Radiation-induced heart disease (RIHD) is a form of cardiotoxicity caused by radioactive substances or radiotherapy, and represents a common long-term complication after thoracic malignancy radiotherapy. RIHD onset is insidious, progression is slow, and significantly affects patients’ long-term quality of life. The pathophysiological mechanisms of RIHD involve multiple pathways, including endothelial cell injury, oxidative stress, inflammatory response, and myocardial fibrosis, ultimately leading to pericarditis, coronary artery disease, valvular heart disease, cardiac dysfunction, and conduction abnormalities, etc. Widespread use of immune checkpoint inhibitors (ICIs) in thoracic tumors, especially the combination of radiotherapy and ICIs, has introduced new changes in cardiac risk. This article reviews the epidemiological characteristics of RIHD, potential molecular targets, clinical manifestations, and treatment options. It also summarizes the value of imaging, electrocardiography, and biomarkers in RIHD monitoring, as well as the cardiac risks associated with combined radiotherapy and immunotherapy. Furthermore, multidisciplinary management strategies and preventive approaches are discussed, aiming to provide a reference for individualized management of RIHD patients in clinical practice.

Objective:To explore the diagnostic value of transcranial magnetic stimulation (TMS), transsacral magnetic root stimulation combined with sacral reflexes, external anal sphincter electromyography and pudendal nerve somatosensory evoked potentials in the assessment of neurogenic lower urinary tract dysfunction (NLUTD).Methods:Twenty-one NLUTD patients (1 with a supra-pontine lesion, 5 with a spinal cord injury, 5 with a cauda equina injury, and 10 with pelvic floor disorders) were enrolled. Needle electromyography (EMG) was used to record TMS-induced and transsacral magnetic stimulation-induced motor evoked potentials (tc-MEPs and ts-MEPs, respectively) related to the external anal sphincter (EAS). The dorsal nerve of the penis or clitoris was stimulated electrically to record the latency of the sacral reflex related to the EAS. Central motor conduction time (CMCT) and the tc/ts-MEP latency ratio were calculated to distinguish central from peripheral lesions.Results:In the one patient with a supra-pontine lesion, although the tc-MEP and ts-MEP latencies were within normal limits, the CMCT was prolonged (28.2ms) and the tc/ts-MEP ratio was large (7.4). Among the five patients with a spinal cord injury, one exhibited prolonged tc-MEP latency (50.6ms) and CMCT (47.8ms), along with a large tc/ts-MEP ratio (18.1). In the five patients with cauda equina injury and the ten with NLUTD secondary to pelvic floor disorders, CMCT was within the normal range [averaging (22.9±4.9ms) and (24.2±3.5ms), respectively], but the ts-MEP latency was prolonged [(7.1±2.1ms) and (8.6±3.7ms), respectively], and the tc/ts-MEP ratio was small [(4.4±0.9) and (4.3±1.5), respectively]. The tc/ts-MEP ratio demonstrated the best rate of abnormality detection (93.8%), with an area under the curve of 0.99, indicating good sensitivity.Conclusions:The tc/ts-MEP ratio can be useful for distinguishing central and peripheral lesions. A markedly increased tc/ts-MEP ratio may suggest central nervous system injury, whereas a decreased ratio may indicate peripheral nervous system injury.

Objective:To investigate the distribution of health needs and healthcare workforce demands among potential service users in community health service institurions (CHSIs) and establish a comprehensive health needs profile for targeted service development.Methods:This is a cross-sectional study. A questionnaire survey (55 items for adults and 39 items for minors) was conducted among 564 residents aged 3-65 in Dapuqiao Subdistrict, Shanghai from March to May 2024. A health sketch model was developed, encompassing five dimensions (intake, basal metabolism, consumption, influencing factors, and somatosensory perception). Health issues were mapped to standardized healthcare services, and annual standardized workloads (SW) were calculated to quantify human resource demands. Results:Among 534 valid responses (94.68% response rate), 355 from the adults and 179 from minors, the top health issues for adults were irregular diet, nutritional imbalance, obesity, somatic fatigue, and disordered eating; for minors, they were nutritional imbalance, medication overuse, insufficient physical activity, picky eating, and anorexia. The total annual SW required to address these needs was 3 906 807.93. Among them, the total SW for each age group was as follows: the total annual SW demand for children aged between 3 and 5 years old was 24 108.90, for children aged between 6 and 11 years old was 141 355.70, for adolescents aged between 12 and 17 years old was 29 813.74, 223 475.50 for 18-24 year olds, 476 426.53 for 25-34 year olds, 1 221 105.84 for 35-44 year olds, 812 200.22 for 45-54 year olds; and 978 321.50 for 55-65 year olds. Workforce allocation analysis revealed a total demand for 139.84 standardized personnel, with rehabilitation therapists (38.16), general practitioners (35.69), and nurses (27.34) being the top three required roles.Conclusions:Health needs and workforce demands vary significantly across age groups. This study provides a data-driven framework for optimizing community health services through stratified health needs profiling and precision resource allocation. Future strategies should prioritize tailored interventions and workforce planning to bridge service gaps and enhance health outcomes.

Objective:To investigate the descrepancy between current supply and demand based on standardiized workload for rational human resource allocation in community health service centers.Methods:A retrospective study was conducted in Dapuqiao Community Health Service Center of Shanghai Huangpu District from January 1st to December 3lst 2023. The current status of demand and supply were analyzed using the 2023 data of the institution. The standardised workload was measured according to the potential basic medical and public health service needs based on the disease profile and population groups in the community. The discrepancy between the current supply and theoretical demand was analyzed.Results:A total of 36 634 patients paid 277 262 visits in outpatient clinics of Dapuqiao Community Health Service Center in 2023. There are total 161 employees in the center, 124 of whom are female (77.02%). The actual calibrated workload of basic medical care and public health service in the center calculated on fee-based medical service items in 2023 was 2 888 425.61 and 455 898.35, respectively; while the theoretically calibrated workload was 5 416 492.42 and 711 230.94, respectively. The center employed 131 medical and health workers currently, calibrated as 90.67 employees based on current demand, while it should be 183.74 calibrated on the theoretical demand, there was a certain discrepancy between the current staffing and the standard staffing based on the standardized workload calculation.Conclusion:At present, the actual standardized workload of basic medical and public health services in Dapuqiao Community Health Service Center still has room for improvement, but there is a certain gap between the current human resource allocation and the demand.

Objective:To explore the diagnostic value of transcranial magnetic stimulation (TMS), transsacral magnetic root stimulation combined with sacral reflexes, external anal sphincter electromyography and pudendal nerve somatosensory evoked potentials in the assessment of neurogenic lower urinary tract dysfunction (NLUTD).Methods:Twenty-one NLUTD patients (1 with a supra-pontine lesion, 5 with a spinal cord injury, 5 with a cauda equina injury, and 10 with pelvic floor disorders) were enrolled. Needle electromyography (EMG) was used to record TMS-induced and transsacral magnetic stimulation-induced motor evoked potentials (tc-MEPs and ts-MEPs, respectively) related to the external anal sphincter (EAS). The dorsal nerve of the penis or clitoris was stimulated electrically to record the latency of the sacral reflex related to the EAS. Central motor conduction time (CMCT) and the tc/ts-MEP latency ratio were calculated to distinguish central from peripheral lesions.Results:In the one patient with a supra-pontine lesion, although the tc-MEP and ts-MEP latencies were within normal limits, the CMCT was prolonged (28.2ms) and the tc/ts-MEP ratio was large (7.4). Among the five patients with a spinal cord injury, one exhibited prolonged tc-MEP latency (50.6ms) and CMCT (47.8ms), along with a large tc/ts-MEP ratio (18.1). In the five patients with cauda equina injury and the ten with NLUTD secondary to pelvic floor disorders, CMCT was within the normal range [averaging (22.9±4.9ms) and (24.2±3.5ms), respectively], but the ts-MEP latency was prolonged [(7.1±2.1ms) and (8.6±3.7ms), respectively], and the tc/ts-MEP ratio was small [(4.4±0.9) and (4.3±1.5), respectively]. The tc/ts-MEP ratio demonstrated the best rate of abnormality detection (93.8%), with an area under the curve of 0.99, indicating good sensitivity.Conclusions:The tc/ts-MEP ratio can be useful for distinguishing central and peripheral lesions. A markedly increased tc/ts-MEP ratio may suggest central nervous system injury, whereas a decreased ratio may indicate peripheral nervous system injury.

Objective:To investigate the distribution of health needs and healthcare workforce demands among potential service users in community health service institurions (CHSIs) and establish a comprehensive health needs profile for targeted service development.Methods:This is a cross-sectional study. A questionnaire survey (55 items for adults and 39 items for minors) was conducted among 564 residents aged 3-65 in Dapuqiao Subdistrict, Shanghai from March to May 2024. A health sketch model was developed, encompassing five dimensions (intake, basal metabolism, consumption, influencing factors, and somatosensory perception). Health issues were mapped to standardized healthcare services, and annual standardized workloads (SW) were calculated to quantify human resource demands. Results:Among 534 valid responses (94.68% response rate), 355 from the adults and 179 from minors, the top health issues for adults were irregular diet, nutritional imbalance, obesity, somatic fatigue, and disordered eating; for minors, they were nutritional imbalance, medication overuse, insufficient physical activity, picky eating, and anorexia. The total annual SW required to address these needs was 3 906 807.93. Among them, the total SW for each age group was as follows: the total annual SW demand for children aged between 3 and 5 years old was 24 108.90, for children aged between 6 and 11 years old was 141 355.70, for adolescents aged between 12 and 17 years old was 29 813.74, 223 475.50 for 18-24 year olds, 476 426.53 for 25-34 year olds, 1 221 105.84 for 35-44 year olds, 812 200.22 for 45-54 year olds; and 978 321.50 for 55-65 year olds. Workforce allocation analysis revealed a total demand for 139.84 standardized personnel, with rehabilitation therapists (38.16), general practitioners (35.69), and nurses (27.34) being the top three required roles.Conclusions:Health needs and workforce demands vary significantly across age groups. This study provides a data-driven framework for optimizing community health services through stratified health needs profiling and precision resource allocation. Future strategies should prioritize tailored interventions and workforce planning to bridge service gaps and enhance health outcomes.

Objective:To investigate the descrepancy between current supply and demand based on standardiized workload for rational human resource allocation in community health service centers.Methods:A retrospective study was conducted in Dapuqiao Community Health Service Center of Shanghai Huangpu District from January 1st to December 3lst 2023. The current status of demand and supply were analyzed using the 2023 data of the institution. The standardised workload was measured according to the potential basic medical and public health service needs based on the disease profile and population groups in the community. The discrepancy between the current supply and theoretical demand was analyzed.Results:A total of 36 634 patients paid 277 262 visits in outpatient clinics of Dapuqiao Community Health Service Center in 2023. There are total 161 employees in the center, 124 of whom are female (77.02%). The actual calibrated workload of basic medical care and public health service in the center calculated on fee-based medical service items in 2023 was 2 888 425.61 and 455 898.35, respectively; while the theoretically calibrated workload was 5 416 492.42 and 711 230.94, respectively. The center employed 131 medical and health workers currently, calibrated as 90.67 employees based on current demand, while it should be 183.74 calibrated on the theoretical demand, there was a certain discrepancy between the current staffing and the standard staffing based on the standardized workload calculation.Conclusion:At present, the actual standardized workload of basic medical and public health services in Dapuqiao Community Health Service Center still has room for improvement, but there is a certain gap between the current human resource allocation and the demand.

ObjectiveTo retrospectively analyze the effect of modified Shugan Dingji Decoction （疏肝定悸汤） on the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation. MethodsA retrospective cohort study was conducted using the electronic medical record database of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine to screen and include patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation from January 1st， 2018， to December 31th， 2021. The included patients were divided into an exposure group and a non-exposure group， each consisting of 100 cases， based on whether they received modified Shugan Dingji Decoction. General information of the patients including age， gender， body mass index， duration of illness and comorbidities， medication history， cardiac structure and function indicators such as left atrial diameter， left ventricular end-diastolic diameter， stroke volume and ejection fraction， and the occurrence of endpoint events assessed through 24-hour dynamic electrocardiography or electrocardiogram to determine the recurrence of paroxysmal atrial fibrillation were collected. Kaplan-Meier （K-M） curves and Log-Rank tests were used to conduct survival analysis on the occurrence of endpoint events in the two groups of patients. Univariate and multivariate Cox regression analyses were used to analyze the impact of various factors on entry into endpoint events. Additionally， a safety assessment was performed by comparing liver and kidney function indicators before and after treatment. ResultsIn the non-exposure group， a total of 49 cases （49.0%） experienced endpoint events， while in the exposure group， there were 26 cases （26.0%）. The Log-rank test indicated significant difference between the two groups （χ²=11.211， P=0.001）. Univariate Cox regression analysis showed that age， duration of illness， hypertension， diabetes， chronic heart failure， left atrial diameter， stroke volume， and the use of modified Shugan Dingji Decoction may be the influencing factors for the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation （P＜0.05 or P＜0.01）. Multivariate Cox regression analysis showed that the risk of endpoint events in the exposure group was significantly lower than that in the non-exposure group （P＜0.01）. Patients with a duration of illness ＞12 months had a significantly higher risk of endpoint events compared to those with a duration of illness ≤12 months （P＜0.01）. Patients without concomitant hypertension had a lower risk of endpoint events compared to those with hypertension （P＜0.05）. Patients with left atrial diameter ＞40 mm had significantly higher risk of endpoint events than those with left atrial diameter ≤40 mm （P＜0.01）. There was no statistically significant difference in liver and kidney function indicators between the two groups before and after treatment （P＞0.05）. ConclusionThe use of modified Shugan Dingji Decoction is a protective factor for patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation， which can help to reduce the recurrence and progression of atrial fibrillation. Long duration of illness， concomitant hypertension， and enlarged left atrial diameter are risk factors for patients to experience endpoint events.

Improving the construction of new mechanisms for the operation of public hospitals is an important task in promoting the comprehensive reform of public hospitals and the construction of modern hospital management systems.It analyzes the background of constructing new operational mechanisms based on policy evolution,histori-cal evolution,and practical needs,and analyzes the problems of imbalanced management resource allocation struc-ture,one-sided pursuit of economic benefits,low input-output efficiency,and low personnel enthusiasm in hospital operation.It proposes to grasp the key path and main measures to improve the construction of new operating mecha-nisms for public hospitals while respecting industry characteristics,adhering to government leadership,and improving market regulation.