Objective:To explore the safety and long-term efficacy of transvaginal reconstructive pelvic surgery (TVRPS) in ≥70-year-old women with severe pelvic organ prolapse (POP).Methods:A single-center, prospective cohort study was conducted on 343 elderly women patients with severe POP who received TVRPS at the Fourth Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA from March 2007 to September 2024. There were 297 cases (86.6%, 297/343) of Ⅲ degree and 46 cases (13.4%, 46/343) of Ⅳ degree prolapse respectively. Among them, anterior pelvic prolapse accounted for 80.8% (277/343), and those with prolapse in two or more sites accounted for 30.0% (103/343). The age was (74.2±3.4) years (range: 70 to 89 years old). There were 300 cases (87.5%, 300/343) with more than one internal medicine disease. Preoperative general conditions were assessed using American Society of Anesthesiologists physical status classification system (ASA) and American College of Surgeons National Surgical Quality Improvement Program-frailty index (ACS NSQIP-FI). TVRPS surgeries included transvaginal hysterectomy, salpingooophorectomy, high uterosacral ligament suspension, sacrospinous ligament fixation, native tissue and mesh repair of the anterior and posterior vaginal walls, mid-urethral sling for anti-urinary incontinence, and levator anal muscle folding suture and perineal repair. Perioperative complications were evaluated using Clavien-Dindo classification system. The objective effect of TVRPS was determined based on pelvic organ prolapse quantification system (POP-Q), and the subjective results were evaluated using pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire-short form 7 (PFIQ-7) and patient global impression of improvement (PGI-I).Results:All patients had a preoperative ASA grade of ≤gradeⅡ, and ACS NSQIP-FI score of ≤0.27. All patients safely and successfully underwent all TVRPS surgeries. The operation time was (154.2±43.2) minutes. The perioperative morbidity and mortality rate were 0.6% (2/343) and 0 (0/343) respectively. None of the patient needed blood transfusion. The follow-up time was (7.5±4.3) years, with the longest being 17 years. Thirty-four cases (9.9%, 34/343) were lost to follow-up, and 22 cases (6.4%, 22/343) died of internal diseases during the follow-up period. The point values of Aa, Ba, C, Ap and Bp in the POP-Q system were significantly decreased after the operation (all P<0.01), the genital hiatus was significantly shortened (all P<0.01), and the perineal body was significantly elongated (all P<0.01). The scores of PFDI-20 and PFIQ-7 were significantly lower than those before the operation (all P<0.01). There were 332 cases (96.8%, 332/343) with an overall symptom impression improvement score of PGI-I≤2. Conclusion:The results on 343 elderly women with severe POP aged an average of 74.2 years show that for elderly POP patients who still have the desire to preserve the vagina and do not meet the conditions for colpocleisis, as long as there is a comprehensive understanding and strict evaluation of the overall condition before the operation, TVRPS is a safe, feasible and long-lasting therapeutic procedure.

Objective:To systematically identify and summarize the best available evidence on feeding management during the peridischarge period for very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI), providing a reference for clinical nursing practice.Methods:Evidence on feeding management for VLBWI/ELBWI during the peridischarge period was retrieved from decision support systems, guideline repositories, major databases, and relevant professional organizations' websites. Sources included clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus documents and so on. The search spanned from database inception to April 2024. Guidelines were reviewed by four researchers, while other documents were screened and appraised by two researchers.Results:A total of 24 documents were included: six clinical decision tools, four guidelines, three systematic reviews, three evidence summaries, and eight expert consensus statements. A total of three primary themes, 10 secondary themes, and 49 best evidence items were synthesized. These covered: pre-discharge feeding management (establishing a peridischarge feeding team, parental feeding education, assessing feeding status of VLBWI/ELBWI, evaluating parental feeding competence, preparing feeding materials/environment and assessing community resources) ; discharge feeding management (providing feeding-related medical records and developing individualized feeding plans) ; post-discharge feeding management (setting growth and development goals, conducting follow-up and growth monitoring, and supplementing necessary nutrients) .Conclusions:The summarized best evidence provides a practical reference for healthcare professionals to effectively implement feeding management for VLBWI/ELBWI during the peridischarge period. Evidence-based strategies should be selectively applied in clinical practice based on individual conditions to ensure a successful transition to home feeding and support healthy growth and development of VLBWI/ELBWI.

Objective:To explore the safety and long-term efficacy of transvaginal reconstructive pelvic surgery (TVRPS) in ≥70-year-old women with severe pelvic organ prolapse (POP).Methods:A single-center, prospective cohort study was conducted on 343 elderly women patients with severe POP who received TVRPS at the Fourth Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA from March 2007 to September 2024. There were 297 cases (86.6%, 297/343) of Ⅲ degree and 46 cases (13.4%, 46/343) of Ⅳ degree prolapse respectively. Among them, anterior pelvic prolapse accounted for 80.8% (277/343), and those with prolapse in two or more sites accounted for 30.0% (103/343). The age was (74.2±3.4) years (range: 70 to 89 years old). There were 300 cases (87.5%, 300/343) with more than one internal medicine disease. Preoperative general conditions were assessed using American Society of Anesthesiologists physical status classification system (ASA) and American College of Surgeons National Surgical Quality Improvement Program-frailty index (ACS NSQIP-FI). TVRPS surgeries included transvaginal hysterectomy, salpingooophorectomy, high uterosacral ligament suspension, sacrospinous ligament fixation, native tissue and mesh repair of the anterior and posterior vaginal walls, mid-urethral sling for anti-urinary incontinence, and levator anal muscle folding suture and perineal repair. Perioperative complications were evaluated using Clavien-Dindo classification system. The objective effect of TVRPS was determined based on pelvic organ prolapse quantification system (POP-Q), and the subjective results were evaluated using pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire-short form 7 (PFIQ-7) and patient global impression of improvement (PGI-I).Results:All patients had a preoperative ASA grade of ≤gradeⅡ, and ACS NSQIP-FI score of ≤0.27. All patients safely and successfully underwent all TVRPS surgeries. The operation time was (154.2±43.2) minutes. The perioperative morbidity and mortality rate were 0.6% (2/343) and 0 (0/343) respectively. None of the patient needed blood transfusion. The follow-up time was (7.5±4.3) years, with the longest being 17 years. Thirty-four cases (9.9%, 34/343) were lost to follow-up, and 22 cases (6.4%, 22/343) died of internal diseases during the follow-up period. The point values of Aa, Ba, C, Ap and Bp in the POP-Q system were significantly decreased after the operation (all P<0.01), the genital hiatus was significantly shortened (all P<0.01), and the perineal body was significantly elongated (all P<0.01). The scores of PFDI-20 and PFIQ-7 were significantly lower than those before the operation (all P<0.01). There were 332 cases (96.8%, 332/343) with an overall symptom impression improvement score of PGI-I≤2. Conclusion:The results on 343 elderly women with severe POP aged an average of 74.2 years show that for elderly POP patients who still have the desire to preserve the vagina and do not meet the conditions for colpocleisis, as long as there is a comprehensive understanding and strict evaluation of the overall condition before the operation, TVRPS is a safe, feasible and long-lasting therapeutic procedure.

Objective:To systematically identify and summarize the best available evidence on feeding management during the peridischarge period for very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI), providing a reference for clinical nursing practice.Methods:Evidence on feeding management for VLBWI/ELBWI during the peridischarge period was retrieved from decision support systems, guideline repositories, major databases, and relevant professional organizations' websites. Sources included clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus documents and so on. The search spanned from database inception to April 2024. Guidelines were reviewed by four researchers, while other documents were screened and appraised by two researchers.Results:A total of 24 documents were included: six clinical decision tools, four guidelines, three systematic reviews, three evidence summaries, and eight expert consensus statements. A total of three primary themes, 10 secondary themes, and 49 best evidence items were synthesized. These covered: pre-discharge feeding management (establishing a peridischarge feeding team, parental feeding education, assessing feeding status of VLBWI/ELBWI, evaluating parental feeding competence, preparing feeding materials/environment and assessing community resources) ; discharge feeding management (providing feeding-related medical records and developing individualized feeding plans) ; post-discharge feeding management (setting growth and development goals, conducting follow-up and growth monitoring, and supplementing necessary nutrients) .Conclusions:The summarized best evidence provides a practical reference for healthcare professionals to effectively implement feeding management for VLBWI/ELBWI during the peridischarge period. Evidence-based strategies should be selectively applied in clinical practice based on individual conditions to ensure a successful transition to home feeding and support healthy growth and development of VLBWI/ELBWI.

Objective:To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS).Methods:A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals.Results:(1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder.Conclusions:Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

Objective:To observe the characteristics and differences of gut microbiota in asthma patients with different inflammatory types through metagenomic analysis.Methods:Adults aged ≥18 years who visited the Respiratory Clinic of Peking University Third Hospital from August 1, 2021 to August 31, 2022 and were primarily diagnosed with asthma were selected as the study subjects. Finally, 29 patients with stable asthma were included. Fresh fecal samples were collected and the fecal DNA was extracted for high-throughput 16sRNA sequencing of gut microbiota. The diversity and community structure of gut microbiota in different groups of asthma patients were compared, and the species differences were analyzed through random forest and LEfSe analysis.Results:There were sex-based differences in asthma patients with different types of inflammation, and the proportion of female patients was higher in neutrophilic asthma patients ( χ2=4.14, P=0.042). There was no significant intergroup difference in the alpha diversity of gut microbiota among asthma patients with different inflammatory types, but there were significant differences in the microbiome. Patients with neutrophilic asthma had higher relative abundance of Bacillales ( P=0.029) and Oscillospiraceae ( P=0.015). In species LEfSe analysis, patients with eosinophilic asthma had a higher relative abundance of fungi. Conclusion:There are intergroup differences in the gut microbiota of asthma patients with different inflammation types, and fungi are biomarkers that distinguish the differences in gut microbiota between patients with eosinophilic asthma and neutrophilic asthma.

Objective:To describe current status and analyze influencing factors of professional quality of life among nurses in the department of hematology and oncology in tertiary grade A children's hospitals, so as to provide some reference for improving the professional quality of life among nurses in the department of pediatric hematological oncology.Methods:This study was a cross-sectional study. By convenient sampling method, the General Data Scale, Professional Quality of Life Scale and Practice Environment Scale were used to investigate 205 nurses in the department of hematology and oncology in 4 tertiary grade A children's hospitals. Influencing factors of professional quality of life among nurses were analyzed by multiple linear regression.Results:Nurses in the department of pediatric hematological oncology with a low level of compassion satisfaction, high level of burnout and secondary trauma stress accounted for 21.0%(43/205), 26.3%(54/205) and 36.6%(75/205), respectively. Multiple linear regression analysis showed that mental health counseling, family supporting and nurses participating in hospital affairs entered into the multiple regression equation of compassion satisfaction ( t=2.08, 4.21, 2.34, all P<0.05), which explained 60.3% of the total variety. Family supporting, turnover intention, sufficient manpower and materials, age and number of children entered into the multiple regression equation of burnout ( t values were -4.42-2.33, all P<0.05), which explained 55.8% of the total variety. Family supporting, sufficient manpower and materials, age entered into the multiple regression equation of secondary trauma stress ( t=-2.37, -2.22, 2.82, all P<0.05), which explained 15.3% of the total variety. Conclusions:The professional quality of life among nurses in the department of pediatric hematology and oncology needs to be improved. Nursing managers should learn from advanced management concepts, actively improve the nursing practice environment of hematology and oncology department, increase the number of nurses, encourage nurses to participate in hospital affairs, attach importance to emotional support for nurses, and carry out regular mental health counseling, continuously improve the quality of professional life of nurses.

Objective:To evaluate the indications, surgical skills and clinic outcomes of abdominal minimal incision sacrocolpopexy (AMISC) for treatment of advanced pelvic organ prolapse (POP).Methods:The retrospective study analyzed 30 women with advanced POP who underwent AMISC between June 2016 and October 2019, including 9 cases of recurrent prolapse and 10 cases of vault prolapse. AMISC was especially applicable to: (1) patients with several medical complications who was unable to tolerate general anesthesia or laparoscopic surgery, but able to tolerate combined spinal-epidural anesthesia and open surgery; (2) other abdominal procedures were indicated to perform with AMISC simultaneously, such as myomectomy, subtotal hysterectomy etc, the specimens were easy to get out of the abdominal cavity and morcellation was avoided; (3) surgeons preferring open surgery to laparoscopic surgery or skilled in open surgery; (4) patients with prior pelvic operations, presenting severe abdominal and pelvic adhesions. Objective outcomes were assessed by pelvic organ prolapse quantification (POP-Q) system. Subjective outcome were assessed by pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire-short form (PFIQ-7) and patient global impression of improvement (PGI-I).Results:All patients with 1-3 medical complications were successfully performed with AMISC without stopping procedure, enlarging the incision or changing to other procedure, the operation duration was (110±19) minutes. The mean time of follow-up was (33.5±12.4) months (range: 8-49 months). The postoperative points of Aa, Ba, C, Ap, Bp reduced significantly and point C improved from (2.33±2.50) cm to (-7.54±1.18) cm after AMISC ( P<0.01). The objective cure rates were both 100% (30/30) in apex and posterior compartment, while 97% (29/30) in anterior compartment. Postoperative scores of PFDI-20 and PFIQ-7 were all significant decreased (all P<0.01). About PGI-I, 29 patients chose “significant improvement”, subjective satisfaction was 97% (29/30). Anterior sacral plexus hemorrhage occurred in 2 cases (7%, 2/30). There was no intestinal obstruction or injury of bladder, bowel and ureter intra- and postoperation. Two cases (7%, 2/30) had mesh exposure. Conclusion:AMISC is a safety, convenient, minimal traumatic and durable procedure for apical prolapse with short learning curve in the most of cases.

OBJECTIVE: To study the effect of rapamycin on scar formation in rabbit eyes following filtering operation and explore the possible mechanism. METHODS: Ninety-six healthy adult rabbits were subjected to trabeculectomy of the left eye and subsequently randomly divided into 4 groups (=24) for treatment with castor oil (control) or rapamycin (1%, 3%, or 5%) eye drops of the operated eyes 4 times a day. The morphology and function of the filtering blebs of the rabbits were compared at 7, 14, 21 and 28 days after the operation; at each of the time points, 6 rabbits from each group were euthanized for detection of expressions of proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) in the tissues in the surgical area using immunohistochemistry. Cultured rabbit subconjunctival fibroblasts (RTFSs) were treated with different concentrations of rapamycin (0.06, 0.25, 1, and 4 mg/L) and the cell apoptosis was detected using flow cytometry. RESULTS: In the first, second and third weeks after the operation, the rate of functional follicle formation was significantly higher in the 3 rapamycin groups than in the control group ( < 0.05), and the number of α- SMA-positive fibroblasts decreased over time in the 3 rapamycin groups. In cultured RTFSs, treatment with rapamycin at different concentrations resulted in increased apoptosis of the cells, and rapamycin above 0.25 mg/L significantly increased the cell apoptosis in a dose-dependent manner. CONCLUSIONS Rapamycin can inhibit hyperplasia of the filtering passage tissue, helps to preserve the functional filtering blebs and prolong their life span, and induces apoptosis of RTFS.

Objective: To investigate the epidemiological characteristics and its associated risk factors of lower urinary tract symptoms in young Chinese obese males. Methods: A total of 126 young males aged 20-40 years admitted to Beijing Friendship Hospital, Capital Medical University were enrolled into two different groups in this study, including 74 obese patients visited metabolic weight loss clinic were included in the experimental group, and 52 conditionally healthy persons were included in the control group. Blood pressure (systolic blood pressure, diastolic blood pressure), insulin resistance (fasting blood glucose, insulin, C-peptide), blood lipid metabolism (triglycerides, high-density lipoprotein cholesterol), and sex hormones (estrogen) of the two groups of subjects. Hormones, serum testosterone), C-reactive protein (CRP), International prostate symptom score (IPSS) and quality of life score (QOL). were compared between the two groups of subjects. Comparisons of measurement data between groups were statistically analyze by t test, expressed by mean ± standard deviation (Mean±SD); the correlation between body mass index and LUTS was analyzed by Spearman rank correlation, and the risk factors of LUTS and clinical variables were analyzed by univariate logistic regression. The significant variables were analyzed by multivariate logistic regression. Results: There were significant statistical differences between experimental group and control group in terms of systolic blood pressure [(144.30±15.78) mmHg vs (125.9±66.11) mmHg, P<0.001], diastolic blood pressure [(89.46±12.76) mmHg vs (81.35±4.58) mmHg, P=0.001], and fasting blood glucose [(6.73±3.15) mmol/L vs (5.26±1.47) mmol/L, P=0.016], insulin [(26.60±19.09) mg/dL vs (13.43±7.68) mg/dL, P<0.001], C-peptide [(4.20±1.73) ng/mL vs (1.59±0.52) ng/mL, P=0.001], triglycerides [(2.42±1.88) mg/dL vs (1.45±0.79) mg/dL, P=0.007), estrogen [(52.32±21.77) ng/L vs (42.11±12.19) ng/L, P=0.023] and CRP [(6.49±4.96) mg/L vs (1.62±1.53) mg/L, P=0.037], but no statistical difference regarding high-density lipoprotein [(1.10±0.55) mg/dL vs (1.06±0.26) mg/dL, P=0.669] and serum testosterone [(275.00±100.68) ng/dL vs (280.28±85.52) ng/dL, P=0.823]. In addition, the experimental group had higher IPSS[(3.81±1.88) scores vs (0.69±0.30) scores, P<0.001] and QOL scores [(2.76±0.68) scores vs (0.12±0.08) scores, P<0.001] than the control group, and higher risk of LUTS [86.49% vs 42.31%, P<0.001], especially moderate LUTS ( 21.62% vs 0, P=0.011). Spearman rank correlation analysis showed that obesity (body mass index≥30 kg/m²) was significantly associated with moderate LUTS risk (r=0.407, P<0.001); Univariate logistic regression analysis showed that systolic blood pressure, insulin, and C-peptide were important risk factors of moderate LUTS in young obese patients (P=0.009, 0.029, 0.002). Systolic blood pressure and fasting C-peptide were independent risk factors by multivariate logistic regression analysis (P=0.011, 0.003). Conclusions The middle severity of LUTS was prevalent in young obese males, and systolic blood pressure and C-peptide were its significant independent risk factors.