Objective To investigate the correlation between dual-energy computed tomography angiography(CTA)parameters of carotid plaques and acute stroke events.Methods A retrospective analysis was conducted on the clinical and imaging data of patients who underwent dual-energy head and neck CTA and brain MRI scans.Utilizing the Siemens workstation(Syngo.Via VB40B),region of interest(ROI)were placed on the thickest slice of the carotid plaque in the axial plane to obtain parameters such as fat fraction(FF),virtual non-contrast(VNC)value,iodine concentration(IC),electron density(Rho),effective atomic number(Zeff),dual energy index(DEI),spectral curve,and corresponding CT values at 40 keV(40 keVHU)and 90 keV(90 keVHU).The slope of the energy spectrum curve(λ)was calculated within the 40 keV-90 keV range.Patients with acute cerebral infarction(ACI)in the ipsilateral anterior circulation territory were classified into the ACI group,while those without were classified into the non-acute cerebral infarction(NACI)(NACI group).Qualitative data were analyzed using the x2 test,and quantitative data were analyzed using the t-test.The predictive performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,and the differences between different ROC curves were compared using the DeLong test.Results A total of 72 patients were included,with 21 in the ACI group and 51 in the NACI group.The mean values of FF,Zeff,and 40 keVHU in the ACI group were greater than those in the NACI group.Statistically significant differences were observed between the groups for Zeff,DEI,40 keVHU,and λ(P＜0.05).40 keVHU demonstrated the highest predictive performance,and the AUC,sensitivity,and specificity was 0.789,81.0％,and 74.5％,respectively.A combined variable constructed through logistic regression analysis yielded an AUC,sensitivity,and specificity of 0.796,85.7％,and 70.6％,respectively,with no significant statistical differences compared to single factor variables.Conclusion Dual-energy CTA parameters of carotid plaques may aid in predicting intraplaque hemorrhage(IPH)and the occurrence of acute stroke events.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To summarize the prediction model for inadequate bowel preparation in adults with colonoscopy to inform clinical practice.Methods:Literature on the prediction model of inadequate bowel preparation for colonoscopy was electronically searched in China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine disc, VIP, Yiigle, PubMed, Embase, Web of Science, CINAHL, PsycINFO, Cochrane Library and Google Scholar. The search period was from database establishment to December 31, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias and applicability of the included literature using the Prediction Model Risk of Bias Assessment Tool (PROBAST) .Results:A total of 22 articles covering 18 models were included. The incidence of inadequate bowel preparation for colonoscopy in adults ranged from 11.6% to 39.0%. The model construction method was dominated by Logistic regression, and some models had good predictive performance but lacked high-quality external validation results. Diabetes, chronic constipation, antidepressants, age, and body mass index were significant predictors of inadequate bowel preparation in colonoscopy.Conclusions:Nursing staff need to be aware of the influencing factors for inadequate bowel preparation and can choose models with good performance to guide clinical practice. Prediction models for inadequate bowel preparation in colonoscopy are currently in the developmental stage, and future research could leverage artificial intelligence to build high-performance, actionable models with extensive external validation.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective To investigate the correlation between dual-energy computed tomography angiography(CTA)parameters of carotid plaques and acute stroke events.Methods A retrospective analysis was conducted on the clinical and imaging data of patients who underwent dual-energy head and neck CTA and brain MRI scans.Utilizing the Siemens workstation(Syngo.Via VB40B),region of interest(ROI)were placed on the thickest slice of the carotid plaque in the axial plane to obtain parameters such as fat fraction(FF),virtual non-contrast(VNC)value,iodine concentration(IC),electron density(Rho),effective atomic number(Zeff),dual energy index(DEI),spectral curve,and corresponding CT values at 40 keV(40 keVHU)and 90 keV(90 keVHU).The slope of the energy spectrum curve(λ)was calculated within the 40 keV-90 keV range.Patients with acute cerebral infarction(ACI)in the ipsilateral anterior circulation territory were classified into the ACI group,while those without were classified into the non-acute cerebral infarction(NACI)(NACI group).Qualitative data were analyzed using the x2 test,and quantitative data were analyzed using the t-test.The predictive performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,and the differences between different ROC curves were compared using the DeLong test.Results A total of 72 patients were included,with 21 in the ACI group and 51 in the NACI group.The mean values of FF,Zeff,and 40 keVHU in the ACI group were greater than those in the NACI group.Statistically significant differences were observed between the groups for Zeff,DEI,40 keVHU,and λ(P＜0.05).40 keVHU demonstrated the highest predictive performance,and the AUC,sensitivity,and specificity was 0.789,81.0％,and 74.5％,respectively.A combined variable constructed through logistic regression analysis yielded an AUC,sensitivity,and specificity of 0.796,85.7％,and 70.6％,respectively,with no significant statistical differences compared to single factor variables.Conclusion Dual-energy CTA parameters of carotid plaques may aid in predicting intraplaque hemorrhage(IPH)and the occurrence of acute stroke events.

Objective:To summarize the prediction model for inadequate bowel preparation in adults with colonoscopy to inform clinical practice.Methods:Literature on the prediction model of inadequate bowel preparation for colonoscopy was electronically searched in China National Knowledge Infrastructure, Wanfang Data, China Biology Medicine disc, VIP, Yiigle, PubMed, Embase, Web of Science, CINAHL, PsycINFO, Cochrane Library and Google Scholar. The search period was from database establishment to December 31, 2023. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias and applicability of the included literature using the Prediction Model Risk of Bias Assessment Tool (PROBAST) .Results:A total of 22 articles covering 18 models were included. The incidence of inadequate bowel preparation for colonoscopy in adults ranged from 11.6% to 39.0%. The model construction method was dominated by Logistic regression, and some models had good predictive performance but lacked high-quality external validation results. Diabetes, chronic constipation, antidepressants, age, and body mass index were significant predictors of inadequate bowel preparation in colonoscopy.Conclusions:Nursing staff need to be aware of the influencing factors for inadequate bowel preparation and can choose models with good performance to guide clinical practice. Prediction models for inadequate bowel preparation in colonoscopy are currently in the developmental stage, and future research could leverage artificial intelligence to build high-performance, actionable models with extensive external validation.

【Objective】 To explore the risk factors of severe postoperative hemorrhage in patients with staghorn renal calculi treated with mini-percutaneous nephrolithotomy (M-PCNL), and to construct a Bayesian network model to predict postoperative hemorrhage. 【Methods】 A retrospective analysis was conducted on 160 patients with staghorn renal calculi who were treated with M-PCNL by surgeons with equivalent qualifications at the First Affiliated Hospital of Xinxiang Medical College during Jan. 2020 and Jan. 2022.A computer-generated random number method was used to divide them into a modeling group (120 cases) and a validation group (40 cases).Patients in the modeling group were divided into severe bleeding group (38 cases) and non-severe bleeding group (82 cases).The general information of the two groups was compared, and the independent risk factors of severe postoperative hemorrhage were analyzed.A Bayesian network model was constructed using R software, the inference prediction was conducted using Netica software, and the performance of the model was evaluated with receiver operating characteristic (ROC) curve. 【Results】 Multivariate logistic regression analysis showed that renal insufficiency (OR: 2.845, 95%CI: 1.563-6.515), mixmum diameter of stones ≥2 cm (OR: 2.063, 95%CI: 1.824-4.555), operation time ≥90 minutes (OR: 3.632, 95%CI: 2.365-7.11), one-stage operation (OR: 2.321, 95%CI: 1.874-6.332), and multi-channel stone removal (OR: 1.842, 95%CI: 1.366-3.687) were independent risk factors of postoperative severe hemorrhage (P<0.05).Based on the above parameters, a Bayesian network model was established, which was then evaluated with the modeling and validation groups internally and externally.The AUC of the modeling group was 0.879 (95%CI: 0.804-0.931, P<0.001), with sensitivity and specificity being 87.68% and 89.63%, respectively.The AUC of the validation group was 0.875(95%CI: 0.818-0.908, P<0.001), with sensitivity and specificity being 87.55% and 89.40%, respectively.The model showed good discrimination. 【Conclusion】 Renal dysfunction, mixmum diameter of stones ≥2 cm, operation time ≥90 minutes, one-stage operation, and multi-channel stone removal are risk factors of severe hemorrhage in patients after M-PCNL.The prediction model has good predictive ability and can effectively describe the complex mechanism between diseases and risk factors.

ObjectiveTo conduct comprehensive assessment of internal and external cadmium exposure and health risks for Shanghai residents. MethodsCadmium levels in food samples were calculated by employing two dietary exposure assessment methods， total diet study （TDS） and food frequency questionnaire （FFQ）， to estimate the daily dietary cadmium exposure of Shanghai residents. The provisional tolerable monthly intake （PTMI） of cadmium set by joint food and agriculture organization/WHO expert committee on food additives （JECFA） was applied to evaluate the health risk. Differences in dietary and urinary cadmium were compared by rank-sum test among different regions， age， gender， smoking status， and BMI groups， and the association between internal and external cadmium exposure was investigated by correlation analysis. ResultsThe mean value of urinary cadmium for 1 300 respondents was 0.542 μg·L^-1. Urinary cadmium was higher in the population in central urban and urban-rural fringe areas than in the suburban area， higher in the older age group than in the younger age group， and higher in the smoking group than in the non-smoking group （all P<0.01）. The two assessment methods showed that the mean values of daily dietary cadmium exposure for Shanghai residents were 0.306 and 0.090 μg·kg^-1， with 3.69% and 0.85% of Shanghai residents exceeding the PTMI， respectively. Correlation analyses showed that dietary exposure to cadmium based on the FFQ method was positively correlated with the urinary cadmium level when smoking status， age， gender， and BMI were adjusted. ConclusionDietary exposure to cadmium of Shanghai residents is mainly derived from vegetables， aquatic products， cereals and potatoes， and is overall at a low-risk level. Dietary exposure assessment based on FFQ and risk monitoring data can effectively estimate long-term cadmium exposure.

Objective:Meta-analysis of influencing factors of colonoscopy screening behavior of first-degree relatives of patients with colorectal cancer was conducted to provide basis for improving the rate of colonoscopy screening.Methods:The literatures and their references related to the influencing factors of colonoscopy screening behavior of first-degree relatives of colorectal cancer patients from the establishment of the database to July 1,2024 were searching in PubMed,Cochrane Library,Web of Science,CINAHL,Embase,China Biomedical Literature Database,China National Knowledge Infrastructure,Wanfang Database and VIP Database.The literatures were extracted and evaluated by two researchers independently according to the standards.In this study,the influencing factors of colonoscopy screening behavior were analyzed by Stata 18.0 software.Results:A total of 11 literatures were included,with a total sample size of 30 985 cases.The results of Meta-analysis showed that the colonoscopy screening rate of first-degree relatives of colorectal cancer patients was 35.30%(95%CI:24.30%-46.20%).First-degree relatives'education level[OR:1.586(95%CI:1.239-2.032)],colorectal cancer prevention and screening knowledge[OR:2.319(95%CI:1.626-3.307)],and perceived susceptibility[OR:1.301(95%CI:1.081-4.328)]and cues to action[OR:4.170(95%CI:2.686-6.469)]were the important factors influencing the colonoscopy screening behavior of the first-degree relatives of patients with colorectal cancer.Conclusion:The colonoscopy screening rate of first-degree relatives of colorectal cancer patients needs to be further improved,and the colonoscopy screening behavior is influenced by many factors.In the future,the results of this study can be referenced,in order to identify high-risk groups,take diversified and targeted intervention measures,improve the colonoscopy screening rate of first-degree relatives of colorectal cancer patients,and further improve the early detection rate of colorectal cancer in China.

Objective:Meta-analysis of influencing factors of colonoscopy screening behavior of first-degree relatives of patients with colorectal cancer was conducted to provide basis for improving the rate of colonoscopy screening.Methods:The literatures and their references related to the influencing factors of colonoscopy screening behavior of first-degree relatives of colorectal cancer patients from the establishment of the database to July 1,2024 were searching in PubMed,Cochrane Library,Web of Science,CINAHL,Embase,China Biomedical Literature Database,China National Knowledge Infrastructure,Wanfang Database and VIP Database.The literatures were extracted and evaluated by two researchers independently according to the standards.In this study,the influencing factors of colonoscopy screening behavior were analyzed by Stata 18.0 software.Results:A total of 11 literatures were included,with a total sample size of 30 985 cases.The results of Meta-analysis showed that the colonoscopy screening rate of first-degree relatives of colorectal cancer patients was 35.30%(95%CI:24.30%-46.20%).First-degree relatives'education level[OR:1.586(95%CI:1.239-2.032)],colorectal cancer prevention and screening knowledge[OR:2.319(95%CI:1.626-3.307)],and perceived susceptibility[OR:1.301(95%CI:1.081-4.328)]and cues to action[OR:4.170(95%CI:2.686-6.469)]were the important factors influencing the colonoscopy screening behavior of the first-degree relatives of patients with colorectal cancer.Conclusion:The colonoscopy screening rate of first-degree relatives of colorectal cancer patients needs to be further improved,and the colonoscopy screening behavior is influenced by many factors.In the future,the results of this study can be referenced,in order to identify high-risk groups,take diversified and targeted intervention measures,improve the colonoscopy screening rate of first-degree relatives of colorectal cancer patients,and further improve the early detection rate of colorectal cancer in China.