Objective By exploring the establishment of a follow-up and pre-visit model,this study aims to facilitate the development of a modernized Chinese medical service model for public hospitals,characterized by optimized workflows,continu-ous care models,efficient services,comfortable environments,and patient-centered attitudes,thereby improving patient experi-ence and enhancing the quality of outpatient follow-up visits.Methods Under the value co-creation framework,with both healthcare providers and patients as core value stakeholders,this program introduced a self-service examination appointment plat-form,established a follow-up and pre-visit process,and implemented time-slot-based appointments for diagnosis and treatment.These steps aim to promote the equitable allocation of medical resources and refine the follow-up and pre-visit model in public hospitals.Results Implementation at Hospital P demonstrated that after process reengineering,patients'average in-hospital time reduced by nearly 135 minutes,significantly enhancing treatment efficiency,satisfaction levels among both medical staff and patients,and accessibility of medical services.Conclusion Grounded in value co-creation theory,the follow-up and pre-visit model of Hospital P is divided into three stages:mutual value positioning of both doctors and patients,collaborative value crea-tion,and sustained value continuation for both.This alignment between process reengineering goals and value co-creation out-comes helps improve the quality of medical services,better meet the medical needs of patients,and achieve a win-win scenario for both doctors and patients.

It is proposed that the essence of the half-interior half-exterior theory of the membrane-source lies in the concept of the interstitial space being half-interior half-exterior. Through analysis of classical medical texts and commentaries by renowned physicians， the relationship between the membrane-source interstitial layer and the Governor Vessel （督脉） is explored. It is argued that the Governor Vessel traverses beyond the membrane-source interstitial half-interior half-exterior layer， and that this layer is related to， but distinct from， the shaoyang channel's half-interior half-exterior characteristic. By examining both historical and modern clinical approaches， further evidence is provided to support the view that the Governor Vessel passes outside this interstitial layer. Based on this relationship， treatment principles and prescriptions for Governor Vessel-related disorders are referenced to formulate strategies for membrane-source disorders， offering new perspectives for addressing complex and difficult clinical conditions.

It is proposed that both "skin interior-membrane exterior" （the region between the skin and membranes） and "membrane-source" are objective parts of human body. Based on relevant ancient texts， interpretations by physicians， and clinical characteristics of diseases， we analysed the relationship between skin interior-membrane exterior and membrane-source， and proposed that skin interior-membrane exterior is essentially equivalent to membrane-source， with skin interior-membrane exterior offering a clearer expression of the meaning. The medicinal practices and prescriptions recorded in materia medica and classical formulas provide evidence to support that skin interior-membrane exterior is same as membrane-source. Based on the researches on their relationship， the formula groups for the treatment of membrane-source diseases developed， potentially expanding the clinical applications of membrane-source formulas and offering new approaches to the diagnosis and treatment of complex diseases in clinic.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective By exploring the establishment of a follow-up and pre-visit model,this study aims to facilitate the development of a modernized Chinese medical service model for public hospitals,characterized by optimized workflows,continu-ous care models,efficient services,comfortable environments,and patient-centered attitudes,thereby improving patient experi-ence and enhancing the quality of outpatient follow-up visits.Methods Under the value co-creation framework,with both healthcare providers and patients as core value stakeholders,this program introduced a self-service examination appointment plat-form,established a follow-up and pre-visit process,and implemented time-slot-based appointments for diagnosis and treatment.These steps aim to promote the equitable allocation of medical resources and refine the follow-up and pre-visit model in public hospitals.Results Implementation at Hospital P demonstrated that after process reengineering,patients'average in-hospital time reduced by nearly 135 minutes,significantly enhancing treatment efficiency,satisfaction levels among both medical staff and patients,and accessibility of medical services.Conclusion Grounded in value co-creation theory,the follow-up and pre-visit model of Hospital P is divided into three stages:mutual value positioning of both doctors and patients,collaborative value crea-tion,and sustained value continuation for both.This alignment between process reengineering goals and value co-creation out-comes helps improve the quality of medical services,better meet the medical needs of patients,and achieve a win-win scenario for both doctors and patients.

The presence of magnetic fields in a magnetic resonance accelerator (MR-linac) can affect the reference dosimetry, and thus the existing Code of Practices (CoPs) are inadequate for MR-linac. In this article, the characteristics of adsorbed dose to water and ionization chamber response in the presence of magnetic fields were introduced and a formalism for reference dosimetry in MR-linac was developed based on the existing CoPs, aiming to provide reference for dosimetric quality control and research work of MR-linac in China.

To investigate the mediating role of vitamin D in the association between exerciseand triglyceride among adolescents, as well as its potential molecular mechanisms.

Objective:To analyze the risk factors of in-hospital mortality in patients with femoral neck fracture and establish a prediction model for in-hospital mortality.Methods:From 2014 to 2023, a total of 4,028,102 hospitalized patients from six directly affiliated hospitals and two co-constructed affiliated hospitals of Peking University were retrospectively analyzed. Among them, 4,744 patients were hospitalized with femoral neck fractures, including 1,486 males and 3,258 females, aged 74±13.3 years (range, 19-103 years). Gender, age, length of hospital stay, hospitalization costs, preoperative comorbidities, treatment methods, anesthesia methods, and in-hospital mortality were extracted from the medical records. According to the presence or absence of in-hospital death, the patients were divided into death group and survival group. The differences in general data and clinical indicators between the two groups were compared, and the indicators with statistically significant differences were included in binary logistic regression analysis to screen the risk factors for in-hospital death in patients with femoral neck fracture. The receiver operating characteristic (ROC) curve for predicting in-hospital mortality of femoral neck fracture was drawn, and the area under the curve (AUC) was calculated.Results:There were 30 cases in the death group and 4,714 cases in the survival group, with a mortality rate of 0.63%. Among the dead patients, 20 had undergone hip replacement, and 10 had received non-surgical treatment. In the death group, age ( t=7.524, P<0.001), length of hospital stay ( t=3.802, P<0.001), hospitalisation cost ( t=3.961, P<0.001), rate of non-surgical treatment ( P<0.001), anaesthesia modality ( P=0.002), dementia ( P=0.045), malignant tumour ( P<0.001), renal insufficiency (χ 2=27.901, P<0.001), hypertension (χ 2=4.155, P=0.042), cerebral infarction (χ 2=8.271, P=0.004), urinary infections ( P=0.043), electrolyte disorders (χ 2=16.660, P<0.001), post-cholecystectomy ( P=0.070), abnormal liver function ( P=0.015), schizophrenia ( P=0.062), myocardial infarction (χ 2=19.057, P<0.001), diabetes mellitus with end-organ damage ( P=0.036), congestive heart failure (χ 2=93.122, P<0.001), and chronic obstructive pulmonary disease (χ 2=27.714, P<0.001) were greater than in the survival group, and the differences were statistically significance ( P<0.10). Bicategory logistic regression analysis showed age ( OR=1.08, P=0.008), non-surgical treatment ( OR=2.87, P=0.017), combined malignancy ( OR=9.35, P<0.001), renal insufficiency ( OR=4.07, P=0.004), hypertension ( OR=4.45, P=0.007), cerebral infarction ( OR=2.42, P=0.040), electrolyte disorders ( OR=4.29, P=0.009), schizophrenia ( OR=41.23, P=0.002), chronic obstructive pulmonary disease ( OR=3.84, P=0.002), and congestive heart failure ( OR=7.08, P<0.001) were the independent risk factors for in-hospital mortality of femoral neck fracture. The AUC and its 95% confidence interval (CI) for the predictive model were 0.908(0.84, 0.97), indicating excellent predictive value. Conclusion:Elderly, non-surgical treatment, malignant tumor, renal insufficiency, hypertension, cerebral infarction, electrolyte disturbance, schizophrenia, chronic obstructive pulmonary disease, congestive heart failure are associated with higher in-hospital mortality in patients with femoral neck fracture.

Objective:To screen high risk children for lysosomal storage diseases (LSD) in southern China and analyze the spectrum characteristics of LSD in this region.Methods:A cross-sectional study was conducted. A total of 7 435 children at high risk of LSD were screened at Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from January 2009 to December 2024. The activities of 22 lysosomal enzymes from peripheral blood leukocytes or plasma were measured by fluorescence or colorimetric assays with synthetic substrates to screen for 24 LSD subtypes.Results:Among the 7 435 high risk children, 759 children were diagnosed with LSD (10.2%). The diagnosed cases included 506 males and 253 females, with an age at diagnosis of 3.0 (2.5, 5.5) years. The common disease types were mucopolysaccharidosis (MPS) (390 cases (51.4%)), sphingolipidoses (269 cases (35.4%)), glycogen storage disease (62 cases (8.2%)), and mucolipidosis types Ⅱ and Ⅲ (29 cases (3.8%)). Among the positive cases, 21 disease subtypes were identified. The 5 frequent subtypes, in descending order, were MPS type Ⅱ (197 cases (26.0%)), Gaucher disease (111 cases (14.6%)), MPS type ⅣA (87 cases (11.5%)), glycogen storage disease type Ⅱ (62 cases (8.2%)), and metachromatic leukodystrophy (MLD) (49 cases (6.5%)). The rarest subtypes were mannosidosis, multiple sulfatase deficiency and Wolman disease, each with 1 case (0.1%).Conclusions:Enzyme activity screening is essential for diagnosing high risk children with LSD. In Southern China, the most common LSD subtypes are MPS Ⅱ, Gaucher disease, MPS ⅣA, glycogen storage disease type Ⅱ, and MLD, while mannosidosis, multiple sulfatase deficiency and Wolman disease are the rarest.

Objective:To compare the clinical outcomes of reconstruction of oral and maxillofacial soft tissue defects using superficial circumflex iliac artery perforator flap （SCIA PF） and radial forearm free flap （RFF）. Methods:A retrospective analysis was conducted on 90 patients with head, neck, and maxillofacial tumors who were treated in our department from June 2019 to January 2024. Patients were divided into two groups based on the surgical method used: the SCIA group（n=45）, who underwent reconstruction with SCIA PF, and the RFF group（n=45）, who received RFF reconstruction. Six months postoperatively, clinical efficacy was evaluated by comparing flap swelling, flap survival rate, and patient satisfaction. Oral function was assessed using standardized scoring systems before surgery, at 1 week, 3 months, and 6 months post-surgery. Hemorheological parameters, including high-shear viscosity（shear rate 200/s）, low-shear viscosity（shear rate 30/s）, plasma viscosity, erythrocyte aggregation index, and erythrocyte sedimentation rate（ESR）, were also measured at each time point. Results:Compared with the RFF group, the SCIA group showed significantly larger flap size, longer flap harvesting and reconstruction times, earlier nasogastric tube removal and oral intake initiation, higher scores in all aspects of oral function, reduced flap edema and faster resolution, higher flap survival rates, and greater overall satisfaction （all P<0.05）. During the follow-up period （preoperative, 1 week, 3 months, and 6 months post-surgery）, hemorheological indices including high-and low-shear viscosity, plasma viscosity, erythrocyte aggregation index, and ESR progressively decreased in the SCIA group （P<0.05）. In the RFF group, these parameters improved significantly by 6 months postoperatively compared with preoperatively and 1-week postoperatively, with a notable decrease in erythrocyte aggregation index at 6 months （P<0.05）. Conclusion:Compared with RFF, SCIA PF provides larger flaps, better functional recovery, higher patient satisfaction, improved flap survival, fewer complications, and more favorable hemorheological profiles following reconstructive surgery for oral and maxillofacial defects.
Humans ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Free Tissue Flaps ; Iliac Artery/transplantation* ; Forearm/surgery* ; Male ; Female ; Soft Tissue Injuries/surgery* ; Head and Neck Neoplasms/surgery* ; Middle Aged ; Treatment Outcome ; Adult