Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

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 observe the value of digital breast tomosynthesis(DBT)-based radiomics nomogram for predicting Ki-67 expression levels in breast invasive ductal carcinoma(BIDC).Methods Data of 374 cases of BIDC were retrospectively analyzed and divided into high-expression group(n=224)and low-expression group(n=150)according to expression of Ki-67 as well as training set(n=271,162 cases in high-expression group and 109 cases in low-expression group)and test set(n=103,62 cases in high-expression group and 41 cases in low-expression group)at the ratio of 7∶3.Clinical characteristics and lesion's image manifestations were compared between groups,and radiomic features were extracted and filtered.Then imaging radiomics models were constructed with 8 classifiers,respectively,and the optimal classifier was selected.A nomogram model was subsequently developed through integrating image features and radiomics scores.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the performance of the above models.Results Significant differences of the maximum diameter and spiculated margin of the lesions were found between groups(both P＜0.05),and AUC of multi-layer perceptron(MLP)image model constructed based on these indexes for predicting BIDC expression level of Ki-67 was 0.654 in training set and 0.715 in test set,of MLP radiomics model constructed based on 8 radiomics features was 0.802 in training set and 0.806 in test set,while of the nomogram model constructed based on image features and radiomics scores was 0.802 in training set and 0.806 in test set,respectively.Conclusion DBT-based radiomics nomogram could be used to effectively predict Ki-67 expression levels in BIDC.

Severe congenital neutropenia(SCN)is a rare disease characterized by the absolute neutrophil count(ANC)less than 0.5× 109/L in peripheral circulating blood.Due to the low neutrophil count,there is an increased risk of bacterial infection.And the most common oral manifestations are severe periodontitis and recurrent oral ulcer.This paper reports a 5-year-old girl with SCN and severe pe-riodontitis.On the basis of systemic treatment,the periodontal inflammation was controlled to a certain extent through periodontal non-sur-gical treatment and regular plaque control by using the WeChat platform for follow-up and oral hygiene.

Objective:To explore the prevalence and risk factors of insomnia in Chinese Air Force servicemen deployed to highland areas.Methods:A total of 718 Air Force servicemen deployed to Qinghai-Tibetan plateau were recruited at May 2024.Sleep quality was assessed with the Pittsburgh Sleep Quality Index.Social-demograph-ic,military service,and psychological characteristics were measured with a self-administered general question-naire.Bivariable and multivariable logistic regressions were performed to identify independent risk factors.Missing data were handled by the multiple imputation.Results:The average sleep duration was(6.9±1.2)h and the aver-age PSQI score was(5.9±4.1).Totally 53.8％of participants experienced clinically significant insomnia.The multivariable analysis revealed that age≥35(aOR=4.07,95％CI=1.11-17.76),stressful event(aOR=3.27,95％CI=2.00-5.49),dysfunctional sleep beliefs and attitudes(aOR=2.59,95％CI=1.75-3.85),and caffeine product usage(aOR=1.69,95％CI=1.17-2.43)were risk factors for insomnia,while Tibetan-indigenous ethnic(aOR=0.44,95％CI=0.20-0.91),higher perceived social support(aOR=0.96,95％CI=0.96-0.99),and positive coping style(aOR=0.96,95％CI=0.93-0.99)were protective factors.Conclusion:Air force service-men deployed to highland areas have sufficient sleep time,but reduced sleep quality.Age,exposed to stress event during deployment,dysfunctional sleep beliefs and attitudes,and caffeine product usage are risk factors for insomni-a,while Tibetan-indigenous ethnic,higher perceived social support and positive coping style act as protective fac-tors.

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 investigate the effect of fenofibrate(FF)on the heart of rats with high-altitude heart dis-ease-induced right ventricular hypertrophy(H-RVH),and to explore the mechanisms and associated signaling pathways.METHODS:A total of 36 six-week-old male SD rats were randomly divided into control,model(H-RVH),and FF inter-vention(H-RVH+FF)groups with 12 rats each.A rat model of H-RVH was established by single subcutaneous injection of Sugen 5416(20 mg/kg)and exposure to a hypoxic condition(5 000 m above sea level)for 21 d in all groups except the control group.The rats in H-RVH+FF group were given FF(60 mg·kg-1·d-1)through gavage,while those in control and model groups received equal volume of saline once daily for 21 d.Rat heart gross morphology was observed,and the heart volume and weight,right ventricular weight and other hypertrophy indexes were measured in each group at the end of the experiment.A right heart floating catheter was used for measuring pulmonary artery and right ventricular pressure.Cardi-ac function was checked through cardiac ultrasonography.The serum levels of atrial natriuretic peptide(ANP),N-termi-nal pro-brain natriuretic peptide(NT-proBNP),free fatty acids(FFA),and myocardial tissue glucose(Glu)in all groups of rats were detected.The protein expression of peroxisome proliferator-activated receptor α(PPARα),fatty acid binding protein 1(FABP1),carnitine palmitoyl transferase 1a(CPT1a),pyruvate dehydrogenase kinase(PDK),and pyruvate dehydrogenase(PDH)were detected through Western blot.RESULTS:(1)Compared with the control group,the H-RVH group showed a significant increase in heart morphology and weight and increases in heart weight/body weight(HW/BW),heart volume,right ventricular weight/heart weight(RVW/HW),and Fulton index(FI)(P<0.05).Cardiac mor-phology,volume,heart weight,and HW/BW significantly decreased in the fenofibrate intervention group compared with the H-RVH group(P<0.05).RVW/HW and FI also decreased.(2)The right heart float catheter test showed that the mean right ventricular pressure(mRVP)and mean pulmonary artery pressure(mPAP)significantly increased in the H-RVH group compared with the control group(P<0.01).The increases in mRVP and mPAP were reversed in rats in the fe-nofibrate intervention group compared with the H-RVH group.(3)Cardiac ultrasonography showed that compared with the control group,the H-RVH group had significantly increased right ventricular anterior wall(RVAW)and right ventricular posterior wall(RVPW)thickness(P<0.01),significantly decreased right ventricular end-diastolic diameter(RVEDD),and right ventricular end-diastolic length(RVEDL)(P<0.01).In addition,pulmonary artery acceleration time(PAAT)was reduced,ejection time(PAET)was prolonged,and PAAT/PAET ratio decreased(P<0.01).Compared with the H-RVH group,the fenofibrate intervention group showed significant decreases in RVAW and RVPW(P<0.05),increases in RVEDD and RVEDL,and an increase in PAAT/PAET ratio.(4)The kit assay showed that the levels of ANP and NT-Pro BNP in serum were significantly higher in the H-RVH group than in the control group(P<0.05),while the levels of both were lower in the fenofibrate intervention group.The levels of serum FFA and myocardial tissue Glu levels(P<0.05)were significantly higher in the H-RVH group than in the control group.The levels of serum FFA and myocardial tissue Glu level were significantly lower in the fenofibrate intervention group than in the H-RVH group(P<0.05).(5)Western blot results showed that the expression levels of PPARα,FABP1,CPT1a,and PDH in the myocardial tissues of rats in the H-RVH group were significantly reduced(P<0.01),whereas the expression level of PDK significantly increased relative to those of the control group(P<0.01).All the effects on the above indices in the H-RVH group can be significantly re-versed by fenofibrate intervention(P<0.05).CONCLUSION:Fenofibrate exerts a protective effect on the hearts of rats with right ventricular hypertrophy associated with high-altitude heart disease by activating PPARα/FABP1/CPT1a,en-hancing fatty acid oxidation,inhibiting PDK,and activating PDH to promote the aerobic oxidation of glucose.Hence,the medication can ameliorate glucose-lipid metabolism disorders.

Objective To observe the value of digital breast tomosynthesis(DBT)radiomics combined with clinical data for predicting molecular type of breast invasive ductal carcinoma(IDC).Methods Totally 309 female patients with Luminal type and 97 with non-Luminal type breast IDC were retrospectively enrolled and divided into training set(n=284)and test set(n=122)at a ratio of 7∶3.Multivariate logistic regression analysis was performed to screen independent impact factors related to Luminal expression of breast IDC based on clinical data and DBT manifestations,then a clinical-imaging model was constructed.The radiomics model was established based on mediolateral oblique position of DBT images,and a combined model was conducted combining with clinical-imaging model and radiomics model.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for predicting molecular type of breast IDC.Results Histopathological grade and lesion margin showed on DBT was the clinical and imaging independent impact factor associated with Luminal expression of breast IDC,respectively(both P＜0.05).AUC of combined model for predicting molecular type of breast IDC in training set and test set was 0.821 and 0.715,respectively,both higher than clinical-imaging model(0.727 and 0.665)and radiomics model(0.776 and 0.663)(all P＜0.05),while no significant difference was found between clinical-imaging model and radiomics model(both P＞0.05).Conclusion DBT radiomics combined with clinical data was helpful for predicting molecular type of breast IDC.

ObjectiveTo develop a scientifically rigorous and contextually appropriate instrument for evaluating the health service experience of pulmonary tuberculosis patients in China, to enable systematic assessment of core medical care dimensions, and to provide quantitative evidence for service improvement. MethodsGrounded in the theoretical framework of healthcare accessibility and the clinical care pathway for tuberculosis patients, the tool was developed through a systematic literature review and the Delphi expert consultation method. A multi-stage cluster sampling strategy was employed to survey pulmonary tuberculosis patients who had been receiving treatment for more than two months, aimed to explore the scale’s applicability in real-world settings. Reliability was assessed using Cronbach’s α and split-half reliability coefficients. Validity was evaluated through content validity, structural validity, convergent validity, and discriminant validity. ResultsThe tool was composed of 21 items across four dimensions: awareness, accessibility, affordability, and acceptability of tuberculosis medical care. It demonstrated a Cronbach’s α coefficient of 0.838 and a split-half reliability coefficient of 0.859. Exploratory factor analyses extracted six factors: satisfaction with healthcare services, supportive role of nurses, affordability of treatment costs, doctor-patient communication, waiting time for medical appointments, and transportation cost. The goodness-of-fit index (GFI) and other indices met the recommended standards, with the loading matrix indicating robust structural validity of the tool. The constructed factor model exhibited satisfactory content validity and discriminant validity. ConclusionThe scale for assessing patients’ experiences with tuberculosis-related medical care developed in this study demonstrates good reliability and validity and serves as a practical tool for evaluating patient experiences of tuberculosis medical care in China.

Objective To observe the value of digital breast tomosynthesis(DBT)-based radiomics nomogram for predicting Ki-67 expression levels in breast invasive ductal carcinoma(BIDC).Methods Data of 374 cases of BIDC were retrospectively analyzed and divided into high-expression group(n=224)and low-expression group(n=150)according to expression of Ki-67 as well as training set(n=271,162 cases in high-expression group and 109 cases in low-expression group)and test set(n=103,62 cases in high-expression group and 41 cases in low-expression group)at the ratio of 7∶3.Clinical characteristics and lesion's image manifestations were compared between groups,and radiomic features were extracted and filtered.Then imaging radiomics models were constructed with 8 classifiers,respectively,and the optimal classifier was selected.A nomogram model was subsequently developed through integrating image features and radiomics scores.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the performance of the above models.Results Significant differences of the maximum diameter and spiculated margin of the lesions were found between groups(both P＜0.05),and AUC of multi-layer perceptron(MLP)image model constructed based on these indexes for predicting BIDC expression level of Ki-67 was 0.654 in training set and 0.715 in test set,of MLP radiomics model constructed based on 8 radiomics features was 0.802 in training set and 0.806 in test set,while of the nomogram model constructed based on image features and radiomics scores was 0.802 in training set and 0.806 in test set,respectively.Conclusion DBT-based radiomics nomogram could be used to effectively predict Ki-67 expression levels in BIDC.