Ketosis is an energy metabolism disorder occurring frequently in periparturient dairy cows,primarily attributed to elevated non-esterified fatty acid(NEFA)levels resulting from nega-tive energy balance(NEB).Excessive NEFA will be incompletely oxidated into large amounts of ketone bodies or be re-esterified and deposit in the liver as a consequence of hepatic limited oxida-tive capacity,ultimately leading to ketosis and fatty liver.Hypoxic microenvironments are com-monly found during the progression of various liver diseases.Hypoxia inducible factor-2 alpha(HIF-2 alpha)has been identified as a crucial regulator of lipid metabolism.However,it is still un-clear the association between HIF-2α and disrupted lipid metabolism in the livers of in ketotic cows.This study aims to investigate the effect of high concentrations of NEFA on HIF-2α expres-sion and cellular oxygen homeostasis through bovine liver tissue and primary hepatocytes.In vivo,hepatic triglyceride(TAG)content was assessed to determine the extent of hepatic lipid accumula-tion,and HIF-2α protein and mRNA levels were analyzed by immunohistochemistry staining,Western blot and qRT-PCR assay in liver tissue samples from dairy cows;in vitro,bovine primary hepatocytes were treated with different concentrations of NEFA.Oil Red O staining and TAG con-tent assay were performed to determine hepatocellular steatosis extent,and immunofluorescence staining.Western blot,and qRT-PCR were performed to analyze HIF-2α expression,in addition,lu-minescent oxygen sensor[Ru(dpp)3]Cl2 was added to indicate intracellular oxygen levels.These results showed a significant increase in TAG content and elevated HIF-2α expression in the liver tissue of ketotic cows,and high concentrations of NEFA induced lipid accumulation,upregulation of HIF-2α expression,and intracellular hypoxia in bovine primary hepatocytes.These findings sug-gested that HIF-2α was significantly"activated"in the liver of ketotic cows and high concentration of NEFA-induced bovine primary hepatocytes,and that high concentrations of NEFA induced in-tracellular hypoxia in vitro.This study provides a potential molecular target for further investiga-tion of the mechanism underlying hepatic lipid metabolism disorders in ketotic cows.

Objective:To explore the clinical significance of complementary systematic lymphadenectomy (SLND) for advanced endometrial cancer (EC) with positive sentinel lymph node biopsy (SLNB) results and the risk factors influencing the prognosis of this group of individuals.Methods:A retrospective case-controlled study was conducted. The clinical data of EC patients diagnosed by histopathologic examination between January 2000 and December 2018 in National Cancer Institute the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. SLNB-positive EC patients were screened and were classified into the SLNB group and the SLNB+SLND group according to the lymph node surgical approach. χ2 test was used for the comparison of clinicopathological characteristics between the 2 groups, the Kaplan-Meier method was used for plotting the survival curves, and the Cox proportional hazards model was used for univariate and multivariate analyses on the factors influencing patients' overall survival (OS). Results:A total of 222 patients were included, including 86 cases in the SLNB group and 136 cases in the SLNB+SLND group, and there were no statistically significant differences in the comparison of clinicopathologic characteristics between the 2 groups (all P > 0.05). The 1-, 3-year OS rates were 94.0%, 80.5%, respectively in the SLNB group; the 1-, 3-year OS rates were 91.8%, 75.7%, respectively in the SLNB+SLND group, and the difference in the OS was not statistically significant ( χ2 = 0.05, P = 0.818). Multivariate Cox regression analysis showed that age ≥ 71 years ( HR = 2.35, 95% CI: 1.27-4.35, P = 0.007), histologic grade Ⅲ ( HR = 3.80, 95% CI: 1.22-11.83, P = 0.021), and not receiving radiotherapy ( HR = 2.08, 95% CI: 1.17-3.70, P = 0.013) were independent risk factors for OS in SLNB-positive EC patients. Conclusions:Age, histologic grade and radiotherapy are independent influencing factors of OS in advanced EC patients with positive SLNB. The further SLND does not provide an additional survival benefit for patients.

Objective:To explore the construction requirements and solutions for a digital full-process management platform for Investigator-Initiated Trials (IIT) in pediatrics in China.Methods:By reviewing literature, the current status and highlights of pediatric IIT digital management systems in Europe and the United States were analyzed. The challenges faced in building a digital full-process management platform for pediatric IIT in China were summarized. The exploration and implementation achievements of our hospital in platform construction were introduced, and future construction priorities were proposed based on practical considerations.Results:The construction and application of digital full-process management platforms for pediatric IIT in Europe and the United States were relatively mature, providing comprehensive digital support for pediatric IIT research, ranging from project management to research design implementation, multi-center data interoperability, and personnel training. In China, the pediatric IIT digital management platform was still under construction, with main challenges including the formulation of construction plans based on hospital-specific conditions, data standardization, and remote recruitment and follow-up platforms.Conclusions:Considering the current status of pediatric IIT digital full-process management systems both domestically and internationally, efforts should be made to further strengthen data standardization, remote subject management, and digital pediatric IIT training from both policy and technical perspectives. This will provide one-stop services and management for projects and researchers, promoting the development of pediatric medical research.

Objective:To construct dynamic cycle management mode of medical equipment,so as to analyze the influence of that on management effect of medical equipment in the department of neurosurgery,and improve the management effect of neurosurgery equipment.Method:Based on the full-process monitoring,full participation and all-round management of the dynamic cycle management mode,the full life cycle management was implemented on medical instruments and equipment.A total of 1,269 used medical equipment in the department of neurosurgery of the Second Affiliated Hospital of Air Force Medical University from January 2022 to December 2023 were selected.During the period from January 2022 to December 2022,the conventional management mode was adopted to manage these equipment.From January and December 2023,the dynamic cycle management mode was adopted to manage them.The management effects of equipment failure and the incidence of risk events of the two management modes were compared.A self-made satisfaction questionnaire was used to investigate the satisfaction scores of medical staffs,who used the equipment,for maintaining and using the equipment.Results:The time of average internal reporting for repair,the time of external reporting for repair,the time of diagnosing fault,total time of reporting repair and total maintenance time in dynamic cycle management mode were respectively(3.15±1.04)min,(19.34±2.81)min,(22.66±3.73)min,(10.04±1.11)min and(5.38±1.92)d,which were significantly lower than those in conventional management mode(t=15.878,21.553,18.755,20.486,7.636,P<0.05).The incidence of risk events of equipment in dynamic cycle management mode was significantly lower than that in conventional management group(x2=8.635,P<0.05).The satisfaction scores of medical staffs who used equipment in dynamic cycle management mode were significantly higher than those in conventional management mode in the timeliness of reporting repair,the speed of diagnosis and maintenance,the used effect after maintenance for failure of equipment,and the differences were significant(t=7.364,7.381,5.413,P<0.05).Conclusion:The application of dynamic cycle management mode for medical equipment in the management for instrument and equipment of the department of neurosurgery in hospital can improve management effect for equipment,and reduce incidence of risk events of equipment,and enhance the satisfaction of staffs who use equipment.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Non-alcoholic fatty liver disease(NAFLD)is a chronic liver disease caused by excessive lipid accumulation in the liver.Its incidence rate is increasing year by year and has become an increasingly serious public healthy problem.The pathogenesis of NAFLD is complex and has not been fully clarified at present.It is mainly related to multiple factors such as genetics,metabolism,intestinal flora and immune response.In order to explore the medication rules and mechanism of action of traditional Chinese medicine(TCM)in the treatment of NAFLD,and to provide references for the treatment of NAFLD with TCM and the research and development of new drugs,this article summarizes the TCM pathogenesis of NAFLD(such as"phlegm and blood stasis interlacing","liver depression and spleen deficiency",etc.)and modern etiology and pathogenesis(such as insulin resistance,lipid disorder,mitochondrial dysfunction,oxidative stress,etc.).The clinical research and experimental data at home and abroad in recent years were integrated to analyze the pathological process of NAFLD intervention by TCM through multiple targets,including improving insulin resistance and lipid metabolism disorders,inhibiting oxidative stress and mitochondrial dysfunction,etc.TCM has shown unique advantages in the prevention and treatment of NAFLD.However,the depth of its mechanism analysis and the level of clinical research still need to be improved.In the future,it is necessary to deepen the mechanism research by combining multi-omics technology to accelerate the modernization development of TCM.

Non-alcoholic fatty liver disease(NAFLD)is a chronic liver disease caused by excessive lipid accumulation in the liver.Its incidence rate is increasing year by year and has become an increasingly serious public healthy problem.The pathogenesis of NAFLD is complex and has not been fully clarified at present.It is mainly related to multiple factors such as genetics,metabolism,intestinal flora and immune response.In order to explore the medication rules and mechanism of action of traditional Chinese medicine(TCM)in the treatment of NAFLD,and to provide references for the treatment of NAFLD with TCM and the research and development of new drugs,this article summarizes the TCM pathogenesis of NAFLD(such as"phlegm and blood stasis interlacing","liver depression and spleen deficiency",etc.)and modern etiology and pathogenesis(such as insulin resistance,lipid disorder,mitochondrial dysfunction,oxidative stress,etc.).The clinical research and experimental data at home and abroad in recent years were integrated to analyze the pathological process of NAFLD intervention by TCM through multiple targets,including improving insulin resistance and lipid metabolism disorders,inhibiting oxidative stress and mitochondrial dysfunction,etc.TCM has shown unique advantages in the prevention and treatment of NAFLD.However,the depth of its mechanism analysis and the level of clinical research still need to be improved.In the future,it is necessary to deepen the mechanism research by combining multi-omics technology to accelerate the modernization development of TCM.

Objective:To explore the need for parental involvement in treatment decision-making for children with type 1 diabetes mellitus, so as to provide basis for medical and nursing staff to formulate targeted intervention strategies.Methods:This was a qualitative study. From April to May 2024, 15 parents of children with type 1 diabetes mellitus admitted to the Department of Endocrine Genetics and Metabolism at Children's Hospital of Soochow University were selected as research subjects for face-to-face semi-structured interviews. Inductive content analysis was used for data analysis.Results:Among the 15 children patients, there were 4 males and 11 females, with an age of (37.61±5.93) years old. Four themes were extracted, including the need for decision-making involvement and expression, the need for diversity decision-making information, the need for multi-channel decision-making communication and the need for diversified decision-making support.Conclusions:Medical and nursing staff should pay attention to decision-making needs of the parents of children with type 1 diabetes when they participate in treatment decision-making, and improve their parents' decision-making self-efficacy and promote their decision-making involvement by adopting diversified decision-making aids and effective decision-making communication.

Ketosis is an energy metabolism disorder occurring frequently in periparturient dairy cows,primarily attributed to elevated non-esterified fatty acid(NEFA)levels resulting from nega-tive energy balance(NEB).Excessive NEFA will be incompletely oxidated into large amounts of ketone bodies or be re-esterified and deposit in the liver as a consequence of hepatic limited oxida-tive capacity,ultimately leading to ketosis and fatty liver.Hypoxic microenvironments are com-monly found during the progression of various liver diseases.Hypoxia inducible factor-2 alpha(HIF-2 alpha)has been identified as a crucial regulator of lipid metabolism.However,it is still un-clear the association between HIF-2α and disrupted lipid metabolism in the livers of in ketotic cows.This study aims to investigate the effect of high concentrations of NEFA on HIF-2α expres-sion and cellular oxygen homeostasis through bovine liver tissue and primary hepatocytes.In vivo,hepatic triglyceride(TAG)content was assessed to determine the extent of hepatic lipid accumula-tion,and HIF-2α protein and mRNA levels were analyzed by immunohistochemistry staining,Western blot and qRT-PCR assay in liver tissue samples from dairy cows;in vitro,bovine primary hepatocytes were treated with different concentrations of NEFA.Oil Red O staining and TAG con-tent assay were performed to determine hepatocellular steatosis extent,and immunofluorescence staining.Western blot,and qRT-PCR were performed to analyze HIF-2α expression,in addition,lu-minescent oxygen sensor[Ru(dpp)3]Cl2 was added to indicate intracellular oxygen levels.These results showed a significant increase in TAG content and elevated HIF-2α expression in the liver tissue of ketotic cows,and high concentrations of NEFA induced lipid accumulation,upregulation of HIF-2α expression,and intracellular hypoxia in bovine primary hepatocytes.These findings sug-gested that HIF-2α was significantly"activated"in the liver of ketotic cows and high concentration of NEFA-induced bovine primary hepatocytes,and that high concentrations of NEFA induced in-tracellular hypoxia in vitro.This study provides a potential molecular target for further investiga-tion of the mechanism underlying hepatic lipid metabolism disorders in ketotic cows.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.