Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

AIM:To explore the clinical significance of stearoyl-CoA desaturase 1(SCD1)in colorectal can-cer and to evaluate the effects and mechanisms of diosgenin glucoside on the proliferation of colorectal cancer cells.METHODS:The expression of SCD1 in colorectal cancer tissues was assessed using qPCR and Western blot,and its cor-relation with clinical features was analyzed.The impact of diosgenin glucoside on the viability of SW620 and HCT116 cells was measured using the CCK-8 assay,and the proliferation was further investigated through cell cloning experiments.Ad-ditionally,the effects of diosgenin glucoside on apoptosis-related genes and SCD1 were evaluated by qPCR and Western blot.Molecular docking was employed to analyze the binding site and binding energy between diosgenin glucoside and SCD1.RESULTS:(1)Both SCD1 mRNA and protein were highly expressed in colorectal cancer tissues,with an 88%positive rate.And SCD1 mRNA expression correlated with cancer type and clinical stage.(2)Diosgenin glucoside de-creased the viability and cloning ability of SW620 and HCT116 cells in a dose-dependent manner.(3)Diosgenin gluco-side upregulated the mRNA and protein expression of pro-apoptotic proteins caspase-3 and Bax in a dose-dependent man-ner,while it downregulated the mRNA and protein expression of the anti-apoptotic protein Bcl-2.(4)Diosgenin glucoside reduced the mRNA and protein expression of SCD1 in a dose-dependent manner and bound to SCD1 via hydrogen and con-jugated bonds with a binding energy of-7.7 kcal/mol.CONCLUSION:(1)SCD1 is closely associated with the type and clinical stage of colorectal cancer.(2)The reduction in viability and proliferation of colorectal cancer cells by diosgenin glucoside may be attributed to its binding to SCD1,which lowers its expression and promotes apoptosis.

Objective:To construct and validate a predictive model for pathological complete response (pCR) in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy.Methods:This retrospective observational study included 595 patients with stage T2-4 and (or) N+M0 LARC diagnosed in the Cancer Hospital of Chinese Academy of Medical Sciences and the Fourth Hospital of Hebei Medical University who had no metastases, tolerated neoadjuvant therapy, completed neoadjuvant therapy, and had undergone radical surgery after neoadjuvant therapy. The training set comprised 299 patients admitted to the Cancer Hospital of Chinese Academy of Medical Sciences from 2013 to 2018, the internal validation set 155 patients admitted from 2019 to 2023, and the external validation set 141 patients admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2021. They were divided into pCR group and non-pCR groups according to postoperative pathology. Among the 299 patients in the training set, 247 were in the non-PCR and 52 in the pCR group; among the 155 patients verified internally, 113 were in the non-PCR and 42 in the pCR group; and among the 141 patients validated externally, 132 were in the non-pCR and nine in the pCR group. Logistic regression was used for univariate and multifactorial analysis to explore the factors associated with pCR and construct a nomogram prediction model. Receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA) were used to validate the performance of the predictive model.Results:Univariate and multivariate logistic regression analysis showed that carbohydrate antigen 19-9 ( P=0.040, OR=0.97, 95%CI: 0.93-0.99), neutrophil count ( P<0.001, OR=0.66, 95%CI: 0.52-0.84), tumor T stage: Stage IV ( P=0.011, OR=0.22, 95%CI: 0.07-0.70), tumor N stage: Stage I ( P=0.003, OR=0.22,95%CI:0.08-0.60), Stage II ( P<0.001, OR=0.03, 95%CI: 0.01-0.09) and involvement of mesorectal fascia ( P=0.004, OR=0.09, 95%CI: 0.02-0.47) were independent predictors of pCR. In the training set, the area under the receiver operating characteristic curve of the model was 0.92 (95%CI: 0.87-0.96), whereas in the internal and external validation sets, the AUCs were 0.78 and 0.81, respectively. The calibration curve showed that the prediction model had good prediction efficiency in both the training and verification sets. Decision curve analysis showed that the net benefit of the model was largest when the threshold probability was in the range of 5.2% to 89.7% (in the internal and external validation sets, the threshold probabilities were in the range of 15.7% to 92.3% and 2.2% to 84.1%, respectively). Conclusion:The nomogram model constructed in this study showed efficacy in predicting whether patients with LARC will achieve pCR after receiving neoadjuvant chemoradiotherapy.

Mosquito-borne viruses,a class of pathogens primarily transmitted by mosquitoes,present severe glo-bal epidemics and pose serious threats to human health.These viruses rely on specific mosquito species for transmi-ssion,and their clinical manifestations vary from mild symptoms to severe complications.Most viruses lack effective treatment agents and vaccines.This review systematically describes the mechanisms of the mosquito-borne virus in-fection transmission,encompassing two key stages:host infection and mosquito infection.During the host infection stage,saliva components of mosquito promote viral invasion and systemic spread within the host by disrupting host hemostasis process,directly interacting with the virus,altering host cell function,and regulating local immune re-sponse,ultimately targeting specific organs and causing disease.During the mosquito infection stage,the targeting of mosquito is regulated by metabolites from host's skin microbiome.Host blood components and mosquito's gut microbiome exert bidirectional regulation in the infection in mosquito's midgut.The viruses break through the mid-gut barrier to enter the hemolymph and further infect the salivary glands.These mechanisms reveal the viruses' adaptive strategies within the host-mosquito ecosystem and emphasize the importance of multifactorial regulation.Future research should focus on molecular interventions,microbial applications,and integrated prevention and con-trol strategies to reduce the risk of mosquito-borne viral transmission.

Our acupuncture-moxibustion(Acu-Moxi)field has entered an era of digital and intelligent transformation,yet systematic and in-depth development remains limited.This article aims to provide an overview and reflection on the digital and intelligent progress of Acu-Moxi in China,offering systematic insights for the comprehensive development of this field.Through a retrieval from CNKI,VIP,and Wanfang databases,along with a discussion of relevant policies,case studies,achievements,and updates,the study evaluated the current advancements in the digitization and intelligence of Acu-Moxi,also discussing the current advantages and challenges.Findings revealed an overall upward trend in publications related to digital-intelligent technologies in Acu-Moxi,key forms including robotics,acupuncture point digitization,smart acupuncture devices,and clinical decision-making models,highlighting the empowering potential of digital intelligence across the discipline.Recently,publications of the Acu-Moxi digitization has decreased sharply,and the number of Acu-Moxi research about digital and intelligent transformation has increased.In conclusion,the field has undergone a transition from comprehensive digital accumulation to increasing intelligence,moving toward integrated digital-intelligent development.However,the internal development of digital and intelligent Acu-Moxi remains uneven.To achieve a harmonious intelligent Acu-Moxi ecosystem,it is crucial to leverage opportunities of discipline and times for systematic and balanced improvement.

Objective:To investigate the predictive value of regional cerebral oxygen saturation (rScO 2) for perioperative neurocognitive disorders (PND) in the preanalgesia of erector spinal plane block (ESPB) combined with parecoxib sodium in elderly patients undergoing radical lung cancer surgery. Methods:A total of 180 elderly patients with lung cancer treated inthe Sixth Affiliated Hospital of South China University of Technology (People's Hospital of Nanhai District) from June 2022 to June 2023 were selected. All patients underwent thoracoscopic radical resection of lung cancer, pre-analgesia by ESPB combined with parecoxib sodium, and rScO 2 was monitored by near infrared spectroscopy. Cognitive function was assessed at 1 d before surgery and 7 d after surgery, and the incidence of PND was determined according to the Z score method. Patients with PND were included in the observation group (21 cases) and those without PND were included in the control group (159 cases). The clinical data, preoperative and postoperative cognitive scale scores, and perioperative rScO 2 were compared between the two groups. Logistic regression model was used to analyze the risk factors of PND. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of rScO 2 to patients' PND. Results:Patients aged ≥75 years, postoperative incision infection, postoperative 1d visual analogue scale (VAS) ≥4 scores, intraoperative blood loss and operative time in the observation group were higher than those in the control group: 61.90%(13/21) vs.34.59%(55/159), 19.05%(4/21) vs. 3.77%(6/159), 42.86%(9/21) vs. 18.87%(30/159), (208.39 ± 61.05) ml vs. (172.45 ± 60.22) ml, (188.96 ± 62.13) min vs. (150.36 ± 52.17)min; the years of education in the observation group was shorter than that in the control group: (8.10 ± 2.25) years vs. (9.89 ± 2.04) years, there were statistical differences ( P<0.05). The scores of mini-mental state examination (MMSE), visual verbal learning test (VVLT), digital span test (DST1) and digital symbol test (DST2) at 7 d after surgery in both groups were lower than those befor surgery, and the scores of MMSE, VVLT, DST1 and DST2 at 7 d after surgery in the observation group were lower than those in the control group: (22.86 ± 2.05) scores vs. (24.85 ± 1.87) scores, (2.95 ± 1.95) scores vs. (4.83 ± 2.01) scores, (7.52 ± 1.83) scores vs. (9.04 ± 1.93) scores, (40.48 ± 5.05) scores vs. (44.35 ± 4.96) scores, there were statistical differences ( P<0.05). The decrease rate of rScO 2 from the baseline value at single lung ventilation 1 h (T 2) in the observation group was higher than that in the control group: (21.32 ± 5.13)% vs. (14.51 ± 5.02)%, there was statistical difference ( P<0.05). The results of Logistic regression analysis showed that rScO 2 reduction rate from the baseline value, age ≥75 years, postoperative 1 d after surgery VAS ≥4 scores, and operation time were independent risk factors for PND; the higher levels of rScO 2 at T 2 and after operation (T 3) were independent protective factors ( P<0.05). The results of ROC curve analysis showed that the area under the curve(AUC) of rScO 2 at T 2 and T 3 and the decrease rate of rScO 2 from the baseline value predicted that the PND in elderly patients with pre-analgesic radical lung cancer with ESPB combined with paracxib sodium were 0.742, 0.716 and 0.822, respectively, in which the AUC of the decrease rate of rScO 2 from the baseline value was the largest. Conclusions:rScO 2 can be used for predicting PND in the elderly patients with radical lung cancer after ESPB combined with parecoxib sodium, especiallythe predictive value of the decrease rate of rScO 2 from the baselinevalue is higher.

Objective:To investigate the clinical manifestations，etiology/triggers，treatment，and prognosis of children with cerebral venous sinus thrombosis（CVST）.Methods:A retrospective analysis was conducted on 36 children with CVST hospitalized at the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University（Hunan Children's Hospital）from May 2014 to January 2024.A centralized telephone follow-up was performed in May 2024，and clinical data including symptoms，imaging findings，treatments，and outcomes were collected.According to the prognosis,the children were divided into favorable-prognosis group and poor-prognosis group,and the differences of clinical characteristics between the two groups were compared.The univariate Logistic regression was applied to identify factors associated with prognosis.Results:Among the 36 cases,there were 29 males and 7 females,ranging in age from 1 month to 13 years and 3 months,with a median age of 4.6(1.0,8.3) years.The common clinical manifestations included headache（24/25，96.0%），consciousness disorder（25/36，69.4%），vomiting（22/36，61.1%），seizures（14/36，38.9%），limb dysfunction（11/36，30.6%）.The leading etiologies were infection（14/36，38.9%），head trauma（8/36，22.2%），and tumors/chemotherapy（6/36，16.7%）.All 36 children underwent MRI+MRV examination of the head,and all of them had different degrees of CVST,the most commonly involved site was transverse sinus (28/36,77.8%).The favorable-prognosis group（ n=18）included 16 patients receiving anticoagulation and 2 trauma cases without anticoagulation.The poor-prognosis group（ n=18）comprised 9 anticoagulated and 9 non-anticoagulated patients.There were no significant differences in age,sex,clinical manifestations,etiology/inducement and thrombus site between the two groups ( P>0.05).However,the proportion of anticoagulant therapy in the favorable-prognosis group was higher than that in the poor-prognosis group(88.9% vs 50.0%).Among the 25 children receiving anticoagulant therapy,16 had a good prognosis (64.0%),while among the 11 children receiving no anticoagulant therapy,only 2 had a good prognosis (18.2%).The prognosis of children receiving anticoagulant therapy was better than that of those receiving no anticoagulant therapy.The difference was statistically significant ( P<0.05).Fourteen children were admitted with intracranial hemorrhage,with 8 receiving anticoagulant therapy (7 with good prognosis,accounting for 87.5%) and 6 not receiving anticoagulant therapy (only 1 with good prognosis,accounting for 12.5%).The prognosis of children receiving anticoagulant therapy was better than that of those receiving no anticoagulant therapy,and the difference was statistically significant ( P=0.026),with no increasing in intracranial hemorrhage after anticoagulant therapy.Univariate Logistic regression analysis showed that inducement/etiology,intracranial hemorrhage before treatment and prognosis were not related（ P >0.05），but anticoagulation treatment was associated with favorable outcomes（ OR=0.125，95% CI 0.017-0.614, P=0.009）. Conclusion:Infection is the primary etiology of pediatric CVST，with headache，lethargy，and vomiting as key symptoms.Transverse sinus is the most commonly involved site.Children suspected of CVST should be examined by MRI/MRV as soon as possible,and early anticoagulation therapy should be given after a clear diagnosis,so as to improve the prognosis.

Objective:To investigate the prognosis of postoperative adjuvant therapy for hepatocellular carcinoma after conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 103 patients with initially unresectable hepatocellular carcinoma (HCC) who were admitted to 11 medical centers in China, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from November 2019 to May 2023 were collected. There were 83 males and 20 females, aged (54±12)years. All 103 patients underwent conversion therapy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) successfully followed by sequential hepatectomy, of which 72 patients undergoing postoperative adjuvant therapy were divided into the adjuvant therapy group, and 31 patients undergoing postoperative follow-up monitoring were divided into the follow-up monitoring group. Observation indicators: (1) follow-up and postoperative condi-tions; (2) analysis of factors influencing recurrence-free survival time of patients; (3) stratified ana-lysis. Comparison of count data between group was conducted using the chi-square test or Fisher exact probability. The R software was used to draw survival curves, and the Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Results:(1) Follow-up and postoperative conditions. All 103 patients were followed up for 21.0(range, 1.9?47.2)months, with the median recurrence-free survival time of 28.7 months and the 1-, 2-, 3-year recurrence-free survival rates of 68.6%, 55.6%, 41.2%. The median overall survival time of 103 patients was unreached, and the 1-, 2-, 3-year overall survival rates were 90.9%, 82.1%, 69.6%, respectively. The median recurrence-free survival time was 33.1 months in patients of the adjuvant therapy group, with the 1-, 2-year recurrence-free survival rates as 77.2%, 61.5%. The median recurrence-free survival time was 11.1 months in patients of the follow-up monitoring group, with the 1-, 2-year recurrence-free survival rates as 46.6%, 40.8%. There was a significant difference in recurrence-free survival between the two groups of patients ( χ2=5.492, P<0.05). (2) Analysis of factors influencing recurrence-free survival time of patients. Results of multivariate analy-sis showed that pathologic complete response and postoperative adjuvant therapy were independent factors influencing recurrence-free survival time of HCC patients undergoing conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy ( hazard ratio=0.297, 0.492, 95% confidence interval as 0.137?0.647, 0.268?0.903, P<0.05). (3) Stratified analysis. Of the 71 patients with non-pathologic complete response, the median recurrence-free survival time of 48 patients in the adjuvant therapy group was 24.0 months, with the 1-, 2-year recurrence-free survival rates as 67.4%, 48.8%. The median recurrence-free survival time of 23 patients with non-pathological complete response in the follow-up monitoring group was 7.4 months, with the 1-, 2-year recurrence-free survival rates as 35.0%, 26.3%. There was a significant difference in recurrence-free survival between the 48 patients with non-pathologic complete response in the adjuvant therapy group and the 23 patients with non-pathologic complete response in the follow-up monitoring group ( χ2=5.241, P<0.05). Conclusion:For HCC patients with conversion therapy of TKIs and ICIs followed by sequential hepatectomy, postoperative adjuvant therapy, compared to postoperative follow-up monitoring, can prolong the recurrence-free survival time of patients, of whom cases with non-pathologic complete response can benefit from adjuvant therapy.

Objective:To explore the effectiveness of rapid cycle deliberate practice (RCDP) in training newly hired nurses′comprehensive emergency competence and to provide references for enhancing their capabilities.Methods:A quasi-experimental study was conducted using purposeful sampling. From September to December 2022, newly hired nurses at Liaocheng Second People′s Hospital were selected as research subjects and randomly assigned to a controlor an observation group using random number table. The control group received traditional group drill training, while the observation group underwent RCDP training. The study compared pre- and post-training scores of emergency theory and skill assessments, scores on the Chinese version of the Perceived Cognitive Ability Scale in Emergency Situations (PCAS), and training satisfaction levels between the two groups.Results:Each group comprised 30 nurses. The control group consisted of 3 males and 27 females, with a mean age of (22.70 ± 1.09) years; the observation group included 2 males and 28 females, with a mean age of (22.93 ± 0.87) years. Post-training comprehensive emergency competence assessment scores was (89.19 ± 1.47) in the control group and (93.00 ± 1.41) in the observation group, with a statistically significant difference ( t = - 4.60, P<0.01). The scores and total scores of PCAS in the observation group were (34.23 ± 1.91), (12.70 ± 1.62), (10.03 ± 1.52) and (56.97 ± 3.09), respectively, which were higher than the (31.70 ± 2.42), (11.90 ± 1.16), (9.10 ± 1.42), and (52.47 ± 3.65) in the control group, the difference between the two groups were statistically significant ( t value were - 5.16 - - 2.20, all P<0.05). The total score of training satisfaction of nurses in the observation group was (41.93 ± 2.53) points, and the difference was statistically significant compared with the (33.80 ± 2.58) pointsin the control group ( t = - 12.33, P<0.01). Conclusions:The application of the RCDP method in training newly recruited nurses′comprehensive emergency competence effectively enhances their learning enthusiasm and initiative, thereby improving training outcomes.

Objective:To investigate the relationship of several adiposity-related anthropometric parameters, including BMI, waist circumference (WC), waist-to-hip ratio (WHR), body fat percentage (BFP) and indoles in plasma with the incidence of atherosclerotic cardiovascular disease (ASCVD) in adults in China.Methods:In China Kadoorie Biobank (CKB) study, blood samples were collected from 2 183 participants in the first resurvey in 2008 to detect indoles. Participants' body weight, body height, WC, hip circumference, and BFP were measured at baseline survey in 2004 and resurvey in 2008, the BMI and WHR were calculated with standardized methods. The long-term follow-up of all participants started from the completion of the resurvey in 2008 until the occurrence of incident ASCVD, death, loss to follow-up or until December 31, 2018. CKB ascertained outcome status (incident ASCVD) through death and disease registries and national health insurance databases, supplemented by active follow-up. Multivariate linear regression model was used to estimate the associations of anthropometric measurements at baseline survey and the first resurvey, and changes in these measurements with 3 indoles [indole, indole-3-acetic acid (IAA), and indole-3-propionic acid (IPA)]. Cox proportional hazard regression model was used to estimate the associations between indoles and the risk for ASCVD.Results:Anthropometric measurements at baseline survey or the first resurvey were negatively associated with plasma IPA level. The regression coefficient ( β) of baseline BMI (per 1.0 kg/m 2) with 0.1 standard deviation ( SD) IPA was -0.23 (95% CI: -0.36 - -0.10) (false discovery rate=0.004). After adjusting for baseline BMI, the β of baseline WC, WHR and BFP with 0.1 SD IPA were -0.09 (95% CI: -0.18 - -0.01), -0.12 (95% CI: -0.19 - -0.05), and -0.20 (95% CI: -0.32 - -0.08), respectively. The annual change in BMI (difference between BMI in 2008 and 2004 divided by the time interval) was associated with indole and IAA, with β of 1.40 (95% CI: 0.58 - 2.21) and -1.07 (95% CI: -1.91 - -0.23), respectively, at each 0.1 increase of SD. Over a median ( Q1, Q3) follow-up of 10.46 (10.36, 10.53) years after 2008 resurvey, 236 cases of ASCVD were recorded. IAA and IPA levels were negatively associated with the risk for ASCVD, with hazard ratios for one SD increase of IAA and IPA of 0.87 (95% CI: 0.76 - 0.99) and 0.84 (95% CI: 0.73 - 0.96), respectively. Conclusions:Our results suggested that anthropometric measurements and their changing trends affect the levels of plasma imicrobial tryptophan metabolite levels, decreased levels of IAA and IPA levels are associated with increased risk of ASCVD and indoles in plasma including IPA and IAA might be the mediating factors for adiposity-induced ASCVD.