Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To establish a finite element model of thoracolumbar kyphosis(TLK)for young patients with idiopathic Scheuermann's disease(SD),validate its effectiveness,and perform fi-nite element analysis to identify biomechanical factors contributing to low back pain caused by SD.Methods One TLK patient(26 years old)and one healthy(30 years old)subject were recruited.Spi-nal DICOM data were reconstructed three-dimensionally using Mimics software.Surface repair and fit-ting were performed in Geomagic Studio 2017,followed by modeling of intervertebral discs and end-plates in 3-matic software.Volume meshing and ligament construction were completed in Hypermesh 2017.Static simulations of the T8-S1 spinal segments for both groups were conducted in ANSYS.Af-ter validating the model using mechanical data,stress and strain distributions across vertebral bodies,intervertebral discs,and facet joint cartilage were calculated under identical constraints and loads.Re-sults 1)Significant differences were observed between the TLK patient and healthy subject in the me-chanical distribution of the T8-S1 segments of the spine.The healthy spine exhibited a peak strain of 1.62 mm,while the TLK patient showed a peak strain of 6.97 mm,330.2%higher than the former.Moreover,the peak stress in the TLK patient(10.51 MPa)exceeded the healthy subject(9.07 MPa)by 16.0%.2)Both groups demonstrated peak vertebral stress at the L5 level(9.07 MPa in the healthy individual vs.10.51 MPa in the TLK patient,15.8%higher).Stress distribution in the TLK patient was markedly uneven,with significant concentrations at the pedicles and laminae of L2,L3,and L4 vertebrae.3)Peak disc stress in the TLK patient was consistently higher,most notably at the L5/S1 segment(0.78 MPa in the TLK patient vs.0.16 MPa in the healthy subject,387.5%higher).4)Facet joint cartilage stress distribution in the TLK patient was abnormal.The healthy subject exhib-ited peak stress at L5/S1(1.53 MPa),whereas TLK patient showed peak stress at L1/L2(7.44 MPa),14.18 times higher than the former.Conclusion This study validates the finite element model of TLK deformity,confirming its utility for TLK-related research.Moreover,significant differences in stress-strain distribution and magnitude are observed between the TLK patient and healthy subject.Meanwhile,prolonged abnormal biomechanical loading,particularly localized stress concentrations in the L1-S1 vertebral bodies,discs,and facet joints,may accelerate degenerative changes and elevate the risk of low back pain.

Objective The aim of this study was to explore the mechanism of Naotaifang(NFT)in preventing neuronal pyroptosis in cerebral ischemia-reperfusion injury(CIRI).Methods Firstly,a network Meta-analysis was conducted to compare the clinical efficacy of Naotaifang and dl-3-n-butylphthalide in treating ischemic stroke,and dl-3-n-butylphthalide was identified as the positive control drug in this study.Then,a rat CIRI model was established using the middle cerebral artery occlusion/reperfusion(MCAO/R)method.Sixty adult male SD rats were randomly divided into model group(Model group),low-dose Naotaifang group(NTF-L group),medium-dose Naotaifang group(NTF-M group),ahigh-dose Naotaifang group(NTF-H group),NBP group(NBP group),and a sham surgery group(Sham group)using a random number table method,with 10 rats in each group.After MCAO/R,rats received NTF(4.5 g/kg for NTF-L,9 g/kg for NTF-M,and 18 g/kg for NTF-H)or Nimodipine(60 mg/kg)or distilled water(Sham group and Model group)via gavage for seven consecutive days.Neurological function was evaluated using the Zea Longa method,infarct volume was assessed by TTC staining,and HE and Nissl staining were used to observe changes in neurons in the ischemic cortex.ELISA was used to measure serum IL-1β and IL-18 levels,and Western blot was used to detect caspase-1 and GSDMD expression in the ischemic cortex.Results Network Meta-analysis showed no significant difference in clinical efficacy,neurological function scores,and TXB2 expression between Nimodipine and NTF interventions.Animal experiments revealed that neurological scores of the Model group was significantly increased,the volume of cerebral infarction was significantly enlarged,the structure of nerve cells in the ischemic cortical area was destroyed,and the number of nerve cells and Nissl bodies was significantly reduced,and expressions of IL-1β,IL-18 inflammatory factors and caspase-1,and GSDMD focal proteins were significantly decreased(P<0.01).The NTF-H group significantly reduced neurological function scores and cerebral infarction volume of rats in the Model group,significantly improved morphology of nerve cells and the number of Nissl body,and significantly decreased the expressions of IL-1β,IL-18 inflammatory factors,caspase-1,and GSDMD necroptosis proteins(P<0.01).There was no significant difference between the NTF-H group and the NBP group in terms of neurological scores,volume of cerebral infarction,IL-1β,IL-18 levels,and caspase-1 and GSDMD protein expression(P>0.05).Conclusion Both NTF and Nimodipine have therapeutic effects on ischemic stroke patients,with no significant difference between them,making Nimodipine a suitable positive control drug.NTF may alleviate CIRI by reducing pyroptosis through the caspase-1/GSDMD signaling pathway.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective: To investigate the mental health status and related factors among primary and secondary school students in western Yunnan Province, so ao to provide scientific evidences for advancing mental health education. Methods: In June 2024, a stratified cluster sampling method was employed to select 4 584 students from 18 schools across Diqing Tibetan Autonomous Prefecture, Lincang City and Baoshan City three regions in western Yunnan Province. The Mental Health Test (MHT) was used for assessment. Latent class analysis (LCA) and Logistic regression were applied for data classification and related factor analysis respectively. Results: The overall positive detection rate of MHT was 11.81%, with a mean total score of 40.50±19.25. The predominant issues were learning anxiety (58.4%), hypersensitivity tendency (31.1%), and self blame tendency (23.1%). LCA categorized students into four groups:severe psychological problems group (74.4% detection rate), learning anxiety hypersensitivity group ( 16.4 %), learning anxiety physical symptoms group (9.2%), and healthy group (0). Logistic regression revealed that compared with the healthy group, the severe problems group showed higher risks among females ( OR =3.01), junior/senior high school students ( OR =1.88/4.02), and those with authoritarian parenting ( OR =3.54); the anxiety hypersensitivity group had higher risks for females ( OR =1.87), senior high students ( OR =1.54), boarders ( OR =1.31), and authoritarian parenting recipients ( OR = 1.85 ); the anxiety physical symptoms group demonstrated increased risks among females ( OR =2.22), senior high students ( OR =2.58), and authoritarian parenting recipients ( OR =2.74), while lower risks were observed for students with parent/grandparent guardians ( OR =0.38) and non only children ( OR =0.58) (all P <0.05). Conclusions Mental health problems are prominent among students in western Yunnan, with gender, grade level, boarding status, guardian type, and parenting style being key determinants. Recommendations include strengthening mental health education, prioritizing left behind children s psychological well being and promoting healthy development.

Objective To establish a finite element model of thoracolumbar kyphosis(TLK)for young patients with idiopathic Scheuermann's disease(SD),validate its effectiveness,and perform fi-nite element analysis to identify biomechanical factors contributing to low back pain caused by SD.Methods One TLK patient(26 years old)and one healthy(30 years old)subject were recruited.Spi-nal DICOM data were reconstructed three-dimensionally using Mimics software.Surface repair and fit-ting were performed in Geomagic Studio 2017,followed by modeling of intervertebral discs and end-plates in 3-matic software.Volume meshing and ligament construction were completed in Hypermesh 2017.Static simulations of the T8-S1 spinal segments for both groups were conducted in ANSYS.Af-ter validating the model using mechanical data,stress and strain distributions across vertebral bodies,intervertebral discs,and facet joint cartilage were calculated under identical constraints and loads.Re-sults 1)Significant differences were observed between the TLK patient and healthy subject in the me-chanical distribution of the T8-S1 segments of the spine.The healthy spine exhibited a peak strain of 1.62 mm,while the TLK patient showed a peak strain of 6.97 mm,330.2%higher than the former.Moreover,the peak stress in the TLK patient(10.51 MPa)exceeded the healthy subject(9.07 MPa)by 16.0%.2)Both groups demonstrated peak vertebral stress at the L5 level(9.07 MPa in the healthy individual vs.10.51 MPa in the TLK patient,15.8%higher).Stress distribution in the TLK patient was markedly uneven,with significant concentrations at the pedicles and laminae of L2,L3,and L4 vertebrae.3)Peak disc stress in the TLK patient was consistently higher,most notably at the L5/S1 segment(0.78 MPa in the TLK patient vs.0.16 MPa in the healthy subject,387.5%higher).4)Facet joint cartilage stress distribution in the TLK patient was abnormal.The healthy subject exhib-ited peak stress at L5/S1(1.53 MPa),whereas TLK patient showed peak stress at L1/L2(7.44 MPa),14.18 times higher than the former.Conclusion This study validates the finite element model of TLK deformity,confirming its utility for TLK-related research.Moreover,significant differences in stress-strain distribution and magnitude are observed between the TLK patient and healthy subject.Meanwhile,prolonged abnormal biomechanical loading,particularly localized stress concentrations in the L1-S1 vertebral bodies,discs,and facet joints,may accelerate degenerative changes and elevate the risk of low back pain.

Objective The aim of this study was to explore the mechanism of Naotaifang(NFT)in preventing neuronal pyroptosis in cerebral ischemia-reperfusion injury(CIRI).Methods Firstly,a network Meta-analysis was conducted to compare the clinical efficacy of Naotaifang and dl-3-n-butylphthalide in treating ischemic stroke,and dl-3-n-butylphthalide was identified as the positive control drug in this study.Then,a rat CIRI model was established using the middle cerebral artery occlusion/reperfusion(MCAO/R)method.Sixty adult male SD rats were randomly divided into model group(Model group),low-dose Naotaifang group(NTF-L group),medium-dose Naotaifang group(NTF-M group),ahigh-dose Naotaifang group(NTF-H group),NBP group(NBP group),and a sham surgery group(Sham group)using a random number table method,with 10 rats in each group.After MCAO/R,rats received NTF(4.5 g/kg for NTF-L,9 g/kg for NTF-M,and 18 g/kg for NTF-H)or Nimodipine(60 mg/kg)or distilled water(Sham group and Model group)via gavage for seven consecutive days.Neurological function was evaluated using the Zea Longa method,infarct volume was assessed by TTC staining,and HE and Nissl staining were used to observe changes in neurons in the ischemic cortex.ELISA was used to measure serum IL-1β and IL-18 levels,and Western blot was used to detect caspase-1 and GSDMD expression in the ischemic cortex.Results Network Meta-analysis showed no significant difference in clinical efficacy,neurological function scores,and TXB2 expression between Nimodipine and NTF interventions.Animal experiments revealed that neurological scores of the Model group was significantly increased,the volume of cerebral infarction was significantly enlarged,the structure of nerve cells in the ischemic cortical area was destroyed,and the number of nerve cells and Nissl bodies was significantly reduced,and expressions of IL-1β,IL-18 inflammatory factors and caspase-1,and GSDMD focal proteins were significantly decreased(P<0.01).The NTF-H group significantly reduced neurological function scores and cerebral infarction volume of rats in the Model group,significantly improved morphology of nerve cells and the number of Nissl body,and significantly decreased the expressions of IL-1β,IL-18 inflammatory factors,caspase-1,and GSDMD necroptosis proteins(P<0.01).There was no significant difference between the NTF-H group and the NBP group in terms of neurological scores,volume of cerebral infarction,IL-1β,IL-18 levels,and caspase-1 and GSDMD protein expression(P>0.05).Conclusion Both NTF and Nimodipine have therapeutic effects on ischemic stroke patients,with no significant difference between them,making Nimodipine a suitable positive control drug.NTF may alleviate CIRI by reducing pyroptosis through the caspase-1/GSDMD signaling pathway.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective:To explore the experience and learning curve of single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach.Methods:Clinical data of 138 patients undergoing single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via oral vestibular approach from Sep. 2019 to Dec. 2021 in the Department of Thyroid and Breast Surgery of Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The cumulative sum (CUSUM) method and best-fit curve analysis were used to compare the differences in each index such as operative time, intraoperative bleeding, number of lymph nodes cleared in the central region and postoperative related complications at various stages of the learning curve.Results:All 138 patients underwent single-line suspension rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach, and one patient was converted to open surgery due to large intraoperative bleeding in the mass. There were 14 males and 124 females, mean age (36.07±8.49) years (20-55 years), thyroid tumor size (7.74±6.49) mm (2.4-50mm), 5 cases underwent Subtotal thyroidectomy, 129 cases underwent Unilateral lobectomy + lymph node dissection in the middle region, and 4 cases total thyroidectomy + central zone lymph node dissection. The number of surgical cases corresponding to the apex of the CUSUM learning curve was 45, and the learning curve was divided into two stages: the learning improvement stage (1-45 cases) and the mastery stage (46-138 cases). The operative time, intraoperative bleeding, postoperative hospital stay, and chin numbness were all lower in the proficiency period than in the learning and training period ( P<0.05), and the number of lymph nodes cleared in the central region was larger than that in the learning and improvement stage ( P<0.05), while the differences in other indexes between the two stages were not statistically significant ( P>0.05) . Conclusion:The single-line suspension suction rod-assisted hybrid cavity-building thyroid surgery via the oral vestibular approach has clinical application value and is worth promoting, and the number of surgical cases to be accumulated to master this technique is 45.