Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI radiomics and signal intensity in hepatobiliary phase(HBP)in predicting the pathological differentiation degree of hep-atocellular carcinoma(HCC).Methods The clinical and imaging data of 224 patients pathologically confirmed with HCC were col-lected.All patients were randomly divided into test group(68 cases)and training group(156 cases)at a ratio of 7︰3.The ITK-SNAP software was used to delineate region of interest(ROI)on arterial phase(AP),portal venous phase(PVP)and HBP,the radiomics features of the tumor tissues were extracted and the radiomics models were established using the FAE software.Logistic regression analysis was used to determine the clinical independent predictors associated with the pathological differentiation degree of HCC and to construct clinical model and clinical-radiomics model.Receiver operating characteristic(ROC)curve was plotted for each model and the area under the curve(AUC)was calculated to compare the diagnostic efficacy of the models.Results Age,alpha-fetoprotein(AFP),and r-glutamyltransferase(r-GT)were independent risk factors for predicting the degree of pathological differentiation of HCC.The AUC of the clinical-radiomics model in the training group and test group were 0.825 and 0.779,respectively,which were higher than those of the radiomics model(0.812 and 0.771)and the clinical model(0.687 and 0.666).Conclusion Gd-EOB-DTPA enhanced MRI radiomics have certain value in predicting the degree of pathological differentiation of HCC,while the predictive value of the signal intensity on HBP and the signal intensity ratio(SIR)on HBP is limited.

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI radiomics and signal intensity in hepatobiliary phase(HBP)in predicting the pathological differentiation degree of hep-atocellular carcinoma(HCC).Methods The clinical and imaging data of 224 patients pathologically confirmed with HCC were col-lected.All patients were randomly divided into test group(68 cases)and training group(156 cases)at a ratio of 7︰3.The ITK-SNAP software was used to delineate region of interest(ROI)on arterial phase(AP),portal venous phase(PVP)and HBP,the radiomics features of the tumor tissues were extracted and the radiomics models were established using the FAE software.Logistic regression analysis was used to determine the clinical independent predictors associated with the pathological differentiation degree of HCC and to construct clinical model and clinical-radiomics model.Receiver operating characteristic(ROC)curve was plotted for each model and the area under the curve(AUC)was calculated to compare the diagnostic efficacy of the models.Results Age,alpha-fetoprotein(AFP),and r-glutamyltransferase(r-GT)were independent risk factors for predicting the degree of pathological differentiation of HCC.The AUC of the clinical-radiomics model in the training group and test group were 0.825 and 0.779,respectively,which were higher than those of the radiomics model(0.812 and 0.771)and the clinical model(0.687 and 0.666).Conclusion Gd-EOB-DTPA enhanced MRI radiomics have certain value in predicting the degree of pathological differentiation of HCC,while the predictive value of the signal intensity on HBP and the signal intensity ratio(SIR)on HBP is limited.

Objective:To construct an evaluation framework with detailed indices for demonstration units (wards) of enteral nutrition nursing, in order to improve the competence of nurses in enteral nutrition nursing and inform the specialized development of enteral nutrition demonstration units (wards).Method:On the basis of literature review and expert discussion, a preliminary draft was developed, and the Delphi expert consultation method was used to conduct two rounds of consultation with 15 clinical experts in the field of enteral nutrition nursing from 15 tertiary hospitals.Results:The effective response rates of questionnaires in two rounds of consultations were both 100%. The first round of expert consultation showed an authority coefficient of 0.90 and a coefficient of variation of 0 to 0.167, while the second round showed an authority coefficient of 0.93 and a coefficient of variation of 0 to 0.113. The Kendall harmony coefficients were 0.338 and 0.368, respectively. Finally, the evaluation framework with detailed indices for the demonstration unit (ward) of enteral nutrition nursing was formed, which consisted of 3 primary indicators, 16 secondary indicators, 54 tertiary indicators, and 62 detailed items.Conclusions:The evaluation framework we developed for the demonstration unit of enteral nutrition nursing follows the diagnosis and treatment process of enteral nutrition management for inpatients, including the triad of structure, process, and outcome. The framework is objective and practical, and can inform the daily practice of enteral nutrition nursing demonstration units (wards) and the development of enteral nutrition nursing specialties.

Objective:To understand the nutritional nursing competence in the enteral nutrition demonstration wards at this stage, so as to inform subsequent training plan.Methods:From September to October in 2023, nurses from 287 institutions involved in the enteral nutrition demonstration ward construction project were selected using convenience sampling. Questionnaires on general characteristics and self-assessment scale on nutrition nursing competence were used for online survey. The status quo and influencing factors of nutrition nursing competence in included institutions were analyzed.Results:A total of 5 409 valid questionnaires were collected, with a response rate of 62.63%. The total score of nutrition nursing competence was 74.74±16.11, with the least subtotals in the domain of nutrtion knowledge. Multiple linear regression showed that influencing factors of nutrition nursing competence includes years of working, department, registered dietitian or not, nutrition management specialist or not, completion of the curriculum in enteral nutrition demonstration ward construction project, and training/supervision arranged by their department concerning nutrtion nursing and relevant evaluation criteria ( P<0.05). Conclusions:The nutritional nursing competence of clinical nurses in the wards involved in enteral nutrition demonstration ward construction project still needs to be improved. Seniors should take into consideration the varying nutritional nursing competence among junior nurses and nurses from different departments, and strengthen the training on nutrition knowledge. It should be encouraged for nurses to actively participate in nutritionist training. Actions including enhancing nutrition specialist training, establishing the multidisciplinary collaborative nutrition care team and conducting regular supervision and assessment should be implemented in the future, to improve the nutritional nursing competence among nurses.

Objective     To investigate short-term outcomes of robot-assisted Heller-Dor myotomy (RAHM-Dor) for achalasia of cardia and our learning curve experience. Methods     The clinical data and recent follow-up results of 42 patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed, including 20 males and 22 females with a mean age of 40.8±18.4 years. Results    Dysphagia was the most common symptom, followed by heartburn and regurgitation. The mean operation time was 122.8±23.9 min. The mean blood loss was 47.5±32.7 mL. Two patients suffered mucosal injury, and successfully repaired by suturing during surgery. There was no esophageal fistula, conversion to an open operation or perioperative death in this series. The median length of hospital stay was 8 (6, 9) d. In all patients, the Stooler and Eckardt scores of postoperative 1, 6 and 12 months decreased compared to those of pre-operation (P<0.001). Conclusion     RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia, and can achieve a satisfying short-term results. The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.

Objective:To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion (PLIF) in the treatment of double segmental lumbar degenerative diseases.Methods:The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed, including 29 males and 22 females, aged 65.5±5.6 years (range 58-73 years). Preoperative intervertebral space degeneration grade by University of California at Los Angeles (UCLA) and Pfirrmann intervertebral disc degeneration grade were recorded. 23 cases of primary responsible segments were treated with decompression, fixation and fusion, and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation (combined group); 28 cases of double segments were treated with decompression, fixation and fusion (fusion group). Disc height index (DHI) and intervertebral foramina height (IFH) of the semi-rigid fixation segments, DHI and IFH of the upper adjacent intervertebral space, and horizontal displacement of the upper adjacent vertebral body (HD) were measured on lateral X-ray films of lumbar spine; In the fusion group, DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured. The efficacy was evaluated by short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry disability index (ODI).Results:51 cases were followed up for 5.4±0.3 years (range 5.2-6.3 years). The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation. SF-MPQ and ODI at 3 months, 1 year, 5 years after operation were significantly different from those before operation ( P<0.05). In the combined group, the DHI of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 37.8%±7.6%, 37.9%±7.4%, 36.5%±6.9% and 36.0%±7.1% respectively ( P>0.05); The IFH of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 21.5±2.8, 21.4±2.8, 20.4±2.7, 19.4±2.4 mm respectively ( P<0.05); The DHI of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 37.1%±9.3%, 36.8%±9.1%, 35.2%±9.1%, 33.9%±8.8% respectively ( P>0.05); The IFH of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 21.9±3.0, 21.4±3.0, 20.4±2.9, 19.5±2.7 mm, respectively ( P<0.05). The HD of upper vertebral body adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 2.2±0.7, 2.3±0.5, 2.5±0.5, 2.8±0.5 mm respectively ( P<0.05). At the last follow-up, one case of semi-rigid titanium rod fracture, one case of screw loosening at semi-rigid internal fixation segment, three cases with unsatisfied numbness relief, and 2 cases of facet joint spontaneous fusion at semi-rigid fixation segment occurred in the combined group. Conclusion:Waveflex semi-rigid internal fixation can protect the degenerative lumbar intervertebral disc, and delay the degeneration of semi-rigid internal fixation segment and adjacent upper segment after interbody fusion, but long-term follow-up and study are needed.

Objective:To explore the development status and research hotspots of international mobile medical application, so as to provide references for domestic research on mobile medical applications.Methods:We systematically searched English documents included in the Web of Science core database from 2009 to 2019, and the document type was the article. CiteSpace (V.5.6.R2 version) software was used to visually analyze research institutions, source journals, cited documents and keywords of international mobile medical applications.Results:A total of 4 705 documents were included. Research on international mobile medical applications continued to increase. The institution and journal with the most publications were the University of Washington and JMIR Mhealth and Uhealth respectively. Through the keyword co-occurrence clustering of related literature, four research hotspots were obtained: the feasibility study of mobile medical applications, the intervention research of mobile medical applications, disease management and self-care, and the evaluation of mobile medical applications. Conclusions:In order to promote the development of mobile medical application in China, it is recommended that future researchers should pay attention to the research result of international authoritative institutions and journals in a timely manner, learn from the knowledge base of international mobile medical application research, and explore the road of application development in line with my country's national conditions.At the same time, it is necessary to standardize the design of research programs, carry out high-quality intervention research, and build my country's mobile medical application evaluation system as soon as possible.

This study summarizes the clinical achievement in key technologies of cancer supportive care. 1) Conceptual change. Medical teams now recognize supportive care as the core of comprehensive treatments for cancer. Supportive care is widely implemented clinically. 2) Team composition and operation mode. The program shapes an ideal supportive care team. The ideal team shall operate as one of the three models: solo practice model, congress practice model, or integrated care model according to the actual situation. 3) Scope of work. Supportive care team provides patients with spiritual care, pharmacologic assist, exercise guidance, nutritional support, effective communication, emotional support, and rehabilitation consultation. Efforts have been made to set up demonstrative wards that are free of pain, bleeding, thrombosis, hunger, and depression nationwide. 4) Standardized pain management for cancer patients. To optimize pain management, a multidisciplinary team is formed, an outpatient follow-up system is set up, and the focus is put on cancer pain education and policy advocacy. 5) A system of nutritional diagnosis and treatment. It urges the bi-diagnosis of cancer and malnutrition for inpatients and leads the proposal of the three-level diagnosis and five-ladder therapy for malnutrition. 6) Extension and expansion of supportive care out of the hospital. The program proposes the hospital-community-home management model, an integrated model for comprehensive nutritional therapy. 7) Emphasis on the quality of life. A new quality of life assessment method for cancer patients and a survival prediction model for end-stage cancer patients are established. 8) Comprehensive nursing care. It integrates spiritual care into the care of cancer patients. A management platform for continuous care service is developed with the help of internet technology and virtual reality.