Objective By applying the long short-term memory(LSTM)neural network model and using lower body landmark coordinates obtained from a markerless motion capture system as inputs,to estimate ground reaction force(GRF)curves during running.Methods The video images and GRF data of 59 amateur runners during running were collected by the markerless motion capture system and three-dimensional(3D)force plates.The LSTM model was established,and the 3D coordinates of 11 lower body landmarks,obtained via the Theia3D markerless system,were used as inputs to estimate the 3D GRF curves during the stance of running.The estimation performance was evaluated using correlation coefficients r,root mean square error(RMSE),and normalized root mean square error(nRMSE)by comparing LSTM model estimation and force plate measurement.Statistical parametric mapping was used to analyze differences in GRF curves estimated by the LSTM model and measured by the force plate,while paired t-tests were used to assess differences in GRF characteristics between model estimation and actual measurement.Results A strong correlation(r＞0.85,P＜0.001)and lower error(RMSE＜0.3 body weight,nRMSE＜15％)was found between the LSTM model estimation and actual measurements.No significant difference was found in GRF curve intervals between LSTM model estimation and actual measurements.There was no significant difference in GRF characteristics between LSTM model estimation and actual measurements(P＞0.05).Conclusions Based on the LSTM model,the 3D GRF curves can be effectively estimated by lower body landmark coordinates obtained from the makerless motion capture system,thereby acquiring the highly accurate GRF characteristics.The LSTM model developed in this study can be used to monitor injury risks during running in outdoor environments.

Objective:To examine the manifestations and causes of administrative burden among primary healthcare professionals,and to explore its impact on job burnout through the mediating role of role conflict,providing theoretical and empirical support for governance-level burden-reduction strategies.Methods:An exploratory sequential mixed-methods design was employed,focusing on primary healthcare professionals in Shandong Province.In the first phase,in-depth interviews were conducted with 175 participants;in the second phase,a questionnaire survey of 1,096 participants and follow-up interviews with 107 participants were carried out.Results:The proportions of respondents who reported"heavy"or"very heavy"burdens were 62.7%for inspection,54.8%for documentation,51.8%for reporting,and 24.4%for meetings.Structural equation modeling showed that administrative burden had a direct effect on job burnout(0.150)and an indirect effect through role conflict(0.093).Qualitative findings further indicated that administrative burden largely stemmed from public health traceability requirements and medical insurance policies,and operated through both resource-based and value-based conflicts.Conclusions:Primary healthcare professionals face considerable administrative burdens,which may heighten job burnout through role conflict.Governance reforms should optimize inspection and assessment,streamline data reporting,refine record-keeping,and promote collaborative governance to break the chain of institutional pressure leading to burnout.

Objective To explore the relationship between dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and clinical pathological features of invasive breast cancer and lymphovascular invasion(LVI).Methods Imaging and clinical pathological data were retrospectively collected from 508 patients with invasive breast cancer who underwent breast DCE-MRI at the First Medical Center of Chinese PLA General Hospital from January 2019 to August 2021.Patients were divided into the LVI-positive(LVI+)group(n=79)and LVI-negative(LVI-)group(n=429)based on postoperative pathological results.Univariate and multivariate logistic regression analyses were used to identify risk factors for LVI.Results Compared with LVI-group,LVI+group had a higher proportion of patients aged<45 years(44.3%vs.27.0%,P=0.002),non-mass-like enhancement(NME)(31.7%vs.17.7%,P=0.004),Ki-67 expression rate(40.0%vs.30.0%,P<0.001),high Ki-67 expression(94.9%vs.78.1%,P=0.001),Luminal B subtype(76.0%vs.60.1%,P=0.008),and positive axillary lymph nodes rate(72.2%vs.31.5%,P<0.001),while the proportion of Luminal A subtype was lower(2.5%vs.21.5%,P<0.001).Univariate and multivariate logistic regression analyses showed that age≥45 years(OR=0.468,95%CI 0.280-0.783,P=0.004)was an independent protective factor for LVI,while NME(OR=1.987,95%CI 1.126-3.444,P=0.016)was an independent risk factor.Compared with Luminal A subtype,patients with Luminal B subtype(OR=10.482,95%CI 3.164-64.923,P=0.001),HER-2 overexpression subtype(OR=11.571,95%CI 2.755-79.341,P=0.003)and triple-negative subtypes(OR=8.433,95%CI 1.985-57.908,P=0.009)had a higher risk of LVI.Conclusions Age≥45 years is an independent protective factor for LVI,while NME is an independent risk factor.Among molecular subtypes,patients with Luminal B,HER-2 overexpression and triple-negative subtypes have a higher risk of LVI compared with the Luminal A subtype.

Objective To compare the clinical efficacy of pulmonary artery thrombus aspiration plus catheter-directed thrombolysis and pulmonary artery thrombus aspiration plus peripheral venous thrombolysis in treating acute intermediate-high-risk pulmonary embolism.Methods The clinical data of patients with acute intermediate-high-risk pulmonary embolism,who received pulmonary artery thrombosis aspiration combined with catheter-directed thrombolysis or peripheral venous thrombolysis at the Affiliated Hospital of Nantong University and the Qidong Municipal People's Hospital from January 2017 to May 2024,were retrospectively analyzed.Based on the propensity score matching(PSM)method,the clinical efficacy of the two treatments was compared.The observation indicators included technical success rate,clinical success rate,changes in cardiopulmonary function,and incidence of complications.Results After propensity score matching,the pulmonary artery thrombosis aspiration combined with catheter-directed thrombolysis group(group A)and the pulmonary artery thrombosis aspiration combined with peripheral venous thrombolysis group(group B)had 40 patients each.In group A and group B,the technical success rate was 100％and 100％respectively,the clinical success rate was 97.5％and 87.5％respectively,and the clinical success rate was 97.5％and 87.5％respectively(P=0.201);the postoperative one-week mean oxygen partial pressure was(98.4±16.4)mmHg and(95.5±14.7)mmHg respectively(P＜0.001);the postoperative one-week mean pulmonary artery pressure was(26.3±10.5)mmHg and(28.5±11.8)mmHg respectively(P=0.005);the mean reduction value of B-type natriuretic peptide(BNP)level was(767.2±1 005.5)ng/L and(831.0±1 371.8)ng/L respectively(P＜0.001).No statistically significant difference in the incidence of surgery-related complications existed between the two groups(P＞0.05).Conclusion In treating patients with acute intermediate-high-risk pulmonary embolism,pulmonary artery thrombosis aspiration combined with catheter-directed thrombolysis is superior to pulmonary artery thrombosis aspiration combined with peripheral venous thrombolysis in better short-term efficacy.

This research investigated the contamination level,distribution of drug-resistant strains,and molecular epidemiologi-cal characteristics of Campylobacter,and further explored transmission pathways and prevention strategies.Cecum,chicken carcass,chicken product,and environmental samples,as well as swabs from workers'hands,were collected from a slaughterhouse in a large broiler group in the Jiaodong area between August 2023 and July 2024.Quantitative contamination assessment of Campylobacter in chicken carcasses and chicken products was performed.After microbial mass spectrometry identification,the representative strains of different links were selected for drug resistance testing and whole genome sequencing(WGS).On the basis of the sequencing results,the resistance genes,virulence genes,multilocus sequence typing(MLST),and phylogenetic characteristics of representative strains were analyzed.Homology comparisons were performed between isolates and strains from patients with diarrhea in the NCBI database.A total of 297 Campylobacter strains were isolated from 806 samples,and the overall detection rate was 36.85%.The detection rate of Campylobacter was highest in the evisceration process(47.33%),followed by the cutting process(35.64%).Overall,the Campylo-bacter detection rate first increased,then decreased,and subsequently increased.Drug sensitivity testing revealed that 90 isolates were resistant to nalidixic acid and ciprofloxacin,and 94.97%of isolates were resistant to tetracycline.WGS showed that both Campylo-bacter jejuni(C.jejuni)and Campylobacter coli(C.coli)carried many drug resistance and virulence genes.ST-14176 of C.jejuni was isolated for the first time herein.The predominant ST-8261 strain of C.jejuni and ST-860,ST-829,and ST-1586 strains of C.coli are known to cause human diarrhea.LOS expression genes associated with Guillain-Barré syndrome(GBS)were detected in both C.jejuni isolates from the slaughter chain and patients with GBS.Some strains exhibited close genetic relatedness to human-derived Campylo-bacter strains from the NCBI database.The detection rate of Campylobacter in the slaughterhouse first increased,then decreased,and subsequently increased,and the quantitative contamination level of each link was similar to the detection rate.Quantitative analysis of chicken carcasses/products revealed that the average bacterial load was highest in eviscerated carcasses(102.80 cfu/g),and the high-est amount of Campylobacter in chicken products reached 451.80 cfu/g.Abundant drug resistance genes and virulence genes were iden-tified,and the drug resistance genes were highly correlated with the drug resistance rate.Therefore,surveillance intensity and control measures for Campylobacter in slaughter processes should be strengthened.

Objective By applying the long short-term memory(LSTM)neural network model and using lower body landmark coordinates obtained from a markerless motion capture system as inputs,to estimate ground reaction force(GRF)curves during running.Methods The video images and GRF data of 59 amateur runners during running were collected by the markerless motion capture system and three-dimensional(3D)force plates.The LSTM model was established,and the 3D coordinates of 11 lower body landmarks,obtained via the Theia3D markerless system,were used as inputs to estimate the 3D GRF curves during the stance of running.The estimation performance was evaluated using correlation coefficients r,root mean square error(RMSE),and normalized root mean square error(nRMSE)by comparing LSTM model estimation and force plate measurement.Statistical parametric mapping was used to analyze differences in GRF curves estimated by the LSTM model and measured by the force plate,while paired t-tests were used to assess differences in GRF characteristics between model estimation and actual measurement.Results A strong correlation(r＞0.85,P＜0.001)and lower error(RMSE＜0.3 body weight,nRMSE＜15％)was found between the LSTM model estimation and actual measurements.No significant difference was found in GRF curve intervals between LSTM model estimation and actual measurements.There was no significant difference in GRF characteristics between LSTM model estimation and actual measurements(P＞0.05).Conclusions Based on the LSTM model,the 3D GRF curves can be effectively estimated by lower body landmark coordinates obtained from the makerless motion capture system,thereby acquiring the highly accurate GRF characteristics.The LSTM model developed in this study can be used to monitor injury risks during running in outdoor environments.

Objective:To examine the manifestations and causes of administrative burden among primary healthcare professionals,and to explore its impact on job burnout through the mediating role of role conflict,providing theoretical and empirical support for governance-level burden-reduction strategies.Methods:An exploratory sequential mixed-methods design was employed,focusing on primary healthcare professionals in Shandong Province.In the first phase,in-depth interviews were conducted with 175 participants;in the second phase,a questionnaire survey of 1,096 participants and follow-up interviews with 107 participants were carried out.Results:The proportions of respondents who reported"heavy"or"very heavy"burdens were 62.7%for inspection,54.8%for documentation,51.8%for reporting,and 24.4%for meetings.Structural equation modeling showed that administrative burden had a direct effect on job burnout(0.150)and an indirect effect through role conflict(0.093).Qualitative findings further indicated that administrative burden largely stemmed from public health traceability requirements and medical insurance policies,and operated through both resource-based and value-based conflicts.Conclusions:Primary healthcare professionals face considerable administrative burdens,which may heighten job burnout through role conflict.Governance reforms should optimize inspection and assessment,streamline data reporting,refine record-keeping,and promote collaborative governance to break the chain of institutional pressure leading to burnout.

This research investigated the contamination level,distribution of drug-resistant strains,and molecular epidemiologi-cal characteristics of Campylobacter,and further explored transmission pathways and prevention strategies.Cecum,chicken carcass,chicken product,and environmental samples,as well as swabs from workers'hands,were collected from a slaughterhouse in a large broiler group in the Jiaodong area between August 2023 and July 2024.Quantitative contamination assessment of Campylobacter in chicken carcasses and chicken products was performed.After microbial mass spectrometry identification,the representative strains of different links were selected for drug resistance testing and whole genome sequencing(WGS).On the basis of the sequencing results,the resistance genes,virulence genes,multilocus sequence typing(MLST),and phylogenetic characteristics of representative strains were analyzed.Homology comparisons were performed between isolates and strains from patients with diarrhea in the NCBI database.A total of 297 Campylobacter strains were isolated from 806 samples,and the overall detection rate was 36.85%.The detection rate of Campylobacter was highest in the evisceration process(47.33%),followed by the cutting process(35.64%).Overall,the Campylo-bacter detection rate first increased,then decreased,and subsequently increased.Drug sensitivity testing revealed that 90 isolates were resistant to nalidixic acid and ciprofloxacin,and 94.97%of isolates were resistant to tetracycline.WGS showed that both Campylo-bacter jejuni(C.jejuni)and Campylobacter coli(C.coli)carried many drug resistance and virulence genes.ST-14176 of C.jejuni was isolated for the first time herein.The predominant ST-8261 strain of C.jejuni and ST-860,ST-829,and ST-1586 strains of C.coli are known to cause human diarrhea.LOS expression genes associated with Guillain-Barré syndrome(GBS)were detected in both C.jejuni isolates from the slaughter chain and patients with GBS.Some strains exhibited close genetic relatedness to human-derived Campylo-bacter strains from the NCBI database.The detection rate of Campylobacter in the slaughterhouse first increased,then decreased,and subsequently increased,and the quantitative contamination level of each link was similar to the detection rate.Quantitative analysis of chicken carcasses/products revealed that the average bacterial load was highest in eviscerated carcasses(102.80 cfu/g),and the high-est amount of Campylobacter in chicken products reached 451.80 cfu/g.Abundant drug resistance genes and virulence genes were iden-tified,and the drug resistance genes were highly correlated with the drug resistance rate.Therefore,surveillance intensity and control measures for Campylobacter in slaughter processes should be strengthened.

Objective To analyze the association between lifestyle and the risk of type 2 diabetes(T2D)among adult residents.Methods The data was sourced from the Shanghai Suburban Adult Cohort and Biobank.A total of 42 096 adult residents who had not developed T2D were recruited from four districts of Shanghai(Songjiang,Jiading,Minhang,and Xuhui)between 2016 and 2019.The follow-up ended on Feb 28,2023.A structured questionnaire was used to collect information on six lifestyle-related items,including smoking,alcohol consumption,BMI,waist circumference(WC),physical activity,and diet.The unhealthy lifestyle scores(UHLS)were calculated by counting the number of all the unhealthy lifestyle items,with a range of 0-6.New-onset T2D events diagnosed by physicians were obtained through the medical information system.Cox proportional hazards regression model and restricted cubic spline model were utilized to evaluate the association between unhealthy lifestyles and the risk of T2D incidence.Results About 28.1%of the participants led 4-6 unhealthy lifestyles.A total of 1 752 new T2D cases were identified during 218 513.4 person-years of follow-up.Analysis of single unhealthy lifestyle showed that abnormal WC(HR=1.5,95%CI:1.4-1.7)and abnormal BMI(HR=1.3,95%CI:1.2-1.5)were associated with an increased risk of T2D.Compared with individuals with a UHLS of 0-1,those with a UHLS of 3 and 4-6 had 30%(95%CI:1.1-1.6)and 50%(95%CI:1.2-1.8)higher risks of T2D,respectively.Each additional unhealthy lifestyle was associated with a 10%increase in T2D incidence risk(HR=1.1,95%CI:1.1-1.2).Conclusion The risk of T2D in adult residents increases with the cumulative number of unhealthy lifestyles.Adult residents with abnormal WC or BMI,or have three or more unhealthy lifestyles accumulated,will increase the risk of new-onset T2D.

Objective:To measure the length and curvature of the external auditory canal (EAC) centerline using a three-dimensional (3D) measurement method based on high-resolution computed tomography (HRCT).Methods:A retrospective analysis was conducted on HRCT images of healthy EAC from 49 patients (64 ears) examined at the Sixth Medical Center of the PLA General Hospital from June to October 2024. The cohort included 25 males (28 ears) and 24 females (36 ears), aged 22-78 years (mean age 47.3 years), categorized into age groups: 18-30 years (20 ears), 31-60 years (22 ears), and 61-80 years (22 ears). The EAC comprised 29 left and 35 right ears. 3D reconstruction of the EAC was performed using medical software (3D Slicer), and the central curve of the EAC was extracted using an improved measurement method to determine its length and curvature. Statistical analysis was performed using Origin Pro 2023 software to compare differences across genders, sides, and age groups.Results:The measurements of EAC length and curvature revealed that the EAC was significantly longer in males than in females (27.46 mm vs. 25.44 mm, P=0.014) and longer on the right side than on the left (27.99 mm vs. 25.87 mm, P=0.031). No statistically significant difference in EAC length was observed among the different age groups ( P>0.05). Furthermore, no statistically significant differences in EAC curvature were found regarding gender, side, or age group (all P>0.05). Conclusion:The HRCT-based 3D reconstruction technique enables the establishment of a rapid and effective automated workflow for extracting the central curve of the EAC and systematically measuring its length and curvature. The data obtained provide a reference and methodological support for further research on anatomical variations of the human EAC and its potential clinical applications, such as the design of otological instruments or surgical planning.