ObjectiveTo systematically investigate the discrepancies between employment preferences and actual job placements among postgraduate students in rehabilitation medicine, explore the influencing factors, and elucidate the underlying mechanisms of their employment decisions. MethodsA cross-sectional questionnaire survey was conducted among 100 full-time postgraduate students who had graduated from Capital Medical University School of Rehabilitation in the past six years. A self-designed questionnaire was used to collect information on personal background, self-assessed competencies, employment preferences, and actual job placements. Logistic regression models were employed to analyze the factors influencing employment preferences and actual job placements, respectively. ResultsEmployment preferences among rehabilitation medicine postgraduates were highly concentrated on large tertiary hospitals (79.0%), yet the actual placement rate (61.0%) showed a significant gap. Preference for tertiary hospitals showed no significant association with individual factors such as gender, degree type or self-assessed competencies (P > 0.05). Univariate analysis revealed that those who entered tertiary hospitals scored significantly higher in self-assessed clinical skills, research ability, communication and coordination, and resource integration (|t| > 3.661, P < 0.001), and demonstrated clearer career planning (P = 0.012). Multivariate logistic regression analysis did not identify any independent predictors of actual employment within the context of this study sample (P > 0.05). ConclusionEmployment among rehabilitation medicine postgraduates is characterized by highly homogeneous preferences coexisting with complexity of factors influencing actual employment. It is recommended to optimize the training system, deepen personalized career education, and establish diversified employment guidance mechanisms to promote rational talent flow and facilitate the balanced development of the rehabilitation medical service system.

To investigate the risk factors for acute kidney injury (AKI) following the use of amphotericin B deoxycholate and to develop a predictive model to guide clinical monitoring and intervention.

Objective: To investigate the association between uric acid level and elevated blood pressure among children and adolescents in Guangzhou, so as to provide a scientific basis for prevention and control of hypertension in the pediatric population. Methods: From March to December 2019, using stratified cluster random sampling, 3 626 children and adolescents aged 6-17 years without elevated blood pressure at baseline were recruited from 6 primary and secondary schools in Guangzhou. Serum uric acid levels were measured at baseline, and divided into four groups ( Q1-Q 4) based on age and sex specific quartiles for analyses. Two waves of follow up were carried out from October 2020 to May 2021 and from October 2021 to May 2022, respectively. Multilevel robust Poisson regression was used to evaluate the association between uric acid level and elevated blood pressure among children and adolescents. The additive interaction between high uric acid level and sugar sweetened beverage (SSB) intake on elevated blood pressure was assessed by stratification analysis and calculation of the relative excess risk due to interaction (RERI). Results: A total of 1 131 new cases of elevated blood pressure were identified during the two follow ups, with an incidence density of 130.5 cases 1 000 person years. Multilevel robust Poisson regression analysis showed that after adjusting for confounders such as gender, age and annual family income, compared with those in the uric acid Q 1 level, the risk of elevated blood pressure in individuals in the Q 4 level increased by 25% ( RR=1.25, 95%CI =1.08-1.44), and the risk of elevated systolic blood pressure increased by 20% ( RR=1.20, 95%CI =1.05-1.36) (both P <0.05); no statistical association was observed between uric acid and elevated diastolic blood pressure (all P >0.05). In the stratified analysis, the statistical associations of uric acid Q 4 level with elevated blood pressure ( RR=1.34, 95%CI =1.13-1.58) and elevated systolic blood pressure ( RR=1.33, 95%CI =1.14-1.55) were only observed in the group with SSB intake ≥ 250 mL/week (both P <0.05). The RERI values for the effect of uric acid Q 4 and Q 3 levels with SSB intake ≥ 250 mL/week on elevated systolic and diastolic blood pressure were 0.29 and 0.44 (both P <0.05). Conclusions High uric acid level is a risk factor for elevated blood pressure among children and adolescents, with a predominant effect on systolic blood pressure. High uric acid level and SSB intake synergistically promote the increase of blood pressure of children and adolescents.

Objective To identify latent profiles of digital health technophobia among elderly patients with breast cancer and to examine differences in demand for on-line nursing care services.Methods Convenient sampling was used in this cross-sectional study.A total of 350 consecutive perioperative elderly patients with primary breast cancer were recruited from the Departments of General Surgery,affiliated to three Tier-IIIA hospitals in Shijiazhuang from June 2022 to June 2023.Data were collected with a general-information questionnaire,technophobia scale,and demand scale for online appointment nursing service.Results All 348 patients completed the survey.Digital health technophobia in elderly patients with primary breast cancer were categorised into four latent profiles:low technophobia(n=65,18.68%),high technophobia with moderate privacy-security concern(n=96,27.59%),moderate technophobia with high privacy security concern(n=85,24.43%),and high technophobia(n=102,29.31%).There was significant difference in demand for online nursing care services regarding the four latent profiles(F=446.149,P<0.05).Conclusion Elderly patients with breast cancer exhibit four profiles regarding digital health technophobia.It is found that each profile associates with specific demands of online nursing care services.Nursing staff should take tailored interventions to target specific digital health technophobia profiles to meet the demands of online nursing care services among the elderly patients with breast cancer.

Objective To investigate the association between cystatin C level and 6-month mortali-ty as well as re-hospitalization in elderly patients with heart failure(HF).Methods The clinical data in this study were from a retrospective cohort study,Zigong Heart Failure Study.A total of 1786 elderly HF patients admitted in Zigong Fourth People's Hospital from December 2016 to June 2019 were selected.According to the tertiles of cystatin C level,the subjected patients were divided into three groups,with the cystatin C level of 1.10±0.17(587 cases),1.60±0.17(599 ca-ses),and 2.91±0.90 mg/L(600 cases),respectively.The primary endpoint was a composite end-point of death at 6 months after discharge and readmission due to HF.Multivariate Cox propor-tional hazards regression analysis was employed to analyze the relationship of the cystatin C level with the composite endpoint of 6-month mortality and readmission due to HF.Restricted cubic spline was used to model the relationship between the cystatin C level and the composite end-point,Kaplan-Meier survival curve was plotted to analyze the differences in 6-month event free survival rates among the three groups,and ROC curve was drawn to analyze the predictive value of cystatin C level for the composite endpoint.Results Multivariate Cox proportional hazards re-gression analysis showed that the middle and upper tertiles of cystatin C level were risk factors for the composite endpoint of 6-month mortality and readmission due to HF(HR=1.170,95％CI:0.970-1.390,P=0.111;HR=1.452,95％CI:1.190-1.756,P=0.000).When taking cystatin C level as a continuous variable,the results remained consistent:for every one standard deviation increase in cystatin C level,HR=1.141,95％CI:1.060-1.226 in Model 3;For every 1 mg/L in-crease,HR=1.152,95％CI:1.057-1.250 in Model 3.Restricted cubic spline displayed a non-linear inverse J-shaped relationship between cystatin C level and the composite endpoint of 6-month mortality and readmission due to HF,with a risk inflection point of cystatin C level at 2.13 mg/L.ROC curve analysis showed that the AUC value of cystatin C level in predicting the composite endpoint,6-month death and re-admission due to HF was 0.572,0.667 and 0.554,respectively.Conclusion Elevated cystatin C level is independently associated with an increased risk of the composite endpoint of 6-month death and re-admission in elderly HF patients.

Objective To investigate the effects of scribble planar cell polarity protein(SCRIB)on proliferation,apoptosis,and autophagy of glioblastoma(GBM)and elucidate its potential underlying mechanisms.Methods The expression level of SCRIB in GBM tissue was queried through the Biomarker Exploration of Solid Tumors(BEST)database.Lentivirus-mediated shRNA interference was employed to downregulate SCRIB expression in human glioblastoma cell lines U87 and U251,which were divided into negative control group(mock)and SCRIB shRNA interference groups(kd1 and kd2).SCRIB expression levels were detected using Western blotting(WB)and quantitative polymerase chain reaction(qPCR).EdU incorporation and cell apoptosis rates were detected by flow cytometry(FCM).CCK-8 assay was used to detect the proliferation vitality of U87 and U251 cells,and WB was used to detect the expression of proliferation-related proteins.Immunofluorescence(IF)staining was conducted to detect the expression of autophagy-related proteins LC3 and p62,followed by quantitative analysis across multiple fields.WB was also used to detect the expression levels of LC3,p62,and proteins in the JAK-STAT3 signaling pathway.Results Compared with that of normal tissues,SCRIB mRNA expression level was significantly upregulated in GBM tissues(P＜0.05).FCM results showed that EdU incorporation rates were significantly reduced(P＜0.001)while cell apoptosis rates were markedly increased(P＜0.001)in U87 and U251 cells with SCRIB knockdown.CCK-8 results indicated that compared with the mock group,the proliferation vitality of U87 and U251 cells in the SCRIB knockdown group was significantly downregulated(P＜0.001).IF staining showed that LC3 fluorescence aggregation was significantly enhanced(P＜0.001),while p62 fluorescence aggregation was significantly reduced(P＜0.001)in the SCRIB knockdown group.WB results showed that compared with the mock group,the protein expression levels of p27,LC3,p-JAK2 and p-STAT3 were upregulated,while C-Myc,Cyclin D1,MCM,PCNA and p62 were downregulated,with statistically significant differences(P＜0.05).Conclusion Downregulation of SCRIB may induce autophagy and apoptosis in glioblastoma cells by inhibiting the JAK-STAT3 signaling pathway,thereby suppressing cell proliferation.

Objective To evaluate answers to typical clinical questions related to neuro-ophthalmology generated by Artificial Intelligence(AI)Large Language Models(LLM)and to explore the performance of neuro-ophthalmology-related questions on LLM in a multidimensional manner using objective and expert assessment.Methods Multicenter,random-ized,cross-sectional pilot study.Thirty typical questions related to neuro-ophthalmology were selected based on four per-spectives:definition,etiology,clinical manifestations and signs,and treatment and prognosis,and were analyzed quantita-tively using Deepseek,Wenxin Yiyin 4.0,Doubao,and Kimi 1.5,which are four open-source LLMs in China,and quantita-tively analyzed with objective assessment;and quantitatively rated by three ophthalmologists using expert assessment for 120 answer texts.Three ophthalmology experts quantitatively scored the 120 answer texts.Three ophthalmologists quantita-tively scored the 120 answer texts.Level 3,5,and 4 Likert scales were developed according to the completeness,accura-cy,professionalism,relevance,and criticality of the question texts,respectively.The best-performing LLM was selected,and its performance was observed across the four types of questions.Additionally,three other experts assessed whether the best-performing one could be evaluated as a substitute for real-world doctor-patient communication.Results In the objective Chinese text reading difficulty analysis,the differences in total word count among the four LLMs were statistically significant(all P＜0.001).Of the four LLMs,Kimi 1.5 performed the best,with frequencies of 61％,29％,and 41％for the highest scores in completeness(3),accuracy and professionalism(5),and relevance and usefulness(4),respective-ly.Kimi 1.5 performed more consistently on the questions on the four areas of neuro-ophthalmologic disorders:definition,etiology,clinical manifestations and signs,treatment,and prognosis,with no between-group differences(P＞0.05).Con-clusion Chinese language LLMs have great potential in the clinical application of neuro-ophthalmology.Kimi 1.5 outper-forms other LLMs in terms of completeness,accuracy,professionalism,relevance,and usefulness,but it still cannot re-place real-world doctor-patient communication.There is a need to explore new diagnostic and therapeutic model of AI+physician in the future.

Objective To investigate the association between cystatin C level and 6-month mortali-ty as well as re-hospitalization in elderly patients with heart failure(HF).Methods The clinical data in this study were from a retrospective cohort study,Zigong Heart Failure Study.A total of 1786 elderly HF patients admitted in Zigong Fourth People's Hospital from December 2016 to June 2019 were selected.According to the tertiles of cystatin C level,the subjected patients were divided into three groups,with the cystatin C level of 1.10±0.17(587 cases),1.60±0.17(599 ca-ses),and 2.91±0.90 mg/L(600 cases),respectively.The primary endpoint was a composite end-point of death at 6 months after discharge and readmission due to HF.Multivariate Cox propor-tional hazards regression analysis was employed to analyze the relationship of the cystatin C level with the composite endpoint of 6-month mortality and readmission due to HF.Restricted cubic spline was used to model the relationship between the cystatin C level and the composite end-point,Kaplan-Meier survival curve was plotted to analyze the differences in 6-month event free survival rates among the three groups,and ROC curve was drawn to analyze the predictive value of cystatin C level for the composite endpoint.Results Multivariate Cox proportional hazards re-gression analysis showed that the middle and upper tertiles of cystatin C level were risk factors for the composite endpoint of 6-month mortality and readmission due to HF(HR=1.170,95％CI:0.970-1.390,P=0.111;HR=1.452,95％CI:1.190-1.756,P=0.000).When taking cystatin C level as a continuous variable,the results remained consistent:for every one standard deviation increase in cystatin C level,HR=1.141,95％CI:1.060-1.226 in Model 3;For every 1 mg/L in-crease,HR=1.152,95％CI:1.057-1.250 in Model 3.Restricted cubic spline displayed a non-linear inverse J-shaped relationship between cystatin C level and the composite endpoint of 6-month mortality and readmission due to HF,with a risk inflection point of cystatin C level at 2.13 mg/L.ROC curve analysis showed that the AUC value of cystatin C level in predicting the composite endpoint,6-month death and re-admission due to HF was 0.572,0.667 and 0.554,respectively.Conclusion Elevated cystatin C level is independently associated with an increased risk of the composite endpoint of 6-month death and re-admission in elderly HF patients.

Objective:To construct an evidence-based practice program for dietary management of patients with non-dialysis chronic kidney disease (CKD) based on best evidence and to evaluate the effectiveness of its application.Methods:The best evidence for dietary management of non-dialysis CKD patients was summarized. From September to October 2022, following the evidence clinical transformation model of the Fudan University Centre for Evidence-based Nursing, the best evidence was screened and evidence-based practice program were developed, taking into account patients' wishes, expert opinions, and clinical contexts. From November 2022 through March 2023, baseline reviews, analysis of barriers and facilitators were implemented. Between April 2023 and April 2024, evidence-based practice was carried out in the Department of Nephrology of the Second Affiliated Hospital of Guangzhou Medical University to compare the implementation rate of review indicators at the system, practitioner, and patient levels, and practitioners' knowledge before and after the application of evidence.Results:A total of 14 review indicators were developed. The implementation rate of the 12 review indicators and the practitioners' knowledge of the CKD diet were elevated after the evidence-based practice ( P<0.05) . Conclusions:Evidence-based practice program for dietary management of patients with non-dialysis CKD has a positive effect on improving practitioners' knowledge of non-dialysis CKD diets, implementation rate of dietary management behaviors, and patients' dietary behaviors.

Objective:To explore the effects of Ziyu Ointment on granulation tissue,TGF-β and downstream Smad protein in the process of wound healing in rats by constructing a rat model of back trauma.Methods:A rat model of back trauma was constructed,and 100 SD male rats were separated into healthy group,back trauma group,Ziyu Ointment treatment group,petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group,with 20 per group.Wound formation surgery was performed,and wound healing of rats in each group was recorded at 5th,10th,and 15th day after operation;the levels of IL-6,IL-1β and TNF-α in the serum of rats in each group were detected;the granulation tissue formed by wound healing at 15th day was selected for HE and Masson staining,the proportion of blood vessel area and collagen area of granulation tissue of rats in each group were analyzed and calculated;the mRNA expression levels of TGF-β1 and Smad3 in granulation tissues of rats in each group were detected by fluorescence quantitative PCR;the expression levels of TGF-β1,Smad3 and p-Smad3 in granulation tissues of rats in each group were detected by Western blot.Results:The healthy group rats had complete epidermal tissue;the levels of serum IL-6,IL-1β,TNF-α,the expression of TGF-β1 mRNA and protein in the wound granulation tissue,and the phosphorylation of Smad3 in the back trauma group were obviously higher than the healthy group(P<0.05);compared with back trauma group,the wound healing rate,proportion of collagen area,and propor-tion of blood vessel area in Ziyu Ointment treatment group and petrolatum treatment group were obviously increased,the serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression,and Smad3 phosphorylation were obviously decreased(P<0.05);compared with Ziyu Ointment treatment group,the petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group had obviously lower wound healing rate,collagen area percentage,and blood vessel area percentage,and obviously lower serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression and Smad3 phosphorylation(P<0.05).Conclusion:Ziyu Ointment can inhibit the expression of related genes and proteins by regulating the TGF-β/Smad signal pathway,thereby alleviating inflammation and promoting wound healing.