OBJECTIVE To evaluate the impact of bundle intervention measures on incidence of catheter-related in-fections in patients of neurosurgery intensive care unit(NICU).METHODS The related data regarding to incidence rates of hospital-associated infections and utilization rates of catheters were collected from the NICU patients of Renji Hospital,Shanghai Jiaotong University from 2007 to 2022.The effect of the bundle intervention measures on reducing the incidence of catheter-related infections was analyzed by means of interrupted tune series(ITS)method.RESULTS There was significant difference in the decline trend of incidence of the infections during the study(the trend x2=91.978,P＜0.001).ITS analysis showed that the utilization rate of catheters only presented the decline trend after the intervention(β2=-0.667,P=0.042),the utilization rate of ventilator tubes only de-clined after the intervention(β3=-26.375,P＜0.001).Th utilization rate of central venous catheters showed a downward trend before the intervention(β1=-2.525,P＜0.001)but did not change significantly after the inter-vention.The incidence of central line-associated bloodstream infection(CLABSI)was decreased(RR=0.268,95％CI:0.124 to 0.581),however,there was significant difference in the change of slope(RR=0.912,95％CI:0.730 to 1.140).The incidence of catheter-associated urinary tract infection(CAUTI)showed a downward trend(RR=0.796,95％CI:0.647 to 0.975),however,there was no significant difference in the change of the level(RR=1.543,95％CI:0.816 to 3.005).The incidence of ventilator-associated pneumonia(VAP)showed a downward trend(RR=0.829,95％CI:0.767 to 0.895),however,there was no significant difference in the change of the level(RR=0.817,95％CI:0.595 to 1.114).CONCLUSIONS The bundle intervention measures may effectively reduce the incidence of catheter-related infections.The incidence rates of the catheter-related infections vary in the chan-ging trends after the interventions are taken,indicating that it is necessary to comprehensively take the character-istics of catheter-related infections into account when carrying out the bundle intervention measures and continu-ously optimize the control strategies.

The compilation instructions for the Expert Consensus on Clinical Application of Yifei Zhike Capsules systematically expound the development background， methodological framework， and core achievements of this consensus. In view of the problems existing in the clinical application of Yifei Zhike Capsules， such as insufficient efficacy evidence and lack of standardized syndrome differentiation， the Institute of Basic Research in Clinical Medicine， China Academy of Chinese Medical Sciences took the lead and collaborated with 21 tertiary grade-A hospitals and research institutions across China to form a multidisciplinary expert group （comprising 30 experts in clinical medicine， pharmacy， and methodology）. The compilation work was carried out in strict accordance with the World Health Organization （WHO） guidelines， the GB/T 1.1-2020 standard， and the writing specifications for the explanatory notes of expert consensus on clinical application of Chinese patent medicines. Through systematic literature retrieval （including 32 studies， with 24 clinical studies）， Grading of Recommendations Assessment， Development and Evaluations （GRADE）-based evidence grading， and multiple rounds of discussions using the nominal group method （25 experts voted to determine 17 clinical questions）， 5 evidence-based recommendations and 11 expert consensus suggestions were formed. It is clarified that this medicine （Yifei Zhike Capsules） is applicable to the treatment of expectoration/hemoptysis in acute and chronic bronchitis and the adjuvant treatment of pulmonary tuberculosis. It is recommended that it can be used alone or in combination with anti-tuberculosis drugs. The safety evaluation shows that this medicine mainly induces the following adverse reactions： mild gastrointestinal reactions （such as nausea and abdominal pain） and rashes. The contraindicated populations include pregnant women and women during menstruation. The compilation process of the consensus underwent three rounds of expert letter reviews， two rounds of peer reviews， and quality control assessments to ensure methodological rigor and clinical applicability. In addition， through policy alignment， academic promotion， and a dynamic revision mechanism， the standardization of clinical application was promoted， providing a demonstration for the evidence-based transformation of characteristic therapies of Miao medicine.

As an exclusive Miao medicine of Honwing Pharma （Guizhou） Co. Ltd.， Yifei Zhike capsules are both a prescription drug and an over-the-counter （OTC） drug. Its main ingredients include Ranunculus ternatus and Panax notoginseng. With the effects of nourishing Yin and moistening the lungs， as well as relieving cough and reducing phlegm， Yifei Zhike capsules are often used in the treatment of acute and chronic bronchitis， pulmonary tuberculosis， and other diseases. However， there is insufficient understanding of their efficacy， suitable syndromes， and safety in clinical practice， with a lack of relevant expert consensus on clinical application. To standardize their clinical application， 30 experts from the fields of respiratory medicine， pharmacy， and evidence-based medicine were invited to develop an Expert Consensus on the Clinical Application of Yifei Zhike Capsules （Consensus for short） through evidence-based medicine methods. The Consensus clarified the syndrome characteristics， disease stages， dosages， treatment courses， combined medication， and other norms in the treatment of acute/chronic bronchitis and pulmonary tuberculosis and could be applicable to clinical physicians and pharmacists in medical and health institutions at all levels. In disease diagnosis， it provided diagnostic criteria for traditional Chinese medicine and Western medicine and clarified that the suitable traditional Chinese medicine syndrome was the syndrome of Qi-Yin deficiency with intermingled phlegm-blood stasis. Clinical studies have confirmed that Yifei Zhike capsules combined with standard anti-tuberculosis therapy can effectively improve the symptoms of pulmonary tuberculosis patients， increase the sputum smear conversion rate， and promote the absorption of lesions. When treating acute cough caused by respiratory tract infections， Yifei Zhike capsules can increase the markedly effective rate and the seven-day disappearance rate of cough symptoms. Meanwhile， recommendations for specific usage， dosages， and treatment courses were given for different diseases， and it was pointed out that long-term medication required key monitoring of adverse reactions. In safety， the adverse reactions of Yifei Zhike capsules involved multiple aspects such as the digestive system and allergic reactions， and pregnant women and women during menstruation were prohibited from using it. In addition， modern research has shown that Yifei Zhike capsules have an adjuvant therapeutic effect on tuberculous pleurisy and may be effective for inflammatory and benign pulmonary nodules. However， further research should be conducted on the toxicological safety of long-term medication. The formulation of the Consensus provides a scientific basis for the rational clinical application of Yifei Zhike capsules， which helps to improve clinical efficacy and reduce medication risks.

As an exclusive Miao medicine of Honwing Pharma （Guizhou） Co. Ltd.， Yifei Zhike capsules are both a prescription drug and an over-the-counter （OTC） drug. Its main ingredients include Ranunculus ternatus and Panax notoginseng. With the effects of nourishing Yin and moistening the lungs， as well as relieving cough and reducing phlegm， Yifei Zhike capsules are often used in the treatment of acute and chronic bronchitis， pulmonary tuberculosis， and other diseases. However， there is insufficient understanding of their efficacy， suitable syndromes， and safety in clinical practice， with a lack of relevant expert consensus on clinical application. To standardize their clinical application， 30 experts from the fields of respiratory medicine， pharmacy， and evidence-based medicine were invited to develop an Expert Consensus on the Clinical Application of Yifei Zhike Capsules （Consensus for short） through evidence-based medicine methods. The Consensus clarified the syndrome characteristics， disease stages， dosages， treatment courses， combined medication， and other norms in the treatment of acute/chronic bronchitis and pulmonary tuberculosis and could be applicable to clinical physicians and pharmacists in medical and health institutions at all levels. In disease diagnosis， it provided diagnostic criteria for traditional Chinese medicine and Western medicine and clarified that the suitable traditional Chinese medicine syndrome was the syndrome of Qi-Yin deficiency with intermingled phlegm-blood stasis. Clinical studies have confirmed that Yifei Zhike capsules combined with standard anti-tuberculosis therapy can effectively improve the symptoms of pulmonary tuberculosis patients， increase the sputum smear conversion rate， and promote the absorption of lesions. When treating acute cough caused by respiratory tract infections， Yifei Zhike capsules can increase the markedly effective rate and the seven-day disappearance rate of cough symptoms. Meanwhile， recommendations for specific usage， dosages， and treatment courses were given for different diseases， and it was pointed out that long-term medication required key monitoring of adverse reactions. In safety， the adverse reactions of Yifei Zhike capsules involved multiple aspects such as the digestive system and allergic reactions， and pregnant women and women during menstruation were prohibited from using it. In addition， modern research has shown that Yifei Zhike capsules have an adjuvant therapeutic effect on tuberculous pleurisy and may be effective for inflammatory and benign pulmonary nodules. However， further research should be conducted on the toxicological safety of long-term medication. The formulation of the Consensus provides a scientific basis for the rational clinical application of Yifei Zhike capsules， which helps to improve clinical efficacy and reduce medication risks.

Objective:To establish a predictive model of neoadjuvant chemotherapy for human epidermal growth factor receptor 2 (HER2) positive breast cancer based on magnetic resonance imaging (MRI) parameters and multimodal ultrasound.Methods:The medical records of 279 patients with HER2 positive breast cancer admitted to Linyi People’s Hospital, Tai’an Central Hospital Affiliated to Qingdao University and Shandong First Medical University affiliated Provincial Hospital from Mar. 2021 to Nov. 2023 were retrospectively analyzed, and randomly divided into a training set ( n=223) and a validation set ( n=56) according to the 8∶2 law. All patients received neoadjuvant chemotherapy combined with targeted therapy and were divided into non-pathologic complete response (NpCR) and pathologic complete response (pCR) groups according to chemotherapy effect. By comparing MRI parameters and multimodal ultrasound parameters of the two groups, and the pCR risk model after neoadjuvant chemotherapy for HER2 positive breast cancer patients was constructed and verified. Results:After 3 cycles of chemotherapy, the incidence of pCR in 223 patients in the training set was 42.15%. Among 56 patients in the validation set, the incidence of pCR was 42.86%. The apparent diffusion coefficient (ADC) of pCR group was higher than NpCR group ( P<0.05). The peak systolic flow velocity (PSV), resistance index (RI), maximum radial change rate, area under the curve (AUC) and peak intensity (PI) in pCR group were higher than NpCR group ( P<0.05), and the ultrasound elastic score in pCR group was lower than NpCR group ( P<0.05). ΔADC ( OR=4.141, 95% CI: 1.820-9.421), maximum diameter change rate ( OR=5.212, 95% CI: 2.291-11.857), PI ( OR=4.802, 95% CI: 2.111-10.923) and ultrasonic elasticity score ( OR=6.629, 95% CI: 1.595-8.256) were the influencing factors of pCR after neoadjuvant chemotherapy for HER2 positive breast cancer ( P<0.05). The sensitivity and specificity of pCR predicted by the training set model after neoadjuvant chemotherapy for HER2 positive breast cancer were 90.43% (95% CI: 82.15%-95.26%), 91.47% (95% CI: 84.91%-95.45%), and the AUC was 0.904 (95% CI: 0.834-0.968). Validation set model predicted the pCR sensitivity after neoadjuvant chemotherapy for HER2 positive breast cancer was 87.50% (95% CI: 66.54%-96.71), specificity was 90.63% (95% CI: 73.83%-97.55%), and AUC was 0.897 (95% CI: 0.821-0.954) . Conclusion:The histogram model based on ΔADC, maximum radial rate of lesion change, PI and ultrasonic elasticity score can be used to evaluate the risk of pCR after neoadjuvant chemotherapy for HER2 positive breast cancer.

Objective:To establish a predictive model of neoadjuvant chemotherapy for human epidermal growth factor receptor 2 (HER2) positive breast cancer based on magnetic resonance imaging (MRI) parameters and multimodal ultrasound.Methods:The medical records of 279 patients with HER2 positive breast cancer admitted to Linyi People’s Hospital, Tai’an Central Hospital Affiliated to Qingdao University and Shandong First Medical University affiliated Provincial Hospital from Mar. 2021 to Nov. 2023 were retrospectively analyzed, and randomly divided into a training set ( n=223) and a validation set ( n=56) according to the 8∶2 law. All patients received neoadjuvant chemotherapy combined with targeted therapy and were divided into non-pathologic complete response (NpCR) and pathologic complete response (pCR) groups according to chemotherapy effect. By comparing MRI parameters and multimodal ultrasound parameters of the two groups, and the pCR risk model after neoadjuvant chemotherapy for HER2 positive breast cancer patients was constructed and verified. Results:After 3 cycles of chemotherapy, the incidence of pCR in 223 patients in the training set was 42.15%. Among 56 patients in the validation set, the incidence of pCR was 42.86%. The apparent diffusion coefficient (ADC) of pCR group was higher than NpCR group ( P<0.05). The peak systolic flow velocity (PSV), resistance index (RI), maximum radial change rate, area under the curve (AUC) and peak intensity (PI) in pCR group were higher than NpCR group ( P<0.05), and the ultrasound elastic score in pCR group was lower than NpCR group ( P<0.05). ΔADC ( OR=4.141, 95% CI: 1.820-9.421), maximum diameter change rate ( OR=5.212, 95% CI: 2.291-11.857), PI ( OR=4.802, 95% CI: 2.111-10.923) and ultrasonic elasticity score ( OR=6.629, 95% CI: 1.595-8.256) were the influencing factors of pCR after neoadjuvant chemotherapy for HER2 positive breast cancer ( P<0.05). The sensitivity and specificity of pCR predicted by the training set model after neoadjuvant chemotherapy for HER2 positive breast cancer were 90.43% (95% CI: 82.15%-95.26%), 91.47% (95% CI: 84.91%-95.45%), and the AUC was 0.904 (95% CI: 0.834-0.968). Validation set model predicted the pCR sensitivity after neoadjuvant chemotherapy for HER2 positive breast cancer was 87.50% (95% CI: 66.54%-96.71), specificity was 90.63% (95% CI: 73.83%-97.55%), and AUC was 0.897 (95% CI: 0.821-0.954) . Conclusion:The histogram model based on ΔADC, maximum radial rate of lesion change, PI and ultrasonic elasticity score can be used to evaluate the risk of pCR after neoadjuvant chemotherapy for HER2 positive breast cancer.

OBJECTIVE To evaluate the impact of bundle intervention measures on incidence of catheter-related in-fections in patients of neurosurgery intensive care unit(NICU).METHODS The related data regarding to incidence rates of hospital-associated infections and utilization rates of catheters were collected from the NICU patients of Renji Hospital,Shanghai Jiaotong University from 2007 to 2022.The effect of the bundle intervention measures on reducing the incidence of catheter-related infections was analyzed by means of interrupted tune series(ITS)method.RESULTS There was significant difference in the decline trend of incidence of the infections during the study(the trend x2=91.978,P＜0.001).ITS analysis showed that the utilization rate of catheters only presented the decline trend after the intervention(β2=-0.667,P=0.042),the utilization rate of ventilator tubes only de-clined after the intervention(β3=-26.375,P＜0.001).Th utilization rate of central venous catheters showed a downward trend before the intervention(β1=-2.525,P＜0.001)but did not change significantly after the inter-vention.The incidence of central line-associated bloodstream infection(CLABSI)was decreased(RR=0.268,95％CI:0.124 to 0.581),however,there was significant difference in the change of slope(RR=0.912,95％CI:0.730 to 1.140).The incidence of catheter-associated urinary tract infection(CAUTI)showed a downward trend(RR=0.796,95％CI:0.647 to 0.975),however,there was no significant difference in the change of the level(RR=1.543,95％CI:0.816 to 3.005).The incidence of ventilator-associated pneumonia(VAP)showed a downward trend(RR=0.829,95％CI:0.767 to 0.895),however,there was no significant difference in the change of the level(RR=0.817,95％CI:0.595 to 1.114).CONCLUSIONS The bundle intervention measures may effectively reduce the incidence of catheter-related infections.The incidence rates of the catheter-related infections vary in the chan-ging trends after the interventions are taken,indicating that it is necessary to comprehensively take the character-istics of catheter-related infections into account when carrying out the bundle intervention measures and continu-ously optimize the control strategies.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. Using data from the Korean Renal Data System (2001–2022), we analyzed 66,129 HD patients, stratified into young (<65 years, n = 24,589), younger-old (65–74 years, n = 17,732), and older-old (≥75 years, n = 23,808) groups. Patients were categorized into BMI quartiles, and survival outcomes were evaluated using Kaplan-Meier curves and event time ratios for the relative change in the survival time. During the follow-up period, 14,360 of the patients (21.7%) died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after a BMI of 25 kg/m2. Lower BMI correlates with higher mortality, particularly in younger HD patients.

Objective To study the protective effect of Irisin in doxorubicin(Dox)induced-Cardiomyopathy and its possible mechanism.Methods AC 16 cells were used to construct Dox injury model and divided into control group(AC 16 cells were cultured with complete medium),Irisin group(AC16 cells were treated with 10 ng·L-1 Irisin for 24 h),Dox group(AC 16 cells were treated with 4 μmol·L-1 Dox for 24 h),Dox+Irisin group(AC 16 cells were pretreated with 10 ng·L-1 Irisin for 2 h,and then treated with 4 pmol·L-1 Dox for 24 h).Cell counting kit-8(CCK-8),terminal deoxynucleotidyl transferase-mediated nick end labeling(TUNEL)and lactate dehydrogenase(LDH)were used to detect the proliferation,apoptosis and mortality of AC 16 cells.Western blot was used to detect the expression levels of nuclear factor-κB(NF-κB)signaling pathway and apoptotic factors B-cell lymphoma-2(Bcl-2),Bcl-2-associated X protein(Bax)and caspase-9 protein.Mito-Tracker Red CMXRos probe was used to detect mitochondrial membrane potential.Results In the contrl group,Irisin group,Dox group,Dox+Irisin group,the rate of apoptosis were(0.97±0.09)％,0,(42.80±6.70)％,(11.74±1.79)％;the expression of Bax protein were 0.85±0.01,0.36±0.02,1.15±0.07,0.37±0.11;the expression of caspase-9 protein were 0.52±0.02,0.59±0.03,1.11±0.02,0.67±0.08;the expression of Bcl-2 protein were 1.01±0.04,1.05±0.25,0.43±0.02 and 0.99±0.30;the probability of mitochondrial damage were(0.02±0.01)％,(0.5±0.15)％,(38.6±2.39)％,(1.58±0.54)％.The difference of the above indexes between the contrl group and the Dox group were statistically significant(all P＜0.05);the difference between Dox group and Dox+Irisin group were statisically significant(all P＜0.05).Conclusion Irisin could reduce the expression level of Bax,caspase-9,p-NF-κB,and p-mTOR caused by Dox,increase the expression level of Bcl-2,ameliorate the myocardial damage caused by Dox,and reduce cardiotoxicity.

Objective:To compare and study the improvement of different iterative reconstruction(IR)algorithms of the tomotherapy(TOMO)Radixact system on the image quality of megavoltage computed tomography(MVCT)imaging system,and the influence of that on the precision of automatic registration,and to explore the reconstruction algorithm that is suitable for clinical application.Methods:Using the MVCT imaging system to respectively scan the Tomo-Phantom HE phantom and the Catphan 604 phantom,and to analyze three groups of images were generated by three kinds of reconstruction algorithms,which included the Standard(STD)algorithm,IR General(IR-G)algorithm and IR Soft Tissue(IR-ST)algorithm,in MVCT image.The noise index(NI),uniformity index(UI)of image,modulation transfer function(MTF),low contrast visibility(LCV)index and contrast-to-noise ratio(CNR)of three groups of images were calculated respectively.The Lucy phantom was used to test the accuracy of automatic registration algorithm.The registration data of four dimensions,included left-right(X-axis),head-foot(Y-axis),vertical(Z-axis)and free rotation(Roll)around the Y-axis,were used to conduct verification analysis for the influences of them on the precision of automatic registration.Results:The NI values of IR-G and IR-ST reconstruction algorithms were respectively 39.58±0.10 and 14.62±0.26,which were better than 39.58±0.10 of STD algorithm,and the UI values of them were respectively 19.87±0.83 and 15.84±2.51,which were better than 24.51±1.81 of STD algorithm,and LCV values of them were respectively 2.50±0.03 and 1.74±0.11,which were better than 3.67±0.04 of STD algorithm.All of them appeared significant increase,but the resolution with high contrast of MTF were respectively 0.23 and 0.21,which were lower than 0.32 of STD.The overall image quality of the IR algorithms was superior to that of the STD algorithm.In the accuracy test of the automatic registration algorithm,the registration precisions of IR-G and IR-ST algorithms on Y-axis were respectively(0.360±0.142)mm and(0.245±0.050)mm,which were significantly higher than 0.145±0.136 of STD algorithm,and the differences of them were significant(Z=6.0,15.0,P<0.05).The differences of registration precisions of other directions were not significant(P>0.05).Conclusion:The IR algorithm has advantages in terms of noise,uniformity and resolution with low-contrast,however,it shows reduction on resolution with high-contrast.This reduction of resolution with high-contrast do not lead to the decrease of the precision of automatic registration.