ObjectiveTo elucidate the mechanism by which total flavonoids of Abelmoschi Corolla （TFA） treat immunoglobulin A （IgA） nephropathy （IgAN） through serum metabolomics analysis. MethodsSPF-grade male SD rats were randomly assigned into six groups （n=10）： blank， model， low-dose TFA （TFA-L， 27 mg·kg^-1）， medium-dose TFA （TFA-M， 54 mg·kg^-1）， high-dose TFA （TFA-H， 108 mg·kg^-1）， and losartan potassium （LST， 4.5 mg·kg^-1） groups. The remaining five groups， excluding the blank group， were modeled with bovine serum albumin （BSA）， lipopolysaccharide （LPS）， and carbon tetrachloride （CCl₄）. Specifically， from weeks 1 to 10， BSA was administered via gavage every other day， and a mixture of castor oil and CCl₄ was injected subcutaneously once a week， with LPS injected into the tail vein at weeks 6 and 8. After successful modeling， each intervention group was administrated with the medication prepared with distilled water once daily by gavage for a continuous period of 4 weeks. The levels of 24-hour urinary total protein （24 h UP） and serum creatinine （SCr） were quantified by kits， and the serum IgA level was determined by enzyme-linked immunosorbent assay （ELISA）. Renal pathological changes were observed by hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. Renal IgA deposition was assessed by immunofluorescence （IF）. Endoplasmic reticulum （ER） stress was observed by transmission electron microscopy. Western blot and immunohistochemistry （IHC） were employed to detect the expression of ER stress-related factors. Non-targeted metabolomics was used to screen differential metabolites for analysis， and key metabolites arachidonic acid （AA）， prostaglandin E₂ （PGE₂）， and cyclooxygenase-2 （COX-2） were validated. ResultsCompared with the blank group， the model group showed increased 24-hour urine protein （24 h UP） and serum creatinine （SCr） levels （P<0.01）， obvious renal pathological damage， elevated serum IgA level （P<0.01）， increased renal AA and PGE₂ levels （P<0.01）， and up-regulated protein levels of COX-2， glucose-regulated protein 78 （GRP78）， phosphorylated eukaryotic initiation factor 2α （P-EIF2α）， activating transcription factor 4 （ATF4）， inositol-requiring enzyme 1α （IRE1α）， and spliced X-box binding protein 1 （XBP1s） in the renal tissue （P<0.05， P<0.01）. Compared with the model group， the intervention groups showed reductions in 24 h UP and SCr levels （P<0.05， P<0.01）， alleviated renal pathological injury， decreased serum IgA level （P<0.05， P<0.01）， and reduced renal AA and PGE₂ levels （P<0.01）. Western blot and IHC results showed that TFA reduced the levels of COX-2， GRP78， P-EIF2α， ATF4， IRE1α， and XBP1s in the renal tissue （P<0.05， P<0.01）. Metabolomics results indicated that 51 commonly differential metabolites were found among the normal， model， and TFA-M groups. TFA ameliorated IgAN by affecting metabolic pathways related to the biosynthesis of arachidonic acid and arginine through L-aspartic acid， prostaglandin 2α， leukotriene B₄， leukotriene D₄， among others. ConclusionTFA can regulate the arachidonic acid metabolism pathway， thereby modulating ER stress， reducing renal damage， and ameliorating IgA nephropathy.

Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

Robot-assisted surgery with its advantages such as three-dimensional high-definition vision, dexterous robotic arms, and tremor filtration, is increasingly being applied to complex radical gastrectomy. However, the role of the surgical assistant remains crucial during the procedure. The assistant is responsible for tasks outside the console, including adjusting robotic arms, changing instruments, exposing the surgical field, and addressing unexpected situations. The technical proficiency of the assistant and their collaboration efficiency with the primary surgeon directly impact the smoothness of surgery and patients' outcomes. With the expansion of robot-assisted surgical indications, the establishment of a standardized training system and the optimization of team collaboration models have become urgent challenges to address. This article draws on the author's practical experience as an assistant in robot-assisted gastric cancer surgeries, conducting an in-depth analysis of the responsibilities and operational skills of surgical assistants in robot-assisted procedures. The aim is to develop a relatively comprehensive set of operational guidelines for surgical assistants in robot-assisted radical gastrectomy, providing valuable references for enhancing the overall efficiency of surgical teams and improving surgical outcomes.

Objective To identify risk factors for colorectal adenomatous polyps using logistic regression analysis,construct a prediction model based on these identified factors,and subsequently evaluate the performance of the model.Methods Encompassed 1,023 patients who underwent large intestine polyp resection at the First Hospital of Handan between January 2017 and January 2022.Among these patients,676 had adenomatous polyps(adenomatous polyp group)and 347 had non-adenomatous polyps(non-adenomatous polyp group).We collected data on basic information,medical history,colonoscopy results,and polyp pathology.By comparing the two groups,we identified significant differences in various indicators,which were selected as candidate factors for model construction.Patients were randomly divided into a training set and a validation set at an 8∶2 ratio.Using the training set data,we constructed a risk prediction model and developed a nomogram using R Studio software to visually present the model.Finally,we internally validated the model using the validation set.The model's discrimination ability was evaluated using the ROC curve,its accuracy was assessed via the calibration curve,and its clinical utility was evaluated through decision curve analysis(DCA).Results Significant differences were observed between the two groups in terms of age,drinking habits,family history of colorectal cancer,hyperlipid-emia,history of cholecystectomy,HP infection,and history of appendectomy(P<0.05).These variables were included in the model construction.A total of 818 participants were randomly assigned to the training set,while 205 were allocated to the validation set.Multivariate logistic regression analysis on the training set confirmed that age(OR=1.021,95%CI:1.006～1.036,P=0.006),alcohol consumption(OR=3.440,95%CI:2.251～5.257,P<0.001),first-degree relatives with colorectal cancer(OR=3.775,95%CI:1.881～7.577,P<0.001),hyperlipidemia(OR=3.428,95%CI:2.443～4.808,P<0.001),history of cholecystectomy(OR=3.916,95%CI:1.756～8.735,P<0.001),Helicobacter pylori(HP)infection(OR=3.292,95%CI:2.309～4.693,P<0.001),and history of appendectomy(OR=3.819,95%CI:2.002～7.286,P<0.001)were independent risk factors for adenomatous polyps.Consequently,a prediction model for large intestine adenomatous polyps was developed using the formula P=1/(1+e-Y),where Y=0.020×age+1.328×first-degree relatives with colorectal cancer+1.235×alcohol consumption+1.232×hyperlipidemia+1.365×cholecystectomy+1.192×HP infection+1.340×appendectomy-1.995.The model demonstrated good performance with AUC values of 0.763(95%CI:0.729～0.797)for the training set and 0.769(95%CI:0.644～0.787)for the validation set.The calibration curve indicated a good fit,and decision curve analysis showed that the model could achieve positive net benefit across a wide range of threshold probabilities,confirming its clinical utility.Conclusions Age,alcohol consumption,a family history of colorectal cancer in first-degree relatives,hyperlipidemia,cholecystectomy,HP infection,and appendectomy were identified as independent risk factors for adenomatous polyps.A prediction model incorporating these risk factors holds significant practical value for predicting the occurrence of colorectal adenomatous polyps.

Objective:To investigate the incidence, clinical management and influencing factors of late-onset neutropenia (LON) in children with primary nephrotic syndrome (PNS) after Rituximab (RTX) treatment.Methods:A retrospective case-control study was conducted.The clinical data of PNS children who received RTX treatment at the First Affiliated Hospital of Xiamen University from March 2020 to August 2024 and were followed up for at least 6 months were collected.The RTX regimen was a single dose of 375 mg/m 2 with a maximum dose of 500 mg, and an additional dose was administered when the reexamination showed that peripheral blood CD19 + B cells were ≥ 1% or nephrotic syndrome relapsed.The patients were divided into an LON group and a non-LON group according to the presence or absence of LON, and then a comparison was made between the groups.The cumulative incidence of LON was estimated by the Kaplan-Meier method.Univariate and multivariate Logistic regression methods were used to identify the influencing factors of LON.Receiver operating characteristic (ROC) curves were plotted to assess the value of each influencing factor for predicting LON. Results:A total of 65 PNS patients were included.The incidence of LON was 19.3%(27/140) after 140 RTX treatment courses, and the first LON appeared 95.0 (64.0, 115.0) days after RTX treatment.Forty-nine patients received repeated RTX treatment.The incidence rates of LON after the first course, the second course, and the third course of RTX were 27.7%(18/65), 10.2%(5/49), and 18.8%(3/16), respectively, with no statistically significant difference ( χ2=5.764, P>0.05). There was also no significant difference in the incidence of LON between patients taking and not taking combined immunosuppressive agents after RTX treatment [35.3%(6/17) vs.37.8%(17/45), χ2=0.033, P>0.05]. Compared with the non-LON group, the LON group had a higher incidence of infections [48.1%(13/27) vs.15.0%(17/113), χ2=14.17, P<0.01], but no serious outcomes were observed in both groups.Multivariate Logistic analysis suggested that the age at treatment with RTX was an independent risk factor for LON after RTX treatment ( OR=0.763, 95% CI: 0.592-0.982). The area under the ROC curve of the age at treatment with RTX for predicting LON was 0.767 (95% CI: 0.628-0.906), with an optimal cutoff of 6.6 years, a sensitivity of 70.6%, and a specificity of 80.0%. Conclusions:The incidence of LON in PNS children after RTX treatment may be underestimated.Children who develop LON are at a higher risk of infections, but the prognosis is favorable.The age at treatment with RTX≤6.6 years is an independent risk factor for LON in PNS children.Close monitoring of neutrophil counts should be emphasized in younger PNS patients receiving RTX therapy.

Objective To investigate the efficacy of surface electromyography biofeedback combined with respiratory training on post-stroke dysphagia and its impacts on serum neuron specific enolase(NSE)and insulin-like growth factor 1(IGF-1)in patients.Methods Totally 120 patients with post-stroke dysphagia in our hospital were stochastically assigned into the control group and the combined group,with 60 patients in each group.Both groups were given conventional treatment first,while the control group received respiratory training treatment.The combined group received surface electromyography biofeedback treatment on the top of the control group.The efficacy,serum NSE,central nervous system specific protein(S100β),IGF-1,functional oral intake scale(FOIS)score,standard swallowing function assessment scale(SSA)score,respiratory function,pharyngeal contraction rate and duration of pharyngeal contraction were compared between the two groups.Results After treatment,the total effective rate was higher in the combined group(x2=4.876,P＜0.05).Compared with before treatment,NSE,S100β,SSA score and pharyngeal contraction rate decreased after treatment in both groups,and those were even lower in the combined group(t=5.193,9.000,8.976,10.614,P＜0.05).Compared with before treatment,IGF-1,FOIS score,force vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow rate(PEF)and duration of pharyngeal contraction increased after treatment in both groups,with even higher levels in the combined group(t=4.212,6.220,3.765,6.935,5.020,4.249,P＜0.05).Conclusion Surface electromyography biofeedback combined with respiratory training can improve neuronal damage in patients with dysphagia,enhance swallowing efficiency,reduce serum NSE,S100β levels and pharyngeal retention time,with significant curative effect.

Objective To evaluate the predictive value of neutrophil/high-density lipoprotein cholesterol ratio(NHR)combined with monocyte/lymphocyte ratio(MLR)for early rebleeding after endoscopic treatment in patients with cirrhosis complicated by acute esophagogastric variceal bleeding(AEVB).Methods A total of 228 patients with cirrhosis complicated by AEVB were included in this study.According to the occurrence of early rebleeding,patients were divided into the rebleeding group(96 cases)and the non-rebleeding group(132 cases).General information and laboratory indicators of both groups were collected,and the End-Stage Liver Disease(MELD)score,Child-Turcotte-Pugh(CTP)score,Fibrosis-4(FIB-4)index,NHR,and MLR were calculated.Logistic regression analysis was used to identify the risk factors for early rebleeding in patients with cirrhosis complicated by AEVB.A nomogram model based on NHR and MLR was constructed to predict the risk of early rebleeding.The predictive performance and goodness of fit of the model were evaluated using receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test,Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI).Results Compared with the non-rebleeding group,systolic blood pressure,platelet count(PLT),albumin/globulin ratio(A/G)and low-density lipoprotein cholesterol(LDL-C)were decreased in the rebleeding group,while total bile acids(TBA),aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),activated partial thromboplastin time(APTT),thrombin time(TT),international normalized ratio(INR),Fibrosis-4(FIB-4),NHR,MLR,MELD score and CTP score were increased(P＜0.05).NHR was positively correlated with AST,TBIL and INR(P＜0.05).MLR was negatively correlated with PLT,and positively correlated with AST,TBIL and FIB-4(P＜0.05).Logistic regression analysis results showed that prolonged TT,elevated NHR and MLR were independent risk factors for early rebleeding in patients with cirrhosis complicated by AEVB.The nomogram model based on NHR and MLR to predict early rebleeding had an area under the curve of 0.810(95%CI:0.754-0.866).The Hosmer-Lemeshow test suggested that the model fit well.IDI and NRI analyse showed that the combination of NHR and MLR had better predictive value for the early rebleeding than that of MELD score and CTP score.Conclusion NHR and MLR are effective indicators for predicting early rebleeding after endoscopic treatment in patients with cirrhosis complicated by AEVB.They are helpful in the early identification of high-risk patients and provide a reference for clinical intervention.

Objective To evaluate the predictive value of neutrophil/high-density lipoprotein cholesterol ratio(NHR)combined with monocyte/lymphocyte ratio(MLR)for early rebleeding after endoscopic treatment in patients with cirrhosis complicated by acute esophagogastric variceal bleeding(AEVB).Methods A total of 228 patients with cirrhosis complicated by AEVB were included in this study.According to the occurrence of early rebleeding,patients were divided into the rebleeding group(96 cases)and the non-rebleeding group(132 cases).General information and laboratory indicators of both groups were collected,and the End-Stage Liver Disease(MELD)score,Child-Turcotte-Pugh(CTP)score,Fibrosis-4(FIB-4)index,NHR,and MLR were calculated.Logistic regression analysis was used to identify the risk factors for early rebleeding in patients with cirrhosis complicated by AEVB.A nomogram model based on NHR and MLR was constructed to predict the risk of early rebleeding.The predictive performance and goodness of fit of the model were evaluated using receiver operating characteristic(ROC)curve,Hosmer-Lemeshow test,Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI).Results Compared with the non-rebleeding group,systolic blood pressure,platelet count(PLT),albumin/globulin ratio(A/G)and low-density lipoprotein cholesterol(LDL-C)were decreased in the rebleeding group,while total bile acids(TBA),aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),activated partial thromboplastin time(APTT),thrombin time(TT),international normalized ratio(INR),Fibrosis-4(FIB-4),NHR,MLR,MELD score and CTP score were increased(P＜0.05).NHR was positively correlated with AST,TBIL and INR(P＜0.05).MLR was negatively correlated with PLT,and positively correlated with AST,TBIL and FIB-4(P＜0.05).Logistic regression analysis results showed that prolonged TT,elevated NHR and MLR were independent risk factors for early rebleeding in patients with cirrhosis complicated by AEVB.The nomogram model based on NHR and MLR to predict early rebleeding had an area under the curve of 0.810(95%CI:0.754-0.866).The Hosmer-Lemeshow test suggested that the model fit well.IDI and NRI analyse showed that the combination of NHR and MLR had better predictive value for the early rebleeding than that of MELD score and CTP score.Conclusion NHR and MLR are effective indicators for predicting early rebleeding after endoscopic treatment in patients with cirrhosis complicated by AEVB.They are helpful in the early identification of high-risk patients and provide a reference for clinical intervention.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

In recent years, botulinum toxin type-A (BTX-A) combined with cosmetic injections and radiofrequency lasers have been widely implemented to achieve better tissue repair. Among these therapies, platelet-rich plasma (PRP), rich in growth factors, has demonstrated notable efficacy in promoting tissue regeneration and repair. However, there is some controversy regarding the combined use of these two biomaterials in the treatment of various diseases. This review summarizes the current status of their combined application in peripheral neuropathic pain, seborrheic alopecia, and facial rejuvenation, also analyzes the advantages, interactions, and influencing factors of the combined application. Although the effectiveness and safety of PRP combined with BTX-A injection therapy in many of the above diseases are relatively high, the conclusion should still be carried out in the future multi-center, large-sample clinical studies to improve the credibility and representativeness of the results.