ObjectiveTo explore the impacts of material type and loading volume of rigid containers on the hydrogen peroxide low temperature plasma sterilization of thoracoscopic instruments, to identify the best rigid containers and loading volume of thoracoscopic instruments. MethodsThoracoscopic instruments sterilized by STERRAD^® 100NX hydrogen peroxide low temperature plasma in Shanghai Pulmonary Hospital affiliated to Tongji University from August to September 2024 were selected as the research items. According to the material of rigid containers, the instruments were divided into polyethylene case group (A), stainless steel case group (B) and silicone resin case group (C). In terms of the loading volume, the rigid containers were divided into (loading capacity <80%) groups of 8, 10 and 12 instruments. The results of physical monitoring, the first type of chemical indicator card monitoring, and the five types of card luminal chemical process challenge device (PCD) monitoring of the 9 groups of A8, A10, A12, B8, B10, B12, C8, C10 and C12 were compared and evaluated. ResultsCompared to A8, A10 A12, C8, C10 or C12 groups, the thoracoscope instruments in the stainless steel containers in B8, B10 or B12 group had higher hydrogen peroxide concentrations and shorter elapsed time in the pressure check phases 1 and phases 2, with the differences statistically significant (P<0.05), followed by the silicone resin case group and the polyethylene case group. The nine groups of physical parameter monitoring, the first type of chemical indicator monitoring, and the five types of chemical PCD monitoring for lumen sterilization achieved 100% qualification rates, and there were no significant differences in the qualified rates of sterilization among the 9 groups (P>0.05). ConclusionWhen using hydrogen peroxide low temperature plasma to sterilize thoracoscopic instruments, it is recommended to use stainless steel or silicone resin rigid containers with a controlled loading capacity (≤12) to ensure optimal sterilization quality.

Objective:To investigate the clinical characteristics, bleeding site distribution, and factors associated with hospitalization for surgical management in patients with refractory posterior epistaxis.Methods:This cross-sectional study retrospectively analyzed data from 3 473 patients with refractory posterior epistaxis treated at ENT department or Emergency Department of Affiliated Zhangzhou Hospital of Fujian Medical University, between January 2018 and December 2024. The demographic and clinical data of patients were collected. Univariate analyses and multivariable logistic regression were applied to identify factors associated with hospitalization for surgical intervention.Results:Among 3 473 patients (65.94%(2 290 cases) male; mean age (54±21) years), 46.96% (1 631 cases)were aged 41-69 years. Bleeding predominantly occurred at night (89.66%, 3 114 cases) and in winter (29.92%, 1 039 cases). The most frequent bleeding sites were the olfactory cleft (25.22%,876 cases) and inferior meatus vault (25.63%,890 cases), followed by the posterior regions of middle meatus (11.26%,391 cases), the foremost regions of nasal cavity (11.20%,389 cases), the nasal septum surface (11.23%,390 cases), the bottom of nasal cavity (9.42%,327 cases), and the others or uncertain sites (6.05%,210 cases). Endoscopic electrocautery was performed in 75.01% of cases. Overall, 2 715 patients required hospitalization for surgery. Univariate analysis identified older age (≥70 years), male sex, alcohol use, nighttime onset, winter season, hypertension, diabetes, and anticoagulant use as significantly associated with hospitalization ( χ2=6.51, 8.03, 5.11, -0.17, 7.53, 12.52, 6.83, 5.18, all P<0.05). Multivariable logistic regression confirmed older age ( OR=2.45, 95% CI: 1.81-7.50), winter season ( OR=9.55, 95% CI: 2.26-9.38), nighttime onset ( OR=6.78, 95% CI: 1.84-6.96), alcohol use ( OR=27.71, 95% CI: 11.97-64.14), hypertension ( OR=7.93, 95% CI: 1.64-11.84), and anticoagulant use ( OR=6.39, 95% CI: 1.06-9.47) as independent positive factors associated with hospitalization for surgical management (all P<0.05). Conclusions:Refractory posterior epistaxis most commonly affects individuals aged 41-69 years, with bleeding frequently originating from the olfactory cleft or inferior meatus vault, and exhibits seasonal (winter) and diurnal (nighttime) patterns. Independent factors significantly associated with the need for hospitalization and surgical intervention include older age, winter onset, nighttime onset, alcohol use, hypertension, and anticoagulant use. Identifying these factors may aid in risk stratification and clinical decision-making.

Objective:To develop a scientific and practical questionnaire for general practice residents, and to conduct multidimensional and comprehensive evaluation of the quality of general practice teaching clinics.Methods:A preliminary draft of the questionnaire items was formulated based on a literature review and in-depth interviews. The Delphi method was employed to conduct two rounds of consultation with 14 experts. Following revisions, a convenience sampling method was used to invite general practice residents from three standardized residency training bases to test the reliability and validity of the questionnaire.Results:The questionnaire consisted of 23 items, covering the three dimensions of preparation, implementation process, and comprehensive evaluation of the teaching clinics. The response rates for the two rounds of the expert consultation were both 100.00%, with expert authority coefficients of 0.89 and 0.90, respectively. The overall Cronbach's α coefficient of the questionnaire was 0.93, and the correlation coefficients between each item score and the total score were all >0.30. Structural validity analysis revealed that three common factors were extracted from the questionnaire, with a cumulative variance contribution rate of 77.89%. Conclusions:The General Practice Teaching Clinic Quality Evaluation Questionnaire for Residents developed in this study demonstrates high reliability and validity. The questionnaire provides a scientific basis for the standardized assessment of teaching quality in general practice clinics. By incorporating resident feedback on the teaching process, the questionnaire promotes the development of a teaching clinic quality improvement mechanism focused on residents and plays a significant role in enhancing the teaching capabilities of supervising physicians in clinics.

Objective To analyze the incidence of cardiovascular events among patients with comorbid chronic obstructive pulmonary disease(COPD)and hypertension(HTN),as well as to identify the associated influ-encing factors.Methods A retrospective analysis was conducted on patients diagnosed with primary hypertension(HTN group,n=64),chronic obstructive pulmonary disease(COPD group,n=64),and concomitant primary hypertension and COPD(combined group,n=64)at our hospital between December 2021 and January 2025.Cardiovascular event incidence,pulmonary function parameters-including forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),peak expiratory flow(PEF),and percent predicted FEV1(FEV1%pred)-and blood pressure levels(systolic blood pressure[SBP],diastolic blood pressure[DBP])were compared across the three groups.Kaplan-Meier curves were constructed to illustrate and compare the cumulative incidence of cardiovas-cular events.Covariance analysis was performed to assess the impact of hypertension on pulmonary function,and Cox proportional hazards regression was employed to identify factors associated with cardiovascular outcomes.Results The total incidence rate of cardiovascular events in the HTN group was 14.06%,which was significantly lower than that in the COPD group(29.69%)and the combined HTN-COPD group(48.44%)(P<0.05).A highly significant difference was observed in the cumulative incidence rates across the three groups(P<0.05).Specifically,the COPD group exhibited a higher cumulative incidence than the HTN group(P<0.05),while the combined group showed the highest incidence,exceeding both the COPD and HTN groups(P<0.05).Pulmonary function parameters-including FVC,FEV1,PEF,and FEV1%pred-were significantly higher in the HTN group compared to both the COPD and combined groups(P<0.05).Moreover,these indices were also higher in the COPD group than in the combined group(P<0.05).Systolic and diastolic blood pressure(SBP and DBP)levels in the combined group were significantly elevated compared to both the HTN and COPD groups(P<0.05),and SBP and DBP in the HTN group were higher than those in the COPD group(P<0.05).After adjusting for potential confounders,the intergroup dif-ference in FVC remained statistically significant(P<0.05),and the effect of group on FEV1%pred was particularly robust(partial η2=0.754,P<0.05).Compared with patients without cardiovascular events,those who experienced events differed significantly by disease type(P<0.05).The proportions of patients with HTN alone and HTN com-bined with COPD were higher in the event group than in the non-event group(P<0.05).Additionally,FVC and FEV1%pred were lower in the event group,whereas SBP and DBP were higher(all P<0.05).Multivariate analysis identified disease type,FEV1%pred,and SBP as independent predictors of cardiovascular events(P<0.05).Deci-sion tree analysis further highlighted that the coexistence of HTN and COPD constitutes a critical determinant in cardiovascular risk stratification.Conclusions The incidence of cardiovascular events in patients with COPD com-bined with HTN was significantly higher than in those with either condition alone.Furthermore,the coexistence of these diseases,along with impaired lung function(as indicated by reduced FEV1%predicted)and increased SBP,were independent risk factors for cardiovascular events.

Objective To analyze the incidence of cardiovascular events among patients with comorbid chronic obstructive pulmonary disease(COPD)and hypertension(HTN),as well as to identify the associated influ-encing factors.Methods A retrospective analysis was conducted on patients diagnosed with primary hypertension(HTN group,n=64),chronic obstructive pulmonary disease(COPD group,n=64),and concomitant primary hypertension and COPD(combined group,n=64)at our hospital between December 2021 and January 2025.Cardiovascular event incidence,pulmonary function parameters-including forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),peak expiratory flow(PEF),and percent predicted FEV1(FEV1%pred)-and blood pressure levels(systolic blood pressure[SBP],diastolic blood pressure[DBP])were compared across the three groups.Kaplan-Meier curves were constructed to illustrate and compare the cumulative incidence of cardiovas-cular events.Covariance analysis was performed to assess the impact of hypertension on pulmonary function,and Cox proportional hazards regression was employed to identify factors associated with cardiovascular outcomes.Results The total incidence rate of cardiovascular events in the HTN group was 14.06%,which was significantly lower than that in the COPD group(29.69%)and the combined HTN-COPD group(48.44%)(P<0.05).A highly significant difference was observed in the cumulative incidence rates across the three groups(P<0.05).Specifically,the COPD group exhibited a higher cumulative incidence than the HTN group(P<0.05),while the combined group showed the highest incidence,exceeding both the COPD and HTN groups(P<0.05).Pulmonary function parameters-including FVC,FEV1,PEF,and FEV1%pred-were significantly higher in the HTN group compared to both the COPD and combined groups(P<0.05).Moreover,these indices were also higher in the COPD group than in the combined group(P<0.05).Systolic and diastolic blood pressure(SBP and DBP)levels in the combined group were significantly elevated compared to both the HTN and COPD groups(P<0.05),and SBP and DBP in the HTN group were higher than those in the COPD group(P<0.05).After adjusting for potential confounders,the intergroup dif-ference in FVC remained statistically significant(P<0.05),and the effect of group on FEV1%pred was particularly robust(partial η2=0.754,P<0.05).Compared with patients without cardiovascular events,those who experienced events differed significantly by disease type(P<0.05).The proportions of patients with HTN alone and HTN com-bined with COPD were higher in the event group than in the non-event group(P<0.05).Additionally,FVC and FEV1%pred were lower in the event group,whereas SBP and DBP were higher(all P<0.05).Multivariate analysis identified disease type,FEV1%pred,and SBP as independent predictors of cardiovascular events(P<0.05).Deci-sion tree analysis further highlighted that the coexistence of HTN and COPD constitutes a critical determinant in cardiovascular risk stratification.Conclusions The incidence of cardiovascular events in patients with COPD com-bined with HTN was significantly higher than in those with either condition alone.Furthermore,the coexistence of these diseases,along with impaired lung function(as indicated by reduced FEV1%predicted)and increased SBP,were independent risk factors for cardiovascular events.

Objective:To develop a scientific and practical questionnaire for general practice residents, and to conduct multidimensional and comprehensive evaluation of the quality of general practice teaching clinics.Methods:A preliminary draft of the questionnaire items was formulated based on a literature review and in-depth interviews. The Delphi method was employed to conduct two rounds of consultation with 14 experts. Following revisions, a convenience sampling method was used to invite general practice residents from three standardized residency training bases to test the reliability and validity of the questionnaire.Results:The questionnaire consisted of 23 items, covering the three dimensions of preparation, implementation process, and comprehensive evaluation of the teaching clinics. The response rates for the two rounds of the expert consultation were both 100.00%, with expert authority coefficients of 0.89 and 0.90, respectively. The overall Cronbach's α coefficient of the questionnaire was 0.93, and the correlation coefficients between each item score and the total score were all >0.30. Structural validity analysis revealed that three common factors were extracted from the questionnaire, with a cumulative variance contribution rate of 77.89%. Conclusions:The General Practice Teaching Clinic Quality Evaluation Questionnaire for Residents developed in this study demonstrates high reliability and validity. The questionnaire provides a scientific basis for the standardized assessment of teaching quality in general practice clinics. By incorporating resident feedback on the teaching process, the questionnaire promotes the development of a teaching clinic quality improvement mechanism focused on residents and plays a significant role in enhancing the teaching capabilities of supervising physicians in clinics.

Objective:To investigate the clinical characteristics, bleeding site distribution, and factors associated with hospitalization for surgical management in patients with refractory posterior epistaxis.Methods:This cross-sectional study retrospectively analyzed data from 3 473 patients with refractory posterior epistaxis treated at ENT department or Emergency Department of Affiliated Zhangzhou Hospital of Fujian Medical University, between January 2018 and December 2024. The demographic and clinical data of patients were collected. Univariate analyses and multivariable logistic regression were applied to identify factors associated with hospitalization for surgical intervention.Results:Among 3 473 patients (65.94%(2 290 cases) male; mean age (54±21) years), 46.96% (1 631 cases)were aged 41-69 years. Bleeding predominantly occurred at night (89.66%, 3 114 cases) and in winter (29.92%, 1 039 cases). The most frequent bleeding sites were the olfactory cleft (25.22%,876 cases) and inferior meatus vault (25.63%,890 cases), followed by the posterior regions of middle meatus (11.26%,391 cases), the foremost regions of nasal cavity (11.20%,389 cases), the nasal septum surface (11.23%,390 cases), the bottom of nasal cavity (9.42%,327 cases), and the others or uncertain sites (6.05%,210 cases). Endoscopic electrocautery was performed in 75.01% of cases. Overall, 2 715 patients required hospitalization for surgery. Univariate analysis identified older age (≥70 years), male sex, alcohol use, nighttime onset, winter season, hypertension, diabetes, and anticoagulant use as significantly associated with hospitalization ( χ2=6.51, 8.03, 5.11, -0.17, 7.53, 12.52, 6.83, 5.18, all P<0.05). Multivariable logistic regression confirmed older age ( OR=2.45, 95% CI: 1.81-7.50), winter season ( OR=9.55, 95% CI: 2.26-9.38), nighttime onset ( OR=6.78, 95% CI: 1.84-6.96), alcohol use ( OR=27.71, 95% CI: 11.97-64.14), hypertension ( OR=7.93, 95% CI: 1.64-11.84), and anticoagulant use ( OR=6.39, 95% CI: 1.06-9.47) as independent positive factors associated with hospitalization for surgical management (all P<0.05). Conclusions:Refractory posterior epistaxis most commonly affects individuals aged 41-69 years, with bleeding frequently originating from the olfactory cleft or inferior meatus vault, and exhibits seasonal (winter) and diurnal (nighttime) patterns. Independent factors significantly associated with the need for hospitalization and surgical intervention include older age, winter onset, nighttime onset, alcohol use, hypertension, and anticoagulant use. Identifying these factors may aid in risk stratification and clinical decision-making.

Objective To investigate the status quo of pain catastrophizing(PC)in the patients with di-abetic peripheral neuropathic pain(DPNP),and to analyze the influencing factors to provide reference for for-mulating clinical preventive intervention strategies.Methods A total of 206 patients with DPNP admitted and treated in the People's Hospital of Guangxi Zhuang Autonomous Region were selected as the research sub-jects by convenience sampling method.The general data questionnaire,Numerical Rating Scale(NRS),Pain Catastrophizing scale(PCS),Perceived Social Support Scale(PSSS)and diabetes distress scale(DDS)were used to conduct the investigation.Results The incidence rate of PC in 206 cases of DPNP patients was 44.66％(92/206),and the total score of PCS was(30.10±5.16)points.The results of multiple linear regres-sion analysis showed that the gender,duration of diabetes(≥10 years),multiple drug use,number of compli-cations(＞5),NRS score,PSSS score and scores of DDS dimensions were the main influencing factors of PC(all P＜0.05),which could explain 92.3％of the total variation of PC.Conclusion The PC incidence rate in the patients with DPNP is high.Clinical healthcare workers should pay attention to the evaluation of PC in these patients,and formulate the scientific and effective targeted intervention measures according to the main influen-cing factors to help the patients to reduce the pain burden in order to reduce the level of PC.

OBJECTIVE To study the effects of bergapten in the treatment of liver fibrosis and its mechanism based on serum metabolomics. METHODS Forty mice were divided into normal control group （0.5% carboxymethyl cellulose sodium solution）， model group （0.5% carboxymethyl cellulose sodium solution）， and BP low-dose and high-dose groups （50， 100 mg/kg）， with 10 mice in each group. Except for the normal control group， the other three groups were all treated with carbon tetrachloride to induce liver fibrosis model； they were given relevant medicine/solution intragastrically， once a day， for consecutive 8 weeks. After the last medication， the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in serum were detected， and liver pathological changes were observed； the expressions of α-smooth muscle actin （α-SMA） and Collagen Ⅰ were detected in liver tissue； the serum of the mice was collected for metabolomics analysis. RESULTS Compared with the model group， serum levels of ALT and AST and protein expressions of α-SMA and Collagen Ⅰ in liver tissue were decreased significantly in BP high-dose and low-dose groups （P＜0.05）， while liver fibrosis was improved significantly. Meanwhile， metabolomics analyses showed that there were a total of 175 serum differential metabolites in the BP high-dose group and model group， of which 18 substances were upregulated and 157 substances were downregulated； the main metabolic pathways involved in bergapten intervention were pyrimidine metabolism， butanoate metabolism， fatty acid synthesis， tyrosine metabolism， β-alanine metabolism， nicotinic acid and nicotinamide metabolism， glutathione metabolism， etc. CONCLUSIONS BP is effective in the treatment of liver fibrosis by regulating pyrimidine metabolism， butanoate metabolism， glutathione metabolism and so on in rats with liver fibrosis.

Objective:To describe the family resilience experience of colorectal cancer patients′ spouses in the process of care, and to provide reference for making effective clinical nursing interventions.Methods:Objective sampling method was used to select the spouses of colorectal cancer patients who were hospitalized in Shanghai East Hospital from March to April 2023. A phenomenological research was used. Semi-structured, in-depth interviews were conducted with 10 spouses of colorectal cancer patients undergoing colostomy. Data was transcribed and analyzed using Colaizzi′s method.Results:Three themes were extracted: family crisis and coping pressure including increased burden of care, accompanying emotional internal friction, heavy economic pressure; internal adjustment and adaptation within the family including positive family beliefs, timely adjustment of family roles, clear and effective communication and interaction; integration and utilization of external resources including active access to information, medical professional support, social external support.Conclusions:With the help of the perspective of family advantage, medical staff should pay attention to the evaluation of care needs and family resilience of colorectal cancer patients′ spouses, to fully mobilize advantage resources and give effective intervention measures to improve the family and social adaptation level of patients and their spouses.