Abstract:Objective To investigate the effects of serum miR-21-5p and miR-34a-5p expression on intestinal flora,inflammatory factors and thyroid function in patients with hashimoto thyroiditis(HT).Methods A total of 114 HT pa-tients(HT group)and 114 healthy volunteers(control group)admitted to author's hospital from June 2021 to June 2024 were enrolled.Serum expression of miR-21-5p and miR-34a-5p,levels of inflammatory factors and thyroid function of the patients were detected in both groups,Alpha diversity index and phylum level relative abundance of intestinal flora were analyzed by 16S rDNA high-throughput sequencing.The correlations of serum miR-21-5p and miR-34a-5p expression with Alpha diversity indexes of intestinal flora,their relative abundances at the phylum level,inflammatory factors and thyroid function indexes were analyzed by Pearson correlation coefficient.Results In the HT group,serum expression of miR-21-5 p and miR-34a-5p,relative abundances of intestinal flora including Firmicutes,Proteobacteria,Actinobacteria,Fuso-bacteria and Verrucomicrobia,as well as serum levels of interferon gamma(IFN-γ),interleukin 6(IL-6),IL-12,tumor necrosis factor alpha(TNF-α)and thyroid stimulating hormone(TSH)were all higher than those in the control group(all P＜0.05).The Chao 1 index and Shannon index of intestinal flora,relative abundance of Bacteroidetes,and serum levels of free triiodothyronine(FT3)and free thyroxine(FT4)in the HT group were lower than those in the control group(all P＜0.05).Correlation analysis showed that serum expression of miR-21-5p and miR-34a-5p in HT patients were negatively correlated with Chao 1 index,Shannon index,relative abundance of Bacteroidetes,ser-um levels of FT3 and FT4(all P＜0.05),while positively correlated with relative abundances of Firmicutes,Pro-teobacteria,Actinobacteria,Fusobacteria and Verrucomi-crobia,as well as serum levels of IFN-γ,IL-6,IL-12,TNF-α and TSH(all P＜0.05).Conclusion Serum miR-21-5p and miR-34a-5p expression are significantly upregulated in HT patients,and are associated with reduced intestinal flora diversity,dysbiosis,aggravated inflammatory response and thyroid dysfunction.

Abstract:Objective To investigate the impact of the neutrophil-to-lymphocyte ratio(NLR)on stroke-associated pneumonia(SAP)complicated with multidrug resistant organisms(MDROs)infections in the neurological intensive care unit(NICU).Methods The clinical data of 65 SAP patients admitted to author's hospital in NICU from January 2021 to June 2024 were retrospectively analyzed,univariate analysis and Logistic regression analysis were used to analyze the risk factors of SAP complicated with MDROs infection,the receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR and length of NICU stay for MDROs infection.Results Among the 65 SAP patients,spu-tum culture and drug sensitivity tests identified the primary pathogens as Klebsiella pneumoniae,Acinetobacter bauman-nii and Staphylococcus aureus.Univariate analysis revealed that compared with the non-MDROs infection group,the pa-tients in MDROs infection group showed statistically significant differences in the proportion of late SAP onset,moderate to severe national institute of health stroke scale(NIHSS)score,proportion of dysphagia,proportion of nasofeeding tube placement,NICU length of stay and NLR(all P＜0.05).Multivariate Logistic regression analysis showed that increased NLR and long length of NICU stay were independent risk factors for SAP complicated with MDROs infection(all P＜0.05).The ROC curve showed that NLR,NICU length of stay and the area under the curve(AUC)of the combined model were 0.721[95％confidence interval(CI):0.594-0.848],0.843(95％CI:0.739-0.946)and 0.892(95％CI:0.814-0.917),respectively,the AUC of combined prediction was greater than that of NLR or NICU length of stay a-lone.Conclusion Elevated NLR can predict the occurrence of MDROs infection to a certain extent,combined with the length of NICU stay,elevated NLR has a higher predictive value for SAP patients with MDROs infection.

Abstract:Objective To investigate the correlation between urinary podocalyxin,serum high mobility group pro-tein A2(HMGA2)and stromal-derived factor 1(SDF-1)levels and the Tervaert stage of diabetic nephropathy(DN)in pathological biopsy.Methods A total of 70 patients diagnosed with DN admitted to the author's hospital from May 2020 to January 2024 were selected as the DN group,and 70 patients with simple diabetes mellitus who were admitted during the same period were selected as the diabetes mellitus group.The clinical data of the two groups were collected.Urine and serum samples were collected in the fasting state at admission,and the levels of urinary podocalyxin,serum HMGA2 and SDF-1 were detected.Univariate and multivariate Logistic regression analysis were used to investigate the effect of urinary podocalyxin,serum HMGA2 and SDF-1 on the occurrence of DN.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of urinary podocalyxin,serum HMGA2 and SDF-1 in different Tervaert stages.Results The serum creatinine level in DN group was significantly higher than that in diabetes mellitus group(P＜0.05).The levels of urinary podocalyxin,serum HMGA2 and SDF-1 in DN group were higher than those in diabetes mellitus group(all P＜0.001);the levels of urinary podocalyxin,serum HMGA2 and SDF-1 in DN patients with differ-ent Tervaert stages were significantly different(all P＜0.001),with the increase of Tervaert stages,the levels of urinary podocalyxin,serum HMGA2 and SDF-1 in DN patients gradually increased,and the differences between two groups were statistically significant(all P＜0.05).Logistic regression analysis showed that urinary podocalyxin,serum HMGA2 and SDF-1 were risk factors for DN(all P＜0.05).Urinary podocalyxin,serum HMGA2 and SDF-1 had high diagnostic value in Tervaert staging.In grade Ⅰ,SDF-1 had the best performance with an area under the curve(AUC)of 0.993(95％CI:0.979-1.000);HMGA2 had the best AUC of 0.899(95％CI:0.799-0.999)in grade Ⅱ;HMGA2 had the best AUC of 0.809(95％CI:0.685-0.932)in grade Ⅲ;urinary podocalyxin in grade Ⅳ was the best,with an AUC of 0.899(95％CI:0.799-0.999).The sensitivity and specificity of each index were different with the change of stage,and the overall performance was good.Conclusion Urinary podocalyxin,serum HMGA2 and SDF-1 are abnormally expressed in DN patients,which are related to the Tervaert stage,and they can be used to predict the occurrence and development of DN.

Abstract:Objective To explore whether Resveratrol(Res)can affect the proliferation,migration and invasion of the triple-negative breast cancer cell line MDA-MB-231 by regulating the wingless-type MMTV integration site family(Wnt)/β-catenin signaling pathway through cancer-associated adipocytes(CAA).Methods MDA-MB-231 cells were treated with different concentrations of Res(25,50,100 umol/L),and the effect of Res on cell proliferation was detected by cell counting kit-8(CCK-8)after 24,48 and 72 h of culture;quantitative-polymerase chain reaction(qPCR)was used to detect the levels of fat markers;logarithmic growth MDA-MB-231 cells were divided into positive control group,nega-tive control group,CAA-CM group,Adi-CM group and CAA-CM+Res group.Fifteen BALB/c mice were divided into control group,high-fat diet group and high-fat diet+Res group based on whether they had high-fat and Res diets.Scratch test and Transwell test were used to verify the effect of Res on the migration and invasion of MDA-MB-231 cells.Hematoxylin-eosin(HE)staining were used to verify the effect of Res on CAA;Western blot and immunohistochemistry were used to verify the effect of Res on the expression of β-catenin and Cyclin D1 protein in CAA.Results ① Compared with Res concentration of 25 μmol/L,the cell survival number of 100 μmol/L concentration at 48 and 72 h decreased(all P＜0.05);compared with Res concentration of 50 μmol/L,the cell survival number of 100 μmol/L concentration at 72 h decreased(P＜0.05).Compared with 24 h,the cell survival number at different Res concentration at 48 and 72 h de-creased(all P＜0.05);compared with 48 h,the cell survival number at 72 h with Res concentration of 25 and 100 μmol/L decreased(all P＜0.05).② Compared with preadipocytes,the mRNA levels of hormone-sensitive lipase(HSL)and preadipocyte factor-1(Pref-1)in mature adipocytes were reduced,while the mRNA levels of peroxisome proliferator-acti-vated receptor γ(PPAR-γ)and CCAAT enhancer-binding protein α(C/EBP-α)increased(all P＜0.01).After mature adipocytes were co-cultured with MDA-MB-23 1 cells in a Transwell chamber,compared with mature adipocytes,the mR-NA levels of HSL and Pref-1 in CAA increased,while the mRNA levels of PPAR-γ and C/EBP-α decreased(all P＜0.01);and the mRNA levels of inflammatory factors interleukin-6(IL-6),IL-1β,C-C motif chemokine ligand 2(CCL2)and C-X-C motif chemokine ligand 8(CXCL8)in CAA increased(all P＜0.01).③ The migration rate and number of in-vasive cells in different groups were statistically significant(all P＜0.001).Compared with the positive control group,the migration rate and number of invasive cells in the negative control group,CAA-CM group,Adi-CM group and CAA-CM+Res group were reduced(all P＜0.05);compared with the negative control group,the migration rate and number of invasive cells in the CAA-CM group and Adi-CM group increased,and the number of invasive cells in the CAA-CM+Res group increased(all P＜0.05);compared with the CAA-CM group,the number of invasive cells in the Adi-CM group was reduced,and the migration rate and number of invasive cells in the CAA-CM+Res group were reduced(all P＜0.05);compared with Adi-CM group,the migration rate and number of invasive cells in the CAA-CM+Res group were reduced(all P＜0.05).④ Compared with the control group,the mice in the high-fat diet group had mature subcu-taneous adipocytes with increased diameter(P＜0.05);after Res intervention,compared with the high-fat diet group,the diameter of breast CAA in the high-fat diet+Res group was reduced(P＜0.05).⑤ Compared with the control group,the expression levels of β-catenin and Cyclin D1 in mice in the high-fat diet group increased,the protein expression levels of β-catenin and Cyclin D1 decreased in the high-fat diet+Res group(all P＜0.05).Compared with the high-fat group,the expression levels of β-catenin and Cyclin D1 in mice in the high-fat+Res group were reduced(all P＜0.05).Conclu-sion Res affects CAA regulation of the Wnt/β-catenin signaling pathway to inhibit the proliferation,migration and inva-sion of MDA-MB-231 cells.

Abstract:Objective To explore the impact of social support on the quality of life among nursing staff in military hospitals,and to explore the mediating role of occupational well-being and the regulating role of physical exercise.Meth-ods A total of 396 nursing staff in military hospitals were selected,and questionnaires were administered using general information questionnaire,physical activity rating scale(PARS),social support rating scale(SSRS),occupational well-being scale(OWBS)and medical outcome study 36-item short form health survey(SF-36),partial least squares structural equation modeling(PLS-SEM)was conducted using SmartPLS 4.0 to establish a mediation model,and the model was validated using Bootstrap method.Results There were significant differences in the quality of life of nursing staff in mili-tary hospitals across aspects such as marital status,income level,weekly night shift frequency and daily sleep duration(all P＜0.05),among which,married and unmarried participants reported higher quality of life than divorced partici-pants;the quality of life of participants with a monthly income of over 6 000 yuan were significantly higher than that of those with an income of less than 6 000 yuan;additionally,the scores of quality of life of those who worked night shifts more than 3 times per week was sig-nificantly lower than those who worked less than 3 times per week;the scores of quality of life of those who slept less than 6 h per day was significantly lower than those who slept more than 6 h per day.Social support significantly positively predicted quality of life(β=0.424,P＜0.001);the results of mediating effect analysis showed that occupational well-being played a mediating role between social support and quality of life,and the mediating effect size was 0.110,accounting for 20.64％of the mediating effect.Moderated mediation model validation showed that physical exercise played a moderating role between social support and occupational well-being(β=0.1 18,P＜0.05),and also played a moderating role between occupational well-being and quality of life(β=0.095,P＜0.05).Conclusion Social support of nursing staff in military hospitals can indirectly affect the quality of life through occupational well-being,and physical exercise plays a moderating role.We can improve the quality of life of nurses by strengthening social support,focusing on occupational well-being and encouraging physical exercise.

Abstract:Objective To investigate the predictive value of quick sequential organ failure assessment(qSOFA)score,hemoglobin(Hb)and fibrinogen(FIB)on the risk of patient mortality with acute upper gastrointestinal bleeding(AUGIB).Methods A total of 286 patients admitted to the department of emergency medicine of the author's hospital from January 2021 to January 2023 were used as investigators.The clinical data of patients at the time of admission was collected,then the patients were divided into the fatal group(n=28)and the survival group(n=258)according to whether they died or not,the general clinical data of the patients between two groups were compared.Logistic regression was used to analyze the influencing factors of death in AUGIB patients.R4.2.3 software and rms software package were used to construct a nomogram model for predicting the mortality risk of AUGIB patients.The receiver operating character-istic(ROC)curve was drawn to evaluate the discrimination of the nomogram model.Calibration curve and Hosmer-Leme-show goodness-of-fit test were used to evaluate the accuracy of the prediction model.Results Compared with the survival group,the proportion of patients with a history of upper gastrointestinal bleeding and qSOFA score in the death group in-creased(all P＜0.05);and the levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),Hb,platelet(PLT),FIB and albumin(ALB)decreased(all P＜0.05).Logistic regression analysis showed that high qSOFA score(OR:2.909,95％CI:1.647-5.141)was an independent risk factor for death in patients with AUGIB,high Hb(OR:0.967,95％CI:0.948-0.987)and high FIB(OR:0.990,95％CI:0.983-0.996)were independent protective factors for death in AUGIB patients.The three variables were introduced into R4.2.3 software to obtain a nomogram model for predicting AUGIB mortality.The area under the curve(AUC)of the model for predicting mortality risk of AUGIB patients was 0.847(95％CI:0.764-0.930),with a sensitivity of 0.786 and a specificity of 0.826.Calibration curve analysis showed that the calibration curve of the model for predicting the mortality of AUGIB patients was roughly consistent with the actual curve.Hosmer-Leme-show goodness of fit test showed that there was no significant difference between the predicted mortality rate of the model and the actual mortality rate(x2=5.788,P=0.671).Conclusion The mortality risk prediction model constructed by qSOFA score,Hb and FIB has a good predictive effect on the death of AUGIB patients.

Abstract:Objective To analyze the factors influencing stigma in patients with thyroid associated ophthalmopathy(TAO)and provide an effective basis for promoting their mental health.Methods A total of 80 TAO patients admitted to the department of orbital disease surgery of author's hospital from June to September 2024 were enrolled,the Chinese version of stigma scale for chronic illness(SSCI)was used to investigate the stigma of patients;binary Logistic regression analysis was performed to screen out the influencing factors affecting the stigma of TAO patients.Results The intrinsic stigma and extrinsic stigma scores of patients with photophobia,tearing,chemosis,conjunctival congestion,exophthalmos,upper eyelid retraction,limited eye movement,diplopia and vision loss were higher than those of patients without such symptoms(all P＜0.05).Binary Logistic regression analysis showed that upper eyelid retraction,conjunc-tival congestion and diplopia were the risk factors of internal stigma(OR values were 8.604,4.589 and 5.309,respec-tively,all P＜0.05);upper eyelid retraction,vision loss and exophthalmos were risk factors for external stigma(OR values were 7.324,5.609 and 5.614,respectively,all P＜0.05).Conclusion Upper eyelid retraction,conjunctival congestion,diplopia,vision loss and exophthalmos are the influencing factors of stigma in TAO patients,which should be paid attention to by clinical medical staff and given corresponding intervention measures.

Abstract:Objective To further explore the new mode of batch of medical rescue and evacuation support from dif-ferent support dimensions,so as to help improve the ability of combat medical support during island offensive operations.Methods Based on the characteristics of modern war,combined with the relevant research inside and outside the military and the current situation of the military medical service strength system,this paper analyzed the key and difficult prob-lems that restricted the treatment of batch of medical rescue and evacuation in island offensive operations,put forward countermeasures and suggestions,and thought and prospected the development trend in the future.Results In the future operations of crossing the sea and landing on islands,batch of medical rescue and evacuation were faced with such major and difficult problems as difficulties in the coordination of medical service of the services and arms,high-pressure situa-tion,low effectiveness of the accompanying support mode,blockage of transport and evacuation channels and large short-comings in the support of health materials,through innovative measures such as opening up the command and coordination link of medical service,studying the treatment plan for batch casualties,improving the level of first-line treatment ability,deepening the application of information and intelligence and giving full play to the system advantages with Chinese char-acteristics,the ability of medical service support in sea crossing and island landing could be improved.Conclusion It is of great practical significance to study the batch of medical rescue and evacuation in island offensive operations with sophisti-cated weapons and equipment,which can maintain the combat effectiveness of Chinese officers and soldiers and provide a solid foundation for winning modern wars.

Abstract:Objective To investigate the effects of Roxadustat on ischemic skin flaps in diabetic mellitus rats and explore its underlying mechanisms.Methods A total of 10 8-week-old male SD rats with successfully induced diabetes were randomly di-vided into normal saline group and Roxadustat group,with 5 rats in each.The rats in Roxadustat group were intraperitoneally in-jected with Roxadustat 25 mg/kg,and the rats in normal saline group were intraperitoneally injected with the same amount of normal saline every other day,7 d before operation and 0,2,4 and 6 days after operation,in total of 8 times.Two 5 cm× 1 cm symmetrical ischemic skin flaps were made on the back of rats,the microcirculation blood perfusion was evaluated by laser speckle flow imaging immediately after operation and 7 d after operation,and the skin flap survival rate at 7 d after operation was calcu-lated.The skin flap tissue and blood were collected at 7 d after operation,and some sections were taken and stained by hematoxylin-cosin(HE)and Masson to evaluate the his-topathological status of rats between two groups;Western blot was used to detect the expression of hypoxic inducible factor 1 alpha(HIF-1α),vascular endothelial growth factor(VEGF),platelet endothelial cell adhesion molecule CD31,type Ⅰ collagen(Col Ⅰ),Col Ⅲ and Col Ⅴ.The expression levels of interleukin 1 beta(IL-1β),IL-6 and tumor necrosis factor alpha(TNF-α)were determined by enzyme-linked immunosorbent assay;the contents of lactic acid,superoxide dismutase(SOD)and malondialdehyde(MDA)in skin flap and plasma were measured.The maximum tensile load of the skin flap incision was detected.Results Seven days after operation,compared with the normal saline group,the skin flap survival rate and the growth rate of skin flap blood perfusion significantly increased in the Roxadustat group(all P＜0.05),the skin flap had less in-flammatory cell infiltration,rich new blood vessels and tight collagen arrangement;the expression levels of HIF-1α,CD31,VEGF,Col I,Col Ⅲ and Col Ⅴ increased(all P＜0.05);the levels of inflammatory markers TNF-α,IL-6 and IL-1 β decreased(all P＜0.05);the lactate level and MDA level in plasma and skin flap tissue decreased,while SOD level increased(all P＜0.05);the maximum load of tensile force increased(P＜0.05).Conclusion Perioperative use of Roxadustat can improve the blood perfusion of diabetic mellitus ischemic skin flap,reduce the level of lactic acid and oxidative stress,reduce inflammatory re-sponse,promote angiogenesis and collagen deposition,and improve the survival rate and healing quality of the skin flap.

Abstract:Objective To explore the influencing factors of the wearing fit of N95 medical protective masks among clinical medical staff,and to provide a basis for the correct use of medical protective masks to improve protective effects.Methods Medical staff in clinical wards were included in the test scope,after wearing N95 medical protective masks,they were first tested for their own fitness,after passing the test,the mask fitness tester was used for rapid detection and quantitative fitness test to detect the mask wearing fitness.Results A total of 93 people participated in the subjective e-valuation questionnaire,and 88 people thought that the fitting of masks was qualified,with a pass rate of 94.62％.The self-test results of 213 people were qualified,and the pass rate was 100.00％;a total of 356 rapid fitness tests were per-formed by 213 people,and 219 of them were qualified,with a pass rate of 61.52％;156 people who were qualified in the rapid fitness test performed 172 times of quantitative fitness tests,and 129 of them were qualified,with a qualified rate of 75.00％.There were significant differences in the passing rates of turning head from side to side and nodding head up and down during the quantitative fitness test and the passing rates of the first normal breathing(P＜0.05).The pass rate of subjective evaluation(94.62％)and the pass rate of quantitative fitness test(75.00％)between the two groups were sta-tistically significant(x2=13.214,P＜0.001).Conclusion The fit test can help the N95 respirators to know the fit sta-tus and the high-risk movements during wearing.Frequent head turning,head nodding and so on should be avoided to re-duce the risk of infection,it can enhance the fit of masks and reduce the risk of infection.

Abstract:Objective To investigate the influence of common subject training on bone metabolism indexes and bone mineral density(BMD)of recruits.Methods A total of 149 recruits enlisted in September 2024 from a certain Armed Police Force unit were randomly selected.Before participating in common subject training,they filled in the general situation questionnaire,and body mass index(BMI)was calculated,serum calcium,serum inorganic phos-phorus,25-hydroxyvitamin D(25-OH-D),β-C-terminal telopeptide of type 1 collagen(β-CTx),bone alkaline phos-phatase(B-ALP),total procollagen type 1 amino-terminal propeptide(TP1NP)levels were measured,and BMD,T value,Z value and relative risk of fracture(RRF)were measured by dual energy X-ray absorptiometry,the above sur-vey and index detection were carried out again at the end of the common subject of new training.Results After 3 months of common subject training,the age and physical exercise ratio of recruits were higher than those before train-ing,and the body weight and BMI were lower than those before training,and the differences were statistically signifi-cant(all P＜0.05).In terms of serological indicators,the levels of B-ALP,TP1NP and β-CTx of recruits after training were significantly higher than those before training,and the levels of serum calcium,serum inorganic phos-phorus and 25-OH-D were significantly lower than those before training(all P＜0.001).In terms of BMD indexes,BMD,T value and Z value of recruits after training were higher than those before,and RRF was lower than that be-fore training(all P＜0.05),but there was no significant difference in the diagnosis results of each grade of BMD compared with that before training(P＞0.05).Conclusion Common subject training can induce high turnover of bone metabolism in recruits,that is,the bone resorption index and bone formation index are increased,the serum cal-cium,inorganic phosphorus and 25-OH-D significantly decreased,and the BMD increased.

Abstract:Objective To explore the predictive validity of joint function screening combined with rating of perceived ex-ertion(RPE)for military training injuries(MTI)in recruits.Methods The data of 144 recruits recruited in a new training base were analyzed and the joint function and RPE screening were carried out after recruitment;the occurrence of MTI was diagnosed and counted by military doctors within 2 months of training,and the diagnostic efficacy,accuracy and clinical applicability of joint function screening and RPE in predicting MTI were evaluated.Results MTI occurred in 46 of 144 recruits,with an incidence of 31.94％.The scores of joint function screening scale and RPE of recruits with MTI were significantly different from those of recruits without MTI(all P＜0.001).Univariate and multivariate binary Logistic regression analysis showed that joint function screening scale and RPE scores were important influencing factors of injury in armed police recruits.The nomogram model was constructed and the receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)of joint function screening scale was 0.752[95％confidence interval(CI):0.660-0.831)],the AUC of RPE score was 0.790(95％CI:0.712-0.874),and the AUC of the two combined tests was 0.844(95％CI:0.753-0.933),and the combined detec-tion had more advantages in the diagnostic effect.The training set and validation set were constructed,the AUC of joint function screening combined with RPE for predicting MTI in the validation set was 0.864(95％CI:0.752-0.971).The ROC curve was calibrated,and the P value of Hos-mer-Lemeshow test of the training set and the validation set was greater than 0.05.The decision curve analysis(DCA)curve was used to evaluate the risk and benefit,within the threshold range,the net benefit of the model was higher than that of the All line and None line.Conclusion Joint function screening scale combined with RPE can more effectively pre-dict the occurrence of MTI in recruits,and the method has good predictive validity and high accuracy.

Abstract:Objective To explore the homogenization path of medical quality management in military rehabilitation and convalescence institutions under the"one hospital with multiple districts"model,solve problems such as scattered re-sources,inconsistent standards and difficulties in managing,and improve the level of medical services and guarantee effi-ciency.Methods The"six unifications"management system(system,standard,training,materials,information,cul-ture)was constructed,information platform construction and remote cooperation were strengthened,three-level quality control organization and multi-dimensional quality monitoring mechanism were improved,and talent introduction and cross-hospital cooperation were optimized.Results Through homogenized management,the service efficiency has been comprehensively enhanced,the professional quality and service awareness of medical staff have been significantly im-proved,and the satisfaction of convalestic staff increased significantly,achieving a balanced allocation and efficient collab-oration of equipment,technology and human resources.Conclusion The"six unifications"homogenization model effec-tively resolves the management challenges of"one hospital with multiple districts",significantly enhancing the standardi-zation and safety of rehabilitation and convalescence services.It provides a replicable quality management model for the transformation of military medical services and holds significant practical value for maintaining the health of officers and soldiers and ensuring the generation of combat effectiveness.

Abstract:Objective To investigate the level of economic toxicity and its influencing factors among young and mid-dle-aged lung cancer patients in Wuhan and to provide a foundation for designing care programs aimed at preventing or mitigating economic toxicity in this population.Methods A total of 407 young and middle-aged patients with lung cancer who were treated in 3 grade A tertiary hospitals in Wuhan from September 2023 to March 2024 were selected by conven-ience sampling method,the general information questionnaire,the comprehensive scores for financial toxicity(COST-PROM),connor-davidson resilience scale(CD-RISC)and the fear of progression questionnaire-short form(FOP-Q-SF)were administered to all participants.Results The COST-PROM score was(13.72±6.33)indicating a relatively high level.The CD-RISC and FOP-Q-SF scores were(33.06±11.67)and(36.45±8.75),respectively.The score of FOP-Q-SF was negatively correlated with the score of COST-PROM(r=-0.133,P＜0.01),and the score of CD-RISC was positively correlated with the score of COST-PROM(r=0.566,P＜0.01).Multivariate Logistic regression analysis showed that occupations of patents,number of minor children,family monthly income,method of medical expenses pay-ment and CD-RISC scores were the main influencing factor of COST-PROM scores(P＜0.05).Conclusion The econom-ic toxicity of young and middle-aged lung cancer patients in Wuhan is common,medical and nursing workers need to take intervention measures according to its influencing factors to enhance their confidence in coping with the disease,so as to reduce the level of economic toxicity of lung cancer patients.

Abstract:Objective To explore the effects of sodium bicarbonate Ringer injection combined with propofol on acid-base balance,lung function and blood-brain barrier permeability in rats with severe traumatic brain injury(sTBI).Meth-ods After successful establishing the sTBI model,40 rats were radomly divided into the model group,propofol group,sodium bicarbonate Ringer group and sodium bicarbonate Ringer+propofol group,with 10 rats in each;another 10 rats without modeling were selected as the control group;the rats in the control group and the model group were not inter-vened;rats in propofol group were intraperitoneally injected with propofol 50 mg/kg once a day;the rats in the sodium bi-carbonate Ringer group were intraperitoneally injected with 5％sodium bicarbonate Ringer 15 ml/kg once a day;the rats in the sodium bicarbonate Ringer+propofol group were intraperitoneally injected with propofol 50 mg/kg+5％sodium bicarbonate Ringer 15 ml/kg once a day,and the intervention lasted for 14 d in each group.50％forced expiratory flow(FEF50),peak expiratory flow(PEF)and respiratory rate were detected by using the animal pulmonary function instru-ment,the levels of pH value,base excess(BE),lactic acid were detected by the micro blood gas analyzer;the content of ethylbenzene(EB)in brain tissue was detected to evaluate the permeability of blood-brain barrier;hema-toxylin-eosin(HE)staining was used to observe the path-ological changes of neurons in the ischemic penumbra area of rat brain tissue,neuron apoptosis was detected by terminal deoxynucl neotidyl transferase-mediated dUTP nick end-labeling(TUNEL).Results Compared with the control group,the FEF50,PEF,respiratory rate,pH and BE levels of rats in the other 4 groups decreased,the contents of lactic acid and EB increased,and the apoptosis rate of neurons increased(all P＜0.05);compared with the model group,the FEF50,PEF,respiratory rate,pH and BE of rats in the sodium bicarbonate Ringer group,propofol group and sodium bi-carbonate Ringer+propofol group increased,the contents of lactic acid and EB decreased,and the apoptosis rate of neu-rons decreased(all P＜0.05);compared with the sodium bicarbonate Ringer group and the propofol group,FEF50,PEF,respiratory rate,pH and BE increased,the contents of lactic acid and EB decreased and the neuronal apoptosis rate decreased in the sodium bicarbonate Ringer+propofol group(all P＜0.05).HE staining showed that the hippocampal neurons in the control group were intact,and the hippocampal neurons in the model group were seriously damaged,ac-companied by cell arrangement disorder and swelling,the neuronal morphological structure damage was improved in the sodium bicarbonate Ringer group,propofol group and sodium bicarbonate Ringer+propofol group,and the sodium bi-carbonate Ringer+propofol group had the most significant improvement.Conclusion Sodium bicarbonate Ringer injec-tion combined with propofol has a certain therapeutic effect on sTBI,and its mechanism may be related to regulating acid-base balance,improving blood-brain barrier permeability and regulating lung function.

Abstract:Objective To analyze the correlation between the level of cholinesterase(CHE)and the infection risk and sarcopenia in bladder cancer patients after radical cystectomy.Methods A retrospective study was conducted on 120 bladder cancer patients treated at author's hospital from January 2022 to January 2024,all patients underwent radical cys-tectomy,and their CHE levels were detected postoperatively,the correlation between CHE and sarcopenia-related indica-tors(total skeletal muscle mass,appendicular skeletal muscle mass,relative skeletal muscle index,handgrip strength,gait speed)were analyzed using Pearson correlation analysis,6 months after surgery,the patients were divided into infection group(n=36)and non-infection group(n=84)based on whether they developed infec-tions,general data of all patients were collected,multiva-riate Logistic regression models were used to identify in-fluencing factors for postoperative infections in bladder cancer patients after radical cystectomy,and receiver operating characteristic(ROC)analysis was conducted to evaluate the predictive value of these risk factors.Results After bladder cancer surgery,the body mass of skeletal muscle of the patients was(42.58±4.44)kg,the limb mass was(19.36±2.58)kg,the relative skeletal muscle index was(6.64±1.02)kg/m2,the handgrip strength was(27.36±3.25)kg,the gait speed was(0.81±0.12)m/s and the serum CHE level was(3 275.82±132.22)U/L;Pearson correlation analysis showed that there was a positive correlation between and the total skeletal muscle mass,appendicular skeletal muscle mass,relative skeletal muscle index,handgrip strength,gait speed and the serum CHE level in patients with blad-der cancer after surgery(r=0.617,0.668,0.684,0.729,0.701,all P＜0.001);compared with the non-infection group,patients in the infection group were older,had a higher prevalence of diabetes and sarcopenia(all P＜0.05);com-pared with the non-infection group,the CHE level was lower and C-reactive protein(CRP)and interleukin 6(IL-6)levels were higher in the infection group(all P＜0.05);multivariate Logistic regression analysis showed that age[odds ration(OR)=1.892,95％confidence interval(CI):1.228-2.917],diabetes mellitus(OR=5.316,95％CI:1.610-17.554),sarcopenia(OR=2.771,95％CI:1.048-7.326),CRP(OR=4.189,95％CI:1.079-16.264)and IL-6(OR=3.642,95％CI:1.599-8.299)were independent risk factors for postoperative infection in patients with bladder cancer;CHE(OR=0.981,95％CI:0.971-0.992)was an independent protective factor for postoperative infection in patients with bladder cancer(P＜0.05);ROC curve showed that the AUC of age,diabetes mellitus,sarcopenia,CHE,CRP and IL-6 in predicting postoperative infection in patients with bladder cancer were 0.781,0.619,0.627,0.883,0.748 and 0.849,respectively.Conclusion The level of CHE in postoperative patients with bladder cancer is related to the sarcopenia of patients,and age,diabetes mellitus,sarcopenia,CHE,CRP,IL-6 are all the influencing factors of infection in patients after radical cystectomy.

Abstract:Objective To investigate the predictive value of plasma Epstein-Barr virus(EBA)-deoxyribonucleic acid(DNA)detection before salvage therapy in patients with recurrent nasopharyngeal carcinoma(rNPC).Methods The clinical data of 92 patients with rNPC in author's hospital from July 2020 to December 2023 were retrospectively analyzed.Clinical baseline data,laboratory test data and 18 F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography(18F-FDG-PET/CT)data of rNPC patients were collected.Blood samples were collected from patients before treatment,and plasma EBV-DNA levels were measured using real-time quantitative polymerase chain reaction.All patients were followed up and overall survival(OS)were recorded.The prognostic risk factors of rNPC and the predictive value of plasma EBV-DNA level for the prognosis of rNPC patients were analyzed.Results According to the recurrence pattern,92 rNPC patients were di-vided into local recurrence group(n=47)and distant recurrence group(n=45),19 patients(40.43％)died in the local recurrence group,while 31 patients(68.89％)died in the distant recurrence group,the median survival time of the two groups was 29.21 months and 20.34 months,respectively.Univariate analysis showed that the plasma EBV-DNA level at recurrence,the percentage of tumor node metastasis classification(TNM)stage Ⅳ,N stage 2-3,cytokeratin 19 fragment antigen 21-1(CYFRA21-1)level and squamous cell carcinoma antigen(SCC-Ag)level at recurrence were lower than those in the distant metastasis group,while the age and the percentage of TNM stage 3-4 were higher than those in the distant metastasis group,the differences between the two groups were statistically significant(all P＜0.05).Spearman correlation analysis showed that EBV-DNA level was positively correlated with the number of metastases(r=0.409,P=0.008)and maximal standard uptake value(SUVmax)(r=0.417,P=0.008)in the distant recurrence group;in the lo-cal recurrence group,EBV-DNA level was also positively correlated with local SUVmax(r=0.34,P=0.036).Cox re-gression analysis showed that serum carcino-embryonic antigen(CEA)at recurrence,SCC-Ag at recurrence and high log10EBVDNA at recurrence were independent risk factors for prognosis of rNPC patients,log10EBVDNA and distant SUVmax at recurrence were independent risk factors for prognosis of rNPC patients with distant recurrence.Receiver operating characteristic(ROC)curve analysis showed that the sensitivity of plasma EBV-DNA combined with traditional tumor markers CEA and SCC-Ag to predict the death of patients with local recurrence was 86.67％.area under the curve(AUC)was 0.827;the sensitivity of plasma EBV-DNA in predicting death of patients with distant recurrence was 94.12％,and AUC was 0.775,which were significantly higher than those of distant SUVmax(P=0.047).In patients with local recurrence and distant recurrence,the median OS of patients with high level of plasma EBV-DNA was shorter than that of patients with low level of plasma EBV-DNA(Log Rank x2 were 4.803 and 5.686,respectively,all P＜0.05).Conclusion Plasma EBV-DNA level can be used as an effective prognostic biomarker for overall survival in rNPC patients with both local recurrence and distant recurrence,and can be used for clinical prognostic risk stratification of rNPC patients.

Abstract:Objective To investigate the distribution of allergen in adolescent allergic rhinitis patients,analyze its influencing factors,establish prediction model and verify it.Methods A total of 932 rhinitis adolescents who visited the outpatient or inpatient department of the author's hospital from January 2022 to August 2024 were selected for the study,and the patients were divided into the model group(n=652)and the validation group(n=280)at a ratio of 7∶3.Ques-tionnaires were used to collect relevant factors that may affect allergic rhinitis in adolescents,and the model group was di-vided into allergic rhinitis group(n=104)and non-allergic rhinitis group(n=548)based on the diagnosis of allergic rhi-nitis.The general information and health status of patients in the allergic rhinitis group and the non-allergic rhinitis group were compared,least absolute shrinkage and selection operator(LASSO)was used to screen the potential variables and then multivariate Logistic regression was performed,the nomogram was used to visualize and transform the results of multivariate analysis,the receiver operating characteristic(ROC)curve and calibration curve were used to verify the mod-el,and the decision curve was used to analyze the clinical applicability of the model.Results In this study,104 cases(15.95％)in the model group and 44 cases(15.71％)in the validation group were diagnosed with allergic rhinitis,and there was no significant difference in the proportion of patients with allergic rhinitis between the two groups(P＞0.05).91.22％of the allergens in 148 patients with allergic rhinitis were inhaled allergens,among which dust mites and house dust were the highest,which accounted for 38.51％and 33.78％,respectively;food allergens ac-counted for 43.92％,and the propotions of shrimp and crab and cod were the highest,which accounted for 14.19％and 10.14％,respectively.Multivariate Logistic regression analysis using LASSO regression screening results showed that place of residence,smoking status of family members,use of carpet at home,adenoid hypertrophy,history of asthma and history of allergy were independent influencing factors for adolescent allergic rhinitis(P＜0.05).The results of model validation showed that the area under the curve(AUC)of the ROC curve of the model group was 0.725[95％confidence interval(CI):0.669-0.781];the AUC of ROC curve in the validation group was 0.713(95％CI:0.658-0.758);in terms of accuracy,the model curve and the ideal model curve were basically fitted diagonally.The results of clinical effec-tiveness analysis showed that the net benefit of the model in predicting allergic rhinitis in adolescents was the highest when the prediction probability threshold was 0.05-0.75.Conclusion The allergens in adolescent allergic rhinitis patients are mainly inhalant allergens,and dust mites and house dust account for a high proportion of allergens,which are mainly af-fected by the place of residence,smoking status of family members and the use of carpet at home,etc.The column-line diagram model based on the above mentioned factors was used for the prediction of allergic rhinitis in adolescents with a high degree of accuracy and discriminative power.

Abstract:Objective To investigate the occurrence and influencing factors of subclinical carotid atherosclerosis(SCAS)and unstable plaque(UP)in military commanders aged 50 to 60,so as to provide reference for preventing cardio-vascular and cerebrovascular diseases.Methods Carotid ultrasound and examination data of 1 170 military commanders aged 50 to 60 who underwent physical examination in author's hospital in 2024 were collected,according to the diagnosis results of SCAS,the subjects were divided into control group(n=510)and SCAS group(n=660);according to the cri-teria of UP,they were divided into observation group(n=798)and UP group(n=372).The incidence of SCAS and UP and related influencing factors were analyzed.Results Among 1 170 military commanders aged 50 to 60,there were 660 cases of SCAS(56.41％)and 372 cases of UP(31.79％).Compared with the control group,the proportion of males,age,proportion of overweight/obesity,levels of creatinine,glycosylated hemoglobin,fasting blood glucose,homocys-teine,proportion of smoking and drinking significantly increased in the SCAS group(all P＜0.05).Compared with the observation group,the proportion of males,age,creatinine,fasting blood glucose,homocysteine levels and proportion of smoking in the UP group significantly increased(all P＜0.05).Logistic regression analysis showed that male,50-60 years old,smoking,overweight/obesity and elevated homocysteine were risk factors for SCAS;50-60 years old and elevated creatinine were risk factors for UP.Conclu-sion Carotid atherosclerosis and plaque in the elderly are chronic process involving multiple factors,single factor intervention cannot comprehensively control the disease,compre-hensive measures to control body weight and other multi-factor full-dimensional management should be taken to effectively reduce and delay the occurrence and development of atherosclerosis,so as to effectively avoid the risk of cardiovascular and cerebrovascular events.

Abstract:Objective To investigate the effect of the Interim Regulations on the Security Policy of Medical Treat-ment for Military Personnel and Military Related Personnel on the hospitalization of the parents of military personnel and their spouses.Methods The K-Means method was used to cluster the classified settlement expenses of military's parents and their spouses'parents.Results The military insurance payment accounted for 10.52％of the total hospitalization cost,the median proportion of military support overall payment was 8.67％,with an average of 610 yuan per person for military support overall payment.The number of hospitalizations in 2023 has significantly increased compared to 2022,but there was no statistically significant difference in the proportion of military insurance payment for patients between the two years(P＞0.05).The inpatients were clustered into 4 groups:the first category consisted of 33 patients,with the highest proportion of other subsidies,and the lowest proportion of individual self-payment and military insurance payment,defined as other subsidies inpatients;the second category(n=123)was defined as the key population of mili-tary medical insurance payment,with the highest proportion of hospitalization expenses paid by the military medical insur-ance and the lowest proportion of other subsidies;category 3(n=177),the proportion of hospitalization expenses paid by basic medical insurance was the highest,defined as patients paid by basic medical insurance;the fourth category consisted of 31 patients,with the highest proportion of individual self-payment and the lowest proportion of reimbursement by basic medical insurance,so they were defined as indi-vidual self-payment patients.There were statistically significant differences in age,gender,number of diagno-ses,proportion of operations,length of stay,total hospi-talization expenses and classified expenses of medical insurance settlement among the 4 types of patients(all P＜0.05).Conclusion The implementation of the Interim Regulations on the Security Policy of Medical Treatment for Military Per-sonnel and Military Related Personnel reduces the financial burden of military's parents and their spouses' parents,the in-patients with resident medical insurance who seek medical treatment in other places are the key population for the overall payment of military insurance.