Objective To explore the association between severe postoperative complications after emergency surgery and mental distress among operating surgeons, and to identify the related factors. Methods This cross-sectional survey was conducted from January 2024 to December 2025. Anonymous questionnaires were administered using a convenience sampling method to operating surgeons who had experienced severe postoperative complications after emergency surgery (Clavien-Dindo grade ≥Ⅲ), and the incidence rate of mental suffering was calculated. Related factors were analyzed using the χ² test, trend test, and multivariable logistic regression. Results A total of 216 operating surgeons who had experienced severe postoperative complications after emergency surgery were included, with an overall prevalence of mental distress of 74.07%. The positive screening rates for anxiety and depression increased significantly with increasing severity of mental distress (P＜0.001). Multivariable logistic regression showed that timing of complication onset was one of the factors most strongly associated with surgeons’ mental distress. Compared with complications occurring on postoperative days 1–3, complications occurring on postoperative days 4–7 were associated with a significantly higher risk of mental distress (OR=10.329, 95%CI 2.947–36.207, P＜0.001). In addition, experience of medical conflict (OR=2.062, 95%CI 1.015–4.187) and an external attribution style (OR=1.996, 95%CI 1.007–3.959) were also independently associated with mental distress (P＜0.05). Conclusion Severe postoperative complications after emergency surgery are commonly accompanied by mental distress among operating surgeons, often with prominent symptoms of anxiety and depression. Influenced by multiple factors, including event characteristics, system responses, and individual cognition, postoperative 4–7 days may represent a critical high-risk window warranting particular attention.

Objective:To investigate the differences in acute intestinal injury and regulatory mechanisms in mice following carbon ion FLASH radiotherapy (FLASH-RT) and conventional dose rate radiotherapy (CONV-RT).Methods:Healthy C57BL/6J mice were randomly divided into three groups: control group, FLASH-RT group (100 Gy/s), and CONV-RT group (0.1 Gy/s), with 9 mice in each group. All mice received carbon ion whole abdominal radiotherapy. DNA double-strand breaks (DSB) and cell proliferation were evaluated by measuring the expression of phosphorylated histone H2AX (γ-H2AX) and nuclear-associated antigen 67 (Ki67) using immunohistochemistry; apoptosis was analyzed using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL); transcriptome sequencing was used to analyze the differences in molecular pathways between FLASH-RT and CONV-RT.Results:Compared with the CONV-RT group, the FLASH-RT group showed significantly reduced intestinal γ-H2AX signal at 3 h after radiotherapy ( t=3.80, P<0.01), significantly increased expression of Ki67 at the base of intestinal crypts at 6 h after radiotherapy ( t=4.30, P<0.001), and a significantly decreased number of TUNEL-positive cells at 12 h after radiotherapy ( t=3.08, P<0.01). Transcriptome sequencing analysis showed that FLASH-RT specifically activated the insulin-like growth factor (IGF) pathway, avoiding the excessive activation of CONV-RT-induced nuclear factor-κB and B cell receptor inflammatory pathways as well as the inhibition of energy metabolism. Conclusions:Compared with CONV-RT, carbon ion FLASH-RT can reduce DSB damage, preserve the proliferative activity of intestinal stem cells, activate the IGF pathway, and regulate inflammatory, immune, and metabolic pathways, thereby significantly alleviating acute intestinal epithelial injury. Specifically, the regulation of repair pathways mediated by reduced DSB and the inhibition of inflammatory pathways are potential protective mechanisms for normal tissues.

Objective:To investigate the differences in acute intestinal injury and regulatory mechanisms in mice following carbon ion FLASH radiotherapy (FLASH-RT) and conventional dose rate radiotherapy (CONV-RT).Methods:Healthy C57BL/6J mice were randomly divided into three groups: control group, FLASH-RT group (100 Gy/s), and CONV-RT group (0.1 Gy/s), with 9 mice in each group. All mice received carbon ion whole abdominal radiotherapy. DNA double-strand breaks (DSB) and cell proliferation were evaluated by measuring the expression of phosphorylated histone H2AX (γ-H2AX) and nuclear-associated antigen 67 (Ki67) using immunohistochemistry; apoptosis was analyzed using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL); transcriptome sequencing was used to analyze the differences in molecular pathways between FLASH-RT and CONV-RT.Results:Compared with the CONV-RT group, the FLASH-RT group showed significantly reduced intestinal γ-H2AX signal at 3 h after radiotherapy ( t=3.80, P<0.01), significantly increased expression of Ki67 at the base of intestinal crypts at 6 h after radiotherapy ( t=4.30, P<0.001), and a significantly decreased number of TUNEL-positive cells at 12 h after radiotherapy ( t=3.08, P<0.01). Transcriptome sequencing analysis showed that FLASH-RT specifically activated the insulin-like growth factor (IGF) pathway, avoiding the excessive activation of CONV-RT-induced nuclear factor-κB and B cell receptor inflammatory pathways as well as the inhibition of energy metabolism. Conclusions:Compared with CONV-RT, carbon ion FLASH-RT can reduce DSB damage, preserve the proliferative activity of intestinal stem cells, activate the IGF pathway, and regulate inflammatory, immune, and metabolic pathways, thereby significantly alleviating acute intestinal epithelial injury. Specifically, the regulation of repair pathways mediated by reduced DSB and the inhibition of inflammatory pathways are potential protective mechanisms for normal tissues.

Objective:To perform FLASH irradiation experiments on cells and animals with carbon ion beams by updating the beam conditions and testing the performance of a clinical carbon ion therapy system.Methods:By using the vertical beam of the carbon ion therapy system and shortening the synchrotron beam extraction time to increase the current intensity, ultra-high dose rate beam could be achieved. Spreading the high current beam in the depth direction using a ridge filter and expanding it horizontally using point scanning technology could form the required field for cellular and animal experiments. The field flatness, penumbra, absorbed dose, average dose rate and other parameters were measured to verify whether the beam performance met the requirements.Results:The spread-out Bragg peak in the depth direction was consistent with the design, and the parameters such as field flatness and penumbra obtained by the measured lateral dose curve met the experimental requirements. After expansion, within a target volume of 20 mm×20 mm×10 mm, the absorbed dose in the field reaches 8 Gy, with the equivalent field dose rate of over 60 Gy/s and the maximum could reach 100 Gy/s. Within a target volume of 30 mm×30 mm×10 mm, the absorbed dose in the field is 4 Gy, and the equivalent filed dose rate of some energy in the field is greater than 40 Gy/s. In the experiment, the energy with a suitable dose rate can be selected for irradiation.Conclusion:After beam optimization, the carbon ion FLASH irradiation conditions for cytology and animal experiments can be realized on synchrotrons, and the beam performance parameters can meet the experimental requirements.

Clinical researches including the Mayo Anesthesia Safety in Kids (MASK) study have found that children undergoing multiple anesthesia may have a higher risk of fine motor control difficulties. However, the underlying mechanisms remain elusive. Here, we report that erythropoietin receptor (EPOR), a microglial receptor associated with phagocytic activity, was significantly downregulated in the medial prefrontal cortex of young mice after multiple sevoflurane anesthesia exposure. Importantly, we found that the inhibited erythropoietin (EPO)/EPOR signaling axis led to microglial polarization, excessive excitatory synaptic pruning, and abnormal fine motor control skills in mice with multiple anesthesia exposure, and those above-mentioned situations were fully reversed by supplementing EPO-derived peptide ARA290 by intraperitoneal injection. Together, the microglial EPOR was identified as a key mediator regulating early synaptic development in this study, which impacted sevoflurane-induced fine motor dysfunction. Moreover, ARA290 might serve as a new treatment against neurotoxicity induced by general anesthesia in clinical practice by targeting the EPO/EPOR signaling pathway.
Animals ; Sevoflurane/toxicity* ; Microglia/drug effects* ; Anesthetics, Inhalation/adverse effects* ; Mice ; Mice, Inbred C57BL ; Receptors, Erythropoietin/metabolism* ; Neuronal Plasticity/drug effects* ; Male ; Prefrontal Cortex/drug effects* ; Erythropoietin/pharmacology* ; Signal Transduction/drug effects*

ObjectiveTo observe the effect of Banxia Xiexintang containing intestinal absorption solution （BXCIAS） on migration and invasion of polymorphonuclear myeloid-derived suppressor cells （PMN-MDSCs） in gastric cancer microenvironment. MethodThe complex solution （containing 0.63 g·mL^-1 crude drug） was prepared. Gastric cancer cells were subjected to non-contact co-culture with PMN-MDSCs in Transwell chamber to create gastric cancer microenvironment. Cell counting kit-8 （CCK-8） assay was used to screen the optimal intervention concentration and time of BXCIAS on PMN-MDSCs for subsequent experiment. The blank group， model group， FAK inhibitor group， and BXCIAS groups （26%， 18%， and 10%） were designed. Scratch assay and Transwell assay were employed to detect the migration and invasion ability of PMN-MDSCs， and enzyme-linked immunosorbent assay （ELISA） to measure the expression of vascular endothelial cell growth factor （VEGF） and matrix metalloproteinase-9 （MMP-9） in tumor microenvironment. The expression levels of PMN-MDSCs pathway-related proteins FAK， phosphorylated （p）-FAK， protein tyrosine kinase （Src）， and p-Src were detected by Western blot. ResultThe inhibition rates of PMN-MDSCs by 5%， 50%， 75%， and 100% BXCIAS at 48 h were higher than those at 24 h （P<0.05， P<0.01）. The inhibition rate of PMN-MDSCs by 50% BXCIAS at 72 h was lower than that at 48 h （P<0.01）， and the inhibition rates by 5% and 100% BXCIAS at 72 h were higher than those at 48 h （P<0.05， P<0.01）. There was no significant difference in the inhibition rate by other concentration levels at 48 h. The half-maximal inhibitory concentration （IC₅₀） at 48 h was 18.09%， indicating that 18% BXCIAS and 48 h were the optimal concentration and time， respectively. The migration distance of PMN-MDSCs was large （P<0.01）， and the number of migrating and invading cells increased （P<0.01） in the mode group compared with those in the blank group. Compared with model group， FAK inhibitor and BXCIAS at different concentration decreased the migration distance of PMN-MDSCs （P<0.01）， and the number of migrating and invading cells （P<0.01）， especially the 26% BXCIAS （P<0.01）. The expression of PMN-MDSCs pathway-related proteins FAK， p-FAK， Src and p-Src （P<0.01） and the expression of VEGF and MMP-9 （P<0.01） were higher in the model group than in the blank group. Compared with model group， FAK inhibitor and BXCIAS （26%， 18%， 10%） decreased the expression of FAK， p-FAK， and Src （P<0.01）， and FAK inhibitor and 18% BXCIAS reduced the expression of p-Src （P<0.01）， and the expression of VEGF and MMP-9 （P<0.01）. ConclusionBXCIAS can inhibit the migration and invasion of PMN-MDSCs by down-regulating the expression of FAK， p-FAK， Src， and p-Src proteins in the FAK signaling pathway of PMN-MDSCs in gastric cancer microenvironment.

ObjectiveTo observe the effect of Banxia Xiexintang （BXT）-containing intestinal absorption solution on the apoptosis of polymorphonuclear myeloid-derived suppressor cells （PMN-MDSCs） in gastric cancer microenvironment. MethodBXT-containing intestinal absorption solution was prepared， and gastric cancer cells and PMN-MDSCs were non-contact co-cultured in Transwell chamber to establish gastric cancer microenvironment. Cell counting kit-8 （CCK-8） assay was used to screen the optimal intervention concentration and time of 0-100% BXT-containing intestinal absorption solution prepared by 0.63 g·mL^-1 reconstitution solution. Cells were classified into blank group， model group， oxaliplatin group （10 mg·L^-1）， and BXT （26%， 18%， 10% BXT-containing intestinal absorption solution） group， and the apoptosis of PMN-MDSCs was detected by flow cytometry. The expression of apoptosis-related B-cell lymphoma 2 （Bcl-2）， Bcl-2-associated X protein （Bax）， and cysteine-aspartic acid protease-3 （Caspase-3） in PMN-MDSCs was detected by Western blot. ResultAfter treatment for 24 h and 48 h， the PMN-MDSCs-inhibiting rate was increased by 5%， 50%， 75%， and 100% BXT-containing intestinal absorption solution compared with that in the blank group （P<0.05， P<0.01）. At 72 h， the PMN-MDSCs-inhibiting rate by 50% BXT-containing intestinal absorption solution was lower than that at 48 h （P<0.01）， and the PMN-MDSCs-inhibiting rate by 5%， 75%， and 100% BXT-containing intestinal absorption solution showed no significant difference from that at 48 h. Moreover， the half-maximal inhibitory concentration （IC₅₀） at 48 h was 18.40%. Thus， 18% BXT-containing intestinal absorption solution and 48 h were the optimal intervention concentration and time. The survival rate of PMN-MDSCs in model group was higher than that in the blank group （P<0.05）， and the apoptosis rate was lower than that in the blank group （P<0.05）. Compared with model group， BXT containing intestinal absorption solution lowered the survival rate and raised apoptosis rate of PMN-MDSCs （P<0.05）， particularly the 26% BXT-containing intestinal absorption solution （P<0.05）. The expression of Bax and Caspase-3 in PMN-MDSCs was lower in the model group than in the blank group （P<0.05）， and the expression of Bcl-2 was higher in the model group than in the blank group （P<0.05）. The expression of Caspase-3 in PMN-MDSCs increased （P<0.05） and the expression of Bcl-2 decreased （P<0.05） in oxaliplatin group and BXT group compared with those in the model group. The expression of Bax rose in oxaliplatin group and BXT group （10% BXT-containing intestinal absorption solution） （P<0.05）. ConclusionBXT can induce the apoptosis of PMN-MDSCs by regulating the expression of apoptosis-related proteins Bax， Caspase-3， and Bcl-2 in gastric cancer microenvironment.

Objective:To explore the symptoms in cervical cancer patients during concurrent chemoradiotherapy, identify symptom clusters, and analyze their influencing factors, so as to provide reference for developing precise symptom management strategies.Methods:From March 2022 to March 2023, convenience sampling was used to select 240 cervical cancer patients who underwent concurrent chemoradiotherapy at the Cancer Center of People's Hospital of Guangxi Zhuang Autonomous Region as the research subject. Patients were surveyed using a General Information Questionnaire and the Chinese version of the M.D. Anderson Symptom Inventory (MDASI-C). Symptom clusters were extracted through exploratory factor analysis, and multiple linear regression was used to explore the influencing factors of the severity of symptom clusters.Results:A total of 240 questionnaires were distributed, and 234 valid questionnaires were collected, with an effective recovery rate of 97.50% (234/240). The 5 symptoms with a high incidence in 234 patients with cervical cancer undergoing concurrent chemoradiotherapy were fatigue, restless sleep, nausea, decreased appetite, and vomiting. The 4 symptom clusters identified by exploratory factor analysis were fatigue related symptom cluster, gastrointestinal related symptom cluster, emotional related symptom cluster, and somatic related symptom cluster. Age, educational level, tumor staging, complications, medical insurance type, and pathological type were the influencing factors for the occurrence of symptom clusters ( P<0.05) . Conclusions:Cervical cancer patients experience multiple symptoms during concurrent chemoradiotherapy, which are interrelated and mutually influencing, often in the form of symptom clusters, with fatigue related symptom clusters being severe. Medical and nursing staff should focus on the core symptoms that play a leading role, develop targeted symptom cluster intervention plans based on the core symptoms of fatigue, improve symptom management efficiency and patient quality of life.

Abstract In order to achieve the goal of reducing the smoking rate among Chinese adults at ages of 15 years and above to below 20% by 2030, smoking cessation services require to be reinforced. The current Chinese smoking cessation service system includes short-term smoking cessation interventions and smoking cessation hotlines at the population level, and smoking cessation clinics at the individual level; however, these smoking cessation services suffer from problems of low awareness, low accessibility and low utilization rate. Based on the publications pertaining to smoking cessation services and released policy documents in China until June 2022, this review analyzes the current status, problems and causes of smoking cessation services, and proposes suggestions for improving the smoking cessation service system construction in China.

Objective:To explore the hotspots of the public concerns about quitting smoking before and during the coronavirus disease 2019 (COVID-19) pandemic.Methods:The monthly search index data of four key words, “the harm of smoking”，“quitting smoking”，“passive smoking” and “electronic cigarette” before the COVID-19 (from January, 2016 to December, 2019) and during the COVID-19 (from January, 2020 to December, 2020) pandemic were manually collected from the Baidu Index platform. The one-way ANOVA was used to compare the differences among annual search indexes of four keywords. The linear regression model was used to test the annual linear trend of search index of each keyword before the COVID-19, and the one-sample t-test was used to analyze the differences of the search indexes during the COVID-19 and the means before the COVID-19. Results:During 2016—2020, the annual average search index of “electronic cigarette” was the highest (1.465 million), followed by “the harm of smoking” (0.884 million) and “quitting smoking” (0.780 million), while “passive smoking” was the lowest (0.171 million). Before the COVID-19 (2016—2019), the search index of each keyword had positive cumulative growth, but there was no significant linear trend of annual change ( P>0.05). During the COVID-19 period (2020), the search index of “the harm of smoking” decreased significantly (0.794 million vs 0.907 million, P=0.011), and “quitting smoking” (0.591 million vs 0.827 million, P=0.172) and “passive smoking” (0.164 million vs 0.172 million, P=0.257) showed a downward trend, while the search index of “electronic cigarettes” bucked the trend and increased significantly (1.825 million vs 1.375 million, P=0.010). Conclusions:The public′s online attention to “electronic cigarette” increases dramatically during COVID-19 along with other information about quitting smoking decreases. There are urgent needs for strengthening regulation and monitoring of electronic cigarettes and carrying out more effective publicity of scientific methods to help quit smoking.