Objective:To investigate the risk factors of intrahepatic cholangiocarcinoma (ICC) with peripheral nerve infiltration (PNI) and the effect of PNI on prognosis.Methods:The clinicopathological and survival data of 153 patients with ICC who underwent radical resection at the Department of Hepatopancreatobiliary Surgery, the Affiliated Lihuili Hospital of Ningbo University from Jan 2012 to Feb 2024 were retrospectively analyzed.Results:There were 144 patients enrolled, including 67 patients in the PNI positive group; 77 patients in the PNI negative group. Multivariate Logistic analysis showed that vascular tumor thrombus and intrahepatic bile duct stones were independent risk factors for ICC with PNI (all P<0.05). The overall recurrence rate of PNI positive patients (71.64 %) was significantly higher than that of PNI negative patients (49.35 %), with statistically significant differences between the two groups ( P<0.05). The median recurrence-free survival time of PNI positive patients was 12 months compared to 32 months in PNI negative patients, with statistically significant differences between the two groups ( P<0.05). The median survival time of PNI positive patients was 15 months vs. 42 months in PNI negative patients with statistically significant differences between the two groups ( P<0.001). Conclusion:Vascular tumor thrombus and intrahepatic bile duct stones are independent risk factors for ICC with PNI, and ICC patients with negative PNI have a less gloomy prognosis.

BACKGROUND: Alpha-glucosidase inhibitors or dipeptidyl peptidase-4 inhibitors are both hypoglycemia agents that specifically impact on postprandial hyperglycemia. We compared the effects of acarbose and sitagliptin add on to metformin on time in range (TIR) and glycemic variability (GV) in Chinese patients with type 2 diabetes mellitus through continuous glucose monitoring (CGM). METHODS: This study was a randomized, open-label, active-con-trolled, parallel-group trial conducted at 15 centers in China from January 2020 to August 2022. We recruited patients with type 2 diabetes aged 18-65 years with body mass index (BMI) within 19-40 kg/m 2 and hemoglobin A1c (HbA1c) between 6.5% and 9.0%. Eligible patients were randomized to receive either metformin combined with acarbose 100 mg three times daily or metformin combined with sitagliptin 100 mg once daily for 28 days. After the first 14-day treatment period, patients wore CGM and entered another 14-day treatment period. The primary outcome was the level of TIR after treatment between groups. We also performed time series decomposition, dimensionality reduction, and clustering using the CGM data. RESULTS: A total of 701 participants received either acarbose or sitagliptin treatment in combination with metformin. There was no statistically significant difference in TIR between the two groups. Time below range (TBR) and coefficient of variation (CV) levels in acarbose users were significantly lower than those in sitagliptin users. Median (25th percentile, 75th percentile) of TBR below target level <3.9 mmol/L (TBR 3.9 ): Acarbose: 0.45% (0, 2.13%) vs . Sitagliptin: 0.78% (0, 3.12%), P = 0.042; Median (25th percentile, 75th percentile) of TBR below target level <3.0 mmol/L (TBR 3.0 ): Acarbose: 0 (0, 0.22%) vs . Sitagliptin: 0 (0, 0.63%), P = 0.033; CV: Acarbose: 22.44 ± 5.08% vs . Sitagliptin: 23.96 ± 5.19%, P <0.001. By using time series analysis and clustering, we distinguished three groups of patients with representative metabolism characteristics, especially in GV (group with small wave, moderate wave and big wave). No significant difference was found in the complexity of glucose time series index (CGI) between acarbose users and sitagliptin users. By using time series analysis and clustering, we distinguished three groups of patients with representative metabolism characteristics, especially in GV. CONCLUSIONS: Acarbose had slight advantages over sitagliptin in improving GV and reducing the risk of hypoglycemia. Time series analysis of CGM data may predict GV and the risk of hypoglycemia. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000039424.
Humans ; Metformin/therapeutic use* ; Sitagliptin Phosphate/therapeutic use* ; Acarbose/therapeutic use* ; Diabetes Mellitus, Type 2/blood* ; Middle Aged ; Male ; Female ; Adult ; Blood Glucose/drug effects* ; Hypoglycemic Agents/therapeutic use* ; Aged ; Glycated Hemoglobin/metabolism* ; Adolescent ; Young Adult ; China ; East Asian People

Objective:To investigate the risk factors of intrahepatic cholangiocarcinoma (ICC) with peripheral nerve infiltration (PNI) and the effect of PNI on prognosis.Methods:The clinicopathological and survival data of 153 patients with ICC who underwent radical resection at the Department of Hepatopancreatobiliary Surgery, the Affiliated Lihuili Hospital of Ningbo University from Jan 2012 to Feb 2024 were retrospectively analyzed.Results:There were 144 patients enrolled, including 67 patients in the PNI positive group; 77 patients in the PNI negative group. Multivariate Logistic analysis showed that vascular tumor thrombus and intrahepatic bile duct stones were independent risk factors for ICC with PNI (all P<0.05). The overall recurrence rate of PNI positive patients (71.64 %) was significantly higher than that of PNI negative patients (49.35 %), with statistically significant differences between the two groups ( P<0.05). The median recurrence-free survival time of PNI positive patients was 12 months compared to 32 months in PNI negative patients, with statistically significant differences between the two groups ( P<0.05). The median survival time of PNI positive patients was 15 months vs. 42 months in PNI negative patients with statistically significant differences between the two groups ( P<0.001). Conclusion:Vascular tumor thrombus and intrahepatic bile duct stones are independent risk factors for ICC with PNI, and ICC patients with negative PNI have a less gloomy prognosis.

Objective:To investigate the medical narrative competence of pediatric staff, and analyze its influencing factors and correlation with psychological resilience, and to discuss strategies to improve narrative competence.Methods:From January 11 to February 25, 2022, by convenience sampling, we sampled pediatric personnel and those on refresher training at Children's Hospital, Zhejiang University School of Medicine for a questionnaire survey involving general information, the narrative competence scale, and the 14-item resilience scale. With the use of SPSS 26.0, the narrative competence of different populations was compared, and factors affecting narrative competence were determined through Pearson correlation analysis and multiple regression analysis.Results:A total of 361 valid questionnaires were included in this study, and there was significant differences in the narrative competence score between different ages, professional titles, working years, income levels, and whether they wrote parallel charts ( P<0.05). The total score of narrative competence of pediatric staffs was (147.13±18.76), and positively correlated with the total resilience score and the score of each dimension ( P≤0.001). The regression analysis showed that writing parallel charts and resilience could explain 53.10% of the variation in narrative competence ( P<0.001). Conclusions:Pediatric staff's narrative competence is at low or intermediate levels. Parallel chart writing and resilience training can improve narrative competence and promote a harmonious doctor-patient relationship.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective:To explore the effect of nursing based on chronic disease trajectory model in patients with gynecological malignant tumors.Methods:From April 2020 to March 2021, 90 patients with gynecological malignant tumors admitted to the Department of Gynecology of Ningbo Medical Center Lihuili Hospital were selected as the research object by convenience sampling method. According to the random number table, the patients were randomly divided into the control group and the intervention group, 45 cases in each group. The control group was given routine nursing, and the intervention group received nursing based on the chronic disease trajectory model on the basis of routine nursing. The effect of the intervention was compared by using the Disease Knowledge Questionnaire for Patients with Gynecologic Malignant Tumors, the Cancer Patients Self-management Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) .Results:After the intervention, the scores of Disease Knowledge Questionnaire for Patients with Gynecologic Malignant Tumors and the Cancer Patients Self-management Scale of the patients in the intervention group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . After the intervention, the scores of physical function, emotional function, cognitive function and general health of EORTC QLQ-C30 in the intervention group were all higher than those in the control group, and the scores of fatigue, shortness of breath, insomnia, and loss of appetite were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Nursing based on chronic disease trajectory model is beneficial to improve disease cognition, self-management ability and quality of life in patients with gynecological malignant tumors.

Objective To evaluate the value of serum uric acid(UA)levels with reference to the age,waist circumference,and body mass index(BMI)in predicting the metabolic syndrome(MS)in obese children.Methods A total of 300 obese children,including 180 boys and 120 girls,were enrolled in this study.The height,BMI,waist and hip circumference,blood pressure,serum glucose,insulin and lipid profile in all participants were measured.Oral glucose tolerance test and insulin releasing test were performed.The boys or girls were divided into 4 groups according to the 4 quantile of UA level,respectively.The clinical characteristics and correlation of UA with the clinical indexes and MS components were compared.The binary Logistic regression analysis was applied in the risk of MS and its components for the 4 groups of obese children.The area under the receiver operating characteristic curve(ROC curve)of UA level,age,waist circumference and BMI were used to predict the MS.Results UA level was increased with the increase of age,waist circumference and BMI,and the UA level was significantly correlated with triacylglycerol,postprandial 2 h glucose(2 h PG)(r=0.196,0.174 in boys;r=0.291,0.179 in girls).In boys,the adjusted odds ratio and 95％CI of the highest quartile of UA for triglyceridemia was 2.71(95％CI:0.77-9.58);which in girls,the adjusted odds ratio and 95％CI of the highest quartile of UA for hyperglycemia,hypertension were 8.45(95％CI:1.76-40.52)and 3.93(95％CI:0.66-23.33),respectively,with significant differences.In boys,the area under the ROC curve of UA level,age,waist circumference and BMI which predict the MS were 0.652 0.626,0.621,0.62,respectively,and the differences were significant(all P<0.05).Conclusions The UA level is significantly correlated with the composition of MS,UA detection combining with reference to the age,waist circumference,and BMI is helpful for the identification of high risk groups of metabolic syndrome.

OBJECTIVETo early assess the impaired renal function in the obese children with non-alcoholic fatty liver disease (NAFLD) and to identify the relationship between NAFLD and impairment of renal function.

METHODSThree hundred and eighty-six obese children were enrolled and divided into NAFLD group and simple obesity group (control) according to the diagnostic criteria. Clinical biochemical parameters and early impaired renal functions were evaluated and compared. Among all patients 234 obese children aged over 10 y were subdivided into 3 groups: NAFLD combined with metabolic syndrome (NAFLD+MS) group, NAFLD group and simple obesity group (control), and the above indexes were compared among 3 groups.

RESULTSThe urinary microalbumin levels in NAFLD, NAFLD+MS (>10y) and NAFLD groups (>10y) were significantly higher than those in controls. Additionally, the positive correlations of urinary microalbumin with systolic pressure, triglyceride and 2h-postprandial blood glucose were found.

CONCLUSIONThere is early renal dysfunction in children with NAFLD and those accompanied with MS, which may be associated with hypertension and glucose-lipid metabolic disorder. The results indicate that NAFLD is not only an early sign of early impaired renal function but also an early stage of chronic kidney disease (CKD) in obese children.

Adolescent ; Albuminuria ; diagnosis ; Child ; Child, Preschool ; Fatty Liver ; complications ; physiopathology ; Female ; Humans ; Kidney ; physiopathology ; Male ; Non-alcoholic Fatty Liver Disease ; Obesity ; complications ; physiopathology

In the traditional identification of pathological voice, linear analysis techniques are usually used to analyze the characteristics of voice, and the linear classical model is often considered to be approximate to of the real voice production process. However, this must have ignored the nonlinear characteristics of voice in the actual generation process. In the paper, based on the nonlinear dynamics analysis method, the pathological voice is analyzed quantitatively and 7-dimensional nonlinear features, Hurst parameter, time delay, the second-order Rényi entropy, Shannon entropy, correlation dimension, Kolmogorov entropy and the largest Lyapunov e exponent are extracted. The experimental results showed that the method of nonlinear dynamics could compensate the deficiencies of the traditional methods, and could analyze normal and pathological voice well. Gaussian mixture model (GMM) and support vector machine (SVM) methods for pattern recognition were used to discriminate the test set including 39 cases of normal and 36 cases of pathological voice, and a better recognition rate is received, 97.22% and 97.30% for each of the mentioned normal and pathological cases, respectively.
Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Nonlinear Dynamics ; Normal Distribution ; Pattern Recognition, Automated ; Support Vector Machine ; Voice Disorders ; diagnosis ; Young Adult

OBJECTIVE: To test the expression of NF-kappaB/p65, MMP-3 and MMP-9 in nasopharyngeal carcinoma (NPC), and analyze their relationship and the clinical significance. METHOD: All samples were examined for the expression of NF-kappaB/p65, MMP-3 and MMP-9 by streptavidin-peroxidase immunohistochemistry. Chi2-test and Spearman-test were used to exam the correlation within them and the expression difference between nasopharyngeal carcinoma and normal nasopharyngeal mucosa. RESULT: Positive expression rate of NF-kappaB/p65 in nasopharyngeal carcinoma was 78.0%; positive expressions rate of MMP-3 and MMP-9 in nasopharyngeal carcinoma were 75.6%. There was positive relationship between NF-kappaB/p65, MMP-3, MMP-9 and N stage. The expression of NF-kappaB/p65 showed a significant positive correlation with the expression of MMP-3 and MMP-9. MMP-3 also had a significant positive correlation with MMP-9. CONCLUSION The result suggests that NF-kappaB/p65, MMP-3 and MMP-9 are highly expressed in nasopharyngeal carcinoma cells. Their expression is correlated with lymph nodes metastasis, but do not have relationship with sex, age, pathological classification and clinical stage. Each of them has positive correlation with the others.
Adult ; Aged ; Female ; Humans ; Male ; Matrix Metalloproteinase 3 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Middle Aged ; NF-kappa B ; metabolism ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Transcription Factor RelA ; metabolism