Objective: To investigate the current status of benefit finding among young and middle-aged patients with type 2 diabetes mellitus (T2DM) and analyze its influencing factors, so as to provide a reference for improving the level of benefit finding in this population. Methods: From November 2022 to May 2023, young and middle-aged patients with T2DM aged 18-59 years hospitalized in the endocrinology departments of 2 tertiary hospitals in Hengyang City, Hunan Province were selected as survey subjects by a convenience sampling method. Basic demographic information was collected using a general questionnaire survey. Benefit finding, resourcefulness, and stigma were evaluated using the Benefit Finding Scale, the Chinese Version of the Resourcefulness Scale, and the Type 2 Diabetes Stigma Assessment Scale, respectively. A multiple linear regression model was used to analyze the influencing factors of benefit finding among young and middle-aged patients with T2DM. Results: A total of 305 young and middle-aged patients with T2DM were investigated, including 222 males (72.79%) and 83 females (27.21%). There were 231 cases aged 45-59 years, accounting for 75.74%. The scores for benefit finding, resourcefulness, and stigma were (42.86±6.06), (75.12±11.30), and (41.20±10.10), respectively. Multiple linear regression analysis showed that young and middle-aged patients with T2DM who were male (β′=0.088), aged 18-<45 years (β′=0.083), absence of diabetes complications (β′=0.124), and had higher resourcefulness scores (β′=0.679) had higher levels of benefit finding, while patients with higher stigma scores (β′=-0.097) had lower levels of benefit finding. Conclusion The level of benefit finding among young and middle-aged patients with T2DM was moderate, and was related to gender, age, diabetes complications, resourcefulness, and stigma.

Objective:To assess the status of undernutrition and appropriate catch-up growth in extremely preterm infants within 24 months of corrected age (CA).Methods:A retrospective cohort study was conducted. A total of 422 extremely preterm infants born at Shenzhen Maternity and Child Healthcare Hospital, Women and Children's Medical Center, Southern Medical University from January 2017 to December 2022 and followed up until 24 months of CA were enrolled. The extremely preterm infants were grouped by gestational age at birth (<25, 25-26, 27 weeks), birth weight (<500, 500-749, 750-999,≥1 000 g), weight for gestational age (large for gestational age (LGA), appropriate for gestational age (AGA), small for gestational age (SGA)) and sex. Weight data within 24 months of CA were collected every 3 months. Nutritional insufficiency, growth rate, and achievement of adequate catch-up growth were analyzed during the period from 0 to 24 months of CA. Z-score method was used to analyze data. Fenton 2013 preterm growth charts (Fenton 2013) were used before 40 weeks of corrected gestational age, and World Health Organization child growth standards (2009) fitted Z-scores were applied from 40 weeks of CA. Changes in weight Z-scores of extremely preterm infants from 0 to 24 months of CA were observed and compared, the occurrence of moderate to severe malnutrition and growth retardation was determined, nutritional insufficiency was assessed, and growth rate as well as the achievement of appropriate catch-up growth were analyzed. The Lambda-mu-sigma method combined with the Z-score fitting model was used to fit and analyze the distribution characteristics of weight percentiles in extremely preterm infants. The Chi-square test was used to compare differences among groups.Results:A total of 422 extremely preterm infants were included, with a gestational age at birth of 26.3(25.4, 27.2) weeks and a birth weight of (880±177) g. Among them, 238 were males and 184 were females; 36 cases (8.5%) were LGA, and 16 cases (3.8%) were SGA. During follow-up within 24 month of CA, 89 cases (21.1%) developed moderate to severe malnutrition. When compared separately among different birth weight and gestational age at birth groups, there had both statistically differences in the incidence of moderate to severe malnutrition ( χ2=42.94 and 9.17, both P<0.05). The incidence was the highest in the birth weight of CA<500 g group and the <25 weeks gestational age at birth group, while it was the lowest in the birth weight of CA≥1 000 g group and the 27 weeks gestational age at birth group in their respective groups. Growth retardation occurred in 5.2% (22/422). However, there had statistically differences in the incidence of growth retardation among different birth weight and gestational age at birth groups, in each grouped time interval ( χ2=21.61 and 4.30, both P<0.05). The proportions of rapid growth were relatively high in the 0-3 months and 3-6 months of CA groups, which were 96 cases (27.4%) and 98 cases (26.6%), respectively. Overall, appropriate catch-up growth was achieved in 341 cases (80.8%) from 0 to 24 months of CA. There had statistically differences in the completion rate of appropriate catch-up growth among different birth weight and gestational age at birth groups ( χ2=23.65 and 7.08, both P<0.05). The completion rate was the highest in the birth weight of CA<500 g group and the <25 weeks of gestational age at birth group, while it was the lowest in the birth weight of CA≥1 000 g group and the 27 weeks of gestational age at birth group. Conclusions:The lower the birth weight and gestational age of extremely preterm infants, the higher the incidence of moderate to severe malnutrition and the lower the achievement rate of adequate catch-up growth within 24 months of CA. The period of 0-6 months of CA is the critical window for catch-up in extremely preterm infants.

Objective:To assess the status of undernutrition and appropriate catch-up growth in extremely preterm infants within 24 months of corrected age (CA).Methods:A retrospective cohort study was conducted. A total of 422 extremely preterm infants born at Shenzhen Maternity and Child Healthcare Hospital, Women and Children's Medical Center, Southern Medical University from January 2017 to December 2022 and followed up until 24 months of CA were enrolled. The extremely preterm infants were grouped by gestational age at birth (<25, 25-26, 27 weeks), birth weight (<500, 500-749, 750-999,≥1 000 g), weight for gestational age (large for gestational age (LGA), appropriate for gestational age (AGA), small for gestational age (SGA)) and sex. Weight data within 24 months of CA were collected every 3 months. Nutritional insufficiency, growth rate, and achievement of adequate catch-up growth were analyzed during the period from 0 to 24 months of CA. Z-score method was used to analyze data. Fenton 2013 preterm growth charts (Fenton 2013) were used before 40 weeks of corrected gestational age, and World Health Organization child growth standards (2009) fitted Z-scores were applied from 40 weeks of CA. Changes in weight Z-scores of extremely preterm infants from 0 to 24 months of CA were observed and compared, the occurrence of moderate to severe malnutrition and growth retardation was determined, nutritional insufficiency was assessed, and growth rate as well as the achievement of appropriate catch-up growth were analyzed. The Lambda-mu-sigma method combined with the Z-score fitting model was used to fit and analyze the distribution characteristics of weight percentiles in extremely preterm infants. The Chi-square test was used to compare differences among groups.Results:A total of 422 extremely preterm infants were included, with a gestational age at birth of 26.3(25.4, 27.2) weeks and a birth weight of (880±177) g. Among them, 238 were males and 184 were females; 36 cases (8.5%) were LGA, and 16 cases (3.8%) were SGA. During follow-up within 24 month of CA, 89 cases (21.1%) developed moderate to severe malnutrition. When compared separately among different birth weight and gestational age at birth groups, there had both statistically differences in the incidence of moderate to severe malnutrition ( χ2=42.94 and 9.17, both P<0.05). The incidence was the highest in the birth weight of CA<500 g group and the <25 weeks gestational age at birth group, while it was the lowest in the birth weight of CA≥1 000 g group and the 27 weeks gestational age at birth group in their respective groups. Growth retardation occurred in 5.2% (22/422). However, there had statistically differences in the incidence of growth retardation among different birth weight and gestational age at birth groups, in each grouped time interval ( χ2=21.61 and 4.30, both P<0.05). The proportions of rapid growth were relatively high in the 0-3 months and 3-6 months of CA groups, which were 96 cases (27.4%) and 98 cases (26.6%), respectively. Overall, appropriate catch-up growth was achieved in 341 cases (80.8%) from 0 to 24 months of CA. There had statistically differences in the completion rate of appropriate catch-up growth among different birth weight and gestational age at birth groups ( χ2=23.65 and 7.08, both P<0.05). The completion rate was the highest in the birth weight of CA<500 g group and the <25 weeks of gestational age at birth group, while it was the lowest in the birth weight of CA≥1 000 g group and the 27 weeks of gestational age at birth group. Conclusions:The lower the birth weight and gestational age of extremely preterm infants, the higher the incidence of moderate to severe malnutrition and the lower the achievement rate of adequate catch-up growth within 24 months of CA. The period of 0-6 months of CA is the critical window for catch-up in extremely preterm infants.

Objectives:To assess the effectiveness of transcatheter aortic valve replacement (TAVR) on electrocardiographic remodeling in patients with severe aortic stenosis (AS), and identify its influencing factors.Methods:A cohort study was conducted on patients with a confirmed diagnosis of severe AS who successfully underwent TAVR at the Second Affiliated Hospital of Dalian Medical University between June 2018 and March 2023. Data, including standard 15-lead electrocardiograms and echocardiograms, were collected before the operation, 1 week after the operation, and 3 months after the operation. The average degree of ST-segment depression in the lateral wall leads of the electrocardiograms, and the amplitude of the T-wave were measured and calculated. The changes of electrocardiograms indexes were observed, and Spearman correlation analysis was used to explore the correlation between each index of electrocardiograms and each index of echocardiography. Multiple linear regression analysis was used to determine the influencing factors of the improvement of electrocardiographic remodeling in patients with severe AS after TAVR.Results:A total of 33 patients with severe AS, aged (73±9) years, were included in the study. Among them there were 15 (45%) males. The degree of ST-segment depression, supra-aortic flow velocity, peak transaortic pressure, and mean transaortic pressure exhibited significant improvement at 1 week post-TAVR (all P<0.05). Similarly, significant improvements in T-wave hypoplasia or inversion, left ventricular mass, and left ventricular mass index were observed at 3 months post-TAVR (all P<0.05). The degree of ST-segment depression was found to be correlated with supra-aortic flow velocity, peak transaortic pressure, and mean transaortic pressure (all P<0.05). Additionally, a correlation was observed between T-wave amplitude and left ventricular mass, left ventricular mass index, left ventricular end-diastolic internal diameter, and left ventricular ejection fraction (all P<0.05). Multiple linear regression analysis revealed that supra-aortic flow velocity was an independent influencing factor of the level of ST-segment depression ( β=-0.156, P=0.007), while left ventricular mass index was identified as an independent influencing factor of T-wave amplitude ( β=-2.007, P=0.001). Conclusion:The improvement in electrocardiographic remodeling could be observed after TAVR in patients with severe AS, which may be due to enhanced cardiac perfusion and regression of left ventricular hypertrophy subsequent to aortic valve opening.

Objective To explore the effect of different ways of out-of-plane shield on the tube current and cumulative radiation dose of CT scan.Methods The CT water membrane was scanned using Philips 128 row iCT scanner in different scanning methods:the 1-3 times,without the out-of-plane shield,the total length of localizer was 150 mm,270 mm,and 390 mm,respectively;the fourth time,the out-of-plane shield was used but was not present in the localizer;from the 5th to 7th pass,with out-of-plane shield and develop it in the localizer,with out-of-plane shield development lengths of 60 mm,180 mm,and 300 mm,respectively,and the out-of-plane shield was not within the formal scanning range.The tube current and cumulative radiation dose of various scanning methods were compared and a line graph of the tube current for scanning each layer was figured.Results(1)There was no statistically significant difference in tube current when there was no out-of-plane shield but the length of the localizer was different(P＞0.05).(2)When the pitch was 0.8,1.0,and 1.15 respectively,with out-of-plane shield but no shield object in the localizer,the scanning tube current was lower than that without shield scanning(P＜0.05).(3)When scanning with three different lengths of out-of-plane shield(60 mm,180 mm,300 mm)in the localizer,regardless of the pitch,the tube current was greater than that of unshield scanning(P＜0.05).(4)When there was a shield in the localizer,the closer to the shield,the higher the tube current in the formal scan.(5)The cumulative dose of scans with out-of-plane shield but without the presence of shield in the localizer was smaller than that of unshield scanning.However,with shield and the presence of shield scanning in the localizer,the cumulative radiation dose was greater than that of unshield scanning.Conclusion The presence of out-of-plane shield in the localizer may increase the tube current and radiation dose for formal scanning,and the closer to the shield,the more significant the increase in tube current.

Objective To explore and analyze the implementation effect of the combined traditional Chinese medicine(TCM)and Western medicine DRG payment model in TCM hospitals,aiming to provide a reference for the reform of medical in-surance payment methods in such hospitals.Methods R language was utilized to statistically analyze the costs and other indica-tors of the sample hospitals before and after the implementation of the combined TCM and Western medicine DRG payment within 1-2 years.Results Following the implementation of the combined TCM and Western medicine DRG payment,there was a de-crease in average hospitalization costs and average length of stay,accompanied by an increase in CMI(average weight).The cost structure underwent changes:the proportions of western medicine fees and auxiliary examination fees decreased,whereas the pro-portion of TCM treatment fees increased.Significant statistical differences were observed in each group of data(p＜2.2e-16).Conclusion The combined TCM and Western medicine DRG payment reform model can facilitate TCM hospitals in reducing medical costs,controlling medical expenses,optimizing the cost structure,and promoting the development of TCM diagnosis and treatment characteristics.

Objective:To systematically evaluate the application of artificial intelligence (AI) in cervical cytopathology diagnosis.Methods:A systematic search was conducted using the keywords ′′cervical cancer′′ ′′cytology′′ ′′artificial intelligence′′ ′′sensitivity′′ and ′′specificity′′ (in both English and Chinese) across databases including PubMed, Web of Science, Embase, Cochrane Library, IEEE Xplore, CNKI, Wanfang, VIP Chinese Science and Technology Journals, and SinoMed. The search covered literature from inception until January 1, 2024, on the application of AI in cervical cytopathological diagnosis. Data were extracted using a predefined data extraction form to compile the contingency table data, from which sensitivity, specificity and area under the curve (AUC) were calculated.Results:A total of 1 616 articles were initially retrieved, and 27 articles were finally included in this study according to the inclusion and exclusion criteria. Five researches were conducted on the diagnosis of cytopathology slides, with pooled AUC, sensitivity and specificity of 0.92 (95% CI: 0.89-0.94), 0.91 (95% CI: 0.77-0.97) and 0.84 (95% CI: 0.77-0.90), respectively. About 22 researches were conducted on the diagnosis of cytopathology images (individual cells or cell clusters), with pooled AUC, sensitivity and specificity of 1.00 (95% CI: 0.99-1.00), 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.97-0.99), respectively. Conclusion:The application of AI in the field of cervical cytopathology shows certain diagnostic performance and potential clinical application value.

Objective:To explore the genotype and the clinical phenotype of SCN2A-related developmental delay in children. Methods:A case series study was adopted. Collect clinical data from 10 cases of children with SCN2A gene variants diagnosed with global developmental delay/intellectual disability who were admitted to the Children′s Hospital between July 2019 and March 2023. Summarize the clinical phenotype and genotype based on clinical data such as general information, clinical manifestations, imaging examinations, laboratory tests, genetic testing results, and comprehensive pediatric neuropsychological development assessment. Results:A total of 10 patients were recruited, including 7 males and 3 females, with an age range of 27 days to 5 years and 9 months. 9 patients underwent children′s neuropsychological and behavioral assessments, and the results were consistent with global developmental delay, including 2 mild cases, 4 moderate cases, and 3 severe cases. 3 cases had autism spectrum disorder, and 2 cases had epilepsy. 6 patients underwent complete head MRI examination, and 4 of them showed abnormalities, including delayed myelination, widening of the local extra brain space in the frontal lobe, and abnormal frontal lobe morphology. All 10 cases had point variants. Among them, 9 cases are de novo and 1 case is maternal inheritance. Out of 10 cases, there were 5 cases with copy number variations, but all of them were of unknown significance. Among the 10 variants, 8 have been reported and 2 have not been reported, namely c.4145A>T(p.N1382I) and c.4937T>A(p.I1646N). In this study, 4 out of 10 patients with SCN2A variants had variation sites located in the S4 segment of domain which constitute Nav1.2, the sodium ion channel encoded by SCN2A. The developmental quotient level was lower when the variation sites were located in the S4 segment of domain, and the difference was statistically significant ( t=-3.101, P=0.017), indicating that the severity of developmental delay may be related to the localization of amino acids corresponding to variant sites within the protein domain. Conclusion:SCN2A mutations are strongly associated with diverse neurodevelopmental disorders. In this study, the phenotypic spectrum of SCN2A variants encompassed epilepsy, global developmental delay, and autism spectrum disorder. Affected individuals exhibited early-onset developmental delays, predominantly moderate to severe in severity. Voltage-sensing domain dysfunction in sodium channels may constitute a critical pathomechanism underlying neurodevelopmental impairments. Further electrophysiological characterization and molecular mechanistic studies are warranted todelineate the genotype-phenotype correlations between specific variant loci and clinical severity.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the genetic diversity of Mycobacterium tuberculosis (MTB) in different types of tuberculosis and its association with clinical features, providing evidence for precise diagnosis and treatment of tuberculosis. Methods:This cross-sectional study included 103 cases of tuberculosis (38 with simple pulmonary tuberculosis, 43 with tuberculous pleurisy, and 22 with pulmonary combined with extrapulmonary tuberculosis) from Shenzhen Third People′s Hospital from 2015 to 2018. Paired bacterial strains from lung and pleural effusion/extrapulmonary sites were collected. Whole-genome sequencing (WGS) was used for drug resistance prediction, and genetic diversity (π value) was calculated as well as differential genes screening. Statistical analysis included paired t-tests and χ2 tests to compare clinical, bacteriological and genetic diversity features among groups.Results:The simple pulmonary tuberculosis group exhibited significantly higher rates of retreatment (71.7%, 27/38), cavitation (70.4%, 19/27), and multidrug-resistant or rifampicin-resistant (MDR/RR) (60.5%, 23/38) compared to the tuberculous pleurisy group (retreatment 11.9%, 5/42; cavitation 11.9%, 5/42; MDR/RR 16.3%, 7/43) and extrapulmonary tuberculosis group (retreatment 9.1%, 2/22; cavitation 18.2%, 4/22; MDR/RR 13.6%, 3/22) ( P<0.05). The overall π values of the MTB strain genomes in lung [(5.94±3.93)×10 ?5], pleural effusion[(6.22±3.51)×10 ?5], and extrapulmonary tissues [(5.83±3.54)×10 ?5] showed no significant differences ( H=0.10, P=0.94). Differential gene diversity analysis revealed that π value alternating genes related to respiration and intermediate metabolism were prominently high [tuberculous pleurisy 32.4% (11/34) and extrapulmonary tuberculosis groups 31.4% (32/102)], while cell wall-associated genes dominated in the simple pulmonary tuberculosis group (42.9%, 6/14). Drug resistance profiles and mutation spectra were identical across isolates from different sites within the same patient. Conclusion:WGS revealed the MTB diversity among different types of tuberculosis. Difference between pulmonary and extrapulmonary environments may impel the adaptive alternations of the bacterial strains to maintain survival with higher overall genome stability. Drug resistance testing of lung-derived isolates may provide references on extrapulmonary tuberculosis treatment.