Patients with lung cancer experience a heavy symptom burden during the perioperative period, which seriously affects their recovery and quality of life. Traditional symptom management models rely mainly on scheduled ward rounds during hospitalization and outpatient follow-up after discharge. However, they have limitations such as delayed symptom recognition, lack of post-discharge monitoring, and non-quantitative symptom assessment, which often lead to delayed interventions and low patient satisfaction. In recent years, the symptom management model based on electronic patient-reported outcomes (ePRO) has been increasingly valued in clinical practice. Existing high-level evidence from both domestic and international studies indicates that, through proactive monitoring, real-time alerts, and remote interventions, this model enables dynamic and continuous symptom management and helps improve patient recovery and healthcare experience. As a supplement to routine medical care, the ePRO-based symptom management model aims to enhance the quality of care rather than replace existing medical processes. To promote the standardized application of this model in perioperative lung cancer care, this consensus integrates domestic and international evidence. After multiple rounds of voting by more than 50 experts, it formulates 12 consensus statements covering the three core components, symptom monitoring, alerting, and intervention, to provide scientific and practical recommendations for clinical practice.

Objective:To develop an integrated health management system based on wearable devices for conducting health management to discharged patients,so as to improve the lifestyle and medication compliance of patients with cardiovascular and cerebrovascular diseases,and control risk factors of disease,and maintain patients'safety.Methods:The wearable devices,mobile terminals,and hospital's medical information platform were systematically integrated to develop an integrated health management system.A total of 75 patients with cardiovascular and cerebrovascular diseases(coronary heart disease and hypertension)who admitted to the Department of Cardiovascular Medicine of The 940th Hospital of People's Liberation Army Joint Service Support Force during March 1 and April 1,2024 were selected,and they were randomly divided into an intervention group and a control group using the random number table method,with 38 cases in the intervention group and 37 cases in the control group.During the 6 months of intervention observation period after discharge,patients in the intervention group used the integrated health management system for self-health management,while the patients of control group were managed with the conventional mode.The rate of medication compliance,changes of health behaviors,and changes of measurement data of body between the two groups were compared after the intervention.Results:The smoking rate of patients in the intervention group was 18.42%(7/38),which was lower than 43.24%(16/37)of the control group,and the difference was statistically significant(x2=3.94,P<0.05).The average rate of medication compliance of patients in the intervention group was(89.00±2.39)%,which was higher than(84.8±2.37)%of the control group,and the difference was statistically significant(t=2.15,P<0.05).The increase in diastolic blood pressure of patients in the intervention group was(1.76±2.06)mmHg,which was lower than(3.05±1.94)mmHg of the control group,and the difference was statistically significant(t=2.49,P<0.05).Conclusion:The integrated health management system based on wearable devices is effective for the self-management of patients with cardiovascular and cerebrovascular diseases,and it has a good effect in controlling the level of blood pressure,improving behavioral habits,and enhancing medication compliance of patients.

Objective:To investigate the relationship between work fit, work stress, and occupational fatigue among medical staff, and to analyze the independent and interactive effects of work fit and work stress on occupational fatigue.Methods:A stratified random sampling method was employed to select 1162 employees from two top-tier hospitals as the research subjects. A questionnaire survey was conducted to collect information on basic demographics, work stress, work fit, and occupational fatigue. Chi-square test, analysis of variance, and logistic regression equations were used to evaluate the interactive effects of work fit and work stress on occupational fatigue.Results:This study included 1162 medical Homo sapiens personnel, among whom 884 were job-adapted and 362 were in a stressful state. Univariate logistic regression analysis showed that the risk of occupational fatigue significantly increased in the 40-49 age group ( OR=1.89) and the bachelor's degree group ( OR=2.52, P<0.01). Smoking and alcohol consumption were also associated with a significantly higher risk of occupational fatigue ( P<0.01). In terms of occupational characteristics, compared to clinical doctors, nurses and pharmaceutical/technical Homo sapiens personnel had lower risks ( OR=0.57, 0.43, P<0.05). Compared to high-ranking Homo sapiens personnel, those with no title or junior titles exhibited lower risks ( OR=0.51, 0.43, P<0.05). Working hours exceeding 55 hours per week and night shifts 3-4 times per week significantly increased fatigue risk ( OR=1.94, 1.90, P<0.05). Occupational stress and job discomfort were identified as risk factors for occupational fatigue ( OR=11.94, 3.26, P<0.05). Job adaptation and occupational stress exhibited a multiplicative interaction on physical fatigue after adjusting for confounders[ OR (95% CI) =0.43 (0.22, 0.84) ]. Additionally, job adaptation and occupational stress demonstrated an additive interaction on mental fatigue, with RERI (95% CI) =2.64 (0.11, 5.59), API (95% CI) =0.38 (0.08, 0.67), and SI (95% CI) =1.78 (1.01, 3.14). Medical Homo sapiens personnel in a stressful state had a 7.25-fold higher risk of fatigue compared to those not in a stressful state, while those with job discomfort had a 2.01-fold higher risk compared to those in an adapted state. Conclusion:Occupational stress and job fit have interactive effects on physical fatigue and mental fatigue in medical Homo sapiens personnel. A stressful state combined with job discomfort increases the risk of fatigue occurrence, providing a basis for developing intervention strategies for occupational fatigue among medical Homo sapiens personnel.

[Purpose]To analyze the results of upper gastrointestinal cancer screening in rural areas of Lhasa from 2015 to 2019.[Methods]Upper gastrointestinal cancer screening program was conducted among residents aged 40～69 years old from 3 rural project sites in Lhasa selected by cluster sampling method from 2015 to 2019.The detected malignant tumors and precancerous le-sions were treated and confirmed by pathological examination.The detection rate of esophagus and stomach cancer were calculated by region,sex and age and compared by x2 test.[Results]A total of 1 399 people underwent gastroscopy,among whom 1 288 completed pathological biopsy(92.07％).Three cases of esophageal cancer were detected with a detection rate of 0.21％(3/1 399),all of which were advanced squamous cell carcinoma.Eight cases of gastric cancer were detected with a detection rate of 0.57％(8/1 399),and 2 cases were early gastric cancer.The detection rate of low-grade and high-grade epithelial neoplasia of gastric mucosa was 0.64％(9/1 399)and 0.21％(3/1 399),respectively.There was no significant difference in the detection rate among different regions,sexes and age groups(all P＞0.05).[Conclusion]The detection rate of upper gastrointesti-nal cancer in screening population in Lhasa is lower than the national average level.Men and the elderly are important target populations for upper gastrointestinal cancer screening,and increasing participation rates is necessary for more effective screening outcomes.

Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Background and aims:Studies indicate that the gut microbiota and its metabolites are involved in the progression of cardiovascular diseases,and enterohepatic circulation plays an important role in this progression.This study aims to identify potential probiotics for the treatment of unstable angina(UA)and elucidate their mechanisms of action.Methods:Initially,the gut microbiota from patients with UA and control was analyzed.To directly assess the effects of Bifidobacterium supplementation,10 patients with UA were enrolled and administered Bifidobacterium(630 mg per intake twice a day for 1 month).The fecal metagenome,serum trimethyl-amine N-oxide(TMAO)levels,and other laboratory parameters were evaluated before and after Bifido-bacterium supplementation.Results:After supplementing with Bifidobacterium for 1 month,there were statistically significant dif-ferences(P＜0.05)in TMAO,aspartate aminotransferase,total cholesterol,and low-density lipoprotein compared to before.Additionally,the abundance of Bifidobacterium longum increased significantly,although the overall abundance of Bifidobacterium did not reach statistical significance.The gut micro-biota,metabolites,and gut-liver axis are involved in the progression of UA,and potential mechanisms should be further studied.Conclusions:Metagenomic analysis demonstrated a reduced abundance of Bifidobacterium in patients with UA.Supplementation with Bifidobacterium restored gut dysbiosis and decreased circulating TMAO levels in patients with UA.This study provides evidence that Bifidobacterium may exert cardiovascular-protective effects through the gut-liver-heart axis.

Lactate dehydrogenase A(LDHA)is an important enzyme involved in the anaerobic glycolysis of cells,catalyzing the conversion of pyruvate to lactate and participating in processes such as tumor proliferation,mi-gration,invasion,and the regulation of the tumor microenvironment.High expression levels of LDHA are often in-dicative of disease progression and poor prognosis in malignant hematological diseases.The expression of LDHA in malignant hematological diseases is closely associated with various molecules,including HIF-1,microRNAs and c-Myc,as well as signaling pathways like PI3K/AKT/GSK3,USP1/PLK1/LDHA and Fbw7/LDHA/lactate/miR-223.Meanwhile,the progression of malignant hematological conditions facilitated by LDHA primarily occurs through the regulation of energy metabolism via glycolytic pathways.

Objective To explore the perioperative therapeutic effects and follow-up manage-ment in 16 patients with left ventricular assist device(LVAD)implantation.Methods A retrospec-tive analysis was conducted in data of 16 patients who underwent LVAD implantation in the depart-ment of cardiovascular surgery.Data of 6-minute walk test(6MWT),European Quality of Life-5 Di-mension-5 Levels(EQ-5D-5L),New York Heart Association(NYHA)classification,echocardio-graphy,chest radiography,cardiothoracic ratio,and occurrence of complications(infection,bleed-ing,thrombosis,right heart failure,neurological issues)were collected via the electronic medical re-cord system before surgery and at 30,60,and 90 days postoperatively.Results All patients sur-vived with the pump at 90 days postoperatively.One patient with preoperative renal insufficiency un-derwent dialysis and received a heart transplant after 8 months.One patient developed a sterile granu-loma at the percutaneous lead site on the abdominal wall,which improved after treatment,no complica-tions occurred in other patients.At 90 days postoperatively,there was no statistically significant differ-ence in the right ventricular area change fraction and tricuspid annular plane systolic excursion com-pared with preoperative values(P＞0.05).The left ventricular ejection fraction,left ventricular end-diastolic diameter,and cardiothoracic ratio showed significant improvement compared with preoperative levels(P＜0.05).At 30 days postoperatively,30％of patients recovered to NYHA class Ⅰ and 70％to class Ⅱ;at 60 days,80％of patients to class Ⅰ and 20％to class Ⅱ;at 90 days,90％to classⅠ and 10％to class Ⅱ.The 6MWT and EQ-5D-5L scores of patients significantly increased within 90 days postoperatively(P＜0.01).Conclusion Through rigorous preoperative assessment by a multidisciplinary LVAD team,refinement of surgical techniques,and comprehensive management during hospitalization,self-management before discharge,daily follow-up after discharge,and fol-low-up management upon returning to the hospital for patients with LVAD implantation,the cardiac function and quality of life of patients are significantly improved at 90 days postoperatively.

Objective:Human papilloma virus(HPV)E6/E7mRNA in situ hybridization detection technology was used to explore whether high-grade squamous intraepithelial lesion(HSIL)of cervix with negative high-risk human papilloma virus(HR-HPV)typing test was caused by HPV infection,so as to provide new insights for the accurate diagnosis and treatment of cervical HSIL.Methods:305 tissue samples were collected from patients with HSIL who underwent cervical biopsy or surgical treatment in the Department of Gynecology,Affiliated Hospital of Shandong Second Medical University,from January 2020 to October2022.Patients with negative HR-HPV genoty-ping results(15 cases)were assigned to the study group,while those with positive results(290 cases)served as the control group.RNAscope in situ hybridization was used to detect the expression of HPV E6/E7 mRNA in the two groups,and the expression of HPV E6/E7 mRNA was analyzed by semi-quantitative scoring of staining inten-sity.Immunohistochemistry(IHC)was used to detect the expression of p16 and Ki-67.Results:①Among 305 pa-tients with HSIL,15 patients had negative HR-HPV typing test,with an incidence of 4.9％(15/305).②73.3％(11/15)of the study group showed positive expression of HPV E6/E7 mRNA,which was statistically significant compared with 100.0％(290/290)of the control group(P＜0.001).③The positive expression rate of p16 in the study group was significantly lower than that in the control group(93.3％vs.100.0％,P=0.049),while there was no significant difference in the positive expression rate of Ki-67 between the two groups(100.0％vs.100.0％).④In the samples with histopathological type cervical intraepithelial neoplasia(CIN)2,the overall score of HPV E6/E7 mRNA in the study group was significantly lower than that in the control group,which was statistically significant(P=0.004).In CIN3 samples,although the overall score of HPV E6/E7 mRNA in the study group was lower than that in the control group,there was no statistically significant difference(P=0.158).Conclusions:4.9％of pa-tients with HSIL in cervical cancer screening may be missed or misdiagnosed due to negative HR-HPV typing test.HPV E6/E7 mRNA in situ hybridization detection technology was helpful to reduce the false negative rate of HR-HPV typing test in HSIL,and it may assist in predicting the progression of cervical lesions,so as to provide a new idea for individualized precise treatment.

BACKGROUND:D1-3-n-butylphthalide has antioxidant and anti-inflammatory effects and has been explored to have protective role in Parkinson's disease,but the underlying mechanisms are unknown.OBJECTIVE:To investigate the protective effect of D1-3-n-butylphthalide by the approach of network pharmacology,molecular docking,and cellular experimental validation.METHODS:(1)Network pharmacology and molecular docking:The database was used to screen the targets of D1-3-n-butylphthalide and Parkinson's disease.The intersection was taken from the construction of the target protein interaction network,and then screen the core targets.The GO and KEGG pathway enrichment was used to further analyze the core targets.The interaction between the target proteins and D1-3-n-butylphthalide was verified by molecular docking.(2)Cell validation:The passage 6 PC12 cells were divided into six groups for culture.The control group was cultured with conventional culture medium.The model group was cultured with N-methyl-4-phenylpyridinium iodide to induce Parkinson's disease model.The ML385 inhibitor group was added with nuclear factor E2-related factor 2 inhibitor ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide treatment group was added with butylphthalide on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide combined with ML385 treatment group was added with D1-3-n-butylphthalide and ML385 on the basis of inducing Parkinson's disease model.The D1-3-n-butylphthalide group was cultured with conventional culture medium containing butylphthalide alone.Cell proliferation,intracellular reduced glutathione and malondialdehyde levels,and protein expression of protein kinase B/glycogen synthase kinase 3β/nuclear factor E2-related factor 2(AKT/GSK-3β/Nrf2)signaling pathway were detected.RESULTS AND CONCLUSION:(1)A total of 52 targets were screened for the intersection of drugs and disease targets,and the core targets including the matrix metalloproteinase 9 and GSK-3β were involved the phosphatidylinositol 3-kinase(PI3K)/AKT and oxidative stress-related signaling pathways.The molecular docking binding energy of D1-3-n-butylphthalide and GSK-3β was-18.27 kJ/mol,which indicated that D1-3-n-butylphthalide had a good binding ability with GSK-3β.(2)Compared with the model group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide treatment group were increased(P＜0.05),the malondialdehyde level was decreased(P＜0.05),and the expression of p-AKT,p-GSK-3β,Nu-Nrf2,and T-Nrf2 proteins was increased(P＜0.05).Compared with the D1-3-n-butylphthalide group,the PC12 cell activity and reduced glutathione level in the D1-3-n-butylphthalide combined with ML385 treatment group were decreased(P＜0.05),the malondialdehyde level was increased(P＜0.05),and the expression of Nu-Nrf2 and T-Nrf2 proteins was decreased(P＜0.05).(3)These results demonstrate that D1-3-n-butylphthalide can inhibit oxidative stress and improve cell activity through the AKT/GSK-3β/Nrf2 signaling pathway,and has a protective effect on the Parkinson's cell model induced by N-methyl-4-phenylpyridinium iodide.