Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Objective To explore the safety and effectiveness of different reinforcement methods in laparoscopic radical resection of low rectal cancer.Methods The clinical data of 215 patients who underwent laparoscopic radical resection of low rectal cancer in Nan-yang Central Hospital from January 2019 to December 2022 were analyzed retrospectively.According to the different ways of anastomotic reinforcement,the patients were divided into three groups:transanal reinforcement group(n=63),transabdominal reinforcement group(n=69)and non-reinforcement group(control group,n=83).The perioperative related indexes,postoperative complications(anasto-motic leakage,bleeding,stenosis)and postoperative anorectal function were compared among the three groups.Results The incidence of anastomotic leakage and the number of anastomotic bleeding in the reinforcement group were significantly lower than those in the non-reinforcement group,the difference was statistically significant(P＜0.05).There was no significant difference in intraoperative blood loss,postoperative first exhaust time,hospital stay,anastomotic stenosis and anorectal function,the difference was not statistically signifi-cant(P＞0.05).The incidence of anastomotic stenosis in the transabdominal reinforcement group was significantly higher than that in the transanal reinforcement group,the difference was statistically significant(P＜0.05).There was no significant difference in operation time,intraoperative blood loss,postoperative first exhaust time,hospital stay,incidence of anastomotic leakage,number of anastomotic bleeding and anorectal function between the two groups,the difference were not statistically significant(P＞0.05).Conclusion Transanal reinforcement of low colorectal anastomosis can significantly reduce the incidence of postoperative complications,which is a safe and effective reinforcement method in laparoscopic radical resection of low rectal cancer.

Objective:To explore the effect of self-management based on empowerment theory in patients with rectal cancer stoma.Methods:Using the convenience sampling method, 46 patients with rectal cancer stoma admitted to the General Surgery of Nanyang Central Hospital from January to October 2020 were selected as the control group, and received routine nursing. A total of 47 patients with rectal cancer stoma who were treated from November 2020 to August 2021 were selected as the observation group, and given self-management based on empowerment theory. The Strategies Used by People to Promote Health (SUPPH) , the Colostomy Self-care Agency Scale, and the Chinese version of City of Hope Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) were used to evaluate the self-efficacy, self-care ability and quality of life of rectal cancer patients with stoma before and after the intervention.Results:After intervention, the total score of SUPPH, the scores of each dimension of the Colostomy Self-care Agency Scale, and the scores of each dimension of the Chinese version of COH-QOL-OQ in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Self-management based on empowerment theory can improve the self-efficacy, self-care ability and the quality of life of rectal cancer patients with stoma.

Objective: To investigate the clinical features and prognostic factors of extrahepatic biliary neuroendocrine neoplasms(EB-NENs). Methods: The clinical data and survival of 21 patients with EB-NENs admitted from May 2014 to May 2018 were analyzed retrospectively. Results: These 21 EB-NENs patients accounted for 1.6% (21/1313) of all biliary tract neoplasms treated during the study period. Seven (33.3%) cases had lymph node metastasis. Five (23.8%) suffered from distant metastasis. The follow up time was (4~46.5) months with median survival time of (23.23 ±4.17) months. Univariate analysis showed that the risk factors for survival were tumor TNM stage (χ²=9.066, P=0.003), lymph node metastasis(χ²=6.399, P=0.011) and distant metastasis (χ²=9.808, P=0.002). By multivariate analysis, independent risk factors were tumor TNM stage(P=0.008, RR=3.003, 95% CI: 1.332~6.774), lymph node metastasis(P=0.023, RR=5.382, 95% CI: 1.261~22.971) and distant metastasis or not(P=0.007, RR=7.423, 95% CI: 1.730~31.851). Conclusion EB-NENs was a rare malignant tumor with poor prognosis. Tumor TNM stage, lymph node metastasis and distant metastasis were independent prognostic factors for EB-NENs patients.

Objective? To explore the effects of strengthening out-of-hospital health beliefs on perceived well-being and behavioral change in elderly patients with colon cancer. Methods? Totally 112 elderly patients with colon cancer admitted in Nanyang City Center Hospital from August 2015 to August 2017 were selected by convenient sampling and divided into two groups (n=56) based on the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received out-of-hospital health beliefs. Both interventions lasted for 6 months. The knowledge needs scale for cancer patients and the Health Promoting Lifestyle Profile-Ⅱ (HPLPⅡ) were used to evaluate the perceived well-being and healthy behaviors in the two groups before and after intervention. Results? The scores of psychological needs, technical needs, medication needs and rehabilitation needs and the total score of the knowledge needs scale for cancer patients in the observation group were higher than those before intervention and those of the control group after intervention. The scores of self-fulfillments, exercise, health responsibility, nutrition, pressure handling and interpersonal support and the total score of HPLP Ⅱ of the observation group were higher than those before intervention and those of the control group after intervention (P＜ 0.05). Conclusions? Strengthening out-of-hospital health beliefs can effectively improve the perceived well-being of elderly patients with colon cancer and enable them to develop healthy behaviors.

Objective To evaluate pelvic peritoneum reconstruction with barbed suture and irrigation and negative pressure drainage in laparoscopy rectal anterior resection for locally advanced rectal cancer.Methods From 2014 to 2018 159 locally advanced rectal cancer patients treated by laparoscopy were derided into study group (n =76),and those received gravity drainage without pelvic peritoneum reconstruction (n =83).Results There were not significant difference in the operation time between the two groups [(165 ± 18) min vs.(160 ± 17) min,t =0.098,P =0.069].There were significant differences in postoperative drainage tube indwelling duration [(5.7 ± 2.4) d vs.(7.4 ± 3.7) d,t =3.309,P =0.001],intraabdominal infection (7％ vs.17％,x2 =3.991,P =0.046) and anastomotic leakage (4％ vs.13％,x/2 =4.280,P =0.039).There was no significant difference in anastomotic stenosis (5％ vs.10％,x2 =1.088,P =0.297) and intestinal obstruction (9％ vs.11％,x2 =0.117,P =0.732) between the two groups.Conclusion It is simple,safe and reliable to perform pelvic peritoneal reconstruction using barbed suture,combined with irrigation and negative pressure drainage,it can decrease drainage tube indwelling duration,reduce the incidence of intraabdominal infection and anastomotic leakage.

Objective To investigate the efficacy and safety of preoperative regional intra-arterial chemoembolization combined with systemic vein chemotherapy in the treatment of locally advanced gastric cancer.Methods The clinical data of 78 locally advanced gastric cancer patients treated by radical D2 gastretomy from January 2010 to December 2012 were retrospectively analyzed.Patients were devided into treatment group receiving regional intra-arterial chemoembolization combined with systemic vein chemotherapy (n =36),and those with preoperative systemic vein chemotherapy (n =42) 3 to 4 weeks before surgery.Systemic chemotherapy with mFOLFOX6 was started after 5 weeks of surgery in the two groups.Results The incidence of toxicity reaction and postoperative anastomotic leakage were lower in treatment group than in control group,all P ＜ 0.05.The 1-year recurrence and overall survival rate were similar between the two groups (all P ＞ 0.05).The 3-year liver metastasis rate was higher in treatment group than in control group (x2 =4.063,P ＜ 0.05).The 3-year survival rate was higher than that of the control group(x2 =4.396,P ＜ 0.05).Conclusions Preoperative systemic vein chemotherapy combined with regional intra-arterial chemoembolization decreases toxicity reaction,anastomotic leakage and liver metastasis,while prolonging 3-year overall survival.

OBJECTIVE:To explore the effects of umbilical therapy by Rheum plamatum combined with early colonic irriga-tion on the quality of life in elderly patients with colon stoma. METHODS:80 patients underwent radical resection of abdominoperi-neal rectal carcinoma were randomly divided into control group and observation,with 40 cases in each group. Control group was given early colonic irrigation;observation group was additionally given umbilical therapy by R. plamatum. Treatment course of 2 groups lasted for one month,and both were followed up for 6 months after treatment. The quality by life in 2 groups was evaluated by using QLQ-C30,and therapy costs were calculated before and after treatment. RESULTS:Compared with before treatment, function score and total health score of 2 groups improved significantly in 1,3,6 months after treatment,while symptom score and single item score decreased significantly,with statistical significance(P<0.05). In 1,3,6 months after treatment,role func-tion,social function,cognitive function,emotional function and total health score of observation group were significantly higher than those of control group,and insomnia and pain score were significantly lower than control group,with statistical significance (P<0.05). 3 and 6 months after treatment,diarrhea and economic difficulty score of observation group were significantly lower than those of control group,with statistical significance(P<0.05). 1 months after treatment,loss of appetite score of observation group were significantly lower than those of control group,with statistical significance (P<0.05). 6 months after treatment, fa-tigue,nausea and vomiting score of observation group were significantly lower than those of control group,with statistical signifi-cance (P<0.05). 6 months after treatment,nursing cost,drug cost and total cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). CONCLUSIONS:The umbilical therapy by R. plamatum com-bined with early colonic irrigation can improve the quality of life in elderly patients with colon stoma significantly and reduce treat-ment cost.

Objective To investigate the efficacy and safety of preoperative systemic chemotherapy combined with regional intraarterial chemoembolization in the treatment of locally advanced gastric cancer.Methods Clinical data of 158 patients of locally advanced gastric receiving neoadjuvant chemotherapy cancer from January 2008 to July 2012 were retrospectively analyzed.Patients were divided into two groups:those who received preoperative systemic chemotherapy plus regional intraarterial chemoembolization (group A,n =78) and those who received preoperative systemic chemotherapy (group B,n =80).Radical resection was perfomed after 3 to 4 weeks.Results The overall satisfactory rate was significantly higher (60％) in group A compared with 42％ in group B (x2 =6.136,P ＜0.05).The incidence rate of toxicity reaction (except nausea) and postoperative conplications such as anastomotic leakage,intestinal obstruction,poor wound healing,abdominal infection and pulmonary infection were all lower in group A than in group B (all P ＜ 0.05),while the incidence rate of nausea was higher in group A than in Group B (x2 =16.458,P ＜ 0.01).There was no perioperative mortality related to neoadjuvant therapy in two groups.Conclusions Preoperative systemic chemotherapy combined with regional intraarterial chemoembolization was associated with better efficacy,and fewer toxicity reactions and postoperative complications in the treatment of locally advanced gastric cancer.