Objective:To understand the current status and analyze the factors of demoralization of patients with chronic heart failure (CHF), providing references for targeted psychological interventions of nursing staff.Methods:Using the cross-sectional survey method, from August 2022 to January 2023, 282 CHF patients who were followed up in the Cardiovascular Department of the First Affiliated Hospital of Zhengzhou University were selected as the study subjects. They were investigated using the General Information Questionnaire, Demoralization Scale Revised Mandarin Version, Brief Illness Perception Questionnaire (BIPQ), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and the factors influencing the demoralization of CHF patients were analyzed using univariate analysis and multiple linear regression.Results:Among 282 cases, male 172 cases, female 110 cases, aged (62.29±10.05) years old. The Demoralization Scale Revised Mandarin Version′s score of CHF patients was (30.30 ± 10.37) points; the score of BIPQ was (42.18 ± 13.94) points; the score of FoP-Q-SF was (35.41 ± 7.29)points, which were at high level. The results of multiple linear regression analysis showed that patient disease duration, disease stages, New York heart association cardiac function classification, the score of BIPQ, and the score of FoP-Q-SF were factors influencing the demoralization of CHF patients ( t values were 3.08 to 12.50, all P<0.05). Conclusions:There is an urgent need to focus on the current status of the demoralization of CHF patients. It is necessary to develop a systematic and effective intervention strategy for demoralization, to take into account patient disease duration, disease stages, illness perception, and fear of progression in a comprehensive manner.

Objective:To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure. It provided a theoretical basis for targeted interventions for healthcare workers.Methods:From October 2022 to March 2023, 320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling. The General Information Questionnaire, Demoralization Scale Redacted Mandarin Version, Brief Illness Perception Questionnaire, Fear of Progression Questionnaire-Short Form, Positive and Negative Affect Schedule (Positive Affect Schedule) were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model.Results:There were 268 valid questionnaires. Of the 268 patients, 168 were male and 100 were female, 3.36% (9/268) were ≤40 years old, 55.22% (148/268) were 41-65 years old, and 41.42% (111/268) were >65 years old. Correlation analysis showed that disease perception was positively correlated with disease progression ′s fear, and every dimension of demoralization ( r values were 0.300-0.586, all P<0.01), and negatively correlated with positive affect ( r=-0.374, P<0.01); disease progression′s fear was negatively correlated with positive affect ( r=-0.318, P<0.01), and positively correlated with every dimension of demoralization ( r values were 0.339-0.464, all P<0.01); positive affect was negatively correlated with every dimension of demoralization ( r values were -0.430--0.334, all P<0.01). Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant ( β=0.407, P<0.01), and both mediating effects of disease progression ′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant ( β=0.074, 0.079, both P<0.01). The chain mediating effect of disease progression ′s fear and positive effect was also significant ( β=0.019, P<0.01). Conclusions:Disease perception could directly predict the demoralization of patients with chronic heart failure and indirectly predict the demoralization of patients with chronic heart failure through the mediating effect of disease progression ′s fear, positive affect, and the chain mediating effect of disease progression ′s fear and positive affect.

As a practical carrier for promoting the tiered diagnosis and treatment model, the medical consor-tium is of great significance for balancing medical resources and boosting medical service efficiency. The construction of medical consortiums not only improves the accessibility of high-quality medical resources for patients, but also enhances the diagnostic and treatment level of member units. Meanwhile, it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction. As the core of medical insurance payment reform, DRG, through indicators such as the case mix index(CMI) and the number of diagnosis related group (DRG), provides objective and quantified data support for case management and disease structure optimization, thus effectively guiding the rational allocation of medical resources and the adjustmentof diseases and surgical types within the medical consortium. Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system, provides a clear direction for medical consortium cooperation, thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win-win situation for all parties involved. This paper, based on the "1+5+1" medical consortium cooperation model centered around Peking Union Medical College Hospital, utilizes DRG indicators to analyze the benefits for patients, member hospitals, and the leading hospital during the medical consortium construction process, with the hope of providing reference for the construction of a medical consortium evaluation system.

Introduction::Observational studies have revealed an association between waist circumference (WC) and atrial fibrillation (AF). However, it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors. Therefore, the causal role of WC in AF is unclear. This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization (MR) analysis.Methods::In our two-sample MR analysis, the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study (GWAS) of WC (42 single nucleotide polymorphisms with a genetic significance of P <5 × 10 –8). The data of WC (from the Genetic Investigation of ANthropometric Traits consortium, containing 232,101 participants) and the data of AF (from the European Bioinformatics Institute database, containing 55,114 AF cases and 482,295 controls) were used to assess the causal role of WC on AF. Three different approaches (inverse variance weighted [IVW], MR–Egger, and weighted median regression) were used to ensure that our results more reliable. Results::All three MR analyses provided evidence of a positive causal association between high WC and AF. High WC was suggested to increase the risk of AF based on the IVW method (odds ratio [OR] = 1.43, 95% confidence interval [CI], 1.30–1.58, P = 2.51 × 10 -13). The results of MR–Egger and weighted median regression exhibited similar trends (MR–Egger OR = 1.40 [95% CI, 1.08–1.81], P = 1.61 × 10 -2; weighted median OR = 1.39 [95% CI, 1.21–1.61], P = 1.62 × 10 -6). MR–Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF. Conclusions::Our findings suggest that greater WC is associated with an increased risk of AF. Taking measures to reduce WC may help prevent the occurrence of AF.

Objective Stereotactic body radiotherapy(SBRT)and radiofrequency ablation(RFA)are primary treatments for hepatocellular carcinoma(HCC)at present.However,the effect of these treatments in clinical trails are rather controversial.The purpose of this paper is to conduct a meta-analysis on the clinical effect and related complications of SBRT and RFA for HCC.Methods A computerized retrieval of academic papers concerning the treatment effect of SBRT and RFA for HCC from the databases of PubMed,Embase,Cochrane Library,Scopus,Web of Science,CBM,CNKI,Wanfang database,VIP was conducted.The retrieval time period was from the establishment of the database to June 2022.Stata14.0 software was used to make meta-analysis.Results A total of 14 retrospective studies including 6 806 patients were included in this analysis.The results of combined hazard ratio(HR)based on overall survival(OS)showed that the OS rate of SBRT was lower than that of RFA(HR=1.25,95％CI=1.10-1.43,12=0％,P=0.000 9),while the results of combined HR of local control(LC)rate indicated that SBRT had a better therapeutic effect(HR=0.61,95％CI=0.47-0.78,I2=0％,P=0.000 1).Subgroup analysis revealed that the combined HR of LC rate favored the performance of SBRT for patients with tumor diameter larger than 2 cm(HR=2.64,95％CI=1.56-4.48,I=0％,P=0.000 3).No statistically significant difference in the incidence of late serious adverse reactions existed between SBRTgroup and RFA group(OR=1.01,95％CI=0.59-1.73,I2=30％,P=0.97).Conclusion SBRT is superior to RFA in controlling local HCC lesions,especially in patients whose tumor diameter is larger than 2 cm,although it does not show certain advantages in the survival benefit.(J Intervent Radiol,2023,32:1233-1241)

As an important biological resource of a country or region, human genetic resources (HGR) are increasingly attracting attention and concern from many countries internationally, and even have been elevated to the dimension of national sovereignty by many countries. As a large country with rich and diverse HGR, relevant regulatory work in China started relatively late compared to foreign countries, but has developed rapidly. However, looking around the world, there is still room for further improvement and development of domestic HGR regulation. By reviewing the regulatory legislation of HGR in some countries abroad, this paper sorted out their advanced experience and highlighted measures in detail, and summarized their deep-seated legislative guidance. A detailed analysis and evaluation were conducted from seven aspects:the advanced level of HGR legislation and the enhancement of legal effectiveness, the systematization and systematization of policies and regulations, the unification of platforms and relevant standards, the highlight of the concept of ethics and the rule of law, the strengthening of anti-discrimination protection, the special protection of major human genetic family resources and national special protection areas of HGR, and the establishment of principled consensus or agreement on HGR in international and local regions, to provide reference for the construction of regulatory policies and legal systems for HGR in China.

Objective : To explore the role and molecular mechanism of circHIPK3 in the migration and invasion of nasopharyngeal carcinoma cells. Methods : Firstly , we searched public databases and analyzed the expression level of circHIPK3 in nasopharyngeal carcinoma tissues and non⁃cancerous tissues in Gene Expression Database (GEO) . Then , the circHIPK3 siRNA was synthesized and transfected into the NPC cell line 5 ⁃8F. After validate the efficiency of circHIPK3 knockdown , the proliferation , migration and invasion capacities of 5 ⁃8F cells were evaluated by CCK⁃8 , wound healing and transwell assay. Meanwhile , the mRNA and protein expression of downstream genes , including CDH1 , CDH2 , MMP2 , MMP9 and IL⁃6/STAT3 were determined by RT⁃qPCR and Western blot. Finally , transcriptome sequencing technology was used to analyze the significantly differentially expressed genes after the interference of circHIPK3 ⁃siRNA in 5 ⁃8F cells , in order to find out the key genes mediating the oncogenesis role of circHIPK3. Results : circHIPK3 expression significantly increased in nasopharyngeal carcinoma tissues compared with non⁃cancerous tissues ( P < 0. 05 ) . After siRNA⁃specific knockdown of circHIPK3 expression in 5 ⁃8F cells , the proliferation , scratch healing rate , and the number of migrated /invaded cells were significantly reduced (P < 0. 05 , P < 0. 01 , P < 0. 05 respectively) . Meanwhile , the mRNA and protein levels of CDH1 significantly increased (P < 0. 001) , but the CDH2 , MMP2 , MMP9 , IL⁃6/STAT3 mRNA and protein levels were significantly reduced (P < 0. 05) . Further analysis by RNA⁃seq showed that the expression of AL645922. 1 , SCO2 , AL136295. 1 and ISY1 ⁃RAB43 was significantly up⁃regulated( P < 0. 05 ) , and the expression of BIVM⁃ERCC5 , FAM47E⁃ST⁃BD1 , INO80B⁃WBP1 , NAIP , C15orf38⁃AP3S2 , BCL2L2⁃PABPN1 and SMIM11B was significantly down⁃regulated (P < 0. 05) in circHIPK3 ⁃siRNA transfected 5 ⁃8F cells. Conclusion circHIPK3 expression is significantly upregulated in nasopharyngeal carcinoma tissues. circHIPK3 promotes 5 ⁃8F cells proliferation , migration and invasion by regulating the expression of E ⁃Cadherin , N ⁃Cadherin , MMP2 , MMP9 and IL⁃6/STAT3. Genes such as AL645922.1 and BIVM⁃ERCC5 may play a key role in promoting the migration and invasion of nasopharyngeal carcinoma 5 ⁃8F cells mediated by circHIPK3.

Objective To explore whether indoor light-assisted therapy can rapidly improve depression and anxiety symptoms in patients with depression,as well as the safety of indoor-light-assisted therapy.Methods From September 2021 to December 2022,patients with depression were recruited from the Mental Health Center of the First Hospital of Hebei Medical University.According to the random number table method,patients were divided into test group and control group.The test group was treated with light therapy 30 minutes from 7:30 am to 8:00 am daily for 2 weeks in addition to antidepressant therapy.Antidepressant therapy was continued after completion of light therapy and patients were followed up for 2 weeks.The control group was treated with regular antidepressants throughout the four-week trial.Hamilton depression scale(HAMD17)and the Hamilton anxiety scale(HAMA)were used to assess the clinical symptoms at the baseline and the end of every week of treatment.Safety was evaluated using patient adverse events,anterior segment photography and visual testing.Results A total of 80 patients were enrolled,including 40 in the test group and 40 in the control group.The data of dropped were processed for missing values and then included in the statistical analysis.At the 1st(20.0％vs.0.0％)and 2nd(45.0％vs.17.5％)weekend of treatment,the response rate in the test group was significantly higher than that in the control group.There was an interaction between the time point and the group in HAMD17 total score(F=9.66,P<0.01).The scores of HAMD17 at the end of every week in the test group were significantly lower than that in the control group(P<0.05).There were significant differences in the reduction rate of total score in HAMD17[33.3％(25.0％,43.3％)vs.13.9％(9.9％,19.8％)]and HAMA[22.4％(16.5％,35.3％)vs.14.2％(4.4％,26.9％)]between the two groups(P<0.05).Incidences of adverse effect were not significantly different between the two groups(12.5％vs.10.0％,P=1.00).There were no severe adverse events or mania was reported in the test group and the eye examination showed no abnormality.Conclusion Compared with antidepressant therapy alone,indoor light therapy combined with antidepressant can quickly improve depression and anxiety symptoms in patients with depression,shorten the duration of depression treatment,and has good safety.

Objective:To analyze the efficacy of the new forest parenting programme (NFPP) for children and families with attention deficit hyperactivity disorder (ADHD) in China, and to explore the feasibility and effectiveness of the programme in China.Methods:Twenty-two children with ADHD diagnosed at the Child Psychology Development and Behavior Outpatient Clinic of the First Affiliated Hospital of Jinan University and their primary caregivers were included in the study from January 2022 to May 2023. The children with ADHD were divided into an experimental group ( n=11) and a control group ( n=11) according to the personal preference of the primary caregivers. The experimental group was provided with the NFPP intervention once a week for a period of 8 weeks. The Chinese version of Swanson Nolan and Pelham, version Ⅳ scale-parent form(SNAP-Ⅳ)and Weiss functional impairment rating scales-parent report(WFIRS-P))were used to assess the improvement of core symptoms and social function impairment in the two groups before and after the intervention. In the experimental group, the Chinese parenting sense of competence scale (C-PSOC) and the parenting styles and dimensions questionnaire (PSDQ) were used to evaluate the parenting efficiency and improvement of parenting styles of primary caregivers in ADHD families before and after NFPP intervention. A Semi-open interview was conducted with 11 primary caregivers of ADHD children in the experimental group at the end of the intervention regarding knowledge of ADHD disease diagnosis and treatment, parenting attitudes, and parenting behaviors. The data was statistically analyzed by SPSS 26.0 software.Statistical analysis of data was used by independent sample t-test, paired sample t-test, Mann Whitney U-test, and rank sum test. Results:(1) Compared with the post-intervention control group, the total score((4.01±1.05), (2.79±0.94), t=2.875, P<0.05) in the SNAP-Ⅳ, the scores of the oppositional defiance dimension((1.27±0.34), (0.70±0.33), t=4.043, P<0.05) in the SNAP-Ⅳ, the scores of the family in WFIRS-P ((0.92±0.47), (0.56±0.26), t=2.246, P<0.05), and the scores of life skills in WFIRS-P (1.1(0.9, 1.3), (0.6(0.5, 0.8), Z=-2.013, P<0.05)were significantly lower in the post-intervention experimental group ( P<0.05). After intervention, the scores of the 3 dimensions of attention deficit, impulsivity/hyperactivity, and oppositional defiance and the total score of the SNAP-Ⅳ in the experimental group were significantly lower than those before intervention (all P<0.05). (2) After intervention, the score of the parenting efficacy dimension in the C-PSOC in experimental group was significantly higher than pre-intervention ( P<0.05). After intervention, the scores of the PSDQ for authoritative parenting style in the self-assessment and other-assessment in the experimental group were significantly higher than pre-intervention (all P<0.05), and the scores of the authoritarian parenting style and the permissive parenting style were significantly lower than pre-intervention (all P<0.05). (3) The results of the semi-open interview suggested that, the primary caregivers of children with ADHD in the experimental group had a positive attitude toward the NFPP intervention and were able to participate in the entire 8-week intervention, and apply the learned parenting skills to daily life to continuously improve parenting efficiency. After the NFPP intervention, the primary caregivers of children with ADHD had a deeper understanding of the knowledge of ADHD diseases, behavioral characteristics of children with ADHD, and so on. In the intervention content, the modules such as time management, communication skills and behavioral prediction were easy to grasp and effective. Conclusion:The NFPP can significantly improve the core symptoms of Chinese children with ADHD, increase the parenting efficacy of their primary caregivers, and improve their parenting styles.

Objective:To evaluate the predictive value of the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration for postoperative acute kidney injury (AKI) in neonates undergoing cardiac surgery.Methods:Perioperative data of 110 consecutive neonates (≤28 days) who underwent cardiac surgery in our hospital from October 2017 to May 2021, were collected retrospectively.According to pROCK criteria, the patients were divided into AKI group and non-AKI group.Demographics, predominant diagnosis, laboratory examination, perioperative management and postoperative outcomes were compared between two groups.The concentration of serum NT-proBNP was routinely measured within 12 h after operation.Multivariate logistic regression analysis was performed for the association between serum NT-proBNP and postoperative AKI.Receiver operating characteristic curve was drawn, and the predictive value of serum NT-proBNP for postoperative AKI was determined according to the area under the curve.Results:A total of 106 neonates were enrolled, and the incidence of postoperative AKI was 54.7%.There were significant difference in the baseline hemoglobin concentration, hematocrit and serum creatinine and serum NT-proBNP concentration between AKI group and non-AKI group ( P<0.05). Multivariate logistic regression analysis indicated that NT-proBNP level was an independent risk factor for AKI after cardiac surgery in neonates ( odds ratio 2.49, 95% confidence interval 1.183-5.23, P=0.016). The area under the curve of NT-proBNP predicting AKI after cardiac surgery was 0.66 (95% confidence interval 0.56-0.76, P=0.007). Conclusions:Elevated serum NT-proBNP concentration is an independent risk factor for AKI after cardiac surgery in neonates and has a certain predictive value for AKI, and close monitoring of perioperative NT-proBNP level is helpful for early identification of high-risk neonates.