Objective:To assess the consistency of ultrasound and dual-energy computed tomography (DECT) in the diagnosis of gouty arthritis(GA), reasons of the differences were further analyzed.Methods:The ultrasound and DECT images of 150 knee joints from 147 patients diagnosed with gout at the Gout Specialty Clinic of Qingdao University Affiliated Hospital from February 2022 to October 2023 were retrospectively analyzed. According to anatomy, the knee joint was anatomically segmented into five regions: intra-articular, anterior, posterior, medial, and lateral.Location of monosodium urate (MSU) deposition was meticulously recorded. The Kappa consistency test was employed to assess the consistency of the two examination results in different regions of the knee joint. The McNemar chi-square test was utilized to conduct a differential analysis between DECT and ultrasound results.Results:Double contour sign(DCS) (81.2%, 92/112) was the most common intra-articular ultrasound sign in knee joints with GA. In the extra-articular region, MSU was commonly deposited in and around the popliteal tendon (ultrasound: 51.6%, 66/128; DECT: 54.7%, 70/128). Corresponding MSU deposits on DECT were found in 9 of 92 joints with DCS and in 9 of 49 joints with aggregates detected on ultrasound.In the assessment of MSU deposits, ultrasound showed an overall higher positive rate than DECT (87.3% vs. 72.3%, P=0.001), with poor consistency between the two examinations (Kappa=0.153). In distinct anatomical regions, ultrasound and DECT showed high consistency in the medial (Kappa=0.697) and lateral (Kappa=0.718) sides and the difference was not statistically significant ( P>0.05). Intra-articular (Kappa=0.289) and anterior (Kappa=0.303) regions exhibited only fair consistency, with statistically significant diagnostic differences ( P<0.05). When exclusively assessing cases with tophus, ultrasound and DECT demonstrated high consistency in the medial and lateral aspects(Kappa=0.685, 0.748) without statistical difference ( P>0.05). In the anterior region, the consistency between the two examinations was moderate (Kappa=0.256), while in the intra-articular region, the consistency of the two methods was lower (Kappa=0.147), and the differences was statistically significant ( P<0.001). Conclusions:Both ultrasound and DECT exhibit good diagnostic capabilities for gouty knee arthritis.However, the consistency between the two techniques varies in different anatomical locations. Clinical assessment should be tailored based on the specific anatomical position. DECT has an advantage in evaluating intra-articular MSU deposits, while ultrasound is more sensitive to detect early and scattered MSU deposits.

Objective:To assess the discriminatory value of the Thyroid Follicular Tumor Ultrasound Risk Stratification System (F-TIRADS) in differentiating follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and to compare its performance with other risk stratification systems(RSS).Methods:A retrospective analysis was conducted on 325 patients (327 thyroid nodules) diagnosed postoperatively as FTC or FTA at Affiliated Hospital of Qingdao University from January 2016 to December 2023. The cases were divided into FTC group (81 nodules) and FTA group (246 nodules). The nodules were classified based on F-TIRADS, the 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS), the 2015 American Thyroid Association guidelines (ATA guidelines), and the 2017 European Thyroid Association Thyroid Imaging Reporting and Data System (EU-TIRADS) by two ultrasound physicians. Multivariate Logistic regression analysis was used to identify independent predictors associated with FTC. Diagnostic performance of the 4 RSS was compared using postoperative pathological results as the gold standard.Results:Multivariate Logistic regression analysis showed maximum diameter, solid composition, hypoechogenicity, unclear or angular margins, marginal or ring calcifications, trabecular structure, and central blood flow were independent predictors of FTC( OR=1.914, 3.427, 9.926, 9.163, 45.918, 3.191, 8.936, respectively; all P<0.05). Within each RSS, the actual malignancy rate increased with higher risk categories, aligning closely with the recommended malignancy rates (except for ATA guidelines). The optimal cut-off values for distinguishing FTC from FTA were FTC risk 50%-90% in F-TIRADS, C-TIRADS 4B, moderately suspicious nodules in ATA guidelines, and EU-TIRADS 4, with areas under the curve of 0.916, 0.808, 0.827, and 0.836, respectively. F-TIRADS demonstrated the best overall performance (sensitivity: 82.72%, specificity: 82.93%), with significant differences compared with C-TIRADS, ATA guidelines, and EU-TIRADS (all P<0.05). Conclusions:F-TIRADS is highly effective in distinguishing FTA from FTC, outperforming C-TIRADS, ATA Guidelines, and EU-TIRADS. Clinicians should pay close attention to solid hypoechoic nodules with unclear or angular margins, marginal or ring calcifications, central blood flow, or a trabecular structure.

Objective To investigate the potential mechanism of Jianpi Shenshi Formula for the treatment of hyperuricemia(HUA)by using network pharmacology and molecular docking techniques.Methods The active ingredients of Jianpi Shenshi Formula were searched and screened by combining TCMSP,BATMAN,and TCM-ID database with literature,and then SwissTargetPrediction was used to obtain the corresponding targets of the ingredients.Cytoscape 3.8.0 was used to construct a"drug-ingredients"network to analyze and obtain the main active ingredients of Jianpi Shenshi Formula.The GeneCards,OMIM,and disgenet databases were used to obtain the relevant targets of hyperuricemia.The intersection targets of Jianpi Shenshi Formula and hyperuricemia were imported into the STRING database for protein-protein interaction(PPI)network analysis,and hub targets for network were screened by CytoHubba plug-in.Meanwhile,the GO function and KEGG pathway enrichment analysis of the intersection targets were carried out using R4.2.2 software.Molecular docking of hub targets and key ingredients was performed using CB-DOCK 2.Results A total of 90 active ingredients of Jianpi Shenshi Formula were screened,among which quercetin,kaempferol,luteolin,stigmasterol,and ethyl linoleate were the main active ingredients,and 837 targets corresponding to the ingredients were obtained,with a total of 64 intersecting targets.CASP3,IL1B,IL6,PPARG,SIRT1,MAPK3,TNF,STAT3,TGFβ1,PTGS2,and XDH were the hub targets.The potential targets of action are mainly enriched in signaling pathways such as inflammation,metabolism,environment,cellular processes,biological systems,and hyperuricemia-related pathways.Conclusion Jianpi Shenshi Formula may exert effects on inhibition of uric acid production,and/or enhancement of uric acid excretion,anti-inflammation,and amelioration of related complications through the modulation of hyperuricemia-related signaling pathways(including neoplastic,infectious,metabolic,and cardiovascular diseases),as well as metabolic,immune,inflammatory,and other biological pathways by a variety of active ingredients such as quercetin,kaempferol,luteolin,stigmasterol,and ethyl linoleate.

Objective To explore the potential categories of self-regulatory fatigue among maintenance hemodialysis patients and their relationships with self-management. Methods A total of 502 maintenance hemodialysis patients in Lanzhou were surveyed using a general information questionnaire, a Self-Regulatory Fatigue Scale, and a Self-Management Scale for Hemodialysis Patients. Potential profile analysis was conducted on self-regulatory fatigue, and its relationship with self-management was explored. Results Based on their self-regulatory fatigue status, maintenance hemodialysis patients could be categorized into four potential groups: low self-regulatory fatigue group (5.0%), moderate self-regulatory fatigue group (49.2%), high self-regulatory fatigue group (13.9%), and high cognitive regulatory fatiguegroup (31.9%). Gender, education level, and monthly per capita family income were identified as influencing factors for the potential categories of self-regulatory fatigue. Significant differences were observed in the total self-management scores among patients belonging to different potential categories of self-regulatory fatigue (F=50.617, P < 0.001). Conclusion Maintenance hemodialysis patients can be classified into four potential categories of self-regulatory fatigue, with patients in the low self-regulatory fatigue group demonstrating higher levels of self-management. Reducing the level of self-regulatory fatigue can contribute to enhancing patients'self-management capabilities.

OBJECTIVE To compare anti-ischemic stroke （IS） effect of different extraction parts from Gastrodia elata， and to provide reference for screening the anti-IS effective parts of G. elata. METHODS G. elata was extracted and separated by ethanol reflux extraction and ethyl acetate extraction. The rat model of diffuse cerebral thrombosis was induced by internal carotid artery injection of arachidonic acid （AA）； the anti-IS effect of G. elata powder， ethanol extract of G. elata， residue of ethanol extract of G. elata， ethyl acetate extract of G. elata， residue of ethyl acetate extract of G. elata， gastrodin and aspirin （positive control drug） were investigated with the content of Evans blue （EB） in the ischemic brain tissue as index. RESULTS Compared with model group， aspirin， ethanol extract of G. elata and ethyl acetate extract of G. elata could significantly decrease the content of EB in the ischemic brain tissue of model rats （P＜0.05）. G. elata powder had the tendency to reduce the content of EB in the ischemic brain tissue of model rats， without statistical significance （P＞0.05）. The residue of ethanol extract of G. elata， residue of ethyl acetate extract of G. elata and gastrodin had little effect on the content of EB in the ischemic brain tissue of model rats. CONCLUSIONS Both ethanol extract of G. elata and ethyl acetate extract of G. elata have anti-IS effects， which are stronger than that of G. elata powder.

【Objective:】 To compare and analyze the trends and hotspots in the field of medical ethics at home and abroad, and explore their teaching enlightenment for medical ethics in China. 【Methods:】 The relevant papers indexed in CNKI and Web of Science database from December 31, 2011 to December 31, 2022 were retrieved with "medical ethics" as the key word. The bibliometric method was used to compare and analyze the research trends, keyword co-occurrence, and changes of research hotspots of medical ethics at home and abroad. 【Results:】 A total of 1,187 Chinese and English papers were included. Medical ethics education and bioethics were the common research topics both domestically and internationally. The research topics in China focused on ethical teaching and the ethical principles in clinical practice, and the research hotspots in the past two years were curriculum ideological and political education, teaching practice, etc. Foreign research focused on ethical issues in clinical practice, and in the past two years, the hotspots were clinical trial ethics, informed consent, and so on. 【Conclusion:】 Medical ethics research at home and abroad has different emphasis, with domestic research being theoretical oriented and foreign research being practical oriented. By deepening the content of courses, improving the sustainable education system, and strengthening interdisciplinary cooperation, the development of ethical education in China can be promoted. This paper can provide reference for improving the education system of medical ethics in China and pointing out the direction of further research on medical ethics.

Objective To analyze the changing trend of disease burden attributable to renal insufficiency in cardiovascular disease (CVD) among the elderly in China from 1990 to 2019, and to forecast the disability-adjusted life years (DALY) in the next 10 years, so as to provide a reference basis for accurate prevention and control of CVD attributable to renal insufficiency in China. Methods Data were obtained from the Global Health Data Exchange (GHDx) database to describe the current status of CVD prevalence attributable to renal insufficiency. The joinpoint model was used to estimate the annual percentage change and average annual percentage change to assess the temporal trend of CVD attributable to renal insufficiency in China. An autoregressive moving average model was created by R4.0.2 software to predict the disease burden of CVD attributable to renal insufficiency in China. Results Compared with 1990, CVD mortality and DALY rates attributed to renal insufficiency increased in the male elderly population and decreased in women. Mortality and DALY rates attributed to ischemic heart disease, ischemic stroke, and peripheral arterial disease attributed to renal insufficiency showed an increasing trend, and mortality and DALY rates for cerebral hemorrhage decreased. There was an overall increasing trend in the attribution of CVD due to renal insufficiency. Conclusion The burden of diseases attributable to renal insufficiency in Chinese elderly with CVD is relatively high, and the impact on each disease is different, which requires the attention of relevant authorities.

Objective:To investigate the detection of suspected occupational diseases in the occupational health examination population in Hangzhou, and to establish a two-level logistic model of influencing factors.Methods:In October 2018, the information of physical examinees was collected through the 2015-2017 occupational health examination and reexamination database of Hangzhou Hospital for the Prevention and Treatment of Occupational Disease. MlwiN 2.02 software was used to establish a 2-level logistic model of suspected occupational diseases, with the occupational hazard factors as the level 2 unit and the employees as the level 1 unit. χ 2 test was used to compare the detection rates of suspected occupational diseases with different characteristics. The trend of detection rates of suspected occupational diseases with age and working age were tested by Cochran-Armitage trend test. Results:The morbidity rate of suspected occupational diseases in 2965 workers was 59.6% (1767/2965) , and the rates caused by different occupational hazardous factors were significantly difference (χ 2=1615.27, P<0.01) , that caused by noises was the highest (98.0%, 1206/1231) , and the next was the dust (87.5%, 70/80) . The rate in male was 61.5% (1532/2492) , and that in female was 49.7% (235/473) , they were significantly difference (χ 2=22.96, P<0.01) . The rates of suspected occupational diseases increased with the ages ( Z=8.77, P<0.01) and working years ( Z=3.62, P<0.01) . The multivariate analysis by 2-level logistic model indicated that gender, age and working year were all no significant, instead the level 2 unit random effect was significant (χ 2=4.77, P<0.05) . Conclusion:Suspected occupational diseases will occur in clusters in occupational hazardous factors. The influence of occupational hazardous factors on suspected occupational diseases was more than that of personal characteristics.

Objective:To investigate the detection of suspected occupational diseases in the occupational health examination population in Hangzhou, and to establish a two-level logistic model of influencing factors.Methods:In October 2018, the information of physical examinees was collected through the 2015-2017 occupational health examination and reexamination database of Hangzhou Hospital for the Prevention and Treatment of Occupational Disease. MlwiN 2.02 software was used to establish a 2-level logistic model of suspected occupational diseases, with the occupational hazard factors as the level 2 unit and the employees as the level 1 unit. χ 2 test was used to compare the detection rates of suspected occupational diseases with different characteristics. The trend of detection rates of suspected occupational diseases with age and working age were tested by Cochran-Armitage trend test. Results:The morbidity rate of suspected occupational diseases in 2965 workers was 59.6% (1767/2965) , and the rates caused by different occupational hazardous factors were significantly difference (χ 2=1615.27, P<0.01) , that caused by noises was the highest (98.0%, 1206/1231) , and the next was the dust (87.5%, 70/80) . The rate in male was 61.5% (1532/2492) , and that in female was 49.7% (235/473) , they were significantly difference (χ 2=22.96, P<0.01) . The rates of suspected occupational diseases increased with the ages ( Z=8.77, P<0.01) and working years ( Z=3.62, P<0.01) . The multivariate analysis by 2-level logistic model indicated that gender, age and working year were all no significant, instead the level 2 unit random effect was significant (χ 2=4.77, P<0.05) . Conclusion:Suspected occupational diseases will occur in clusters in occupational hazardous factors. The influence of occupational hazardous factors on suspected occupational diseases was more than that of personal characteristics.

Objective: To establish and implement a smartphone-based school syndromic surveillance system, and to provide references for school communicable disease control and prevention. Methods: A smartphone-based school syndromic surveillance system was constructed and applied. A list of seven symptoms including fever, cough, vomit, diarrhea, rash, red eye and parotid swelling was classified as targeted indicators. Spatio-temporal permutation scanning was applied to automatic early warning. Results: A total of 1 973 school joined the syndromic surveillance system. System usage rate was 54.13%, no significant differences were found among different types of schools(χ2=1.58, P=0.67), whereas significant differences were observed among counties（χ2=726.78, P<0.01). Totally, 852 036 pieces of symptoms data were reported during September 2018 to March 2019, the primary symptoms included cough (35.17%) and fever (21.11%). Time trends in different symptoms varied with time, with fever and cough highest in January, vomit and diarrhea in November. Thirteen pieces of early warning were confirmed as school communicable diseases by field investigation, the average number of the infected students were four. Conclusion The smartphone-based school syndromic surveillance system is generally acceptable. Characteristic seasonal distributions of school communicable diseases are reflected accurately by surveillance system which plays an active role in prevention and control of school communicable diseases.