Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

Objective To determine whether an intelligerct cloud platform follow-up model demonstrates superiority over conventional methods in enhancing follow-up quality,reducing costs,and improving functional recovery following total knee arthroplasty(TKA).Methods A retrospective cohort study was conducted on 260 patients undergoing TKA at our hospital from October 2022 to September 2023.According to the different postoperative follow-up methods,they were divided int a cloud platform group(n=130)and a traditional group(n=130).The baseline data,pre-and postoperative knee function scores,and follow-up costs were collected and compared between the 2 groups.Results The cloud platform group exhibited significantly higher rate of follow-up satisfaction,reduced resource utilization,shorter per-follow-up duration,fewer accompanying persons per visit,lower total follow-up expenditures,and decreased cumulative follow-up time when compared with the traditional group(P<0.05).At 6 weeks,3,6,and 12 months postoperatively,better range of motion(ROM)was observed in the cloud-based group than the traditional group(P<0.05),but no intergroup differences were seen in other knee function scores.Conclusion Cloud platform follow-up enhances early postoperative ROM(6 weeks to 12 months)and demonstrates marked cost-effectiveness when compared to the conventional mode.It represents a viable alternative for post-TKA rehabilitation surveillance.

Depression is a high-incidence mental disorder with complex causes and multifaceted pathogenic mechanisms. Its pathogenesis has not yet been fully elucidated， which has hindered the development of novel and highly effective antidepressant drugs. This condition severely affects human physical and mental health while imposing a significant socio-economic burden. At present， several hypotheses exist regarding the pathogenesis of depression， including monoamine neurotransmitter imbalances， neurotrophic factor deficiencies， neural plasticity impairments， glutamate dysregulation， neuroinflammatory disorders， gut microbiota imbalances， and mitochondrial autophagy dysfunction. Currently， most clinical antidepressants are monoamine neurotransmitter reuptake inhibitors. Although they exhibit certain therapeutic effects， they are associated with significant drawbacks， such as severe adverse reactions and poor patient compliance. In contrast， traditional Chinese medicine （TCM）， characterized by its multi-targeted effects， mild efficacy， and minimal side effects， has demonstrated significant advantages in the treatment of depression. Chinese medicine Polygalae Radix possesses the functions of calming the mind， enhancing cognitive functions， harmonizing the heart and kidneys， and dispelling phlegm to open orifices. It is often included in compound prescriptions for the clinical treatment of depression. Based on current hypotheses regarding the pathogenesis of depression， this paper systematically reviews research progress on the antidepressant mechanisms of Polygalae Radix from multiple perspectives， including its active components， its use in herbal pairings， and its inclusion in TCM compound prescriptions. This review aims to provide a scientific basis for the clinical application of Polygalae Radix in antidepressant therapy and to serve as a reference for the modernization of its antidepressant research.

Objective To investigate the changes and clinical value of inflammatory derived indices re-lated to myelosuppression caused by chemotherapy in patients with solid tumors.Methods The clinical data of 189 patients with malignant tumor who received chemotherapy in Jiangxi Cancer Hospital from January 2022 to August 2023 were retrospectively analyzed.According to the grade of myelosuppression,they were di-vided into 0 degree(n=35),Ⅰ degree(n=23),Ⅱ degree(n=31),Ⅲ degree(n=21),Ⅳ degree non-infec-tion(n=51)and Ⅳ degree infection(n=28).The levels of inflammatory index[monocyte(MO),lympho-cyte(LY)],reticulocyte(RET),prealbumin(PA),albumin(ALB),inflammatory infection index[C reactive protein(CRP)and serum amyloid A(SAA)]and complex derived inflammatory index[neutrophil to lym-phocyte ratio(NLR),systemic immunoinflammatory index(SII),systemic inflammatory response index(SI-RI),lymphocyte to C reactive protein ratio(LCR),C reactive protein to albumin ratio(CAR)]were collected and compared in patients with different degrees of myelosuppression.The correlation between each index and myelosuppression score was analyzed,and the influencing factors of myelosuppression after chemotherapy in tumor patients were analyzed by multivariate logistic regression.Results With the severity of myelosuppres-sion,the levels of MO,LY,SII,SIRI and LCR decreased gradually and showed a downward trend(P＜0.05).The levels of CRP,SAA and CAR were increased gradually(P＜0.05).RET and PA levels were decreased when myelopathic depression reached Ⅲ degree or above(P＜0.05).When myelosuppression reached gradeⅣ and above,the level of NLR decreased(P＜0.05).CRP,SAA and CAR were positively correlated with my-elosuppression degree,while MO,LY,RET,PA,NLR,SII,SIRI and LCR were negatively correlated with my-elosuppression degree(P＜0.05).The results of multivariate logistic regression analysis showed that LY and NLR were the influencing factors of myelosuppression caused by chemotherapy in tumor patients(P＜0.05).Conclusion Myelosuppression caused by solid tumor chemotherapy can lead to a continuous decline in the body's anti-tumor immunity.Deep myelosuppression is unfavorable to the prognosis of patients,and infection can promote the development of tumors and lead to poor prognosis.

L-valine is an important essential branched-chain amino acid widely used in industries such as feed, pharmaceuticals, and food. In order to further enhance the production performance of L-valine, this study systematically engineered the metabolism of a Corynebacterium glutamicum strain, preserved in the laboratory, which is capable of producing L-valine. First, strain VH-9 was obtained by enhancing the precursor supply, synthesis pathway, and transport system of L-valine. In a 5 L fermenter, the titer, yield, and productivity of L-valine were 76.6 g/L, 0.45 g/g, and 2.39 g/(L·h), respectively. Furthermore, strain VH-18 was obtained by enhancing the uptake of substrate glucose and balancing energy supply to reduce succinate accumulation, with the titer, yield, and productivity of L-valine increased to 82.7 g/L, 0.52 g/g, and 2.58 g/(L·h), respectively. After optimization of fermentation conditions, the titer, yield, and productivity of L-valine in strain VH-18 were further improved to 88.7 g/L, 0.54 g/g, and 2.77 g/(L·h), respectively. This study has achieved the high-efficiency production of L-valine through a systems metabolic engineering strategy.
Corynebacterium glutamicum/genetics* ; Metabolic Engineering/methods* ; Valine/biosynthesis* ; Fermentation ; Glucose/metabolism*

BACKGROUND: Previous evidence showed that ambient air pollution and cardiovascular mortality are related. However, there is a lack of evidence towards the modification effect of long-term lifestyle on the association between short-term ambient air pollution and death from cardiovascular events. METHOD: A total of 14,609 death from major adverse cardiovascular events (MACE) were identified among the China Kadoorie Biobank participants from 2013 to 2018. Ambient air pollution exposure including particulate matter 2.5 (PM_2.5), SO₂, NO₂, CO, and O₃ from the same period were obtained from space-time model reconstructions based on remote sensing data. Case-crossover design and conditional logistic regression was applied to estimate the effect of short-term exposure to air pollutants on MACE mortality. RESULTS: We found MACE mortality was significantly associated with PM_2.5 (relative percent increase 2.91% per 10 µg/m³ increase, 95% CI 1.32-4.53), NO₂ (5.37% per 10 µg/m³ increase, 95% CI 1.56-9.33), SO₂ (6.82% per 10 µg/m³ increase, 95% CI 2.99-10.80), and CO (2.24% per 0.1 mg/m³ increase, 95% CI 1.02-3.48). Stratified analyses indicated that drinking was associated with elevated risk of MACE mortality with NO₂ and SO₂ exposure; physical inactivity was associated with higher risk of death from MACE when exposed to PM_2.5; and people who had balanced diet had lower risk of MACE mortality when exposed to CO and NO₂. CONCLUSIONS The study results showed that short-term exposure to ambient PM_2.5, NO₂, SO₂, and CO would aggravate the risk of cardiovascular mortality, yet healthy lifestyle conduct might mitigate such negative impact to some extent.
Humans ; Cardiovascular Diseases/epidemiology* ; China/epidemiology* ; Male ; Female ; Air Pollution/adverse effects* ; Middle Aged ; Air Pollutants/analysis* ; Particulate Matter/analysis* ; Environmental Exposure/adverse effects* ; Life Style ; Aged ; Adult ; Risk Factors ; Cross-Over Studies ; East Asian People

Objective To investigate the microstructural changes of white matter in patients with relapsing-remitting multiple sclerosis(RRMS)and its correlation with clinical functional scores.Methods A total of 20 patients with RRMS(RRMS group)and 20 healthy controls(HC)(HC group)were selected and underwent diffusion tensor imaging(DTI)and expanded disability status scale(EDSS)scores.Patients with RRMS were categorized into two groups based on their EDSS scores,including MS-1 group(motor dysfunction with visual impairment)and MS-2 group(motor dysfunction).Image processing was performed via tract-based spatial statistics(TBSS).Group comparisons were executed using the t-test,while correlations were analyzed utilizing Spearman correlation.Results In the RRMS group,reduced fractional anisotropy(FA)values were accompanied by increased mean diffusivity(MD)and radial diffusivity(RD)values in the forceps major,forceps minor,bilateral cingulum,bilateral uncinate fasciculus,bilateral superior longitudinal fasciculus,bilateral inferior longitudinal fasciculus,bilateral inferior fronto-occipital fasciculus,bilateral corticospinal tract and bilateral anterior thalamic radiation compared with the HC group.Additionally,In the RRMS group,increased axial diffusivity(AD)values were noted in the forceps major,forceps minor,bilateral superior longitudinal fasciculus(temporal),right inferior fronto-occipital fasciculus,bilateral corticospinal tract and right anterior thalamic radiation compared with the HC group.Compared with the MS-2 group,the MS-1 group exhibited higher FA values in the right cingulum(cingulate gyrus part)and higher AD values in the left cingulum(cingulate gyrus part).Correlation analysis revealed negative correlations between the FA values of the forceps major,right superior longitudinal fasciculus and the motor function scores in RRMS group.Conversely,positive correlations were identified between the MD values of the forceps minor,right superior longitudinal fasciculus,right inferior fronto-occipital fasciculus,left corticospinal tract and the RD values of the forceps minor,right cingulum(hip-pocampus),right superior longitudinal fasciculus,and left corticospinal tract,as well as the motor function scores.Conclusion RRMS patients exhibit microstructural damage in white matter and are associated with motor dysfunction,which provides imaging support for the pathological mechanisms underlying motor dysfunction in RRMS patients.

Objective:To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOCO) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:From January 2019 to December 2021, 233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital. The median follow-up duration was 3.9 years. The 367 non-culprit vessels of the 233 patients were divided into the VOCO group (33 vessels, 9.0%) and the non-VOCO group (334 vessels, 91.0%). Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared. Receiver operating characteristic (ROC) curves were used to assess the correlation between hemodynamic pattern and VOCO, and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results:The 233 enrolled patients were aged (62.5±12.9) years, with 193 males (82.8%). In the VOCO group, the maximum quantitative flow ratio (QFR) decreased within 20 mm of the QFR-assessed segment, the difference in QFR across the entire vessel, the length of functionally significant vessel, and the maximum gradient of QFR decrease (dQFR/dsmax) were significantly greater than those in the non-VOCO group. ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.009 6 (area under the curve: 0.691, 95% CI: 0.606-0.775, P<0.001). Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO ( HR=1.199, 95% CI: 1.070-1.343, P=0.002). When anatomical and functional stenosis severities were included in the model, a high pullback pressure gradient (PPG) index ( HR=1.572, 95% CI: 1.052-2.351, P=0.027) emerged as an independent predictor of VOCO. Multivariable logistic regression analysis revealed that a low PPG index( OR=2.851, 95% CI: 1.945-4.178, P<0.001) was an independent predictor of QFR≤0.80 without long-term VOCO. Conclusion:In patients with STEMI, localized hemodynamic patterns of coronary artery stenosis, characterized by high dQFR/dsmax and high PPG index, are associated with long-term VOCO.

Promoting the construction of compact urban medical group has become an important part of building a high-quality,efficient,equitable,and accessible integrated integrated medical service system.Based on the policy orientation of the state to promote the construction of compact urban medical groups,it selects typical practical cases from Minhang(Shanghai),Luohu(Shenzhen),Hefei,and Qiqihar.lt analyzes their current explorations in organizational models and operational mechanisms,summarizes the main challenges they face,and accordingly proposes targeted optimization pathways,aiming to provide a reference for optimizing integrated medical service systems and forming establishing a orderly medical seeking system.