Objective:To evaluate the effectiveness of a workshop-driven interactive teaching model in clinical alarm training for undergraduate nursing interns in the intensive care unit (ICU).Methods:A total of 120 undergraduate nursing students who interned in the ICU from November 2023 to April 2024 were enrolled and randomly assigned using a random number table into a control group ( n=60, traditional teaching) and an intervention group ( n=60, workshop-driven interactive teaching). Clinical alarm knowledge, attitudes, and practices (KAP); perception of patient safety culture; and training satisfaction were assessed before and after the training using validated questionnaires. Differences between groups were analyzed using independent sample t-test, paired sample t-test, chi-square test, and the Mann-Whitney U test with SPSS 22.0. Results:There were no significant differences between the two groups in clinical alarm KAP scores or patient safety culture perception scores before the training ( P>0.05). After the training, the intervention group showed significantly higher scores in clinical alarm KAP [(127.58±6.45) vs. (123.48±7.61), t=3.17, P=0.002] and patient safety culture perception [(99.44±9.17) vs. (95.45±12.03), t=-2.04, P=0.044] compared with the control group. Satisfaction with training content, teaching quality, and overall instructional design was significantly higher in the intervention group than in the control group ( P<0.05). Within-group comparisons showed that the intervention group had significant improvements in clinical alarm KAP [(127.58±6.45) vs. (120.10±10.25), t=-5.10, P<0.001] and patient safety culture perception [(99.44±9.17) vs. (94.46±12.12), t=-2.65, P=0.010] after training. No significant changes were observed in the control group after training ( P>0.05). Conclusions:The workshop-driven interactive teaching model can effectively enhance the clinical alarm KAP levels and patient safety culture perception among undergraduate nursing interns in the ICU. This teaching approach provides a scientific basis for optimizing clinical alarm education and cultivating high-quality nursing professionals.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.

Objective:To evaluate the effectiveness of a workshop-driven interactive teaching model in clinical alarm training for undergraduate nursing interns in the intensive care unit (ICU).Methods:A total of 120 undergraduate nursing students who interned in the ICU from November 2023 to April 2024 were enrolled and randomly assigned using a random number table into a control group ( n=60, traditional teaching) and an intervention group ( n=60, workshop-driven interactive teaching). Clinical alarm knowledge, attitudes, and practices (KAP); perception of patient safety culture; and training satisfaction were assessed before and after the training using validated questionnaires. Differences between groups were analyzed using independent sample t-test, paired sample t-test, chi-square test, and the Mann-Whitney U test with SPSS 22.0. Results:There were no significant differences between the two groups in clinical alarm KAP scores or patient safety culture perception scores before the training ( P>0.05). After the training, the intervention group showed significantly higher scores in clinical alarm KAP [(127.58±6.45) vs. (123.48±7.61), t=3.17, P=0.002] and patient safety culture perception [(99.44±9.17) vs. (95.45±12.03), t=-2.04, P=0.044] compared with the control group. Satisfaction with training content, teaching quality, and overall instructional design was significantly higher in the intervention group than in the control group ( P<0.05). Within-group comparisons showed that the intervention group had significant improvements in clinical alarm KAP [(127.58±6.45) vs. (120.10±10.25), t=-5.10, P<0.001] and patient safety culture perception [(99.44±9.17) vs. (94.46±12.12), t=-2.65, P=0.010] after training. No significant changes were observed in the control group after training ( P>0.05). Conclusions:The workshop-driven interactive teaching model can effectively enhance the clinical alarm KAP levels and patient safety culture perception among undergraduate nursing interns in the ICU. This teaching approach provides a scientific basis for optimizing clinical alarm education and cultivating high-quality nursing professionals.

Objective:To observe the efficacy of Biling Weitong Granules combined with Morodan in the treatment of elderly patients with Helicobacter pylori(Hp)-positive chronic atrophic gastritis(CAG)and its influence on inflammatory factors and gastrointestinal function.Methods:A total of 102 elderly patients with Hp-positive CAG who were admitted to our hospital from April 2023 to September 2024 were prospectively included,the syndrome differentiation type in traditional Chinese medicine is qi stagnation and blood stasis type.According to the envelope lottery method,the patients were divided into control group(n=51 cases,treated with Morodan)and study group(n=51 cases,treated with Biling Weitong Granules combined with Morodan).The clinical efficacy,Hp eradication rate,traditional Chinese medicine syndrome scores,inflammatory factors[C-reactive protein(CRP),interleukin-1 β(IL-1 β),tumor necrosis factor-α(TNF-α)]and gastrointestinal function indicators[gastrin(GAS),pepsinogen Ⅰ(PG Ⅰ)/pepsinogen Ⅱ(PG Ⅱ),gastrin 17(G-17)]and the occurrence of adverse reactions were compared between the two groups.Results:Compared with the control group 2 weeks after treatment,the total effective rate,Hp eradication rate,GAS and PG Ⅰ/PG Ⅱ levels in the study group were higher,while the main symptom score,secondary symptom score,total score,CRP,TNF-α,IL-1[3 and G-17 levels were lower(P＜0.05).There was no difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Biling Weitong Granules combined with Morodan in the treatment of elderly patients with Hp-positive CAG,can improve the clinical therapeutic effect and Hp eradication rate,inhibit the inflammatory response,and improve gastrointestinal function.

Objective:To observe the efficacy of Biling Weitong Granules combined with Morodan in the treatment of elderly patients with Helicobacter pylori(Hp)-positive chronic atrophic gastritis(CAG)and its influence on inflammatory factors and gastrointestinal function.Methods:A total of 102 elderly patients with Hp-positive CAG who were admitted to our hospital from April 2023 to September 2024 were prospectively included,the syndrome differentiation type in traditional Chinese medicine is qi stagnation and blood stasis type.According to the envelope lottery method,the patients were divided into control group(n=51 cases,treated with Morodan)and study group(n=51 cases,treated with Biling Weitong Granules combined with Morodan).The clinical efficacy,Hp eradication rate,traditional Chinese medicine syndrome scores,inflammatory factors[C-reactive protein(CRP),interleukin-1 β(IL-1 β),tumor necrosis factor-α(TNF-α)]and gastrointestinal function indicators[gastrin(GAS),pepsinogen Ⅰ(PG Ⅰ)/pepsinogen Ⅱ(PG Ⅱ),gastrin 17(G-17)]and the occurrence of adverse reactions were compared between the two groups.Results:Compared with the control group 2 weeks after treatment,the total effective rate,Hp eradication rate,GAS and PG Ⅰ/PG Ⅱ levels in the study group were higher,while the main symptom score,secondary symptom score,total score,CRP,TNF-α,IL-1[3 and G-17 levels were lower(P＜0.05).There was no difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Biling Weitong Granules combined with Morodan in the treatment of elderly patients with Hp-positive CAG,can improve the clinical therapeutic effect and Hp eradication rate,inhibit the inflammatory response,and improve gastrointestinal function.

Objective:This study aimed to evaluate the feasibility and safety of surgical intervention for patients with stage Ⅳ esophageal cancer who demonstrated tumor regression following first-line treatment.Methods:This was a descriptive case series. The inclusion criteria for surgery were as follows: (1) an initial diagnosis of stage Ⅳ esophageal cancer, i.e. cT4b or cM1; (2) the presence of residual tumor following first-line therapy deemed potentially resectable upon reassessment; and (3) sufficient organ function to tolerate surgical procedures. Clinical data were retrospectively collected for 63 patients with stage Ⅳ esophageal cancer who underwent surgery following first-line therapy at Sun Yat-sen University Cancer Center between January 2014 and December 2023. Of these patients, 12 were initially staged as IVA, and 51 as IVB. Post-treatment restaging revealed that 9 patients achieved a clinical complete response, while 3 were downstaged to stage Ⅰ, 14 to stage Ⅱ, 24 to stage Ⅲ, and 13 to stage ⅣB (with regression of distant metastatic lesions enabling curative resection). Surgical approaches included right thoracic esophagectomy ( n=55), left thoracic esophagectomy ( n=4), and transmediastinal esophagectomy ( n=4). Additionally, 7 patients required extended organ resection. Two-field lymph node dissection was performed in 49 patients, while 14 underwent three-field lymph node dissection. Postoperative management varied: 31 patients received no adjuvant therapy, 11 underwent immunochemotherapy, 8 received immunotherapy alone, 8 underwent chemotherapy, 4 received chemoradiotherapy, and 1 received combined radiotherapy and immunotherapy. The primary endpoints were overall survival (OS) and progression-free survival (PFS), with secondary endpoints including surgical outcomes and postoperative complications. Results:All 63 patients successfully underwent surgery without intraoperative mortality. R0 resection was achieved in 58 cases (92.1%), while R1 and R2 resections were performed in 1 case (1.6%) and 4 cases (6.3%), respectively. The mean operative time was 357±135 minutes. Postoperative complications were observed in 27 cases (42.9%), with 9 cases (14.3%) classified as Clavien-Dindo grade Ⅲ or Ⅴ. One patient (1.6%) died perioperatively. The median follow-up duration was 21 months (range: 4–107 months). The median OS was 64.8 months (95% CI: 50.9–78.6 months), and the median PFS was 68.0 months (95% CI: 53.9–82.3 months). Among 24 patients with supraclavicular lymph node metastases, 6 experienced recurrence and 8 died. Of 25 patients with abdominal metastases, 3 had recurrence and subsequently died. All 4 patients with lung metastases and both patients with bone metastases experienced recurrence and death.Conclusions:Surgical intervention is a feasible and safe treatment option for selected patients with stage Ⅳ esophageal cancer who demonstrate the potential for curative resection following first-line therapy.

Purpose: The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. Methods: This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. Results: Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). Conclusion Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

Purpose: The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. Methods: This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. Results: Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). Conclusion Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

Purpose: The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. Methods: This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. Results: Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). Conclusion Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.

Objective:This study aimed to evaluate the feasibility and safety of surgical intervention for patients with stage Ⅳ esophageal cancer who demonstrated tumor regression following first-line treatment.Methods:This was a descriptive case series. The inclusion criteria for surgery were as follows: (1) an initial diagnosis of stage Ⅳ esophageal cancer, i.e. cT4b or cM1; (2) the presence of residual tumor following first-line therapy deemed potentially resectable upon reassessment; and (3) sufficient organ function to tolerate surgical procedures. Clinical data were retrospectively collected for 63 patients with stage Ⅳ esophageal cancer who underwent surgery following first-line therapy at Sun Yat-sen University Cancer Center between January 2014 and December 2023. Of these patients, 12 were initially staged as IVA, and 51 as IVB. Post-treatment restaging revealed that 9 patients achieved a clinical complete response, while 3 were downstaged to stage Ⅰ, 14 to stage Ⅱ, 24 to stage Ⅲ, and 13 to stage ⅣB (with regression of distant metastatic lesions enabling curative resection). Surgical approaches included right thoracic esophagectomy ( n=55), left thoracic esophagectomy ( n=4), and transmediastinal esophagectomy ( n=4). Additionally, 7 patients required extended organ resection. Two-field lymph node dissection was performed in 49 patients, while 14 underwent three-field lymph node dissection. Postoperative management varied: 31 patients received no adjuvant therapy, 11 underwent immunochemotherapy, 8 received immunotherapy alone, 8 underwent chemotherapy, 4 received chemoradiotherapy, and 1 received combined radiotherapy and immunotherapy. The primary endpoints were overall survival (OS) and progression-free survival (PFS), with secondary endpoints including surgical outcomes and postoperative complications. Results:All 63 patients successfully underwent surgery without intraoperative mortality. R0 resection was achieved in 58 cases (92.1%), while R1 and R2 resections were performed in 1 case (1.6%) and 4 cases (6.3%), respectively. The mean operative time was 357±135 minutes. Postoperative complications were observed in 27 cases (42.9%), with 9 cases (14.3%) classified as Clavien-Dindo grade Ⅲ or Ⅴ. One patient (1.6%) died perioperatively. The median follow-up duration was 21 months (range: 4–107 months). The median OS was 64.8 months (95% CI: 50.9–78.6 months), and the median PFS was 68.0 months (95% CI: 53.9–82.3 months). Among 24 patients with supraclavicular lymph node metastases, 6 experienced recurrence and 8 died. Of 25 patients with abdominal metastases, 3 had recurrence and subsequently died. All 4 patients with lung metastases and both patients with bone metastases experienced recurrence and death.Conclusions:Surgical intervention is a feasible and safe treatment option for selected patients with stage Ⅳ esophageal cancer who demonstrate the potential for curative resection following first-line therapy.