Objective To explore the economic toxicity perceptions and experiences of caregivers of colorectal cancer patients from the perspective of social ecological systems theory.Methods Using purposive sampling,18 caregivers of colorectal cancer patients hospitalized in the gastrointestinal sur-gery and oncology departments of a tertiary grade A hospital in Yangzhou were selected for semi-struc-tured interviews.The Colaizzi 7-step analysis method was employed to organize and analyze the data.Results Three main themes and nine sub-themes were extracted regarding the economic toxicity expe-riences and needs of caregivers of colorectal cancer patients.Microsystem included multiple negative experiences,impacted individual health,and difficulties in surrogate decision-making;mesosystem in-cluded heavy family financial burden,altered family lifestyle,and tense family atmosphere;macrosys-tem included needs for the scope and intensity of medical insurance reimbursement,needs for medical resources and services,and a desire for social support.Conclusion The ecological system of caregiv-ers of colorectal cancer patients is not optimistic,and is generally affected by economic toxicity.Inter-vention strategies can be sought from multiple aspects,including alleviating the negative experiences of caregivers,strengthening social support,and paying attention to the needs of caregivers,aiming to re-duce the level of economic toxicity among caregivers of colorectal cancer patients.

Objective To explore the relationship between serum chitosinase 3-like protein 1(CHI3L1)and Syndecan-1(SDC1)levels and bone metabolism in elderly patients with type 2 diabetes mellitus and their predictive efficacy on osteoporosis.Methods A total of 412 elderly patients with type 2 diabetes admitted to this hospital from May 2019 to May 2023 were included in this study,and were divided into normal bone mass group(n=151),reduced bone mass group(n=138)and osteoporosis group(n=123)according to the iffer-ences in bone mineral density.Serum CHI3L1 and SDC1 levels were detected by enzyme-linked immunosor-bent assay,and serum levels of type 1 collagen cross-linked carboxyl terminal peptide(CTX),25-hydroxyvita-min D[25-(OH)D],osteocalcin(OC),and type 1 procollagen N-terminal propeptide(P1NP)were deter-mined by automatic chemiluminescence immunoassay.Pearson correlation analysis was used to investigate the relationship between serum CHI3L1,SDC1 and bone metabolism in elderly patients with type 2 diabetes.Re-ceiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum CHI3L1 and SDC1 on osteoporosis in elderly patients with type 2 diabetes.Multivariate Logistic regression analysis was used to investigate the influencing factors of osteoporosis in elderly patients with type 2 diabetes.Results There were significant differences in diabetes course,fasting blood glucose,HbA1c and HDL-C a-mong normal bone mass group,decreased bone mass group and osteoporosis group(P＜0.05).The levels of serum CHI3L1,25-(OH)D,P1NP and osteocalcin in osteoporosis group were lower than those in osteopenia group,and those in osteopenia group were lower than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum SDC1 and CTX levels in osteoporosis group were higher than those in osteopenia group,and those in osteopenia group were higher than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum CHI3L1 was positively correlated with 25-(OH)D,P1NP and OC(P＜0.05),and negatively correlated with CTX(P＜0.05).Serum SDC1 was negatively correlated with 25-(OH)D,P1NP,OC(P＜0.05),and positively correlated with CTX(P＜0.05).The area under the curve(AUC)of serum CHI3L1,SDC1 and their combination predicted osteoporosis in elderly pa-tients with type 2 diabetes were 0.851,0.772 and 0.904,respectively.Multivariate Logistic regression analysis showed that long duration of diabetes,increased HbA1c,high expression of OC,CHI3L1＞4.16 ng/mL,SDC1≥50.94 ng/mL were all influential factors for osteoporosis in elderly patients with type 2 diabetes(P＜0.05).Conclusion Low expression of CHI3L1 and high expression of SDC1 in serum are associated with ab-normal bone metabolism in elderly patients with type 2 diabetes.These two indexes are expected to be used as biological markers to predict osteoporosis in elderly patients with type 2 diabetes.

Objective To investigate the gene expression profile of cervical exfoliated cells from woman treated by artificial cycle,and their potential association with endometrial receptivity in order to screen specific biomarkers closely related to the receptivity.Methods A total of 19 female patients were enrolled from those preparing for frozen embryo transfer(FET)at the Reproductive Center of First Medical Center of Chinese PLA General Hospital from February 2024 to October 2024.Under the artificial cycle frozen embryo transfer protocol,the endometrial tissues were collected on the 4th day after progesterone administration(P+4)to verify their endometrial receptivity status.Additionally,cervical exfoliated cells were collected on the 4th day(P+4)and the 6th day(P+6)after progesterone administration.RNA sequencing(RNA-Seq)was used to detect gene expression profiles.Differentially expressed genes(DEGs)were identified using the criteria of|log2fold change|＞1 and a false discovery rate(FDR)＜0.05,followed by bioinformatics analysis.The protein-protein interaction(PPI)network of DEGs was constructed using R software(4.4.1)and analyzed with gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)analyses.The candidate genes were identified based on the PPI network using Cytoscape software.Quantitative reverse transcription PCR(RT-qPCR)was employed to validate the target candidate genes both in vitro and in vivo.Results The rsERT confirmed that all 19 women were in state of endometrial receptivity at P+6.RNA-Seq identified 3 458 DEGs in cervical exfoliated cells between P+4 and P+6.The up-regulated DEGs were mainly enriched in the pathways associated with immune response and cell differentiation,and the down-regulated ones were mainly enriched in the pathways associated with lipid metabolism and cell proliferation.Using maximal clique Centrality(MCC)algorithm in the PPI network,the top 20 genes were selected.Among them,6 genes,such as IFIT2,OASL,MX1,RSAD2,IFIT1 and IFIT3,tied for the first place,and the 6 genes all belong to interferon-stimulated genes(ISGs).qRT-PCR indicated that the above 6 genes showed significantly higher expression levels in the cervical exfoliated cells at the P+4 stage than the cells at the P+6 stage(P＜0.05).Conclusion There are changes in the expression levels of the genes related to immunity and cytoskeleton remodeling in cervical exfoliated cells during the endometrial receptivity phase.The decrease in the expression of ISGs may serve as a potential biomarker for endometrial receptivity.

Objective To investigate the mediating role of anxiety and depression in social sup-port and burnout among primary caregivers of stroke patients.Methods A convenience sampling method was employed to select 506 primary caregivers of stroke patients as research subjects.The Gen-eral Information Questionnaire,Caregiver Burnout Inventory for Stroke Patients,Multidimensional Scale of Perceived Social Support,and Hospital Anxiety and Depression Scale were used for data col-lection.Results The total scores for caregiver burnout,social support,anxiety,and depression a-mong primarycaregivers of stroke patients were(72.83±14.32),(47.79±7.74),(10.49±3.00),and(10.45±3.06),respectively.Correlation analysis revealed a negative correlation between caregiver burnout and social support(r=-0.245,P＜0.001),and positive correlations with anxiety and depression(r=0.178,0.216,P＜0.001).Anxiety and depression partially media-ted the relationship between social support and caregiver burnout,accounting for 7.9％and 10.7％of the total effect,respectively.Conclusion Social support,anxiety,depression,and burnout are closely interrelated.Social support can directly or indirectly influence the occurrence of burnoutthrough anxiety and depression.Medical staff should pay attention to the anxiety and depression status of primary caregivers of stroke patients and enhance social support levels to reduce the incidence of burnout by alleviating anxiety and depression.

Objective:To investigate the correlation between c-myc gene rearrangement and clinical characteristics, 18F-deoxyglucose (FDG) PET-CT imaging features and prognosis of patients with diffuse large B-cell lymphoma (DLBCL). Methods:A retrospective cohort study was conducted. A total of 152 patients with DLBCL confirmed by pathology and underwent 18F-FDG PET-CT examination one week before treatment at Shanxi Province Cancer Hospital from September 2010 to December 2022 were selected, and their clinical data and PET-CT imaging data were collected. Fluorescence in situ hybridization (FISH) method was used to detect c-myc gene rearrangement in tumor tissues. The clinical characteristics and PET-CT imaging features between patients with and without c-myc gene rearrangement were compared. Kaplan-Meier method was used to plot the progression-free survival (PFS) and overall survival (OS) curves of patients, and log-rank test was used for inter group comparison. Univariate and multivariate Cox proportional hazards models were used to analyze the factors affecting the prognosis of DLBCL patients. Results:Among the 152 patients, there were 85 males (55.9%) and 67 females (44.1%); the age was (58±15) years old (range: 25-81 years old); 22 cases (14.5%) had c-myc gene rearrangement (including 7 cases of double hit), while the remaining 130 cases (85.5%) did not have c-myc gene rearrangement. There were statistically significant differences in the compositions of patients with different treatment plans, National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) scores, elevated lactate dehydrogenase (LDH) levels, positive bcl-6 protein, 18F-FDG PET-CT parameters, metabolic tumor volume (MTV) ≥ 256.04 cm 3, total lesion glycolysis (TLG) ≥ 2 292.34 g between patients with and without c-myc gene rearrangement (all P < 0.05); there were no statistically significant differences in the compositions of patients with different genders, age, tumor involvement range, Ann Arbor staging, immunophenotyping, bone marrow invasion, hepatitis B virus infection, CD10 protein, MUM1 protein, bcl-2 protein, and other 18F-FDG PET-CT imaging parameters (all P > 0.05). The MTV [(727±268) cm 3vs. (314±33) cm 3] and TLG [(8 965±1 868) g vs. (5 341±627) g] of patients with c-myc gene rearrangement were higher than those of patients without c-myc gene rearrangement, and the differences were statistically significant ( t values were 3.07 and 2.19, respectively, and P values were 0.003 and 0.035, respectively); there was no statistically significant difference in the maximum standardized uptake value, average standardized uptake value, tumor maximum standardized uptake value-to-blood maximum standardized uptake value ratio (TBR), and tumor maximum standardized uptake value-to-liver maximum standardized uptake value ratio between patients with and without c-myc gene rearrangement (all P > 0.05). The median follow-up period was 79.5 months (range: 6-153 months). The PFS and OS of patients with c-myc gene rearrangement were worse than those of patients without c-myc gene rearrangement, and the differences were statistically significant (both P < 0.001). Univariate Cox regression analysis showed that Ann Arbor staging, NCCN-IPI score, LDH level, c-myc gene rearrangement, MTV, TLG, and TBR were all associated with poor PFS and OS in DLBCL patients (all P < 0.05); multivariate Cox regression analysis showed that the presence of c-myc gene rearrangement was an independent risk factor for PFS (with vs. without, HR = 3.362, 95% CI: 1.825-6.193, P < 0.001) and OS (with vs. without, HR = 4.441, 95% CI: 2.226-8.857, P < 0.001) in DLBCL patients, and NCCN-IPI score (≥ 4 points vs. 0-3 points, HR = 2.439, 95% CI: 1.086-5.495, P = 0.031) and MTV (≥ 256.04 cm 3vs. <256.04 cm 3, HR = 2.439, 95% CI: 1.021-5.814, P = 0.045) were independent risk factors for PFS. Conclusions:DLBCL patients with c-myc gene rearrangement have high tumor burden, late clinical stage and poor prognosis. The rearrangement of c-myc gene may be a predictive factor for disease progression and death in DLBCL patients.

Polygonatum sibiricum polysaccharide(PSP)is a polysaccharide with multiple pharma-cological activities that has been widely studied and used in the human body.However,there is cur-rently a lack of research investigating the potential advantages of PSP in poultry farming.This study investigated the effects of adding PSP to drinking water on the growth performance,antioxi-dant status,serum biochemical indicators,ileal tissue morphology,immune organs,and intestinal function of chicks.88 Hailan brown laying hens were randomly divided into 4 groups,with 22 hens in each group,namely the blank control group(CON),and fed with basic feed;The low-dose PSP group(250 mg/L),the medium dose PSP group(500 mg/L),and the high-dose PSP group(1 000 mg/L)were fed with corresponding doses of PSP through drinking water on the basis of basic feed,and the experimental period was 21 d.The initial and final body weight and immune or-gan relative quality of chicks,serum biochemical indicators,the activities of SOD,CAT,and GSH-Px,as well as the contents of T-AOC and MDA in the serum of chicks were measured;HE stai-ning method was used to observe the pathological changes of intestinal tissue slices in the ileum;Real time fluorescence quantitative PCR technology was used to detect the mRNA expression lev-els of cytokines ZO-1,Claudin-1,Occludin,Mucin-2,IL-1β,TNF-a,IFN-γ,IL-4,IL-8,and IL-10 in the ileum.The results showed that compared with the blank control group,the addition of medium dose PSP significantly increased the final relative quality(P＜0.01),the final body weight and ADG of PSP500 group chicks significantly increased(P＜0.01),and the F/G of PSP250 and PSP500 groups significantly decreased(P＜0.05 or P＜0.01).The villus height of the jejunum in the 200,500,and 1 000 mg/L PSP groups of chicks significantly increased(P＜0.05).The SOD ac-tivity significantly increased(P＜0.01),and the CAT activity in the PSP1000 group significantly increased(P＜0.01).The PSP500 and PSP1000 groups significantly reduced the mRNA expression of cytokines IL-1β,IL-4,and IFN-γ in the ileum(P＞0.05);PSP did not show significant changes in serum total protein(TP),albumin(ALB),glucose(GLU),cholesterol(T-CHO)content,and immune organ index(P＜0.05).In summary,PSP can improve growth performance,enhance an-tioxidant capacity,improve ileal morphology and epithelial barrier function,and regulate mucosal immune status.Considering the overall economic benefits,the recommended level of PSP addition is 500 mg/L.

Objective:To explore the influencing factors of self-management of first-treatment pulmonary tuberculosis patients based on the random forest model, and to provide a theoretical basis for clinical staff to improve the self-management of pulmonary tuberculosis patients by providing efficient, high-quality, and individualized interventions.Methods:A cross-sectional study was used to select pulmonary tuberculosis patients who were hospitalized in the Department of Respiratory Medicine of the Fourth People′s Hospital of the Ningxia Hui Autonomous Region and who met the inclusion and exclusion criteria from December 2023 to February 2024 by using the convenience sampling method as the study subjects. General information questionnaire, Chronic Disease Patients′ Self-health Management Ability Assessment Scale, Perceived Social Support Scale, Hospital Anxiety and Depression Scale, and a tuberculosis prevention and treatment knowledge questionnaire were used to conduct the survey, and Spearman′s correlation was used to analyze the correlation between variables, and multivariate linear regression and a random forest model were used to analyze the influencing factors of self-management.Results:A total of 204 first-treatment pulmonary tuberculosis patients, 111 males and 93 females, 64 patients aged 18-44 years, 59 patients aged 45-59 years, and 81 patients ≥60 years were finally investigated. The total self-management score of tuberculosis patients was 162.00 (148.00, 176.75), and the total self-management score was positively correlated with the total perceived social support score, family support, friend support, and other support, respectively ( r values were 0.307-0.400, all P<0.01), negatively correlated with the anxiety and depression scores, respectively ( r=-0.195, -0.313, both P<0.01), and positively correlated with the total score of knowledge of tuberculosis control ( r=0.257, P<0.01); the results of multiple linear stepwise regression analysis showed that literacy, family support, other support, anxiety, and knowledge of tuberculosis control were the influencing factors of self-management ability ( t values were -2.89-2.98, all P<0.05), which explained a total of 23.1% of the total variance; and the random forest model ranked the importance of the influencing factors in the order of high to low were other support, family support, knowledge of tuberculosis control, literacy, and anxiety. Conclusions:The self-management of first-treatment pulmonary tuberculosis patients is at an intermediate level, In order to improve the self-management ability of first-treatment pulmonary tuberculosis patients, clinical personnel should establish a "patient-centered" self-management education concept, pay attention to the construction of their social support system, provide adequate, continuous, individualized knowledge education and information support, promote their psychological health, and reduce their negative emotions.

Objective To investigate the prevalence and burden of retinoblastoma(RB)in China based on the Glob-al Burden of Disease Study 2021(GBD 2021),thus providing a theoretical foundation for the diagnosis and treatment of RB.Methods Relevant indicators such as the standardized incidence rate,standardized prevalence rate,standardized mortality rate,and standardized disability-adjusted life year(DALY)rate of RB in the total population,males,and females in China from 1990 to 2021 were analyzed to assess the prevalence and disease burden of this disease.The Joinpoint model was employed to analyze the annual percent change(APC)and the average annual percent change(AAPC)of the overall standardized incidence rate,overall standardized prevalence rate,overall standardized mortality rate,and overall standard-ized DALY rate of RB in China from 1990 to 2021.In addition,the changes in the overall standardized incidence rate,over-all standardized prevalence rate,overall standardized mortality rate,and overall standardized DALY rate were compared be-tween China and the globe from 1990 to 2021.Results Compared with 1990,the standardized incidence rate of RB in the total population,males,and females in China increased by 1.840 times,2.154 times,and 1.689 times,respectively,in 2021;the standardized prevalence rate of RB in the total population,males,and females in China increased by 1.876 times,2.133 times,and 1.701 times,respectively;the standardized mortality rate of RB in the total population,males,and fe-males in China decreased by 0.679 times,0.636 times,and 0.714 times,respectively;the standardized DALY rate of RB in the total population,males,and females in China decreased by 0.652 times,0.616 times,and 0.676 times,respectively.Joinpoint analysis showed that compared with 1990,the APPC of the overall standardized incidence rate and the overall standardized prevalence rate in China in 2021 increased by 3.21 and 3.23,respectively;the AAPC of the overall standard-ized mortality rate and the overall standardized DALY rate decreased by 3.61 and 3.46,respectively.Compared with 1990,the global overall standardized incidence rate and overall standardized prevalence rate increased by 0.237 times and 0.242 times,respectively.The global overall standardized mortality rate and overall standardized DALY rate decreased by 0.212 times and 0.195 times,respectively.Conclusion Compared with 1990,the standardized incidence rate and standardized prevalence rate of RB in the total population,males,and females in China increased in 2021,while the standardized mortal-ity rate and DALY rate decreased in 2021,indicating an increase in the prevalence of the disease but a decrease in the dis-ease burden.From 1990 to 2021,the difference between the overall standardized incidence rate and overall standardized prevalence rate in China and the global level first increased and then decreased;however,the overall standardized mortality rate and overall standardized DALY rate in China were always lower than the global level.

Polygonatum sibiricum polysaccharide(PSP)is a polysaccharide with multiple pharma-cological activities that has been widely studied and used in the human body.However,there is cur-rently a lack of research investigating the potential advantages of PSP in poultry farming.This study investigated the effects of adding PSP to drinking water on the growth performance,antioxi-dant status,serum biochemical indicators,ileal tissue morphology,immune organs,and intestinal function of chicks.88 Hailan brown laying hens were randomly divided into 4 groups,with 22 hens in each group,namely the blank control group(CON),and fed with basic feed;The low-dose PSP group(250 mg/L),the medium dose PSP group(500 mg/L),and the high-dose PSP group(1 000 mg/L)were fed with corresponding doses of PSP through drinking water on the basis of basic feed,and the experimental period was 21 d.The initial and final body weight and immune or-gan relative quality of chicks,serum biochemical indicators,the activities of SOD,CAT,and GSH-Px,as well as the contents of T-AOC and MDA in the serum of chicks were measured;HE stai-ning method was used to observe the pathological changes of intestinal tissue slices in the ileum;Real time fluorescence quantitative PCR technology was used to detect the mRNA expression lev-els of cytokines ZO-1,Claudin-1,Occludin,Mucin-2,IL-1β,TNF-a,IFN-γ,IL-4,IL-8,and IL-10 in the ileum.The results showed that compared with the blank control group,the addition of medium dose PSP significantly increased the final relative quality(P＜0.01),the final body weight and ADG of PSP500 group chicks significantly increased(P＜0.01),and the F/G of PSP250 and PSP500 groups significantly decreased(P＜0.05 or P＜0.01).The villus height of the jejunum in the 200,500,and 1 000 mg/L PSP groups of chicks significantly increased(P＜0.05).The SOD ac-tivity significantly increased(P＜0.01),and the CAT activity in the PSP1000 group significantly increased(P＜0.01).The PSP500 and PSP1000 groups significantly reduced the mRNA expression of cytokines IL-1β,IL-4,and IFN-γ in the ileum(P＞0.05);PSP did not show significant changes in serum total protein(TP),albumin(ALB),glucose(GLU),cholesterol(T-CHO)content,and immune organ index(P＜0.05).In summary,PSP can improve growth performance,enhance an-tioxidant capacity,improve ileal morphology and epithelial barrier function,and regulate mucosal immune status.Considering the overall economic benefits,the recommended level of PSP addition is 500 mg/L.

Objective To investigate the prevalence and burden of retinoblastoma(RB)in China based on the Glob-al Burden of Disease Study 2021(GBD 2021),thus providing a theoretical foundation for the diagnosis and treatment of RB.Methods Relevant indicators such as the standardized incidence rate,standardized prevalence rate,standardized mortality rate,and standardized disability-adjusted life year(DALY)rate of RB in the total population,males,and females in China from 1990 to 2021 were analyzed to assess the prevalence and disease burden of this disease.The Joinpoint model was employed to analyze the annual percent change(APC)and the average annual percent change(AAPC)of the overall standardized incidence rate,overall standardized prevalence rate,overall standardized mortality rate,and overall standard-ized DALY rate of RB in China from 1990 to 2021.In addition,the changes in the overall standardized incidence rate,over-all standardized prevalence rate,overall standardized mortality rate,and overall standardized DALY rate were compared be-tween China and the globe from 1990 to 2021.Results Compared with 1990,the standardized incidence rate of RB in the total population,males,and females in China increased by 1.840 times,2.154 times,and 1.689 times,respectively,in 2021;the standardized prevalence rate of RB in the total population,males,and females in China increased by 1.876 times,2.133 times,and 1.701 times,respectively;the standardized mortality rate of RB in the total population,males,and fe-males in China decreased by 0.679 times,0.636 times,and 0.714 times,respectively;the standardized DALY rate of RB in the total population,males,and females in China decreased by 0.652 times,0.616 times,and 0.676 times,respectively.Joinpoint analysis showed that compared with 1990,the APPC of the overall standardized incidence rate and the overall standardized prevalence rate in China in 2021 increased by 3.21 and 3.23,respectively;the AAPC of the overall standard-ized mortality rate and the overall standardized DALY rate decreased by 3.61 and 3.46,respectively.Compared with 1990,the global overall standardized incidence rate and overall standardized prevalence rate increased by 0.237 times and 0.242 times,respectively.The global overall standardized mortality rate and overall standardized DALY rate decreased by 0.212 times and 0.195 times,respectively.Conclusion Compared with 1990,the standardized incidence rate and standardized prevalence rate of RB in the total population,males,and females in China increased in 2021,while the standardized mortal-ity rate and DALY rate decreased in 2021,indicating an increase in the prevalence of the disease but a decrease in the dis-ease burden.From 1990 to 2021,the difference between the overall standardized incidence rate and overall standardized prevalence rate in China and the global level first increased and then decreased;however,the overall standardized mortality rate and overall standardized DALY rate in China were always lower than the global level.