Objective To analyze the influencing factors of cholecystolithiasis among Tibetan residents living at extreme altitude.Methods From Aug.10 to 17,2023,Nima County People's Hospital in Nagqu,in collaboration with Tibetan-aid doctors,organized physical examinations for Tibetan residents in Jiwa Township.The physical examination data were collected,and the general information and dietary habits of the examinees were recorded.Based on the results of abdominal ultrasound examination,the 448 enrolled participants were assigned to a cholecystolithiasis group(106 cases)and a non-cholecystolithiasis group(342 cases).Additionally,multivariable logistic regression analysis was conducted to investigate the factors influencing the occurrence of cholecystolithiasis among Tibetan residents.Results There were significant differences in age,weight,body mass index,systolic blood pressure,diastolic blood pressure,finger pulse oxygen,and educational level between the 2 groups(all P＜0.05).The results of multivariate logistic regression analysis showed that age(odds ratio[OR]=1.062,95％confidence interval[CI]1.020-1.106),weight(OR=1.120,95％CI 1.067-1.176),smoking(OR=4.751,95％CI 1.627-13.869),cholesterol(OR=1.429,95％CI 1.129-1.810),amount of butter tea drink(OR=2.123,95％CI 1.656-2.721),alanine transaminase(OR=1.045,95％CI 1.028-1.062),low educational level(OR=6.994,95％CI 2.615-18.702),fatty liver(OR=4.409,95％CI 1.499-12.968)and meat-based diet(OR=3.725,95％CI 1.255-11.055)were correlated with cholecystolithiasis.Conclusion The incidence of cholecystolithiasis among Tibetan residents living at extreme altitude may be related to various factors mentioned above,which provides clues for the prevention,early diagnosis,and treatment of local cholecystolithiasis.

Objective To explore the feasibility and precautions of small incision bile duct stone removal in primary hospitals in extremely high-altitude areas.Methods The experience of small incision biliary exploration and cholecystectomy under general anesthesia at primary hospitals during the author's medical aid to Xizang in the high-altitude areas of northern Xizang was summarized(from June 2022 to December 2022).Results A total of 11 cases of small incision common bile duct stone removal were completed.Abdominal drainage was performed in all patients,including 6 cases with T-shaped tubes and 5 cases with primary closure of the common bile duct.The patients recovered well after surgery and was discharged.Conclusion In extreme high-altitude areas,under the guidance of medical aid doctors,it is completely feasible for primary hospitals to carry out small incision bile duct stone removal by selecting appropriate cases,training surgical skills,and performing detailed preoperative preparation.

Objective To investigate the diarrhea after minilaparotomy cholecystectomy among Tibetan residents in extremely high-altitude areas.Methods A retrospective analysis was conducted on the clinical data of 71 patients who underwent small incision cholecystectomy at the County People's Hospital during the period of medical aid(from June 2022 to December 2022).There were 38 patients(53.52%)with postoperative diarrhea and 33 patients(46.48%)without diarrhea.Results The duration of diarrhea was less than 1 week in 8 patients,ranged from 1 week to 3 months in 21 patients,and lasted for more than 3 months in 9 patients.There were significant differences between the two groups in terms of age(P<0.000 1),body mass index(P<0.000 1),proportions of patients with liver cirrhosis(P=0.012 9),history of acute cholecystitis(P=0.002 1),history of coronary heart disease(P=0.040 7),and presence of tenderness in the right upper abdomen during admission(P<0.000 1),white blood cell count(P=0.007 0),alanine aminotransferase(P=0.047 3),gallbladder diameter(P=0.003 4),gallbladder wall thickness(P=0.000 4),surgical duration(P=0.004 7),postoperative antibiotic use(P=0.000 6),postoperative hospital stay(P=0.000 2),and immediate resumption of butter tea(P<0.000 1).Age and immediate resumption of butter tea after surgery were independent risk factors for diarrhea after minilaparotomy cholecystectomy.Conclusion There is a higher incidence of diarrhea following small incision cholecystectomy in the residents of extremely high-altitude areas,which is associated with various factors such as the environment and lifestyle of the region.It is essential to enhance health education on gallstone and cultivate good personal health habits.Clinicians should conduct a detailed preoperative assessment.Patients should avoid drinking butter tea during perioperative period to avoid postoperative diarrhea.

Objective:To assess the prevalence of exercise addiction among college students and explore its relationship with negative emotion and exercise frequency.Methods:A total of 837 college students were enrolled from January 1, 2022 to December 31, 2022. The cross-sectional survey was administered using the exercise dependence scale revised(EDS-R) and the depression, anxiety, and stress scale 21 items (DASS-21). Data analysis was conducted with SPSS 26.0 software, including partial correlation analysis and hierarchical regression.Results:Among college students, the students in the group with risk and symptoms of exercise addiction accounted for 4.9%(EDS-R score (110.32±11.51), DASS-21-depression score 21.00(10.50, 25.00), DASS-21-anxiety score 21.00(11.50, 24.00), DASS-21-stress score 42.00(22.00, 47.50)). The students in the group without risk but with symptoms accounted for 42.53%(EDS-R score (60.02±12.91), DASS-21-depression score 8.00(1.00, 14.00), DASS-21-anxiety score 8.00(3.00, 14.00), DASS-21-stress score 15.00(4.00, 28.00)), and the students in the group without risk and symptoms accounted for 52.57%(EDS-R score (31.57±7.51), DASS-21-depression score 8.00(5.00, 12.00), DASS-21-anxiety score 7.00(3.00, 10.00), DASS-21-stress score 15.00(6.00, 21.00)). Exercise addiction scores were positively correlated with stress ( r=0.303, P<0.001), anxiety ( r=0.327, P<0.001), and depression ( r=0.259, P<0.001). The results of the hierarchical regression analysis also showed that the main risk variables were anxiety (△ R2=0.175, F=60.954) and exercise frequency (△ R2=0.044, F=21.401). Additionally, male college students had a higher risk of exercise addiction than female( P<0.01), but there was no gender difference in negative emotions( P>0.05). Conclusion:The college students were susceptible to developing an exercise addiction, especially among individuals with high exercise frequency and anxiety symptoms.It provides robust behavioral evidence in support of early detection and treatment of high-risk exercise addiction groups.

Objective:To investigate the necessity of adaptive re-planning during radiotherapy for nasopharyngeal carcinoma (NPC) and its impact on dose improvement.Methods:Clinical data of 89 NPC patients admitted to Sun Yat-sen University Cancer Center from July 2014 to December 2017 were retrospectively analyzed. All patients received 25+7 rounds of adaptive re-planning during radiotherapy. Plan-A was defined as the initial CT scan-based 25-fraction radiotherapy plan, while plan-B was defined as the re-planned 7-fraction radiotherapy plan based on a subsequent CT scan. The changes in the target and parotid gland volumes were compared between plan-A and plan-B. Plan-I was a one-time simulation of plan-A extended to 32 fraction radiotherapy plan, and plan-II was generated through registration and fusion of the plan-A and plan-B for adaptive re-planning. The differences in dose metrics, homogeneity index (HI), conformity index (CI), and dose to organs at risk (OAR) were compared between plan-I and plan-II. Statistical analysis was performed by using paired t-test. Results:Compared with plan-A, the gross tumor volume of massive bleeding lesions (GTV nx) and parotid gland volume of plan-B were decreased by 13.14% and 11.12%, respectively (both P<0.001). While planning clinical target volume of metastatic lymph nodes (PCTV nd) of plan-B was increased by 7.75%( P<0.001). There were significant changes in the lymph nodes of plan-A and plan-B. The D mean, D 5%, D 95% of massive bleeding lesions planning target volume (PTV nx) and D 5% of high risk planning target volume (PTV1) in plan-II were all significantly higher than those in plan-I (all P<0.05). The CI of PTV nx and PTV1 in plan-II was closer to 1 than that in plan-I. In all assessed OAR, the D mean, D 50%, and D max of plan-II were significantly lower than those of plan-I (all P<0.05). Conclusions:During radiotherapy, NPC patients may experience varying degrees of primary tumor shrinkage, parotid gland atrophy, and lymph node changes. It is necessary to deliver re-planning and significantly improve the dose of target areas and OAR.

Objective:To analyze the value of the modified 5-factor frailty index in assessing postoperative complications and mortality in elderly hip fracture patients.Methods:In this retrospective study, clinical data were collected of hip fracture patients aged 60 years and above surgically treated at Beijing Luhe Hospital affiliated to Capital Medical University between January 2015 and December 2019.Patients' group assignment was based on whether the modified frailty index score was ≤1 or ≥2, and a post-surgery follow-up was conducted for survival at 30 days, 1 year, 2 years, and 4 years, which was analyzed by the Kaplan-Meier method.Multivariate Cox regression analysis was used to identify factors affecting death in elderly patients.Results:A total of 1 208 patients were included, with 890 in the group with the index score ≤1 and 318 in the group with the index score ≥2.There was no difference in mortality at 30 days(1.6% or 14/890 vs.1.9% or 6/318, P=0.707), 1-year(11.3% or 99/874 vs.11.6% or 36/310, P=0.917), 2-years(19.7% or 168/852 vs.24.3% or 73/300, P=0.099)and 4-years(44.0% or 238/541 vs.51.5% or 106/206, P=0.071). The incidence of postoperative complications in the group with the score ≥2 was higher(14.8% or 47/318 vs.9.7% or 86/890, P=0.012), including the incidence of stroke(6.3% or 20/318 vs.1.8% or 16/890, P<0.001)and the incidence of postoperative pneumonia(6.0% or 19/318 vs.3.1% or 28/890, P=0.029), and the differences were statistically significant.Multivariate Cox regression analysis showed that age, being female, the Charlson comorbidity index score and low hemoglobin at admission were risk factors for 1-year, 2-year and 4-year mortality post-surgery(all P<0.05), while the modified frailty index score had no correlation with postoperative mortality. Conclusions:A modified frailty index ≥2 is predictive of increased risk of postoperative pneumonia and stroke in patients with hip fractures, but is not correlated with the risk of postoperative mortality.

Objective: To explore the association among neck-shoulder pain (NSP), low back pain (LBP) and co occurring symptoms with mental sub health in adolescents, so as to provide evidence for improving physical and mental health of adolescents. Methods: Stratified cluster random sampling method was used to select 7 986 students from 12 middle and high schools in Shenzhen, Nanchang, and Shenyang cities from October to December 2019. The Assessment of Spinal Health of Youth (ASHY) and the Brief Instrument on Psychological Health of Youth (BIOPHY) were used to assess NSP, LBP and mental sub health. Binary Logistic regression model was used to analyze the association between NSP, LBP and co occurring symptoms with mental sub health in adolescents. Results: The detection rates of adolescents with NSP, LBP and co occurring symptoms and mental sub health were 9.1% , 9.8%, 9.5%, and 10.0%, respectively. The co occurring rate of neck shoulder pain, low back pain and mental sub health was 3.2%. After adjusting for confounding variables such as gender, age, being an only child, family residence, and parental education level, NSP ( OR=6.01, 95%CI =5.02-7.19), LBP ( OR=5.08, 95%CI =4.25-6.07), and co occurring symptoms ( OR= 5.96 , 95%CI =4.98-7.12) in adolescents were positively correlated with mental sub health risk ( P <0.01). Stratifying the gender, boys with NSP, LBP and co occurring symptoms ( OR =6.84, 5.80, 6.74)had a higher risk of mental sub health compared to girls ( OR =5.52, 4.65, 5.49) ( P <0.01). Conclusions NSP, LBP and co occurring symptoms in adolescents are associated with mental sub health. The mental health status of boys is more affected by NSP, LBP and their co occurring symptoms. Measures should be taken to improve spinal health in adolescents to reduce the incidence of mental sub health.

Abstract Adolescence is a unique transitional period from childhood to adulthood, during which behavioral habits and physiological cycles undergo significant changes, and biorhythms are vulnerable to be disrupted. Meanwhile, due to increased rates of overweight and obesity, cardiovascular metabolic risk significantly increases during adolescence. The article reviews the prevalence, correlation, and potential epigenetic regulatory mechanisms of biorhythm disorders and adolescent cardiovascular metabolic health, providing a theoretical basis for regulating biorhythm to promote adolescent cardiovascular metabolic health.

Trastuzumab has improved survival rates in human epidermal growth factor receptor 2(HER2)-positive breast cancer(BC),but drug resistance leads to treatment failure.Natural killer(NK)cell-mediated antibody-dependent cell cytotoxicity(ADCC)represents an essential antitumor immune mechanism of trastuzumab.Traditional Chinese medicine(TCM)has been used for centuries to treat diseases because of its capacity to improve immune responses.Xianling Lianxia formula(XLLXF),based on the principle of"strengthening body and eliminating toxin",exhibits a synergistic effect in the trastuzumab treatment of patients with HER2-positive BC.Notably,this synergistic effect of XLLXF was executed by enhancing NK cells and ADCC,as demonstrated through in vitro co-culture of NK cells and BC cells and in vivo inter-vention experiments.Mechanistically,the augmented impact of XLLXF on NK cells is linked to a decrease in cytokine inducible Src homology 2(SH2)containing protein(CISH)expression,which in turn activates the Janus kinase 1(JAK1)/signal transducer and activator of transcription 5(STAT5)pathway.Collectively,these findings suggested that XLLXF holds promise for enhancing NK cell function and sensitizing pa-tients with HER2-positive BC to trastuzumab.

Objective To investigate the research status and the research hotspots on male nurses at home and abroad in last decade,so as to provide references for further research in male nurses.Methods Literature between 2013 and 2024 on male nurses were retrieved from the Web of Science(WOS)and CNKI.CiteSpace 6.2.6 R7 software was used to analyse the volume of publication,keyword co-occurrence,keyword clustering and emergence.Results A total of 736 articles were included in the study.From 2013 to 2023,the number of published papers of male nurses in CNKI and WOS showed an increasing trend.The research was primarily affiliated with 263 institutions across 62 countries.The country with the highest volume of publication is China,followed by the United States,although there was a need to enhance collaboration with other nations.The institution with the most publications is the Hong Kong Polytechnic University.A comprehensive analysis of keyword co-occurrence,clustering,and emerging trends revealed that the research hotspots in the field of male nursing in CNKI mainly includes the advantages of male nurses,psychological capital,humanistic care,development,needs,professional identification.Whereas WOS focuses on the topics such as gender bias against male nurses,mental health,workplace violence,ambivalent sexism,motivational barriers,individual differences,societal prejudice and knowledge and attitucle.Both domestic and international research on male nurses primarily consist of cross-sectional surveys and qualitative studies,with fewer intervention studies.Currently,the researches regarding male nursing focus on the qualitative study of mental health of male nurses.Conclusion Focusing on the mental health and professional status of male nurses,domestic scholars need to increase the formulation and implementation of interventions in this field in order to address the practical issues faced by male nurses,therefore to promote the comprehensive development of the nursing profession,enhance the overall quality and service quality of the nursing team,and provide patients with higher quality in nursing services.