Peritoneal metastasis is one of the common site of colorectal cancer metastasis and associated with a poor prognosis. The core strategy for colorectal cancer peritoneal metastasis primarily revolves around a comprehensive treatment approach with cytoreductive surgery and systemic chemotherapy as the mainstay, supplemented by intraperitoneal chemotherapy. As an important supplement to treatment, intraperitoneal chemotherapy has broad application prospects. The main modalities are hyperthermic intraperitoneal chemotherapy (HIPEC), neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), early postoperative intraperitoneal chemotherapy (EPIC), sequential postoperative intraperitoneal chemotherapy (SPIC), normothermic intraperitoneal chemotherapy (NIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). To promote the standardized application of intraperitoneal chemotherapy, further research on the mechanisms underlying peritoneal metastasis of colorectal cancer, selection of effective intraperitoneal chemotherapy agents, determination of optimal timing and administration protocols, exploration of the feasibility of sequential intraperitoneal chemotherapy and conduction of valuable basic and clinical research are currently needed. This paper will review the development and origins of intraperitoneal chemotherapy, treatment modalities, as well as the current application status and prospects of various treatment approaches in the context of peritoneal metastasis of colorectal cancer.

Peritoneal metastasis is one of the common site of colorectal cancer metastasis and associated with a poor prognosis. The core strategy for colorectal cancer peritoneal metastasis primarily revolves around a comprehensive treatment approach with cytoreductive surgery and systemic chemotherapy as the mainstay, supplemented by intraperitoneal chemotherapy. As an important supplement to treatment, intraperitoneal chemotherapy has broad application prospects. The main modalities are hyperthermic intraperitoneal chemotherapy (HIPEC), neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), early postoperative intraperitoneal chemotherapy (EPIC), sequential postoperative intraperitoneal chemotherapy (SPIC), normothermic intraperitoneal chemotherapy (NIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). To promote the standardized application of intraperitoneal chemotherapy, further research on the mechanisms underlying peritoneal metastasis of colorectal cancer, selection of effective intraperitoneal chemotherapy agents, determination of optimal timing and administration protocols, exploration of the feasibility of sequential intraperitoneal chemotherapy and conduction of valuable basic and clinical research are currently needed. This paper will review the development and origins of intraperitoneal chemotherapy, treatment modalities, as well as the current application status and prospects of various treatment approaches in the context of peritoneal metastasis of colorectal cancer.

Objective To observe the correlations of conventional ultrasound and contrast-enhanced ultrasound(CEUS)features with expression level of Ki-67 of intrahepatic cholangiocarcinoma(ICC).Methods A total of 77 patients with pathologically confirmed ICC were retrospectively enrolled.According to the expression level of Ki-67 of target lesions,the patients were divided into high expression group(Ki-67≥20%,n=53)and low expression group(Ki-67＜20%,n=24).The features showed on conventional ultrasound and CEUS were compared between groups,and the variables being significantly different were analyzed with multivariate logistic regression to select ultrasonic features being correlated with Ki-67 expression level of ICC.Results The mean maximum diameter of ICC in high expression group was larger than that in low expression group([6.2±2.0]cm vs.[5.2±1.9]cm,P=0.041),and the percentage of ICC with maximum diameter>5 cm in high expression group was higher than that in low expression group(66.04%vs.33.33%,P=0.007).No significant difference of the lesions shape,border nor the internal echogenicity showed on conventional ultrasound was found between groups(all P＞0.05).The percentage of ICC with peripheral rim enhancement and enlargement after enhancement in high expression group were both higher than those in low expression group(both P＜0.05),but no significant difference of the enhancement pattern,the presence or absence of non-enhance area within the lesion nor the peak intensity of lesions was found between groups(all P＞0.05).The maximum diameter larger than 5 cm(OR=5.612,P=0.004)and peripheral rim enhancement(OR=3.880,P=0.025)were both independent factors for predicting high Ki-67 expression level of ICC.Conclusion ICC with the maximum diameter larger than 5 cm and peripheral rim enhancement on CEUS might indicate high expression level of Ki-67,which was helpful for clinical treatment decisions.

Objective:To identify the risk factors and to construct a predictive model for early postnatal mortality (with the first 7 days of life) in extremely preterm infants.Methods:This retrospective study involved 244 extremely preterm infants with a gestational age of 22 to 27 weeks and 6 days, born at the Affiliated Hospital of Jining Medical College from January 2017 to December 2022. They were divided into an early survival group ( n=140) and an early mortality group ( n=84), based on survival for ≥7 days after birth. LASSO and logistic regression were used to select risk factors for early mortality. A nomogram predictive model was constructed using the R software program. The goodness-of-fit tests, area under the curve (AUC), calibration curves, and decision curves were used to evaluate its performance and clinical usefulness. Results:LASSO regression and multivariate logistic regression analyses showed that breech delivery ( OR=3.055, 95% CI: 1.125-8.296), intubation in the delivery room ( OR=4.320, 95% CI: 1.328-14.053), diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h after birth ( OR=11.552, 95% CI: 3.056-43.677), and use of adrenaline in the delivery room ( OR=10.706, 95% CI: 1.454-78.816) were risk factors for early mortality in extremely preterm infants. Conversely, large gestation age ( OR=0.234, 95% CI: 0.125-0.436), antenatal administration of corticosteroids to promote fetal lung maturity ( OR=0.046, 95% CI: 0.014-0.145), and the use of pulmonary surfactant within 6 h after birth ( OR=0.021, 95% CI: 0.004-0.122) were protective factors against mortality. The goodness of fit test of the early death risk nomogram prediction model for extremely preterm infants indicates a good fit ( P=0.702). The AUC of the model was 0.963 (95% CI: 0.943-0.983), with a sensitivity of 0.904 (95% CI: 0.806-0.949), specificity of 0.892 (95% CI: 0.829-0.938), and accuracy of 0.880. Decision curve analysis indicated that a threshold probability>2% would yield a net benefit. Conclusions:Breech delivery, intubation in the delivery room, use of adrenaline in the delivery room, and the diagnosis of grade Ⅲ-Ⅳ neonatal respiratory distress syndrome within 6 h post-birth are independent risk factors for early mortality in extremely preterm infants. Large gestational age, antenatal administration of corticosteroids to promote fetal lung maturity and use of pulmonary surfactant within 6 h after birth are protective factors. The constructed prediction model based on the aforementioned factors can quantitatively, conveniently, and intuitively assess the risk of early mortality in extremely preterm infants.

AIM: To explore the effect of spinal anesthesia on ventricular arrhythmia and involved mechanisms in myocardial ischemia-reperfusion (MIR) rats. METHODS: The rat MIR model was made by occlusion the left anterior descending coronary artery for 30 minutes and reperfusion for 45 minutes. Bupivacaine (0.05 mL / 100 g, 1 mg / kg) was injected slowly via intrathecal for spinal anesthesia. The electromyelogram at T2 thoracic spinal cord was recorded. Ventricular arrhythmias, cardiac function, myocardial damage were assessed by electrocardiography, echocardiography and TTC or HE staining. RESULTS: MIR reduced left ventricular short-axis shortening (LVFS) and left ventricular ejection fraction (LVEF), caused myocardial histological damage and ventricular arrhythmias, promoted spinal electrical discharge frequency and amplitude in T2 dorsal horn. Spinal injection of bupivacaine could significantly reduce spinal cord electrical activities and eliminate MIR-induced arrhythmias. Moreover, bupivacaine also significantly improved MIR-induced myocardial histological damage and cardiac function inhibition. CONCLUSION: Spinal anesthesia can reduce ventricular arrhythmias induced by MIR. The mechanism may be related to the effect of abolishing spinal nerve excitability.

Objective:To understand the psychological experiences of adolescents with comorbid depression and anxiety disorders who have completed Williams life skills training (WLST) .Methods:This is a qualitative study. A total of 16 adolescents with comorbid depression and anxiety disorders who were treated at Hangzhou Seventh People's Hospital between March 2021 and January 2022 and completed the WLST during their hospitalization were selected by purposive sampling. Semi-structured interviews were conducted to gather and subsequently analyze interview data, leading to the extraction of main themes.Results:The psychological experiences of adolescents with comorbid depression and anxiety disorders after completing WLST included correctly recognizing and effectively addressing social phobia, strengthening psychological adjustment capabilities and enhancing self-efficacy, discovering a sense of belonging within a group.Conclusions:WLST can change depression and anxiety conditions, alleviate the fear of social interactions, enhance self-regulation efficacy, provide a sense of belonging within a team, maintain good mental and physical health, and improve the quality of life in adolescents with comorbid depression and anxiety disorders.

Schizophrenia is a serious mental disease. The diagnosis of schizophrenia so far relies heavily on subjective evidence, including self-reported experiences by patients, manifestations described by relatives, and abnormal behaviors assessed by psychiatrists. The diagnosis, monitoring of the disease progression and therapy efficacy assessment are challenging due to the lack of established laboratory biomarkers. Based on the current literature, clinical consensus, guidelines, and expert recommendations, this review highlighted evidence-based potential laboratory biomarkers for the diagnosis of schizophrenia, including genetic biomarkers, neurotransmitters, neurodevelopmental-related proteins, and intestinal flora, and discussed the potential future directions for the application of these biomarkers in this field, aiming to provide an objective basis for the use of these biomarkers in the early and accurate diagnosis, treatment, and prognosis and rehabilitation assessment of schizophrenia.

Objective:To construct an early predictive model for the death of patients after extracorporeal membrane oxygenation (ECMO) based on the baseline information of patients and laboratory indicators.Methods:The clinical data of 139 patients who underwent ECMO in Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2015 to December 2021 were collected, including age, gender, primary disease, ECMO model, other clinical characteristics, and laboratory indicators 2 hours after establishment of ECMO. The patients were divided into training cohort ( n = 111) and validation cohort ( n = 28) according to a ratio of 4∶1. The least absolute shrinkage and selection operator (Lasso) regression and multivariate Logistic regression were used to select predictive factors, and a nomogram was used to establish the predictive model. The calibration and discrimination of the model were assessed using the receiver operator characteristic curve (ROC curve), the calibration curve and Kaplan-Meier analysis. Results:Four predictive variables including anion gap (AG), lactic acid (Lac), arterial partial pressure of oxygen (PaO 2), and serum amylase (AMY) 2 hours after ECMO were selected from 34 laboratory indicators by Lasso regression. These variables and three other clinically important factors [primary diseases, ECMO model, and acute kidney injury (AKI)] were analyzed using multivariate Logistic regression (forward: LR method), Finally, four strong predictive factors (Lac-2 h, PaO 2-2 h, AMY-2 h, and primary diseases) for mortality were used to construct a nomogram [the area under ROC curve (AUC) was 0.85, 95% confidence interval (95% CI) was 0.78-0.92]. The optimal cut-off value of the ROC curve was 0.398 based on the maximum principle of the Youden index, corresponding to 80.2% accuracy, 89.1% sensitivity, and 68.1% specificity. The validation cohort with an in-hospital mortality of 64.3% was used to verify the performance of the model by ROC curve and Kaplan-Meier analysis. According to the optimal cut-off value of the ROC curve (0.398), the validation cohort was divided into low- and high-risk groups. Based on this model, the survival probability of the low-risk group was significantly higher than that of the high-risk group ( P = 0.018), indicating this model had good discriminative ability in the validation cohort. Based on this model, the AUC of the validation cohort was 0.76, 95% CI was 0.58-0.94, and the accuracy rate was 71.43%, which indicated this model showed good calibration consistency. Conclusions:The predictive model incorporating Lac-2 h, PaO 2-2 h, AMY-2 h, and primary diseases may be significant for predicting the in-hospital mortality of patients undergoing ECMO.

Objective:To investigate the epidemiological characteristics and relevant factors among individuals characterized by their longevity in multiple regions of Guangxi Zhuang Autonomous Region, and provide a valuable scientific perspective for the research in health and longevity of the elderly in Guangxi.Methods:Registration and face-to-face questionnaire on a door-to-door basis were adopted to collect the demographic characteristics of the long-lived individuals (≥90 years old) in Bama of Hechi city, Yongfu of Guilin city, Dongxing of Fangchenggang city, Guangxi. Then, among the local general population, individuals within the age group between 40 and 85 years old were selected randomly as controls. Correlations were then analyzed between the relative health and longevity of the subjects and their gender, ethnicity, family history, disease history, marital status, the number of family generations, the number of children, smoking, drinking, outdoor activities, sleep and other health-related factors, then the result was subject to further analysis by comparing the long-lived population and the control population respectively.Results:Among 691 500 of the permanent residents of Bama, Yongfu and Dongxing city, 1 005 cases were 90 years old and over with a ratio of 145.34 out of 100 000 persons; within the 1 005 cases, 944 were aged between 90 and 100 (longevity rate: 136.51/100 000) with an average age of (93.28±2.57); 61 cases were aged 100 or over, arriving at a centenarian rate of 8.82/100 000 with an average age of (102.00±3.05) years. Significant differences were found just among three particular factors — regional distribution ( P=0.014), history of disease ( P=0.002), four generations of family ( P=0.008) between nonagenarians and centenarians ( P<0.05), while the other 15 indicators did not show anything noteworthy. The result indicated that longevity and centenarians might be the same group and then we combined both groups into one. By cross-comparison between the longevity-plus- centenarians and the control group in the region, factors listed below exhibited significant correlation with health and longevity: marital status ( OR=26.469, 95% CI: 13.208-53.045), number of generations within the family ( OR=5.419, 95% CI: 3.418-8.592), number of male offspring ( OR=2.013, 95% CI: 1.555-2.607), number of female offspring ( OR=1.380, 95% CI: 1.122-1.696), and the frequency of outdoor activities ( OR=10.226, 95% CI: 3.164-33.045). Conclusions:The longevity rate is higher in the general natural population in Bama, Yongfu and Dongxing of Guangxi. The phenomenon may owe to favorable family structure, atmosphere within or out of the family or other elements related with social surrounding. Among them all, mentality, inclination to physical exercise and regular rhythm of life may all exert tremendous contributory influence here.

Objective:To explore the epidemiologic characteristics of long-lived population and influencing factors in Shanglin county of Guangxi and provide scientific basis for the study of health and longevity in Guangxi.Methods:We collected and analyzed the general demographic cross-sectional data of the long-lived individuals (≥90 years old) in 11 villages and towns by multi-source registration and face-to-face interview. The age group control design was adopted to conduct a comparison among the longevity group (90-100 years old), centenarian group (≥100 years old), the longevity plus centenarian group and control group (local population aged 40-85 years), and identify the factors related to longevity.Results:Among the 496 007 people registered in Shanglin, 1 533 were aged ≥90 years, including 1 453 in the longevity group, with an average age of (92.84±2.46) years, and 80 in the centenarian group, with an average age of (102.67±2.60) years. The spatial distribution of long-lived individuals and centenarians was mainly in the north and central areas, and sparse in southwest area. Analysis on factors related to health and longevity indicated that old people with Zhuang ethnic ( OR=1.551,95% CI:1.308-1.838), married ( OR=55.507,95% CI:36.087-85.377) and moderately high waist-to-hip ratio ( OR=258.056,95% CI:27.775-2 397.569), and SBP ( OR=1.019,95% CI:1.013-1.026) tended to live longer. Conclusions:We found that the rate of longevity in Shanglin was higher than the average level in Guangxi and China. Longevity in Shanglin country had unique spatial and population distribution characterics of female longevity more than male longevity, mainly Zhuang ethnic and so on. Being women, married, family history of longevity, appropriate high waist-to-hip ratio, SBP and blood sugar level might be positive factors for longevity in Shanglin, but the impacts of other factors on longevity need further study.