BACKGROUND:The decreased postural control ability due to mild cognitive impairment in elderly people leads to the increased risk of falls.Dual-task is the primary research paradigm for evaluating the relationship between cognition and postural control in the scenes close to real life.The sample entropy of the plantar center of pressure(COP)displacement during standing can represent the complexity of postural control. OBJECTIVE:Based on the COP displacement sample entropy,to analyze the differences in postural stability characteristics and control strategies between older adults with mild cognitive impairment and cognitively normal older adults during the dual-task with postural control and spatial working memory,aiming to explore the impact of cognitive impairment on the postural control ability during standing. METHODS:Sixteen older adults with mild cognitive impairment and 17 cognitively normal older adults were eligible and selected for the study.They completed five test tasks,including spatial working memory,double-feet balance stance,Romberg stance,double-feet balance stance-spatial working memory dual-task,and Romberg stance-spatial working memory dual-task,with three valid completions of each task.The plantar COP data were collected by the Kistler 3D force platform.The indicators included cognitive behavior(cognitive score and reaction time)and kinematic indexes(COP displacement and sample entropy). RESULTS AND CONCLUSION:The older adults with mild cognitive impairment performed the spatial working memory task with the greatest cognitive score and the shortest reaction time,the double-feet balance stance-spatial working memory dual-task with moderate cognitive score and reaction time,and the Romberg stance-spatial working memory dual-task with the smallest cognitive score and the longest reaction time,where the differences were significant among the tasks(P<0.05).In the older adults with mild cognitive impairment,the anterior-posterior and medial-lateral COP displacements were significantly greater,and their sample entropy values were significantly smaller in the double-feet balance stance-spatial working memory dual-task and Romberg stance-spatial working memory dual-task than in the double-feet balance stance and Romberg stance tasks(P<0.05).In the spatial working memory task,there were no significant differences in cognitive score and reaction time between the both groups(P>0.05);however,in the double-feet balance stance-spatial working memory dual-task and Romberg stance-spatial working memory dual-task,cognitive scores were significantly smaller and reaction times were longer in the older adults with mild cognitive impairment compared with the cognitively normal older adults(P<0.05).In the double-feet balance stance-spatial working memory dual-task and Romberg stance-spatial working memory dual-task,the older adults with mild cognitive impairment exhibited significantly greater anterior-posterior and medial-lateral COP displacements and significantly smaller sample entropy values compared with the cognitively normal older adults(P<0.05).All findings indicate that compared with cognitively normal older adults,older adults with mild cognitive impairment exhibit smaller complexity,poorer systematic adaption and decreased automatic regulation of the postural control during performing the dual-tasks,who are more susceptible to spatial working memory interference,leading to the increased risk of falls.

BACKGROUND:Hydroxy safflower yellow A has anti-ischemia,anti-oxidation,anti-thrombotic and anti-inflammatory effects.Whether it affects neuronal pyroptosis after glucose-oxygen deprivation/reglucose-reoxygenation is still unclear. OBJECTIVE:To investigate the protective effect of hydroxy safflower yellow A on neuronal pyroptosis and its mechanism. METHODS:HT22 cells in logarithmic growth phase were randomly divided into five groups:normal group,model group,hydroxy safflower yellow A group,colivelin group,and colivelin+hydroxy safflower yellow A group.HT22 cells were treated with glucose-oxygen deprivation/reglucose-reoxygenation to establish neuronal pyroptosis model,and then treated with STAT3 agonist Colivelin and hydroxy safflower yellow A.JC-1 probe was employed to assess changes in mitochondrial membrane potential.Reactive oxygen species kit was used to determine the content of reactive oxygen species in cells.GSDMD/TUNEL staining was conducted to observe cell pyroptosis.Immunofluorescence analysis was performed to detect STAT3 and GSDMD protein expression.RT-PCR was utilized for assessing mRNA expression levels of STAT3,NLRP3,and Caspase-1.Western blot assay was utilized to measure the protein expression levels of p-STAT3,NLRP3,GSDMD,Cleaved-caspase-1,and interleukin-1β. RESULTS AND CONCLUSION:(1)Compared with the normal group,the number of pyroptotic cells increased in HT22 cells in the model group along with a significant increase in protein expression levels of p-STAT3,NLRP3,Cleaved-caspase-1,GSDMD,and interleukin-1β.Compared with the model group,the number of pyroptotic cells reduced,and the expression of pyroptosis-related proteins significantly decreased in the hydroxy safflower yellow A group.(2)In comparison with the model group,pyroptosis worsened in the colivelin group where mitochondrial membrane potential decreased along with elevated reactive oxygen species content and increased mRNA expression levels of STAT3,NLRP3,and Caspase-1,as well as increased protein expression levels of p-STAT3,NLRP3,GSDMD,Cleaved-caspase-1,and interleukin-1β.Compared with the Colivelin group,above indexes were improved in the colivelin+hydroxy safflower yellow A group.These results suggest that hydroxy safflower yellow A plays a neuroprotective role through STAT3 signaling pathway to inhibit HT22 pyroptosis after glucose-oxygen deprivation/reglucose-reoxygenation treatment.

Objective To investigate the current situation of ethical system construction in the publication of medical science and technology journals in universities,to explore the problems in the construction of ethical system in the publication of medical science and technology journals in universities,and propose corresponding suggestions.Methods A total of 55 medical university journals included in the 2023 edition of the China Science and Technology Journal Citation Reports(Core Edition)Natural Science Volume were selected as the research subjects,and their publishing ethics system construction was investigated through the journal's official website.Results Only 18 journals have clear publishing ethics sections on their official websites,covering publishing ethics systems related to authors,reviewers,editors,and publishers,while other journals only mention publishing ethics systems related to authors,reviewers,editors,and publishers in their submission guidelines,peer reviews,and related statements published on their respective official websites,and the coverage is incomplete and the publishing process is opaque.Conclusion Ethical systems and strengthen the prevention and handling of academic misconduct,to strengthen the promotion of publishing ethics system and enhance the integrity awareness of authors,to promote transparency in the publishing process and strengthen supervision and to early warning of various publishing processes.

Objective To explore effective management methods for improving the efficiency of medical record quality control and enhancing medical record quality.Methods Based on a medical record quality control system,a full-cycle medical record quality management model was constructed,encompassing"pre-task reminders,real-time quality control during treatment,in-hospital process control,submission verification upon discharge,post-discharge terminal quality control,and re-verification af-ter archiving."Results Medical records achieved 100％quality control,and their quality significantly improved.The defect rate of medical record front pages and the delayed writing rate of surgical records in the hospital's discharged medical records continued to decline in the year before system implementation,the first year after implementation,and the second year after im-plementation.The 3-day retrieval rate of medical records increased significantly in the first year after implementation,with statis-tically significant differences in all three indicators(front page defect rate:x2=114.966,P＜0.001;delayed writing rate of sur-gical records:x2=8 056.614,P＜0.001;3-day retrieval rate:x2=798.201,P＜0.001).Conclusion The full-cycle medi-cal record management model based on a quality control system can effectively improve medical record quality and enhance man-agement efficiency.Future efforts should focus on integrating continuously optimized AI technology to strengthen system perform-ance.

Objective To analyze the quality of medical record home pages for discharged patients in a tertiary hospital in Guangzhou in 2023 based on the dual dimensions of Diagnosis-Related Groups(DRG)and Disease Intervention Program(DIP),and to provide a basis for improving the refinement of medical record home page quality management.Methods Dis-charge medical records from a tertiary general hospital in 2023 were selected.All medical records were grouped using DRG,while medical records under Guangzhou medical insurance and cross-province medical insurance implemented under DIP were simulated for DIP grouping.The writing defects in the discharge medical records were analyzed,as well as the DRG grouping,RW,and DIP standard scores of medical records with home page filling defects.Results Among 172 230 discharge medical records,171 786 were grouped into DRG,91 768 were grouped into DIP,and 91 604 were grouped into both DRG and DIP.A significant positive correlation was found between RW and DIP standard scores(r2=0.681,P＜0.001).Among the 91 604 medical records grouped into both DRG and DIP,1 942(2.12％)had writing defects,including 837(0.91％)with home page defects.DRG groups with more home page defect records included NC15,HK2,EJ13,EB15,HJ13,and RE19.Conclusion Quality defects in medical record home pages impact the accuracy of DRG and DIP grouping.Systematic measures such as strengthening medical record writing training and establishing scientific reward and punishment mechanisms should be implemented to provide data sup-port for the further advancement of DRG/DIP payment reform.

In the era of precision medicine,integrating radionuclide-based molecular imaging with targeted internal radiotherapy,integrated theranostics of nuclear medicine emerged as a promising and rapidly advancing field to achieve both visualization and precise treatment of tumors.The advances of commonly used and emerging radiotheranostic agents in oncology were systematically reviewed in this article.

Objective:To determine the clinical issues in the Clinical practice guidelines for postoperative pain management in adults (2024 edition). Methods:A preliminary list of clinical issues for the guidelines was developed through literature review, clinical surveys, and expert interviews. This was followed by two rounds of Delphi questionnaire surveys, with quality control and statistical analysis conducted using expert positive coefficient, mean item scores, full score ratio, coefficient of variation, Cronbach′s α coefficient, and expert authority level to finalize the list of clinical issues.Results:The experts participating in the Delphi questionnaire surveys had multidisciplinary collaborative backgrounds and regional representativeness, with a high level of authority. The overall positive coefficient of expert participation in the surveys was 78.9%. Through two rounds of the Delphi method and based on the screening criteria of a mean score ≥3.5, coefficient of variation ≤30%, and full score ratio ≥30%, 17 clinical issues were ultimately included following an expert consensus meeting.Conclusions:Through the Delphi method and rigorous quality control, the clinical issues in the Clinical practice guidelines for postoperative pain management in adults (2024 edition) are determined, laying a foundation for the subsequent development of the guidelines.

Objective:To evaluate the association between body temperature and duration of mechanical ventilation in the intensive care unit (ICU) among patients after coronary artery bypass grafting (CABG).Methods:Clinical data from patients, aged >18 yr, undergoing primary isolated CABG, between 2008 and 2019, were extracted from the Medical Information Mart for Intensive Care Ⅳ version 2.0 database. Participants were stratified into 3 groups based on the mean body temperature in ICU: hypothermia group (<36.0 ℃), normothermia group (36.0 ℃ ≤ temperature <37.3 ℃), and hyperthermia group (≥37.3 ℃). Multivariable linear regression and linear curve fitting were performed to assess the association between body temperature and duration of mechanical ventilation.Results:A total of 4, 588 patients were finally included in the statistical analysis, including 133 cases in hypothermia group, 4, 177 cases in normothermia group and 278 cases in hyperthermia group. The duration of mechanical ventilation was significantly prolonged in both hypothermia and hyperthermia groups compared with normothermia group ( P<0.05). The results of multivariable linear regression demonstrated that each 1 ℃ increase in body temperature was associated with a 2.43 h reduction in the duration of mechanical ventilation in hypothermia group ( P<0.001), and each 1 ℃ temperature elevation corresponded to a non-significant reduction of 0.12 h in hyperthermia group ( P=0.851). The results of linear curve fitting revealed a U-shaped relationship between body temperature and duration of mechanical ventilation, and an inflection point was identified at 36.71 ℃, with duration of mechanical ventilation prolonged with temperatures either below or above this threshold ( P<0.05). Conclusions:Hypothermia during ICU stay following CABG may lead to prolonged mechanical ventilation in patients.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.