Objective To compare the long-term survival outcomes of patients with T_1-2N₀M₀ duodenal neuroendocrine tumor (DNET) after endoscopic resection (ER) or surgical resection (SR). Methods Patients diagnosed with T_1-2N₀M₀ DNET between January 1, 2004, and December 31, 2015, were extracted from the SEER database. Kaplan-Meier survival curve and log-rank test were used to compare overall survival (OS) rate and cancer-specific survival (CSS) rate between patients undergoing ER or SR. Propensity score matching (PSM) was used to reduce grouping differences, and multivariate Cox regression was used to analyze factors affecting OS and CSS before and after PSM. Results A total of 656 patients were included, with 457 in ER group and 199 in SR group. Before PSM, there was no significant difference in the 5-year OS rate between the ER and SR groups (88.9% vs 89.6%), but there was a significant difference in the 5-year CSS rate (99.3% vs 96.9%, P＝0.017). Before PSM, multivariate Cox regression analysis showed advanced age was an independent risk factor for decreased OS (P＜0.001). After PSM, there was no significant difference between the ER group (n＝187) and SR group (n＝187) in 5-year OS rate (90.2% vs 88.9%) or CSS rate (98.9% vs 96.7%). After PSM, multivariate Cox regression also showed advanced age was an independent risk factor for decreased OS, while resection method was not an independent factor for OS or CSS. Conclusions There is no significant difference in OS or CSS after endoscopic treatment and surgical treatments for patients with T_1-2N₀M₀ DNET, and advanced age is an independent factor for OS.

Objective To evaluate the efficacy and safety of transcatheter aortic valve implantation(TAVI)for the treatment of primary aortic valve regurgitation(NAVR)and to compare the difference in the choice of prosthetic valve size and the difference in complications with aortic stenosis(AS).Methods According to the definition of Valve Academic Research Consortium(VARC-3),143 patients with NAVR/AS treated with TAVI and patients with NAVR treated with surgical aortic valve replacement(SAVR)at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,China,from March 2019 to September 2024 were selected,and clinical data on baseline,perioperative,and primary endpoint events were were retrospectively collected and compared.Results Forty-three patients with NAVR were treated with TAVI,with a device success rate of 86.0％and a surgical success rate of 95.3％.Subgroup comparisons:(1)NAVR-TAVI group than NAVR-SAVR group:patients in the TAVI group had a significantly shorter operative time than those in the SAVR group(P＜0.001);complete left bundle branch block was more likely to occur after TAVI(P=0.042),and complete right bundle branch block was more likely to occur after SAVR(P=0.044).SAVR postoperatively The incidence of congestive heart failure was higher(P=0.013),and the mortality rate was significantly higher in the SAVR group than in the TAVI group(P=0.019).(2)NAVR-TAVI group than AS-TAVI group:the differences in access selection,THV size[28(22,34)mm vs.24(22,32)mm,P=0.044]and proportion of THV overdiameter[14％(7％,20％)vs.7％(3％,11％),P＜0.001]were statistically significant.patients in AS and NAVR groups had 1 case of permanent pacing after TAVI treatment.In the AS and NAVR groups,there was 1 case of permanent pacemaker implantation after TAVI.2 patients in the AS group were converted to surgical treatment,and 6 patients died.Conclusions The use of"off-label"(transfemoral)and"on-label"(transapical)TAVI devices(both from domestic sources)is safer than SAVR for the treatment of NAVR,especially in elderly and high-risk patients.Compared with patients with AS treated with TAVI,larger diameter annulas are usually selected for NAVR,with higher rates of valve migration,but overall safety and efficacy are comparable to AS.

Objective:To test the reliability and validity of the ADHD self-report scale-revised (ASRS-R) among Chinese children aged 8-14 and provide preliminary evidence for the use of ASRS-R as a tool for identifying attention deficit hyperactivity disorder (ADHD) symptoms in Chinese children aged 8-14 years.Methods:In October 2023, elementary school students aged 8-14 from five elementary school in Shenzhen were selected for the survey through convenience sampling. The subjects were tested using ASRS-R and strengths and difficulties questionnaire (SDQ). Among them, exploratory factor analysis and item analysis were conducted on sample 1 ( n=1 558), confirmatory factor analysis, calibration correlation validity and reliability analysis were conducted on sample 2 ( n=1 648), and retest reliability analysis was conducted on sample 3 ( n=300).The data was subjected to item analysis, exploratory factor analysis, confirmatory factor analysis, calibration correlation validity and reliability analysis by SPSS 25.0 and AMOS 23.0 softwares. Results:Exploratory factor analysis showed that the KMO value was 0.947, the cumulative variance contribution was 41.061%, and the loadings for the entries ranged from 0.454 to 0.697.The confirmatory factor analysis showed a good fit of the two-factor model ( χ2/ df=3.355, CFI=0.959, TLI=0.952, RMSEA=0.038, SRMR=0.029, AGFI=0.962, NFI=0.943, IFI=0.952), and was applicable to primary school students of different grades and genders. The internal consistency coefficients of the total scale, the dimensions of inattention and hyperactive/impulsivity were 0.876, 0.815, 0.769, respectively and the retest reliability of total scale was 0.984. Item analysis showed that the correlation coefficients between the score of each item and the total score of the scale ranged from 0.503 to 0.663(all P<0.01). Conclusion:The ASRS-R has good reliability and validity and is suitable for the identification of ADHD behavior in Chinese children aged 8-14.

Objective:To explore and analyze the correlation between the expression of mismatch repair(MMR)protein and programmed death ligand 1(PD-L1)in colorectal cancer(CRC)tissue and clinical pathological characteristics.Methods:The study period were from July 2021 to December 2024,200 cases of colorectal cancer patients treated in our hospital were selected as the research subjects.Collected all patient lesion tissue samples(lesion group)and adjacent tissue samples(located ≥5 cm from the tumor edge,adjacent group),and used the immunohistochemistry(IHC)method to detect the expression of Mismatch repair(MMR)(MLH1,MSH2,MSH6,and PMS2)protein and PD-L1 protein.Investigated the clinical and pathological characteristics of patients and conducted correlation analysis.Results:The positive rates of dMMR and pMMR protein expression in the lesion group were 39.00％and 70.00％,respectively,while those in the adjacent cancer group were 11.00％and 89.00％,respectively.There were significant difference compared between the lesion group and the adjacent cancer group(P＜0.05).The positive rate of PD-L1 protein expression in the lesion group were 25.00％,while that in the adjacent cancer group were 80.00％.The expression of PD-L1 protein in the lesion group were significantly lower than that in the adjacent cancer group(P＜0.05).There were significant differences in the positive rates of MMR and PD-L1 protein expression among patients with different histological differentiation,clinical stages,and lymph node metastasis(P＜0.05),while there were no significant differences in the positive rates of MMR and PD-L1 protein expression among patients of different genders,ages,and disease sites(P＞0.05).Spearman analysis showed there were correlation between the expression of MMR and PD-L1 proteins in colorectal cancer tissues and clinical pathological features such as histological differentiation,clinical staging,and lymph node metastasis(P＜0.05).Conclusion:Low expression of MMR and PD-L1 proteins are commonly observed in colorectal cancer tissues.The expression of MMR and PD-L1 proteins in colorectal cancer tissues are correlated with clinical pathological features such as histological differentiation,clinical staging,and lymph node metastasis.

Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

Mesenchymal stem cells(MSCs)play a crucial role in tissue repair and regeneration,and the extracellular vesicle(EV)released by them holds great promise for applications in clinical biomarkers,vaccines,and drug delivery.However,MSCs-derived EV(MSCs-EV)face challenges such as low pro-duction yield,poor retention,and targeted delivery issues.There-fore,engineering MSCs-EV to enhance their performance and en-able visual research has become a hot topic.Curcumin(CUR),an active component in traditional chinese medicine,exhibits pharmacological effects but has limited bioavailability.Using MSCs-EV as a carrier for CUR delivery can address its solubility and bioavailability challenges.This article reviews the drug loading methods,engineering strategies of MSCs-EV,and their important applications in the delivery and treatment of CUR for cartilage injury diseases.It provides a basis for the clinical ap-plication of engineered MSCs-EV in CUR delivery for cartilage repair,offering potential solutions to the challenges in cartilage tissue repair.

Objective:To explore the role positioning and job responsibilities of integrated care managers in China, with a view to providing reference for policy formulation and career development.Methods:The qualitative study was conducted. From December 2023 to July 2024, 18 frontline workers and managers working in integrated care in two hospitals, two community health service centers and seven elderly care institutions in Beijing were selected by purposive sampling method to conduct semi-structured interviews. Colaizzi 7-step analysis was used to analyze the data.Results:A total of six core roles and seven responsibilities of the integrated care managers were identified, including the role of the comprehensive assessor and the responsibility of conducting comprehensive health assessments, the role of the team collaborator and the responsibility of organizing interdisciplinary discussions, decision-making and collaboration, the role of the case manager and the responsibility of developing and implementing integrated care plans, the role of the resource integrator and the responsibility of coordinating and integrating resources, the role of the service controller and the responsibility of supervising and optimizing care services, the role of professional leader and communicator and the responsibility of promoting team building and development, and the responsibility of leading professional innovation and growth.Conclusions:As an emerging complex professional talent to cope with population aging, clarifying their roles and responsibilities is of great significance in realizing the goal of healthy aging and building an integrated healthcare service system in China. Integrated care managers should be based on personalized, multi-level, and whole-process care service needs, flexibly adapt to diversified role changes, and stimulate their own intrinsic motivation and innovation ability to provide high-quality care services.

Objective:To understand the usability evaluation indicators for intelligent caregiving robots in elderly care from the perspectives of stakeholders, and provide a reference for constructing a usability evaluation indicator system for these robots.Methods:This study was a qualitative study. From November 2023 to May 2024, purposive sampling was used to select eight intelligent robot developers from three engineering universities and one medical technology company, seven intelligent product usage managers from three elderly care institutions in Beijing, and seven elderly users who have used intelligent caregiving robots at Xuanwu Hospital of Capital Medical University. Semi-structured interviews were conducted with these participants. The content analysis method was employed to organize and analyze the interview data, and themes were extracted.Results:A total of four themes and eleven sub-themes were identified: safety and reliability (mechanical safety, sensory safety, privacy safety) , performance (effectiveness, fault tolerance, intelligence) , user experience (learnability, ease of use, comfort) , and cost-effectiveness (cost-performance ratio, usage cost) .Conclusions:The usability evaluation indicators for intelligent caregiving robots in elderly care, extracted from multiple perspectives, provide a reference for constructing a scientific, reasonable, and comprehensive usability evaluation indicator system for intelligent caregiving robots in elderly care.

Objective:To explore the impact of community environment on the functional ability in the elderly based on a person-environment fit perspective.Methods:The descriptive qualitative research method was used. Applying the purposive sampling method, elderly people attending two community health centers and their subordinate health stations in Beijing were selected as respondents from January to May 2024. An interview outline was developed based on the person-environment fit theory, and semi-structured interviews were used to collect information. Thematic analysis was used for data analysis.Results:A total of 16 community elderly people were interviewed, and four themes were finalized, including multidimensional compensation of the environment for individual competence (accessible and convenient environments compensate for declining motor abilities, supportive physical environments compensate for declining vision and vitality, social support compensates for declining cognitive abilities, and age-friendly environments enhancing a sense of belonging and security) , congruence of personal preferences with the community environment (diversity of activities to meet individualized needs, environmental stability to ensure a sense of control over life, age-friendly digital environments to meet the digital needs of the elderly) , personal influencing factors of the perceived environment (length of residence, personal health status, personal social relations) , and coping styles with person-environment mismatches (enhancement of individual capabilities, use of assistive devices for self-empowerment, proactive home age-friendly adaptation, self-psychological adjustment) .Conclusions:Community healthcare workers should emphasize the role of the environment and give full consideration to the individual characteristics, needs and preferences of the elderly people, and pay special attention to the elderly people who have a poor perception of the environment and encourage them to take positive coping styles to adapt to the environment.

This study was aimed at establishing a method of ultra-fast quantitative PCR for Brucella detection.We used an exogenous recombinant plasmid as the internal reference and targeted the T4SS secretion system,an important Brucella viru-lence factor,to design specific primers and probes.The sensitivity,specificity,and repeatability of this method were evaluated,and a standard curve was constructed.The coincidence rate of detection findings with this method versus quantitative PCR was determined.This method markedly decreased the detection time to only 10 minutes.The standard curve demonstrated a good linear relationship(Y=-3.410 7x+38.357,R2=0.998 5)with a low minimum detection limit of 10 copies/μL.The method exhibited good specificity and did not specifically amplify several common clinical bacteria other than Brucella.The de-tection of three concentrations of positive plasmids yielded coefficients of variation(CVs)of 0.20％to 0.91％,thus demonstra-ting the method's excellent repeatability.Furthermore,140 clinical samples were analyzed concurrently with the fluorescence PCR method,which yielded a 100％compliance rate and consistent results.Our findings indicated that the Brucella ultra-fast quantitative PCR was ultrafast;had high sensitivity,high specificity,and good specificity;and can be used for the clinical de-tection of Brucella and emergency investigation of epidemics.Therefore,this method is valuable for the early diagnosis of Bru-cella.