Objective:To explore the application value of diaphragmatic thickening fraction (DTF) and lung ultrasound score (LUS) in predicting the weaning outcome of elderly patients with acute respiratory distress syndrome (ARDS) under mechanical ventilation, and to analyze their correlation, thereby providing evidence for clinical decision-making.Methods:A retrospective analysis was conducted on elderly ARDS patients admitted to the ICU of the First Affiliated Hospital of Jinzhou Medical University from January 2020 to December 2023. The inclusion criteria included age > 60 years, endotracheal intubation, mechanical ventilation time >24 h, and a diagnosis of ARDS based on the Berlin definition. Exclusion criteria included neuromuscular diseases, spinal cord injury, post-thoracoabdominal surgery, thoracic or tracheal deformity, and mid-course tracheostomy conversion. Patients were divided into a success group and a failure group based on weaning outcomes. Demographic data, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores, Sequential Organ Failure Assessment (SOFA) scores, oxygenation index at ICU admission, and pre-extubation DTF, LUS, and oxygenation index were recorded. Binary logistic regression analysis was used to identify independent risk factors affecting weaning outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of DTF and LUS for weaning outcomes. Pearson correlation analysis was conducted to examine the relationship between DTF and LUS.Results:A total of 317 patients were included, including 212 in the success group and 105 in the failure group. There were no statistically significant differences in gender, age, APACHEⅡ score, SOFA score, etc., between the two groups (all P>0.05). Pre-weaning LUS was higher in the failure group than in the success group [(17.26±3.04) vs. (13.69±4.06), P<0.001], and the DTF was significantly lower than that of the successful group [(27.83%±6.37%) vs. (40.15%±6.49%), P<0.001]. Binary logistic regression identified LUS and DTF as independent influencing factors for weaning outcomes (both P<0.05). ROC analysis revealed that LUS predicted weaning failure with an AUC of 0.748 (95% CI: 0.695-0.801, P<0.001), sensitivity of 83.81% and specificity of 56.60%. DTF predicted weaning success with an AUC of 0.935 (95% CI: 0.909-0.961, P<0.001), sensitivity of 83.02% and specificity of 89.52%. A negative correlation was observed between LUS and DTF before weaning ( r=-0.385, P<0.001). Conclusions:Both DTF and LUS are effective indicators for assessing weaning outcomes in elderly ARDS patients, offering complementary clinical insights. Higher LUS reflects more severe pulmonary pathology and increased weaning risk, while lower DTF indicates impaired diaphragmatic function and reduced likelihood of successful extubation. Integration of these parameters provides a comprehensive foundation for clinical decision-making.

Objective:To investigate the policy impacts of the Beijing-Tianjin-Hebei coordinated development strategy on medical and health resources in Beijing,Tianjin,and Hebei.It also seeks to analyze these effects comprehensively and provide recommendations.Methods:Relevant data on medical and health resources from 2005 to 2022 across all 31 provinces,municipalities,and autonomous regions were summarized.The entropy weight method was used to construct the comprehensive index,allocation index and utilization index of Beijing-Tianjin-Hebei healthcare resources as important indicators for evaluating the policy effects,and the regression control method was used to analyze the policy effects of Beijing-Tianjin-Hebei healthcare integration on the healthcare resources in Beijing,Tianjin and Hebei.Results:The coordinated development strategy has produced varying policy effects on medical and health resources in these three locations,with more pronounced effects observed in Beijing and Hebei compared to Tianjin;however,a comprehensive breakthrough towards promoting efficient utilization of regional medical and health resources has not yet been achieved.Conclusion:On the basis of further optimizing the allocation of resources,it is needed to enhance the efficiency of resource utilization,while identifying the positioning of synergistic development of Beijing,Tianjin and Hebei to further enhance the effect of health policies

Objective:To investigate the policy impacts of the Beijing-Tianjin-Hebei coordinated development strategy on medical and health resources in Beijing,Tianjin,and Hebei.It also seeks to analyze these effects comprehensively and provide recommendations.Methods:Relevant data on medical and health resources from 2005 to 2022 across all 31 provinces,municipalities,and autonomous regions were summarized.The entropy weight method was used to construct the comprehensive index,allocation index and utilization index of Beijing-Tianjin-Hebei healthcare resources as important indicators for evaluating the policy effects,and the regression control method was used to analyze the policy effects of Beijing-Tianjin-Hebei healthcare integration on the healthcare resources in Beijing,Tianjin and Hebei.Results:The coordinated development strategy has produced varying policy effects on medical and health resources in these three locations,with more pronounced effects observed in Beijing and Hebei compared to Tianjin;however,a comprehensive breakthrough towards promoting efficient utilization of regional medical and health resources has not yet been achieved.Conclusion:On the basis of further optimizing the allocation of resources,it is needed to enhance the efficiency of resource utilization,while identifying the positioning of synergistic development of Beijing,Tianjin and Hebei to further enhance the effect of health policies

This paper discusses the necessity of artificial intelligence(AI)technology empowering the field of traditional Chinese medicine(TCM)in the context of the intelligent era,the connotation and tasks of smart TCM,and the progress of related research and transformation.It closely follows the national orientation,rigid needs and problems,conducts top-level design,and proposes popular AI technologies that can be used in the field of TCM in the future and the research directions that smart TCM will focus on in the fu-ture,in order to further promote the integration of multidisciplinary cross-innovation and help realize the modernization,inheritance and innovation of TCM and lay the foundation.

Objective To investigate the therapeutic effectiveness of ozone combined with low-temperature plasma coagulation therapy on patients with cervical spondylotic radiculopathy and its influence on inflammatory responses.Methods Ozone in combination with low-temperature plasma radio-frequency coagulation was applied to 75 patients with cervical spondylotic radiculopathy in Pain Medicine Department of Capital Medical University Affiliated Beijing Anzhen Hospital from May 2022 to May 2023.Pain scores were assessed using Visual Analog Scale(VAS)and Neck Disability Index(NDI)before and two weeks after treatment.Enzyme-linked immunosor-bent assay(ELISA)was used to analyze the level of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6)and interferon-gamma(IFN-γ)before and two weeks after treatment.Results After treatment with ozone plus low-temperature plasma radiofrequency,VAS and NDI scores showed a significant decrease[VAS:5.36(4,7)vs.1.32(1,2),P＜0.000 1;NDI:32.72(24,70)vs.7.62(3.55,8.9),P＜0.000 1].Two weeks after surgical intervention,there was an effective reduction in the level of IL-6,TNF-αand IFN-γ alleviating the inflammatory re-sponse[IL-6:4.33(2.51,5.04)vs.3.49(2.08,4.43),P＜0.05;TNF-α:1.95(1.41,2.21)vs.1.61(1.02,2.03),P＜0.05;IFN-γ:1.84(1.18,2.47)vs.1.55(0.76,2.09),P＜0.05].Conclusions This Ozone combined with low-temperature plasma radiofrequency ablation is an effective technology for treatment of cer-vical spondylotic radiculopathy.

This paper discusses the necessity of artificial intelligence(AI)technology empowering the field of traditional Chinese medicine(TCM)in the context of the intelligent era,the connotation and tasks of smart TCM,and the progress of related research and transformation.It closely follows the national orientation,rigid needs and problems,conducts top-level design,and proposes popular AI technologies that can be used in the field of TCM in the future and the research directions that smart TCM will focus on in the fu-ture,in order to further promote the integration of multidisciplinary cross-innovation and help realize the modernization,inheritance and innovation of TCM and lay the foundation.

Objective:An early diagnosis model of acute aortic dissection (AAD) was established based on chest pain center database.Methods:The clinical data of patients who attended Chest Pain Center of Department of Emergency in Affiliated Hospital of Jining Medical University of Shandong Province from January 2020 to December 2020 were retrospectively collected. Patients were divided into AAD and non-AAD groups according to whether or not AAD was diagnosed. The clinical related indicators of the two groups were compared. The research indicators with statistical differences between the two groups were included in multivariate Logistic regression analysis, and the early diagnosis of AAD nomogram model was established. The receiver operating characteristic (ROC) curve of the model was used to evaluate the prediction accuracy, and the Homser-Lemeshow statistics were used to test the goodness of fit for the model. A total of 630 patients with chest pain who visited the hospital from January 2021 to March 2021 were also collected for external validation of the model. The t-test of independent samples was used to compare the measurement data of normal distribution, nonparametric test was used to compare the measurement data of skewness distribution, and χ 2 test was used to compare the counting data between groups. Results:A total of 2 738 patients were included, of which 4.09% (112/2 738) were AAD patients. Univariate analysis showed that in AAD group, male morbidity (74.11%(83/112)), hypertension history (70.54%(79/112)), aortic disease history (10.71%(12/112)), family history of aortic disease (4.46%(5/112)), sudden onset of symptoms (76.79%(86/112)), percentage of patients with laceration pain (38.39%(43/112)), patients with back pain (66.07%(74/112)), patients with abdominal pain (16.96%(19/112)), systolic blood pressure ((159.44±30.94) mmHg), bilateral blood pressure/pulse asymmetry (23.21% (26/112)), incidence of complicated neurological signs (7.14%(8/112)) and D-dimer (3.57(2.10, 6.62) mg/L) were significantly higher than those in non-AAD group (59.56%(1 564/2 626), 46.23%(1 214/2 626), 0.23%(6/2 626), 0.08%(2/2 626), 35.99%(945/2 626), 0.08%(2/2 626), 3.08%(81/2 626), 3.81%(100/2 626), (142.46±27.90) mmHg, 0.15%(4/2 626), 0.27%(7/2 626), 0.31(0.20, 0.50) mg/L). Age ((57.95±14.35) years old) and CK-MB (1.50(0.90, 3.25) μg/L) were significantly lower than those in the non-AAD group ((61.94±15.77) years, 2.50(1.24, 4.81) μg/L). The differences were statistically significant (the statistical values were χ 2=9.47, χ 2=25.46, χ 2=180.80, χ 2=81.11, χ 2=76.17, χ 2=975.60, χ 2=798.00, χ 2=44.72, t=6.28, χ 2=527.20, χ 2=93.22, Z=14.09, t=2.61, and Z=3.51, respectively; P values were 0.002, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.009, and <0.001, respectively). Multivariate analysis showed that history of hypertension ( OR=3.088, 95% CI:1.294-7.374), history of aortic disease ( OR=20.771, 95% CI:2.132-202.361), family history of aortic disease ( OR=266.425, 95% CI:17.610-4 030.851), sudden onset of symptoms ( OR=3.538, 95% CI:1.643-7.619), laceration pain ( OR=1 771.971, 95% CI:204.048-15 387.935), back pain ( OR=61.550,95% CI:27.987-135.367), abdominal pain ( OR=12.325, 95% CI:4.201-36.161), systolic blood pressure ( OR=1.026, 95% CI:1.013-1.039), bilateral blood pressure/pulse asymmetry ( OR=338.357, 95% CI:60.704-1 885.949) and D-dimer ( OR=1.241, 95% CI:1.176-1.309) were independent factors for the diagnosis of AAD in patients with chest pain (P values were 0.011, 0.009, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, <0.001, and <0.001, respectively). Furthermore, the nomogram model was constructed. ROC curve analysis showed that the area under the curve was 0.976 ( P<0.01), the specificity was 94.52%, and the sensitivity was 91.96%. The statistics of Homser-lemeshow was used to test the goodness of fit, which shows that the model can be fitted well (χ 2=2.928, P=0.939). The prediction model was verified by external validation data, and the area under the ROC curve was 0.934 ( P<0.01), indicating that the model had good prediction performance. Conclusions:History of hypertension, history of aortic disease, family history of aortic disease, sudden onset of symptoms, laceration pain, back pain, abdominal pain, systolic blood pressure, bilateral blood pressure/pulse asymmetry and D-dimer were independent factors for the diagnosis of AAD in patients with acute chest pain. The AAD early diagnosis nomogram model based on the above factors has good predictive performance.

Objective:To make a new simple respirator and observe the oxygen therapy effect of the respirator on patients with severe and critical coronavirus disease 2019 (COVID-19).Methods:Based on the infectivity and hospital requirements of COVID-19, a new simple respirator was designed by the medical staff of the Department of Anesthesiology of the Second Affiliated Hospital of Nanchang University, which was applied on the 22 patients with severe and critical COVID-19 who needed oxygen therapy admitted to the Cancer Center of Tongji Medical College of Huazhong University of Science and Technology from February 15th to March 15th in 2020. The new simple respirator contained two National Utility Model Patents (a respirator: ZL 2015 2 0410623.6, a fluid switch and oxygen suction device: ZL 2017 2 0873509.6), which was mainly composed of anesthesia mask and filter, L-shaped connecting tube, soft breathing bladder, connecting tube and elastic fixing belt. When in use, the anesthesia mask was fixed to the patient's mouth and nose with elastic straps, the connecting tube was inserted into the oxygen meter interface, the oxygen flow was adjusted to 6-10 L/min, and the L-shaped connecting tube was opened immediately after the soft breathing bag was full. The carbon dioxide and excess oxygen in the body was discharged from exhaust port. The oxygen flow was lowered to 2-3 L/min, the patient's respiratory rate (RR) was observed through the soft breathing bag fluctuations, and the oxygen flow was adjusted at any time. The changes of pulse oxygen saturation (SpO 2), RR and heart rate (HR) before and after application of new simple respirator were observed, and the blood gas test results of part of the patients were collected. Results:Twenty-two patients with severe and critical COVID-19 had significantly higher SpO 2 at 10 minutes after application of the new simple ventilator than before application (0.994±0.007 vs. 0.952±0.017, P < 0.01), and RR was significantly lower than that before application (times/min: 27.59±3.63 vs. 29.64±3.81, P < 0.01); after 1 day of application, each index was further improved. All 13 patients who received blood gas analysis indicated no carbon dioxide accumulation. Conclusions:The new simple respirator can significantly improve the oxygen therapy effect of patients with severe and critical COVID-19. At the same time, 2019 novel coronavirus (2019-nCoV) can be filtered through the filter to reduce the formation of aerosol and protect the medical staff and patients.

Objective: To investigate the effect of erythropoietin (EPO) on the expression of aquaporin 2-3 after the release of unilateral ureter obstruction in young rats. Methods: Twenty-four SD rats were randomly divided into 3 groups(CUUO-R group, CUUO-R+ EPO group and sham group, with 8 rats in each group). The CUUO-R model was built through unilateral ureteral ligation, after 48 h the obstruction was released.EPO was given to the CUUO-R+ EPO group at the time point of removing obstruction, and then repeated every other day for 1 week, and the same volume of saline was simultaneously given to the CUUO-R rats.The rats in sham group experienced the laparotomy and free dissection of left ureter but not ligation.The kidneys were harvested 7 d after the release of CUUO.The methods of Western blot and immunohistochemistry were used to examine the effects of erythropoietin on the expression of AQP2 and AQP3. Results: The osmotic pressure of CUUO-R+ EPO group was higher than those of CUUO-R group, but lower than that of sham group(P=0.007). The concentration of creatinine and urea in the CUUO-R group[(58.001±2.416) μmol/L and (9.025±1.158) mmol/L]were higher than those of CUUO-R+ EPO group [(57.072±2.286) μmol/L and (1.479±0.043) mmol/L] and sham group [(54.820±1.536) μmol/L and (6.929±0.604) mmol/L]. The differences of the concentration of creatinine and urea between CUUO-R group and sham group were statistically significant(P<0.05). There was no significant difference between CUUO-R+ EPO group and Sham group(P>0.05). The immunohistochemistry showed that the expressions of AQP2 and AQP3 in co-llecting duct in CUUO-R group were significantly weaker than those of in sham group, and the expression of those in CUUO-R+ EPO group were slightly weaker than sham group.These results were further confirmed by Western blot, as the relative quantity of AQP2 and AQP3 were also the lowest in CUUO-R group(AQP2 in 3 groups were 0.974±0.109, 1.923±0.097 and 2.002±0.044, F=392.4, P=0.000; AQP3 in 3 groups were 0.941±0.048, 1.497±0.043 and 1.863±0.043, F=735.8, P=0.000). Conclusions EPO treatment is beneficial for the recovery expre-ssion of AQP2 and AQP3 as well as renal function at the early period after the release of ureteral obstruction in young rats.

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.