Objective To provide a comprehensive and multi-dimensional objective assessment of the online medi-cal service quality supplied by public hospitals in China,and providing feasible suggestions for further improving.Methods It adopted a standardized patient method and relied on the IOM model to conduct a descriptive analy-sis of the online medical service quality from the perspectives of safety and effectiveness,efficiency,patient-cen-tered care,and accessibility.Results The process quality(adherence to checklist)in public hospital was 17.65％,the diagnostic accuracy was 66.04％,and the treatment correctness was 88.68％.The average consultation fee was 50 yuan.The patients'disease experience was 4.00 points,the social situation was 0,and the agreement between the physician and the patient was 12.00 points.The average time waiting for first response was about 1.60 hours,the average time waiting for each response was about 5.14 hours,and the patient's total time was about 20.32 hours.The time for response was 3,and the total words of providers was 149.50.Conclusion Internet medical ser-vices quality in public hospital are still insufficient in three aspects:the process quality(adherence to checklist),pa-tient-centered care,and accessibility.Improving online medical service quality can be achieved by strengthening"in-process supervision"and improving physicians'comprehensive clinical ability.

With the accelerated progress of population aging and the shift in the disease spectrum, the prevention and management of chronic diseases and multimorbidity are facing great challenges. Multimorbidity measurement is a process that assesses and quantifies the complexity and severity of multiple disease states in a population, which is of great significance for understanding the epidemiology and disease burden of multimorbidity, as well as for optimizing medical services and policy. This article reviews existing multimorbidity measurement indicators, tools, and applications from two dimensions, static and dynamic attributes, aiming to improve the accuracy and comprehensiveness of multimorbidity epidemiology, diagnosis, and treatment.

Objective:To observe the protective effect of Jinbuhuan Jianwei Jiedu Decoction on gastric mucosa of rats with chronic atrophic gastritis (CAG); To explore its mechanism through the farnesyl ester X receptor (FXR)/G protein bile acid coupled receptor 5 (TGR5) pathway.Methods:Wistar rats were randomly divided into normal control group, model group, folic acid group, low-, medium-, and high-dosage groups, with 10 rats in each group. Except for the normal control group, the other rats were used to establish a CAG model by alternate gavage of 2% sodium salicylate+20 mmol/L sodium deoxycholate+methylnitrosoguanidine (MNNG) for free consumption. The folic acid group was treated with 1.43 mg/kg by gavage, while the low-, medium-, and high-dosage groups were treated with 9.68, 19.35 and 38.7 g/kg of Jinbuhuan Jianwei Jiedu Decoction by gavage, once a day, for 12 weeks. The gastric mucosal blood flow and histopathological changes in each group of rats were observed. Rat gastric juice was collected, and gastric juice pH and pepsin activity were detected. ELISA method was used to detect the levels of serum tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and total bile acid (TBA). Western-blot and RT-PCR were used to detect the protein and mRNA levels of FXR, TGR5, CDX2 and SOX2 in gastric mucosal tissue.Results:Compared with the normal control group, the gastric mucosal blood flow and pepsin activity in the low-, medium-, and high-dosage groups increased significantly, and the pH value of gastric juice of medium-, and high-dosage groups decreased ( P<0.05). The levels of TNF-α, IL-6, TBA in serum of low-, medium-, and high-dosage groups decreased ( P<0.05); and FXR, TGR5, CDX2 in gastric mucosal tissue decreased, while the protein expression of SOX2 increased ( P<0.05). Conclusion:Jinbuhuan Jianwei Jiedu Decoction has a repairing effect on gastric function and mucosal lesions in CAG rats. Its mechanism may be related to the inhibition of abnormal activation of FXR/TGR5 pathway, regulation of bile acid and inflammatory mediator secretion.

With the accelerated progress of population aging and the shift in the disease spectrum, the prevention and management of chronic diseases and multimorbidity are facing great challenges. Multimorbidity measurement is a process that assesses and quantifies the complexity and severity of multiple disease states in a population, which is of great significance for understanding the epidemiology and disease burden of multimorbidity, as well as for optimizing medical services and policy. This article reviews existing multimorbidity measurement indicators, tools, and applications from two dimensions, static and dynamic attributes, aiming to improve the accuracy and comprehensiveness of multimorbidity epidemiology, diagnosis, and treatment.

Objective To provide a comprehensive and multi-dimensional objective assessment of the online medi-cal service quality supplied by public hospitals in China,and providing feasible suggestions for further improving.Methods It adopted a standardized patient method and relied on the IOM model to conduct a descriptive analy-sis of the online medical service quality from the perspectives of safety and effectiveness,efficiency,patient-cen-tered care,and accessibility.Results The process quality(adherence to checklist)in public hospital was 17.65％,the diagnostic accuracy was 66.04％,and the treatment correctness was 88.68％.The average consultation fee was 50 yuan.The patients'disease experience was 4.00 points,the social situation was 0,and the agreement between the physician and the patient was 12.00 points.The average time waiting for first response was about 1.60 hours,the average time waiting for each response was about 5.14 hours,and the patient's total time was about 20.32 hours.The time for response was 3,and the total words of providers was 149.50.Conclusion Internet medical ser-vices quality in public hospital are still insufficient in three aspects:the process quality(adherence to checklist),pa-tient-centered care,and accessibility.Improving online medical service quality can be achieved by strengthening"in-process supervision"and improving physicians'comprehensive clinical ability.

Objective:To explore the value of the amyloid-tau-neurodegeneration (ATN) framework in neuroimaging based on PET for diagnosing mild cognitive impairment (MCI) and Alzheimer′s disease (AD), and analyze its relationship with clinical cognition.Methods:From May 2022 to March 2024, a total of 98 cases (23 males and 75 females, age (67.8±8.6) years) with a diagnosis of AD, MCI, or non-AD (control patients, CP) who underwent 18F-FDG, 18F-AV45, and 18F-AV1451 PET/CT imaging in the Second Affiliated Hospital of Guangzhou Medical University were included retrospectively. The clinical data, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) scores were recorded. Cases were divided into MCI group, mild AD group, moderate AD group, moderate-severe AD group, and CP group. PET images were visually and semi-quantitatively evaluated. SUV mean and SUV ratio (SUVR) were obtained from independent brain regions of 18F-FDG ( n=8), 18F-AV45 ( n=14) and 18F-AV1451 ( n=14). ROC curve analysis was performed with clinical diagnosis as a criterion. The consistency between visual assessment and the clinical diagnosis was analyzed by Cohen′s Kappa coefficient. Semi-quantitative comparisons between groups were performed using the independent-sample t test, one-way analysis of variance, Mann-Whitney U test, or Kruskal-Wallis rank sum test. Age was used as a covariate to calculate the partial correlation coefficient between SUVR and cognitive scores. Results:The sensitivity and specificity of comprehensive visual assessment in diagnosing AD+ MCI were 87.65%(71/81) and 14/17 respectively, showing a moderate consistency with clinical diagnosis ( Kappa=0.60, P<0.001). Semi-quantitative analysis showed that 18F-FDG uptakes in all independent brain regions of MCI patients were higher than those of AD patients, whereas the uptakes of 18F-AV45 and 18F-AV1451 were lower ( t values: 2.66-3.95, z values: 4.98-15.04, all P<0.05). The difference in 18F-AV45 uptake among the three subgroups of AD was relatively small ( H values: 0.46-4.06, F values: 0.03-0.08, all P>0.05). Except for the medial temporal and occipital lobes, the 18F-AV1451 uptake in the moderate-severe AD group tended to be higher than that in the moderate and mild AD groups, though not statistically significant ( H values: 0.20-5.17, all P>0.05). 18F-FDG PET semi-quantitatively distinguished MCI from CP with a high sensitivity (13/14), 18F-AV45 demonstrated a high sensitivity for diagnosing AD+ MCI (92.59%, 75/81), and 18F-AV1451 had a high specificity for distinguishing AD from MCI (14/14) (AUCs: 0.87, 0.90 and 0.92). The uptakes of 18F-FDG in gray matter of AD and MCI patients were positively correlated with MMSE and MoCA scores ( r values: 0.30-0.43, 0.29-0.45, all P<0.05), while the uptakes of 18F-AV45 and 18F-AV1451 were negatively correlated with MMSE and MoCA scores ( 18F-AV45, r values: from -0.39 to -0.30, from -0.38 to -0.30, all P<0.05; 18F-AV1451, r values: from -0.50 to -0.28, from -0.53 to -0.28, except for medial temporal lobe P>0.05, all others P<0.05). Conclusion:The PET-based neuroimaging ATN framework is helpful for early diagnosis of MCI and AD, as well as for AD staging, and may reflect the disease progression and clinical cognitive status of AD to a certain extent.

Objective To comprehensively review the clinical research on the treatment of hyperlipidemia with traditional Chinese Medicine(TCM)through the evidence mapping,and to understand the distribution of evidence in this field. Methods Databases including CNKI,Wangfang,VIP,SinoMed,PubMed,Cochrane Library,and Embase were searched from January 2004 to December 2023 to collect clinical studies,systematic reviews/meta-analyses,guidelines and clinical pathways related to the treatment of hyperlipidemia with TCM. The results were analyzed and displayed in charts and graphs according to the screening criteria,and the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis of Chinese herbal medicine (PRISMA-CHM) were used to evaluate the quality of the systematic review/meta-analysis. Results A total of 1223 studies were included in the analysis according to Population,Intervention,Comparison,Outcome and Study design(PICOS) principles,involving 920 RCTs,249 non-RCTs,49 systematic reviews/meta-analyses,and 5 guidelines/expert consensus. In recent years,the overall number of clinical research publications has shown a downward trend. Hyperlipidemia frequently occurs in middle-aged and elderly people,and age of onset tends to be younger. The sample size of randomized controlled studies is mostly concentrated in 60-300 cases. There are many types of clinical treatment regimens for the treatment of hyperlipidemia with TCM,among which TCM decoction (50.13％) and Chinese patent medicine (38.41％) account for a relatively high proportion,and TCM exercise therapy (0.51％) is the lowest treatment. Jiangzhi Decoction has attracted more attention in trial group of TCM decoction,while Xuezhikang Capsule has attracted more attention in trial group of Chinese patent medicine. In terms of methodological design,199 papers(21.63％) explicitly mentioned the method of generating random sequence,17 papers(1.85％) mentioned allocation concealment,37 papers (4.02％) mentioned blinding. The control group was dominated by the statins,including simvastatin and atorvastatin. The outcome indicators mainly include the total effective rate,TCM syndrome score,blood lipid level,coagulation index,and adverse reactions,while the attention of TCM characteristic efficacy,inflammation,oxidative stress,and vascular endothelial index were low. The methodological and reporting quality of the systematic review/Meta-analysis were generally not high. AMSTAR-2 evaluation was extremely low,and the average PRISMA-CHM score was 15. Conclusion TCM has certain advantages in the treatment of hyperlipidemia,but there is a lack of high-quality evidence-based proof,and more high-quality clinical studies are still needed to further provide evidence supports in the future. It has been suggested that more large-sample and multi-center clinical studies should be carried out in the future. We should formulate systematic reviews/Meta analysis and guidelines/expert consensus according to the guidelines of clinical practice issues,also consult international standards and regulations,enhance normativity and reliability to improve the quality of their evidence.

In order to clarify the transmission mechanism of the impact of mechanization on the occupational health of miners and to provide empirical evidence for the development of new quality productivity in the coal industry that balances health and efficiency. In August 2022, we selected a typical coal mine, constructed a comprehensive evaluation index of miners' occupational health through a questionnaire survey based on the fully connected neural network model. A Bayesian model was used to verify the influence of mechanization level on miners' occupational health. We found that: the predicted probability of occupational diseases could be used as a comprehensive indicator of the level of occupational health, providing a basis for early intervention and prevention of occupational diseases. Mechanization could directly promote the improvement of miners' occupational health level, and also indirectly affect occupational health level by influencing hazards level and work intensity. The indirect effect of mechanization on work intensity was positive, and the indirect effect of mechanization on hazards level was positive. Presented the "inverted U-shaped" process in the mechanization breakthrough semi-mechanized level would realize the economies of scale of health protection, its impact on the prevention and control of occupational hazards would turn from negative to positive.

Objective:To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity.Methods:Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95% CI to evaluate the association between SES and the progression of multimorbidity. Results:Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95% CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95% CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases ( OR=1.45, 95% CI: 1.11-1.89), cognitive disorder ( OR=1.84, 95% CI: 1.16-2.91), physical-psychological multimorbidity ( OR=1.87, 95% CI: 1.37-2.56), physical-cognitive multimorbidity ( OR=3.58, 95% CI: 2.54-5.06), psychological-cognitive multimorbidity ( OR=5.66, 95% CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity ( OR=3.21, 95% CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions:The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.

In order to clarify the transmission mechanism of the impact of mechanization on the occupational health of miners and to provide empirical evidence for the development of new quality productivity in the coal industry that balances health and efficiency. In August 2022, we selected a typical coal mine, constructed a comprehensive evaluation index of miners' occupational health through a questionnaire survey based on the fully connected neural network model. A Bayesian model was used to verify the influence of mechanization level on miners' occupational health. We found that: the predicted probability of occupational diseases could be used as a comprehensive indicator of the level of occupational health, providing a basis for early intervention and prevention of occupational diseases. Mechanization could directly promote the improvement of miners' occupational health level, and also indirectly affect occupational health level by influencing hazards level and work intensity. The indirect effect of mechanization on work intensity was positive, and the indirect effect of mechanization on hazards level was positive. Presented the "inverted U-shaped" process in the mechanization breakthrough semi-mechanized level would realize the economies of scale of health protection, its impact on the prevention and control of occupational hazards would turn from negative to positive.