OBJECTIVE To comprehensively evaluate the 16 commonly used kinds of enteral nutrition preparations in Hebei province， aiming to provide a reference for the selection of drugs in medical institutions and clinical drug decision-making. METHODS Based on the Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions （the Second Edition）， evaluation evidence was collected， and the included drugs were scored and evaluated from four dimensions of pharmaceutical characteristics， clinical characteristics， economy and other attributes. RESULTS & CONCLUSIONS The scores for Enteral nutritional emulsion （TPF-T）， Enteral nutritional emulsion （TPF-D）， Enteral nutritional emulsion （TPF）， Enteral nutritional emulsion （TPF-HE）， Enteral nutritional emulsion （TP）， Enteral nutritional emulsion （SP）， Enteral nutritional suspension （TPF） （1.5 kcal/mL， 1 kcal＝4.184 kJ）， Enteral nutritional suspension （TPF） （1.0 kcal/mL）， Intact protein enteral nutrition （powder）， Enteral nutritional suspension （TPF-DM）， Enteral nutritional suspension （TPF-MCT）， Enteral nutritional suspension （SP）， Short- peptide enteral nutrition， Enteral nutritional powder （TP）， Enteral nutritional suspension （TPF-D） and Enteral nutritional suspension （TPF-FOS） were 82.9， 84.1， 84.1， 86.1， 78.4， 79.1， 82.6， 82.3， 82.4， 80.2， 83.0， 82.4， 82.1， 85.7， 76.0， 82.4 points， respectively. All medications scored above 70 points. In practice， appropriate drugs can be selected according to clinical requirements and patient needs.

AIM: To investigate the influencing factors of stereoscopic function reconstruction after intermittent exotropia(IXT)surgery and the construction of a nomogram prediction model.METHODS:A total of 204 patients with IXT(all underwent strabismus correction surgery)admitted to our hospital from September 2021 to October 2023 were randomly divided into modeling group(143 cases)and validation group(61 cases). The patients in the modeling group were further divided into reconstructive group and non-reconstructive group according to whether they had stereoscopic function reconstruction after surgery; the general patient information was collected; Multivariate Logistic regression analysis was performed on the influencing factors of stereoscopic visual function reconstruction after IXT surgery. The nomogram model was constructed using R software. The ROC curve was drawn to evaluate the distinction of the nomogram model. The decision curve analysis(DCA)was used to evaluate the clinical application value of the model.RESULTS:Reconstruction occurred in 50.5%(103 cases)of the 204 patients, and reconstruction occurred in 50.3%(72 cases)of the 143 patients in the modeling group. There were differences in age of onset, course of disease and postoperative horizontal strabismus between the reconstructive group and the non-reconstructive group(all P<0.05). Multivariate Logistic regression analysis showed that age of onset and postoperative horizontal strabismus were risk factors for stereoscopic visual function reconstruction after IXT surgery(all P<0.05), and the course of disease was a protective factor(P<0.05). The AUC of the modeling group was 0.892, and the H-L test was χ2=6.654 and P=0.615. The AUC of the validation group was 0.935, and the H-L test was χ2=6.498 and P=0.642. The DCA curve showed that the clinical value of the nomogram model was higher when the probability was 0.09-0.95.CONCLUSION: The age of onset, course of disease and postoperative amount of horizontal strabismus are the influencing factors of stereoscopic visual function reconstruction after IXT surgery, and the nomogram model constructed by this can better predict postoperative stereoscopic function reconstruction.

Objective To compare the efficacies of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of post-chronic aplastic anemia(CAA)myelodysplastic syndrome(MDS)and primary MDS.Methods A retrospective analysis was conducted on 32 patients who received allo-HSCT treatment in Department of Hematology,North China University of Science and Technology Affiliated Hospital between Feb.2012 and Feb.2022,including 12 patients with post-CAA MDS and 20 patients with primary MDS.The overall survival rate,cumulative incidence of relapse(CIR)rate,non-relapse mortality(NRM)rate,and event-free survival rate were compared between the 2 groups.Results The median follow-up time for CAA to progress to MDS was 120(72-180)months.All the patients were followed up for 36(3-79)months after allo-HSCT.The 3-year overall survival rate of the post-CAA MDS group was significantly higher than that of the primary MDS group(83.8%vs 45.0%,P=0.035).The 3-year CIR of the post-CAA MDS group was significantly lower than that of the primary MDS group(16.7%vs 55.0%,P=0.021).There was no significant difference in the event-free survival rates or NRM rates between the 2 groups(both P＞0.05).Conclusion The post-CAA MDS patients have better survival after allo-HSCT than the primary MDS patients.Early allo-HSCT treatment may improve the prognosis.

In terms of the complexity of the"left"and"right"concepts,these directional terms not only indicate spatial orientation but also embody hierarchical order,official titles,systemic imbalances,and temporal sequences.This study explains the medical theory of"liver is born on the left and lung is hidden on the right,"and reveals its implications for ascending and descending of qi movement pathways,sequential patterns,non-equilibrium states,and the centrality of the middle,thus linking the connotation of this theory and its application.In view of this,the theory of"liver is born on the left and lung is hidden on the right"can be used in the clinical diagnosis and treatment of qi-blood-body fluid and emotional diseases,and guides disease prevention and treatment,as well as enhances the subjective initiative of health maintenance and longevity.This study not only deepens the modern interpretation of the classical theory but also provides novel perspectives for its application in disease prevention and treatment.

Objective:To evaluate the effect and causality of serum metabolites on the pathogenesis of ulcerative colitis (UC), so as to provide reference for nutritional programs for patients with UC.Methods:Two-sample Mendelian randomization (MR) analysis was performed to estimate the causal relationship between serum metabolites and UC. Genome-wide association studies (GWAS) of 1 400 metabolites were performed, with the metabolites as exposure and UC as outcome. Inverse-variance weighted (IVW) was used to calculate causal estimates. Four other MR methods with different modeling assumptions including MR-Egger, weighted median, weighted mode, and simple mode were used as additional analyses to improve the stability of the results. The results were validated through heterogeneity and pleiotropy tests. Finally, the possible causal metabolites were analyzed by metabolic pathway analysis.Results:MR analysis revealed that 85 metabolites had a possible causal relationship with UC. Among them, phosphatidylglycerol 1,2-dipalmitoyl-gpc (DPPC) ( P=2.75×10 -6) and isovaleryl carnitine (C5) ( P=1.84×10 -5) were significant risk factors for UC. Metabolic pathway analysis identified 5 metabolic pathways that might be affected by these metabolites (all P<0.05), among which the porphyrin ( P=0.004) and pyrimidine metabolic pathways ( P=0.008) had higher confidence in impacting UC. Conclusions:There are causal relationships between some serum metabolites (in particular 1,2-dipalmitoyl-GPC and isovalerylcarnitine) and the risk of UC. The porphyrin and pyrimidine metabolic pathways may impact the pathogenesis of UC.

Objective:To explore the factors influencing healthcare-seeking time in diabetic foot patients and to develop and validate a predictive model for healthcare-seeking time.Methods:A total of 299 diabetic foot patients hospitalized in the Department of Endocrinology and Metabolism at the First Affiliated Hospital of Zhengzhou University from March 2023 to January 2024 were recruited for model development and internal validation. Sixty additional patients from the Second Affiliated Hospital of Zhengzhou University from September 2023 to January 2024 were used for external validation. Kaplan-Meier survival curves were used to estimate healthcare-seeking times. Cox regression analysis identified influencing factors and constructed the model. Random Survival Forest (RSF) was employed for variable selection and model construction. Internal validation was conducted using 10-fold cross-validation, and model evaluation utilized the integrated Brier score, C-index, and prediction error curve. Results:Kaplan-Meier analysis revealed that education level, foot self-care ability, lower extremity vascular disease, and disease perception significantly influenced healthcare-seeking time ( P<0.05). Cox regression identified gender, income level, medical payment method, living situation, marital status, ulcer history, social support, disease perception, and healthcare behavior perception as significant influencing factors ( P<0.05). RSF variable selection indicated that social support, disease perception, e-health literacy, healthcare behavior perception, and age were the most valuable factors for model construction. In external validation, the Brier scores for the Cox regression and RSF models were 0.059 and 0.088, respectively, while the C-indices were 0.862 and 0.683. Prediction error curves showed that the Cox regression model had lower prediction errors and higher predictive performance. Conclusions:The Cox regression model demonstrated superior performance and can assist nurses in effectively identifying high-risk populations for delayed healthcare-seeking in diabetic foot patients. This allows for timely interventions to improve healthcare behavior and reduce delays.

Based on the Delphi method, this study conducted an expert questionnaire survey on the diagnostic criteria of edema in TCM by integrating preliminary literature research, aiming to further standardize the revision of Edema diagnosis in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine (ZY/T001.1－94). Relevant literature on TCM edema was comprehensively retrieved from CNKI, Wanfang Data, VIP and CBM from 1994 to July 1, 2021. The content extracted from the literature was integrated with the diagnostic criteria outlined in the 1994 Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine to establish the questionnaire item pool; two rounds of Delphi expert surveys were conducted to identify content requiring revisions. Subsequently, the degree of concentration and coordination of the expert opinions were analyzed to determine items for inclusion in the revised draft. Ultimately, the finalized revised diagnostic criteria for edema were developed through expert panel discussions. Results showed expert participation rates of 84.21% and 78.13% in respective survey rounds. The progressive increase in Kendall's coefficient of concordance (Kendall's W=0.169 in Round 1 to Kendall's W=0.368 in Round 2) quantitatively validated enhanced expert consensus (both the degree of concentration and coordination) and systematic alignment of revision proposals for diagnostic items. The study findings demonstrated an urgent need for improving the diagnostic criteria section of the the 1994 Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine, and the proposed revisions would be expected to enhance the applicability and specificity of edema diagnostic standards in clinical practice.

Objective:To evaluate the effect and causality of serum metabolites on the pathogenesis of ulcerative colitis (UC), so as to provide reference for nutritional programs for patients with UC.Methods:Two-sample Mendelian randomization (MR) analysis was performed to estimate the causal relationship between serum metabolites and UC. Genome-wide association studies (GWAS) of 1 400 metabolites were performed, with the metabolites as exposure and UC as outcome. Inverse-variance weighted (IVW) was used to calculate causal estimates. Four other MR methods with different modeling assumptions including MR-Egger, weighted median, weighted mode, and simple mode were used as additional analyses to improve the stability of the results. The results were validated through heterogeneity and pleiotropy tests. Finally, the possible causal metabolites were analyzed by metabolic pathway analysis.Results:MR analysis revealed that 85 metabolites had a possible causal relationship with UC. Among them, phosphatidylglycerol 1,2-dipalmitoyl-gpc (DPPC) ( P=2.75×10 -6) and isovaleryl carnitine (C5) ( P=1.84×10 -5) were significant risk factors for UC. Metabolic pathway analysis identified 5 metabolic pathways that might be affected by these metabolites (all P<0.05), among which the porphyrin ( P=0.004) and pyrimidine metabolic pathways ( P=0.008) had higher confidence in impacting UC. Conclusions:There are causal relationships between some serum metabolites (in particular 1,2-dipalmitoyl-GPC and isovalerylcarnitine) and the risk of UC. The porphyrin and pyrimidine metabolic pathways may impact the pathogenesis of UC.

Objective:To develop a quality control model for anal sphincter ultrasound images and validate its diagnostic performance across multiple centers.Methods:A retrospective analysis was conducted on anal sphincter ultrasound images from seven medical centers in China between May 2019 and June 2022. A total of 7 040 images from 3 116 patients were included and divided into a training set（4 912 images）and a validation set（2 128 images）. The images were classified as standard or non-standard images by three experts. Three models were developed based on different image feature extraction methods：a single-branch model，a multi-branch weighted model，and a multi-branch ensemble model. The diagnostic performance of each model was evaluated using the area under the ROC curve（AUC），sensitivity，specificity，accuracy，positive predictive value，and negative predictive value，respectively. The optimal model was selected and compared with the performance of 4 doctors with varying experience levels. Sixty days later，the images with the assistance of the model's output were reassessed by the doctors to evaluate its impact on manual quality control.Results:① Among the 3 models，the multi-branch ensemble model demonstrated the highest AUC and sensitivity，with an AUC of 0.966（95% CI=0.958 - 0.974），a sensitivity of 91.83%，and a specificity of 91.41%. This model was named M quality. ② M quality's AUC was slightly lower than that of Senior A and B（0.966 vs. 0.976，0.976，and P<0.05），its sensitivity was slightly lower than that of Senior A（91.83% vs. 95.61%， P<0.001）but comparable to Senior B（91.83% vs. 92.89%， P=0.315），its specificity was slightly lower than Senior A and B（91.41% vs. 94.44%，98.18%，and P<0.05）. However，M quality significantly outperformed Junior A and B in AUC and sensitivity（AUC：0.966 vs. 0.850，0.818；sensitivity：91.83% vs. 84.90%，61.46%；all P<0.001），its specificity was higher than that of Junior A（91.41% vs. 80.28%， P<0.001）but lower than that of Junior B（91.41% vs. 95.96%， P<0.001）. ③ With model assistance，Senior B's sensitivity（92.89% vs. 94.20%， P=0.001）and Senior A's specificity（94.44% vs. 96.56%， P<0.001）improved significantly. Junior A and B showed significant improvements in AUC and sensitivity（AUC：0.931 vs. 0.850，0.914 vs. 0.818；sensitivity：91.83% vs. 84.90%，89.53% vs. 61.46%；all P<0.001）. After model assistance，Junior A's specificity increased（93.62% vs. 80.28%， P<0.001），while Junior B's specificity decreased（91.60% vs. 95.96%， P=0.013）. Conclusions:This study develops a quality control model for anal sphincter ultrasound images with robust diagnostic performance，approaching the level of seniors. The model significantly enhances the image quality assessment capabilities of juniors，demonstrating promising clinical application potential.

Objective To explore a new training strategy suitable for clinical education and talent cultivation in gy-necologic oncology.Methods Ninety undergraduates from each of the two grades of clinical medicine curriculum at Kunming Medical University were randomly divided into control group(n=40)and research group(n=50).The"4+3"teaching model of plan-do-check-action(PDCA)cycle integrated with TBL were adopted,whereas the control group was educated with classic methods.Two groups of students were evaluated with quantitative assessments and anonymous questionnaire surveys.Results Multidimensional questionnaire surveys indicated that the teaching model of the test group provided a better learning experience than classic teaching methods as proved by significant improvements in educational reform(58％),learning interest(64％),skill development(72％),capacity building of learning(66％)and satisfaction with the new model of training(70％)(P＜0.05,＜0.01).Further-more,the PDCA cycle can address the short-comings of the previous teaching iteration.In written exams,the class-room quiz scores,regular grades,and comprehensive scores of the research group were(18.38±5.81),(29.09±0.29),and(82.38±4.03)points respectively all higher than those of the control group(P＜0.01).Conclusions The PDCA cycle and the TBL-embedded teaching model promote the standardization of gynecologic oncology teach-ing procedures,thereby enhancing teaching quality and achieving precise alignment between student satisfaction and assessment performance.