Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Irritable bowel syndrome （IBS） is a functional bowel disorder characterized primarily by abdominal pain and altered defecation habits. In recent years， traditional Chinese medicine （TCM） has made progress in multiple aspects of IBS research and treatment， including syndrome distribution， development of TCM formulas， clinical efficacy evaluation， external therapies， and psychosocial regulation. However， it still faces challenges such as over-reliance on symptomatic manifestations rather than biomarkers for diagnostic criteria， and the lack of high-quality evidence-based data supporting the efficacy of TCM formulas in treating IBS. This paper proposed that TCM diagnosis and treatment of IBS should adhere to the strategy of integrating the holistic concept with syndrome differentiation and treatment， combining TCM external therapies such as acupuncture， moxibustion and acupoint application）， and emphasizing individualized diagnosis and treatment for psychosomatic abnormalities. Future research should integrate multi-omics technologies， artificial intelligence and other methods to deepen the understanding of the pathogenesis of IBS and the mechanisms of TCM formulas， so as to promote the standardization and internationalization of TCM in the diagnosis and treatment of IBS.

The diagnosis,treatment,and prognosis evaluation of cervical spondylosis are challenging in clinic.Machine learning(ML)models can improve the accuracy and efficiency of cervical spondylosis diagnosis by processing complex clinical data,assist in selecting more precise treatment plans,and evaluate prognosis.Through the domestic and foreign literature review on the application of ML models in cervical spondylosis in recent years,the study classifies and summarizes the relevant models applied in the diagnosis,treatment,and prognosis evaluation of cervical spondylosis,introduces classic algorithms such as random forest,as well as new algorithms such as convolutional neural networks,deep neural networks and long short-term memory networks,aiming to provide reference ML solutions for various stages of cervical spondylosis diagnosis and treatment.

Chronic gastritis is a chronic inflammation of the gastric mucosa caused by various etiologies and can be categorized into chronic non-atrophic gastritis and chronic atrophic gastritis.Chronic atrophic gastritis is a common disorder of the digestive system characterized by gastric mucosal gland atrophy,mucosal thinning,and basal layer thickening.The development of intestinal metaplasia and atypical hyperplasia on this basis is recognized as a precancerous lesion of gastric cancer and represents a key stage in the"inflammation-cancer transformation"of chronic gastritis.However,universally recognized and effective treatment strategies for this"inflammation-cancer transformation"process are lacking in clinical practice.This study integrates Correa′s cascade reaction with clinical practice,summarizing the pathogenesis of the"inflammation-cancer transformation"of chronic gastritis as weakness of the middle jiao and blood stasis.It suggests that the"inflammation-cancer transformation"process involves the pathological development of spleen and stomach deficiency,transportation and transformation dysfunction,turbid phlegm,blood stasis,and the gradual formation of cancerous toxins,with spleen and stomach weakness as the core mechanism and phlegm and blood stasis as the crucial pathological link.Based on an in-depth exploration of the deficiency of the middle jiao and blood stasis,supported by pharmacological research and clinical experience,this paper proposes the therapeutic approach of strengthening the spleen and replenishing qi,expelling phlegm and activating blood.It discusses the related prescriptions in preventing and treating the"inflammation-cancer transformation"of chronic gastritis.This study aims to provide new perspectives and insights for the prevention and treatment of chronic gastritis with traditional Chinese medicine,offering a novel framework for clinical treatment.

Objective To compare the short-term outcomes and long-term prognosis between laparoscopic and open surgery for large gastric gastrointestinal stromal tumors(GISTs).Methods A retrospective cohort study was conducted on 110 patients with large gastric GISTs who underwent surgical treatment in the medical department of general surgery,Chinese People's Liberation Army General Hospital,from January 2015 to December 2020.Among them,47 were males(42.73%)and 63 were females(57.28%),with a median age of 55 years.Patients were divided into the open surgery group(n=57)and the laparoscopic surgery group(n=53)based on the surgical approach.Pro-pensity score matching(PSM)was performed using a 1∶1 nearest-neighbor matching method,resulting in 34 patients in each group after matching.Short-term outcomes and long-term prognosis were compared between the two groups.Results After matching,the laparoscop-ic surgery group showed significantly better outcomes than the open surgery group in terms of drainage tube removal time,operative time,intraoperative blood loss,and postoperative hospital stay(all P<0.05).No significant differences were observed in nasogastric tube removal time,time to first flatus,or time to resuming oral intake(all P>0.05).The open surgery group had lower hospitalization cost compared to the laparoscopic surgery group(P<0.05).Regarding long-term survival,the 1-,3-,and 5-year disease-free survival(DFS)rates in the lapa-roscopic surgery group were 100%,88.1%,and 88.1%,respectively,while those in the open surgery group were 100%,94.1%,and 94.1%.The 1-,3-,and 5-year overall survival(OS)rates in the laparoscopic surgery group were 100%,100%,and 88.8%,respectively,compared to 100%,97.1%,and 94.7%in the open surgery group.No statistically significant differences were found in DFS and OS between the two groups(both P>0.05).Conclusions Laparoscopic resection of large gastric GISTs is safe and feasible,without increasing the risk of tumor recurrence,and achieves comparable efficacy to open surgery.However,its application should still be approached with caution.

Objective:To explore the chain mediating role of general self-efficacy and humanistic care competence between oncology nurses' empathy and medical narrative competence, with a view to informing the development of targeted medical narrative competence enhancement strategies.Methods:Convenience sampling was used to select 1 104 oncology nurses from 17 ClassⅢ Grade A hospitals in Yunnan Province from May to August 2023 for the study. The General Information Questionnaire, Narrative Competence Scale, Chinese version of the Jefferson Scale of Empathy, Caring Ability Inventory, and General Self-Efficacy Scale were used to survey oncology nurses. Pearson correlation was used to analyze the correlation among oncology nurses' general self-efficacy, empathy, humanistic care competence, and medical narrative competence. Mediating effects were analyzed using Model 6 in the SPSS macro program PROCESS 4.0 plug-in. Bootstrap method was used to repeat the sampling 5 000 times for the chained mediating effect test.Results:A total of 1 104 questionnaires were distributed and the number of valid questionnaires recovered was 931, with a valid recovery rate of 84.33% (931/1 104). Among 931 oncology nurses, the scores of Narrative Competence Scale, Caring Ability Inventory, Chinese version of Jefferson Scale of Empathy, and General Self-Efficacy Scale were (151.52±17.61), (191.68±18.80), (95.31±13.96), and (27.59±6.02), respectively. There was a positive two-by-two correlation among oncology nurses' medical narrative competence, empathy, humanistic care competence, and general self-efficacy ( P<0.01). General self-efficacy and humanistic care competence acted as chain mediators between oncology nurses' empathy and medical narrative competence, with the mediating effect accounting for 43.13% of the total effect. Conclusions:General self-efficacy and humanistic care are mediating variables between oncology nurses' empathy and medical narrative competence. Nursing managers should focus on the cultivation of nurses' empathy, stimulate nurses' self-efficacy, and promote the practice of nursing humanistic care, which in turn improves oncology nurses' medical narrative competence and the quality of nursing services.

Objective:To explore the clinical efficacy of layered thinning superficial circumflex iliac artery perforator (SCIP) flap based on color Doppler ultrasound (CDU) positioning.Methods:The study was a retrospective observational study. From February 2023 to February 2024, 14 patients who met the inclusion criteria were admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital Affiliated to Capital Medical University, including 11 males and 3 females, aged 15 to 60 years. The wound area was from 7 cm×4 cm to 14 cm×11 cm. Before the flap transplantation surgery, CDU was used to accurately locate the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery. During the surgery, the SCIP flap was thinned in layers to repair the hand and forearm wounds of 11 patients and foot wounds of 3 patients. The flap incision area ranged from 8 cm×5 cm to 15 cm×12 cm. The donor area wounds of flaps were sutured directly. During the surgery, the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was observed and compared with the result of CDU positioning before the surgery, and the flap thickness was measured. The flap survival and occurrence of adverse reactions were observed after the surgery. During follow-up, the appearance and texture of flaps, and the wound healing in the donor area was observed. At the last follow-up, the function of the wrist and hand in the affected limbs was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the function of the foot and ankle in the affected limbs was evaluated according to the scoring standard of American Orthopaedic Foot and Ankle Society.Results:During the surgery, the deep fascial exit point of the superficial branch of the superficial circumflex iliac artery in the flap donor area was consistent with the result of CDU positioning before the surgery, and the distance between them was less than 10 mm. The flap thickness was 5 to 8 mm with an average of 6.2 mm. All the flaps survived after surgery. During the follow-up of 5 to 12 months, the flaps had good appearance and texture, all the wounds in the donor areas healed with only linear scar left. At the last follow-up, the function of the wrist and hand in the affected limbs was evaluated as excellent in 9 cases, good in one case, and fair in one case; the function of the foot and ankle in the affected limbs was evaluated as excellent in one case and good in two cases.Conclusions:CDU examination can provide precise preoperative perforator positioning for layered thinning of SCIP flap and contribute to the optimization of flap design, so as to avoid the problem of flap necrosis caused by improper preoperative design to some extent and improve the safety of surgery. In addition, the layered thinning SCIP flap results in less damage to the donor area and is beneficial for the recovery of the affected limb function, which is worthy of clinical promotion.

Objective To compare the short-term outcomes and long-term prognosis between laparoscopic and open surgery for large gastric gastrointestinal stromal tumors(GISTs).Methods A retrospective cohort study was conducted on 110 patients with large gastric GISTs who underwent surgical treatment in the medical department of general surgery,Chinese People's Liberation Army General Hospital,from January 2015 to December 2020.Among them,47 were males(42.73%)and 63 were females(57.28%),with a median age of 55 years.Patients were divided into the open surgery group(n=57)and the laparoscopic surgery group(n=53)based on the surgical approach.Pro-pensity score matching(PSM)was performed using a 1∶1 nearest-neighbor matching method,resulting in 34 patients in each group after matching.Short-term outcomes and long-term prognosis were compared between the two groups.Results After matching,the laparoscop-ic surgery group showed significantly better outcomes than the open surgery group in terms of drainage tube removal time,operative time,intraoperative blood loss,and postoperative hospital stay(all P<0.05).No significant differences were observed in nasogastric tube removal time,time to first flatus,or time to resuming oral intake(all P>0.05).The open surgery group had lower hospitalization cost compared to the laparoscopic surgery group(P<0.05).Regarding long-term survival,the 1-,3-,and 5-year disease-free survival(DFS)rates in the lapa-roscopic surgery group were 100%,88.1%,and 88.1%,respectively,while those in the open surgery group were 100%,94.1%,and 94.1%.The 1-,3-,and 5-year overall survival(OS)rates in the laparoscopic surgery group were 100%,100%,and 88.8%,respectively,compared to 100%,97.1%,and 94.7%in the open surgery group.No statistically significant differences were found in DFS and OS between the two groups(both P>0.05).Conclusions Laparoscopic resection of large gastric GISTs is safe and feasible,without increasing the risk of tumor recurrence,and achieves comparable efficacy to open surgery.However,its application should still be approached with caution.

Objective:To analyze the correlation between the skin temperature variation trajectory in the radiation field and the occurrence of grade 2 or higher radiation dermatitis in female breast cancer patients during postoperative radiotherapy.Methods:This prospective cohort study used convenience sampling to select 103 breast cancer patients who underwent modified radical mastectomy and subsequent radiotherapy at the Fourth Hospital of Hebei Medical University from May 2022 to December 2022. All patients received three-dimensional conformal radiotherapy (3D-CRT), with an irradiation field covering the chest wall ± supraclavicular and infraclavicular lymphatic drainage regions, and a prescribed dose of 50 Gy delivered in 25 fractions. Skin temperature in the irradiated area was measured using an infrared thermometer before radiotherapy and on the days of the 5 th, 10 th, 15 th, 20 th, and 25 th fractions. The latent classes of skin temperature variation trajectories were identified using the Mplus latent class growth model, and logistic regression was applied to analyze the correlation between the skin temperature variation trajectory and the occurrence of grade 2 or higher radiation dermatitis. Results:The skin temperature variation trajectories in the irradiated field of breast cancer patients undergoing postoperative radiotherapy could be divided into two groups: the temperature non-increasing group (81/103) and the temperature increasing group (22/103). The Akaike information criterion (AIC) was 66.468, the Bayesian information criterion (BIC) was 116.528, and the entropy was 0.810, with a likelihood ratio test P-value of 0.037, and a Bootstrap-based likelihood ratio test P-value<0.001. After adjusting for covariates such as age and body mass index, logistic regression analysis showed that the risk of developing grade 2 or higher radiation dermatitis in the temperature increasing group was 6.92 times of that in the temperature non-increasing group ( OR=6.92, 95% CI = 2.30-20.82, P=0.001). Conclusions:There is group heterogeneity in the skin temperature variation trajectories of breast cancer patients undergoing radiotherapy, and patients with a rise in skin temperature have a higher risk of developing grade 2 or higher acute radiation dermatitis.

Chronic gastritis is a chronic inflammation of the gastric mucosa caused by various etiologies and can be categorized into chronic non-atrophic gastritis and chronic atrophic gastritis.Chronic atrophic gastritis is a common disorder of the digestive system characterized by gastric mucosal gland atrophy,mucosal thinning,and basal layer thickening.The development of intestinal metaplasia and atypical hyperplasia on this basis is recognized as a precancerous lesion of gastric cancer and represents a key stage in the"inflammation-cancer transformation"of chronic gastritis.However,universally recognized and effective treatment strategies for this"inflammation-cancer transformation"process are lacking in clinical practice.This study integrates Correa′s cascade reaction with clinical practice,summarizing the pathogenesis of the"inflammation-cancer transformation"of chronic gastritis as weakness of the middle jiao and blood stasis.It suggests that the"inflammation-cancer transformation"process involves the pathological development of spleen and stomach deficiency,transportation and transformation dysfunction,turbid phlegm,blood stasis,and the gradual formation of cancerous toxins,with spleen and stomach weakness as the core mechanism and phlegm and blood stasis as the crucial pathological link.Based on an in-depth exploration of the deficiency of the middle jiao and blood stasis,supported by pharmacological research and clinical experience,this paper proposes the therapeutic approach of strengthening the spleen and replenishing qi,expelling phlegm and activating blood.It discusses the related prescriptions in preventing and treating the"inflammation-cancer transformation"of chronic gastritis.This study aims to provide new perspectives and insights for the prevention and treatment of chronic gastritis with traditional Chinese medicine,offering a novel framework for clinical treatment.