The development and validation of clinical prediction models based on artificial intelligence (AI) and machine learning methods have become increasingly widespread. However, the prediction model bias risk and applicability evaluation tool developed in 2019 (i.e., PROBAST-2019) has shown significant limitations. Therefore, an expanded and updated version of the PROBAST-2019 tool was released in 2025, known as the PROBAST+AI tool. The tool is divided into two parts including model development and model evaluation. It aims to comprehensively and systematically evaluate potential methodological quality issues in model development, bias risks in model evaluation, and the applicability of models, regardless of the modeling method used. This paper provides a systematic interpretation of the PROBAST+AI tool's items and case analyses, with the aim of guiding and assisting researchers engaged in related studies and promoting the high-quality development of clinical predictive model research.

Objective:To compare the effects of different exercise modes on inflammation, endothelium functioning and the ambulatory blood pressure (ABP) of middle-aged hypertensive patients, so as to provide a basis for optimizing rehabilitation training prescriptions.Methods:Ninety persons with hypertension were randomly divided into an aerobic exercise group, a resistance training group and a control group, each of 30. All maintained their routine daily living habits and medications. In addition, the aerobic exercise group performed aerobic exercise, while the resistance training group took resistance exercise for twelve weeks. Inflammatory response, endothelium functioning and 24-hour ABP were evaluated before and after the experiment.Results:The subjects tolerated the different exercises well. After the experiment, the daytime systolic blood pressure (SBP) and 24-hour SBP of those in both exercise groups had decreased significantly, on average. Flow-mediated dilation had increased significantly. The average plasma nitric oxide and interleukin-10 levels had increased significantly, and the average C-reactive protein, monocyte chemoattractant protein-1, vascular cell adhesion molecule-1, lectin-like oxidized LDL receptor-1, and endothelin-1 levels had decreased significantly in the aerobic exercise group, but not in the control group.Conclusions:Both regular aerobic exercise and resistance training benefit blood pressure control and reduce the risk of cardiovascular disease, at least among middle-aged persons with hypertension. Aerobic exercise tends to have the better effect.

Objective:To explore the feasibility and effectiveness of hierarchical teaching based on team-based learning (TBL) combined with Bandura's role model theory in improving the training effectiveness of newly hired gastroenterology nurses.Methods:The 98 nurses recruited in the Department of Gastroenterology from July 2019 to July 2023 were divided into a control group (47) and an observation group (51) according to their order of enrollment. The control group received routine teaching, while the observation group received hierarchical teaching based on TBL plus Bandura's role model theory. The two groups were compared for theoretical and skill assessment scores, clinical communication skills, teamwork ability, training effectiveness, and satisfaction with teaching.Results:After the training, the theoretical and practical assessment scores of the observation group were (81.69±4.26) and (80.29±5.21) points, respectively, which were significantly higher than the (77.57±4.16) and (75.28±5.43) points in the control group ( P<0.05). After the training, both groups showed significant improvements in building harmonious relationships, listening skills, team participation, problem confirmation, information transmission, and validation of feelings, with the observation group scoring higher than the control group. After the training, the trust and support, team orientation, team leadership, and team mental model dimensions scores of both groups were significantly improved, and the observation group showed higher scores than the control group. After the training, the leadership ability, critical patient monitoring, teaching and cooperation, planning evaluation, communication, and professional development scores of both groups were significantly improved, and the observation group demonstrated higher scores than the control group. The observation group scored higher on various dimensions of teaching satisfaction than the control group ( P<0.05). Conclusions:Hierarchical teaching based on TBL plus Bandura's role model theory can improve the quality of training newly hired nurses in the gastroenterology department, enhance their clinical communication skills, teamwork abilities, and clinical nursing quality, and facilitate the cultivation of high-quality gastroenterology clinical nurses.

Objective:To understand the iodine nutritional status of pregnant women in Beijing, and analyze the influencing factors of thyroid disease.Methods:From 2021 to 2023, a stratified random sampling method was used to select at least 100 pregnant women from each of the 16 administrative districts under the jurisdiction of Beijing each year, using cross-sectional survey. Random urine samples and household salt samples were collected to determine urinary iodine and salt iodine levels, and were analyzed iodine nutritional status. Binary logistic regression model and restricted cubic spline(RCS) model were sued to analyze the influencing factors of thyroid disease in pregnant women (age, residential area, ethnicity, pregnancy, etc.).Results:A total of 4 878 pregnant women were investigated from 2021 to 2023, and the overall median urinary iodine level was 129.11 μg/L, indicating a deficiency in iodine nutrition (< 150 μg/L). There was a statistically significant difference in the urinary iodine levels of pregnant women between different years ( H = 20.22, P < 0.001). There was a statistically significant difference in median urinary iodine levels of pregnant women in different pregnancy stage ( H = 11.57, P = 0.003). The median of salt iodine value was 24.00 mg/kg, and the consumption rate of qualified iodized salt was 75.05% (3 661/4 878). The comparison of salt iodine levels between different years showed statistically significant differences ( H = 14.20, P < 0.001). Binary logistic regression analysis showed that the risk of thyroid disease in urban area was higher than that in suburban area ( OR = 2.01, P < 0.001), while the risk of disease in central government areas was lower ( OR = 0.52, P = 0.044). Compared with late pregnancy, the risk of the disease was lower in the early pregnancy ( OR = 0.60, P = 0.003) and the middle pregnancy ( OR = 0.71, P = 0.046). Supplementing with iodine can reduce the risk of the disease ( OR = 0.48, P < 0.001). The analysis of the RCS model showed that there was a nonlinear dose-response relationship between the risk of thyroid diseases in pregnant women and urinary iodine, with a U-shaped curve and cut-off values of 127.74, 472.66 μg/L. Conclusion:From 2021 to 2023, the iodine nutrition of pregnant women in Beijing is in iodine deficiency state, and factors affecting thyroid disease include residential area, pregnancy, supplementing with iodine, and urinary iodine.

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.

Objective:To explore the construction and application of the evaluation system for ideological and political education in clinical medicine courses based on analytic hierarchy process (AHP) and fuzzy comprehensive evaluation (FCE) models.Methods:The evaluation system for ideological and political education in clinical medicine courses was constructed based on AHP and FCE models in the Yaahp software. Ideological and political education checklist teaching that places equal emphasis on medical ethics and skill was implemented in internal medicine course taken by 185 students in The First Affiliated Hospital of Xi'an Jiaotong University. At the end of the course, the evaluation system was used to obtain quantitative comprehensive evaluation results.Results:Based on AHP and FCE models, the evaluation system for ideological and political education in clinical medicine courses was established. The goal was education of students with both medical ethics and skill, the criteria included teachers' ethics, curriculum design, students' experience and development assessment, and thirteen alternatives were used in the system. The implementation effect of ideological and political education in internal medicine course of the first semester in the 2020-2021 academic year was evaluated by the evaluation system. The quantitative comprehensive evaluation score was 4.080 (range 1-5), which showed that the ideological and political education checklist teaching with equal emphasis on medical ethics and skill achieved good educating effect.Conclusion:The evaluation system for the implementation effect of ideological and political education in clinical medicine courses can be constructed based on the AHP and FCE models. The evaluation system is scientific, quantitative, comprehensive, and improvable.

Liver fibrosis is a reversible pathological process caused by chronic liver damage and a major risk factor for hepatocellular carcinoma (HCC). Hepatic stellate cell (HSC) activation is considered the main target for liver fibrosis therapy. However, the efficiency of this strategy is limited due to the complex microenvironment of liver fibrosis, including excessive extracellular matrix (ECM) deposition and hypoxia-induced imbalanced ECM metabolism. Herein, nilotinib (NIL)-loaded hyaluronic acid (HA)-coated Ag@Pt nanotriangular nanozymes (APNH NTs) were developed to inhibit HSCs activation and remodel the microenvironment of liver fibrosis. APNH NTs efficiently eliminated intrahepatic reactive oxygen species (ROS) due to their inherent superoxide dismutase (SOD) and catalase (CAT) activities, thereby downregulating the expression of NADPH oxidase-4 (NOX-4) and inhibiting HSCs activation. Simultaneously, the oxygen produced by the APNH NTs further alleviated the hypoxic microenvironment. Importantly, the released NIL promoted collagen depletion by suppressing the expression of tissue inhibitor of metalloproteinase-1 (TIMP-1), thus synergistically remodeling the microenvironment of liver fibrosis. Notably, an in vivo study in CCl₄-induced mice revealed that APNH NTs exhibited significant antifibrogenic effects without obvious long-term toxicity. Taken together, the data from this work suggest that treatment with the synthesized APNH NTs provides an enlightening strategy for remodeling the microenvironment of liver fibrosis with boosted antifibrogenic activity.

Clinical cases treated by magnetic compression anastomosis (MCA) for different causes and types of intestinal stenosis/ atresia to successfully achieve intestinal recanalization were reviewed, so as to explore the clinical application of MCA. From May 2019 to August 2022, 4 patients underwent colorectal MCA for intestinal recanalization in the First Affiliated Hospital of Xi'an Jiaotong University and Northwest Women and Children's Hospital. All operations went well, and the intestinal anastomosis was recanalized. The magnetic ring was discharged in 7-15 days, and the postoperative colonoscopy or radiography showed that the anastomosis was intact. MCA can be used to treat different types of colorectal stenosis and atresia due to different reasons, and can also be used to assist intestinal anastomosis in colorectal surgery.

【Objective】 To study the diagnostic value of balloon expulsion test, anorectal manometry, and colonic transit test for detecting constipation with defecation disorders. 【Methods】 Outpatients with functional constipation were retrospectively analyzed and classified into dyssynergic defecation constipation and non-dyssynergic defecation constipation according to the Rome Ⅳ diagnostic criteria. We studied the differences in symptomatological characteristics and results of the three testing methods between the two groups of patients. 【Results】 Among the 48 patients with functional constipation included, there were 13 males (27.1%) and 35 females (72.9%) with an age of (44.8±12.3) years, including 32 patients (66.7%) with defecation disorder and 16 patients (33.3%) with non-defecation disorder. The percentage of anal distension was significantly higher in patients with dyssynergic defecation constipation than in those with non-dyssynergic defecation constipation (34.4% vs. 0.0%, P=0.021). All the three tests had diagnostic value for dyssynergic defecation constipation, but with low diagnostic agreement between the results of each test. The diagnostic sensitivity of anorectal manometry was 100%, but the specificity (56.3%) was low, and both the positive predictive value (82.1%) and the negative predictive value (100%) were higher; the diagnostic sensitivity (75.0%) and specificity (81.3%) of the balloon expulsion test were both higher. The Youden index of colonic transit test was the smallest. The anal resting pressure and maximum systolic pressure of dyssynergic defecation constipation were lower than those of non-dyssynergic defecation constipation (75.2 mmHg vs. 97.1 mmHg, 168.7 mmHg vs. 251.6 mmHg). The two types of constipation did not significantly differ in anorectal pressure gradients during simulated defecation or rectal sensory function. 【Conclusion】 The balloon expulsion test can be used as a primary screening test for constipation with defecation disorders, and anorectal manometry has the highest comprehensive diagnostic value, but there is a certain false positive rate, and the colonic transit test has the lowest diagnostic efficacy. Thus a comprehensive analysis of the patient’s symptoms and the results of different tests is needed in clinical practice.

Objective To investigate the effect of body mass fluctuation on the prognosis of patients with atrial fibrillation.Methods The patients diagnosed with atrial fibrillation in the People′s Hospital of Xinjiang Uygur Autonomous Region from 2012 to 2014 were selected.Among the 540 patients,the patients were divided into normal body( BMI ≤ 25 kg／m2 ),overweight (25 kg／m2＜BMI＜30 kg／m2 ) and obesity (BMI ≥30 kg／m2) according to the baseline body mass.The median body mass fluctuation of the three groups was 2.40 kg,and according to the median body mass fluctuations,the patients were divided into two groups:the high body mass fluctuation group and the low body mass fluctuation group.Changes of body mass were observed and the incidence of cardiac death,acute coronary syndrome,chronic heart failure,cerebral embolism and peripheral vascular embolization were monitored.Results During the follow?up period,as the increased of body mass fluctuation,the incidence rate of end point events also increasing continuously.The main end point event was used as the composite end point (HR(95%CI): 1.03 (1.06～1.15); P＝0.02), including the cardiogenic death ( HR( 95%CI): 1.04 ( 1.09～1.12); P＝0.03),the incidence of acute coronary syndrome (HR(95%CI): 1.04 (0.96～1.08); P＝0.06) and the heart failure incidence ( HR (95%CI): 95%CI: 1.04 (1.01～1.09),P＝0.04).The secondary endpoint as composite endpoint ( HR (95%CI): 1.16 (1.15～1.31); P＝0.01),including the cerebral embolism (HR(95%CI): 1.21 (1.23～1.54); P＝0.01) and the peripheral vascular embolism (HR(95%CI): 1.03 (0.91～1.03); P＝0.01) .After adjusting for all confounding factors,the quartile group with the highest body mass fluctuations was 6.2% higher in the main endpoint event than the lowest body quartile and 14.2% higher in the secondary endpoint.The occurrence of major endpoint events and secondary endpoint events in the quadruple group with high body mass fluctuation was significantly higher than that in the quadruple group with the lowest body mass fluctuation(main endpoint: 4.4% vs 10.6%; ( HR ( 95%CI): 1.86 ( 1.53 ～ 2.41); P＜0.01;secondary endpoints: 15.6% vs 29.8%; ( HR ( 95%CI) 2.12 ( 1.56 ～ 3.58); P＜0.01).The main endpoint events were cardiogenic death (HR(95%CI): 1.85 (1.73～2.3); P＜0.01); incidence of acute coronary syndrome (HR(95%CI): 1.02 (0.94～1.35); P＝0.08); incidence of heart failure (HR(95%CI): 1.48 (1.28～1.62); P＜0.01); secondary endpoint events were cerebral embolism (HR(95%CI):2.23 (1.93～3.91).( P＜0.01),peripheral vascular embolism ( HR( 95%CI): 1.05 (0.96～1.42); P＝0.13).For patients with normal body mass,body mass fluctuations had no significant effect on prognosis (main endpoints: 6.1% vs 5.3%; (HR(95%CI): 1.04 (0.94 ～ 1.43); P＝0.064; secondary endpoint: 16.7% vs 17.4%; ( HR ( 95%CI): 1.12 ( 0.84～ 1.09); P＝0.072), but for overweight and obese patients,the greater the fluctuation of body mass,the higher the incidence of adverse events (main endpoint:super?recombination: 5.8% vs 11.2%; ( HR ( 95%CI): 1.532 ( 1.135 ～ 3.156); P＜0.001; obese group: 8.3% vs 15.1%; (HR(95%CI): 1.584 (1.258～3.489); P＜0.001; secondary end points: super recombination: 17.1% and 21.3%; (HR(95%CI): 341.00 ( 1.132～ 1.984); P＝0.013; obese group:19.4% and 25.2%; ( HR ( 95%CI): 1.315 ( 1.128～2.123); P＝ 0.018).Conclusion Body mass fluctuations can significantly affect the prognosis of patients with atrial fibrillation and has a greater impact on patients with overweight and obesity.