ObjectiveTo explore psychological experiences and care needs of elderly patients with chronic obstructive pulmonary disease (COPD) following dysphagia. MethodsFrom April to June, 2024, 13 elderly patients with COPD and dysphagia received treatment in Yixing No. 2 People's Hospital (Yixing Occupational Disease Institute) and Northern Jiangsu People's Hospital were interviewed. Nvivo 11.0 and content analysis were employed to analyze and summarize themes. ResultsTwo main themes were identified. The psychological experiences included fear of eating due to swallowing and choking, swallowing anxiety in social situations, concerns about malnutrition, and emotional loss related to family. The care needs included improvement in swallowing function, adjustment of food texture, assistance with disease adaptation and effective access to health education information. ConclusionHealthcare professionals should thoroughly understand the psychological and needs of elderly patients with COPD-related dysphagia, and comprehensive nursing strategies should be developed and implemented to improve swallowing function and overall quality of life.

Objective: To analyze the chemical constituents of Shanxiangyuanye (Turpiniae Folium) through liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, and to evaluate their anti-oxidant, hypoglycemic, and anti-glycation activities related to diabetic complications. Methods: The supernatant of Shanxiangyuanye (Turpiniae Folium) (TFS), obtained following water extraction and alcohol precipitation, was analyzed by LC-MS/MS. Antioxidant activity of TFS in vitro was evaluated using three experimental approaches: the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay, the 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS+) radical cation decolorization assay, and the hydroxyl (·OH) radical scavenging assay. To comprehensively evaluate hypoglycemic potential, α-glucosidase inhibition was measured to analyze in vitro hypoglycemic activity. Subsequently, in vitro models were developed to examine anti-glycation activity through the bovine serum albumin (BSA)-fructose (Fru), BSA-methylglyoxal (MGO), BSA-glyoxal (GO), and D-arginine (Arg)-MGO systems, with particular attention to the inhibitory effects of TFS. Furthermore, the concentrations of fructosamine, protein carbonyls, sulfhydryl groups, and β-amyloid in the glycation solution were quantified using the BSA-Fru model following 7-d of incubation at 37 °C. Results: Using LC-MS/MS analysis in both positive and negative ion modes, we identified 750 chemical components in TFS, primarily including organic acids, amino acids, and their derivatives. In vitro activity studies demonstrated that TFS exhibited remarkable free radical scavenging capacity, with half-maximal inhibitory concentrations (IC50) of 0.47, 1.56, and 0.36 mg/mL against DPPH, ABTS+, and ·OH radicals, respectively. Regarding hypoglycemic activity, TFS dose-dependently inhibited α-glucosidase activity (IC50 = 0.21 mg/mL), displaying comparable efficacy to the clinical drug acarbose (IC50 = 0.23 mg/mL). Notably, TFS intervened in the glycation process: IC50 values were 0.22, 1.91 – 4.96, and 4.09 mg/mL in the BSA-Fru, BSA-MGO/GO, and Arg-MGO models, respectively, with the most prominent inhibitory effects observed in the BSA-Fru model. Furthermore, although TFS may not effectively preserve thiol groups in BSA or reduce thiol oxidation during glycation, it significantly reduces fructosamine levels (in a dose-dependent manner), decreases β-amyloid formation, and inhibits protein carbonylation (P < 0.000 1). Conclusion The findings demonstrate that TFS exhibits a complex chemical composition with potent antioxidant, hypoglycemic, and anti-glycation activities. These results provide compelling scientific evidence supporting TFS’s potential as a natural adjuvant for diabetes prevention and complication management, while laying a solid foundation for its applications in functional food development and adjunctive antidiabetic therapeutics.

Objective: To analyze the disease burden of chronic obstructive pulmonary disease (COPD) and changes in its risk factors among residents in Zhejiang Province from 1990 to 2021, so as to identify key priorities for COPD prevention and control. Methods: Data on COPD mortality and disability-adjusted life years (DALY) for residents in Zhejiang Province from 1990 to 2021 were collected from the Global Burden of Disease (GBD) 2021 database. Standardized mortality and standardized DALY rate were calculated using the GBD 2021 world population standard structure. Premature mortality was computed via the life table method. The average annual percent change (AAPC) was applied to analyze trends in COPD mortality, DALY rate, and premature mortality. Changes in deaths of COPD risk factors were evaluated using population attributable fraction (PAF). Results: From 1990 to 2021, the standardized COPD mortality in Zhejiang Province decreased from 272.40/100 000 to 70.56/100 000 (AAPC=-4.395%), and the standardized DALY rate declined from 4 167.37/100 000 to 1 071.89/100 000 (AAPC=-4.396%). Similar downward trends were observed in both males (AAPC=-3.933%, -4.173%) and females (AAPC=-4.785%, -4.480%), all P<0.05. Crude mortality and DALY rates increased with age, and the crude mortality and DALY rates of various age groups in Zhejiang Province showed decreasing trends from 1990 to 2021 (all P<0.05). The premature mortality declined from 4.37% to 0.60% from 1990 to 2021 (AAPC=- 6.206%), with consistent trends across males and females (AAPC=- 6.144%, - 6.379%, all P<0.05). From 1990 to 2021, particulate matter pollution showed the largest reduction in PAF (- 56.76%), while ambient ozone pollution had the largest increase (103.07%) in Zhejiang Province. By 2021, smoking became the leading risk factor for deaths of COPD (PAF=43.32%). Conclusions The standardized mortality, standardized DALY rate, and premature mortality for COPD show consistent declining trends in Zhejiang Province from 1990 to 2021. However, risk factors such as smoking and ambient ozone pollution require intensified focus to further reduce disease burden of COPD.

Objective:To investigate neuroprotective effect of alpinetin on ischemic stroke(IS)rats by regulating Shh/Gli1 signaling pathway.Methods:Fifteen rats were randomly collected as control group,remaining rats were used to construct an IS model.Rats that successfully modeling were randomly grouped into model group,alpinetin group(5 mg/kg),Shh/Gli1 signaling pathway inhibitor cycloparamide group(15 mg/kg)and alpinetin+cycloparamide group(5 mg/kg alpinetin+15 mg/kg cycloparamide),with 15 rats in each group,and administered once a day for two consecutive weeks,control group and model group were given equal amounts of physiological saline.Zea-Longa scoring method was applied to evaluate neural function;ELISA was applied to detect inflammatory factors levels;mass of brain tissue was weighed and water content of brain tissue was calculated;TTC staining was applied to measure volume of cerebral infarction;HE staining was applied to observe nerve cell damage;TUNEL staining was applied to detect neuronal apoptosis;qRT-PCR and Western blot were used to detect mRNA and protein expressions of Shh and Gli1.Results:There were no abnormalities in hippocampal tissue of control group,while hippocampal tissue structure of model group rats was abnor-mal,with disordered cell arrangement and nuclear pyknosis of nerve cells,cell damage rate,Zea-Longa score,infarct volume,IL-1β,IL-6,TNF-α,brain tissue water content,and cell apoptosis rate in model group were obviously higher than control group(P<0.05),mRNA and protein levels of Shh and Gli1 were obviously decreased(P<0.05);compared with model group,cells in alpinetin group were arranged more neatly,and phenomenon of neuronal cell nucleus pyknosis was improved,cell damage rate,Zea-Longa score,infarct volume,IL-1β,IL-6,TNF-α,brain tissue water content,and cell apoptosis rate were obviously decreased(P<0.05),mRNA and protein levels of Shh and Gli1 were obviously increased(P<0.05),trend of above indicators in cyclophosphamide group was opposite,ciclopramide reversed neuroprotective effect of alpinetin on IS rats.Conclusion:Alpinetin may exert neuroprotective effects on IS rats by activating Shh/Gli1 signaling pathway.

AIM To explore the clinical effects of Danzhi Xiaoyao Powder combined with Hetiao Duren Anshen Acupuncture Method on patients with post-stroke depression.METHODS Ninety-eight patients were randomly assigned into control group(49 cases)for 4-week intervention of conventional treatment,and observation group(49 cases)for 4-week intervention of Danzhi Xiaoyao Powder,Hetiao Duren Anshen Acupuncture Method and conventional treatment.The changes in clinical effects,MoCA score,intestinal flora(Enterococcus,Lactobacillus,Escherichia coli,Bifidobacterium),immune function indices(IgM,IgG,IgA),depression status indices(HAMD score,SDS score)and incidence of adverse reactions were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed increased MoCA score,immune function indices(P＜0.05),decreased HAMD score,SDS score(P＜0.05),reduced Enterococcus,Escherichia coli(P＜0.05),and elevated Lactobacillus,Bifidobacterium(P＜0.05),especially for the observation group(P＜0.05).No significant difference in incidence of adverse reactions was found between the two groups(P＞0.05).CONCLUSION For the patients with post-stroke depression,Danzhi Xiaoyao Powder combined with Hetiao Duren Anshen Acupuncture Method can safely and effectively improve cognitive functions,humoral immunities,regulate intestinal flora,and alleviate depression symptoms.

Objective:To investigate the safety and short-term efficacy of yttrium-90 [ 90Y] resin microspheres transarterial radioembolization (TARE) for the treatment of initial unresectable malignant hepatic tumor. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients with initial unresectable malignant hepatic tumor who were admitted to The First Affiliated Hospital of Army Medical University from June 2022 to June 2023 were collected. All patients were males, aged (57±4)years. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after treatment within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison before and after treatment within the group was conducted using the paired rank sum test. Count data were described as absolute numbers or proportions. Results:(1) Pre-treatment assessment. All 10 patients completed pre-treatment assessment, with 8 cases undergoing once of technetium 99-polymerised protein perfusion test and 2 cases under-going ≥ twice of technetium 99-polymerised protein perfusion test. The ratio of uptake of techne-tium 99-polymerised protein in tumor tissue to normal tissue, the hepatopulmonary shunting ratio and the therapeutic requirement of 90Y resin microspheres in 10 patients were 5.8±1.2, 4.8%±0.8% and (1.10±0.20)GBq, respectively. (2) Treatment strategy of 90Y resin microspheres TARE. Of the 10 patients, cases treated with whole tumor radioembolisation, radioembolisation of the main target lesion+non-target lesion radiofrequency ablation, radioembolisation of the main target lesion+non-target lesion iodine-125 particles implantation, radioembolisation of the liver lobe or liver segment were 6, 2, 1, 1, respectively. During the treatment period, one elderly case did not receive target therapy combined with immunotherapy due to intolerance, and the remaining 9 cases received target therapy combined with immunotherapy. Of the 10 patients, there were 7 cases receiving once of 90Y resin microspheres TARE, and 3 cases receiving twice of 90Y resin microspheres TARE. (3) Follow-up. All 10 patients were followed up for 4.5(range, 3.0-12.0)months. During the follow-up, none of patient had adverse event associated with 90Y resin microspheres TARE. The tumor diameter, alpha-fetoprotein (AFP), abnormal prothrombin, alanine aminotransferase (ALT), aspartate amino-transferase (AST), albumin (Alb), total bilirubin (TBiL), glutamyltransferase (GGT) of the 10 patients were 96(72,135)mm, 26(6,833)μg/L, 290(56,2 997)Au/L, (36±13)IU/L, (41+16)IU/L, (40±4)g/L, (15.3±4.1)μmol/L, (99±68)IU/L before receiving 90Y microspheres TARE. The above indicators of the 10 patients were 63(43,97)mm, 4(3,357)μg/L, 38(25, 142) Au/L, (40±16)IU/L, (51±28)IU/L, (39±4)g/L, (14.4±1.2) μmol/L, (134±93)IU/L after 90 days of receiving 90Y microspheres TARE. There were significant differences in tumor diameter and abnormal prothrombin ( Z=-2.08, -2.24, P<0.05) and there was no significant difference in AFP, ALT, AST, Alb, TBil, GGT ( Z=-1.27, t=0.63, 1.69, 1.73, 0.67, 1.30, P>0.05). During the follow-up period, 5 cases achieved clinical complete response, 4 cases achieved clinical partial remission, and 1 case experienced non-target lesion progression within 30 days after receiving 90Y resin microspheres TARE. The disease remission rate and disease control rate of the 10 patients were 9/10 and 9/10, respectively. None of patient died during follow-up period. Conclusion:90Y resin microspheres TARE for the treatment of initial unresectable malignant hepatic tumor is safe and feasible, and can achieve satisfactory short-term efficacy when combined with other treatment methods.

Objective:To investigate the influencing of preoperative total bilirubin (TBil) on perioperative complications of hepatolithiasis receiving liver resection.Methods:The retrospective cohort study was conducted. The clinical data of 300 patients with hepatolithiasis who were admitted to 2 medical centers from January 2010 to January 2022 were collected. There were 115 males and 185 females, aged (54±13)years. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers, and the chi-square test was used for comparison between groups. Variables with P<0.10 in the univariate analysis were included into the multivariate analysis. Univariate analysis was conducted using the Logistic regression model,and multivariate analysis was conducted using the Logistic stepwise regression model with backward Wald method. Continuous variables were converted into categorical variables based on commonly reported cutoff values when conducting Logistic regression analysis. Results:(1) Comparison of clinical data of patients with different preoperative TBil. Of 300 patients with hepatolithiasis, there were 252 cases with low level of preoperative TBil as 14.4(11.1,19.7)μmol/L, and there were 48 cases with high level of preoperative TBil as 44.0(31.3,59.8)μmol/L. Of the pati-ents with low level of preoperative TBil, neutrophils percentage was 62%±10%, cases with intra-operative blood transfusion was 29, and cases undergoing anatomical liver resection was 166. Of the patients with high level of preoperative TBil, neutrophils percentage was 70%±11%, cases with intraoperative blood transfusion was 22, and cases undergoing anatomical liver resection was 15. There were significant differences in cases classified as>grade 2 of ASA classification, neutrophils percentage, cases with intraoperative blood transfusion and cases undergoing anatomical liver resection between patients with low and high level of preoperative TBil ( t=5.182, χ2=33.669, 18.775, P<0.05). (2) Comparison of perioperative complications of patients with different preoperative TBil. Of the 252 patients with low level of TBil, there were 151 cases with complications including 35 cases of serious complications, there was 1 case with postoperative liver failure, the duration of postoperative hospital stay was 13.0(10.0,16.0)days. Of the 48 patients with high level of TBil, there were 32 cases with complications including 17 cases of serious complications, there were 6 cases with postoperative liver failure, the duration of postoperative hospital stay was 14.0(10.0,18.8)days. There were significant differences in cases with serious complications and cases with postoperative liver failure between patients with low and high level of preoperative TBil ( χ2=13.041, 20.879, P<0.05). (3) Analysis of factors influencing postoperative serious complications in patients undergoing liver resection. Results of multivariate analysis showed that age, body mass index (BMI), preoperative TBil and volume of intraoperative blood loss were independent factors influencing postoperative serious complications in patients undergoing liver resection for hepatolithiasis ( odds ratio=3.852, 2.358, 2.935, 5.135, 95% confidence interval as 1.478?9.979, 1.110?5.009, 1.398?6.158, 2.088?12.626, P<0.05). Conclusions:Patients with high level of preoperative TBil have a significantly increased risk of postoperative serious complications and liver failure who receive liver resection for hepatolithiasis. Age, preoperative BMI, TBil and volume of intraoperative blood loss are independent factors influencing postoperative serious complications in patients undergoing liver resection for hepatolithiasis.

Objective To assess the feasibility of utilizing the ExacTracDynamic surface monitoring system(ETD)for setup and body surface monitoring in patients with thoracic tumors undergoing intensity-modulated radio-therapy(IMRT).Methods Patients receiving IMRT for thoracic tumors were included in this study.The enrolled patients were alternatively assigned to either conventional cross curve positioning(control group)or surface monitoring system-assisted positioning(experimental group).ETD X-ray images were utilized for calibration purposes prior to radiotherapy,enabling the determination of setup errors.A region of interest(ROI)was delineated on the body surface above the sternum,and real-time body surface monitoring was performed based on this ROI during radiotherapy.Post-radiotherapy X-ray images were obtained to verify patient position.Data regarding left-right(X),head-foot(Y),abdomen-back(Z),pitch,roll,and yaw directions were recorded and analyzed.Results A total of 60 patients were enrolled,with 754 fractions of radiotherapy in the control group and 718 fractions in the experimental group.The setup errors in the X and Z directions were significantly smaller in the experimental group compared to the control group(P<0.05).Moreover,there was a significant reduction in the number of setup errors≤0.50 cm for X,Y,and Z directions,as well as≤1.00° for Roll angle in the experimental group compared to the control group(P<0.05).Additionally,differences were observed between surface monitoring and X-ray image verification regarding position deviation along Y and Z directions(P<0.05),although these deviations remained within submillimeter levels on average.Conclusion Surface monitoring system-assisted positioning can enhance radiotherapy setup accuracy among thoracic tumor patients,particularly along X and Z directions.Furthermore,when setting ROI above sternum on body surface area,surface monitoring provides better reflection of target area's position deviation.

Objective To develop and evaluate the equivalence of the Mandarin test material for tracking of noise tolerance(TNT)test.Methods Six different speech materials were developed(themes including daily life,entertainment,family,festivals,outdoors,and school).Four-minute TNT tests were measured in 21 normal hear-ing subjects using six different test materials.For each session,the tolerable noise level(TNL)and TNT scores were acquired and calculated for 3 time windows(31～240 s,31～120 s,151～240 s).Results Statistic analysis showed significant differences in the TNL(F=43.611,P＜0.05)among the normal hearing listeners.There were statistically significant differences in standardize z-scored TNT scores of the six different materials in the three time windows(P＜0.05).Post-hoc comparisons revealed that all significant differences involved the family and daily life themes.Conclusion Entertainment,festival,outdoors and school themed test materials can serve as the materials of Mandarin tracking of noise tolerance test and can be appied in research and clinical testing.

Objective To evaluate the Mandarin tracking of noise tolerance(TNT)test material and compare the differences between the average tolerable noise level(aTNL)value obtained from assessment and the program-estimated tolerable noise level(eTNL).Methods A total of 25 subjects with normal hearing and aural communica-tional ability were selected to undergo two of the mandarin TNT tests successively(respectively test 1,C1;test 2,C2),and 13 of them completed the third test(C3)under the same test condition as test 2 at least 1 week later.The stimulus for the three test conditions was presented with"speech 0°,continuous noise 180°".Results The aTNL of 25 participants for C1 and C2 was 83.42±3.09 dB SPL and 83.50±3.18 dB SPL,respectively.The eTNL of 25 participants for C1 and C2 were 84.08±3.53 dB SPL and 83.95±3.85 dB SPL,respectively.The aTNL and eT-NL for 13 subjects who participated in C3 was 83.16±2.13 dB SPL and 83.18±2.64 dB SPL,respectively.The intra-session(C1 vs C2)and inter-session(C2 vs C3)test-retest reliability were 2.36 dB and 2.75 dB,respectively.Pearson correlation analysis showed that intra-session(r=0.837,P＜0.001)and inter-session(r=0.867,P＜0.001)test-retest reliability was good.There was no statistical difference between aTNL and eTNL in the other TNT tests(P＞0.05 for both)except that aTNL and eTNL were statistically different in C1(P＜0.01),and more than 90％of the subjects could obtain eTNL within 1 minute.Conclusion The test-retest reliability of Mandarin tracking of noise tolerance test is good,with advantages of high reliability and efficiency.