Objectives:To systemically evaluate the efficacy and safety of His-Purkinje conduction system pacing(HPCSP,including His bundle pacing[HBP]and left bundle branch area pacing[LBBAP])combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure.Methods:The PubMed,Cochrane Library,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,and Yiigle were searched for studies on HPCSP combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure since the established until July 31,2024.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results:A total of 13 studies were included with 1 071 patients,the success rate of HPCSP combined with atrioventricular node ablation was 93.1%.The meta-analysis results revealed that,in terms of effectiveness outcomes,compared with baseline,left ventricular end-diastolic diameter(mean difference[MD]=-3.11,95%CI:-4.16 to-2.06,P<0.000 01)was significantly reduced,New York Heart Association(NYHA)cardiac function classification(MD=-1.36,95%CI:-1.48 to-1.24,P<0.000 01)was significantly decreased,and left ventricular ejection fraction(MD=9.86,95%CI:7.02 to 12.69,P<0.000 01)was significantly increased during follow-up.The pacing QRS duration was prolonged from baseline after atrioventricular node ablation(MD=7.83,95%CI:2.79 to 12.87,P=0.002);In terms of safety outcomes,HPCSP pacing thresholds remained stable(MD=0.07,95%CI:-0.01 to 0.15,P=0.11)and impedance was decreased(MD=-78.84,95%CI:-120.21 to-37.47,P=0.000 2)during operation and follow-up.The complication rate was 7.9%,the heart failure rehospitalization rate was 4.5%and the mortality rate was 5.8%.Compared with biventricular pacing(BVP),HPCSP was correlated with shorter pacing QRS duration(MD=-39.08,95%CI:-62.35 to-15.80,P=0.001)and higher left ventricular ejection fraction(MD=4.38,95%CI:0.37 to 8.40,P=0.03),there was no significant difference in left ventricular end-diastolic diameter(MD=-9.11,95%CI:-19.93 to 1.72,P=0.100).During follow-up,LBBAP exhibited a lower pacing threshold than HBP(MD=0.61,95%CI:0.23 to 1.00,P=0.002);Endpoint event rates were similar between HBP and LBBP(RR=1.47,95%CI:0.83 to 2.60,P=0.190).Conclusions:Results of this meta-analysis demonstrate that HPCSP combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure is effective and safe.HPCSP is associated with better ventricular electro-mechanical synchronization and cardiac function compared with BVP,and LBBAP pacing parameters are superior to HBP.

Objective To preliminarily describe the current situation of chronic disease drug continuity between community hospitals and the Affiliated Hospital of Qingdao University in the medical alliance,to explore the key points for further improving the connection between upper and lower-level hospitals in the medical alliance,and to improve the drug supply guarantee and the ability of pharmaceutical services of primary medical institutions.Methods The nine community hospitals within the medical alliance centered on the Affiliated Hospital of Qingdao University were taken as the research subjects to investigate the medication continuity between the community hospitals and the core hospital in terms of cardiovascular diseases,diabetes,and respiratory system diseases before and after the medical alliance.Results Before the integration of medical alliances,the drug linkage rate for cardiovascular diseases,diabetes,and respiratory system diseases in community hospitals and core hospitals was relatively low.After the integration of medical alliances,the average drug linkage rate for the three chronic diseases significantly increased,all exceeding 60%.At the same time,the drug catalog in community hospitals was streamlined,reducing the phenomenon of one drug having multiple specifications.There is a significant difference in the number of drug varieties provided by different community hospitals for the three chronic diseases.Conclusion The medical alliance with the Affiliated Hospital of Qingdao University as the core promotes the up-down linkage of drug treatment in community hospitals,simplifies the drug catalog of primary medical structure,and facilitates the treatment and prescription of chronic patients.

DiGeorge(DGS)syndrome is an autosomal dominant disorder caused by 22q11.2 microdeletions,most patients developed the disease in childhood.22q11.2 deletion syndrome,and the mutation types are dominated by haploid deletion of this gene.We report a young patient with hypoparathyroidism(parathyroidism)induced by DGS syndrome combined with hypocalcemic heart failure.Genetic testing revealed pathogenic copy number variants associated with the clinical phenotype of the subject.About 2 674 kb of deletion variation was detected at q11.21 position on chromosome 22,which contained the TBX1 gene and was a pathogenic mutation.This paper discusses the clinical features,pathogenesis and current treatment of DGS,and emphasizes the importance of early screening,early diagnosis and treatment,and regular follow-up of heart failure,aiming to enhance the awareness of clinicians and geneticists on DGS syndrome.

As an important support for hospital operations,hospital logistic maintenance services suffer from pain points such as low efficiency and passive maintenance.The fundamental reason is the lack of a closed-loop mechanism.Based on the closed-loop theory and combined with mathematical modeling,this paper constructs a quality control system for logistic mainte-nance services and proposes a four-stage management process:In the planning stage,optimization goals and constraints are clari-fied.In the design stage,a comprehensive optimization model is established to minimize response time deviation and total mainte-nance costs while maximizing the one-time repair rate.In the execution stage,a maintenance task allocation matrix is generated based on the model solution to optimize resource scheduling.In the inspection stage,RTD,FFR,and QMS are introduced to quantitatively evaluate service performance.In the improvement stage,problem feedback is addressed,and model parameters are adjusted to form a closed loop.Hospital A is used as a practical case study,and the application effect of the quality control sys-tem is verified through analysis of its maintenance data.The quality control system has significant effects on optimizing the re-sponse efficiency,stability,and resource utilization of logistic maintenance services,providing a practical reference for other medical institutions.

Objective To preliminarily describe the current situation of chronic disease drug continuity between community hospitals and the Affiliated Hospital of Qingdao University in the medical alliance,to explore the key points for further improving the connection between upper and lower-level hospitals in the medical alliance,and to improve the drug supply guarantee and the ability of pharmaceutical services of primary medical institutions.Methods The nine community hospitals within the medical alliance centered on the Affiliated Hospital of Qingdao University were taken as the research subjects to investigate the medication continuity between the community hospitals and the core hospital in terms of cardiovascular diseases,diabetes,and respiratory system diseases before and after the medical alliance.Results Before the integration of medical alliances,the drug linkage rate for cardiovascular diseases,diabetes,and respiratory system diseases in community hospitals and core hospitals was relatively low.After the integration of medical alliances,the average drug linkage rate for the three chronic diseases significantly increased,all exceeding 60%.At the same time,the drug catalog in community hospitals was streamlined,reducing the phenomenon of one drug having multiple specifications.There is a significant difference in the number of drug varieties provided by different community hospitals for the three chronic diseases.Conclusion The medical alliance with the Affiliated Hospital of Qingdao University as the core promotes the up-down linkage of drug treatment in community hospitals,simplifies the drug catalog of primary medical structure,and facilitates the treatment and prescription of chronic patients.

Objective To investigate the relationships of the expression levels of BUB1 mitotic checkpoint serine/threonine kinase B(BUB1B)and kinesin family member 11(KIF11)in peripher-al blood with postoperative recurrence in non-muscle-invasive bladder cancer(NMIBC)patients trea-ted with transurethral resection of bladder tumor(TURBT).Methods A retrospective case-control study design was employed.A total of 188 NMIBC patients who received standard TURBT treatment in the 215th Hospital of Shaanxi Nuclear Industry during initial visit from January 2019 to December 2021 were selected as research objects.Patients were followed up for 36 months and divided into re-currence group(n=68)and non-recurrence group(n=120)based on pathological examination re-sults.Additionally,50 healthy individuals who underwent physical examinations during the same period were selected as control group.The levels of BUB1B mRNA and KIF11 mRNA in peripheral blood were compared among the recurrence group,non-recurrence group,and control group.Clinical data were compared between the recurrence and non-recurrence groups.Cox proportional hazards regression models were used to analyze the postoperative follow-up data of NMIBC patients with TURBT.Kaplan-Meier plots were drawn to assess the proportional hazards assumption(PH assumption)of the Cox model.The predictive efficacy of various indicators for postoperative recurrence in NMIBC patients was eval-uated using receiver operating characteristic(ROC)curve.Results The levels of BUB1B mRNA and KIF11 mRNA in peripheral blood in the control group,non-recurrence group,and recurrence group sucessively increased(P＜0.001).The recurrence group had a significantly higher number of patients with pathological T1 staging and multiple tumors compared to the non-recurrence group(P＜0.05).The Kaplan-Meier curves for the number of tumors,pathological staging,BUB1B mRNA,and KIF11 mRNA levels were generally parallel to recurrence rates between the two groups,meeting PH assumption.Multiple tumors,pathological T1 staging,BUB1B mRNA,and KIF11 mRNA levels were independent influencing factors for recurrence in NMIBC patients after TURBT treatment(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)for predicting postoper-ative recurrence in NMIBC patients by multiple tumors,pathological T1 staging,BUB1B mRNA,and KIF11 mRNA levels were 0.674,0.746,0.610 and 0.642,respectively.The combined pre-diction using these indicators yielded an AUC of 0.826(95％CI,0.767 to 0.884),with a sensitiv-ity of 86.80％and a specificity of 75.30％,indicating good predictive efficacy.Conclusion Ele-vated levels of BUB1B mRNA and KIF11 mRNA in peripheral blood are significantly associated with postoperative recurrence in NMIBC patients after TURBT and serve as independent risk factors for recurrence.As non-invasive biomarkers,BUB1B mRNA and KIF11 mRNA in peripheral blood com-bined with clinical parameters can significantly improve the predictive efficacy of postoperative recur-rence,providing a new strategy for individualized monitoring.

Objectives:To systemically evaluate the efficacy and safety of His-Purkinje conduction system pacing(HPCSP,including His bundle pacing[HBP]and left bundle branch area pacing[LBBAP])combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure.Methods:The PubMed,Cochrane Library,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,and Yiigle were searched for studies on HPCSP combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure since the established until July 31,2024.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results:A total of 13 studies were included with 1 071 patients,the success rate of HPCSP combined with atrioventricular node ablation was 93.1%.The meta-analysis results revealed that,in terms of effectiveness outcomes,compared with baseline,left ventricular end-diastolic diameter(mean difference[MD]=-3.11,95%CI:-4.16 to-2.06,P<0.000 01)was significantly reduced,New York Heart Association(NYHA)cardiac function classification(MD=-1.36,95%CI:-1.48 to-1.24,P<0.000 01)was significantly decreased,and left ventricular ejection fraction(MD=9.86,95%CI:7.02 to 12.69,P<0.000 01)was significantly increased during follow-up.The pacing QRS duration was prolonged from baseline after atrioventricular node ablation(MD=7.83,95%CI:2.79 to 12.87,P=0.002);In terms of safety outcomes,HPCSP pacing thresholds remained stable(MD=0.07,95%CI:-0.01 to 0.15,P=0.11)and impedance was decreased(MD=-78.84,95%CI:-120.21 to-37.47,P=0.000 2)during operation and follow-up.The complication rate was 7.9%,the heart failure rehospitalization rate was 4.5%and the mortality rate was 5.8%.Compared with biventricular pacing(BVP),HPCSP was correlated with shorter pacing QRS duration(MD=-39.08,95%CI:-62.35 to-15.80,P=0.001)and higher left ventricular ejection fraction(MD=4.38,95%CI:0.37 to 8.40,P=0.03),there was no significant difference in left ventricular end-diastolic diameter(MD=-9.11,95%CI:-19.93 to 1.72,P=0.100).During follow-up,LBBAP exhibited a lower pacing threshold than HBP(MD=0.61,95%CI:0.23 to 1.00,P=0.002);Endpoint event rates were similar between HBP and LBBP(RR=1.47,95%CI:0.83 to 2.60,P=0.190).Conclusions:Results of this meta-analysis demonstrate that HPCSP combined with atrioventricular node ablation for the treatment of atrial fibrillation combined with heart failure is effective and safe.HPCSP is associated with better ventricular electro-mechanical synchronization and cardiac function compared with BVP,and LBBAP pacing parameters are superior to HBP.

DiGeorge(DGS)syndrome is an autosomal dominant disorder caused by 22q11.2 microdeletions,most patients developed the disease in childhood.22q11.2 deletion syndrome,and the mutation types are dominated by haploid deletion of this gene.We report a young patient with hypoparathyroidism(parathyroidism)induced by DGS syndrome combined with hypocalcemic heart failure.Genetic testing revealed pathogenic copy number variants associated with the clinical phenotype of the subject.About 2 674 kb of deletion variation was detected at q11.21 position on chromosome 22,which contained the TBX1 gene and was a pathogenic mutation.This paper discusses the clinical features,pathogenesis and current treatment of DGS,and emphasizes the importance of early screening,early diagnosis and treatment,and regular follow-up of heart failure,aiming to enhance the awareness of clinicians and geneticists on DGS syndrome.

As an important support for hospital operations,hospital logistic maintenance services suffer from pain points such as low efficiency and passive maintenance.The fundamental reason is the lack of a closed-loop mechanism.Based on the closed-loop theory and combined with mathematical modeling,this paper constructs a quality control system for logistic mainte-nance services and proposes a four-stage management process:In the planning stage,optimization goals and constraints are clari-fied.In the design stage,a comprehensive optimization model is established to minimize response time deviation and total mainte-nance costs while maximizing the one-time repair rate.In the execution stage,a maintenance task allocation matrix is generated based on the model solution to optimize resource scheduling.In the inspection stage,RTD,FFR,and QMS are introduced to quantitatively evaluate service performance.In the improvement stage,problem feedback is addressed,and model parameters are adjusted to form a closed loop.Hospital A is used as a practical case study,and the application effect of the quality control sys-tem is verified through analysis of its maintenance data.The quality control system has significant effects on optimizing the re-sponse efficiency,stability,and resource utilization of logistic maintenance services,providing a practical reference for other medical institutions.

Objective To provide a scientific benchmark for the era of population aging and improve the medical care environment for the elderly in terms of hospital facility accessibility.Methods A random sampling method was used to select 375 individuals from 10 healthcare institutions in a specified city as survey participants from December 2022 to February 2023.A total of 375 questionnaires titled"Comprehensive Rating Scale for Patient Experience in Medical Facilities(Accessibility Category)"were distributed among the participants,with 356 valid responses received and subjected to reliability and validity assessments.The questionnaire included 6 accessibility indicators,each rated from 1 to 10,to evaluate the accessibility level of healthcare fa-cilities.The acquired data was analyzed using the Rank Sum Ratio method and the Four Quadrants model.Results The average score for building accessibility in the city's medical institutions was 35.86,with several indicators at a moderate level,indicating a need for an improvement of the facility accessibility.Meanwhile,the economic operational status of various medical institutions appeared to influence the implementation of accessibility features,which also correlated with local government construction plan-ning,staff awareness of accessible infrastructure,and other factors.Conclusion Medical facilities in cities could implement bar-rier-free modifications in parking,toilets,and other areas,improve the use of accessible AI technology,and develop intelligent medical scenarios in order to meet the challenges of an aging society,improve the medical care quality for the elderly,and reduce social security cost.The governments should accelerate the improvement of supportive policies and regulations and bolster support for the accessibility enhancements.Higher education and research institutions can collaborate with healthcare providers for innova-tive integration of industry academia,research,and application,fostering the conversion of research into practical solutions.