Objective Controversies exist as to the influences of the characteristics of lymph node metastasis ( LNM) on the prognosis of low-grade endometrial carcinoma ( LGEC) .The aim of this study was to investigate the risk factors of LNM and their im-pact on the prognosis of LGEC. Methods This study included 218 LGEC patients treated by retroperitoneal lymph node dissection. We analyzed the pathologic characteristics of LNM and its relationship with the survival rate of the patients. Results LNM was ob-served in 37 of the 218 patients (16.97%), including 20 cases of pelvic (54.05%), 6 cases of para-aortic (16.22%), and 11 ca-ses of both pelvic and para-aortic ( 29.73%) LNM.Independent risk factors of LNM included deep myometrial infiltration ( OR:5.21, 95%CI:2.77-9.81), cervical stromal involvement (OR:3.15, 95% CI:1.12-8.35), lymphovascular invasion (OR:1.15, 95%CI:1.02-1.30), and abnormally high serum CA125 (OR:3.46, 95%CI:1.56-7.67) (P<0.05).There were sig-nificant differences in the 3-year survival rate between the patients with LNM and those without LNM (83.8%vs 95.0%, P<0.05) as well as in the 3-year tumor-free survival rate (73.0% vs 90.1%, P<0.05). Conclusion Deep myometrial infiltration, cervical stromal involvement, lymphovascular invasion, and abnormally high serum CA125 are the risk factors of LNM in LGEC patients, and LNM affects the prognosis of the LGEC patients.

Objects:To investigate the current situation of counselors'implementation and their attitude to informed consent in Beijing.Methods:Eleven counselors who worked in Beijing were interviewed,the average of their working years was (7.4 ± 4.4).A semi-structured interview was used to learn about their practicing processes in and viewpoints on informed consent,and their interview transcripts were analyzed through qualitative method.Results:The results could be categorized into four categories,including the content of informed consent,the influential factors of informed consent,problems and confusions,and the significance of informed consent.The crucial role of informed consent in psychotherapy was generally recognized by counselors,and they could obey the related rules as well.The therapists had some confusion and problems about informed consent,such as the form and length,the consent for special population and online consultation.Conclusion:Basically,the counselors in Beijing could comply with the ethical standards of informed consent.However,they also suggest that certain limitations of these rules should be noticed.

The DNA fragments of ag85b、esat-6、hsp65、mpb64 and ag85b-esat-6、hsp65-esat-6、mpb64-esat-6 were amplified by PCR and SOE technique.These seven fragments were inserted into pCDNA3.1(+)vector to construct recombinant plasmids pCA、pCE6、pCH、pCM、pCAE、pCHE and pCME.The seven plasmids were transfected into SP2/0 cell in vitro to detect the expression of target genes.BALB/c mice were intramuscularly vaccinated with the seven plasmids and the control vector pCDNA3.1(+)and PBS respectively.The serum antibodies and the spleen lymphocyte proliferation(SLP)and secreted IFN～? of spleen were tested.The results of indirect ELISA showed the levels of antibodies in all recombinant plasmids groups were significantly higher than the two control groups(P

Course paper grading often involves subjective factors. Teachers may introduce biases into the grading due to their preferences for certain topics, resulting in inaccurate grading results that fail to reflect the true abilities of students. Taking the grading results of the "Clinical Pharmacology" course as an example, this article investigates the analytical method for detecting topic bias in the course paper grading. A comparative analysis was performed on the differences in the scores between different topics graded by the same teacher and between the same topic graded by different teachers by calculating the vertical bias factor and the horizontal bias factor, and a scientific and feasible analytical method was established. This method can help teachers quickly discover biases in their course paper grading, thereby making the grading more objective and accurate.

Objective: To investigate the sleep and mental health status of adolescents in Shandong Province, to explore the correlation between sleep and mental health, so as to provide a basis for adolescent physical and mental health management. Methods: From February to March 2023,a multistage stratified whole cluster sampling method was used to randomly select 3 cities in Shandong Province, one urban area and one township in each city, one junior high school and one senior high school in the urban area and the township, respectively, and then 4 classes were randomly selected from each grade level of each school, and all 3 667 students in the classes were surveyed by using the Pittsburgh Sleep Quality Index Scale (PSQI) short form and the Chinese Middle School Students Mental Health Inventory (MMHI-60). Results: The prevalence of sleep deprivation among adolescents in Shandong Province was 37.44%, and the detection rate of psychological problems was 46.41%. Adolescent psychology could be divided into four latent categories:psychological immune group (39.6%), psychological low risk group (12.2%), psychological medium risk group (13.2%) and psychological high risk group (35.0%). Multifactorial Logistic regression analyses showed that gender, school year, sleep duration and sleep quality were influencing factors for the psychological latent categories ( OR =1.39-9.55, P < 0.05 ), and that adolescents with sleep deprivation and poor sleep quality were more inclined to be classified as being in the psychological medium and high risk groups. Conclusions The sleep and mental health of adolescents in Shandong Province is not very good. Comprehensive prevention and control of psychological problems should not only focus on personality and psychological characteristics, but also need to be combined with the sleep condition of adolescents.

Suffering is prevalent in the palliative care population and is an important factor affecting the quality of life of palliative care patients and their family caregivers. In this paper, we review the assessment content, measurement methods, current application status and advantages and disadvantages of suffering assessment tools for palliative care patients, analyze the problems of current suffering assessment tools for palliative care patients and make suggestions, aiming to provide reference for palliative suffering treatment in China.

Objective:To explore the application effect of BOPPPS teaching model and "Internet + WeChat" platform in the teaching of Clinical Pharmacology.Methods:Undergraduate students from two consecutive batches of clinical medicine in Wuhan University were selected as the control group and the experimental group. The control group adopted the traditional teaching method, and the experimental group adopted the BOPPPS teaching model combined with the "Internet + WeChat" platform. SPSS 12.0 was used for t test. Results:The scores of the final test in the experimental group and the control group were (86.34±7.36) and (80.77±9.21), respectively, with statistical significance ( P<0.05). For the questions of clinical case analysis, with a total score of 20 points, the scores of the experimental group students (13.31±2.25) were significantly higher than those of the control group (10.58±3.04), with significant difference ( P<0.001). Conclusion:The application of BOPPPS model and "Internet + WeChat" platform in the undergraduate teaching of Clinical Pharmacology could improve students' examination performance, and especially the ability of solving clinical problems comprehensively.

Objective:To investigate the correlation between collateral circulation and infarct pattern and outcome in acute ischemic stroke patients with anterior circulation intracranial atherosclerosis.Methods:Acute ischemic stroke patients with anterior circulation intracranial atherosclerotic severe stenosis or occlusion admitted to the Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College from September 2018 to March 2020 were included prospectively. According to diffusion-weighted imaging, the infarct patterns were divided into perforator pattern, territorial pattern, watershed pattern, and mixed pattern. At 90 d after onset, the modified Rankin Scale was used to evaluate the outcome. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 89 patients were enrolled, 50 (56.2%) had good collateral circulation and 39 (43.8%) had poor collateral circulation. The distribution patterns of infarct: 22 patients (24.7%) were perforator pattern, 26 (29.2%) were territorial pattern, 17 (19.1%) were watershed pattern, and 24 (30.0%) were mixed pattern. The proportion of patients with good collateral circulation was 81.8%, 65.4%, 29.4% and 41.7%, respectively in the perforator pattern group, territorial pattern group, watershed pattern group, and mixed pattern group. Good collateral circulation was more common in the perforator pattern group, and poor collateral circulation was more common in the watershed pattern group. At 90 d after onset, 53 patients (59.6%) had a good outcome and 36 (40.4%) had a poor outcome. The baseline homocysteine level in the good outcome group was significantly lower than that in the poor outcome group (17.91±4.62 μmol/L vs. 20.35±4.67 μmol/L; t=2.436, P=0.017), and the proportion of patients with good collateral circulation was significantly higher than that of patients with poor outcome (73.6% vs. 30.6%; χ2=16.124, P<0.001). Multivariate logistic regression analysis showed that higher homocysteine level was an independent risk factor for poor outcome (odds ratio 1.174, 95% confidence interval 1.061-1.298; P=0.002) and good collateral circulation was an independent protective factor for good outcome (odds ratio 0.095, 95% confidence interval 0.038-0.239; P<0.001). Conclusions:Good collateral circulation was more common in patients with perforator pattern, and poor collateral circulation was more common in patients with watershed pattern. Good collateral circulation was independently associated with the good clinical outcome in acute ischemic stroke patients with anterior circulation intracranial atherosclerosis.

Objective:To investigate the predictive value of dynamic platelet and hemagglutination-related parameters in patients with acute pancreatitis (AP).Methods:The patients admitted to the Department of Emergency Surgery in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2020 were analyzed. According to the inclusion criteria and exclusion criteria, patients with AP were retrospectively enrolled. According to the Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (Shenyang, 2019), the patients were divided into two groups: severe acute pancreatitis (SAP group) and non-severe acute pancreatitis (non-SAP group) [including mild acute pancreatitis (MAP) and moderate severe acute pancreatitis (MSAP)]. A normal distribution of the maximum and mean aggregation rates of dynamic platelets (arachiidonic acid), plateletcrit (PCT) and bedside index for severity in acute pancreatitis (BISAP) scores and other measurement data were tested by t test, while measurement data of prothrombin time (PT), fibrinogen (FIB) and D-dimer that did not conform to normal distribution were tested by Mann-Whitney U test. χ 2 test was used for the counting data such as sex, age and etiology of patients in the two groups. The prognostic value of statistically significant indicators for non-SAP group and SAP group was further analyzed by receiver operating characteristic (ROC) curve. Results:A total of 146 patients with AP were enrolled, including 50 patients in SAP group and 96 in non-SAP group. The maximum and average aggregation rates of dynamic platelet (aracidonic acid) in the SAP group were (71.76±17.62) % and (67.91±18.10) %, PT (12.02±1.33) s, FIB (4.76±2.08) g/L, D-dimer (3.75±6.04) μg/L, PCT (0.23±0.08) %, and BISAP scores (1.42±1.18), which were all significantly higher than those in the non-SAP group [the maximum and average aggregation rates of dynamic platelet (arachiidonic acid) (46.65±20.11) % and (42.50±20.71) %, PT (11.50±1.51) s and FIB (3.91±1.48) g/L, D-dimer (1.00±1.37) μg/L, PCT (0.19±0.06) %, BISAP scores (0.45±0.66)] (all P<0.05). According to area under the ROC curve, the maximum and average aggregation rates of dynamic platelets (arachiidonic acid) in serum of patients with SAP were 0.83 and 0.82, respectively, and the sensitivities were 0.56 and 0.68, respectively. The specificity was 0.99 and 0.81, respectively, which was better than PT, FIB, D-dimer, PCT and BISAP scores in predicting the severity of AP. Conclusions:The maximum and average aggregation rates of dynamic platelets (arachidonic acid), PT, FIB, D-dimer, PCT and BISAP scores can be used as predictors of the severity of acute pancreatitis. The maximum and average aggregation rates of dynamic platelets (arachiidonic acid) were the best in predicting the severity of AP.

Objective:To verify the capability of small intestinal capsule endoscopy with intelligent assistant system based on deep convolutional neural network (DCNN) in the identification and diagnosis of small intestinal bleeding.Methods:A total of 158 235 small intestinal capsule endoscopy images of 1 970 patients were collected from ESView platform (including 3 765 images of 165 patients with small intestinal bleeding) for training of DCNN-based small intestinal capsule endoscopy with intelligent assistant system. In the validation phase, the capability of the system in identification and diagnosis of small intestinal bleeding was verified by images of 100 patients with small intestinal bleeding (10 cases of active bleeding, 31 cases of blood clot and 59 cases of submucosal hemorrhage).Results:Small intestinal bleeding lesions could be identified by the DCNN-based intelligent assistant system, and also could be displayed with mark on the original capsule endoscopy images. This system also could mark multiple bleeding images of the same lesion and multiple different bleeding lesions in the same image. With this system the average reading time of 100 cases of small intestinal bleeding of images the doctors used was (5.23±1.31) minutes per case. The sensitivity of the diagnosis of small intestinal bleeding was 99.00% (95% confidence interval 93.76% to 99.95%).Conclusions:The sensitivity of small intestinal bleeding identification by small intestinal capsule endoscopy with DCNN-based intelligent assistant system is high, which can be used to assist image reading doctors to identify and diagnose of small intestinal bleeding.