ObjectiveTo systematically explore the current practical status, core predicaments, and optimization paths of effective contract fulfillment by family doctors in Shanghai from the perspective of informatization, and to provide empirical support and policy references for the high-quality development of contracted services. MethodsA mixed research approach was adopted. The connotation of effective contract fulfillment, the current status of informatization support, and the priority of demand were comprehensively analyzed through policy document review, in-depth interviews with key informants, and a questionnaire survey covering 45 community health service centers across all 16 districts of Shanghai. ResultsThe family doctor contract service in Shanghai has formed a dual-core framework of “accurate contracting” and “substantive service delivery”, yet challenges persist in system interoperability, health data integration, and the limited diversity of service outreach tools. The comprehensive utilization rate of the information integration terminal in the 45 surveyed community health service centers was merely 50.74%. Three prioritized demands were identified: horizontal connectivity between the Hospital Information System (HIS) and the public health system for contract status updates, integration of “medical-prevention-management” information, and automated generation of health assessments. Based on these findings, this study proposed a closed-loop fulfillment pathway of “tag generation-task management-service delivery-data return”. ConclusionTo facilitate the high-quality development of contracted services, it is recommended to transform the concept of contracted services and promote the integration of medical care and disease prevention through information system construction from a holistic perspective. Concurrently, municipal top-level design and district-level platform development should be reinforced to refine data governance and application. Furthermore, substantial efforts should be devoted to cultivating interdisciplinary talents bridging clinical practice and information technology, thus strengthening the convergence of clinical and information operations.

Objective:To compare the efficacy and safety of Rotarex mechanical thrombectomy (Rotarex) combined with drug-coated balloon (DCB) versus percutaneous transluminal angioplasty (PTA) combined with DCB in the treatment of femoropopliteal artery in-stent restenosis (ISR).Methods:A multicenter, prospective, randomized controlled trial was conducted. 46 patients with femoropopliteal artery ISR admitted to five hospitals (Beijing Friendship Hospital, Capital Medical University; Beijing Chaoyang Hospital, Capital Medical University; Beijing Jishuitan Hospital, Capital Medical University; Xuanwu Hospital, Capital Medical University; Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University) from July 2020 to June 2024 were enrolled. Patients were randomly divided into the Rotarex+ DCB group ( n=24) and the PTA+ DCB group ( n=22) using a random number table. The clinical data of the two groups were collected, including clinical characteristics, Fontaine classification, stent placement location, stent duration, and lesion length. The primary endpoint was the target blood vessel patency rate at 6 and 12 months postoperatively; the secondary endpoints included improvement in clinical symptoms (Fontaine classification), rate of reintervention, and safety indicators. Measurement data were expressed as mean±standard deviation ( ± s), and the t-test was used for comparison between groups; count data were expressed as the number of cases and percentages, and intergroup comparisons were performed using the Chi-test or Fisher exact probability method. Results:At 12 months postoperatively, the target blood vessel patency rate in the Rotarex+ DCB group was significantly higher than that in the PTA+ DCB group (81.8% vs 45.5%, P=0.012), and the proportion of patients in Fontaine classification stage I was also higher (86.4% vs 45.5%, P=0.004). The results at the 6-month follow-up were consistent (target blood vessel patency rate: 87.0% vs 59.1%, P=0.035). In terms of safety, no severe complications such as arterial rupture, amputation, or procedure-related death occurred during the perioperative period in either group. During the postoperative follow-up, no amputation or procedure-related deaths occurred in either group. Conclusion:For the treatment of femoropopliteal artery ISR, Rotarex mechanical thrombectomy combined with DCB is significantly superior to PTA+ DCB in terms of 12-month target blood vessel patency rate and improvement of clinical symptoms, with comparable safety.

Military training represents one of the most essential activities for troops during peacetime,of which the prevention and treatment of training-induced injuries are a very important part.Recent findings of research suggest that cold atmospheric plasma(CAP)exhibits a distinctive and multifaceted superiority in terms of broad-spectrum sterilization,rapid blood coagulation and healing promotion for wounds.Consequently,CAP has good prospects of applications in diverse fields such as clinical medicine,emergency rescue and military medicine.Based on a review of the research progress in plasma medicine,the applicability of CAP in the prevention and treatment of military training injuries was discussed in this paper by focusing on the urgent issues related to military training injury,including the typical application scenarios and methods for CAP,the safety and effectiveness of plasma trauma prevention and treatment,and the key issues facing the prevention and treatment of military training injuries.

Objective To assess the prognostic significance of the Controlling Nutritional Status (CONUT) score in patients with non-small cell lung cancer (NSCLC) and its association with clinicopathological characteristics. Methods The relevant studies investigating the association between CONUT score and prognosis of NSCLC patients were systematically searched in the PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang Database and other databases from their inception to July 2023. Two independent researchers screened the references according to predefined inclusion and exclusion criteria, extracted data and conducted quality assessment. The quality of included references was evaluated using New Castle-Ottawa Scale (NOS). The meta-analysis was performed using Stata 17.0 software, and a combined hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association of CONUT score with prognosis and clinicopathological characteristics in NSCLC patients. Results A total of 17 cohort studies, comprising 5182 NSCLC patients with stage Ⅰ-Ⅳ, were included in this analysis. All studies had a NOS≥6 points. The meta-analysis showed that there was a significant correlation between CONUT score and overall survival (OS) as well as disease-free survival (DFS) among NSCLC patients: the higher the score, the shorter the OS [HR=1.87, 95%CI (1.58, 2.21), P<0.001] and DFS [HR=1.91, 95%CI (1.63, 2.24), P<0.001]. These differences were statistically significant. Furthermore, CONUT score was significantly associated with age, smoking status, tumor stage, and N stage (P<0.05). Conclusion A higher CONUT score is associated with a poorer OS and DFS in patients with NSCLC, and CONUT score can be used as a potential predictor of NSCLC prognosis.

Objective To investigate the effect of Haematococcus pluvialis(HP)on bleomycin(BLM)-induced pulmonary fibrosis in mice and on TGF-β1-induced human fetal lung fibroblasts(HFL1).Methods Thirty male C57BL/6 mice were randomly divided into control group,BLM-induced pulmonary fibrosis model group,low-and high-dose HP treatment groups(3 and 21 mg/kg,respectively),and 300 mg/kg pirfenidone(positive control)group.The effects of drug treatment for 21 days were assessed by examining respiratory function,lung histopathology,and expression of fibrosis markers in the lung tissues of the mouse models.In TGF-β1-induced HFL1 cell cultures,the effects of treatment with 120,180 and 240 μg/mL HP or 1.85 μg/mL pirfenidone for 48 h on expression levels of fibrosis markers were evaluated.Transcriptome analysis was carried out using the control cells and cells treated with TGF-β1 and 240 μg/mL HP.Results HP obviously alleviated BLM-induced lung function damage and fibrotic changes in mice,evidenced by improved respiratory function,lung tissue morphology and structure,inflammatory infiltration,and collagen deposition and reduced expressions of fibrotic proteins.HP at the high dose produced similar effect to PFD.In TGF-β1-induced HFL1 cells,treatment with 240 μg/mL HP significantly reduced the mRNA and protein expression levels of α-SMA and FN.Transcriptome analysis revealed that multiple key genes and pathways mediated the protective effect of HP against pulmonary fibrosis.Conclusion HP alleviates pulmonary fibrosis in both the mouse model and cell model,possibly as the result of the synergistic effects of its multiple active components.

Objective:To explore the factors influencing the recovery of swallowing function after a brainstem hemorrhage and to construct a prediction model.Methods:Clinical data on 134 persons with dysphagia after a brainstem hemorrhage were collected retrospectively. According to their swallowing ability at discharge, the patients were divided into a swallowing recovery group and a non-recovery group. Univariate correlation analysis and multivariate logistic regression analysis were used to explore the independent factors influencing the recovery of swallowing function and to construct a prediction nomogram. The receiver operating characteristics (ROC) curves were evaluated to analyze the nomogram′s predictive value and those of the relevant influencing factors.Results:Sixty-two of the patients (46%) had recovered their swallowing function at discharge, while 72 (54%) had not. Univariate correlation analysis showed that there had been significant differences in tracheal intubation, NIHSS score, FOIS score, Barthel index and Glasgow coma scale (GCS )score between the two groups, on average. The multivariate logistic regressions showed that a low NIHSS score, a high FOIS score and a high GCS score were independent predictors of swallowing function recovery, so they were used in the prediction model. ROC curve analysis showed that the area under the curve (AUC) of the prediction model was 0.953 (95% CI: 0.902~0.982) with a sensitivity of 87% and a specificity of 93%. The model′s predictions were thus better than using an NIHSS score, GCS score or FOIS score alone. Conclusions:NIHSS score, GCS score and FOIS score can independently predict the recovery of swallowing function after a brainstem hemorrhage. A prediction model constructed using all three has good predictive power.

Objective:To explore the risk factors for malnutrition after a traumatic brain injury and to construct a model which usefully predicts that risk.Methods:This was a retrospective study of 374 patients with a craniocerebral injury for whom the relevant clinical data were available. Based on their nutritional status, they were stratified into a malnutrition group ( n=220) and a control group ( n=154). Univariate and multivariate logistic regressions were evaluated seeking to identify the independent risk factors associated with malnutrition, and a prediction model was constructed based on the results. The model′s discrimination ability and accuracy were assessed using a receiver operating characteristics (ROC) curve. Results:A total of 220 patients (58.8%) developed malnutrition. Multifactorial logistic regression analysis showed that the independent risk factors for malnutrition were: age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8, or a Barthel index ≤40. In the ROC curve analysis, the area under the curve quantifying the model′s ability to predict malnutrition was 0.924 (95% CI: 0.896, 0.951), with a sensitivity of 0.868 and a specificity of 0.857, indicating its good prediction performance. Conclusions:Age ≥60 years, pulmonary infection, dysphagia, cognitive impairment, a GCS score ≤8 or a Barthel index ≤40 are independent predictors of malnutrition after a traumatic brain injury. The prediction model constructed based on those risk factors has demonstrated useful predictive power for malnutrition.

Objective To evaluate the status of latent tuberculosis infection(LTBI)with Mycobacterium tubercu-losis and the risk of LTBI activation after glucocorticoid therapy in patients with anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Methods Clinical data of AAV patients who visited Xiangya Hospital of Central South University from May 2018 to May 2023 were retrospectively analyzed.According to the results of in-terferon-γ release assay(IGRA),they were divided into a LTBI group and a non-LTBI group.The LTBI group was subdivided into an active TB group(ATB group)and a non-ATB group according to the presence of ATB.General conditions and biochemical indicator characteristics of the two groups were compared.The COX regression model was used to analyze the risk factors for LTBI activation in AAV patients.Results A total of 302 AAV patients were included in this study,with an age of 64.0(53.0,71.0)years old,169 male cases(55.96％),and an IGRA positive rate of 24.17％(n=73).The proportion of patients with renal insufficiency in the LTBI group was higher than that in the non-LTBI group(79.45％vs 60.70％),with statistically significant difference(P＜0.05).In the LTBI group,the age of patients was 62.0(53.5,72.0)years old,44 cases were male(60.27％),out of which 11 cases(15.07％)had ATB.In the non-LTBI group,4 male cases(1.75％)had ATB.In the LTBI group,there were statistically significant differences between the ATB group and the non-ATB group in terms of daily average glucocorticoid levels,age,renal dysfunction,neutrophils,and blood creatinine(all P＜0.05).COX univariate re-gression analysis showed that statistically significant differences existed among the groups in terms of daily average glucocorticoid levels,daily average glucocorticoid levels＞11.75 mg/day,age,age＞65 years old,and blood crea-tinine levels ≥150 μmol/L(all P＜0.05).COX multivariate regression analysis showed that daily average glucocor-ticoid levels＞11.75 mg/day(OR=0.14,95％CI:1.30-79.01)and age＞65 years(OR=0.08,95％CI:0.01-0.85)were independent influencing factors for LTBI activation.Conclusion AAV patients have a high rate of LT-BI,and daily average glucocorticoid levels＞11.75 mg/day is an independent risk factor for LTBI activation in AAV patients.Age＞65 years may benefit from receiving lower doses of immunosuppressive therapy,but it is necessary to expand sample size for further study.

Objective:To explore the current situation and influencing factors of anxiety before early orthodontic treatment for malocclusion in school-age children.Methods:Convenience sampling was used to select 124 school-aged children who underwent early orthodontic treatment for malocclusion at the Hospital of Stomatology, Wenzhou Medical University from October 2023 to October 2024 as study subjects. The Chinese Version of the Modified Yale Preoperative Anxiety Scale (Cm-YPAS) was used to assess pre-treatment anxiety in pediatric patients, while the Self-Rating Anxiety Scale was employed to evaluate parental anxiety, and patient general information was collected. Logistic regression analysis was employed to investigate factors influencing anxiety before early orthodontic treatment in school-age children.Results:The Cm-YPAS scores for 124 school-aged children undergoing early orthodontic treatment were (45.76±7.42), with a pre-treatment anxiety incidence of 54.84% (68/124). Logistic regression analysis showed that age, oral treatment experience, educational background, and parental anxiety score were the influencing factors of anxiety before early orthodontic treatment in school-age children ( P<0.05) . Conclusions:The incidence of pre-treatment anxiety is relatively high among school-age children undergoing early orthodontic treatment. Appropriate nursing interventions should be implemented based on influencing factors to alleviate the pre-treatment anxiety of children.

Objective:To study the correlations of neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)with arte-riovenous fistula(AVF)stenosis in hemodialysis(HD)patients.Methods:Data were collected from 625 patients who underwent arterio-venous fistula hemodialysis at the Department of Nephrology,Affiliated Hospital of North Sichuan Medical College between January 2021 and June 2022.Of these,395 eligible patients with complete information were selected as subjects of study.The 245 patients with AVF stenosis were designated as group 1 and the 150 patients with-out AVF stenosis were designated as group 2.The routine biochemi-cal parameters and complete blood count were recorded for all pa-tients.Results:①Compared with patients in group 2,those in group 1 showed significantly higher NLR(5.07(4.00,6.66)vs.3.46(2.63,4.15),P<0.001),PLR(169.52(127.56,227.11)vs.125.66(89.31,165.31),P<0.001),and C-reactive protein(Hs-CRP)(1.90(0.80,2.99)vs.0.82(0.42,1.27),P<0.001).②Multivariate logistic regression analysis,which was corrected for age,sex,body mass index,AVF anastomosis,puncture method,and diabetes,showed that NLR(OR=2.195,95%CI=1.674～2.878,P<0.001),PLR(OR=1.008,95%CI=1.002～1.012,P=0.007),and Hs-CRP(OR=2.170,95%CI=1.607～2.751,P<0.001)were independent risk factors for AVF ste-nosis in HD patients.③Receiver operating characteristic curve analysis showed that the area under the NLR curve(0.799,95%CI=0.756～0.838,P<0.001),PLR(0.694,95%CI=0.646～0.740,P<0.001),and Hs-CRP(0.717,95%CI=0.670～0.761,P<0.001)could be used to predict AVF stenosis.Their optimal critical values for prediction were 4.08,122.49,and 1.62,respectively.Their combina-tion showed improved prediction effect(AUC 0.870,95%CI=0.833～0.901,P<0.001),high sensitivity(79.18%),and high specificity(81.33%).Conclusion:NLR,PLR,and Hs-CRP were independent risk factors and predictors of AVF stenosis,and their combination has higher predictive value.