Objective: To compare the effectiveness of the uniportal bichannel dual-media spinal endoscopic technique (UBD-TLIF) with open transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) with lumbar instability in older patients aged ≥65 years. Methods: This retrospective study included 64 older patients with LDH and lumbar instability who were admitted to Shanghai Tenth People Hospital between January 2023 and June 2025. General surgical parameters, perioperative pain levels, pre- and postoperative back and leg pain scores, functional outcomes, complication status, and lumbar spine stability were recorded and analyzed. Results: In the UBD-TLIF group, intraoperative blood loss was significantly lower than in the O-TLIF group. The UBD-TLIF group also demonstrated shorter incision length, reduced bed rest duration, and a shorter hospital stay compared with the O-TLIF group (p<0.05). Postoperatively, patients in the UBD-TLIF group showed significant improvement in visual analogue scale and Oswestry Disability Index scores (p<0.001). No complications were observed in either group. Conclusion Both UBD-TLIF and O-TLIF improved lumbar function in older patients with LDH and lumbar instability and demonstrated acceptable safety profiles. Compared with O-TLIF, UBD-TLIF, characterized by a smaller incision, was associated with reduced intraoperative blood loss, decreased early postoperative pain, and accelerated early recovery.

Objective Based on the intervention map to develop a comprehensive nutrition education program for pancreaticoduodenectomy patients and to explore the effect of its clinical application,aiming at providing references for clinical nursing practice.Methods A convenience sampling method was used to select 76 patients who were to undergo pancreaticoduodenectomy in the department of hepatobiliary and pancreatic surgery of a tertiary hospital in Anhui Province as the study subjects.The 38 patients admitted from October 2021 to September 2022 were in a control group,and the 38 patients admitted from October 2022 to July 2023 were in an experimental group.The experimental group received the comprehensive nutritional education programme constructed in this study,and the control group used conventional nutrition health education measures,and the length of intervention for both groups was from pre-hospitalization to discharge for 6 months.Nutrition-related indicators,postoperative complications,hospitalisation time,hospitalisation costs and satisfaction were compared between the 2 groups.Results A total of 64 patients completed this study,with 33 in the experimental group and 31 in the control group.Repeated measurement analysis of variance showed that the interaction effects of BMI,total serum protein and serum preprotein were statistically significant(P＜0.05).The incidence of complications,hospitalization days and hospitalization costs of the experimental group were lower than those of the control group(P＜0.05).The scores of nutrition education-related satisfaction in the experimental group were higher than those in the control group(P＜0.001).Conclusion A comprehensive nutritional education program based on intervention map can improve the nutritional status of pancreaticoduodenectomy patients to a certain extent,reduce the occurrence of complications,and promote patients'recovery.

Objective To explore the application effects of an innovative teaching model(blended 5MP)that organically combines blended teaching and the five-minute teaching method in clinical teaching for operating room nursing students.Methods Using convenience sampling,94 nursing students who interned in operating room of Kunming Children's Hospital from July 2023 to March 2024 were randomly assigned to observation and control groups,with 47 students in each group.For the control group,a traditional blended learning approach was utilized,whereas the observation group implemented a blended 5MP teaching model.Results The observation group's post-class assignment scores,theoretical exam scores,and practical skills assessment scores were all significantly higher than those in the control group,with a statistically significant difference(P<0.05).The observation group also had higher scores in the Self-Assessment of Clinical Reasoning and Reflection Scale,with a statistically significant difference(P<0.05).Furthermore,the observation group reported higher satisfaction rates regarding teaching methods,teaching formats,theoretical instruction,practical instruction,and overall satisfaction compared to the control group,with statistically significant differences(P<0.05).Conclusion The blended approach combines online and offline instructional modalities,allowing for a more strategic allocation of educational resources.This methodology enables students to thoroughly acquire essential knowledge and skills while simultaneously fostering advanced clinical reasoning and reflective competencies.By adopting this innovative educational model,institutions can significantly enhance the academic experience and professional development of nursing students.

Objective: To identify the risk factors for pulmonary arterial hypertension(PAH) in maintenance peritoneal dialysis(MPD) patients and to develop and validate a nomogram-based risk-prediction model. Methods: A total of 168 hospitalized MPD patients from the Department of Nephrology were enrolled.Body-fluid composition was measured by bioelectrical impedance analysis,and pulmonary-artery systolic pressure(PASP) was assessed by echocardiography.Patients were randomly allocated into a training set and a validation set at 1:1 ratio.Variables with P< 0. 05 in multivariable Logistic regression in the training set were incorporated to construct a nomogram .The validation set was used to test the model ’s predictive performance . ROC curves , calibration curves , and decision-curve analysis were applied to evaluate accuracy , consistency , and clinical usefulness of the model . Results: Dialysis vintage ( OR : 1 . 038 , 95% CI: 1 . 008 - 1 . 069 , P = 0. 012) , hemoglobin level ( OR : 0. 961 , 95% CI: 0. 929 - 0. 994 , P = 0. 021) , and extracellular water/intracellular water ratio (E/I) (OR : 1 . 069 , 95% CI: 1 . 024- 1 . 115 , P = 0. 002) were independent risk factors for PAH . ROC analysis yielded area under curve as 0. 867 (95% CI: 0. 782 - 0. 953) and 0. 808 (95% CI: 0. 714 - 0. 902) in the training and validation sets , respectively .Calibration plots showed that the predicted curves for both the training and validation sets closely overlapped with the ideal reference line , indicating that the nomogram risk-prediction model had good predictive performance . Decision-curve analysis demonstrated that , within threshold ranges of 0. 13 - 0. 76 ( training set ) and 0. 20 - 0. 76 (val- idation set ) , clinical net benefit was substantial when interventions were guided by the nomogram . Conclusion Dialysis vintage , hemoglobin level , and fluid-overload index (E/I) are independent risk factors for PAH in MPD patients . The nomogram based on these parameters reliably predicts PAH risk and may aid clinical decision-making.

Objective Based on the intervention map to develop a comprehensive nutrition education program for pancreaticoduodenectomy patients and to explore the effect of its clinical application,aiming at providing references for clinical nursing practice.Methods A convenience sampling method was used to select 76 patients who were to undergo pancreaticoduodenectomy in the department of hepatobiliary and pancreatic surgery of a tertiary hospital in Anhui Province as the study subjects.The 38 patients admitted from October 2021 to September 2022 were in a control group,and the 38 patients admitted from October 2022 to July 2023 were in an experimental group.The experimental group received the comprehensive nutritional education programme constructed in this study,and the control group used conventional nutrition health education measures,and the length of intervention for both groups was from pre-hospitalization to discharge for 6 months.Nutrition-related indicators,postoperative complications,hospitalisation time,hospitalisation costs and satisfaction were compared between the 2 groups.Results A total of 64 patients completed this study,with 33 in the experimental group and 31 in the control group.Repeated measurement analysis of variance showed that the interaction effects of BMI,total serum protein and serum preprotein were statistically significant(P＜0.05).The incidence of complications,hospitalization days and hospitalization costs of the experimental group were lower than those of the control group(P＜0.05).The scores of nutrition education-related satisfaction in the experimental group were higher than those in the control group(P＜0.001).Conclusion A comprehensive nutritional education program based on intervention map can improve the nutritional status of pancreaticoduodenectomy patients to a certain extent,reduce the occurrence of complications,and promote patients'recovery.

Objectives:To report a V-shape bichannel endoscopy(VBE)system and evaluate the preliminary clinical effects of VBE assisted transforaminal lumbar interbody fusion(VBE-TLIF).Methods:20 patients with lumbar diseases underwent VBE-TLIF surgery in our hospital from January 2020 to April 2021 were retrospectively reviewed.There were 13 males and 7 females,with a mean age of 57.0±11.7 years old(28-77 years old).The operative time and complications were collected,and visual analogue scale(VAS)scores,Oswestry disability index(ODI)before surgery and at 3d,3,6,12 and 18 months after surgery were recorded to evaluate the relief of patients'symptoms.And also,modified MacNab's criteria and radiological examination results at final follow-up were analyzed to to evaluate the overall satisfactory and fusion rate.Results:The average follow-up time of 20 patients was 27.0±3.6 months(22-36 months),and the clinical symptoms of patients relieved significantly.The average VAS leg pain score and VAS back pain score reduced respectively from 6.3±1.6 and 5.7±1.1 before operation to 1.9±0.9 and 2.3±0.8 at 3d postoperatively,and further to 0.7± 0.6 and 0.9±0.7 at 18 months after the surgery,and both with significant differences(P＜0.05).Comparing with the preoperative average ODI[(60.2±15.3)％],the ODI at the 18th month after surgery was(15.0±5.8)％,and the difference was with statistical significance(P＜0.05).There was one patient experienced transient hip flexion weakness and improved after one month of symptomatic treatment;One patient experienced cage immigration causing nerve root irritation and underwent reoperation,the fusion rate was 95％(19/20);No serious operation related complications occurred.The overall excellent and good rate was 95％by modified MacNab's criteria.Conclusions:VBE-TLIF is a safe and effective minimally invasive lumbar fusion technique,and its primary clinical application is satisfactory in outcomes.

Objective : To explore the relationship between geriatric nutritional risk index( GNRI) and perioperative nutritional status，postoperative recovery and complications in elderly patients with gastric cancer． Methods : In this retrospective study，212 elderly patients ( aged ≥60 years ) with gastric cancer who underwent gastrectomy were recruited．GNRI was used to retrospectively assess the patients' preoperative nutritional status ，and analyze the relationship between GNRI and perioperative nutritional status，postoperative recovery and complications．The ROC curve was applied to explore the value of GNRI in predicting postoperative complications. Results : The inci- dence of preoperative nutritional risk in elderly patients undergoing gastric cancer surgery was 45. 07%．Compared with the patients whose GNRI＞98 points，the patients whose GNRI≤98 points had different degrees of decrease in serum total protein，albumin，prealbumin，hemoglobin and lymphocyte counts before surgery，day 1 and day 5－8 after surgery (P ＜0. 05) ．The patients whose GNRI ＜92 points had longer postoperative hospital stay than those with GNRI＞98 points (P＜0. 05) ．With the decrease of GNRI scores，the incidence of complications showed an upward trend(P＜0. 001) ．The multivariate analysis of the relationship between GNRI and postoperative complica- tions showed that TNM staging of III －IV and GNRI ＜92 points were independent risk factors for complications. GNRI had a good predictive value for the occurrence of complications (AUC = 0. 639，95% CI : 0. 570－0. 703，P = 0. 001，Cut-off value : 92. 21) ． Conclusion GNRI can be used for preoperative nutritional assessment for eld- erly gastric cancer patients．Patients with GNRI＜92. 21 points should be actively given nutritional therapy to im- prove perioperative nutritional status，speed up postoperative recovery，and reduce the occurrence of complications.

Objective:To explore the influencing factors of embryos quality during the cycle of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and pregnancy outcomes of frozen-thawed embryo transfer (FET) in patients with polycystic ovary syndrome (PCOS). Methods:A retrospective case-control study design was used to analyze patients who received IVF/ICSI treatment at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2015 to December 2019, underwent whole embryo cryopreserved and performed the first FET. The 1233 cycles included were divided into control group ( n=561) and PCOS group ( n=672) according to PCOS diagnosis. The general clinical characteristics, laboratory-related indicators and pregnancy outcomes of patients between the two groups were compared, and the affecting factors of the late miscarriage rate were analyzed by multivariate logistic regression. Results:1) In terms of the general clinical characteristics between the two groups, the differences of duration of infertility [(3.95±2.01) years vs. (4.84±2.91) years, P=0.007], body mass index (BMI) [(21.96±2.52) kg/m 2vs. (23.96±3.50) kg/m 2, P<0.001], basal luteinizing hormone [(4.71±2.38) mU/L vs. (8.18±5.40) mU/L, P<0.001], basal estradiol [(45.49±31.80) ng/L vs. (56.67±54.17) ng/L, P=0.032], basal testosterone [(42.80±13.45) ng/L vs. (53.45±38.67) ng/L, P=0.001], gonadortopin initial used dosage [(230.80±54.07) U vs. (192.11±53.79) U, P<0.001] were statistically significant. The endometrium preparation plan in the FET cycle, more PCOS group patients received hormone replacement treatment [64.1% (431/672) vs. 26.6% (149/561)], while more patients in control group received natural cycle transplantation [73.4% (412/561) vs. 35.9% (241/672)], and the differences were statistically significant (all P<0.001). 2) In terms of the laboratory results, the number of oocytes retrieved in PCOS group (23.36±9.53) was higher than that in control group (20.32±8.81, P=0.002). The number of high-quality embryos and the rate of high-quality embryos in PCOS group [2.94±3.13; 33.3% (2016/6048)] were lower than those in control group [4.17±3.65, P=0.034; 46.3% (2339/5049), P<0.001], and the differences were statistically significant. 3) In the pregnancy outcomes, the high-quality embryo transfer rate and the biochemical pregnancy rate in control group were higher than those in PCOS group [71.0% (743/1046) vs. 59.3% (761/1284), P<0.001; 7.3% (41/561) vs. 4.5% (30/672), P=0.033], and the late miscarriage rate in PCOS group [10.3% (43/418)] was higher than that in control group [4.3% (16/326), P=0.002]. 4) Logistic regression analysis was performed on the influencing factors of late miscarriage. After correcting the confounding factors, PCOS ( OR=2.573, 95% CI=1.270-5.212, P=0.009) and maternal high BMI ( OR=1.080, 95% CI=0.991-1.176, P=0.031) were the risk factors for late miscarriage. Conclusion:The number of high-quality embryos and the rate of high-quality embryos in PCOS patients were lower than those in non-PCOS patients. PCOS and high BMI were risk factors for late miscarriage in patients. Improving endocrine disorders and weight control in PCOS patients before fertility treatment is of positive significance for improving the pregnancy outcome of patients.

Objective:To explore the influencing factors of embryos quality during the cycle of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and pregnancy outcomes of frozen-thawed embryo transfer (FET) in patients with polycystic ovary syndrome (PCOS). Methods:A retrospective case-control study design was used to analyze patients who received IVF/ICSI treatment at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2015 to December 2019, underwent whole embryo cryopreserved and performed the first FET. The 1233 cycles included were divided into control group ( n=561) and PCOS group ( n=672) according to PCOS diagnosis. The general clinical characteristics, laboratory-related indicators and pregnancy outcomes of patients between the two groups were compared, and the affecting factors of the late miscarriage rate were analyzed by multivariate logistic regression. Results:1) In terms of the general clinical characteristics between the two groups, the differences of duration of infertility [(3.95±2.01) years vs. (4.84±2.91) years, P=0.007], body mass index (BMI) [(21.96±2.52) kg/m 2vs. (23.96±3.50) kg/m 2, P<0.001], basal luteinizing hormone [(4.71±2.38) mU/L vs. (8.18±5.40) mU/L, P<0.001], basal estradiol [(45.49±31.80) ng/L vs. (56.67±54.17) ng/L, P=0.032], basal testosterone [(42.80±13.45) ng/L vs. (53.45±38.67) ng/L, P=0.001], gonadortopin initial used dosage [(230.80±54.07) U vs. (192.11±53.79) U, P<0.001] were statistically significant. The endometrium preparation plan in the FET cycle, more PCOS group patients received hormone replacement treatment [64.1% (431/672) vs. 26.6% (149/561)], while more patients in control group received natural cycle transplantation [73.4% (412/561) vs. 35.9% (241/672)], and the differences were statistically significant (all P<0.001). 2) In terms of the laboratory results, the number of oocytes retrieved in PCOS group (23.36±9.53) was higher than that in control group (20.32±8.81, P=0.002). The number of high-quality embryos and the rate of high-quality embryos in PCOS group [2.94±3.13; 33.3% (2016/6048)] were lower than those in control group [4.17±3.65, P=0.034; 46.3% (2339/5049), P<0.001], and the differences were statistically significant. 3) In the pregnancy outcomes, the high-quality embryo transfer rate and the biochemical pregnancy rate in control group were higher than those in PCOS group [71.0% (743/1046) vs. 59.3% (761/1284), P<0.001; 7.3% (41/561) vs. 4.5% (30/672), P=0.033], and the late miscarriage rate in PCOS group [10.3% (43/418)] was higher than that in control group [4.3% (16/326), P=0.002]. 4) Logistic regression analysis was performed on the influencing factors of late miscarriage. After correcting the confounding factors, PCOS ( OR=2.573, 95% CI=1.270-5.212, P=0.009) and maternal high BMI ( OR=1.080, 95% CI=0.991-1.176, P=0.031) were the risk factors for late miscarriage. Conclusion:The number of high-quality embryos and the rate of high-quality embryos in PCOS patients were lower than those in non-PCOS patients. PCOS and high BMI were risk factors for late miscarriage in patients. Improving endocrine disorders and weight control in PCOS patients before fertility treatment is of positive significance for improving the pregnancy outcome of patients.

BACKGROUNDThe MAPK phosphatases (MKPs) are a family of dual-specificity phosphatases (DUSPs) that can dephosphorylate both phosphothreonine and phosphotyrosine residues, thus inactivating MAPK signaling. DUSP6 is a cytoplasmic MKP that can inactivate ERK. DUSP6 has been implicated in the development of some tumors. The aim of this research was to investigate the expression of DUSP6 in hepatocellular carcinoma (HCC) and the correlation of DUSP6 with mitogen-activated protein kinases (MAPKs), clinicopathological characteristics, and prognosis.

METHODSTissues from 305 patients who had undergone hepatectomy for HCC was used in this study. The expression of DUSP6, p-ERK, p-JNK, and p-p38α was determined using tissue microarrays for immunohistochemical analysis. The prognostic value of DUSP6 and other clinicopathological factors were evaluated.

RESULTSThe expression of DUSP6 was significantly higher in the tumor tissue when compared to the peritumor or normal liver tissue (P < 0.001). Tumor DUSP6 expression was significantly associated with disease-free survival (DFS) (P = 0.013). Tumor DUSP6 expression was an independent prognostic factor for DFS (Hazard ratio = 1.635, P = 0.006).

CONCLUSIONSDUSP6 is over expressed in tumor tissue compared to peritumor or normal liver tissue. Higher expression of DUSP6 in tumor tissue, than in peritumor tissue, is associated with the recurrence after curative resection of HCC, and the relative tumor DUSP6 expression has good power to predict the recurrence of HCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; metabolism ; Dual Specificity Phosphatase 6 ; metabolism ; Female ; Humans ; Immunohistochemistry ; Liver Neoplasms ; metabolism ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; metabolism ; Tissue Array Analysis ; Young Adult