Objective To explore the correlation between nutritional status and frailty in elderly patients with cardiovascular disease (CVD), and to provide suggestions for the prevention of frailty occurrence in elderly patients with CVD. Methods A retrospective study was conducted on 357 elderly CVD patients who were admitted to the Third Affiliated Hospital of Chengdu Medical College from May 2024 to July 2024. These patients were divided into a frailty group and a non-frailty group based on the presence or absence of frailty. Data on the patients' nutritional status indicators [body mass index (BMI), weight loss, calf circumference, albumin, and grip strength], general demographic and clinical data, laboratory and physiological indicators, and functional and activity indicators were collected. The influencing factors of frailty and the correlation between nutritional status indicators and frailty were analyzed. Results Among the 357 patients, 69 cases (19.33%) were detected with frailty, while 288 (80.67%) were without frailty. Multivariate logistic regression analysis revealed that age (OR=1.120, 95% CI: 1.023–1.225) and weight loss (OR=2.776, 95% CI: 1.145–6.732) were risk factors influencing the occurrence of frailty in elderly CVD patients (P<0.05), while grip strength (OR=0.902, 95% CI: 0.831–0.980), albumin level (OR=0.892, 95% CI: 0.806–0.988), and calf circumference (OR=0.900, 95% CI: 0.829–0.978) were protective factors of frailty occurrence in elderly CVD patients (P<0.05). Conclusion The incidence rate of frailty is relatively high in elderly patients with CVD. Age and weight loss are independent risk factors for frailty, while high grip strength level, high albumin level, and large calf circumference are independent protective factors of frailty.

Objective To systematically analyze the trend of incidence, mortality and disease burden of chronic obstructive pulmonary disease (COPD) in China from 1994 to 2023, reveal the influence of age-period-cohort factors on COPD in China and the attribution characteristics of risk factors, and provide empirical basis for formulating precise prevention and control strategies. Methods The Global Burden of Disease (GBD) 2023 database was used to extract the data of the whole population, gender and age groups of COPD in China from 1994 to 2023. The Joinpoint regression model was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) of the standardized rate. The age-period-cohort model was adopted to quantify its impacts on the incidence and mortality of COPD. It also analyzed the attributable effects as well as temporal trend characteristics of seven GBD level-3 risk factors (including smoking, ambient particulate matter pollution, occupational exposure, etc.) in Chinese population in 1994 and 2023 on the standardized mortality rate and standardized disability-adjusted life years (DALYs) rate of COPD. Results From 1994 to 2023, the incidence and mortality of COPD in China showed an upward trend, but the standardized incidence [AAPC=−1.16%, 95%CI (−1.18, −1.14), P<0.001] and standardized mortality [AAPC=−2.87%, 95%CI (−3.02, −2.73), P<0.001] decreased significantly, and the decline rate of standardized incidence in females (AAPC=−1.29%) was slightly higher than that in males (AAPC=−1.04%). The decline rate of standardized mortality in males (AAPC=−3.65%) was higher than that in females (AAPC=−1.94%). The age-period-cohort model revealed a nonlinear increase in the age effect, a graded decline in the cohort effect, and a significant period effect on mortality and male morbidity (P<0.001). In terms of attribution of risk factors, the top three attribution risks of the whole population in 2023 were still smoking, particulate matter pollution and second-hand smoke. Compared with 1994, the attribution of environmental ozone pollution, second-hand smoke, high temperature, smoking and occupational particulate matter/gas/smoke exposure increased, and the attribution of particulate matter pollution decreased. Conclusion From 1994 to 2023, the overall disease burden of COPD in China shows a downward trend. Age and cohort are the core driving factors of the disease, and period factors have a more significant impact on death. The changes in the attribution structure suggest that while consolidating the effectiveness of particulate matter pollution control, it is necessary to strengthen the comprehensive prevention and control strategies of tobacco control, coordinated emission reduction of ozone and multiple pollutants, extreme temperature protection and protection of key occupational groups, so as to continuously reduce the disease burden of COPD.

Objective: To analyze the mortality trend of chronic respiratory diseases in Lianyungang City, Jiangsu Province from 2011 to 2024, and predict the mortality from 2025 to 2029, so as to provide the evidence for developing forward-looking prevention and control strategies and targeted intervention measures. Methods: Chronic respiratory disease death surveillance data in Lianyungang City from 2011 to 2024 were collected through the Jiangsu Chronic Disease Management Information Platform. The crude mortality was calculated and standardized using the data of the Sixth National Population Census in 2010. Average annual percent change (AAPC) was used to analyze the mortality trends of chronic respiratory diseases by gender, region, and age in Lianyungang City from 2011 to 2024. The GM (1,1) grey model was established using the crude mortality of chronic respiratory diseases from 2011 to 2024 to predict the crude mortality of chronic respiratory diseases from 2025 to 2029. Results: From 2011 to 2024, the crude mortality and standardized mortality of chronic respiratory diseases in Lianyungang City were 52.20/105 and 36.57/105, respectively. The crude mortality and standardized mortality were 53.14/105 and 43.79/105 in males, respectively, which were higher than 51.17/105 and 30.14/105 in females (both P<0.05). The crude mortality and standardized mortality were 55.62/105 and 39.85/105 in rural areas, respectively, which were higher than 38.11/105 and 24.15/105 in urban areas (both P<0.05). From 2011 to 2024, the standardized mortality of chronic respiratory diseases showed downward trends in the total population, males, females, urban areas, and rural areas (AAPC=-6.956%, -5.175%, -8.659%, -4.290%, and -7.369%, all P<0.05). The crude mortality of chronic respiratory diseases in the total population showed an upward trend with increasing age (P<0.05), reaching a peak of 1 371.20/105 in the ≥80 years group. The top two causes of chronic respiratory disease deaths were chronic obstructive pulmonary disease and bronchial asthma, with 31 792 cases and 3 254 cases, accounting for 82.40% and 8.43%, respectively. The GM (1,1) grey model prediction results showed that the crude mortality of chronic respiratory diseases in the total population from 2025 to 2029 would be 37.91/105, 36.32/105, 34.80/105, 33.34/105, and 31.95/105, respectively (average relative error=8.76%). Conclusions From 2011 to 2024, the mortality of chronic respiratory diseases in Lianyungang City showed a downward trend. The risk of death from chronic respiratory diseases was higher in males, rural areas, and the elderly. It is predicted that the mortality of chronic respiratory diseases will decrease year by year from 2025 to 2029.

Objective To explore the efficiency improvement in segmenting neural network with the application of Transformer + U-Net artificial intelligence (AI) and modeling with the application of Python scripts in three-dimensional (3D) printing brachytherapy. Methods A Transformer + U-Net AI neural network model was constructed, and Adam optimizer was used to ensure rapid gradient descent. Computed tomography or magnetic resonance imaging data of patients were standardized and processed as self-made data sets. The training set was used to train AI and the optimal result weight parameters were saved. The test set was used to evaluate the AI ability. Python programming language was used to write an automated script to obtain the output segmentation image and convert it to the STL file for import. The source applicator and needle could be automatically modeled. The time of automatic segmentation and modeling and the time of manual segmentation and modeling were entered by two people, and the difference was verified by paired t-test. Results Dice similarity coefficient (DSC), mean intersection over union (MIOU), and Hausdorff distance (HD95) were used for evaluation. DSC was 0.9341, MIOU was 0.8762, and mean HD95 was 2.516. The mean time of manual segmentation was 1187 s, and the mean time of AI segmentation was 145 s (P < 0.01). The mean time of manual modeling was 321 s, and the mean time of modeling with Python automated scripts was 18 s (P < 0.01). Conclusion The application of Transformer + U-Net automatic segmentation and Python automated scripts can effectively improve work efficiency in the 3D printing brachytherapy for cervical cancer.

This paper systematically reviews the application progress of machine learning in perioperative transfusion medicine, focusing on its significant achievements in identifying transfusion risk factors, accurately predicting transfusion requirements, and enabling dynamic monitoring with real-time feedback. It also examines the methodologies, performance metrics, and clinical significance of constructing machine learning models across various surgical specialties, including orthopaedics, cardiac surgery, trauma, and obstetrics. The review further analyzes major challenges currently facing the field, including data bias, model overfitting and interpretability issues, alongside privacy and ethical concerns. Finally, it outlines future directions, highlighting how multimodal data fusion, deep learning applications, multicentre validation, and interdisciplinary collaboration are poised to significant potential for advancing the clinical translation of intelligent transfusion models, achieve personalized precision transfusion management, and enhance patient safety and therapeutic outcomes.

Traditional Chinese medicine （TCM） has unique advantages in alleviating the symptoms of diabetic kidney disease （DKD） and slowing its progression. However， traditional clinical trials often use the occurrence of end-stage renal disease as the end point， requiring long-term follow-up， which increases trial complexity and costs， thereby limiting the feasibility of TCM clinical studies. This paper suggested that in clinical trials of TCM for DKD， both the estimated glomerular filtration rate （eGFR） change rate （≥30%） and eGFR slope can serve as potential surrogate outcome measures. If the intervention course is short （＜1 year）， the eGFR change rate （≥30%） is recommended as a surrogate outcome measure， whereas in long-term interventional studies （≥1 year）， the eGFR slope may be more appropriate. Furthermore， based on biochemical indicators such as eGFR slope and urinary albumin-to-creatinine ratio （UACR） change rate， integrating TCM symptom evaluation， TCM syndrome evaluation， and quality of life scales can help develop internationally recognized patient-reported outcome measures （PROMs） for TCM clinical trials， which will be a key step in enhancing the evaluation system for the effectiveness of TCM in treating DKD.

BACKGROUND:Flap transplantation technique is a commonly used surgical procedure for the treatment of severe tissue defects,but postoperative flap necrosis is easily triggered by ischemia-reperfusion injury.Therefore,it is still an important research topic to improve the survival rate of transplanted flaps. OBJECTIVE:To review the pathogenesis and latest treatment progress of flap ischemia-reperfusion injury. METHODS:CNKI,WanFang Database and PubMed database were searched for relevant literature published from 2014 to 2024.The search terms used were"flap,ischemia-reperfusion injury,inflammatory response,oxidative stress,Ca2+overload,apoptosis,mesenchymal stem cells,platelet-rich plasma,signaling pathways,shock wave,pretreatment"in Chinese and English.After elimination of irrelevant literature,poor quality and obsolete literature,77 documents were finally included for review. RESULTS AND CONCLUSION:Flap ischemia/reperfusion injury may be related to pathological factors such as inflammatory response,oxidative stress response,Ca2+overload,and apoptosis,which can cause apoptosis of vascular endothelial cells,vascular damage and microcirculation disorders in the flap,and eventually lead to flap necrosis.Studies have found that mesenchymal stem cell transplantation,platelet-rich plasma,signaling pathway modulators,shock waves,and pretreatment can alleviate flap ischemia/reperfusion injuries from different aspects and to varying degrees,and reduce the necrosis rate and necrosis area of the grafted flap.Although there are many therapeutic methods for skin flap ischemia/reperfusion injury,a unified and effective therapeutic method has not yet been developed in the clinic,and the advantages and disadvantages of various therapeutic methods have not yet been compared.Most of the studies remain in the stage of animal experiments,rarely involving clinical observations.Therefore,a lot of research is required in the future to gradually move from animal experiments to the clinic in order to better serve the clinic.

Objective:To explore the degree of change in anteversion angle and related risk factors after intramedullary nail fixation of intertrochanteric femur fracture in the elderly.Methods:The data of 256 elderly patients who underwent intramedullary nail fixation for intertrochanteric fractures of the femur at Tianjin Hospital of Tianjin University from March 2020 to March 2023 were selected, including 114 males and 142 females, with an age of 75.40±10.69 years (range, 65-94 years). The degree of change in the anteversion angle of the affected hip before and after the surgery was measured by CT scan of the hip, the Receiver Operating Characteristic Curve (ROC) was plotted, the area under the ROC curve was analyzed, and the optimal degree of grouping was determined by calculating the Youden Index, then all the patients were divided into two groups. The correlation between various risk factors (age, sex, type of internal fixation, fracture AO type, quality of reduction, fracture medial cortical defect or not, cusp distance) and the change of anterior tilt angle was screened by univariate and multivariate logistic regression analyses.Results:All 256 patients were followed up for 20.7±2.1 months (range, 18-23 months). Anteversion on the healthy side was 12.68°±5.10° (range, 5°-28°); postoperative anteversion on the affected side was 15.04°±7.67° (range, 9°-36°). By comparing the difference in the anterior tilt angle between the affected side and the healthy side, it was found that the anterior tilt angle of 67 patients was completely restored to the healthy side level after the operation. The anteversion angle was enlarged in 131 cases, of which the mildly increased angle (1°-9°) was found in 106 cases, moderately increased (10°-15°) was found in 17 cases, and significantly increased (>15°) was found in 8 cases; 58 patients showed anteversion angle reduction, of which 45 cases were mildly reduced (1°-9°), 13 cases were moderately reduced (10°-14°). The area under the ROC curve for the patient's anteversion angle and its 95% CI were 0.714(0.559, 0.867), and the maximum value of its Youden Index was 0.221, which corresponded to the optimal critical angle of 4°. There was no statistically significant difference in age, gender, reduction quality or fracture AO classification between the group with an anteversion angle>4° and the group with an anteversion angle≤4° ( P>0.05). The types of internal fixation, medial cortical defect and insufficient tip apex distance (TAD) were included in the binary variable logistic regression analysis. The results showed that single-nail internal fixation [ OR=0.412, 95% CI(0.244, 0.695), P=0.007], medial cortical defect [ OR=0.471, 95% CI(0.279, 0.793), P=0.009] and TAD>25 mm [ OR=0.367, 95% CI(0.207, 0.651), P=0.003] are independent risk factors for changes in anteversion angle after intramedullary nail fixation of intertrochanteric femur fractures in elderly. Conclusion:Single-nail internal fixation, medial cortical defect and TAD >25 mm are independent risk factors for the change of anteversion angle after intramedullary nail internal fixation of intertrochanteric fractures in the elderly.

The menopausal age is one of the important menopausal factors, and women of different menopausal ages have different risks of diabetes. This study reviewed the evidence from prospective studies on the association between the age at natural menopause and diabetes risk, both domestically and internationally, and presented its research design and main findings. Advanced menopause, especially premature and early menopause, will increase the risk of diabetes in postmenopausal women. The research on the influence of delayed menopause on the incidence of diabetes is still insufficient. Many factors may modify the association between menopausal age and the risk of diabetes.

Objective To analyze the characteristic influencing factors for enlarged perivascular spaces(EPVS)in different regions of acute ischemic stroke(AIS)patients and explore their un-derlying pathogenesis.Methods A total of 172 AIS patients admitted to our department from September 2020 to September 2023 were consecutively enrolled.According to the distribution of EPVS,they were divided into basal ganglia EPVS group(n=103)and non-basal ganglia EPVS group(n=69),as well as centrum semiovale EPVS group(n=77)and non-centrum semiovale EPVS group(n=95).General information,NIHSS score at onset,TOAST classification,fasting blood glucose,liver function,coagulation function,and homocysteine(Hcy)level were collected in all the patients.Multivariate logistic regression analysis was used to identify independent influen-cing factors for EPVS in different regions.Results The basal ganglia EPVS group had significant-ly advanced age and larger proportion of hypertension than the non-basal ganglia EPVS group,while the centrum semiovale EPVS group had smaller proportion of hyperhomocysteinemia,and larger ratios of smoking and alcohol consumption,higher alanine aminotransferase(ALT)level,and longer thrombin time than the non-centrum semiovale EPVS group(P＜0.05,P＜0.01).Mul-tivariate logistic regression analysis showed that hypertension(OR=2.093,95％CI:1.045-4.192,P=0.037)and age(OR=1.071,95％CI:1.016-1.130,P=0.011)were independent influ-encing factors for basal ganglia EPVS,while alcohol consumption(OR=2.418,95％CI:1.097-5.330,P=0.029)and thrombin time(OR=1.593,95％CI:1.129-2.249,P=0.008)were inde-pendent influencing factors for centrum semiovale EPVS.Conclusion EPVS in different regions of AIS patients are associated with distinct risk factors.Age and hypertension are primary influen-cing factors for basal ganglia EPVS,while alcohol consumption and prolonged thrombin time are significant factors for centrum semiovale EPVS.