Abstract To clarify the service targets, service contents, and safeguard mechanisms of the basic public service program for student vision health management, the study grounded in the current status of child and adolescent myopia prevention and control in China and integrated with the practical experience and innovative practices of Wuhan National Demonstration Area for Student Vision Health Management, takes education as the main thread and schools as the base, consolidating resources from multiple stakeholders including education administrative departments, schools, families, and professional technical service institutions. Centering on four core components—vision health education, monitoring and record keeping, risk prevention and control, and dynamic management, the study constructs a multi tiered basic public service system for vision health management of primary and secondary school students. It further proposes the use of an intelligent management platform and a "three tier color coded early warning" mechanism (red, yellow, blue) to prevent and control student myopia at the source, providing schools with replicable and operable implementation pathways to enhance the level of student vision health management.

Objective:To evaluate the cumulative live birth rate (CLBR) and cost-effectiveness of fixed versus adjusted follicle-stimulation hormone (FSH) dosages in infertile women with different ovarian responses during their first assisted reproductive technology (ART) cycle.Methods:A retrospective real-world cohort study was conducted on 5 419 infertile women who underwent their first ART treatment at the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2017. All patients received an individualized starting dosage of gonadotropin. Based on whether FSH dosages were adjusted during controlled ovarian stimulation (COS), patients were divided into fixed-dosage group ( n=2 061) and adjusted-dosage group ( n=3 358). Clinical outcomes and FSH cost-effectiveness were compared between the two groups across different ovarian response groups, with CLBR as the primary outcome. Propensity score matching (PSM) and multivariable logistic regression were used to adjust for potential confounders. Results:FSH dosage adjustments were found in 62.0% (3 358/5 419) of cycles during COS. After PSM, baseline characteristics were comparable between the two groups (all P>0.05). After adjusting for confounders using multivariable logistic regression, FSH dosage adjustment was not significantly associated with CLBR ( OR=1.06, 95% CI: 0.94-1.20, P=0.332). Compared with the adjusted-dosage group, the fixed-dosage group showed no significant differences in CLBR in poor-, normal-, and high-responder groups (all P>0.05). The incidence of ovarian hyperstimulation syndrome (OHSS) did not differ significantly between the two groups ( P>0.05). In poor-, normal-, and high-responder groups, the total FSH dosages in the fixed-dose group [1 350 (375, 1 825) U, 1 200 (375, 1 500) U and 525 (375, 1 128) U, respectively] were significantly lower than those in the adjusted-dose group [1 875 (1 425, 2 294) U, P=0.001; 1 425 (450, 1 875) U, P<0.001; 600 (375, 1 425) U, P=0.020]. Similarly, average FSH costs in different ovarian response groups in the fixed-dosage group [4 725.0 (1 312.5, 6 387.5) yuan, 4 200.0 (1 312.5, 5 250.0) yuan and 1 837.5 (1 312.5, 3 947.3) yuan, respectively] were significantly lower than those in the adjusted-dosage group [6 562.5 (4 987.5, 8 028.1) yuan, P=0.001; 4 987.5 (1 575.0, 6 562.5) yuan, P<0.001; 2 100.0 (1 312.5, 4 987.5) yuan, P=0.020]. For normal-responders, the FSH cost per high-quality embryo in the fixed-dosage group [1 365.0 (875.0, 2 537.5) yuan] was significantly lower than that in the adjusted-dosage group [2 056.3 (1 268.8, 3 412.5) yuan, P<0.001]. Conclusion:FSH dosage adjustment during COS is not associated with CLBR or the incidence of OHSS. However, the fixed-dose group exhibited lower total FSH dosages and costs across different ovarian response populations. In the context of ART being covered by medical insurance, fixed FSH dosage may represent a more cost-effective ovarian stimulation protocol.

Objective To investigate how interference from motor and cognitive tasks affects the postural stability of older adults during stair descent.Methods A total of 52 elderly subjects were recruited.Using the Vicon infrared motion capture system and Kistler force plate,the kinematic and dynamic data were collected simultaneously during stair descent under three conditions:single task(ST),motor task(MT),and cognitive task(CT).The body stability during stair descent was assessed quantitatively using the margin of stability(MoS)algorithm.Repeated measures ANOVA was applied to compare differences across conditions.Results Compared to the ST condition,both step speed(P<0.001)and step frequency(P<0.001)were significantly reduced under MT and CT conditions.Step length(P=0.037)was also significantly reduced under the CT condition compared to those under the ST condition.In the aspect of anterior-posterior dynamic stability,compared to the ST condition,centroid velocity(P<0.001)and extrapolated centroid position(P<0.001)were significantly increased,while MoS(P<0.001)was significantly decreased under both MT and CT conditions.In comparison to the CT condition,centroid displacement(P=0.011)and velocity(P=0.014),as well as extrapolated centroid position(P<0.001),were significantly greater those under the MT condition.In the aspect of medial-lateral dynamic stability,compared to the ST condition,centroid displacement(P<0.001)was significantly reduced under MT and CT conditions.Additionally,the extrapolated centroid position(P=0.001)was significantly reduced,and MoS(P=0.038)was significantly increased under the MT condition compared to those under the ST condition.Conclusions Older adults adjust their gait in response to dual-task interference during stairs descent by'slowing down step speed,reducing step frequency,and shortening step length'.This adjustment helps maintain medial-lateral dynamic stability,but significantly decreases anterior-posterior dynamic stability,thereby increasing the risk of falls.

[Objective]To evaluate the efficacy of different acupuncture therapies in treating patients with insomnia with heart and spleen deficiency,thereby providing evidence-based guidance for clinical practice in selecting optimal treatment regimens.[Methods]A systematic search was performed across China National Knowledge Infrastructure(CNKI),WanFang,China Biomedical Literature Database(SinoMed),China Science and Technology Journal Database(VIP),PubMed,the Cochrane Library,Web of Science and Embase for randomized controlled trials assessing different acupuncture interventions for heart-spleen deficiency insomnia.The retrieval time limit was from the establishment date of the databases to August 2024.Data were analyzed by using Review Manager 5.3 and Stata 17.0 software.[Results]Ultimately,28 studies were included,encompassing 10 distinct acupuncture modalities and involving a total of 2 117 patients.According to the network Meta-analysis,moxibustion,warm acupuncture,acupuncture plus moxibustion,ear acupuncture with moxibustion,as well as ear acupressure beads combined with acupuncture demonstrated superior effectiveness compared with conventional sedative-hypnotic medications in enhancing Pittsburgh sleep quality index(PSQI)scores,and the ranking from high to low was warm acupuncture,ear acupoint pressure bead plus acupuncture,ear acupoint pressure bead plus moxibustion,moxibustion,acupuncture plus moxibustion,electroacupuncture,simple acupuncture,acupoint catgut embedding.Regarding clinical efficacy rates,warm acupuncture,acupuncture plus moxibustion,ear acupoint pressure bead plus acupuncture,pure acupuncture,electroacupuncture,and acupoint catgut embedding exhibited greater efficacy than conventional sedative-hypnotic medications.And the ranking in terms of clinical efficacy was electroacupuncture,warm acupuncture,acupoint catgut embedding,ear acupoint pressure bead plus acupuncture,simple acupuncture,acupuncture plus acupoint injection,acupoint injection,acupuncture plus moxibustion,ear acupoint pressure bead plus moxibustion.[Conclusion]Electroacupuncture can effectively increase the total clinical effective rate of insomnia treatment,warming moxibustion can effectively improve the PSQI score of patients.In clinical practice,an appropriate treatment plan can be selected based on the patient's own condition.

Objective To systematically integrate the qualitative studies on body image experience in breast cancer patients,in order to provide references for the clinical formulation of corresponding intervention programs.Methods Systematical search was conducted for qualitative studies on the body image experiences of breast cancer patients in databases including PubMed,Web of Science,Cochrane Library,CINAHL,PsycINFO,CNKI,WanFang Database,VIP and CBM.The search period was from the establishment of the database to July 2024.The quality of the literature was evaluated using the 2016 edition of the qualitative research appraisal tool from the Evidence-Based Health Care Center of the Joanna Briggs Research Institute in Australia,and the results were integrated using the pooled integration method.Results A total of 14 pieces of the literature were included,and 36 research results were extracted and summarized into 7 new categories.Totally 3 integrated results were obtained,namely the negative impact of changes in body image,patients' self-adjustment and growth,and patients' need for external support.Conclusion Breast cancer patients are plagued by multiple body images.Medical staff should pay attention to the psychological state of patients,do a good job in health education,improve the understanding and support of the society,provide targeted professional guidance,promote the psychological adaptation of patients,meet the emotional needs of patients,establish multiple support systems,and improve the body image and quality of life of patients.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To explore the predictive value of preoperative CT angiography (CTA) for incomplete endothelialization of the occluder after left atrial appendage closure (LAAC) in patients with atrial fibrillation.Methods:The clinical data of 92 atrial fibrillation patients underwent LAAC in the Tangdu Hospital of Air Force Military Medical University from January 2022 to June 2024 were retrospectively analyzed. CTA examinations were performed both before operation and 3 months after operation. Before operation, the long diameter of left atrial appendage opening, short diameter of left atrial appendage opening, area of left atrial appendage opening, diameter of anchoring area and effective depth were measured. After operation, the condition of occluder endothelialization was evaluated, and the patients were divided into the completely endothelialization group and the incomplete endothelialization group. Multivariate Logistic regression analysis was used to analyze the independent risk factors of occluder incomplete endothelialization after LAAC in patients with atrial fibrillation. The predictive value of independent risk factors was evaluated by the receiver operating characteristic (ROC) curve.Results:Among the 92 patients, CTA 3 months after the operation showed that 58 cases had complete occluder endothelialization (complete endothelialization group), and 34 cases had occluder incomplete endothelialization (incomplete endothelialization group). Before operation, the long diameter of left atrial appendage opening, short diameter of left atrial appendage opening, area of left atrial appendage opening and diameter of anchoring area in incomplete endothelialization group were significantly larger than those in complete endothelialization group: (28.35 ± 1.77) mm vs. (26.21 ± 2.21) mm, (22.09 ± 2.01) mm vs. (20.86 ± 1.75) mm, (512.76 ± 63.35) mm 2 vs. (453.83 ± 75.39) mm 2 and (24.71 ± 2.50) mm vs. (23.12 ± 2.40) mm, and there were statistical differences ( P<0.01); there was no statistical difference in effective depth between the two groups ( P>0.05). Multivariate Logistic regression analysis result showed that the long diameter of left atrial appendage opening before operation was an independent risk factor for occluder incomplete endothelialization after LAAC in patients with atrial fibrillation ( OR = 2.141, 95% CI 1.217 to 3.768, P<0.01). ROC curve analysis result showed that the area under the curve of the long diameter of left atrial appendage opening before operation for predicting occluder incomplete endothelialization after LAAC in patients with atrial fibrillation was 0.768 (95% CI 0.674 to 0.862, P<0.01), the optimal cut-off value was 26.5 mm, the sensitivity was 88.2%, and the specificity was 55.2%. Conclusions:A larger long diameter of left atrial appendage opening before operation can lead to occluder incomplete endothelialization after LAAC in patients with atrial fibrillation.

Objective:To evaluate the efficacy of peritoneal dialysis (PD) in the treatment of acute kidney injury (AKI) in critically ill neonates.Methods:It was a retrospective study. The baseline characteristic data, PD protocols, PD catheter placement methods and clinical outcomes of AKI neonates who underwent PD in the General Hospital of Ningxia Medical University between July 2015 and December 2024 were collected and analyzed.Results:(1) Among the 8 neonates with AKI, gestational age was (30.38±6.02) weeks, and birth weight was 1 397.5 (839.0, 2 312.5) g, with 6 premature infants. The time from birth to AKI onset was 144 (48, 294) hours. The leading cause of AKI was sepsis (6/8). The treatment time of PD was (93.12±37.20) hours. (2) Renal function recovery: After PD treatment, urine output was significantly increased ( Z=-3.29, P<0.001), and serum creatinine was significantly decreased ( t=2.66, P=0.032). (3) Hyperkalemia: Six out of 8 patients presented with hyperkalemia, which significantly decreased after PD treatment ( t=3.37, P=0.008). (4) Acid-base balance:Five out of 8 neonates had metabolic acidosis, and 3 of 5 neonates achieved basically complete correction (including lactic acidosis). There was no statistically significant difference in acid-base balance indicators before and after PD treatment (all P>0.05). (5) PD-related complications: Two out of 8 patients experienced peritoneal dialysate leakage, and no other PD-related complications occurred. (6) Outcomes: The hospital stay was 27.0 (8.0, 57.5) days. Four out of 8 neonates survived, while the other 4 neonates died after withdrawal of treatment. The primary cause was multiple organ failure. Conclusions:PD is a safe and effective treatment for neonatal AKI, facilitating early renal recovery and correction of electrolyte and acid-base imbalances.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

OBJECTIVE To analyze the status of targeted monitoring of the health care-associated infections in in-tensive care unit(ICU)of a three-A hospital of northwest China in recent 7 years so as to provide bases for formu-lating effective prevention and control measures for the health care-associated infections.METHODS The related data were successively collected from the ICU hospitalized patients of the Second Affiliated Hospital of Air Force Medical University who were under the targeted monitoring by nosocomial infection real-time monitoring system from Jan.2017 to Dec.2023.The data included the incidence of infections,infection sites,use of catheters,inci-dence of catheter-related infections,and distribution and prevalence trend of pathogens.RESULTS A total of 49,137 hospitalized patients from five ICU wards of respiratory medicine department,neurosurgery department,neurology department,thoracic surgery department and critical care medicine department were under the monito-ring,1446(1681 case-times)of whom had health care-associated infections,with the infection rate 2.94％,the case-time infection rate 3.42％.The respiratory system was the major infection site of the patients with the health care-associated infections.Among the patients with instrument-associated infections,20.70％had ventilator-asso-ciated pneumonia(VAP),5.71％had urinary catheter-associated urinary tract infection(CAUTI),and 1.96％had catheter-related bloodstream infection(CRBSI).Totally 405 strains of non-repetitive pathogens were isolated from 477 patients with instruments-associated infections,78.77％of which were gram-negative bacteria.The iso-lation rate of multidrug-resistant organisms(MDROs)was 44.12％,and Acinetobacter baumannii was the pre-dominant species of pathogen isolated from the patients with VAP.CONCLUSIONS The targeted monitoring of health care-associated infections may facilitate the awareness of dynamic changes of the infections in a accurate and timely manner so as to provide bases for developing effective prevention and control measures for the health care-associated infection.It is necessary to strengthen the prevention and control of the infections in critical care medi-cine department,neurosurgery department as well as the lower respiratory tract infections and prevent the MDROs infection in the meantime.