Objective:To evaluate the predictive value of preoperative frailty combined with nutritional status for prolonged postoperative ileus (PPOI) in the patients with gynecological malignancies.Methods:Patients undergoing elective surgery for gynecological malignancies in the Affiliated Hospital of Jiangnan University from April 2022 to February 2023 were selected. The Frail scale was used to evaluate the frailty within 24 h of admission, and the nutritional status was evaluated by the Controlling Nutritional Status score. The general characteristics of patients and occurrence of PPOI were recorded, and the risk factors for PPOI were analyzed by multivariate logistic regression. The ability of frailty, nutritional status and their combination to predict PPOI was assessed by the receiver operating characteristic curve.Results:Two hundred and fourteen patients were finally included, 52 cases developed of PPOI, and 98 cases were frail patients. Preoperative frailty combined with moderate to severe malnutrition was an independent risk factor for PPOI in the patients with gynecological malignancies ( P<0.05), and the area under the curve in predicting the occurrence of PPOI was 0.796 (95% confidence interval 0.736-0.857) in the patients with gynecological malignancies. Conclusions:Preoperative frailty combined with moderate to severe malnutrition has a higher accuracy in predicting PPOI in the patients with gynecological malignancies.

Screening for diabetes and its complications contributes to slowing the progression of diabetes mellitus. Based on the setting of grass-roots diabetes complication screening workstation with the concept of two stages of screening and three levels of prevention, we proposed a hospital-community-family integrated diabetes management strategy. This article discusses the background, organization structure, operation mechanism and implementation process of this strategy, aiming to provide reference for constructing a suitable and practical grass-roots diabetes management model.

Acute kidney injury(AKI)remains a global public health problem with high incidence,high mortality rates,expensive medical costs,and limited treatment options.AKI can further progress to chronic kidney disease(CKD)and eventually end-stage renal disease(ESRD).Previous studies have shown that trauma,adverse drug reactions,surgery,and other factors are closely associated with AKI.With further in-depth exploration,the role of gut microbiota in AKI is gradually revealed.After AKI occurs,there are changes in the composition of gut microbiota,leading to disruption of the intestinal barrier,intestinal immune response,and bacterial translocation.Meanwhile,metabolites of gut microbiota can exacerbate the progression of AKI.Therefore,elucidating the specific mechanisms by which gut microbiota is involved in the occurrence and development of AKI can provide new insights from the perspective of intestinal microbiota for the prevention and treatment of AKI.

OBJECTIVES: The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN. METHODS: Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN. RESULTS: The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN. CONCLUSIONS The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.

Objective:To evaluate clincal value of preoperative peripheral blood CD4/CD8 and neutrophil to lymphocyte ratio (NLR) in papillary thyroid carcinoma (PTC) coexisted with Hashimoto’s thyroiditis (HT) .Methods:Clinicopathological data of 202 patients diagnosed as PTC treated with operation from Jul.2016 to Jun.2019 were retrospectively analyzed. They were divided into Treatment Group including 94 PTC coexisted with HT and Control Group including 108 thyroid cancer according to the postoperateive pathology report. CD4+ and CD8+ subsets in peripheral blood were analyzed by flowcytometer and blood counts were measured before surgery.Results:There was no significant difference in gender, tumor size, number of lesions or lymph node metastasis between the two goups. In comparison with Control Group, median age was lower (39.5 vs 50.5, P=0.001) and CD4/CD8 raito (1.9731.973 Cvs 1.24141973 CD P=0.001) was higher in Treatment group. There was a higher proportion of bilateral lobe thyroidectomy in Treatment Group (40/94 vs 26/108, P=0.005) . A multivariate model analysis identified CD4/CD8 raito as independent risk factor for incidence of PTC coexisted with HT [ OR=0.035, 95% CI (0.009-0.093) , P=0.001]. The NLR level of thyroid cancer patients was correlated with lateral lymph node metastasis negatively (correlation coefficients=-0.286, P=0.045) . Conclusions:PTC might have some connection with HT mediated by body inmune status. Preoperative NLR level is correlated with lateral lymph node metastasis.

To improve the quality control of private hospital is urgent in China. Through the visiting to International Neuroscience Institute, Hannover, Germany, the author analyzed the advantages of Germany Medical System, and provided several beneficial aspirations for Chinese Medical System Reformation, including sound Medical Insurance System, efficient quality control based on information platform, powerful government and civilian regulator, elastic Salary Administration, and high self-discipline of medical staff.

Background: Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking.We aimed to assess the performance of hemoglobin A1c (HbA1c) and its cut-off point in detecting diabetes in the abovementioned population. Methods: Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the goldstandard for confirming diabetes. Results: The areas under the ROC curves for HbA1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P = 0.01). HbA1c ≤ 5.1% (32 mmol/mol) and ≥ 6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. Conclusions HbA1c could detect diabetes effectively in community-dwellers with hypertension.

The laboratory medicine is aimed to support clinical decisions and patient health by providing accurate results. The internal statistical quality control (SQC) can help laboratories detecting the instability of the analytical system and preventing laboratories from reporting the patient results with medically important errors, so it is essential to ensure the quality of testing results and patient safety. The traditional methods of designing SQC strategy are based on the probability of error detection (P_ed) and the probability of false rejection (P_fr). With the introduction of risk management concepts, the design of SQC strategy began to be based on the patient risk parameter [MaxE(N_uf)] proposed by Parvin, which means the maximum increase in the number of unacceptable patient results reported compared to the in-control condition during the existence of an undetected out-of control error condition. MaxE(N_uf) is related to the SQC frequency and patient risk, which is very essential for optimizing the SQC frequency and designing a risk-based SQC strategy.

Objective To explore the associations of anxiety with optimism ,resilience and related demographic factors in lung cancer patients , and to provide a scientific basis for reducing the level of anxiety and improving the psychosomatic health. Methods A total of 130 lung cancer pa-tients from the department internal medicine of respiratory tumors in Liaoning Cancer Hospital&Institute were investigated by convenience sam-pling method from February 2013 to January 2014. The survey was anonymous. Finally,107 questionnaires were effective,and the effective rate was 82.307%. Results Among lung cancer patients,optimism and resilience were positively and significantly associated with anxiety. Physical ex-ercise had an effect on the anxiety symptoms. Conclusion Optimism and resilience have significant predictive value on the anxiety among lung cancer patients. It is important to encourage lung cancer patients to improve their psychological health ,so as to reduce their anxiety symptoms effec-tively.

Objective To explore the value of applying personalized medicine in the clinical teach-ing of glioma surgery. Methods Totally 80 7-year program undergraduates were divided into experimental class and control class randomly, with 40 cases in each group. The experimental class received personalized medical teaching through introducing idea and method of personalized medicine. The control class received conventional teaching. The effect of teaching was evaluated by questionnaire and examination. The data were analyzed through Chi-square and t-test test. Result Questionnaire survey of satisfaction showed that 37 students of experimental class (92.5%) were interested in the new course. Questionnaire survey of teaching effect showed that in experimental class 36 students (90%) felt it could increase learning interest, 37 students (92%) believed it improved glioma diagnosis and treatment, 34 students (85%) felt their medical view ex-panded, 38 students had consolidated clinical thinking, and 32 students (80%) improved negotiation with patients. All issues were significantly better than control class (P<0.05). Meanwhile, statistical difference was found in average score between experiment class and control class [(88.71 ±6.54) vs. (76.49 ±7.32)] (P=0.000). Conclusion The introduction of personalized medicine concept helps medical students to make personalized diagnosis and treatment plan for glioma patients, and is conducive to the cultivation of their clinical thinking ability and evidence based medicine concept, which is worthy of promotion.