Objective:To investigate the influencing factors for gastroesophageal reflux disease (GERD) after laparoscopic Heller-Dor surgery for esophageal achalasia.Methods:The retrospective case-control study was conducted. The clinical data of 210 patients with esophageal achalasia who were admitted to Shanxi Provincial Cancer Hospital from January 2021 to December 2023 were collected. There were 119 males and 91 females, aged (47±12)years. All patients underwent laparoscopic Heller-Dor surgery. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors for GERD after laparoscopic Heller-Dor surgery; (4) development and evaluation of a predictive model for GERD after laparoscopic Heller-Dor surgery. Univariate and multivariate analyses were performed using stepwise Logistic regression. Results of multivariate analysis were used to construct a nomogram in predicting GERD. The predictive performance was assessed using the area under the receiver operating characteristic curve. The calibration curve was used to evaluate the accuracy of the model, and the decision curve was used to assess the overall net benefit of the model.Results:(1) Surgical situations. All 210 patients underwent laparoscopic Heller-Dor surgery. The operation time was (128±31)minutes, volume of intraoperative blood loss was (25±9)mL, and length of lower esophageal sphincter (LES) myotomy was (5±3)cm. The length of low esophageal myotomy >6 cm was performed in 49 patients, and length of gastric fundus myotomy >2 cm was performed in 58 patients. Intraoperative mucosal perforation occurred to 3 patients and was repaired intraoperatively. One patient required conversion to open surgery. Postoperative complications occurred in 18 patients. The duration of postoperative hospital stay was (4.3±2.4)days. (2) Follow-up. All 210 patients were followed up for 4(range,7-33)months after surgery. During follow-up, 32 pati-ents had GERD, including 17 cases presenting dysphagia and 25 cases presenting acid regurgitation and heartburn (the same patient may have two symptoms). There were 29 cases with body mass index (BMI) >28 kg/m2. Symptom severity scores of 210 patients showed heartburn of 0.6(range, 0-3.0), reflux of 0.7(range, 0-3.0), chest pain of 0.4(range, 0-2.0), cough and hoarseness of 0.5(range, 0-2.0), nausea and vomiting 0.3(range, 0-2.0), dysphagia 0.8(range, 0-3.0). The LES pressure was (15±8)mmHg (1 mmHg=0.133 kPa), LES relaxation rate was 81%±13.0%, and integrated relaxation pressure was (9±6)mmHg. Esophageal manometry classification showed type Ⅰ, Ⅱ, and Ⅲ in 0, 8, and 0 patients, respectively. There were 208 patients achieved symptom relief after drug or symptomatic treatment. Only two patients with severe symptoms were unresponsive to medication and subsequently underwent surgery at another hospital, with symptoms improving postoperatively. (3) Influen-cing factors for GERD after laparoscopic Heller-Dor surgery. Results of multivariate analysis showed that male, smoking history, length of lower esophageal myotomy >6 cm, and postoperative BMI >28 kg/m2 were independent risk factors for GERD after laparoscopic Heller-Dor surgery ( odds ratio=4.02, 6.34, 5.41, 7.38, 95% confidence interval as 1.50-10.78, 3.31-12.31, 1.77-13.47, 2.80-15.42, P<0.05). (4) Development and evaluation of a predictive model for GERD after laparoscopic Heller-Dor surgery. A predictive nomogram model for GERD was constructed based on the results of multivariate analysis. The receiver operating characteristic curve of predictive nomogram model for GERD had an area under curve of 0.91 (95% confidence interval as 0.82-0.97), demonstrating good discrimination. The calibration curve showed good agreement between predicted and observed probabilities, with a mean absolute error of 0.033. The decision curve demonstrated that within a threshold probability range of 0.2-0.8, the predictive model had greater net benefit than "treat-all" or "treat-none" strategies, indicating clinical utility of this model in clinical decision. Conclusions:Male, smoking history, length of lower esophageal myotomy >6 cm, and postoperative BMI >28 kg/m2 are independent risk factors for GERD after laparoscopic Heller-Dor surgery for esophageal achalasia. The predictive model for GERD after laparoscopic Heller-Dor surgery based on these factors shows strong predictive accuracy.

Objective:To investigate the influencing factors for gastroesophageal reflux disease (GERD) after laparoscopic Heller-Dor surgery for esophageal achalasia.Methods:The retrospective case-control study was conducted. The clinical data of 210 patients with esophageal achalasia who were admitted to Shanxi Provincial Cancer Hospital from January 2021 to December 2023 were collected. There were 119 males and 91 females, aged (47±12)years. All patients underwent laparoscopic Heller-Dor surgery. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors for GERD after laparoscopic Heller-Dor surgery; (4) development and evaluation of a predictive model for GERD after laparoscopic Heller-Dor surgery. Univariate and multivariate analyses were performed using stepwise Logistic regression. Results of multivariate analysis were used to construct a nomogram in predicting GERD. The predictive performance was assessed using the area under the receiver operating characteristic curve. The calibration curve was used to evaluate the accuracy of the model, and the decision curve was used to assess the overall net benefit of the model.Results:(1) Surgical situations. All 210 patients underwent laparoscopic Heller-Dor surgery. The operation time was (128±31)minutes, volume of intraoperative blood loss was (25±9)mL, and length of lower esophageal sphincter (LES) myotomy was (5±3)cm. The length of low esophageal myotomy >6 cm was performed in 49 patients, and length of gastric fundus myotomy >2 cm was performed in 58 patients. Intraoperative mucosal perforation occurred to 3 patients and was repaired intraoperatively. One patient required conversion to open surgery. Postoperative complications occurred in 18 patients. The duration of postoperative hospital stay was (4.3±2.4)days. (2) Follow-up. All 210 patients were followed up for 4(range,7-33)months after surgery. During follow-up, 32 pati-ents had GERD, including 17 cases presenting dysphagia and 25 cases presenting acid regurgitation and heartburn (the same patient may have two symptoms). There were 29 cases with body mass index (BMI) >28 kg/m2. Symptom severity scores of 210 patients showed heartburn of 0.6(range, 0-3.0), reflux of 0.7(range, 0-3.0), chest pain of 0.4(range, 0-2.0), cough and hoarseness of 0.5(range, 0-2.0), nausea and vomiting 0.3(range, 0-2.0), dysphagia 0.8(range, 0-3.0). The LES pressure was (15±8)mmHg (1 mmHg=0.133 kPa), LES relaxation rate was 81%±13.0%, and integrated relaxation pressure was (9±6)mmHg. Esophageal manometry classification showed type Ⅰ, Ⅱ, and Ⅲ in 0, 8, and 0 patients, respectively. There were 208 patients achieved symptom relief after drug or symptomatic treatment. Only two patients with severe symptoms were unresponsive to medication and subsequently underwent surgery at another hospital, with symptoms improving postoperatively. (3) Influen-cing factors for GERD after laparoscopic Heller-Dor surgery. Results of multivariate analysis showed that male, smoking history, length of lower esophageal myotomy >6 cm, and postoperative BMI >28 kg/m2 were independent risk factors for GERD after laparoscopic Heller-Dor surgery ( odds ratio=4.02, 6.34, 5.41, 7.38, 95% confidence interval as 1.50-10.78, 3.31-12.31, 1.77-13.47, 2.80-15.42, P<0.05). (4) Development and evaluation of a predictive model for GERD after laparoscopic Heller-Dor surgery. A predictive nomogram model for GERD was constructed based on the results of multivariate analysis. The receiver operating characteristic curve of predictive nomogram model for GERD had an area under curve of 0.91 (95% confidence interval as 0.82-0.97), demonstrating good discrimination. The calibration curve showed good agreement between predicted and observed probabilities, with a mean absolute error of 0.033. The decision curve demonstrated that within a threshold probability range of 0.2-0.8, the predictive model had greater net benefit than "treat-all" or "treat-none" strategies, indicating clinical utility of this model in clinical decision. Conclusions:Male, smoking history, length of lower esophageal myotomy >6 cm, and postoperative BMI >28 kg/m2 are independent risk factors for GERD after laparoscopic Heller-Dor surgery for esophageal achalasia. The predictive model for GERD after laparoscopic Heller-Dor surgery based on these factors shows strong predictive accuracy.

Left atrial reverse remodeling refers to the reversal of left atrial structure,function,and electrical remodeling,and the restoration of left atrial morphology,functional parameters,and myocardial tissue,which mostly indicates that the disease is on the way of improvement.Heart failure with recovered ejection fraction (HFrecEF) has become an entity of widespread concern,and the progression of the disease is related to the nature and severity of myocardial injury,rather than being limited to the trajectory of left ventricular ejection fraction (LVEF) changes.In recent years,it has been found that the left atrial reverse remodeling is closely related to the prognosis,risk stratification,and drug selection of patients with HFrecEF.This article reviews the definition,pathophysiology,evaluation methods of left atrial reverse remodeling in patients with heart failure,its application in patients with HFrecEF,and the controversies and related considerations in the diagnosis of left atrial reverse remodeling.

Left atrial reverse remodeling refers to the reversal of left atrial structure,function,and electrical remodeling,and the restoration of left atrial morphology,functional parameters,and myocardial tissue,which mostly indicates that the disease is on the way of improvement.Heart failure with recovered ejection fraction (HFrecEF) has become an entity of widespread concern,and the progression of the disease is related to the nature and severity of myocardial injury,rather than being limited to the trajectory of left ventricular ejection fraction (LVEF) changes.In recent years,it has been found that the left atrial reverse remodeling is closely related to the prognosis,risk stratification,and drug selection of patients with HFrecEF.This article reviews the definition,pathophysiology,evaluation methods of left atrial reverse remodeling in patients with heart failure,its application in patients with HFrecEF,and the controversies and related considerations in the diagnosis of left atrial reverse remodeling.

Objective:To form the expert consensus on nursing care of adults with status epilepticus (SE), promote nurses to provide standardized and safe first aid, monitoring and support to SE patients, and effectively prevent and control complications, with a view to controlling seizures as soon as possible.Methods:The medical and nursing evidence on SE was retrieved, evaluated and summarized, and the retrieval time limit was from the establishment of the database to March 31, 2022. Recommendations and studies were extracted to form a first draft of consensus. A total of 31 experts were selected to conduct two rounds of Delphi expert consultation and expert demonstration meetings to analyze, revise and improve the experts' suggestions and form a consensus final draft.Results:The expert positive coefficient was 100.00% (31/31), the expert judgment coefficient was 0.93, the familiarity degree was 0.87, and the authority coefficient was 0.90. Kendall's harmony coefficient was 0.25 to 0.27 ( P<0.05). The final consensus included adult SE identification, first aid, monitoring and support, complication prevention and control, and effect evaluation of terminating SE. Conclusions:This consensus is practical and provides guidance for clinical nursing practice and quality control of SE patients.

The acupuncture method of Shugan-Tiaoshen is proposed by the famous old Chinese medicine Professor Shan Qiuhua in Shandong Province in combination with Traditional Chinese Medicine theory and clinical experience. Shugan-Tiaoshen acupuncture method is widely used in clinic and has curative effect. It can treat mental diseases, nervous system diseases, digestive system diseases, endocrine system diseases, urinary system diseases, diseases caused by physical and chemical factors and other internal diseases, as well as surgical diseases such as skin trauma, facial symptoms and breast diseases. It can also treat gynecological diseases. It can also improve the brain function of stress disorder. The role of soothing liver and regulating spirit in clinic is never underestimated. In clinical practice, doctors should try their best to combine regulating spirit with treating spirit. Shugan-Tiaoshen acupuncture provides a good idea for clinical treatment, but there are still some problems in the current researches, such as the lack of multi-center, large sample trials, or well-design mechanism researches.

Objective The aim of this study was to determine whether active part of Glycyrrhiza extract (GL)induced apoptosis in Hela cells and its inhibitory mechanism.Methods HeLa cells were treated with 25 g/mL of GL for 24hs.Cell viability and apoptosis in HeLa cells were determined by MTT,AO/EB fluorescent double staining,transmission electron microscope(TEM),and Western blot.Results The MTT results showed that GL significantly inhibited the proliferation of HeLa cells in a dose-response.After treatment for 24 hrs,large number of early apoptotitc cell were observed using AO/EB fluorescent double staining and TEM.The expression of Pro-caspase-9 and Cleaved-caspase-3 protein was higher in GL-treated cells them those of the control cells(P<0.05).Conclusion GL can activate Caspase-3 and Caspase-9 genes to induce apoptosis in HeLa cells.

Objective To analyze the preventive effect of the targeted nursing intervention on lower limb venous thrombosis in patients with hemiplegia after stroke.Methods A total of 120 stroke cases from October 2014 to December 2015 in department of neurology in our hospital were divided into control group and intervention group according to random number table method.The control group was given routine nursing,and the intervention group was given targeted nursing intervention on the basis of the control group.After nursing,the compliance rate of two groups before and after nursing,mastery of disease related knowledge,the incidence of lower limb venous thrombosis and nursing effect were compared.Results There was no significant difference in medication compliance between the two groups before nursing intervention (P ＞ 0.05).In the intervention group,the correct medication,reasonable diet,regular physical examination,smoking cessation,functional exercise,mood control compliance rate were significantly improved,and there was significant difference compared with the control group (P ＜ 0.05).The awareness rate of the intervention group was significantly higher than that of the control group (P ＜ 0.05).The nursing effective rate was significantly higher in the intervention group than that of the control group,(43.10％ vs.85.94％,P ＜ 0.05).There were 3 cases(13.79％) with deep vein thrombosis in the control group,and 1case(1.61％) in the intervention group,there was significant difference in deep vein thrombosis (P ＜ 0.05).Conclusion The nursing intervention of department of neurology for stroke patients can significantly improve the compliance rate and disease related knowledge,reduce the incidence of venous thrombosis,improve the nursing effect,so it is worthy of promotion in clinical nursing work.

Objective To analyze the preventive effect of the targeted nursing intervention on lower limb venous thrombosis in patients with hemiplegia after stroke.Methods A total of 120 stroke cases from October 2014 to December 2015 in department of neurology in our hospital were divided into control group and intervention group according to random number table method.The control group was given routine nursing,and the intervention group was given targeted nursing intervention on the basis of the control group.After nursing,the compliance rate of two groups before and after nursing,mastery of disease related knowledge,the incidence of lower limb venous thrombosis and nursing effect were compared.Results There was no significant difference in medication compliance between the two groups before nursing intervention (P ＞ 0.05).In the intervention group,the correct medication,reasonable diet,regular physical examination,smoking cessation,functional exercise,mood control compliance rate were significantly improved,and there was significant difference compared with the control group (P ＜ 0.05).The awareness rate of the intervention group was significantly higher than that of the control group (P ＜ 0.05).The nursing effective rate was significantly higher in the intervention group than that of the control group,(43.10％ vs.85.94％,P ＜ 0.05).There were 3 cases(13.79％) with deep vein thrombosis in the control group,and 1case(1.61％) in the intervention group,there was significant difference in deep vein thrombosis (P ＜ 0.05).Conclusion The nursing intervention of department of neurology for stroke patients can significantly improve the compliance rate and disease related knowledge,reduce the incidence of venous thrombosis,improve the nursing effect,so it is worthy of promotion in clinical nursing work.

JAK2 V617F gene mutation positive myeloproliferative neoplasms (MPN) consists of polycythemia vera (PV),essential thrombocythemia (ET) and primary myelofibrosis (PMF).This article focuses on their risk scoring systems and treatment including first-and second-line therapies,JAK2 inhibitors,cytoreduction,antifibrosis and other single-agent or combination therapy.