ObjectiveTo evaluate the impact of stroke on diaphragmatic function by ultrasound. MethodsFrom April, 2024 to June, 2025, 40 stroke patients (stroke group) were recruited in Xuanwu Hospital Capital Medical University. Additionally, 40 sex- and age-matched healthy subjects (control group) were recruited without directional selection. Diaphragmatic excursion and diaphragmatic thickness during quiet breathing and deep breathing were assessed using ultrasound in both groups, and the diaphragmatic thickening fraction was calculated. The stroke group was further divided into two subgroups according to disease course: ≤ 30 days group and > 30 days group, for subgroup analysis. ResultsDuring both quiet and deep breathing, diaphragmatic excursion on the affected side in the stroke group was smaller than that on the unaffected side and in the control group (P < 0.05). During quiet breathing, diaphragmatic thickening fraction on the affected side in the stroke group was smaller than that on the unaffected side and in the control group (P < 0.05), while the diaphragmatic thickening fraction on the unaffected side was significantly smaller than that in the control group (P < 0.01). During deep breathing, the bilateral diaphragmatic thickening fraction in the stroke group was significantly smaller than that in the control group (P < 0.001), and the bilateral end-inspiratory diaphragmatic thickness was significantly smaller than that in the control group (P < 0.001). During quiet breathing, diaphragmatic excursion in both the ≤ 30 d group and the > 30 d group was smaller than that in the control group (P < 0.05); during deep breathing, diaphragmatic excursion in the ≤ 30 d group was smaller than that in the control group (P < 0.05). In both quiet breathing and deep breathing, the diaphragmatic thickening fraction in the ≤ 30 d group and the >30 d group were lower than those in the control group (P < 0.05). During deep breathing, end-inspiratory diaphragmatic thickness in both the ≤ 30 d group and the > 30 d group was significantly smaller than that in the control group (P < 0.01). ConclusionUltrasound can effectively identify the impact of stroke on patients' diaphragmatic function. In stroke patients, both diaphragmatic excursion and contractile performance are reduced on the affected side, while contractile performance is also reduced on the unaffected side.

AIM: To compare the agreement between the ARK Biometer Combo and OA 2000 in patients wearing orthokeratology lenses.METHODS: A prospective study. A total of 148 patients(148 eyes)who were wearing orthokeratology lenses and returned for follow-up at the Shanghai Eye Disease Prevention and Treatment Center from August to September 2024 were included. Biometric measurements were performed using both the ARK Biometer Combo and OA 2000. Parameters including axial length(AL), corneal central thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), corneal curvature(Kf and Ks), astigmatism(AST), white-to-white corneal diameter(WTW)and pupil diameter(PD)were obtained. Differences in measurement parameters between the two biometers were compared, and agreement was assessed.RESULTS: There were no statistically significant differences in the measurements of Kf, Ks and AST between the two biometers(P>0.05). Statistically significant differences were found in the measurements of AL, CCT, ACD, LT, WTW and PD(t=2.559, P=0.012; t=16.771, P<0.0001; t=4.749, P<0.0001; t=-15.212, P<0.0001; t=-14.915, P<0.0001; t=-2.402, P=0.018). ICC ranged from 0.615 to 0.999. Bland-Altman analysis showed that the maximum absolute values of the 95% limits of agreement(LoA)of AL, CCT, ACD, LT, Kf, Ks, AST, WTW and PD were 0.07 mm, 35.07 μm, 0.07 mm, 0.12 mm, 0.66 D, 1.14 D, 1.00 D, 0.76 mm, and 0.98 mm, respectively.CONCLUSION: In orthokeratology patients, the ARK Biometer Combo and OA 2000 showed good agreement in measuring AL, CCT, ACD, Kf and LT, and can be used interchangeably.

Objective: To analyze the status of outdoor activities on weekends among children and adolescents of different educational stages in Shanghai and their impact on myopia, so as to provide a basis for formulating more specific prevention and control protocol of myopia. Methods: From September to October 2022, a stratified cluster random sampling method was employed to select 84 schools (27 kindergartens, 21 primary schools, 15 junior high schools and 21 high schools) across Shanghai, enrolling a total of 28 654 children and adolescents aged 4 to 18 for the study. Ophthalmic examinations were conducted to ascertain the prevalence of myopia among children and adolescents. Additionally, a questionnaire survey was administered to collect data on outdoor activity duration and associated factors. Multivariate Logistic regression analysis was utilized to investigate the associated factors of outdoor activity levels on weekends. Results: The overall myopia detection rate among children and adolescents was 58.4%, with a higher rate observed in girls (59.2%) compared to boys (57.6%). The myopia detection rates for children and adolescents with an average daily outdoor activity duration of ≥2 h and <2 h on weekends were 54.6% and 68.8%, and the differences were statistically significant ( χ 2=8.12,460.89, P <0.01). Multivariable Logistic regression analysis revealed that girls ( OR =0.80), those with a myopic parent ( OR =0.68), schools from urban districts ( OR =0.72), higher education stages (primary school: OR =0.65, junior high school: OR =0.24, high school: OR =0.14) and spending≥2 h/d on homework during weekends ( OR =0.57) among children and adolescents were less likely to engage in outdoor activities for ≥2 h on weekends ( P <0.01). After incorporating gender, parental myopia status, educational stage, school location, average daily duration on weekends for spending on homework, electronic product usage and outdoor activities as dependent variables in a multivariate Logistic regression analysis, the results showed that children and adolescents with an average outdoor activity duration for ≥2 h on weekends had a lower risk of myopia ( OR =0.86, P < 0.01). Conclusions The level of outdoor activity among children and adolescents on weekends needs to be improved. Outdoor activities on weekends is an associated factor for myopia among children and adolescents. Particularly, girls, those with myopic parents, schools from urban districts, and spending long hours on homework during weekends among children and adolescents require increased attention.

Objective: To investigate the visual acuity and correction conditions of children and adolescents in Shanghai, so as to provide a scientific basis for developing intervention measures to prevent myopia and protect vision among children and adolescents. Methods: From October to December 2022, a stratified cluster random sampling survey was conducted, involving 47 034 students from 16 municipal districts in Shanghai, covering kindergartens (≥5 years), primary schools, middle schools, general high schools and vocational high schools. According to the Guidelines for Screening Refractive Errors in Primary and Secondary School Students, the Standard Logarithmic Visual acuity Chart was used to examine naked vision and corrected vision of students, and general information was collected. The distribution and severity of visual impairment in different age groups were analyzed, and χ 2 tests and multivariate Logistic regression were used to explore factors associated with visual impairment. Results: The detection rate of visual impairment among children and adolescents was 76.2%, with a higher rate among females (78.8%) than males ( 73.8 %), higher among Han ethic students ( 76.2 %) than minority students (71.2%), and higher among urban students (76.7%) than suburban students (75.8%), all with statistically significant differences ( χ 2=162.6, 10.4, 5.5, P <0.05). The rate of visual impairment initially decreased and then increased with age, reaching its lowest at age 7 (53.8%) and peaking at age 17 (89.6%) ( χ 2 trend = 3 467.0 , P <0.05). Severe visual impairment accounted for the majority, at 56.6%, and there was a positive correlation between the severity of visual impairment and age among children and adolescents ( r =0.45, P <0.05). Multivariate Logistic regression showed that age, BMI, gender, ethnicity and urban suburban status were associated with visual impairment ( OR =1.18, 1.01, 1.38 , 0.79, 0.88, P <0.05). Among those with moderate to severe visual impairment, the rate of spectacle lens usage was 62.8%, yet only 44.8 % of those who used spectacle lens had fully corrected visual acuity. Females (64.9%) had higher spectacle lens usage rates than males (60.6%), and general high school students had the highest spectacle lens usage (83.9%), and there were statistically significant differences in gender and academic stages ( χ 2=57.7, 4 592.8, P <0.05). Conclusions The rate of spectacle lens usage among students with moderate to severe visual impairment is relatively low, and even after using spectacle lens, some students still do not achieve adequate corrected visual acuity. Efforts should focus on enhancing public awareness of eye health and refractive correction and improving the accessibility of related health services.

Objective:To investigate the correlations between physical, psychological and social frailty in elderly patients with multimorbidity.Methods:This study utilized a mixed method. A questionnaire survey was conducted from February to June 2024, among elderly patients with multimorbidity attending 4 primary health care centers in urban Beijing selected by the convenience sampling method. The FRAIL Frailty Assessment Scale, WHO-5 Index of Well-Being Scale, and HALFT Scale were used to assess the patients′ physical, psychological, and social frailty, respectively. Spearman correlation analysis was used to analyze the correlation between different dimensions of frailty in elderly with multimorbidity. Logistic regression model was used to analyze the factors influencing physical, psychological and social frailty. The elderly with multimorbidity who were assessed to have at least 1 or more types of frailty in the quantitative study were selected for in-depth interviews in the form of online and offline combination. The topics of in-depth interview included the real experience of the different dimensions of frailty, the possible causes and the difficulties caused. The sample size was determined according to the principle of information saturation. Thematic analysis was used to summarize, code and analyze the interview data.Results:A total of 919 participants were included in the quantitative study, with a mean age of (74.09±6.03) years, 329(35.80%) were males and 590(64.20%) were females. The prevalence of physical, psychological, and social frailty was 17.85%(164/919), 21.44%(197/919), 11.21%(103/919), respectively. A total of 21 participants were included in the qualitative study, with a mean age (76.90±5.13)years, 5(23.81%) males and 16(76.19%) females. Spearman correlation analysis showed that physical and psychological frailty were moderately correlated ( r=0.311, P<0.001), psychological and social frailty were weakly correlated ( r=0.218, P<0.001), and physical and social frailty were weakly correlated ( r=0.267, P<0.001). Logistic regression analysis showed that the age, the number of multimorbidities, the psychological frailty and social frailty were the influencing factors for physical frailty (all P<0.05). The gender, number of multimorbidity, type of medication taken, physical frailty and social frailty were influencing factors of psychological frailty (all P<0.05). And age, number of multimorbidities, physical frailty and psychological frailty were influencing factors of social frailty (all P<0.05). A total of 3 themes were extracted through in-depth interviews, namely, "physical and psychological frailty are interrelated""physical and social frailty are interrelated", and "psychological and social frailty are interrelated". Conclusions:The physical, psychological, and social frailty in elderly patients with multimorbidity interacts with each other. Whereas the number of multimorbidities is a common risk factor for all three.

Objective:To analyze the current status, research hotspots, and development trends on the integration of primary care and prevention in China.Methods:This was a bibliometric analysis. Literature related to research on the integration of primary care and prevention in China was retrieved from CNIKI, Wanfang, VIP, Chinese Medical Journal Full Text Database, PubMed, and Web of Science for the period from January 1, 2015, to April 1, 2025. CiteSpace software was used to conduct a visual analysis of publication volume, authors and their collaborations, institutions, and keywords in the included literature.Results:A total of 292 domestic publications on the integration of primary healthcare and public health were analyzed. Research on primary healthcare-public health integration in China exhibited an overall upward trend from 2015 to 2025. Based on publication volume and temporal distribution, domestic research can be categorized into an exploratory phase (2015-2020) and a rapid development phase (2021-2025). The institutions publishing relevant research were predominantly universities and research centers, with a low institutional network density (0.013), indicating relative weak inter-institutional collaboration. The co-occurrence density among authors was 0.013 9. Collaboration predominantly occurred in small clusters, with limited cross-regional cooperation. Keywords that appeared frequently and had an intermediary centrality exceeding 0.1 included chronic diseases (0.40), public health (0.23),health management (0.18), and hypertension (0.17). Keyword clustering analysis showed that the top three categories mainly focused on public health, chronic diseases, and health management. Since 2024, emerging keywords with high burst intensity have included big data, health literacy, primary care hospitals, and infectious diseases.Conclusions:Research on the integration of medical and preventive care at the primary healthcare level in China has entered a stage of rapid development. Current research hotspots focus primarily on chronic disease management, the implementation status and barriers of primary healthcare and prevention integration models. Future research is expected to emphasize the application of intelligent technologies, and the enhancement of public health emergency response capacity.

Objective To explore the effect of interest induction combined with integrated healthcare nursing on improvements of mental health and prognosis in children with lobar pneumonia.Methods A total of 126 children diagnosed as lobar pneumonia in the Hebei Children's Hospital from October 2023 to October 2024 were selected as research objects and randomly divided into study group(n=63)and control group(n=63).The control group received conventional nursing interven-tions,while the study group received the interest induction combined with integrated healthcare nursing model.The time for improvement of clinical symptoms,psychological scores,therapeutic compliance,and the occurrence of complications were compared between the two groups.Results The resolution time for fever,obvious alleviation time for cough,relief time for shortness of breath,and disappear-ance time for moist rales in the study group were significantly shorter than those in the control group(P＜0.05).After the intervention,the scores of the Multidimensional Anxiety Scale for Children(MASC-C)and the Child Behavior Checklist(CBCL)in both groups were significantly lower than those before the intervention,and the scores in the study group were significantly lower than those in the control group(P＜0.05).The compliance scores of the study group in terms of taking medication on time,functional exercise,dietary adjustment,and self-monitoring dimensions were all significantly higher than those of the control group(P＜0.05).In the study group,there was 1 case of atelecta-sis and 1 case of pneumothorax,with a total complication rate of 3.17％(2/63);there was 1 case of pleural effusion,1 case of atelectasis,and 2 cases of pneumothorax in the control group,with a total complication rate of 6.35％(4/63).There was no significant difference in the total complica-tion rate between the two groups(x2=0.700,P＞0.05).Conclusion The interest induction combined with integrated healthcare nursing model can improve therapeutic compliance,shorten the time for improvement of clinical symptoms,and enhance the mental health of children.

Objective:To investigate the correlations between physical, psychological and social frailty in elderly patients with multimorbidity.Methods:This study utilized a mixed method. A questionnaire survey was conducted from February to June 2024, among elderly patients with multimorbidity attending 4 primary health care centers in urban Beijing selected by the convenience sampling method. The FRAIL Frailty Assessment Scale, WHO-5 Index of Well-Being Scale, and HALFT Scale were used to assess the patients′ physical, psychological, and social frailty, respectively. Spearman correlation analysis was used to analyze the correlation between different dimensions of frailty in elderly with multimorbidity. Logistic regression model was used to analyze the factors influencing physical, psychological and social frailty. The elderly with multimorbidity who were assessed to have at least 1 or more types of frailty in the quantitative study were selected for in-depth interviews in the form of online and offline combination. The topics of in-depth interview included the real experience of the different dimensions of frailty, the possible causes and the difficulties caused. The sample size was determined according to the principle of information saturation. Thematic analysis was used to summarize, code and analyze the interview data.Results:A total of 919 participants were included in the quantitative study, with a mean age of (74.09±6.03) years, 329(35.80%) were males and 590(64.20%) were females. The prevalence of physical, psychological, and social frailty was 17.85%(164/919), 21.44%(197/919), 11.21%(103/919), respectively. A total of 21 participants were included in the qualitative study, with a mean age (76.90±5.13)years, 5(23.81%) males and 16(76.19%) females. Spearman correlation analysis showed that physical and psychological frailty were moderately correlated ( r=0.311, P<0.001), psychological and social frailty were weakly correlated ( r=0.218, P<0.001), and physical and social frailty were weakly correlated ( r=0.267, P<0.001). Logistic regression analysis showed that the age, the number of multimorbidities, the psychological frailty and social frailty were the influencing factors for physical frailty (all P<0.05). The gender, number of multimorbidity, type of medication taken, physical frailty and social frailty were influencing factors of psychological frailty (all P<0.05). And age, number of multimorbidities, physical frailty and psychological frailty were influencing factors of social frailty (all P<0.05). A total of 3 themes were extracted through in-depth interviews, namely, "physical and psychological frailty are interrelated""physical and social frailty are interrelated", and "psychological and social frailty are interrelated". Conclusions:The physical, psychological, and social frailty in elderly patients with multimorbidity interacts with each other. Whereas the number of multimorbidities is a common risk factor for all three.

Objective:To analyze the current status, research hotspots, and development trends on the integration of primary care and prevention in China.Methods:This was a bibliometric analysis. Literature related to research on the integration of primary care and prevention in China was retrieved from CNIKI, Wanfang, VIP, Chinese Medical Journal Full Text Database, PubMed, and Web of Science for the period from January 1, 2015, to April 1, 2025. CiteSpace software was used to conduct a visual analysis of publication volume, authors and their collaborations, institutions, and keywords in the included literature.Results:A total of 292 domestic publications on the integration of primary healthcare and public health were analyzed. Research on primary healthcare-public health integration in China exhibited an overall upward trend from 2015 to 2025. Based on publication volume and temporal distribution, domestic research can be categorized into an exploratory phase (2015-2020) and a rapid development phase (2021-2025). The institutions publishing relevant research were predominantly universities and research centers, with a low institutional network density (0.013), indicating relative weak inter-institutional collaboration. The co-occurrence density among authors was 0.013 9. Collaboration predominantly occurred in small clusters, with limited cross-regional cooperation. Keywords that appeared frequently and had an intermediary centrality exceeding 0.1 included chronic diseases (0.40), public health (0.23),health management (0.18), and hypertension (0.17). Keyword clustering analysis showed that the top three categories mainly focused on public health, chronic diseases, and health management. Since 2024, emerging keywords with high burst intensity have included big data, health literacy, primary care hospitals, and infectious diseases.Conclusions:Research on the integration of medical and preventive care at the primary healthcare level in China has entered a stage of rapid development. Current research hotspots focus primarily on chronic disease management, the implementation status and barriers of primary healthcare and prevention integration models. Future research is expected to emphasize the application of intelligent technologies, and the enhancement of public health emergency response capacity.

Objective:To compare the characteristics of background mucosa, lesion features, and the efficiency of endoscopic submucosal dissection(ESD)between elderly and non-elderly patients with early gastric cancer(EGC).Methods:This study retrospectively collected data on patients with EGC who underwent ESD treatment at Beijing Hospital from April 2020 to December 2022.The clinical characteristics, background mucosa, lesion features, ESD outcomes, and pathological results of the patients were analyzed to compare the differences between elderly and non-elderly patients.Results:A total of 100 patients with EGC were selected, comprising 57 patients in the elderly group and 43 patients in the non-elderly group, with a total of 111 lesions identified(64 lesions in the elderly group and 47 lesions in the non-elderly group).The proportion of patients with a history of chronic atrophic gastritis was significantly higher in the elderly group(89.5%、51/57)compared to the non-elderly group(74.4%、32/43), with a statistically significant difference( P=0.047).Additionally, the difference in the extent of atrophy between elderly patients with EGC and their non-elderly counterparts was statistically significant( P=0.022).Among these patients, the proportion of those classified as Kimura-Takemoto C0 to C1 in the elderly group(15.6%、10/64)was lower than that in the non-elderly group(40.4%、19/47).In contrast, the proportion of patients classified as C2 to C3 in the elderly group(65.6%、42/64)was higher than that in the non-elderly group(51.1%、24/47), and the proportion of those classified as O1 to O3 in elderly patients(12.5%、8/64)was also higher than in the non-elderly group(4.3%、2/47).Furthermore, the difference in the extent of intestinal metaplasia between elderly and non-elderly patients with early gastric cancer was statistically significant( P=0.007).The overall proportion of total intestinal metaplasia in elderly patients(85.9%、55/64)was significantly higher than that in non-elderly patients(61.7%、29/47).Notably, the proportion of patients exhibiting extensive intestinal metaplasia(intestinal metaplasia present in both the gastric antrum and gastric body)was greater in the elderly group(43.8%、28/64)compared to the non-elderly group(23.4%、11/47).The Kyoto gastric cancer risk endoscopic score for elderly patients with EGC was(2.43±1.28)points, significantly higher than that of the non-elderly group(1.72±1.41)points, with a statistically significant difference observed( t=2.778, P=0.006).No statistically significant differences were observed in the proportions of total resection rates, R0 resections, curative resections, or postoperative complications following ESD when comparing elderly patients with EGC to their non-elderly counterparts. Conclusions:The proportion of extensive atrophy and intestinal metaplasia was higher in the background mucosa of elderly patients with EGC, and correspondingly, the Kyoto endoscopic gastric cancer risk score was elevated.Therefore, endoscopic examinations for elderly patients with chronic atrophic gastritis should be conducted with greater care and comprehensiveness.