The ninth edition of TNM staging for lung cancer has been announced at the 2023 World Lung Cancer Congress and implemented from January 1, 2024. The focus of the ninth TNM staging change is dividing N2 into N2a and N2b, as well as M1c into M1c1 and M1c2. Although the T staging has not changed, it has played an important role in verifying the eighth edition of the T staging. The subdivision of stage N2 has led some patients with ⅢA of the eighth edition to experience ascending or descending stages, which will more accurately help to assess the condition and prognosis of patients with mediastinal lymph node metastasis, as well as the design of related clinical studies. Modifying the M1c staging will help define oligometastasis and explore new treatment models in the future. The ninth edition of the TNM staging system provides a more detailed division of different tumor loads, but there is no clear explanation for the staging of lung cancer after neoadjuvant therapy. Further data analysis is needed, and it is expected to be answered in the tenth edition of TNM staging.

The ninth edition of TNM staging for lung cancer has been announced at the 2023 World Lung Cancer Congress and implemented from January 1, 2024. The focus of the ninth TNM staging change is dividing N2 into N2a and N2b, as well as M1c into M1c1 and M1c2. Although the T staging has not changed, it has played an important role in verifying the eighth edition of the T staging. The subdivision of stage N2 has led some patients with ⅢA of the eighth edition to experience ascending or descending stages, which will more accurately help to assess the condition and prognosis of patients with mediastinal lymph node metastasis, as well as the design of related clinical studies. Modifying the M1c staging will help define oligometastasis and explore new treatment models in the future. The ninth edition of the TNM staging system provides a more detailed division of different tumor loads, but there is no clear explanation for the staging of lung cancer after neoadjuvant therapy. Further data analysis is needed, and it is expected to be answered in the tenth edition of TNM staging.

This paper summarized the experience of Professor FANG Dingya in staged treatment of Sjögren's syndrome from the perspective of dryness toxin. It is believed that the cause of Sjögren's syndrome is externally-contracted dryness， consumption of essence and fluid， congenital and acquired essence deficiency， depleted essence and insufficient blood， and the core mechanism is internal accumulation of dryness toxin. The treatment can be divided into three stages， that is dryness toxin transforming into fire-heat， damp-heat and phlegm-stasis， from the perspective of dryness metal qi transformation. It is emphasized to dispel pathogen mainly， to clear and moisten with yin-nourishing medicinals in supplementation， and to treat by stages based on syndrome differentiation. For dryness toxin with fire-heat， it is suggested to moisten dryness， resolve toxins and subdue fire， with self-made Runzao Jiedu Decoction （润燥解毒汤） in modification. For dryness toxin with damp-heat， the method of nourishing yin， clearing heat and draining dampness should be used， and Chunze Decoction （春泽汤） in modification is suggested. For dryness toxin with phlegm-stasis， it is recommended to unblock collaterals， disperse phlegm and dissipate stasis， with self-made Sanyu Xiaotan Decoction （散瘀消痰汤） in modification.

ObjectiveTo investigate the expression of lysophosphatidic acid （LPA） in patients with liver cancer， as well as its influence on malignant biological behavior of liver cancer and related regulatory mechanism. MethodsFrom January 2016 to December 2022， 26 patients with liver cancer， 28 patients with liver cirrhosis， and 28 individuals undergoing physical examination were enrolled. ELISIA was used to measure the content of LPA in plasma and peritoneal effusion of the patients with liver cancer or liver cirrhosis accompanied by peritoneal effusion， and the content of LPA was measured in plasma of the normal population at the same time， so as to clarify the difference in the expression of LPA in different populations， such as the patients with liver cancer and those with liver cirrhosis. MTT cell proliferation assay and cell migration assay were used to observe the influence of LPA and its inhibitor pertussis toxin （PTX） on the proliferation， migration， and invasion of SMMC7721 cells. In order to investigate the effect of LPA on the expression of RhoA and its upstream and downstream molecules FAK and P53 after binding to its receptor， qPCR and Western blot were used to observe the effect of LPA on the mRNA and protein expression levels of P53， FAK， and RhoA in SMMC7721 cells. A one-way analysis of variance was used for comparison of the means of continuous data between multiple groups， and the SNK-q test was used for comparison between two groups. ResultsCompared with the patients with liver cirrhosis， the patients with liver cancer had a significantly higher concentration of LPA in plasma （4.99±0.55 μmol/L vs 2.63±0.43 μmol/L， P<0.05） and peritoneal effusion （5.19±0.63 μmol/L vs 2.91±0.46 μmol/L， P<0.05）， and the patients with liver cancer also had a significantly higher level of plasma LPA than the normal population （4.99±0.55 μmol/L vs 1.61±0.39 μmol/L， P<0.05）. The cell proliferation assay showed that LPA significantly promoted the proliferation of SMMC7721 cells， and cell proliferation rate increased with the increase in dose and time； in particular， the middle-and high-dose groups had a significantly higher proliferation rate than the control group （P<0.05）. PTX inhibited the proliferative capacity of SMMC7721 cells in a time-dependent manner， and there was a significant difference between the groups （P<0.05）. The proliferation rate of the 72-hour high-dose LPA group was 3.6 times that of the control group， while the proliferation rate of the PTX group was 0.6 times that of the control group； the proliferation rate of the 72-hour high-dose LPA+PTX group was 1.2 times that of the control group. In addition， LPA increased the migration ability of hepatoma cells， while PTX inhibited their migration， in a time-dependent manner， and there was a significant difference between the groups （P<0.05）. The migration rate of the 72-hour high-dose LPA group was 3.09 times that of the control group， while the migration rate of the PTX group was 0.4 times that of the control group； the migration rate of the 72-hour high-dose LPA+PTX group was 0.99 times that of the control group. qPCR and Western blot showed that there were significant reductions in the mRNA and protein expression levels of P53 in SMMC7721 cells after LPA treatment， while there were significant increases in the mRNA and protein expression levels of FAK and RhoA； there was a significant difference between the LPA group and the control group （P<0.05）. ConclusionThere is an abnormal increase in the expression of LPA in patients with liver cancer， and LPA can promote the proliferation of liver cancer cells and increase their migration ability. At the same time， LPA changes the expression levels of P53， FAK， and RhoA， which may be associated with the promotion of tumor development and progression by LPA.

Purpose: This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction. Materials and Methods: Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. Results: The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of allcause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359–0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344–0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m2 ), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. Conclusion The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.

Purpose: This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction. Materials and Methods: Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. Results: The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of allcause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359–0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344–0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m2 ), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. Conclusion The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.

Objective:To understand the cognition and related factors on the use of HIV non-occupational post-exposure prophylaxis (nPEP) among men who have sex with men (MSM).Methods:The snowballing method was applied to recruit research subjects who were ≥18 years old, had sex with men in the past three months, and were aware of nPEP in MSM groups in Beijing, Shenzhen, and Kunming from March 15 to April 14, 2019. Data on social demographics, behavioral characteristics, basic knowledge of nPEP, consultation, and using nPEP were collected through "i guardian Platform". The logistic regression model was used to analyze the related factors affecting the use of nPEP.Results:Among 1 809 investigated, 39.8% (720 persons) were aware of the basic knowledge of nPEP, 33.4% (605 persons) had consulted nPEP, and 15.0% (271 persons) had used nPEP. In addition, multivariate logistic regression analysis showed that factors as whether to have sex with men infected with HIV in the last three months ( OR=2.58, 95% CI: 1.64-4.07), the frequency of HIV testing in the past year ( OR=2.47, 95% CI: 1.28-5.11), nPEP knowledge awareness ( OR=0.70, 95% CI: 0.49-0.99), whether to consult nPEP ( OR=70.98, 95% CI: 40.51-136.83) were related to the use of nPEP. Conclusions:MSM still have poor cognition of nPEP. It is necessary to strengthen the publicity and education of nPEP in MSM and promote the use of nPEP after HIV exposure as soon as possible.

Objective:To explore the current status of undergraduate nursing students' professional self-efficacy, and analyze the influence of uncertainty stress on nursing students' professional self-efficacy.Methods:From April 10 to 17, 2020, the cluster convenience sampling was used to select 1 526 nursing undergraduates from four universities in Zhejiang Province as the research object. The cross-sectional survey was conducted with the General Information Questionnaire for Nursing Students, Professional Self-efficacy Questionnaire for Nurse Students (PSQNS) and the Uncertain Stress Questionnaire. Multiple linear regression was used to analyze the influencing factors of professional self-efficacy of nursing students. A total of 1 526 questionnaires were issued, and 1 474 valid questionnaires were returned with the effective response rate of 96.6%.Results:Among 1 474 undergraduate nursing students, the total PSQNS score was (91.10±14.11) , and the item average score was (3.37±0.52) , and the score rate was 67.48%, which was in the middle level. The results of multiple linear regression analysis showed that the preference for the nursing major, uncertainty stress, academic achievement in school, reasons for choosing the nursing major, and family economic status were the influencing factors of professional self-efficacy of undergraduate nursing students with statistical differences ( P<0.05) , which could explain 33.4% of the variation. Conclusions:The professional self-efficacy of undergraduate nursing students needs to be improved. Nursing educators can improve their professional self-efficacy by reducing the uncertainty stress of nursing students.

Objective To analyze the psychological and behavioral status and influencing factors of college students during the epidemic of COVID-19 in Wuhan. Methods The students from two universities in Wuhan area were selected by stratified cluster sampling, and the self-designed questionnaires were used to conduct the online survey. Statistical analysis was performed using SPSS 22.0. Results Among 3 966 college students surveyed in this study, the proportion of students in Wuhan who thought that their own infection probability was higher than others (11.25%), that their family members were more likely to be infected (15.29%), that they were very worried about their own infection (22.93%), that they were very worried about the infections in the same community (25.27%), and that their own infection risk was higher than others (9.77%), was higher than those of students in other three regions. The total incidence of depression was 27.10%. Multivariate logistic regression analysis showed that the humanities and social science majors living in the city, worrying about the infection of themselves and their families, feeling that they had a higher chance of infection than other, being not optimistic about the epidemic situation, and thinking that the infection had a great impact on people's emotions were the risk factors of depression during the epidemic. Conclusion College students in Wuhan had psychological and behavioral problems during the COVID-19 epidemic. These problems were related to whether they were located in the epidemic area and whether they were worried about infections.

Objective: To investigate the effects of clustered warming intervention on spontaneous hypothermia and coagulation function in patients with emergency trauma. Methods: A total of 118 cases of emergency trauma patients admitted from January 2017 to December 2018 in Changzhou Second People′s Hospital were selected as subjects. According to the time of admission, there were 62 cases in the control group from January 2017 to December 2017 and 56 cases in the treatment group from January 2018 to December 2018. The control group used routine emergency nursing intervention and warming measures, and the treatment group combined with clustered warming intervention. The changes of body temperature, coagulation function, spontaneous hypothermia and prognosis were compared between the two groups. Results: When entering the Emergency Department and entering the Emergency Department for 60 minutes, the body temperature of the emergency trauma patients in the treatment group were (36.41±0.75) and (36.74±0.65)℃, and the control group were (35.42±0.80) and (35.54±0.76)℃. The difference between the two groups was statistically significant (t value was 6.914, 9.168, P<0.01). After entering the Emergency Department for 60 minutes, the activated partial thromboplastin time, prothrombin time, and thrombin time in the treatment group were (35.24±2.25), (13.56±1.02), (17.45±1.52) s, and the control group was (39.45±3.42), (15.12±1.34), (19.20±1.23) s. The difference between the two groups was statistically significant (t value was 7.802, 7.058, 6093, P<0.01). The incidence of spontaneous hypothermia and duration of hypothermia in the treatment group were 16.07%(9/56), (7.32±1.14) h, and that in the control group was 41.94%(26/62) and (18.42±3.20) h. The difference between the two groups was statistically significant (χ² value was 9.432, t value was 24.579, P<0.01). The incidence of chills, infection and death in the observation group was 16.07%(9/56), 7.14%(4/56), and 5.36%(3/56), and that in the control group was 51.61%(32/62), 24.19%(15/62), and 17.74%(11/62). The difference between the two groups was statistically significant (χ² value was 16.393, 6.322, 4.316, P< 0.05 or 0.01). Conclusions Clustered warming intervention can help prevent the risk of spontaneous hypothermia in emergency trauma patients, antagonize coagulation dysfunction and improve patient prognosis.