Clinical practice guidelines represent the best recommendations for patient care. They are developed through systematically reviewing currently available clinical evidence and weighing the relative benefits and risks of various interventions. However, clinical practice guidelines have to go through a long translation cycle from development and revision to clinical promotion and application, facing problems such as scattered distribution, high duplication rate, and low actual utilization. At present, the clinical practice guideline information platform can directly or indirectly solve the problems related to the lengthy revision cycles, decentralized dissemination and limited application of clinical practice guidelines. Therefore, this paper systematically examines different types of clinical practice guideline information platforms and investigates their corresponding challenges and emerging trends in platform design, data integration, and practical implementation, with the aim of clarifying the current status of this field and providing valuable reference for future research on clinical practice guideline information platforms.

Objective To clarify the risk factors of diaphragmatic dysfunction (DD) after cardiac surgery with extracorporeal circulation. Methods A retrospective analysis was conducted on the data of patients who underwent cardiac surgery with extracorporeal circulation in the Department of Cardiovascular Surgery of Peking University People's Hospital from January 2023 to March 2024. Patients were divided into two groups according to the results of bedside diaphragm ultrasound: a DD group and a control group. The preoperative, intraoperative, and postoperative indicators of the patients were compared and analyzed, and independent risk factors for DD were screened using multivariate logistic regression analysis. Results A total of 281 patients were included, with 32 patients in the DD group, including 23 males and 9 females, with an average age of (64.0±13.5) years. There were 249 patients in the control group, including 189 males and 60 females, with an average age of (58.0±11.2) years. The body mass index of the DD group was lower than that of the control group [(18.4±1.5) kg/m2 vs. (21.9±1.8) kg/m2, P=0.004], and the prevalence of hypertension, chronic obstructive pulmonary disease, heart failure, and renal insufficiency was higher in the DD group (P<0.05). There was no statistical difference in intraoperative indicators (operation method, extracorporeal circulation time, aortic clamping time, and intraoperative nasopharyngeal temperature) between the two groups (P>0.05). In terms of postoperative aspects, the peak postoperative blood glucose in the DD group was significantly higher than that in the control group (P=0.001), and the proportion of patients requiring continuous renal replacement therapy was significantly higher than that in the control group (P=0.001). The postoperative reintubation rate, tracheotomy rate, mechanical ventilation time, and intensive care unit stay time in the DD group were higher or longer than those in the control group (P<0.05). Multivariate logistic regression analysis showed that low body mass index [OR=0.72, 95%CI (0.41, 0.88), P=0.011], preoperative dialysis [OR=2.51, 95%CI (1.89, 4.14), P=0.027], low left ventricular ejection fraction [OR=0.88, 95%CI (0.71, 0.93), P=0.046], and postoperative hyperglycemia [OR=3.27, 95%CI (2.58, 5.32), P=0.009] were independent risk factors for DD. Conclusion The incidence of DD is relatively high after cardiac surgery, and low body mass index, preoperative renal insufficiency requiring dialysis, low left ventricular ejection fraction, and postoperative hyperglycemia are risk factors for DD.

Iodine is an essential micronutrient for the synthesis of thyroid hormones and for growth and development in the human body. Recent studies have revealed that iodine can exert biological functions beyond the thyroid. By modulating oxidative stress and gut microbiota abundance, it influences systemic metabolic homeostasis. Imbalance in iodine nutrition during pregnancy is closely associated with the onset and progression of gestational metabolic diseases. Based on studies pertaining to the relationship between iodine nutrition during pregnancy and gestational metabolic diseases from 1980 to 2025, this review summarized the relationship of iodine nutrition during pregnancy with gestational metabolic diseases, including gestational diabetes mellitus, gestational hypertension and preeclampsia, gestational overweight or obesity, and gestational dyslipidemia, and described the underlying biological mechanisms, so as to provide the evidence for formulating prevention and control strategies for gestational metabolic diseases.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021.Methods:A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children.Results:The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M ( Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 ( χ 2trend=111.427, P<0.001). The median of urinary iodine concentration M ( Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [ M ( Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [ M ( Q1, Q3): 173.00 (113.00, 250.30) μg/L] ( P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95% CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95% CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95% CI: 2.64%-3.10%), 588/20 530] ( P=0.001). Conclusion:From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

Objective To observe effect of reconstructing physiological fulcrum in the treatment of elderly patients with intertrochanteric fracture of the femur. Methods Clinical materials of 40 elderly patients with osteoporotic intertrochanteric fracture of femur in the Tongling City People's Hospital from October 2020 to October 2022 were retrospectively analyzed. Among them, 20 patients treated with proximal femoral nail anti-rotation (PFNA) were assigned to the PFNA group, and 20 patients treated with proximal femoral bionic nail (PFBN) were assigned to the PFBN group. The operation time, intraoperative blood loss, length of hospital stay, postoperative rehabilitation, and incidence of complications were compared between the two groups. Results The postoperative weight-bearing time in the PFBN group was (8.50±1.99) days, which was significantly shorter than (20.15±4.87) days in the PFNA group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, length of hospital stay, fracture healing time, excellent and good rate of fracture reduction quality, and excellent and good rate of Harris score between the PFBN group and the PFNA group (P>0.05). During the follow-up period of 10 to 14 months, no patients had complications such as wound infection, bone nonunion, implant failure, or deep venous thrombosis. Conclusion Both PFBN and PFNA can effectively treat elderly patients with osteoporotic intertrochanteric fracture of femur. However, patients treated with PFBN can take bed-off activities earlier, which is beneficial for postoperative rehabilitation, and the reason may be related to the double triangular stable structure reconstructed by PFBN.

Objective This study aimed to analyze the impact of genetic factors on the clinical presentation of tic disorder and investigate the pathogenesis of tic disorder considering different sources of genetic influence and generations,along with the distribution characteristics of evidence from Chinese medicine.Methods Inclusion of 474 cases of tic disorder was assembled(from October,2020 to October,2023),and clinical data on the children,including gender,age of onset,disease duration,initial symptoms,severity,comorbidities,and family history,and TCM patterns were collected.Firstly,the children were divided into genetic and nongenetic groups based on family history,and their clinical manifestations were observed.Secondly,the age of peak incidence of tic disorder in China(6 or 9 years)was used as the age segmentation point to explore the influence of heredity on clinical manifestations at different ages and the distribution of TCM patterns.Finally,children with genetically-related tic disorder were selected as probands to carry out family studies.The morbidity of the first-degree,second-degree and third-degree relatives of the probands were investigated to analyze the morbidity characteristics and distribution of TCM patterns of children with tic disorder under different genetic types.Results Out of 474 children,226 cases(47.7％)belonged to the genetic group,and 248 cases(52.3％)to the nongenetic group.Compared with the non-genetic group,the genetic group had a younger age of onset(P=0.013),a longer duration of illness(P=0.011),a higher degree of severity(P＜0.01),and more comorbid conditions(P=0.016).Children in the genetic group with an age of onset under 6 years accounted for a larger proportion of the liver-hyperactive and wind-driven pattern(26.5％)and a smaller proportion of the qi depression transforming into fire pattern(17.1％),which were significantly different from those in the non-genetic group(P=0.016).In the genetic group,146 cases(64.6％)were inherited from the father,80 cases(35.4％)from the mother,and there was no significant difference in the developmental characteristics of children with tic disorder from different sources of genetic influence.Furthermore,183 cases(81.0％)were inherited from the parent-child generation,26 cases(11.5％)from the second generation,and 17 cases(7.5％)from the third generation;the difference in initial symptoms between different genetic generations was statistically significant(P=0.042).Conclusion Children with genetically related tic disorder have a younger age of onset,their condition is more severe,and they are more likely to be comorbid with other psychiatric disorders.The variation in the distribution of Chinese medicine patterns among children with tic disorder of different ages of onset.

Objective:To investigate the expression of F-spondin (SPON1) in cervical cancer tissues and its effects on the biological behavior of Hela cell line, including proliferation, apoptosis, invasion, and migration.Method:Select 80 samples of cervical cancer tissue and 80 samples of cervical inflammation tissue stored in the Pathology Department of Xuzhou Medical University from January 2022 to May 2023. Immunohistochemistry was used to detect the expression of SPON1 in cervical cancer and chronic cervicitis tissues, and the corresponding clinicopathological data were collected for analysis. Small disturbance RNA(siRNA) was used to interfere with the expression of SPON1 in Hela cell lines. Untransfected cells were set as normal control group (Ctrl group), negative control group (NC siRNA group), and siRNA knockout group (SPON1 siRNA group). The interference effect was detected by qPCR and Western blot. Cell proliferation assay (CCK-8), flow cytometry, Transwell, and scratch assay were used to detect the proliferation, apoptosis, invasion, and migration of each group of cells. Each experiment was repeated three times. Quantitative data that conforms to a normal distribution are represented by xˉ± s. The comparison of means among the three groups was conducted using one-way analysis of variance; Compare pairwise using LSD- t test. Calculate the percentage based on qualitative data, and compare the rates between groups using the chi square test. P<0.05 indicates a statistically significant difference. Results:Compared with the chronic cervicitis group, the positive expression rate of SPON1 in cervical cancer tissues (72.5% (58/80)) was higher than that in chronic cervicitis tissues (20.0% (16/80)), and the difference was statistically significant ( χ2=44.35, P<0.001). The positive expression rate of SPON1 was positively correlated with the clinical stage, pathological differentiation and tumor diameter of cervical cancer ( χ2 values were 4.10, 4.98, and 4.40, respectively; P values were 0.043, 0.026, and 0.036, respectively), and were not related to the age and tissue type of patients ( χ2 values were 0.72 and 0.14, P values were 0.386 and 0.713, respectively). The relative expressions of SPON1 mRNA were 1.000±0.014, 0.966±0.082, and 0.365±0.036, respectively. The expression levels of SPON1 protein were 1.000±0.013, 1.022±0.031, and 0.655±0.026, respectively. The number of cells that penetrated the model in the three groups was (113.3±4.1), (107.0±3.1), and (80.3±3.2), respectively. The wound healing rates of the three groups were (56.00±3.45)%, (55.00±5.03)%, and (35.33±3.76)%, respectively, and the apoptosis rates of the three groups were (5.88±0.44)%, (6.27±0.38)%, and (10.50±0.39)%, respectively. Compared with the Ctrl group and the NC-siRNA group, the proliferation ability of cells in the siRNA interference group decreased (all P<0.001), invasion ( P values were 0.001 and 0.004) and migration ( P values were 0.029 and 0.035), and the apoptosis rate was increased ( P=0.001). Conclusion:SPON1 is highly expressed in cervical cancer tissue and is associated with the occurrence and development of cervical cancer. Inhibiting SPON1 expression significantly reduces the proliferation, invasion, and migration ability of Hela cells, and promotes their apoptosis.

Objective:To establish a prediction model for symptomatic radiation pneumonitis (SRP) after radiotherapy for thoracic cancer based on a longitudinal cohort and dose interval variations.Methods:Clinical data of 587 patients who received thoracic radiotherapy in Department of Radiotherapy of Yunnan Cancer Hospital from July 2022 to June 2023 were retrospectively analyzed. The National Cancer Institute common terminology criteria for adverse events (CTCAE) version 5.0 was used to grade radiation pneumonitis, and clinical factors, traditional independent dosimetric characteristics and dose interval variation characteristics were collected. Features used to predict the occurrence of SRP were screened using genetic algorithms and analyzed the correlation between the selected features and SRP occurrence. Predictive models for SRP occurrence were established using the selected features and evaluated, and the optimal predictive model was visualized using a column chart.Results:The incidence of SRP was 35.94%. Five clinical factors, seven independent dosimetric features and six dose interval variation features were screened out by genetic algorithms to effectively predict the occurrence of SRP. The area under ROC curve (AUC) of clinical factors combined with traditional independent dosimetric factors and dose interval variation factors was 76%. The AUC of clinical factors combined with traditional independent dosimetric factors and that of clinical factors combined with dose interval variation factors was 69% and 67%, respectively. The addition of the characteristics of dose interval variation factors significantly improved the effectiveness of the prediction model.Conclusions:The supplement of the characteristics of dose interval variation factors can significantly improve the performance of the SRP prediction model for thoracic tumors after radiotherapy. The SRP prediction model based on dose interval variations can effectively predict the occurrence of SRP.

Objective To investigate the incidence of motoric cognitive risk(MCR)syndrome and declines in both motor and cognitive functions in elderly patients with enlarged perivascular spaces(EPVS).Methods A total of 113 patients(≥60 years old)with EPVS identified by head MRI admitted to our department from March 1 to November 30,2023 were consecutively recrui-ted,and according to having MCR syndrome or not,they were divided into MCR group(44 cases)and non-MCR group(69 cases).Cognitive function and motor function were assessed with aid of Montreal Cognitive Scale(MoCA),Simple Mental State Examination Scale(MMSE),trail making test,and motor function assessments,including Tinetti Balance and Gait Scale,Short Physical Performance Battery(SPPB),8-meter walk,Timed up and Go test(TUGT),walking and contin-uous subtraction task(WSS),walking and semantic fluency task(WSF),and TUGT and serial subtraction task(TUGSS).The motor and cognitive functions were compared between the two groups,and the risk factors related to MCR syndrome in EPVS patients were analyzed by multi-variate logistic regression.Results Compared with the non-MCR group,the MCR group had low-er MoCA score,total SPPB score,8-meter walk speed,and longer times of TMT-A,TMT-B,WSS,WSF and TUGSS(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that in Model 1(including variables with differences in univariate analysis),MoCA score,8-meter walk speed,and TUGSS time were independent risk factors for MCR syndrome in EPVS patients(P＜0.05,P＜0.01);in Model 2(adjusting for age,sex,education level,and comorbidities),MoCA score(OR=0.621,95％CI:0.432-0.929,P=0.010),8-meter walk speed(OR=1.332,95％CI:1.115-1.591,P=0.002),and TUGSS time(OR=0.393,95％CI:0.232-0.665,P=0.001)re-mained independent risk factors for MCR syndrome in EPVS patients.Conclusion Among elderly EPVS patients,those with MCR syndrome show significantly worse cognitive and motor function compared to those without.MoCA score,8-meter walk speed,and TUGSS time are related factors for MCR occurrence in EPVS patients.