With the advancement of the times and technology, the proportion of early gastric cancer has been increasing year by year, and its treatment methods have shifted towards more minimally invasive approaches, with better function-preserving and postoperative quality of life. Function-preserving surgery has gradually become the mainstream surgical option for early gastric cancer. Function-preserving surgeries mainly include segmental gastrectomy, pylorus-preserving gastrectomy, local gastrectomy, and sentinel lymph node navigation surgery. Although significant progress has been made in various function-preserving surgeries in recent years, there are still controversies regarding the selection of surgical indications, assessment of tumor radicality, surgical safety, and postoperative gastric function evaluation. Further high-quality evidence-based research is still needed to confirm the safety and effectiveness of function-preserving surgery for early gastric cancer.

With the advancement of the times and technology, the proportion of early gastric cancer has been increasing year by year, and its treatment methods have shifted towards more minimally invasive approaches, with better function-preserving and postoperative quality of life. Function-preserving surgery has gradually become the mainstream surgical option for early gastric cancer. Function-preserving surgeries mainly include segmental gastrectomy, pylorus-preserving gastrectomy, local gastrectomy, and sentinel lymph node navigation surgery. Although significant progress has been made in various function-preserving surgeries in recent years, there are still controversies regarding the selection of surgical indications, assessment of tumor radicality, surgical safety, and postoperative gastric function evaluation. Further high-quality evidence-based research is still needed to confirm the safety and effectiveness of function-preserving surgery for early gastric cancer.

Objective:To gain an in-depth understanding of the barriers to active management in elderly patients with chronic heart failure (CHF) and to provide evidence for targeted interventions.Methods:A descriptive qualitative research method was adopted. Using purposive sampling, a total of 14 elderly CHF patients admitted to the Department of Cardiovascular Medicine, the First Affiliated Hospital of Bengbu Medical College, from January to February 2025 were selected as study participants. Based on the Theoretical Domains Framework (TDF), a semi-structured in-depth interview guide was developed. NVivo 12.0 software was used to organize and code the data, and directed content analysis was applied.Results:Eight TDF-related domains of barriers were identified and summarized into four themes: misconceptions of disease and information processing barriers (knowledge; memory, attention, and decision processes) ; dependence on family members and limited accessibility of medical resources (social influence; environmental context and resources) ; negative goal motivation and low management confidence (goals; beliefs about consequences and capabilities) ; and emotional management obstacles and fatigue from self-regulation (emotion) .Conclusions:On the basis of meeting elderly CHF patients' knowledge needs, healthcare professionals should expand their access to information, improve social support systems, stimulate intrinsic motivation and self-efficacy, and alleviate negative emotions and fatigue related to self-regulation, thereby enhancing the positivity of self-health management and achieving sustainability in health management.

This study explored whether Astragalus polysaccharide(APS)can regulate the VEGF/VEGFR signaling pathway to affect the proliferative activity of rat intestinal mucosal microvascu-lar endothelial cells(RIMMVECs).RIMMVECs were isolated from newborn rats,then purified and treated with APS at concentrations of 0.1,1.0,10.0,100.0,1 000.0,and 10 000.0 mg/L.MTT was used to determine the effect of APS on RIMMVECs proliferation and screen for the optimal concentration of APS.Subsequently,flow cytometry was used to detect the changes in cell cycle to evaluate the stage of action of APS on the cell cycle in RIMMVECs.Then,the ELISA was used to detect the changes of VEGFA in cell supernatant to evaluate the potential of cell proliferation and angiogenesis.The changes in fluorescence intensity of Fluo-8AM was observed using fluorescence microscopy to evaluate intracellular Ca2+levels.Finally,Western blot was used to detect the ex-pression of PERK in RIMMVECs to analyze the possible mechanism of APS.The results showed that 100 mg/L APS significantly enhanced the proliferative activity of RIMMVECs,increased the content of VEGFA in the cell supernatant,the intracellular Ca2+levels,and the expression of PERK protein,indicating that APS promotes the proliferation of RIMMVECs,which may be a-chieved by promoting the expression of VEGFA and activating the ERK pathway.

Objective:To systematically search and summarize high-quality evidence-based evidence on the prevention and management of refeeding syndrome in patients with anorexia nervosa, and to provide a basis for preventive management of patients at high risk.Methods:A computerized search was conducted for evidence on the prevention and management of refeeding syndrome in patients with anorexia nervosa in relevant domestic and international databases and professional team websites, including clinical decision-making, guidelines, expert consensus, evidence summaries and systematic evaluations, and randomized controls. The search timeframe was from database construction to August 2024. Two researchers trained in systematic evidence-based knowledge independently performed literature screening, quality assessment, and extraction and summarization of evidence according to inclusion and exclusion criteria.Results:A total of 15 publications were included, which contained 4 guidelines, 3 expert consensus, 3 clinical decision-making, 3 systematic evaluations, and 2 randomized control trials. Thirty-one pieces of evidence for the prevention and management of refeeding syndrome were summarized in seven areas: treatment team, risk factors, risk assessment, preventive measures, clinical diagnosis, management measures, and patient safety.Conclusions:The best evidence summarized in this study for the prevention and management of refeeding syndrome in anorexia nervosa provides an evidence-based basis for practitioners to implement refeeding syndrome prevention and management measures.

Background::B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T (CAR-T) therapy yield remarkable responses in patients with relapsed/refractory multiple myeloma (R/RMM). Circulating tumor DNA (ctDNA) reportedly exhibits distinct advantages in addressing the challenges posed by tumor heterogeneity in the distribution and genetic variations in R/RMM.Methods::Herein, the ctDNA of 108 peripheral blood plasma samples from patients with R/RMM at the First Affiliated Hospital, School of Medicine, Zhejiang University was thoroughly investigated before administration of anti-BCMA CAR-T therapy to establish its predictive potential. Flow cytometry is used primarily to detect subgroups of T cells or CAR-T cells.Results::In this study, several tumor and T cell effector-mediated factors were considered to be related to treatment failure by an integrat analysis, including higher percentages of multiple myeloma (MM) cells in the bone marrow ( P = 0.0125), lower percentages of CAR-T cells in the peripheral blood at peak ( P = 0.0375), and higher percentages of CD8 + T cells ( P = 0.0340). Furthermore, there is a substantial correlation between high ctDNA level (>143 ng/mL) and shorter progression-free survival (PFS) ( P = 0.007). Multivariate Cox regression analysis showed that high levels of ctDNA (>143 ng/mL), MM-driven high-risk mutations (including IGLL5 [ P = 0.004], IRF4 [ P = 0.024], and CREBBP [ P = 0.041]), number of multisite mutations, and resistance-related mutation ( ERBB4, P = 0.040) were independent risk factors for PFS. Conclusion::Finally, a ctDNA-based risk model was built based on the above independent risk factors, which serves as an adjunct non-invasive measure of substantial tumor burden and a prognostic genetic feature that can assist in predicting the response to anti-BCMA CAR-T therapy.

This study explored the effect of the Mycobacterium tuberculosis(Mtb)PE/PPE family protein PE_PGRS37 on the growth of Mycobacterium smegmatis(Ms)and macrophage autophagy during Mtb infection.The pe_pgrs37 gene was amplified from Mtb genome through PCR,and the recombinant vector pAIN-PE_PGRS37 was successfully constructed through homologous recombi-nation.pAIN-PE_PGRS37 and pAIN were integrated into Ms through electroshock to construct pAIN-PGRS37/Ms and pAIN/Ms re-combinant bacteria.Western blotting indicated that the PE_PGRS37 protein was correctly expressed in pAIN-PE_PGRS37/Ms.The re-combinant bacteria were inoculated in 7H9/7H10 medium,and their colony morphology and growth curves were observed.No signifi-cant difference in colony morphology was observed between pAIN-PE_PGRS37/Ms and pAIN/Ms.The growth rate significantly in-creased between 10 and 16 h,and a plateau was reached at 26 h.After infection of U937 cells with pAIN-PE_PGRS37/Ms and pAIN/Ms,macrophage autophagy flow was detected with western blotting and immunofluorescence.In the pAIN-PE_PGRS37/Ms-infected group,compared with the pAIN/Ms-infected group,macrophage LC3-II and p62 protein expression was significantly up-regulated(P<0.001)and inhibited autophagosome and lysosome fusion.The intracellular survival of the recombinant bacteria was detected through colony counting,and pAIN-PE_PGRS37/Ms showed significantly greater survival in macrophages at 12 h,24 h,and 48 h than pAIN/Ms(P<0.05).Our results suggested that PE_PGRS37 protein promotes Mycobacterium survival in macrophages by blocking macro-phage autophagy flow,thus inhibiting macrophage autophagy.

Objective:To systematically search and summarize high-quality evidence-based evidence on the prevention and management of refeeding syndrome in patients with anorexia nervosa, and to provide a basis for preventive management of patients at high risk.Methods:A computerized search was conducted for evidence on the prevention and management of refeeding syndrome in patients with anorexia nervosa in relevant domestic and international databases and professional team websites, including clinical decision-making, guidelines, expert consensus, evidence summaries and systematic evaluations, and randomized controls. The search timeframe was from database construction to August 2024. Two researchers trained in systematic evidence-based knowledge independently performed literature screening, quality assessment, and extraction and summarization of evidence according to inclusion and exclusion criteria.Results:A total of 15 publications were included, which contained 4 guidelines, 3 expert consensus, 3 clinical decision-making, 3 systematic evaluations, and 2 randomized control trials. Thirty-one pieces of evidence for the prevention and management of refeeding syndrome were summarized in seven areas: treatment team, risk factors, risk assessment, preventive measures, clinical diagnosis, management measures, and patient safety.Conclusions:The best evidence summarized in this study for the prevention and management of refeeding syndrome in anorexia nervosa provides an evidence-based basis for practitioners to implement refeeding syndrome prevention and management measures.

Objective To observe the efficacy,safety,and compliance of lamotrigine combined with magnesium valproate in treating children with depressive episodes of bipolar disorder,and to explore the effects on thyroid hormone levels,brain-derived neurotrophic factor(BDNF),C-reactive protein(CRP),interleukin-1(IL-1),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and plasma concentration of valproate.Methods The children with bipolar disorder diagnosed from January 2023 to February 2025 were selected,and divided into the observation group and control group.The control group was treated with magnesium valproate tablets,and the observation group was added lamotrigine in addition to the treatment given to the control group.Both groups were treated continuously for 8 weeks.The clinical efficacy,the Hamilton Depression Scale-24(HAMD-24)score,Clinical Global Impression(CGI)assessment,thyroid hormone levels,BDNF,CRP,IL-1,IL-10 and TNF-α,daily average dose of magnesium valproate(D),blood concentration of valproate(C),C/D ratio,mean dosing interval(h),incidence of adverse reactions,and medication adherence and satisfaction scores in both groups was observed.Results A total of 100 children were included,50 in each group.After treatment,the total effective rate of the observation group was 98.00％which was significantly higher than that of the control group(84.00％)(P＜0.05).The serum free triiodothyronine(FT3),free thyroxine(FT4),BDNF and IL-10 in both groups increased compared to the previous(P＜0.05),while HAMD-24 score,CGI score,thyroid-stimulating hormone(TSH),CRP,IL-1 and TNF-α decreased(P＜0.05),and all indicators in the observation group were better than those in the control group(P＜0.05).Both groups had no serious or new adverse drug reactions,and the incidence of total adverse reactions,the difference in the incidence of total adverse reactions was not statistically significant(P＞0.05).There was no statistically significant difference in valproic acid blood concentrations between the two groups of children(P＞0.05).The medication compliance score and satisfaction score of the observation group were significantly higher than those of the control group(P＜0.05).Conclusion Combination of lamotrigine with magnesium valproate in children with depressive episodes of bipolar disorder improves treatment effective and clinical symptoms,promotes a rise in thyroid hormone and BDNF as well as improves inflammatory factors and increases medication adherence and satisfaction in children with a better safety profile.

Objective To construct a home care readiness program for caregivers of patients with chronic heart failure based on the McMaster Family Functioning Model and explore its application effects.Methods The pro-gram was developed through literature analysis,expert correspondence and pre-testing.86 pairs of patients with chronic heart failure and their caregivers who were admitted to the Department of Cardiology of a tertiary-level hos-pital in Bengbu City were conveniently selected from December 2023 to April 2024 as the study subjects.Using the coin-flip method,the patients were randomly divided into 43 pairs in an experimental group and 43 pairs in a control group on a ward-by-ward basis.The experimental group implemented the program on the basis of routine care,and the control group was given routine care.Differences in caregiver home care readiness,caregiver caregiv-ing ability and patients' quality of life were compared between the 2 groups at the time of admission,at the time of discharge,and 1 and 3 months after discharge.Results A total of 81 pairs of patients and their caregivers completed the intervention,with 41 in the experimental group and 40 in the control group.Repeated-measures ANOVA showed that there was an interaction effect between time and group for caregiver home care readiness,caregiver caregiving ability,and patient quality of life in both groups(F=320.995,P＜0.001;F=83.303,P＜0.001;F=113.283,P＜0.001).Simple effect analyses showed that caregiver home care readiness and caregiver caregiving com-petence scores were higher in the experimental group than those in the control group at the time of discharge and at 1 and 3 months post-discharge(P＜0.001);quality of life scores of patients in the experimental group were lower than it in the control group at 1 and 3 months post-discharge(P＜0.001).Conclusion The implemen-tation of the program can effectively improve the home care readiness and caregiving ability of caregivers of pa-tients with chronic heart failure,and improve the quality of life of patients.