Objective: To explore the effect of tumor cell perineural invasion on the prognosis of cervical cancer and the early predictive factors of perineural invasion in patients with cervical cancer. Methods: A retrospective a⁃ nalysis was conducted on the clinical , pathological , and survival data of 551 patients with cervical cancer. These patients were categorized into a survival group (n = 477) and a death group (n = 74) . The baseline characteristics of the two groups were compared using independent samples t ⁃tests , Wilcoxon rank⁃sum tests , and chi⁃square tests.Multivariate binary Logistic stepwise regression analysis was employed to identify independent risk factors associated with mortality. In addition , univariate Logistic regression analysis was performed to determine predictive factors for perineural invasion. A predictive model for perineural invasion in cervical cancer was subsequently developed based on the multivariate regression equation , and its predictive accuracy was assessed using the ROC curve. Results: In the basic data of cervical cancer patients , the high level of perineural invasion , lymphatic metastasis and postopera⁃tive pathological stage in pathological data had an impact on the poor prognosis of patients ( P < 0 . 0 5 ) , Lympho⁃vascular space invasion , parametrial involvement , and tumor invasion depth ≥ 1/2 were identified as significant predictors of PNI. The predictive value was the best in the multivariate model ( Area under the curve = 0. 80) . Conclusion Perineural invasion is an independent risk factor for poor prognosis of cervical cancer patients , and the occurrence of perineural invasion can be effectively predicted by the constructed multivariate mode.

Objective:To explore the pain sensations and experiences of patients with post-stroke hemiplegic shoulder pain, and to provide reference for the formulation of intervention plans.Methods:Objective sampling method was used to conduct semi-structured interviews on 15 patients with post-stroke hemiplegic shoulder pain in the department of neurology and rehabilitation department of Wuhan No.1 Hospital from January to March 2024. The interview outline was established based on the information-knowledge-attitude-practice (IKAP) theory, and the data were analyzed, summarized and extracted by Colaizzi 7-step analysis method.Results:According to the four core components of the IKAP theory, ten themes were extracted. The information and knowledge included the neglect of the importance of early management for hemiplegic shoulder pain, the lack of understanding of the relevant knowledge about hemiplegic shoulder pain, and the use of restricted or incorrect attribution methods in relation to hemiplegic shoulder pain. The attitude included a perception of pain as uncontrollable, the suppression of pain expression, the concern regarding the persistent presence of pain, and the experience of negative emotions. The practice included the adverse effects stemming from hemiplegic shoulder pain, the strategies employed to cope with hemiplegic shoulder pain, and the expectation of multifaceted social support.Conclusions:Patients with post-stroke hemiplegic shoulder pain bear many burdens and have needs in terms of pain experiences. Healthcare professionals need to strengthen pain health education and guidance, help patients develop correct pain cognition and beliefs, refine the pain management system, assist patients in establishing a diverse social support system, enhance their pain coping abilities, and comprehensively promote the rehabilitation of the disease.

Objective:To explore the pain sensations and experiences of patients with post-stroke hemiplegic shoulder pain, and to provide reference for the formulation of intervention plans.Methods:Objective sampling method was used to conduct semi-structured interviews on 15 patients with post-stroke hemiplegic shoulder pain in the department of neurology and rehabilitation department of Wuhan No.1 Hospital from January to March 2024. The interview outline was established based on the information-knowledge-attitude-practice (IKAP) theory, and the data were analyzed, summarized and extracted by Colaizzi 7-step analysis method.Results:According to the four core components of the IKAP theory, ten themes were extracted. The information and knowledge included the neglect of the importance of early management for hemiplegic shoulder pain, the lack of understanding of the relevant knowledge about hemiplegic shoulder pain, and the use of restricted or incorrect attribution methods in relation to hemiplegic shoulder pain. The attitude included a perception of pain as uncontrollable, the suppression of pain expression, the concern regarding the persistent presence of pain, and the experience of negative emotions. The practice included the adverse effects stemming from hemiplegic shoulder pain, the strategies employed to cope with hemiplegic shoulder pain, and the expectation of multifaceted social support.Conclusions:Patients with post-stroke hemiplegic shoulder pain bear many burdens and have needs in terms of pain experiences. Healthcare professionals need to strengthen pain health education and guidance, help patients develop correct pain cognition and beliefs, refine the pain management system, assist patients in establishing a diverse social support system, enhance their pain coping abilities, and comprehensively promote the rehabilitation of the disease.

Objective:To explore the efficacy and safety of camrelizumab combined with apatinib as the second-line treatment for patients with advanced gastric cancer.Methods:The clinical data of 19 patients with advanced gastric cancer in Hebei General Hospital from August 2019 to March 2022 were retrospectively analyzed. All patients received camrelizumab combined with apatinib as the second-line treatment. The treatment efficacy and adverse reactions were evaluated; the survival analysis was performed using Kaplan-Meier method; Cox proportional hazards model was used to analyze the influencing factors for overall survival (OS) of patients.Results:Among 19 patients, no one achieved complete remission, 4 patients (21.1%) achieved partial remission, 9 patients (47.4%) had stable disease. The objective response rate (ORR) and disease control rate (DCR) were 21.1% (4/19) and 68.4% (13/19), respectively. The ORR of patients with deficient mismatch repair (dMMR) was higher than that of patients with proficient mismatch repair (pMMR) [100.0% (2/2) vs. 11.8% (2/17), P < 0.05], and patients with programmed death receptor ligand 1 (PD-L1) combined positive score (CPS) ≥1 had a higher DCR than patients with PD-L1 CPS < 1 [100.0% (5/5) vs. 25.0% (1/4), P < 0.05]. The median follow-up time of 19 patients was 14.7 months (12.0-17.4 months), the median progression-free survival time and OS time were 2.8 months and 5.7 months (95% CI 2.4-8.9 months). Increased lactate dehydrogenase (LDH) was negatively correlated with OS ( χ2 = 10.262, P = 0.001). Multivariate Cox regression analysis showed that LDH was an independent influencing factor for the OS of patients (<250 U/L vs. ≥250 U/L: HR = 0.149, 95% CI 0.039-0.657, P = 0.005). The most common treatment-related adverse reactions were fatigue (52.6%, 10 cases), anemia (47.4%, 9 cases), thrombocytopenia (36.8%, 7 cases), rash (36.8%, 7 cases), and reactive capillary hemangioma (36.8%, 7 cases). Conclusions:Camrelizumab combined with apatinib as the second-line treatment for advanced gastric cancer have good efficacy and safety.

Objective:To establish the normal reference value of lumbar bone mineral density (BMD) under quantitative CT (QCT) in Chinese healthy adult females and to explore the regional differences.Methods:Total of 35 431 healthy women who met the inclusion criteria of Chinese health quantitative CT big data program were selected in this study. The BMD of the central plane of L 1 and L 2 vertebrae was measured by Mindways′s QCT system, and the mean value was taken. One-way analysis of variance was used to compare the BMD differences of lumbar vertebrae in women of different ages and regions. The subjects were grouped by an age interval of 10 years, and the level of BMD in different regions of the same age group were compaired. Results:The peak BMD of Chinese healthy adult women appeared in the age group of 20-29 years (Northeast China(183.01±24.58) mg/cm 3, North China (188.93±24.80) mg/cm 3, East China (187.54±27.71) mg/cm 3, South China (186.22±33.72) mg/cm 3, Central China (176.33±24.91) mg/cm 3, Southwest China(182.25±28.00) mg/cm 3), and then it decreased with age. The level of BMD in different regions decreased with the age. Before the age of 70 years, BMD in Central and Southwest China was always at a low level((176.23±24.91) to (90.38±28.12) mg/cm 3, 182.25±28.00 to (88.55±25.68) mg/cm 3), lower than those in Northeast China ((183.01±24.58) to (99.69±27.85) mg/cm 3), North China ((188.93±24.80) to (95.89±26.12) mg/cm 3), East China ((187.54±27.71) to (95.65±27.86) mg/cm 3). After 70 years of age, BMD tended to be the same in different regions ( P>0.05). The BMD values in Central China and Southwest China were similar in the age group of 40-60 years ( P>0.05). The BMD values in the health adult femles in the age group of 60 years in different regions of Chinawere all lower than those of bone mass abnormality (all P<0.05). The detection rate of osteoporosis in females over 50 years was the highest in Southwest China (25.65%) and it was the lowest in North China (17.30%). Conclusions:This study establishes reference values of BMD under QCT in healthy Chinese women, which can be used as a reference basis for identifying women with low BMD who are at risk of osteoporosis. The BMD value is the lowest in Southwest China and the highest in South China.

Objective:To explore the application value of situational bilingual teaching in standardized residency training of gynecology.Methods:The study enrolled 64 gynecological residents of Guangzhou Women and Children's Medical Center, and they were randomized into experimental group and control group, with 32 residents in each group. The control group was taught by the traditional teaching method, using self-compiled teaching materials of our hospital. The experimental group was taught by the situational bilingual teaching mode, and the teaching materials were the same as those of the control group. The training time of the two groups was two months. After teaching, the training effect was evaluated through examination and satisfaction survey. SPSS 22.0 software was used for t test and chi-square test. Results:After training, the scores of theoretical knowledge, operation skills and case analysis in the experimental group were significantly higher than those before training and after training in the control group ( P<0.05). The learning interest, autonomous learning ability, theoretical knowledge mastery, clinical thinking ability and communication ability of the experimental group were significantly better than those of the control group ( P<0.05). The number of residents who were very satisfied with the training was significantly higher than that of the control group, and that of residents who were basically satisfied with the training were less than that of the control group ( P<0.05). Conclusion:The application of situational bilingual teaching in the standardized residency training of gynecology has good teaching effects, which can significantly improve the theoretical performance, clinical operation ability and case analysis ability of the training residents, and also improve the satisfaction of the training residents.

Objective:To compare clinical features of patients with pyogenic liver abscesses with and without septated lobulations.Methods:Patients diagnosed to have pyogenic liver abscesses who were treated in our hospital from January 2011 to March 2021 were enrolled into this retrospective study. There were 203 males and 132 females, with age of (56±14) years old. The patients were divided into two groups by findings on computed tomography and ultrasound into the septated lobulation group ( n=68) and the non-septated lobulation group ( n=267). The clinical data of these patients were compared. Results:In the septated lobulation group, the neutrophil count was 9.17(5.97, 12.33)×10 9/L and the TBil was 17.65(11.92, 27.84) μmol/L. These were significantly higher than the corresponding figures of 7.81(5.42, 10.81)×10 9/L, 12.90(9.00, 19.68) μmol/L, respectively in the non-septated lobulation group ( P<0.05). The difference in the maximum diameters of the septated lobulation group was also significantly larger than the non-septated lobulation group ( P=0.032). Additionally, pus culture showed the proportion of Klebsiella pneumoniae positive patients in the septated lobulation group was significantly higher than that in the non-septated lobulation group [41.18% (28/68) vs. 25.84% (69/267), P=0.013]. The use of fluoroquinolones in patients in the septated lobulation group was higher than that in the non-septated lobulation group [20.59% (14/68) vs. 10.11% (27/267), χ 2=5.54, P=0.019]. Conclusion:Compared to patients without septated lobulations, those with septated lobulations had a larger diameter of abscesses, a higher positive rate of Klebsiella pneumoniae on pus culture and a higher proportion of patients receiving fluoroquinolones.

Mucosal vaccines can effectively induce an immune response at the mucosal site and form the first line of defense against microbial invasion. The induced mucosal immunity includes the proliferation of effector T cells and the production of IgG and IgA antibodies, thereby effectively blocking microbial infection and transmission. However, after a long period of development, the transformation of mucosal vaccines into clinical use is still relatively slow. To date, fewer than ten mucosal vaccines have been approved. Only seven mucosal vaccines against coronavirus disease 2019 (COVID-19) are under investigation in clinical trials. A representative vaccine is the adenovirus type-5 vectored COVID-19 vaccine (Ad5-nCoV) developed by Chen and coworkers, which is currently in phase III clinical trials. The reason for the limited progress of mucosal vaccines may be the complicated mucosal barriers. Therefore, this review summarizes the characteristics of mucosal barriers and highlights strategies to overcome these barriers for effective mucosal vaccine delivery.

Objective:Based on the policy goals of family doctors′ contracted services, to build an indicator system as policy tools for policy outcomes assessment and policy delivery optimization.Methods:Through literature and policy review, an evaluation conceptual framework was built based on policy goals of family doctors′ contracted services, and an indicator system was established using Delphi method.Results:Upon consultation of 21 experts, an indicator system for policy effect assessment of the family doctors′ contracted services was established, covering both policy implementations and goal effects. This system consisted of 7 level-2 indicators and 23 level-3 indicators.Conclusions:The indicator system oriented to policy goals, ensures the pertinence of policy effect assessment to play a strong guidance on practical implementation of the family doctors′ contracted services.

Objective:To analyze the policy implementation of family doctors′ contracted services in different regions based on practices in typical regions.Methods:From April to October 2019, we conducted field investigations in 14 regions, collected data on policy formulation and implementation, organizational form and service content of contracting service, incentive mechanism and capacity development. By means of key persons′ interview, we tried to understand the background of district/county policy implementation, as well as policy delivery and existing difficulties. The measurement data were expressed by means, and the qualitative data were used to extract the key content through semantic analysis.Results:The policy of family doctors′ contracted services had been promoted from pilot exploration to normative development. 71.0% of responsible entities of the contracted services in research regions were family doctor teams. Contraction fee has begun to reflect the value of family doctors′ work, while the average contracted service fees in the eastern, central and western regions were 125, 31.25 and 42.5 yuan/person/year respectively. Comprehensive incentives and health insurance policies in some regions played a role in promoting contracted services.Conclusions:It is necessary to establish the family doctors′ " three roles" management concept, namely health gatekeeper, rights exchanger and resource coordinator; strengthen the professional training and capacity promoting of family doctors, implement the connotation of contracted service fees and economic incentives, in order to play the policy′s basic role in constructing a health-centered system.