Ten-eleven translocation 2 （TET2）， as a core enzyme in epigenetic regulation， dynamically regulates the differentiation and function of CD4⁺ T cells by mediating DNA demethylation. Recent studies have shown that TET2 deficiency can promote the progression of autoimmune hepatitis （AIH） by disrupting the Th17/Treg balance and activating inflammatory signals along the gut-liver axis. This article systematically reviews the bridging role of TET2 between CD4⁺ T cells and gut microbiota， explores the molecular mechanisms by which it drives AIH through the gut microbiota-epigenetics-immunity network， and discusses the potential intervention strategies targeting the TET2-microbiota axis.

Objective To investigate the application value of bedside ultrasound monitoring of quadriceps muscle changes in mechanically ventilated children in the early treatment of ICU-acquired muscle weakness (ICU-AW). Methods Eighty-two pediatric ICU patients with mechanical ventilation for>48 hours were selected. On the day of admission (D₀) and on day 7 (D₇), bedside ultrasound was performed to measure the thickness and cross-sectional area of the rectus femoris and vastus intermedius muscles. Patients were classified using Medical Research Council scores into control group (n = 63) and muscle weakness group (n = 19). Muscle parameters and atrophy rates were compared between groups. Diagnostic performance was assessed using receiver operating characteristic curves. Results The incidence of ICU-AW was 23.17%. At both D₀ and D₇, the average thickness of the rectus femoris, the average thickness of the vastus intermedius, the average area of the rectus femoris, and the average area of the vastus intermedius were significantly different between the two groups (P<0.05). The atrophy rates of the thickness of the rectus femoris and the area of the vastus intermedius were lower in the control group than in the muscle weakness group at both D₀ and D₇ (P<0.05). The area under the receiver operating characteristic curve for quadriceps parameters in diagnosing ICU-AW was 0.871, with a sensitivity of 89.47% and a specificity of 79.37%. Conclusion Bedside ultrasound dynamic monitoring of quadriceps changes enables early identification of ICU-AW and provides a basis for clinical intervention.

OBJECTIVE To establish a scientific， systematic， multi-dimensional performance management system for pharmacy practice， so as to improve the efficiency and quality of pharmacy practice performance management in public hospitals. METHODS Based on the four dimensions of the balanced scorecard theory， finance， customer， internal process， learning and growth， reference indicators for pharmacy practice performance management were summarized. The Delphi method was used to screen indicators， and the analytic hierarchy process was applied to determine the weights of indicators. A pharmacy practice performance management system was then constructed. Based on this system， action plans were formulated and implemented. The effectiveness was evaluated from two aspects： customer reviews and changes in pharmacy practice outcomes. RESULTS A total of 28 reference indicators were summarized， and a performance management system for pharmacy practice was constructed， consisting of 4 primary indicators， 9 secondary indicators， and 20 tertiary indicators. Compared with action plans implementation before， the satisfaction of clinical departments was significantly improved， and 11 pharmacy practice performance management indicators were optimized after implementation. CONCLUSIONS A scientific and systematic performance management system for pharmacy practice has been successfully established， which can provide a reference for the innovation of hospital pharmacy practice management and the high quality development of pharmacy practice.

Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

Objective To observe the effects of electroacupuncture on IL-4/STAT6/SPDEF pathway-related protein expressions in model mice of ulcerative colitis(UC);To explore the mechanism of electroacupuncture improving the intestinal mucus barrier.Methods Totally 48 BALB/c mice were randomly divided into blank group(12 mice)and modeling group(36 mice).The UC models were established in the modeling group using 3%dextran sulfate sodium free drinking.After successful modeling,mice were further randomly divided into model group,electroacupuncture group and sulfasalazine(SASP)group,with 12 mice in each group.The electroacupuncture group received electroacupuncture at"Guanyuan","Tianshu","Zusanli"and"Shangjuxu"acupoints for 20 minutes per day,the SASP group was administered sulfasalazine enteric-coated tablet suspension(500 mg/kg)by gavage,the blank group received no intervention,the model group was only confined for continuous 7 days.The general conditions were observed and disease activity index(DAI)score were recorded,HE staining was used to observe the morphology of colonic tissue and evaluate the colonic mucosal damage index(CMDI)score,AB-PAS staining was used to observe the number of goblet cells in colonic tissue,and immunofluorescence staining was used to detect the expression of mucin 2(MUC2)protein in colonic tissue,ELISA was used to detect the contents of serum tumor necrosis factor-α(TNF-α)and γ interferon(IFN-γ),and Western blot was used to detect the protein expressions of interleukin(IL)-4,signal transducer and activator of transcription(STAT)6 and epithelial specific transcription factor(SPDEF)in colonic tissue.Results Compared with the blank group,the model group showed mucous stool,bloody stool,reduced intake of food and water,reduced body mass,increased DAI and CMDI scores(P<0.01),with intestinal villi shedding and necrosis,destruction of colonic crypt villi structure,accompanied by severe neutrophil infiltration,thinning of mucus layer,atrophy and reduction of goblet cells(P<0.01),the expression of MUC2 in colonic tissue significant decreased(P<0.01),the contents of TNF-α and INF-γ in serum significantly increased(P<0.01),while the protein expressions of IL-4,STAT6 and SPDEF in colonic tissue significantly decreased(P<0.01).Compared with the model group,both the electroacupuncture group and SASP group showed improved mucous stool,bloody stool,increased body mass,decreased DAI and CMDI scores(P<0.05),the morphology of the intestinal epithelium was basically normal,the glandular structure has improved,there was a small amount of inflammatory cell infiltration and slight edema,the thickness of the mucus layer was restored,the atrophy reduced and number of goblet cells increased(P<0.05),the expression of MUC2 in colonic tissue significantly increased(P<0.05),while the contents of TNF-α and IFN-γ in serum significantly decreased(P<0.05),the expressions of IL-4,STAT6 and SPDEF protein in colonic tissue significantly increased(P<0.05).Conclusion Electroacupuncture can facilitate the repair of the intestinal mucus barrier and inhibit inflammation,potentially through the activation of IL-4/STAT6/SPDEF pathway-related protein expressions.

Objective To summarize the effect of standardized perioperative nursing management in the treatment of early hypopharyngeal carcinoma and precancerous lesions with endoscopic submucosal dissection(ESD).Methods A total of 43 patients who underwent ESD treatment for hypopharyngeal mucosal lesions in Zhejiang Cancer Hospital from June 1,2018 to June 1,2023 were selected as the study objects,and 12 patients who underwent ESD treatment from June 1,2018 to November 30,2020 were divided into control group,and 31 patients who underwent ESD treatment from December 1,2020 to June 1,2023 were divided into observation group,the control group received routine perioperative nursing management,and the observation group received standardized perioperative nursing management.Observation indicators were compared between two groups.Results Intubation method,operation time,postoperative exposure satisfaction,postoperative pain score,and hospital length were significant between two groups(P＜0.05).Conclusion ESD treatment of early hypopharyngeal cancer and precancerous lesions with standardized perioperative nursing management effect is good,can increase the surgical area exposure satisfaction,shorten the operation time and hospital stay,reduce patients'postoperative pain and discomfort,help patients to recover.

Objective:To explore the application effect of the BOPPPS[bridge-in(B), objective(O), pre-assessment(P), participatory learning(P), post-assessment(P), Summary(S) ]model combined with scenario-based teaching in out-of-school first aid training for school-aged children, aiming to offer insights for relevant educational practices.Methods:A quasi-experimental study was conducted. Using cluster sampling, 131 school-aged children participating in Wuhan first aid summer camp from July to August 2024 were selected as participants. Among them, 65 children enrolled in July 2024 were assigned to the control group and received training using traditional teaching methods, while 66 children enrolled in August 2024 were assigned to the experimental group and underwent training designed with the BOPPPS model integrated with scenario-based teaching according to the time of entry into the camp. After the training, theoretical exam scores, learning process evaluations, and training satisfaction were compared between the two groups.Results:The control group included 31 boys and 34 girls, aged (9.32 ± 1.83) years; the experimental group included 34 boys and 32 girls, aged (9.71 ± 1.73) years. After the intervention, the total scores of theoretical examination, learning process evaluation, and training satisfaction in the experimental group were (90.27 ± 4.41), (42.79 ± 1.39), and (21.43 ± 2.41) points, respectively, which were higher than those in the control group (82.05 ± 6.29), (38.85 ± 1.91), and (19.54 ± 3.02) points, and the differences were statistically significant ( t=6.94, 3.15, 4.16, all P<0.05). Conclusions:This out-of-school first aid training for school-aged children leveraged the professional expertise of a tertiary grade A hospital′s pediatric department. The integration of the BOPPPS model with scenario-based teaching effectively enhanced the first aid competencies of school-aged children and improved their satisfaction with the training.

Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

Objective To observe the effects of electroacupuncture on IL-4/STAT6/SPDEF pathway-related protein expressions in model mice of ulcerative colitis(UC);To explore the mechanism of electroacupuncture improving the intestinal mucus barrier.Methods Totally 48 BALB/c mice were randomly divided into blank group(12 mice)and modeling group(36 mice).The UC models were established in the modeling group using 3%dextran sulfate sodium free drinking.After successful modeling,mice were further randomly divided into model group,electroacupuncture group and sulfasalazine(SASP)group,with 12 mice in each group.The electroacupuncture group received electroacupuncture at"Guanyuan","Tianshu","Zusanli"and"Shangjuxu"acupoints for 20 minutes per day,the SASP group was administered sulfasalazine enteric-coated tablet suspension(500 mg/kg)by gavage,the blank group received no intervention,the model group was only confined for continuous 7 days.The general conditions were observed and disease activity index(DAI)score were recorded,HE staining was used to observe the morphology of colonic tissue and evaluate the colonic mucosal damage index(CMDI)score,AB-PAS staining was used to observe the number of goblet cells in colonic tissue,and immunofluorescence staining was used to detect the expression of mucin 2(MUC2)protein in colonic tissue,ELISA was used to detect the contents of serum tumor necrosis factor-α(TNF-α)and γ interferon(IFN-γ),and Western blot was used to detect the protein expressions of interleukin(IL)-4,signal transducer and activator of transcription(STAT)6 and epithelial specific transcription factor(SPDEF)in colonic tissue.Results Compared with the blank group,the model group showed mucous stool,bloody stool,reduced intake of food and water,reduced body mass,increased DAI and CMDI scores(P<0.01),with intestinal villi shedding and necrosis,destruction of colonic crypt villi structure,accompanied by severe neutrophil infiltration,thinning of mucus layer,atrophy and reduction of goblet cells(P<0.01),the expression of MUC2 in colonic tissue significant decreased(P<0.01),the contents of TNF-α and INF-γ in serum significantly increased(P<0.01),while the protein expressions of IL-4,STAT6 and SPDEF in colonic tissue significantly decreased(P<0.01).Compared with the model group,both the electroacupuncture group and SASP group showed improved mucous stool,bloody stool,increased body mass,decreased DAI and CMDI scores(P<0.05),the morphology of the intestinal epithelium was basically normal,the glandular structure has improved,there was a small amount of inflammatory cell infiltration and slight edema,the thickness of the mucus layer was restored,the atrophy reduced and number of goblet cells increased(P<0.05),the expression of MUC2 in colonic tissue significantly increased(P<0.05),while the contents of TNF-α and IFN-γ in serum significantly decreased(P<0.05),the expressions of IL-4,STAT6 and SPDEF protein in colonic tissue significantly increased(P<0.05).Conclusion Electroacupuncture can facilitate the repair of the intestinal mucus barrier and inhibit inflammation,potentially through the activation of IL-4/STAT6/SPDEF pathway-related protein expressions.

Objective To summarize the effect of standardized perioperative nursing management in the treatment of early hypopharyngeal carcinoma and precancerous lesions with endoscopic submucosal dissection(ESD).Methods A total of 43 patients who underwent ESD treatment for hypopharyngeal mucosal lesions in Zhejiang Cancer Hospital from June 1,2018 to June 1,2023 were selected as the study objects,and 12 patients who underwent ESD treatment from June 1,2018 to November 30,2020 were divided into control group,and 31 patients who underwent ESD treatment from December 1,2020 to June 1,2023 were divided into observation group,the control group received routine perioperative nursing management,and the observation group received standardized perioperative nursing management.Observation indicators were compared between two groups.Results Intubation method,operation time,postoperative exposure satisfaction,postoperative pain score,and hospital length were significant between two groups(P＜0.05).Conclusion ESD treatment of early hypopharyngeal cancer and precancerous lesions with standardized perioperative nursing management effect is good,can increase the surgical area exposure satisfaction,shorten the operation time and hospital stay,reduce patients'postoperative pain and discomfort,help patients to recover.