Objective To describe and evaluate the clinical studies of postoperative pain sensitization caused by sleep deprivation through the evidence map system,understand the distribution of evidence in this field,and provide reference for subsequent evidence research.Methods A computer-based search of PubMed,EMBASE,Cochrane library,Web of Science,CNKI,Wanfang Data,VIP and Chinese Biomedical Literature Database from inception to August 2023 was conducted to obtain intervent ion studies,observational studies and systematic reviews/Meta-analysis of postoperative pain sensitization caused by sleep deprivation.The research characteristics and methodological quality were analyzed and evaluated.The Cochrane Handbook for Systematic Reviews,the Newcastle-Ottawa Scale(NOS)and the AMSTAR-2 scale were used to evaluate the quality of the included studies,and the evidence was comprehensively analyzed and displayed by means of bubble chart,table and text.Results A total of 35 observational studies(31 cohort studies and 4 case-control studies),15 randomized controlled trials and 4 systematic reviews/Meta-analyses were included.The number of publications increased rapidly after 2018 and peaked in 2022,and clinical studies in this field mainly fo-cused on cohort studies,with fewer randomized controlled trials and systematic reviews/Meta-analysis studies.The results of the evidence map showed that in terms of quality,22 studies were'high quality',24 studies were'medium quality',and 8 studies were'low quality'.Thirty studies showed that sleep deprivation could induce postoperative pain sensitization.Only 2 studies suggested that sleep disorders were not significantly asso-ciated with postoperative pain sensitization,and ten studies were uncertain whether sleep deprivation could in-duce postoperative pain sensitization.Conclusions Overall evidence shows that sleep deprivation can induce postoperative pain sensitization,but the evaluation dimensions are limited and the methodological quality of the included literature needs to be improved.More high-quality,large-sample and standardized clinical studies should be carried out in the future to provide better scientific basis for clinical work.

Objective:To review the literature on improving patients′medical experience, analyze the current research status in this field, and provide references for enhancing patients′medical experience.Methods:A search was conducted for studies related to improving patients′medical experience published from January 2015 to November 2024 in eight databases, including CNKI and Web of Science. Using software CiteSpace 6.4.R1 and VOSviewer 1.6.19 to analyze publication trends, keyword clustering, existing problems in the process of improving patients′medical experience, and the measures taken.Results:6 507 articles were included, of which 4 452 were in English (68.4%) and 2 055 were in Chinese (31.6%). The annual number of publications showed a nearly linear growth trend ( R2 = 0.983 9). The clustering analysis results indicated that domestic and international research mainly focused on patient-centered diagnostic and treatment systems, behaviors, services, and environments. Existing studies revealed that there were still problems such as long waiting times for appointments and consultations (292 articles), uneven distribution of medical resources (198 articles), and poor doctor-patient communication (155 articles). To improve patients′medical experience, the following intervention measures were proposed: accelerating the medical reform process and strengthening government responsibilities (169 articles); enhancing service concepts and innovating service models (363 articles); optimizing the consultation process and simplifying medical procedures (221 articles); improving the consultation environment and optimizing the facilities in the consultation area (181 articles); and integrating technological advantages to cover the entire medical process (346 articles). Conclusions:Research on improving patients' medical experience was increasingly attracting the attention of more and more scholars. Issues such as low service efficiency, unbalanced resource allocation, and poor doctor-patient communication need to be given special attention. In the future, it is recommended to enhance the experience of patients′ medical experience by strengthening policy and institutional guarantees, accelerating the construction of information technology, improving doctor-patient communication skills and humanistic care, and enhancing the capacity of primary medical services.

To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

ObjectiveTo investigate the safety and efficacy of puncture cyanoacrylate selective seal （PCSS） under endoscopic ultrasound in the treatment of gastroesophageal varices （GOV）. MethodsA total of 100 patients with liver cirrhosis who underwent endoscopic therapy for the secondary prevention of GOV bleeding in Beijing Ditan Hospital， Capital Medical University， from March 1 to December 31， 2023 were enrolled and randomly divided into PCSS group and traditional endoscopy group. The patients were followed up for 6 months after surgery， and the two groups were compared in terms of clinical outcome and complications. The primary outcome measure was the rate of alleviation or disappearance of GOV， and the secondary outcome measure was variceal rebleeding and death. The independent-samples t test was used for comparison of normally distributed or approximately normally distributed quantitative data between two groups， and the Wilcoxon non-parametric test was used for comparison of non-normally distributed quantitative data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of qualitative data between two groups. ResultsThere were 50 patients in the PCSS group， among whom 1 patient was lost to follow-up， and there were 50 patients in the traditional endoscopy group， among whom 3 patients were lost to follow-up. There were no significant differences between the two groups in baseline data such as age， sex， Child-Pugh class， varices grade， and GOV typing （all P>0.05）. Compared with the traditional endoscopy group， the PCSS group had significantly better results of the number of endoscopic treatment sessions （t=-15.671， P=0.001）， the total amount of tissue adhesive used （t=-2.830， P=0.006）， and the rate of alleviation or eradication of varices sclerosis （χ²=7.078， P=0.029）. Both groups had low rates of postoperative rebleeding， adverse reactions， and complications， and there were no significant differences between the two groups （all P>0.05）. ConclusionCompared with traditional endoscopy， PCSS can significantly enhance treatment outcome while maintaining safety standards.

Objective:To review the literature on improving patients′medical experience, analyze the current research status in this field, and provide references for enhancing patients′medical experience.Methods:A search was conducted for studies related to improving patients′medical experience published from January 2015 to November 2024 in eight databases, including CNKI and Web of Science. Using software CiteSpace 6.4.R1 and VOSviewer 1.6.19 to analyze publication trends, keyword clustering, existing problems in the process of improving patients′medical experience, and the measures taken.Results:6 507 articles were included, of which 4 452 were in English (68.4%) and 2 055 were in Chinese (31.6%). The annual number of publications showed a nearly linear growth trend ( R2 = 0.983 9). The clustering analysis results indicated that domestic and international research mainly focused on patient-centered diagnostic and treatment systems, behaviors, services, and environments. Existing studies revealed that there were still problems such as long waiting times for appointments and consultations (292 articles), uneven distribution of medical resources (198 articles), and poor doctor-patient communication (155 articles). To improve patients′medical experience, the following intervention measures were proposed: accelerating the medical reform process and strengthening government responsibilities (169 articles); enhancing service concepts and innovating service models (363 articles); optimizing the consultation process and simplifying medical procedures (221 articles); improving the consultation environment and optimizing the facilities in the consultation area (181 articles); and integrating technological advantages to cover the entire medical process (346 articles). Conclusions:Research on improving patients' medical experience was increasingly attracting the attention of more and more scholars. Issues such as low service efficiency, unbalanced resource allocation, and poor doctor-patient communication need to be given special attention. In the future, it is recommended to enhance the experience of patients′ medical experience by strengthening policy and institutional guarantees, accelerating the construction of information technology, improving doctor-patient communication skills and humanistic care, and enhancing the capacity of primary medical services.

ObjectiveTo investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. MethodsThe patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. ResultsA total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. ConclusionEndoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS.

To describe and evaluate the clinical studies of postoperative pain sensitization caused by sleep deprivation through the evidence map system, understand the distribution of evidence in this field, and provide reference for subsequent evidence research.

Objective To systematically evaluate the control effects of different concentrations of atropine on myopia in Chinese children.Methods PubMed,Embase,The Cochrane Library,Web of Science,CBM,WanFang Data,VIP and CNKI databases were retrieved to collect the studies on children's myopia control by atropine from the establishment of the database to April 2023.After the literature screening,data extraction and bias risk valuation were carried out by 2 research-ers,a Meta-analysis was performed via RevMan 5.4 software.Results A total of 32 studies were included,comparing the effects of 7 different concentrations of atropine and placebo.The Meta-analysis showed that compared with placebo,0.1 g·L-1 atropine had a significant impact on the change of spherical equivalent[MD=0.39,95％CI(0.26,0.52),P＜0.05],and significantly suppressed the axial length increment[MD=-0.18,95％CI(-0.24,-0.12),P＜0.05].Among other concentrations,0.2g·L-1,0.5g·L-1 and 10 g·L-1 atropine had sound effects on myopia control.Conclusion Exist-ing evidence shows that compared to placebo,atropine at concentrations of0.1 g·L-1,0.2 g·L-1,0.5 g·L-1and 10 g·L-1 has better effects on controlling the spherical equivalent and axial length of children with myopia.Among them,at-ropine at the concentration of 0.1 g·L1 may have the best effect.

Objective:To explore the effects of paeoniflorin on Th17,Treg cell subsets and lung function in rats with chronic bronchitis(CB),so as to enrich its pharmacological effects.Methods:CB model was established by compound induction in SD rats,and SD rats were randomly divided into CB group(normal saline),low-dose paeoniflorin group(50 mg/kg),medium-dose paeoniflo-rin group(100 mg/kg),high-dose paeoniflorin group(200 mg/kg)and Helao group(positive control,Helao oral liquid),with 10 rats in each group;another 10 rats in the control group(normal saline)were given 2 ml/100 g corresponding drugs by gavage after modeling.After administration,the general conditions of rats were observed and the lung function and blood gas were analyzed;the morphology of lung tissue was observed by HE staining;the lung CD4+T,CD8+T,Th17(CD4+IL-17+T)and Treg(CD4+CD25+Foxp3+T)cells were detected by flow cytometry;the levels of IL-10,IL-22 and IL-17 in the lung were detected by ELISA.Results:In CB group,the activity of rats were slow,the color of hair were dim,the body were curled up,accompanied with cough and moist nasal cavity,the above symptoms and injuries were alleviated in different degrees in paeoniflorin groups and Helao group,and the high dose group was the least.Compared with control group,the airway resistance,arterial partial pressure of carbon dioxide(PaCO2),IL-17,IL-22 levels,CD4+T,CD8+T,Th17 cells,Th17/Treg,CD4+T/CD8+T were higher in CB group,arterial partial pressure of oxygen(PaO2),IL-10 and Treg cells were lower(all P<0.05);compared with CB group,the airway resistance,PaCO2,IL-17,IL-22 levels,CD4+T,CD8+T,Th17 cells,Th17/Treg,CD4+T/CD8+T in low-,medium-and high-dose paeoniflorin groups decreased in turn,PaO2,IL-10 and Treg cells increased in turn(all P<0.05);there was no significant difference in airway resistance and the other above indexes be-tween the medium-dose paeoniflorin group and Helao group(P>0.05).Conclusion:Paeoniflorin can regulate the activation of T lym-phocytes,reduce the differentiation of Th17 cells,increase the differentiation of Treg cells,and reduce the inflammatory level and lung injury in CB rats.

Objective:To investigate the risk factors of lower extremity deep venous thrombosis (LEDVT) in patients with sepsis during hospitalization in intensive care unit (ICU), and to construct a nomogram prediction model of LEDVT in sepsis patients in the ICU based on the critical care scores combined with inflammatory markers, and to validate its effectiveness in early prediction.Methods:726 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2015 to December 2021 were retrospectively included as the training set to construct the prediction model. In addition, 213 sepsis patients admitted to the ICU of the Affiliated Hospital of Jining Medical University from January 2022 to June 2023 were retrospectively included as the validation set to verify the performance of the prediction model. Clinical data of patients were collected, such as demographic information, vital signs at the time of admission to the ICU, underlying diseases, past history, various types of scores within 24 hours of admission to the ICU, the first laboratory indexes of admission to the ICU, lower extremity venous ultrasound results, treatment, and prognostic indexes. Lasso regression analysis was used to screen the influencing factors for the occurrence of LEDVT in sepsis patients, and the results of Logistic regression analysis were synthesized to construct a nomogram model. The nomogram model was evaluated by receiver operator characteristic curve (ROC curve), calibration curve, clinical impact curve (CIC) and decision curve analysis (DCA).Results:The incidence of LEDVT after ICU admission was 21.5% (156/726) in the training set of sepsis patients and 21.6% (46/213) in the validation set of sepsis patients. The baseline data of patients in both training and validation sets were comparable. Lasso regression analysis showed that seven independent variables were screened from 67 parameters to be associated with the occurrence of LEDVT in patients with sepsis. Logistic regression analysis showed that the age [odds ratio ( OR) = 1.03, 95% confidence interval (95% CI) was 1.01 to 1.04, P < 0.001], body mass index (BMI: OR = 1.05, 95% CI was 1.01 to 1.09, P = 0.009), venous thromboembolism (VTE) score ( OR = 1.20, 95% CI was 1.11 to 1.29, P < 0.001), activated partial thromboplastin time (APTT: OR = 0.98, 95% CI was 0.97 to 0.99, P = 0.009), D-dimer ( OR = 1.03, 95% CI was 1.01 to 1.04, P < 0.001), skin or soft-tissue infection ( OR = 2.53, 95% CI was 1.29 to 4.98, P = 0.007), and femoral venous cannulation ( OR = 3.72, 95% CI was 2.50 to 5.54, P < 0.001) were the independent influences on the occurrence of LEDVT in patients with sepsis. The nomogram model was constructed by combining the above variables, and the ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting the occurrence of LEDVT in patients with sepsis was 0.793 (95% CI was 0.746 to 0.841), and the AUC in the validation set was 0.844 (95% CI was 0.786 to 0.901). The calibration curve showed that its predicted probability was in good agreement with the actual probabilities were in good agreement, and both CIC and DCA curves suggested a favorable net clinical benefit. Conclusion:The nomogram model based on the critical illness scores combined with inflammatory markers can be used for early prediction of LEDVT in ICU sepsis patients, which helps clinicians to identify the risk factors for LEDVT in sepsis patients earlier, so as to achieve early treatment.