Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective To establish a forensic age inference method based on age-related changes in maxillofacial CBCT imaging of Han population in North China.Methods CBCT imaging data of Han people aged 7～50 years were collected from September 2021 to September 2023.Mimics 17.0 software was used to perform 3D reconstruction on 480 cases that met the inclusion criteria(420 cases in the experimental group,60 cases in the blind test group,with a 50%male-to-female ratio)and obtain measured values for 16 indicators.The data were then statistically analyzed using SPSS 27.0 to identify age-related significant indicators and establish regression equations.Results Regression equations based on age-related significant indicators were established for different genders and age intervals.The accuracy of the equations decreased as the age interval increased.The blind test accuracy rates of regression equations for males across different age groups ranged between 62.6%and 80.6%,while for females,they ranged between 55.3%and 76.6%.Conclusion This study enriches maxillofacial skeletal data for Chinese population and establishes multivariate age inference regression equations based on significant indicators of age-related changes in maxillofacial CBCT,providing a new reference basis and inference method for forensic age assessment.

Objective To establish a forensic age inference method based on age-related changes in maxillofacial CBCT imaging of Han population in North China.Methods CBCT imaging data of Han people aged 7～50 years were collected from September 2021 to September 2023.Mimics 17.0 software was used to perform 3D reconstruction on 480 cases that met the inclusion criteria(420 cases in the experimental group,60 cases in the blind test group,with a 50%male-to-female ratio)and obtain measured values for 16 indicators.The data were then statistically analyzed using SPSS 27.0 to identify age-related significant indicators and establish regression equations.Results Regression equations based on age-related significant indicators were established for different genders and age intervals.The accuracy of the equations decreased as the age interval increased.The blind test accuracy rates of regression equations for males across different age groups ranged between 62.6%and 80.6%,while for females,they ranged between 55.3%and 76.6%.Conclusion This study enriches maxillofacial skeletal data for Chinese population and establishes multivariate age inference regression equations based on significant indicators of age-related changes in maxillofacial CBCT,providing a new reference basis and inference method for forensic age assessment.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Forensic medicine is the key force in crime scene investigations and identifications.It is also the traditional technique with the most personnel and the widest coverage of applications in criminalistics.Virtual autopsy is an innovative method of postmortem examination with high level scientific technology,high examining efficiency,and high digital value.Its unique advantages of non-invasiveness,digitalization,and reproducibility help to change the public's traditional concept of forensic autopsy.It can also improve the scientific and accuracy in identification of causes of death,help to accumulate data resources,and connect with the development of big data strategies and artificial intelligence in public security.Under the tide of developing new quality productive forces,forensic practitioners should focus on the opportunity of researches and practices on virtual autopsy.As a new quality identifying technology,virtual autopsy will strength the public security by fulfilling forensic mission and expanding medical-legal applications.

Forensic medicine is the key force in crime scene investigations and identifications.It is also the traditional technique with the most personnel and the widest coverage of applications in criminalistics.Virtual autopsy is an innovative method of postmortem examination with high level scientific technology,high examining efficiency,and high digital value.Its unique advantages of non-invasiveness,digitalization,and reproducibility help to change the public's traditional concept of forensic autopsy.It can also improve the scientific and accuracy in identification of causes of death,help to accumulate data resources,and connect with the development of big data strategies and artificial intelligence in public security.Under the tide of developing new quality productive forces,forensic practitioners should focus on the opportunity of researches and practices on virtual autopsy.As a new quality identifying technology,virtual autopsy will strength the public security by fulfilling forensic mission and expanding medical-legal applications.

Objective:To investigate the pathological characteristics, treatment timing, and prognosis of de Winter syndrome.Methods:Six patients with de Winter syndrome who received treatment in the Department of Cardiovascular Medicine, The First People's Hospital of Tianmen from July 2017 to September 2020 were included in this study. The clinical risk factors, characteristics of coronary artery lesions, electrocardiogram evolution, echocardiography, high-sensitivity troponin, and brain natriuretic peptide were evaluated. All patients were followed up for 12 months after discharge.Results:Among the six patients included, four patients underwent coronary angiography and percutaneous coronary intervention. Coronary angiography results showed that anterior descending artery lesions occurred in all patients, consisting of occlusion of the anterior descending artery in three patients and severe stenosis of the anterior descending artery in one patient. After surgery, TIMI3 blood flow recovered in all patients. Electrocardiogram showed anterior wall ST segment elevation in five patients, and anterior wall and inferior wall ST segment elevation in one patient. One patient refused to undergo coronary angiography and was discharged after conservative management with drugs. de Winter syndrome was not identified in time in one patient. The patient died after being admitted to the hospital through routine procedures. Five recovered patients were followed up for 12 months, consisting of one patient who was re-admitted because of heart failure, and four patients in whom no adverse events occurred.Conclusion:Identification of electrocardiogram manifestations of de Winter syndrome and implementation of coronary angiography and percutaneous coronary intervention as early as possible can substantially reduce mortality rate and improve long-term prognosis.

Objective: To investigate the forecasting value of serum fibroblast growth factor 23(FGF23) for major adverse cardiovascular adverse events (MACE) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Methods: One hundred and five patients with ACS who underwent PCI in the First People′s Hospital of Tianmen City from June 2017 to June 2019 were enrolled. According to the happening of a MACE event occurs, the patients were divided into the MACE group (32 cases) and the non-MACE group (32 cases). The differences of general data, ultrasound indicators and biochemical indicators of patients between the two groups were compared. Logistic regression analysis was used to analyze independent risk factors for MACE after PCI in patients with ACS. Receiver operating characteristic (ROC) curve analysis was used to predict the predictive value of postoperative MACE in patients with ACS. Results: There were no significant difference in the comparison of general data such as age and gender between the two groups (P>0.05). The Global Registered Risk of Acute Coronary Events (GRACE) score in the MACE group was significantly higher than that in the non-MACE group [(119.18 ± 11.49) scores vs. (111.57 ± 9.31) scores, P<0.05]. Compared with the non-MACE group, the left ventricular end diastolic diameter (LVEDD), brain natriuretic peptide (BNP), C-reactive (CRP), and FGF23 in the MACE group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased [(52.04 ± 3.43) mm vs. (48.57 ± 3.69) mm, (509.48 ± 52.08) ng/L vs. (474.68 ± 89.27) ng/L, (9.61 ± 2.06) mg/L vs. (7.85 ± 0.83) mg/L, (504.73 ± 82.27) ng/L vs. (331.99 ± 81.68) ng/L, (34.77 ± 2.93)% vs. (37.80 ± 3.62)%] (P<0.05). Logistic multivariate regression analysis showed that LVEF, CRP, and FGF23 were independent risk factors for MACE after PCI in patients with ACS (P<0.05). ROC curve analysis showed that AUC of LVEF that predicted for MACE after PCI in patients with ACS was 0.747,and AUC of CRP and FGF23 were 0.772 and 0.944. The AUC of FGF23 was significantly higher than that of LVEF and CRP (Z = 3.867, 2.698, P<0.05). Conclusions Abnormal elevation of serum FGF23 is associated with cardiovascular adverse events after PCI in patients with ACS, which can be used as a serum indicator for early assessment of poor cardiovascular outcomes in patients.

Objective:To investigate the correlation between the plasma trimethylamine oxide (TMAO) level and the disease severity in patients with acute coronary syndrome (ACS).Methods:The clinical data of 200 patients with ACS (ACS group) and 90 chest discomfort patients without obvious coronary artery disease (control group) in Department of Cardiology Medicine, the First People′s Hospital of Tianmen City, Hubei Province, from June 2018 to June 2019 were retrospectively analyzed. The plasma TMAO level were detected by high performance liquid chromatography tandem spectroscopy with stable isotope dilution. Left ventricular ejection fraction (LVEF), left ventricle diameter (LAD), left ventricular posterior wall end-systolic thickness (PWS) and left ventricular posterior wall end-diastolic thickness (LVPWT) were examined by color ultrasound. The diagnostic value of plasma TMAO for ACS was analyzed by receiver operating characteristic (ROC) curve. Correlation was analyzed by Pearson correlation analysis.Results:The TMAO, LAD, PWS and LVPWT in ACS group were significantly higher than those in control group: (6.33 ± 1.31) μmol/L vs. (3.75 ± 1.11) μmol/L, (39.63 ± 8.89) mm vs. (31.90 ± 8.79) mm, (12.88 ± 1.76) mm vs. (7.00 ± 1.27) mm and (13.45 ± 2.51) mm vs. (8.97 ± 2.00) mm, the LVEF was significantly lower than that in control group: (44.63 ± 10.00)% vs. (59.71 ± 11.58)%, and there were statistical differences ( P<0.01). ROC curve analysis result showed that when the optimal cutoff value of plasma TMAO was 4.83 μmol/L, the area under curve (AUC) was 0.942, and its sensitivity and specificity for diagnosing ACS were 87.50% and 88.89%; when the optimal cutoff value of plasma TMAO was 4.66 μmol/L, the AUC was 0.908, and its sensitivity and specificity of early diagnosis of ACS were 88.00% and 83.33%. The correlation analysis result showed that the plasma TMAO had negative correlation with LVEF in patients with ACS ( r=-0.715, P<0.01), and positive correlation with LAD, PWS and LVPWT ( r=0.715, 0.746 and 0.729; P<0.01). Conclusions:The plasma TMAO level in patients with ACS is significantly increased, which is related to the level of heart function. Plasma TMAO can be used as an indicator of early diagnosis and severity assessment of ACS.

Objective To preliminarily explore the feasibility of tree shrew as a new kind of animal model in research of amblyopia,to discuss the primary visual cortex plasticity mechanism of form deprivation in tree shrew,and to provide a theoretical basis for further understanding the mechanism of amblyopia formation and recovery.Methods Sixty 30-days old tree shrews were divided into five groups,12 in each group:the group A had the right eye sutured for 1 month;the group B had the right eye sutured for 2 months;the group C had the left eye sutured for 1 month and then opened and the righ eye was sutured for 1 month,in other words,the group C was performed by alternating suture;the tree shrews of control group 1(D1) were in the same age as the the group A,but fed in normal breedingenvironment;the tree shrews of control group 2(D2) were at the same age of groups B and C,but fed with a normal diet.Samples of the visual cortex were taken after the completion of modeling,and were processed to observe the histology and ultrastructure of the visual cortex,the neuron apoptosis,and the c-fos protein expression in the tree shrews of different groups.Results Damages to different degrees were found by histological and electron microscopic examination of the visual cortex in each experimental group,and they were more obvious in the group sutured for 2 months.TUNEL staining showed that there were no significant differences between the apoptosis in the experimental and control groups.The expression of c-fos mRNA and protein in the experimental groups was decreased,and it was the lowest in the group sutured for 2 months.There was a small increase in the c-fos expression after the alternate suture,and no significant difference of c-fos expression was found in the control groups.Conclusions Different degrees of deprivation amblyopia lead to different histopathological changes.There is a plasticity in the neurons affected by amblyopia.Tree shrew can be used as an ideal animal model for the studies of form deprivation amblyopia.