Objective:To investigate the current status and influencing factors of decision anxiety in guardians of children with acute appendicitis under Endoscopic retrograde appendicitis therapy (ERAT) background, and to provide reference for the development of targeted intervention programs for decision anxiety.Methods:Convenient sampling method was used to select 254 guardians of children with acute appendicitis treated in the Department of Pediatrics, Second Affiliated Hospital of PLA Air Force Medical University from February 2023 to April 2024. A cross-sectional survey was conducted using the General Data Questionnaire, the State-Trait Anxiety Inventory Form Y-State anxiety subscale and the Preparation for Decision Making Scale. Multiple linear regression was used to analyze the influencing factors in guardians of children with acute appendicitis.Results:Among the guardians of 254 children with acute appendicitis, 156 were males and 98 were females, aged (37.44 ± 3.63) years old. The decision anxiety score of guardians of children with acute appendicitis was (52.49 ± 6.54). The results of multiple linear regression showed that age of children, gender of guardian, education level of guardian, per capita monthly income of family, decision making tendency and decision preparation were the main influencing factors of decision anxiety in guardians of children with acute appendicitis ( t values were -7.07-3.58, all P<0.05), which could explain 64.4% of the total variation. Conclusions:The decision anxiety in guardians of children with acute appendicitis is at a high level. Medical staff should provide targeted decision guidance, improve decision assistance programs and provide more effective decision support for guardians of children with acute appendicitis.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective:To investigate the current status and influencing factors of decision anxiety in guardians of children with acute appendicitis under Endoscopic retrograde appendicitis therapy (ERAT) background, and to provide reference for the development of targeted intervention programs for decision anxiety.Methods:Convenient sampling method was used to select 254 guardians of children with acute appendicitis treated in the Department of Pediatrics, Second Affiliated Hospital of PLA Air Force Medical University from February 2023 to April 2024. A cross-sectional survey was conducted using the General Data Questionnaire, the State-Trait Anxiety Inventory Form Y-State anxiety subscale and the Preparation for Decision Making Scale. Multiple linear regression was used to analyze the influencing factors in guardians of children with acute appendicitis.Results:Among the guardians of 254 children with acute appendicitis, 156 were males and 98 were females, aged (37.44 ± 3.63) years old. The decision anxiety score of guardians of children with acute appendicitis was (52.49 ± 6.54). The results of multiple linear regression showed that age of children, gender of guardian, education level of guardian, per capita monthly income of family, decision making tendency and decision preparation were the main influencing factors of decision anxiety in guardians of children with acute appendicitis ( t values were -7.07-3.58, all P<0.05), which could explain 64.4% of the total variation. Conclusions:The decision anxiety in guardians of children with acute appendicitis is at a high level. Medical staff should provide targeted decision guidance, improve decision assistance programs and provide more effective decision support for guardians of children with acute appendicitis.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Cadmium/metabolism* ; Kidney ; Cells, Cultured ; Mitochondria ; Metallothionein/metabolism* ; Liver

Objective: To design the proficiency testing (PT) project (No. NIFDC-PT-183) for assays of bismuth potassium citrate capsules and organize to assess the proficiency of complexometric titration in laboratories, and provide some technical analyses and advices.
Methods: Two groups of samples with different concentration were prepared. The uniformity was evaluated with one-way analysis of variance and the stability was confirmed with t-test, whose results all conformed the requirements. The samples with three combinations were randomly distributed to 279 laboratories. The determination was performed according to the assays of bismuth potassium citrate capsules in Volume Ⅱ of the Chinese Pharmacopoeia 2015. The median value and normalized interquartile range (NIQR) of robust statistical analysis was adopted and Z-scores were used to evaluate the results from each of laboratories.
Results: Among 279 laboratories, 240 laboratories results were satisfactory, 23 were questionable, and the other 16 were unsatisfied. The satisfaction rate was 86.0%.
Conclusion: The overall capacity of national laboratories for assays of bismuth potassium citrate capsules is good while a portion of participants require further improvement.

Aim To investigate the effect of bruceine A on apoptosis and invasion of non-small cell lung cancer(NSCLC)cells and to explore its possible molecular mechanism.Methods CCK-8 and cell colony assay were used to detect the effect of bruceine A on prolifer-ation and clone formation ability of NSCLC cells.3D matrigel drop invasion assay and flow cytometry were used to detect cell invasion ability and apoptosis rate.Western blot was used to detect expressions of epitheli-al-mesenchymal transition(EMT)key proteins and ap-optosis key proteins.The anti-tumor effect of bruceine A was detected on A549 xenograft mice in vivo.Online databases,molecular docking methods and drug affinity responsive target stability(DARTS)were used to pre-dict and screen the potential binding targets of bruceine A.Results Bruceine A significantly inhibited the proliferation and colony formation of NSCLC cells.Bruceine A significantly induced the apoptosis in NSCLC cells and inhibited cell invasion ability,signifi-cantly up-regulated the protein expressions of c-caspase3,c-PARP,Bax and E-cadherin,and signifi-cantly down-regulated the protein expressions of Bcl-2,N-cadherin,Vimentin and Snail(P＜0.05).In the tumor-bearing mouse models,bruceine A significantly decreased the tumor volume and tumor weight(P＜0.05).Target prediction,molecular docking and Western blot analysis of DARTS sample revealed that bruceine A could increase the stabilization of HSP90α.Conclusions Bruceine A reduces the EMT levels and induces apoptosis in NSCLC cells through the EMT signaling axis.Bruceine A may exert its anti-cancer effect by binding to HSP90α.

Objective:To systematically evaluate the effect of cognitive behavioral therapy (CBT) in elderly patients with depression.Methods:The randomized controlled trials on the effect of CBT in elderly patients with depression, published until December 15, 2022, were searched in PubMed, CINHAL, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, WanFang Data, and VIP. Two researchers independently screened the literature, extracted data, and used the revised Cochrane risk of bias tool for randomized trials (ROB 2.0) to evaluate the quality of the included studies. Statistical analysis was conducted using Stata 16.0, and the quality of evidence was rated using Appraisal of Guidelines for Research and Evaluation (GRADE) predictor software.Results:A total of 11 randomized controlled trials were included, with a total of 833 elderly patients with depression. Randomized effect models were used to analyze outcome indicators such as depression, anxiety, and quality of life by combining effect quantities. Meta-analysis and GRADE evidence quality showed that compared to the control group, medium quality evidence showed that CBT could relieve depression in elderly depression patients with a statistical difference [ SMD=-1.58, 95% CI (-2.16, -0.99), P<0.05]. Low quality evidence suggested that CBT could alleviate anxiety in elderly depression patients also with a statistical difference [ SMD=-2.25, 95% CI (-4.04, -0.47), P<0.05]. Very low quality evidence indicated that CBT did not significantly improve the quality of life in elderly depression patients compared to conventional or pharmacological treatment [ SMD=-0.09, 95% CI (-2.07, 1.88), P>0.05] . Conclusions:Existing evidence suggests that CBT can alleviate depression and anxiety in elderly depression patients, but its improvement in quality of life is not yet significant. Treatment feedback and forms of CBT may become a research focus in recent years on intervention for elderly depression patients.

Neonatal necrotizing enterocolitis(NEC)is a life-threatening intestinal disease in newborns, and early identification of NEC is a major clinical challenge.Although clinical manifestations, routine laboratory tests and imaging examinations are essential for NEC, more and more studies in recent years based on the understanding of the pathogenesis of NEC have reported that NEC-related biomarkers such as fatty acid-binding proteins, cytokines, and intestinal flora have potential value in its prediction, early diagnosis, severity assessment and prognosis.This review will discuss the biomarkers related to NEC that have been studied in recent years from three aspects: blood, urine and feces, so as to guide clinical application.

Objective:To study the risk factors of stage Ⅱ/Ⅲ necrotizing enterocolitis(NEC)in very low birth weight infants by retrospective clinical analysis.Methods:Very low birth weight infants admitted to the NICU of Shanghai Children′s Medical Center within 24 hours after birth from July 1, 2017 to June 30, 2022 were included.Control group and NEC group were determined according to Bell staging criteria.Basic data, maternal history, major adverse events of preterm infants before NEC onset, and treatment during hospitalization were collected.Results:There were 437 cases in control group and 22 cases in NEC group.Compared with the control group, the gestational age of NEC group was lower[28.79(27.86, 29.61)weeks vs 30.00(28.79, 31.71)weeks, P=0.002]. The proportion of sepsis was higher(36.4% vs 6.6%, P<0.05), especially the proportion of late-onset sepsis(36.4% vs 6.2%, P<0.05). The proportion of hemodynamically significant patent ductus arteriosus(hsPDA)was higher(27.3% vs 5.7%, P<0.05). The proportion of shock before NEC onset was higher(18.2% vs 3.4%, P=0.010). The proportion of RBC transfusion within 48 hours before NEC onset was higher(27.3% vs 9.8%, P=0.026). However, the ratio of eclampsia/preeclampsia in pregnant mother was lower(0 vs 24.3%, P=0.008). Conclusion:Small gestational age, sepsis, hsPDA, shock and blood transfusion are risk factors for NEC, while eclampsia/preeclampsia in pregnant mother may be a protective factor for NEC.