ObjectiveTo explore the long-term dynamic trajectories of fasting blood glucose （FBG） and insulin resistance （IR） in patients with type 2 diabetes mellitus （T2DM） and their influencing factors. MethodsThis retrospective cohort study included 1 896 T2DM patients registered at Tongren Hospital from May 2020 to May 2025. Based on longitudinal follow-up data of FBG and fasting insulin， joint latent class mixed models （JLMM） were applied to identify FBG-IR trajectories. Univariate and multinomial logistic regression was used to examine demographic characteristics， lifestyle， and clinical determinants of trajectory type. ResultsFour distinct FBG-IR trajectories were identified： stable FBG-IR （9.76%）， rising FBG-stable IR （5.01%）， stable FBG-elevated IR （75.90%）， and elevated FBG-IR （9.34%）. Compared with the stable FBG-IR group， age ≥60 years was protective against the elevated FBG-stable IR trajectory （OR=0.55， 95%CI：0.33-0.92， P=0.023）. Highereducation increased the risk of stable FBG-elevated IR （OR=1.40， 95%CI：1.01-1.94， P=0.046）. Abnormal blood pressure was associated with lower risks of stable FBG-elevated IR （OR=0.66， 95%CI：0.48-0.92， P=0.013） and elevated FBG-IR （OR=0.48， 95%CI：0.31-0.74， P=0.001）. Non-drinkers were less likely to belong to the stable FBG-elevated IR trajectory （OR=0.39， 95%CI：0.16-0.95， P=0.038）. ConclusionsThe evolution trajectory of FBG and IR in T2DM patients shows significant heterogeneity. The majority of patients have a deterioration of IR first. Age， education level， blood pressure， and alcohol consumption are the main influencing factors. Joint assessment of FBG and IR is helpful for early identification of high-risk individuals and guiding individualized intervention.

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated disease. Patients with IBD are at significantly increased risk of anxiety and depression, with possible mechanisms including genetic susceptibility, brain-gut axis and dysbiosis. This review summarizes the latest research progress on the epidemiology, risk factors, mechanisms and treatment of anxiety and depression in IBD patients.

Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated disease. Patients with IBD are at significantly increased risk of anxiety and depression, with possible mechanisms including genetic susceptibility, brain-gut axis and dysbiosis. This review summarizes the latest research progress on the epidemiology, risk factors, mechanisms and treatment of anxiety and depression in IBD patients.

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective:To analyze the clinical efficacy and prognostic factors of comprehensive treatment for atypical teratoid / rhabdomyoma tumor (AT/RT).Methods:Clinical data of children diagnosed with AT/RT who underwent radiotherapy in Department of Oncology of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2012 to September 2022 were retrospectively analyzed. Pearson Chi-square test or continuous-corrected Chi-square test or Fisher's exact probability method were used for inter-group comparison of categorical variables. Independent sample t-test or Wilcoxon rank-sum test were used for inter-group comparison of continuous variables. Kaplan-Meier method was used to calculate the 1-year and 2-year overall survival (OS) rate and progression free survival (PFS) rate. Univariate and multivariate Cox regression analyses were employed to determine relevant prognostic factors. Results:A total of 45 patients were included, with a male/female ratio of 1.65:1, including 27 children aged ≥3 years old. All patients received surgery and radiotherapy in which 39 patients received chemotherapy, 41 craniospinal irradiation (CSI), and 4 whole brain or focal radiation therapy. The median follow-up was 28 (13.5, 49) months. A total of 14 patients died after comprehensive treatment. The 1-year OS rate was 80.0% and the PFS rate was 71.1%. The 2-year OS rate was 75.5% and the PFS rate was 65.7%. Survival prognostic analysis showed negative imaging assessment after radiotherapy ( HR=0.087, 95% CI: 0.011-0.697, P=0.022) was a favorable factor for PFS. The primary tumor<4.8 cm ( HR=0.221, 95% CI: 0.052-0.935, P=0.040) and CSI ( HR=0.085, 95% CI: 0.011-0.651, P=0.018) were favorable factors for OS. In subgroup analysis, CSI also improved OS in children aged ≥3 years ( HR=0.014, 95% CI: 0-0.470, P=0.017), but there was no significant difference in PFS. In children without cerebrospinal fluid dissemination, negative radiographic results after radiotherapy ( HR=0.066, 95% CI: 0.009-0.481, P=0.007; HR=0.076, 95% CI: 0.008-0.695, P=0.024, respectively) and CSI (HR=0.105, 95% CI: 0.012-0.937, P=0.044; HR=0.054, 95% CI: 0.005-0.629, P=0.020, respectively) were favorable factors for PFS and OS in children, and the primary tumor<4.8 cm also suggested a longer OS ( HR=0.094, 95% CI: 0.013-0.690, P=0.020). Conclusions:Comprehensive treatment including radiotherapy improves clinical prognosis of children with AT/RT. Our study shows that negative imaging results after radiotherapy are associated with PFS improvement. The primary tumor<4.8 cm and CSI are favorable factors for OS. CSI is also a significantly positive prognostic factor in children aged ≥3 years and those without cerebrospinal fluid dissemination.

Objective To understand the epidemic status of biological stings on an island and the knowledge about environmental emergencies of personnel stationed on the island.Methods With convenience sampling,we investigated 270 personnel using a self-designed anonymous questionnaire based on clinical treatment situation and on-the-spot investigation of the island.Results A total of 270 questionnaires were distributed,and 254 valid questionnaires were returned,with an effective rate of 94.07％.A total of 164(64.57％)personnel had a history of stings,with median times of 2(0,5).The main clinical symptoms were local swelling and pain(142 cases,86.59％)and pruritus(110 cases,67.07％).The personnel scored 14(11,17)for the first aid knowledge about island environmental emergencies(the full score was 26).The vast majority of personnel(227 cases,89.37％)believed that it was necessary to learn the knowledge about island environmental emergencies,and the majority of personnel(186 cases,73.23％)hoped to learn through centralized teaching.Conclusion The environmental emergencies represented by biological stings are becoming increasingly serious,so it is necessary to carry out multiple prevention and environmental control measures,and to carry out regular and long-term training for personnel stationed on islands.

Objective To explore the status quo and potential profile of self-management in elderly patients with venous leg ulcers,analyse the differences and influencing factors in different profiles,and provide references for clinical nursing.Methods Convenient sampling method was used to select patients who were followed up in the department of vascular surgery and vascular department of 3 tertiary A hospitals in Shanghai from October 2022 to May 2023 as the study subjects.General data questionnaire,Chronic Wound Patient Self-management Behavior Questionnaire,Health Literacy Management Scale,Brief Illness Perception Questionnaire,Social Support Rating Scale,Chronic Disease Self-Efficacy Scale and Geriatric Depression Scale-15 were used for investigation.Mplus 8.3 was used for potential profile analysis,and SPSS 25.0 was used for univariate analysis and multiple Logistic regression analysis.Results A total of 316 valid questionnaires were collected,and the patients were divided into 3 potential profiles according to their self-management level:low management-inefficient wound response,middle management-highly effective compliance and high management-efficient wound response,accounting for 25.63％,46.84％and 27.53％respectively.Multiple Logistic regression analysis showed that duration of illness,depression,health literacy,self-efficacy and illness perception were factors influencing the potential profile of self-management in elderly patients with venous leg ulcers.Conclusion The self-management level of elderly patients with venous leg ulcers is at a medium level and has obvious classification characteristics.Clinical nurses can take targeted nursing measures according to different characteristics of patients to improve their self-management ability.

Objective:To construct the enteral nutrition nursing scheme of ICU patients with abdominal hypertension based on internal abdominal pressure classification, and provide reference for effectively preventing enteral nutrition intolerance of ICU patients with abdominal hypertension.Methods:According to the "6S" evidence pyramid model, searched from top to bottom for relevant literature on enteral nutrition support for ICU patients with abdominal hypertension in databases such as BMJ Best Practice, Cochrane Library, Guidelines International Network, Medlive, UpToDate, PubMed, Ovid, Web of Science, Embase, China National Knowledge Infrastructure, VIP, Wanfang Medicine, Chinese Biomedical Literature. Developed an enteral nutrition care plan for ICU patients with abdominal hypertension based on intra-abdominal pressure grading, with a search date from database establishment to January 25, 2023. The Delphi expert letter consultation method was used to conduct two rounds of letter consultation with 20 experts to solicit expert opinions and determine the intervention plan.Results:The age of 20 experts was (43.75 ± 5.28) years old, with a working experience of (22.00 ± 6.98) years. The effective recovery rates of the two rounds of Delphi expert correspondence questionnaires were 100%(20/20), the expert judgment basis coefficients were 0.945 and 0.970, the familiarity coefficients were 0.865 and 0.895, and the authority coefficients were 0.905 and 0.932, respectively. Kendall coordination coefficient of importance of the first, second and third level items in the two rounds of expert correspondence were 0.100, 0.093, 0.098 and 0.200, 0.165, 0.119. The Kendall coordination coefficients of operability for the first, second and third level items were 0.117, 0.130, 0.115 and 0.200, 0.184, 0.154, respectively. Finally, an enteral nutrition nursing scheme for patients with abdominal hypertension in ICU was formed, which included 5 primary items, 30 secondary items and 51 tertiary items.Conclusions:The Delphi method in this study has a high degree of authority and enthusiasm of experts, and a good degree of coordination of expert opinions. The established enteral nutrition nursing scheme for ICU patients with abdominal hypertension based on intra-abdominal pressure classification is reliable and scientific, and can provide reference for clinical nursing practice of enteral nutrition for ICU patients with abdominal hypertension.

Objective:To study the urinary iodine levels of children in Jiangxi Province and provide a basis for prevention and treatment of iodine deficiency disorders and scientific iodine supplementation.Methods:From March to July in 2022, a systematic sampling method was used in 99 counties (cities, districts, abbreviated as counties) in Jiangxi Province. One township (street) was selected from each county in five directions: east, west, south, north and middle. One primary school was selected from each township (street), and 40 non boarding children aged 8 - 10 (half male and half female) were selected from each primary school. One random urine sample was collected to test urinary iodine, and the distribution of urinary iodine in different regions, genders, and ages were compared.Results:A total of 19 842 urine samples were collected from children, with a median urinary iodine level of 181.90 μg/L. The median urinary iodine levels of children in different cities ( H = 1 014.05, P < 0.001), genders ( Z = 6.44, P < 0.001) and ages groups ( H = 29.82, P < 0.001) were compared, and the differences were statistically significant. Conclusion:The urinary iodine level of children in Jiangxi Province is at an appropriate level, but the distribution of urinary iodine is uneven among different regions, genders, and ages, indicating that scientific and precise iodine supplementation is necessary for the prevention and treatment of iodine deficiency disorders.