Purpose To quantitatively compare the diffusion parameters of mono-and biexponential diffusion-weighted imaging models,and to obtain optimal sets of b-values in diffusion-weighted MRI for obtaining monoexponential apparent diffusion coefficient(ADC)close to perfusion-insensitive intravoxel incoherent motion(IVIM)model ADC(ADCIVIM)in identifying of pulmonary solid benign and malignant lesions.Materials and Methods IVIM was performed in 40 patients with solid nodule and masse in Xi'an Gaoxin Hospital from July 2021 to August 2022 using a 3.0T MR imager.Two experienced diagnostic radiologists subjectively evaluated the IVIM images.A single index model was used to calculate ADC values(ADC0-1 000,ADC20-1 000,ADC50-1 000,ADC80-1 000,ADC150-1 000,ADC300-1 000,ADC500-1 000,ADC300,500,1 000,ADC300,800,1 000,ADC300,500,ADC300,800 and ADC300,1 000).The reference standard ADCIVIM value were calculated using a double-exponential model.The physician's measurements between two physicians were measured.The malignant and benign groups were compared and receiver operator characteristic curve for all parameters were analyzed.Results The measurement consistency of ADC values under b value sets and ADCIVIM was very good,and the intraclass correlation coefficient was more significant than 0.75.The differences between ADCIVIM and ADC values in each b group were statistically significant(t=-6.016--2.500,all P<0.05).The area under the curve(AUC)of ADCIVIM was the largest(0.906),with an optimal threshold of 1.271×10-3 mm2/s,a sensitivity of 80.0%and a specificity of 93.0%.The diagnostic efficacy close to ADCIVIM were ADC300,800(AUC=0.891),ADC50-1 000(AUC=0.827)and ADC300,800,1 000(AUC=0.795),respectively.The optimal threshold of ADC300,800 was 1.140×10-3 mm2/s,the sensitivity and specificity were 80.0%and 93.7%,respectively.Conclusion Combining b-values 300 s/mm2 and 800 s/mm2 is recommended as routine scanning parameters for identifying the insensitive monoexponential ADC between benign and malignant solid pulmonary lesions.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.

Purpose To quantitatively compare the diffusion parameters of mono-and biexponential diffusion-weighted imaging models,and to obtain optimal sets of b-values in diffusion-weighted MRI for obtaining monoexponential apparent diffusion coefficient(ADC)close to perfusion-insensitive intravoxel incoherent motion(IVIM)model ADC(ADCIVIM)in identifying of pulmonary solid benign and malignant lesions.Materials and Methods IVIM was performed in 40 patients with solid nodule and masse in Xi'an Gaoxin Hospital from July 2021 to August 2022 using a 3.0T MR imager.Two experienced diagnostic radiologists subjectively evaluated the IVIM images.A single index model was used to calculate ADC values(ADC0-1 000,ADC20-1 000,ADC50-1 000,ADC80-1 000,ADC150-1 000,ADC300-1 000,ADC500-1 000,ADC300,500,1 000,ADC300,800,1 000,ADC300,500,ADC300,800 and ADC300,1 000).The reference standard ADCIVIM value were calculated using a double-exponential model.The physician's measurements between two physicians were measured.The malignant and benign groups were compared and receiver operator characteristic curve for all parameters were analyzed.Results The measurement consistency of ADC values under b value sets and ADCIVIM was very good,and the intraclass correlation coefficient was more significant than 0.75.The differences between ADCIVIM and ADC values in each b group were statistically significant(t=-6.016--2.500,all P<0.05).The area under the curve(AUC)of ADCIVIM was the largest(0.906),with an optimal threshold of 1.271×10-3 mm2/s,a sensitivity of 80.0%and a specificity of 93.0%.The diagnostic efficacy close to ADCIVIM were ADC300,800(AUC=0.891),ADC50-1 000(AUC=0.827)and ADC300,800,1 000(AUC=0.795),respectively.The optimal threshold of ADC300,800 was 1.140×10-3 mm2/s,the sensitivity and specificity were 80.0%and 93.7%,respectively.Conclusion Combining b-values 300 s/mm2 and 800 s/mm2 is recommended as routine scanning parameters for identifying the insensitive monoexponential ADC between benign and malignant solid pulmonary lesions.

Objective To investigate the impact of nutritional risk-based intervention on the quality of life and survival prognosis of patients with the locally advanced pancreatic cancer and undergoing the chemotherapy.Methods A total of 118 patients with the pancreatic cancer and admitted to the Department of Hepatobiliary and Minimally Invasive Surgery,Lincang People's Hospital from April 2021 to April 2024 were selected and randomly divided into the nutritional intervention group and the control group,with 59 patients in each group.All patients received the palliative chemotherapy,and the control group received the routine dietary guidance,while the intervention group received the nutritional intervention based on the nutritional risk score.The nutritional status,quality of life score,and survival prognosis of the two groups were compared.Results The NRS2002 score of the intervention group and the control group gradually increased from the first to the sixth chemotherapy,and the NRS2002 score of the intervention group was lower than that of the control group at the 4th,5th,and 6th chemotherapy(P<0.05).The incidence of malnutrition in the intervention group was lower than that of the control group at the 1st,2nd,and 3rd chemotherapy(11.9%,30.9%,and 32.2%,respectively),but there was no significant difference(P>0.05);The incidence of malnutrition in the intervention group was significantly lower than that of the control group at the 4th,5th,and 6th chemotherapy(32.2%,45.8%,and 52.5%,respectively),while the incidence of malnutrition in the control group was 59.3%,69.5%,and 88.5%,respectively(P<0.05);The quality of life score of the intervention group in all dimensions was significantly higher than that of the control group after the treatment(P<0.05).After the nutritional intervention,the median OS time and median PFS time of the patients were significantly improved(P<0.05).Conclusion Nutritional intervention can reduce the nutritional risk during the chemotherapy for locally advanced pancreatic cancer patients and improve their quality of life.

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort(CRBD)in elderly male patients after ureteroscopic lithotripsy(URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A(esketamine group)and group B(control group),45 cases in each.After induction of general anesthesia,group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL,while group B received an equal volume of saline.The occurrence and severity of CRBD were recorded at T0(immediately after catheter removal),T1(30 min after catheter removal),T2(2 h after catheter removal),and T3(6 h after catheter removal)time points.The neurocognitive status and the incidence of perioperative neurocognitive disorder(PND)were assessed using the mini-mental state examination(MMSE)score one day before surgery and 6 h after surgery.Relevant indicators during the perioperative period and in the postanesthesia care unit(PACU)observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration,recovery time,dosages of propofol and remifentanil between the two groups(P>0.05).Compared with group B,group A showed significantly lower CRBD incidence rate at T0,T1,T2 and T3 time points,and the severity rate of CRBD at T0,and T1 time points in group A was significantly lower than that in group B,the differences were statistically significant(P<0.05).Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B,the differences were statistically significant(P<0.05).Compared with group B,group A required fewer tramadol hydrochloride administrations at T0,exhibited higher Ramsay sedation scale(RASS)scores,and lower Visual analog the scale(VAS)scores and Richer agitation-sedation Scale(SAS)scores,the differences were statistically significant(P<0.05).No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL,which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.

Objective:To introduce a surgical technique utilizing suture plate fixation for the treatment of elbow "terrible triad" injuries and to evaluate its clinical outcomes.Methods:A retrospective analysis was conducted on 11 patients (9 males and 2 females; mean age: 40.5±9.0 years, range: 26-53 years) with elbow terrible triad injuries who underwent treatment via a single lateral approach (Kaplan approach) combined with loop plate fixation at the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2018 and July 2022. During surgery, coronoid process fractures were stabilized using loop plates. Among the radial head fractures, 7 cases were fixed with headless compression screws, while 4 cases underwent radial head prosthetic replacement. Additionally, the lateral collateral ligament complex and common extensor tendon origin were repaired using one suture anchor in all cases. Postoperative evaluations included elbow range of motion (ROM), encompassing flexion-extension and forearm pronation-supination. Radiographic assessments were performed to evaluate the alignment of the humeroradial and humeroulnar joints, degenerative changes, and heterotopic ossification. Functional outcomes were assessed using the Mayo elbow performance score (MEPS) during follow-up.Results:All surgeries were successfully completed without intraoperative complications such as neurovascular injuries. Primary wound healing was achieved in all cases, with no instances of infection or other early complications. The mean follow-up duration was 15.55±3.78 months (range, 12-24 months). At 2 weeks postoperatively, the mean flexion-extension ROM was 66.82°±6.69°, forearm rotation ROM was 132.55°±10.61°, and MEPS was 62.73±3.44 points. By 3 months postoperatively, these values improved to 99.27°±10.82°, 159.18°±9.18°, and 83.18±10.31 points, respectively. At the final follow-up, further improvements were observed, with flexion-extension ROM reaching 115.18°±4.29°, forearm rotation ROM 164.73°±8.71°, and MEPS 95.45±7.89 points. Statistical analysis revealed significant increases in flexion-extension ROM ( F=268.014, P<0.001), forearm rotation ROM ( F=67.621, P<0.001), and MEPS ( F= 63.100, P<0.001) over time. At the final follow-up, MEPS outcomes were rated as excellent in 9 cases and good in 2 cases, yielding an excellent-to-good rate of 100%. Radiographic evaluation confirmed satisfactory joint alignment and bony union in all patients, with no reports of significant pain, elbow instability, or neurological deficits. Mild heterotopic ossification was observed in 2 cases but did not impair daily activities or necessitate additional treatment. Conclusion:The suture plate technique significantly reduced operative time, minimized surgical trauma, and lowered the risks of elbow infection and stiffness, demonstrating favorable clinical outcomes.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.

Objective To assess the efficacy and the survival rate of the hip joint following the treatment of osteonecrosis of the femoral head(ONFH)with ultrasound-guided percutaneous intra-articular platelet-rich plasma(PRP)injection in combination with percutaneous silver needle thermalolysis.Methods Fifty-six patients diag-nosed with ARCO(Association Research Circulation Osseous)stage Ⅱ ONFH were randomly allocated into two groups.The first group,designated as the PRP injection combined with silver needle thermalolysis group(Group R,n=28),and the second group,the steroid injection combined with silver needle thermalolysis group(Group S,n=28).Both groups underwent three injections(administered at 4-week intervals)and one session of silver needle thermalolysis.Outcome measures,including the Numerical Rating Scale(NRS)for pain assessment,Harris Hip Score(HHS),daily consumption of non-steroidal anti-inflammatory drugs(etoricoxib)and tramadol,progression to ARCO stage Ⅲ,and the rates of surgical intervention,were recorded at baseline,3 days,and 1,3,6,and 12 months after the treatment.Results When compared to the baseline,both groups manifested significant decreases in NRS scores and enhancements in HHS at all follow-up time points(P<0.05).Specifically,Group R demonstrated more favorable outcomes compared to Group S.At 3,6,and 12 months,Group R had lower NRS scores(P<0.01)and more notable improvements in HHS(P<0.01).Additionally,the daily analgesic consumption(etoricoxib and tramadol)in Group R was significantly lower than that in Group S at 3,6,and 12 months(P<0.01).Moreover,Group R exhibited a significantly lower progression rate to ARCO stage III and a lower hip replacement surgery rate(P<0.05).Conclusions Ultrasound-guided intra-articular PRP injection in combination with silver needle therma-lolysis expedites pain alleviation,enhances hip function,reduces analgesic dependence,and retards the progression of ONFH.This approach thus represents a clinically viable option for early-stage intervention.

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline, functional impairment, and neuropsychiatric symptoms. It represents the most prevalent form of dementia among the elderly population. Accumulating evidence indicates that oxidative stress plays a pivotal role in the pathogenesis of AD. Notably, elevated levels of oxidative stress have been observed in the brains of AD patients, where excessive reactive oxygen species (ROS) can cause extensive damage to lipids, proteins, and DNA, ultimately compromising neuronal structure and function. Amyloid β‑protein (Aβ) has been shown to induce mitochondrial dysfunction and calcium overload, thereby promoting the generation of ROS. This, in turn, exacerbates Aβ aggregation and enhances tau phosphorylation, leading to the formation of two pathological features of AD: extracellular Aβ plaque deposition and intracellular neurofibrillary tangles (NFTs). These events ultimately culminate in neuronal death, forming a vicious cycle. The interplay between oxidative stress and these pathological processes constitutes a core link in the pathogenesis of AD. The signaling pathways mediating oxidative stress in AD include Nrf2, RCAN1, PP2A, CREB, Notch1, NF‑κB, ApoE, and ferroptosis. Nrf2 signaling pathway serves as a key regulator of cellular redox homeostasis, exerts important antioxidant capacity and protective effects in AD. RCAN1 signaling pathway, as a calcineurin inhibitor, and modulates AD progression through multiple mechanisms. PP2A signaling pathway is involved in regulating tau phosphorylation and neuroinflammation processes. CREB signaling pathway contributes to neuroplasticity and memory formation; activation of CREB improves cognitive function and reduce oxidative stress. Notch1 signaling pathway regulates neuronal development and memory, participates in modulation of Aβ production, and interacts with Nrf2 toco-regulate antioxidant activity. NF‑κB signaling pathway governs immune and inflammatory responses; sustained activation of this pathway forms “inflammatory memory”, thereby exacerbating AD pathology. ApoE signaling pathway is associated with lipid metabolism; among its isoforms, ApoE-ε4 significantly increases the risk of AD, leading to elevated oxidative stress, abnormal lipid metabolism, and neuroinflammation. The ferroptosis signaling pathway is driven by iron-dependent lipid peroxidation, and the subsequent release of lipid peroxidation products and ROS exacerbate oxidative stress and neuronal damage. These interconnected pathways form a complex regulatory network that regulates the progression of AD through oxidative stress and related pathological cascades. In terms of therapeutic strategies targeting oxidative stress, among the drugs currently used in clinical practice for AD treatment, memantine and donepezil demonstrate significant therapeutic efficacy and can improve the level of oxidative stress in AD patients. Some compounds with antioxidant effects (such asα-lipoic acid and melatonin) have shown certain potential in AD treatment research and can be used as dietary supplements to ameliorate AD symptoms. In addition, non-drug interventions such as calorie restriction and exercise have been proven to exerted neuroprotective effects and have a positive effect on the treatment of AD. By comprehensively utilizing the therapeutic characteristics of different signaling pathways, it is expected that more comprehensive multi-target combination therapy regimens and combined nanomolecular delivery systems will be developed in the future to bypass the blood-brain barrier, providing more effective therapeutic strategies for AD.

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort(CRBD)in elderly male patients after ureteroscopic lithotripsy(URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A(esketamine group)and group B(control group),45 cases in each.After induction of general anesthesia,group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL,while group B received an equal volume of saline.The occurrence and severity of CRBD were recorded at T0(immediately after catheter removal),T1(30 min after catheter removal),T2(2 h after catheter removal),and T3(6 h after catheter removal)time points.The neurocognitive status and the incidence of perioperative neurocognitive disorder(PND)were assessed using the mini-mental state examination(MMSE)score one day before surgery and 6 h after surgery.Relevant indicators during the perioperative period and in the postanesthesia care unit(PACU)observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration,recovery time,dosages of propofol and remifentanil between the two groups(P>0.05).Compared with group B,group A showed significantly lower CRBD incidence rate at T0,T1,T2 and T3 time points,and the severity rate of CRBD at T0,and T1 time points in group A was significantly lower than that in group B,the differences were statistically significant(P<0.05).Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B,the differences were statistically significant(P<0.05).Compared with group B,group A required fewer tramadol hydrochloride administrations at T0,exhibited higher Ramsay sedation scale(RASS)scores,and lower Visual analog the scale(VAS)scores and Richer agitation-sedation Scale(SAS)scores,the differences were statistically significant(P<0.05).No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL,which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.