Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

This study aims to evaluate the effects of sodium butyrate(NaBu)on preliminary follicle development of mice,using an in vitro 3D culture system.Preantral follicles were isolated from mouse ovaries(12.5 days post-birth)and cultured in vitro,NaBu was added for treatment during the culture process.Follicle morphology was observed and follicular diameter,survival rate,antral formation rate,oocyte maturation rate and early embryonic development were evaluated.The re-sults showed that an in vitro 3D culture system for preantral follicles of mice was successfully es-tablished.Matured follicles were cultured following an initial induction period of 8 days,after which M Ⅱ-stage oocytes were effectively expelled.During the process of follicle culture,the addition of varying doses(0.05-1.00 mmol/L)of NaBu from 0th day to 8 days had not showed any significant promotion in follicle development at any of the tested concentrations.NaBu at a dose of 0.10 mmol/L significantly increased antral formation rate(treated on 4th day for 2 days).In conclusion,short-term administration of appropriate doses of NaBu could significantly facilitate in vitro preantral follicle development and oocyte maturation by ensuring sustained developmental potential within follicles.This study may provide a theoretical basis for sodium butyrate to improve the reproduc-tive capacity of livestock and poultry in the breeding process.

This paper summarized the experience of Chinese medical master Han Mingxiang in treating pathogenic-damp caused diseases by the method of dispelling dampness.Han Mingxiang believes that refractory diseases are usually caused by pathogenic cold and dampness,and complicated diseases are usually caused by phlegm and stagnation.Predominant dampness causes the inactivation of yang,and warming therapy is not the only one choice for activating yang.In clinical practice,he emphasizes the principles for dispelling dampness mainly by simultaneous treatment of phlegm and qi,lifting lucid yang and lowering turbid yin,nourishing spleen and resolving dampness,expelling and resolving pathogens by elevation and dispersion,relieving exterior and activating yang,which is summed up as"warming,resolving,dispersing and activating,regulating qimovement".For the treatment of the diseases caused by pathogenic-damp,the warm-natured medicines are usually used frequently,and the warm-natured medicines are not limited to the pungent-warm medicine.For dispelling dampness,the method of relieving exterior and promoting qi movement,percolating and draining dampness with aromatics,and relieving fluid retention with pungent-sweet medicine can be chosen flexibly based on syndrome differentiation,thus to reach the goal of activating yang and resolving stagnation and to obtain satisfactory efficacy.

Anatomy of laboratory animals plays an important role in laboratory animal science,veterinary medicine,and other life sciences.Integrating mind mapping into the entire teaching process can effectively help teachers to optimize the organization of teaching contents and stimulate students' enthusiasm and self-motivation for learning.This manuscript aims to explore the feasibility,advantages,and challenges of applying mind-mapping tools for teaching anatomy of laboratory animals.We analyze the different application scenarios from the perspectives of both teachers and students,with the aim of providing practical teaching tools and methodologies to enhance instructional effectiveness in the teaching of anatomy of laboratory animals.

This study aims to evaluate the effects of sodium butyrate(NaBu)on preliminary follicle development of mice,using an in vitro 3D culture system.Preantral follicles were isolated from mouse ovaries(12.5 days post-birth)and cultured in vitro,NaBu was added for treatment during the culture process.Follicle morphology was observed and follicular diameter,survival rate,antral formation rate,oocyte maturation rate and early embryonic development were evaluated.The re-sults showed that an in vitro 3D culture system for preantral follicles of mice was successfully es-tablished.Matured follicles were cultured following an initial induction period of 8 days,after which M Ⅱ-stage oocytes were effectively expelled.During the process of follicle culture,the addition of varying doses(0.05-1.00 mmol/L)of NaBu from 0th day to 8 days had not showed any significant promotion in follicle development at any of the tested concentrations.NaBu at a dose of 0.10 mmol/L significantly increased antral formation rate(treated on 4th day for 2 days).In conclusion,short-term administration of appropriate doses of NaBu could significantly facilitate in vitro preantral follicle development and oocyte maturation by ensuring sustained developmental potential within follicles.This study may provide a theoretical basis for sodium butyrate to improve the reproduc-tive capacity of livestock and poultry in the breeding process.

Anatomy of laboratory animals plays an important role in laboratory animal science,veterinary medicine,and other life sciences.Integrating mind mapping into the entire teaching process can effectively help teachers to optimize the organization of teaching contents and stimulate students' enthusiasm and self-motivation for learning.This manuscript aims to explore the feasibility,advantages,and challenges of applying mind-mapping tools for teaching anatomy of laboratory animals.We analyze the different application scenarios from the perspectives of both teachers and students,with the aim of providing practical teaching tools and methodologies to enhance instructional effectiveness in the teaching of anatomy of laboratory animals.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Background::Clinical opportunistic screening is a cost-effective cancer screening modality. This study aimed to establish an easy-to-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.Methods::We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China. The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics. The final model was derived based on unconditional logistic regression, and predictors were selected according to the Akaike information criterion. External validation was carried out with 32,614 participants from a community-based randomized controlled trial.Results::This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors, including advanced age, male gender, family history of gastric cancer, low body mass index, unexplained weight loss, consumption of leftover food, consumption of preserved food, and epigastric pain. This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve (AUC) of 0.791 (95% confidence interval [CI]: 0.750–0.831). External validation of the model in the general population generated an AUC of 0.696 (95% CI: 0.570–0.822). This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.Conclusion::This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.

Objective To investigate the effect of esketamine combined with erector spinae plane block(ESPB)on the quality of early postoperative recovery in patients undergoing thoracoscopic pulmonary surgery.Methods Ninety patients who underwent thoracoscopic lung surgery(thoracoscopic radical resec-tion of lung cancer,thoracoscopic lobectomy or segmentectomy)from May 2022 to July 2023 were selected,47 males and 43 females,aged 18-64 years,BMI 18-25 kg/m2,ASA physical statusⅠorⅡ.According to random number table method,the patients were divided into two groups:the ESPB group(group C)and the esketamine combined with ESPB group(group D),45 patients in each group.Patients in the two groups completed ultrasound-guided ESPB,followed by sufentanil anesthesia induction and patient-controlled intra-venous analgesia(PCIA)in group C,while esketamineanesthesia induction,maintenance,and PCIA in group D.The intraoperative dosage of anesthetics,numerical rating scale(NRS)score during activity 1 hour,6,12,24,and 48 hours after operation,the number of PCIA compressions within 24 hours after op-eration,the number of rescue analgesia after operation,the recovery time of anesthesia,the incidence of postoperative nausea and vomiting within 2 days after operation and the adverse reactions related to esket-amine were recorded.The 40-item recovery quality scale(QoR-40)score was used to evaluate the quality of recovery of patients 1 day before operation and 2 days after operation.The hospital anxiety and depression scale(HADS)was used to assess patients anxiety and depression 1 day before surgery and at discharge.Results Compared with group C,the dosage of propofol and remifentanil intraoperatively,the incidence of postoperative nausea and vomiting were decreased(P＜0.05),the QoR-40 score was increased 2 days after operation,HADS score at discharge was decreased in group D(P＜0.05).Conclusion Esketamine combined with ESPB is safe and effective for patients undergoing thoracoscopic lung surgery.The periopera-tive analgesia is perfect,the adverse reactions are few,and the quality of early recovery is high,which pro-vides a new anesthesia choice for such surgery.

Blended teaching can promote the learning engagement of students and enhance their experience by combining online independent learning and offline class learning. We applied blended teaching in the course of Histology and Embryology in the large class of 147 nursing undergraduates in Chongqing Medical University. First, the teaching method was designed by a pre-course survey, and online resources were constructed. Second, students' online learning activities and group discussions were guided by a learning map. Then, flipped classes were carried out in offline class hours. Finally, an end-of-course survey and final exam scores were used evaluate the effectiveness of blended teaching. A total of 142 valid questionnaires were returned; 123 students (86.6%) approved of the effectiveness of blended teaching, 133 students (93.7%) showed improved abilities in various aspects, and 79 students (55.6%) were able to complete their online learning tasks in fewer hours than required for face-to-face lectures. The final exam results showed that the average score of blended teaching class increased by 3.5 points compared with that of the traditional face-to-face lecture class. In conclusion, blended teaching in Histology and Embryology in the large class can achieve good learning and teaching effects and thus holds promise for application.