Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Rheumatoid arthritis （RA） is a chronic systemic autoimmune disease with complex pathogenesis， poor cure rate， long course of disease， and high disability rate， which seriously affects patients' quality of life. Western medicine treatment of RA mainly includes non-steroidal anti-inflammatory drugs， rheumatic drugs， glucocorticoids， biologics， and targeted small-molecule drugs， which have large side effects and many adverse reactions. Traditional Chinese medicine （TCM） has systematic， comprehensive， multi-target， and multi-mechanism advantages in the treatment of RA. Through the overall syndrome pattern identification， it is effective in relieving symptoms， delaying onset， and relieving pain in RA patients by dispelling wind and removing dampness， dissipating cold and dredging collaterals， clearing heat and removing toxin， resolving phlegm and removing blood stasis， and relaxing sinew and activating collaterals. In recent years， TCM has made remarkable progress in the intervention of RA by regulating the nuclear transcription factor-κB （NF-κB） signaling network. They include Toll-like receptor 4 （TLR4）， phosphoinositol 3 kinase （PI3K）/protein kinase B （Akt）， mitogen-activated protein kinase （MAPK）， Nod-like receptor protein 3 （NLRP3）， nuclear factor E₂ associated factor 2 （Nrf2）， Janus kinase 2 （JAK2）/signaling and transcriptional activator 3 （STAT3）， and Toll-like receptor 2 （TLR2）. The regulatory mechanism of NF-κB signaling network is complex： TLR4 is the upstream receptor of NF-κB， PI3K/Akt and MAPK pathways can not only regulate the activity of NF-κB， but also serve as its downstream effect pathway， Nrf2 and NF-κB often have antagonistic effects in the regulation of inflammatory response. Therefore， the research progress of regulating NF-κB signaling network by traditional Chinese medicine in the intervention of RA was summarized to provide a reference for the treatment of RA disease and the development of new drugs.

In Western developed countries,precision nuclear medicine diagnosis and treatment for neuroendocrine neoplasms(NENs)have been widely adopted in clinical practice.Over the past two decades,China has made significant progress in both research and clinical application of nuclear medicine-based NENs management.With internationally approved diagnostic and therapeutic agents soon entering the Chinese market and the ongoing clinical trials of domestically developed innovative drugs,there is an urgent need to establish standardized diagnostic and treatment guideline.To address this,the Chinese Society of Nuclear Medicine and the Chinese Neuroendocrine Tumor Society have collaborated to develop the Clinical Guideline for Precision Nuclear Medicine Diagnosis and Treatment of Neuroendocrine Neoplasms(2025 Edition).The guideline integrates the latest research advances and international recommendations with China's clinical practice,aiming to standardize and optimize NENs management through nuclear medicine in China.

OBJECTIVE To understand the healthcare-seeking behavior of patients with AIDS co-infected with tu-berculosis and analyze the factors influencing delayed consultation and diagnosis,and to provide a theoretical basis for the implementation of interventional tuberculosis control measures.METHODS Two hundred and two patients with AIDS complicated with tuberculosis who were first admitted to Yunnan Infectious Diseases Hospital from Jan.2020 to Dec.2023 were selected,and their clinical data were collected through the inpatient medical record system.Multivariate logistic regression model was used to analyze the factors influencing delayed consultation and diagnosis.RESULTS Time of admission,place of residence,presence of lung cavities,distribution of lung lesions,intermediate hospital visited,sputum culture results,etiological situation,CD4+/CD8+cell ratio,and CD8+cell counts were the factors influencing delayed consultation(P<0.05).The initial diagnosis and Gene-Xpert results were the factors influencing delayed diagnosis(P<0.05).Multivariate logistic regression analysis showed that ad-mission in 2021(OR=3.842,95%CI:1.651-8.966),and presence of lung cavity(OR=8.007,95%CI:1.381-6.436),single lung lesion accumulation(OR=0.637,95%CI:0.049-8.267)were risk factors for delayed consultation.A 10%reduction in body mass(OR=2.070,95%CI:1.056-4.059)and negative Gene-Xpert re-sults(OR=1.667,95%CI:0.688-4.038)were risk factors for delayed diagnosis.CONCLUSIONS The issues of delayed medical consultation and diagnosis in patients with AIDS complicated with tuberculosis remain severe,with different factors influencing the delay.Special attention should be paid to the screening for latent tuberculosis infection in people infected with HIV.When experiencing suspicious symptoms,patients should go be encouraged to take exams at designated tuberculosis hospitals,repeatedly collect sputum samples and monitor changes in body mass,all of which are positively significant in reducing delays.

Objective:To study the spatial distribution and characteristics of iodine content in residential drinking water in Shaanxi Province, and provide a basis for scientific prevention and control of iodine deficiency disorders.Methods:From March to October 2022, an investigation was conducted in all counties (districts, referred to as counties) of Shaanxi Province, with administrative villages as survey units. For centralized water supply systems, two terminal water samples were collected, and iodine content was measured separately, with the average value representing the drinking water iodine content at that location. For decentralized water supply systems, a 10% sampling method was used to divide each administrative village into five areas (east, south, west, north, and center), with 10% of water wells sampled from each area (if fewer than 10 water wells, the well with the largest drinking population was selected; if fewer than 5 wells, all wells were sampled). One water sample was collected from each water well, and iodine content was determined using the arsenic-cerium catalytic spectrophotometry method. Spatial autocorrelation and spatial scan analysis were used to analyze the spatial distribution and characteristics of drinking water iodine content.Results:A total of 53 990 drinking water samples were collected, with a median water iodine content of 6.66 μg/L, ranging from 0.10 to 779.40 μg/L. Drinking water iodine content was detected in 112 counties, showing a significant spatial positive correlation (global autocorrelation, Moran's I = 0.74, Z = 43.83, P < 0.001). Local autocorrelation analysis showed that the difference in the distribution of iodine content in drinking water among 36 counties was statistically significant ( P < 0.05), with 22 counties showing low-low clustering and 12 counties showing high-high clustering. Spatial scanning identified three water iodine clustering areas, including two high-water iodine cluster areas and one low-water iodine cluster area. Conclusions:The distribution of iodine content in residential drinking water in Shaanxi Province shows significant spatial clustering and heterogeneity, requiring targeted interventions to achieve precise prevention and control of iodine deficiency disorders.

Objective To investigate iodine content in drinking water and clarify the distribution characteristics of iodine in water in Shaanxi Province.Methods A cross-sectional survey method was used to collect water samples from administrative villages in the province.Two tap water samples were taken from the centralized water supply villages,and 10％samples were taken from the decentralized water supply villages.Water iodine was detected by arsenic cerium catalytic spectrophotometry.Water iodine areas were divided according to national standards:＜40 μg/L was iodine deficiency area,40-100 μg/L was iodine adequate area,＞100 μg/L was high iodine area.According to the ecological regionification scheme of the Chinese Academy of Sciences,Shaanxi Province was divided into three types:the central and eastern Inner Mongolia Platea-Loess Plateau ecological region,the Fenwei Basin ecological region,and the Qinba Mountains ecological region.SPSS 25.0 was used for statistical analysis.Results The median of water iodine in Shaanxi Province was 6.66 μg/L.The survey of water iodine content was conducted in 22 848 administrative villages,1 309 townships,112 counties and 14 municipalities in the whole province.The median water iodine was less than 40 μg/L in 91.75％(20 963/22 848)of the administrative villages,between 40 and 100 μg/L in 7.40％(1 691/22 848)of the administrative villages,and more than 100 μg/L in 0.85％(194/22 848)of the administrative villages.The median of water iodine in the central and eastern Inner Mongolia Platea-Lose Plateau ecological zone,the Fenwei Basin ecological zone,and Qinba Mountains ecological zone was 12.35,8.88,and 2.00 μg/L,respectively,and the differences among different ecological zones were statistically significant(H=6 616.23,P＜0.001).The median of water iodine of centralized and decentralized water supply was 6.72 and 6.21 μg/L,respectively,and differences between different water supply methods were statistically significant(Z=5.638,P＜0.01).Conclusion The overall external environment of Shaanxi Province is iodine deficient,and most of the administrative villages are iodine deficient areas.There are a certain proportion of high iodine water source areas and suitable iodine areas.

In Western developed countries,precision nuclear medicine diagnosis and treatment for neuroendocrine neoplasms(NENs)have been widely adopted in clinical practice.Over the past two decades,China has made significant progress in both research and clinical application of nuclear medicine-based NENs management.With internationally approved diagnostic and therapeutic agents soon entering the Chinese market and the ongoing clinical trials of domestically developed innovative drugs,there is an urgent need to establish standardized diagnostic and treatment guideline.To address this,the Chinese Society of Nuclear Medicine and the Chinese Neuroendocrine Tumor Society have collaborated to develop the Clinical Guideline for Precision Nuclear Medicine Diagnosis and Treatment of Neuroendocrine Neoplasms(2025 Edition).The guideline integrates the latest research advances and international recommendations with China's clinical practice,aiming to standardize and optimize NENs management through nuclear medicine in China.

Objective To explore the changes in serum microRNA-210(miR-210)and hypoxia-inducible factor(HIF-1α)levels before and after endovascular treatment in patients with acute ischemic stroke(AIS).Methods A total of 60 AIS patients admitted to the Neurology Depart-ment of Xining First People's Hospital from January 2023 to March 2024 were recruited,and based on the modified Rankin Scale(mRS)score in 3 months after onset,they were divided into a good prognosis group(41 cases,mRS score:0-2)and a poor prognosis group(19 cases,mRS score:3-6).Serum levels of miR-210 and HIF-1α were measured and compared before treatment,and at 3 and 7 d after treatment,and the levels were also compared between the good and poor prognosis groups before treatment and at 3 and 7 d after treatment.Spearman correlation analysis was used to evaluate the relationship between prognosis and serum miR-210 and HIF-1α levels in AIS patients.ROC curve analysis was performed to assess the predictive value of serum miR-210 and HIF-1α levels for prognosis.Results The serum levels of miR-210 and HIF-1α were significantly increased in the AIS patients at 3 and 7 d after treatment than those before(P＜0.05),with the miR-210 level at 7 d obviously higher than that at 3 d,and the HIF-1α level at 7 d notably lower than that at 3 d(P＜0.05).Spearman correlation analysis revealed a negative correlation between pre-treatment serum miR-210 level and prognosis(r=-0.271,P＜0.05),while a positive correla-tion between pre-treatment serum HIF-1α level and prognosis(r=0.398,P＜0.05).The expres-sion levels of miR-210 and HIF-1αwere significantly higher in the poor prognosis group than the good prognosis group(P＜0.01).ROC curve analysis indicated that the AUC value of miR-210 and HIF-1α in predicting prognosis was 0.818 and 0.815,with a specificity of 0.850 and 0.700,and a sensitivity of 0.800 and 0.800,respectively,and the AUC value of the two indicators combined together was 0.880,and the sensitivity was 0.900,significantly better than the single indicator(P＜0.01).Conclusion Post-treatment serum miR-210 and HIF-1α levels are closely related to mRS score in AIS patients.Their combined detection can improve the predictive accuracy for prognosis.

Objective To explore the changes in serum microRNA-210(miR-210)and hypoxia-inducible factor(HIF-1α)levels before and after endovascular treatment in patients with acute ischemic stroke(AIS).Methods A total of 60 AIS patients admitted to the Neurology Depart-ment of Xining First People's Hospital from January 2023 to March 2024 were recruited,and based on the modified Rankin Scale(mRS)score in 3 months after onset,they were divided into a good prognosis group(41 cases,mRS score:0-2)and a poor prognosis group(19 cases,mRS score:3-6).Serum levels of miR-210 and HIF-1α were measured and compared before treatment,and at 3 and 7 d after treatment,and the levels were also compared between the good and poor prognosis groups before treatment and at 3 and 7 d after treatment.Spearman correlation analysis was used to evaluate the relationship between prognosis and serum miR-210 and HIF-1α levels in AIS patients.ROC curve analysis was performed to assess the predictive value of serum miR-210 and HIF-1α levels for prognosis.Results The serum levels of miR-210 and HIF-1α were significantly increased in the AIS patients at 3 and 7 d after treatment than those before(P＜0.05),with the miR-210 level at 7 d obviously higher than that at 3 d,and the HIF-1α level at 7 d notably lower than that at 3 d(P＜0.05).Spearman correlation analysis revealed a negative correlation between pre-treatment serum miR-210 level and prognosis(r=-0.271,P＜0.05),while a positive correla-tion between pre-treatment serum HIF-1α level and prognosis(r=0.398,P＜0.05).The expres-sion levels of miR-210 and HIF-1αwere significantly higher in the poor prognosis group than the good prognosis group(P＜0.01).ROC curve analysis indicated that the AUC value of miR-210 and HIF-1α in predicting prognosis was 0.818 and 0.815,with a specificity of 0.850 and 0.700,and a sensitivity of 0.800 and 0.800,respectively,and the AUC value of the two indicators combined together was 0.880,and the sensitivity was 0.900,significantly better than the single indicator(P＜0.01).Conclusion Post-treatment serum miR-210 and HIF-1α levels are closely related to mRS score in AIS patients.Their combined detection can improve the predictive accuracy for prognosis.

Objective:To study the spatial distribution and characteristics of iodine content in residential drinking water in Shaanxi Province, and provide a basis for scientific prevention and control of iodine deficiency disorders.Methods:From March to October 2022, an investigation was conducted in all counties (districts, referred to as counties) of Shaanxi Province, with administrative villages as survey units. For centralized water supply systems, two terminal water samples were collected, and iodine content was measured separately, with the average value representing the drinking water iodine content at that location. For decentralized water supply systems, a 10% sampling method was used to divide each administrative village into five areas (east, south, west, north, and center), with 10% of water wells sampled from each area (if fewer than 10 water wells, the well with the largest drinking population was selected; if fewer than 5 wells, all wells were sampled). One water sample was collected from each water well, and iodine content was determined using the arsenic-cerium catalytic spectrophotometry method. Spatial autocorrelation and spatial scan analysis were used to analyze the spatial distribution and characteristics of drinking water iodine content.Results:A total of 53 990 drinking water samples were collected, with a median water iodine content of 6.66 μg/L, ranging from 0.10 to 779.40 μg/L. Drinking water iodine content was detected in 112 counties, showing a significant spatial positive correlation (global autocorrelation, Moran's I = 0.74, Z = 43.83, P < 0.001). Local autocorrelation analysis showed that the difference in the distribution of iodine content in drinking water among 36 counties was statistically significant ( P < 0.05), with 22 counties showing low-low clustering and 12 counties showing high-high clustering. Spatial scanning identified three water iodine clustering areas, including two high-water iodine cluster areas and one low-water iodine cluster area. Conclusions:The distribution of iodine content in residential drinking water in Shaanxi Province shows significant spatial clustering and heterogeneity, requiring targeted interventions to achieve precise prevention and control of iodine deficiency disorders.