ObjectiveTo analyze the output and efficiency of chronic disease management services for hypertension and diabetes in community health service institutions in Shanghai, to evaluate the allocation and efficiency of chronic disease management resources, and to provide references for improving the efficiency of chronic disease management in Shanghai’s communities. MethodsA total of 73 community health institutions from 15 districts of Shanghai were selected. Based on the chronic disease management resource data of community health institutions in 2019, 2021, and 2023, descriptive methods and the BCC model in Data Envelopment Analysis (DEA) were used to analyze the resource allocation, service output, and the efficiency of chronic disease management services in community health institutions in Shanghai. ResultsFrom 2019 to 2023, the indicators of resource allocation and service output of community health service institutions in Shanghai all showed upward trends. In terms of service efficiency, the average number of chronic disease patients managed by each health technician decreased from 237 to 231, and the number of patients served per 1 000 working hours decreased from 54 to 44. DEA efficiency analyses showed that the average overall efficiency increased from 0.867 in 2019 to 0.886 in 2021 and then decreased to 0.811 in 2023. The average technical efficiency decreased from 0.901 to 0.847, which was the main reason for the decline in overall efficiency. The average scale efficiency showed an initial increase followed by a decrease, rising from 0.961 in 2019 to 0.977 in 2021 and dropping back to 0.955 in 2023. The number of strong effective districts (overall efficiency=1.000) decreased from 6 in 2019 to 3 in 2023, and the efficiency differences between districts expanded. The range of overall efficiency widened from 0.622‒1.000 to 0.513‒1.000, indicating a decline in overall efficiency and an increase in inter-district heterogeneity. ConclusionFrom 2019 to 2023, the total volume of resource allocation and service output for chronic disease management in community health service institutions in Shanghai increased continuously. However, both the service output efficiency and the overall resource allocation efficiency declined, driven primarily by a decrease in technical efficiency, and accompanied by widening inter‑district disparities.

Based on medical rescue operations aboard simulated hospital ships,this paper explores the medical care practice mode employed during maritime rescue missions,points out the deficiencies in current medical practices during rescue operations,and puts forward countermeasures to improve the practice based on past casualty reception and rescue training exercise.With a comprehensive analysis of casualty reception team practices on simulated hospital ships,this paper aims to provide insights for the continuous optimization of maritime medical care.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

To investigate the molecular mechanisms underlying the mechanosensitive ion channel PI-EZO2 in osteoarthritis(OA),we developed a lentiviral vector for endogenous PIEZO2 overexpression and established a stable PIEZO2-high-expressing immortalized human primary chondrocyte line.By map-ping the open reading frame of the PIEZO2 locus and designing sequence-specific sgRNA,we employed the CRISPR/Cas9 synergistic activation mediator(SAM)system to precisely integrate transcriptional ac-tivation elements into the PIEZO2 promoter region.Lentiviral-mediated targeted genomic integration en-sured endogenous PIEZO2 overexpression,confirmed by mCherry fluorescence tracing coupled with flow cytometric sorting,which revealed membrane-specific localization of PIEZO2 protein(localization effi-ciency:78.49％).Quantitative PCR demonstrated a 17-fold upregulation of PIEZO2 mRNA,while Western blotting validated enhanced membrane-localized protein expression.Strikingly,PIEZO2-overex-pressing chondrocytes exhibited hallmark OA metabolic phenotypes compared to wild-type controls:typeⅡ collagen mRNA expression decreased to 50％of baseline levels,whereas matrix metalloproteinase 13(MMP13)mRNA surged by 20-fold.These alterations recapitulated the pathological matrix metabolic phenotype observed in biomechanical OA models induced by cyclic mechanical stress(10％strain,0.5 Hz,8 h/day for 2 consecutive days).Collectively,we successfully generated a human chondrocyte model with stable PIEZO2 overexpression,which faithfully mirrors mechanotransduction-driven OA progression.This engineered cellular system provides a robust platform for dissecting PIEZO2-mediated mechanosig-naling networks and advancing targeted therapeutic discovery.

To investigate the clinical value of endoscopic ultrasound-guided puncture drainage in the treatment for liver abscess and abdominal and pelvic abscess with difficulty in conventional puncture drainage. Data of 12 such patients in the Second Affiliated Hospital of Soochow University from January 2015 to November 2023 were retrospectivly analyzed. Results showed liver abscess in 4 cases, abdominal and pelvic abscess in 8 cases. All patients had fever with varying degrees of abdominal pain. Twelve patients with liver abscess and abdominal and pelvic abscess received 13 times of endoscopic ultrasound-guided puncture (1 patient with a large abdominal and pelvic cyst complicated with infection received transgastric and transrectal puncture of 2 times). The puncture needle was successfully penetrated into the pus cavity. Four patients with liver abscess underwent endoscopic ultrasound-guided suction and irrigation, and the abscess was almost completely aspirated. Seven patients with abdominal and pelvic abscess underwent endoscopic ultrasound-guided suction and irrigation, of which 5 cases were almost completely aspirated, and 2 cases had poor drainage effect due to the viscous pus (1 case returned to normal temperature after anti-infection treatment; 1 case had recurrent fever after the operation, and septic shock and death occurred 2 weeks after the operation). A patient with recurrent abdominal and pelvic sclerosis after the operation had multiple abscesses in the abdomen and pelvis, and percutaneous CT-guided drainage was performed for abdominal abscess, but the fever was still repeated. Endoscopic ultrasound-guided balloon dilation plus double pig tail and nasobiliary duct drainage were performed. The patient's temperature returned to normal and abdominal pain was relieved 48 hours after the operation. The total effective rate of abscess drainage was 83.3% (10/12), and the effective rate of suction combined with irrigation for abscess drainage was 81.8% (9/11), and no operation-related complications were observed in all patients. After 3 months of follow-up, no recurrence occurred in 10 patients with effective drainage of abscess, and abscess was self-absorbed in 1 patient with pelvic abscess without effective drainage and no recurrence was observed. Endoscopic ultrasound-guided puncture drainage is of certain clinical value for some liver abscesses and abdominal and pelvic abscesses that are difficult to be drained by conventional puncture, and can reduce the secondary trauma caused by surgical operations.

Objective Radial artery occlusion(RAO)is one of the common complications following coronary intervention via the traditional radial artery approach.This study aims to evaluate the clinical effectiveness of retrograde recanalization of occluded radial arteries through the distal transradial approach(dTRA)approach.Methods A total of 35 patients with RAO admitted to the cardiovascular department of the Anhui Chest hospital between December 2022 and April 2024,who were scheduled to undergo coronary intervention and had attempted recanalization of RAO via dTRA approach were selected.The primary result was the success rate of recanalizing RAO via dTRA.The secondary results included factors influencing the failure of recanalization via dTRA,postoperative puncture complications,and the patency rate at the 3-month follow-up.Results This study divided the patients into a successful group(29 cases,82.9％)and a failed group(6 cases,17.1％)based on whether the distal radial artery was successfully opened and occluded.The proportion of smoking(100.00％vs.17.24％,P=0.040),history of diabetes(100.00％vs.10.34％,P=0.025),and chronic total occlusion of coronary artery(83.33％vs.17.24％,P=0.030)in the failure group were higher than those in the success group,and the difference was statistically significant.The application rate of balloon tracking assisted technology in the failed group(16.67％vs.58.62％,P=0.045),and the diameter of the radial artery at 3 days after surgery[(1.63±0.13)mm vs.(2.13±0.32)mm,P=0.021]and the peak radial artery blood flow velocity at 3 days postoperatively[(0.10±0.78)m/s vs.(0.50±0.13)m/s,P＜0.001]were all lower in the successful group,and the differences were statistically significant.Logistic regression analysis 3 days after surgery showed that chronic complete occlusion of the coronary artery was an independent risk factor for surgical opening failure(OR 0.042,95％CI 0.004-0.438,P=0.008).After 3 months of follow-up,the patency rate of the successful group was 55.2％.Conclusions Retrograde recanalization of RAO via dTRA is safe and feasible,but its long-term patency rate is not high.

Objective Radial artery occlusion(RAO)is one of the common complications following coronary intervention via the traditional radial artery approach.This study aims to evaluate the clinical effectiveness of retrograde recanalization of occluded radial arteries through the distal transradial approach(dTRA)approach.Methods A total of 35 patients with RAO admitted to the cardiovascular department of the Anhui Chest hospital between December 2022 and April 2024,who were scheduled to undergo coronary intervention and had attempted recanalization of RAO via dTRA approach were selected.The primary result was the success rate of recanalizing RAO via dTRA.The secondary results included factors influencing the failure of recanalization via dTRA,postoperative puncture complications,and the patency rate at the 3-month follow-up.Results This study divided the patients into a successful group(29 cases,82.9％)and a failed group(6 cases,17.1％)based on whether the distal radial artery was successfully opened and occluded.The proportion of smoking(100.00％vs.17.24％,P=0.040),history of diabetes(100.00％vs.10.34％,P=0.025),and chronic total occlusion of coronary artery(83.33％vs.17.24％,P=0.030)in the failure group were higher than those in the success group,and the difference was statistically significant.The application rate of balloon tracking assisted technology in the failed group(16.67％vs.58.62％,P=0.045),and the diameter of the radial artery at 3 days after surgery[(1.63±0.13)mm vs.(2.13±0.32)mm,P=0.021]and the peak radial artery blood flow velocity at 3 days postoperatively[(0.10±0.78)m/s vs.(0.50±0.13)m/s,P＜0.001]were all lower in the successful group,and the differences were statistically significant.Logistic regression analysis 3 days after surgery showed that chronic complete occlusion of the coronary artery was an independent risk factor for surgical opening failure(OR 0.042,95％CI 0.004-0.438,P=0.008).After 3 months of follow-up,the patency rate of the successful group was 55.2％.Conclusions Retrograde recanalization of RAO via dTRA is safe and feasible,but its long-term patency rate is not high.

Objective·To investigate the performance and psychological mechanisms of inhibitory control in patients with alcohol use disorder(AUD)under different emotional contexts,and to examine the influence of emotion regulation difficulties on inhibitory control.Methods·A total of 28 male AUD inpatients(AUD group)and 28 age-and education-matched healthy controls(HC group)were recruited.The emotional Go/Nogo task(angry/neutral facial expressions)was used to evaluate the subjects'behavioral inhibition,and the hierarchical drift-diffusion model(HDDM)was used to quantify the cognitive parameters(drift rate,decision threshold,and non-decision time).The Difficulties in Emotion Regulation Scale(DERS)and Alcohol Use Disorder Identification Test(AUDIT)were used for clinical evaluation.The moderated mediation effects were tested by bootstrap method.Results·The AUD group scored higher than the HC group on the DERS total score and all sub-dimensions(goal-directed behavior,impulse control,strategy access,and emotional clarity),and the difference was statistically significant(all P<0.05).At the behavioral level,compared with the HC group,the AUD group had elevated commission error rates[F(1,54)=8.62,P=0.005]and omission error rates[F(1,54)=4.28,P=0.043],and the reaction time of angry face stimuli was generally prolonged[F(1,54)=12.26,P=0.001].Cognitive modeling showed that the drift rate of the AUD group was significantly lower than that of the HC group[F(1,54)=15.56,P<0.001],indicating impaired information processing efficiency.The moderated mediation model showed that,under the condition of angry face stimuli,the drift rate partially mediated the relationship between group and commission error rate,and the total indirect effect value was 9.564(95%CI 3.874?16.387).Further analysis showed that the conditional indirect effect increased to 10.133(95%CI 3.963?17.927)at high levels of emotion regulation difficulty(one standard deviation above the mean),and to 9.011(95%CI 3.778?14.921)at low levels(one standard deviation below the mean).Conclusion·The deficits in information processing efficiency of AUD patients partly explains the impairment of inhibitory control,and this effect is associated with individual emotion regulation capacity.It is suggested that abnormal processing of social threat information may be an important factor affecting the impairment of inhibitory control in AUD patients,especially in individuals with weak emotion regulation ability.

To investigate the clinical value of endoscopic ultrasound-guided puncture drainage in the treatment for liver abscess and abdominal and pelvic abscess with difficulty in conventional puncture drainage. Data of 12 such patients in the Second Affiliated Hospital of Soochow University from January 2015 to November 2023 were retrospectivly analyzed. Results showed liver abscess in 4 cases, abdominal and pelvic abscess in 8 cases. All patients had fever with varying degrees of abdominal pain. Twelve patients with liver abscess and abdominal and pelvic abscess received 13 times of endoscopic ultrasound-guided puncture (1 patient with a large abdominal and pelvic cyst complicated with infection received transgastric and transrectal puncture of 2 times). The puncture needle was successfully penetrated into the pus cavity. Four patients with liver abscess underwent endoscopic ultrasound-guided suction and irrigation, and the abscess was almost completely aspirated. Seven patients with abdominal and pelvic abscess underwent endoscopic ultrasound-guided suction and irrigation, of which 5 cases were almost completely aspirated, and 2 cases had poor drainage effect due to the viscous pus (1 case returned to normal temperature after anti-infection treatment; 1 case had recurrent fever after the operation, and septic shock and death occurred 2 weeks after the operation). A patient with recurrent abdominal and pelvic sclerosis after the operation had multiple abscesses in the abdomen and pelvis, and percutaneous CT-guided drainage was performed for abdominal abscess, but the fever was still repeated. Endoscopic ultrasound-guided balloon dilation plus double pig tail and nasobiliary duct drainage were performed. The patient's temperature returned to normal and abdominal pain was relieved 48 hours after the operation. The total effective rate of abscess drainage was 83.3% (10/12), and the effective rate of suction combined with irrigation for abscess drainage was 81.8% (9/11), and no operation-related complications were observed in all patients. After 3 months of follow-up, no recurrence occurred in 10 patients with effective drainage of abscess, and abscess was self-absorbed in 1 patient with pelvic abscess without effective drainage and no recurrence was observed. Endoscopic ultrasound-guided puncture drainage is of certain clinical value for some liver abscesses and abdominal and pelvic abscesses that are difficult to be drained by conventional puncture, and can reduce the secondary trauma caused by surgical operations.