Objective:To analyze the effects of hemoglobin, albumin, lymphocyte and platelet count (HALP) scores on the survival of gallbladder cancer patients after radical surgery, and to construct a prognostic prediction model and evaluate based on HALP scores.Methods:The clinical data of 95 patients with gallbladder cancer who underwent surgical treatment in Fuzong Clinical Medical College of Fujian Medical University (the 900th Hospital) from January 2010 to December 2022 were retrospectively analyzed, including 40 males and 55 females, with the age of (63.3±12.2) years. All patients were divided into a low HALP group (HALP score ≤35.4, n=45) and a high HALP group (HALP score >35.4, n=50) based on the optimal cut-off value of 35.4 for predicting postoperative survival as determined by the receiver operating characteristic (ROC) curve. Survival curves were plotted by the Kaplan-Meier method, and survival comparisons were performed using the log-rank test. Univariate and multivariate Cox regression were used to analyze the effect of HALP score on survival after radical surgery in patients with gallbladder cancer. Based on the multifactorial results, nomogram was constructed to predict the survival of gallbladder cancer patients after radical surgery, and ROC curves, consistency indexes were evaluated in the model. Results:A total of 95 patients were followed up for 1-150 months, with a median of 13 months. The 1-, 3-, and 5-year postoperative cumulative survival rates of patients in the low HALP group were 56.2%, 31.2%, and 11.1%, respectively, which were lower than those of the high HALP group, which were 82.9%, 59.6%, and 40.7%, and the difference was statistically significant ( χ2=12.50, P<0.001). Based on multifactorial Cox regression analysis, preoperative total bilirubin ≥23 μmol/L, with lymph node metastasis, tumor TNM stage Ⅲ-Ⅳ, and postoperative incision infection were the risk factors for survival after radical surgery in patients with gallbladder cancer, and a HALP score of >35.4 and Child-Pugh A were protective factors (all P<0.05). Based on the results of multivariate Cox regression analysis to construct a nomogram for predicting overall survival after radical surgery in patients with gallbladder cancer, the consistency index between the prediction of the nomogram and the actual situation was 0.801 (95% CI: 0.752-0.850), and the area under the ROC curve for predicting overall survival was 0.812 (95% CI: 0.704-0.902). Conclusion:The preoperative high HALP score (HALP > 35.4) is a protective factor for survival after radical surgery in gallbladder cancer patients, and the nomogram constructed based on the HALP score for survival prediction after radical surgery for gallbladder cancer has high accuracy and can be used for the assessment of postoperative survival.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Objective:To analyze the effects of hemoglobin, albumin, lymphocyte and platelet count (HALP) scores on the survival of gallbladder cancer patients after radical surgery, and to construct a prognostic prediction model and evaluate based on HALP scores.Methods:The clinical data of 95 patients with gallbladder cancer who underwent surgical treatment in Fuzong Clinical Medical College of Fujian Medical University (the 900th Hospital) from January 2010 to December 2022 were retrospectively analyzed, including 40 males and 55 females, with the age of (63.3±12.2) years. All patients were divided into a low HALP group (HALP score ≤35.4, n=45) and a high HALP group (HALP score >35.4, n=50) based on the optimal cut-off value of 35.4 for predicting postoperative survival as determined by the receiver operating characteristic (ROC) curve. Survival curves were plotted by the Kaplan-Meier method, and survival comparisons were performed using the log-rank test. Univariate and multivariate Cox regression were used to analyze the effect of HALP score on survival after radical surgery in patients with gallbladder cancer. Based on the multifactorial results, nomogram was constructed to predict the survival of gallbladder cancer patients after radical surgery, and ROC curves, consistency indexes were evaluated in the model. Results:A total of 95 patients were followed up for 1-150 months, with a median of 13 months. The 1-, 3-, and 5-year postoperative cumulative survival rates of patients in the low HALP group were 56.2%, 31.2%, and 11.1%, respectively, which were lower than those of the high HALP group, which were 82.9%, 59.6%, and 40.7%, and the difference was statistically significant ( χ2=12.50, P<0.001). Based on multifactorial Cox regression analysis, preoperative total bilirubin ≥23 μmol/L, with lymph node metastasis, tumor TNM stage Ⅲ-Ⅳ, and postoperative incision infection were the risk factors for survival after radical surgery in patients with gallbladder cancer, and a HALP score of >35.4 and Child-Pugh A were protective factors (all P<0.05). Based on the results of multivariate Cox regression analysis to construct a nomogram for predicting overall survival after radical surgery in patients with gallbladder cancer, the consistency index between the prediction of the nomogram and the actual situation was 0.801 (95% CI: 0.752-0.850), and the area under the ROC curve for predicting overall survival was 0.812 (95% CI: 0.704-0.902). Conclusion:The preoperative high HALP score (HALP > 35.4) is a protective factor for survival after radical surgery in gallbladder cancer patients, and the nomogram constructed based on the HALP score for survival prediction after radical surgery for gallbladder cancer has high accuracy and can be used for the assessment of postoperative survival.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To build a training and promotion model for traditional Chinese medicine nursing tourism project in Zhejiang Province, promoting homogeneous management and standardized promotion of traditional Chinese medicine nursing tourism project.Methods:From July 2022 to June 2023, purposive sampling was used to select 20 experts from ClassⅢ traditional Chinese medicine hospitals in Zhejiang Province for Delphi expert consultation. Two rounds of consultation were conducted via email to construct a training and promotion model for traditional Chinese medicine nursing tourism project in Zhejiang Province.Results:In the two rounds of expert consultation, the effective response rate of the questionnaire was 100% (20/20), the familiarity coefficient of the experts was 0.89, the judgment coefficient was 0.94, and the authority coefficient of the experts was 0.92. The Kendall harmony coefficients for two rounds of consultation were 0.268 and 0.105, respectively, with statistically significant differences ( P<0.001). The training and promotion model for traditional Chinese medicine nursing tourism project in Zhejiang Province included six first-level indicators, 22 second-level indicators, 74 third-level indicators, and 28 fourth-level indicators. Conclusions:The construction process of the training and promotion model for traditional Chinese medicine nursing tourism project in Zhejiang Province is rigorous and standardized, providing reference for training and helping to promote innovation and sustainable development of traditional Chinese medicine nursing.

Objective To observe clinical efficacy and safety of less invasive surfactant administration(LISA)in treatment of respiratory distress syndrome(RDS)in extremely premature infants.Methods A total of 65 cases premature infants diagnosed with RDS admitted to neonatal intensive care unit of Xiaogan Central Hospital from January 2021 to December 2023,with gestational age of 28+0～31+6 weeks.They were divided into LISA group(n=33)and intubation administration of surfactant extubation(InSurE)group(n=32)using a random number table method.The incidence of adverse events,blood gas analysis before and after administration,pulse oxygen saturation(SpO2),changes in blood pressure,clinical efficacy,complications,and outcomes were compared between two groups.Results There was no statistically significant difference in the incidence of drug reflux,bradycardia,apnea,or SpO2＜80％between two groups of operations(P＞0.05).During the operation,SpO2 of LISA group was lower than that of InSurE group,and blood pressure monitoring at the 2nd and 4th minutes were lower than those of InSurE group at the corresponding time points,with statistically significant differences(P＜0.05).After 1 hour of treatment,arterial partial pressure of oxygen in LISA group was higher than that in InSurE group,and arterial partial pressure of carbon dioxide was lower than that in InSurE group,with statistically significant differences(P＜0.05).The mechanical ventilation ratio and oxygen therapy time within 72 hours in LISA group were lower than those in InSurE group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in reuse rate of pulmonary surfactant(PS),and hospitalization time between two groups(P＞0.05).The incidence of grade 3-4 periventricular intraventricular hemorrhage,P-IVH in LISA group was lower than that in InSurE group,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in the incidence of other complications between two groups(P＞0.05).Conclusion Less invasive PS treatment for extremely premature infants with RDS can reduce the incidence of mechanical ventilation,shorten oxygen therapy time,and reduce the occurrence of severe P-IVH.

Objective To observe clinical efficacy and safety of less invasive surfactant administration(LISA)in treatment of respiratory distress syndrome(RDS)in extremely premature infants.Methods A total of 65 cases premature infants diagnosed with RDS admitted to neonatal intensive care unit of Xiaogan Central Hospital from January 2021 to December 2023,with gestational age of 28+0～31+6 weeks.They were divided into LISA group(n=33)and intubation administration of surfactant extubation(InSurE)group(n=32)using a random number table method.The incidence of adverse events,blood gas analysis before and after administration,pulse oxygen saturation(SpO2),changes in blood pressure,clinical efficacy,complications,and outcomes were compared between two groups.Results There was no statistically significant difference in the incidence of drug reflux,bradycardia,apnea,or SpO2＜80％between two groups of operations(P＞0.05).During the operation,SpO2 of LISA group was lower than that of InSurE group,and blood pressure monitoring at the 2nd and 4th minutes were lower than those of InSurE group at the corresponding time points,with statistically significant differences(P＜0.05).After 1 hour of treatment,arterial partial pressure of oxygen in LISA group was higher than that in InSurE group,and arterial partial pressure of carbon dioxide was lower than that in InSurE group,with statistically significant differences(P＜0.05).The mechanical ventilation ratio and oxygen therapy time within 72 hours in LISA group were lower than those in InSurE group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in reuse rate of pulmonary surfactant(PS),and hospitalization time between two groups(P＞0.05).The incidence of grade 3-4 periventricular intraventricular hemorrhage,P-IVH in LISA group was lower than that in InSurE group,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in the incidence of other complications between two groups(P＞0.05).Conclusion Less invasive PS treatment for extremely premature infants with RDS can reduce the incidence of mechanical ventilation,shorten oxygen therapy time,and reduce the occurrence of severe P-IVH.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Cholangiocarcinoma is the most common malignant tumor of the biliary tract, with a relatively high mortality rate and an incidence rate increasing year by year. Due to atypical symptoms in the early stage and complex anatomical location, it is often difficult for patients with cholangiocarcinoma to be diagnosed in the early stage, and therefore, they often miss the optimal treatment period and tend to have poor prognosis. In recent years, studies have shown that miRNAs play a key role in the pathophysiological process of the development and progression of cholangiocarcinoma. This article reviews the regulatory role of miRNAs in the development, invasion, metastasis, drug resistance, and tumor microenvironment of cholangiocarcinoma and introduces the latest advances in exosome miRNA and cholangiocarcinoma, so as to provide potential treatment strategies for cholangiocarcinoma.