BackgroundLow medication compliance among patients with severe mental disorders increases the disease burden on both the patients' families and the society. Medication adherence is influenced by numerous factors. Traditional methods such as Logistic regression struggle to quantify the importance of these factors. By introducing Extreme Gradient Boosting （XGBoost） combined with Shapley Additive Explanations （SHAP）， enables the quantification of the relative contribution weights of each factor， providing support for identifying the core influencing factors. ObjectiveTo explore the influencing factors of medication adherence among patients with severe mental disorders in Zhuhai， aiming to provide references for optimizing patient management strategies. MethodsExtract the data of patients with severe mental disorders who were registered on the mental health system platform in Zhuhai City from January 1， 2023 to March 31， 2025. A total of 9 329 patients were finally included for analysis. Influencing factors were screened using univariate analysis and multivariate logistic regression analysis， and an XGBoost model combined with the SHAP algorithm was constructed to quantify the importance of each influencing factor. ResultsAmong 9 329 patients， 8 446 demonstrated medication adherence， yielding an adherence rate of 90.53%. Multivariable analysis identified several risk factors significantly associated with medication non-adherence， being unmarried （OR=1.237， 95% CI： 1.019–1.502） or divorced （OR=1.389， 95% CI： 1.038–1.832）， a diagnosis of mental retardation with psychiatric disorders （OR=3.025， 95% CI： 2.402–3.796） or paranoid psychosis （OR=5.117， 95% CI： 3.086–8.299）， a disease duration of 2–4 years （OR=1.355， 95% CI： 1.085–1.696）， 4–6 years （OR=2.143， 95% CI： 1.671–2.747）， or >6 years （OR=1.681， 95% CI： 1.365–2.079）， lack of guardian subsidies （OR=1.412， 95% CI： 1.099–1.801）， absence of a disability certificate （OR=1.900， 95% CI： 1.588–2.282）， not being enrolled in care and support groups （OR=1.384， 95% CI： 1.183–1.617） or community services （OR=1.313， 95% CI： 1.042–1.645）， and not cohabiting with a guardian （OR=1.257， 95% CI： 1.048–1.501）. Conversely， the enrollment in special outpatient disease programs （OR=0.716， 95% CI： 0.609–0.842） and a family history of mental illness （OR=0.713， 95% CI： 0.503–0.982） were identified as protective factors. The XGBoost model exhibited robust predictive performance， with a sensitivity of 0.433， specificity of 0.944， accuracy of 0.891， Area Under the Curve （AUC） of 0.837， and F1 value of 0.449. Feature importance ranking indicated that the top three factors were disease duration， diagnosis， and the acquisition of disability certificates. ConclusionPolicy-based support （acquisition of disability certificates， special outpatient disease enrollment） and clinical disease characteristics （disease duration， diagnosis type） are key factors affecting medication adherence among patients with severe mental disorders in Zhuhai City. ［Funded by Zhuhai Medical Research Project （number， 2220009000281）］

BACKGROUND:Cistanoside A has the effects of anti-inflammation,antioxidation,antioxidation,reducing renal damage and anti-osteoporosis,but its effect on osteoclast differentiation,function and its underlying molecular mechanisms remain unclear. OBJECTIVE:To investigate the effect of Cistanoside A on osteoclast differentiation and bone resorption induced by receptor activator of nuclear factor kappa-B ligand(RANKL)in vitro and its mechanism. METHODS:Bone marrow macrophages were obtained from the femur and tibia of 4-6-week-old C57BL/6 mice.The cytotoxic effect of Cistanoside A(5,10,20,40,80,and 160 μmol/L)on bone marrow macrophage viability was examined using the cell counting kit-8 assay kit.Tartrate-resistant acid phosphatase staining was performed to observe the effect of different concentrations of Cistanoside A on osteoblast differentiation and its effective intervention concentration was determined.There was positive control group,Cistanoside A low,medium,and high dose groups(40,80,and 160 μmol/L).After cell attachment,50 ng/mL RANKL was added to induce osteoblast differentiation,and the corresponding dose of Cistanoside A was added to the Cistanoside A low,medium,and high dose groups,respectively.F-actin ring and 2-(4-Amidinophenyl)-6-indolecarbamidine dihydrochloride staining were performed to detect the effects of Cistanoside A on the formation of osteoclasts.Toluidine blue staining of bone abrasion slices was used to observe the effects of Cistanoside A on bone resorption function of osteoclasts.The expression of upstream and downstream proteins of the JNK/MAPK pathway was detected by Western blot.The expression of genes related to osteoclast differentiation and bone resorption function such as tartrate-resistant acid phosphatase,DC-STAMP,Nfatc-1,Ctsk and c-Fos was detected by RT-qPCR. RESULTS AND CONCLUSION:Tartrate-resistant acid phosphatase staining,F-actin ring staining and resorption pit assay showed that Cistanoside A significantly inhibited RANKL-induced osteoclast differentiation and bone resorption in a dose-dependent manner compared with the positive control group.The results of RT-qPCR showed that compared with the positive control group,both high and low dose groups of Cistanoside A could significantly downregulate the mRNA expression of tartrate-resistant acid phosphatase,DC-STAMP,Nfatc-1,Ctsk and c-Fos in a dose-dependent manner.The results of western blot assay showed that the high dose group of Cistanoside A significantly inhibited the expression of p-JNK protein at 10,20,30 and 60 minutes of intervention;compared with the positive control group,Cistanoside A significantly inhibited the expression of Nfatc1 and c-Fos proteins in a dose-dependent manner.To conclude,Cistanoside A could inhibit the formation and bone resorption of osteoclasts by reducing the level of p-JNK protein,inhibiting the activation of MAPK pathway and the expression of key genes in osteoclasts.

Objective:To investigate the prevalence and potential classification of symptoms after total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA), and to analyze the differences in demographic characteristics and surgical data, compare the different potential subgroups, in order to provide a basis for clinical symptom management plans.Methods:This study was a multicenter cross-sectional survey. Through convenience sampling, patients with KOA undergoing TKA in the orthopaedic wards of four tertiary hospitals in Urumqi were selected as the study from November 2023 to February 2024. The study subjects were surveyed using a general information questionnaire, the Visual Analogue Scale (VAS) for pain, the Hospital Anxiety and Depression Scale (HADS), and the Pitts Burgh Sleep Quality Index (PSQI), and the degree of postoperative joint swelling and size of ecchymosis were measured. Latent class analysis was performed using Mplus 8.3 software, and Logistic regression analysis was conducted using SPSS 26.0 software to explore the influencing factors of the latent classes.Results:Totally 337 effective questionnaires were collected, and the recovery rate was 94.7% (337/356), and the age distribution ranged from 47 to 85 (65.19 ± 6.99) years old, with 90 (26.7%) males and 247 (73.3%) females. There were 92.3% (311/337) of TKA patients with postoperative symptom cluster. The symptom cluster of patients with TKA were identified as 3 classes. They were named as "high level pain-psychological disorder group"(12.5%, 39/311), "high bruises-moderate psychological disorders group"(25.4%, 79/311) and "low symptom burden group" (62.1%, 193/311). The results of the unordered multi-class logistic regression analysis showed that age 45-59 years ( OR = 2.367), body mass index 24.0-27.9 kg/m 2 ( OR = 0.207), living with children/parents ( OR = 6.473), and this being the second joint surgery ( OR = 0.040) were the factors influencing the "high level pain-psychological disorders group" (all P<0.05). The factors influencing the "high bruises-moderate psychological disorders group" were living with children/parents ( OR = 4.023), comorbid chronic diseases ( OR = 1.979, 3.842), and intraoperative blood loss ≤100 ml ( OR = 2.342) (all P<0.05). Conclusions:The postoperative symptom cluster of TKA patients have a relatively high incidence, and there is heterogeneity within the symptom cluster, so nurses need to identify at-risk patients early according to the characteristics of different categories and give interventions.

Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.

The laparoscopic vision platform developed from the prototype of candlelight reflector device to HD, 3D and 4K ultra HD, which revolutionized surgery from open surgery to minimally invasive surgery. With the continuous application in gastric cancer surgery, the importance of laparoscopy in radical gastrectomy is gradually recognized. Radical gastrectomy mainly includes lymph node dissection and digestive tract reconstruction. The reconstruction of digestive tract after radical gastrectomy for distal gastric cancer has been a hot topic of discussion and research, which is directly related to the incidence of postoperative complications, nutritional status and quality of life. This paper mainly discusses the Roux-en-Y digestive tract reconstruction of radical gastrectomy for distal gastric cancer with 4K laparoscopic.

According to the current evidence-based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer.However, the postoperative five-year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch-making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

According to the current evidence?based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer. However, the postoperative five?year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch?making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

According to the current evidence?based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer. However, the postoperative five?year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch?making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

Objective: To investigate the clinical value of endoscopic ultrasonography (EUS) and Multi-slice Spiral CT (MSCT) in the preoperativestaging of tumor(T) and lymph node (N) metastasis in patients with SiewertⅡand Ⅲ typeadenocarcinoma of esophagogastric junction(AEG). Methods: Clinical data of 145 Siewert Ⅱ and Ⅲ type AEG patientswithout preoperative chemoradiotherapy were retrospectively reviewed. Theyall received preoperative EUS and MSCT examination and underwent surgical resection, and the results of EUS and MSCT were compared with their postoperative pathologic staging. Results: The sensitivity, specificity, and accuracy of EUS for T stage in Siewert Ⅱ and Ⅲ type AEG were higher than those of MSCT. The total accuracy of EUS and MSCT were 90.3% and 63.5%, respectively, and the difference was statistically significant (χ²=29.52, P<0.01). The sensitivity of EUS for T1, T2 and T3 were 89.5%, 91.1% and 85.2%, respectively, which were significantly higher than 42.1%, 66.7% and 29.6% of MSCT (χ²=9.47, P<0.01 for T1; χ²=8.07, P<0.01 for T2; χ²=17.40, P<0.01 for T3). In addition, the total accuracy of EUS and MSCT for lymph node metastasis status of Siewert Ⅱ and Ⅲ type AEG were 75.9% and 64.8%, respectively, showing a statistically significant difference(χ²=4.23, P=0.04). The sensitivity of EUS for N1 and N2 were 82.1% and 79.2%, respectively, which were significantly higher than 53.6% and 60.4% of MSCT (χ²=5.24, P=0.02; χ²=4.48, P=0.03). There was no statistical significance for sensitivity of EUS and MSCT in N0 and N3 (P>0.05). Conclusion EUS diagnosis of T and N staging in Siewert Ⅱ/Ⅲ type AEG showed significantly greater performance than MSCT.

Objective To explore the effects of low-dose X-ray irradiation effects on ischemic flap survival and its possible mechanism.Methods From June, 2014 to December, 2014, 80 SD rats were include in the study, the rats were randomly divided into 2 groups: the experimental group A and control group B.There were 40 rats in each group.The ischemic flaps with the size of 9 cm × 3 cm were designed on the back of the rats.The pedicle of the flaps was near to the tail.A sterile biological isolating membrane was placed under the flap to block the blood supply between muscular layer and flaps.The flaps were intermittently sutured into their original position.The group A was immediately received single and local irradiation of 0.2 Gy after surgery, The group B was not treated.On days 1 to 14 after operation,general observation,HE staining and the western blot of the flaps were performed to calculate the survival vate of the flaps, observe neovascularization and determin the content of VEGF and MMP-9, respectively.Results On the third, seventh and fourteenth days, survival rates of the flaps in the experimental group [(66.46 ± 4.37)％, (44.30 ± 3.86)％, (32.20 ± 4.22)％, respectively] were higher than the control group [(43.15 ± 5.03)％, (27.71 ± 3.20)％, (16.40 ± 5.34)％, respectively] after inspection, there were statistically significant differences between these indices (P ＜ 0.01), HE staining of the flaps in the experimental group were seen in the fibroblast infiltration and neovascularization were higher than that of control group, and experimental group within the lumen of blood vessels were arranged in order, the groups were visible tissue edema obviously control, neovascularization in small numbers, the lumen was irregular.On the third and seventh days, MVD rates of the flaps in the experimental group (85.54 ± 6.12, 44.32 ± 3.56, respectively) were higher than the control group (49.35 ± 4.75,18.75 ± 2.89,respectively) after inspection, there were statistically significant differences between these indices (P ＜ 0.01).VEGF and MMP-9 protein content in the flap for the seventh day in the experimental group were significantly higher than that of the control group.Conclusion Low-dose X-ray irradiation can promote the survival rate of ischemic flap, the mechanism may be related to the expression of VEGF and MMP-9 increased and promoted angiogenesis of the flaps after low-dose X-ray irradiation.