Objective To explore the clinical value of artificial intelligence (AI) quantitative parameters in distinguishing pathological grades of stageⅠ invasive adenocarcinoma (IAC). Methods Clinical data of patients with clinical stageⅠ IAC admitted to Yantaishan Hospital Affiliated to Binzhou Medical University from October 2018 to May 2023 were retrospectively analyzed. Based on the 2021 WHO pathological grading criteria for lung adenocarcinoma, IAC was divided into gradeⅠ, grade Ⅱ, and grade Ⅲ. The differences in parameters among the groups were compared, and logistic regression analysis was used to evaluate the predictive efficacy of AI quantitative parameters for grade Ⅲ IAC patients. Parameters were screened using least absolute shrinkage and selection operator (LASSO) regression analysis. Three machine learning models were constructed based on these parameters to predict grade Ⅲ IAC and were internally validated to assess their efficacy. Nomograms were used for visualization. Results A total of 261 IAC patients were included, including 101 males and 160 females, with an average age of 27-88 (61.96±9.17) years. Six patients had dual primary lesions, and different lesions from the same patient were analyzed as independent samples. There were 48 patients of gradeⅠ IAC, 89 patients of grade Ⅱ IAC, and 130 patients of grade Ⅲ IAC. There were statitical differences in the AI quantitive parameters such as consolidation/tumor ratio (CTR), ect among the three goups. (P<0.05). Univariate analysis showed that the differences in all variables except age were statistically significant (P<0.05) between the group gradeⅠ+grade Ⅱand the group grade Ⅲ . Multivariate analysis suggested that CTR and CT standard deviation were independent risk factors for identifying grade Ⅲ IAC, and the two were negatively correlated. Grade Ⅲ IAC exhibited advanced TNM staging, more pathological high-risk factors, higher lymph node metastasis rate, and higher proportion of advanced structure. CTR was positively correlated with the proportion of advanced structures in all patients. This correlation was also observed in grade Ⅲ but not in gradeⅠand grade ⅡIAC. CTR and CT median value were selected by using LASSO regression. Logistic regression, random forest, and XGBoost models were constructed and validated, among which, the XGBoost model demonstrated the best predictive performance. Conclusion Cautious consideration should be given to grade Ⅲ IAC when CTR is higher than 39.48% and CT standard deviation is less than 122.75 HU. The XGBoost model based on combined CTR and CT median value has good predictive efficacy for grade Ⅲ IAC, aiding clinicians in making personalized clinical decisions.

Mesenchymal stem cells(MSCs)have become a key focus in the development of cell-based therapeutic products due to their wide availability,lack of ethical constraints,and potential for immune privileges.However,the transition from basic MSC transplantation techniques to fully devel-oped therapeutic drugs presents numerous challenges given the current regulatory framework in China and from the perspective of drug development and review.This article summarizes the problems faced in this transition,particularly the challenges posed by theheterogeneity of MSC sources,the complexity of unique manufacturing processes,and the complexities of quality characterization.The article also offers suggestions and countermeasures in the hopes of advancing the research,development,and registration of MSC-based therapeutic products.

Mesenchymal stem cells(MSCs)have become a key focus in the development of cell-based therapeutic products due to their wide availability,lack of ethical constraints,and potential for immune privileges.However,the transition from basic MSC transplantation techniques to fully devel-oped therapeutic drugs presents numerous challenges given the current regulatory framework in China and from the perspective of drug development and review.This article summarizes the problems faced in this transition,particularly the challenges posed by theheterogeneity of MSC sources,the complexity of unique manufacturing processes,and the complexities of quality characterization.The article also offers suggestions and countermeasures in the hopes of advancing the research,development,and registration of MSC-based therapeutic products.

Objective The study aimed to elucidate the evolution of the syndromes in Traditional Chinese Medicine(TCM)and TCM syndrome elements in different chronic stages of psoriasis vulgaris.Methods A database was constructed using electronic medical records collected from July 2019 to March 2024 from 1,049 patients with psoriasis vulgaris.The study used Sankey diagrams and network association graphs to analyze the evolution of TCM syndromes and their elements in patients at the different stages:initial diagnosis,progressive stage(Week 2-3),progressive stage(Week 4-5),skin lesion improvement stage(Week 6-7),and remission stage.The syndrome elements network was constructed using community detection algorithms,and the association rules between local skin lesion syndrome differentiation and overall syndrome differentiation were displayed using heatmaps.Results(ⅰ)Initial diagnosis.In the syndrome differentiation of local skin lesions,blood heat syndrome was the most common(79.79％);among the disease location of TCM syndrome elements(called"disease location"),liver was the most prevalent(35.62％);and among the pathological factors of TCM syndrome elements(called"pathological factors"),fire(heat)was the most common(75.48％).(ⅱ)Active stage(Week 2-3).In the syndrome differentiation of local skin lesions,blood heat syndrome remained the most prevalent(73.13％);among the disease location,liver was still the most prevalent(31.71％);and among the pathological factors,fire(heat)continued to be the most common(82.11％),while dampness(22.26％)and qi stagnation(8.39％)began to increase.(ⅲ)Active stage(Week 4-5).The syndrome differentiation of local skin lesions was dominated by blood heat syndrome(45.91％)and blood dryness syndrome(37.19％);among disease location,the interior was the most prevalent(15.25％);and among the pathological factors,fire(heat)remained the most common(50.66％),with an increase in yin deficiency(34.26％).(ⅳ)Skin lesion improvement stage(Week 6-7).In the syndrome differentiation of local skin lesions,both blood dryness syndrome(49.44％)and blood stasis syndrome(33.33％)increased;among the disease location,meridians increased most significantly and became the most prevalent(13.44％);and among the pathological factors,blood stasis increased most significantly and became the most prevalent(28.20％).(ⅴ)Remission stage.In the syndrome differentiation of local skin lesions,blood stasis syndrome became the primary(55.69％),while the percentage of blood dryness syndrome decreased(21.16％);meridians(25.71％)and blood stasis(62.34％)remained the most predominant syndrome elements related to disease location or pathological factors.Conclusion The overall pattern of TCM syndromes in psoriasis vulgaris evolved from excess to deficiency.From the initial diagnosis to the active phase(Week 2-3),heat syndrome dominated;during the active phase(Week 4-5),heat syndrome coexisted with damp syndrome or yin deficiency syndrome;changes in the syndrome element network were the most significant during the lesion improvement phase,with blood stasis gradually increasing and peaking during the remission phase.Blood stasis,dampness,and qi stagnation were pervasive throughout psoriasis vulgaris;qi stagnation and blood stasis may be the main elements causing further deterioration and prolonged course of the disease during the active phase in patients.

Objective:The aim was to explore the needs of patients readmitted with chronic heart failure (CHF) for pre-discharge preparation services and to provide reliable evidence to support the development of a discharge preparation service plan.Methods:The research was based on the phenomenology research method. Using a purposive sampling method, 12 readmitted patients with CHF from the First Hospital of Heilongjiang University of Traditional Chinese Medicine were selected and interviewed in a semi-structured manner between February and April 2023, and the data were analyzed using the Colaizzi seven-step analysis.Results:Among 12 patients, 6 males, 6 females, aged 53 to 85 years old. The discharge preparation service needs of readmitted patients with CHF can be categorised into 3 major themes of physiological-psychological-social, containing 6 sub-themes: the need to improve self-management skills, the need for rehabilitation and exercise, the need for improvement of negative emotions, the need for improvement of health education, the need for improvement of home care, and the need for health resource services.Conclusions:Patients readmitted with CHF have greater needs for self-management knowledge and skills, family care needs, professional guidance needs, and information on referral services from primary health resources, and nursing staff should focus on assessing such needs of patients in order to develop individualized plans for discharge preparation services for patients with CHF.

ObjectiveTo observe the effect of Banxia Xiexintang on the autophagy of interstitial cells of Cajal （ICCs） in the gastric antrum of rats with gastric electric dysrhythmia， and explore the protective effect and regulatory mechanism. MethodThirty-two SD rats were randomly assigned into a normal group， a model group， a Banxia Xiexintang （24.68 g·kg^-1） group， and a positive drug （2.7 mg·kg^-1） group. The rat model of gastric electric dysrhythmia was established by the method of dieting every other day and drinking dilute hydrochloric acid， and Banxia Xiexintang and the positive drug were administrated for intervention. The body weight of each rat was recorded weekly. The gastric electric activity was recorded by the biological function experimental system. The ultrastructural changes of the gastric antrum tissue were observed by a transmission electron microscope. The co-expression of receptor tyrosine kinase （c-kit）/mammalian homolog of yeast Atg6 （Beclin1） in the gastric antrum tissue was detected by double immunofluorescence labeling method. The expression of microtubule-associated protein 1 light chain 3B （LC3B） and p62 protein in the gastric antrum tissue was determined by Western blot， and the LC3BⅡ/Ⅰ ratio was calculated. ResultCompared with the normal group， the modeling reduced the body weight （P<0.01） and decreased the dominant frequency and dominant power of gastric electricity （P<0.01）. In addition， the modeling caused ultrastructural damage of ICCs in gastric antrum， degeneration and necrosis of organelles， and appearance of a small number of autophagic vesicles. The results of double immunofluorescence labeling showed that the modeling inhibited the positive expression of c-kit and promoted the positive expression of Beclin1 in gastric antrum tissue. Western blot results showed that the modeling increased the ratio of LC3BⅡ/Ⅰ （P<0.01） and down-regulated the expression of p62 protein （P<0.01） in the gastric antrum tissue. Compared with the model group， Banxia Xiexintang and the positive drug increased the body weight （P<0.01） and the dominant frequency and dominant power of gastric electricity （P<0.01）， repaired the ultrastructural damage of ICCs in gastric antrum tissue， promoted the positive expression of c-kit and inhibited the positive expression of Beclin1 in the gastric antrum tissue. Furthermore， Banxia Xiexintang up-regulated the expression of p62 （P<0.05） and inhibited the transformation of LC3BⅠ into LC3BⅡ in gastric antrum tissue （P<0.05）. ConclusionBy regulating the expression of autophagy-related proteins， Banxia Xiexintang can reduce the autophagy and regulate the number and structure of ICCs and thus improve the gastric electric rhythm of rats， which preliminarily explains the mechanism of Banxia Xiexintang in the treatment of epigastric stuffiness.

Objective:To retrieve and analyze the evidence related to perioperative blood glucose management in patients with coronary heart disease (CHD) complicated by diabetes undergoing percutaneous coronary intervention (PCI) , and provide clinical guidance for glucose management.Methods:Systematic searches were conducted on domestic and international guideline websites, evidence-based databases, primary research databases, and related association websites for evidence concerning perioperative blood glucose management for this patient group. The search included clinical decisions, guidelines, expert consensus, evidence summaries, and systematic reviews, covering the time span from database inception to February 2022. Two evidence-trained researchers independently conducted literature quality assessments and evidence extraction, with disputes resolved by a third party.Results:Eighteen articles were included: one clinical decision, nine guidelines, and eight expert consensuses. The findings were summarized into eight aspects: team formation and training, admission assessment and treatment, blood glucose control targets, preoperative glucose management, intraoperative glucose management, postoperative glucose management, perioperative abnormal glucose management, and discharge management, totaling 35 evidence points.Conclusions:This study consolidates evidence related to perioperative blood glucose management for patients with CHD complicated by diabetes undergoing PCI. However, during the evidence translation and application process, conditions of the application site, medical resources, and patient preferences should be fully considered. After assessing the feasibility and applicability of the evidence, a personalized blood glucose management plan should be developed for the patient, aiming to improve blood glucose levels and prognosis.

Objective To probe into the gaps between the inpatient care needs at public tertiary hospitals and existing nursing services,for measures to improve the quality of nursing service.Methods The simple clinical score(SCS),Barthel index scale,patient care needs questionnaire,and actual service status questionnaire were used in a multi-centered stratified random sampling survey, covering the adult inpatient wards of 72 departments at six tertiary hospitals.The results were subject to a stratified analysis of patient care needs, and a comparative analysis between patient care needs and the actual status of the service.Results Statistically significant differences were found between the nursing needs of patients from among different departments,self-care abilities and those with different conditions(P<0.05); the patient care needs and actual service status in cleaning, eating, excretion, activities, health education, basic treatment and nursing of traditional Chinese medicine in terms of the differences were statistically significant (P<0.05); the comparative analysis found differences between patient care needs and actual service status.The top five patient care needs which were greater than the actual service status were namely temperature measuring,rehabilitation guidance,routine inspection,observation and psychological care.The top five areas with actual service status greater than patient care needs were namely turnover /back flapping, toilet assistance,temperature measuring,hands washing before and after meals,and herbal fumigation.The top five areas with minimal gap between needs and service were namely oral care, moxibustion, perineal care,assistance in using toilet in bed and manicure.Conclusions Departments, self-care abilities and conditions of patients vary with their needs of nursing.Based on the existing problems between patient care needs and the actual service status,nurses should increase their care in such soft indicators as rehabilitation guidance,routine inspection and disease observation, and fully meet the needs of patients.On the other hand,they are expected to enhance patients′health education and health literacy in such hard indicators as temperature measuring,turnover and back flapping.

Sphingosine 1-phosphate (S1P) is one of the crucial signal molecules, which can regulate many biological functions inside and outside cells. It plays an important role in regulating numerous physiological and pathological processes after being combined with S1P receptors (S1PRs). S1P/S1PRs signaling pathways have become a hot spot in the current research on endothelial inflammation and atherosclerosis. This review described the current development of the role of S 1P and its receptors in atherosclerosis.

Objective To explore the effect of ultrasound-guided stellate ganglion block (SGB) in the incidence of postoperative headache, nausea and vomiting in conventional thyroidectomy. Methods Ninety patients undergoing conventional thyroidectomy were randomly allocated to three groups with 30 patients in each group. In group L, SGB was performed with 5 ml 0.5% lidocaine; in group N, SGB was performed with 5 ml 0.9% sodium chloride; and in group C, no prior block was performed. Postoperatively, during the 48 h after surgery, every episode of postoperative headache and postoperative nausea and vomiting was recorded and a safety assessment was performed. In group L and group N, the hemodynamic status of the vertebral artery and carotid artery was recorded before and after the SGB was performed. In group C, the hemodynamic status of the vertebral artery and carotid artery was recorded before and after the neck was in the full extension position. Results One patient of group N and one patient of group C was discharged. During the 48 h after surgery, headache occured in 5 patients (16.7%) of group L, 8 patients (27.6%) of group N, and 17 patients (58.6%) of group C, and the headache rate in group C was significantly higher than that in group L (P=0.0007). The headache mostly occurred at 2 h and 4 h after operation. During the 48 h after surgery, nausea and vomiting occured in 8 patients (26.7%) of group L, 11 patients (37.9%) of group N, and 20 patients (60.9%) of group C, and the nausea and vomiting rate in group C was significantly higher than that in group L (P=0.0017) and group N (P=0.0343). The nausea and vomiting mostly occurred at 2 h and 4 h after operation.In group L and group N, and the inner diameters of the vertebral and carotid arteries after SGB were wider than those before SGB (P<0.05). In group C, the inner diameters of the vertebral and carotid arteries after the neck extension position were narrower than prostration position (P<0.05). No side effects were observed during or after SGB. Conclusions Preoperative SGB performed with 5 ml 0.5%lidocaine is an effective technique for reducing postoperative headache and nausea and vomiting after thyroidectomy.