ObjectiveTo evaluate the clinical efficacy and economic value of the Jiangsu Traditional Chinese Medicine （TCM） Diagnosis and Treatment Protocol for Dominant Diseases （abbreviated as the Diagnosis and Treatment Protocol） in adult patients with non-severe community-acquired pneumonia （CAP） based on real-world clinical data. MethodsA retrospective real-world cohort study was conducted using electronic medical records of adult patients hospitalized for non-severe CAP from September 1st， 2023 to December 31st， 2024 across 10 TCM hospitals in Jiangsu province. Patients were classified into an exposure group and a non-exposure group based on whether they received Chinese herbal medicine （CHM） according to the Diagnosis and Treatment Protocol. The non-exposure group received only conventional western medicine， while the exposure group additionally received differentiated CHM for at least five consecutive days. Outcomes were compared between two patient groups， including cough resolution rate， sputum resolution rate （assessed by volume， color， and consistency）， incidence of abnormal C-reactive protein （CRP）， incidence of abnormal white blood cell （WBC） count， and radiographic resolution rate of pulmonary infiltrates on chest imaging. Multivariable logistic regression was performed to identify factors influencing clinical efficacy. Subgroup analyses were conducted according to age， gender， smoking status， history of hypertension， and pneumonia severity score （CURB-65）， and the efficacy of treatment for cough and sputum was analyzed within each subgroup. Cost-effectiveness analysis was conducted using cough resolution rate as the outcome measure， evaluating the pharmacoeconomics of the two groups. ResultsA total of 1688 patients were included with 1293 in the exposure group and 395 in the non-exposure group. Compared to the non-exposure group， the exposure group demonstrated significantly higher resolution rates of cough， sputum volume， color， and consistency， as well as a significantly lower incidence of abnormal CRP （P＜0.05）. No statistically significant difference was observed between the groups in terms of abnormal WBC count and radiographic resolution rate of pulmonary infiltrates （P＞0.05）. Logistic regression analysis showed that the cough resolution rate in the exposure group was 1.83 times that of the non-exposure group， while the probabilities of resolution in sputum volume， color， and consistency were 1.37， 2.09， and 1.56 times those of the non-exposure group， respectively （P＜0.05）. Subgroup analyses showed that the exposure group achieved significantly higher cough resolution rates across most subgroups except for populations with a CURB-65 score ≥2 or those with a history of hypertension （P＜0.05）. Specifically， among females， patients aged ≥18 and ＜65 years， non-smokers， those without hypertension， and those with a CURB-65 score of 0， the exposure group showed a higher cough resolution rate than the non-exposure group （P＜0.05）. From an economic perspective， total hospitalization cost， length of stay， antibiotic cost， and CHM cost all differed significantly between groups （P＜0.05）. The cost-effectiveness ratio （CER） was 10,788.80 CNY/case in the exposure group， while 22,513.80 CNY/case in the non-exposure group. This implies that， compared with the exposure group， the non-exposure group incurred an additional 17,302.27 CNY to achieve one case of cough resolution. When the willingness-to-pay threshold ranged from 0 to 50,000 CNY， the probability of economic advantage was consistently higher in the exposure group than in the non-exposure group. ConclusionOn the basis of conventional western medicine， the addition of CHM in accordance with the Diagnosis and Treatment Protocol can effectively improve clinical symptoms， reduce inflammatory markers， promote clinical recovery， and is more cost-effective in treating adults with non-severe CAP.

ObjectiveTo observe the real‑world effectiveness and economic outcomes of Weishi Qingjin Formula （苇石清金方， WQF） in the treatment of adult community‑acquired pneumonia （CAP） with phlegm‑heat obstructing the lung syndrome. MethodsBased on a multicenter， real-world retrospective cohort study， clinical data were collected from hospitalized adult patients diagnosed with non‑severe CAP and phlegm‑heat obstructing the lung syndrome in 10 traditional Chinese medicine （TCM） hospitals in Jiangsu province. Patients were divided into an exposure group （those who received oral WQF） and a non‑exposure group （those who did not）. The following outcomes were compared between the two groups before and after treatment， which were remission rates of clinical symptoms including cough， expectoration （sputum volume， color， consistency）， and chest pain， levels of inflammatory markers including C‑reactive protein （CRP） and white blood cell count （WBC）， and the rate of pulmonary inflammatory absorption on chest CT. Subgroup analyses were performed based on age， gender， smoking status， presence of hypertension， and the severity of community-acquired pneumonia （CURB‑65） score， comparing the two groups in terms of cough remission rate， chest pain remission rate， and chest CT absorption rate. For health economic evaluation， cost‑effectiveness analysis was used to calculate the cost‑effectiveness ratio （CER） and incremental cost‑effectiveness ratio （ICER）. Univariate sensitivity analysis and probabilistic sensitivity analysis were performed to test the robustness of the results. ResultsA total of 647 patients in the exposure group and 1491 patients in the non-exposure group were included in the final statistical analysis. There was no statistically significant difference in length of hospital stay， gender， marital status， smoking history， bronchoscopy history， and comorbidities between the groups （P＞0.05）， but age， CURB-65 score， and antibiotic use. The exposure group had significantly higher remission rates of cough and sputum consistency than the non-exposure group （P＜0.05）. After adjusting for confounders using propensity score matching and logistic regression， the cough remission rate in the exposure group was 1.49 times that of the non-exposure group （P＜0.01）. No significant difference was observed between groups in the reduction rates of CRP and WBC， and in the rate of pulmonary inflammatory absorption on chest CT （P＞0.05）. Subgroup analyses revealed that the cough remission rate in the exposure group was significantly better than that in the non-exposure group except for patients aged ≥65 years， smokers， hypertensive patients， those using other type antibiotics or not using antibiotics， and those with a CURB-65 score ≥1 （P＜0.05）. Among smokers， the chest pain remission rate in the exposure group was 4.38 times that of the non-exposure group （P＜0.01）. No significant difference in chest CT absorption rate was found between groups across subgroups of gender， age， hypertension status， or antibiotic type （P＞0.05）. In terms of economic evaluation， CER was 10,877.60 CNY/case in the exposure group and 16,773.10 CNY/case in the non-exposure group. Compared to the exposure group， the non-exposure group incurred an additional 15,034.26 CNY to achieve one case of cough resolution， indicating a more favorable cost-effectiveness profile. Probabilistic sensitivity analysis yielded results consistent with the cost-effectiveness analysis， confirming the robustness of the findings. ConclusionWQF demonstrates significant efficacy in improving cough symptoms in the treatment of adult CAP with phlegm-heat obstructing the lung syndrome， and also exhibits favorable economic benefits.

ObjectiveTo evaluate the clinical efficacy and economic value of the Jiangsu Traditional Chinese Medicine （TCM） Diagnosis and Treatment Protocol for Dominant Diseases （abbreviated as the Diagnosis and Treatment Protocol） in adult patients with non-severe community-acquired pneumonia （CAP） based on real-world clinical data. MethodsA retrospective real-world cohort study was conducted using electronic medical records of adult patients hospitalized for non-severe CAP from September 1st， 2023 to December 31st， 2024 across 10 TCM hospitals in Jiangsu province. Patients were classified into an exposure group and a non-exposure group based on whether they received Chinese herbal medicine （CHM） according to the Diagnosis and Treatment Protocol. The non-exposure group received only conventional western medicine， while the exposure group additionally received differentiated CHM for at least five consecutive days. Outcomes were compared between two patient groups， including cough resolution rate， sputum resolution rate （assessed by volume， color， and consistency）， incidence of abnormal C-reactive protein （CRP）， incidence of abnormal white blood cell （WBC） count， and radiographic resolution rate of pulmonary infiltrates on chest imaging. Multivariable logistic regression was performed to identify factors influencing clinical efficacy. Subgroup analyses were conducted according to age， gender， smoking status， history of hypertension， and pneumonia severity score （CURB-65）， and the efficacy of treatment for cough and sputum was analyzed within each subgroup. Cost-effectiveness analysis was conducted using cough resolution rate as the outcome measure， evaluating the pharmacoeconomics of the two groups. ResultsA total of 1688 patients were included with 1293 in the exposure group and 395 in the non-exposure group. Compared to the non-exposure group， the exposure group demonstrated significantly higher resolution rates of cough， sputum volume， color， and consistency， as well as a significantly lower incidence of abnormal CRP （P＜0.05）. No statistically significant difference was observed between the groups in terms of abnormal WBC count and radiographic resolution rate of pulmonary infiltrates （P＞0.05）. Logistic regression analysis showed that the cough resolution rate in the exposure group was 1.83 times that of the non-exposure group， while the probabilities of resolution in sputum volume， color， and consistency were 1.37， 2.09， and 1.56 times those of the non-exposure group， respectively （P＜0.05）. Subgroup analyses showed that the exposure group achieved significantly higher cough resolution rates across most subgroups except for populations with a CURB-65 score ≥2 or those with a history of hypertension （P＜0.05）. Specifically， among females， patients aged ≥18 and ＜65 years， non-smokers， those without hypertension， and those with a CURB-65 score of 0， the exposure group showed a higher cough resolution rate than the non-exposure group （P＜0.05）. From an economic perspective， total hospitalization cost， length of stay， antibiotic cost， and CHM cost all differed significantly between groups （P＜0.05）. The cost-effectiveness ratio （CER） was 10,788.80 CNY/case in the exposure group， while 22,513.80 CNY/case in the non-exposure group. This implies that， compared with the exposure group， the non-exposure group incurred an additional 17,302.27 CNY to achieve one case of cough resolution. When the willingness-to-pay threshold ranged from 0 to 50,000 CNY， the probability of economic advantage was consistently higher in the exposure group than in the non-exposure group. ConclusionOn the basis of conventional western medicine， the addition of CHM in accordance with the Diagnosis and Treatment Protocol can effectively improve clinical symptoms， reduce inflammatory markers， promote clinical recovery， and is more cost-effective in treating adults with non-severe CAP.

ObjectiveTo observe the real‑world effectiveness and economic outcomes of Weishi Qingjin Formula （苇石清金方， WQF） in the treatment of adult community‑acquired pneumonia （CAP） with phlegm‑heat obstructing the lung syndrome. MethodsBased on a multicenter， real-world retrospective cohort study， clinical data were collected from hospitalized adult patients diagnosed with non‑severe CAP and phlegm‑heat obstructing the lung syndrome in 10 traditional Chinese medicine （TCM） hospitals in Jiangsu province. Patients were divided into an exposure group （those who received oral WQF） and a non‑exposure group （those who did not）. The following outcomes were compared between the two groups before and after treatment， which were remission rates of clinical symptoms including cough， expectoration （sputum volume， color， consistency）， and chest pain， levels of inflammatory markers including C‑reactive protein （CRP） and white blood cell count （WBC）， and the rate of pulmonary inflammatory absorption on chest CT. Subgroup analyses were performed based on age， gender， smoking status， presence of hypertension， and the severity of community-acquired pneumonia （CURB‑65） score， comparing the two groups in terms of cough remission rate， chest pain remission rate， and chest CT absorption rate. For health economic evaluation， cost‑effectiveness analysis was used to calculate the cost‑effectiveness ratio （CER） and incremental cost‑effectiveness ratio （ICER）. Univariate sensitivity analysis and probabilistic sensitivity analysis were performed to test the robustness of the results. ResultsA total of 647 patients in the exposure group and 1491 patients in the non-exposure group were included in the final statistical analysis. There was no statistically significant difference in length of hospital stay， gender， marital status， smoking history， bronchoscopy history， and comorbidities between the groups （P＞0.05）， but age， CURB-65 score， and antibiotic use. The exposure group had significantly higher remission rates of cough and sputum consistency than the non-exposure group （P＜0.05）. After adjusting for confounders using propensity score matching and logistic regression， the cough remission rate in the exposure group was 1.49 times that of the non-exposure group （P＜0.01）. No significant difference was observed between groups in the reduction rates of CRP and WBC， and in the rate of pulmonary inflammatory absorption on chest CT （P＞0.05）. Subgroup analyses revealed that the cough remission rate in the exposure group was significantly better than that in the non-exposure group except for patients aged ≥65 years， smokers， hypertensive patients， those using other type antibiotics or not using antibiotics， and those with a CURB-65 score ≥1 （P＜0.05）. Among smokers， the chest pain remission rate in the exposure group was 4.38 times that of the non-exposure group （P＜0.01）. No significant difference in chest CT absorption rate was found between groups across subgroups of gender， age， hypertension status， or antibiotic type （P＞0.05）. In terms of economic evaluation， CER was 10,877.60 CNY/case in the exposure group and 16,773.10 CNY/case in the non-exposure group. Compared to the exposure group， the non-exposure group incurred an additional 15,034.26 CNY to achieve one case of cough resolution， indicating a more favorable cost-effectiveness profile. Probabilistic sensitivity analysis yielded results consistent with the cost-effectiveness analysis， confirming the robustness of the findings. ConclusionWQF demonstrates significant efficacy in improving cough symptoms in the treatment of adult CAP with phlegm-heat obstructing the lung syndrome， and also exhibits favorable economic benefits.

Objective To compare the effectiveness of femoral neck system(FNS)and inverted triangle cannulated screws(ITCS)in the treatment of femoral neck fractures in young adults.Methods A retrospective study was conducted on 106 young and middle-aged patients who had been surgically treated for femoral neck fracture at our hospital from December 2020 to June 2022.The patients were assigned to FNS group(57 cases)or ITCS group(49 cases)according to the different internal fixations.The operation time,intraoperative fluoroscopy frequency,intraoperative blood loss,extra assisted reduction procedures(Kirschner wire prying reduction or open reduction),hospital stays,healing time,complications,postoperative recovery,and follow-up duration were compared between the two groups.Results The operation time,fluoroscopy frequency,and healing time in the FNS group were less than those in the ITCS group(P<0.001).The shortening degree and length of femoral neck in moderate and severe patients of the FNS group were lower than those of the ITCS group(P<0.001).The Harris score of the FNS group was higher than that of the ITCS group 12 months after surgery(P<0.001).There was no significant difference in intraoperative blood loss,reduction assistance,Garden index,or hospital stays between the two groups(P>0.05).Conclusion FNS is a better choice for internal fixation in patients with femoral neck fractures than ITCS,with faster recovery and less postoperative complications.

Objective To compare the effectiveness of femoral neck system(FNS)and inverted triangle cannulated screws(ITCS)in the treatment of femoral neck fractures in young adults.Methods A retrospective study was conducted on 106 young and middle-aged patients who had been surgically treated for femoral neck fracture at our hospital from December 2020 to June 2022.The patients were assigned to FNS group(57 cases)or ITCS group(49 cases)according to the different internal fixations.The operation time,intraoperative fluoroscopy frequency,intraoperative blood loss,extra assisted reduction procedures(Kirschner wire prying reduction or open reduction),hospital stays,healing time,complications,postoperative recovery,and follow-up duration were compared between the two groups.Results The operation time,fluoroscopy frequency,and healing time in the FNS group were less than those in the ITCS group(P<0.001).The shortening degree and length of femoral neck in moderate and severe patients of the FNS group were lower than those of the ITCS group(P<0.001).The Harris score of the FNS group was higher than that of the ITCS group 12 months after surgery(P<0.001).There was no significant difference in intraoperative blood loss,reduction assistance,Garden index,or hospital stays between the two groups(P>0.05).Conclusion FNS is a better choice for internal fixation in patients with femoral neck fractures than ITCS,with faster recovery and less postoperative complications.

Objective To investigate the prevalence and influencing factors of polypoid lesion of gallbladder(PLG)of soldiers stationed on an island.Methods A total of 687 soldiers stationed on an island who underwent annual physical examination from October to December 2020 were selected.They took transabdominal ultrasound and blood biochemical examination,and filled out the questionnaire.There were 62 cases with PLG(PLG group)and 625 cases without PLG(non-PLG group).Age,body mass index(BMI),blood pressure,smoking,eating habits,blood biochemical indexes,and self-rating depression scale(SDS)scores were compared between the two groups.Logistic regression analysis was performed to obtain the independent risk factors for the prevalence of PLG of the soldiers.Results There were significant differences in age,BMI,blood pressure,smoking,irregular diet,total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and SDS scores between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that age,high BMI,smoking,irregular diet,high TC,high TG,high LDL-C,and high SDS scores were independent risk factors for PLG(all P<0.05).Conclusion There is a high overall prevalence of PLG in the soldiers of this island,which is related to age,high BMI,smoking,irregular diet,high TC,high TG,high LDL-C,and high SDS scores.

Objective To analyze the characteristics of clinical indicators in patients with type 2 diabetes,and to establish a simple and effective risk prediction model for type 2 diabetes complicated with coronary heart disease by screening risk prediction indicators with machine learning.Methods A retrospective study was conducted,and 217 patients diagnosed with coronary artery disease combined with type 2 diabetes mellitus who were hospitalized in the Hospital from January 2022 to November 2023 were selected.Additionally,214 patients diagnosed with T2DM during the same period in the outpatient department were selected as the con-trol group.Their routine laboratory test data were recorded.The Least Absolute Shrinkage and Selection Op-erator(Lasso)algorithm was used to select features,and the models were built by using seven machine learn-ing algorithms:Random Forest,Decision Tree,Support Vector Machine,eXtreme Gradient Boosting,Logistic Regression,K-Nearest Neighbor,and Artificial Neural Network.The diagnostic efficacy of different models through receiver operating characteristic curve(ROC),area under curve(AUC),calibration curve,specificity,sensitivity,F1 value,and other indicators were evaluated.Results Twenty key factors,including age,gender,systolic blood pressure,diastolic blood pressure,heart rate,C-reactive protein and blood glucose were selected using Lasso regression.When incorporated into various models,the SVM model exhibited the highest sensitiv-ity(88.37％),negative predictive value(82.14％),and area under curve(0.845).The Random Forest model had the highest accuracy(76.47％),positive predictive value(76.74％),and F1 score(0.77).Meanwhile,the XGBoost algorithm demonstrated relatively good specificity(80.95％).After introducing the SHAP model,it was inferred that blood glucose had a significant positive impact on the occurrence of coronary heart disease in individuals with type 2 diabetes.Conclusion Machine learning can serve as an effective tool for assessing the risk of coronary heart disease in patients with type 2 diabetes.In this study,SVM,Random Forest,and XG-Boost models all demonstrate good predictive performance,indicating promising clinical application prospects.

Objective::Eosinophils (EOS) are inflammatory innate immune cells that play an important role in arterial thrombogenesis. There is a paucity of data on whether EOS levels have an impact on long-term outcomes following ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the impact of EOS count on the clinical outcomes of STEMI patients who underwent emergency percutaneous coronary intervention (PCI).Methods::This is a retrospective multicenter cohort study. A total of 754 patients with STEMI who required emergency PCI at 5 centers were screened between October 2015 and November 2016. Patients were divided into 2 groups based on EOS count: EOS count <0.02 × 10 9/L group ( n = 264) and EOS count ≥0.02 × 10 9/L group ( n = 490). Baseline demographic characteristics, clinical information, and medical test data were collected at study entry. The primary endpoint was all-cause death. The secondary endpoint was a major adverse cardiac event. Multivariablete Cox regression analysis was performed to identify the independent predictors of all-cause death, with a follow-up period of 5 years. Results::The incidence of all-cause death (14.8% vs. 7.6%, P = 0.002) and major adverse cardiac event (20.1% vs. 13.1%, P = 0.011) were significantly higher in EOS count <0.02 × 10 9/L group compared with ≥0.02 × 10 9/L group. Multivariablete Cox regression analysis showed that an EOS count <0.02 × 10 9/L, age ≥65 years, previous heart failure, previous stroke, and left ventricular ejection fraction ≤ 40% were independent predictors of all-cause death in patients with STEMI who underwent an emergency PCI. Conclusions::Low EOS counts were associated with all-cause mortality in STEMI patients who underwent emergency PCI.

Objective:The treatment of head and neck in plexiform neurofibroma (PNF) is a major clinical problem, lacking consensus on surgical treatment, classification, operation timing, and treatment method. The purpose of this study was to provide a basis for further consensus formation by analyzing the clinical manifestations, surgical conditions, tumor recurrence, post-operation satisfaction, and changes in quality of life of patients undergoing PNF surgery in head and neck.Methods:Through medical record review and telephone follow-up, a retrospective analysis was conducted on neurofibromatosis type 1 (NF1) patients admitted for surgical treatment for PNF patient in head and neck from May 2012 to July 2022 in Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Complete collection and statistical analysis of patients’clinical data, using telephone follow-up to investigate the immediate postoperative satisfaction and long-term surgical satisfaction of patients and/or their families, as well as standardized quality of life questionnaires HRQol(health related quality of life) and PlexiQol(plexiform neurofibroma quality of life). Based on the data about changes in quality of life before and after surgery and long-term surgical satisfaction, patients were divided into surgical benefit and non-benefit groups. Binary and multivariate logistic regression analysis were used to analyze the clinical characteristics of patients with long-term surgical benefit.Results:Totally 512 patients with head and neck NF1 were admitted for surgery with complete medical records. 121 patients were identified as NF1 related PNF diagnosed by medical history and radiological examination, and effective follow-up was obtained. There were 70 males and 51 females, aged (25.60±12.85) years old, ranging from 7 to 63 years old, with 41 patients who were ≤ 18 years old and 80 patients over 18 years old. 62.81%(76/121) of patients exhibiting clinical dysfunctions, and the tumor mass were mainly characterized by invasive growth. 41.32%(50/121) of patients underwent multiple surgical treatments, with a total of 215 surgeries performed on 121 patients. The surgical objective included appearance improvement and functional repair. The incidence of postoperative complications was 6.05%(13/215). The follow-up period after last operation was (51.41±27.66) months, and 42.15%(51/121) of patients reported postoperative tumor recurrence. 76.03%(92/121) of patients were satisfied with immediate postoperative result, while the rate decreased to 46.28%(56/121) during long-term follow-up. Family members of patients who were ≤ 18 years old had a higher proportion of dissatisfaction with the scars caused by surgery and a stronger willingness to undergo another surgery. The tumor recurrence was closely related to surgical benefits ( OR=2.32, P<0.05). Further analysis found that the gender and age of patients were the main risk factors for the recurrence. The recurrence risk in patients ≤ 18 years old was significantly higher than in that over 18 years old( OR=3.49, P=0.004), and the highest in the 7-12 year-old group, reaching 68.42%(13/19). The recurrence risk in male patients was significantly lower than that in females ( OR=0.40, P=0.026). Conclusion:The clinical manifestations of PNF patients in head and neck region are complex. Clinical diagnosis and treatment in PNF should focus on the applications in comprehensive method such as full preoperative evaluation, active multi-disciplinary treatment cooperation and combined therapies in order to improve the safety and effectiveness of treatment and reduce tumor recurrence.