Objective To construct a quality evaluation index system for non-medical technical services in public hospitals,aiming to provide a more scientific and feasible basis for evaluating patient service quality.Methods Based on literature research,the SERVQUAL theory was used to preliminarily formulate a comprehensive and full-cycle evaluation index for patient service quality.The final evaluation index system was determined through expert consultation,and the Analytic Hierarchy Process was used to determine the weights of the evaluation indices.Results The questionnaire response rates for the two rounds of expert consultation were both 100％.The authority coefficients of the experts were 0.82 and 0.80,respectively,indicating a high level of expert authority.The Kendall's W coefficient increased from 0.088 to 0.107 between the two rounds,and the difference was statistically significant (P<0.001),indicating good consistency of expert opinions.The consistency results of each judgment matrix were less than 0.1,passing the consistency test.The final evaluation index system consisted of six primary indicators (tangibility,reliability,responsiveness,assurance,empathy,and continuity) and 33 secondary indicators.Conclusion The selection of evaluation indicators revolves around the core service processes of outpatient,inpatient,and other hospital services,focusing on key elements at various critical junctures that influence patient experience.The evaluation indicators aim to guide hospitals to improve not only essential needs but also desired improvements in service quality,thus promoting the continuous enhancement of hospital services.

Objective To explore the value of dual-energy CT Bone Marrow Edema in quantitatively evaluating the timing of rib fracture evolution.Methods Sixty patients with thoracic trauma were scanned by dual-energy CT.Using CT Bone Marrow Edema technique,bone marrow CT values were standardized and quantified in both the Bone Marrow Edema area at the rib fracture site and in normal areas 1 cm on both sides of the fracture.The increments of standardized CT values for Bone Marrow Edema and VNCa were obtained for three stages of healing.The numerical variables were statistically described,and both the standardized CT value increments and VNCa standardized CT value increments were compared between the three stages and between each pair of stages.Diagnostic efficacy for stages with significant differences was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),and Cut-offvalues were calculated.Results There were significant differences in standardized CT value increments and VNCa standardized CT value increments across the three stages of Bone Marrow Edema(H=10.788,p=0.005;F=115.787,p=0.000).The standardized CT value increment of Bone Marrow Edema showed significant differences between the cartilaginous callus stage(fibrous callus stage)and the bony callus-remodeling stage(H=54.958,p=0.003),while the other pairwise comparisons showed no statistical significance(H=-25.603,p=0.183;H=29.354,p=0.113,respectively).However,the VNCa standardized CT value increments showed statistical significance across all three pairwise comparisons(all p=0.000).The ROC curve for differentiating the cartilaginous callus stage(fibrous callus stage)from the bony callus-remodeling stage using Bone Marrow Edema standardized CT value increment had an AUC of 0.652,with a Cut-offvalue of 81.575 Hu.The ROC curve for distinguishing the hematoma inflammation stage from the cartilaginous callus stage(fibrous callus stage)using VNCa standardized CT value increment had an AUC of 0.668,with a Cut-offvalue of 55.700 Hu.The ROC curve for differentiating the cartilaginous callus stage(fibrous callus stage)from the bony callus-remodeling stage using VNCa standardized CT value increment had an AUC of 0.905,with a Cut-offvalue of 37.625 Hu.Conclusion Dual-energy CT Bone Marrow Edema can quantitatively evaluate the timing of rib fracture evolution,and the differences in standardized CT value increments at different stages can provide a theoretical basis for forensic identification of fractures at different time periods.The Cut-offvalues of standardized CT value increments can,to some extent,predict the time stage of a fracture,providing quantitative evidence for forensic experts in the identification of rib fractures.

Objective To investigate the impact of aortic valve calcification on ascending aortic elasticity.Methods A total of 103 patients with aortic valve calcification indicated by coronary computed tomography angiography(CCTA)(calcification group),and 101 patients without aortic valve calcification(non calcification group)were selected.The calcification group was subdivided into group A,group B,and group C based on the number of calcified leaflets.The original data was automatically reconstructed at 5％R-R intervals throughout the cardiac cycle.Cross-sectional area and diameter of the ascending aorta were measured at 45 mm above the annulus,and four ascending aortic elasticity indicators aortic(％A),aortic distensibility(AD),aortic compliance(AC)and aortic stiffness index(ASI)were calculated.Agatston method was used to calculate the aortic valve calcification score.The effect of aortic valve calcification on the elasticity of the ascending aortic and its correlation were analyzed.Results The％A,AD,and AC of the calcification group were lower than those of the non calcification group,but the ASI was higher than that of the non calcification group,the difference was statistically significant(P＜0.05).The number of calcified leaflets affected ascending aortic elasticity,with comparisons between groups A and B,the difference was no statistically significant(P＞0.05),groups A and C,and groups B and C,the difference was statistically significant(P＜0.05).Calcification score was negatively correlated with％A,AD,and AC,and positively correlated with ASI.Conclusion Aortic valve calcification can affect the elasticity of the ascending aortic,and more than two calcified leaflets have more significant effects on the elasticity of the ascending aortic.

BACKGROUND:One of the main goals after anterior cruciate ligament reconstruction is to restore normal gait patterns.However,to date,a limited number of studies have examined changes in gait asymmetry after anterior cruciate ligament reconstruction.OBJECTIVE:To explore asymmetric changes in knee kinematics and dynamics under different stride length conditions.METHODS:Thirty subjects(15 males and 15 females)3 months after anterior cruciate ligament reconstruction of the single knee were included in this study.Among them,each subject received the walking test with three different stride lengths,a normal stride length and a 30％as well as a 50％increase in the normal stride length.Knee kinematic and kinetic indices were collected by means of an Italian BTS infrared motion capture system and a dynamometer table,where kinematic indices included knee flexion,extension,and adduction angles,and kinetic indices included ground reaction forces,knee flexion moments,knee extension moments,and knee adduction moments.The asymmetry index values of the kinematic and kinetic indices were calculated.A one-way analysis of variance was used to compare the differences in asymmetry of each parameter under different stride length conditions.RESULTS AND CONCLUSION:(1)Compared with the asymmetry indices of normal step length,the indices of knee flexion angle,knee flexion moments,knee adduction moments,knee extension moments,and ground reaction forces were significantly lower when the step length was increased by 30％(P＜0.05);the indices of knee adduction angle,knee flexion angle,knee extension angle,knee adduction moments,knee extension moments,knee flexion moments,and ground reaction forces were significantly lower when the step length was increased by 50％(P＜0.05).(2)When the step length was increased by 50％,the indexes of knee adduction angle,knee extension moments,and ground reaction forces were significantly lower than when the step length was increased by 30％(P＜0.05).(3)These findings suggest that increasing stride length improves gait asymmetry after anterior cruciate ligament reconstruction,but an increase of 50％is superior,which in turn relieves the loads placed on the anterior cruciate ligament during walking.Meanwhile,step length can be used as an adjustable variable in gait to prevent and relieve symptoms of pain,improve knee function,and enhance quality of life in patients with post-anterior cruciate ligament reconstruction injuries in future clinical work.

BACKGROUND:Unilateral knee osteoarthritis patients experience abnormal alterations in lower extremity gait biomechanics,yet few studies have analyzed changes in gait dynamics and muscle activation in knee osteoarthritis patients from the perspective of gait asymmetry.OBJECTIVE:To explore the effects of unilateral knee osteoarthritis on gait dynamics and muscle activation asymmetry in elderly women.METHODS:Thirty female patients with unilateral knee osteoarthritis attending Beijing Jishuitan Hospital Guizhou Hospital from October 2023 to March 2024 were selected as the knee osteoarthritis group,and 30 healthy elderly females without musculoskeletal disorders from the neighboring community were recruited as the control group.The kinetic and muscle activation levels of the subjects in both groups during walking were synchronously collected by a P-6000 force platform and a Free EMG300 surface EMG device.Kinetic parameters included the first and second peak forces of vertical ground reaction force.Muscle activation indexes included normalized root mean square values of rectus femoris,long head of biceps femoris,and lateral gastrocnemius muscle during the braking and pushing phases.Asymmetry index of the kinetic and muscle activation indexes were calculated separately in patients with K-L grade Ⅱ and Ⅲ knee osteoarthritis and controls and compared between groups by independent samples t-test and one-way analysis of variance.RESULTS AND CONCLUSION:(1)The difference between the second peak of vertical ground reaction force of both limbs in the knee osteoarthritis group was statistically significant(P＜0.05),as well as the difference between the standardized root mean square of rectus femoris in the braking phase and gastrocnemius and biceps femoris in the pushing phase(P＜0.05).(2)In terms of asymmetry index,the difference between the asymmetry index values of the first peak of vertical ground reaction force between the two groups of subjects was not statistically significant(P＞0.05),while the difference between the second peak asymmetry index values was statistically significant(P＜0.05).The difference in asymmetry index values of standardized root mean square of rectus femoris muscle during the braking phase as well as gastrocnemius and biceps femoris muscles during the pushing phase was statistically significant between the two groups of subjects(P＜0.05).(3)The asymmetry index of the standardized root mean square values of the second peak of vertical ground reaction force,rectus femoris in the braking phase,gastrocnemius in the pushing phase,and biceps femoris in the osteoarthritis group of the knee with K-L classification grade Ⅱand Ⅲ were significantly higher than those of the control group(P＜0.05).The asymmetry indices of standardized root mean square values of the second peak of vertical ground reaction force,rectus femoris in the braking phase and biceps femoris in the pushing phase were higher in the osteoarthritis group of the knee with K-L classification Ⅲ than in the osteoarthritis group of the knee with classification Ⅱ(P＜0.05).(4)The asymmetry indices of the second peak of vertical ground reaction,the rectus femoris muscle in the braking phase,and the muscle activation of the biceps femoris and gastrocnemius muscles in the pushing phase can be used as an important index for identifying gait asymmetry in the knee osteoarthritis,which is helpful in providing a theoretical basis for the development of rehabilitation treatment programs.It is also worth noting that extra attention should be paid to patients with higher severity of knee osteoarthritis in the clinical monitoring of gait asymmetry.

Objective To investigate the impact of aortic valve calcification on ascending aortic elasticity.Methods A total of 103 patients with aortic valve calcification indicated by coronary computed tomography angiography(CCTA)(calcification group),and 101 patients without aortic valve calcification(non calcification group)were selected.The calcification group was subdivided into group A,group B,and group C based on the number of calcified leaflets.The original data was automatically reconstructed at 5％R-R intervals throughout the cardiac cycle.Cross-sectional area and diameter of the ascending aorta were measured at 45 mm above the annulus,and four ascending aortic elasticity indicators aortic(％A),aortic distensibility(AD),aortic compliance(AC)and aortic stiffness index(ASI)were calculated.Agatston method was used to calculate the aortic valve calcification score.The effect of aortic valve calcification on the elasticity of the ascending aortic and its correlation were analyzed.Results The％A,AD,and AC of the calcification group were lower than those of the non calcification group,but the ASI was higher than that of the non calcification group,the difference was statistically significant(P＜0.05).The number of calcified leaflets affected ascending aortic elasticity,with comparisons between groups A and B,the difference was no statistically significant(P＞0.05),groups A and C,and groups B and C,the difference was statistically significant(P＜0.05).Calcification score was negatively correlated with％A,AD,and AC,and positively correlated with ASI.Conclusion Aortic valve calcification can affect the elasticity of the ascending aortic,and more than two calcified leaflets have more significant effects on the elasticity of the ascending aortic.

Cerebral proliferative angiopathy(CPA)was initially regarded as a variant of arteriovenous malformation.However,its distinct histological,angiographic,and pathophysiological features have led to its reclassification as an independent entity.CPA is an exceptionally rare form of cerebral vascular malformation,its pathogenesis is primarily linked to diffuse vascular proliferation secondary to chronic hypoperfusion.Clinically,CPA presents with a heterogeneous spectrum of manifestations,most commonly severe headaches and epileptic seizures.Neuroimaging(MR)typically reveals a complex interplay of aberrant vessels within the brain parenchyma,which may complicate the clinical management and lead to a higher rate of poor prognosis.This article reviewed current knowledge on the pathogenesis,epidemiology,clinical features,diagnostic approaches,and treatment options for CPA,with the aim of enhancing understanding of its underlying mechanisms and guiding future therapeutic strategy optimizations.

BACKGROUND:In recent years,the use of blood flow restriction training in the rehabilitation of ankle injuries has gradually increased,and this technique can improve muscle strength,and can achieve a similar effect of high-load resistance training when combined with low-intensity resistance training. OBJECTIVE:To elucidate the current application status of blood flow restriction training in the prevention and rehabilitation of foot and ankle injuries. METHODS:A literature search was conducted on CNKI,PubMed,and Web of Science databases. The Chinese search terms were "blood flow restriction training,pressure training,ankle,ankle joint," and the English search terms were "blood flow restriction,BFR,KAATSU,ankle,foot." Relevant literature from database inception to July 2023 was retrieved,and 50 articles were ultimately included according to inclusion and exclusion criteria. RESULTS AND CONCLUSION:In foot and ankle applications,blood flow restriction training is primarily used in studies of Achilles tendon thickness and ankle muscle strength in healthy individuals,as well as in chronic ankle instability,after Achilles tendon ruptures,and after external ankle fractures. Single blood flow restriction training can reduce the thickness of Achilles tendon in healthy individuals,while long-term training can make it thicker. Blood flow restriction training can prevent muscle strength decline in healthy individuals,while low-intensity blood flow training can promote ankle muscle strength recovery in injured patients. In current research,few adverse events related to blood flow restriction have been found,and future research should compare the efficacy of different training programs in different populations and optimize the research content.

Objective:To address the critical issue of missing dynamic border molding information in edentulous direct digital impression technology, this study explores innovative digital solutions and conducts preliminary application validation.Methods:Based on the myostatic line theory, a methodology was established: intraoral scanner (IOS) high-frequency video was utilized to dynamically capture functional molding data of soft tissues, integrated with a self-developed mobility gradient recognition algorithm to achieve dynamic threshold segmentation between the muscle dynamic zone and myostatic zone, termed "optical digital molding technology". Ten edentulous patients with well-fitting complete dentures, treated at the Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2024 to December 2024, were enrolled. The standard deviation between the muscle static line (generated by mobility gradient algorithm with thresholds of 0.3-0.7 mm) and the denture border curve was analyzed to optimize the dynamic threshold, followed by single-case clinical validation.Results:Among the mobility thresholds of 0.3-0.7 mm, the 0.5 mm threshold yielded the smallest standard deviation between the myostatic line and denture border. Clinical validation demonstrated that dentures designed with this threshold exhibited no displacement during dynamic functional tests, with marginal sealing meeting clinical standards.Conclusions:The optical digital border molding technique for edentulous soft tissue boundaries translates the myostatic line theory into quantifiable parameters for the first time. Based on data from 10 cases, a mobility threshold of 0.5 mm is recommended for clinical application.

Objective To explore the value of dual-energy CT Bone Marrow Edema in quantitatively evaluating the timing of rib fracture evolution.Methods Sixty patients with thoracic trauma were scanned by dual-energy CT.Using CT Bone Marrow Edema technique,bone marrow CT values were standardized and quantified in both the Bone Marrow Edema area at the rib fracture site and in normal areas 1 cm on both sides of the fracture.The increments of standardized CT values for Bone Marrow Edema and VNCa were obtained for three stages of healing.The numerical variables were statistically described,and both the standardized CT value increments and VNCa standardized CT value increments were compared between the three stages and between each pair of stages.Diagnostic efficacy for stages with significant differences was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),and Cut-offvalues were calculated.Results There were significant differences in standardized CT value increments and VNCa standardized CT value increments across the three stages of Bone Marrow Edema(H=10.788,p=0.005;F=115.787,p=0.000).The standardized CT value increment of Bone Marrow Edema showed significant differences between the cartilaginous callus stage(fibrous callus stage)and the bony callus-remodeling stage(H=54.958,p=0.003),while the other pairwise comparisons showed no statistical significance(H=-25.603,p=0.183;H=29.354,p=0.113,respectively).However,the VNCa standardized CT value increments showed statistical significance across all three pairwise comparisons(all p=0.000).The ROC curve for differentiating the cartilaginous callus stage(fibrous callus stage)from the bony callus-remodeling stage using Bone Marrow Edema standardized CT value increment had an AUC of 0.652,with a Cut-offvalue of 81.575 Hu.The ROC curve for distinguishing the hematoma inflammation stage from the cartilaginous callus stage(fibrous callus stage)using VNCa standardized CT value increment had an AUC of 0.668,with a Cut-offvalue of 55.700 Hu.The ROC curve for differentiating the cartilaginous callus stage(fibrous callus stage)from the bony callus-remodeling stage using VNCa standardized CT value increment had an AUC of 0.905,with a Cut-offvalue of 37.625 Hu.Conclusion Dual-energy CT Bone Marrow Edema can quantitatively evaluate the timing of rib fracture evolution,and the differences in standardized CT value increments at different stages can provide a theoretical basis for forensic identification of fractures at different time periods.The Cut-offvalues of standardized CT value increments can,to some extent,predict the time stage of a fracture,providing quantitative evidence for forensic experts in the identification of rib fractures.