ObjectiveTo explore the regulatory effects and mechanisms of Astragali Radix polysaccharide （APS） on inhibitor of differentiation1 （ID1） and protein kinase B （Akt） in gastric cancer. MethodsImmunohistochemical staining was used to detect the expression of ID1 and Akt in 61 gastric cancer tissue samples and 20 adjacent normal gastric tissue samples. Immunofluorescence was used to detect the localization of ID1 and Akt. The effects of APS at the concentrations of 0.625， 1.25， 2.5， 5， 10， 20 mg·L^-1 on the proliferation of gastric cancer MGC-803 cells were examined by the cell counting kit-8（CCK-8） method and the colony formation assay. The target information of APS was retrieved from the Traditional Chinese Medicine Systems Pharmacology and Analysis Platform and Swiss Target Prediction. Keywords such as gastric cancer， gastric tumor， and stomach cancer were searched against GeneCards， UniProt， DisGeNET， and Online Mendelian Inheritance in Man （OMIM） for the screening of gastric cancer-related targets. The online tool jvenn was used to create the Venn diagram to identify the common targets， and STRING and Cytoscape were used to construct the protein-protein interaction network. Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analyses were conducted via R 4.2.2 to predict the potential roles of APS in the development of gastric cancer. The cell scratch assay was employed to assess the effect of APS on the migration of MGC-803 cells. The protein and mRNA levels of ID1 and Akt in the cells treated with APS were determined by Western blot and Real-time PCR， respectively. ResultsCompared with the adjacent normal gastric tissue， the gastric adenocarcinoma tissue showed increased positive expression of ID1 （χ² =81.00， P<0.01）. Immunofluorescence detection showed that ID1 and Akt were mainly located in the cytoplasm of gastric adenocarcinoma cells. Bioinformatics analysis identified 14 common genes shared between APS and gastric cancer. The average degree of protein-protein interaction network nodes was 14.29. GO and KEGG pathway enrichment results showed that ID1 and Akt were significantly enriched in the Rap1 and phosphatidylinositol-3-kinase （PI3K） /Akt signaling pathways. Cell experiments demonstrated that 5-fluorouracil （0.1 mg·L^-1） and APS （10， 20 mg·L^-1） groups showed decreased cell proliferation， migration， and colony formation. Compared with the control group， 10， 20 mg·L^-1 APS inhibited the proliferation of MGC-803 cells （P<0.01）， with 10 mg·L^-1 APS demonstrating stronger inhibitory effect. In addition， APS at 10， 20 mg·L^-1 inhibited the migration （P<0.01） and colony formation （P<0.05， P<0.01） of MGC-803 cells. Compared with the control group， APS at 10， 20 mg·L^-1 down-regulated the protein levels of ID1 （P<0.01） and Akt （P<0.05） and the mRNA levels of ID1 （P<0.05， P<0.01） and Akt （P<0.05， P<0.01） in MGC-803 cells. ConclusionID1 and Akt are highly expressed in the gastric adenocarcinoma tissue， which may be related to the development of gastric cancer. APS can down-regulate the protein and mRNA levels of ID1 and Akt to exert anti-tumor effects， which is expected to provide new therapeutic targets for gastric cancer treatment.

From the perspective of palliative care， focusing on the entire process surrounding the death of terminally ill children， with an emphasis on the value of death for children. It explores the children’s understanding of death and the process of self-value pursuit， elucidating the construction of the value of death. Furthermore， it interprets the multifaceted implications of the value of death for children from three dimensions： terminally ill children， caregivers， and society. Additionally， it explores the role of the construction of the value of death in achieving a good death for terminally ill children， optimizing care models， and accelerating the formation of a societal environment of good death， as so to enhance contemporary society’s understanding and appreciation for the value of death for children， bridging the gap in pediatric palliative care and providing a theoretical basis for improving the quality of life for terminally ill children.

Objective Based on the background of disease diagnosis related groups(DRGs)in public hospitals to construct the nursing quality evaluation index system for percutaneous radiofrequency ablation(PRFA)of liver cancer so as to improve the nursing quality for PRFA of liver cancer.Methods Using three-dimensional quality model and through interview,literature analysis,two rounds of Delphi expert letter inquiry and analytic hierarchy process,the evaluation standard of PRFA nursing quality of liver cancer was established,and its effect was validated in clinical practice.Results The evaluation index system of PRFA nursing quality for liver cancer was constructed,which included 3 first-level indexes,9 second-level indexes and 22 third-level indexes.After clinical application,the incidence of intraoperative and postoperative moderate-severe pain,the incidence of high fever,and the 24-hour number of times required care in the intervention group were lower than those in the control group(P＜0.05),the incidence of postoperative Ⅲ degree vomiting in the intervention group was remarkably lower than that in the control group(P＜0.01),and the average hospitalization days in the intervention group were less than those in the control group(P＜0.05),and the average hospitalization expense in the intervention group was lower than that in the control group,but the difference was not statistically significant(P＞0.05).Conclusion The PRFA nursing quality evaluation index system for liver cancer is scientific and practical,which is helpful for improving the outcome of patients and promoting the quality of nursing.

Focusing on the field of palliative care，the Rodgers evolutionary concept analysis method was used to analyze the literature related to good death in the context of Chinese culture.The development history and application，definition and characteristics，influencing factors and their impacts，measuring indicators and tools of the concept of good death were elaborated，and further discussions were conducted.Good death refers to an individual’s peaceful and painless journey towards death，without subjective pain or concern，and calmness under the premise of sufficient longevity，while receiving care and companionship during the process of death from family，especially children and grandchildren，as well as achieving moral fulfilment and transcendence.The characteristics of good death in the context of Chinese traditional culture include the indirect expression of physical and mental pain being “understood” and properly handled，the construction of dying dignity based on virtue rather than autonomy，the emphasis on filial piety and emotional connections in the family，making after-death arrangements and realizing intergenerational inheritance，as well as the emphasis on achieving the integrity of life at the moment of death，which have distinct Chinese cultural characteristics.In the future，the connotation and extension of the concept of good death should be further explored，so as to assist in the development of localized theory and practice systems of good death.

Objective:To analyze the potential clinical biological factors influencing the major pathological response (MPR) to neoadjuvant immunochemotherapy in patients with resectable head and neck squamous cell carcinoma (HNSCC).Methods:This retrospective study enrolled patients with resectable HNSCC who underwent neoadjuvant immunochemotherapy at Sun Yat-sen University Cancer Center from June 1, 2019 to December 31, 2021. Binary logistic regression was used to analyze the correlation between clinical characteristics, inflammatory markers and MPR, and a nomogram model was constructed. The calibration curve and decision curve analysis were used to verify the predictive ability and accuracy of the nomogram model.Results:A total of 173 patients were included in the study, with 141 males and 32 females, aged from 22 to 83 years. After pathological assessment, the patients were divided into two groups: MPR group (108 cases) and non MPR group (65 cases). Logistics regression analysis indicated that the patients with HPV+oropharyngeal cancer, partial response or complete response by imaging assessment, low pre-treatment platelet/lymphocyte ratio, low pre-treatment C reactive protein/albumin ratio and lower pre-and post-treatment C reactive protein/albumin ratio difference were more likely to have MPR (all P<0.05). Nomogram model was constructed based on the above factors, with a C-index of 0.826 (95% CI: 0.760-0.892), and the calibration curve and decision curve analysis confirmed the prediction accuracy of the model. Conclusion:This study shows that many factors are related to MPR of patients with resectable HNSCC receiving neoadjuvant immunochemotherapy and the constructed nomogram model helps to develop personalized treatment strategies for the patients.

Objective To evaluate the therapeutic effect of removing uterine fibroids by binding the lower segment of uterus with pressure pulse band and blocking uterine blood supply combined with various suture methods during cesarean section.Methods A total of 260 cases of pregnant women undergoing elective cesarean section due to cicatricial uterus treated in Ningbo Women and Children's Hospital from 2015 to 2020 were selected.They were divided into two groups using the random number table method.In study group of 130 cases,the lower section of the uterus was bound with compression vein band and uterine fibroids were removed during cesarean section.In control group,130 cases underwent pure cesarean section.Through consulting patients'medical records and telephone visits,the general data,operation related data and postoperative recovery data of patients were collected and compared.Results The operation time in study group was longer than that in control group[(72.01±22.63)min vs.(58.78±11.64)min],the amount of intraoperative blood loss was higher than that of control group[(543.52±294.79)ml vs.(412.46±98.49)ml],the proportion of postoperative fever was higher than that of control group(10.0％vs.0.8％),and the postoperative hospital stay was longer than that of control group[(5.13±1.23)d vs.(4.47±0.72)d],the difference was statistically significant(P<0.05),and there was no statistically significant difference in postoperative exhaust time[(16.07±4.90)h vs.(16.14±4.93)h],the difference was not statistically significant(P>0.05).There were no cases of re-operation or death in both groups,and the newborns were all in good condition.Conclusion In the course of cesarean section,binding the lower segment of the uterus with pressure pulse band combined with various suture methods to remove uterine fibroids,although increased intraoperative blood loss,operation time,postoperative fever incidence,hospital stay,but can help patients solve uterine fibroids disease at the same time,and without serious complications.

From the perspective of hospice care,focusing on the entire process before and after the occurrence of a death event,taking the interpretation of the concept of death value in hospice care as the starting point,this paper explored the value connotation implied in the process of death from the perspectives of the terminal person,caregivers,and social culture,as well as summarized the characteristics of the death value.Meanwhile,in the current social context of the difficulty in achieving good death due to the shallow understanding of death,this paper analyzed the great significance of the construction of the death value concept in hospice care for improving the personal death quality of the terminal person,promoting the quality of end-of-life,and accelerating the formation of a social environment of good death,with a view to stimulating academic attention to the construction of the death value of terminal person,and providing conceptual reference for improving the quality of hospice care services.

Objective To explore the effectiveness of ADDIE instruction model(Analyse,Design,Develop,Implement,Evaluate)in the on-the-job training for neonatal transfer nurses to improve the comprehensive ability in life-saving as well as to ensure the safety of neonates during the transfer.Methods The pre-and post-control study in self-trained comparison was conducted with 35 neonatal nurses in our hospital.Thirty-five neonatal nurses in our hospital were included in a special training group for neonatal transport.According to the ADDIE instruction model,the training needs of nurses were analysed,special training protocols were designed and developed,training rules were implemented and the effects of training on the nurses were evaluated.Scores in professional theoretical knowledge,practical and various skills and teamwork and communication abilities in neonatal transfer were compared before and after the implementation of the ADDIE instruction model.Results All of the 35 nurses had completed the training and responded to the survey.The scores in professional theoretical knowledge,practical skills and teamwork and communication abilities in the neonatal transfer nurses were all significantly increased after the training with ADDIE instruction model(P＜0.001).Conclusions On-the-job training of ADDIE instruction model among the neonatal transfer nurses can effectively enhance the professional knowledge and practice skills,enable the nurses to play a leading role in the process of treatment and improve abilities in teamwork and communication of the neonatal transfer nurses.The ADDIE instruction model provides valuable insights in the training of neonatal transfer nurses.

Sepsis is the main cause of infection death in intensive care unit(ICU),and thrombocytopenia is a common complication.Persistent thrombocytopenia is a marker of poor prognosis in critically ill patients.Sepsis-associated thrombocytopenia(SAT)involves a variety of pathophysiological mechanisms,and platelets play a key role in coagulation and inflammatory response.Platelet count(PLT)can not only predict the prognosis of patients with sepsis,but also be used as a therapeutic target to improve the success rate of rescue in patients with sepsis.This article will review the pathophysiological mechanism,prognosis and treatment of platelets in septic patients.

This article reported a prenatal diagnosis of fetal bladder prolapse caused by patent urachus and ruptured urachal cyst. On August 8, 2023 (12 weeks and 5 days of gestation), a routine prenatal ultrasound examination in Heping Hospital Affiliated to Changzhi Medical College revealed that one of the twins had an anechoic area (22.0 mm×17.0 mm) protruding into the umbilical cord at the umbilical opening, which was connected to the bladder in a bell-shaped manner through an unclosed urachus. Regular follow-up ultrasounds indicated that the cyst increased in size as the pregnancy progressed, the biggest was 38.3 mm×30.2 mm (23 +5 gestational weeks). At 33 weeks and 5 days of gestation, ultrasound showed that the cyst had disappeared, and a high-echo mass (21.3 mm×15.2 mm) was visible at the umbilical opening, while the bladder was not visible even upon repeated scans. These observations led to the diagnosis of bladder prolapse due to patent urachus and ruptured urachal cyst. Postnatally, the infant was transferred to an external hospital for surgical treatment, where the diagnosis of bladder prolapse was further confirmed and prolapse repair and umbilicoplasty were done. Postoperative pathology verified that the protruding high-echo mass was bladder tissue. Follow-up examinations at 2 months of age showed no significant complications.