Objective:To reveal the current status and existing problems in the coupling and coordinated development of medical security and common prosperity in China,and to provide decision-making references for advancing the high-quality development of medical security,achieving the goal of common prosperity,and promoting the coordinated development of both systems.Methods:The entropy weight method was employed to measure the levels of medical security and common prosperity across 31 provinces from 2013 to 2022.A coupling coordination degree model was utilized to explore the coupling dynamic relationship between these two systems.Kernel density estimation was applied to analyze the dynamic evolution of their coupling coordination,while Moran's I and Dagum's Gini coefficient were used to investigate the spatial differentiation characteristics of their coupling coordination.Results:Over the decade,both medical security and common prosperity levels in different pronvinces improved significantly,with regional disparities continuously narrowing.The coordinated development degree between medical security and common prosperity achieved a substantial leap,shifting from provinces predominantly categorized as"barely coordinated"and"primary coordination"to those concentrated in"intermediate coordination".The coordinated development of medical security and common prosperity exhibits spatial spillover effects and spatial disparities,with the primary source of spatial differences stemming from disparities between the eastern region and other areas.Conclusion:Future efforts should focus on integrating the medical security system to enhance operational efficiency and reduce costs,promoting the scientific and rational allocation of medical resources guided by common prosperity,and driving high-quality coupling and coordinated development through dual-way empowerment between medical security and common prosperity.

Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Objective:To reveal the current status and existing problems in the coupling and coordinated development of medical security and common prosperity in China,and to provide decision-making references for advancing the high-quality development of medical security,achieving the goal of common prosperity,and promoting the coordinated development of both systems.Methods:The entropy weight method was employed to measure the levels of medical security and common prosperity across 31 provinces from 2013 to 2022.A coupling coordination degree model was utilized to explore the coupling dynamic relationship between these two systems.Kernel density estimation was applied to analyze the dynamic evolution of their coupling coordination,while Moran's I and Dagum's Gini coefficient were used to investigate the spatial differentiation characteristics of their coupling coordination.Results:Over the decade,both medical security and common prosperity levels in different pronvinces improved significantly,with regional disparities continuously narrowing.The coordinated development degree between medical security and common prosperity achieved a substantial leap,shifting from provinces predominantly categorized as"barely coordinated"and"primary coordination"to those concentrated in"intermediate coordination".The coordinated development of medical security and common prosperity exhibits spatial spillover effects and spatial disparities,with the primary source of spatial differences stemming from disparities between the eastern region and other areas.Conclusion:Future efforts should focus on integrating the medical security system to enhance operational efficiency and reduce costs,promoting the scientific and rational allocation of medical resources guided by common prosperity,and driving high-quality coupling and coordinated development through dual-way empowerment between medical security and common prosperity.

OBJECTIVE To analyze the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treatment of carbapenem-resistant Acinetobacter baumannii(CRAB)pulmonary infection.METHODS A retrospective analysis was conducted on the clinical data of patients with CRAB pulmonary infection in our hospital from May 2021 to October 2024.Information such as age,gender,admitting department,infection status,underlying medical conditions,mechanical ventilation time,combination anti-infective treatment regimens,and the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)score 24 h before medication was compiled.Based on the effectiveness of the treatment,patients were divided into treatment-effective group and treatment-ineffective group.Univariate analysis and multivariate Logistic regression analysis were employed to identify independent factors influencing clinical efficacy.RESULTS A total of 156 patients were included,and 108 patients were treated effectively,with an effective rate of 69.23%.The results of univariate analysis indicated that there were statistically significant differences between 2 groups in terms of the duration of mechanical ventilation time,APACHE-Ⅱ score 24 h before medication,the number of complication types,the proportion of abnormal coagulation function,anti-infective treatment course,and hospital stay before medication(P＜0.05).The results of multivariate Logistic regression analysis showed that APACHE-Ⅱ score≥15 points 24 h before medication[OR=2.965,95%CI(1.284,6.845),P=0.020],mechanical ventilation time≥10 d[OR=3.577,95%CI(1.185,10.793),P=0.037]and hospital stay≥14 d before medication[OR=2.422,95%CI(1.036,5.654),P=0.041]were independent risk factors,and anti-infective treatment course＞7 d was a protective factor[OR=0.445,95%CI(0.221,0.895),P=0.043].CONCLUSIONS This study shows that the effective rate of polymyxin B combined with other antibiotics in the treatment of CRAB pulmonary infection is less than 70%.The mechanical ventilation time≥10 d,APACHE-Ⅱ score≥15 points 24 h before medication,and hospital stay≥14 d before medication may lead to treatment failure,whereas anti-infective treatment course＞7 d may be associated with treatment success.

OBJECTIVE To systematically evaluate the influential factors for the clinical efficacy of tigecycline in the treatment of severe infections caused by multidrug-resistant Gram-negative bacteria （MDR-GNB）. METHODS Retrieved from PubMed， Embase， The Cochrane Library， CNKI database， Wanfang database and VIP database， the studies about the influential factors for the clinical efficacy of tigecycline in the treatment of adult patients with severe infections caused by MDR-GNB from the database construction to April 30， 2025. After screening literature， extracting data and evaluating the quality of literature， systematic review was performed by using RevMan 5.3 software. RESULTS A total of 14 studies involving 2 033 patients were included， of which 1 355 patients showed effective treatment outcomes. The meta-analysis results showed that Acute Physiology and Chronic Health Evaluation （APACHE）-Ⅱ ＞ 20 [OR＝4.50， 95%CI （2.28， 8.85）， P＜0.001]， malignant tumor [OR＝1.96， 95%CI （1.41， 2.72）， P＜0.001]， hemodialysis [OR＝2.09， 95%CI （1.40， 3.12）， P＜0.001]， septic shock [OR＝3.07， 95%CI （2.00， 4.72）， P＜0.001]， mechanical ventilation [OR＝2.31， 95%CI （1.57， 3.39）， P＜0.001]， coagulation dysfunction [OR＝ 3.03， 95%CI （2.09， 4.37）， P＜0.001]， glucocorticoids use＞3 days [OR＝2.26， 95%CI （1.14， 4.45）， P＝0.020]， and longer hospitalization time before using tigecycline [OR＝3.33， 95%CI （1.34， 8.30）， P＝0.010] were risk factors for the clinical efficacy of tigecycline in treatment of severe infections caused by MDR-GNB. Tigecycline initial double-dose regimen [OR＝0.23， 95%CI （0.13， 0.42）， P＜0.001]， combination therapy [OR＝0.15， 95%CI （0.05， 0.48）， P＝0.001]， and prolonged treatment course [OR＝0.91， 95%CI （0.88， 0.95）， P＜0.001] were protective factors. CONCLUSIONS There are many influential factors for the clinical efficacy of tigecycline in the treatment of severe infections caused by MDR-GNB， among which APACHE-Ⅱ score＞20， malignant tumor， hemodialysis， septic shock， mechanical ventilation， coagulation dysfunction， glucocorticoids＞3 d and longer hospitalization time before using tigecycline before tigecycline （No.20251606） use are risk factors； tigecycline double dose， combined medication and longer treatment course are protective factors.

Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Objective:To explored the clinical characteristics and risk factors of acute kidney injury (AKI) caused by vancomycin combined with piperacillin sodium and tazobactam sodium (VPT) in adult patients with severe infections.Methods:Clinical data of adult patients with VPT-related AKI (AKI group) hospitalized at the Affiliated Hospital of Gansu Medical College and People′s Hospital of Hengshui from January 2022 to August 2023 due to severe infections were collected. The occurrence time, severity, and prognosis of AKI in the AKI group were descriptive statistically analyzed. According to the ratio of 1∶1, patients in the control group were randomly selected from those who did not develop AKI after using VPT in the same period. The general information, disease status, baseline laboratory tests results, and the application of VPT and combined drugs, etc. in patients of the 2 groups were collected. The influencing factors of AKI caused by VPT were analyzed by univariate and multivariate logistic regression.Results:A total of 1 547 adult patients with severe infections were treated with VPT, of which 175 (11.3%) developed AKI. Among the 175 patients, 81 (46.3%) were male and 94 (53.7%) were female, with an age of (55±22) years; the time from VPT treatment to the occurrence of AKI was (4±1) days, and the severity of AKI was staged as grade 1, 2 and 3 in 97 (55.4%), 54 (30.9%), and 24 (13.7%) patients, respectively. After drug withdrawal, the renal function gradually recovered in 169 (96.6%) of the 175 patients with AKI, and 6 (3.4%) patients needed continuous renal replacement therapy. Multivariate logistic regression analysis showed that the trough concentration of vancomycin >20 mg/L [odds ratio ( OR)=2.105, 95% confidence interval ( CI): 1.427-3.105, P=0.022], the duration of vancomycin treatment ≥11 days ( OR=1.518, 95% CI: 1.232-1.871, P=0.014), the duration of piperacillin sodium and tazobactam sodium treatment ≥14 days ( OR=1.826, 95% CI: 1.152-2.894, P=0.029) and longer duration of combined vasoactive drugs ( OR=3.315, 95% CI: 1.428-7.695, P=0.005) were independent risk factors for VPT-related AKI. Conclusions:VPT-related AKI in adult patients with severe infections mostly occurs within one week of combination therapy, and the severity was mostly stage 1 and 2. The trough concentration of vancomycin >20 mg/L, longer course of VPT treatment, and longer time of combined vasoactive drugs can increase the risk of VPT-related AKI.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

To summarize the nursing experience of a pediatric patient with multiple organ burns in the abdominal cavity and liver laceration caused by a fireworks explosion.The following nursing points were implemented:immediate activation of a multidisciplinary trauma rescue team upon admission to initiate emergency measures for traumatic shock;implementation of target-oriented fluid management to expedite postoperative intestinal function recovery;active control of abdominal infection to minimize the risk of septic shock;thorough and accurate assessment was conducted to prevent postoperative complications such as gastrointestinal hemorrhage,bile-leakage,gallbladder perforation,and delayed intestinal necrosis;nutritional screening and assessment was performed to develop personalized nutritional support programs;emphasis should be placed on pain assessment to implement individualized analgesia measures;the provision of high-quality psychological support focusing on addressing psychological trauma.The child was successfully discharged 36 days after surgery and exhibited satisfactory recovery during the two-month follow-up period.

Objective To investigate the correlation between random urinary albumin-to-creatinine ratio(ACR)and 24 hour urine total protein quantification(24h UTP)in patients with immunoglobulin A nephropathy(IgAN),and analyze the consistency of these methods in clinical diagnosis.Methods A total of 230 patients with primary IgAN admitted to Peking University Shenzhen Hospital from January 2019 to December 2020 were selected as the research subjects.Correlation analysis and intraclass correlation coefficient(ICC)were used to assess the correlation between ACR and 24h UTP and their consistency in clinical diagnosis.Subgroup analysis was performed using different chronic kidney disease(CKD)stages and urine protein levels.Receiver operating characteristic(ROC)curves were plotted with 24h UTP=0.5 g/24h,1.0 g/24h and 3.5 g/24h as boundary points to determine the optimal cut-off values for ACR.Results There was a positive correlation between ACR[0.79(0.41～1.45)g/g]and 24h UTP[1.02(0.58～1.80)g/24h]in patients with IgAN(r=0.85,P<0.01),and the consistency in clinical diagnosis between the two methods was moderate(ICC=0.63,P<0.01).Subgroup analysis revealed that the correlation and consistency between ACR and 24h UTP was not affected by CKD stages,with correlation coefficients(r)of different CKD staging ranging from 0.76 and 0.86(all P<0.01)and ICC values ranging from 0.53 and 0.72 across different CKD stages.However,it was affected by urine protein level.When 24h UTP was≤0.5 g/24h,there was no significant correlation between ACR and 24h UTP(r=0.08,P>0.05).In subgroups with 24h UTP≤0.5 g/24h,0.5 g/24h<24h UTP≤1 g/24h and 24h UTP>3.5 g/24h,the consistency between the two methods was negligible(all ICC<0.20).ROC curve results showed that when 24h UTP=0.5 g/24h,1.0 g/24h and 3.5 g/24h,the optimal cut-offvalues of ACR were 0.30 g/g,0.57 g/g and 1.28 g/g,respectively.Conclusion In IgAN patients,ACR cannot simply replace 24h UTP for urine protein level evaluation.Especially when 24h UTP≤1 g/24h and 24h UTP>3.5 g/24h,ACR may not accurately reflect the true urine protein level.