Patients with anxiety disorders exhibit complex and diverse clinical manifestations, with symptoms showing significant overlap with somatic diseases. In clinical practice, relying solely on psychiatric symptoms and prioritizing anxiety disorders as the diagnostic pathway, while neglecting systematic evaluation of somatic symptoms and comprehensive analysis of auxiliary examinations could lead to missed or incorrect diagnoses, which may delay the appropriate treatment. This diagnostic dilemma is particularly evident in patients who have visited multiple general hospitals without identifying a clear somatic etiology before ultimately presenting to psychiatric services. This paper reports a case of a middle-aged patient who remained undiagnosed after multiple general hospital visits. The patient developed symptoms including anxiety, sleep disorders, nausea, and dysphagia due to working in a locked-down area. After failing to obtain a clear diagnosis, the patient was admitted to psychiatry department. While anti-anxiety therapy alleviated some symptoms, the patient subsequently developed progressive anemia, which was unresponsive to blood supplementation. Multidisciplinary Team consultation and bone marrow aspiration excluded anemia related to psychiatric medications and confirmed a diagnosis of acute myeloid leukemia. The patient achieved a favorable prognosis following bone marrow transplantation. This case highlights the importance of systematically differentiating between somatic and psychiatric symptoms in clinical practice.

Objective:To understand nurses' experiences providing discharge preparation services for elderly patients with multiple chronic diseases and offer references for developing intervention strategies for discharge preparation services for these patients.Methods:A purposive sampling method was used to select 24 nurses from the cardiovascular departments, geriatrics wards, and other internal medicine departments of three Grade A tertiary hospitals, four Grade B hospitals, and one community health service center in Guilin City between March and April 2024. An interview outline was developed based on the social-ecological system theory, and semi-structured interviews were conducted to collect data. A directed content analysis method was used to analyze the data.Results:A total of three themes were identified: micro-level (nurses have a positive attitude but face shortcomings in age-appropriate discharge preparation services), meso-level (team collaboration mechanisms are weak), and macro-level (there is a desire to link social resources) .Conclusions:Nurses' discharge preparation services for elderly patients with multiple chronic diseases are inadequate. It is recommended to enhance nurses' discharge preparation skills through core competency-based training, improve the development of innovative healthcare platforms, and promote establishing of a multi-dimensional social care support system to improve the quality of discharge preparation services for elderly patients with multiple chronic diseases.

Objective:To understand nurses' experiences providing discharge preparation services for elderly patients with multiple chronic diseases and offer references for developing intervention strategies for discharge preparation services for these patients.Methods:A purposive sampling method was used to select 24 nurses from the cardiovascular departments, geriatrics wards, and other internal medicine departments of three Grade A tertiary hospitals, four Grade B hospitals, and one community health service center in Guilin City between March and April 2024. An interview outline was developed based on the social-ecological system theory, and semi-structured interviews were conducted to collect data. A directed content analysis method was used to analyze the data.Results:A total of three themes were identified: micro-level (nurses have a positive attitude but face shortcomings in age-appropriate discharge preparation services), meso-level (team collaboration mechanisms are weak), and macro-level (there is a desire to link social resources) .Conclusions:Nurses' discharge preparation services for elderly patients with multiple chronic diseases are inadequate. It is recommended to enhance nurses' discharge preparation skills through core competency-based training, improve the development of innovative healthcare platforms, and promote establishing of a multi-dimensional social care support system to improve the quality of discharge preparation services for elderly patients with multiple chronic diseases.

Patients with anxiety disorders exhibit complex and diverse clinical manifestations, with symptoms showing significant overlap with somatic diseases. In clinical practice, relying solely on psychiatric symptoms and prioritizing anxiety disorders as the diagnostic pathway, while neglecting systematic evaluation of somatic symptoms and comprehensive analysis of auxiliary examinations could lead to missed or incorrect diagnoses, which may delay the appropriate treatment. This diagnostic dilemma is particularly evident in patients who have visited multiple general hospitals without identifying a clear somatic etiology before ultimately presenting to psychiatric services. This paper reports a case of a middle-aged patient who remained undiagnosed after multiple general hospital visits. The patient developed symptoms including anxiety, sleep disorders, nausea, and dysphagia due to working in a locked-down area. After failing to obtain a clear diagnosis, the patient was admitted to psychiatry department. While anti-anxiety therapy alleviated some symptoms, the patient subsequently developed progressive anemia, which was unresponsive to blood supplementation. Multidisciplinary Team consultation and bone marrow aspiration excluded anemia related to psychiatric medications and confirmed a diagnosis of acute myeloid leukemia. The patient achieved a favorable prognosis following bone marrow transplantation. This case highlights the importance of systematically differentiating between somatic and psychiatric symptoms in clinical practice.

Objective:To investigate the risk factors of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) complicated with pancreatogenic portal hypertension (PPH) and to establish a prediction model.Methods:From January 1, 2016 to December 31, 2022, a total of 1 095 patients diagnosed with MSAP or SAP at the First Affiliated Hospital of Kunming Medical University were enrolled and divided into PPH group (145 cases) and non-PPH group (950 cases) according to the presence or absence of concomitant PPH. The general data (gender, etiology of acute pancreatitis, days of hospitalization, etc.), complications (portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, etc.), laboratory indicators (albumin, D-dimer, etc.), and scores of modified computed tomography severity index (MCTSI) were collected in the two groups. The least absolute shrinkage and selection operator(LASSO) and multivariate logistic regression analysis were performed to analyze the independent risk factors of MSAP and SAP complicated with PPH, and the nomogram prediction model was established. The area under the curve of the receiver operating characteristic curve was calculated to evaluate the discrimination of the calibration curve and Hosmer-Lemeshow goodness of fit test were used to assess the predictive accuracy of the model, and clinical decision curve analysis (DCA) was used to evaluate the clinical practicability of the model.Results:The results of LASSO and multivariate logistic regression analysis showed that portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, days of hospitalization, MCTSI and decreased albumin were independent risk factors of MSAP and SAP complicated with PPH ( OR=7.013, 2.085, 1.846, 1.030, 1.235 and 0.955; 95% confidence interval 4.061 to 12.112, 1.255 to 3.463, 1.066 to 3.199, 1.013 to 1.047, 1.123 to 1.357 and 0.927 to 0.983; all P<0.05). The area under the curve of the model was 0.820 (95% confidence interval 0.780 to 0.859), the calibration curve was close to the reference curve, and the Hosmer-Lemeshow goodness-fit test showed that the model had a good fit ( χ2=9.82, P=0.278). The result of DCA indicated that the model had a high net benefit in a wide range of risk threshold (threshold probability 0.1 to 0.9), and had certain clinical practicability. Conclusions:Portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, days of hospitalization, MCTSI and decreased albumin are the independent risk factors of MSAP and SAP complicated with PPH. The established nomogram model has good differentiation, calibration and clinical practicability.

Objective To investigate the relationship between serum cathepsin B(CTSB)and long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1(lncRNA MALAT1)levels and disease severity in patients with sepsis-associated acute kidney injury(SA-AKI)and their prognostic value.Methods A total of 80 patients with SA-AKI admitted to Deyang People's Hospital from January 2021 to January 2023 were selected as the SA-AKI group,and 80 patients with simple sepsis in the same period were selected as the simple sepsis group.According to the severity of the disease,SA-AKI patients were divided into stage 1(22 cases),stage 2(27 cases),and stage 3(31 cases).According to the 28 d clinical outcome,the pa-tients were divided into death group(35 cases)and survival group(45 cases).Enzyme-linked immunosorbent assay and real-time fluorescence quantitative PCR were used to detect serum CTSB and lncRNA MALAT1 levels.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with SA-AKI.Receiver operating characteristic curve was used to analyze the predictive value of se-rum CTSB and lncRNA MALAT1 levels for death in patients with SA-AKI.Results Compared with the sim-ple sepsis group,the serum levels of CTSB and lncRNA MALAT1 were significantly increased in the SA-AKI group(P＜0.05).The serum levels of CTSB and lncRNA MALAT1 in patients with stage 1,stage 2,and stage 3 SA-AKI were increased in turn(P＜0.05).The 28 d mortality of the 80 patients was 43.75％.AKI stage 3,acute physiology and chronic health evaluation Ⅱ score,sequential organ failure assessment score,ele-vated blood lactate,CTSB and lncRNA MALAT1 were independent risk factors for death in patients with SA-AKI(P＜0.05).The area under the curve of serum CTSB combined with lncRNA MALAT1 for predicting the death of patients with SA-AKI was 0.894,which was higher than 0.797 and 0.793 predicted by serum CTSB or lncRNA MALAT1 levels alone(P＜0.05).Conclusion The increased levels of serum CTSB and ln-cRNA MALAT1 in patients with SA-AKI are closely related to the aggravation of the disease and poor prog-nosis.Serum CTSB combined with lncRNA MALAT1 levels have a high predictive value for the prognosis of patients with SA-AKI.

Objective:To investigate the risk factors of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) complicated with pancreatogenic portal hypertension (PPH) and to establish a prediction model.Methods:From January 1, 2016 to December 31, 2022, a total of 1 095 patients diagnosed with MSAP or SAP at the First Affiliated Hospital of Kunming Medical University were enrolled and divided into PPH group (145 cases) and non-PPH group (950 cases) according to the presence or absence of concomitant PPH. The general data (gender, etiology of acute pancreatitis, days of hospitalization, etc.), complications (portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, etc.), laboratory indicators (albumin, D-dimer, etc.), and scores of modified computed tomography severity index (MCTSI) were collected in the two groups. The least absolute shrinkage and selection operator(LASSO) and multivariate logistic regression analysis were performed to analyze the independent risk factors of MSAP and SAP complicated with PPH, and the nomogram prediction model was established. The area under the curve of the receiver operating characteristic curve was calculated to evaluate the discrimination of the calibration curve and Hosmer-Lemeshow goodness of fit test were used to assess the predictive accuracy of the model, and clinical decision curve analysis (DCA) was used to evaluate the clinical practicability of the model.Results:The results of LASSO and multivariate logistic regression analysis showed that portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, days of hospitalization, MCTSI and decreased albumin were independent risk factors of MSAP and SAP complicated with PPH ( OR=7.013, 2.085, 1.846, 1.030, 1.235 and 0.955; 95% confidence interval 4.061 to 12.112, 1.255 to 3.463, 1.066 to 3.199, 1.013 to 1.047, 1.123 to 1.357 and 0.927 to 0.983; all P<0.05). The area under the curve of the model was 0.820 (95% confidence interval 0.780 to 0.859), the calibration curve was close to the reference curve, and the Hosmer-Lemeshow goodness-fit test showed that the model had a good fit ( χ2=9.82, P=0.278). The result of DCA indicated that the model had a high net benefit in a wide range of risk threshold (threshold probability 0.1 to 0.9), and had certain clinical practicability. Conclusions:Portal vein thrombosis, pancreatic pseudocyst, pancreatic encapsulated necrosis, days of hospitalization, MCTSI and decreased albumin are the independent risk factors of MSAP and SAP complicated with PPH. The established nomogram model has good differentiation, calibration and clinical practicability.

Aim Toinvestigatingtheinductionof CYPs in hepatocytes or HepG2 cells by triptolide(TP) andthepossiblemechanism.Methods AfterTPtreat-ment,the expression of CYPs in rat primary hepato-cytes or human HepG2 cells was detected by real-time PCR and Western blot assays.Specific inhibitors or gene knockdown method were employed to analyze the possiblemechanism.Results Theexpressionof CYP1A2,2C7,2C11,2C12,2D2,2E1 and 3A1 in rat primary hepatocytes was induced by TP.The fold was 19,2,31,3,21,88 and 34 at 50 nmol·L-1, respectively while at 100 nmol·L-1 it was 20,5,30,23,61,83 and 38,respectively.In HepG2 cells,the expression of human CYP1A1,2B6,2C9,2C19, 2D6,2E1 and 3A4 was also induced by TP.The ac-tivities of nuclear receptor PXR and CAR were inhibi-ted.TP upregulated p53 expression,and the induction of several CYPs caused by TP was blocked when p53 wasinhibited.Conclusions TPinducesCYPsexpres-sion in rat hepatocytes and HepG2 cells.Nuclear re-ceptors may not be involved in TP induced CYPs, while the mechanism may partly attribute to p53.

Objective To evaluate the safety and immunogenicity of one booster dose of inactivated hepatitis A vaccine in young adults.Methods The subjects were selected from participants in the clinical trial of immunogenicity of inactivated and attenuated live hepatitis A vaccine in young adults.Eligible subjects were those who had received one dose of inactivated or attenuated hepatitis A vaccine,could be contacted and were sero-negative before primary vaccination.All qualified subjects were immunized with one booster dose of inactivated hepatitis A vaccine.The blood samples were collected before booster dose vaccination and 28 days after the immunization.Anti-HAV antibody titer ≥20 mIU/ml was considered to be sero-protected against hepatitis A virus.Results The GMCs in the inactivated HAV vaccine group and attenuated live vaccine group before booster dose vaccination were 70.80 mIU/ml and 50.12 mIU/ml,respectively,and the sero-protection rates were 94.7％ and 65.0％,respectively.After the vaccination of the booster dose,the sero-protection rates in both groups were 100.0％,and the GMCs were 2 816.09 mIU/ml and 2 654.55 mIU/ml,respectively.Conclusion The GMCs and sero-protection rates of anti-HAV antibody in young adults declined after three years of the primary vaccination.However,the higher GMC and sero-protection rate were observed in the inactivated vaccine group than in the attenuated live vaccine group.Significant increases of GMC levels were observed in both groups after one booster dose vaccination.

Objective To explore the relationship between coagulation/anticoagulation imbalance and oxidative stress in the patients with chronic obstructive pulmonary disease during acute exacerbation (AECOPD)before and after treatment.Methods Plasma tissue factor(TF)and tissue factor pathway inhibitor(TFPl)activity was detected by chromogenic assay in 28 AECOPD patients before and after treatment as well as in 30 healthy controls.The total antioxidative capacity(TAC),malondialdehyde (MDA)and gtutathione peroxidase(GSH-PX)in plasma were measured in both groups.Results The levels of plasma TF and TFPI,and their ratio(TF/TFPI)in AECOPD patients before treatment were significantly higher than those after treatment(all P<0.0 1),the latter were still higher than those in the healthy persons(all P<0.01).The levels of the TAC and GSH-PX in plasma in AECOPD patients before treatment were significantly lower than those after treatment(all P<0.01),the latter were still lower than those in the healthy persons(all P<0.01).The plasma MDA in AECOPD patients before treatment was significantly higher than that after treatment(P<0.0 1),which was still higher than that in the healthy persons(P<0.05).There were negative correlations between TF/TFPI ratio and TAC(r=-0.518.P<0.01),GSH-PX(r=-0.454,P<0.05),PaO2(r=-0.511,P<0.01)respectively and a positive correlation between TF/TFPI ratio and the percentage of neutrophils(r=0.379,P<0.05)in AECOPD patients before treatment.There still were negative correlations between TF/TFPI ratio and TAC (r=-0.420,P<0.05),FEV1% to predicted(r=-0.480,P<0.05)respectively,and a positive correlation between TF/TFPI ratio and MDA(r=0.45 1,P<0.05)in AECOPD patients after treatment.Conclusions There existed coagulation/anticoagulation imbalance and oxidation/antioxidation imbalance before and after treatment in AECOPD patients and their relationship was explored.