Objective To explore the nutritional status in elderly patients with type 2 diabetes mellitus (T2DM) and analyze its relationship with the risk of sarcopenia. Methods A retrospective analysis was conducted on 312 elderly patients with T2DM admitted to the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army between January 2023 and December 2025. Based on the presence or absence of sarcopenia, the patients were classified into a sarcopenia group (121 cases) and a non-sarcopenia group (191 cases). The nutritional status and related factors were compared between the two groups. Binary logistic regression analysis was adopted to analyze the correlation and influencing factors. Results The incidence rate of sarcopenia among elderly patients with T2DM was 38.78%. Compared with the non-sarcopenia group, the sarcopenia group had older age and higher proportions of patients with daily activity dependence, coronary heart disease, and gastrointestinal diseases. Conversely, the proportions of patients exercising ≥4 times per week and those paying attention to nutritional knowledge were lower in the sarcopenia group than those in the non-sarcopenia group (P<0.05). The body mass index (BMI), calf circumference (CC), body weight, albumin (ALB), hemoglobin (Hb), and MNA-SF score in the sarcopenia group were lower compared with those in the non-sarcopenia group (P<0.05). After logistic regression analysis, it was found that low BMI, exercising ≥4 times per week, dependence on daily activity, and low ALB and Hb were independent factors influencing sarcopenia in elderly patients with T2DM (P<0.05). Conclusion The incidence rate of sarcopenia is relatively high in elderly patients with T2DM. Low BMI, low ALB, low Hb, reduced weekly exercise frequency, and daily activity dependence are independent related factors. It is necessary to pay clinical attention to nutritional assessment and intervention.

OBJECTIVE To establish population pharmacokinetic model of levetiracetam （Lev） for Chinese patients with post- stroke epilepsy （PSE）， and provide reference for formulating individualized dosing regimens for Lev therapy in this specific population. METHODS Blood concentration data and clinical diagnosis and treatment information of PSE patients meeting the inclusion criteria were retrospectively collected and divided into model group and validation group at an 8∶2 ratio using a random number method. Based on the model group data， a population pharmacokinetic model was developed using nonlinear mixed-effects modeling. Internal evaluation was performed through goodness-of-fit tests and bootstrap analysis， while external validation was conducted using the validation group data. RESULTS A total of 75 blood concentration measurements from 70 PSE patients were collected， with 60 measurements from 55 patients used for model development and 15 measurements from 15 patients reserved for external validation. The final model estimated a population typical value of clearance at 2.98 L/h. Estimated glomerular filtration rate， daily dose， and homocysteine level significantly influenced clearance of Lev （P＜0.01）. The model demonstrated satisfactory predictive performance， as evidenced by goodness-of-fit tests， bootstrap analysis， and external validation results. CONCLUSIONS Daily dose， estimated glomerular filtration rate， and homocysteine level are identified as significant covariates influencing Lev clearance in Chinese PSE patients. When making clinical decisions， comprehensive consideration should be given to the patient’s treatment response， physiological and pathological conditions， and the occurrence of adverse reactions， etc. The dosage of Lev should be adjusted based on the results of population pharmacokinetic model.

Objective To integrate and optimize the hospital adverse event reporting system,and to enhance the repor-ting rate of medical safety adverse events by using PDCA cycle management method.Achieve closed-loop management of adverse events,improve the efficiency of adverse event management in the hospital,assist in hospital grading review and-quality develop-ment,and reduce the mortality rate of low-risk groups in the hospital.Methods Based on the SPO theory,the quality control circle,PDCA management,flow chart and description method were used,and combined with the previous adverse event manage-ment experience,the adverse event reporting and tracking process was simplified,and adverse event management information platform was optimized and restructured.The period from January to December 2023(control group)and the period from January to 2024(observation group)were compared and analyzed for the number of adverse event reports per 100 discharges and the mor-tality rate of the low-risk group before and after the implementation of PDCA cycle management.Results The application of PDCA cycle management effectively improved the reporting rate of medical safety adverse events and reduced the mortality rate of the hospital's low-risk group.Conclusion The integrated and designed adverse event management system has good applicability and can be promoted for use in hospital management.

Objective:To explore the relationship between irrational procrastination and compulsory citizenship behavior among clinical nurses,and to investigate the role of psychological entitlement in this relationship.Meth-ods:A sample of 413 clinical nurses from a tertiary hospital was selected for this study.The Irrational Procrastina-tion Scale(IPS),Compulsory Citizenship Behavior Scale(CCBS),and Psychological Entitlement Scale(PES)were used for evaluation.Results:The scores of IPS,CCBS and PES were positively correlated with each other(r=0.53,0.56,0.39,Ps＜0.01).Psychological entitlement partially mediated the relationship between compulsory citi-zenship behavior and irrational procrastination among clinical nurses,with an indirect effect of 0.17,accounting for 13.85％of the total effect.Conclusion:Psychological entitlement plays a partial mediating role in the relationship between compulsory citizenship behavior and irrational procrastination among clinical nurses.

Objective To integrate and optimize the hospital adverse event reporting system,and to enhance the repor-ting rate of medical safety adverse events by using PDCA cycle management method.Achieve closed-loop management of adverse events,improve the efficiency of adverse event management in the hospital,assist in hospital grading review and-quality develop-ment,and reduce the mortality rate of low-risk groups in the hospital.Methods Based on the SPO theory,the quality control circle,PDCA management,flow chart and description method were used,and combined with the previous adverse event manage-ment experience,the adverse event reporting and tracking process was simplified,and adverse event management information platform was optimized and restructured.The period from January to December 2023(control group)and the period from January to 2024(observation group)were compared and analyzed for the number of adverse event reports per 100 discharges and the mor-tality rate of the low-risk group before and after the implementation of PDCA cycle management.Results The application of PDCA cycle management effectively improved the reporting rate of medical safety adverse events and reduced the mortality rate of the hospital's low-risk group.Conclusion The integrated and designed adverse event management system has good applicability and can be promoted for use in hospital management.

Objective:To explore the relationship between irrational procrastination and compulsory citizenship behavior among clinical nurses,and to investigate the role of psychological entitlement in this relationship.Meth-ods:A sample of 413 clinical nurses from a tertiary hospital was selected for this study.The Irrational Procrastina-tion Scale(IPS),Compulsory Citizenship Behavior Scale(CCBS),and Psychological Entitlement Scale(PES)were used for evaluation.Results:The scores of IPS,CCBS and PES were positively correlated with each other(r=0.53,0.56,0.39,Ps＜0.01).Psychological entitlement partially mediated the relationship between compulsory citi-zenship behavior and irrational procrastination among clinical nurses,with an indirect effect of 0.17,accounting for 13.85％of the total effect.Conclusion:Psychological entitlement plays a partial mediating role in the relationship between compulsory citizenship behavior and irrational procrastination among clinical nurses.

Objective:To investigate the iodine nutrition status of children aged 8-10 and pregnant women in Longxi County, Gansu Province.Methods:Descriptive epidemiological method was used to analyze the water iodine monitoring data in 2017 and the iodine deficiency disorders monitoring data from 2017 to 2023 in Longxi County (sourced from the Institute for Endemic Disease Prevention and Control of Gansu Provincial Center for Disease Control and Prevention), including the data of water iodine, salt iodine and urinary iodine levels of children aged 8 to 10 and pregnant women, and children's thyroid B-mode ultrasound examination results. Iodine nutrition was evaluated based on the "Guidelines for Monitoring Salt Iodization Projects and Determining Population Iodine Nutrition".Results:In 2017, a total of 85 water samples were collected, with a median iodine level of 1.6 μg/L, ranging from 0.2 to 10.9 μg/L. Except for one water sample with an iodine level of 10.9 μg/L, the iodine level of all other water samples was less than 10 μg/L. From 2017 to 2023, a total of 1 585 children and 718 pregnant women were monitored. The urinary iodine levels were 190.8 (120.2, 252.2), 137.0 (79.8, 195.8) μg/L, respectively. The coverage rate of iodized salt in Longxi County from 2017 to 2023 ranged from 99.4% to 100%, the consumption rate of qualified iodized salt ranged from 61.8% to 93.0%, and the qualified rate of iodized salt ranged from 62.1% to 93.0%. The median range of the urinary iodine for children in Longxi County was 125.9 to 228.5 μg/L. There was a statistically significant difference in the urinary iodine levels among children from different years ( P < 0.001). There was no statistically significant difference in urinary iodine levels among children of different genders and ages ( P > 0.05). There were statistically significant differences in the composition ratio of iodine nutrition status among children of different years, genders, and ages ( P < 0.05). The median range of urinary iodine in pregnant women was 121.0-180.5 μg/L. Except for 2017, the median urinary iodine of pregnant women in all other years was less than 150 μg/L. There were statistically significant differences in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women in different years ( P < 0.001). There was no statistically significant difference ( P > 0.05) in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women during different stages of pregnancy, and all pregnant women were iodine deficient in the early, middle, and late stages (median urinary iodine < 150 μg/L). Six hundred and sixty-five children underwent B-mode ultrasound examination, with a goiter rate ranging from 0 to 5.0%. Conclusion:From 2017 to 2023, the iodine nutrition of children aged 8 to 10 in Longxi County is in an appropriate state, while the iodine nutrition of pregnant women is in a deficiency state.

Objective To explore the correlation between the expression of serum microRNA(miR)-1298-5p,miR-625-5p,and miR-155 with the degree of Helicobacter pylori(Hp)infection in elderly gastric cancer patients.Methods From January 2021 to November 2023,120 elderly patients with gastric cancer admitted to the hospital from January 2021 to November 2023 were selected as the gastric cancer group,and 130 non-gas-tric cancer patients who underwent gastroscopy were selected as the control group.The expression levels of miR-1298-5p,miR-625-5p and miR-155 in serum were detected by fluorescence quantitative PCR(qPCR).Car-bon 13 urea breath test was used to detect the positive rate of Hp infection in two groups,and the degree of Hp infection in elderly patients with gastric cancer were evaluated.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of serum miR-1298-5p,miR-625-5p,and miR-155 expression levels for Hp infection in elderly gastric cancer patients.Pearson method was applied to analyze the correlation between serum miR-1298-5p,miR-625-5p,miR-155 expression and positive rate of Hp infection in elderly gas-tric cancer patients.Results Compared with the control group,the expression levels of miR-1298-5p and miR-625-5p in serum of gastric cancer group decreased(P＜0.05),while the positive rate of Hp infection and the expression level of serum miR-155 increased(P＜0.05).The expression levels of serum miR-1298-5p and miR-625-5p in elderly gastric cancer patients with Hp grade Ⅰ,Ⅱ,and Ⅲ infection were lower than those without Hp infection,while the expression level of miR-155 was higher(P＜0.05).Patients with poor differ-entiation,lymph node metastasis,and TNM stage Ⅲ-Ⅳ had lower expressions of serum miR-1298-5p and miR-625-5p(P＜0.05),and higher expression of miR-155(P＜0.05)than those with moderate-high differen-tiation,no lymph node metastasis,and TNM stage Ⅰ-Ⅱ.The expression levels of serum miR-1298-5p and miR-625-5p were negatively correlated with the positive rate of Hp infection in elderly patients with gastric cancer(r=-0.443,-0.386,both P＜0.001),and the expression levels of serum miR-155 were positively correlated with the positive rate of Hp infection(r=0.525,P＜0.001).The area under the curve(AUC)of serum miR-1298-5p,miR-625-5p and miR-155 combined diagnosis of Hp infection in elderly gastric cancer pa-tients was higher than that of single diagnosis(P＜0.05).Conclusion The expression levels of miR-1298-5p and miR-625-5p in serum of elderly gastric cancer patients with Hp infection decrease,while the expression level of miR-155 increases.These three factors are related to the degree of Hp infection and have good diag-nostic value for the occurrence of Hp infection.

Objective:To investigate the predictive value of radiomics features derived from dynamic contrast-enhanced MRI (DCE-MRI) based on habitat imaging technology for pathological complete response after neoadjuvant therapy (NAT) for breast cancer.Methods:All patients were female, aged 25-67 years. Patients were stratified into training ( n=83) and validation ( n=36) sets via stratified random sampling (7∶3 ratio). Pathological complete remission (pCR) and non-pathological complete remission (non-pCR) were defined using the Miller-Payne grading system. All patients underwent DCE-MRI before NAT. ITK-Snap software was used to outline the region of interest (ROI), the imaging histological features of the entire tumor region were extracted and screened, a traditional imaging histological model for predicting post-NAT pCR (ROI overall model) was constructed; the tumor region was divided into three subregions using habitat imaging technology, and the imaging histological features within ROI subregion 1, ROI subregion 2, and ROI subregion 3 were extracted and screened, and the habitat imaging model for predicting post-NAT pCR were constructed (ROI subregion 1 model, ROI subregion 2 model, ROI subregion 3 model). Univariate logistic regression identified clinical predictors of pCR for clinical model construction. Combined models integrating clinical predictors and habitat imaging features were established. The efficacy of each model in predicting pCR after NAT in breast cancer was evaluated using receiver operating characteristic curves and area under the curve (AUC), and the efficacy of clinical application of the models was evaluated using decision curve analysis (DCA). Results:Of the 119 patients, 74 were pCR patients, with 52 in the training set and 22 in the validation set, and 45 were non-pCR patients, with 31 in the training set and 14 in the validation set. Logistic regression analysis showed that human epidermal growth factor receptor 2 status ( OR=0.254, 95% CI 0.093-0.697, P=0.008) was an independent predictor of pCR after NAT, and this was used to construct a clinical prediction model. The predictive efficacy of ROI subregion 1 model and ROI subregion 2 model in the habitat model was higher than that of the traditional imaging histology model (ROI overall model), with AUCs of 0.805, 0.748,0.728 for the training set and 0.776,0.718,0.708 for the validation set, respectively. The combined clinical prediction model for predicting pCR after NAT in breast cancer had AUCs of 0.877 and 0.818 for the training and validation sets, respectively. DCA showed a higher net benefit for the combined model than for the traditional imaging histology model and the habitat imaging histology model. Conclusion:Compared with the traditional method of extracting the entire tumor region, extracting radiomics features from DCE-MRI subregions based on habitat imaging technology can improve the predictive performance of NAT efficacy in breast cancer.

Objective To explore the application effect of midazolam combined with oxycodone in fiberoptic bronchoscope intubation of burn patients with difficult airway.Methods 80 burn patients with difficult airway who underwent fiberoptic bronchoscope intubation from March 2023 to March 2024 were included as the study subjects.They were assigned into two groups based on anesthesia medication:the control group(40 cases)was given midazolam anesthesia,and the combined group(40 cases)was given midazolam combined with oxycodone anesthesia.The one-time success rate of intubation,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)],Ramsay sedation score,and adverse reactions were compared between the two groups.Results The success rate of intubation in the combined group(95.00%)was higher than that in the control group(72.50%),the difference was statistically significant(P<0.05).The HR and MAP of both groups decreased after administration(T1),1 min after intubation(T2),and 5 min after intubation(T3)compared to before administration(T0),and the HR of the combined group was lower than that of the control group,while the MAP was higher than that of the control group,the differences were statistically significant(P<0.05).The SpO2 at T1,T2 and T3 time points in the control group was significantly lower than T0 time point,the SpO2 of the combined group was higher than that of the control group at T1 and T2 time points,the differences were statistically significant(P<0.05);The Ramsay sedation score at T2 and T3 time points was lower than that of the control group,the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the combined group(12.50%)showed no obvious difference compared to the control group(7.50%)(P>0.05).Conclusion The combination of midazolam and oxycodone has a good healing effect in fiberoptic bronchoscope intubation of burn patients with difficult airway,with a higher success rate of intubation,better sedation,and can maintain hemodynamic stability.It also has high medication safety.