The real-time Delphi method represents a refinement of the classical Delphi technique, designed to overcome limitations such as prolonged study duration and delayed feedback during consensus development. This article, building upon the classical Delphi foundation, systematically elaborates on the application process, advantages, and limitations of the real-time Delphi method. It further presents currently available websites or software capable of facilitating real-time Delphi exercises and offers considerations and recommendations for its application in guideline development, aiming to serve as a reference for relevant researchers.

Cognitive dysfunction often occurs in Alzheimer's disease, Parkinson's disease, cerebrovascular disease, or other neurodegenerative diseases, and can significantly impact the life quality of patients and create serious social, psychological, and economic burdens for individuals and their families. Numerous studies have confirmed that exercise can slow the decline in cognitive function through multiple pathways, in which fibronectin type III domain-containing protein 5 (FNDC5) plays an important role. However, the current research on the modulation of FNDC5 by exercise and its ability to improve hippocampal cognitive function lacks a systematic and comprehensive understanding. Therefore, this review focuses on the latest research progress regarding the role of exercise-induced FNDC5 in cognitive function, systematically reviews the positive effects of FNDC5 on cognitive function impairment caused by various factors, and clarifies the specific mechanisms by which exercise-induced FNDC5 improves cognitive function by inhibiting neuroinflammation and improving hippocampal neurogenesis and hippocampal synaptic plasticity. Based on the existing literature, we also identify the areas that require further research in this field. Overall, this review provides a theoretical basis for exercise-based prevention and improvement of cognitive function impairment.
Humans ; Cognition/physiology* ; Fibronectins/physiology* ; Exercise/physiology* ; Hippocampus/physiology* ; Cognitive Dysfunction/prevention & control* ; Neuronal Plasticity ; Animals ; Neurogenesis

Objective:To investigate the clinical efficacy and safety of ultrasonic bone scalpel in nasal osteotomy.Methods:A retrospective analysis was conducted on clinical data from the patients who received ultrasonic bone scalpel-assisted nasal osteotomy in the Nasal Plastic & Reconstructive Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2023 and April 2024. All patients underwent open lateral approach osteotomy using an ultrasonic bone scalpel under direct vision, combined with augmentation rhinoplasty using autologous costal cartilage grafting. Intraoperatively, the nasal dorsum was fully exposed, and the lateral nasal cartilage was separated from the nasal septum, followed by precise bone tissue incision using the ultrasonic bone scalpel. Parameters recorded included operative time, and postoperative complications. Based on the standardized photographs taken before the operation and during the 6-month follow-up after the operation, the observer global aesthetic improvement scale (GAIS) was evaluated by a third-party doctor, with a score ranging from 1 to 5. The smaller the score, the more significant the improvement compared to before the operation. The satisfaction of patients with the surgical outcome was evaluated and classified into four levels: very satisfied, satisfied, dissatisfied, and very dissatisfied.Results:A total of 25 female patients were enrolled, aged 20 to 38 years, with an average age of 27.1 years. All procedures were completed successfully, with a mean operative time of (25.4±4.2) minutes. Postoperative localized swelling of varying degrees was observed. Follow-up ranged from 6 to 18 months, with nasal contour and curvature stabilizing by 6 months postoperatively. No complications, such as infection, nasolacrimal duct, lacrimal sac, medial canthal ligament, nerve injuries, or sensory disturbances, were reported. Two cases exhibited mild nasal bone widening at the 6-month follow-up, though no surgical revision was requested. Significant improvement in external nasal morphology was achieved in all patients, with high satisfaction rates. The patients satisfaction survey showed that 18 cases (72%) were very satisfied and 7 cases (28%) were satisfied with the surgical outcome. GAIS scores reflected positive evaluations [(1.24±0.51) points].Conclusion:The ultrasonic bone scalpel for nasal osteotomy offers the advantages of high-precision cutting and efficient hemostasis. It is highly effective in reshaping the nasal contour, with shorter osteotomy time, reduced intraoperative bleeding, and a lower postoperative complication rate. This study provides some insights into plastic surgeons in optimizing nasal bone modification strategies.

Objective To investigate the effect of dexmedetomidine(Dex)on bone loss in tail-suspended rats and primarily explore its regulatory mechanism on bone metabolism.Methods A total of 30 male rats were randomly divided into a control group,a model group,and a Dex group,with 10 animals in each group.Rat model of osteoporosis was established by hind limb suspension for 4 weeks.Dex at a dose of 10 μg/kg was given intraperitoneally,once every other day from the day of tail suspension.And equal amount of normal saline was given to the control and model group.Bone histological staining was used to observe the trabecular bone area fraction.Biomechanical three-point bending test was employed to measure the maximum load,stiffness,and fracture energy.Dual calcein/alizarin red fluorescence labeling and tartrate resistant acid phosphatase(TRAP)staining were applied respectively to detect the mineral apposition rate and bone formation rate as well as the number of osteoclasts on bone surfaces.Secondly,after primary osteoblasts were isolated from the tibiae of tail-suspended rats and then treated with 1 nmol/L Dex,the proportion of alkaline phosphatase(ALP)-positive osteoblasts and the activity of the enzyme were detected by ALP staining and activity test.qRT-PCR was applied to measure the expression of osteogenic activity-related factors,including osteocalcin(Ocn),Runt related transcription factor 2(Runx2),Osterix protein(Osx),and type 1 collagen(Col1).Results The animal experiments revealed that Dex treatment significantly increased the tibial trabecular bone area fraction,inhibited the decrease in bone mechanical strength,and enhanced the mineralization deposition rate and new bone formation rate of trabecular bone in the tail-suspended rats(all P＜0.001).The in vitro experiments showed that Dex treatment obviously improved ALP activity and the number of ALP-positive osteoblasts in primary osteoblasts isolated from tail-suspended rats(P＜0.01),and up-regulated the expression levels of osteogenic differentiation-related genes,such as Ocn,Runx2,Osx and Col1(P＜0.01).Conclusion Dex exerts anti-bone loss effect in tail-suspended rats,which may be associated with its stimulation on osteoblast-mediated bone formation.

ObjectiveTo explore the construction of a risk assessment indicator system for common infectious diseases in Shanghai’s childcare institutions, and to provide a reference standard for the prevention and control of infectious diseases, staff training and system construction in childcare institutions. MethodsBy combining the Delphi method with the literature review and expert consultation, the hierarchical dimensions and items at all levels of the risk assessment indicator system for common infectious diseases in Shanghai’s childcare institutions were constructed, and the weighting coefficients were determined by analytic hierarchy process. ResultsA total of 14 experts from the field of childcare institutions, infectious disease control, child healthcare and health supervision participated in the Delphi consultation. The system consisted of four core dimensions: organizational management, team building, hardware equipment, and infectious disease surveillance and disposal, with the weighting coefficients of 0.285 9, 0.261 6, 0.204 3 and 0.248 2, respectively. The evaluation indicator system consisted of 4 primary indicators, 15 secondary indicators and 45 tertiary items. The positivity coefficients of the two rounds of Delphi consultation were 0.93 and 1.00, the authority coefficients were both 0.81, and the Kendall’s coefficient of concordance were 0.44 and 0.49, respectively (P<0.01). ConclusionThe high expert engagement and coordination indicate that organizational management and team building remain the critical priorities for infectious disease prevention and control in Shanghai’s childcare institutions. It is recommended to strengthen financial investment, improve institutional mechanisms, and enhance personnel reserves and capacity building for healthcare teachers, thereby systematically upgrading the infectious disease control capabilities of childcare institutions.

Objective To introduce the concepts and principles of the win ratio method and to analyze it in the context of a case study of a clinical trial in cerebrovascular disease.Methods Based on the study of clopidogrel with aspirin in high risk patients with acute non disabling cerebrovascular events 2,and key prognostic factors,the outcome events were defined sequentially as ① time to death within 90 d,② time to recurrence of ischemic stroke within 90 d,③ time to moderate-to-severe hemorrhage within 90 d.Using clopidogrel combined with aspirin as the reference group,the winning ratio(Rw)of ticagrelor combined with aspirin was analyzed by the win ratio method,and the 95% confidence interval(CI)of Rw was estimated by the Bootstrap method and compared with the hazard ratio(HR)calculated by the competing risk model.Results When only fatal events were considered,the win ratio method suggested that the ticagrelor group was significantly better than the clopidogrel group,Rw=2.00(95% CI:1.52-2.47),and after stepwise inclusion of ischemic stroke and moderate-to-severe hemorrhage recurrence,the win ratio method yielded a value of 1.29(95% CI:1.25-1.57),and the HR value from Fine and Gray competing risk regression was 0.78(95% CI:0.65-0.95),both of which indicated that the efficacy of the ticagrelor group was superior to that of the clopidogrel group.Conclusion The win ratio method can be used to analyze clinical trials with composite endpoints after prioritizing multiple outcome variables,showing the advantages of win ratio and its promising application in cerebrovascular disease research.

Objective To introduce the concepts and principles of the win ratio method and to analyze it in the context of a case study of a clinical trial in cerebrovascular disease.Methods Based on the study of clopidogrel with aspirin in high risk patients with acute non disabling cerebrovascular events 2,and key prognostic factors,the outcome events were defined sequentially as ① time to death within 90 d,② time to recurrence of ischemic stroke within 90 d,③ time to moderate-to-severe hemorrhage within 90 d.Using clopidogrel combined with aspirin as the reference group,the winning ratio(Rw)of ticagrelor combined with aspirin was analyzed by the win ratio method,and the 95% confidence interval(CI)of Rw was estimated by the Bootstrap method and compared with the hazard ratio(HR)calculated by the competing risk model.Results When only fatal events were considered,the win ratio method suggested that the ticagrelor group was significantly better than the clopidogrel group,Rw=2.00(95% CI:1.52-2.47),and after stepwise inclusion of ischemic stroke and moderate-to-severe hemorrhage recurrence,the win ratio method yielded a value of 1.29(95% CI:1.25-1.57),and the HR value from Fine and Gray competing risk regression was 0.78(95% CI:0.65-0.95),both of which indicated that the efficacy of the ticagrelor group was superior to that of the clopidogrel group.Conclusion The win ratio method can be used to analyze clinical trials with composite endpoints after prioritizing multiple outcome variables,showing the advantages of win ratio and its promising application in cerebrovascular disease research.

Objective:To investigate the clinical efficacy and safety of ultrasonic bone scalpel in nasal osteotomy.Methods:A retrospective analysis was conducted on clinical data from the patients who received ultrasonic bone scalpel-assisted nasal osteotomy in the Nasal Plastic & Reconstructive Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2023 and April 2024. All patients underwent open lateral approach osteotomy using an ultrasonic bone scalpel under direct vision, combined with augmentation rhinoplasty using autologous costal cartilage grafting. Intraoperatively, the nasal dorsum was fully exposed, and the lateral nasal cartilage was separated from the nasal septum, followed by precise bone tissue incision using the ultrasonic bone scalpel. Parameters recorded included operative time, and postoperative complications. Based on the standardized photographs taken before the operation and during the 6-month follow-up after the operation, the observer global aesthetic improvement scale (GAIS) was evaluated by a third-party doctor, with a score ranging from 1 to 5. The smaller the score, the more significant the improvement compared to before the operation. The satisfaction of patients with the surgical outcome was evaluated and classified into four levels: very satisfied, satisfied, dissatisfied, and very dissatisfied.Results:A total of 25 female patients were enrolled, aged 20 to 38 years, with an average age of 27.1 years. All procedures were completed successfully, with a mean operative time of (25.4±4.2) minutes. Postoperative localized swelling of varying degrees was observed. Follow-up ranged from 6 to 18 months, with nasal contour and curvature stabilizing by 6 months postoperatively. No complications, such as infection, nasolacrimal duct, lacrimal sac, medial canthal ligament, nerve injuries, or sensory disturbances, were reported. Two cases exhibited mild nasal bone widening at the 6-month follow-up, though no surgical revision was requested. Significant improvement in external nasal morphology was achieved in all patients, with high satisfaction rates. The patients satisfaction survey showed that 18 cases (72%) were very satisfied and 7 cases (28%) were satisfied with the surgical outcome. GAIS scores reflected positive evaluations [(1.24±0.51) points].Conclusion:The ultrasonic bone scalpel for nasal osteotomy offers the advantages of high-precision cutting and efficient hemostasis. It is highly effective in reshaping the nasal contour, with shorter osteotomy time, reduced intraoperative bleeding, and a lower postoperative complication rate. This study provides some insights into plastic surgeons in optimizing nasal bone modification strategies.

[Objective] To evaluate the clinical efficacy and safety of different chemotherapeutic regimens combined with sintilimab as first-line treatment for Her-2 negative advanced gastric cancer. [Methods] We retrospectively collected the clinical data of patients with Her-2 negative advanced gastric cancer treated with albumin-bound paclitaxel plus S-1 combined with sintilimab (n=40) and oxaliplatin plus S-1 combined with sintilimab (n=36) at The Affiliated Hospital of Xuzhou Medical University from September 1, 2021 to July 1, 2023. The clinical efficacy and adverse reactions were evaluated separately in patients treated with albumin-bound paclitaxel plus S-1 combined with sintilimab and in those treated with oxaliplatin plus S-1 combined with sintilimab. Factor analysis was made on two sets of clinical data separately. [Results] The objective response rate (ORR) of albumin-bound paclitaxel group and oxaliplatin group was 57.5% and 52.8%, respectively. The disease control rate (DCR) of albumin-bound paclitaxel group and oxaliplatin group was 85.0% and 80.6%, respectively. The median progression-free survival (PFS) of patients in albumin-bound paclitaxel group and oxaliplatin group was 8.3 months and 9.0 months. The incidence of adverse reactions in albumin-bound paclitaxe group was 87.5% (35/40), and that in the oxaliplatin group was 91.7% (33/36). Factor analysis of the clinical data of albumin-bound paclitaxel group and oxaliplatin group revealed that liver metastasis was an independent risk factor for PFS. [Conclusion] Both albumin-bound paclitaxel combined with S-1 and sintilimab, and oxaliplatin combined with S-1 and sintilimab show promising efficacy and manageable side effects when used as first-line treatment for Her-2 negative advanced gastric cancer.

The unique advantages of traditional Chinese medicine (TCM) in treating late onset hypogonadism in male have gradually emerged with the continuous deepening of the understanding and research on late onset hypogonadism in male. Time sequence is a general summary of the natural growth and operational laws. Tian gui and testosterone have their normal time sequences, and they may be associated with each other. A man′s tian gui follows the regular time sequence from " inception" to " exhaustion" throughout " eight" under normal physiological conditions. " Tian gui out of time sequence" includes the loss of tian gui exuberance (dysfunction of viscera dominated by the liver) and exhaustion in the time sequence (pathological deficiency of viscera dominated by the kidney), resulting in " tian gui exhaustion" in advance of " eight eight". Tian gui and testosterone are key concepts in Chinese and Western medicine for understanding late onset hypogonadism in male. The theory of " tian gui out of time sequence" may be closely related to the core pathogenesis of this condition, particularly in cases of liver depression and kidney deficiency. This study suggests that restoring the normal time sequence of tian gui while treating the liver and kidney simultaneously through time-sharing treatment should be effective. The use of Xiongcan Yishen Formula has shown promising therapeutic result, offering new insights and references for treating late onset hypogonadism in male using TCM.