Objective To establish an expert consensus on the management of low anterior resection syndrome(LARS)in patients with rectal cancer post-surgery(hereinafter referred to as"consensus"),aiming to standardize the related work of medical institutions in the context of post-operative LARS.Methods A comprehensive search of domestic and international databases was conducted to collect guidelines,expert consensuses,systematic reviews,evidence summaries,and original research related to post-operative LARS in rectal cancer published from the establishment of the databases until August 2024.Based on clinical practice experience,a preliminary draft of the"consensus"was formed.From September to November 2024,22 experts were invited to participate in 2 rounds of expert consultations,during which the draft content was revised and improved,and the final version of the"consensus"was determined through expert validation.Results A total of 22 experts responded,achieving a response rate of 100％.The effective recovery rate of the consultation questionnaires in both rounds was 100％,with an expert authority coefficient of 0.89,a judgment coefficient of 0.97,and a familiarity degree of 0.84.The Kendall harmony coefficients for the 2 rounds of expert consultations were 0.122 and 0.136,respectively(P＜0.001).This consensus covers 5 main aspects:definition,assessment,prevention,treatment,and follow-up management of LARS.Conclusion This consensus demonstrates a high level of scientific rigor and can provide a strong reference for clinical nursing personnel in the specialized care of rectal cancer patients with post-operative LARS.

Background and Aims:Oncoplastic breast-conserving surgery(OBCS)integrates oncologic and plastic surgical techniques and includes two primary approaches:volume displacement and volume replacement.The pedicled lateral thoracic artery perforator(LTAP)flap is a commonly used technique for volume replacement.Although recent studies in China have confirmed its safety in OBCS,its patient-reported outcomes have not been systematically evaluated,and comparative data with volume displacement techniques remain lacking.Therefore,this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty(volume displacement)in OBCS,to inform surgical decision-making.Methods:A retrospective case-control study was conducted,including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024.Patients were divided into the LTAP flap group(27 cases)and the mammoplasty group(79 cases)based on the surgical technique.Intraoperative variables,cosmetic outcomes,postoperative complications,and Breast-Q scores before and after surgery were compared between the two groups.Results:There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores(all P>0.05).The LTAP group had longer operative times,larger excised tissue volumes,and greater postoperative drainage volumes(all P<0.001).Postoperative cosmetic outcomes were significantly better in the LTAP group,with a higher rate of excellent-to-good cosmetic results(88.9%vs.57.3%)and higher Breast-Q scores in breast satisfaction,psychosocial well-being,and physical well-being(all P<0.05).There were no significant differences in complication rates or local recurrence between the two groups(all P>0.05).Conclusion:In OBCS,the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction.It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.

Objective:To evaluate the effect of laser-assisted laser in situ keratomileusis (LASIK) surgery for optimized monovision correction in the treatment of age-related accommodative deficiency with myopia on regulatory function.Methods:A cohort study was conducted.A total of 74 consecutive patients (74 eyes) with age-related accommodative insufficiency and myopia who underwent optimized monovision LASIK at Lanzhou Bright Eye Hospital from October 2019 to October 2021 were enrolled.Only non-dominant eye data were analyzed.Patients were randomized into a control group (37 cases, 37 eyes) treated with FS-LASIK and an optimization adjustment group (37 cases, 37 eyes) treated with Q-value adjusted monovision FS-LASIK.Preoperative and postoperative (within 1 year) data were collected for both groups, including distance visual acuity, near visual acuity, central 3 mm corneal equivalent spherical refraction (SE), anterior corneal Q-value, amplitude of accommodation (AMP), monocular positive relative accommodation (PRA), and lens thickness (LT).The differences of different indicators (AMP, PRA, LT) related to accommodation power at different time points were compared between the two groups.The correlation between near visual acuity, PRA, LT and AMP in the optimized adjustment group was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of LanZhou Bright Eye Hospital (No.LP-202302).Written informed consent was obtained from each subject.Results:There were significant overall differences in distance visual acuity, near visual acuity, Q value, and SE in non-dominant eyes at different time points in the two groups ( Ftime=244.98, 69, 843.65, 454.80; all P<0.05).There was a significant overall difference in Q value between the two groups ( Fgroup=2.49, P<0.05).Compared with preoperative, the postoperative distance visual acuity and near visual acuity of patients in both groups were improved, with an increase in Q value and a decrease in SE, with statistically significant differences (all P<0.05).One year after surgery, the near visual acuity and Q value of the optimized adjustment group were better than those of the control group, with statistically significant differences (both P<0.05).There were significant differences in AMP and PRA in non-dominant eyes at different time points between the two groups (AMP: Fgroup=19.03, P<0.05; Ftime=4.99, P<0.05.PRA: Fgroup=42.67, P<0.05; Ftime=28.64, P<0.05).At 1 month, 6 months and 1 year after surgery, AMP and PRA increased in the optimization adjustment group compared with the preoperative and control group, and the differences were statistically significant (all P<0.05).There were significant differences in LT before and after surgery in non-dominant eye between the two groups ( Ftime=4.94, P<0.05).Among them, the LT in the optimization adjustment group became thinner at different time points after surgery than before surgery, and the differences were statistically significant (all P<0.05).In the optimization adjustment group, near visual acuity at 1 year after surgery in non-dominant eye was positively correlated with AMP ( r=0.269, P<0.05), and PRA was negatively correlated with AMP ( r=-0.601, P<0.05), and preoperative LT was positively correlated with preoperative AMP ( r=0.276, P<0.05). Conclusions:Optimized monovision LASIK for the treatment of age-related accommodative insufficiency with myopia significantly improves the myopia-related accommodation parameters AMP, PRA, and LT.

Objective:To evaluate the effect of laser-assisted laser in situ keratomileusis (LASIK) surgery for optimized monovision correction in the treatment of age-related accommodative deficiency with myopia on regulatory function.Methods:A cohort study was conducted.A total of 74 consecutive patients (74 eyes) with age-related accommodative insufficiency and myopia who underwent optimized monovision LASIK at Lanzhou Bright Eye Hospital from October 2019 to October 2021 were enrolled.Only non-dominant eye data were analyzed.Patients were randomized into a control group (37 cases, 37 eyes) treated with FS-LASIK and an optimization adjustment group (37 cases, 37 eyes) treated with Q-value adjusted monovision FS-LASIK.Preoperative and postoperative (within 1 year) data were collected for both groups, including distance visual acuity, near visual acuity, central 3 mm corneal equivalent spherical refraction (SE), anterior corneal Q-value, amplitude of accommodation (AMP), monocular positive relative accommodation (PRA), and lens thickness (LT).The differences of different indicators (AMP, PRA, LT) related to accommodation power at different time points were compared between the two groups.The correlation between near visual acuity, PRA, LT and AMP in the optimized adjustment group was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of LanZhou Bright Eye Hospital (No.LP-202302).Written informed consent was obtained from each subject.Results:There were significant overall differences in distance visual acuity, near visual acuity, Q value, and SE in non-dominant eyes at different time points in the two groups ( Ftime=244.98, 69, 843.65, 454.80; all P<0.05).There was a significant overall difference in Q value between the two groups ( Fgroup=2.49, P<0.05).Compared with preoperative, the postoperative distance visual acuity and near visual acuity of patients in both groups were improved, with an increase in Q value and a decrease in SE, with statistically significant differences (all P<0.05).One year after surgery, the near visual acuity and Q value of the optimized adjustment group were better than those of the control group, with statistically significant differences (both P<0.05).There were significant differences in AMP and PRA in non-dominant eyes at different time points between the two groups (AMP: Fgroup=19.03, P<0.05; Ftime=4.99, P<0.05.PRA: Fgroup=42.67, P<0.05; Ftime=28.64, P<0.05).At 1 month, 6 months and 1 year after surgery, AMP and PRA increased in the optimization adjustment group compared with the preoperative and control group, and the differences were statistically significant (all P<0.05).There were significant differences in LT before and after surgery in non-dominant eye between the two groups ( Ftime=4.94, P<0.05).Among them, the LT in the optimization adjustment group became thinner at different time points after surgery than before surgery, and the differences were statistically significant (all P<0.05).In the optimization adjustment group, near visual acuity at 1 year after surgery in non-dominant eye was positively correlated with AMP ( r=0.269, P<0.05), and PRA was negatively correlated with AMP ( r=-0.601, P<0.05), and preoperative LT was positively correlated with preoperative AMP ( r=0.276, P<0.05). Conclusions:Optimized monovision LASIK for the treatment of age-related accommodative insufficiency with myopia significantly improves the myopia-related accommodation parameters AMP, PRA, and LT.

Background and Aims:Oncoplastic breast-conserving surgery(OBCS)integrates oncologic and plastic surgical techniques and includes two primary approaches:volume displacement and volume replacement.The pedicled lateral thoracic artery perforator(LTAP)flap is a commonly used technique for volume replacement.Although recent studies in China have confirmed its safety in OBCS,its patient-reported outcomes have not been systematically evaluated,and comparative data with volume displacement techniques remain lacking.Therefore,this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty(volume displacement)in OBCS,to inform surgical decision-making.Methods:A retrospective case-control study was conducted,including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024.Patients were divided into the LTAP flap group(27 cases)and the mammoplasty group(79 cases)based on the surgical technique.Intraoperative variables,cosmetic outcomes,postoperative complications,and Breast-Q scores before and after surgery were compared between the two groups.Results:There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores(all P>0.05).The LTAP group had longer operative times,larger excised tissue volumes,and greater postoperative drainage volumes(all P<0.001).Postoperative cosmetic outcomes were significantly better in the LTAP group,with a higher rate of excellent-to-good cosmetic results(88.9%vs.57.3%)and higher Breast-Q scores in breast satisfaction,psychosocial well-being,and physical well-being(all P<0.05).There were no significant differences in complication rates or local recurrence between the two groups(all P>0.05).Conclusion:In OBCS,the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction.It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.

Objective To establish an expert consensus on the management of low anterior resection syndrome(LARS)in patients with rectal cancer post-surgery(hereinafter referred to as"consensus"),aiming to standardize the related work of medical institutions in the context of post-operative LARS.Methods A comprehensive search of domestic and international databases was conducted to collect guidelines,expert consensuses,systematic reviews,evidence summaries,and original research related to post-operative LARS in rectal cancer published from the establishment of the databases until August 2024.Based on clinical practice experience,a preliminary draft of the"consensus"was formed.From September to November 2024,22 experts were invited to participate in 2 rounds of expert consultations,during which the draft content was revised and improved,and the final version of the"consensus"was determined through expert validation.Results A total of 22 experts responded,achieving a response rate of 100％.The effective recovery rate of the consultation questionnaires in both rounds was 100％,with an expert authority coefficient of 0.89,a judgment coefficient of 0.97,and a familiarity degree of 0.84.The Kendall harmony coefficients for the 2 rounds of expert consultations were 0.122 and 0.136,respectively(P＜0.001).This consensus covers 5 main aspects:definition,assessment,prevention,treatment,and follow-up management of LARS.Conclusion This consensus demonstrates a high level of scientific rigor and can provide a strong reference for clinical nursing personnel in the specialized care of rectal cancer patients with post-operative LARS.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the application of CT image omics model in the differential diagnosis of ganglioneuroblastoma (GNB) and neuroblastoma (NB) in childhood.Methods:A retrospective case series study was performed. The clinical and imaging data of 23 NB and 23 GNB pediatric patients confirmed by surgery and pathology in Shanxi Children's Hospital from January 2013 to December 2013 were collected. The original CT images in the normal scan phase, arterial phase and venous phase of all the children before operation were extracted from the PACS system in DICOM format. ITK-SNAP (ver.3.4.0) software was applied to manually outline and extract the image omics features layer by layer of the lesions in the normal scan phase, arterial phase and venous phase of each patient before surgery. The minimum absolute contraction selection operator and stepwise multi-factor logistic regression method were used to screen out effective features in different scan phases. The corresponding phase image omics model was established by using logistic model. The diagnostic efficiency of each phase of the image omics model was evaluated by using the receiver operating characteristic curve, calibration curve and decision curve.Results:A total of 1 361 image omics features were extracted from the original CT images in the 3 phases. The model was established by using multi-factor logistic regression to extract 4 features in the normal scan phase, 2 features in the arterial phase, 3 features in the venous phase and 7 features in the combination of the 3 phases. The area under the curve (AUC) of the model in the normal scan phase was 0.940, the accuracy was 89.1%, the sensitivity was 91.3% and the specificity was 87.0%; the AUC of the model in the arterial phase was 0.923, the accuracy was 84.8%, the sensitivity was 82.6%, and the specificity was 87.0%; the AUC of the model in the venous phase was 0.949, the accuracy was 87.8%, the sensitivity was 83.3%, and the specificity was 91.3%; the AUC of 3 phases combined model was 0.964, the accuracy was 95.1%, the sensitivity was 94.7%, and the specificity was 95.5%. The results showed that the single-phase image omics model was effective in the differential diagnosis of NB and GNB in childhood; the AUC, accuracy, sensitivity and specificity of the 3 phases combined imaging model were higher than those of the single-phase imaging model. The calibration curve and decision curve showed that the probability of differential diagnosis of NB and GNB in childhood by the 3 phases combined model had a high consistency with the observed value, and a good net benefit could be achieved.Conclusions:CT-based image omics model has a high clinical value in the differential diagnosis of NB and GNB in childhood.

Objective:To explore the application and effect of multi-level quality control system (referred to as “quality control”) in health management center setting.Methods:The health management center of Hanzhong Central Hospital constructed a multi-level quality control system of “hospital-department-unit” and “department-unit-quality-controller” in August 2019. A total of 83 619 people who underwent physical examination in the Health Management Center of Hanzhong Central Hospital from August 2018 to July 2020 were selected as the subjects. 32 009 people who underwent physical examination from August 2018 to July 2019 were selected as the control group, and 51 610 people who underwent physical examination from August 2019 to July 2020 were selected as the experimental group. The timely notification of important abnormal results and the follow-up of the “four-high” population (hypertension, hyperglycemia, hyperlipidemia, and hyperuricemia) were observed. Two thousand satisfaction questionnaires and two thousand physical examination reports were collected from the institutions who had received both physical examination in the Health Management Center of Hanzhong Central Hospital for two consecutive years. The physical examination items of the above clients were basically the same. The satisfaction rate of the two groups of physical examination and the qualification rate of the physical examination reports were measured respectively.Results:The results showed that the timely notification rate of important abnormal results (99.4% vs 96.6%), follow-up rate of “four-high” population (hypertension 95.1% vs 91.2%, hyperglycemia 95.3% vs 91.6%, hyperlipidemia 94.6% vs 92.3%, hyperuricemia 92.7% vs 86.4%), satisfaction rate of physical examination (physical examination environment 94.0% vs 91.3%, service attitude 96.4% vs 91.9%, waiting time 97.6% vs 95.4%, physical examination process 98.3% vs 96.8%, professional level of medical staff 97.2% vs 95.1%), and qualified rate of physical examination report (accuracy of input information 99.5% vs 98.1%, accuracy of main examination conclusion 99.4% vs 97.3%, normative sorting 99.8% vs 98.8%, rationality of health advice 99.2% vs 96.8%) in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion:The establishment of a multi-level quality control system in health examination service can improve the timely notification rate of important abnormal results, the follow-up rate of the “four-high” population, the satisfaction of physical examinees, and the qualified rate of physical examination reports.

Aim To study the effects of eugenol on hypoglycemic effect and hepatic glucose and lipid metabolism in type 2 diabetic mice, and to explore the possible mechanism. Methods The model of type 2 diabetes induced by long term high-fat diet was divided into four groups. The blood glucose and body weight of each group were measured once a week. After six weeks, the liver tissues of mice in each group were dissected and the liver mass and body mass of mice were weighed. Liver index, lipid metabolism and liver function were measured. Oral glucose tolerance test was performed. The levels of blood glucose, insulin, triglyceride, cholesterol, resistin, leptin, auxin, glucagon and plasminogen activator inhibitor-1 in serum were measured. He staining was used to observe the pathological changes of liver tissues. The expressions of SHP, pfoxo1, pCREB, PEPCK and G6Pase proteins in liver were detected by Western blot. Results Compared with HFD group, E40 group had lower body weight, smaller liver volume and healthy dark red. Compared with HFD group, E40 group decreased liver index, lipid metabolism and liver function. OGTT test showed that glucose tolerance was enhanced and the area under the curve was decreased in E40 group compared with HFD group. The levels of blood glucose, insulin, triglyceride, resistin, leptin, glucagon and plasminogen activator inhibitor-1 in E40 group were lower than those in HFD group. He staining showed that hepatocytes in HFD group were larger and accompanied with bullous steatosis than those in RD group. Hepatocyte steatosis and liver pathological state were significantly improved in E40 group. The results of Western blot showed that compared with HFD group, the expression of SHP, pfoxo1 and pCREB protein in E40 group was up-regulated, and the expression of PEPCK and G6Pase protein was down-regulated. Conclusions Eugenol can regulate the SHP/pFOXO1/PCREB/PEPCK/G6Pase signaling pathway, regulate glucose and lipid metabolism, inhibit insulin resistance, improve blood glucose level and glucose and lipid metabolism disorders in type 2 diabetes mellitus.