2023)was downloaded from the Gene Expression Omnibus(GEO),two groups of samplesare named the POAG group and the control group.The downscaling,clustering,grouping,and visualization of data were performed using the Seurat package in R.The cellular communication pattern was analyzed by using the CellChat package in R to identify the differences in the cellular communication pattern between the POAG group and the control group.Meanwhile,the differen-tial gene analysis was performed based on the transcriptome sequencing(RNA-seq)dataset GSE27276(including the atrial horn tissue samples from 17 POAG patients and 19 healthy individuals,data updated to 2023)from the GEO to identify spe-cific cellular communication signaling changes.Results There were no significant differences in the cell types between the control group and the POAG group,including trabecular meshwork cells,macrophages,melanocytes,pericytes,Schlemm's canal cells,myelinating Schwann cells,nonmyelinating Schwann cells,smooth muscle cells,and vascular en-dothelial cells.There was a significant difference in the cellular communication intensity between the POAG group and the control group.The expression of macrophage migration inhibitory factor(MIF)-CD74,C-X3-C motif chemokine ligand 1(CX3CL1)-C-X3-C motif chemokine receptor 1(CX3CR1),and HBB in the POAG group was significantly up-regulated compared with the control group,while the expression of secreted phosphoprotein 1(SPP1)-(ITGA8+ITGB1),SPP1-(IT-GA4+ITGB1),IGF2-IGF2R,CCL8-CCR1,and CCL8/26/24/2-ACKR2 in the POAG group was significantly down-regulated compared with the control group.The RNA-seq analysis results confirmed that the expression levels of HBB,HBD,HBA,and CD74 were higher in the POAG group than in the control group.Conclusion The up-regulation of MIF-CD74 and the down-regulation of SPP1-(ITGA8+ITGB1)and SPP1-(ITGA4+ITGB1)in trabecular meshwork tissues may participate in the fibrotic process,which may be a potential pathogenic mechanism of POAG.

Objectives:This study aims to explore the relationship between the pericoronary fat attenuation index(FAI)and triglyceride-glucose(TyG)index and atrial fibrillation recurrence after radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation(AF).Methods:This retrospective study enrolled consecutive AF patients who underwent their first successful RFCA at the Affiliated Hospital of Xuzhou Medical University from 2019 to 2023.Pericoronary FAI was quantitatively measured,and the TyG index was calculated.Patients were divided into three groups according to the TyG index quartile:T1 group(TyG index<8.45,n=114);T2 group(8.45≤TyG index≤8.93,n=114);T3 group(TyG index>8.93,n=120).Linear regression was used to analyze the correlation between the TyG index and proximal FAI of three coronary arteries.Logistic regression was employed to explore the correlation between pericoronary FAI,TyG index,and AF recurrence post-RFCA,restrictive cubic splines(RCS)were plotted.Additive interaction and mediation analyses were used to explore the role of pericoronary FAI in the relationship between the TyG index and post-RFCA AF recurrence.Subgroup analysis was performed to explore the predictive value of the TyG index for postoperative recurrence in different patient subgroups.Results:A total of 348 patients were included.After adjusting for confounding factors using linear regression analysis,each unit increase in the TyG index was associated with a 5.389 HU increase in left circumfleex artery(LCX-FAI)(95%CI:3.874-6.904,P<0.001).During one-year follow-up,90 cases(25.86%)experienced AF recurrence.RCS analysis indicated that there was no significant nonlinear relationship between LCX-FAI,TyG index,and AF recurrence after RFCA(Pnon-linear=0.378,Pnon-linear=0.469).The recurrence rate of AF in patients with TyG index>9.08 and LCX-FAI>-83.65 HU was about 57.737 times higher than those with TyG index≤9.08 and LCX-FAI≤-83.65 HU(OR=57.737,95%CI:23.755-155.656,P<0.001).There was an additive interaction between the TyG index and LCX-FAI:relative excess risk due to interaction(RERI)was 50.901(95%CI:0.215-101.587),attributable proportion due to interaction(AP)was 0.882(95%CI:0.769-0.994),and the synergy index(S)was 9.713(95%CI:3.380-27.910).Mediation analysis indicated that LCX-FAI mediated 22%of the relationship between the TyG index and AF recurrence.Subgroup analysis revealed no multiplicative interaction between the type of atrial fibrillation and the TyG index in terms of AF recurrence risk(Pinteraction=0.562).Conclusions:In patients with atrial fibrillation,the TyG index is positively correlated with LCX-FAI,patients with TyG index>9.08 and LCX-FAI>-83.65 HU have significantly increased risk of AF recurrence after RFCA.LCX-FAI partially mediates the relationship between the TyG index and post-RFCA recurrence.Furthermore,the TyG index can effectively predict AF recurrence in both persistent and paroxysmal atrial fibrillation patients.

Objective To explore the prediction efficiency of Ki-67 expression status in pituitary adenoma(PA)based on a joint model of siamese network and transfer learning.Methods The preoperative MR T1WI enhanced sequence images of 370 patients with PA diagnosed by surgery and pathology were retrospectively collected.According to the results of immunohistochemical,all patients were divided into high proliferation index group(Ki-67≥3,n=97)and low proliferation index group(Ki-67＜3,n=273),and all the sample data were randomly divided into training set and test set according to the ratio of 7∶3.Two single predictive models,ResNet-50 and VGGNet-16 and combined them with the siamese network and transfer learning were built.The prediction efficiency of different models were evaluated via accuracy rate,precision rate,recall rate,F1 score and receiver operating characteristic(ROC)curve as the main criteria.Results Compared with a single predictive model,the model combined with siamese network and transfer learning showed a better performance for predicting the Ki-67 of PA.Additionally,the ResNet-50 joint model exhibited the superior predictive performance.The accuracy rate was 0.872 7,the precision rate was 0.812 5,the recall rate was 0.764 7,the F1 score was 0.787 9,and the area under the curve(AUC)was 0.841 6.Conclusion The joint model based on siamese network and transfer learning exhibits a higher efficiency for predicting the Ki-67 expression status in PA,which can help the clinicians to formulate more personalized treatment for the patients.

Objective To analyze the clinical characteristics and treatments of children with myocarditis,and to investigate the relation-ship between arrhythmia and prognosis.Methods A total of 244 patients diagnosed with myocarditis from January 2012 to December 2023 were included and retrospectively analyzed.The patients were divided into three groups:fulminant myocarditis(FMC),myocarditis(MC),and suspected myocarditis(SMC).The data included the clinical characteristics at disease onset,the treatment,and the relationship between different arrhythmias and the prognosis among the three groups.Results Among the 244 children with FMC/MC/SMC,132/244(54.1％)developed arrhythmia,ventricular arrhythmia was observed in 83/132(62.9％),and 86/105(81.9％)showed no persistent arrhythmia.The proportion of children in the FMC group who presented with palpitations,cardio-cerebral syndrome,cardiogenic shock,cardiac insufficiency,and death was significantly higher than that in the MC and SMC groups(P＜0.01).Five children with third-degree(Ⅲ°)atrioventricular block(AVB)recovered after controlling their ventricular rate without a temporary pacemaker.Conclusion Most children with FMC/MC/SMC have different types of arrhythmias,of which ventricular arrhythmias are the most common,and rarely persist.FMC has severe clinical symptoms and the highest mortality rate.Ventricular tachycardia usually occurs during the administration of vaso-active drugs in patients with Ⅲ ° AVB;if the ventricular rate can be controlled promptly,these patients have a good prognosis.

OBJECTIVE:Anterior cervical decompression and fusion is a classic surgical method for the treatment of degenerative cervical spondylosis.The use of nail plates increases the fusion rate and stability and indirectly leads to adjacent vertebral degeneration and postoperative dysphagia.In this paper,the clinical results and complications of ROI-CTM self-locking system and traditional cage combined with screw-plate internal fixation in the treatment of degenerative cervical spondylosis were compared by meta-analysis to provide evidence-based support for the selection of internal fixation methods in anterior cervical decompression and fusion. METHODS:CNKI,WanFang,VIP,PubMed,Cochrane Library,Web of Science,and Embase databases were searched for Chinese and English literature on the application of ROI-CTM self-locking system and fusion cage combined with screw plate internal fixation in the treatment of degenerative cervical spondylosis.The retrieval time range was from inception to July 2023.Two researchers selected the literature strictly according to the inclusion and exclusion criteria.The Cochrane bias risk tool was used to evaluate the quality of randomized controlled trials.Newcastle-Ottawa Scale was used to assess the quality of cohort studies.Meta-analysis was performed using RevMan 5.4 software.Outcome indicators included operation time,intraoperative blood loss,Japanese Orthopaedic Association score,Neck Disability Index,C2-C7 Cobb angle,fusion rate,incidence of adjacent vertebral degeneration,cage subsidence rate,and incidence of dysphagia. RESULTS:Thirteen articles were included,including eleven retrospective cohort studies and two randomized controlled trials,with 1 136 patients,569 in the ROI-C group,and 567 in the cage combined with the nail plate group.Meta-analysis results showed that the operation time(MD=-15.52,95%CI:-18.62 to-12.42,P<0.000 01)and intraoperative blood loss(MD=-24.53,95%CI:-32.46 to-16.61,P<0.000 01)in the ROI-C group and the fusion device combined with nail plate group.Postoperative adjacent segment degeneration rate(RR=0.40,95%CI:0.27-0.60,P<0.000 01)and postoperative total dysphagia rate(RR=0.18,95%CI:0.13-0.26),P<0.000 01)were statistically different.The two groups had no significant difference in Japanese Orthopaedic Association score,Neck Disability Index,C2-C7 Cobb angle,fusion rate,or cage subsidence rate(P≥0.05). CONCLUSION:Applying an ROI-CTM self-locking system and traditional cage combined with plate internal fixation in anterior cervical decompression and fusion can achieve satisfactory clinical results in treating degenerative cervical spondylosis.The operation of the ROI-CTM self-locking system is more straightforward.Compared with a cage combined with plate internal fixation,the ROI-CTM self-locking system can significantly reduce the operation time and intraoperative blood loss and has obvious advantages in reducing the incidence of postoperative dysphagia and adjacent segment degeneration.The ROI-CTM self-locking system is recommended for patients with skip cervical spondylosis and adjacent vertebral disease.However,given its possible high settlement rate,using a fusion cage combined with screw-plate internal fixation is still recommended for patients with degenerative cervical spondylosis with multiple segments and high-risk factors of fusion cage settlement,such as osteoporosis and vertebral endplate damage.