Objective:To investigate the efficacy and safety of sentinel lymph node dissection in the treatment of early cervical cancer.Methods:This study used a prospective study design. A total of 122 patients with early cervical cancer who received treatment at Jinhua Maternal & Child Health Care Hospital form June 2022 to June 2024 were included in this study. These patients were divided into an observation group and a control group ( n = 61/group) using a random number table method. In the observation group, sentinel lymph node resection instead of systematic lymphadenectomy was performed, while in the control group, systematic lymphadenectomy was performed. Perioperative indicators, postoperative lymph node pathology results, complications, and postoperative tumor recurrence rates were compared between the two groups. Additionally, sentinel lymph node imaging results were evaluated in the observation group. Results:After treatment, the surgical time, duration of pelvic drainage tube retention, duration of catheter retention, postoperative hospital stay, number of lymph nodes dissected, and time to postoperative bowel function recovery in the observation group were (178.33 ± 8.29) minutes, (7.19 ± 1.38) days, (11.73±2.57) days, (8.09±1.34) days, (12.48 ± 2.63), and (2.28 ± 0.69) days, respectively. These values were significantly shorter or lower than those in the control group [(239.41 ± 9.83) minutes, (9.74 ± 1.75) days, (12.88 ± 2.76) days, (9.53 ± 1.47) days, (133.27 ± 11.43) mL, (26.18 ± 2.27), (3.12 ± 0.98) days, t = 37.10, 8.94, 2.38, 5.65, 30.80, 5.47, all P < 0.05]. There were no statistically significant differences in postoperative pathological results between the two groups ( χ2 = 2.03, 0.12, both P > 0.05). The overall incidence of perioperative complications in the observation group was significantly lower than that in the control group [1.46% (1/61) vs. 8.19% (5/61), χ2 = 5.55, P < 0.05). Conclusions:Sentinel lymph node resection can significantly enhance the perioperative outcomes of patients with cervical cancer and reduce the incidence of complications. Additionally, there were no recurrences of cervical cancer during the follow-up period. Therefore, sentinel lymph node resection is a safe and feasible procedure.

OBJECTIVE: To investigate the impact of early antimicrobial therapy on the prognosis of patients with suspected sepsis in emergency and outpatient settings. METHODS: A prospective cohort study was conducted. Patients with suspected sepsis admitted to the emergency department of Taizhou Hospital, Zhejiang Province, from May 1, 2022, to July 31, 2023, were enrolled. Participants were divided into an early group (0-1 hour) and a delayed group (> 1 hour) according to duration from admission to antimicrobial administration. General information, initial vital signs, laboratory parameters within 24 hours after admission, disease severity scores, vasoactive drug usage, and clinical outcomes of the patient were collected. Kaplan-Meier survival curve was used to analyze 28-day survival. Multivariate Cox proportional hazards regression was performed to identify independent risk factors for prognosis of the patients with suspected sepsis in emergency and outpatient settings. Sensitivity analyses were conducted through subgroup analyses. RESULTS: A total of 143 patients with suspected sepsis were enrolled in the analysis, with 66 patients in the early group and 77 in the delayed group. No statistically significant differences were observed in baseline characteristics (age, gender, vital signs, laboratory parameters, disease severity scores) or clinical outcomes [vasoactive drug usage rate, mechanical ventilation duration, length of intensive care unit (ICU) stay, total hospitalization duration] between the two groups. The 28-day mortality, multidrug resistance rate and sepsis confirmation rate did not differ significantly between the early group and delay group [28-day mortality: 18.2% (12/66) vs. 20.8% (16/77), multidrug resistance rate: 3.0% (2/66) vs. 2.6% (2/77), sepsis confirmation rate: 87.9% (58/66) vs. 88.3% (68/77), all P > 0.05]. Kaplan-Meier survival curve analysis showed no difference in 28-day cumulative survival between the two groups (Log-Rank test: χ² = 2.528, P = 0.112). Multivariate Cox proportional hazards regression identified vasoactive drug usage [hazard ration (HR) = 2.465, 95% confidence interval (95%CI) was 1.019-5.961, P = 0.045] and endotracheal intubation (HR = 5.516, 95%CI was 2.195-13.858, P < 0.001) as independent risk factors for 28-day death of the patients with suspected sepsis in emergency and outpatient settings. Further exploration of the impact of early antimicrobial therapy on 28-day death in different subgroups of the patients with suspected sepsis in emergency and outpatient settings was conducted through subgroup analysis. The results showed that in the patients with different ages (< 60 years old: HR = 1.214, 95%CI was 0.535-2.751, P = 0.643; ≥ 60 years old: HR = 2.085, 95%CI was 0.233-18.668, P = 0.511), sequential organ failure assessment (SOFA) scores (< 6: HR = 1.411, 95%CI was 0.482-4.128, P = 0.530; ≥ 6: HR = 0.869, 95%CI was 0.292-2.587, P = 0.801), shock indexes (< 1: HR = 1.095, 95%CI was 0.390-3.077, P = 0.863; ≥ 1: HR = 1.364, 95%CI was 0.458-4.059, P = 0.577) and whether diagnosed with sepsis or not (yes: HR = 0.943, 95%CI was 0.059-15.091, P = 0.967; no: HR = 1.207, 95%CI was 0.554-2.628, P = 0.636) subgroups, early usage of antibiotics had not shown any advantage in improving prognosis compared with delayed usage. CONCLUSION Early antimicrobial therapy does not improve the prognosis of patients with suspected sepsis in emergency and outpatient settings.
Humans ; Sepsis/drug therapy* ; Prospective Studies ; Prognosis ; Emergency Service, Hospital ; Outpatients ; Female ; Male ; Anti-Infective Agents/therapeutic use* ; Middle Aged ; Aged ; Proportional Hazards Models ; Treatment Outcome

Objective:To analyze the implementation and effectiveness of standardized training for medical aesthetic practitioners in Guangdong province from 2015 to 2023.Methods:Training data from 2015 to 2023 were retrospectively collected from programs organized by the Guangdong Medical Association, including sessions in aesthetic surgery, dermatology, dentistry, traditional Chinese medicine, laser aesthetics, and injectable aesthetics. The training implementation was summarized. A random sample of 120 trainees was selected to complete a questionnaire to assess training outcomes.Results:A total of 45 offline standardized training sessions were held, covering both theoretical and practical instruction. The total training duration reached 180 days, involving 6 776 participant attendances. Aesthetic surgery accounted for the highest number (1 701 attendances), followed by aesthetic dermatology (1 197 attendances). Among specialized technical programs, laser aesthetics (1 708 attendances) and injectable aesthetics (1 578 attendances) had the most participants. Most trainees (5 705 attendances) were physicians from tertiary public general hospitals. A total of 116 questionnaires were collected, with 115 participants expressing satisfaction with the course content, teaching arrangement, and training materials. All trainees passed the skills assessment and received training certificates.Conclusions:The standardized training for medical aesthetic practitioners in Guangdong province from 2015 to 2023 has been well implemented and shows favorable outcomes. It contributes to improving the technical competence of professionals in the medical aesthetics field.

Objective:To investigate the efficacy and safety of sentinel lymph node dissection in the treatment of early cervical cancer.Methods:This study used a prospective study design. A total of 122 patients with early cervical cancer who received treatment at Jinhua Maternal & Child Health Care Hospital form June 2022 to June 2024 were included in this study. These patients were divided into an observation group and a control group ( n = 61/group) using a random number table method. In the observation group, sentinel lymph node resection instead of systematic lymphadenectomy was performed, while in the control group, systematic lymphadenectomy was performed. Perioperative indicators, postoperative lymph node pathology results, complications, and postoperative tumor recurrence rates were compared between the two groups. Additionally, sentinel lymph node imaging results were evaluated in the observation group. Results:After treatment, the surgical time, duration of pelvic drainage tube retention, duration of catheter retention, postoperative hospital stay, number of lymph nodes dissected, and time to postoperative bowel function recovery in the observation group were (178.33 ± 8.29) minutes, (7.19 ± 1.38) days, (11.73±2.57) days, (8.09±1.34) days, (12.48 ± 2.63), and (2.28 ± 0.69) days, respectively. These values were significantly shorter or lower than those in the control group [(239.41 ± 9.83) minutes, (9.74 ± 1.75) days, (12.88 ± 2.76) days, (9.53 ± 1.47) days, (133.27 ± 11.43) mL, (26.18 ± 2.27), (3.12 ± 0.98) days, t = 37.10, 8.94, 2.38, 5.65, 30.80, 5.47, all P < 0.05]. There were no statistically significant differences in postoperative pathological results between the two groups ( χ2 = 2.03, 0.12, both P > 0.05). The overall incidence of perioperative complications in the observation group was significantly lower than that in the control group [1.46% (1/61) vs. 8.19% (5/61), χ2 = 5.55, P < 0.05). Conclusions:Sentinel lymph node resection can significantly enhance the perioperative outcomes of patients with cervical cancer and reduce the incidence of complications. Additionally, there were no recurrences of cervical cancer during the follow-up period. Therefore, sentinel lymph node resection is a safe and feasible procedure.

Objective:To analyze the implementation and effectiveness of standardized training for medical aesthetic practitioners in Guangdong province from 2015 to 2023.Methods:Training data from 2015 to 2023 were retrospectively collected from programs organized by the Guangdong Medical Association, including sessions in aesthetic surgery, dermatology, dentistry, traditional Chinese medicine, laser aesthetics, and injectable aesthetics. The training implementation was summarized. A random sample of 120 trainees was selected to complete a questionnaire to assess training outcomes.Results:A total of 45 offline standardized training sessions were held, covering both theoretical and practical instruction. The total training duration reached 180 days, involving 6 776 participant attendances. Aesthetic surgery accounted for the highest number (1 701 attendances), followed by aesthetic dermatology (1 197 attendances). Among specialized technical programs, laser aesthetics (1 708 attendances) and injectable aesthetics (1 578 attendances) had the most participants. Most trainees (5 705 attendances) were physicians from tertiary public general hospitals. A total of 116 questionnaires were collected, with 115 participants expressing satisfaction with the course content, teaching arrangement, and training materials. All trainees passed the skills assessment and received training certificates.Conclusions:The standardized training for medical aesthetic practitioners in Guangdong province from 2015 to 2023 has been well implemented and shows favorable outcomes. It contributes to improving the technical competence of professionals in the medical aesthetics field.

ObjectiveTo investigate the mechanism of Baihuan Xiaoyao Decoction （Xiaoyaosan added with Lilii Bulbus and Albiziae Cortex） in alleviating depression-like behaviors of juvenile rats by regulating the polarization of microglia. MethodSixty juvenile SD rats were randomized into normal control， model， fluoxetine， and low-， medium-， and high-dose （5.36， 10.71， 21.42 g·kg^-1， respectively） Baihuan Xiaoyao decoction groups. The rat model of juvenile depression was established by chronic unpredictable mild stress （CUMS）. The sucrose preference test （SPT） was carried out to examine the sucrose preference of rats. Forced swimming test （FST） was carried out to measure the immobility time of rats. The open field test （OFT） was conducted to measure the total distance， the central distance， the number of horizontal crossings， and the frequency of rearing. Morris water maze （MWM） was used to measure the escape latency and the number of crossing the platform. The immunofluorescence assay was employed to detect the expression of inducible nitric oxide synthase （iNOS， the polarization marker of M1 microglia） and CD206 （the polarization marker of M2 microglia）. Real-time polymerase chain reaction was employed to determine the mRNA levels of iNOS， CD206， pro-inflammatory cytokines ［tumor necrosis factor （TNF）-α， interleukin （IL）-1β， and IL-6］ and anti-inflammatory cytokines （IL-4 and IL-10） in the hippocampus. Western blotting was employed to determine the protein levels of iNOS and CD206 in the hippocampus. The levels of IL-4 and IL-6 in the hippocampus were detected by enzyme-linked immunosorbent assay. ResultCompared with the normal control group， the model rats showed a reduction in sucrose preference （P<0.05）， an increase in immobility time （P<0.05）， decreased motor and exploratory behaviors （P<0.05）， and weakened learning and spatial memory （P<0.05）. In addition， the model rats showed up-regulated mRNA and protein levels of iNOS and mRNA levels of IL-1β， IL-6， and TNF-α （P<0.05）. Compared with the model group， Baihuan Xiaoyao decoction increased the sucrose preference value （P<0.05）， shortened the immobility time （P<0.01）， increased the motor and exploratory behaviors （P<0.05）， and improved the learning and spatial memory （P<0.01）. Furthermore， the decoction down-regulated the positive expression and protein level of iNOS， lowered the levels of TNF-α， IL-1β， and IL-6 （P<0.01）， promoted the positive expression of CD206， and elevated the levels of IL-4 and IL-10 （P<0.01） in the hippocampus of the high dose group. Moreover， the high-dose Baihuan Xiaoyao decoction group had higher sucrose preference value （P<0.01）， shorter immobility time （P<0.01）， longer central distance （P<0.01）， stronger learning and spatial memory （P<0.01）， higher positive expression and protein level of iNOS （P<0.01）， lower levels of TNF-α， IL-1β， and IL-6 （P<0.05， P<0.01）， lower positive expression and mRNA level of iNOS （P<0.05）， and higher levels of IL-4 and IL-10 （P<0.05， P<0.01） than the fluoxetine group. ConclusionBaihuan Xiaoyao decoction can improve the depression-like behavior of juvenile rats by inhibiting the M1 polarization and promoting the M2 polarization of microglia in the hippocampus.

AIM:To explore the mechanism by which Chaijin-Jieyu-Anshen tablet(CJJY)-medicated serum prevents synaptic injury in rat anterior cingulate cortex(ACC)neurons using an in vitro depression model.METHODS:Cells(astrocytes,microglia and neurons)were isolated from the ACC of SD rats.The isolated cells were characterized by immunofluorescence staining.An in vitro depression model was developed using 1 mg/L lipopolysaccharide(LPS)com-bined with 200 μmol/L corticosterone(CORT).These cells were divided into control group,model group(CORT+LPS),glucocorticoid receptor(GR)blocker(GR-)group(CORT+LPS+RU486),GR agonist(GR+)group(CORT+LPS+dexa-methasone),CX3C chemokine receptor 1(CX3CR1)blocker(CX3-)group(CORT+LPS+AZD8797),CX3CR1 agonist(CX3+)group(CORT+LPS+fractalkine),CJJY group(CORT+LPS+CJJY-medicated serum),CJJY/GR+group(CORT+LPS+CJJY-medicated serum+dexamethasone),and CJJY/CX3+group(CORT+LPS+CJJY-mediated serum+fractalkine).The morphological characteristics of all ACC cells were observed by high-content analysis.The levels of neuroendocrine-related factors,adrenocorticotropic hormone(ACTH),corticotropin-releasing hormone(CRH)and CORT,and neuroin-flammatory mediators,tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-6 and glutamate(Glu),in the cell supernatants were quantified by ELISA.Immunofluorescence staining was used to analyze the protein expression of GR and vesicular glutamate transporter 1(VGluT1)in astrocytes,as well as CX3CR1 and adenosine A2A receptor(A2AR)in microglia.Immunofluorescence staining with Nissl and β-tubulin was performed to evaluate synaptic damage in ACC neurons.RESULTS:In an in vitro model of depression,CJJY-medicated serum prevented morphological damage to ACC neurons,microglia and astrocytes.Moreover,CJJY-medicated serum reversed abnormal increases in the levels of ACTH,CRH,CORT,TNF-α,IL-1β,IL-6 and Glu in cell supernatants(P<0.05 or P<0.01).It was also found that CJJY-medi-cated serum reduced abnormal expression of GR,VGluT1,CX3CR1 and A2AR(P<0.05 or P<0.01),alleviating damage to the neuronal dendrites and dendritic spines of ACC neurons.CONCLUSION:The CJJY-medicated serum regulates GR/CX3CR1 double signaling in glia,and attenuates rat ACC neuronal synaptic damage in an in vitro depression model,indicating that CJJY-medicated serum controls depression by affecting the GR/CX3CR1 double signaling.

OBJECTIVE To optimize the extraction process and to primarily evaluate the anti-anxiety and anti-depression efficacy of polysaccharide from Baihe dihuang decoction. METHODS Based on Plackett-Burman experimental design， using the comprehensive score of yield and content of polysaccharide as indicators， with extraction time， water amount， alcohol precipitation concentration as factors， Box-Behnken response surface methodology was used to optimize the extraction process of polysaccharide from Baihe dihuang decoction； and the validation test was conducted. Forty ICR mice were divided into control group， venlafaxine group [positive control， 13.5 mg/（kg·d）]， Baihe dihuang polysaccharide high-dose and low-dose groups [5.28， 2.64 g/（kg·d），by raw material]， with 10 mice in each group （half male and half female）. Administration groups were given corresponding drug solution intragastrically， and control group was given water 10 mL/kg intragastrically， once a day， for 7 test， forced swimming test and tail suspension test were used to evaluate the effects of the extract prepared by the optimal process on the anxiety-like and depression-like behavior of mice； enzyme-linked immunosorbent assay was used to detect the effects of the extract on the levels of neurotransmitter in cerebral tissue of mice. RESULTS The optimal extraction process of Baihe dihuang decoction was： the water amount of 25 times， extract time of 1.5 hours， and alcohol precipitation concentration of 70%. In 3 times of validation test， the average yield and content of polysaccharide were 33.10% and 0.62 mg/mg， the relative deviations of which from the predicted values （36.14% and 0.65 mg/mg） were 8.40% and 4.62% respectively （RSD＜2%， n＝3）. The polysaccharide extract of Baihe dihuang decoction could effectively increase the percentages of open-arms entry， the percentages of open-arms time， the total distance of voluntary activities and the activity distance in central area， and significantly shortened the immobility time of forced swimming test and tail suspension test （P＜0.05 or P＜0.01）. The polysaccharide extract could significantly increase the levels of 5-hydroxytryptamine， norepinephrine （except for the Baihe dihuang polysaccharide low-dose group） and gamma-aminobutyric acid in cerebral tissue of mice， while significantly decrease the levels of glutamic acid （except for the Baihe dihuang polysaccharide low-dose group） （P＜0.05 or P＜ 0.01）. CONCLUSIONS The optimized extraction process of polysaccharide from Baihe dihuang decoction is stable and feasible， and the obtained polysaccharide extract has obvious anti-anxiety and anti-depression effect in vivo.

In Vivo Dosimetry ; Radiotherapy Dosage ; Radiometry/methods* ; Electronics ; Radiotherapy, Intensity-Modulated/methods* ; Phantoms, Imaging ; Algorithms

Objective:To design a knowledge-based cervical cancer planning model and apply it to cases of endometrial cancer and rectal cancer in order to explore the generalization of the model.Methods:A total of 179 cases of pelvic regions with different prescribed doses of dual-arc volumetric modulated arc therapy clinical plans were collected, of which 99 cases of cervical cancer clinical plans with a prescribed dose of 50.4 Gy were used as the training set to establish the RapidPlan model, and the remaining clinical plans were divided into 4 validation groups with 20 cases in each group. The clinical plans for cervical cancer and endometrial cancer with a prescription dose of 50.4 Gy were named groups A and B, while the clinical plan for endometrial cancer and rectal cancer with a prescription dose of 45 Gy were named groups C and D. The model was used to redesign the clinical plans in the 4 groups and the automatic plans were obtained. The planning target volume (PTV) and organ at risk (OAR) dosimetry parameters were compared between automatic plans and clinical plans.Results:The conformity index (CI) of the automatic plans in the A, B, C, and D groups were equivalent to that of the clinical plans ( P>0.05). The homogeneity index (HI) and D2% of the automatic plans in groups A, B, and C were all lower than those in clinical plans(HI, Z=-3.248, -3.360, -2.329, P<0.05; D2%, Z=-2.987, -3.397, -2.442, P<0.05). The HI and D2% of the automatic plans in group D were similar those in the clinical plans ( P>0.05). While ensuring the PTV coverage, the average value of OAR dosimetry parameters in all automatic plans groups were lower than that of the clinical plans. Conclusions:The RapidPlan model established by the cervical cancer clinical plans can complete the automatic plan design for endometrial cancer and rectal cancer under different prescription doses, which preliminarily proves the possibility of the generalization of the RapidPlan model.