Objective To establish the functional constipated mouse model by compound diphenoxylate, and explore the anti-constipation effect of black garlic polysaccharide. Methods Mouse small intestine ink propulsion experiment and mouse defecation experiment were carried out respectively. The mice in each experiment were randomly divided into blank group, model group, positive group and black garlic polysaccharide （0.25, 0.5, 1 g/kg） groups. Mice in blank group and model group were given distilled water, and in positive group were given lactulose oral solution. Compound diphenoxylate （5 mg/kg） was intragastric administrated after 1 week of administration, and small intestine propulsion experiment and defecation experiment were conducted respectively. Results Compared with model group, intestinal propulsion rate of black garlic polysaccharide groups was significantly increased and first dejection time was significantly shorten, and the number, weight and fecal water content increased significantly at 6 h in middle and high dose groups. Conclusion Black garlic polysaccharide could promote intestinal propelling, shorten defecation time and increase fecal water content.

OBJECTIVE To evaluate the cost-effectiveness of different sequential treatment regimens for human epidermal growth factor receptor 2 （HER-2）-positive advanced gastric cancer from the perspective of the Chinese health system. METHODS Survival data were obtained from the ToGA， WJOG 4007 and RAINBOW-Asia trials， and adjusted using network meta-analysis. A four-state Markov model was constructed to evaluate the cost-effectiveness of six treatment sequences， with a lifetime simulation horizon and a cycle period of 4 weeks （28 d）， and the main output parameters of the model included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analysis was conducted to test the robustness of the basic analysis results， and a price reduction scenario analysis for trastuzumab was performed. RESULTS Compared with chemotherapy sequentially treated with paclitaxel， the ICER of trastuzumab combined with chemotherapy sequentially treated with paclitaxel， or irinotecan， or ramucirumab plus paclitaxel were 349 845.25， 772 410.64， and 2 510 470.39 yuan/QALY， respectively， all exceeding three times China’s 2023 per capita gross domestic product （GDP） （268 074 yuan/QALY） as the willingness-to-pay （WTP） threshold. This indicated that chemotherapy sequential paclitaxel was the optimal treatment regimen. The sensitivity analysis confirmed the robustness of the basic analysis. The scenario analysis showed that when trastuzumab was reduced by more than 20%， trastuzumab combined with chemotherapy sequentially treated with paclitaxel became cost-effective under this study’s WTP threshold. CONCLUSIONS When using three times China’s 2023 per capita GDP as the WTP threshold， chemotherapy sequentially treated with paclitaxel is the optimal regimen for HER-2 positive advanced gastric cancer， with trastuzumab combined with chemotherapy sequentially treated with paclitaxel as the second best option. With enhanced medical insurance optimization， trastuzumab combined with chemotherapy sequentially treated with paclitaxel is expected to become the most cost-effective treatment regimen.

Objective To investigate the early diagnostic value of serum double cortin-like kinase 1(DCLK1),latent transforming growth factor binding protein 2(LTBP2)combined with transvaginal real-time shear wave elastography(SWE)for cervical cancer.Methods A total of 155 patients with cervical lesions treated in our hospital from August 2021 to December 2022 were selected as the research objects.Seventy-five patients with cervical cancer(the cervical cancer group)and 80 patients with cervical intraepithelial neoplasia(the CIN group)were diagnosed by surgical pathology,another 80 volunteers without cervical related diseases who participated in physical examinations at our hospital during the same period were selected as the control group.All subjects of each groups underwent serum DCLK1 and LTBP2 levels detection and transvaginal SWE examination.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum DCLK1 and LTBP2 for cervical cancer;the diagnostic value of serum DCLK1 and LTBP2 combined with transvaginal SWE for cervical cancer was analyzed by fourfold table analysis.Results The serum levels of DCLK1 and LTBP2 of patients in the cervical cancer group were obviously higher than those in the CIN group and the control group(P<0.05).Compared with before surgery,the serum levels of DCLK1 and LTBP2 1,3,and 6 months after surgery in cervical cancer patients gradually decreased,and there were statistical differences in pairwise comparisons at each time point(P<0.05).The area under the curve of serum DCLK1 and LTBP2 for diagnosing cervical cancer were 0.868 and 0.754,respectively,with sensitivity of 86.67% and 78.67%,specificity of 81.25% and 60.00%,and optimal cutoff values of 1.49 ng/mL and 19.02 μg/mL.The maximum and average elastic modulus of lesion tissue in the cervical cancer group were obviously higher than those in the CIN group(P<0.05).The positive rates of serum DCLK1,serum LTBP2,and transvaginal SWE in the diagnosis of cervical cance were 86.67%,78.67%,and 82.67%,respectively,which were consistent with the gold standard(Kappa=0.624,0.501,0.673,P<0.001),and the positive rate of the combination of them in the diagnosis of cervical cancer was 97.33%,which was highly consistent with the gold standard(Kappa=0.846,P<0.001).The sensitivity and accuracy of the three combined diagnosis were obviously higher than those of the single indicator diagnosis of serum DCLK1,LTBP2,and transvaginal SWE,the specificity of the three combined diagnosis was obviously higher than that of the single indicator diagnosis of serum DCLK1 and LTBP2,the misdiagnosis rate of the three combined diagnosis was obviously lower than that of the single indicator diagnosis of serum DCLK1 and LTBP2,and the differences were all statistically significant(P<0.05).Conclusion Serum DCLK1 and LTBP2 combined with transvaginal SWE has high application value in the diagnosis of cervical cancer,which can further improve the sensitivity and accuracy of diagnosis,and reduce the misdiagnosis rate.

Objective:To explore the cognition and behavior of nurses in blood purification centers on the quality of death of patients undergoing maintenance hemodialysis.Methods:The descriptive phenomenological research method was adopted. From August to October 2022, a total of 14 nurses from blood purification centers in three hospitals, namely Beijing Union Medical College Hospital, Beijing Hospital and Beijing Chaoyang Hospital were selected as interview subjects by the purposive sampling method. Semi-structured in-depth interview method was used to collect data, and Colaizzi 7-step analysis method was used to analyze data.Results:The cognition and behavior of nurses in the blood purification center towards the quality of death of maintenance hemodialysis patients were analyzed into four themes, namely factors affecting the quality of death of patients, convenient conditions for nurses to carry out quality of death improvement work, proactive measures taken by nurses to improve the quality of death and obstacles in the process of improving the quality of death of patients.Conclusions:The nurses in the blood purification centers have special characteristics in their feelings about the death of patients with maintenance hemodialysis, and they have certain cognition and judgment about the quality of death of patients. Managers need to pay attention to the relevant needs and suggestions of the nurses in the blood purification centers and provide help and guidance, so as to continuously improve the quality of patient death and achieve the goal of optimal death of patients.

Objective: Surgical procedures for patients with posttraumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery. Methods: We consecutively enrolled PTS patients (arachnoid lysis group, n = 42; shunting group, n = 14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal magnetic resonance imaging preoperatively, 3–12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and blood-spinal cord barrier disruption was detected by quotient of albumin (Qalb, cerebrospinal fluid/serum). Results: The ages (p = 0.324) and sex (p = 0.065) of the PTS and control groups did not differ significantly. There were also no significant differences in age (p = 0.216), routine blood data and prognosis (p = 0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (p < 0.001), and the shunting group had a significantly higher QAlb (p < 0.001) than the arachnoid lysis group. A high preoperative QAlb (odds ratio, 1.091; 95% confidence interval, 1.004–1.187; p = 0.041) was identified as the predictive factor for the shunting procedure, with the receiver operating characteristic curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67. Conclusion Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb > 12.67, shunting represents the final recourse, necessitating the exploration and development of novel treatments for these patients.

Objective:To collect and analyze the quality control data of gastric cancer surgery in Jiangsu Province from 2020 to 2022,and study the role of publishing surgical quality control data in promoting the improvement of gastric cancer surgery of China. Methods:An online questionnaire was created and distributed to the members of Jiangsu Gastric Cancer Union(JSGCU).The questionnaire collected information including the basic situation of hospital,the diagnosis and treatment of early gastric cancer,advanced gastric cancer and metastatic gastric cancer,the digestive tract reconstruction,the surgical safety,the economic indicators,and so on. Results:The quality control data of gastric cancer surgery in Jiangsu Province from 2020 to 2022 were consistently collected and published.The data analysis results show that there was a gradual increase in the percent of patients with stage Ⅰ gastric cancer,reflecting the success efforts of early screening and diagnosis.Laparoscopic surgery showed a steady increase and became the mainstream approach for curative surgery of gastric cancer in Jiangsu Province.The percent of hospital with lymph node dissection≥30 was also increased.Different locations of gastric cancer exhibited specific patterns in the choice of anastomosis methods after curative surgery.The rate of grade 3 or higher complications in laparoscopic gastric cancer surgery was slightly lower than that in open surgery.For patients experiencing complications,their postoperative hospitalization duration and expenditure were significantly higher.Finally,there was a gradual increase in the proportion of hospital choosing to close the mesentery during gastric cancer surgery. Conclusion:The publication of the quality control data of gastric cancer surgery in Jiangsu Province has driven the improvement of gastric cancer surgery standards of China.

Objective To investigate the effect of rehabilitation instruction based on resourceful theory on the execution intention of exercise behaviour in patient with the first-episode stroke.Methods From September 2022 to February 2023,a total of 80 inpatients with first-episode stroke from a general hospital in Anhui Province participated in the study.Patients in Wards Ⅰ and Ⅱ were assigned to an intervention group,while those in Wards Ⅲ and Ⅳ were assigned to a control group,with 40 patients per group.The patients in control group received standard interventions,while those in the intervention group were offered with a rehabilitation instruction based on resourceful theory in addition to the standard interventions.Stroke patient rehabilitation exercise behaviour execution intention questionnaire,resourcefulness scale and modified Barthel were employed for assessments before and after the intervention.Results After the intervention,the intervention group showed significantly higher scores inexecutive intention of exercise behaviour,resourcefulness level and daily living activities compared to those in the control group(all P＜0.01).Conclusion Rehabilitation instruction based on the theory of resourcefulness can effectively increase the executive intention of exercise behaviour in the patients with first-episode stroke,improve the resourcefulness thinking levels and enhance the daily living activity of the patients.

Objective:To dynamically monitor the changes of fibrinogen-like protein 2 (FGL2), Vaspin and transport protein (TSPO) in the perioperative period of craniocerebral trauma, and analyze their correlation with disease progression and significance.Methods:One hundred and eight patients with craniocerebral trauma admitted to Hubei Jianghan Oilfield General Hospital Guanghuayuan District from June 2019 to June 2022 were selected and according the scores of Glasgow outcome scale (GOS) at 3 months postoperatively they were divided into good group (GOS 4 - 5 scores, 68 cases) and poor group (GOS 1 - 3 scores, 40 cases). The changes of FGL2, Vaspin and TSPO were monitored and compared between the two groups at preoperatively, 1 d postoperatively and 3 d postoperatively. Pearson analysis was applied to analyze the relationship between FGL2, Vaspin and TSPO at 1, 3 d postoperatively. The value of FGL2, Vaspin, TSPO and combined prediction of disease regression at 3 d postoperatively was analyzed by receiver operating characteristic (ROC) curve.Results:The rate of multiple injuries and brain herniation formation in the poor group were higher than those in the good group: 30.00% (12/40) vs. 7.35% (5/68), 20.00% (8/40) vs. 2.94% (2/68), and the scores of Glasgow coma scale (GCS) was lower than that in the good group: (8.04 ± 1.25) scores vs. (9.18 ± 1.33) scores, there were statistical differences ( P<0.05). The levels of FGL2, Vaspin and TSPO were all higher at 1 d postoperatively than before surgery in patients with different disease regressions, with each index decreasing at 3 d postoperatively compared with 1 d postoperatively in the good group, but continuing to increase at 3 d postoperatively in the bad group ( P<0.05). The levels of FGL2, Vaspin and TSPO in the poor group were higher than those in the good group at 1 d and 3 d postoperatively: at 1 d postoperatively: (314.01 ± 88.67) μg/L vs. (275.33 ± 79.24) μg/L, (0.27 ± 0.08) μg/L vs. (0.22 ± 0.07) μg/L, (3.28 ± 1.03) μg/L vs. (2.01 ± 0.64) μg/L; at 3 d postoperatively: (374.85 ± 92.33) μg/L vs. (259.94 ± 81.78) μg/L, (0.30 ± 0.09) μg/L vs. (0.20 ± 0.06) μg/L, (3.77 ± 1.15) μg/L vs. (1.68 ± 0.52) μg/L, there were statistical differences ( P<0.05). The results of Pearson analysis showed that FGL2, Vaspin and TSPO were negatively correlated with GOS scores at 1 d and 3 d postoperatively (at 1 d postoperatively: r = - 0.729, - 0.796, - 0.814, P<0.05; at 3 d postoperatively: r = - 0.862, - 0.855, - 0.905, P<0.05), FGL2, Vaspin and TSPO were more strongly correlated with GOS scores at 3 d postoperatively (larger r values). The results of ROC curve analysis showed that FGL2, Vaspin and TSPO all had a predictive value for disease regression, and the area under the curve of FGL2 combined with Vaspin and TSPO was the largest (0.923 , 95% CI 0.855 to 0.965). Conclusions:There are many influencing factors in the prognosis of craniocerebral trauma. The changes of FGL2, Vaspin and TSPO during the perioperative period can predict the progress and regression of patients, and the combined dynamic monitoring is more conductive to evaluate the prognosis.

Objective: Surgical procedures for patients with posttraumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery. Methods: We consecutively enrolled PTS patients (arachnoid lysis group, n = 42; shunting group, n = 14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal magnetic resonance imaging preoperatively, 3–12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and blood-spinal cord barrier disruption was detected by quotient of albumin (Qalb, cerebrospinal fluid/serum). Results: The ages (p = 0.324) and sex (p = 0.065) of the PTS and control groups did not differ significantly. There were also no significant differences in age (p = 0.216), routine blood data and prognosis (p = 0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (p < 0.001), and the shunting group had a significantly higher QAlb (p < 0.001) than the arachnoid lysis group. A high preoperative QAlb (odds ratio, 1.091; 95% confidence interval, 1.004–1.187; p = 0.041) was identified as the predictive factor for the shunting procedure, with the receiver operating characteristic curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67. Conclusion Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb > 12.67, shunting represents the final recourse, necessitating the exploration and development of novel treatments for these patients.

Objective: Surgical procedures for patients with posttraumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery. Methods: We consecutively enrolled PTS patients (arachnoid lysis group, n = 42; shunting group, n = 14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal magnetic resonance imaging preoperatively, 3–12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and blood-spinal cord barrier disruption was detected by quotient of albumin (Qalb, cerebrospinal fluid/serum). Results: The ages (p = 0.324) and sex (p = 0.065) of the PTS and control groups did not differ significantly. There were also no significant differences in age (p = 0.216), routine blood data and prognosis (p = 0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (p < 0.001), and the shunting group had a significantly higher QAlb (p < 0.001) than the arachnoid lysis group. A high preoperative QAlb (odds ratio, 1.091; 95% confidence interval, 1.004–1.187; p = 0.041) was identified as the predictive factor for the shunting procedure, with the receiver operating characteristic curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67. Conclusion Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb > 12.67, shunting represents the final recourse, necessitating the exploration and development of novel treatments for these patients.