Objective To explore the effects of muscle mass and muscle strength on frailty in patients with maintenance hemodialysis (MHD).Methods MHD patients at The First Affiliated Hospital of Xi’an Jiaotong University were investigated from January to May 2024. Their frailty was evaluated using the Frailty Assessment Scale, and muscle mass (SMI) and muscle strength (HGS) were assessed with a body composition analyzer and a grip strength meter. Relevant data including sociodemographic characteristics, clinical medical information, and personal lifestyle habits were collected. Logistic regression analysis was utilized to analyze the impacts of muscle mass and muscle strength on frailty, and the masking effect of muscle strength between muscle mass and frailty was explored based on the path analysis method.Results A total of 340 MHD patients were surveyed. The prevalence rates of frailty, low SMI, and low HGS were 43.5%, 41.8%, and 39.1%, respectively. Among the 148 frail MHD patients, 45.3% had both low HGS and low SMI. After adjusting for confounding factors, muscle strength was a protective factor against frailty. In the overall population, the masking effect between SMI→HGS→frailty was significant, with a masking effect value of −0.068 (95% CI: −0.102 to −0.041). Subgroup analysis showed a masking effect value of −0.069 (95% CI: −0.112 to −0.035) in males; in females, the effect of muscle mass on frailty was completely masked by muscle strength, with a masking effect value of −0.074 (95% CI: −0.149 to −0.007).Conclusion Increasing muscle strength is significantly associated with reduced frailty in MHD patients. Grip strength, as a marker of muscle strength, is more significant than muscle mass. Muscle strength plays a masking role between muscle mass and frailty.

Objective To construct a nomogram model to predict the risk of delirium during ICU admission in alcohol withdrawal patients.Methods Data were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV version 2.2) on patients admitted to the ICU for alcohol withdrawal and were randomly divided into training and validation sets based on a 7:3 ratio. Lasso regression analysis combined with logistic regression analysis was used to select the best variables to construct the model for visualization in the form of the nomogram.Results Five optimal variables were screened as independent risk factors for delirium during ICU admission in alcohol withdrawal patients in this study, which were mean heart rate (OR=0.967, 95%CI: 0.953-0.982), SOFA score (OR=1.151, 95%CI: 1.054-1.257), OASIS score (OR=1.131, 95%CI: 1.089-1.174), use of propofol (OR=2.453, 95%CI: 1.187-5.071) and LMR (OR=0.876, 95%CI: 0.774-0.991). The area under the ROC curve (AUC) of the column-line graphical model constructed on the basis of these five optimal variables was 0.852 (95%CI: 0.820-0.885); the accuracy of the model was 0.706, the precision was 0.743, the recall was 0.690, the F1 score was 0.716, and the Brier score was 0.157; the mean absolute error of the calibration curve was 0.014; clinical decision curve analysis (DCA) showed a large net benefit at threshold probabilities of 0.07-0.95.Conclusion The nomogram model developed in this study can accurately predict the risk of delirium during ICU admission in patients with alcohol withdrawal and can be useful for early clinical prevention, intervention, and graded care.

Objective To explore the potential profile classification of cognitive function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and analyze the influencing factors of different cognitive function classifications.Methods A convenient sampling of 210 OSAHS patients treated in the First People’s Hospital of Yongkang City from April 2021 to April 2024 was conducted to score cognitive function by using the Montreal Cognitive Assessment Scale (MoCA), and the optimal number of cognitive function categories were analyzed and named by potential profile. Clinical data of patients were collected by using hospital electronic medical record system, and the influencing factors of cognitive function classification were analyzed with univariate analysis and multifactor logistic regression.Results The cognitive function of 210 active OSAHS patients could be classified into three potential categories: 54 cases (25.71%) of low cognitive function, 86 cases (40.95%) of middle cognitive function-low memory, 70 cases (33.33%) of high cognitive function. Multivariate logistic regression analysis showed that age (OR=1.043, 95%CI=1.001-1.088), OSAHS severity (OR=1.694, 95%CI=1.069-2.685), and HSP70 (OR=1.589, 95%CI=1.006-2.509) were independent factors of middle cognitive function-low memory type in OSAHS patients with high cognitive function as reference. Age (OR=1.117, 95%CI=1.055-1.183), smoking history (OR=6.893, 95%CI=2.518-18.867), drinking history (OR=4.972, 95%CI=1.893-13.064), OSAHS severity (OR=2.668, 95%CI=1.441-4.942), HSP70 (OR=2.769, 95%CI=1.484-5.168), GABA (OR=0.940, 95%CI=0.910-0.970) were independent factors of low cognitive function type in OSAHS patients (P<0.05).Conclusion There is a certain heterogeneity in the classification of potential profiles of cognitive function in OSAHS patients. Medical staff can focus on OSAHS patients’ age, lifestyle, condition, HSP70 and GABA levels to classify patients and take appropriate measures to reduce cognitive function impairment.

Objective To analyze the effect of group narrative psychological intervention on non-suicidal self-injury behavior (NSSI) in adolescent depression patients.Method A total of 118 adolescent depression patients treated in a certain hospital from January 2022 to June 2023 were randomly divided into two groups: the control group of 59 patients and the observation group of 59 patients. The control group received routine nursing care, while the observation group received group narrative psychological intervention besides routine nursing care. The occurrence of NSSI in two groups of patients was statistically analyzed to compare their levels of depression, psychological resilience, and self-esteem before and after the intervention.Results Three months after the intervention, the frequency of NSSI and the degree of injury in the observation group patients were significantly reduced and lower than those in the control group patients (P<0.05). Before and after the intervention, the differences in SDS score, HAMD score, CD-RISC score, and SES score in the control group were 10.01±2.15, 6.91±1.78, 9.45±2.54, and 7.08±1.53, respectively, while the differences in the observation group were 16.14±3.02, 10.08±2.06, 15.10±2.86, and 11.75±2.12, respectively. The differences of the observation group were higher than those of the control group (P<0.05).Conclusion Group narrative psychological intervention can improve the depression situation of adolescent depression patients, reduce NSSI, and is worthy of clinical application.

Objective To study the fairness of health resource allocation in China's maternal and child health hospitals and provide a reference for further optimizing resource allocation, as maternal and child health hospitals have gradually become an influential part of the medical institutions in China and play a significant role in comprehensively improving the health level of women and children.Methods The Lorenz curve, Gini coefficient, and agglomeration degree were used to analyze the fairness of health resource allocation in China's maternal and child health hospitals from three dimensions: population, economy, and geography.Results (1) The total amount of health resources in China's maternal and child health hospitals is showing an increasing trend; (2) the fairness of resource allocation based on population is better than that based on economy and geographic area; (3) there is a significant regional gap in the health resources of maternal and child health hospitals in China. In terms of geographical distribution fairness, densely populated areas are superior to areas with average or sparse populations; in terms of population distribution fairness, areas with an average population are better than areas with dense or sparse populations.
Conclusion The gap between the supply and demand of health resources in China's maternal and child health hospitals still needs to be filled; it is necessary to focus on improving the fairness of health resource allocation in China's maternal and child health hospitals in terms of geographic dimensions and narrowing the gap in regional health resource allocation.

Objective To understand the construction and operation of Internet hospitals in China and provide a reference for improving relevant policies and developing Internet hospitals.Methods A questionnaire survey was conducted on 136 medical institutions in 8 provinces in China to collect operational data in 2022 of Internet hospitals and entity hospitals they were based on. SPSS 26.0 software was used to analyze the data, and the Mann-Whitney U test was used to compare Internet hospitals of different grades.Results Among the 136 medical institutions, 54 have established Internet hospitals, accounting for 39.7%. Among the 54 Internet hospitals, 27.8% have received government investment, 40.7% have set up independent management departments, and 85.2% have reached effective operation. In 2022, the median number of Internet hospitals in effective operation was 20000, which had a large gap compared with the median number of entity hospitals, which was 1.37 million. The top three business systems with the highest construction ratio in Internet hospitals were online diagnosis and treatment system, e-prescription and online medical order system, prescription review and drug distribution system, accounting for 83.3%, 75.9% and 75.9%, respectively.Conclusion In China, Internet hospitals have not established a relatively mature management and operation system, and the financial support is insufficient. Compared with the scale of offline hospitals, the promotion and application of Internet hospitals in China need to be further strengthened. It is necessary to strengthen policy guidance, give full play to the subjective initiative of hospitals, ensure capital investment, standardize the Internet operation and management system, and optimize the construction of information platforms, so as to enhance patients’ experience and satisfaction of Internet hospitals.

Objective To establish a casemix for hospitalization costs of stroke rehabilitation, provide a basis for cost management of stroke rehabilitation hospitalization, and offer ideas and references for exploring medical insurance payment reform.Methods A total of 7540 in-patient cases with stroke rehabilitation treatment discharged from a tertiary hospital in Xuzhou from January 2018 to December 2023 were collected. Mann-Whitney U test, Kruskal-Wallis H test, and Generalized linear regression analysis were used to explore the influencing factors of hospitalization costs for stroke rehabilitation treatment. The CART algorithm of machine learning was used to establish a casemix model for stroke rehabilitation in-patients.Results Multivariate analysis showed that age, medical payment method, length of stay, diabetes, endotracheal intubation, number of other diagnostic codes, number of surgical codes, and ADL grade had a statistically significant impact on hospitalization costs. The CART algorithm established a casemix plan for 8 stroke rehabilitation in-patients. After calculation, the homogeneity within each group and heterogeneity between groups were good, and the overall grouping was reasonable.Conclusion Tracheal intubation, length of hospital stay, number of surgical codes, number of other diagnostic codes, and ADL can be used as classification factors for developing a casemix of hospitalization costs of stroke rehabilitation in-patient treatment. The CART algorithm of machine learning can provide methodological references for exploring a casemix of hospitalization costs of stroke rehabilitation in-patient treatment.

Objective：To explore methods for accurately describing the transition state of disease patterns, facilitating the analysis of related impacts caused by disease pattern transitions. 

Methods：Based on the theory of multidimensional vector similarity and distance metrics, a Disease Pattern Distance Index (DPI) was constructed. Using the disease structure data of inpatients in Shenzhen from 2007 to 2022, the study analyzed the changes in disease patterns and their relationship with the average cost per hospitalization. 

Results：Taking 2007 as the baseline, the in-hospital disease pattern distance index in Shenzhen gradually increased, reaching 20.93 by 2022, indicating a gradual change in disease patterns. Among them, the proportions of trauma/toxicity, pregnancy/delivery, and infectious diseases decreased, while the proportions of tumors, urogenital diseases, and musculoskeletal and connective tissue diseases significantly increased. A positive correlation was found between the Disease Pattern Distance Index and the average cost per hospitalization (r = 0.9929, P < 0.01). 

Conclusion：Disease patterns can be characterized by multidimensional vectors, and the method of measuring vector distances can describe the relative relationships between disease patterns.

Objective To investigate the impact of medication adherence on blood pressure control in community-dwelling hypertensive patients. 

Methods A follow-up study was conducted on hypertensive patients managed by the Community Health Service Center of Sanxiang Town, Zhongshan City, Guangdong Province, from January 2022 to December 2023. Participants were provided with home blood pressure monitors to collect self-measured blood pressure data, and antihypertensive prescription information was obtained from local community clinics. Two time periods were set: T₁ (2022) and T₂ (2023). Annual medication adherence indicators and blood pressure control effect indices were extracted for each participant. A cross-lagged model was used to analyze the longitudinal associations and predictive relationships between medication adherence and blood pressure control. 

Results A total of 305 patients were included. In the autoregressive path, the associations between medication adherence and blood pressure control at T₁ and T₂ were statistically significant (P < 0.01), both showing positive correlations. In the cross-lagged path, medication adherence at T₁ predicted blood pressure control at T₂ (β₁ = -0.068, P < 0.05), indicating that better medication adherence was associated with reduced severity of blood pressure exceeding the target level. 

Conclusion Both medication adherence and blood pressure control exhibited certain stability, and medication adherence had a definite predictive significance for subsequent good blood pressure control.

Objective To investigate the association between the triglyceride-glucose index (TyG) and renal function with the incidence of depression. 

Methods The study population comprised middle-aged and older adults without baseline depression from the UK Biobank database. Exposure variables were the TyG index and renal function. Traditional and additive Cox proportional hazards models were used to estimate the associations between the TyG index, renal function, and depression incidence. 

Results A total of 383,860 eligible participants were included, among whom 20,711 (5.40%) were diagnosed with depression during follow-up. The results showed: - Compared with the lowest TyG quartile (Q1), higher TyG quartiles were associated with a significantly increased risk of depression (HR_Q4 = 1.42, 95%CI: 1.36–1.47; HR_Q3 = 1.27, 95%CI: 1.22–1.32; HR_Q2 = 1.13, 95%CI: 1.09–1.18). - Compared with the normal renal function group, the renal dysfunction group had a significantly higher risk of incident depression (HR_{moderate-severe dysfunction} = 2.14, 95%CI: 1.96–2.33; HR_{mild dysfunction} = 1.32, 95%CI: 1.28–1.36). - No additive (RERI = 0.01, 95%CI: –0.05–0.07) or multiplicative (HR = 0.99, 95%CI: 0.95–1.04) interaction was observed between the TyG index and renal function in relation to depression incidence. 

Conclusion Middle-aged and older adults with a high baseline TyG index or renal dysfunction have a higher risk of depression. Monitoring the TyG index and estimated glomerular filtration rate (eGFR) is recommended for early prevention of depression in this population.

Objective To analyze the effect of tobacco control interventions among rural residents in Tongxiang City, Zhejiang Province, and provide a basis for formulating tobacco control strategies in Tongxiang City. Methods A stratified multi-stage random sampling method was used to select 640 rural permanent residents aged 15–69 years from 4 towns in Tongxiang City as the survey subjects. Tobacco control health interventions were implemented, and the intervention effects were analyzed. 

Results Correct rate of knowledge about tobacco hazards: The correct rate increased from 43.29% before intervention to 68.32% after intervention, with a statistically significant difference (χ²=81.297, P<0.001).Correct rate of knowledge about smoking cessation skills: The correct rate increased from 55.98% before intervention to 72.39% after intervention, with a statistically significant difference (χ²=37.469, P<0.001). Correct rate of knowledge about secondhand smoke handling: The correct rate increased from 29.69% before intervention to 54.69% after intervention, with a statistically significant difference (χ²=82.002, P<0.001). Smoking rate: The smoking rate decreased from 22.97% before intervention to 17.34% after intervention, with a statistically significant difference (χ²=6.291, P=0.012). 

Conclusion After health interventions, the awareness rate of tobacco control knowledge among rural residents significantly increased, and the smoking rate significantly decreased, indicating that the intervention measures are effective and worthy of further promotion.

Objective To systematically evaluate the efficacy and safety of Chinese herbal decoctions containing Astragalus membranaceus and Poria cocos (HF-D) in the treatment of nephrotic syndrome (NS). 

Methods Databases including VIP, CNKI, WanFang, CBM, PubMed, Embase, and Cochrane were searched for clinical randomized controlled trials (RCTs) on HF-D for NS published between 2010 and 2023. Literature quality was assessed using the Cochrane Risk of Bias Tool, and data were analyzed with ReviewManager 5.3, Stata 12.0, and R software. 

Results Following PRISMA 2020 guidelines, 15 RCTs involving 1,538 patients were included. Meta-analysis showed: Efficacy outcomes: - The trial group had a significantly higher total response rate than the control group [RR=1.21, 95%CI: (1.13, 1.29), P<0.01].  The recurrence rate was significantly lower in the trial group [RR=0.38, 95%CI: (0.22, 0.66), P<0.01]. Laboratory indices: The trial group exhibited significantly lower levels of 24-hour urinary protein [MD=−1.20, 95%CI: (−1.43, −0.97), P<0.01], serum creatinine [MD=−7.13, 95%CI: (−13.15, −1.10), P<0.05], blood urea nitrogen [MD=−0.55, 95%CI: (−1.04, −0.06), P<0.05], total cholesterol [MD=−1.51, 95%CI: (−2.11, −0.91), *P*<0.01], and triglycerides [MD=−0.74, 95%CI: (−1.11, −0.36), P<0.01] compared to the control group. Serum albumin levels were significantly higher in the trial group [MD=5.65, 95%CI: (4.03, 7.27), P<0.01]. Safety outcomes: The incidence of adverse events was significantly lower in the trial group [RR=0.41, 95%CI: (0.28, 0.62), P<0.01]. Publication bias analysis: Egger’s test showed good symmetry in the funnel plot for 24-hour urinary protein (P>|t|=0.7), but trim-and-fill analysis for total response rate indicated potential unavoidable publication bias. 

Conclusion HF-D demonstrates promising efficacy and safety in treating NS, though further large-sample, high-quality RCTs are needed for validation.