Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry,and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus.Methods By the convenience sampling method,a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15,2024.The survey was conducted using the instrument for evaluating clinical applicability of guide-lines(version 2.0)and a self-compiled questionnaire on the clinical implementation of the restraint consensus.Results A total of 7,844 valid questionnaires were collected,with a valid questionnaire recovery rate of 93.78％.The results of clinical applicability scoring showed that the consensus had the lowest availability score(64.72％)and the highest acceptability score(76.74％).The results showed that nurses' receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions(P＜0.05).4,774 participants(87.42％)believed that the application of consensus could enhance the standardization of nurses' restraint operations.The safety rate of the restraint consensus was 79.51％,and the economic ratio was 76.87％.Among the evaluators,1,739(22.17％)believed that there were implementation obstacles in the consensus.Conclusion The clinical applicability of the consensus is relatively good,and the application of the consensus helps to improve the standardization of clinical operations.In the future,efforts should be made to strengthen the promotion and training of the consensus,develop hierarchical promotion strategies according to the characteristics of medical institutions,and improve the quality of evidence for the consensus,so as to further enhance the clinical application effect of the consensus.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

ObjectiveTo examine the relationship between metabolic syndrome (MS) and its key components in granulomatous mastitis (GM), we explored potential pathological mechanisms through the lens of traditional Chinese medicine (TCM), particularly the concept of intermingled phlegm-blood stasis.MethodsIn this retrospective study, we enrolled 172 patients with GM and 164 patients with non-inflammatory benign breast masses. Metabolic indicators (waist circumference [WC], blood lipids, etc.), inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α), and adipose tissue CD68 expression were measured. Logistic regression was used to analyze risk factors and receiver operating characteristic curves were used to evaluate diagnostic efficacy. The correlation between TCM pathogenesis and biomarkers was also examined.ResultsMS prevalence was significantly higher in the GM group than in the controls (26.16% vs. 6.10%, P .001). Multivariate analysis identified abdominal obesity (WC ≥ 80 cm, odds ratio [OR] = 1.065) and low levels of high-density lipoprotein cholesterol (HDL-C; 1.29 mmol/L, OR = 0.066) as independent risk factors for GM (P .001 for both). Among patients with GM, HDL-C levels were inversely correlated with inflammatory markers (r = −0.341 to −0.440), whereas patients with concurrent MS demonstrated greater CD68 macrophage infiltration (P .001). According to TCM, abdominal obesity corresponds to “spleen deficiency with phlegm-dampness accumulation,” and low HDL-C reflects “deficiency of vital qi,” which collectively lead to phlegm-blood stasis obstruction in the mammary collaterals; this aligns with the key MS driving mechanisms of chronic inflammation and immune dysregulation.ConclusionMS promotes GM development through chronic inflammation and immune dysregulation, with abdominal obesity and low HDL-C levels serving as core risk factors. The TCM theory of intermingled phlegm-blood stasis provides a novel interpretation of the metabolic-inflammatory mechanisms underlying GM. Accordingly, we propose phlegm-resolving and blood-activating strategies as potential therapeutic approaches for metabolic–immune axis regulation.

Objective:To explore the value of non-invasive habitat imaging (HI) multi-parametric MRI (mpMRI) in predicting the risk of prostate cancer (PCa).Methods:In this cross-sectional study, 220 patients with PCa confirmed by radical prostatectomy (RP) who underwent multi-parametric MRI (mpMRI) scanning at Xijing Hospital, Air Force Military Medical University from January 2018 to May 2024 were retrospectively collected. Patients were divided into a training set (154 cases) and a test set (66 cases) by simple random sampling in a 7∶3 ratio. Based on mpMRI imaging, the apparent diffusion coefficient (ADC), perfusion fraction (f), and mean kurtosis (MK) of each voxel were integrated. The K-means clustering algorithm was used to divide the PCa target lesions into habitat subregions, generate habitat maps, and calculate the proportion of each habitat subregion in the entire lesion. According to the 2019 International Society of Urological Pathology (ISUP) guidelines, patients were categorized into a low-risk group (ISUP≤2, 65 cases) and a high-risk group (ISUP≥3, 155 cases). The RP specimens were matched with the habitat map to identify corresponding habitat subregions, and the ISUP grade of each subregion was individually evaluated to calculate the detection rate of high-risk PCa patients. The logistic regression analysis was applied to identify the independent risk factors associated with PCa risk, and the HI-clinical imaging model and clinical imaging model were constructed. The efficacy of the models was assessed using receiver operating characteristic curve.Results:Based on the optimal cluster number, the habitat was divided into three subregions. Habitat 1 had lower ADC and f values and higher MK values, while habitat 2 had the opposite characteristics, and habitat 3 was intermediate. The proportion of habitat 1 in the high-risk group was 28.8%, in the low-risk group was 8.9%. In the training set, the comparison of habitat subregions with pathological results showed that the detection rate of high-risk lesions was 66.9% (103/154) in habitat 1, 25.3% (39/154) in habitat 2, and 47.4% (73/154) in habitat 3. The logistic regression analysis indicated that the proportion of habitat 1 ( OR=3.03, 95% CI 1.77-5.18, P<0.001), prostate-specific antigen ( OR=1.66, 95% CI 1.04-2.66, P=0.034), and the prostate imaging reporting and data system score ( OR=1.65, 95% CI 1.00-2.70, P=0.048) as independent risk factors for high-risk PCa. In the training set, the area under the curve (AUC) for predicting PCa risk was 0.854 (95% CI 0.789-0.920) for the HI-clinical imaging model and 0.779 (95% CI 0.701-0.856) for the clinical imaging model. In the test set, the AUC values were 0.809 (95% CI 0.693-0.895) and 0.738 (95% CI 0.619-0.856), respectively. Conclusion:HI based on mpMRI can effectively predict the risk of PCa.

Objective To investigate the role of high-temperature requirement factor A2(HTRA2)in the mitochondrial unfolded protein response(mtUPR)model induced by the neurotoxin 1-methyl-4-phenylpyridinium(MPP+)and the compensatory effects of other proteases.Methods The mtUPR cell model was established by treating SH-SY5Y cells with MPP+.Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay,and mitochondrial morphological changes and intracellular reactive oxygen species(ROS)levels were examined under transmission electron microscopy and fluorescence microscope,respectively.Western blot(WB)was used to detect the expression levels of C/EBP Homologous Protein(CHOP),Heat shock protein family E member 1(HSPE1),YME1-like 1 ATPase(YME1L1),Caseinolytic mitochondrial matrix peptidase proteolytic subunit(CLPP),and Lon peptidase 1,mitochondrial(LONP1).Lentivirus-mediated knockdown(KD)of the HTRA2 gene in SH-SY5Y cells was performed.The mRNA and protein expression levels of HTRA2 were detected by quantitative real-time polymerase chain reaction and WB,respectively.After induction of mtUPR in HTRA2-KD SH-SY5Y cells with 400 μmol/L MPP?,cell viability and protein expression levels of HTRA2,YME1L1,CLPP,and LONP were evaluated using the CCK-8 assay and WB,respectively.Results mtUPR cell model was successfully established following treatment of SH-SY5Y cells with 400 μmol/L MPP+for 24 hours.Compared to the control group,there was no significant change in cell viability.Under electron microscopy,there were no remarkable alterations in the mitochondrial cristae and size in the mtUPR group.The average fluorescence intensity of ROS in the mtUPR group was 1.25±0.08 fold that of the PBS group,and the difference was statistically significant(P=0.001).The expression levels of CHOP,HSPE1,HTRA2,CLPP,and LONP were significantly higher in the mtUPR group than in the control group,which were 2.68±0.94、2.83±0.89、1.67±0.20,1.65±0.28,and 1.66±0.13 times that of control group,respectively(all P<0.05).The expression level of YME1L1 in the mtUPR group was 1.28±0.27 times that of the control group,with no statistical significance(P>0.05).After knockdown of the HTRA2 gene in SH-SY5Y cells,the expression levels of CLPP,YME1L1,and LONP1 increased to 1.46±0.79,1.41±0.12,and 1.32±0.25 times that of the empty virus group,respectively(all P<0.05).Following treatment with 400 μmol/L MPP+for 24 hours in HTRA2-KD SH-SY5Y cells,cell viability in HTRA2-KD group decreased to 88.4%±6.1%of the empty virus group(P<0.05).In the HTRA2 group,there were no significant changes in the expression levels of YME1L1 and LONP1 compared to the empty virus group(all P>0.05),while the expression level of CLPP increased to(1.88±0.62)times that of the empty virus group(P=0.033).Conclusion HTRA2 is an important mitochondrial protease in the MPP+-induced mtUPR response,and other mitochondrial proteases partially compensate for the function of HTRA2.

Objective A comprehensive evaluation of three kinds of closed triple therapy(fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol,beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol)for stable maintenance treatment of chronic obstructive pulmonary disease(COPD)is conducted to provide reference for drug selection and rational clinical use in medical institutions.Methods Based on the Quick Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions(Second Edition),this study collected drug instructions,clinical guidelines,and relevant literature from databases such as China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database for Chinese Technical Periodicals(VIP),PubMed,Embase and Cochrane Library.Quantitative indicators were established to evaluate three inhalations that closed triple therapy formulations from five dimensions:effectiveness,pharmacological characteristics,safety,economy,and other attributes.Results The comprehensive scores of the formulations included in the evaluation are all above 80 points,among which the comprehensive score of fluticasone furoate,umeclidinium bromide and vilanterol trifenatate powder for inhalation is the highest at 89.2 points,followed by budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol at 87.6 points,and the lowest score of beclometasone dipropionate,formoterol fumarate and glycopyrrolate inhalation aerosol at 82.9 points.Conclusions All three formulations have shown good clinical efficacy,and different triple formulations have different advantages in clinical treatment.Through the comprehensive evaluation of three types of inhalation triple preparations,it can provide a reference for drug selection in medical institutions,and provide a basis for clinical scientific,rational,safe,and personalized medication.

Objective To verify the applicability of a pig STR multiplex amplification system for detecting processed foods containing pork and their digestive samples,and to evaluate its potential in food safety and forensic biological evidence analysis.Methods DNA profiles were obtained using the pig STR amplification system from food samples with different levels of processing(raw pork,boiled pork,fried pork,and sausage)and from digestive samples(rat gastric contents).The influence of processing methods on DNA integrity was assessed.The uniformity of large-scale processed ham products,the consistency of DNA profiles from different parts of the same sample,and the DNA degradation patterns after rat digestion were examined.Results STR profiling of pig DNA was successful in all tested samples.Short fragments showed high amplification stability,while long fragment signals weakened with increasing processing complexity.In processed ham products,DNA profiles were consistent across all sampled parts,with fragment drift within±0.5 bp.Analysis of rat gastric contents showed slight DNA degradation within 2 hours;after 3 hours,long fragment signals weakened,and after 4 hours,some loci signals were lost.Conclusion The pig STR multiplex amplification system exhibits excellent performance in detecting processed pork products and their digestive samples.It can meet the requirements of food traceability and forensic biological evidence analysis for processed pork,providing new insights for the advancement of forensic testing techniques in this field.

Objective:To determine the actual metastasis rate of paracolic lymph nodes (PCN) more than 10 cm proximal to rectal tumors and explore the significance of PCN dissection in the prognosis of patients with rectal cancer. ?Methods:This was a prospective observational cohort study. The clinical data of 457 consecutive patients with rectal cancer who underwent radical surgery at the Colorectal Tumor Center of West China Hospital, Sichuan University from January 2015 to May 2022 were included. Inclusion criteria: (1) Pathologically confirmed rectal adenocarcinoma (anal margin ≤ 12 cm); (2) R0 resection was performed with a proximal margin ≥ 10 cm (measured on the in vivo specimen during surgery after intestinal mobilization); (3) For stage IV patients, only those with resectable metastatic lesions by R0 were included; (4) Patients who completed the full course of neoadjuvant therapy (TNT) must meet the surgical window of 8-12 weeks after radiotherapy. Exclusion criteria: tumors located more than 15 cm from the anal margin, synchronous multiple primary colorectal cancers, positive tumor margins, preoperative imaging suggesting lateral lymph node metastasis (LLNM), presence of Lynch syndrome or familial adenomatous polyposis, emergency surgery, recurrence after rectal cancer surgery, T4b tumors requiring combined organ resection, previous radiotherapy and chemotherapy for non-rectal cancer, and those with cardiac, pulmonary, renal and other organ dysfunction that could not tolerate surgery. After standard total mesorectal excision (TME), the proximal intestinal tube was transected at a level more than 10 cm above the lesion, and then intestinal anastomosis or enterostomy was completed. The distance from the tumor edge was marked and measured in vivo during the operation, and lymph nodes were harvested from the fresh specimen. Patients with PCN metastasis beyond 10 cm proximal to the tumor were classified into the positive lymph node group (pPCN group), while those without PCN metastasis beyond 10 cm proximal to the tumor were classified into the negative lymph node group (nPCN group). The differences in clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) between the two groups were compared, and risk factor analysis and survival analysis of pPCN were performed.Results:There were 16 cases (3.5%) in the pPCN group, 15 cases (3.3%) had central lymph node metastasis; the nPCN group included 441 cases. When comparing the baseline characteristics between the pPCN group and the nPCN group, there was no statistically significant difference in other aspects except that the cN stage was more advanced in the pPCN group ( P=0.006) (all P>0.05). The number of positive mesenteric lymph nodes in the pPCN group was higher than that in the nPCN group ( P<0.001), and the proportion of patients with a total number of harvested lymph nodes ≥12 and the number of lymph nodes with a short diameter >5 mm were both higher (all P<0.05). The proportion of patients with positive lymph nodes within 10 cm and the number of positive lymph nodes within 10 cm were also higher in the pPCN group (both P<0.001). Similar to the clinical TNM staging, the proportions of patients with pT3 and N2 stages, as well as the incidence of poorly differentiated tumors (G3, G4) were higher in the pPCN group ( P<0.001). The results of multivariate analysis showed that among the preoperative pathological characteristic variables, the presence of positive lymph nodes within 10 cm (OR=14.869, 95%CI: 2.993-73.858, P=0.001) and low tumor differentiation grade (OR=7.189, 95%CI: 2.091- 24.714, P=0.002) were independent risk factors for pPCN. The median follow-up time of the patients in this group was 63 (0-63) months. No local recurrence occurred in the pPCN group, and the 5-year OS was 50.0%, which was significantly lower than 78.0% in the nPCN group (HR=2.496, 95%CI: 1.263-4.930, P=0.008). The 3-year DFS was 43.8%, also significantly lower than 77.7% in the nPCN group (HR=2.950, 95%CI:1.488-5.846, P=0.002). Multivariate Cox prognostic analysis suggested that age ≥65 years (HR=2.041, 95%CI: 1.375-3.031, P<0.001), female (HR=1.838, 95%CI: 1.171-2.884, P=0.008), tumor length ≥3 cm (HR=1.747, 95%CI: 1.076-2.834, P=0.024), more advanced cT stage (HR=2.865, 95%CI: 1.234-6.653, P=0.014), and cM1 (HR=4.368, 95%CI: 2.480-7.694, P<0.001) were independent risk factors affecting OS. No neoadjuvant therapy (HR=0.636, 95%CI: 0.413-0.980, P=0.040) and cM1 (HR=5.556, 95%CI: 3.335-9.256, P<0.001) were independent risk factors affecting DFS. pPCN showed a tendency to be an independent risk factor for DFS (HR=1.942, 95%CI: 0.966-3.906, P=0.063). Conclusion:The incidence of pPCN is higher than expected, and the prognosis of patients is poor. Patients with high-risk factors may benefit from extended proximal intestinal resection (>10 cm) to avoid residual positive PCN, thereby reducing local recurrence.

Objective:To systematically synthesize the real experiences of cancer patients undergoing prehabilitation and provide a reference for the development of targeted prehabilitation programs.Methods:A systematic search was conducted in China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, Web of Science, PubMed, Embase, CINAHL, and Cochrane Library databases for qualitative studies on the prehabilitation experiences of cancer patients. The quality of the included studies was appraised, and the findings were integrated using a Meta-aggregative approach. The search covered publications up to June 30, 2024.Results:A total of 17 studies were included, yielding 76 themes. These were synthesized into 12 categories and further integrated into four integration results: heavy physical and psychological burden with low adherence to programs; positive cognition supported by multiple factors leads to high adherence under appropriate interventions; unmet practical needs require urgent attention; physical and psychological benefits are sustained and influential.Conclusions:Multiple factors affect patients' adherence to prehabilitation, and unmet needs are common. Future research should aim to identify barriers and meet patients' needs.

Objective To investigate the role of high-temperature requirement factor A2(HTRA2)in the mitochondrial unfolded protein response(mtUPR)model induced by the neurotoxin 1-methyl-4-phenylpyridinium(MPP+)and the compensatory effects of other proteases.Methods The mtUPR cell model was established by treating SH-SY5Y cells with MPP+.Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay,and mitochondrial morphological changes and intracellular reactive oxygen species(ROS)levels were examined under transmission electron microscopy and fluorescence microscope,respectively.Western blot(WB)was used to detect the expression levels of C/EBP Homologous Protein(CHOP),Heat shock protein family E member 1(HSPE1),YME1-like 1 ATPase(YME1L1),Caseinolytic mitochondrial matrix peptidase proteolytic subunit(CLPP),and Lon peptidase 1,mitochondrial(LONP1).Lentivirus-mediated knockdown(KD)of the HTRA2 gene in SH-SY5Y cells was performed.The mRNA and protein expression levels of HTRA2 were detected by quantitative real-time polymerase chain reaction and WB,respectively.After induction of mtUPR in HTRA2-KD SH-SY5Y cells with 400 μmol/L MPP?,cell viability and protein expression levels of HTRA2,YME1L1,CLPP,and LONP were evaluated using the CCK-8 assay and WB,respectively.Results mtUPR cell model was successfully established following treatment of SH-SY5Y cells with 400 μmol/L MPP+for 24 hours.Compared to the control group,there was no significant change in cell viability.Under electron microscopy,there were no remarkable alterations in the mitochondrial cristae and size in the mtUPR group.The average fluorescence intensity of ROS in the mtUPR group was 1.25±0.08 fold that of the PBS group,and the difference was statistically significant(P=0.001).The expression levels of CHOP,HSPE1,HTRA2,CLPP,and LONP were significantly higher in the mtUPR group than in the control group,which were 2.68±0.94、2.83±0.89、1.67±0.20,1.65±0.28,and 1.66±0.13 times that of control group,respectively(all P<0.05).The expression level of YME1L1 in the mtUPR group was 1.28±0.27 times that of the control group,with no statistical significance(P>0.05).After knockdown of the HTRA2 gene in SH-SY5Y cells,the expression levels of CLPP,YME1L1,and LONP1 increased to 1.46±0.79,1.41±0.12,and 1.32±0.25 times that of the empty virus group,respectively(all P<0.05).Following treatment with 400 μmol/L MPP+for 24 hours in HTRA2-KD SH-SY5Y cells,cell viability in HTRA2-KD group decreased to 88.4%±6.1%of the empty virus group(P<0.05).In the HTRA2 group,there were no significant changes in the expression levels of YME1L1 and LONP1 compared to the empty virus group(all P>0.05),while the expression level of CLPP increased to(1.88±0.62)times that of the empty virus group(P=0.033).Conclusion HTRA2 is an important mitochondrial protease in the MPP+-induced mtUPR response,and other mitochondrial proteases partially compensate for the function of HTRA2.