Objective:To quantitatively evaluate the level of the three medical linkage in China from 2009 to 2022,explore the influencing factors and driving paths of the three medical linkage in China,and provide a new perspective for promoting the development of the three medical linkage.Methods:An optimized coupling coordination degree model was used to calculate the coupling coordination degree between the trinity healthcare systems and different binary systems within the systems in 31 provinces of China(excluding Hong Kong,Macao and Taiwan),and the Fuzzy-set Qualitative Comparative Analysis method was used to explore the condition configurations of multi-factor-driven three medical linkage.Results:From 2009 to 2022,the coupling coordination degree between the trinity healthcare systems in each province of China generally showed an increasing trend year by year.Among the binary systems,the overall coordinated development situation between the medical and medical insurance systems was the best and the regional development was the most balanced.The coupling coordination degree gap between the trinity healthcare system and the internal binary systems among provinces gradually widened,and the multi-polarization trend intensified.The paths to promote high-level three medical linkage can be summarized into two types:internal and external balanced development type(H1)and government-led type(H2,H3),among which the H1 path with per capita GDP and health expenditure as core conditions was the most common.Conclusion:It is suggested to enhance institutional and technological innovation,and integrate resources through a cross-departmental collaboration mechanism and digital technology.Provinces should select high-level optimization paths by leveraging regional endowments to narrow the regional development gap.Meanwhile,under the impetus of high-level policies,the protection and supervision system continues to improve,thereby promoting the three medical linkage.

Objective: To establish a machine learning-based precision blood donor recruitment model at the county level and assess its generalizability and applicability. Methods: A retrospective study was conducted using blood donation and SMS recruitment data from the Taicang Branch of the Suzhou Blood Center between 2019 and 2024. Multiple machine learning algorithms were employed, including extreme gradient boosting, support vector machine, k-nearest neighbor, logistic regression, decision tree, random forest, and multilayer perceptron. These were combined with techniques such as synthetic minority oversampling, undersampling, and cost-sensitive learning (using MFE and MSFE loss functions). Model parameters were optimized through grid search to identify the best-performing model. Results: In a prospective comparative study against conventional methods, the machine learning models increased the recruitment success rate among high-willingness donors by an average of 129.15%, and the recruitment efficiency per SMS improved by 125.02% compared with the traditional method. Under full-scale SMS sending, the recruitment rate per SMS increased by 42.61%, and SMS sending efficiency improved by 31.77%, significantly enhancing recruitment performance. Conclusion: This study represents the first application of a machine learning-based precision donor recruitment model at the county-level in China. The precise recruitment framework not only improves recruitment efficiency and reduces recruitment costs but also demonstrates strong scalability and generalizability. It provides a scientific and feasible intelligent pathway to ensure the safety and sustainability of the blood supply.

Objective To construct a prognostic model of future asthma exacerbation risk in adults by com-bining novel biomarkers of serum chitinase-3-like protein 1(YKL-40),dipeptidyl peptidase-4(DPP4)and conventional predictors.Methods Patients with asthma in the non-acute exacerbation phase were recruited from the People's Hospital of Yubei District of Chongqing,from March 2022 to May 2023.Baseline clinical da-ta collected included medical history,forced expiratory volume in the first second(FEV1)/forced vital capacity(FVC),percentage of predicted forced expiratory volume in the first second(FEV1％pred),blood eosinophil count(EOS),blood neutrophil count(NEU),fractional exhaled nitric oxide(FeNO),serum YKL-40,and ser-um DPP4,etc.The patients were followed for one year to gather data on asthma acute exacerbations and their timings as defined in this study.A COX proportional hazards regression model was used to construct a prog-nostic model for future asthma exacerbations,with internal validation and results presentation.Results A to-tal of 224 patients with asthma completed the study.During the one-year follow-up period,102 patients experi-enced acute exacerbations as defined in this study.Based on univariate COX regression,stepwise regression for variable selection,clinical significance,and model simplicity,asthma control test(ACT)score group,number of asthma exacerbations in the past year group,log10(YKL-40),log10(FeNO),log10(EOS),and FEV1％pred were the following predictors were included in the final model.The overall C-statistic of the model was 0.795(95％CI:0.754-0.836),the area under the curve at the 52-week follow-up was 0.879(95％CI:0.834-0.924),and the Brier score at the 52-week follow-up was 0.142(95％CI:0.117-0.168).The calibration curve was close to a slope of 1,and bootstrap validation suggested good stability of the prediction model.The model was presented using a Nomogram and a dynamic scoring table in a web APP,which can be used to predict the risk of asthma exacerbations within 52 weeks for individual patients.Conclusion The prediction model based on serum YKL-40,EOS,FeNO,the number of asthma exacerbation in the past year group,FEV1％pred and ACT scores group can accurately predict the probability of acute attacks in 52 weeks of asthma patients.

Objective To investigate the relationship between cystatin C(CysC)/prealbumin(PAB)ratio and lung function and chronic obstructive pulmonary disease(COPD)assessment test(CAT)score in patients with COPD.Methods A total of 216 COPD patients admitted to the hospital from February 2021 to February 2024 were selected as the study group,and 150 healthy subjects were selected as the control group during the same period.CysC and PAB levels were detected by immunoturbidimetry,CysC/PAB ratio was calculated,lung function was detected and CAT scores were recorded.Pearson correlation was used to analyze the rela-tionship between CysC/PAB ratio,lung function and CAT score in COPD patients.Results The CysC and CysC/PAB ratio in the study group was significantly higher than that in the control group,and the level of PAB was significantly lower than that in the control group,with statistical significance(P＜0.05).The forced expiratory volume in the first second as a percentage of predicted value(FEV1％pred),the percentage of pre-dicted forced vital capacity(FVC％pred)and the ratio of the first second forced expiratory volume to forced vital capacity(FEV1/FVC)of the study group were lower than those of the control group,and the CAT score of the study group was higher than that of the control group,with statistical significance(P＜0.05).The Cy-sC/PAB ratio and CAT score of COPD patients with the global initiative for chronic obstructive lung disease(GOLD)grade 4 were significantly higher than those with GOLD grade 3,GOLD grade 2 and GOLD grade 1,and the difference was statistically significant(P＜0.05).The ratio of CysC/PAB in very severely affected pa-tients was higher than that in severely affected,moderately affected and mildly affected patients,while the ra-tio of FEV1％pred,FVC％pred and FEV1/FVC was lower than that in severely affected,moderately affected and mildly affected patients,and the difference was statistically significant(P＜0.05).In COPD patients,Cy-sC/PAB ratio was negatively correlated with FEV1％pred,FVC％pred,FEV1/FVC,and positively correlated with CAT score(P＜0.05).Conclusion CysC/PAB ratio is highly expressed in COPD patients,and its level is related to lung function and CAT score,which can reflect the degree of disease and quality of life in COPD patients to a certain extent.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To investigate the influencing factors of the quality of inpatient medical record home page information in public hospitals under the background of the reform of diagnosis related groups(DRG)-based payment system and their mechanisms of action, so as to provide references for continuous improvement of the quality of medical record home page information.Methods:From July to August 2024, semi-structured interviews were conducted with clinical physicians and personnel engaged in the filling, quality control, review, and management of inpatient medical record home pages in public hospitals in Hangzhou, using purposeful sampling. The interview data were qualitatively analyzed based on the grounded theory to identify the influencing factors of the quality of medical record home page information and construct a theoretical model of the mechanisms of action of these factors.Results:Through open coding of the 17 interview materials, 53 initial concepts and 13 categories were identified. Further induction through axial coding led to the extraction of four main categories: external environment, organizational resources, person-job fit, and work ecology. The theoretical model of the mechanisms of action of the influencing factors on the quality of medical record home page information was as follows: external environmental factors such as policies and regulations played a macroscopic guiding role in the quality of medical record home pages; organizational resource factors such as the hospital′s information construction played a mesoscopic regulating role in the quality of medical record home pages; person-job fit factors such as the professional skills of clinical physicians and medical record-related staff played a direct driving role in the quality of medical record home pages; and work ecology factors such as the workload of clinical physicians and medical record-related staff played an external modulating role in the quality of medical record home pages.Conclusions:Under the background of DRG reform, the quality of inpatient medical record home page information was influenced by multiple factors. To systematically improve the quality of medical record home page information, it is necessary for multiple parties to work together. Relevant government departments should improve the top-level design and optimize the external environment, guide and assist medical institutions in building quality control systems, and strengthen resource allocation. Medical institutions should focus on enhancing the job competence and person-job fit of relevant personnel and also use intelligent means to optimize work processes to reduce workload.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective To improve and refine the relevant regulations and guiding principles of warnings on drug instructions and labels in China.Methods This paper sorted out the drug instructions of small molecule anti-tumor drugs listed by the U.S.Food and Drug Administration(FDA)from 2005 to 2022,included the drugs mentioned in the QT interval prolongation risk,analyzed the clinical research and QT research results,and sorted out the identification and warning rules of the instructions.Results A total of 35 drugs were included,4 drugs wrote the risk of QT interval prolongation in the black box warning,21 drugs were wrote in the warning and precautions position,6 drugs were wrote in the adverse reaction section,and 2 drugs were only described under clinical pharmacology section.According to the severity of the QT interval prolongation caused by the drug and whether there were serious clinical consequences,they were displayed in the warnings(black box warnings),precautions(warnings and precautions)and adverse reactions in the instructions.Conclusion The aim of this article is to provide a reference for the writing of QT risk warning information of the instructions of domestic drug production enterprises and regulatory departments.It is recommended to clarify the severity of drug safety and the location of the instructions in clinical research,and continue to carry out safety monitoring and update the instructions in time after listing.

Objective To evaluate the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in differentiating histopathological types of brain metastases from non-small cell lung cancer(NSCLC).Methods Sixty-eight patients with brain metastases confirmed by pathology were collected,including 47 lung adenocarcinoma patients divided into a lung adenocarcinoma group and 21 lung squamous cell carcinoma patients into a lung squamous cell carcinoma group.The two groups were compared in terms of the DCE-MRI derived parameters including volume transfer constant(Ktrans),extra vascular extracellular volume fraction(Ve)and plasma volume fraction(Vp);ROC curves were used to assess the diagnostic efficacy of different quantitative parameters for the pathologic types of brain metastases from lung adenocarcinoma group or lung squamous cell carcinoma.SPSS 22.0 software was used for statistical analysis.Results The lung adenocarcinoma group had the values of Ktrans,Ve,Vp and Ve+Vp higher than those of the lung squamous cell carcinoma group,with the differences being statistically significant(all P＜0.05).ROC curve analysis results showed that Ktrans,Vp and Ve had high differential diagnosis values for the pathologic types of brain metastases from lung adenocarcinoma group or lung squamous cell carcinoma,with the AUC being 1.000,0.998 and 0.875,the optimal Youden index being 0.183 min-1,0.039 and 0.270,the sensitivity being 100.00％,100.00％and 80.56％and the specificity being 100.00％,97.06％and 80.88％,respectively.Conclusion The quantitative parameters of DCE-MRI gain advantages in the differential diagnosis of NSCLC brain metastases,and provide references for the diagnosis and treatment of brain metastases of lung cancer.[Chinese Medical Equipment Journal,2025,46(5):54-59]

OBJECTIVE: To investigate the effects of acupuncture on the neurotransmitter levels and gut microbiota in a mouse model of Tourette syndrome (TS). METHODS: Thirty-six male C57/BL6 mice were randomly divided into 4 groups using a random number table method: 3,3'-iminodipropionitrile (IDPN) group, control group, acupuncture group, and tiapride group, with 9 mice in each group. In the IDPN group, acupuncture group, and tiapride group, mice received daily intraperitoneal injections of IDPN (300 mg/kg body weight) for 7 consecutive days to induce stereotyped behaviors. Subsequently, in the acupuncture intervention group, standardized acupuncture treatment was administered for 14 consecutive days to IDPN-induced TS model mice. The selected acupoints included Baihui (DU 20), Yintang (DU 29), Waiguan (SJ 5), and Zulinqi (GB 41). In the tiapride group, mice were administered tiapride (50 mg/kg body weight) via oral gavage daily for 14 consecutive days. The control group, IDPN group, and acupuncture group received the same volume of saline orally for 14 consecutive days. Stereotypic behaviors were quantified through behavioral assessments. Neurotransmitter levels, including dopamine (DA), glutamate (Glu), and aspartate (ASP) in striatal tissue were measured using enzyme-linked immunosorbent assay. Dopamine transporter (DAT) expression levels were additionally quantified through quantitative polymerase chain reaction (qPCR). Gut microbial composition was analyzed through 16S ribosomal RNA gene sequencing, while metabolic profiling was conducted using liquid chromatography-mass spectrometry (LC-MS). RESULTS: Acupuncture administration significantly attenuated stereotypic behaviors, concurrently reducing striatal levels of DA, Glu and ASP concentrations while upregulating DAT expression compared with untreated TS controls (P<0.05 or P<0.01). Comparative analysis identified significant differences in Muribaculaceae (P=0.001), Oscillospiraceae (P=0.049), Desulfovibrionaceae (P=0.001), and Marinifilaceae (P=0.014) following acupuncture intervention. Metabolomic profiling revealed alterations in 7 metabolites and 18 metabolic pathways when compared to the TS mice, which involved various amino acid metabolisms associated with DA, Glu, and ASP. CONCLUSIONS Acupuncture demonstrates significant modulatory effects on both central neurotransmitter systems and gut microbial ecology, thereby highlighting its dual therapeutic potential for TS management through gut-brain axis regulation.
Animals ; Tourette Syndrome/metabolism* ; Gastrointestinal Microbiome ; Neurotransmitter Agents/metabolism* ; Acupuncture Therapy ; Male ; Mice, Inbred C57BL ; Mice