Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Objective To explore the types of symptom clusters in patients with bladder instillation and identify the core symptoms through symptom network analysis,and to provide evidence for symptom management of the patients.Methods Convenience sampling was used to select 226 patients with bladder instillation for bladder cancer at a Tier-IIIA hospital in Guiyang from March 2023 to July 2024.Data were collected through review of medical record,general information questionnaires and symptom assessment questionnaires specific to the patients with bladder instillation.Exploratory factor analysis was used to extract symptom clusters,and symptom relationships were analysed using R language for network layout and centrality calculations.Results A total of 223 patients with bladder cancer completed the survey.Four symptom clusters were identified,namely the urinary system symptom cluster,digestive system symptom cluster,somatic symptom cluster and psychological symptom cluster,with a cumulative variance contribution rate of 66.038%.The symptom network analysis showed strong associations between dysuria and urethral pain during catheterisation,incomplete emptying and dysuria,as well as distress and poor sleep quality.In terms of centrality indicators,the top three symptoms by strength were dysuria(rS=2.26),incomplete emptying(rS=0.99)and poor sleep quality(rS=0.90).Of the expected impacts,the top three were dysuria(rE=2.09),poor sleep quality(rE=1.34)and frequency of urinary(rE=0.55).Regarding the closeness centrality,the top three were dysuria(rC=2.23),incomplete emptying(rC=0.64)and poor sleep quality(rC=0.54).Dysuria had the highest strength,expected impact and closeness centrality,indicating the dysuria was the core symptom in the patients with bladder cancer.Conclusion For the patients with bladder instillation experience,multiple and interconnected symptoms appear at the same time and together they form a symptom clusters,of which the pain in urination is the core symptom.Medical staff should consider symptom prevalence and core symptoms and to develop the targeted and precise management strategies for targeted nursing.

Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Aim To investigate the effect and mechanism of angiotensin Ⅱ(Ang Ⅱ)on ferroptosis in white adi-pocytes.Methods The 3T3-L1 preadipocytes were differentiated into white adipocytes by inducer stimulation.The experiment was divided into control group,Ang Ⅱ group,Ang Ⅱ+Fer-1(ferroptosis inhibitor)group and Ang Ⅱ+PFT-α(p53 inhibitor)group.Ang Ⅱ was used to treat cells.RT-qPCR and Western blot were used to detect the expression levels of ferroptosis factors and adipokines.JC-1 kit was used to detect mitochondrial membrane potential(MMP)level.Iron ion kit was used to detect intracellular iron content.Glutathione(GSH)kit was used to detect GSH content.Fer-1 and Ang Ⅱ were added to treat cells to detect the the changes of ferroptosis level.The expression of p53 and spermidine/spermine N1-acetyltransferase 1(SAT1)protein was detected.Subsequently,PFT-α and Ang Ⅱ were added to co-treat cells to detect the changes of p53 and SAT1 protein expression,and to observe the effect of inhibiting p53 expression on the expression levels of ferroptosis factors and adipokines.Results 3T3-L1 cells were successfully differentiated into white adipocytes by stimulator-induced differentiation.Ang Ⅱ induced ferroptosis in white adipocytes.RT-qPCR results showed that compared with control group,the mRNA expression of anti-ferroptosis factor glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11)and iron regulatory protein 1(IRP-1)was down-regulated in Ang Ⅱ group,and the mRNA expression of pro-ferroptosis factor acyl-CoA synthetase of long-chain family member 4(ACSL4)was up-regulated.Western blot results showed that compared with control group,the protein expression of SLC7A11 and GPX4 was down-regulated in Ang Ⅱ group,and the protein expression of ACSL4 was up-regulated.Ang Ⅱ treatment increased the content of intracellular iron ions and decreased the levels of GSH and MMP.Compared with Ang Ⅱ group,the mRNA expression of IRP-1 and SLC7A11 was up-regulated in Ang Ⅱ+Fer-1 group.Ang Ⅱ induced changes in the expression profile of adipokines in white adipocytes.Western blot results showed that compared with control group,the protein ex-pression of pro-inflammatory adipokine leptin(LEP),resistin(RETN),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)was up-regulated in Ang Ⅱ group,and the protein expression of anti-inflammatory adipokine adiponectin(AD-PN)and omentin 1(ITLN1)was down-regulated.In addition,Ang Ⅱ increased the protein expression of p53 and SAT1.Inhibition of p53 expression can improve the level of ferroptosis and adipokine expression in white adipocytes trea-ted with Ang Ⅱ.Western blot results showed that compared with Ang Ⅱ group,the protein expression of p53 and SAT1 was down-regulated in Ang Ⅱ+PFT-α group,the protein expression of SLC7A11 and GPX4 was up-regulated,and the protein expression of ACSL4 was down-regulated.The protein expression of ADPN was up-regulated in Ang Ⅱ+PFT-αgroup,and the protein expression of TNF-α,LEP and RETN was down-regulated.Conclusion Ang Ⅱ induces fer-roptosis in white adipocytes through activating the p53/SAT1 signaling pathway.

To meet the demand of national governance modernization and high-quality development of public hospitals,it constructed a three-dimensional analysis framework of"synergy,technology empowerment and proactive governance"in response to the outstanding problems of insufficient synergy in the supervision network,weak monitoring and early warning capability,and passive response to supervision.The purpose is to:at the level of synergy and linkage,from the definition of the subject's function,the sharing of supervisory information,and the linkage of rectification and improvement to jointly build a multi-subject co-governance supervisory network,form a common supervisory pattern,break down the barriers to synergy,and make a closed-loop governance;at the level of technological empowerment,through the use of tools such as blockchain technology,AI auditing models,and data decision support platforms,to realize a full chain traceability,intelligent risk early warning,and intelligent driven penetrating supervision with data decision support.At the level of active governance,the aim is to expand the key indicators in auditing and assessment,and give play to the guiding role of economic responsibility auditing and the driving effect of national-level comprehensive assessment,so as to promote the behavioral mode of the supervisory body from"passive compliance"to"active governance".It provides a systematic solution with both theoretical innovation and practical applicability for the modernization of the financial and accounting supervision system of public hospitals.

Objective To explore the types of symptom clusters in patients with bladder instillation and identify the core symptoms through symptom network analysis,and to provide evidence for symptom management of the patients.Methods Convenience sampling was used to select 226 patients with bladder instillation for bladder cancer at a Tier-IIIA hospital in Guiyang from March 2023 to July 2024.Data were collected through review of medical record,general information questionnaires and symptom assessment questionnaires specific to the patients with bladder instillation.Exploratory factor analysis was used to extract symptom clusters,and symptom relationships were analysed using R language for network layout and centrality calculations.Results A total of 223 patients with bladder cancer completed the survey.Four symptom clusters were identified,namely the urinary system symptom cluster,digestive system symptom cluster,somatic symptom cluster and psychological symptom cluster,with a cumulative variance contribution rate of 66.038%.The symptom network analysis showed strong associations between dysuria and urethral pain during catheterisation,incomplete emptying and dysuria,as well as distress and poor sleep quality.In terms of centrality indicators,the top three symptoms by strength were dysuria(rS=2.26),incomplete emptying(rS=0.99)and poor sleep quality(rS=0.90).Of the expected impacts,the top three were dysuria(rE=2.09),poor sleep quality(rE=1.34)and frequency of urinary(rE=0.55).Regarding the closeness centrality,the top three were dysuria(rC=2.23),incomplete emptying(rC=0.64)and poor sleep quality(rC=0.54).Dysuria had the highest strength,expected impact and closeness centrality,indicating the dysuria was the core symptom in the patients with bladder cancer.Conclusion For the patients with bladder instillation experience,multiple and interconnected symptoms appear at the same time and together they form a symptom clusters,of which the pain in urination is the core symptom.Medical staff should consider symptom prevalence and core symptoms and to develop the targeted and precise management strategies for targeted nursing.

To meet the demand of national governance modernization and high-quality development of public hospitals,it constructed a three-dimensional analysis framework of"synergy,technology empowerment and proactive governance"in response to the outstanding problems of insufficient synergy in the supervision network,weak monitoring and early warning capability,and passive response to supervision.The purpose is to:at the level of synergy and linkage,from the definition of the subject's function,the sharing of supervisory information,and the linkage of rectification and improvement to jointly build a multi-subject co-governance supervisory network,form a common supervisory pattern,break down the barriers to synergy,and make a closed-loop governance;at the level of technological empowerment,through the use of tools such as blockchain technology,AI auditing models,and data decision support platforms,to realize a full chain traceability,intelligent risk early warning,and intelligent driven penetrating supervision with data decision support.At the level of active governance,the aim is to expand the key indicators in auditing and assessment,and give play to the guiding role of economic responsibility auditing and the driving effect of national-level comprehensive assessment,so as to promote the behavioral mode of the supervisory body from"passive compliance"to"active governance".It provides a systematic solution with both theoretical innovation and practical applicability for the modernization of the financial and accounting supervision system of public hospitals.

OBJECTIVE To establish a interview outline design process and quality control evaluation method based on grounded theory,providing ideas for qualitative research interview outline design in medical fields.METHODS A literature review was conducted to understand the current research status;a preliminary interview outline was developed around the research content.The triangulation method,group evaluation,expert review and pre-interview were adopted to execute the interview outline and conduct quality control.The evaluation indicators and target values were formulated(an average score for the overall quality evaluation of all indicators ≥4.5,and an average score for individual indicators ≥ 4.00)to evaluate the effect of the interview outline.Taking the research on the mechanism of physicians'prescribing behavior under the background of Diagnosis Related Groups(DRGs)payment as an example,the methodological contents of above interview outline were applied in practical research.RESULTS The interview outline included basic information and interview questions.The interview questions were divided into three parts:influencing factors survey,promoting and hindering factors of standardizing physician prescription behavior,and communication,with a total of 12 questions.After being reviewed by members of the research group,experts review and pre-interview,a total of 9 people participated in the quality control evaluation of the interview outline.The overall evaluation score was 4.94(＞4.50),and the average score of each indicator was greater than 4.00,indicating that the quality of the outline met the requirements for the interview and could be used for the formal interview.CONCLUSIONS The established interview outline design and quality control method based on grounded theory provides ideas for the qualitative research interview outline design in the medical field,and lays the foundation for further using grounded theory to study the influencing factors and mechanisms of physician prescription behavior under the DRG background.

Objective:To understand the status and influencing factors of social isolation in elderly individuals with chronic diseases.Methods:A multi-stage sampling method was used to select elderly individuals from eight communities or villages in Hefei from July to September 2022. The study employed a general information survey, the Lubben Social Network Scale (LSNS-6) , the Geriatric Depression Scale (GDS-15) , the Social Support Rating Scale (SSRS) , and the Personal Social Capital Scale 16 (PSCS-16) . Binary Logistic regression analysis was used to explore the factors influencing social isolation in elderly individuals with chronic diseases.Results:A total of 1 133 elderly individuals were surveyed, among which 538 had chronic diseases. Among the 538 elderly individuals with chronic diseases, 209 were socially isolated, resulting in a social isolation rate of 38.8%. Binary Logistic regression analysis revealed that living area, fear of falling, depression, social capital, and social support were significant factors influencing social isolation ( P<0.05) . Conclusions:The social isolation rate among elderly individuals with chronic diseases is high. Special attention should be given to elderly individuals living in rural areas, those who fear falling, and those experiencing depression. Additionally, improving social capital and social support can help alleviate social isolation in these elderly individuals.

Objective:To explore the potential categories and influencing factors of attitudes to aging among the elderly in nursing homes.Methods:Convenience sampling was used to select elderly from 15 nursing homes in Anhui Province from March to July 2024 for the study. The survey was conducted using the General Information Questionnaire, Attitudes to Ageing Questionnaire, Belongingness Scale for Older Adults in Nursing Facilities, and the Lubben Social Network Scale. Mplus 8.3 was used to conduct a latent profile analysis, and multivariate Logistic regression was employed to explore the factors influencing the latent categories of attitudes toward aging among the elderly in nursing facilities.Results:A total of 370 questionnaires were distributed, and 366 valid questionnaires were recovered, with an effective recovery rate of 98.9%. The attitudes to aging of 366 elderly of nursing facilities were expressed in three potential categories, namely, negative-perceived type (48.6%), moderate-low psychosocial loss type (35.0%), and positive and optimistic-comprehensive type (16.4%). Multicategorical Logistic regression analysis showed that the number of children, location of the nursing home, educational level, self-rating health, belongingness to the nursing home, and social network were the influencing factors of the potential categories of attitudes to aging among the elderly in the nursing home, and the difference was statistically significant ( P<0.05) . Conclusions:There is group heterogeneity in the attitudes to aging among the elderly in nursing homes. Healthcare professionals should focus on negative-perceived elderly and provide targeted interventions based on the potential categories of factors influencing their attitudes to aging.