ObjectiveTo investigate the association between endothelin receptor type A gene （EDNRA） and congenital bilateral absence of the vas deferens （CBAVD）. MethodsThis case-control study consisted of 124 subjects with CBAVD and 100 fertile controls.Two single nucleotide polymorphisms （SNPs： rs5335 and rs1801708） in the EDNRA gene were genotyped via PCR， PCR-RFLP analysis， and direct sequencing. ResultsNo significant differences existed between EDNRA polymorphisms and CBAVD phenotype （rs1801708： P=0.220 2， 0.163 2； rs5335： P=0.805 8， 0.818 6）. However， the rs1801708-rs5335 haplotype AG was notably associated with an increased risk of CBAVD （P=0.008 6， OR=2.178， 95% CI： 1.207-3.929）. A significantly protective effect of rs1801708-rs5335 haplotype GG on CBAVD （P=0.038 5， OR= 0.671， 95% CI： 0.460-0.980） was observed. After Bonferroni correction， the result for haplotype A-G remained significant （P =0.008 6<0.012 5）， while haplotype G-G was not significant. ConclusionThe rs1801708-rs5335 AG haplotype of EDNRA is a potential risk factor for CBAVD development in Han Chinese.

Objective To analyze the clinical efficacy and safety of transurethral blue laser vaporization of prostate (BVP) in the treatment of benign prostatic hyperplasia (BPH), and to explore the feasibility of its promotion in primary hospitals. Methods Clinical data of 30 BPH patients undergoing BVP in our hospital during Sep. and Dec. 2024 were retrospectively analyzed. The preoperative prostate volume, decrease in hemoglobin level 2 hours after operation, operation time, postoperative bladder irrigation time, catheter indwelling time, and intra-/postoperative complications were recorded. The changes of international prostate symptom score (IPSS), quality of life (QoL) score, and maximum urinary flow rate (Qmax) were compared before operation and 6 months after operation. Results The mean prostate volume was (46.9±15.7) mL. BVP was successfully completed in 28 patients. The 2 unsuccessful cases (6.7%) converted to transurethral resection of the prostate (TURP) due to intraoperative bleeding. For the 28 successful cases, the median postoperative 2-hour hemoglobin decrease was 4 (2, 11) g/L, mean operation time (59.8±13.2) min, median postoperative bladder irrigation time 21 (18, 23) h, median postoperative catheter indwelling time 5 (5, 5) d, and median postoperative hospital stay 6 (5, 6) d. After catheter removal, urinary retention with infection occurred in 1 case (3.6%), and hemorrhage in 1 case (3.6%). No severe complications occurred during the perioperative period. At 6 months postoperatively, the 28 patients showed significant improvement compared to preoperative values in IPSS[11 (10, 11) vs. 22 (21, 26), P＜0.001], QoL score[2 (2, 3) vs. 5 (5, 6), P＜0.001], and Qmax[ (17.2±5.6) mL/s vs. (7.8±1.4) mL/s, P＜0.001]. Conclusion BVP is a safe and effective treatment for BPH, offering advantages such as minimal blood loss, short operation time, and few complications. It effectively improves patients' lower urinary tract symptoms and quality of life, and is recommended for promotion in primary hospitals.

ObjectiveTo construct a machine learning model combining two-dimensional shear wave elastography （2D-SWE） and serological markers， and to investigate its clinical value in differentiating primary biliary cholangitis （PBC） from overlap syndrome （OS）. MethodsA total of 199 patients with pathologically confirmed PBC or OS in Nantong Third People’s Hospital from January 2021 to December 2025 were retrospectively enrolled， with 125 patients in the PBC group and 74 in the OS group. The patients were randomly divided into a training set with 139 patients and a test set with 60 patients at a ratio of 7∶3. Related data were collected， including serological markers， conventional two-dimensional ultrasound parameters， and 2D-SWE parameters （including velocity of shear wave ［VS］ and liver fibrosis index ［LFI］）. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Logistic regression analyses were used to identify independent predictive factors， which were then incorporated into six machine learning models， and 5-fold cross-validation was used for optimization of parameters. The indicators including the area under the receiver operating characteristic curve （AUC） were compared in the test set to determine the best model， and the SHapley additive exPlanations （SHAP） analysis was used for model interpretation. ResultsFemale patients accounted for 87.8% in the OS group and 79.2% in the PBC group. Compared with the PBC group， the OS group had significantly higher age， VS， LFI， splenic area， aspartate aminotransferase， total bilirubin， prothrombin time， immunoglobulin G （IgG）， and immunoglobulin M （Z=-2.883， -6.524， -4.000， -3.061， -2.194， -2.372， -4.079， -6.964， and -2.709， all P<0.05） and a significantly lower platelet count （Z=4.098， P<0.001）， and there were also significant differences between the two groups in the proportion of patients with positive anti-nuclear antibody， fibrosis stage， and inflammation grade （χ²=3.458， 63.198， and 101.038， all P<0.05）. Variables without multicollinearity were included in the regression analysis， and the multivariate Logistic regression analysis showed that VS （odds ratio ［OR］=4.503， 95% confidence interval ［CI］： 1.698 — 11.943， P=0.003）， LFI （OR=1.813， 95%CI： 1.050 — 3.132， P=0.033）， and IgG （OR=1.121， 95%CI： 1.026 — 1.226， P=0.012） were independent predictive factors for differentiating PBC from OS. Six machine learning models were constructed based on these variables， among which the logistic regression model showed the best predictive performance in the test set， with an AUC of 0.881 （95%CI： 0.788 — 0.974）， a sensitivity of 0.731， and a specificity of 0.794. The SHAP analysis showed that IgG contributed the most to model prediction. ConclusionThe noninvasive multimodal machine learning model combining 2D-SWE parameters （VS， LFI） and serum IgG can effectively differentiate PBC from OS， providing a reference for clinical decision-making regarding the need for liver biopsy.

OBJECTIVE To construct a pharmacy service quality evaluation system， identify weaknesses in the integrated development of pharmacy services， and provide a reference for the homogenized and high-quality development of pharmacy services in compact urban medical groups.METHODS Guided by the five core dimensions of the Servperf model， the Delphi method was used to screen and optimize items， and a tripartite pharmacy service quality evaluation system， covering clinicians， pharmacists， and patients， adapted to the characteristics of compact urban medical groups was constructed. A multicenter cross-sectional empirical investigation was conducted in six compact urban medical groups in Chongqing using the evaluation system.RESULTS Through two rounds of Delphi consultation with 12 experts， a tripartite pharmacy service quality evaluation system was successfully constructed， comprising 5 dimensions and 78 items （24 for clinical pharmacists， 23 for clinical medical staff， and 31 for patients and family members）. The Cronbach’s α coefficients for all dimensions exceeded 0.81， and the KMO values all exceeded 0.7. A total of 1 339 valid questionnaires were collected， including 279 from clinical pharmacists， 727 from clinical medical staff， and 333 from patients and family members. The empirical investigation showed that the overall quality of regional basic pharmacy services was good， but significant inter-group differences existed in service perceptions among the three groups. The score differences across the five dimensions were all statistically significant among the three groups （all P ＜0.001）. Except for the tangibles dimension， in which clinical medical staff scored significantly lower than clinical pharmacists and patients/family members， patients/family members scored significantly higher than clinical medical staff and clinical pharmacists in the other four dimensions （ P ＜0.05）. For the 78 items， expert expectations largely matched the perceptions of the three groups， with a mean difference of 0.08 points； only 13 items showed a difference exceeding 0.5 points， representing marked gap，with “participating in multidisciplinary team consultation and making effective recommendations” showing the largest difference of 0.94 points.CONCLUSIONS The physician‑ pharmacist‑patient tripartite evaluation system constructed in this study is scientific and reliable. Empirical investigation confirms that the basic pharmaceutical support services of the medical groups are well established， whereas the development of high‑level collaborative services has notable weaknesses， and marked heterogeneity exists in service perception among the three groups.

Objective: To analyze the serotypes and VP1 coding region genetic characteristics of poliovirus (PV) isolated from Acute Flaccid Paralysis (AFP) Surveillance System and environmental sewage surveillance samples in Anhui Province. Methods: PV was isolated from fecal samples of polio cases and their close contacts in the AFP Surveillance System and environmental sewage surveillance samples in Anhui Province in 2023. Intratype identification was performed by rRT-PCR method. The nucleotide sequence variation sites and variation numbers in the VP1 coding region were amplified and determined. The mutation hotspots, neurovirulence determinants, and antigenic determinant site changes were analyzed. A PV phylogenetic tree was constructed based on the VP1 coding region gene, and the genetic association between PV in Anhui Province and other foreign vaccine-derived PV (VDPV) was analyzed. Results: A total of 35 PV strains were isolated in Anhui Province in 2023, including 10 strains from AFP Surveillance System samples and 25 strains from environmental sewage surveillance samples. By intratype identification, there were 14 type Ⅰ PV strains and 21 type Ⅲ PV strains. By VDPV screening, there were 2 type Ⅰ VDPV strains, with VP1 coding region nucleotide sequence variation numbers of 10-<150; all others were vaccine-like strains. The mutation rates of nt2747 and nt2795 sites in type Ⅰ PV were higher, which were 78.57% and 21.43%, respectively. Three strains had revertant mutations at the attenuated site nt2795. Twelve strains had mutations at antigenic determinant site 1. The mutation rates of nt3353, nt3346, and nt3357 sites in type Ⅲ PV were higher, which were 42.86%, 28.57%, and 28.57%, respectively. No revertant mutations were found at attenuated sites. Four strains had mutations at antigenic determinant site 2, and 6 strains had mutations at antigenic determinant site 3. Phylogenetic tree analysis showed that the isolated 2 type Ⅰ VDPV strains were on the same independent main branch, which was different from other isolated type Ⅰ PV strains, and had a distant genetic relationship with other VDPV monitored abroad. Conclusions In 2023, the VP1 coding regions of type Ⅰ and type Ⅲ PV isolated in Anhui Province had mutation hotspots, and revertant mutations occurred at attenuated sites. Type Ⅰ VDPV had no genetic association with previously discovered VDPV. It is recommended to strengthen PV surveillance and sequence analysis capabilities to reduce the risk of circulating VDPV.

In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.

Although symptomatic treatment is widely applied in clinical practice， it is often regarded as a relatively low-level therapeutic method. Based on Traditional Chinese Medicine （TCM） state theory， the macroscopic， mesoscopic， and microscopic characterization parameters of TCM symptomatology are horizontally integrated， the full life cycle of states （pre-disease， incipient disease， manifest disease， post-disease） is vertically covered， and the cognitive system of "symptoms" is reconstructed from multiple dimensions. Accordingly， the application approach of symptomatic treatment at different state stages is proposed： implementing preventive intervention in the pre-disease state， strengthening the interception of disease progression in the incipient disease state， regulating dynamic development and treatment in the manifest disease state， and formulating a staged diagnosis and treatment strategy which focuses on functional rehabilitation in the post-disease state.

OBJECTIVE To evaluate the efficacy and safety of high-dose ilaprazole combined with amoxicillin for newly diagnosed elderly patients with Helicobacter pylori （Hp） infection， and analyze independent risk factors for failure of Hp infection eradication treatment. METHODS Totally 200 cases of newly diagnosed elderly patients with Hp infection in Xinxiang Central Hospital from August 1， 2021 to December 1， 2024 were selected and randomly divided into control group and study group， with 100 cases in each group. The control group was treated with classic quadruple therapy regimen （Amoxicillin capsules+ Clarithromycin tablets+Bismuth potassium citrate tablets+Ilaprazole enteric-coated tablets）. The study group was treated with high- dose Ilaprazole enteric-coated tablets+Amoxicillin capsules. All patients were administered medication for 2 weeks. Hp eradication rates in the two groups were compared using intention-to-treat （ITT） and per-protocol （PP） analyses. The incidence of adverse reactions in both groups was also recorded. The multiple-factor Logistic regression analysis was used to identify independent risk factors for failure of Hp infection eradication treatment. RESULTS In ITT and PP analyses， there was no significant difference of Hp eradication rates between the two groups （P＞0.05）. There was no significant difference in incidence of mild to moderate adverse reactions between the two groups （P＞0.05）. BMI ≤18.5 kg/m2， BMI ＞23.9 kg/m2， rural residence， concomitant diabetes and concomitant heart disease were identified as independent risk factors influencing the failure of Hp infection eradication treatment （P＜0.05）. CONCLUSIONS The efficacy and safety of high-dose ilaprazole combined with amoxicillin are comparable to classic quadruple therapy regimen in treating newly diagnosed elderly patients with Hp infection. Independent risk factors influencing the failure of Hp infection eradication treatment include BMI ≤18.5 kg/m2， BMI ＞23.9 kg/m2， rural residence， concomitant diabetes and concomitant heart disease.

Objective The Hybrid Education Competence Instrument(HybridEduCom)was sinicized,and its reliability and validity were tested.Methods The translation,cultural adjustment and pre-investigation of HybridEduCom were followed by the Brislin translation model.The reliability and validity of the HybridEduCom was tested by surveying 553 educators in medical and nursing related fields by convenience sampling from March to April 2024.Results The Chinese version of HybridEduCom consisted of 46 items in 5 dimensions:planning and resourcing competence,technology competence,interaction competence,digital pedagogy competence,and ethical competence in the hybrid education.The confirmatory factor analysis resulted in the second-order five-factor model,with the chi-square and degree of freedom ratio being 1.274,approximate root mean square error being 0.022,goodness of fit index being 0.913,and standard fit index(NFI)being 0.934,and Tucker-Lewis and comparative fit index being 0.985.All main evaluation indexes were within the acceptable range of the judgment criteria.The item-content validity index was 0.833-1.000,and the scale-content validity index was 0.968.The Cronbach's α for the whole scale was 0.982,while varied from 0.892 to 0.936 for each dimension.The test-retest reliability of the scale was 0.978.Conclusion The reliability and validity of the Chinese version of HybridEduCom were satisfactory,and it can serve as a valid assessment instrument for the implementation of hybrid education competence of Chinese higher medical and nursing educators.

Objective:To apply the Timed Up and Go Test(TUGT)to investigate the correlation between motor function, emotional state, cognitive function, and sleep quality among elderly individuals in the Chinese community.Methods:A cross-sectional study was conducted, involving 739 subjects aged 60 to 90 years, who were randomly recruited from December 2021 to August 2023 across Beijing, Tianjin, Zhejiang, Guangdong, and Hainan Provinces in China.Basic demographic information was collected, and the TUGT was utilized to assess motor function.Based on the TUGT time(t), the subjects were divided into three groups: normal motor function group, mild motor abnormality group, and significant motor abnormality group.Cognitive function was evaluated using the Chinese Revised Mini-Mental State Examination(MMSE), while the Patient Health Questionnaire Depression Scale(PHQ-9)was employed to measure the degree of depression.Additionally, the Epworth Sleepiness Scale(ESS)was used to assess excessive daytime sleepiness.The correlation between subjects' motor function and their cognitive abilities, mood, and sleep was subsequently analyzed.Results:Systolic blood pressure, heart rate, PHQ-9, MMSE, and ESS scores were identified as significant factors influencing TUGT time.Specifically, TUGT time was positively correlated with PHQ-9 and ESS scores, while exhibiting negative correlations with systolic blood pressure, heart rate, and MMSE scores.Additionally, TUGT time was negatively correlated with the MMSE subcomponents of orientation, immediate memory, and verbal ability.All observed differences were statistically significant(all P<0.05).Logistic regression analysis indicated that an increase in the PHQ-9 score was associated with an odds ratio( OR)of 1.099(95% CI: 1.045-1.155, P<0.001)(mild motor abnormality group)and 1.150(95% CI: 1.066-1.242, P<0.001)(Significant motor abnormality group).Additionally, a reduction in the MMSE score was observed, with an OR of 0.939(95% CI: 0.886-0.995, P<0.001)(mild motor abnormality group)and 0.793(95% CI: 0.729-0.862, P<0.001)(Significant motor abnormality group).Furthermore, an increase in the ESS score was noted, with ORs of 1.139(95% CI: 1.094-1.186, P<0.001)(mild motor abnormality group)and 1.203(95% CI: 1.132-1.279, P<0.001)(Significant motor abnormality group).These findings suggest that these variables are independently related to decreased motor function. Conclusions:Depression, cognitive impairment, and excessive daytime sleepiness are independent risk factors for motor dysfunction among elderly individuals in community settings.The Timed Up and Go Test TUGT can be utilized for the early screening of motor function decline in this population.