ObjectiveTo introduce visual teaching into the course design of medical humanistic care based on the concept of implementation science， evaluate the teaching implementation effect and feedback， and provide references for optimizing course teaching outcomes and improving students’ humanistic care competence. MethodsA visual teaching program for medical humanistic care was designed， with key steps including clarifying teaching objectives， content， methods， and curriculum assessment. This program was implemented in the medical humanistic care course teaching involving 50 elective students. Multi-dimensional evaluation of teaching effectiveness was conducted through course grades， visual teaching evaluation， and humanistic workshop assessment， combined with inductive content analysis of students’ learning experiences in the workshops. ResultsThe 50 students achieved above-average course grades （89.60±3.41） and demonstrated high satisfaction with the overall course and visual teaching. All the 6 groups obtained relatively high scores in the medical humanistic care workshops. Four themes were extracted， namely， enhancing humanistic care competencies， deepening familial and interpersonal relationships， realizing emotional expression and self-growth， and strengthening integration of humanistic care concepts with practice. ConclusionThe teaching of medical humanistic care course has achieved favorable effects， which contributes to deepening students’ understanding of humanistic care and enhancing their humanistic care competence. Students demonstrate high levels of recognition and satisfaction with the course.

Objective To investigate the value of serum long noncoding RNA small nucleolar RNA host gene 7(lncRNA SNHG7)and microRNA(miR)-34a-5p expression in the diagnosis and prognostic evaluation of bloodstream infection(BSI).Methods A total of 193 suspected BSI patients admitted to the emergency department of Guangxi Wuzhou Red Cross Hospital from March 2022 to March 2023 were collected as the study subjects.After diagnosis,BSI patients were included as the infection group(n=100),and non BSI patients were included as the non infection group(n=93).After 28 days of treatment,BSI patients were separated into a death group(n=32)and a survival group(n=68)based on their prognosis.The real time fluorgenic quantitative PCR(qRT-PCR)method was applied to detect the expression levels of serum lncRNA SNHG7 and miR-34a-5p.The Target Scan Human website was applied to predict the targeting relationship between miR-34a-5p and lncRNA SNHG7.Pearson method was applied to analyze the correlation between serum lncRNA SNHG7 level and miR-34a-5p level.Multivariate Logistic regression was applied to analyze the influencing factors of prognosis in patients with BSI.Receiver operating characteristic(ROC)curve was applied to analyze the prognostic value of serum lncRNA SNHG7 and miR-34a-5p.Results The serum lncRNA SNHG7 level(1.47±0.35)in the infection group was obviously higher than that in the non infection group(1.03±0.15),and the miR-34a-5p level(0.85±0.21)was obviously lower than that in the non infection group(1.02±0.13),and the differences were statistically significant(t=11.203,6.703,all P<0.05).Compared with survival group,the serum lncRNA SNHG(1.68±0.21 vs 1.37±0.19),C-reactive protein(CRP)(85.74±9.16mg/L vs 63.18±7.68mg/L),procalcitonin(PCT)levels(56.37±8.72ng/ml vs 34.69±5.54ng/ml),albumin(92.51±10.18g/L vs 65.27±7.24g/L),Acute Physiological and Chronic Health Evaluation(APACHE II)scores(28.15±5.12scores vs 16.35±4.31scores)of the death group were obviously higher,and serum miR-34a-5p level(0.67±0.14 vs 0.93±0.16)was obviously lower,the differences were statistically significant.(t=7.357～15.340,all P<0.05).LncRNA SNHG7 had a targeted binding site with miR-34a-5p,and lncRNA SNHG7 was negatively correlated with miR-34a-5p(r=-0.568,P<0.05).Serum lncRNA SNHG7 and miR-34a-5p were prognostic factors for BSI patients(all P<0.05).The area under the curve(AUC)of serum lncRNA SNHG7,miR-34a-5p,and their combined evaluation of prognosis in BSI patients was better than that of serum lncRNA SNHG7 and miR-34a-5p detected sepatately(Z=0.001,2.304,all P<0.05),with sensitivity and specificity of 78.12%and 97.06%,respectively.Conclusion The serum lncRNA SNHG7 level in BSI patients is obviously elevated,while the serum miR-34a-5p level is obviously reduced.The two are closely related to the prognosis of BSI patients,and the combination of the two has good evaluation value for the prognosis of BSI patients.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective To evaluate the efficacy,safety and economy of three Janus kinase inhibitors in the treatment of rheumatoid arthritis(RA)using a rapid health technology assessment method,and to provide a basis for drug access and rational clinical use.Methods PubMed,Cochrane Library,Embase,CNKI,WanFang Data databases and the official websites of foreign health technology assessment(HTA)institutions were searched electronically to collect HTA reports,systematic reviews/Meta-analysis and pharmacoeconomics studies of tofacitinib,baricitinib,and upadacitinib in the treatment of RA from inception to December 31,2024.Two reviewers independently screened the literature,extracted information and performed quality assessment of the included studies,and then performed descriptive analysis on the results.Results A total of 16 literature were included,including 12 systematic reviews/Meta-analysis and 4 pharmacoeconomic studies.In terms of efficacy,taking the American College of Rheumatology(ACR)evaluation criteria for symptom relief 20％(ACR20),ACR50,ACR70 and disease activity score 28(DAS28)＜2.6 response rates as the efficacy indicators,upadacitinib 30 mg and upadacitinib 15 mg had better effectiveness in the treatment of RA patients.In terms of safety,the incidence of adverse drug events was the lowest in RA patients treated with 15 mg of upadacitinib.The incidence of serious adverse drug events in RA patients treated with tofacitinib 5 mg was the lowest.In terms of economy,compared with tofacitinib and baricitinib,upadacitinib 15 mg was the most economical.Conclusion Upadacitinib 15 mg has better efficacy,safety and economy in the treatment of RA patients.

Objective To investigate the value of serum long noncoding RNA small nucleolar RNA host gene 7(lncRNA SNHG7)and microRNA(miR)-34a-5p expression in the diagnosis and prognostic evaluation of bloodstream infection(BSI).Methods A total of 193 suspected BSI patients admitted to the emergency department of Guangxi Wuzhou Red Cross Hospital from March 2022 to March 2023 were collected as the study subjects.After diagnosis,BSI patients were included as the infection group(n=100),and non BSI patients were included as the non infection group(n=93).After 28 days of treatment,BSI patients were separated into a death group(n=32)and a survival group(n=68)based on their prognosis.The real time fluorgenic quantitative PCR(qRT-PCR)method was applied to detect the expression levels of serum lncRNA SNHG7 and miR-34a-5p.The Target Scan Human website was applied to predict the targeting relationship between miR-34a-5p and lncRNA SNHG7.Pearson method was applied to analyze the correlation between serum lncRNA SNHG7 level and miR-34a-5p level.Multivariate Logistic regression was applied to analyze the influencing factors of prognosis in patients with BSI.Receiver operating characteristic(ROC)curve was applied to analyze the prognostic value of serum lncRNA SNHG7 and miR-34a-5p.Results The serum lncRNA SNHG7 level(1.47±0.35)in the infection group was obviously higher than that in the non infection group(1.03±0.15),and the miR-34a-5p level(0.85±0.21)was obviously lower than that in the non infection group(1.02±0.13),and the differences were statistically significant(t=11.203,6.703,all P<0.05).Compared with survival group,the serum lncRNA SNHG(1.68±0.21 vs 1.37±0.19),C-reactive protein(CRP)(85.74±9.16mg/L vs 63.18±7.68mg/L),procalcitonin(PCT)levels(56.37±8.72ng/ml vs 34.69±5.54ng/ml),albumin(92.51±10.18g/L vs 65.27±7.24g/L),Acute Physiological and Chronic Health Evaluation(APACHE II)scores(28.15±5.12scores vs 16.35±4.31scores)of the death group were obviously higher,and serum miR-34a-5p level(0.67±0.14 vs 0.93±0.16)was obviously lower,the differences were statistically significant.(t=7.357～15.340,all P<0.05).LncRNA SNHG7 had a targeted binding site with miR-34a-5p,and lncRNA SNHG7 was negatively correlated with miR-34a-5p(r=-0.568,P<0.05).Serum lncRNA SNHG7 and miR-34a-5p were prognostic factors for BSI patients(all P<0.05).The area under the curve(AUC)of serum lncRNA SNHG7,miR-34a-5p,and their combined evaluation of prognosis in BSI patients was better than that of serum lncRNA SNHG7 and miR-34a-5p detected sepatately(Z=0.001,2.304,all P<0.05),with sensitivity and specificity of 78.12%and 97.06%,respectively.Conclusion The serum lncRNA SNHG7 level in BSI patients is obviously elevated,while the serum miR-34a-5p level is obviously reduced.The two are closely related to the prognosis of BSI patients,and the combination of the two has good evaluation value for the prognosis of BSI patients.

Background Construction workers represent a high risk group for occupational injuries. Currently, domestic and international studies examining the factors affecting occupational injuries among construction workers focus on demographic and behavioural characteristics. However, there is limited attention to psychosocial, use of digital technology, and health status of workers. Objective To analyze the occurrence of occupational injuries among workers in the construction industry, explore impacts of psychosocial risk, use of digital technology, health status, and preventive measures at the workplace on occupational injuries, and provide a basis for the development of preventive measures. Methods Publicly available data from the European Union Occupational Safety and Health Administration were retrieved, comprising a sample of 2167 construction workers. The outcome indicator was the presence of occupational injuries among workers. A total of 25 variables in the dimensions of psychosocial risk, use of digital technology, health status, and preventive measures at the workplace were extracted after Chi-square test, and then a combination of Boruta's algorithm and logistic regression was applied to identify the key factors affecting occupational injuries. Results Among the 2167 construction workers surveyed, 182 (8.6%) reported experiencing occupational injuries. The Boruta algorithm identified eight characteristics which in descending order of importance were musculoskeletal disorders, job type, depression and anxiety, level of completed education, use of electronic smart products, timely solution of safety problems, overall fatigue, and age. The logistic regression results indicated that six variables had statistically significant effects on occupational injuries: age, job type, level of completed education, musculoskeletal disorders, overall fatigue, and timely solution of safety problems (P<0.05). Conclusion Occupational injuries in construction workers are influenced by a variety of factors, including age, job type, level of completed education, musculoskeletal disorders, overall fatigue, and timely solution of safety problems. Companies and workers should take targeted measures to reduce the incidence of occupational injuries.

Background Light gradient boosting machine (LightGBM) has become a popular choice in prediction models due to its high efficiency and speed. However, the "black box" issues in machine learning models lead to poor model interpretability. At present, few studies have evaluated the severity of occupational injuries from the perspective of LightGBM model and model interpretability. Objective To evaluate the application value of LightGBM models and model interpretability methods in occupational injury prediction. Methods The Mine Safety and Health Administration (MSHA) occupational injury data set of mining industry workers from 1983 to 2022 was used. Injury severity (death/fatal occupational injury and permanent/partial disability) was used as the outcome variable, and the predictor variables included the month of occurrence, age, sex, time of accident, time since beginning of shift, accident time interval from shift start, total experience, total mining experience, experience at this mine, cause of injury, accident type, activity of injury, source of injury, body part of injury, work environment type, product category, and nature of injury. Feature sets were screened using least absolute shrinkage and selection operator (Lasso) regression. A LightGBM model was then employed to predict occupational injury, with area under curve (AUC) of the model serving as the primary evaluation metric; an AUC closer to 1 indicates better predictive performance of the model. The interpretability of the model was evaluated using Shapley additive explanations (SHAP). Results Through Lasso regression, 7 key influencing factors were identified, including accident time interval from shift start, experience at this mine, cause of injury, accident type, body part of injury, nature of injury, and work environment type. A LightGBM model, constructed based on feature selection via Lasso regression, demonstrated good predictive performance with an AUC value of 0.9941 (95%CI: 0.9917, 0.9966), accuracy of 0.9743, specificity of 0.9781, and sensitivity of 0.9640. The predicted probability of fatal occupational injuries showed high consistency with the actual probability of fatal occupational injuries. In the occupational injury prediction model, the importance of each indicator was analyzed through its SHAP value, and it was found that the body part of injury and the nature of injury were the two main features that affected the prediction results of the model, and the impacts of other features were relatively small. The distribution of SHAP values across body part of injury was broad, with significant impacts on the model's prediction of fatal risk, particularly for injuries to the head and neck, as well as multi-part injuries. The nature of injury also exerted influences on the model in different directions, with suffocation/drowning, crushing, and multi-part injuries having a greater impact on the risk of fatal occupational injuries. Conclusion LightGBM model is capable of efficiently processing large-scale data and providing high-precision prediction results. Research on model interpretability aids in more accurately exploring and analyzing various key risk factors for fatal occupational injuries among mining workers, and further reveals the complex interactions among these factors. This, in turn, enables better preventive intervention and protection measures, as well as optimal resource allocation for labor workers.

Objective To explore the effect of prominent cortical vein(PCV)sign on the clinical prognosis of patients undergoing endovascular recanalization for acute anterior circulation cerebral infarction.Methods A total of 102 patients with acute anterior circulation large-vessel occlusion in Zhongshan Municipal Hospital of Tradiontional Chinese Medicine from January 1,2020 to December 21,2022,who received endovascular recanalization,were enrolled in this study.The clinical data and radiographic materials were collected.According to whether PCV sign was present or not,the patients were divided into PCV group and non-PCV group.The clinical data were compared between the two groups.Logistic regression analysis was used to analyze the correlation between the postoperative 90-day mRS score and the occurrence of PCV.Results Compared with non-PCV group,in PCV group the incidence of atrial fibrillation was even higher,and the good rate of collateral compensation was even lower,and the postoperative(7±2)-day NIHSS score was even lower;the differences in above indexes between the two groups were statistically significant(all P＜0.05).Ninety days after treatment,the proportion of patients having modified Rankin Scale(mRS)score ≤2 points in the non-PCV group was 76.3％,which was higher than 58.6％in the PCV group,but the difference was not statistically significant(P=0.074).Logistic regression analysis indicated that a positive correlation existed between the presence of PCV sign and atrial fibrillation(OR=9.679,95％CI=1.264-74.364)and a negative correlation existed between the presence of PCV sign and good collateral compensation(OR=0.015,95％CI=0.033-0.331).No relationship existed between the postoperative 90-day good prognosis and the presence of preoperative PCV sign(OR=2.078,95％CI=0.680-6.348),but patient's age,preoperative intravenous thrombolysis were negatively correlated with the preoperative Alberta Stroke Program Early CT(ASPECT)score(P＜0.005).Conclusion In patients with anterior circulation acute ischemic stroke(AIS),the occurrence of PCV sign is associated with the impaired collateral compensation and atrial fibrillation,but its impact on the clinical outcomes of patients after receiving reperfusion therapy remains uncertain.PCV sign may be used as a potential evaluation indicator for inadequate cerebrovascular collateral compensation.

Objective:To explore the efficacy of unilateral biportal endoscopic (UBE) decompression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar burst fracture.Methods:A retrospective series study was conducted on the clinical data of 26 patients with thoracolumbar burst fracture who were admitted to Second Affiliated Hospital, University of South China between January 2023 and June 2024, including 18 males and 8 females, aged 14-58 years [(37.2±12.7)years]. Fractured segments included T 12 in 2 patients, L 1 in 3, L 2 in 9, L 3 in 7, and L 4 in 5. According to the American Spinal Injury Association (ASIA) scale, 2 patients were classified as grade C and 24 as grade D. All the patients were treated with UBE decompression combined with percutaneous pedicle screw fixation. The anterior vertebral height ratio (AVHR), vertebral wedge angle (VWA), kyphosis Cobb angle (KCA), vertebral compression efficiency ratio (VCER), visual analogue scale (VAS) and ASIA grade were compared preoperatively, at 3 days postoperatively and at the last follow-up. Postoperative complications were observed. Results:All the patients were followed up for 6-12 months [(8.7±1.9)months]. At 3 days postoperatively and at the last follow-up, AVHR [(93.7±2.2)%, (88.8±2.5)%], VWA [(3.9±1.2)°, (4.4±1.3)°] and KCA [(5.4±1.4)°, (6.1±1.4)°] were significantly improved compared with those preoperatively [(76.7±3.1)%, (7.0±2.9)°, (12.3±3.4)°, respectively] ( P<0.05). At the last follow-up, AVHR was decreased but VWA and KCA were increased in comparison with those at 3 days postoperatively ( P<0.05). VCER was (18.5±6.9)% at 3 days postoperatively and (18.1±6.4)% at the last follow-up, which were improved in comparison with that preoperatively [(53.6±7.7)%] ( P<0.05). There was no significant difference in VCER at the last follow-up and at 3 days postoperatively ( P>0.05). The VAS score was decreased from (8.5±0.7)points preoperatively to (3.5±0.7)points at 3 days postoperatively and further to (1.0±0.8)points at the last follow-up ( P<0.05), and there was statistically significant difference between the VAS scores at 3 days postoperatively and at the last follow-up ( P<0.05). At the last follow-up, 2 patients with ASIA grade C recovered to grade D, while 24 patients with ASIA grade D recovered to grade E ( P<0.01). Asymptomatic epidural hematoma was found in 1 patient and drainage tube-related limb pain in 1, but no instances of incision infection, cerebrospinal fluid leakage, decreased muscle strength, loosening or breakage of internal fixation were observed in other patients. Conclusion:The combined application of UBE decompression and percutaneous pedicle screw fixation demonstrates significant clinical advantages in treating thoracolumbar burst fractures, including fracture reduction of the injured vertebra, spinal canal decompression, thoracolumbar back pain relief, neurological function recovery and lower complication rates.