ObjectiveTo analyze the characteristics of 150 patients with spinal cord injury complicated with spasticity. MethodsA cross-sectional survey was conducted on 150 patients with spinal cord injury accompanied by spasticity from September, 2019 to December, 2024. Their age, gender, cause of injury, injury site, severity of injury, spasticity severity and other indicators were recorded. The relationships between different characteristics were analyzed, and a correlation analysis of disease duration, spasticity grade, injury level, injury severity and age were conducted. ResultsThere was no significant difference in age distribution between patients with tetraplegia and paraplegia (Z = 0.806, P = 0.420). The proportions of trauma (χ² = 3.982, P = 0.046) and tetraplegia (χ² = 10.559, P = 0.010) were higher in males than in females. Trauma was the main cause of injury in both tetraplegia and paraplegia patients; the proportion of tetraplegia was higher than paraplegia in trauma patients, while paraplegia was higher than tetraplegia in non-trauma patients (χ² = 11.885, P < 0.001). Patients with tetraplegia was dominated by incomplete injury, whereas patients with paraplegia was dominated by complete injury (χ² = 10.885, P = 0.012). Grade A injury was predominant in trauma patients (P = 0.003). Spasticity grade showed a very weak positive correlation with disease duration (r = 0.175, P = 0.032) and age (r = 0.168, P = 0.040). Injury severity showed a very weak positive correlation with age (r = 0.183, P = 0.025). ConclusionCharacteristics of patients with spinal cord injury complicated with spasticity is different with gender, cause of injury, injury level, injury severity.

ObjectiveTo develop and validate a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease. MethodsSelf-reported data from 2 673 respondents in the 2020 China Health and Retirement Longitudinal Study were analyzed. The participants were randomly divided into a training set (n = 1 871) and a validation set (n = 802). Heart disease status was determined using a self-report questionnaire. Logistic regression analysis was performed to identify predictors, and a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease was developed using R software. Bootstrap resampling was used for internal validation, and model performance was further evaluated in the randomly split validation set. The predictive performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and calibration curves.. ResultsA total of 2 673 older adults with heart disease were included, out of whom 315 participants in the training set had cognitive impairment. Lasso regression analysis identified age, education level, place of residence, instrumental activities of daily living and depression as predictors of concurrent cognitive impairment. A prediction model incorporating these five variables was constructed. The AUC were 0.827 (95%CI 0.804 to 0.850) in the training set and 0.847 (95%CI 0.812 to 0.882) in the validation set. The Hosmer-Lemeshow test yielded P = 0.154 and P = 0.716 in the training and validation sets, respectively. Calibration curves showed good agreement between predicted and observed probabilities. Decision curve analysis indicated that the model provided favorable net benefit and predictive performance. ConclusionThe nomogram may provide a useful reference for risk screening and early intervention for cognitive impairment in older adults with heart disease.

The mechanistic target of rapamycin （mTOR） is an important signaling functions as a central regulator of cell growth, proliferation and metabolism. Dysregulated mTOR signaling has been implicated in various inflammatory and hyperproliferative skin conditions. Emerging data suggest that mTOR signaling is tightly associated with acne pathogenesis. The regulatory mechanisms of the mTOR signaling pathway in the pathogenesis of acne were summarized and the current progress of therapeutic targeting mTOR pathway for acne were discussed in this paper.

ObjectiveTo investigate the effect of emodin on the odontoblastic differentiation of human dental pulp cells （HDPCs） induced by lipopolysaccharide （LPS）. MethodsHDPCs were isolated， cultured and pretreated with LPS and emodin at gradient concentrations. The protein expression levels of odontoblastic differentiation markers （ALP， RUNX2， DMP-1 and DSPP） were detected by Western blot. Bioinformatics analysis and small interfering RNA （siRNA） transfection were performed to identify and verify the downstream signaling pathways and targets of emodin. ResultsCompared with the LPS group， the protein expression levels of ALP， RUNX2， DMP-1 and DSPP significantly increased in the Emodin group （all P<0.05）. GO and KEGG enrichment analysis showed that the MAPK signaling pathway was the most significantly enriched pathway. Western blot results demonstrated that the p-ERK/ERK expression ratio was elevated in the OIM+LPS+Emodin group compared with the OIM+LPS group （P<0.05）. The top 10 hub genes associated with emodin-mediated promotion of HDPC odontoblastic differentiation under inflammatory conditions were screened via bioinformatics， including CD44， ITGB2， SP1， TLR2， CCL2， CCL5， ITGAX， CD86， ICAM1 and SYK. RT-qPCR results revealed that the mRNA expression of CD44 was upregulated in the OIM group compared to the CON group （P<0.01）. After CD44 knockdown， the protein levels of ALP， RUNX2， DMP-1 and DSPP decreased in the si-CD44 group compared to the si-NC group （all P<0.05）. ConclusionEmodin can significantly promote odontoblastic differentiation of LPS-challenged HDPCs， and its regulatory effect is closely related to the upregulation of CD44 expression and activation of the ERK signaling pathway.

Objective:To investigate the drug resistance of newly diagnosed HIV-1 infected patients in Shanghai and to provide reference value for clinical antiretroviral therapy (ART).Methods:The peripheral venous blood plasma of 196 newly diagnosed HIV-1 infected patients screened according to the inclusion and exclusion criteria at the Shanghai Public Health Clinical Center from April to June 2023 was collected, HIV-1 RNA was extracted, the pol region was amplified by reverse transcription-polymerase chain reaction (RT-PCR) for sequencing, the mutation sites and ART drug resistance were analyzed.Results:The plasma of 196 newly diagnosed HIV-1 infected patients was amplified successfully in 162 cases (amplification success rate was 82.65%). The subtypes consisted of CRF07_BC(51.23%), CRF01_AE (27.78%), and others (6.79%), CRF55_01B (5.56%), B (3.70%), CRF01_AE/B (3.70%) and CRF08_BC (1.23%). The overall transmitted drug resistance rate was 7.41%, the protease inhibitors (PIs), non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs), nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), integrase inhibitors (INSTIs) resistance rates were 3.09%, 3.70%, 0.00% and 0.62%, respectively. The proportion of NNRTIs-related mutation sites in B (66.67%) and CRF55_01B (88.89%) was higher than that in CRF07_BC (13.25%); the proportion of NNRTIs-related mutation sites in CRF55_01B (88.89%) was higher than that in CRF01_AE (22.22%) and other subtypes (18.18%), the difference was statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the probability of PIs-related mutation sites in CRF01_AE/B was 21.71 times that of CRF07_BC[odds ratio ( OR)=21.71, 95% confidence interval ( CI): 3.36-140.27, P=0.001]. Conclusions:The transmitted drug resistance among newly diagnosed HIV-1 infected patients in Shanghai is at the moderate epidemic level, mainly NNRTIs and PIs-related drug resistance, and the INSTIs resistance rate is low, the use of INSTIs in ART regimens should be considered.

Objective:To investigate the clinical characteristics, treatment and prognosis of juvenile dermatomyositis (JDM) complicated by sever gastrointestinal hemorrhage in children.Methods:A retrospective analysis was conducted on 4 JDM patients with sever gastrointestinal hemorrhage admitted to our hospital, from January 2017 to January 2025. Data including demographics, clinical manifestations, laboratory and imaging findings, treatment courses, and outcomes were reviewed.Results:The cohort comprised 4 patients (2 males, 2 females), with onset ages of 6.1, 6.2, 10.0 and 8.0 years. All presented with rash and fatigue and were diagnosed with severe refractory JDM (strongly positive anti-NXP2 antibodies). Sever gastrointestinal hemorrhage occurred 18, 12, 51, and 2 months after JDM diagnosis. Two cases had confirmed gastrointestinal infections due to contaminated food. Abdominal pain was the initial gastrointestinal symptom and black stool was observed in all cases, hemoglobin levels dropped below 60 g/L (case 1-4 decreased to 38, 59, 60 and 43 g/L respectively). All patients exhibited intestinal wall thickening. Active bleeding sites included the duodenum (3 cases: 2 cases near the duodenal papilla, 1 cases with diffuse duodenal oozing). Emergency endoscopic hemostasis was performed in 3 cases. One patient with diffuse duodenal bleeding required additional glucocortieoid pulse therapy after failed interventional embolization. Three patients stabilized following aggressive treatment of JDM, while 1 case died due to duodenal perforation.Conclusions:Anti-NXP2 antibody-positive JDM patients are prone to gastrointestinal involvement, particularly in chronic cases. Duodenal bleeding is common, with vascular erosion and deep mucosal ulcers posing life-threatening risks. For children with positive anti-NXP2 antibodies who present with abdominal pain and thickened intestinal walls, early endoscopic examination should be conducted as soon as possible to detect digestive tract lesions and provide timely treatment. Patients with severe digestive tract bleeding usually require active treatment for the underlying disease combined with endoscopic hemostasis therapy. Under timely treatment, the prognosis is relatively favorable.

Objective:We aimed to analyze the spatio-temporal trend of breast cancer incidence and mortality in Shandong Province from 2012 to 2023 and predict the development trend from 2024 to 2030.Methods:Data on the incidence and mortality of breast cancer in Shandong Province from 2012 to 2023 were obtained from the Shandong Cancer Registry. The incidence, age-specific incidence, mortality, and age-specific mortality in different years, as well as in urban and rural areas, were calculated, and the rates were standardized based on the age composition of the Chinese standard population in 2000. The average annual percent change (AAPC) rate was calculated using Joinpoint 4.8.0.1 software. The global and local spatial autocorrelation analysis were performed using GeoDa 1.12 software. The Bayesian age-period-cohort model was used to predict the trend of breast cancer incidence and mortality from 2024 to 2030.Results:From 2012 to 2023, the breast cancer age-standardized incidence rate (ASIR) showed an increasing trend. The ASIR increased from 30.48/100 000 in 2012 to 39.94/100 000 in 2023 (AAPC=2.59%, P<0.001). The ASIR of urban and rural females also showed an upward trend. Additionally, the ASIR in rural areas (AAPC=3.33%, P<0.001) increased more than that in urban areas (AAPC=1.83%, P=0.002). The incidence peak of breast cancer mainly concentrated in population aged 45-64 years, and with the increase of years, the incidence peak gradually moved forward. The age-standardized mortality rate (ASMR) showed a downward trend. The ASMR decreased from 6.89/100 000 in 2012 to 4.93/100 000 in 2023 (AAPC=-3.12%, P<0.001). The ASMR of urban and rural females also showed a downward trend (urban: AAPC=-3.56%, P=0.007; rural: AAPC=-2.72%, P<0.001). The spatial analysis showed that from 2015 to 2023, the clustering areas of breast cancer incidence and mortality in Shandong had changed significantly. In 2015, the "High-high clusters" of ASIR mainly included Wendeng District in Weihai City, Dongying District, Kenli District, Lijin County, Guangrao County in Dongying City, Tianqiao District, Shizhong District in Jinan City; In 2023, the "High-high clusters" mainly included Jiaxiang County, Liangshan County, Jinxiang County, Wenshang County, Rencheng District in Jining City, Hedong District in Linyi City, Guangrao County in Dongying City. In 2015, the "High-high clusters" of ASMR only included Wenshang County in Jining City. In 2023, the "High-high clusters" mainly included Laizhou County in Yantai City, Junan County and Yishui County in Linyi City, Gaotang County in Liaocheng City, Dongping County and Ningyang County in Taian City. The Bayesian age-period-cohort model predicted that the ASIR trend of breast cancer in Shandong tended to be smooth (AAPC=0.33%, P=0.001). However, the ASMR remained decreasing (AAPC=-4.68%, P<0.001). Conclusions:The breast cancer incidence in Shandong showed an increasing trend, and it is expected to be smooth by 2030. However, the mortality showed a continuous downward trend. The incidence peak was mainly in the population aged 45-64 years, with obvious regional differences. Targeted prevention and control measures should be taken for high-risk groups and areas in Shandong Province.

Objective:To apply multifunctional debridement machine in burn wounds and complicated skin ulcers of wound surgery on the basis of its convenience in application,and analyze its application value.Methods:The multi-functional debridement machine realized the design of hardware system,the design of intelligent handle,the design of frequency tracking system and other integration design,so as to deal with wound quickly and accurately.A total of 156 patients with burn wounds and complicated skin ulcers who admitted to West Branch of Qingdao Municipal Hospital from January 2022 to January 2024 were selected,and they were divided into control group(78 cases)and observation group(78 cases)by random number method.Patients in the control group were treated by using the mode with bedhead and bedside debridement and dressing change every other day,while patients in the observation group were treated by multi-functional debridement machine.The effect was analyzed after treatment.Results:The healing rate of the observation group was 93.59%,which was significantly higher than that of the control group(73.08%)(x2=11.815,P＜0.05),and the healing time of the observation group was significantly shorter than that of the control group,and the difference was statistically significant(t=10.701,P＜0.05).The scores of wound depth,range of wound injury and degree of tissue necrosis in the observation group were lower than those in the control group,and the score of growth speed of granulation tissue was significantly higher than that in the control group,and the differences were statistical significance(t=5.617,7.993,4.781,5.133,P＜0.05).The pain scores on 1st day,7th day and 14th day after dressing change in the observation group were all lower than those in the control group,and the differences were statistical significance(t=19.898,11.801,10.191,P＜0.05).The sterilization rates of wound on the 3rd day,7th day and 10th day after treatment in the observation group were all higher than these in the control group,and the differences were statistical significance(t=15.168,13.476,6.785,P＜0.05).Conclusion:The hardware system of multifunctional debridement machine has large output power,high efficiency and obvious debridement effect.It has significant advantages in the treatment of burn wounds and complicated skin ulcers of wound surgery,which can relieve the degree of wound pain,and improve the cleaning effect and promote rapid recovery of wound.

Objective:To investigate the diagnostic value and imaging features of high resolution magnetic resonance imaging(HR-MRI)in patients with lesions in carotid artery and intracranial artery.Methods:Sixty-nine patients with suspected lesions in carotid artery and intracranial artery who admitted to Handan Central Hospital from June 2021 to December 2023 were selected,and they underwent routine MRI and HR-MRI examinations.Digital subtraction angiography(DSA)examination was used as the"gold standard"to analyze the detection rates of different MRI examinations for lesions in carotid artery and intracranial artery.The diagnostic efficacy of them was calculated,and the HR-MRI imaging features of positive cases and negative patients were compared under the"gold standard".Results:For 69 patients with suspected lesions in carotid artery and intracranial artery,41 cases(59.42%)were confirmed by"gold standard"examination,and 31 positive cases were confirmed by routine MRI examination,and 35 positive cases were confirmed by HR-MRI examination,and 39 positive cases were confirmed by combined examination of routine MRI and HR-MRI.The results indicated that the accuracy,sensitivity,specificity,positive and negative predictive values of the combined examination of routine MRI and HR-MRI were respectively 88.41%,87.80%,89.29%,92.31%and 83.33%,all of which were higher than those of single image examination,and the differences were statistically significant(x2=5.459,7.329,6.216,6.395,6.141,P<0.05).The irregular shape,blurred boundary,high signal,plaque formation,intra-plaque bleeding,displacement of common carotid artery or vein,and calcification of lesion in HR-MRI imaging features of positive patients were significantly higher than those of negative patients,and the differences were statistically significant(x2=8.918,4.418,7.001,4.746,8.743,5.951,4.947,P<0.05),respectively.Conclusion:The detection rates both of routine MRI and HR-MRI are higher in patients with lesions in carotid artery and intracranial artery.However,the combined examination of them can improve the diagnostic sensitivity and specificity,and the morphology,boundary,signal and calcification foci of confirmed patients are more obvious in HR-MRI examination,which can provide reference for subsequent diagnosis and treatment.

Objective:To analyze the research progress and hotspots of clinical pathway informatization at home and abroad, and provide references and guidance for the construction of clinical pathway informatization in China.Methods:The relevant literature on clinical pathway informatization research were retrieved from China National Knowledge Infrastructure and Web of Science databases, which were published from January 1, 2000 to July 20, 2023. Bibliometric and thematic analysis methods were used to analyze the commonalities and differences in annual publication volume, high-frequency author collaboration networks, high-frequency keywords, and research hotspots of domestic and foreign literature.Results:This study included a total of 257 domestic literature and 174 foreign literature. The number of domestic publications had gradually increased since 2005, with the highest number in 2012 and a significant downward trend after 2015; The overall number of foreign publications was on the rise. Domestic high-frequency authors mostly came from medical institutions, while foreign high-frequency authors were mainly concentrated in universities and research institutes, and both had formed author collaboration networks. However, the research continuity of foreign authors were better than that of domestic authors. There were commonalities in the electronicization and semantics of clinical pathways, process design and management, disease management, and clinical decision support in relevant research hotspots at home and abroad, but there were significant differences in system integration, process design, pathway analysis, and disease management. Foreign related researches had the advantages of leading technology.Conclusions:There were certain similarities and differences in the research topics of clinical pathway informatization at home and abroad, and relevant studies abroad had shown certain frontiers in the application of new technologies. In the future, China should learn from international advanced experience, utilize emerging technologies such as machine learning and big language models, strengthen patient-centered, promote the precise and intelligent development of clinical pathway management, and improve the quality of medical services.