Objective To develop a nomogram-based predictive model for assessing the risk of respiratory distress syndrome(RDS)in premature infants in the high-altitude region of Dali.The predictive performance and clinical applicability of the model will be systematically evaluated to provide evidence-based guidance for the early diagnosis and clinical management of respiratory distress in premature infants.Methods A total of 680 preterm infants admitted to the Dali Maternal and Child Health Hospital between January 2020 and December 2024 were enrolled in the study and randomly divided into a training set(n=476)and a validation set(n=204)at a ratio of 7∶3.Independent predictors were identified through univariate logistic regression and multivariate stepwise regression analyses,and a nomogram model was subsequently developed using R software.The performance of the model,including its discrimination,calibration,stability,and clinical applicability,was evaluated using the receiver operating characteristic curve(ROC),Hosmer-Lemeshow goodness-of-fit test,bootstrap resampling method,and decision curve analysis(DCA).Results The final model incorporated seven independent variables:gestational age,birth weight,Apgar score,blood oxygen saturation,gestational hyperglycemia,prenatal glucocor-ticoid therapy,and maternal history of infection.The areas under the curve(AUCs)for the training and validation sets were 0.88(95%CI:0.84～0.92)and 0.83(95%CI:0.76～0.89),respectively,with all Hosmer-Lemeshow test p-values exceeding 0.05.The bootstrap-corrected AUC was 0.85(95%CI:0.81～0.89).DCA indicated that the model achieved the highest net benefit at a risk threshold range of 10%to 35%.Conclusions This model integrates multiple risk factors associated with the occurrence of RDS in plateau environments,demonstrating robust predictive performance for RDS in preterm infants residing in high-altitude areas such as Dali.It can serve as a valuable tool for risk stratification and clinical decision-making,and may also provide a reference for future multicenter prospective studies.

Objective To investigate the CT imaging manifestations of tumor-like proliferation of extramedullary hematopoiesis(EMH)in thalassemia(TM).Methods A retrospective analysis was conducted on the clinical data of 41 patients with tumor-like proliferation of EMH in TM.The CT imaging features of the patients were analyzed,including the location,lesion morphology,density,and degree of enhancement of the lesions.Results Lesions of varying sizes were identified on both sides of the thoracic vertebrae in all 41 cases,including 20 cases with lesions in the inner edge of the ribs and 1 case within the spinal epidural space.A total of 23 abdominal scans and 2 lumbar scans,lesions were found in the sacral region in 18 cases,primarily in the presacral area and sacral wings.Lesions adjacent to the thoracic paravertebral and in the sacral region were quasi-circular,while those on the ribs were quasi-circular or flat and mound-shaped,closely adhering to the inner edge of the ribs.Intraspinal epidural lesions were characterized by a longitudinal orientation,positioned adjacent to the posterior part of the thoracic spinal canal.Most lesions showed homogeneous moderate density.Bone erosion was observed in 14 rib lesions and 7 sacral region lesions,resulting in heterogeneous slightly high density shadow of the lesions.Small nodular high density shadow were identified in 4 cases,and small amounts of fatty density shadow were observed in 4 cases.20 cases showed mild-to-moderate enhancement on enhanced scan,and 11 cases showed"vascular traversal sign"in thoracic paravertebral lesions.Conclusion The CT manifestations of tumor-like proliferation of EMH in TM are characteristic.The combination of typical CT manifestations and medical history facilitates an accurate diagnosis.Indicators such as fat replacement,iron deposition nodules,bone erosion,and"vascular traversal sign"are valuable in the diagnosis of tumor-like proliferation of EMH.

Objective To develop a nomogram-based predictive model for assessing the risk of respiratory distress syndrome(RDS)in premature infants in the high-altitude region of Dali.The predictive performance and clinical applicability of the model will be systematically evaluated to provide evidence-based guidance for the early diagnosis and clinical management of respiratory distress in premature infants.Methods A total of 680 preterm infants admitted to the Dali Maternal and Child Health Hospital between January 2020 and December 2024 were enrolled in the study and randomly divided into a training set(n=476)and a validation set(n=204)at a ratio of 7∶3.Independent predictors were identified through univariate logistic regression and multivariate stepwise regression analyses,and a nomogram model was subsequently developed using R software.The performance of the model,including its discrimination,calibration,stability,and clinical applicability,was evaluated using the receiver operating characteristic curve(ROC),Hosmer-Lemeshow goodness-of-fit test,bootstrap resampling method,and decision curve analysis(DCA).Results The final model incorporated seven independent variables:gestational age,birth weight,Apgar score,blood oxygen saturation,gestational hyperglycemia,prenatal glucocor-ticoid therapy,and maternal history of infection.The areas under the curve(AUCs)for the training and validation sets were 0.88(95%CI:0.84～0.92)and 0.83(95%CI:0.76～0.89),respectively,with all Hosmer-Lemeshow test p-values exceeding 0.05.The bootstrap-corrected AUC was 0.85(95%CI:0.81～0.89).DCA indicated that the model achieved the highest net benefit at a risk threshold range of 10%to 35%.Conclusions This model integrates multiple risk factors associated with the occurrence of RDS in plateau environments,demonstrating robust predictive performance for RDS in preterm infants residing in high-altitude areas such as Dali.It can serve as a valuable tool for risk stratification and clinical decision-making,and may also provide a reference for future multicenter prospective studies.

Objective To investigate the CT imaging manifestations of tumor-like proliferation of extramedullary hematopoiesis(EMH)in thalassemia(TM).Methods A retrospective analysis was conducted on the clinical data of 41 patients with tumor-like proliferation of EMH in TM.The CT imaging features of the patients were analyzed,including the location,lesion morphology,density,and degree of enhancement of the lesions.Results Lesions of varying sizes were identified on both sides of the thoracic vertebrae in all 41 cases,including 20 cases with lesions in the inner edge of the ribs and 1 case within the spinal epidural space.A total of 23 abdominal scans and 2 lumbar scans,lesions were found in the sacral region in 18 cases,primarily in the presacral area and sacral wings.Lesions adjacent to the thoracic paravertebral and in the sacral region were quasi-circular,while those on the ribs were quasi-circular or flat and mound-shaped,closely adhering to the inner edge of the ribs.Intraspinal epidural lesions were characterized by a longitudinal orientation,positioned adjacent to the posterior part of the thoracic spinal canal.Most lesions showed homogeneous moderate density.Bone erosion was observed in 14 rib lesions and 7 sacral region lesions,resulting in heterogeneous slightly high density shadow of the lesions.Small nodular high density shadow were identified in 4 cases,and small amounts of fatty density shadow were observed in 4 cases.20 cases showed mild-to-moderate enhancement on enhanced scan,and 11 cases showed"vascular traversal sign"in thoracic paravertebral lesions.Conclusion The CT manifestations of tumor-like proliferation of EMH in TM are characteristic.The combination of typical CT manifestations and medical history facilitates an accurate diagnosis.Indicators such as fat replacement,iron deposition nodules,bone erosion,and"vascular traversal sign"are valuable in the diagnosis of tumor-like proliferation of EMH.

Objective Based on the secreted frizzled-related protein 2(SFRP2)-Wnt/β-catenin signaling pathway,this study explored the effect and mechanism of Cuiru Keli(CRKL)in the treatment of postpartum hypogalactia.Methods A rat model of postpartum hypogalactia was established by gavaging 2 mL of 1.6 mg/mL bromocriptine mesylate to female rats on the third day after delivery.Female rats with a delivery time difference of less than 48 hours were selected and randomly assigned to 7 groups,including a normal group(without any modeling or medication),a model group,a CRKL low-dose group of model group model rats receiving CRKL at the dose of 3 g/kg,a CRKL medium-dose group of model rats receiving CRKL at the dose of 6 g/kg,a CRKL high-dose group of model rats receiving CRKL at the dose of 9 g/kg,a positive drug group of model rats receiving domperidone at the dose of 3 mg/kg,and a negative control(NC)group of model rats receiving normal saline.Each group contained 6 rats.Except for the normal and model groups,the remaining 5 groups were continuously administered with the respective intervention drugs at the specified doses by gavage once a day for 10 days.Changes in the total litter mass of the offspring in the 7 groups within 10 days were measured,and HE staining was performed to identify pathological changes in the mammary tissue(MT).Six groups of rats(excluding the positive control group)were used to observe the pathological changes of eosinophils in pituitary tissue.ELISA was performed to determine the content of prolactin(PRL)in serum,immunohistochemical staining was used to determine the expression of prolactin receptor(PRLR)in MT,and RT-qPCR was used to determine the mRNA expression of genes related to lactation in MT.Network pharmacology and molecular docking were used to study the therapeutic effect and mechanism of CRKL on postpartum hypogalactia,particularly whether it acted through the SFRP2-Wnt/β-catenin signaling pathway.The mechanism of CRKL treatment was further validated by detecting mRNA(RT-qPCR)and protein expression(Western blot)of related pathway genes.Cell experiments were conducted using primary culture rat mammary epithelial cells(RMEC)from rat MT.RMEC were divided into four groups,including a normal group(primary culture RMEC,untreated),SFRP2 overexpression group(primary cultured RMEC treated with SFRP2 overexpression vector),SFRP2 overexpression+CRKL group(receiving treatment for SFRP2 overexpression group plus 10% drug-containing serum),and negative control group(primary culture RMEC treated with empty vector).The effect of CRKL on the expression of lactation-related genes FASN,CSN2,and GLUT1 mRNA after SFRP2 overexpression was detected by RT-qPCR.Results In this study,CRKL was administered at a dose of 3 g/kg in the CRKL low-dose group,6 g/kg in the medium-dose group,and 9 g/kg in the high-dose group(P<0.05 or P<0.01).Compared with the model group,CRKL at all doses significantly increased the total litter weight gain of the offsprings within 10 days(P<0.05 or P<0.01),and effectively increased lactation(P<0.01),the area of mammary lobules,and the size and filling of acinar cavities.CRKL at all doses also increased the number of eosinophils that secreted PRL in the pituitary gland of the postpartum hypogalactia rat model,and increased the content of PRL in the serum(P<0.05 or P<0.01).CRKL promoted the secretion and expression of PRL in postpartum hypogalactic model rats.In addition,it significantly promoted the expression of genes related to milk fat,milk protein,and lactose synthesis in MT(P<0.05 or P<0.01).Network pharmacology predicted that the Wnt signaling pathway might be a key pathway for CRKL in treating postpartum hypogalactia.The molecular docking results showed that related chemical components in CRKL had good binding ability with CCND1 and SFRP2.Compared with the model group,CRKL at all doses inhibited the expression of SFRP2 gene in vivo(P<0.01)and activated the mRNA and protein expression of CCND1 and c-Myc in the Wnt/β-catenin signaling pathway in MT(P<0.05 or P<0.01).Cell experiments showed that,compared to the normal group,SFRP2 overexpression reduced the mRNA expression of milk synthesis-related genes FASN,CSN2,and GLUT1 in RMEC(P<0.01).The CCK8 results indicated that 10% of the drug-containing serum was the effective concentration administered to cells(P<0.01).After administering drug-containing serum,the expression of the lactation-related genes FASN,CSN2,and GLUT1 were up-regulated(compared with the SFRP2 overexpression group,P<0.01).Conclusion CRKL alleviates postpartum hypogalactia through the SFRP2-Wnt/β-catenin signaling pathway.SFRP2 might be a potential new target for the diagnosis and treatment of postpartum hypogalactia.This reveals a new mechanism of CRKL in treating postpartum hypogalactia and promotes its clinical application.

Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.

AIM: To investigate the effect of an effective component total sterone (TSR) of Echinops latifolius Tausch, the main component of a Chinese patent medicine Cuiru Keli (national drug standard WS3-413 (Z-085)-2003 (Z), on lactation and its possible mechanism. METHODS: After mating between male and female SD rats, 60 female rats were randomly divided into normal control group, model group, TSR low-dose and high-dose groups and prolactin granule positive control group, with 12 female rats in each group and 8 newborn rats in each nest. In addition to the normal control group, the rats in each group were intraperitoneally injected with levodopa 2 mg/kg once a day for 7 days from the second day of delivery. The rats in the normal control group were given normal saline by gavage once a day for 14 days. From the beginning of self-sufficiency, the single lactation of the female rats was measured every day until the 14th day, and then the female rats in each group were killed. Pathological HE staining was used to observe the morphological changes of mammary gland tissue in each group. ELISA was used to detect the levels of serum prolactin (PRL) and 5-hydroxytryptamine (5-HT). Immunohistochemistry was used to detect the distribution of PRL in mammary gland tissue of each group. Furthermore, Real-time qPCR was used to detect the expression of milk protein, milk fat related genes β-casein, FAS, ACC and the expression of canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2 in mammary gland of each group. RESULTS: Both low and high dose TSR could significantly increase the single lactation volume, improve the pathological morphology of mammary gland, and increase the serum levels of PRL and 5-HT. TSR increased the distribution of PRL and up-regulated the expression of milk protein, milk fat related genes β-casein, FAS, ACC and canonical Wnt signaling pathway related genes β-catenin, c-Myc, CCND1, SFRP4, DNMT1, MeCP2.CONCLUSION: TSR can significantly promote lactation in lactation deficient rats, and its mechanism may be related to promoting the release of PRL and 5-HT in serum, increasing the distribution of PRL in mammary gland, up-regulating the milk protein and milk fat related genes and activating the canonical Wnt signal.

Objective:To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods:A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who underwent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019，including 160 males and 66 females，with the age of 18 to 85 years ［（49.5 ± 16.3）years］. According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology，there were 118 patients with tracheostomy within 7 days of tracheal intubation （early group） and 104 patients with tracheostomy after 7 days of tracheal intubation （late group） before matching，and there were 87 patients in early group and 87 patients in late group after matching. Data were compared between groups including the gender，age，underlying disease，injury severity score （ISS），Glasgow coma score （GCS），number of fractured ribs，total number of rib fractures （NTRF），first rib fracture，flail chest，traumatic brain injury，combined injuries （spine，maxillofacial，sternum），acute respiratory distress syndrome （ARDS），volume fraction of pulmonary contusion（VPC），blood lactic acid （within 24 hours of admission），hemothorax，pneumothorax，mechanical ventilation time，duration of tracheostomy，time from tracheal intubation to incision，length of hospital stay，length of stay in ICU，closed thoracic drainage，number of fiberoptic bronchoscopy，multi-drug resistant bacteria infection，ventilator-associated pneumonia，antibiotic use time，duration of sedative and analgesic drugs used and 28-day mortality. The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy. The Pearson method was used to compare the relationship between multiple factors. The receiver operating characteristic （ROC） curve was used to predict indicators that affect the prognosis of patients with early tracheostomy，and calculate the best cut-off value. The Kaplan-Meier single factor and COX multivariate survival were used to analyze the relevant factors affecting the 28-day mortality of patients.Results:（1） In early group，the NTRF，ARDS and VPC were higher than those in late group，and the time from tracheal intubation to incision and 28-day mortality rate were lower than those in late group （ P < 0.05），while the two groups showed no significant differences in the gender，age，underlying diseases and ISS （ P > 0.05）. （2） The multivariate Logistic regression analysis showed that there was statistical significance in NTRF （ OR = 1.775，95% CI 1.439-2.188），ARDS（ OR = 3.740，95% CI 1.441-9.711），VPC （ OR = 1.087，95% CI 1.052-1.124） （ P < 0.05）； the Pearson method analysis showed a significant correlation between VPC and NTRF （ r = 0.369， P < 0.05） and a low degree of correlation between ARDS and VPC （ r = 0.179， P < 0.05），but there was no significant correlation between ARDS and NTRF （ r = 0.132， P > 0.05）. （3） The ROC curve analysis showed that the area under the curve （AUC） of the VPC and NTRF ［AUC = 0.832 （95% CI 0.770-0.893），AUC = 0.804 （95% CI 0.740-0.868）］ were significantly higher than those of the number of rib fractures ［AUC = 0.437（95% CI 0.352-0.523），GCS ［AUC = 0.519 （95% CI 0.432-0.605）］ and ISS ［AUC = 0.484 （95% CI 0.398-0.571）］ （ P < 0.05）. After calculating the Yorden index，the best cut-off value for VPC was 23.9，and the best cut-off value for NTRF was 8.5. （4） The Kaplan-Meier single factor and multivariate COX model survival analysis showed that the 28-day survival ratio of patients with early tracheostomy was significantly better than that of late tracheostomy （ P < 0.05）. Conclusions:The NTRF，ADRS and VPC are independent risk factors for the timing and prognosis of early tracheostomy. There is a significant correlation between VPC and NTRF. The VPC ≥ 23.9% and or NTRF ≥ 8.5 can be used to predict early tracheostomy in patients with multiple rib fractures. Early tracheostomy may benefit the 28-day survival of patients with multiple rib fractures.

Objective:To evaluate the reliability and validity of the Chinese version of the Ohkuma questionnaire.Methods:The Ohkuma questionnaire was translated and revised, before it was used to investigate 70 elderly patients. Cronbach′s alpha coefficient, Cohen′s kappa coefficient and Pearson correlation were used to evaluate the scale′s internal reliability, sub-item retest reliability and total score retest reliability. KMO and Bartlett tests were used to evaluate the validity. The correlation between the Chinese version of the Ohkuma questionnaire and ratings from video fluoroscopy before and after treatment was used to evaluate the scale′s discrimination ability.Results:The Cronbach′s alpha of the Chinese version of Ohkuma questionnaire was 0.831, with 0.814 in the initial evaluation and 0.808 in a second evaluation. The Cohen′s kappas of the 15 sub-items ranged from 0.728 to 1.000. The Pearson correlation coefficient of the total score was 0.914. The scale′s KMO value was 0.701. A t-test of the Ohkuma scores before and after treatment showed a statistically significant difference.Conclusion:The revised Chinese Ohkuma questionnaire has good reliability, validity and discriminatory power. It can be used to screen for dysphagia among the elderly.

OBJECTIVE：To understand the situation of healthcar e workers’occupational exposure of hazardous drugs （chemotherapeutic drugs and antiviral drug ）and relative cognition level ，and to provide reference for improving the level of occupational protection. METHODS ：During Oct. 2018 to Mar. 2019，healthcare workers from 12 hospitals of different levels and different departments in Shaanxi province were selected as respondents to conduct a self-designed questionnaire survey. Information we surveyed contained baseline characteristics ，hazardous drugs exposure ，physical health status ，and occupational protection. Valid questionnaires were collected and analyzed statistically. RESULTS ：A totally of 1 848 questionnaires were sent out ，and 1 767 questionnaires were collected ，including 95 were pharmacists ，100 were physicians ，and 1 572 were nurses. The frequency of diarrhea and menstrual disorders in healthcare workers with long-term exposure to antiviral drugs （antiviral drug exposure group ） and cross-exposure to antiviral drugs and chemotherapeutic drugs （cross-exposure group ）were significantly higher than unexposed group （P＜0.05）. The incidence of routine blood abnormalities in cross-exposure group ，antiviral drug exposure group and healthcare workers with long-term exposure to chemotherapy drugs （chemotherapy drug exposure group ） was higher than unexposed group by 9.13％，5.50％ and 12.34％，respectively. 84.7％ of the respondents had little knowledge of hazardous drugs ， and 8.15％ of the respondents had never received occupational protection training. Additionally ，the ratio of healthcare workers receiving occupational protection training in the cross-exposure group was significantly higher than unexposed group （P＜0.05）， and the ratio of healthcare workers receiving occupational protection training in antiviral drug exposure group were significantly lower than unexposed group （P＜0.05）. CONCLUSIONS ：Long-term exposure to hazardous drugs will cause certain occupational hazards to healthcare workers. It is necessary to improve healthcare workers ’awareness of self-protection ，increase the input of hospitals in occupational protection training and establish occupational protection standards in order to improve the current situation of occupational protection of healthcare workers.