ObjectiveTo quantitatively evaluate the effect of phrenic nerve-abdominal muscle electrical stimulation on pulmonary ventilation distribution in stroke patients using electrical impedance tomography (EIT). MethodsThirty-five stroke patients were enrolled at the First Affiliated Hospital of Chongqing Medical University from September, 2024 to June, 2025, and all received standardized phrenic nerve-abdominal muscle electrical stimulation. Percentage of ventilation in gravity-dependent regions of interesting (ROI%), center of ventilation (COV), global inhomogeneity index (GI) and change in end-expiratory lung impedance (ΔEELI) were measured with EIT monitoring before treatment (T0), immediately after treatment (T1), and at five, ten, 15, 20, 25, 30, 40 and 50 minutes after treatment (T2 to T9). ResultsThere were significant differences in ROI% (F = 7.003, P < 0.001) and COV (F = 5.722, P < 0.001) at different time points, both peaking at T1, followed by a downward trend until T5. No significant differences were observed in GI (F = 1.849, P = 0.097) and ΔEELI (F = 0.208, P = 0.871) across time points; however, GI at T7 was lower than that at T0 (P < 0.05). ConclusionPhrenic nerve-abdominal muscle electrical stimulation can improve the ventilation ratio in gravity-dependent regions and shift the center of ventilation dorsally. The improvement in ventilation distribution generally peaks at the end of treatment and lasts for approximately 20 minutes.

Collaborative diagnosis and treatment between Traditional Chinese Medicine(TCM)and Western Medicine,as an important measure for the modernization and innovation of TCM,faces great challenges such as inadequate medical resource supply and supply-demand imbalance in the context of high-quality development strategy.Supply-demand analysis and the input-output framework of modern economic theory were applied to systematically analyze the operational status of collaborative diagnosis and treatment of TCM and Western Medicine in China,and explore the intrinsic economic mechanism of its development.Furthermore,in line with the concept of the"Three Medical Synergistic Collaborations",it proposes policy recommendations from the dimension of medical care,medical insurance,and medicine.

Collaborative diagnosis and treatment between Traditional Chinese Medicine(TCM)and Western Medicine,as an important measure for the modernization and innovation of TCM,faces great challenges such as inadequate medical resource supply and supply-demand imbalance in the context of high-quality development strategy.Supply-demand analysis and the input-output framework of modern economic theory were applied to systematically analyze the operational status of collaborative diagnosis and treatment of TCM and Western Medicine in China,and explore the intrinsic economic mechanism of its development.Furthermore,in line with the concept of the"Three Medical Synergistic Collaborations",it proposes policy recommendations from the dimension of medical care,medical insurance,and medicine.

Objective:To analyze the overall level,structure,and regional differences of central government's health and wellness transfer payments to local governments in China,providing a basis for improving the fiscal transfer payment system.Methods:The regional differences and their changes in central government's health and wellness transfer payments to local governments were analyzed using range,standard deviation,coefficient of variation,and Kendall's coefficient of concordance.Results:From the perspective of the per capita level of central government's health and wellness transfer payments to local governments,the relative differences among provinces have shown a downward trend,but the absolute differences have expanded.Meanwhile,the absolute and relative differences in the proportion of central government's health and wellness transfer payments to local governments in total government health expenditures have remained relatively stable.The Kendall's coefficient of concordance between per capita central government's health and wellness transfer payments to local governments and per capita general public budget revenue has shown a downward trend.Conclusion:Due to the different standards for sharing the expenditure responsibilities of common fiscal matters between the central and local governments,the existence of regional differences in central government's health and wellness transfer payments to local governments is inevitable.However,within regions with similar levels of economic development,there should not be significant differences in the standards and degrees of central government's health and wellness transfer payments to local governments.Therefore,it is necessary to evaluate the current standards for the division of fiscal powers,responsibilities,and expenditure responsibilities between the central and local governments,optimize the allocation mechanism of fiscal transfer payments,control the expansion of regional differences,and improve the regular assessment mechanism for fiscal transfer payments.

Objective To explore the efficiency of operating room(OR)and its influencing factors from a phenomeno-logical perspective,proposing corresponding improvement strategies.Methods A phenomenological method was adopted,invol-ving in-depth interviews with 13 surgical team members from a tertiary Traditional Chinese Medicine(TCM)orthopedic hospital in Henan Province,to collect and analyze their multifaceted understanding of OR efficiency.Results The study demonstrated eight interpretative ways of efficiency among team members.The overall framework was largely organization-oriented,with addi-tional human-centered considerations regarding the factors influencing efficiency.Conclusion A unified understanding is crucial for improving both efficiency and quality.This study suggests strategies to optimize OR processes through lean management and human-centered team development to enhance operating room efficiency.Additionally,it highlights the need for future research to incorporate more patient views.

Objective:To explore effect of Yishen Paidu Formula on inflammatory response in chronic renal failure(CRF)rats and role of Calcineurin/nuclear factor of activated T cell(NFAT).Methods:CRF rat model was constructed,and randomly grouped into model group,low,medium and high doses Yishen Paidu Formula groups,with 10 rats in each group,another 10 rats were fed normally as a blank group;general situation of rats was recorded;urine protein quantification kit was applied to detect 24-hour urine protein level of CRF rats in each group;serum creatinine and urea nitrogen levels of CRF rats were detected;ELISA was applied to detect serum IL-1β,IL-6 and TNF-α levels in CRF rats;pathological changes of renal tissue were observed by HE staining;Western blot was applied to detect expressions of fibroblast growth factor 23(FGF23),Klotho protein,Calcineurin,NFAT protein in renal tissue of CRF rats in each group.Results:Compared with blank group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously increased in model group,level of Klotho protein was obviously decreased(P<0.05).Compared with model group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously decreased in low,medium and high doses Yishen Paidu Formula groups,level of Klotho protein was obviously increased,which were more significant with dosage increase(P<0.05).Conclusion:Yishen Paidu Formula may alleviate inflammatory response in CRF rats by inhibiting Calcineurin/NFAT signaling pathway.

Objective:To develop and validate machine learning models for predicting the cumulative live birth rate (CLBR) following in vitro fertilization (IVF) and to analyze key predictive features using SHAP values. Methods:This retrospective study included data from patients who underwent IVF-embryo transfer at the Department of Reproductive Medicine, Baoding Maternal and Child Health Hospital, between January 2017 and December 2022. Patients were categorized into two groups based on live birth outcome: the live birth group ( n=1 036) and the non-live birth group ( n=756). The dataset was randomly divided into a training set and a validation set in a ratio of 7∶3. Five algorithms were utilized for model development: logistic regression, random forest, extreme gradient boosting (XGBoost), support vector machine, and neural networks. Model performance was assessed using the area under the receiver operating characteristic (AUC) curve, F1 score, and calibration curves. Clinical decision curve analysis (DCA) was employed to evaluate the clinical utility of the models. SHAP values were used to interpret feature importance in the XGBoost model and enhance its explainability. Results:The XGBoost model demonstrated the best performance in predicting CLBR,with accuracy of 72.44%, AUC of 0.775, and F1 score of 0.654, accuracy and F1 score outperforming logistic regression (accuracy was 70.02%, F1 score was 0.585), random forest (accuracy was 71.69%, F1 score was 0.606), support vector machine (accuracy was 70.20%, F1 score was 0.607), and neural network (accuracy was 68.72%, F1 score was 0.560). The calibration curve of XGBoost closely aligned with the diagonal line, indicating that the predicted probabilities were very close to the actual outcomes, demonstrating good calibration. DCA indicated that the XGBoost model provided higher net benefits across a wide range of clinical decision thresholds. SHAP value analysis identified number of previous IVF failures, antral follicle count, anti-Müllerian hormone level, percentage of normal sperm morphology, and sperm DNA fragmentation index as key predictors of CLBR.Conclusion:The XGBoost model exhibits excellent predictive performance and calibration for CLBR, with SHAP values providing important insights into feature importance. This model has the potential to support the development of personalized treatment strategies in clinical practice. However, its generalizability needs to be validated using external datasets to ensure its applicability to diverse populations.

Objective:To explore effect of Yishen Paidu Formula on inflammatory response in chronic renal failure(CRF)rats and role of Calcineurin/nuclear factor of activated T cell(NFAT).Methods:CRF rat model was constructed,and randomly grouped into model group,low,medium and high doses Yishen Paidu Formula groups,with 10 rats in each group,another 10 rats were fed normally as a blank group;general situation of rats was recorded;urine protein quantification kit was applied to detect 24-hour urine protein level of CRF rats in each group;serum creatinine and urea nitrogen levels of CRF rats were detected;ELISA was applied to detect serum IL-1β,IL-6 and TNF-α levels in CRF rats;pathological changes of renal tissue were observed by HE staining;Western blot was applied to detect expressions of fibroblast growth factor 23(FGF23),Klotho protein,Calcineurin,NFAT protein in renal tissue of CRF rats in each group.Results:Compared with blank group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously increased in model group,level of Klotho protein was obviously decreased(P<0.05).Compared with model group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously decreased in low,medium and high doses Yishen Paidu Formula groups,level of Klotho protein was obviously increased,which were more significant with dosage increase(P<0.05).Conclusion:Yishen Paidu Formula may alleviate inflammatory response in CRF rats by inhibiting Calcineurin/NFAT signaling pathway.

Objective:To investigate the efficacy of nasolacrimal duct stent placement combined with endonasal endoscopic dacryocystorhinostomy (EES-DCR) in the treatment of chronic dacryocystitis and analyze the recurrence rate of this condition.Methods:A retrospective analysis was performed on 312 patients with chronic dacryocystitis admitted to Department of Otolaryngology Head and Neck Surgery, Xi'an People's Hospital (Xi'an Fourth Hospital) from April 2021 to April 2023. All patients were divided into the non-implantation group (EES-DCR only) and the implantation group (nasolacrimal duct stent placement combined with EES-DCR) based on the surgical procedure used. Baseline data were excluded using propensity score matching method, and 156 patients were included in each group. Clinical efficacy, incidence rates of complications, and epiphora status (epiphora degree, tear film breakup time, Schirmer test strip wetting length) before surgery and at 1 month after surgery, as well as recurrence rate within 1 year of treatment were compared between the two groups.Results:The total efficacy in the implantation group was significantly higher than that in the non-implantation group [98.08% (153/156) vs. 93.59% (146/156), χ2 = 3.93, P = 0.047). The overall incidence rate in the implantation group was significantly lower than that in the non-implantation group [5.13% (8/156) vs. 12.18% (19/156), χ2 = 4.90, P = 0.027). At 1 month after surgery, both the degree of epiphora and the wetting length of Schirmer test strip significantly decreased in both groups, while the tear film breakup time significantly increased (both P < 0.05) compared with before surgery. The degree of epiphora and the wetting length of Schirmer test strip in the implantation group were (1.25 ± 0.26) points and (12.37 ± 2.24) mm, respectively, which were significantly lower than those in the non-implantation group [(1.44 ± 0.29) points, (13.32 ± 2.60) mm, t = 4.81, P < 0.001; t = 3.45, P < 0.001]. The tear film breakup time in the implantation group was (12.43 ± 2.31) seconds, which was significantly longer than that in the non-implantation group [(11.38 ± 2.15) seconds, t = 4.15, P < 0.001]. The total recurrence rate in the implantation group was 5.13% (8/156), which was significantly lower than that in the non-implantation group [11.54% (18/156), χ2 = 4.19, P = 0.041]. Conclusions:Nasolacrimal duct stent placement combined with EES-DCR effectively treats chronic dacryocystitis, reduces the degree of epiphora, and lowers the recurrence rate of the disease. This combined therapy has few complications and is safe and effective.

With the rapid advancement and iterative development of new artificial intelligence technologies, there remains a regulatory vacuum in corresponding governance measures among governments worldwide. Simultaneously, a technological and governance gap exists between developing countries and developed economies. In response, the World Health Organization (WHO) has released "Ethics and Governance of Artificial Intelligence for Health: Guidance on Large Multi-Modal Models" to assist governments in strengthening governance capabilities in this field. This paper provides an in-depth analysis of the Guidance, aiming to identify challenges and risks associated with the application of multimodal large models in healthcare. Guided by ethical principles for advancing health through artificial intelligence, the paper examines the three-tier governance framework and recommendations outlined in the Guidance. Additionally, it evaluates the current state of AI governance in China, offering insights and reference points for improving AI governance in China′s healthcare sector.