ObjectiveTo observe the short-term and long-term efficacy of traditional Chinese medicine （TCM） surgical operations in treating mixed hemorrhoids. MethodsA multi-center retrospective cohort study was conducted， collecting clinical data from 17，831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province. Standardized and structured datasets were obtained through artificial intelligence models. Patients who underwent western surgical treatment were categorized into the western surgery group （11,646 cases）， and those receiving TCM surgical operations were categorized into the TCM surgery group （6185 cases）. Propensity score matching （1∶1 matching） was used to balance baseline data between groups. The primary outcome was the one-year recurrence rate， and secondary outcomes included the main symptoms （rectal bleeding， degree of prolapse） and secondary symptoms （anal distension， anal edema， wound secretion and exudation， anal stenosis， residual skin tags， perianal itching， and anal pain） measured on days 7， 28， and 60 after discharge. ResultsAfter matching， 2194 patients were included in each group. Symptom scores showed that at 28 days after discharge， the TCM surgical group had superior improvement in rectal bleeding ［OR=5.786， 95%CI （3.092，10.827）］， degree of prolapse ［OR=4.510， 95%CI （1.649，12.333）］， and anal edema ［OR=3.188， 95%CI （1.295，7.845）］ compared to the western surgical group. At 60 days post-discharge， the TCM group still showed advantages in improving rectal bleeding ［OR=5.237， 95%CI （1.077，25.464）］ and anal pain ［OR=11.697， 95%CI （1.186，115.336）］ （P＜0.05）. Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1% （8/726）， while that in the western surgery group was 2.3% （10/444）， with no statistically significant difference between the two groups （P＞0.05）. ConclusionBased on real-world data， TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement， particularly in terms of hemostasis， reducing swelling， and alleviating prolapse of anal masses.

AIM: To explore the application value of machine learning models in predicting the myopia control efficacy of orthokeratology(OK)in pediatric population, and analyze the key factors affecting axial length(AL)elongation.METHODS: This retrospective study included myopic subjects aged 8-17 y who were fitted with OK lenses and completed a 6 mo follow-up between January 1, 2021 and December 1, 2023. Baseline demographic and ocular biometric parameters were collected, including age, eye laterality, cycloplegic refraction, corneal curvature(K1 and K2)and AL. AL change(ΔAL)at 6 mo after lens wearing was defined as the primary outcome. Four machine learning models—decision tree, random forest, extreme gradient boosting(XGBoost), and neural network—were developed to predict treatment efficacy, and their predictive performance was compared. Multiple linear regression analysis was performed to identify relevant factors associated with ΔAL.RESULTS: A total of 102 myopic patients(159 eyes)aged 8-17 y were included in this study, including 57 bilateral eyes and 45 unilateral cases. Among them, 56 were boys(54.9%)and 46 were girls(45.1%). The mean age was 11.98±1.93 y. At baseline, the mean spherical error was -2.28±1.37 D, the mean cylindrical power was -0.65±0.36 D, and AL was 24.60±0.82 mm, the mean flat keratometry(K1)was 42.55±1.39 D, and the mean steep keratometry(K2)was 43.58±1.44 D.After 6 mo of lens wear, the AL increased to 24.68±0.59 mm, The mean spherical power was -2.45±1.46 D, the cylindrical power was -0.68±0.38 D, the K1 value was 42.52±1.33 D, and the K2 value was 43.61±1.51 D. The mean ΔAL was 0.08±0.17 mm.The performance comparison of four machine learning models in predicting the efficacy of OK on AL control showed that the decision tree model achieved the best predictive performance(MAE=0.11, MSE=0.02, R2=0.44). Feature importance analysis indicated that age, baseline AL and K1 were the top three predictors. Multiple linear regression showed that age was negatively associated with ΔAL(β=-0.03, P<0.001), while other variables were not significantly associated(all P>0.05).CONCLUSION: Machine learning models can effectively predict the efficacy of OK in controlling axial elongation in children. The decision tree model shows the best performance. Age is a key factor affecting the therapeutic effect of OK, while baseline AL and corneal curvature also contribute to prediction.This study provides new data support for individualized myopia prevention and control strategies in the pediatric population.

Objective:To investigate the status of leisure crafting and post competence and their correlation among anesthesia specialist nurses.Methods:A convenience sampling method was used to conducted a questionnaire survey on 280 anesthesia specialist nurses at grade A tertiary hospitals in 19 provinces of China. Data were collected using a general information questionnaire, the Chinese version of Leisure Crafting Scale, and the Post Competency Scale for Anesthesia Specialist Nurses. SPSS 24.0 was used for t test and one-way analysis of variance. A Pearson correlation analysis was used to assess relationships between variables. Results:The total score of leisure crafting was (30.41±6.69) and the average score was (3.38±0.74). The total score of post competency was (141.76±21.76) and the average score was (3.73±0.57). A positive correlation was observed between leisure crafting and post competency ( r=0.215, P<0.01). Conclusions:Managers should encourage anesthesia specialist nurses to actively engage in leisure crafting and provide diverse opportunities for leisure crafting to improve their post competence and ultimately the quality of anesthesia nursing.

Objective To investigate residents'willingness to use"internet+nursing services"of a community in Xiamen City and provide reference for the code of practice to promote the service.Methods A total of 350 community residents in Xiamen City were investigated by convenience sampling from January to December 2023.The questionnaire was self-designed with regard to their willingness to use"internet+nursing services".Results 336 questionnaires were effectively collected.The total score of willingness to use"internet+nursing services"of community residents in Xiamen City was(68.80±8.73)points,but only 19.6％of residents knew about"internet+nursing services".There were statistically significant differences in willingness to use among community residents with different ages,medical payment type,whether they knew"internet+nursing services"or not,and the number of service items needed(P＜0.05).Among them,age,whether they knew"internet+nursing services"or not and the number of service items needed were the main influencing factors of willingness to use(P＜0.05).Conclusion Community residents in Xiamen City show above the middle level of willingness to use"internet+nursing services".However,the popularity of"internet+nursing services"has a large room for improvement.The publicity to the residents should be strengthened,and the care needs of residents with different demographic characteristics should be considered.The supporting application functions of such platforms should be designed to meet the health needs of community residents,especially elderly patients with great demand for services.

Objective To investigate residents'willingness to use"internet+nursing services"of a community in Xiamen City and provide reference for the code of practice to promote the service.Methods A total of 350 community residents in Xiamen City were investigated by convenience sampling from January to December 2023.The questionnaire was self-designed with regard to their willingness to use"internet+nursing services".Results 336 questionnaires were effectively collected.The total score of willingness to use"internet+nursing services"of community residents in Xiamen City was(68.80±8.73)points,but only 19.6％of residents knew about"internet+nursing services".There were statistically significant differences in willingness to use among community residents with different ages,medical payment type,whether they knew"internet+nursing services"or not,and the number of service items needed(P＜0.05).Among them,age,whether they knew"internet+nursing services"or not and the number of service items needed were the main influencing factors of willingness to use(P＜0.05).Conclusion Community residents in Xiamen City show above the middle level of willingness to use"internet+nursing services".However,the popularity of"internet+nursing services"has a large room for improvement.The publicity to the residents should be strengthened,and the care needs of residents with different demographic characteristics should be considered.The supporting application functions of such platforms should be designed to meet the health needs of community residents,especially elderly patients with great demand for services.

A male patient,51 years old,was diagnosed as follows:① type 2 diabetes mellitus;② grade 2 hypertension(extremely high risk).To improve circulation,the patient was administered pentoxifylline injection 0.2 g mixed with 250 mL of 0.9％sodium chloride injection via an intravenous drip,once daily(qd).After 4 days of treatment,liver function tests showed the following results:alanine aminotransferase(ALT)at 2 390.80 U·L-1,aspartate aminotransferase(AST)at 948.28 U·L-1,and gamma-glutamyltransferase(GGT)at 517.81 U·L-1.It was highly probable that pentoxifylline caused abnormally elevated liver enzymes,with a clear drug-related association.After discontinuing pentoxifylline injection and initiating liver-protecting and en-zyme-lowering treatment,the liver function indicators gradually improved.Enhanced monitoring during the clinical use of pentoxi-fylline is essential to ensure patient safety.

Objective To explore the anti-intestinal fibrosis mechanism of Dahuang Zhechong pill.Methods Based on the network pharmacology method,the traditional Chinese medicine systems pharmacology database and analysis platform,SwissTargetPrediction database and metabolomics technology was used.OmicsNet 2.0 platform combined with the findings of network pharmacology and metabolomics,and molecular simulation docking and molecular biology methods were used to study the mechanism of anti-intestinal fibrosis of Dahuang Zhechong pill.Results Dahuang Zhechong pill contains 142 potential active ingredients and 855 anti-intestinal fibrosis targets.The 10 core ingredients(quercetin,acacetin,oroxylin a,kaempferol,moslosooflavone,panicolin,etc.)may play a role in regulating lipid metabolism and atherosclerosis,EGFR tyrosine kinase inhibitor resistance,HIF-1 signaling pathway,TNF signaling pathway and IL-17 signaling pathway.Metabolomics results showed that 59 endogenous substances(oxaloacetic acid,ethylthioisonicamide,6-benzylaminopurine,tyrosine and cortisol,etc.)may be the key metabolites of this drug against intestinal fibrosis.Central carbon metabolism,TCA cycle and amino acid metabolism were the key mechanisms,EGFR,AKT1,MAPK1,PTPN11,CASP3,PPARG,MET and PDGFRB may be the core targets.Dahuang Zhechong pill could significantly improve the levels of colorectal edema,inflammatory factors,inflammatory cell infiltration,collagen fiber deposition and α-SMA expression in mice with intestinal fibrosis,reduce the expression levels of pro-inflammatory factors IL-17 and IL-23 in serum,and increase the level of anti-inflammatory factor IL-10.Molecular dynamics simulations demonstrated stable conformational binding between core active ingredients and key targets.Conclusion Dahuang Zhechong pill may regulate EGFR/AKT1/MAPK mediated metabolism-inflammation interaction network through flavonoid components,and can improve intestinal fibrosis in multiple dimensions through molecular validation.

The menopausal age is one of the important menopausal factors, and women of different menopausal ages have different risks of diabetes. This study reviewed the evidence from prospective studies on the association between the age at natural menopause and diabetes risk, both domestically and internationally, and presented its research design and main findings. Advanced menopause, especially premature and early menopause, will increase the risk of diabetes in postmenopausal women. The research on the influence of delayed menopause on the incidence of diabetes is still insufficient. Many factors may modify the association between menopausal age and the risk of diabetes.

Objective:To analyze the current situation and core issues of medical escort services in Shanghai through a two-side (supply and demand) survey, so as to provide references for formulating targeted strategies for the standardized management of this industry.Methods:From June to August 2024, a questionnaire survey on awareness of escort services was conducted among patients at 16 tertiary public hospitals in Shanghai. The survey covered patients′ basic information, their needs, concerns, and expectations regarding escort services. Concurrently, a specialized questionnaire was administered to trainees enrolled in Shanghai Open University′s " elderly care escort service provider" program. This survey covered the companions′ basic profiles, types of service recipients, relevant qualifications, training programs, and standardized service procedures. Data were organized and analyzed by using SPSS 26.0 software.Results:The survey on awareness of patient escort services yielded 855 valid responses, achieving a 92.13% response rate. Among these 855 patients, the primary demand for escort services was queue management for examinations (515 cases, 71.47%), followed by assistance with registration/payment/medication pickup (528 cases, 61.74%). 587 patients (68.66%) expressed willingness to use the service. The main concerns included lack of professional expertise among attendants (538 cases, 62.92%), trust issues (494 cases, 57.78%), and fee concerns (456 cases, 53.33%). Expectations for service supervision primarily focused on service quality and safety (618 cases, 72.28%) and pricing standards (609 cases, 71.23%). The specialized survey on medical escort services yielded 194 valid questionnaires, achieving a 100.00% response rate. Among the 194 medical escort service providers, 82.5% (160 individuals) were full-time practitioners, 31.96% (62 individuals) held relevant qualification certificates, and 72.68% (144 individuals) had participated in related training programs. Regarding standardized services, 74.74% (145 individuals) of medical escorts obtained patient information prior to service delivery, 56.70% (110 individuals) signed agreements with users, and 67.01% (130 individuals) maintained records of their medical escort services.Conclusions:Shanghai′s medical escort services had achieved some success, yet faced challenges including high patient demand coupled with low trust, insufficient certification and training for escorts, and an urgent need to improve service standardization. It is recommended that medical institutions further strengthen their primary role in managing escort services. By enhancing top-level design, establishing standardized training and certification mechanisms, implementing comprehensive quality monitoring and credit evaluation systems, and other measures, they could elevate the professional competence of practitioners, reinforce patient safety safeguards, and promote the high-quality, standardized development of escort services.

Early correction of childhood malocclusion is timely managing morphological, structural, and functional abnormalities at different dentomaxillofacial developmental stages. The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion. This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence, aiming to provide general guidance on appropriate imaging examination selection, comprehensive and accurate imaging assessment for early orthodontic treatment patients.
Humans ; Malocclusion/diagnostic imaging* ; Child ; Consensus