As a novel long-acting glucagon-like peptide-1 （GLP-1） receptor agonist， semaglutide plays a pivotal role in the treatment of obesity and related metabolic diseases. This article systematically reviews the research progress of semaglutide in the treatment of obesity and related metabolic diseases from three aspects： mechanism of action， clinical applications， and existing challenges. It is found that its mechanism of action involves multi-organ synergistic regulation and metabolic intervention. Its clinical applications encompass the treatment of obesity， diabetes， polycystic ovary syndrome， and liver-related metabolic syndromes， and it demonstrates groundbreaking value in cardiovascular and renal protection. However， it still faces multiple challenges in terms of adverse reactions， individualized treatment， economic accessibility， ethical controversies， and risks. In the future， it is essential to further accumulate long-term safety data on semaglutide， optimize combination treatment regimens， and address key issues such as individualized medication for special populations， in order to fully realize its clinical application value.

With the rapid advancement of artificial intelligence technology, chatbots have shown great potential in the healthcare sector. From personalized health advice to chronic disease management and psychological support, chatbots have demonstrated significant advantages in improving the efficiency and quality of healthcare services. As the scope of their applications expands, the relationship between technological complexity and practical application scenarios has become increasingly intertwined, necessitating a more comprehensive evaluation of both aspects. This paper, from the perspective of he althcare applications, systematically reviews the technological pathways and development of chatbots in the medical field, providing an in-depth analysis of their performance across various medical scenarios. It thoroughly examines the advantages and limitations of chatbots, aiming to offer theoretical support for future research and propose feasible recommendations for the broader adoption of chatbot technologies in healthcare.

Objective:To investigate the feasibility of ultra-low dose (ULD) CT pulmonary angiography (CTPA) combined with deep learning reconstruction (DLR) in the diagnosis of pulmonary embolism (PE).Methods:This cross-sectional study prospectively enrolled 100 patients with suspected PE who underwent CTPA examination in Zhongshan Hospital Fudan University, and Shanghai Geriatric Medical Center from April to July 2024, and were randomly divided into the routine dose (RD) group and ULD group according to block randomization. Effective dose (ED) were calculated. The noise index of RD group and ULD group was set to 10 and 20, respectively. Other scanning parameters and contrast agent injection protocol were the same. The CT images of RD group were reconstructed using hybrid iterative reconstruction (HIR), while ULD images were reconstructed with HIR and DLR (ULD-HIR subgroup and ULD-DLR subgroup). The image quality of the three groups of images was subjectively evaluated (overall image noise, pulmonary artery display) and objectively evaluated [signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of the images] respectively. Finally, the diagnostic results of PE by the expert committee composed of three chief physicians were taken as the gold standard, and one physician with lower qualifications independently evaluated the diagnostic rate of PE in the three groups of images. Objective image quality parameters across the three groups were compared using ANOVA, with LSD post hoc test was used for multiple comparisons. Subjective scores among the three groups were analyzed using the Kruskal-Wallis H test, with Bonferroni corrected pairwise post hoc test was applied for multiple pairwise comparisons. Results:The ED in the RD group and ULD group were (2.7±0.5) mSv and (0.7±0.2) mSv, respectively, and the differences were statistically significant ( t=26.42, P<0.001). The overall differences in CT values of pulmonary arteries at all levels in the images of the RD group, the ULD-HIR subgroup, and the ULD-DLR subgroup were not statistically significant ( P>0.05).The RD group, ULD-HIR subgroup and ULD-DLR subgroup overall differences in SNR and CNR at all levels pulmonary arteries were statistically significant ( P<0.001), in which except for the differences in CNR and SNR values of the left pulmonary arterial trunk in the RD group and the ULD-HIR subgroup, and SNR values of basal segment pulmonary artery of the lower lobe of the left lung, which were not statistically significant ( P>0.05), the differences of the rest of the indexes in the pairwise comparisons between the groups were statistically significant ( P<0.05). The overall differences in the subjective scores of image pulmonary vascular display and image noise in the RD group, ULD-HIR subgroup and ULD-DLR subgroup were statistically significant ( P<0.001), except that the differences in the subjective scores of image pulmonary vascular display in the ULD-DLR subgroup were not statistically significant when compared with that of the RD group ( P>0.05) and that of the rest of the metrics in the between-groups two-by-two comparisons were all statistically significant ( P<0.05). The difference in diagnostic rates of PE in the pulmonary artery trunk, lobe and segmental levels in the images of the RD group, ULD-HIR subgroup and ULD-DLR subgroup was not statistically significant ( P>0.05). Conclusions:DLR can significantly reduce the radiation dose of CTPA examination. Even at ultra-low radiation dose, its image quality is still better than HIR reconstruction at conventional doses and preserve diagnostic accuracy of PE at the lobe level and segment level.

Objective:To retrospectively analyze the efficacy and safety of different radiotherapy doses in treating esophageal squamous carcinoma(ESCC)patients aged ≥80 years.Methods:This retrospective study collected clinical data from ESCC patients aged ≥80 years who underwent radiotherapy at the Fourth Hospital of Hebei Medical University from January 2016 to September 2021.Observation variables included overall survival(OS), progression free survival(PFS), complete response(CR), partial response(PR), stable disease(SD), progressive disease(PD), and adverse reactions.Survival rates were estimated using the Kaplan-Meier method and compared via log-rank tests.Cox regression models were employed for multivariate analysis.Results:A total of 165 patients who met the enrollment criteria were included in this study, including 88(88/165, 53.3%)males and 77(77/165, 46.7%)females, age 80 to 100 years(median age 83 years), 66 cases(66/165, 40.0%)in the radiotherapy dose ≥60 Gy group and 99 cases(99/165, 60.0%)in the <60 Gy group.Of the 165 patients, the effective rate was 71.5%(118/165).The median overall survival(OS)of the whole group was 19.0 months, The median Progression Free Survival(PFS)for the whole group was 13 months.The results showed that radiotherapy dose, lesion length, Nutritional Risk Index(NRI), eating condition, recurrence/progression and chemotherapy were factors influencing OS.The survival of patients in the ≥60 Gy group, ≤5 cm group, well-nourished group(NRI ≥45)group, soft diet and general diet group and combined chemotherapy group is better.Cox multivariate analysis revealed that radiotherapy, dose eating condition and the lesion length were independent prognostic factors for OS.The OS rate of the radiation therapy group with a dose of ≥ 60 Gy was better than that of the<60 Gy group( P=0.001), the OS of the general or soft diet group was better than that of the semi liquid or liquid diet group( P=0.008), and the OS of the lesion length ≤ 5 cm group was better than that of the>5 cm group( P=0.020).The incidence rates of radiation-induced esophagitis, myelosuppression, radiation pneumonia, and gastrointestinal reactions in the entire group were 60.0%(99/165), 12.1%(20/165), 22.4%(37/165), and 14.5%(24/165), respectively.51.5%(85/165)of the group experienced local recurrence, 10.3%(17/165)had distant organ metastasis, and 9.1%(15/165)had non regional lymph node metastasis.As of the follow-up date, there were a total of 99 deaths in the entire group. Conclusions:For patients aged 80 years or older with esophageal cancer, higher radiation doses, better feeding and nutritional status have more beneficial for prolonged survival.Local recurrence remains the main reason for treatment failure in elderly patients with esophageal cancer.

Objective:To develop a post competence assessment scale for nurses in the health management (physical examination) center and assess its reliability and validity.Methods:This study adopted an empirical approach. A total of 801 nurses from the health management (physical examination) center were recruited to participate in this study. A research team was formed in August 2024. This team transformed the previously constructed core competence evaluation index system for health management specialist nurses in the health management (physical examination) center (comprising 6 first-level indicators and 70 third-level indicators) into a preliminary post competence assessment scale. Seven experts evaluated the content validity of the scale. In September 2024, a pilot survey was conducted among 27 nurses from the health management (physical examination) center of Sichuan Provincial People′s Hospital using convenience sampling. From October to November 2024, the first main survey was administered to 385 nurses of health management (physical examination) center across 54 cities in China using both convenience sampling and snowball sampling methods, followed by exploratory factor analysis (EFA). Subsequently, utilizing the refined scale obtained after eliminating certain items, a second main survey was conducted among 389 nurses in the health management (physical examination) center, followed by a confirmatory factor analysis (CFA). The reliability of the final scale was assessed using Cronbach′s α coefficient, split-half reliability, composite reliability, and test-retest reliability.Results:The finalized scale for nurses′ post competency in health management (physical examination) center comprises five dimensions—basic nursing service competency, health management practice competency, knowledge integration competency, professional development competency, and professional attitude—with a total of 57 items. The item level content validity index (I-CVI) of the items of the content validity display scale ranged from 0.857 to 1.000, and the content validity index of each dimension ranged from 0.984 to 1.000. The scale-level Content Validity index/average (S-CVI/Ave) was 0.995. The contribution rate of the 6 factors extracted by EFA was 74.07%. After group discussion and CFA, the scale of the 5-factor structural equation model was constructed. The total Cronbach′s α coefficient of the scale was 0.986, the split-half reliability was 0.865, the composite reliability was 0.960-0.980, the total table test-retest reliability was 0.762, and the test-retest reliability of each dimension was 0.681-0.731.Conclusion:The developed assessment scale for assessing the post competence of nurses in the health management (physical examination) center demonstrates excellent reliability and validity.

Objective To analyze the proteomic differences between mouse secondary oocytes,also known as metaphase Ⅱ oocytes(M Ⅱ),and the first polar bodies(PB1)using high-resolution single-cell proteomics,to identify key proteins regulating embryonic development,and to provide a molecular basis for optimizing in vitro oocyte maturation systems.Methods Paired samples of M Ⅱ(n=5)and PB1(n=5)were analyzed using high-resolution single-cell mass spectrometry(timsTOF HT).Quantitative proteomics and bioinformatics approaches were employed to conduct differential protein screening and functional enrichment.Results Using the timsTOF HT platform,we achieved the detection of over 3 000 proteins per single cell and identified 277 proteins specifically enriched in M Ⅱ.Gene Set Enrichment Analysis(GSEA)revealed that these M Ⅱ-specific proteins were significantly enriched in gene regulation and DNA damage repair pathways associated with mitochondrial energy metabolism.Cross-species GSEA comparison between human and mouse homologs demonstrated elevated expression of heat shock proteins,including Hsp90b1,Hspa5,etc.,in the mTORC1 pathway in M Ⅱ(P＜0.05).In addition,key factors regulating cumulus complex development,such as Calr,Aldoa,etc.,were significantly upregulated.Conclusion M Ⅱ strategically retains proteins essential for embryonic development through asymmetric division.The timsTOF HT platform demonstrated superior sensitivity in analyzing and identifying these proteins.According to the protein analysis results,the distribution of mTORC1 pathway proteins indicates that they play a key role in embryonic metabolism regulation.In particular,heat shock proteins facilitate protein folding and maintain endoplasmic reticulum homeostasis,thereby ensuring oocyte maturation and the embryonic developmental potential.

Objective To explore the effect of vaginal sacrospinous ligament suspension(VSSLS)with uterus preservation in treatment of patients with moderate to severe pelvic organ pro-lapse(POP).Methods A total of 92 patients with moderate to severe POP were randomly divided into control group and observation group,with 46 cases in each group.The control group received va-ginal anterior and posterior wall repair(VAPWR),while the observation group underwent VSSLS.The intraoperative blood loss,operation time and hospital stay were compared between the two groups;the Pelvic Floor Distress Inventory-20(PFDI-20)was used to evaluate quality of life;the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12(PISQ-12)was used to assess conditions of sexual satisfaction degree,dyspareunia,sexual frequency,and perceived control during sexual activi-ty;surgical complications in both groups were recorded.Results The observation group had less intr-aoperative blood loss,shorter operation time,and shorter hospital stay compared with the control group(P＜0.01).After treatment,the observation group had lower scores in all dimensions of the PFDI-20 compared with the control group,and the decreasing range was significantly greater than that in the control group(P＜0.01).After treatment,the observation group had significant higher scores for sex-ual satisfaction degree,sexual frequency and perceived control during sexual activity compared with the control group,and the change in these indicators before and after treatment was also significantly greater in the observation group,while the score for dyspareunia was significantly lower in the observation group,with a significant decrease compared with the control group(P＜0.01).The incidence of complications was significantly lower in the observation group than that in the control group(P＜0.01).Conclusion As a surgical approach for the treatment of moderate to severe POP,VSSLS can significantly improve patient's quality of life.

Objective To compare the application value of indocyanine green(ICG),nano-car-bon,methylene blue(MB)tracing methods,and ICG combined with nano-carbon tracing method in laparoscopic surgery for stage Ⅰ to Ⅱ endometrial cancer according to International Federation of Gynecology and Obstetrics(FIGO)staging system.Methods A retrospective selection of 92 pa-tients who underwent laparoscopic surgery for stage Ⅰ to Ⅱ endometrial cancer was conducted.Based on intraoperative sentinel lymph node(SLN)tracing method,the patients were divided into ICG group(n=24,using ICG tracing method),nano-carbon group(n=22,using nano-carbon tracing meth-od),MB group(n=23,using MB tracing method),and combined group(n=23,using ICG combined with nano-carbon tracing method).Surgical-related indicators,pathological results,and the incidence of complications were compared among the four groups.The detection efficacy of different tracing methods was also compared,using pathological results of surgical specimens as the gold standard.Results There were no statistically significant differences in the SLN resection time,to-tal operative time,and intraoperative blood loss among the four groups(P＞0.05).The number of lymph nodes resected intraoperatively in the combined group was significantly higher than that in the other three groups(P＜0.05).There were no statistically significant differences in the pathological results of surgical specimens(tumor invasion depth＞50％,tumor diameter＞2 cm,tumor invasion of the cervix or lymphovascular space)among four groups(P＞0.05).The complication rates in the ICG group,nano-carbon group,MB group,and combined group were 4.17％,9.09％,8.70％,and 13.04％,respectively,with no statistically significant difference(P＞0.05).Using the pathological results of surgical specimens as the gold standard,the detection accuracy,sensitivi-ty,and specificity of ICG combined with nano-carbon tracing method for SLNs in patients with stage Ⅰto Ⅱ endometrial cancer were 86.96％,90.00％,and 66.67％,respectively.The positive predictive value and negative predictive value were 94.74％and 50.00％,respectively.The detection efficacy of this combined method was higher than that of the other three methods.Conclusion Compared with the ICG,nano-carbon,and MB tracing method,ICG combined with nano-carbon tracing method has a higher application value in laparoscopic surgery for stage Ⅰ toⅡ endometrial cancer.It can accurately i-dentify the status of lymph node metastasis,with a moderate price and simple operation.

Objective:To establish a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology, standardize the training process, and provide an effective evaluation method.Methods:Based on literature review and discussions, a preliminary expert consultation questionnaire was developed. From July to November 2024, a modified Delphi method was adopted and relevant experts were invited to assess the importance, validity, and feasibility of each indicator using a 5-point Likert scale. The results were used to screen and refine the entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology.Results:In the two rounds of expert consultation, the valid questionnaire return rate reached 100.00%, with an expert judgment basis coefficient of 0.73 and a familiarity coefficient of 0.90. Based on expert feedback, the final framework retained 3 first-level indicators and 12 second-level indicators. Modifications included renaming "Anesthesia Management" to "Anesthetic Drug Management", swapping the order of "Intraoperative Emergency Management" and "Airway Management", and removing the indicator "Resuscitation Assessment".Conclusions:This study preliminarily developed a framework of entrustable professional activity indicators for non-anesthesiology residents during rotation in the Department of Anesthesiology. The framework provides a simple and practical competency evaluation method for standardized training, which can enhance training quality and effectiveness.

Objective:To explore the dynamic change trajectory and influencing factors of postoperative fatigue (POF) in patients with early digestive tract cancer undergoing endoscopic submucosal dissection (ESD), so as to provide theoretical basis for individualized management of such patients.Methods:Using cross-sectional survey and convenient sampling method, the patients who underwent ESD for early cancer of digestive tract in the endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June 2024 were selected as the research objects. The questionnaires were conducted at 30 min, 24 h, 3 days, 5 days, 7 days after ESD with Christensen's postoperative fatigue score. Spearman test was used to analyze the correlation between pain, insomnia and POF. The latent variable growth model was used to identify the potential categories of POF trajectory, and the influencing factors were analyzed by Logistic regression.Results:A total of 232 patients were finally induded, with ages of 19-94(59.53 ± 13.29) years, including 120 males and 112 femalss. The POF level of patients with early cancer of digestive tract showed a downward trend one week after operation. Three postoperative fatigue trajectories were fitted, 9.05% in moderate or severe fatigue low-speed smooth descent group (C1 group); 32.76% in moderate fatigue first decreased quickly and then slowly group (C2 group) and 58.19% in mild fatigue continuous decline group (C3 group). The result of Logistic regression analysis showed that, compared with C1 group, people without religious beliefs were morelikely to enter C2 group [ β = 1.572, OR = 4.818(1.033 - 22.465), P<0.05]; compared with C3 group, patients with high pain level and severe insomnia degree were likely to enter C1 [ β = 2.621, 0.663, OR were 13.754(2.692 - 70.283) and 1.942(1.429 - 2.638), both P<0.05] and C2 [ β = 2.010, 0.491, OR were 7.464(1.890 - 29.482) and 1.634(1.348 - 1.982), both P<0.05] group. Conclusions:There were three potential types of POF in patients with early digestive tract cancer ESD. Medical staff should pay attention to patients with severe insomnia, intense pain and religious beliefs, and give staged fatigue assessment and individualized intervention, so as to reduce the level of POF and promote rapid recovery.