Objective:To evaluate the application efficiency of the artificial prenatal sonography quality assurance system（PSAIS）in the quality control of fetal image quality during the first trimester（11-14 weeks），and to assist the quality control of fetal ultrasound examinations in the first trimester in Liaoning Province using this system.Methods:One hundred fetuses（2 757 ultrasound images）from early pregnancy ultrasound screenings at the Shengjing Hospital Affiliated to China Medical University in November 2022 were retrospectively randomly selected as the test set. The performance of PSAIS were evaluated by 3 obstetric ultrasound experts. First，the experts' sectional classification was used as the gold standard，the accuracy of PSAIS in classifying standard sections was assessed；the consistency between PSAIS and expert ratings was evaluated using the intraclass correlation coefficient（ICC）. The difference of time between PSAIS and expert quality control was analyzed. Finally，PSAIS was used to evaluate the quality of early pregnancy fetal ultrasound examinations at various levels of hospitals in Liaoning province，involving a total of 35 hospitals. Ten early pregnancy fetal ultrasound screening cases were randomly selected from each hospital. The specific evaluation content included the number of stored ultrasound images per examination，the completion rate of standard sections，image quality scores for each examination and individual images，excellence rates and pass rates. The assessment results were statistically described and analyzed.Results:The accuracy rate of PSAIS classification reached to 88.25%（706/800）；the ICC between PSAIS and expert ratings was 0.978. PSAIS analysis showed that the time for each early pregnancy fetal ultrasound examination was less than the average time required by experts（3.0 s vs. 63.5 s， P<0.05）.Quality control checks revealed statistically significant differences among hospitals at various levels in terms of the number of stored images，completeness of sections，scoring，excellence rate，and pass rate（all P<0.05）. Among them，tertiary hospitals performed better than secondary hospitals，private hospitals outperformed public ones，and specialized hospitals excelled over general hospitals. In the evaluation of section standardization，the fetal median sagittal plane had the highest completion rate［99.43%（348/350）］，while the umbilical cord abdominal wall entry transverse plane scan had the lowest completion rate［31.14%（109/350）］. Conclusions:PSAIS can reliably assess the quality of early pregnancy fetal ultrasound examinations，significantly enhancing the efficiency of quality control. There are noticeable differences among hospitals at various levels in Liaoning Province regarding the image quality of early pregnancy fetal ultrasounds，and there are also some common issues in standardizing sections. The quality of obstetric ultrasound images still needs further improvement.

Objective:To evaluate the application efficiency of the artificial prenatal sonography quality assurance system（PSAIS）in the quality control of fetal image quality during the first trimester（11-14 weeks），and to assist the quality control of fetal ultrasound examinations in the first trimester in Liaoning Province using this system.Methods:One hundred fetuses（2 757 ultrasound images）from early pregnancy ultrasound screenings at the Shengjing Hospital Affiliated to China Medical University in November 2022 were retrospectively randomly selected as the test set. The performance of PSAIS were evaluated by 3 obstetric ultrasound experts. First，the experts' sectional classification was used as the gold standard，the accuracy of PSAIS in classifying standard sections was assessed；the consistency between PSAIS and expert ratings was evaluated using the intraclass correlation coefficient（ICC）. The difference of time between PSAIS and expert quality control was analyzed. Finally，PSAIS was used to evaluate the quality of early pregnancy fetal ultrasound examinations at various levels of hospitals in Liaoning province，involving a total of 35 hospitals. Ten early pregnancy fetal ultrasound screening cases were randomly selected from each hospital. The specific evaluation content included the number of stored ultrasound images per examination，the completion rate of standard sections，image quality scores for each examination and individual images，excellence rates and pass rates. The assessment results were statistically described and analyzed.Results:The accuracy rate of PSAIS classification reached to 88.25%（706/800）；the ICC between PSAIS and expert ratings was 0.978. PSAIS analysis showed that the time for each early pregnancy fetal ultrasound examination was less than the average time required by experts（3.0 s vs. 63.5 s， P<0.05）.Quality control checks revealed statistically significant differences among hospitals at various levels in terms of the number of stored images，completeness of sections，scoring，excellence rate，and pass rate（all P<0.05）. Among them，tertiary hospitals performed better than secondary hospitals，private hospitals outperformed public ones，and specialized hospitals excelled over general hospitals. In the evaluation of section standardization，the fetal median sagittal plane had the highest completion rate［99.43%（348/350）］，while the umbilical cord abdominal wall entry transverse plane scan had the lowest completion rate［31.14%（109/350）］. Conclusions:PSAIS can reliably assess the quality of early pregnancy fetal ultrasound examinations，significantly enhancing the efficiency of quality control. There are noticeable differences among hospitals at various levels in Liaoning Province regarding the image quality of early pregnancy fetal ultrasounds，and there are also some common issues in standardizing sections. The quality of obstetric ultrasound images still needs further improvement.

Objective:To explore the influencing factors and implementation paths of medical and preventive integration of chronic disease in county medical communities (CMCs), providing references for further promoting the integration of medical and prevention and improving the collaborative mechanism of medical and prevention.Methods:From October to November 2023, based on the principle of geographically balanced sampling, medical staff from 6 leading hospitals and 18 other member units of 6 CMCs in Zhejiang Province were selected as survey subjects. A self-designed survey questionnaire was conducted, mainly including the development and evaluation of chronic disease medical and preventive integration services in CMCs. The service development was designed according to the collaborative symbiosis management model, including 4 dimensions of collaborative symbiosis scenarios, willingness, ability, and process, as well as 11 secondary elements. Using secondary elements as the conditional variables and the integration effect of chronic disease medical and prevention as the outcome variable, a qualitative comparative analysis method was used to explore the relationship between multiple conditional variables and their combinations with high integration effect of chronic disease medical and prevention.Results:571 valid questionnaires were collected, with an effective response rate of 96.62%. The consistency of a single secondary element(including conditional non sets) on the high effectiveness of medical and preventive integration was less than 0.9, which cannot constitute a necessary condition for explaining the outcome variable. The configuration analysis results showed that the consistency of the condition combination formed by the interaction of multiple secondary elements was 0.835-0.845, indicating that the condition combination of multiple elements constituted a sufficient non necessary condition for the high integration effect of chronic disease medical and prevention. The configuration path for achieving high integration of medical and preventive effects could be divided into four categories, among which the feature of scenario-process dominance was to create a perfect service scenario and service process as the main focus; The characteristic of the willingness-process dominant type was to stimulate the service willingness of medical staff and improve the service process as the leading factor; The characteristic of the scenario-willingness-ability dominant type was to create a comprehensive service scenario, stimulate the service willingness of medical staff, and enhance service capabilities as the main focus; The characteristic of the willingness-ability-process dominant type was to stimulate the service willingness of medical staff, enhance service capabilities, and improve the service process as the dominant factor. In addition, the four types of configuration paths mentioned above all covered the two secondary elements of endogenous dynamics and professional competence, with a total coverage of 0.626 and a total consistency of 0.821.Conclusions:The configuration path formed through the interaction of multiple elements can effectively achieve the integration of chronic disease medical and prevention. The CMCs should choose the appropriate configuration path based on the actual situation. In addition, special attention should be paid to the endogenous motivation and professional capacity building of medical staff.

Clinical trials play a crucial role in advancing the field of human health care. The registration of clinical trials can effectively identify potential publication bias and prevent unnecessary duplication of research efforts, serving as a source of transparent data for health care professionals and researchers, enhancing the quality of clinical research, and presenting more transparent, standardized, authentic, and useful clinical trials. To enhance the capacity for evidence production in traditional medicine from the source, the International Traditional Medicine Clinical Trial Registry (ITMCTR), a cross-regional registry focusing on the theme of traditional medicine, was established. Under the current registration background, this study aims to introduce the problems and current status related to clinical trial registration, as well as the features and functions of the ITMCTR. The results of this study illustrate the necessity of establishing a specialized registration platform for traditional medicine to assist researchers in understanding the basic background of registration and relevant information regarding registration platforms, regardless of whether their research is related to traditional medicine or not. Ultimately, the results of this work will help researchers choose the appropriate platform for more efficient and transparent registration.

Background::Dual-energy computed tomography (DECT) is purported to accurately distinguish uric acid stones from non-uric acid stones. However, whether DECT can accurately discriminate ammonium urate stones from uric acid stones remains unknown. Therefore, we aimed to explore whether they can be accurately identified by DECT and to develop a radiomics model to assist in distinguishing them.Methods::This research included two steps. For the first purpose to evaluate the accuracy of DECT in the diagnosis of uric acid stones, 178 urolithiasis patients who underwent preoperative DECT between September 2016 and December 2019 were enrolled. For model construction, 93, 40, and 109 eligible urolithiasis patients treated between February 2013 and October 2022 were assigned to the training, internal validation, and external validation sets, respectively. Radiomics features were extracted from non-contrast CT images, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to develop a radiomics signature. Then, a radiomics model incorporating the radiomics signature and clinical predictors was constructed. The performance of the model (discrimination, calibration, and clinical usefulness) was evaluated.Results::When patients with ammonium urate stones were included in the analysis, the accuracy of DECT in the diagnosis of uric acid stones was significantly decreased. Sixty-two percent of ammonium urate stones were mistakenly diagnosed as uric acid stones by DECT. A radiomics model incorporating the radiomics signature, urine pH value, and urine white blood cell count was constructed. The model achieved good calibration and discrimination {area under the receiver operating characteristic curve (AUC; 95% confidence interval [CI]), 0.944 (0.899–0.989)}, which was internally and externally validated with AUCs of 0.895 (95% CI, 0.796–0.995) and 0.870 (95% CI, 0.769–0.972), respectively. Decision curve analysis revealed the clinical usefulness of the model.Conclusions::DECT cannot accurately differentiate ammonium urate stones from uric acid stones. Our proposed radiomics model can serve as a complementary diagnostic tool for distinguishing them in vivo.

Hypertrophic cardiomyopathy (HCM), the most common single-gene cardiovascular disease, is associated with increased risk for arrhythmias, heart failure, and sudden cardiac death. The hemodynamic changes known to occur during pregnancy can exacerbate heart failure and arrhythmias in women with HCM. We present a 30-year-old woman with HCM to illustrate the benefits of multidisciplinary team management of severe left ventricular outflow tract obstruction (peak gradient >100 mmHg) for optimal maternal and fetal outcomes.

Hypertrophic cardiomyopathy (HCM), the most common single-gene cardiovascular disease, is associated with increased risk for arrhythmias, heart failure, and sudden cardiac death. The hemodynamic changes known to occur during pregnancy can exacerbate heart failure and arrhythmias in women with HCM. We present a 30-year-old woman with HCM to illustrate the benefits of multidisciplinary team management of severe left ventricular outflow tract obstruction (peak gradient >100 mmHg) for optimal maternal and fetal outcomes.

Objective:To explore the risk factors of acute kidney injury(AKI) in patients after radical nephrectomy.Methods:We retrospectively collected clinical information of 920 patients with renal cell carcinoma who underwent radical nephrectomy at Zhongshan Hospital, Fudan University from February 2013 to September 2017. There were 612 male and 308 female patients included in this study, with a median age of 60 (range from 20-75 years). 313 patients (34.0%) had hypertension, 132 patients (14.3%) had diabetes, and 111 patients (12.1%) had smoking history. 829 cases (90.1%) were in stage 1-2 for preoperative renal function staging, and 91 cases (9.9%) were in stage 3-5. Preoperative hemoglobin was lower than the lower limit of normal in 391 cases (42.5%), white blood cell count increased in 66 cases (7.2%), and platelet increased in 72 cases (7.8%). Albumin was lower than the lower limit of normal in 65 cases (7.1%), lactate dehydrogenase increased in 73 cases (7.9%). blood urea nitrogen increased in 48 cases (5.2%), uric acid increased in 123 cases (13.4%), and urinary protein was positive in 88 cases (9.7%). 496 cases (53.9%) underwent open surgery and 424 (46.1%) underwent laparoscopic surgery. The changes in serum creatinine were followed up within 48 hours after surgery. AKI was defined according to the KDIGO standard. Logistic regression was used to analyze the risk factors for postoperative stage 2-3 AKI in patients.Results:Stage 1-3 AKI occurred on 627, 42 and 10 patients during hospitalization, respectively. Univariate analysis showed that diabetes ( OR=2.34, P=0.01), positive urine protein ( OR=2.22, P=0.04), and elevated white blood cell count ( OR=2.54, P=0.02) were significantly associated with postoperative stage 2-3 AKI. Multivariate logistic regression analysis showed that diabetes ( OR=2.51, P=0.01) and elevated white blood cell count ( OR=2.69, P=0.02) were independent risk factors for postoperative stage 2-3 AKI. Conclusion:Renal cell carcinoma patients with diabetes or preoperative elevated white blood cell count are more likely to develop stage 2-3 AKI after radical nephrectomy.

Objective The objective is to probe into the effects of astragaloside Ⅳ (AS-Ⅳ) on activity and proliferative function of endothelial progenitor cells (EPCs),which lays a foundation for further study on the effects of AS-Ⅳ on vascular neovascularization mediated by endothelial progenitor cells.Methods The mononuclear cells were isolated by the density gradient centrifugation in umbilical cord blood of full-term healthy infants,and EPCs were obtained by subculture and cell identification when the cells presented spindle shapes.The obtained EPCs were randomly divided into the experimental group and the control group.In the experimental group,EPCs were cultured by AS-Ⅳ with different concentration gradients (25 mg/L,50 mg/L,100 mg/L,200 mg/L and 400 mg/L),while in the control group,they were treated with the same amount of phosphate buffer saline (PBS) solutions.The effects of AS-Ⅳ on the proliferation of endothelial progenitor cells was studied by cell counting kit-8 (CCK-8) cell proliferation experiment,and the activity rate of EPCs cells was measured at the optimum concentration of EPCs proliferation.Results EPCs were successfully obtained after confirming nuclear staining test of CD31 antibody and 4',6-diamidi-no-2-phenylindole (DAPI).Further study showed that AS-Ⅳ can promote the proliferation of EPCs,and its optimal concentration of EPCs proliferation is 100 mg/L.Compared with the normal control group,the activity rate of endothelial progenitor cells after intervention of AS-Ⅳ was 98.7％,higher than 98.12％ in the control group,with significant difference (x2 =49.59,P ＜0.01).Conclusions AS-Ⅳ can enhance the activity of human EPCs and promote their proliferation in vitro.

Objective To evaluate the efficacy of distal radioulnar joint (DRUJ) dorsal ligament reconstruction using extensor retinaculum transposition with triagular fibrocartilage complex (TFCC) repair and dorsal capsuloplasty for chronic DRUJ dorsal instability.Methods From October 2007 to July 2016,data of 18 patients (11 men and 7 women with a mean age of 37.4 years) were retrospectively analyzed who underwent DRUJ dorsal ligament reconstruction with extensor retinaculum transposition,DRUJ dorsal capsuloplasty,and TFCC repair for DRUJ dorsal instability.The tissue flap of extensor retinaculum was fixed at the ulnar edge of distal radius by two micro anchors after TFCC repair and dorsal capsuloplasty of the DRUJ capsule.X-ray examination of wrist was performed for all the patients after operation to identify the reduction of DRUJ.The wrist range of flexion and extension,the forearm range of rotation,and the grip strength of hand were measured.Modified Mayo wrist scores,DASH scores and visual analogue scale (VAS) were used to evaluate the function and pain of wrist and upper extremity.Results 18 patients were followed up for 12-70 months with an average period of 34 months.The stability of the DRUJ was restored in 16 patients.The other 2 cases wore long arm splint for 6 weeks after operation due to the residual instability of the DRUJ,after that the instability of DURJ were improved to grade I.The flexion and extension of wrist,the rotation of forearm were improved,but there were no significant difference comparing to those of pre-operation.The VAS,modified Mayo and DASH scores,grip strength of hand were significantly improved from preoperative 4.2±1.1,67.4±11.2,51.3±14.2,16.3±3.7 kg to postoperative 0.2±0.5,83.9±11.6,15.9±3.2,24.9±6.4 kg at the latest follow-up.Conclusion Extensor retinaculum transposition with TFCC repair and DRUJ dorsal capsuloplasty can effectively relieve pain and recovery stability of DRUJ,which was an effective method for chronic DRUJ dorsal instability.