Guidelines, consensuses and standards play a significant role in guiding clinical diagnosis and treatment practices, optimizing the allocation of medical resources and reducing medical costs. To fully leverage the pivotal role of the National Clinical Research Center as a bridge between research evidence, recommendations of guidelines, consensuses and standards, and clinical practice, it is particularly urgent to construct a set of appropriate and efficient management system for guidelines, consensuses and standards. The National Clinical Research Center for Geriatric of West China Hospital, Sichuan University (hereinafter referred to as the center) has set the overall goal of " transparency, standardization, coordination, linkage and innovation leadership" and three phased goals of " achieving scientific, transparent and applicable management" " improving the multi-level, multi-subject coordination and linkage mechanism" and " promoting the homogenization of diagnosis and treatment services, process guarantee and standardized management" to explore the establishment of a management system for guidelines, consensuses and standards. Under this framework, the center has established the management committee and office for guidelines, consensuses and standards; build a dual-channel funding support model of " out-of-hospital+ in-hospital", established differentiated implementation models and formulated standardized processes; respectively formed clinical expert groups, methodology expert groups and evidence synthesis working groups, and carried out personnel training; and constructed a support platform for formulation, evaluation and promotion. As of October 2024, relying on the established management system for guidelines, consensuses and standards, the center has achieved a series of results in three aspects: formulating international evidence-based clinical practice guidelines, establishing a system of guidelines, consensuses and standards for geriatric disability, and building a standard system for medical and nursing integration, which has strongly supported clinical practice and the improvement of people′s livelihood by the government, and preliminarily completed the construction goals of the first phase, and can provide references for medical institutions committed to building a management system for guidelines, consensuses and standards.

The diagnosis,treatment,and prognosis evaluation of cervical spondylosis are challenging in clinic.Machine learning(ML)models can improve the accuracy and efficiency of cervical spondylosis diagnosis by processing complex clinical data,assist in selecting more precise treatment plans,and evaluate prognosis.Through the domestic and foreign literature review on the application of ML models in cervical spondylosis in recent years,the study classifies and summarizes the relevant models applied in the diagnosis,treatment,and prognosis evaluation of cervical spondylosis,introduces classic algorithms such as random forest,as well as new algorithms such as convolutional neural networks,deep neural networks and long short-term memory networks,aiming to provide reference ML solutions for various stages of cervical spondylosis diagnosis and treatment.

The diagnosis,treatment,and prognosis evaluation of cervical spondylosis are challenging in clinic.Machine learning(ML)models can improve the accuracy and efficiency of cervical spondylosis diagnosis by processing complex clinical data,assist in selecting more precise treatment plans,and evaluate prognosis.Through the domestic and foreign literature review on the application of ML models in cervical spondylosis in recent years,the study classifies and summarizes the relevant models applied in the diagnosis,treatment,and prognosis evaluation of cervical spondylosis,introduces classic algorithms such as random forest,as well as new algorithms such as convolutional neural networks,deep neural networks and long short-term memory networks,aiming to provide reference ML solutions for various stages of cervical spondylosis diagnosis and treatment.

Guidelines, consensuses and standards play a significant role in guiding clinical diagnosis and treatment practices, optimizing the allocation of medical resources and reducing medical costs. To fully leverage the pivotal role of the National Clinical Research Center as a bridge between research evidence, recommendations of guidelines, consensuses and standards, and clinical practice, it is particularly urgent to construct a set of appropriate and efficient management system for guidelines, consensuses and standards. The National Clinical Research Center for Geriatric of West China Hospital, Sichuan University (hereinafter referred to as the center) has set the overall goal of " transparency, standardization, coordination, linkage and innovation leadership" and three phased goals of " achieving scientific, transparent and applicable management" " improving the multi-level, multi-subject coordination and linkage mechanism" and " promoting the homogenization of diagnosis and treatment services, process guarantee and standardized management" to explore the establishment of a management system for guidelines, consensuses and standards. Under this framework, the center has established the management committee and office for guidelines, consensuses and standards; build a dual-channel funding support model of " out-of-hospital+ in-hospital", established differentiated implementation models and formulated standardized processes; respectively formed clinical expert groups, methodology expert groups and evidence synthesis working groups, and carried out personnel training; and constructed a support platform for formulation, evaluation and promotion. As of October 2024, relying on the established management system for guidelines, consensuses and standards, the center has achieved a series of results in three aspects: formulating international evidence-based clinical practice guidelines, establishing a system of guidelines, consensuses and standards for geriatric disability, and building a standard system for medical and nursing integration, which has strongly supported clinical practice and the improvement of people′s livelihood by the government, and preliminarily completed the construction goals of the first phase, and can provide references for medical institutions committed to building a management system for guidelines, consensuses and standards.

ObjectiveTo investigate risk factors for postoperative sore throat in patients with double-lumen endotracheal intubation. MethodsThe data used in this post-hoc analysis were prospectively collected from a randomized， controlled trial. Age from 18 to 65 years old， ASAI-Ⅲ patients undergoing general anesthesia with a double-lumen endotracheal tube were enrolled. The perioperative data collected retrospectively were as follows： gender， age， smoking history， endotracheal tube diameter， duration of endotracheal tube， dose of Sufentanil， use of Flurbiprofen Axetil， cough after extubation， etc..Dynamometer was applied to assess extubation force. According to occurrence of postoperative sore throat， patients were divided into two groups： those who experienced sore throats and those who did not. Comparative analysis and multivariate logistic regression analysis were performed to screen the risk factors. ROC curve was used for predicting the predictive value of risk factors. ResultsAmong the 163 patients ， 74 （45.4%） had postoperative sore throat vs 89 （54.6%） not had. Multivariate logistic regression showed female ［OR95%CI=3.83（1.73， 8.50）， P=0.000 1］ and extubation force ［OR95%CI=1.78（1.45， 2.17）， P＜0.001］ were independent risk factors for postoperative sore throat. AUC value showed the extubation force was 0.773［95%CI（0.701， 0.846）， P＜0.001］. Youden index was 0.447， and the cut-off valve of extubation force was 13N. ConclusionFemale and extubation force were risk factors for sore throat in patients with double lumen endotracheal intubation.

BACKGROUND:Intervertebral disk degeneration is a pathological change caused by a series of complex molecular mechanisms that result in the aging and damage of intervertebral discs,ultimately leading to severe clinical symptoms.Traditional Chinese medicine has unique advantages in the treatment of intervertebral disk degeneration due to its low cost,non-addictive nature,multi-target effects,minimally toxic and side effects,and high patient acceptance. OBJECTIVE:To review the latest research results of traditional Chinese medicine monomer intervention-related signaling pathways in the treatment of intervertebral disk degeneration,describe and analyze the action mechanism of traditional Chinese medicine monomer on intervertebral disk degeneration,and provide a new approach and theoretical basis for future basic research and clinical treatment. METHODS:The first author searched for relevant literature from January 2018 to February 2023 in CNKI,PubMed,VIP,and WanFang using the search terms"intervertebral disc,signal pathway".The articles that did not meet the criteria were excluded after preliminary screening of the titles and abstracts.Finally,72 articles were selected for review and analysis. RESULTS AND CONCLUSION:Traditional Chinese medicine monomers can regulate multiple classical signaling pathways such as Wnt/β-catenin,PI3K/Akt,mTOR,NF-κB,and MAPK.They achieve this by regulating oxidative stress,adjusting the expression of pro/anti-apoptotic proteins in cells,stimulating cellular autophagy function,reducing stimulation of cell inflammatory factors,increasing the expression of extracellular matrix markers,reducing the production of matrix-degrading enzymes,maintaining the synthesis and stability of extracellular matrix,inducing differentiation of mesenchymal stem cells in the nucleus pulposus into nucleus pulposus cells,promoting endogenous repair and reconstruction,controlling apoptosis and aging of nucleus pulposus cells,and increasing the activity of nucleus pulposus cells.These actions improve the microenvironment within the intervertebral disc,maintain the normal physiological function of the intervertebral disc,and delay intervertebral disc degeneration.

BACKGROUND:At present,bone marrow mesenchymal stem cells are the main seed cells used in cell therapy for the treatment of intervertebral disc degeneration.However,the use of bone marrow mesenchymal stem cells as seed cells for the regeneration of fibrous rings is at risk of heterotopic ossification and teratoma at the repair site.Therefore,it is of great economic and social significance to find a new kind of seed cells for tissue engineering of annulus fibrosus for the treatment of intervertebral disc degeneration. OBJECTIVE:To isolate and purify rat annulus fibrosus-derived stem cells by adherent method combined with fibronectin differential adhesion screening method,and to observe its purification effect and biological characteristics. METHODS:Annulus fibrosus tissue was obtained from a SD rat intervertebral disc.Primary annulus fibrosus-derived stem cells were obtained by the mechanical-enzymatic digestion method.Annulus fibronectin differential adhesion method was used to purify annulus fibrosus-derived stem cells.Morphological changes and proliferation of cells were observed through a microscope.The expression levels of stem cell markers were detected by immunofluorescence technique and qPCR.The screened cells were subjected to multi-lineage cell differentiation and characteristic gene detection. RESULTS AND CONCLUSION:(1)The purified cells grew well,and most of them were angular and star-shaped multi-process cells,which had good proliferation ability.(2)Cells were positive for cell membrane surface antigens CD73,CD90 and CD105,while negative for CD45 and CD34.(3)After specific induction,cells could successfully differentiate into osteoblasts,chondroblasts and lipoblasts.(4)Collagen-I,Runx-2 after osteogenic induction,Collagen Ⅱ,Sox-9 after chondrogenic induction,and PPAR-γ and LPL after lipogenic induction were highly expressed in cells,and the difference was significant compared with that before induction(P<0.05).(5)These findings confirm that the adherent method combined with fibronectin differential adhesion method is effective enough to screen,isolate and purify rat annulus fibrosus-derived stem cells,and has good cell biological properties,good proliferation ability and multiple differentiation potential.

Anomalous aortic origin of the coronary artery(AAOCA) refers to the abnormal initiation, route, or distribution of coronary arteries, which is generally believed to be caused by abnormal or incomplete development of embryonic coronary arteries, and is a rare congenital cardiovascular malformation. It can exist independently without other congenital heart disease. With the development of medical science and people's understanding of AAOCA, more and more AAOCA has been detected, and its clinical significance has attracted more and more attention. Based on abnormal coronary artery opening, malignant or potential contorts can cause long-term blood flow dynamic change, appear abnormal blood vessel hardening of the arteries, at the same time due to walk in the pulmonary artery and the ascending aorta between two vessels, vulnerable to the extrusion of large blood vessels, which caused a temporary blood flow in coronary artery interruption, can cause acute angina pectoris, myocardial infarction, arrhythmia, exercise-induced cardiac syncope. This review focuses on the anatomy, diagnosis and treatment of coronary artery abnormalities arising from aorta.

Objective:To measure the beam stability of the electron FLASH radiotherapy accelerator developed by the Institute of Applied Electronics of Chinese Academy of Engineering Physics and to evaluate the performance of scintillator, fast current sensor (FCT) and graphite under the electron FLASH beam.Methods:Each continuous beam exit deviation and each pulse deviation at the electron FLASH radiotherapy accelerator in the same working state were measured. The correlation among three monitors and the measured dose of the accelerator at different electron beam energy (controlled by changing the charging voltage) and different beam pulse numbers were compared, which were validated by a Monte Carlo simulation procedure.Results:At the first high pressure, the first 10 scintillators and FCT signals were relatively large, approximately 2% deviation compared with the average value of 400 pulses. Among 40 beam outflows, the deviation between each pulse was within ±5%. In the accelerator steady state, each beam outflow deviation was within ±1%. Both simulated and measured values showed that the monitor could not be used for dose monitoring at different electron beam energy. However, when the energy was the same, only the number of beam pulses was changed, and linear relationship was observed between the number of the three monitors and the dose measured by the film (all R 2 > 0.999). Conclusions:The beam deviation of each beam outflow of this electron FLASH accelerator is within ±1%. Under the stability of the accelerator beam, the scintillator, FCT and graphite can meet the dose monitoring of the target area, which can provide reference for dose monitoring for subsequent biological experiments.

Open fund projects play an important role in strengthening discipline construction and enhancing research capabilities. The National Clinical Research Center for Geriatrics of West China Hospital, Sichuan University (hereinafter referred to as the Center) initiated the establishment of open fund projects in 2018. However, due to their strong disciplinary and autonomous nature, as well as the presence of uncertainty, these projects posed new challenges to project management. Therefore, based on the theory of project integration management, the Center has established an integrated management system for open fund projects. This system was achieved by identifying the construction objectives of open fund projects, defining their scope of application, and integrating the four essential elements of project management: execution, processes, control, and support. It ensured standardized execution through organizational and institutional measures, optimized management processes, implemented control through the development of milestone lists, risk registration lists, superior funding lists, and non-performing lists, and integrated technology and platforms as support. The system was implemented since 2020, realizing comprehensive and holistic management of open fund projects across all stages and elements, thereby effectively enhancing management efficiency and quality. As of December 2023, 112 open fund projects have been approved, with a total funding of 31.943 million yuan. These projects have yielded a series of achievements in cohort study and platform construction, academic output, and have demonstrated remarkable effectiveness in projects and talents cultivation. The construction and application of this system can provide reference for medical institutions in managing open fund projects.