OBJECTIVES: To develop an early atrial fibrillation (AF) risk prediction model based on large-scale electrocardiogram (ECG) data from the Chinese population. METHODS: The data of multiple ECG records of 30 383 patients admitted in the Chinese PLA General Hospital between 2009 and 2023 were randomly divided into the training set and the internal testing set in a 7:3 ratio. The predictive factors were selected based on the training set using univariate analysis, LASSO regression, and the Boruta algorithm. Cox proportional hazards regression was used to establish the ECG model and the composite model incorporating age, gender, and ECG model score. The discrimination power, calibration, and clinical net benefits of the models were evaluated using the area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curves. RESULTS: The cohort included 51.1% male patients with a median age of the patients of 51 (36, 62) years and an AF incidence of 4.5% (1370/30 383). In the ECG model, the parameters related to the P wave and QRS complex were identified as significant predictors. In the testing set, the AUROC of the ECG model for predicting 5-year AF risk was 0.77 (95% CI: 0.74-0.80), which was increased to 0.81 (95% CI: 0.78-0.83) after incorporating age and gender, with a net reclassification improvement of 0.123 and an integrated discrimination improvement of 0.04 (P<0.05). The calibration curve of the model was close to the diagonal line. Decision curve analysis showed that the clinical net benefit of the composite model was higher than that of the ECG model across the majority of threshold probability. CONCLUSIONS The composite model incorporating quantitative ECG features during sinus rhythm, along with age and gender, can effectively predict AF risk in the Chinese population, thus providing a low-cost screening tool for early AF risk assessment and management.
Humans ; Atrial Fibrillation/epidemiology* ; Electrocardiography ; Middle Aged ; Male ; Female ; China/epidemiology* ; Proportional Hazards Models ; Adult ; Risk Factors ; Risk Assessment ; East Asian People

Hospital caregivers,as crucial auxiliary groups in the healthcare system,face persistent stigmatization rooted in sociocultural and institutional dynamics,leading to diminished professional dignity and distorted service behaviors.This paper explores the social construction and cultural reproduction mechanisms underlying such stigmatization,revealing how internalized stigma and service alienation reinforce each other.Drawing on ethical and structural analysis,the study proposes a dual-path the-oretical framework integrating psychological empowerment and institutional enfranchisement.By enhancing individual resilience and reshaping organizational structures,this integrated approach seeks to reconstruct the occupational identity of care workers and foster an ethical breakthrough in service delivery,ultimately promoting the de-stigmatization and sustainable development of the profession.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

BACKGROUND:Oblique lumber interbody fusion has become a mature lumbar fusion method at present,and its method of assisting lateral screw-rod fixation under the same channel has attracted attention in recent years.However,there is currently no consensus on the optimal intraoperative placement of lateral screw-rod,and there is a lack of relevant biomechanical evidence.OBJECTIVE:To establish various oblique lumber interbody fusion combined with lateral screw-rod fixation models,evaluate their impact on lumbar spine biomechanics,and provide biomechanical foundations for the implantation of lateral screw-rod.METHODS:Using CT images of a healthy adult,the L4-L5 Stand-Alone oblique lumber interbody fusion model and lateral screw-rod fixation models with different screw placement positions were established by using Mimics,Geomagic and SolidWorks software,including nine double screw-rod fixation models and five single screw-rod fixation models.Ansys Workbench software was employed to analyze the range of motion,peak stress of internal fixation and cage under conditions of flexion,lateral bending,and rotation.RESULTS AND CONCLUSION:(1)The range of motion of all internal fixation models was less than Stand-Alone oblique lumber interbody fusion model.Both single screw-rod and double screw-rod showed the least range of motion when placed close to the upper endplates of L4 and L5,and the former had more restrictions on the motion.(2)The peak stress of cage in all internal fixation models was lower than Stand-Alone oblique lumber interbody fusion model.Except for right rotation condition,double screw-rod was minimal cage stress when placed anterior superior and posterior inferior quadrants of L4 and L5,which was similar to that when placed proximaly to L4 lower and L5 upper endplates;screw-rod showed minimal stress when placed proximally to L4 lower and L5 upper endplates.(3)Under flexion-extension condition,double rod-screw exhibited minimal internal fixation stress when positioned close to the upper endplates of L4 and L5;single-rod fixation showed minimal stress when placed proximally to L4 lower and L5 upper endplates.(4)It is indicated that the position of lateral screw-rod is one of the important factors that affect the biomechanical properties of oblique lumber interbody fusion,double screw-rod performs better biomechanical properties than single-rod fixation.The best biomechanical stability can be obtained when double screw-rod is placed close to the upper endplate of the vertebral body.The risk of cage subsidence is greatly reduced when the double screw-rod is placed in the anterior superior and posterior inferior quadrants of the upper and lower vertebrae or adjacent to the upper and lower endplates.

Objective: To investigate the correlation of emotional and behavioral problems with sleep problems in children with cerebral palsy, so as to provide reference for intervention of emotional and behavioral problems in children. Methods: A cross sectional survey was conducted, and 402 children aged 6-18 with cerebral palsy who were adopted by social welfare institutions in Guangzhou City from January 2023 to January 2024 were selected to investigate their full time nurses. The Parents Strengths and Difficulties Questionnaire (SDQ) was used to assess the emotional and behavioral problems of children with cerebral palsy, and the Children s Sleep Habits Questionnaire (CSHQ) was used to assess sleep problems. Multiple linear regression analysis was used to analyze the correlation between the sleep problem of children with cerebral palsy and the emotional and behavioral problems. Results: The prevalence of emotional and behavioral difficulties among children with cerebral palsy was 15.7%. The median sleep problem score of children with emotional and behavioral problems [37.0(36.0, 41.0)] was significantly higher than that of children without emotional and behavioral [35.0(34.0, 36.0)] ( Z =-5.74, P <0.01). The results of multiple linear regression analysis showed that after adjusting covariables such as age, gender, cerebral palsy classification, language retardation, visual impairment and epilepsy, the total sleep problem score of children with cerebral palsy was positively correlated with the total difficulty score ( β= 0.28, 95%CI =0.17-0.34, P <0.05). Conclusions Sleep problems in children with cerebral palsy are associated with emotional and behavioral difficulties. Understanding of the management of sleep problems in children with cerebral palsy should be enhanced to reduce the incidence of emotional and behavioral problems in children with cerebral palsy.

With the rapid advancement of science and technology， human organoid technology has demonstrated immense potential in medical research and treatment， but it has also raised complex ethical issues. Ethical research on human organoid has gradually become a hot field of concern in the international academic community. Taking 262 papers from the Web of Science core database from 2016 to 2024 as a sample， this paper employed bibliometrics and visualization methods to analyze the hotspots and evolutionary trends of international research on the ethics of human organoid. The results showed that international research on the ethics of human organoid exhibited a significant growth trend， going through three phases： a slow accumulation period， a sustained explosion period， and a circuitous growth period. The primary research forces were concentrated in the United States， China， the United Kingdom， and Italy， with China gradually emerging in this domain. The research hotspots were mainly focused on the following aspects. The first was the research of classical ethical issues， encompassing an overview of the overall ethical issues in the research and application of human organoid technology， and the ethical issues of organoid biobanks. The second was the new challenges in ethical issues， including the moral status and ethical governance of brain organoids， embryoid bodies， and gonadal organoids. The third was ethical issues arising from cross-disciplinary applications， covering the ethical challenges posed by chimeras formed through transplanting human brain organoid into non-human animals and hybrids created by connecting human brain organoid with artificial intelligence （AI）， robots， and other non-biological entities. As technology continues to advance， the complexity and importance of ethical issues related to human organoid will persistently increase， and research in this field will continue to deepen and expand in the future.

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

ObjectiveTo improve the quality and service performance of community visual health services in Shanghai, and to establish a set of reasonable and effective evaluation index system for community visual health services. MethodsCentered on the national and Shanghai-based visual health policies and based on the current status and development trends of community visual health service program in Shanghai, the candidate indicators were formed through literature review and expert interviews, firstly. The framework of an evaluation index system was formulated through qualitative research successively, which was further revised and perfected using the Delphi method. Coefficient weights were calculated using the analytic hierarchy process (AHP), culminating in the establishment of the community visual health evaluation index system, lastly. ResultsA total of 22 visual health experts from district-level center for disease control, hospital ophthalmology and leaders in charging of visual health service in community health centers participated in the Delphi questionnaire survey, with a questionnaire recovery rate of 100% and an expert authority coefficient of 0.86, indicating high credibility. After a round of correspondence to experts’ importance ratings and discussions, a comprehensive evaluation index system comprising 3 primary indicators, 12 secondary indicators, and 47 tertiary indicators, along with 5 additional indicators, was finalized. ConclusionAn index system tailored to effective evaluation for community visual health initiatives was drawn up in this study, which can promote the capacity building in community eye health services, facilitating the high-quality development of visual health courses, and enhancing residents’ eye health.

Objective To explore the mediating role of intolerance of uncertainty(IU)and moderating role of the negative emotion differentiation in the influence of perceived stress on anxiety among college students from a cognitive perspective.Methods A total of 271 participants were surveyed using the perceived stress scale,intolerance of uncertainty scale,depression anxiety and stress scale(Chinese version),and the test on negative emotional differentiation.SPSS 22.0 was used to perform descriptive statistics and correlation analyses and to test the moderated mediation model.Results Perceived stress affected anxiety and IU played a mediating role-perceived stress could affect anxiety through influencing IU.At the same time,the influence of IU on anxiety could be adjusted through the negative emotion differentiation.The higher the degree of negative emotion differentiation,the lower the degree of anxiety increase(β=0.17,t=5.70,P＜0.01).Conclusion It may be effective to develop training programs to reduce anxiety by regulating perceived stress,increasing acceptance of uncertainty,and improving the negative emotion differentiation,which can help individuals reduce anxiety by perceiving and adjusting anxiety-related emotional or cognitive factors in a timely manner.

BACKGROUND:Oblique lumber interbody fusion has become a mature lumbar fusion method at present,and its method of assisting lateral screw-rod fixation under the same channel has attracted attention in recent years.However,there is currently no consensus on the optimal intraoperative placement of lateral screw-rod,and there is a lack of relevant biomechanical evidence.OBJECTIVE:To establish various oblique lumber interbody fusion combined with lateral screw-rod fixation models,evaluate their impact on lumbar spine biomechanics,and provide biomechanical foundations for the implantation of lateral screw-rod.METHODS:Using CT images of a healthy adult,the L4-L5 Stand-Alone oblique lumber interbody fusion model and lateral screw-rod fixation models with different screw placement positions were established by using Mimics,Geomagic and SolidWorks software,including nine double screw-rod fixation models and five single screw-rod fixation models.Ansys Workbench software was employed to analyze the range of motion,peak stress of internal fixation and cage under conditions of flexion,lateral bending,and rotation.RESULTS AND CONCLUSION:(1)The range of motion of all internal fixation models was less than Stand-Alone oblique lumber interbody fusion model.Both single screw-rod and double screw-rod showed the least range of motion when placed close to the upper endplates of L4 and L5,and the former had more restrictions on the motion.(2)The peak stress of cage in all internal fixation models was lower than Stand-Alone oblique lumber interbody fusion model.Except for right rotation condition,double screw-rod was minimal cage stress when placed anterior superior and posterior inferior quadrants of L4 and L5,which was similar to that when placed proximaly to L4 lower and L5 upper endplates;screw-rod showed minimal stress when placed proximally to L4 lower and L5 upper endplates.(3)Under flexion-extension condition,double rod-screw exhibited minimal internal fixation stress when positioned close to the upper endplates of L4 and L5;single-rod fixation showed minimal stress when placed proximally to L4 lower and L5 upper endplates.(4)It is indicated that the position of lateral screw-rod is one of the important factors that affect the biomechanical properties of oblique lumber interbody fusion,double screw-rod performs better biomechanical properties than single-rod fixation.The best biomechanical stability can be obtained when double screw-rod is placed close to the upper endplate of the vertebral body.The risk of cage subsidence is greatly reduced when the double screw-rod is placed in the anterior superior and posterior inferior quadrants of the upper and lower vertebrae or adjacent to the upper and lower endplates.