Objective To explore the impact of the connect,introduce,communicate,ask,respond,exit(CICARE)communication model combined with feedback health education model on the compliance and anxiety level of elderly outpatients before colonoscopy.Methods A total of 346 patients aged ≥60 who visited the Outpatient Department,the Second Hospital of Jiaxing City for the first time and underwent colonoscopy from September to December 2023 were randomly divided into control group(n=86),communication group(n=84),feedback group(n=86),and combined group(n=90)using random number table method.The control group were provided routine education to patients undergoing colonoscopy through watching colon preparation videos,verbal education,and written propaganda educational materials;The communication group were implemented health education for colonoscopy by using the CICARE communication model;The feedback group were implemented health education for colonoscopy by using feedback method;The combined group were implemented the above education to patients by using the CICARE communication model combined with feedback method.The compliance with colon preparation,intestinal cleanliness,and patient anxiety scores before colonoscopy were evaluated and compared among the four groups.Results There were no statistically significant differences in dietary compliance and medication compliance among the four groups(P＞0.05),but there was a statistically significant difference in exercise compliance(P＜0.05).Different educational methods had statistical significance on patients'intestinal cleanliness and anxiety scores(P＜0.001),and further post hoc comparisons showed that the education method of the combined group could improve the overall intestinal cleanliness score and reduce patient anxiety score.Conclusion The health education model of the CICARE communication method combined with feedback has a significant effect on health education for elderly patients,which can improve the compliance with colon preparation and reduce patient anxiety scores.

Objective:To construct and validate a nomogram model for predicting sepsis-associated acute kidney injury (SA-AKI) risk in intensive care unit (ICU) patients.Methods:A retrospective cohort study was conducted. Adult sepsis patients admitted to the department of ICU of the 940th Hospital of Joint Logistic Support Force of PLA from January 2017 to December 2022 were enrolled. Demographic characteristics, clinical data within 24 hours after admission to ICU diagnosis, and clinical outcomes were collected. Patients were divided into training set and validation set according to a 7∶3 ratio. According to the consensus report of the 28th Acute Disease Quality Initiative Working Group (ADQI 28), the data were analyzed with serum creatinine as the parameter and AKI occurrence 7 days after sepsis diagnosis as the outcome. Lasso regression analysis and univariate and multivariate Logistic regression analysis were performed to construct the nomogram prediction model for SA-AKI. The discrimination and accuracy of the model were evaluated by the Hosmer-Lemeshow test, receiver operator characteristic curve (ROC curve), decision curve analysis (DCA), and clinical impact curve (CIC).Results:A total of 247 sepsis patients were enrolled, 184 patients developed SA-AKI (74.49%). The number of AKI patients in the training and validation sets were 130 (75.58%) and 54 (72.00%), respectively. After Lasso regression analysis and univariate and multivariate Logistic regression analysis, four independent predictive factors related to the occurrence of SA-AKI were selected, namely procalcitonin (PCT), prothrombin activity (PTA), platelet distribution width (PDW), and uric acid (UA) were significantly associated with the onset of SA-AKI, the odds ratio ( OR) and 95% confidence interval (95% CI) was 1.03 (1.01-1.05), 0.97 (0.55-0.99), 2.68 (1.21-5.96), 1.01 (1.00-1.01), all P < 0.05, respectively. A nomogram model was constructed using the above four variables. ROC curve analysis showed that the area under the curve (AUC) was 0.869 (95% CI was 0.870-0.930) in the training set and 0.710 (95% CI was 0.588-0.832) in the validation set. The P-values of the Hosmer-Lemeshow test were 0.384 and 0.294, respectively. In the training set, with an optimal cut-off value of 0.760, a sensitivity of 77.5% and specificity of 88.1% were achieved. Both DCA and CIC plots demonstrated the model's good clinical utility. Conclusion:A nomogram model based on clinical indicators of sepsis patients admitted to the ICU within 24 hours could be used to predict the risk of SA-AKI, which would be beneficial for early identification and treatment on SA-AKI.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis-associated acute kidney injury (SA-AKI) is a common organ dysfunction of sepsis, and its incidence and mortality are increasing, which brings heavy economic burden to patients and society. Early diagnosis and effective intervention can block the occurrence and progression of SA-AKI effectively, improve prognosis, and reduce medical costs. Diagnosis on SA-AKI relies on urine volume and serum creatinine, which has the disadvantages of being easily disturbed and delaying. The identification of biomarkers in blood and urine can facilitate diagnosis and provide targeted therapy to enhance the management of SA-AKI. This article reviews the characteristics of a variety of SA-AKI biomarkers that have been found and validated, including pre-damage biomarkers, damage biomarkers and functional biomarkers, and explore the clinical value of newly discovered biomarkers related to the diagnosis and treatment of SA-AKI, such as blood uncoupling protein 2 (UCP2), Sestrin 2 protein and pannexin 1 (PANX1), to provide reference for the early diagnosis and effective treatment of SA-AKI.

Microglial surveillance plays an essential role in clearing misfolded proteins such as amyloid-beta, tau, and α-synuclein aggregates in neurodegenerative diseases. However, due to the complex structure and ambiguous pathogenic species of the misfolded proteins, a universal approach to remove the misfolded proteins remains unavailable. Here, we found that a polyphenol, α-mangostin, reprogrammed metabolism in the disease-associated microglia through shifting glycolysis to oxidative phosphorylation, which holistically rejuvenated microglial surveillance capacity to enhance microglial phagocytosis and autophagy-mediated degradation of multiple misfolded proteins. Nanoformulation of α-mangostin efficiently delivered α-mangostin to microglia, relieved the reactive status and rejuvenated the misfolded-proteins clearance capacity of microglia, which thus impressively relieved the neuropathological changes in both Alzheimer's disease and Parkinson's disease model mice. These findings provide direct evidences for the concept of rejuvenating microglial surveillance of multiple misfolded proteins through metabolic reprogramming, and demonstrate nanoformulated α-mangostin as a potential and universal therapy against neurodegenerative diseases.

Objective:In order to understand the changing trends of gastric cancer incidence and mortality in early-onset and late-onset in China from 2000 to 2019.Methods:The Global Burden of Disease research data was collected, and Excel and R 4.2.1 softwares were used to examine the incidence rate, mortality rate, and disability-adjusted life years (DALY) of Chinese people from 2000 to 2019, with a focus on gender, age, and year.Results:In 2019, the crude incidence rates were 7.06/100 000 (95% UI: 6.63/100 000-7.59/100 000) and 114.52/100 000 (95% UI: 108.79/100 000-121.63/100 000) for early- and late-onset gastric cancer, respectively. The crude mortality rate for early-onset gastric cancer was 3.29/100 000 (95% UI: 3.11/100 000- 3.50/100 000), while the crude mortality rate for late-onset gastric cancer was 81.88/100 000 (95% UI: 78.15/100 000-86.04/100 000). Additionally, the crude DALY rates for these two types of gastric cancer were 156.48/100 000 (95% UI: 148.82/100 000-165.84/100 000) and 1 750.13/100 000 (95% UI: 1 661.21/100 000-1 852.99/100 000). The standardized incidence of early-onset gastric cancer decreased from 5.49/100 000 in 2000 to 4.76/100 000 in 2019, and that of late-onset gastric cancer decreased from 143.45/100 000 in 2000 to 123.02/100 000 in 2019.The standardized mortality rate of early-onset gastric cancer decreased from 4.16/100 000 in 2000 to 2.18/100 000 in 2019, and that of late-onset gastric cancer decreased from 140.82/100 000 in 2000 to 91.49/100 000 in 2019. The standardized DALY rate for early-onset gastric cancer in 2019 was 105.87/100 000 (95% UI: 87.98/100 000 -125.60/100 000), lower than 198.84/100 000 (95% UI: 179.47/100 000- 219.83/100 000) in 2000. The standardized DALY rate for late onset gastric cancer in 2019 was 1 821.11/100 000 (95% UI: 1 509.42/100 000-2 158.53/100 000), lower than 2 932.52/100 000 (95% UI: 2 665.92/100 000-3 252.60/100 000) in 2000. Conclusions:The standardized mortality rate of early-onset gastric cancer in China showed a decreasing trend from 2000 to 2019. The standardized mortality rate of late onset gastric cancer showed a trend of first increasing and then decreasing. Notably, the incidence, mortality, and DALY of late-onset gastric cancer were significantly higher than those of early-onset gastric cancer during this period. Additionally, male incidence, mortality, and crude DALY rates were higher than female.

A 65-year-old male patient with stage Ⅳa lung adenocarcinoma had microscopic hema- turia for more than 10 years, and his urinary occult blood fluctuated between (+) and (++). Because his tumor target gene test showed that the epidermal growth factor receptor L858R mutation was positive, he received gefitinib 250 mg once daily orally. Laboratory tests before treatments showed albumin (ALB) 37.2 g/L, serum creatinine (Scr) 73 μmol/L, and urine occult blood (++). After 2 days of treatment, the patient developed generalized rashes, obvious foam urine, and severe edema of both lower limbs. Two weeks later, laboratory tests showed urinary occult blood (++++), urinary protein (++++), ALB 28.3 g/L, and Scr 111 μmol/L. The Scr peak value was 135 μmol/L and ALB trough value was 21.5 g/L. The drug eruptions and nephrotic syndrome caused by gefitinib were considered, gefitinib was discontinued, and symptomatic and supportive treatments were given. After 3 days, the rashes and edema gradually subsided, and the anti-tumor drug was switched to osimertinib. The pathological examination of renal puncture showed IgA nephropathy. Gefitinib-induced nephrotic syndrome on the basis of primary IgA nephropathy was considered. After 17 days, the patient′s rashes completely subsided and the edema was significantly improved. At 8 months of follow-up, the laboratory tests showed ALB 37.9 g/L, Scr 130 μmol/L, and urinary protein (++), suggesting that the renal injury had not yet fully recovered.

A 65-year-old male patient with stage Ⅳa lung adenocarcinoma had microscopic hema- turia for more than 10 years, and his urinary occult blood fluctuated between (+) and (++). Because his tumor target gene test showed that the epidermal growth factor receptor L858R mutation was positive, he received gefitinib 250 mg once daily orally. Laboratory tests before treatments showed albumin (ALB) 37.2 g/L, serum creatinine (Scr) 73 μmol/L, and urine occult blood (++). After 2 days of treatment, the patient developed generalized rashes, obvious foam urine, and severe edema of both lower limbs. Two weeks later, laboratory tests showed urinary occult blood (++++), urinary protein (++++), ALB 28.3 g/L, and Scr 111 μmol/L. The Scr peak value was 135 μmol/L and ALB trough value was 21.5 g/L. The drug eruptions and nephrotic syndrome caused by gefitinib were considered, gefitinib was discontinued, and symptomatic and supportive treatments were given. After 3 days, the rashes and edema gradually subsided, and the anti-tumor drug was switched to osimertinib. The pathological examination of renal puncture showed IgA nephropathy. Gefitinib-induced nephrotic syndrome on the basis of primary IgA nephropathy was considered. After 17 days, the patient′s rashes completely subsided and the edema was significantly improved. At 8 months of follow-up, the laboratory tests showed ALB 37.9 g/L, Scr 130 μmol/L, and urinary protein (++), suggesting that the renal injury had not yet fully recovered.

Objective:To study the impact of preoperative serum HBV DNA levels on prognosis of hepatocellular carcinoma (HCC) patients undergoing hepatectomy with curative intent.Methods:The clinical data of patients with HCC treated by hepatectomy with curative intent at the Guangxi Medical University Cancer Hospital from January 2010 to December 2016 were retrospectively analyzed. According to the preoperative serum HBV DNA levels, patients were divided into three groups: the control group (HBV DNA negative), the low load group (<10 4 copy/ml) and the high load group (≥10 4 copy/ml). The clinical data of these patients were collected and long-term survival outcomes of these patients were followed-up. The Kaplan-Meier method was used to compare the overall survival (OS) and recurrence-free survival (RFS) rates among the three groups. Using the Barcelona clinic liver cancer classification (BCLC), patients with different serum HBV DNA levels were further divided into three subgroups: stage 0/A, stage B and stage C. The OS and RFS rates of patients in each of these subgroups were compared. Results:Of 1 180 patients who were enrolled in the study, there were 1 024 males and 156 females, aged (48.6±10.8) years. The 1-, 3- and 5-year OS rates for patients in the control group ( n=258) were 91.5%, 79.3% and 74.9%, respectively; while those in the low load group ( n=289) were 87.2%, 68.6% and 61.6%, respectively; and those in the high load group ( n=633) were 85.4%, 68.9% and 60.7%, respectively. The 1-, 3- and 5-year OS rates in the control group were significantly better than those in the low load group and the high load group ( P<0.05). The 1-, 2- and 3-year RFS rates in the control group were significantly higher than those in the high load group ( P<0.05). Subgroup analysis showed that in the BCLC 0/A subgroup ( n=786) the 1-, 3- and 5-year OS rates in the control group were significantly better than those in the high load group ( P<0.05). In the BCLC B subgroup ( n=181), the 1-, 2- and 3-year RFS rates in the control group were significantly higher than those in the high load group ( P<0.05). In the BCLC C subgroup ( n=214), there were no significant differences in the 1-, 3- and 5-year OS and 1-, 2- and 3-year RFS rates among the three groups ( P>0.05). Conclusion:For HCC patients undergoing hepatectomy with curative intent, the higher the preoperative serum HBV-DNA level, the worse the long-term survival outcomes.

Objective To study the correlation between serum prealbumin level before liver resection and prognosis of patients with primary hepatocellular carcinoma (HCC).Methods The clinical data of patients with HCC who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from August 2007 to October 2016 were retrospectively analyzed.The previous albumin of 200 mg/L and the pre-albumin as predicted by the maximum selection rank statistic method were used as the bounding group,and reduced groups and the correlation between pre-operative serum pre-albumin levels and clinicopathological characteristics were analyzed.The Kaplan-Meier method was used to calculate the overall survival rate of patients with the different cutoff levels.The Cox proportional regression model was used to analyze,and cirrhosis,alpha-fetoprotein levels and Barcelona Clinic Liver Cancer staging were used to adjust the relationship between serum prealbumin and prognosis of liver resection for HCC patients.Analysis of stratified variables was performed and their interactions with serum prealbumin were analyzed.Results Of the 2 022 patients included in this study,there were 1 739 males and 283 females.Their age was 49.5 ± 11.2 years.The median follow-up was 37.4 months.The optimal cutoff value of prealbumin predicted by the maximum selection rank statistic method was 166 mg/L.Regardless of the cutoff values of previous albumin 200 mg/L or prealbumin 166 mg/L,multivariate analysis showed that preoperative serum prealbumin level was an independent prognostic risk factor for patients (P ＜0.05).The prognosis of patients with ＞200 mg/L (＞ 166 mg/L) serum prealbumin before surgery was significantly better than that of patients with ≤200 mg/L (≤166 mg/L) prealbumin,the differences were significant (all P ＜ 0.05).After adjusting for confounding factors,the prealbumin level correlated with prognosis of patients with HCC [cutoff value 200 mg/L:HR (95％ CI) was 1.59 (1.35-1.86),cutoff value 166 mg/L:HR (95％ CI) was 1.69 (1.44-1.98),all P ＜ 0.05].The results of stratified analysis showed that the relationship between prealbumin levels and the prognosis of HCC patients became more robust.Conclusions Preoperative serum prealbumin was an independent risk factor for prognosis of HCC patients,and it had predictive value on prognosis of HCC patients.

Objective To analyze the clinical manifestations, computed tomography scan (CT), gastroscope, endo-scopic ultrasonography (EUS), and therapy method of gastritis cystica profunda. Methods Retrospectively analyzed clinical manifestations, CT, gastroscope, EUS, and pathological results of 6 cases of gastritis cystica profunda. Results In these 6 cases, 3 of them were doubted gastric carcinoma, 3 cases were considered stomach mass by CT. Gastroscope hinted apophysis lesions, but all cases were suggested gastritis cystica profunda by EUS. And all cases were removed through endoscopic submucosal dissection (ESD). Pathology were confirmed the diagnosis. Conclusion EUS combined with endoscopic mucosal resection (EMR) or ESD technique can improve the diagnostic rate. For gas-tritis cystica profunda which are not associated with malignant tumor can be treated through ESD.