Implementation science aims to facilitate the efficient dissemination and sustainable application of evidence based interventions, and has accordingly generated a variety of theories, models, and frameworks. Among these, the Exploration, Preparation, Implementation, and Sustainment (EPIS) frameworkfunctions both as a process model and a determinant framework, emphasizing the staged and iterative nature of implementation, and systematically explaining the influence of multilevel factors on implementation processes and outcomes through four dimensions: outer context, inner context, bridging factors, and innovation factors. The EPIS framework has been widely applied in health and public service settings internationally, yet its use in China based research remains relatively limited. This article systematically introduces the core components and application methods of the EPIS framework, and illustrates its value in identifying key influencing factors, developing implementation strategies, and optimizing implementation outcomes through case examples from the health sector, aiming to provide a methodological reference for implementation research and the promotion of evidence based interventions in China.

Objective To investigate the risk factors and intervention measures for surgical site infec-tion following posterolateral approach lumbar fusion surgery.Methods A total of 1 078 patients who under-went posterolateral approach lumbar fusion surgery in the department of spine surgery from January 1,2022 to December 31,2023 were included.Patient related information was collected through the real-time nosocomi-al infection monitoring system,while medical visit information was obtained via the outpatient electronic med-ical record system.Multivariate logistic regression analysis was performed to identify risk factors for surgical site infection.Results Among the 1 078 patients,34 cases(3.15%)developed surgical site infections,while 1 044 cases did not.Multivariate logistic regression analysis revealed that age,smoking,hypertension,diabetes,concurrent hospital stay,operative time,duration of postoperative antimicrobial use after initial surgery,and total antimicrobial use duration were significant risk factors for surgical site infection(P＜0.05).Among the 34 infected patients,the duration of antimicrobial use varied significantly across different infection sites(P＜0.05),with the longest duration observed in patients with deep space infections.Conclusion Targeted surveil-lance of surgical site infections should be reinforced based on these risk factors.Perioperative infection control measures must be strictly implemented to improve the scientific,precise,and standardized management of sur-gical-related nosocomial infections.

BACKGROUND:Previous studies have indicated that cathepsin K can intervene with the occurrence and development of osteoporosis by regulating bone mineral density in middle-aged and older adults. However,whether there is a causal relationship between the cathepsin family and bone mineral density in other populations remains unknown. OBJECTIVE:To investigate the causal relationship between cathepsin and bone mineral density.METHODS:Genetic loci associated with eight cathepins were extracted from the IEU Open GWAS database as instrumental variables,and bone mineral density values in five age groups acted as an outcome. The causal relationship between cathepin and bone mineral density was assessed by two-way Mendelian randomization analysis. Heterogeneity of the genetic instrumental variables was assessed using Cochran's Q test,pleiotropy was assessed using the MR-Egger intercept test,and the sensitivity of single nucleotide polymorphisms used as instrumental variables to the causal effect of exposure and outcome was assessed using the leave-one-out method. RESULTS AND CONCLUSION:The results of the inverse variance weighting method with positive Mendelian randomization showed that cathepin H was negatively associated with bone mineral density in people aged 45-60 years[odds ratio (95％ confidence interval)=0.965(0.94-0.99),P=0.04];cathepin Z was negatively associated with bone mineral density in people aged 30-45 year[odds ratio (95％ confidence interval)=1.06 (1.00-1.11),P=0.03]. The results of sensitivity analysis showed a stable causal relationship,and MR-Egger intercept analysis did not detect potential horizontal pleiotropy. The inverse Mendelian randomization results showed that bone mineral density had no significant inverse effect on cathepin. The above results confirm that cathepin can affect bone mineral density in some age groups,which may increase the risk of osteoporosis and should be given more attention.

Objective To investigate the impact of catheter ablation(CA)combined with left atrial appendage closure(one-stop procedure)on cardiac function in atrial fibrillation(AF)patients,and analyze the risk factors for late AF recurrence after one-stop pro-cedure.Methods A total of 225 patients who visited the Inner Mongolia Autonomous Region People's Hospital for AF from January 2020 to December 2023 were included,and they were divided into the one-stop procedure group(n=93)and the CA group(n=132)ac-cording to the procedure,and 55 patients with matching clinical baseline characteristics were respectively screened out at a ratio of 1:1 by the method of propensity score matching,namely the CA group(n=55)and the one-stop procedure group(n=55),and the changes in cardiac function between the two groups were compared between preoperative and 1-year postoperative periods.Risk factors for late post-operative recurrence of AF and their predictive value in the one-stop procedure group were assessed using multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve.Results At 1 year postoperatively,N-terminal B-type natriuretic peptide(NT-proBNP),left atrial internal diameter(LAD),and left ventricular end-diastolic diameter(LVEDD)were significantly lower and left ventricular ejection fraction(LVEF)was significantly higher in both groups compared with the preoperative period(P＜0.05),but there was no statistically significant difference in the improvement degree of cardiac function between the two groups at 1 year postopera-tively(P＞0.05).The results of the univariate analysis showed that there were statistically significant differences in NT-proBNP,LAD,and left ventricular end-systolic diameter(LVESD)in the one-stop procedure late postoperative recurrence group compared with late postoperative non-recurrence group(P＜0.05),and the results of multivariate Logistic regression analysis showed that the preoperative NT-proBNP(OR=1.075,95％CI:1.029-1.124,P=0.001)and preoperative LAD(OR=1.222,95％CI:1.094-1.365,P＜0.001)were the risk factors for late recurrence of AF after one-stop procedure.The results of the ROC curve analysis showed that the area under the curve(AUC)of NT-proBNP,LAD,and the combination of the two in predicting late recurrence of AF after one-stop procedure were 0.788,0.772 and 0.846,respectively,with a sensitivity of 84.4％,68.8％and 87.5％,and a specificity of 68.9％,78.7％and 77.0％,respectively.Conclusion Both one-stop procedure and CA can significantly improved cardiac function in patients with AF with comparable results.Preoperative LAD enlargement and NT-proBNP elevation are independent risk factors for late recur-rence of AF after one-stop procedure,and the combination of the two can effectively improve the efficacy of AF recurrence risk assess-ment.

Objective To establish a quantifiable quality control index system for infection management in neonatal specialty hospitals for the comprehensive evaluation of neonatal healthcare-associated infection(HAI)management quality,and to promote the continuous enhancement and improvement of neonatal HAI management quality.Methods The framework of the index system was preliminarily established through literature research and focus group discussion,the indexes were repeatedly screened using Delphi expert consultation approach,and the weights of each index were determined using the analytic hierarchy process.The empirical study of the established index sys-tem was conducted using TOPSIS method and rank sum ratio method.Results Three rounds of expert consultation were conducted,and the effective response rate of the questionnaire was 100％.The authoritative coefficient of the third round of expert consultation was 0.89,and the Kendall's coefficient of concordance for expert opinion was 0.322.The established index system included 3 first-level indexes,6 second-level indexes,and 16 third-level inde-xes.Thirteen of third-level indexes could be directly obtained from the hospital information system.Conclusion The quality control index system for neonatal HAI management established in this study is relatively scientific,with rational weights and all quantifiable indexes.It can be used for vertical and horizontal evaluations of neonatal HAI management quality,providing a reference for the continuous improvement of neonatal HAI management work.

Objective To establish a quantifiable quality control index system for infection management in neonatal specialty hospitals for the comprehensive evaluation of neonatal healthcare-associated infection(HAI)management quality,and to promote the continuous enhancement and improvement of neonatal HAI management quality.Methods The framework of the index system was preliminarily established through literature research and focus group discussion,the indexes were repeatedly screened using Delphi expert consultation approach,and the weights of each index were determined using the analytic hierarchy process.The empirical study of the established index sys-tem was conducted using TOPSIS method and rank sum ratio method.Results Three rounds of expert consultation were conducted,and the effective response rate of the questionnaire was 100％.The authoritative coefficient of the third round of expert consultation was 0.89,and the Kendall's coefficient of concordance for expert opinion was 0.322.The established index system included 3 first-level indexes,6 second-level indexes,and 16 third-level inde-xes.Thirteen of third-level indexes could be directly obtained from the hospital information system.Conclusion The quality control index system for neonatal HAI management established in this study is relatively scientific,with rational weights and all quantifiable indexes.It can be used for vertical and horizontal evaluations of neonatal HAI management quality,providing a reference for the continuous improvement of neonatal HAI management work.

Objective To investigate the impact of catheter ablation(CA)combined with left atrial appendage closure(one-stop procedure)on cardiac function in atrial fibrillation(AF)patients,and analyze the risk factors for late AF recurrence after one-stop pro-cedure.Methods A total of 225 patients who visited the Inner Mongolia Autonomous Region People's Hospital for AF from January 2020 to December 2023 were included,and they were divided into the one-stop procedure group(n=93)and the CA group(n=132)ac-cording to the procedure,and 55 patients with matching clinical baseline characteristics were respectively screened out at a ratio of 1:1 by the method of propensity score matching,namely the CA group(n=55)and the one-stop procedure group(n=55),and the changes in cardiac function between the two groups were compared between preoperative and 1-year postoperative periods.Risk factors for late post-operative recurrence of AF and their predictive value in the one-stop procedure group were assessed using multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve.Results At 1 year postoperatively,N-terminal B-type natriuretic peptide(NT-proBNP),left atrial internal diameter(LAD),and left ventricular end-diastolic diameter(LVEDD)were significantly lower and left ventricular ejection fraction(LVEF)was significantly higher in both groups compared with the preoperative period(P＜0.05),but there was no statistically significant difference in the improvement degree of cardiac function between the two groups at 1 year postopera-tively(P＞0.05).The results of the univariate analysis showed that there were statistically significant differences in NT-proBNP,LAD,and left ventricular end-systolic diameter(LVESD)in the one-stop procedure late postoperative recurrence group compared with late postoperative non-recurrence group(P＜0.05),and the results of multivariate Logistic regression analysis showed that the preoperative NT-proBNP(OR=1.075,95％CI:1.029-1.124,P=0.001)and preoperative LAD(OR=1.222,95％CI:1.094-1.365,P＜0.001)were the risk factors for late recurrence of AF after one-stop procedure.The results of the ROC curve analysis showed that the area under the curve(AUC)of NT-proBNP,LAD,and the combination of the two in predicting late recurrence of AF after one-stop procedure were 0.788,0.772 and 0.846,respectively,with a sensitivity of 84.4％,68.8％and 87.5％,and a specificity of 68.9％,78.7％and 77.0％,respectively.Conclusion Both one-stop procedure and CA can significantly improved cardiac function in patients with AF with comparable results.Preoperative LAD enlargement and NT-proBNP elevation are independent risk factors for late recur-rence of AF after one-stop procedure,and the combination of the two can effectively improve the efficacy of AF recurrence risk assess-ment.

BACKGROUND:Previous studies have indicated that cathepsin K can intervene with the occurrence and development of osteoporosis by regulating bone mineral density in middle-aged and older adults. However,whether there is a causal relationship between the cathepsin family and bone mineral density in other populations remains unknown. OBJECTIVE:To investigate the causal relationship between cathepsin and bone mineral density.METHODS:Genetic loci associated with eight cathepins were extracted from the IEU Open GWAS database as instrumental variables,and bone mineral density values in five age groups acted as an outcome. The causal relationship between cathepin and bone mineral density was assessed by two-way Mendelian randomization analysis. Heterogeneity of the genetic instrumental variables was assessed using Cochran's Q test,pleiotropy was assessed using the MR-Egger intercept test,and the sensitivity of single nucleotide polymorphisms used as instrumental variables to the causal effect of exposure and outcome was assessed using the leave-one-out method. RESULTS AND CONCLUSION:The results of the inverse variance weighting method with positive Mendelian randomization showed that cathepin H was negatively associated with bone mineral density in people aged 45-60 years[odds ratio (95％ confidence interval)=0.965(0.94-0.99),P=0.04];cathepin Z was negatively associated with bone mineral density in people aged 30-45 year[odds ratio (95％ confidence interval)=1.06 (1.00-1.11),P=0.03]. The results of sensitivity analysis showed a stable causal relationship,and MR-Egger intercept analysis did not detect potential horizontal pleiotropy. The inverse Mendelian randomization results showed that bone mineral density had no significant inverse effect on cathepin. The above results confirm that cathepin can affect bone mineral density in some age groups,which may increase the risk of osteoporosis and should be given more attention.

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia(RMPP),precisely identify the joint predictors in these children,and construct a prediction model.This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies.Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1,2023,and February 29,2024.Among these children,119 with RMPP were classified into the RMPP group,while the remaining 163 with general MPP(GMPP)were assigned to the GMPP group.The clinical data of both groups,encompassing age,gender,duration of fever,symptoms,laboratory test indices,chest imaging data,complications,etc.,were compared.A logistic probability model(LogP model)for joint application was constructed.The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic(ROC)curve,and the calibration of the model was assessed by means of a calibration curve.Results In comparison with the GMPP group,children in the RMPP group exhibited a significantly longer duration of fever(P=0.002).Moreover,they had a higher incidence of complications,including myocardial damage and coagulation dysfunction(P<0.05).Regarding inflammatory markers,the levels of C-reactive protein(CRP),procalcitonin(PCT),and lactate dehydrogenase(LDH)were notably elevated in the RMPP group(P<0.05),whereas the level of albumin(Alb)was lower(P=0.001).In the RMPP group,the levels of interleukin-2(IL-2),interleukin-5(IL-5),interleukin-8(IL-8),interleukin-1β(IL-1β),and D-Dimer were increased,while the levels of interleukin-6(IL-6)and interleukin-17(IL-17)were decreased(P<0.05).Chest computed tomography(CT)scans revealed a higher proportion of lung consolidation,pleural effusion,and atelectasis in the RMPP group(P<0.05).Multivariate logistic regression analysis demonstrated that CRP,total bilirubin(T-BIL),LDH,IL-17,and prothrombin time(PT)were independent risk factors for RMPP(P<0.05).The receiver operating characteristic(ROC)predictive model established based on these factors had an area under the curve(AUC)of 0.787(95%confidence interval[CI]:0.693～0.880),with a cutoff value of 0.421,a sensitivity of 0.786,and a specificity of 0.660.The calibration curve indicated that the predicted probability matched well with the reference probability,and there was no statistical difference in the results of the Hosmer-Lemeshow test(P>0.05).Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever,moderate lung lesions,other organ injuries,and high inflammatory markers.CRP,T-BIL,LDH,IL-17,and PT can act as independent risk factors for RMPP.

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia(RMPP),precisely identify the joint predictors in these children,and construct a prediction model.This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies.Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1,2023,and February 29,2024.Among these children,119 with RMPP were classified into the RMPP group,while the remaining 163 with general MPP(GMPP)were assigned to the GMPP group.The clinical data of both groups,encompassing age,gender,duration of fever,symptoms,laboratory test indices,chest imaging data,complications,etc.,were compared.A logistic probability model(LogP model)for joint application was constructed.The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic(ROC)curve,and the calibration of the model was assessed by means of a calibration curve.Results In comparison with the GMPP group,children in the RMPP group exhibited a significantly longer duration of fever(P=0.002).Moreover,they had a higher incidence of complications,including myocardial damage and coagulation dysfunction(P<0.05).Regarding inflammatory markers,the levels of C-reactive protein(CRP),procalcitonin(PCT),and lactate dehydrogenase(LDH)were notably elevated in the RMPP group(P<0.05),whereas the level of albumin(Alb)was lower(P=0.001).In the RMPP group,the levels of interleukin-2(IL-2),interleukin-5(IL-5),interleukin-8(IL-8),interleukin-1β(IL-1β),and D-Dimer were increased,while the levels of interleukin-6(IL-6)and interleukin-17(IL-17)were decreased(P<0.05).Chest computed tomography(CT)scans revealed a higher proportion of lung consolidation,pleural effusion,and atelectasis in the RMPP group(P<0.05).Multivariate logistic regression analysis demonstrated that CRP,total bilirubin(T-BIL),LDH,IL-17,and prothrombin time(PT)were independent risk factors for RMPP(P<0.05).The receiver operating characteristic(ROC)predictive model established based on these factors had an area under the curve(AUC)of 0.787(95%confidence interval[CI]:0.693～0.880),with a cutoff value of 0.421,a sensitivity of 0.786,and a specificity of 0.660.The calibration curve indicated that the predicted probability matched well with the reference probability,and there was no statistical difference in the results of the Hosmer-Lemeshow test(P>0.05).Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever,moderate lung lesions,other organ injuries,and high inflammatory markers.CRP,T-BIL,LDH,IL-17,and PT can act as independent risk factors for RMPP.