Objective To parse the current situation of obstetrics resources in Chinese Public General Hospitals,and explore a new path for the development of obstetric medical service system in public hospitals.Methods Literature search and qualitative interview methods were used to sort out the obstetric resources and services of public general hospitals.Results The obstetrics departments in public general hospitals play an important role in the obstetrics service system,which face more operation pressures and transformation difficulties in the background of low fertility.Public general hospitals can strengthen the inner horizontal integration by multidisciplinary collaboration,and external vertical with medical alliances and obstetric alliances,so as to provide high-quality and continuous obstetric services for regional pregnant women and enhance system resilience.Conclusion Centralized multidisciplinary integration inside the hospitals and alliance with other obstetrics departments outside the hospitals,namely Two"Centralized Development"may be a new path for the high-quality development of obstetrics department in public general hospitals under the background of low fertility rate.

Objective:To explore the research hotspots and trends in the radiomics field based on bibliometric for breast cancer.Methods:Publications related to radiomics for breast cancer during January 2012 to June 2024 were retrieved from the Web of Science Core Collection databases.Then,the R software's package"bibliometric"tool,VOSviewer and CiteSpace softwares were used to conduct visual analysis of radiomics-related bibliometric for breast cancer,which involved to publication trends,countries,institutions,journals,authors,keywords,and highlight keywords.Results:A total of 683 radiomics-related literatures for breast cancer were obtained,and 518 articles were finally included after non-English literatures and non-Article literatures were excluded.China and Sun Yat-sen University emerged as the leading country(326 articles)and institution(83 articles).The top three journals with the most of published articles were respectively,and.Professor Mao Ning has the largest number of articles,followed by Pinker Katja and Liang Changhong.The results of keywords and highlight keywords showed that current radiomics researches for breast cancer mainly focused on the applications of magnetic resonance imaging(MRI),machine learning,deep learning,artificial intelligence,and radiogenomics in prediction for diseases'prognosis,and assessment for treatment's response.Conclusion:The applications of machine learning,deep learning and multi-parameter imaging belongs to hot-research fields in assessment for personalized treatment.Future research directions would more and more tend to integrate artificial intelligence and multi-omics analysis,so as to promote prognostic assessment and personalized treatment.

Objective In order to summarize the implementation status and effectiveness of entrusted management projects in municipal hospitals of Beijing,the project aims to better promote the extension of high-quality urban re-sources to county-level hospitals.Methods Through survey questionnaires and focus group interviews,the survey questionnaire includes the size of the hospital,the number of surgeries,Case Mix Index,annual average number of new technologies and projects,personnel training entrusted,and interviews with 50 heads of municipal hospi-tals,district hospitals,and district level government relevant departments.Results Measures for medical homogeni-zation,talent cultivation,management,and cultural homogenization were sorted out.In terms of hospital scale,level evaluation,medical service capabilities,and the proportion of master's degree and above personnel in the managed hospitals,an upward trend was observed.Conclusion The medical cooperation project entrusted by Beijing Municipal Hospitals promotes the integration of regional medical services,and provides reference for the expansion and sinking of high-quality medical resources from the management mechanism,operation mechanism and key measures.

Objective To observe the effectiveness and safety of the"Stomach Three Needles"in preventing acute chemotherapy-induced nausea and vomiting(CINV)in patients with breast cancer.Methods Seventy patients with breast cancer who received highly emetogenic chemotherapy(HEC)and were admitted to the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2023 to May 2025 were selected as research subjects.They were divided into treatment group(35 cases)and control group(35 cases)according to the random number table method.The treatment group received"Stomach Three Needles"combined with triple-drug prophylactic antiemetic therapy,while the patients in control group were given triple-drug prophylactic antiemetic therapy alone.The severity of nausea and vomiting symptoms during the acute phase,functional living index-emesis(FLIE),and adverse reactions between two groups of patients were compared.Results The severity grades of acute-phase nausea and vomiting symptoms in treatment group were all lower than those in control group(P＜0.05).The complete response rate and total effective rate of acute-phase nausea and vomiting in treatment group were significantly higher than those in control group(P＜0.05).The FLIE score of the patients in treatment group was significantly higher than that in control group(P＜0.05).There was no statistically significant difference in the occurrence of adverse reactions such as headache,fatigue,constipation,and abdominal distension between two groups of patients(P＞0.05).Conclusion The"Stomach Three Needles"combined with triple-drug prophylactic antiemetic therapy can effectively reduce the incidence and severity of acute CINV in breast cancer patients,improve their quality of life,and has good safety.It is worthy of clinical promotion.

This report evaluates the preliminary outcomes of a "six-in-one" integrated cough and asthma center developed under a dual-contract physician model at the Changfeng Community Health Service Center in Putuo District, Shanghai. By combining the efforts of family doctors and medical specialists, the center integrated six core functions-clinical treatment, prevention, nursing, rehabilitation, pharmacy, and nutrition-into a seamless management system covering screening, diagnosis, therapy, and follow-up. Supported by specialist guidance and teaching clinics, the model significantly enhanced comprehensive respiratory disease management capabilities within the community setting. The initiative not only improved patient health outcomes but also strengthened multidisciplinary collaboration and resource efficiency, offering a replicable example for improving chronic disease management in primary care through integrated and coordinated service delivery.

Objective:To investigate the early warning value and prognostic assessment of patients with urosepsis using white blood cells (WBC), procalcitonin (PCT), combined with T helper cell subsets type 1 (Th1) and T helper cell subsets type 2 (Th2) cytokine profiles.Methods:A retrospective selection was made of 97 patients with urosepsis admitted to Inner Mongolia University for Nationalities Affiliated Hospital from January 2019 to June 2023 as the case group. During the same period, 60 patients with simple urinary tract infections were selected as the control group, and 60 patients with simple urinary tract infections transitioning to urosepsis were collected as the transition group. The clinical data and laboratory indexes of the three groups were collected, and the differences of WBC, PCT and Th1/Th2 cytokines profiles were compared. Point-biserial correlation was used for analysis. The subject work curve (ROC) was drawn. The area under the curve (AUC) was used to evaluate the early warning value of WBC, PCT and Th1/Th2 cytokines profiles in patients with urosepsis. The patients in the case group were followed up for 28 d. According to the survival outcome, they were divided into death group and survival group. The differences of WBC, PCT and Th1/Th2 cytokines profiles between the two groups were compared. Point-biserial correlation was used to assess their relationship with prognosis, and ROC curves were plotted to evaluate the predictive value of these indicators for urosepsis prognosis.Results:The levels of WBC, PCT, interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) in different groups of patients were compared. The case group had higher levels than the transformation group and the control group: (12.02 ± 4.11) × 10 9/L vs. (9.88 ± 3.11) and (6.25 ± 2.21) × 10 9/L, (38.52 ± 12.9) ng/L vs. (25.54 ± 10.12) and (12.53 ± 5.01) ng/L, (60.36 ± 20.62) ng/L vs. (45.21 ± 6.95) and (30.64 ± 10.65) ng/L, (25.62 ± 6.85) ng/L. vs. (22.41 ± 3.62) and (20.41 ± 5.95) ng/L, (5.81 ± 0.85) ng/L vs. (5.21 ± 0.15) and (4.71 ± 0.86) ng/L, (5.01 ± 0.62) ng/L vs. (4.51 ± 0.21) and (3.81 ± 0.54) ng/L, there were statistical differences ( P<0.05). Point-biserial correlation confirmed a positive correlation between these indicators and urosepsis ( r>0, P<0.05). ROC curves showed that WBC, PCT, IL-6, IL-10, IFN-γ, and TNF - α had good predictive value for urosepsis, and several combinations had high predictive value, with AUC values of 0.771, 0.871, 0.823, 0.707, 0.860, 0.753, and 0.939, respectively. WBC, PCT, IL-6 and IFN-γ had good predictive value for the transition from simple urinary tract infection to urosepsis, while IL-10 and TNF-α had lower predictive value. The combined predictive value of the above indicators was the highest, with AUC values of 0.824, 0.861, 0.871, 0.869, 0.623, 0.644 and 0.965, respectively, all of which had certain predictive value. Out of 97 patients, 34 died, with a mortality rate of 35.05% (34/97). The levels of WBC, PCT, IL-6, IL-10, TNF - α, and IFN - γ in the deceased group were significantly higher than those in the survival group: (18.00 ± 6.39) × 10 9/L vs. (13.91 ± 4.51) × 10 9/L, (4.96 ± 2.17) ng/L vs. (3.41 ± 0.62) ng/L, (167.52 ± 10.52) ng/L vs. (158.61 ± 14.50) ng/L, (54.50 ± 9.51) ng/L vs. (48.42 ± 12.62) ng/L, (5.84 ± 1.21) ng/L vs. (5.10 ± 1.48) ng/L, (4.33 ± 1.82) ng/L vs. (3.54 ± 1.12) ng/L, there were statistical differences ( P<0.05). Point-biserial correlation analysis revealed a positive correlation between WBC, PCT, IL-6, IL-10, TNF-α, IFN-γ and prognosis ( r>0, P<0.05). The ROC curve was drawn to show that WBC, IL-6, IL-10, TNF-α and IFN-γ had a relatively low predictive value for the prognosis of patients. PCT and the combination of various indicators had a good predictive value for the prognosis of patients, and the combined predictive value was the highest. The AUCs were 0.675, 0.687, 0.637, 0.637, 0.637, 0.727 and 0.880, respectively. Conclusions:WBC, PCT, IL-6, IL-10, TNF-α and IFN-γ are associated with urosepsis and its prognosis, and the combined predictive value is the highest.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.

Objective:To investigate the clinical characteristics of a family with maturity-onset diabetes of the young type 3(MODY3) and assess its association with the novel HNF1A-c.47T>A variant.Methods:A genetic pedigree of the MODY3 family was constructed, and clinical data were collected. Whole-exome sequencing combined with Sanger sequencing was used, followed for familial co-segregation analysis. Bioinformatics tools, including multiple sequence alignment–based conservation analysis and protein structural prediction, were conducted to validate the association between the novel HNF1A-c.47T>A variant and MODY3.Results:Seven MODY3 patients were diagnosed in this family, all harboring the HNF1A-c.47T>A heterozygous variant. AlphaFold2 protein structure prediction indicated that the HNF1A-c.47T>A variant altered the conformation of the first pair of α-helices within the protein dimerization domain.Conclusion:Based on co-segregation analysis, sequence conservation assessment, protein structure prediction, and classification based on American College of Medical Genetics and Genomics(ACMG) Guidelines, the HNF1A-c.47T>A variant was determined to be pathogenic for MODY3. This study reports this novel pathogenic variant, expanding the mutational spectrum of MODY3. By revealing its disruptive effect on the protein dimerization domain, the findings provide a potential molecular basis for the diagnosis and management of patients carrying similar variants.

Objective:To investigate nationwidely the alert threshold for intraoperative bleeding intervention during dilation and curettage (D&C) for type Ⅱ cesarean scar pregnancy (CSP) in the first trimester.Methods:A retrospective cross-sectional survey was conducted. From March 11 to April 14, 2022, obstetricians and gynecologists affiliated with professional associations or institutions of Family Planning Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Associaton were surveyed using “Expert Consultation Questionnaire on Alert Threshold for Intraoperative Blood Loss in CSP”. The questionnaire was distributed via WeChat using the Questionnaire Star platform. Observation indicators included professional expertise of participants, preferred treatment modalities for type Ⅱ CSP, and an alert threshold for intraoperative bleeding during D&C.Results:A total of 361 valid questionnaires were collected. Among 361 participants, 73.7% (266/361) held the title of associate chief physician or higher, 61.2% (221/361) had ≥20 years of clinical experience, and 71.8% (178/248) worked in tertiary general hospitals. The most common treatment for type Ⅱ CSP was D&C following pretreatment with medication, uterine artery embolization (UAE), or high intensity focused ultrasound (HIFU), the percentage was 35.73% (129/361). 51.2% (185/361) of participants recommended an alert threshold of 100 ml for intraoperative bleeding during D&C. Cross-analysis revealed that participants managing <30 cases annually preferred ultrasound-guided D&C (32.0%, 56/175), those managing 30-99 cases or 100-199 cases per year favored pretreatment with medication, UAE or HIFU+D&C (39.0%, 55/141; 52.9%, 18/34), those managing ≥200 cases per year preferred hysteroscopic D&C (4/11). The most frequently selected alert threshold was 100 ml. In the subgroup analysis of participants with ≥100 cases annual admissions for CSP, 46.7% (21/45) of participants chose medication, UAE or HIFU pretreatment+D&C, while 53.3% (24/45) supported setting the alert threshold at 100 ml.Conclusions:The preferred treatment for type Ⅱ CSP is D&C following medication, UAE or HIFU pretreatment, with an intraoperative bleeding alert threshold of 100 ml. Timely alerts and proactive interventions could reduce injury severity, improve outcomes, and optimize CSP management strategies.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.