Objective To explore the effect of evening primrose oil(EPO)on aortic endothelial damage in rats with polycystic ovary syndrome(PCOS),using network pharmacology and in vivo experiments.Methods The potential targets of EPO for improving aortic endothelial injury in PCOS rats were predicted by network pharmacology,and the selected core targets and renin-angiotensin signaling(RAS)pathway were verified by experiments.Fifty-eight female SD rats were divided randomly into a blank group(n=10)and a modeling group(n=48).Rats in the blank group were fed a normal diet and rats in the modeling group received a high-fat diet for 8 weeks.The PCOS model was prepared at week 6 by administration of letrozole(1 mg/(kg·d))for 21 days.Blood was taken from the tail vein after modeling and serum was collected to detect hormone levels.The model rats were then divided randomly into four groups and treated with the corresponding drugs for 6 weeks.Blood,blood vessels,and ovaries were then collected.Tissue morphology was examined by hematoxylin and eosin staining and serum levels of luteinizing hormone(LH),testosterone(T),follicle-stimulating hormone(FSH),endothelin(ET-1),and tumor necrosis factor(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).Serum levels of nitric oxide(NO)were determined by spectrophotometry.Protein expression levels of core targets and RAS pathway-related factors were assessed by western blotting and immunohistochemistry.Results Twenty-five intersection targets of EPO and PCOS were identified by network pharmacological analysis.Kyoto encyclopedia of genes and genomes analysis showed that EPO improved vascular injury in PCOS rats via multiple pathways,including RAS.Serum levels of ET-1,FSH,LH,and T measured by ELISA were significantly decreased after EPO treatment,compared with the model group(P＜0.01).EPO significantly decreased the expression levels of Ang Ⅰ,VEGF-B,AT2R,ET-1,and TNF-α proteins in the aorta(P＜0.01)and significantly increased expression levels of Ang Ⅱ,CD31,and endothelial NO synthase proteins(P＜0.01).Conclusions EPO may ameliorate vascular endothelial injury in PCOS model rats by inhibiting the RAS signaling pathway and by overactivation of the ACE/Ang Ⅱ/AT1 axis.

Objective With the comprehensive implementation of Diagnosis-Related Groups(DRG)and Diagnosis-In-tervention Packet(DIP)payment reforms,ambulatory surgery has been widely adopted in clinical practice due to its efficiency and cost-effectiveness.However,medical insurance compliance issues have become increasingly prominent during management processes.Standardizing ambulatory surgery management and ensuring the security of medical insurance funds have grown in im-portance.Methods Based on the current status of ambulatory surgery medical insurance policies in Tianjin,this study analyzes common compliance issues under DRG/DIP payment systems,explores their causes,and proposes targeted management strate-gies.Results Tianjin currently has 786 ambulatory surgery procedures,with orthopedics being the most common specialty,fol-lowed by ophthalmology,urology,and general surgery.From 2020 to 2024,the sample hospital completed 12,705 ambulatory surgery cases,with a significant increase in 2024.In 2020,the most frequent procedure was circumcision,while in 2024,it was colonoscopic polypectomy.Under DRG/DIP payment systems,common medical insurance compliance issues include upeoding,split hospitalization,excessive treatment,cost shifting,and undertreatment.Conclusion Healthcare and medical insurance sys-tems should collaborate to implement targeted management strategies.These include strengthening hospital medical record and coding management,improving medical quality control,refining medical insurance supervision mechanisms and payment stand-ards,and establishing a multi-stakeholder collaborative oversight system.These measures aim to standardize ambulatory surgery management,safeguard medical insurance funds,and promote the healthy development of the healthcare industry.

To investigate the protective effect of Lycium barbarum glycopeptide(LbGp)on testicu-lar injury induced by D-galactose(D-gal)in aging rats,male SD rats were randomly divided into 6 groups:the blank control group(Control),aging model group(Model),positive control group(β-nicotinamide mononucleotide,NMN),low dose LbGp group(LLbGp),medium dose LbGp group(MLbGp)and high dose LbGp group(HLbGp).The testicular mass of rats was counted,the morphological changes of testicular tissue were observed by hematoxylin-eosin(HE)staining,the testicular senescence was detected by β-galactosidase(SA-β-gal)staining,and the levels of testos-terone(T),luteinizing hormone(LH)and follicle stimulating hormone(FSH)in serum were de-tected.The levels of oxidative factors such as glutathione peroxidase(GSH-Px),superoxide dis-mutase(SOD),malondialdehyde(MDA),catalase(CAT)and inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-6(IL-6)in rat tissues were measured.TUNEL staining was used to detect the apoptosis of testicular cells,epididymal sperm quality,and the expression of Keap1,Nrf2 and Nqo1 mRNA were analyzed.The results showed that compared with the Model group,the testicular coefficient of Lycium barbarum glycopeptide rats in MLbGp and HLbGp groups increased(P＜0.01),the level of T in serum and sperm quality increased(P＜0.05),the structural degeneration and aging of testicular tissue decreased(P＜0.01),the level of antioxidant factors increased,and the levels of inflammatory factors and apopto-sis decreased(P＜0.05).The expression of Keap1 decreased significantly(P＜0.01),while the ex-pression of Nrf2 and Nqo1 mRNA increased(P＜0.05).The above results indicate that Lycium barbarum glycopeptide can improve D-gal-induced testicular senescence,attenuate oxidative stress,reduce inflammatory response,decrease apoptosis,and exert a protective effect on testicular injury in rats due to senescence through the Keap1-Nrf2 signaling pathway.

With the rise of digital healthcare in recent years, digital tools, as a new type of health management tool, are expected to become a feasible tool for rehabilitation exercise in stroke patients. The aim of this article is to review the current status of the application of digital tools in self-management of stroke recovery. In addition, the concept, function and application effect of digital tools are introduced, and the existing problems and future research directions are pointed out, in order to provide reference for the self-management of stroke patients in China.

Objective:To examine the safety and effectiveness of a novel domestic transcatheter aortic valve system in addressing severe aortic valve stenosis.Methods:This prospective, multicenter, single-arm target-value clinical trial enrolled patients with severe aortic stenosis meeting inclusion criteria from 13 Chinese centers between July 2021 and April 2022. The primary endpoint was all-cause mortality at 1-year post-procedure. Secondary endpoints included safety outcomes (30-day all-cause mortality, 1-year major adverse cardiovascular events, device success) and efficacy parameters (transvalvular pressure gradient, paravalvular leak severity, New York Heart Association(NYHA)class improvement, and quality of life). Survival analysis was performed using the Kaplan-Meier analysis.Results:The study included 134 patients, 85 males and 49 females, with an age of (73.6±5.6)years (range: 65.1 to 91.8 years). Bicuspid aortic valve morphology was present in 59.7% (80/134). Device success rate was 99.3%, with one case converted to open surgery due to coronary obstruction. All-cause mortality was 0.8% (95% CI: 0.1% to 5.3%) at both 30-day and 1-year follow-up, significantly lower than the 25% target value ( P<0.01). Permanent pacemaker implantation rates remained 2.2% (3/134) at both timepoints. Stroke incidence was 0.7% (1/134) at 30 days and 1.5% (2/134) at 1 year. Myocardial infarction rates were 0.7% (1/134) at both intervals. The postoperative transvalvular pressure gradient of the aortic valve was (6.6±3.1) mmHg(1 mmHg=0.133 kPa) (range: 4 to 8 mmHg). Among the patients, 32 cases (23.9%) had mild paravalvular leakage, 4 cases (3.0%) had moderate paravalvular leakage, and no severe paravalvular leakage was observed. NYHA class Ⅰ and Ⅱ patients increased from 18.7% preoperatively to 99.3% postoperatively. Conclusion:The novel domestic transcatheter aortic valve system demonstrates satisfactory 1-year safety and efficacy outcomes in treating severe aortic stenosis.

Objective:To provide theoretical support and practice model for improving the clinical medical education supervision system of university-affiliated hospitals.Methods:This study focused on the group of reserve teaching supervision experts. Through literature research, questionnaire survey, and expert interview, the Competency Evaluation Criteria for Reserve Teaching Supervision Experts was constructed, which was implemented according to the training framework of "theory, practice, summary, and feedback". The paired t-test was performed using SPSS 24.0. Results:The research team formulated the Competency Evaluation Criteria for Reserve Teaching Supervision Experts through expert interviews. Six basic competencies and three advanced competencies for reserve teaching supervision experts were identified and their weights were assigned. A supervision team was established with supervision experts (including reserve teaching supervision experts) and teaching staff at a ratio of 1∶6.9, achieving an increase in the coverage of supervised specialties. A toolkit for enhancing the supervision capabilities of reserve experts was developed, and its effectiveness was analyzed. Statistical analysis showed that the overall score gap between reserve teaching supervision experts and senior supervision experts gradually narrowed. In terms of teaching demeanor and teaching effectiveness, there were no significant differences between the two types of experts. However, in terms of teaching content scores, there was a significant difference between reserve teaching supervision experts and senior supervision experts ( P<0.05). Conclusions:The training mechanism of reserve teaching supervision experts can effectively bridge the structural defects of the traditional supervision team. However, further emphasis is needed on the standardization and professionalization of teaching content supervision.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.

To investigate the protective effect of Lycium barbarum glycopeptide(LbGp)on testicu-lar injury induced by D-galactose(D-gal)in aging rats,male SD rats were randomly divided into 6 groups:the blank control group(Control),aging model group(Model),positive control group(β-nicotinamide mononucleotide,NMN),low dose LbGp group(LLbGp),medium dose LbGp group(MLbGp)and high dose LbGp group(HLbGp).The testicular mass of rats was counted,the morphological changes of testicular tissue were observed by hematoxylin-eosin(HE)staining,the testicular senescence was detected by β-galactosidase(SA-β-gal)staining,and the levels of testos-terone(T),luteinizing hormone(LH)and follicle stimulating hormone(FSH)in serum were de-tected.The levels of oxidative factors such as glutathione peroxidase(GSH-Px),superoxide dis-mutase(SOD),malondialdehyde(MDA),catalase(CAT)and inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-6(IL-6)in rat tissues were measured.TUNEL staining was used to detect the apoptosis of testicular cells,epididymal sperm quality,and the expression of Keap1,Nrf2 and Nqo1 mRNA were analyzed.The results showed that compared with the Model group,the testicular coefficient of Lycium barbarum glycopeptide rats in MLbGp and HLbGp groups increased(P＜0.01),the level of T in serum and sperm quality increased(P＜0.05),the structural degeneration and aging of testicular tissue decreased(P＜0.01),the level of antioxidant factors increased,and the levels of inflammatory factors and apopto-sis decreased(P＜0.05).The expression of Keap1 decreased significantly(P＜0.01),while the ex-pression of Nrf2 and Nqo1 mRNA increased(P＜0.05).The above results indicate that Lycium barbarum glycopeptide can improve D-gal-induced testicular senescence,attenuate oxidative stress,reduce inflammatory response,decrease apoptosis,and exert a protective effect on testicular injury in rats due to senescence through the Keap1-Nrf2 signaling pathway.

Objective To establish dynamic nomogram models for postoperative recurrence and survival risk of patients with AFP-negative hepatocellular carcinoma(ANHC)based on multimodal clinical data,to identify ANHC-specific prognostic biomarker combinations by integrating tumor biological characteristics and treatment response parameters through machine learning,and to provide an individualized risk assessment tool for overcoming the limitations of traditional serum biomarkers.Methods A retrospective analysis was performed for 421 ANHC patients who underwent hepatectomy in Eastern Hepatobiliary Surgery Hospital from April 2012 to December 2018,and they were randomly divided into training group with 210 patients and validation group with 211 patients.The univariate and multivariate Cox proportional-hazards regression models were used to identify independent prognostic factors and establish a nomogram model,and the receiver operating characteristic(ROC)curve,the calibration curve,and the decision curve analysis were used to assess the performance of the model.Related indicators were measured,including prealbumin(PA),white blood cell count(WBC),tumor size,and microvascular invasion.The chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups,and the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous variables between two groups.Results The multivariate analysis showed that multiple tumors(hazard ratio[HR]=3.30,P<0.001),WBC(HR=1.05,P=0.005),blood glucose(HR=1.15,P=0.026),CA19-9(HR=1.17,P=0.005),and tumor size(HR=1.17,P<0.001)were independent risk factors for disease-free survival(DFS),while PA(HR=0.99,P=0.022)was a protective factor.Incomplete tumor capsule(HR=0.60,P=0.009),age(HR=1.02,P=0.035),prothrombin time(PT)(HR=1.27,P=0.023),CA19-9(HR=1.01,P<0.001),and tumor size(HR=1.15,P<0.001)were independent risk factors for overall survival(OS).The DFS nomogram achieved an AUC of 0.74(95%confidence interval[CI]:0.64-0.84)in the training group and 0.67(95%CI:0.57-0.77)in the validation group,while the OS nomogram had an AUC of 0.76(95%CI:0.64-0.88)and 0.73(95%CI:0.60-0.87),respectively.The calibration curve and the decision curve analysis showed that the models had good predictive accuracy and clinical practicability.Conclusion Preoperative indicators,including tumor number,PA,WBC,and tumor size,can effectively predict postoperative recurrence in ANHC patients,while tumor capsule integrity,age,and PT are significantly associated with OS.The nomogram models established have good performance and can provide a basis for individualized prognostic assessment.

Background and purpose:Diffuse large B-cell lymphoma(DLBCL)is subclassified into germinal center B-cell-like(GCB)and non-GCB subtypes,which differ in prognosis and treatment response.However,current distinction still relies on invasive pathological assays.This study developed radiomics and deep-learning models based on multiparametric magnetic resonance imaging(MRI)to non-invasively differentiate the two subtypes preoperatively,thereby reducing dependence on histopathological examination.Methods:This study retrospectively included patients with pathologically confirmed DLBCL diagnosed at Huashan Hospital,Fudan University,and other institutions between March 2013 and December 2024.Using multiparametric MRI data,we developed DLBCL-subtype classification models that combined 4 radiomics-based machine-learning algorithms:support vector machine(SVM),logistic regression(LR),Gaussian process(GP)and Naive Bayes(NB),with 3 deep-learning architectures[densely-connected convolutional networks 121(DenseNet121),residual network 101(ResNet101)and EfficientNet-b5].Additionally,two radiologists with different experience levels independently classified DLBCL on MRI in a blinded fashion.Model and radiologist performance were quantified using the area under the receiver operating characteristic curve(AUC),accuracy(ACC),and F1-score to evaluate their ability to distinguish GCB from non-GCB subtypes.This study was approved by the Ethics Committee of Huashan Hospital of Fudan University(No.KY2024-663),and all patients signed informed consents.Results:A total of 173 patients were enrolled(55 with GCB subtype and 118 with non-GCB subtype).Radiomics and deep learning methods effectively distinguished DLBCL subtypes.Among these,the GP radiomics model(based on T1-CE+T2-FLAIR+ADC sequences)and DenseNet121 deep learning model(based on T1-CE+T2-FLAIR+ADC sequences)demonstrated optimal performance.Both achieved excellent results on the internal validation set(GP:AUC=0.900,ACC=0.896,F1=0.840;DenseNet121:AUC=0.846,ACC=0.854,F1=0.774)and maintained robustness on the external validation set.Furthermore,the classification efficacy of the optimal AI model surpassed that of experienced radiologists(highest physician AUC=0.678).Conclusion:Radiomics and deep-learning models based on multiparametric MRI features can effectively differentiate GCB from non-GCB subtypes of DLBCL.Among them,GP and DenseNet121 exhibit outstanding performance,especially when integrating multi-sequence feature sets for classifying DLBCL subtypes on complex imaging data.