Objective:To explore the application value of part-cut jejunal transection in digestive tract reconstruction of totally laparoscopic total gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 112 patients with gastric cancer who underwent totally laparoscopic total gastrectomy in The Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2022 were collected. There were 81 males and 31 females, aged (70±8)years. Among the 112 patients, 60 patients undergoing diges-tive tract reconstruction by Roux-en-Y anastomosis with part-cut jejunum were set as the part-cut group, and 52 patients undergoing digestive tract reconstruction by traditional Roux-en-Y anasto-mosis were set as the traditional group. Observation indicators: (1) propensity score matching status and comparison of clinical data of patients between the two groups after matching; (2) intraopera-tive and postoperative conditions; (3) follow-up. Comparison of measurement data with normal dis-tribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Com-parison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method, with the caliper value of 0.02. Results:(1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 112 patients, 90 patients were successfully matched, with 45 cases in each of the part-cut group and the traditional group. After propensity score matching, the elimination of body mass index, clinical TNM staging confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the total operation time and digestive tract reconstruction time of patients in the part-cut group were (217.0±15.1)minutes and (34.7±1.8)minutes, versus (252.6±21.9)minutes and (52.6±7.4)minutes in the traditional group, respectively, showing significant differences in the above indicators between the two groups ( t=?8.97, ?15.66, P<0.05). (3) Follow-up. After propensity score matching, 90 patients were followed up postoperatively for (47±15)months. During the follow-up, no patient in either group received secondary surgery, and there was no death. There were 3 cases and 10 cases of Roux stasis syndrome in the part-cut group and the traditional group, respectively, showing a significant difference between the two groups ( χ2=4.41, P<0.05). Conclusion:Compared with traditional Roux-en-Y anastomosis, the Roux-en-Y anastomosis with part-cut jejunum in totally laparoscopic total gastrectomy can signifi-cantly shorten the time for digestive tract reconstruction and reduce the incidence of postoperative Roux stasis syndrome.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.

Objective:To explore the application value of part-cut jejunal transection in digestive tract reconstruction of totally laparoscopic total gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 112 patients with gastric cancer who underwent totally laparoscopic total gastrectomy in The Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2022 were collected. There were 81 males and 31 females, aged (70±8)years. Among the 112 patients, 60 patients undergoing diges-tive tract reconstruction by Roux-en-Y anastomosis with part-cut jejunum were set as the part-cut group, and 52 patients undergoing digestive tract reconstruction by traditional Roux-en-Y anasto-mosis were set as the traditional group. Observation indicators: (1) propensity score matching status and comparison of clinical data of patients between the two groups after matching; (2) intraopera-tive and postoperative conditions; (3) follow-up. Comparison of measurement data with normal dis-tribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Com-parison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method, with the caliper value of 0.02. Results:(1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 112 patients, 90 patients were successfully matched, with 45 cases in each of the part-cut group and the traditional group. After propensity score matching, the elimination of body mass index, clinical TNM staging confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the total operation time and digestive tract reconstruction time of patients in the part-cut group were (217.0±15.1)minutes and (34.7±1.8)minutes, versus (252.6±21.9)minutes and (52.6±7.4)minutes in the traditional group, respectively, showing significant differences in the above indicators between the two groups ( t=?8.97, ?15.66, P<0.05). (3) Follow-up. After propensity score matching, 90 patients were followed up postoperatively for (47±15)months. During the follow-up, no patient in either group received secondary surgery, and there was no death. There were 3 cases and 10 cases of Roux stasis syndrome in the part-cut group and the traditional group, respectively, showing a significant difference between the two groups ( χ2=4.41, P<0.05). Conclusion:Compared with traditional Roux-en-Y anastomosis, the Roux-en-Y anastomosis with part-cut jejunum in totally laparoscopic total gastrectomy can signifi-cantly shorten the time for digestive tract reconstruction and reduce the incidence of postoperative Roux stasis syndrome.

Objective To observe the impact of brain-computer interface(BCI)robot combined with task-oriented training(TOT)on hand function and activities of daily living in stroke patients.Methods A total of 40 patients with subacute stroke who were hospitalized in the Department of Rehabilitation Medicine of Anhui No.2 Province People's Hospital from December 2022 to December 2024 were prospectively and consecutively included in this study.The stroke patients were randomly assigned to the experimental group and the control group using the random number table method,with 20 cases in each group.Baseline data were collected from all patients,including gender,age,personal history(smoking,drinking),past medical history(hypertension,diabetes),stroke type(hemorrhagic stroke,ischemic stroke),hemiplegia side(left,right),disease course,stroke location(basal ganglia,internal capsule),and admission assessment indicators(including kinesthetic and visual imagery questionnaire[KVIQ-20]score,mini-mental state examination[MMSE]score and National Institutes of Health stroke scale[NIHSS]score).Both groups of patients received conventional rehabilitation training and TOT.The experimental group then underwent BCI robot training combined with TOT on this basis.Both groups received treatments for 4 weeks,and the upper limb and hand functions of all patients were evaluated using the Fugl-Meyer upper extremity function assessment scale(FMA-UE),the wrist-hand part of the FMA-UE scale(FMA-WH),the Wolf motor function test(WMFT),and the modified Ashworth scale(MAS)before and after the treatment;the hand function related part(feeding[10 score],bathing[5 score],dressing[10 score],grooming[5 score],and toilet using[10 score])of modified Barthel index(MBI)was used to assess the patients'hand dexterity to perform daily activities.Results(1)No statistically significant differences were found in the baseline data between the two groups of patients(all P＞0.05).(2)Before treatment,the scores of FMA-UE,FMA-WH,WMFT,MAS and hand function related score of MBI in the experimental group were(18.75±7.38),(2.95±1.54),(26.90±8.69),(1.10±0.66),and(15.45±1.82)respectively,while those in the control group were(15.90±5.39),(2.25±1.12),(24.15±6.78),(1.25±0.60),and(15.65±3.12)respectively.There were no statistically significant differences in the scores of FMA-UE,FMA-WH,WMFT,MAS and hand function related score of MBI between the two groups before treatment(all P＞0.05).After 4 weeks of treatment,the scores of FMA-UE,FMA-WH,WMFT,MAS and hand function related score of MBI in the experimental group were(27.10±7.76),(5.75±2.97),(40.85±10.19),(0.73±0.57),and(21.15±2.66)respectively,while those in the control group were(21.25±5.29),(4.00±1.49),(31.85±7.60),(0.73±0.64),and(17.40±3.14)respectively.The time main effects(Ftime values were 925.061,138.138,624.635 and 405.986 respectively,all P＜0.01),group main effects(Fgroup values were 4.460,4.562,5.011 and 4.411 respectively,all P＜0.05),and the interaction effects of time and group(Ftime×group values were 44.358,7.356,52.506 and 114.128 respectively,all P＜0.05)of FMA-UE,FMA-WH,WMFT and hand function related score of MBI scores were all significant.The time main effect of MAS scores was significant(Ftime value was 59.478,P＜0.01),while the group main effect(Fgroup value was 0.162,P＞0.05),the interaction effects of time and group(Ftime×group value was 1.652,P＞0.05)were not significant.Conclusion The combined task-oriented training with BCI robots can improve the upper limb and hand functions of stroke patients,enhance their ability to perform daily activities,and the effect is superior to that of single task-oriented training.

Background and purpose:Epithelial ovarian cancer(EOC)has a poor prognosis and is prone to developing resistance to platinum-based chemotherapy.Exosomes are currently believed to be involved in platinum resistance in ovarian cancer.This study explored the role and mechanism of exosomes on platinum resistance of ovarian cancer.Methods:Through ultracentrifugation,exosomes were isolated and analyzed using electron microscopy,particle size studies,and Western blot for detailed exosome analysis.We detected the expression levels of exosomal proteins and related signaling pathways.Exosomal protein expression profile was analyzed by proteomics.Key differential proteins were screened by intersecting with existing drug resistance datasets.Furthermore,patients diagnosed with EOC via pathological analysis at the Fudan University Shanghai Cancer Center from August 2023 to August 2024,who underwent surgery and fulfilled the eligibility requirements,were gathered to examine the link between the expression of interferon-stimulated gene 15(ISG15)in serum exosomes and resistance to platinum medication.The expression levels of related proteins in serum exosomes were quantitatively detected by enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve was plotted to explore the predictive value of serum exosomal protein in ovarian cancer resistance.Results:Exosomes derived from platinum-sensitive and drug-resistant ovarian cancer cells were extracted and proteomic analysis was further performed.We identified 9 differential proteins associated with platinum-resistance and found the key molecule interferon-stimulated gene 15(ISG15).Compared with sensitive cells,the expression of ISG15 in exosomes of drug-resistant ovarian cancer cells was significantly upregulated.Exosome tracer tests showed that exosomes were successfully taken up by ovarian cancer receptor cells.After coculture with drug-resistant exosomes,the expression level of ISG15 in ovarian cancer receptor cells was increased.Knockdown ISG15 in EOC cells decreased the expression of ISG15 in exosomes,and incubation of ISG15-knockdown exosomes decreased the cell viability on the condition of platinum drugs,indicating that ISG15 in exosomes regulated platinum resistance of ovarian cancer cells.Moreover,ISG15 could regulate the expression of multidrug resistance protein 1(MDR1)through phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)/nuclear factor-kappa-light-chain-enchancer of activated B cells(NF-κB)signaling pathway.This study included a total of 87 patients.Clinical serum samples also showed that the expression of ISG15 in exosomes was higher in platinum-resistant ovarian cancer patients than in sensitive ovarian cancer patients.Using serum exosomal ISG15 as an indicator to distinguish between sensitivity and resistance,the area under ROC curve was 0.779(P＜0.05),cutoffvalue was 27.35ng/mL,sensitivity was 70.2%,and specificity was 76.4%.Conclusion:ISG15 in exosomes can regulate the expression of MDR1 in ovarian cancer cells through PI3K/AKT/NF-κB signaling pathway,and promote platinum resistance in ovarian cancer cells.

Background and purpose:Epithelial ovarian cancer(EOC)has a poor prognosis and is prone to developing resistance to platinum-based chemotherapy.Exosomes are currently believed to be involved in platinum resistance in ovarian cancer.This study explored the role and mechanism of exosomes on platinum resistance of ovarian cancer.Methods:Through ultracentrifugation,exosomes were isolated and analyzed using electron microscopy,particle size studies,and Western blot for detailed exosome analysis.We detected the expression levels of exosomal proteins and related signaling pathways.Exosomal protein expression profile was analyzed by proteomics.Key differential proteins were screened by intersecting with existing drug resistance datasets.Furthermore,patients diagnosed with EOC via pathological analysis at the Fudan University Shanghai Cancer Center from August 2023 to August 2024,who underwent surgery and fulfilled the eligibility requirements,were gathered to examine the link between the expression of interferon-stimulated gene 15(ISG15)in serum exosomes and resistance to platinum medication.The expression levels of related proteins in serum exosomes were quantitatively detected by enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve was plotted to explore the predictive value of serum exosomal protein in ovarian cancer resistance.Results:Exosomes derived from platinum-sensitive and drug-resistant ovarian cancer cells were extracted and proteomic analysis was further performed.We identified 9 differential proteins associated with platinum-resistance and found the key molecule interferon-stimulated gene 15(ISG15).Compared with sensitive cells,the expression of ISG15 in exosomes of drug-resistant ovarian cancer cells was significantly upregulated.Exosome tracer tests showed that exosomes were successfully taken up by ovarian cancer receptor cells.After coculture with drug-resistant exosomes,the expression level of ISG15 in ovarian cancer receptor cells was increased.Knockdown ISG15 in EOC cells decreased the expression of ISG15 in exosomes,and incubation of ISG15-knockdown exosomes decreased the cell viability on the condition of platinum drugs,indicating that ISG15 in exosomes regulated platinum resistance of ovarian cancer cells.Moreover,ISG15 could regulate the expression of multidrug resistance protein 1(MDR1)through phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)/nuclear factor-kappa-light-chain-enchancer of activated B cells(NF-κB)signaling pathway.This study included a total of 87 patients.Clinical serum samples also showed that the expression of ISG15 in exosomes was higher in platinum-resistant ovarian cancer patients than in sensitive ovarian cancer patients.Using serum exosomal ISG15 as an indicator to distinguish between sensitivity and resistance,the area under ROC curve was 0.779(P＜0.05),cutoffvalue was 27.35ng/mL,sensitivity was 70.2%,and specificity was 76.4%.Conclusion:ISG15 in exosomes can regulate the expression of MDR1 in ovarian cancer cells through PI3K/AKT/NF-κB signaling pathway,and promote platinum resistance in ovarian cancer cells.

Objective By establishing a model to screen out patients with potentially large positional deviations based on their abdominal circumference,personalized solutions can be taken to address setup errors in these patients and ensure treatment efficacy.Methods A total of 81 patients treated at Tianjin People's Hospital from May 2021 to June 2023 were selected as the study subjects.The correlations between setup errors in the lateral,longitudinal,and vertical directions and abdominal circumference were analyzed.Subsequently,linear regression was performed for the direction with a significant correlation to abdominal circumference to establish a linear regression model.Finally,the 81 patients were divided into a normal setup group and an abnormal setup group with 0.7 cm as the critical value.A receiver operating characteristic(ROC)curve was plotted,and the maximum Youden index was calculated to determine the optimal cutoff value for identifying patients prone to abnormal setup.Results The correlation analysis of abdominal circumference and setup errors in various directions showed that the correlation coefficient between abdominal circumference and longitudinal direction positioning error was 0.406 2,and the correlation was statistically significant and positively correlated.The correlation coefficients for abdominal circumference and the lateral as well as longitudinal directions were-0.117 5 and-0.067 47,respectively,with P values greater than 0.05,indicating no statistical significance.A linear regression model was established for abdominal circumference and longitudinal direction,and the results showed an R2of 0.165,with a regression coefficient B of 0.008(t=3.951,P<0.01),indicating that the model was well constructed.ROC curve analysis showed an area under the curve of 0.715,with a 95%confidence interval of 0.57-0.86 and a maximum Youden index of 0.478.The corresponding optimal cutoff value was determined to be at 87 cm,with sensitivity at 0.875 and specificity at 0.603.Conclusion The abdominal circumference is significant to diagnose whether the longitudinal setup error is abnormal.Patients with an abdominal circumference greater than 87 cm are more likely to experience abnormal positioning during radiotherapy,which is reflected in the longitudinal setup errors being the largest.It is recommended to provide individualized target area margins for patients with an abdominal circumference greater than 87 cm,or perform daily cone-beam computed tomography to correct setup errors,thereby ensuring target coverage and treatment efficacy.

Objective:Systematically review the release status and characteristics of policies related to cross-regional medical insurance settlement policies in China,providing reference for promoting the convenience of medical insurance settlement services and improving management efficiency.Methods:Using content analysis,a two-dimensional framework of"policy objectives-policy tools"was constructed.A total of 127 policy documents were coded and analyzed.Results:Demand-based tools were applied most frequently(43.6%),followed by environmental and supply-based tools.Policy objectives mainly focused on improving service convenience,supported by expanding coverage and ensuring regulatory security.Conclusions:China's cross-regional medical insurance settlement policies have improved service accessibility and strengthened institutional supervision while gradually expanding coverage.However,deficiencies remain in assessment refinement and emergency mechanisms.Greater interdepartmental coordination is needed to enhance regulatory linkage and ensure the safe operation of medical insurance funds.

Objective:Systematically review the release status and characteristics of policies related to cross-regional medical insurance settlement policies in China,providing reference for promoting the convenience of medical insurance settlement services and improving management efficiency.Methods:Using content analysis,a two-dimensional framework of"policy objectives-policy tools"was constructed.A total of 127 policy documents were coded and analyzed.Results:Demand-based tools were applied most frequently(43.6%),followed by environmental and supply-based tools.Policy objectives mainly focused on improving service convenience,supported by expanding coverage and ensuring regulatory security.Conclusions:China's cross-regional medical insurance settlement policies have improved service accessibility and strengthened institutional supervision while gradually expanding coverage.However,deficiencies remain in assessment refinement and emergency mechanisms.Greater interdepartmental coordination is needed to enhance regulatory linkage and ensure the safe operation of medical insurance funds.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.