Objective To analyze the prevalence status of cardiometabolic risk factor (CMRF) and its aggregation among workers engaged in new forms of employment. Methods A total of 5 429 new employment workers (including couriers, online food delivery workers, and ride hailing drivers) who underwent health medical examinations at a tertiary hospital in Beijing City were selected as the research subjects using the judgment sampling method. Data on waist circumference, blood pressure, blood glucose, and blood lipid levels were collected to analyze their CMRF [central obesity, elevated blood pressure, elevated blood glucose, elevated triglycerides, and reduced high-density lipoprotein cholesterol (HDL-C)] and their aggregation (with ≥ 2 of the above 5 risk factors) status. Results The detection rates of central obesity, elevated blood pressure, elevated blood glucose, elevated triglycerides, and reduced HDL-C were 61.2%, 38.2%, 29.5%, 40.9% and 22.6%, respectively. The detection rates of CMRF aggregation was 57.8%. The result of multivariable logistic regression analysis showed that male, age ≥45 years, smoking, overweight, and obesity were risk factors for CMRF aggregation (all P<0.05). Conclusion The detection rate of CMRF and its aggregation among workers with new forms of employment in Beijing City is relatively high. Targeted prevention and control efforts should be strengthened for high-risk populations, especially males, workers aged ≥45 years, smokers, and those who are overweight or obese.

ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

The biography, medical writings and family lineages of Qilu medical masters in the Ming and Qing dynasties were collected and collated, so as to analyze their contributions to expounding acupuncture and moxibustion theories, practicing medical ethics and morals, and academic inheritance in later generations; as well as exploring the valuable guidance to clinical practice of modern acupuncture and moxibustion. ZHAI Liang, YUE Hanzhen, HUANG Yuanyu and LIU Kui were representatives of Qilu masters in the Ming and Qing dynasties. They showed their respects on classics with high inclusion, laid stress on elaboration and innovation in theories and practice of meridians, acupoints and acupuncture technique specially. Based on family heritage and apprenticeship, not only the academic school of acupuncture-moxibustion with regional characteristics had been cultivated, but also the important foundation been laid for the perfection of acupuncture-moxibustion diagnosis and treatment system in later generations. The integration of medical ethics and medical skills showed the spirit of "the benevolence of a doctor". These masters devoted themselves to the collation and research of medical books, collected the classics of medical masters, and wrote a number of easily-learned popular works for clinical application to benefit future generations.
Moxibustion/history* ; Humans ; China ; Acupuncture/education* ; Acupuncture Therapy/history* ; History, 20th Century ; History, 19th Century

The accuracy of medical imaging diagnosis will directly impact the clinical forensic evaluation's scientific validity and objectivity.This study systematically analyzed the primary causes of misdiagnosis and missed diagnosis in imaging examinations,focusing on representative cases,including rib fractures,traumatic subarachnoid hemorrhage,joint injuries with ligament damage,nasal fractures,congenital skeletal variations,and epiphyseal injuries.Key contributing factors encompassed limitation of imaging technologies,the insufficient interpretive experience of examiners,the complexity of injury mechanisms,and inadequate post-traumatic dynamic imaging follow-up.To address these issues,improvement strategies are proposed,which were establishing standardized imaging review protocols,implementing multimodal imaging approaches,rigorous evaluation of original imaging data,and enhancing professional knowledge regarding anatomical variations and injury differentiation.These measures aim to elevate the quality of forensic imaging diagnosis,providing more precise and reliable strategies for forensic clinical identifications.

Purpose To investigate the immunohistochemical HER2 expression in a large group of patients with urothelial carcinoma and to compare the results with the pathologic features and survival rate.Methods A total of 519 urothelial carcinoma specimens were collected from two centers.HER2 expression was measured by EnVision immuno-histochemistry.HER2 expression was compared with clinicopathological parameters,and further analyzed in relation to patient prognosis.Results The median age of the 519 patients was 66 years with a male to female ratio of 1.93∶1.Among them,160 cases were radical specimens,and 359 were transurethral resection specimens.The overall HER2 positivity rate was 61.7％(320/519),of which 148 cases(28.5％)were HER2 1+,238(45.9％)were HER2 2+,and 82(15.8％)were HER2 3+.In addition,51 cases(9.8％)were HER2-negative.HER2-positive ex-pression was associated with age,tumor location,histological grade,histological type,surgical approach,lymphovas-cular invasion,and neural invasion(all P＜0.05),but there was no significant correlation with gender,pT stage,muscular invasion,or lymph node metastasis.Univariate and multivariate logistic regression analysis showed that age≥ 66 years,higher tumor grade,and lymphovascular invasion were risk factors for positive HER2 expression,and high histological grade and lymphovascular invasion were independent risk factors affecting HER2 expression after controlling for confounders.Survival analysis showed no significant difference in recurrence-free survival between patients with HER2-positive and HER2-negative non-muscle-invasive urothelial carcinoma(P=0.274).Conclusion High histologic grade,tumor lymphovascular invasion,and neural invasion were associated with positive HER2 expression in patients with urothelial carcinoma,and higher histologic grade and lymphovascular invasion are important factors affect-ing HER2 expression.However,HER2-positive expression may not affect the prognosis of patients with non-muscle-invasive bladder urothelial carcinoma.

This study was aimed at establishing a method of ultra-fast quantitative PCR for Brucella detection.We used an exogenous recombinant plasmid as the internal reference and targeted the T4SS secretion system,an important Brucella viru-lence factor,to design specific primers and probes.The sensitivity,specificity,and repeatability of this method were evaluated,and a standard curve was constructed.The coincidence rate of detection findings with this method versus quantitative PCR was determined.This method markedly decreased the detection time to only 10 minutes.The standard curve demonstrated a good linear relationship(Y=-3.410 7x+38.357,R2=0.998 5)with a low minimum detection limit of 10 copies/μL.The method exhibited good specificity and did not specifically amplify several common clinical bacteria other than Brucella.The de-tection of three concentrations of positive plasmids yielded coefficients of variation(CVs)of 0.20％to 0.91％,thus demonstra-ting the method's excellent repeatability.Furthermore,140 clinical samples were analyzed concurrently with the fluorescence PCR method,which yielded a 100％compliance rate and consistent results.Our findings indicated that the Brucella ultra-fast quantitative PCR was ultrafast;had high sensitivity,high specificity,and good specificity;and can be used for the clinical de-tection of Brucella and emergency investigation of epidemics.Therefore,this method is valuable for the early diagnosis of Bru-cella.

Objective:Explore the effect of modified position on correction of breech presentation and the ma-ternal and infant outcomes in primiparas at 30-34 weeks of gestation in the midwifery clinic.Methods:From Jan-uary to December2024,274 primiparas at30-34 weeks of gestation who visited the midwifery clinic of The Gener-al Hospital of Northern Theater Command were selected.They were randomly divided into two groups according to the coin-tossing method.Through the inclusion exclusion,and elimination criteria,the selected pregnant women were finally categorized into the knee-chest position group(control group,n=126)and the modified position group(observation group,n=140).The success rate of breech presentation correction,delivery mode,duration of labor,1-minute and 5-minute Apgar scores of vaginally delivered infants,umbilical artery blood gas,postpartum re-covery,and postpartum depression incidence were compared between the two groups.Results:The success rate of breech presentation correction in the observation group was significantly higher than that in the control group(77.9%vs 58.7%,P<0.05).After breech presentation correction,the vaginal delivery rate was higher in the ob-servation group than in the control group(80.7%vs 66.2%,P<0.05).Among women who achieved vaginal de-livery,the intrapartum complication rate was significantly lower in the observation group than in the control group(22.7%vs.46.9%,P<0.05).The duration of the first stage of labor(557.7±195.5 min vs.629.6±208.2 min)and the second stage of labor(67.7±11.4 min vs.79.6±10.3 min)was significantly shorter in the observation group than in the control group(P<0.05).The pH of umbilical artery blood gas of newborns in the observation group delivered vaginally was significantly higher than that in the control group(7.367±0.028 vs.7.322±0.027,P<0.05).There were no statistically significant differences in the1-minute and5-minute Apgar scores of vaginally delivered infants,base excess,and lactate between the two groups(P>0.05).The initial time of lactation(21.7±4.4 h vs.23.5±4.1 h),time to ambulation(8.2±1.2 d vs.9.2±1.4 d),time for lochia to subside(29.6±4.8 d vs.34.1±4.8 d),and postpartum hemorrhage(298.1±56.1 ml vs.362.9±42.6 ml)in the observation group were significantly lower than those in the control group(P<0.05).There were no statistically significant differ-ences in the depression scores(EPDS)at 1 week and 6 weeks postpartum between the two groups of women with vaginal delivery(P>0.05).Conclusions:The modified position in the midwifery clinic significantly improves the success rate of breech presentation correction for primiparas at 30-34 weeks of gestation,good maternal and infant outcomes,and could be widely applied in clinical practice.

Objective To explore the application effect of a mobile learning platform for tumor diagnosis and treatment combined with the case-based learning method(CBL)in the standardized training of oncology residents.Methods Fifty-two 2022-level trainees who underwent the resident physician standardized training in the Oncology Department of the First Affiliated Hospital of Kunming Medical University from August to December 2024 were selected as the research subjects.Using the random number table method,they were divided into the observation group and the control group,with 26 trainees in each group.The control group adopted the CBL teaching method,while the observation group adopted the tumor diagnosis and treatment mobile learning platform combined with the CBL teaching method.During the graduation assessment,the mastery degree of basic knowl-edge in the oncology specialty,the analysis ability of clinical cases,the performance level of clinical operation skills,and the sat-isfaction with the standardized training in oncology for the two groups of trainees were compared.Results The scores of the obser-vation group students in terms of their mastery of basic knowledge in oncology,their ability to analyze clinical cases,and their satis-faction with the oncology residency training teaching were[(84.42±3.43)points,(85.08±2.94)points,(7.50±1.03)points],which were significantly higher than those of the control group[(82.15±4.32)points,(82.12±3.82)points,(5.89±1.28)points](P＜0.05).There was no significant difference in the clinical operation skills scores between the two groups of students(P＞0.05).Conclusion The application of our mobile learning platform for tumor diagnosis and therapy combined with CBL can effectively enhance the educational outcomes and satisfaction in medical oncology standardized residency training.

Objective:To investigate the current status of clinical nurses' knowledge, attitudes, and practices (KAP) regarding geriatric frailty syndrome in a general hospital and to analyze the influencing factors.Methods:Using convenience sampling, 319 clinical nurses from the First Affiliated Hospital of Wenzhou Medical University, were recruited between May and September 2024. A KAP questionnaire on geriatric frailty syndrome was developed through literature review and the Delphi method. Data were collected with a demographic questionnaire and the KAP questionnaire. Multiple linear regression was performed to identify factors influencing KAP levels.Results:The finalized KAP questionnaire consisted of three dimensions and 27 items. Cronbach's α coefficients for the total scale and the knowledge, attitudes, and practices subscales were 0.974, 0.981, 0.974, and 0.967, respectively. The overall KAP score among 319 nurses was (96.65±20.83). The average scores for each dimension were (4.08±0.82) for attitudes, (3.84±0.84) for practices, and (3.12±1.00) for knowledge. Multiple linear regression indicated that age and positions were respective significantly influenced the total KAP score and attitudes score ( P<0.05) ; frailty-related training was also a significant factor for KAP score and dimension scores ( P<0.05) . Conclusions:Clinical nurses demonstrated a moderate overall KAP level regarding geriatric frailty syndrome, with relatively high attitudes but insufficient professional knowledge. Hospital managers should provide effective education and training for frontline nurses to improve KAP levels and to promote early identification, assessment, and intervention of geriatric frailty.

Objective To explore the clinical,radiological,and arthroscopic outcomes of anterior cru-ciate ligament(ACL)reconstruction combined with posterior tibial slope(PTS)reducing osteotomy in patients with increased PTS and excessive anterior tibial subluxation(ATS)due to primary ACL inju-ry.Methods This retrospective study included patients who underwent ACL reconstruction between 2016 and 2022 in our department.The inclusion criteria were PTS≥15° and ATS≥6 mm,and all pa-tients received ACL reconstruction combined with PTS reducing osteotomy with a follow-up of more than 2 years.Before and after the operation,they were assessed KT-1000 side-to-side difference(KT SSD),pivot shift grade,Lachman test,anterior tibial subluxation of the medial and lateral compart-ments(ASMC and ASLC),magnetic resonance imaging(MRI),and arthroscopic findings of associat-ed injuries.Moreover,graft laxity was defined as graft laxity observed on MRI or arthroscopy,KT SSD>3 mm,or pivot>1+,while graft failure was defined as graft rupture on MRI or arthroscopy,KT SSD>5 mm,or pivot>2+.Meanwhile,clinical outcomes were compared preoperatively and post-operatively,and graft status and associated injuries were described.Results A total of 30 patients were included,with an average age of 31 years,and 23%of female.The inter-observer reliability for mea-surements of PTS and ATS was greater than 0.80.Compared to preoperative values,postoperative PTS(18.2° vs.6.8°,P<0.001),KT SSD(7.8 mm vs.1.2 mm,P<0.001),ASLC(7.5 mm vs.4.5 mm,P=0.002),and ASMC(5.0 mm vs.2.7 mm,P=0.034),all showed significant improvements.In addi-tion,the proportion of patients with postoperative pivot grade of 2+to 3+(73.3%vs.6.7%,P<0.001)and Lachman grades Ⅱ-Ⅲ(70%vs.3.3%,P<0.001)reduced significantly.At the last follow-up,the incidence of graft laxity was 20%,and that of the graft failure was 13.3%.Among all pa-tients,1 patient(3.3%)had graft roof impingement or cyclops lesion,and 3(10%)suffered from concomitant cartilage injury,with 4(13.3%)undergoing intercondylar notchplasty due to intercondylar notch hyperplasia.However,no complications related to osteotomy,such as infection,non-union,or fixation failure,were observed.Conclusion Over a follow-up period of at least 2 years,for primary ACL injury patients with steep PTS and excessive ATS,combined ACL reconstruction with PTS reduc-ing osteotomy improves knee stability,but significantly reduces PTS,the incidence of severe pivot grade,anterior tibial subluxation in both medial and lateral compartments,and delays the occurrence of graft laxity and failure.