Objective:To assess the safety of a novel domestically developed direct visualization system of peroral cholangiopancreatoscopy for the exploration of biliary tract.Methods:Clinical data from 384 patients with biliary tract diseases who underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Endoscopy Center of Shanghai Xuhui District Central Hospital from November 2017 to December 2022 were retrospectively analyzed. Patients were categorized into 2 groups based on the type of cholangioscope: the novel cholangiopancreatoscopy system group ( n=159) and the SpyGlass group ( n=225). In the novel cholangiopancreatoscopy system group, the new direct visualization system of China-made peroral cholangiopancreatoscopy was used for bile duct exploration, while the SpyGlass group utilized the SpyGlass system for bile duct inspection. Propensity score matching (PSM) was used as a nearest-neighbor method with a caliper of 0.01 to minimize confounding factors, resulting in a balanced sample of 122 patients in each group after matching. The primary outcome was the incidence of short-term complications, with secondary outcomes including technical success rates and post-treatment outcomes. Results:After PSM, there were no significant differences in baseline characteristics between the two groups ( P>0.05). Regarding short-term postoperative complications, pancreatitis occurred in 1.6% (2/122) of patients in the novel cholangiopancreatoscopy system group and 7.4% (9/122) in the SpyGlass group. The new system significantly reduced the incidence of post-procedure pancreatitis ( χ2=4.665, P=0.031). The cholecystitis was absent in the novel cholangiopancreatoscopy system group, while it occurred in 0.8% (1/122) cases in the SpyGlass group, with no significant difference between the two groups after the procedure ( P=1.000). Regarding technical success rate, the novel system group achieved a rate of 99.2% (121/122), while the SpyGlass group achieved 97.5% (119/122) ( P=0.622). A slightly higher success rate was observed in the novel system group.There were 81 cases of postoperative biliary drainage in the novel cholangiopancreatoscopy system group and 74 cases in the SpyGlass group. Conclusion:The novel direct visualization system of peroral cholangiopancreatoscopy is safer than SpyGlass in the exploration of biliary system diseases. Endoscopists are encouraged to choose the appropriate cholangioscopy system based on individual patient characteristics for the direct visualization, diagnosis, and treatment of biliary diseases.

ObjectiveTo study the relationship between qi stagnation constitution and suboptimal health status (SHS) or lifestyle.MethodsFrom 2012 to 2013, we conducted a cross-sectional survey of 24 159 Chinese individuals aged 12–80 years. The qi stagnation constitution was assessed using the Constitution in Chinese Medicine Questionnaire. Health status was evaluated through medical records and the Subhealth Measurement Scale V1.0 (SHMS V1.0). Health-promoting lifestyles were measured using the Health-Promoting Lifestyle Profile II (HPLP-II).ResultsOf the 24 159 participants, 16.1% and 15.2% were classified as “always” and “sometimes” having the qi stagnation constitution, respectively. Those classified as “rarely” having the qi stagnation constitution scored higher on both the HPLP-II and SHMS V1.0. The participants classified as “always” having the qi stagnation constitution showed a significant association with SHS or disease compared to other imbalanced constitutions. Those in the “always” category were approximately 21 times more likely to be classified as having SHS (odds ratio [OR]: 21.17, 95% confidence interval [CI]: 15.74–28.45), whereas those in the “sometimes” category were approximately six times more likely (OR: 5.89, 95% CI: 5.04–6.90). Accordingly, the qi stagnation constitution score was significantly associated with the diagnosis of SHS, with an area under the curve of 0.77 (P .001). A score of 18.75 yielded the highest Youden Index (0.407), with a sensitivity of 60.5% and a specificity of 80.3%. Significant associations were observed between health-promoting lifestyles and qi stagnation constitution severity in an ordinal regression analysis (P .001). Protective factors included stress management (OR: 1.59), self-actualization (OR: 1.57), and exercise (OR: 1.36). In contrast, poorer interpersonal relationships (OR: 0.79), greater health responsibilities (OR: 0.86), and poorer nutrition (OR: 0.91) were associated with increased severity.ConclusionModulating the qi stagnation constitution through lifestyle interventions may help prevent the progression of SHS to disease, which aligns with core preventive principles in traditional Chinese medicine.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

Objective:To assess the safety of a novel domestically developed direct visualization system of peroral cholangiopancreatoscopy for the exploration of biliary tract.Methods:Clinical data from 384 patients with biliary tract diseases who underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Endoscopy Center of Shanghai Xuhui District Central Hospital from November 2017 to December 2022 were retrospectively analyzed. Patients were categorized into 2 groups based on the type of cholangioscope: the novel cholangiopancreatoscopy system group ( n=159) and the SpyGlass group ( n=225). In the novel cholangiopancreatoscopy system group, the new direct visualization system of China-made peroral cholangiopancreatoscopy was used for bile duct exploration, while the SpyGlass group utilized the SpyGlass system for bile duct inspection. Propensity score matching (PSM) was used as a nearest-neighbor method with a caliper of 0.01 to minimize confounding factors, resulting in a balanced sample of 122 patients in each group after matching. The primary outcome was the incidence of short-term complications, with secondary outcomes including technical success rates and post-treatment outcomes. Results:After PSM, there were no significant differences in baseline characteristics between the two groups ( P>0.05). Regarding short-term postoperative complications, pancreatitis occurred in 1.6% (2/122) of patients in the novel cholangiopancreatoscopy system group and 7.4% (9/122) in the SpyGlass group. The new system significantly reduced the incidence of post-procedure pancreatitis ( χ2=4.665, P=0.031). The cholecystitis was absent in the novel cholangiopancreatoscopy system group, while it occurred in 0.8% (1/122) cases in the SpyGlass group, with no significant difference between the two groups after the procedure ( P=1.000). Regarding technical success rate, the novel system group achieved a rate of 99.2% (121/122), while the SpyGlass group achieved 97.5% (119/122) ( P=0.622). A slightly higher success rate was observed in the novel system group.There were 81 cases of postoperative biliary drainage in the novel cholangiopancreatoscopy system group and 74 cases in the SpyGlass group. Conclusion:The novel direct visualization system of peroral cholangiopancreatoscopy is safer than SpyGlass in the exploration of biliary system diseases. Endoscopists are encouraged to choose the appropriate cholangioscopy system based on individual patient characteristics for the direct visualization, diagnosis, and treatment of biliary diseases.

Objective This study aims to analyze the relationship between reproductive tract microecological changes,metabolic differences,and pregnancy outcomes at different time points in the frozen-thawed embryo transfer cycle while patients are undergoing hormone replacement therapy,which will be a breakthrough point for improving outcomes.Methods A total of 20 women undergoing frozen-thawed single blastocyst transfer for the first time at the Reproductive Medicine Center of Fujian Maternal and Child Health Hospital between July 2022 and January 2023 were recruited for this study.Their vaginal and cervical secretions were collected for 16S rRNA sequencing and non-targeted metabolomics analysis on days 2-5 of menstruation,day 7 after estrogen replacement therapy started,the day when progesterone was added,and the day of transplantation.The subjects were divided into different groups according to their clinical pregnancy status and the sequencing results were analyzed using bioinformatics methods.Results 1)The alpha-diversity index of the vaginal and cervical microbiota was higher on days 2-5 of menstruation(P<0.01),but did not differ significantly on day 7 after oral estrogen replacement therapy started,the day of progesterone administration,and the day of transplantation(P≥0.1).2)Both the pregnant group and the non-pregnant group showed a variety of microorganisms and metabolites with significant differences in the lower reproductive tract at different time points.3)Microbial analysis at different time points showed that there were significant differences in vaginal flora,including Peptoniphilus,Enterocloster,Finegoldia,Klebsiella,Anaerobutyricum,Agathobaculum,Sporanaerobacter,Bilophila,Prevotella,and Anaerococcus in the pregnant group(P<0.05).4)Metabolite analysis at different time points showed that there were significant differences in 3-hydroxybenzoic acid,linatine,(R)-amphetamine,hydroxychloroquine,and L-altarate in the vaginal secretions of the pregnant group(P<0.05),and that there were significant differences in isocitric acid,quassin,citrinin,and 12(R)-HETE in the cervical secretions(P<0.05).5)Metabolite analysis at different time points showed that,in the non-pregnant group,there were significant differences in linatine,decanoyl-L-carnitine,aspartame,sphingosine,and hydroxychloroquine in the vaginal secretions(P<0.05),and the isocitric acid,quassin,ctrinin,and 12(R)-HETE in the cervical secretions(P<0.05).6)Combined microbiome and metabolomics analysis showed that certain metabolites were significantly associated with microbial communities,especially Klebsiella.Conclusions Significant differences in the microbiota genera and metabolites at different time points were found during the frozen-embryo transfer cycle of hormone replacement therapy,which may be used as potential biomarkers to predict pregnancy outcomes of embryo transfer.

Through comprehensive and systematic collection of existing evidence,systematic review adopts clinical epidemiological methods,strictly evaluates the quality of evidence,qualitatively or quantitatively combines research results,and finally provides a reliable basis for solving a focused clinical problem.The number of systematic reviews has increased rapidly.With references to the Checklist,this review discussed the typical issues with current systematic reviews in nursing,and highlighted the crucial components for reporting systematic reviews at every essential step.

Objective:To explore the effect of health belief model in the prevention of lower extremity deep vein thrombosis (DVT) in patients with lung cancer after operative.Methods:From January 2019 to June 2020, 80 lung cancer patients admitted to Henan Provincial Chest Hospital were selected as research objects by convenience sampling method. The patients were randomly divided into control group and research group with 40 cases each. The routine health education was used in the control group, and the health belief model was used in the research group on the basis of the control group. Both groups intervened until discharge. We compared the DVT prevention knowledge and health belief of the two groups of patients before and after the intervention, and counted the incidence of DVT in the two groups of patients.Results:After intervention, the scores of all dimensions of the DVT Health Questionnaire and DVT Health Belief Questionnaire in the research group were higher than those in the control group, with statistically significant differences ( P<0.05) . The incidence of DVT in the research group was lower than that in the control group with a statistical difference ( P<0.05) . Conclusions:The health belief model can improve the health knowledge and health belief of lung cancer patients to prevent DVT, reduce the occurrence of DVT, and is worthy of clinical promotion and application.

OBJECTIVE To provide reference for strengthening the quality of pharmaceutical care in retail chain pharmacies and the professional capabilities of licensed pharmacists， and to meet the public’s pharmaceutical care needs. METHODS A combination of questionnaire survey and informant interview was used to investigate the general information of licensed pharmacists in retail chain pharmacies in Guangdong province， the implementation of pharmaceutical care， the competence and knowledge status of the surveyed licensed pharmacists， and the factors affecting the development of pharmaceutical care. RESULTS & CONCLUSIONS A total of 444 questionnaires were sent out and 326 effective questionnaires were collected， with an effective recovery rate of 73.42%. Among 326 surveyed licensed pharmacists， a college degree or higher accounted for 40.18%， and the pharmacy major or related accounted for 79.75%. A total of 185 （56.75%） of the surveyed licensed pharmacists indicated that the retail chain pharmacies where they worked had established specified areas of pharmaceutical care； 320 （98.16%）， 137 （42.02%） and 181 （55.52%） of the surveyed licensed pharmacists indicated that the retail chain pharmacies where they worked could provide services such as rational medication guidance for patients， decocting traditional Chinese medicines and establishing health records， etc. The self-assessment scores of the surveyed licensed pharmacists were significantly higher than 3 （median） for competence and knowledge level， but the self-assessment scores for medication therapy management competence and pharmaceutical care practice were relatively low. The surveyed licensed pharmacists believed that the main factors affecting the development of pharmaceutical care in retail chain pharmacies included patients’ lack of trust or cooperation （196， 60.12%）， sales performance requirements （170， 52.15%）， and heavy daily workload （165， 50.61%）. It is recommended that relevant authorities expedite the legislative process of the Pharmacist Law， optimize the continuing education system for licensed pharmacists， and implement a star-rating evaluation system for pharmaceutical care capabilities in pharmacies， so as to encourage retail chain pharmacies and licensed pharmacists to pursue a more specialized development path. At the same time， pharmaceutical retail chain enterprises should shift their business mindset， increase investment in pharmaceutical care， enhance the professional atmosphere in the pharmacies， optimize the compensation structure for licensed pharmacists， and elevate the pharmaceutical care capabilities of both the pharmacies and licensed pharmacists to fulfill the pharmaceutical care needs of the public.

Acute lymphoblastic leukemia (ALL) accounts for 75%-85% of the cases of childhood leukemia. As a result of the progress made in diagnosis and treatment, an event-free survival rate of 70%–80% has been reported in our country. Consequently, research should focus on long-term physical function and quality of life of childhood ALL survivors. In the past 20 years, cancer rehabilitation has achieved rapid development in European and American countries, but gaps remain in clinical practice and academic research of rehabilitation for childhood leukemia. Specifically, rehabilitation for childhood leukemia in our country lags behind, compared with that in Western developed countries. In this commentary, we describe a relatively comprehensive childhood ALL survivorship care quality framework to improve patients' long-term quality of life.