Objective:To develop outcome indicators for the implementation of comprehensive inter-ventions targeting the multimorbidity of myopia and obesity in children and adolescents,providing a basis for the co-prevention of multimorbidity and the outcome measurement of implementation research in children and adolescents.Methods:Based on the RE-AIM framework,a preliminary set of indicators was constructed.The Delphi method was employed,with experts scoring and providing feedback on the proposed indicators via questionnaires.After each round of consultation,expert enthusiasm index,authority coefficient,coordination degree,and consensus level were calculated.Expert opinions were col-lected and analyzed to modify,delete,or add indicators based on consultation results and screening crite-ria.Two Delphi rounds were conducted until consensus was achieved.Results:A total of 28 experts par-ticipated actually in both rounds.The Kendall's W coefficients for the two rounds of expert consultation were0.352(x2=413.952,P＜0.001)and 0.499(x2=405.044,P＜0.001),both statistically sig-nificant.The final outcome indicators for implementation research on comprehensive interventions for myopia and obesity comorbidity in children and adolescents included five primary dimensions with 13 secondary and 20 tertiary indicators.The dimension of reach included the number of children and adoles-cents involved,participant representativeness,and full-course participation representativeness.The di-mension of effectiveness included multimorbidity incidence,myopia incidence,spherical equivalent,body mass index(BMI),overweight and obesity prevalence,waist-to-height ratio,comprehensive health knowledge score,and comprehensive health behavior score.The dimension of adoption covered school representativeness and representativeness of school nurses and teachers involved in implementation.The dimension of implementation included fidelity,content modification,and cost.The dimension of mainte-nance included individual health outcomes and organizational sustainment.Conclusion:This study developed implementation outcome indicators for comprehensive interventions targeting multimorbidity of myopia and obesity among the children and adolescents based on the RE-AIM framework.These indica-tors can serve as a reference for optimizing intervention research strategies related to common multimor-bidity among children and adolescents in China.

Objective:It aims to deepen the understanding of the coupled and coordinated development of health investment and economic growth,and to provide a scientific basis for the development of health policies for China's ten largest urban ag-glomerations.Methods:Based on the provincial panel data of ten major urban agglomerations from 2013 to 2022,entropy weight method,coupled coordination degree model,spatial autocorrelation model and quantile regression model are used for analysis.Results:In observation period,the level of two-system coupling and coordination grows from 0.397 in 2013 to 0.645 in 2022;the global Moran's I decreases from-0.020 to-0.357.In the dynamic leapfrog analysis,22.2%of provinces and munici-palities experience positive leapfrogging,while 16.7%of provinces and municipalities show negative leapfrogging.Baesd on lo-calised Moran Index,the quantile regression results show that the proportion of the people in higher education,the level of ur-banization and the level of labor force have a positive influence on the level of coupling and coordination between these two sys-tems,with the β coefficient showing a tendency of increasing and then decreasing;medical research institutes have a negative influence on the level of coupling and coordination between these two systems on the 0.1-0.3 quantile;the level of foreign invest-ment has a positive influence on the 0.1 quantile,and the 0.6-0.8 quartile has a negative effect.GDP per capita has a weak ef-fect on the level of coordination between these two systems.Conclusion:The two-system coupling and coordination level of the ten major urban agglomerations shows an overall increase,but there are regional differences,and it is affected by the integra-tion of science and education,economic level and human resources.

AIM:To analyze the expression of se-creted phosphoprotein 1(SPP1)and programmed cell death-ligand 1(PD-L1)in SMARCA4-deficient non-small cell lung cancer,and to provide a scientif-ic basis for the study of the follow-up treatment of this rare pathological type of lung cancer.METH-ODS:The clinical and pathological characteristics of 12 patients with this disease were analyzed retro-spectively,and the patients were divided into two groups of adenocarcinomas and poorly differentiat-ed carcinomas according to their morphological characteristics,and the relationship between the expression of SPP1 and PD-L1 was analyzed in the two groups.RESULTS:SPP1 expression was detect-ed in all patients and Its expression level was signif-icantly higher in the poorly differentiated carcino-ma group compared with the adenocarcinoma group(P=0.015);PD-L1 expression was found in 6/7 patients(5 cases were not measured),compared with the adenocarcinoma group,PD-L1 was also highly expressed in the poorly differentiated carci-noma group(P=0.048)and the PD-L1 difference be-tween the two groups suggested that the results were similar to those of SPP1.CONCLUSION:SMARCA4-deficient non-small cell lung cancer has high positive expression of SPP1 and PD-L1.It was more pronounced in patients with poorly differenti-ated carcinoma.There may be a positive correla-tion between SPP1 and PD-L1 expression in SMAR-CA4-deficient non-small cell lung cancer and the mechanism of the correlation needs to be further verified in subsequent studies.

Objective This is to develop a comprehensive performance evaluation index system for physicians under the DRG system and to conduct practical research.Methods The"cost ratio"is used to establish a"sharing coefficient"to define the distribution of performance among physicians treating the same patient;the Delphi technique is applied to ascertain the weights of evalation index,and the weighted comprehensive index method is utilized to construct the performance evaluation index system for DRG physicians;empirical research on physician performance evaluation is conducted using hospital data.Results Following performance sharing and weighted integration,the basic evaluation indicators and the performance evaluation index of DRG both exhibit an approximate normal distribution between 0～100 points;the performance evalation index of DRG score can be utilized for the overall assessment of physicians,and the strengths and weaknesses of physician diagnosis and treatment can be analyzed based on various dimensional indices and scores.The performance sharing of the evaluation results of the same physician is more accurate than the traditional method,especially for the physicians with more transferred patients.Conclusion Using the"allocation coefficient"to divide the weight of"one patient and multiple doctors"and incorporating the weight into the comprehensive evaluation index system make the results more objective and accurate.The comprehensive performance evaluation index system for DRG physicians,based on the"sharing coefficient"and weighted comprehensive index method,offers a scientific and practical tool for hospital performance distribution management.

AIM:To analyze the expression of se-creted phosphoprotein 1(SPP1)and programmed cell death-ligand 1(PD-L1)in SMARCA4-deficient non-small cell lung cancer,and to provide a scientif-ic basis for the study of the follow-up treatment of this rare pathological type of lung cancer.METH-ODS:The clinical and pathological characteristics of 12 patients with this disease were analyzed retro-spectively,and the patients were divided into two groups of adenocarcinomas and poorly differentiat-ed carcinomas according to their morphological characteristics,and the relationship between the expression of SPP1 and PD-L1 was analyzed in the two groups.RESULTS:SPP1 expression was detect-ed in all patients and Its expression level was signif-icantly higher in the poorly differentiated carcino-ma group compared with the adenocarcinoma group(P=0.015);PD-L1 expression was found in 6/7 patients(5 cases were not measured),compared with the adenocarcinoma group,PD-L1 was also highly expressed in the poorly differentiated carci-noma group(P=0.048)and the PD-L1 difference be-tween the two groups suggested that the results were similar to those of SPP1.CONCLUSION:SMARCA4-deficient non-small cell lung cancer has high positive expression of SPP1 and PD-L1.It was more pronounced in patients with poorly differenti-ated carcinoma.There may be a positive correla-tion between SPP1 and PD-L1 expression in SMAR-CA4-deficient non-small cell lung cancer and the mechanism of the correlation needs to be further verified in subsequent studies.

Objective:It aims to deepen the understanding of the coupled and coordinated development of health investment and economic growth,and to provide a scientific basis for the development of health policies for China's ten largest urban ag-glomerations.Methods:Based on the provincial panel data of ten major urban agglomerations from 2013 to 2022,entropy weight method,coupled coordination degree model,spatial autocorrelation model and quantile regression model are used for analysis.Results:In observation period,the level of two-system coupling and coordination grows from 0.397 in 2013 to 0.645 in 2022;the global Moran's I decreases from-0.020 to-0.357.In the dynamic leapfrog analysis,22.2%of provinces and munici-palities experience positive leapfrogging,while 16.7%of provinces and municipalities show negative leapfrogging.Baesd on lo-calised Moran Index,the quantile regression results show that the proportion of the people in higher education,the level of ur-banization and the level of labor force have a positive influence on the level of coupling and coordination between these two sys-tems,with the β coefficient showing a tendency of increasing and then decreasing;medical research institutes have a negative influence on the level of coupling and coordination between these two systems on the 0.1-0.3 quantile;the level of foreign invest-ment has a positive influence on the 0.1 quantile,and the 0.6-0.8 quartile has a negative effect.GDP per capita has a weak ef-fect on the level of coordination between these two systems.Conclusion:The two-system coupling and coordination level of the ten major urban agglomerations shows an overall increase,but there are regional differences,and it is affected by the integra-tion of science and education,economic level and human resources.

Background Metals and metalloids in fine particulate matter (PM_2.5) may cause damage to the respiratory and circulatory systems of the human body, and long-term exposure is prone to causing chronic poisoning, cancer, and other adverse effects. Objective To assess the distribution characteristics of metals and metalloids in outdoor PM_2.5 in a southern city of China, conduct source apportionment, and evaluate the associated health risks, thereby providing theoretical support for further pollution control measures. Methods PM_2.5 samples were collected in districts A, B, and C of a southern China city, and the concentrations of 17 metals and metalloids were detected by inductively coupled plasma-mass spectrometry (ICP-MS). Pollution sources were assessed through enrichment factor and principal components analysis, and the main pollution sources were quantified using absolute principal component scores-multivariate linear regression (APCS-MLR). Health risks were evaluated based on the Technical guide for environmental health risk assessment of chemical exposure (WS/T777—2021). Results The ambient air PM_2.5 concentrations in the city were higher in winter and spring, and lower in summer and autumn. The annual average concentrations of ambient PM_2.5 in districts A, B, and C were 36.7, 31.9, and 24.4 μg·m⁻³, respectively. The ambient PM_2.5 levels in districts B and C were below the second-grade limit set by the Ambient air quality standards (GB 3095—2012). The enrichment factors of cadmium (Cd), aluminum (Al), and antimony (Sb) were greater than 10, those of copper (Cu), lead (Pb), arsenic (As), nickel (Ni), mercury (Hg), and molybdenum (Mo) fell between 1 and 10, and those of manganese (Mn), vanadium (V), chromium (Cr), cobalt (Co), barium (Ba), beryllium (Be), and uranium (U) were below or equal to 1. The comprehensive evaluation of source analysis showed that the main pollution sources in districts A and C and the whole city were coal-burning. In district B, the main pollution source was also coal combustion, followed by industrial process sources and dust sources. The carcinogenic risks of As and Cr were between 1×10⁻⁶ and 1×10⁻⁴. However, the hazard quotients for 15 metals and metalloids in terms of non-carcinogenic risk were below 1. Conclusion Cr and As in the atmospheric PM_2.5 of the city present a certain risk of cancer and should be paid attention to. In addition, preventive control measures should be taken against relevant pollution sources such as industrial emission, dust, and coal burning.

Objective This is to develop a comprehensive performance evaluation index system for physicians under the DRG system and to conduct practical research.Methods The"cost ratio"is used to establish a"sharing coefficient"to define the distribution of performance among physicians treating the same patient;the Delphi technique is applied to ascertain the weights of evalation index,and the weighted comprehensive index method is utilized to construct the performance evaluation index system for DRG physicians;empirical research on physician performance evaluation is conducted using hospital data.Results Following performance sharing and weighted integration,the basic evaluation indicators and the performance evaluation index of DRG both exhibit an approximate normal distribution between 0～100 points;the performance evalation index of DRG score can be utilized for the overall assessment of physicians,and the strengths and weaknesses of physician diagnosis and treatment can be analyzed based on various dimensional indices and scores.The performance sharing of the evaluation results of the same physician is more accurate than the traditional method,especially for the physicians with more transferred patients.Conclusion Using the"allocation coefficient"to divide the weight of"one patient and multiple doctors"and incorporating the weight into the comprehensive evaluation index system make the results more objective and accurate.The comprehensive performance evaluation index system for DRG physicians,based on the"sharing coefficient"and weighted comprehensive index method,offers a scientific and practical tool for hospital performance distribution management.

Objective To construct and validate a prediction model for urosepsis in patients after upper urinary tract stone surgery using various machine learning algorithms.Methods A total of 7 464 upper urinary tract stone patients who underwent surgery at the Sixth Affiliated Hospital of Guangxi Medical University from Jun.2018 to Jun.2023 were enrolled and randomly assigned to training(5 224 cases)or validation sets(2 240 cases)at a ratio of 7∶3.Among them,622(8.33%)cases developed urosepsis postoperatively.Six machine learning algorithms,including extreme gradient boosting(XGBoost),logistic regression,light gradient boosting machine(LightGBM),random forest(RF),adaptive boosting(AdaBoost),and gradient boosting decision tree(GBDT),were used to construct prediction models for postoperative urosepsis.The model's predictive ability and clinical benefits were evaluated using receiver operating characteristic(ROC)curves,Shapley additive explanation(SHAP)analysis,calibration curves,and decision curve analysis(DCA).Results The clinical features included body mass index(BMI),number of surgeries,heart rate,Barthel index,venous thrombo embolism(VTE)risk assessment,gender,American Society of Anesthesiologists(ASA)grade,urinary nitrite,and urinary leukocyte in the models.In the training set,the XGBoost,LightGBM,and RF models performed excellently,with area under curve(AUC)values of ROC curves reaching 1.00.In the validation set,the logistic regression model performed the best,with an AUC value of ROC curve of 0.76,showing good predictive stability and calibration.The AdaBoost and GBDT models followed with AUC values of 0.74 and 0.75,respectively,while the AUC values of the LightGBM,XGBoost,and RF models were 0.71,0.70,and 0.68.In terms of model interpretability,SHAP analysis showed the contribution of variables in a descending order as:heart rate,urinary leukocytes,gender,BMI,Barthel index,VTE risk assessment,urinary nitrite,number of surgeries,and ASA grade.Conclusion A logistic regression model for early risk prediction of postoperative urosepsis in upper urinary tract stone patients has been successfully constructed.This model has good predictive performance and calibration,and can effectively assist clinical diagnosis.

AIM: To investigate the changes of retinal nerve fiber layer(RNFL)thickness, retinal thickness and blood flow density in different stages of diabetic retinopathy(DR)patients based on optical coherence tomography angiography(OCTA).METHODS: A retrospective analysis was conducted on 382 patients(382 eyes)diagnosed with DR in our hospital from February 2023 to February 2024. According to the staging criteria, the patients were divided into mild group(n=121), moderate group(n=133), severe group(n=72), and proliferative group(n=56). The general clinical data of the four groups of patients was compared; OCTA was used to scan and collect data from all patients, and the RNFL thickness, retinal thickness, and blood flow density were compared among the four groups of patients.RESULTS: There was no statistically significant difference in age, gender, hypertension, chronic kidney disease, and random blood glucose among patients in the mild, moderate, severe, and proliferative groups(all P>0.05). As the stage of DR worsened, the duration of the disease gradually prolonged(P<0.05). The thickness of the RNFL(superior, inferior, temporal, nasal, and average thickness)and retinal thickness significantly increased with the severity of DR(all P<0.001); however, there was no statistically significant difference in inferior RNFL thickness between the moderate and mild groups(P>0.05). The blood flow density in the superficial and deep retinal layers, as well as in the choroidal capillary layer, significantly decreased with the progression of DR(all P<0.05). Nevertheless, there was no statistically significant difference in superficial retinal blood flow density between the moderate and severe groups(P>0.05).CONCLUSION: OCTA can accurately observe the changes in RNFL thickness, retinal thickness, and blood flow density in patients with DR at different stages, which can serve as sensitive indicators for monitoring DR progression.