Working memory training,as a low-cost and efficient computerized cognitive training,can improve the cognitive function and behavioral decision-making of chronic disease patients,enhance their self-management awareness and ability,and demonstrate good application prospects in chronic disease management.This article reviewed the origin and development of working memory training,its application in chronic disease management,effectiveness evaluation,application challenges,and suggestions,providing references for improving the quality of chronic disease management.

Objective:To summarize experience of managing adult Langerhans cell histiocytosis(LCH) in hypothalamic-pituitary region(HPR) from Shanghai Huashan Hospital.Methods:Adult HPR-LCH patients diagnosed at oar endocrinology department from January 2013 to February 2022 were included. Clinical characteristics and treatment response were retrospectively analyzed.Results:A total of 27 adult HPR-LCH patients were included, with 14 cases involving the hypothalamus(H group) and 13 cases without(group NH). The common radiological findings included thickening of the pituitary stalk(25/27, 92.6%). At the time of diagnosis, 14 cases(51.9%) presented with panhypopituitarism, and 19 cases(70.4%) exhibited metabolic abnormalities. The group H had higher proportions of adrenal insufficiency, central hypothyroidism, panhypopituitarism, and diabetes compared to group NH(78.6% vs 23.1%; 78.6% vs 23.1%; 92.9% vs 30.8%, 35.7% vs 0%, respectively, all P<0.05). Hypothalamus syndrome was identified in 71.4%(10/14) of group H. The inital diagnosis rate was 79.2%(19/24), with 48.1% and 51.9% through biopsy of sellar and extrasellar lesions, respectively. Repeated biopsies confirmed the diagnosis in 25.9%(7/27) of cases. The peripheral lesions included bone, thyroid, lung, lymph node, thymus and liver. Out of 20 cases treated with chemotherapy, the objective response rate was 85% at 12 weeks. Four cases received local therapy, one case received traditional Chinese medicine treatment, one case abandoned treatment, and one case was lost to follow-up. The median follow-up time was 28(range 15 to 54) months. During this period, there were 3 deaths in group H and 1 death in group NH. Conclusion:Adult HPR-LCH patients presented with diabetes insipidus and high prevalences of hypopituitarism, hypothalamus syndrome and metabolic abnormalities. Typical imaging features were pituitary stalk thickening. A solitary mass in the HPR was usually very small, posing a great challenge for early diagnosis. Systemic evaluation would help to clarify the diagnosis. Patients with hypothalamus involvement had a higher mortality rate, suggesting the hypothalamus as a risk organ with poor prognosis.

Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic sleeve gastrectomy (LSG).Method:The retrospective cohort study was conducted. The clinical data of 1 181 patients undergoing LSG in the Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected. There were 242 males and 939 females, aged (31±8)years. Of 1 181 patients, 598 cases receiving routine perioperative care were divided into the control group, and 583 cases receiving perioperative care with ERAS were divided into the ERAS group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between the groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney rank sum test was used for comparison between the groups. Count data were expressed as absolute numbers or percentages, and the chi-square test or Fisher exact probability were used for comparison between the groups. Repeated measurement data were analyzed using the repeated ANOVA, with baseline scores as covariates. Simple effects analysis was conducted in case of interaction, and multiple comparisons were adjusted using the Bonferroni method. Results:(1) Postoperative outcomes. The numerical rating scale (NRS) scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35±0.93 to 2.57±0.83 in the control group, versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group, showing significant difference between the two groups ( Ftime=66.58, Fgroup=1 765.85, Finteraction=6.90, P<0.05). After adjusting NRS scores for pain at immediate return to the ward as the baseline, results of simple effects analysis showed that on the third postoperative mornings, the NRS scores in the ERAS group were lower by 1.89, 1.53, and 1.76 respectively compared to the control group ( P<0.05). Cases with nausea at immediate return to the ward and on the third postoperative mornings changed from 497 to 97 in the control group, versus changed from 198 to 11 in the ERAS group, showing signifi-cant difference between the two groups ( χ2=294.45, 398.76,209.39, 73.00, P<0.05). Cases with vomiting at immediate return to the ward and on the third postoperative mornings changed from 243 to 41 in the control group, versus changed from 51 to 2 in the ERAS group, showing significant difference between the two groups ( χ2=160.54, 149.37, 71.76, 35.69, P<0.05). The duration of postoperative hospital stay was (3.22±0.65)days in the control group, versus (2.17±0.49)days in the ERAS group, showing a significant difference between the two groups ( t=-11.89, P<0.05). (2) Complications. The incidence of cases with dehydration within postoperative 30 days was 0.50%(3/598) in the control group, versus 0.69%(4/583) in the ERAS group, showing no significant difference between the two groups ( P>0.05). None of patient in the control group and the ERAS group experienced bleeding, gastric leakage, intra-abdominal infection, and no patient had unplanned secondary surgery within postoperative 30 days. Conclusions:ERAS in perioperative period of LSG are safe and feasible. Compared to routine care, ERAS can significantly reduce postoperative pain, decrease the incidence of postoperative nausea and vomiting, shorten the postoperative hospital stay, and do not increase the rate of postoperative complications or unplanned secondary surgeries within postoperative 30 days.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Objective To investigate the correlation between baseline data,early treatment response and prognosis in children with acute lymphoblastic leukemia(ALL).Methods Ninety-two children with ALL were divided into the endpoint event group(19 cases)and the event-free survival group(73 cases)according to whether there was an endpoint event(recurrence or death).The age and gender at initial diagnosis were recorded.Initial white blood cell count(WBC),platelet count(PLT),immunophenotype,chromosome karyotype,fusion gene,prednisone test,bone marrow remission status on the 15th day of induction chemotherapy and minimal residual disease(MRD)on the 15th,33rd and 55th day of induction chemotherapy were detected.The correlation between the above baseline data and early treatment response and the occurrence of endpoint event in children with ALL was analyzed.Logistic regression was used to analyze influencing factors of endpoint events in children with ALL.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of baseline data and early treatment response to endpoint events in children with ALL.Results The proportion of WBC≥100×109/L at first diagnosis,prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were higher in the endpoint event group than those in the event-free survival group(P<0.05),and there were no significance differences in remaining indicators(P>0.05).Logistic regression analysis showed that prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were risk factors for endpoint event in children with ALL(P<0.05),and the combined value of the two indicators was better than that of a single indicator in predicting endpoint events in children with ALL.Conclusion Prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy are associated with recurrence and death in children with ALL.

Objective:To analyze the monitoring results of iodine deficiency disorders (IDD) in Hainan Province from 2011 to 2023, key prevention and control measures taken during this period, and the impact of related events on the monitoring results.Methods:From 2011 to 2023, a systematic sampling method was used to divide 21 cities (districts, counties) in Hainan Province into 5 districts based on east, west, south, north, and center each year. One township (street) was selected from each district, and 40 children aged 8 - 10 (non boarding students) and 20 pregnant women were selected from each township (street) for determination of iodine level of their household salt and urine samples. Based on the monitoring results, the impact of key events such as the pre reduction (2011), post reduction (implementation of new iodized salt standard, 2012 - 2023), salt industry system reform (2017), and the two-year campaign for endemic disease prevention and control (2019, 2000), on the salt iodine coverage rate and qualified iodized salt consumption rate, the urinary iodine level and its distribution in children and pregnant women were analyzed in Hainan Province. B-ultrasound was used to detect the situation of thyroid enlargement was analyzed.Results:(1) In 2011, the median iodine level in edible salt of residents in Hainan Province was 32.1 mg/kg. It was 30.8 mg/kg after the implementation of the new standard in 2012. In 2013, the salt iodine level of residents had significantly decreased to 25.9 mg/kg, with 24.5, 24.2, and 23.8 mg/kg in 2017, 2019, and 2020, respectively. The differences of median salt iodine levels between different years were statistically significant ( H = 29.01, P < 0.001). The coverage rate of iodized salt among residents in Hainan Province from 2011 to 2023 was 98.08% (80 727/82 308), and the difference between different years was statistically significant (χ 2 = 9.51, P = 0.023). The consumption rate of qualified iodized salt was 95.65% (78 738/82 308), and the difference between different years was statistically significant (χ 2 = 21.80, P < 0.001). (2) The median urinary iodine level of children from 2011 to 2023 was 177.5 μg/L, with a median of 204.2 μg/L in 2011. After the implementation of the new standard, the median urinary iodine level of children was 194.9 μg/L in 2012. In 2013, the median urinary iodine level in children decreased to 167.8 μg/L, and had remained within the range of 100 - < 200 μg/L thereafter. In 2017, 2019, and 2020, the median urinary iodine levels were 170.4, 172.8, and 186.3 μg/L, respectively. There was no statistically significant difference in different years ( H = 1.67, P = 0.061). The proportion of children with urinary iodine < 100 μg/L from 2011 to 2023 was 16.29% (8 740/53 634), and the proportion of children with urinary iodine between 100 and < 200 μg/L was 43.96% (23 575/53 634). The differences between different years were statistically significant (χ 2 = 21.50, 23.40, P < 0.001). The childhood goiter rate from 2011 to 2023 was 0.19% (101/53 634). (3) The median urinary iodine level of pregnant women was 153 μg/L in 2011, it was 154.7 μg/L in 2012 after the implementation of the new standard, and it had remained within the range of 100 - < 150 μg/L since then. The median urinary iodine level of pregnant women was 126.2 μg/L in 2013. The median urinary iodine level in 2017, 2019 and 2020 were 123.5, 133.8, and 135.4 μg/L, respectively. There was a statistically significant difference in the median urinary iodine levels of pregnant women between different years ( H = 92.10, P < 0.001). From 2011 to 2023, the proportion of pregnant women with a median urinary iodine level < 150 μg/L was the highest (55.75%, 14 761/26 477). Conclusion:From 2011 to 2023, although the monitoring results of iodine deficiency disorders in children and pregnant women in Hainan Province have fluctuated, they are still in a state of continuous elimination of IDD.

Objective To explore the experience and causes of self-neglect of elderly diabetic patients in community,so as to provide references for community nursing workers to identify and intervene the self-neglect behavior of elderly diabetic patients.Methods An interpretative phenomenological method was used to collect data from elderly diabetic patients registered in 3 community health service centers in Hangzhou,Zhejiang Province through semi-structured interviews.Van Manen's method was used to analyze qualitative data.Results The experience and reasons of self-neglect of elderly diabetic patients in community were summarized into 4 themes and 10 sub-themes,including neglecting personal health(low sense of self-worth,high level of self-esteem,being afraid of compromising the family),neglecting blood glucose management(weak health awareness,difficulty in blood glucose management),inadequate self-care capacity(poor financial situation,insufficient personal time,diminished mobility)and inadequate perceived support(low social support,insufficient emotional support).Conclusion The experience and reasons of self-neglect of elderly diabetic patients in community are diversified.Community health services and nursing workers should pay attention to the performance of self-neglect behavior of elderly diabetic patients and actively explore effective prevention and intervention measures.

Objective An HPLC-MS/MS method was established for the simultaneous determination of 7 components in Qingkailing Oral Liquid.Methods The assay was performed on a Waters ACQUITY UPLC BEH C18 column(2.1 mm×10 mm,1.7 μm)and the sample was eluted with a gradient mobile phase containing 10 mmol·L-1 of ammonium acetate and 0.1%of formic acid in water(A)-methanol(B).The mass spectrometry was carried out by electrospray ionization(ESI)with positive/negative ions in multiple reaction monitoring(MRM)mode for quantitative analysis.Results The linear ranges of adenine,chlorogenic acid,caffeic acid,geniposide,baicalin,hyodeoxycholic acid and cholic acid were 0.100 4-3.213,0.784 5-8.982,0.998-3.194,0.622 5-19.92,25.05-300.6,2.513-30.15 and 7.775-93.30 μg·mL-1(r≥0.999 0).The average recoveries(n=6)were 100.9%,98.74%,101.2%,100.2%,100.8%,99.97%and 98.94%with RSD of 1.58%,0.59%,1.78%,1.25%,0.65%,1.69%and 1.07%.The contents of the above mentioned 7 components in 15 tested samples were in the ranges of 0.12-0.18,0.19-0.24,0.06-0.09,0.34-0.37,4.54-4.85,0.49-0.67 and 1.82-2.19 mg·mL-1.The contents of 7 components in tested sample from different manufacturers were closed.Conclusion The method has shown good sensitivity,accuracy,and repeatability.The study can provide reference and data support for the quality control and subsequent research of Qingkailing Oral Liquid.

Objective: To investigate the factors affecting depression and anxiety symptoms among the elderly, so as to provide the basis for promoting mental health among the elderly. Methods: The elderly aged 60 years and above in Ningbo City, Zhejiang Province were recruited using the multistage stratified random sampling method from June to August 2022, and demographic information, lifestyle and self-rated health status were collected by questionnaires. The symptoms of depression and anxiety were assessed by the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. The presence of depressive and anxiety symptoms was determined when both the PHQ-9 score and the GAD-7 score were 10 points and higher. Factors affecting depressive and anxiety symptoms were identified using a multivariable logistic regression model. Results: A total of 7 771 individuals were surveyed, including 3 490 males (44.91%) and 4 281 females (55.09%), and had a mean age of (72.11±6.79) years. The prevalence of depression and anxiety symptoms was 2.05%. Multivariable logistic regression analysis identified residence (urban area, OR=0.316, 95%CI: 0.201-0.498), sedentary duration (<3 h/d, OR=0.349, 95%CI: 0.232-0.525; 3-5 h/d, OR=0.458, 95%CI: 0.313-0.671), physical activity (≥3 times/week, OR=0.551, 95%CI: 0.373-0.815), sleep quality (poor, OR=2.491, 95%CI: 1.738-3.571), social isolation (OR=1.688, 95%CI: 1.148-2.481) and self-rated health (poor, OR=5.857, 95%CI: 3.547-9.671; normal, OR=1.903, 95%CI: 1.234-2.937) as the influencing factors for depression and anxiety symptoms among the elderly. Conclusion The prevalence of depression and anxiety symptoms among the elderly is associated with residence, sedentary duration, sleep quality, physical activity, social interactions and self-rated health status.