Objective:To explore the stemness characteristics of Luminal-type breast cancer (LBC, based on PAM50 classification) in patients aged over 60, evaluate the association between stemness and prognosis differences in LBC,, and construct a stemness-based prognostic prediction model.Methods:Based on data of LBC patients aged over 60 from the TCGA-BRCA database, we first applied single-sample gene set enrichment analysis (ssGSEA) using 26 stemness-related gene sets from the StemChecker database to calculate stemness scores for each sample.Subsequently, unsupervised clustering was used to identify stemness-related subtypes in LBC and evaluate prognostic differences between them.Furthermore, we performed weighted gene co-expression network analysis (WGCNA) and LASSO-Cox regression to construct a specific risk score model for LBC patients, which was then external validated in the METABRIC dataset.Results:Based on the analysis of tumor stemness-related gene sets, LBC patients aged over 60 could be further divided into two distinct stemness subtypes: C1 and C2.Among them, the C2 subtype showed a better prognosis ( HR=0.54, 95% CI: 0.30-0.97, P=0.035). Through WGCNA, we successfully identified key gene modules closely associated with stemness subtypes, and subsequently developed a prognostic risk score model for elderly LBC.This model not only accurately predicted survival outcomes of overall elderly LBC patients, but also demonstrated strong prognostic value within molecular subtypes: it effectively distinguished high-and low-risk populations in Luminal A ( HR=0.28, 95% CI: 0.13-0.63, P=0.001) and Luminal B ( HR=0.07, 95% CI: 0.01-0.57, P=0.001) patients. Conclusions:Integrating tumor stemness features can improve the accuracy of prognostic assessment for elderly LBC patients and provide a basis for individualized treatment.The results suggest that the risk score model constructed in this study has potential clinical application value in guiding treatment decisions for this type of elderly LBC patients.

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

AIM:To elucidate the intervention and mechanism of 4'-hydroxychalcone(4-HC)in colitis mice through the regulation of Th17/Treg homeostasis.METHODS:Using a dextran sodium sulfate(DSS)-induced colitis model in mice,we meticulously observed the pathological characteristics of colon tissue via HE staining.Additionally,we employed immunohistochemical analysis and Western blot techniques to assess the expression levels of proteins associated with the JAK/STAT signaling pathway,as well as the specific content of tight junction proteins such as ZO-1 and occludin.The differentiation of Th17 and Treg cells was analyzed through flow cytometry.RESULTS:Compared to the normal group,the DSS group exhibited a consistent decline in body weight,coupled with symptoms of diarrhea and hematochezia,an increase in the DAI score,and a notable reduction in colon length.In contrast,the body weight of the 4-HC group dis-played an upward trend following an initial decrease,with improvements in diarrhea and hematochezia symptoms,a reduc-tion in the DAI score,and a restoration of colon length relative to the model group.The integrity of colon tissue in the 4-HC group was significantly better than that in the DSS group,evidenced by a marked increase in the number of goblet cells and an enhancement in crypt integrity,while the average histology score showed a decrease.Western blot analysis re-vealed substantial increase in ZO-1 and occludin expression after 4-HC treatment.Flow cytometry results indicated a dra-matic decrease in the differentiation rate of Th17 cells in spleen lymphocytes and mesenteric lymph nodes,while the dif-ferentiation rate of Treg cells was significantly elevated.Immunohistochemical and Western blot analyses demonstrated that 4-HC markedly reduced the phosphorylation of STAT1 and STAT3,while up-regulating the phosphorylation of STAT6,suggesting that 4-HC modulates CD4+T cell activity through the JAK-STAT pathway.CONCLUSION:The 4-HC may enhance the course of DSS-induced colitis in mice,alleviate colonic tissue damage,and modulate the balance be-tween Th17 and Treg cells,potentially involving the JAK/STAT signaling pathway.

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

AIM:To elucidate the intervention and mechanism of 4'-hydroxychalcone(4-HC)in colitis mice through the regulation of Th17/Treg homeostasis.METHODS:Using a dextran sodium sulfate(DSS)-induced colitis model in mice,we meticulously observed the pathological characteristics of colon tissue via HE staining.Additionally,we employed immunohistochemical analysis and Western blot techniques to assess the expression levels of proteins associated with the JAK/STAT signaling pathway,as well as the specific content of tight junction proteins such as ZO-1 and occludin.The differentiation of Th17 and Treg cells was analyzed through flow cytometry.RESULTS:Compared to the normal group,the DSS group exhibited a consistent decline in body weight,coupled with symptoms of diarrhea and hematochezia,an increase in the DAI score,and a notable reduction in colon length.In contrast,the body weight of the 4-HC group dis-played an upward trend following an initial decrease,with improvements in diarrhea and hematochezia symptoms,a reduc-tion in the DAI score,and a restoration of colon length relative to the model group.The integrity of colon tissue in the 4-HC group was significantly better than that in the DSS group,evidenced by a marked increase in the number of goblet cells and an enhancement in crypt integrity,while the average histology score showed a decrease.Western blot analysis re-vealed substantial increase in ZO-1 and occludin expression after 4-HC treatment.Flow cytometry results indicated a dra-matic decrease in the differentiation rate of Th17 cells in spleen lymphocytes and mesenteric lymph nodes,while the dif-ferentiation rate of Treg cells was significantly elevated.Immunohistochemical and Western blot analyses demonstrated that 4-HC markedly reduced the phosphorylation of STAT1 and STAT3,while up-regulating the phosphorylation of STAT6,suggesting that 4-HC modulates CD4+T cell activity through the JAK-STAT pathway.CONCLUSION:The 4-HC may enhance the course of DSS-induced colitis in mice,alleviate colonic tissue damage,and modulate the balance be-tween Th17 and Treg cells,potentially involving the JAK/STAT signaling pathway.

Objective:To explore the stemness characteristics of Luminal-type breast cancer (LBC, based on PAM50 classification) in patients aged over 60, evaluate the association between stemness and prognosis differences in LBC,, and construct a stemness-based prognostic prediction model.Methods:Based on data of LBC patients aged over 60 from the TCGA-BRCA database, we first applied single-sample gene set enrichment analysis (ssGSEA) using 26 stemness-related gene sets from the StemChecker database to calculate stemness scores for each sample.Subsequently, unsupervised clustering was used to identify stemness-related subtypes in LBC and evaluate prognostic differences between them.Furthermore, we performed weighted gene co-expression network analysis (WGCNA) and LASSO-Cox regression to construct a specific risk score model for LBC patients, which was then external validated in the METABRIC dataset.Results:Based on the analysis of tumor stemness-related gene sets, LBC patients aged over 60 could be further divided into two distinct stemness subtypes: C1 and C2.Among them, the C2 subtype showed a better prognosis ( HR=0.54, 95% CI: 0.30-0.97, P=0.035). Through WGCNA, we successfully identified key gene modules closely associated with stemness subtypes, and subsequently developed a prognostic risk score model for elderly LBC.This model not only accurately predicted survival outcomes of overall elderly LBC patients, but also demonstrated strong prognostic value within molecular subtypes: it effectively distinguished high-and low-risk populations in Luminal A ( HR=0.28, 95% CI: 0.13-0.63, P=0.001) and Luminal B ( HR=0.07, 95% CI: 0.01-0.57, P=0.001) patients. Conclusions:Integrating tumor stemness features can improve the accuracy of prognostic assessment for elderly LBC patients and provide a basis for individualized treatment.The results suggest that the risk score model constructed in this study has potential clinical application value in guiding treatment decisions for this type of elderly LBC patients.

OBJECTIVE: To provide evidence for further reducing the incidence of central line-associated bloodstream infection (CLABSI) according to investigation of the prevention and control of CLABSI in intensive care unit (ICU) in Shandong Province. METHODS: The questionnaire was developed by experts from Shandong Critical Care Medical Quality Control Center, combining domestic and foreign guidelines, consensus and research. A convenient sampling method was used to recruit survey subjects online from October 11 to 31, 2023 in the province to investigate the management status of central venous catheter (CVC) in ICU units of secondary and above hospitals. RESULTS: A total of 201 valid data were collected, involving 186 hospitals in the province, with a total of 201 ICU units, mainly comprehensive ICU (91%). The beds in ICU units were mainly single rooms (89%) and triple rooms (79%), and the ratio of doctors to total beds was 0.54 : 1. The training on the knowledge and operation of intravascular catheter-associated bloodstream infection in each ICU unit was mainly irregular (49%), and 96% of the catheter operators were authorized by the hospital. In terms of CVC selection, 89% of ICU units used dual-chamber CVC, and 86% of ICU units used catheters without antibiotic coating. When selecting the placement site, for conventional CVC catheterization, 65% preferred subclavian vein. Femoral vein was preferred in 87% of ICU units undergoing continuous renal replacement therapy. 95% of ICU units had established standardized operation procedure (SOP) for CVC placement. 86% of ICU units were capable of ultrasound positioning or guided puncture at the time of catheterization. During catheterization, 88% of ICU units met the sterile dress code. Before and after catheterzation, 81% and 77% of ICU units standardized hand hygiene. Only 31% of ICU units were covered from head to toe by aseptic wipes. For the choice of skin disinfectant, the majority of ICU units (72%) only used iodophor. After tube placement, 54% of ICU units chose sterile transparent dressing and 25% chose sterile gauze dressing. 98% of ICU units were sutured to secure the catheter. Regarding catheter replacement and removal, 45% of ICU units could not be removed or replaced within 2 days in emergency situations where the principle of sterility was not guaranteed. When CLABSI was suspected, 55% of ICU units were able to obtain the catheter tip, transcatheter blood culture, and contralateral peripheral vein blood culture at the same time. For CVC replacement frequency, most ICU units (75%) would not be replaced regularly, and some ICU units would be replaced regularly, but the frequency of replacement was different. For CLABSI prevention and control, 82% of ICU units developed a verification form or supervision form. When analyzing the sources of CLABSI data, most of them were filled in by themselves (60%). As for the frequency of data analysis, 57% were once a month. CONCLUSIONS All ICU units in Shandong Province are standardized in terms of the authorization of operators, the formulation of SOP, the formulation and implementation of verification form and supervision form, ultrasound-guided puncture, and hand hygiene before and after catheterization. However, there are still deficiencies in the training on knowledge and operation of intravascular catheter-associated bloodstream infections, maximum aseptic coverage, catheter replacement and removal, and the reporting sources of CLABSI data, which need to be strengthened in the follow-up work. At present, the selection of CVC, the selection of catheterization site, the selection of skin disinfectant and the selection of dressings after catheterization still need further research.
Intensive Care Units ; Humans ; Surveys and Questionnaires ; China/epidemiology* ; Cross-Sectional Studies ; Catheter-Related Infections/epidemiology* ; Catheterization, Central Venous/methods* ; Cross Infection/epidemiology* ; Central Venous Catheters/adverse effects* ; Infection Control/methods*

Objective:Comparison with non-elderly patients to analyze the clinicopathological characteristics of elderly female breast cancer(BC)patients and to explore the factors influencing their prognosis.Methods:Data were collected from 86, 064 female BC patients in the National Cancer Institute's Surveillance, Epidemiology, and End Results(SEER)database, spanning from 1975 to 2015.Patients aged 65 and older were classified as the elderly group, while those under 65 were designated as the non-elderly group.The baseline characteristics and clinicopathological differences between the two groups were analyzed using the chi-square test.The Kaplan-Meier method was employed to plot overall survival(OS)and breast cancer-specific survival(BCSS)curves for both groups.Additionally, factors influencing OS and BCSS in elderly BC patients were examined through univariate and multivariate Cox regression analyses.Results:In comparison to the non-elderly group, elderly BC patients exhibited a higher proportion of white individuals, widows, residents from non-metropolitan areas, lower median household income, lower histological grade, and earlier clinical stage.Furthermore, this group demonstrated a greater prevalence of estrogen receptor(ER)and progesterone receptor(PR)positivity, a lower prevalence of human epidermal growth factor receptor 2(HER2)positivity, and fewer individuals received standard treatment(all P<0.001).The prognosis for the elderly group was poorer, characterized by increased risks of all-cause mortality and breast cancer-specific mortality( P<0.001).Multivariate analysis revealed that receiving standard treatment served as a protective factor for both OS and BCSS in elderly patients. Conclusions:In this cohort, elderly breast cancer patients were characterized by an earlier clinical stage, lower histological grade, higher rates of ER and PR positivity, and a lower rate of HER2 positivity.Their OS and BCSS rates were significantly worse than those of the non-elderly group.The analysis indicates that inadequate and non-standard treatment is a major influencing factor, necessitating increased attention from clinicians.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.